







































 Humanities and Social Science Research; Vol. 8, No. 5; 2025 

ISSN 2576-3024   E-ISSN 2576-3032 

https://doi.org/10.30560/hssr.v8n5p9 

 9 Published by IDEAS SPREAD 

 

On the Margins of TCM and Modern Medicine: Ethnomedical Healers 

Seeking Official Qualification Certification 

 Mingzhe Li1 

1 Shanghai World Foreign Language Academy, China 

Correspondence: Mingzhe Li, Shanghai World Foreign Language Academy, Shanghai 200233, China. 

 

Received: August 4, 2025; Accepted: September 7, 2025; Published: September 8, 2025 

 

Abstract 

This study focuses on ethnomedical healers in Lijiang, Yunnan Province, China, and adopts the perspective of 

medical anthropology to examine, through field work, in-depth interview, and case study, institutional 

shortcomings and individual predicaments ethnomedical healers face in seeking the legal status for medical 

practice under the modern medicine and the “Traditional Chinese Medicine (TCM) Specialist” systems. The 

current assessment system and ethnomedical practice are not aligned in terms of theoretical frameworks, diagnostic 

and treatment methods, and linguistic logic.  Particularly, the systematic discrepancy between the knowledge 

system required by standardized examinations and ethnomedical healers’ experiential knowledge system has 

resulted in a large number of “skilled but uncertified” ethnomedical healers struggling to gain official recognition. 

This study aims to explore the possibility of institutional reform and the coexistence of diverse medical systems 

by probing into the institutional challenges facing ethnomedicine from the perspective of modern medicine.  

Keywords: Medical Anthropology, Lijiang of Yunnan, Ethnomedical Healers 

1. Introduction 

Ethnomedical healers represent a branch of TCM in the broad sense. They typically practice in ethnic communities, 

with medical knowledge inherited through family lineages, especially the knowledge of local herbal medicine, and 

provide healthcare services to local communities. Well-established systems of ethnomedicine in China include 

Tibetan, Mongolian, Uyghur, and Dai medicine, among others. In the multi-ethnic communities of Lijiang, Yunnan 

Province, in southwestern China, there exists a group of ethnomedical healers—primarily from the Naxi, Bai, and 

Lisu ethnic groups—who persistently “seek official medical qualification certification.” Despite their knowledge 

of herbal medicine, current medical qualification certification policies increasingly label them as “illegal 

practitioners.” Today, these grassroots healers, who have family-inherited knowledge or specialize in specific 

herbal therapies, if they cannot obtain a medical qualification certificate, will face the risk of having their 

ethnomedical knowledge and methods being lost.  

The field work was conducted in Lijiang City and and its surrounding counties. This study uses anthropological 

methods, including participant observation, in-depth interviews and case study, based on visits in July 2024 and 

2025. It focuses on ethnomedical healers in Lijiang, examining the limitations and marginalisation they face under 

the current TCM Specialist assessment system. 

2. Ethnomedical Healers Seeking Official Qualification Certification 

Most ethnomedical healers in Lijiang possess herbal medicine knowledge passed down through generations. 

However, amid China’s efforts to modernize, standardize, and provide universal access to healthcare services, 

their lack of formal training in modern medical knowledge has placed them in a dual marginalization: they are 

neither incorporated into the modern medical system nor able to practice freely as folk healers. Currently, there 

are four types of medical practitioner qualification certificate in China. 

2.1 The Doctor’s Certificate  

In China, the doctor’s qualification examinations are organized by provincial health administration departments 

and consist of two categories: the Physician Qualification Exam and the Assistant Physician Qualification Exam. 

The doctors' qualification exam applicants must hold either a bachelor's degree or higher in medicine, or an 

associate degree plus assistant doctor's certificate, plus at least two years' experience in a medical institution. The 

exam content is primarily based on modern medical science, encompassing disciplines such as anatomy, 

physiology, pharmacology, pathology, and infectious diseases.[1] 



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2.2 The Rural Doctor’s Certificate 

The Rural Doctor’s Certificate originated from China’s modern-era “barefoot doctor” system.[2] Those holders are 

typically without formal modern medical training, retain an agricultural hukou status, and work part-time in both 

farming and medical care. This credential was established to safeguard grassroots rural healthcare services. 

Eligibility for this certificate is relatively straightforward: candidates must be graduates of a secondary medical 

school. Upon completion of a short-term training program and passing a computer-based examination, they qualify 

for legal medical practice. However, the scope of practice is strictly limited by this certificate. Holders are 

permitted to practice only within single subdistrict-level clinics supervised by the local health commission. 

