Saturday, February 18, 2017

〈When Doctors are patients〉: My Struggle with Prediabetes for 15 years

When Doctors are patients:
My Struggle with Prediabetes for 15 years

Jen-Yih Chu MD, PhD

Department of Medicine, St. Louis University School of Medicine and Cardinal Glennon Children’s Medical Cental

Preface
When I went back to Taiwan 4 years ago, my twin cousins returned a few books I gave to them. Both are physicians and just a few years younger than me. When I left Taiwan for the United States soon after graduation from medical school, I gave these books to them. One of these books is a Chinese translation of When physicians are patients edited by Doctors Max Pinner and Benjamin Miller (Picture 1, reference 1).
Picture 1.  Book cover of “When physicians are patients edited by Max Pinner and Benjamin Miller


I bought the book while I was a medical student and was very impressed. It is interesting to know that I wrote some notes at the end of the book more than 50 years ago. I wrote some comments that this was a great book and I should read again time to time. After I came back to US, I went to the library and borrowed the original book  which was published more than 60 years ago.
Both the original English and Chinese translation books had very moving stories about how and why the book were written or translated.  After searching I also found a  book review about the original book. (Picture 2).

Picture 2.  Book Review



After I read the Chinese translation again and also the original book, I wrote two articles in the Taipei Medical Association Magazine about these two books. I also made a plea to the physician colleagues in the articles. In order to continue this kind of spirit¸ let’s write similar but modern stories. If physicians write more about their stories, it will give the general public more accurate health information and it also will benefit physician authors as mentioned by many writers/translators in both books.
A physician friend saw my plea and asked me why not write an article about my experience as an example. He said at the age of 75, I must to have suffered from some medical problems.  Indeed, I have been hospitalized a few times and had a few surgeries. I agreed to write and hope my writing will encourage other physicians to write their experiences.
 I decided to write my own experience about my struggle with prediabetes for the last 15 years. The problem of diabetes has been increasing exponentially in the last few decades especially in the developing countries with new found wealth. Taiwan is one of these places.   
We all know that there are many problems once we have diabetes. The diagnosis of diabetes is frequently delayed because there are hardly any obvious signs and symptoms at the early stage. Most of those with early diabetes have no pain, no fever and other obvious discomfort. However, the major and capillary vascular damages occur at the time of prediabetes, well before the diagnosis of diabetes.  
Fortunately, the damage is rather mild as compared to those with full-brown diagnosis of diabetes. The morbidity and mortality increase tremendously after the blood glucose reached the threshold level of diabetes. Therefore, it is important to find out whether we have prediabetes or not.

The definition of prediabetes
             
            Quite different from preeclampsia, which is usually presented with edema, hypertension and/or proteinuria, prediabetes generally has no signs and symptoms. Therefore, we need to “find” the condition.  Even without any sign and symptom, people with prediabetes have slight higher mortality rate, higher cardiovascular diseases and other medical problems then those without.
The term of prediabetes was quite vague just couple decades ago.  The term of prediabetes has been implied by some for those developing diabetes during the pregnancy. The term of “borderline diabetes” has also being used for a while. The term of prediabetes was better defined when American Diabetes Association (ADA) set criteria for the diagnosis of prediabetes in 1997. The World of Health Organization (WHO) also followed the suit and set the similar criteria in 1999.
The originally criteria of fasting glucose of 110-125 mg/dl as prediabetes was later changed to 100-125 mg/dl. WHO and International Diabetes Federation (IDF), however, did not follow ADA. The criteria were somewhat confusing.  In 2011, the term of “categories of increased risk for diabetes” was introduced by ADA. Generally, these two terms are used exchangeable (Table 1). The 2015 criteria of prediabetes are set as the following table. (Table 1)

Table 1.  Laboratory definition of  Prediabetes/Categories of Increased Risk for Diabetes.


The main purpose to present these terms and criteria of the diagnosis of prediabetes / Categories of Increased Risk for Diabetes is to alarm people to be more careful.  Once anyone has prediabetes, it is very likely it will progress to diabetes if nothing is intervened.  Once the threshold of blood glucose levels of diabetes is reached, the vascular and other damage will increase tremendously.  Morbidity and mortality may increase few times higher.
The chance to become diabetes is much higher in prediabetes than people with normal blood sugar. Quite a few studies found people with prediabetes progressed to diabetes at the rate about 10% a year, if they did not change their life style or taking medicine.
My Own Experience how prediabetes was found
            About16 years ago, I had some leg and back pain. When I was first seen by my primary doctors, quite a lot of blood tests, imaging and other studies were performed. My physician missed my abnormal fasting blood sugar. My fasting blood glucose was just over the diagnosis of diabetes (127mg/dl) . My doctor did not tell me that my glucose level was higher than the criteria of diabetes.
            My leg and back pain gradually got better and I did not go back for follow-up.  I visited another physician for an unrelated problem a few months later. I was seen by a medical student first. She looked at my chart and told me I had diabetes and she showed the blood glucose result to me. I was “shocked” to know that.  In order to confirm the diagnosis, I went back to my primary doctor to repeat the blood tests as indicated at the end of in the next Table2.

Table 2. The 2015 criteria for the diagnosis  of diabetes.

            The repeated blood tests including A1C, fasting glucose and 2 hour after glucose loading were all in the range of prediabetes and did not reach the criteria of diabetes in the past 15years.
Literature Review
            After the diagnosis of prediabetes, I had a discussion with an endocrinologist colleague,  and he recommended a new medicine to me. I just asked him in the hallway or in the lounge.  He did not examine me in his office. Fortunately, I did not follow his advice. The medicine he suggested was later reported to have quite a few significant side effects.
            I did considerable literature search and had discusssion with my physician. He agreed with me that taking medication should not be the first step. Life style change is more important.  After reviewing the literature, I believe there are 3 independent factors of my life style I should follow carefully.  The three factors are: 1) weight control 2) increase physical activities through labor and exercise 3) modifying my diet.
There are a lot studies confirming the life style change is the most effective means to prevent or delay the advancement of prediabetes to diabetes. Many studies showed those with prediabetes decrease their risk of developing diabetes at least 50% if they undergo an  intensive education program to modify their life style.
After reviewing literature, I remind myself time to time that I have a high risk of diabetes.  Once the criteria of diabetes are reached, I have much higher mortality rate and much more health complications.  I tell myself I must work hard to modify my life style in order to prevent or delay the progression of prediabetes to diabetes.
How I try to modify my life style
I know I should work on these three important and independent programs mentioned above.  Good weight control is effective even without increasing physical activity or changing diets. Similarly, labor/exercise will also benefit diabetes prevention without any effort on weight control and diet change. There are many different dietary programs recommended by the experts, there are still some common rules.  I can follow.
1)      Weight Control         
Body Mass Index (BMI; ie dividing weight in kg)by height in meter square) is a good guide for weight control.  In general, BMI of 25 kg/m2 is set as the normal upper limit.  Above 25 is overweight and more than 30 is obesity. In Asians, many organizations use 24 (some even use 23) as the cut point for upper normal limit, 28 and more as obese.
In a nurse study in USA, if BMI of 18-22.9 is base index of 1, the risk to have diabetes for those with BMI of 23-24.9 was 2.67, for overweight of 25-29.9 was 7.59, for those of obesity at BMI at 30-34.9 was 20.1, severe obesity at BMI of over 35 was 38.8.
 Various bariatric surgical procedures to lose weight is enough to improve the condition of diabetes or prevent diabetes. To control weight by labor/exercise and diet will have much better results.
I tried very hard to control my weight. When I knew I had prediabetes, I was close to 60 years old. My weight was about 145 pound.  I lost about 10 pounds and I did try to lose weight to maintain a BMI around 22-23. There are considerable data that the BMI at the borderline of overweight (i.e. 25-27 ) has the lowest mortality for seniors.  I did not find the data for East Asian in US. However, I found a report from Hongkong. It is best not to increase or decrease the weight for seniors (>65 years old). Now, I try hard to maintain my weight around 140-142 pound my BMI at 23 or slightly higher.
2)      Labor/ Exercise
Insulin resistance is the main feature in Type 2 diabetes.  Because of insulin resistance, the functions of insulin decrease. With the blood glucose increases and glucose and lipid metabolism are in dysfunction. Increase in physical activities is effective to decrease insulin resistance. Labor and /or exercise not only decrease the blood glucose it will also increase high density (good) lipoprotein and decrease the low (bad) density lipoprotein and triglycerides.
Most articles discuss mainly the benefit of different exercise, I believe labor should be emphasized. In a few developed countries, the people that live the longest and are the most healthy are those in the areas the people need to do more labor such as Okinawa of Japan.  We should learn from our ancestors. Just a few generations ago, our grand and great grand-parents needed long hours of labor to make a living, hardly anyone of them got diabetes.
I like vegetables gardening(Picture 3). There are many folds of benefits to grow vegetables in your own garden. Labor for gardening is quite significant. Not only are the home growing vegetables without insecticides more healthy, I eat more vegetables just because I grow them myself and I don’t want to waste them.
Any kind of labor such as cleaning house, yard or other household work all can achieve the same or better effects as exercise. I don’t need to find a gym. Labor has another superiority, the brain coordinates the different parts of body to complete the task. Labor may be better than certain monotonous exercises.
Picture 3.  Healthy vegetables growing from a small area need a lot of labor.

