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widely used in traditional Chinese medicine, and public support for them in China remains strong. Although most Chinese believe in the superior diagnostic powers of bio- medicine, many prefer acumoxa treatment for chronic dis- eases where the side effects of biomedicine are a concern.

The regular use of acumoxa in clinical settings has not been matched by modern, internationally acceptable, sci- entific research. Most of the thousands of studies done since 1970—seeking to identify biomedical mechanisms permitting acupuncture anesthesia and surgical analgesia, exploring possible biomedical correlates to the meridians or channels, and determining how acupuncture points relate to needling sensation between acupuncture points and the organs—have included too few subjects, used little or poor patient blinding, had bad or no control groups, and were characterized by multiple sources of bias. Several reviews of this literature have drawn negative conclusions due to these methodological flaws. Some randomized controlled trials have focused on these methodological issues, but no firm conclusions have been reached on how acupuncture works.

Acupuncture has long been practiced in Taiwan, Sin- gapore, Japan, and Korea, and it is becoming part of health- care systems around the world, partly due to PRC efforts to globalize traditional Chinese medicine. In 1971 the New York Times reporter James Reston (1909–1995) brought acupuncture to the attention of Americans by describing his acupuncture anesthesia for an emergency appendectomy at a Chinese hospital while part of President Richard Nix- on’s entourage to China. A 1975 call by the World Health Organization (WHO) for acupuncture courses in Beijing, Shanghai, and Nanjing has provided many American and European practitioners with valuable training and hospital experience unavailable in their own countries. In 1980 WHO promulgated a list of conditions effectively treated with acupuncture, including respiratory, gastrointestinal, gynecological, and nervous disorders, and chronic pain tied to back injuries and arthritis. Acupuncture is also considered helpful in reducing the side effects of chemotherapy and surgery. Acupuncture can be used most effectively in treat- ing chronic problems, but it has limited effectiveness against acute disorders that require surgery or emergency care.

SEE ALSO Medicine, Traditional.

B I B L I O G R A P H Y Academy of Traditional Chinese Medicine. An Outline of Chinese

Acupuncture. Beijing: Foreign Languages Press, 1975. Birch, Steven, and Ted Kaptchuk. History, Nature, and Current

Practice of Acupuncture: An East Asian Perspective. In Acupuncture: A Scientific Appraisal, eds. Edzard Ernst and Adrian White, 11–30. Oxford: Butterworth Heinemann, 1999.

Ernst, Edzard. The Recent History of Acupuncture. American Journal of Medicine 121, 12 (2008): 1027–1028.

Lo, Vivienne. Introduction: Survey of Research into the History and Rationale of Acupuncture and Moxa since 1980. In

Celestial Lancets: A History and Rationale of Acupuncture and Moxa, Lu Gwei-Djen and Joseph Needham, xxv–li. New ed. London: Curzon, 2002.

Scheid, Volker. Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham, NC: Duke University Press, 2002.

Sierpina, Victor S., and Moshe A. Frenkel. Acupuncture: A Clinical Review. Southern Medical Journal 93, 5 (2005): 330–337.

Sivin, Nathan. Traditional Medicine in Contemporary China: A Partial Translation of Revised Outline of Chinese Medicine (1972), with an Introductory Study on Change in Present-day and Early Medicine. Ann Arbor: Center for Chinese Studies, University of Michigan, 1987.

Taylor, Kim. A New, Scientific, and Unified Medicine: Civil War in China and the New Acumoxa, 1945–49. In Innovation in Chinese Medicine, ed. Elisabeth Hsu, 343–369. Cambridge, U.K.: Cambridge University Press, 2001.

White, Adrian, and Edzard Ernst. 2004. A Brief History of Acupuncture. Rheumatology 43, 5 (2004): 662–663.

Lowell Skar

ADOPTIONS China is often presumed to lack traditions of adoption because of the influence of Confucianism, with its heavy emphasis on patrilineal biological ties in organizing family and society. Normative texts argued against adoption, and traditional Chinese law prohibited adoption outside patri- lineal surname lines. However, in practice, adoption has a long and varied tradition in China and has been docu- mented as quite common for hundreds of years. A num- ber of strains in Confucianism and in popular culture support adoptive ties outside as well as inside bloodlines and encourage the adoption of both boys and girls to build family and kinship.

EARLY MODERN PRACTICE

James Lee and Wang Feng (1999), providing evidence of relatively high adoption rates in China dating back to the eighteenth century, argue that the traditional Chinese family system was characterized by high levels of adoption compared to Europe’s low-adoption kinship practices. China’s rate of adoption probably varied from 1 to 10 percent of live births at various times and places.