Practicing beyond the authorized geographical area is deemed illegal.[3] 

2.3 The TCM Apprentice’s and Specialist’s Certificate 

To address the challenges facing practitioners of traditional and ethnic medicine who were unable to obtain legal 

certification and practice legally due to academic qualification restrictions, China introduced the Qualification 

Assessment for TCM Apprentices and Specialists in 2007. This assessment system provided a pathway to legal 

medical practice for traditional healers with skills acquired through family or mentorship training. It targeted 

traditional medicine (including ethnomedicine) practitioners with years of mentorship or practice. Candidates must 

have at least five years of relevant clinical experience and be recommended by at least two licensed TCM doctors. 

The assessment included a written test and a practical evaluation, comprising oral exams, case presentations, 

clinical demonstrations, and panel review. Holders of this certificate, after working on probation as a licensed 

assistant doctor, may apply to take the national doctor’s qualification examination. However, the long assessment 

times and complex application procedures deterred many ethnomedical healers with limited education. The 

difficulties will be detailed below. [4] 

2.4 The TCM Specialist’s Certificate 

In 2017, based on the Law of the People’s Republic of China on Traditional Chinese Medicine, the Interim 

Administrative Measures for the Qualification Assessment and Registration of TCM Specialists were promulgated 

and put into practice, formally recognizing the legal status of medical qualifications obtained through mentorship, 

practice, and assessment. This new assessment system cut short the lengthy process of obtaining a doctor’s 

qualification certificate for holders of the TCM Specialist’s Certificate, but the eligibility criteria and assessment 

procedures remain largely the same.[5] 

3. Crossing the Threshold to an Elusive Legal License 

While multiple pathways exist for obtaining legal practice qualifications, most ethnomedical healers face 

significant challenges in securing official credentials. According to data from the Lijiang Ethnomedicine 

Association in 2025, it had fewer than 400 members, of whom only 70-80 held Rural Doctor’s Certificate, even 

fewer, just 29, hold the TCM Specialist’s Certificate, and most of these certified practitioners are around 60 years 

old. Of these, only two are women, and less than one-third are from minorities, including two Yi, two Naxi (one 

of whom is Mosuo), two Lisu, and two Tibetan practitioners.[6] 

3.1 The TCM Specialist Evaluation Dilemma  

From an institutional perspective, the TCM Specialist’s Certificate indeed provides folk healers a standardized, 

expedited route to legal practice. However, field research reveals significant bottlenecks in the implementation of 

this assessment system, including stringent execution, limited quotas, and low pass rates. According to 2023 data 

from Yunnan Province, of the more than 3,000 folk medicine practitioners who applied for the TCM Specialist’s 

Certificate, only about 60 succeeded, with a pass rate of less than 2%, and Lijiang was given only three exam slots, 

highlighting the extreme scarcity of resources. 

Through follow-up visits and in-depth interviews, the following difficulties were identified: 

3.1.1 The Disparity in Knowledge Systems Between Academy-Trained Examiners and Practice-Oriented 

Candidates 

Why it is so difficult for ethnomedical healers to pass the TCM Specialist’s Certificate assessment is mainly 

because of the structural disconnection between the assessment system and the ethnomedical knowledge system. 

The current assessment is largely based on the theoretical framework of modern medical science and traditional 

TCM knowledge, while most ethnomedical healers rely on experiential knowledge passed down orally. As a result, 

many ethnomedical healers struggle to respond to the examiners’ theoretical questions and find it challenging to 

demonstrate their practical medical skills in the exam setting. Specifically, exam content such as the recitation of 

the “Twelve Meridians” and “sterile operation” requirements in modern medicine is disconnected from 



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ethnomedical practice. In addition, the expert panel, whose members are mostly from TCM colleges and 

universities, bases their evaluation system on academic theories and often demands that candidates explain 

ethnomedical practice using standardized terminology. This double standard consequently excludes many 

ethnomedical healers with rich clinical experience, as they struggle to translate their practical knowledge into the 

theoretical discourse required for certification.  

3.1.2 The Institutional Barrier Caused by Complex and Contradictory Eligibility Criteria 

The series of “high barriers” set by the eligibility mechanism for the TCM Specialist’s Certificate examination is 

another significant institutional obstacle for ethnomedical healers to obtain certification. There are two prominent 

structural contradictions with this system: first, applicants are required to provide treatment cases from five years 

of unlicensed practice, effectively forcing ethnomedical healers into a dilemma between “illegal practice” and 

“obtaining qualifications”; second, applicants are required to provide two recommendation letters, which poses 

significant practical difficulties in ethnic minority areas. Each licensed TCM doctor with at least 15 years of 

medical practice is permitted to recommend only two candidates per year. However, eligible recommenders are 

already scarce in these areas. This structural constraint has directly resulted in only around 1,000 out of tens of 

thousands of ethnomedical healers in Yunnan Province completing registration. Areas such as Lijiang face a severe 

shortage of available slots. 

