**The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among Hong Kong People**

Judy Yuen-man Siu

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/53281

## **1. Introduction**

Alternative medicine is often embedded in a society's social and cultural beliefs. Every society has its unique social and cultural belief system in health and diseases, and this can influence how people understand and classify diseases. Such classification system embedded in local so‐ cial and cultural system is referred as folk taxonomy in anthropological terms as suggested by Emile Durkheim in 1912, and this classification is often based on people's own cultural belief system rather than scientific knowledge. Folk taxonomy is noted as a form of ethnoscience, which "refers to system of classification that people construct to organize knowledge of their universe… Such systems are based on taxonomic hierarchies in which some entities are or‐ dered hierarchically…and other entities are contrasted taxonomically" [1]. Understanding the folk taxonomies of diseases will be another important approach in understanding people's therapeutic approach(es), since their cultural understandings on diseases can be crucial in in‐ fluencing their choices of remedy. As Kleinman (1980) stated,

Since beliefs about illness are always closely linked to specific therapeutic interventions and thus are systems of knowledge and action, they cannot be understood apart from their use.

Beliefs about illness, the central cognitive structure of every health care system, are closely tied to beliefs about treat‐ ment. Thus, ideas about the cause of illness (as well as its pathophysiology and course) are linked to ideas about practi‐ cal treatment interventions. Part of medicine's therapeutic mandate is that sickness beliefs organize health care seeking choices and treatment interventions [2].

© 2012 Siu; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The motivations for seeking alternative medicine for therapy are many, and they are never sim‐ ple. As treatment decision is closely related to the cultural beliefs about illnesses and diseases, hence Kleinman (1980) argued that a structural analysis of the cultural understandings and classification of diseases, ie. folk taxonomy of diseases, can enable the understanding of peo‐ ple's motivations in practicing alternative medicine. "Medical anthropologists have shown that the application of values to types of illness has an important influence upon the decisions people make in responding to particular episodes of sickness" [2].

emphasizing the cultivation of mind and moral will and aiming at escaping from "hard life". The third follows the Confucian tradition, emphasizing on the setting of the conceptual mind, righteousness, honesty of higher thought, and altruism, and the obtaining of rest, steadiness, and tranquility. The fourth tradition is medical *qigong*, which aims at the preven‐ tion and treatment of diseases, with the primary goal of health maintenance [5]. Although theoretically there are four traditions, the boundary of these traditions is not clear-cut in

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27

**Figure 1.** Heart disease patients practicing *tai chi* in a function of biomedical setting. (Photo courtesy by *Mingpao*)

*Tai chi* is another form of breathing exercise which falls into the category of soft *qigong*. Some people would refer it as a form of "active gong" (動功), since the practice of *tai chi* requires body movement; whereas *qigong* is often referred as "quiet gong" (靜功), since its practice mainly involves breathing and mind control as well as meditation. As Miura (1989) stated,

Contrary to popular perception, *Qigong* is not a type of *Taiji quan*, but rather the other way around. *Taiji quan* seems to

have developed through combinations of various *Qigong* styles with martial and longevity practices… They have cer‐

tain basic features in common: martially inspired exercises, abdominal respiration, relaxation, and the collection of en‐

practice.

ergy in the lower cinnabar field [6].

Hong Kong is a medical pluralistic society. Alongside the mainstream medical system of bi‐ omedicine, other alternative medical systems such as traditional Chinese medicine, *qigong* (氣功) and *tai chi* (太極) co-exist. Many personal, social, and cultural forces intertwine to‐ gether in influencing people's choice of remedy. Besides the perceptions on different medi‐ cal systems and the illness experiences during the therapeutic process [3], the underlying cultural perceptions on diseases also explain why people turn to alternative medicine such as *qigong* and *tai chi* for remedy in Hong Kong. In other words, people's *qigong* and *tai chi* practice can be influenced by their underlying cultural health and disease beliefs, which are reflected in their folk classification of diseases. In this chapter, I therefore sought to construct a folk taxonomy of diseases of my research participants in order to understand their under‐ lying motivation in *qigong* and *tai chi* practice.

#### **1.2.** *Qigong* **and** *tai chi* **in Hong Kong**

*Qigong* and *tai chi* are common alternative medicine practice in Hong Kong. According to Hong Kong Tai Chi Association, more than 300,000 people were practicing in morning *tai chi* classes in 2001 [4]. Presumably there are more than 300,000 *qigong* followers in Hong Kong after a decade now as many other followers practice outside these morning classes. Not only do *qigong* practitioners aim at reaching the balance of *qi*, the maintenance of health, and life prolongation through the practice, but *qigong* practice itself has also become a popular reme‐ dy among patients who receive biomedical treatment. Some patients' resource centres in bi‐ omedical hospitals also provide *qigong* classes for their patients.

Little literature has provided a clear definition of *qigong*. As Dong (1990) stated, "[*q*]*igong* is an ancient Chinese system of 'breathing' or 'vital energy' mind control exercises" [5]. Gener‐ ally, most people would describe *qigong* as a form of "breathing exercise".

Two categories of *qigong*, hard *qigong* and soft *qigong*, can be identified according to litera‐ ture. Hard *qigong* is considered as a kind of martial arts. Breaking steel rods, splitting bricks by hand, and resisting attacks by assailants with weapons are common representations of hard *qigong*. Soft *qigong* is mainly for health maintenance purpose [5]. As this chapter con‐ cerns the role of *qigong* as alternative medicine and its relation with cultural beliefs, soft *qi‐ gong* is the focus of this chapter.

Four major traditions are noted within the category of soft *qigong* according to literature. The first tradition is Taoist *qigong*, which emphasizes the training of body and mind and fo‐ cuses on the relationship between the individual and the cosmic environment. Prolongation of life expectancy is a key focus of this tradition. The second tradition is Buddhist *qigong*, emphasizing the cultivation of mind and moral will and aiming at escaping from "hard life". The third follows the Confucian tradition, emphasizing on the setting of the conceptual mind, righteousness, honesty of higher thought, and altruism, and the obtaining of rest, steadiness, and tranquility. The fourth tradition is medical *qigong*, which aims at the preven‐ tion and treatment of diseases, with the primary goal of health maintenance [5]. Although theoretically there are four traditions, the boundary of these traditions is not clear-cut in practice.

The motivations for seeking alternative medicine for therapy are many, and they are never sim‐ ple. As treatment decision is closely related to the cultural beliefs about illnesses and diseases, hence Kleinman (1980) argued that a structural analysis of the cultural understandings and classification of diseases, ie. folk taxonomy of diseases, can enable the understanding of peo‐ ple's motivations in practicing alternative medicine. "Medical anthropologists have shown that the application of values to types of illness has an important influence upon the decisions

Hong Kong is a medical pluralistic society. Alongside the mainstream medical system of bi‐ omedicine, other alternative medical systems such as traditional Chinese medicine, *qigong* (氣功) and *tai chi* (太極) co-exist. Many personal, social, and cultural forces intertwine to‐ gether in influencing people's choice of remedy. Besides the perceptions on different medi‐ cal systems and the illness experiences during the therapeutic process [3], the underlying cultural perceptions on diseases also explain why people turn to alternative medicine such as *qigong* and *tai chi* for remedy in Hong Kong. In other words, people's *qigong* and *tai chi* practice can be influenced by their underlying cultural health and disease beliefs, which are reflected in their folk classification of diseases. In this chapter, I therefore sought to construct a folk taxonomy of diseases of my research participants in order to understand their under‐

*Qigong* and *tai chi* are common alternative medicine practice in Hong Kong. According to Hong Kong Tai Chi Association, more than 300,000 people were practicing in morning *tai chi* classes in 2001 [4]. Presumably there are more than 300,000 *qigong* followers in Hong Kong after a decade now as many other followers practice outside these morning classes. Not only do *qigong* practitioners aim at reaching the balance of *qi*, the maintenance of health, and life prolongation through the practice, but *qigong* practice itself has also become a popular reme‐ dy among patients who receive biomedical treatment. Some patients' resource centres in bi‐

Little literature has provided a clear definition of *qigong*. As Dong (1990) stated, "[*q*]*igong* is an ancient Chinese system of 'breathing' or 'vital energy' mind control exercises" [5]. Gener‐

Two categories of *qigong*, hard *qigong* and soft *qigong*, can be identified according to litera‐ ture. Hard *qigong* is considered as a kind of martial arts. Breaking steel rods, splitting bricks by hand, and resisting attacks by assailants with weapons are common representations of hard *qigong*. Soft *qigong* is mainly for health maintenance purpose [5]. As this chapter con‐ cerns the role of *qigong* as alternative medicine and its relation with cultural beliefs, soft *qi‐*

Four major traditions are noted within the category of soft *qigong* according to literature. The first tradition is Taoist *qigong*, which emphasizes the training of body and mind and fo‐ cuses on the relationship between the individual and the cosmic environment. Prolongation of life expectancy is a key focus of this tradition. The second tradition is Buddhist *qigong*,

people make in responding to particular episodes of sickness" [2].

omedical hospitals also provide *qigong* classes for their patients.

ally, most people would describe *qigong* as a form of "breathing exercise".

lying motivation in *qigong* and *tai chi* practice.

**1.2.** *Qigong* **and** *tai chi* **in Hong Kong**

26 Alternative Medicine

*gong* is the focus of this chapter.

**Figure 1.** Heart disease patients practicing *tai chi* in a function of biomedical setting. (Photo courtesy by *Mingpao*)

*Tai chi* is another form of breathing exercise which falls into the category of soft *qigong*. Some people would refer it as a form of "active gong" (動功), since the practice of *tai chi* requires body movement; whereas *qigong* is often referred as "quiet gong" (靜功), since its practice mainly involves breathing and mind control as well as meditation. As Miura (1989) stated,

Contrary to popular perception, *Qigong* is not a type of *Taiji quan*, but rather the other way around. *Taiji quan* seems to have developed through combinations of various *Qigong* styles with martial and longevity practices… They have cer‐ tain basic features in common: martially inspired exercises, abdominal respiration, relaxation, and the collection of en‐ ergy in the lower cinnabar field [6].

As there are different traditions of *qigong* practice, therefore the way of practice is varied. There is no single method of practice. However, health maintenance is the ultimate goal for all *qigong* traditions. Its practice emphasizes on the balance of *qi*, or the cosmic force within body, to achieve health. In traditional Chinese medicine concept, the balance of *qi* within hu‐ man body is important for good health. *Qigong* practice emphasizes the attention on breath‐ ing and a relaxation of mind. Through attaining a peaceful mind in the practice, a balance of *qi*, and thus health, can be restored.

