Soc. Set. & Med. 1973, Vol. 7, pp. 307-318. Pergamon Press. Printed in Great Britain.

ASIAN MEDICAL SYSTEMS: A SYMPOSIUM ON THE ROLE

OF COMPARATIVE SOCIOLOGY IN IMPROVING

HEALTH CARE*"'J

CARL E. TAYLOR, CHARLEs LESLIE et al.

PREFACE

HISTORIANS, sociologists, anthropologists, a philosopher and physicians trained in modern

and Asian medicine came together at Burg Wartenstein, Austria, in July 1971 to discuss the
pluralistic medical systems in Asian countries. We were concerned with the Great Traditions
of Chinese, Hindu and Arabic medicine, particularly in relation to the emergence of
"Western" or international scientific medicine in the nineteenth and twentieth centuries.
Analyses of these traditions are theoretically important for medical sociology and relevant
to the practical problems of improving medical care. The symposium here recorded was
devoted to these problems.
Charles Leslie organized the symposium and has edited the transcript for publication.
Carl Taylor, who led the symposium, has worked in many countries, but he grew up in
India and has a lifetime interest and knowledge of that country.

OPENING COMMENTS BY CARL TAYLOR

A tourist was lost in the fog in London. As he went along, bumping into walls and falling
over curbs, he kept calling out, "Where am I? Where am I going?" Finally, a voice came
out of the fog and said, "You're going into the Thames; I'm just getting out". In compara­
tive research on medical systems, we have been fumbling around individually in a fog.
Now we should come together to create an essentially new interdisciplinary field.
The realities we must take into account iTl creating this interdisciplinary field may not be
what some anthropologists assume them to be. Raymond Firth said to me something to the
effect that if anthropologists are going to join in research on medical systems, they will
have to get money from the vast resources devoted to health research. He added that be­
cause of the shortage of personnel, we have to train anthropologists specially to get them
to move into this area. Several stereotypes were buried in that comment, especially the idea
of vast resources in the health field. A further comment by Charles Leslie was that the best
anthropological research will probably be done outside the health services, where the
anthropologist can do what he likes to do: stand outside and study events in a relatively
uncommitted manner. I have the impression that anthropologists who take this approach
think they are writing beautifil and professionally satisfying studies, 'ut then they wonder
why nobody makes use of them. I admit that this may be an old-fashioned stereotype of
anthropologists. We have got to learn that the stereotypes anthropologists have of doctors
and that doctors have of anthropologists get in the way of good communication.
My question is, how can historical and anthropological inquiry on comparative systems

* This isan edited account of a conference organized by the author (Ed.).

307
308. CARL E. TAYLOR, CHARLES LESLIE et al.

of health care contribute in a practical manner to medical care in Asian countries? A