3.1.3 The Language Barrier in a Modernized Assessment Setting  

The language barrier has become a systemic barrier for ethnomedical healers in the assessment process, 

representing a major challenge commonly faced by candidates from ethnic minority areas. The exclusive use of 

Standard Chinese, or Putonghua, throughout the examination and evaluation process creates a dual disadvantage 

for practitioners from Naxi, Yi, and other ethnic minorities, who speak dialects as their mother tongue, particularly 

as most of these candidates are elderly. First, the language barrier distorts the accurate representation of medical 

knowledge. Pronunciation issues and limited Putonghua proficiency directly impact scoring outcomes, leading to 

point deductions or even disqualification for many candidates despite their demonstrated clinical competence. In 

response to this challenge, President Liu[7] of the Lijiang Ethnomedicine Association once proposed a policy to 

provide translators for examiners, which was ultimately rejected by authorities. Second, a fundamental disconnect 

exists between the narrative logic inherent to ethnomedical knowledge and the standardized, theory-driven 

discourse expected by academically trained examiners. While ethnomedical healers typically articulate medical 

reasoning based on their understanding and experience, examiners often prefer the standardized, logical discourse 

system. This epistemological divide frequently results in the mischaracterization of nuanced practical expertise as 

“unsubstantiated conjecture.”  

3.2 The Significance of Legal Practice Status for Ethnomedical Healers 

The health authorities in Lijiang have indeed recognized the practical challenges facing ethnomedical healers in 

balancing the needs of knowledge transmission and legitimate practice. As a result, they have refrained from 

strictly enforcing penalties against these practitioners for “illegal” practice. Nevertheless, for ethnomedical healers, 

obtaining official certification remains critically important for passing down medical traditions and for its practical 

utility in allowing them to practice legally.  

First, from a legal perspective, possession of a medical certificate serves as the definitive criterion distinguishing 

“legitimate” from “illegal” medical practice. In most parts of China, practicing medicine without certification 

entails criminal liability and administrative penalties, including a minimum fine of 50,000 yuan. However, the 

situation in Lijiang presents a notable exception. Through active coordination by the Lijiang Ethnomedicine 

Association, local authorities have adopted a relatively tolerant stance toward folk medicine practitioners operating 

within the jurisdiction of “One District and Four Counties.” It is important to note, however, that this policy is 

limited only to Lijiang; if they practice medicine outside the designated areas—in Sichuan or Guizhou, for 

example—they will be held accountable for breaking the law. As President Liu said, “If we follow the Law on 

Licensed Doctors, it is illegal for them to practice medicine. But the Law on Traditional Chinese Medicine 

stipulates that ‘five years of clinical experience’ is a prerequisite for certification, then there is a question mark to 

the legality of their practice.”[8] The ambiguity of the current certification system places ethnomedical healers in a 

legal gray area. 

Second, the doctor’s qualification certification directly correlates with income growth. Holders of the doctor’s 

qualification certificate are authorized to extend their practice beyond village-level settings to county- and city-

wide jurisdictions. More importantly, inclusion in the national medical insurance reimbursement system enables 

them to charge higher consultation fees. Furthermore, they are eligible to open private clinics and apply for 



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professional titles. For the younger generation of ethnomedical healers, having a certificate not only means legal 

protection but also serves as a “passport” into modern healthcare markets.  

Last but not least, official certification carries significant social recognition value. Most ethnomedical healers do 

not rely on medical practice as their main source of income, typically sustaining themselves through agriculture 

or other forms of labor. Their healing practice is more driven by a sense of medical ethics, social responsibility, 

and deep-rooted community ties. Although grassroots reputational recognition already constitutes a form of social 

recognition, state-issued medical certification represents formal acceptance by the mainstream healthcare system 

and official authority. 

Consequently, despite persistent structural inequalities in examination design, most ethnomedical healers are still 

willing to invest substantial time and effort in pursuing certification.  

3.3 “Herbalists” with Prescriptions but No Qualifications 

3.3.1 Ethnomedical Healers who Possess Herbal Medicine Knowledge but are Unable to Apply it  

The field research reveals a significant number of folk medicine practitioners in the Lijiang area who possess 

traditional medical practice backgrounds and specialize in herbal treatments. However, these practitioners, armed 

with extensive herbal medicine knowledge, generally find it challenging to realize their value due to the lack of a 

certificate. In in-depth interviews, most of them felt they had “specialized skills” but were restricted from 

exercising them by the lack of a medical certificate. This study presents the predicament of unlicensed herbalists 

in the Lijiang area through in-depth interviews with folk medicine practitioners of different ages, genders, and 

ethnic backgrounds, as well as those who have and have not obtained the TCM Specialist’s Certificate, and 

members of the Lijiang Ethnomedicine Association. It combines data statistics and case analysis to offer a multi-

perspective view. 

