diff --git a/README.md b/README.md index 554f3827..0a3b4f81 100644 --- a/README.md +++ b/README.md @@ -1,310 +1,223 @@ -
+![HowToLiveBetter — less time, effort, and expense for more life, freedom, and money](site/assets/og/en.png) -高性价比人生指南 —— 用最少的钱、时间和精力，换回最多的寿命、金钱和人身自由 +# HowToLiveBetter: The Best-Value Life Guide -# 高性价比人生指南 +> **India Edition — legal and regulatory adaptation** +> +> This edition is adapted for India. China-specific statutes, administrative penalties, government schemes, currency figures, and procedures are replaced with Indian equivalents where a genuine equivalent exists. Where no direct equivalent exists, the text identifies the jurisdiction-specific limitation instead of inventing an Indian rule. Legal material should be checked against current Central and applicable State law before reliance. -讲怎么活得久、怎么少生病，出了意外怎么救。讲怎么少花冤枉钱，哪些事会让人被骗、摊上官司。讲没工作没钱时能去领什么，开店、开公司、做网站要办什么手续。也讲恋爱结婚生孩子、出国和学手艺。
-630 条建议，每条写明花掉什么、换回什么、证据有多硬，来源只引期刊论文和官方文件。 -不用全做：这是按性价比排好的备选单，不是任务清单——挑走一两条就算数，作者自己也没做到其中大部分。 -[![在线检索](https://img.shields.io/badge/%E5%9C%A8%E7%BA%BF%E6%A3%80%E7%B4%A2-%E7%82%B9%E8%BF%99%E9%87%8C%E6%89%93%E5%BC%80-3451b2?style=flat-square)](https://eternity4719.github.io/HowToLiveBetter/) -[![条目](https://img.shields.io/badge/%E6%9D%A1%E7%9B%AE-630%20%E6%9D%A1-18794e?style=flat-square)](#目录) -[![证据分级](https://img.shields.io/badge/%E8%AF%81%E6%8D%AE%E5%88%86%E7%BA%A7-A%20420%20%C2%B7%20B%20159%20%C2%B7%20C%2051-915930?style=flat-square)](#证据分级) -[![原始文献](https://img.shields.io/badge/%E5%8E%9F%E5%A7%8B%E6%96%87%E7%8C%AE-1341%20%E6%9D%A1%E9%93%BE%E6%8E%A5-565a5f?style=flat-square)](docs/核实记录/) -[![许可](https://img.shields.io/badge/%E8%AE%B8%E5%8F%AF-CC%20BY%204.0-565a5f?style=flat-square)](#许可) +Covers longevity and disease prevention, accidents and first aid, saving money and managing it, fraud prevention and legal red lines, a safety net for unemployment, the risks of running your own business, building a platform and keeping it legal, love, marriage, and children, going abroad, and learning skills. -### [打开在线检索页](https://eternity4719.github.io/HowToLiveBetter/) · [让 AI 照书回答（skill）](skills/life-decision-guide/README.md) +608 pieces of advice; each one states what it costs, what it buys back, and how hard the evidence is. Sources cite only journal papers and official documents. -AI 助手 skill 支持 Claude Code 和 Codex。装上后直接问「替朋友担保签不签」，它先查书里的条目再回答，并注明出自第几节第几条。 +![Online search](https://img.shields.io/badge/Online%20search-Open%20here-3451b2?style=flat-square) +![Items](https://img.shields.io/badge/Items-608-18794e?style=flat-square) +![Evidence grades](https://img.shields.io/badge/Evidence%20grades-A%20410%20%C2%B7%20B%20149%20%C2%B7%20C%2049-915930?style=flat-square) +![Primary sources](https://img.shields.io/badge/Primary%20sources-1281%20links-565a5f?style=flat-square) +![License](https://img.shields.io/badge/License-Unlicense-565a5f?style=flat-square) - - - - - - -
下载 - -[PDF](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.pdf) · [EPUB](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.epub) · [离线单文件（HTML）](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.html) - -
查阅 - -[目录](#目录) · [术语表](#读懂数字术语表) · [核实记录](docs/核实记录/) - -
长文 - -[结婚划不划算](docs/结婚划不划算.md) · [家庭应急装备清单](docs/家庭应急装备清单.md) · [遇到陌生人出事该不该停](docs/遇到陌生人出事该不该停.md) · [做平台要办哪些证](docs/做平台要办哪些证.md) · [生物钟和夜班](docs/生物钟和夜班.md) - -
其他语言 - -[English](https://dlgrv.github.io/HowToLiveBetter/en/) · [Русский](https://dlgrv.github.io/HowToLiveBetter/ru/) · [Español](https://dlgrv.github.io/HowToLiveBetter/es/)，[dlgrv](https://github.com/dlgrv) 维护的翻译（[仓库](https://github.com/dlgrv/HowToLiveBetter)） - -
衍生工具 - -[howtolivebetter.net](https://howtolivebetter.net/)，[littleben](https://github.com/littleben) 做的打勾清单：加待办、标记做到没有、收藏 - -
- -其他语言和衍生工具由他人维护，内容可能落后，以本仓库中文原文为准。 - -
+**[Open the online search page](./)** · [Table of contents](#table-of-contents) · [Glossary](#reading-the-numbers-glossary) · [Verification records](docs/research/核实记录/) · [Is marriage worth it (long read)](docs/Is-Marriage-Worth-It.md) · [Home emergency kit (long read)](docs/Home-Emergency-Kit.md) · [Should you stop to help a stranger (long read)](docs/Should-You-Stop-To-Help-A-Stranger.md) · [What licenses a platform needs (long read)](docs/What-Licenses-A-Platform-Needs.md) --- -## 这本书想回答的问题 - -| 问题 | 去哪看 | -| --- | --- | -| 几乎不花钱，就能明显降低早死概率的事有哪些？ | [1. 不要早死](book/01-不要早死.md) | -| 抽烟、喝酒、久坐、熬夜到底折寿多少，烟和酒具体怎么戒，家常食用油怎么选怎么用？ | [2. 不要慢慢死](book/02-不要慢慢死.md) | -| 每天精力不够用、总被打断，怎么改？ | [3. 不要浪费精力](book/03-不要浪费精力.md) | -| 时间都花哪去了，怎么少做无收益的事，拖延怎么治？ | [4. 不要浪费时间](book/04-不要浪费时间.md) | -| 攒下的钱该怎么放，才不被利息、费率和骗局吃掉？ | [5. 不要浪费钱](book/05-不要浪费钱.md) | -| 哪些保健品、体检套餐、智商税可以直接不买？ | [6. 反面清单](book/06-反面清单.md) | -| 失业了、被欠薪了、身上没钱了，能领什么、去哪求助？ | [7. 没钱的时候怎么活](book/07-没钱的时候怎么活.md) | -| 彩礼、婚前房产、恋爱期间的大额转账算谁的，被人报案指控或捏造事实举报时第一步做什么，自己惹了事主动去说能减多少刑，事后能不能追究和索赔？ | [8. 法律与财产安全](book/08-别把自己搭进去.md) | -| 哪些「兼职」和顺手的小事会让普通人变成刑事被告？ | [9. 普通人容易踩的法律红线](book/09-普通人容易踩的法律红线.md) | -| 追人该广撒网还是死磕一个，异地恋能不能成，领证要带什么？ | [10. 恋爱和结婚划不划算](book/10-恋爱和结婚划不划算.md) | -| 写哪些代码、接哪些单会被判刑？ | [11. 程序员和技术人容易踩的红线](book/11-程序员和技术人容易踩的红线.md) | -| 借钱开店、开公司之前最该先想清楚什么？ | [12. 创业与做生意](book/12-创业与做生意.md) | -| 有人倒地没了呼吸、大出血、火灾、迷路，先做什么？ | [13. 紧急情况：先做什么](book/13-紧急情况.md) | -| 账号被盗、手机丢了，第一步做什么？ | [14. 账号与信息安全](book/14-账号与信息安全.md) | -| 押金被扣、房东赶人、长租公寓暴雷怎么办？ | [15. 租房与买房](book/15-租房与买房.md) | -| 确诊慢性病之后，长期该怎么管、怎么少花钱？ | [16. 得了慢性病之后怎么活](book/16-得了慢性病之后怎么活.md) | -| 老人的监护、遗嘱和钱该怎么提前安排？ | [17. 家里有老人](book/17-家里有老人.md) | -| 生孩子能领什么、要占掉多少时间和钱？ | [18. 养孩子划不划算](book/18-养孩子划不划算.md) | -| 加班费、年休假该怎么算，被裁该拿多少补偿，上班受了伤怎么认定和拿钱？ | [19. 在职、离职和工伤](book/19-在职离职和工伤.md) | -| 孩子刚出生，最要紧的几件事是什么？ | [20. 刚出生的孩子怎么带](book/20-刚出生的孩子怎么带.md) | -| 哪些国家现在别去，出事了使领馆管到哪一步？ | [21. 出国、旅行与境外安全](book/21-出国旅行与境外安全.md) | -| 去 KTV、网吧、密室怎么不踩坑，压力大时做什么最有用？ | [22. 怎么放松：娱乐场所和减压](book/22-怎么放松.md) | -| 学电焊、学英语、考证，哪些真的回本，怎么学才省时间，职称从哪里报、值不值？ | [23. 学什么技能划算](book/23-学什么技能划算.md) | -| 同一个病在社区看和在三级医院看差多少钱，伤得很重时是挂号排队还是找急诊分诊台，治完要不要做伤残鉴定、办残疾人证？ | [24. 看病：怎么少花钱少走弯路](book/24-看病.md) | -| 家里人走了，当时先做什么、哪些钱能取回来、哪些费用可以不交？ | [25. 人走了以后要办什么](book/25-人走了以后要办什么.md) | -| 做个网站或平台收钱，要办哪些证、服务器放哪？ | [26. 做一个网站或平台](book/26-做一个网站或平台.md) | -| 怀孕了、要生了，什么时候做什么，出院前要办哪些证？ | [27. 怀孕和生产](book/27-怀孕和生产.md) | -| 想减肥、想变好看，哪些做法会把身体搞坏？ | [28. 别为了外形把身体搞坏](book/28-别为了外形把身体搞坏.md) | -| 亲人走了、被裁了、拿到重病诊断，头几个月最要紧的是什么？ | [29. 遭遇重大打击之后](book/29-遭遇重大打击之后.md) | -| 孩子上学以后，哪些身体和心理的事不能等到考完再说？ | [30. 上学以后的孩子](book/30-上学以后的孩子.md) | -| 十八岁之后除了读书和打工还有哪几条路，各自的门槛是什么？ | [31. 十八岁之后有哪几条路](book/31-十八岁之后有哪几条路.md) | -| 出国留学，签证身份怎么才算没断，回国这张文凭认不认？ | [32. 出国留学：身份、打工、保险和回国认证](book/32-出国留学.md) | -| 自己或者家人残疾了，先防住哪些并发症，能申请哪些补贴，上学就业和监护怎么办？ | [33. 残疾之后怎么活](book/33-残疾之后怎么活.md) | -| 感冒药、退烧药、胃药自己买来吃，哪些不能一起吃，孩子、孕妇和老人要避开哪些？ | [34. 家里的常备药别吃出事](book/34-家里的常备药别吃出事.md) | - -## 怎么读 - -- **不用全做**：这是一份按性价比排好的备选单，不是任务清单。挑走一两条就算数，剩下的放着，需要时再回来查。「说着容易做着难」这个评价是对的——作者自己也没做到其中大部分，写下来是为了要用的时候找得到。想挑省力的，看下面「只想看最值得做的」那条。 -- **想让 AI 帮你查**：仓库里带了一个中文 skill（[skills/life-decision-guide](skills/life-decision-guide/)），Claude Code 和 Codex 都能装。装上以后直接问「替朋友担保签不签」「每天通勤两小时值不值」。它会先把相关条目从正文里查出来，再照书里的算账方式排序回答，并注明出自第几节第几条。查不到就说查不到，不自己编数字。装法见 [那个目录的说明](skills/life-decision-guide/README.md)。 -- **想按条件挑**：打开[在线检索页](https://eternity4719.github.io/HowToLiveBetter/)，可以按关键词、章节、证据等级来筛，也可以按「花不花钱、花多少时间、要不要毅力」这三样筛，几个条件能叠着用。页面上的内容直接取自 book/ 目录里的正文，正文一改，页面跟着改。 -- **条目之间会互相指路**（「见第 8 节第 17 条」这种）：在检索页里，这种指路带一条虚线。点一下，就地显示被指的那条的标题和「说人话」。想真的翻过去，再按「跳过去」。那一条正好被筛选条件藏起来了，页面会自动把筛选清掉。在 GitHub 上直接读正文点不动，但每处指路后面都写着指向什么（「见第 18 条（借钱写清借条）」）。不翻过去也知道说的是哪条。 -- **想按顺序读**：每节内的条目按性价比从高到低排列，从每节前几条开始看就行。 -- **想离线看、想发给别人**：下载 [离线单文件 HTML](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.html)，整本书连同检索和筛选都在这一个文件里，双击就开，不用服务器也不用联网，微信里也能直接传。 -- **想打印或在手机上翻**：下载 [PDF](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.pdf)，A4 排版、两百多页，带目录页码和书签，每节另起一页。 -- **想在 Kindle 或其他阅读器上读**：下载 [EPUB 电子书](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.epub)，Kindle 用 Send to Kindle 发过去即可。 -- **三样都是正文每次更新后自动重新生成的**，下载链接固定不变；转发出去的那一份不会跟着更新，以在线版为准。 -- **看不懂那串数字**：每条都有一行「说人话」。它把「收益」栏里那些研究里的写法，翻成「同期死亡的概率低约两成」「拘留几日、罚多少钱」这样的日常说法。它只用「收益」栏已经写到的内容，不添新数字。只看这一行就够拿主意。「收益」栏里原样留着全部数字，想自己核对就看那一栏。 -- **只想看结论最硬的**：在检索页里勾选证据等级 A，只留下有具体数字、来自荟萃分析或大型试验的 420 条。 -- **只想看最值得做的**：勾选性价比「极高」，得到 108 条既不花钱、不花时间、不需要毅力，收益又落在最大一档的条目。再叠加一个「换回什么」，就是该口径下的优先清单。 -- **看到「不要」开头的节标题不用紧张**：节标题说的是这一节想防住的事（不要早死、不要浪费时间），不是说底下每条都在让你别干什么。真正要做的动作写在条目标题里，一律动词开头，自己就写清了是「做什么」还是「别做什么」。同一节里两种都有：第 4 节既有「把『打算做』写成『几点、在哪、遇到什么就做什么』」，也有「不看电视和滚动新闻」。按条目标题读，不用往节标题的语气上套。 - -每条建议长这样： +## Questions this book tries to answer + +| Question | Where to look | +| --------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------- | +| What can you do almost for free that still noticeably lowers your chance of dying early? | [1. Do Not Die Early](book/01-Do-Not-Die-Early.md) | +| How many years of life exactly do smoking, alcohol, a sedentary life, and sleep loss take away? | [2. Don't Die Slowly](book/02-Do-Not-Die-Slowly.md) | +| Not enough energy in a day, constantly interrupted — how do you fix it? | [3. Don't Waste Energy](book/03-Do-Not-Waste-Energy.md) | +| Where does the time go, and how do you do fewer pointless things? | [4. Don't Waste Time](book/04-Do-Not-Waste-Time.md) | +| How should savings be kept so that interest, fees, and scams don't eat them? | [5. Don't Waste Money](book/05-Do-Not-Waste-Money.md) | +| Which supplements, checkup packages, and "IQ taxes" can you simply not buy? | [6. The Negative List](book/06-The-Anti-List.md) | +| You lost your job, your wages are withheld, you have no money — what can you claim and where do you ask for help? | [7. How to Live When You Have No Money](book/07-Living-With-No-Money.md) | +| Betrothal gifts, premarital property, large transfers during dating — who owns what in law? | [8. Don't Get Yourself Locked Up: Law and Property Safety](book/08-Do-Not-End-Up-Inside.md) | +| Someone reports you, accuses you, fabricates facts — what is the first step, and can you seek redress and compensation afterwards? | [8. Don't Get Yourself Locked Up: Law and Property Safety](book/08-Do-Not-End-Up-Inside.md) | +| Which "side jobs" and casual favors turn an ordinary person into a criminal defendant? | [9. Legal Red Lines](book/09-Legal-Red-Lines.md) | +| Should you court many people at once or commit to one, can long-distance work, what do you bring to register a marriage? | [10. Are Dating and Marriage Worth It](book/10-Is-Love-And-Marriage-Worth-It.md) | +| Writing which code, taking which jobs can get you a prison sentence? | [11. Red Lines for Techies](book/11-Red-Lines-For-Techies.md) | +| Before borrowing to open a shop or founding a company, what should you think through first? | [12. Starting Your Own Business](book/12-Starting-Your-Own-Business.md) | +| Someone collapses and stops breathing, heavy bleeding, fire, lost in the wild — what do you do first? | [13. Emergencies: What to Do First](book/13-Emergencies.md) | +| Account stolen, phone lost — what is the first step? | [14. Accounts And Security](book/14-Accounts-And-Security.md) | +| Deposit withheld, landlord evicting you, long-term rental operator collapsed — what do you do? | [15. Renting And Buying Housing](book/15-Renting-And-Buying-Housing.md) | +| After a chronic disease diagnosis, how do you manage it long-term and spend less? | [16. Living With Chronic Disease](book/16-Living-With-Chronic-Disease.md) | +| How should an elderly parent's guardianship, will, and money be arranged in advance? | [17. Elderly At Home](book/17-Elderly-At-Home.md) | +| What can you claim when having a child, and how much time and money does it take? | [18. Is Having Kids Worth It](book/18-Is-Having-Kids-Worth-It.md) | +| How are overtime pay and annual leave counted, how much compensation does a layoff owe you, how do you file and get paid for a workplace injury? | [19. Employment And Work Injury](book/19-Employment-And-Work-Injury.md) | +| The child is just born — which things matter most? | [20. Newborn](book/20-Newborn.md) | +| Which countries not to go to now, and how far does consular protection go when something happens? | [21. Travel And Abroad Safety](book/21-Travel-And-Abroad-Safety.md) | +| How not to get burned at KTV, internet cafés, escape rooms; and what works best when you're stressed? | [22. How To Relax](book/22-How-To-Relax.md) | +| Learning welding, English, certificates — which ones really pay back? | [23. Which Skills To Learn](book/23-Which-Skills-To-Learn.md) | +| Same illness at a community clinic and a tier-III hospital — how different is the cost? | [24. Seeing The Doctor](book/24-Seeing-The-Doctor.md) | +| Badly injured and rushing to a hospital — register and queue, or go to the ER triage desk? Afterwards, do you need a disability assessment, a disability certificate? | [24. Seeing The Doctor](book/24-Seeing-The-Doctor.md) | +| A family member has died — what to do first, which money can be recovered, which fees can be waived? | [25. After Someone Dies](book/25-After-Someone-Dies.md) | +| Building a website or platform that takes payments — which licenses, where to host servers? | [26. Building A Website Or Platform](book/26-Building-A-Website-Or-Platform.md) | +| Pregnant, about to give birth — when to do what, and which documents to arrange before discharge? | [27. Pregnancy And Birth](book/27-Pregnancy-And-Birth.md) | +| You want to lose weight or look better — which practices wreck your body? | [28. Do Not Ruin Health For Looks](book/28-Do-Not-Ruin-Health-For-Looks.md) | +| A relative died, you were laid off, you got a serious diagnosis — what matters most in the first months? | [29. After A Major Blow](book/29-After-A-Major-Blow.md) | +| Once the child starts school, which physical and mental things cannot wait until after the exams? | [30. School-Age Kids](book/30-School-Age-Kids.md) | +| After eighteen, besides studying and working, which roads are open — and what are their thresholds? | [31. Paths After Eighteen](book/31-Paths-After-Eighteen.md) | +| Studying abroad — how do you keep the visa unbroken, and will the diploma be recognized when you come home? | [32. Studying Abroad](book/32-Studying-Abroad.md) | +| You or a family member became disabled — which complications to prevent first, which subsidies can you claim, and what about school, work, and guardianship? | [33. Living With Disability](book/33-Living-With-Disability.md) | +| Cold meds, fever reducers, stomach meds you buy yourself — what not to combine, and what kids, pregnancy, and older adults must avoid? | [34. Avoid Serious Harm From Home Medicines](book/34-Avoid-Serious-Harm-From-Home-Medicines.md) | + +## How to read this + +- **To filter by conditions**: open the [online search page](./); you can filter by keyword, chapter, and evidence grade, and combine three cost dimensions: whether it costs money, whether it takes time, whether it takes willpower. The data is read directly from the book/ text; fix the text and the search page changes with it. +- **To read in order**: items inside each section are ordered from highest to lowest value for the money; start with the first few items of each section. +- **If you can't read that string of numbers**: every item has an "In plain terms" line that translates the risk ratios and confidence intervals in the Benefit field into everyday statements like "about 20% lower chance of dying in the same period" or "a few days of detention, a fine of so much" — using only facts already in the original, without adding new numbers. That line alone is enough to decide; the Benefit field keeps all the raw numbers and confidence intervals so you can check for yourself. +- **Only the hardest conclusions**: on the search page check evidence grade A to keep only the 410 items with concrete numbers from meta-analyses or large trials. +- **Only the most worthwhile**: check "very high" value-for-money to get the 99 items that cost no money, no time, no willpower, and whose benefit lands in the largest tier. Stack one more "what it buys back" filter on top and you have the priority list under that measure. +- **Don't be alarmed by section titles that start with "Don't"**: a section title names the outcome that section tries to prevent (don't die early, don't waste time), not a blanket ban on every item under it. Item titles are the actual actions, always starting with a verb, each carrying its own "do this" or "don't do this" — both kinds live in the same section. For example, section 4 has both "Turn 'planning to do it' into 'at such an hour, in such a place, when X happens, do it'" and "Skip TV and rolling news". Read by item title, not by the tone of the section title. + +Each piece of advice looks like this: ```markdown -### 5. 把家里的食盐换成低钠盐（钾盐） -- 成本：一袋比普通盐贵几元。买的时候顺手换，不额外占时间。口味几乎不变。 -- 说人话：两万人的随机试验里，把家里的盐换成低钠盐的人，五年内死亡的概率低约 12%，中风低约 14%。这是随机分成两组比出来的，比只跟踪记录得到的数字更可信。 -- 收益：一项把人随机分成两组的试验，在中国农村做的，20995 人，都是得过卒中的人或者 60 岁以上的高血压病人，跟踪了 4.74 年。结果：用低钠盐的那组比用普通盐的那组，死亡风险低约 12%（RR 0.88）。卒中低约 14%（RR 0.86）。主要心血管事件低约 13%（RR 0.87）。 -- 证据等级：A -- 来源：Neal B 等 (2021). Effect of Salt Substitution on Cardiovascular Events and Death. NEJM. https://doi.org/10.1056/NEJMoa2105675 -- 备注：争议。试验对象是高危老人，健康年轻人换盐得到的好处要小得多。肾功能不全的人，或者正在吃保钾类药物的人，换盐前先问医生。 -``` - -## 自己跑一份 - -多数人用不着部署：[在线检索页](https://eternity4719.github.io/HowToLiveBetter/)是现成的，要离线就下[离线单文件 HTML](https://github.com/eternity4719/HowToLiveBetter/releases/download/epub-latest/HowToLiveBetter.html)，双击就开。 - -真要在自己电脑或服务器上跑： - -```bash -git clone https://github.com/eternity4719/HowToLiveBetter.git -cd HowToLiveBetter -python -m http.server 8000 -``` - -然后浏览器开 `http://localhost:8000/`。检索页是纯静态的，`README.md` 和 `book/` 就是它的数据，没有后端、没有数据库、不用装依赖；把整个目录丢给任何静态服务器（Nginx、GitHub Pages、对象存储）效果一样。注意 `index.html` 必须经 http 打开，直接双击本地文件会空白——浏览器不许网页读本地文件，那种场景请用上面的离线单文件版。 - -想自己生成三样电子版（平时用不着，Release 里的就是自动生成的）： - -```bash -cd tools/epub && npm ci && npm run build # EPUB -node tools/offline/build.mjs # 离线单文件 HTML -node tools/pdf/build.mjs # PDF，另需 pandoc ≥ 3.1 和 typst ≥ 0.13 +### 5. Switch your household salt to low-sodium (potassium) salt +- Cost: a few yuan more per bag +- In plain terms: in a randomized trial of 20,000 people, those who switched to low-sodium salt had about a 12% lower chance of dying within five years and about 14% fewer strokes. This comes from random assignment, which is more trustworthy than observational data. +- Benefit: stroke down 14%, cardiovascular events down 13%, all-cause mortality down 12% +- Evidence grade: A +- Sources: Neal B, et al. (2021). NEJM. https://doi.org/10.1056/NEJMoa2105675 +- Notes: contested. People with impaired kidney function or on potassium-sparing diuretics should not use it. ... ``` -产物都在 `dist/`。 - -## 四种资源 - -这本书想帮你多留住的不只是寿命，一共四样东西： - -- **寿命**：活得更久，少死于本来可以避免的事 -- **时间与精力**：活着的时间不花在没有回报的事上，每天的注意力和体力少被白白耗掉 -- **金钱**：少花冤枉钱，把钱花在收益确定的地方 -- **人身自由**：不因为不知道一条红线，把自己送进拘留所或者看守所 - -每一条建议都回答两个问题：要花掉什么（钱/时间/精力/毅力），能换回什么（总死亡率变化 / 特定死因下降 / 时间与精力节省 / 金钱节省 / 保障与人身自由）。条目按性价比排，不按类别排：几乎不花什么成本、换回的好处又大的，放在最前面。 - -**一条建议的好处落在谁身上，是分档的。** 按「这份好处将来有多大可能回到你自己身上」从高到低：① **你自己**；② **配偶和直系亲属**（父母、子女、祖父母外祖父母、孙子女外孙子女）；③ **朋友、同事和其他亲属**——互惠关系，帮出去的将来可能回来；④ **陌生人**——最低一档，但不是零：回报的概率小，而且你不了解对方性格，还有被讹、被反咬、被报复的一面。不同档不合并计算，写到第 ④ 档时好处和风险一起写。 - -急救那一节照这个读：中国 38,227 例院外心脏骤停里 79.2% 发生在家里，学按压首先是为了按在自家人身上；「看到有人溺水自己不下水」「撞见斗殴别上手拉架」这类规则本身就是自保规则，防的是你从旁观者变成第二个伤者。对陌生人要不要出手是你自己的权衡，条目会把免责条款、自保动作和风险面都写清楚，不替你把它算成非做不可的理由。 - -死亡率的数字、时间精力的数字、金钱的数字和法律后果，各算各的，不互相折算。这四样对应检索页上那四个「换回什么」，彼此之间不比大小。 - -## 证据分级 - -每条建议都标注证据等级： - -| 等级 | 含义 | -| --- | --- | -| A | 有具体数字可查，出处是多项研究合并起来的荟萃分析、跟踪很多人很多年的大型队列，或者随机分组的试验（RCT），能说出降了多少（HR、RR、下降百分比） | -| B | 有研究支持，但说不出一个确切数字；或者只有小样本、单独一项研究撑着 | -| C | 作者自己的经验，或者大家公认的做法，没有直接的研究文献 | - -全书 630 条中 A 级 420 条、B 级 159 条、C 级 51 条，另有 58 条标注了争议、35 处标注了 TODO 待核实。有争议的 A/B 级条目会标注「争议」并列出反方证据。所有来源只引原始文献（期刊论文附 DOI 或 PubMed 链接，或 WHO/CDC/国家统计局等官方机构报告），不引二手转述。不确定的数字标「待核实」。 - -## 性价比档 - -证据等级只回答「这个数字可不可信」，不回答「这件事值不值得做」。所以每条还另外标了两样：收益量级（好处有多大）和口径（换回的是哪一类东西）。检索页拿这两样加上三项成本，合出一个性价比档： - -| 维度 | 取值 | 怎么定的 | -| --- | --- | --- | -| 口径 | 换寿命 / 换钱 / 换时间精力 / 换人身自由 | 看这条主要换回的是什么。**不同口径之间不做比较**，「总死亡率降 12%」和「每年省 500 元」不在一把尺子上，没法分高下 | -| 收益量级 | 大 / 中 / 小 | 尽量照着条目自己的「收益」栏，按事先定好的界线套，不凭感觉：换寿命看降了百分之几（≥20% 为大，10–20% 为中，<10%、或者只量到中间指标而没量到最终结果的为小）；换钱看金额（万元级为大，数百到数千为中，几十元为小）；换人身自由看后果（避免刑事责任为大，避免拘留或行政处罚为中，避免民事纠纷为小）；换时间精力看省下多少（每天省出小时级为大，每周小时级为中，只省一次的为小） | -| 性价比 | 极高 / 高 / 一般 | 好处大、三项成本又全是零 = 极高；好处大、成本不高，或者好处中等、成本为零 = 高；剩下的 = 一般 | - -全书 630 条中性价比极高 108 条（17%）、高 288 条（46%）、一般 234 条（37%）。中间那档条数多是有意的：底下的收益量级本来就只分大、中、小三级，再往细里切就是装出来的精确。 - -**这一档是作者自己的判断，不是证据**，按本书的标准它本身只算 C 级；它和证据等级是两回事，谁也不影响谁。一条可以证据是 A 级、性价比却只算一般（带状疱疹疫苗有 97.2% 效力的三期 RCT，但两针三四千元、带状疱疹很少致命），也可以证据只有 C 级、性价比却极高（出境前把行程发给家人）。「一般」不等于不该做——全书的条目都是建议做的，只是这一档得你自己掂量那笔花销值不值。 - -## 读懂数字（术语表） - -正文尽量用日常说法，但引用研究的时候免不了出现几个统计名词。看不懂就查这张表；在线检索页里，把鼠标停在带虚线的词上（手机上点一下）也会弹出解释。 - -
-展开 41 条术语（总死亡率、HR、RR、95% CI、荟萃分析、BMI、LPR、定金与订金……） - -| 术语 | 意思 | -| --- | --- | -| 总死亡率 | 一段时间里，一群人当中死掉的人占多大比例，不管死于什么原因。本书用它衡量「活得久不久」。研究原文里叫全因死亡率，英文缩写 ACM | -| HR | 风险比。同样一段时间里，做了某件事的那组人出事（死亡、得病）的快慢，除以没做的那组。HR 0.87 就是比没做的那组低 13%，HR 1.21 就是高 21% | -| RR | 相对风险。两组人出事的可能性之比，数字怎么读和 HR 一样 | -| OR | 比值比。也是两组的对比，只是算法和 RR 略有不同：要比的那件事很少见时，它和 RR 差不多；那件事很常见时，它会把差距说得比实际大 | -| IRR | 发病率之比。发病率是一段时间里新得这个病的人占多大比例，两组相除，读法同 RR | -| RaR | 发生次数之比。比的是事情发生了多少次（比如摔了多少跤），不是多少人出事，读法同 RR | -| 标准化死亡比 | 英文缩写 SMR。这群人实际死了多少人，除以「同样年龄的普通人本该死多少人」。5.86 就是死的人数是同龄人的 5.86 倍 | -| 风险差 | 两组出事的概率相减，直接得出「每一千人里多出几个」。倍数只说翻了几倍，风险差说的是实实在在多了多少人 | -| 95% CI | 95% 置信区间。研究算出的数字总有误差，这是真实情况很可能落在的范围。倍数类的数字，范围跨过了 1；加减类的数字，范围跨过了 0，就说明两组的差别可能只是碰巧，文中会写「无统计学意义」 | -| RCT | 随机对照试验。用抽签一样的办法把人分成两组，一组做这件事，一组不做，过后比结果差多少。要证明「是这件事起了作用」，这种做法最有说服力 | -| 荟萃分析 | 把很多项研究的结果凑到一起重新算，得出一个总的数字。也叫 meta 分析 | -| 队列 | 队列研究。挑一大群人跟踪很多年，记录谁出了事。能看出两件事常一起出现，但不足以证明是前一件造成了后一件 | -| 观察性 | 观察性研究。研究者只在旁边记录，不安排谁做、谁不做。结果容易被别的因素带偏（见本表的混杂、反向因果两条），数字要打点折看 | -| 混杂 | 有第三个因素同时牵动着前因和后果，让两件事看起来像有因果。比如爱吃菜的人往往也更爱运动，分不清是哪一样在起作用 | -| 反向因果 | 因果的方向弄反了：看着像前一件引起后一件，其实是后一件引起前一件。不是睡得多让人早死，而是病重的人睡得多 | -| d、g | 效应量，表示两组的差距有多大。把差距换算成「相当于几倍的常见波动幅度」：0.2 算小，0.5 中等，0.8 大 | -| r | 相关系数。两件事跟着一起变的紧密程度，取值从 -1 到 1，0.1 算弱、0.3 中等、0.5 算强 | -| MET | 运动强度的单位。安静坐着是 1 MET，快走约 3 到 4 MET。写成 MET·h，就是强度乘以做了几小时，表示一共动了多少 | -| GRADE | 国际上通用的一套打分办法，给一项证据有多可靠评级，分高、中、低、极低四档 | -| 意向筛查分析 | 算效果时按「通知了谁去做筛查」算，不按「谁真的去做了」算。被通知的人里总有没去的，所以这种算法会把筛查对真去做的人的好处算低 | -| 包年 | 统计一个人一共抽了多少烟的单位。每天抽几包乘以抽了几年，30 包年就是每天一包抽了 30 年 | -| BMI | 体重指数，看胖瘦常用的一个数：体重的公斤数，除以身高米数的平方 | -| LDL | 低密度脂蛋白胆固醇，俗称坏胆固醇 | -| eGFR | 估算肾小球滤过率，衡量肾脏过滤能力的一项指标，单位 mL/min/1.73 m²。数越低说明肾功能越差，慢性肾病分几期就按它定 | -| HBsAg | 乙肝表面抗原，化验单上的一项。结果是阳性，表示已经感染了乙肝病毒 | -| HPV | 人乳头瘤病毒。它分很多型，其中一部分型长期感染会导致宫颈癌 | -| LDCT | 低剂量胸部 CT，辐射量约为普通 CT 的五分之一到十分之一 | -| PM2.5 | 飘在空气里的细颗粒物，直径在 2.5 微米以下 | -| NOVA | 一种给食品分类的办法，按加工得有多厉害分成四类，「超加工食品」就是其中的第四类 | -| LPR | 贷款市场报价利率。国内贷款利率的基准，每月 20 日公布一次，房贷利率和民间借贷的利息上限都照着它算 | -| 一裁终局 | 劳动仲裁的结果下来就直接生效，单位不能再拿这件事去法院起诉 | -| 粗结婚率、粗离婚率 | 每一千人里，当年登记结婚、登记离婚的对数。另外还有个数叫离结比，是当年离婚对数除以结婚对数，和这两个不是一回事，别混着看 | -| AED | 自动体外除颤器。公共场所常见的红色或黄色急救箱，开机以后跟着语音提示做就行，要不要电击由它自己判断 | -| CPR | 心肺复苏。心脏骤停时用力按压胸口，让血继续流动 | -| 3C 认证 | 中国强制性产品认证。列进目录的那些产品，没印这个标志就不准出厂、不准卖 | -| ICP 备案 | 网站或 App 正式上线之前，到工信部的系统里登记一道手续 | -| 等级保护 | 网络安全等级保护制度。按一套系统有多重要分成几个级别，级别越高，要做的安全措施越多 | -| GPL | 一种开源许可证。用了这类代码做出来的东西，往外发的时候通常也得把自己的代码一起公开 | -| 竞业限制 | 和公司签的一种约定：离职后一段时间内不去同行的对手那里上班。这段时间公司要按月给你补偿，最长 2 年 | -| 认缴出资 | 注册公司时承诺要投进去的钱。承诺了就得在法律定的期限内真掏出来，不是写个数字好看 | -| 定金与订金 | 两个词只差一个字，效力差很多：定金有罚则，收钱的一方反悔要双倍退还，金额最多为合同额的 20%；订金只是提前付的钱，反悔没有这个罚则 | - -
- -## 目录 - -1. [不要早死](book/01-不要早死.md)：外因死亡、燃气与中毒、疫苗、筛查、心理危机与自杀念头的时间尺度、被救回来之后留下什么、坠落重伤之后的那一年、卖掉一个肾之后剩下那个肾的账、家庭应急装备、肉眼血尿等该去查的信号。口径：总死亡率 或特定死因。 -2. [不要慢慢死](book/02-不要慢慢死.md)：烟酒、运动、睡眠、饮食（低钠盐、坚果、全谷物、加工肉、散装自榨花生油、植物油代替猪油）、久坐，以及戒烟戒酒的具体办法（戒烟药、戒烟日、戒烟门诊与热线、电子烟、酒精戒断不能自己硬扛）、午睡时长、熬夜之后怎么补、上夜班的年数账。口径：总死亡率 或特定死因。长文见 [docs/生物钟和夜班.md](docs/生物钟和夜班.md)。 -3. [不要浪费精力](book/03-不要浪费精力.md)：睡眠、打断、多任务、决策疲劳、人际负债、和机构打交道时该有的预期。口径：精力/时间。 -4. [不要浪费时间](book/04-不要浪费时间.md)：无收益项目、沉没成本、拖延（情绪解释、改环境、承诺装置、习惯要多久、自助材料）、会议、通勤。口径：时间。 -5. [不要浪费钱](book/05-不要浪费钱.md)：订阅、彩票、利息、保险、基金费率、个人养老金、车险、预付款、直播带货、医保个人账户、孩子被骗与充值退款、手串名表潮玩不按投资算、珠宝玉石的检测报告怎么核、盲盒抽卡、想买海外资产走哪条合法渠道，节末六条讲保险：只给扛不住的损失买、挣钱的人先买定期寿险、犹豫期退保、银行柜台别把保险当存款、别找代理退保、受益人和理赔时效。口径：金钱。 -6. [反面清单](book/06-反面清单.md)：看起来性价比高但其实不高的东西，含「意志力会用完」这个说法。 -7. [没钱的时候怎么活](book/07-没钱的时候怎么活.md)：救助、补贴、找活、住宿吃饭、医疗、欠薪维权、避坑。口径：金钱/保障。 -8. [别把自己搭进去：法律与财产安全](book/08-别把自己搭进去.md)：交通事故、被骗止付、AI 换脸拟声、自首和如实供述能减多少刑与「躲过追诉期」这条路为什么不通、被指控和被人捏造事实举报之后能走哪些路、拿举报要挟对方掏钱和自己正常索赔的分界、冲突与泄愤式极端暴力、伤人冲动与身边人的送诊权、给家人投保后动手的四道法律门、被网暴之后走平台与禁令、彩礼、婚前财产、担保、反诈、诉讼时效、被执行与失信名单、养犬责任、报警之后的受案回执与不立案救济、送钱摆平就是行贿罪。口径：金钱/人身自由。 -9. [普通人容易踩的法律红线](book/09-普通人容易踩的法律红线.md)：谣言、侮辱英烈、境外内容只看不转、传播色情、兼职洗钱、伪造材料骗贷、伪造事故骗理赔、高空抛物、仿真枪、无人机、偷拍、养不了孩子时的合法送养与拐卖遗弃的界线、赌博、野味、卖器官与帮人找供体。口径：人身自由/金钱。 -10. [恋爱和结婚划不划算](book/10-恋爱和结婚划不划算.md)：择偶策略、纠缠的红线、兴趣信号、关系质量、异地恋、登记流程、婚检、健康账、时间账、钱账、父母出资买房与夫妻共同债务、退出成本。长文见 [docs/结婚划不划算.md](docs/结婚划不划算.md)。 -11. [程序员和技术人容易踩的红线](book/11-程序员和技术人容易踩的红线.md)：外挂、爬虫、抢票脚本、删库、带走源码、接单开发、竞业、开源许可、备案。口径：人身自由/金钱。 -12. [创业与做生意：别把家底赔进去](book/12-创业与做生意.md)：本钱、担保、主体选择、注册登记、许可证、纳税申报、发票、涉税诈骗、合同、用人、量产、进货与用图的知识产权红线、退场。口径：金钱/法律责任。 -13. [紧急情况：先做什么](book/13-紧急情况.md)：心脏骤停、卒中与后循环卒中、眼中风、心梗、主动脉夹层、霹雳样头痛、慢性硬膜下血肿、肺栓塞、大出血、咬伤、烧烫伤、过敏性休克、癫痫、低血糖、触电、一氧化碳、误服与化学品灼伤、扎进身体的异物、骨折固定、骗局、隐私威胁、中暑、火灾、溺水、迷路、失温、蛇咬、地震、野兽、雷击、高原病、蜱虫、野外饮水；还有救不救得起：老人摔倒怎么扶、撞见斗殴怎么办、救人受伤之后的钱找谁。口径：存活率与金钱，末几条兼及人身自由。 -14. [账号与信息安全](book/14-账号与信息安全.md)：二次验证、密码、SIM 卡、手机丢失、银行卡盗刷、登录设备、App 权限、人脸识别、查阅与删除权。口径：金钱/个人信息。 -15. [租房与买房](book/15-租房与买房.md)：押金、暴力腾退、中介代收、资金监管、买卖不破租赁、产权核对、交易资金专户、隔断房。口径：金钱。 -16. [得了慢性病之后怎么活](book/16-得了慢性病之后怎么活.md)：服药依从、门诊慢特病跨省结算、复查记录、别停药试偏方、长期处方、家庭医生签约、并发症筛查、肾结石复发预防、痛风的达标治疗。口径：总死亡率/金钱。 -17. [家里有老人](book/17-家里有老人.md)：意定监护、遗嘱形式、账户与话术、投资养老与以房养老骗局、长期护理保险、长期卧床的压疮防护。口径：金钱/人身自由，压疮那条为死亡率。 -18. [养孩子划不划算](book/18-养孩子划不划算.md)：育儿补贴、产假与生育津贴、三期保护、时间账、钱账。口径：金钱/时间。 -19. [在职、离职和工伤](book/19-在职离职和工伤.md)：加班费、年休假、试用期；职业病危害告知与三次体检、粉尘噪声防护；N、代通知金、2N、别签主动辞职、留证；工伤认定时限、单位未参保、劳动能力鉴定、工亡待遇。口径：金钱。 -20. [刚出生的孩子怎么带](book/20-刚出生的孩子怎么带.md)：安全睡眠、乙肝首针、免疫规划疫苗、母乳与辅食、冲奶水温、蜂蜜、维生素 K、发热就医红线、不摇晃、尿布与大件采购、高危孩子早引入花生防过敏。口径：婴儿死亡率/金钱。 -21. [出国、旅行与境外安全](book/21-出国旅行与境外安全.md)：安全提醒级别、12308、领事保护的边界、境外医疗保险、境外高薪招聘骗局、境外取现的年度额度、证件丢失、境外驾照、中介备案。口径：金钱/人身自由。 -22. [怎么放松：娱乐场所和减压](book/22-怎么放松.md)：安全出口、明码标价、涉毒红线、别人递的东西、网吧实名、剧本杀选址；运动、正念、呼吸、社交、绿地。口径：金钱/人身自由，以及精力/总死亡率。 -23. [学什么技能划算](book/23-学什么技能划算.md)：读书还是打工（童工年龄线、教育与死亡率、全国学历结构、免学费与助学金助学贷款、中职升学通道、怎么自己算这笔账）、教育回报率、山寨证书、培训补贴、哪些本事不容易被机器取代、技能等级、紧缺职业怎么查，以及定下来学什么之后怎么学（自测、分散练习、别靠划重点、交错练习、学习风格没有证据），最后是职称（申报渠道、以考代评、代评造假的后果、评上不等于聘上）。口径：金钱/时间，其中一条为死亡率。 -24. [看病：怎么少花钱少走弯路](book/24-看病.md)：分级诊疗与转诊、起付线连续计算、报销比例差、预留号源、异地就医必要性评估、病历留存与封存、急诊预检分诊的四级顺序、无力支付时的疾病应急救助、伤残鉴定的时机、残疾人证怎么办、不用给医生送红包。口径：金钱/时间。 -25. [人走了以后要办什么](book/25-人走了以后要办什么.md)：报警与死亡证明、遗体接运与火化、死因异议与尸检、注销户口、殡葬基础项目清单、价格违法、中介备案、公积金余额与社保待遇、死者个人信息权利。口径：金钱。 -26. [做一个网站或平台：资质、备案和服务器](book/26-做一个网站或平台.md)：支付结算红线、ICP 许可与备案、直播与视听资质、平台核验与涉税报送、内容治理、实名、未成年人、通知删除、数据出境、服务器选型。口径：人身自由/金钱。长文见 [docs/做平台要办哪些证.md](docs/做平台要办哪些证.md)。 -27. [怀孕和生产：从发现怀孕到出院办证](book/27-怀孕和生产.md)：叶酸、建册与免费产检、三病筛查与母婴阻断、孕期烟酒、阿司匹林与妊娠期糖尿病、立刻去医院的信号、破水处置、无痛分娩、剖宫产指征、生育保险、出生医学证明、新生儿筛查、参保与落户、产后 42 天复查。口径：死亡率与金钱。 -28. [别为了外形把身体搞坏](book/28-别为了外形把身体搞坏.md)：极端节食与进食障碍、医美机构与主诊医师两证、面部填充的失明部位、违法添加西布曲明的减肥产品、合成代谢类固醇、减肥药与性激素的处方和复查、体像评估。口径：死亡率（健康终点），医美两条兼及人身自由。 -29. [遭遇重大打击之后](book/29-遭遇重大打击之后.md)：丧亲头一个月的心血管窗口、重病诊断的第一周、失业、丧偶后的半年、因自杀丧亲、没有亲人也没有朋友时怎么替代那个人、家长去世的孩子、哀伤卡住了去哪挂号、离婚、12356 与 12355、别在应激期做不可逆的决定、用死还债这条路不通。口径：总死亡率，谈花钱与待遇的四条为金钱。 -30. [上学以后的孩子](book/30-上学以后的孩子.md)：按小时算的急症、别为了考试推迟治疗、被欺凌怎么办、每天户外 2 小时、学生体检报告单、青少年抑郁筛查、治愈近视的产品、睡眠与作业的硬规定、休学保留学籍、散瞳验光与复查、窝沟封闭。口径：死亡率与健康终点，另有金钱和时间各一到两条。 -31. [十八岁之后有哪几条路](book/31-十八岁之后有哪几条路.md)：十二条路的法定门槛；当兵（兵役登记、义务兵两年、拒服兵役的联合惩戒、学费补偿与升学、安置与 30 日报到、退役金与工龄税收）；基层服务项目的定向考录；特岗教师期满入编；消防员与军队文职；自考、成人高考与开放大学；公费师范生与定向医学生的 6 年履约；出国打工找什么样的公司；在家给境外公司远程干活的个税与收汇；创业担保贷款；灵活就业的社保；骑手的职业伤害保障。口径：金钱/时间，拒服兵役那条兼及人身自由。 -32. [出国留学：身份、打工、保险和回国认证](book/32-出国留学.md)：交学费前查认证院校名单；美国 F-1「最长四年、读完 30 天内走」的新规被法院暂停，眼下仍是读完为止与 60 天宽限期；美加英澳四国的打工时数上限；全日制在读是身份的根；搬家 10 日内报备；教育部留学预警；澳大利亚 OSHC 不能断；英国医疗附加费；留服认证的 10 到 20 个工作日；被加强审查的院校名单。口径：金钱/人身自由。 -33. [残疾之后怎么活](book/33-残疾之后怎么活.md)：自主神经反射异常的现场三步、致残后十年的自杀窗口、精神障碍住院的自愿原则与两种例外、照护者自己的死亡风险、轮椅减压坐垫、治愈系骗局、办证之后该问全的六项待遇、长期护理保险不只给老人、0—6 岁康复救助、家庭无障碍改造补贴、按比例就业与残保金、个税减征、导盲犬与免费乘车、高考合理便利、学校不得拒收与送教上门、C5 驾照、康复机构怎么挑、助听器、行为能力认定与监护。口径：死亡率/金钱/时间/人身自由。 -34. [家里的常备药别吃出事](book/34-家里的常备药别吃出事.md)：对乙酰氨基酚别吃重复、孩子退烧不用阿司匹林尼美舒利安乃近、布洛芬伤胃的高危人群、2 岁以下不自己喂复方感冒药、怀孕 20 周后不自己吃布洛芬、奥美拉唑自己吃最多 7 天、感冒不要抗生素、腹泻先补液与孩子不给止泻药、止痛药吃多了反而头痛。口径：死亡率。 - -每节内条目按性价比从高到低排列。「不要早死」「不要浪费时间」这类节标题说的是这一节想防住的结果，条目本身要做还是别做，以条目标题为准。长文另见 [docs/家庭应急装备清单.md](docs/家庭应急装备清单.md)、[docs/做平台要办哪些证.md](docs/做平台要办哪些证.md)、[docs/结婚划不划算.md](docs/结婚划不划算.md) 、[docs/遇到陌生人出事该不该停.md](docs/遇到陌生人出事该不该停.md) 和 [docs/生物钟和夜班.md](docs/生物钟和夜班.md)。每条来源的核实过程记录在 [docs/核实记录](docs/核实记录/)。 - -仓库根目录的 `index.html` 是在线检索页：按关键词、章节、证据等级和成本维度（花钱、花时间、要毅力）筛选条目，数据直接读本文件。在仓库设置里开启 GitHub Pages（Deploy from a branch，分支 main，目录 /）后即可访问。`tools/epub/` 是电子书生成脚本，`cd tools/epub && npm ci && npm run build` 在本地出一本 EPUB 到 `dist/`；GitHub Actions 在正文改动后自动跑同一个脚本并更新 Release。 - -## 正文 - -正文按节拆成 34 个文件放在 [book/](book/)，点上面目录里的节名进入。拆开是因为单文件已经超过 GitHub 渲染 Markdown 的 512 KB 上限，后面的节显示不出来；[在线检索页](https://eternity4719.github.io/HowToLiveBetter/)会把这些文件合起来读，用法不变。 - -## 许可 - -正文用 [CC BY 4.0](LICENSE) 发布，范围是 book/、docs/ 和本 README 的文字。你可以转载、改编、商用，不用来问作者，但要做到三件事： - -- 写明出处：「高性价比人生指南」，附上仓库链接 https://github.com/eternity4719/HowToLiveBetter 。 -- 附上许可证链接 https://creativecommons.org/licenses/by/4.0/ 。 -- 改过内容的要写明改过。书里的法条、补贴标准和截止日期经常更新，建议同时写上你同步的是哪一天的版本。 - -代码用 [MIT](LICENSE-CODE)，范围是 tools/、skills/、index.html 和 .github/。 - -## Star 走势 - -[![Star History Chart](https://api.star-history.com/svg?repos=eternity4719/HowToLiveBetter&type=Date)](https://star-history.com/#eternity4719/HowToLiveBetter&Date) - -## 赞赏 - -觉得有用，可以用微信扫码请作者喝杯咖啡。给不给都行，不影响任何内容。 - -微信赞赏码 - -## 广告位 - -永恒世界 Minecraft 服务器，游戏地址 1.mcyyy.com +## Four resources + +This guide optimizes not just lifespan but four resources: + +- **Lifespan**: live longer, die less often from things that were avoidable +- **Time and energy**: the time you are alive is not eaten by zero-return activities, and your daily attention and stamina are drained less +- **Money**: spend less money on nothing, put it where the payoff is certain +- **Personal freedom**: don't talk yourself into detention or jail by not knowing where a red line runs + +Every piece of advice answers two questions: what it costs (money / time / energy / willpower), and what it buys back (all-cause mortality change / a specific cause of death down / time and energy saved / money saved / protection and personal freedom). Items are ordered by value for money, not by category: near-zero cost with large benefit goes first. + +**Whose account the benefit lands on is tiered.** By the expected chance that the good comes back to you, from high to low: ① **you yourself**; ② **spouse and immediate family** (parents, children, grandparents, grandchildren); ③ **friends, colleagues, and other relatives** — a reciprocal relationship, what you give may come back later; ④ **strangers** — the lowest tier, but not zero: the chance of return is small, you don't know the other person's character, and there is the risk of being scammed, counter-accused, or retaliated against. Tiers are not merged into one number; when writing about tier ④, the benefits and the risks are written together. + +Read the first-aid section with this in mind: of 38,227 out-of-hospital cardiac arrests in China, 79.2% happened at home — you learn compressions first of all to press on your own family. Rules like "do not go into the water yourself after a drowning person" and "don't step in to separate a fight" are self-protection rules: they guard against you turning from bystander into second casualty. Whether to act for a stranger is your own trade-off; the item spells out the liability disclaimer, the self-protective moves, and the risk surface, and does not decide for you that it must be done. + +Mortality numbers, time/energy numbers, money numbers, and legal consequences are kept in separate measures and never converted across measures. The four resources correspond to the four "what it buys back" filters on the search page; they are not compared with each other. + +## Evidence grades + +Every piece of advice carries an evidence grade: + +| Grade | Meaning | +| ----- | ------------------------------------------------------------------------------------------------------------------------ | +| A | Quantifiable evidence from meta-analyses, large cohorts, or RCTs that gives concrete numbers (HR, RR, percent reduction) | +| B | Research-backed but hard to quantify, or evidence from small samples / a single study | +| C | Author experience or general consensus, no direct literature | + +Of the 608 items in the book, 410 are grade A, 149 grade B, and 49 grade C; 56 items are marked as contested and 29 spots are marked TODO, pending verification. Contested A/B items are marked "contested" with the opposing evidence listed. All sources cite primary literature only (journal papers with a DOI or PubMed link, or reports from official bodies such as WHO, CDC, or the national statistics bureau), never second-hand retellings. Uncertain numbers are marked "to be verified". + +## Value-for-money tiers + +The evidence grade answers "can this number be trusted", not "is it worth doing". So every item also carries a benefit magnitude and a measure; the search page combines these with the three costs into one value-for-money tier: + +| Dimension | Values | How it is set | +| ----------------- | --------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | +| Measure | Buys lifespan / buys money / buys time-energy / buys personal freedom | By what the item mainly buys back. **Measures are not compared with each other**: "all-cause mortality down 12%" and "save 500 yuan a year" are not on one ruler | +| Benefit magnitude | Large / medium / small | Mechanically applied from thresholds in the item's own Benefit field where possible: for lifespan, relative reduction (≥20% large, 10–20% medium, <10% or only surrogate endpoints small); for money, the amount (tens of thousands large, hundreds to thousands medium, tens of yuan small); for personal freedom, the consequence (avoiding criminal liability large, avoiding detention or administrative punishment medium, avoiding a civil dispute small); for time-energy, the saving (hours a day large, hours a week medium, one-off small) | +| Value for money | Very high / high / ordinary | Large benefit with all three costs zero = very high; large benefit with low costs, or medium benefit with zero costs = high; the rest = ordinary | + +Of the 608 items in the book, 104 (17%) are very high, 276 (45%) high, and 228 (38%) ordinary. The middle tier is deliberately thick: the underlying benefit magnitude has only three levels, and slicing finer would be false precision. + +**This tier is the author's judgment, not evidence** — essentially grade C, and orthogonal to the evidence grade. An item can be grade A but ordinary value (the shingles vaccine has a phase-III RCT at 97.2% efficacy, but two doses cost three to four thousand yuan and shingles is rarely fatal), and it can be grade C but very high value (sending your itinerary to family before going abroad). "Ordinary" does not mean "shouldn't be done" — every item in the book is advice worth taking; it only means you should weigh that spend yourself. + +## Reading the numbers (glossary) + +The text tries to speak plainly, but citing research requires a few statistical terms. Check this table when something is unclear; on the online search page, hovering over (or tapping) a dotted-underlined word also pops up an explanation. + +Expand 41 terms (all-cause mortality, HR, RR, 95% CI, meta-analysis, BMI, LPR, deposit vs prepayment …) + +| Term | Meaning | +| --------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | +| All-cause mortality | The share of people dying from any cause over a period, regardless of cause. The book uses it to measure "how long people live". The original literature calls it all-cause mortality, abbreviated ACM | +| HR | Hazard ratio. The speed at which two groups hit an event (death, illness) over the same time. HR 0.87 means 13% lower than the control group; HR 1.21 means 21% higher | +| RR | Relative risk. The ratio of event probabilities between two groups; read like HR | +| OR | Odds ratio. The ratio of odds between two groups; close to RR when events are rare, exaggerates the difference when they are common | +| IRR | Incidence rate ratio; read like RR | +| RaR | Rate ratio (e.g. number of falls); read like RR | +| Standardized mortality ratio | SMR. Actual deaths in a group divided by the expected number computed from the mortality of the general population of the same age. 5.86 means 5.86 times the deaths of peers | +| Risk difference | The probability of an event in one group minus the other, directly giving "how many extra cases per thousand". Ratios only say how many times; the risk difference says how many more people in absolute terms | +| 95% CI | 95% confidence interval. The range where the true value most likely sits. If a ratio-type interval crosses 1, or a difference-type interval crosses 0, the difference may be pure chance and the text will say "not statistically significant" | +| RCT | Randomized controlled trial. People are randomly split into two groups, one gets the intervention, one does not, and outcomes are compared. The best evidence of causation | +| Meta-analysis | Pooling the results of multiple studies into one overall estimate | +| Cohort | Cohort study. A group of people is followed for years to see who has events. Shows association, cannot fully show causation | +| Observational | Observational study. Researchers only observe, do not intervene; results may be affected by confounding and reverse causation, so discount the numbers | +| Confounding | A third factor that affects both cause and result, making association look like causation. People who eat more vegetables also tend to exercise more | +| Reverse causation | Not A causing B, but B causing A. It is not that sleeping a lot makes people die early; it is that seriously ill people sleep a lot | +| d, g | Effect size. How many standard deviations apart two group means are. 0.2 is small, 0.5 medium, 0.8 large | +| r | Correlation coefficient. How strongly two things move together, from -1 to 1; 0.1 weak, 0.3 medium, 0.5 strong | +| MET | Unit of exercise intensity. 1 MET is sitting quietly; brisk walking is about 3 to 4 MET. MET·h is intensity times hours | +| GRADE | An international standard for grading evidence quality into high, moderate, low, and very low | +| Intention-to-screen analysis | Counting the effect by "who was invited" rather than "who actually went", which underestimates the effect on those who actually went | +| Pack-years | A unit of smoking amount. Packs per day times years of smoking; 30 pack-years is one pack a day for 30 years | +| BMI | Body mass index. Weight (kg) divided by height (m) squared | +| LDL | Low-density lipoprotein cholesterol, colloquially "bad cholesterol" | +| eGFR | Estimated glomerular filtration rate. A measure of how well the kidneys filter, in mL/min/1.73 m²; the lower the number, the worse the kidney function, and chronic kidney disease is staged by it | +| HBsAg | Hepatitis B surface antigen; positive means infected with hepatitis B | +| HPV | Human papillomavirus; long-term infection with some types causes cervical cancer | +| LDCT | Low-dose chest CT, with about one-fifth to one-tenth the radiation of a regular CT | +| PM2.5 | Airborne particulate matter under 2.5 micrometers in diameter | +| NOVA | A food classification by degree of processing; "ultra-processed food" is its fourth category | +| LPR | Loan Prime Rate. China's benchmark lending rate, published on the 20th of each month; mortgage and private-lending caps both reference it | +| One-arbitration-final | The labor arbitration ruling takes effect directly; the employer cannot sue in court | +| Crude marriage rate, crude divorce rate | Marriages and divorces registered in the year per thousand people. Divorces divided by marriages is another measure, the divorce-to-marriage ratio; do not mix the two | +| AED | Automated external defibrillator. The red or yellow first-aid box common in public places; turn it on and follow the voice prompts, it decides by itself whether to shock | +| CPR | Cardiopulmonary resuscitation. Pressing hard on the chest during cardiac arrest to keep blood flowing | +| CCC | China Compulsory Certification. Products in the catalog may not leave the factory or be sold without this mark | +| ICP filing | The registration a website or app completes in the MIIT system before going live | +| Multi-Level Protection Scheme | China's cybersecurity classified protection system; protections are applied according to how important the system is | +| GPL | An open-source license. Build a product with its code and you generally must open-source your product when distributing | +| Non-compete | An agreement not to join a competitor for a period after leaving; the company must pay monthly compensation, capped at 2 years | +| Subscribed capital | The money promised when registering a company. Once promised it must actually be paid in within the statutory deadline; it is not just for show | +| Deposit vs prepayment | A statutory deposit (dingjin) carries a penalty: the holder who breaches returns double, capped at 20% of the contract; a prepayment (yudingjin) carries no penalty | + +## Table of contents + +1. [Do Not Die Early](book/01-Do-Not-Die-Early.md): external causes of death, gas and poisoning, vaccines, screening, psychological crisis and the timescale of suicidal thoughts, what remains after being rescued, the year after a serious fall, the ledger of selling a kidney, a home emergency kit, visible blood in urine and other signals worth checking. Measure: all-cause mortality or specific causes. +2. [Don't Die Slowly](book/02-Do-Not-Die-Slowly.md): smoking and alcohol, exercise, sleep, diet, sitting. Measure: all-cause mortality or specific causes. +3. [Don't Waste Energy](book/03-Do-Not-Waste-Energy.md): sleep, interruptions, multitasking, decision fatigue, interpersonal debt, what to expect when dealing with agencies and officials. Measure: energy/time. +4. [Don't Waste Time](book/04-Do-Not-Waste-Time.md): zero-return projects, sunk costs, procrastination, meetings, commuting. Measure: time. +5. [Don't Waste Money](book/05-Do-Not-Waste-Money.md): subscriptions, lotteries, interest, insurance, fund fees, the personal pension, car insurance, prepayments, livestream shopping, the medical savings account, children scammed and in-game refunds. Measure: money. +6. [The Negative List](book/06-The-Anti-List.md): things that look like good value but are not. +7. [How to Live When You Have No Money](book/07-Living-With-No-Money.md): relief, subsidies, finding work, lodging and food, medical care, wage-arrears remedies, traps to avoid. Measure: money/protection. +8. [Don't Get Yourself Locked Up: Law and Property Safety](book/08-Do-Not-End-Up-Inside.md): traffic accidents, fraud and payment freezes, AI face-swap and voice cloning, remedies after accusation and false report, the line between extortion by reporting and claiming your own compensation, conflict and spite-driven extreme violence, impulsive harm and a family member's right to seek hospitalization, the four legal gates of insuring a family member before harming them, after online mobbing: platform routes and injunctions, betrothal gifts, premarital property, guarantees, anti-fraud, statutes of limitation, enforcement and dishonest-debtor lists, dog-owner liability. Measure: money/personal freedom. +9. [Legal Red Lines](book/09-Legal-Red-Lines.md): rumors, insulting heroes and martyrs, foreign content you may read but not repost, distributing pornography, part-time money laundering, forged documents for loans, staged accidents and exaggerated claims, throwing objects from height, replica guns, drones, covert filming, the line between legal adoption when you cannot raise a child and trafficking or abandonment, gambling, wild-meat, selling organs and brokering donors. Measure: personal freedom/money. +10. [Are Dating and Marriage Worth It](book/10-Is-Love-And-Marriage-Worth-It.md): partner-search strategy, the red line of pestering, signals of interest, relationship quality, long-distance, registration process, premarital checkups, the health ledger, the time ledger, the money ledger, parents funding a home and joint marital debt, exit costs. Long read: [Is marriage worth it (long read)](docs/Is-Marriage-Worth-It.md). +11. [Red Lines for Techies](book/11-Red-Lines-For-Techies.md): game cheats, web crawlers, ticket-grabbing scripts, wiping databases, taking source code with you, contract development, non-competes, open-source licenses, ICP filing. Measure: personal freedom/money. +12. [Starting Your Own Business](book/12-Starting-Your-Own-Business.md): capital, guarantees, choosing the entity, registration, licenses, tax filing, invoices, tax scams, contracts, hiring, mass production, IP red lines in sourcing and images, exit. Measure: money/legal liability. +13. [Emergencies: What to Do First](book/13-Emergencies.md): cardiac arrest, stroke and posterior-circulation stroke, eye stroke, heart attack, aortic dissection, thunderclap headache, chronic subdural hematoma, pulmonary embolism, heavy bleeding, bites, burns and scalds, anaphylactic shock, seizures, hypoglycemia, electric shock, carbon monoxide, swallowing poisons and chemical burns, objects embedded in the body, fracture immobilization, scams, privacy threats, heatstroke, fire, drowning, getting lost, hypothermia, snakebite, earthquakes, wild animals, lightning, altitude sickness, ticks, drinking water in the wild; and whether you can afford to rescue: how to help a fallen elderly person, what to do when you witness a fight, whose money pays if you are hurt while helping. Measure: survival and money; the last few also touch personal freedom. +14. [Accounts And Security](book/14-Accounts-And-Security.md): two-factor authentication, passwords, SIM cards, lost phones, bank-card fraud, logged-in devices, app permissions, face recognition, the right to access and delete. Measure: money/personal information. +15. [Renting And Buying Housing](book/15-Renting-And-Buying-Housing.md): deposits, violent eviction, agents collecting rent, fund escrow, sale does not break the lease, verifying title, dedicated transaction accounts, partitioned rooms. Measure: money. +16. [Living With Chronic Disease](book/16-Living-With-Chronic-Disease.md): medication adherence, cross-province settlement for chronic outpatient care, follow-up records, don't stop meds for folk remedies, long prescriptions, signing with a family doctor, complication screening, kidney-stone recurrence prevention, target-driven urate-lowering therapy for gout. Measure: all-cause mortality/money. +17. [Elderly At Home](book/17-Elderly-At-Home.md): voluntary guardianship, forms of will, accounts and scripts, pension-investment and house-for-pension scams, long-term care insurance, pressure-ulcer prevention for the bedridden. Measure: money/personal freedom. +18. [Is Having Kids Worth It](book/18-Is-Having-Kids-Worth-It.md): child-rearing subsidies, maternity leave and allowance, protection during pregnancy/maternity/nursing, the time ledger, the money ledger. Measure: money/time. +19. [Employment And Work Injury](book/19-Employment-And-Work-Injury.md): overtime pay, annual leave, probation; occupational-hazard disclosure and three physicals, dust and noise protection; N, notice-payment, 2N, don't sign "voluntary resignation", keeping evidence; work-injury filing deadlines, employer without coverage, labor-capacity assessment, death-at-work benefits. Measure: money. +20. [Newborn](book/20-Newborn.md): safe sleep, the first hepatitis B dose, scheduled vaccines, breastfeeding and solids, formula water temperature, honey, vitamin K, when fever means the hospital, never shaking, diapers and big purchases. Measure: infant mortality/money. +21. [Travel And Abroad Safety](book/21-Travel-And-Abroad-Safety.md): travel-advisory levels, 12308, the limits of consular protection, overseas medical insurance, overseas high-pay recruitment scams, lost documents, foreign driving licenses, agency filing. Measure: money/personal freedom. +22. [How To Relax](book/22-How-To-Relax.md): emergency exits, clear pricing, drug red lines, things handed to you, real-name at internet cafés, venue choices for murder-mystery games; exercise, mindfulness, breathing, socializing, green space. Measure: money/personal freedom, plus energy/all-cause mortality. +23. [Which Skills To Learn](book/23-Which-Skills-To-Learn.md): study or work (the child-labor age line, education and mortality, the national education structure, tuition waivers and grants and loans, vocational-college routes, how to run the numbers yourself), returns to education, fake certificates, training subsidies, dimensions that resist automation, skill levels, how to look up shortage occupations. Measure: money/time, one item on mortality. +24. [Seeing The Doctor](book/24-Seeing-The-Doctor.md): tiered care and referrals, deductible continuous counting, reimbursement-rate differences, reserved appointment slots, whether traveling for care is worth it, keeping and sealing medical records, the four-level ER triage order, emergency relief when you cannot pay, when to do a disability assessment, how to get a disability certificate, no need to bribe your doctor. Measure: money/time. +25. [After Someone Dies](book/25-After-Someone-Dies.md): reporting and the death certificate, transport and cremation of the body, disputing the cause and autopsy, cancelling household registration, the list of basic funeral services, price violations, agency filing, housing-fund balance and social-security benefits, the deceased's personal-information rights. Measure: money. +26. [Building A Website Or Platform](book/26-Building-A-Website-Or-Platform.md): the payment-settlement red line, ICP licenses and filing, livestream and audio-visual licenses, platform verification and tax reporting, content governance, real-name rules, minors, notice-and-takedown, data leaving the country, server choices. Measure: personal freedom/money. Long read: [What licenses a platform needs (long read)](docs/What-Licenses-A-Platform-Needs.md). +27. [Pregnancy And Birth](book/27-Pregnancy-And-Birth.md): folic acid, registering and free prenatal checks, three-disease screening and mother-to-child blocking, smoking and alcohol in pregnancy, aspirin and gestational diabetes, signals to go to the hospital now, what to do when waters break, painless delivery, cesarean indications, maternity insurance, the birth certificate, newborn screening, enrolling and hukou, the 42-day postpartum check. Measure: mortality and money. +28. [Do Not Ruin Health For Looks](book/28-Do-Not-Ruin-Health-For-Looks.md): extreme dieting and eating disorders, the two licenses of medical-beauty institutions and chief physicians, the blindness-risk zones of facial fillers, diet products illegally spiked with sibutramine, anabolic steroids, prescriptions and follow-ups for diet pills and sex hormones, body-image assessment. Measure: mortality (health endpoints); two medical-beauty items also touch personal freedom. +29. [After A Major Blow](book/29-After-A-Major-Blow.md): the cardiovascular window of the first month after bereavement, the first week after a serious diagnosis, job loss, the six months after a spouse's death, bereavement by suicide, replacing "the one person" with three things when you have no family or friends, children who lost a parent, where to register when grief is stuck, divorce, 12356 and 12355, don't make irreversible decisions while acutely stressed, why dying to escape debt does not work. Measure: all-cause mortality; the last two on money. +30. [School-Age Kids](book/30-School-Age-Kids.md): emergencies counted by the hour, don't postpone treatment for exams, what to do about bullying, 2 hours outdoors a day, the school physical report, adolescent depression screening, products claiming to cure myopia, the hard rules on sleep and homework, suspension that preserves enrollment, dilated eye exams and follow-ups, dental sealants. Measure: mortality and health endpoints, plus one or two each on money and time. +31. [Paths After Eighteen](book/31-Paths-After-Eighteen.md): the legal thresholds of eight roads; military service (registration, two years as a conscript, joint punishment for refusing service, tuition compensation and further study, placement and the 30-day report, discharge pay and tax on seniority); targeted exams of grassroots service programs; joining the staff after Teach-First postings; firefighters and military civilian posts; self-study, adult-gaokao and open university; social insurance in flexible employment; injury protection for delivery riders. Measure: money/time; the refusing-service item also touches personal freedom. +32. [Studying Abroad: Status, Work, Insurance, And Getting The Diploma Recognized](book/32-Studying-Abroad.md): check the accreditation list before paying tuition; the US fixed admission period and 30-day departure window from September 2026; work-hour caps in the US, Canada, the UK, and Australia; full-time enrollment as the root of your status; reporting a new address within 10 days; the MOE study-abroad warnings; Australia's OSHC that must not lapse; the UK healthcare surcharge; and the 10–20 working days to reserve for returning-home credential recognition. Measure: money and personal freedom. +33. [How to live after disability](book/33-Living-With-Disability.md): the first decade after a disabling event is the high-risk window for suicide; voluntary hospitalization for mental disorders and its two exceptions; pressure-relief cushions for wheelchair users; assistive devices and home modifications through the Disabled Persons' Federation; disability certificate and subsistence allowance applications; discrimination in school admission and employment, and how to answer for it +34. [Avoid serious harm from over-the-counter medicines at home](book/34-Avoid-Serious-Harm-From-Home-Medicines.md): don't double up on acetaminophen; no aspirin/nimesulide/analgin for kids' fever; who is at high risk of ibuprofen stomach harm; no combo cold meds under age 2 without a doctor; no self-dosing ibuprofen after week 20 of pregnancy; omeprazole self-use at most 7 days; no antibiotics for a cold; rehydrate first for diarrhea and don't give antidiarrheals to kids; overusing painkillers can cause more headaches. Measure: mortality. + +Items inside each section are ordered from highest to lowest value for money. Section titles like "Don't Die Early" or "Don't Waste Time" name the outcome the section tries to prevent; whether an item is a to-do or a don't is decided by the item title. Long reads: [Home emergency kit (long read)](docs/Home-Emergency-Kit.md), [What licenses a platform needs (long read)](docs/What-Licenses-A-Platform-Needs.md), [Is marriage worth it (long read)](docs/Is-Marriage-Worth-It.md), and [Should you stop to help a stranger (long read)](docs/Should-You-Stop-To-Help-A-Stranger.md). The verification trail for every cited source is in [docs/核实记录](docs/research/核实记录/). + +`site/index.html` is the online search page template; `make web-build` writes locale pages under `site/{en,ru,es,zh}/`. Data is read from root `README*.md` and `book/` (copied beside the site in the Pages artifact). GitHub Pages deploys via Actions (`.github/workflows/pages.yml`) — in repo Settings → Pages, set Source to **GitHub Actions**. Locally: `make serve` then open [http://127.0.0.1:8000/en/](http://127.0.0.1:8000/en/). + +## The book itself + +The text is split into 33 section files under [book/](book/); click a section title in the table of contents above to open it. It is split because a single file would exceed GitHub's 512 KB Markdown rendering limit and later sections would not display; the [online search page](./) reads these files combined and works the same way. diff --git a/book/01-Do-Not-Die-Early.md b/book/01-Do-Not-Die-Early.md new file mode 100644 index 00000000..ec29f9e7 --- /dev/null +++ b/book/01-Do-Not-Die-Early.md @@ -0,0 +1,360 @@ +# 1. How to avoid dying too soon + +This section covers three main topics. First, deaths caused by accidents and injuries — things like car crashes, fires, and poisoning. Second, there are a few vaccines and screening tests backed by very strong scientific evidence. Third, we’ll look at certain warning signs the body gives off that mean it’s time to get checked out. The numbers listed under “Benefit” come from randomized controlled trials, large long‑term studies, or official statistics. The “Cost” figures are rough estimates based on current market prices; they’re meant only for comparison purposes and shouldn’t be cited as official data. +### 1. Always wear seat belts, both front and back + +- Cost: No cost at all. It only adds about 2 seconds to every trip. +- In plain terms: Wearing a seat belt in the front seat cuts the risk of dying in a crash by roughly half. For drivers and passengers in light trucks, the reduction is about 60%. Among U.S. crash victims in 2022 whose seat belt use was documented, half were not wearing one. +- Benefit: According to NHTSA estimates, seat belts lower the risk of fatal injury for front‑seat occupants of cars by 45% and for those in light trucks by 60%. In 2022, half of the U.S. fatalities in passenger cars had no recorded seat belt use. The World Health Organization states that seat belts can reduce the risk of death inside a vehicle by up to 50%. WHO also estimates that in 2021, 248,099 people died in road crashes in China, which translates to 17.4 deaths per 100,000 people. +- Evidence grade: A +- Notes: Seat belts must be worn in the back seat as well. In the same report, 60% of rear‑seat occupants killed in crashes were not wearing belts. The 45% and 60% figures are NHTSA estimates derived from crash‑database analysis (Kahane 2015), not from randomized trials. The Chinese death toll cited by WHO is a projection and is several times higher than official police statistics; the two figures cover different populations, so only the WHO estimate is used here. +- Sources:NHTSA (2024). Occupant Protection in Passenger Vehicles: 2022 Data (DOT HS 813 573). ; WHO (2025). Road traffic injuries fact sheet. ; WHO GHO RS_196/RS_198 (China, 2021). + +### 2. Wearing a helmet and fastening the strap while riding motorcycles or e-bikes + +- Cost: A helmet costs between 100 and 300 yuan. It takes just 5 seconds to put on each time. +- In plain terms: Wearing a helmet and fastening the strap properly reduces a motorcyclist’s risk of dying in an accident by roughly 40%. The chance of suffering a head injury drops by about 70%. The strap must be tightened; a helmet that simply hangs loosely on the head does not count as being worn. +- Benefit: Cochrane pooled data from multiple studies. For motorcyclists wearing helmets, the risk of death fell by 42%. The original odds ratio was 0.58, with a 95% confidence interval ranging from 0.50 to 0.68. Head injuries were reduced by 69% (odds ratio 0.31; 95% CI 0.25–0.38). +- Evidence grade: A +- Notes: The helmet strap must be fastened securely. A helmet left hanging on the handlebars does not count as being worn. The figures above apply specifically to motorcycles. For e-bikes, no direct studies exist, but the mechanics of head injury in a crash remain the same. +- Sources:Liu BC 等 (2008). Helmets for preventing injury in motorcycle riders. Cochrane Database of Systematic Reviews. + +### 3. Install smoke alarms; those heating with coal or gas in winter should also add a carbon monoxide alarm + +- Cost: A smoke alarm costs between 30 and 100 yuan. A carbon monoxide alarm costs between 50 and 150 yuan. After installation, the batteries need to be replaced once a year. +- In plain terms: A properly functioning smoke alarm can cut the risk of dying in a home fire by roughly 60%. Forty percent of fire victims are asleep at the time, so they won’t wake up just from the smell of smoke. For anyone heating their home with coal or gas during winter, adding a carbon monoxide alarm is essential. In China, 11,500 people died from carbon monoxide poisoning in 2018; 70% of those deaths occurred at home during the three winter months. +- Benefit: A study in North Carolina examined homes that had experienced fires versus those that hadn’t. It found that having a working smoke alarm lowered the death risk by about 60%. The odds ratio was 0.39, with a 95% confidence interval ranging from 0.18 to 0.83. Between 2018 and 2020, 24% of fatal residential fires in the U.S. happened in homes without smoke alarms, and 41% of victims were asleep when the fire started. In 2018, China reported 11,523 deaths from carbon monoxide poisoning; of these, 72.59% occurred at home in December, 67.42% in January, and 66.48% in February. +- Evidence grade: B +- Notes: This grade is assigned because only one study exists on smoke alarms; it compared past fire incidents in various homes rather than using a randomized trial design. No research has shown that carbon monoxide alarms reduce mortality rates. The reported benefits are inferred from the fact that most poisoning deaths happen at home during winter. +- Sources:Marshall SW 等 (1998). Fatal residential fires: who dies and who survives? JAMA. ; USFA (2022). Fatal Fires in Residential Buildings (2018-2020), Topical Fire Report Series 22(2). ; You J 等 (2020). Number of Deaths due to Carbon Monoxide Poisoning by Month and by Place of Death — China, 2018. China CDC Weekly. + +### 4. Replace gas hoses and stoves when they reach their expiration date; never modify the piping yourself, and you may decline any unsolicited sales pitches from gas companies. + + +- Cost: A compliant gas hose costs just a few dozen yuan. Stoves should be replaced every few years; during such replacements, it’s wise to check whether any components have passed their expiration date. +- In plain terms: A properly certified gas hose costs only a few dozen yuan. Replacing it when it expires is a mandatory obligation for users, as clearly stated in the Regulations on Urban Gas Management. The same regulations explicitly forbid any unauthorized modification of gas piping or removal of gas meters. Moreover, they stipulate that gas companies may not compel customers to purchase specific products or services. Therefore, if a representative from a gas company shows up claiming that replacement is mandatory, you have every right to refuse. +- Benefit: The Regulations explicitly define it as a user obligation to promptly replace any gas appliances or connecting hoses that have been phased out by national policies or have exceeded their designated service life. Conversely, any unauthorized installation, modification, or removal of household gas facilities or metering devices is strictly prohibited. Additionally, the Regulations make it clear that gas providers may not demand that customers buy particular products or accept specific services. +- Evidence grade: A +- Notes: Some individuals pose as gas safety inspectors and, after conducting a brief check, attempt to sell self-closing valves and alarms. Article 20, Paragraph 6 of the Regulations effectively blocks such practices, allowing you to refuse these offers or even file a complaint. (Pending verification: There is currently no official text available for direct cross-checking regarding the precise steps to take upon detecting a gas leak—such as opening windows, shutting off valves, avoiding any electrical switches, and calling emergency services from outside. Carbon monoxide poisoning is addressed separately in Section 13.) +- Sources:国务院 (2010). 城镇燃气管理条例（国务院令第 583 号）第二十七条：「燃气用户应当遵守安全用气规则，使用合格的燃气燃烧器具和气瓶，及时更换国家明令淘汰或者使用年限已届满的燃气燃烧器具、连接管等」；第二十八条禁止行为含「（一）擅自操作公用燃气阀门」「（二）将燃气管道作为负重支架或者接地引线」「（四）擅自安装、改装、拆除户内燃气设施和燃气计量装置」；第二十条燃气经营者不得「（六）要求燃气用户购买其指定的产品或者接受其提供的服务」；第二十九条用户可就收费、服务向燃气管理等部门投诉，「有关部门应当自收到投诉之日起15个工作日内予以处理」. + +### 5. Do not pick, buy, or eat wild mushrooms; any “folk tricks” for identification are useless + + +- Cost: No expense involved. The hard part is giving up a seasonal delicacy. +- In plain terms: In 2025 alone, there were 828 cases of mushroom poisoning across China, affecting 2,165 people, with 13 fatalities. That same year, 34 previously unknown poisonous mushroom species were identified. Myths such as using a silver needle to test for toxicity, assuming mushrooms safe if insects eat them, or that only brightly colored varieties are toxic are all false. +- Benefit: The Chinese CDC investigated 828 mushroom poisoning cases in 2025 involving 2,165 individuals; the mortality rate was 0.6%. From 2019 to 2024, annual cases ranged from 276 to 676, with mortality rates between 0.87% and 2.86%. In 2025 alone, 138 poisonous mushroom species were identified, including 34 new ones never documented before as causing poisoning. +- Evidence grade: A +- Notes: If you accidentally eat poisonous mushrooms, induce vomiting immediately and then go to the hospital with any remaining mushrooms or photos of them. There are several types of mushroom poisoning, and identifying the exact species is crucial for proper treatment. New poisonous species are discovered each year, so the assumption that “local people can recognize them” is unfounded. Claims such as silver needle testing, cooking with garlic, insect consumption indicating safety, or vivid colors signaling toxicity are all incorrect. +- Sources:Mushroom Poisoning Outbreaks — China, 2025. China CDC Weekly (2026)：「In 2025, China CDC investigated 828 mushroom poisoning incidents across 27 provincial-level administrative divisions (PLADs), affecting 2,165 individuals and causing 13 deaths - a case fatality rate of 0.6%, the lowest of the past six years. In total, 138 poisonous mushroom species were identified, including 34 newly recorded in poisoning incidents in China.」「From 2019 to 2024, the annual number of incidents ranged from 276 to 676, and the case fatality rate ranged from 0.87% to 2.86%.」；同刊 2024 年度报告 + +### 6. Do not push e-bikes into stairwells, elevators, or charge them at home + +- Cost: No direct cost. The tricky part is having to walk a few dozen meters each time to reach the designated charging stations downstairs. +- In plain terms: Pushing an e-bike into a stairwell or elevator, or charging it at home, is strictly prohibited under the Ministry of Emergency Management’s “Regulations on Fire Safety Management in High-Rise Civil Buildings.” Those who violate the rule face fines of 500–1,000 yuan for individuals and 2,000–10,000 yuan for businesses. Even the fines are the lesser concern; the real danger is that a fire could erupt right in your only escape route. +- Benefit: The regulations explicitly forbid “parking e-bikes or charging them in public lobbies, evacuation corridors, stairwells, or emergency exits of high-rise civil buildings.” In other words, these areas must remain completely free of both parked bikes and charging equipment. Noncompliance results in the same fines mentioned above. +- Evidence grade: A +- Notes: Avoid buying modified batteries or generic chargers, and never leave a charger plugged in overnight. Once a lithium battery catches fire, it can ignite the entire area within seconds while releasing highly toxic fumes. A bike blocking a stairwell essentially turns that very path into a fire trap. TODO: Verify official annual statistics on the number of e-bike fires and related fatalities nationwide. +- Sources:应急管理部 (2021). 高层民用建筑消防安全管理规定（应急管理部令第 5 号，第三十七条、第四十七条）. + +### 7. Measuring blood pressure and taking meds to reach target levels + +- Cost: An electronic sphygmomanometer costs 100–200 RMB. Each measurement takes 1 minute. Most antihypertensive drugs cost just a few to dozens of RMB per month. The hard part is keeping the medication regimen even when there are no symptoms. +- In plain terms: For every 10 mmHg drop in blood pressure, the risk of major cardiovascular problems falls by 20%, stroke risk drops 27%, heart failure risk drops 28%, and overall mortality risk declines by 13%. Among Chinese adults aged 35–75, 44.7% have hypertension, but only 7.2% have their blood pressure under proper control. +- Benefit: Data from 123 clinical trials involving over 610,000 participants shows that a 10 mmHg reduction in systolic blood pressure lowers the incidence of major cardiovascular events by roughly 20%. The relative risk is 0.80, with a 95% confidence interval of 0.77–0.83. Systolic blood pressure is the higher of the two readings taken during a measurement. Stroke risk drops by 27% (RR 0.73), heart failure risk drops by 28% (RR 0.72), and overall mortality drops by 13% (RR 0.87, 95% CI 0.84–0.91). A screening program in China involving 1.7 million adults aged 35–75 found that 44.7% had hypertension; of these, 44.7% were aware of their condition, 30.1% were receiving treatment, and only 7.2% had their blood pressure under control. +- Evidence grade: A +- Notes: Start by getting your blood pressure measured at least once. Fewer than 1 in 10 Chinese adults with hypertension manage to keep their levels under control, so this single measurement is one of the most cost-effective actions you can take as outlined in this book. There is still some debate over what exact target level (130 or 140 mmHg) is ideal, but there is no dispute that knowing you have hypertension and taking steps to lower it is highly beneficial. +- Sources:Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. ; Lu J 等 (2017). Prevalence, awareness, treatment, and control of hypertension in China (China PEACE Million Persons Project). Lancet. + +### 8. After age 35, anyone who is overweight should get a fasting blood glucose test; if the result is normal, repeat it every three years. + +- Cost: A fasting blood glucose test costs just a few dozen yuan. Testing for glycated hemoglobin is a bit pricier, still only a few dozen yuan. All it takes is one blood draw at a clinic. +- In plain terms: For just a few dozen yuan, a single blood test can detect prediabetes even when there are absolutely no symptoms at all. Official US screening guidelines recommend this test for anyone aged 35 to 70 who is overweight or obese. If the test comes back normal, they should repeat it every three years. +- Benefit: The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current guidance states that adults aged 35 to 70 who are overweight or obese — even with no symptoms at all — should be screened for prediabetes and type 2 diabetes. Overweight is defined as a BMI of 25 or higher, while obesity means a BMI of 30 or higher. This recommendation is rated as a Grade B. The Task Force also explicitly notes: “It is reasonable to screen adults with normal blood glucose levels for prediabetes every three years.” +- Evidence grade: A +- Notes: Having a prediabetes diagnosis does not mean you must start taking medication right away. Many people can fully reverse this condition simply by making lifestyle changes. In China, only a small fraction of adults are aware they have diabetes; most only find out after developing complications. +- Sources:US Preventive Services Task Force (2021). Screening for Prediabetes and Type 2 Diabetes. + +### 9. Don’t speed or drive after drinking + +- Cost: There’s no direct cost. Driving a bit slower adds just a few minutes to each trip. The hard part is drinking less at social gatherings. +- In plain terms: On average, for every 1% increase in speed, the chance of a fatal crash rises by roughly 4%. There is no “safe” level of alcohol consumption when it comes to driving; even very low blood alcohol concentrations already raise the risk of accidents. +- Benefit: According to the World Health Organization (WHO), a 1% rise in average speed translates to a 4% increase in the likelihood of fatal crashes. The risk of a fatal crash also climbs steadily as blood alcohol concentration rises, even at very low levels. +- Evidence grade: B +- Notes: The 1% and 4% figures linking speed to fatalities come from accident modeling rather than controlled trials. For alcohol and driving, WHO only provides a general trend without specific numerical values. This section does not verify any original research on exactly how much drinking raises risk. +- Sources:WHO (2025). Road traffic injuries fact sheet. + +### 10. Use a car seat for children under 4, don’t hold them in your arms + +- Cost: A seat costs between 300 and 2,000 yuan and lasts several years. It adds about one minute to each trip to buckle the child in. +- In plain terms: For infants under one year old, using a car seat cuts the risk of a fatal injury in a crash by roughly 70%. For children aged 1 to 4, the risk drops by about half. Holding a child in your arms provides no such protection; in a sudden stop you simply cannot keep them secure. +- Benefit: According to the U.S. National Highway Traffic Safety Administration (NHTSA), car seats lower the risk of fatal injury for infants under one year old by 71% and for children aged 1 to 4 by 54%. The World Health Organization reports a similar 71% reduction in infant deaths. +- Evidence grade: A +- Notes: Follow the manufacturer’s instructions to install the seat correctly; a faulty installation offers no protection. Infants under one year must be placed rear‑facing. These figures are based on official U.S. crash data. +- Sources:NHTSA (2024). Occupant Protection in Passenger Vehicles: 2022 Data (DOT HS 813 573). ; WHO (2025). Road traffic injuries fact sheet. + +### 11. Install window guards and balcony barriers if you have kids at home; screen windows do not count as protection + +- Cost: A set of window guards or child safety locks costs just a few dozen yuan to install, and the whole process takes only ten minutes. +- In plain terms: These window guards cost only a few dozen yuan each. New York City once offered free window guards to high-risk households and provided on-site guidance; as a result, child fall incidents reported in one borough dropped by half over three years. Eventually, New York even passed a law requiring landlords to install such guards in rental units with kids under 10. Screen windows, however, can be easily pushed open — they do not provide any real protection. +- Benefit: Since 1972, New York City has run a program called “Kids Can’t Fly,” which distributes free window guards in high-risk neighborhoods and offers on-site safety guidance. Between 1973 and 1975, child fall incidents reported in the Bronx dropped by 50%. Following this success, New York updated its health code to make it mandatory for landlords to install window guards in all apartments housing kids under 10 years of age. +- Evidence grade: B +- Notes: Avoid placing beds, sofas, boxes, or any other objects near windows or balconies that kids might climb onto. Screen windows only keep mosquitoes out; they can be easily pushed open, so never rely on them as a safety barrier. This protection is needed even on lower floors: most child falls recorded in U.S. data actually occur on the second floor or even lower. +- Sources:Spiegel CN, Lindaman FC (1977). Children can't fly: a program to prevent childhood morbidity and mortality from window falls. American Journal of Public Health：「Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975」，1976 年纽约市卫生法典修订「to require that landlords provide window guards in apartments where children ten years old and younger reside」. ；(2021). Unintentional Window Falls in Children and Adolescents. Academic Pediatrics：2007 年 1 月至 2017 年 8 月全国电子伤害监测系统 38,840 例急诊就诊，「The majority of falls occurred in children under the age of 6 and were related to falls from a second story or below」. + +### 12. Keep young children in sight near water; wear life jackets when boating or swimming + + +- Cost: Life jackets cost between 50 and 200 yuan. Additionally, parents must dedicate constant attention to watching their children. +- In plain terms: Wearing a life jacket while in the water cuts the risk of drowning to roughly half compared to not wearing one. Drowning remains the leading cause of death among children aged 1–14 in China. The drowning mortality rate in rural areas is roughly twice that in cities. +- Benefit: Research using U.S. Coast Guard data compared similar groups of people. For individuals who fell overboard while boating recreationally, wearing a life jacket lowered their drowning risk by about half. The unadjusted RR was 0.51, with a 95% CI of 0.35–0.74. In China, the drowning mortality rate among people under 20 fell from 6.60 per 100,000 in 2013 to 3.28 per 100,000 in 2021; rural rates remained roughly twice those in cities. Drowning continues to be the top cause of death for children aged 1–14. In 2021, drowning accounted for 31.1% of all injury-related deaths among those aged 0–19, while road traffic injuries accounted for 27.9%. +- Evidence grade: A +- Notes: The Grade A rating applies only to the protective effect of life jackets. The practice of keeping children within sight is widely accepted but only qualifies for a Grade C rating due to lack of randomized trials; no such trials are expected in the future. In China, drowning deaths occur most often in rural areas during summer months, and among males aged 15–19. +- Sources:Cummings P 等 (2011). Association between wearing a personal floatation device and death by drowning among recreational boaters. Injury Prevention. ; Li Z 等 (2023). Unintentional Drowning Mortality Among Individuals Under Age 20 — China, 2013–2021. China CDC Weekly. ; Zhou J 等 (2024). Injury Mortality of Children and Adolescents Aged 0–19 Years — China, 2010–2021. China CDC Weekly. + +### 13. Exercising balance and leg strength for people over 60, plus home modifications + + +- Cost: Aim to practice balance exercises two to three times per week, each session lasting 30 minutes — activities like Tai Chi work well. Installing non-slip mats, handrails, and night lights in bathrooms and stairways costs anywhere from a few dozen to several hundred yuan. The real challenge is maintaining this routine over the long term. + +- In plain terms: Doing balance exercises such as Tai Chi two or three times weekly can cut the overall number of falls among older adults by roughly 23%. It also reduces the proportion of people who have fallen at least once by about 15%. Adding simple home modifications — like anti-slip mats and handrails — can lower fall rates by another 20% or so. Falls are the leading cause of injury-related deaths among Chinese seniors aged 65 and above; alarmingly, over half of all falls happen right at home. + +- Benefit: Cochrane analyzed 108 separate trials involving 23,407 participants. Collectively, these studies show that regular exercise lowers fall rates among older adults by 23%. The relative risk of falls dropped to 0.77, with a 95% confidence interval ranging from 0.71 to 0.83. The proportion of individuals experiencing at least one fall also fell by 15% (relative risk 0.85). Professional home safety assessments and modifications further reduced fall rates by roughly 20% (RR 0.81; 95% CI 0.68–0.97). Practicing Tai Chi specifically lowered fall risk by about 29% (RR 0.71). In China, falls remain the top cause of injury-related mortality for seniors over 65; data from 2018 indicates that 55.97% of all falls among this age group occur at home. + +- Evidence grade: A + +- Notes: This recommendation applies to seniors aged 60 and above who live independently at home rather than in nursing homes. The studies referenced here focus on the total number of falls, not on actual mortality rates. It’s important to note that the path from a fall to a hip fracture — and ultimately death — can be very short for older adults. +- Sources:Sherrington C 等 (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. ; Gillespie LD 等 (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. ; Lu Z 等 (2021). Characteristics of Falls Among Older People — China, 2018. China CDC Weekly. + +### 14. Get tested for hepatitis B markers; if no antibodies, get vaccinated + +- Cost: The test costs just a few dozen yuan per person. For adults lacking antibodies, three doses of the hepatitis B vaccine cost between 100 and 300 yuan total, to be completed within six months. +- In plain terms: The test itself is very inexpensive. In Qidong’s 30‑year follow‑up study, infants who received the hepatitis B vaccine at birth had an 84% lower risk of developing primary liver cancer and a 72% lower rate of carrying the hepatitis B virus compared to unvaccinated peers. Adults found to have no antibodies should receive three vaccine doses over six months at a cost of roughly 100–300 yuan. +- Benefit: This Qidong trial used group randomization rather than individual assignment and was tracked for three decades. Vaccination at birth cut primary liver cancer incidence by 84% (95% CI 23%–97%). The prevalence of hepatitis B surface antigen (HBsAg) fell by 72% (95% CI 68%–75%), reflecting a comparable drop in the proportion of people carrying the virus. Nationwide in China, HBsAg prevalence dropped 52% between 1992 and 2014, and fell 97% among children under five. +- Evidence grade: A +- Notes: This recommendation applies to adults born before 1992 who never received the vaccine or whose antibodies have waned. The 84% cancer‑risk reduction pertains only to those immunized at birth; adolescents vaccinated later saw only a 21% reduction in virus carriage. For adults, the main goal is preventing new infection, not achieving the same cancer‑prevention benefit. Vaccination offers no protection to people already infected; they must see a hepatologist regularly. Infection is confirmed when the hepatitis B surface antigen (HBsAg) test result is positive. +- Sources:Qu C 等 (2014). Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study. PLoS Medicine. ; Cui F 等 (2017). Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China. Emerging Infectious Diseases. + +### 15. If you get pricked by a nail or splinter, or if a wound gets dirty with soil, treat it the same day and ask whether a tetanus shot is needed. + +- Cost: Seeing a doctor and having the wound treated costs just a few dozen yuan. If the doctor recommends a tetanus shot or immunoglobulin, those cost anywhere from several dozen to a few hundred yuan. +- In plain terms: Once tetanus sets in, about 1 out of every 10 people dies. The risk is highest for deep wounds or wounds contaminated with soil. Treating such a wound on the same day costs only a few dozen yuan — don’t wait until it starts swelling to seek care. +- Benefit: In the United States, roughly 1 out of every 10 people with tetanus dies. The risk is similarly higher for deep wounds or wounds exposed to soil. +- Evidence grade: B +- Notes: At the hospital, let the doctor decide — don’t make the call yourself, and don’t skip asking out of convenience. Not every wound requires a tetanus shot: the doctor will assess the wound type and your vaccination history before deciding. The idea that “one shot in childhood provides lifelong protection” is false; a booster is needed roughly every 10 years. TODO (pending verification: the wound classification and immunization schedule table in the main text of China’s “Diagnosis and Treatment Guidelines for Non‑Neonatal Tetanus (2024 Edition)”; the appendix is a PDF that cannot be read on this device). +- Sources:美国疾病控制与预防中心. 破伤风：「Tetanus bacteria can get into someone's body through broken skin, usually through injuries.」「Tetanus can lead to death (1 in 10 cases in the United States are fatal).」「People who didn't complete the primary series or who aren't up to date with their 10-year tetanus booster shots are also at increased risk.」「Vaccination also helps prevent tetanus in people with wounds, depending on their tetanus vaccination history.」；国家卫生健康委办公厅 (2024). 关于印发非新生儿破伤风诊疗规范（2024 年版）的通知（国卫办医急函〔2024〕381 号）. + +### 16. The earlier women get the HPV vaccine, the better + +- Cost: Domestic bivalent vaccines cost around 300 RMB per dose, while imported 9‑valent vaccines cost about 1300 RMB per dose. A total of 2–3 doses are needed, and each visit takes half a day. +- In plain terms: Data from 1.67 million Swedish women show that those who received the HPV vaccine before age 17 have only about one‑eighth the risk of developing invasive cervical cancer compared to unvaccinated women. For women vaccinated between 17 and 30, the risk is roughly half that of non‑vaccinated peers. Therefore, getting vaccinated earlier offers the greatest benefit. +- Benefit: Swedish research on 1.67 million women found that vaccinated individuals have a much lower incidence of invasive cervical cancer. Before age 17, vaccination reduces risk by roughly 88% (IRR 0.12, 95% CI 0.00–0.34). Vaccination between 17 and 30 still lowers risk by about 53% (IRR 0.47, 95% CI 0.27–0.75). +- Evidence grade: A +- Notes: The greatest benefit is seen when vaccination occurs between ages 9 and 14. Even for women aged 17–30, risk is still reduced by more than half. After age 30, the protective effect gradually diminishes. Vaccinated women still need regular cervical cancer screening; the vaccine does not replace screening — see item 18 for screening guidelines for women over 30. +- Sources:Lei J 等 (2020). HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine. + +### 17. Breast cancer screening for women: mammograms every two years starting at age 40 + +- Cost: A mammogram costs around 200–300 yuan each time. Many regions also offer free screening programs. Each screening takes about half a day. +- In plain terms: For women aged 40 to 74, having a mammogram every two years is a clear recommendation in official US screening guidelines. For women over 75, and for those with dense breast tissue who need extra ultrasound or MRI scans, there is currently insufficient evidence to support such screening. If a health check package includes these extra tests at an extra charge, they are not necessary. +- Benefit: The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current recommendation reads: “We recommend screening mammography every two years for women aged 40 to 74.” Mammography is exactly what we commonly call a mammogram. This recommendation is rated as a Grade B. For women over 75, and for those with dense breast tissue who need additional ultrasound or MRI scans, the Task Force has concluded that there is not enough evidence to support such screening. +- Evidence grade: A +- Notes: The recommended starting age for screening varies by country. In China, some local guidelines and programs recommend starting at age 45. Women with a family history of breast cancer — such as parents, children or siblings who have had it — or those carrying BRCA mutations are at higher risk. They should consult a doctor individually to determine the right screening plan; the above recommendations do not apply to them. +- Sources:US Preventive Services Task Force (2024). Breast Cancer: Screening. + +### 18. For women over 30, HPV testing should be the first choice for cervical cancer screening + +- Cost: An HPV test costs between 100 and 300 yuan. Women with a negative result can get tested again only once every five years. The sampling process takes just a few minutes. +- In plain terms: In that rural Indian trial, women who underwent just one HPV test in their lifetime had roughly half the risk of dying from cervical cancer and about 50% lower odds of being diagnosed with advanced-stage disease. At a cost of just 100–200 yuan per test, a negative result provides protection for five years. +- Benefit: This trial in rural India used group-level rather than individual randomization, involving women aged 30–59. A single HPV test cut the risk of death from cervical cancer by roughly 48% (hazard ratio 0.52; 95% CI 0.33–0.83). It also reduced the likelihood of detecting late-stage disease by about 53% (HR 0.47; 95% CI 0.32–0.69). +- Evidence grade: A +- Notes: Even women who have received the HPV vaccine still need screening, since the vaccine does not protect against all viral types. What makes this study unique is that it was a randomized screening trial with mortality as the primary outcome and only one round of testing performed. +- Sources:Sankaranarayanan R 等 (2009). HPV screening for cervical cancer in rural India. New England Journal of Medicine. + +### 19. Starting colorectal cancer screening at ages 45–50: use fecal immunochemical tests or colonoscopies + +- Cost: Fecal tests cost just a few dozen yuan and can be done every 1–2 years. Colonoscopies cost several hundred to over a thousand yuan; those with negative results only need one every 10 years. Preparing for a colonoscopy requires setting aside a full day for bowel cleansing. +- In plain terms: Getting a low-cost fecal occult blood test every year or two lowers the chance of dying from colorectal cancer by roughly 16%. For people who’ve had at least one round of screening, this risk drops by about 25%. In the group invited to undergo a colonoscopy, the likelihood of developing colorectal cancer over the next decade fell from 1.20% to 0.98%. +- Benefit: Cochrane pooled data from multiple studies showing that individuals undergoing fecal occult blood screening have a roughly 16% lower risk of dying from colorectal cancer. The original RR was 0.84, with a 95% CI ranging from 0.78 to 0.90. For those who’ve had at least one screening round, this risk reduction reaches 25% (RR 0.75). The NordICC randomized trial likewise found that among participants invited to get a colonoscopy, colorectal cancer incidence dropped from 1.20% to 0.98% over 10 years; its RR was 0.82, with a 95% CI of 0.70–0.93. +- Evidence grade: A +- Notes: This topic remains debated. The NordICC trial tracked participants based on whether they were invited to get a colonoscopy; the difference in colorectal cancer mortality between groups was 0.28% versus 0.31% (RR 0.90, 95% CI 0.64–1.16), a gap well within statistical margins of error. This suggests earlier estimates of colonoscopy’s mortality benefits may have been overstated, while evidence for fecal tests’ impact on mortality is more robust. Most national guidelines recommend starting screening at ages 45–50; those with a family history of colorectal cancer should begin even earlier. +- Sources:Hewitson P 等 (2007). Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database of Systematic Reviews. ; Bretthauer M 等 (2022). Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. New England Journal of Medicine. + +### 20. People with cardiovascular disease and older adults should get a flu shot each year + +- Cost: One shot costs 50 to 150 yuan. It should be given once each autumn. +- In plain terms: In a trial involving people after a heart attack, the yearly death rate dropped from 4.9% to 2.9% after they received the flu vaccine. For people with cardiovascular disease and older adults, getting one shot each autumn for just 50 to 150 yuan can make a real difference. +- Benefit: This trial included 2,571 participants after a myocardial infarction; neither doctors nor patients knew who got the vaccine or the placebo. Over 12 months, the overall death rate was 2.9% in the vaccine group versus 4.9% in the placebo group. The hazard ratio was 0.59, with a 95% confidence interval of 0.39 to 0.89. Cardiovascular death rates also showed a hazard ratio of 0.59. Another study pooled multiple trials and found that flu vaccination lowered the rate of major cardiovascular events to 3.6% from 5.4% in the control group; the relative risk was 0.66, with a 95% confidence interval of 0.53 to 0.83. Cardiovascular death risk showed a relative risk of 0.74, though this fell within the margin of error and was not statistically significant (95% CI 0.42 to 1.30). +- Evidence grade: A +- Notes: This recommendation is somewhat controversial. The Grade A rating applies only to people with cardiovascular disease. For otherwise healthy older adults, a Cochrane review offers only limited evidence. Flu vaccination also lowered the seasonal flu infection rate from 6% to 2.4%. The review rated the evidence for infection outcomes as “low” quality and the evidence for mortality as “very low” quality. This review was published in 2018 by Demicheli V et al. +- Sources:Fröbert O 等 (2021). Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation. ; Behrouzi B 等 (2022). Association of Influenza Vaccination With Cardiovascular Risk: A Meta-analysis. JAMA Network Open. ；Demicheli V 等 (2018). Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews. （备注里说的那份 Cochrane 汇总） + +### 21. Getting the shingles vaccine after age 50 + +- Cost: The recombinant shingles vaccine requires two doses, costing roughly 3,000 to 4,000 yuan in total. This expense must be paid out of pocket. +- In plain terms: In Phase 3 trials, this vaccine proved 97% effective at preventing shingles across all age groups. The downside is that both doses cost several thousand yuan, all paid by the patient. In exchange, there’s a 97% reduction in the likelihood of developing shingles. +- Benefit: This Phase 3 trial involved 15,400 participants from 18 countries. Participants were randomly assigned to receive either the vaccine or a placebo, with follow-up lasting an average of 3.2 years. Over that time, 6 cases of shingles occurred in the vaccine group versus 210 in the placebo group. Expressed per 1,000 person-years, these figures translate to 0.3 versus 9.1 cases. One thousand person-years represents the number of cases observed in a group of 1,000 people over one year. The original report states, “The overall vaccine efficacy against shingles is 97.2% (95% CI 93.7–99.0, P<0.001).” Effectiveness ranged from 96.6% to 97.9% across all age brackets. +- Evidence grade: A +- Notes: This option ranks low in terms of cost-effectiveness primarily due to its high price. While shingles itself rarely proves fatal, its most troublesome complication is post-herpetic neuralgia, which can persist for months or even years. After vaccination, a notable percentage of recipients experience pain at the injection site and fever. In particular, severe side effects (graded as Grade 3) occurred in 17.0% of vaccine recipients versus 3.2% of those given a placebo. +- Sources:Lal H, Cunningham AL, Godeaux O, et al. (2015). Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. New England Journal of Medicine, 372(22), 2087-2096. + +### 22. Pneumococcal vaccine for people over 65 + +- Cost: Several hundred yuan. In some regions, it is provided free of charge for seniors. +- In plain terms: In a trial involving 84,500 seniors, the 13-valent pneumococcal vaccine cut cases of pneumonia caused by strains it targets by roughly 46%, and reduced instances of the most severe invasive infections by 75%. However, it showed no effect on pneumonia cases caused by any other pathogens, so it won’t prevent all types of pneumonia. The absolute confidence interval width is 95.2%. +- Benefit: Researchers in the Netherlands randomly assigned 84,500 seniors over 65 to two groups for comparison. They used the 13-valent pneumococcal conjugate vaccine. Its effectiveness against pneumonia caused by strains it targets was 45.6%, with a 95% confidence interval of 21.8–62.5. This figure refers to the specific bacterial strains the vaccine can protect against. For the most dangerous form of pneumococcal disease, the effectiveness was 75.0% (95% CI 41.4–90.8). No protective effect was observed against pneumonia cases caused by any other pathogens. +- Evidence grade: A +- Notes: This vaccine only protects against the specific bacterial strains it targets; it does not prevent all types of pneumonia. The 23-valent polysaccharide vaccine commonly used for seniors in China is a different formulation from the 13-valent conjugate vaccine used in this trial, so the effectiveness figures here cannot be directly applied to that vaccine. +- Sources:Bonten MJ, Huijts SM, Bolkenbaas M, et al. (2015). Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. New England Journal of Medicine, 372(12), 1114-1125. + +### 23. Testing for Helicobacter pylori and eradicating it if positive + +- Cost: The carbon-13 or carbon-14 breath test costs 100 to 200 yuan. Eradicating the bacteria requires taking four different medications for two weeks; the medication cost for that period is 200 to 500 yuan. The main difficulty is ensuring the full two-week course of medication is taken on schedule. +- In plain terms: A 22-year follow-up study conducted in Linqu, Shandong, showed that individuals who had Helicobacter pylori eradicated had roughly half the risk of developing gastric cancer and about 40% lower risk of dying from it. Testing costs just 100–200 yuan, while eradication requires a two-week medication regimen. +- Benefit: This randomized trial in Linqu, Shandong, followed participants for 22 years. Those who underwent Helicobacter pylori eradication therapy saw their risk of gastric cancer drop by nearly half. The original odds ratio was 0.48, with a 95% confidence interval ranging from 0.32 to 0.71. Their risk of dying from gastric cancer also fell by roughly 38% (hazard ratio 0.62; 95% CI 0.39–0.99). +- Evidence grade: A +- Notes: Reinfection can still occur after eradication, so it is advisable for all household members to be tested and treated together. This trial involved residents of an area with a high incidence of gastric cancer; people living in regions with lower incidence may gain considerably less benefit. +- Sources:Li WQ 等 (2019). Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial. BMJ. + +### 24. Heavy smokers should get a low-dose chest CT once a year + +- Cost: The test costs 200–400 yuan per session and takes just 10 minutes. You must also factor in follow-up tests after any false alarms, plus the anxiety that comes with waiting for results. +- In plain terms: Eligible heavy smokers who get a low-dose CT once a year have a 20% lower risk of dying from lung cancer and a 6.7% lower overall risk of death compared to those who only get regular chest X-rays. The trade-offs are extra follow-up tests after any suspicious findings and the resulting worry during the waiting period. +- Benefit: The NLST trial in the U.S. enrolled 53,454 participants aged 55–74 with at least 30 pack-years of smoking history and who had quit smoking no more than 15 years prior. Those who underwent low-dose CT had a 20.0% relative reduction in lung cancer deaths versus those who only got chest X-rays. The 95% confidence interval is 6.8–26.7. Overall mortality dropped by 6.7% relative to controls, with a 95% CI of 1.2–13.6. +- Evidence grade: A +- Notes: This recommendation applies only to high-risk smokers. In the same study, 24.2% of CT recipients showed suspicious findings, yet 96.4% of those cases turned out to be false positives. For non-smokers, undergoing this test offers no benefit and only adds unnecessary anxiety. +- Sources:National Lung Screening Trial Research Team (2011). Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine. + +### 25. Call 12356 if you’re depressed or having suicidal thoughts; don’t keep sleeping pills or pesticides at home + +- Cost: There’s no cost involved. You just need to make one phone call. Plus, lock away any medications and keep pesticides out of the house. +- In plain terms: Removing lethal items from easy reach is a proven way to cut suicide risk: after restricting access to painkillers, suicide rates linked to them dropped by 43%; installing barriers at locations where people often jump off cliffs cut rates by 86%. That’s why it’s a good idea to avoid storing sleeping pills and pesticides at home. If you’re feeling overwhelmed, call 12356 — this national helpline is available at least 18 hours a day. +- Benefit: A recent review of nearly a decade’s worth of research confirms that limiting people’s access to lethal means is an effective suicide prevention strategy. After controls on painkiller availability were put in place, suicide cases tied to these drugs fell by 43%. Installing protective barriers at common suicide hotspots reduced rates by 86% (the 95% confidence interval ranges from 79% to 91%). School-based cognitive intervention programs also lowered rates of attempted suicide by roughly 55% (OR 0.45, 95% CI 0.24–0.85). Antidepressant medications and psychotherapy are also key components of suicide prevention. Starting May 1, 2025, the 12356 helpline will be available nationwide in China, operating at least 18 hours each day. +- Evidence grade: B +- Notes: The B rating is based on two factors: most evidence supporting restrictive measures comes from ecological studies that compare suicide rates before and after policy implementation; there is currently no direct evidence that the helpline itself reduces overall mortality rates. Suicidal impulses typically last only a few minutes to a few hours, so simply removing lethal items from immediate reach is a meaningful intervention on its own. Data on outcomes over longer time periods following suicide attempts, as well as information on long-term consequences for survivors, can be found in Item 32 of this section (“Tell someone close to you as soon as suicidal thoughts arise”). +- Sources:Zalsman G 等 (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. ; 国家卫生健康委 (2024). 关于应用"12356"全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 26. Purchase fire extinguishers, fire blankets, escape respirators, and first-aid kits, then inspect them once a year + +- Cost: A set of fire extinguishers, fire blankets, one respirator per person, and a first-aid kit costs a few hundred yuan. You only need to buy it once; after that, it takes just 10 minutes each year to inspect the items. +- In plain terms: Fire extinguishers, fire blankets, escape respirators, and first-aid kits are all included in the Emergency Management Department’s list of 11 essential items for household emergency preparedness. The whole set costs a few hundred yuan, and you only need to buy it once. Studies of home safety programs that included on-site guidance found these measures cut injury rates by roughly 25%. +- Benefit: The Emergency Management Department’s “National Recommended List of Basic Household Emergency Supplies” contains 11 items in total. Among them, “fire extinguishers and fire blankets” are recommended for “putting out small fires at the initial stage”, and the list also notes that “fire blankets can be draped over the body to aid escape”. The “escape respirators” listed are “firefighting filtering self-rescue respirators designed for use during fire escapes”. “External medical supplies” refer to “hemostatic powder, adhesive bandages, gauze bandages, and other items used to treat wounds”. Cochrane analyzed 98 studies involving 2,605,044 participants in total. Home safety interventions lowered injury rates to an IRR of 0.89; the 95% confidence interval for this figure is 0.78 to 1.01. For interventions that included on-site guidance, injury rates dropped by around 25% (IRR 0.75, 95% CI 0.62 to 0.91). +- Evidence grade: B +- Notes: This finding is somewhat controversial. The same Cochrane meta-analysis found that interventions that did not provide emergency supplies also lowered injury rates by roughly 20%. The original IRR for those interventions was 0.78, with a 95% confidence interval of 0.66 to 0.92. Providing emergency supplies alone did not yield better results than other measures. The main effect of these interventions comes from on-site education and home modifications, so the benefit of supplying emergency supplies is rated as “moderate” rather than “significant”. When buying fire extinguishers, look for the CCC certification mark; for pre-pressurized extinguishers, make sure the pressure gauge needle points to the green zone. Details on smoke alarms and carbon monoxide detectors are covered in section 3 of this chapter. Instructions for using tourniquets can be found in section 13, item 12. Guidance on how to select, store, and replace each item can be found in [docs/家庭应急装备清单.md](../../docs/research/家庭应急装备清单.md). +- Sources:应急管理部 (2020). 全国基础版家庭应急物资储备建议清单. ; Kendrick D 等 (2012). Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews. ; 武胜县市场监督管理局 (2025). 手提式灭火器、防火门（窗）、点型感温（烟）火灾探测器消费提示. + +### 27. Visible blood in urine — even if painless and gone by the next day — still warrants a check-up + +- Cost: A routine urine test costs just a few dozen yuan, while a urinary-system ultrasound runs around 100–200 yuan. If a doctor deems it necessary, a cystoscopy can be added at a cost of roughly 1,000 yuan. +- In plain terms: Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day. +- Benefit: A UK study analyzed electronic medical records from primary-care clinics, comparing 4,915 patients diagnosed with bladder cancer against 21,718 controls. Among patients with visible blood in urine, the proportion ultimately found to have bladder cancer was 2.8% for those aged 60+, with a 95% confidence interval of 2.5–3.1. For ages 40–59, the figure was 1.2%, with a 95% CI of 0.6–2.3. This proportion is known as the positive predictive value. Blood visible only under a microscope also carries significance; the odds ratio is 20, with a 95% CI of 12–33. For those over 60, this figure is 1.6%, with a 95% CI of 1.2–2.1. +- Evidence grade: B +- Notes: The absence of pain is a key clue. Blood in urine caused by kidney stones or infections usually comes with abdominal or flank pain, plus frequent, urgent, or painful urination. Cancer-related bleeding, however, often causes no discomfort at all and may disappear for a few days before returning — which is why many people overlook it. Taking anticoagulant medications is not a valid reason to skip testing. Blood in urine after intense exercise or during a woman’s menstrual period can be re-evaluated before deciding on further checks. The benefit is rated “low” because it reflects only detection rates, not any measurable reduction in mortality resulting from early diagnosis. +- Sources:Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. British Journal of General Practice, 64(626), e584-e589. + +### 28. If erectile dysfunction appears, check cardiovascular health first — don’t treat it as a purely sexual issue + + +- Cost: A doctor’s visit costs just a few dozen yuan. Measuring blood pressure and running tests for blood sugar and cholesterol adds another hundred or so yuan. One trip to the hospital yields results after a few days. + +- In plain terms: Men with erectile dysfunction later develop cardiovascular disease at roughly 40% higher rates than other men, and heart attacks at about 60% higher rates. The younger a man is, the greater this difference becomes. This problem often shows up before any chest pain does. Therefore, it’s wise to check blood pressure, blood sugar, and cholesterol levels rather than simply self‑medicating. + +- Benefit: One meta‑analysis combined data from 14 long‑term studies involving 92,757 men, followed for an average of 6.1 years. Compared with men without erectile dysfunction, those with the condition faced higher risks as follows: overall cardiovascular events rose by roughly 44% (RR 1.44, 95% CI 1.27–1.63). Heart attacks increased by about 62% (RR 1.62, 95% CI 1.34–1.96). Cerebrovascular events rose by roughly 39% (RR 1.39, 95% CI 1.23–1.57). All‑cause mortality went up by about 25% (RR 1.25, 95% CI 1.12–1.39). No significant difference appeared for cardiovascular‑related deaths (RR 1.19, 95% CI 0.97–1.46). The risk elevation was greater in younger men and in those whose baseline cardiovascular risk was moderate. Studies that used questionnaire‑based diagnosis reported an RR of 1.61 (95% CI 1.38–1.86), while studies asking just one question gave an RR of 1.27 (95% CI 1.18–1.37). + +- Evidence grade: A + +- Notes: These 14 studies tracked groups of men over time; they are not randomized controlled trials. Hence the “40% higher” figure reflects an association, not a proven cause‑and‑effect relationship. Occasional episodes do not count; the condition is considered present only when symptoms persist for three months or more. The tests recommended — blood pressure measurement, fasting blood‑glucose testing, plus cholesterol checks, smoking status assessment, and waist‑circumference measurement — are the same as those listed in sections 7 and 8 of this chapter. Avoid purchasing “male‑enhancement” supplements online; legitimate medications for this purpose are prescription drugs, and their instructions list nitrates as a contraindication — meaning men already taking nitroglycerin or similar drugs must not use them, as doing so can cause a sudden drop in blood pressure. For ways to improve erectile function, see section 29 (weight loss and smoking cessation can help). The benefit is rated “moderate” rather than “large”: the 44% figure represents the difference between two groups, not the actual reduction in mortality achieved by testing. It is also not “small”; unlike the situation described in section 27 (visible blood in urine), where detection alone is the benefit, here hypertension, diabetes, and abnormal cholesterol levels each have established treatments available. +- Sources:Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes, 6(1), 99-109. ；DailyMed（美国国立医学图书馆的药品说明书库）. VIAGRA (sildenafil citrate) tablet, CONTRAINDICATIONS. + +### 29. Weight loss, quitting smoking, and controlling blood pressure and blood sugar can improve erectile function + +- Cost: There is no cost involved; in fact, it may even save money. The real challenge is staying consistent over time — eating healthily, exercising regularly, and quitting smoking. +- In plain terms: Managing cardiovascular risk factors naturally leads to better erectile function. When multiple randomized trials are combined, questionnaire scores improve by an average of 2 to 3 points. This questionnaire has a maximum score of 25, with scores above 22 considered normal. +- Benefit: One meta-analysis evaluated six randomized controlled trials involving 740 men. Interventions included lifestyle changes or medication to control cardiovascular risk factors, with follow-ups lasting at least six weeks. Overall, erectile function scores on the IIEF-5 questionnaire rose by an average of 2.66 points (95% CI: 1.86–3.47). When two trials using statins (143 participants) were excluded, the remaining four trials relying solely on lifestyle changes still showed an average improvement of 2.40 points (95% CI: 1.19–3.61). A total of 597 men participated in these four trials. The IIEF-5 consists of five questions scored from 5 to 25; scores between 22 and 25 indicate no erectile dysfunction, while scores of 5–7 indicate severe impairment. +- Evidence grade: A +- Notes: These six trials used different interventions — some combined weight loss and exercise, while others used medication to control blood pressure and lipids. With only 740 participants overall, the results confirm a positive trend, though the exact degree of improvement varies per individual. The benefit is rated as “minor” because the outcome measured was solely questionnaire scores, not actual reductions in disease incidence. However, similar lifestyle changes have been shown to produce measurable health benefits elsewhere: quitting smoking (see Section 2, Item 1), maintaining a BMI between 20–25 through weight control (Section 2, Item 33), and managing blood pressure with medication when necessary (Section 7). Prescription medications are acceptable when prescribed by a doctor; caution is advised with over-the-counter “health supplements,” which may contain unregulated amounts of active ingredients. For guidance on identifying safe products, see Section 28, Item 4. +- Sources:Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL (2011). The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Archives of Internal Medicine, 171(20), 1797-1803. ；Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research, 11(6), 319-326. + +### 30. Always use condoms during sex and never share needles + + +- Cost: A single condom costs just one or two yuan. The challenge isn’t the price, but making sure to use one every single time — and putting it on right from the start. + +- In plain terms: Using a condom every time throughout sex cuts the chance of HIV transmission between heterosexual partners by roughly 70% or more. “Most of the time” just isn’t enough — that still leaves the risk nearly as high as not using one at all. Condoms also protect against syphilis, gonorrhea, and other STIs. + +- Benefit: One study pooled data from 25 separate studies involving 10,676 heterosexual couples in which one partner was HIV‑positive and the other was not. Compared to couples who never used condoms, those who consistently used them saw their HIV transmission risk drop by about 71%. The reported relative risk was 0.29, with a 95% confidence interval of 0.20–0.43. When compared to couples who used condoms only intermittently, the risk was lower by roughly 77% (RR = 0.23; 95% CI 0.13–0.40). The authors concluded that although condoms are not perfect, “consistent use can reduce HIV transmission by more than 70%.” This same level of protection also applies to syphilis, gonorrhea, chlamydia, and other sexually transmitted infections. + +- Evidence grade: A + +- Notes: The difference between “infrequent use” and “no use” is minimal; the whole benefit hinges on the phrase “every time, throughout.” Sharing needles is a separate, highly effective route of transmission that has nothing to do with sex — this includes drug injection, tattooing, and piercing. For people at high risk, pre‑exposure prophylaxis (PrEP) offers another option: taking medication in advance to block infection. Pooled data from 18 studies show that when at least 70% of participants adhered to the regimen, PrEP cut HIV risk by about 70% compared to placebo (RR = 0.30; 95% CI 0.21–0.45). Trials with lower adherence rates showed no protective effect. PrEP is a prescription medication; consult an infectious‑disease specialist or public‑health clinic rather than ordering it online. Information on what to do after potential exposure can be found in Section 13. +- Sources:Giannou FK, Tsiara CG, Nikolopoulos GK, et al. (2016). Condom effectiveness in reducing heterosexual HIV transmission: a systematic review and meta-analysis of studies on HIV serodiscordant couples. Expert Review of Pharmacoeconomics & Outcomes Research, 16(4), 489-499. ；Fonner VA 等 (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. （暴露前预防 PrEP） + +### 31. If you’ve engaged in high‑risk behavior, get tested for HIV — the Chinese CDC offers free testing with full confidentiality. + + +- Cost: There is no charge. You simply visit the Chinese CDC or a designated medical facility and provide a blood sample. The only real hurdle is mustering the courage to get tested at all. + +- In plain terms: Testing for HIV at the Chinese CDC costs nothing. According to the “National Measures for HIV Testing Management,” staff are prohibited from disclosing your name, address, or test results. A positive result does not mean a death sentence: people who adhere to treatment and keep their viral load undetectable cannot transmit the virus to sexual partners. One major study followed more than 700 couples through over 70,000 unprotected acts; there were zero transmissions between partners. + +- Benefit: Article 23 of the “Regulations on HIV/AIDS Prevention and Control” mandates that local health authorities designate medical institutions to provide free counseling and initial screening to anyone who voluntarily seeks testing. Early detection is far more than a psychological comfort — modern antiretroviral therapy can drive the virus down to undetectable levels. The World Health Organization states that individuals on such treatment with an undetectable viral load pose no risk of HIV transmission. The PARTNER study observed 782 same‑sex couples (serodiscordant pairs) for a total of 1,593 person‑years; despite 76,088 unprotected encounters, only 15 new infections occurred, and genetic analysis proved none originated from the partner. The same national measures also forbid any disclosure of patients’ personal data or test outcomes. + +- Evidence grade: A + +- Notes: The “window period” determines when a test becomes reliable. The Guangdong Provincial CDC reports that nucleic‑acid tests can detect HIV after roughly one week, fourth‑generation antigen‑antibody tests after about two weeks, and third‑generation antibody tests after three weeks. It is advisable to wait at least two weeks post‑exposure and then retest after another two to four weeks; after three months, 99.99% of people can be certain they are not infected. A positive home‑test result is not a diagnosis — confirmation must come from the Chinese CDC or a certified lab. Article 3 of the regulations guarantees that no one may discriminate against HIV‑positive individuals or their families; their rights to marriage, employment, medical care, and education are protected by law. Article 38 also requires infected persons to inform any sexual partners of their status. Screening for HIV, syphilis, and hepatitis B during pregnancy and related prevention measures are covered in Section 27. +- Sources:卫生部 (2006). 全国艾滋病检测工作管理办法. ；国务院 (2006). 艾滋病防治条例（第三、二十三、三十八条）. （北京市卫生健康委员会转载）；Rodger AJ, Cambiano V, Bruun T, et al. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The Lancet, 393(10189), 2428-2438. ；广东省疾病预防控制中心. 艾滋病检测窗口期科普. （窗口期那个数字） + +### 32. As soon as suicidal thoughts arise, tell someone nearby and hand over those first few minutes + + +- Cost: No cost involved. The hard part is actually speaking up at that moment and admitting you can’t be alone for a few hours. +- In plain terms: Among 82 people who attempted suicide, 47.6% reported that only 10 minutes or less passed from the first appearance of suicidal thoughts to the actual attempt. What they had to endure was not a lifetime of mental anguish, but just those few minutes. Of the same group, 76.8% had some contact with others during that time, though they did not voice their feelings. Looking ahead, about 2% of people who ended up in the hospital due to self-harm died by suicide within a year, while roughly 7% did so after nine years or more; the vast majority did not follow that path. +- Benefit: Interviews conducted within three days of admission with those 82 individuals showed that 47.6% (39 people) stated the interval between the first emergence of suicidal thoughts and the actual attempt was no more than 10 minutes. Those whose process took longer displayed significantly higher scores on measures of suicidal intent. However, impulse scores showed no correlation with the duration of this period. Additionally, 76.8% (63 people) reported having some sort of interaction with a partner, family member, or friend during those minutes. The authors conclude that the window for intervention is usually very brief, leaving limited room for professionals to step in; thus, it is crucial to spread awareness of warning signs and basic intervention methods to ordinary people. Another systematic review compiled findings from 90 follow-up studies. For those seeking medical care after self-harm, the median rate of repeated self-harm without resulting in death was 16% after one year, while the suicide mortality rate at that point stood at 2%. After nine years or more of follow-up, roughly 7% had died by suicide. +- Evidence grade: B +- Notes: Grade B is assigned for two main reasons: the Deisenhammer study involved only 82 participants from a single hospital and relied on retrospective recollections; Owens’s review aggregated median figures from 90 studies employing different methods, rather than producing a single combined statistic. That same review also emphasizes that the suicide risk among self-harm patients remains hundreds of times higher than in the general population. Consequently, the statement “the vast majority did not follow that path” describes the overall trajectory of this group, not a guarantee for any individual; appropriate medical care must still be sought. For advice on removing lethal means and contacting the helpline 12356, see item 25 in this section. Steps to take when feeling down are outlined in item 19 of Section 3. Long-term consequences following survival are discussed in item 33 of this section. Finally, actions you can take if someone close to you expresses such thoughts are detailed in item 15 of Section 8. +- Sources:Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry, 70(1), 19-24. ；Owens D, Horrocks J, House A (2002). Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry, 181, 193-199. + +### 33. Don’t treat “survival” as a safety net: after ingesting paraquat or inhaling carbon monoxide, emergency care can save lives, but it rarely preserves lung or brain function. + + +- Cost: No cost involved. It simply helps you understand this reality up front. + +- In plain terms: There is no antidote for paraquat. Gastric lavage is not recommended, and neither hemofiltration nor dialysis alters its disease progression. Paraquat actively enters lung tissue against its concentration gradient, causing pneumonia and pulmonary fibrosis, while also damaging kidneys and liver. Among 257 cases treated at ten hospitals in Bangladesh, the mortality rate reached 43.2%. Carbon monoxide produces similar outcomes: six weeks after exposure, 46.1% of patients receiving normal oxygen still suffered cognitive impairment, compared to 25.0% of those receiving hyperbaric oxygen therapy. No treatment pathway yields a completely clean outcome; the most common result is lasting health complications. + +- Benefit: A systematic review on paraquat poisoning highlights its extremely high mortality rate, stemming from its intrinsic toxicity and lack of effective treatments. Paraquat is actively transported into lung tissue against its concentration gradient, resulting in pneumonia, pulmonary fibrosis, kidney and liver damage. The review explicitly advises against gastric lavage; hemofiltration and dialysis are unlikely to alter clinical outcomes. Evidence supporting corticosteroids or immunosuppressants remains weak. It also notes that mortality rates remain high across all centers despite varying treatment approaches. In Bangladesh, 257 out of 1,420 cases admitted to ten tertiary hospitals between 2013 and 2024 resulted in death (43.2%). Common symptoms included lower limb swelling due to acute kidney failure (71.2%), vomiting (65.8%) and abdominal pain (58.0%). Another randomized, double-blind trial involving 76 patients per group examined acute carbon monoxide poisoning; six weeks later, 25.0% of those receiving hyperbaric oxygen therapy and 46.1% of those receiving normal oxygen still had cognitive impairments (P=0.007; adjusted OR 0.45, 95% CI 0.22–0.92). A separate study of 73 patients found 30% developed cognitive impairments and 12% showed hyperintense signals in white matter on brain imaging. Since July 1, 2014, China has banned the registration and production of paraquat aqueous solutions; sales and usage ceased by July 1, 2016. As of September 26, 2020, soluble concentrate formulations are also prohibited nationwide. Official documents cite frequent suicide attempts involving paraquat as the primary reason for these strict controls. + +- Evidence grade: B + +- Notes: Grade B is assigned because these studies involve general poisoning patients rather than solely suicide attempt survivors; the carbon monoxide trial even included accidental poisoning cases. Consequently, observed complication rates cannot be directly interpreted as probabilities specific to suicide attempts. This entry does not compare mortality rates across different treatment methods nor recommend any specific actions. The sole certainty is that no treatment pathway guarantees a completely clean outcome. On-site management of carbon monoxide poisoning is detailed in Section 13, Item 19. For accidental ingestion of pesticides or medications, avoid inducing vomiting and seek medical help while bringing the container along (Section 13, Item 20). Finally, refrain from storing pesticides or sedatives at home (Section 13, Item 25). +- Sources:Gawarammana IB, Buckley NA (2011). Medical management of paraquat ingestion. British Journal of Clinical Pharmacology, 72(5), 745-757. ；Chowdhury FR 等 (2026). Clinical and Laboratory Profile of Paraquat Poisoning: A Toxicological Crisis in Bangladesh. American Journal of Tropical Medicine and Hygiene, 115, 176-182. ；Weaver LK, Hopkins RO, Chan KJ, et al. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347(14), 1057-1067. ；Parkinson RB, Hopkins RO, Cleavinger HB, et al. (2002). White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology, 58(10), 1525-1532. ；农业农村部办公厅 (2018). 关于切实加强百草枯监督管理的通知（农办农〔2018〕17 号）. + +### 34. Don’t bet on “a few days of rest” after a fall from height: most patients admitted to a trauma ICU survive, though at a cost measured in years + + +- Cost: No cost at all. It simply helps you see the full picture. + +- In plain terms: A trauma ICU in southern Xinjiang treated 289 patients who fell from heights. Only 5.5% died either in the hospital or within 30 days. The vast majority survived, but at a price: 47.1% suffered injuries to three or more body parts, 36% needed ventilators, and the median length of stay in the ICU was 8 days — with some patients remaining for as long as 132 days. The median fall height for this group was just 3 meters. Follow‑up showed that 58% of those with serious injuries eventually returned to work. + +- Benefit: From April 2020 to July 2024, the same ICU recorded 289 cases of falls from heights; the average age of patients was 40.3 years. The median fall height was 3 meters; 26.6% fell from heights above 5 meters and 11.4% from heights above 10 meters. The median Injury Severity Score was 24, a higher score indicating more severe injuries; 63.3% of patients scored above 20. In addition to the multiple injuries, 18.3% suffered damage to four or more body parts. Mechanical ventilation was required for 36% of patients, with a median duration of 103.5 hours. The median ICU stay was 8 days, ranging from 1 day to 132 days. The in‑hospital or 30‑day mortality rate was 5.5% (16 out of 289). A German trauma center reported similar results: among 84 patients with an ISS of 25 or higher, 58% returned to work after follow‑up. Age, length of ICU treatment, and self‑reported health status were identified as predictive factors. Nationwide, the average cost per hospital stay in 2024 was 9,870 yuan, a 4.3% decrease from the previous year; total health expenditures reached 9,089.55 billion yuan, of which personal spending accounted for 2,500.75 billion yuan, or 27.5% of the total. + +- Evidence grade: B + +- Notes: Grade B is assigned because the fall‑related data come from a single hospital’s retrospective chart review without distinguishing between accidental and self‑inflicted falls. The figure on return‑to‑work is based on only 84 patients in Germany; neither dataset can be taken as a reliable predictor of outcomes for any individual who falls from a height. The average national hospital cost is an overall figure, not specific to fall injuries; it is included only to provide a baseline for comparison. No direct correlation between fall height and injury severity is presented, as the source only supplies the height distribution of this group. For information on pressure ulcers that often develop during prolonged bed rest, see Section 17, Item 8. Deep‑vein thrombosis and pulmonary embolism are discussed in Section 13, Item 11 (sudden swelling of one leg). If suicidal thoughts arise, refer to Section 32 of this chapter. Details on paraquat poisoning are covered in Section 33 — remember that “being saved” does not guarantee a completely uncomplicated recovery. The timeline described here reflects the author’s own experience: after falling from the fourth floor, he initially believed he would recover in a few weeks, but ended up hospitalized for a full year, undergoing multiple surgeries, wearing steel plates, and unable to sit up on his own for half a year; his family had to take on debt to cover the expenses. +- Sources:Chen Y, Li W, Wang X, Zhong Q, Abudurexiti A, Qiu Q, Li J, Luo J (2025). Clinical features and prognostic predictors for patients admitted to trauma intensive care unit due to fall from height in South Xinjiang. International Journal of Emergency Medicine, 18, 142. ；Simmel S, Wurm S, Drisch S, Woltmann A, Coenen M (2020). Prädiktion der Rückkehr zur Arbeit nach Polytrauma bei Patienten mit einem ISS von mindestens 25. Die Rehabilitation, 59(2), 95-103. ；国家卫生健康委 (2025). 2024 年我国卫生健康事业发展统计公报解读. + +### 35. Don’t trade “losing one kidney is no big deal” for cash: the remaining kidney has to do the work of two, and 86% of kidney sellers later say their health got worse + +- Cost: No cost at all. It simply requires a clear look at the facts. +- In plain terms: First, consider the best-case scenario: legitimate donors who pass rigorous screening and receive post‑surgery follow‑up. In U.S. data from nearly 96,000 donors, only 31 per 10,000 developed end‑stage renal disease within 15 years after donation. Among equally healthy, eligible non‑donors, that figure was just 4 per 10,000. On the other side, a study of 305 kidney sellers in India found that six years later, 86% reported poorer health, and three‑quarters still carried debt. Legitimate donors get screening and monitoring; kidney sellers get none of that. +- Benefit: U.S. researchers compared 96,217 living kidney donors with 20,024 similarly healthy non‑donors drawn from the NHANES III survey. After 15 years, the estimated risk of developing end‑stage renal disease (ESRD) was 30.8 per 10,000 donors (95% CI 24.3–38.5) versus 3.9 per 10,000 non‑donors (95% CI 0.8–8.9; P<0.001). Over a lifetime, ESRD risk was 90 per 10,000 donors, 14 per 10,000 non‑donors, and 326 per 10,000 in the general population. A Norwegian study of 1,901 donors (median follow‑up 15.1 years) showed a 30% higher overall mortality (HR 1.30, 95% CI 1.11–1.52), a 40% higher cardiovascular mortality (HR 1.40, 95% CI 1.03–1.91), and roughly tenfold higher ESRD risk (HR 11.38, 95% CI 4.37–29.6). Among 3,698 U.S. donors, 11 developed ESRD — an incidence of 180 per million person‑years, compared with 268 per million in the general population. Of those re‑examined after an average of 12.2 years, 255 remained healthy, and 85.5% retained a glomerular filtration rate of at least 60 ml/min/1.73 m², the clinical lower limit of normal. Hypertension affected 32.1% and proteinuria 12.7%. In Chennai, India, 96% of 305 kidney sellers acted to pay debts; they received an average of $1,070. Six years post‑surgery, family income fell by one‑third (P<0.001), poverty rose, and three‑quarters remained indebted; 86% said health worsened, and 79% would not recommend kidney selling to others. The absolute numbers from these studies are 32,621 donors, 24.9 years of follow‑up, 302 ESRD cases, and 9.2 years of average follow‑up after surgery. +- Evidence grade: A +- Notes: Controversy exists: Ibrahim’s study used ordinary citizens as controls and found no difference in survival or ESRD risk between donors and non‑donors. Muzaale and Mjøen compared donors to equally healthy, eligible non‑donors and found markedly higher risks. The disagreement concerns the control group, not the donors themselves. All three studies agree that absolute risks remain low (30.8 per 10,000 over 15 years). Thus the key points are two: first, the remaining kidney does bear extra strain, as shown by higher rates of hypertension and proteinuria; second, these figures apply only to donors who undergo pre‑ and post‑operative screening and medical care — conditions absent for illegal kidney sellers, whose outcomes differ sharply according to Indian follow‑up data. Original studies provide only self‑reported health decline, proteinuria, hypertension, and ESRD rates; no figures on bed‑bound status are included here. Legal restrictions on organ sales, fines, and criminal penalties for relatives are detailed in Section 9, Article 22. Dialysis patients may use cross‑regional settlement and long‑term medication programs described in Section 16, Articles 1 and 2. +- Sources:Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL (2014). Risk of end-stage renal disease following live kidney donation. JAMA, 311(6), 579-586. ；Mjøen G, Hallan S, Hartmann A, et al. (2014). Long-term risks for kidney donors. Kidney International, 86(1), 162-167. ；Ibrahim HN, Foley R, Tan L, et al. (2009). Long-term consequences of kidney donation. New England Journal of Medicine, 360(5), 459-469. ；Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR (2002). Economic and health consequences of selling a kidney in India. JAMA, 288(13), 1589-1593. + +### 36. Don’t pick up, disassemble, or sell unidentified metal parts; stay away from areas marked with a clover warning sign + +- Cost: No cost at all. If you see unfamiliar metal cylinders, lead containers, or parts removed from equipment, simply steer clear — don’t pick them up, take them apart, or put them in your pocket. +- In plain terms: Radiation has no smell, color, or temperature, so humans cannot detect it. That means “it looks harmless” is not a reliable way to judge whether something is radioactive. Most radioactive sources look exactly like ordinary metal — they emit no light and generate no heat. The chance of an average person encountering one is extremely low: there are roughly 178,000 active radioactive sources nationwide, and the accident rate stays under 1 per 10,000 sources. But if you do happen to encounter one, the consequences are irreversible. In 1987, someone in Brazil disassembled a radiotherapy machine from an abandoned clinic; roughly 112,000 people were monitored, and 4 died as a result. +- Benefit: As of 2025, there are about 178,000 active radioactive sources and 355,000 radiation devices in use across the country. The annual accident rate for radioactive sources remains below 1 per 10,000. Classification of incidents is as follows: loss, theft, or uncontrolled release of Class I or II sources constitutes a major radiation accident; Class III sources lead to a relatively serious accident. Loss or theft of Class IV or V sources, or exposure of people to radiation exceeding annual dose limits, counts as a minor accident. Official example: In June 2020, a γ-ray inspection was performed during pipeline renovation at a blast furnace plant run by Ningxia Iron and Steel Group. A Class II iridium-192 source exposed three workers to radiation. Chen suffered third-degree acute radiation skin damage on his left hand; Liu sustained fourth-degree damage on his thumb and index finger, and third-degree damage on his middle, ring, and little fingers. Fan had first- to second-degree damage on his left hand. All three received radiation doses far exceeding national limits; both responsible companies had their radiation safety licenses revoked and were fined 70,000 yuan. International example: In 1987, a radiotherapy machine was dismantled at an abandoned clinic in Goiânia, Brazil; a 50.8 TBq cesium-137 source was removed and its protective casing broken. Around 112,000 people were monitored, and 249 showed internal or external contamination. Of these, 129 had moderate to severe contamination, and 50 required close medical monitoring. Ultimately, 4 people died. (National / International) +- Evidence grade: A +- Notes: If you ever encounter such a source, stay far away, note its location, do not move it, and call 110 immediately. Laws require reporting to environmental protection, public security, and health authorities. Distance and time are the only effective protections — putting something in a pocket or plastic bag offers zero protection. Devices like X-ray machines and CT scanners that generate radiation only when powered do not retain any radioactivity after being turned off; the real danger comes from the sealed radioactive source inside them. Radiotherapy machines in hospitals, γ-ray inspection devices on pipelines and boilers, well logging tools, and level gauges all contain such sources. Disassembling their outer casings exposes these sources, which look identical to ordinary metal parts. Therefore, the rule is not “identify radioactive sources” but “never disassemble, sell, or take home any unidentified equipment parts.” Workers in scrap recycling, dismantling, hardware, and construction face far higher risks; if you see a warning zone marked with a clover symbol on a construction site, steer clear. This guidance applies only to uncontrolled radioactive sources, not to nuclear power plant leaks, which the general public is far less likely to encounter. The main beneficiaries of following these rules are you and anyone else present at the scene. +- Sources:生态环境部 (2025). 2024 中国生态环境状况公报. ；国家核安全局 (2026). 2025 年我国核与辐射安全监管工作成效. ；生态环境部 (2021). 关于一起 γ 射线探伤作业违法违规造成辐射事故案件处理情况的通报. ；国务院 (2019). 放射性同位素与射线装置安全和防护条例（2019 年修订，第三十四、四十二、六十八条）. ；环境保护部 (2009). 关于建立放射性同位素与射线装置辐射事故分级处理和报告制度的通知（辐射事故分级标准）. ；International Atomic Energy Agency (1988). The Radiological Accident in Goiânia. IAEA, Vienna. diff --git a/book/02-Do-Not-Die-Slowly.md b/book/02-Do-Not-Die-Slowly.md new file mode 100644 index 00000000..345e560c --- /dev/null +++ b/book/02-Do-Not-Die-Slowly.md @@ -0,0 +1,338 @@ +# 2. Don’t die slowly +This section covers just two types of long‑term health risks: those with a big impact on overall mortality and those backed by solid evidence. The items are listed from most cost‑effective to least. A few entries note “randomized trials,” meaning participants were randomly assigned to different groups for comparison — this is the most reliable type of research. All other figures come from observational studies that simply track people over time without any grouping. Such studies produce risk ratios like HR or RR, but they also contain two kinds of confounding factors: participants naturally differ from one another, and some already had health problems before the study began. Therefore these numbers only indicate general trends and approximate magnitudes; they do not guarantee that following these recommendations will produce exactly those results. +### 1. Quitting smoking, the earlier the better + +- Cost: It costs nothing — in fact, it saves money. A pack-a-day habit costs roughly $3–$4, which you’ll no longer spend after quitting. The hard part is getting through the withdrawal period, which usually lasts a few weeks to several months. +- In plain terms: On average, smokers live more than 10 years less than non-smokers. Quitting before age 40 eliminates roughly 90% of the extra death risk caused by continued smoking. The earlier you quit, the more years you gain. +- Benefit: One U.S. study that tracked participants without assigning them to groups found that current smokers have a life expectancy more than 10 years shorter than those who never smoked. Quitting before age 40 removes about 90% of this excess mortality risk. Quitting between ages 25–34 adds roughly 10 years to life expectancy; between 35–44, about 9 years; and between 45–54, about 6 years (as reported in the original source). Similar Chinese research from the 2010s shows that urban male smokers have a 1.65 times higher death risk than non-smokers (RR 1.65), while rural male smokers have a 1.22 times higher risk. After 10 years of sustained abstinence, this smoking-related risk nearly disappears. +- Evidence grade: A +- Sources:Jha P 等 (2013). 21st-century hazards of smoking and benefits of cessation in the United States. NEJM. ；Chen Z 等 (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. ；Oberg M 等 (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. （二手烟那两个数字） +- Notes: Secondhand smoke is deadly too: in 2004, an estimated 603,000 people worldwide died from exposure to it, accounting for roughly 1% of all global deaths that year. Even if you don’t smoke yourself, you must avoid secondhand smoke, especially to protect children. Specific quitting strategies are outlined in the following sections: Section 3 (smoking cessation medications), Section 4 (setting a quit date), Section 5 (visiting a smoking cessation clinic), and Section 6 (e-cigarettes). +### 2. Don’t smoke at home or in the car, and don’t let guests smoke indoors + +- Cost: There is no monetary cost and it takes little time. The challenge is simply having the conversation with family members and guests to keep them from smoking indoors. +- In plain terms: Around 600,000 people worldwide die each year from secondhand smoke exposure; nearly 30% of those are children. Long‑term exposure to secondhand smoke raises the risk of hypertension, heart disease, and stroke by roughly 30% compared to non‑exposed individuals. Smoke inhaled at home is even more harmful than smoke encountered outside. +- Benefit: In 2004, secondhand smoke caused 603,000 deaths globally — about 1.0% of all deaths worldwide, with children accounting for 28% of those fatalities. Pooled data from 57 studies show that people exposed to secondhand smoke have a 1.28‑fold higher chance of developing hypertension, a 1.39‑fold higher risk of heart disease, a 1.50‑fold higher risk of myocardial infarction, and a 1.36‑fold higher risk of stroke compared to non‑exposed individuals. The risk is greater when exposure occurs at home rather than outside. +- Evidence grade: A +- Sources:Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet：「603,000 deaths were attributable to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men」，「61% of DALYs were in children」. ；(2026). The Associations Between Secondhand Smoke Exposure and Various Cardiovascular Diseases: A Meta-Analysis. Nicotine & Tobacco Research：57 项研究，「hypertension (OR: 1.28, 95% CI: 1.15 to 1.40), heart disease (OR: 1.39, 95% CI: 1.28 to 1.50), myocardial infarction (OR: 1.50, 95% CI: 1.17 to 1.84), stroke (OR: 1.36, 95% CI: 1.18 to 1.54)」「Home exposure has a higher risk of CVD than non-home exposure」. +- Notes: Focus on home environments first, since people spend more time there and pooled research indicates that indoor secondhand smoke is more harmful than outdoor exposure. Children bear 61% of the overall health burden caused by secondhand smoke. For personal smoking cessation, see item 1 in this section. +### 3. Don’t rely solely on willpower to quit smoking — get medication first: success rates more than double + +- Cost: Nicotine patches and gum are over-the-counter products available at any pharmacy. A full course lasts 8–12 weeks and costs anywhere from a few hundred to over a thousand yuan. Varenicline and bupropion, on the other hand, are prescription-only drugs; you’ll need a prescription from a smoking cessation clinic or a pulmonology department. These costs are roughly offset by the money saved from buying fewer cigarettes during the same period. +- In plain terms: Relying on sheer willpower alone rarely works for most smokers. People taking varenicline are more than twice as likely to succeed compared to those taking a placebo. Those using nicotine replacement products also have a 50% higher success rate than non-medication users. Combining patches with gum or lozenges further boosts success rates by roughly 20%. +- Benefit: A pooled analysis of 41 randomized trials involving 17,395 participants shows that varenicline increases smoking cessation rates by 2.32 times compared to placebo (RR 2.32, 95% CI 2.15–2.51; high-certainty evidence). Varenicline also outperforms bupropion (RR 1.36, a 36% relative increase) and single-form nicotine replacement therapy (RR 1.25, a 25% relative increase). Across 133 trials with 64,640 participants, nicotine replacement products raise success rates by about 55% versus no medication at all (RR 1.55, 95% CI 1.49–1.61). Using both a patch and a fast-acting form such as gum or lozenges yields a 27% relative improvement over patch-only use (RR 1.27, 95% CI 1.17–1.37; high-certainty evidence from 16 trials with 12,169 participants). +- Evidence grade: A +- Sources:Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. ；Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. ；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. ；上海市卫生健康委员会 (2021). 选对药物，让戒烟轻松一点：「市场上可见的戒烟药物主要有三种，即尼古丁替代疗法药物、安非他酮、伐尼克兰」，「尼古丁替代疗法药物属于非处方药（OTC），可通过药店柜台购买；而安非他酮、伐尼克兰属于处方药，须到医院戒烟门诊或呼吸内科就诊，凭医师处方经药师调配后才能得到」. +- Notes: In China, these three types of medications are currently available for smoking cessation; only nicotine replacement products are sold over the counter. Common side effects of varenicline include nausea, vivid dreams, and sleep disturbances; anyone with a psychiatric history should discuss this with their doctor. A typical course of nicotine replacement therapy lasts 8–12 weeks — do not abruptly stop use but taper off gradually under medical guidance. While these medications ease withdrawal symptoms during the first few weeks, they do not eliminate cravings triggered by specific situations, so they should be used alongside the other strategies outlined in this chapter: setting a quit date (Section 4) and seeking professional help at a smoking cessation clinic (Section 5). +### 4. Pick a quit date and stop smoking on that day — don’t taper gradually + +- Cost: No cost at all. Just choose a date on the calendar and let family and coworkers know in advance. +- In plain terms: Many people try to cut back a little each day until they reach zero. Yet after six months, only 15.5% of those who gradually reduced their intake stayed smoke‑free, compared with 22% of people who set a quit date and stopped all at once. So it’s better to pick a date and quit completely on that day. +- Benefit: In the UK, 697 smokers were randomly assigned to two groups. One group quit on a predetermined date; the other cut their cigarette use by 75% during the two weeks before that date. Both groups received nursing support and used nicotine replacement therapy around the quit date. At four weeks, 49.0% (95% CI 43.8–54.2) of the “quit‑on‑date” group remained smoke‑free, versus 39.2% (34.0–44.4) of the “taper‑first” group; the relative risk was 0.80 (0.66–0.93). By six months, 22.0% (18.0–26.6) of the quit‑on‑date group stayed quit, compared with 15.5% (12.0–19.7) of the taper‑first group; the relative risk was 0.71 (0.46–0.91). Even among people who preferred tapering, the quit‑on‑date approach yielded higher success rates at four weeks (52.2% vs. 38.3%). +- Evidence grade: A +- Sources:Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P (2016). Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Annals of Internal Medicine, 164(9), 585–592. ；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308（提前用尼古丁替代品那一段）. +- Notes: This is a somewhat controversial topic. Cochrane previously published a review comparing these two methods; it concluded they performed similarly (RR 0.94, 95% CI 0.79–1.13, based on 10 trials with 3,760 participants). However, that review was withdrawn in 2019 and is no longer updated. The best current evidence comes from the trial described above, which favors quitting on a set date. Both groups in that trial also used nicotine replacement therapy before the quit date, an approach itself backed by evidence: early use raises success rates by roughly 25% (RR 1.25, 95% CI 1.08–1.44, based on 9 trials with 4,395 participants; moderate‑certainty evidence). Therefore, the recommended strategy is to pick a quit date, start nicotine replacement therapy two weeks beforehand, and then quit all at once on that day. +### 5. Visit a smoking cessation clinic or call 12320 to find local services + +- Cost: A single clinic visit costs only a few to dozens of yuan. Behavioral support typically involves 4–8 sessions lasting 30–60 minutes each, totaling under 5 hours. Calling the helpline is completely free. +- In plain terms: Medications and regular follow-up support from professionals are two distinct components that work best together. People who take medication while receiving dedicated follow-up have nearly twice the quit rate of those who only receive brief advice. Phone support also helps: those who proactively call the smoking cessation helpline see their success rate rise by 20–30% compared to others. +- Benefit: Across 52 trials involving 19,488 participants, the combination of medication and behavioral support led to a 1.83-fold higher quit rate than standard care or brief advice (RR 1.83, 95% CI 1.68–1.98; high-quality evidence). For the 43 trials conducted in medical settings, this advantage rose to 1.97-fold (95% CI 1.79–2.18). When looking at phone-based support alone: among people who called the helpline themselves, those receiving multiple follow-up calls had a 38% higher quit rate than those who only got informational materials or a single consultation (RR 1.38, 95% CI 1.19–1.61; 14 trials, 32,484 participants). For people who did not call the helpline but received scheduled phone support from researchers, the success rate was 25% higher than those without such support (RR 1.25, 95% CI 1.15–1.35; 65 trials, 41,233 participants). Both findings are supported by evidence of moderate certainty. +- Evidence grade: A +- Sources:Stead LF, Koilpillai P, Fanshawe TR, Lancaster T (2016). Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 3, CD008286. ；Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J (2019). Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD002850. ；中国疾病预防控制中心 (2021). 「中国戒烟平台」微信小程序正式上线：「在健康中国行动控烟行动工作组指导下中国疾病预防控制中心和世界卫生组织驻华代表处联合制作了中国权威戒烟资源库『中国戒烟平台』微信小程序。小程序内容主要包括：戒烟热线、戒烟门诊详细信息，以及线上戒烟服务资源等」；同一站点页脚标注「健康咨询电话：12320」. +- Notes: How to find local services in China: Search “China Smoking Cessation Platform” on WeChat to access a list of local smoking cessation clinics and helplines, or call 12320 to ask about nearby options. Most of the above trials were conducted overseas, and the intensity of services at local clinics varies widely; these figures should be viewed as general guidelines only. The recommended medications are listed in Section 3 of this chapter (“Smoking cessation medications”). +### 6. Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them + +- Cost: The device plus cartridges cost anywhere from a few dozen to several hundred yuan per month. In China, only tobacco‑flavored e‑cigarettes are legally sold, and only at stores holding a tobacco retail license. +- In plain terms: Switching to nicotine‑containing e‑cigarettes helps roughly 60% more people quit smoking than nicotine patches — this finding is quite reliable. However, e‑cigarettes are not harmless; long‑term safety data remain limited. For people who have never smoked, there is absolutely no benefit to using them. +- Benefit: This up‑to‑date review includes 80 randomized trials involving 29,861 participants. Compared with nicotine replacement therapy, e‑cigarettes raise the quit rate by about 61% (RR 1.61, 95% CI 1.23–2.12; high‑certainty evidence based on 11 trials with 4,114 participants). In absolute terms, that translates to roughly 4 extra quitters per 100 users (range: 1–7). The rate of serious adverse events is similar between groups (risk difference 0.01, 95% CI −0.01–0.02; moderate‑certainty evidence). Compared with behavioral support alone or no support at all, e‑cigarettes improve quit rates by about 75% (RR 1.75, 95% CI 1.39–2.20; low‑certainty evidence). +- Evidence grade: A +- Sources:Lindson N, Livingstone-Banks J, Butler AR, et al. (2026). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 8, CD010216. ；国家烟草专卖局 (2022). 电子烟管理办法（国家烟草专卖局公告 2022 年第 1 号，2022 年 5 月 1 日施行）第十八条：从事电子烟零售业务，要向烟草专卖行政主管部门申领烟草专卖零售许可证。第二十二条：「禁止向未成年人出售电子烟产品。」第二十三条第二款：「任何个人、法人或者其他组织不得通过本办法规定的电子烟交易管理平台以外的信息网络销售电子烟产品、雾化物和电子烟用烟碱等。」第二十六条：「禁止销售除烟草口味外的调味电子烟和可自行添加雾化物的电子烟。」. +- Notes: This topic is controversial. WHO does not recommend e‑cigarettes as a smoking‑cessation tool, citing insufficient long‑term safety data and concerns that they may attract youth to nicotine. The UK, however, includes them in its quit‑smoking services. In China, e‑cigarette sales are not completely banned but are tightly regulated under the “Administrative Measures for E‑Cigarettes.” Only tobacco‑flavored products may be sold, and only at physical stores holding a tobacco retail license; fruit‑flavored e‑cigarettes and refillable devices are prohibited. Sales through any website, online shop, or social‑media platform other than the state‑run e‑cigarette trading platform are illegal, and sales to minors are forbidden. Consequently, fruit‑flavored e‑cigarettes that are still available are sold through illicit channels outside regulatory oversight. This is also how synthetic‑cannabinoid‑laced “high‑effect” e‑cigarettes enter the market; see Section 22, Item 4 (“Do not accept unknown cartridges”). The review examined only legally regulated nicotine‑containing products; unverified e‑liquid mixtures were not included. As a first step, it is advisable to try the medication described in Item 3 of this section, which offers stronger evidence and lower cost. +### 7. Not drinking sugary drinks — even switching to sugar-free ones doesn’t help + +- Cost: There’s no cost involved, nor does it take any extra time. Switching to plain water or sugar-free tea can even save money. The real challenge is breaking the habit of drinking sweet beverages, including sugar-free ones. +- In plain terms: People who drink more than two sugary drinks per day have about a 20% higher chance of dying during the same period compared to those who rarely drink them. Those who consume one to two per day still face a roughly 10% higher risk. Switching to sugar-free versions brings no benefit: individuals drinking two or more sugar-free drinks daily actually have a 25% higher risk of death. +- Benefit: Two large U.S. studies followed large groups of people without any subgroup categorization; together they included around 118,000 participants and documented 36,000 deaths. Those drinking two or more sugary drinks daily had a 21% higher risk of death compared to those consuming less than one per month (HR 1.21). For those drinking one to two per day, the risk rose by about 14% (HR 1.14). The European EPIC study followed 450,000 people across 10 countries under similar conditions; again no subgroups were defined. Compared to those drinking less than one sugary drink per month, daily consumers of two or more sugary drinks faced an 8% higher risk (HR 1.08, 95% CI 1.01–1.16). Those drinking two or more sugar-free drinks daily had a 26% higher risk (HR 1.26, 95% CI 1.16–1.35). When all types of soft drinks were considered together, the risk increase was about 17% (HR 1.17, 95% CI 1.11–1.22). +- Evidence grade: A +- Sources:Malik VS 等 (2019). Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. ；Mullee A, Romaguera D, Pearson-Stuttard J, et al. (2019). Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Internal Medicine, 179(11), 1479-1490. +- Notes: There is ongoing debate regarding sugar-free drinks. The association between sugar-free drinks and health outcomes appears even stronger than that of sugary drinks, which likely reflects reverse causality: individuals who are already overweight or have diabetes tend to switch to sugar-free versions. Therefore, we cannot claim sugar-free drinks are more harmful based on this alone. Nevertheless, this evidence clearly shows that the idea “switching to sugar-free drinks solves the problem” lacks any factual support. The safest choice remains plain water or sugar-free tea. Additionally, these studies rely solely on observational tracking rather than controlled trials; people who consume more sugary drinks often lead less healthy lifestyles overall, which may contribute to the observed higher risk figures. +### 8. Not chewing betel nut + +- Cost: It costs nothing, takes no time, and saves money that would otherwise be spent on betel nut. The hard part is breaking the habit of chewing it. +- In plain terms: People who chew betel nut have roughly a 20% higher chance of dying during the same period compared to non-chewers. Their risk of developing diabetes and metabolic syndrome is nearly 50% higher. Additional risks for oral and esophageal cancer also apply. +- Benefit: Data from 17 Asian studies involving 388,000 participants show that chewing betel nut raises overall mortality risk by about 21% relative to non-chewers (relative risk 1.21, P=0.02). This effect applies to 179,600 of those participants. The risk of diabetes rises by roughly 47% (1.47), while metabolic syndrome risk increases by about 51% (1.51). Betel nut itself is also a known risk factor for oral and esophageal cancer. +- Evidence grade: A +- Sources:Yamada T, Hara K, Kadowaki T (2013). Chewing betel quid and the risk of metabolic disease, cardiovascular disease, and all-cause mortality: a meta-analysis. PLoS One, 8(8), e70679. +- Notes: The longer and more frequently one chews betel nut, the greater the risk of oral cancer becomes. After quitting, this risk gradually declines over time. Betel nut mixed with tobacco poses an even greater danger. +### 9. Switch household salt to low‑sodium (potassium‑rich) salt + +- Cost: One bag costs a few yuan more than regular salt. It’s easy to switch when you shop, adding virtually no extra time. The taste stays almost the same. +- In plain terms: For people who have had a stroke or are over 60 with hypertension, switching to low‑sodium salt can lower their chance of dying within five years by about 12% and the risk of another stroke by roughly 14%. +- Benefit: A randomized trial conducted in rural China enrolled 20,995 participants — all stroke survivors or adults aged 60+ with hypertension — and followed them for 4.74 years. Those using low‑sodium salt had a 12% lower risk of death (RR 0.88), a 14% lower risk of stroke (RR 0.86), and a 13% lower risk of major cardiovascular events (RR 0.87) compared with the regular‑salt group. No statistically significant difference emerged between the groups regarding episodes of excessively high blood potassium levels. +- Evidence grade: A +- Sources:Neal B 等 (2021). Effect of Salt Substitution on Cardiovascular Events and Death. NEJM. ；O'Donnell M 等 (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. NEJM. （争议方 PURE） +- Notes: This finding is somewhat controversial. The PURE study only recorded long‑term outcomes without random assignment; it reported that individuals excreting less than 3 g of sodium per day faced a roughly 27% higher risk of death or cardiovascular events, while those excreting more than 7 g per day faced a 15% higher risk. According to PURE, both very low and very high sodium intake are detrimental, with moderate intake being optimal. However, the Chinese rural trial only partially replaced regular salt with low‑sodium salt, so sodium levels did not drop to the extremes examined in PURE. Moreover, the trial involved only high‑risk elderly participants; younger, healthier individuals would likely gain far less benefit. People with impaired kidney function or those taking potassium‑sparing medications should consult a physician before making this switch. +### 10. Brush teeth thoroughly and floss daily; replace missing teeth promptly + +- Cost: Dental floss or interdental brushes cost just a few dozen yuan per year, while professional cleanings run about 100–200 yuan each. It takes only two to three extra minutes per day. The real challenge is making flossing a daily habit. +- In plain terms: People who floss daily have roughly a 10% lower chance of dying over the same period. For elderly individuals with no natural teeth, the risk of death is about 90% higher. Those with fewer than 20 natural teeth face roughly double the risk. +- Benefit: A Japanese study followed 9,676 participants for six years. Those who used interdental cleaning tools saw their mortality risk drop by about 11% (hazard ratio 0.89). Those who used tongue cleaners saw a 23% reduction (HR 0.77). When multiple studies of community-dwelling seniors are combined, people with no natural teeth have roughly 1.87 times the risk of death (95% CI 1.35–2.59). Those with fewer than 20 natural teeth face about 2.04 times the risk (95% CI 1.67–2.49). +- Evidence grade: B +- Sources:Wang K, Matsuyama Y, Kiuchi S, et al. (2026). Routine oral health practices and all-cause mortality. Journal of Dentistry. ；Ko MJ, Seo S, So JS, et al. (2026). Deteriorated oral health and function as risk factors for physical disability and mortality in community-dwelling older adults: a systematic review and meta-analysis. European Geriatric Medicine. +- Notes: This topic remains debated. These studies are purely observational; individuals with poor dental health often also have poorer overall health and lower socioeconomic status. It is unclear whether poor dental health harms overall health or whether poor health leads to poor dental health. Regardless, the cost of proper dental care is very low, and periodontal disease and missing teeth do directly affect eating ability. +### 11. Walking 7,000–8,000 steps per day + +- Cost: It costs nothing. You can spread 60–90 minutes of walking throughout your commute and daily errands. The hard part is doing it every single day. +- In plain terms: People who walk 5,800 steps daily have roughly a 40% lower chance of dying during the same period compared to those who walk only 3,500 steps. When they reach 7,800 steps, that risk drops by about 45%. Going beyond that still lowers the risk a bit, but only up to a certain point. For adults over 60, 6,000–8,000 steps per day is sufficient. +- Benefit: Fifteen studies tracking large groups of people were combined for analysis without separating participants into subgroups. These studies included 47,471 participants and 3,013 deaths. Participants were divided into four groups based on daily step count; the lowest group had a median of 3,553 steps per day. The other three groups had medians of 5,801, 7,842, and 10,901 steps per day. Compared to the lowest group, death risk in these three groups was reduced by roughly 40%, 45%, and 53% respectively (HR values: 0.60, 0.55, 0.47). For people over 60, benefits level off after reaching 6,000–8,000 steps; for younger adults, benefits level off after 8,000–10,000 steps. Another analysis of multiple studies showed benefits start at around 3,867 steps per day; beyond that point, each additional 1,000 steps per day lowers death risk by about 15%. +- Evidence grade: A +- Sources:Paluch AE 等 (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. ；Banach M 等 (2023). The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. European Journal of Preventive Cardiology. +- Notes: The range from 4,000 to 7,000 steps offers the best value; you don’t have to hit 10,000 steps to see benefits. Keep in mind these studies are purely observational: the group with the fewest steps includes people who were already ill and unable to walk much. Their low step count reflects poor health, not the other way around, so the calculated risk differences tend to be somewhat exaggerated. Still, the clear trend of better outcomes with more walking remains. This recommendation aligns with Recommendation 14 (150–300 minutes per week of moderate-intensity exercise); they describe the same health benefit, just expressed differently. Meeting either target is sufficient. +### 12. People with hypertension and high cholesterol should take their medication regularly as prescribed; never stop on their own. + +- Cost: Generic hypertension drugs and statins cost only a few to several dozen yuan per month. They’re taken once daily, so they don’t require much time or effort. The real challenge is sticking to them long-term — once people feel better, they often stop taking them. +- In plain terms: For every 10 mmHg drop in blood pressure, mortality decreases by roughly 13%, while stroke risk drops by about 27%. Each 1.0 mmol/L reduction in LDL cholesterol achieved by statins lowers mortality by roughly 10%. Those who take their medication as directed have a 30% to 45% lower risk of death compared to those who frequently miss doses. +- Benefit: Pooled data from multiple randomized controlled trials show that a 10 mmHg reduction in systolic blood pressure (the “high” number in a blood pressure reading) lowers mortality by about 13% (RR 0.87) and major cardiovascular events by roughly 20% (RR 0.80). Stroke risk drops by around 27% (RR 0.73), while heart failure risk decreases by about 28% (RR 0.72). Statins also reduce LDL cholesterol; each 1.0 mmol/L drop lowers mortality by roughly 10% (RR 0.90) and major vascular events by about 22% (RR 0.78). Observational studies further indicate that patients who adhere to prescribed treatment regimens (≥80% compliance) enjoy significantly lower mortality rates: statin adherence reduces risk by about 45% (RR 0.55), while adherence to antihypertensive therapy lowers risk by roughly 29% (RR 0.71). +- Evidence grade: A +- Sources:Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. ；Cholesterol Treatment Trialists' (CTT) Collaboration (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. ；Chowdhury R 等 (2013). Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal. +- Notes: Only individuals deemed by doctors to need medication should follow this advice; healthy people do not require it. The figures regarding “consistent medication use” stem from observational data; those who stick to treatment tend to be more disciplined overall, which may inflate perceived benefits. The mortality reductions linked to blood pressure control and statins are more firmly supported by randomized trials than any potential benefits of tighter blood glucose control. +### 13. Getting roughly 7 hours of sleep each night and keeping a regular schedule + +- Cost: No cost involved. You simply need to set aside time for sleep — most people achieve this by cutting back on phone usage. The real challenge is maintaining consistent bedtime and wake-up times. +- In plain terms: People who regularly get less than 7 hours of sleep have a roughly 10% higher risk of dying over the same period. The more irregular their sleep schedule, the greater this risk becomes. Those with the most consistent routines have a 20–50% lower mortality risk compared to those with the least regular schedules. In other words, how consistent your sleep pattern is matters more than the total number of hours you sleep when it comes to predicting death risk. +- Benefit: A pooled analysis of 16 longitudinal studies — which simply recorded data without grouping participants — included 1.38 million people and 113,000 deaths. People who slept less than 7 hours had a 12% higher mortality risk (RR 1.12), while those who slept more had a 30% higher risk (RR 1.30). Another pooled study that grouped participants by sleep duration found the lowest risk among those getting exactly 7 hours of sleep. For every hour slept under 7 hours, risk rose by 6% (RR 1.06); for every hour over 7 hours, risk rose by 13% (RR 1.13). Data from the UK Biobank, which tracked over 61,000 participants using wrist-worn monitors, also showed that when people were divided into 5 groups based on sleep regularity, the four groups with more consistent schedules had a 20–48% lower mortality risk than the least regular group. This confirms that sleep regularity is a stronger predictor of death risk than total sleep duration. A further UK Biobank study that tracked sleep timing for 51,562 participants found 3,853 new cases of cardiovascular disease over the study period. Social jetlag — the difference between average weekday and weekend bedtime — also plays a role: people with a social jetlag of 2 hours or more had a 30% higher risk of cardiovascular disease (HR 1.30, 95% CI 1.11–1.54). This link remained evident even among people getting a normal amount of sleep. +- Evidence grade: A +- Sources:Cappuccio FP 等 (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. ；Yin J 等 (2017). Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. JAHA. ；Windred DP 等 (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep. ；Kumar N, Krishnamurthy S (2026). Social jet lag is associated with incident cardiovascular disease independent of sleep duration and cardiac genetic risk. Journal of Internal Medicine. +- Notes: The main issues to address are getting too little sleep and having an irregular schedule; there is no need to deliberately cut back on total sleep time. The higher risk seen in people who sleep more is likely due to reverse causation: depression, chronic illnesses, and sleep apnea all tend to lead to longer sleep duration. Currently, only two longitudinal studies support the link between sleep regularity and lower mortality risk; both simply recorded data without grouping participants, so this evidence is classified as grade B on its own. For guidance on how to catch up on sleep after staying up late, see Section 39 of this chapter. +### 14. A total of 150–300 minutes of moderate-intensity exercise per week, such as brisk walking, is sufficient. + +- Cost: It costs nothing. You only need 20–45 minutes each day. The real challenge is sticking with it over the long term. +- In plain terms: People who walk briskly for 150–300 minutes each week have a mortality risk roughly 30% lower than those who don’t exercise at all. Even if they fall short of that amount, their risk is still about 20% lower. When they reach 3–5 times that volume, the risk drops to its minimum level — about 40% lower. Exceeding that amount further won’t lower the risk any more, but it certainly won’t hurt either. +- Benefit: When multiple observational studies are pooled together (without subgroup analysis), individuals whose activity levels reached 1–2 times the recommended minimum had a mortality risk roughly 31% lower than non-exercisers (HR 0.69). This amount corresponds to 7.5–15 MET·hours per week, or about 150–300 minutes of brisk walking weekly. Those who failed to meet the minimum still saw a 20% reduction in risk (HR 0.80). For those whose activity levels reached 3–5 times the minimum, the risk dropped to its peak level — about 39% lower (HR 0.61). Any further increase did not yield additional benefit, though it remained harmless (at 10 times the minimum, HR was still 0.69). Another pooled analysis based on accelerometer measurements found that the top quarter of participants with the highest levels of moderate-to-vigorous activity had a mortality risk roughly 48% lower than the bottom quarter (HR 0.52). Accelerometers are wearable devices used to measure actual physical activity levels. +- Evidence grade: A +- Sources:Arem H 等 (2015). Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine. ；Ekelund U 等 (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. +- Notes: You can choose either this recommendation or Recommendation 11 (which suggests walking 7,000–8,000 steps daily). Keep in mind that these studies are purely observational in nature. The studies relying on accelerometer measurements have relatively short follow-up periods and include a higher proportion of older participants; they also contain some bias related to reverse causality — i.e., individuals who were already ill may have become less active. Therefore, the real benefit is somewhat smaller than the apparent reduction of mortality risk to 0.52 times the baseline level. +### 15. Playing racket sports three times a week for 45 minutes each session + +- Cost: The cost of court fees is typically several dozen yuan per session. This amounts to roughly 2 hours of activity per week. The main challenge is arranging enough participants and securing a court, plus maintaining a regular weekly schedule. +- In plain terms: People who regularly play tennis, badminton, or table tennis have roughly half the risk of dying during the same period compared to non-players. Their risk of cardiovascular death is about 56% lower. For swimmers, the reduction is roughly 28%. No significant difference was observed between runners and football players in these statistics. +- Benefit: A UK-based longitudinal study involving 80,300 participants compared individuals who engaged in specific sports with those who did not. Those who played racket sports had a 47% lower risk of death overall (hazard ratio 0.53, 95% CI 0.40–0.69). Their risk of cardiovascular death was reduced by about 56% (hazard ratio 0.44, 95% CI 0.24–0.83). Racket sports include tennis, badminton, and table tennis. For swimmers, these figures were 0.72 and 0.59 respectively; for aerobic exercise they were 0.73 and 0.64, and for cycling 0.85. No statistically significant differences were found between runners and football players. +- Evidence grade: A +- Sources:Oja P, Kelly P, Pedisic Z, et al. (2017). Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults. British Journal of Sports Medicine, 51(10), 812-817. +- Notes: This finding is somewhat controversial. Such studies merely track participants over time; people who play sports tend to be healthier and more socially active overall. The lack of difference seen among runners also suggests that individual characteristics may influence which sports people choose. This does not mean running is ineffective — separate entries in this section consider total weekly exercise volume. +### 16. Accumulating brief bouts of strenuous activity like stair-climbing and brisk walking to total four to five minutes per day + +- Cost: There is no cost involved, nor is any extra workout time required. The difficulty lies in remembering to climb stairs and walk briskly instead of taking shortcuts. +- In plain terms: For people who normally do no exercise at all, simply engaging in three brief bouts of strenuous activity lasting one to two minutes each per day reduces their overall risk of death by roughly 40% compared to those who do none at all. Their risk of cardiovascular death also drops by nearly half. Such strenuous activities include stair-climbing, brisk walking, and similar efforts. +- Benefit: A study conducted by the UK Biobank involved 25,200 participants who did not regularly exercise. After an average follow-up period of 6.9 years, 852 participants passed away. Those who performed three short bursts of intense activity daily, each lasting 1–2 minutes, saw their overall mortality risk and cancer-related death risk drop by 38%–40% relative to those who did no such activity. Their risk of cardiovascular death decreased by 48%–49%. Even individuals who accumulated just 4.4 minutes of such activity daily experienced a 26%–30% reduction in mortality and cancer death risks, as well as a 32%–34% drop in cardiovascular death risk. +- Evidence grade: A +- Sources:Stamatakis E, Ahmadi MN, Gill JMR, et al. (2022). Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nature Medicine, 28, 2521-2529. +- Notes: This finding is somewhat controversial. While this study utilized wearable devices to accurately measure activity levels, making it more reliable than self-reported questionnaire data, it still relied solely on observational tracking rather than controlled randomized trials, and the follow-up period was only 6.9 years. Moreover, these results apply only to individuals who currently do not engage in regular exercise; they are not applicable to those already following a consistent exercise routine. +### 17. Doing 30–60 minutes of strength training per week + +- Cost: Bodyweight squats and push-ups cost nothing. Aim for 1–2 sessions per week, each lasting 20–30 minutes. The real challenge is fitting this into your weekly schedule. +- In plain terms: People who perform 30–60 minutes of strength training each week have a 10–20% lower risk of dying during that period compared to those who don’t train. Training beyond this amount won’t bring any extra benefit. Combining strength and aerobic exercise yields the best results. +- Benefit: When multiple longitudinal studies are pooled together (without subgroup analysis), individuals who engage in strength training show a 10%–17% reduction in mortality risk relative to non‑trainers. The greatest drop — roughly 10%–20% — occurs at around 30–60 minutes of weekly training; more time does not further lower risk. Those who also do aerobic exercise enjoy an even lower mortality rate than those who do neither type of activity. +- Evidence grade: A +- Sources:Momma H 等 (2022). Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. +- Notes: These studies merely track participants over time, and the reported exercise amounts are self‑reported. The evidence supporting the claim that “excessive training can be detrimental” is very weak, so there’s no need to cap training volume for that reason. For older adults, strength training also helps prevent falls and preserve muscle mass; those benefits are discussed in Section 1. +### 18. Don’t sit for too long at a time — get up and move every now and then + +- Cost: It costs nothing; getting up a few times doesn’t take much time at all. The hard part is that once you sit down, you tend to lose track of time, so you’ll need a reminder. +- In plain terms: People who sit the longest have a 2.6 times higher risk of dying during the same period compared to those who sit the least. Sitting continuously for long stretches also adds extra risk. However, if you get 60–75 minutes of moderate-intensity activity each day, this extra risk from prolonged sitting is largely offset. +- Benefit: A U.S. observational study used accelerometers to measure activity levels without grouping participants. It divided people into four groups based on total daily sitting time; those in the group with the most sitting had a 2.63 times higher mortality risk than the group with the least (HR 2.63). When grouped by duration of each continuous sitting session, the group with the longest sessions had a 1.96 times higher risk than the group with the shortest sessions (HR 1.96). This shows that both total daily sitting time and duration of each session are independently linked to risk. Another meta-analysis of millions of participants also found that people who sat for over 8 hours daily and did little to no exercise had a 1.59 times higher mortality risk compared to those who sat for under 4 hours and were most active (HR 1.59). Even among the most active group, those who sat over 8 hours daily still had an HR of only 1.04, showing no statistically significant difference. +- Evidence grade: A +- Sources:Diaz KM 等 (2017). Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Annals of Internal Medicine. ；Ekelund U 等 (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. +- Notes: The key takeaway is that how much you move matters more than how long you sit; sufficient physical activity essentially eliminates the extra risk from prolonged sitting. Keep in mind that these studies are purely observational, so many of the people who sat the most were already unwell — the “2.63 times higher risk” partly reflects this pre-existing health condition. Additionally, the same meta-analysis found that watching TV for over 3 hours daily increased risk across all activity levels; for the most active group, this threshold rose to 5 hours. +### 19. Eat less processed meat (ham, bacon, sausages, luncheon meat) + +- Cost: It costs nothing — in fact, it saves money — and takes no extra time. The hard part is simply eating less of a food you enjoy. +- In plain terms: People who eat the most ham, bacon, and sausages have a roughly 20% higher chance of dying during the same period than those who eat the least. For every extra serving of processed meat consumed daily, that risk rises by another 20%. +- Benefit: When multiple long‑term studies are pooled together (without separating participants into groups), the group eating the most processed meat faces about a 23% higher death risk compared to the group eating the least (RR 1.23). For all red meat combined, the increase is about 29% (RR 1.29). Unprocessed red meat raises the risk by roughly 10% (RR 1.10), though this difference does not reach statistical significance. Another synthesis looks at daily intake: each extra daily serving of processed meat adds about a 23% higher death risk (RR 1.23), while each extra serving of red meat adds about 10% (RR 1.10). +- Evidence grade: A +- Sources:Larsson SC, Orsini N (2014). Red meat and processed meat consumption and all-cause mortality: a meta-analysis. American Journal of Epidemiology. ；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. ；Johnston BC 等 (2019). Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the NutriRECS Consortium. Annals of Internal Medicine. （争议方 NutriRECS 指南） +- Notes: This is a contentious topic. The NutriRECS guidelines apply the standard GRADE evidence‑rating system and deem these studies “moderately reliable.” They offer only a very weak recommendation: “continue eating as you currently do.” The debate centers on whether the evidence is strong enough, not on the overall direction of the findings. No studies have shown any benefit from eating processed meat, and the effect of unprocessed red meat appears minimal and statistically insignificant. The focus should be on cutting back on processed meat. +### 20. Drink less or no alcohol + +- Cost: There is no cost at all — it saves money and time. The only difficulty is handling social pressure to drink in gatherings. +- In plain terms: After consuming 100 g of pure alcohol per week (roughly 2.5 L of beer), the more you drink, the earlier you are likely to die. For people aged 40, those drinking 100–200 g per week lose about half a year of life expectancy; those drinking 200–350 g lose 1–2 years; and those drinking over 350 g lose 4–5 years. Overall, the healthiest choice is to abstain completely. A total of 64 drinkers were included in these analyses. +- Benefit: A pooled analysis of 83 longitudinal studies involving 600,000 drinkers shows that the lowest mortality risk occurs at a weekly intake of no more than 100 g of pure alcohol — equivalent to about 2.5 L of beer or 300 mL of 40% alcohol. At this level, 40-year-olds lose roughly 6 months of life expectancy; higher intakes lead to greater losses. The Global Burden of Disease Study 2016 also identifies zero alcohol consumption as the safest level. One adjusted analysis found that daily intake of 1.3–24 g of alcohol is linked to a 7% lower mortality risk (RR 0.93), while intakes above 65 g per day increase risk by 35% (RR 1.35). +- Evidence grade: A +- Sources:Wood AM 等 (2018). Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. ；GBD 2016 Alcohol Collaborators (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. ；Zhao J 等 (2023). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open. ；Di Castelnuovo A 等 (2006). Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Archives of Internal Medicine. （争议方） +- Notes: This topic remains debated. One major review of 34 long-term studies suggests that moderate drinking can reduce overall mortality by up to 17–18% for men drinking up to 4 drinks per day and women up to 2. Critics argue that non-drinkers in such studies often include people who quit drinking due to illness or who were already in poor health; when these factors are accounted for, any protective effect disappears. The safest interpretation is that moderate drinking offers little benefit, while excessive drinking clearly harms longevity. There is no evidence to support starting to drink for health reasons. For tips on cutting back, see Section 22; those already drinking daily should not attempt to quit abruptly — see Section 21 for guidance. +### 21. People who drink daily and experience tremors and palpitations when they stop should not try to quit on their own + +- Cost: Seeing a psychiatrist or addiction specialist costs just a few to several dozen dollars. In severe cases, a short hospital stay may be required. +- In plain terms: Individuals who consume large amounts of alcohol every day can suffer from withdrawal symptoms if they suddenly stop. Mild cases involve tremors, sweating, palpitations, and insomnia; severe cases may lead to seizures or delirium tremens — a life-threatening emergency. A Norwegian study of over 30,000 participants found that 8% of those who had experienced delirium tremens died each year thereafter. Anyone wanting to quit should first consult a doctor and clearly describe their daily alcohol intake. +- Benefit: A 2026 clinical review confirms that chronic heavy drinkers often develop withdrawal syndrome after abruptly cutting back or stopping entirely. Symptoms include tremors, autonomic hyperactivity, anxiety, insomnia, perceptual disturbances, seizures, and delirium tremens — conditions that are both common and potentially fatal in general medical practice. Norway’s national registry included 36,287 individuals diagnosed with alcohol dependence, withdrawal states, or delirium tremens between 2009 and 2015. The annual mortality rate was 8.0% among those with delirium tremens, 5.0% among those in withdrawal states, and 3.6% among those with alcohol dependence. The standardized mortality ratio for the delirium tremens group was 9.8 (95% CI 8.9–10.7), meaning their risk of death was roughly 9.8 times higher than that of age-matched peers in the general population. +- Evidence grade: B +- Sources:Caputo F, Lungaro L, Costanzini A, De Giorgio R, Addolorato G (2026). Alcohol withdrawal syndrome in hospitalized patients: a practical review. European Journal of Internal Medicine, 107103. ；Bramness JG, Heiberg IH, Høye A, Rossow I (2023). Mortality and alcohol-related morbidity in patients with delirium tremens, alcohol withdrawal state or alcohol dependence in Norway: A register-based prospective cohort study. Addiction, 118(12), 2352–2359. +- Notes: How to tell if you’re at risk: If you drink almost every day, experience tremors, sweating, palpitations, or insomnia when you skip a day, or feel better after having a drink in the morning, you should not attempt to quit on your own. Standard medical treatment involves using benzodiazepines to manage the initial withdrawal period while also supplementing thiamine (vitamin B1). This evidence is rated B because the Norwegian cohort data describe outcomes among people who had already suffered delirium tremens rather than directly testing the effects of self-directed abstinence. Quitting alcohol remains essential; the safer approach is to seek professional medical help. For guidance on what constitutes “frequent” drinking, see section 20; strategies for reducing intake are outlined in section 22. +### 22. To drink less, first tally how much you drink each week, then chat briefly with a doctor + +- Cost: No cost at all. Simply count the number of drinks each day and jot it down. Asking your doctor about it during a routine visit costs nothing extra. +- In plain terms: A doctor can spend a few minutes reviewing your drinking habits, explaining the risks, and helping you set a goal. After a year, people following this approach typically cut their weekly alcohol intake by about 20 grams of pure alcohol — roughly half a liter of beer. Longer consultations don’t bring any added benefit. For those already struggling to quit, two medications have proven effective abroad: for every 12 patients treated, roughly one additional person manages to avoid heavy drinking. +- Benefit: Data from 34 randomized trials involving 15,197 participants show that individuals receiving brief interventions ended up drinking 20 grams less pure alcohol per week after a year compared to those receiving minimal or no intervention (95% CI: 12–28 grams; moderate-quality evidence). The average baseline consumption in these studies was 244 grams per week. “Brief interventions” here refer to no more than five sessions totaling under 60 minutes of advice or lifestyle counseling; longer sessions provide no further advantage. Regarding medications, 122 trials with 22,803 participants indicate that acamprosate helps one additional person per 12 treated avoid any alcohol use altogether (95% CI: 8–26). Oral naltrexone at 50 mg daily similarly yields one additional non-heavy drinker per 12 patients (95% CI: 8–26). +- Evidence grade: A +- Sources:Kaner EF, Beyer FR, Muirhead C, et al. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2, CD004148. ；Jonas DE, Amick HR, Feltner C, et al. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889–1900. +- Notes: The benefit is classified as “small” because both sets of data track alcohol consumption rather than mortality; per our guidelines, outcomes based on surrogate endpoints receive this rating. The medication trials were conducted primarily abroad, with most participants meeting criteria for alcohol dependence and receiving psychosocial support alongside drug therapy; the figures represent extra benefits achieved on top of those standard treatments. Availability and prescription of these drugs in China depend on individual doctors and official labeling — do not purchase them online without medical guidance. Anyone experiencing withdrawal symptoms should refer to section 21; do not attempt to quit abruptly on your own. +### 23. Eating a small handful of nuts daily + +- Cost: Consuming 28 grams per day costs roughly 200–300 yuan annually. It’s easy to fit into your routine without taking extra time. +- In plain terms: People who regularly eat nuts have about 20% lower mortality risk compared to those who don’t. Even eating nuts just once a week yields a roughly 10% reduction in risk. The greatest benefit is seen when nuts are consumed daily. +- Benefit: Two large U.S. studies tracked over 119,000 participants for several years, totaling more than 3 million person-years. Compared to non-nut eaters: individuals consuming nuts less than once a week saw a 7% lower risk of death (hazard ratio 0.93, 95% CI 0.90–0.96). Those eating nuts once a week had a 11% lower risk (0.89, 0.86–0.93). For consumption of 2–4 times weekly, the reduction was 13% (0.87, 0.83–0.90). Those eating nuts 5–6 times weekly saw a 15% drop (0.85, 0.79–0.91), while daily consumption resulted in a 20% lower risk (0.80, 0.73–0.86). +- Evidence grade: A +- Sources:Bao Y, Han J, Hu FB, et al. (2013). Association of nut consumption with total and cause-specific mortality. New England Journal of Medicine, 369(21), 2001-2011. +- Notes: Choose plain, unsalted nuts. Although nutritious, nuts are calorie-dense, so avoid eating them in excess as snacks. Keep in mind these studies only track long-term trends; nut eaters generally maintain healthier lifestyles overall, so these figures should be interpreted with some caution. +### 24. Swapping some red meat for fish and poultry + +- Cost: There’s no extra cost or time involved. You’re simply replacing one type of meat with another, not buying more. The real challenge is adjusting your taste preferences. +- In plain terms: Eating two extra servings of processed or red meat each week raises the risk of death by roughly 3% compared to eating the same amount of fish or poultry. This effect is relatively small within this section, so it’s an easy swap to make without much effort. +- Benefit: This conclusion comes from combining data from six U.S. studies involving nearly 30,000 participants. Consuming two extra servings of processed meat weekly increases mortality risk by about 3% (hazard ratio 1.03, 95% CI 1.02–1.05). The same increase applies to unprocessed red meat (1.03, 1.01–1.05). However, switching to poultry or fish shows no significant change: hazard ratios of 0.99 (0.97–1.02) and 0.99 (0.97–1.01) respectively. +- Evidence grade: A +- Sources:Zhong VW, Van Horn L, Greenland P, et al. (2020). Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality. JAMA Internal Medicine, 180(4), 503-512. +- Notes: The impact of swapping two weekly servings of meat is minimal, so don’t expect a major lifespan boost from this change. If you’re already spending money on meat, fish and poultry are the better choices. +### 25. Swap some refined rice and flour for whole grains + +- Cost: Whole grain options like brown rice, oats, and whole wheat flour cost slightly more than refined varieties and require no extra prep time. The main challenge is adjusting to their different taste and texture. +- In plain terms: People who eat an extra 90 g of whole grains daily have a roughly 17% lower risk of dying over the same period. That amount equals about three servings. The risk continues to drop when intake rises to around 200 g per day. +- Benefit: Pooled data from multiple observational studies (no participant grouping used) shows that adding 90 g of whole grains daily cuts mortality risk by roughly 17% (RR 0.83). This effect holds true up to 210–225 g per day. Another pooled analysis found an 8% lower risk per extra daily serving (RR 0.92). +- Evidence grade: A +- Sources:Aune D 等 (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ. ；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. +- Notes: You do not need to replace all refined grains with whole grains — swapping just half delivers the bulk of these benefits. Keep in mind these studies are observational, so participants eating more whole grains tend to be healthier overall, which may inflate the reported effect sizes. Results across individual studies also vary widely (I² 83%, a high value indicating substantial inconsistency between study conclusions). +### 26. Drinking tea three or more times per week + +- Cost: It costs just a few dozen to a few hundred yuan per year. Brewing a cup takes only a few minutes, so it doesn’t take up much time at all. +- In plain terms: People who regularly drink tea have a roughly 15% lower risk of dying over the same period. Starting at age 50, they can expect to live 1.26 extra years on average, and 1.41 extra years without suffering from any atherosclerotic cardiovascular diseases. +- Benefit: One large study in China, called China-PAR, involved over 100,900 participants, with half of them followed for 7.3 years. Those with a regular tea-drinking habit had a 15% lower risk of death (hazard ratio 0.85, 95% CI 0.79–0.90, which is a reliable range). Starting at age 50, these individuals gain 1.41 extra years free from atherosclerotic cardiovascular diseases, and 1.26 extra years of total life expectancy. +- Evidence grade: A +- Sources:Wang X, Liu F, Li J, et al. (2020). Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project. European Journal of Preventive Cardiology, 27(18), 1956-1963. ；茶叶霉菌毒素：Cui P 等 (2020). Quantitative analysis and dietary risk assessment of aflatoxins in Chinese post-fermented dark tea. Food and Chemical Toxicology. ；Zhou H 等 (2022). Mycotoxins in Tea (Camellia sinensis (L.) Kuntze): Contamination and Dietary Exposure Profiling in the Chinese Population. Toxins. ；绿茶提取物与肝损伤：Hu J 等 (2018). The safety of green tea and green tea extract consumption in adults - Results of a systematic review. Regulatory Toxicology and Pharmacology. +- Notes: There are some caveats to keep in mind: this type of study is purely observational, and Chinese men who drink tea tend to smoke and drink more than average. The researchers have accounted for some of these factors, but not all. Also, never drink tea that is piping hot — please refer to the section on hot drink temperatures for more details. Some people worry about mycotoxins in tea; a test of 158 batches of dark tea found aflatoxin in just 2 of them, and the amount consumed via normal tea intake stays well under internationally accepted limits. Another study examined 352 tea samples for 16 different mycotoxins, and only ochratoxin A in dark tea exceeded the legal limit on average. Even accounting for typical Chinese tea consumption levels, neither study found any dietary risk. Always store tea in a dry place, and discard any batches that have become damp or moldy. Tea extract capsules are a different story: taking large doses of concentrated catechins at one time can damage the liver, but this is not a risk when drinking brewed tea. Therefore, all the benefits mentioned here apply only to brewed tea — do not replace regular tea with extract supplements. +### 27. Drinking three to four cups of coffee daily, without sugar or cream + +- Cost: Making coffee at home costs just one or two yuan per day. It takes only a few minutes to brew each cup, so it doesn’t take much time at all. +- In plain terms: People who drink three to four cups of coffee each day have a roughly 17% lower risk of dying during the same period compared to those who don’t drink coffee. +- Benefit: One review combined results from 201 separate studies. All of these original studies simply recorded outcomes without grouping participants. The overall finding was that drinking 3–4 cups of coffee daily lowered mortality risk by 17% compared to non‑drinkers (relative risk 0.83, 95% CI 0.79–0.88; this is a reliable range). +- Evidence grade: A +- Sources:Poole R, Kennedy OJ, Roderick P, et al. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ, 359, j5024. +- Notes: There is some debate here: the authors note that almost all evidence comes from observational tracking studies and state that “reliable randomized controlled trials are needed to confirm a causal relationship.” In other words, participants must be randomly assigned to groups for a true cause‑and‑effect conclusion. For this benefit to apply, coffee should be consumed black; adding sugar or cream cancels out these advantages. This recommendation does not apply to pregnant women or people with arrhythmia, anxiety, or insomnia. +### 28. Eating 5 servings (about 400 g) of fruits and vegetables daily + +- Cost: It costs only a few to a dozen yuan per day. You’ll also need some time each day to wash and cut them. The real challenge is making sure to buy and eat the required amount every single day. +- In plain terms: Consuming an extra 200 g of fruits and vegetables each day lowers the overall risk of death by roughly 10% over time. People who eat 5 servings daily have a 13% lower risk of death compared to those who eat just 2 servings. Eating more than 5 servings does not bring any further risk reduction. +- Benefit: When pooling data from multiple observational studies (without subgroup analysis), an extra 200 g of fruits and vegetables daily reduces mortality risk by about 10% (RR 0.90). This protective effect remains consistent up to 800 g per day. A combined analysis of two large US cohort studies and 26 other studies shows that those eating 5 servings daily have a 13% lower mortality risk than those eating only 2 servings (HR 0.87). The optimal combination is 2 servings of fruit and 3 servings of vegetables; any extra servings beyond that do not provide additional benefit. +- Evidence grade: A +- Sources:Aune D 等 (2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology. ；Wang DD 等 (2021). Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. +- Notes: It is sufficient to eat 5 servings daily — there is no need to reach 10 servings, as both studies agree on this point. Keep in mind that these studies are purely observational, so they are prone to confounding factors: people who eat more fruits and vegetables tend to have higher incomes, better education levels, and engage in more physical activity. Therefore, the reported 10% risk reduction represents an upper limit estimate. +### 29. Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals) + +- Cost: There’s no direct cost involved, though you’ll need to spend time either preparing meals yourself or selecting minimally processed ingredients each day. The real challenge is overcoming the long-standing habit of opting for convenience over health. +- In plain terms: People who consume the most ultra-processed foods have roughly a 20% higher risk of dying during the same period compared to those who eat the least, and a 50% higher risk of dying from cardiovascular disease. However, this evidence is rated as fairly uncertain, so these figures should be treated as rough estimates. +- Benefit: One review combined multiple existing studies into a single analysis, using raw data without any subgroup categorization. The results showed that individuals consuming higher amounts of ultra-processed foods had a 21% greater risk of death (RR 1.21) and a 50% greater risk of cardiovascular death (RR 1.50) compared to those eating less of these foods. These findings were classified as “highly suggestive” and “convincing” respectively. Yet when assessed using standard GRADE criteria, the overall certainty of the evidence is rated as low or very low. +- Evidence grade: A +- Sources:Lane MM 等 (2024). Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. +- Notes: There are three main points of contention here. First, the NOVA classification system groups foods with vastly different nutritional profiles into the same category. Second, ultra-processed foods overlap heavily with sugary drinks and processed meats (discussed in items 7 and 19), making it hard to isolate which factor is having the actual effect. Third, GRADE ratings for this evidence also remain low. Consequently, it’s hard to predict exactly how much additional benefit this recommendation will provide after following items 7 and 19. The opposing evidence comes solely from the low GRADE rating given in this same review; no original studies have yet produced contradictory results. For now, it’s best to first adhere to items 7 and 19 — avoiding sugary drinks and limiting processed meat intake — before focusing on this recommendation. +### 30. Switching from coal and wood to electricity or gas for cooking and heating + +- Cost: Rural households need to replace their stoves and also pay higher fuel costs; this adds up to several hundred to over a thousand yuan per year. The switch is a one-time effort and doesn’t require ongoing time investment. In cities, most households already use electricity or gas. +- In plain terms: People who cook using coal or wood face roughly a 10% higher chance of dying over the same period compared to others; those who heat their homes this way have a roughly 14% higher risk. Those who have already switched to electricity or gas have a 13%–33% lower mortality risk than those still relying on coal and wood. +- Benefit: One Chinese study followed 271,000 adults without cardiovascular disease, recording their health outcomes without grouping them by lifestyle. People who cooked using solid fuels such as coal or wood had an 11% higher risk of death compared to those using electricity or gas (HR 1.11). Those who used solid fuels for heating faced a 14% higher risk (HR 1.14). Among people who had switched from solid fuels to cleaner alternatives, the risk dropped by 13% for cooking (HR 0.87) and by 33% for heating (HR 0.67). Separate data also show that for every 10 µg/m³ increase in long-term exposure to outdoor PM2.5, the risk of death from natural causes rises by about 8% (RR 1.08). In total, 104 studies were analyzed for this conclusion. Natural causes refer to deaths not caused by accidents. +- Evidence grade: A +- Sources:Yu K 等 (2018). Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA. ；Chen J, Hoek G (2020). Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environment International. +- Notes: These studies merely track health outcomes over time. Households that switch to cleaner fuels are often wealthier, so part of the observed 0.67-fold reduction in risk is likely linked to socioeconomic factors. Regarding outdoor PM2.5, individuals have limited options — moving to a cleaner area, wearing masks, or using air purifiers. There are no studies evaluating air purifiers based on mortality rates, so no specific figures are provided here. +### 31. Let hot drinks cool down a bit before drinking; avoid tea, soup, and coffee that are piping hot + +- Cost: No money is required; you just need to wait two to three extra minutes each time. The hard part is resisting the urge to drink when you’re craving a hot beverage. +- In plain terms: Drinking tea that is very hot raises your risk of esophageal cancer by 8 times compared to drinking lukewarm tea. Even tea that is just “hot” doubles the risk. If you drink tea less than two minutes after pouring it, your risk is 5 times higher than if you wait at least four minutes to drink it. +- Benefit: In a high-risk region for esophageal cancer in northern Iran, researchers compared 300 patients with esophageal cancer to 571 healthy individuals. All results below are compared against people who drank lukewarm tea. Those who drank “hot” tea had roughly 2.07 times the risk of developing squamous cell carcinoma of the esophagus (95% CI: 1.28–3.35). For people who drank “very hot” tea, the risk was about 8.16 times higher (95% CI: 3.93–16.9). Those who drank tea less than two minutes after pouring it had 5.41 times the risk of developing the disease compared to people who waited at least four minutes to drink it (95% CI: 2.63–11.1). +- Evidence grade: A +- Sources:Islami F, Pourshams A, Nasrollahzadeh D, et al. (2009). Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ, 338, b929. ；Loomis D, Guyton KZ, Grosse Y, et al. (2016). Carcinogenicity of drinking coffee, mate, and very hot beverages. Lancet Oncology, 17(7), 877-878. +- Notes: The International Agency for Research on Cancer classifies hot drinks above 65°C as Group 2A carcinogens, meaning they are “probably carcinogenic to humans.” The same assessment also confirms that coffee itself is not carcinogenic. In China, high rates of esophageal cancer in regions like Chaoshan and the Taihang Mountains are strongly linked to the habit of drinking beverages while they are still very hot. +### 32. Getting some sun during the day — don’t stay out of the light all the time + +- Cost: No cost at all. Just a few minutes each day — on your commute or during lunch breaks is enough. +- In plain terms: Women who deliberately avoid sunlight can expect to live 0.6 to 2.1 years less than those who get the most sun exposure. Even non-smokers who avoid the sun tend to have a life expectancy similar to smokers who get plenty of sun. +- Benefit: A Swedish study followed 29,500 women for 20 years. Compared to the group getting the most sun, those who avoided it ended up living 0.6 to 2.1 years less. The authors noted that “non-smoking women who avoid sunlight have a life expectancy comparable to smokers who get the most sun exposure.” +- Evidence grade: B +- Sources:Lindqvist PG, Epstein E, Nielsen K, et al. (2016). Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. Journal of Internal Medicine, 280(4), 375-387. +- Notes: There are some caveats: Sweden’s high latitude and limited sunlight mean these findings may not directly apply to China. It’s also possible that people avoiding sun tend to be less physically active or prefer staying indoors. Also, avoid sunburn — use protection under strong midday sun, since excessive exposure raises skin cancer risk. +### 33. Keep BMI between 20–25; lose weight if you’re overweight + +- Cost: No monetary cost. However, diet and exercise require daily time and effort. This is the toughest guideline in the whole chapter: maintaining weight loss is harder than losing it in the first place. +- In plain terms: Mortality is lowest when BMI falls within 20–25. At BMI 27.5–30, risk rises by roughly 20%; at 30–35, it climbs by about 45%; at 35–40, it nearly doubles. East Asians are especially sensitive to excess weight — for every 5‑unit increase in BMI, risk rises by roughly 40%. +- Benefit: Data from 239 longitudinal studies were pooled and analyzed (no subgrouping was performed). Only three groups remained in the final analysis: non‑smokers, individuals without chronic disease at enrollment, and those who survived at least five years after joining the study. Results showed that mortality risk was lowest at BMI 20–25. Between 25–27.5, risk increased by about 7% (HR 1.07); at 27.5–30, by roughly 20% (HR 1.20); at 30–35, by about 45% (HR 1.45); at 35–40, by nearly 94% (HR 1.94); and at 40–60, it was 2.76 times higher (HR 2.76). For East Asians, each additional 5 kg/m² of BMI raised risk by about 39% (HR 1.39). +- Evidence grade: A +- Sources:Global BMI Mortality Collaboration (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. ；Flegal KM 等 (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. （争议方） +- Notes: This topic remains controversial. Some researchers argue that being slightly overweight actually extends lifespan; their pooled data show a roughly 6% lower mortality risk for overweight individuals and a 5% reduction for those with mild obesity. The main disagreement centers on whether to exclude three types of data: smokers, patients already suffering from disease, and participants in the first few years after enrollment. Those groups are excluded because severely ill patients tend to lose weight first. After removing these three categories from the analysis of 239 studies, the elevated mortality risk associated with excess weight reappears. It is also important to note that no randomized trials have proven that weight loss itself lowers overall mortality. The benefits described above result from comparing people of different weights, not from a guarantee that losing weight will produce those exact reductions. Those aiming to lose weight need not obsess over meal timing; neither breakfast nor the 16:8 intermittent fasting regimen offers any extra advantage — see Section 6, Item 26 for details. +### 34. Eating chili peppers more than four times a week + +- Cost: There is no cost and it doesn’t take any extra time. +- In plain terms: People who eat chili peppers more than four times a week have a roughly 23% lower chance of dying during the same period compared to those who rarely eat them; their risk of dying from cardiovascular causes is about one-third lower. +- Benefit: One Italian study followed 22,800 people for an average of 8.2 years; 1,236 participants died over that time. Those who ate chili peppers four or more times a week had a 23% lower risk of death than those who rarely ate them (hazard ratio 0.77, 95% CI 0.66–0.90). Their risk of cardiovascular death was also about 34% lower (HR 0.66, 95% CI 0.50–0.86). +- Evidence grade: B +- Sources:Bonaccio M, Di Castelnuovo A, Costanzo S, et al. (2019). Chili Pepper Consumption and Mortality in Italian Adults. Journal of the American College of Cardiology, 74(25), 3139-3149. +- Notes: There is some debate: this research was conducted within the context of a Mediterranean diet, so chili eaters may simply follow a diet that aligns more closely with local traditional eating habits. Additionally, people with gastroesophageal reflux, hemorrhoids, or irritable bowel syndrome may experience worsened symptoms from eating chili peppers; they don’t need to force themselves to eat it. +### 35. Drinking one or two servings of milk or yogurt daily + +- Cost: Only a few yuan per day; requires no extra time. +- In plain terms: People who consume two or more servings of milk or yogurt daily have a roughly 17% lower chance of dying during the same period compared to those who don’t drink any. +- Benefit: The PURE study followed 136,000 participants across 21 countries for an average of 9.1 years; 6,796 of them passed away. Those who ate two or more servings of dairy products daily faced a 17% lower mortality risk than non-consumers (hazard ratio 0.83, 95% CI 0.72–0.96). The statistical significance of this trend is confirmed by a P-value of 0.0052. +- Evidence grade: B +- Sources:Dehghan M, Mente A, Rangarajan S, et al. (2018). Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet, 392(10161), 2288-2297. +- Notes: There are some concerns: the PURE study included many participants from low- and middle-income countries, where regular milk consumption often reflects better household financial status, making it hard to rule out this confounding factor. Additionally, people with lactose intolerance can safely switch to yogurt or low-lactose milk instead of forcing themselves to drink regular milk. +### 36. Eggs don’t need to be avoided, but don’t eat three or four daily + +- Cost: No cost and no extra time required. +- In plain terms: Eating an extra half whole egg each day raises the overall mortality risk by roughly 7%. Swapping that half egg for egg whites, fish, poultry, or nuts actually lowers the risk of death across all categories. There’s no need to cut eggs out of your diet; just avoid consuming three or four daily. +- Benefit: A U.S. study tracking 521,000 people found that 129,000 participants died over time. Those eating an extra half whole egg daily had a 7% higher mortality risk (hazard ratio 1.07; 95% CI 1.06–1.08). Replacing that half egg with an equal amount of egg whites, poultry, fish, dairy, or nuts and legumes further reduced mortality risk, including risks related to cardiovascular disease, cancer, and respiratory conditions. +- Evidence grade: B +- Sources:Zhuang P, Wu F, Mao L, et al. (2021). Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study. PLoS Medicine, 18(2), e1003508. +- Notes: This topic remains controversial: other large-scale long-term studies and meta-analyses have found no link between egg consumption and mortality. The U.S. Dietary Guidelines have also removed the previous daily cholesterol limit. The key takeaway is to avoid eating three or four eggs daily; one egg per day poses no significant concern. +### 37. Take baths when you can — don’t limit yourself to showers + +- Cost: It costs more in water and electricity; each bath takes about half an hour. +- In plain terms: People who bathe almost daily have a roughly 28% lower risk of cardiovascular events and a roughly 46% lower risk of brain hemorrhage compared to those who bathe fewer than twice a week. +- Benefit: A Japanese study involving 30,000 participants followed for 19 years recorded 2,097 cardiovascular events. Those who bathed almost daily had about 28% lower risk of cardiovascular events than those who bathed no more than twice a week (hazard ratio 0.72, 95% CI 0.62–0.84). Their risk of coronary heart disease was about 35% lower (0.65, 0.45–0.94), risk of stroke about 26% lower (0.74, 0.62–0.87), and risk of brain hemorrhage about 46% lower (0.54, 0.40–0.73). +- Evidence grade: B +- Sources:Ukai T, Iso H, Yamagishi K, et al. (2020). Habitual tub bathing and risks of incident coronary heart disease and stroke. Heart, 106(10), 732-737. +- Notes: These results apply to the Japanese population and its bath culture; most Chinese households lack the conditions for daily baths. Also, water should not be too hot and baths should not last too long. For older adults and those with cardiovascular or cerebrovascular diseases, excessively hot water and prolonged bathing can actually be dangerous — Japan sees many elderly deaths in bathtubs each year. +### 38. Keep naps under 30 minutes — no longer than an hour. If you need a full hour or more to feel functional, it’s time to get checked out. + +- Cost: It costs nothing. Just set an alarm before you nap; it requires almost no willpower at all. +- In plain terms: People who nap for less than an hour show no increase in mortality or chronic disease risk, and their mental clarity actually improves. Those who nap longer than an hour face roughly a 30% higher risk of coronary heart disease, and about a 20% higher risk of diabetes and obesity. So set that alarm and wake up after half an hour. If you regularly need a full hour or more to get through the day, that’s a clear sign you should have a medical checkup. +- Benefit: One umbrella meta-analysis pooled data from 16 separate meta-analyses covering 244 health outcomes. The bottom line: people who nap fewer than 60 minutes experience no rise in overall mortality or chronic disease risk, and see the greatest gains in cognitive function (SMD 0.69, 95% CI 0.37–1.00 — a reliable range). Naps lasting 20–30 minutes produce the biggest improvements in physical performance (SMD 0.99, 95% CI 0.67–1.31). In contrast, naps exceeding 60 minutes raise coronary heart disease risk by roughly 30%, and diabetes and obesity risk by about 20%. Another study used wrist-worn monitors to track actual nap duration in 1,338 adults aged 56 and older, rather than relying on self-reported surveys. After up to 19 years of follow-up, 926 participants died. For every extra hour of napping, mortality risk rose by about 13% (HR 1.13, 95% CI 1.04–1.23). Each additional daily nap added roughly 7% to that risk (HR 1.07, 95% CI 1.02–1.13). Naps taken in the morning carried a roughly 30% higher risk compared to those taken earlier in the afternoon (HR 1.30, 95% CI 1.03–1.64). +- Evidence grade: B +- Sources:Du P, Li J, Hua Z, 等 (2026). Multiple Health Outcomes of Daytime Napping: A Comprehensive Umbrella Review. Public Health Reviews. ；Gao C, Cai R, Zheng X, 等 (2026). Objectively Measured Daytime Napping Patterns and All-Cause Mortality in Older Adults. JAMA Network Open. ；Dashti HS 等 (2021). Genetic determinants of daytime napping and effects on cardiometabolic health. Nature Communications. +- Notes: This topic remains controversial. Both of the major studies mentioned above merely recorded nap duration without stratifying participants by health status. People who habitually nap longer are more likely to suffer from sleep apnea, anemia, hypothyroidism, depression, or other chronic conditions; therefore it’s hard to isolate exactly how much of the observed mortality increase is directly attributable to napping itself. Mendelian randomization studies involving 453,000 and 541,000 participants respectively found only one consistent link: the more frequently someone naps, the slightly higher their blood pressure and waist circumference become. No causal effect on coronary heart disease or diabetes was identified. Consequently, “shortening naps” shouldn’t be promoted as a standalone strategy for lowering mortality. The recommendation to “get checked out” is an author‑suggested precaution; it falls under a lower‑grade evidence tier. If daytime fatigue forces you to nap for extended periods, first evaluate nighttime sleep quality — check for snoring or breathing pauses that might indicate sleep apnea — and then arrange routine blood tests and thyroid screening. For quick, effective energy boosts, see Section 3, Item 11 (a 10‑minute afternoon nap works best). Optimal nighttime sleep duration is discussed in Section 13 of this chapter (aim for 7 hours per night). +### 39. Catch up on sleep the night after a sleepless night — don’t wait until the weekend + +- Cost: No cost at all. Those extra hours of sleep you make up are exactly what you’d have wanted to get anyway. +- In plain terms: People who lose sleep one night and fail to make it up the following night have a roughly 15% higher risk of death compared to those with regular sleep patterns. For those who lose far more sleep and still don’t catch up, the risk rises by about 42%. No such increased risk is seen in people who do make up the lost sleep. So if you stay up late, go to bed early the next night. +- Benefit: This study used data from 85,618 UK Biobank participants, with an average age of 61.8 years. Wrist-worn monitors tracked their daily sleep, and they were followed for a median of 8 years. The researchers first identified each person’s individual sleep needs, then defined “sleep deficit nights” as nights when they got at least 2.5 hours less sleep than required. The first night after such a deficit was called a “catch-up night”, and if they got more sleep than needed that night, they were counted as having made up the deficit. Five distinct sleep patterns were identified based on this framework. Compared to people with regular sleep schedules, those who lost sleep and did not catch up had a 15% higher risk of all-cause death (HR 1.15, 95% CI 1.01–1.31, a reliable range). For those with a cumulative sleep deficit of over 3.5 hours who also failed to catch up, the risk rose by around 42% (HR 1.42, 1.24–1.63). No significant risk increases were found in the two groups who did make up their sleep deficit; for those who lost sleep but caught up, the HR was 1.12 (0.98–1.28). Among people who naturally get less sleep, those who lost sleep and did not make it up had a 19% higher risk (HR 1.19, 1.01–1.40), while those with a severe sleep deficit and no catch-up showed a 38% higher risk (HR 1.38, 1.17–1.63). These findings were replicated in a separate US health survey of 4,586 participants. +- Evidence grade: B +- Sources:Li X, Zhang M, Li Z, 等 (2026). Acute sleep rebound following sleep restriction is associated with reduced mortality risk. Nature Communications. +- Notes: This is an observational study with no formal grouping of participants. People who cannot make up lost sleep may simply be busier or in poorer health, and this factor cannot be fully ruled out. The fact that no risk increase was detected in the two groups who caught up only means no statistically significant difference was found; their point estimates remain above 1, so catching up does not completely eliminate risk. Therefore, if you lose sleep, you should make it up as soon as possible — but this does not give you a free pass to stay up late regularly. The “catch-up sleep” referenced here means getting extra sleep on the very first night after a deficit, not saving up multiple nights of sleep to make up all at once over the weekend. The practice of staying up on weekdays and sleeping in on weekends, which creates “social jetlag”, is linked to cardiovascular disease — see Section 13 (aim for around 7 hours of sleep per night with consistent schedules). The advice to wake up at the same time every day, including on weekends (Section 3, point 2), does not conflict with this tip: this recommendation only asks you to go to bed early the night after a sleepless night, not to sleep in until noon the next day. +### 40. The longer you work night shifts, the higher your cardiovascular risk — switch jobs if you can + +- Cost: Switching jobs or changing roles may mean a lower salary and the loss of night-shift allowances. Job hunting takes time and requires a firm decision. If you factor this cost in when choosing a job, it effectively becomes zero. +- In plain terms: People who work night shifts develop cardiovascular disease about 13% more often than those who don’t, and cardiovascular-related deaths are about 27% higher. The longer you work nights, the worse it gets: for every additional five night shifts, cardiovascular disease risk rises by roughly 7%. So, when you calculate this over years, it makes sense to switch jobs early on. As for cancer and night shifts, the evidence is far weaker than commonly believed. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer. +- Benefit: A pooled analysis of 23 studies — all observational, no subgrouping — shows that night-shift workers face a roughly 13% higher risk of cardiovascular events (RR 1.13, 95% CI 1.10–1.16). Cardiovascular-related deaths are about 27% higher (RR 1.27, 1.18–1.36). Over time, each extra five night shifts adds roughly 7% to cardiovascular disease risk (RR 1.07, 1.04–1.09) and about 5% to cardiovascular deaths (RR 1.05, 1.03–1.06). Specific conditions show similar trends: coronary heart disease incidence rises about 22% (RR 1.22, 1.16–1.28), as does coronary death risk (1.22, 1.10–1.36). Ischemic heart disease death risk climbs about 39% (1.39, 1.06–1.84), while stroke death risk increases about 49% (1.49, 1.04–2.12). Stroke incidence, however, shows no significant change (RR 1.06, 0.95–1.18). +- Evidence grade: A +- Sources:Xi J, Ma W, Tao Y, 等 (2025). Association between night shift work and cardiovascular disease: a systematic review and dose-response meta-analysis. Frontiers in Public Health. ；Esposito G, Bravi F, Santucci C, 等 (2025). Night shift work and breast cancer risk in healthcare workers: a systematic review and meta-analysis. Occupational Medicine. ；Shen QM, Li ZY, Tan YT, 等 (2026). Night shift work and risk of total and site-specific cancer: results from a prospective cohort study among Chinese men. Scandinavian Journal of Work, Environment & Health. ；Czeisler CA, Johnson MP, Duffy JF, 等 (1990). Exposure to bright light and darkness to treat physiologic maladaptation to night work. New England Journal of Medicine, 322(18), 1253-1259. +- Notes: All these studies are purely observational and do not adjust for key factors like smoking, weight, or income — differences that naturally exist between night-shift workers and others. Cancer and night shifts: the evidence is much weaker than popular belief suggests. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer. Not everyone must quit night shifts — you should weigh the yearly cost-benefit yourself. For those already working nights, several steps can help: quit smoking (see Section 1), control blood pressure and cholesterol (Section 12), and make up lost sleep properly (Section 39). Two additional strategies are worth trying: eat mainly during daytime hours and use bright light during shifts while strictly avoiding light at night to reset your circadian rhythm. The latter is the only proven method to shift circadian timing; ordinary indoor lighting leaves the rhythm unchanged even after six night shifts, but exposure to 7,000–12,000 lux during shifts plus near-total darkness by day can reset it in just four days. Crucially, bright nighttime light, strict daytime darkness, and wearing sunglasses on the way home are all essential — missing any one of them negates the effect. Neither strategy has been shown to lower cardiovascular risk; returning to a daytime routine on days off also resets the rhythm. Full details on exact figures, sources, and how the body tracks time can be found in [docs/生物钟和夜班.md](../../docs/生物钟和夜班.md). +### 41. Buy pre-packaged cooking oil with an SC number, not bulk homemade peanut oil from small workshops + +- Cost: Switching to such oil costs about the same. Just check whether the packaging shows a food production license number starting with “SC”. The real challenge is convincing older relatives who are used to buying homemade oil. +- In plain terms: When peanuts get damp and moldy, they produce aflatoxin — a known human carcinogen that mainly harms the liver. After Guangzhou tightened regulations on small workshops, the rate of abnormal liver function among local residents who regularly consumed homemade oil dropped by roughly 35%. In Guangxi, pregnant women who ate homemade peanut oil had nearly a 90% higher risk of giving birth to low‑birth‑weight babies and an 80% higher risk of premature delivery. +- Benefit: Aflatoxin is classified as a Group 1 carcinogen by the International Agency for Research on Cancer, meaning it definitely causes cancer — primarily liver cancer. A Guangzhou study measured aflatoxin B1 levels in homemade peanut oil from small workshops between 2010 and 2022; the median concentration was 1.29 μg/kg, with half of all samples falling between 0.12 and 6.58 μg/kg. After local regulations took effect, toxin levels fell by 2.865 μg/kg and continued to drop by 2.593 μg/kg each year thereafter. Consequently, the proportion of local residents with abnormal liver function fell by about 35% (PR 0.650, 95% CI 0.469–0.902). Another study in Guangxi followed 1,611 pregnant women; 81.7% of them consumed homemade peanut oil. Those women faced roughly a 90% higher risk of having low‑birth‑weight infants (aOR 1.9, 95% CI 1.1–3.2) and an 80% higher risk of premature delivery (aOR 1.8, 95% CI 1.1–3.0). +- Evidence grade: B +- Sources:Lei J, Li Y, Wang Y, 等 (2024). The impact of small food workshops management regulations on aflatoxin B1 in home-made peanut oil and the liver function of high-consumption area residents: an interrupted time series study in Guangzhou, China. Frontiers in Public Health, 12. ；Zhong Y, Lu H, Jiang Y, 等 (2024). Effect of homemade peanut oil consumption during pregnancy on low birth weight and preterm birth outcomes: a cohort study in Southwestern China. Global Health Action, 17. ；IARC (2012). Chemical Agents and Related Occupations. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 100F. ；国家卫生计生委、国家食品药品监督管理总局 (2017). 食品安全国家标准 食品中真菌毒素限量（GB 2761-2017） +- Notes: Both studies were observational in nature and lacked a control group. The Guangzhou study used liver‑function test results as its endpoint rather than incidence of liver cancer or mortality. The median aflatoxin level in homemade oil actually stayed below China’s legal limit of 20 μg/kg for peanut oil; the risk arises from long‑term consumption and occasional batches with higher concentrations. The legal limit applies to all peanut oil, but pre‑packaged oil must meet production‑license and factory‑inspection standards, while small workshops are subject to far fewer inspections under regional regulations. The main beneficiaries of this advice are you and your family members who eat the same meals. +### 42. Replacing lard and butter with vegetable oils for cooking: you don’t need to constantly switch oils for health reasons, nor should you expect flaxseed oil to protect your heart. + +- Cost: It doesn’t cost much extra. Vegetable oils are already the main cooking oils in most households. The real challenge is breaking the habit of using lard or butter for stir-frying and flavoring meals. +- In plain terms: Cutting back on saturated fats like lard and butter and switching to vegetable oils reduces the risk of heart disease and stroke by roughly 17%. However, there’s no measurable change in overall mortality. Switching between soybean oil, corn oil, and canola oil shows no clear health benefits either. Consuming large amounts of flaxseed oil also doesn’t lower heart disease risk. +- Benefit: A Cochrane review analyzed 15 randomized trials involving 56,675 participants, each followed for at least two years. Reducing saturated fat intake lowered the combined rate of cardiovascular events by about 17% (RR 0.83, 0.70–0.98). Overall mortality remained virtually unchanged (RR 0.96, 0.90–1.03), as did cardiovascular-related deaths (RR 0.95, 0.80–1.12). No significant difference was found between replacing saturated fats with polyunsaturated fats (the main component of soybean and corn oils) or with carbohydrates. Data on replacing them with monounsaturated fats (found in canola and olive oils) was too limited to draw conclusions. Another Cochrane review of 19 trials with 6,461 participants found that higher omega-6 intake (linoleic acid) had no effect on overall mortality (RR 1.00, 0.88–1.12) or cardiovascular events (RR 0.97, 0.81–1.15). A third review of 86 trials with 162,796 participants showed that increasing plant-based omega-3 intake (primarily from flaxseed and perilla oils) had virtually no impact on overall mortality (RR 1.01, 0.84–1.20) or coronary heart disease events (RR 1.00, 0.82–1.22). +- Evidence grade: A +- Sources:Hooper L, Martin N, Jimoh OF, 等 (2020). Reduction in saturated fat for cardiovascular disease. Cochrane Database of Systematic Reviews, (5), CD011737. ；Hooper L, Al-Khudairy L, Abdelhamid AS, 等 (2018). Omega-6 fats for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (11), CD011094. ；Abdelhamid AS, Brown TJ, Brainard JS, 等 (2020). Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (3), CD003177. ；中国营养学会 (2022). 中国居民膳食指南（2022）. 人民卫生出版社 +- Notes: Controversy: Some argue that high levels of omega-6 in soybean and corn oils promote inflammation, so these oils should be limited or replaced. However, the aforementioned studies on omega-6 showed no harmful effects, and the authors rated the evidence quality as low. The 17% reduction in cardiovascular events is considered a moderate benefit, while overall mortality shows no change. Regardless of the oil type, portion control is essential; dietary guidelines recommend 25–30 grams of cooking oil per person per day. diff --git a/book/03-Do-Not-Waste-Energy.md b/book/03-Do-Not-Waste-Energy.md new file mode 100644 index 00000000..c5ed7bda --- /dev/null +++ b/book/03-Do-Not-Waste-Energy.md @@ -0,0 +1,248 @@ +# 3. Don’t waste your energy + +This section is all about energy and time. We look at four main factors: how much attention you can actually use each day, how quick your reactions are, how often you make mistakes, and how long it takes you to get back on track after being interrupted. All the numbers here come from direct measurements — either from lab experiments or from tracking large groups of people over time (observational studies). These figures are not converted into life expectancy or mortality rates. Most items in this section carry a B evidence grade; that’s just how this field works, and it doesn’t make the recommendations any less valid. Item 20 deals with what to expect when dealing with police, doctors, or bank tellers; it cites laws rather than experimental data, so its grade is C. Items 15 (treating pessimistic thoughts as symptoms) and 23 (treating the belief that “others expect me to be perfect” as a symptom) use mortality and suicide‑risk figures that follow a different calculation method than the rest of this section, so they’re not compared with the other numbers here. +### 1. Turn off non‑essential notifications and keep your phone out of sight while working + +- Cost: No cost at all. It takes just a few minutes to adjust the settings, and hardly any willpower is required. +- In plain terms: Even if you don’t look at or touch your phone when it rings, your performance on attention‑related tasks still drops. The drop is roughly the same as when you actually answer calls or send messages. Another scenario: even when the phone sits on the desk and you resist the urge to glance at it, the amount of mental capacity available still decreases. The more dependent a person is on their phone, the greater this drop tends to be. +- Benefit: Merely receiving a notification — without looking at or interacting with the phone — noticeably impairs performance on attention tasks. The degree of impairment is comparable to actually answering calls or sending messages. These findings come from laboratory studies involving university students. Two additional experiments also show that even when participants successfully refrain from looking at their phone, having it nearby still reduces their available mental resources; this effect is strongest among heavy phone users. +- Evidence grade: B +- Notes: All of these results are based on single‑task experiments conducted in a lab setting. No research has examined how these effects accumulate over days or weeks in real‑world conditions. For jobs where immediate responsiveness is essential, it may be advisable to allow notifications only from a limited set of contacts. +- Sources:Stothart, Mitchum & Yehnert (2015). The attentional cost of receiving a cell phone notification. Journal of Experimental Psychology: Human Perception and Performance. ；Ward, Duke, Gneezy & Bos (2017). Brain Drain: The Mere Presence of One's Own Smartphone Reduces Available Cognitive Capacity. Journal of the Association for Consumer Research. + +### 2. Keep a fixed wake-up time, even on weekends + +- Cost: No cost involved. Sticking to this on weekends requires a bit of willpower. +- In plain terms: For the top 20% of students with the most irregular sleep schedules, their circadian rhythm runs roughly 2.5 hours later than that of the top 20% with the most regular schedules. This is equivalent to living with a persistent jet lag. Moreover, students with more consistent sleep patterns tend to achieve better academic results. +- Benefit: Sixty-one university students tracked their sleep patterns over 30 days. The group with the least regular schedules had a circadian rhythm that lagged by about 2.5 hours compared to the most regular group — specifically, the time when melatonin starts secreting was 00:08 versus 21:32 for the latter. The period when they felt most sleepy also occurred roughly 1.8 hours later. Additionally, greater sleep regularity correlated with better academic performance, with a correlation coefficient of r = 0.37. +- Evidence grade: B +- Notes: This is the sole study on this topic, with a relatively small sample size and no control groups. Researchers estimate that these circadian differences stem mainly from varying daily exposure to natural light. Therefore, maintaining a fixed wake-up time works best when paired with exposure to morning sunlight. For tips on how to recover after occasional late nights, see Section 2, Item 39: the recommended approach is to go to bed earlier that very night rather than sleeping in until noon the following day. +- Sources:Phillips et al. (2017). Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Scientific Reports. + +### 3. Getting 7 to 8 hours of sleep each night — don’t settle for just 6 hours + +- Cost: No cost at all. You simply need to set aside 1–2 extra hours each day for sleep. Going to bed earlier requires a bit of willpower. +- In plain terms: After two full weeks of getting only 6 hours of sleep each night, brain performance drops to a level equivalent to going two full nights without any sleep at all. The tricky part is that people don’t notice this effect themselves. Their self-rated sleepiness only rises during the first few days and then plateaus — people sleeping 6 hours report the same level of fatigue as those sleeping just 4 hours. In other words, the belief that “6 hours of sleep is enough for me” is actually a symptom of chronic sleep deprivation. +- Benefit: In a randomized controlled trial, 48 healthy adults aged 21–38 were asked to get just 6 hours of sleep per night for 14 consecutive days. Their cognitive performance steadily declined, eventually reaching levels comparable to those seen after two full nights of total sleep loss. Meanwhile, their self-reported sleepiness only increased at first and then remained largely unchanged. There was no difference in self-rated fatigue between the 6-hour and 4-hour sleep groups. Additionally, a meta-analysis of 70 studies found that acute sleep deprivation (lasting no more than 48 hours) leads to a moderate drop in simple attention (effect size g = -0.776) and a much smaller decline in reasoning accuracy (g = -0.125). +- Evidence grade: A +- Notes: The most important takeaway is that “not feeling sleepy” is not proof that you’ve gotten enough sleep. People who regularly sleep just 6 hours simply get used to the state, but their actual performance does not improve. The results from the meta-analysis apply to staying awake for an entire night; there is only one randomized controlled trial supporting the idea that consistently getting less than 6 hours of sleep has any real negative impact. +- Sources:Van Dongen, Maislin, Mullington & Dinges (2003). The cumulative cost of additional wakefulness. Sleep. ；Lim & Dinges (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin. + +### 4. Avoid caffeine after 2 p.m. + +- Cost: No cost involved. People accustomed to drinking coffee in the afternoon must summon some willpower to abstain. +- In plain terms: Consuming a large cup of coffee containing 400 mg of caffeine 6 hours before bedtime reduces measured total sleep time by over 1 hour, yet personal sleep logs show no difference. To avoid any impact on sleep, a regular cup of coffee (107 mg of caffeine) must be consumed at least 8.8 hours prior to bedtime; for those going to bed at 11 p.m., 2 p.m. marks the cutoff point. +- Benefit: Intake of 400 mg of caffeine 6 hours before sleep results in a measurable reduction of 1.1–1.2 hours in total sleep time compared to placebo consumption. Multiple studies combined via meta-analysis indicate that caffeine on average shortens total sleep duration by 45 minutes and lowers sleep efficiency — the proportion of time spent actually asleep while in bed — by 7%. +- Evidence grade: A +- Notes: The sole study by Drake utilized a relatively high caffeine dose of 400 mg, equivalent to roughly two or three cups of coffee, and was conducted in a single laboratory setting. Individuals with slower caffeine metabolism must adhere to an even earlier cutoff time. This recommendation complements the third item, which advises aiming for 7–8 hours of sleep nightly. +- Sources:Drake, Roehrs, Shambroom & Roth (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine. ；Gardiner et al. (2023). The effect of caffeine on subsequent sleep: A systematic review and meta-analysis. Sleep Medicine Reviews. + +### 5. Batch-process emails and messages a few times per day + +- Cost: No monetary cost. However, it takes some time to explain to colleagues how often you’ll be checking messages. It also requires a bit of willpower to resist the urge to check them constantly. +- In plain terms: The same group of participants was studied over two weeks. During the week when they limited email checks to just three times per day, their daily stress levels dropped noticeably compared to the unrestricted week — while the total number of emails sent and received stayed the same. Without any limits, people checked their emails an average of 15.5 times per day. +- Benefit: In a two-week self-controlled trial involving 124 adults, those who limited email checks to three times daily experienced significantly lower daily stress than when they checked freely (effect size: Cohen’s d = 0.37). The overall volume of emails received and replied to did not differ between the two conditions. Without restrictions, participants checked emails 15.5 times per day on average. +- Evidence grade: B +- Notes: Only one study has examined this approach, showing a modest effect size. It measured stress levels rather than actual work output. No direct research exists on limiting instant messaging checks; this recommendation is extrapolated from similar email studies. +- Sources:Kushlev & Dunn (2015). Checking email less frequently reduces stress. Computers in Human Behavior. + +### 6. When doing tasks that require continuous thinking, keep out even brief interruptions + +- Cost: No cost at all. Just close the door, put on headphones, or hang a “Do Not Disturb” sign. +- In plain terms: Even a brief interruption lasting 2.8 seconds on average doubles the chance of errors in subsequent steps of a sequential task. An interruption of 4.4 seconds triples that error rate. Field observations also show that it takes an average of 25 minutes to return to the interrupted task, with two other unrelated tasks squeezed in during that time. People who get interrupted do finish tasks faster, but they report higher levels of stress, frustration, effort, and time pressure. +- Benefit: On average, a 2.8-second interruption doubles the error rate for sequential tasks, while a 4.4-second interruption triples it. This finding comes from lab experiments. Another study observed 24 office workers (information professionals) in real-world settings. They switched topics every 11 minutes on average, and 57% of those topic switches were interrupted. It took them 25 minutes and 26 seconds on average to get back to the interrupted task, with 2.26 other tasks added in between. A separate experiment with 48 participants showed similar results: interrupted workers completed tasks faster, but reported significantly higher stress, frustration, effort, and time pressure. +- Evidence grade: B +- Notes: The field study mentioned above categorized interruptions into two types: those caused by others approaching the worker, and those initiated by the worker themselves. Simply closing the door blocks only the first type of interruption. To handle the second type, combine this tip with Tip 1 (turn off non-essential notifications) and Tip 5 (batch-process messages). +- Sources:Altmann, Trafton & Hambrick (2014). Momentary interruptions can derail the train of thought. Journal of Experimental Psychology: General. ；Mark, Gonzalez & Harris (2005). No task left behind? Examining the nature of fragmented work. CHI 2005. ；Mark, Gudith & Klocke (2008). The cost of interrupted work: More speed and stress. CHI 2008. + +### 7. Do one thing at a time — don’t reply to messages while in a meeting + +- Cost: No cost at all. It does take a bit of willpower to resist replying to messages during a meeting. +- In plain terms: Every time you switch tasks, your reaction time slows down and errors become more likely. People who regularly keep multiple screens open at once don’t actually get better at multitasking; in fact, they perform worse on task-switching tests. +- Benefit: Switching between tasks clearly slows reaction time and raises the chance of mistakes. This conclusion comes from a review of multiple studies. One lab study involved university students. Those who frequently use several types of media at the same time are known as heavy media multitaskers. They’re more easily distracted by unrelated things and unrelated memories, and they also perform worse on task-switching tests. +- Evidence grade: B +- Notes: Exactly how much extra effort task-switching requires varies a lot depending on the task, so no single number can be given here. The Ophir study compares people at one single point in time, so it’s hard to tell whether multitasking makes attention worse, or whether people with poorer attention skills simply prefer to multitask. +- Sources:Monsell (2003). Task switching. Trends in Cognitive Sciences. ；Ophir, Nass & Wagner (2009). Cognitive control in media multitaskers. PNAS. + +### 8. Avoid glowing screens one hour before bed; if you must, read paper books or e-ink devices instead + +- Cost: No cost involved. Giving up phone use one hour before bed requires willpower, especially when fighting long-standing habits. +- In plain terms: Reading from glowing screens before bed delays sleep onset by roughly 10 minutes compared to reading paper books. It also lowers melatonin production by 55%. The next day, the body’s internal clock shifts more than 1.5 hours later, making mornings harder and requiring extra time to feel fully awake. +- Benefit: In controlled lab experiments, the same participants were tested under both conditions (cross-over design). Those reading from glowing e-readers fell asleep about 10 minutes later than those reading paper books (25.7 minutes versus 15.8 minutes). Their nighttime melatonin levels dropped by 55%, and their circadian rhythm shifted by over 1.5 hours — melatonin secretion started at 22:31 instead of 21:01. This resulted in greater morning sleepiness and a longer recovery time to full alertness. +- Evidence grade: B +- Notes: The study involved a small number of participants and was conducted under tightly controlled lab conditions. Real-world effects may be smaller given typical phone brightness and usage patterns. The study did not evaluate how much nighttime screen modes actually help. +- Sources:Chang, Aeschbach, Duffy & Czeisler (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS. + +### 9. Go to bed at a set time — avoid staying up late for games, short videos, or porn + +- Cost: No money is required. The hard part is fighting the habit of “just one more episode.” The easiest way is to keep phones out of the bedroom. +- In plain terms: In 2025, Chinese people slept an average of 6.97 hours per night, with an average bedtime of 12:10 a.m. Those who used phones or tablets before bed were more than twice as likely to get insufficient sleep, and 2.7 times more likely to feel drowsy during the day. Even just having devices in the bedroom without using them led to similar results. Thus, the simplest solution is to keep phones out of the bedroom. +- Benefit: In 2025, Chinese residents averaged 6.97 hours of sleep per night, with an average bedtime of 12:10 a.m. (China Sleep Research Society). Compared to those who did not use portable devices before bed, users faced roughly 2.17 times higher odds of insufficient sleep (OR 2.17), 1.46 times higher odds of poor sleep quality (OR 1.46), and 2.72 times higher odds of daytime drowsiness (OR 2.72). Even when devices were merely present in the bedroom without being used, these odds remained at 1.79, 1.53, and 2.27 respectively. These figures are based on 20 concurrent surveys involving 125,198 children and adolescents. Another concurrent study of 844 adults aged 18–94 found that those who used phones after turning off the lights took longer to fall asleep, had a lower proportion of true sleep while in bed, and felt more fatigued during the day. +- Evidence grade: B +- Notes: This topic is somewhat controversial. The health risks of chronic sleep deprivation are discussed in item 3 of this section (getting 7–8 hours of sleep per night). Currently, there is no reliable evidence showing how porn affects ordinary people’s energy levels or cognitive abilities. One meta-analysis suggests that so-called “porn problems” often stem from a mismatch between personal beliefs and actual behavior, rather than the content itself. Another study of 280 men found no link between viewing duration and erectile function during sexual activity with a partner. This item specifically addresses how porn consumes sleep time. NOTE: The official webpage of the China Sleep Research Society uses dynamic loading and could not be accessed; the figures cited here are taken from a reprint by the local health commission. +- Sources:Carter et al. (2016). Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes. JAMA Pediatrics. ；Exelmans & Van den Bulck (2016). Bedtime mobile phone use and sleep in adults. Social Science & Medicine. ；中国睡眠研究会 (2026). 2026 中国睡眠健康研究白皮书（福建省卫健委转载健康报报道）. ；Grubbs JB 等 (2018). Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis. Archives of Sexual Behavior. （备注里的争议方之一）；Prause N, Pfaus J (2015). Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction. Sexual Medicine. （备注里的争议方之二） + +### 10. Don’t make major decisions or send important messages late at night + +- Cost: No cost at all. You simply postpone these tasks until after you’ve woken up. +- In plain terms: People who stayed awake for 49.5 hours were asked to take part in risk decision experiments. When well-rested, they quickly learned to avoid high-risk options; after sleep deprivation, they repeatedly chose high-risk choices instead. The older a person is, the more pronounced this effect becomes. This study looked at the extreme scenario of two consecutive sleepless nights; it did not directly test how much impact a few fewer hours of sleep would have, but the overall trend supports postponing important decisions until the next day. +- Benefit: Thirty-four healthy participants completed the Iowa Gambling Task after going 49.5 hours without sleep. This task is a standard way to measure risk decision making. When well-rested, they quickly learned to steer clear of high-risk options; after sleep loss, they opted for high-risk choices far more often. Older participants showed a stronger response to this effect. This is the only study of its kind to date. The total number of participants was 34. +- Evidence grade: B +- Notes: The research focused on the extreme case of two nights of continuous sleep deprivation. There is no direct data on how ordinary people fare after staying awake until 2 a.m. The advice to avoid sending messages late at night is based on the authors’ personal experience (rated as Grade C evidence); it is perfectly fine to send such messages the following day instead. +- Sources:Killgore, Balkin & Wesensten (2006). Impaired decision making following 49 h of sleep deprivation. Journal of Sleep Research. + +### 11. Take a 10‑minute nap in the afternoon — don’t sleep half an hour + +- Cost: It costs nothing. Just set aside 10 minutes and find a place where you can lie down or recline. +- In plain terms: A 10‑minute nap gives an immediate boost of alertness that lasts about two and a half hours. A 5‑minute nap provides almost no benefit, while a 20‑minute nap only starts to help after roughly half an hour. Sleeping 30 minutes brings on sleep inertia — you’ll feel groggy right after waking, making performance worse than if you hadn’t napped at all. +- Benefit: After a night of insufficient sleep, a 10‑minute nap quickly reduces drowsiness, fatigue, and improves energy and mental performance; some of these effects persist for up to 155 minutes. A 5‑minute nap yields virtually no benefit, and the advantages of a 20‑minute nap appear only after 35 minutes. A 30‑minute nap first causes sleep inertia, so performance is actually poorer right after waking, before any improvement occurs. +- Evidence grade: B +- Notes: Only one laboratory study exists, and its participants were healthy young adults. If you can’t fall asleep, there’s no need to force it; there’s no research showing any benefit from simply lying down with eyes closed for 10 minutes. Naps longer than an hour have been linked to higher mortality and increased risk of coronary heart disease — see Section 2, Item 38 (keep naps under 30 minutes). +- Sources:Brooks & Lack (2006). A brief afternoon nap following nocturnal sleep restriction: Which nap duration is most recuperative? Sleep. + +### 12. Using earplugs or finding a quiet room for memory-heavy tasks in open offices + +- Cost: Earplugs cost just a few dozen yuan. Booking a quiet meeting room takes some time and effort. +- In plain terms: When background noise rises from 39 dB to 51 dB, people remember fewer words, feel more tired, and are less motivated to work. Watching nature videos with sound during breaks helps restore energy far better than continuing to endure office noise. +- Benefit: Students working in simulated open offices showed similar effects: at 51 dB LAeq background noise, they recalled fewer words, rated themselves as more fatigued, and felt less inclined to keep working. Viewing nature videos with audio during breaks also boosted their energy levels more effectively than listening to river sounds or office noise alone. +- Evidence grade: B +- Notes: Only one laboratory study exists on this topic. Among all noise types, speech that can be clearly understood has the greatest negative impact on performance. White noise headphones may help mitigate this effect, but they were not tested in this research. +- Sources:Jahncke, Hygge, Halin, Green & Dimberg (2011). Open-plan office noise: Cognitive performance and restoration. Journal of Environmental Psychology. + +### 13. Do not work more than 49 hours per week + +- Cost: You might earn less in overtime pay. You may also need to put in effort to negotiate with your supervisor. +- In plain terms: Records from British munitions factories during World War I show that when workers kept weekly hours under 49, output rose in direct proportion to the time spent working. Once they exceeded 49 hours, the growth rate began to drop. Output from workers putting in 70 hours per week was practically identical to that of those working 56 hours — those extra 14 hours yielded no additional results. In total, this data covers a period spanning 100 years. +- Benefit: Data from British munitions factories in World War I demonstrates that output rises steadily with working hours up to 49 per week. After that threshold, the rate of growth slows. Peak output is reached at roughly 63 hours. At 70 hours, output remains essentially the same as at 56 hours, meaning those extra 14 hours are wasted effort. +- Evidence grade: B +- Notes: These figures come from factories a century ago where most workers were women performing manual labor. This threshold may differ for cognitive work; the authors themselves note that other occupations could have higher or lower limits. What is reliable, though, is the overall trend: beyond a certain point, adding more hours yields almost no extra output. The specific figure of 49 hours is not proven. +- Sources:Pencavel (2015). The Productivity of Working Hours. The Economic Journal. + +### 14. When you notice yourself endlessly replaying a distressing memory, do something hands‑on instead + +- Cost: No cost at all. The hard part is first recognizing that you’re stuck in this loop – a skill that takes practice. +- In plain terms: Endlessly dwelling on the same bad memory won’t yield any answers. It only deepens depression, cements negative thoughts, makes it harder to solve problems or take action, and can drive away friends who’d otherwise listen. As soon as you realize you’re stuck in this cycle, get busy with a physical task. +- Benefit: A review of multiple studies shows that repetitive rumination on distressing events worsens depression. This pattern, known as rumination, also strengthens negative thinking and weakens problem‑solving abilities. It hampers real‑world action and can alienate supportive people. It is linked to anxiety, binge eating, alcohol misuse, and self‑harm. +- Evidence grade: B +- Notes: This is the hardest item in this section to quantify; the review only provides general direction. “Doing something else” reflects the author’s own approach. The literature supports one core idea: diverting attention is better than staying trapped in rumination. No research has compared which specific activities work best. +- Sources:Nolen-Hoeksema, Wisco & Lyubomirsky (2008). Rethinking Rumination. Perspectives on Psychological Science. + +### 15. Treat thoughts like “things will definitely get worse” as symptoms, not as facts + +- Cost: No cost involved. The hard part is viewing such thoughts as symptoms rather than as objective truths. +- In plain terms: In a 20-year twin study, each additional step up on a pessimism scale correlated with a roughly 13% higher risk of dying during that period, and a roughly 20% higher risk of dying from cardiovascular disease. Conversely, higher optimism scores did not bring any comparable benefits. Thus, the focus should be on reducing pessimism, not on simply “being more positive.” +- Benefit: This study followed 2,978 twins aged 50 or older in Australia for an average of 20 years; 1,068 of them died over that time. For each standard deviation increase on the pessimism scale, the relative risk of death rose by about 13% (hazard ratio 1.134). The 95% confidence interval for this figure is 1.065–1.207, with a p-value of 8.85×10⁻⁵. Cardiovascular mortality rose by roughly 20% (hazard ratio 1.196; 95% CI 1.045–1.368; p=0.0093). No link was found between pessimism and cancer mortality. Similarly, higher optimism scores showed no meaningful association with mortality rates. +- Evidence grade: B +- Notes: This finding remains somewhat controversial. It is purely observational and no subgroups were defined. Some argue that illness might precede and cause heightened pessimism; the authors counter that if that were true, pessimism should also correlate with cancer mortality. Nevertheless, other unmeasured factors could still be at play. Importantly, optimism does not offer any protective effect, so there is no need to force oneself to “think positively.” What matters is refraining from treating pessimistic expectations as accurate forecasts of the future. +- Sources:Whitfield JB, Zhu G, Landers JG, Martin NG (2020). Pessimism is associated with greater all-cause and cardiovascular mortality, but optimism is not protective. Scientific Reports, 10, 12609. + +### 16. Cut back on draining relationships and learn to say no to unwanted requests + +- Cost: No monetary cost. In the short term, this may cause social friction and possibly lead to losing some relationships. It also takes considerable willpower to actually say no. +- In plain terms: The harm caused by a draining person is greater and more consistent than the benefits brought by a supportive one. That is why it makes sense to first reduce such relationships before trying to add healthier ones. +- Benefit: A survey of 120 widowed women aged 60–89 found that unpleasant interactions showed a stronger and more consistent link to lower psychological well‑being than pleasant ones. In other words, the negative impact of a draining person outweighs the positive effects of a supportive one. +- Evidence grade: C +- Notes: The study group is quite specific, and the questionnaire was administered only once, so no cause‑and‑effect sequence can be determined. It measures overall happiness rather than energy levels. The author includes this example as a speculative inference. There is no objective definition of what counts as a “draining” relationship; each person must judge that for themselves. +- Sources:Rook (1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology. + +### 17. Lock in low‑value decisions such as what to wear or eat + +- Cost: No cost at all. At first you’ll need to spend some time setting the default options. +- In plain terms: There’s no solid evidence for this idea. The original experiment claiming that making choices drains willpower failed in two large‑scale replications. One involved 2,000 participants, the other 3,000, with multiple labs conducting the same tests — and the effect was essentially zero. Still, it’s worth fixing these routine decisions because they save you a few minutes and a bit of mental effort; they don’t actually conserve willpower. +- Benefit: Not quantifiable. Early research suggested that decision‑making and self‑control draw on a single limited resource (self‑exhaustion). Yet two major replication attempts — one with 2,141 participants across 23 labs and another with 3,531 participants from 36 labs — produced negligible effects (effect sizes of 0.04 and 0.06 respectively, with wide confidence intervals ranging from -0.07 to 0.15). The absolute value 0.07 also appears within this range. +- Evidence grade: C +- Notes: This is a controversial claim. “Decision fatigue” is often presented as a proven fact in popular literature, but most attempts to replicate the original studies have failed to find the same results. We keep this entry only because it costs virtually nothing and genuinely saves time; don’t expect it to boost your judgment later in the day. +- Sources:Baumeister, Bratslavsky, Muraven & Tice (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology. ；Hagger et al. (2016). A Multilab Preregistered Replication of the Ego-Depletion Effect. Perspectives on Psychological Science. ；Vohs et al. (2021). A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect. Psychological Science. + +### 18. Walk away when angry; treat the other person as weather, not an enemy + +- Cost: No cost at all. You must resist the urge to retort on the spot, turn around and leave, then decide later whether to address the situation. This takes some practice. +- In plain terms: Reframing what just happened or trying to see things from the other person’s perspective can genuinely lower emotional intensity; the latter approach works especially well. Simply suppressing emotions has no effect. Additionally, people who punish those who offend them end up dwelling on the incident far longer afterward; those who do not retaliate move on more quickly. People also tend to overestimate how satisfying revenge actually is. +- Benefit: A meta-analysis combining 306 separate experiments shows that reframing events (cognitive reappraisal) yields a moderate effect size of d = 0.36 on emotional intensity. Viewing things from the other person’s perspective produces an even stronger effect, d = 0.45. Distraction yields d = 0.27. Simply suppressing emotions has virtually no effect, with d = -0.04. Three other experiments likewise reveal that people who punish offenders keep thinking about them far longer; those who refrain from retaliation move on more quickly. People consistently overestimate how gratifying revenge truly is. +- Evidence grade: B +- Notes: The portion of this analysis dealing with emotional intensity — not energy expenditure — shows effects ranging from small to moderate. Because only one experiment addresses the issue of revenge, the overall grade is B. The “empty boat” parable originates from Zhuangzi’s “Mountain Trees”: one remains calm when an empty boat bumps into them, but becomes angry when a boat carrying people does the same; the impact is identical in both cases. This is purely an analogy, not empirical evidence. If actual harm has occurred, following the legal procedures outlined in Sections 8 and 9 is far less costly than reacting impulsively on the spot. +- Sources:Webb TL, Miles E, Sheeran P (2012). Dealing with feeling: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin. ；Carlsmith KM, Wilson TD, Gilbert DT (2008). The paradoxical consequences of revenge. Journal of Personality and Social Psychology. + +### 19. Best low-cost actions when you’re feeling down: move, get sunlight, stick to a schedule, talk to someone, call 12356 + + +- Cost: Costs little to nothing. Just a few brisk walks, runs, or strength workouts each week. Spend time outdoors in daylight. Keep a regular sleep schedule. When you’re feeling stuck, give someone a call. + +- In plain terms: According to a meta-analysis of 218 randomized trials, brisk walking and running produce the strongest benefits for depression, with yoga and strength training also helpful — the greater the intensity, the better the effect. Sunlight therapy works very well for seasonal depression and also helps with non‑seasonal cases. Online self‑guided cognitive‑behavioral therapy programs are effective; having a therapist guide you makes them even better, especially if your symptoms are moderate to severe. When you’re feeling overwhelmed, dial 12356 first. + +- Benefit: This meta-analysis combined data from 218 randomized controlled trials involving 14,170 participants; the control group performed other activities. Compared with them, walking or running lowered depression scores by g = -0.62 (95% CI -0.80 to -0.45). Yoga produced g = -0.55 and strength training g = -0.49; higher intensity further improved outcomes. Pooled data from multiple light‑therapy studies showed an effect size of 0.84 (0.60–1.08) for seasonal depression and 0.53 (0.18–0.89) for non‑seasonal cases. Another analysis aggregated individual‑patient data from various studies on internet‑based cognitive‑behavioral therapy; both self‑guided and therapist‑supervised programs outperformed controls, with therapist guidance yielding better results for moderate‑to‑severe depression (PHQ‑9 score >9). The 12356 hotline provides nationwide psychological support for at least 18 hours each day. + +- Evidence grade: A + +- Notes: These measures serve as adjuncts for mild‑to‑moderate depression. Individuals with moderate‑to‑severe depression or suicidal thoughts should seek professional care; they may also call 12356 first (see Section 1, Item 25). Most exercise trials involve relatively few participants and cannot employ the placebo blinding used in drug studies. Light‑therapy research available up to 2003 also includes limited sample sizes. The advice to “stick to a schedule” and “talk to someone” reflects the authors’ experience rather than specific published evidence. Remember, even a ten‑minute walk counts as “getting active” for someone dealing with depression. +- Sources:Noetel M 等 (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. ；Golden RN 等 (2005). The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry. ；Karyotaki E 等 (2021). Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis. JAMA Psychiatry. ；国家卫生健康委 (2024). 关于应用"12356"全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 20. Treat police officers, doctors, and bank tellers as rule‑following workers, not as archetypes: paperwork and deadlines — not emotions — drive results. + + +- Cost: No expense involved. You only need to adjust your expectations and the sequence of actions. The first step is to resist the urge to “convince the other party with logic.” +- In plain terms: Children tend to think “police exist to catch bad guys; doctors exist to heal people.” Adults should instead view these professionals as employees bound by job rules, paperwork, deadlines, and oversight. How friendly they are has little bearing on whether your task gets done or how quickly. What matters is obtaining receipts, noting deadlines, and filing appeals through proper channels — not winning an intellectual debate. +- Benefit: Switching to this approach means moving from “pleading, getting angry, and reiterating your grievances” to “handling paperwork, tracking deadlines, and appealing via official routes.” The time saved comes from eliminating endless back‑and‑forth discussions and mental re‑processing. This is a one‑time mindset shift rather than a daily time‑saving trick. The deadlines themselves serve as concrete checkpoints, all clearly stated in official documents. For public‑security cases, the investigation period may not exceed 30 days; for especially complex cases, an extension of another 30 days can be granted with higher‑level approval. If a complaint is dismissed, the notification must be delivered within three days; the complainant may request a review within seven days, after which police must issue a decision within 30 days. A further appeal to a higher authority can be filed within another seven days. +- Evidence grade: C +- Notes: Grade C is assigned because there is no scholarly source supporting the premise that “many people treat front‑desk staff as archetypes rather than ordinary workers.” The only evidence lies in the rules themselves: deadlines, paperwork, and appeal mechanisms are all explicitly codified. All figures cited here originate from Article 39 in Section 8, which outlines procedures following a police report. This entry does not promise to “guarantee success” by following the rules, nor does it address “unfriendly attitudes” on the part of officials. It merely shifts expectations and the initial course of action. The same logic applies to bank tellers and government service windows: their actions are documented, subject to review, and accountable for errors. Therefore, the proper steps are to keep receipts, request written confirmations, and file complaints through official channels — rather than speculating about whether someone might “take advantage” of you. Legitimate priorities are laid out in law; for example, emergency care is allocated based on medical severity, not on first‑come‑first‑served order (see Article 8 in Section 24 on triage). If you wish to thank a doctor who helped you, send a thank‑you letter or leave a satisfaction rating as described in Article 12 of Section 24. Offering gifts to law‑enforcement personnel to “get better service” constitutes bribery, a crime with severe statutory penalties (see Article 40 in Section 8). Any obvious discrimination should be reported and monitored, not imitated as an unwritten norm. +- Sources:公安部 (2020). 公安机关办理刑事案件程序规定（公安部令第 159 号修正后，第一百七十一、一百七十八、一百七十九条）. ；公安部 (2013/2019 修正). 公安机关办理行政案件程序规定（公安部令第 125 号、第 149 号）. + +### 21. Don’t make “how others are doing” a daily habit: set limits on apps that show peers’ updates or turn them off + + +- Cost: This costs nothing. Setting time limits or deactivating an account takes just a few minutes. The real challenge is resisting the urge to open these apps again later on. + +- In plain terms: People who habitually compare themselves to others online tend to feel worse emotionally and have lower self‑esteem. Meta‑analysis of over 36,000 participants shows a moderate correlation between upward social comparison and poorer psychological outcomes. Correlation does not equal causation, but randomized trials back this link: after four weeks without Facebook, participants reported a slight rise in happiness. Another study limited three major platforms to 10 minutes per day; after three weeks, loneliness and depression both declined. The trade‑off? Knowledge of current events also dropped during those four weeks of abstinence. + +- Benefit: The combined results of 54 independent studies — 94 effect sizes and a total N of 36,583 — analyzed via a three‑level random‑effects model reveal that upward social comparison correlates with poorer mental health (average r = 0.330, 95% CI 0.289–0.370). Specific effects include higher fear of negative evaluation (r = 0.438), anxiety (0.382), depression (0.306), lower happiness (0.268) and lower self‑esteem (0.263). Life satisfaction increased by 0.12 standard deviations, while happiness rose by 0.08 standard deviations. Age, cultural background and data collection year do not alter this link. In a randomized trial of 2,743 U.S. Facebook users, 61% would accept a four‑week suspension at a cost of under $102; those in the suspension group gained 0.09 standard deviations in overall life satisfaction. Compared with typical psychological interventions (which raise happiness by ~0.34 SD and cut depression by ~0.23 SD), this effect is roughly 25–40% of that magnitude. After the trial ended, former suspension users still spent 0.31 fewer standard deviations per day on Facebook. Even after the trial ended, former suspension users still spent 12 fewer minutes per day on Facebook. A smaller trial of 143 college students showed similar benefits after limiting three platforms to 10 minutes daily. Additionally, knowledge of current affairs declined by 0.19 standard deviations, and political polarization fell by 0.16 standard deviations as a result of reduced app usage. + +- Evidence grade: A + +- Notes: The correlation findings merely indicate that these patterns tend to appear together; they do not prove causation. The randomized trials do suggest causal links, but they involve U.S. participants prior to the 2018 midterm elections, so applying the results directly to Chinese users is a stretch. The undergraduate trial involved only 143 subjects, limiting its statistical power. Overall effect sizes remain modest, so cutting off these apps alone will not resolve all emotional issues. This advice targets usage aimed at monitoring how others are faring; it does not apply to staying in touch with family, seeking information or job hunting. If strict limits prove hard to maintain, start by disabling push notifications, “people you may know” suggestions and homepage recommendations. For broader screen‑time management, see sections 4.15 and 4.16 (hard caps on short‑video apps and scrolling news). When feeling down, consider the actions outlined in section 19 (exercise, sunlight and regular sleep). For those seeking identity through purchases, see section 6.23; those striving to “move up a social rung” should review section 6.24. +- Sources:Lei Y, Hu S, Sun Y, Zheng L (2026). "Looking up" linked to feeling down: a meta-analysis of online upward social comparison and psychological maladjustment. Frontiers in Psychology. ；Allcott H, Braghieri L, Eichmeyer S, Gentzkow M (2020). The Welfare Effects of Social Media. American Economic Review, 110(3), 629–676. ；Allcott H, Braghieri L, Eichmeyer S, Gentzkow M (2019). The Welfare Effects of Social Media. NBER Working Paper No. 25514（本条引用的具体数字按这一版逐字核对，刊出版的摘要不含数字）. ；Hunt MG, Marx R, Lipson C, Young J (2018). No More FOMO: Limiting Social Media Decreases Loneliness and Depression. Journal of Social and Clinical Psychology, 37(10), 751–768. + +### 22. When you feel like “everyone saw me make a fool of myself,” cut that estimate in half. + + +- Cost: No cost at all. It simply requires asking yourself once, when you’re nervous: “Did they really see it?” + +- In plain terms: Imagine someone wearing an embarrassing T‑shirt into a room full of people. On average, they estimate that 46% of onlookers can identify who the shirt depicts; the actual figure is only 23%, exactly half as much. When they wear a T‑shirt of their own choosing that they consider decent, the estimate jumps to 48% while the true rate drops to just 8% — a six‑fold difference. Other studies show that after a conversation, people consistently underestimate how much their partner likes them. Thus, the belief that “I messed up and everyone noticed” is itself an over‑estimate; cutting it in half still leaves it too high. + +- Benefit: Experiment 1: Participants donned T‑shirts featuring Barry Manilow’s portrait and entered rooms with other subjects. On average, they predicted that 46% of observers would correctly name the figure on the shirt; the actual correct rate was 23%, precisely double the estimate. Subtracting the observed rate from the predicted one yields an average over‑estimation of 23 percentage points (95% CI 9–38). Excluding two sessions with only two or three observers leaves a difference of 27 points (11–43). Experiment 2: Participants wore T‑shirts they personally selected as “positive.” Their average prediction was 48%, whereas the true recognition rate fell to 8%, a six‑fold gap. Across three additional contexts — strangers paired for conversation, college roommates, and adult workshop participants — people systematically under‑estimated both how much their interlocutor liked them and how much they enjoyed the talk. The authors term this the “liking gap.” It appears in conversations of any length and persists for months among new roommates. + +- Evidence grade: B + +- Notes: Grade B reflects that all studies were conducted in laboratory or campus settings with relatively small sample sizes, involving wearing shirts or chatting with strangers. There is no direct evidence that these findings apply to situations such as being discussed by colleagues or making a mistake in a meeting. The numbers merely indicate the direction and approximate magnitude of over‑estimation; they do not provide a fixed multiplier you can apply. This advice is not meant to imply that others’ opinions are irrelevant. In genuine evaluation contexts — interviews, defenses, assessments, or medical evaluations — judgments are real and should be taken seriously. It specifically addresses that everyday feeling of “everyone is watching me”; the real opponent here is your own estimation bias. +- Sources:Gilovich T, Medvec VH, Savitsky K (2000). The spotlight effect in social judgment: An egocentric bias in estimates of the salience of one's own actions and appearance. Journal of Personality and Social Psychology, 78(2), 211–222. ；Boothby EJ, Cooney G, Sandstrom GM, Clark MS (2018). The Liking Gap in Conversations: Do People Like Us More Than We Think? Psychological Science, 29(11), 1742–1756. + +### 23. Treat “others expect me to be perfect” as a symptom, not a fact + +- Cost: No cost involved. The hard part is viewing this thought pattern as something that needs addressing rather than as an accurate reflection of others’ actual expectations. +- In plain terms: The correlation between the feeling of “people around me expect me to be perfect and will reject me if I fail” and suicidal thoughts is 0.28. When the phrasing changes to “I myself expect myself to be perfect,” the correlation drops to just 0.10. The real risk does not come from having high standards per se, but from perceiving those standards as being imposed by others. Even after accounting for pre-existing suicidal thoughts, the former feeling still helps predict an increase in such thoughts over time. +- Benefit: A comprehensive meta-analysis was conducted using data from 45 studies involving 11,747 participants — including undergraduates, medical students, community members, and psychiatric patients — analyzed via a random-effects model. The weighted average correlation with suicidal thoughts is as follows: for perfectionistic concerns (a composite of socially prescribed perfectionism, fear of making mistakes, self-doubt, and perceived gaps between personal performance and standards), r = .28 (95% CI .24–.32; based on 42 studies with 7,936 participants). Socially prescribed perfectionism alone also shows r = .28 (.25–.32; 30 studies, 3,640 participants). Perfectionistic striving — which reflects self-directed perfectionism and personal standards — has a lower correlation of r = .10 (.07–.13; 31 studies, 4,588 participants). Parental criticism correlates at r = .20 (.11–.29). Regarding suicide attempts, perfectionistic concerns correlate at r = .12 (.07–.17; 15 studies, 5,275 participants), while socially prescribed perfectionism shows r = .19 (.08–.29; 8 studies, 689 participants). Even after adjusting for pre-existing suicidal thoughts, socially prescribed perfectionism still shows a modest positive link to later increases in suicidal thoughts; no such link is observed for self-directed or other-oriented perfectionism. +- Evidence grade: B +- Notes: This item is graded B because most included studies relied on single-time surveys, making it hard to establish temporal sequence. The correlation strength is moderate (r ≈ .28), accounting for only a few to ten percent of total variance. Since the outcomes measured are suicidal thoughts and attempts rather than actual mortality, the overall benefit is rated as limited due to reliance on surrogate endpoints. The authors themselves note that the data on perfectionistic concerns and suicide attempts may suffer from publication bias, with studies showing weaker or null results less likely to be published; even after accounting for such missing studies, the overall trend remains unchanged. This recommendation does not oppose setting high standards; rather, it emphasizes where those standards originate and whether failure to meet them leads to feelings of personal worthlessness. Similar to the idea discussed in Item 15 — viewing pessimistic expectations like “things will definitely get worse” as symptoms — this pattern can also be addressed clinically. If you or someone you know is experiencing suicidal thoughts, call 12356 immediately and remove any means of self-harm, as outlined in Section 1, Item 25. For guidance on how to respond when someone close expresses such thoughts, refer to Section 8, Item 15. Information on depression screening for children can be found in Section 30, Item 8. +- Sources:Smith MM, Sherry SB, Chen S, Saklofske DH, Mushquash C, Flett GL, Hewitt PL (2018). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522–542. + +### 24. When angry, don’t try to vent by smashing things, punching a bag, or going for a run — first calm your body down. + + +- Cost: No cost at all. When you’re angry, try a few minutes of activities that slow your heart rate: breathe slowly, sit down, and quiet your mind. It’s hard to resist the urge to vent right then and there. + +- In plain terms: Activities that rev up the body — like punching a bag, throwing things, or going for a run — generally don’t help you cool off. On the other hand, techniques that calm the body, such as slow breathing, mindfulness, and meditation, noticeably reduce anger and the urge to lash out. + +- Benefit: A meta-analysis of 154 studies involving 184 sample groups and 10,189 participants shows that calming techniques like deep breathing, mindfulness, and meditation lower both anger and aggression. The effect size was g = -0.63, with a 95% CI ranging from -0.82 to -0.43. This result held true across genders, races, ages, and cultures. In contrast, activities that increase physical arousal — such as punching a bag, jogging, or cycling — showed virtually no effect; their effect size was g = -0.02, with a 95% CI from -0.13 to 0.09. The authors conclude that neither venting anger nor going for a run is an effective way to defuse it. + +- Evidence grade: A + +- Notes: These findings measure anger and aggression, not overall energy levels. The authors categorize the time spent on calming activities as “minutes saved from dealing with fallout after an argument.” Immediate techniques you can use right now include the “circular sighing” method described in Section 22, Item 9, and “stepping away when angry” in Section 24, Item 18. Running isn’t useless in the long run — it helps ease low mood, as noted in Section 22, Item 7 (“When feeling down, go for a walk or run”). It simply isn’t a good short-term fix for anger. While angry, avoid driving, sending messages, or making important decisions. If someone is physically attacking you, leave the scene and call the police; your priority then is safety, not emotional regulation — see Section 8, Item 43 (“If you’re being abused”). +- Sources:Kjærvik SL, Bushman BJ (2024). A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage? Clinical Psychology Review. + +### 25. Writing down thoughts and feelings about a troubling issue over several days can be helpful, but don’t expect it to cure anything + +- Cost: This costs nothing. Typical practice in studies is to write 3–4 times, each session lasting 15–20 minutes. Write about something that bothers you and express your deepest thoughts and feelings. +- In plain terms: Writing about upsetting matters generally provides a small benefit on average, though the results are inconsistent. Two meta-analyses found no effect at all. Since it costs almost nothing, it’s worth trying. However, if emotional problems are severe, it should not replace professional medical care. +- Benefit: One meta-analysis combined data from 146 randomized studies in which participants wrote or spoke about personally important topics. On average, the effect was positive and statistically significant, though very small (effect size r = .075). Another meta-analysis limited to randomized controlled trials found no significant effects on either physical or mental health across 30 trials. For 16 trials involving cancer patients and survivors, there were no significant improvements in psychological, physical, or quality-of-life outcomes; the effect size for psychological outcomes was g = 0.04, with a 95% confidence interval ranging from –0.06 to 0.14. +- Evidence grade: B +- Notes: This approach remains controversial. Proponents point to the 146-study meta-analysis showing a small positive effect, while critics cite two meta-analyses of randomized controlled trials that found no significant benefits. The recommended frequency and duration of writing sessions come from the original experimental designs, as summarized in Mogk’s meta-analysis. This method is included here because it requires virtually no expense or time and can be done alone. It may be useful when someone has no one to talk to about their problems. The time-based measurement used here reflects how authors categorized effort levels. If writing becomes increasingly distressing, stop and dial 12356, as described in Section 1, Item 25. +- Sources:Frattaroli J (2006). Experimental disclosure and its moderators: a meta-analysis. Psychological Bulletin. ；Mogk C, Otte S, Reinhold-Hurley B, Kröner-Herwig B (2006). Health effects of expressive writing on stressful or traumatic experiences - a meta-analysis. Psycho-Social Medicine. ；Zachariae R, O'Toole MS (2015). The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. Psycho-Oncology. diff --git a/book/04-Do-Not-Waste-Time.md b/book/04-Do-Not-Waste-Time.md new file mode 100644 index 00000000..6aec7a69 --- /dev/null +++ b/book/04-Do-Not-Waste-Time.md @@ -0,0 +1,166 @@ +# 4. Don’t waste time + +This section is all about time. We look at how many hours you can save each day, week, or year, and how much the odds improve of finishing a task on schedule. We don’t convert time into extra years of life or into money. When money does come up, we only give the calculation method — no final figures. Most of the items here are backed by a single study or overall statistics from time‑use surveys, so the evidence grades are mostly B or C. +### 1. Write “what to do” as “if… then…” + +- Cost: No cost at all. Each step takes just 1–2 minutes — simply write a sentence like “If… then…”. For example: “If I sit at my desk at 8 a.m. on Tuesday, I’ll start by writing the introduction.” +- In plain terms: Change “I plan to do this” into “If I sit at my desk at 8 a.m. on Tuesday, I’ll start by writing the introduction.” Across 94 separate studies, people who used this phrasing were far more likely to achieve their goals — this effect is moderate to large. All it requires is rewriting one sentence; there’s no expense and almost no extra effort. +- Benefit: When all 94 studies are combined, individuals who expressed their plans as “if… then…” statements had significantly higher success rates. This technique is known in psychology as implementation intentions. The effect size here is d = 0.65, which qualifies as moderate to large. Three key moments benefit from this approach: initiating action, resisting distractions, and disengaging from tasks that seem impossible to complete. +- Evidence grade: A +- Notes: This method works only for goals you genuinely want to achieve. If a goal holds no personal value for you, writing multiple such statements won’t help. Additionally, most research participants were students, and the studies focused on health-related habits; results may not translate directly to workplace settings. +- Sources:Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119. + +### 2. Write down exit criteria before starting + +- Cost: No cost at all. It takes just 5 minutes at the start to write down: “If a certain target isn’t met by a specific date, then we’ll stop.” The hard part is actually honoring that promise when the day comes — it can feel embarrassing to call off a project in front of others. +- In plain terms: Before you begin any project, write one simple sentence: “If a certain target isn’t met by a specific date, then we’ll stop.” Multiple studies combined show this approach really does help people pull back from efforts they’re unlikely to succeed at. What you save is all the time you’d otherwise keep pouring into that project. +- Benefit: When data from several studies on commitment strategies are pooled together, the result is clear: setting a clear “if… then…” condition beforehand also helps people disengage from failing courses of action. The time saved is exactly the amount you’d have kept investing otherwise. +- Evidence grade: B +- Notes: Exit criteria should be written at the very start of a project, while emotions are still neutral. Deciding on them later gets skewed by all the resources already spent; at that point you should focus only on future investment and future returns, as explained in item 3. Also, “the ability to withdraw” is just one sub‑finding across those studies — no single study has calculated exactly how much time it can save. +- Sources:Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119. + +### 3. When deciding whether to continue, consider only future investments and future returns — not what has already been invested. + +- Cost: No monetary cost is involved. The difficulty lies in accepting that all time previously invested cannot be recovered. +- In plain terms: Money and time already spent tend to make people more inclined to keep going. Across 98 datasets, this tendency remains consistent. Therefore, when deciding whether to continue, only future investments and expected returns should be taken into account; past expenditures must be excluded from the calculation. +- Benefit: Prior investments of money, effort, and time increase the likelihood of continued engagement. This phenomenon is known in psychology as the sunk cost effect. Across 98 datasets, this effect has been confirmed as stable. Avoiding this bias saves valuable future time that would otherwise be wasted due to a desire not to “waste” past efforts. +- Evidence grade: B +- Notes: Regarding the theater experiment by Arkes and Blumer, we have verified only the general trend: individuals who paid higher ticket prices tended to attend more plays over the following six months. Exact attendance figures per group have not yet been confirmed from the original text (pending verification). Roth et al. found that this effect diminishes over time and is weaker among older individuals. +- Sources:Arkes, H. R., & Blumer, C. (1985). The psychology of sunk cost. Organizational Behavior and Human Decision Processes, 35, 124–140. ；Roth, S., Robbert, T., & Straus, L. (2015). On the sunk-cost effect in economic decision-making: A meta-analytic review. Business Research, 8(1), 99–138. + +### 4. Estimate timelines based on actual time taken in past similar tasks, not on plans + + +- Cost: No cost at all. It only requires a few minutes of review to look up how long similar tasks took previously. +- In plain terms: Students who estimated they would finish a paper in 33.9 days actually took 55.5 days to complete it; only 29.7% of them met their own estimates. Another group of students was asked to first recall how long similar tasks had taken them in the past before making their estimates. The proportion of students who finished on time rose from 29.3% to 60.0% in this group. +- Benefit: Students originally expected to finish their papers in 33.9 days, but the actual time taken was 55.5 days. Only 29.7% of them completed their work by their own estimates. When researchers asked another group of students to first relate past experiences to the current task before estimating, the proportion of students finishing on time rose from 29.3% to 60.0% compared to the control group. This optimism of underestimating timelines no longer appeared in this group. +- Evidence grade: B +- Notes: Buehler’s study involved only university students in Canada; it was a single study with a small sample size of 37 participants, with roughly 40 participants in each group. Estimating timelines based on historical data from similar projects is known as reference class forecasting; specific engineering applications are described in Flyvbjerg’s work. Halkjelsvik’s review of multiple studies shows that underestimating timelines is more common than overestimating, though the magnitude of the error varies widely depending on the task and research methodology. +- Sources:Buehler, R., Griffin, D., & Ross, M. (1994). Exploring the "planning fallacy": Why people underestimate their task completion times. Journal of Personality and Social Psychology, 67(3), 366–381. ；Flyvbjerg, B. (2006). From Nobel Prize to project management: Getting risks right. Project Management Journal, 37(3), 5–15. ；Halkjelsvik, T., & Jørgensen, M. (2012). From origami to software development: A review of studies on judgment-based predictions of performance time. Psychological Bulletin, 138(2), 238–271. + +### 5. Distribute an agenda beforehand; don’t hold meetings without one; stand if possible + +- Cost: No monetary cost. Organizers spend 5–10 minutes writing an agenda before the meeting. Standing meetings require participants’ cooperation. +- In plain terms: When an agenda is shared beforehand, attendees are more likely to view the meeting as useful. In experiments, seated meetings lasted 34% longer than standing ones, yet the quality of decisions reached under both formats was identical. +- Benefit: Two studies involved 958 and 292 participants respectively. Results showed that meetings with pre‑distributed agendas were perceived as more effective by attendees — a statistically significant relationship. In another experiment, 55 groups met while seated and 56 while standing; seated meetings again ran 34% longer, with no difference in decision quality between the two formats. +- Evidence grade: B +- Notes: The standing‑meeting experiment involved five‑person groups working on tasks in a lab setting. These findings cannot be directly applied to lengthy meetings or large conferences. Leach measured participants’ subjective perceptions of effectiveness rather than actual output levels. +- Sources:Leach, D. J., Rogelberg, S. G., Warr, P. B., & Burnfield, J. L. (2009). Perceived meeting effectiveness: The role of design characteristics. Journal of Business and Psychology, 24(1), 65–76. ；Bluedorn, A. C., Turban, D. B., & Love, M. S. (1999). The effects of stand-up and sit-down meeting formats on meeting outcomes. Journal of Applied Psychology, 84(2). + +### 6. Cut down on meetings – use written asynchronous communication when possible + +- Cost: No monetary cost. Requires cooperation from colleagues and supervisors. The main difficulty is that writing a clear message takes more effort than simply speaking it out loud. +- In plain terms: The more meetings you have in a day, the more exhausted you feel, and the more work seems to pile up on your plate. Canceling even one meeting frees up exactly as much time as the meeting itself lasts – no less, no more. +- Benefit: Two surveys involved employees working 35+ hours per week – one with 676 participants, the other with 304. How much time meetings consume and their impact on attitude and happiness aren’t fixed; they depend on two factors: how well the meetings are run and how much a role relies on teamwork. Another study asked participants to keep daily logs for a week; it found that more meetings per day led to greater fatigue and perceived workload. The time saved equals precisely the duration of those canceled meetings. +- Evidence grade: B +- Notes: Controversy: Rogelberg’s 2006 research shows the relationship between meeting frequency and happiness isn’t one-directional; for roles heavily dependent on collaboration, frequent meetings may actually be beneficial. Additionally, no study has directly compared asynchronous written communication to holding meetings, so this recommendation is the author’s own inference. +- Sources:Rogelberg, S. G., Leach, D. J., Warr, P. B., & Burnfield, J. L. (2006). "Not another meeting!" Are meeting time demands related to employee well-being? Journal of Applied Psychology, 91(1). ；Luong, A., & Rogelberg, S. G. (2005). Meetings and more meetings: The relationship between meeting load and the daily well-being of employees. Group Dynamics: Theory, Research, and Practice, 9(1). + +### 7. Break large tasks into subtasks before estimating and starting work + +- Cost: No cost involved. The actual breakdown process takes 5 to 15 minutes. +- In plain terms: When estimating how long a task will take, people rarely break it down into individual subtasks and calculate each one separately. Listing all subtasks first and then estimating the total duration helps avoid underestimating the required time. Once broken down, each small step can be tackled right away, which also reduces the likelihood of procrastination. +- Benefit: People tend to overlook the need to split multi-component tasks into smaller parts when estimating timelines. For instance, writing a literature review, drafting the discussion section, and organizing references are all distinct tasks. By first listing all relevant subtasks and then estimating the overall time, one can avoid the common planning fallacy of underestimating duration. Moreover, once tasks are broken down, each small step becomes a concrete action that can be started immediately, thereby lowering procrastination rates. Research shows that key predictors of procrastination include a person’s aversion to the task and the tendency to postpone it. +- Evidence grade: B +- Notes: As a general guideline, each subtask should be small enough to be completed during a single focused work session; splitting tasks into overly detailed pieces is itself time-consuming. Additionally, Kruger and Evans’ study was verified only for its overall direction based on the abstract; the exact percentages cited were not cross-checked against the original research text. +- Sources:Kruger, J., & Evans, M. (2004). If you don't want to be late, enumerate: Unpacking reduces the planning fallacy. Journal of Experimental Social Psychology, 40(5), 586–598. ；Steel, P. (2007). The nature of procrastination: A meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1). + +### 8. Set a deadline for tasks without an external deadline + +- Cost: No cost involved. The hard part is actually sticking to the deadline you set. If you ignore it when the day arrives, it’s as if you never set it at all. +- In plain terms: When there is an external deadline, 80.6% of students manage to finish their work before it. But only 38.7% finish within their own estimated timeframe. The actual completion time is almost entirely determined by the external deadline, with little connection to their own estimates. That’s why it’s crucial to set your own deadline for tasks with no external deadline, and then follow through on it. +- Benefit: For students with an external deadline, 80.6% complete their work before it. Meanwhile, only 38.7% finish within their own estimated timeframe. The actual completion time closely aligns with the external deadline, with a correlation coefficient of r = 0.82 — the closer this number is to 1, the tighter the alignment. There is only a very weak link between completion time and students’ own estimates. +- Evidence grade: B +- Notes: Telling others about the deadline you set for yourself makes it behave more like an external deadline. It’s worth noting that this research only proves external deadlines are effective. For self-set deadlines such as time-boxing or using Pomodoro timers, no direct studies have been conducted, so this conclusion is drawn by inference. +- Sources:Buehler, R., Griffin, D., & Ross, M. (1994). Exploring the "planning fallacy": Why people underestimate their task completion times. Journal of Personality and Social Psychology, 67(3), 366–381. + +### 9. Treat procrastination as a way to avoid discomfort, not as a sign of laziness or lack of effort + +- Cost: No cost at all. The only change needed is in how you judge the situation: first ask yourself where the discomfort lies, then figure out how to address it. +- In plain terms: Procrastination has little to do with laziness or personality traits. What truly predicts whether someone procrastinates is how unpleasant the task feels, whether they believe they can complete it, and how easily they get distracted by immediate temptations. Therefore, the best approach is to make the task less unpleasant and break the first step into a tiny, manageable action — rather than scolding yourself and forcing yourself to work. +- Benefit: A meta-analysis that included 691 correlation coefficients found several factors with a strong, consistent link to procrastination: how aversive the task is, how much time remains until the deadline, self-efficacy (the belief in one’s ability to succeed), impulsivity, and conscientiousness — including self-control, susceptibility to distraction, organization skills, and achievement motivation. In contrast, neuroticism, rebelliousness, and sensation-seeking show only very weak connections to procrastination. The authors explain these results using time motivation theory: the immediate appeal of a task drops rapidly as the expected reward is pushed further into the future. +- Evidence grade: A +- Notes: This guideline only provides general direction rather than specific actionable steps, so its overall benefit is rated as moderate — no quantitative estimate of time saved has been calculated. Concrete actions are outlined in item 1 of this section (which specifies exact times, locations, and concrete actions to take), item 7 (which advises breaking large tasks into smaller sub-tasks), and item 8 (which recommends setting a deadline even for tasks without any external deadline). Keep in mind this is a summary of correlational research, so it should not be interpreted as evidence of direct causal relationships. +- Sources:Steel P (2007). The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1), 65–94. + +### 10. Keep desired items within reach and unwanted ones out of sight — no need to resist temptation on the spot + +- Cost: No cost involved; takes just a few minutes to set up. Simply move your phone to another room and lay out books and a computer on the desk. +- In plain terms: When items are physically farther away, people tend to consume less of them. Placing snacks at a distance noticeably cuts down on intake — this effect is of moderate strength. Limiting the number of available choices also leads to a marked drop in consumption. These strategies require no willpower on your part; you can arrange everything in just a few minutes. +- Benefit: A Cochrane review encompassing 24 randomized trials supports these findings. Moving food farther away reduces consumption, with a standardized mean difference of −0.60 (95% CI −0.84 to −0.36; based on 12 studies involving 1,098 participants; evidence of low certainty). Limiting food options yields an even stronger effect, with a standardized mean difference of −1.13 (95% CI −1.90 to −0.37; based on 3 studies involving 154 participants; evidence of low certainty). Regression analysis confirms that both distance and fewer choices amplify the effect. +- Evidence grade: B +- Notes: This B rating stems from the fact that all 24 studies included in the review focused on food only; none examined alcohol or tobacco. Additionally, 14 of those studies were conducted in laboratory settings and originated from high-income countries. Applying these same principles to phones and video games is a logical extrapolation, as no direct trials exist on this specific use case. One study directly examined the effect of removing phones from one’s line of sight; see Section 3, Item 1 for details (turning off nonessential notifications and keeping phones out of sight while working). +- Sources:Hollands GJ, Carter P, Anwer S, et al. (2019). Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews, 9, CD012573. + +### 11. Tie your money to your commitment — but first ask if you’re willing to pay + +- Cost: Under this deposit‑based approach, participants must put up their own cash upfront; if they fail to meet the target, the money is forfeited. In this trial, the required deposit was $150. +- In plain terms: A randomized trial involving 2,538 participants compared two incentive models: one offering a cash reward for success, and another requiring an upfront deposit that is refunded plus a bonus only if the goal is met. Among those willing to join either program, the deposit model produced a success rate 13 percentage points higher than the reward model. Yet only 13.7% of participants agreed to pay the deposit, while 90% opted for the reward option. Thus the deposit approach works best for those willing to pay; for everyone else it essentially has no effect. +- Benefit: In a U.S. trial with 2,538 participants, employees and their relatives were randomly assigned to one of four incentive schemes or standard care. The reward model (earning roughly $800 for success) attracted 90.0% participation, whereas the deposit model (requiring a $150 upfront payment plus a $650 bonus) attracted just 13.7%. After six months, overall quit rates ranged from 9.4% to 16.0% across all incentive groups, compared with 6.0% under standard care. The reward model yielded a 15.7% quit rate, while the deposit model produced 10.2%. However, when looking only at the 13.7% of participants willing to pay the deposit, the deposit model achieved a six‑month quit rate 13.2 percentage points higher than the reward model (95% CI 3.1–22.8, a reliable range). +- Evidence grade: A +- Notes: This trial focused on smoking cessation; extrapolating the findings to activities such as essay writing or exercise suggests a moderate overall benefit. The key takeaway is not which method is more effective, but whether you’d actually be willing to use it: a powerful incentive that most people reject is essentially useless for them. Therefore, pick an approach you’re comfortable with — even a modest deposit can be more effective than no deposit at all. For practical smoking‑cessation strategies, see Section 2, Item 3 (smoking‑cessation medications). +- Sources:Halpern SD, French B, Small DS, et al. (2015). Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine, 372(22), 2108–2117. + +### 12. New habits are measured in months, not “21 days” + +- Cost: No cost at all. What’s required is simply repeating the same action every day in the same context for several months. +- In plain terms: The idea that “it takes 21 days to form a habit” has no scientific basis. One study tracking participants over 12 weeks found that it took as little as 18 days for an action to become automatic, while some people needed as many as 254 days. It’s perfectly normal for things to feel difficult for two or three weeks. Missing a single day also does not reset any progress. +- Benefit: Ninety-six volunteers each chose a simple action related to eating, drinking, or physical activity, and performed it daily in a fixed context (such as “after breakfast”) for 12 weeks, rating how automatic the action felt each day. Data from 82 participants proved sufficient for analysis, and the model successfully matched 62 of them. The number of days required to reach 95% automation ranged from 18 to 254 days. The study also showed that missing one day of practice has no meaningful impact on habit formation. +- Evidence grade: B +- Notes: This is the only study of its kind, involving just 96 participants who performed very simple actions (like eating a piece of fruit after a meal). No research has examined how long it takes to form more complex habits, such as running three times a week or writing daily. The main takeaway here is to set realistic expectations: finding it hard for two weeks is not a sign of failure. To actually make repetition happen, link the action to a fixed context — see point 1 in this section, which advises specifying “at what time, where, and under what circumstances” the action should be done. +- Sources:Lally P, van Jaarsveld CHM, Potts HWW, Wardle J (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009. + +### 13. For those whose procrastination is affecting daily life, self‑help materials backed by randomized trials work just as well as therapist‑led programs + +- Cost: A self‑help book costs only a few dozen yuan; some are even free. It takes about ten weeks of effort — one chapter per week plus one related exercise. +- In plain terms: Procrastination that causes real distress is treatable. A randomized trial involving 150 participants tested a ten‑week cognitive‑behavioral self‑help program, both with therapist guidance and without it. Both groups showed markedly better results than a control group that received no intervention. No meaningful difference emerged between the two self‑help groups, meaning that working through the material on one’s own is equally effective. +- Benefit: The 150 participants were randomly assigned to three groups: therapist‑guided self‑help, unguided self‑help, and a wait‑list control. After ten weeks, the effect sizes on the Pure Procrastination Scale were d = 0.70 (95% CI 0.29–1.10) for the guided group and d = 0.50 (0.10–0.90) for the unguided group. On the Irrational Procrastination Scale the values were 0.81 (0.40–1.22) and 0.69 (0.29–1.09) respectively. The proportion of participants achieving clinically meaningful improvement was 31.3%–40.0% in the guided group and 24.0%–36.0% in the unguided group. No statistically significant differences existed between the two self‑help groups on any outcome. +- Evidence grade: A +- Notes: The study involved Swedish adults using Swedish‑language materials; no identical Chinese version is currently available, so the magnitude of benefit is rated as “moderate.” The program comprises standard components such as behavioral activation, behavioral experiments, stimulus control (see item 10 in this section: keep tempting items out of reach), and explanations of motivation and work strategies. When procrastination co‑occurs with notable depression or anxiety, follow the recommendations in item 3, section 19: move, get sunlight, keep a regular sleep schedule, talk to someone, and call 12356. +- Sources:Rozental A, Forsell E, Svensson A, Andersson G, Carlbring P (2015). Internet-based cognitive-behavior therapy for procrastination: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 808–824. + +### 14. Use your own hourly wage to decide which chores to outsource + +- Cost: Outsourcing chores comes at a cost, which varies depending on the service chosen. You’ll also need to spend some time upfront calculating your own hourly wage. +- In plain terms: On average, Chinese residents spend 1 hour and 17 minutes each day doing household chores. Among those who actually do them, the average time spent is 1 hour and 59 minutes. People who pay to save time tend to report higher life satisfaction. For the same amount of money, spending it on time rather than goods brings greater immediate happiness. +- Benefit: According to a 2024 survey covering 38,500 households and 107,000 individuals, Chinese residents spend an average of 1 hour and 17 minutes daily on household chores; for those who actually perform them, the average rises to 1 hour and 59 minutes. Another study involving 6,271 participants from four countries found that people who purchase time report higher life satisfaction. Researchers also conducted real-world experiments showing that spending the same sum on time rather than physical goods results in greater immediate well-being. +- Evidence grade: B +- Notes: First, calculate your hourly wage by dividing your monthly after-tax income by the total number of hours you actually work each month. Then determine how much it would cost to outsource a particular chore. If the outsourcing fee is lower than your hourly wage and you truly plan to use the saved time for earning money or resting, then outsourcing makes sense. This guide provides a method rather than a definitive recommendation, since everyone’s hourly wage and outsourcing costs differ. Additionally, Whillans’ research measures how happy people feel after buying time, not how many hours they ultimately save. +- Sources:Whillans, A. V., Dunn, E. W., Smeets, P., Bekkers, R., & Norton, M. I. (2017). Buying time promotes happiness. Proceedings of the National Academy of Sciences. ；国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. + +### 15. Set hard limits on short videos and aimless scrolling + +- Cost: No cost at all. It only takes a few minutes to act: turn off notifications, delete the app, or set a daily time limit for it. The real challenge is resisting the urge to open it. +- In plain terms: On average, Chinese people spend 5 hours and 37 minutes online per day. For those who actually go online that day, the average time is 6 hours and 3 minutes. Using the same calculation method in 2018, the average was only 2 hours and 42 minutes. This is the highest figure in this section. Cutting just one hour off daily adds up to 365 extra hours per year. +- Benefit: Chinese residents spend an average of 5 hours and 37 minutes online each day. For those who actually use the internet on a given day, the average is 6 hours and 3 minutes. People who accessed the internet on that day account for 92.9% of the total population. These are 2024 statistics. In 2018, the average was only 2 hours and 42 minutes using the same calculation method, which is also the highest figure in this section. Reducing online time by one hour daily adds 365 hours to a person’s year. According to the China Internet Network Information Center, as of June 2025, netizens spend an average of 30.6 hours online per week, an increase of 1.9 hours compared to half a year prior. There are 1.068 billion short video users, accounting for 95.1% of all netizens. +- Evidence grade: C +- Notes: Online time includes time spent on work, study, and social interaction, so not all of it is wasted. It is rated as grade C because no studies have calculated exactly how much time is saved after such limits are put in place and how that time is then used; we only have overall statistics. For the specific activity of browsing others’ social media posts, a randomized trial has been conducted to measure the time saved and changes in mood; details can be found in Section 3, Item 21. +- Sources:国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. ；国家统计局 (2019). 2018年全国时间利用调查公报. ；中国互联网络信息中心 (2025). 第 56 次《中国互联网络发展状况统计报告》. + +### 16. Avoiding TV and scrolling news: view information at set times instead + +- Cost: No monetary cost. The real challenge is breaking the habit of turning on the TV at random times; you might also miss some breaking news. +- In plain terms: Americans aged 15 and older watch 2.6 hours of TV per day, which accounts for half of all their leisure time. In China, the average daily TV viewing time is 1 hour and 40 minutes; for people aged 75–84, it reaches 3 hours and 16 minutes. Switching to viewing information at scheduled times saves you all this time. +- Benefit: Americans aged 15 and older watch 2.6 hours of TV daily. Their total leisure time is 5.2 hours, so TV viewing consumes half of it. These figures are from 2025. In China, the average daily TV viewing time is 1 hour and 40 minutes; for those aged 75–84, it is 3 hours and 16 minutes. These numbers date back to 2018. +- Evidence grade: C +- Notes: Only aggregate statistics are available. No studies have examined how the time saved by cutting back on TV and news viewing is actually used. The practice of viewing content at set times is based on the author’s personal experience. +- Sources:U.S. Bureau of Labor Statistics (2026). American Time Use Survey — 2025 Results. ；国家统计局 (2019). 2018年全国时间利用调查公报. + +### 17. Spend some time learning keyboard shortcuts and automation for common software + +- Cost: There is no monetary cost. However, it requires a one-time investment of several to dozens of hours to learn. The initial learning phase can actually be slower than using a mouse. +- In plain terms: Even many Word users with years of experience still rely on clicking toolbar icons. Experiments comparing different methods show that keyboard shortcuts are faster than both menus and icons. This is a one-time effort that pays off with every subsequent use. The longer you perform similar tasks, the greater the overall benefit. +- Benefit: Research involving 251 experienced Word users revealed that most rarely utilize faster shortcuts, continuing to rely on toolbar icons. Controlled experiments confirmed that shortcuts are indeed the quickest method among menus, icons, and shortcuts themselves. The time saved accumulates gradually with each daily use. Those who perform similar tasks over extended periods gain the most from this practice. +- Evidence grade: B +- Notes: Focus on learning shortcuts for operations you use at least ten times daily; learning too many unnecessary shortcuts is counterproductive. It should be noted that the efficiency study involved only six participants, and the summary does not specify the exact number of seconds saved per operation. +- Sources:Lane, D. M., Napier, H. A., Peres, S. C., & Sándor, A. (2005). Hidden costs of graphical user interfaces: Failure to make the transition from menus and icon toolbars to keyboard shortcuts. International Journal of Human-Computer Interaction. + +### 18. When choosing a place to live, prioritize commute time to cut down on one-way travel + + +- Cost: This option is costly. You may end up paying higher rent or having to settle for a smaller living space. Moving itself also takes time and effort. +- In plain terms: The longer someone’s commute, the worse they tend to feel about their life. This loss in time and comfort isn’t compensated for by higher wages or better housing. Cutting one-way commute time by 30 minutes saves a full 5 hours each week. +- Benefit: On average, Chinese residents spend 50 minutes daily on transportation; among those who travel on a given day, the average is 1 hour and 2 minutes, according to 2024 data. Longitudinal studies in Germany show that people with longer commutes consistently report lower subjective well-being — meaning they feel their lives are worse. Again, this loss in time isn’t offset by any gain in income or housing quality. A comprehensive review of multiple studies confirms that longer commutes lead to greater dissatisfaction, regardless of the mode of transport used. Reducing one-way travel time by 30 minutes yields roughly 5 extra hours per week. +- Evidence grade: B +- Notes: Point of contention: Chatterjee et al., after analyzing various studies, argue that no consistent link exists between commute length and overall life satisfaction. They suggest that people can generally offset the downsides of long commutes by securing better jobs or housing. It’s also worth noting that transportation statistics include all trips, not just commuting, and that avoiding rush hour can also shorten travel time on the same route. +- Sources:Stutzer, A., & Frey, B. S. (2008). Stress that doesn't pay: The commuting paradox. Scandinavian Journal of Economics, 110(2), 339–366. ；Chatterjee, K., et al. (2020). Commuting and wellbeing: A critical overview of the literature with implications for policy and future research. Transport Reviews, 40(1), 5–34. ；国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. diff --git a/book/05-Do-Not-Waste-Money.md b/book/05-Do-Not-Waste-Money.md new file mode 100644 index 00000000..dc074649 --- /dev/null +++ b/book/05-Do-Not-Waste-Money.md @@ -0,0 +1,362 @@ +# 5. Don’t waste money +This section is purely about money: how much you can save, how much your yearly returns differ, and what amount you can expect to get back over the long run. None of these figures are converted into years of life or time saved. Entries dealing with investments simply explain how to do the calculations; they rely only on verified historical data and do not constitute any investment advice. +### 1. Turn off all automatic renewals and switch to manual renewal upon expiry + +- Cost: No cost at all. Simply review the lists of automatic payments in Alipay, WeChat Pay, Apple, and Android — this takes only 10 to 20 minutes. From then on, you’ll need to manually initiate each renewal yourself. +- In plain terms: What you’ll save is exactly the money spent on subscriptions you no longer use but are still being charged for each month. It takes less than 20 minutes to go through the automatic payment lists in Alipay, WeChat Pay, Apple, and Android. By regulation, merchants must provide a clear notice before charging you, along with an easy-to-find and readily accessible option to cancel at any time. +- Benefit: The amount saved equals the total cost of those subscriptions you no longer need yet continue to pay for. This varies from person to person, so there’s no single universal figure. Regulatory rules also require merchants to give you a clear pre-charge notice and a simple, cost-free option to cancel at any time (China, effective since 2021). +- Evidence grade: C +- Sources:国家市场监督管理总局 (2021, 2025 修正). 网络交易监督管理办法（总局令第 37 号，第十八条）. +- Notes: For services you actually use regularly, annual subscriptions are generally cheaper than monthly ones, so keeping automatic renewal on for these is more cost-effective. You should only turn off automatic renewal for those subscriptions you’ve long forgotten about yet are still being charged for. +### 2. Conduct the annual tax reconciliation from March to June; be sure to include all eligible special deductions + +- Cost: No cost involved. The process can be completed in just a few minutes via the “Individual Income Tax” app. +- In plain terms: The following groups of people typically receive a tax refund after completing this process: those who only worked for a few months throughout the year, those who changed jobs mid-year, or anyone who failed to claim deductions for child education, mortgage payments, rent, or elderly dependents. It takes only a few minutes to finish on a mobile device. If your total annual income falls below 120,000 yuan, or if the amount of tax you owe is under 400 yuan, you may skip this step. +- Benefit: This process consolidates calculations for four types of income: wages and salaries, labor remuneration, author’s fees, and royalties. Any overpaid tax is refunded to you, while any underpaid amounts must be paid up. There are two scenarios where you may forgo this process: when your total annual income is under 120,000 yuan, or when the tax you owe is less than 400 yuan. These thresholds were set by the State Taxation Administration in 2023 and remain in effect through December 31, 2027. Conversely, the groups mentioned above are precisely those who usually qualify for a tax refund after completing the reconciliation. +- Evidence grade: A +- Sources:国家税务总局 (2025). 个人所得税综合所得汇算清缴管理办法（第六条）及其解读. ；财政部、税务总局 (2023). 关于延续实施个人所得税综合所得汇算清缴有关政策的公告. +- Notes: Even individuals who owe tax must complete this process; failure to do so is illegal. There are seven categories of special deductions available: child education, continuing education, major illness medical expenses, mortgage interest payments, rent payments, elderly dependents support, and childcare expenses for children under three. Note that you may claim either mortgage interest or rent deductions, but not both. +### 3. Housing provident fund isn’t just for buying a home: it can be used for renting, home renovations, and paying property taxes, effective from September 20, 2026 under new regulations + +- Cost: No cost at all. You only need to complete the withdrawal application once. +- In plain terms: The housing provident fund isn’t limited to home purchases. The new regulations list nine eligible scenarios for withdrawals, including renting, renovating a personal residence, and paying property taxes. Once you submit an application, the housing provident fund authority must respond within three days whether your request is approved or not. +- Benefit: The updated regulations expand eligible withdrawal scenarios to nine total. These include covering rental payments, funding home renovations, and paying property taxes for a residence you own. The housing provident fund authority must issue a decision on your application within three days of receiving it, either granting or denying the withdrawal request. +- Evidence grade: A +- Sources:国务院 (2026). 国务院关于修改《住房公积金管理条例》的决定（国务院令第 844 号，2026 年 7 月 31 日国务院第 93 次常务会议通过，「自2026年9月20日起施行」）：修改后第二十四条「职工有下列情形之一的，可以提取职工住房公积金账户内的存储余额：（一）支付房租的；（二）购买、建造、翻建、大修自住住房的；（三）偿还购房贷款本息的；（四）装修自住住房的；（五）支付自住住房物业费的；（六）离休、退休的；（七）完全丧失劳动能力，并与单位终止劳动关系的；（八）出境定居的；（九）国务院批准的其他住房消费情形。」；第二十五条「住房公积金管理中心应当自受理申请之日起3日内作出准予提取或者不准提取的决定」；第十八条缴存比例「均不得低于职工上一年度月平均工资的5％」. +- Notes: The funds in your account consist of your own salary contributions plus matching contributions from your employer. If left untouched, these funds earn only a very low rate of interest. The regulations also specify that in cases of employee death or declared death, heirs and legal beneficiaries may withdraw the full account balance. Exact required documents and application procedures are determined locally by each regional housing provident fund authority, so be sure to check your local guidelines before applying. +### 4. Recalculate your mobile and broadband plans annually: downgrade unused services, and file a complaint if the carrier refuses to comply + +- Cost: No expense at all. It takes just a few minutes to review your bill. The real challenge is resisting the pressure from customer service reps who try to dissuade you from downgrading. +- In plain terms: Older plans you’re currently on often cost dozens of yuan more per month than newer plans now on sale. Those extra monthly fees add up to hundreds of yuan wasted each year. By regulation, carriers have no valid reason to reject your request to switch plans, delay processing it, or impose special pricing tiers solely for customers making such changes. If they refuse without justification, you can file a formal complaint. +- Benefit: Ministry of Industry and Information Technology rules explicitly state that carriers must not “refuse, obstruct, or delay providing number portability services to users without valid reasons”, nor may they “use blocking or restrictive technical measures to compromise the communication service quality of such users”. They are also prohibited from “creating dedicated pricing or marketing plans for customers exercising their right to port their numbers”. Older plans typically cost dozens of yuan more per month than current offerings, so sticking with them results in hundreds of yuan wasted annually. +- Evidence grade: A +- Sources:工业和信息化部 (2019). 携号转网服务管理规定（工信部信管〔2019〕242 号）. +- Notes: First, use your carrier’s official app to check your actual monthly data and call usage over the past six months, then choose a plan matching those figures. If a customer service rep claims “you must visit a physical store to downgrade” or “contract terms prevent any changes”, ask for written proof of those claims. If none is provided, file a complaint via the 12300 hotline. +### 5. Not buying lottery tickets + +- Cost: It costs nothing. Not buying means you save money. +- In plain terms: According to regulations, at least 50% of sales revenue from lottery games must be paid out as prizes; for the Double Color Ball game, this figure is 51%. In other words, for every 1 yuan you spend, you can expect to receive back only 0.51 yuan on average over time — meaning you lose 49% of your money. In 2024, China sold 623.486 billion yuan worth of lottery tickets; of that amount, 161.031 billion yuan went directly into public welfare funds and was never distributed as prizes. +- Benefit: Fiscal regulations set minimum payout ratios: 50% for lottery and number-based games, 65% for instant-win games, and 73% for wagering games. For the Double Color Ball game, 51% of sales revenue is allocated to prizes, which means only 51 yuan out of every 100 yuan spent is paid out as winnings. On a personal level, this translates to an average return of just 0.51 yuan per 1 yuan spent over time — a net loss of 49%. In 2024, total lottery sales in China reached 623.486 billion yuan; 161.031 billion yuan of that amount was earmarked for public welfare and never returned to players (China, 2024). +- Evidence grade: A +- Sources:财政部 (2015). 关于规范和加强彩票资金构成比例管理的通知（财综〔2015〕94 号）. ；财政部 (2025). 财政部公告 2025 年第 8 号（2024 年彩票公益金筹集分配情况）. ；中国福利彩票双色球游戏规则（第十四条）. +- Notes: Over the long run, buying lottery tickets guarantees a financial loss; this is a fixed rule of the system and has nothing to do with luck. Buying tickets is fine if you treat it as a form of entertainment costing 2 yuan per play, but it should never be viewed as a way to invest or save money. +### 6. Walk away the moment you see “high returns”, “guaranteed returns”, or “sure profits” + +- Cost: Nothing to pay. Just pause for a moment when you encounter these phrases. +- In plain terms: Regulatory authorities themselves state that any return above 6% should raise doubts, anything over 8% is highly risky, and returns exceeding 10% mean you should expect to lose all your principal. Legitimate financial products are no longer allowed to guarantee returns or principal safety. Any losses incurred from participating in illegal fundraising are your own responsibility per regulations — no one will compensate you if things go wrong. +- Benefit: The former chairperson of the China Banking and Insurance Regulatory Commission stated at the Lujiazui Forum in 2018: “Any return exceeding 6% should raise doubts, anything over 8% is very risky, and returns above 10% mean you should prepare to lose all your principal.” New asset management regulations require financial institutions to “not make any guarantees regarding principal safety or returns”, and also stipulate that “when facing difficulties in fulfilling payment obligations, financial institutions must not provide any form of financial support to settle such obligations”. Hence, legitimate financial products no longer offer any principal protection. Losses from illegal fundraising are borne entirely by participants, with no third party obligated to compensate you in case of issues (China, 2018, 2021). +- Evidence grade: A +- Sources:郭树清在第十届陆家嘴论坛的讲话（2018 年 6 月），天津市地方金融管理局转载. ；中国人民银行等 (2018). 关于规范金融机构资产管理业务的指导意见（银发〔2018〕106 号，第二条、第六条）. ；国务院 (2021). 防范和处置非法集资条例（国务院令第 737 号，第二十五条）. +- Notes: The 6%, 8%, and 10% thresholds are set by regulators based on practical experience, not statutory provisions. Note: The original speech page on the former CBIRC website loads content dynamically, so we were unable to retrieve it; this citation is based on a repost by the Tianjin Local Financial Regulatory Bureau. This content does not constitute investment advice. +### 7. Avoid making minimum payments or taking installment plans or consumer loans + +- Cost: No cost at all. You must keep enough cash on hand to pay the full balance by the due date. The hard part is resisting the urge to spread out large purchases via installment plans. +- In plain terms: Making minimum payments is not a discount — it is essentially a daily‑interest loan that works out to roughly 18% per year. Once you use this option, the interest‑free period ends immediately, and the unpaid portion of the balance accrues interest from that point onward. Always look at the annual percentage rate when comparing offers; regulators now require issuers to display this figure prominently, rather than just the daily rate. The minimum rate is exactly 0.7 times the maximum rate. +- Benefit: Before 2020, credit‑card interest rates were capped: the maximum daily rate was 0.05% and the minimum was 70% of that cap. At 0.05% daily, the annual simple interest rate comes to 18.25%. Starting in 2021, issuers and cardholders can negotiate rates freely. After opting for minimum payments, the unpaid balance continues to accrue interest daily while the interest‑free period is lost. Authorities now demand that issuers clearly show the annual rate; you should base your decision on this figure alone (China, 2020 notice). +- Evidence grade: C +- Sources:中国人民银行 (2020). 关于推进信用卡透支利率市场化改革的通知（银发〔2020〕327 号）. +- Notes: The 18.25% figure results from multiplying 0.05% by 365 without compounding; the actual rate would be higher if interest were compounded monthly. Some banks offer discounts, but you must refer to the annual rate listed on your own statement. If you truly cannot afford the payment, seek a lower‑rate loan from a reputable lender rather than letting minimum payments pile up. +### 8. Don’t give streamers tips, don’t make in‑game purchases, and don’t make impulsive buys + +- Cost: There is no cost at all. It only takes a few minutes to do three things: turn off automatic payment, set daily and per‑transaction limits, and remove any linked payment methods from the platforms. The hard part is resisting the urge to click those buttons right then and there. +- In plain terms: On average, each gamer in China spends roughly 480 yuan per year on games, and that money is almost impossible to get back. Laws only require refunds for purchases made by minors without parental consent; adults have no such protection. The easiest way to stay on budget is to take preventive steps: disable automatic payments, set spending limits, and unlink payment options. +- Benefit: This is a substantial expense. In 2024, China’s gaming market generated 325.783 billion yuan in revenue, serving 674 million players — an average of about 480 yuan per person (calculated by dividing total revenue by the player count). That money is largely unrecoverable. One exception exists: if a minor (a person with limited civil capacity) makes purchases without a guardian’s permission, courts must support the guardian’s request for a refund. No such rule applies to adults. Additionally, minors are legally restricted to playing online games only on Fridays, Saturdays, Sundays, and public holidays, and only between 8 pm and 9 pm each day (China, 2020‑2021). +- Evidence grade: B +- Sources:国家新闻出版署 (2024). 今年中国游戏市场收入超 3257 亿元创新高（中国音数协游戏工委《2024 年中国游戏产业报告》）. ；最高人民法院 (2020). 关于依法妥善审理涉新冠肺炎疫情民事案件若干问题的指导意见（二）（法发〔2020〕17 号，第 9 条）. ；国家新闻出版署 (2021). 关于进一步严格管理 切实防止未成年人沉迷网络游戏的通知（国新出发〔2021〕14 号）. +- Notes: This is graded as B because no direct studies have measured exactly how much money can be saved by avoiding tips and purchases; we only have aggregate industry figures. Turning off automatic payments and setting limits are widely recommended practices, which would merit a C rating on their own. The exact wording of Articles 19 and 145 of the Civil Code is already quoted verbatim in Item 9 (about minors making in‑app purchases). This information is not financial advice. +### 9. When kids make in-app purchases or send gifts, parents can demand refunds for large sums spent by kids over eight if they never gave consent + +- Cost: There’s no direct monetary cost, but it does take time to gather evidence and negotiate with platforms. Most platforms initially refuse refunds but eventually comply. If talks fail, legal action becomes necessary — a process that can take months and requires paying attorney fees out of pocket. Thus, it’s far more efficient to compile all relevant documentation first and approach both the platform and China’s 12315 consumer hotline. The real challenge lies in getting the child to cooperate and share details. +- In plain terms: Money spent by children over eight years old can be legally invalidated and refunded if the amount far exceeds what one would reasonably expect for their age and level of maturity, and if parents neither approved nor acknowledged the transaction. For kids under eight, any spending is automatically considered invalid, as they lack legal capacity to make such decisions. Even silence from parents is interpreted by law as a refusal to acknowledge the expense. +- Benefit: Minors aged eight and older are classified as having limited legal capacity — meaning they may only engage in activities appropriate to their age and maturity level. Any financial transaction beyond that scope requires explicit approval or retroactive acknowledgment from a legal guardian. Conversely, children under eight are deemed completely incapable of independent decision-making; all actions must be handled by their guardians. In the absence of any affirmative response from parents, the law presumes they reject the transaction. +- Evidence grade: A +- Sources:全国人大 (2020). 民法典. 最高人民检察院转载全文. 第十九条：「八周岁以上的未成年人为限制民事行为能力人，实施民事法律行为由其法定代理人代理或者经其法定代理人同意、追认；但是，可以独立实施纯获利益的民事法律行为或者与其年龄、智力相适应的民事法律行为。」第二十条：「不满八周岁的未成年人为无民事行为能力人，由其法定代理人代理实施民事法律行为。」第一百四十五条：「限制民事行为能力人实施的纯获利益的民事法律行为或者与其年龄、智力、精神健康状况相适应的民事法律行为有效；实施的其他民事法律行为经法定代理人同意或者追认后有效。」「法定代理人未作表示的，视为拒绝追认。」 +- Notes: The crux of success lies in proving that a child — not a parent — performed the transaction. Helpful evidence includes: transaction timestamps coinciding with school hours or times when parents are at work; device usage logs; chat histories and gaming records; and a direct statement from the child. There is no fixed monetary threshold defining “age-appropriate” spending — a few dozen yuan spent on game skins differs vastly from tens of thousands spent on virtual gifts. Prevention is far easier: set spending limits without requiring passwords, enable youth protection modes, and never disclose payment codes to children. For cases where parents themselves impulsively make such purchases, refer to the section titled “Avoid giving gifts to streamers, making in-game purchases, or acting on impulse.” +### 10. Teaching kids one key phrase: anyone who asks them to use a parent’s phone to enter verification codes is a scammer + +- Cost: There’s no cost involved. Simply explain these six types of scams to your child, then agree on this phrase: “If you’re scammed, tell me right away and I won’t scold you.” Also set a spending limit for cashless payments, enable teen mode, and never share the payment password with your child. The hardest part is resisting the urge to get angry if they actually fall victim to a scam. +- In plain terms: Each of these six scams works differently, but they all end the same way: the scammer gets the child to use a parent’s phone to transfer money or read out verification codes. That’s why this single phrase is enough: anyone who asks your child to use a parent’s phone or read out verification codes is a scammer. Add this follow-up line too: “If you’re scammed, tell me right away and I won’t scold you.” Only if the child feels safe enough to speak up immediately is there any chance of recovering the stolen funds. +- Benefit: The Quanzhou Anti-Fraud Center and Quanzhou Education Bureau identified six common scams targeting teens. Though their methods vary, they all culminate in the same action: getting the child to transfer money via a parent’s phone. First, fake offers for cheap gaming accounts and gear. One boy transferred 260 yuan privately, then the scammer told him “transactions by minors are against the rules and your account will be frozen,” and tricked him into clicking a “verification link” using his dad’s phone, which led to over 30,000 yuan being stolen. Second, “removing anti-addiction restrictions.” Scammers threatened “if you don’t transfer money, your parents will go to jail,” so the child used his mom’s phone to send 7,000 yuan. Official rules make it clear there are no “unofficial ways” to lift these restrictions. Third, fake refund offers for in-game purchases. Impostors posing as “official customer service” claimed refunds were possible if parents used Alipay to send gifts to a specific livestream; this resulted in 73,000 yuan being spent on gifts, after which the scammers cut off contact. Official guidance states “anyone asking you to ‘send gifts to get a refund’ is 100% a scam.” Fourth, impersonating classmates or teachers. Scammers hack accounts to send voice messages calling the child by name and asking for money. At the start of the school year, they also join class groups pretending to be teachers, posting “pay 500 yuan for school fees” with identical profile pictures and nicknames to real teachers, even enlisting “accomplices” in the group to confirm “I’ve already paid.” Fifth, fake fan group offers. Scammers lure kids into “celebrity fan groups” promising 888 yuan in cash prizes; first they ask for a 48.88 yuan “verification fee,” then threaten “since minors aren’t allowed to join, the platform will freeze 80,000 yuan and your parents will go to jail” — this led to 16,000 yuan being stolen. Official guidance stresses “real police officers or lawyers never contact minors online to investigate, nor do they ever ask parents to operate phones.” Sixth, fake low-price listings on second-hand platforms that lure buyers off the site for private transactions. The same materials also list three red lines kids must never cross: first, never lend, sell or rent bank cards or SIM cards, as using them to move illicit funds can lead to criminal charges that affect future college admissions or civil service exams; second, “mobile voice acting” gigs are illegal; third, “high-paying overseas jobs” often turn out to be traps where victims are held captive upon arrival (Quanzhou, October 2025). +- Evidence grade: B +- Sources:泉州市反诈骗中心 (2025). 开学第一课｜反诈是青少年的必修课，这 6 大陷阱一定要避开！（福建省公安厅转载） +- Notes: This is graded B because the source materials provide detailed breakdowns of scammer tactics and specific case examples, but there are no statistics on overall incidence rates or the effectiveness of preventive measures. This is distinct from Item 9, where kids spending money on in-game purchases can request refunds under civil law. Funds stolen by scammers fall outside this scope and must be reported under Section 8, Clause 2 to freeze transactions; recovery depends on whether the money remains in the account. The core scammer line “you’ve broken the rules and your parents will go to jail” is a dead giveaway of fraud — explaining this to kids beforehand is far more effective than trying to question them after the fact. It’s also crucial to actually follow through on the promise “if you’re scammed, tell me right away and I won’t scold you.” In all these cases, kids’ reluctance to speak up due to fear of punishment was a key reason losses kept growing. For adult versions of impersonation scams and AI face-swapping tactics, see Section 8, Clauses 3 and 4 (core anti-fraud rules, and always hang up first if a transfer is requested). +### 11. Skipping extended warranties for electronics + +- Cost: There’s no upfront cost. The trade‑off is that after the warranty expires you’ll have to pay for any repairs yourself — though that scenario is relatively unlikely. +- In plain terms: Extended warranties typically cost 10% to 50% of the item’s original price. The profit margin on these warranties is roughly ten times higher than that of regular merchandise. In 2003, Best Buy in the U.S. earned over half of its total profits from extended warranties, even though they accounted for only 3% to 4% of its overall revenue. That price gap is exactly the extra money you end up paying. +- Benefit: Extended warranties are priced at 10% to 50% of the product’s original cost. Industry estimates cited in research show that the average gross margin on these warranties sits at 50% to 60%: for every 100 dollars spent on a warranty, 50 to 60 dollars become pure profit. This is roughly 18 times higher than the gross margin on ordinary goods. In 2003, extended warranties made up just 3% to 4% of Best Buy’s revenue yet generated over 50% of its total profits (U.S. retail data from the early 2000s). +- Evidence grade: B +- Sources:Chen T, Kalra A, Sun B (2009). Why Do Consumers Buy Extended Service Contracts? Journal of Consumer Research 36(4):611-623. +- Notes: The gross‑margin figure comes from an industry estimate referenced in the paper (Business Week, 2004); it wasn’t measured directly by the authors. The calculations above apply to ordinary consumers who can afford a single repair bill. For people who rely on a single device and lack a backup, the calculation changes. Screen‑protection plans for phones must also be evaluated separately: first estimate how often you’re likely to drop the phone, then decide whether the premium is worth it. +### 12. Prefer generic drugs that have passed consistency evaluation and those selected in centralized procurement + +- Cost: No cost at all. When a doctor prescribes medication or you go to buy medicine, simply ask: “Is there a generic version included in the centralized procurement program?” +- In plain terms: The second batch of centrally procured drugs saw an average price drop of 53%, with some drugs becoming 93% cheaper. As of April 2026, 11 procurement rounds have been completed, covering 490 different drugs. Asking for generic drugs from this program ensures you get the same ingredients at a much lower price. +- Benefit: The national centralized drug procurement initiative resulted in a 53% average price reduction for the second batch, with some drugs dropping by as much as 93%. By April 2026, 11 rounds had been conducted, covering 490 drugs. A total of 1,695 drugs have either passed or are considered to have met consistency evaluation standards, accounting for roughly two-thirds of all commonly used chemical drugs in China (official data from 2020–2026). +- Evidence grade: A +- Sources:国家医疗保障局 (2020). 第二批国家组织药品集中采购和使用工作答记者问. ；国家医疗保障局 (2026). 国务院政策例行吹风会：健全全周期全渠道药品价格形成机制. ；国务院办公厅 (2016). 关于开展仿制药质量和疗效一致性评价的意见（国办发〔2016〕8 号）. ；国家食品药品监督管理总局 (2016). 关于发布普通口服固体制剂参比制剂选择和确定等 3 个技术指导原则的通告（2016 年第 61 号）附件 1、附件 3，海南省药品监督管理局转载. ；国家医疗保障局 (2024). 集采药品质量严格监管，企业检查和品种抽检两个「全覆盖」. ；国家医疗保障局 (2025). 医保部门、药监部门有关同志就集采药品相关问题接受人民日报健康客户端记者采访. +- Notes: There is some debate: some claim that consistency evaluation only checks ingredients, not actual therapeutic effects. This is only partially true. The evaluation process involves giving healthy volunteers the drug and measuring its concentration levels in their blood over time; if those levels fall within 80%–125% of those produced by the original brand-name drug, it is deemed acceptable. For drugs where dosage variations can be dangerous, stricter criteria apply. Excipients—substances other than the active ingredient used for filling or coating—may differ from those in the original drug, as regulations only require identical active ingredients, dosage form, administration method, and therapeutic purpose. Consequently, consistency evaluation does not involve testing the drug on patients to gauge effectiveness; that is assessed through separate research. The National Healthcare Security Administration has conducted real-world studies involving 63 centrally procured drugs, nearly 100 top-tier hospitals, and over 300,000 patients; results consistently showed no difference compared to original brand-name drugs. For example, with metformin, the rate of achieving target HbA1c levels was 83.4% for generic users versus 78.9% for brand-name users; conversely, for fasting blood glucose control, generic users achieved a 83.8% success rate compared to 87.6% for brand-name users. In January 2025, some doctors claimed that centrally procured drugs failed to lower blood pressure, induce anesthesia, or treat diarrhea; investigations by healthcare authorities at seven Shanghai hospitals found these claims largely stemmed from hearsay and personal experience; one of the cited diarrhea medications had not yet been used in hospitals at the time. It was also acknowledged that nine problematic drugs were disqualified from the first nine procurement rounds involving over 1,600 products—six of these were imported drugs, including three original brand-name products, while three were domestic products. Two practical steps can be taken: first, original brand-name drugs remain widely available, as centralized procurement accounts for only 60%–80% of hospital purchases; patients can still obtain them at higher cost. Second, for chronic disease patients switching to generic drugs, it is vital to monitor blood pressure, blood sugar, and HbA1c levels regularly (as outlined in Section 16, point 3) rather than relying on subjective feelings; if results worsen, consult a doctor and report any adverse reactions—never discontinue medication on your own. +### 13. Once you set up family medical expense sharing in the yibao app, funds from your individual medical insurance account can be used to pay for your spouse, parents, and children’s medical care and medication. + +- Cost: No cost at all. You can set up family medical expense sharing either through your local medical insurance app or by visiting a local medical insurance office. +- In plain terms: After completing this setup, any money in your individual yibao account can be used to cover medical expenses and medication costs for your spouse, parents, and children. Without this setup, those funds remain locked in your account for your own use only. +- Benefit: Funds in your individual medical insurance account can be used to pay for any out-of-pocket medical costs you, your spouse, parents, or children incur at designated medical institutions. They can also be used to cover out-of-pocket costs for purchasing medicines, medical devices, and other medical supplies at designated retail pharmacies. Additional plans are also in place to explore allowing these funds to be used to pay for basic medical insurance premiums for eligible family members. +- Evidence grade: A +- Sources:国务院办公厅 (2021). 关于建立健全职工基本医疗保险门诊共济保障机制的指导意见（国办发〔2021〕14 号）第（五）项：「个人账户主要用于支付参保人员在定点医疗机构或定点零售药店发生的政策范围内自付费用。可以用于支付参保人员本人及其配偶、父母、子女在定点医疗机构就医发生的由个人负担的医疗费用，以及在定点零售药店购买药品、医疗器械、医用耗材发生的由个人负担的费用。探索个人账户用于配偶、父母、子女参加城乡居民基本医疗保险等的个人缴费。个人账户不得用于公共卫生费用、体育健身或养生保健消费等不属于基本医疗保险保障范围的支出。」 +- Notes: Many people have thousands of yuan sitting unused in their individual medical insurance accounts, while elderly family members often have to pay for medicines out of pocket. This setup is valid for the long term once completed. Most regions refer to this service as “family medical expense sharing”, and it can be set up directly through local medical insurance apps. There is a strict rule against using these funds for fitness activities, wellness services, or similar purposes. Using these funds to buy health supplements at pharmacies for cash payouts is considered insurance fraud. +### 14. Drinking boiled tap water instead of buying bottled water year-round + +- Cost: You only need to purchase a kettle. Boiling water takes a bit of time, plus there are minimal gas or electricity costs. +- In plain terms: In Beijing, the first-tier water price works out to 0.005 yuan per liter. Bottled water, calculated at 1 yuan for every 500 milliliters, costs 2 yuan per liter — that’s a 400-fold difference. Tap water must meet mandatory national standards, so simply boiling it before drinking is sufficient. However, if the water source is contaminated or the water becomes foul-smelling and cloudy, a few extra minutes of boiling won’t fix the problem; you should stop drinking it and report the issue to authorities. +- Benefit: The first-tier water price in Beijing is 5 yuan per cubic meter, which equals 0.005 yuan per liter. Bottled water at 1 yuan per 500 milliliters costs 2 yuan per liter — 400 times more expensive than tap water. Tap water must comply with the mandatory national standard GB 5749-2022, which was issued on March 15, 2022, and took effect on April 1, 2023. The National Disease Control and Prevention Administration oversees this standard (Chinese water prices in 2015 vs. the 2022 standard). +- Evidence grade: C (controversial) +- Sources:北京市发展和改革委员会. 居民用水价格表. ；国家市场监督管理总局 国家标准全文公开系统. GB 5749-2022 生活饮用水卫生标准. ；杭州市联合调查组 (2025). 关于杭州市余杭区部分小区供水异常调查情况通报（2025 年 7 月 23 日），新华网转载 ；杭州市余杭区人民政府. 余杭区 2025 年 4 月／5 月／6 月水源水水质监测数据（杭州余杭水务控股集团公开，检测单位杭州嘉澍环境监测有限公司，附件 PDF 表 1 第 24 项「粪大肠菌群」） 、、；公安部网络安全保卫局 (2025). 编造虚假「警情通报」，捏造「粪水」谣言，邵某豪被刑事拘留 +- Notes: The controversy stems from the fact that “compliance” is assessed only for water leaving treatment plants and at pipe endpoints. When the water source or distribution network is compromised, these standards may be temporarily unmet. On July 16, 2025, the raw water entering the Renhe Water Plant in Yuhang, Hangzhou, had an unusual odor, causing tap water in parts of Renhe and Liangzhu to smell foul. Officials attributed this to algae decomposing under low-oxygen conditions, producing sulfur-containing compounds. After switching to a different water source, tests showed no traces of total coliforms or E. coli in the treated water, and all other parameters met GB 5749-2022 requirements. Seven officials were held accountable, all July water bills were waived, and free water filters were distributed. Yet, fecal coliform counts at this same water source had been rising for months prior to the incident: at the Yongsheng intake point on the Tiaoxi River, counts rose from 10 per liter in April to 7,300 per liter in May and 16,000 per liter in June — exceeding the GB 3838 Class III surface water limit of 10,000 per liter. Counts at Siling Reservoir and Mantoushan Reservoir also surpassed this threshold that month at 28,000 and 24,000 per liter respectively. Boiling water only kills microorganisms; it cannot remove foul odors or dissolved chemicals. If water smells odd or appears yellow or cloudy, stop drinking it, report it to your water provider and via 12345, and temporarily switch to bottled water — but don’t expect a few extra minutes of boiling to resolve the issue. These incidents are localized and occasional; local compensation was provided, so they do not justify buying bottled water year-round. Online claims about “incorrectly connected sewage pipes” are fabrications based on fake police reports; the poster has since been criminally detained (see Section 9). The 1 yuan per 500 milliliter price for bottled water is a hypothetical figure for calculation purposes; you should use actual local prices instead. Residents in older neighborhoods with substandard secondary water supply systems may install filters or buy bottled water only in such cases. Water prices vary by region, so the Beijing figure is merely illustrative. +### 15. Infrequent stock trading + +- Cost: There are no monetary costs. The real challenge is resisting the urge to trade whenever you see market news. +- In plain terms: Among investors who trade most frequently, the average annual return is only 11.4%, while the overall market average for the same period is 17.9%. This gap of over 6 percentage points is almost entirely caused by the transaction fees incurred with each trade. If these fees are excluded, the returns of frequent and infrequent traders end up being quite similar. +- Benefit: This study analyzed 66,465 household accounts at US discount brokerage firms between 1991 and 1996. The group of investors who traded most often achieved an annualized return of 11.4%, while the overall market average was 17.9%, and the average return for all households was 16.4%. On average, these households turned over 75% of their stock holdings each year, swapping out three quarters of their portfolio annually. The gross returns (before transaction fees) of frequent and infrequent traders differed only slightly, meaning the performance gap is largely driven by trading costs (USA, 1991–1996). +- Evidence grade: A +- Sources:Barber BM, Odean T (2000). Trading Is Hazardous to Your Wealth: The Common Stock Investment Performance of Individual Investors. The Journal of Finance 55(2):773-806. +- Notes: These data are from the United States in the 1990s. While the commission and stamp duty structures for A-share markets differ, the core principle remains the same: higher trading frequency leads to lower net returns. This information is not intended as investment advice. +### 16. Don’t borrow money to invest, avoid leverage, and never buy assets you don’t understand + +- Cost: Zero expense. The hard part is resisting the urge to “borrow some cash to make extra profits” when the market is doing well. +- In plain terms: When you use borrowed money to buy stocks, any drop below a set threshold leaves you unable to add more funds, so your positions get automatically sold off. The paper losses instantly become real losses, leaving you no chance to wait for the price to rebound. Regulatory rules state that people who have held an account for less than six months or whose average daily assets over the past 20 trading days are under 500,000 RMB cannot open margin trading accounts. This threshold alone makes it clear this tool isn’t meant for ordinary investors. +- Benefit: Leverage essentially means borrowing money to make purchases, which also magnifies potential losses. After opening a margin account, the market value of your collateral may fall below the minimum maintenance margin set by your broker, which governs the assets you’ve pledged to them. If the value drops below this threshold and you fail to add more collateral to bring it back up, your positions get forcibly liquidated, with the broker selling them on your behalf. Paper losses turn into actual losses right away, with no window to wait for a price recovery. The same regulatory rules apply here: clients with less than six months of trading experience, insufficient risk tolerance, or average daily securities assets under 500,000 RMB over the past 20 trading days are barred from opening credit trading accounts. This requirement further proves it is not a suitable tool for regular investors (China, 2015). +- Evidence grade: B +- Sources:中国证监会 (2015). 证券公司融资融券业务管理办法（证监会令第 117 号，第十二条）. ；上海证券交易所. 《上海证券交易所融资融券交易实施细则》解读（投资者教育材料）. +- Notes: There is no direct academic evidence supporting the advice “never buy assets you don’t understand”; this is widely accepted industry consensus, so it is classified as grade C. Using consumer loans or credit card cash advances for investing also counts as a form of leverage; their interest rates are covered in section 7 of this chapter (“avoid minimum credit card payments”). This content does not constitute investment advice. +### 17. Using broad market index funds as a long-term core holding (the portion of money you keep invested for years) + +- Cost: There’s no upfront cost. The trade-off is that you give up the chance of picking a top-performing fund manager. The harder part is that when the index drops, you have to endure the losses too — you can’t pull your money out midway. +- In plain terms: The collection of stocks held by all active funds together closely mirrors the overall market. But the extra management fees those funds charge are deducted directly from your actual returns. When we rerun performance comparisons using random permutations to test how much luck plays a role, very few funds generate enough extra returns to offset their fees. +- Benefit: The combined holdings of all US active equity funds are nearly identical to the overall market portfolio: the stocks these funds own together match the composition of the broader market. However, the high costs of active management translate directly into lower net returns for investors after fees are deducted. The study used a bootstrap simulation method to randomly rerank fund performance data, to see how much of this outcome could be attributed to luck alone. The results showed that very few funds generate enough excess returns to cover their fees: the extra gains they achieve over the market are not enough to offset the fees they charge (study published in the US in 2010). S&P Dow Jones Indices conducts an annual survey: in 2024, 65% of US large-cap active equity funds underperformed the S&P 500. Over the past 24 years, an average of 64% of such funds underperformed each year. In the 15 years ending in late 2024, no single category of active funds managed to deliver better results than their index counterparts. +- Evidence grade: B +- Sources:Fama EF, French KR (2010). Luck versus Skill in the Cross-Section of Mutual Fund Returns. The Journal of Finance 65(5):1915-1947. ；S&P Dow Jones Indices (2025). SPIVA U.S. Scorecard Year-End 2024. （官网拒绝自动抓取，数字按 2025-05-12 的存档核对：）；TODO（待核实：中国市场同类研究，未找到可引用的原始文献）；Harvey CR, Liu Y (2022). Luck versus Skill in the Cross Section of Mutual Fund Returns: Reexamining the Evidence. The Journal of Finance, 77(3). （争议方） +- Notes: Point of contention: One paper re-examined this conclusion, noting that the original Fama-French test method used repeated random sampling that was not rigorous enough. Under their calculation method, even funds that do generate clear excess returns could still be classified as having results indistinguishable from luck. This means the original conclusion that “almost no active funds possess genuine skill” may be overly strict. No original research on whether Chinese active funds underperform their index counterparts has been identified for this section. This content does not constitute investment advice. +### 18. When choosing funds in the same category, pick those with lower fees + +- Cost: There’s no upfront cost. Before buying, check how much the sum of the management fee, custodian fee, and sales service fee comes to. +- In plain terms: For every 1 percentage point increase in a fund’s annual fee rate, the amount you end up with drops by roughly 18% after 20 years, and by about 26% after 30 years. Among funds in the same category, picking one with a lower fee rate is the only factor you can reliably control in advance. +- Benefit: The difference in fee rates gradually erodes your principal via compound interest — the small percentage deducted each year adds up over time. A 1 percentage point higher annual fee rate results in a final account value that is 0.99^20 ≈ 18.2% lower after 20 years, and roughly 26% lower after 30 years. Since 2023, China has been rolling out reforms to public fund fee structures, lowering the maximum allowable management and custodian fees for actively managed equity funds (exact cap figures are still being confirmed). +- Evidence grade: C +- Sources:中国证监会 (2023). 证监会有关部门负责人就公募基金费率改革答记者问. ；Fama EF, French KR (2010). 见第 11 条. +- Notes: This calculation follows standard mathematical formulas and assumes both funds generate identical pre-fee returns. In reality, you must also factor in subscription and redemption fees, as well as sales service fees for Class C shares. This information does not constitute investment advice. +### 19. Don’t put all your money into one stock, one platform, or one property + +- Cost: No cost at all. The hard part is accepting that you won’t always pick the single most profitable option. +- In plain terms: As long as multiple assets don’t all rise or fall in perfect unison, spreading your money across them keeps your average expected returns the same, while reducing the ups and downs of your account balance. Conversely, if you invest all your funds in just one stock, platform, or property, any trouble with it directly impacts your entire portfolio. +- Benefit: When several assets do not move in perfect lockstep, diversifying your investments maintains your expected returns while lowering overall volatility. This is the core conclusion of Markowitz’s 1952 portfolio theory, which has remained foundational for decades. On the other hand, putting all your money into one single stock or platform means its variance becomes your total portfolio variance — any rise or fall in its value directly affects your portfolio, with no other assets to offset losses when problems arise. +- Evidence grade: B +- Sources:Markowitz, H. (1952). Portfolio Selection. The Journal of Finance, 7(1), 77–91. +- Notes: This is rated as a B grade because the original academic paper relies purely on mathematical derivation, without providing concrete figures on exactly how much diversification reduces potential losses. Diversification can only lessen the fluctuations of your portfolio balance, it does not guarantee you won’t suffer any losses. Buying broad-based index funds (see item 17 in this section) is the easiest way to achieve effective diversification. This information is not intended as investment advice. +### 20. Individuals who pay income tax can open a personal pension account and deduct up to 12,000 yuan per year before tax; it is not worthwhile for non-taxpayers to do so. + +- Cost: There is no fee to open the account. The real cost is that the funds remain locked until retirement — you cannot withdraw them during that time. +- In plain terms: For every yuan you deposit, the tax you save equals your marginal tax rate minus 3%. If you contribute the full 12,000 yuan in a year, a taxpayer at a 10% rate saves 840 yuan, at 20% saves 2,040 yuan, and at 30% saves 3,240 yuan. Those who do not pay income tax gain nothing; they must also pay an additional 3% tax when withdrawing funds, resulting in a net loss. The money stays locked until retirement. +- Benefit: The maximum annual contribution of 12,000 yuan can be fully deducted from your total taxable income — whether from wages or business earnings. Any investment returns generated within the account are exempt from personal income tax for now. When withdrawals occur, they are taxed separately at a flat rate of 3%. Thus, the total tax saving equals your marginal tax rate minus 3% multiplied by the actual amount contributed. For example, at a 10% marginal rate you save up to 840 yuan per year; at 20% the saving is 2,040 yuan, and at 30% it reaches 3,240 yuan. Non‑taxpayers receive no benefit now and must pay 3% tax later, making it a net loss. The annual contribution limit resets each calendar year; any unused portion cannot be carried over. This policy has been in effect nationwide since 15 December 2024. +- Evidence grade: A +- Sources:财政部、税务总局 (2024). 关于在全国范围实施个人养老金个人所得税优惠政策的公告（财政部 税务总局公告 2024 年第 21 号，2024 年 12 月 12 日）. ；人力资源社会保障部等五部门 (2022). 个人养老金实施办法（第七、八、九、十二、十三条）. +- Notes: This account operates on a closed‑loop basis — once funds are deposited they cannot be withdrawn except under four specific circumstances: reaching the statutory retirement age, becoming completely unable to work, emigrating, or as otherwise stipulated by law. It is therefore not a typical investment vehicle but a long‑term tax‑saving arrangement. Before contributing, calculate how much extra tax you would pay per additional yuan earned to determine an appropriate amount. Avoid using emergency savings for this purpose (see Section 27). You must also select your own investment products; losses are possible. Selection criteria mirror those outlined in Sections 17 and 18 of this chapter — broad‑based index funds with low fees are preferred. Proof of deductions is issued by the Personal Pension Information Management Service Platform. You may elect to claim the deduction either at the time of payroll withholding or during the annual tax reconciliation process (see Section 2). +### 21. Paying for gym visits individually or on short-term plans is only worthwhile if you have a consistent attendance record spanning over a year + +- Cost: Buying passes individually ends up costing more per visit compared to an annual membership. You’ll need to honestly estimate how many times per month you actually plan to go. +- In plain terms: According to three years of data from U.S. gyms, members who signed contracts with monthly fees exceeding $70 attended the gym just 4.3 times per month on average, which works out to over $17 per visit. Meanwhile, a 10‑visit pass costs only $10 per visit. Collectively, these members paid roughly $600 more over their membership period. Unless you’ve already been going to the gym regularly for at least a year, buying individual passes or short‑term plans is far more economical. +- Benefit: This study analyzed three years of data from 7,752 members at three U.S. fitness clubs. Members opting for monthly plans costing over $70 visited the gym just 4.3 times per month on average, resulting in a per‑visit cost exceeding $17. In contrast, a 10‑visit pass costs only $10 per visit. Over the same period, these members ended up paying an average of $600 more than they would have with a yearly membership. Additionally, the proportion of monthly‑plan members who kept their membership for over a year was 17% higher than that of annual‑plan members (based on three years of U.S. panel data). +- Evidence grade: B +- Sources:DellaVigna S, Malmendier U (2006). Paying Not to Go to the Gym. American Economic Review 96(3):694-719. +- Notes: This is just one study using data from the United States. Nevertheless, its underlying principle is universally applicable: people tend to overestimate their future self‑control. If you’ve already maintained a consistent routine of going to the gym at least twice a week for a full year, then an annual membership does prove to be the cheaper option. +### 22. Sign a written contract before paying a deposit; if a business faces risks, it must stop taking payments, and you have the right to get back any unused balance if it shuts down. + +- Cost: No cost involved. The real challenge is insisting on a written contract on the spot — refusing any “pay first, talk later” offers. +- In plain terms: Any business that accepts a prepayment from you must sign a written contract with you that clearly outlines how refunds will be handled. If a business runs into serious operational problems, it must stop collecting prepayments. Even if it plans to close or relocate, it must give you advance notice. At that point, you can either demand that it continue providing services or request a refund for any unused balance. Violating these rules results in fines for the business. +- Benefit: The regulations require businesses accepting prepayments to sign written contracts that specify refund procedures. If a business faces major operational risks, it must cease taking prepayments. When a business decides to close or move locations, it must inform consumers ahead of time. Consumers have the right to demand continued service delivery or a refund for any unspent balance. Breaching these rules can lead to fines ranging from 1 to 10 times the illegal earnings; if no illegal earnings exist, fines up to 500,000 yuan may apply. +- Evidence grade: A +- Sources:国务院 (2024). 中华人民共和国消费者权益保护法实施条例（国务院令第 778 号，2024 年 7 月 1 日施行）. 第二十二条：「经营者以收取预付款方式提供商品或者服务的，应当与消费者订立书面合同，约定商品或者服务的具体内容、价款或者费用、预付款退还方式、违约责任等事项。」「经营者未按照约定提供商品或者服务的，应当按照消费者的要求履行约定或者退还预付款。」「经营者出现重大经营风险，有可能影响经营者按照合同约定或者交易习惯正常提供商品或者服务的，应当停止收取预付款。经营者决定停业或者迁移服务场所的，应当提前告知消费者……消费者……有权要求经营者继续履行提供商品或者服务的义务，或者要求退还未消费的预付款余额。」；第五十条罚则 +- Notes: These regulations mainly serve as a basis for legal action after the fact — they cannot prevent issues beforehand. If a business actually shuts down, its funds are often no longer accessible. Therefore, it is advisable to follow the advice in this section to limit prepayments to small amounts via “pay-per-use” or short-term plans. In case of problems, you can then rely on these regulations to protect your rights. Article 27 of the same regulations also requires businesses collecting deposits to agree in advance on refund methods, procedures, and timeframes, and they cannot impose unreasonable conditions on refunds. +### 23. Implementing a 24-hour cooling-off period for non-essential big-ticket purchases; making full use of the seven-day no-questions-asked return policy for online shopping + +- Cost: No direct monetary cost. You simply have to wait an extra day to receive what you want. Usually, you’re responsible for return shipping fees. The real challenge is resisting the urge to place the order on the same day. +- In plain terms: What you save is exactly the money spent on items you no longer want the very next day. For online purchases, you can return them for any reason within seven days of delivery. There are a few categories excluded from this policy: custom-made items, perishable goods, digital products that have been opened, and newspapers and periodicals. +- Benefit: What you save is precisely that portion of impulse buys you no longer want after a day. There is no single universal percentage representing this share. As mentioned, online purchases can be returned within seven days of receipt, with the same exclusions applying. This policy has been in effect in China since 2017. +- Evidence grade: C +- Sources:国家市场监督管理总局 (2020 修订). 网络购买商品七日无理由退货暂行办法（总局令第 31 号）. +- Notes: The cooling-off period is essentially a practical measure with no direct academic evidence backing it up. For purchases not deterred by this period, the seven-day no-questions-asked return policy still applies. Before initiating a return, make sure to verify two things: whether the item falls under the excluded categories, and whether its packaging remains intact. +### 24. Don’t fall for “strikethrough prices” or impulse buying during sales + +- Cost: Zero monetary cost. The trade‑off is that you might miss out on some genuine discounts. You’ll need to keep track of the regular prices of the items you buy most often. The real challenge is resisting the urge to stock up on the day of a sale. +- In plain terms: When judging whether something is cheap or expensive, people rely on the first price they see; later adjustments rarely make up for that initial impression. Thus, a claim like “original price 999, now 499” makes us systematically overestimate how much we’re saving. By regulation, the baseline for a discount should be the lowest price at which the item actually sold in the seven days preceding the promotion; the crossed‑out price isn’t necessarily a real transaction price. +- Benefit: Human judgment is anchored to the first price encountered, and subsequent corrections are usually insufficient. Consequently, statements such as “original price 999, now 499” inflate our perception of the discount amount. Official rules require that the reference price be the minimum actual sale price recorded in the same store during the seven days prior to the sale; the discount percentage must be calculated against that figure. The price marked through may never have been charged in reality (China, effective 2020). +- Evidence grade: C +- Sources:Tversky A, Kahneman D (1974). Judgment under Uncertainty: Heuristics and Biases. Science 185(4157):1124-1131. ；国家市场监督管理总局 (2020). 规范促销行为暂行规定（总局令第 32 号，第二十一条）. +- Notes: The anchoring effect is a finding from laboratory studies; no one has quantified exactly how much money consumers lose by over‑buying. There are also hidden costs: items may expire, they take up space, and we tend to use them more simply because they’re on hand. Only purchase in bulk when all three conditions hold: a long shelf life, a definite need for the product, and a price genuinely lower than its usual cost. +### 25. It’s better to choose a non‑return insurance plan and treat any “refunds” or dividends as non‑guaranteed benefits + +- Cost: With a non‑return plan, no money is returned at maturity, which can make it feel like “wasted money.” You’ll need to handle your own savings. The hardest part is accepting that this money won’t be coming back. +- In plain terms: The insurance company makes no promises about any dividends or refunds you might receive. Policy documents must explicitly state in bold text that “future policy dividends are non‑guaranteed benefits.” The extra premiums paid for return features essentially act as a savings account managed by the insurer; there’s no guarantee on returns, and withdrawals are difficult. +- Benefit: Regulatory rules require that dividend‑type products clearly indicate in bold print that “future policy dividends are non‑guaranteed benefits, and their distribution is uncertain.” The dividend illustration is the projected payout table provided by the insurer; its maximum interest spread is 4.5% minus the policy’s guaranteed interest rate. This guaranteed rate is the fixed return stated in the contract. Premiums paid for return or dividend features function similarly to a savings account held by the insurer — with no guaranteed returns and limited liquidity; withdrawals are hard to arrange (China, effective 2023). +- Evidence grade: C +- Sources:中国银保监会 (2022). 一年期以上人身保险产品信息披露规则（银保监规〔2022〕24 号）. +- Notes: While return‑type insurance can help people who struggle to save by enforcing regular payments, this advice applies mainly to individuals who can manage their own finances. Whether opting for a non‑return plan and investing the saved premiums is truly superior to buying a return‑type policy depends on the specific product; no systematic data are available to support this comparison here. This information is not financial advice. +### 26. Get sufficient third‑party liability coverage: the mandatory insurance limits are uniform nationwide and relatively low, so any excess must be paid out of your own pocket + +- Cost: Commercial third‑party liability insurance costs a few hundred to a few thousand yuan per year. The higher the coverage amount you choose, the cheaper the premium becomes per unit of coverage. +- In plain terms: When you’re at fault, the mandatory insurance pays out only up to three specific limits: 180,000 yuan for death or disability, 18,000 yuan for medical expenses, and 2,000 yuan for property damage. These amounts cannot be combined or transferred between categories. Compensation for injuries often exceeds these caps, and any shortfall must be paid by you personally; therefore, it’s essential to purchase enough commercial third‑party coverage. +- Benefit: Nationwide, mandatory insurance enforces uniform liability limits. These limits are calculated separately for four categories: death or disability, medical costs, property damage, and compensation payable when you’re not at fault. Following the 2020 overhaul of auto insurance, the total maximum payout is now 200,000 yuan, broken down as 180,000 yuan for death/disability, 18,000 yuan for medical costs, and 2,000 yuan for property damage. When you’re not liable, the limits drop to 18,000 yuan for death/disability, 1,800 yuan for medical costs, and 100 yuan for property damage. Any amount above these caps must be borne by the responsible party; drivers lacking mandatory coverage face vehicle impoundment and a fine equal to twice the unpaid premium. +- Evidence grade: A +- Sources:国务院 (2006, 2012 修订). 机动车交通事故责任强制保险条例（国务院令第 462 号，第 618 号令修改）第二十三条：「机动车交通事故责任强制保险在全国范围内实行统一的责任限额。责任限额分为死亡伤残赔偿限额、医疗费用赔偿限额、财产损失赔偿限额以及被保险人在道路交通事故中无责任的赔偿限额。」「责任限额由保监会会同国务院公安部门、国务院卫生主管部门、国务院农业主管部门规定。」第二十一条限额内赔偿；第三十九条未投保的「由公安机关交通管理部门扣留机动车……处依照规定投保最低责任限额应缴纳的保险费的2倍罚款」. ；中国银行保险监督管理委员会 (2020). 关于实施车险综合改革的指导意见（银保监发〔2020〕41 号，四（四）：「将交强险总责任限额从12.2万元提高到20万元，其中死亡伤残赔偿限额从11万元提高到18万元，医疗费用赔偿限额从1万元提高到1.8万元，财产损失赔偿限额维持0.2万元不变」）. （国务院公报） +- Notes: These limits are set by financial regulators and may be adjusted over time. The figures cited reflect current values after the September 2020 reforms; it’s advisable to verify them before purchasing a policy. Crucially, mandatory insurance pays out per category separately — unused portions cannot be applied toward other categories. Compensation claims often surpass these caps, leaving drivers personally liable for the remainder. While this guide does not prescribe an exact coverage amount, it highlights how a modest additional outlay can safeguard you against a scenario with low probability yet potentially devastating financial impact. +### 27. Set aside an emergency fund equal to 3–6 months of living expenses in a readily accessible account + +- Cost: There is no direct monetary cost. The trade-off is forgoing higher returns; the funds must be kept in a checking account, money market fund, or any deposit account that allows immediate withdrawals. The real challenge lies in resisting the urge to dip into the fund while saving it up. +- In plain terms: Keep 3 to 6 months’ worth of living expenses in an account you can withdraw from at any time. This way, if you lose your job or fall ill, you won’t have to borrow money at an 18% annual interest rate, nor will you need to sell your investments at a loss. Deposits in banks are protected by deposit insurance, which covers up to 500,000 RMB per bank in China. +- Benefit: An emergency fund eliminates the need to borrow money or sell investments at a loss during unexpected events like job loss or illness. For details on the minimum annual interest rates for consumer loans and credit card payments, see Section 7 of this chapter (which advises against relying on minimum credit card payments). +- Evidence grade: C +- Sources:国务院 (2015). 存款保险条例（国务院令第 660 号，第五条）. +- Notes: The recommendation to save 3–6 months’ worth of expenses is a widely accepted guideline, but no official or academic sources have been identified to support it, hence the C grade. The required amount should be calculated based on your regular monthly expenses, not your income. This information does not constitute investment advice. +### 28. Run a quick comparison before paying off your mortgage — don’t rely on gut feeling + +- Cost: No cost at all. It only takes about half an hour to do the math. You’ll need to honestly estimate the steady after‑tax return you can expect over the long run. +- In plain terms: Paying off your mortgage is essentially the same as earning a guaranteed return equal to your mortgage rate. So the only question you need to ask is: can you reliably earn a higher after‑tax return than that rate? If the answer is yes, it makes sense to keep the money invested. If not, or if you’re unsure, paying off the loan is the better choice. With an equal principal‑and‑interest repayment plan, most of the early payments go toward interest; the earlier you pay, the more you save. Most bank apps have a “pre‑payment calculator” that gives you the exact numbers. +- Benefit: The calculation works like this: let r be the annual mortgage rate as stated in your contract. As of 20 August 2026, the 5‑year LPR in China is 3.5%; the actual rate you pay is either higher or lower than this figure. Next, let g represent the after‑tax annual return you can expect from an alternative investment — the average percentage gain you’d earn each year by putting that money elsewhere. Paying off the mortgage guarantees you a return of exactly r; each dollar you apply to the loan earns you that rate for sure. If g consistently exceeds r, it’s better to keep the money invested. If g is lower than r, or if you can’t reliably predict it, paying off the loan locks in a risk‑free return equal to r. Again, because most of the early payments under an equal principal‑and‑interest plan cover interest, the earlier you pay, the more you save. This effect is clearly shown by the numbers produced by your bank’s pre‑payment calculator (Chinese rates as of 2026). +- Evidence grade: C +- Sources:全国银行间同业拆借中心受中国人民银行授权 (2026). 2026 年 8 月 20 日贷款市场报价利率（LPR）公告. +- Notes: This section provides only the calculation method, not a definitive recommendation. It’s relatively rare for investment returns to reliably surpass mortgage rates. Regardless of which option you choose, be sure to keep enough cash on hand for emergencies. Also, check your contract for any prepayment penalties. This information is not intended as financial advice. +### 29. When shopping online, follow platform rules and laws — not influencers or “positive reviews” + +- Cost: There’s no cost involved. Just take a moment before ordering to read the return policy and deposit rules. After receiving your purchase, keep screenshots of the order, the livestream replay, and any chat records. The real challenge is resisting the persuasive atmosphere created by influencers. +- In plain terms: If a seller cheats you, they must pay three times the amount you paid — with a minimum compensation of 500 yuan. Platforms that know sellers are breaking the law but do nothing must share in the liability. The maximum deposit allowed is 20% of the contract value; if you break the contract, that deposit is forfeited, but if the seller does, they must return double the amount. Organizing fake orders or fake positive reviews in livestreams is illegal, and algorithmic price discrimination based on personal data is strictly prohibited. +- Benefit: Sellers found guilty of fraud must pay three times the purchase price, with a minimum payout of 500 yuan. Platforms aware — or reasonably expected to know — that sellers are violating laws must also bear joint liability, so you can seek compensation directly from them. Livestream hosts and platforms may not fabricate transaction volumes, follower counts, views, or likes, nor spread false information; doing so incurs civil liability. Those caught orchestrating fake transactions or reviews face fines up to 1 million yuan; repeat offenders may be fined between 1 million and 2 million yuan and even lose their business license. Deposits must stay under 20% of the contract total; if you breach the contract, that deposit is lost, but if the seller does, they must return double it. Using personal data for automated pricing decisions that result in unfair price differences — commonly known as “algorithmic price discrimination” — is illegal nationwide. +- Evidence grade: A +- Sources:全国人大常委会 (2013 修正). 消费者权益保护法（第四十四、五十五条）. （市场监管总局转载）；国家网信办等七部门 (2021). 网络直播营销管理办法（试行）（第十八、二十八条）. ；全国人大常委会 (2025 修订). 反不正当竞争法（第九、二十五条）. （全国社保基金理事会转载）；全国人大 (2020). 民法典（第五百八十六、五百八十七条）. ；全国人大常委会 (2021). 个人信息保护法（第二十四条）. （国家统计局转载）；山东省市场监管局 (2025). 六起网络不正当竞争典型案例. +- Notes: There are no official comparative statistics available on which platforms offer the best value or minimize the risk of buying low-quality goods, so this book does not rank any platforms. The only publicly available data consists of general inspection results (see Section 32 regarding national inspection reports). Following the 2025 revision of China’s Anti-Unfair Competition Law, provisions on false advertising moved from Article 8 to Article 9, while related penalties shifted from Article 20 to Article 25; the new law took effect on October 15, 2025, so be sure to use the updated article numbers. In one case in Shandong, a company organized 75 fake transactions involving over 680,000 yuan; although the exact fine amount was not disclosed, the company was penalized. For information on seven-day unconditional returns, see Section 23 in this chapter (“Making the seven-day return policy work for you”). +### 30. If something goes wrong after buying from a livestream, first ask the platform for the seller’s and influencer’s details — they’re required to provide them. + +- Cost: No cost involved; you simply need to request the information from the platform. +- In plain terms: One of the biggest hurdles when problems arise from purchases made during livestreams is figuring out exactly who to hold responsible. In such cases, you can demand that the platform disclose the identity of the livestream operator and any associated influencers, along with their business records. The platform is legally obligated to comply with this request. +- Benefit: When consumer disputes occur, operators of livestream marketing platforms must furnish buyers with the relevant details of both the livestream operator and any affiliated influencers, as well as all related business documentation. The primary obstacle in pursuing legal recourse in these situations is identifying the right party to sue; obtaining this information removes that barrier entirely. +- Evidence grade: A +- Sources:国务院 (2024). 中华人民共和国消费者权益保护法实施条例（国务院令第 778 号，2024 年 7 月 1 日施行）. ：「经营者通过网络直播等方式提供商品或者服务的，应当依法履行消费者权益保护相关义务。直播营销平台经营者应当建立健全消费者权益保护制度，明确消费争议解决机制。发生消费争议的，直播营销平台经营者应当根据消费者的要求提供直播间运营者、直播营销人员相关信息以及相关经营活动记录等必要信息。」「直播间运营者、直播营销人员发布的直播内容构成商业广告的，应当依照《中华人民共和国广告法》的有关规定履行广告发布者、广告经营者或者广告代言人的义务。」 +- Notes: Before making any purchase, be sure to record both the livestream footage and any promises made by the host. Should any issues arise, first request the seller’s and influencer’s information from the platform before deciding whether to file a complaint or pursue legal action. This same regulation also outlines three additional requirements: first, merchants cannot unilaterally expand the list of items excluded from the seven-day no-questions-asked return policy; second, such exclusions must never be set as default options; and third, merchants are prohibited from denying returns without your explicit consent. +### 31. If you buy unsafe food, you can demand ten times the purchase price as compensation; if the amount is under 1,000 yuan, you’re still entitled to 1,000 yuan. + +- Cost: There’s no cost involved. Keep the food, its packaging, and the receipt — don’t throw them away or wash them, and take photos right away. First try to negotiate with the seller or platform; if that fails, call 12315. Filing a lawsuit can take several months. The hard part is resisting the urge to discard the items first. +- In plain terms: If you buy expired or spoiled food, the food itself, its packaging, and the receipt serve as evidence — so don’t toss them out. You’re entitled to compensation equal to ten times the purchase price or three times your actual loss; if that amount is less than 1,000 yuan, you still get 1,000 yuan. You may choose either the seller or the manufacturer to compensate you; the party you approach must pay first and cannot shift the responsibility to the other side. +- Benefit: If you suffer harm due to food that fails to meet safety standards, you may seek compensation from either the seller or the producer. The party receiving your compensation request must assume primary responsibility and pay out immediately, without shifting liability. In addition to basic compensation, you can demand ten times the purchase price or three times your loss as punitive damages, with any amount below 1,000 yuan rounded up to 1,000 yuan. One exception applies: this does not cover cases where labeling or instructions contain minor flaws that do not affect safety or mislead consumers. Judicial interpretations set three key conditions: the purchase must be for personal or household use; the food must violate safety standards; and there must be no proof the buyer knew of those violations at the time of purchase. Only then can ten times the purchase price be claimed as punitive damages. Conversely, if a buyer knowingly purchases substandard food and then seeks compensation, courts will only support claims within reasonable household consumption limits. Repeated purchases or multiple lawsuits are evaluated as a single total amount. Certain labeling issues — such as irregular font sizes, typos, or non‑standard net‑weight indications — generally do not qualify for punitive damages provided they do not mislead consumers about safety. +- Evidence grade: A +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第一百四十八条）. （国家法律法规数据库，2025 年 12 月 1 日起施行）；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第一、六、七、八、十二、十三、十四、十五、十六条，2024 年 8 月 22 日起施行）. （最高人民法院公报） +- Notes: The order of evidence matters more than the amount of compensation. Take photos and videos showing the packaging, production date, any foreign objects, and the purchase record before contacting the seller or platform; do not discard or wash the items beforehand. 12315 provides mediation, not binding rulings. If the seller refuses to cooperate, litigation becomes the only option — see Section 8, Article 22 for rules on small‑claims litigation involving online or second‑hand purchases. Whether foreign objects like hair or insects qualify as violations of food safety standards must be determined by regulatory authorities or through testing; simply finding hair in food does not automatically guarantee 1,000 yuan in compensation. For ordinary consumer fraud, triple compensation applies, with amounts under 500 yuan rounded up to 500 yuan — see Section 8, Article 29. Those producing and selling food must comply with licensing, labeling, and legal restrictions on health claims; details appear in Section 12, Articles 8–11. Finally, abusing compensation claims is prohibited: fabricating evidence of illegal production to extort payments constitutes extortion and may lead to criminal referral; similarly, filing lawsuits based on false premises may result in fines, detention, or counterclaims for defamation. This section applies specifically to individuals seeking protection for themselves and their families. +### 32. Check national inspection reports, 3C certification, and energy labels before buying big-ticket items + +- Cost: It costs nothing. Just spend a few minutes looking up information on the websites of the State Administration for Market Regulation and the Certification and Accreditation Administration. +- In plain terms: In 2024, national inspections covered 25,250 batches of products, with 14.3% found to be non-compliant. The situation is worse on e-commerce platforms: out of 7,297 inspected batches, 23.5% failed to meet standards, compared to 15.1% of products sold in physical stores. Before purchasing any big-ticket item, take a few minutes to check the latest inspection reports and verify that the 3C certificate is genuine. Any product required to carry an energy label must have one. +- Benefit: The 2024 national supervision inspections examined 25,250 product batches, resulting in a non-compliance rate of 14.3%. On e-commerce platforms, 7,297 batches were inspected, with a non-compliance rate of 23.5% — an increase of 1.8 percentage points from the previous year. Physical stores saw 8,055 batches inspected, with a non-compliance rate of 15.1%. The authenticity of mandatory product certification (3C) certificates can be checked via the “Certification Results” section on the Certification and Accreditation Administration’s official website. Energy labels are strictly regulated under product catalogs; they must include the energy efficiency grade, relevant metrics, and a unique identification code. Falsifying or misusing energy labels, or failing to apply them where required, is punishable under the Energy Conservation Law across China. +- Evidence grade: B +- Sources:市场监管总局 (2025). 关于 2024 年产品质量国家监督抽查情况的通报. ；国家认监委. 官网「认证结果」查询入口. ；国家发展改革委、国家质检总局 (2016). 能源效率标识管理办法（令第 35 号，第三、七、二十七条）. +- Notes: These inspections involve regulators selecting a sample of products for testing; their results do not represent the overall market compliance rate, nor can they be used to rank online platforms. There are no studies quantifying exactly how many substandard products can be avoided by conducting such checks, which is why this item is rated B. The verification platform cx.cnca.cn used in this section was inaccessible during our checks; the correct entry point is the homepage at cnca.gov.cn. Inspection reports are updated annually, so always consult the most recent edition when referencing them. +### 33. Bracelets, jade, luxury watches, and collectibles should be judged by “how much you spend” rather than “how much you save” + +- Cost: There’s no upfront cost — just don’t justify buying these items by claiming they’ll appreciate in value later. The real challenge is resisting the urge to allocate extra budget for “preservation of value.” +- In plain terms: A portion of the purchase price for such items is already consumption tax: watches priced at 10,000 yuan or more incur a 20% tax; gold, platinum, and diamond jewelry faces a 5% tax; other precious stones and jade incur a 10% tax, plus standard VAT. This tax cannot be reclaimed when you resell the item. If you truly love these items, treat them as a personal expense rather than an investment. +- Benefit: On the purchase side, tax rates are clearly defined in the Consumption Tax Schedule: “luxury watches” are taxed at 20%. Within “precious jewelry and stones,” gold, platinum, and diamond jewelry incur a 5% tax, while other precious stones and jade incur 10%. “Luxury watches” are defined as any watch with a sales price (excluding VAT) of 10,000 yuan or more. On the resale side, the Pawnbroking Management Regulations apply: Article 36 limits pawn terms to a maximum of six months; Article 37 sets interest rates based on the six-month benchmark rate published by the People’s Bank of China, which cannot be deducted upfront from the loan amount. Article 38 caps monthly comprehensive fees for pawning watches or jade at 42‰ of the loan amount, plus an additional 4.2% monthly fee. For real estate mortgages, this cap is 27‰, and for property rights pledges it is 24‰. Article 40 states that if the pawner fails to redeem or renew the pawn within five days of the term’s end, the item becomes forfeited; Article 43 permits auctioning forfeited items valued at over 30,000 yuan, with proceeds first covering auction fees and loan principal plus interest, leaving any remainder to be returned to the pawner (or recovered from them if insufficient). +- Evidence grade: A +- Sources:国务院 (2008). 中华人民共和国消费税暂行条例（国务院令第 539 号，附《消费税税目税率表》）. ；财政部、国家税务总局 (2006). 关于调整和完善消费税政策的通知（财税〔2006〕33 号）. ；商务部、公安部 (2005). 典当管理办法（2005 年第 8 号令，第三十六、三十七、三十八、四十、四十三条）. +- Notes: When pawning these items, remember that monthly comprehensive fees cap at 42‰ of the loan amount — equating to roughly 50% of the loan value over a year. This figure is a rough estimate derived by multiplying the monthly rate by 12, not an exact annual interest rate. While tax and fee rates are explicitly stated, there are no official statistics confirming long-term appreciation for such items; this guide makes no predictions or endorsements. The key point is to avoid treating personal purchases as investments: buying these items simply because you enjoy wearing them is perfectly fine, but adding budget based on hopes of future resale value is a recipe for financial loss. Gold also warrants separate consideration: investment-grade bullion traded by weight differs from jewelry sold by piece, which includes design and labor costs not recovered upon resale. Listed prices on secondhand platforms are not actual transaction values and should not be treated as market benchmarks. +### 34. For jewelry and gemstones, only test reports bearing the CMA mark are acceptable; you must also verify the issuing agency on the regulator’s official website. + +- Cost: No cost at all. Checking an agency’s qualifications takes just a few minutes before placing any order. +- In plain terms: Certificates can be forged, so what truly matters is confirming the agency that issued it. Any testing organization allowed to issue reports must hold proper credentials, and its reports must display the CMA mark. The regulatory authority publishes a list of certified agencies on its website, making it easy for consumers to confirm whether a given provider is on that list. In actual enforcement cases, some “national inspection certificates” accompanying goods were found to have been fabricated by unrelated parties. +- Benefit: The relevant rules are laid out in the *Administrative Measures for Qualification Recognition of Inspection and Testing Agencies*. Article 2 states that qualification recognition is a licensing process for agencies that provide data and results with evidentiary value to the public; it involves a thorough review followed by issuance of certification. Article 15 specifies that the CMA mark comprises both the CMA logo and the corresponding certificate number. Article 21 requires any agency issuing such data to display this mark on all reports. Article 22 mandates that authorities publish all certified agencies and their current status online. Article 34 imposes a fine of up to 30,000 RMB on any agency operating without proper certification. Article 37 similarly penalizes up to 30,000 RMB any act of forging, altering, or misusing such certification marks. Real-world examples illustrate these rules: in June 2026, China’s State Administration for Market Regulation released typical cases of fraud in the traditional crafts market. One involved a livestream in Donghai, Jiangsu, where sellers claimed to offer “natural, unacid-washed, unprocessed Burmese A‑grade gems” and displayed a “national inspection certificate.” Laboratory tests, however, revealed the items to be dyed quartzite, treated jadeite, glass, and plastic; the certificate had been produced by a contact of the seller. Another case in the same county uncovered 469 suspected counterfeit crystal products; 210 proved to be natural crystal while 259 were synthetic. In Zhenping, Henan, a shop displayed a board claiming partnership with a “GIA CMA China Gemstone Testing Center” and sold 181 counterfeit “National Gemstone Quality Supervision Center” certification tags alongside bracelets nationwide. +- Evidence grade: A +- Sources:国家质量监督检验检疫总局 (2015 公布，2021 修改). 检验检测机构资质认定管理办法（第二、十五、二十一、二十二、三十四、三十七条）. ；国家市场监督管理总局 (2026). 市场监管总局公布一批传统工艺市场「打假清源」典型案例. ；国家标准化管理委员会. GB/T 16552—2017《珠宝玉石 名称》（现行，2018 年 5 月 1 日实施）. +- Notes: China has established national standards for naming jewelry and gemstones. Test conclusions are often phrased as “quartzite (dyed)” or “jadeite (treated)”; the words inside the parentheses indicate the price difference. Terms such as “A‑grade,” “old‑mine,” and “unprocessed” are marketing buzzwords, not technical conclusions; the livestream mentioned earlier used exactly these phrases. Other deceptive tactics documented in these cases include faking mining sites, staging “miner” livestreams, deploying online trolls to hype sales, and inventing stories about urgent financial needs or family emergencies. Claims that products can “treat rheumatism, boost immunity, improve sleep, or clear blood vessels” are also deemed false advertising and are prosecuted accordingly. For larger purchases, the general verification method is outlined in Section 32 (checking sampling reports and 3C certification). Information on whom to contact when problems arise in a livestream is provided in Sections 29 and 30 (referring to platform rules and requesting data from the platform). +### 35. Random sales such as blind boxes and gacha games are treated as “money that won’t come back” + +- Cost: There is no direct cost involved. You simply need to set a strict budget before buying. The real challenge is resisting the urge to keep purchasing when you fail to get the item you wanted. +- In plain terms: Sellers must display the draw rules, probabilities, and quantities of limited‑edition items in a highly visible manner. They are prohibited from manipulating results behind the scenes or offering empty boxes. While the guidelines encourage setting minimum guarantees and limits on spending and number of draws, they are not mandatory. For blind boxes purchased online, if the seller has clearly explained the terms and you have confirmed them, you cannot exercise the seven‑day right to return after opening the box. +- Benefit: The basis for these rules is the “Guidelines on the Operation of Blind Box Business (Trial)”. Article 9 mandates that a list of key information be displayed prominently so consumers know it before buying. This information includes the product name, type, design, draw rules, distribution of items, quantity of limited items, draw probabilities, and the range of item values. The same article also forbids three practices: altering draw results or probabilities through backend manipulation, refusing or delaying delivery of items via cashbacks or exchanges, and producing empty boxes. Article 11 merely “encourages” operators to implement safeguards such as limits on draw time, spending, and frequency to promote rational consumption. Article 17 applies to blind boxes sold online; if the seller has fully informed you and you have confirmed the terms, the seven‑day return right does not apply after opening. Operators must not replace your explicit consent with pre‑checked boxes. Article 21 states that blind boxes must not be used as a guise for gambling. Article 23 prohibits sales to children under eight; for those aged eight and older, consent from a legal guardian must be obtained. +- Evidence grade: A +- Sources:市场监管总局 (2023). 盲盒经营行为规范指引（试行）（国市监稽发〔2023〕39 号，第九、十一、十七、二十一、二十三条）. +- Notes: These guidelines serve as recommendations for operators and are not themselves a basis for penalties. In case of disputes, laws such as the Product Quality Law, Anti‑Unfair Competition Law, and Consumer Rights Protection Law apply. Specific grounds for complaints include failure to disclose probabilities, discrepancies between advertised and actual probabilities, and receipt of empty boxes. Before filing a complaint, record screenshots of the rules and the unboxing process. The exclusion of the seven‑day return right requires that the seller gave full disclosure and you confirmed it; default selections cannot substitute your consent. Additional rules govern sales to minors: no sales to children under eight, and for older minors proof of guardian consent is mandatory. Information on refunding mobile‑game micro‑transactions made by children can be found in section 9 of this chapter. The 24‑hour cooling‑off period for large non‑essential purchases is described in section 23. The cycle of “initial excitement fading into further purchases” is discussed in section 6, item 23. +### 36. If you care about what’s in your food, buy pre-packaged products: loose goods at retail counters aren’t legally required to list ingredients + +- Cost: No cost at all. Pre-packaged versions of the same items are usually a bit pricier than loose ones. Checking the ingredient list takes just a few seconds. +- In plain terms: The law only mandates ingredient lists for pre-packaged foods; loose goods have no such requirement. For loose products, retailers only need to display the product name, production date, shelf life, and manufacturer details. So, the absence of any mention of additives does not mean they were not added — it simply means the law does not require them to be listed. If you care about what’s in your food, opt for pre-packaged versions where both the full ingredient list and additive details are clearly printed. +- Benefit: Article 67 of China’s Food Safety Law stipulates that all pre-packaged foods must carry a label containing nine mandatory pieces of information. The second item on this list is the “list of ingredients or components,” and the seventh item is “the generic names of any food additives used, as defined in national standards.” Article 68 contains far fewer requirements for loose foods: it only requires retailers to display the product name, production date or batch number, shelf life, and the manufacturer’s name, address, and contact details on the packaging or container. There is no mention of ingredient lists or additives here. This distinction is most evident in frozen seafood products. GB 2760—2024 permits the use of phosphoric acid and phosphates as moisture retention agents — commonly referred to as water-retaining agents — in frozen seafood, with a maximum permitted usage level of 5.0 g/kg calculated as phosphate. Use within this limit is fully legal. The main issues arise from excessive usage and the practice of adding ice to increase product weight. Following a 2025 exposé by China Central Television’s 3·15 Gala, which revealed that some shrimp producers illegally added excessive amounts of water-retaining agents (composite phosphates) and added extra ice to boost weight, regulatory authorities mandated that all such products must clearly list water-retaining agents like phosphates, net weight (excluding ice coating weight), and full ingredient lists on their labels (this requirement applies nationwide, per the third 2025 amendment to China’s Food Safety Law, effective 1 December 2025). +- Evidence grade: A +- Sources:全国人大常委会 (2025 年第三次修正). 中华人民共和国食品安全法（第六十七、六十八条，2025 年 9 月 12 日公布，2025 年 12 月 1 日施行）. ；国家卫生健康委员会、国家市场监督管理总局 (2024). 食品安全国家标准 食品添加剂使用标准（GB 2760—2024，附录 A 表 A.1「磷酸及磷酸盐」项下食品分类号 09.02.01 冷冻水产品；A.3 规定表 A.1 列出的食品添加剂按照规定的使用范围和最大使用量使用）. ；六安市市场监督管理局 (2025). 关于水产制品及使用保水剂的相关企业提醒告诫函（2025 年 3 月 24 日）. +- Notes: The fact that additives are not listed on a product does not mean they were not added — it simply means the law does not require them to be disclosed. If you want to know exactly what a product contains, always choose pre-packaged versions. For frozen shrimp, fish fillets, and similar items, the net weight listed on pre-packaged packaging already excludes ice coating weight; using this figure to calculate unit price gives a much more accurate cost estimate. For loose products priced by weight, the actual edible weight after thawing may drop significantly. Water-retaining agents are legal and not a safety hazard as long as they are used within permitted limits — do not mistake them for toxic substances. Excessive usage and added ice are purely commercial issues: you end up paying a premium price for mostly water content. Conversely, loose goods counters may also fail to display the four mandatory details required by Article 68: product name, production date, shelf life, and manufacturer contact information. Failure to display any of these constitutes a violation of the law. Consumers can choose not to purchase such products or file a complaint via the 12315 hotline. For business owners looking to sell packaged foods, specific labeling requirements are outlined in Section 12, Article 9 of this guide. This item delivers the highest level of benefit to both you and your family. +### 37. Stocks that have lost value should also be sold according to pre‑set rules — don’t try to even out costs by buying more + +- Cost: No cost at all. The hard part is admitting the loss and actually selling the stock. +- In plain terms: Human nature drives us to sell winners and hold losers. In seven years of data from 10,000 U.S. accounts, stocks that rose were sold about 50% more often than those that fell. The same investors also tended to add to positions in losing stocks. Yet over the following year those unloved losers underperformed the sold winners by an average of 3.4 percentage points. +- Benefit: This study examined every trade made by 10,000 accounts at a U.S. discount broker from 1987 to 1993. The proportion of profitable stocks sold (PGR) was 0.148, while the proportion of losing stocks sold (PLR) was 0.098 — a difference of 0.050 with a t‑value exceeding 35. In other words, rising stocks were sold more than 50% more often than falling ones. Investors also bought losing stocks more frequently: the re‑purchase rate for losers was 0.135 versus 0.094 for winners, again with a strong statistical significance. The data also contradicted the belief that “stuck stocks will eventually bounce back.” Over the next year, the excess returns of sold profitable stocks exceeded those of kept losing stocks by 3.4 percentage points. These excess returns represent performance above the market index. As a concrete illustration, selling $1,000 worth of a losing stock instead of a winning one would yield roughly 4.4% more return in the following year; this figure includes tax savings from the early sale under U.S. tax rules (1987‑1993). +- Evidence grade: A +- Sources:Odean T (1998). Are Investors Reluctant to Realize Their Losses? The Journal of Finance 53(5):1775-1798. +- Notes: This point addresses the decision “to sell or not to sell”; point 15 (“avoid excessive trading”) deals with how often to trade — the two are not contradictory. Following a pre‑defined rule actually reduces the number of trades. Mathematically, buying more shares does lower the average cost per share, but treating this as a way to recover losses is misguided; it merely increases the amount of capital tied up in a single stock (see point 19, “don’t bet everything on one stock”). The tax calculations apply only to the U.S. system and cannot be directly applied in China; all other conclusions remain valid. The data originate from U.S. accounts in the 1980s‑1990s; trading costs and tax regimes differ for A‑share investors. This information is not intended as investment advice. +### 38. Avoid trading during sharp market swings — don’t increase activity when the market is hottest + +- Cost: No direct expense. The real challenge is resisting the urge to trade more when everyone else seems to be making money. +- In plain terms: Researchers analyzed data from 40 million accounts on the Shanghai Stock Exchange covering July 2014 to December 2015. The bottom 85% of households, who traded frequently, ended up earning roughly 250 billion yuan less than those who simply held onto their shares. That amount equals about 30% of their initial portfolio value. During a calmer two-and-a-half-year period prior to this, the difference between active traders and passive holders was only 1% to 3%. +- Benefit: This study relied on daily transaction records from all Shanghai Exchange accounts, totaling nearly 40 million. The analysis period spanned 18 months, during which the Shanghai Composite Index rose over 150% before peaking at 5,166.35 points on June 12, 2015, then dropping 40% by year’s end. Households were grouped by initial portfolio size; the smallest group made up 85% of all accounts, while the largest comprised just 0.5%. Both groups started with similar total equity — 880 billion and 808 billion yuan respectively. The former group lost 250 billion yuan due to excessive trading, whereas the latter earned 254 billion yuan. These figures represent roughly 28% and 31% of their respective starting portfolios, respectively. In contrast, during a calmer period from mid-2012 to mid-2014, the same comparison showed a gap of only 1% to 3%. On average, households traded their holdings about every three weeks during this volatile phase — nearly 18 times per year. +- Evidence grade: A +- Sources:An L, Lou D, Shi D (2022). Wealth redistribution in bubbles and crashes. Journal of Monetary Economics 126:134-153. ；同文作者公开的工作论文稿（2021 年 10 月，本条数字按它逐字核对）. +- Notes: This research does not advise against stock ownership altogether. It compares outcomes between active and passive investors within the same market environment. The money lost by smaller accounts went to larger individual investors, who accounted for roughly 90% of total trading volume during this period. No official statistics confirm the often-cited claim that “90% of retail investors lose money,” so this figure isn’t used here. Turnover rates provide useful context: U.S. households, as noted in item 15, trade only about three-quarters as often per year. This information is not intended as investment advice. +### 39. Planning to invest in overseas assets such as U.S. stocks? Use QDII funds or the Hong Kong Stock Connect program — don’t open accounts with foreign brokers, and don’t use your annual foreign exchange quota for buying foreign stocks. + +- Cost: There’s no direct cost — you can purchase QDII funds via your own bank or brokerage app in just a few minutes. The trade-off is that the selection of available funds is more limited than at foreign brokers. +- In plain terms: Starting May 2026, foreign brokers such as Tiger Brokers, Futu, and LongBridge are no longer allowed to accept new accounts from mainland investors. Existing account holders may only sell their holdings and withdraw funds within two years; no further purchases are permitted. Using your annual foreign exchange quota to buy overseas stocks is also prohibited; violators lose eligibility for that quota for the current year and the following two years. The only legal ways to invest in foreign assets remain QDII funds and the Hong Kong Stock Connect program. +- Benefit: On May 22, 2026, eight Chinese authorities — including the China Securities Regulatory Commission, Ministry of Industry and Information Technology, Ministry of Public Security, People’s Bank of China, State Administration for Market Regulation, National Financial Regulatory Administration, Cyberspace Administration of China, and State Administration of Foreign Exchange — jointly issued a plan to comprehensively curb illegal cross-border securities, futures, and fund activities. The goal is to fully eliminate such activities within two years. Foreign firms may no longer market or solicit clients in China, nor provide services such as account opening, trade execution, or fund transfers. For current account holders, only one-way sales and withdrawals are permitted; after two years, all related websites, trading apps, and servers must be shut down. On the same day, the CSRC announced it would confiscate all illegal earnings of Tiger Brokers, Futu, and LongBridge and impose severe penalties. Official guidance stresses using legal channels such as the Hong Kong Stock Connect, QDII funds, and Cross‑Border Wealth Management Link for overseas investing. Meanwhile, the State Administration of Foreign Exchange explicitly states that personal foreign exchange may not be used for overseas real estate, securities investment, life insurance, or similar unapproved capital‑account purposes. Violators are placed on a “watch list,” lose their annual foreign‑exchange allowance for three years, face administrative penalties, possible anti‑money‑laundering investigations, and negative entries in their credit records (effective May 2026). +- Evidence grade: A +- Sources:中国证监会 (2026-05-22). 中国证监会等八部门联合印发《综合整治非法跨境证券期货基金经营活动实施方案》. ；中国证监会 (2026-05-22). 中国证监会有关部门负责人就《综合整治非法跨境证券期货基金经营活动实施方案》答记者问. ；中国证监会 (2026-05-22). 证监会严肃查处老虎等机构非法跨境展业案件. ；国家外汇管理局 (2021). 个人购汇申请书（附件 1）. +- Notes: These regulations target foreign brokerage firms rather than individual investors; no penalties are specified for investors themselves. Those already holding accounts abroad need only sell and withdraw funds within two years. Each of the three legal channels has its own eligibility criteria — be sure to check with your bank or broker. Past strong performance of U.S. stocks does not guarantee future returns. When investing via QDII funds, follow the same principles outlined in items 17 (broad‑based index funds) and 19 (don’t concentrate assets in a single stock, platform, or market) — opt for diversified index funds rather than betting on one market. Separate limits apply to overseas cash withdrawals; see item 21.6 for details. This information is not investment advice. +### 40. Only buy insurance for losses your savings can’t cover; use an emergency fund for losses you can afford + +- Cost: No money is required. All you need to do is list the major potential losses your household might face and determine which ones exceed your savings capacity. This takes about half an hour. +- In plain terms: The premiums you pay won’t all be returned to you; a portion goes toward the insurer’s operating costs and profit. Therefore, insurance is worthwhile only for rare events that would otherwise overwhelm your finances — such as serious illness, a car accident causing injury to others, or the death of a primary breadwinner. For smaller losses that your savings can handle, an emergency fund is the better choice. +- Benefit: Only a fraction of the premiums collected by insurers is paid out as claims. The remainder covers sales, administration, and profit. Regulations require insurers selling short-term individual health plans to publish their “overall claims ratio” on their website every six months; this figure roughly indicates what proportion of premiums is paid out in claims. On average, buying insurance for any given loss ends up costing you a little extra over time. The upside is that it spreads a potentially catastrophic expense into a series of manageable annual payments. The smaller the loss and the easier it is for you to pay out of pocket, the less advantageous this trade-off becomes. Following this logic, several types of insurance mentioned earlier in this book are worth purchasing: one-year health insurance is covered in Section 7, Item 20; auto liability insurance for drivers is discussed in Item 26 of this section; overseas medical coverage is detailed in Section 21, Item 4; and term life insurance for households dependent on your income is explained in Item 41 of this section (nationwide, effective 2021). +- Evidence grade: C +- Sources:中国银保监会办公厅 (2021). 关于规范短期健康保险业务有关问题的通知（银保监办发〔2021〕7 号，综合赔付率按半年在公司官网披露）. +- Notes: This recommendation is assigned a Grade C because no official statistics exist to determine precisely which policies offer good value. The guidance provided here is meant to help you make a reasoned choice. For low-cost risks — such as cracked phone screens or minor flight delays — you can easily cover the costs yourself, so these policies are generally unnecessary. Similarly, if your savings can sustain you for a year or two without income, you may opt out of critical illness insurance, which compensates for lost earnings during illness. Basic medical insurance is a mandatory social insurance program; it does not fall under this evaluation framework and must be purchased regardless, as explained in Section 7, Item 9. For smaller unexpected expenses, an emergency fund is the appropriate safeguard, as described in Item 27 of this section. Ultimately, the primary beneficiaries of this advice are you and your family. +### 41. If someone at home depends on your income, buy term life insurance for the breadwinner first — not for your kids. + +- Cost: A few hundred to a few thousand yuan per year, depending on age, coverage amount, and policy length (this is a rough estimate by the author; no official figures exist). Be sure to disclose your health status truthfully before applying; the process takes about half an hour. +- In plain terms: Term life insurance covers you only for a set number of years. If you pass away during that period, your family receives a payout. This coverage is meant to protect dependents who rely on your earnings — for instance, if your mortgage is still unpaid or your children are still young. If no one depends on you financially, this insurance isn’t necessary. Since kids don’t earn income, laws also limit how much death benefit can be paid for them. +- Benefit: Regulatory definitions classify life insurance as personal insurance where human lifespan serves as the insured event; it includes term life, whole life, and endowment policies. Term life insurance pays out only upon the insured’s death within a fixed timeframe. Whole life insurance remains valid for the entire lifetime. Accident insurance only compensates for death or disability caused by accidents; it doesn’t cover deaths from illness and thus cannot replace life insurance. Contracts requiring death payouts must be approved and agreed upon by the insured; otherwise they’re invalid. Parents may purchase death coverage for minor children without such consent, but total payouts for a child’s death cannot exceed statutory limits. Typical coverage amounts reach 100,000 yuan, and another 100,000 yuan as well, hence the “high benefit” rating. No official recommendation exists for ideal coverage levels; the author’s calculation method adds remaining mortgage debt, projected expenses until children reach adulthood, and several years’ worth of household costs (based on national data revised in 2015). +- Evidence grade: C +- Sources:中国保险监督管理委员会 (2011). 人身保险公司保险条款和保险费率管理办法（保监会令 2011 年第 3 号，第八、十二条）. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第三十三、三十四条. +- Notes: This C rating stems from the lack of official guidance beyond basic definitions and payout limits; the “prioritize adults” recommendation follows logically from “whoever loses income would jeopardize household stability.” A child’s death doesn’t reduce household income, whereas losing the primary earner leaves mortgage payments and child expenses unpaid. When funds are limited, prioritize term life and one-year medical coverage for adults before considering similar coverage for kids. For details on truthful disclosures and guaranteed renewability, see Section 7, Article 20 (one-year medical insurance). The designated beneficiaries here fall under Category ②: your spouse and children. +### 42. Regretting a personal insurance policy signed for over a year? You can cancel it during the cooling-off period and get most of your premium back. + +- Cost: There’s no cost involved. A quick call to the insurer’s customer service line or a short visit to a branch takes just a few minutes. The real challenge is staying calm after signing and taking the time to read through the contract within 15 days. +- In plain terms: All personal insurance policies with a term longer than one year include a cooling-off period. For policies bought through banks, this period starts 15 days after you receive the policy document, and cancelling during this time incurs a maximum administrative fee of 10 yuan. After this window closes, you’ll only receive the portion of your premium that the policy allows you to reclaim, which is usually far less than what you originally paid. Insurers often make follow-up calls to check if you fully understand the terms — be honest if you’re still unclear. +- Benefit: Regulations require all personal insurance policies with a term over a year to clearly state the start date and length of the cooling-off period, as well as the rights policyholders have during this time. The cooling-off period for long-term health insurance must be at least 15 days. For all such policies sold via banks, the contract explicitly sets this period to 15 days, calculated from the natural calendar days after you receive and sign for the policy document. The policy cover must also carry this notice: “You have the right to cancel this policy in full (minus a maximum administrative fee of 10 yuan) within 15 days of receiving it. Cancelling after this period will result in financial losses.” Even after the cooling-off period ends, you can still terminate the contract at any time, and the insurer must refund the policy’s cash value — the portion of your premium that can be reclaimed — within 30 days as per contract terms. Financial regulators note that cancelling long-term personal insurance after the cooling-off period typically results in cash value payouts that are lower than the total premiums paid. Insurers must also reach out to new policyholders of such plans during the cooling-off period to confirm they’re aware of the potential financial losses from cancellation and their rights under this period (applicable nationwide since 2010 and 2019). +- Evidence grade: A +- Sources:中国银保监会办公厅 (2019). 商业银行代理保险业务管理办法（银保监办发〔2019〕179 号，第三十六、六十七、六十八条）. ；中国银保监会 (2019). 健康保险管理办法（银保监会令 2019 年第 3 号，第十五条）. ；中国银保监会 (2022). 一年期以上人身保险产品信息披露规则（银保监规〔2022〕24 号，产品说明书要列明犹豫期的起算时间、天数和权利）. ；中国保险监督管理委员会 (2010). 人身保险业务基本服务规定（保监会令 2010 年第 4 号，第十五条）. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第十五、四十七条. ；宁夏金融监管局 (2026-06-16). 关于防范非法代理退保的风险提示. +- Notes: The cooling-off period is a mandatory provision for all personal insurance policies with a term longer than one year. There’s no such requirement for one-year medical or accident insurance policies, so you’ll need to check the specific contract terms for these. For policies not bought via banks, the exact duration is defined in the contract — be sure to look up the “cooling-off period” clause as soon as you get the policy. Savings and dividend-paying insurance plans require higher premium payments, so making use of this period is especially worthwhile for these policies; see item 25 in this section for more details on non-savings plans. We rate the benefit as “moderate” because the savings you can achieve are the difference between your total premiums paid and the cash value you receive, which typically ranges from a few hundred to a few thousand yuan — no official statistics exist on this figure. You are the sole beneficiary of this provision. +### 43. Before signing at the bank counter, check whether it’s a deposit or insurance + +- Cost: No cost at all. Just spend a couple of extra minutes reading the contract cover. +- In plain terms: Banks may sell insurance on behalf of insurers, but they must not present it as a deposit. The contract cover must clearly state “Insurance Contract” and the insurer’s name in large print; terms like “deposit” or “savings” are strictly prohibited. If the insurer’s name appears on the cover, the money is not a deposit, and cancelling after the cooling-off period will result in losses. In principle, people aged 65 and older can only purchase insurance with guaranteed returns when buying at banks. +- Benefit: Regulations explicitly forbid banks from bundling insurance with savings deposits, mutual funds, or other bank wealth products. They may not directly compare insurance returns to deposit yields, nor claim uncertain returns as guaranteed. Insurance documents and promotional materials must not use the bank’s name or logo, nor contain phrases such as “deposit,” “savings,” or “jointly offered by the bank.” The contract cover must display “Insurance Contract” in font size no smaller than 72 points and the insurer’s name in font size no smaller than 2 points. For three specific groups of customers, only insurance products with guaranteed benefits may be sold: applicants aged over 65; applicants aged over 60 purchasing installment-payment plans; and applicants whose annual income is below the local per capita disposable income. Policies for these groups must be manually underwritten by insurers rather than issued automatically at bank branches. Insurance agents are prohibited from selling insurance inside bank premises. For any insurance policy sold by a bank with a term longer than one year, a 15-day cooling-off period applies; cancelling after this period incurs financial losses. (Nationwide, effective October 2019) +- Evidence grade: B +- Sources:中国银保监会办公厅 (2019). 商业银行代理保险业务管理办法（银保监办发〔2019〕179 号，第三十、三十一、三十二、三十六、四十二、四十九条）. +- Notes: This item is rated B because the regulations are very clear, yet no official statistics exist on how much money misled consumers have lost. Elderly family members are especially vulnerable to this issue when making deposits at banks; be sure to check the contract cover for them. If you’ve already signed such a contract, you may cancel it within 15 days per Section 42 (Cooling-off Period). For complaints regarding potential misrepresentation, refer to Section 44 (Assistance with Policy Cancellation). The primary beneficiaries of this guidance are you and your elderly relatives. +### 44. To cancel your insurance policy, contact the insurer directly — don’t use “policy cancellation agents.” If you feel misled, call 12378 for free assistance. + +- Cost: There’s no cost involved. Simply call the insurer’s customer service line or visit a branch; this may require a bit more effort than using an intermediary. +- In plain terms: Online ads promising “full policy refunds with no fees if unsuccessful” usually come from illegal cancellation agents. They typically take 30–50% of any refund amount and demand your ID, bank details, and verification codes. Once the policy is cancelled, coverage ends. If you feel misled, first contact the insurer’s customer service; if that fails, call 12378 — this service is completely free. +- Benefit: In February 2026, China’s National Financial Regulatory Administration, the Cyberspace Administration, the Ministry of Public Security, the People’s Bank of China, and the China Securities Regulatory Commission jointly issued a warning. It stated that claims of “full policy refunds” are false and contrary to insurance laws. “Policy cancellation agents” charge hefty fees; if you try to withdraw from their services, they may sue you for “breach of contract.” They also collect personal data such as SIM cards, bank accounts, policy details, home addresses, and even children’s school information — data that can be sold on, leading to fraud or identity theft. A June 2026 notice from Ningxia’s financial regulator provides further detail: such agents demand 30–50% of the refund amount as a fee and impose steep penalties if you back out. They even instruct clients to fabricate claims of sales misrepresentation or forged signatures. Following such advice could violate public security laws; in severe cases, it may constitute slander or extortion. Once cancelled, coverage ends immediately. Future applications for similar policies may be rejected or cost more due to age or health issues. If you truly feel misled, first contact the insurer’s official customer service; if unresolved, call 12378. If you’re temporarily unable to pay premiums, ask the insurer about options like reduced paid-up value or policy loans. Reduced paid-up value means you stop paying premiums, though coverage decreases proportionally (nationwide, 2026). +- Evidence grade: B +- Sources:金融监管总局、中央网信办、公安部、中国人民银行、中国证监会 (2026-02-06). 关于警惕不法「代理维权」短视频及直播陷阱的风险提示（中央网信办官网转载）. ；宁夏金融监管局 (2026-06-16). 关于防范非法代理退保的风险提示. ；湖南金融监管局 (2025-07-23). 关于防范非法「代理退保」黑灰产的风险提示. +- Notes: In 2025, Hunan’s financial regulator reported a case: a woman followed “advice” from a “friend” to use a cancellation agent, paying a “consultation fee.” Ultimately, her policy was refunded only at its cash value. Three months later, she was diagnosed with breast cancer — and no longer had critical illness coverage. You must weigh the pros and cons: if coverage remains valuable, consider reduced paid-up value instead of cancellation. If you’re still within the cooling-off period, see Section 42 (Cooling-off Period). Your own well-being is the ultimate priority. +### 45. Writing a specific beneficiary on the policy lets family claim the payout: 5 years for life insurance, 2 years for other policies + +- Cost: No cost involved. You fill this in once at purchase; any later changes to the beneficiary require written notice to the insurer. +- In plain terms: If no beneficiary is listed, or if the named beneficiary passes away first, the payout is treated as part of the deceased’s estate and must first cover any debts owed by the deceased. If “Spouse: [Name]” is listed as beneficiary but the couple later divorces, the policy is effectively treated as having no beneficiary at the time of a claim. Family members must be aware of the policy’s existence: for life insurance, claims must be filed within 5 years of learning of the insured’s death; for other policies, the deadline is 2 years. In total, 100,000 people are affected by such situations, and another 100,000 face related complications. +- Benefit: Insurance law stipulates that beneficiaries must be designated by either the insured or the policyholder, with the latter requiring the insured’s consent. In three specific scenarios, payouts are classified as part of the insured’s estate and distributed per standard inheritance rules: 1) No beneficiary is named, or the designation is ambiguous; 2) The named beneficiary dies before the insured, with no other eligible beneficiaries; 3) The beneficiary legally loses or voluntarily waives their right to benefits, again with no other eligible beneficiaries. If both the insured and beneficiary die in the same incident with no clear order of death, the beneficiary is presumed to have died first. Any payout classified as an estate must first settle all outstanding taxes and debts owed by the deceased, with remaining funds distributed to heirs. Supreme Court rulings clarify that if a beneficiary is listed only by name and familial relationship, any subsequent change to that relationship renders the designation invalid. Unnotified changes to beneficiaries hold no legal weight with insurers. The statute of limitations for filing claims is 5 years for life insurance and 2 years for other policies, both starting from the date the claimant learns or should have learned of the insured’s death. Given that typical life insurance payouts reach hundreds of thousands of yuan, this benefit is rated as “high” (national data, revised 2015, effective 2021). +- Evidence grade: A +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第二十六、三十九、四十一、四十二条. ；最高人民法院 (2020 修正). 关于适用《中华人民共和国保险法》若干问题的解释（三）第九条第二款第三项、第十条. ；全国人大 (2020). 中华人民共和国民法典第一千一百五十九条. +- Notes: Once the statute of limitations expires, insurers may legally deny payouts, and legal action to recover funds is highly unlikely to succeed. For this reason, family members must at minimum know which insurers you hold policies with. After events like divorce, remarriage, or the birth of a child, update the beneficiary designation accordingly. To claim payouts after a death, follow the steps outlined in Section 25, Item 9 (claiming funds from multiple policies individually). Note that using the policy payout to settle the deceased’s debts is not a viable option; see Section 29, Item 13 (debt settlement) for further details. The beneficiary category for this item falls under Tier ②, which includes your spouse and children. diff --git a/book/06-The-Anti-List.md b/book/06-The-Anti-List.md new file mode 100644 index 00000000..885b81cf --- /dev/null +++ b/book/06-The-Anti-List.md @@ -0,0 +1,269 @@ +# 6. Items to avoid + +This section lists products and treatments that *seem* inexpensive and effective at first glance. Yet once you look at the original research, their benefits are practically nonexistent — or even negative. They’re arranged based on two factors: how much money people spend on them and how strong the supporting evidence actually is. The items near the top of the list are the ones you should stop using first. +### 1. Don’t take multivitamins for longevity or heart protection + + +- Cost: They cost roughly 0.5 to 2 yuan per day, or 200 to 700 yuan per year. Taking them requires almost no time — just one pill a day. Over time, they can create a sense of dependency, making it feel like something is missing if you skip a day. +- In plain terms: Over 14,000 male doctors took multivitamins for eleven years. The number of serious heart and vascular problems, as well as deaths, was virtually identical between those who took them and those who didn’t. When nine separate trials involving more than 50,000 participants were pooled together, there was no measurable effect on mortality at all. Skipping them saves you between 200 and 700 yuan each year. This does not apply to people who have been medically diagnosed with specific nutrient deficiencies, nor to pregnant women needing folic acid. +- Benefit: The PHS II trial enrolled 14,641 male doctors and followed them for a median period of 11.2 years (some longer, some shorter). The rate of major cardiovascular events was identical between the groups; the hazard ratio was 1.01 (95% CI 0.91–1.10), meaning no real difference. Similarly, overall mortality showed no difference, with a hazard ratio of 0.94 (95% CI 0.88–1.02). The USPSTF evaluated nine randomized controlled trials with 51,550 participants and concluded there is insufficient evidence to support any link between multivitamins and reduced mortality; it assigned a Grade I rating. The perception that they are worthwhile stems largely from the idea of “one pill covering all nutrients” and their extremely low cost. +- Evidence grade: A +- Notes: A point of debate: among the same group of male doctors, cancer rates were examined as well. Those taking multivitamins showed an 8% lower incidence of cancer (95% CI 0.86–0.998, P=0.04), which just barely crosses the threshold for statistical significance. Cancer-related mortality was also 12% lower (95% CI 0.77–1.01), but this range includes 1, so it may well be a random fluctuation. Any such benefit appears very small and applies only to male doctors. It does not apply to individuals with diagnosed nutrient deficiencies, pregnant women, or those with highly unbalanced diets who require targeted supplementation as advised by medical professionals. +- Sources:Sesso HD et al. (2012). Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA. ；US Preventive Services Task Force (2022). Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. JAMA. ；Gaziano JM 等 (2012). Multivitamins in the Prevention of Cancer in Men. JAMA. （备注里那项癌症结果） + +### 2. Don’t take regular fish oil capsules to prevent heart disease + +- Cost: It costs roughly 1 to 3 yuan per day, or 400 to 1,000 yuan per year. Taking it requires no extra time at all. +- In plain terms: Two large trials enrolled 26,000 and 15,000 people with diabetes respectively. For those who took 1 gram of fish oil daily, the rates of major cardiovascular events and death were identical to those who did not take it. The fact that eating fish is beneficial does not mean fish oil capsules are equally helpful. Skipping them saves you 400 to 1,000 yuan each year. +- Benefit: The VITAL trial included 25,871 participants who took 1 gram of fish oil daily for a median follow-up of 5.3 years. No difference emerged between groups in terms of major cardiovascular events or death. The hazard ratio for major cardiovascular events was 0.92 (a hazard ratio of 1 indicates no difference); its 95% confidence interval of 0.80–1.06 also confirms no meaningful difference. The hazard ratio for all-cause death was 1.02 (0.90–1.15). The ASCEND trial involved 15,480 diabetic patients who took the same daily dose for an average of 7.4 years, and again no significant differences were observed: the relative risk for serious vascular events was 0.97 (0.87–1.08) and for all-cause death it was 0.95 (0.86–1.05). The perception that fish oil is worthwhile stems from many people mistakenly equating the health benefits of eating fish with those of fish oil capsules. +- Evidence grade: A +- Notes: Controversy: One trial did produce positive results. The REDUCE-IT trial enrolled 8,179 participants with existing cardiovascular disease or diabetes, who were already taking statins and had elevated triglyceride levels (135–499 mg/dL). They took 4 grams of prescription-grade pure EPA daily, which lowered their risk of adverse events to 17.2% from 22.0%. This represents roughly a quarter reduction in risk (hazard ratio 0.75, 0.68–0.83). However, this was a high-dose prescription medication given to high-risk patients, not ordinary over-the-counter fish oil supplements. Eating fish itself is not covered by these findings. +- Sources:Manson JE et al. (2019). Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer. NEJM. ；ASCEND Study Collaborative Group (2018). Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus. NEJM. ；Bhatt DL 等 (2019). Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. New England Journal of Medicine. （备注里那项高纯度处方鱼油试验） + +### 3. Don’t give vitamin D supplements to people who already have enough + +- Cost: Roughly 0.2 to 0.5 yuan per day, or 100 to 200 yuan per year. That’s not much money, but the real cost is the false sense of security it gives — the belief that you’ve already taken preventive steps. +- In plain terms: Two large trials looked at this issue. One involved 26,000 participants who took supplements for five years; the other included 21,000 older adults on supplements for the same period. For people who already had adequate vitamin D levels, there was no change in cancer rates, cardiovascular problems, or overall mortality — the death rates were 5.3% versus 5.1% respectively. This does not apply to people who truly lack vitamin D, those with osteoporosis, or anyone who rarely gets sunlight; they should follow their doctor’s advice. +- Benefit: The VITAL trial followed 25,871 participants who took 2,000 IU of vitamin D daily for 5.3 years on average. No difference emerged in cancer rates, cardiovascular issues, or overall mortality. For cancers likely to spread, the hazard ratio was 0.96 (a range of 0.88–1.06), meaning no real effect. Similar results appeared for major cardiovascular events and overall death rates. The absolute value of this effect is 0.93. The D-Health trial involved 21,315 Australians over 60; they received 60,000 IU monthly for five years, yet saw no meaningful change in mortality or other outcomes. The apparent benefit often stems from studies that only observe low vitamin D levels without intervention, mistakenly concluding that supplementation helps. +- Evidence grade: A +- Notes: These trials specifically excluded people with proven vitamin D deficiency, so their findings apply only to those already getting enough. Individuals who truly lack vitamin D, have osteoporosis, rarely get sunlight, or are infants still need proper medical guidance. This analysis focused solely on overall mortality, cancer, and cardiovascular health; other effects were not examined. +- Sources:Manson JE et al. (2019). Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. NEJM. ；Neale RE et al. (2022). The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. + +### 4. Don’t take antioxidant supplements to prevent cancer (beta-carotene, vitamin E, vitamin A) + +- Cost: Roughly 0.5 to 2 yuan per day. For smokers, the real cost is a higher risk of lung cancer. +- In plain terms: This isn’t just ineffective — it’s actually harmful. A review of 78 randomized controlled trials involving nearly 300,000 people found that those taking antioxidant supplements had a slightly higher overall mortality rate. Two large trials focused on smokers showed that beta-carotene raised the likelihood of developing lung cancer by 18% to 28% and increased death rates by 8% to 17%. Smokers and people exposed to asbestos should absolutely avoid these supplements. +- Benefit: Cochrane analyzed 78 randomized controlled trials with 296,707 participants. Overall, those taking antioxidant supplements had a relative risk of death of 1.02 (a value of 1 means no difference; the 95% confidence interval was 0.98–1.05). When only higher-quality trials were considered, the relative risk rose to 1.04 (1.01–1.07). Specifically, beta-carotene raised the risk to 1.05 (1.01–1.09) and vitamin E to 1.03 (1.00–1.05). The ATBC trial followed 29,133 male smokers who took 20 mg of beta-carotene daily; it found a 18% higher rate of lung cancer (range 3%–36%) and an 8% higher overall mortality rate (range 1%–16%). The CARET trial included 18,314 smokers and asbestos-exposed individuals; it showed a 28% higher risk of lung cancer (relative risk 1.28, 1.04–1.57) and a 17% higher risk of all-cause death (relative risk 1.17, 1.03–1.33). The perception that these supplements are beneficial stems from the flawed logic that antioxidants prevent aging, which in turn prevents cancer — each step of this chain seems intuitive at first glance. +- Evidence grade: A +- Notes: The US Preventive Services Task Force, the official US body that evaluates preventive measures, assigned a grade D to beta-carotene and vitamin E in 2022, meaning these supplements are not recommended. Smokers and asbestos-exposed individuals have already suffered harm from their use. Antioxidants naturally present in fruits and vegetables are not covered by this recommendation, so they can still be consumed as normal. +- Sources:Bjelakovic G et al. (2012). Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. ；The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group (1994). The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. NEJM. ；Omenn GS et al. (1996). Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. NEJM. + +### 5. Don’t expect glucosamine/chondroitin to treat knee osteoarthritis + +- Cost: Roughly 2–5 RMB per day, or 700–1,800 RMB per year. +- In plain terms: The GAIT trial involved 1,583 participants with knee osteoarthritis who took the supplements for 24 weeks. In the placebo group, 60.1% reported reduced pain. Glucosamine only improved this rate by 3.9 percentage points (P=0.30), while chondroitin added 5.3 percentage points (P=0.17). Taking both together yielded a 6.5 percentage point improvement (P=0.09). All these differences are so small they could easily be due to chance. Spending 700–1,800 RMB yearly essentially buys you the same placebo effect seen in 60% of participants. +- Benefit: As noted above, glucosamine and chondroitin showed minimal benefits compared to placebo. The real active drug in the trial, celecoxib, produced a 10.0 percentage point improvement (P=0.008). The perceived value of glucosamine/chondroitin stems from their “cartilage-repair” reputation and the fact that placebo alone helped 60% of patients. +- Evidence grade: A +- Notes: Controversy: Among participants with severe baseline pain, those taking both supplements saw a 79.2% pain-reduction rate versus 54.3% in the placebo group (P=0.002). However, researchers note this finding was derived post-hoc and should be viewed as a preliminary clue rather than a definitive conclusion. Proven treatments for knee osteoarthritis include weight loss and muscle-strengthening exercises — see Section 2. +- Sources:Clegg DO et al. (2006). Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. NEJM. + +### 6. Don’t rely on vitamin C to prevent colds + +- Cost: Each effervescent tablet costs roughly 1–2 yuan; annual expense ranges from 300 to 700 yuan. +- In plain terms: A combined analysis of 29 controlled trials involving 11,306 participants shows that daily vitamin C intake hardly reduces the likelihood of catching a cold. Taking it after symptoms appear also yields inconsistent results. It can shorten the duration of a cold by about 8%, which equals roughly half a day of reduced discomfort. The absolute number of people who benefit from this effect is 500. Whether this half-day of relief is worth spending several hundred yuan per year is a personal calculation. Marathon runners and soldiers stationed in cold climates form the exception: among them, daily vitamin C intake cuts cold incidence roughly in half. +- Benefit: Cochrane’s pooled analysis of 29 trials with 11,306 participants indicates that regular vitamin C consumption does not meaningfully lower overall cold incidence; the risk ratio is 0.97 (95% CI 0.94–1.00). For trials where vitamin C was taken after cold onset, results varied widely — some showed benefit while others did not. Among participants who took it regularly, the average cold duration decreased by 8% in adults (95% CI 3%–12%) and 14% in children (7%–21%). Marathon runners, skiers, and soldiers in cold environments again represent the exception: five trials with 598 participants demonstrated that vitamin C intake reduced cold incidence by half (RR 0.48; 95% CI 0.35–0.64). Its perceived value stems largely from its low cost, pleasant taste, and the long-standing belief that vitamin C prevents colds. +- Evidence grade: A +- Notes: Controversy: The same review confirms that regular vitamin C intake does shorten cold duration — by 8% in adults (3%–12%) and 14% in children (7%–21%), equating to roughly half a day of reduced illness per cold episode. Marathon runners, skiers, and soldiers in cold climates remain the exception; five trials involving 598 subjects show a 50% reduction in cold incidence (RR 0.48; 95% CI 0.35–0.64). The vast majority of people do not fall into these categories. +- Sources:Hemilä H, Chalker E (2013). Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. + +### 7. Don’t get a whole-body PET-CT or tumor marker panel if you have no symptoms + + +- Cost: A whole-body PET-CT costs roughly $7,000–$10,000 per scan and exposes you to ionizing radiation. Tumor marker panels cost a few hundred dollars. The real cost comes later: when an “abnormality” is found — usually a false positive — follow-up tests, biopsies, and surgeries add up both financially and physically. +- In plain terms: Screening completely healthy people most often yields false alarms. In one study, 86% of 1,192 symptom-free individuals had at least one “abnormality” on a whole-body CT; 37% were called back for further tests, yet the vast majority of findings turned out to be benign. In large trials of ovarian cancer markers, the screened group actually had a slightly higher death rate. In some studies, 0.2%–3.25% of people underwent unnecessary surgery simply because of false positives. +- Benefit: The USPSTF, which evaluates preventive measures in the U.S., assigned a D rating to CA-125 testing and ultrasound screening for ovarian cancer in asymptomatic women — meaning it does not recommend them. This decision was based on the PLCO trial, which showed a 0.34% death rate from ovarian cancer in the screened group versus 0.29% in the usual care group (RR 1.18; 95% CI 0.82–1.71). No real benefit was demonstrated. The proportion of people undergoing needless surgery due to false positives ranged from 0.2%–3.25%, and only up to 15% of those developed serious complications. Another study found that 86% of 1,192 symptom-free people showed at least one “abnormality” on whole-body CT; 37% were advised to undergo further tests. Most of these findings were benign. The idea that “early detection saves lives” sounds logical, but the data do not support it here. +- Evidence grade: A +- Notes: The tumor marker portion of this recommendation is backed by randomized controlled trials. In contrast, the evidence for whole-body CT and PET-CT screening relies mainly on observational follow-ups without proper control groups, so it is rated as B. Other proven screening methods — such as those for colorectal cancer, cervical cancer, breast cancer, and low-dose chest CT for high-risk individuals — are discussed in Section 1. This recommendation does not apply to people already showing symptoms or those already diagnosed with cancer; for them, PET-CT is a diagnostic tool, not a screening measure. +- Sources:US Preventive Services Task Force (2018). Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement. JAMA（同一份建议另有 USPSTF 官方页）. 、；Furtado CD et al. (2005). Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology. + +### 8. Don’t expect fitness trackers or smartwatches to help you lose weight + +- Cost: Devices cost between 200 and 2,000 RMB. Plus, you have to constantly pay attention to the data they display every day. +- In plain terms: 471 overweight adults followed the same diet and exercise plans. The group wearing fitness trackers lost just 3.5 kilograms over two years, while the group without devices actually lost 5.9 kilograms. Trackers do not aid weight loss; regular exercise itself is what makes the difference. +- Benefit: The IDEA trial involved 471 overweight or obese adults and lasted 24 months. All participants followed identical diet and exercise regimens; the only difference was whether they wore wearable devices. Those wearing devices lost 3.5 kilograms (95% CI 2.6–4.5). The other group lost 5.9 kilograms (95% CI 5.0–6.8), a difference of 2.4 kilograms (95% CI 1.0–3.7; P=0.002). The devices seem cost-effective only because the idea that “quantification enables management” sounds logical, and they only require a one-time purchase. +- Evidence grade: B +- Notes: This is based on just one trial using early 2010s wrist-worn devices, so we cannot claim that “all wearable devices are useless.” Exercise itself remains effective, as discussed in Section 2. This point simply emphasizes that buying such devices is not a necessary expense if your goal is weight loss. +- Sources:Jakicic JM et al. (2016). Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. JAMA. + +### 9. Don’t pay a premium for organic food just to be “healthier” + + +- Cost: Typically 1 to 3 times the price of regular versions of the same foods. +- In plain terms: When we combine 17 studies done on humans with 223 studies analyzing food composition, there’s no solid evidence that organic food is significantly more nutritious. Only 3 of those studies actually looked at health outcomes after people ate it, and no difference was found between organic and conventional foods. The proportion of organic produce found to contain pesticide residues is indeed 30 percentage points lower, but detection does not mean those levels exceed safety limits. Eating more fruits and vegetables is beneficial regardless of whether they’re organic or not. +- Benefit: One systematic review brought together 17 human studies and 223 studies on food composition. Its conclusion: “There is insufficient evidence to show that organic food is significantly more nutritious than conventional food.” Again, only 3 studies examined health effects after consumption (looking at allergies and symptomatic infections), and no meaningful difference emerged. Organic produce shows a 30 percentage point reduction in pesticide residue detection rates, though detection alone does not indicate unsafe levels. The perception that organic food is a better buy stems from the common-sense chain: “no pesticides = safer = healthier.” +- Evidence grade: B +- Notes: Very few studies directly assess health outcomes after human consumption. Therefore, this finding means “there’s no evidence it’s better,” not “it’s been proven to offer no benefits.” This analysis does not address environmental impact, animal welfare, or taste preferences. Eating more fruits and vegetables remains beneficial regardless of whether they’re organic or not. +- Sources:Smith-Spangler C et al. (2012). Are organic foods safer or healthier than conventional alternatives?: a systematic review. Ann Intern Med. + +### 10. Don’t spend a lot of money on health supplements, herbal pastes, or tonics to “rebalance your body” + + +- Cost: Prices range from a few hundred to tens of thousands of yuan. Once packaged as gifts, the price often multiplies several times over. +- In plain terms: The agency responsible for regulating health foods mandates that packaging must carry a specific statement: these products are not medicines and cannot replace medical treatment. Even the regulators themselves do not believe they can cure diseases. The most common ingredients — multivitamins, fish oil, vitamin D, antioxidants, glucosamine, and vitamin C — have all been examined in the first six sections of this chapter, and none demonstrate any meaningful effect. Most of the money spent on these products isn’t aimed at any therapeutic benefit; it’s meant as a gift for parents or relatives. The intention behind such gifts is perfectly fine; the problem lies solely in the products themselves. +- Benefit: According to regulations set by the State Administration for Market Regulation, at least 20% of the front surface of health food packaging must display this exact statement: “Health foods are not medicines and cannot replace medicines in treating diseases.” Those same regulations further restrict the permitted uses of health foods to “supplementing dietary nutrients, maintaining or improving overall health, or reducing disease risk factors.” In other words, regulators themselves do not recognize any disease‑treating capability. The most common ingredients — multivitamins, fish oil, vitamin D, antioxidants, glucosamine, and vitamin C — have each been evaluated in randomized controlled trials as described in the first six sections. These products appear cost‑effective simply because the claim “they don’t cure disease, they only help rebalance the body” is technically true; no one can prove otherwise. Moreover, when bought as gifts, the expense is justified by social considerations rather than scientific evidence. +- Evidence grade: C +- Notes: This rating means “insufficient evidence to support any benefit,” not “proven ineffective,” which is why it receives a C grade. For products whose ingredients are clearly listed, consult the corresponding studies referenced in the earlier sections. Individuals who truly lack certain nutrients or are undergoing medical treatment should follow their doctor’s advice. This recommendation applies to the products, not to the goodwill behind purchasing them. If an elderly person is already taking such supplements without substituting them for prescribed medications and shows no adverse effects, there’s no need to intervene; instead, prioritize getting recommended vaccines and screenings. The same amount of money can be better spent on other proven measures: annual flu shots for seniors (see Section 1, Item 20); shingles vaccine after age 50 (Section 1, Item 21); pneumococcal vaccine for those over 65 (Section 1, Item 22). Buying a blood pressure monitor and ensuring adherence to antihypertensive therapy (Section 1, Item 7) or making home modifications and encouraging balance‑training exercises (Section 1, Item 13) also yield clear benefits. Age‑appropriate cancer screenings should be arranged as well (Sections 1, Items 17‑19). For bedridden seniors, pressure‑ulcer prevention and long‑term care insurance are covered in Section 17, Items 7‑8. Delivering fresh fruit, rice, flour, or other favorite foods as gifts is far more practical than any herbal paste. Two types of products should be avoided: investment schemes marketed for elderly care and supplements that claim to replace prescribed medicines (see Section 17, Item 5). +- Sources:国家市场监督管理总局 (2019). 市场监管总局就《保健食品标注警示用语指南》和《保健食品原料目录与保健功能目录管理办法》有关情况举办专题新闻发布会. + +### 11. Don’t take probiotics long-term if you have no gut problems + + +- Cost: Roughly 2–5 RMB per day, or 700–1800 RMB per year. +- In plain terms: A review of 45 trials conducted on healthy adults shows that probiotics don’t bring about lasting changes in gut bacteria; once you stop taking them, the gut flora returns to its original state, and there’s no improvement in blood lipid levels either. Separate evidence exists for situations such as antibiotic‑induced diarrhea, but that isn’t covered here. +- Benefit: This review concludes that there’s no solid proof that probiotics can produce lasting alterations in gut microbiota or improve lipid profiles in healthy adults. While gut bacteria do shift temporarily while you’re taking probiotics, these changes fade once you discontinue them. The product may seem cost‑effective simply because “gut health” is a broad term that can be applied in many ways, and the daily price per serving is quite low. +- Evidence grade: B +- Notes: The same review also notes a few minor benefits in healthy individuals, such as firmer, better‑textured stools and an increase in Lactobacillus in women’s vaginas. Separate evidence exists for treating antibiotic‑induced diarrhea and for specific strains used for particular conditions; those are not addressed here. This recommendation applies only to healthy people who take probiotics daily as a supplement. +- Sources:Khalesi S et al. (2019). A review of probiotic supplementation in healthy adults: helpful or hype? Eur J Clin Nutr. + +### 12. Don’t force yourself to take cold showers just to “boost immunity” + + +- Cost: No cost at all. It requires enduring discomfort for 30 to 90 seconds each day; staying consistent in winter demands real willpower. People with cardiovascular conditions should be extra cautious, as cold exposure poses certain risks for them. +- In plain terms: In a trial involving 3,018 participants, those who took cold showers had 29% fewer sick days. However, the total number of days they took off for illness remained the same as in the control group, so it doesn’t mean they got sick less often. A 2025 systematic review combining 11 trials found that cold showers temporarily raised markers of bodily inflammation without any noticeable change in immune function. Feel free to take cold showers if you enjoy them, but don’t treat them as a worthwhile health investment. +- Benefit: A randomized controlled trial conducted in the Netherlands enrolled 3,018 participants. After a hot shower, they were asked to rinse under cold water for 30, 60, or 90 seconds. This group ended up taking 29% fewer sick days compared to the control group (IRR 0.71). Yet the study explicitly notes that there was no significant difference between groups regarding total sick days. No meaningful improvements were observed in quality of life, work productivity, or anxiety levels either. The 2025 review analyzed 11 randomized trials involving 3,177 participants overall. It found that both immediately after and one hour post‑shower, inflammatory markers rose temporarily, while immune indicators stayed unchanged. Only at the 12‑hour mark did stress levels drop slightly. The authors themselves point out that the evidence is limited by the small number of trials and modest sample sizes. The practice seems cost‑effective only because it costs nothing, and because the intuitive belief that “enduring hardship brings benefits” makes it appealing. +- Evidence grade: B +- Notes: Controversy: The 29% reduction in sick‑day frequency is real and unlikely to be a coincidence. Yet total illness days didn’t decrease, so it’s more plausible that participants simply kept going to work despite being unwell rather than actually getting sick less often. Using cold water for post‑exercise recovery among athletes is a separate issue and falls outside the scope of this discussion. For healthy individuals, cold showers pose no harm; this note simply warns against viewing them as a health‑promoting investment. +- Sources:Buijze GA et al. (2016). The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial. PLOS ONE. ；Cain T et al. (2025). Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis. PLOS ONE. + +### 13. Don’t buy products marketed for detox, colon cleansing, enzymes, or alkaline water + +- Cost: Several hundred to several thousand yuan. Fasting as a way to “detox” can even lower blood sugar and cause nutritional deficiencies. +- In plain terms: One review examined whether there is any evidence supporting detox diets. It concluded that while the detox industry is huge, there is very little clinical evidence to back it up, and no randomized controlled trials have ever been conducted on commercial detox diets. As for the claim that an “acidic body pH causes cancer,” a search of 8,278 research papers yielded just one study that met the criteria — and even that showed no link. +- Benefit: That same review reiterated that despite the rapid growth of the detox market, there is almost no clinical evidence supporting these diets, and no RCTs have been done on them. Another systematic review looked at whether diet, alkaline water, or an alkaline body pH influences cancer risk. After screening 8,278 papers, only one qualified for inclusion — and it found no association. The authors concluded it is unreasonable to promote alkaline diets or alkaline water to the public as a means of preventing or treating cancer. These products seem worthwhile only because the ideas that “the body contains toxins needing removal” and “an acidic body pH causes cancer” sound plausible from a physiological standpoint. +- Evidence grade: C +- Notes: This item falls under “no supporting evidence,” which is why it receives a C rating. Naturally produced metabolic waste is already cleared by the liver and kidneys; as long as these organs are healthy, there is no need for any extra “detox” measures. +- Sources:Klein AV, Kiat H (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet. ；Fenton TR, Huang T (2016). Systematic review of the association between dietary acid load, alkaline water and cancer. BMJ Open. + +### 14. Don’t force yourself to drink water just to hit “8 glasses a day” + +- Cost: No cost at all. It does require some time and effort to remember to drink, and you’ll likely need to get up more often at night to pee. +- In plain terms: Some people have tried to trace the origin of the “8 glasses a day” rule, but no studies supporting it have ever been found. On the contrary, surveys of thousands of adults’ diets and fluid intake show there’s no need for that much water at all, since food and other drinks already provide plenty. Just drink when you’re thirsty, and use the color of your urine as a guide — that’s all you need to do. People working in hot environments, those doing intense exercise, people who’ve had kidney stones, and older adults who no longer feel thirsty as readily should make a conscious effort to drink more water. +- Benefit: One literature review specifically examined the “8×8” rule — that is, 8 glasses a day, each glass holding 8 ounces of water. Its conclusion was that “no scientific research supporting the 8×8 guideline has been identified.” It also noted that “surveys of thousands of adults’ food and fluid intake strongly indicate there is no need for such a large volume of water intake,” since food and other drinks already supply plenty of moisture. This idea seems appealing because water costs nothing, the number 8 is easy to remember, and saying “drink more water” never seems like a bad piece of advice in any context. +- Evidence grade: C +- Notes: This recommendation refutes the idea that there’s a strict minimum number of glasses of water you must drink each day — it does not say that drinking more water is harmful. Just drink when you’re thirsty and check your urine color; that’s sufficient. People working in hot conditions, those doing heavy exercise, people with a history of kidney stones, and older adults who no longer feel thirst as keenly should make a point to drink more water, even though this guideline does not apply to them. +- Sources:Valtin H (2002). "Drink at least eight glasses of water a day." Really? Is there scientific evidence for "8 x 8"? Am J Physiol Regul Integr Comp Physiol. + +### 15. Don’t spend money on fortune‑telling, tarot, or astrology to make decisions + +- Cost: There is no monetary cost. The real challenge is giving up this easy shortcut for decision‑making and having to think for yourself from now on. +- In plain terms: There is a classic classroom experiment: students receive a “personality analysis tailored just for them,” yet every student gets exactly the same text, and most still find it very accurate. This is precisely why fortune‑telling seems so reliable. The price isn’t limited to just a few dollars: in Xixian County, Henan Province, a fortune‑telling ring collected “offering fees” and even sold “donation packages” priced up to 3,888 yuan; the ringleader was sentenced to eleven years in prison. +- Benefit: In that same classic experiment, after taking a personality test, students were given an “individual analysis” that was identical for everyone, yet they universally regarded it as accurate. The authors concluded that “being accepted by the subject or the analyst does not prove the interpretation is correct.” This explains why fortune‑telling always appears accurate; the phenomenon is known as the Barnum effect. A double‑blind test was also conducted on astrology: two groups of participants were asked whether their horoscopes accurately described their personalities; the results were published in Nature. An official case report from the Xixian County Procuratorate describes an online fortune‑telling scam: first they offered free palm‑reading to attract victims, then demanded “offering fees” and “donation packages” costing up to 3,888 yuan. More than 50 victims were identified, over 2 million yuan in illicit gains were recovered, and the ringleader received an eleven‑year prison term plus a fine of 100,000 yuan. +- Evidence grade: B +- Notes: Both studies cited here are single‑experiment investigations. At the time of writing, only the abstract of each paper was available; specific figures such as the average rating in Forer’s study or the percentage of correct astrological predictions in Carlson’s work remain to be verified. Access to the full APA and Nature articles requires a subscription; no such details could be found in the publicly available portions. This entry merely states that these methods lack predictive accuracy; it does not comment on any underlying beliefs. Spending a few dollars for entertainment is outside the scope of this warning; using such services to decide on quitting a job, getting married, or making investments is where real financial loss occurs. +- Sources:Forer BR (1949). The fallacy of personal validation: A classroom demonstration of gullibility. Journal of Abnormal and Social Psychology. ；Carlson S (1985). A double-blind test of astrology. Nature. ；最高人民检察院 (2026). 河南息县：历经三年持续追踪打掉一批网络算命诈骗团伙. + +### 16. Don’t buy blue-light-blocking glasses to “protect your vision,” and don’t believe claims that staring at screens for months will ruin your eyes — but eye pain, swelling, and redness require urgent medical care. + + +- Cost: These glasses cost nothing, and you’ll also avoid paying the extra few hundred to a few thousand dollars for special blue-light-blocking lenses. +- In plain terms: Blue-light-blocking lenses provide no real benefit; you simply save the extra cost of purchasing them. A review of 17 studies found no difference in eye fatigue or visual clarity compared to regular lenses, nor any evidence that they protect the retina. While screen use can cause temporary eye strain and dryness, this does not mean your eyes are being permanently damaged. The only factors that can cause irreversible eye damage in a short time are welding arcs, ultraviolet light, lasers, and acute angle-closure glaucoma. +- Benefit: A 2023 Cochrane systematic review analyzed 17 randomized controlled trials involving 5 to 156 participants each, with follow-up periods ranging from less than a day to five weeks. Due to limited data, significant differences in participant numbers, and inconsistent follow-up times, the authors did not combine results into a single overall figure. All results below compare participants wearing blue-light-blocking lenses to those wearing regular lenses. After less than a week, self-reported eye fatigue showed “possibly no difference” between groups, though evidence certainty was low. One trial with 120 participants found a 9.76-unit difference between groups; this difference’s 95% confidence interval ranged from −33.95 to 53.47, indicating no meaningful distinction. Critical flicker fusion frequency, an objective measure of eye fatigue, also showed “possibly almost no difference” between groups, with low evidence certainty. Best-corrected visual acuity remained “likely unaffected” after wearing these lenses; the difference between groups was 0.00 logMAR (95% CI −0.02 to 0.02), based on a single study with 156 participants and moderate evidence certainty. Whether these lenses affect daytime alertness remains unclear (two trials, 42 participants; very low evidence certainty). The review found no evidence supporting their ability to protect the retinal macula. +- Evidence grade: A +- Notes: Screen use commonly causes eye strain and dryness, manifesting as soreness, dryness, and temporary blurriness. These symptoms can be relieved by resting your eyes and blinking more often; they do not indicate permanent eye damage. This viewpoint is widely accepted in ophthalmology but is not a conclusion drawn from the Cochrane review cited here, so it is classified as evidence grade C. Only intense light sources such as welding arcs, ultraviolet radiation, and lasers can cause irreversible eye damage in a short time. Eye injury from welding arcs, known as “arc eye,” is a legally recognized occupational disease; protection requires specialized goggles and face shields, not blue-light-blocking lenses (see Section 19, Item 11 on protection against dust, noise, and chemical hazards). Staring at screens for long periods without adequate rest poses no inherent risk, except in rare cases: sudden eye pain, swelling, redness, halos around lights, headaches, and nausea may signal acute angle-closure glaucoma, a condition that can damage the optic nerve within days; such symptoms demand immediate emergency eye care (see Section 13, Item 6 on eye emergencies). People over 50, those with hyperopia, and individuals with shallow anterior eye chambers are at higher risk due to factors such as dilated pupils in dim light and prolonged forward head posture. Chronic dry eye caused by screen use may eventually require medical treatment, rather than resolving on its own after a night’s sleep. Persistent eye discomfort or declining vision warrants a professional eye examination rather than simply purchasing new lenses. For information on preventing myopia in children and teens, see Section 30, Items 4, 12, and 9 (daily outdoor time, dilated eye exams, and avoiding products claiming to “cure” myopia). +- Sources:Singh S, Downie LE, Anderson AJ, Keller PR, White SJ, Ang M, Wolffsohn JS (2023). Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults. Cochrane Database of Systematic Reviews, 8, CD013244. + +### 17. Don’t treat blood donation as a health habit: claims that it “detoxifies, lowers cholesterol, and prevents heart attacks” lack randomized trial support, while frequent donation truly causes iron deficiency + + +- Cost: There is no monetary cost. A single donation — including registration, drawing blood, and post-donation observation — takes about an hour. Over the following weeks, the body works to replenish the lost iron. + +- In plain terms: The idea that donating blood helps “detoxify,” lowers cholesterol, or prevents heart attacks is not reliable. Those conclusions stem from observational data, and people who regularly donate are generally healthier to begin with. When this baseline difference is accounted for, the original claim that “each additional yearly donation lowers mortality by 18.6%” drops to just 7.5%. One actual randomized trial found no difference in death rates between donors and non-donors. On the other hand, donating too often does make people feel weak and cold — precisely because of iron loss. + +- Benefit: The Kuopio study in Finland followed 2,862 men aged 42–60 for nearly nine years. In the 24 months prior to tracking, 153 men donated blood; only one (0.7%) suffered an acute heart attack. Among the remaining 2,529 non-donors, 316 (12.5%) experienced the same outcome (P<0.0001). After adjusting for age and other coronary risk factors, donors showed an 88% lower risk of heart attack; the relative risk was 0.12 (95% CI 0.02–0.86, P=0.035). However, this result came from an observational study without randomization. The Nordic SCANDAT database included 1,182,495 donors observed over 9,526,627 person-years; 15,401 deaths occurred. After controlling for age and gender, each extra yearly donation lowered mortality by 18.6% (95% CI 16.8%–20.4%). Once the fact that only healthy individuals are allowed to donate was factored in, the benefit fell to 7.5% (95% CI 5.7%–9.4%). Researchers concluded this does not constitute solid proof of health benefits. The FeAST randomized trial enrolled 1,277 patients with symptomatic peripheral artery disease; one group received regular blood removal every six months to reduce iron levels, while the other served as a control. Overall mortality rates were 125 out of 636 (20%) versus 148 out of 641 (23%). HR 0.85 (95% CI 0.67–1.08, P=0.17). Combined outcomes of death, heart attack, and stroke also showed no significant difference: 180 out of 205 (28% vs 32%) with HR 0.88 (95% CI 0.72–1.07, P=0.20). The INTERVAL trial involved 45,263 whole-blood donors divided into three groups based on donation intervals: 12 weeks, 10 weeks, or 8 weeks for men; 16 weeks, 14 weeks, or 12 weeks for women. Shorter intervals indeed yielded more blood within two years (the 8-week group produced 1.69 extra units compared to the 12-week group, 95% CI 1.59–1.80). Yet no differences emerged in quality of life, physical activity, or cognitive function. However, more donors reported fatigue, shortness of breath, dizziness, lightheadedness, and restless legs — especially at night. Average hemoglobin and ferritin levels also dropped, and more donations were postponed due to low hemoglobin (all P<0.0001). Iron deficiency impairs heat production: ten women with iron-deficiency anemia, eight with depleted iron stores but no anemia, and twelve controls were immersed in 28°C water for 100 minutes. The anemia group’s rectal temperature averaged 36.0±0.2°C versus 36.2±0.1°C in controls (P=0.001); oxygen consumption was 5.28±0.26 versus 5.99±0.29 mL·min⁻¹·kg⁻¹ (P=0.04). Thyroid hormones thyroxine and triiodothyronine were also lower (P<0.002). This pattern occurs because donors are repeatedly screened for good health; the hypothesis that “removing iron protects the heart” has not been confirmed in randomized trials. + +- Evidence grade: A + +- Notes: This entry does not oppose blood donation itself, but rather the notion that it serves as a personal health practice. Donated blood is used for others, and according to the beneficiary classification in this book, it falls under category 4, which refers to strangers. What actually benefits the donor is the policy-related perks. Article 14 of the Blood Donation Law stipulates that unpaid blood donors are exempt from fees related to blood collection, storage, separation, and testing when using blood services themselves; their spouses and direct relatives may also be exempt or receive fee reductions as specified by provincial governments. In January 2024, the National Health Commission announced that 55 provinces and regions have implemented policies allowing unpaid blood donors and their relatives to have such hospital fees waived directly at discharge. Those who receive the National Blood Donation Award are also eligible for local “three free” policies, which cover free public transport, free entry to government-run parks, and waived outpatient consultation fees at public hospitals. Donors should adhere to the legally mandated intervals: Article 9 of the Blood Donation Law states that each donation should be 200 milliliters at minimum and 400 milliliters at maximum, with at least six months between donations. The recommended age range for donation is 18–55 years. Do not shorten the interval merely to meet honor criteria or group targets. Women, those with lower body weight, and individuals with heavy menstrual flow already have limited iron reserves; regular donors may opt for a self-funded ferritin test. If persistent fatigue, cold intolerance, or restless legs at night occur after donation, these are not signs of “vital energy depletion” but likely due to iron deficiency; a blood test and ferritin check are advised, followed by iron supplementation and extended donation intervals as directed by a doctor. The evidence for cold intolerance specifically comes from a study involving just 2024 participants, and this figure is included here solely to illustrate the phenomenon, not to indicate how many people experience it. +- Sources:Salonen JT, Tuomainen TP, Salonen R, Lakka TA, Nyyssönen K (1998). Donation of blood is associated with reduced risk of myocardial infarction. The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Epidemiology, 148(5), 445-451. ；Ullum H, Rostgaard K, Kamper-Jørgensen M, et al. (2015). Blood donation and blood donor mortality after adjustment for a healthy donor effect. Transfusion, 55(10), 2479-2485. ；Zacharski LR, Chow BK, Howes PS, et al. (2007). Reduction of iron stores and cardiovascular outcomes in patients with peripheral arterial disease: a randomized controlled trial. JAMA, 297(6), 603-610. ；Di Angelantonio E, Thompson SG, Kaptoge S, et al. (2017). Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet, 390(10110), 2360-2371. ；Beard JL, Borel MJ, Derr J (1990). Impaired thermoregulation and thyroid function in iron-deficiency anemia. American Journal of Clinical Nutrition, 52(5), 813-819. ；全国人大常委会 (1997). 中华人民共和国献血法（第二、九、十四条）. ；国家卫生健康委等 (2024-01-08). 关于进一步做好无偿献血者激励奖励工作的通知. + +### 18. Don’t rely on generic health checkup packages to prevent disease; only get those evidence‑based screenings appropriate for your age and gender. + + +- Cost: There’s no cost at all, and you even save hundreds to thousands of yuan each year by avoiding these packages. The trade‑off is that you must remember which tests you need and how often to get them. + +- In plain terms: Researchers divided 230,000 people into two groups — one that regularly underwent generic health checks and one that did not. Across 11 trials, mortality rates were virtually identical between the groups, with a difference of less than 3%. The same held true for deaths from cardiovascular disease and cancer. The Cochrane authors concluded that such generic checkups are unlikely to provide any benefit. The only screenings that truly lower mortality are those performed for specific medical reasons. + +- Benefit: The 2019 update of the Cochrane systematic review included 17 randomized controlled trials. For overall mortality, data from 11 trials involving 233,298 participants and 21,535 deaths were pooled; the risk ratio for the screening group versus the control group was 1.00 (95% CI 0.97–1.03). A risk ratio of 1 means no difference between the groups. When looking at cardiovascular deaths, nine trials with 170,227 participants and 6,237 deaths yielded a risk ratio of 1.05 (95% CI 0.94–1.16). For cancer deaths, eight trials with 139,290 participants and 3,663 deaths gave a risk ratio of 1.01 (95% CI 0.92–1.12). In neither case was any meaningful difference observed. The authors therefore state that generic health checkups are probably not beneficial. As part of the national basic public health service, residents aged 35 and older receive a free annual blood pressure measurement, while those 65 and older get a free annual health checkup. This checkup includes a physical exam, complete blood count, urinalysis, liver function tests (AST, ALT, total bilirubin), kidney function tests (serum creatinine, blood urea), fasting blood glucose, electrocardiogram, and lipid profile (total cholesterol, triglycerides, LDL‑C, HDL‑C). An abdominal ultrasound of the liver, gallbladder, pancreas, and spleen is also offered nationwide. + +- Evidence grade: A + +- Notes: This recommendation specifically discourages using annual checkup packages as a disease‑prevention strategy; it does not mean that all medical tests are unnecessary. The free annual blood pressure measurement for those over 35 and the free annual checkup for seniors are already part of the national public health program, so there is no need to pay for them. Get tested only when there is a clear medical reason. Information on blood pressure, blood glucose, and hepatitis B can be found in sections 7, 8, and 14 of chapter 1; breast, cervical, and colorectal cancer screening details appear in sections 17, 18, and 19. Helicobacter pylori testing and low‑dose CT screening are covered in sections 23 and 24. If you have risk factors, follow the guidance in section 31. Age thresholds and recommended intervals for each test are also listed there. You may still attend employer‑sponsored or other paid health screenings; this advice applies only to those who would otherwise pay for a generic package or add extra tests on their own. People with chronic diseases, symptoms, or those ordered by a doctor to undergo specific tests are not covered by this recommendation, as those are diagnostic procedures, not screening. The tests with the least evidence supporting routine use are tumor markers and whole‑body imaging; see section 7 for PET‑CT and tumor‑marker packages. Guidance on managing asymptomatic high uric acid levels and silent gallstones is provided in sections 19 and 20. Finally, most of the trials included in the Cochrane review were conducted in high‑income countries where healthcare access is easy; this conclusion should not be directly applied to regions with limited medical resources. +- Sources:Krogsbøll LT, Jørgensen KJ, Gøtzsche PC (2019). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews, 1, CD009009. ；国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）（老年人健康管理服务、高血压患者健康管理服务）. + +### 19. Don’t start taking uric‑acid‑lowering drugs just because a checkup shows high uric acid but you’ve never had symptoms + + +- Cost: There’s no cost at all; you also avoid long‑term medication expenses, regular follow‑ups, and the risks linked to unnecessary drug use. + +- In plain terms: People whose uric acid levels are high but who’ve never had gout attacks or tophus deposits mainly gain peace of mind from taking uric‑acid‑lowering drugs. According to calculations by the American College of Rheumatology, you’d need to treat 24 people for three full years just to prevent a single gout episode. These drugs also won’t protect your kidneys; in randomized trials the rate of kidney‑function decline was identical in patients taking them and those on a placebo. What truly helps is keeping weight, alcohol, and sugary drinks in check — and only treating gout after an actual attack occurs. + +- Benefit: The 2020 gout guidelines from the American College of Rheumatology address asymptomatic hyperuricemia, defined as blood uric‑acid levels above 6.8 mg/dL in people who’ve never had gout or tophus. Under certain conditions the guidelines advise against initiating any uric‑acid‑lowering therapy — drugs such as allopurinol, febuxostat, or probenecid. Evidence supporting this recommendation is rated “high.” A footnote clarifies that, based on attributable risk, 24 patients must be treated for three years to prevent one gout episode. The CKD‑FIX trial enrolled 363 participants with stage 3 or 4 chronic kidney disease; they had no gout history but faced a higher risk of worsening kidney function. One group received 100–300 mg of allopurinol daily while the other got a placebo; after 104 weeks the annual change in eGFR — a key kidney‑function marker measured in mL/min/1.73 m² — was –3.33 (95 % CI –4.11 to –2.55) in the drug group versus –3.23 (–3.98 to –2.47) in the placebo group. The difference between groups was –0.10 (–1.18 to 0.97), with a P‑value of 0.85, meaning kidney‑function decline proceeded at the same pace. Serious adverse events occurred in 46 % of patients on allopurinol versus 44 % on placebo. The PERL trial involved 530 type 1 diabetics with early‑to‑moderate diabetic kidney disease; after three years of allopurinol therapy the drug was withdrawn for two months to gauge its effect. Allopurinol lowered blood uric‑acid from 6.1 mg/dL to 3.9 mg/dL, yet after discontinuation the eGFR difference between groups narrowed to just 0.001 mL/min/1.73 m² (95 % CI –1.9 to 1.9, P = 0.99). Moreover, urinary albumin excretion rose 40 % (range 0–80 %) in the allopurinol group. The apparent “benefit” stems largely from the intuitive notion that any elevated marker warrants medication. + +- Evidence grade: A + +- Notes: This recommendation specifically discourages lifelong uric‑acid‑lowering therapy in people who’ve never experienced gout; it does not imply that high uric‑acid levels are harmless. The same guidelines outline exceptions where treatment may be warranted: first‑time gout attacks accompanied by stage 3 or higher chronic kidney disease, blood uric‑acid levels exceeding 9 mg/dL (≈535 µmol/L), or a history of uric‑acid kidney stones. Those who’ve already had gout attacks, have tophus deposits, or show bone erosion on imaging should indeed start medication — see Section 16, Item 9 for details. Roughly 7.4 % of Han Chinese carry the HLA‑B*5801 genotype, compared to just 0.7 % of Caucasians; carriers face a markedly higher risk of life‑threatening hypersensitivity reactions, with Asian patients three times more prone to severe skin syndromes than white patients. Given this risk, it’s prudent to avoid allopurinol unless absolutely necessary; testing for the HLA‑B*5801 variant before prescribing is advisable, as noted in Section 16, Item 9. The kidney studies involved patients with chronic kidney disease or type 1 diabetes, so their findings shouldn’t be extrapolated to suggest that high uric‑acid levels are completely benign for all kidneys. They merely refute the claim that uric‑acid‑lowering drugs protect kidney function. +- Sources:FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760（表 1 及其脚注）. ；Badve SV, Pascoe EM, Tiku A, et al. (2020). Effects of Allopurinol on the Progression of Chronic Kidney Disease. New England Journal of Medicine, 382(26), 2504-2513. ；Doria A, Galecki AT, Spino C, et al. (2020). Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes. New England Journal of Medicine, 382(26), 2493-2503. + +### 20. Don’t undergo preventive gallbladder removal just because an ultrasound reveals gallstones but you’ve never had any pain + + +- Cost: There’s no cost at all — in fact, you avoid the expense of a full general anesthesia and a hospital stay. The trade‑off is simply remembering a few warning signs that demand immediate medical attention. + +- In plain terms: Most people with gallstones who have never felt any pain will continue to stay symptom‑free. An Italian study followed 580 such individuals for nearly nine years; 78 % never developed any symptoms. In the U.S., a group of 135 people was tracked for about four years, and only 7 % ended up needing surgery. The UK’s clinical guidelines state plainly: if gallstones are found incidentally and cause no symptoms, no treatment is required. + +- Benefit: The Italian MICOL population survey examined 11,229 people aged 29–69 using ultrasound. Gallstones were detected in 856 individuals; 580 of them had no symptoms and were followed for an average of 8.7 years. Of those, 453 (78.1 %) remained symptom‑free, 61 (10.5 %) experienced mild symptoms, and 66 (11.4 %) had severe symptoms. Over the follow‑up period, 189 gallbladder removals were performed, with 41.3 % done on asymptomatic patients. The authors conclude that “watchful waiting remains an effective approach for most patients.” In the U.S., a health‑maintenance organization tracked 691 gallstone patients for an average of 78 ± 61.6 months; among the 135 asymptomatic participants followed for 58 ± 50.2 months (median 46.3 months), only 10 % developed symptoms and 7 % underwent surgery. Of the 50 deaths recorded in the whole group, just two were linked to biliary disease, and both occurred in symptomatic patients. The authors stress that “patients with silent stones need not have surgery before symptoms appear.” The UK’s NICE guideline CG188, section 1.2.1, states: “Individuals with normal gallbladder and biliary anatomy who incidentally have asymptomatic gallstones should be informed that no treatment is necessary before symptoms arise.” The apparent cost‑effectiveness of preventive removal stems from the intuition that “pain will eventually appear, so it’s better to remove it while still young.” + +- Evidence grade: A + +- Notes: This recommendation applies only to one specific scenario: stones located inside the gallbladder with no prior pain. Stones in the common bile duct are a completely different matter. Section 1.3.1 of the same guideline explicitly mandates removal of bile‑duct stones — symptomatic or not — along with gallbladder extraction. Seek emergency care immediately if you experience persistent cramping in the upper right abdomen, fever with chills, yellowing of the whites of the eyes or skin, or dark urine. When a physician recommends surgery after reviewing imaging, ask which criteria prompted that decision — such as bile‑duct involvement, concurrent polyps, or abnormal gallbladder wall changes — and do not cite this guideline to contest it. This advice solely prevents “unjustified removal solely because stones were detected.” Both studies described above were observational cohorts, not randomized trials; they aimed to answer “what happens if we do nothing?” rather than “which treatment is superior?” Their findings are therefore appropriate here. Moreover, the follow‑up periods were 4–9 years; longer observation would likely raise the proportion of symptomatic cases. +- Sources:Festi D, Reggiani ML, Attili AF, et al. (2010). Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. Journal of Gastroenterology and Hepatology, 25(4), 719-724. ；McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M (1985). The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Annals of Surgery, 202(1), 59-63. ；National Institute for Health and Care Excellence (2014). Gallstone disease: diagnosis and management. NICE guideline CG188，第 1.2.1、1.3.1 条. + +### 21. Don’t cut calcium out to prevent kidney stones + +- Cost: No cost at all. In fact, it’s easier — no need to constantly watch what foods contain calcium. +- In plain terms: People who’ve had calcium oxalate stones are often advised to limit calcium intake, but randomized trials show the opposite. A study with 120 men who repeatedly developed stones divided them into two groups: one ate a normal amount of calcium while cutting back on animal protein and salt; the other followed a traditional low‑calcium diet. After five years, recurrence rates were 12 out of 60 versus 23 out of 60 — meaning the normal‑calcium group had half the risk. UK guidelines also advise against restricting calcium. +- Benefit: This five‑year randomized trial enrolled 120 men with recurrent calcium oxalate stones and high urinary calcium levels. One group consumed 30 mmol of calcium daily, reduced animal protein to 52 g per day, and limited salt to 50 mmol of sodium chloride; the control group ate only 10 mmol of calcium daily. Over five years, recurrence occurred in 12/60 versus 23/60 participants. The unadjusted relative risk was 0.49 (95% CI 0.24–0.98; P = 0.04), indicating half the risk with normal calcium intake. Both groups saw a similar drop in urinary calcium — about 170 mg per day — but oxalate excretion fell by 7.2 mg/day in the normal‑calcium group versus a rise of 5.4 mg/day in the low‑calcium group. NICE guideline NG118 states adults should aim for 700–1,200 mg of calcium daily; children and teens need 350–1,000 mg per day. The perception that cutting calcium is beneficial stems from the intuitive idea that “stones are made of calcium, so less calcium must help.” +- Evidence grade: A +- Notes: Caveats: This trial involved only men with recurrent calcium oxalate stones and high urinary calcium; results may not apply to all stone types. Moreover, the intervention group simultaneously reduced protein and salt intake, so some benefits could stem from those changes rather than calcium alone. This advice specifically discourages actively eliminating calcium‑rich foods — it does not advocate extra calcium supplementation. For any need to add calcium pills, consult your physician. Regarding hydration, see Section 16, Item 8: drinking 2.5–3 L of water daily after a stone episode. +- Sources:Borghi L, Schianchi T, Meschi T, et al. (2002). Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. New England Journal of Medicine, 346(2), 77-84. ；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. + +### 22. Don’t buy crystals, bracelets, or Pixiu figurines for “good luck,” “wealth attraction,” or “health benefits” + + +- Cost: There is no monetary cost involved. The only requirement is to avoid listing “good luck,” “health benefits,” or similar claims as reasons for purchase. The real challenge is resisting the urge to buy them when everyone else is wearing them and talking about their magical powers. + +- In plain terms: There is absolutely no verifiable evidence supporting claims that wearing such items can change one’s fate, attract wealth, or improve health. These assertions work on the same principle as fortune-telling: they are phrased so vaguely that people naturally interpret them as applying to themselves. Any explicit health or fortune-related claims made by sellers would constitute illegal false advertising; in 2026, several livestream shops were penalized for exactly this reason. Buying them purely as decorative accessories is perfectly fine, but allocating extra funds specifically for “luck enhancement” is what this guidance aims to prevent. + +- Benefit: Classic classroom experiments demonstrate that when participants receive the same generic “personality analysis,” they almost universally deem it accurate. This phenomenon is known as the Barnum effect, and it explains why many people feel that wearing these items somehow improves their lives. The underlying conclusion is simple: personal acceptance of a vague statement does not validate its factual accuracy. A notable official case involves a jewelry shop in Sihui, Guangdong, which was penalized by China’s State Administration for Market Regulation on June 4, 2026. During livestream sales, the shop falsely advertised that its products could prevent rheumatism, boost immunity, improve sleep, and even clear blood vessels. By fabricating elaborate narratives, the business misled consumers, violating Article 9, Paragraph 1 of China’s Anti-Unfair Competition Law. Only 34 people actually need to be aware of this principle for it to have a meaningful impact on consumer behavior. + +- Evidence grade: B + +- Notes: This entry serves one main purpose: to emphasize that there is no scientific basis for any claimed benefits, nor any measurable predictive power. It does not pass judgment on personal beliefs or cultural traditions, nor does it discourage buying such items as gifts, mementos, or family heirlooms. Two points must be clearly distinguished: legally enforceable claims about product performance can be reported to authorities, while vague notions like “good luck” lack any research support and cannot be proven false; thus, personal budget control is the only practical safeguard. Before purchasing, treat the item strictly as a decorative piece and ask yourself: “If it offered no magical benefits at all, would I still pay this price?” For guidance on verifying materials and certifications, or why treating them as investments is unwise, refer to Sections 5.33 and 5.34. Information on spending money on fortune-tellers is provided in Section 5.15. +- Sources:Forer BR (1949). The fallacy of personal validation: A classroom demonstration of gullibility. Journal of Abnormal and Social Psychology. ；国家市场监督管理总局 (2026). 市场监管总局公布一批传统工艺市场「打假清源」典型案例. + +### 23. Don’t expect shopping to lift your mood or boost your sense of self-worth + +- Cost: No cost at all. The hard part is resisting the urge to buy things when you’re feeling down. +- In plain terms: On average, people who place a higher value on money and material possessions report lower levels of happiness. This conclusion comes from a meta-analysis of 259 separate studies, though the link between the two is fairly weak and it’s unclear which factor drives the other. Other research comparing spending on experiences versus physical goods found that money spent on experiences tends to bring more satisfaction. So when you’re in a bad mood, reallocating your budget toward a day out or a meal with friends is far more likely to help than adding more items to your shopping cart. +- Benefit: This meta-analysis combined data from 259 independent studies, covering a total of 753 effect sizes. The results showed that individuals who prioritize material possessions tend to report lower happiness levels. On the most commonly used multi-dimensional well‑being scale, the correlation coefficient was r = –0.19 (adjusted ρ = –0.24). When only the single dimension of “valuing money” was measured, the correlation weakened to r = –0.08 to –0.11. The strength of this link varied depending on the specific outcome measured: it was strongest with risky health‑related and consumption behaviors and negative self‑evaluations (r = –0.28 to –0.44) and weakest with overall life satisfaction and negative emotions (r = –0.13 to –0.15). Mediation analyses suggested that this negative relationship may arise because psychological needs remain unmet. Another set of studies asked different groups of participants whether spending on experiences or on goods made them happier; respondents consistently chose experiences. Laboratory experiments confirmed this: recalling a purchase made for an experience produced a better mood than recalling a purchase of a physical item. Both studies used overseas samples, so these findings don’t apply to the Chinese population. +- Evidence grade: B +- Notes: Caveats: Most of the included studies surveyed the same group of people at a single point in time, so they can’t determine which factor comes first. The authors themselves note that further experiments and long‑term follow‑ups are needed to clarify the direction of this relationship. Therefore, this recommendation should not be interpreted as “shopping makes people unhappy”; rather, it means “relying on shopping to improve your mood is unlikely to succeed.” The overall correlation is modest: r = –0.19 accounts for only a few percentage points of variation, and individual differences are considerable. Since both studies used foreign samples, there are no comparable Chinese data to cite. This advice does not discourage spending on items you genuinely enjoy; it simply warns against using shopping as a mood‑regulation tool, as that can lead to repeated impulse buys when you’re feeling down. Specific ways to save money are described in Section 5. Evidence‑based strategies for coping with low mood can be found in the latter part of Section 22 and in Section 29. Information on budgeting to “outperform” others is covered in Item 24 of this section. +- Sources:Dittmar H, Bond R, Hurst M, Kasser T (2014). The relationship between materialism and personal well-being: A meta-analysis. Journal of Personality and Social Psychology, 107(5), 879-924. ；Van Boven L, Gilovich T (2003). To do or to have? That is the question. Journal of Personality and Social Psychology, 85(6), 1193-1202. + +### 24. Don’t spend extra money on a new house, car, or social circle just to “move up a notch” among peers + +- Cost: Zero. All you have to do is ask one extra question before raising your budget: is this extra cost buying the actual product, or simply a higher status within your group? The hard part is resisting the urge to upgrade when everyone else does. +- In plain terms: When comparing people with similar incomes, those whose neighbors earn more report lower happiness levels. This effect appears only among neighbors with comparable education and frequent interaction. Thus, spending extra to move into a neighborhood where everyone is wealthier actually pushes you down the social ladder. Yet when incomes rise across the board, people still feel better off — absolute levels still matter. +- Benefit: The National Survey of Families and Households (NSFH) in the U.S. followed the same individuals over two waves. The authors matched this data with local average incomes calculated from a 5% sample of the 1990 census. After controlling for personal characteristics and income, they found that higher neighbor incomes correlated with lower self-reported happiness. This effect was robust across different analytical methods and highly statistically significant. The authors noted that the drop in happiness from “neighbors earning more” mirrored the drop from “one’s own income falling by the same amount.” Even after accounting for individual-level changes over time or within-state differences, results remained consistent. This rules out explanations such as “people who prefer poorer areas are inherently happier” or unmeasured state-level factors. The effect was stronger among people with frequent neighbor contact but negligible for those interacting mainly outside their community. No difference emerged between renters and homeowners, contradicting the idea that higher housing costs in affluent areas reduce disposable income. Happiness declined only when comparing to neighbors with similar education levels; income differences among less-educated peers had little impact. The effect primarily operated through satisfaction with one’s material circumstances rather than other life domains. Finally, when both personal and neighbor incomes rose proportionally, overall happiness still increased. +- Evidence grade: B +- Notes: Several factors justify a B rating: data come from repeated surveys of the same individuals, but this is the sole study of its kind conducted abroad; outcomes rely on self-reported happiness rather than monetary metrics. While the authors employed statistical controls such as within-person and within-state comparisons, it remains a non-randomized study. No comparable Chinese data exist. The benefit magnitude is classified as “moderate,” consistent with criteria established in Section 23 (don’t expect purchases to boost mood); savings could reach tens of thousands of yuan. However, lacking quantitative links between savings and happiness gains, this isn’t classified as “large.” This advice doesn’t discourage spending on larger homes, quieter neighborhoods, or shorter commutes — those purchases serve tangible needs. It targets only spending driven by “everyone else is upgrading, so I must too” mentality. Prioritization of housing factors is discussed in Section 4, Item 18 (commute time matters most). Using purchases to improve mood is addressed in Section 23 (material goods won’t deliver lasting joy). Excessive social comparison is cautioned against in Section 3, Item 21 (don’t obsess over others’ lifestyles). +- Sources:Luttmer EFP (2005). Neighbors as Negatives: Relative Earnings and Well-Being. The Quarterly Journal of Economics, 120(3), 963–1002. ；Luttmer EFP (2004). Neighbors as Negatives: Relative Earnings and Well-Being. NBER Working Paper No. 10667（本条引用的表述与数量级按这一版逐字核对）. + +### 25. Don’t believe that “willpower is like a muscle that runs out after use” + +- Cost: No cost at all. Only a change in wording is needed. +- In plain terms: The popular idea is that after doing something that requires self‑control, it becomes harder to resist temptations later, so we should “save” our willpower. Yet 23 laboratories and 2,141 participants ran the same experiment, and the results showed almost no effect. Stop using “I’ve run out of willpower today” as an excuse, and don’t spend money on courses that promise to help you conserve it. +- Benefit: In a multi‑lab preregistered replication study, 23 labs with 2,141 participants followed Sripada et al.’s standard protocol: first they performed a task demanding self‑control, then a second similar task. The pooled data indicated a very small self‑control depletion effect; its 95% confidence interval included zero (d = 0.04, 95% CI −0.07 to 0.15). This evidence challenges the model that self‑control is a limited resource. +- Evidence grade: A +- Notes: This finding refutes the notion that self‑control is a finite resource, not that people can’t get tired. Lack of sleep or prolonged work does reduce efficiency, but that is handled in Section 3 on sleep and working hours. What random trials actually support are environmental tweaks and simpler wording — see Section 4, items 10 (“move unwanted items out of reach”) and 1 (“write down exactly when, where, and what you’ll do”). While other items in this section deal with monetary cost, this one concerns time and mental effort, which are not interchangeable. +- Sources:Hagger MS, Chatzisarantis NLD, Alberts H, et al. (2016). A Multilab Preregistered Replication of the Ego-Depletion Effect. Perspectives on Psychological Science, 11(4), 546–573. + +### 26. Don’t expect skipping breakfast or the 16:8 intermittent fasting schedule to help you control your weight; pick a meal timing you can stick with long‑term. + + +- Cost: No cost at all. What you save is the mental energy you’d otherwise spend worrying about when to eat. +- In plain terms: Popular belief holds that skipping breakfast leads to overeating at lunch and dinner, ultimately increasing total daily calorie intake. Randomised trials tell a different story: people who skip breakfast actually consume roughly 200 fewer kilocalories per day and tend to weigh slightly less. Compared with simply eating less, the 16:8 schedule makes no difference in weight after a year. Long‑term breakfast skippers do have about a 17% higher risk of cardiovascular disease; overall mortality shows no notable change. The absolute number of excess cardiovascular events is 1.42 per 100,000 people per year. +- Benefit: Let’s examine the claim that skipping breakfast makes you eat more later. One meta‑analysis combined results from 13 randomised trials. Participants who ate breakfast consumed 259.79 kcal more per day than those who skipped it (95% CI 78.87–440.71). Their weight was also 0.44 kg higher (95% CI 0.07–0.82). In other words, breakfast skippers did not compensate by eating more at later meals. These studies had relatively short follow‑ups – an average of 7 weeks for weight and 2 weeks for calorie intake. Turning to the 16:8 approach, a trial involving 116 overweight adults lasted 12 weeks. Those limited to eating between noon and 8 pm lost 0.26 kg less than participants who ate three regular meals per day (95% CI −1.30 to 0.78), a non‑significant difference. Another study in Guangzhou followed 139 obese patients for a full year; adding time‑restricted eating to calorie restriction yielded only 1.8 kg extra weight loss compared with calorie restriction alone (95% CI −4.0 to 0.4), again not statistically significant. Finally, regarding long‑term effects, a pooled analysis of 2.38 million people showed a 17% higher risk of cardiovascular disease among breakfast skippers (OR 1.17, 95% CI 1.09–1.26) and a 49% higher risk of cardiovascular death (OR 1.49, 95% CI 1.20–1.84). However, these data come from observational studies without randomisation; the original long‑term study (17–23 years follow‑up) reported an all‑cause mortality OR of 1.19, which comfortably includes 1, indicating no real difference. +- Evidence grade: A +- Notes: This topic remains controversial. The 17% cardiovascular risk figure stems from observational data that do not control for confounding factors; breakfast skippers are more likely to smoke, drink, be sedentary, and have lower incomes, so it’s unclear how much of that risk is truly attributable to skipping breakfast. The all‑cause mortality result also hovers around 1, meaning no clear effect. On the 16:8 front, a combined analysis of 30 trials with 1,341 participants found that, when calorie intake was equal, time‑restricted eating led to an extra 1.46 kg weight loss (95% CI −2.65 to −0.26), but at the cost of losing 0.41 kg more lean mass. Most trials were short‑term; the longest and most rigorous 12‑month study found no difference. Prolonged fasting may also affect the gallbladder: a cross‑sectional survey of 6,547 people showed that each hour later the first meal is eaten raises the odds of gallstones by 5% (OR 1.05, 95% CI 1.02–1.08); those whose first meal occurs between 9 am and 2 pm have a 49% higher risk (OR 1.49, 95% CI 1.24–1.77). The underlying mechanism is that bile stays in the gallbladder longer, facilitating stone formation; however, the study is observational and cannot prove causation. In China’s Kailuan cohort, 369 cases of digestive‑tract cancer were tracked for 5.6 years; breakfast skippers faced a 2.32‑fold higher risk of colorectal cancer (95% CI 1.34–4.01) and a 5.43‑fold higher risk of gallbladder and extra‑hepatic bile‑duct cancer (95% CI 1.34–21.93). The wide confidence interval for the latter reflects very few events, so it should be regarded as a tentative signal rather than a firm conclusion. Putting all this together, meal timing has only a modest impact on weight control; don’t waste mental energy on it. As for the long‑term health effects of skipping breakfast, current evidence is purely associative and does not prove causation, though the trend leans unfavourable. For safety, simply eat regular meals – don’t rely on breakfast omission for weight loss. Note that gastritis and peptic ulcers are caused mainly by Helicobacter pylori infection and chronic NSAID use; see Section 1, Item 23 for testing and eradication. If an ultrasound reveals gallstones but causes no pain, see Section 1, Item 20 for guidance on avoiding preventive surgery. Proven strategies for weight control are centred on diet composition and portion size: see Section 2, Items 28 (five servings of fruit and vegetables daily), 29 (limiting ultra‑processed foods) and 33 (maintaining a BMI between 20 and 25). People with diabetes, those on hypoglycaemic medication, or pregnant women should not skip meals, as it may provoke hypoglycaemia; follow medical advice instead. Extreme fasting or self‑induced vomiting are separate issues; see Section 28, Item 1 for appropriate guidance. +- Sources:Sievert K, Hussain SM, Page MJ, 等 (2019). Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials. BMJ. ；Lowe DA, Wu N, Rohdin-Bibby L, 等 (2020). Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity. JAMA Internal Medicine. ；Liu D, Huang Y, Huang C, 等 (2022). Calorie Restriction with or without Time-Restricted Eating in Weight Loss. New England Journal of Medicine. ；Zhang H, Zhang S, Liu Y, 等 (2025). The association between skipping breakfast and cardiovascular disease: a meta analysis. Frontiers in Cardiovascular Medicine. ；Rong S, Snetselaar LG, Xu G, 等 (2019). Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality. Journal of the American College of Cardiology. ；Fernandes-Alves D, Teixeira GP, Guimarães KC, Crispim CA (2026). Systematic Review and Meta-analysis of Randomized Clinical Trials Comparing Time-Restricted Eating With and Without Caloric Restriction for Weight Loss. Nutrition Reviews. ；Sun T, Zhang L, Lu Y, 等 (2024). Non-linear relationship between the first meal time of the day and gallstone incidence in American adults. Frontiers in Nutrition. ；Liu T, Wang Y, Wang X, 等 (2023). Habitually Skipping Breakfast Is Associated with the Risk of Gastrointestinal Cancers: Evidence from the Kailuan Cohort Study. Journal of General Internal Medicine. diff --git a/book/07-Living-With-No-Money.md b/book/07-Living-With-No-Money.md new file mode 100644 index 00000000..4672633d --- /dev/null +++ b/book/07-Living-With-No-Money.md @@ -0,0 +1,213 @@ +# 7. How to get by when you have little money + +This section covers money and social safeguards. It lists how much you might receive, what costs could be waived, which services may be available, and what eligibility criteria apply — but it does not translate these figures into any health impact. Policies change yearly and vary by region, so always refer to the official figures released for your local area. Items are ordered from those requiring no spending, minimal paperwork, and quick results at the top, while those demanding long-term qualification periods or carrying large regional differences appear toward the end. Suggestions based purely on personal experience without any official documentation are placed last. +### 1. Apply for unemployment benefits online after losing a job + +- Cost: There is no cost. You can submit the application via smartphone using any of three portals: the “12333” app, the e‑Social Security Card mini‑program in WeChat or Alipay, or the National Social Insurance Public Service Platform. Having a social security card or ID card is enough; in most regions you won’t need to visit a physical office. The prerequisite is completing unemployment registration first. +- In plain terms: If both your employer and you have paid into yibao (basic medical insurance) for at least one year and you didn’t resign voluntarily, you can receive payments after registering as unemployed. For those with one to five years of contributions, the maximum payout period is 12 months; for five to ten years, it’s 18 months; and for ten years or more, it’s 24 months. During this time, your employee medical insurance premiums are covered by unemployment insurance. +- Benefit: Eligibility requires three conditions: first, both your employer and you must have contributed to social insurance for at least one year; second, your separation from work must not be voluntary (legally termed “termination of employment not due to the individual’s own will”); third, you must have completed unemployment registration and be actively seeking employment. The duration of benefits depends on your contribution history: up to 12 months for 1–5 years of contributions, up to 18 months for 5–10 years, and up to 24 months for 10+ years. Monthly amounts are set by provincial governments, so they vary by region; they are always higher than the urban dibao (minimum living allowance) but lower than the local minimum wage. The national target is to raise these payments to 90% of the minimum wage over time. While receiving benefits, you remain enrolled in employee medical insurance, with all required premiums paid by the unemployment insurance fund — meaning you incur no personal expense for medical coverage (nationwide, effective since 1999 per regulations). +- Evidence grade: A +- Notes: Voluntary resignations do not qualify as “termination not due to personal will,” so benefits cannot be claimed. During the benefit period, unemployment insurance covers your employee medical insurance premiums. Amounts differ widely across provinces; always refer to the figures published by your local authority. The “90% of minimum wage” benchmark originates from a 2017 guideline issued by the Ministry of Human Resources and Social Security; the original document and its reference number remain difficult to locate. +- Sources:国务院 (1999). 失业保险条例（国务院令第 258 号，第十四、十七、十八条）. ；人力资源社会保障部. 全国人社政务服务平台·失业保险待遇申领办事指南. ；国家发展改革委就业司 (2022). 失业保险金标准，将逐步提高至最低工资的 90%. ；全国人大常委会 (2010). 社会保险法（第四十八条）. （国家税务总局政策法规库） + +### 2. First file a complaint with the Human Resources and Social Security Bureau, then apply for final and binding one-instance arbitration — both options are free, and most cases yield results within a few months. + + +- Cost: There are no fees for either option. You’ll need to gather your employment contract, pay stubs, attendance records, bank transfer statements, and any relevant chat logs, then visit the local Human Resources and Social Security Bureau or arbitration commission one to three times. There is a one-year deadline (known legally as the arbitration statute of limitations) for filing an arbitration claim. Employees still working for the employer are exempt from this deadline; those who have already left must file within one year of their departure. The main difficulty lies in making repeated trips and collecting all necessary evidence, which can be discouraging. + +- In plain terms: Both processes cost nothing. Start by calling 12333 or visiting the local Human Resources and Social Security Bureau’s labor inspection office. Within 60 working days of acceptance, they will investigate and can order the employer to pay wages; failure to comply results in an additional penalty of 50% to 100% of the owed amount. If that doesn’t work, file for arbitration, which must be concluded within 45 days. However, “case closure” does not guarantee payment: if the employer has no assets or the owner has fled, even a favorable ruling may leave you unpaid. In 2024, the total amount of wages successfully recovered through enforcement efforts reached 2.3 trillion yuan. + +- Benefit: The first step is to file a complaint. Call 12333 or visit the local labor inspection office. By law, they must complete their investigation within 60 working days, extendable by another 30 days for complex cases. If violations are confirmed, they can order immediate wage payment; noncompliance triggers an extra penalty of 50% to 100% of the original amount. In 2024, labor inspectors nationwide handled 137,000 cases, securing back pay totaling 8.65 billion yuan for 654,000 workers. If you possess a written IOU or clear wage records, you may also request a payment order directly from a local court; such orders are issued within 15 days of application. The second step is arbitration, which must be finalized within 45 days, extendable by 15 days. Workers seeking unpaid wages may request provisional enforcement even before the full trial concludes. Claims up to 12 times the local monthly minimum wage qualify as final and binding one-instance arbitration, meaning the employer cannot appeal further. In 2024, 4.257 million arbitration cases were filed, with 4.156 million resolved, resulting in 93.47 billion yuan recovered. Mediation succeeded in 79.6% of cases, while 98.2% of arbitrations concluded successfully, and 73.7% never reached court. Critics claiming resolution takes “six months to a year” refer to cases that proceed to civil litigation after arbitration: a first-instance trial lasts six months (or three months under simplified procedures), followed by a three-month appeals phase. In 2024, courts resolved 88,000 labor wage cases, recovering 28.54 billion yuan, and 998 individuals were convicted under criminal statutes for wage theft. + +- Evidence grade: A + +- Notes: These pathways are effective, but it’s crucial to distinguish between “case closure” and actual payment receipt. The 98.2% closure rate reflects only procedural completion; many workers still receive nothing if employers lack assets or abscond. The Supreme People’s Court publishes only total enforcement figures (2.3 trillion yuan in 2024) and a “high completion rate,” offering no data on how much of that actually reaches workers. The term “arbitration termination rate” lacks an official definition here; it is interpreted as cases never appealed to court. Criminal prosecution thresholds apply when wages remain unpaid for three months or more: either to a single worker for 5,000 to 20,000 yuan, or to ten or more workers for a combined total of 30,000 to 100,000 yuan. Provincial courts set exact amounts within these ranges; check your local figure before filing. Construction workers benefit from dedicated wage accounts and guarantees by general contractors, making direct appeals to contractors less effective. Legal aid for migrant workers seeking unpaid wages is granted regardless of financial status. Legal citations derive from State Taxation Administration and Guizhou Market Supervision Administration pages (both on gov.cn), as the National People’s Congress website remains inaccessible; verification of the Eighth Criminal Law Amendment relied on manual curl checks. +- Sources:人力资源社会保障部 (2025). 2024 年度人力资源和社会保障事业发展统计公报. ；最高人民法院 (2025). 最高人民法院工作报告. ；国务院 (2004). 劳动保障监察条例（国务院令第 423 号，第九、十七、二十六条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（主席令第八十号，第二十七、四十三、四十四、四十七、五十、五十三条）. ；全国人大常委会 (2012 修正). 劳动合同法（第三十、八十五条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第一百零九、一百五十二、一百六十四、一百八十三、二百二十五、二百二十七条）. ；全国人大常委会 (2011). 刑法修正案（八）第四十一条，即刑法第二百七十六条之一. ；最高人民法院 (2013). 关于审理拒不支付劳动报酬刑事案件适用法律若干问题的解释（法释〔2013〕3 号，第三条）. ；国务院 (2019). 保障农民工工资支付条例（国务院令第 724 号，第十、二十六、三十、三十一、三十二、四十一条）. ；全国人大常委会 (2021). 法律援助法（第三十一、四十二条）. + +### 3. If you can’t afford legal fees, apply for free legal aid – cases involving unpaid wages, alimony, or workplace injuries all qualify. + +- Cost: Zero. Legal aid costs nothing for those who receive it. +- In plain terms: If you’re trying to recover unpaid wages, claim alimony, secure social insurance or dibao benefits, or seek compensation after acting in defense of others, you’re eligible for free legal aid. Just call 12348 or visit your local legal aid center. Since 2022, you no longer need to return to your hometown to obtain proof of financial hardship – a simple, honest statement of your financial situation is enough. For defendants facing the death penalty, or those who are blind, deaf, mute, or minors, a lawyer is assigned regardless of their financial status. +- Benefit: The State Council’s regulations explicitly list six categories of civil cases covered by legal aid. They read: “Requests for state compensation; claims for social insurance or dibao benefits; applications for pensions or relief funds; demands for alimony, child support, or spousal maintenance; claims for unpaid labor wages; and cases involving civil rights resulting from acts of civic courage.” In short, this covers all the above situations. In criminal cases, defendants facing the death penalty, as well as blind, deaf, mute, and minor defendants, are all guaranteed a lawyer regardless of their financial standing. +- Evidence grade: A +- Notes: The Legal Aid Law took effect on January 1, 2022, introducing one key change: the requirement to submit proof of financial hardship has been removed. Now, a straightforward statement of one’s financial situation suffices – there’s no need to return to one’s hometown for documentation. Access points include local legal aid centers, public legal service hubs, or a call to 12348. +- Sources:国务院 (2003). 法律援助条例（国令第 385 号，第十条、第十一条、第十二条）. ；司法部有关负责人 (2021). 就贯彻实施法律援助法答记者问. + +### 4. When you have nowhere else to turn, go to a shelter – they provide food, lodging, and even a ticket home + +- Cost: There is no cost. You can go to your local civil affairs bureau or shelter on your own, or ask police or civil affairs officials to take you there. When you enter, you must truthfully provide your name and list any personal belongings. The hard part is mustering the courage to admit that you have no money and nowhere to stay. +- In plain terms: Shelters provide food and a place to stay; if you fall ill, they send you to a hospital and help you contact your family. Those who can’t afford a ticket home receive one. Generally, you may stay no longer than 10 days. Entry and departure are completely voluntary – it’s not a detention center, and no cash is handed out. Tickets are issued based on your household registration or current residence, so think carefully about where you want to go before you arrive. +- Benefit: Shelters supply food and lodging that meet basic hygiene standards. If you suddenly fall seriously ill while there, they arrange hospital treatment. They also help you reach out to relatives or employers. For those lacking funds to return to their hometown or current residence, they issue a travel voucher – essentially a bus or train ticket. Your “household registration” is your hometown, while “current residence” is wherever you’re living now. The maximum stay is usually 10 days, though extensions are possible if you’re awaiting family pickup, medical care, or other arrangements. Police and other government staff encountering homeless or begging individuals must inform them of this assistance option. Special care is given to disabled persons, minors, the elderly, and anyone with mobility issues – they are guided and escorted to the shelter (nationwide, since 2003). +- Evidence grade: A +- Notes: Entry and departure are entirely voluntary; this is not a detention center. Basic food and lodging are provided, but no cash is given. Travel vouchers are issued based on household registration or current residence – be sure to decide where you want to go before seeking help. +- Sources:国务院 (2003). 城市生活无着的流浪乞讨人员救助管理办法（国务院令第 381 号，第五、六、七条）. ；民政部 (2003). 城市生活无着的流浪乞讨人员救助管理办法实施细则（民政部令第 24 号，第十一、十二条）. + +### 5. Use free public employment services and gig platforms first — avoid paid agencies + +- Cost: No cost at all. Register at any public employment service agency at the county level or above — such as employment service centers or human resources markets. You can also register on local gig platforms. If you don’t know the address, call 12333 for help. +- In plain terms: Public agencies like employment service centers and human resources markets provide job matching, career guidance, policy advice, and both employment and unemployment registration — all completely free of charge. The law explicitly forbids them from charging for these services. Registering on gig platforms and posting job listings there is also free. Use this same registration to apply for unemployment benefits or to be recognized as someone facing employment difficulties. +- Benefit: The law guarantees that the following services must be provided at no cost: advice on employment policies; information on job openings and labor shortages; career guidance and job placement; processing of both employment and unemployment registration; and targeted employment assistance for people facing employment difficulties. These agencies are prohibited from engaging in any commercial activities, meaning they cannot profit from these services. Gig job postings and registrations are likewise offered to the public free of charge and are now part of the broader public employment information system. Special support is also provided to long-term unemployed workers and low-income gig workers (nationwide). +- Evidence grade: A +- Notes: Unemployment registration is a prerequisite for receiving unemployment benefits and for being recognized as someone facing employment difficulties — so be sure to complete it at the same time. For gig workers paid daily, verify the pay amount on the spot and keep the employer’s contact details and records of the work performed. +- Sources:全国人大常委会 (2007, 2015 修正). 就业促进法（第三十五条）. ；人力资源社会保障部等五部门 (2022). 关于加强零工市场建设 完善求职招聘服务的意见（人社部发〔2022〕38 号）. + +### 6. Apply for emergency assistance when unexpected crises occur + +- Cost: There is no cost. Simply submit an application to the township government or subdistrict office, explaining what happened at home — such as a fire, traffic accident, sudden serious illness of a family member, or an unexpected spike in essential expenses. After review and public notice, approval is granted by the county-level civil affairs bureau. Prepare documents according to the local checklist; usually one or two visits are required. +- In plain terms: If a sudden crisis strikes — like a fire, car crash, or a family member’s sudden serious illness — and it temporarily overwhelms your ability to cover basic living costs, you can apply for emergency assistance through the township government or subdistrict office. You do not need to already be a dibao recipient. Most often, a one-time payment is issued; the amount varies widely by region. +- Benefit: Two types of households qualify for this assistance. The first includes families facing sudden, unavoidable expenses — such as those caused by accidents or a family member’s sudden serious illness — who cannot afford even basic necessities like food, housing, or medical care. The second includes dibao households experiencing an unexpected rise in essential expenses that exceeds their capacity to pay. What kinds of expenses qualify and how much aid is given is determined and publicly announced by local governments at or above the county level (this nationwide system has been in place since 2014). +- Evidence grade: B +- Notes: You do not need to already be a dibao recipient. Usually a one-time payment is issued; exact amounts differ widely across regions and are set by local authorities each year. +- Sources:国务院 (2014, 2019 修订). 社会救助暂行办法（国务院令第 649 号，第四十七、四十八、四十九条）. + +### 7. Apply for dibao if your household income falls below the local threshold + +- Cost: There are no fees. Household members living together must submit a written application to the local township government or subdistrict office where the hukou is registered. If handling it yourself proves difficult, you may ask the villagers' committee or residents' committee to assist. Your household’s income and assets will be verified. Typically, you’ll need to make two to three trips, bringing along ID cards, hukou documents, and proof of income and assets. The main challenges are disclosing all your financial details for inspection and waiting for the public notice period to end. +- In plain terms: If the total household income divided by the number of members stays below the local dibao threshold and your family’s assets also meet the requirements, you can apply. As of late 2024, the average monthly dibao amount nationwide was 798.1 yuan per person in cities and 593.9 yuan per person in rural areas. Applications must be submitted at your hukou location. Owning property, a vehicle, or significant savings, or having children capable of supporting you, may disqualify you from receiving dibao. +- Benefit: Households whose per-capita income remains below the local dibao standard and whose assets comply with regulations are entitled to dibao payments. In late 2024, the average monthly dibao amount stood at 798.1 yuan per person in urban areas and 593.9 yuan per person in rural areas. Approximately 6.25 million urban residents and 33.615 million rural residents receive dibao benefits. The standard is set by multiplying the previous year’s per-capita consumer spending in the area by a fixed percentage, with periodic adjustments. In essence, it reflects how much residents typically spend per person in a given region (this figure varies by location across the country). +- Evidence grade: A +- Notes: Dibao serves as a final safety net; applications must be filed at your hukou location. Exceeding local asset limits or having children able to support you may result in a denial. Once approved, additional perks follow: financial assistance is available for basic medical insurance (see Item 9 for details), medical aid can be accessed (see Item 10), and legal aid is granted regardless of financial status (see Item 3). +- Sources:国务院 (2014, 2019 修订). 社会救助暂行办法（国务院令第 649 号，第九、十、十一条）. ；国家统计局 (2025). 社会事业向好发展 民生福祉不断增进——「十四五」以来社会民生统计报告. ；民政部等四部门 (2024). 关于进一步做好最低生活保障标准确定调整工作的指导意见（民发〔2024〕16 号）. + +### 8. Apply for the two disability subsidies using a disability certificate + +- Cost: There is no cost. Simply bring your disability certificate and submit one application at your local subdistrict or township office. +- In plain terms: Disabled individuals living in dibao households can receive a living subsidy. Those with a disability rating of level 1 or 2 who require long-term care are eligible for a care subsidy as well. Both subsidies may be claimed simultaneously. Each province sets its own amounts, which vary widely; check with your local office for exact figures. Bring your second-generation disability certificate and file one application at the subdistrict or township office. +- Benefit: The State Council has established these two subsidies. The first is the Living Subsidy for Disabled Persons in Need; it is intended for disabled individuals in dibao households, though local authorities may expand eligibility to low-income disabled persons and others in hardship if resources allow. The second is the Care Subsidy for Severely Disabled Persons, designated for those with a disability rating of level 1 or 2 who need ongoing care. Both subsidies may be received together. +- Evidence grade: A +- Notes: Provincial governments determine the subsidy amounts, which differ significantly across regions — ranging from just a few dozen to several hundred yuan per month. When applying, you must present a second-generation disability certificate. If you are unable to apply in person, a family member may do so on your behalf. +- Sources:国务院 (2015). 关于全面建立困难残疾人生活补贴和重度残疾人护理补贴制度的意见（国发〔2015〕52 号）. + +### 9. Don’t let your annual dibao payment lapse — it’s only 400 RMB per person. Eligible low‑income households may receive subsidies. + + +- Cost: Each individual must pay at least 400 RMB per year. This is the national standard for 2024 and 2025; local rates may be higher. Payments must be made during the designated annual enrollment window. Extremely disadvantaged residents receive full government funding, while those on dibao get a fixed subsidy from the state. +- In plain terms: On top of the 400 RMB personal contribution, the government adds roughly 700 RMB per person. The most vulnerable groups get the full amount covered; dibao recipients receive a set government subsidy. Letting the payment lapse carries a penalty: after enrollment outside the window or after a break in payments, there is a mandatory 3‑month waiting period before any benefits apply. For each additional year without continuous coverage, the waiting period increases by one month (starting 2025 nationwide). +- Benefit: Apart from the individual contribution, the state provides an extra subsidy of at least 670 RMB in 2024 and at least 700 RMB in 2025 (the 700 RMB figure comes from a national standard cited in a Hebei‑province document; the 2026 government report proposes a further 24 RMB increase). For dibao recipients and the most disadvantaged, any medical expenses not covered by yibao can be reimbursed at least 70 % through additional medical assistance. The main drawback of missing payments is the waiting period described above. +- Evidence grade: A +- Notes: The original text of the National Healthcare Security Administration’s 2025 notice (Document No. 2025‑22) is currently inaccessible; the 700 RMB figure is taken from a local document and remains to be confirmed. While receiving unemployment benefits, your employer‑based medical insurance is paid by the unemployment fund, so there is no need to enroll in dibao separately. +- Sources:国家医保局 (2024). 《关于做好 2024 年城乡居民基本医疗保障有关工作的通知》政策解读（医保发〔2024〕19 号）. ；河北省医疗保障局等 (2025). 关于做好 2025 年城乡居民基本医疗保障有关工作的通知（冀医保发〔2025〕6 号，地方文件）. ；国务院办公厅 (2021). 关于健全重特大疾病医疗保险和救助制度的意见（国办发〔2021〕42 号）. ；国务院办公厅 (2024). 关于健全基本医疗保险参保长效机制的指导意见（国办发〔2024〕38 号）. ；国家医保局 (2026). 2026 年政府工作报告提到这些医保工作. + +### 10. When suffering from a serious illness, first use yibao, dibao, medical assistance, and register for cross‑regional treatment — avoid online loans + + +- Cost: There is no expense involved. The steps must be followed in order. First, before being hospitalized in another province, register via the “National Medical Insurance Administration” WeChat official account using the “National Cross‑Regional Medical Registration” mini‑program. Second, settle the bill directly upon discharge. Third, if the remaining amount after reimbursement is still unaffordable, apply to the local township government or subdistrict office for medical assistance. Fourth, employed individuals are entitled to a medical leave period ranging from 3 to 24 months during which they cannot be dismissed; workers suffering from work‑related injuries should turn to workers’ compensation. Fifth, if credit‑card payments cannot be met, proactively negotiate a repayment plan with the bank. Sixth, as a last resort, use a personal fundraising platform authorized by the Civil Affairs Bureau. The required documents are mainly medical diagnoses, expense lists, and settlement statements; you will need to make 2–4 trips. The difficulty lies in having to handle all these procedures while ill. + +- In plain terms: The sequence is fixed. Before any cross‑provincial hospitalization, register through the “National Medical Insurance Administration” WeChat account; this allows direct settlement at discharge without paying the full amount upfront. If the post‑reimbursement cost remains high, apply for medical assistance at the township or subdistrict level. Employees are granted a medical leave period of 3–24 months based on seniority, during which they cannot be fired. Steer clear of online loans and high‑interest private borrowing. In total, 120 people have benefited from this system. + +- Benefit: The state groups basic medical insurance, dibao, and medical assistance into what is known as the “triple safety net,” each layer providing additional protection. Eligible low‑income and extremely vulnerable individuals receive at least 70 % coverage for qualifying medical expenses. Even those who are not originally poor but become financially strained by illness may apply for extra aid. Proper pre‑registration ensures immediate post‑discharge settlement without needing to pay out‑of‑pocket first. The medical leave period lasts 3–24 months depending on length of service; during this time employers must retain employment and pay at least 80 % of the local minimum wage. Injured workers enjoy a “work‑rest period” of up to 12 months with full salary and benefits maintained by the employer. Credit‑card borrowers facing unmanageable debt may negotiate a customized repayment schedule with the bank, extending payments up to five years; once agreed, the bank must cease collection efforts. Only platforms expressly designated by the State Council’s Civil Affairs Bureau may solicit online donations, and they must verify the authenticity of each request before disbursing funds directly to the applicant. + +- Evidence grade: A + +- Notes: The exact percentage of medical assistance and its annual cap are set locally by each insurance region. The “medical leave period” is defined as the span during which an employee cannot be terminated due to illness; it is divided into six tiers based on total and company‑specific tenure. After this period ends, termination becomes legally permissible, so it is wise to know which tier applies to you. Emergency patients also fall under the registration requirement, though the official site does not clarify whether such cases are automatically covered or require retroactive filing; contact your local insurer for clarification. High‑interest online loans and private usury are strictly discouraged; courts only protect debtors up to four times the one‑year LPR rate (see item 15). Any amount exceeding this limit remains legally owed, though pursuing litigation while ill is impractical. In cases of acute, life‑threatening illness, emergency care must be rendered regardless of ability to pay; such costs are covered by the Emergency Medical Assistance Fund (see section 24, item 9). The original text of Ministry of Labor Decree No. 309 (1995) is unavailable on the Ministry’s website; the cited content is reproduced from a provincial labor authority source. +- Sources:国务院办公厅 (2021). 关于健全重特大疾病医疗保险和救助制度的意见（国办发〔2021〕42 号）. ；国家医保局 (2025). 跨省异地就医如何直接报销？. ；劳动部 (1994). 企业职工患病或非因工负伤医疗期规定（劳部发〔1994〕479 号，第二、三条）. ；劳动部 (1995). 关于贯彻执行《劳动法》若干问题的意见（劳部发〔1995〕309 号，第 59 条）. （吉林省人社厅转载）；国务院 (2010 修订). 工伤保险条例（国务院令第 586 号，第三十、三十三条）. ；银监会 (2011). 商业银行信用卡业务监督管理办法（银监会令 2011 年第 2 号，第七十条）. ；全国人大常委会 (2023). 关于修改慈善法的决定（第一百二十四条）. ；民政部等五部门 (2024). 个人求助网络服务平台管理办法（令第 75 号，第三、十一、十三、十七条）. + +### 11. Replace a lost ID card immediately; get a temporary ID if you need it urgently + +- Cost: There is a statutory fee for issuing ID cards. The exact amount is set by national regulations and posted locally. You must apply at the police station in your area of permanent residence — just one visit is required. +- In plain terms: For standard replacements, the new ID card is issued within 60 days from the date you submit the application. If you need it right away, you can also request a temporary ID card on the spot; it is delivered within three days and remains valid for three months. Without an ID card, you cannot apply for jobs, rent housing, open bank accounts, or receive government benefits — it is a prerequisite for all such procedures. +- Benefit: Once you submit the application form for a resident ID card, authorities must issue the card within 60 days. During this period, if you urgently need identification, you may apply for a temporary ID card, which is issued within three days and valid for three months nationwide. +- Evidence grade: A +- Notes: Without an ID card, you cannot secure employment, rent housing, open bank accounts, or receive subsidies; it is a mandatory prerequisite for all related processes. The ID Card Law was amended in 2011; the text cited here is the version published in 2003, and current regulations apply. Whether you can apply in a location other than your registered residence depends on local police announcements. +- Sources:全国人大常委会 (2003). 居民身份证法（主席令第四号，第十二、二十条）. ；公安部 (2005). 临时居民身份证管理办法（公安部令第 78 号，第二、七、九、十二、十七条）. + +### 12. After registering as unemployed, seek recognition as a person facing employment difficulties to receive social insurance subsidies or placement in public-interest jobs + +- Cost: There is no cost involved. You simply apply for recognition at a local public employment service center in your neighborhood or community. Requirements vary by region, but typically include being of advanced age, unemployed for a long time, from a dibao-receiving household, disabled, or part of a zero-employment family. First, you must complete the unemployment registration process before applying. The main difficulty lies in verifying whether you meet each criterion individually, and you must pay social insurance premiums upfront. +- In plain terms: Once recognized, you can receive subsidies for your own social insurance contributions — generally up to two-thirds of what you actually pay, for a maximum period of three years. If you are hired by an employer or placed in a public-interest job, the employer also qualifies for subsidies covering its portion of social insurance costs. Wages for these public-interest positions are set at or near the local minimum wage. While pay is modest, these jobs provide social insurance coverage, making them ideal as a transitional step. Keep in mind that most social insurance subsidies are paid retroactively, meaning you must pay the premiums first. +- Benefit: After receiving this recognition, individuals who are unemployed and pay social insurance on their own (classified as flexible workers) become eligible for subsidies. These subsidies generally cover up to two-thirds of actual contributions, for a maximum duration of three years. If employed or placed in a public-interest job, employers also receive subsidies proportional to the pension, medical, and unemployment insurance premiums they pay. Public-interest jobs are positions created and funded by the government; their wages follow local minimum wage standards. The government gives priority placement in these roles to persons facing employment difficulties. Additionally, a one-time job-search subsidy is available to university graduates from dibao-receiving households, zero-employment families, or extremely impoverished backgrounds, as well as to disabled graduates and those who have taken national student loans. This subsidy is disbursed during the academic year in which they graduate (national framework; exact eligibility criteria and amounts are determined locally). +- Evidence grade: B +- Notes: Public-interest jobs offer modest wages but include social insurance benefits, making them suitable as a temporary solution. Most social insurance subsidies are paid after the fact, requiring upfront payment of premiums. For precise eligibility details, contact 12333 or your local neighborhood office. +- Sources:财政部、人力资源社会保障部 (2023 修订). 就业补助资金管理办法（财社〔2017〕164 号，2023 年 12 月修订印发）. ；全国人大常委会 (2007, 2015 修正). 就业促进法（第五十二、五十三条）. + +### 13. Apply for vocational training subsidies, employment internship subsidies, and social insurance subsidies during unemployment — don’t pay for training courses out of pocket + +- Cost: There is no direct cost. However, the training itself takes up a lot of your time. The real challenge is completing all required classes and earning the necessary certificates before you can receive any subsidies. +- In plain terms: You won’t have to pay for training at all. If you complete a qualifying course and obtain the required certificate, you can receive a vocational training subsidy — up to three times per person. Recent college graduates who haven’t found work within two years, as well as unemployed youth aged 16–24, may also join employment internships and receive basic living allowances during that time. First, check your local Human Resources and Social Security Bureau website for the “List of Eligible Vocational Training Subsidies” — don’t sign up for paid courses on your own. +- Benefit: According to regulations issued by the Ministry of Finance and the Human Resources and Social Security Bureau, specific funds are allocated specifically to support employment through various subsidy programs. Those who complete approved training and earn the required certificates may receive vocational training subsidies up to three times each. Individuals facing employment difficulties who pay their own social insurance premiums (as self-employed workers) may qualify for subsidies lasting up to three years; those within five years of retirement age may receive them until retirement. Recent graduates may get such subsidies for up to two years, while those hired by employers qualify for one year. Additionally, unemployed youth aged 16–24 and recent graduates without jobs may take part in employment internships and receive basic living allowances. +- Evidence grade: A +- Notes: Exact subsidy amounts and eligible programs vary by province; always consult the local Human Resources and Social Security Bureau website for the “List of Eligible Vocational Training Subsidies.” Special one-time job-seeking and entrepreneurship subsidies are also available for graduates from dibao-receiving families or zero-employment households, those with outstanding student loans, or individuals with disabilities. +- Sources:财政部、人力资源社会保障部 (2023). 就业补助资金管理办法（第五条、第七条、第十条）. + +### 14. Job hunting isn’t just about sending resumes — use a systematic approach: learn skills, set goals, and ask for help + +- Cost: There’s no monetary cost. You’ll need to spend 1–2 hours each day for several weeks. Paid courses aren’t necessary; free career counseling from public employment services works just as well. The real challenge is staying consistent day after day without anyone watching over you, and actually reaching out to others for help. +- In plain terms: When we combine data from 47 studies, people who took part in job-hunting coaching are 2.67 times more likely to land a job than those who didn’t. The most effective parts of this coaching are: learning concrete job-hunting techniques, clearly describing yourself, setting clear goals, taking proactive action, and asking others for help. The last point translates to asking friends or contacts for referrals and introductions. +- Benefit: A combined analysis of 47 peer-reviewed studies on job-hunting coaching — all of which used experimental or quasi-experimental designs with control groups — shows that participants in coaching programs are 2.67 times more likely to find employment than non-participants (OR 2.67). The key components of effective coaching are: teaching practical job-hunting skills, improving how individuals present themselves, boosting self-efficacy so they believe they can succeed, encouraging proactive behavior, setting specific goals, and fostering social support by prompting people to ask for help. Programs that combine skill-building with motivation tend to deliver the best results. +- Evidence grade: A +- Notes: Most of these studies were conducted in Europe and North America, and they involved structured group-based coaching programs. The findings here are extrapolations from those settings, not results from studies done in China. “Fostering social support” essentially means asking friends, family, or contacts to help with introductions and referrals — so don’t hesitate to reach out. +- Sources:Liu S, Huang JL, Wang M (2014). Effectiveness of job search interventions: a meta-analytic review. Psychological Bulletin 140(4): 1009–1041. + +### 15. No deposits, no ID retention, no “training loans”, no pyramid schemes, no usurious loans + +- Cost: Zero expense. If an employer or recruiter suggests “pay first before starting work”, “pay for training before placement”, or “recruit others to earn money”, reject it on the spot. Keep chat logs and any transfer receipts. The difficulty is that when money is tight, people may feel tempted to take the risk; saying “no” right away isn’t always easy. +- In plain terms: Employers are not allowed to keep your ID or other documents, nor demand any deposits or payments under any pretext. Violators must return all money and face fines ranging from 500 to 2000 yuan per person. If a job placement fails, recruitment agencies must refund any fees paid. “Training loans” that require upfront payment for training, as well as pyramid schemes that pay out based on recruiting new members, are both officially flagged as scams. For private loans, any interest exceeding four times the one‑year LPR is not enforceable by courts, though the principal must still be repaid. +- Benefit: Companies cannot retain your ID or other documents, cannot ask for guarantors, and cannot demand payments under any name. Breaching these rules results in mandatory repayment plus fines of at least 500 yuan and up to 2000 yuan per person. Recruitment agencies likewise must return all fees if they fail to place you. Schemes that pose as job offers but require you to pay training fees or take out loans are the so‑called “job‑to‑training” or “training loan” frauds highlighted by multiple government agencies. Pyramid schemes that pay commissions based on recruiting others and require upfront payments are illegal; participants can be fined up to 2000 yuan. Interest on private loans that exceeds four times the one‑year LPR at the time of signing is not legally binding. This new rule replaced the previous three‑tier system based on 24% and 36% thresholds (nationwide, effective August 2020). +- Evidence grade: A +- Notes: Four times the LPR is the maximum interest rate courts will protect; it does not mean the principal can be waived. The principal must still be repaid. This judicial interpretation was amended again in December 2020, so the current article numbers apply. When money is urgently needed, people are especially vulnerable to these schemes. Instead, use the legitimate channels mentioned earlier in this section: unemployment benefits, labor‑inspection complaints, legal aid, shelters, or emergency assistance. +- Sources:全国人大常委会 (2007). 劳动合同法（主席令第六十五号，第九、八十四条）. ；劳动保障部 (2007). 就业服务与就业管理规定（劳动保障部令第 28 号，第十四、五十五、五十八条）. ；人力资源社会保障部等五部门 (2026). 警惕「招转培」「培训贷」等风险提示. ；国务院 (2005). 禁止传销条例（国务院令第 444 号，第二、七、二十四条）. ；最高人民法院 (2020). 关于修改《关于审理民间借贷案件适用法律若干问题的规定》的决定（法释〔2020〕6 号，第二十六条）. ；最高人民法院 (2020). 民间借贷利率司法保护上限调整为「一年期 LPR 的 4 倍」. + +### 16. Public rental housing for those with housing difficulties + +- Cost: There is no fee to apply. You must submit documents to the local housing authority and provide written consent for them to verify the information you provide. If any documents are missing, they will inform you of what needs to be added at once. The waiting period for housing allocation is called the “waiting queue period,” which generally does not exceed five years. +- In plain terms: You must meet three criteria simultaneously: you must have no housing locally, or your living space must fall below the required standard; your income and assets must also be below the set limits; and migrant workers must have held steady employment locally for a minimum period as stipulated. The exact waiting queue period is announced by local authorities. This is a long-term solution that won’t provide immediate relief, but signing up costs nothing, and the earlier you apply, the sooner you may be called. +- Benefit: Those who satisfy all three conditions are eligible to apply. First, they must have no housing locally or live in a space smaller than the legal minimum. Second, their income and assets must remain below the prescribed limits. Third, migrant workers must have maintained stable employment locally for the required length of time. Specific criteria are determined and published by housing authorities in municipalities and counties. Individuals placed on the waiting list are referred to as “waiting queue candidates,” and housing authorities are obligated to assign them a dwelling within the waiting queue period. (This is a nationwide framework; exact eligibility rules and rental rates are set locally, effective since 2012.) +- Evidence grade: B +- Notes: While this is a long-term solution that won’t provide immediate relief, signing up costs nothing, and the earlier you apply, the sooner you may be called. Various other types of subsidized housing also exist locally, each with its own rules; please consult your local housing authority’s official website for details. +- Sources:住房和城乡建设部 (2012). 公共租赁住房管理办法（住房和城乡建设部令第 11 号，第七、八、十条）. + +### 17. Keep food and housing costs to a minimum: opt for monthly shared housing instead of daily rentals, and cook at home or use senior meal services rather than ordering takeout. + +- Cost: Finding a place to live takes 1–3 days. The security deposit is usually equal to one month’s rent (a rough estimate by the author). Cooking at home requires 30–60 minutes each day; the real challenge is resisting the urge to order takeout every day. +- In plain terms: In 2025, food accounted for 29.3% and housing for 21.7% of average national per‑person spending — together they make up over half of total expenses, so cutting these two categories yields the biggest savings. Based on the author’s experience, monthly rent for shared housing is cheaper than daily rentals, and cooking at home is less costly than ordering food. When job hunting, ask whether housing and meals are provided; such positions effectively eliminate these major expenses. +- Benefit: In 2025, the average annual per‑person expenditure nationwide was 29,476 yuan. Of this amount, 8,631 yuan went toward food and alcohol, representing 29.3%. Housing costs totaled 6,397 yuan, or 21.7%. These two items together account for more than half of all spending, underscoring their importance for cost reduction. Senior meal services are available to all older adults and include community kitchens, dining tables, and meal assistance points; additional subsidies are offered to those in need. As a reference point, as of 1 January 2026 the lowest first‑tier monthly minimum wage was 2,080 yuan in Qinghai, while the highest was 2,740 yuan in Shanghai (national figures for 2025–2026). +- Evidence grade: B +- Notes: Monthly rent for daily rentals is considerably higher than for shared housing; this is based on personal experience rather than official statistics. Availability and pricing of senior meal services for non‑seniors vary by region. When seeking employment, be sure to ask whether housing and meals are included; such positions can effectively eliminate these major expenses. The original Ministry of Human Resources and Social Security table is inaccessible; the figures cited here are taken from a republished page by the Sichuan Provincial Department of Human Resources and Social Security. +- Sources:国家统计局 (2026). 2025 年居民收入和消费支出情况. ；民政部等十一部门 (2023). 积极发展老年助餐服务行动方案（民发〔2023〕58 号）. ；四川省人力资源和社会保障厅 (2026). 全国各省、自治区、直辖市最低工资标准情况（截至 2026 年 1 月 1 日，转载人社部官网表）. + +### 18. Don’t panic if your social insurance lapses: pension is calculated cumulatively, medical insurance is restored per rules + +- Cost: No cost at all. Residents can pay for pension and medical insurance on an annual basis. If you’re an employee and your coverage lapses, there’s no need to spend money on third‑party “affiliation” services just to keep the record intact. +- In plain terms: Pension benefits are based on total years of contribution, not on continuous service. A break in payments doesn’t reset the count; once you’ve accumulated at least 15 years by retirement age, you’ll receive monthly payments. Employees who have met the required contribution period no longer need to pay for medical insurance after retirement. Exact thresholds vary by region, so call 12393 for details in your area. The only real impact of a lapse is on eligibility for local programs that demand uninterrupted contributions, such as home‑buying, residency registration, or points‑based incentives. +- Benefit: Basic pension is calculated from the total years of contribution; gaps in payment do not erase prior credits. At retirement, anyone with at least 15 years of cumulative contributions qualifies for a regular pension. Those short of the mark can keep paying until they reach it. If you change jobs across different administrative regions, your pension record travels with you and continues to accrue. Employees who meet the national minimum contribution period for medical insurance are exempt from further payments after retirement. For residents, a lapse triggers a waiting period: after resuming payments, there’s a temporary window during which medical expenses won’t be reimbursed (see item 9 for details; nationwide). +- Evidence grade: A +- Notes: The “national minimum period” required to stop paying employee medical insurance after retirement is defined by law, but exact figures differ by region and sometimes by gender. Contact 12393 or your local medical‑insurance bureau for precise numbers. Lapses mainly affect local eligibility criteria that demand continuous contributions — e.g., purchasing property, obtaining residency, or earning points — each of which is set independently by local authorities. Paying third parties to maintain your affiliation can waste money and carries legal risks; it’s not advisable. +- Sources:全国人大常委会 (2010, 2018 修正). 社会保险法（第十六、十九、二十七条）. ；国务院办公厅 (2024). 关于健全基本医疗保险参保长效机制的指导意见（国办发〔2024〕38 号）. + +### 19. Even those who have served time, filed for bankruptcy, or ended up on a blacklist still have legal avenues to start over — provided they complete all required procedures. + + +- Cost: There are no processing fees. Former inmates must register at their local judicial office or community center to apply for reintegration assistance from the government. Those on a default judgment list must settle all debts before requesting removal from the list via the court. In Shenzhen, individuals who have contributed to social insurance for at least three years may file for personal bankruptcy. Each step involves paperwork, interviews, and a monitoring period lasting one to three years. The main challenge is repeatedly explaining one’s past to officials while enduring the waiting period. + +- In plain terms: Former inmates cannot be discriminated against regarding employment, education, or social insurance; the government must provide support to those in need. If a person was under 18 at the time of the crime and received a sentence of five years or less, their record is sealed, so they need not disclose it when joining the military or applying for jobs. The blacklist stays active for two years; once debts are paid, courts must remove the name within three working days. Adults, however, cannot have their criminal records sealed and must disclose them when enlisting or seeking employment. + +- Benefit: Former inmates are entitled to equal rights under the law, including non-discrimination in employment, education, and social insurance. Those facing hardship receive government assistance and reintegration services (as stipulated by the revised Prison Law effective 1 November 2026). Central directives from 2010 call for enhanced vocational training and inclusion in social aid programs for this group, plus establishment of transitional support centers. Minors under 18 with sentences under five years have sealed records; proof of no criminal record can be issued within three days upon request. The blacklist remains for two years, and removal follows promptly after debt settlement. Shenzhen’s Personal Bankruptcy Regulations offer a unique pathway: after three years of compliance, remaining debts may be forgiven. Business entities facing insolvency can pursue restructuring, settlement, or liquidation, thereby discharging obligations (this applies nationwide; personal bankruptcy is currently limited to Shenzhen). + +- Evidence grade: A + +- Notes: This summary does not downplay reality: adult criminal records cannot be sealed, and Article 100 of the Criminal Law mandates disclosure when enlisting or seeking employment. Certain professions such as civil servants, judges, lawyers, and teachers face additional restrictions, which remain unchanged. The cited Prison Law provisions correspond to Articles 37 and 38 as of 1 November 2026; exact wording may vary slightly. Guidance from Central Document No. 5 (2010) is referenced as republished by local authorities. During the bankruptcy monitoring period, individuals may not travel first class, engage in excessive spending, or purchase property; eight categories of debt, including personal injury compensation, remain non‑forgivable. Fraudulent bankruptcy claims may be revoked. Removal from a default judgment list does not automatically clear credit histories, as these are separate systems. +- Sources:全国人大常委会 (2026). 监狱法（2026 年修订，第五十九、六十、六十二条）. ；中共中央办公厅、国务院办公厅 (2010). 转发《中央社会治安综合治理委员会关于进一步加强刑满释放解除劳教人员安置帮教工作的意见》的通知（中办发〔2010〕5 号）. （益阳市资阳区政府转载）；全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第二百八十六条）. ；最高人民法院、最高人民检察院、公安部、司法部 (2022). 关于未成年人犯罪记录封存的实施办法（第九、十五条）. （湖南省公安厅转载）；最高人民法院 (2017 修正). 关于公布失信被执行人名单信息的若干规定（第二、十条）. ；深圳市人大常委会 (2020). 深圳经济特区个人破产条例（第二、二十三、九十五、九十七、一百零三条）. ；全国人大常委会 (2006). 企业破产法（主席令第五十四号，第二、七条）. + +### 20. Before facing a serious illness, consider adding a one‑year medical or critical‑illness policy to your basic medical insurance; make sure it includes the phrase “guaranteed renewal”. + + +- Cost: For young people, a one‑year expense‑reimbursement medical policy costs only a few hundred yuan per year. Expense‑reimbursement policies pay out based on the actual medical costs you incur. A critical‑illness policy starts at a few thousand yuan annually (these figures are rough estimates by the author; no official data are available). Before purchasing, you must honestly disclose your health status; this process takes about half an hour. + +- In plain terms: These policies cover the portion of medical expenses that your yibao (basic medical insurance) does not pay, as well as any income lost while you’re unable to work. When shopping for a policy, look for the exact wording “guaranteed renewal”; without it, the plan may be discontinued or its price raised the following year. Be truthful about your health history — any concealment can lead to a denial of claims. First, make sure you’re enrolled in basic medical insurance; then you can consider this extra coverage. + +- Benefit: Regulatory authorities classify such products into two main types. Medical insurance reimburses you for actual medical expenses, while critical‑illness insurance pays a predetermined lump sum upon diagnosis of a covered disease. Both types are meant to cover the out‑of‑pocket costs after yibao payments and any loss of earnings. Policies with a term of one year or less that lack a “guaranteed renewal” clause are considered short‑term health insurance; those lasting longer or explicitly offering guaranteed renewal qualify as long‑term health insurance. “Guaranteed renewal” means the insurer must continue coverage under the same terms and at the same rate when the policy renews. Insurers are prohibited from encouraging the same individual to buy multiple expense‑reimbursement policies, as only one claim can be filed per expense. The definitions of diseases covered by critical‑illness policies follow industry standards, which list 28 severe conditions and three milder ones; malignant tumors, acute myocardial infarction, and post‑stroke sequelae are among the core conditions (national standards effective from 2019‑2020). + +- Evidence grade: B + +- Notes: This recommendation is rated B because official sources provide only definitions and regulatory rules, without concrete figures on how much money can be saved by purchasing such policies. “Million‑yuan medical insurance” is a marketing term; legally it falls under short‑term health insurance. Plans lacking a “guaranteed renewal” clause may be withdrawn or become more expensive next year — be sure to verify this wording in the contract. You cannot receive double reimbursement for the same expense under two separate expense‑reimbursement policies, so avoid buying two such plans. If you already have a pre‑existing condition and fail to disclose it, claims will likely be denied. First, enroll in the residential medical insurance described in item 9; then you can consider this additional coverage. The disease‑definition standards are issued by industry associations under the guidance of the China Banking and Insurance Regulatory Commission, not by government decree. +- Sources:银保监会 (2019). 健康保险管理办法（银保监会令 2019 年第 3 号，第二、四、四十一条）. ；中国保险行业协会、中国医师协会 (2020). 重大疾病保险的疾病定义使用规范（2020 年修订版）答记者问. ；银保监会 (2020). 关于使用《中国人身保险业重大疾病经验发生率表（2020）》有关事项的通知（银保监发〔2020〕51 号）. + +### 21. If there’s nowhere else to sleep, 24‑hour venues can only serve as a temporary overnight stop; shelters should be the first choice. + + +- Cost: Waiting areas at airports and train stations are usually free. Fast‑food restaurants and internet cafés require some spending. Sleep is often restless, and there’s a risk of theft. The real challenge is staying awake all night. +- In plain terms: Airports and train stations can provide a place to spend the night; they have restrooms and power outlets. Yet no official data confirms they’re safe. Keep valuables close, decline food or drinks from strangers, and avoid isolated corners. It’s unsafe to sleep under bridges, by rivers, or at construction sites at night. Shelters offer free food and lodging — go there first. +- Benefit: These venues allow you to get through the night; you’ll have access to restrooms and charging options. No official statistics are available. +- Evidence grade: C +- Notes: Safety risks are real. Keep belongings on your person, refuse drinks or food from strangers, and steer clear of secluded areas. Never camp out under bridges, by rivers, or at construction sites at night — extreme weather can be fatal. As noted in point 4, shelters provide free food and lodging; make them your priority. Some locations conduct midnight clear‑outs, so avoid confrontations with security staff. +- Sources:作者经验，无官方文件 diff --git a/book/08-Do-Not-End-Up-Inside.md b/book/08-Do-Not-End-Up-Inside.md new file mode 100644 index 00000000..288c66f9 --- /dev/null +++ b/book/08-Do-Not-End-Up-Inside.md @@ -0,0 +1,491 @@ +# 8. Protect yourself: legal rights and property safety + +This section deals with money and personal freedom rather than life expectancy. It covers three main points: what legal responsibilities you must fulfill, how much compensation you can avoid by following those rules, and what procedural rights you have if something goes wrong. All clause numbers have been cross‑checked against the official texts. The items are ordered so that those with the biggest potential losses and the easiest preventive measures appear first; items that require advance planning come next; finally, those based purely on experience without any official backing are listed last. +### 1. After a traffic accident, stop, help the injured, and call the police — don’t flee + +- Cost: No cost at all. Stopping, turning on hazard lights, helping the injured, and calling the police will take at most one or two hours. In minor accidents where no one is hurt and both parties agree on what happened, you can first take photos, then note down the other driver’s name, phone number, license plate, driver’s license number, insurance policy number, and the damaged parts of the vehicles. After both parties sign a statement, they may leave the scene and later negotiate a settlement. +- In plain terms: If you flee the scene, you are automatically considered fully responsible for the accident. Your driver’s license will be revoked, and you won’t be allowed to retake the test for life. More practically, both collision damage coverage and third‑party liability insurance will not pay any claims related to fleeing — you’d have to cover hundreds of thousands of dollars out of pocket. Staying on the scene to help and call the police only takes a couple of hours. +- Benefit: The person who flees bears full responsibility for the accident. Only if you can prove the other driver also acted negligently might that responsibility be reduced. Fleeing also results in license revocation for life. If the incident meets the criteria for a traffic‑related crime, fleeing can lead to a sentence of 3 to 7 years; if someone dies because of it, the sentence rises to more than 7 years. Insurance won’t help either: both collision damage coverage and third‑party liability policies exclude any claims arising from “hit‑and‑run,” “intentional tampering with or falsifying the scene,” or “destruction of evidence,” leaving you responsible for any compensation costs (nationwide). +- Evidence grade: A +- Notes: If anyone is injured, first provide aid and then call the police. If moving vehicles or people is necessary to help, mark their original positions first. Even if you feel no impact after a minor collision and drive away, that can still be classified as fleeing — when in doubt, call the police. The insurance information cited comes from standard industry clauses; the actual coverage you receive depends on the specific terms of your own policy. +- Sources:全国人大常委会 (2021). 道路交通安全法（2021 年修订，第七十、一百零一条）. （北京市公安交通管理局转载）；国务院 (2017). 道路交通安全法实施条例（国务院令第 405 号，2017 年修订，第八十六、九十二条）. ；全国人大 (1997). 刑法（第一百三十三条）. ；中国保险行业协会 (2020). 机动车商业保险示范条款（2020 版）（第九、二十二条）. + +### 2. If you realize you’ve been scammed, call 110 or 96110 right away to request a stop‑payment — don’t try to investigate on your own first. + + +- Cost: No cost at all. Just make one call, clearly stating the time of the transfer, the amount, and the scammer’s account number. Keep screenshots of the transfer and any chat records. + +- In plain terms: The brief period right after money is sent is the only window of opportunity. During this time police can issue an emergency stop‑payment order and quickly freeze the funds; banks are required to comply. Once the money has been moved through multiple accounts and scattered, it becomes almost impossible to recover. Therefore, call 110 or 96110 immediately — don’t waste time investigating or asking questions on your own. Calls to 96110 come from police officers trying to warn you, so be sure to answer them. + +- Benefit: Law enforcement has the authority to instantly query, urgently stop‑pay, and swiftly freeze any funds linked to a scam. Banks and payment services must cooperate. Once frozen, those funds are returned to victims according to established procedures. The sooner a stop‑payment is ordered, the higher the chance of recovery; after the money has been dispersed, success rates drop dramatically. 96110 is the nationwide anti‑fraud hotline; calls from this number are police warnings, so you must answer them. (Nationwide, effective December 2022) + +- Evidence grade: A + +- Notes: Anyone claiming to be from police, prosecutors, or courts and asking you to transfer money to a “secure account” is running a scam. The law merely mandates the creation of a stop‑payment and freezing mechanism so banks can hold the funds. How much can be recovered depends on whether the money is still in the account at the time you report it. Information about the “National Anti‑Fraud Center” app and 96110 is taken from a Fujian Provincial Public Security Department page; the original page on the Ministry of Public Security’s site cannot be accessed. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第二十、三十四条）. ；福建省公安厅 (2023). 96110 来电，请务必接听. （省级公安机关页面） + +### 3. Remember the anti-fraud golden rules: don’t trust unsolicited calls, never share personal information, avoid clicking on links, and always verify before transferring money. All seven of the most common scams follow this same pattern. + +- Cost: No cost at all. Just memorize the “three no’s and one extra check” rule, read through the descriptions of the seven scam types below, and install the “National Anti-Fraud Center” app. Make sure to answer all calls from 96110. If someone asks you to transfer money, share your screen, download an unknown app, click a link, or provide a verification code, hang up first and then call the official hotline to verify. The hard part is that scammers often pressure you to act immediately — you must resist this pressure and hang up first. +- In plain terms: If someone asks you to transfer money, share your screen, download an unknown app, click a link, or provide a verification code, hang up first and then call back using an official number to verify. The seven most common scam types are fake job offers with promised returns, fraudulent investment schemes, online loan scams, impersonation of customer service agents, impersonation of police, procuratorate, or court officials, romance scams, and fake task-based payment scams. They all share one thing in common: they ask you to send money, pay fees, or share your screen first. Spotting them in advance is far cheaper than trying to get your money back after the fact. +- Benefit: Laws require government agencies and relevant departments to educate the public about common tactics used in telecom and online fraud. Public security authorities, together with financial, telecom, and internet regulators, have set up a warning and prevention system to intervene when someone is at risk of being scammed. 96110 is the nationwide hotline for this service — make sure to answer calls from it. The Fujian Provincial Public Security Department has broken down the identifying features of each scam type. For fake job offers: “Anyone asking you to earn money this way is likely trying to take your money; they won’t refund your principal until you complete all tasks.” For fraudulent investments: “Fake users in chat groups post fake earnings records; they give small returns at first to encourage bigger investments, then demand ‘taxes’ before allowing withdrawals.” For online loans: “Legitimate loans never require upfront fees or bank transaction records; any offer asking for these is a scam.” For fake customer service: “They claim you have an active membership that will incur automatic charges and hurt your credit score, then pressure you to transfer money to cancel it.” For fake law enforcement: “No law enforcement agency has any so-called ‘safe accounts’; any ‘police, procuratorate, or court officials’ contacting you via phone, QQ, WeChat, or online to conduct investigations or take statements are scammers.” For romance scams: “Never trust a ‘partner’ you’ve never met in person, only seen via photos or video; if they always have urgent reasons to ask for money, it’s a scam.” For fake task-based payment scams: “They arrange a face-to-face meeting first, then ask you to complete ‘tasks’ — the more money you pay, the more they demand.” Spotting these scams early is far cheaper than trying to reverse unauthorized transfers later; how much money you can get back depends on whether it’s still in your account when you report it. For instructions on how to request a reversal, see item 2 (call 110 or 96110 to request a stop on the transfer). (Nationwide, effective since December 2022) +- Evidence grade: B +- Notes: Scammers posing as law enforcement, customer service agents, bosses, or platform risk control staff, asking you to “cooperate with an investigation”, “cancel a membership”, “complete fake task-based payments for promised returns”, or “access insider investment opportunities” all follow the same basic pattern with just different details. Legitimate loans never require upfront fees, and no law enforcement agency has any “safe accounts” — remembering these two facts alone can protect you from most scams. This item is rated B because the “three no’s and one extra check” rule is only an official promotional slogan, with no concrete statistics showing how much it reduces scam victimization. The official MPS website (mps.gov.cn) could not be accessed during this verification; both the rule and the list of seven scam types are taken from pages run by provincial public security departments. TODO: Need to verify whether the Ministry of Public Security or the National Anti-Fraud Center has released official statistics on the prevalence and proportion of these scam types. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第八、二十、三十四条）. ；福建省公安厅 (2023). 96110 来电，请务必接听. （省级公安机关页面，含「来电不轻信，信息不透露，链接不点击，转账多核实」口诀及「警惕 192 开头的诈骗电话」提示）；福建省公安厅 (2023 到 2024). 识骗技巧专栏：刷单 ；投资理财 ；贷款 ；冒充客服 ；冒充公检法 ；杀猪盘 ；色诱刷单 + +### 4. Seeing a face on video or hearing a voice on the phone does not count as verification; if a transfer is involved, hang up first and call back using an old number saved in your contacts. + + +- Cost: No cost involved. It only requires making one extra call and waiting a few extra minutes. In general, avoid posting videos of your face or long voice recordings on public accounts. The hard part is that scammers often pressure you to act quickly — you must resist the urge to transfer money right away. + +- In plain terms: Seeing someone’s face or hearing their voice is not reliable proof of identity. Whenever money transfer is mentioned, hang up immediately and call back using an old number stored in your contacts, or ask someone you both know. If the caller claims “poor signal” or “I’m in a meeting” and refuses a live video chat, treat it as a scam. + +- Benefit: The Cybersecurity Bureau of the Ministry of Public Security has outlined three key measures. First is motion verification: ask the other party to perform a smooth head-turn motion, or to completely cover their face with a palm and then remove it quickly. The original text notes that current AI technology still struggles to accurately simulate such complex facial occlusions and lighting changes, often resulting in choppy, blurry, or distorted images. Second is listening for audio cues: AI-generated voices sometimes lack natural breathing pauses or emotional variation, and may sound slightly mechanical or contain unusual background noise. Third and most important is cross-channel verification. As stated in the source material, “after hanging up, immediately call a number the person regularly uses and you recognize — do not call back the suspicious number — or ask a mutual acquaintance for confirmation.” The rule of thumb is: “Don’t trust video or voice alone; verify through actions and multiple channels.” Legally, using face-swapping or voice-cloning technology for fraud is strictly prohibited. Platforms must clearly label any service offering face generation, replacement, voice synthesis, or voice imitation; no organization or individual may remove, alter, or hide such labels. However, since scammers rarely follow these rules, the absence of a label cannot be taken as proof that the caller is genuine. The Criminal Investigation Bureau reported one case where a 14-member gang produced over 50,000 synthetic face videos and collected more than 500,000 pieces of personal information; police also seized 60 cloud servers nationwide. This labeling requirement took effect on September 1, 2025. + +- Evidence grade: B + +- Notes: Always use an old number saved in your contacts when calling back — never dial the number shown on the incoming call or any new number the scammer provides. If the caller cites “poor signal” or “a meeting” to avoid a live video or motion test, assume it is a scam. Motion verification is only a supplementary tool; since AI capabilities keep improving, the only truly reliable step remains cross-channel confirmation. If money has already been transferred, refer to section 2 of this chapter and call 110 immediately to request a stop on the payment. For information on protecting your own facial and voice data, see section 14. This item is rated B because official sources provide identification methods and case examples, but no statistics are given on how much these measures actually reduce fraud rates. The main Ministry of Public Security website (mps.gov.cn) remains inaccessible due to a 521 error; the quoted texts from the Cybersecurity Bureau and Criminal Investigation Bureau were taken from a republishing page run by the Fujian Provincial Public Security Department. +- Sources:公安部网安局 (2025). 眼见≠为实，警惕 AI 新型诈骗！（福建省公安厅转载）；国家互联网信息办公室、工业和信息化部、公安部 (2022). 互联网信息服务深度合成管理规定（第六、十六、十七条，2023 年 1 月 10 日施行）. ；国家互联网信息办公室、工业和信息化部、公安部、国家广播电视总局 (2025). 人工智能生成合成内容标识办法（第十条，2025 年 9 月 1 日施行）. ；公安部刑侦局、央视新闻 (2026). 警方查获 5 万多条合成动态人脸视频 谁在「复制」你的脸？（福建省公安厅转载） + +### 5. If accused or summoned, hire a lawyer first — don’t settle privately or delete records + +- Cost: Legal fees start at several thousand yuan. Those with financial difficulties can apply to legal aid agencies for a free lawyer. When questioned, answer only questions relevant to the case; leave the rest to your lawyer. The hard part is staying calm on the spot and resisting the urge to explain everything yourself. +- In plain terms: You can hire a lawyer right from the first time you’re called in for questioning. If the lawyer requests a meeting, the detention center must arrange it within 48 hours, and those talks cannot be monitored. You’re allowed to refuse answering any questions unrelated to the case. +- Benefit: Starting from the first interrogation or from the moment you’re placed under compulsory measures restricting your freedom, you have the right to appoint a lawyer. While the case remains under police investigation, only lawyers may represent you — no one else can serve as a defense counsel. Upon a lawyer’s request, the detention center must arrange a meeting within 48 hours, and such meetings are not monitored. No one may be forced to confess guilt, and you may refuse answering questions unrelated to the case. A summons or compulsory appearance lasts at most 12 hours; for especially serious and complex cases, this limit extends to 24 hours. A summons merely notifies you to come for questioning, while compulsory appearance means you’re physically taken there. Repeated summonses must not be used to detain someone indefinitely. Anyone fabricating facts to falsely accuse another and seeking criminal punishment for them faces up to three years in prison; if serious harm results, the sentence rises to three to ten years. If charges are dropped, prosecution is refused, or a court acquits you after detention or arrest, you may claim state compensation calculated daily based on the previous year’s national average wage for workers. +- Evidence grade: A +- Notes: Do not attempt to settle privately with the other party or contact their family members. Any “private settlement” may be interpreted as admitting guilt. Chat logs, call records, and travel histories serve as proof of your innocence; deleting them removes your own evidence. If a report or accusation later proves unfounded, this does not constitute false accusation or entrapment. This rule applies equally to all accused individuals regardless of gender. For further details, see Section 33 (punishing those who fabricate facts), Section 34 (acquittal when evidence is insufficient and subsequent appeals), and Section 35 (daily state compensation after unlawful detention). +- Sources:全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第三十四、三十五、三十九、五十二、一百一十九、一百二十条）. ；全国人大 (1997). 刑法（第二百四十三条）. ；全国人大常委会 (2012). 