 
    
            No exercise is too small to do. When I get older, I can’t do more strenuous exercise. I walk quite a lot regularly as my routine exercise. I use stairs instead of elevator except when it is more than 5 floors. Sometimes, I purposely choose to walk to a place to talk to people instead of using phones. I park my car in the far away areas in the parking lot.  I like to go to shopping with my wife because I can walk in the mall while she is shopping.
            In order to “force” myself walk more, I turn off the water in the bathroom in the first floor at home. I forces me to walk upstairs regularly. I use the printer in the larger office far away so I can walk more. I don’t  get my coffee in the next room, I go to the main lounge 2 floors above.
3)      Dietary management
There is a lot of evidence that dietary habits in rich societies contribute significantly to the current world epidemics of diabetes.  The tremendous increase in diabetes in the world in developing countries is due to the abundant and easily available Western foods.
What is the best diet program that will help to prevent or delay diabetes is quite controversial.  I try very hard not to eat too much in order to keep my weight stable.  There are many different diets recommended for those with diabetes and prediabetes.  Even though there are many quite different diet programs recommend, there are some common grounds I can follow.
I eat less meat, especially beef and pork, of course less animal fat. I eat chicken, turkey and fish instead. I avoid bacon and butter in any kind of food in any meals. I eat a lot of vegetables and fruits. I use different kinds of vegetable oils especially olive oil. Try hard to eat food made from whole grains.
I try very hard to avoid junk foods such as french fries and donuts (Picture 4).  I only occasionally eat one quarter of a donut or an order of fries. In restaurants, I eat only part of dessert. Small portion of desserts I enjoy are mainly homemade, the types prepared with much lower portion of sugar and fat.
Picture 4.   Food I try hard to avoid.
 
The dietary program I described above probably will be most consistent with a Mediterranean diet. I use more olive oil and eat more vegetarian meals than I used to in the last few years.
I eat mainly home cooked simple meals. During the season, we used a lot of vegetables from my own garden and other commonly available ingredians. I try hard to avoid delicious food in the restaurant because those are generally prepared with a lot of salts, animal fats and sugars.
To stick to “healthy diets” is not an easy task. Many studies show different kinds of diet programs have very similar effect of losing weight gradually. The maximal effect is usually achieved around 6 months. People then start to gain weight gradually.  Many people participating in the studies eventually regain their weight after the programs are terminated. Of all diets, Mediterranean diet has the best reputation that people will continue after the study program is finished. In addition, some studies showed the Mediterranean diet probably the “best” diet program for people with diabetes and prediabetes.. 
How to self-discipline : 
Once I knew I had prediabetes I started above program immediately. I did not postpone to a later day. In order to maintain these programs of labor and exercise, healthy diets and good weight control, self-discipline is the most important issue. Good blood sugar control achieved for a short period isn’t enough. We need a plan to make the good control to last “forever”.
During any study program, people are monitored closely by the program management team. Nurses or other personnel in the team will teach or remind them frequently how to modify their life style. They are reminded of their exercise program and diets. Once the program finished, many “relapsed” to the old life style and lost the good control.  I borrow the idea how to monitor myself closely like the study programs.
In the beginning, I use quite different ways to remind myself to stick to the good life style. I bought a pedometer to make sure I walk enough steps every day. I recorded the steps on a calendars for a few years. I also recorded my main course of meals every day. At the end of month, I review my dietary history of the month and make adjustments later according to my record.
In addition, I bought a home use glucose monitoring devise. I check my fasting blood glucose every few days or during my trials of special diets and/or exercise programs.  When I go to see my physicians, I ask them to order A1C for me. I monitor my status of prediabetes very carefully.
 I believe all these different kinds of monitoring system remind me of what study coordinators would do. As a high risk person of developing diabetes, I need those systems to remind me to continue  a good life style and do my best to get good control.
Conclusion:
Because of reading an old book When Doctors are patients which was published more than than 60 years ago, I tried to write my own experience about my struggle with prediabetes in the last 15 years. Try hard not to let prediabetes becoming diabetes with weight control, labor/exercise and diets. Most importantly, how to self-discipline myself  to stick with a good life style is the most difficult one.

Reference:
1)      Pinner M, Miller BFWhen doctors are patients. 
         New York, WW Norton and Co., 1952.

Monday, February 13, 2017

TAIWANESE HAKKA

TAIWANESE HAKKA,  
General Information about Hakka

INTRODUCTION

Content

GENERAL INFORMATION ABOUT HAKKA
   1. What is Hakka
   2. Origin of Hakka
        2.1 Westerners' views
        2.2 Chinese's views
             2.21 Lo, Hiong-lim's studies 
             2.22 Fong, Hok-ka's studies
             2.23 Chin, Chii-phin's studies    
        2.3 Modern Biological Studies       
CULTURE AND LANGUAGE OF HAKKA IN TAIWAN
HISTORY OF HAKKA IN TAIWAN 
 

1. WHAT IS HAKKA ?

        The "Hakka" in Honsii(Han characters) means "Guest People" literally.  It is
still not certain why, how and when the term "Hakka" was used. The CD-Rom 
encyclopedia "Encarda" that comes with many computer describes Hakka as 
"term applied to a migratory people of southern China."  However, Hakka 
probably have been in southern China for thousands years.  They are not 
migratory. Many moved to less populated areas because of the pressure of 
population growth. Hakka moved and settled in Taiwan also hundreds years 
ago.  Most of them live in farming community before. They are not "Guest 
People" of their community. Some are "newcomer" in certain areas. The term 
"Hakka" is not appropriate but sticks to this group of people for centuries.

2. ORIGIN OF HAKKA:

2.1 Westerners' views:

        The CD-Rom encyclopedia "Encarda" said "They are thought to be 
descended from the Burmese or Thais or from the aboriginal inhabitants of 
northern China.  The Hakka have always been persecuted by the natives of 
the regions in which they have settled."
 