The table below presents a statistical overview of some of the ethnomedical healers interviewed during the field 

survey: 

 

Table 1. Overview of Ethnomedical Healers in Lijiang (Partial)[9] 

Pseudonym 
Ethnic 

Group 

Years of 

Practice 

Rural Doctor’ 

Certificate 

(Yes/No) 

TCM Specialist 

Certificate 

(Yes/No) 

Reasons for Not Obtaining Certification  

Doctor He  Tibetan     No Yes / 

Doctor 

Zhuoma  
Tibetan    27 No Yes / 

Doctor Zhou Naxi  No Yes / 

Doctor Mu  Naxi 37 No No Lack of training, health issues 

Doctor He  Naxi 17 Yes No Inadequate modern medical theory 

Doctor 

Wang  
Bai 26 No No Use of toxic herbs in prescriptions 

Doctor Zhao  Bai  21 Yes No 

Inadequate theoretical knowledge in 

modern medical science, strong accent 

in speaking Putonghua 

 

3.3.2 Doctor Wang, a Herbalist who can’t Treat Illnesses Without Toxic Herbs 

“There’s no way around it. I can’t control it. Without toxic herbs, I wouldn’t know how to treat illnesses!”  

Doctor Wang, a well-known inheritor of ethnomedicine in Diantou Village, Jiuhe Bai Autonomous Township, 

Lijiang, comes from a family of herbalists. He began learning traditional medical skills at the age of 19 and started 

practicing medicine at 29. With 26 years of clinical experience, he is proficient in identifying and using over a 

thousand types of Chinese herbal medicines and is respectfully referred to as the “King of Herbal Medicine” in 

the Lijiang area. His family-passed-down prescriptions cover a variety of therapies, including oral intake, topical 

application, acupuncture, and cupping, which can effectively treat a wide range of diseases, especially excelling 

in treating external injuries, bone injuries, and chronic illnesses. His distinctive therapeutic methods enjoy 

widespread local recognition. It is said that a patient with a severed thumb, after receiving topical treatment with 

his secret herbal formulation, regenerated new tissue and skin within days. This stands in stark contrast to modern 

medicine’s complicated process involving registration, suturing, the use of antibiotics, and long-term recovery. 



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Doctor Wang once held a “Specialized Skill” certificate and practiced legally during a three-year policy period in 

Yunnan, accumulating rich clinical experience and a “high reputation” among his fellow countrypeople. However, 

after the “Specialized Skill” Certificate expired, he failed to obtain the TCM Specialist’s Certificate despite taking 

the exam twice. Wang’s failure is closely related to his use of toxic herbs in his secret formula.  

In the first assessment, he mentioned in both his application case and the interview that he often included toxic 

herbs in his prescriptions for patients, especially Aconite and Kusnezoff Monkshood Root[10]. In Naxi medicine, 

“toxic” and “beneficial” are relative. Often, “the more toxic the medicine, the more effective it is.” That is, after 

processing and neutralization, some toxic herbs have a more significant therapeutic effect than ordinary herbal 

medicines. However, to avoid potential treatment risks, the modern medical system prohibits the use of any “toxic 

medicinal materials.” Therefore, it was not surprising that Wang did not pass the assessment. 

Learning from his first failure and with the assistance of President Liu of the Lijiang Ethnomedicine Association, 

Wang revised his application materials to remove all toxic herb components from his treatment cases and was 

advised to avoid mentioning toxic herbs during the assessment. However, how could a few words of advice change 

a 20-year-plus treatment habit? In the second assessment, Wang again blurted out the toxic herb formula when 

explaining his self-prepared prescription and was “vetoed” by the examiners. In Doctor Wang’s medical 

knowledge system, the preparation of toxic herbs is a “skill” rather than a “risk,” while in the examiners’ evaluation 

criteria, “toxic” is directly equated with “illegal” and “risk.” 

Now, when Doctor Wang recalls the two assessment experiences, he does not show obvious regret. He holds 

complex views regarding certification, expressing concern that Westernized standardized examinations could 

disrupt his own cognitive framework: “As a practitioner of Chinese medicine, I should adhere to its theoretical 

foundations. Studying Western medical concepts would only create confusion in my mind.”[11] Furthermore, Wang 

prioritizes caring for his elderly mother in her advanced years—even if certified, he would be unwilling to leave 

his homeland to practice. Thus, certification is a must-have for him. His medical knowledge has already been 

inherited by his children and three apprentices, allowing his practice to continue serving local communities through 

the traditional principle of “Yi Bu Kou Men” (medical care is not actively solicited, but respectfully provided 

when sought). 

Doctor Wang’s case reflects the deep-seated problems of the current assessment system: when traditional 

ethnomedicine is based on its distinct theoretical system and diagnostic and treatment logic, the standardized 

modern medical assessment model not only fails to objectively evaluate its actual medical value but may also 

create institutional exclusion. There is a fundamental epistemological conflict between ethnomedicine’s “using 

toxicity to counteract toxicity” treatment philosophy and the modern medicine’s “toxicity avoidance”; there is an 

evaluative conflict between ethnomedicine’s individualized diagnostic and therapeutic experience and the unified 

assessment standards of modern medicine; and there is a cultural value conflict between ethnomedical healers 

serving dual roles as cultural custodians and healthcare providers and the current assessment system that reduces 

their multidimensional medical practice into singular certification criteria. The root of this assessment system’s 

dilemma lies in its failure to acknowledge the importance of ethnomedicine as a local knowledge system. 