Division of the Department of Education of the Hong Kong Government, *tai chi* started to become a health-oriented exercise. The morning *tai chi* classes provided an opportunity for the Hong Kong people to learn about *tai chi* as an alternative means for them to enhance

The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among...

http://dx.doi.org/10.5772/53281

29

In Mainland China, the transition from martial arts tradition to health orientation of *qigong* practice also occurred around the same time by the end of the 1970s. One of the most fa‐ mous *qigong* practitioners in this orientation is Guo Lin (郭林), who was a self-healed cancer victim teaching *qigong* in Beijing since the early 1970s. Guo Lin's "New *Qigong* Therapy",

The health orientation of *qigong* and *tai chi* practice was further emphasized in 2003 Hong Kong, where the Severe Acute Respiratory Syndrome (SARS) outbreak hit Hong Kong from March to May 2003. The *tai chi* athlete Li Hui, for example, introduced a new *tai chi* style called "*qi* enhancing and lung nurturing gong" (益氣養肺功) at that time, which claimed to have particular benefits to the lungs. The outbreak of the SARS epidemic led to the sudden rise in the attendance rate and the number of new *qigong* and *tai chi* learners. The health ori‐ entation of *qigong* and *tai chi*, thus, has been fully demonstrated and established in Hong

To understand how the cultural perceptions of *qigong* followers influence their understand‐ ing and organization of knowledge on diseases and so their therapeutic choices, free listing and pile sort [9] were conducted in Hong Kong with 57 participants. Among these 57 partic‐ ipants, 4 *qigong* masters and 53 *qigong* followers were asked to do two parts of qualitative study. The first part was the free listing of diseases, and the second part was the pile sort on the seventy-two diseases in which they had free listed. These 57 participants, who had the experiences in *qigong* and/or *tai chi* practice, were sampled purposively to join this qualita‐ tive exercise. The study revealed the relationship between the folk taxonomy of diseases and their alternative medicine practice. These 57 participants age ranged from 32 to 60, and were

The 57 participants were asked to free list all the diseases that they knew and/or have heard at the time of study. This was to ensure the selected seventy-two diseases could represent the range of diseases that the participants, and so the public to some extent, were familiar with. The seventy-two diseases mentioned by the participants and used in the pile sort were

hailed as a cure for cancer, quickly spread to all parts of China [7].

engaging in *qigong* and/or *tai chi* practice at the time of study.

their health.

Kong.

**2. Methods**

**2.1. Free listing**

shown in Table 1.

#### **1.3. History of** *qigong* **development as alternative medicine in Hong Kong**

In Hong Kong, the practice of "active gong" – *tai chi* – is more easily visible than the practice of "quiet gong" – *qigong*. However, this does not necessarily indicate there are more *tai chi* followers than *qigong* followers. As the practice of *tai chi* requires more space than the prac‐ tice of *qigong*, the practice of *tai chi* often takes place in outdoor areas such as parks. On the other hand, as the practice of "quiet gong" – *qigong* – requires a high state of calmness and tranquility, it often takes place indoors. Hence, people are more aware of the practice of *tai chi* than the practice of *qigong* in Hong Kong.

The term *qigong* first emerged in 1949 in Mainland China,

it was only after 1949 that *qigong* became a generally-used term in Chinese medical, scientific and popular discourse,

including in a single category all Chinese gymnastic, meditation, visualization and breathing techniques, to which,

over the years, were added martial, performance, trance, divination, charismatic healing, and talismanic techniques, as

well as the study of paranormal phenomena… [7].

In accordance with the four traditions, *tai chi* comes from the Taoist tradition of *qigong* prac‐ tice. The emergence of *tai chi* is closely related to Taoist priests. As they lived in remote hilly areas with poor transportation and medical facilities, they developed the practice of martial arts in order to strengthen their health and resist against potential attacks of wild animals. These Taoist priests pioneered the practice of *tai chi* [8].

The founder of *tai chi* is Zhang San-feng (張三豐), who was born after the Tang Dynasty Chi‐ na. The practice was then spread by Taoist priests. Master Cheng Tin-hung, who is the founder of the Hong Kong Tai Chi Association in 1972, is recorded as one of the pioneers who introduced *tai chi* in Hong Kong [8].

When *tai chi* first came to Hong Kong, it was more a martial arts tradition rather than for potential use of health in the period between the 1940s and the 1970s. Only until late 1975 and early 1976 that *tai chi* came to a watershed for its development in Hong Kong. Due to the introduction of the official morning *tai chi* classes by the Leisure and Physical Education Division of the Department of Education of the Hong Kong Government, *tai chi* started to become a health-oriented exercise. The morning *tai chi* classes provided an opportunity for the Hong Kong people to learn about *tai chi* as an alternative means for them to enhance their health.

In Mainland China, the transition from martial arts tradition to health orientation of *qigong* practice also occurred around the same time by the end of the 1970s. One of the most fa‐ mous *qigong* practitioners in this orientation is Guo Lin (郭林), who was a self-healed cancer victim teaching *qigong* in Beijing since the early 1970s. Guo Lin's "New *Qigong* Therapy", hailed as a cure for cancer, quickly spread to all parts of China [7].

The health orientation of *qigong* and *tai chi* practice was further emphasized in 2003 Hong Kong, where the Severe Acute Respiratory Syndrome (SARS) outbreak hit Hong Kong from March to May 2003. The *tai chi* athlete Li Hui, for example, introduced a new *tai chi* style called "*qi* enhancing and lung nurturing gong" (益氣養肺功) at that time, which claimed to have particular benefits to the lungs. The outbreak of the SARS epidemic led to the sudden rise in the attendance rate and the number of new *qigong* and *tai chi* learners. The health ori‐ entation of *qigong* and *tai chi*, thus, has been fully demonstrated and established in Hong Kong.

## **2. Methods**

As there are different traditions of *qigong* practice, therefore the way of practice is varied. There is no single method of practice. However, health maintenance is the ultimate goal for all *qigong* traditions. Its practice emphasizes on the balance of *qi*, or the cosmic force within body, to achieve health. In traditional Chinese medicine concept, the balance of *qi* within hu‐ man body is important for good health. *Qigong* practice emphasizes the attention on breath‐ ing and a relaxation of mind. Through attaining a peaceful mind in the practice, a balance of

In Hong Kong, the practice of "active gong" – *tai chi* – is more easily visible than the practice of "quiet gong" – *qigong*. However, this does not necessarily indicate there are more *tai chi* followers than *qigong* followers. As the practice of *tai chi* requires more space than the prac‐ tice of *qigong*, the practice of *tai chi* often takes place in outdoor areas such as parks. On the other hand, as the practice of "quiet gong" – *qigong* – requires a high state of calmness and tranquility, it often takes place indoors. Hence, people are more aware of the practice of *tai*

it was only after 1949 that *qigong* became a generally-used term in Chinese medical, scientific and popular discourse,

including in a single category all Chinese gymnastic, meditation, visualization and breathing techniques, to which,

over the years, were added martial, performance, trance, divination, charismatic healing, and talismanic techniques, as

In accordance with the four traditions, *tai chi* comes from the Taoist tradition of *qigong* prac‐ tice. The emergence of *tai chi* is closely related to Taoist priests. As they lived in remote hilly areas with poor transportation and medical facilities, they developed the practice of martial arts in order to strengthen their health and resist against potential attacks of wild animals.

The founder of *tai chi* is Zhang San-feng (張三豐), who was born after the Tang Dynasty Chi‐ na. The practice was then spread by Taoist priests. Master Cheng Tin-hung, who is the founder of the Hong Kong Tai Chi Association in 1972, is recorded as one of the pioneers

When *tai chi* first came to Hong Kong, it was more a martial arts tradition rather than for potential use of health in the period between the 1940s and the 1970s. Only until late 1975 and early 1976 that *tai chi* came to a watershed for its development in Hong Kong. Due to the introduction of the official morning *tai chi* classes by the Leisure and Physical Education

**1.3. History of** *qigong* **development as alternative medicine in Hong Kong**

*qi*, and thus health, can be restored.

28 Alternative Medicine

*chi* than the practice of *qigong* in Hong Kong.

well as the study of paranormal phenomena… [7].

who introduced *tai chi* in Hong Kong [8].

The term *qigong* first emerged in 1949 in Mainland China,

These Taoist priests pioneered the practice of *tai chi* [8].

To understand how the cultural perceptions of *qigong* followers influence their understand‐ ing and organization of knowledge on diseases and so their therapeutic choices, free listing and pile sort [9] were conducted in Hong Kong with 57 participants. Among these 57 partic‐ ipants, 4 *qigong* masters and 53 *qigong* followers were asked to do two parts of qualitative study. The first part was the free listing of diseases, and the second part was the pile sort on the seventy-two diseases in which they had free listed. These 57 participants, who had the experiences in *qigong* and/or *tai chi* practice, were sampled purposively to join this qualita‐ tive exercise. The study revealed the relationship between the folk taxonomy of diseases and their alternative medicine practice. These 57 participants age ranged from 32 to 60, and were engaging in *qigong* and/or *tai chi* practice at the time of study.

#### **2.1. Free listing**

The 57 participants were asked to free list all the diseases that they knew and/or have heard at the time of study. This was to ensure the selected seventy-two diseases could represent the range of diseases that the participants, and so the public to some extent, were familiar with. The seventy-two diseases mentioned by the participants and used in the pile sort were shown in Table 1.


**Diseases free listed Codes**

Hand, Foot, and Mouth Disease

**Chinese Terms of Diseases (Names in brackets are layman usage in Cantonese Chinese)**

The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among...