        The above statement is really very vague.  The author probably
wrote it purposely that way because the origin of Hakka is still not well
understood.  There are many theories based on different studies.  There are
no consensus about it. It varied from "pure" Hon (Han in Mandarin) people
to southern or northern aborigines of China.
 
        The discussion of Hakka in The Encyclopedia Americana (by
Grolier Inc., 1982 edition) is somewhat different. They said the origins of
Hakka are unknown and the most common opinion is that they moved
from northern or central China in stages whenever population pressures
demanded or during periods of frequent warfare.  They moved to
Kuangtung in 13th century. Because they were late comer and were not
welcomed  into the settled lowland and delta communities and they were
forced into less fertile uplands.
 
        Another popular The New Encyclopedia Britannica (Encyclopedia
Britannica, Inc.,1989 edition) said that "group of North Chinese who
migrated to South China, especially Kwangtung and Fukien provinces,
during the Southern Sung dynasty (1127-1279), when North China was
occupied by Inner Asian tribesmen."
 
        More professional or scientific view-points from western scholars 
should be available. I did not try hard to find more information. No doubt to 
anyone, there are many different theories.  One popular book "The Languages 
of China" by S. Robert Ramsey (Princeton University Press, 1987) has a short 
comment about Hakka in the next two paragraph. More recent information will 
be discussed later in the modern theories section later, please read that 
section for details.
 
        " The name 'Hakka' is a word of Cantonese origin literally means 
'guest' or 'stranger'. The Hakka were called this when they began migrating 
into Yue-speaking territory, and the exotic name seems to have stuck quite 
simply because, until fairly recently, many Cantonese and Min mistakenly 
thought that the Hakka were not Chinese at all, but rather some kind of 
strange non-Han "barbarians" like the Tai or the Miao. In many parts of 
South China, these 'guest' are still treated as outsiders and intruders even 
though everyone now concedes that they are Han Chinese.
 
        The Hakka identify themselves as Northern Chinese, and this 
contention has some basis in fact.  Local genealogies and other historical 
records indicated that many of the ancestors of the Hakka were people 
originally from the Northern Plains who in a series of waves migrated deeper 
and deeper into the South.  What remains to be explored, however, are the 
contributions made by local populations to the formation of the Hakka people, 
and how these differed from those that made up the Yue or the Min.  For no 
matter what the ethnic origin of the Hakka, the group is linguistically 
Southern Chinese. The Hakka dialects are historically allied to the other 
Southern dialects around them.  The have some unmistakably Northern features, 
but they are actually not much more like Mandarin than Cantonese is.  The 
Hakka dialects were formed in the South--almost surely in northeastern 
Guangdong--and the present widespread distribution of their speakers is the 
result of large-scale migrations that took place out of Meixian during the 
Qing dynasty." (above two paragraph from Ramsey's book)
  

2.2 Chinese's views:

        However, some literature written in Chinese especially those 
by the Hakka scholars claimed Hakka were originally from northern China
The Hakka ancestors migrated by stages to southern China because their
"homeland" was occupied by "barbarian" tribes. They claimed the Hakka
was the most authentic Han.  Their studies were based mainly from Hakka's
"family tree book" (Tsu-phu). The classic research was done by Professor Lo,
Hiong-lim (  ). However, many recent studies in China, including some 
Hakka used more scientific studies based on anthropological, social and
linguistic evidences and concluded that Hakka is originated primarily from 
southern ethnic groups rather than migrated from northern China.  That view
is represented by Professor Fong, Hok-ka's (  ) book.  He wrote a book 
"Investigation in Depth about the Origin of Hakka (     ,
first published in China 1994, new edition published in Taiwan 1996 ).
More studies to compare the Tsu-phu of Hakka and non-Hakka were done by 
few scholars especially Professor Chin, Chii-ping (   ).  To no 
surprise to many people, they have another view that is different from 
professors Lo and Fong.  Professor Chin basically believed the Southern 
Chinese all migrated from northern China but there are no difference between
Hakka and non-Hakka. Here we summarized the conclusion of these three 
different views.
 
        Lo, Hiong-lim (Hsiang lin Lo,    ) is the first studied the 
family tree book systematically.  He published two books "An Introduction 
to the Study of the Hakkas: Its Ethnic, Historical and Cultural Aspects" 
(1933) and "The Study of the Origin of Hakka" (1953).  The citations about 
the origin of Hakka from northern China came mainly from these two books. 
In the first chapter of first book, Mr. Lo wrote a lot about the armed 
conflicts (sie-teu, hsie-to in Mandarin ) between Hakka and local 
groups. Partly because of these conflicts, non-Hakka groups called Hakka 
not Hon (Han) people.  Many Hakka scholars and government officials started
to publish articles and books to argue that Hakka are Hon people.
 
        In that chapter, he mentioned in length about Cantonese 
calling Hakka "barbarian" tribes. Cantonese even used the Hon 
character with "khien" (ch'yuan in Mandarin, dog, ) next to the "Hak" 
character or called Hakka "ch'i", a Hon character with the "dog" sign.  A 
textbook about world geography published in Shanghai in 1920 had following 
statement "In the mountains are many wild tribes and backward people such 
as Hakka and Ikias".  Similar incidents happened again and again. Partly 
because of these incidents, many Hakkas started to form organizations and 
publish own journals to defend the Hakka are indeed Hon people.
 
        In the first chapter, page 12, Mr. Lo summarized the 4 theories of 
the origin of Hakka in 1933 before his own research.  #1 Hakka are one 
tribe of Miao and Man ("Barbarian" ) of southern China. #2 Hakka are the 
descendants of ancient Yet tribe (Yue in Mandarin,   ). #3 Hakka 
originate from northern China but are not Hon. #4 Hakka are the most authentic 
Hon people. Mr. Lo's book has a lot of references in each chapter. 

2.21 Mr. Lo Hiong-lim's study

        After the very good induction, his second chapter discussed the 
origin of Hakka. He started with a definition of Hon.  "Hon is a mixture of 
numerous tribes or ethnic groups that resided in East Asia". With this kind 
of definition, it is not that important whether Hakka Hon or not. He then 
wrote about how he reconstructed five stages of migration of Hakka using 
the family tree books.
 
        #1 MIGRATION:
        The first stage started in East Chin (Tsin,晉) dynasty when the 
northern China was occupied by northern "barbarians".  It is about AD 
317-819. He based on the descriptions of 8 family tree books.  Mr. Lo he 
himself also admitted in the book (page 43), "these description although 
is rather fragmented, it is still able to speculate that Hakka ancestors' 
migration to south began in East Chin era".  The evidence is based on the 
description such as "our family ancestor moved to south because of Five 
Barbarian disturbed China (Five Fu loan Fa    )". 
 
        The family tree books have the tendency to use the famous people as 
their ancestors.  For example, the Liu' family, the first family he cited, 
originated from the second son of King Liu Phi (Liu Pei, ) of famous 
Three Kingdom era. Many ancestors of other family tree books were government 
officials. Mr. Lo also cited some history books about the new counties 
established in provinces along Yangtze River during the East Chin era as 
the evidence of first Hakka migration.
 
        #2 MIGRATION:
        Mr. Lo's theory of second migration started in AD 874 of late Tang() 
dynasty.  Because of poor harvest for years, famine swept the northern and 
central China. Vong Chhau (Huang Ch'ao,黃巢) was able to get hungry people 
together to rebel. These undisciplined army murdered thousands and 
thousands people.  According to Mr. Lo, during the Vong Chhau's era, the 
Hakka ancestors moved again from Yangtze River areas to further south.  
Again, he based on more than 10 family tree books to back up his theory.  
During the second migration, Hakka moved to southern Kongsi (Tsiang-hsi,江西), 
western Fukkian (Fu-tsien,福建) and few to eastern Kuangtung. Mr. Lo also 
mentioned that much less than 1% of family name was cited in the book, 
however, he said he still could made the assumption that Vong Chhau's 
rebellion caused Hakka's second migration.
 
