Medicinal treatment and surgical treatment in ancient China. Gallery of China Features of medicine of Ancient China

China occupies one of the leading places in world medical tourism. Modern clinics, advanced technologies and highly qualified personnel make Chinese medicine one of the best in the world.

Public clinic in Shanghai

The global medical tourism market is estimated at about $40 billion a year. China seeks to attract as many tourists from all over the world to its clinics as possible. Thanks to its vast economic opportunities, China has one of the most advanced healthcare systems in the world. Clinics equipped with the most modern medical equipment, highly qualified doctors and medical workers, as well as a developed infrastructure make it possible to provide medical services at the highest level, while maintaining an acceptable pricing policy.

The times when people went to China for the help of traditional Chinese medicine (based on acupuncture and phytotherapeutic procedures) are in the past, now they go to China for the treatment of the most serious diseases: cardiology, oncology, surgery, ophthalmology, endocrinology, etc.

China Health System

In China, all clinics, both public and private, are under state control. At the state level, all aspects of the work of clinics are regulated: uniform standards of technical equipment, requirements for the level of education and qualifications of doctors and medical workers are introduced.

Since 2003, insurance medicine has been introduced in China and therefore there are no significant differences between the service in a private and in a public clinic. In the same way, there is no difference between serving citizens of the country and foreigners. Foreigners are entitled to any medical assistance. If it is provided for by the insurance policy, then the treatment is free of charge, otherwise, medical services are paid for.

Pros of medical tourism in China

Chinese medicine has many benefits:

Modern hospitals and clinics

To date, there are 35 multidisciplinary clinics in China that have international accreditation. In China, at the state level, all standards for the operation of hospitals, both public and private clinics, are regulated. This guarantees high quality standards of services in any medical institution. China also has advanced research centers, primarily in the areas of immunology, cardiology, oncology, and stem cell research.

Highly qualified doctors and nurses

Chinese doctors are trained to the highest standards. Many specialists have been trained in the USA, have international diplomas and are fluent in English.

Competitive cost of treatment

The cost of treatment for a foreigner in China is lower than the cost of treatment in America or Western Europe. The quality of services provided by Chinese clinics meets all Western standards.

Traditional Chinese Medicine

Traditional methods of treatment are also in great demand both among the Chinese themselves and among foreign patients - acupuncture, phototherapy, stone therapy, hypnosis and other alternative methods of treatment and healing.

What is the best treatment in China

As already indicated above, China has advanced methods of diagnostics and laboratory research. China has made many discoveries and know-how in the field of medicine. At a particularly high level in China are developed:

prosthetic and implant surgeries
heart surgery
vascular surgery
study of the hormonal system
cancer treatment
treatment of diseases of the digestive system
musculoskeletal problems
neurological diseases
dentistry
plastic surgery and cosmetology

With great economic power, China is investing heavily in the development of medicine, and in the near future it has every chance of becoming a leader in world health care.

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Subject: PRC healthcare system

Introduction

1 General characteristics of health care in China

1.1 Dynamics of development

1.2 Health System Transformation - People's Republic of China

1.3 Traditional Chinese medicine and pharmacology

2 PRC health reform study

2.1 Reforming the healthcare system in the PRC

2.2 Priority areas for reforming the healthcare system

2.3 Current health issues in China

Conclusion

INTRODUCTION

Everyone is familiar with the incredible richness of the traditions of ancient Chinese medicine. In China, for the first time in the world, a conscious medical concept of health, illness and treatment was formulated, and systematized knowledge about human health was presented in a number of treatises and is the most valuable monuments of ancient thought. It was in China that they began to study diseases and establish their causes by analyzing symptoms.

After the founding of the PRC in 1949, considering disease prevention, health protection and the further development of traditional medicine as an important part of the strategy, the Chinese government pays great attention to the widespread establishment of medical and health institutions and the training of medical personnel. There are hospitals of various levels and medical organizations throughout the country, and an integral medical and preventive network has been formed in cities and rural areas. Health care in China has become the most important state affair. At present, numerous medical personnel work in China, an integral system of educational institutions of medical sciences has been formed, which has given the country a whole galaxy of outstanding specialists in medicine and pharmacology. By the end of 1998, there were 310 thousand medical organizations in the country (including outpatient clinics), 3.14 million hospital beds (in hospitals and sanitary and epidemiological stations - 2.91 million), 4.42 million medical personnel working in this area ( 1.41 million doctors in hospitals and sanitary and epidemiological stations, 1.07 million nurses), which is respectively 85.6, 36.9 and 8.8 times more than what was in 1949.

1 GENERAL CHARACTERISTICS OF PRC HEALTH CARE

1.1 Dynamics of development

In accordance with the system of state medical care and labor insurance, created in the 50s. in China, the treatment of workers and employees in case of illness or injury is carried out entirely at the expense of the state. This system has played an active role in protecting the health of workers and employees, stimulating economic development and ensuring social stability. However, as the economy developed and the reform of the country's economic system deepened, its shortcomings became more and more apparent. Because health care is usually paid for by governments and businesses, these costs are rising too fast and have become a burden on the state budget. On the other hand, the waste of sanitary and hygienic resources is inevitable. Medical care in rural areas, with the exception of a small number of well-to-do regions where it is provided free of charge, still remains paid. In the country, the general health care system has not yet reached perfection, its scope is small, so it is imperative to reform the public health care system.

This reform in cities and towns involves the creation of a mechanism for reimbursement of costs of medical institutions. This means that the health insurance system should be built taking into account local financial and social conditions; the cost of treatment should be borne by both the state and enterprises, as well as the patients themselves. In rural areas, a cooperative system of medical care under the leadership of local governments, which operates at the expense of society with financial assistance from the government and on the basis of voluntary participation of the population, should be fully developed and improved. It is planned to set up insurance funds mainly through contributions from individuals and support from collectives and local authorities in order to provide the peasants with basic medical care, fulfill the tasks of disease prevention and avoid poverty due to illness. The expansion of the coverage of the health insurance system not only favors the full and timely service of medical institutions, but also meets the requirements for the stable development of the medical institutions themselves.

The level of medical science is rapidly rising, control over medicines and sanitary supervision are continuously increasing. A system of medical insurance for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. Traditional Chinese medicine and pharmacology, as well as a combination of Chinese and Western medicine methods, are developing together. The incidence of many infectious diseases has significantly decreased, epidemics are localized, the work of medicine and health care in rural areas is being strengthened, which has significantly improved the health of the population. In terms of the average life expectancy of the population, the reduction in the death rate of infants and women in childbirth, China is in the forefront among developing countries, in some respects it has reached the level of developed Western countries.