During late imperial times and earlier, there is much evidence of a variety of adoption practices, varying by region, class, and ethnicity. In legal documented practice, the only legitimate reason for adoption was to obtain a male heir for the patrilineal family. The adoptive heir was sup- posed to be obtained from close male relatives, ideally if not exclusively from a brother. But in popular practice there were many other purposes for adoption, purposes involving girls as well as boys, and adoption from strangers was

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probably common. In Southeast China and elsewhere, adop- tion was often used to obtain a “little daughter-in-law,” or future bride, for a son. But girls were also adopted as daugh- ters by childless couples and by unmarried adults. Sometimes girls were adopted under the belief that this would overcome infertility and lead to the birth of a son. Sonless couples might adopt a daughter’s husband to provide a male heir. Adoption could thus involve an adult. Adoptions were also prompted to provide homes for orphans and abandoned children. In other words, a variety of formal and informal adoption practices, serving sundry purposes, could be found in China in the past. Although adoption often carried a lesser status and might create weaker bonds than biological ties, when biology failed, bringing unrelated children and sometimes young adults into the family was a common way to build family and kinship.

THE IMPACT OF THE ONE-CHILD POLICY

In contemporary China, adoption has continued to be practiced, although patterns have altered. The adoption of little daughters-in-law has virtually disappeared, while adopting girls as daughters has become the most common form of adoption, with nonrelative adoption more com- mon than adoption from relatives. Demographic evidence indicates that after an apparent initial drop in the mid- twentieth century to below 1 percent of live births, adop- tion increased from 1980 through the 1990s with the advent of the one-child policy, reaching 2.1 percent of live births in 1986, or nearly 1 million adoptions, according to a sample survey. Demographers found that the majority of these adoptions were girls and that the number of adop- tions, as well as the proportion of girls, were increasing each year, although the vast majority of adoptions were not officially registered. Smaller local studies in the 1990s and 2000s confirmed these patterns and further indicated that half or more of all adoptions were of foundlings.

The increase in adoption and in the availability of girls was a direct result of the high-pressure birth-planning campaigns waged throughout China beginning in the 1980s. The government, under its one-child policy, sought to implement rules restricting couples to one child, later loosened slightly in most of the countryside to two children if the first was a girl. In a largely rural society with waning but still strong preferences for a son, people used adoption as a means to hide a second or third daughter and to be able to try again for a son. At the same time, because the value of daughters was also increasing, people without daughters were often happy to adopt other families’ excess daughters. Some “adoptions” were merely a ruse to hide a child tem- porarily, especially those of relatives and close friends living in other areas. But actual adoptions, involving the perma- nent transfer of the child into a new family, either through arrangement or outright abandonment, were also suspected by the authorities as a means to hide children.

Consequently, birth-planning officials quickly moved to block this loophole with regulations that forbade adoption except by childless couples over thirty-five. Birth parents who hid a child by adopting it out would be punished and would not be allowed an additional birth if they were caught. Adoptive parents who had another child or who were too young were also subject to birth-planning penalties if caught. In 1991 these birth-planning regulations became part of the nation’s first adoption law, one of the most restrictive adoption laws ever enacted.

The combination of strict, often coercive birth-planning campaigns and highly restrictive one-child adoption regula- tions created waves of female-infant abandonment that surged throughout the country from the late 1980s through the first years of the twenty-first century, particularly in the Yangzi River area and areas extending south and southwest. Although spontaneous adoption of these abandoned female infants continued despite the restrictive one-child adoption law, usually in violation of the law and hence unregistered, increasing numbers of abandoned children reached the orphanages in unprecedented numbers by the early 1990s. Conditions even at the best state orphanages were over crowded and extremely poor, with insufficient funds for medical care and staffing. As a result, mortality rates were very high, and babies languished with little attention.

INTERNATIONAL ADOPTION

Having severely restricted the pool of legally qualified domes- tic adopters to bolster population-control policies, the govern- ment turned to international adoption, limited entirely to children living in orphanages, to lessen the number of chil- dren in state orphanages and, more important, to provide a source of funding for these severely underfunded, highly stressed welfare institutions. As international adoption to the United States, Canada, and Europe gradually increased from a few hundred per year in the early 1990s to a peak of 13,000–14,000 in 2005, more resources were brought into the institutions through adoption fees and charitable interna- tional organizations, sometimes funded by adoptive parents. By 2008 over 100,000 Chinese children, mostly girls, had been adopted internationally, over 70,000 to the United States.

While international adoption helped improve condi- tions in many orphanages and provided a partial solution for the abandonment crisis, it also created further incentives for orphanage directors to favor international adoption over domestic adoption and to rely on a continuing supply of healthy infants for international adoption to finance the care of the disabled, unadoptable population that remained in the orphanages. Thus, even though the government in 2000 slightly eased legal restrictions on domestic adoption from orphanages (but not on the much higher number of adop- tions that occur outside orphanages), a financial bias in favor of international adoption became built into the system. This

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