        #3 MIGRATION:
        Sung dynasty moved to south in 1127 AD. When Mongolian conquered the 
most of Europe and Asia, the South Sung dynasty and southern China was no 
exception.  However, according to Mr. Lo Hakka settled in southern China
fought Mongolian vigorously.  The third migration started in South Sung 
dynasty and continued to the end of Yuan dynasty (Mongolian dynasty) and the 
beginning of Ming dynasty.
 
        Mr. Lo listed 18 family names in the book.  In this table and 
other description, more details and exact dates were given in some family 
tree books. Most of these families moved from southern Kongsi and western 
Fukkian to eastern Kuangtung.
 
        #4 MIGRATION:
        The 4th migration is not due to the war.  This migration is more 
recent and is much better documented. For example, at the beginning of Chhing 
(ch'in ) dynasty, Hakka people started to move to Sichon (Sichuan,四川). 
This migration was secondary to the pressure of population increase.  The 
areas in Kongsi, Fukkien and Kuangtung where Hakka inhabited are primarily 
mountainous areas and very few farming land are available.  Hakka started to 
move to areas with less population. Sichon (Sichuan) was less populated 
because of rebellion of Chong, Sian-Chung (Chang, Hsian-Chung   ) at 
the end of Ming dynasty. Some moved to Hunan and Kongsi provinces.  Some 
started also to migrate to Taiwan.  Details about the immigration of Hakka 
to Taiwan will be discussed more detailed later. The fourth migration 
according to Mr. Lo is in the period between 1700-1800. Migration to other 
parts of Asia started in this era too.
 
        #5 MIGRATION:
        The 5th migration of Mr. Lo's book discussed about the migration of 
Hakka from eastern Kuangtung to other parts of Kuangtung and Kongsi provinces. 
Migration to Taiwan, other parts of Asia, Pacific islands, central America 
and Africa became more and more common.  Many Hakka communities were 
established in those areas.
 
        Mr. Lo's second book on the origin of Hakka published after the
second world war (I read somewhere it was published in Hong Kong 1953, the 
copy I have did not specify the publication date) gave more information 
about stage #4 and #5 migration.  It also gave some more information about 
the migration to other areas especially overseas during stage 5.
 
COMMENT:
 
        After reading the Mr. Lo's two books, I still had a lot of doubts 
about the theory that Hakka migrated from North China to south in stages. 
The family tree books give very vague information especially the first 2-3 
stages.  The migration records in the family tree books of the later stages 
especially the #4, #5 may be more meaningful and real.  The record of the 
first two stages probably are merely "legendary". It is also possible the 
people that really migrated from northern and central China are really small 
in number.  Therefore, the modern biological studies indicated Hakka are 
primarily southern Mongoloid groups not northern groups. 
 
        Some information in the Lo's first book is very old and inaccurate. 
The first book was published in 1933. The information about the distribution
of Hakka in Taiwan is the information of 18th century.  The book listed the 
partial Hakka areas as Tsong-fa, Tsu-lo and Fung-san three counties.  The 
name of those counties were really old names.  According to the Taiwan's 
history book, the name of those three counties existed simultaneously only 
between 1723-1788.  He did list more modern names in his second book. 
Professor Chin (in section 2.23) also mentioned the error of listing few 
counties in Fukkien as pure Hakka areas but actually are pure Hoklo areas.

2.22 FONG, HOK-KA'S THEORY:

        Recent archaeological findings in the Hakka areas, mainly at the 
border of Kwangtung, Fuk-kien and Kong-si provinces, suggested that there were
many evidences that highly developed civilization already existed well before
Chhin ( ) era. Many artifacts unearthed could be traced to the civilization
of 6,000 years ago.  More than hundreds sites were found in China.
 
        Yet (Yue or) is the general term used for the ethnic groups
in southern China. Hundred Yet indicated many different groups.  From 
the archeological findings, the people lived in south had highly developed 
Pak-Yet (百越) Culture and the exchange of culture with northern China was 
well established before the Chhin era. The population of southern China 
during that era was estimated to be "considerable" by Professor Fong's book.
 
        After Chhin conquered other countries and established Chhin dynasty ( 
221 BC), they sent government and military personnel to the south.  Some 
of these personnel stayed in the south. The influence of northern culture increased 
significantly after Chhin dynasty. The sinicization (漢化 )of southern ethnic 
groups became inevitable because of long occupation of south by northern 
governments after the Chhin dynasty.  Professor Fong believed the identity 
of pro-Hakka was developed during the period of Chhin dynasty (began in 221 
BC) to South-North Era (南北朝 ended in 589 AD).
 
        Sinicization after the end of South-North Era was further accelerated 
by the arrival of more northern immigrants. The three main languages of 
southern China (Fukienese, Cantonese and Hakka) were developed during the
period of Sui-Tong (  、唐 581-907 AD ) to Five-Dynasty ( , 907-960 AD). 
These three languages all had some common characters of southern languages 
and old northern language. 
 
        Before the Five-Dynasty, there was almost no record in history about 
the activities in Hakka areas.  After Sung dynasty (), more literature 
regarding current Hakka area can be found.  Professor Fong called "Era the 
Hakka Stepping into History".  Hakka systematically migrated to further 
south, west and other areas began in Ming dynasty (1368-1644) and Chhing 
dynasty.
 
        In the chapter 8 (Common origin of Hakka), Professor Fong said there
was no evidence of massive migration from northern to southern China from 
the historical records.  It is impossible that southern China was a vacuum 
place waiting the northern people to move in.  There indeed some northern 
ethnic people migrated to south, however, the number of people migrated 
from north was really very minute.  The small number of northern people 
brought in northern culture and language.  The mixture of both Yet and 
northern culture formed the special Hakka culture.  The primary ancestors 
of Hakka were Yet people in the south not very few northern immigrants.
 
        Professor Fong listed many archaeological evidences to back up his 
theory. He also listed the population data to demonstrate that there was no
of massive migration from northern China. He also did a lot of field studies 
about the culture, customs, religion and women of Hakka and aborigines 
especially the "She" () group.  He found some similarity between two 
cultures.       
COMMENTS:
        Professor Fong is a very diligent scholar.  His arguments based on 
more scientific evidences.  His conclusion is certainly consistent with the
more modern biological studies cited below.  More recent studies of family 
tree book, the same method used by Lo Hiong-lim to prove his theory of 5 stages 
of migration, found Hakka and non-Hakka have same ancestors.  In the preface 
of Fong's book, a professor cited one study that the difference between 
different ethnic groups in Kwangchou area is not due to biological origin.  
Apparently they all have same origin but currently belong to three different
ethnic groups because of social and culture differences.  Professor Fong 
believes culture is more important.
 
2.23 Chin, Chii-phin's Views (  )
 
        Dr. Chin, Chii-phin is the professor and chairman , Department of
History,   Xiamen University. He recently published a book entitled  "A New
Theory on the Origin of Hakka: Who are Hakka" (         
  ).  This book has another view on the origin of Hakka. He discusses
mainly that there are no differences in orgin between Hakka and Non-Hakka. 
 