3.3.3 Doctor He, a Gynecology Specialist Who is Only Certified to Treat Spleen and Stomach Disorders 

“I did pass the exam, but it was really tough, and now I can only treat spleen and stomach disorders.” 

Doctor He was born into a traditional medical family in the multi-ethnic area of Lijiang. As a Tibetan, his father 

was a folk herbalist who traveled between villages. Doctor He began learning Naxi medical knowledge from a 

Dongba (Naxi religious leader) master at a young age and became the fifth-generation inheritor of ethnomedicine. 

In his medical system, he is best at using “urine diagnosis” to treat diseases. This diagnostic method originates 

from the theoretical techniques of the traditional Naxi “Golden-Turtle Eight-Diagram Chart,” which emphasizes 

the correspondence between the five internal organs and six bowels in the human body and the five elements of 

“wood, fire, earth, metal, and water.” 



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Figure 1. The Naxi “Golden-Turtle Eight-Diagram Chart”[12] 

 

The Naxi urine diagnosis technique, inherited by Doctor He, has a unique diagnostic logic: morning urine, which 

stays in the human body for the longest time, is considered to most accurately reflect the body’s condition. Doctor 

He’s diagnostic method is as follows: he stirs the urine with a hollow hemp stalk and observes the color of the 

urine, the size of the foam, its duration, location, and other floating objects. The direction in which the foam stays 

after stirring is interpreted according to the “Golden-Turtle Eight-Diagram Chart” to identify the location of the 

disease. For example, if the foam stays to the south, it usually indicates a problem with the kidneys. In addition, 

he also takes into account the wind direction, the patient’s diet of the previous day, and their complexion to make 

a comprehensive judgment. Doctor He says, “No matter which part of the body is ill, it will cause pain and 

discomfort, tilting the balance between different parts. The foam in the urine will concentrate in the ‘heavy’ 

position, that is, the position where there is pain.”[13] 

Doctor He is capable of treating a variety of diseases, especially gynecological disorders. However, when he took 

the Yunnan provincial examination for the TCM Specialist’s Certificate in 2022, to maximize his chances of 

certification, he made a strategic decision to forgo applying for the disease categories in which he possessed the 

most profound clinical expertise. Instead, he applied for certification in spleen and stomach disorders, a domain 

he perceived as more familiar and more readily translatable into the standardized TCM terminology. This choice 

enabled him to become one of the exceedingly rare practitioners in the Lijiang area to obtain formal qualification 

certification. However, it also directly limits his practice to the treatment of spleen and stomach disorders, creating 

a clear mismatch between the scope of his certified practice and his actual area of expertise.  

Doctor He’s success was hard won. He underwent systematic exam-preparation training in various aspects 

provided by the Lijiang Ethnomedicine Association. During the two-year preparation period, he not only 

systematically received training in converting Naxi medical concepts into standardized TCM expressions, 

including repeated drilling of Putonghua pronunciation for key terms, but also received non-verbal communication 

training, including standardized posture, deliberate eye contact, and controlled speech rhythm. Moreover, he 

received training in differentiated presentation strategies, such as highlighting the commonalities between Naxi 

medicine and TCM theory and employing comparative frameworks to stimulate examiners’ interest. President Liu 

also repeatedly advised Doctor He, “Do not just passively answer the examiners’ questions. Treat the exam site as 

a stage for teaching Naxi medicine.”[14] During the exam preparation, although Doctor He did learn a certain 

amount of basic TCM theory, he invested substantial time and effort into interview skills and mock-answer training. 

The above-mentioned training process far exceeded the traditional scope of “medical skills assessment” and was 

more like a large-scale “exam-taking skills” training project.  



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The case of Doctor He, who is good at gynecology but has to practice in the field of spleen and stomach disorders, 

also reflects the series of dilemmas faced by most ethnomedical healers. First, the difference in evaluation 

standards. The TCM theory, which serves as the basis for exam preparation, does have some help and value for 

him. However, the difficulty of the exam is not the level of medical skills, but the difference in evaluation standards. 

Second, the mismatch of the certification system. In the practice of the specialist assessment, the candidates’ 

diagnostic ability and experience come second to the comprehensive training they received in preparing for the 

exam, in expressing and presenting themselves. As a result, certification mismatch is common, where “competent 

doctors may not pass the exam, and those who pass may not be competent.” 