related question is, how can comparative studies ofmedical systems contribute to the general
theory of social change ? Theoretical understanding is part of the justification for doing this
type of work, and I will comment briefly on it [2].
In theoretical analyses of socia! change, especially in the shift to modernity, medicine
may be a more important index than has been realized. In China and India, particularly,
medicine emerged as a specific focus of cultural tension in the traditionalism/modernity
dilemma. Furthermore, a person's view of his own future as part of his world view is
influenced very strongly by his expectation of life, and by his expLctation of illness. When
these expectations change as a result ofbetter health care there is a whole shift in orientation.
This shift in world view may influence planning for children as more children begin to sur­
vive, and thus have a dramatic impact on the demography of the -vhole society.
A practical issue in planning comparative research on Asian medical systems is that
whether or not studies of the relationships between traditional and modern nedicine are
utilized depends on general medical policy, and such policy is part of the political decision­
making process. When we study the possibilities of using traditional medical systems in the
government health services, we will only fool ourselves if we think we can have a determining
influence. The more important considerations of which we should be aware are political
issues, and we should work within them. This awareness has two interacting dimensions.
One is symbolic. In this regard I like Ralph Croizier's statement about China, "...the
name 'Chinese medicine' will probably be with us for some time. And so long as it is, so
long as there is a concern that medicine in China will not be all 'Western medicine', ...
non-medical factors ... are going to be relevant to the future of Chinese medicine-and
to the future of medicine in China". This statement puts in clear perspective the fact that
the symbolic aspect of having something distinctly Chinese (or Indian) is real and is going
to determine whether the label is going to be used.
However, the second dimension is that within the framework of existing medical policies,
our research can influence what is included under the label. I will pose three questions
which will be the basis for the rest of my discussion. The first question is, "What should
be included from traditional medicine in health services which are under governmental
control ?"The second is, "How can this be done ?"And the third question is, "Who among
the indigenous practitioners can be most readily involved in this integration of services?"
Let us turn to the "what" question. In the first place, we do not want to integrate into
governmental health services anything that is dangerous. For example, in studies of the
Dai, or indigenous midwife, our Johns Hopkins group in the Punjab is analyzing what
they do under three headings: practices that are dangerous, those that are neutral according
to our best present knowledge, and those that are positively beneficial. We need to analyze
the practices of the whole range of traditional curers in this manner.
One slogan that is frequently heard in India and other Asian countries is that indigenuous
drugs are innocuous, that even if they do not benefit patients, they cannot harm them.
Although we hear this repeatedly, I do not believe it. Many mistakes are being made because
of the improper use of some of these drugs. For example, mercurials and other heavy
metals that are extensively used in Ayurvedic and Islamic medicine are extremely dangerous.
Yet because they are being used in traditional medicine some people suppose that they
should be exempt from questioning.
Let me give another example. In Jamaica doctors found a number of deaths coming to
autopsy, particularly in children and younger adults, in which there was a peculiar cirrhosis
 Asian Medical Systems 309
resulting in tremendous liver damage. It was a challenging problem because it did not fit
any of the known categories of liver disease. Finally someone with an anthropological bent
suggested that maybe it was caused by the "bush tea" that was widely used as an indigenous
medicine. The process by which medical research was then able to identify the toxic chemi­
cals in "bush teas" responsible for this clinical syndrome is a fascinating story. We must be
aware of the frequency of this sort of sequence in objectively studying traditional health
practices and recognize that prolonged usage has little meaning in scientific verification
unless controlled research has been done.
Of course, we must look for the beneficial effects of traditional practices. This is where
much research has already been done. One hears frequently about Foxglove and Rawolfia.
In addition, we must study the components of traditional medicine that provide pastoral
care, the "comfort functions" of good medical care that are derived from culturally condi­
tioned practices which support general health.
With respect to practices that seem neutral, there is a question I consider still open. I can
argue on both sides of this question myself, and raise it because we need to recognize that
there is a problem. One notion is that if you cannot find anything wrong with something
that is being done and is culturally acceptable, you should leave it alone on the assumption
that if it persists it must be all right. This represents a neutral stance toward an apparently
neutral practice. An opposite position has recently been taken by the Food and Drug
Administration in the United States, which very clearly now insists that if a medication
does not help, it must be eliminated from approved usage.
Another area of research is based on the idea of integrating aspects of indigenous practice
to improve communications between health professionals and patients. Possible examples
are: (a) using local terminology for disease and therapy even though this may require
including concepts and standards with no scientific validation, i.e., the hot-cold categories
of food which have been extensively studied in Latin American folk mediciie and are also
used throughout Asia; (b) concepts of growth and development that directly influence
health practices; (c) child rearing practices that influence life patterns, such as William
Caudill's research comparing American and Japanese child care and its iifluence on general
response to the social and physical environment. Such topics provide an exciting area of
research that will have immediate applicability to improving health services.
Another type of research is to identify traditional practices and beliefs that act within
the multiple causal complexes that are responsible for many chronic diseases. Fred Dunn
uses the term, "behavioural epidemiology", for this type of research. A good example is
the demonstration that smoking causes lung cancer, emphysema and other afflictions of the
heart, stomach and other organs. In every society cultural patterns and social relationships
influence the occurrence of different diseases. We have mentioned Jamaican "bush tea".
Even more clearly derived from indigenons beliefs is the example mentioned by Gananath
Obeyesekere, in which the loss of semen through urethritis, or its equivalent in women of
vaginitis, is a "cultural disease" that causes more concern and worry in Ceylon and India
than most other conditions. Yet another kind of investigation is the work of our Johns
Hopkins team in the Punjab in wblich we have shown that magical practices associated with
marasmus essentially negate usual approaches to care.
Now I turn to the "how" question of making anthropological research useful in improving
medical care in Asian countries. The "how" issue is again primarily determined by political
considerations. But as professional specialists, we may influence health planning. We return
to the question of whether we can do the best research by working outside or within the
310 CARL E. TAYLwR, CHARLE LEsuE et at.