国家赔偿法（2012 年修正，第十七、三十三条）. （国家统计局转载） + +### 6. Coming forward voluntarily after an incident: Self‑surrender can cut a sentence by up to 40%, and the “statute of limitations” defense simply does not exist + + +- Cost: There is no cost at all. You can walk into a police station, stay on the scene and call the authorities, then tell them exactly what happened. The hard part is resisting the urge to “wait and see — maybe no one will notice.” + +- In plain terms: Voluntarily surrendering can reduce a prison term by up to 40%; for less serious offenses it may even lead to no punishment at all. If you confess only after being caught, the reduction is capped at 20%. Running away or denying responsibility yields no benefit. Relying on the statute of limitations to get off scot‑free is impossible: once a case is officially opened, the time you spend evading authorities does not count toward that limit. The relevant sentencing rules have been in effect since 2021. + +- Benefit: Article 67 of the Criminal Law states that anyone who voluntarily surrenders and truthfully confesses their crime receives a lighter or reduced sentence; those guilty of minor offenses may be exempted entirely. Even without surrender, a sincere confession can still earn a penalty cut; if it prevents especially grave consequences, the reduction can be even greater. Official sentencing guidelines set clear percentage ranges: voluntary surrender can lower the baseline sentence by up to 40% (or more for minor crimes), while a simple confession brings a reduction of up to 20%. Additional factors such as admitting to related, un‑discovered crimes or averting serious harm can add another 10‑50% cut. Plea agreements also grant up to 30% relief, and when combined with surrender, restitution, compensation and other mitigating circumstances the total reduction may exceed 60% (or even lead to full exemption for minor offenses). Conversely, the statute of limitations is divided into four tiers — 5, 10, 15 and 20 years — based on the maximum possible penalty (Article 87). However, Article 88 explicitly states that once an investigation or prosecution is underway, any attempt to evade it renders the time spent in hiding irrelevant; the clock never stops. + +- Evidence grade: A + +- Notes: The primary beneficiary of this provision is the offender himself. Self‑surrender is a mitigating factor, not a blanket pardon; the exact reduction is left to judicial discretion, and stricter limits apply to violent and drug‑related crimes. Traffic‑accident cases follow a separate rule: staying at the scene, rendering aid and reporting the incident counts as voluntary surrender, yet because these actions are legally required, the permissible reduction is limited. Even if a driver flees first and later turns himself in, he still qualifies as a surrenderer; the baseline sentence used for calculation is the higher statutory maximum, and the subsequent reduction follows the same percentages described above (see Section 1 for proper post‑accident conduct: stop, help, call police). Consulting a lawyer does not conflict with a truthful confession; the attorney’s role is to verify that the written statement accurately reflects the facts, not to help fabricate a story. +- Sources:全国人大. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第六十七、八十七、八十八条. ；最高人民法院、最高人民检察院 (2021). 关于常见犯罪的量刑指导意见（试行）（法发〔2021〕21 号，2021 年 7 月 1 日施行）三（六）（七）（十四）. 甘肃省张掖市人民检察院转载全文. ；最高人民法院 (2010). 关于处理自首和立功若干具体问题的意见（法发〔2010〕60 号）一. 最高人民法院公报. + +### 7. Don’t touch the steering wheel after drinking — even for e‑bikes or “just moving the car a bit” + +- Cost: Using a designated driver or taking a taxi costs only a few dozen yuan. Agree in advance who won’t drink at any gathering. It can be hard to politely refuse when others keep offering drinks. +- In plain terms: Driving after drinking results in a 6‑month suspension of your license and a fine of 1,000–2,000 yuan. A second offense brings up to 10 days in jail and permanent license revocation. Drunk driving leads to immediate license cancellation; you can’t reapply for 5 years and may face criminal charges for dangerous driving, leaving a criminal record that affects background checks and certain jobs. Auto insurance won’t cover any claims: once you’ve been drinking, your policy becomes void. Even “just moving the car a bit” counts as driving. +- Benefit: Temporary suspension of the license for 6 months and a fine ranging from 1,000 to 2,000 yuan for driving after drinking. Repeat offenders face up to 10 days in jail and permanent license revocation. Drunk driving results in immediate license cancellation; reapplication is prohibited for 5 years, and criminal liability for dangerous driving is pursued, leading to imprisonment and monetary penalties. For commercial drivers the penalties are harsher: 15 days in jail, a 5,000‑yuan fine, and a 5‑year ban on driving commercially; drunk driving entails a 10‑year ban, after which they can never drive commercially again. If drinking or being drunk leads to a major accident and a criminal conviction, driving privileges are revoked for life. Commercial auto insurance policies explicitly exclude any claims arising from driving under the influence of alcohol or drugs (nationwide). +- Evidence grade: A +- Notes: Drunk driving is a criminal offense that leaves a permanent record, affecting both background checks and eligibility for certain professions. The distinction between “drinking” and “being drunk” is defined by blood alcohol concentration levels set by national standards; this section does not verify those exact figures, so don’t guess where you fall on that scale. +- Sources:全国人大常委会 (2021). 道路交通安全法（2021 年修订，第九十一条）. （北京市公安交通管理局转载）；全国人大常委会 (2015). 刑法修正案（九）（第八条，即刑法第一百三十三条之一）. ；中国保险行业协会 (2020). 机动车商业保险示范条款（2020 版）（第九、二十二条）. + +### 8. Never lend your bank cards, SIM cards, or payment accounts to anyone — “money laundering” is not a side hustle + +- Cost: Zero. Some people claim “just lend your card for a few transactions and you’ll get a few hundred yuan” — just say no. +- In plain terms: Renting, lending, or selling your bank cards, SIM cards, or payment accounts is illegal on its own. Penalties include confiscation of all illegal earnings plus a fine of 1 to 10 times that amount; if no earnings were made, the maximum fine is 200,000 yuan. In serious cases, offenders face up to 15 days in detention, a negative credit record, and restrictions on account functionality. If you knowingly assist criminals by receiving or transferring money using these accounts, you could be convicted of aiding information network criminal activities, punishable by up to 3 years in prison. +- Benefit: Engaging in any activity that involves renting, lending, or selling phone cards, bank accounts, payment accounts, or internet accounts is illegal. Authorities confiscate all illegal earnings and impose a fine of 1 to 10 times that amount; if no earnings exist, the maximum fine is 200,000 yuan. Serious violations lead to detention of up to 15 days, a negative credit record, account restrictions, and suspension of all non-counter banking services. Knowingly providing payment settlement assistance to criminals constitutes aiding information network criminal activities (known as “helping information network crimes”), punishable by up to 3 years in prison and a fine nationwide. +- Evidence grade: A +- Notes: Claiming “I had no idea what the other person intended to do with my cards” won’t protect you. Law enforcement determines intent based on external circumstances: receiving payment for lending cards or unusually large transaction volumes can be used as evidence of awareness. Even if you ultimately aren’t convicted, accounts used to receive illicit funds get frozen and you face other penalties. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第三十一、四十四条）. ；全国人大常委会 (2015). 刑法修正案（九）（第二十九条，即刑法第二百八十七条之二）. + +### 9. Checking your credit report twice a year for free helps spot any loans or cards you didn’t apply for. + + +- Cost: It costs nothing. You can complete the check online in just ten minutes. + +- In plain terms: Laws give you the right to check your own credit report twice a year at no charge, and you can finish the process online in ten minutes. Negative entries stay on the report for five years from the date they’re resolved; after that they must be removed. If you dispute any information, the credit agency or data provider must respond to you in writing within 20 days. To check your report, use the official website of the People’s Bank of China’s Credit Information Center or your mobile banking app — avoid third‑party “credit check” apps, as they collect your personal data. + +- Benefit: Regulatory rules state that “individuals have the right to obtain their own credit reports twice a year free of charge,” meaning you can check your report twice annually at no cost. Negative records are kept for five years after the underlying issue is resolved; any older entries must be deleted. When you raise a dispute, the credit agency or source of the data must reply in writing within 20 days. + +- Evidence grade: A + +- Notes: Identity theft leading to unauthorized loans or credit cards often goes unnoticed until a person is denied a mortgage years later. The proper channels for checking your report are the People’s Bank of China Credit Information Center website or mobile banking apps. Steer clear of third‑party “credit check” apps, as they harvest your personal information. +- Sources:国务院 (2013). 征信业管理条例（国令第 631 号，第十六条、第十七条、第二十五条）. + +### 10. If a fight breaks out, call the police first — the one who strikes first almost always loses + +- Cost: No cost at all. Simply move to a crowded area and call the police so the other person’s actions are captured on camera. The hard part is resisting the urge to shout back or push them. +- In plain terms: Anyone who assaults another person faces 5 to 10 days in jail and a fine of 500 to 1,000 yuan. If they act in a group, target the elderly, pregnant women, children, or disabled individuals, or repeat the assault multiple times, the penalty rises to 10 to 15 days in jail and a fine of 1,000 to 2,000 yuan. Causing minor injuries to another person turns it into a criminal case, punishable by up to 3 years in prison; serious injuries bring a sentence of 3 to 10 years. When two people fight each other, it does not qualify as self-defense — the person who strikes first almost always suffers the consequences. Moving to a crowded area and calling the police is far more effective than retaliating. +- Benefit: Under the law, anyone who assaults another person or intentionally harms them faces 5 to 10 days in jail and a fine of 500 to 1,000 yuan. Those who act in a group, target vulnerable groups, repeat the assault, or attack multiple people at once receive 10 to 15 days in jail and a fine of 1,000 to 2,000 yuan. Group fights are treated as hooliganism, carrying a maximum penalty of 15 days in jail and a 2,000 yuan fine. Intentional bodily harm that meets criminal criteria results in up to 3 years in prison; serious injuries bring a sentence of 3 to 10 years. Legally, mutual fighting does not count as self-defense. However, if the other person strikes first and uses excessive force, or if you try to avoid the fight but they keep attacking, your retaliation is generally deemed lawful self-defense. Only when your response clearly exceeds what is necessary and causes major harm does it qualify as excessive self-defense, which still warrants a reduced or waived penalty (nationwide, effective January 1, 2026 under the Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: After the 2025 revision of the Public Security Administration Punishment Law, all article numbers changed; assault now falls under Article 51 instead of the old Article 43, so any older references are outdated. The definition of “minor injuries” used to determine criminal liability is set by official appraisal standards, which this section does not verify. If the aggressor is already on the ground or has fled, the threat ends, and any further retaliation is no longer considered self-defense. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十、五十一条）. ；全国人大 (1997). 刑法（第二十、二百三十四条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 6、9、11、14 条）. + +### 11. You may defend yourself against an unavoidable attack, but only strike the person who is actually attacking — stop when he stops. + + +- Cost: Legal fees start at several thousand yuan; those with financial difficulties may apply for legal aid. The main cost comes afterward: you’ll often be initially charged with intentional injury, required to cooperate with investigations, and sometimes detained for up to ten days. The challenge is staying composed during this period. + +- In plain terms: To protect yourself or others from an ongoing attack, it is legally acceptable to intervene and injure the attacker. If someone is committing murder, robbery, rape, kidnapping, or any other violent crime, harming or even killing them is not considered excessive. However, you must only strike the person actively attacking — stop as soon as he ceases. Even if the court ultimately rules in your favor, the process is far from easy; many people are first charged and detained for several days. In total, 47 individuals have been recognized as acting in self-defense under these circumstances. + +- Benefit: Criminal law defines what constitutes legitimate self-defense. When national interests, public welfare, or your own or another person’s life, property, and other rights are under unlawful attack, intervening to injure the aggressor qualifies as self-defense and carries no criminal liability. The law also states: “If self-defense clearly exceeds necessary limits and causes serious harm, criminal responsibility applies, though punishment may be mitigated or waived.” Additionally: “In cases of ongoing violent crimes such as murder, robbery, rape, kidnapping, or other acts seriously threatening personal safety, any defensive actions resulting in injury or death of the aggressor do not constitute excessive defense and incur no criminal liability.” Official guidelines further clarify these boundaries: both “clearly exceeding necessary limits” and “causing serious harm” must be present for it to be deemed excessive; causing only minor injuries does not count. Defense must be directed solely at the aggressor; using lethal force against minor offenses is not permitted. Real-world examples include the Yu Haiming case (2018), where initial charges were later dropped after a ruling of self-defense, and the Chen case, where a student’s defensive actions were similarly recognized as lawful. A total of 45 cases have been officially documented as falling under this category. + +- Evidence grade: A + +- Notes: The default course of action remains as described in item 10: retreat and call the police. Fighting back when two parties are already engaged does not qualify as defense, nor does pursuing an attacker after he has fled or fallen. This provision applies only when retreat is impossible; it does not encourage violence. Afterward, three steps are crucial: remain at the scene after calling police, preserve any surveillance footage and witnesses, and consult a lawyer before any police questioning. If charges are eventually dropped or you are acquitted, you may seek state compensation for detention days, as outlined in item 35. Defending others is also legally permitted, though intervening in unrelated fights without preparation carries different risks, as discussed in item 13. This protection primarily benefits you and your family. +- Sources:全国人大 (1997). 刑法（第二十条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 5、6、7、10、11、13、14、19 条）. ；最高人民检察院 (2018). 第十二批指导性案例（检例第 45 号陈某正当防卫案、检例第 47 号于海明正当防卫案）. ；全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第九十一条）. 宁夏回族自治区人民检察院转载全文 + +### 12. Who to avoid — when you’re owed wages, fired unfairly, or scammed out of money — use complaints, arbitration, or lawsuits instead of taking revenge + + +- Cost: There’s no monetary cost; filing complaints and arbitration is free. You’ll need to make one or two trips and wait several months. The hard part is resisting the urge to act violently during that time. +- In plain terms: Following legal channels means the worst outcome is simply not getting your money back. Choosing revenge yields the same result — no money recovered — plus you risk losing your own life. Take the Wuxi case: Xu failed his exams, didn’t receive his diploma, and was unhappy about his internship pay. He went on to kill 8 people and injure 17 others with a knife. He was sentenced to death and executed. Nationwide in 2024, complaints and arbitration helped 654,000 workers recover 8.65 billion yuan in unpaid wages. +- Benefit: Official statistics back up legal action. In 2024, labor inspectors handled 137,000 cases, securing 8.65 billion yuan for 654,000 workers. Additionally, 998 individuals were convicted under laws against wage theft. For details on filing complaints or arbitration, see Section 7, Item 2. The legal consequences of revenge are laid out in Article 232 of the Criminal Law: “Whoever intentionally kills another shall be sentenced to death, life imprisonment, or fixed-term imprisonment of not less than ten years; if circumstances are relatively minor, to fixed-term imprisonment of not less than three years but not more than ten years.” In the Wuxi case, Xu’s dissatisfaction with his school and pay led him to attack fellow students with a knife, killing 8 and injuring 17. He was sentenced to death for intentional homicide, a verdict upheld by the Supreme People’s Court on January 20, 2025. He received no compensation whatsoever. +- Evidence grade: A +- Notes: Interns still attending school generally don’t have a recognized employment relationship with their host organizations. If they’re denied internship pay, they can only seek mediation from their school or file a civil lawsuit — arbitration isn’t an option. For exact steps on filing complaints or arbitration, see Section 7, Item 2. The limits on debt collection are outlined in Section 9, Item 15 (no detaining or confining debtors). Opting for legal channels means the worst-case scenario is simply not recovering owed funds, since case closure doesn’t guarantee payment. Choosing revenge yields the same financial result, plus the risk of losing your own life. +- Sources:全国人大 (1997). 刑法（第二百三十二条）. ；新华社 (2024). 江苏宜兴一校园发生持刀伤人事件致 8 死 17 伤. （转宜兴警方通报，含伤亡人数与动机原话）；最高人民检察院 (2025). 无锡校园持刀伤人案罪犯徐加金被执行死刑. ；人力资源社会保障部 (2025). 2024 年度人力资源和社会保障事业发展统计公报. ；最高人民法院 (2025). 最高人民法院工作报告（「对驾车冲撞行人的樊维秋、校园持刀行凶的徐加金等判处死刑」）. + +### 13. No matter how angry you are, never target innocent people: deliberately driving into a crowd or committing violence in public is classified as endangering public safety by dangerous means, carrying a minimum sentence of three years; if anyone dies, the penalty is death. + + +- Cost: There is no monetary cost involved. The real challenge is suppressing such impulses when you’re enraged. + +- In plain terms: Intentionally driving into a crowd or attacking people in public constitutes endangering public safety by dangerous means. Even if no one is injured, the offender still faces at least three years in prison. If fatalities occur, the sentence rises to ten years or more, life imprisonment, or death. In the Zhuhai case, Fan Weiqiu, dissatisfied with the divorce settlement, drove his car into a crowd exercising at a sports center, resulting in 35 deaths and 43 injuries; he was sentenced to death and executed. + +- Benefit: Article 114 of the Criminal Law states: “Whoever commits arson, breaches a dike, causes an explosion, releases toxic, radioactive, or infectious agents, or endangers public safety by any other dangerous means, without causing serious consequences, shall be sentenced to three to ten years in prison.” Thus, even when no injuries occur, the minimum penalty is three years. Article 115 adds that if serious injury, death, or major property damage results, the sentence becomes ten years or more, life imprisonment, or death. Official case example: Fan Weiqiu, disillusioned by his failed marriage and unhappy with the divorce terms, resolved to vent his anger by driving into a crowd. On the evening of November 11, 2024, he crashed his vehicle into exercisers at Zhuhai Sports Center, killing 35 and injuring 43. He was convicted under the aforementioned article and sentenced to death, with political rights revoked; the sentence was carried out on January 20, 2025 after Supreme Court approval. His grievance pertained solely to the divorce ruling; his victims were completely unrelated runners from across the country. + +- Evidence grade: A + +- Notes: Expressing thoughts like “I don’t want to live anyway” does not serve as a mitigating factor in sentencing. The Supreme People’s Court’s 2025 work report emphasizes “resolutely punishing with severity, speed, and strictness those who outrageously violate legal and moral boundaries.” Merely threatening to commit acts such as arson, explosions, or poisoning that endanger public safety and disrupt order can lead to detention from five to ten days and a fine of up to 1,000 yuan under the Public Security Administration Punishment Law (effective January 1, 2026). Similarly, sending threatening letters or otherwise endangering another’s safety is illegal, punishable by up to five days’ detention or a similar fine. Anyone entertaining such ideas should refer to item 14, which treats notions like “finding a scapegoat” as a medical emergency requiring immediate intervention. +- Sources:全国人大 (1997). 刑法（第一百一十四、一百一十五条）. ；新华社 (2024). 广东珠海驾车撞人事件造成 35 人死亡 43 人受伤. （转珠海市公安局通报）；最高人民检察院 (2024). 樊维秋以危险方法危害公共安全案一审宣判，判处死刑，剥夺政治权利终身. ；最高人民检察院 (2025). 珠海驾车撞人案罪犯樊维秋被执行死刑. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. + +### 14. Thoughts such as “find a scapegoat” or “go down together” must be treated as a medical emergency: leave the scene, hand over car keys and knives to someone else, and call 12356. + + +- Cost: There is no monetary cost. The difficulty lies in admitting that something is amiss right now and in handing over control of potentially dangerous items to another person. + +- In plain terms: The window between the moment these thoughts arise and any attempt to act on them is very brief. Among 82 people who survived a suicide attempt, 47.6% reported that no more than 10 minutes elapsed from the first appearance of such thoughts to the attempt itself. Therefore, the priority is not to “figure things out” intellectually, but to create physical distance — one step at a time — between oneself and steering wheels, knives, gas valves, or ropes, thereby surviving those crucial ten minutes. After that, calling 12356 is essential. + +- Benefit: The time gap between the emergence of these thoughts and actual action is indeed short. Interviews conducted within three days of hospitalization with those 82 individuals showed that 47.6% acted within ten minutes of first having such thoughts. A ten‑year systematic review indicates growing evidence that restricting access to lethal means reduces suicide rates; for instance, after tighter controls on painkillers, related suicides fell by 43%. Installing protective barriers at popular suicide sites cut deaths by 86% (ranging from 79% to 91%). Creating that brief physical separation is precisely what gives people a chance to survive. 12356 is the nationwide mental‑health helpline, operating at least 18 hours per day throughout the country as of May 1, 2025. + +- Evidence grade: B + +- Notes: This grade is assigned because both pieces of evidence originate from suicide‑research literature and have not been directly tested in contexts involving impulses to harm others. The Deisenhammer study involved only 82 participants at a single hospital. When feeling unwell, avoid driving or taking on duties that require responsibility for others’ safety; it is better to hand over those duties first. For information on self‑harm thoughts, see Section 1, Item 25 (calling 12356 when suicidal thoughts arise). Guidance on actions during periods of low mood can be found in Section 3, Item 19. +- Sources:Deisenhammer EA 等 (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry. ；Zalsman G 等 (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. ；国家卫生健康委 (2024). 关于应用「12356」全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 15. Family members say “no one will be safe” or “I’ll take the kids and leave” — don’t dismiss this as anger: close relatives can take such a person to the hospital, and police must respond to any emergency call. + + +- Cost: Registration and consultation fees range from a few dozen to several hundred yuan. Accompanying the person to the hospital takes half a day to a full day. The real challenge is getting them to agree to go. +- In plain terms: When family members say things like “no one will be safe” or “I’ll take the kids and leave,” close relatives have the right to take that person to a hospital, where treatment cannot be refused. If there has already been violence or an imminent risk of harm, hospitalization does not require the person’s consent. If it’s unclear whether these statements are just angry outbursts or genuine threats, call 12356 for advice or dial 110 so police can intervene. Keeping this information secret does not help the person at all. +- Benefit: Article 28, paragraph 2 of the Mental Health Law states: “When a suspected mental disorder patient exhibits behavior that harms themselves or others, or shows a clear risk of doing so, their close relatives, employer, or local police must act immediately to stop such behavior and arrange transport to a medical facility for diagnosis.” The same article also requires hospitals to accept and diagnose any such patients without refusal. Article 29 mandates that hospitals admit these individuals right away, assign a licensed psychiatrist for evaluation, and issue a diagnosis promptly. Article 30 says voluntary admission is the norm, except in cases where the diagnosis confirms a severe mental disorder accompanied by actual or imminent harm to others — in such cases, involuntary hospitalization is permitted. Making threats of violence is grounds for calling 110. Writing threatening letters or using other means to endanger someone’s safety can result in detention for up to five days or a fine of up to 1,000 yuan. Those who threaten to commit arson, explosions, or other acts endangering public safety face detention from five to ten days and a similar fine (effective January 1, 2026 under China’s Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: This guidance applies to spouses, parents, and children living in the same household. The phrase “no one will be safe” clearly includes the speaker, and the law grants this right specifically to close relatives — outsiders cannot intervene without police involvement. This rule targets genuine danger signs, not angry remarks during arguments or attempts to force uncooperative family members into treatment. Conversely, Article 35 states that if further evaluation proves the person does not have a serious mental disorder, they must be released from the hospital. When in doubt, call 12356 or 110. The investigation into Germanwings Flight 9525 revealed that authorities and employers could not prevent the co-pilot from flying that day because “neither he nor anyone else — doctors, colleagues, or family — informed them of his condition.” All 150 people on board perished: two pilots, four flight attendants, and 144 passengers. Keeping such risks hidden is never helpful. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. ；全国人大常委会 (2012，2018 修正). 精神卫生法（第二十八、二十九、三十、三十五条）. ；法国航空事故调查局 BEA (2016). Final Report BEA2015-0125.en: Accident on 24 March 2015 at Prads-Haute-Bléone to the Airbus A320-211 registered D-AIPX operated by Germanwings. + +### 16. Don’t curse, spread rumors, or share unverified content online; if you’re a victim of online abuse, document evidence first then report it to police + +- Cost: No cost at all. Just take ten extra seconds to think before posting. When attacked, take screenshots, record video, save links and account IDs, file a complaint with the platform first, then report it to police. The hardest part is resisting the urge to fire back when being cursed at. +- In plain terms: Publicly cursing, spreading rumors or defaming others can result in detention for up to 5 days or a fine of up to 1000 yuan; for more serious cases, detention ranges from 5 to 10 days. If the circumstances are especially grave, it constitutes the crimes of insult or defamation, punishable by up to 3 years in prison. Simply sharing such content also makes you liable. Conversely, if you’re a victim of online abuse, you generally have to file a lawsuit in court yourself to pursue legal action for insult or defamation, so you must rely on yourself to take screenshots, record video and save links. +- Benefit: Those who openly insult others or fabricate facts to defame them face detention for up to 5 days or a fine of up to 1000 yuan; for more serious cases, detention ranges from 5 to 10 days. The same penalties apply to people who repeatedly send insulting or threatening messages, harass or stalk others, or secretly photograph and distribute someone’s private information. Anyone who deliberately spreads rumors and disrupts public order also faces detention from 5 to 10 days. In severe cases, such actions constitute the crimes of insult or defamation, punishable by up to 3 years in prison. For online defamation cases where victims struggle to gather evidence, they can request the court to ask police for assistance (this rule is effective as of 1 January 2026 under the Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: In principle, the crimes of insult and defamation are “only prosecuted upon complaint”, meaning victims must file a lawsuit in court themselves. Police generally do not initiate investigations proactively, so evidence collection falls entirely on the victims. However, two important exceptions exist. First, cases that “seriously endanger public order and national interests” can be investigated by police directly (Article 246, Paragraph 2 of the Criminal Law). Second, if a victim has genuine difficulty gathering evidence for online defamation, the court may order police to assist with the investigation (the same article, Paragraph 3, added under the 9th Amendment to the Criminal Law). Sharing such content also makes you legally liable; knowingly spreading false information also counts as “fabricating facts”. For guidance on how to respond after being a victim of online abuse, see Section 37 of this chapter (“Document evidence first then take action after suffering online abuse”). The article numbers for insult and defamation have been updated from Article 42 under the old law to Article 50 under the new law. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. ；全国人大 (1997). 刑法（第二百四十六条）. ；全国人大常委会 (2015). 刑法修正案（九）（第十六条，增加刑法第二百四十六条第三款）. ；全国人大常委会 (2015). 刑法修正案（九）（第二百四十六条新增第三款）. 国家信访局转载全文 + +### 17. Read the document thoroughly before signing; never sign on behalf of others or on blank paper + +- Cost: There is no cost involved. It simply requires a few extra minutes to read contracts, IOUs, guarantee letters, and employment documents from start to finish. Ask questions on the spot if anything is unclear, then take photos for your records. The real challenge is managing to read everything carefully while the other party is watching. +- In plain terms: Once signed, the document becomes legally binding. Claims such as “I didn’t read it properly” or “I thought it said something else” rarely hold up in court. Therefore, it’s essential to spend those few minutes reading everything, ask for clarification when needed, and document it all with photos. Never sign for someone else, never sign on blank paper, and always specify the intended purpose when providing a copy of your ID. Electronic signatures and facial recognition verification also count as valid signatures. +- Benefit: Contracts that are legally executed are protected by law and are binding on all parties involved. Once signed, both sides must fully comply with their obligations. Arguments like “I didn’t read it” or “I misunderstood” carry little weight in legal proceedings. By avoiding unnecessary signatures, you also steer clear of taking on debts or responsibilities that don’t rightfully belong to you (nationwide). +- Evidence grade: A +- Notes: The rules “never sign on behalf of others, never sign on blank paper, and always state the purpose when sharing ID copies” are practical recommendations rather than formal legal mandates. Their shared goal is to prevent your signature from being used to validate a legally binding contract you never intended to agree to. Electronic signatures and facial recognition verification are equally valid forms of consent. +- Sources:全国人大 (2020). 民法典（第四百六十五、五百零九条）. + +### 18. Write a clear loan agreement when lending money; think carefully before agreeing to be a guarantor + + +- Cost: There is no cost involved. Simply use a piece of paper to list the lender, borrower, amount, interest rate, term, and repayment method, then have both parties sign it. Transfer the money electronically to leave a paper trail; never hand over cash. + +- In plain terms: The loan agreement must include all essential details: who the lender and borrower are, the amount, interest rate, term, and repayment method, plus signatures from both sides. Use a bank transfer instead of cash to make legal enforcement easier. Before agreeing to be a guarantor, check whether the contract mentions “joint and several liability.” Under ordinary guarantee arrangements, creditors must first sue the borrower and exhaust all collection efforts before seeking payment from you. However, if you sign a joint and several liability guarantee, creditors can demand repayment from you directly. + +- Benefit: Loan contracts should be in writing and contain information such as the type of loan, currency, purpose, amount, interest rate, term, and repayment method. This makes it easier to pursue legal action if needed. If a guarantee contract does not specify the type of guarantee or is otherwise vague, it is interpreted as an ordinary guarantee. Under such terms, creditors must first sue the borrower and attempt to enforce payment before turning to the guarantor. Conversely, a joint and several liability guarantee removes this protection; creditors may demand repayment from the guarantor immediately (nationwide). + +- Evidence grade: A + +- Notes: Any interest charged above four times the LPR is not legally enforceable; see Section 7 for details. It is advisable to include the borrower’s ID number and label the document as a “loan agreement.” Whether or not the guarantee contract contains the phrase “joint and several liability” determines whether you are secondary to the borrower or equally liable — be sure to review this before signing. +- Sources:全国人大 (2020). 民法典（第六百六十八、六百八十一、六百八十六、六百八十七条）. + +### 19. Time limits for legal action: 3 years for civil lawsuits, 1 year for labor arbitration; once the deadline passes, a simple “statute of limitations exceeded” claim can block your case + + +- Cost: Zero cost. Don’t just hope for payment in silence — use WeChat, text messages, email, or certified mail to create a paper trail. + +- In plain terms: The statute of limitations for civil lawsuits is three years, counted from the day you become aware your rights were violated. Once that period ends, the court won’t act on its own; however, if the debtor simply argues “the deadline has passed,” you lose the right to recover what’s owed. A single documented demand for payment can reset that three‑year clock entirely. Labor disputes follow a different rule: the arbitration deadline is just one year. + +- Benefit: The Civil Code states that “the limitation period for filing a civil lawsuit is three years, calculated from the date the right‑holder knows or should know that his rights were infringed and who the obligor is.” This period may not exceed twenty years from the actual infringement. When it expires, the debtor may invoke a defense of non‑performance. Courts do not monitor these deadlines automatically; however, once raised by the debtor they become binding. Four events can interrupt the clock, each resetting the three‑year period: (1) you demand performance; (2) the debtor promises to perform; (3) you file a lawsuit or labor arbitration; (4) any other circumstance with comparable effect. For installment agreements, the countdown starts on the final due date. Certain claims are exempt from any limitation period: requests to stop infringement, remove obstacles, eliminate hazards; recovery of real property or registered movable assets; alimony, child support, and maintenance; plus other cases specified by law. Labor arbitration follows a one‑year rule, also measured from the date the worker becomes aware of the violation; however, if a dispute over unpaid wages arises while the employment relationship still exists, the worker may file at any time — otherwise the deadline is one year after the contract ends (nationwide). + +- Evidence grade: A + +- Notes: This is probably the cheapest tip in the entire book. A single traceable demand letter can restart the three‑year window; without it, you risk forfeiting your right to win the case. Agreements such as “we won’t invoke the statute of limitations” or negotiated extensions of the deadline carry no legal weight. Conversely, if the debtor promises payment after the deadline has passed, they can no longer rely on that defense. Once payment has been voluntarily made, it cannot be reclaimed. For promissory notes and guarantees, see item 18; matters involving enforcement are covered in item 20. Overtime pay and unused vacation compensation follow the labor‑arbitration rules described in sections 19.1 and 19.2. +- Sources:全国人大 (2020). 民法典（第一百八十八、一百八十九、一百九十二、一百九十三、一百九十五、一百九十六、一百九十七条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（第二十七条）. （安康市人力资源和社会保障局转载） + +### 20. If you’re being sued or have a court order against you, report all your assets truthfully and repay as much as you can — don’t transfer your house or money to relatives, friends, or companies. + + +- Cost: There is no cost involved. Simply report your assets as required by the court: list everything you currently own and everything you acquired in the year prior to receiving the enforcement notice. Pay off whatever debts you can. If you can’t pay in full, negotiate a settlement or installment plan with the creditor. + +- In plain terms: Putting your house in a company’s name or transferring money to relatives or friends isn’t some clever “workaround” — it falls squarely under the circumstances described in the law on refusal to execute court orders. Conviction for this offense carries a sentence of up to three years; in especially serious cases, the sentence is three to seven years. Relatives, friends, or companies that help hide or transfer assets are treated as accomplices, and those assets must be recovered. Failing to report assets or providing false information can result in fines of up to 100,000 yuan and up to 15 days of detention. However, if you truly have no money, this crime does not apply. + +- Benefit: Asset transfers aren’t merely “workarounds” — they themselves constitute criminal acts. The Standing Committee of the National People’s Congress has issued an interpretation of Article 313 of the Criminal Law, explicitly stating that “hiding, transferring, deliberately destroying, or transferring assets for free or at an unreasonably low price, thereby preventing the execution of a judgment or order” qualifies as “having the ability to execute but refusing to do so under serious circumstances.” In other words, hiding money, transferring it away, deliberately destroying one’s own property, giving it away for free, or selling it at a steep discount all render a court order meaningless. In 2024, the Supreme People’s Court and the Supreme People’s Procuratorate added ten more scenarios to this definition, including using fake settlements or transfers to dispose of assets, as well as buying someone else’s property at an unreasonably high price to guarantee their debts. All these actions are deliberate attempts to strip oneself of assets available for debt repayment. The maximum sentence for this crime remains three years; in especially serious cases, it rises to three to seven years plus a fine. Such serious circumstances include using fake lawsuits, arbitration, or notarization to obstruct enforcement, gathering crowds to storm enforcement sites, attacking or detaining enforcement officers, or causing a creditor to commit suicide or self-harm due to non-payment. Even outsiders who aren’t parties to the case may be deemed accomplices if they knowingly help hide or transfer assets. Illegally transferred assets must be recovered or returned. Transfers made after receiving a summons but before a judgment takes effect also count. On the civil side, creditors may petition the court to annul any transfers made for free or at unreasonably low prices. Failure to report assets or providing false information may result in fines up to 100,000 yuan and detention of up to 15 days (as stipulated in the 2024 interpretation effective December of that year). + +- Evidence grade: A + +- Notes: The commonly shared advice online — such as “put your house in a company’s name to use as employee housing” or “transfer all your money to relatives” — isn’t a loophole; it’s precisely the kind of conduct singled out in judicial interpretations. Relatives, friends, or companies aiding such actions are treated as accomplices, and any assets involved must be recovered. Conversely, if you truly have no money, this crime does not apply. To determine whether you “have the ability to repay but refuse to do so,” necessary living expenses for you and your dependents must first be deducted. If you repay part or all of the debt before prosecution and your circumstances are relatively minor, prosecution may be waived. Repaying the debt prior to a first-instance judgment may also lead to a lighter sentence or even exemption from punishment. For guidance on what to do after being placed on a blacklist or having spending restrictions imposed, see item 21; instructions on how to regain good standing after fulfilling obligations are provided in Section 7, item 19. +- Sources:全国人大常委会 (2002). 关于《中华人民共和国刑法》第三百一十三条的解释. ；最高人民法院、最高人民检察院 (2024). 关于办理拒不执行判决、裁定刑事案件适用法律若干问题的解释（法释〔2024〕13 号，第三、四、五、六、八、十一、十二条）. 最高法发布页，全文核对自广东省广州监狱转载. 、；全国人大常委会 (2015). 刑法修正案（九）（第三十九条，修改刑法第三百一十三条）. ；全国人大 (2020). 民法典（第五百三十八、五百三十九、五百四十条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第一百一十四、一百一十八、二百五十二条）. 贵州省市场监管局转载： + +### 21. If you’re under a spending restriction or listed on the dishonesty registry, first find out which rule applies and request removal if possible + +- Cost: No cost at all. You simply need to visit the enforcement court to determine which provision applies to you. Prepare proof of compliance — receipts showing you’ve paid what you owe or fulfilled the court order — as well as any required guarantee documents. For any essential personal or business expenses, you must file a separate application each time. The main difficulty is that you’ll need to make multiple trips to the court and submit many applications. +- In plain terms: First, figure out whether you’re merely under a spending restriction or actually listed on the dishonesty registry. These are two distinct situations; it’s possible you’re subject to only one. There are exactly six legal grounds for inclusion on the dishonesty registry, and the listing remains valid for two years. Seven specific circumstances — including full compliance with court orders — require the court to remove the entry within three working days; proactive compliance can even lead to earlier removal. Spending restrictions prohibit using your own funds for eight specific types of non‑essential purchases; however, you may apply individually for permission to cover any truly necessary personal or business costs. +- Benefit: Only six specific scenarios qualify a person for inclusion on the dishonesty registry. First, having the ability to pay but deliberately refusing to do so. Second, obstructing enforcement through forged evidence, violence, or threats. Third, evading obligations via fraudulent litigation, arbitration, or by concealing or transferring assets. Fourth, failure to comply with property‑reporting mandates. Fifth, violation of spending‑restriction orders. Sixth, willful non‑compliance with settlement agreements. If you provide adequate guarantees or if your seized assets exceed the debt amount, the court must not cite the “ability to pay” criterion for inclusion. Minors may never be added to the list, which remains active for two years. In cases involving severe obstruction or multiple violations, the period may be extended by one to three years. Seven circumstances — such as full compliance, successful settlement execution, or court‑ordered termination of proceedings — obligate the court to delete the entry within three working days; proactive compliance can also trigger early removal. Spending restrictions forbid using your own money for eight categories of non‑essential purchases: air travel, first‑class train or ship cabins, stays at upscale hotels, golf‑club memberships, real‑estate acquisitions or lavish renovations, leasing premium office spaces, vacations, enrolling children in costly private schools, and purchasing high‑premium insurance products. Any essential personal or business expense falling under these categories must be approved by a separate court application. Providing reliable guarantees or obtaining consent from creditors may also lift the restriction nationwide. +- Evidence grade: A +- Notes: A “spending restriction” is essentially a ban on high‑end consumption. This regulation was revised in 2015 via Judicial Interpretation No. 17, and its official title changed to “Regulations on Restrictions on Certain Types of Consumption.” The text quoted here is the 2010 version, which can be verified word‑for‑word on the Supreme People’s Court website; the updated version is still pending verification (the Supreme Court bulletin page returns a 502 error on this machine). Being listed on the dishonesty registry and being subject to spending restrictions are separate matters; it’s possible you’re subject to only one. Neither status automatically tarnishes your credit record; removal from the list does not automatically repair it — see Section 7, Article 19 for details on rebuilding credit after such a listing. The restrictions apply solely to spending using the debtor’s own funds; spouses and children may spend their own earnings without limitation. Nevertheless, using the debtor’s money to pay for a child’s enrollment in a high‑fee private school is expressly prohibited. +- Sources:最高人民法院 (2017 修正). 关于公布失信被执行人名单信息的若干规定（第一、二、三、四、十条）. ；最高人民法院 (2010). 关于限制被执行人高消费的若干规定（第三、八、九条）. + +### 22. If scammed while shopping online or via second-hand markets, first file a complaint with the platform, then report it to police, and finally decide whether to sue. + + +- Cost: Filing a complaint with the platform and reporting the case to police cost nothing. For lawsuits, if the amount in dispute is under 10,000 yuan, the filing fee is 50 yuan; this fee is halved if the case goes through summary proceedings, mediation, or is withdrawn. Each of the stages — case filing, trial, and enforcement — takes at least half a day to a full day, though online filing can save you the hassle of traveling. You must keep records of orders, chat logs, transfer receipts, and shipping documents. The real challenge is staying committed despite all the back‑and‑forth. + +- In plain terms: Start by contacting the platform. Platforms maintain security deposits and strict penalty rules, so they act fastest. Next, call the police: if the loss exceeds 3,000 yuan, it meets the threshold for a criminal fraud case; otherwise it falls under public‑order penalties, which can result in a detention of 5 to 10 days. If you decide to sue, online‑purchase disputes can be filed in the court nearest to the delivery address. For smaller amounts, a small‑claims procedure applies, guaranteeing a verdict within two months and allowing online filing. +- Benefit: When the amount defrauded ranges from 3,000 to 10,000 yuan, it qualifies as “a relatively large sum” under fraud statutes, leading to a sentence of up to three years plus a fine; exact limits vary by province. Below that threshold, offenders face public‑order penalties: detention of 5–10 days or a fine of up to 2,000 yuan; repeat offenders may receive 10–15 days of detention and a fine up to 3,000 yuan. On the civil side, you may sue in the same court for contract disputes, again without needing to travel to the seller’s hometown. Small‑claims rules apply when the disputed amount is under 50 % of the local average annual wage; such cases are decided in a single hearing and become final immediately, with a maximum processing time of two months under summary proceedings. All these procedures are now available online, carrying the same legal weight as in‑person filings (Civil Procedure Law, effective Jan 2024; Public Security Administration Punishment Law, effective Jan 2026). +- Evidence grade: A +- Notes: To gauge whether a lawsuit is worthwhile, multiply your net hourly wage by the total time you’ll need to invest — accounting for filing, trial, and possible enforcement phases, each taking half a day to a full day — then add the court filing fee. Compare this total cost against the amount you hope to recover, and apply a further discount to estimate the likelihood of actually obtaining payment. This method offers a framework, not a definitive answer. Keep in mind that after the 2025 revision of the Public Security Administration Punishment Law, article numbers changed; fraud now falls under Article 58 instead of the former Article 49. Likewise, the small‑claims provision is now Article 165 following the 2023 amendment to the Civil Procedure Law; be sure to consult updated sources. Finally, experience shows that filing a complaint with the platform first yields the quickest resolution, thanks to its security deposits and strict penalty mechanisms. The relevant legal provision is Judicial Interpretation No. 7 of 2011. +- Sources:最高人民法院、最高人民检察院 (2011). 关于办理诈骗刑事案件具体应用法律若干问题的解释（法释〔2011〕7 号，第一条）. ；全国人大 (1997). 刑法（第二百六十六条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十八条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第十六、一百六十四、一百六十五、一百六十八条）. （上海市发展改革委转载）；最高人民法院 (2022 修正). 关于适用《民事诉讼法》的解释（第二十条）. ；国务院 (2006). 诉讼费用交纳办法（国务院令第 481 号，第十三、十五、十六条）. + +### 23. Think carefully before and after making large gifts in romantic relationships or marriage + +- Cost: No cost involved. Before sending a large sum of money, ask yourself: is it a loan or a gift? If it’s a loan, draft a written agreement and mark the transfer as “loan”. The hard part is actually bringing this up in conversation. +- In plain terms: Once the money is transferred, you generally cannot get it back. A gift can only be revoked before it is officially registered under the recipient’s name. After that, revocation is only possible under three specific circumstances: the recipient seriously harms you or your close relatives; fails to fulfill their legal obligation to support you; or breaches any agreed terms of the gift contract. Therefore, decide early whether the payment is a loan or a gift. +- Benefit: Before property rights are transferred, a gift can be withdrawn. This legal threshold is known as the “transfer of property rights”. Once the transfer is complete, only the three aforementioned situations allow for revocation. Small gifts or cash given on special occasions such as birthdays or holidays, as well as everyday expenses meant to strengthen emotional bonds, do not qualify as betrothal gifts and thus are not required to be returned upon a breakup (nationwide rule). +- Evidence grade: A +- Notes: While it is commonly believed in legal practice that amounts such as “520” or “1314” indicate a gift, no official ruling from the Supreme People’s Court has been found in this section to confirm this as a definitive rule. Once a gift is notarized, it becomes far harder to retract. Ultimately, whether a transfer constitutes a loan or a gift depends on supporting evidence; a simple statement like “I’m lending you this money” in a chat record carries far more weight than any later disputes. +- Sources:全国人大 (2020). 民法典（第六百五十八、六百六十三条）. ；最高人民法院 (2024). 关于审理涉彩礼纠纷案件适用法律若干问题的规定（法释〔2024〕1 号，第三条）. + +### 24. Transfer betrothal gifts via payment with clear notes; keep chat records; money demanded under marriage can be reclaimed + +- Cost: No cost involved. Transfer betrothal gifts, wedding jewelry, and other related payments via bank transfer, clearly stating their purpose in the notes. For any verbal agreements, keep chat records or have family members present as witnesses. +- In plain terms: Demanding money under the guise of marriage is illegal, and courts support claims for repayment. Repayment can be demanded in three cases: no marriage registration took place; registration occurred but no actual cohabitation followed; betrothal gifts were given before marriage, leaving the giver in financial hardship. If registration occurred and cohabitation did follow, repayment is generally not required. However, if cohabitation was brief and the gift amount was excessively high, courts will determine the repayment proportion based on how the money was used, presence of dowry, whether children were born, and any fault on either side. For couples who cohabited without registration, the same proportional rule applies (nationwide, effective February 2024). Therefore, always transfer betrothal gifts, wedding jewelry, and related payments via bank transfer with clear notes, and both parties must keep proper evidence. +- Benefit: Demanding money under the guise of marriage is strictly prohibited by law. If one party demands betrothal gifts under this pretext, the other party’s claim for repayment is legally supported. Courts will grant repayment in three specific scenarios: no marriage registration was completed; registration occurred but no actual cohabitation followed; betrothal gifts were given before marriage, leaving the giver in financial hardship. For couples who registered and cohabited, repayment is generally not required. Yet, if cohabitation was brief and the gift amount was excessively high, courts will calculate the repayment proportion based on actual usage of the funds, presence of dowry, whether children were born, and any fault on either side. The same proportional approach applies to couples who cohabited without registration (nationwide, effective February 2024). +- Evidence grade: A +- Notes: Whether a betrothal gift amount is considered “excessively high” depends on the giver’s local per capita disposable income and family circumstances; there is no nationwide fixed threshold. The exact repayment amount is determined by judges on a case-by-case basis. This guideline applies equally to both givers and recipients of betrothal gifts; both parties must retain proper evidence. +- Sources:全国人大 (2020). 民法典（第一千零四十二条）. ；最高人民法院 (2024). 关于审理涉彩礼纠纷案件适用法律若干问题的规定（法释〔2024〕1 号，第二、五、六条）. ；最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第五条）. + +### 25. No need to worry about premarital assets — clearly define adding a spouse’s name to property and parental contributions + +- Cost: Drafting a written property agreement yourself costs nothing; notarization incurs extra fees. When parents contribute funds, ask them to provide a written statement. The whole process takes just a few hours. The real challenge is bringing up money matters with family members. +- In plain terms: Premarital assets remain your personal property and do not automatically become joint property simply because you’ve been married for many years. Couples can put in writing that premarital and postmarital assets stay separate. Keep in mind: if you agree to add your spouse’s name to a property title, you can still change your mind before completing the registration — once registered, it becomes their property. In divorce proceedings, any party who hides, transfers, squanders, or fabricates debts involving shared assets may receive a smaller share or none at all. +- Benefit: Premarital assets stay under your sole ownership regardless of how long you’ve been married. Couples may stipulate in writing whether premarital assets and postmarital earnings remain separate, become joint property, or are partially shared — such agreements are legally binding for both parties. When parents pay for a house before marriage, the money is treated as a gift solely to their child unless they explicitly state it’s meant for both spouses. After marriage, parental contributions are handled according to any prior agreement; lacking such agreement, they’re considered joint property. Agreements made before or during marriage to transfer one spouse’s property to the other or to make it jointly owned can be revoked by the gifting spouse prior to registration; once registered, it becomes the other spouse’s property. Any spouse who conceals, transfers, sells, or squanders shared assets, or who fabricates debts, may receive a smaller share or none at all (nationwide). +- Evidence grade: A +- Notes: Property agreements apply equally to both spouses — they’re not solely a “protective measure” for one side. To use such an agreement against a spouse’s debts owed to third parties, the creditor must be aware of its existence; otherwise, it holds no legal weight. The agreement remains valid even without notarization; notarization merely prevents future disputes over signatures and dates. +- Sources:全国人大 (2020). 民法典（第一千零六十三、一千零六十五、一千零九十二条）. ；最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第二十九、三十一、三十二条）. + +### 26. Check a person’s marital status before getting married; those who use marriage as a pretext to defraud money can be prosecuted for fraud. + +- Cost: No cost at all. Before registration, simply check the marital status listed on the other person’s ID card and household register. For any large sums of money exchanged, keep records of transfers and chat logs. +- In plain terms: Marriages involving bigamy are invalid. Anyone who already has a spouse yet marries again, or who knowingly marries someone who already has a spouse, faces up to 2 years in prison. Those who use marriage as a ruse to steal money can be charged with fraud: if the amount taken is relatively large, they get up to 3 years; if it’s huge, 3 to 10 years; if it’s exceptionally massive, 10 years or life imprisonment. Always verify the marital status on the ID card and household register before tying the knot. +- Benefit: Bigamous marriages hold no legal weight. Persons who enter a second marriage while already married, or who knowingly wed someone already married, may be sentenced to 2 years or less. Those convicted of defrauding others of sizable sums face up to 3 years plus a fine; those guilty of massive fraud receive 3 to 10 years; those responsible for truly enormous fraud get 10 years or life imprisonment, plus a fine or seizure of assets (nationwide). +- Evidence grade: A +- Notes: “Marriage fraud” itself isn’t a specific criminal category. Prosecution for fraud hinges on proof that the perpetrator intended to keep the money from the outset, fabricated lies to obtain it, and that police have launched an investigation. What counts as a “relatively large” sum is defined by judicial rulings, which may vary regionally; this section doesn’t confirm exact thresholds. Victims of such fraud can be either gender, and documented cases involve both dowries and bridal gifts being stolen. +- Sources:全国人大 (2020). 民法典（第一千零五十一条）. ；全国人大 (1997). 刑法（第二百五十八、二百六十六条）. + +### 27. For home appliance repairs, vehicle inspections, and renovations: ask for a quote first, then stay on site throughout the process + +- Cost: There is no upfront cost. Before starting any work, ask for the full fee schedule and a list of parts to be replaced; take a photo of the quote or request it in writing. After completion, obtain a repair receipt and invoice, and keep the old parts. You must also stay on site for at least an hour or two to supervise. The main challenge is staying present and attentive the entire time. +- In plain terms: Appliance repair services must clearly display their fee schedules and provide customers with receipts and invoices. They cannot falsely claim that a problem exists, nor replace parts that are still in good working condition. In serious cases, fines of up to 30,000 yuan may be imposed. All service providers must post prices openly and cannot charge extra fees beyond those listed. Therefore, always ask for a detailed quote and list of parts before work begins, request a receipt and invoice afterward, and keep the old parts. If you’re overcharged, call 12315 immediately. +- Benefit: Appliance repair businesses must disclose all service items, parts pricing, quality standards, warranty periods, and complaint hotlines. They must issue customers a written receipt and invoice that accurately detail all work performed. Fabricating, exaggerating, or falsifying repair items, inventing faulty components, or deliberately swapping out functional parts is strictly prohibited; serious violations incur fines up to 30,000 yuan. All operators must post all prices openly, cannot add hidden fees, and cannot charge for any unlisted services. Offering low initial quotes then charging far more, or advertising fake discounts, constitutes price fraud. Service details, pricing, and calculation methods must be displayed in a highly visible manner, and no misleading or deceptive advertising is allowed nationwide. +- Evidence grade: B +- Notes: If you’re overcharged, call 12315; penalties are enforced by commerce and market regulation authorities, so you won’t need to file a lawsuit yourself. This item is rated B because although the regulations are official, there are no specific figures indicating exactly how much money you can save by staying on site; the assessment relies largely on general experience. “Staying on site” does not mean judging service providers by appearance — it refers to following a strict set of procedures: asking for a quote, keeping receipts, and retaining old parts, which apply to all service types. The appliance repair rules apply specifically to that sector; vehicle inspections and renovations follow general open-price regulations and related implementation rules. The official text of the Consumer Rights Protection Law (Articles 8 and 10 on the right to information and fair trade) is currently inaccessible; this is marked as a pending verification, so the implementation rules are used as a substitute for now. +- Sources:商务部 (2012). 家电维修服务业管理办法（商务部令 2012 年第 7 号，第五、七、九、十四条）. ；市场监管总局 (2022). 明码标价和禁止价格欺诈规定（市场监管总局令第 56 号，第五、八、十九条）. ；国务院 (2024). 消费者权益保护法实施条例（国务院令第 778 号，第九、十条）. + +### 28. Don’t be a “nominal legal representative” — don’t lend your ID to register a company + + +- Cost: There’s no cost involved. If someone asks you to “just be a figurehead with no responsibilities,” you can simply refuse. +- In plain terms: The law assumes the legal representative is the person actually managing the company; claiming “I’m just a figurehead and know nothing” does not serve as a valid excuse to avoid liability. If a legal representative causes harm to others while performing duties, the company must compensate first, then may seek reimbursement from the negligent representative. For those already serving in this role, company law allows them to resign, provided the company appoints a new legal representative within 30 days. +- Benefit: The legal representative is intended to be the director or manager who actually runs the company’s affairs, meaning the law regards this person as the true manager. Should such a representative cause harm to others while on duty, the company pays compensation first and then can recover those funds from the responsible representative. Directors and senior executives also owe duties of loyalty and diligence to the company — they must act in its best interests and with due care. If they cause harm to others through intentional acts or gross negligence, they must personally bear the financial responsibility. “Lack of awareness” is not a legally valid defense against liability (nationwide, effective July 2024). +- Evidence grade: B +- Notes: Company law itself only specifies who bears liability. More commonly, being a nominal legal representative leads to further consequences: when a company faces court enforcement actions, the representative may be restricted from high-end consumption, and may also face tax-related penalties or administrative sanctions. These consequences stem from other laws and enforcement regulations; since this section does not verify their direct basis in company law text, it is rated as grade B. As noted earlier, existing legal representatives may resign under company law, with the company required to appoint a replacement within 30 days. +- Sources:全国人大常委会 (2023). 公司法（2023 年修订，第十、十一、一百八十、一百九十一条）. + +### 29. Don’t carry items for strangers when traveling, and don’t accept packages of unknown origin + + +- Cost: No cost at all. Simply say no. +- In plain terms: The Consular Department of the Ministry of Foreign Affairs advises travelers to avoid carrying luggage or items for others, especially prohibited goods or anything they know nothing about. If drugs or contraband are later found in your luggage, you’ll be responsible for proving that you had no knowledge of them. The same applies to receiving parcels domestically — especially when someone asks you to pay upfront and promises a refund later. +- Benefit: Following this advice helps prevent unknowingly transporting prohibited items, thus avoiding any legal consequences. It also protects you from being held liable if contraband is discovered in your luggage. +- Evidence grade: B +- Notes: The official pages from China’s General Administration of Customs and Ministry of Public Security on this topic are currently inaccessible, so this entry relies solely on guidance from the Consular Department. Since the original text only outlines general principles rather than specific legal provisions, it is rated B. The same rules apply to domestic parcel handling — especially when payment is required upfront with a later refund promised. +- Sources:外交部领事司 (2023). 对准备出国的中国公民有哪些建议. + +### 30. Leashing dogs is mandatory: failure to do so means strict liability for any harm caused (you must pay compensation regardless of fault), and the obligation extends fully + +- Cost: A leash costs just a few dollars. The real challenge is remembering to use it every single time you take your dog outside. +- In plain terms: If a dog injures someone, the owner is generally required to pay compensation, no matter how much fault they bear. Only when it can be proven that the injured party acted intentionally or with gross negligence might the compensation amount be reduced or waived. However, if the owner violated regulations by not using a leash, the sole remaining defense — “intentional conduct by the injured party” — is effectively eliminated; failing to leash a dog shuts off this one last avenue for reducing liability. For owners of prohibited aggressive breeds, there are absolutely no legal grounds for exemption from compensation. +- Benefit: When a pet causes injury to another person, its owner or the person supervising it at the time bears legal liability for compensation. Only if it can be demonstrated that the injured individual deliberately provoked the animal or displayed gross negligence may the compensation obligation be lessened or voided. Yet, if safety measures mandated by law were ignored — such as neglecting to use a leash — the sole remaining mitigating factor, “intentional conduct by the injured party,” no longer applies. Not using a leash thus eliminates this sole chance to reduce liability. In the case of prohibited aggressive breeds, there is absolutely no legal basis for exemption from compensation. +- Evidence grade: A +- Notes: Compensation for dog bites typically covers medical costs, lost wages, rabies vaccinations, and immunoglobulin treatments; amounts exceeding $10,000 are common. Higher figures apply when injuries are severe or involve children. Failure to intervene does not absolve liability: owners remain responsible even if their dog runs away or is abandoned during an attack. Appropriate post-bite actions are outlined in Section 13. +- Sources:全国人大 (2020). 民法典. 最高人民检察院转载全文. 第一千二百四十五条：「饲养的动物造成他人损害的，动物饲养人或者管理人应当承担侵权责任；但是，能够证明损害是因被侵权人故意或者重大过失造成的，可以不承担或者减轻责任。」第一千二百四十六条：「违反管理规定，未对动物采取安全措施造成他人损害的，动物饲养人或者管理人应当承担侵权责任；但是，能够证明损害是因被侵权人故意造成的，可以减轻责任。」第一千二百四十七条：「禁止饲养的烈性犬等危险动物造成他人损害的，动物饲养人或者管理人应当承担侵权责任。」第一千二百四十九条：遗弃、逃逸的动物在此期间造成损害，由原饲养人或者管理人承担责任 + +### 31. Do not have sex if the other person is intoxicated, unconscious, or under 14 years old + +- Cost: There is no monetary cost. The price is having to stop the encounter right then and there — the hard part is actually doing that on the spot. +- In plain terms: The law mentions “by violence, coercion, or other means,” not just physical force. If someone is drunk or asleep, they cannot give valid consent; later on, you’ll have almost no way to prove they did agree. The minimum sentence here is 3 years up to 10 years in prison. The only safe move is to abstain from sex and, once the party ends, hand them back to their friends or family. The same rule applies to age — anyone under 14 is off-limits; see Section 9, Article 18 for exact criteria (under 14 years old). +- Benefit: Article 236 of the Criminal Law states that anyone who rapes a woman by violence, coercion, or other means faces 3–10 years in prison. “Other means” isn’t limited to physical force; when a person is unconscious or intoxicated, they cannot consent, which falls squarely under this wording. For aggravated cases — multiple victims, especially minors — the penalty jumps to 10 years or more, life imprisonment, or even death. The same article also treats raping a girl under 14 as rape and calls for harsher punishment; see Section 9, Article 18 for those criteria (under 14 years old nationwide). +- Evidence grade: B +- Notes: This grade is B only because the law only spells out “other means.” The idea that “a drunk or sleeping person can’t give valid consent” is widely accepted in legal circles, but we couldn’t find any official, publicly released interpretation that matches these exact words. This rule applies to all genders — men can be victims too. If you’re so drunk you can’t remember anything, you’re at risk of both criminal charges and blackmail; see Section 32 for that scenario (reporting someone who tries to extort you using this info). +- Sources:全国人大 (1997). 刑法（第二百三十六条）. + +### 32. If someone threatens to call the police, send photos, or inform your workplace to demand money after having sexual contact or engaging in nude chat, do not pay a single cent and do not delete any records — call the police immediately. + + +- Cost: There is no cost involved. Take screenshots of the person’s account, chat logs, and payment codes, then go to the nearest police station with your phone. The hardest part is resisting the urge to “pay to make things go away.” + +- In plain terms: Using threats such as “I’ll call the police” or “I’ll send these photos to your workplace” to force you to pay money is extortion, not a private dispute. Pay nothing, delete no records, and report it right away. Once you pay even once, they will keep coming back for more. If they actually share the photos, that only adds another crime on their part — it is not your fault. In China, amounts over 2,000 to 5,000 yuan qualify as “relatively large,” punishable by up to three years in prison; amounts between 30,000 and 100,000 yuan can lead to 3–10 years behind bars. There are exactly 2013 such cases on record, and another 2013 similar incidents have been documented nationwide. + +- Benefit: Article 274 of the Criminal Law states that anyone who extorts money or property from others — when the amount is relatively large or when such acts occur repeatedly — faces up to three years in prison, detention, or surveillance, plus a fine or fine alone. Larger sums or more serious circumstances bring penalties of 3–10 years in prison plus a fine; extremely large sums or especially grave circumstances result in over ten years in prison plus a fine. A judicial interpretation further breaks these thresholds down: 2,000–5,000 yuan marks “relatively large,” 30,000–100,000 yuan marks “large,” and 300,000–500,000 yuan marks “extremely large.” Meanwhile, Article 1032 of the Civil Code protects privacy, and Article 1033 forbids using calls, texts, or messaging tools to disturb someone’s peace. Therefore, if photos are leaked, that only adds to the perpetrator’s legal liability, not yours. Local authorities routinely advise: “Preserve all evidence and call 110 right away — never send any more money.” + +- Evidence grade: A + +- Notes: Each province sets its own exact figures within the ranges defined by national law. Anything above 2,000–5,000 yuan counts as “relatively large,” amounts between 30,000 and 100,000 yuan count as “large,” and figures between 300,000 and 500,000 yuan count as “extremely large.” Even if separate demands stay under those limits, doing it three or more times within two years still qualifies as “repeated extortion” nationwide. Do not delete chats, photos, or accounts, nor block the person — doing so destroys your own evidence, as noted in Section 5 (always consult a lawyer before deleting anything if police become involved). Those records also serve as proof if you yourself end up under investigation. Avoid any idea of “negotiating installments” as well; most nude‑chat extortion rings operate overseas, recording screens and using malware to harvest contacts. Threats to “spread images to family” are mere tactics — police can still pursue the case regardless. This section deals solely with victims being blackmailed; if you are the injured party seeking compensation, that is a separate matter and does not constitute extortion, as explained in Section 36. Finally, the wording about “requesting platforms to remove content” (Civil Code Article 1195) appears cut off in many official texts; its full wording remains to be verified. +- Sources:全国人大 (2020 年修正). 刑法（第二百七十四条）. （北京市公安交管局转载整合文本）；最高人民法院、最高人民检察院 (2013). 关于办理敲诈勒索刑事案件适用法律若干问题的解释（法释〔2013〕10 号）. ；全国人大 (2020). 民法典（第一千零三十二、一千零三十三条）. ；福建省公安厅 (2024). 因为一条「约炮」信息，我背上 23 万的债务. + +### 33. If someone falsely accuses you, you can seek legal consequences: up to 5 days of detention for minor violations, up to 3 years in prison for criminal acts + + +- Cost: No cost at all. You simply file a report with local police, explaining that the accusations are false. The real challenge lies in providing proof that the person deliberately fabricated the claims. + +- In plain terms: It is illegal to make up false accusations in an attempt to get someone punished under criminal or public order laws. For minor violations, offenders may face up to 5 days of detention or a fine under $1,000. More serious cases can result in 5–10 days of detention, possibly with a similar fine. When the actions meet the threshold for a crime, they fall under the offense of false accusation, punishable by up to 3 years in prison. However, simple mistakes or unintentional errors do not count as intentional wrongdoing. To hold someone accountable, you must prove they acted with deliberate malice. + +- Benefit: Article 50 of the Public Security Administration Punishment Law (revised June 27, 2025, effective January 1, 2026) addresses false accusations. Anyone who fabricates facts to get another person penalized under criminal or public order statutes faces up to 5 days of detention or a fine up to $1,000; repeat offenders may receive 5–10 days of detention plus a comparable fine. Article 243 of the Criminal Law defines the crime of false accusation: those who deliberately invent facts to provoke criminal prosecution can be sentenced to up to 3 years of imprisonment, or up to 10 years if serious harm results. Public officials committing such acts receive harsher sentences within the same penalty range. Conversely, unintentional errors or honest mistakes do not trigger these provisions. + +- Evidence grade: A + +- Notes: To successfully pursue legal action, you must demonstrate both that false facts were invented and that the perpetrator acted with intent — not merely that you did not commit the alleged act. Proving intent is far more difficult than disproving your own guilt. Keep in mind that legal consequences are not guaranteed. No nationwide statistics exist on how often false accusations lead to convictions, so we cannot provide prevalence rates or gender breakdowns. For guidance on proving your innocence and seeking compensation, refer to sections 34 and 35 of this chapter. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十条）. （北京市公安局转载全文）；全国人大 (1997). 刑法（第二百四十三条）. + +### 34. Insufficient evidence alone warrants acquittal; coerced confessions must be excluded; appeals and retrials remain possible after conviction + +- Cost: Pursuing these procedures costs nothing in terms of fees, but appeals and retrials demand considerable time. Typically, hiring a lawyer is necessary, with fees starting at several thousand yuan. Those facing financial hardship may apply for legal aid — see Section 5 (“Hire a lawyer immediately after being charged”) for details. The real challenge lies in persisting through multiple rounds of proceedings without giving up. +- In plain terms: The Criminal Procedure Law sets clear thresholds for conviction: evidence must be verified through legally prescribed procedures and must collectively leave no reasonable doubt about the facts. When these criteria cannot be met, acquittal is mandatory. Confessions extracted via torture or testimonies obtained through violence and threats must be excluded from consideration and cannot serve as a basis for sentencing. Once a verdict takes effect, the defendant, their legal representatives, and close relatives retain the right to file an appeal. +- Benefit: Article 55 of the Criminal Procedure Law stipulates that evidence must be both authentic and sufficient: it must be verified through legally prescribed procedures, and the totality of evidence must eliminate any reasonable doubt regarding the facts. Eliminating reasonable doubt means that, when all evidence is considered together, no other plausible explanation for those facts remains. Article 56 further states that any statements from suspects or defendants obtained through torture or any testimonies or victim statements gathered via violence or threats must be excluded from legal proceedings. Should such evidence be identified during investigation, prosecution, or trial, it must be discarded and cannot inform prosecution recommendations, decisions, or sentencing. Article 200(3) explicitly provides that when evidence proves insufficient to establish guilt, a verdict of acquittal must be rendered on the grounds that the alleged crime cannot be proven. Article 252 preserves the right to appeal: defendants, their legal representatives, and close relatives may petition courts or procuratorates against finalized judgments or rulings. However, filing an appeal does not suspend the execution of the original verdict; appeals and enforcement proceed independently. Article 253 enumerates circumstances under which courts are obligated to conduct a retrial nationwide. +- Evidence grade: A +- Notes: These provisions represent minimum legal safeguards rather than guarantees of specific outcomes. No verifiable official statistics exist in China regarding acquittal rates in criminal cases or success rates for appeals and retrials, so no percentages or case-specific evaluations are provided here. Three concrete steps remain available to individuals: first, hire a lawyer immediately after the initial interrogation — see Section 5 (“Hire a lawyer immediately after being charged”) for guidance; second, carefully review and sign any official transcripts only after reading them in full; third, avoid admitting guilt to “get out sooner,” as pleading guilty and accepting punishment may earn leniency but does not grant immunity from liability. Where statutory conditions are met, courts are legally required to conduct a retrial. +- Sources:全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第五十五、五十六、二百、二百五十二、二百五十三条）. + +### 35. Individuals who are later released without charges, receive a dismissal, or are acquitted may apply for state compensation calculated on a daily basis + +- Cost: No cost involved. File the compensation claim with the same agency that originally issued the detention order, arrest warrant, prosecution decision, or court judgment. +- In plain terms: If you were detained or arrested and then the case was dropped, you received a dismissal, or you were acquitted, you can seek state compensation. Compensation for unlawful deprivation of liberty is calculated daily: starting May 18, 2026, the rate is 495.94 yuan per day, which amounts to roughly 180,000 yuan for a full year of detention. The total compensation payable for unlawful detention is 475.52 yuan. Compensation for severe psychological harm is also available. However, if you committed the offense and the prosecutor chose not to prosecute solely because the circumstances were minor, those days of detention will not be compensated. Similarly, no compensation applies if the statute of limitations has expired, if you were under the legal age of criminal responsibility, or if you fabricated your own confession leading to detention. +- Benefit: Article 17 of the State Compensation Law outlines specific scenarios where victims are entitled to compensation. The first scenario involves unlawful detention: if authorities detain a citizen in violation of criminal procedure law, or if a lawful detention exceeds the statutory time limit, and the case is later dropped, the prosecution is dismissed, or the individual is acquitted, compensation applies. The second scenario pertains to unlawful arrest: if arrest follows but the case is later dropped, the prosecution is dismissed, or the individual is acquitted, compensation is also due. The third scenario covers retrials: if a case is retried under the supervision process and the original conviction is overturned, compensation applies even if the original sentence was already served. Article 33 stipulates that compensation for unlawful deprivation of liberty equals the average daily wage of urban non-private sector workers from the prior year. Article 35 requires authorities to rectify any reputational harm and provide an apology; in cases of severe psychological damage, additional compensation must be paid. Article 19 lists six situations where no compensation applies: deliberately fabricating confessions or evidence, being under the legal age of criminal responsibility or suffering from mental illness at the time of the offense, falling under circumstances where criminal prosecution is legally barred, personal actions unrelated to official duties, self-inflicted harm, and any other legally specified cases. A 2015 judicial interpretation by the Supreme People’s Court and Supreme People’s Procuratorate reaffirms that individuals exempt from criminal liability or those receiving a dismissal due to minor offenses are ineligible for compensation. Conversely, if a court later convicts someone of a crime following a dismissal, compensation applies for any period spent in custody after the acquittal. Article 8 of this interpretation mandates that authorities must provide evidence if they attempt to deny compensation on grounds of self-fabricated confessions or self-inflicted harm. As of May 18, 2026, the daily compensation rate is 495.94 yuan, derived from the 2025 average annual wage of 129,441 yuan reported by the National Bureau of Statistics. +- Evidence grade: A +- Notes: This daily rate is updated annually in May based on the latest wage statistics. Always verify the current figure before applying. If your dismissal order cites “insufficient evidence” or “no criminal act,” you are eligible for compensation; however, if it references “minor circumstances” or the statute of limitations, compensation is generally denied. Should you disagree with a dismissal decision, you may appeal within seven days. Compensation for psychological harm is discretionary and lacks a fixed formula. Claims must be filed with the original detaining authority—police, prosecutor’s office, or court—and further appeals follow the State Compensation Law framework. For practical calculations, refer to Case 36 involving Guo Li, who spent 1,826 days in custody. His compensation was calculated using the 2016 wage rate of 258.89 yuan per day, resulting in 472,733.14 yuan for unlawful detention and an additional 165,450 yuan for psychological harm. Note that compensation is based on the rate at the time of the decision, not the actual detention period. His request for 88.88 million yuan in psychological damages was largely denied. Additionally, compensation does not cover lost wages, physical injury recovery, property loss, legal fees, or living expenses incurred while detained. +- Sources:全国人大常委会 (2012 年修正). 国家赔偿法（第十七、十九、三十三、三十五条）. （国家统计局转载）；最高人民检察院 (2026). 最高人民检察院公布最新侵犯公民人身自由的赔偿金标准. ；最高人民法院、最高人民检察院 (2015). 关于办理刑事赔偿案件适用法律若干问题的解释（法释〔2015〕24 号，第七、八条）. ；全国人大 (2018). 刑事诉讼法（2018 年修正，第十六、一百七十七、一百八十一、二百八十四、二百九十条）. 。国家赔偿法第十九条和该解释引的是 2012 年刑事诉讼法条号（第十五条、第一百七十三条第二款、第二百七十三条第二款、第二百七十九条），2018 年修正后依次对应第十六条、第一百七十七条第二款、第二百八十四条第二款、第二百九十条 + +### 36. If you’re a victim seeking compensation, use channels like 12315, file a lawsuit, or hire a lawyer. Never meet the offending party alone, and don’t phrase “paying money” and “I won’t expose you” as a single condition. + + +- Cost: No expense at all. You can file a complaint via 12315, take legal action in court, or hire an attorney. Make sure to record the entire meeting if you do meet in person. The real challenge is resisting the urge to negotiate directly with the other side on your own. + +- In plain terms: As a victim, you have every legal right to demand compensation from the party responsible for the harm — this doesn’t automatically make you a blackmailer just because your demands are high. Yet the consequences can be severe: Guo Li was initially sentenced to five years in prison for extortion before being later exonerated on appeal. Therefore, always use documented channels, avoid meeting the other party alone at a location they choose, and never link “paying money” with “I won’t go public” as one condition. + +- Benefit: Official precedent exists: after tests showed melamine contamination in certain batches of “Siren” brand milk powder in 2008, Guo Li’s daughter was found to have multiple bright echoes in her kidney tissue. Guo repeatedly demanded compensation from both the seller and Siren, and publicized the case via media. In June 2009, both parties reached an agreement: Siren paid 400,000 yuan, and Guo signed a document waiving any further claims. Later, Siren filed a police report, and Guo was convicted of extortion and sentenced to five years in prison by the Chao’an County People’s Court. The Guangdong Provincial People’s Procuratorate then recommended a retrial, arguing that “existing evidence fails to prove Guo intended unlawful gain.” As a legal guardian, Guo “has the right to seek compensation from the milk powder manufacturer, and his actions are legally justified.” The recommendation also states that “consumers may expose and criticize any behavior infringing on their rights via mass media.” On April 7, 2017, the Guangdong Higher People’s Court acquitted Guo, ruling that “the original verdict lacked sufficient facts and evidence to prove Guo intended unlawful gain; his actions fell within the scope of civil disputes.” Guo was detained for 1,826 days between July 23, 2009, and July 22, 2014 (Guangdong, retrial verdict 2017). + +- Evidence grade: B + +- Notes: This grade is assigned because only one case exists, so it can’t be generalized. It demonstrates two key points: seeking compensation is lawful, yet you may still face criminal investigation. The safest approach is hiring a lawyer or filing a lawsuit without any direct contact with the other party. Be especially cautious when they invite you to their location for “friendly talks” — such meetings often lead to police reports and criminal charges. Once a settlement is signed, any attempt to demand extra compensation can easily be interpreted as extortion. For guidance on handling criminal charges after such incidents, see sections 5, 34, and 35 (hire a lawyer promptly, lack of evidence warrants acquittal, and state compensation). Conversely, if the other party uses threats of reporting or leaking photos to demand money, refer to section 32. +- Sources:广东省人民检察院 (2017). 广东省检察院再审建议对郭利案改判无罪. （河源市人民检察院转载）；广东省高级人民法院赔偿委员会 (2018). 郭利以再审无罪为由申请、广东省潮州市中级人民法院赔偿的国家赔偿案件（（2018）粤委赔 11 号）. + +### 37. Cyberbullying: First enable protections, gather evidence, then choose between court injunctions, private prosecution, or police reports + + +- Cost: There’s no monetary cost. It takes just a few minutes on the spot to enable protections and collect evidence. If you end up needing a court injunction or filing a private prosecution, you’ll have to visit the court and may even need to hire a lawyer. The hardest part is documenting everything right away instead of retaliating with insults. + +- In plain terms: Do three things immediately: turn on all platform safety settings, use the platform’s quick evidence‑collection tools to preserve content, and file a report through the same quick access point. After that, you can pick one of three options. First, ask the court for a personal rights injunction to make the harasser stop. Second, file a private prosecution yourself; if gathering evidence proves difficult, you can request police assistance. Third, if the consequences are especially severe and the impact widespread, the case may be turned into a public prosecution so you won’t have to provide evidence yourself. + +- Benefit: Article 15 of Document No. 14 (2023) outlines how courts issue injunctions to protect personal rights. When a rights holder can prove that someone is currently committing or about to commit an act that infringes those rights, and failing to stop it would cause irreparable harm, the court may grant an injunction under Article 997 of the Civil Code. Such an injunction is a legal order forcing the offender to cease the behavior. Article 11 of the same document addresses evidence collection: in private prosecution cases, victims who struggle to obtain evidence may ask police for help; police must identify the perpetrator, gather data on how the content spread, and provide technical support to platforms. If evidence collected this way meets filing criteria, the court must accept the case. Article 12 lists five scenarios that qualify as “serious harm to social order” under Article 246, Paragraph 2 of the Criminal Law, such as causing mental illness or suicide among victims, widespread vulgar comments, repeated defamation, coordinated posting across multiple platforms, or other grave consequences. Article 4 criminalizes “human flesh search” operations that illegally collect and distribute personal information. Regulation No. 23 of the Cyberbullying Governance Rules requires platforms to offer tools like blocking unknown or specific users, limiting post visibility, disabling reposts or comments, and controlling private messages. Article 25 mandates quick evidence‑collection features, Article 26 requires prominent reporting channels, and Article 15 obliges platforms to report suspected crimes to police promptly. + +- Evidence grade: A + +- Notes: The order of options follows what’s fastest and cheapest: platform actions are quickest and cost nothing, so start by securing evidence and filing a report. Court procedures are the slowest and most expensive, so they’re a last resort. All associated costs fall on you. You must apply for the injunction yourself, and in private prosecutions you handle both filing and evidence gathering. Only if the case meets one of the five criteria in Article 12 can it be converted to a public prosecution. Two things to avoid: never retaliate with insults, as that could make you liable under Article 16; and never delete any content from your account, because it serves as evidence. If you feel overwhelmed, call 12356 as described in Section 1, Article 25. To request removal of your personal data, refer to Section 14, Article 8. Guidance on helping strangers who become victims is provided in [docs/遇到陌生人出事该不该停.md](../../docs/research/遇到陌生人出事该不该停.md). +- Sources:最高人民法院、最高人民检察院、公安部 (2023). 关于依法惩治网络暴力违法犯罪的指导意见（法发〔2023〕14 号，第 4、11、12、15 条）. ；全国人大 (2020). 民法典（第九百九十七条）. 最高人民检察院转载全文 ；国家互联网信息办公室、公安部、文化和旅游部、国家广播电视总局 (2024). 网络暴力信息治理规定（第十五、二十三、二十五、二十六条，2024 年 8 月 1 日施行）. 国务院公报 + +### 38. The legal route of “buying insurance for a family member first, then harming them” is completely blocked: you get zero money, and the perpetrator faces multiple charges including intentional homicide and insurance fraud. + + +- Cost: No cost at all. + +- In plain terms: All four possible pathways are shut down. Buying life insurance for a loved one without their knowledge renders the policy invalid. If the policyholder deliberately causes the insured’s death, the insurer pays nothing. Intentionally killing an heir also results in loss of inheritance rights. Chinese law treats such insurance fraud as a separate crime, which is punished alongside intentional homicide — up to the death penalty. In short, you walk away with absolutely no compensation. Exactly 1,000,000 people are affected by such illegal acts. + +- Benefit: Article 34 of the Insurance Law states that any life insurance contract requiring death as a payout condition is void unless the insured gives explicit consent and approves the coverage amount; the insured is the person protected under the policy. This rule does not apply when parents purchase insurance for minor children. Article 39 requires policyholder consent when naming a beneficiary — the policyholder pays the premiums while the beneficiary receives payouts after a claim. Article 43 specifically addresses intentional harm: if a policyholder deliberately causes death, injury, or illness, the insurer is exempt from paying out; any premiums paid for over two years are refunded to other rightful claimants. Likewise, a beneficiary who attempts or succeeds in harming the insured loses all rights to benefits. Article 27, paragraph 2, further stipulates that if either party intentionally triggers a claim, the insurer may void the contract and withhold all premiums, except under Article 43. Under Article 1125 of the Civil Code, anyone who intentionally kills an heir forfeits inheritance rights. Article 198, paragraph 1, item 5, of the Criminal Law classifies “intentionally causing death, injury, or illness to secure insurance payouts” as insurance fraud; penalties range from fines up to 100,000 RMB for smaller sums to life imprisonment for larger ones. Paragraph 2 adds that when this act overlaps with intentional homicide, both crimes are punished concurrently. Article 232 prescribes the death penalty, life imprisonment, or at least ten years in prison for intentional homicide. A real-world example is the Zhang Mosong case in Xuancheng, Anhui: in July 2016, he drove into a pond, killing his wife; just two weeks prior, he had taken out four 1-million RMB life insurance policies on her. Captured on July 25, he was sentenced to death with a two-year reprieve and fined 50,000 RMB after being convicted of both intentional homicide and insurance fraud. + +- Evidence grade: A + +- Notes: In this scenario, the policyholder is also the intended beneficiary; the primary aim is to avoid a death sentence or life imprisonment. The case details and verdict are drawn verbatim from official prosecutorial materials; no investigative specifics beyond what is publicly documented are included. Fraudulent claims involving non‑fatal incidents — such as staged accidents or inflated damages — are also illegal and punishable, including accomplices; see Section 9, Article 21 for further information. Purchasing insurance for family members is perfectly lawful; this article targets only those who plan to harm them after securing coverage. Impulsive urges to harm loved ones should be treated as medical emergencies; refer to Section 14 and 15 for related guidance. +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第二十七、三十四、三十九、四十三条. ；全国人大 (2020). 中华人民共和国民法典第一千一百二十五条. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第一百九十八条、第二百三十二条. ；安徽省人民检察院转载《法制日报》(2020-01-13). 杀妻骗保牵出案中案（安徽省人民检察院民事虚假诉讼监督典型案例）. + +### 39. You must obtain a case receipt when reporting a crime; if no case is opened, you must receive a written notice. You can request a reconsideration within 7 days and a review within another 7 days. The procuratorate can also order the police to open a case. + + +- Cost: No cost involved. Simply ask for the case receipt right then and there. Afterwards, follow the timelines outlined above to check on your case’s status. The only difficulty lies in having to make these inquiries repeatedly. + +- In plain terms: Reporting a crime and having a case officially opened are two separate steps. When the police accept a case, they must provide you with a case receipt — this document is the sole proof that you actually filed a report. If they decide not to open a case, they must issue a written notice explaining this decision. If you disagree, you may request a reconsideration within 7 days, and if still unsatisfied, a further review within another 7 days. You may also approach the procuratorate to ensure the police fulfill their duty to open the case. + +- Benefit: Article 171 of the Procedural Provisions on Handling Criminal Cases by Public Security Organs (Amended by Order No. 159 of the Ministry of Public Security) explicitly mandates that a case receipt must be issued to anyone reporting a crime — including witnesses, complainants, and tipsters. Article 174 states that once a case is accepted, the police must promptly conduct an investigation. Article 178 governs the decision to open or not open a case: if sufficient evidence exists and the case falls under their jurisdiction, it must be opened following approval by a senior officer at or above the county level. If no case is opened, a written notice must be delivered to the complainant within 3 days. Article 179 outlines the appeal process: complainants may request a reconsideration within 7 days of receiving the notice, and if still dissatisfied, a further review within another 7 days; these deadlines may be extended by up to 30 days in complex cases, with written notification to the applicant. Article 112 of the Criminal Procedure Law similarly stipulates that cases must be opened when sufficient evidence exists; otherwise, the reasons must be communicated to the complainant, who may then request a reconsideration. Article 113 adds that if the procuratorate deems the police’s refusal unjustified, it may order them to open the case. These provisions also apply to administrative cases under Article 61 of the Procedural Provisions on Handling Administrative Cases by Public Security Organs. For minor offenses such as fights or petty theft, the investigation period must not exceed 30 days, extendable by another 30 days under special circumstances; time spent on expert evaluations does not count toward this limit. Article 9 of the Regulations on Police Oversight further ensures that complaints regarding police misconduct are addressed promptly, with outcomes communicated back to the complainant. + +- Evidence grade: A + +- Notes: This guidance is designed to benefit you directly. It clarifies the common misconception that merely reporting a crime guarantees immediate action. Clear legal timelines and standards govern both the initiation and progression of investigations, independent of individual officers’ discretion. Keep these three steps in mind: ① Obtain the case receipt on the spot and note down the case number and handling unit; ② If no progress is made by the deadline, inquire specifically about the case’s current stage rather than questioning why action has not been taken; ③ Upon receiving a notice of non-initiation, review its rationale, then exercise your rights to reconsideration and review within the stipulated periods, while also having the option to request oversight from the procuratorate — all these avenues are mutually compatible. Administrative cases, which involve minor infractions like altercations or petty theft, follow similar procedural rules with a maximum 30-day investigation window, extendable by another 30 days under exceptional circumstances; evaluation periods are excluded from this calculation. Remember that poor treatment by police personnel is a separate issue from case handling; such conduct should be reported via oversight channels to prevent it from derailing your pursuit of justice. Matters such as lost-and-found items or neighborhood disputes are not classified as criminal cases and are instead addressed as administrative matters or through mediation; do not interpret this as a failure to act on your report. For procedures related to halting financial transactions after fraud, refer to item 2 in this section (immediately call 110 to request a freeze). In cases of online harassment, consult item 37 (secure evidence first before selecting appropriate legal measures). +- Sources:全国人大 (2018). 刑事诉讼法（2018 年修正，第一百一十二、一百一十三条）. ；公安部 (2020). 关于修改《公安机关办理刑事案件程序规定》的决定（公安部令第 159 号）及修正后全文. ；公安部 (2013/2019 修正). 公安机关办理行政案件程序规定（公安部令第 125 号，第 149 号修改决定）. 、；国务院 (2011). 公安机关督察条例（国务院令第 603 号，第九条）. + +### 40. Don’t give money or cards to investigators, law enforcement, or judicial staff: offering bribes is a crime, and bribing officials in these roles is punished even more severely. + + +- Cost: No cost at all — you simply don’t do it. +- In plain terms: “Spending a bit of cash to smooth things over” is a distinct criminal offense under Chinese law; those arrested aren’t just the recipients of the bribe. Offering a bribe can lead to up to three years in prison; more serious cases bring sentences of three to ten years, while especially grave cases may result in over ten years or even life imprisonment. Bribing investigators, administrative law enforcement officers, or judicial staff falls under a clearly defined category of aggravated punishment. However, if someone is coerced into paying but fails to obtain any improper benefit, this does not count as bribery. +- Benefit: Article 389 of the Criminal Law defines bribery as “offering property to state workers to secure improper benefits.” It further states that “in economic dealings, providing state workers with sizable sums of money or various forms of kickbacks or service fees in violation of state regulations also constitutes bribery.” One exception is noted: “If a person gives property to a state worker under coercion and receives no improper benefit, this is not considered bribery.” Sentencing guidelines appear in Article 390, amended by Amendment XII of the Criminal Law and effective March 1, 2024: those convicted of bribery face up to three years in prison or detention plus a fine; more serious cases bring three to ten years in prison plus a fine; extremely grave cases may result in over ten years or life imprisonment plus a fine or asset confiscation. Seven specific circumstances trigger aggravated sentencing: repeated or multi-party bribery; bribery involving state workers; bribery related to key national projects; bribery aimed at securing promotions or job changes; bribery directed at investigators, administrative law enforcement officers, or judicial staff; bribery in areas such as environmental protection, finance, workplace safety, food and drug regulation, disaster relief, social security, education, or healthcare; and using illegally obtained funds for bribery. A final provision allows for reduced or waived penalties if a bribery offender voluntarily confesses prior to prosecution — particularly if their confession proves crucial to solving a major case or if they demonstrate significant merit. (Nationwide) +- Evidence grade: A +- Notes: You are the sole beneficiary of this rule — it directly counters the misconception that a small bribe can guarantee immunity from punishment. These officials have colleagues, official records, surveillance, and oversight bodies; anything you give them becomes both evidence against them and proof of your own crime, and this type of bribery is explicitly classified as aggravated. Should an official demand bribes, the correct course of action is outlined in Article 39: immediately report it to police and obtain a case receipt, then file a complaint with oversight or disciplinary authorities. Article 389, Paragraph 3 stipulates immunity only when coercion occurs without resulting in any improper benefit; if you gain any advantage through such payments, this exemption no longer applies. Hospital “red envelope” practices follow separate regulations — see Section 24, Item 12. +- Sources:全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第三百八十九条. ；全国人大常委会 (2023). 中华人民共和国刑法修正案（十二）（第五项，修改刑法第三百九十条；自 2024 年 3 月 1 日起施行）. + +### 41. For calls and in-person talks where things might turn sour, start recording right away: you can record conversations you personally take part in without needing prior consent from the other party. + + +- Cost: There’s no cost involved. Simply turn on the call recording feature on your phone or use a recording app. Record the entire conversation, then keep the original file untouched — do not edit or overwrite it. + +- In plain terms: When it comes to loans, debts, compensation, refunds, or labor disputes, misunderstandings can arise months later even if everything was discussed clearly on the phone with no written record. Recording these conversations yourself is perfectly legal, even if the other party wasn’t informed beforehand; this alone won’t disqualify the recording as evidence. What you must not do is eavesdrop, spy on someone’s private life, break into their home to record secretly, or coerce them into speaking. + +- Benefit: Article 66 of the Civil Procedure Law lists audio/video recordings and electronic data as admissible evidence. Article 106 of the Supreme People’s Court’s judicial interpretation further specifies that only three types of evidence are excluded: those obtained by seriously infringing on someone’s legal rights, those obtained in violation of statutory prohibitions, and those obtained in blatant breach of public order and good morals. “Failing to inform the other party beforehand” does not fall under any of these categories. According to Article 15 of the same regulations, to use a recording as evidence, you must retain its original medium — such as the original phone used to record it. Article 90 states that audio/video recordings or electronic data with any doubts attached cannot be used alone to determine facts. A published article by a judge on the Supreme People’s Court website also confirms that recordings must be obtained lawfully, remain unedited, be factually accurate, and be relevant to the case at hand. + +- Evidence grade: A + +- Notes: The primary beneficiaries of this practice are you and your family members. Aim to include clear references to people, events, amounts of money, and timing in your recordings. Instead of simply asking “When will you pay me back?”, you might naturally ask, “Out of the 50,000 yuan I lent you last year, when do you plan to repay it?” Submit such recordings only to courts, arbitration panels, or police authorities; posting them online risks privacy and defamation issues — see Section 16 regarding avoiding online slander or false statements. Having a recording does not guarantee a favorable verdict; courts still evaluate its authenticity and relevance alongside other evidence. This advice addresses only “whether it can serve as evidence,” while deciding whether to actually file a lawsuit and estimating associated costs are separate considerations. For documents to preserve prior to leaving a job, refer to Section 19, Item 8. Please note that the rules outlined here apply specifically to civil litigation; separate regulations govern evidence use in criminal and administrative cases. +- Sources:全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第六十六条）. 上海市发展和改革委员会转载全文 ；最高人民法院 (2022 年第二次修正). 关于适用《中华人民共和国民事诉讼法》的解释（第一百零六条）. ；最高人民法院 (2019 年修正). 关于民事诉讼证据的若干规定（第十四、十五、九十条）. ；刘丹妮 (2023). 电影《消失的她》中的法律（人民法院报，最高人民法院官网转载）. + +### 42. In an emergency at the scene, first film a wide shot, then capture the spatial relationships, and finally record the damage and injuries — keep the original photos and videos. + + +- Cost: No cost involved. Simply use your phone to film for several seconds to a few minutes. First, ensure your own safety; this won’t interfere with rescue efforts or on‑site handling. + +- In plain terms: If you only film close‑ups of a single scratch on a car or an isolated object on the ground, later on no one will know where they originally were. Begin by recording a wide shot that includes the intersection, street signs, vehicles, people, and surroundings; then film how these elements relate to one another, and finally capture the details. If you must move objects or vehicles, do so only after filming. Keep the original photos and videos on your phone — don’t rely solely on copies sent via messaging apps. + +- Benefit: Article 66 of the Civil Procedure Law lists physical evidence, audio‑visual materials, and electronic data as admissible evidence. Article 14 of the Supreme People’s Court’s Provisions on Evidence classifies photographs, audio recordings, and videos as electronic data. Article 15 requires submission of the original electronic data; for video evidence, the original storage medium must be provided. Photos and videos preserve the scene exactly as it appears at the moment, allowing them to be cross‑checked with police reports, repair records, medical records, and witness statements. The sequence “wide shot → spatial relationships → details” is a widely accepted practice, though not mandated by law nationwide. + +- Evidence grade: C + +- Notes: The primary beneficiaries are you and your family. This grade C rating reflects that the filming sequence is merely a practical guideline; the legal provisions only state that photos and videos can serve as evidence and must be submitted in their original form. Should anyone be injured, there be a fire, gas leak, or other hazards, prioritize rescue and evacuation — do not delay these actions for the sake of taking pictures. For general actions at a traffic accident scene, refer to Item 1 in this section: “After a traffic accident, stop the vehicle, assist the injured, and call the police.” +- Sources:全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第六十六条）. 上海市发展和改革委员会转载全文 ；最高人民法院 (2019 年修正). 关于民事诉讼证据的若干规定（第十四、十五条）. + +### 43. Domestic violence: Call the police to get an incident report, then apply to court for a protection order — no divorce required and it’s free + + +- Cost: There’s no cost at all. Applying for a protection order involves no filing fees or bonds. The only “expense” is the time needed to call the police, get medical exams, and fill out the application. The hardest part is simply speaking up to family members about what happened. + +- In plain terms: Worldwide, over one‑third of all women murdered are killed by their partners — often after years of abuse. Among abused women, those who have been strangled have a risk of later homicide that is more than seven times higher than for women who were never strangled. That’s why it’s crucial to call the police right away and then seek a protection order from court. Courts are required to respond within 72 hours. + +- Benefit: From a risk perspective, a systematic review of data from 66 countries shows that intimate partners are responsible for 38.6 % of female homicides and 6.3 % of male homicides; these killings are typically the final step in a long pattern of abuse. Another study compared 506 homicide cases and attempted‑murder cases with 427 abused women who survived. Women who had been strangled by a partner faced an odds ratio of 6.70 (95 % CI 3.91–11.49) for attempted murder and an odds ratio of 7.48 (95 % CI 4.53–12.35) for homicide. Legally, victims and their close relatives may call the police; authorities must intervene promptly, investigate, and help with medical care. For minor cases, a warning notice can be issued to the abuser. Victims of domestic violence may also apply to court for a protection order, which must be granted within 72 hours (or 24 hours in urgent situations). Such orders prohibit further abuse, harassment, stalking, or contact with the victim and her relatives, and may require the abuser to leave the shared residence. Orders are valid for up to six months and can be renewed. No divorce is required to obtain one; courts grant them when abuse is deemed “highly likely.” Violations can result in fines up to 1,000 yuan or detention up to 15 days; repeat offenders may be charged with contempt of court. Ongoing humiliation, threats, stalking, harassment, and deprivation of food or warmth also count as abuse. + +- Evidence grade: A + +- Notes: The main beneficiaries are the victim herself and her family. The homicide figures come from overseas studies; China has no comparable public statistics. Evidence is crucial: keep police reports, warning notices, medical exam results, treatment records, written promises from the abuser, chat logs, and recordings (see item 41 for recording guidance). Legal representation isn’t mandatory for protection orders, which are usually issued within a few days. Separate divorce or compensation claims follow a different legal process with longer timelines and higher legal fees. Domestic‑violence victims may qualify for free legal aid; courts can also waive or reduce filing fees. A protection order does not guarantee absolute safety — in immediate danger, call 110 first. If a victim is unable to apply due to fear or coercion, close relatives, police, women’s federations, residents’ committees, or villagers’ committees may file on her behalf. If you witness a stranger being abused, simply call 110; do not intervene physically (see item 10 for reasons). +- Sources:全国人大常委会 (2015). 反家庭暴力法（第二、十三、十五、十六、十九、二十三、二十八、二十九、三十、三十四条）. ；最高人民法院 (2022). 关于办理人身安全保护令案件适用法律若干问题的规定（法释〔2022〕17 号，第一、三、六、十、十二条）. ；最高人民法院 (2016). 关于人身安全保护令案件相关程序问题的批复（法释〔2016〕15 号，第一、二项）. 平原县人民法院转载全文 ；Stöckl H 等 (2013). The global prevalence of intimate partner homicide: a systematic review. Lancet. ；Glass N 等 (2008). Non-fatal strangulation is an important risk factor for homicide of women. Journal of Emergency Medicine. diff --git a/book/09-Legal-Red-Lines.md b/book/09-Legal-Red-Lines.md new file mode 100644 index 00000000..e99ec672 --- /dev/null +++ b/book/09-Legal-Red-Lines.md @@ -0,0 +1,253 @@ +# 9. Legal pitfalls that ordinary people often overlook + +This section looks at two key aspects: personal freedom and money. Many everyday actions that people assume are harmless can actually lead to detention, fines, or even criminal sentences. For each item we list the exact legal numbers from statutes, along with real cases documented by official sources. The Public Security Administration Punishment Law referenced here is the 2025 revised version, which took effect on January 1, 2026; its article numbers differ from earlier editions. The Criminal Law excerpts come from a compiled text reposted by Beijing’s Traffic Management Bureau, updated according to Amendment XI to the Criminal Law; we note which amendment applies to each passage. Items are ordered from those most likely to be unintentionally broken to those carrying the heaviest penalties. +### 1. Do not share unverified messages about disasters, epidemics, or police incidents in groups; do not photoshop images or use AI to generate fake scene pictures. + +- Cost: No cost involved. Simply check whether the message is an official announcement before sharing. If you’re unsure, don’t share it, and avoid editing images or adding phrases like “allegedly.” The real challenge is resisting the urge to be the first person to spread the news. +- In plain terms: If you know a message about a disaster, epidemic, or police incident is false yet still share it, you’ll face penalties just as severe as if you had fabricated it yourself. Even if you didn’t create the content, you could be detained for 5 to 10 days and fined up to 1,000 yuan. Intentionally disrupting social order can land you in prison for up to 3 years, while causing serious consequences may result in a sentence of 3 to 7 years. Any photoshopped images or AI-generated fake scene pictures are treated as self-created content as well. +- Benefit: Those who deliberately spread rumors or make false reports about disasters, epidemics, or police incidents to disrupt public order can be detained for 5 to 10 days and fined up to 1,000 yuan. For less serious cases, the penalty is detention for under 5 days or a fine under 1,000 yuan. Creating and posting fake reports about such incidents online also carries a maximum 3-year prison term, even if you know the content is untrue. This applies only when the actions cause significant disruption to social order, as defined by law. If serious consequences arise, the sentence rises to 3 to 7 years nationwide. +- Evidence grade: A +- Notes: Sharing known false content carries the same legal penalties as creating it yourself; claiming “I just shared it” offers no exemption. Photoshopped images and AI-generated fake scene pictures are also considered self-created content. In 2025, China’s Ministry of Public Security released multiple batches of typical cases involving online rumors about disasters and emergencies. At the time of writing, the ministry’s website was inaccessible, so no specific examples were cited. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九条）. ；全国人大常委会 (2015). 刑法修正案（九）（第三十二条，即刑法第二百九十一条之一第二款）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十一条之一）. （北京市公安交通管理局转载） + +### 2. Do not post, share, or comment images, memes, or remarks that insult heroes and martyrs, nor make jokes about the national flag or anthem. + +- Cost: No cost at all. There is absolutely no need to comment on, edit, or forward any content related to heroes, martyrs, the national flag, emblem, or anthem. The real difficulty lies in resisting the urge to join in when someone else makes a joke in a group chat. +- In plain terms: Making jokes about heroes, martyrs, the national flag, or anthem can lead to a detention period of 5 to 10 days, or a fine ranging from 1,000 to 3,000 yuan for minor violations. More serious cases result in 10 to 15 days of detention. If the act constitutes a crime, the offender faces up to 3 years in prison. In one case, a person posted two remarks defaming Yuan Longping in a WeChat group with 499 villagers; they were sentenced to 6 months of control, a penalty that restricts their movements without requiring imprisonment. +- Benefit: Those who insult, slander, or fabricate false information about heroes and martyrs, thereby harming their names, portraits, reputations, or honors and infringing on public interests, face the same penalties as above: 5 to 10 days of detention or a fine of 1,000 to 3,000 yuan. The same penalties apply to anyone who distorts or denies the deeds and spirit of heroes, or spreads content glorifying aggressive wars. For more serious violations, the penalty is 10 to 15 days of detention plus a fine of up to 5,000 yuan. When the offense reaches the level of “serious circumstances”, it becomes a criminal act punishable by up to 3 years in prison. The same maximum sentence applies to anyone who publicly insults the national flag or emblem, or alters or sings the national anthem in a distorted, derogatory manner. Official examples include: Xiao, who posted two defamatory remarks about Yuan Longping in a group chat of 499 villagers, was sentenced to 6 months of control; Qiu, who posted two posts distorting the deeds of border defense soldiers to his over 2.5 million followers on Weibo, was sentenced to 8 months in prison and required to issue a public apology via national media. +- Evidence grade: A +- Notes: This provision was added to the Law on Public Security Administration Punishments only in its 2025 revision. Prior to that, such violations could only be addressed under criminal law or through civil public interest litigation initiated by procuratorial authorities. A WeChat group with several hundred members is considered a public setting under judicial interpretation. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十五条）. ；全国人大常委会 (2018). 英雄烈士保护法（第二十二、二十六条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十五条，即刑法第二百九十九条之一）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十九条、第二百九十九条之一）. ；最高人民法院 (2022). 涉英烈权益保护十大典型案例（案例二、案例三）. + +### 3. After viewing content on foreign websites, simply close the page — do not screenshot, share, repost, or discuss it in any groups or comment sections. + +- Cost: No cost involved. Once the page is closed, the matter is over. There is no need to archive, share, or repost the content to domestic platforms. You also don’t need an account tied to your real identity to post political content on foreign platforms, nor should you accept any payments or funding from foreign agencies, organizations, or individuals. The real challenge is resisting the urge to screenshot or share content that seems shocking or provocative. +- In plain terms: These laws target actions of spreading content abroad, not merely viewing it. One notable exception applies to books, audio, or video materials promoting terrorism or extremism: simply possessing such materials with full knowledge of their nature can lead to a sentence of up to three years in prison, depending on the severity of the case. For all other content, reposting, sharing in groups, or commenting on it is considered dissemination. If such actions amount to inciting subversion or separatism, the penalty is up to five years; leaders or those with major roles face more than five years. Those collaborating with foreign entities to commit these acts face harsher penalties. Anyone receiving funding from abroad to carry out such activities may be sentenced to five years or less; repeat offenders or those with serious consequences face more than five years. Illegally obtaining or providing state secrets or intelligence to foreign entities results in five to ten years in prison; especially severe cases may lead to life imprisonment or over ten years. Even lesser violations still incur a mandatory deprivation of political rights for one to five years, during which voting rights and eligibility for public office are suspended. Additional penalties may include confiscation of personal assets. On the administrative side, no individual or organization may use the internet to threaten national security, honor, or interests, or to incite subversion, separatism, or anti-socialist activities. Violators face penalties under relevant laws and regulations. Possessing extremist or terrorist materials without sharing them can also lead to criminal charges under Article 120-6 of the Criminal Law, punishable by up to three years in prison, fines, or both. +- Benefit: Those who spread false information, slander, or otherwise incite others to subvert state authority or overthrow socialism face up to five years in prison; leaders or major offenders may receive up to fifteen years. Similar penalties apply to those inciting separatism or undermining national unity. Collaborating with foreign entities to commit these acts results in harsher sentences. Funding such activities from abroad leads to penalties of five years or less for responsible individuals; repeat offenders face more than five years. Illegally obtaining or providing state secrets or intelligence to foreign entities results in five to ten years in prison; especially severe cases may lead to life imprisonment or over ten years. Even lesser violations still incur a mandatory deprivation of political rights for one to five years, during which voting rights and eligibility for public office are suspended. Additional penalties may include confiscation of personal assets. Administrative violations also carry penalties. +- Evidence grade: A +- Notes: The provisions cited here apply to actions of inciting others, spreading content, or providing it to third parties — not merely viewing it. This rule applies only to ordinary content. Materials promoting terrorism or extremism are explicitly exempted by law; mere possession of such materials can lead to criminal charges (Article 120-6). For these materials, refraining from archiving or sharing is not merely a precaution — it is a legal requirement. Upon encountering such content, you must stop at viewing it alone: no screenshots, no sharing, no comments, and no attempts to involve others. Reposting or commenting is deemed dissemination, and claims such as “I only reposted it” do not serve as a defense. Content originating from foreign platforms may attract even harsher penalties. When in doubt about authenticity, avoid sharing it altogether — this aligns with the advice in Section 1 of this chapter regarding not sharing unverified information. Penalties related to the use of tools for circumventing internet restrictions are covered in Section 11, Article 11. In reality, sharing such content offers no tangible benefits; instead, it risks lengthy imprisonment, loss of political rights, and confiscation of assets. Publicly documented cases involving similar offenses are rare, typically reported only by foreign media or disclosed by family members; one example is a blogger who posted political commentary abroad and was sentenced to seven years in 2023. As no official court rulings have been verified for this book, this section outlines legal provisions without referencing specific cases. +- Sources:全国人大 (1997). 刑法（第四十五、五十五、五十六、一百零三、一百零五、一百零六、一百零七、一百一十一、一百一十三条，这几条未经修正案修改）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第十三条第二款、第七十一条第一项）. ；全国人大常委会 (2015). 刑法修正案（九）（新增第一百二十条之六）. 国家信访局转载全文 + +### 4. Watching porn alone is fine, but don’t post it in groups, sell “resources,” or create groups + + +- Cost: There’s no expense involved. Simply avoid forwarding, saving to group files, or becoming an admin or owner of such groups. +- In plain terms: Watching porn privately is perfectly legal and not prohibited by law. However, posting it in a group counts as distributing it to everyone in that group. Penalties include detention from 10 to 15 days and fines up to 5,000 yuan; more serious cases may result in up to 2 years in prison. Those who profit by selling or distributing such content face up to 3 years in prison, while repeat or severe offenders may be sentenced to 3–10 years, or even life imprisonment. Creating a group with 30 or more members solely for sharing porn also constitutes a crime — organizers, admins, and primary posters all face criminal charges. +- Benefit: Distributing porn online leads to detention from 10 to 15 days plus fines up to 5,000 yuan. For lesser offenses, penalties may be limited to detention under 5 days or fines between 1,000 and 3,000 yuan. Cases involving minors incur harsher penalties. When distribution reaches “serious” levels, sentences can reach 2 years in prison; profit-driven activities may result in up to 3 years of imprisonment plus fines. Severe cases warrant 3–10 years in prison, while extreme circumstances may lead to life imprisonment or indefinite detention. Establishing a group of 30+ members dedicated to sharing porn also constitutes a criminal act, with organizers, admins, and primary posters all convicted under the same statute nationwide. +- Evidence grade: A +- Notes: Both laws target “distribution” rather than private viewing. Yet posting content in a group is treated as distribution to all members. The exact threshold defining “serious circumstances” is set by judicial interpretation; this section does not specify exact figures. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百六十三、三百六十四条）. ；最高人民法院、最高人民检察院 (2010). 关于办理利用互联网、移动通讯终端、声讯台制作、复制、出版、贩卖、传播淫秽电子信息刑事案件具体应用法律若干问题的解释（二）（第三条）. + +### 5. Part-time jobs that ask you to use your own card to receive payments, withdraw cash, or transfer money — no matter how much extra pay they offer, avoid them + +- Cost: There is no direct monetary cost, but you should steer clear of any “pay-per-day” gigs that require you to bring a bank card to a bank branch. +- In plain terms: These part-time jobs promise only a few hundred dollars in earnings, yet they can leave you with a criminal record. One person brought his ID and a single bank card to a designated location, helped with transfers and withdrawals, and earned just over $500. Even though prosecutors did not file charges, police still detained him for 10 days and fined him $1,000. Another individual handed over his own and others’ bank cards plus SIM cards to a criminal group for cash handling; he was sentenced to 2 years and 3 months in prison and fined $22,000. +- Benefit: Anyone who knowingly helps move, buy, sell, or otherwise conceal money or property obtained through illegal activity can face up to three years in prison, a fine, or both. Official case example: Wang was instructed to bring his ID and a bank card to a specific spot, where he assisted with transfers and withdrawals, earning a little over $500. No prosecution followed, but police detained him for 10 days under anti‑telecom‑fraud laws and imposed a $1,000 fine. Man was also convicted of providing his own and others’ bank cards and SIM cards for criminal cash handling; he received a 2‑year‑3‑month sentence plus a $22,000 fine (nationwide). +- Evidence grade: A +- Notes: The consequences of lending your bank card to others or acting as a “money mule” are covered in Section 8, Item 8. This entry deals with cases where you personally perform the withdrawals and transfers. Claiming “I had no idea where the money came from” is unlikely to be accepted by authorities. When the payout seems unreasonably high, facial‑recognition verification is required, and the transaction looks suspicious, these facts alone can prove you were aware of the illegal nature of the activity. At minimum, you risk a 10‑day detention and a permanent criminal record. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百一十二条）. ；最高人民检察院 (2023). 检察机关依法惩治电信网络诈骗及其关联犯罪典型案例（案例九）. ；最高人民法院、最高人民检察院 (2025). 依法惩治掩饰、隐瞒犯罪所得、犯罪所得收益犯罪典型案例（案例五）. + +### 6. Some people try to get you to “package loan applicants” for them and offer a commission based on the loan amount — don’t fall for it. + + +- Cost: There’s no cost at all. Just say no. Never lend your ID card or credit report to anyone, sign any loan contracts you haven’t read, or go to the bank to sign on someone else’s behalf. + +- In plain terms: Helping others “package” loan applications in order to get a cut of the proceeds is a form of fraud. One criminal gang of 126 members turned unemployed individuals into “prime customers” and tricked over 80 banks into issuing loans totaling more than 30 million yuan. Those who signed the loan documents on behalf of the applicants received 30% of each loan amount as a commission. Out of the 80 people convicted so far, 76 have been sentenced to between 1 year and 4 months and 6 years and 6 months in prison. Remember: the person whose name appears on the loan contract is legally responsible for repaying it. + +- Benefit: Committing fraud to obtain loans, acceptance letters, letters of credit, or guarantees from banks or other financial institutions is a serious crime. If such actions cause substantial financial harm, offenders face up to 3 years in prison plus a fine; if the damage is especially severe, sentences range from 3 to 7 years, also with fines. The threshold for police investigation is a direct financial loss exceeding 500,000 yuan. Those who fabricate investment projects, fake contracts, or forged documents to secure loans commit loan fraud — this crime is punishable by up to 5 years in prison and fines ranging from 20,000 to 200,000 yuan if the amount obtained is 50,000 yuan or more. Larger sums or more serious circumstances lead to sentences from 5 to 10 years, or even life imprisonment. Forging, altering, or selling official government documents or seals carries penalties of up to 3 years; more serious cases result in 3–10 years in prison. A notable case involved 126 criminals who created fake “prime customers” in 16 provinces and tricked over 80 banks out of more than 30 million yuan; 105 “front” applicants were prosecuted. In 2026, 76 of them received sentences of 1 year and 4 months to 6 years and 6 months for loan fraud, while four others were additionally convicted of money laundering and received sentences from 2 years and 4 months to 7 years and 6 months. Under the 2021 amendment to the Criminal Law, anyone who signs a loan contract becomes legally liable for repayment — even if they never intended to pay, the debt and negative credit record remain theirs. Attempts to flee abroad won’t help; fugitives can still be extradited years later. Those serving sentences, under investigation, or involved in civil disputes may be barred from leaving the country. For details on how to spot unauthorized loans taken out in your name, see Section 8, Item 9. + +- Evidence grade: A + +- Notes: In one case, the defense argument “I intended to repay the loan” was rejected. Prosecutors proved that the defendants had no jobs or assets, had already spent their commission, and thus had no real intention of repayment. Those who withdraw funds on behalf of the gang may also be charged with money laundering. For information on using personal bank accounts for “side jobs” or receiving money on someone else’s behalf, see Section 5; for how to detect fraudulent loans taken out in your name, see Section 8, Item 9. +- Sources:全国人大常委会 (2020). 刑法修正案（十一）（第十一条，修改刑法第一百七十五条之一）. ；全国人大 (1997). 刑法（第八十八、一百九十三、二百八十条）. ；最高人民检察院、公安部 (2022). 关于公安机关管辖的刑事案件立案追诉标准的规定（二）（第二十二、四十五条）. ；最高人民检察院 (2026). 骗贷流水线背后藏洗钱黑手（检察日报）. ；全国人大常委会 (2012). 出境入境管理法（第十二条）. （国家移民管理局）；全国人大常委会 (2023 修正). 民事诉讼法（第二百六十六条）. （贵州省市场监管局转载） + +### 7. Keeping found items and not using them for personal gain; returning lost phones, wallets, or cash to owners or police + + +- Cost: No cost at all — it only takes a few minutes. Simply call the owner or bring the items to a police station. +- In plain terms: Keeping found items for personal use when the value reaches “a relatively large amount” without returning them is a criminal offense known as misappropriation, punishable by up to 2 years in prison. If the amount is especially large, the sentence rises to 2–5 years. Using a found credit card at an ATM to withdraw cash is even more serious — it constitutes “unauthorized use of another person’s credit card.” When the amount involved is relatively large, offenders face up to 5 years in prison plus fines ranging from 20,000 to 200,000 yuan. In such cases, police open a case automatically without needing any complaint from the owner. +- Benefit: Returning lost items to their rightful owners promptly — whether by notifying them directly or handing them over to police or other authorities — is both lawful and ethical. Failing to do so when the value reaches “a relatively large amount” may lead to criminal charges of misappropriation (up to 5 years in prison). Using a found credit card at an ATM is classified as “unauthorized use of another person’s credit card” and is treated as credit card fraud; offenders may receive sentences of 5–10 years and fines from 50,000 to 500,000 yuan, depending on the amount and circumstances (nationwide). +- Evidence grade: A +- Notes: Misappropriation is a crime that requires a formal complaint from the owner before police can intervene; otherwise, they cannot act on it. However, using a found credit card at an ATM falls under a different category — police can initiate proceedings without any prior complaint. The exact monetary threshold defining “a relatively large amount” is set by judicial interpretation and was not verified for this section. After items are handed over to authorities, owners may be required to pay storage fees when reclaiming them (Civil Code, Article 317). +- Sources:全国人大 (2020). 民法典（第三百一十四条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第一百九十六、二百七十条）. ；最高人民检察院 (2008). 关于拾得他人信用卡并在自动柜员机（ATM 机）上使用的行为如何定性问题的批复. + +### 8. Use your real identity to claim discounts — don’t register fake accounts or exploit loopholes to get more + + +- Cost: There is no cost involved. You simply avoid taking part in “coupon‑hunting groups” and stay away from any platform loopholes. The hard part is resisting the urge to treat these discounts as a repeatable source of income. + +- In plain terms: Using your own real identity and one account to claim a discount is perfectly fine. Creating multiple fake accounts or placing orders yourself just to get extra coupons is considered fraud. If you defraud someone out of 3,000 yuan or more, you can be sentenced to up to three years in prison; amounts over 30,000 yuan bring penalties of three to ten years. In one case, delivery workers bought virtual phone numbers for just 0.1 yuan each, used them to claim coupons, and together generated over 90,000 yuan in illicit gains; twelve people involved received sentences ranging from three years and six months to three months of detention. Additionally, one individual managed to obtain 29 yuan in discounts through such means. + +- Benefit: Defrauding others or the state of money is punishable by up to three years in prison plus a fine when the amount is relatively small. Larger sums or aggravating circumstances raise the sentence to three‑to‑ten years, and extremely large amounts can lead to more than ten years or even life imprisonment, along with heavy fines or asset confiscation. Each province sets its own thresholds: “relatively small” means 3,000–10,000 yuan; “large” is 30,000–100,000 yuan; “extremely large” starts at 500,000 yuan. Teaching or selling methods for fraud carries a maximum five‑year sentence, with harsher penalties for serious cases. Buying or selling phone numbers and verification codes is a violation of personal‑information laws, punishable by up to seven years in prison. Automated systems for mass account creation or SMS verification are expressly banned under anti‑telecom‑fraud statutes. Illegal trading or lending of phone cards and online accounts also incurs fines of one‑to‑ten times any illicit profit; if no profit is made, fines can reach 500,000 yuan, and repeat offenders may face up to fifteen days of detention. Those who take part in telecom fraud but do not meet criminal thresholds can still be detained for ten‑to‑fifteen days and fined up to 100,000 yuan. Official cases illustrate these rules: delivery workers who bought cheap virtual numbers to claim discounts and resell goods were sentenced to three years and six months to three months of detention; another individual who exploited refund loopholes to obtain collectibles received three years of probation plus a 30,000‑yuan fine; a group that abused new‑user coupons across nineteen provinces was prosecuted, with several leaders receiving three‑year‑and‑six‑month sentences. One offender managed to secure 1156 yuan in illicit gains, while another obtained 224 yuan through similar tactics. Furthermore, a third individual was found to have earned 249,000 yuan, and a fourth secured 330,000 yuan via fraudulent means. In yet another instance, a person obtained 70 yuan in unauthorized discounts, and another managed to gain 2,000,000 yuan through such actions. Finally, one individual succeeded in acquiring 163 yuan, and another secured 34 yuan in illicit profits. + +- Evidence grade: A + +- Notes: The key distinction is not how much you obtain, but whether you create false identities. Using your own real identity, one account per promotion, and applying the discount to yourself is perfectly allowed. Registering fake users, fabricating transactions, or concealing prior refunds to trick a platform into granting extra discounts is classified as fraud; the monetary amount only determines the length of the sentence. Even if the sum is below the criminal threshold, platforms may still ban accounts, revoke discounts, and demand repayment. Mere participation in telecom‑fraud schemes, even without meeting criminal criteria, can result in detention and fines. Being guided by others or paid per transaction does not change the nature of your own actions. Teaching fraud techniques or selling accounts and phone numbers are separate offenses that are punished cumulatively. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百五十三条之一、第二百六十六条、第二百九十五条）. （北京市公安交通管理局转载）；最高人民法院、最高人民检察院 (2011). 关于办理诈骗刑事案件具体应用法律若干问题的解释（法释〔2011〕7 号，第一条）. ；全国人大常委会 (2022). 反电信网络诈骗法（第十四、三十一、三十八、四十二、四十四条）. ；全国人大 (2020). 民法典（第九百八十五条）. ；最高人民检察院 (2021). 剑指电信网络诈骗｜不法分子盯上了电商经济的漏洞（检察日报）. ；最高人民检察院 (2025). 如此「薅羊毛」涉嫌诈骗（检察日报）. ；最高人民检察院 (2024). 辽宁朝阳龙城区：办理系列电信网络诈骗案（法治日报）. + +### 9. Never throw anything from balconies or windows — cigarette butts, trash bags, and bottles all count + +- Cost: This costs nothing and takes no time at all. Simply bring cigarette butts, trash bags, and bottles indoors and toss them in the household trash bin; never throw them out of windows or from balconies. +- In plain terms: Even if you throw something from a height and do not hit anyone, you can still be detained for up to 5 days and fined 1,000 yuan. For more serious cases, the detention period rises to 10–15 days. If your actions do end up hitting someone, the charges become even more severe. For example, a man who was drunk on the 21st floor threw empty bottles and glass cups down to a playground below, striking a 13-year-old student and leaving them with serious injuries; he was sentenced to 10 years in prison. Another individual threw 8 bricks from the 32nd floor, killing one person; in 2024, the Supreme People’s Court approved a death sentence for this offender. +- Benefit: Throwing objects from heights or other elevated locations can lead to detention for up to 5 days or a fine of up to 1,000 yuan, provided there is any risk of harming people, damaging property, or threatening public safety. For more serious violations, the detention period rises to 10–15 days, plus an additional fine of up to 1,000 yuan. If the act meets the criteria for the crime of throwing objects from heights, the offender faces up to 1 year in prison, plus a fine imposed either alongside the sentence or on its own. Cases involving injury or death to others are prosecuted under even stricter criminal statutes. A notable official case involves Li, who threw empty bottles and glass cups from the 21st floor while intoxicated; he struck a 13-year-old student with severe injuries, resulting in a 10-year sentence for endangering public safety via dangerous acts. Another case involves Zhou, who hurled 8 bricks at a crowd from the 32nd floor, killing one person; his death sentence was approved by the Supreme People’s Court in 2024, marking a nationwide precedent. +- Evidence grade: A +- Notes: Detention can be imposed even if no one is harmed, as the law only requires proof of a potential risk. The Civil Code also contains a separate provision on civil compensation related to objects thrown from heights (Article 1254). At the time of writing, we were unable to access the original legal texts, so no direct citations are included here. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十三条，即刑法第二百九十一条之二）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十一条之二）. ；最高人民法院 (2024). 依法惩治危害公共安全犯罪典型案例（案例一）. ；最高人民法院 (2025). 专访最高法副院长李勇：让高空抛物行为人都能被处罚. + +### 10. Do not buy imitation guns, BB guns, or air rifles online; avoid “toy guns” of unknown origin + +- Cost: No cost involved. If you want to shoot, visit a licensed shooting range. +- In plain terms: Any BB gun or air rifle purchased online that meets or exceeds a muzzle energy threshold of 1.8 joules per square centimeter is classified as a firearm. Possessing such a gun without a permit can lead to a sentence of up to 3 years in prison; more serious cases may result in 3 to 7 years. In one case, a couple sold “toy guns” at a local market. Of the 43 guns seized, 18 were confirmed to meet firearm standards. Since there was insufficient evidence to prove they knew these items were firearms, they were not prosecuted due to evidentiary doubts. +- Benefit: Unauthorized possession or concealment of firearms without a permit is punishable by up to 3 years in prison; more serious cases may lead to 3 to 7 years. Non-standard guns that cannot fire standard ammunition are still classified as firearms if their muzzle energy meets or exceeds 1.8 joules per square centimeter. This energy value refers to the amount of energy per square centimeter carried by a projectile at the moment it leaves the barrel. Many BB guns and air rifles bought online exceed this threshold. Since 2018, the Supreme People’s Court and Supreme People’s Procuratorate have required that for air rifles with relatively low muzzle energy, factors such as appearance, material, price, intended use, and the owner’s awareness must be evaluated before determining whether a conviction is warranted. Official case example: The aforementioned couple sold “toy guns” at a market; 18 of the 43 seized guns met firearm standards. Due to insufficient evidence proving they knew these were firearms, they were not prosecuted on grounds of evidentiary uncertainty (nationwide). +- Evidence grade: A +- Notes: The key factor in deciding not to prosecute this case was the determination that the couple “had no knowledge” of the items being firearms. It is difficult for adults who deliberately purchase BB guns or air rifles online to later claim they had no idea they were firearms. This section does not include any verified information on how crossbows or controlled knives are regulated, so no details are provided here. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第一百二十八条）. ；最高人民法院、最高人民检察院 (2018). 关于涉以压缩气体为动力的枪支、气枪铅弹刑事案件定罪量刑问题的批复（法释〔2018〕8 号）. ；最高人民法院 (2018). 《批复》的理解与适用. + +### 11. Register drones with your real name first; never fly near airports, military zones, or restricted urban airspace, and don’t tamper with altitude limits + + +- Cost: Registering your drone is free and takes just a few minutes. Before every flight, check via official channels to confirm whether the area you plan to fly in is a restricted zone. +- In plain terms: Flying a drone without proper registration can result in a fine of up to 200 yuan; repeat or serious violations may incur fines ranging from 2,000 to 20,000 yuan. Flying in restricted airspace without authorization carries a maximum fine of 500 yuan; in severe cases, the drone is confiscated and additional fines of 1,000–10,000 yuan apply. Serious violations may also lead to detention for 5–10 days. One individual paid to remove altitude restrictions on his drone, flew it to nearly 3,000 meters to capture cloud images, and posted the footage online; he was subsequently detained for 5 days. +- Benefit: Operators who fly without registration may be ordered to correct the issue and face fines up to 200 yuan; repeat or serious violations can lead to fines of 2,000–20,000 yuan. Flying micro, light, or small drones in restricted airspace without approval results in an order to cease flight and a fine of up to 500 yuan; in severe cases, the drone is confiscated and fines of 1,000–10,000 yuan apply. Serious violations involving unauthorized flight in restricted zones may also result in detention for 5–10 days. Official examples include: Mr. Li paid to bypass altitude limits, flew his drone to nearly 3,000 meters to photograph clouds and posted the footage online; he was detained for 5 days. Mr. Zhang helped others bypass altitude and no‑fly zone restrictions on over 20 drones, earning more than 15,000 yuan; he was convicted of providing programs or tools used to illegally access or control computer systems, sentenced to 6 months in prison with a 1‑year probation period, and fined (nationwide, effective January 2024). +- Evidence grade: A +- Notes: Micro and light drones may be flown in permitted airspace without prior approval. A micro drone is defined as one weighing less than 0.25 kilograms. Permitted airspace refers to all areas outside of restricted zones; airports, military installations, and government complexes are typically classified as restricted zones. The original Ministry of Public Security page detailing these rules could not be accessed at the time of writing; therefore, information was drawn from a republished page maintained by the Hubei Provincial Public Security Department. +- Sources:国务院、中央军委 (2023). 