1.2 Transforming the healthcare system - People's Republic of China

With the formation of the People's Republic of China in 1949, the country's healthcare system was also transformed. And earlier, since the 19th century, there were a number of missionary hospitals and dispensaries in China. Some were multiple beds in a back room, others were more or less complete establishments. The new government decided that well-stocked hospitals should form the core of China's new healthcare system.

healthcare medicine pharmacology chinese

Xiamen Chinese Hospital, Fujian Province, China
Source: Wellcome Images

By 1990, the country had a network of modern hospitals. Originally funded by the government, hospitals in China today no longer receive all of their funding from the government alone. As a result of post-1979 reforms, hospitals now receive two-thirds of their funding from patients for treatment directly, or from insurance companies, which is more common in recent times. Ironically, the new economic policies introduced after 1979 created a new market for traditional Chinese medicine. To reduce the growing imbalance between urban and rural healthcare, hospitals (including traditional Chinese medicine) have been built in every area of China. These institutions are designed primarily to provide cheap medicine to the majority of the country's inhabitants.

The Chinese government continues to improve the healthcare system to make medical care in towns and villages equally high quality and affordable. The efforts of the authorities are supported by millions of rural doctors.

This three-story building is a hospital in the village of Mafu in the west of Hunan Province, located in central China. Dr. Tian Rui works here. She came to Mafu in 1992, right after graduating from medical school. At first, almost none of the local residents went to the doctor: either there was no money to pay for medical care, or they simply did not believe in medicine. But even under these conditions, Tian Rui has been able to cure more than two thousand people over the years. In the beginning, Tian Rui had to go home to the sick. It took Tian Rui much more time to get to the most remote corners of the village along the mountain roads than the treatment itself.

Tian Rui, medic: “Of course, this is not an easy path. Especially for a woman, and yet I'm happy in my own way.

Few villagers earn more than a few hundred yuan, or US$50, a year. Therefore, many simply cannot afford to pay for the services of a doctor. Tian Rui says that when a person comes to the clinic, they first treat him, and only then does the conversation about money begin. If they are not available, they are asked to bring the payment for treatment later, when the money appears. For 18 years of work, Tian Rui has accumulated several notebooks, where she writes down countless debts, she no longer expects to receive the lion's share of them.

Tian Rui says that at first people did not trust doctors, and some were even shy. According to Tian Rui, after free gynecological examinations began in the village, female diseases were found in 90% of the villagers. Now this figure has been reduced by half.

Tian Rui, medic: “Now they come by themselves if they don't feel well. And before - they were shy, it was difficult to persuade them even for a simple inspection.

Gradually, not only trust in doctors appears, but also problems with money are being solved. Thanks to the healthcare reform, more and more villagers are beginning to receive preferential medical care. Health insurance covered almost 90% of the country's population, and from this year it is planned to increase the maximum amount of insurance payments for rural residents. Farmers with health insurance are expected to be able to get back 70% of their medical expenses.

Improvement of the three-stage medical and preventive network in rural areas

About 75 percent of China's population lives in rural areas, so medicine and healthcare in the countryside are constantly in the focus of the state. After 1978, since the reform and opening up policy, the country's medical authorities have set themselves the goal of further developing rural sanitation and providing peasants with medical care, considering this as one of the key points in building a new socialist village with Chinese characteristics. Along with this, on the basis of the comprehensive development of medicine in the countryside, general sanitary and hygienic measures have come to the fore. Currently, in rural areas, a three-stage (county, volost and village) treatment and prophylactic system has mainly been formed. In 1998, China had 2,037 county hospitals, 50,600 rural municipality sanitary and epidemiological stations, and 728.8 hospitals or outpatient clinics were established in almost 90 percent of 730,000 villages throughout the country. There are 1.328 million doctors and health workers in rural areas, of which 74.59 percent are rural doctors. China has laid a good foundation for achieving the World Health Organization's goal of "Providing health care for all by the year 2000".

Within 50 years after the founding of the PRC, medical institutions were established in the country, in which the main place is occupied by sanitary and epidemiological stations designed for sanitary supervision and disease prevention. A nationwide network of sanitary supervision and epidemic control has been formed. In 1998, there were 4018 such institutions in the country, including 1696 county sanitary and epidemiological stations, 1889 specialized departments or centers for prevention and treatment.

In order to completely eliminate or localize infectious diseases and epidemics, the Chinese government promulgated the "Law on the Prevention and Treatment of Infectious Diseases", "China Action Plan for the Eradication of Polio for 1995", "Thesis of the program to eliminate the disease from iodine deficiency by 2000 in China” and other documents, is actively developing work on immunization. Immunological vaccination of children was successfully carried out, which made it possible to significantly reduce the incidence of measles, poliomyelitis, diphtheria, whooping cough, epidemic encephalitis B and other diseases. At present, disease prevention work and the patriotic movement for sanitation and hygiene are being deepened, the health status of the urban and rural population has improved significantly compared to the period preceding 1949. The average life expectancy of the population throughout the country has increased from 35 to 70 years.

The main causes of death are malignant tumors, diseases of the blood vessels of the head and cardiovascular diseases. In this regard, the situation in China is similar to developed countries. Research institutions and medical institutions are developing active activities in the field of preventing cardiovascular and cerebrovascular diseases, oncosis and other chronic non-communicable diseases, and monitoring outbreaks of infectious diseases both within the country and abroad. For 50 years, China has made remarkable progress in the prevention and treatment of diseases. In 1996, the Department of Disease Localization under the Ministry of Health of the People's Republic of China was awarded the World Health Organization's Excellence Award.

Health protection of women and children. The focus is on the health of women and children. After the formation of the PRC, the Chinese government began to pay great attention to protecting the health of women and children, proclaiming this as a national strategy. Committees for work with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were already 2,724 health facilities for women and children throughout the country, including 1,507 county maternal and child health centers with 73,000 medical specialists.

To ensure the protection of women's health, the People's Republic of China adopted the Laws of the People's Republic of China "On protecting the rights and interests of women", "On protecting the health of mother and child", the regulation "On the protection of labor of female workers" and other legal acts. China is actively working on the use of safe methods of childbirth; mandatory medical examinations for pregnant women, care for pregnant women at risk, hospital births, post-natal care, and a number of other measures have been introduced in cities and rural areas to ensure the health of mothers and children. The introduction of these measures gave positive results: the death rate of women in childbirth decreased from 1,500 cases per 100,000 people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has begun to pay special attention to the health and development of children. Thus, the Law “On the Protection of the Rights of Minors” and the “Program to Encourage Breastfeeding of Children” were adopted; 5,890 newborn hospitals have been set up throughout the country, reducing infant mortality from 200 cases in 1949 to 31 cases per 1,000 newborns.

Since 1978, nationwide routine vaccination has been introduced in China. At the state level, measures are being taken to increase the level of physical development of children, and programs are being created to improve their nutrition.

Since the founding of the PRC, the Chinese government has paid great attention to protecting the health of women and children. Under the NPC and the CPPCC, respectively, an institution for legislative enforcement of the rights and interests of women and children and an institution for supervising the implementation of laws have been established. Committees for work with women and children have been established under the State Council of the People's Republic of China and local governments. By the end of 1998, there were 2,724 health care institutions for women and children throughout the country, including 1,507 county points (stations) for the protection of maternal and child health, and 73,000 medical personnel. An integral network of institutions for the protection of the health of women and children has been formed, covering the entire country.