political structure of the modern medical system. For the best prospects of influencing
decisions that will improve health services, I think you have got to work within the system.
There are ways of working inside the system and still maintaining objectivity. But if you
stay outside of the bureaucratic system of modern medicine, your research will not have
much practical effect, and you will ask plaintively, "Why doesn't somebody use my wonder­
ful findings".
A direct contribution to the channeling ofresources would be to help Asian health planners
and administrators control the massive pharmaceutical trade of improper and un­
qualified medical practice. This is an area which causes much frustration. Objective re­
search in medical sociology and anthropology can provide practical insights and approaches.
The third question is "who" among the wide range of practitioners of Asian medicine
can be used to improve governmental health services. First, let us consider the elite urban
specialists in private practice of Ayurvedic or Chinese medicine. They will continue to fill
an important role in Asian countries. I do not think we need to worry too much about the
future of these specialists because in an entrepreneurial manner they are taking care of
themselves. They set the standards for the practice of the traditional systems of medicine.
They are in lucrative urban practices, and I thirk they are going to continue to be there.
We recognize them;
we !earn from them; we work with them in research on traditional
drugs; but having said that I think we must move on to other groups among whom social

research may have more influence in improving state health services.

Next come the village practitioners. Here we have a massive range of categories, from
regular indigenous faith healers and many types of one-disease specialists and those who
use only one category of drugs or treatments on various diseases. Many among this broad
range ofvillage practitioners are going to be rendered non-functional and replaced gradually
as organized health services spread. This will be a spontaneous process. In Turkey Attaturk
tried to legislate against these village practitioners, but this was a classic example of a law
which did not work because there was no one to replace them, and new categories of prac­
titioners called "needle-men" emerged. We can encourage administrative decision-makers
in health services not to make the same mistake because such laws cannot be enforced and
they cause resentment. It is more effective to rely on a spontaneous process of replacement
in which people become dissatisfied with traditional practices when they learn about and
have access to something better.
It does seem practical, however, to define those categories of traditional village practi­
tioners who can be trained for particular roles in the health services. I consider this to be
an exciting area for research. The best example is the indigenous midwife, called a Dai in
India. Here is an area in which most governments want help. Contributions can have im­
mediate practical value, and good research may build relationships with Asian policy­
makers and facilitate other applied research.
Another issue relevant to the "who" question arises in connection with efforts to develop
educational programs for traditional village practitioners. In India and some other countries,
support exists for schools where the urban elite practitioner can be trained. But these schools
have not been effective in devising educational programs to give special training to meet
village needs. The Maoist approach to training "barefoot doctors" should be contrasted
with the democratic and spontaneous evolutionary approach India has used for training
the ANM, auxiliary-nurse-midwife, as the key peripheral worker in the health center team.
The contrast has tremendous educational implications because of the lack of compulsion
available in the political system and the need to provide inducements.
 Asian Medical Systems 311

I want to conclude by listing some constraints and some favorable factors which determine
the effectiveness of applied research of the kind I have been discussing. The biggest constraint
is the attitude of the medical profession. I say this frankly and humbly. We have to con­
sider both organizational blocks and individual attitudes. It is necessary to realize that part
of the problem is the basic insecurity of the medical profession in many Asian countries.
For example, Indian doctors have acquired from Western countries an image of a society
in which medical professionals have high prestige. This status applies mainly to private
practitioners with an affluent practice. But most find themselves working in a socialized
system of health care much cioser to the Soviet model. They are very sensitive about the
fact that they end up as a low status group in the general organization of the government.
It is true that ministries of health rank very low in political and economic status in the
governments of many devcioping countries. This creates insecurity, and health policy
decision-makers tend to be defensive and easily threatened by anything which might further
lower their prestige. It is important to realize that no social research will be acceptable
unless these administrators can be convinced that it will help their work. Government
agencies often work primarily as a blocking mechanism, and in these bureaucratic relations
issues of status and future prospects are obviously important.
A second constraint is the lack of cooperation between the national, regional and local
levels of organization. A third is the difficulty that health specialists with different kinds of
training have in communicating with each other. This is particularly true of those who are
trained in systems as different in their basic concepts as the Asian medical traditions and
modern medicine. A fourth is a problem of conceptualization, for as yet we do not have
sophisticated analytic models which will help us understand the pluralistic medical systems
of Asian countries. We all too often lump divergent practitioners together as though they
were all the same.
Now let me list some favorable factors. In India particularly, and it is also obviously true
for China, there is a political commitment to maintain at least a symbolic role for traditional
medicine in the governmentally supported system of health services. This means that re­
search on the history and social organization of traditional medicine in its relationship
with modern medical institutions will be considered relevant by policy-makers.
A second favorable circumstance is that leaders within the medical profession have
learned that planning for health services will not be easily accomplished. They are looking
for help because standard approaches have failed. Third is the fact that almost all develop­
ing countries have accepted the social responsibility of providing health services reaching
out to rural areas. This provides a rationale for research on how this process can be ac­
celerated. Development of mass services for rural areas may come faster than once seemed
possible. I would not have believed 15 years ago when India started the present massive
expansion of rural health centers that they would have been able to now have about 5000
health centers, or almost one in every community development block in the country.
Finally, a consideration that applies most directly to India is the strong official commit­
ment to family planning. Government health workers recognize their need for help in this
work. They are aware of and eager for research on the cultural and Ayurvedic roots of
popular thinking about health, procreation and family structure in the hope that it will
facilitate the effective implementation of the national family planning program.