Gastric Cancer GAC 胃癌 57 57 57 Gastroenteritis GAE 腸胃炎 51 46 12 Gastric Ulcer GAU 胃潰瘍 57 31 32 German Measles GEM 德國痳疹 57 30 1 Glaucoma GLA 青光眼 57 2 1 Gout GOU 痛風 41 48 52 Headache HEA 頭痛 32 38 40 Liver Cancer HEC 肝癌 57 57 57 Heart Disease HED 心臟病 57 24 45 Hemorrhoid HEM 痔瘡 48 38 21 Hepatitis HEP 肝炎 51 43 34 Herpes HER 疱疹 57 28 4

Hypertension HYP 高血壓 57 34 57 Influenza INF 流行性感冒 43 43 2 Renal Disease KID 腎病 57 5 40 Leukemia LEU 白血病 (血癌) 57 57 57 Lung Cancer LUC 肺癌 57 57 57 Malaria MAL 瘧疾 57 3 2 Measles MEA 痳疹 31 49 21 Mental Illness MEI 精神病 42 23 57 Meningitis MEN 腦膜炎 57 1 0 Nasopharyngeal Cancer NPC 鼻咽癌 57 57 57 Osteoporosis OST 骨質疏鬆症 32 25 57 Otitis Media OTI 中耳炎 57 30 1 Parkinson's Disease PAS 柏金遜症 57 2 38 Pharyngitis PHA 喉嚨發炎 41 40 13 Pneumonia PNE 肺炎 57 13 34 Psoriasis PSO 牛皮癬 48 42 20

**Best Treatment Approach(es) as suggested by 57 participants**

http://dx.doi.org/10.5772/53281

**Chinese medicine** *Qigong / tai chi*

31

**Biomedicine**

HFM 手足口病 57 11 1

The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among... http://dx.doi.org/10.5772/53281 31

**Diseases free listed Codes**

30 Alternative Medicine

**Chinese Terms of Diseases (Names in brackets are layman usage in Cantonese Chinese)**

AIDS AIDS 愛滋病 57 57 57 Allergic Rhinitis ALR 過敏性鼻炎 (鼻敏感) 32 30 49 Alzheimer's Disease ALS 腦退化症(老人痴呆症) 57 0 18 Anaemia ANA 貧血 40 57 57 Stroke APO 中風 57 21 53 Appendicitis APP 闌尾炎 (盲腸炎) 57 34 35 Arthritis ART 關節炎 15 40 57 Asthma AST 哮喘 50 48 54 Bone Cancer BOC 骨癌 57 57 57 Brain Cancer BRC 腦癌 57 57 57 Bronchitis BRO 氣管炎 51 29 42 Cataract CAT 白障 57 3 3 Cholera CHO 霍亂 57 18 1 Chicken-Pox CHP 水痘 40 42 11 Cirrhosis CIR 肝硬化 57 53 43 Cold COL 傷風 42 48 40 Constipation CON 便秘 23 46 36 Cough COU 咳嗽 34 45 31

Colon and Rectal Cancer CRC 大腸癌 57 57 57

Cystitis CYS 膀胱炎 48 39 22 Diabetes DBT 糖尿病 57 48 48 Dengue Fever DEF 登革熱 57 10 4 Diarrhea DIR 腹瀉 38 31 12 Dizziness DIZ 頭暈 24 41 40 Down's Syndrome DOS 唐氏綜合症 57 0 5 Eczema ECZ 濕疹 50 45 6 Emphysema EMP 肺氣腫 52 32 48 Epilepsy EPI 腦癇 (癲癇) 57 20 36 Fever FEV 發燒 45 40 2 Gastric Bleeding GAB 胃出血 57 24 12

**Best Treatment Approach(es) as suggested by 57 participants**

> **Chinese medicine**

*Qigong / tai chi*

**Biomedicine**



**3. Results**

bility…

elements and nature.

al environment of a society.

**3.1. What was shown from the free listing?**

The free listing of diseases from the participants showed that the concept of "disease" could be varied. Some of the items listed by the participants were "symptoms" rather than "dis‐ eases" from the biomedical point of view. The participants perceived uncomfortable and ab‐ normal feelings, or "symptoms" in the biomedical sense, as diseases, and their descriptions could be different from the biomedical explanations. The fact that some of the participants perceived "symptoms" and "discomforts" as diseases introduced a conceptual distinction between "illness" and "disease". Kleinman indicated that illness could include people's re‐ sponses to symptoms, and they could perceive "symptoms" as "diseases" in this sense,

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33

illness…means to conjure up the innately human experience of symptoms and suffering. Illness refers to how the sick

person and the members of the family or wider social network perceive, live with, and respond to symptoms and disa‐

Disease is the problem from the practitioner's perspective. In the narrow biological terms of the biomedical model, this

In many cases, the participants had already classified the diseases into groups in their free listing. They would free list the diseases together if they perceived them as having similar

The participants also tended to free list those diseases that caught their attention most and that they were most familiar with in the first instance. They started with the more serious and lifethreatening diseases, such as cancers and heart disease. They then proceeded to free list those

The free listing also features common diseases in a society, those which have been present for a long time as well as those which have recently emerged. Hand, foot, and mouth dis‐ ease, for example, was a new disease common in kindergartens and widely reported in the media at the time of the study, hence it was mentioned frequently by the participants.

In addition, the free listing of diseases could be time- and/or environment-bound. As the free listing was conducted in summer, therefore those diseases that mainly occur in summ‐ er, such as cholera, were often mentioned. Presumably the results of the free listing would vary depending on time and context. The free listing could thus reflect the social and cultur‐

diseases that occur commonly and which they often experienced, such as cold and flu.

means that disease is reconfigured *only* as an alteration in biological structure or functioning [10].

**Table 1.** The 72 Diseases free listed for the Pile Sort

#### **2.2. Pile sort**

After the free listing, the names of the mentioned seventy-two diseases were printed on a set of cards. The same set of 57 participants was asked to classify these seventy-two dis‐ eases into groups according to their own knowledge and classification criteria. They were asked to put those diseases which they thought to be similar together in the same pile. The therapeutic choices on these seventy-two diseases were also asked (Table 1). By do‐ ing this, it demonstrated not only the folk taxonomy of diseases of each participant, but al‐ so the relationship between the folk taxonomy of diseases and the therapeutic choices, as well as the practice of alternative medicine, among the participants in Hong Kong con‐ text. As the folk taxonomy of diseases reflects the underlying cultural perception of health and diseases, this experiment enabled the exploration of how close the relationship be‐ tween the underlying cultural health and disease belief and the practice of *qigong* and *tai chi* is. The folk taxonomy of diseases and the therapeutic choices for these seventy-two dis‐ eases could provide part of the reasons why the participants attempted *qigong* and *tai chi* for certain diseases, but not others.

## **3. Results**

**Diseases free listed Codes**

**Table 1.** The 72 Diseases free listed for the Pile Sort

for certain diseases, but not others.

**2.2. Pile sort**

Systemic Lupus Erythematosus

32 Alternative Medicine

**Chinese Terms of Diseases (Names in brackets are layman usage in Cantonese Chinese)**

Kidney Stones REC 腎石 57 24 19 Rheumatism RHE 風濕 49 52 57 Sinusitis SIN 鼻竇炎 48 32 28

Sore Throat SOT 喉嚨痛 24 38 24 Bone Spurs SPU 骨刺 35 51 57 Stomachache STA 胃痛 48 40 35 Syphilis SYP 梅毒 57 2 6 Tuberculosis TB 肺結核 (肺癆) 57 30 35 Athlete's Foot TIP 足蘚(香港) 57 38 2 Tonsillitis TON 扁桃腺發炎 57 24 15 Urethritis URE 尿道炎 44 37 8 Urticaria URT 蕁痳疹 (風癩) 34 47 3

After the free listing, the names of the mentioned seventy-two diseases were printed on a set of cards. The same set of 57 participants was asked to classify these seventy-two dis‐ eases into groups according to their own knowledge and classification criteria. They were asked to put those diseases which they thought to be similar together in the same pile. The therapeutic choices on these seventy-two diseases were also asked (Table 1). By do‐ ing this, it demonstrated not only the folk taxonomy of diseases of each participant, but al‐ so the relationship between the folk taxonomy of diseases and the therapeutic choices, as well as the practice of alternative medicine, among the participants in Hong Kong con‐ text. As the folk taxonomy of diseases reflects the underlying cultural perception of health and diseases, this experiment enabled the exploration of how close the relationship be‐ tween the underlying cultural health and disease belief and the practice of *qigong* and *tai chi* is. The folk taxonomy of diseases and the therapeutic choices for these seventy-two dis‐ eases could provide part of the reasons why the participants attempted *qigong* and *tai chi*

**Best Treatment Approach(es) as suggested by 57 participants**

> **Chinese medicine**

*Qigong / tai chi*

**Biomedicine**

SLE 紅斑狼瘡 57 41 43

#### **3.1. What was shown from the free listing?**

The free listing of diseases from the participants showed that the concept of "disease" could be varied. Some of the items listed by the participants were "symptoms" rather than "dis‐ eases" from the biomedical point of view. The participants perceived uncomfortable and ab‐ normal feelings, or "symptoms" in the biomedical sense, as diseases, and their descriptions could be different from the biomedical explanations. The fact that some of the participants perceived "symptoms" and "discomforts" as diseases introduced a conceptual distinction between "illness" and "disease". Kleinman indicated that illness could include people's re‐ sponses to symptoms, and they could perceive "symptoms" as "diseases" in this sense,

illness…means to conjure up the innately human experience of symptoms and suffering. Illness refers to how the sick

person and the members of the family or wider social network perceive, live with, and respond to symptoms and disa‐

bility…

Disease is the problem from the practitioner's perspective. In the narrow biological terms of the biomedical model, this

means that disease is reconfigured *only* as an alteration in biological structure or functioning [10].

In many cases, the participants had already classified the diseases into groups in their free listing. They would free list the diseases together if they perceived them as having similar elements and nature.

The participants also tended to free list those diseases that caught their attention most and that they were most familiar with in the first instance. They started with the more serious and lifethreatening diseases, such as cancers and heart disease. They then proceeded to free list those diseases that occur commonly and which they often experienced, such as cold and flu.

The free listing also features common diseases in a society, those which have been present for a long time as well as those which have recently emerged. Hand, foot, and mouth dis‐ ease, for example, was a new disease common in kindergartens and widely reported in the media at the time of the study, hence it was mentioned frequently by the participants.

In addition, the free listing of diseases could be time- and/or environment-bound. As the free listing was conducted in summer, therefore those diseases that mainly occur in summ‐ er, such as cholera, were often mentioned. Presumably the results of the free listing would vary depending on time and context. The free listing could thus reflect the social and cultur‐ al environment of a society.

The diseases free listed by the participants not only reflected a culture's focus on disease, but also portrayed the institutional and social forces shaping the social beliefs and ideology on health and diseases of people. Female participants tended to free list more diseases than male participants. This could be related to their higher ratio in engaging domestic role in which they could have more time to learn about diseases from various media. The "wom‐ en's television programmes" in the afternoon, in particular, could be a popular medium for housewives to learn about diseases that were of current concern. On the other hand, male participants were more reluctant to free list sexually-transmitted diseases and those diseases that were suffered by females exclusively.