4. Reality, Dilemmas, and Reform: Perspectives of TCM and Western Medicine Practitioners  

To further explore the cognitive differences between different medical systems, this study employs an 

interdisciplinary comparative research method. Several young practitioners with backgrounds in TCM or Western 

medicine from major hospitals or medical colleges in Shanghai and Guangzhou were invited to participate in the 

field survey. Supplementary interviews were conducted regarding their perceptions of ethnomedical healers, the 

TCM Specialist system, and the relationship between ethnomedicine and modern medicine.  

4.1 A Public Health Perspective on the Drawbacks of Ethnomedical Diagnosis and Treatment Methods  

Ms. Wang,[15] a postgraduate student majoring in public health from Shanghai Jiao Tong University, expressed 

different views on the hygiene issues in the diagnostic and therapeutic processes of some ethnomedical healers. 

She believes that in the absence of strict disinfection or the implementation of infectious disease control procedures, 

some medical practices may pose a potential risk of cross-infection. For example, Doctor Wang, after finishing 

farm work, performs cupping and blood-letting for patients without disinfection. Although this might be efficient, 

there is a risk of spreading infectious diseases. In contrast, Doctor Zhao, who holds a Rural Doctor Certificate, 

will always wear gloves and use alcohol swabs and other modern medical protective measures, even when just 

providing head therapy for patients, demonstrating a higher level of hygiene awareness and professional standards. 

Ms. Wang is cautious about the certification of ethnomedical healers. She emphasizes that medical practice must 

be based on a systematic theoretical framework and standardized hygiene criteria. She also believes that although 

Doctor Wang’s herbal therapy, which “uses toxicity to counteract toxicity,” has certain therapeutic effects, its 

excessive reliance on toxic medicinal materials, lack of systematic theoretical support, and risk management 

mechanisms make it difficult to meet modern medical review standards. In comparison, she is more inclined to 

practitioners who can clearly explain the logic of diagnosis and treatment using TCM theory, such as Doctor 

Zhou[16]. For ethnomedicine practitioners with specialized skills, she believes that establishing a differentiated 

qualification certification channel based on the “specialized skill” certificate model in Yunnan Province is a 

rational solution. She also pointed out a weakness in the current TCM Specialist assessment system: the lack of 

corresponding “standardized training” (i.e., residency training), which means that even if some ethnomedical 

healers pass the exam, they are unable to effectively implement the mainstream medical practice standards. 

In summary, Ms. Wang, with her background in public health knowledge, prefers to establish a continuous training 

system and hygiene evaluation mechanism to ensure both efficacy and safety, rather than making a conclusion 

based on a one-time assessment, when it comes to solving the dilemma of the ethnomedicine practitioner 

assessment system. 

4.2 A Clinical Medicine Perspective on the Certification of Ethnomedical Healers 

Doctor Zhong, a postgraduate student with a background in modern clinical medicine[17], shared the importance of 

“official certification” and “evidence-based” practice in the modern medical system during her participation in the 

field survey of ethnomedicine, and her insights into the current TCM Specialist assessment system. 

As a physician who has undergone systematic clinical training in modern medicine, she pointed out that from the 

patient’s perspective, official licensing and institutional accreditation are prerequisites for gaining trust. “If I were 

a patient, I would want to know if the doctor has an official license. A professional qualification certificate would 

make me feel more at ease.”[18] She does not dismiss the empirical expertise of certain ethnomedical healers, but 

maintains that the current system lacks a stable and standardized evaluation framework capable of reliably 

distinguishing which healers merit certification. Particularly given the numerous uncontrolled variables in areas 

such as theoretical articulation, diagnostic standardization, and hygiene safeguards, she argues that precipitous 

certification could undermine public trust in healthcare governance.  

She also emphasized the differences between modern “evidence-based medicine” and the “dialectical medicine” 

of folk traditional medicine. The diagnostic and treatment process of ethnomedicine often lacks systematic 

evidence-based medical support, and its efficacy evaluation mainly relies on the subjective symptom improvement 



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described by patients. However, in the framework of modern medicine, the diagnosis and efficacy evaluation of 

organic diseases such as heart failure depend largely on objective and quantifiable structural indicators. Therefore, 

there is a widespread problem of “inability to verify the correctness of the theory” facing both TCM and 

ethnomedicine practitioners, which leads to the “misalignment” problem in the institutional assessment and makes 

it difficult to formulate a scientific and consistent certification mechanism. In addition, she pointed out that there 

is room for improvement in the current application mechanism. Whether it is the treatment experience learned in 

the field survey or the ten treatment cases filled in the application materials, their authenticity lacks verification, 

and there is a risk of “survivor bias.”  

In summary, Doctor Zhong is reserved about “whether to issue a certificate.” She does not deny that the TCM 

Specialist system, to some extent, prevents the erosion of folk hype or “undeserved” medical skills on the medical 

system, nor does she deny that a legal channel should be provided for some ethnomedical healers. However, she 

still insists that a more verifiable, comprehensive, fair, and socially responsible set of standards must be established. 

