A Cultural Perspective of Health and Wellness

Journal of China Tourism Research

ISSN: 1938-8160 (Print) 1938-8179 (Online) Journal homepage: http://www.tandfonline.com/loi/wctr20

A Cultural Perspective of Health and Wellness Tourism in China Liyuan Huang & Honggang Xu To cite this article: Liyuan Huang & Honggang Xu (2014) A Cultural Perspective of Health and Wellness Tourism in China, Journal of China Tourism Research, 10:4, 493-510, DOI: 10.1080/19388160.2014.951752 To link to this article: http://dx.doi.org/10.1080/19388160.2014.951752

Published online: 27 Oct 2014.

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Date: 11 March 2016, At: 03:25

Journal of China Tourism Research, 10: 493–510, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1938-8160 print / 1938-8179 online DOI: 10.1080/19388160.2014.951752

A Cultural Perspective of Health and Wellness Tourism in China 中国健康与养生旅游的文化透视

Downloaded by [Sun Yat-Sen University] at 03:25 11 March 2016

LIYUAN HUANG HONGGANG XU Health and wellness tourism has experienced fast growth during the last two decades. The aging population and severe pollution in China make the wellness industry even more attractive. However, there has been limited academic research in this area. This paper aims to explore the key features of Chinese wellness tourism through a case study in Bama, Guangxi Autonomous Region. The paper argues that the behaviours of Chinese wellness tourists are greatly influenced by the traditional Chinese wellness culture. Being in nature, doing moderate exercise in nature, and appropriate diet are the key activities for the wellness tourists in Bama. While these activities are also practised in daily life back home, the tourists believe that the best results from these practices can be achieved in Bama. The traditional beliefs in health and new scientific discovery about the Bama county as a longevity place have together contributed to the current behaviours of wellness tourists. Practical implications are also suggested. KEYWORDS. Chinese culture, tourist activities, Yangsheng, wellness tourism

近二十年来健康和养生旅游得到了长足的发展，中国由于其老龄化和严重的污染问题也引发了养生热潮。但是，这一现象却很少被学术界所关注。基于在广西巴马的案例研究，本文讨论了中国养生旅游的主要特征。研究认为，养生游客的行为深受中国传统文化的影响，与自然同在、在自然中开展活动，以及谨慎饮食是巴马养生游客的重要活动内容。尽管这些游客在居住地也开展类似的养生活动，但他们认为在巴马开展上述活动可达到最佳的养生效果。深植于中国文化的健康信念，以及关于巴马长寿之乡的科学发现都影响了养生游客的行为。最后，本文对于如何在实践中开展养生旅游也提出了建议。关键词：中国文化, 游客活动, 养生，养生旅游

Introduction With some prevailing phenomena derived from China’s economic and social developments, such as an aging population, heavy workloads, and high healthcare costs, health has become one of the main drivers of travel in the last 20 years. When people travel for the sake of health, the associated tourism activities can be defined as health tourism (García-Altés, 2005). In order to meet the new market demand, many hospitality Liyuan Huang is a doctoral candidate in the School of Tourism Management at Sun Yatsen University and a Lecturer at Nanfang College of Sun Yat-sen University, Guangdong, China (E‐mail: [email protected]). Honggang Xu is a Professor in the School of Tourism Management at Sun Yat-sen University, Guangdong, China (E‐mail: [email protected]).

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and tourism businesses market their products labelled with health or wellness (Chen, 2007; Mueller & Kaufmann, 2001). Wellness, as a subset concept of health as suggested by many scholars (Gonzales, Brenzel, & Sancho, 2001; Hall, 2011; Mueller & Kaufmann, 2001; Voigt Laing, Wray et al., 2010), promotes a holistic philosophy of life that one’s body, mind and spirit are all in a harmonious state. Despite the fast growth of health and wellness tourism, academic studies in this area are limited (Voigt, 2010). Recently, this area has begun to attract increasing research attention (Hall, 2011). One of the challenges in studying health or wellness tourism is that the concepts, perceptions and approaches of health and wellness vary across countries. The perceptions of health are mostly socially constructed and influenced by one’s culture and historical background (Huijbens, 2011; Smith & Puczko, 2009). Culture shapes an individual’s belief in health (Wilson, 2003), therefore a specific cultural lens should be taken into account to understand the behaviours and experiences of health or wellness tourists. Most of the existing studies in this area were conducted in the Western cultural context; however, little research has been carried out in the Eastern cultural regions, where health and wellness practices have a long tradition. This study implements an exploration from a cultural perspective into the understanding of Chinese wellness tourists’ behaviours through a case study in Bama County, Guangxi Autonomous Region (Province). It is expected that the findings of this study will provide an alternative way to view wellness and wellness tourism. The study also provides new insights to marketers of Chinese wellness tourism.