        The copy I based on is published in Taiwan, l998. Professor Chen
used a lot of information from Tsu-phu (family history record) as professor
Lo did. However, professor Chen is different from professor Lo that he also
studied the Tsu-phu from non-Hakka.  There are no difference between Hakka 
and non-Hakka in their records of the origin areas, southward migration 
route or ancestors.  For  example, he has a table of origin areas of the 
southward migration of different family names from both Hakka and Hoklo 
counties. The names of origin areas of Hakka and Hoklo are almost identical. 
The comparison was made mainly between Hakka and Hoklo, however, smaller
number of examples came also from Cantonese. Hakka and Non-Hakka branched 
out from the same ancestors during southward migration. Hakka branched out 
from Non-Hakka and non-Hakka branched out from Hakka.There are interlocking 
migration of Hakka and Non-Hakkas. He made comments many times that there 
were basically no difference among Hakka, Hoklo and Cantonese. 
 
        He made few comments about the authenticity of  these Tsu-phu.
Both Hakka and non-Hakka had the tendency to name the famous and the
prominent people  as their ancestors.  He also made the comments that older
the generation higher the rank in the society of their ancestors.  For example,
Liu family of Hakka and non-Hakka all name Liu Pang (  ) , first
emperor of Han dynasty or Liu Phi (   , the King of  Shu of three
Kingdom Era as Liu their ancestor.  Famous scholar Chu Hi (  ) is the
ancestor of all Chu families regardless Hakka or non Hakka. Some Tsu-phu
clearly mentioned that each of brothers of one generations went to different
areas and became the beginning ancestor of different ethnic groups.  For
example, eight of Chen?s 79th generations went to Canton, Hokkien,
Hakka, Funan, Fupei, Hangchiu, Suchiu etc. areas to start their new
branches of Chen?s families. Hakka and Non-Hakka branched out from the
same ancestors during southward migration
 
        Comparing these Tsu-phu, regardless real or false, professor Chen
also found the southward migration routes basically the same between
Hakka and non-Hakka.  The five migrations pattern described by professor
Lo is not unique for Hakka.  All family history books, Hakka or non Hakka, 
record the similar pattern of migration. Therefore, it not surprised to find out
that Hakka branched out from non-Hakka and  non-Hakka branched out
from Hakka in the Tsh-phu. The interlocking migration pattern between
Hakka and non-Hakka  repeated again and again on both directions.
 
        In the last chapter, professor Chen concluded that Hakka and other
southern ethnic groups mainly came from north.  There are no significant
difference about their origin between Hakka and non-Hakka . Either Hakka
or non-Hakka are melting pots of all southern ethnic groups. He also raised
some questions for further discussion and research. First is how to define
Hakka, if Hakka and non-Hakka are basically the same. Professor Chen
argued that Hakka is not only similar to other non-Hakka in origin, there are
also not much different in culture, customs and civilization. Only real unique
part  about Hakka is the language only.       
 
        Then he raised the second question, how can the language influence
the formation of Hakka.  He make a point about the ratio of groups of the
new and original populations. If  the Hakka migrated to a new area and
Hakka language transplanted to the new areas successfully then all
population there became Hakka. If the Hakka language is not established in
the new area, then immigrants disappeared and adopted the new identity of
the ethnic group of other  language.   The culture, civilization and  origin are
much  less important. 
 
        He also raised the question about the Tsu-phu study.  To use Tsu-
phu to define the Hakka origin is not only a bad but also dangerous idea.  He
and professor Lo both used Tsu-phu to investigate the ?origin ?of Hakka
but both of them pointed out the authenticity of Tsu-phu.  Basically they all
agreed the statement  ?The least reliable record in the world is Tsu-phu. If
we write the history of immigration based on Tsu-phu, we can not get the
truth?made by another  historian scholar Tan in one history reports. 
Professor Chen  made some comments about the dangers of such
assumptions especially about including all famous historical people as
Hakka.  He also believed some errors  professor Lo made in claming some
areas as pure Hakka counties probably based on  the Tsu-phu studies.  
 
        Finally, the question about the reason of  the formation of  Hakka is
raised.  How and why the name Hakka was adopted ?  He believes that the
population pressure in original Hakka areas is the key.  When Hakka tried to
expand to other areas because population grew and conflict between Hakka
and non-Hakka  developed after they settled in non-Hakka areas. Hakka was
used by other ethnic groups  because they were essentially the ?guest ?
people to the non-Hakka areas.  In order to unify among themselves, the
identity using the most common used name of  " guest " (i.e. Hakka) 
developed. The name of Hakka started to appear in literature only after 17th
century, at the same time of conflict between Hakka and non-Hakka began.  
 
Comments:
 
        Professor Chenbook is very interesting.  If you read his book
carefully, you can realize the similarity among all these family history record
(Tsu-phu) , regardless Hakka or non-Hakka.  Dr. Chen pointed out many
times the errors and inconsistency of these records.  The true value of these
Tsu-phu studies is really doubtful. To me, the most valuable contribution of 
this book probably is to demonstrate that the history written based on these
studies is very questionable and likely not true.
 
        Other than the languages, there are probably still some difference in
culture, custom and biology among Hakka, Min, Cantonese and other
southern ethnic groups.  Similarity of migration pattern in Hakka and non-
Hakka based on Tsu-phu studies probably illustrates the common southern
Chinese belief that originated from northern China is much more prestigious
than southerner. In the Lo, Hiong-lin book, there are pages of  description
about the Cantonese attacking  Hakka as non-Han at all.  Similar
fingerpointing to each other who is Han who is not Han among Cantonese,
Hokkien and Hakka is still going in different publications and modern media,
especially in BBS discussion groups.
 
        In the Robert Ramsey book (The Language of China) has a
chapter on the minorities of south China.  There is a small part (page 235)
about how the Zhuang people ere brought protesting out of the Chinese
closet? when Chinese government determined to raise the ethnic conscious
of the Zhuang people. Millions had never been known existed were found by
researcher. In one study, none of 152 clans admitted to a Southern origin. 
They  all claimed originated from northern China with ancestry from palace
or other historical high official.  maginative attempts to conceal their
identity? was the words Dr. Ramsey used.  Dr. Ramsey description fits
very well with Professor Chen book.
 
Cultures and Language of Hakka
 
HAKKA IN TAIWAN
 
{to be continued} 
 

TAIWANESE HAKKA:
Origin--MODERN BIOLOGICAL STUDIES

Content 

GENERAL INFORMATION ABOUT HAKKA 
2. ORIGIN OF HAKKA  
   2.3 MODERN BIOLOGICAL STUDIES:
        2.31 Immunoglobulin Studies
        2.32 Human Leukocyte Antigen Studies
        2.33 G6PD Deficiency Studies
        2.34 Multiple Genes Analysis
        2.35 Other Biological Studies
        2.36 Hakka Taiwanese and Taiwanese Aborigine
CULTURE AND LANGUAGE OF HAKKA IN TAIWAN
HISTORY OF HAKKA IN TAIWAN

1) Immunoglobulin Studies:

        Human immunoglobulins have structural differences.  These 
differences can be used as genetic markers for population genetics. One of 
these markers Gm is in immunoglobulin G H (heavy) chain. These genetic 
markers are inherited in fixed combinations termed Gm haplotypes.  It has 
been recognized that the Gm haplotypes common to Mongoloid populations are 
Gm ag, axg, ab3st and afb1b3.
 
        Prof. Hideo Matsumoto of Osaka Medical College collected blood 
from different areas and analyzed the difference of Gm markers.  He 
divided the Mongoloid populations into two groups. One is northern group 
which is characterized by high frequency of Gm ag and Gm ab3st and extremely 
low frequency of Gm afb1b3 haplotype, and the other one southern group 
characterized by a remarkably high frequency of Gm afb1b3 and a low 
frequency of Gm ag and Gm ab3st.
 