In order to effectively ensure the protection of women's health, the "Law of the People's Republic of China on the Protection of the Rights and Interests of Women", the "Law on the Protection of Maternal and Child Health", the "Regulation on the Protection of Labor of Workers", the "Temporary Regulations on the Protection of the Health of Workers" and other legal acts have been adopted. In China, work has been actively launched on the use of safe methods of childbirth and measures to protect the health of women during the childbearing period. Compulsory medical examinations for pregnant women, registration of premature pregnancies, care for extremely risky pregnant women, hospital births, post-natal care and a number of other measures have been introduced in cities and rural areas to ensure the health of mother and child. These measures have had positive results in maternal and child health in China, for example, the death rate of women in childbirth has decreased from 1500 cases per 100 thousand people in 1949 to 61.9 cases in 1995.

Since 1978, the Chinese government has attached particular importance to the health and development of children. The "Thesis of the program to improve the welfare of children in China for the 90s" was developed. and the "Law on the Protection of Minors", promulgated the "Programme to Encourage Mother's Milk Feeding of Children". At the same time, the movement for the care of infants was widely launched, 5890 hospitals for the care of newborns were established throughout the country, due to which the infant mortality rate decreased from 200 cases per thousand newborns before 1949 to 31 per thousand. Since 1978, a nationwide routine vaccination has been carried out. The level of physical development of children is constantly increasing and their nutritional status is steadily improving.

1.3 Traditional Chinese Medicine and Pharmacology

Chinese medicine and pharmacology are an important part of the brilliant culture of the Chinese nation. For several thousand years, they have made an outstanding contribution to the prosperity and power of China. Chinese traditional medicine, distinguished by a noticeable therapeutic effect, national identity, original methods of diagnosis and treatment, systematic theoretical provisions and richest historical documentation, has its own special place in the medicine of the world and has become the common wealth of the treasury of world medical science. Chinese medicine has a long history, it shows its great vitality in our days. It and modern medicine complement each other, which is the specificity and advantage of traditional Chinese medicine.

Chinese medicine and pharmacology arose during the primitive system. Primitive people in their struggle with nature created the beginnings of medicine. While looking for food, they noticed that certain foods could alleviate or cure diseases, which was the beginning of the discovery and use of Chinese medicines. With the advent of fire, people learned that by warming themselves with a hot stone or sand wrapped in skins or tree bark, some ailments can be cured, then, based on repeated practice, methods of hot medicinal compress and cauterization were discovered. Using stone products as tools of production, people realized that pricks and blows on one part of the human body relieve the pain of another part. Thus, a method of treatment with stone and bone needles was created, which later turned into acupuncture, and the doctrine of meridians and collaterals was formed.

The main theoretical views of Chinese medicine consist in the original knowledge of dense and hollow visceral organs, meridians and collaterals, "Qi" and blood, body fluid, the causes of disease and pathogenesis. Methods of treatment of Chinese medicine - "four methods of examining the patient" and the study of the disease: visual (studying the complexion), auditory (listening to the patient's voice), oral (finding out by questioning the patient's condition) and palpable (feeling his pulse). The study of disease means the process of knowing the cause of disease by analyzing, inducing, investigating, and judging on the basis of disease symptoms and physical symptoms seen through the "four methods of examining the patient." In addition to the main method of treatment based on the use of medicine, Chinese medicine also uses acupuncture, massage, breathing exercises "qigong" and some other original methods of treatment.

More than 2 thousand years ago, the first Chinese medical treatise Huangdi Neijing was born, which laid the theoretical foundation of Chinese medicine. After that, many other classical medical works were published, such as the Canon on Difficult Questions in Medicine, the Treatise on Exogenous Febrile and Miscellaneous Diseases, and the Treatise on the Etiology and Symptomatology of Diseases. The Shennong Bencao Jing (Shennong Pharmacopoeia) is the oldest specialized work on pharmacology in China. "Tangbencao" is the first pharmacopoeia in China, which was published by the government, it is the world's first state-owned pharmacopoeia. During the Ming Dynasty, Li Shizhen compiled the Bencao Gangmu (Compendium of Medicinal Substances) pharmacopeia, in which he described 1,892 types of medicinal herbs and other medicinal raw materials and provided more than 10,000 recipes based on them.

After the founding of the PRC, the government attaches great importance to Chinese medicine and supports its development. In 1986, the State Administration for Traditional Chinese Medicine was established. After 2 years, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was established, which develops a development strategy, course, policy and legal provisions in this area. It organizes the combination of Chinese medicine and pharmacology and manages their integration.

Education in the field of traditional medicine is developing rapidly, higher and secondary educational institutions with the teaching of Chinese medicine and pharmacology, correspondence institutes, evening institutes, schools are open, and an external study system is being carried out. Thanks to all this, specialists in Chinese medicine have been trained in large numbers in the country. In the production of Chinese medicines, an integral system has been formed, which is distinguished by a rich assortment and advanced technologies. In China, traditional medicine practitioners learn from each other, trying to find a way to combine Chinese and Western medicine, which is new in China. At present, there is a situation in the country in which Chinese, Western and Chinese-Western medicine coexist, adopt each other's positive and develop together. The system of theoretical views of Chinese medicine has a deep content. Western Chinese medicine workers, using advanced science and technology and modern methods, have carried out long-term research work on the basic theoretical knowledge of Chinese medicine and its treatment methods. Therefore, they have made progress in the scientific commentary on solid and hollow visceral organs, blood stasis, and the essence of acupuncture treatment. China is at the forefront of the world in 5 areas of medicine, including replantation of severed limbs, burn treatment, fracture treatment, acute abdominal disease, and acupuncture anesthesia. Successes in the last 3 areas have been achieved by combining the methods of traditional Chinese and Western medicine.

In recent years, encouraging progress has been made in the treatment of cardiovascular and cerebrovascular diseases, immunological diseases, oncosis, and fractures using Chinese medicine methods. The opening and systematization of traditional folk medicine recipes, the processing and preparation of Chinese medicines, and the reshaping of finished medicines have received new development, which has enhanced the ability of Chinese medicine to prevent and treat diseases and expand its service area. Chinese medicine in the treatment of acute diseases of the abdominal cavity has opened up new methods of non-surgical treatment. The traditional Chinese medicine acupuncture, acupuncture anesthesia, and acupuncture pain relief are now spread to 120 countries and regions around the world. In 1987, the World Acupuncture Federation was founded in Beijing, in which more than 50 thousand representatives from 100 countries and regions of the world participate. It is the first international scientific organization headquartered in China, and China is its chairman. In 1989, Beijing hosted the International Qigong Therapy Conference, which was attended by representatives of 29 countries and regions of the world. In 1991 China hosted the International Conference on Traditional Medicine and Pharmacology, where dozens of countries jointly developed and adopted the Beijing Declaration. So far, China has already established relations with more than 100 countries and regions in the world in the field of medical care, research work and academic exchange.

