DUSK WITHOUT SUNSET: ACTIVELY AGING IN TRADITIONAL CHINESE MEDICINE by Daisy Xiaohui Yang B.A., Wuhan Univerity, China 1998 Submitted to the Graduate Faculty of Arts and Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2006 UNIVERSITY OF PITTSBURGH SCHOOL OF ARTS AND SCIENCES This dissertation was presented by Daisy Xiaohui Yang It was defended on [April 21, 2006] and approved by Nicole Constable, Professor, Department of Anthropology Akiko Hashimoto, Professor, Department of Sociology Carol McAllister, Associate Professor, Department of Behavioral and Community Health Sciences Dissertation Advisor: Joseph Alter, Professor, Department of Anthropology ii Copyright © by Daisy Xiaohui Yang 2006 iii DUSK WITHOUT SUNSET: ACTIVELY AGING IN TRADITIONAL CHINESE MEDICINE Daisy Xiaohui Yang, PhD University of Pittsburgh, 2006 Drawing on theoretical perspectives in critical medical anthropology, this dissertation focuses on the intersection between Traditional Chinese Medicine (TCM), aging and identity in urban China. It gives special attention to elderly people’s embodied agency in assimilating, challenging, and resisting political and social discourses about getting old. In most general terms my argument is that embodied agency is expressed by participating in daily health regimens referred to as yangsheng. With its origins in ancient Chinese medical texts and health practices, but also having incorporated many modern elements, yangsheng may be understood as a system of beliefs and practices designed for self-health cultivation. In light of major anthropological theories that provide an understanding of biopower, somatization and agency my argument is two fold. First, the state discourse on healthy aging, prompted by social, economic and demographic changes, has had a tremendous effect on how the elderly think and act with reference to their physical and mental health. Second, the elderly have adopted a life style known as yangsheng, and this enables them to engage actively with the state discourse and institutionalized, commercialized medicine. As a broad way of thinking and living that exists beyond the domain of medicine per se, yangsheng enables the elderly to maintain a positive attitude towards aging. More importantly, in a context of significant demographic and policy changes toward health care and social support for the aged, it provides modes of thinking and various practical methods for the elderly to take an active role in building up, maintaining and restoring their health. Therefore, TCM based yangsheng not only grants the elderly an alternative to, or escape from, the expense and alienation of institutionalized medicine; it also allows for more control over the social, economic and cultural implications of aging in today’s China. Drawing upon interviews with elderly people who have actively sought alternatives to institutionalized health care, this research provides an important anthropological corrective to the literature that tends to presume the universality of what are in fact arbitrary categorizations such as being either “healthy” or “sick” and either “old” or “young.” I argue that both good health and aging are things that can be proactively and creatively negotiated. iv TABLE OF CONTENTS 1.0 OVERVIEW................................................................................................................................1 1.1 PREAMBLE.......................................................................................................................1 1.2 THE SITE: WUHAN........................................................................................................9 1.3 AN AGING POPULATION…………………………………………………………... 15 1.4 ILLNESS, FAMILY AND OLD AGE CARE ………………………………………..18 1.5 WHO WILL CARE FOR THE ELDERLY………………………………………..…23 1.6 ORGANIZATION OF THE DISSERTATION…………………………………….…28 2.0 BEYOND THE DOMAIN OF MEDICINE............................................................................31 2.1 AGING AND TRADITIONAL CHINESE MEDICINE (TCM)................................ 31 2.2 METHODOLOGY..........................................................................................................41 3.0 AGING, THE ELDERLY AND YANGSHENG………………………………….………….49 3.1 LAO AND LAO NIAN REN…………………………………………………………….49 3.2 YANGSHENG –CULTIVATE HEALTH AND CARE FOR LIFE.……………...….61 4.0 STATE DISCOURSES OF HEALTHY AGING…………………………………………..72 4.1 OLD-AGE MEDICAL CARE: UNAFFORDABLE ILLNESS…………………...…73 4.2 TO BE A HEALTHY ELDERLY PERSON………………………………………….81 4.3 IT IS NEVER TOO LATE TO CONTRIBUTE THE REMAINING ENERGY (FA HUI YU RE HAI BU CHI)…………………… ………………………………….87 4.4 MEDICALIZATION: SEXUALITY, FAMILY AND LOGEVITY………………...91 5.0 MARKETING HEALTH, MARKETING AGING………………………………….