DISCUSSION
William Caudill. Your work has been in India largely, and I suppose you have been asked
u.m. 714--p
!312 CARL E. TAYLOR, CHARLES LESLIE et al.

-by the government to come in and be helpful. I have the perspective of someone who works
in,Japan. What gets in the way of my thinking about how to make my work practical, in
the framework of practicality you assume, is that I cannot conceive of the Japanese govern­
ment asking me to help them with their problems of health planning. Japan is perfectly
competent to take care of its own problems.
I also think of my own country. Like many other Americans, in recent years I have had
some qualms about what I might be doing that would make more sense than what I am
doing. In my own area of speciality the United States government has committed itself to
community mental health centers, with one center for every several 100,000 people. About
40 per cent of this goal has been achieved, and the program isgoing ahead. Yet, I feel that
the medical profession does not know how to run these centers. The whole idea of a com­
munity health center requires research on the demographic, social, interpersonal and cul­
tural characteristics of tho society in that (horrible term) "catchment area". A "catchment
area" could have a meaningful definition, but often it does not. When I look at medicine
in the United States, it needs exactly the same practical research and point of view that you
say needs to be applied in the Indian situation.
Japan also needs research to bring the worthy attributes of Chinese medicine into better
relationship with other medical practices. They certainly have deficiencies in their medical
program, although I do not think Westerners have any immediate role to play other than
the collaborative and collegial one that presently exists. For practical and for theoretical
understanding we can learn from each other by working comparatively.
I am just saying that my focus is a little wider than yours. You are talking about a
developing country siuation.
Carl Taylor. The research my department at Johns Hopkins has conducted in India did
not occur just because the Indian government asked us to come in. Our dircussions with
the Indian government led to mutual recognition of shared interests. Our initiatives coin­
cided with their need. Our first project on rural orientation of physicians moved into three
research projects on population, nutrition and functional analysis of rural health services.
New activities have evolved from long-term research relationships. We went to a great deal
of trouble to build practical programs related to the ministry services and try to respond to
their initiatives on specific subjects.
One of the reasons research projects in India have been criticized for academic colonialism
is the strong feeling that foreign research workers take data off and Indians have no control
on the interpretations given to the data. This is perhaps their greatest worry. Ifwe tie our work
into ministry interests, we can have a continuing evolution ofresearch with pragmatic results.
Charles Leslie. Concensus to do research on what aspects of indigenous Asian medicine
could be integrated into the state health services should not be difficult. The issues will sift
down to empirical questions, and I believe that traditional practitioners are open to innova­
tion and new ideas. This should be even more the case if they feel they are participating in
new programs that respect their ideas.
Among the harmful items in traditional practice I can add another example to your list:
glaucoma caused by a poppy that got into indigenous medicine in India and Pakistan when
it was erroneously identified with a plant mentioned in Ayurvedic texts. This poppy origi­
nally came from Mexico, and was introduced to India by the Portuguese in the sixteenth
or seventeenth centuries. Knowledge generated by research which demonstrates dangers
like the use of this poppy should spread and be accepted. The medicines have been studied,
though more work needs to be done.
 Asian Medical Systems 313