Literature Review Health and Wellness The widely accepted definition of health is that of the World Health Organization (WHO): “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). While this definition attempts to emphasise the difference between health and the absence of illness, it does not really provide a clear connotation of health or operational guidance for people who seek a healthy life style. The concept of wellness in this sense provides a clearer picture of the status that people can strive for. The wellness concept was first introduced in 1959 by Halbert Dunn, who observed that a poor lifestyle can bring about severe health problems other than diseases. He emphasised the holistic well-being of one’s body, spirit and mind, as well as being harmonised with the environment (Dunn, 1959). Later, wellness was further developed to include self-responsibility (Travis & Ryan, 1988), spirituality (Sweeney & Witmer, 1991), social contact and environmental sensitivity (Mueller & Kaufmann, 2001), and even occupational and emotional dimensions (Smith & Puczko, 2009). As a result, wellness is regarded as the optimal state of health (Myers, Sweeney, & Witmer, 2000) that can be achieved through a lifestyle practice, to be more specific, activities such as physical health/beauty care, nutrition/food, intelligence/education, relaxation/medication, and so on (Mueller & Kaufmann, 2001). Yet, as a new concept in the Western world, “wellness” can have different translations in different languages and cultures. For example, although there is no exact term, “wohlbefinden” in German (Wellness Tourism Worldwide, 2011), and “hyvinvointi” in Finnish (Konu, 2010), can be regarded as the translation for well-being, wellness, and welfare.


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Health and Wellness Tourism There is, however, no agreed definition of health tourism (Rodrigues, Kastenholz, & Rodrigues, 2010). Many researchers tend to use health tourism as an umbrella term to cover all tourist activities related to health (Cohen, 2008; Connell, 2006; Garcia-Altes, 2005; Gonzales et al., 2001; Hall, 2011; Lunt & Carrera, 2010; Mueller & Kaufmann, 2001; Voigt et al., 2010), while others use the terms such as healthcare tourism (Gilbert & Weerdt, 1991; Goodrich & Goodrich, 1987; Henderson, 2004), medical tourism (Bookman & Bookman, 2007), or holistic tourism (Smith & Kelly, 2006a). The variety of these definitions reflects the complex nature of the concept of health and the degree to which medical intervention is used. Previous studies seem to regard wellness tourism as a subset of health tourism (Gonzales et al., 2001; Hall, 2011; Konu, 2010; Mueller & Kaufmann, 2001; Voigt et al., 2010). For those who do not intend to undergo medical treatment in a hospital but want to improve or maintain their health conditions, wellness tourism seems to be an appropriate alternative. However, there are different views on what can be referred to as wellness activities. Some widely-recognised wellness activities are spa, massage, beauty/ body care, consumption of healthy food, and physical exercises (Chen, Prebensen, & Huan, 2008; Hjalager & Konu, 2011; Lee & King, 2008; Mak, Wong, & Chang, 2009; Smith & Kelly, 2006a). Nature tourism, ecotourism and community tourism (Gonzales et al., 2001), pilgrimage (Devereux & Carnegie, 2006), yoga (Lehto, Brown, Chen, & Morrison, 2006), New Age tourism (Pernecky & Johnston, 2006, p. 37), medication and spiritual retreat (Kelly, 2010; Smith & Kelly, 2006a; Voigt, Brown, & Howat, 2011), outdoor activities and sports (Konu, Tuohino, & Komppula, 2010; Pechlaner & Fischer, 2006; Rodrigues et al., 2010) are also advocated in this category. Although existing empirical studies are limited, a review of these studies reveals that the diversity may be induced by cultural influences on wellness activities. Although enjoying a spa, for instance, is a worldwide activity of wellness tourism, 80% of the spa tourists in a Muslim society are male (Sayilia, Akcaa, Dumanb, & Esengun, 2007). On the contrary, more than 75% of spa consumers in Australia and Hong Kong are female (Mak et al., 2009; Voigt et al., 2011). Hiking is considered as a wellness activity by Westerners (Rodrigues et al., 2010). It seems that therapeutic approaches in Asia focus more on spirituality and holism than on natural resources (Smith & Puczko, 2009). These studies, nonetheless, have not examined the cultural or social reasons behind these activities. The diversity of wellness activities implies different perceptions of tourists regarding wellness and the approaches to wellness. This diversity makes it difficult for researchers and practitioners to share knowledge that can normally be obtained through a certain group of tourists. Voigt et al. (2011) suggest that motivation and benefit sought may be important indicators to categorise wellness tourists. Active pursuit of a state of well-being through synergies of body, mind, and soul is the characteristic distinction (Huijbens, 2010) between wellness tourists and others. However, current research cannot support this as a good approach towards an understanding of wellness. Most wellness tourists, for example, cannot be identified as genuine wellness tourists because their top motivations are relaxation and escape from routine life (Chen et al., 2008; Lehto et al., 2006; Mak et al., 2009; Rodrigues et al., 2010; Smith & Kelly, 2006a; Voigt et al., 2011). Of course, other diverse motivations are also found, such as seeking physical health (Mak et al., 2009), selftransformation (Voigt et al., 2011), wholeness of physical, mental, emotional, and spiritual well-being (Lehto et al., 2006; Smith & Kelly, 2006a) for spiritual retreat and medication customers, and spirituality for pilgrimage tourists (Devereux & Carnegie, 2006).