**Cluster Diseases**

6 Glaucoma, cataract.

5 Osteoporosis, spurs, rheumatism, gout, stroke, arthritis.

8 Systemic Lupus Erythematosus, meningitis, dizziness, headache.

**Table 2.** The folk taxonomies of diseases that are suggested by the participants

EPI

CAT

 SLE RHE MEN

BRC NPC KID

**Figure 2.** The Multidimensional Scaling Diagram of Diseases as classified by the participants

 LUC HEC CIR

7 Parkinson's Disease, Alzheimer's Disease, Down's Syndrome, epilepsy, mental illness.

MEI HER

 OST SPU GOU APO DIZ HEA FEV COL AST TB ALR ART COU INF SOT

HYP DIR PHA BRO

 DBT SIN TON HED ANA STA CON GAE APP HEM

 CYS URE GAU PNE BOC GAB EMP

OTI

LEU CRC GAC REC HEP

PAS ALS DOS GLA SYP

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 AIDS DEF HFM GEM CHO MAL MEA URT PSO ECZ CHP TIP

The free listing gives a general picture of how people of a culture view diseases, and how the social, environmental, and institutional forces influence people's views on diseases. The free listing shows how people organize the knowledge of diseases, and the diseases in which a soci‐ ety is familiar with and concerns about. Therefore, free listing of diseases can reveal the differ‐ ence between cultural belief system of "diseases" and biomedical point of view.

#### **3.2. Folk taxonomies of diseases as mentioned by the participants**

After the disease free listing, the participants were asked to do pile sort in which they were asked to classify the free listed diseases into groups. They were asked to put those diseases which they thought to be similar together in the same pile according to their own knowl‐ edge and understanding. The 57 pile sorts were analyzed by ANTHROPAC. A multidimen‐ sional scaling diagram of the 72 diseases was generated and constructed by ANTHROPAC according to the classification of the 57 participants (Figure 2). This showed how the partici‐ pants classified diseases according to their own knowledge. Those diseases that were locat‐ ed closely together were perceived as similar by the participants.

Several clusters, ie. folk taxonomies, of diseases in Hong Kong context were illustrated from the multidimensional scaling diagram (Table 2). The folk taxonomies illustrated how the participants perceived and organized the knowledge of the free listed diseases. Those dis‐ eases in the same taxonomy were sharing similar nature and characteristics according to the participants.


Eight clusters were noted in participants' folk taxonomy of diseases.


**Table 2.** The folk taxonomies of diseases that are suggested by the participants

The diseases free listed by the participants not only reflected a culture's focus on disease, but also portrayed the institutional and social forces shaping the social beliefs and ideology on health and diseases of people. Female participants tended to free list more diseases than male participants. This could be related to their higher ratio in engaging domestic role in which they could have more time to learn about diseases from various media. The "wom‐ en's television programmes" in the afternoon, in particular, could be a popular medium for housewives to learn about diseases that were of current concern. On the other hand, male participants were more reluctant to free list sexually-transmitted diseases and those diseases

The free listing gives a general picture of how people of a culture view diseases, and how the social, environmental, and institutional forces influence people's views on diseases. The free listing shows how people organize the knowledge of diseases, and the diseases in which a soci‐ ety is familiar with and concerns about. Therefore, free listing of diseases can reveal the differ‐

After the disease free listing, the participants were asked to do pile sort in which they were asked to classify the free listed diseases into groups. They were asked to put those diseases which they thought to be similar together in the same pile according to their own knowl‐ edge and understanding. The 57 pile sorts were analyzed by ANTHROPAC. A multidimen‐ sional scaling diagram of the 72 diseases was generated and constructed by ANTHROPAC according to the classification of the 57 participants (Figure 2). This showed how the partici‐ pants classified diseases according to their own knowledge. Those diseases that were locat‐

Several clusters, ie. folk taxonomies, of diseases in Hong Kong context were illustrated from the multidimensional scaling diagram (Table 2). The folk taxonomies illustrated how the participants perceived and organized the knowledge of the free listed diseases. Those dis‐ eases in the same taxonomy were sharing similar nature and characteristics according to the

1 Bone cancer, brain cancer, nasopharyngeal cancer, leukemia, colorectal cancer, gastric cancer, lung cancer, liver cancer, cirrhosis, renal disease, kidney stone, gallstone, hepatitis. 2 Cholera, malaria, Dengue Fever, Hand foot and mouth disease, German measles, measles, urticaria,

3 Fever, cold, asthma, tuberculosis, allergic rhinitis, cough, influenza, sore throat, pharyngitis, otitis

ence between cultural belief system of "diseases" and biomedical point of view.

**3.2. Folk taxonomies of diseases as mentioned by the participants**

ed closely together were perceived as similar by the participants.

Eight clusters were noted in participants' folk taxonomy of diseases.

psoriasis, eczema, chicken-pox, athlete's foot, syphilis, herpes.

4 Appendicitis, hemorrhoid, cystitis, urethritis, gastric ulcer, gastric bleeding, pneumonia,

media, bronchitis, sinusitis, tonsillitis.

emphysema.

that were suffered by females exclusively.

participants.

34 Alternative Medicine

**Cluster Diseases**


#### *Cluster 1*

This cluster consisted those diseases that were serious and life-threatening from the partici‐ pants' point of view and those diseases that often required surgical treatment, such as can‐ cers, kidney stones, and gallstones. On the other hand, the language of a culture also influenced the perceptions and cultural beliefs of people and the ways in which they classi‐ fied diseases. Hepatitis was situated next to the gallstone in this cluster because, according to some participants, there was a Chinese slang expression which literally means "liver and gall bladder help and complement with each other" (肝膽相照). See the Sapir-Whorf Hy‐ pothesis, as recounted in Bonvillain (2000),

tion in Hong Kong's biomedicine played a role in influencing participants' perceptions in this group of diseases, as some participants indicated that most of the diseases in this cluster

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This cluster mainly contained the diseases in relation to gastrointestinal and urological sys‐ tem. However, two diseases in relation to breathing system were also grouped in this cate‐ gory. In participants' terms, the diseases in this cluster were related to "internal organs".

This cluster was made up of those diseases that were perceived as having a long-term im‐ pact on patients, or chronic diseases. This cluster mainly consisted bone and joint diseases. Some participants used age as a criterion in grouping these diseases together in the same category, having the impression that these diseases were mainly suffered by the elderly.

This cluster consisted of ophthalmological diseases in participants' understanding. The dis‐ eases of glaucoma and cataract were usually straightforward to participants, since they often

This cluster contained those diseases that were related to mind, nerve, and brain function, and the participants often had the impression that these diseases were chronic and incura‐ ble. Another feature noted in this cluster was that the participants often did not have much knowledge on these diseases, since many of these names were new and "foreign" to them.

This cluster contained diseases in relation to head, though Systemic Lupus Erythematosus was located in this cluster as well. Some participants commented as Systemic Lupus Erythe‐ matosus has skin symptoms, especially in the area of face. Therefore, they grouped this dis‐

The folk taxonomies of the seventy-two diseases showed how the participants organized and understood diseases by using their own cultural beliefs. From the multidimensional scaling diagram as shown in Figure 2, there were at least two scales at work regarding the nature of the diseases. On the first scale, the diseases perceived as life-threatening were lo‐ cated at one end, while the diseases perceived as infectious and contagious, and as chronic and incurable, were located at the other. In the second scale, the diseases perceived as chronic and long term were located at one end, and the diseases perceived as acute and short term were located at the other. Such scaling demonstrated when the participants made classifications, whether the diseases are life-threatening or not and whether they are acute or

were under the specialty of otorhinolaryngology [11].

grouped these two diseases together in the same pile quickly.

chronic were the subconscious force at work in their perceptions.

*Cluster 4*

*Cluster 5*

*Cluster 6*

*Cluster 7*

*Cluster 8*

ease under the category of "head".

Some elements of language, for example, in vocabulary or grammatical systems, influence speakers' perceptions and

can affect their attitudes and behavior… In fact, both Sapir and Whorf wavered in their statements on the issue of caus‐

al or directional relationship between language and thought [1].

#### *Cluster 2*

This cluster consisted infectious and contagious diseases from the participants' point of view. This mainly included dermatological diseases. All dermatological diseases were in‐ cluded in this cluster. Other infectious diseases that are not dermatological but with skin symptoms were also classified in this category. Some other infectious diseases such as chol‐ era, malaria, and Dengue Fever were in this cluster as well. Such lay classification revealed the underlying perceptions of the participants on dermatological diseases as contagious (though not all of them were contagious), which were perceived as similar to those infec‐ tious diseases such as cholera, malaria, and Dengue Fever. On the other hand, the partici‐ pants perceived some infectious diseases as dermatological, even though they are infectious in nature. For example, German measles, measles, and hand, foot and mouth disease are in‐ fectious in nature. However, because the symptoms of these diseases often appear on skin, this led the participants to have an impression that infectious diseases were similar to der‐ matological diseases.

The sexually-transmitted diseases, such as syphilis and herpes, were located closely to this cluster of infectious and dermatological diseases. Besides the contagious nature and the skin symptoms, the specialty classification in Hong Kong's biomedicine also played a role in in‐ fluencing participants' perceptions, since both the sexually-transmitted diseases and derma‐ tological diseases were under the same specialty – Dermatology and Venereology [11]. The biomedical institution thus constructed the disease perceptions of the participants. From the participants' viewpoints, the diseases in this cluster were infectious and contagious.

#### *Cluster 3*

This cluster consisted the diseases and symptoms of the upper and lower respiratory sys‐ tem, which were perceived as common for anyone to suffer. Again, the specialty classifica‐ tion in Hong Kong's biomedicine played a role in influencing participants' perceptions in this group of diseases, as some participants indicated that most of the diseases in this cluster were under the specialty of otorhinolaryngology [11].

#### *Cluster 4*

*Cluster 1*

36 Alternative Medicine

*Cluster 2*

matological diseases.

*Cluster 3*

pothesis, as recounted in Bonvillain (2000),

al or directional relationship between language and thought [1].