        Dr. Matsumoto speculated that the origin of the Gm afb1b3 
characteristic of southern Mongoloids exists in Yunnan and Guangxi areas 
of southwest China.  The origin of the Gm ab3st characteristic of northern 
Mongoloids exists in Siberia, most likely in the Baikal area. (
"Characteristics of Mongoloid Populations and Immunogenetics of Various 
Diseases Based on the Genetic Markers of Human Immunoglobulins" by H 
Matsumoto in "Expl Clin Immunogenet 1989; 6:68-87").
 
        No specific study on Hakka by Dr. Matsumoto was found.  However, 
he had one paper on Taiwanese ("Gm and Km allotypes of the Taiwanese" by H 
Matsumoto et al in "Jap J Human Genet 1975; 20:169-173").  From the study in 
Taichung area, an area with about 5% Hakka and 95% Hoklo, they classified 
Taiwanese as southern Mongoloid group characterized by a high frequency of 
Gm afb1b3.  They did not make comment about the difference between Hakka and 
Hoklo. (In their paper, however, they did mention Minnan and Hakka groups in 
Taiwan).
 
        Similar study done by a group of Chinese scholars, however, did a  
study in an area with primarily Hakka population.  This paper ("Study on 
Immunoglobulin Allotypes in the Chinese: a Hypothesis of the Origin of the 
Chinese Nation" by T Zhao et al in "Acta Genetica Sinica 1991; 18:97-108").  
Their study also suggested that Chinese originated from two distinct 
populations, southern and northern.  Hakka from Meixian clearly belongs to 
southern Mongoloid group. 
 
        Phylogenetic tree of 74 populations was constructed using 
unweighted pair-group clustering method by T Zhao et al. The closest 
"relatives" of Hakka are the people from Guangzhou, She () people and the 
people from Liuzhou of Guangxi.  Hakka also have close "relatives" from 
other southern aboriginal groups such as Mulao, Zhuang, Dong, Jing, 
Miao, Bouyei, and Shui.  
 
        From the above data, at least biologically, Hakka is primarily 
originated from southern Mongoloid groups rather than from northern or 
central China (Chung-yuan, He-nan) as many believe.
 

2)Human Leukocyte Antigen (HLA):

 
        Dr. Chen, Kuang-ho (    in Taipei recently published an
 article ?Genetic Finding and Mongoloid Population Migration in China ?
in Bulletin of the Institute of Ethnology, Academia Sinica No. 73, 209-
232, 1992.  He used data from three following articles:
 
1) Sun Y et al : A comparative Study of HLA Distribution among
Some Nationalities in China: I. Gene Frequencies and Genetic
distance. Journal of Chinese Microbiology and Immunology 4:205-
211,1984
2) Zhao, Tongmao et al: Genetic Distance Estimated on the Basis of
HLA. Academia anthropologica Sinica #:165-170, 1984
3) Zhao, Tongmao : HLA Fenxing Yuanli He Yingyong , Shanghai,
China, Shanghai  Kexue Jishue. 1982
 
        He used standardized isonomy to measure similarities between
populations.  He made a taxonomy tree of the average linkage analysis
from 25 Mongoloid populations in China. This figure can be seen in :
Taxonomy Tree of the Average Linkage Analysis of HLA in Chinese Populations
(can't be found anymore)
        The summary of his findings:
 
1) Chinese populations can be divided into northern and southern
groups.
2)  The northern group is split into the Mongolian and Hanren (Han people)
subgroups.  However, there is no southern Hanren subgroup in southern group. 
Hanren and national minorities have mixed. 
3) Hanren admixtures are less pronounced in north. On the other hand,
the heterogeneity of southern Hanren is so mixed that there is no way
to identify Southern Hanren. The genetic mixture of Southern Hanren
with national minorities has advanced to the point that the genetic
distance between a particular Southern Han population and a
neighboring minority may be shorter that the genetic distance between
two particular neighboring Han populations.
 
        In the discussion section, he made few very interesting points
as follows:
        There is one generally accepted theory that Hanren moved along
Huanghe (Yellow River) migrated eastward, then moved towards the
south. However, northern Hanren have not mixed with any southern
Han populations and vice versa. There are three possible explanation
for this contradiction. 
 
        A) The number of investigated Han may not statistically large
enough, other wise, either the general understanding is wrong or the
origin of Hanren is not unique.
        B) The unique migration route never existed. Nor is there any
indication of the existence of other routes to south.
        C) There were at least two Han origins which were separated at
Changjiang (Yangtze River).
 
        As a result of discussions with Dr. Du, Ruofu (    ), the
Division of Human Population Genetics of the Genetics of the
Genetics Institute, Academic Sinica, Beijing.  Two terms used by
historians might be able to explain the findings, "jianbing" and
"ronghe" (     ). 
 
        Jianbing describes a situation where the name of a minority
population is accepted by a new population which formed from an
admixture of minority population with an aboriginal majority
population and/or populations. The latter population would, in effect,
lose its identity. The minority is generally the invader and the majority
population the invaded.
 
        Ronghe is a situation where an invaded majority regains its
identity after a long period of exchanging genes with its invaders.  In
most situations the consequence of mixing genes is the key factor
which distinguishes ronghe from jianbing. Jianbing occurred in the
south and ronghe most likely occurred in the north.
 
        Before the Han( ) dynasty, the majority of invading
populations were from the south. Two examples are the war between the 
Han emperor Huangdi ( ) and leader of southern population
Qiyu(  ) and northern invasion by Chuguo(   ) from south.
Qin Shi-huang(  ),  the first northern emperor to unify China,
not only brought all of the Han populations under his control but
absorbed Chugo and south and later expanded Hanren territory to
further south.
 
        The HLA data certainly agreed with the immunoglobulin data.  
Hakka and other southern populations (such as Wu, Ming, Yue and others) 
in China and Taiwan (Hoklo, aboriginal groups) are primarily southern
origin rather than migrated from northern China.
 
        Recently, I found a brochure of "The Chicago Community Cord 
Blood Bank". If you want to donate the cord blood to the bank or to 
request a donor, there is a form of Parents' Ancestry for both mother 
and father.  Under Asian/Pacific Islander, there were following categories
to be checked. ( ) Asian Indian, ( ) Filipino, ( )Hawaiian/Polynesian,
( )Japanese, ( )Korean, ( )Northern Chinese, ( )Southeast Asian/Southern 
Chinese, ( )Oriental, not otherwise specified. To find the best suitable 
donor is based on HLA typing. In order to find a best donor quickly, which 
category would you like to check, if you are a Hakka.  A firm believer that
Hakka are the descendants of people from Tsung-Ngien (Chung-yuan, Central 
Plain) or Northern China would check the category of ( ) Northern Chinese?
 

3) Glucose-6-phosphate Dehydrogenase (G6PD)

        Glucose-6-phosphate Dehydrogenase is an enzyme in the red 
blood cell. It help to maintain the stability of red blood cell.  If the
level of G6PD is low (deficiency) in the individual, the red blood cell
is more like to hemolyse, especially under the stress with certain drugs
or consumption of  raw fava bean.  The condition is still called ?
favism ?     especially in case of fava bean ingestion. Hakka 
in Taiwan is well known to have high prevalence of G6PD deficiency among 
the different ethnic groups. Two most common abnormal G6PD were named as 
Taiwan-Hakka and Taipei-Hakka before.
 
        The G6PD gene is located in X-chromosome.  Therefore, male
have higher deficient rate because  one affected X-chromosome gene
is generally sufficient to cause deficiency (male has XY chromosome).
However, female with XX chromosome is less likely to cause
significant problems if they have one other normal gene in X
chromosome.  It is a hereditary disorder.
 