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The authors believe that there is a need to explicitly consider the local cultural and social context to study wellness tourism. A cultural approach may be suitable to understand wellness tourism in the case of China, where there is a long history and tradition of natural health care and wellness (Laing & Weiler, 2008), and practising natural health care and wellness has been a daily habit. Wellness tourism can be considered as a new form of wellness in the modern world and an extension of wellness practice in a place away from home. Yet, these practices are not new to wellness tourists. The following sections will review the wellness culture in China, and through an empirical study the authors would like to seek the linkage between Chinese wellness culture and wellness tourism.


Health and Wellness in China Compared with Western countries, wellness has a much longer history and stronger influence than the concept of health in China. The Chinese words for health and wellness are Jiankang and Yangsheng respectively. Jiankang was not in the Chinese literature until recent decades, while Kangjian, a transposed expression to Jiankang, was found in Chinese classical works,1 denoting that being strong is based on a balanced and peaceful condition. Yangsheng, on the other hand, has been used throughout Chinese history and it permeates Chinese routine life. The Chinese term Yangsheng was first proposed by Zhuang Zi, the representative figure of Taoism – an influential philosophy in Chinese culture together with Confucianism (Heung & Kucukusta, 2013). Yangsheng is the art of self-cultivation by being harmonious with the internal and external environments (Ren, Xing, & Fu, 2007) to prevent illness and achieve optimal well-being. Yangsheng promotes self-healing, health cultivation and a positive state of mind, ultimately leading to the preservation of one’s health. Over a thousand years a systematic approach towards Yangsheng has been developed, including philosophical principles and practices. The philosophical principles are the art of Yangsheng, emphasising a holistic approach, body-mind holism, and bodymind-nature holism towards health. These principles are summarised in Chinese history in Neijing (also known as the Yellow Emperor’s Inner Classic), one of the earliest Chinese medical works, which dates back more than two millennia (Wu & Ling, 1993). The following is a short summary of the principles. Tian-ren-he-yi (Nature and mankind in unity). Yangsheng can only be achieved when human beings are in harmony with the nature. It is believed that the micro cosmos of human beings is mysteriously interrelated to the cosmos of the universe (Leung, 1998). As a result, human beings’ way of living should accord with the operation of the universe. Moreover, nature provides the elements for human life: being with nature and breathing in fresh air can promote health through the mechanism of Chi (vital energy). Yin and Yang. The Chinese divide all natural phenomena into two contrary components: day/night, upper/lower, man/woman, good/bad, and positive/negative. The tenet of contradiction and change is called the principle of Yin and Yang, and governs the Chinese way of life. The Yin-Yang Principle has long dominated Chinese thinking on wellness and illness. In traditional Chinese medicine knowledge, health is viewed as a harmony between the forces of Yin and Yang within the body and between the body and its environment. Illness, in contrast, is an imbalance or disequilibrium between these forces. “The law of Yin and Yang is the natural order of the universe, the foundation of all things, mother of all changes, the root of life and death. In healing, one must grasp the root of the disharmony, which is always subject to the law of Yin and Yang” (Ni, 1995, p. 17).


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Chi. The understanding of health and longevity cannot be achieved without the discussion of Chi, or Qi as pronounced in Mandarin. “The idea of Qi is fundamental to Chinese medical thinking, yet no English word or phrase can adequately capture its meaning… Chinese thought does not distinguish between matter and energy, but we can perhaps think of Qi as matter on the verge of becoming energy, or energy at the point of materializing” (Kaptchuk, 1983, p. 35). Chi is the source of life and is defined as the energy circulating in one’s body. This system of Chi forms the basis for the diagnosis and treatment of illnesses, as well as for the promotion of health and prevention of diseases. Illness is the consequence of an improper flow of Chi through the system. Theory of the Five Elements. Chinese believe that the Yin and Yang forces control the workings of the Universe, which is made up of the five symbolic elements: wood, fire, earth, metal, and water. The proper balance between the five elements is the working principle of the Wu Hsing (five elements) theory (Reid, 1987). Everything in the Universe (or on earth) is dominated by one of the five elements. The interplay between these elements together with the balance between Yin and Yang explains all changes and activities in nature, including the balance of life and body functions (Chan, 1995) (Table 1). The theory of the five elements is rooted in nature. It demonstrates a human’s conceptualisation of the law and order of nature. In addition, it reifies the cyclical pattern of nature and dynamic balance and harmony that inform such a pattern. Throughout Chinese history, these principles gradually turn into the following practices, which can be divided into three categories. The first is being in a good environment, since all the basic principles of Yangsheng emphasise that being in harmony with nature and exchanging Chi and other elements with nature are key to maintain one’s health. As a result, it is very important to be physically present in a place where the natural features are desirable, for example, a place with high-quality water, Chi, and so on. The second category includes activities that can be practised in daily life, including food therapy, regulation of the mind and regular exercise (Aspell, 2012; Rawl, 1992).