This cluster consisted those diseases that were serious and life-threatening from the partici‐ pants' point of view and those diseases that often required surgical treatment, such as can‐ cers, kidney stones, and gallstones. On the other hand, the language of a culture also influenced the perceptions and cultural beliefs of people and the ways in which they classi‐ fied diseases. Hepatitis was situated next to the gallstone in this cluster because, according to some participants, there was a Chinese slang expression which literally means "liver and gall bladder help and complement with each other" (肝膽相照). See the Sapir-Whorf Hy‐

Some elements of language, for example, in vocabulary or grammatical systems, influence speakers' perceptions and

can affect their attitudes and behavior… In fact, both Sapir and Whorf wavered in their statements on the issue of caus‐

This cluster consisted infectious and contagious diseases from the participants' point of view. This mainly included dermatological diseases. All dermatological diseases were in‐ cluded in this cluster. Other infectious diseases that are not dermatological but with skin symptoms were also classified in this category. Some other infectious diseases such as chol‐ era, malaria, and Dengue Fever were in this cluster as well. Such lay classification revealed the underlying perceptions of the participants on dermatological diseases as contagious (though not all of them were contagious), which were perceived as similar to those infec‐ tious diseases such as cholera, malaria, and Dengue Fever. On the other hand, the partici‐ pants perceived some infectious diseases as dermatological, even though they are infectious in nature. For example, German measles, measles, and hand, foot and mouth disease are in‐ fectious in nature. However, because the symptoms of these diseases often appear on skin, this led the participants to have an impression that infectious diseases were similar to der‐

The sexually-transmitted diseases, such as syphilis and herpes, were located closely to this cluster of infectious and dermatological diseases. Besides the contagious nature and the skin symptoms, the specialty classification in Hong Kong's biomedicine also played a role in in‐ fluencing participants' perceptions, since both the sexually-transmitted diseases and derma‐ tological diseases were under the same specialty – Dermatology and Venereology [11]. The biomedical institution thus constructed the disease perceptions of the participants. From the

This cluster consisted the diseases and symptoms of the upper and lower respiratory sys‐ tem, which were perceived as common for anyone to suffer. Again, the specialty classifica‐

participants' viewpoints, the diseases in this cluster were infectious and contagious.

This cluster mainly contained the diseases in relation to gastrointestinal and urological sys‐ tem. However, two diseases in relation to breathing system were also grouped in this cate‐ gory. In participants' terms, the diseases in this cluster were related to "internal organs".

#### *Cluster 5*

This cluster was made up of those diseases that were perceived as having a long-term im‐ pact on patients, or chronic diseases. This cluster mainly consisted bone and joint diseases. Some participants used age as a criterion in grouping these diseases together in the same category, having the impression that these diseases were mainly suffered by the elderly.

#### *Cluster 6*

This cluster consisted of ophthalmological diseases in participants' understanding. The dis‐ eases of glaucoma and cataract were usually straightforward to participants, since they often grouped these two diseases together in the same pile quickly.

#### *Cluster 7*

This cluster contained those diseases that were related to mind, nerve, and brain function, and the participants often had the impression that these diseases were chronic and incura‐ ble. Another feature noted in this cluster was that the participants often did not have much knowledge on these diseases, since many of these names were new and "foreign" to them.

#### *Cluster 8*

This cluster contained diseases in relation to head, though Systemic Lupus Erythematosus was located in this cluster as well. Some participants commented as Systemic Lupus Erythe‐ matosus has skin symptoms, especially in the area of face. Therefore, they grouped this dis‐ ease under the category of "head".

The folk taxonomies of the seventy-two diseases showed how the participants organized and understood diseases by using their own cultural beliefs. From the multidimensional scaling diagram as shown in Figure 2, there were at least two scales at work regarding the nature of the diseases. On the first scale, the diseases perceived as life-threatening were lo‐ cated at one end, while the diseases perceived as infectious and contagious, and as chronic and incurable, were located at the other. In the second scale, the diseases perceived as chronic and long term were located at one end, and the diseases perceived as acute and short term were located at the other. Such scaling demonstrated when the participants made classifications, whether the diseases are life-threatening or not and whether they are acute or chronic were the subconscious force at work in their perceptions.

#### **3.3. The interrelationship between the folk taxonomy of diseases and the choices of remedy**

Cultural belief system affects how people organize their knowledge on diseases. In addition, common sense, lay perceptions, and illness and treatment experiences also influence peo‐ ple's decisions in choosing remedy. This section will examine the interrelationship between the folk taxonomy of diseases and the choice of therapies, and whether the same choice of therapies were to be used on the same clusters of diseases among the participants. The par‐ ticipants' choices on the therapeutic approaches provide a framework of the underlying rea‐ sons for their *qigong* and *tai chi* practice.

ceived cancers as more life-threatening and dangerous than renal disease, hence they were more motivated to search for other alternative medicine for remedy in cancers. Also, the known and established remedies of biomedicine in renal disease, kidney stones and gall‐ stones explain why the participants tended to only attempt biomedicine for treatment.

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39

Another cluster of disease which showed clear corelation between folk taxonomy and treat‐ ment choices was dermatological, sexually-transmitted, and infectious diseases. Most partic‐ ipants would first seek biomedicine for therapy for this cluster of diseases, and then some of them, especially those older ones, would use traditional Chinese medicine afterwards. The underlying Chinese cultural belief in health motivated these participants considering tradi‐ tional Chinese medicine for remedy. In that case they would perceive their body suffered from "wet toxin" (濕毒). As this concept is embedded in traditional Chinese medicinal be‐ lief, therefore adopting the remedy with the same cultural medicinal belief would be per‐ ceived as a "sensible" solution for the participants. On the other hand, the participants believed biomedicine was the best remedy for contagious diseases. As contagious diseases were more "polluting" in both physical and cultural sense, participants would prefer the remedy that they were most confident. Also, biomedicine often gave an impression "quick" to the participants, therefore biomedicine was often attempted in order to get rid of such so‐

Social and cultural environment and gaze on certain groups of diseases also influenced par‐ ticipants' decision in remedies. As shown from the folk taxonomies in the multidimensional scaling diagram, dermatological diseases located closely to sexually-transmitted diseases. Sexually-transmitted diseases receive much stigmatization in Chinese culture. As dermato‐ logical diseases located closely to the cluster of sexually-transmitted diseases, which indicat‐ ed these two types of diseases were similar from participants' viewpoint, presumably the participants would want to get rid of dermatological diseases in order to avoid being stig‐ matized. As biomedicine was perceived as giving a quick treatment, the participants were

Age was another influential element in predicting how participants choose treatment ap‐ proach. Same disease could be perceived differently by different age groups. Take inflam‐ matory disease as an example, the treatment choices can be varied for different age groups. Younger participants were more under western cultural exposure so they were more moti‐ vated and ready in choosing biomedicine. Antibiotics were widely known by these young participants. In contrast, middle-aged and the elderly participants would prefer traditional Chinese medicine more as they were under more influence of Chinese culture. They be‐ lieved many inflammatory diseases, and dermatological diseases, were induced by the "wet hot" (濕熱) and the toxins of the body, and the best way to deal with these bad forces was

Whether the disease itself has a cultural medicinal explanation would be remarkable in par‐ ticipants' choice of alternative medicine. If the disease had a cultural medicinal explanation, participants would be more motivated in using alternative medicine. As alternative medi‐ cine is embedded in a community's cultural belief, therefore using the same cultural medici‐

cial labeling as soon as possible.

thus motivated to choose biomedicine in the first instance.

the use of traditional Chinese medicine in order to "clear the root".

After the pile sorts, the participants were asked about their choice of therapies in dealing with those seventy-two diseases. They were asked to rank their choice of therapeutic ap‐ proaches for suitability (Table 1). Their treatment decisions were to be compared with their folk taxonomy of diseases. Treatment choices are to be influenced by one's cultural beliefs. As Kleinman (1988) stated:

local cultural orientations (the patterned ways that we have learned to think about and act in our life worlds and that

replicate the social structure of those worlds) organize our conventional common sense about how to understand and

treat illness; thus we can say of illness experience that it is always culturally shaped… Expectations about how to be‐

have when ill also differ owing to our unique individual biographies [10].

An obvious interrelationship between the folk taxonomy and treatment choices was noted for cluster 1 diseases, which were perceived as life threatening and serious. As most of the diseases in this cluster were cancers that were life-threatening, all 57 participants had no hesitation in asserting that they would try all forms of remedies, including biomedicine, tra‐ ditional Chinese medicine, *qigong, tai chi*, and even other folk remedies. All the participants except two would choose biomedicine first, and then traditional Chinese medicine and *qi‐ gong* as the complement. The participants had more confidence and trust in biomedicine to cope with the life-threatening diseases. They believed they would need biomedical investi‐ gation and treatment at the beginning stage. Once the diagnosis was confirmed, then they would seek traditional Chinese medicine and *qigong* afterwards as a complement.

Although the participants would use all the remedies they knew for life-threatening diseas‐ es, the acceptability of alternative medicine was much higher for cancers than for renal dis‐ ease, kidney stones, and gallstones. Some participants even would try all sorts of alternative medicine for the treatment of cancers, no matter how "strange" the remedies were. Howev‐ er, participants tended not to search alternative remedies for renal disease, though a few would search for *qigong*, and then traditional Chinese medicine for treatment. As most par‐ ticipants recognized the necessity of adopting biomedical therapy such as dialysis (for renal disease) and surgery (for kidney stones and gallstones), they would only seek traditional Chinese medicine and *qigong* afterwards as a supplementary remedy. As participants per‐ ceived cancers as more life-threatening and dangerous than renal disease, hence they were more motivated to search for other alternative medicine for remedy in cancers. Also, the known and established remedies of biomedicine in renal disease, kidney stones and gall‐ stones explain why the participants tended to only attempt biomedicine for treatment.