        The prevalence of G6PD deficiency varies greatly throughout
the world.  A world map of G6PD deficiency from WHO Working
Group (Bull. WHO 1989: 67:601) also demonstrated that Taiwan and southern
China have a high deficiency rate.  In the area around the 
provinces of Kuangtung, Kuangsi, Yun-nan and the neighboing Southeast 
Asian countries all have high prevalence of the deficiency. The 
deficiency rate is listed as 3-6.9 % or higher in southern China
However, the deficiency rate of northern China is less than 0.5%.  
 
        It is very interested to know, comments were made by some
medical articles about the high deficiency rate of Hakka in Taiwan.
They merely mentioned that it is interesting to note the discrepancy
between the northern Chinese and Hakka.  Two articles mentioned this
because the Hakka claimed they migrated from northern China but
have much higher rate.  ( Tang, KT et al in Blood 1992, 79:2135 and
Chen, WP et al in Chinese Medical Journal (Taipei) 1987; 40: 443). 
In the later article, in a northern general hospital (in Taipei, Taiwan) 
12.9% of male newborn and 7.8% of male and female have G6PD deficiency 
if both parents are Hakka. In overall population (including Hakka), the 
rate of G6PD deficiency is 2.9% (male) and 1.9% (male and female) 
respectively. The later figure of 2.9% and 1.9% are low because this 
hospital is located at the area that many new residents came after 1949
and significant number of them are from northern China.
 
        In the past two decades, molecular analysis of abnormal G6PD
became possible.  Exact location of abnormal nucleotide in G6PD
gene and abnormal amino acid in G6PD enzyme were found.  Some
abnormalities found in Hakka were found also in other ethnic groups
not only in China but also in Southeast Asia. These hereditary
abnormalities, however, are not found in northern Chinese.
 
        The vast majority of more than 100 molecularly identified G6PD
mutants are single amino acid replacements caused by single missense
nucleotide mutations.  The molecularly known mutants will allow more
accurate study of population movement. Taiwan, southern China, Southeast
Asia, and southern Pacific islands were known to have a high prevalence of
G6PD deficiency. 
        The two most common mutants in Taiwan, 1376T and 1388A, or their
biochemically equivalent mutants were commonly found in southern China,
Thailand, Vietnam, Singapore, Laos, Malaysia, and Indonesia. The third most
common 493G mutant in Taiwan has not been found in China or overseas
Chinese but is a relatively common mutant in the Philippines. This mutant is
the most common one among one aboriginal group, the Siasiat, in Taiwan.
Two other relatively uncommon 1360T and 487A mutants in Taiwan have not
been found in China. However, 1360T is the most common mutant in the
Philippines and  is also found in the Vanuatu islands in Melanesia. The 487A
mutant is more common in other Southeast Asian countries.  Another
uncommon 592T mutant in Taiwan is the most common one in another
aboriginal group,the Ami, and this mutant can also be found in China and
Laos
 
        F8C/G6PD polymorphism studies are available from certain areas.
Han and aboriginal groups in Taiwan have a similar pattern suggesting they
might have the same ancestors. The same F8C/G6PD haplotype was found in
1376T mutants in the Taiwanese and the Li minority in Hainan, China.  The
G6PD mutant and F8C/G6PD polymorphism studies suggest that the Han and
minorities of southern China, southeastern Asians, Han and aboriginal groups
in Taiwan probably originate from the same ancestors somewhere in
Southeast Asia or southern China. The current Han population in Taiwan and
southern China are unlikely the descendants of massive migration of northern
Chinese. 
        
        Again, the G6PD data is consistent with those of immunoglobulin, 
and HLA. From G6PD data, the origin of Hakka is again primarily from 
Southern Mongoloid rather than Northern Mongoloid, Tsung-Ngien (Chung-
yuan) or Northern Chinese.
 
(If you have big-5 Honsii fonts, there is an article on "G6PD mutation and
Ethnic Relationship in Taiwan published in Taiwan Medical Journal 
42:252-256,1999, it is available on Internet. There is another article on 
G6PD deficiency in Hakka Taiwanese Newsletter #18, the address is:
Hakka Taiwanese Newsletter #18--can't be found anymore)

4). Multiple Genes Analysis

        L.L Cavalli-Sforza, P. Menozzi and A. Piazza published a book
" The History and Geography of Human Genes" in 1994 by Princeton
University Press, Princeton, New Jersey.  It is a remarkable book about 
the genetics of human population. The book is more than thousand
pages thick and has more than 500 genetic map based on different
genes. They use scientific methods to analyze many genes in many
populations of the world. Base on the data they collected, they
calculate the genetic distance among different populations and have
proposed various "genetic trees".
 
        In the chapter (chapter 4) of Asia, based on 68.6 genes on
average, a tree was constructed from 39 populations. These genes
include all above mentioned immunoglobulin, HLA, and G6PD genes. 
Again North China and South China belong to different major clusters. 
They made a comment that , despite millennia of common history and
many migrations,  a profound initial genetic difference between these
two regions has been in part maintained.
  
        South Chinese join Southeast Asians while the North Chinese
associate with Koreans, Japanese, Ainu, Bhutanese and Tibetans. 
Other Southeast Asians includes Malaysian, Balinese, Viet Muong,
Thai, Indonesian and Philippine.
 
        This genetic tree also showed the Northern Chinese is closer to
Caucasoid than to Southern Chinese.  The authors comment that
unlike the data from physical anthropology, the tree showed a major
distinction between Southeast Asia and the rest of Asia.  The
association between East and Northeast Asians and the all Asian
Caucasoids (such as Arabian, Iranian, Asian Indian) are clear from
these gene studies. 
 
        In the section of East and Central Asia (sections 4.12 ) and
Southeast Asia (section 4.13), there are more detail discussion and
other methods of analysis.  Regardless what kind of methods they
used, all the genetic trees and maps demonstrate that Southern Chinese
is distant from Northern Chinese.
 
        In the part discuss China, it mentioned that at least 52
minorities or isolated ethnic groups in China.  Almost half of these
ethnic groups live in the Yun-nan provinces and these ethnic groups
may be the enclaves of original inhabitants.  It said by far the majority
of modern Chinese, however, call themselves Han, the dominant
group.
 
        A tree of Han based on blood type ABO, RH, MN by Du et al
(Chinese Surnames and the Genetic Differences between North and
South) clearly demonstrated a separation of north and south.   Base on
the Han surnames from the 1982 census in the same paper, Du et al
find their frequency distribution originates a tree that is in substantial
agreement with the genetic one, in spite of transmission of surnames
limited only by the male line.
 
        No specific data of Hakka was shown or discussed in the book. 
Hakka is only mentioned once when the waves of migration to Taiwan
are discussed.  All these biological gene studies, Hakka in Taiwan or
China are primarily not the descendants of Northern Mongoloids but
primarily descendants of original southerners. 

5) Other Biological Studies:

        Similarly, there are also other biological data, especially  
thalassemia genes and mitochondria DNA, might be very helpful to trace the 
origin of Hakka.  Will try to obtain these data and to update them here 
later.

6) Hakka Taiwanese and Taiwanese Aborigine

        The contribution of Taiwanese aboriginal groups to Hakka Taiwanese 
should be a very important component in discussing the origin of Hakka in 
Taiwan. From the above 3)Glucose-6-phosphate Dehydrogenase (G6PD) study, 
partial ancestry of the current Han population in Taiwan might come from 
aboriginal groups. Some aboriginal groups of Taiwan might have originally 
migrated from the Philippines, or Taiwan is the ancestral origin for 
Taiwanese aboriginal groups, Filipinos and other southern Pacific Islanders
as some recent studies suggest.   
 