Table 1. Relationship between the Five Elements and the Balance of Nature and Body Function: The Wu Hsing Theory. Nature Elements

Season

Weather

Wood

Spring

Wind

Fire

Summer

Heat

Earth Metal

Long Humid Summer Autumn Dry

Water

Winter

Source. Chan (1995)

Cold

Body Function Internal Organs Liver, gall bladder Heart, small intestine Spleen, stomach Lungs, Large intestine Kidneys, bladder

Sensory Body Organs Structures Emotion Anger

Taste

Eyes

Tendons

Tongue Mouth

Blood Happiness Bitter vessels Muscles Worry Sweet

Nose

Skin, hair Grief

Pungent

Ears

Bones, hair

Salty

Fear

Sour


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Food therapy is widely practised. Food has a direct influence on Chi, as it gives human beings the energy to function. Without proper nourishment through diet, Chi levels would become low, leading to fatigue, dysfunction of internal organs, and low immunity to diseases. Herbal intake is often used as a supplement. Regulating the mind is regarded as a way to preserve health and prevent diseases. To regulate the mind is to maintain a peaceful mind. This refers to a state of mind that is relaxed yet engaged, free from excessive desires, and emotionally stable. It is also important for the mind to relax as much as it works – a healthy balance of Yin and Yang. The importance of regular exercise and its beneficial effects on health and lifestyle have always been a concern. Chigong (an exercise to accommodate positive Chi in one’s body) and other exercises were designed to help practitioners release tensions from their muscles and tendons – stimulating blood and body fluids to flow in and out of the joints, flushing out toxins along the way. The third category includes acupressure, acupuncture, moxibustion, and others. These activities are not practised daily, but help facilitate the flow of energy and material exchange between the body and nature. For instance, acupressure is said to help get poisonous materials out of the body. Although Chinese society has undergone tremendous changes over the past 20 years, the introduction of a health and medical system has greatly changed people’s attitude towards illness and its treatment. Yet, the knowledge and beliefs of Yangsheng, to a certain extent, are still widely accepted and practised in the daily life of Chinese people. This is especially true when Chinese seek better health or are exposed to a chronic disease that cannot be cured through Western medical knowledge. Chinese Wellness Tourism Research on health and wellness tourism is limited in China. Papers on this topic are mainly policy studies or viewpoint papers focused on the promotion of health and wellness tourism. Through a careful examination of the literature, it can be observed that scholars in China attempt to promote wellness tourism based on the traditional culture and knowledge described previously. In her article, Wang (2008) may be the first Chinese author who nominated Yangsheng tourism. Wu (2006) defines wellness tourism as tourism activities that can be used to adjust physiological status and strengthen the physical condition. She points out, without detailed explanation, that wellness tourism can be categorised into five types based on the Chinese Five Element theory. Although these papers are only viewpoint papers, they reveal the linkage between wellness tourism and traditional Chinese culture, and how wellness tourism in China could be developed. Four kinds of tourism activities are promoted as wellness tourism, namely spa, ecotourism activities, forest-related activities and activities related to Chinese medicine (Zhou & Fang, 2012). Apart from the spa, the other three activities may have different meanings in the Chinese context. Although “eco (ecology)” is not an indigenous concept in China, it fits well into the Chinese belief in the importance of nature to health. It is believed that pleasant natural surroundings, such as a habitat following Fengshui principles, are ideal for wellness (Zhou & Fang, 2012). Furthermore, since eco does not only refer to nature but also to a balanced and harmonious system, eco brings additional clues to contribute to health. This association of eco with tourism has already been noted by Buckley, Cater, Linsheng & Chen (2008) in their comparative studies of ecotourism and Shengtai lvyou (the Chinese expression of ecotourism). Buckley et al. (2008) find that one of the key features of Shengtai lvyou in China is health motivation.



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Forest tourism activities are also identified as one of the wellness products in China. Chinese people’s interests in forest tourism originate from a widespread belief in the health benefits from the rich negative oxygen ions and other emissions from trees (Zhou & Fang, 2012). Although the concept of a ‘green shower’, which is based on some scientific reports, comes initially from Europe, it is widely accepted by Chinese that exchanging materials with nature is a way of practising wellness. Chinese medicine tourism is promoted as a potential area with competitive advantage to attract international tourists (Heung & Kucukusta, 2012). However, its advantage is not due to medical facilities, but to a unique medical knowledge system and rich Chinese culture (Tian, 2005). This argument is supported by Smith and Kelly (2006b), who point out that the flow of wellness tourists from developed to undeveloped countries is probably due to such tourists’ craving for consolations in the oriental philosophy and aboriginal therapy. In summary, although we can find certain links between the Chinese traditional culture and wellness in the aforementioned studies, there is a lack of empirical research on the linkage between Chinese wellness culture and wellness tourism. In this study, we attempt to explore this issue through a case study in Bama.

Methodology This study applies a case study approach, which is an empirical inquiry approach that is appropriate to study research problems in an explanatory nature (Yin, 2003). The Bama county in Guangxi Autonomous Region (see Figure 1) is chosen because of its renown as a wellness tourism destination. The total population in Bama was over 270,000 in 2013, with over 86% from ethnic groups, namely Yao, Zhuang and Han. The total area is about 1,971 km2. Economically and culturally, it is a fringe region of China.

Figure 1. The geographical map of Bama.