….....101 5.1 THE FATE OF THE TCM PROFESSION…………………………………….……102 5.2 COMSUME TO BE HEALTHY……………………………………………………..109 6.0 LEARN TO BE HEALTHY……………………………………………………………..…..118 6.1 HONG ZHAOGUANG AND HIS HEALTH TEACHING…………………….…...118 6.2 SCIENCE AND CULT………………………………………………………………..130 6.3 CONCEPTUAL REVOLUTION OF HEALTH……………………………….……136 v 6.4 CONCLUSION……………………………………………………………………….138 7.0 THE UNIVERSITY FOR THE AGED (UFA) …………………………………………...140 7.1 UNIVERSITY FOR THE AGED……………………………………………………141 7.2 UFAS IN WUHAN……………………………………………………………………143 7.3 WHO WORKS AT UFAS……………………………………………………………149 7.4 WHO GOES TO UFAS………………………………………………………………151 7.5 WHY GO TO A UFA…………………………………………………………………155 7.6 THE RED MOUNTAIN UNIVERSITY FOR THE AGED………………….…….165 7.7 CONCLUSION………………………………………………………………….…….172 8.0 HEALTH PRACTICES IN DAILY LIFE………………………………………………….174 8.1 ELDERLY EXERCISE IN WUHAN: THE OVERALL PICTURE………………174 8.2 ELDERLY EXERCISE ON THE MULTI-COMMUNITY LEVEL……………...178 8.3 ELDERLY EXERISE ON THE COMMUNITY LEVEL……………………….…193 8.4 YANGSHENG ON AN INDIVIDUAL LEVEL………………………………..….…196 8.5 CONCLUSION…………………………………………………………………..….…201 9.0 CONCLUSION…………………………………………………………………………….…202 9.1 BODY, STATE AND TCM………………………………………………………..…202 9.2 THE FUTURE OF OLD-AGE CARE IN CHINA……………………………….…209 9.3 THE CHINA CASE AND THE AGING STUDIES……………………………...…210 GLOSSARY..............................................................................................................................................212 BIBLIOGRAPHY....................................................................................................................................215 vi LIST OF FIGURES Figure 1.1. Location of Wuhan.…………………………………………………………….…….....9 Figure 1.2. Map of Three Towns of Wuhan……………………………………………….……....11 Figure 5.1. Increase of Medical Personnel by Type, China 2002………………………….…......105 Figure 5.2. Statistics on Hospital Affairs, Wuhan 2002…………………………………….…....106 Figure 7.1. Course List of the Wuhan University for the Aged (Spring 2004)…..……….……...145 Figure 7.2. Cat Walk Show in Late Qing Costumes……………………………………….……..148 Figure 7.3. UFA Performance…………………………………………………………….………160 Figure 7.4. Off-Stage Group Photo with Make-Up and Self-Made Costumes On………………...163 Figure 7.5. Acupuncture Class.…...……………………………………………………………….170 Figure 8.1. Public Exercise Equipment..………………………………………………………....177 Figure 8.2. Ground Calligraphy. …………………………………………………………………..181 Figure 8.3. Waist Drum Practice and Performances………………………………………………186 Figure 8.4. Codger Xiao and His Tendon Dragging Gong….……………………………………..191 vii 1.0 OVERVIEW 1.1 PREAMBLE Although it might seem too personal to begin a dissertation on the problem of aging in contemporary China with an account of how my parents responded to the inevitable process of getting older, it provides a very clear perspective on a set of broader issues that I will subsequently describe and analyze in more “objective” ethnographic terms. I came back to Wuhan, the city where I was born and had lived for more than twenty years, in January 2004. The day I arrived at home was two days before the Spring Festival (Chinese New Year) Eve, the grandest holiday in China. It was the first time I was able to spend the holiday with my family since I had gone to the U.S. to study for my Ph.D. four years earlier. I arrived at one o’clock in the morning due to the traffic delay on my way back from Shanghai, and my parents were still waiting. The moment I saw them I was shocked by how much they had changed. They were both much older than the images I had in my mind. I guess I was not prepared for the inevitable process of aging that they had been going through. Maybe I never will adjust to it. My parents were overjoyed by my return and told me that they had already started to count down the days several months before. My mother had called me several times during the eight weeks before my return, asking what foods I wanted to eat when I got back. “You have to leave me enough time to prepare your favorite dishes,” she said. Father told me on the phone that the kitchen was piled with all kinds of foods that “should be enough for a whole year,” and mother had made dozens of zongzi (glutinous rice dumpling)—my favorite food—and stored them in the freezer. I was complaining how it would be impossible to preserve all those foods well before we three could eat them up. “You know your mom. How could I ever stop her?’ said my father. “You are the only one in the family who could possibly talk her out of something.” And, in fact, even I cannot in most cases. 1 Nobody could ever talk my mother out of anything about which she had made up her mind. No matter how many times I told her to hire an hourly maid to clean the windows