In recent years, with the spread of homeopathic and drug-free treatments, Chinese medicine has attracted worldwide attention. The framework of international cooperation in the field of medicine is expanding. Japan, the United States and Germany have established cooperative relations with China. The World Health Organization has established 7 cooperative centers of traditional medicine and pharmacology in China. Among all the foreign students and trainees studying natural sciences in China, the most numerous are specialists in Chinese medicine. The joint teaching of Chinese medicine by the Beijing Institute of Traditional Chinese Medicine and the State University of England served as a precedent for the opening of the specialty of Chinese medicine in other universities in England and Europe. Japan and the Republic of Korea have schools of Chinese medicine; in France, USA, Italy, Australia and other countries - institutes of Chinese medicine and institutes of acupuncture; in Germany at the University of Munich - an institute for the study of theoretical knowledge of Chinese medicine.

Today, Chinese medicine and pharmacology are important components of the culture of the Chinese nation and occupy a special place in world medical science. With a centuries-old history, traditional Chinese medicine exists in our time, complementing modern medicine. After the formation of the PRC, the government began to attach great importance to medicine and support its development. In 1986, the State Administration for Traditional Chinese Medicine was established. After 2 years, on its basis, the State Administration for Traditional Chinese Medicine and Pharmacology was established, which develops a development strategy, course, policy and bills in this area. This management ensures the interaction of Chinese medicine and pharmacology, as well as their integration.

However, whatever the achievements of Chinese medicine, they remained available only to the emperor and a limited number of persons close to him. Ordinary citizens for many centuries did not have access to medical care, and their average life expectancy was a little over 35 years.

The situation changed dramatically with the beginning of the reign of Mao Zedong. It was he who, in the middle of the last century, created an extensive system of primary medical care, modeled on the Soviet one, which became accessible to ordinary people, primarily peasants. Semashko's healthcare model turned out to be the only correct way to organize medical care in a country in which millions of people live on a vast territory. And today the question again arises: what should be an effective health care system designed for a population exceeding 1/5 of the world's inhabitants?

The rise of the new Chinese medicine. After the formation of the PRC in 1949, the Chinese government began to pay great attention to the widespread establishment of medical and health institutions and the training of medical personnel. Today, there are hospitals of various levels and medical organizations throughout the country, and an integral medical and preventive network has been formed in cities and rural areas. Large specialized clinics operate in large cities, including traditional medicine hospitals. Mid-sized cities in all provinces and autonomous regions also operate comprehensive and specialized hospitals with modern facilities. In most rural areas, a three-stage treatment and prevention network has been introduced at the county, volost and village levels; central county hospitals have been established in counties, rural municipality outpatient clinics have been set up in volosts, and first-aid posts have been established in administrative villages.

Health care in the PRC has become one of the most important areas of development of the state. Qualified medical personnel began to work in China, an integral system of educational medical institutions was formed, which produced a whole galaxy of outstanding specialists in medicine and pharmacology. If a few decades ago in China there were 1.48 doctors and 2.34 hospital beds per 1,000 people, by the end of 1998 there were already 310,000 medical organizations in the country, including outpatient clinics; 3.14 million hospital beds; 4.42 million medical staff, of which 1.41 million are doctors in hospitals and sanitary and epidemiological stations and 1.07 million nurses, which is ten times higher than the same figures after World War II.

Medical science in China today is actively developing, control over the use of medicines and sanitary supervision is being strengthened. A system of medical insurance for workers and employees in cities and towns has been established on the basis of public planning and private contributions, and the scope of this system is gradually expanding. The incidence of many infectious diseases has decreased markedly, and epidemics have been effectively contained. In order to completely eradicate infectious diseases and epidemics, the Chinese government has passed the Law on the Prevention and Treatment of Infectious Diseases and other documents, and actively pursues immunization work. Immunological vaccination of children has been successfully completed, which has significantly reduced the incidence of measles, poliomyelitis, diphtheria, whooping cough, epidemic encephalitis and other diseases.

At present, the health status of the urban and rural population of China has improved significantly compared to the period before 1949. The average life expectancy of the population throughout the country has doubled. About 75% of China's people live in rural areas, so provincial medicine and health care is the focus of the state, which is constantly engaged in preventive medicine, which has greatly improved the health status of the population.

2 PRC HEALTH REFORM STUDY

2.1 Rreformatione health care systems in China

Health care is an integral part of the social sphere of the PRC, the state of which, in many respects, can be considered as a key indicator that characterizes the entire social policy of the country's leadership and the general level of development of Chinese society.

The situation that has developed today in the field of protecting the health of the population of China has every reason to be considered a crisis. This was a natural result of China's accelerated economic development to the detriment of the balanced development of all spheres of the country's life.

Obviously, without such a huge strain of all resources - primarily human - China would not have entered the ranks of regional and world economic giants in such a short time. Nevertheless, already the beginning of the 21st century showed that the existing healthcare system is experiencing most of the serious problems that shook the entire Chinese society at that time, including the ever-increasing social stratification, the gap between city and countryside, etc. In 2000, spending on medicine per villager was 188.6 yuan, compared to 710.2 yuan per city dweller, i.e., 3.8 times lower. Between 1991 and 2000, the total expenditure under this item increased by almost 50.7 billion yuan, of which only 6.3 billion, i.e. 12.4% of the total increase, fell on the countryside, despite the fact that The rural population was almost twice as large as the urban population. Only in 10% of villages by the beginning of the 2000s, medical cooperative services were preserved. More than 80% of peasants are forced to be treated at their own expense. The share of public health expenditures in the total state budget expenditures decreased from 4% in 1980 to 1.71% in 2000, which put China in one of the last places in the world in this indicator. The poorest countries in Africa spend twice as much per capita on health care as China.

This is not to say that Chinese health care was in complete decline during the period of the “reform and opening up” policy. For example, the increase in life expectancy in China is a rather impressive achievement during these years (see Figure 1).

Thus, the average life expectancy in China in 2006 exceeded the global indicator by an average of 5 years, and the same indicator in low-income countries - by 13-14 years.

Figure 1 - Life expectancy at birth in China (life years)

Cit. by: BergerI. » Domestic notes» No. 3, 2008,. Thus, the average life expectancy in China in 2006 exceeded the global indicator by an average of 5 years, and the same indicator in low-income countries - by 13-14 years. However, it should be noted that the pace of the country's economic development clearly exceeded the growth rate of spending on health care and the income of ordinary citizens of the PRC, which led to extremely serious consequences. The main crisis trends in this area are as follows:

- Low level of state financing of the healthcare sector. As for the level of state subsidies for health care, as can be seen from Table 1, the share of the state in spending on health care in the PRC was only 38.8% in 2005, while in the world as a whole it reaches 56%. Only 1% of the state budget goes to health care in the PRC, while in the aggregate, 4.6% of public funds are spent on this purpose in low-income countries of the world, and the global figure in 2005 reached 8.3%.

Table 1 - Healthcare Expenditures

	Total health spending as % of GDP	Government share of total health spending (%)	Share of health care in total government spending (%)


Low income countries
Low-middle income countries
Middle-income countries
High income countries
World at large

cit. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. As a result, this leads to the fact that health care costs per capita in China are extremely low. Beyond that of advanced economies, even comparing these expenditures to global health spending is more than telling (see table 2).