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Liyuan Huang and Honggang Xu 250 217.67

200 176.41

150

147.09

100

93.81 64.64

50


0

9.07

11.4

12.21

26.2

2004 2005 2006 2007 2008 2009 2010 2011 2012

Figure 2. Tourist arrivals between 2004 and 2012 (Units: 10,000 visits). (Source: Bama Tourist Bureau.)

In the past five years, Bama has established its reputation as a longevity destination through China Central Television (CCTV) broadcasts. The CCTV documentaries on the exploration of the mythical high number of centenarians has brought about a dramatic growth of visitors to the region (see Figure 2). The field work was performed by one of the authors in the summers of 2012 and 2013 (in total 44 days) in Poyue village (see Figure 3), Bama, the most popular place among wellness tourists. The purpose of this study is to understand the behaviours of Chinese wellness tourists, therefore the data collection was conducted mainly by participant observation. The

Figure 3. Map of Poyue village and its surrounding attractions.



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interview results provide additional information to the observation materials and enhance the reliability of this research. After entering the field, the author realised that wellness tourists in Bama were of different health status and were likely to conceal some key information purposely, since personal health is obviously a private issue. Hence, the participant observation method was adopted, as suggested by some researchers in the study of spiritual activities (Bauer, 1984; Gesler, 1996; Williams, 2010). The researcher settled down in a large guesthouse in Poyue village and joined the activities of wellness tourists. She bought a monthly ticket to Baimo cave the most prestigious wellness attraction and probably the main reason that Poyue has become the gathering venue for “the birds of passage” (an alternative name for wellness tourists). She visited excursion sites such as the county town, Jiazhuan County and Bapan Tun (also called the Longevity village or Changshou village in Mandarin). Meanwhile, the researcher also joined a trip to the surrounding tourist sites, such as Shuijing Palace, Jiangzhou Fairy Bridge, and the San-men-hai Scenic Spot (a Karst landscape attraction). She actively communicated with the tourists and listened to their conversations; the field experiences and clues were recorded by field notes and photos. When getting acquainted with some tourists and fellow lodgers in the guesthouse, the researcher was able to conduct semi-structured interviews. The respondents selected were those who were willing to be interviewed, good talkers, and accessible (Johnson, 1990). The interview questions covered the way in which they got to know the place, reasons for visiting, duration of stay, benefits of the place, healing effects, their perceptions of Bama, and personal backgrounds. The questions asked varied by individuals depending on the situation. In her second visit in 2013, the researcher conducted in-depth interviews with 12 tourists, among whom seven were acquaintances known from the 2012 field work. In total, 83 respondents were interviewed. As shown in Table 2, 66 of the respondents were tourists and 17 were locals. The locals include government officials, owners of small businesses, and villagers, who provided official documentations and oral narrations of Bama’s history and tourism development. Each interview lasted from 20 minutes to an hour, and about one-third of interviews were recorded. All unrecorded conversations were noted down shortly after the conversation and the recorded conversations were transcribed afterwards. For the tourist, their motivations to travel to Bama were used as a guideline to identify who were wellness tourists and who were not (Voigt et al. 2011). As long as the tourist’s motivation or benefit sought was health-related, he/she was identified as a wellness tourist. As a result, 55 tourists out of 66 were identified as wellness tourists. Observations

Table 2. The Field Work. Interviewees Time 16 July – 9 August 2012 8 August – 29 August 2013 Total

Place

Tourists

Locals

Poyue village, Changshou village, Bama County Town Poyue village, Changshou village, Baima village, Bama County Town, San-men-hai Attraction in Fengshan County

54

11

12

6

83


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were made mainly by going to the places where those wellness tourists frequently gathered or by following the morning excursion routes taken by the wellness tourists. Observation notes, documents from officers, and interviews with the tourists were the information sources used by the researchers to analyse the case. Observation notes were the primary data used in this study. The interview transcriptions were used to corroborate the findings, identify the motivations and clarify who were wellness tourists. The transcriptions were manually coded by the researchers. In the findings section, we use direct quotations from the interviewed wellness tourists to verify and provide further evidence on the findings from the observations. Since health status is a sensitive topic concerning the privacy of the interviewees, in the following sections, the “surname + alphabet + gender” pattern is used to represent the interviewee. For those who did not disclose their names, their place of origin is used to represent them. Analysis is a process of transforming data into findings. There are plenty of guidelines for qualitative analysis. Based on the field work and previous studies, analytical induction was considered to be the most suitable analysis method. Analytical induction, in contrast to grounded theory, which aims to construct theories from field work data basically (Glaser & Strauss, 2011), begins with propositions or theory-derived assumptions and then verifies these propositions and assumptions based on qualitative data (Patton, 2002). This method is useful in examining existing propositions rather than discovering emergent concepts or generating new theories. The assumption in this research, that the Chinese Yangsheng culture plays a key role in understanding wellness tourist behaviours, comes from both previous studies and the impressions in the field work. The Chinese cultural lens was applied to understand the observation data in the data analysis process.