Research about how the traditional medicine can be used, and who to incorporate into
the health services has been almost completely neglected and is crucial for improving the
delivery of medical care. I question whether this reaearch is always most effective when it
is done by scholars within the medical bureaucracy. Work done within the system must
deal with constraints that are different from work done outside the system. An exampl e of
one advantage someon~e outside the system can have comes from the remark a highly placed
medical educator made to me, "I am glad an American has taken up the study of indigenous
medicine because you can expose a lot of the error and superstition that we must tolerate".
Naturally, he would expect me to expose people that he disagreed with. But the point is well
taken that it is good to have an outsider study a system of health practices without the
constraints of researchers who work inside the system.
When you ask which traditional practitioners should be studied to see how they might
take new roles in government health services, you say urban elite practitioners will be
around for quite a while and can care for themselves in private practice. Although they are
the main people who speak for indigenous medicine within the government bureaucracy,
you recommend that no research be done on ways for them to participate more effectively
in the state medical system. You deal only with the village practitioners. This recommenda­
tion to "set aside" tile possible role of the urban practitioners of indigenous medicine
corresponds to the attitude of the Bhore Committee Report of 1946. That Committee
surveyed medical institutions throughout India. It was the first large-scale survey of health
problems and medical services in India, and it was used by the government for 15 years to
establish guidelines for developing the medical system. But the Committee pretended that
the indigenous system did not exist. There was nothing in its report about the numerous
colleges, hospitals, clinics and other institutions for indigenous medicine.
When you think about who to use to improve health services in India, you must not put
the educated, urban practitioner of indigenous medicine aside. These are strategic people
for the overall system.
Carl Taylor. Can we have clarification of whether you mean who to use in terms of service
or in research. You are not thinking about just using them and their insights in research?
Charles Leslie. No, I am talking about service. The indigenous colleges of medicine, the
;,irofessional associations, the Ayurvedic and Unani pharmaceutical companies are institu­
tions of the urban, elite practitioners, and these are the people about which there has been
a policy of no policy.
I am unsure about this, but it appears to me that China has had a more effective policy
than India for developing medical services to the country as a whole. The Chinese policy
has been to fully use the indigenous system to extend and improve the modern medical
system, rather than to have a no policy position toward the educated, professionalized,
indigenous practitioners.
Carl Taylor. Could we get some reactions to this.
Ralph Croizier. Of course the Chinese model is very relevant. The problem is that we do
not really know what has gone on in China. The reservation I have regarding your com­
parison of China and India is that the medical policy in China does not exist in a vacuum.
There has been a revolution, and the policy of integration exists in the context of strong
state control, to put it mildly. A great deal of head knocking has gone on--most of the
knocking on the head of the modern medical profession. Also, there are no pure traditional
Chinese doctors like the Ayurvedic practitioners in India who say, in effect, we do not want
to have anything to do with modern medicine. Those have been re-educated. Without a
314 CARL E. TAYLOR, CHARLES LFSLIE el at.

