Since the 1980s and 1990s, medical history of disease research in China has been multiplying. Scholars examined epidemics and countermeasures throughout Chinese history and reflected on the ways historical experience could help inform the construction of modern epidemic prevention and control systems in response to major public health emergencies. 

Ancient experience

Historically, measures taken against epidemic diseases generally fell into two categories: immediate countermeasures after the occurrence of an epidemic and routine preventive measures or health practices. Speaking about the response from a national point of view, the measures taken by the imperial court and local governments in ancient China mainly included establishing hospitals for doctors to diagnose and treat the patients, preparing and dispensing ready-made medicine, performing Taoist sacrificial ceremonies to pray for blessings and remove ill fortune, publishing and dispensing prescriptions, burying the corpses, providing shelters to accommodate and quarantine patients, as well as patient isolation in local areas.

For society and individuals, direct countermeasures mainly included supplying medicine, printing and distributing prescriptions, requesting government assistance in treatment, and establishing ad hoc clinics to take in patients. Also, people living through times of outbreak opted to stay at home, avoid epidemic-stricken areas, or dispel pestilential qi by burning incense or herbs like cangzhu (rhizoma atractylodis) and baizhi (radix angelicae dahuricae).

As for preventative measures, the most prominent was the inoculation of rendou (literally, human pox) that emerged after the mid-Ming Dynasty (1368–1644). The principle of the inoculation was to make a healthy person immune to smallpox by exposing them to the virus from an infected person.

In addition, customs and habits conducive to health were widely promoted, such as maintaining personal hygiene by keeping a clean environment and frequent bathing, repelling mosquitoes and flies, adopting a sober lifestyle to ensure plentiful vital qi, and drinking boiled water and eating scallions and garlic to avoid pestilential qi.

There is no doubt that China has made progress in tackling epidemics throughout history. It is also true that Chinese medicine has made great achievements in the treatment of epidemic diseases such as typhoid fever and febrile diseases. However, the above measures and experiences were by no means common practice in each dynasty, and represent a small selection curated from numerous historical records in China’s long history.

Moreover, when placed in historical context, it is easy to see that in the face of epidemic outbreaks, society was in panic and populations often plummeted. Composed reactions or effective and systematic disease prevention and control were not the norm.

In particular, there were no institutional provisions on epidemic prevention and control in ancient China. Famine relief was always taken seriously in China, and specific and systematic regulations were set up for relief from natural disasters including floods, droughts, locust infestations, and for preparation in anticipation of natural disasters, particularly in the Ming and Qing dynasties, by which time national famine relief mechanisms were quite mature.

However, though an epidemic can be considered a disaster, its prevention and treatment are obviously different from general disaster relief. Ordinary disaster relief efforts such as giving money and food, exempting citizens from taxation, and providing porridge are not applicable.

In government organizations, only the Imperial Health Institute, which mainly served the royal court, was somewhat involved in epidemic response. Charitable drug stores were also set up all over the country in the Song and Yuan dynasties to help the poor and the sick. However, there were no institutional provisions on epidemic prevention and treatment in ancient China. Moreover, the Song and Yuan dynasties’ relatively proactive policy on disease treatment was not sustained in the Ming and Qing dynasties when the population was larger and saw more frequent pestilences.

During the Ming and Qing dynasties, social forces played a relatively positive role. It was government policy to draw support from emerging social forces, particularly village gentries. The government encouraged these social groups to make use of local medical resources and charitable organizations to perform temporary rescue activities and set up facilities like medical bureaus. They hoped that these facilities would develop into places where epidemic diseases could be routinely diagnosed and treated, changing the function of purely charitable organizations.

Lack of systematic countermeasures

In summary, traditional disease control in China has three main characteristics. First, the state has always paid attention to epidemics and their treatment, but hasn’t put a complete system of institutional provisions in place. This is distinct from systematic responses to other disasters, and left disease treatment to be largely performed voluntarily by society.

Second, Chinese society has accumulated rich and commendable experiences in treating epidemics throughout a long history, but these experiences are mostly scattered, perceptual and fragmented, without systematic review and summary, and thus failed to lead to comprehensive knowledge about epidemic treatment.

Finally, the key to disease prevention and control is quarantine. However, there were many records of people escaping from isolation and quarantine. In fact, the practice of quarantine was not encouraged or supported by mainstream society or popular ideology, resulting in its failure to develop in theory or practice.

Limitations of anti-epidemic efforts

Technically speaking, under the social and medical conditions of ancient China, it was extremely difficult for the state to fully assume the complex responsibility of disease prevention and control. For one, medical facilities run by the government were limited in efficiency and capability and could not meet the demand of epidemic treatment of the general public. Also, epidemic treatment was technically more complex than relief for hunger and cold, due to complexities including the ever-changing nature of epidemic situations and inter-patient variability, regional imbalances in ancient medical resources, and difficulties in cross-regional deployment.

In addition, ancient China’s scientific and technical levels were poor. There was still no scientific explanation for the cause, prevalence, and prevention of epidemic diseases. Traditional Chinese Medicine (TCM) treatment focuses on different syndrome types between yin and yang, cold and heat, deficiency and excess, and exterior-interior differences. If the doctors cannot apply the correct medicine to symptoms, treatment may be counterproductive. Therefore, even if the government had the resources and ability, they may not be able to achieve the desired effect.

Moreover, as a special disaster, epidemics would affect people’s livelihoods, but unlike flood, drought, locust swarms and other natural disasters, epidemics did not tend to directly lead to a mass uprising, threatening the imperial rule.

Besides, no scientific or effective methods and measures for pathogen analysis and control had been established at that time. The mortality and infectiousness of epidemics varied greatly, so did the susceptibility of individuals. Therefore, it is debatable, whether it was reasonable to simply isolate or ignore the epidemic cases out of fear, as the human ethics related to providing necessary treatment to patients were complicated by a lack of medical knowledge and infrastructure.

Also, some of the quarantine or isolation of infected areas may not be effective and might even cause the spread of the disease, if not carried out properly. In this regard, it is understandable to criticize the anti-ethical behavior of abandoning relatives, given that traditional Chinese society heavily emphasized ethics and morality, but this is not conducive to helping people better understand the infectiousness and countermeasures of epidemics.

Conclusion

The COVID-19 outbreak not only brings a lot of harm to human life and health, but also warns us of the existing problems in human society. Both history and present day have proven that epidemics are not only natural disasters, but also man-made calamities. To avoid repeating the mistakes of the past, we must reflect on historical experiences critically.

By reviewing and reflecting on the characteristics and logic of epidemic responses in Chinese history, we may be glad that we live in good times, but it is not difficult to notice the inadequacy of China’s current epidemic prevention and control. There is no doubt that in terms of technology, institutional construction and resource allocation capacity, there are fundamental changes compared with the past. More importantly, the idea that “people’s safety and health always come first” has become the core governance philosophy.

However, the inherent logic of history has a strong inertia. If we don’t carefully reflect on the traditional methods of epidemic prevention and control and interpret its underlying respect for the individual life and the value and rights of health, the past will be the past and its warning may be in vain.

Yu Xinzhong is a professor from the Faculty of History at Nankai University.