Findings The majority of the 55 tourists interviewed were from middle to old age (see Figure 4). Of the 55 tourists, 31 were male and 24 were female. Twenty-four of them were from Guangdong, while the others came from Chongqing, Beijing, Hubei, Hunan, Heilongjiang, and so on. With regard to their health condition, 20 of the tourists claimed that they were healthy, 18 had chronic illnesses such as cardiovascular disease, and

The Distribution of Age 19

20 18

16

16

13

14 12 10

No.of Tourists

8 6 4 2 0

3

2

1

1

31–40 41–50 51–60 61–70 71–80 81–90 91–100

Figure 4. Age distribution of the 55 wellness tourists.


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diabetes, four were cancer patients, and 13 did not provide information. Twenty of the interviewees were first-time visitors, while the others had visited the place at least twice. Unlike Western wellness tourists, the tourists to Bama showed strong cultural characteristics in their behaviours. They carried out many activities that follow the principles of Yangsheng: a holistic approach towards health care and recovery, being with nature, exchanging energy and materials with nature, moderate exercise and food therapy.


Activities at Baimo Cave Baimo cave consists of many interlinking large caves and craters surrounded by the Panyang river. The term Baimo means “spring outlet” in the local Zhuang dialect. Baimo cave is renowned for its magical effect on health, and the Panyang river is believed to generate highly-concentrated negative oxygen ions. The density of anions in the air is claimed to be as high as 60,000 to 90,000 per cubic meter, which is demonstrated on a projection screen inside the cave, while in normal situations there are only few hundred per cubic meter. It is believed that the cave generates strong terrestrial magnetism. A female interviewee, ECF from Hubei, showed the researcher the location where the strongest magnetic field was detected. A single entry ticket to Baimo cave cost RMB 70. A monthly ticket cost RMB 300 in August 2013, rising from RMB 150 in the previous year, which only allowed 15 days of visit per month. Even though the entrance fee had been doubled, more and more visitors came to visit the cave due to its reputation and its magical charm for health. Usually, both guided tour groups and wellness tourists visit the cave in the morning but only wellness tourists remain in the afternoon. It is said that tourists can enjoy either magnetic treatment in the cave or taking in more oxygen in the craters, where people are exposed in the open space. It was observed that in the humid and cool cave, some tourists would simply sit quietly on the benches, and occasionally chatted with others in low voices. Visitors were laying down on mats, practising Tai Chi, and performing group dance guided by a leader in the cave. In the crater, some people queued to get water from the Panyang river, some performed Tai Chi along the road or sat near bushes with a parasol on a small stool, while others played musical instruments such as cucurbit flutes. Contemplation and retreat, which are perceived as spiritual benefits to wellness tourists, were also observed in Baimo cave. Water-related Activities According to Chinese understanding, water nourishes everything and is the source of life. In Bama, it is common to see tourists carrying various sizes of water bottles. Although tap water is readily available in the village, the tourists prefer to obtain underground water themselves, either from the Baimo cave, or from the Min mountain where the water is cleaner and fresher. Tourists use the water for drinking and cooking. They have a strong belief that the underground water is better than that from other sources. If you do not drink water from the Baimo cave, you come for nothing. The water here is hexagonal water. The duration of one cycle of body water is 18 days. I have been here for 54 days and have gone through three cycles. Now my body is weak in alkaline. (LiAM) Tourists believe that the water has been tested and analysed by authorised institutions, and is therefore safe to drink. The locals also promote the water for its quality.

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Liyuan Huang and Honggang Xu We all drink tap water here without boiling. Visitors are surprised to see this. Water here should not be boiled because its vigour will be lost. There are some outsiders asking us to deliver our water to them. (HuangEM, a local businessman in tourism)


Air (Qi), Qigong and Exercises The Chinese word Chi, or Qi is a very complicated concept and can only be explained by those who have learned it systematically. However, the concept of Qi is closely related to breathing; therefore air quality is important and appreciated in Qi-related exercises. Tourists tend to join more outdoor activities such as dancing and practising Qigong in Bama due to their belief that Bama is a place full of negative ions which are beneficial to health. Some tourists claimed that they did not have an out-of-breath feeling when they climb the mountains when they were in Bama. Climbing Baiyun mountain (located in Guangzhou) is very different from climbing Min mountain. I feel breathless and out of breath there. But in Bama, I do not feel that. I take deep breaths and even want to breathe more. The air here is so fresh. (MaiAF) In Bama, tourists always use open spaces. The spacious countryside setting provides them with a pleasant place for activities. Baimo cave is the most popular among the scenic spots. Many tourists would not enter the cave; they stay around the entrance close to the Panyang river, dancing, singing or chatting with one another. The Min mountain is also popular with tourists; tourists like to walk along the trails for 4 to 5 km. Fresh air seems to be important to tourists visiting Bama. For instance, Changshou village, which is 4 km from Poyue village, is promoted by the local government as a longevity village. Although the landscape along the Panyang river is attractive and suitable for excursions, tourists seldom travel between the two villages due to busy traffic and auto vehicle emissions. Food and Medicinal Herbs Chinese wellness philosophies submit that longevity is heavily dependent on an appropriate diet, in which herbal medicine is an important supplement. Based on the Five Elements theory, healthy food needs to be in line with the seasons. In Bama, tourists tend to believe that local food is “ecologically” (organically) grown, more authentic and rustic than food offered in cities, and hence is good for health. The most famous local specialty in Bama is the Fragrant Pig. The longevity foods promoted in Bama are Fructus Cannabis, a Chinese medicine herb, and corn. Fructus Cannabis can be ground into powder and used for soups. Tourists said the following regarding the food. Corn porridge here is very tasty indeed, and richer than that in the cities. The pork here is local, and it won’t take much time to stew. I only cook it for 40 to 50 minutes. (ZhouAF) I bought a kilogram of honey at RMB 36 and take two or three spoons every day. I bought dozens of kilograms every time I visited. I took with me 10 kilograms last year. (XiangAM)