**3.3. The interrelationship between the folk taxonomy of diseases and the choices of**

Cultural belief system affects how people organize their knowledge on diseases. In addition, common sense, lay perceptions, and illness and treatment experiences also influence peo‐ ple's decisions in choosing remedy. This section will examine the interrelationship between the folk taxonomy of diseases and the choice of therapies, and whether the same choice of therapies were to be used on the same clusters of diseases among the participants. The par‐ ticipants' choices on the therapeutic approaches provide a framework of the underlying rea‐

After the pile sorts, the participants were asked about their choice of therapies in dealing with those seventy-two diseases. They were asked to rank their choice of therapeutic ap‐ proaches for suitability (Table 1). Their treatment decisions were to be compared with their folk taxonomy of diseases. Treatment choices are to be influenced by one's cultural beliefs.

local cultural orientations (the patterned ways that we have learned to think about and act in our life worlds and that

replicate the social structure of those worlds) organize our conventional common sense about how to understand and

treat illness; thus we can say of illness experience that it is always culturally shaped… Expectations about how to be‐

An obvious interrelationship between the folk taxonomy and treatment choices was noted for cluster 1 diseases, which were perceived as life threatening and serious. As most of the diseases in this cluster were cancers that were life-threatening, all 57 participants had no hesitation in asserting that they would try all forms of remedies, including biomedicine, tra‐ ditional Chinese medicine, *qigong, tai chi*, and even other folk remedies. All the participants except two would choose biomedicine first, and then traditional Chinese medicine and *qi‐ gong* as the complement. The participants had more confidence and trust in biomedicine to cope with the life-threatening diseases. They believed they would need biomedical investi‐ gation and treatment at the beginning stage. Once the diagnosis was confirmed, then they

Although the participants would use all the remedies they knew for life-threatening diseas‐ es, the acceptability of alternative medicine was much higher for cancers than for renal dis‐ ease, kidney stones, and gallstones. Some participants even would try all sorts of alternative medicine for the treatment of cancers, no matter how "strange" the remedies were. Howev‐ er, participants tended not to search alternative remedies for renal disease, though a few would search for *qigong*, and then traditional Chinese medicine for treatment. As most par‐ ticipants recognized the necessity of adopting biomedical therapy such as dialysis (for renal disease) and surgery (for kidney stones and gallstones), they would only seek traditional Chinese medicine and *qigong* afterwards as a supplementary remedy. As participants per‐

would seek traditional Chinese medicine and *qigong* afterwards as a complement.

**remedy**

38 Alternative Medicine

sons for their *qigong* and *tai chi* practice.

have when ill also differ owing to our unique individual biographies [10].

As Kleinman (1988) stated:

Another cluster of disease which showed clear corelation between folk taxonomy and treat‐ ment choices was dermatological, sexually-transmitted, and infectious diseases. Most partic‐ ipants would first seek biomedicine for therapy for this cluster of diseases, and then some of them, especially those older ones, would use traditional Chinese medicine afterwards. The underlying Chinese cultural belief in health motivated these participants considering tradi‐ tional Chinese medicine for remedy. In that case they would perceive their body suffered from "wet toxin" (濕毒). As this concept is embedded in traditional Chinese medicinal be‐ lief, therefore adopting the remedy with the same cultural medicinal belief would be per‐ ceived as a "sensible" solution for the participants. On the other hand, the participants believed biomedicine was the best remedy for contagious diseases. As contagious diseases were more "polluting" in both physical and cultural sense, participants would prefer the remedy that they were most confident. Also, biomedicine often gave an impression "quick" to the participants, therefore biomedicine was often attempted in order to get rid of such so‐ cial labeling as soon as possible.

Social and cultural environment and gaze on certain groups of diseases also influenced par‐ ticipants' decision in remedies. As shown from the folk taxonomies in the multidimensional scaling diagram, dermatological diseases located closely to sexually-transmitted diseases. Sexually-transmitted diseases receive much stigmatization in Chinese culture. As dermato‐ logical diseases located closely to the cluster of sexually-transmitted diseases, which indicat‐ ed these two types of diseases were similar from participants' viewpoint, presumably the participants would want to get rid of dermatological diseases in order to avoid being stig‐ matized. As biomedicine was perceived as giving a quick treatment, the participants were thus motivated to choose biomedicine in the first instance.

Age was another influential element in predicting how participants choose treatment ap‐ proach. Same disease could be perceived differently by different age groups. Take inflam‐ matory disease as an example, the treatment choices can be varied for different age groups. Younger participants were more under western cultural exposure so they were more moti‐ vated and ready in choosing biomedicine. Antibiotics were widely known by these young participants. In contrast, middle-aged and the elderly participants would prefer traditional Chinese medicine more as they were under more influence of Chinese culture. They be‐ lieved many inflammatory diseases, and dermatological diseases, were induced by the "wet hot" (濕熱) and the toxins of the body, and the best way to deal with these bad forces was the use of traditional Chinese medicine in order to "clear the root".

Whether the disease itself has a cultural medicinal explanation would be remarkable in par‐ ticipants' choice of alternative medicine. If the disease had a cultural medicinal explanation, participants would be more motivated in using alternative medicine. As alternative medi‐ cine is embedded in a community's cultural belief, therefore using the same cultural medici‐ nal approach is to be perceived as the most optimal approach. Just like "wet hot" and toxins is a Chinese cultural medicinal concept, hence these problems are believed to be best over‐ come by the Chinese approaches.

For the cluster of diseases that were more common and less serious, such as those in relation to upper respiratory tract infections, the acceptability of traditional Chinese medicine as a remedy was high among the participants. However, the interrelationship between the dis‐ eases in this cluster and the choice of remedy was rather weak. Some participants would choose biomedicine as first line for remedy on account of its fast relief and efficacy, while others would choose traditional Chinese medicine as first line treatment. But in general old‐ er participants tended to choose traditional Chinese medicine as the first option for these diseases. Only when they failed to experience the efficacy that they would then turn to bio‐

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41

The above findings illustrate that the folk taxonomies of diseases are closely related to peo‐ ple's organization of disease knowledge and perceptions, which is often based on their cul‐ tural belief system. This influence their treatment choices and decisions to a certain extent. From the participants' choices of therapies and their explanations on their treatment deci‐ sions, they usually had their own interpretations on the best treatment for those diseases. These revealed how they perceived the strengths and weaknesses of biomedicine, tradition‐ al Chinese medicine, and *qigong* to a certain extent. These underlying perceptions served as the underlying motivations for the participants' practice of alternative medicine such as tra‐ ditional Chinese medicine and *qigong*. The folk taxonomies of diseases and the treatment de‐ cisions showed that their alternative medicine practice was to be related to the perceived weaknesses of biomedicine and the perceived strengths of traditional Chinese medicine and

From the participants, the folk taxonomy consisting the relatively more serious diseases such as the life threatening diseases, the contagious and dermatological diseases, and oph‐ thalmological diseases, a remarkable correlation with biomedicine was observed. In con‐ trast, for the folk taxonomy that consisted of the less serious diseases such as the non-life threatening chronic diseases and the bone and joint problems, a strong correlation with al‐ ternative medicine practice such as traditional Chinese medicine and *qigong* was noted. As Lupton (2000) stated, "[t]he more common and the less serious the illness, the more likely it is that lay theories of causation and treatment draw upon traditional folk-models of illness" [12]. Although apparent correlation was observed between some taxonomies of diseases and remedy preferences, such correlation was not applicable to all taxonomies. The cultural per‐ ceptions of a disease were still a more decisive factor in influencing the treatment choices of the participants. On the other hand, another point to be noted is the common belief among the participants that they could still practice alternative medicine, in particular *qigong*, in al‐ most all kinds of health problems, since it could strengthen their health and alleviate the suf‐

fering without conflicting with other remedies and exerting any harm to the body.

As alternative medicine practice is embedded in a community's cultural belief system, there‐ fore, the cultural values and ideal will be transmitted and reinforced through people's prac‐

**4.** *Qigong* **practice and the Chinese philosophical teaching**

medicine for treatment.

*qigong* on managing different diseases.

Another cluster which demonstrated a clear relationship between folk taxonomy and treat‐ ment choices were ophthalmological diseases. There was a strong preference in biomedical treatment among the participants in this category of diseases. As the biomedical treatment of ophthalmological diseases has long been established, hence the participants believed that only biomedicine and surgery could treat these diseases. Only a few older participants would attempt traditional Chinese medicine and *qigong* as a follow up treatment, since sur‐ gery was perceived as "hurt" to human body. Traditional Chinese medicine and *qigong* would be adopted only for rebuilding the body status after biomedical surgery according to these few participants.

Language influences how people think and perceive things. As demonstrated by the partici‐ pants, the names of diseases could serve as an influential factor for determining suitable reme‐ dy. The participants tended to seek biomedical remedies for the cluster of brain, mind, and nerve diseases. As the names of the diseases, ie. Parkinson's Disease, Alzheimer's Disease, Down's Syndrome, in this cluster are "western" and "foreign" to them, they believed biomedi‐ cine was better in treating these "western" diseases. Another example was German Measles. All the participants would choose biomedicine as treatment for German Measles, though more participants would choose traditional Chinese medicine for ordinary measles instead.

Although gastrointestinal, urological, and lung diseases were in the same cluster according to the participants, treatment choices varied for these three groups of diseases. Participants preferred adopting biomedicine as the first line of treatment for the gastrointestinal and lung diseases, whereas they preferred traditional Chinese medicine in urological diseases such as cystitis and urethritis, and hemorrhoid, though younger participants would prefer biomedicine for urological diseases. For lung diseases, the acceptability of alternative medi‐ cine such as traditional Chinese medicine and *qigong* was higher for emphysema than for pneumonia. Since emphysema is a chronic lung disease, therefore the participants would search for alternative medicine as a complement. Pneumonia, on the other hand, is an acute disease, therefore biomedicine was still the first option for them.

Alternative medicine was shown to be popular in dealing chronic and long-term diseases, and the findings from the participants demonstrated the same picture. Traditional Chinese medicine and *qigong* were regarded as in a higher priority as treatment choice among the participants in managing chronic diseases.

Bone and joint diseases was another cluster which showed the strongest correlation between the folk taxonomy and alternative medicine practice as suggested by the participants. Most participants would choose *tai chi* in the first instance for this cluster of bone and joint diseas‐ es, since they recognized the weaknesses and experienced the limitations of biomedicine in managing bone and joint problems from their personal experiences. Besides practicing *tai chi*, acupuncture in traditional Chinese medicine was another popular treatment option as suggested by the participants, since acupuncture has a long history in dealing bone and joint diseases in Chinese society.