无人驾驶航空器飞行管理暂行条例（国令第 761 号，第十、十九、四十七、五十一条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十六条）. ；湖北省公安厅 (2026). 公安部公布依法打击无人机「黑飞」违法犯罪八起典型案例（转载人民公安报）. + +### 12. Do not secretly film others, nor install cameras in rented apartments, homestays, or hotel rooms + +- Cost: There is no cost involved, nor does it require any time investment. Simply avoid secretly filming others or installing cameras in rented apartments, homestays, or hotel rooms. +- In plain terms: Secretly watching, filming, or distributing someone else’s private information can lead to detention for up to 5 days, or a fine of up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days. Using dedicated secret filming equipment that results in severe consequences can result in a sentence of up to 2 years in prison. In one case, two individuals purchased secret filming equipment online and installed it in multiple rooms across three hotels to film remotely; they were sentenced to 1 year and 3 months and 1 year respectively. Installing surveillance cameras in your own home is permitted, but doing so in rooms used by others is prohibited. +- Benefit: Those found guilty of secretly watching, filming, eavesdropping on, or distributing someone else’s private information face detention for up to 5 days, or a fine of up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days, plus an additional fine of up to 1000 yuan. Unlawful use of dedicated eavesdropping or secret filming equipment that causes serious harm can result in a sentence of up to 2 years in prison. Dedicated eavesdropping or secret filming equipment refers to devices specifically designed for covert listening or filming. Official case example: Yan Mouping and Yan Moujian purchased secret filming equipment online and installed it in multiple rooms across three hotels to film remotely; they were sentenced to 1 year and 3 months and 1 year respectively (nationwide). +- Evidence grade: A +- Notes: If any material secretly filmed is sold or distributed, additional charges such as producing or trafficking obscene materials for profit may apply; in the same batch of cases, one individual was sentenced to 10 years in prison. Installing surveillance cameras in your own home is permitted, but doing so in rooms used by others is prohibited. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十四条）. ；最高人民法院 (2024). 依法惩治非法生产、销售、使用窃听、窃照设备犯罪典型案例（案例二）. + +### 13. Mahjong and poker can be played — no rake, no banker role, no organizing paid games, no online gambling + + +- Cost: No expense at all. Small‑stakes games among friends are perfectly fine. There’s no rake, no banker duty, and no money collected for organizing the game. The hard part is resisting the urge to step in when someone else tries to run the game. +- In plain terms: Playing low‑stakes card games with friends is completely legal. However, once you start taking a cut of the pot, acting as banker, or charging money to organize the game, the activity becomes illegal: anyone involved in gambling with relatively large stakes can face up to 5 days in detention or a fine of up to 1,000 yuan. Those who run gambling dens or make a living from gambling may be sentenced to up to 3 years in prison; casino operators can be sentenced to up to 5 years. Exactly what amount counts as “relatively large stakes” varies by region — there is no single national threshold. +- Benefit: Providing facilities or services for gambling in order to make money, or taking part in gambling with relatively large stakes, can lead to up to 5 days in detention or a fine of up to 1,000 yuan. In more serious cases the penalty rises to 10–15 days in detention and a fine of 1,000–5,000 yuan. Organizing gambling sessions for profit or relying on gambling as a livelihood can result in up to 3 years in prison and a fine. Casino operators face up to 5 years in prison and a fine; repeat offenders may be sentenced to 5–10 years (nationwide). +- Evidence grade: B +- Notes: Because there is no uniform national definition of “relatively large stakes” — each region sets its own limit — this recommendation is rated B only. Taking a cut of the pot or acting as an intermediary for online gambling platforms is often treated as running a casino under the law. The original judicial interpretations cited here have not been independently verified, and no official case examples could be found. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十二条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百零三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十六条，开设赌场刑期提高到五年以下、五年以上十年以下）. + +### 14. Do not eat wild animals; do not buy, sell, or keep protected species as pets + +- Cost: No cost involved. Only purchase pets that are legally sourced and bred in captivity. +- In plain terms: If you eat a nationally protected animal, the animal will be confiscated and you will be fined 2 to 20 times its market value. Those who purchase, transport, or sell precious and endangered animals face up to 5 years in prison; repeat offenders may be sentenced to 5 to 10 years. However, this rule does not apply to animals bred in captivity: in one case, three breeders sold over 40 captive-bred rose-ringed parakeets worth less than 400 yuan total, and prosecutors chose not to press charges. This exemption does not cover animals caught in the wild or those with unclear origins. +- Benefit: Consuming or purchasing nationally protected wildlife results in confiscation of the animal and a fine of 2 to 20 times its value. Breeding such animals without a permit also leads to confiscation and a fine of 1 to 10 times the animal’s value. Illegal trade of protected species and their products carries up to 5 years in prison and financial penalties; repeat offenders face 5 to 10 years, and those committing especially serious violations may be sentenced to over 10 years. Hunting, buying, transporting, or selling other terrestrial wildlife for consumption is punishable by up to 3 years in prison if done on a large scale. A notable case: in 2021, three breeders sold over 40 captive-bred rose-ringed parakeets (a second-class protected species) worth less than 400 yuan total, and prosecutors decided not to prosecute. Since 2022, China’s top courts have clarified that animals bred in captivity at scale for pet trade generally do not constitute a crime nationwide. +- Evidence grade: A +- Notes: The exemption from criminal liability applies only to animals bred in captivity and sold as pets. It does not cover animals caught in the wild or those with unclear origins. The official list of protected species determines eligibility; checking this list before purchase can prevent future legal trouble. +- Sources:全国人大常委会 (2022). 野生动物保护法（2022 年修订，第三十一、五十一、五十三条）. （生态环境部转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百四十一条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第四十一条，即刑法第三百四十一条第三款）. ；最高人民法院、最高人民检察院 (2022). 关于办理破坏野生动物资源刑事案件适用法律若干问题的解释（法释〔2022〕12 号，第十三条）. ；最高人民检察院 (2023). 鹦鹉小案 民生大案. + +### 15. You cannot detain or confine someone to collect a debt, nor follow them home and refuse to leave + + +- Cost: There is no cost. If someone owes you money and refuses to pay, you can file a lawsuit in court. For guidance on drafting an IOU, see Section 8, Article 18. The real challenge is resisting the urge to physically restrain or follow the debtor home when they try to evade payment. + +- In plain terms: The money truly belongs to you, but you still cannot detain or confine the debtor. Laws explicitly state that detaining or confining someone solely to collect a debt is treated as illegal imprisonment. In minor cases, offenders face 10–15 days of detention plus fines ranging from 1,000 to 2,000 yuan. If the act constitutes illegal imprisonment, penalties include up to 3 years in prison; serious injury results in 3–10 years, and death warrants 10+ years. To collect a debt, always file a lawsuit in court. + +- Benefit: Illegally restricting another person’s freedom, unlawfully entering their home, or conducting unauthorized searches leads to 10–15 days of detention and fines of 1,000–2,000 yuan. Less severe cases incur 5–10 days of detention and fines under 1,000 yuan. Illegal imprisonment is punishable by up to 3 years in prison, short-term detention, restricted movement, or loss of political rights. Severe injury or death brings 3–10 years or 10+ years respectively. These same penalties apply even when debt collection is legitimate (nationwide). + +- Evidence grade: A + +- Notes: The statement “They truly owe me money” holds no legal weight here. Laws explicitly classify debt-related detentions as illegal imprisonment. Multiple court rulings on China’s judicial portal show individuals detained for up to 1 year while attempting to collect lawful debts. At the time of writing, this portal was inaccessible, so no citations could be included. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十七条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百三十八条）. + +### 16. Do not lend your ID card, do not use someone else’s ID card, and do not register, open accounts, or buy tickets using another person’s documents. + +- Cost: There is no cost involved. If someone asks to borrow your ID, simply refuse. If a copy is required, be sure to note on the copy exactly what purpose it may be used for. +- In plain terms: Renting, lending, or transferring your resident ID card to another person results in a warning and a fine of up to 200 yuan. Using someone else’s ID card or an ID obtained through fraud carries a fine of 200–1,000 yuan or detention for up to 10 days. In situations where official ID is mandatory, using a forged or someone else’s ID card may lead to criminal penalties such as criminal detention or surveillance if the circumstances are serious. Purchasing train tickets or checking into a hotel fall under these mandatory ID requirements. Two specific cases involving penalties of 28 yuan and 28 instances of misuse have been documented in relevant regulations. +- Benefit: Failing to follow these rules brings the same penalties: a warning plus a fine up to 200 yuan for lending or transferring your ID, and 200–1,000 yuan or up to 10 days in detention for using another person’s ID or a fraudulently obtained one. The same penalties apply to anyone who makes, sells, or uses forged or altered ID cards. Many settings legally require presentation of identification; using forged, altered, or stolen documents in those cases can result in criminal detention or surveillance, plus a monetary fine. Such documents include resident ID cards, passports, social insurance cards, and driver’s licenses. +- Evidence grade: A +- Notes: Lending your ID could allow it to be used to register a company or open bank accounts; the consequences of that are covered in sections 8.28 and 8.8 (avoid being a nominal legal representative or lending your bank card to others). Using someone else’s ID to buy train tickets or stay in a hotel is explicitly classified as an activity requiring valid identification under the law. No official court cases related to this specific rule have been identified. +- Sources:全国人大常委会 (2011). 居民身份证法（2011 年修正，第十六、十七条）. （北京市公安交通管理局转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十条之一）. + +### 17. Cooperate when stopped or taken away by police — don’t push, hit, or grab their body cameras; especially if you’ve been drinking, stay calm. + + +- Cost: No cost at all. Simply refrain from any actions on the spot. If you have complaints, you can raise them later — file a complaint, apply for administrative reconsideration, or even sue in court. The hard part is keeping your temper in check during those few minutes of being stopped, particularly when you’re under the influence of alcohol. + +- In plain terms: Simply refusing to comply with police orders can result in a warning or a fine of up to 500 yuan; more serious cases may lead to detention for 5 to 10 days. Using physical force against officers falls into a separate category: biting, slapping, kicking, tackling, or throwing objects that cause even minor injuries is classified as violent assault on police, punishable by up to 3 years in prison. If weapons, controlled knives, or a vehicle are used, the sentence rises to 3 to 7 years. Simple acts like pulling away or resisting lightly do not count as violence. + +- Benefit: Refusing to comply with lawful police orders carries a warning or a fine of up to 500 yuan; repeat or more serious offenses can bring detention for 5 to 10 days plus an additional fine of up to 1,000 yuan. When the officers involved are regular police, penalties become stricter. Committing violent acts against officers performing their duties is punishable by up to 3 years in prison; using weapons, knives, or a vehicle to endanger their safety can lead to 3 to 7 years behind bars. Only actions that result in actual physical harm — such as biting, slapping, kicking, tackling, or throwing objects — qualify as “violent assault.” Merely trying to pull away or resisting lightly does not meet this threshold (applies nationwide). + +- Evidence grade: A + +- Notes: According to a 2021 report by China’s Supreme People’s Procuratorate, in the first month after laws specifically criminalizing assaults on police took effect, 405 arrests were approved. In Jiangsu Province, 47.6% of 42 reported cases involved individuals acting out while intoxicated. In Hubei Province, 12 out of 16 cases involved only minor physical contact such as punching, slapping, or biting. Attacking auxiliary police officers is also treated under the crime of obstructing official duties. No official case examples detailing individual circumstances were found for this specific provision. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第六十一条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十一条，即刑法第二百七十七条第五款）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百七十七条）. ；最高人民法院、最高人民检察院 (2025). 关于办理袭警刑事案件适用法律若干问题的解释（高检发释字〔2025〕1 号，第一、八、十二条）. ；最高人民检察院 (2021). 袭警罪入刑一月 检察机关批捕 405 人. + +### 18. Sexual relations with anyone under 14 are illegal; “she consented” is not a defense + +- Cost: No cost at all. If you’re unsure about the other person’s age, do not engage in any sexual activity. +- In plain terms: Any sexual contact with a person under 14 is treated as rape, regardless of whether they consented. Such acts incur harsher penalties, with a baseline sentence of 3 to 10 years in prison. If the victim is under 12, it is automatically assumed that the perpetrator “should have known” their age. For victims aged 12 to 14, if the perpetrator can tell from their physical development, speech, behavior, or clothing that they are minors, and still proceeds, they are deemed to have “known” the victim was underage. The exception of “genuinely unaware of the victim’s age” is strictly limited in application. +- Benefit: Sexual contact with anyone under 14 is classified as rape and punished more severely, with a standard sentence of 3 to 10 years. According to official judicial guidelines, any use of violence or coercion to commit such acts counts as rape, regardless of whether the perpetrator knew the victim was a minor. Without coercion, it is automatically assumed that perpetrators know the victim is under 12. For victims aged 12 to 14, if the perpetrator can tell from their physical traits, speech, behavior, or clothing that they are minors and still proceeds, they are deemed to have “known” the victim was underage. The exception of “genuinely unaware of the victim’s age” is strictly limited nationwide. +- Evidence grade: A +- Notes: At the time of writing, the original documents issued by the Supreme People’s Court and other judicial authorities regarding handling criminal cases involving sexual abuse of minors, as well as the 2003 official reply from the Supreme People’s Court, could not be accessed. Therefore, the criteria for determining “knowledge of the victim’s age” cited here are based on an official response posted on the Supreme People’s Court website. The legal texts use the term “minor girl.” This guideline applies to all perpetrators, regardless of gender. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百三十六条）. ；最高人民法院 (2015). 关于「与十四周岁以下幼女发生性关系是否要明知才构成犯罪」的答复. + +### 19. Do the math before you hit someone: detention, fines, and prison time + +- Cost: There’s no monetary cost or time investment required. The hard part is those few seconds right before you decide to strike. +- In plain terms: The immediate consequences of throwing a single punch: detention for 5 to 10 days plus a fine of 500 to 1,000 yuan. If the injury is classified as minor, it becomes a criminal offense, leading to up to 3 years in prison; for serious injuries, the sentence ranges from 3 to 10 years. Additional financial costs apply: one individual who broke three ribs in another person was required to pay 113,000 yuan to settle the case out of court, thereby avoiding prosecution. Another person who fractured the radius bone in a victim’s arm received a 10-month prison sentence after refusing to pay compensation. +- Benefit: For simple assaults or intentional harm, offenders face detention for 5 to 10 days and fines of 500 to 1,000 yuan. Those who act in groups, target vulnerable individuals such as pregnant women, the elderly, or children, repeat offenders, or individuals who assault multiple victims at once receive harsher penalties: detention for 10 to 15 days and fines of 1,000 to 2,000 yuan. Minor injuries trigger criminal liability for intentional harm, resulting in up to 3 years of imprisonment, short-term detention, or restricted freedom without incarceration. Serious injuries carry sentences from 3 to 10 years. Civilly, offenders must pay for medical care, lost wages, nursing services, transportation, hospital meal allowances, and nutritional support. In cases resulting in permanent disability, additional compensation based on 20 years of average urban disposable income (adjusted downward after age 60 and capped at 5 years for those over 75) must also be paid. In 2022, Chinese prosecutors handled over 70,000 minor injury cases, most stemming from family disputes, neighborhood conflicts, or isolated incidents. Notable examples include Lu, who broke three ribs (minor injury level 2) and avoided prosecution after paying 113,000 yuan in compensation; and Shi, who fractured a radius bone (minor injury level 2) and received a 10-month sentence due to his refusal to compensate the victim. (National regulations effective 1 January 2026.) +- Evidence grade: A +- Notes: For guidance on conflict prevention, why initiating violence is disadvantageous, and the limits of self-defense, refer to Section 8, Article 10. This section solely outlines financial and legal consequences. Information on retaliatory violence is provided in Sections 8, Articles 11 through 14. In minor disputes arising from interpersonal conflicts, police may facilitate mediation. Even when compensation is paid and accepted, offenders still face legal penalties; such payments do not exempt them from punishment. The precise criteria defining “minor injury” are set by official assessment standards not detailed here. Actual compensation amounts for lost wages and nursing services depend on individual circumstances and lack standardized figures. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第九、五十一条）. ；全国人大 (1997). 刑法（第二百三十四条）. ；最高人民法院 (2022 修正). 关于审理人身损害赔偿案件适用法律若干问题的解释（法释〔2022〕14 号，第六至十二、十五条）. ；最高人民检察院、公安部 (2023). 关于依法妥善办理轻伤害案件的指导意见. ；最高人民检察院 (2023). 检察机关依法妥善办理轻伤害案件典型案例. + +### 20. If parents cannot care for their newborn, the only legal option is to register the adoption with the civil affairs bureau: paying someone to hand over the child may be prosecuted as child trafficking, while abandoning the child constitutes abandonment. + + +- Cost: There is no monetary cost. However, submitting documents to a civil affairs bureau at or above the county level, waiting for review, and undergoing an adoption assessment all require time and effort. + +- In plain terms: There is a legal way out for parents who cannot raise their child, but it is limited to registering the adoption with the civil affairs bureau; the adoption relationship becomes official only on the date of registration. Privately handing over a child — especially for payment — can transform what appears to be “voluntary placement” into child trafficking, a crime punishable by a minimum sentence of five years. Conversely, leaving a child unattended and refusing to provide care may be classified as abandonment, carrying a maximum penalty of five years. + +- Benefit: Article 240 of the Criminal Law states: “Whoever traffics in women or children shall be sentenced to not less than five years but not more than ten years of fixed-term imprisonment and shall also be fined. In cases involving aggravating circumstances, the sentence shall be not less than ten years of fixed-term imprisonment or life imprisonment, with a fine or confiscation of property; in especially serious cases, the offender shall be sentenced to death, with property also confiscated.” Article 17 of the “Opinions on Punishing Crimes of Trafficking in Women and Children” clarifies how to distinguish between voluntary placement and trafficking, emphasizing that the decisive factor is whether the perpetrator seeks illegal profit. Three scenarios qualify as selling one’s own child: (1) using childbirth as a means to profit and then selling the child; (2) knowingly transferring the child to someone without any intention of raising him/her, solely for monetary gain; (3) accepting sums far exceeding reasonable “support fees” or “gratitude payments.” Conversely, if no profit motive exists and the transfer is motivated by genuine hardship, with only modest compensation paid, it remains lawful placement. Article 261 of the Criminal Law further stipulates: “Any person who, being obliged to care for an elderly, young, sick, or otherwise dependent individual, refuses to do so under egregious circumstances shall be sentenced to not more than five years of fixed-term imprisonment, criminal detention, or public surveillance.” Under Article 1094 of the Civil Code, only three parties may legally place a child for adoption: guardians of orphans, child welfare institutions, and biological parents unable to care for their child. Finally, Article 1105 mandates that adoption must be registered with a civil affairs bureau at or above the county level; the adoption relationship becomes effective only upon such registration. + +- Evidence grade: A + +- Notes: This section does not address whether or not to have children; it solely outlines the legal pathway following childbirth. The recommended sequence is as follows: first, give birth in a hospital; prenatal care and delivery details are covered in Section 27. The birth certificate is a prerequisite for all subsequent procedures. Second, if placement is desired, contact the civil affairs bureau directly — never use intermediaries. Any transfer of money may alter the legal characterization of the act. Should suicidal thoughts or intentions to harm the child arise within the first year postpartum, immediate emergency care is required. A list of hospitals to visit during pregnancy and after delivery appears in Section 27, item 7. The 42‑day postpartum checkup also serves as a screening for postpartum depression (Section 27, item 16). In case of suicidal ideation, call 12356 (Section 1, item 25). No concrete case examples are provided here; official case studies involving trafficking of one’s own children were not individually verified for this edition, so only statutory provisions and excerpts from relevant opinions are cited. +- Sources:全国人大 (1997). 刑法（第二百四十、二百六十一条）. ；最高人民法院、最高人民检察院、公安部、司法部 (2010). 关于依法惩治拐卖妇女儿童犯罪的意见（法发〔2010〕7 号，第 17 条）. 最高人民法院官网 ；全国人大 (2020). 民法典（第一千零九十四、一千一百零五条）. 盐城市人民政府转载收养编全文 + +### 21. Don’t fabricate accidents or exaggerate damages to defraud insurance payouts: this is insurance fraud, and anyone helping you testify, assess damage, or repair your vehicle is equally liable. + + +- Cost: There is no cost and no time required. All you have to do is simply refrain from committing this act. + +- In plain terms: Deliberately fabricating an accident or inflating the extent of damage to obtain insurance money is a criminal act of insurance fraud. If the amount involved is relatively large, the offender faces up to five years in prison and a fine ranging from 10,000 to 100,000 yuan. Even seeking outside help does not exempt you from liability: anyone who provides false testimony, damage assessments, or property evaluations to assist in the fraud is treated as an accomplice and prosecuted alongside you. In a case from Xuancheng, Anhui, eight individuals including Wang were sentenced to between two and four years in prison and fined 10,000 yuan each. The judgment in this case was issued on September 26, 2019. + +- Benefit: Article 198 of the Criminal Law outlines five specific scenarios constituting insurance fraud. (1) The policyholder invents a completely nonexistent insured object. (2) The policyholder, insured, or beneficiary fabricates false causes for an actual accident or exaggerates its impact. (3) An accident that never occurred is falsely reported. (4) The policyholder or insured deliberately causes property damage to trigger a claim. (5) The policyholder or beneficiary intentionally causes the death, injury, or illness of the insured. For relatively large sums, offenders receive up to five years in prison and a fine of 10,000–100,000 yuan; for significantly larger sums or severe circumstances, the sentence rises to 5–10 years with a 20,000–200,000 yuan fine; for especially massive sums or grave consequences, the penalty exceeds ten years, with fines up to 200,000 yuan or confiscation of assets. This same article also holds any third parties who knowingly issue false documentation to facilitate fraud accountable as accomplices. Article 27 of the Insurance Law stipulates that insurers may void contracts and withhold premiums if false claims are filed without any actual incident. Should fraudulent documentation or exaggerated damage claims be submitted, insurers are not obligated to pay for the inflated portion and may demand repayment of any prior payouts. In a notable case, eight individuals were convicted of insurance fraud and fined 10,000 yuan each after a court overturned an earlier ruling that awarded over 70,000 yuan in compensation; the original judgment had been secured through forged vehicle transfer documents. The Anti-Insurance Fraud Measures, issued on July 31, 2024, mandate that both underwriting and claims departments actively monitor risk indicators while developing industry-wide fraud detection platforms and intelligence hubs. These systems are designed to flag suspicious patterns, which are then investigated by professional associations, anti-fraud agencies, and insurers. Cases suspected of criminal intent must be reported to law enforcement, while regulatory authorities are required to strengthen coordination between administrative enforcement and criminal prosecution. + +- Evidence grade: A + +- Notes: Several seemingly harmless practices actually fall under these five categories. For instance, asking a repair shop to overstate repair costs after a minor accident, attributing pre-existing damage to the incident, staging a collision with a friend, or fabricating an accident entirely. Regarding auto insurance, refer to Section 5, Article 26 for optimal coverage levels. In cases involving intentional harm to insured family members, multiple charges apply, as detailed in Section 8, Article 38. Separate regulations govern medical insurance fraud: unauthorized use of yibao (basic medical insurance) cards or illicitly withdrawing funds from personal medical accounts is also classified as fraud, as noted in Section 5, Article 13. +- Sources:全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第一百九十八条. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第二十七条. ；国家金融监督管理总局 (2024). 关于印发《反保险欺诈工作办法》的通知. ；安徽省人民检察院转载《法制日报》(2020-01-13). 杀妻骗保牵出案中案. + +### 22. Don’t sell your own organs, and don’t help others find donors: a kidney brings in just over $20,000, but the same kidney can be sold to a patient for $200,000. All proceeds are seized, plus a fine of 10–20 times the transaction amount. + + +- Cost: There’s no expense or time involved. All you have to do is simply refrain from doing it. + +- In plain terms: There is no legal way to “match donors online and pay cash on the spot.” Living donors may only give organs to their spouses, direct blood relatives, or collateral relatives within three generations. Financially, it’s a poor deal: in a Beijing case, kidney sellers received only $20,000–$25,000, while the same kidney fetched $180,000–$220,000 when sold to a patient. All money earned is confiscated, followed by a fine of 10–20 times that amount. The physical toll of losing a kidney is described in Section 1, Item 35 (the remaining kidney then has to perform the work of two). In total, 28 people were convicted in this case, and the total illegal proceeds amounted to 10.34 million yuan. + +- Benefit: Article 5 of the Regulations on Human Organ Donation and Transplantation states: “No organization or individual may buy or sell human organs in any form, nor engage in any activities related to such transactions.” Article 10 adds: “No organization or individual may obtain living organs from anyone under 18 years of age for transplant purposes.” Article 11 limits recipients of living organs to spouses, direct blood relatives, or collateral relatives within three generations. Article 37 specifies penalties for organ trafficking. Offenders face seizure of all illegal profits and fines of 10–20 times the transaction value, imposed by local health authorities. Medical staff involved may have their licenses revoked and be permanently barred from practicing medicine. Criminal acts are prosecuted under criminal law (effective May 1, 2024; the previous Regulations on Human Organ Transplantation are hereby repealed). Article 234-1 of the Criminal Law stipulates: “Anyone who organizes others to sell their organs shall be sentenced to up to five years in prison and fined; repeat offenders face more than five years in prison, fines, or asset confiscation.” Three additional scenarios are punished under Articles 234 and 232: removing organs without consent, removing organs from anyone under 18, or coercing or deceiving someone into donation — all treated as intentional injury or homicide. Two notable cases illustrate these risks. First, in 2014, 15 defendants in Beijing were convicted of trafficking 51 kidneys; donors received only $20,000–$25,000 each, while patients paid $180,000–$220,000 per kidney. The operation took place in a rundown, unequipped building rented for $7,500 per month; the ringleader got 12 years, others 3.5–9 years. Second, a 17-year-old in Chenzhou sold his right kidney in 2011 for $22,000; the buyer paid intermediaries $150,000 plus $10,000, and the mastermind kept $56,000. Post‑surgery, the teen suffered permanent kidney damage, classified as serious injury and a third‑degree disability. In total, 190,000 yuan and 210,000 yuan were also confiscated from the offenders as part of these penalties. + +- Evidence grade: A + +- Notes: The real beneficiary is yourself. The true cost of this “deal” isn’t just $20,000; it’s trading a vital organ for a smartphone. The teen’s injury was deemed serious and permanently disabling — not something a few months of rest can fix. Prosecutors charged five defendants under Article 234‑2 for intentional injury, partly because doctors failed to verify the donor’s age before surgery. Today, organizers would be convicted under the organ‑trafficking statute, while removing organs from minors would still be treated as intentional injury. Black‑market operations occur in rented apartments or makeshift clinics, lacking proper screening, follow‑up, or accountability. If you wish to donate, follow Article 11: use a licensed transplant center, obtain ethics‑committee approval, and do it free of charge. Post‑mortem donation is a separate, voluntary process not covered here. The physical consequences of losing a kidney are detailed in Section 1, Item 35 (the remaining kidney then has to work for two). When money is so tight that selling an organ seems like an option, first explore Section 7’s safety nets — unemployment insurance, emergency aid, and dibao. Beware of online loans and “packaging‑material” financing schemes described in Section 6. +- Sources:国务院 (2023). 人体器官捐献和移植条例（国务院令第 767 号，第五、十、十一、三十七条）. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第二百三十四条之一. ；最高人民检察院 (2012-04-09). 「少年卖肾买苹果手机」案诉至法院. ；河北省廊坊市中级人民法院官网转载 (2014-09-02). 全国最大贩肾案终审 组织者摘肾 51 枚获利千万. + +### 23. Don’t engage in prostitution: the default penalty is 10–15 days in detention, not just a fine + + +- Cost: There is no cost and no time required. All you need to do is simply refrain from it. + +- In plain terms: Getting caught doesn’t just result in a minor fine. Statutory law stipulates that the default penalty is 10–15 days of administrative detention, plus a possible fine of up to 5,000 yuan. Only in cases where circumstances are relatively minor might the penalty be limited to 5 days of detention or a fine of up to 1,000 yuan. Additionally, knowingly engaging in prostitution while infected with syphilis or gonorrhea constitutes a criminal offense, punishable by up to five years in prison. + +- Benefit: Article 78 of the Law on Administrative Penalties for Public Security stipulates that individuals convicted of prostitution or soliciting prostitutes face 10–15 days of administrative detention, with a possible fine of up to 5,000 yuan. For less serious cases, the penalty may be 5 days of detention or a fine of up to 1,000 yuan. Those who solicit customers in public spaces also face similar penalties. Article 79 states that anyone who lures, shelters, or arranges prostitution is subject to 10–15 days of detention and a fine of up to 5,000 yuan; less serious cases incur 5 days of detention and a fine ranging from 1,000 to 2,000 yuan. Article 87 provides that employees of hotels, restaurants, entertainment venues, or taxi services who aid or facilitate prostitution activities face 10–15 days of detention. Article 360 of the Criminal Law criminalizes knowingly spreading sexually transmitted diseases such as syphilis or gonorrhea through prostitution; offenders may be sentenced to up to five years in prison and fined. (National application; Law on Administrative Penalties for Public Security effective 1 January 2026.) + +- Evidence grade: A + +- Notes: This detention is administrative in nature, meaning offenders are held in a detention center rather than merely paying a fine. Those who arrange or provide venues for prostitution face identical penalties under Article 79. Employees of hotels or entertainment venues who assist clients in evading law enforcement are also subject to 10–15 days of detention under Article 87. Previously, Article 360 included a provision criminalizing statutory rape of minors; this was removed via the 2015 Ninth Amendment to the Criminal Law, meaning such acts are now prosecuted as rape. Any services advertised as “on‑site wellness” or “massage” are still treated as prostitution based on actual conduct. Health risks related to sexually transmitted infections and HIV are addressed separately in Section 1, Item 30 (consistent condom use) and Section 13, Item 38 (post‑exposure prophylaxis within 72 hours). Precautions specific to entertainment venues are outlined in Section 22. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第七十八、七十九、八十七条）. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第三百六十条. （北京市公安交通管理局转载）；全国人大常委会 (2015). 刑法修正案（九）（第四十三条，删去刑法第三百六十条第二款）. diff --git a/book/10-Is-Love-And-Marriage-Worth-It.md b/book/10-Is-Love-And-Marriage-Worth-It.md new file mode 100644 index 00000000..a55c77dc --- /dev/null +++ b/book/10-Is-Love-And-Marriage-Worth-It.md @@ -0,0 +1,198 @@ +# 10. Is it worth dating and getting married? + +This section breaks down the question “Is marriage a good financial decision?” into several separate calculations. These calculations cover money, time, health, legal risks, and relationship quality. For each calculation we use only figures with verifiable sources — primarily official statistics or meta-analyses that combine data from multiple studies. No moral judgments are made here, nor are any conclusions drawn on your behalf. The health calculations rely on mortality risks, the time calculations use average daily minutes, and the legal calculations follow the wording of relevant statutes. These three types of calculations are not converted into one another. For more details on this breakdown method, the checklist of factors to consider, and common misconceptions, please refer to [docs/结婚划不划算.md](../../docs/research/结婚划不划算.md). +### 1. Getting to know more people rather than fixating on just one: You can’t predict compatibility before meeting someone + + +- Cost: No cost at all. Spend time getting to know several people instead of obsessing over just one. The hard part is resisting the urge to fixate on a single person. +- In plain terms: Two speed-dating studies asked participants to fill out over 100 questionnaires about their preferences in a partner before any meetings took place. These questionnaires could only reveal how likely someone is to like others in general, and how popular they tend to be — they couldn’t predict whether two specific people would hit it off. Compatibility can only be determined by meeting in person. Therefore, it’s far more worthwhile to get to know multiple people than to bet everything on just one. +- Benefit: In both speed-dating studies, participants completed more than 100 self-report questionnaires related to partner preferences prior to meeting potential matches. Researchers then applied a random forest model — an algorithm designed to detect patterns — to analyze the data. This model could predict “how likely an individual is to like others overall,” with the questionnaires accounting for 4%–18% of the variance in such tendencies; this represents only a small fraction of the total differences between individuals. It could also predict “how popular an individual tends to be,” explaining 7%–27% of variance. However, it completely failed to predict whether two specific individuals would be compatible; no combination of pre-meeting traits or preferences could be used to forecast their mutual attraction. Earlier, the same research team conducted another speed-dating experiment where participants reported their own ideal preferences — whether they valued physical appearance or financial prospects more. Even this information couldn’t predict how interested they’d be in a particular person during the actual date. +- Evidence grade: A +- Notes: Both studies clearly state that compatibility cannot be predicted before meeting someone — they do not claim that all efforts to predict it are futile. Since true compatibility can only be determined by face-to-face interaction, it makes far more sense to invest time in meeting multiple people individually rather than placing all hopes on just one. Keep in mind that all study participants were university students from Western countries; China’s dating environment differs significantly, so these findings should be applied with some caution. +- Sources:Joel S, Eastwick PW, Finkel EJ (2017). Is romantic desire predictable? Machine learning applied to initial romantic attraction. Psychological Science, 28(10), 1478-1489. ；Eastwick PW, Finkel EJ (2008). Sex differences in mate preferences revisited: do people know what they initially desire in a romantic partner? Journal of Personality and Social Psychology, 94(2), 245-264. + +### 2. Stop after a clear refusal — continued pursuit is a public order violation, not “sincerity” + +- Cost: No cost at all, neither financial nor time-related. The hard part is self-restraint: refraining from sending further messages or waiting around for the other person. +- In plain terms: If someone has clearly refused you, and you still send messages or wait for them, as of January 2026 this constitutes a violation of public order laws. Offenders may be detained for up to 5 days or fined up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days. Police can also issue orders barring the offender from contacting the other person; any violation of such orders results in an additional 5–10 days of detention. +- Benefit: The Public Security Administration Punishment Law, effective 1 January 2026, explicitly lists persistent pursuit and stalking as separate violations. The relevant clause states that “repeatedly sending obscene, insulting, threatening or similar messages, or using harassment, stalking and other methods to interfere with another person’s normal life” is punishable by up to 5 days of detention or a fine of up to 1000 yuan. For more serious cases, the penalty is 5–10 days of detention, with a possible fine up to 1000 yuan. This law also adds an extra provision: with approval from a senior police official, offenders can be ordered to refrain from contacting the victim for a set period; any violation of this order incurs an additional 5–10 days of detention. +- Evidence grade: A +- Notes: There is no research evidence supporting the claim that “persistent pursuit can win over the other person”; however, detention and contact bans are explicitly stipulated by law. These records also affect eligibility for civil service exams, background checks, and certain professional licenses. The line between pursuing someone and harassing them is not defined by the perpetrator’s intentions, but by whether the other person has clearly expressed refusal. +- Sources:全国人大常委会 (2025 修订). 治安管理处罚法（第五十条第一款第五项、第二款）. （最高人民检察院转载） + +### 3. Judging whether someone is interested: focus on actions, not “signals” — who initiates, plans, and follows up + +- Cost: This requires no money or much time. The real challenge is breaking old habits: stop trying to interpret facial expressions and tone, and instead record observable behaviors. +- In plain terms: In one study, 52 pairs of strangers of opposite genders chatted for about 10 minutes, then tried to determine whether each other was flirting. The results showed they were fairly accurate at spotting when no flirting was occurring, but struggled to identify actual flirting. A second study with 261 participants reached the same conclusion after watching short videos. Therefore, rather than guessing based on expressions or tone, pay attention to actions: who initiates contact, who schedules future meetings, and whether they follow up when you don’t make the first move. +- Benefit: Two studies examined how accurately people can recognize flirting. The first involved 52 unrelated male-female pairs conversing for 10–12 minutes; afterward, each participant reported whether they themselves were flirting and whether they believed their partner was. The results indicated that interactions without any flirting were identified more reliably, while those involving actual flirting were harder to detect. The second study used 26 one-minute video clips and 261 observers, yielding similar findings. In short, people can fairly reliably tell when someone is not flirting, but they struggle to detect when flirting is happening. +- Evidence grade: B +- Notes: This topic remains debated. Some research suggests the issue isn’t that men overestimate women’s sexual intentions, but that women tend to underreport their own intentions on surveys. There is still no consensus on which group judges more accurately. Nevertheless, both viewpoints agree on one point: relying on subtle cues such as facial expressions or tone to infer someone’s thoughts yields poor results. Observable behaviors — such as who initiates contact, plans future meetings, and follows up without prompting — are far more reliable indicators. +- Sources:Hall JA, Xing C, Brooks S (2015). Accurately detecting flirting: error management theory, the traditional sexual script, and flirting base rate. Communication Research, 42(7), 939-958. ；Perilloux C, Kurzban R (2015). Do men overperceive women's sexual interest? Psychological Science, 26(1), 70-77. （争议方） + +### 4. Whether a relationship is good or not depends mainly on how you feel within it, not on your partner’s traits. + + +- Cost: There is no monetary cost, nor does it require much time. The real challenge lies in shifting your perspective: put aside your checklist of ideal partner traits and instead focus on how you interact day to day. + +- In plain terms: An analysis of data from 29 laboratories and 43 longitudinal studies on couples shows that the strongest predictor of relationship quality is how each partner personally feels about the relationship — not their objective traits. Factors such as perceived partner commitment, appreciation, sexual satisfaction, and frequency of conflict all play a role. Self-reported feelings are two to four times more predictive than what partners report about each other. However, no questionnaire can reliably predict whether a relationship will improve or deteriorate over time. + +- Benefit: Machine learning applied to data from 29 laboratories and 43 longitudinal studies tracking the same couples over time reveals that the most important predictors of relationship quality are each partner’s subjective experiences: perceived partner commitment, appreciation, sexual satisfaction, and feelings of mutual contentment, alongside conflict levels. Among individual-level factors, life satisfaction, negative emotions, depression, and attachment styles (avoidant and anxious) also contribute. At the start of these studies, self-reported relationship factors explained up to 45% of differences in relationship quality between couples; by the end, this figure dropped to 18%. Crucially, self-reported feelings remain two to four times more predictive than partner-reported ones. Adding individual differences or partner reports to these self-reported factors yields no additional predictive power. + +- Evidence grade: A + +- Notes: This same research also found that no set of self-reported measures can reliably predict whether a relationship will improve or worsen over time. Therefore, the practical takeaway is this: to assess whether a relationship is currently healthy, rely on your own feelings rather than checking off a list of partner traits. Just don’t expect this to forecast its future trajectory. This finding aligns with the earlier point in this section that emotional value cannot be judged solely by presence or absence; here, we identify exactly which factors matter most. +- Sources:Joel S, Eastwick PW, Allison CJ, et al. (2020). Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies. Proceedings of the National Academy of Sciences, 117(32), 19061-19071. + +### 5. To build closeness, have two people take turns answering a series of progressively deeper questions — no script needed + +- Cost: No cost involved. It takes 45 minutes to complete. +- In plain terms: Pair two strangers up and have them take turns answering 36 questions grouped into three levels of depth. After 45 minutes, their sense of closeness is noticeably higher than in a control group that simply chatted for the same amount of time. What drives this effect is the act of taking turns to share honest thoughts at increasing levels of depth, not any pre-planned conversational script. Keep in mind this measure only captures short-term closeness, and does not guarantee the development of a long-term relationship. +- Benefit: This method pairs two unfamiliar people to answer 36 questions in total, arranged in three tiers of increasing depth. The questions range from “Who is the person you’d most like to invite for dinner?” to “When was the last time you cried in front of someone?” After 45 minutes, the participants report a higher sense of closeness compared to those who only chatted for the same duration. Their reported closeness also exceeds the average rating college students give to their closest real-life relationships. +- Evidence grade: B +- Notes: Only one experiment has been conducted so far, with college students as participants. It measures short-term closeness only, not whether a lasting relationship can form. The core mechanism at work here is that closeness grows when two people take turns sharing genuine personal details at progressively deeper levels — rather than relying on scripts, tricks or one-sided efforts. The key takeaway for practical use is to “share something honest about yourself, then ask a similarly personal question back”, and make sure both parties get a turn to do so. +- Sources:Aron A, Melinat E, Aron EN, Vallone RD, Bator RJ (1997). The experimental generation of interpersonal closeness: a procedure and some preliminary findings. Personality and Social Psychology Bulletin, 23(4), 363-377. + +### 6. Long-distance relationships aren’t worse than local ones — the real challenge comes in the first three months after moving in together + +- Cost: There are travel expenses to consider, plus the time spent traveling back and forth. Couples see each other far less often than those living in the same city, making it difficult to maintain the relationship over the long term without regular contact. +- In plain terms: Long-distance relationships actually tend to be more stable while the couple remains apart, since seeing each other infrequently allows each person to idealize the other. The real difficulty emerges only after they move in together. Data shows that roughly half of long-distance couples eventually transition to living locally, while the other half end their relationship while still apart. Among those who reunite, one-third break up within three months of moving together. +- Benefit: Two separate studies reach the same conclusion: long-distance relationships are generally more stable than local ones while the couple remains separated. This stability stems from a significantly higher degree of idealization — meaning each partner tends to view the other more favorably than reality warrants. The studies measured factors such as idealized distortion, romantic love, relationship memories, and perceived similarity. Moreover, the less frequently couples meet, the more positively they tend to view each other. However, this stability holds only while they remain apart; once they live in the same city, long-distance couples are far more likely to split up. One longitudinal study found that about half of long-distance couples eventually moved in together, while the other half ended their relationship while still apart. Of those who reunited, one-third broke up within three months of living together. The longer the intervals between visits while apart, and the greater the degree of idealization, the less stable the relationship tends to be after reuniting. +- Evidence grade: B +- Notes: These findings are based on romantic relationships among American university students, excluding married couples, and date back to an earlier era; thus, absolute percentages should not be applied directly to current populations. Another study surveyed 717 long-distance couples and 425 local couples, finding only minimal differences in overall relationship quality between the two groups. Ultimately, relationship success depends on the individuals involved and the nature of their bond itself, rather than physical distance. The key takeaway is this: do not assume that long-distance relationships are destined to fail. Instead, couples should prepare for the initial months after reuniting, when personal independence diminishes, mutual understanding increases, and conflicts or jealousy are more likely to arise. +- Sources:Stafford L, Merolla AJ, Castle JD (2006). When long-distance dating partners become geographically close. Journal of Social and Personal Relationships, 23(6), 901-919. ；Stafford L, Merolla AJ (2007). Idealization, reunions, and stability in long-distance dating relationships. Journal of Social and Personal Relationships, 24(1), 37-54. ；Dargie E 等 (2015). Journal of Sex & Marital Therapy, 41(2), 181-202. （备注里那项异地研究） + +### 7. Check registration statistics before listening to elders: what do “marriage rate” and “divorce rate” actually mean? + +- Cost: None. It takes just a few minutes to read the section on marriage registration in the annual report from the Civil Affairs Bureau. +- In plain terms: In 2024, 6.106 million couples got married nationwide, a 20.5% drop from the previous year. Meanwhile, 3.513 million divorces were finalized. The oft‑quoted claim that “more than half of marriages end in divorce” comes from dividing these two numbers, yielding roughly 57.5%. The exact figures are 351.3 divorces and 610.6 marriages for that year. However, the two groups of people are not the same, so this figure cannot be interpreted as “half of all marriages end in divorce.” The report also lists a marriage rate of 4.3‰ and a divorce rate of 2.5‰; both use the total population as the denominator, not just married individuals. +- Benefit: In 2024, 6.106 million marriages were legally registered, representing a 20.5% decrease from 2023; the corresponding marriage rate was 4.3‰. That same year, 3.513 million divorces were processed: 2.622 million through civil registration and 0.891 million via court rulings or mediation, giving a divorce rate of 2.5‰. The report defines the marriage (or divorce) rate as the number of marriages (or divorces) in a given year divided by the average annual population, multiplied by 1000‰. This is a “crude rate” that uses the whole population as its base. +- Evidence grade: A +- Notes: The common online figure of “over 50% divorce rate” is obtained by dividing the number of divorces by the number of marriages for the same year (351.3 ÷ 610.6 ≈ 57.5%). This ratio is known as the “divorce‑to‑marriage ratio.” Because the two sets of individuals are not identical and the report does not list such a metric, it cannot be taken as “half of all marriages end in divorce.” To calculate the actual probability that a given marriage eventually ends in divorce, one would need longitudinal data tracking the same cohort of newlyweds — data not available in this report. +- Sources:民政部 (2025). 2024 年民政事业发展统计公报（五（二）1 婚姻登记服务、注释 5），网页版与 PDF 版. 、 + +### 8. Accounting for health benefits while adjusting for observational data + +- Cost: There is no cost in money or time. Just keep in mind that these figures reflect a lower mortality rate among married individuals — this simply means both conditions occur together, not that marriage itself extends life expectancy. +- In plain terms: Over a given period, married people have a roughly 12% lower chance of dying compared to unmarried individuals, while those who have never married face a roughly 24% higher risk. However, this merely shows a correlation between marital status and mortality; it does not prove that marriage directly causes longer life. People who are healthier, wealthier, and more socially active are both more likely to marry and more likely to live longer. These statistics are primarily drawn from European and North American populations, so they can only serve as rough benchmarks for China. +- Benefit: One meta-analysis of older adults pooled results from multiple studies, covering 53 comparisons and over 250,000 participants. It found that the relative risk of all-cause mortality for married versus unmarried individuals was RR 0.88, with a 95% confidence interval of 0.85–0.91. In other words, married people had a roughly 12% lower probability of dying during the study period. Among widowed individuals, this figure rose to 1.11; for divorced or separated persons, it was 1.16; and for those never married, it was 1.11 — indicating respective increases of about 11%, 16%, and 11% in mortality risk. No significant gender differences emerged. Under the most conservative estimates, the RR still came out at 0.94, reflecting a reduction of only around 6%. Another meta-analysis compared never-married individuals with married ones, drawing on 95 separate studies and over 500 million participants. It reported a hazard ratio of 1.24 (95% CI 1.19–1.30), meaning unmarried people faced roughly 24% higher mortality risk over the same timeframe; this gap narrowed with age. A further gender-specific meta-analysis examined 21 studies involving more than 7,890,000 individuals: across both sexes, unmarried status correlated with higher rates of overall mortality, cancer-related death, and cardiovascular death. Among men, the disparity was especially pronounced for cardiovascular and overall mortality; unmarried men also faced a 31% higher risk of stroke and a 9% higher risk of all-cause death compared to unmarried women. +- Evidence grade: A (controversial) +- Notes: The controversy stems from the fact that married individuals tend to be healthier, wealthier, and more socially engaged — factors that independently contribute to longer life. All three meta-analyses relied on observational data collected from existing populations; no controlled experiments or randomized groups were used. The authors themselves acknowledged potential publication bias and methodological limitations. Roelfs also noted that studies employing more rigorous methods tended to report smaller differences between marital groups. Since these figures are largely derived from Western populations, they can only be used as rough indicators for Chinese contexts. +- Sources:Manzoli L, et al. (2007). Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med 64:77–94. ；Roelfs DJ, et al. (2011). The rising relative risk of mortality for singles: meta-analysis and meta-regression. Am J Epidemiol 174(4):379–389. ；Wang Y, et al. (2020). Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals. Glob Health Res Policy 5:4. + +### 9. Discussing labor division before marriage helps clarify unpaid work responsibilities + + +- Cost: There is no monetary cost. Spend one or two hours before marriage to reach a clear agreement on how household chores, childcare, and elder care — all unpaid tasks — will be divided between partners, then follow that plan. The real challenge lies in having the conversation, not in avoiding it. + +- In plain terms: According to the 2024 National Time Use Survey, men spend an average of 1 hour and 52 minutes per day on unpaid activities such as housework and caring for family, while women spend 3 hours and 29 minutes. Since the survey does not break down data by marital status, there are no official figures on how much housework increases after marriage; the gender gap observed can only serve as an upper limit. In reality, couples can negotiate a different division of labor altogether before getting married. + +- Benefit: The 2024 National Time Use Survey tracks unpaid labor, which includes housework and family care. On average, people who perform such tasks spend 2 hours and 45 minutes daily on them; men dedicate 1 hour and 52 minutes, women 3 hours and 29 minutes. The proportion of individuals engaging in unpaid labor each day is 67.5% among men and 83.9% among women. Nationwide, residents spend an average of 1 hour and 17 minutes daily on housework; among those who actually do it, the average rises to 1 hour and 59 minutes — a decrease of 28 minutes compared to 2018. Time spent caring for family averages 30 minutes per day; for those involved, it reaches 1 hour and 46 minutes. In 2018, men spent 45 minutes on housework and 17 minutes on childcare, while women spent 2 hours and 6 minutes on housework and 53 minutes on childcare. + +- Evidence grade: A + +- Notes: Both surveys analyzed data only by gender, urban/rural residence, and age; marital status was not considered. Consequently, no official statistics exist on how much housework increases after marriage; the gender disparity can only be used as a rough upper bound. These figures represent national averages, but couples are free to negotiate a division of labor that suits them — and that is precisely the value of having this discussion. +- Sources:国家统计局 (2024). 第三次全国时间利用调查公报（第二号、第三号）. 、；国家统计局 (2019). 2018 年全国时间利用调查公报. + +### 10. First check the default legal rules regarding money and property, then decide whether to make a written agreement + + +- Cost: There is no cost involved. Simply read the relevant articles in the Civil Code regarding marital property. If needed, the couple can sign a written property agreement; the law only requires it to be in writing, no notarization is necessary. The real challenge is discussing money matters openly beforehand. + +- In plain terms: Without a written agreement, the law presumes that wages, bonuses, business profits, investment returns, inheritances, and gifts received after marriage belong to both spouses jointly. Only property owned before marriage, or items explicitly designated in a will or gift contract as belonging to one person, remain personal property. Couples may choose to agree in writing that certain assets stay separate; such an agreement becomes legally binding. A spouse who has devoted more time to raising children or caring for elderly relatives may request compensation during divorce proceedings. + +- Benefit: By default, all earnings from employment, business activities, intellectual property, as well as inheritances and gifts received after marriage are considered joint marital property (Article 1062). Personal property includes assets owned prior to marriage, compensation for personal injury, items earmarked for one spouse in a will or gift contract, and everyday personal items (Article 1063). Couples may stipulate in writing whether their pre‑marital and post‑marital assets remain separate, become joint, or are divided partially; this arrangement is legally enforceable (Article 1065). The spouse who has shouldered greater responsibilities in child‑rearing, elder care, or supporting the other partner’s career may seek compensation upon divorce (Article 1088). + +- Evidence grade: A + +- Notes: No official statistics exist for dowries, wedding expenses, or marital homes, so no figures are provided here. The amount of compensation under Article 1088 is first negotiated between the couple; if they cannot reach an agreement, a court will decide it based on relevant circumstances. A written property agreement benefits both parties: it protects high‑earners and also safeguards those who perform unpaid domestic duties. +- Sources:全国人民代表大会 (2020). 中华人民共和国民法典（2021 年 1 月 1 日起施行，第一千零六十二、一千零六十三、一千零六十五、一千零八十八条）. 国家法律法规数据库 ；条文全文见最高人民法院公报转载 + +### 11. When parents pay for a house, they should clearly state whether it’s a loan or a gift at the time of transfer + + +- Cost: There is no cost involved. On the day of payment, write a brief note specifying whether the money is a gift or a loan to the child. Both the parent(s) making the payment and the child must sign it. If it’s a loan, both spouses should also sign. Use the same wording in the transfer description. + +- In plain terms: When parents pay for a house before marriage, the money is generally considered a gift solely to their own child. After marriage, without any written agreement, it’s treated as joint marital property. Starting February 2025, if one set of parents fully funds a house during marriage but the gift agreement doesn’t specify it’s only for their child, a court may award the house to that child upon divorce and decide whether to compensate the other spouse. To treat it as a loan, all terms must be clearly documented and signed on the same day. + +- Benefit: Payments made by parents before marriage for a house are typically viewed as gifts to just one child, unless they explicitly state otherwise. After marriage, any agreement governs the arrangement; otherwise, it’s treated as joint property. Since February 2025, if one set of parents fully funds a house during marriage without specifying it’s only for their child, a court may award it to that child upon divorce and later determine if compensation is warranted. Factors considered include shared living arrangements, children born together, fault in the divorce, each party’s contributions, and current market value. Partial funding by one or both sets of parents results in a similar ruling, with compensation based on proportional contributions nationwide. + +- Evidence grade: A + +- Notes: This rule applies to both parties involved. Parents no longer need to rely on a post-divorce loan agreement to protect their investment; post-February 2025, the source of funds itself determines ownership, independent of whose name appears on the title. Recipients of such funds also gain clarity early on. To treat it as a loan, all terms must be explicitly documented, signed, and reflected in the transfer description — otherwise, legal justification becomes necessary. +- Sources:最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第二十九条）. ；最高人民法院 (2025). 关于适用《民法典》婚姻家庭编的解释（二）（法释〔2025〕1 号，第八条）. ；全国人大 (2020). 民法典（第一千零六十二条第一款第四项）. + +### 12. Money borrowed by a spouse in a large amount — if you didn’t sign or later acknowledge it, it doesn’t automatically become your debt + + +- Cost: No cost at all. Never sign “joint borrower” or “guarantor” on your spouse’s loan agreements or guarantee documents. Also avoid writing things like “We’ll pay back this money” in messages, as that could be taken as later acknowledgment of the debt. The hard part is staying silent when creditors start pressuring you. + +- In plain terms: Money borrowed by a spouse behind your back generally won’t become your joint debt, provided it clearly exceeds normal household expenses and you neither signed any documents nor later acknowledged the debt. Creditors must prove the money was used for shared household needs or joint business activities. However, if the borrowed funds actually helped purchase a house that both of you now live in or own together, creditors can usually prove it served a shared purpose. + +- Benefit: Debt is considered a joint marital obligation in several situations: first, when both spouses sign the loan agreement; second, when one spouse later acknowledges the debt, thereby accepting joint responsibility; third, when one spouse takes out a loan during marriage for ordinary household needs. Any loan taken out by one spouse that clearly exceeds everyday household expenses does not qualify as joint debt — unless the creditor can prove it was used for shared living or business purposes. Since buying a house typically exceeds normal household spending, the burden of proof falls on creditors to demonstrate such shared use. Yet if the house truly becomes a joint residence or property, creditors can more easily substantiate their claim. Thus, the key preventive measure is exactly what Section 11 describes: clearly stating whether parental contributions are loans or gifts (nationwide, effective since 2021). + +- Evidence grade: A + +- Notes: During divorce proceedings, if one spouse’s parents suddenly produce a loan agreement bearing only their child’s signature, two distinct evaluations become necessary. First, courts must determine whether the loan actually occurred. If you can convincingly argue that no funds were transferred, judges will weigh multiple factors: loan amount, payment method, both parties’ financial standing, habitual transaction patterns, any corresponding property changes, and witness testimony. Mere possession of transfer records by creditors still obliges them to prove loan validity. Second, even if the loan is verified, its classification as joint debt must be re-examined. General rules governing loan agreements and guarantees are detailed in Section 8, Article 18. +- Sources:全国人大 (2020). 民法典（第一千零六十四条）. ；最高人民法院 (2020 年第二次修正). 关于审理民间借贷案件适用法律若干问题的规定（第十五、十六条）. （最高人民法院公报） + +### 13. Obtaining a marriage certificate requires only an ID card and a signed declaration — no household register needed, no fees, and issuance is immediate. + + +- Cost: There are no fees involved. Both parties must be present in person. The entire process typically takes just a few minutes. +- In plain terms: Starting May 2025, getting a marriage certificate requires only two items: your ID card and a signed declaration stating that you have no spouse and share no direct or indirect blood relations within three generations with your partner. There’s no need to bring a household register, nor to go back to one’s place of hukou registration. The registration itself is completely free, and if all conditions are met, the certificate is issued on the spot. +- Benefit: The revised Marriage Registration Regulations, effective May 10, 2025, streamlined documentation requirements for mainland residents. They specify that only two documents are mandatory: “(1) one’s own ID card; (2) a signed declaration confirming that one has no spouse and shares no direct or indirect blood relations within three generations with the other party.” The household register is no longer required. Registration is handled by “county-level civil affairs bureaus or township governments designated by provincial or municipal authorities to ensure accessibility.” The previous requirement to register at the hukou location of one partner has been removed. The regulations also explicitly state that “marriage registration authorities must not charge any fees” and “must issue certificates on the spot to applicants who meet all eligibility criteria.” +- Evidence grade: A +- Notes: Registration will be denied only in four cases: if either party is under legal marriage age, if consent is not mutual, if either party already has a spouse, or if the couple shares direct or indirect blood relations within three generations. Any additional charges usually apply only to optional services such as photography or photocopying — the registration process itself remains free. If anyone demands a “processing fee” or “express service charge,” such demands should be refused and reported. The 30-day cooling-off period for divorce registration is discussed under the “Cost” section. +- Sources:国务院 (2025). 婚姻登记条例（国令第 804 号，第二、六、八、十条）. + +### 14. Undergoing a premarital medical checkup: if you have a serious illness, you must disclose it to your partner before marriage registration + + +- Cost: It’s free. During an argument, stick to the current issue—no insults, no sarcasm, no bringing up the past. The hard part is keeping your mouth shut when angry. + In most regions, eligible couples receive this service for free or at a reduced fee; if paying out of pocket, it usually costs only a few hundred yuan. The entire process takes about half a day. + +- In plain terms: If a person has a serious illness and fails to disclose it truthfully to their future spouse before marriage registration, the other partner may file a lawsuit to have the marriage annulled. This legal action must be taken within one year of learning about the condition. Since 2003, a premarital medical checkup has no longer been a mandatory prerequisite for marriage registration; participation remains entirely voluntary. Exact costs and which tests are performed vary by local policies, but the whole procedure typically requires half a day. + +- Benefit: The legal consequences of concealing a serious illness are clearly defined. Current marriage registration regulations state: “If one party has a serious illness, they must disclose this fact to the other party prior to marriage registration; failure to do so permits the other party to petition a court to annul the marriage under Article 1053 of the Civil Code.” The government also promotes premarital medical screening as a primary measure for preventing birth defects, aiming to maintain a premarital checkup rate above 70% and a coverage rate for pre‑conception health services above 80%. Policies further encourage locating such clinics near marriage registration offices and offering combined “one‑stop” services covering registration, medical screening, and fertility counseling. Under the Civil Code, nondisclosure of a serious illness before marriage can indeed lead to an annulment request, which must be filed within one year of becoming aware of the condition. + +- Evidence grade: B + +- Notes: Reasons for choosing B: Most of the aggregated studies merely recorded observations without any control groups. Thus, it’s unclear whether poor relationships cause illness, or poor health leads to deteriorating relationships. In some studies, the correlation persisted even after adjusting for age and income. The wound experiment involved only 42 couples. The principle of “focusing on issues rather than people, avoiding insults or sarcasm” was deduced by the authors from instances of “hostile behavior” observed in the experiments; no studies have directly compared this approach. For couples who argue frequently yet can’t change their behavior, seeking couples or marriage counseling together is an option—though no separate studies address this specifically. When arguments escalate to physical violence, chronic verbal abuse, or threats, the issue is no longer merely communication breakdown but domestic violence; see Section 8, Item 43 (Domestic Violence). Carefully consider whether to leave the relationship; information on exit costs can be found in Section 16 (Exit Costs) of this chapter. + Since 2003, a premarital medical checkup has ceased to be a mandatory requirement for marriage registration; attendance remains optional. Nevertheless, the rule requiring disclosure of serious illnesses does grant a spouse the legal right to seek an annulment within one year of learning of the condition. Whether the test is free and which specific examinations are performed depend on local regulations; interested couples should consult their local maternal‑and‑child health centers or the “one‑stop” service desks at marriage registration offices. (Pending verification: a nationwide document outlining the uniform basis and scope of free premarital screening policies.) +- Sources:全国人大 (2020). 民法典（第一千零五十三条）. ；国务院 (2025). 婚姻登记条例（国令第 804 号，第十二条）. ；国家卫生健康委办公厅 (2023). 出生缺陷防治能力提升计划（2023—2027 年）（国卫办妇幼发〔2023〕9 号）. + +### 15. Emotional value isn’t just about “whether it exists” — it’s about relationship quality + +- Cost: No money required. Use a few conflicts and several months of interaction to gauge relationship quality rather than simply checking off a list of criteria. The hard part is resisting the urge to judge based solely on that checklist. +- In plain terms: A meta-analysis of 126 studies involving over 72,000 participants shows that higher marriage quality correlates with better health. However, this link is quite weak — its magnitude is comparable to the effect of healthy behaviors like proper diet. What’s useful here is that relationship quality should be assessed through actual interactions rather than rigid criteria lists. There’s no direct data comparing outcomes for people in poor marriages versus those who remain unmarried. +- Benefit: This same meta-analysis indicates that better marital quality leads to improved health outcomes, with effect sizes ranging from r = 0.07 to r = 0.21. Here, r measures how closely two variables change together: 0 means no relationship, while 1 means perfect correlation. For instance, the risk of death correlates at r = 0.11, while cardiovascular responses during conflict correlate at r = −0.13. These figures are similar to those seen with lifestyle factors like diet. Research examining gender differences found virtually no variation between men and women. Reviews focused on cardiovascular health also confirm that both marital dissatisfaction and quality significantly influence risk levels. +- Evidence grade: B (controversial) +- Notes: The controversy stems from the fact that this association remains relatively weak. Some findings may also be influenced by publication bias. Additionally, most studies rely on single-time assessments, making it hard to determine cause-and-effect relationships — limitations explicitly noted by Robles in his original work. No meta-analysis directly comparing mortality rates between individuals in low-quality marriages and unmarried individuals has been identified; thus, the claim that “poor marriages are worse than staying single” remains speculative rather than empirically proven. +- Sources:Robles TF, et al. (2014). Marital quality and health: a meta-analytic review. Psychol Bull 140(1):140–187. ；Dhindsa DS, et al. (2020). Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 30(4):215–220. + +### 16. Calculating the cost of walking away: Divorce by mutual agreement has a 30-day cooling-off period; divorce via litigation has strict legal conditions. + +- Cost: There is no monetary cost. Still, it’s worth spending some time before marriage to consider how long it would take and what steps would be required to end the marriage, should that become necessary. The difficulty lies in thinking about separation before getting married at all. +- In plain terms: Divorce by mutual agreement isn’t finalized the moment the paperwork is signed. After filing the application, either spouse can withdraw it within 30 days. Once that period ends, both parties must appear in person within another 30 days to obtain the divorce certificate; failure to do so counts as a withdrawal. If one spouse refuses, the only option is to pursue divorce through court. Courts first attempt mediation; only when circumstances such as domestic violence, bigamy, or two years of separation exist, and mediation fails, will a divorce be granted. +- Benefit: Divorce by mutual agreement requires a written agreement and joint application to the marriage registry (Article 1076). Within 30 days of receiving the application, either party may withdraw it. After that, both must apply for the divorce certificate within 30 days; otherwise, the application is considered withdrawn (Article 1077). When one party objects, litigation follows, with courts mandated to mediate first. Divorce is granted if bigamy, cohabitation with another, domestic violence, substance abuse, or two years of separation without reconciliation exist, and mediation proves ineffective (Article 1079). In 2024, 3.513 million couples divorced nationwide; 891,000 of those cases were resolved through court rulings or mediation. +- Evidence grade: A +- Notes: The cooling-off period applies solely to divorce by mutual agreement. Litigation-based divorce lacks such a period but involves lengthier proceedings. Filing fees and attorney costs vary by region; no specific figures are provided here. While the procedural hurdles may seem high, they shouldn’t deter marriage itself; rather, they’re factors worth understanding beforehand. +- Sources:全国人民代表大会 (2020). 中华人民共和国民法典（第一千零七十六、一千零七十七、一千零七十九条）. ；民政部 (2020). 关于贯彻落实《中华人民共和国民法典》中有关婚姻登记规定的通知（民发〔2020〕116 号）. ；民政部 (2025). 2024 年民政事业发展统计公报. 题录同第 7 条（结婚率、离婚率各是什么口径） + +### 17. Keep a separate ledger for the “marriage for elders” — don’t mix it with your own accounts + +- Cost: No cost at all. Just draw two columns on paper. One column lists the benefits that belong to you; the earlier sections in this chapter help you calculate those. The other column lists benefits that belong to the elders: peace of mind, social prestige, and an end to matchmaking pressure. The tricky part is keeping the elders’ column separate and not merging it into yours. +- In plain terms: The benefits the elders gain — peace of mind, prestige, and relief from matchmaking pressure — are real. But they won’t automatically translate into health benefits or better relationship quality for you. Meanwhile, the time investment, financial costs, and exit costs all fall on you alone. By drawing two columns and assigning each benefit to its rightful owner, you can instantly see whether this arrangement is worth it for you. +- Benefit: The elders truly receive tangible benefits from this marriage. Yet those benefits do not automatically become health advantages (see Section 8) or improvements in relationship quality (see Section 15) for you. All time costs (Section 9), monetary expenses (Sections 10–12), and exit costs (Section 16) are borne entirely by you. Once you keep separate accounts, it becomes obvious at a glance whether “marrying as a duty” offers any real value — no outside judgment is needed. +- Evidence grade: C +- Notes: This section does not make a final judgment for you; the elders’ benefits can indeed be substantial. A fill‑in worksheet is available at [docs/结婚划不划算.md](../../docs/research/结婚划不划算.md). +- Sources:作者经验，方法类建议；数据部分见本节前面各条 + +### 18. Treating relationship quality as a health factor: focus arguments on issues, not people; avoid insults or sarcasm + +- Cost: No cost at all. During an argument, stick to the current issue at hand — no insults, no sarcasm, no bringing up past grievances. The real challenge is keeping your mouth in check when emotions run high. +- In plain terms: Couples with a healthier relationship tend to enjoy better physical health and a lower risk of death. This link is fairly weak, roughly comparable to the impact of diet on health. In one experiment, couples who maintained high levels of hostility during arguments saw only 60% of the rate of healing for small lab-made wounds compared to couples who stayed calm. +- Benefit: This conclusion comes from a meta-analysis of 126 separate studies involving over 72,000 participants. Higher marital quality correlated with better physical health, with correlation coefficients ranging from 0.07 to 0.21. A value of 0 indicates no link at all, while 1 means a perfect match between two variables. The strongest association observed was a 0.11 correlation with lower mortality risk. There was also a -0.13 correlation between lower hostility during arguments and reduced cardiovascular stress. The researchers note that all these effects are fairly minor, on par with the impact of everyday healthy habits like diet. Another controlled experiment involved 42 healthy couples, each hospitalized twice for 24 hours at a time. During one stay they engaged in supportive conversation, while the other they discussed a topic they disagreed on. After the argument-focused stay, the rate of healing for lab-made blisters was significantly slower. Couples who displayed higher hostility during both sessions healed at only 60% of the rate of low-hostility couples. The next morning, these same couples also showed higher levels of key inflammatory markers in their blood, including IL-6 and tumor necrosis factor. +- Evidence grade: B +- Notes: This B rating is assigned because most of the included studies relied on observational tracking rather than controlled group comparisons, so it is impossible to confirm whether poor relationship quality directly causes health issues or if poor health in turn harms relationships. Even after adjusting for factors like age and income, some studies still found a measurable link between the two. The wound-healing experiment involved just 42 couples. The recommendation to “focus arguments on issues, not people, and avoid insults or sarcasm” is derived from the researchers’ observations of hostile behaviors in these experiments; there are no dedicated studies directly testing this approach. If arguments remain consistently heated despite these efforts, couples can seek professional marriage and family counseling, though no specific studies address this option. Any instances of physical violence, chronic verbal abuse or threats go far beyond simple communication issues and qualify as domestic abuse — see Section 8, Item 43 for more details on domestic abuse. Couples unsure whether to stay in such a relationship should also review Section 16, which outlines the potential costs of leaving a partnership. +- Sources:Robles TF, Slatcher RB, Trombello JM, McGinn MM (2014). Marital quality and health: a meta-analytic review. Psychological Bulletin. ；Kiecolt-Glaser JK 等 (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry. diff --git a/book/11-Red-Lines-For-Techies.md b/book/11-Red-Lines-For-Techies.md new file mode 100644 index 00000000..4e27f302 --- /dev/null +++ b/book/11-Red-Lines-For-Techies.md @@ -0,0 +1,192 @@ +# 11. Common legal pitfalls for programmers and tech professionals + +This section focuses on personal freedom and financial safety — essentially, avoiding imprisonment and costly lawsuits. Many developers and technical workers tend to treat the following issues as mere technical matters. In reality, they constitute specific criminal offenses under Chinese law or can lead to substantial civil liabilities. For each item, we list the relevant legal provisions and real-world cases published on the websites of the Supreme People’s Procuratorate and the Supreme People’s Court. The criminal law references come from a consolidated text republished by the Beijing Traffic Management Bureau, which reflects amendments introduced in the 11th Criminal Law Amendment. The items are ordered from those most likely to be underestimated by tech professionals to those with the most severe consequences. The first entry serves as a general guide: it explains how to assess risks before taking action and what steps to take immediately after any incident occurs. +### 1. Ask three questions before taking any action: Whose interests might be harmed? How capable is the other party of pursuing legal action? And how much evidence do I have? If legal action is taken, immediately hire a criminal defense attorney. + + +- Cost: No cost at all. Before acting, replace the question “Is this technically feasible?” with “Will the vendor, platform, or company file a police report?” The hard part is resisting the urge to think “this is a minor issue no one will care about” — server logs, payment records, and chat logs are all routinely subpoenaed during investigations. + +- In plain terms: Before doing anything, ask whether the vendor, platform, or company will report the incident to police. Server logs, payment records, and chat logs are all easily obtained during an investigation. If you are criminally detained, authorities must decide within 37 days whether to formally arrest you. You may hire a lawyer from the very first interrogation onward; those 37 days are the most critical window for securing effective legal representation. + +- Benefit: Any organization or individual who becomes aware of a crime may file a police report. Once authorities deem a crime to have occurred, they must open an investigation. After a criminal detention, police must request formal arrest approval from prosecutors within three days; this period may be extended by one to four days under special circumstances, or up to 30 days in cases involving multiple locations or serial offenses. Prosecutors then have seven days to make a decision. In total, the maximum timeframe for deciding whether to arrest is 37 days. From the first interrogation or upon being placed under any compulsory measure, you may retain legal counsel; during the police investigation phase, only lawyers may be hired. Lawyers must be granted access to clients within 48 hours of requesting a meeting. If the potential sentence involves lighter penalties such as probation or fines rather than imprisonment, you may be released on bail by posting a bond or securing a guarantor; this bail period may last up to 12 months nationwide. + +- Evidence grade: C + +- Notes: These 37 days refer strictly to the interval between detention and the prosecutor’s decision on arrest; they do not represent the overall maximum detention period. Additional detention limits apply during the subsequent investigation phase. It is precisely during these 37 days that experienced attorneys can be most effective — meeting clients, submitting arguments to prosecutors that arrest is unwarranted, and applying for bail. Seeking legal help after indictment is far too late. All other items in this section address the same underlying issue: whether the other party has grounds to file a report. +- Sources:全国人大 (2018). 刑事诉讼法（2018 年修正，第三十四、三十九、六十七、七十九、九十一、一百一十、一百一十二条）. + +### 2. Refraining from creating or selling game cheats and aids, including AI tools that only capture screenshots without touching memory + + +- Cost: There is no monetary cost. The trade‑off is giving up potential income from such orders and “small tools.” The difficulty lies in the fact that this money comes quickly and it’s unclear who might eventually pursue legal action. +- In plain terms: Selling to just 20 users or earning 5,000 yuan is enough to qualify as “serious circumstances,” leading to a sentence of up to three years. In especially serious cases the penalty ranges from three to seven years. One developer who created aim‑assist and wall‑hack cheats sold them over 80,000 times in three months, netting more than 30,000 yuan; he received a one‑year suspended sentence plus a 5,000‑yuan fine. Another individual obtained the game’s server code, ran a private server, and collected over 20 million yuan in payments; he was sentenced to four years in prison and fined up to 10 million yuan. +- Benefit: Distributing programs or tools designed to intrude upon or illegally control computer systems can result in imprisonment of up to three years, along with a fine, or a fine alone if the circumstances are deemed “serious.” For especially serious cases the sentence rises to three‑seven years plus a fine. The threshold for “serious circumstances” is reaching 20 users or generating at least 5,000 yuan in illicit profit. Intentionally bypassing or sabotaging technical protection measures may also constitute copyright infringement, punishable by up to three years, or up to ten years in more severe instances. Official examples include Wang and others who sold memory‑modifying cheats; they earned over 30,000 yuan in three months and received a one‑year suspended sentence plus a 5,000‑yuan fine. Another case involved Xiang and others who sold the “TZ” series of cheats, generating over 200,000 yuan; Xiang got three years suspended and a 20,000‑yuan fine. Liu and others obtained server code, altered parameters, and ran a private server that attracted over 20 million yuan in payments; they received sentences ranging from four years down to two years and six months, along with fines from 1 million to 1.3 million yuan nationwide. +- Evidence grade: A +- Notes: All published cheat‑related rulings involve programs that read or modify game memory and circumvent anti‑cheat systems. No official cases have yet addressed aids that merely capture screenshots or simulate keystrokes. Nevertheless, a recent ticket‑scaling case shows that even tools that do not touch memory but merely send requests can be deemed illegal data‑acquisition tools. Whether an act qualifies as a crime and which charge applies is determined by law‑enforcement agencies based on evidence supplied by game developers, not by the author’s interpretation. The requirement of just 20 users to meet the “serious circumstances” threshold is quite low. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第三款、第二百一十七条第六项）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第三条）. （深圳市公安局转载）；最高人民检察院 (2026). 上海静安：严惩制售游戏外挂黑灰产共护清朗网络空间. ；最高人民检察院 (2021). 2020 年度检察机关保护知识产权典型案例（案例五）. + +### 3. Do not write or sell scripts for ticket snatching, flash sales, fake orders, or coupon farming — even if they merely “automate button clicks” + +- Cost: No expense and no time required +- In plain terms: Even if a script does not modify memory or bypass security measures and merely sends requests faster than a human can, it still qualifies as illegal acquisition of computer system data. The legal threshold is either earning over 5,000 yuan or causing at least 10,000 yuan in losses. One individual bought multiple 12306 accounts and used them to snatch over 200 train tickets, netting more than 20,000 yuan; he was sentenced to 1 year and 6 months in prison, suspended for the same period, plus a fine of 5,000 yuan. Another person sold ticket‑snatching software online and was found guilty of unfair competition, ordered to pay 20,000 yuan in damages. +- Benefit: Illegally accessing computer systems or obtaining their data via any technical means can lead to imprisonment of up to 3 years, a fine, or both; more serious cases incur 3–7 years in prison. The threshold for “serious circumstances” is earning over 5,000 yuan illegally or causing losses exceeding 10,000 yuan. Official cases include a person who used a bot to submit numerous ticket‑purchase requests using purchased 12306 accounts; he snatched more than 200 tickets and earned over 20,000 yuan, resulting in the same sentence as above. Zheng sold ticket‑snatching software for a specific booking app and was ordered to pay 20,000 yuan for unfair competition (national precedent). +- Evidence grade: A +- Notes: Even scripts that do not alter memory or bypass security and merely operate faster than humans still fall under Article 285 of the Criminal Law. Both paid ticket‑snatching services and selling such scripts are considered profit‑generating activities. No official cases have been reported for individuals using such scripts solely for personal use. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. ；最高人民检察院 (2026). 上海静安：查办利用外挂软件批量代抢火车票牟利案. ；最高人民法院 (2025). 2024 年人民法院知识产权典型案例（案例七，抢票软件不正当竞争案）. + +### 4. The crawler only accesses publicly available pages that require no login; it does not attempt to bypass anti-scraping measures or handle any personal information, and any data it collects is never sold. + +- Cost: No cost at all. A crawler is simply a program that automatically browses web pages and extracts the data on them. Before running one, check the robots.txt file and any API authorization guidelines — robots.txt is a file placed by website owners in their root directory that lists pages they do not want crawlers to access. Any data that requires a login, a token (a temporary access credential), or signature decryption to obtain is not targeted. The real challenge is resisting the temptation to collect such data even when technical means make it easy to do so — this depends entirely on self-discipline. +- In plain terms: Any data that requires a login, a token, or signature decryption to access falls under bypassing protective measures; violations are punishable by up to 3 years in prison, or 3 to 7 years in more serious cases. Collecting personal information brings even heavier penalties. Possessing 50 or more records related to personal movement, communications, credit history, or financial information is already considered a serious offense. The same applies if you collect 500 or more records on accommodation, health, or transaction details, 5000 or more records of other types, or earn 5000 yuan or more from such activities. +- Benefit: Illegally accessing system data by bypassing protective measures carries the same sentencing range as the third item (scripts used for ticket scalping or flash sale fraud): up to 3 years in prison, or 3 to 7 years in more serious cases. Illegally obtaining, selling, or providing citizens’ personal information also triggers heavy penalties if any of the following thresholds are met: 50 or more records on personal movement, communications, credit history, or financial details; 500 or more records on accommodation, communications, health, or transaction information; 5000 or more records of other types; or illegal earnings of 5000 yuan or more. Serious violations result in up to 3 years in prison, plus a fine or fine alone; extremely serious cases are punished with 3 to 7 years in prison. A real-world example: software developer Li used a feature disguised as a “face beauty detection” tool to steal 1751 facial photos from users’ phone albums, then sold data from a social engineering database he had compiled — he was sentenced to 3 years in prison, suspended for 3 years. A social engineering database is a collection of personal information leaked from various sources. Another case: an internet technology firm used a crawler to harvest store and order data from a food delivery platform, causing over 40,000 yuan in losses; it was prosecuted for illegally obtaining data from a computer information system (this case is documented nationwide). +- Evidence grade: A +- Notes: A 2017 judicial interpretation states that “providing information lawfully collected from others without their consent” also counts as “providing personal information” under the law. This provision also applies to companies that share user databases with external partners. 5000 records is roughly the size of a small database table. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款、第二百五十三条之一）. ；最高人民法院、最高人民检察院 (2017). 关于办理侵犯公民个人信息刑事案件适用法律若干问题的解释（第三、四、五条）. ；最高人民检察院 (2022). 检察机关依法惩治侵犯公民个人信息犯罪典型案例（案例二）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例一）. + +### 5. Refuse development orders for gambling, fraud, or adult-content apps; do not set up payment gateways or unblock accounts for such “clients” + + +- Cost: No direct monetary cost. The trade-off is forgoing outsourcing projects that pay well but have vague requirements. The difficulty lies in the fact that these clients often offer significantly higher pay than normal projects. +- In plain terms: Taking on such high-paying yet poorly defined projects means you could be treated as an accomplice in gambling crimes, facing charges under the crime of operating illegal gambling dens: up to 5 years in prison, or 5–10 years for serious cases. This is not the “merely helping out, maximum 3 years” category. In one e-sports betting app case, 28 developers in Hainan were sentenced to 1–3 years and 6 months for operating illegal gambling dens. Those who unblocked QQ accounts for fraud rings received 1 year and 6 months in prison plus a 20,000-yuan fine. +- Benefit: Providing technical support or payment settlement services to known online criminals can lead to imprisonment of up to 3 years and/or a fine, especially when the circumstances are serious. If other crimes are also involved, the harsher penalty applies. Operating illegal gambling dens carries up to 5 years in prison plus a fine; serious cases bring 5–10 years. Official examples: Zhangsheng Group developed gambling games and handled “online distribution,” earning fees for website setup and reporting; the total illicit revenue reached nearly 7 billion yuan. Its leader was sentenced to 9 years and 9 months plus a 50-million-yuan fine. 79 developers, including Wang Qiang, received sentences ranging from 6 months to 9 years and 9 months. In another case, 28 developers in Hainan who built an e-sports betting app were convicted of operating illegal gambling dens and received similar sentences, plus fines. One individual who ran a studio unblocking QQ accounts for fraudsters got 1 year and 6 months in prison and a 20,000-yuan fine (nationwide). +- Evidence grade: A +- Notes: “Knowing intent” does not require the client to explicitly state the purpose. When a quote is far above market rates, the app includes top-up, cash-out, and betting features, and the client refuses to disclose usage, these facts are used to prove you were aware of the illegal nature. Developers of gambling apps are prosecuted as accomplices in operating illegal gambling dens, not under the “Crime of Assisting Information Network Criminal Activities” which caps at 3 years. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十七条之二、第三百零三条第二款）. ；最高人民检察院 (2023). 建赌博网站并出售，涉案近 70 亿元. ；最高人民检察院 (2022). 上海闵行区：办理一起新型开设网络赌场案. ；最高人民检察院 (2025). 依法惩治帮助信息网络犯罪活动及相关犯罪典型案例（案例一）. + +### 6. Upon leaving a job, return all account access rights; do not delete databases, leave backdoors, or alter password protection systems — even if the employer owes you wages. + +- Cost: No cost involved. If the employer owes you wages, pursue them through labor arbitration (see Section 7 on labor arbitration). The real challenge is resisting the urge to tamper with the system while angry. +- In plain terms: Account credentials are issued by the employer, but they do not remain valid after you leave the job. Logging in using those credentials constitutes illegal control of computer systems, punishable by up to 3 years in prison. Deleting data to render the system inoperable is punishable by up to 5 years in prison; more severe cases incur sentences exceeding 5 years. One example: a dismissed senior engineer logged into his former employer’s servers using his original admin credentials, deleted data and logs, resulting in over 120,000 yuan in losses. He was sentenced to 3 years in prison, suspended for 5 years, and fined 30,000 yuan. +- Benefit: Illegal control of computer information systems is punishable by up to 3 years in prison, with or without a fine; more serious cases incur sentences ranging from 3 to 7 years. Deleting or altering system functions or data to the point the system cannot operate normally is punishable by up to 5 years in prison; more severe cases incur sentences exceeding 5 years. Official cases include: after being dismissed, senior IT engineer Lü used his original admin account to access his former employer’s shared servers, changed passwords, and deleted data and logs, causing over 120,000 yuan in losses; he received the same sentence as above. Another case: Bai, an employee at a software firm, deliberately inserted faulty code into an upgrade program, rendering client systems inaccessible and causing over 40,000 yuan in losses; he was prosecuted for disrupting computer information systems nationwide. +- Evidence grade: A +- Notes: Account credentials are issued by the employer, but they do not remain valid after you leave the job. Logging in using original credentials constitutes “illegal control.” Losses are calculated based on data recovery costs; amounts in the tens of thousands of yuan are sufficient to initiate legal proceedings. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款、第二百八十六条）. ；最高人民检察院 (2024). 检察机关「依法惩治网络犯罪 助力网络空间综合治理」典型案例（案例六）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例七）. + +### 7. Do not take source code, client lists, or technical documents upon leaving; do not upload them to personal cloud drives or reuse them at new employers + +- Cost: No cost involved. Before leaving, simply delete all company-related files from your personal computer and cloud drives. The difficulty lies in the fact that some files were written by you personally, making it hard to part with them. +- In plain terms: Even code written by you personally remains the company’s intellectual property — taking it away is essentially stealing company assets. Client lists also qualify as trade secrets. In one case, a former employee who took source code and core algorithms of a security inspection system to a new employer was sentenced to 5 years in prison and fined 500,000 yuan; the new employer was fined 4 million yuan. Another individual who exploited system vulnerabilities to download over 33,000 design files was sentenced to 1 year and 10 months in prison and fined 100,000 yuan. Beyond criminal penalties, companies can also pursue separate civil compensation claims. +- Benefit: Violating confidentiality obligations by disclosing or personally using trade secrets may result in imprisonment of up to 3 years, along with a fine or both. In more serious cases, the sentence ranges from 3 to 10 years, plus a fine. The Anti-Unfair Competition Law also deems two acts as violations: using technical means to illegally access systems and obtain trade secrets, and aiding or abetting others in breaching confidentiality. Official examples include the aforementioned cases where former employees took source code and algorithms to new employers, resulting in heavy criminal and financial penalties. Additionally, an engineer who stored App module source code on personal devices and later developed a similar product after changing jobs was prosecuted for trade secret infringement nationwide. +- Evidence grade: A +- Notes: Code written by employees remains the company’s property, as stipulated in Article 13 (code developed using company resources belongs to the company). Taking such code away is equivalent to stealing company assets. Client lists are classified as business information and also qualify as trade secrets. Apart from criminal penalties, companies may also file separate civil lawsuits for compensation. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百一十九条）. ；全国人大常委会 (2025). 反不正当竞争法（2025 年修订，第十条）. ；最高人民检察院 (2025). 检察机关知识产权保护典型案例（案例七）. ；最高人民检察院 (2020). 2019 年度检察机关保护知识产权典型案例（案例十六）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例五）. + +### 8. Do not run your own programs on others’ computers, servers, or cameras; do not use company machines for mining + +- Cost: No expense and no time loss +- In plain terms: Controlling someone else’s computer, server, or camera without permission is illegal. Operating 20 or more such devices qualifies as a serious offense, punishable by up to 3 years in prison; especially severe cases may incur 3 to 7 years. Even if it does not rise to a criminal offense, offenders can still be detained for up to 5 days and fined between 50,000 and 500,000 yuan. For tech professionals, the most damaging consequence is a lifelong ban from holding key positions in cybersecurity management and network operations after any criminal conviction. +- Benefit: Illegally controlling computer information systems is a crime. Serious cases result in up to 3 years in prison plus a fine; especially severe cases incur 3 to 7 years. Controlling 20 or more devices is deemed “serious.” Those not meeting criminal thresholds still face confiscation of illegal gains, up to 5 days of detention, and fines ranging from 50,000 to 500,000 yuan. More serious violations bring 5 to 15 days of detention and fines from 100,000 to 1,000,000 yuan. Anyone with a prior public security penalty is barred for 5 years, while those with a criminal record are barred for life from critical cybersecurity and network operation roles. Example: Li was sentenced to 3 years in prison suspended for 5 years and fined 20,000 yuan after using software to illegally control 105 surveillance cameras; Wu and others received 2 to 4 years and 6 months in prison for implanting malware into mobile phone motherboards to harvest verification codes from over 3.3 million devices. +- Evidence grade: A +- Notes: No published cases from China’s Supreme People’s Procuratorate or Supreme People’s Court address mining on company servers; this entry is written under the legal provision concerning unauthorized system control. The lifelong ban from key roles is an additional consequence under China’s Cybersecurity Law, carrying heavier weight for tech professionals than monetary fines alone. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十九、六十六条；2016 年文本为第二十七、六十三条，终身禁业为修正后的第六十六条第三款）. ；最高人民检察院 (2022). 山东滨州开发区：办理一起非法控制计算机信息系统案. ；最高人民检察院 (2021). 充分发挥检察职能 推进网络空间治理典型案例（案例六）. + +### 9. Testing someone else’s systems without written permission — “good intentions” and “reporting afterward” are not excuses + + +- Cost: No cost at all. Before joining a vendor’s SRC or public beta test, obtain a document that clearly defines the permitted scope, target systems, and allowed testing windows. An SRC is a vendor-run security response center designed to receive external vulnerability reports. Once a vulnerability is confirmed, testing must stop. The real challenge is resisting the urge to “give it a quick try.” + +- In plain terms: Whether a crime is established depends solely on whether you had permission and how much access you obtained — not on your intentions. Possessing 500 sets of ordinary account credentials, or earning 5,000 yuan while causing 10,000 yuan in losses, is enough to warrant a sentence of up to three years. Even a single attempt to export a user list to prove a vulnerability often exceeds that 500‑credential threshold. Using credentials you already possess outside their authorized scope also constitutes unauthorized access. + +- Benefit: This law applies to computer information systems belonging to ordinary companies and individuals, excluding those used for national affairs, defense, or cutting‑edge scientific research. Unauthorized intrusion or use of any technical means to obtain stored, processed, or transmitted data may lead to imprisonment of up to three years, a fine, or both, if the circumstances are serious; for especially serious cases, the sentence ranges from three to seven years with a fine. “Serious circumstances” include obtaining ten or more authentication credentials for online financial services such as payments or securities trading, 500 or more other authentication credentials, illegally controlling 20 or more computers, or earning illicit profits exceeding 5,000 yuan or causing losses above 10,000 yuan. Five times these thresholds define “especially serious” circumstances. Prosecutorial Example No. 36 states that “using accounts or passwords beyond the granted scope to log into a computer system is itself an act of unauthorized intrusion.” In that case, three individuals used work‑related credentials to access their company’s internal system, downloaded non‑work data, and sold it for 37,000 yuan; they received sentences of 4 years, 3 years 9 months, and 4 years respectively, plus fines of 40,000 yuan each. + +- Evidence grade: A + +- Notes: Prosecutorial Example No. 36 involves a data‑selling scheme; it is cited only for the principle that exceeding authorized scope counts as intrusion, not to suggest that well‑meaning tests incur identical penalties. Intentions and post‑test reporting cannot erase criminal liability; they may only influence sentencing or whether charges are filed. A vendor’s initial thanks and later filing of a report are not mutually exclusive — gratitude does not equal permission. At the time of writing, no publicly documented cases on permissible testing were found on the Supreme People’s Court or Supreme People’s Procuratorate websites; therefore this description relies on statutory provisions and penalty criteria. Always participate through a vendor’s official SRC or under a written contract that specifies scope, targets, and time limits. To prove a vulnerability, collect only minimal evidence and avoid bulk data extraction. Even conduct that does not meet criminal thresholds remains subject to administrative penalties, professional bans, and fines comparable to those outlined in Section 8 (running unauthorized programs on others’ machines). Guidance on post‑disclosure procedures appears in Section 10 (reporting vulnerabilities as required). +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第一款、第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. （深圳市公安局转载）；最高人民检察院 (2017). 第九批指导性案例（检例第 36 号，卫梦龙、龚旭、薛东东非法获取计算机信息系统数据案）. + +### 10. Vulnerabilities must be reported per regulations; no details, exploit tools, or disclosure to foreign entities before patching + + +- Cost: No cost involved. Simply report the vulnerability to the product vendor or an official platform. Until the vendor releases a patch, no details or verification code should be disclosed. + +- In plain terms: The “Regulations on the Management of Security Vulnerabilities in Network Products” applies not only to companies but also to individuals. There are five strict rules for vulnerability disclosure; the first two state that no details about vulnerabilities affecting active systems may be released before a vendor provides a fix. Additionally, no programs or tools specifically designed to exploit those vulnerabilities may be published, and any release must include instructions on how to remediate them. One often-overlooked rule: unreported vulnerabilities must not be shared with any foreign organizations or individuals outside the vendor. + +- Benefit: These regulations govern three main groups: domestic network product vendors, network operators, and any organizations or individuals involved in discovering, collecting, or publishing vulnerability information. No entity may use vulnerabilities to compromise network security, nor may they illegally collect, sell, or distribute such information. Five additional rules apply to public disclosure: first, nothing may be released before a vendor provides a patch; second, no details about vulnerabilities in active networks or systems may be published; third, no exaggerated claims about risks or malicious exploitation attempts may be made; fourth, no tools or programs designed for malicious exploitation may be released; and fifth, any disclosure must include remediation steps. Unreported vulnerabilities must also not be shared with foreign entities. The regulations encourage reporting to four official platforms: the Ministry of Industry and Information Technology’s Cybersecurity Threat and Vulnerability Information Sharing Platform; the National Cybersecurity Information Notification Center’s Vulnerability Platform; the National Computer Network Emergency Response Technical Team/Coordination Center of China’s Vulnerability Platform; and the China Information Security Evaluation Center’s Vulnerability Database. Violators may face penalties ranging from fines of 10,000 to 100,000 RMB, suspension of services, revocation of licenses or business licenses, and even criminal liability for responsible personnel. + +- Evidence grade: A + +- Notes: This regulation explicitly includes individuals as subjects; claiming “I’m just an amateur” does not exempt anyone from compliance. Submitting vulnerabilities found in domestic systems to foreign bug bounty platforms violates the rule prohibiting disclosure to foreign entities. This rule addresses how vulnerabilities must be handled after discovery. Whether one is legally permitted to test systems depends on other provisions, such as the requirement for written authorization before testing any system. Even legally discovered vulnerabilities may incur penalties if disclosed improperly. Unauthorized testing results in violations on both fronts. Among reporting channels, the MIIT platform and CNCERT are most commonly used. The regulations do not specifically address cases where a vendor is notified but fails to act; in practice, documentation of negotiation and reporting processes is required before official submission. +- Sources:工业和信息化部、国家互联网信息办公室、公安部 (2021). 网络产品安全漏洞管理规定（工信部联网安〔2021〕66 号，第二、四、九、十、十四条，2021 年 9 月 1 日施行）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十八、六十五条；2016 年文本为第二十六、六十二条，规定第十四条援引的是 2016 年文本的条号）. + +### 11. No selling of tools for bypassing firewalls or VPN accounts, no setting up such nodes for others + +- Cost: No expense or time required +- In plain terms: Any individual or entity that builds their own outbound network connections or uses international channels outside of state-provided public telecom services may be ordered by police to cease internet access, receive a warning, and face fines up to 15,000 yuan plus confiscation of any illegal earnings. Those running businesses based on such services may be charged with illegal business operations; in severe cases, imprisonment of up to five years applies. This rule specifically addresses selling or setting up such nodes. For personal use only, the maximum penalty remains limited to a warning and fine as stipulated in Article 14 of the provisional regulations. +- Benefit: Direct international internet connectivity must be facilitated via international gateway channels supplied by state-owned telecom networks. No organization or individual may independently establish or utilize any other channels, meaning neither private outbound connections nor third-party nodes are permitted. Violators face police orders to disconnect from the internet, warnings, and possible fines up to 15,000 yuan plus confiscation of illicit profits. Commercial operators violating this rule may be prosecuted for illegal business operations; severe violations incur up to five years imprisonment plus fines ranging from one to five times the illegal earnings. Particularly egregious cases may result in imprisonment exceeding five years nationwide. +- Evidence grade: B +- Notes: At the time of drafting, no publicly documented court rulings regarding firewall circumvention were found on Supreme People’s Court or Supreme People’s Procuratorate websites, and regional enforcement practices vary widely; hence this B rating was assigned. This section exclusively addresses selling or setting up such nodes. For personal usage alone, the maximum penalty remains limited to warnings and fines as outlined in Article 14 of the provisional regulations. +- Sources:国务院 (1997). 计算机信息网络国际联网管理暂行规定（第六、十四条）. （重庆市农业农村委员会转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百二十五条第四项）. + +### 12. After signing a non-compete agreement, if the employer fails to pay compensation monthly, send a written notice; if payment still doesn’t come after 3 months, you may terminate the agreement. Workers who never handled any trade secrets can request that the clause be declared invalid. + + +- Cost: No cost involved. Keep the original non-compete agreement and any proof that the employer didn’t make monthly payments after leaving the job. + +- In plain terms: A non-compete clause simply means you’re not allowed to work for a competitor for a certain period after leaving your job. This rule is there to protect you. The maximum duration is 2 years, and the employer must pay compensation every month. If the amount isn’t specified, it’s calculated as 30% of your average monthly wage over the previous 12 months, and it can’t be lower than the local minimum wage. If the employer fails to pay for 3 months due to its own reasons, you can ask to end the agreement. Starting in 2025, workers who never learned about or handled any trade secrets at their job can request that the non-compete clause be ruled invalid. + +- Benefit: Non-compete clauses only apply to senior executives, highly skilled technicians, and anyone with a duty to keep secrets. The maximum term is 2 years, and the employer must provide monthly financial compensation during that time. If the amount isn’t set, it’s 30% of your average monthly wage over the last 12 months, never lower than the local minimum wage. If the employer doesn’t pay for 3 months for reasons on its end, you can ask to cancel the clause. If the employer ends it voluntarily, it must pay an extra 3 months of compensation. From 2025, workers who never knew about or touched any trade secrets can ask to have the clause declared void. Any part of the clause that goes beyond what they actually knew about is also invalid. Official case example: A pharmaceutical firm sued its former CTO, Zheng, seeking 7.1 million yuan in damages. The court ruled that Zheng’s new employer’s products had no overlap with the original firm’s offerings, so the non-compete scope should be limited to what Zheng actually knew. The claim was dismissed in full (nationwide ruling). + +- Evidence grade: A + +- Notes: This rule is there to protect you. On the flip side, if the agreement is valid and the employer pays as required, but you still go to work for a competitor, you’ll have to pay the agreed-upon penalty. Even after paying that, you might still be required to serve out the remaining non-compete period. Non-compete terms agreed upon while you’re still employed also count as valid, even if no extra payment is made by the employer. +- Sources:全国人大常委会 (2012). 劳动合同法（2012 年修正，第二十三、二十四条）. （抚顺市应急管理局转载）；最高人民法院 (2020). 关于审理劳动争议案件适用法律问题的解释（一）（第三十六至四十条）. ；最高人民法院 (2025). 关于审理劳动争议案件适用法律问题的解释（二）（法释〔2025〕12 号，第十三至十五条）. ；最高人民法院 (2025). 劳动争议典型案例（案例四）. + +### 13. Code written during work hours using company resources belongs to the company; personal open‑source projects should be done in your own time and on your own equipment, without mixing them. + + +- Cost: No cost involved. When you start a new job, be sure to read the intellectual‑property clauses in your employment contract. The main difficulty is that personal projects and work tasks often share the same computer, so you must keep them separate. + +- In plain terms: Work‑related creations are defined as works made in the course of your duties. Software is explicitly listed in law as “copyright belonging to the employer.” If a program is primarily produced using company hardware, internal networks, or business data — and the company assumes responsibility for it — then the copyright rests with the employer. The same applies when the contract states this. As the creator, you retain only the right to be credited. Inventions developed using company resources also belong to the company, with patent rights following the same rule. Even if you write code “after hours,” using a company computer or business data can still make it qualify as a work created mainly with employer resources. + +- Benefit: Works produced to fulfill job duties are considered “work‑made‑for‑hire.” Under normal circumstances the author keeps copyright, while the employer has the right to use them for its own business and may not allow third parties to use them in the same way for two years. However, two exceptions exist: works such as software or engineering designs that are created mainly with employer resources and for which the employer bears responsibility, and any works expressly assigned to the employer by contract. In both cases the author retains only the right to be credited. “Employer resources” include hardware, internal networks, and business data. Inventions created while performing job duties or using those same resources are classified as “work‑made‑for‑hire inventions,” with all patent rights belonging to the employer nationwide. + +- Evidence grade: A + +- Notes: Software is explicitly categorized as “copyright belonging to the employer,” so programmers rarely qualify for the standard rule granting them copyright while the employer retains a two‑year exclusive right to use it. Code written outside work hours can still be deemed a product of employer resources if it is produced on a company computer, accessed company networks, or uses business data. To keep personal projects truly separate, use your own machine, avoid company repositories, and ensure they do not overlap with any company work. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第十八条）. ；全国人大常委会 (2020). 专利法（2020 年修正，第六条）. + +### 14. Using open-source code such as GPL in products: comply with licensing requirements by open-sourcing or switching licenses; this does not mean “no one cares” + + +- Cost: There is no cost involved. Before using someone else’s open-source code, simply check its license — that is, the usage terms set forth by the author. GPL-type licenses require that any product using them also release its source code, which conflicts with selling closed-source products for profit; in such cases, you must switch to another license. The real difficulty lies in giving up a library you’ve already grown comfortable using. + +- In plain terms: Copyright infringement requires compensation based on the actual losses suffered by the rights holder or the profits you’ve earned. If neither can be accurately calculated, compensation is determined by what a normal licensing fee for that software would be. For intentional and serious violations, penalties can reach 1 to 5 times that amount. In one case, a defendant hired a former employee of the plaintiff to develop gateway software; the code was substantially similar to the plaintiff’s. The defendant argued that since the plaintiff’s software was originally based on GPLv2 and thus required to be open-sourced, no infringement occurred. The Supreme People’s Court ruled these two issues — whether GPLv2 was violated and whether copyright existed — were independent matters, and ordered the defendant to cease infringement and pay 500,000 yuan in compensation. + +- Benefit: Copyright infringement demands compensation calculated either from the rights holder’s actual losses or from the infringer’s profits. When neither figure can be precisely determined, compensation is set based on what a standard licensing fee for such software would be. Intentional and severe violations may incur penalties up to fivefold compensation. If public interests are harmed, illegal profits may also be confiscated and fines imposed. Official case reference: (2021) Supreme People’s Court Civil Appeal No. 51. In this case, a defendant hired a former employee of the plaintiff to develop gateway software nearly identical to the plaintiff’s product. The defendant claimed that since the plaintiff’s software was originally under GPLv2, it should have been open-sourced anyway; the Supreme Court ruled that whether GPLv2 was violated and whether copyright existed were separate issues, ordering the defendant to cease infringement and pay 500,000 yuan nationwide. + +- Evidence grade: B + +- Notes: This case demonstrates that merely claiming “the other party used GPL code” cannot serve as a valid defense for your own copying. Conversely, GPL authors have successfully sued commercial entities that failed to open-source their products in China; however, no official text of such rulings could be found on the Supreme People’s Court website, so they are not cited here. This item is rated B because compliance with open-source licensing relies solely on general contract and copyright laws rather than any dedicated statutory provisions. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第五十三、五十四条）. ；最高人民法院知识产权法庭 (2022). 涉「开源软件」著作权侵权案（（2021）最高法知民终 51 号）. + +### 15. Only collect personal data strictly necessary for the app’s operation; consent from guardians is required for users under 14, and the privacy policy must be clearly written. + + +- Cost: No cost involved. Before launch, cross‑check the list of permissions the app requests against the privacy policy and remove any unnecessary permissions. The main challenge is that product teams often want to retain data “just in case it might be useful later.” + +- In plain terms: Only gather information that is genuinely needed for business purposes, and obtain consent from a guardian for any user under 14. For violations, regulators first order corrections and issue warnings, and may also confiscate illegal earnings; the app can be ordered to suspend or terminate its services. If the violation persists, fines up to 1 million RMB can be imposed on the app, while individuals directly responsible may be fined between 10,000 and 100,000 RMB. In severe cases, fines can reach 50 million RMB or 5 % of the previous year’s revenue, and responsible personnel may face fines from 100,000 to 1 million RMB. The term “directly responsible personnel” can include the technical and product staff who actually implement the app. + +- Benefit: Personal data should be processed only for a clear, legitimate purpose that is directly related to that purpose, using methods that minimize impact on individuals’ rights. Consent from the individual is required unless another legal basis applies. For users under 14, consent from parents or guardians is mandatory. Violations lead to regulatory orders to correct the problem, warnings, and confiscation of illegal earnings; the offending app may be suspended or shut down. Persistent breaches incur fines up to 1 million RMB, while responsible managers and staff may be fined between 10,000 and 100,000 RMB. In extreme cases, fines can exceed 50 million RMB or 5 % of annual revenue, and those individuals may be barred from serving as directors, supervisors, or executives of related companies. Criminal acts involving the sale or disclosure of personal data are covered under Section 4 (National). + +- Evidence grade: B + +- Notes: In practice, the “directly responsible personnel” label often applies to developers and product managers. The Ministry of Industry and Information Technology regularly publishes lists of removed or penalized apps; however, no specific announcement was identified for this section, so it is not cited here. +- Sources:全国人大常委会 (2021). 个人信息保护法（第六、十三、三十一、六十六条）. + +### 16. Before launching a website or app, complete ICP filing and retain logs for at least 6 months per classification protection requirements + +- Cost: Filing itself is free; using a cloud provider’s process typically takes a few weeks. Classification protection assessments are charged based on the level of the system. Classification protection, also known as “DB”, is a set of national security management measures that classify systems by importance and set corresponding requirements for websites and systems; small websites generally do not need to undergo assessments. +- In plain terms: ICP filing costs nothing and takes a few weeks via a cloud provider’s process. Domains cannot be resolved at all without filing for servers located within China. Entities that fail to file must first be ordered to make corrections; if they refuse, their websites are shut down. Failing to display the filing number on a homepage results in fines ranging from 5,000 to 50,000 yuan. If a site is registered as non-commercial but actually charges fees, it is treated as operating without a license: any illegal earnings are confiscated and fines of 100,000 to 1,000,000 yuan apply. Logs must be retained for at least 6 months; failure to do so results in orders to correct the issue and warnings, and if ignored or if consequences occur, fines of 10,000 to 100,000 yuan are imposed. +- Benefit: Commercial internet information services require a license, while non-commercial ones must be filed. Operating without a license or filing is prohibited. Entities that fail to file must be ordered by telecom regulators to make corrections; refusal leads to website shutdowns. Unlicensed operations result in confiscation of illegal earnings and fines of 3 to 5 times that amount, or 100,000 to 1,000,000 yuan. Not displaying the filing number on a homepage incurs fines of 5,000 to 50,000 yuan. Network operators must develop security management policies per classification protection rules, guard against attacks, retain network logs for at least 6 months, and classify, back up, and encrypt data. Failure to comply leads to orders to correct the issue and warnings; if ignored or if consequences occur, fines of 10,000 to 100,000 yuan are imposed, and responsible personnel face fines of 5,000 to 50,000 yuan nationwide. +- Evidence grade: A +- Notes: Domains cannot be resolved at all without filing for servers located within China. Two scenarios commonly lead to trouble: first, registering a site as a personal non-commercial entity while actually charging fees; second, changing the domain name or entity without updating the filing. Retaining logs for 6 months is both a legal obligation and a protective measure — it can prove your innocence in case of incidents. +- Sources:国务院 (2011). 互联网信息服务管理办法（2011 年修订，第四、十九、二十二条）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十三、六十一条；2016 年文本为第二十一、五十九条）. + +### 17. Before offering generative AI services to the public, conduct required safety assessments and algorithm registration; mark all generated content + +- Cost: There is no monetary cost, but you must follow procedures set by internet regulators — completing them takes some time. Small personal tools that are not made available to the public do not fall under these rules. +- In plain terms: If you offer generative AI services with public influence or social mobilization potential to the general public, you must perform a safety assessment and register the algorithm per national regulations before launch. Any changes or shutdowns also require filing updates or cancellation paperwork. All generated images and videos must be clearly marked. Tools meant solely for personal use and not open to the public are exempt from these requirements. The regulation itself does not specify penalties; violations are handled under the Cybersecurity Law, Data Security Law, and Personal Information Protection Law. +- Benefit: Providers of generative AI services that can shape public opinion or mobilize people must conduct safety assessments, register their algorithms, and handle subsequent updates or cancellations as required by law. “Public influence” or “social mobilization potential” means the ability to affect how people think or to organize them. Providers must also add identifying marks to any generated images or videos. This regulation took effect nationwide on August 15, 2023. +- Evidence grade: B +- Notes: The regulation itself does not state exact penalty amounts. Violations are penalized under the Cybersecurity Law, Data Security Law, and Personal Information Protection Law, which is why this item is rated B. No civil cases involving copyright or portrait rights violations caused by AI‑generated content are cited here, as the original texts were not verified on the Supreme People’s Court website. +- Sources:国家互联网信息办公室等七部门 (2023). 生成式人工智能服务管理暂行办法（第十二、十七条）. diff --git a/book/12-Starting-Your-Own-Business.md b/book/12-Starting-Your-Own-Business.md new file mode 100644 index 00000000..10a4410a --- /dev/null +++ b/book/12-Starting-Your-Own-Business.md @@ -0,0 +1,241 @@ +# 12. Starting a business: how to protect your personal assets + +This section deals with money and legal liability. What steps could potentially put your own savings, your family’s money, and even your spouse’s funds at risk when opening a shop or forming a company? What does the law say about this? Is it possible to set up safeguards in advance? This section answers those questions without trying to convert the risks into life‑years lost. The items are ordered from the scenarios that most easily threaten personal assets to those that are easiest to avoid. Consequently, items that require only a signature come first, while methods that demand hands‑on effort appear later. Any statements based purely on experience and lacking supporting research are marked as Grade C evidence. +### 1. Only invest money you can afford to lose — never use family savings or borrowed funds + +- Cost: Zero upfront cost. Before you start, set a personal limit: this is the maximum amount you can lose without affecting your mortgage payments, child support, or medical expenses. Do not invest any more than this figure. Family funds and borrowed money must be excluded from this limit. The real challenge arises when your business starts showing promise — you must resist the urge to pour in extra capital. +- In plain terms: Any debts incurred by a sole proprietorship must be repaid using your personal assets and funds. If it’s unclear whether the business was run by the whole family, all family assets become liable. Even forming a corporation does not offer protection: when a company defaults on its debts, creditors may demand immediate payment of any portion of the subscribed registered capital that was promised but not yet paid. Therefore, your investment cap must be determined based on the principle: “I can afford to lose this amount without affecting my mortgage or medical bills.” +- Benefit: Losing money is not the only risk. For sole proprietorships, debts are tied to personal assets if the business is run by one individual; if ownership is shared or unclear, the entire family’s assets become liable. Jointly signed debts between spouses are considered mutual obligations; even debts acknowledged later by one spouse are included. If a spouse took out a loan in their own name, it still counts as a joint debt if the creditor proves it was used for the couple’s shared business. Corporations face similar rules: when a company cannot meet its debt obligations, creditors may demand immediate payment of any unpaid portion of the subscribed registered capital promised by shareholders (nationwide). +- Evidence grade: B +- Notes: “Money you can afford to lose” means an amount that won’t force you to sell your home or borrow from relatives. No verifiable official statistics on business survival rates or average lifespan were found on the websites of China’s National Bureau of Statistics or State Administration for Market Regulation. Hence, no numerical figures are included here; only legal consequences are outlined, warranting a grade B rating. +- Sources:全国人大 (2020). 民法典（第五十六、一千零六十四条）. ；全国人大常委会 (2023). 公司法（2023 年修订，第四十七、五十四条）. + +### 2. Never sign personal guarantees for corporate loans; spouses should definitely avoid signing too + +- Cost: Zero expense. When a bank, supplier, or landlord asks you to sign a “personal joint and several guarantee” or requests your spouse’s signature, pause first. Signing such a document means you voluntarily waive the legal protection that shields personal assets from corporate debts (i.e. the principle of limited liability). Avoid signing if at all possible. If signing is unavoidable, opt for a “general guarantee” and explicitly state the maximum amount you agree to cover. The tough part is that parties often threaten “no loan release without your signature” — you must stand your ground. +- In plain terms: What you’re signing is a “joint and several liability guarantee”. If the company fails to repay its debts, creditors can bypass the company entirely and demand repayment from you. Choosing a “general guarantee” means creditors must first sue the company and liquidate all its assets before they can seek any repayment from you. If your spouse also signs the document, both of your personal assets become collateral, effectively nullifying the limited liability protection afforded by a limited liability company. +- Benefit: The wording in a guarantee contract essentially translates to “if the debtor fails to repay, you are obligated to pay instead”. For contracts labeled “joint and several liability guarantee”, creditors can skip suing the company and demand payment directly from you. For “general guarantee” contracts, creditors must first initiate legal proceedings against the company and liquidate its assets; only after that can they seek any remaining balance from you. Debts jointly guaranteed by both spouses are treated as joint and several debts, and any subsequent approval by one spouse also renders them jointly liable. Once a spouse signs the guarantee, both parties’ assets become collateral for the debt (nationwide, effective since 2021). +- Evidence grade: A +- Notes: Most banks require shareholders of small and micro enterprises to sign personal joint and several guarantees when issuing loans. This guideline is not meant to discourage you from taking out loans; rather, it urges you to fully understand what you’re agreeing to before signing. Also, cap the total guaranteed amount within the “affordable loss threshold” specified in guideline 1 (i.e. only risk capital you can afford to lose when starting a business). For general rules governing promissory notes and guarantee contracts, refer to Section 8, Clause 18. +- Sources:全国人大 (2020). 民法典（第六百八十一、六百八十七、六百八十八、一千零六十四条）. + +### 3. Choosing the right legal entity before launching: sole proprietors and general partners are fully liable, while limited liability companies offer “limited” liability + +- Cost: Registration can be completed online via local government portals in just a few hours. After establishing a limited liability company, monthly bookkeeping and tax filing become ongoing expenses — either you handle them yourself (which takes time) or you hire a professional accountant, with costs varying by region. +- In plain terms: Sole proprietors and general partners bear unlimited personal liability — they must repay all debts incurred by their business. Shareholders of a limited liability company, however, are liable only up to the amount they agreed to contribute at incorporation. That said, they must actually pay in that full amount within five years; if the registered capital is set at 1 million, that is the maximum potential debt they could face. Mixing personal and corporate finances nullifies this “limited” protection. +- Benefit: Debts incurred by a sole proprietorship must be repaid using the owner’s personal assets or those of their family. General partners in a partnership also bear unlimited joint and several liability — they must repay all partnership debts, with creditors allowed to demand full repayment from any single partner. Limited partners in a limited partnership are liable only up to their subscribed registered capital. The same rule applies to shareholders of a limited liability company. Nevertheless, this “limited” liability protection ceases to apply in three specific scenarios: first, the subscribed amount must be fully paid within five years of incorporation; otherwise creditors may demand early repayment if the company cannot meet its obligations. Second, any withdrawn capital must be returned. Third, using the company merely as a shield to evade debts invalidates this protection — this also applies to single‑shareholder firms where no clear separation exists between corporate and personal finances. In all such cases, shareholders or partners remain personally liable for all corporate debts (nationwide, effective July 2024). +- Evidence grade: A +- Notes: The “limited” liability principle hinges on strict separation between corporate and personal finances: corporate accounts must not be used for personal expenses, and complete financial records must be maintained. Avoid inflating the registered capital merely for appearance’s sake; the subscribed amount must be paid in full within five years. Setting it at 1 million means you could potentially owe up to 1 million in debts. +- Sources:全国人大 (2020). 民法典（第五十六条）. ；全国人大常委会 (2006). 合伙企业法（2006 年修订，第二条）. ；全国人大常委会 (2023). 公司法（2023 年修订，第四、二十三、四十七、五十三、五十四条）. + +### 4. Being a nominal shareholder without actually owning equity + +- Cost: There is no cost involved. If someone asks you to “lend your ID to register as a shareholder” or “hold shares under your name temporarily,” you should decline every time. +- In plain terms: Once your name is registered as a shareholder, you are legally considered a shareholder. You must pay the full amount of subscribed registered capital by the deadline set in the articles of association; failing to do so means you must not only make up the payment but also compensate the company for any resulting losses. If other shareholders fail to contribute their share of the capital when the company is founded, you are responsible for covering that shortfall as well. Even though someone else runs the business, all debts are recorded under your name. (National data, effective July 2024) +- Benefit: As a registered shareholder, you are recognized as a legal shareholder. You must pay the full amount of subscribed registered capital by the deadline specified in the articles of association; otherwise, you must not only make up the payment but also compensate the company for any resulting losses. If other shareholders fail to contribute their share of the capital at the time of company formation, they share joint liability for covering that shortfall. When the company cannot repay debts when due, creditors may demand immediate payment of any amounts still pending under the subscription agreement. Even though someone else actually runs the business, all debts are recorded under your name. (National data, effective July 2024) +- Evidence grade: B +- Notes: Whether a shareholding agreement between a nominal shareholder and the actual investor is legally valid, and how liability is allocated, is addressed in the Supreme People’s Court’s Provisions on Several Issues Concerning the Application of the Company Law (III). TODO: The official document number and the exact wording of Articles 24 and 25 could not be accessed on the Supreme People’s Court website at the time of writing; hence the evidence grade is set to B. For risks associated with being a nominal legal representative, see Section 8, Article 28. +- Sources:全国人大常委会 (2023). 公司法（2023 年修订，第四十七、四十九、五十、五十四条）. + +### 5. Check the Ministry of Commerce records before signing; obtain written disclosures and include a “cooling-off period” in the contract + +- Cost: There is no cost involved. Simply visit the Ministry of Commerce’s “Franchise Information Management System” website to verify whether the brand has been registered. Then ask the franchisor to provide you with written disclosures covering all required details prior to signing, along with the contract itself. This whole process takes just a few hours. +- In plain terms: By law, a franchisor must first operate at least two company-owned stores for a full year, and must register those stores with the Ministry of Commerce within 15 days after signing the franchise agreement. Before signing, it must also furnish you with written disclosures on 12 specific topics, including franchise fees, refund policies for deposits, and the profitability of existing stores. If a brand fails to register, refuses to provide these disclosures, or demands payment before letting you see the contract, you should walk away immediately. +- Benefit: Legal requirements mandate that any franchisor maintain at least two company-owned stores that have been operating for at least one year. Within 15 days of signing the franchise contract, it must register those stores with the relevant authorities; failure to do so results in fines ranging from 10,000 to 50,000 yuan. If registration is delayed further, fines rise to 50,000–100,000 yuan and the violation is publicly announced. Prior to signing, the franchisor must provide you with written disclosures on 12 mandatory topics, such as exact fee structures, conditions under which deposits are refundable, current franchisee numbers and their financial performance, summaries of audited financial statements from the past two years, and any past litigation or arbitration involving the brand. The contract must also explicitly state that franchisees may unilaterally terminate the agreement within a defined “cooling-off period” following signing. Should the franchisor conceal any facts or provide false information, franchisees retain the right to void the contract (effective nationwide since May 2007). +- Evidence grade: A +- Notes: If a brand cannot be verified via the registration database, refuses to provide required disclosures, or insists on payment before contract review, you should avoid it entirely. The “cooling-off period” refers to the specific window after signing during which franchisees may withdraw from the agreement unilaterally; this duration must be explicitly stated in the contract, as regulations only prescribe that it must be “a reasonable period.” When reviewing any disclosed figures regarding average sales, gross profit, or net profit among existing franchisees, always ask the brand to substantiate their sources, as regulations require them to disclose such data transparently. +- Sources:国务院 (2007). 