similar political process in India, I am skeptical that the democratic, pluralistic system that
prevails now could make this work at all. In fact, it might really be a reactionary step.
Reasoning from the Chinese situation, where I believe the broad social and political con­
text has been removed with which traditional medicine, particularly the elite practitioner
was identified, I would guess this is not the case in India and that the elite practitioners
might be politically and socially a conservative force.
Pai Unschuld. I see the situation quite differently from Leslie. At one time the Chinese
freely incorporated traditional practitioners into the public health system, but I think this
time is over, and that these attempts actually failed. Since that failure the Chinese have
backed the barefoot doctor, and in this new system you do not read one word about the
traditional practitioners, the ones they had backed before. I believe the Chinese have a
policy not unlike the one that Dr. Taylor recommended. The Chinese conducted extensive
research on drugs, and they found many with properties that are very efficacious. They use
the medications by incorporating them into the practice of a newly developed and well
publicized practitioner. The greatest advantage of this policy is the complete new model of
doctor. Actually, we must judge by evaluating the propaganda, but apparently the Chinese
now have what Leslie called a policy of no policy toward the old practitioners.
Charles Leslie. What I want to stress is that there is now in India a dual system of pro­
fessionalized medicine, with a large infrastructure of institutions for Ayurvedic and Unani
medicine that are in a very ambiguous paramedical relationship to the modern medical
system. A medical catastrophe would occur if that infrastructure was suddenly abolished,
because it serves to meet a very large part of the demand for medical care. I do not think
Croizier is correct to infer that the so-called elite practitioners who created this infra-
structure were or are now a "conservative force". They support various political leaders
and parties-here is the Indiaii luralism again-and they have certainly been modernizing
indigenous medical education and practice. If modernization is "progressive", then they are
progressive.
The medical system depends on the infrastructure of professionalized indigenous medi­
cine, and yet the attitude of physicians trained in modern medicine prevents a rational
approach to the utilization of the Ayurvedic colleges, hospitals and other institutions to
improve the overall system of medical services.
The Chinese have been more direct and practical than the Indians in utilizing indigenous
medical institutions. Yet the Indians have had more to work with, since the professionaliza­
tion of indigenous medicine was more highly developed in India in 1949 than it was in
China. For research oriented to practical affairs to turn away from the professional urban
practitioners of traditional medicine, and to confine itself to the village midwife, or to pro­
moting the gradual process by which other village practitioners will be replaced, is to turn
away from a major health planning problem in India.
Frederick Dunn. I would like to support Leslie. 1 have been thinking about American
medical education. We have a large number of medical schools, and there is a clear dif­
ferentiation between a few schools that tend to concei.trate on the education of educators
and on the theoretical development of medicine, and a large number of schools that are
concerned primarily with training practitioners. Something like this is what we are talking
about with respect to Ayurveda. The elite, urban aspect is the educational, theorizing part
of Ayurveda. Insofar as Ayurveda can be incorporated into the government medical system,
it would be a beheaded system if the urban institutions were excluded. I do not mean to
suggest that all of the system can be incorporated, because obviously research would be
 Asian Medical Systems 315
directed to defining those parts of the elite area, as of the non-elite area, that could usefully
be fitted into an integrated system of government services.
Finally, on the point of conservatism. While the elite practitioners may be a conservative
force, as has been suggested, I would thinkthatthenon-elitewouldbeatleastasconservative.
CarlTaylor. The fact that they are both conservative does not make them more amenable.
The fact that the whole body of nractitioners is conservative just makes it that much more
of a problem for a progressive reformer to incorporate them into his system.
One other comment. I agree with a lot of what you said, but I tried to separate research
activity, where it is obviously desirable to develop a relationship with the elite of the
Ayurvedic system, from what can be done to provide mass service. What are you recom­
mending? You not only want the contribution of the learned urban practitioner of Ayur­
vedic medicine at the intellectual planning level, where he is already making a contribution,
but you want research on how to incorporate him into the health services. That is what you
guys are recommending?
Charles Leslie. That is exactly what we are talking about. A lot of practitioners, with
their associations and colleges, are in official and quasi-official relationships already. They
get government funds. There are government colleges, hospitals, and pharmaceutical plants
that manufacture indigenous medicine, and government dispensaries where they are pres­
cribed. The question is whether you could increase the efficacy of the overall delivery of
health services by a fuller recognition of the contribution Ayurvedic and Unani institutions
make to health care in India.
CarlTaylor. I think we have a very clear issue posed here.
MarjorieTopley. In China, is the barefoot doctor someone who was the traditional village
specialist, and who is now being brought back in a specialized role ? One observation I
would like to make is that Chinese medicine seems to have a new theory, which is the
thought of Mao. This is the little book which barefoot doctors carry as a reference for what
they do.
Paul Unschuld. I would say that it is a great advantage that the barefoot doctor is clearly
distinguished from the old traditional practitioners. They are young people out of the middle
and lower peasant class, if I use the right Maoist term, who are trained in the basic skills
for western style diagnoses and are given authority to treat minor diseases by means of
effective indigenous medicine, as well as by simple chemotherapy. But they must bring
serious diseases to more fully trained doctors.
They receive 3-6 week courses in centers, and at one time were trained by students of
medical schools who were forced to go into the countryside. The research work on the
traditional drugs has been in pharmacological research laboratories, and has not come out
of old texts. The ingredients have been proven scientifically to be useful, and the ability to
use them in modern medical terms is important.
MarjorieTopley. In that case, what is the relationship between the local system and these
centers that exist somewhere else? I gather that the barefoot doctors are encouraged to use
locally popular remedies, so if they do not get their training in the local areas, who tells
them about these herbs?
Paul Unschuld. First, they are supplied with effective traditional drugs by the government.
Second, we read many stories that the barefoot doctors after a short training program go
into the mountains close to their villages to search for drugs which they test. Also, they are
said to seek the advice of older people in the locality. The most important thing about their
practice is that they are not trained to think in the old terms of Chinese medical theory.
;316 CARL E. TAYLOR, CHARL LESLm et al.

,:.MarjorieTopley. But they rely on older people in the area.