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The local market is popular among wellness tourists and has been expanding over the last two years. There is a variety of food and medicinal herbs for sale, such as cannabis pastry, Fructus Cannabis, cannabis oil, millet, black millet, pearl barley, corn, dried bamboo shoots, lotus root starch, star anise, cinnamon, dried mushroom, agaric, white butterflies, chrysanthemum, jasmine, hawthorn leaves, and so on. All these herbs are claimed to be locally grown and produced. Wellness tourists in Bama tend to be serious about the food they buy and eat. Some tourists visited the villages to find out what is planted and eaten. They learned how to identify local corns from those from outside the area. Local produce would be preferred. For instance, Ganoderma, which is popular in other attractions, is not preferred by tourists in Bama as it is believed to be not locally grown.


Visiting Elderly Local People In the Chinese culture, wellness would naturally lead to longevity. As a cultural connotation, the word “longevity” implies quality of life, virtue, and fortune. Longevity is the most invaluable brand asset for Bama. For many tourists, Bama can be regarded as a Fengshui habitat with good natural environment and energy forces for health. There may be other places with a natural environment which is similar to Bama, but the county was named the town of longevity … which cannot be imitated. This is a brand effect. (BuAM) A lot of tourists hope to understand what drives longevity, thus a visit to local centenarians becomes a must on their agenda. They usually greet the elderly, ask about their daily lives as well as their wellness practices, and express their blessings by giving the elderly ‘lucky money’ in red pockets. What impresses wellness tourists the most, is that the elderly engage in lifelong labour work regardless of their age. Another impression is the local people’s lifestyle and attitude toward life. As commented by a tourist from Chongqing: the people here do not plan for anything. They do not plan for what to do the next day or the next month. They just do what they need to, eat when they are hungry, sleep when they are sleepy, and work when they have to. They have a simple mind and live a simple life. (YuCM)

Discussion The Practice of Daily Wellness Activities China is experiencing rapid economic growth, at the cost of a severely polluted environment, especially in the urban areas. Meanwhile, with increasing income and also rising costs of medical service, the demand for health and wellness has been rapidly growing. The high demand is reflected in the development of health and wellness tourism, and the search for good health in other places. Although travelling for wellness has only emerged in recent years, wellness practices in a Chinese life style have been long established. The wellness activities identified in the case of Bama, such as breathing, exercising, sitting and resting in a natural environment, and food therapy are often practised in the daily lives of urban Chinese people who do not have time to get away but want to stay healthy.

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Why Tourists Choose Bama as a Wellness Destination The development of Bama into a popular wellness destination provides an interesting case study. The research shows the constructive nature of a destination in its process of turning into a healing place. Bama has a better environmental quality than the urban areas and has a unique scenic landscape. Yet nearby places, such as Fengshan, enjoy similar environmental qualities but are seldom being by tourists. As pointed out by Gesler (1996), scientific data are not necessarily important to determine the value of a destination, on the contrary, what tourists perceive regarding a destination plays a more determinative role in its development. The beliefs in the healing power of this particular venue are supported and reinforced by several factors: marketing by the most respected media, CCTV; the pleasant and beautiful landscape; the harmonious village; the approachable centenarians; the remedial properties; and a few healing examples. The aforementioned factors work together to enhance tourist perceptions of the wellness benefits from the Yangsheng principles. In the field work, it was evident that people select Bama because they believe it is a magical place for health, which is supported by word of mouth, personal experiences, scientific evidence as well as stories broadcasted by the media. CCTV is the most influential and reliable information source for seniors in China due to its authorative status. Since 2008, CCTV has made a series of documentary films on the longevity in Bama. In these programmes, CCTV addressed some of the following “facts” about Bama. In the 1970s, a group of medical experts, organized by a Chinese gerontology association, implemented an exploratory investigation on centenarians in Bama. The International Nature Medicine Association, set up by a Japanese doctor, frequently published articles about Bama during 1991–1995 and organised three conferences on the theme of Bama. Since then, Bama has been promoted as a miraculous wellness destination by the local government. CCTV also broadcast some life stories about healing. For instance, Professor Chen from Guangxi University was diagnosed with leukaemia, but later he regained his health in Bama. He bought a house in Bama and frequently spends his time there. He is keen to share his story and has become a witness to the magic healing power of the place. These TV programmes and anecdotes are well-known among the tourists. Although they might not have watched these TV programmes, they could have received the message from other sources and developed faith in it. My home town is in Jiangxi [a province in the eastern part of China]… I managed to purchase a piece of land there. It cost me over 1 million dollars and I furnished a house. I planned to stay there initially, but that place is not comparable to this [in terms of the environment]…. As you see, they have got real data. CCTV would not report without a clue. In addition, an international natural medical association also recognises that Bama is a longevity place. (ZhouBM) The comments from the international medicinal association also added a scientific flavour to the place and gave people more confidence. According to the Bureau of Statistics in Guangxi in its Sixth National Census in 2010, the longevity phenomenon in Bama was proven by the surprising data that 20,200 residents in Bama were over 65, and 80 people were over 100. It is common to see old and healthy people around in Bama. Visiting and talking to the elderly people also reinforce the tourists’ belief in this place.