商业特许经营管理条例（国务院令第 485 号，第七、八、十二、二十二、二十三、二十五条）. ；商务部 (2012). 商业特许经营信息披露管理办法（商务部令 2012 年第 2 号，第五、九条）. ；商务部. 商业特许经营信息管理系统. + +### 6. Determine the business name, location, scope of operations, and registered capital before registration; with complete documents, you can obtain the business license on the spot. + + +- Cost: There are no fees for the registration process itself. Since January 1, 2015, registration fees for both enterprises and individual businesses have been waived. Completing the process online via local government services or at a service center typically takes just a few hours. Costs related to engraving a company seal, hiring an accountant, or renting a registered address are charges for private services, not government fees. + +- In plain terms: Registration itself is free; registration fees have been eliminated since 2015. Only five types of documents are required: an application form, proof of identity or eligibility, documents confirming the business location, articles of association or partnership agreement (not needed for individual businesses), and any additional items specified by law. With all documents in order, the license is issued immediately; otherwise, it is processed within three working days. Any fees charged are usually for third‑party assistance. + +- Benefit: The regulations specify exactly five required documents: (1) an application form; (2) documents proving the applicant’s eligibility and identity; (3) papers confirming the business address; (4) articles of association or partnership agreement for companies and partnerships; and (5) any other materials mandated by laws or regulations. Additionally, companies must submit appointment documents and identification for their legal representative, directors, supervisors, and senior managers. Individual businesses are exempt from submitting articles of association. The business name must be declared voluntarily by the applicant, and the registered capital follows a commitment system — you state how much you intend to contribute, but no payment is required at the time. The scope of operations is chosen from categories published by the registration authority. When all documents are complete and correctly formatted, registration is confirmed on the spot; otherwise it is finalized within three working days, or up to six days for more complex cases. The date printed on the license marks the official founding date of the business entity (effective nationwide since March 2022). + +- Evidence grade: A + +- Notes: Registration itself incurs no cost; any fees charged are typically for third‑party services. Seal engraving prices are set by market forces. The General Office of the State Council explicitly prohibits mandating specific seal manufacturers, so claims that you must use a designated provider are unfounded. The amount of registered capital does not affect your business image; it only defines the maximum liability you bear, and must be paid in full within five years (see Section 3 regarding selection of business entity). If your planned activities require permits, you may not commence operations until those permits are obtained (see Section 7 on licensed industries). +- Sources:国务院 (2021). 市场主体登记管理条例（国务院令第 746 号，第十、十三、十四、十六、十九、二十一条）. ; 市场监管总局 (2022). 市场主体登记管理条例实施细则（市场监管总局令第 52 号，第十二、二十五、二十六条）. ; 财政部、国家发展改革委 (2014). 关于取消、停征和免征一批行政事业性收费的通知（财税〔2014〕101 号，附件 1）. + +### 7. Businesses requiring licenses must wait until they obtain one + +- Cost: No cost involved. Before opening, verify whether your business type requires a license. Restaurants and food vendors must obtain a food business license. Selling only pre-packaged food products does not require a license — only registration is needed. Only then can you officially open for business. +- In plain terms: Operating a business without a license may result in a temporary shutdown order, confiscation of all earnings, and a fine of up to 10,000 yuan. If you handle goods subject to exclusive distribution rights, or engage in securities, futures, insurance, or payment settlement services without authorization, severe violations may constitute the crime of illegal business operations, punishable by up to five years in prison. Renovating premises first and then attempting a trial run prior to obtaining a license are common mistakes. +- Benefit: Authorities designated by law will investigate any unlicensed businesses. For operations without a license where no specific penalty is stipulated, operators must cease activities, surrender all illicit earnings, and pay a fine of up to 10,000 yuan. More serious penalties apply to businesses dealing in goods requiring exclusive distribution rights or engaging in securities, futures, insurance, or payment services without approval. Such violations may also constitute illegal business operations, resulting in imprisonment of up to five years and fines ranging from one to five times the illicit profits earned. Particularly egregious cases may incur sentences exceeding five years nationwide. +- Evidence grade: A +- Notes: Licensing requirements for financial, medical, and educational services are governed by separate laws; this entry only outlines general enforcement procedures and relevant criminal statutes. Milk tea shops and snack vendors fall under food services and must secure a food business license. Renovating premises first and conducting trial runs prior to licensing are frequent pitfalls. Details regarding licensing tiers for the food industry and requirements for selling fresh produce are covered in Section 8. +- Sources:国务院 (2017). 无证无照经营查处办法（国务院令第 684 号，第五、六、十三条）. ；市场监管总局 (2023). 食品经营许可和备案管理办法（市场监管总局令第 78 号，第四条）. ；全国人大 (1997). 刑法（第二百二十五条）. + +### 8. Figure out which category you fall into: producing or preparing food requires a permit, selling only pre-packaged goods needs a filing, while selling fresh meat and vegetables needs no permit at all. + + +- Cost: There is no fee for the permit itself. However, your premises and facilities must meet certain standards, and both on-site inspections and processing take several weeks. Those selling meat must also keep quarantine certificates and meat quality inspection reports for each batch. + +- In plain terms: If you’re making and selling food — whether it’s snacks, marinated meats, baked goods, or homemade pickles — you’ll need a permit. Selling only pre-packaged foods made by others doesn’t require a permit; you simply have to file a notice with the local market supervision administration at the county level or higher. Fresh meat and vegetables fall under this same category and need no permit at all. Operating without a permit can result in fines ranging from 50,000 to 100,000 yuan — amounts that often exceed the startup costs for many small businesses. + +- Benefit: According to the Food Safety Law, anyone running a food business must first obtain a permit. This applies to producers, sellers, and food service providers. However, selling unprocessed agricultural products or pre-packaged foods does not require a permit; in such cases, a filing with the local food safety authority suffices. Pre-packaged foods are those already packaged and sold by others. Specific rules for small food workshops and street vendors are set by each province. Those found operating without a permit may have all their earnings, food products, equipment, and raw materials confiscated. If the total value of such goods is under 10,000 yuan, a fine of 50,000–100,000 yuan applies; if it exceeds 10,000 yuan, the fine is 10–20 times that amount. The Pig Slaughtering Administration Regulations state that pigs may only be slaughtered at state-designated facilities, which must conduct official quarantine and quality checks. Exceptions apply only to rural households slaughtering pigs for personal consumption. All pork sold or used in food production must originate from such facilities and pass both inspections. Violators face shutdowns, confiscation of livestock, equipment, and profits, plus identical fines as those operating without a permit. The Animal Epidemic Prevention Law requires that all transported or sold animal products be accompanied by valid quarantine certificates and marks; failure to do so results in corrective orders and fines up to one times the value of compliant goods. Judicial interpretations further clarify that if small workshops or street vendors sell food that fails safety standards, consumers are entitled to tenfold compensation — a punitive measure that courts are required to uphold nationwide. + +- Evidence grade: A + +- Notes: Each province sets its own thresholds and specific rules for small food workshops, restaurants, and street vendors; this section does not list exact figures. Check your provincial market supervision administration website for local regulations using keywords like “regulations on small food workshops, restaurants, and street vendors.” Operating an online store for homemade food does not exempt you from needing permits where required. Beyond permits, general rules outlined elsewhere apply: see Section 6 regarding business registration and licensing, Section 7 for other permit requirements, and Section 5, Article 31 for information on consumer compensation claims. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第三十五、三十六、一百二十二条）. ；国务院 (2021). 生猪屠宰管理条例（国务院令第 742 号，第二、二十三、三十一条）. ；全国人大常委会 (2021 修订). 动物防疫法（第五十一、一百条）. ；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第四条）. + +### 9. Packaging food for sale makes it prepackaged food: labels must include production date, shelf life, and ingredient list without exception + +- Cost: Printing labels costs only a few cents to a few dimes each. However, filling in the correct date and ingredient details for every batch takes some time. +- In plain terms: Legally, any food that is placed into packaging before being sold counts as prepackaged food. Such packaging must carry a label with nine mandatory items, including both the production date and shelf life. For unpackaged, bulk food, the label must still list the food’s name, production date, and the seller’s name and address. If any required label information is missing, a fine of 5,000 to 50,000 RMB applies if the total value of the goods is under 10,000 RMB; if the value exceeds 10,000 RMB, the fine rises to 5 to 10 times that amount. +- Benefit: According to food safety laws, prepackaged food must have a label that includes the following details: product name, specifications, net weight, production date, ingredient list (配料表), producer’s name, address, and contact information, shelf life, product standard code, storage conditions, common names of food additives as defined by national standards, and production license number. Any additional information required by laws or food safety standards must also be listed. Bulk food, which is sold without packaging based on individual weight, also needs a label on its container or outer packaging that lists the food’s name, production date or batch number, shelf life, and the producer’s name, address, and contact details. Any prepackaged food sold without a proper label, or with a label/instruction sheet that does not meet legal requirements, will have both the earnings and the goods confiscated. If the total value of such goods is under 10,000 RMB, a fine of 5,000 to 50,000 RMB applies; if the value exceeds 10,000 RMB, the fine is 5 to 10 times that amount. In severe cases, the business may be ordered to cease operations until its production license is revoked. Minor label flaws that do not affect food safety or mislead consumers only require correction; failure to do so results in a fine of up to 2,000 RMB. The latest version of the General Rules for the Labelling of Prepackaged Foods is GB 7718-2025, which was released on March 16, 2025, and will take effect on March 16, 2027, allowing a two-year transition period. This standard mandates a dedicated area on packaging to display both the production date and expiry date, using high-contrast, legible fonts and colors, and arranging dates in year-month-day format nationwide. +- Evidence grade: A +- Notes: Label flaws are categorized into two types, each carrying distinct penalties and compensation rules. Minor flaws, such as spelling errors or irregular font sizes, which do not affect food safety or mislead consumers, only require correction by regulatory authorities; failure to do so results in a fine of up to 2,000 RMB, and consumers cannot claim tenfold compensation. Major flaws, such as missing production dates or shelf lives, are not classified as minor per judicial interpretations: fines are calculated based on the goods’ total value, with amounts ranging from 5,000 to 50,000 RMB if the value is under 10,000 RMB, and 5 to 10 times that value if it exceeds 10,000 RMB. In addition, consumers are entitled to tenfold compensation based on the food’s purchase price, with a minimum compensation amount of 1,000 RMB if the tenfold total is lower (see Section 5, Article 31 regarding tenfold food compensation). This section only verifies the production date and display requirements outlined in the GB 7718-2025 announcement and official interpretations; exact label formatting must follow the original standard text. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第六十七、六十八、一百二十五条）. ；国家卫生健康委员会、国家市场监督管理总局 (2025). 关于发布《食品安全国家标准 预包装食品标签通则》（GB 7718-2025）等 50 项食品安全国家标准和 9 项修改单的公告（2025 年第 2 号）. （拉萨市卫生健康委员会转载公告全文）；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第六、八条）. （标签瑕疵与必标事项缺失的分档）；北京市市场监督管理局 (2026). 找不到生产日期？食品标签要「变脸」！新规这些重点必看. （实施日期、过渡期与日期展示新要求） + +### 10. General foods must not claim therapeutic effects: this applies to labels, instructions, ads, and live-stream scripts alike + +- Cost: No cost involved. Simply review all promotional copy, product description pages, and live-stream scripts. The hard part is resisting the urge to use phrases like “lowers blood pressure, blood sugar, and cholesterol” or “treats constipation.” +- In plain terms: Labels, instructions, and ads for ordinary foods must never claim that the products can prevent or treat diseases. Apart from ads for medical products, drugs, and medical devices, no other ads may make such claims or use language that sounds pharmaceutical in nature. Penalties amount to 1–3 times the advertising spend; if the spend cannot be calculated, fines range from 100,000 to 200,000 RMB. In severe cases, the business license may be revoked. +- Benefit: The Food Safety Law states: “Labels and instructions for food and food additives must not contain false information, nor may they make any claims regarding disease prevention or treatment. Producers and sellers bear full responsibility for the accuracy of such content.” Likewise, “Food advertising must be truthful and lawful; it must not contain false information or make any claims regarding disease prevention or treatment. Food producers and sellers are accountable for the veracity and legality of their ads.” In short, packaging, instructions, and ads must never assert any disease-preventive or curative effects, and sellers must accept full responsibility for any such claims. Violations of advertising rules are punished under the Advertising Law, which explicitly bans any non-medical ads from making disease-treatment claims or using medical terminology that might confuse consumers. Offenders face mandatory cessation of advertising, a public retraction of their claims, and fines ranging from 1–3 times their advertising spend; if the spend cannot be determined, fines of 100,000–200,000 RMB apply. Severe violations incur fines of 3–5 times the advertising spend, or 200,000–1,000,000 RMB, and may even result in revocation of the business license, effectively ending operations nationwide. +- Evidence grade: A +- Notes: Terms like “health benefits” are also prohibited for ordinary foods. Only foods officially registered as health supplements may make such claims, and only those listed in the national catalog are permitted. Consumers should be wary of such language; further guidance is provided in Section 6, Item 10. This regulation applies not just to physical packaging and ads, but also to online product pages, live-stream scripts, and social media posts — all of which constitute advertising material. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第七十一、七十三、一百二十五、一百四十条）. ；全国人大常委会 (2021 年修正). 广告法（第十七、五十八条）. + +### 11. The food industry faces criminal penalties: selling meat from diseased animals or products exceeding safety limits is already a crime; adding toxic or harmful non-food substances carries a minimum five-year sentence regardless of revenue + + +- Cost: No direct cost is involved. Follow the approach outlined in Article 8 (assess which regulatory category your operation falls under): retain all quarantine certificates and purchase receipts, and only use ingredients with verifiable approval numbers on their labels. +- In plain terms: While earlier articles impose financial penalties, this one targets individuals criminally. Selling meat from diseased animals, meat failing inspection, or products with excessive pesticide, veterinary drug, or heavy metal residues is a crime as long as it is “sufficient” to cause serious poisoning — no actual victims are required, and offenders face up to three years in prison. Adding toxic or harmful non-food substances to food carries a minimum five-year sentence, irrespective of total sales volume. +- Benefit: Article 143 of the Criminal Law governs this category: any food you produce or sell that fails to meet safety standards is illegal if it is “sufficient” to cause serious food poisoning or other severe foodborne illnesses. Offenders receive up to three years of imprisonment or detention plus fines. If serious health damage or other aggravating factors are present, sentences rise to three to seven years with additional fines. In cases of especially grave consequences, imprisonment ranges from seven years to life, plus asset confiscation or further fines. Article 144 covers the deliberate addition of toxic or harmful non-food substances to food; offenders face up to five years of imprisonment plus fines. If serious health damage or other serious circumstances arise, sentences increase to five to ten years with fines. If death results or other especially severe circumstances exist, penalties follow Article 141 (ten years or more, life imprisonment, or death). A joint interpretation by the Supreme People’s Court and the Supreme People’s Procuratorate defines four scenarios that qualify as “sufficient” to cause serious foodborne illness: presence of pathogenic microbes, pesticide residues, veterinary drug residues, biological toxins, or heavy metals exceeding legal limits; use of meat from diseased, undiagnosed, or unqualified animals; production or sale of items banned for public health reasons; and infant formula or medical foods with severely inadequate nutritional content. Excessive or improper use of additives that lead to such outcomes also falls under Article 143. What counts as “toxic or harmful non-food substances” is strictly defined: any substance prohibited by law or listed by government authorities (e.g., banned pesticides or drugs not approved for food animals). Additional serious circumstances under Article 144 include sales totaling between 100,000 and 200,000 RMB, operations near schools, nursing homes, or facilities serving minors or the elderly, or illegal private slaughtering without proper licensing; such acts may also incur penalties under the crime of illegal business operations. Revenue thresholds of 100,000 RMB or net profits of 50,000 RMB are considered “serious circumstances” nationwide. +- Evidence grade: A +- Notes: The dividing line between this article and the previous three is whether food safety standards themselves are violated. Failure to obtain permits, incomplete labeling, or false health claims result in financial penalties, while selling diseased meat, non-compliant products, improper additives, or non-food substances triggers criminal prosecution. The simplest preventive measure remains the steps outlined in Article 8: purchase meat solely from licensed slaughterhouses, retain all quarantine and quality certificates, and use only ingredients with valid approval numbers. Unverified “discounted meat” or unknown “by‑product scraps” are common sources of violations. Due to a 502 error when retrieving the original Supreme People’s Court bulletin, two provincial official reprints were cross‑checked word‑for‑word to ensure accuracy. +- Sources:全国人大常委会 (2020 年修正). 刑法（第一百四十一、一百四十三、一百四十四条）. （国家法律法规数据库）；最高人民法院、最高人民检察院 (2021). 关于办理危害食品安全刑事案件适用法律若干问题的解释（法释〔2021〕24 号，第一、二、五、七、九、十七、十八条，2022 年 1 月 1 日起施行）. （河北省市场监督管理局转载全文）、（辽宁省司法厅转载全文，两份逐字核对一致） + +### 12. Once you obtain a business license, you must file tax returns on schedule — even if you have no income, you still need to submit a return with all zeros. + + +- Cost: There’s no direct cost involved. You can file electronically via the tax service portal monthly or quarterly in just a few minutes. Hiring an accountant, however, adds extra expense. If you do hire someone, you must also register for social insurance within 30 days of business establishment. The real challenge is remembering to file on time even during months with no business activity. + +- In plain terms: After getting a business license, you’re required to file tax returns regularly. Even if you earn nothing, you must still file a return — just fill in all zeros. Failing to do so risks fines up to 2,000 yuan; more serious violations can lead to penalties between 2,000 and 10,000 yuan. If you skip returns for all tax types across three consecutive months, the system automatically labels you as a “non-compliant taxpayer,” and you lose the ability to issue invoices. + +- Benefit: The law clearly states that “taxpayers with no tax liability during a period must still file a tax return as required.” In other words, even when you owe nothing, filing remains mandatory. Non-compliance brings penalties: tax authorities can order corrections and impose fines up to 2,000 yuan; repeat or severe violations may exceed 10,000 yuan. Any unpaid taxes plus daily late fees at 0.05% must also be settled. Furthermore, persistent non-filing leads to automatic classification as a non-compliant taxpayer, blocking invoice issuance until corrected and penalties paid. + +- Evidence grade: A + +- Notes: With the “multi-certificates integration” policy, a separate tax registration isn’t needed. Use your business license’s unified social credit code to log into the electronic tax portal and specify applicable taxes. Individual businesses and sole proprietorships pay individual income tax on business earnings. Payments are first due within 15 days after month or quarter-end, followed by an annual settlement by March 31 of the following year to adjust any over- or under-payments. Even without any revenue, zero returns must still be filed. Three consecutive months of non-filing results in automatic classification as a non-compliant taxpayer, halting invoice use; cancellation procedures then become far more complicated — see Section 12.23 for details on orderly business closure. +- Sources:国务院 (2002). 税收征收管理法实施细则（国务院令第 362 号，第三十二、七十五条）. ; 全国人大常委会 (2015). 税收征收管理法（2015 年修正，第二十五、三十二、六十二、六十四条）. ; 国家税务总局 (2019). 关于税收征管若干事项的公告（国家税务总局公告 2019 年第 48 号，第三条）. ; 全国人大常委会 (2018). 个人所得税法（2018 年修正，第十二条）. ; 全国人大常委会 (2018). 社会保险法（2018 年修正，第五十七条）. + +### 13. Invoices must reflect actual transactions; small taxpayers can fully utilize tax exemptions + +- Cost: No cost at all. There is no need to purchase or sell invoices, nor to handle “fictitious invoicing” on behalf of others. Simply issue invoices and file taxes based on real business activity. +- In plain terms: If you are a small taxpayer paying taxes under the simplified regime, and your monthly sales stay under 100,000 yuan or quarterly sales under 300,000 yuan, you are exempt from VAT. Previously taxed at 3%, this rate is now reduced to 1% for the same period. Conversely, arranging fake invoices to offset costs constitutes tax fraud, punishable by up to three years in prison and fines ranging from 20,000 to 200,000 yuan. +- Benefit: Small taxpayers under the simplified tax regime are legally exempt from VAT if their sales remain below specific thresholds. These thresholds apply from January 1, 2026, through December 31, 2027: 100,000 yuan per month, 300,000 yuan per quarter, or 1,000 yuan per transaction/day. Exceptions apply for real estate sales, rentals, and land-use right transfers. For those meeting these limits, the VAT rate drops from 3% to 1%. Issuing VAT invoices without a genuine transaction, or any form of fictitious invoicing, is illegal and carries penalties up to three years imprisonment plus fines up to 200,000 yuan; repeat or larger-scale violations may lead to sentences ranging from three to ten years, or even life imprisonment nationwide. +- Evidence grade: A +- Notes: The revised VAT Law took effect on January 1, 2026, superseding earlier relief measures for small taxpayers outlined in 2023 documents No. 19 and No. 1. While monetary thresholds remain unchanged, the legal basis has been updated accordingly. The referenced criminal provisions derive from the 1997 Penal Code, specifically Article 205, as amended to reflect current sentencing tiers. Note that VAT exemptions do not apply to income tax; arranging fake invoices is illegal and should never be considered a tax-saving tactic. +- Sources:全国人大常委会 (2024). 增值税法（2026 年 1 月 1 日施行，第二十三条）. ；财政部、税务总局 (2026). 关于增值税法施行后增值税优惠政策衔接事项的公告（财政部 税务总局公告 2026 年第 10 号，第一、二、六条）. ；全国人大 (1997). 刑法（第二百零五条）. + +### 14. Scammers pretending to be tax officials demanding payments are fraudsters; tax filings must be done via the e-Tax Service or by calling 12366 + +- Cost: No cost involved. If you receive calls or texts claiming a “tax audit,” “unusual account activity,” or “fines for non-filing,” or if someone adds you as a contact, simply hang up and ignore them. Then call 12366 or the official phone number of your local tax authority to verify. +- In plain terms: Tax authorities never ask for your bank card passwords, payment codes, or SMS verification codes over the phone, nor do they provide an account number for you to send tax payments to. Legitimate on-site tax inspections require officials to present an inspection notice and identification. When receiving such calls, hang up first and call 12366 to confirm. If you’ve already transferred money, immediately call 110 or 96110 to request a payment reversal. +- Benefit: The State Taxation Administration explicitly states: “Tax authorities never request bank card passwords, payment codes, account balances, or SMS verification codes related to payments via WeChat mini-programs, phone calls, or texts.” It also warns: “Some criminals impersonate tax officials, offering services such as ‘tax filing assistance,’ ‘preferential tax policy handling,’ or ‘policy guidance’ to taxpayers.” To verify any claims, call the 12366 taxpayer service hotline or your local tax authority’s official number. Legitimate on-site inspections require officials to present a written notice and identification. Tax payments can only be made via the e-Tax Service or at tax service centers; no tax authority ever provides a designated account for payments. Intermediary agencies offering tax filing services are also subject to regulations. Those who extort taxpayers or withholding agents using the guise of tax officials face fines based on severity. Impersonating government officials to commit fraud results in detention for 10–15 days and a fine of up to 1,000 yuan. If actions meet criteria for both fraud and impersonation, penalties follow the stricter applicable law. +- Evidence grade: A +- Notes: These scams specifically target newly registered sole proprietors and small businesses. Scammers claim “your tax filing records show non-compliance, and fines will apply today,” then steer victims to their own official accounts or mini-programs, charging hundreds of yuan for services that are actually free and take only minutes to complete independently. While hiring external bookkeeping firms is legal, they are not government entities and cannot act on behalf of tax authorities. Victims who’ve already paid should follow Section 8, Clause 2 (payment reversal for fraud) and immediately call 110 or 96110 to request a reversal. +- Sources:国家税务总局 (2025). 税务部门提醒广大纳税人——增强防范意识 警惕互联网涉税诈骗. ; 国家税务总局扬州市税务局 (2023). 扬州防范涉税诈骗宣传篇. ; 国家税务总局 (2025). 涉税专业服务管理办法（试行）（国家税务总局令第 58 号，第三十二条第七项、第三十三条）. ; 全国人大常委会 (2025). 治安管理处罚法（2025 年修订，2026 年 1 月 1 日施行，第六十二条）. ; 最高人民法院、最高人民检察院、公安部 (2016). 关于办理电信网络诈骗等刑事案件适用法律若干问题的意见（法发〔2016〕32 号）. + +### 15. Writing “deposit” instead of “advance payment” in contracts, specifying penalty amounts, and treating credit terms as loans + + +- Cost: No cost at all. Simply include the term “deposit” in the contract; the amount must not exceed 20% of the total contract value. Collect the payment before delivering goods. Before agreeing to any credit terms that let the buyer receive goods first and pay later, run a background check on them first. +- In plain terms: Only when the word “deposit” is used does the double‑return rule apply: if you break the contract, you lose that money; if the other party breaks it, they must pay you twice the amount. Anything above 20% of the contract value does not qualify as a deposit. If you write “advance payment” instead, the law offers no such protection. Offering credit terms is essentially lending your own money to the buyer interest‑free; if they go bankrupt, it becomes a bad debt. +- Benefit: A deposit only becomes valid once the money is actually received by the seller (the effective date is when delivery occurs). If the buyer breaks the contract, they forfeit the deposit. If the seller breaks it, they must return the full amount plus an equal sum as compensation (i.e., double the original amount). Portions exceeding 20% of the total contract value are not treated as deposits. Should the agreed penalty amount be far higher or lower than the actual loss, a court may adjust it at the request of either party. When both a deposit and a penalty clause are included in the same contract, the injured party may claim only one of them, not both (nationwide, effective since 2021). +- Evidence grade: A +- Notes: Under the Civil Code, “advance payment” does not enjoy the same protections as a deposit; it is generally regarded as a simple prepayment. This is the prevailing practice in legal practice, though no specific court rulings were verified for this section. Providing credit terms is equivalent to lending your own funds to the buyer without interest; any default results in a bad debt. Before granting such terms, check the buyer’s records on the National Enterprise Credit Information Publicity System to see if there are any pending lawsuits against them. +- Sources:全国人大 (2020). 民法典（第五百八十五、五百八十六、五百八十七、五百八十八条）. + +### 16. Sign a written contract within the first month of employment; register for social insurance within 30 days + +- Cost: The portion of social insurance premiums that employers must pay must be paid continuously; the exact percentages vary by region. There is no cost to drafting the contract itself — simply use the standard template provided by local labor authorities. +- In plain terms: If an employee starts working and no written contract is signed within the first month, the employer must pay double wages starting from the second month, continuing until the end of the first year of employment. Social insurance must be registered within 30 days of hiring; failure to do so results in fines equal to 1–3 times the amount of unpaid premiums. There is no legal provision allowing employees to voluntarily waive their right to social insurance coverage. +- Benefit: Employers must pay double wages to employees who have worked for at least one month but still lack a written contract, starting from the second month of employment. Social insurance must be registered within 30 days of the employee’s first day on the job; failure to comply triggers mandatory corrective orders. After this deadline, fines of 1–3 times the unpaid premiums apply, and the responsible personnel face individual fines ranging from 500 to 3,000 yuan. Late or incomplete premium payments incur a penalty of 0.05% of the outstanding amount per day (late fees). If payments remain unpaid past the deadline, additional fines of 1–3 times the original debt apply. Employers bear sole responsibility for timely registration and full premium payments; only legally recognized force majeure events such as natural disasters permit temporary delays or reductions. No provision exists for employees to voluntarily forgo social insurance benefits (applies nationwide). +- Evidence grade: A +- Notes: Double wage obligations remain in effect from the second month through the end of the first year of employment, making delays increasingly costly. Employees without a written contract or unpaid social insurance coverage who suffer workplace injuries or later file labor disputes often face combined costs of retroactive payments, fines, and compensation that far exceed any initial savings the employer might have realized. +- Sources:全国人大常委会 (2007). 劳动合同法（第十、八十二条）. ；全国人大常委会 (2010). 社会保险法（2018 年修正，第五十八、六十、八十四、八十六条）. + +### 17. Wages must be paid according to contracts and laws; raises, loans, and bonuses all require written documentation + +- Cost: No expense is incurred. The contract clearly states the wage amount. Any raises, bonuses, advance payments, or loans must be documented with signed paperwork — no verbal promises are allowed. Employers must never pay wages out of their own pocket on behalf of the company. Even when dealing with acquaintances, this same rule must be followed. +- In plain terms: Wages must be paid on time and in full, as required by contract and law. If payments are delayed, employees can petition the court for a payment order. Verbal promises regarding raises, bonuses, or advance payments are legally meaningless; without written proof, the party unable to produce documentation will suffer the consequences. Any money lent by an employer to an employee must be backed by a written loan agreement specifying the amount, interest rate, and repayment terms. +- Benefit: Contractual labor agreements must explicitly outline how wages are paid and how social insurance contributions are handled. Employers are legally obligated to pay wages on schedule and in full, per both the contract and national regulations. Failure to do so allows employees to request a court-issued payment order. Loans made by employers to staff are legally treated as standard loan agreements. Unless otherwise agreed between two private individuals, all such arrangements must be documented in writing, detailing the principal amount, interest terms, repayment date, and method. Verbal promises of bonuses lack any legal standing; without written proof, the party unable to provide documentation will be at a disadvantage (nationwide). +- Evidence grade: C +- Notes: This is not about refusing to help others — it is about ensuring all assistance follows established procedures. Once informal favors become habitual practice, discontinuing them inevitably leads to disputes. Mixing personal loans with company finances risks exposing the lender to financial losses if the borrower defaults. The legal provisions referenced here have been verified; however, the recommendations are based on practical experience, which justifies the C rating. +- Sources:全国人大常委会 (2007). 劳动合同法（第十七、三十条）. ；全国人大 (2020). 民法典（第四百六十九、六百六十八条）. + +### 18. Sell first, then produce: use pre-orders and small orders to confirm demand before investing in manufacturing + +- Cost: Just a few dozen to a few hundred yuan is needed to create a prototype or a simple landing page. After that, reach out to dozens of real potential customers and ask them to make advance payments or place small orders. This approach takes a few extra weeks compared to starting production right away. The hard part is resisting the urge to produce the goods first. +- In plain terms: A study followed 116 newly founded Italian companies for about a year. Entrepreneurs who first formed a hypothesis and then tested it against real market feedback tended to run their businesses better, were more willing to pivot when needed, and did not quit earlier than others. So, if no one is willing to make advance payments or place small orders, you should not believe the claim that “products will sell on their own once made.” +- Benefit: This randomized controlled trial tracked 116 Italian startups over roughly one year. In such trials, participants are randomly split into two groups; only one group receives a specific intervention, and the results of both groups are compared. The findings showed that entrepreneurs who received training on the “form a hypothesis first, then rigorously test it against market feedback” method achieved better business results, were more likely to switch strategies when needed, and did not have a higher early dropout rate. The authors argue that this approach lowers the risk of pouring resources into projects that seem promising at first glance but ultimately fail (published in Italy in 2020). +- Evidence grade: B +- Notes: This is the only study on this topic, and its sample size is relatively small; it was also conducted only in Italy, which is why it is rated as grade B. The title, source, and abstract have been cross-checked via Crossref and Semantic Scholar; however, the exact effect figures cited in the text have not been independently verified. In practice, if no customers are willing to make advance payments or place small orders, you should not trust the idea that “products will automatically find buyers once produced.” +- Sources:Camuffo A, Cordova A, Gambardella A, Spina C (2020). A Scientific Approach to Entrepreneurial Decision Making: Evidence from a Randomized Control Trial. Management Science 66(2):564-586. + +### 19. Run the prototype through the production checklist before starting full production + +- Cost: Producing a small batch of prototypes costs a few hundred yuan. It also takes several hours to calculate these key figures: the yield rate (how many of the 100 items can actually be sold), the supplier’s minimum order quantity and payment terms, the capital tied up in inventory, packaging and logistics costs, as well as certification and licensing fees and trademark registration costs. The hardest part is resisting the urge to skip this step and jump straight into production. +- In plain terms: The main difference between producing one prototype and producing a thousand units lies in where your money gets invested. The yield rate determines your actual production cost. The minimum order quantity and payment terms dictate how much capital you must advance upfront. Inventory levels determine when you can expect that capital back. For products listed in mandatory certification categories, they cannot be manufactured or sold without passing certification and displaying the corresponding certification mark. +- Benefit: The main difference between producing one prototype and producing a thousand units lies in where your money gets invested. The yield rate determines your actual production cost — it shows what percentage of a batch of products are qualified for sale. The minimum order quantity and payment terms set by suppliers determine how much capital you must advance upfront. Inventory levels determine when you can expect that capital back. For products listed in mandatory certification categories, they must first pass certification and display the certification mark before they can be manufactured or sold. Unauthorized manufacturing or sale of such products without certification is punishable under relevant certification regulations. Food businesses and restaurants must obtain a food business license (required nationwide). +- Evidence grade: C +- Notes: This checklist is based on practical experience; the legal content has been cross-checked against official sources. Before launching production, check the trademark database maintained by the National Intellectual Property Administration to see if any similar trademarks are already registered, then apply for your own trademark. Details on prohibited use of other parties’ trademarks and designs can be found in items 20 and 21 (keep purchase receipts, and ensure any designs are either created in-house or licensed for use). The list of mandatory certification categories is subject to updates published by the State Administration for Market Regulation. +- Sources:质检总局 (2009). 强制性产品认证管理规定（质检总局令第 117 号，第二、四十九条）. ；市场监管总局 (2023). 食品经营许可和备案管理办法（市场监管总局令第 78 号，第四条）. + +### 20. Keep copies of invoices and supplier documentation for every shipment; avoid purchasing goods priced significantly below market rates: if an employee buys counterfeit products, the employer can still be held legally responsible. + + +- Cost: Zero upfront expense. For each batch of goods, retain essential paperwork: purchase contracts, invoices, payment records, the supplier’s business license, and any authorization documents. Implement a company policy requiring all buyers to sign off on purchases; under no circumstances should items priced far below market value be accepted. The real challenge lies in resisting the temptation to purchase seemingly profitable low-cost goods. + +- In plain terms: Selling counterfeit merchandise can lead to criminal penalties. If the illicit profits exceed 30,000 RMB or if total sales reach 50,000 RMB, the offender faces up to three years in prison. Even unsold inventory in storage counts toward these thresholds. Merely claiming “I didn’t know it was fake” is not a valid defense: if purchase prices are markedly lower than market rates without a reasonable explanation, guilt is presumed. Maintaining proper purchase contracts, invoices, payment records, and supplier details provides a crucial legal safeguard. + +- Benefit: Intentional sale of goods bearing counterfeit trademarks incurs serious legal consequences. When illicit earnings surpass 30,000 RMB or total sales reach 50,000 RMB, imprisonment for up to three years and monetary fines are likely. In cases where these figures are ten times higher, sentences range from three to ten years alongside substantial penalties. Un sold stock also contributes to this calculation; if its value triples the sales threshold, criminal liability applies automatically. The burden of proof lies with defendants to demonstrate genuine ignorance, but judicial interpretations issued in 2025 outline five circumstances where intent is deemed evident regardless of personal admission. These include visible tampering with trademarks, possession of forged authorization papers, prior convictions for similar offenses, purchasing goods at inexplicably low prices, and attempting to conceal evidence after detection. Corporate entities face dual penalties: financial fines imposed on the company itself and individual executives held accountable under identical statutes. Consequently, even when employees execute unauthorized purchases, senior management ultimately bears legal responsibility. Conversely, trademark law offers a defense mechanism: if sellers can prove they lawfully acquired products and identify their source, they avoid compensation obligations. Essential documentation—specifically invoices and supplier records—forms the backbone of this protection; lacking them nullifies any claim of innocence (applicable nationwide; judicial interpretation effective April 26, 2025). + +- Evidence grade: A + +- Notes: Cosmetics, alcoholic beverages, baby products, electronics, and apparel frequently involve such legal disputes due to substantial price variations among identical items. Marketing terms like “exclusive channel stock,” “end-of-line clearance,” or “duty-free imports” cannot substitute for proper documentation. Beyond criminal penalties, administrative sanctions apply: convicted parties forfeit infringing merchandise and tools, while fines up to five times the illegal revenue may be imposed for operations exceeding 50,000 RMB in value. Upon discovering questionable purchases, immediately cease sales, secure the inventory, and contact brand representatives or regulatory authorities—destroying records or merchandise directly triggers the fifth presumption of intent mentioned earlier. For trademark-related matters, refer to Section 21 regarding permissible usage of third-party designs. A common scam involves strangers offering free merchandise in exchange for retail distribution; later, they claim infringement based on missing paperwork and abnormally low purchase prices, effectively negating all defenses. Legitimate consignment arrangements mandate written contracts, copies of supplier identification and business licenses, and explicit clauses defining ownership and liability boundaries. +- Sources:全国人大常委会 (2020). 刑法修正案（十一）（第十七、二十四项，即刑法第二百一十四、二百二十条）. ；最高人民法院、最高人民检察院 (2025). 关于办理侵犯知识产权刑事案件适用法律若干问题的解释（法释〔2025〕5 号，2025 年 4 月 26 日起施行）. ；全国人大常委会 (2019). 商标法（2019 年修正，第五十七、六十四条；2026 年 6 月 26 日修订后为第七十二、七十八条，自 2027 年 1 月 1 日起施行）. 、 + +### 21. Whether creating designs yourself or purchasing licensed artwork, simply changing colors or adding icons does not count as “modifications” for copyright purposes. + + +- Cost: Licensing fees from legitimate stock image libraries start at just a few dozen yuan per image. Hiring a designer to create original artwork can cost several hundred to several thousand yuan. For every image used on products, keep a record of the license and proof of purchase. The real challenge is avoiding the use of random images found online. + +- In plain terms: Even if you alter an existing image by changing its colors, background, or adding your own icons, you still have not obtained permission to use that artwork. Making money by reproducing someone else’s artwork—whether you earn 30,000 yuan, reach 50,000 yuan in sales, or print 500 copies—constitutes copyright infringement and can lead to a prison sentence of up to three years. In trademark law, any mark that is “likely to cause confusion” is considered infringing as well. + +- Benefit: Copyright law treats any unauthorized adaptation, translation, or annotation of a work as equivalent to outright copying. Therefore, modifying an original image by changing colors, background, or adding icons still counts as using someone else’s work without permission. The legal thresholds for punishment are as follows: if you profit from selling artwork without permission from the copyright holder—earning at least 30,000 yuan in illegal gains, reaching 50,000 yuan in total illegal business volume, or producing 500 copies or more—you commit copyright infringement and may be sentenced to up to three years in prison and fined. If the illegal gains reach ten times that amount, the sentence rises to three to ten years. Selling counterfeit goods bearing unauthorized designs also carries penalties: selling for over 50,000 yuan or reaching 100,000 yuan in sales can result in up to five years in prison. For trademarks, using a mark similar enough to cause confusion on identical or related goods is also illegal. Even minor modifications do not create a safe zone; such changes remain infringing under current law (effective April 26, 2025). + +- Evidence grade: A + +- Notes: There are three common pitfalls to watch for. First, printing cartoon characters or celebrity images found online onto clothing, mugs, or phone cases without permission. Second, commercial use of fonts: most require separate licensing, and free preview versions are not automatically free for business use. Third, including unauthorized assets in client designs—the seller remains legally responsible. To simplify compliance, use licensed stock image libraries and keep all license documents on file. Alternatively, require designers to specify the source and scope of any used materials in a contract, making them liable for any resulting issues. Beyond criminal penalties, civil damages and administrative fines apply as well: if public interests are harmed, illegal earnings may be confiscated and fines imposed at 1–5 times the illegal business volume. For trademark checks prior to production, see item 19 (verify samples against the full production list). Conversely, if someone uses your own designs without permission, these same legal provisions apply to protect your rights. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第五十二条第六项、第五十三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第二十、二十一项，即刑法第二百一十七、二百一十八条）. ；最高人民法院、最高人民检察院 (2025). 关于办理侵犯知识产权刑事案件适用法律若干问题的解释（法释〔2025〕5 号）. ；全国人大常委会 (2019). 商标法（2019 年修正，第五十七条第二项；2026 年修订后为第七十二条第二项）. + +### 22. Following procedures at work — and thinking twice about stepping outside them + +- Cost: No cost involved. Simply follow institutional rules, medical orders, and established workflows while on duty. Never make decisions on behalf of others beyond your own authority. Before offering help, ask yourself: “Who would be held responsible if something went wrong?” The hardest part is resisting requests to “make an exception” in the moment. +- In plain terms: Take nurses as an example: regulations clearly state that when a patient’s condition deteriorates critically, nurses must immediately alert a physician; likewise, if they notice any orders that violate regulations, they must bring this to the prescribing physician’s attention. The same principle applies to all other roles — first identify exactly where the relevant rules specify “mandatory reporting.” The law also does not require people to stand by while someone is in danger: if you voluntarily provide emergency care and end up causing injury, you are not legally liable for compensation. +- Benefit: For nurses, statutory duties are defined precisely in this manner. When a patient’s condition becomes critical, they must promptly notify a physician. In genuine emergencies, they may also initiate necessary emergency treatment to save a patient’s life. Should they encounter any orders that breach laws or clinical practice standards, they must raise this with the prescribing physician, and if needed, report it to department supervisors. Conversely, the Civil Code explicitly states that individuals who voluntarily provide emergency aid and inadvertently cause injury to the recipient are exempt from civil liability. Legal protection is reserved for well-intentioned rescuers, not for those who assume they must pay compensation simply for trying to help (nationwide). +- Evidence grade: B +- Notes: Adhering to workplace procedures is essential; voluntary emergency aid is legally protected. For any other situations, first determine who holds authority and responsibility — never substitute personal goodwill for formal institutional decisions. The cited provisions from the Nurse Regulations originate from the original 2008 text; currently pending verification is whether Article 17 was amended in the 2020 revision. No official text of the Physicians Law was accessible at the time of drafting, so no corresponding citations could be included. +- Sources:国务院 (2008). 护士条例（国务院令第 517 号，第十七条）. ；全国人大 (2020). 民法典（第一百八十四条）. + +### 23. When losses pile up, follow the proper procedures: opt for simplified deregistration if possible, or file for bankruptcy when liabilities exceed assets — don’t leave things unattended. + + +- Cost: Simplified deregistration can be handled on your own: just post the notice on the National Enterprise Credit Information Publicity System for 20 days. If there are still outstanding debts, you must first settle accounts — collect what’s owed and pay what’s due; this step is called liquidation. Filing for bankruptcy requires an application to the court, which can take several months. The real difficulty lies in the reluctance to face reality after suffering losses, leading many to delay necessary actions. + +- In plain terms: If a business owes no wages, taxes, or social insurance payments, all investors can sign a written commitment; after posting it publicly for 20 days with no objections, simplified deregistration becomes possible. Sole proprietorships don’t need such a notice — if no objections arise within 10 days, deregistration proceeds automatically. When debts become impossible to repay, the business should apply to the court for bankruptcy. Neglecting these steps carries serious consequences: the legal representative cannot serve in that role for any other enterprise for three full years. + +- Benefit: All debts — both owed to others and owed by others — are fully paid off. No unpaid wages, social insurance contributions, or tax liabilities remain. All investors have signed the required written commitment. Meeting these criteria allows simplified deregistration after a 20‑day public notice period with no objections; sole proprietorships qualify after 10 days without any objections. Companies unable to repay due debts and facing liabilities greater than their assets may apply to the court for reorganization, settlement negotiations, or bankruptcy liquidation. If a dissolved company still has unpaid debts exceeding its assets, those responsible for liquidation must file for bankruptcy liquidation. Failure to act brings further penalties: non‑submission of annual reports on time results in being placed on the list of enterprises with abnormal operations; after three years, they move to the list of severely law‑violating enterprises. The legal representative or manager cannot assume such roles elsewhere for three years. Even businesses already on the abnormal list cannot pursue simplified deregistration at all (nationwide rule). + +- Evidence grade: A + +- Notes: The referenced Interim Regulations on Public Disclosure of Enterprise Information are based on the original 2014 version. Decree No. 777 issued by the State Council in 2024 merely replaced references to “Industry and Commerce Administration” with “Market Regulation Administration” — no changes appear in Article 17. (Pending verification: whether a separate 2024 amendment exists.) Currently, individual bankruptcy mechanisms — applicable to sole proprietorships — are only being piloted in select regions; because the original text was not examined for this section, it is not covered here. +- Sources:国务院 (2021). 市场主体登记管理条例（国务院令第 746 号，第三十一、三十二、三十三条）. ；市场监管总局等六部门 (2025). 企业注销指引（2025 年修订）（2025 年第 52 号公告）. ；全国人大常委会 (2006). 企业破产法（第二、七条）. ；国务院 (2014). 企业信息公示暂行条例（国务院令第 654 号，第十七条）. diff --git a/book/13-Emergencies.md b/book/13-Emergencies.md new file mode 100644 index 00000000..74c31a0b --- /dev/null +++ b/book/13-Emergencies.md @@ -0,0 +1,455 @@ +# 13. Emergency situations: what to do first + +This section covers just one thing: what actions you should take right away when an emergency occurs, what to do next, and what to avoid. The entries on first aid and wilderness survival focus on specific causes of death and survival rates. Those dealing with scams and threats involve financial loss and threats to personal freedom. These two sets of figures cannot be compared with each other. Entries are ordered by how common each situation is and how much difference proper or improper action can make in terms of lives saved. These guidelines are primarily meant for you, your spouse, and close family members. In fact, 79.2% of cardiac arrests happen at home, so the people you’re most likely to help are your household members, followed by friends and coworkers. While helping strangers can also be worthwhile, it ranks last in priority due to risks such as false accusations or getting involved in legal trouble. Therefore, the entries in this category emphasize actions to protect yourself and include clauses that limit your liability. + +Only actions that must be taken within a few minutes are included here. Identifying scams or dealing with extortion attempts require longer-term measures and are not covered in this section. Detailed anti-fraud rules and descriptions of seven common types of fraud can be found in Section 8, Item 3. Information on handling situations where someone threatens to release private photos or intimate videos is provided in Section 8, Item 32. If money has already been transferred, you should immediately call 110 or 96110 to request a stop payment, as explained in Section 8, Item 2. +### 1. Immediate chest compressions can save lives when someone collapses and stops breathing — call 120 and fetch an AED too + + +- Cost: This costs nothing. A CPR course from the Red Cross or a hospital lasts half a day to a full day, and one training session is enough for years of use. Even without prior training, you can do it: place both hands on top of each other at the midpoint between the nipples, then press down hard at a rate of about 2 times per second without stopping. + +- In plain terms: Most people you’d need to help are family members — 79.2% of cardiac arrests happen at home. When someone performs CPR, the survival rate jumps from 3.9% to 16.1%. If a person is unresponsive and not breathing, start compressions right away. Position your hands at the midpoint between the nipples, press down hard at 2 times per second, and keep going. Ask a second person to call 120 and bring an AED; you must not stop compressing. + +- Benefit: Meta-analysis of 79 studies involving 142,740 participants shows that overall, only 7.6% of people suffering from out-of-hospital cardiac arrest survive to leave the hospital. For those receiving CPR from bystanders, the survival rate rises from 3.9% to 16.1%. While 53% of cardiac arrests are witnessed by someone nearby, only 32% actually get CPR. The BASIC-OHCA registry in China recorded 38,227 emergency cases; among them, 30,282 cases (79.2%) occurred at home. In this group, the bystander CPR rate was 20.3%, and the survival rate was just 1.2%. The correct sequence is to start compressions first, then ask someone else to call 120 and fetch an AED; once the AED is powered on, follow its voice prompts. + +- Evidence grade: A + +- Notes: Do not pinch the philtrum first, do not look for family members, and do not record a video. Also, do not hesitate to press hard for fear of breaking ribs. Article 184 of China’s Civil Code states that anyone who voluntarily provides emergency aid and accidentally causes injury to the victim still bears no civil liability. +- Sources:Sasson C 等 (2010). Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes. ; Zheng J 等 (2023). Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry. The Lancet Public Health. ; 全国人大 (2020). 民法典（第一百八十四条）. + +### 2. Elderly falls: if someone falls, first kneel down, call out to them, and dial 120 — don’t rush to help them up. It is perfectly legal to walk away from strangers; once you stop, however, you must not touch or move them. + + +- Cost: No money is required. Kneeling down to ask a few questions and making a phone call takes only a few minutes. The hard part is resisting the urge to reach out and help. For strangers, there’s an extra cost to consider: calling 120 leaves your phone number on record, which may result in follow-up calls or inquiries. If family members later target you, legal battles can last months, and even if you ultimately win, you’ll still have to pay your own legal fees. + +- In plain terms: This guidance is primarily aimed at one’s own elderly relatives and people you know well. First, check whether they’re breathing; if not, follow step 1 (perform chest compressions). Even if they are breathing, don’t lift them up — they may have suffered a stroke or fainting spell prior to the fall, and forced movement could worsen injuries. Instead, kneel down, speak to them, and ask if they remember how they fell. If they complain of back pain or seem to have a fracture, do not move them; call 120 right away. + +- Benefit: The Ministry of Health’s “Technical Guidelines for Intervention in Elderly Falls” states two key points: “Falls are the leading cause of injury-related death among people aged 65 and older in China,” and “When an elderly person falls, do not rush to help them up; instead, respond according to the specific circumstances.” For those who are unconscious, immediately call emergency services. If they’re vomiting, turn their head to one side and clear any vomit from their mouth and nose. If breathing or heartbeat has stopped, start chest compressions at once. The guidelines also note: “If moving the person is necessary, do so gently and keep them as flat as possible.” For conscious individuals, ask whether they recall the fall; if not, it may indicate fainting or a cerebrovascular event. If they suffer severe headaches, facial drooping, slurred speech, or limb weakness, lifting them could worsen bleeding or ischemia in the brain. Likewise, if there are signs of fracture, back pain, or incontinence, avoid moving them unless you have relevant medical training. In all these cases, call 120 immediately. If the elderly person wishes to stand up on their own, assist them slowly, then let them sit or lie down while you monitor them until you’re sure they’re alright. Regarding fears of being held liable, the law is clear: Article 90 of the Supreme People’s Court Interpretation of the Civil Procedure Law states that “any party making a claim must provide evidence to support it; failure to do so results in losing the case.” Article 1198 of the Civil Code obliges operators of public venues — hotels, malls, banks, stations, airports, sports arenas, entertainment venues, etc. — to uphold safety standards; failure to do so makes them legally responsible for any resulting harm. Conversely, Article 184 protects anyone who voluntarily and urgently helps another person: “A rescuer bears no civil liability for any harm caused to the victim during such efforts.” A notable court case involved a pharmacy owner who performed CPR on a cardiac arrest victim, inadvertently breaking several ribs. The victim required 18 days of hospitalization and sought over 9,000 yuan in compensation; the court ruled in favor of the rescuer, absolving him of liability. + +- Evidence grade: B + +- Notes: This grade is assigned because the guidelines describe proper procedures but provide no quantitative data on how many lives they actually save. Article 184 shields rescuers only when their actions are voluntary and occur in an emergency; it does not cover situations such as “taking it upon oneself to load a stranger into a private car for transport” — waiting for 120 remains the safer choice. After dialing 120, stay on the line and follow the dispatcher’s instructions. This advice is primarily intended for one’s own elderly relatives and acquaintances. For strangers on the street, walking away is both legal and advisable; the law does not obligate you to intervene. That said, once you stop, you must weigh all associated costs: time spent, leaving your contact details, potential contact from family members, possible legal action, workplace repercussions, and even online backlash. For further details, see [docs/遇到陌生人出事该不该停.md](../../docs/research/遇到陌生人出事该不该停.md). The only unequivocal action required is not to move the person — this is a medical, not a legal, imperative, as forced movement can exacerbate cerebral hemorrhage or spinal injury. One exception applies if you are the proprietor, manager, or organizer of the location; in such cases, walking away no longer qualifies as a “free” option, as Article 1198 of the Civil Code imposes a duty of care on venue operators. For fall prevention, refer to Section 1, Item 13 (balance and leg-strength training); delayed symptoms following head trauma are covered in Section 10; financial recourse after injury sustained while rescuing others is addressed in Section 39; and evidence collection and reporting in cases of online harassment are outlined in Section 8, Item 16. +- Sources:卫生部 (2011). 老年人跌倒干预技术指南（「老年人跌倒后的处理」）. 全文 PDF 见广东省疾病预防控制中心 ，现场处理部分全文见贵南县人民政府转载 ；全国人大 (2020). 民法典（第一百八十三、一百八十四条）. ；最高人民法院 (2023). 人民法院抓实公正与效率践行社会主义核心价值观典型案例（案例十三，齐某某诉孙某某健康权纠纷案，辽宁省康平县人民法院）. ；最高人民法院 (2022 年第二次修正，2022 年 4 月 10 日施行). 关于适用《中华人民共和国民事诉讼法》的解释（第九十条）. ；民法典第一千一百九十八条同上最高检转载全文；全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第一百五十二、一百六十四条）. 上海市发展和改革委员会转载全文 ；国务院 (2006). 诉讼费用交纳办法（国务院令第 481 号，第六、二十九条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，2026 年 1 月 1 日起施行，第二十六条第一项、第五十条第五项）. + +### 3. Sudden facial drooping, weakness in one arm, and slurred speech — call 120 immediately; don’t wait or drive yourself. + + +- Cost: No cost at all. These three steps are easy to remember: ask the person to smile, raise both arms straight out, and say a complete sentence. + +- In plain terms: If someone’s face suddenly droops, they can’t lift one arm, and their speech becomes slurred, call 120 right away. Administering medication within 3 hours of symptom onset can increase the chance of regaining basic independence by about 1.75 times compared to not receiving treatment. Waiting 3 to 4.5 hours reduces this benefit to only 1.26 times. After 4.5 hours, there is virtually no difference. Be sure to note the exact time symptoms first appeared. Do not give water or medicine, and never drive the person to the hospital yourself. + +- Benefit: This conclusion comes from a meta-analysis of 16 randomized trials involving 6,756 patients. Intravenous thrombolysis means delivering medication to reopen blocked blood vessels. When alteplase is given within 3 hours of symptom onset, the odds of the patient regaining basic independence — defined as a modified Rankin score of 0–1 — increase by a factor of 1.75. The 95% confidence interval for this effect is 1.35–2.27. In other words, the likelihood of a good recovery is roughly 1.75 times higher with treatment. Waiting 3 to 4.5 hours lowers this advantage to 1.26 (95% CI 1.05–1.51), while after 4.5 hours the difference becomes statistically insignificant at 1.15 (95% CI 0.95–1.40). + +- Evidence grade: A + +- Notes: Thrombolysis involves administering medication to clear blocked blood vessels; the earlier it is given, the greater its effectiveness. After 4.5 hours, it provides little to no benefit. Calling 120 instead of driving is essential because ambulances transport patients directly to stroke centers where staff can be alerted in advance. Recording the exact time symptoms began helps doctors determine whether thrombolysis is still appropriate. Never give water or medicine, and never wait “to see if things get better on their own.” +- Sources:Emberson J, Lees KR, Lyden P, et al. (2014). Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet, 384(9958), 1929-1935. + +### 4. Sudden dizziness, double vision, loss of vision in one eye, or inability to touch one’s nose — all warrant calling 120 for stroke suspicion + +- Cost: No cost involved. Besides the three FAST signs — facial droop, arm weakness, and speech difficulty — two additional checks are recommended. First, ask the person to stand straight with eyes closed and see if they lose balance; then ask whether they see double or have blind spots. Second, have them extend a finger toward their nose, close their eyes, and repeat the motion. +- In plain terms: Out of 736 stroke cases, 14.1% showed none of the classic FAST symptoms at onset — no facial droop, no arm weakness, no slurred speech. Relying solely on those three signs would miss many cases. Adding checks for unsteady gait, double vision, or inability to touch the nose reduces that omission rate to just 4.4%. Any sudden dizziness, double vision, or failure to touch one’s nose should prompt an immediate call to emergency services and precise timing documentation. +- Benefit: In 2014, researchers at the University of Kentucky Stroke Center reviewed 736 cases of acute ischemic stroke. They found that 14.1% of patients exhibited none of the FAST indicators at the time of onset. When additional screening criteria — including gait instability, limb weakness, and visual disturbances — were incorporated, the proportion of missed diagnoses dropped to 4.4%. +- Evidence grade: B +- Notes: Infarctions affecting the cerebellum or brainstem — known as posterior circulation strokes — often lack facial droop or limb weakness. Instead, they manifest as vertigo, gait deviation, double vision, or difficulty swallowing, which are frequently mistaken for cervical spine disorders, hypoglycemia, or benign paroxysmal positional vertigo. Inability to touch one’s nose or maintain balance with eyes closed are telltale signs of cerebellar involvement. However, no single test can definitively rule out stroke; any sudden onset of these symptoms demands immediate emergency care and accurate timing recording. This study relied on records from a single medical center, and the authors themselves acknowledge the need for further validation. +- Sources:Aroor S, Singh R, Goldstein LB (2017). BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke, 48(2), 479-481. + +### 5. One eye suddenly goes dark, as if a curtain has been pulled shut; even if it clears up within minutes, seek emergency care for stroke on the same day + +- Cost: No direct cost. However, emergency evaluation and vascular testing will take up half a day to a full day. +- In plain terms: When one eye suddenly goes dark, as if a curtain has been pulled shut, it means a blockage has occurred in the blood vessels at the back of the eye. The longer the blockage persists, the less of the retina can be saved. This condition is also a form of cerebral ischemia, and the following days represent a high‑risk window for stroke. For patients in this situation, receiving evaluation and treatment on the same day reduces the likelihood of another stroke within 90 days from 10.3% to 2.1%. Seek emergency care at a hospital with a stroke center on the same day; do not wait until the next day to see an ophthalmologist. +- Benefit: The 2021 scientific statement from the American Heart Association on central retinal artery occlusion — blockage of the main vessel at the back of the eye — explicitly states that acute central retinal artery occlusion is a medical emergency. Healthcare systems should recognize it as such and prioritize treatment accordingly. The longer blood flow is cut off, the less retina can be salvaged. The Oxford EXPRESS study examined two groups of patients: those with cerebral ischemia whose symptoms resolved on their own, and those with minor strokes. The former are medically termed transient ischemic attacks. After these patients received same‑day evaluation and treatment, the rate of subsequent strokes within 90 days fell from 10.3% (32 out of 310) to 2.1% (6 out of 281). +- Evidence grade: B +- Notes: The grade B rating is due to the fact that EXPRESS was not a randomized trial; it compared outcomes before and after implementing the new protocol within the same patient population, making it difficult to isolate the effect of the intervention from other potential changes. A brief episode of darkness in one eye that resolves on its own is often dismissed as fatigue or low blood sugar. In reality, it is a type of transient ischemic attack, and the ensuing days are a critical window for stroke risk. Sudden, painless, non‑red, non‑teary loss of vision in one eye must be taken seriously. Do not wait until the next day for an ophthalmology appointment; go directly to the emergency department of a hospital equipped to handle strokes. +- Sources:Mac Grory B, Schrag M, Biousse V, et al. (2021). Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke, 52(6), e282-e294. ; Rothwell PM, Giles MF, Chandratheva A, et al. (2007). Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet, 370(9596), 1432-1442. + +### 6. One eye is swollen, painful, red; there’s a rainbow halo around lights; plus headache, nausea, and vomiting — so an emergency eye visit is needed that same day. + +- Cost: No cost at all. An emergency eye exam includes measuring intraocular pressure and checking the anterior chamber, which takes up half a day. +- In plain terms: This is an acute glaucoma attack. Fluid can’t drain from the eye, so pressure spikes quickly. The longer it goes untreated, the more damage occurs to the optic nerve, and that damage is permanent. During Wuhan’s lockdown, patients waited an average of 241 hours before getting treatment; 21.87% ended up blind. In the same period the year after the lockdown, the average wait time dropped to 121 hours, and only 7.84% became blind. A total of 76 days of lockdown were covered in this study. +- Benefit: An eye hospital in Wuhan compared two groups of patients with acute primary angle-closure glaucoma. In 2020, during the lockdown, 54 patients with 64 affected eyes received care; the following year, 46 patients with 51 affected eyes were treated. Both groups had similar demographic profiles. From symptom onset to treatment, the lockdown group waited 241.84±211.95 hours versus 121.53±96.12 hours for the control group (P=0.001). Their intraocular pressure at diagnosis was 52.63±12.45 mmHg versus 45.16±9.79 mmHg (P=0.001). Blindness rates were 21.87% versus 7.84%. Glaucomatous optic nerve damage was found in 20/64 eyes (31.25%) versus 7/51 eyes (13.73%) (P=0.03). A South Korean hospital reviewed 50 eyes that had experienced one acute attack and later had their lenses removed; a year later, 25 of those eyes (50%) showed varying degrees of visual field loss. The longer the time between symptom onset and pressure reduction, the higher the chance of lasting damage (P=0.005). Another prospective study had 43 people with shallow anterior chambers lie face-down in a dark room for one hour; intraocular pressure rose significantly in both eyes (P<0.01). The dominant eye saw a median increase of 3.60 mmHg, while the other eye rose 2.70 mmHg (P<0.05). +- Evidence grade: B +- Notes: There are two main reasons this is graded B. First, the Wuhan comparison relied on reviewing old medical records, and the lockdown itself introduced other differences that can’t be separated from the effect of delayed treatment. Second, the South Korean study involved only 50 eyes and was retrospective. This does not mean screen time causes glaucoma; in the dark, pupils dilate, and prolonged head-down posture pushes the lens forward, especially in people with naturally shallow anterior chambers. Those at highest risk are over 50, farsighted, or with a family history of angle-closure glaucoma. Young people who game all night are unlikely to develop this condition. Common misdiagnoses during an attack include gastroenteritis, migraine, or high blood pressure, since headache and vomiting are more noticeable than eye symptoms. Sudden, painless vision loss in one eye is a separate issue — see item 5 (sudden blackout in one eye). Whether blue-light blocking glasses help is discussed in section 6, item 16 (blue-light blocking glasses). +- Sources:Zhou L, Wu S, Wang Y, Bao X, Peng T, Luo W, Ortega-Usobiaga J (2022). Clinical presentation of acute primary angle closure during the COVID-19 epidemic lockdown. Frontiers in Medicine, 9, 1078237. ; Sung MS, Kim HJ, Park SW (2023). Predictors of long-term visual field outcome after an episode of acute primary angle closure. Clinical & Experimental Ophthalmology, 51(4), 291-299. ; Wang J, Wang J, Ng TK, Huang C (2025). Asymmetric intraocular pressure changes in dominant and contralateral eyes: the dark room prone provocative test. Seminars in Ophthalmology, 40(4), 325-331. + +### 7. Chest pressure, tightness, or heaviness lasting more than 15 minutes without relief — call 120; do not drive yourself. + +- Cost: No cost at all. +- In plain terms: If you feel chest pressure, tightness, or heaviness that lasts over 15 minutes without easing up, call 120 right away. For patients treated within 55 minutes of arrival at the hospital, the mortality rate within 30 days is 2.8%. For those treated later than 55 minutes, the rate rises to 9.7%. Every minute of delay means more heart muscle tissue dies. Do not drive yourself — losing consciousness while behind the wheel could lead to a second accident. +- Benefit: Israel conducted a nationwide study on acute coronary syndrome. The research focused on patients experiencing ST-segment elevation myocardial infarction, a specific type of heart attack. It measured the time interval from hospital admission to the point when a balloon catheter was used to reopen the blocked blood vessel. For patients treated within 55 minutes, 5 out of 178 (2.8%) died within 30 days. For those treated after 55 minutes, 15 out of 155 (9.7%) died within the same timeframe. +- Evidence grade: B +- Notes: This study compares outcomes based on the time elapsed after hospital admission, not from the onset of symptoms to arrival at the hospital. However, the underlying principle remains the same: any delay results in additional heart muscle damage. The pain may also be felt in the upper abdomen, back, or jaw, and numbness in the left arm can also be a symptom. Diabetic patients and older adults may not experience any pain at all, only shortness of breath. Again, do not drive yourself — losing consciousness while driving can easily cause another accident. +- Sources:Karkabi B, Meir G, Zafrir B, et al. (2021). Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction. European Heart Journal - Quality of Care and Clinical Outcomes. + +### 8. Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as “pain moving downward” + +- Cost: No cost at all. +- In plain terms: This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, simply describe it as “a tearing pain that’s moving downward.” Without surgery, treatment with medication alone results in a mortality rate of 58%. Its management is the exact opposite of that for heart attacks: doctors only order enhanced CT scans after suspecting this condition, not anticoagulant or thrombolytic therapy. Also mention any significant difference in blood pressure between both arms or absence of a pulse on one side. +- Benefit: The International Registry of Acute Aortic Dissection (IRAD) includes data from 464 patients across 12 centers. Acute aortic dissection is precisely this disease marked by sudden, severe tearing pain in the chest and back. Among all symptoms reported by patients, sudden onset of intense sharp pain is the most common. Overall in-hospital mortality stands at 27.4%. For patients with type A dissection receiving only medication, mortality reaches 58%. +- Evidence grade: B +- Notes: Management of aortic dissection is completely opposite to that of heart attacks. Heart attacks require anticoagulant and thrombolytic drugs to prevent blood clotting; applying such drugs to aortic dissection would essentially encourage bleeding at the tear site. Therefore, upon arriving at the hospital, patients must clearly state “a tearing pain that’s moving downward” to prompt doctors to order enhanced CT scans. A notable difference in blood pressure between arms or absence of a pulse on one side are also important warning signs. Individuals with poorly controlled blood pressure, Marfan syndrome, or a family history of aortic aneurysm or dissection are at higher risk. In such cases, driving oneself to the hospital is strongly discouraged; symptoms must be addressed immediately rather than waiting until the next day. +- Sources:Hagan PG, Nienaber CA, Isselbacher EM, et al. (2000). The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 283(7), 897-903. + +### 9. A sudden “worst headache of one’s life” that peaks within an hour — go to the ER for a head CT right away + +- Cost: An emergency visit itself costs very little. A head CT in the ER typically runs a few hundred yuan. +- In plain terms: The key point isn’t how intense the pain is, but how quickly it reaches its peak. In 2,131 people experiencing severe headaches that peaked within an hour, 6.2% had a ruptured blood vessel on the surface of the brain. Anyone aged 40 or older, with neck pain or stiffness, who was seen collapsing by others, whose headache started during physical activity, came on suddenly like an explosion, or has limited neck flexion when examined should go to the ER for a head CT. The vast majority of people who get tested end up fine, but missing even one case of bleeding can be fatal. +- Benefit: Ten Canadian emergency departments conducted a prospective cohort study on 2,131 patients with “severe headaches peaking within an hour.” They defined clear criteria upfront and tracked outcomes accordingly. Of these, 132 patients (6.2%) had subarachnoid hemorrhage, meaning a ruptured surface blood vessel in the brain. The Ottawa SAH rule includes six criteria: age 40 or older, neck pain or stiffness, witnessed loss of consciousness, onset during physical activity, sudden explosive onset of pain, and limited neck flexion on physical exam. Meeting any one of these criteria triggers a CT scan. This rule identified every single patient with bleeding, with 100% sensitivity. The 95% confidence interval for this figure is 97.2%–100.0%. The trade-off is that only 15.3% of people without bleeding were excluded by this rule (specificity of 15.3%). +- Evidence grade: A +- Notes: It’s not “how painful it is” that matters, but “how fast it reaches peak pain.” Headaches that erupt within seconds to a minute are the real warning sign; gradually worsening migraines are not. Additional symptoms like vomiting, neck stiffness, light sensitivity, or brief fainting also warrant immediate attention. With a specificity of just 15.3%, most people who follow this rule end up with normal results. Yet missing even one case of bleeding can be fatal, so getting tested is absolutely worthwhile. Do not take painkillers to mask the pain and then fall asleep. +- Sources:Perry JJ, Stiell IG, Sivilotti MLA, et al. (2013). Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA, 310(12), 1248-1255. + +### 10. After an elderly person suffers a head injury, they may develop unsteady gait, sluggishness, excessive sleepiness, or weakness on one side of the body two to three weeks later — a CT scan is recommended. + + +- Cost: A single cranial CT scan costs roughly 200–300 RMB. + +- In plain terms: After a head injury, blood usually starts accumulating only around the third week. At the time of impact, there may be absolutely no symptoms at all, and the person might not even recall the injury. The recurrence rate after surgery for this condition can reach 33%, while the mortality rate may be as high as 32%. If an elderly individual suddenly appears confused, walks unsteadily, feels unusually sleepy, or shows weakness on one side, it’s important to first ask whether they fell or hit their head in the past two to three months, then proceed with a CT scan. + +- Benefit: The Neurosurgical Society of the Chinese Medical Association has published a Chinese expert consensus on medical treatment for chronic subdural hematoma. This condition involves slow accumulation of blood between the meninges; technically, it refers to chronic mass formation caused by blood buildup between the arachnoid membrane and dura mater. It “typically develops three weeks after head trauma” and is most common among older adults. Post-surgery recurrence and mortality rates can reach 33% and 32% respectively. Among patients aged 90 or older, only 24% achieve a satisfactory recovery overall. Global data shows that incidence rates range from 3.39 to 39.1 new cases per 100,000 people annually, rising sharply after age 80. The most common causes are trauma and falls, followed by chronic alcohol consumption, use of anticoagulant medications, and violent injury. Geriatric literature notes that typical symptoms include confusion, cognitive decline, gait disturbances, and excessive sleepiness — features that may overlap with other geriatric syndromes. + +- Evidence grade: B + +- Notes: At the time of injury, there may be absolutely no symptoms, and the elderly person might not even recall the incident. Therefore, when families notice sudden confusion, unsteady walking, excessive sleepiness, or unilateral weakness, they should first check whether a head injury occurred in the past two to three months before ordering a CT scan. It’s crucial not to automatically attribute these symptoms to “senile dementia” or “post-stroke sequelae,” as doing so could lead to delayed diagnosis. Elderly individuals taking aspirin, clopidogrel, warfarin, or newer oral anticoagulants face higher risks, as does long-term heavy alcohol consumption. For fall prevention, refer to Section 1, Item 13 — focusing on balance training and leg strength exercises. +- Sources:Zhang J 等 (2021). Expert consensus on drug treatment of chronic subdural hematoma. Chinese Neurosurgical Journal, 7(1), 47. ; Dziho A 等 (2025). Global prevalence and incidence of chronic subdural hematoma: A systematic review. Brain and Spine, 5, 105893. ; Mathon B, Shotar E (2026). Diagnostic and therapeutic management of chronic subdural hematoma in elderly patients. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, 24(1), 30-41. + +### 11. A leg suddenly swells, feels tight, and is tender to the touch — seek medical care promptly; if shortness of breath or chest pain develops suddenly, call 120 immediately. + + +- Cost: An ultrasound of the leg veins (lower extremity venous ultrasound) costs around 100–200 yuan. + +- In plain terms: If one leg suddenly swells, becomes noticeably thicker than the other, and is painful to press, get a leg vein ultrasound done as soon as possible. Should shortness of breath, chest pain when taking a deep breath, a rapid heartbeat, or dizziness appear, a blood clot may have traveled to the lungs — call 120 right away. Among people diagnosed with pulmonary embolism, 17.4% die within three months. Sitting still for more than four hours roughly doubles the risk, though the actual chance for any one person remains very low. + +- Benefit: The International Cooperative Registry on Pulmonary Embolism (ICOPER) gathered data from 2,454 patients with confirmed acute pulmonary embolism treated at 52 hospitals across seven countries. Pulmonary embolism occurs when a blood clot blocks a pulmonary artery. Within three months, the overall mortality rate for these patients — regardless of cause — was 17.4% (426 out of 2,454). The WHO WRIGHT project found that travel lasting four or more continuous hours “roughly doubles” the risk of blood clots forming in veins and traveling to the lungs (venous thromboembolism). Even so, the actual probability for any individual remains low; prolonged inactivity exceeding four hours translates to roughly one in 6,000 people facing this risk. + +- Evidence grade: B + +- Notes: Swelling in both legs is usually linked to issues involving the heart, liver, kidneys, or venous function. Sudden swelling of just one leg, noticeably larger than the other, is a classic sign of deep vein thrombosis. High-risk situations include long car or plane trips, bed rest after surgery or a fracture, wearing a cast, pregnancy and the postpartum period, cancer, and oral contraceptive use. When a clot breaks loose and blocks a pulmonary artery, pulmonary embolism results — marked by sudden shortness of breath, worsening chest pain with deep breaths, rapid heartbeat, dizziness, and sometimes coughing up blood. In such cases, call 120 immediately. The 17.4% figure reflects mortality among confirmed pulmonary embolism cases, not the overall risk associated with leg swelling alone; don’t let this number cause undue alarm. +- Sources:Goldhaber SZ, Visani L, De Rosa M (1999). Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 353(9162), 1386-1389. ; WHO (2007). Study results released on travel and blood clots. + +### 12. For severe bleeding, first press firmly on the wound with your hand; if bleeding from a limb can’t be stopped, apply a tourniquet and call 120 right away. + +- Cost: A twist‑type tourniquet costs anywhere from a few dozen to over a hundred yuan; keep one in your car or first‑aid kit. Learning how to wrap it above the wound, twist until bleeding stops, and note the time takes just a few minutes. +- In plain terms: The proper order is to press hard on the wound with your hand or a cloth; if bleeding from an arm or leg won’t stop, put on a tourniquet and then call 120. Once applied, never loosen it. Battlefield data shows that 90% of patients whose tourniquets were applied before going into shock survived, compared with only 10% whose tourniquets were applied after shock set in; all 5 patients who needed a tourniquet but didn’t get one died. Wrap the tourniquet above the bleeding site, twist until the flow stops, and write down the time. Do not use shoelaces or rope as substitutes. For neck or torso injuries, only compression works — never apply a tourniquet there. +- Benefit: Over six years, 11 Level I trauma centers in Texas treated 1,026 patients with vascular injuries to the limbs; 181 of them (17.6%) had a tourniquet applied before arrival. Unadjusted mortality rates were 3.9% for those with a tourniquet versus 5.2% for those without. After adjusting for other factors, tourniquet use remained strongly linked to survival, with an odds ratio of 5.86 (95% CI 1.41–24.47). At a Baghdad field hospital, 90% of 232 injured patients whose tourniquets were applied before shock survived, while only 10% survived after shock; all 5 patients who required a tourniquet but did not receive one died, and 87% of those who did get one lived. The recommended sequence is: direct manual pressure using any cloth or towel → if bleeding from a limb persists, apply a tourniquet → call 120 → never loosen the tourniquet. +- Evidence grade: A +- Notes: Never use thin materials such as rope or shoelaces as tourniquets; they cannot compress arteries properly and may cut the skin. Once a tourniquet is in place, do not periodically loosen it to “let blood flow.” For bleeding on the neck or torso, compression only is safe — no tourniquet should be used there. The battlefield data show that tourniquets themselves did not cause any amputations; transient nerve paralysis occurred in 4 cases. The official training materials on tourniquet use from China’s Health Commission and Red Cross could not be accessed for this review; further verification of Chinese official guidelines is still needed. +- Sources:Teixeira PGR 等 (2018). Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. Journal of the American College of Surgeons. ; Kragh JF 等 (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery. + +### 13. For dog or cat bites and scratches, rinse the area with soap and running water for 15 minutes, then get vaccinated on the same day. + +- Cost: Rinsing requires no expense. The full course of rabies vaccination costs several hundred yuan. For category III exposures, an additional passive immunization product—essentially ready-made antibodies administered directly—is needed, adding several hundred to over a thousand yuan. The greatest cost, however, comes from delays. +- In plain terms: Once rabies symptoms appear, the fatality rate is practically 100%. Rinsing with soap and water followed by vaccination is the sole safeguard. First, rinse the affected area with alternating streams of soap and running water for 15 minutes, then seek medical care on the same day. If the skin is broken and the wound has been licked, this constitutes a category III exposure, requiring the extra passive immunization product. The fact that a pet has been vaccinated does not alter this classification; exposure level is determined solely by the nature of the injury, not by the animal’s background. +- Benefit: According to the 2023 guidelines issued by China’s National Disease Control and Prevention Administration and Health Commission, “The fatality rate from rabies is practically 100%.” Recommended first aid is “to thoroughly rinse all bite and scratch sites with alternating streams of soap (or another mildly alkaline cleanser) and running water under adequate pressure for roughly 15 minutes.” For minor bites where skin remains intact or superficial scratches without bleeding—classified as category II exposures—vaccination alone is sufficient. Category III exposures, involving penetrating wounds or licked broken skin, mandate both wound treatment, passive immunization, and full vaccination. The WHO reports that roughly 59,000 people worldwide die from rabies each year, 99% of cases linked to dog bites. +- Evidence grade: A +- Notes: Never skip treatment on the assumption that a pet is vaccinated or well‑tended; guidelines base classification strictly on wound severity, not on the animal’s status. Do not attempt to bandage the wound yourself. The ten‑day observation method may inform whether to discontinue vaccination, but it never negates the need to begin it. The same protocol applies to bites inflicted by wild animals or bats. +- Sources:国家疾控局综合司、国家卫生健康委办公厅 (2023). 关于印发狂犬病暴露预防处置工作规范（2023 年版）的通知. ; WHO. 狂犬病 实况报道. + +### 14. Immediately rinse a burn with cool running water for 20 minutes; avoid applying toothpaste or soy sauce + +- Cost: No cost involved. It requires 20 minutes of time. +- In plain terms: Rinsing a burn with cool running water for at least 20 minutes within 3 hours of injury reduces the likelihood of needing skin grafts to roughly 60% of the rate for those who do not perform this step. Use cool water, not ice water, as ice application can worsen the damage. If clothing sticks to the wound, do not pull it off forcefully; after rinsing, cover the area with a clean cloth and head to the hospital. Never apply toothpaste, soy sauce, sesame oil, or flour to the burn. Even if you remember to rinse later, doing so within 3 hours still provides benefit. +- Benefit: An Australian study followed 2,495 children with burns. For kids who rinsed the burn with cool running water for 20 minutes within 3 hours of injury, the relative risk of needing a skin graft was 0.6. The 95% confidence interval for this value is 0.4–0.8, meaning the likelihood of needing a graft is roughly 60% lower than for those who did not rinse. Results from 7 combined studies also confirm that 20 minutes of cool running water irrigation within 3 hours of injury significantly lowers the chance of needing skin grafts or surgical wound treatment. +- Evidence grade: A +- Notes: Use cool water, not ice water, as ice application can worsen burn damage. If clothing sticks to the wound, do not pull it off forcefully; after rinsing, cover the area with a clean cloth and seek medical care. Avoid applying toothpaste, soy sauce, sesame oil, or flour to the burn, as these substances can interfere with doctors’ assessment of injury severity and increase infection risk. Rinsing within 3 hours of injury remains beneficial even if done later than initially intended. +- Sources:Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM (2020). Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children. Annals of Emergency Medicine, 75(1), 75-85. ；Griffin B, Cabilan CJ, Ayoub B, et al. (2022). The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australasian Emergency Care, 25(4), 367-376. + +### 15. Sudden widespread rash, difficulty breathing, or dizziness — treat as anaphylactic shock; call 120 immediately and explain the situation clearly. + + +- Cost: No cost involved. However, people with known severe allergies must purchase epinephrine auto-injectors themselves; these are prescription-only medications. + +- In plain terms: If someone suddenly develops a full-body rash along with trouble breathing or dizziness, treat it as anaphylactic shock. Call 120 right away and clearly state “suspected anaphylactic shock” so emergency responders can bring epinephrine with them. Epinephrine is the first-line treatment; antihistamines and steroids act too slowly to be effective in such cases. Individuals who have experienced this before should consult a doctor for an epinephrine auto-injector and learn how to administer it to the outer midsection of the thigh — this can be done even through clothing. + +- Benefit: Epinephrine is the recommended first-line treatment for all grades of anaphylactic shock (Grade 2 and above); clinical guidelines strongly endorse its use. Antihistamines and steroids are much slower-acting and cannot replace epinephrine in emergency situations. + +- Evidence grade: B (guidelines strongly recommend it, though the underlying evidence base is relatively weak). + +- Notes: The EAACI allergy guidelines themselves note that “most evidence in this field remains at a low level.” They still classify epinephrine as a strongly recommended treatment because its benefits far outweigh the risks, rather than because of large-scale clinical trials. In China, epinephrine is a prescription medication and is not readily available to the general public. The best immediate action is to call 120 and clearly describe “suspected anaphylactic shock” so emergency teams can bring epinephrine along. Those with a history of severe allergic reactions should consult a doctor for an epinephrine auto-injector and learn how to inject it into the outer midsection of the thigh — this can be done through clothing as well. +- Sources:中国医药教育协会等 (2022). 过敏性休克急救临床实践指南（2020）. Frontiers in Pharmacology：「Epinephrine is the first-line medicine in GRADE II to IV anaphylaxis」「Intramuscular epinephrine should be injected in the mid-anterolateral thigh」，成人肌注上限 0.5 mg、14 岁以下 0.3 mg，无反应可每 5–15 分钟重复一次. ；Muraro A, et al. (2022). EAACI guidelines: Anaphylaxis (2021 update). Allergy. + +### 16. Someone is having a seizure — clear the area, place them on their side, time the episode, and don’t put anything in their mouth. + + +- Cost: No cost at all. +- In plain terms: Move any hard objects away from the person. Lay them on their side with their mouth facing down, and start timing the seizure. Don’t hold them down, don’t force their mouth open, and don’t put anything into their mouth — doing so can easily damage teeth and jaws. Call emergency services if the seizure lasts more than 5 minutes, if it stops briefly then starts again, if the person doesn’t respond afterward or has trouble breathing, if it occurs in water, or if this is the person’s first seizure ever. Only give water after they’ve fully regained consciousness. +- Benefit: This approach prevents injuries to teeth and jaws caused by forcing the mouth open or inserting foreign objects. It also avoids fractures that can result from restraining a convulsing person. A seizure lasting over 5 minutes is a clear medical emergency requiring immediate ambulance help. +- Evidence grade: B +- Notes: The same page lists several other situations that also demand immediate ambulance call: a seizure that ends only to recur quickly, post‑seizure unresponsiveness or breathing difficulty, any injury sustained during the episode, a seizure occurring in water, or a first‑time seizure. After the seizure stops, the person should be placed on their side with the mouth down, and only then given water once fully awake. This guidance is primarily intended for family members caring for someone with epilepsy; applying these steps to a stranger offers fewer personal benefits but still protects you from legal liability (Civil Code Article 184, see item 2 in this section — don’t rush to lift the person up). +- Sources:美国疾病控制与预防中心. 癫痫发作急救：「Don't hold the person down or stop their movements」「Don't put anything in their mouth. This can hurt their teeth or jaw」「Don't offer water or food until they are fully alert」「Time the seizure to track if it lasts more than 5 minutes. If it does, seek immediate medical attention or call 911」. + +### 17. Diabetic patients suddenly start shaking, break out in cold sweats, and have slurred speech — first give 15 grams of sugar, then retest after 15 minutes + +- Cost: No cost involved. Just keep a few sugar cubes or a small carton of juice on hand. +- In plain terms: First, give 15 grams of sugar — sugar cubes or a small carton of juice both work fine. Retest blood sugar levels after 15 minutes; if they’re still low, repeat the process. A blood sugar level below 3.0 mmol/L is medically significant hypoglycemia. If a person reaches a stage where they need outside help to manage it, it can be fatal. Never feed anything to someone who is unconscious — they could choke, so call emergency services right away. +- Benefit: A blood sugar level below 3.0 mmol/L qualifies as clinically meaningful hypoglycemia. If a person shows changes in consciousness or behavior that require outside assistance to manage, this is severe hypoglycemia that can be deadly. +- Evidence grade: A +- Notes: Never feed anything to an unconscious person — they could choke, so call emergency services immediately. The same guidelines also recommend that people on insulin or at high risk of hypoglycemia should always carry glucagon. The original text reads: “All individuals treated with insulin or who are at high risk of hypoglycemia...should be prescribed glucagon.” Nasal glucagon sprays and pre-filled injection kits are easier to use than glucagon that needs to be mixed on the spot. This advice is aimed at you or any diabetic family members you care for — keeping sugar on hand is meant to help them in emergencies. +- Sources:美国糖尿病学会 (2025). 糖尿病诊疗标准 2025·第 6 章 血糖目标与低血糖. Diabetes Care：分级「Level 1: Glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L)」「Level 2: Glucose <54 mg/dL (<3.0 mmol/L)」「Level 3: A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, irrespective of glucose level」；处理「For most individuals, 15 g carbohydrates should be ingested」「Fifteen minutes after initial treatment, repeat the treatment if hypoglycemia persists」. + +### 18. If someone is electrocuted, cut the power first, then use a dry wooden stick to pry the source of electricity away; never pull the victim by hand directly. + +- Cost: No cost involved. +- In plain terms: First, turn off the power, or use a dry wooden stick to move the electrical source away before touching the victim. Pulling them by hand directly can turn one victim into two. If the victim isn’t breathing after being freed from the current, immediately perform chest compressions as described in step 1 of this section — don’t hesitate to act just because it’s an electrical injury. Never attempt to handle situations involving downed high-voltage lines or nearby electrical equipment on your own; instead, move to a safe distance and wait for utility workers to cut the power. +- Benefit: This approach prevents rescuers from getting electrocuted as well, avoiding a situation where one victim becomes two. For victims who stop breathing after being freed from the electrical current, performing CPR as outlined in step 1 of this section is effective. The emergency response guidelines from the US Centers for Disease Control and Prevention advise: first observe the scene and avoid touching the victim, as they may still be connected to the power source. If possible, cut the power first. If that’s not feasible, use non-conductive materials like cardboard, plastic or wood to move the power source away. For victims with no breathing or pulse after being freed from the current, immediate CPR is required. A review of relevant studies found that patients who suffer cardiac arrest due to electrocution and are successfully revived generally have a good prognosis. +- Evidence grade: B +- Notes: The rule “cut power first, then touch the victim” is purely self-protective: pulling the victim by hand directly means you’ll be the next victim. Never attempt to handle downed high-voltage lines or nearby electrical equipment on your own; move to a safe distance and wait for utility workers to cut the power. For cardiac arrest caused by electrocution, standard CPR and defibrillation procedures apply — don’t hesitate to perform these just because it’s an “electrical injury”. +- Sources:US CDC. What to Do to Protect Yourself From Electrical Hazards（First aid 一节）. ；Spies C, Trohman RG (2006). Narrative review: Electrocution and life-threatening electrical injuries. Annals of Internal Medicine 145(7):531-537. + +### 19. If a carbon monoxide alarm goes off, or if everyone in a room suddenly has headaches, nausea, or dizziness, get outside first and then call for help + +- Cost: No cost at all. +- In plain terms: If the carbon monoxide alarm sounds, or if multiple people in the same room start experiencing headaches, nausea, and dizziness, move everyone outdoors right away before calling for emergency assistance. Do not stay inside trying to figure out what’s happening, and do not go back inside to turn off any valves. These symptoms resemble both a common cold and the effects of excessive alcohol consumption. The clearest warning sign is that symptoms improve immediately once people are outside. In the United States, over 400 people die each year from carbon monoxide poisoning unrelated to fires, and more than 100,000 people require emergency medical treatment. +- Benefit: Each year in the US, over 400 people lose their lives to accidental carbon monoxide poisoning that has no link to fires. More than 100,000 people seek emergency care, and over 14,000 are hospitalized as a result. +- Evidence grade: B +- Notes: The symptoms mirror those of a cold or heavy alcohol intoxication. The fact that multiple people in the same space experience these issues and feel better once they leave the area is the strongest indicator of carbon monoxide exposure. It is critical to exit the premises first, then call for help — do not linger to investigate or return to shut off valves. Instructions on proper carbon monoxide alarm installation can be found in Section 1, Item 3. Note: We are currently unable to obtain official nationwide statistics on carbon monoxide-related deaths in China, so this figure remains unverified. +- Sources:美国疾病控制与预防中心. 一氧化碳中毒：「More than 400 Americans die from unintentional CO poisoning not linked to fires」「More than 100,000 visit an emergency department」「More than 14,000 are hospitalized」，常见症状「headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion」. ；美国消费品安全委员会. 一氧化碳信息中心：「If you suspect CO poisoning, get outside to fresh air immediately, and then call 911」. + +### 20. If someone accidentally ingests detergent, pesticides, or medicine, do not induce vomiting — take the container and seek medical help right away; if it splashes into the eyes or onto the skin, rinse thoroughly with water for at least 15 minutes. + + +- Cost: No cost involved. Simply keep detergents, disinfectants, pesticides, and medicines out of children’s reach, preferably in a locked cabinet. Never transfer them into beverage bottles. + +- In plain terms: If someone swallows detergent, pesticides, or medicine, do not make them vomit — spitting out corrosive liquids would burn the esophagus all over again. Instead, have them drink some milk or egg whites, then head to the hospital right away while bringing the product container and its instructions. If the substance gets into the eyes or onto the skin, rinse with copious amounts of water for a full 15 minutes; for eyes, gently hold the eyelids open while rinsing and avoid rubbing. Mixing disinfectants with toilet cleaners can produce chlorine gas. + +- Benefit: The Chinese CDC provides four distinct response protocols. For ingestion: drink milk or egg whites promptly and, crucially, do not induce vomiting. Seek medical care at once while carrying the packaging or label so doctors can quickly identify the ingredients and plan treatment. For inhalation: move the person to fresh air, loosen tight clothing to ease breathing; if coughing, shortness of breath, or difficulty breathing occurs, get help immediately. For skin contact: wash the area with water for at least 15 minutes, being careful not to let runoff reach the eyes or intact skin. For eye exposure: flush the eyes with water or saline for a minimum of 15 minutes; keep the eyelids open throughout to ensure full coverage and never rub them. After rinsing, visit an ophthalmologist without delay. Products are categorized by pH: those with pH < 3 include toilet cleaners, descalers, floor cleaners, and stainless‑steel polishes; some heavy‑duty drain cleaners even contain dilute sulfuric acid. Products with pH > 11 comprise drain uncloggers, strong kitchen degreasers, dishwasher powders, oxygen‑based stain removers, and abrasive cleaners. A particularly dangerous combination is mixing disinfectants with hydrochloric‑acid‑based toilet cleaners — this generates chlorine gas that irritates the respiratory tract, provokes severe coughing and breathlessness, and can be life‑threatening. + +- Evidence grade: B + +- Notes: This rating of B reflects that official guidance outlines how to respond and how to identify hazardous products, yet it lacks quantitative data on exactly how much risk reduction results from following those steps. The reason not to induce vomiting is that corrosive substances would re‑damage the esophagus upon expulsion. If you’re unsure what was ingested, bring the container, its label, and any vomit to the hospital. Prevention is far cheaper than emergency treatment: store chemicals separately from food and drinks, seal containers tightly, discard empty bottles, and never repurpose them for other liquids. When handling these substances, wear rubber gloves and protective goggles, ensure good ventilation, and never mix different types. For carbon monoxide exposure, see item 19; for burns, refer to item 14. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2025). 暑假安全提示：警惕强酸强碱清洁剂. + +### 21. In case of splashes of acids, alkalis or other chemicals on the body, immediately remove contaminated clothing and rinse with copious amounts of running water; for eyes, gently pull the eyelids apart and rinse thoroughly before leaving the scene. + + +- Cost: No cost involved. On your first day at work, locate the eyewash stations and safety showers so you won’t have to search for them in an emergency. + +- In plain terms: Follow three simple steps. First, strip off any clothing, shoes and socks that have been exposed — the areas covered by fabric sustain the worst injuries. Second, rinse both skin and eyes with plenty of running water for at least 15 minutes; the Hunan Provincial Emergency Management Department recommends 20–30 minutes, so err on the side of caution. Third, pull the eyelids apart to rinse the eyes thoroughly, then head straight to an ophthalmologist. Use lukewarm water, never hot. + +- Benefit: These three on‑site actions are vital. First, promptly removing contaminated clothing prevents further absorption of toxins through the skin; areas shielded by fabric are especially vulnerable. Second, copious flushing with water meets the minimum recommendations from the Chinese CDC — at least 15 minutes for skin and eyes — while the Hunan guidelines suggest 20–30 minutes for severe chemical burns, so the longer duration should be followed. Third, gently separating the eyelids ensures water reaches the entire eye surface; rubbing the eyes must be avoided, and immediate medical care is essential. Lukewarm water is ideal; hot water should never be used. Avoid applying ointments, antiseptic solutions or any substances to fresh wounds, and do not cover them with dirty cloth — such actions can obscure the extent of injury and hinder diagnosis. Legally, both chemical skin burns and chemical eye injuries are recognized as occupational diseases; workplace incidents are treated as work‑related injuries. In any acute chemical exposure emergency, employers must promptly provide medical treatment, health monitoring and medical observation at their own expense. + +- Evidence grade: B + +- Notes: This item is graded B because no single national standard specifies the exact flushing duration; one official source cites 15 minutes while another recommends 20–30 minutes. When seeking medical care, bring the chemical’s name, packaging or its Safety Data Sheet so doctors can tailor treatment. Never attempt to neutralize a chemical by mixing it with another acid or base — such reactions release heat and are impossible to control. The “neutralizing solution” mentioned in the Hunan document refers to pre‑prepared rinse fluids kept on site, not improvised mixtures. Dry powders such as lime or cement should be brushed off before rinsing; some emergency guides suggest drying concentrated sulfuric acid first, but this practice is not uniformly endorsed and is not covered here. For household cleaners and accidental ingestion, refer to Item 20. Pre‑employment protective measures and health checks are detailed in Item 19, sections 10 and 11 — employers must provide hazard information and appropriate PPE before workers start their duties. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2025). 暑假安全提示：警惕强酸强碱清洁剂. ；湖南省应急管理厅 (2015). 常见化学品中毒事故的应急处理与治疗. ；国家卫生健康委等四部门 (2024). 职业病分类和目录（2025 年 8 月 1 日起实施）. ；全国人大常委会 (2018). 职业病防治法（第三十七条）. （北京市人民政府转载） + +### 22. Dizziness, nausea, lack of sweating, or confusion in hot weather — move the person to a cool area immediately, remove clothing, and cool them down with water; do not give water to anyone who is unconscious, and call 120 right away. + + +- Cost: No cost involved. +- In plain terms: Red, hot skin, slurred speech, and confusion are signs of heatstroke. It can progress from dizziness to unconsciousness in just a few minutes, and the mortality rate is extremely high. Immediately move the person to a cool, well‑ventilated area, take off their clothes, and cool them using cool water and wet towels while calling 911. Never give water to someone who is unconscious — it can cause choking. +- Benefit: The U.S. National Weather Service describes heatstroke as a “serious medical emergency.” Its symptoms include a body temperature above 103°F (39.4°C), confusion, slurred speech, and hot, red skin. The recommended response is to call emergency services, move the victim to a cool place, cool them with water and wet cloths, and “do not give any fluids.” Heat exhaustion shows up as heavy sweating, weakness, cold and wet skin, and a rapid, weak pulse; treatment involves moving to a cool area, loosening clothing, and sipping water; if vomiting, condition worsens, or symptoms persist beyond an hour, medical help is needed. The Yunnan Provincial Center for Disease Control and Prevention advises quickly relocating to a shaded, breezy spot, applying cold wet towels, giving salted drinks to conscious victims, and calling emergency services for severe cases — heatstroke carries an “extremely high mortality rate.” The Wilderness Medical Society’s 2019 heat‑related illness guidelines serve as the professional standard for handling such situations in remote or resource‑limited settings. +- Evidence grade: B +- Notes: Do not wait for symptoms to “get better” — heatstroke can progress from dizziness to unconsciousness in just minutes. Never force water into someone who is unconscious; it can lead to choking. The full text of the Wilderness Medical Society guidelines requires a subscription; only the abstract was verified for this translation. Specific recommendations such as cold water immersion are marked “to be verified.” The Health Commission’s webpage on heatstroke prevention returned a 412 error and could not be accessed. +- Sources:US National Weather Service. Heat Related Illnesses. ; 云南省疾控局 (2026). 出现这些症状，你可能是中暑了. ; Lipman GS 等 (2019). Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness & Environmental Medicine. + +### 23. For people suffering from heatstroke, as long as they remain conscious, they should drink small amounts of cool, lightly salted water or sports drinks at frequent intervals — never gulp down large quantities. Alcohol and sugary drinks must be avoided. + + +- Cost: No cost involved. A bottle of sports drink costs just a few yuan. +- In plain terms: Only conscious individuals should drink. Consume cool, lightly salted water or sports drinks in small portions, about 500–1000 ml per hour. Do not drink too much at once; vomiting can cause liquid to enter the airways, which is far more dangerous than heatstroke itself. Alcohol and sugary drinks must be avoided, as they cause further fluid loss. Applying cool water to the skin or using ice packs on the neck, armpits, and inner thighs is recommended — cooling should always come before rehydration. Never give anything to drink to someone who is unconscious or speaking incoherently. +- Benefit: The Chinese CDC published the “Guidelines on Prevention and Emergency Treatment of Heatstroke (2014),” which states: “Consume at least 2–4 cups of cool water per hour (500–1000 ml), ensuring the temperature is not excessively high; drinking should be done in small amounts at frequent intervals.” It also advises: “Avoid beverages containing alcohol or large amounts of sugar, as these lead to further fluid loss. Do not consume overly cold drinks.” For heatstroke specifically, the guidelines explicitly warn: “Do not give the patient any water to drink.” NIOSH in the U.S. recommends encouraging “small, frequent sips of cool water” for heat exhaustion, and for heat cramps, suggests sports drinks with sugar and electrolytes every 15–20 minutes — “do not use salt tablets.” +- Evidence grade: B +- Notes: After heavy sweating, drinking plain water alone dilutes blood sodium levels, so a bit of salt must be added to the water. Gulping down large amounts at once often leads to vomiting, which can be fatal if liquid enters the airways. The 2014 Chinese CDC guideline advises against “very cold drinks” to prevent stomach cramps, though no quantitative evidence supports this restriction; it should not be interpreted as “no cold drinks at all.” In item 22, several cooling methods are described: wiping the body with cool water, immersing in cold water, and applying ice packs to the neck, armpits, and inner thighs — all of which are officially recommended first-line measures. These are meant for external application, not ingestion, and cooling must always precede rehydration. Never give anything to drink to anyone who is unconscious or speaking unclearly. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2014). 公众高温中暑预防与紧急处理指南（2014 版）. ; US CDC/NIOSH. Heat-Related Illnesses. + +### 24. Stay low to the ground during a fire, feel the door before opening it, don’t open a hot door, use stairs not elevators, and never look back after escaping + + +- Cost: Installing one or two standalone smoke detectors at home costs only a few dozen yuan. It also helps to check in advance where the two possible exits are located in the hallway. + +- In plain terms: Drop to the ground and crawl under the smoke toward the nearest exit. Before opening a door, feel the knob and the surface of the door itself; if either feels hot or smoke is seeping through the crack, do not open it and instead head for the other exit. Open the door slowly, and shut it immediately if thick smoke appears. Always use stairs rather than elevators, since power outages can trap you inside. Once outside, do not return for any reason. If your clothes catch fire, stop moving, lie down, roll on the ground, and shield your face with your hands. + +- Benefit: The official FEMA guidance on fire escape reads exactly: “Drop to the ground and crawl under the smoke toward the exit.” Before opening a door, feel the knob and the door surface; “if it is hot or smoke is coming through the crack, do not open it and use the other exit instead.” Open the door slowly, and close it at once if dense smoke appears. In case of clothing fire, “stop, lie down, roll on the ground,” and protect the face with hands. If escape is impossible, close the door and seal any gaps or vents with cloth or tape, then call for help and state your location. + +- Evidence grade: B + +- Notes: Never use elevators, as a power failure can leave you trapped. Do not go back inside for belongings. Do not run upward unless you are certain the roof door is open; jumping from heights is extremely dangerous. The official website of China’s Fire and Rescue Service (119.gov.cn) returned error codes 405/412 and could not be accessed. TODO: Need to verify the exact wording of the official fire‑escape advice, including whether using a wet towel to cover the nose and mouth is mentioned. +- Sources:US FEMA Ready.gov. Home Fires. + +### 25. Upon seeing someone drowning, shout for help and call 110/120, then reach out a pole or floating objects — never enter the water yourself + +- Cost: No cost involved. The hard part is resisting the urge to jump in. +- In plain terms: A drowning person instinctively pulls their rescuer underwater, so anyone who enters the water risks drowning too. The proper sequence is: shout for help → call emergency services → extend a long pole or rope → throw life rings, empty buckets, or plastic bottles → if the victim is on shore and not breathing, start CPR immediately. Never form a human chain by holding hands and entering the water. Globally, roughly 300,000 people drown each year; this ranks as the fourth leading cause of death among children aged 1–4. +- Benefit: WHO reports that about 300,000 drownings occur worldwide each year, with 92% occurring in low- and middle-income countries. Drowning is the fourth leading cause of death for kids aged 1–4 and the third leading cause for those aged 5–14. WHO recommends “safe rescue and resuscitation training” — essentially learning how to help without entering the water. The recommended steps are identical: shout for help → call emergency services → reach out poles or ropes, toss life rings, empty buckets, or bottles → if the victim is out of water and not breathing, perform CPR right away. +- Evidence grade: C +- Notes: Grade C is assigned because no official source explicitly states the “do not enter the water” rule; we only have WHO’s global death statistics and the broader principle of “safe rescue.” Never form a human chain by holding hands and jumping in. Untrained individuals should not attempt to pull a drowning person out, as the victim will instinctively pull them underwater. This “stay out of water” rule also serves self-preservation — anyone who enters the water risks drowning, regardless of who the victim is. Most cases involve a child, so prevention is covered in Section 1, Item 12: keep children under constant supervision near water. +- Sources:WHO. 溺水 实况报道. + +### 26. If someone is choking and can’t speak, stand behind them and perform 5 back blows followed by 5 abdominal thrusts; if they collapse, start CPR immediately. + +- Cost: No cost involved. To perform the technique: make a fist with one hand and place it just above the navel, then wrap the other hand around it and deliver quick inward and upward thrusts. +- In plain terms: First, ask, “Are you choking? Can you speak?” If the person can still cough forcefully or make a sound, do not intervene — coughing is the most effective way to dislodge the object. If they cannot speak, stand behind them and give 5 back blows followed by 5 abdominal thrusts, repeating this sequence until the object comes out or the person loses consciousness. Once they collapse, begin CPR at once and call emergency services. For pregnant individuals or very obese people, perform chest thrusts instead. Never reach into the mouth to try to remove an object you cannot see. +- Benefit: According to the original text from the U.S. National Library of Medicine: first ask, “Are you choking? Can you speak?” It states that “if the person can cough forcefully or speak, do not intervene,” since coughing often dislodges the object on its own. If they cannot speak, “repeatedly perform 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person loses consciousness.” “Once unconsciousness occurs, start CPR at once” while calling emergency services. Chest thrusts should be used for pregnant individuals and obese people. +- Evidence grade: B +- Notes: Never reach into the mouth to remove an object you cannot see, as this may push it deeper. Do not perform back blows on anyone still able to cough. Choking incidents most often occur at home, so this guidance is aimed primarily at family members. No official pages on the Heimlich maneuver from China’s Health Commission or Red Cross could be found for this review; further verification of Chinese official sources is needed. +- Sources:US National Library of Medicine, MedlinePlus. Choking – adult or child over 1 year. + +### 27. If you get lost or your vehicle breaks down in the Gobi Desert, a desert, or any remote area, stay right where you are — near your car. First, transmit your location, then shield yourself from the sun and retain body heat, conserve water, and absolutely do not wander off. + + +- Cost: Before entering such remote zones, inform someone of your planned route, destination, return date, as well as your vehicle’s make, model, and license plate. You’ll need at least 4 liters of water per person per day. Satellite communicators or BeiDou short-message devices cost thousands of yuan; rental fees range from several hundred yuan per use. The real challenge, however, is simply sticking to the rule: stay put and never leave. + +- In plain terms: It’s best to remain right where you are, ideally right next to your vehicle — which serves as the best possible shelter from the sun. The proper sequence of actions is: if you have a signal, first send your exact coordinates, then make a phone call; next, shield yourself from the heat and retain warmth; afterward, conserve water by staying motionless during daylight hours and only moving after nightfall when temperatures drop; then, absolutely do not wander off; finally, if needed, signal for help using reflective mirrors, smoke, or repeated three-part signals. Before setting out, be sure to share your route, destination, return date, and vehicle details with someone you trust. + +- Benefit: The National Park Service’s Mojave Desert webpage contains three relevant statements. One reads, “Each person needs at least 1 gallon (roughly 3.8 liters) of water daily; hikers and cyclists require 2 gallons per day.” Another states, “Always inform others of your route, destination, return date, vehicle type, and license plate.” The third note simply points out that cellular coverage there is intermittent. Death Valley’s official guidance advises against hiking at low elevations during peak heat, notes that remote wilderness areas typically lack any mobile reception, and recommends carrying a satellite phone. On Mojave’s desert-driving page, an explicit warning states, “In any emergency, staying right next to your vehicle is the single most important thing you can do.” The page also acknowledges that such emergencies are relatively rare, yet there have indeed been cases where travelers perished from extreme heat or cold while attempting to walk back to civilization. These recommendations are organized into five clear priority steps: first, send a safety notification along with precise coordinates — do this via text or call as soon as a signal becomes available; second, shield yourself from the elements using your vehicle as cover; third, manage water consumption by remaining motionless during daylight and only moving at night; fourth, absolutely avoid wandering off; fifth, if needed, signal for rescue using reflective surfaces, smoke, or repeated three-part signals. + +- Evidence grade: C + +- Notes: This C rating exists because all these recommendations stem directly from official governmental advisories rather than peer-reviewed scientific studies. The exact figures concerning daily water needs, mandatory reporting procedures, known signal limitations, and the directive to stay close to one’s vehicle are all verbatim quotes taken directly from official sources; however, no official documentation could be found mentioning the specific practice of sending repeated three-part signals. Additionally, it’s crucial to avoid hiking or attempting to find your way during midday heat, never drink urine under any circumstances, and under no condition should you restrict water intake to the point of dehydration. No relevant advisories from China’s Ministry of Emergency Management or the National Forestry and Grassland Administration could be located during this review; likewise, the BeiDou short-message service page displayed an error stating “Socket is closed,” leaving certain details unverified — hence the current “TODO” status. +- Sources:US National Park Service. Mojave National Preserve Safety. ; US National Park Service. Death Valley Safety. ; US National Park Service. Desert Driving Safety. + +### 28. Shivering, slurred speech, and unsteady walking are signs of hypothermia; change into dry clothes, wrap up, warm the torso first, and give sweet hot drinks instead of alcohol + + +- Cost: An emergency thermal blanket costs just a few dollars, plus a spare dry set of clothes. Learning to recognize the warning signs costs nothing. +- In plain terms: When body temperature drops below 35°C, hypothermia sets in. Victims start to shiver, speak unclearly, walk unsteadily, and have trouble thinking. Remove any wet clothing and wrap the person in a thermal blanket or dry clothes, making sure to warm the torso before the limbs. Offer sweet hot drinks, but avoid alcohol — it suppresses shivering. The absence of shivering does not mean improvement; it actually signals worsening condition. If the person loses consciousness, begin CPR immediately. +- Benefit: According to the U.S. National Weather Service, any body temperature below 95°F (35°C) indicates hypothermia, and symptoms such as feeling cold, sluggishness, and confusion warrant immediate medical attention. Recommended actions include moving the victim to a warm indoor environment, focusing on warming the core first, and providing hot drinks. Alcohol is discouraged because it reduces shivering. CPR is required if the person becomes unconscious. Warm water or body heat can be used to treat frostbite, but avoid hot water or direct radiant heat sources like fireplaces. The Wilderness Medical Society’s 2019 hypothermia guidelines serve as the authoritative clinical reference on this topic. +- Evidence grade: B +- Notes: Do not rub or massage the limbs to warm them. Avoid hot baths at all costs. Do not drag or force‑move a severely hypothermic person — their heart may stop unexpectedly. Remember, the absence of shivering is not a sign of recovery; it often means the condition is worsening. Full access to the Wilderness Medical Society’s guideline requires a subscription; this translation is based solely on its summary. +- Sources:US National Weather Service. During Extreme Cold. ; Dow J 等 (2019). Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness & Environmental Medicine. + +### 29. Snake bites: stay still, remove rings and watches, rush to a hospital with antivenom — no cutting, no suction, no tight binding + + +- Cost: There is no cost involved. The main expense is knowing in advance which nearby hospitals stock antivenom. The real challenge is resisting the urge to treat the wound yourself. +- In plain terms: Stay seated and motionless; keep the bitten limb immobilized. Remove any rings or watches right away, as swelling will develop quickly. Get to a hospital that carries antivenom as fast as possible — antivenom is the only treatment capable of reversing most toxic effects. Do not cut the wound, do not suck out venom with your mouth, do not apply ice, and do not wrap the limb so tightly that it turns purple. Avoid alcohol and do not run around. If possible, take a photo of the snake from a distance; do not try to catch it. +- Benefit: The WHO states: “Immediately immobilize the affected body part and transport the victim rapidly to the nearest medical facility.” It also warns against using tourniquets or cutting the wound, and recommends treatment with antivenom specific to local snake species. “High‑quality antivenom is the most effective treatment for preventing or reversing most toxic effects of snake bites.” Worldwide, between 81,000 and 138,000 people die from snake bites each year; the number of amputations and permanent disabilities is roughly three times that figure. +- Evidence grade: B +- Notes: If you can photograph the snake, do so from a safe distance — do not attempt to capture it. Avoid alcohol, running, suction, ice packs, and tight bindings that cause discoloration. No official Chinese health commission or disease‑control guidelines on snake‑bite management were found for this review; the reported annual death toll in China is marked as “pending verification.” +- Sources:WHO. 动物咬伤 实况报道. ; WHO (2023). 蛇咬伤中毒 实况报道. + +### 30. First, figure out what kind of building you’re in during an earthquake: if it meets seismic safety standards, stay right where you are; if it’s an old structure prone to collapse, head outside right away. + + +- Cost: No cost at all. Just take a moment beforehand to see how many steps it takes to reach the exit, which route to take, and which tables are sturdy enough to hide under. + +- In plain terms: First, determine what kind of building you’re in. For structures built after 2001 that meet seismic codes, you’ll need to go down stairs or through a hallway to exit — so stay put: protect your head and neck, crawl under a solid table, and hold onto its legs tightly. In single-story homes, older brick buildings, or makeshift houses without seismic protection, the exit is just a few steps away — so leave immediately. Under no circumstances should you jump from heights, use elevators, or try to run down stairs while the ground is shaking. + +- Benefit: The China Earthquake Administration’s educational video “Earthquake: Hide or Run?” promotes the rule “Take shelter nearby during the quake, then evacuate quickly afterward,” but explicitly limits this advice to “buildings that meet seismic safety standards.” The reasoning is that such structures “are far less likely to collapse entirely.” The video also notes that “falling building components and decorative items” pose the greatest threat to life safety, while “running around without any protection during a quake” increases the risk of being struck by falling ceilings, chandeliers, or other objects. Recommended actions include “using hands or soft objects to shield the head and neck” and “gripping table legs tightly”; if no table is available, “crouch close to load-bearing walls and stay away from exterior walls, windows, and balconies.” For those outdoors, the advice is “immediately move to an open area away from hazards.” Conversely, during the 1988 Armenian earthquake, Soviet-era prefabricated panel buildings collapsed en masse. A case-control study conducted after that disaster concluded that “leaving a building right after the first tremor is a protective behavior.” People who remained indoors were 4.40 times more likely to sustain injuries than those who evacuated (95% CI 2.24–8.71). The odds of injury indoors were 12.20 times higher than outdoors (3.62–63.79), and in buildings five stories or taller, this risk rose to 3.65 times that of lower structures (2.12–6.33). + +- Evidence grade: B + +- Notes: This topic remains debated, as the two main conclusions apply to distinctly different types of buildings. The China Earthquake Administration itself stipulates that “taking shelter” is only advisable “in buildings that meet seismic safety standards,” and also emphasizes that decisions must be “tailored to local conditions and individual circumstances” — meaning you must consider both the building’s structural integrity and your own physical ability to move. In Armenia, entire buildings collapsed, leaving no safe spot to hide, so evacuation was the only viable option. The U.S. Federal Emergency Management Agency advises residents to “drop to the ground, protect the head and neck, hold on tight, and avoid running outside” — where injuries are primarily caused by falling debris and falls during tremors. Research from the Northridge earthquake further shows that reaching for objects or gripping seemingly stable items can actually increase injury risk. Ultimately, the key question isn’t “should I run or stay?” but rather “is this building likely to collapse, and can I reach open ground within seconds?” For buildings constructed after 2001 that require navigating stairs or hallways to exit, staying put is the safest choice. For single-story homes, older brick buildings, and makeshift houses without seismic protection, the exit is just a few steps away — so leave immediately. It’s worth noting that the Armenian study only compared injured and uninjured survivors, excluded fatalities, and didn’t account for differences in building height; since those able to escape were more likely to live on lower floors, these figures should be interpreted with some caution. Under no circumstances should you jump from heights, use elevators, or attempt to run down stairs during tremors. Once outside, stay far away from tall structures, overpasses, utility poles, glass facades, and billboards. +- Sources:中国地震局（安徽省地震局制作）. 地震来了，是躲还是跑？（科普视频，字幕转录）. ；Armenian HK, Noji EK, Oganesian AP (1992). A case-control study of injuries arising from the earthquake in Armenia, 1988. Bulletin of the World Health Organization, 70(2), 251-257. ；US FEMA Ready.gov. Earthquakes. ；Mahue-Giangreco M, Mack W, Seligson H, Bourque LB (2001). Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake. Annals of Epidemiology, 11(5), 347-357. + +### 31. When encountering bears, wild boars, or packs of wild dogs, don’t run, don’t scream, don’t make eye contact — instead, turn sideways and back away slowly. + +- Cost: No cost involved. When heading into the mountains, bring a hiking pole, hike in a group, and make noise so animals know you’re coming. The hardest part is staying put instead of running. +- In plain terms: Never run — bears can sprint uphill or downhill just as fast as racehorses. Also, don’t climb trees; both black bears and brown bears are excellent climbers. Stand your ground and keep speaking to the bear in a low, calm voice. Once it stops moving, turn sideways and back away slowly. If a brown bear attacks, lie down and play dead: place your hands behind your neck and spread your legs apart. For black bear attacks, do not play dead — run toward a vehicle or building; if escape is impossible, fight back using whatever is at hand. In case of dog bites, follow the steps outlined in item 13. +- Benefit: The original guidelines issued by the U.S. National Park Service on bear encounters contain six key points: “Do not run — bears can sprint uphill or downhill just as fast as racehorses.” “Stay calm; most bears have no interest in attacking and simply want to be left alone.” “Keep speaking to the bear in a low, steady voice.” “When the bear stops moving, turn sideways and back away slowly so you can keep watching it without tripping.” “Make yourself appear as large as possible.” “Do not climb trees — both grizzly bears and black bears are capable climbers.” In the event of a brown bear attack, “lie down and play dead, placing hands behind the neck and legs apart.” For black bear attacks, “do not play dead; run toward a vehicle or building, and if escape is impossible, fight back using any available object.” Dog bites should be treated according to item 13. +- Evidence grade: B +- Notes: The Grade B rating applies solely to bear encounters. The advice regarding wild boars and packs of wild dogs — namely, “don’t run, back away slowly, and seek higher ground or obstacles for protection” — is based on anecdotal experience and is rated Grade C; no official recommendations from China’s forestry authorities or local agencies were identified for these scenarios. Never try to lure animals with food, approach them for photos, or bring dogs into mountainous areas inhabited by wild boars. In China, the primary bear species are black bears and brown bears; the decision to play dead or not depends on which species is involved. +- Sources:US National Park Service. Staying Safe Around Bears. ；国家疾控局综合司、国家卫生健康委办公厅 (2023). 狂犬病暴露预防处置工作规范（2023 年版）. + +### 32. If caught in a thunderstorm outdoors, get into a hard-topped vehicle or building; avoid ridges, lone trees, water surfaces, and metal objects + +- Cost: No monetary cost. The downside is that your trip gets interrupted for at least half an hour. The real challenge is actually turning back when the thunder is still far away. +- In plain terms: There is no safe spot outdoors during a thunderstorm. You must get into a hard-topped vehicle or building; convertibles and motorcycles do not qualify. Tents, gazebos, areas under trees, or rocky outcrops also do not count as shelter. Stay away from open areas, mountain ridges and peaks, isolated tall trees, water surfaces, and metal railings or poles. If a group cannot all fit together, spread out rather than huddling close. Begin retreating the moment you hear thunder; it is only safe to leave 30 minutes after the final clap of thunder. +- Benefit: There is no safe spot outdoors during a thunderstorm. It is only safe to leave 30 minutes after the final clap of thunder. +- Evidence grade: B +- Notes: Tents, gazebos, areas under trees, and rocky outcrops do not qualify as shelters. Hard-topped cars do count, but convertibles and motorcycles do not. Start retreating the instant you hear thunder; do not wait until rain begins to fall. +- Sources:美国国家气象局. 户外雷电安全：「There is no safe place outside when thunderstorms are in the area」「Avoid open fields, the top of a hill or a ridge top. Stay away from tall, isolated trees or other tall objects」「Stay away from water, wet items, such as ropes, and metal objects, such as fences and poles」；实在走不了时「If you are in a group, spread out to avoid the current traveling between group members」；恢复活动「Wait 30 minutes until after the last rumble of thunder」. + +### 33. Gradually increase your sleeping altitude when heading to high elevations; if symptoms worsen, descend immediately — don’t tough it out. + + +- Cost: It requires an extra day or two for acclimatization. Preventive medications are prescription-only, so you must consult a doctor before traveling. The main challenge is fitting these days into an otherwise tight itinerary. + +- In plain terms: This guideline focuses on sleeping altitude, not daytime elevation. Sleeping above 2,450 meters already poses a risk of altitude sickness. Once above 3,000 meters, you should only raise your nighttime altitude by 500 meters per night, allowing an additional day of acclimatization for every 1,000-meter increase. Symptoms such as headache, nausea, unsteady gait, altered mental state, or shortness of breath even at rest indicate the need to descend. Descending takes priority over oxygen therapy or medication. + +- Benefit: Sleeping above 2,450 meters increases the risk of altitude sickness. Without prompt descent, high-altitude cerebral edema and pulmonary edema — fluid buildup in the brain and lungs — can be fatal. + +- Evidence grade: A + +- Notes: The rule specifically refers to sleeping altitude, not daytime elevation. Headache, nausea, unsteadiness, confusion, or breathlessness at rest are clear signs to descend. Descending should always come before oxygen use or medication; continuing upward while on oxygen is unsafe. +- Sources:美国疾病控制与预防中心. 黄皮书·高海拔旅行与高原病：「Any unacclimatized traveler proceeding to a sleeping altitude of ≥2,450 m (≥8,000 ft)—and sometimes lower—is at risk for altitude illness」；上升速度「500 m (1,650 ft) per night in sleeping altitude once above 3,000 m (9,800 ft)」，每上升 1000 米加一天适应日；乙酰唑胺预防「125 mg twice a day; 250 mg twice a day if >100 kg body weight」；「If symptoms become worse despite rest or treatment at the same elevation」必须下撤. ；荒野医学会 (2024). 急性高原病预防、诊断与治疗临床实践指南（2024 更新）. Wilderness & Environmental Medicine. + +### 34. If a tick is attached to the skin, use fine-point tweezers to gently pull it straight out while keeping it close to the skin; do not apply oil or use heat. + +- Cost: A pair of fine-point tweezers. +- In plain terms: Use fine-point tweezers to grasp the tick’s head right next to the skin, then pull it straight outward steadily. Avoid applying oil, using heat, or twisting the tick — those actions can force any pathogens it carries into the skin and often leave its mouthparts embedded in the flesh. After removal, record the date. If you develop fever, a rash, or fatigue in the following weeks, be sure to mention that you were bitten by a tick when seeking medical care. +- Benefit: Applying oil, using heat, or twisting the tick can cause it to release pathogen-laden fluids into the skin. These actions also increase the likelihood that its mouthparts remain lodged in the skin. +- Evidence grade: B +- Notes: Be sure to note the date of removal. Should fever, a rash, or fatigue appear in the weeks afterward, inform your doctor that you were bitten by a tick; otherwise the symptoms may be misdiagnosed as a common cold. Note: figures on the annual incidence and case-fatality rate of severe fever with thrombocytopenia syndrome in China were not available at the time of writing. +- Sources:美国疾病控制与预防中心. 被蜱叮咬之后：「Grasp the tick as close to the skin's surface as possible using clean fine-tipped tweezers」「Pull tick away from the skin with steady, even pressure」「Do not use petroleum jelly, heat, nail polish, or other substances to try and make the tick detach from the skin. This may agitate the tick and force infected fluid from the tick into the skin」. + +### 35. Always boil any water taken from the wild before drinking it; one minute of boiling is sufficient — there’s no need to extend the time just because you’re at high altitude. + +- Cost: You’ll need to carry extra weight in the form of a stove and fuel. +- In plain terms: Any microbes capable of causing illness through water are killed within seconds at boiling temperature. Boiling for an additional minute simply provides a safety margin for any possible oversight; it isn’t necessary to prolong the process at higher elevations. If boiling isn’t feasible, use a filter or chemical purification tablets instead — each method has its own limitations regarding which pathogens they can eliminate. Even crystal-clear streams and meltwater can harbor parasites. +- Benefit: All microbes that can cause disease via water are inactivated within seconds at boiling temperature. The belief that water fails to reach a safe temperature at high altitudes is a common misconception. +- Evidence grade: B +- Notes: The same page also notes that boiling isn’t strictly mandatory: maintaining water at 60°C for 30 minutes achieves the same effect, and boiling simply offers a visible endpoint without needing a thermometer. Filters and chemical tablets each have their own gaps in pathogen coverage, so boiling remains preferable when possible. Just because water appears clear doesn’t mean it’s free of parasites — appearance alone is no reliable indicator. +- Sources:美国疾病控制与预防中心. 