When referring to the admission mechanism of international medical colleges, she suggests that recommendation 

systems and clinical case weighting evaluation mechanisms can be introduced as appropriate, but the premise is 

that there must be perfect information verification and follow-up training to truly be responsible to patients, the 

system, and ethnomedical healers. 

4.3 Perspectives of TCM Professionals  

In addition to the above two participants with backgrounds in public health or modern medicine, this field survey 

also included a couple of TCM professionals from Guangzhou University of Chinese Medicine: one is engaged in 

TCM research, while the other provides medical consultations online as a “barefoot doctor”; though neither is a 

registered licensed doctor, both have received systematic training on TCM theories. 

Mr. Liang, the “barefoot doctor,” holds relatively straightforward and positive views. After observing the 

diagnostic and treatment processes of ethnomedical healers, he gave high praise, especially impressed by Doctor 

Wang’s treatment of bone injuries. He believes that Doctor Wang’s pulse-taking, analysis, and prescribing are all 

very professional and live up to his “reputation” among neighbors. As a TCM practitioner who has received 

systematic academic training, Liang can confirm the practical efficacy of ethnomedical healers in specific fields 

through clinical observation. 

In contrast, Ms. Chen, the researcher with a Ph.D., is more critical. She believes that some ethnomedical healers 

have a relatively singular approach to syndrome differentiation and a more formulaic use of medicine, which fails 

to reflect the core TCM philosophy of emphasizing a holistic view and differentiation of individual constitutions. 

For example, she observed that some of Doctor Wang’s prescriptions, regardless of the patient’s constitution or 

disease stage, have almost the same combination of medicinal herbs, lacking targeted modifications. In contrast, 

in clinical practice of TCM professionals who have received proper formal TCM training, auxiliary or adjuvant 

ingredients are often added based on the patient’s specific constitution and manifestations of deficiency, excess, 

cold, or heat to enhance efficacy or reduce side effects, which is less common among ethnomedical healers. 

Moreover, Ms. Chen believes that the use of toxic herbs is too risky and unnecessary, as other non-toxic herbs can 

achieve similar effects. In her view, the safety of medication should not be overshadowed by its efficacy.  

However, the couple agrees on the pharmacological value of the vast majority of herbal medicines used by 

ethnomedical healers. The herbs collected and processed by these healers often demonstrate bioactivity. Combined 

with Lijiang’s superior geographical conditions—renowned as the “homeland of medicinal herbs”—these locally 

sourced herbs consistently show superior efficacy compared to the standardized, pre-processed formulations 

available in urban hospitals.  

In summary, the views of this couple reveal a spectrum of attitudes, ranging from recognition and appreciation to 

skepticism, within the institutionalized TCM community toward ethnomedicine. This indicates that ethnomedical 

healers are not entirely outside modern healthcare systems, and their diagnostic and therapeutic approaches can 

gain technical acknowledgment from practitioners with systematic training. However, significant gaps remain in 

terms of standardization and other aspects.  

4.4 Differences Among Ethnomedical Healers 

Compared to the established medical systems of Tibetan, Mongolian, Uyghur, and Dai medicine within the current 

ethnomedical framework, ethnomedicine in Lijiang, such as Naxi medicine and Lisu medicine, is in a relatively 

disadvantaged position. Currently, there is more government policy support for Mongolian, Tibetan, Uyghur, and 

Dai medicine in terms of academic inheritance, medical innovation promotion, and more. In addition, many 

Tibetan and Mongolian medicines have been included in the national catalog of medicines covered by medical 



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insurance. In contrast, Lijiang’s ethnomedicines (such as Naxi herbal medicines) remain predominantly self-

collected and self-administered within local communities, or are marketed as semi-processed herbal products, with 

a relatively low commercialization and specialization level, hindering their access to mainstream healthcare 

markets. According to Doctor Zhuoma, a Tibetan physician interviewed in this field survey, one reason Tibetan 

medicine can be widely incorporated into the national healthcare systems is that most of the examiners in the TCM 

Specialist assessment are Tibetan doctors. Therefore, they can better understand the unique theories of Tibetan 

medicine articulated by the candidates, such as blood-letting therapy and Tibetan medicinal baths. These 

innovations are not confined to the theoretical framework of modern TCM. Thus, the evaluation and certification 

by examiners from the same ethnic group are more accurate and more in line with the candidates’ actual situations. 

However, for ethnomedical healers in the Lijiang area, the examiners, most of whom are from modern medical 

backgrounds, often possess only a partial understanding of the theoretical frameworks and therapies unique to 

Naxi and other ethnic medical traditions. Consequently, the evaluation criteria they employ are ill-suited to 

evaluate ethnomedical knowledge systems. The lack of official discourse power in the evaluation system also 

exacerbates disparities among China’s diverse ethnomedical traditions, which is one of the obstacles preventing 

Lijiang’s ethnomedical healers from obtaining formal qualification certification. 