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Introduction of Science into the Traditional Wellness Culture The tourist’s behaviours and practices observed in Bama basically follow the wellness tradition in China. It is observed that wellness tourists attempt to build a connection with nature by various means, such as excursions, Qigong, Taiji, meditation and food. The way in which these behaviours actually work on human health is, however, not well understood by Chinese. In fact, apart from some common concepts such as balance, the hot or cold characteristics of food and the human body, other Chinese concepts or knowledge such as Tian-ren-he-yi, Wu Hsing, or even Yin and Yang, are not really sufficiently discussed or understood in Chinese society – nor is more sophisticated knowledge, such as Neijing. Instead, people talk about the terms which sound “scientific”, such as high density of negative oxygen ions, weak-alkaline hexagonal water and strong magnetic strength of the earth, because formal education and medical institutions nowadays are very much in favour of these evidence-based scientific approaches rather than Chinese traditional knowledge. The “scientific” terms, therefore, are more powerful than the traditional knowledge. Yet, people do not genuinely understand or bother to understand how these elements work scientifically. These “scientific” terms serve as a function to reinforce the practices and beliefs people learn from daily life throughout the centuries.

Conclusion In the process of China’s modernisation, traditional Chinese knowledge on wellness and herbal medicine has been greatly neglected in the formal education system. This results in ignorance of the classical literature of health or wellness philosophies and sophisticated principles such as Neijing. However, through the centuries, these principles have been transformed into common knowledge and daily practices of the Chinese. Overall, these Yangsheng principles are based on the tenet of building a connection between the universe and humans in a holistic way. As a result, what the Chinese wellness tourists would like to do is to be in a quality natural environment. The behaviours of wellness tourists in China can be observed to be quite similar to some of the wellness tourists’ behaviours in the Western world. Altogether these activities promote a good lifestyle to enable one’s body, spirit and mind, to be harmonious with the environment (Dunn, 1959). These activities such as being with nature, doing exercises in nature, have also been proved by geographical science and environmental psychology to promote better health for human beings (Huijbens, 2010; Rodrigues et al., 2010). The value of traditional wisdom to improve health should therefore be reassessed. What the authors further argue is that, in China, these behaviours are based on common beliefs and knowledge inherited through the centuries, although some people do not know or have forgotten the reasons behind the Chinese knowledge system. This is where culture takes effect, and also the most effective way to promote wellness activities and behaviours. This understanding may also be applied to other Eastern countries, such as Thailand and India, where there is a strong tradition in healthcare and wellness. Understanding the Chinese Yangsheng knowledge and its impact on wellness tourism will help in formulating policies for relevant industries both in and outside China. As for healthcare policies, there is a need to reflect on the current healthcare policies, which have been very reliant on official medical institutions and western scientific knowledge in health. The traditional wellness practices gain little support from the government. With some governmental inputs, traditional wellness knowledge and practices can bring greater benefits to society. Some training programmes and information on the traditional


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knowledge of wellness, for instance, should be delivered with government support. As for the destinations, although wellness tourism can bring potential economic benefits, it can be seen that destination quality management and reasonable cost for services are crucial for the sustainable development of wellness tourism. A proper destination management plan should be formulated, implemented, and monitored. More important is the cooperation between the tourism and health authorities (Hjalager, 2011; Voigt et al, 2010) to formulate policies incorporating wellness therapies into the healthcare system and enabling everyone to benefit from wellness tourism, so as to achieve the social benefits of wellness tourism. For Bama, there is an urgent call for an environmental protection plan. Much concern has been raised after the field trip. It was observed that tall buildings have been constructed within a short period of time, replacing the local village houses. The tourists rushing into Bama have undoubtedly brought economic benefits to the villagers, but they also disturb the peaceful life and tranquil environment there. The local infrastructure, such as drainage and garbage disposal facilities, is unable to meet the increasing demand. Busy traffic causes air pollution due to auto vehicle emissions. The decay of the environment will not only drive away tourists but also the local people who have been living there for decades. This study has some limitations. First, the wellness tourists interviewed were those who seemed to be more accessible, for example, fellow lodgers staying in the same guesthouse. For those who rent the villagers’ houses and seldom go out, the current tourist sample may not be representative. As data were collected in the summer time, the views of those wellness tourists who visit Bama in other seasons may be underrepresented.

Note 1.

“Brush talks from dream brook” and “The scholars”.

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