Table 2 - Health expenditure per capita

	Total expenditure at average official exchange rate (USD)	Total IFR costs (international dollar)	Government spending at average official exchange rate (USD)	RFP Government Spending (International Dollar)


High income countries
World at large

cit. By: I. Berger. Chinese healthcare. Reference//» Domestic notes» No. 3, 2008,http://www.strana-oz.ru/?numid=44&article=1682. However, changes in this area are still visible. After the decision on the need for healthcare reform was made, the growth in healthcare spending intensified significantly (see Table 3).

Table 3 - Growth of expenditures of the Ministry of Health on the provision of medical services per capita in % compared to the previous year

- Insufficient level of accessibility of medical services for the population of China. The low level of public spending on the development of the health care system in China is exacerbated by the fact that for the majority of the country's population, obtaining quality medical care is an almost unaffordable luxury. On average, spending on these services in China accounts for about 11.8% of the family budget, second only to spending on food and education. In 2003, a farmer's net annual income was 2,622 yuan on average, and the average cost of a hospital stay was 2,236 yuan.

Another significant problem is that the ever-growing social inequality in the PRC is also projected onto access to medical care. In this regard, the most protected and well-off group of the Chinese population are government officials and party functionaries. According to some data, up to 80% of government subsidies for medicine go to serve this group. The lowest benefits, respectively, are for low-income rural residents and labor migrants who have not received health insurance.

Problem health insurance exacerbates the inability of certain population groups to access basic health services. The fact is that, just like pension insurance, only the working urban population gets the freest access to this type of service, and on the condition that these people work in state institutions. After the introduction of a law obliging the employer to conclude an employment contract with all employees, regardless of the type of enterprise, this situation began to improve, since under the contract the employer is obliged to provide employees with medical insurance. However, the process is moving extremely slowly and the practice of verbal contract (especially with rural migrant workers) is still very strong.

As for the rural population, only a small percentage of them were involved in the compulsory health insurance system. And the introduction of a system of cooperative medical insurance in the countryside is extremely slow and very limited in funds.

Closely related to the above problem is also the question of the discrepancy between the quality of medical services in the PRC and the requirements of the modern development of the state.

The duality of the problem also lies in the fact that obtaining medical care in China is inaccessible to a fairly large group of the population, not only due to the fact that they do not have enough money to pay for it, but also because the level and number of medical institutions and medical personnel also do not meet the requirements of society.

Concerning medical staff Strange as it may seem, but in China in 2006 there were 15 doctors and only 10 paramedical personnel per 10,000 people (the global figure is 13 and 28, respectively). In general, this level of medical staffing (see Table 4) is considered insufficient by world standards. If we compare similar figures in China and Kazakhstan, in 2006 in Kazakhstan there were 37.6 doctors of all specialties and 125.2 paramedical personnel per 10 thousand people.

Table 4 - Medical personnel in China in 2006-2007 million people



medical specialists
Of which: doctors and residents

Auxiliary medical staff
Pharmacists
Medical controllers
Other healthcare workers
Management staff
Technical staff

Another important indicator characterizing the level of quality of medical care in the country is number of medical facilities and hospital beds . In this regard, it is important to note the following. First, over the period that has passed since the start of the “reform and openness” policy, these indicators have not changed dramatically (see Figure 2).

Secondly, this indicator itself also lags behind similar indicators in other states. Thus, in Kazakhstan in 2006, the number of hospital beds per 1,000 people was 7.73, which exceeded the Chinese figure by almost 3 times.

Figure 2 - Dynamics of changes in the number of hospital beds per 1 thousand people in the PRC during the period of the policy of "reforms and openness"

In general, over the past two years, this indicator has remained relatively stable and no special qualitative improvements have been observed in this area, and given the continued high rate of natural growth, one can raise the question of a deterioration in the situation. Of particular concern is the fact that the number of medical institutions in rural areas is decreasing, as well as the number of research and preventive institutions, which is especially dangerous, given the frequency of various kinds of epidemics in China.

The problem is also that bO Most of the state subsidies for the development of health care have recently been directed to the development of social health insurance and to increase the population's access to medical services, but not to improve the quality of medicine itself.

Table 5 - Number of medical facilities and hospital beds in China, 2006-2007

	medical institutions	hospital beds

Total
Hospitals
Multidisciplinary
Chinese medicine hospitals
Specialized hospitals
Regional centers for the provision of medical care
health centers
Rural health posts
outpatient clinics
Polyclinics
Donor centers
Centers for the protection of motherhood and childhood
Specialized research institutes for disease prevention
Centers for Disease Prevention and Control

In addition, other indicators characterizing the state of not only the quality of medical services in the state, but also the overall socio-economic development of the country are child mortality rates . In general, China shows a positive trend in this indicator (see table 6), however, in comparison with other countries, the comparison of some data is simply intimidating.

Thus, the infant mortality rate in China in 2006 was 17.2‰, while in Kazakhstan it reached 13.9‰. However, the infant mortality rate under 5 in the same year was 1.29‰ in Kazakhstan, and 20.6‰ in China (and 23.6‰ in rural areas)! At the same time, the World Health Organization (WHO), speaking of child mortality rates in China as of August 2008, cites data that the infant mortality rate in China is 23‰, and the infant mortality rate under 5 years is 30 ‰.

Table 6 - Regional indicators of mortality of women in labor and children in China for 2006-2007

This indicates both the low level of pediatrics and the general low standard of living of the population, including the lack of the necessary sanitary and hygienic conditions, nutrition, vaccination, etc. in most settlements. Thus, according to the WHO, in 2006, 81% of the rural and 98% of the urban population had sustainable access to potable water, and only 59% of the rural and 74% of the urban population of China were provided with normal sanitary conditions.

Another problematic trend in the development of the modern Chinese healthcare system is uncertainty in the priorities of its development. In connection with the orientation towards the introduction of market relations in the healthcare sector and the withdrawal of the state from this area, the situation in this sector has approached critical. This is due to the fact that the role of state support has significantly decreased, but at the same time, conditions were not created for the full-fledged inflow of private capital into the field of medicine. In fact, for more than two decades of reforms, the conditions for the creation of non-state hospitals have not appeared. Prices for medical services and medicines are still controlled by the state. They are not installed by hospitals, but by the relevant government departments.

In addition, the absolute majority of hospital beds, equipment and medical personnel are concentrated in state medical institutions. With long-term support from the government, few hospitals have concentrated the best resources and have a monopoly position that non-state medical institutions cannot compete with.

The other side of the problem is that in public, non-profit hospitals, staff salaries and bonuses, as well as the running costs of the institutions, are largely funded by their own commercial activities. Hence the desire of doctors to prescribe a lot of expensive drugs to patients, prescribe expensive examinations and procedures. The state controls the prices of about 20% of drugs circulating on the pharmaceutical market and has repeatedly reduced prices in recent years. However, market-controlled drug prices are rising, sometimes many times over. In the vast majority of medical institutions, mark-ups on the price of dispensed medicines reach 30-40%, far exceeding the standard of 15% established by the state.