For the cluster of diseases that were more common and less serious, such as those in relation to upper respiratory tract infections, the acceptability of traditional Chinese medicine as a remedy was high among the participants. However, the interrelationship between the dis‐ eases in this cluster and the choice of remedy was rather weak. Some participants would choose biomedicine as first line for remedy on account of its fast relief and efficacy, while others would choose traditional Chinese medicine as first line treatment. But in general old‐ er participants tended to choose traditional Chinese medicine as the first option for these diseases. Only when they failed to experience the efficacy that they would then turn to bio‐ medicine for treatment.

nal approach is to be perceived as the most optimal approach. Just like "wet hot" and toxins is a Chinese cultural medicinal concept, hence these problems are believed to be best over‐

Another cluster which demonstrated a clear relationship between folk taxonomy and treat‐ ment choices were ophthalmological diseases. There was a strong preference in biomedical treatment among the participants in this category of diseases. As the biomedical treatment of ophthalmological diseases has long been established, hence the participants believed that only biomedicine and surgery could treat these diseases. Only a few older participants would attempt traditional Chinese medicine and *qigong* as a follow up treatment, since sur‐ gery was perceived as "hurt" to human body. Traditional Chinese medicine and *qigong* would be adopted only for rebuilding the body status after biomedical surgery according to

Language influences how people think and perceive things. As demonstrated by the partici‐ pants, the names of diseases could serve as an influential factor for determining suitable reme‐ dy. The participants tended to seek biomedical remedies for the cluster of brain, mind, and nerve diseases. As the names of the diseases, ie. Parkinson's Disease, Alzheimer's Disease, Down's Syndrome, in this cluster are "western" and "foreign" to them, they believed biomedi‐ cine was better in treating these "western" diseases. Another example was German Measles. All the participants would choose biomedicine as treatment for German Measles, though more

Although gastrointestinal, urological, and lung diseases were in the same cluster according to the participants, treatment choices varied for these three groups of diseases. Participants preferred adopting biomedicine as the first line of treatment for the gastrointestinal and lung diseases, whereas they preferred traditional Chinese medicine in urological diseases such as cystitis and urethritis, and hemorrhoid, though younger participants would prefer biomedicine for urological diseases. For lung diseases, the acceptability of alternative medi‐ cine such as traditional Chinese medicine and *qigong* was higher for emphysema than for pneumonia. Since emphysema is a chronic lung disease, therefore the participants would search for alternative medicine as a complement. Pneumonia, on the other hand, is an acute

Alternative medicine was shown to be popular in dealing chronic and long-term diseases, and the findings from the participants demonstrated the same picture. Traditional Chinese medicine and *qigong* were regarded as in a higher priority as treatment choice among the

Bone and joint diseases was another cluster which showed the strongest correlation between the folk taxonomy and alternative medicine practice as suggested by the participants. Most participants would choose *tai chi* in the first instance for this cluster of bone and joint diseas‐ es, since they recognized the weaknesses and experienced the limitations of biomedicine in managing bone and joint problems from their personal experiences. Besides practicing *tai chi*, acupuncture in traditional Chinese medicine was another popular treatment option as suggested by the participants, since acupuncture has a long history in dealing bone and joint

participants would choose traditional Chinese medicine for ordinary measles instead.

disease, therefore biomedicine was still the first option for them.

participants in managing chronic diseases.

diseases in Chinese society.

come by the Chinese approaches.

40 Alternative Medicine

these few participants.

The above findings illustrate that the folk taxonomies of diseases are closely related to peo‐ ple's organization of disease knowledge and perceptions, which is often based on their cul‐ tural belief system. This influence their treatment choices and decisions to a certain extent. From the participants' choices of therapies and their explanations on their treatment deci‐ sions, they usually had their own interpretations on the best treatment for those diseases. These revealed how they perceived the strengths and weaknesses of biomedicine, tradition‐ al Chinese medicine, and *qigong* to a certain extent. These underlying perceptions served as the underlying motivations for the participants' practice of alternative medicine such as tra‐ ditional Chinese medicine and *qigong*. The folk taxonomies of diseases and the treatment de‐ cisions showed that their alternative medicine practice was to be related to the perceived weaknesses of biomedicine and the perceived strengths of traditional Chinese medicine and *qigong* on managing different diseases.

From the participants, the folk taxonomy consisting the relatively more serious diseases such as the life threatening diseases, the contagious and dermatological diseases, and oph‐ thalmological diseases, a remarkable correlation with biomedicine was observed. In con‐ trast, for the folk taxonomy that consisted of the less serious diseases such as the non-life threatening chronic diseases and the bone and joint problems, a strong correlation with al‐ ternative medicine practice such as traditional Chinese medicine and *qigong* was noted. As Lupton (2000) stated, "[t]he more common and the less serious the illness, the more likely it is that lay theories of causation and treatment draw upon traditional folk-models of illness" [12]. Although apparent correlation was observed between some taxonomies of diseases and remedy preferences, such correlation was not applicable to all taxonomies. The cultural per‐ ceptions of a disease were still a more decisive factor in influencing the treatment choices of the participants. On the other hand, another point to be noted is the common belief among the participants that they could still practice alternative medicine, in particular *qigong*, in al‐ most all kinds of health problems, since it could strengthen their health and alleviate the suf‐ fering without conflicting with other remedies and exerting any harm to the body.

## **4.** *Qigong* **practice and the Chinese philosophical teaching**

As alternative medicine practice is embedded in a community's cultural belief system, there‐ fore, the cultural values and ideal will be transmitted and reinforced through people's prac‐ tice. Alternative medicine practice also conveys other symbolic meanings as discussed by Lupton (2000), particularly the aspects of virtue and goodness within the Chinese culture.

proved by emotional control, but the Chinese teachings of the ideal emotional expression –

The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among...

http://dx.doi.org/10.5772/53281

43

The *qigong* practice, in addition, tries to reaffirm the importance of morality. As some mas‐ ters indicated during lectures, since the practice requires appropriate control of emotional expression, there is a close relationship between the practice and the enhancement of morali‐

Morality in contemporary society is a result of the control of laws, which aim at controlling one's behavior. It is very

similar to *qigong*, since it emphasizes that a follower has to control himself or herself in a highly relaxed and tranquil

Some traditions of *qigong* also reaffirm the Chinese perception of the world and the cosmic order. The "five elements" (五行) – gold (金), wood (木), water (水), fire (火), and earth (土) – are the keys to achieving order and disorder. "Five element" should be in an appropriate order; otherwise, bad consequences can occur. Some traditions of *qigong* claim they can re‐ store the order of the "five elements" within the human body in order to achieve health. The

The practice of *qigong*, therefore, reaffirms the traditional Chinese moral teachings, the idea of cosmic order, and worldview. However, as the contemporary practice in Hong Kong focuses on its pragmatic usage to treat diseases and maintain health, its close relationship with the Chi‐ nese philosophical ideas is not emphasized. Anyway, the folk taxonomies of diseases among the participants are discussed, and the interrelationship between the folk taxonomies of diseas‐ es and the treatment options in Hong Kong context are examined in this chapter. All these have to do with the cultural belief system of a community, and the cultural backgrounds, traditions, and the personal experiences of people. The cultural understanding of diseases can thus pro‐

As demonstrated in this chapter, a community's social and cultural belief system is remarka‐ ble in influencing people's understandings on diseases. This affects how they perceive and classify diseases, which can be reflected from the folk taxonomy of diseases. As folk taxono‐ my is a classification system embedded in a community's social and cultural beliefs, there‐ fore each society has its own folk taxonomy of diseases. People's cultural perceptions on diseases can also influence how they choose remedy, whether biomedicine and/or alterna‐ tive medicine should be adopted. Alternative medicine is mostly embedded in the cultural beliefs of a community, hence it is mostly used on those diseases which can fit with their cultural understandings. Also, biomedicine has its own weaknesses and limitations, there‐ fore, alternative medicine is often used on those diseases which cannot be handled by bio‐

imbalance of the "five elements" within the human body can lead to diseases.

vide another perspective on understanding alternative medicine practice.

neutral expression of emotion – can also be reaffirmed.

ty. One *qigong* master indicated in his lecture:

state, so as to reach the "highest" [trance] state of the practice.

**5. Conclusion**

Other than traditional Chinese medicine, *qigong* is another popular alternative medicine in Hong Kong. The operating logic of *qigong* reaffirms Chinese philosophical ideas and teach‐ ings. As its followers are more concerned with the pragmatic and therapeutic value of *qi‐ gong*, its connections with Chinese philosophical teachings are under-emphasized in contemporary practice. Although these philosophical ideas and teachings are not the focus of the practice, they still feature in the lectures in some traditions of *qigong* practice. These lectures are closely tied to the Chinese cultural medical belief system, as well as the Chinese cultural beliefs and values.

In the lectures of a *qigong* class during fieldwork, the master often emphasized the importance of reaching a highly relaxed and tranquil state in order to achieve the "highest" state of the practice, ie. trance. In order to reach such a state, the followers ought to control their emotions and feelings by forgetting all happiness and unhappiness, and their social roles in the real world. They ought to imagine that they are relaxing in a quiet and beautiful environment.

The importance of reaching a highly tranquil state recalls the importance of the ancient Chi‐ nese teaching about controlling the "seven emotions" (七情) properly, linking this with health. The ancient Chinese teachings, particularly the Confucian ideas, emphasize that one should not expose one's emotions in a vigorous manner. The "seven emotions" include: happiness (喜), anger (怒), worry (憂), puzzle (思), sadness (愁), fright (驚), and fear (恐). If one expresses these emotions in a vigorous manner, one will fall short of the model of an ideal human. In the practice of *qigong*, it is believed that failure to control emotions or to ex‐ press them in an inappropriate manner can be harmful to one's health. As one female in‐ formant who has recovered from cancer stated:

In the past, I often felt unhappy and got angry easily. I was often annoyed with the staff. As I could not scold them, so I lost my temper to my family instead… Perhaps I expected too much on the job, so it exerted a lot of pressure on myself… I think these negative emotions accumulated to cause the disease. If I had known how to control my emo‐ tions and express them properly in the past, I would not need to suffer [from cancer]. The practice [of *qigong*] can let me learn how to control my emotions and attain calmness. I feel like I am having a rebirth in personality now.

Hence, not only does *qigong* practice affirm Chinese ideas of morality, virtue and goodness, but it also provides a sense of renewal for some participants. Such sense of renewal not only confines to the restoration of health, but which also includes a renewal in the psychological state of some participants.

Some *qigong* masters, thus, insisted that controlling emotions is the key in maintaining health, since a follower has to control emotion and keep calm so that he or she can achieve the "trance" state. Through the practice of *qigong*, not only can health be maintained or im‐ proved by emotional control, but the Chinese teachings of the ideal emotional expression – neutral expression of emotion – can also be reaffirmed.