5. Conclusion 

The difficulties ethnomedical healers face in practicing legally are essentially not due to their inadequacy in 

medical skills but rather the structural limitations of the modern medical system and institutions in recognizing 

diverse medical traditions. These practitioners are squeezed into a “gray area”—they possess unique diagnostic 

and therapeutic memories passed down through generations, but they remain marginalized in a position of “having 

specialized skills but unable to exercise them” due to their inability to fit into mainstream certification and lack of 

discourse power in the evaluation system.  

The TCM Specialist system implemented in China was well-intended as a policy attempt to integrate folk medical 

resources. However, in practice, it has revealed deep-seated contradictions in the compatibility of knowledge 

systems, ignoring the diversity of knowledge structures and differences in expression and operation among TCM, 

Western medicine, and ethnomedicine. The requirement for a standardized assessment of empirical medical skills 

has instead created new institutional problems.  

During the field survey, every ethnomedicine practitioner I encountered held this belief: regardless of who, when, 

or where, the most basic and core job of a physician is to heal the sick and save lives. Whether or not they have 

official recognition or sufficient discourse power, ethnomedical healers still persist in using their family-passed-

down medical skills to alleviate the suffering of patients in the countryside and take on the responsibility of healing. 

This evaluation system and practical wisdom even transcend the value system associated with the Doctor’s 

Certificate—their medical value is not simply reflected in a piece of paper but is profoundly embedded in the 

memories of recovered patients.  

In summary, findings from this field survey and in-depth interviews with various groups from diverse medical 

backgrounds reveal that the certification challenges facing ethnomedical healers reflect a deeper question: When 

modernity encounters diverse medical traditions, by what criteria should “legitimacy” be defined? Should it 

prioritize theoretical conformity or return to therapeutic efficacy? The marginalization of ethnomedical healers by 

TCM and Western medicine systems precisely illustrates that a truly inclusive medical system should respect and 

accept diverse therapeutic paradigms and acknowledge the right to practice medicine through the lens of diverse 

knowledge systems. 

References 

[1] The Standing Committee of the National People’s Congress. (2021). The law on licensed doctors of the People’s 

Republic of China. 

[2] Fang, X. (2024). Barefoot doctors and western medicines in China (G. Dong et al., Trans.). Social Sciences 

Academic Press. (Original work published 2024) 

[3] The State Council. (2024). Administrative regulations on the medical practice of rural doctors (Decree No. 

386 of the State Council). https://www.gov.cn/zwgk/2005-05/23/content_165.htm 

[4] Ministry of Health of the People’s Republic of China. (2006). Measures on the qualification assessment and 

examination of traditional medicine apprentices and specialists (Decree No. 52 of the Ministry of Health). 

https://www.nhc.gov.cn/wjw/c100221/202201/6ce13fc2e98f4e35973ef62d1e6f32da.shtml 

[5] National Health and Family Planning Commission. (2017). Interim administrative measures for the 

qualification assessment and registration of TCM specialists. 



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[6] Data source: Lijiang Ethnomedicine Association.  

[7] Liu Jianqin (1966- ), President of the Lijiang Ethnomedicine Association, has been dedicated to digging and 

sorting out the traditional medical knowledge of the Naxi ethnic group.  

[8] Interview with Liu Jianqin. July 4, 2025.  

[9] Data source: Lijiang Ethnomedicine Association and case interviews.  

[10] Aconite and Kusnezoff Monkshood Root are highly toxic. China’s Administrative Measures for Toxic Drugs 

for Medicinal Useclearly stipulates the processing and management methods for these two types of medicinal 

materials. To prevent risks in medical use, except for designated institutions, no other units or individuals are 

allowed to engage in the procurement, distribution, or formulation of toxic drugs. This also restricts the 

inheritance and use of ethnomedicine practitioners' secret remedies that employ “using toxicity to counteract 

toxicity.”  

[11] Interview with Doctor Wang on July 5, 2025.  

[12] The Golden Turtle Bagua Chart painted on the wall of the Lijiang Ethnomedicine Association, photo taken 

on July 16, 2024.  

[13] Interview with Doctor He on July 4, 2025.  

[14] Interview with President Liu on July 4, 2025.  

[15] Ms. Wang is a postgraduate student majoring in public health at Shanghai Jiao Tong University. The interview 

was conducted on July 8, 2025.  

[16] Doctor Zhou is Vice President of the Lijiang Ethnomedicine Association, specialized in the research of Naxi 

medicine theory and committed to the conservation and teaching of ethnomedicine.  

[17] Doctor Zhong is a postgraduate student in the Cardiology Department at Shanghai Jiao Tong University 

School of Medicine, with a background in modern clinical medicine. She has several years of clinical 

internship experience in public hospitals and has participated in a medical education exchange program in the 

United States. 

[18] Interview with Doctor Zhong on July 7, 2025.  

 

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