Thus, the above crisis trends demonstrate the urgent need for large-scale reform of the health care system in China. The fourth generation of PRC leaders in the middle of the current decade began a gradual transition to a policy focused on improving the quality of life of the population and developing the social sphere of society. This strategy was finalized at the 17th Congress of the Communist Party of China in the autumn of 2007. Hu Jintao's speech at the convention focused more on the government's responsibility for healthcare reforms. They spoke about the need to strengthen the generally useful nature of healthcare, to increase the investment activity of the state in this segment.

At the meetings held after the congress, it was decided, on the basis of the existing independent developments, to prepare a new consolidated draft of the health care reform "with Chinese characteristics" and submit it to the public. The project was supposed to provide for the creation by 2020 of a system that would guarantee the provision of basic medical services to all residents of the city and village.

The Health Development Program for the 11th Five-Year Plan (2006-2010) sets the goal of creating a universally accessible basic health care system. Strengthening the leading role of the government, increasing its responsibility, reforming the management of public medical institutions, strengthening their generally useful character, preventing the blind pursuit of profit, and alleviating the burden on the population are coming to the fore. The parallel development of Chinese and Western medicine, the use of Chinese and Western medicines are proclaimed. Particular importance is attached to health care in the countryside and at the communal level in cities. The creation of non-state medical institutions is also encouraged.

The government intends to use the increase in health care spending primarily to subsidize the covered population rather than increase investment in public health facilities. Thus, a course was proclaimed for the development of the medical services market.

Problem reforming the health insurance system also in recent years, a period of important decisions has passed.

The system of basic health insurance today covers mainly urban population of China . In 2007, 223.11 million people took part in the basic health insurance program. urban population, which is 65.79 million more than in 2006. However, despite such impressive growth, this figure only covered 37.6% of China's total urban population in 2007.

An experiment is currently underway to introduce a system of basic health insurance for the non-working urban population. Within the framework of this program, it is expected to allocate at least 40 yuan per person per year.

Regarding health insurance rural population this aspect deserves special attention. During the entire period of the “reform and openness” policy, the rural population (most of which was more than short of funds) practically did not have access to medical services on an equal basis with urban residents.

In order to eliminate this state of affairs in China, an experiment began in 2003 to introduce a cooperative rural health insurance system. Under the new system, each farmer pays 10 yuan to the health care fund. The central and local authorities pay the same amount for it. When a farmer is forced to seek medical help, part of the cost of treatment is paid from the fund. Since 2008, this system has been officially extended to all villages in China.

The number of rural population covered by the system of basic health insurance in 2007 amounted to 31.31 million people, which is 7.64 million people. more than in 2006. This is only 4.3% of the total rural population. At the same time, by the end of 2007, the system of medical care on a cooperative basis covered 730 million people, or almost 90% of the rural population. However, the system suffers from a lack of funds and is unable to support villagers in cases of serious illness requiring hospital treatment. Within the framework of the new five-year plan (2006-2010), it is envisaged to create a "socialist village" in the PRC. 30 billion yuan ($3.8 billion) will be allocated for rural health care.

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No matter how great the achievements of traditional Chinese medicine, for centuries they were only available to the elite. By the beginning of the formation of the PRC in 1949, the average life expectancy was 35 years, and out of five born, one died ... The situation changed with the beginning of the reign of Mao Zedong. And over the past 60 years, China's health care has experienced a rapid and at the same time unusually interesting development.

Not by the day, but by the hour

Already in the early 1950s, an extensive system of public medical care began to be built at an incredible pace, on the model of the Soviet and with the huge help of the USSR. Semashko's health care model turned out to be the only correct way to organize health care in a country with a huge population and territory.

Hospitals of various levels began to appear in the cities, the first medical institutes and schools for the training of nurses and paramedics. In rural areas, a three-tier network at the county, rural municipality and village levels has begun to be introduced. Central district hospitals were organized in the counties, volost outpatient clinics in the volosts, first-aid posts in the villages, as well as at industrial enterprises.

But if the treatment of workers, employees and the military was carried out at the expense of the state, then the leadership of the PRC was forced to leave medical care in the countryside for a fee. The paramedic in such clinics was usually from the same village, chosen by the authorities for his literacy and having completed short-term training courses. It was possible to pay him off not only with a small coin, but also with a chicken carcass, or ... not pay at all if they were the poorest of the fellow villagers. And if the health center was located in the so-called administrative villages, the same building housed a sanitary and epidemiological station and a "point for protecting the health of mother and child."

What kind of results could bring this primitive health care, created in just 10 years, where one specialist accounted for thousands of village paramedics and midwives? The fruits, however, have turned out to be in a way that the history of world health has not known, and which in 2010 remains inaccessible not only to the poorest countries in Africa, but even to India, a country as rapidly developing as China.

By the mid-1960s, 80% of the rural and more than 90% of the urban population of China gained access to a network of medical institutions. Life expectancy has exceeded 50 years, children have fallen from 200 per 1000 born to 30. China became one of the first countries in the world to eradicate a number of infectious diseases, in particular, smallpox.

In addition to protecting health, this system provided economic development and social stability, and proved so strong that it withstood two severe blows, which fell mainly on the link of qualified medical care. In the spring of 1960, the "great friendship" between the USSR and the PRC broke down, thousands of Soviet doctors and medical school teachers left the country. And six years later, the tragic decade of the Cultural Revolution began. Thousands of intellectuals, including those in white coats, went to communes for re-education.

Give capitalist medicine!

In the thirty years that have passed since the beginning of Deng Xiaoping's reforms in 1976 and until the Fifth Plenum of the CPC Central Committee, which divided the Chinese "perestroika" into two periods, the health care of this country has experienced an unusually difficult and interesting time to study. The new leaders overestimated the role of market relations in the development of health care, and it has largely degraded compared to the Mao era. However, in others it has gone ahead.

In 2005, the health insurance system in the country covered less than 50% of half of the urban and only 10% of the rural population. Budget spending on medicine fell from 2.5-3% in different years of Mao's rule to 1.7%. As a result, in 2004, the state accounted for only 17% of national spending on healthcare, enterprises and social institutions 29%, and citizens 54%. The average costs of citizens for treatment increased incomparably faster than their incomes. Over the period not even from 1976, but from 1990 to 2004, they increased by more than 10 times!

By the way, even today the high cost of treatment and medicines occupies a prominent place among other social problems in China. Medical expenses eat up about 12% of the family budget, second only to food expenses. The average cost of treating a serious illness is now about $1,000, the average monthly income of a worker is $250, and that of a peasant is three times less.

So, the reformers hoped in vain that the state could, by lowering taxes everywhere, reducing its spending on health care and opening the doors to entrepreneurs, to ensure the development of this industry. Business rushed into the industry of medicines and medical products, and in real healthcare, it ran into the effective demand of the population for medical services. In their national volume in 2006, the private sector accounted for less than 5%, and today this figure has grown by only a few percent, with the lion's share of commercial healthcare being institutions and private practitioners of traditional Chinese medicine.