The *qigong* practice, in addition, tries to reaffirm the importance of morality. As some mas‐ ters indicated during lectures, since the practice requires appropriate control of emotional expression, there is a close relationship between the practice and the enhancement of morali‐ ty. One *qigong* master indicated in his lecture:

Morality in contemporary society is a result of the control of laws, which aim at controlling one's behavior. It is very

similar to *qigong*, since it emphasizes that a follower has to control himself or herself in a highly relaxed and tranquil

state, so as to reach the "highest" [trance] state of the practice.

Some traditions of *qigong* also reaffirm the Chinese perception of the world and the cosmic order. The "five elements" (五行) – gold (金), wood (木), water (水), fire (火), and earth (土) – are the keys to achieving order and disorder. "Five element" should be in an appropriate order; otherwise, bad consequences can occur. Some traditions of *qigong* claim they can re‐ store the order of the "five elements" within the human body in order to achieve health. The imbalance of the "five elements" within the human body can lead to diseases.

The practice of *qigong*, therefore, reaffirms the traditional Chinese moral teachings, the idea of cosmic order, and worldview. However, as the contemporary practice in Hong Kong focuses on its pragmatic usage to treat diseases and maintain health, its close relationship with the Chi‐ nese philosophical ideas is not emphasized. Anyway, the folk taxonomies of diseases among the participants are discussed, and the interrelationship between the folk taxonomies of diseas‐ es and the treatment options in Hong Kong context are examined in this chapter. All these have to do with the cultural belief system of a community, and the cultural backgrounds, traditions, and the personal experiences of people. The cultural understanding of diseases can thus pro‐ vide another perspective on understanding alternative medicine practice.

## **5. Conclusion**

tice. Alternative medicine practice also conveys other symbolic meanings as discussed by Lupton (2000), particularly the aspects of virtue and goodness within the Chinese culture.

Other than traditional Chinese medicine, *qigong* is another popular alternative medicine in Hong Kong. The operating logic of *qigong* reaffirms Chinese philosophical ideas and teach‐ ings. As its followers are more concerned with the pragmatic and therapeutic value of *qi‐ gong*, its connections with Chinese philosophical teachings are under-emphasized in contemporary practice. Although these philosophical ideas and teachings are not the focus of the practice, they still feature in the lectures in some traditions of *qigong* practice. These lectures are closely tied to the Chinese cultural medical belief system, as well as the Chinese

In the lectures of a *qigong* class during fieldwork, the master often emphasized the importance of reaching a highly relaxed and tranquil state in order to achieve the "highest" state of the practice, ie. trance. In order to reach such a state, the followers ought to control their emotions and feelings by forgetting all happiness and unhappiness, and their social roles in the real world. They ought to imagine that they are relaxing in a quiet and beautiful environment.

The importance of reaching a highly tranquil state recalls the importance of the ancient Chi‐ nese teaching about controlling the "seven emotions" (七情) properly, linking this with health. The ancient Chinese teachings, particularly the Confucian ideas, emphasize that one should not expose one's emotions in a vigorous manner. The "seven emotions" include: happiness (喜), anger (怒), worry (憂), puzzle (思), sadness (愁), fright (驚), and fear (恐). If one expresses these emotions in a vigorous manner, one will fall short of the model of an ideal human. In the practice of *qigong*, it is believed that failure to control emotions or to ex‐ press them in an inappropriate manner can be harmful to one's health. As one female in‐

In the past, I often felt unhappy and got angry easily. I was often annoyed with the staff. As I could not scold them, so

I lost my temper to my family instead… Perhaps I expected too much on the job, so it exerted a lot of pressure on

myself… I think these negative emotions accumulated to cause the disease. If I had known how to control my emo‐

tions and express them properly in the past, I would not need to suffer [from cancer]. The practice [of *qigong*] can let

Hence, not only does *qigong* practice affirm Chinese ideas of morality, virtue and goodness, but it also provides a sense of renewal for some participants. Such sense of renewal not only confines to the restoration of health, but which also includes a renewal in the psychological

Some *qigong* masters, thus, insisted that controlling emotions is the key in maintaining health, since a follower has to control emotion and keep calm so that he or she can achieve the "trance" state. Through the practice of *qigong*, not only can health be maintained or im‐

me learn how to control my emotions and attain calmness. I feel like I am having a rebirth in personality now.

cultural beliefs and values.

42 Alternative Medicine

state of some participants.

formant who has recovered from cancer stated:

As demonstrated in this chapter, a community's social and cultural belief system is remarka‐ ble in influencing people's understandings on diseases. This affects how they perceive and classify diseases, which can be reflected from the folk taxonomy of diseases. As folk taxono‐ my is a classification system embedded in a community's social and cultural beliefs, there‐ fore each society has its own folk taxonomy of diseases. People's cultural perceptions on diseases can also influence how they choose remedy, whether biomedicine and/or alterna‐ tive medicine should be adopted. Alternative medicine is mostly embedded in the cultural beliefs of a community, hence it is mostly used on those diseases which can fit with their cultural understandings. Also, biomedicine has its own weaknesses and limitations, there‐ fore, alternative medicine is often used on those diseases which cannot be handled by bio‐ medicine. This chapter demonstrates how people's cultural understandings on diseases can influence treatment approaches, and thus the practice of alternative medicine in Hong Kong.

[4] Hong Kong Tai Chi Association.《太極拳功三百問》Tai Chi Quan Gong Shan Bai Wen. [Three Hundred Questions in Tai Chi Quan]. Hong Kong: Hong Kong Tai Chi

The Cultural Perceptions, Folk Taxonomies and the Relationship with Alternative Medicine Practices Among...

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45

[5] Dong P., Aristide H.E. Chi Gong: The Ancient Chinese Way to Health. New York:

[6] Miura K. The Revival of Qi: Qigong in Contemporary China. In: Kohn L., Sakade Y. (eds.). Taoist Meditation and Longevity Techniques. Ann Arbor: Center for Chinese

[7] Palmer D.A. Modernity and Millenialism in China: Qigong and the Birth of Falun

[8] Cheng T.H., Tsui W.K, editors.《鄭天熊太極武功》。Zheng Tian Xiong Tai Chi Wu Gong Lu. [Cheng Tin-hung's style in tai chi and martial arts]. Hong Kong: Hong

[9] Bernard H.R. Research Methods in Anthropology: Qualitative and Quantitative Ap‐

[10] Kleinman A. The Illness Narratives: Suffering, Healing, and the Human Condition.

[11] The Medical Council of Hong Kong. List of Registered Doctors: Specialist Registra‐ tion. http://www.mchk.org.hk/doctor/spec/index.htm. (accessed on 6 July 2012).

[12] Lupton D. Medicine as Culture: Illness, Disease and the Body in Western Societies.

Association; 2001.

Marlowe and Company; 1990.

Kong Tai Chi Association; 1996.

London: Sage Publications Ltd; 2000.

NY: Basic Books; 1988.

Studies, University of Michigan; 1989. p. 331 – 358.

proaches, 3rd ed. Walnut Creek, CA: AltaMira Press; 2002.

Gong. Asian Anthropology 2003; 2(3): 79 – 109.

Although cultural belief system can influence how people perceive and classify diseases and thus the disease folk taxonomy as well as their treatment choices, the interrelationship be‐ tween folk taxonomy of diseases and treatment choices is not always absolute. As demon‐ strated by the participants, only some taxonomies of diseases, such as those that are lifethreatening, serious, ophthalmological, and chronic bone and joint diseases show apparent relationship in the treatment choices. Treatment choices, however, are still more embedded in people's cultural perceptions on individual diseases.

The use of alternative medicine was widely welcome by the participants, since they would attempt alternative medicine (traditional Chinese medicine and/or *qigong/ tai chi*) for most common diseases. The key message is although alternative medicine may not treat all dis‐ eases efficaciously, still it is effective in maintaining and enhancing health, which is required for all kinds of diseases. From the participants' point of view, qigong and tai chi practice can be used on most diseases, since the balance of qi inside human body will be important for maintaining health and helping to fight against diseases. It is particularly common in the use of health restoration after biomedicine treatment.

## **Author details**

Judy Yuen-man Siu

Address all correspondence to: judysiu@hkbu.edu.hk

David C. Lam Institute for East-West Studies, Hong Kong Baptist University, Hong Kong, China

## **References**


[4] Hong Kong Tai Chi Association.《太極拳功三百問》Tai Chi Quan Gong Shan Bai Wen. [Three Hundred Questions in Tai Chi Quan]. Hong Kong: Hong Kong Tai Chi Association; 2001.

medicine. This chapter demonstrates how people's cultural understandings on diseases can influence treatment approaches, and thus the practice of alternative medicine in Hong Kong.

Although cultural belief system can influence how people perceive and classify diseases and thus the disease folk taxonomy as well as their treatment choices, the interrelationship be‐ tween folk taxonomy of diseases and treatment choices is not always absolute. As demon‐ strated by the participants, only some taxonomies of diseases, such as those that are lifethreatening, serious, ophthalmological, and chronic bone and joint diseases show apparent relationship in the treatment choices. Treatment choices, however, are still more embedded

The use of alternative medicine was widely welcome by the participants, since they would attempt alternative medicine (traditional Chinese medicine and/or *qigong/ tai chi*) for most common diseases. The key message is although alternative medicine may not treat all dis‐ eases efficaciously, still it is effective in maintaining and enhancing health, which is required for all kinds of diseases. From the participants' point of view, qigong and tai chi practice can be used on most diseases, since the balance of qi inside human body will be important for maintaining health and helping to fight against diseases. It is particularly common in the

David C. Lam Institute for East-West Studies, Hong Kong Baptist University, Hong Kong,

[1] Bonvillain N. Language, Culture and Communication: The Meaning of Messages. NJ:

[2] Kleinman A. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley, CA: Univer‐

[3] Siu J.Y.M. The Use of Qigong and Tai Chi as Complementary and Alternative Medi‐ cine (CAM) among Chronically Ill Patients in Hong Kong. In: Bhattacharya A. (ed). A Compendium of Essays on Alternative Therapy. Rijeka: InTech; 2012. p.175-192.

in people's cultural perceptions on individual diseases.

use of health restoration after biomedicine treatment.

Address all correspondence to: judysiu@hkbu.edu.hk

Prentice-Hall Inc; 2000.

sity of California Press; 1980.

**Author details**

44 Alternative Medicine

Judy Yuen-man Siu

China

**References**


**Section 2**

**Compositional Analysis**
