Murky Medicine

A Barefoot Doctor's Manual, by the Revolutionary Health Committee of Hunan Province, Seattle: Madrona Publishers, 1981, 384 pp., $12.95.

Mussolini is best remembered for making the trains run on time; Mao Tse-tung, for bringing health to the Chinese masses. After liberation, China had a severe shortage and maldistribution of Western-style medical facilities. Mao managed to expand massively rural health services during the Great Proletarian Cultural Revolution by exiling professors and surgeons to reeducation camps and burning books. Traditional practitioners, once referred to as charlatans and witch doctors, were made respectable, and millions of workers and peasants received rudimentary medical training. Barefoot doctors, who spend much of their time toiling in the rice paddies, have about three months of formal training.

The Barefoot Doctors Manual has been highly touted as the model of an easily understood, prevention-oriented, popular health manual. The remedies are "tested and tried," and regarded as safe and economical. In this new edition, the publisher's preface moderates the warning issued previously about the use of herbs by the untrained and omits the mention of at least one West Coast death attributed to illegally imported Chinese medicines.

The scope of the book is ambitious, extending from anatomy and physiology (both Western and Chinese concepts) to diagnosis and treatment of all sorts of medical conditions by Western drugs, acupuncture, and herbs. Tables of differential diagnoses for various symptoms are rather sophisticated: for headache, 14 causes are listed, ranging from tuberculous meningitis to acute glaucoma. The herbal approach seems the simplest; it is only necessary to distinguish exposure, liver yang-dominant, and kidney-deficient headache to choose the proper concoction. Acupuncture, massage, aspirin, and "other" treatments are also described, the last very succinctly: "treat cause of headache."

The section on first aid includes techniques taught in Girl Scouts for applying triangular bandages but differs from Western practice in crucial respects. Many types of tourniquets are pictured, to be loosened every hour, whereas Hamilton-Bailey's Textbook of Emergency Surgery recommends them only to allow sufficient time to clamp an artery, unless the limb is so badly injured that amputation is inevitable. The section on fractures does not allude to traction, a simple measure that has saved countless lives of soldiers who would have otherwise bled to death from fractures of the femur.

Acupuncture has stimulated great interest in the West and clearly is beneficial in the treatment of pain. Its efficacy in treating drowning victims, heat stroke, and gallstones (even when complicated by bile duct obstruction) is unproved and unlikely. Revolutionary developments increase the degree of stimulation by imbedding sutures in the acupuncture points and by incising them and moving a scalpel around in the fat tissue. The barefoot doctor is cautioned to stay away from nerves and blood vessels, although one acupuncture point appears to be directly over the median nerve to the hand. Presumably, he will know where these are already, for no detailed diagrams are found in the book, despite pictures identifying the waist and the toes, as well as the eyeballs and the testicle, two locations where needle puncture is specifically contraindicated.

Herbs attract great attention both from lay people and scientists, who remember that digitalis was isolated from foxglove. The new appendix in this edition adds summaries of "scientific investigations," which conspicuously lack criteria for diagnoses and assessment of results and in most cases control groups. The broad spectrum—indeed, paradoxical activities—attributed to the herbs is quite remarkable: Ho hsieh both loosens up clots and stops bleeding. Yuan-tan (which is lead monoxide!) is used for vomiting, convulsions, and body odor. Man-t'o-lo aids rheumatoid pains, prolapse of the rectum, wheezing, and ringworm.

The Chinese seem to consider surgery a last resort, and its indications are stated very vaguely. Although the scalpel (at acupuncture points) is advised for bronchial asthma, intestinal parasites, and peptic ulcer, it is not mentioned for the relief of boils and felons. The patient may be referred after twice-daily acupuncture (for an unstated period) has failed to cure appendicitis. Surgical intervention evidently is never necessary in obstetrics. Chinese babies seem all to emerge head first, and if part of the placenta remains behind, herbs substitute for the curet.

Some Western drugs are available in China but are often used quite differently. Penicillin is prescribed (in tiny doses) for appendicitis but not for streptococcal infections of the skin. In carbon monoxide poisoning, the barefoot doctor must use his discretion in "symptomatic treatment through selective use of dextrose, nikethamide, caffeine or 1:1000 epinephrine according to different conditions." The clarity and completeness of these instructions is quite characteristic of the book.

The accurate information that the book does contain is difficult to find. While the book is fascinating for students of Chinese culture, the reader wishing medical advice is strongly urged to obtain a Boy Scout Manual in preference to this one.

Jane Orient is a medical doctor in private practice in Arizona.