In 2005, sociologist Yang Tuan of the PRC Academy of Social Sciences wrote: “After the distribution of land plots among peasant families, their incomes increased, but the lack of a social protection system and government allocations for the development of public welfare led the peasants to return to an isolated lifestyle. "Many public institutions such as rural schools, health centers, nursing homes are in ruins. China has not invested in the health sector for two decades, hoping that people will pay for themselves. Today, WHO puts China on fourth-lowest out of 190 countries in terms of equal access to healthcare, only Brazil, Burma and Sierra Leone are behind us, and the government rightly described this result as "shameful" in one of its official studies."

Eliminate neoliberal distortions

And yet, the average life expectancy of the Chinese had grown to 70 years by 2005, not only due to the fact that, thanks to the take-off of the economy, poverty and malnutrition of the vast majority of the population was replaced by poverty, and for some even modest prosperity. The quality of medical services has increased, including in rural areas. Since 2003, a new mechanism of cooperative medical care has been launched for peasants. And the health insurance system for citizens working in state-owned enterprises has gone ahead compared to the Mao era. And although some businessmen shied away from the obligation to provide their employees with medical insurance, a significant part of those employed in the commercial sector also received it. The formation of a national medical science began. The country was already fully self-sufficient in health personnel. A small stratum of the wealthiest citizens gained access to high-tech medical care in China.

Launched in 2005, after the Fifth Plenum of the CPC Central Committee, health care reform was designed to preserve the best that had been achieved while at the same time eliminating "neoliberal distortions".

die

The Fifth Plenum of the CPC Central Committee, which determined the main guidelines for the Eleventh Five-Year Plan (2006-2010) in terms of economic and social development, was truly a turning point in China's reforms. The transition from the concept of enrichment put forward by Deng Xiaoping to the slogan of universal prosperity began, that is, the idea of greater social equality began to be embodied. The obsession with economic growth has given way to the doctrine of sustainable development for the sake of improving the quality of life. The goal was to strengthen social security in order to prevent distortions in economic and social development.

And in the 5 years that have passed since this plenum, China, as resolutely and rapidly as in the early 1950s, began to restore and improve its health care. Budget spending on it doubled, exceeding 3% of GDP. The number of newly opened village hospitals and first-aid posts was measured in thousands, county hospitals - hundreds. Each year, more than 100,000 rural feldshers and nurses were trained in medical qualification courses.

And there are many such impressive figures. We will clarify the main ones. Average life expectancy last year was 72.3 years. Of the 1.3 billion people in China in 2009, 63% of city dwellers and 85% of peasants were provided with medical insurance. And for the second decade of the 21st century, China is hatching ambitious plans to create an unprecedented health insurance system on an unprecedented scale.

In breadth is great, but in depth?

October 2008 The Chinese government has submitted for public discussion a draft of a new stage of medical reform, which was approved by the State Council at the beginning of last year. Let's clarify the key goals of the project: to provide insurance coverage for 90% of the population by 2011; create a powerful pharmaceutical industry, not only generics, but also innovative drugs; to improve the infrastructure of primary and basic medical care. It was decided to allocate 125 billion dollars for the implementation of these plans, and so far the investments are on schedule.

But by 2020, China plans not only to provide 100% of the population with basic medical care, already mainly on the basis of budget financing, but also to introduce a multi-level health insurance system. That is, it is expected that a significant part of the Chinese people (planned figures are not specified) by the beginning of the 2030s will also be provided with insurance covering the qualified treatment of most diseases, in a word, the one that is common in developed countries.

Recall that in China now there are 3 main health insurance programs. Two of them, namely the rural cooperative medical insurance scheme (RCMIS) and the basic medical insurance scheme for urban workers (BMI), guarantee only basic outpatient and inpatient care.

But since 2007, the city residents insurance system (URMIS - urban resident medical insurance scheme) has also been launched, which is already close to medical "European standards" and provides treatment for most diseases not covered by the BMI policy. In 2007 41 million people were holders of such a policy, and by the beginning of 2010. already more than 300 million. If we add here the wealthy Chinese who do not have insurance, but pay for quality treatment from time to time, then we can safely assume that a third of the country's population already has access to high-tech, but high-quality specialized medical care today.

So will China be able to catch up with developed countries in 10 years in terms of its health care and the level of health of its citizens? The medical sector of China, like the rest of the Celestial Empire, still remains a country of contrasts, where well-equipped clinics coexist with the house of the village "fershal" from the stories of A.P. Chekhov, entering which the rural priest was baptized on a bottle of carbolic acid .... But along with poverty fading into the past, China's health care also has the brilliance of an offensive impulse, precision in the best Western achievements and the ability to weave them with the experience of traditional folk medicine. In a word, I would like to believe that the Chinese people will be able to carry out their plans.

From a historical perspective, Chinese medicine was ahead of Western medicine in some respects. Already more than two thousand years ago, during the reign of the dynasty of the "Spring and Autumn Periods" (770-476 BC) and the "Warring Empires" (475-221 BC), there was a record in China work on medicine, the book "Nei-ching". Works of the Greek physician Hippocrates, who lived in 446-377. BC, who is considered the father of Western medicine, belong to a later time. The Nei Ching can therefore be considered the world's oldest work on medicine. It summarizes the practical medical experience accumulated by previous generations of Chinese doctors, substantiates the theoretical systematics of the traditional art of healing in China, conveys the basics of Chinese medicinal therapy, as well as acupuncture and moxibustion, acupuncture*.

When comparing the medicine of China and Western countries, some other priorities of Chinese medicine are also revealed. These include the use of narcotic drugs to achieve complete anesthesia during abdominal and other surgical interventions by the Chinese surgeon and acupuncturist Hua Tuo more than seventeen hundred years ago. Hua Tuo, who lived from A.D. 112 to 207, used the now-famous Ma-fei-san tea blend to anaesthetize his daring operations. The physician Zhang Zhuangqing (150-219 AD) already wrote at that time his work “Consideration of various diseases from exposure to cold”, in which issues of a special dialectical diagnosis of Chinese medicine are developed, which have retained their significance to this day. This happened during the lifetime of the Greco-Roman physician Galen (AD 129-199), who set forth a fundamental and extensive medical doctrine that remained mandatory for Western physicians until the end of the Middle Ages.

Another significant milestone in the history of Chinese medicine is the publication by Li Shizhen in 1578 of the pharmaceutical collection Ben-Jiao Gan-Mu. In total, more than six thousand Chinese medical books have come down to us, which tell about various methods of treatment and which serve as reference aids for Chinese doctors to this day.

In general, Chinese medicine has had a great influence on the development of medicine in other countries, using for its part many ideas of foreign medical science. Already in the era of the Qing Dynasty (221-26 BC) and Han (206 BC - 220 AD), there was an exchange of medical knowledge between China, Korea, Vietnam and Japan, which was subsequently extended to the Arab world, Russia and Turkey. The normative Chinese book on medicinal therapy, Ben-Jiao Gan-Mu, was translated into many languages, including Latin, Korean, Japanese, Russian, English, and French, and was widely distributed in the Western world.

Under the influence of the Western colonial powers, the decline of traditional medicine in China began in the middle of the 19th century. The ruling elite of the country began to give preference to Western medicine; traditional Chinese medicine was discriminated against as primitive and backward and began to decline. Things came to a real suppression of Chinese medicine under the Kuomintang government (1912-1949). Only after the coming to power of Mao Zedong did a revival of traditional medicine take place, which again brought it worldwide recognition. Currently, the PRC recognizes that the future of Chinese medicine lies in the combination of traditional Chinese and modern Western methods.