        We are collecting more other data and will update later.
  

TAIWANESE HAKKA:
CULTURE AND LANGUAGE IN TAIWAN

  Content

GENERAL INFORMATION ABOUT HAKKA
MODERN BIOLOGICAL STUDIES      
CULTURE AND LANGUAGE OF HAKKA IN TAIWAN
          Characters about Hakka
          Culture
          Language
HISTORY OF HAKKA IN TAIWAN
 

I)CHARACTERS ABOUT HAKKA

        The Encarda encyclopedia also said "They differ from the Chinese in
dress and customs and they speak a distinct dialect related to those of
southern China."  In the words of the author, it seems taht the Hakka are 
not Chinese.  This encyclopedia also said " the Hakka are a thrifty, industrious 
people, chiefly agricultural ". 
 
        The two other encyclopedia mentioned above also emphasize the 
difference between Hakka and Chinese such as "A close-knit people with 
their own distinctive customs and dialect, the Hakka have never been 
completely assimilated into Chinese society.--- they maintained their 
cultural solidarity, intermarrying rarely with other Chinese and refusing to 
practice such customs as the foot-binding of women." (American Encyclopedia)
Encyclopedia Britannica also said "-- the Hakka never became fully 
assimilated into the native population.---an extremely industrious, shrewd 
people, the Hakka tend to be very clannish."
 
        Because I don't know Hakka elsewhere that much at all, I will 
discuss Hakka in Taiwan only. The above discussion about the special 
characters of Hakka is certainly much less prominent in Taiwanese Hakka in
the modern era. More detail discussion about Hakka in Taiwan is in next 
chapter.
II) CULTURE (TO BE COMPLETED)
III) LANGUAGE ( TO BE COMPLETED)
 
HISTORY OF HAKKA IN TAIWAN
 
 
{to be continued}     Albert Chu
 
 
----------------------------------------------------------

HAKKA IN TAIWAN
 
        The population of Hakka in Taiwan is about 3 millions.  The
population studies in the early 20th century during Japan colonial era to
more recent one two decades ago, showed the 13-15 % of population in Taiwan
are Hakka. The percentage of Hakka may vary significantly according to the
definition of Hakka.  If it is based on the paternal origin, it may be more. 
If it is based on the ability to speak Hakka, the only character that may
differentiate Hakka from other Taiwanese, the percentage probably will
be much lower.
 

Immigration History

1) Before 1622, the year Holland left Taiwan:

        Who are the first Hakka immigrants to Taiwan?
 
        Fishermen, merchants and/or pirates are the most likely the first 
groups visited Taiwan. In the Chinese literature, Hon people settled in 
Phang-fu (Peng-hu, Pescadores, the island between Taiwan and China mainland, 
a county of Taiwan) islands many years ago (the earliest record in 1167).  
Hon people settled in Taiwan island probably hundreds years later.  The 
Chinese literature about the commercial activities with Taiwan started 
in late 16th century. Involvement of Hakka or not in the above activities 
was not mentioned in these literature ( the term Hakka probably did not 
exist at that time).  
 
        In the late 16 century, pirate groups might start to use Taiwan 
as their operating headquarters.  Lim Tho-khien (  乾) and Lim Fung 
  鳳)were leaders of two separate groups.  They and their followers 
came from Chheu-chu. Some of them might be Hakka.  However, none of these 
two groups eventually settled in Taiwan.  One pirate leader, Ngien Sii-ki
 (  ) settled in central Taiwan in 1624.  Tshang Chi-liung (  
龍)became the group leader after Ngien's death in 1625. Tshang is the 
father of the famous Tshang Siin-kung (Cheng Ch'eng-kung, Coxiny   ). 
Ngien, Tshang and their followers came from southern Fuk-kien. There was no
definite record about Hakka immigration to Taiwan during this era either.
 
        About the same period, Holland occupied Phang-fu islands in 1622 
and later retreated to southern Taiwan in 1624.  Spain also occupied 
northern Taiwan between 1626-1642.  Immigration from China increased 
considerably during the era occupied by HollandHolland colonial government
needed manpower and encouraged Hon people moving to Taiwan. There might be 
some Hakka migrated to Taiwan during early 17 century. Don't know anyone 
really try to investigate the literature from Holland, whether there is any 
record of Hakka immigration to Taiwan or not during the occupation by Holland
First Hakka dictionary as Hakka-Dutch dictionary is published in 1897 
(more than 100 years ago).  Hakka probably migrated to Indonesia during that 
period too.  They should be quite familiar with Hakka.
 

2) Tshang's era:

 
        Tshang Chi-liung later left Taiwan and established his base in 
southern Fuk-kien and became officer in Ming Dynasty. Tshang Siin-kung
later inherited his father's army after his father surrendered to Manchurian
(Chhing Dynasty).  After he lost his battle to Chhing's army, Tshang Siin-
kung decided in 1661 to relocate the headquarters to Taiwan to recuperate.
Holland surrendered and left Taiwan in 1662 after 38 years' occupation of 
Taiwan.
 
        In order to isolate Tshang's group, Chhing's government, prohibited 
people to live within 30 miles off seashore.  This policy actually became a 
good opportunity for Tshang's government.  He tried hard to recruit those 
homeless people in Fuk-kien and Kwangtung to Taiwan.  According the some 
literature, close to about 100,000 people have moved to Taiwan during the 
period of Tshang's regime in Taiwan.  There must be some Hakka among those 
immigrated to Taiwan because the book did say Tshang's government went 
to Tshau-tsiu and Hui-tsiu of Kwangtung to recruit immigrants.
 
        Tshang Siin-kung died in 1662 and his son Tshang Kin (  ) and 
later his grandson succeeded him.  In 1683, Chhing government sent Tshang's 
former general Sii Long (I ) to eradicate Tshang's regime. Tshang 
surrendered and Tshang's era in Taiwan finished after 23 years' occupation 
in Taiwan. Tshang's regime of 21 years is an important era of Taiwan's 
history. The history of Taiwan certainly will not be the same if Tshang 
did not invade Taiwan.  His son Tshang Kin should also be mentioned for 
his program to settle in Taiwan
 

3) Sii Long and the Policy Unfriendly to Hakka 

        Sii Long is a very important figure in Taiwan's history and his 
policy of immigration also affected Hakka in Taiwan. 
 
        Sii Long was a general under Tshang.  He surrendered to Chhing 
government after Tshang Siin-kung killed Sii's father and brother 
after a dispute.  Chhing government promoted him and he later became the 
commander-in-chief of navy to invade Taiwan. 
 
        After conquer the Taiwan, Chhing government first decided to abandon 
Taiwan because it is worthless to keep this "barbarian island". Sii Long 
wrote an long essay to Chhing's emperor the importance to keep Taiwan. 
Taiwan became a part of Fuk-kien province in 1684. He set up the infamous 
immigration three rules.  1) Strict application and permission for sailing 
to Taiwan 2) No spouse or family members allowed to Taiwan nor were they 
allowed to marry in Taiwan 3) People from Kwangtung is not permitted to 
apply to sail to Taiwan. Sii Long did not like Hakka or people in 
Kwangtung probably because pirate from Kwangtung gave him a lot of trouble 
before.
 
        Partly because of third rule, Hakka's population in Taiwan was much
less than Hoklo's population.
 

Chhing's era

        The Chhing's government did not pay too much attention to Taiwan. 
Taiwan became an independent province in 1885, more than 200 years later.  
 
        In the first 190 years of Chhing's rule, Chhing not only did not 
encourage the immigration but actually set up difficult rules to discourage 
the people to immigrate to Taiwan.
 

{to be continued} Albert Chu