Paul Unschuld.The tradition is cut off. That is the main point.
ManfredPorkert. By what authority can you say that?
Paul Unschuld. Of course, we can only interpret the stories they publish about barefoot
doctors.
ManfredPorkert. Well, they do not say that directly. We have no direct information on this.
MarjorieTopley. There ace people in Hong Kong who were formerly barefoot doctors
but who have come out of China. They now work as male nurses in some of the big hos­
pitals. My impression from talking to people about this is that there has not been as great
a break with the traditional system as Unschuld thinks. The barefoot doctors have to ask
the local people about their practices, and to learn from them. Even if they are trained out­
side the community, when they come to the local situation they have to respond to what
the people believe and want.
Paul Unschuld.Perhaps the ideas and policy which I described do not work everywhere in
China in the way they were intended to work. However, in Taiwan, where I have studied,
many practitioners refer to the theoretical tradition of Chinese medicine, but they do not
understand its terms, and they could shift quickly to another terminology. I think the same
thing must also have been true in China. Quite a lot of these barefoot doctors will have a
stock of empirical practices that were formerly related to Chinese medical theories, but
they will not understand those theories, or try to rationalize their practices in terms of them.
Charles Leslie. Still, we have a point of information. What has happened since the
Cultural Revolution to the professionalized practitioners of Ch~aese medicine who were
learned people? And, before the Cultural Revolution, who trained the modern doctors
who took courses in traditional medicine?
Ralph Croizier.The learned practitioners, by and large, were the people who gave courses
on Chinese medicine to the modern doctors. But we do not know since the Cultural Revolu­
tion, or I do not know anyway, what has happened to them. They no longer receive the
publicity that they used to have. This could be interpreted several ways. You could interpret
it as Unschuld has done, and say that they have had their day and that they are being
allowed quietly to fade away. Or you could interpret it another way. By and large, modern
medical specialists have also dropped from the publicity, but they are still there. They are
just not given publicity in the campaign for the rural cooperative health system in the way
the barefoot doctors are publicized. That is what the drum beating is about. But what the
drum beating is about is not necessarily the whole medical picture. We will have to get to
China. In the meantime someone should be interviewing systematically those barefoot doc­
tors who have come to Hong Kong.
ManfredPorkert. I want to make a point in connection with what William Caudill said
a while ago. My point refers only to China and Japan. I do not make any inference for India.
The Japanese government, and much less of course, the Chinese government, is not going
to ask our advice on how they should improve, and can improve, health care. The only
way that we can have the minutest influence of this kind is by our theoretical work to
furnish paradigms which they cannot furnish because they do not have the perspective on
medical systems generally, and on the Chinease system or the Japanese system in particular,
which we bring to the subject. The Chinese or Japanese may oftheir own accord come to use
ideas which we also use in our studies. But if we say to them that their medical systems have
such-and-such weak points, thcy will be reluctant to accept our ideas. Nobody, and above
all the Chinese, likes to be criticized by the westerner.
 Asian Medical Systems 317

CarlTaylor. What you say suggests that wherever we work will differ from other countries.
William Caudill.I do not think that each system is unique. This is a conference on com­
parative Asian medical systems, but we have not confined ourselves solely to that. Rende
Fox, Mark Field and others presented material on Western medicine, or on other more
general topics. Although your work takes place in India, you refer what you do to more
general contexts.
We have been talking about India, Japan and China, but there are many parallels in the
United States. In a way, we have something like Ayurvedic medicine in the United States.
We have chiropractors, osteopaths, spirit healers and so on. We have a host of people that
perform medical roles. Whether they belong or do not belong to the formal medical system
is a matter of on .'s faith and definition, but they behave in the area which isusually thought
to be medical. And if we want to conduct research that will be useful for designing a better
health referral system for community medicine, making it wider than in the past, we run
into exactly the same problems we encounter in India. Are we going to bring the osteopath
and chiropractor in, or the faith healers, or the man who by government contract dispenses
methadone in Washington, D.C.? He is not a physician, but he is running a clinic where
every day he puts heroin addicts on methadone. Is lie part of the medical system? By my
definition he is. If we are thinking about the better delivery of health services to wider
proportions of the population, then a very exciting new definition of medicine is implicit
in the issues we have discussed. India, China and Japan happen to be our focus here, but
the definition is relevant to the United States and other countries.
Carl Taylor. In learning how to organize community health services the United States
has been indebted to developing countries. This has been less true for the mental health
centers, I think, than for other health center activities. The experimental programs that
really set the pattern for the whole neighborhood health center movement in the United
States were developed by persons who had learned the business overseas.
Alan Beals. The more I have listened, the more I have felt that there is an incredible
government bias in this discussion. We seem to believe that a system developed by a govern­
ment and imposed upon the people necessarily has some influence. I have studied culture
change for years, and I hardly ever consider government policy in thinking about what
happened.