Initially, Chinese medicine consisted of four disciplines. So, in the era from the Yin Dynasty (1324-1066 BC) to the Zhou Dynasty (1066-1221 BC), differences existed between dietology (Yin-yang-i), medical medicine (Nei -ge), external medicine or surgery (Wai-ga) and veterinary medicine (Shou-i). From the Tang Dynasty (618-907) to the Song Dynasty (960-1279), Chinese medicine was further divided. 11 different directions emerged:

Adult Health Care (Da-feng-mai).
General medicine (Ze-i).
Pediatrics (Hao-feng-mai).
Treatment of paralysis (Feng-ga).
Gynecology (Fu-ge).
Ophthalmology (Yang-ge).
Dentistry (Gou-chi).
Treatment of diseases of the pharynx and larynx (Yang-hou).
Orthopedics (Chzheng-gu).
External diseases and surgery (Jin-zhuang).
Acupuncture and moxibustion, or acupuncture
(Zhen-jiu).

Currently, Chinese medicine is divided into nine specialized areas: internal medicine, external medicine, gynecology, pediatrics, ophthalmology, laryngology, orthopedics, massage, and acupuncture. Each of these areas covers a large body of knowledge that should be studied specifically as a medical specialty. The only thing that has become known in the West is acupuncture and moxibustion, "acupuncture." All these various special areas have a common theoretical basis, which is presented comprehensively for the first time for Western doctors in this book.

Along with the prescription of special medicines and the use of acupuncture, Chinese medicine knows the following methods of influence, which are used according to indications in various fields of medicine:

Scraping massage, for example, with a coin (Hua Sha).
Sticking drugs on the skin (Bo-di).
Banks (Hua-guan).
The introduction of medicines into the skin by ironing (Yun-fa).
Hydrotherapy (similar to our Kneipp therapy)
(Shui-lao).
Balneotherapy (Yu-fa).
Treatment with medicinal vapors and smokes (Hun-zheng).
Bandaging with beeswax (La-lao).
Dirt (Nee-leo).
Therapeutic gymnastics (Dao-yin).
Massage (Duy-na).
Chinese breathing therapy (Qi-gong).
Pinch therapy of the spine (mainly in children)
(Ni-zhi).
Skin incisions (Ga-zhi).

Various methods are currently being used in China in various ways in medical practice and are being improved as far as possible.

Looking for the typical features that distinguish Chinese medicine from modern Western medicine, one comes across two decisive factors:

Consideration of a person as a single whole (Cheng-di).
Dialectical diagnostics and treatment depending on syndromes (Bin-zheng)*.

Chinese medicine considers a person as an organic whole, in which the central place is occupied by accumulative and hollow organs (Jiang-fu), and internal communications are provided by channels (meridians) and neighboring vessels (Ching-luo). All phenomena of the surrounding world, including man and nature, are interpreted by Chinese medicine as an interaction between the two principles of yin and yang, which are different aspects of a single reality. The emergence and development of disease is considered by Chinese medicine as the result of a struggle between the body's defenses (Zheng) and the disease-causing disorder (Ha), as a manifestation of an imbalance between yin and yang, or as a result of internal causes that exist within the human body. Thus, in the Su-wen part of the book "Nei-jing" it is said: "Where the disease-causing disorder (Ha) penetrates, there is definitely a lack of qi (functional principle," energy ")".

And in addition to the same part of Su-wen we read: “Where the protective forces (Zheng) are located, the disease-causing disorder (He) does not penetrate.”

In the treatment of diseases, Chinese medicine pays the most attention to prevention. In this regard, at present, as well as millennia ago, the principle of "treat the patient before the disease arises" is applied. The basic rule of treatment is "elimination of the cause of the disease (Ben)". The therapeutic rules also include the treatment of the patient with strict consideration of his individual predisposition, geographical location and season.

A holistic approach to the analysis of phenomena

The holistic approach to the analysis of phenomena characteristic of Chinese medicine is based mainly on two factors:

Considering the human body as an organically integrated whole.
Recognition of the integrity of the relationship between man and
nature.

The human body as an organic whole

Chinese medicine proceeds from the fact that the various parts of the human body are in close organic relationship with each other. The center of this organic whole is located in the five dense organs, whose relationship to other parts of the body is established through a system of channels (Ching-luo), which, according to traditional Chinese ideas, includes blood vessels and nerve pathways. The action of the channel system is manifested in the interaction between individual dense and hollow organs and in the exchange between internal organs and other parts of the body.

Preventive medicine in ancient China

The strength of ancient Chinese medicine was the prevention of disease. Even in the treatise "Nei Ching" it was noted: "The tasks of medicine are to heal the sick and strengthen the health of the healthy."

From ancient times, important therapeutic and preventive measures in ancient China were massage, therapeutic exercises at xing or (translated from Chinese - the game of five animals), based on the imitation of a stork, monkey, deer, tiger and bear, respiratory gymnastics, which was used by the people to maintain health and achieve longevity.

The Chinese chronicles report on the improvement of ancient cities from the middle of the 1st millennium BC. e. (pavements, sewerage, water supply). There is evidence of the widespread introduction of variolation in order to prevent smallpox. So, according to legend in the XII century. BC e. during a smallpox epidemic, Chinese healers tried to prevent the spread of the disease by rubbing smallpox pustules into the nostrils of healthy children (girls in the right nostril, and boys in the left).

Medicinal treatment and surgical treatment in ancient China

Medicinal medicine in ancient China reached a high level of perfection. From folk Chinese medicine entered the world practice: from plants - ginseng, magnolia vine, camphor, tea, rhubarb, resin; from products of animal origin - deer antlers, liver, gelatin; from mineral substances - iron, mercury, sulfur, etc. In 502, the first Chinese pharmacopoeia known in the world was created, in seven books of which 730 species of medicinal plants are described. In ancient China, there were institutions that today are called pharmacies.

However, all who have come down to. Our works on medicines were compiled not in ancient (slave-owning), but in feudal China, that is, during the Middle Ages - the time of the rapid flowering of traditional Chinese culture and medicine.

The first special medical schools also appeared in China only in the Middle Ages (from the 6th century). Until that time, knowledge of traditional healing was passed down by inheritance or in a narrow circle of initiates.

The development of surgical treatment in ancient China (as well as the autopsy of human corpses) was difficult. neno religious prohibitions that arose in the last centuries BC. e. in connection with the establishment of Confucianism.

Hua Guo is considered to be the greatest surgeon in ancient China. (141--208), who became famous as a skilled diagnostician and expert in zhen-jiu therapy. He successfully treated fractures, performed operations on the skull, chest and abdominal cavities. In one of the ancient Chinese books, a case of recovery of a patient is described, to whom Hua Tuo removed part of the spleen. For anesthesia during operations, Hua Tuo used mafusan, mandrake, and acupuncture, achieving the desired result by introducing one or two needles.