When some people refer to the medical system in India, they mean the doctors that are
on the government payroll, but I mean everybody that is treating a patient. If someone
wants to do research that may have practical utility for improving the medical system, but
says we should consider only one set of practitioners and set the other practitioners aside,
particularly the Ayurvedic ones, what can then be done about the mercurial drugs that they
use in treating patients? Should research look for replacements forthesedrugs that can be
advertised through the existing pharmaceutical channels? Or should research be directed
to the ways these practitioners could be given better instructions on how to use penicillin?
Should studies help them to improve their diagnostic skills and way of referring patients to
modern scientific niedicin,. because everyone seems to agree that they do refer to modern
medical institutions? This is a health education problem. Whether or not they are included
in some official medical scheme, the fact is that they are there, and they are there in large
numbers. If you do not do anything about them, then all those patients who do not go to
the Western medical practitioner receive worse care than they would if the government took
notice of what was going on.
Carl Taylor. I can see that my comment that we should start by looking at the urban
318 CARL E. TAYLOR, CQARLEs LEsLJE et al.

practitioners of traditional medicine and then put them aside and concentrate on village
practitioners has drawn considerable fire. I think it has been important in posing the issue.
Those who are involved in health planning have to consider the overall medical system from
the perspective of what governments can manipulate.
I would like to reiterate that our research can contribute a lot of practical things to health
planning. Although we have spent most of the time talking about the "how" and the
"who" questions posed by my opening remarks, we must balance our interest in these
questions by recognizing that the thing that will be most useful to health planners is our
ability to identify the "what" issues, the content of traditional Asian medicine that can be
utilized in state medical systems. On the basis of better identification of these components
they may work out relationships with traditional practitioners on a practical basis. I hope
that we will have sustained interactions with continuing feedback between administrators
in the health services of Asian countries and the academic community we represent.

REFERENCE3

53, July
1. Wenner-Gren Foundation for Anthropological Research, blurg-Wartenstein Symposium No.transcript
19-27, 1971, Charles Leslie, organizer. Participants in the sympsoium who appear in the edited
River-
of the session here published are, in alphabetical order: ALAN R. BEALS (University of California, of
(National Institute of Mental Health),
RALPH C. CROIZiER (University
side), WILLIAM CAUDILL
Rochester), FREDERICK L. DUNN (University of California, Berkeley), CHARLES LESLIE (New York Uni-

University),
versity), MANFRED PORKERT (University of Munich), CARL E. TAYLOR (Johns Hopkins
MARJORIE TOPLEY (Hong Kong), PAUL U. UNSCHULD (Munich). Other participants were: A. L. BASHAM
(Australian National University), J.CHRISTOPH BURGEL (University of Bern), MARK G.FIELD (Boston
Vaidya
University), RENEE C. Fox (University of Pennsylvania), BRAHMANANDA GUPrA (Shyamadas
Sastra Pith), MERVYN A. JASPAN (University of Hull), W. T. JONES (California Institute of Technology),
at
of California
EDWARD MONTGOMERY (Washington University), GANANAT- OBEYESEKERE (University
OTSUKA
San Diego), LrrA OSMUNDSEN (Director of Research for the Wenner-Gren Foundation), YASUO
(Yokohama City University Medical School), IVAN POLUNIN (University of Singapore). In addition,
ZELDA
RAYMOND and ROSEMARY FIRTl attended and contributed to several sessions of the symposium.
LESLIE was rapporteuse and transcribed the session here published.
2. The symposium discussed conceptual models and priorities for further research. A report of this session
of the symposium, "Research Needs to Develop the Comparative Study of Asian Medical Systems"
a new
has been prepared by Charles Leslie and will be published in Asian Studies ProfessionalReview,
Association for Asian Studies. The theoretical issues discussed in this report are: (1)the
publication of the
biases introduced in comparative research by using the terms "Western", "scientific" and "modern" to
refer to one system, in contrast to "traditional", "folk", or "primitive"; and (2) the utility of different
conceptual models of "the medical system" for comparative studies.