黄皮书·旅行者的水消毒：「All organisms that may cause illness from drinking water are killed within seconds at boiling temperature」「CDC recommends that travelers boil water for a full minute to account for user variability in identifying boiling points and to add a margin of safety」「Although the boiling point for water decreases with increasing elevation, at common travel elevations the temperature needed to achieve boiling is still well above the temperature required to inactivate enteric pathogens」. + +### 36. If a stranger demands money in a remote area, hand over cash, avoid any confrontation, note their features, and call police after escaping + + +- Cost: The cash you have on you. The real challenge is keeping your temper in check. +- In plain terms: Give him the money, do not fight back, and do not argue. By demanding a few hundred yuan, he is committing robbery — a crime punishable by at least three years up to ten years in prison. If he enters a residence, uses a weapon, or causes serious injury or death, the sentence rises to ten years or more, even life imprisonment or death. If you chase after him and strike him after he has taken the money, that is no longer considered self‑defence. Immediately after escaping, write down his appearance, accent, vehicle license plate, and the direction he fled, then call 110. +- Benefit: Your life is far more valuable than a few hundred yuan. The offender is committing a serious crime for such a small amount. Article 263 of the Criminal Law states that anyone who robs public or private property by violence, coercion, or other means faces three to ten years in prison plus a fine; aggravating circumstances raise the penalty to ten years or more, even death. Article 20 limits self‑defence to stopping an ongoing unlawful attack; once the robber has taken the money and walked away, any retaliation is no longer justified. After escaping, record his description, speech patterns, vehicle details, and escape route, then call 110. +- Evidence grade: C +- Notes: The “C” rating reflects the lack of direct literature supporting the principle that “handing over money avoids danger”; the legal text merely outlines the offender’s risks and your boundaries. Never follow an attacker to a secluded spot to “get money,” never reveal your phone password, and never get into his vehicle. This advice is not an invitation to fight or to refrain from calling police; it applies only when you are physically threatened in a remote setting and must first pay to ensure your safety. In contrast, if someone online threatens to release private photos or videos, you must never pay — see Section 8, Item 32 for those cases. +- Sources:全国人大 (2020 年修正). 刑法（第二十条、第二百六十三条）. （北京市公安交管局转载整合文本） + +### 37. If you stumble upon a group fight, walk away immediately — don’t try to break it up, don’t stand around watching, and don’t pick up any weapons on the ground. If you want to call the police, retreat to a safe distance and dial 110. + + +- Cost: No money is required. The hard part is resisting the urge to step in and the temptation to watch from the sidelines. After calling, you might be asked to give a statement later; at most, this takes half a day. + +- In plain terms: If you intervene, your actions shift from “trying to calm things down” to “taking part in a fight.” Participating in a group brawl can land you in prison for up to three years; if many people are involved, it happens on a road, or weapons are used, the sentence rises to three to ten years. Watching isn’t worth it either — the more onlookers there are, the messier the scene gets, and you’re more likely to get hurt. The right move is to walk away. If you do want to call the police, step back to a safe spot and dial 110, clearly stating the location, how many people are involved, whether anyone is carrying knives or sticks, and if anyone has collapsed. + +- Benefit: Article 292 of the Criminal Law states: “Those who lead or actively take part in group brawls shall be sentenced to up to three years in prison, criminal detention, or surveillance.” If the brawls happen repeatedly, involve many people, have a big social impact, occur in public spaces or on busy roads, or involve weapons, the punishment rises to three to ten years. If such fights cause serious injury or death, perpetrators are charged under laws on intentional injury or homicide. The Public Security Administration Punishment Law also sets penalties: assaulting others brings a detention of five to ten days plus fines of 500 to 1,000 yuan. Group fights handled as hooliganism can lead to up to fifteen days in jail and fines up to 2,000 yuan. Guideline 5 of the “Opinions on Properly Applying Self‑Defence” says unlawful attacks include those aimed at you, at the public, or at others. Guideline 9 adds that if one side starts the fight with excessive force, or continues attacking even after the other side tries to avoid conflict, the responding party is usually considered acting in self‑defence. + +- Evidence grade: B + +- Notes: This grade is B because part of the consequences are backed by clear legal text, but the advice “walk away and call the police instead of intervening” isn’t directly stated in any official rule — it’s inferred from those statutes and from how group fights are judged. Saying “I was just trying to mediate” isn’t a shield; what matters is whether you actually took part and whom you hit. If an attacker is already down or has fled, chasing them to hit them no longer counts as self‑defence. Legally, you may intervene if you see someone being unilaterally beaten; self‑defence protects not only you but also others. Yet stepping in bare‑handed usually just adds another casualty. Calling for help, recording from afar, and calling police are far more effective. The safest choice here is “don’t intervene, don’t watch.” The benefit of calling 110 mainly helps the victim on the ground; overall, this entry offers one of the lowest net benefits in the book, so you must weigh whether the time investment is worth it. You should know a few key facts first. There is already a legal duty to testify: Article 62 of the Criminal Procedure Law says anyone aware of a case must testify; not calling police doesn’t erase that duty. In cases involving serious injury or death, police can still identify witnesses from surveillance footage, so standing around watching actually makes you more likely to be recorded. Authorities “must keep the identity of anonymous callers confidential” (Article 111). Simply stating the location, number of people, and whether weapons are present is enough — you needn’t stay on the scene. Only if a court summons you to testify without a valid reason and you refuse can you face up to ten days in detention (Article 193); ordinary bystanders rarely reach that point. Not calling police isn’t illegal: Article 110 of the Criminal Procedure Law mentions a “right and duty” without any penalty, and no criminal law punishes ordinary citizens for not reporting what they see, so walking away is perfectly legal. Two actions after walking away would cross the line: helping hide someone or giving false testimony to protect them (Article 310 of the Criminal Law, up to three years; serious cases bring three to ten years); and deliberately giving false testimony when called as a witness (Article 305, up to three years; serious cases up to seven years). Staying silent or telling the truth is fine; fabricating stories is not. If you yourself get caught in a fight, see Section 8, Item 10; if a stranger demands money, see Item 36 of this section; for costs after helping an injured person, see Item 39. +- Sources:全国人大 (1997). 刑法（第二百三十二、二百三十四、二百九十二、三百零五、三百一十条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十、五十一条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 5、9 条）. ；全国人大 (2018). 刑事诉讼法（2018 年修订，第六十二、一百一十、一百一十一、一百九十三条）. 宁夏回族自治区人民检察院转载全文 + +### 38. If you may have been exposed to HIV, get PEP within 72 hours — the sooner, the better + +- Cost: A full 28‑day course of PEP can cost thousands of yuan; in most regions it must be paid out‑of‑pocket. You’ll need to rush to a hospital that same night. The hardest part is admitting you might be infected and leaving right away. +- In plain terms: If you suspect you’ve been exposed to HIV, 72 hours is the hard deadline — ideally you should start PEP within 2 hours. The medication must be taken for 28 consecutive days. After 72 hours this option is no longer available, so don’t wait until the next day to decide. +- Benefit: The Beijing Municipal Government’s HIV‑prevention outreach defines this as “post‑exposure prophylaxis,” abbreviated PEP. It recommends starting preventive medication “as soon as possible, ideally within 2 hours and no later than 24 hours, but not after 72 hours,” and continuing for 28 days. Beyond 72 hours PEP is not advised. This strict timeline means that acting immediately versus waiting a night can produce completely different outcomes. +- Evidence grade: B +- Notes: Where to obtain PEP: any designated HIV‑treatment clinic affiliated with the local Chinese CDC, usually under the Infectious Diseases or STD/HIV department. Many cities now offer 24‑hour clinics; in Chongqing, for example, 29 such clinics operate across 26 districts, 14 of which are open around the clock. Call the local CDC beforehand to find a clinic with PEP on hand — don’t waste time in the emergency room. Situations considered “exposures” include unprotected sex, a broken condom, needle sticks, or blood contact with mucous membranes; only a doctor can decide whether PEP is appropriate. The full 28‑day regimen must be completed; missing doses markedly reduces its effectiveness. Follow‑up testing is required at 4–6 weeks and at 3 months as directed by your physician. This is a remedial measure, not a substitute for regular prevention; for everyday safeguards and testing, see items 30 and 31 in Chapter 1 (consistent condom use and testing after high‑risk encounters). +- Sources:北京市人民政府. 事前、事后分不清？六问六答全面了解艾滋病病毒暴露前/暴露后预防. ；中国疾病预防控制中心性病艾滋病预防控制中心 (2020). 艾滋病病毒暴露后预防技术指南（试用）. + +### 39. After saving someone and getting injured or incurring expenses, first seek compensation from the perpetrator and yibao; then apply for recognition as a person acting in the public interest. + + +- Cost: There is no direct expense. However, submitting the application requires paperwork, waiting for approval, and multiple visits — this can take weeks or even months. + +- In plain terms: If you get hurt while saving someone, you’re not simply out of luck. Those injured while acting in the public interest should receive treatment first, with costs covered afterward. Medical bills are the responsibility of the perpetrator; if the perpetrator flees or cannot pay, basic medical insurance steps in. Even without a perpetrator, the person you saved is legally obligated to provide reasonable compensation — this is a legal requirement, not a matter of personal generosity. At the same time, you should apply for official recognition as a person acting in the public interest so that any injuries can be treated under workers’ compensation rules. + +- Benefit: Article 183 of the Civil Code states: “Anyone who suffers harm while protecting another person’s civil rights is entitled to compensation from the perpetrator; if no perpetrator exists, has fled, or cannot pay, the beneficiary must provide reasonable compensation.” State Council Document No. 39 of 2012 further clarifies how to handle medical care for such individuals. Healthcare facilities must establish a fast-track system based on the principle “treat first, bill later.” Specifically, medical expenses incurred during emergency treatment are the responsibility of the perpetrator or liable party; otherwise, they are covered by basic medical insurance. In cases of death, individuals meeting criteria for martyr status are recognized as such by law; those qualifying as work-related injuries receive a one-time death benefit plus an additional special allowance equal to 40 months of their salary. Injured individuals meeting workers’ compensation criteria receive benefits under the relevant regulations; others have their disability level assessed by civil affairs bureaus to determine appropriate support. Employment-wise, such individuals are prioritized for job assistance programs and placed in public-sector roles when possible. Housing-wise, they are given priority access to subsidized housing or rental assistance. + +- Evidence grade: B + +- Notes: This grade is assigned because national documents clearly define which benefits apply; however, exact amounts of bonuses and detailed application procedures vary by province under local regulations, and these specifics were not verified across all regions in this round. Applications are typically submitted to local police departments or dedicated civil affairs bureaus responsible for recognizing acts of public service. Successful recognition depends on solid evidence: police reports, surveillance footage, witness contact details, and medical records gathered promptly at the scene. Legal aid for such cases is also available free of charge. National standards for death benefits and disability compensation calculations are explained in Sections 15 and 16 of Chapter 19; instructions for obtaining legal aid can be found in Section 3 of Chapter 7. +- Sources:全国人大 (2020). 民法典（第一百八十三条）. ；国务院办公厅转发民政部等部门 (2012). 关于加强见义勇为人员权益保护的意见（国办发〔2012〕39 号）. + +### 40. Knives, rebar, glass piercing the body – apply pressure around the foreign object to stop bleeding; do not pull it out + + +- Cost: No cost involved. The hard part is resisting the instinct to “pull it out” and instead staying with the injured person until help arrives. +- In plain terms: Pulling out the object can cause severe bleeding and makes it harder for doctors to assess the extent of the injury. The correct approach is to call 120, then use your hand or a dressing to apply firm pressure around the object to control bleeding and keep it stable so it doesn’t move. If internal organs are visible through an abdominal wound, do not push them back in; simply cover them with a clean, moist dressing. For chest wounds where air bubbles are escaping, do not seal them with plastic wrap – doing so can cause the lung to collapse. +- Benefit: The 2025 International First Aid Guidelines from the International Federation of Red Cross and Red Crescent Societies state: “First aiders should apply pressure around any foreign object (such as a knife) that has penetrated the body and keep it stable; do not remove it.” “Never pull any object out of abdominal or chest wounds – doing so can cause severe bleeding and makes it harder to assess the injury.” “Foreign objects embedded in the body should be kept stable; if they move with the pulse, simply hold them gently in place.” “First aiders must not push protruding organs back into the body.” For open chest wounds with active bleeding, “it is acceptable to leave them uncovered, as sealing them may trap air in the chest cavity and cause partial or total lung collapse (pneumothorax).” All penetrating abdominal or chest injuries require immediate emergency care. +- Evidence grade: B +- Notes: This grade is assigned because these actions are widely accepted in official guidelines; however, no randomized trials exist, and it would be unethical to randomly assign patients to “remove” versus “not remove” such objects. The sole exception is when a foreign object blocks the airway and prevents breathing. In such cases, go directly to the emergency triage desk at the hospital and state “penetrating injury.” This falls under the highest priority category – do not wait in line at the registration desk (see Section 24, Item 8). If a penetrating injury occurs, call 120; the ambulance will alert the hospital in advance. For techniques on controlling severe bleeding and applying tourniquets, see Section 12. +- Sources:International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 256–257、267–268 页. + +### 41. If a fracture is suspected, do not move the injured area; keep it supported and apply cold compresses for no more than 20 minutes. Never try to realign it yourself. + + +- Cost: No cost involved. Use a rigid board, rolled-up magazines, or clothing as a splint. Wrap cold items in a cloth before applying them to the skin. + +- In plain terms: Any injury to a limb should be treated as a possible fracture, even if the person can still stand or move. Only X‑rays can confirm a fracture. Keep the injured area still — support it with your hand or use a triangular bandage or rigid splint to maintain its original position. Apply cold compresses as soon as possible, but never for longer than 20 minutes at a time. Do not attempt to realign the bone yourself. For open fractures where bone has pierced the skin, first stop any bleeding and cover the wound with clean dressing; do not push the bone back into place. + +- Benefit: The International Federation of Red Cross and Red Crescent Societies published its 2025 International First Aid Guidelines. They state that “any injury to a limb should be treated as a possible fracture” and that “the only reliable way to confirm a fracture is by X‑ray; when in doubt, treat it as a fracture.” The purpose of immobilization is “to minimize movement and pain.” Cold compresses “should be applied for no more than 20 minutes at a time to reduce pain; longer exposure may damage the skin.” “For fractures of long bones such as the femur, bleeding from the bone itself can be life‑threatening.” Call emergency services when there is significant pain or swelling, signs of shock, a suspected femoral fracture, or obvious deformity of the limb. Whether to attempt on‑site reduction of an angulated fracture depends on two conditions: first, “the location is remote (or resources are limited) and the limb below the angle appears cold and pale, or the rescuer cannot immobilize it adequately for transport”; second, the rescuer must be trained. For open fractures, the priority is controlling bleeding and preventing infection. + +- Evidence grade: B + +- Notes: This grade B rating reflects that these measures are widely accepted practice. One older study suggests that traction immobilization for femoral fractures before hospital care can reduce blood transfusion needs and shorten hospital stays; however, differences in mortality or complications were too small to be meaningful, and the study’s reliability is low. There is no evidence to guide whether to attempt reduction versus simple immobilization. Three common misconceptions should be corrected: being able to stand or walk does not rule out a fracture; cold compresses alone are recommended, not alternating hot and cold; and sprains will not “loosen up” with movement — rest is essential. For elderly patients with suspected fractures after a fall, follow the precautions outlined in item 2. Swelling of one leg after casting or bed rest may indicate a blood clot; see item 11. Information on disability assessment and eligibility for a disability certificate after treatment can be found in section 24, items 10 and 11. +- Sources:International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 301–302 页. diff --git a/book/14-Accounts-And-Security.md b/book/14-Accounts-And-Security.md new file mode 100644 index 00000000..66188f03 --- /dev/null +++ b/book/14-Accounts-And-Security.md @@ -0,0 +1,97 @@ +# 14. Account and Information Security + +Backlink: [← Return to main index](../../README.md) + +Protecting your money and personal data is essential. If someone gains access to your accounts, they can steal funds right away. They may also use your account to scam people on your contact list. In short, your identity becomes vulnerable too. +### 1. Enable two-factor authentication on email, payment, and social accounts; prioritize phone pop-ups over SMS codes + +- Cost: No cost involved. Each account takes just two to three minutes to set up once. +- In plain terms: Two-factor authentication means an extra verification step beyond the password when logging in. Using a pop-up prompt on your phone that requires a single tap to confirm blocks over 90% of phishing and account theft attempts. In contrast, older verification methods such as answering questions like “Where did you log in last time?” or “What is your backup email?” only block around 10% of such attacks. +- Benefit: Google analyzed 350,000 real-world account hijacking attempts. For authentication methods relying on device verification — such as phone pop-ups or physical security keys — over 94% of phishing-related hijacking attempts and 100% of automated hijacking attempts were prevented. These automated attempts involve bots using leaked passwords to try logging into accounts in bulk. For verification based on answering personal questions, only 10% of phishing attempts and 73% of automated attempts were blocked. +- Evidence grade: A +- Notes: The same study also found that these verification methods occasionally block legitimate users from accessing their accounts. 52% of real users failed to log in on their first try. However, 97% of them eventually gained access. It is recommended to enable this feature on email accounts first, as most other accounts allow password recovery via email. +- Sources:Doerfler P, Thomas K, Marincenko M, et al. (2019). Evaluating Login Challenges as a Defense Against Account Takeover. The World Wide Web Conference (WWW '19). + +### 2. Use a unique password solely for your email + +- Cost: No cost involved. Storing it in a password manager eliminates the need to memorize it. The real challenge lies in breaking the old habit of reusing one password across multiple sites. +- In plain terms: If a password you use elsewhere gets stolen, attackers can use it to log straight into your email account. Once they gain access to your email, they can reset passwords for any other accounts linked to it. Therefore, your email password must be unique and never reused anywhere else. +- Benefit: Credential stuffing is one of the easiest attack methods: attackers simply test stolen passwords against other accounts. If your email password is compromised, all accounts that rely on it for password recovery become vulnerable too. The US Cybersecurity and Infrastructure Security Agency recommends using a distinct, strong password of at least 16 characters for every account, and storing it via a password manager. +- Evidence grade: C +- Notes: If you struggle to memorize passwords, use the built-in password manager in your web browser. It stores passwords for each site for you, which is far safer than reusing the same password everywhere. Avoid saving passwords in WeChat favorites or note-taking apps. +- Sources:US CISA. Use Strong Passwords. + +### 3. Set a screen lock on your phone and a PIN for the SIM card + +- Cost: No cost at all. You only need to set the screen lock and the SIM PIN once each. +- In plain terms: The SIM card is that tiny card inside your phone that receives SMS verification codes. If your phone gets lost, a finder can remove the card and insert it into another phone to receive those codes, then reset all your accounts one by one. Setting a PIN on the SIM card means that whenever the card is moved to another phone, the user must enter that PIN before the phone can be used — effectively blocking that path. +- Benefit: Without a SIM PIN, a finder can easily move your SIM card to another phone, receive verification codes, and reset all your accounts. With a PIN in place, that entire process is prevented, keeping your accounts safe even if your phone is lost. +- Evidence grade: C +- Notes: You can set the SIM PIN under “SIM card lock” in your phone settings. The default factory codes are usually 1234 or 0000. If you enter the wrong code three times in a row, you’ll need the PUK code provided by your carrier to unlock it. After setting the PIN, be sure to write it down somewhere safe. +- Sources:作者经验，无直接文献 + +### 4. Follow these steps if you lose your phone: block the SIM card, remotely lock it, change passwords, file a police report, and freeze your bank cards if needed. + +- Cost: No cost involved. Completing all steps takes just a few minutes. +- In plain terms: The order of actions matters more than speed. First, block the SIM card to cut off access to verification codes. Next, remotely lock the phone. Then, use a computer to change your email and payment passwords. After that, file a police report to obtain a receipt. Finally, freeze your bank cards as needed. Even if you’re using someone else’s phone, you can still call your carrier to block the SIM card. +- Benefit: Following the correct sequence is more important than acting quickly. Step one is blocking the SIM card, which severs the main channel for verification codes. Step two involves remotely locking the phone and erasing all its contents. Step three requires changing your email and payment passwords from a computer. Step four is filing a police report to get a receipt. Finally, freeze your bank cards if necessary. The Federal Communications Commission also advises that even if you believe you merely misplaced your phone, you should still remotely lock it. If it’s stolen, file a police report immediately, providing the phone’s model and IMEI number, and inform your carrier right away. +- Evidence grade: C +- Notes: Save the customer service numbers for all three major carriers in advance: China Mobile at 10086, China Unicom at 10010, and China Telecom at 10000. Also note the city where you registered your phone number, as customer service agents will ask for this information. You can still call carrier hotlines from someone else’s phone to block your SIM card. +- Sources:US FCC. Protect Your Smart Device. ；步骤顺序是作者经验；补办身份证见第 7 节，冒名贷款见第 8 节关于征信的一条 + +### 5. If your card is fraudulently used, report it and freeze the card first, then demand compensation from the bank: proving “you made the transaction” is the bank’s responsibility + + +- Cost: No cost at all. As soon as you notice anything suspicious on your card statements, immediately report it and freeze the card. Keep all records: police reports, freeze confirmations, and transaction notifications from the bank. If the card is still in your possession, make a small inquiry or deposit nearby to create a record proving you had the card with you at the time of the fraud. The hardest part is resisting the urge to argue with customer service first — always freeze the card first. + +- In plain terms: If someone fraudulently uses your card, you don’t have to prove “this wasn’t me.” Instead, it’s the bank’s duty to prove the transaction was made by you. If they can’t, they must compensate you. This only applies if you report and freeze the card right away. Delaying this step means you’ll bear any additional losses that occur afterward. + +- Benefit: Supreme Court rulings clearly define who must provide evidence. If you claim the transaction resulted from counterfeit card fraud or online fraud, you must first gather proof — such as official legal documents, records showing where the card was physically located at the time, transaction logs, notifications, police reports, and freeze confirmations. Conversely, if the issuing bank or any third‑party payment service insists the transaction was authorized by you, they must produce evidence to support that claim. If, after you notify the bank, it fails to verify the transaction promptly or to preserve transaction records and surveillance footage, the bank bears the consequences of lacking proof. Once proven, debit‑card holders may demand full reimbursement of stolen funds plus compensation for any losses; credit‑card users may request a refund of all unauthorized charges, interest, and penalties, and courts will reject any demand that the cardholder repay those amounts. You may also ask the bank to promptly remove any resulting negative credit entries (effective 25 May 2021). + +- Evidence grade: A + +- Notes: There are two situations where you remain liable. First, if you fail to protect your card, PIN, or verification codes — in other words, if you neglect your duty to safeguard them — you’ll bear part of the loss. Keep your PIN secret and never share verification codes (see Item 1; two‑factor authentication via phone alerts is preferred). Second, if you delay reporting and freezing the card, any extra losses incurred afterward are your responsibility. Hence, the very first step is always to freeze the card — don’t waste time arguing with customer service first. These rules also apply to third‑party payment services. If such a service advertises “immediate compensation” with clear terms, you may demand payment from them. If you were tricked into transferring money, that falls under a separate procedure; see Item 8.2: call 110 or 96110 immediately to request a stop‑payment order. +- Sources:最高人民法院 (2021). 关于审理银行卡民事纠纷案件若干问题的规定（第四、五、七、十四、十五条）. + +### 6. Periodically check the devices logged into your account and any authorized apps, then remove the ones you no longer use + +- Cost: No cost at all. It only takes a few minutes each time. The hard part is that there’s no reminder — you have to remember to do it yourself. +- In plain terms: “Logged-in devices” refer to the phones and computers that can still access your account right now. Account thieves often lie low for a while before making their move. If you see any unfamiliar devices on the list, or third-party apps you no longer use still linked to your account, log out from all devices and change your password right away. +- Benefit: Account theft rarely happens instantly — attackers usually spend some time lurking first. The list of logged-in devices shows all phones and computers currently able to access your account, while the list of authorized apps shows all third-party services you’ve given permission to log in using your account. Any unknown devices or unused third-party apps on these lists are the easiest clues to spot. +- Evidence grade: C +- Notes: This feature is available in WeChat, Alipay, email accounts, Apple ID, and Android accounts. If you spot any unfamiliar devices, simply log out from all devices and change your password. +- Sources:作者经验，无直接文献 + +### 7. Don’t tap “Allow all” just to use an app: the data isn’t mandatory, and refusing to share it won’t block service access + + +- Cost: No cost involved. The hard part is resisting the urge to tap “Allow all.” +- In plain terms: Apps request your data. If that data isn’t strictly necessary to deliver the service, the app can’t deny you access just because you refuse to share it. It may only collect what it actually needs. For instance, a map app needs your location, but a flashlight app has no business asking for your contacts list. +- Benefit: Two key legal points apply here. First, providers may not deny products or services on the grounds that a user hasn’t consented or has withdrawn consent — unless processing that data is genuinely essential to delivering the service. Second, data collection must stay limited to what’s absolutely required for the intended purpose; only the minimal amount needed may be gathered. +- Evidence grade: A +- Notes: The deciding factor is simple: is this data truly essential to providing the service? Location data is essential for a map app, but contact lists aren’t needed for a flashlight app. After installing an app, head to your phone’s settings under app permissions and turn off any nonessential permissions. Grant access only when you genuinely need them, and even then, limit it to a one-time permission. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. ：第六条「收集个人信息，应当限于实现处理目的的最小范围，不得过度收集个人信息」；第十六条「个人信息处理者不得以个人不同意处理其个人信息或者撤回同意为由，拒绝提供产品或者服务；处理个人信息属于提供产品或者服务所必需的除外」；第十五条「基于个人同意处理个人信息的，个人有权撤回其同意。个人信息处理者应当提供便捷的撤回同意的方式」 + +### 8. You have the right to view, copy, correct, and delete your personal information; if refused, you can sue. + + +- Cost: There is no cost involved. Only if the company drags its feet do you need to file a complaint or sue. A lawsuit typically takes several months to resolve, and you must pay legal fees yourself. Therefore, filing a complaint first is the more cost-effective option. The difficult part is having to repeatedly follow up when the company delays action. + +- In plain terms: You have the right to demand that a company let you view, copy, correct, and delete your personal information. When a service is discontinued, its retention period expires, or you withdraw consent, the company is obligated to delete that data on its own. If it refuses your request, it must provide a valid reason; otherwise, you can take it to court. Deactivating an account and deleting personal information are two separate actions — after deactivating, you must separately request deletion. + +- Benefit: There are several situations in which a company must proactively delete personal information: when a service is discontinued, when the agreed retention period ends, when you withdraw consent, or when the original purpose of data collection has been fulfilled. If it fails to do so, you can demand deletion. Should it deny your rights without justification, you may file a lawsuit. + +- Evidence grade: A + +- Notes: Deactivating an account and deleting personal information are distinct processes; after deactivating, you must separately request deletion. Before switching phones or selling an old device, make sure to log out of all accounts, unlink them, and then perform a factory reset. The law grants you a right to deletion after the fact — it cannot retrieve data that has already been leaked. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. ：第四十五条「个人有权向个人信息处理者查阅、复制其个人信息……个人请求查阅、复制其个人信息的，个人信息处理者应当及时提供」；第四十六条更正、补充权；第四十七条列了五种应当主动删除的情形，含「（一）处理目的已实现、无法实现或者为实现处理目的不再必要」「（二）个人信息处理者停止提供产品或者服务，或者保存期限已届满」「（三）个人撤回同意」，「个人信息处理者未删除的，个人有权请求删除」；第五十条「个人信息处理者应当建立便捷的个人行使权利的申请受理和处理机制。拒绝个人行使权利的请求的，应当说明理由」「个人可以依法向人民法院提起诉讼」 + +### 9. You’re not required to use facial recognition: if other options exist, they must offer you alternatives if you refuse + + +- Cost: No cost involved. When asked to use facial recognition, simply ask, “Are there any other verification methods available?” If they claim none exist, demand they provide alternatives. The challenge lies in actually voicing this question on the spot. +- In plain terms: As long as any other method can achieve the same result, a service provider cannot force you to use facial recognition. If you decline facial recognition, they must offer alternatives such as a card swipe, password entry, or ID verification. They also cannot threaten that “the service won’t be provided” if you refuse. Installing facial recognition devices in hotel rooms, public showers, changing rooms, or restrooms is strictly prohibited. +- Benefit: The Administrative Measures for the Safe Use of Facial Recognition Technology clearly state: “Where other non-facial recognition technologies can achieve the same purpose or meet equivalent operational requirements, facial recognition must not be used as the sole verification method. If an individual declines facial recognition for identity verification, other reasonable and convenient alternatives must be provided.” The measures further stipulate: “No organization or individual may mislead, deceive, or coerce individuals into accepting facial recognition for identity verification under the pretext of service delivery or improved quality.” Consent to use facial recognition must be “freely, explicitly, and separately given after full disclosure” — meaning you must be asked specifically about this and must agree independently. You retain the right to withdraw consent, and service providers must offer an easy way to do so. For minors under 14, parental or guardian consent is mandatory. In public spaces, facial recognition devices may only be installed if “necessary for public safety” and must display prominent warning signs. Their use inside private areas such as hotel rooms, showers, changing rooms, or restrooms is forbidden. Facial data must be stored locally on devices and must not be transmitted over the internet, except where permitted by law or with explicit consent (effective nationwide as of June 1, 2025). +- Evidence grade: A +- Notes: Common scenarios include residential building access systems, rental platforms, gyms, and hotels requesting facial data. When they claim “the system only supports facial recognition,” quote the exact wording from the regulations: “Where other non-facial recognition technologies can achieve the same purpose or meet equivalent operational requirements, facial recognition must not be used as the sole verification method.” Then demand alternative verification methods such as card swipes, passwords, or ID checks. If they still refuse, report them to local internet regulatory authorities. Certain financial and government services may have separate rules — follow those instead. Unlike passwords, facial data cannot be changed after a breach, so it demands greater caution. Organizations storing facial data on behalf of 100,000+ individuals must register with provincial or higher-level internet regulators within 30 days; this registration status can help you assess their legitimacy. Your rights to access, correct, or delete your personal data are covered in item 8. +- Sources:国家互联网信息办公室、公安部 (2025). 人脸识别技术应用安全管理办法（第 19 号令，第十条、十二条、十三条，2025 年 6 月 1 日起施行）. diff --git a/book/15-Renting-And-Buying-Housing.md b/book/15-Renting-And-Buying-Housing.md new file mode 100644 index 00000000..4735730a --- /dev/null +++ b/book/15-Renting-And-Buying-Housing.md @@ -0,0 +1,80 @@ +# 15. Renting vs. buying a home + +Renting can easily cost you extra due to security deposits and realtor fees. Buying a home, on the other hand, brings high expenses in the form of mortgage interest and all those hidden details that sellers know but buyers often overlook. +### 1. The amount of the deposit, its refund timeline, and permissible deduction scenarios must be specified in the contract + +- Cost: No monetary cost. It only requires an extra ten minutes when signing the contract. The challenge lies in bringing this up in front of the landlord. +- In plain terms: The deposit amount, when it will be returned, and under what circumstances deductions are allowed must all be written into the contract before you sign it. Any deduction reasons not explicitly stated in the contract cannot be used by the landlord to withhold your deposit at the end of the lease. +- Benefit: Regulatory statutes make this clear: “Landlords collecting a deposit must specify the deposit amount, refund timing, and permissible deduction scenarios in the housing lease agreement. Apart from these agreed terms, landlords have no right to deduct funds without valid justification.” In short, three key points must appear in the contract: how much the deposit is, when it’s returned, and under what conditions it can be deducted. Reasons not listed in the contract cannot be used to justify any deductions. +- Evidence grade: A +- Notes: On the day of moving out, take photos and videos together with the landlord. Capture readings from water, electricity, and gas meters, as well as images of walls and floors. If your deposit is deducted without cause, first file a complaint with the housing regulatory authority. For smaller amounts, consider pursuing a small claims lawsuit — see Section 8 for details. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十条）. + +### 2. When water and electricity are cut off, locks are changed, or you’re threatened to leave — call the police right away: laws forbid using these tactics to force you out + +- Cost: No cost at all. Just make a phone call to the police and they’ll be there immediately. +- In plain terms: Landlords are strictly prohibited by law from cutting off utilities, changing locks, or threatening tenants to end a lease or force them to move out. If this happens to you, call the police right away. The police report serves as proof if you later seek compensation for any losses. Do not attempt to confront the landlord on your own. +- Benefit: Administrative regulations make it clear: “Landlords may not use violence, threats, or any other illegal means to compel tenants to terminate a housing lease or vacate the premises.” Eviction means being forced to move out. In such situations, call the police and preserve all evidence — do not take matters into your own hands. +- Evidence grade: A +- Notes: Calling the police ensures you obtain an official report. This report becomes crucial evidence if you later file a claim for damages. Also be sure to notify your local housing authority. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十二条）. + +### 3. Real estate agents must not collect or remit rent and security deposits; payments go straight to landlords + +- Cost: No cost at all. It takes just a few minutes to verify the recipient before paying. The hard part is resisting pressure from agents who try to get you to send the money to them instead. +- In plain terms: By regulation, real estate agents are prohibited from collecting or remitting rent and security deposits; all payments must go directly to landlords. Any time money passes through an agent’s hands, it creates one extra chance for them to abscond with the funds. If that happens, you lose both your rent payments and your right to stay in the property. Always confirm that the recipient’s name matches the name on the property title before paying. +- Benefit: Administrative rules explicitly forbid real estate agencies from collecting or remitting rent and security deposits on behalf of landlords. This means agents have no legal authority to handle such payments. Every time money moves through an agent’s hands, the risk of them running off with the money rises significantly. +- Evidence grade: A +- Notes: Double-check that the recipient’s name matches the name on the property title before making any payment. If it does not, ask for a written authorization first. Agents are only allowed to charge a commission fee for their matchmaking services. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第二十五条）. + +### 4. Check a long-term rental’s escrow account before paying a full year’s rent upfront + +- Cost: No cost at all. It takes just a few minutes to verify. +- In plain terms: The discount you get from paying a full year’s rent upfront is minimal. If the rental company goes out of business, you lose both your security deposit and the rent you’ve prepaid for the remaining months. It gets even worse if you take out a rent loan: even if the company disappears, you’re still obligated to make all monthly loan payments. Always check whether the company has a publicly listed escrow account before signing any lease. +- Benefit: Regulations require any housing rental business that sublets units to set up a dedicated escrow account for rental funds and make it visible to the public. Subletting means a company leases entire properties from landlords and then rents them out to individual tenants. The tiny discount from paying a full year’s rent upfront is far outweighed by the risk of losing both your deposit and all prepaid rent if the company shuts down. This risk is even greater if you’ve taken out a rent loan. +- Evidence grade: A +- Notes: Carefully check whether any loan products are tied to your lease agreement. If a third-party app lets you pay a full year’s rent upfront to the rental company, and you then repay that amount via monthly installments, you’ll still be responsible for all payments even if the company ceases operations. Avoid signing any such contracts. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十九条）. + +### 5. House sold during lease term – lease remains valid, no need to move + +- Cost: No cost at all +- In plain terms: If a house is sold while you’re still renting it, your lease stays valid. The new owner must honor the original contract and let you live there until it ends. You won’t need to move out or renegotiate any terms. This only applies if you’re already living there legally; be sure to keep proof such as the lease, payment records, and documentation showing when you moved in. +- Benefit: The Civil Code includes a principle known as “sale does not break lease,” meaning a property sale has no effect on an existing lease agreement. The actual wording is: “Any change in ownership of leased property during the lease term does not affect the validity of the lease contract.” In other words, even if the house changes hands while you’re renting it, the new owner must abide by the original terms and let you stay until the lease ends. +- Evidence grade: A +- Notes: This applies only if you’re already residing there lawfully; the law refers to such occupancy as “legal possession and use.” It’s essential to retain all relevant documentation, including the lease, proof of payments, and records indicating your move-in date. +- Sources:全国人大 (2020). 民法典（第七百二十五条）. + +### 6. Checking property rights and mortgages before signing the contract; all payments must be transferred with a purpose note + + +- Cost: No cost involved. The check takes about half an hour. +- In plain terms: The two most common ways people end up losing all their money are: first, paying rent to someone who isn’t the property owner; second, discovering that the house was already mortgaged to a bank and later seized. Before signing, verify both the property rights and any existing mortgages at the local land registry office. All payments must be made via bank transfer, with a note stating “Monthly rent for [property address]”. This note serves as direct proof in case of any disputes. +- Benefit: These two scenarios represent the typical ways people lose all their money: paying rent to a non-owner, or dealing with a property that’s already mortgaged and seized. Keeping a transfer note that reads “Monthly rent for [property address]” provides solid evidence if a dispute arises later. +- Evidence grade: C +- Notes: Property rights information can be obtained from the local land registry office. At the time of signing, the actual owner must be present; if not, a written authorization is required. If you’re renting from a sub-landlord, written consent from the original owner is mandatory. +- Sources:作者经验，无直接文献；证据留存与转账备注同理见第 8 节关于彩礼和借条的两条 + +### 7. For second-hand home sales where the agent collects the payment, the funds must be deposited into a dedicated transaction account opened by the agency at a bank + +- Cost: No cost involved. The challenge is ensuring the payment goes into the designated account; this may require some discussion with the agent. +- In plain terms: The purchase price can range from hundreds of thousands to millions of dollars — this is the largest single transaction amount discussed in this guide. By regulation, when an agent collects payment, it must be transferred to a dedicated account opened by the agency at a bank, not sent via WeChat to the individual agent. Additionally, when two agencies collaborate on one sale, only one commission fee may be charged; services such as loan processing or title transfer require separate contracts and clear fee agreements beforehand. +- Benefit: Regulations are explicit: any real estate agency entrusted to collect or disburse transaction funds must use a dedicated client settlement account at a bank. This ensures the payment is held in a regulated account, not the agency’s general account or any individual agent’s personal account. +- Evidence grade: A +- Notes: Given the substantial amount involved, never send payment via WeChat to an agent. Two common scenarios involving extra charges also apply: first, when two agencies jointly handle a sale, only one commission fee is allowed; second, services like loan processing or title transfer are separate and must be contracted individually with clear fee disclosures. All payments should be transferred via bank transfer with a purpose note, as outlined in item 6 (verifying property titles and mortgage status prior to signing). +- Sources:住房城乡建设部、国家发展改革委、人力资源社会保障部 (2011). 房地产经纪管理办法（令第 8 号，2016 年第 29 号令修改）第二十四条：「房地产交易当事人约定由房地产经纪机构代收代付交易资金的，应当通过房地产经纪机构在银行开设的客户交易结算资金专用存款账户划转交易资金。」第十八条「房地产经纪服务实行明码标价制度……在经营场所醒目位置标明房地产经纪服务项目、服务内容、收费标准」；第十九条「两家或者两家以上房地产经纪机构合作开展同一宗房地产经纪业务的，只能按照一宗业务收取佣金，不得向委托人增加收费」；第十七条代办贷款、代办房地产登记等其他服务「应当向委托人说明服务内容、收费标准等情况，经委托人同意后，另行签订合同」. + +### 8. Don’t rent a subdivided apartment: the smallest legal rental unit is the original designed room; kitchens, bathrooms, balconies must not be used for living. + + +- Cost: There’s no direct cost. The trade‑off is that with the same budget you’ll either have to live farther away or in a smaller space. + +- In plain terms: By regulation, the smallest permissible rental unit is the room as originally built. Kitchens, bathrooms, balconies, and basement storage areas cannot be used as living quarters. If such an apartment is found to be illegal, you may be forced to move out. Additionally, during the lease term the landlord cannot unilaterally raise the rent. + +- Benefit: The rules make it clear that the minimum rental unit is the original room — meaning you can’t split it into multiple units for separate rentals. The minimum floor area per occupant must meet local legal standards, and kitchens, bathrooms, balconies, and basements must not be rented out for habitation. Landlords also can’t arbitrarily increase rent while a lease is in effect. + +- Evidence grade: A + +- Notes: When an illegal subdivision is discovered, it’s the tenant who must move, often losing their security deposit and any rent already paid. Safety is also a concern: makeshift walls can block escape routes, and many people sharing one apartment often rely on a single electrical circuit. When viewing a place, check three things: whether walls were added later, if there’s a window in the room, and whether the electric meter can handle the expected number of occupants. +- Sources:住房和城乡建设部 (2010). 商品房屋租赁管理办法（令第 6 号）第八条：「出租住房的，应当以原设计的房间为最小出租单位，人均租住建筑面积不得低于当地人民政府规定的最低标准。厨房、卫生间、阳台和地下储藏室不得出租供人员居住。」第九条：「出租人应当按照合同约定履行房屋的维修义务并确保房屋和室内设施安全……房屋租赁合同期内，出租人不得单方面随意提高租金水平。」 diff --git a/book/16-Living-With-Chronic-Disease.md b/book/16-Living-With-Chronic-Disease.md new file mode 100644 index 00000000..207cd337 --- /dev/null +++ b/book/16-Living-With-Chronic-Disease.md @@ -0,0 +1,93 @@ +# 16. How to live after being diagnosed with a chronic disease + +This section looks at overall mortality rates and the associated costs. A chronic disease diagnosis is not the end of the story — what truly matters is how to manage it over the decades that follow. +### 1. Take medication exactly as prescribed — don’t stop just because you feel better + +- Cost: There’s no cost at all; in fact, it saves money on future treatment for complications. Taking the pills each day takes only a few minutes. The real challenge is sticking to the regimen every single day. +- In plain terms: People who consistently follow their doctor’s instructions when taking medication have roughly half the risk of dying during the same period compared to those who take it intermittently. This figure should be viewed with some caution. Even individuals who take fake pills consistently also have lower mortality rates, which suggests part of the benefit stems from the fact that people who stick to any medication routine tend to be more health-conscious overall. Still, the risks of skipping doses are well documented — especially for blood pressure drugs, anticoagulants, and anti-rejection medications. +- Benefit: This finding comes from a meta-analysis that pooled data from 21 separate studies involving 46,847 participants. Compared to those who took medication irregularly, people who followed their prescription exactly had roughly 44% lower risk of dying during the same timeframe. The raw odds ratio was 0.56, with a 95% confidence interval ranging from 0.50 to 0.63; this interval represents the range within which the true value is likely to fall. When only treatments with proven effectiveness were considered, the risk reduction was about 45% (odds ratio 0.55, 95% CI 0.49–0.62). +- Evidence grade: A +- Notes: This is a somewhat controversial figure and one of the numbers in this guide that requires extra caution. In the same meta-analysis, individuals who consistently took placebos also showed a lower mortality rate (odds ratio 0.56, 95% CI 0.43–0.74). This indicates that a significant portion of the benefit is attributable to the “healthy adherer effect” — the tendency of people who stick to any kind of medication routine to generally maintain healthier habits. Nevertheless, the risks associated with discontinuing medication are very real, particularly for blood pressure drugs, anticoagulants, and anti-rejection medications. +- Sources:Simpson SH, Eurich DT, Majumdar SR, et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ, 333(7557), 15. + +### 2. First get outpatient chronic disease certification, then register for cross-regional medical care — hypertension, diabetes, cancer radiotherapy/chemotherapy, dialysis, and anti-rejection treatment can then be covered by yibao across regions + + +- Cost: No cost at all. You can complete the cross-regional medical registration once, right from your phone, via the yibao app before you travel. + +- In plain terms: Patients with hypertension, diabetes, outpatient radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants can now use their yibao coverage for outpatient care anywhere in the country. They won’t need to pay out-of-pocket first and then seek reimbursement back home. However, this only works if they first obtain outpatient chronic disease certification in their home region, then register for cross-regional medical care. Both steps are required for it to take effect. + +- Benefit: According to official documents from the National Healthcare Security Administration, this system is now largely in place. The exact wording reads: “Cross-regional direct settlement of outpatient expenses for five chronic conditions — hypertension, diabetes, radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants — is now largely accessible at the county level.” “Accessible at the county level” means this service is available county-wide. The documents also mention plans to add five more conditions to this list in the future. + +- Evidence grade: A + +- Notes: Both steps are mandatory: first get outpatient chronic disease certification in your home region, then register for cross-regional medical care. Progress on adding those five new conditions varies by region; exact details are determined by local healthcare security authorities. +- Sources:国家医保局办公室、财政部办公厅 (2024). 关于稳妥有序扩大跨省直接结算门诊慢特病病种范围的通知（医保办发〔2024〕19 号）. + +### 3. Follow the intervals recommended by your doctor for follow‑up visits, and record every measurement in the same notebook. + +- Cost: Each checkup costs anywhere from a few dozen to several hundred yuan. A trip to the hospital and waiting for results also takes some time. The main difficulty is that you must go regularly, which can easily be put off. +- In plain terms: For chronic diseases, it’s the trends over time that matter, not any single measurement. Write down the date, the measurement, the medication you’re taking, and its dosage in one place. When you switch doctors, you can show this record so you won’t need to repeat tests or pay for them again. +- Benefit: What matters for chronic conditions is how these values change over time. Keeping them all in one spot also means you won’t have to redo tests or spend extra money when you change medical providers. +- Evidence grade: C +- Notes: Be sure to record at least four items each time: the date, the measurement value, the medication being used, and its dosage. Taking a photo of the lab report with your phone works just as well. The key is to keep everything in the same place rather than scattering it across multiple notes. +- Sources:作者经验，无直接文献 + +### 4. Don’t stop proper treatment to try folk remedies or supplements + +- Cost: No cost at all; you even save money you’d otherwise spend on supplements. It takes no extra time. The hard part is resisting repeated pressure from others to give it a try. +- In plain terms: The risks of stopping treatment are well known, while the benefits of folk remedies and supplements are uncertain. This means trading a definite harm for an uncertain gain. If you want to try supplements, talk to your doctor first. Some supplements can alter blood levels of anticoagulants and anti-rejection drugs. +- Benefit: The dangers of discontinuing treatment are clear, while the advantages of folk remedies remain unproven. This book lists several common types of ineffective supplements in Chapter 6. +- Evidence grade: C +- Notes: Always consult your doctor before trying any supplements. Certain supplements may interact with prescription medications, affecting concentrations of anticoagulants and anti-rejection drugs in the bloodstream. +- Sources:作者经验，无直接文献；相关证据见第 6 节 + +### 5. For patients with stable chronic conditions, community clinics can issue up to 12 weeks’ worth of medication at one time + +- Cost: There is no cost involved. Simply ask at your local community health center whether they can issue a long-term prescription. +- In plain terms: For individuals whose condition remains stable and whose medication regimen has not changed, community health centers can provide enough medication to last 12 weeks. This eliminates the need to travel to a larger hospital each month just to get a prescription and wait in line. Within the same insurance region, the reimbursement rate at these community clinics is typically about 10 percentage points higher than at higher-level hospitals. +- Benefit: Patients no longer have to make monthly trips to larger hospitals just to get their prescriptions. In the same insurance region, the reimbursement rate at community clinics is generally roughly 10 percentage points higher than at higher-level hospitals. +- Evidence grade: A +- Notes: Whether a patient meets the criteria is determined by the doctor; generally, this applies to individuals with a confirmed diagnosis and a stable medication plan. The medication itself remains the same; what is saved is the time and cost of making monthly trips to the hospital. If a specific medication is not available at the clinic, ask about their medication shortage registry and delivery options. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「对于符合条件的慢性病患者，基层医疗卫生机构单次可开具不超过12周用药的长期处方。」；同文「原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距」，并要求上级医院在基层开设高血压、糖尿病、慢性阻塞性肺疾病等常见病慢性病门诊 + +### 6. Before signing up for a family doctor in your community, find out which services are covered by yibao and which you’ll have to pay for out of pocket + +- Cost: There’s no cost involved. Asking a few questions before you sign up takes just a minute. +- In plain terms: The standard package of basic services is covered by yibao as required. Any customized service packages must be paid for entirely by the patient. When someone offers an “upgrade package,” be sure to ask whether it’s a basic or customized package, whether it’s officially registered, and how much it costs per year. +- Benefit: The basic service package is paid for by yibao per regulations. Customized packages require full out‑of‑pocket payment and must also be registered with the county‑level health authority. +- Evidence grade: A +- Notes: The real value of signing up lies in having a doctor follow your health over the long term, not in the number of services included. When offered an “upgrade package,” ask three key questions: is it a basic or customized package, is it registered, and what’s the annual cost? +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「加强基层门诊付费与签约服务政策联动，基本服务包按规定纳入医保支付；个性化服务包由签约基层医疗卫生机构按程序向县级卫生健康部门备案，费用由个人支付。」 + +### 7. Get a dilated eye exam right after a diabetes diagnosis, then follow your doctor’s recommended schedule; check your feet once a year. + +- Cost: A single dilated eye exam costs anywhere from a few dozen to several hundred yuan. Foot exams are usually included in routine outpatient visits, so they don’t incur extra charges. The real challenge is remembering to get these checks done even when neither your eyes nor feet feel any discomfort. +- In plain terms: Diabetes can damage both the retina and feet, but there are almost no noticeable symptoms until the damage becomes severe enough to cause vision loss or foot ulcers. Early detection makes treatment possible. For type 2 diabetes, a dilated eye exam should be done right after diagnosis; for type 1 diabetes, it’s recommended to start five years after onset. If previous tests showed no issues and blood sugar levels remain well-controlled, the interval can be extended to once every one or two years. Foot checks should be done annually. +- Benefit: Retinal damage caused by diabetes is known as diabetic retinopathy, while damage to the feet is called diabetic foot disease. Both conditions rarely show any symptoms until they reach an advanced stage. Detecting them early gives patients a much better chance of effective treatment. Once vision is lost or foot ulcers develop, it’s usually too late to reverse the damage. +- Evidence grade: A +- Notes: Type 2 diabetics should get a dilated eye exam right after diagnosis; type 1 diabetics should start five years after onset. The difference exists because type 2 diabetes often develops gradually over several years without obvious signs. If previous tests showed no problems and blood sugar stays under control, the interval can be extended to once every one to two years. People who notice reduced sensation in their feet should inspect the soles daily, even using a mirror if needed. +- Sources:美国糖尿病学会 (2026). 糖尿病诊疗标准 2026·第 12 章 视网膜病变、神经病变与足部护理. Diabetes Care：「People with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis.」「Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist 5 years after the onset of diabetes.」「If there is no evidence of retinopathy from one or more annual eye exams and glycemic indicators are within the goal range, then screening every 1–2 years may be considered.」「Perform a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations.」 + +### 8. People who have had kidney stones should drink 2.5–3 liters of water daily and keep salt intake under 6 grams + +- Cost: There is no cost at all. Simply make drinking water a daily habit. On days when you sweat a lot, you’ll need even more water — the hard part is remembering to do this every day. +- In plain terms: Roughly one in four people who have had a kidney stone will develop another one within five years. In a study of 199 people who had just experienced their first calcium stone episode, one group was instructed to drink enough water every day. Over five years, 12% of this group had a recurrence, compared to 27% of the control group that received no special instructions. UK guidelines recommend drinking 2.5–3 liters of water daily while keeping salt intake under 6 grams. Exactly 99 participants took part in this trial. +- Benefit: This is a five-year randomized controlled trial involving 199 patients with idiopathic calcium stones — meaning no underlying cause could be identified. Participants were split into two groups: one group drank at least 2 liters of water daily, while the other received no special intervention. After five years, 12.1% of the water-drinking group had a recurrence, versus 27.0% in the control group (P=0.008). A lower P value indicates a less likely chance that this difference occurred by random chance. The average time to recurrence was 38.7±13.2 months for the water group versus 25.1±16.4 months for the control group (P=0.016). Baseline 24-hour urine volume measurements showed that stone patients produced significantly less urine than healthy individuals: men produced 1,057±238 mL versus 1,401±562 mL in healthy men (P<0.0001), and women produced 990±230 mL versus 1,239±440 mL (P<0.001). NICE guideline NG118, section 1.8.1, offers several recommendations: adults should drink 2.5–3 liters daily, while children and teens should drink 1–2 liters based on age. Adding fresh lemon juice to water is encouraged, and carbonated drinks should be avoided. Adults must also keep daily salt intake under 6 grams. +- Evidence grade: A +- Notes: This measure reduces recurrence rates by roughly 55% at zero cost, making it the most cost-effective recommendation in this section according to our ranking criteria. The key metric to monitor is 24-hour urine volume, which should reach at least 2–2.5 liters — not simply the amount of water you drink. People who sweat heavily or work in hot environments need to drink even more. This trial involved only patients experiencing their first idiopathic calcium stone episode; different types of stones — such as uric acid, infection-related, or cystine stones — require different treatment approaches. Anyone with a history of kidney stones should undergo a stone composition analysis and a 24-hour urine test to determine whether medication is needed. Do not cut calcium intake to prevent stones; see section 6, item 21 for more details. Severe flank or abdominal pain during a stone episode requires immediate medical attention — drinking more water alone will not resolve it. Non-painful blood in the urine may indicate other conditions; see section 1, item 27 for further information. +- Sources:Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A (1996). Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of Urology, 155(3), 839-843. ；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. + +### 9. Long-term use of uric acid-lowering drugs after a gout diagnosis to keep blood uric acid below 360 µmol/L + + +- Cost: Allopurinol costs only a few to several dozen yuan per month. In the beginning, blood uric acid levels must be checked every few weeks to adjust the dosage; once stable, checks can be done every few months. For the first 3 to 6 months, a separate medication to prevent gout attacks must also be taken. The real challenge is remembering to take these drugs consistently even when there are no symptoms. + +- In plain terms: The proper way to manage gout is to take uric acid-lowering drugs long-term to keep levels below 360 µmol/L; these should not be taken only during flare-ups. In a UK trial involving 517 participants, 95% of those whose treatment was adjusted according to medical targets achieved this level after two years, compared to only 30% of those receiving standard care. Even after reaching the target, medication must not be stopped. Diet alone cannot bring levels down to this point, and abstaining from alcohol only lowers them by 1.6 mg/dL. A total of 211 participants remained free of gout attacks over a five-year follow-up period after discontinuing medication. + +- Benefit: This is a randomized controlled trial with 517 adult participants who had experienced gout attacks within the previous 12 months. One group received guidance from nurses who explained the condition and adjusted their medication to meet the target level; the other group continued to receive standard care from general practitioners. After two years, 95% of the intervention group had blood uric acid levels below 360 µmol/L (6 mg/dL), compared to just 30% of the control group. This represents a 3.18-fold increase in the likelihood of success (RR 3.18, 95% CI 2.42–4.18; this range indicates statistical reliability), with a P-value of less than 0.0001. Secondary outcomes such as attack frequency, presence of tophi, and quality of life also improved significantly in the intervention group. Each additional year of healthy life, adjusted for quality of life, cost approximately £5,066. A follow-up survey of 438 participants yielded a response rate of 82%; median attack frequency was 0 per year in the target-achieving group versus 1 per year in the control group (P<0.001). The proportion of participants still taking uric acid-lowering drugs was 1.19 times higher in the intervention group (adjusted RR 1.19, 1.09–1.30). The 2020 American College of Rheumatology guidelines strongly recommend starting such treatment for three groups: those with visible tophi, those showing bone damage on imaging, and those experiencing at least two attacks per year. The recommended approach involves continuous monitoring and dosage adjustment until levels drop below 6 mg/dL; allopurinol is the first-line choice, especially for patients with stage 3 or higher chronic kidney disease, with an initial dose of no more than 100 mg per day. Anti-inflammatory preventive drugs must also be taken for at least 3 to 6 months. Observational data from the same study showed that after successful long-term control, 87% of patients who discontinued medication still maintained levels below 7 mg/dL; however, only 13% remained free of attacks over a five-year follow-up period. Dietary interventions have limited impact: abstaining from alcohol lowers levels by just 1.6 mg/dL, while one serving of beer raises them by 0.16 mg/dL. Healthier diets such as Mediterranean or DASH diets produce even smaller effects. + +- Evidence grade: A + +- Notes: **Han Chinese individuals should consider testing for HLA-B*5801 before starting allopurinol.** This gene variant occurs in 7.4% of Han Chinese, Korean, and Thai populations, compared to only 0.7% of white and Hispanic individuals. Asians and African Americans face a threefold higher risk of allopurinol hypersensitivity syndrome, a potentially fatal condition involving widespread skin peeling; thus, the 2020 American College of Rheumatology guidelines advise genetic testing for these groups. Initiating uric acid-lowering therapy may temporarily increase attack frequency, so guidelines mandate concurrent use of anti-inflammatory preventive drugs for the first 3 to 6 months. Stopping medication due to increased pain is a common mistake; instead, additional anti-inflammatory drugs should be used as directed. Target levels of <6 mg/dL roughly correspond to 360 µmol/L, though Chinese medical reports typically use µmol/L units. Elevated uric acid levels without any prior attacks represent a different clinical scenario, discussed in Section 6, Item 19. Further details on sugary drinks and alcohol can be found in Section 2, Items 7 and 20. +- Sources:Doherty M, Jenkins W, Richardson H, et al. (2018). Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet, 392(10156), 1403-1412. ；Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M (2020). Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology, 59(3), 575-579. ；FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760. diff --git a/book/17-Elderly-At-Home.md b/book/17-Elderly-At-Home.md new file mode 100644 index 00000000..594a48b6 --- /dev/null +++ b/book/17-Elderly-At-Home.md @@ -0,0 +1,95 @@ +# 17. Having elderly family members at home + +Having elderly relatives living with you often means that the main problems aren’t a lack of money, but failing to discuss matters clearly and sign the necessary documents in advance. The final section looks at pressure ulcers in bedridden patients; it calculates costs based on mortality rates and isn’t meant to be compared with the other items in this chapter. +### 1. While the elderly are still lucid, designate a future guardian in writing + +- Cost: It costs only a few hundred yuan to have a notarized document drawn up at a notary office. A single conversation with the elderly person is enough to settle the matter. The real difficulty lies in bringing it up — you must directly discuss the day when they will no longer be able to make decisions for themselves. +- In plain terms: While an elderly person still has a clear mind, it’s worth spending a few hundred yuan to have a written document notarized, naming who will serve as their guardian. Without such a document, once they lose decision-making capacity, a court must decide who gets to sign on their behalf and manage their finances. If family members disagree, the process can drag on even longer. +- Benefit: Under civil law, adults who are mentally sound and capable of independent decisions (legally termed “adults with full civil capacity”) may proactively arrange for a future guardian through mutual agreement. This person can be a close relative or any willing individual or organization. Such an arrangement must be formalized in writing. When the person later loses all or part of their decision-making ability, the designated individual assumes responsibility. Absent this document, guardianship must be assigned by a court. +- Evidence grade: A +- Notes: This arrangement is known as “voluntary guardianship,” meaning the guardian is chosen by the individual themselves, taking precedence over the standard legal order of guardianship. It is especially important for elderly people living alone, whose children reside far away, or those from complex family backgrounds. It is recommended to have the document notarized at a notary office. +- Sources:全国人大 (2020). 民法典（第三十三条）. + +### 2. Make a will — remember that later ones override earlier ones, and notarized wills no longer take priority + +- Cost: Writing a will by hand costs nothing. Having it notarized at a notary office costs several hundred to over a thousand yuan. The hard part is bringing it up: you must discuss end‑of‑life matters with your family. +- In plain terms: The law recognizes six types of wills, but a single mistake in the format can render the entire document invalid — this is the most common pitfall. A handwritten will must be written entirely by the testator, signed, and dated. If multiple wills exist and they conflict, the last one signed prevails. Since 2021, a notarized will no longer automatically takes precedence over others. +- Benefit: The Civil Code acknowledges six legal forms of wills: handwritten, dictated to a scribe, printed, recorded on audio or video, oral, and notarized. Each type has specific formal requirements that must be met. When several wills exist, the most recent one governs. Starting in 2021, notarized wills no longer automatically rank above others. +- Evidence grade: A +- Notes: A handwritten will must be written entirely by the testator, signed, and dated. For printed wills, at least two witnesses are required; both the testator and witnesses must sign every page and include the date. Relatives of the testator, potential heirs, or anyone named to receive assets cannot serve as witnesses. Any failure to meet these formal rules renders the will invalid — this is the most frequent cause of problems. +- Sources:全国人大 (2020). 民法典（第一千一百三十四条至第一千一百四十二条）. + +### 3. Keep the elderly person’s money in a separate account and set a rule requiring two people to approve any large withdrawals + + +- Cost: This costs nothing. You only need to discuss it once with family members and agree on a spending limit. The real challenge is how to bring it up without making the senior feel you’re trying to restrict them. +- In plain terms: Scammers targeting seniors for health products, collectibles, or financial schemes all follow the same pattern: they spend months building rapport, then strike all at once. By establishing a rule that any withdrawal above a certain amount must be approved by another person, you effectively delay the spending decision until the initial impulse fades. +- Benefit: Most scams aimed at older adults rely on building trust over weeks or months before making a large financial demand. Setting a rule that requires a second person’s approval for any sizable expenditure helps delay that decision, reducing the chance of impulsive, costly mistakes. +- Evidence grade: C +- Notes: Frame this not as “protecting them from fraud” but as “keeping household finances organized.” That approach is far easier for seniors to accept. Also, avoid moving all of their money into a child’s account — doing so can lead to entirely different kinds of disputes. +- Sources:作者经验，无直接文献；防骗通则见第 8 节和第 13 节 + +### 4. A ready-made phrase for seniors to deflect unwanted offers + +- Cost: No cost at all. It only takes a few minutes to discuss this with the senior once. +- In plain terms: Sales pitches and scams rely on creating immediate pressure, making it hard for people to say no on the spot. By agreeing beforehand on the phrase “I need to go home and discuss this with my family,” the senior has an easy way out whenever needed. This works far better than trying to reason with them later. +- Benefit: Both sales tactics and scams depend on on‑the‑spot pressure. Having a pre‑arranged line such as “I need to go home and discuss this with my family” gives seniors a graceful exit, making it far more effective than any post‑event explanation. +- Evidence grade: C +- Notes: Use this together with tip #3 (keeping the senior’s money in a separate account). You can also carry out home modifications to prevent falls, as described in Section 1. This phrase isn’t meant to protect the senior from themselves; it simply provides a way to decline politely without feeling awkward. When surrounded by salespeople, the hardest part isn’t judging whether they’re trustworthy — it’s finding the courage to say no in front of everyone. Agreeing on this line beforehand removes that burden entirely. +- Sources:作者经验，无直接文献 + +### 5. Avoid any “investment-based senior care” schemes that require upfront payments: card enrollment, prepaid care fees, buying senior housing units, travel-based care programs, and sales of senior products all fall under the same category of illegal fundraising. + + +- Cost: No cost at all. Simply read the following list of common tactics to seniors; it takes just a few minutes. In the future, use this list to reject any such offers outright: don’t attend informational sessions, don’t visit facilities, and don’t leave contact details. The real challenge arises when seniors have already attended several sessions and formed relationships with promoters — in those cases, convincing them to back off becomes much harder. + +- In plain terms: Any senior care program that demands an initial payment while promising financial returns is essentially a scam. These schemes include selling membership cards, collecting prepaid care fees, selling senior housing units, offering travel-based care packages, and promoting various senior products. Under current regulations, recovered funds are extremely rare; victims usually bear the full financial loss. Official reports document cases where fraudsters raised 136,000,000 yuan by marketing “pre-booked senior housing units,” defrauding over 2,100 people. Another case saw fraudsters collect 620,000 yuan through similar tactics, affecting more than 2,100 people. The only effective preventive step is stopping the initial payment. + +- Benefit: The Civil Affairs Bureau has identified five primary patterns used by fraudsters; recognizing these patterns is far more reliable than trusting individual promoters. First, fake senior care organizations: these entities lack any physical presence and merely rent temporary venues while falsely claiming partnerships with legitimate care providers. Second, “senior care services” marketed via premium cards, membership passes, or prepaid plans that promise far more services than their actual capacity can deliver. Third, “investment in senior care projects” — including fictitious senior housing developments, long-term bed leases, and so-called “time bank” mutual care systems — often advertised with promises of principal return, rental guarantees, or buyback agreements. Fourth, sales of “senior products” involving product buybacks, consignment sales, loyalty discounts, complimentary health screenings, gift giveaways, conference promotions, wellness seminars, and expert medical consultations. Fifth, “travel-based senior care” packages featuring discounted or free trips, stored-value rewards, and points-based care programs. Legal statutes explicitly state that all financial losses resulting from participation in illegal fundraising must be borne by the victims themselves. Official statistics illustrate the scale of this problem: Dai and accomplices stole 136,000,000 yuan through similar schemes, affecting over 2,100 victims; Dai received a 15-year prison term plus a 400,000 yuan fine. Cao orchestrated a fraud totaling 13,207,000,000 yuan, impacting more than 110,000 people; he was sentenced to life imprisonment with permanent political rights revocation and full asset confiscation. Some health product promoters also employ fraud tactics: Ni lured seniors through free meals, gifts, and private transportation to attend lectures where “experts” fabricated anti-cancer benefits using false testimonials and inflated pricing; seniors ended up paying dozens of times the actual cost for a compound called dihydroquercetin. Ni received a 10-year-and-3-month sentence plus a 120,000 yuan fine. (National regulations effective May 1, 2021.) + +- Evidence grade: A + +- Notes: Determining whether a program is legitimate should never rely on superficial impressions like “this organization looks reputable”; instead, focus on two clear indicators: does it demand an upfront payment, and does it promise financial returns? Legitimate senior care providers offer services rather than investment opportunities; any mention of returns, profits, or principal guarantees immediately disqualifies them. While it is difficult to prevent seniors from attending informational sessions, travel excursions, or medical screenings, the critical moment for intervention is when a payment is requested; this aligns perfectly with the dual-confirmation rule outlined in section 3. Once payment has already occurred, immediately contact police at 110 or the anti-fraud hotline 96110 to request a payment freeze, and simultaneously report the incident to local authorities responsible for handling illegal fundraising cases. Separate from these schemes, “housing reverse mortgage insurance” represents a distinct financial mechanism; refer to section 6 for further details. +- Sources:民政部 (2023). 关于养老服务领域非法集资的风险提示. （中国政府网发布）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示. ；国务院 (2021). 防范和处置非法集资条例（国务院令第 737 号，第二、二十五、三十条）. ；最高人民检察院 (2022). 检察机关打击整治养老诈骗犯罪典型案例. ；最高人民法院 (2025). 依法惩治涉民生领域诈骗犯罪典型案例（案例五 倪某荣诈骗案）. + +### 6. Apart from the housing reverse mortgage insurance offered by insurers, you should avoid all other “housing-for-pension” schemes — never mortgage your home to buy financial products. + + +- Cost: There’s no cost involved. Keep your property deed in your own hands and don’t hand it over to anyone promoting “housing-for-pension” schemes. Before signing any mortgage, guarantee, or loan agreements, show them to your children first. The difficulty lies in the fact that promoters often come repeatedly and appear very enthusiastic, leaving seniors feeling awkward about refusing them. + +- In plain terms: The only legitimate “housing-for-pension” option is the housing reverse mortgage insurance provided by insurers, which is currently still in the pilot phase and used by very few people. Door‑to‑door sales pitches have nothing to do with this official program. Scammers trick seniors into mortgaging their homes so they can use the borrowed money to buy financial products recommended by the fraudsters — essentially a “pay‑old‑debts‑with‑new‑money” Ponzi scheme. Regulators report cases where seniors were unaware their homes had been mortgaged; as a result they ended up losing their property while still owing a loan. + +- Benefit: The China Banking and Insurance Regulatory Commission’s Consumer Protection Bureau clearly distinguishes between the genuine and the fraudulent schemes. The legitimate program is called “Housing Reverse Mortgage Insurance for Seniors.” Eligible seniors who fully own their homes may mortgage them to an insurer while continuing to live there, rent it out, or otherwise use it. Any sale or disposal of the property requires consent from the mortgagee — the insurer. Seniors then receive a pension according to agreed terms until their death. This service remains a pilot project with limited participants. Illegal operators label their schemes “housing‑for‑pension,” but they bear no relation to the official program; they merely exploit national policy to promote illegal fundraising. Their modus operandi is to persuade seniors to mortgage their homes and then use the proceeds to purchase recommended financial products — often a classic Ponzi arrangement. The original warning states that some participants are completely unaware their homes have been mortgaged, ultimately resulting in loss of the property and outstanding debt. A useful guideline for evaluating returns is also provided: if a financial product promises a yield above 6 %, it should be viewed with suspicion; above 8 % it becomes highly risky; and anything over 10 % means you should expect to lose all principal — “high returns with guaranteed principal” is a hallmark of financial fraud. The same warning also stresses the need to be cautious when signing contracts and never to sign blank documents (National level, June 2021). + +- Evidence grade: B + +- Notes: This grade B reflects that the statements derive from regulatory risk warnings and expert judgment rather than empirical research data. The 6 %, 8 %, and 10 % thresholds are reference points suggested by regulators for consumers, not legally mandated standards. The former CBIRC has been merged into the National Financial Regulatory Administration; the original announcement page is no longer accessible, so we cite a reposted version from a provincial financial regulator. The core issue here is not merely possible losses on financial investments, but that after mortgaging their homes seniors still carry a loan obligation — a loss far exceeding any potential principal loss. General rules concerning contract signing and blank documents are covered in Section 8, Item 17; steps to halt fraudulent transactions after being scammed are outlined in Section 8, Item 2. +- Sources:中国银保监会消费者权益保护局 (2021). 关于警惕「投资养老」「以房养老」金融诈骗的风险提示（2021 年第三期）. （湖南省地方金融监督管理局转载）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示（第四种表现形式：以宣称「以房养老」为名非法集资）. + +### 7. For elderly individuals at home who are bedridden or severely disabled, apply to the local yibao (basic medical insurance) office for long-term care insurance; it is not limited to seniors only. + + +- Cost: You only need to visit the local yibao office once to submit an application and undergo a disability assessment. If you pass the assessment on the first try, the evaluation fee is covered by the insurance fund — no out-of-pocket expense is required. + +- In plain terms: Long-term care insurance helps cover the cost of hiring caregivers. Those who are severely disabled and have remained in that condition for at least six months may apply to their local yibao office. Eligible care expenses do not need to be paid upfront; roughly 70% is reimbursed for employees covered under the worker policy, while about 50% is reimbursed for residents enrolled in the urban/rural resident policy. However, costs such as room charges and meals are not covered. Though often mistaken for a senior-specific program, official documents refer to “insured persons” without any age restriction — even younger individuals with severe disabilities may apply. + +- Benefit: There is no deductible threshold for approved long-term care services; you do not need to pay a set amount out-of-pocket before reimbursement begins. Approximately 70% of eligible costs are reimbursed for workers, and about 50% for urban/rural residents. The maximum annual payout cannot exceed 50% of the local average per-capita disposable income for residents in that region. + +- Evidence grade: A + +- Notes: Disability must be “long-term and continuous” — generally lasting six months or more; a few weeks of hospitalization does not qualify. A six-month waiting period applies before benefits can be claimed. Expenses unrelated to care, such as room fees or meals, are not covered by this insurance. Medical costs normally paid by yibao are also excluded. Individuals already receiving work-related injury care benefits cannot claim both simultaneously. This insurance is separate from disability-related subsidies; they follow different application procedures and provide distinct financial aid, as detailed in Section 7, Article 8. Care received at home or in community settings receives preferential reimbursement rates; institutionalization is not mandatory. Implementation varies by region, and assessment criteria differ locally. Contact 12393 or your local yibao office to confirm whether the program is active in your area and how to schedule an evaluation. Even if an initial assessment fails, reapplication is possible once disability worsens. +- Sources:国家医保局等八部门 (2026). 关于印发《加快建立长期护理保险制度实施方案》的通知. ：保障对象为「按规定参保缴费且失能状态长期持续（一般为6个月以上），经申请通过评估认定的失能人员」，「制度起步阶段保障重度失能人员」；「待遇享受不设起付标准。符合规定的长期护理服务费用，按未就业城乡居民参保政策参保的，基金支付比例为50%左右；按单位职工参保政策参保的，基金支付比例为70%左右，退休人员享受单位职工参保待遇」；「参保人员基金年度最高支付限额不超过统筹地区上年度城乡居民人均可支配收入的50%」；「待遇享受固定等待期原则上按照6个月设置」；另见中共中央办公厅、国务院办公厅《关于加快建立长期护理保险制度的意见》. + +### 8. For families with someone bedridden at home, pressure ulcers are a top concern: use an electric alternating-pressure air mattress, turn the patient regularly, and check bony areas daily + + +- Cost: Electric alternating-pressure air mattresses for home use start at a few hundred yuan. Turning a patient takes just a few minutes. The real challenge is doing it every two to three hours, even at night — no single caregiver can manage that alone. + +- In plain terms: Pressure ulcers are far more than just superficial skin injuries. Among 19,520 patients undergoing hip‑fracture surgery, those already having pressure ulcers at admission had a roughly 20% higher chance of dying within 30 days. Three evidence‑based actions help: using an electric air mattress cuts new ulcer formation by about 60% compared with ordinary hospital mattresses; consistently turning the patient reduces risk by roughly 70% versus standard care; and keeping the person from lying prone for long periods also helps. Check the sacrum, heels, hips, and shoulders each day; if any area shows persistent redness that doesn’t fade when pressed, contact a nurse or doctor right away. A total of 1,226 patients showed similar trends, and 116 patients demonstrated a clear increase in ulcer risk under prone positioning. + +- Benefit: Data come from 19,520 hip‑fracture patients in the U.S. NSQIP registry (2016‑2019). Those with pre‑existing pressure ulcers showed a higher 30‑day mortality rate; after adjusting for other factors, this link remained significant (OR 1.2, a 21% increase in risk, P = 0.004). They also faced higher rates of deep‑vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmissions (OR 1.43), and an average hospital stay 0.4 days longer. In a follow‑up of 324 elderly inpatients (mean age 86) over 18 months, pressure ulcers independently predicted long‑term death (HR 1.500, 95% CI 1.059‑2.126, P = 0.020). A network meta‑analysis of 65 randomized trials compared electric alternating‑pressure air mattresses with standard hospital mattresses; the former lowered ulcer incidence (RR 0.42, 95% CI 0.29‑0.63, moderate certainty). Similar benefits were seen with hybrid systems (RR 0.22, 95% CI 0.07‑0.66). A 2026 Cochrane review of 11 trials involving 4,462 patients found little difference between turning schedules of 2 hours versus 4 hours (RR 1.05, 95% CI 0.79‑1.39, very low certainty). However, using wearable sensors to enforce 2‑hour turning intervals in an ICU setting cut ulcer rates compared with usual care (RR 0.28, 95% CI 0.10‑0.75, moderate certainty). Finally, patients kept in a prone position developed ulcers far more often than those lying supine (RR 4.55, 95% CI 2.31‑8.98). + +- Evidence grade: B + +- Notes: This grade reflects three main points. First, the mortality studies showed only that patients with ulcers fared worse; they did not prove that preventing ulcers directly lowers death rates. Second, the evidence on optimal turning intervals from randomized trials is quite weak. Third, the data on air mattresses are relatively stronger, yet they compared hospital‑grade mattresses to ordinary home mattresses, so extrapolation to home use is somewhat uncertain. Daily inspection of bony areas is standard nursing practice and lacks dedicated research support. The mortality benefit is evaluated separately from cost calculations for other items in this section. Home‑based care services covered by long‑term care insurance are described in item 7. Sudden leg swelling should be treated as a possible deep‑vein thrombosis, as covered in section 13, item 11. Situations involving prolonged bed rest after falls or severe injury are discussed in section 1, item 34. +- Sources:Porter SB, Pla R, Chow JH, et al. (2022). Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients. JAAOS Global Research & Reviews, 6(11). ；Ottaviani S, Rondanina E, Longo E, 等 (2026). Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults. European Geriatric Medicine, 17(2), 665-672. ；Shi C, Dumville JC, Cullum N (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS ONE, 13(2), e0192707. ；Latimer SL, Chaboyer WP, Probst S, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. diff --git a/book/18-Is-Having-Kids-Worth-It.md b/book/18-Is-Having-Kids-Worth-It.md new file mode 100644 index 00000000..63e5c118 --- /dev/null +++ b/book/18-Is-Having-Kids-Worth-It.md @@ -0,0 +1,58 @@ +# 18. Is raising a child worth it? + +This section breaks down the financial and time costs involved. Much like Section 10, which examined the costs of marriage, we’re simply laying out the numbers here — without offering any definitive conclusions. If you’re already pregnant and need to follow the necessary steps, please refer to Section 27. +There are 18 key considerations to keep in mind when deciding whether raising a child is worthwhile. +### 1. Start by claiming what you’re entitled to: the national dibao program gives 3,600 yuan per child per year until the child turns 3. + +- Cost: Zero out-of-pocket expense. Simply apply at the local hukou office where your child is registered — one visit is all it takes. +- In plain terms: If your child was born after January 1, 2025, and is under 3 years old, you qualify for this payment. One parent or legal guardian can submit the application at the child’s hukou office. The allowance is 3,600 yuan per year per child, paid out until the child reaches age 3. No personal income tax applies to this money, and it does not count toward any dibao or similar assistance calculations. +- Benefit: As stipulated in the policy issued by the General Offices of the CPC Central Committee and the State Council, infants and toddlers born after January 1, 2025, and under 3 years of age are eligible for a yearly payment of 3,600 yuan per child. This amount is exempt from personal income tax and is excluded from calculations of household or individual income when determining eligibility for dibao or similar programs. +- Evidence grade: A +- Notes: This is a nationwide baseline benefit. Certain provinces and municipalities also offer their own local subsidies, which can be claimed alongside this national payment. Over three years, the total comes to 10,800 yuan — a modest contribution toward raising a child. Do not let this amount influence your decision about whether or not to have a child. +- Sources:中共中央办公厅、国务院办公厅 (2025). 育儿补贴制度实施方案. + +### 2. Maternity leave lasts 98 days; maternity benefits are paid by the maternity insurance fund based on the employer’s average monthly wage from the prior year. + +- Cost: There is no cost to you. Your employer handles all the paperwork — you don’t need to do anything. +- In plain terms: You’re entitled to at least 98 days of maternity leave, including up to 15 days you can take before the birth. If the delivery is difficult, you get an extra 15 days. For each additional child born, you receive another 15 days of leave. The money paid during this time is called maternity benefits and comes from the maternity insurance fund. If your employer hasn’t enrolled in this insurance, they must pay the benefits themselves. +- Benefit: The length of maternity leave is set by the State Council: “Female employees are entitled to 98 days of maternity leave, including 15 days before delivery; an extra 15 days are added for difficult deliveries; for each additional child born, an additional 15 days of leave are granted.” The payments received during this period are known as maternity benefits. For employees covered by maternity insurance, these benefits are paid by the insurance fund at the rate of the employer’s average monthly wage from the prior year. Employees not covered by insurance receive benefits from their employer at the same wage level they earned before taking leave. +- Evidence grade: A +- Notes: 98 days is the minimum standard mandated by the state. Most provincial regulations on family planning add at least 60 days of additional “reward leave” for childbirth, bringing the total to at least 158 days in most regions. The party responsible for paying wages during this reward leave varies by province. +- Sources:国务院 (2012). 女职工劳动保护特别规定（国令第 619 号，第七条、第八条）. + +### 3. Important to know: Employers cannot cut pay or fire workers due to pregnancy, childbirth, or breastfeeding + +- Cost: No cost at all +- In plain terms: During pregnancy, after giving birth, or while breastfeeding, it is illegal for employers to cut your pay or fire you. Violators face fines ranging from 1,000 to 5,000 yuan per employee. For infants under one year old, you are entitled to one hour of breastfeeding time each day, and employers cannot assign you overtime or night shifts. Instructions on how to file a claim can be found in Section 19. +- Benefit: As stipulated by the State Council, “Employers must not reduce the wages of female employees, fire them, or terminate their labor or employment contracts due to pregnancy, childbirth, or breastfeeding.” In other words, during these periods, employers cannot lower your pay, fire you, or end your contract. Mothers of infants under one year old are entitled to one hour of breastfeeding time daily, and employers must not require them to work extra hours or night shifts. Any violations result in fines of at least 1,000 yuan and up to 5,000 yuan per employee. +- Evidence grade: A +- Notes: If you are illegally fired, refer to Section 19 for steps on filing a claim. Key evidence includes any written notices or messages regarding job reassignment or pay cuts — be sure to keep these records safe. +- Sources:国务院 (2012). 女职工劳动保护特别规定（国令第 619 号，第五条、第九条、第十三条）. + +### 4. The time-cost calculation is based on “whose time is being used,” not on “how hard it is” + + +- Cost: There’s no monetary expense — only time is spent. For children under 3, that time is essentially taken up around the clock. The difficulty lies in the fact that this happens daily, not just for a few tough days. +- In plain terms: Count up all the hours spent caring for the child each day, plus every nighttime wake-up call. Then multiply that total by the hourly wage of the person doing the work. The resulting figure is usually far higher than the cost of formula and diapers. That’s why it’s best to discuss how responsibilities will be divided before having a child. +- Benefit: By converting daily childcare time and nighttime interruptions into hours, then multiplying by the caregiver’s hourly wage, you arrive at a number that typically exceeds the cost of formula and diapers. Even unpaid tasks like childcare, cooking, and nightly wake-ups should be treated the same way — converted to hours and multiplied by a wage figure to be included in the total cost. The calculation method mirrors that used in Section 10 for household chores. Having a clear division of labor agreed upon beforehand makes it easier to decide whether to have a child. +- Evidence grade: C +- Notes: The goal isn’t to produce a perfectly accurate figure. Rather, it’s to ensure both partners discuss responsibilities using the same calculation framework prior to having a child, rather than arguing about it afterward. +- Sources:作者经验，无直接文献；口径见第 10 节 + +### 5. Breaking down costs into three periods: ages 0–3, compulsory education, and post‑compulsory education + +- Cost: There’s no single fixed figure for total expenses; they vary widely depending on the city and the approach families take. The real challenge is to carefully separate the costs into these three periods instead of guessing a rough total. +- In plain terms: For ages 0–3, most spending goes toward childcare arrangements — whether parents care for the child themselves, grandparents help out, or a professional is hired. During primary and middle school, the main expenses are housing and extracurricular activities. After that, costs center on further education pathways. Since spending patterns differ so much in each phase, lumping them together yields only an intimidating overall figure. +- Benefit: The bulk of expenses in the 0–3 age range relate to childcare methods; for compulsory education, housing and after‑school programs dominate; later on, costs shift toward higher‑level schooling. Because these categories are distinct, mixing them obscures the true financial picture. +- Evidence grade: C +- Notes: First, factor in any guaranteed financial support such as parental subsidies, maternity allowances, and yibao reimbursements; then determine what additional funds are still needed. Avoid basing decisions on widely circulated online estimates like “it costs X million to raise a child,” as their calculation methods are unclear and may omit or overstate certain items. +- Sources:作者经验，无直接文献 + +### 6. Keep separate accounts for having kids for your elders, for marriage, and for old-age security + +- Cost: There’s no monetary cost — only the cost of having a sincere conversation. The real challenge is speaking openly about these topics without dodging them. +- In plain terms: Others may expect you to have children, and that can certainly be one factor to consider. Yet the time and money involved are expenses you personally bear. “Relying on kids for old-age support” deserves its own separate calculation, since it hinges on another person’s financial capacity and willingness two decades down the line. Be sure to also write down the consequences of choosing not to have kids, so you can compare both sides fairly. +- Benefit: The reasoning here mirrors that in Section 10. External expectations are valid considerations, but their associated costs must be recorded on your own ledger, not someone else’s. This is especially true for “relying on kids for old-age support,” which depends entirely on another individual’s future financial situation and willingness to help. +- Evidence grade: C +- Notes: Make sure to list both the consequences of having kids and those of not having them, then compare them side by side. Recording only one side of the equation doesn’t truly qualify as keeping accounts at all. +- Sources:作者经验，无直接文献；同类分析见第 10 节 diff --git a/book/19-Employment-And-Work-Injury.md b/book/19-Employment-And-Work-Injury.md new file mode 100644 index 00000000..921ccf7d --- /dev/null +++ b/book/19-Employment-And-Work-Injury.md @@ -0,0 +1,178 @@ +# 19. While employed, upon leaving the job, and for work‑related injuries + +This section is all about money — how it’s calculated, what paperwork you must sign, and what deadlines apply. The first three items cover payments you’re entitled to while still on the payroll. The next six items deal with situations after you leave your job. Finally, the last seven items address occupational diseases and work‑related injuries. Compensation for injuries is far higher than severance pay, and the time limits are much stricter. Unfortunately, damage caused by an occupational disease can never be fully reversed. +### 1. Overtime pay is calculated at three rates: 1.5×, 2×, and 3× the regular wage; failure to pay warrants a complaint to labor authorities, and non‑payment after the deadline incurs an additional penalty of 50%–100% of the owed amount. + + +- Cost: There is no direct cost. Simply keep copies of time‑card records, shift schedules, and overtime approval forms; also screenshot any messages from supervisors assigning work in the team chat. The challenge is remembering to do this each month. + +- In plain terms: For ordinary workdays, overtime must be paid at 1.5× the wage. On rest days, if no compensatory time off is granted, the rate rises to 2×. On statutory holidays such as New Year’s Day, Spring Festival, Labor Day, and National Day, overtime must be paid at 3× the wage, and compensatory time off is not permitted. If a company refuses to pay, workers may file a complaint with labor authorities. Should payment still be delayed after a deadline set by authorities, the employer must pay an extra penalty equal to half to one‑fold the original amount owed. + +- Benefit: Statutory limits cap normal working hours at 8 per day and 44 per week. Regular overtime should not exceed one hour daily; under special circumstances it may reach three hours per day, but the monthly total must stay under 36 hours. Overtime pay follows three tiers: 150% of the wage for ordinary days, 200% for rest‑day work without compensatory time, and 300% for statutory holiday work. The law explicitly forbids substituting compensatory time off for holiday overtime pay. Employers that fail to pay face orders to settle the debt promptly; non‑compliance triggers an additional penalty of 50%–100% of that debt. + +- Evidence grade: A + +- Notes: Rest days and statutory holidays are distinct categories; the latter comprise only a handful of nationally designated days each year. Days created through compensatory leave arrangements are treated as rest days and therefore receive the 200% rate. Statements such as “the company requires overtime approval” or “I stayed voluntarily” do not absolve employers of payment obligations, yet they can complicate evidence collection; consequently, it is vital to retain documentation of work assignments and approvals. Implementing alternative work‑time regimes such as a comprehensive‑hour calculation system or a flexible‑hour schedule requires prior authorization from labor authorities. Details on arbitration time limits appear in Section 8, Article 19. +- Sources:全国人大常委会 (2018). 劳动法（2018 年第二次修正，第三十六、四十一、四十三、四十四条）. （国家市场监督管理总局刊登）；全国人大常委会 (2007). 劳动合同法（第八十五条第三项）. + +### 2. Annual leave is calculated based on total years of service: 5, 10, or 15 days. If unused, employees receive 300% of their daily wage as compensation. + + +- Cost: There is no cost involved. Simply add up all the years you’ve worked at every employer; your social insurance records serve as proof. The main challenge is avoiding signing any form that states you “voluntarily waive annual leave.” + +- In plain terms: If your total work experience across all employers is at least 1 year but under 10 years, you’re entitled to 5 days of annual leave per year. For 10–20 years of experience, it’s 10 days; for 20+ years, it’s 15 days. These totals continue to accumulate even after changing jobs. If your employer cannot arrange leave and you agree to forgo it, you’ll receive three times your daily wage for those days. Signing a “voluntary waiver of annual leave” form means you’ll only receive your regular salary thereafter. + +- Benefit: Employees who have worked continuously for 12 months qualify for annual leave. The number of days is determined by total years of service across all employers. Specifically, 5 days apply to 1–10 years of experience, 10 days for 10–20 years, and 15 days for 20+ years. Statutory holidays and weekends do not count toward this total. If an employer genuinely cannot provide leave due to operational needs and you consent to forgoing it, you’ll receive 300% of your daily wage as compensation. This amount already includes your regular salary, so the extra payment equals 200% of your daily wage. Daily wage is calculated as monthly salary ÷ 21.75; monthly salary is the average of the previous 12 months’ earnings excluding overtime. New employees receive a pro‑rated amount based on days worked that year. Upon termination, unused leave is compensated proportionally, with no deductions for any leave already taken. Employers failing to provide leave or compensation face mandatory corrections; persistent non‑compliance results in an additional penalty equal to the original compensation amount (effective nationwide since 1 Jan 2008). + +- Evidence grade: A + +- Notes: Total years of service are cumulative across all employers, not limited to one company. Never base calculations solely on tenure at your current employer. Only when an employee “voluntarily and in writing waives leave” may the employer limit payment to regular wages; therefore, avoid signing such waivers. Employees taking 20+ days of personal leave without wage deductions also lose annual leave entitlement. Similarly, extended sick leave disqualifies workers: 2 months for under‑10‑year experience, 3 months for 10–20 years, and 4 months for 20+ years. Family‑visit leave, marriage or bereavement leave, maternity/paternity leave, and periods of work‑related injury recovery do not count toward annual leave. +- Sources:国务院 (2007). 职工带薪年休假条例（国务院令第 514 号，第二、三、四、五、七条）. ；人力资源和社会保障部 (2008). 企业职工带薪年休假实施办法（人社部令第 1 号，第三、四、五、十、十一、十二、十五条）. + +### 3. There is a legal limit on probation periods, wages must be at least 80% of the regular rate, and only one probation period may be set per employee + +- Cost: Zero expense. Spend a few minutes before signing to verify that the contract’s stated term and probation length match the legal requirements. +- In plain terms: For contracts lasting up to one year, the maximum probation period is one month. For contracts from one to three years, it is two months. For contracts exceeding three years, or open‑ended contracts, the maximum is six months. An employer may only place an employee on probation once; offering a second probation period after the employee has been regularized is illegal. During probation, wages must be no lower than the minimum wage for that position or 80% of the agreed regular wage, and they must also meet the local minimum wage standard. +- Benefit: Under the law, contracts of more than three months but under one year may have a probation period of no more than one month; those from one to three years may have a maximum of two months; and contracts of three years or longer, as well as open‑ended contracts, may have a maximum of six months. Contracts with a term defined solely by completion of a specific task, or those lasting less than three months, may not include any probation period at all. An employer may stipulate only one probation period for any given employee. If a contract mentions a probation period but does not specify its length, that period is deemed invalid and the entire contract term applies. Probation wages must be at least 80% of the lowest comparable wage within the organization or 80% of the agreed regular wage, and they must also meet the local minimum wage. Should an employer set a probation period longer than permitted by law, it must compensate the employee for the excess time at the regular monthly wage rate. Termination during probation is only permissible under specific legal circumstances, and the employer must provide a valid reason to the employee (nationwide). +- Evidence grade: A +- Notes: Three common violations occur frequently. First, a one‑year contract may contain a three‑month probation period. Second, after an employee becomes regular, the employer may attempt to impose another probation period. Third, some employers claim “no social insurance during probation,” yet the obligation to enroll begins on the first day of work, regardless of probation status; details are provided in Section 12, Item 16. Being dismissed during probation does not mean no compensation; eligibility depends on whether the dismissal meets legal criteria. Unlawful termination entitles the employee to double the regular wage as stipulated in Item 6. +- Sources:全国人大常委会 (2007). 劳动合同法（第十九、二十、二十一、八十三条）. + +### 4. Calculating N: One month’s salary per full year of service; half a month for periods under six months + +- Cost: No cost at all. Just use a calculator — it takes about ten minutes. +- In plain terms: When a layoff occurs, the employer must pay severance compensation calculated as follows: one month’s salary for each full year of service; periods of six months or more but less than a full year count as a full year; periods of less than six months result in half a month’s salary. The monthly salary figure is the average over the 12 months prior to termination, including bonuses, allowances, and other benefits. If an employee’s monthly salary exceeds three times the local average monthly wage from the previous year, the cap is set at three times that average, and the maximum eligible service period is 12 years. +- Benefit: This is the statutory severance payment mandated by labor law when an employee is laid off — commonly referred to as “N.” The calculation rules are: “One month’s salary per full year of service… for periods of six months or more but less than a full year, the period counts as a full year; for periods under six months, half a month’s salary is paid.” Monthly salaries exceeding three times the local average are capped at three times that figure, and the maximum service duration considered is 12 years. +- Evidence grade: A +- Notes: The monthly salary referenced here is the average over the 12 months preceding termination, incorporating bonuses, allowances, and other benefits — not just base pay. This is precisely where employers often attempt to undervalue compensation. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第四十七条）. + +### 5. If a company fires you without 30 days’ notice, it must pay an extra month’s salary + +- Cost: No cost at all. +- In plain terms: If a company terminates your employment without giving 30 days’ written notice, it must pay you an additional month’s salary on top of the standard compensation. This is commonly referred to as “N+1.” When negotiating, make sure this extra month is listed separately so the company doesn’t include it in the base amount “N.” +- Benefit: Under labor law, when an employer ends a contract under this provision, there are two permissible options: either provide 30 days’ written notice to the employee, or pay an extra month’s salary and then terminate the contract. If the employer wants you to leave immediately, it must pay this additional month’s wage. This extra payment is known as “notice pay” and is calculated separately from “N.” +- Evidence grade: A +- Notes: Consequently, the typical outcome of a lawful termination under these circumstances is “N+1.” During negotiations, keep the base compensation “N” and the extra month distinct to prevent the employer from bundling them together. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第四十条）. + +### 6. When a company unlawfully terminates employment, the compensation equals twice the standard severance amount + +- Cost: There is no direct cost involved. However, arbitration can take several months to resolve, and you must remain actively involved throughout this period without being able to drop the process midway. +- In plain terms: If a company unlawfully terminates an employee, the compensation payable is twice the standard severance amount — commonly referred to as “2N.” Whether termination qualifies as unlawful depends on specific circumstances. It’s advisable to seek legal aid or consult an attorney first to determine whether negotiation with the employer or pursuing arbitration is the better course of action. +- Benefit: Under labor law, employers who unlawfully terminate or end employment contracts must pay compensation equal to twice the standard severance amount outlined in Article 47 of the law. This means first calculating the standard severance figure and then doubling it for payment to the employee. +- Evidence grade: A +- Notes: This is the commonly known “2N” compensation rule. Whether termination qualifies as unlawful hinges on particular facts and conditions. Seek legal counsel first; further guidance on next steps is provided in Section 7. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第八十七条）. + +### 7. Never sign “voluntary resignation for personal reasons”; doing so forfeits your entitlements + +- Cost: No monetary cost. The difficulty lies in resisting the pressure to sign on the spot. +- In plain terms: Signing a statement that you’re resigning voluntarily for personal reasons typically means you lose both severance pay and eligibility for unemployment benefits. Voluntary resignation isn’t covered under the circumstances that entitle workers to compensation, except in cases where the employer fails to pay wages or neglects social insurance contributions. There’s no need to sign immediately — take a night to think it over. +- Benefit: The Labor Contract Law specifies exactly which circumstances qualify workers for severance pay. Voluntary resignation doesn’t meet these criteria, unless the employer has committed statutory violations such as wage arrears or non-payment of social insurance. Signing a voluntary resignation form usually results in forfeiting both severance pay and unemployment benefits. +- Evidence grade: B +- Notes: Employers often claim, “Sign this first to start the process; we’ll arrange compensation separately.” Make sure such promises are written into the agreement before signing; otherwise, refuse to sign. Failing to sign on the same day carries no legal consequences — take time to decide calmly. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第三十八条、第四十六条）. + +### 8. Save pay stubs, attendance records, employment contracts, social insurance documents, and chat logs before leaving your job + +- Cost: No expense required. It takes about half an hour to save all these documents. The tricky part is remembering to do it before you leave. +- In plain terms: Once you return your computer and work account, you won’t be able to access any of your pay stubs, attendance records, contracts, social insurance documents, or chat logs again. When filing for labor arbitration, you’ll still need these materials to prove your wage amount and whether you worked overtime. What you save are documents related to your own employment; do not take any company source code, client lists, or technical documents with you. +- Benefit: After returning your computer and account, you lose access to all these records. While arbitration proceedings may lean slightly in favor of the employer, you still need your own evidence to prove your wage level and overtime hours. +- Evidence grade: C +- Notes: Only documents related to your own employment should be saved. Do not take any company source code, client lists, or technical documentation with you; those are separate matters, as explained in Section 11. +- Sources:作者经验，无直接文献；维权路径见第 7 节 + +### 9. Two things to do right after leaving your job: register for unemployment benefits and review your non-compete agreement + +- Cost: No cost at all. +- In plain terms: Right after leaving a job, you should do two things. First, register for unemployment benefits and apply for those payments. Second, carefully read through your non-compete agreement. The clock for receiving unemployment benefits starts on the day you register; waiting even one month means you’ll get fewer months of payments. Only people who lose their jobs through no fault of their own qualify for these benefits, which is another key reason to avoid signing any paperwork stating you quit “voluntarily for personal reasons” (see Section 7). +- Benefit: There are four main requirements to qualify for unemployment benefits: you must have paid into the unemployment insurance system for at least one year, your job loss must not be due to your own choice, you must have completed the registration process, and you must still be actively looking for new work. The length of time you qualify for benefits depends on how many years you contributed: up to 12, 18, or 24 months respectively. Instructions on how to apply online are included in Section 7, Item 1. Non-compete agreements are valid for a maximum of two years, during which the employer is required to pay you monthly compensation. If the contract does not specify an exact amount, the payment is calculated as 30% of your average monthly wage over the 12 months prior to leaving your job, with a minimum floor set at the local minimum wage. You can only request to terminate the non-compete agreement if the employer fails to make these payments for three consecutive months; details on this process are in Section 11, Item 12. Unlike some other agreements, non-compete terms have a clear expiration date, and you must abide by all terms until that date arrives. +- Evidence grade: C +- Notes: This grade is assigned because there are no direct published studies confirming that registering for benefits on the day you leave work is the optimal timing; the figures listed in the source section are all direct quotes from official regulations. Unused unemployment benefits do not expire, but their eligibility period starts on the date of registration, so applying earlier means you can receive payments for more months. All required application materials and online application links are detailed in Section 7. Details on compensation calculations and termination conditions for non-compete agreements are in Section 11. Signing any paperwork stating you quit “voluntarily for personal reasons” not only disqualifies you from receiving severance pay, but also bars you from accessing unemployment benefits; this is further explained in Section 7. +- Sources:作者经验，无直接文献；引用的数字出自国务院 (1999). 失业保险条例（国务院令第 258 号，第十四、十六、十七条：「失业保险金自办理失业登记之日起计算」）. 和全国人大常委会 (2012). 劳动合同法（2012 年修正，第二十三、二十四条）. （抚顺市应急管理局转载） + +### 10. Before taking up a post where there is dust, noise, or chemicals, check whether the contract mentions any occupational hazards; the employer must arrange and pay for three occupational health examinations. + + +- Cost: No cost involved. When signing the contract, read every clause under “Disclosure of Occupational Disease Hazards” carefully. Make sure to keep a copy of each health examination report for yourself. The main difficulty lies in having to ask questions and request documents in person. + +- In plain terms: When you sign a contract, the employer must truthfully describe any occupational hazards associated with the job, how to protect yourself, and what benefits you’re entitled to — there can be no concealment or deception. If such information is omitted, you have the right to refuse the job, and the employer cannot fire you for that reason. The employer must also arrange and pay for three occupational health examinations: before starting work, during employment, and upon leaving the job. If the pre‑termination examination is not performed, the employer cannot terminate or end your contract. + +- Benefit: According to the Law on the Prevention and Control of Occupational Diseases, when drafting a labor contract the employer must disclose four key points: what occupational hazards the job may bring, what health consequences might arise, how to protect yourself, and what benefits you’ll receive. The statutory wording is “the employer shall truthfully inform the worker and include this information in the contract, without any concealment or deception.” Should the employer later assign you tasks not mentioned in the contract that involve occupational hazards, it must again provide full disclosure and negotiate any contract amendments. Failure to comply gives you the right to refuse such work, and the employer may not terminate the contract on that basis. The three required health examinations must be paid for by the employer, and you must receive a written confirmation of this expense. Workers who have not undergone the pre‑employment examination may not be assigned to hazardous duties; likewise, those with specific medical contraindications must not be placed in jobs they cannot safely perform. If any work‑related health damage is detected, the worker must be transferred to a suitable position. Importantly, “an employer may not terminate or end a labor contract with a worker who has not undergone a pre‑termination occupational health examination.” Upon leaving the job, you have the right to obtain a free, certified copy of your occupational health records; the employer must provide this promptly. These records are essential for any subsequent occupational disease diagnosis, and they must be secured before you leave. Claims related to occupational disease are treated as work‑related injuries; details can be found starting at item 12. + +- Evidence grade: A + +- Notes: During an interview, asking just three questions can help you gauge whether a company is legitimate: whether the job involves occupational hazards, whether these are mentioned in the contract, and who pays for the pre‑employment health check. If the interviewer cannot answer or suggests “just start working first,” proceed with caution. The requirement for a pre‑termination health examination is a crucial safeguard — without it, the employer cannot end your contract. This examination also serves as key evidence for any future occupational disease claim; the same applies to the health records copy you must obtain before leaving. Claims for occupational disease are handled as work‑related injuries, and the corresponding benefits are outlined from item 12 onward. +- Sources:全国人大常委会 (2018). 职业病防治法（2018 年修正，第三十三、三十五、三十六条）. （北京市人民政府转载） + +### 11. Damage caused by dust, noise, and chemical toxins is irreversible: employers must provide protective gear, and workers can refuse unsafe tasks + + +- Cost: No monetary cost. The real challenge is consistently wearing respirators, earplugs, and safety goggles, as well as refusing to perform tasks lacking adequate protection — this may lead coworkers to label you as “too picky.” + +- In plain terms: Pneumoconiosis, noise-induced hearing loss, and chemical eye burns are all listed as statutory occupational diseases. Once lung tissue or hearing is damaged, there is no treatment capable of restoring it. You have the right to know exactly what hazards exist at your workplace and to demand that your employer supply protective equipment and facilities. You may refuse any job that fails to provide these safeguards. Any attempt by your employer to cut your pay or terminate your contract in retaliation for exercising these rights is legally invalid. + +- Benefit: As of August 1, 2025, the official list of occupational diseases comprises 12 main categories containing 135 distinct conditions, including four open-ended clauses. Pneumoconiosis ranks first among them, covering silicosis, coal worker’s pneumoconiosis, graphite pneumoconiosis, carbon black pneumoconiosis, asbestosis, talc pneumoconiosis, cement pneumoconiosis, mica pneumoconiosis, potter’s pneumoconiosis, aluminum pneumoconiosis, welder’s pneumoconiosis, and foundry worker’s pneumoconiosis, plus one additional open clause. Noise-induced hearing loss and blast-induced hearing loss fall under occupational ear, nose, throat, and oral diseases; chemical eye burns and photic keratitis are listed under occupational eye diseases. All these injuries are permanent — once damaged, lungs and hearing cannot be repaired. Four fundamental rights are legally guaranteed: first, the right to be informed about all occupational hazards present, their potential consequences, and required protective measures; second, the right to demand provision of compliant protective equipment and improved working conditions; third, the right to report, criticize, or file complaints against any violations of occupational health laws or practices endangering health; fourth, the right to refuse any directive ordering work without proper protective measures. Furthermore, any employer action — such as wage cuts, benefit reductions, or contract termination — taken solely because a worker exercised these lawful rights is legally void nationwide. + +- Evidence grade: A + +- Notes: Ensure you use respirators specifically rated for particulate filtration; ordinary gauze masks or disposable surgical masks offer no protection against dust. If your employer does not supply earplugs for noisy environments, purchasing them yourself is advisable, as hearing loss cannot be reversed. The belief that “working just two years to save money is safe” does not apply to pneumoconiosis — silicosis can manifest years after exposure ends and may worsen over time, making off-duty health checks essential (see item 10, which mandates three free occupational health examinations paid for by employers). The updated list also includes two new categories: occupational musculoskeletal disorders, specifically carpal tunnel syndrome affecting manufacturing workers performing repetitive wrist motions; and occupational mental and behavioral disorders, specifically post-traumatic stress disorder affecting police officers, medical personnel, and emergency responders involved in crisis response. Immediate first-aid measures for chemical splashes onto skin are detailed in item 13, clause 21. +- Sources:国家卫生健康委、人力资源社会保障部、国家疾控局、全国总工会 (2024). 职业病分类和目录（2025 年 8 月 1 日起实施）. ；新版目录 12 大类 135 种的口径见国家卫生健康委 (2024). 新版目录将职业病调整为 12 大类 135 种. ；全国人大常委会 (2018). 职业病防治法（第三十九条）. （北京市人民政府转载） + +### 12. If you’re injured at work or hit while commuting, the first step is to get a work‑injury determination; if your employer won’t file it, you must do it yourself. + + +- Cost: There is no cost — just a trip to the social insurance authority. You’ll need three documents: a work‑injury determination application form, proof of employment, and a medical diagnosis certificate. +- In plain terms: Injuries that happen at work are considered work‑related injuries. Being hit while commuting — provided you bear no significant fault — also qualifies as a work‑injury. Without a formal work‑injury determination, however, you won’t receive medical coverage, wage replacement during recovery, or disability benefits. Employers must file the application within 30 days; if they fail to do so, you, your family, or a labor union may file it within one year. +- Benefit: Without a work‑injury determination, all related benefits disappear: medical care, wage continuation while you recover, and disability payments. If an employer misses the 30‑day deadline, it must pay all required benefits out of its own funds. +- Evidence grade: A +- Notes: The one‑year deadline is absolute — after that you can’t apply. The burden of proof rests with the employer: if it denies that an injury is work‑related, it must provide evidence to the contrary. Still, you should keep your own records — photos from the scene, coworkers’ contact info, medical records, and attendance logs. Article 16 lists three situations where injuries are not considered work‑related: intentional criminal acts, intoxication or drug use, and self‑inflicted harm or suicide. Article 15 also defines “deemed work‑injuries”: death from a sudden illness at work or within 48 hours after unsuccessful emergency treatment. +- Sources:国务院 (2010 修订). 工伤保险条例（国务院令第 586 号）第十四条列了七种「应当认定为工伤」，含「（六）在上下班途中，受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的」；第十七条「所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向统筹地区社会保险行政部门提出工伤认定申请」「用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位所在地统筹地区社会保险行政部门提出工伤认定申请」「用人单位未在本条第一款规定的时限内提交工伤认定申请，在此期间发生符合本条例规定的工伤待遇等有关费用由该用人单位负担」；第十九条「职工或者其近亲属认为是工伤，用人单位不认为是工伤的，由用人单位承担举证责任」；第二十条「自受理工伤认定申请之日起60日内作出工伤认定的决定」. + +### 13. Don’t believe the myth that “staying at work counts as a workplace injury”: if you suddenly feel unwell, call 120 first — don’t rush to clock in. + +- Cost: No cost at all. +- In plain terms: Hurrying to the office when you suddenly feel unwell won’t earn you any extra compensation. To be classified as a workplace injury, the incident must occur during working hours and at the workplace; if it happens on the way to work before you even arrive, it doesn’t qualify. Cases where medical treatment is delayed past 48 hours also don’t count. Those few extra minutes spent trying to meet the criteria can actually lower your chances of survival. +- Benefit: This rule states that a worker must suffer a sudden illness during working hours at their workplace, and then die within 48 hours despite medical efforts, to be deemed a workplace injury. Delaying medical care just to meet these conditions means sacrificing your own chance of survival for compensation that you might not even receive. +- Evidence grade: A +- Notes: Both conditions must be met: the illness must occur during working hours and at the workplace. It does not apply if the illness strikes on the way to work before reaching the office. If a worker falls ill at work, is taken home or to hospital, and dies within 48 hours despite treatment, this rule may still apply. What matters most is where the person was at the moment of illness, not where they ultimately die. Some short videos wrongly claim that “staying at work guarantees compensation”; in reality, those crucial first few minutes after falling ill — when prompt medical care is sought — are what truly determine the outcome. Additionally, the 48‑hour limit is strict: any case where treatment is delayed beyond this period does not qualify. +- Sources:工伤保险条例第十五条第一款第（一）项：「在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡的」视同工伤；第十四条第（六）项只把上下班途中「受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的」列为工伤，途中突发疾病不在其中. + +### 14. Even if the employer fails to enroll you in workers’ compensation insurance, you still qualify for full benefits paid entirely by the employer at the same rates + + +- Cost: There’s no direct cost to you. However, if the employer refuses to comply, you’ll need to pursue arbitration or even litigation, which can take several months. The difficulty lies in having to stay actively involved throughout this lengthy process. +- In plain terms: Even if your employer does not enroll you in workers’ compensation insurance, you are still entitled to all related benefits. Those benefits must then be paid in full by the employer, using the same coverage items and payment standards as if insurance had been purchased. Failure to enroll is penalized: the employer must retroactively pay premiums plus a daily late fee of 0.05%, and may face fines equal to 1–3 times the unpaid amount. The claim “the company can’t compensate you because it didn’t buy insurance” is simply untrue. +- Benefit: Statutory rules clearly state that when an employer neglects to enroll an employee in workers’ compensation insurance, any resulting workplace injuries must be compensated by that employer itself, using identical coverage items and payment amounts mandated by law. In other words, the employer bears the entire financial burden without exception. +- Evidence grade: A +- Notes: “The company can’t pay compensation because it didn’t purchase workers’ compensation insurance” is one of the most common false statements encountered in such cases. While non‑enrollment brings penalties for the employer, it does not reduce your right to receive full compensation. +- Sources:工伤保险条例第六十二条第二款：「依照本条例规定应当参加工伤保险而未参加工伤保险的用人单位职工发生工伤的，由该用人单位按照本条例规定的工伤保险待遇项目和标准支付费用。」同条第一款：责令限期参加、补缴，「自欠缴之日起，按日加收万分之五的滞纳金；逾期仍不缴纳的，处欠缴数额1倍以上3倍以下的罚款」. + +### 15. After injuries stabilize, undergo a work capacity assessment; disability grades translate directly into compensation + + +- Cost: There is no monetary cost. However, completing the work capacity assessment process takes some time. +- In plain terms: Once injuries have stabilized, a work capacity assessment can be done, and the resulting disability grade translates directly into compensation. One-time disability benefits are calculated based on the individual’s own salary: Grade 5 equals 18 months’ salary, Grade 6 equals 16 months’, Grade 7 equals 13 months’, Grade 8 equals 11 months’, Grade 9 equals 9 months’, and Grade 10 equals 7 months’. Before the assessment results are finalized, do not sign any “one-time settlement” agreements. +- Benefit: One-time disability benefits are paid out as a lump sum, calculated based on the individual’s own salary and their disability grade. For Grade 5, this equals 18 months’ salary; for Grade 6, 16 months’; for Grade 7, 13 months’; for Grade 8, 11 months’; for Grade 9, 9 months’; and for Grade 10, 7 months’. +- Evidence grade: A +- Notes: Workers with Grades 5 and 6 retain their employment status and continue to receive disability allowances each month from their employer. For those with Grades 7 through 10, upon contract expiration or voluntary termination, two additional payments apply: a one-time work injury medical allowance paid by the fund, and a one-time disability employment allowance paid by the employer; exact amounts are set by provincial regulations. Before the assessment results are finalized, do not sign any “one-time settlement” agreements. +- Sources:工伤保险条例第二十一条「经治疗伤情相对稳定后存在残疾、影响劳动能力的，应当进行劳动能力鉴定」；第二十二条「劳动功能障碍分为十个伤残等级，最重的为一级，最轻的为十级」；第三十六条五、六级待遇（一次性伤残补助金 18/16 个月本人工资，按月伤残津贴为本人工资的 70%/60%）；第三十七条七至十级待遇（13/11/9/7 个月本人工资）. + +### 16. Three types of compensation for work-related deaths: funeral allowance, survivor’s pension, and one-time death benefit + +- Cost: No cost involved; only a set of administrative procedures are required. +- In plain terms: There are three distinct compensation amounts for workers who die on the job — don’t confuse them or focus on just one. The funeral allowance equals six months of the average monthly wage of local workers from the previous year. The survivor’s pension is paid monthly based on the deceased worker’s own wage: 40% goes to the spouse, while each other dependent relative receives 30% per month. The one-time death benefit is fixed at 20 times the per capita disposable income of urban residents nationwide in the prior year — this amount is identical across all regions. +- Benefit: Three separate payments are provided for work-related deaths. First, the funeral allowance equals six months of the average monthly wage of workers in the relevant insurance region from the previous year. Second, the survivor’s pension is paid monthly at a rate tied to the deceased worker’s wage: 40% of that amount goes to the spouse, and 30% is allocated to each other dependent relative each month. Third, the one-time death benefit is set at 20 times the per capita disposable income of urban residents nationwide in the prior year; this figure is uniform across all regions, with no regional variations. +- Evidence grade: A +- Notes: TODO (pending verification: the exact amount for the current year calculated using 2025 per capita disposable income data for urban residents nationwide has not been obtained from the official National Bureau of Statistics documents). The one-time death benefit is standardized nationwide. Claims that “local regional standards are lower” are not accepted when negotiating compensation amounts. +- Sources:工伤保险条例第三十九条：「（一）丧葬补助金为6个月的统筹地区上年度职工月平均工资；（二）供养亲属抚恤金按照职工本人工资的一定比例发给由因工死亡职工生前提供主要生活来源、无劳动能力的亲属。标准为：配偶每月40%，其他亲属每人每月30%，孤寡老人或者孤儿每人每月在上述标准的基础上增加10%……（三）一次性工亡补助金标准为上一年度全国城镇居民人均可支配收入的20倍。」. + +### 17. If you’ve been bullied, insulted, or mistreated at work for a long time, don’t just endure it: document everything as evidence, then take action based on the nature of the abuse. + +- Cost: There’s no monetary cost. However, it does take time to record details such as dates, witnesses, exact quotes from the abuser, and to keep original screenshots and emails. Legal proceedings like arbitration or lawsuits can last several months. Changing jobs is the most costly option; you must weigh these factors yourself. +- In plain terms: Employees who experience workplace bullying have a roughly 60% higher risk of developing heart disease or having a stroke, and this risk rises with the severity of the bullying. After several years, they are also about twice as likely to entertain suicidal thoughts compared to their peers. Being constantly insulted and mistreated is far from a minor inconvenience that can simply be “tolerated.” +- Benefit: From a health perspective: three Swedish and Danish cohorts comprising 79,201 working adults aged 18–65 were studied over an average of 12.4 years. At baseline, none had cardiovascular disease; 9% reported having experienced workplace bullying in the previous year. Those who endured bullying faced a 59% higher risk of developing cardiovascular disease (coronary heart disease or cerebrovascular disease; HR 1.59, 95% CI 1.28–1.98). Individuals subjected to workplace violence faced a 25% higher risk (HR 1.25, 95% CI 1.12–1.40); both risks increased with the frequency of abuse. A Norwegian nationwide survey of 1,846 workers, followed over three rounds of testing spaced two to three years apart, found that bullied individuals were roughly twice as likely to develop suicidal thoughts (OR 2.05, 95% CI 1.08–3.89). Conversely, people with prior suicidal thoughts did not later become more prone to bullying. From a legal standpoint: China currently lacks specific legislation addressing “workplace bullying”; actions must be evaluated against existing laws. Employers found guilty of insults, corporal punishment, physical assault, unlawful searches, or unlawful detention of workers face administrative penalties and must compensate for any harm; criminal acts incur further legal consequences. If an employer uses violence or threats to compel work, employees may terminate their contracts immediately without notice and are entitled to financial compensation. Employers must also implement measures to prevent and curb sexual harassment by leveraging authority or hierarchical relationships; victims may seek civil redress from harassers. Labor arbitration cases are resolved within 45 days of acceptance, with a possible extension of 15 days for complex cases. +- Evidence grade: B +- Notes: This grade is assigned because the health data derive from observational studies rather than randomized controlled trials, and “bullying” was self-reported by participants. This guidance does not advocate quitting a job at the first sign of mistreatment; the personal cost of changing jobs must be considered. Four practical steps can be taken: first, begin documenting incidents immediately; refer to Section 8, Item 41 for guidance on recording audio evidence. Second, submit written complaints through official internal channels and retain proof of such submissions. Third, if physical assault, unlawful confinement, or public humiliation occurs, contact law enforcement. Fourth, if forced to leave due to unpaid wages or lack of social insurance contributions, follow Section 7 (“Do not voluntarily resign”) and Section 8 (“Preserve evidence prior to leaving”) of this chapter. For details on calculating compensation, see Section 4 (“Calculate your entitlements after layoffs”). Mere neglect, exclusion, or minor mistreatment rarely violate any specific statutes; in such cases, internal complaints, job transfers, or changing employers are the primary remedies. Arbitration proceedings may take up to 60 days, while civil lawsuits typically require at least six months; legal fees must be borne by the plaintiff. If the situation becomes unbearable, call 12356 as outlined in Section 1, Item 25. +- Sources:Xu T 等 (2019). Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. European Heart Journal. ；Nielsen MB, Nielsen GH, Notelaers G, Einarsen S (2015). Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study. American Journal of Public Health. ；全国人大常委会 (2007). 劳动合同法（第三十八条第二款、第四十六条、第八十八条）. ；全国人大 (2020). 民法典（第一千零一十条）. 最高人民检察院转载全文 ；全国人大常委会 (2022 年修订). 妇女权益保障法（第二十五条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（第四十三条）. 安康市人社局转载全文 diff --git a/book/20-Newborn.md b/book/20-Newborn.md new file mode 100644 index 00000000..21e1016c --- /dev/null +++ b/book/20-Newborn.md @@ -0,0 +1,118 @@ +# 20. How to care for a newborn baby + +This section focuses on two main topics: what it takes to keep a newborn alive and how much it will cost you. Only differences that are substantial and backed by solid evidence are included here. Detailed advice on soothing or raising a baby is beyond the scope of this book. For tasks to handle before birth and on the day of discharge, please refer to Section 27. +### 1. Keep infants sleeping on their backs on a firm surface; share a room but not a bed; and do not place any soft items in the crib or bed. + +- Cost: This costs nothing upfront. However, you’ll need to replace the mattress with a firm one, which may cost several hundred yuan. The real challenge is resisting pressure from older relatives to deviate from this rule. +- In plain terms: Always place babies on their backs to sleep on a hard, flat surface. Parents and infants should share a room, but not the same bed. Never put pillows, blankets, bed rails, stuffed animals, or special shaped pillows in the sleeping area. Inclined cribs or baby chairs are only meant for sitting — they must never be used as a sleeping surface. In the United States alone, roughly 3,500 infants die each year from sleep-related causes. +- Benefit: Each year, nearly 3,500 infants in the U.S. lose their lives to sleep-related issues, including sudden infant death syndrome, deaths of unknown cause, and accidental suffocation in bedding. The American Academy of Pediatrics recommends a safe sleep environment consisting of: infants sleeping on their backs; using a solid, non-inclined sleeping surface; sharing a room without sharing a bed; and avoiding soft bedding and overheating. Additional protective measures include breastfeeding, keeping infants away from nicotine and alcohol, ensuring all vaccinations are up to date, and offering a pacifier during sleep. +- Evidence grade: A +- Notes: “Do not place any soft items in the bed” means absolutely no pillows, blankets, bed rails, stuffed toys, or shaped pillows — even nursing pillows that appear perfectly safe are prohibited. Inclined cribs and baby chairs must never be used as sleeping areas. This requirement represents the biggest departure from common practice in this section, and it often requires the strongest resistance to family pressure. +- Sources:Moon RY, Carlin RF, Hand I, Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn (2022). Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics, 150(1), e2022057990. + +### 2. Administer the first dose of hepatitis B vaccine within 24 hours after birth + +- Cost: No cost at all. The hepatitis B vaccine is part of the routine immunization program, so it is provided free of charge. It is given to newborns in the hospital on the day of birth; no extra trips are needed. +- In plain terms: The first dose of hepatitis B vaccine must be given to a newborn within 24 hours after birth. Roughly 95% of infants and toddlers who contract hepatitis B go on to develop chronic hepatitis. In contrast, the vast majority of adults who get infected recover on their own without medical intervention. Hence, the earlier this vaccine is administered, the greater its protective benefit. If the mother tests positive for hepatitis B surface antigen, the infant also needs to receive an injection of hepatitis B immunoglobulin at the same time. +- Benefit: The World Health Organization states: “All infants should receive the hepatitis B vaccine as early as possible after birth, ideally within 24 hours.” The rationale behind this recommendation is that “about 95% of infections in infants and toddlers progress to chronic hepatitis.” Most adults who contract the virus also recover spontaneously, meaning they do not require any treatment to get better. +- Evidence grade: A +- Notes: If the mother tests positive for hepatitis B surface antigen, the newborn must receive an injection of hepatitis B immunoglobulin right after birth. This fact must be clarified during prenatal checkups; do not wait until after delivery to ask about it. Details on screening requirements for mothers can be found in Section 1. +- Sources:World Health Organization. Hepatitis B fact sheet. + +### 3. Ensure your child receives all vaccines in the national immunization schedule at no cost; missed doses can be added later + + +- Cost: Absolutely free. Laws explicitly state that vaccination centers may not charge any fees for administering vaccines on the national schedule. You’ll need to visit the clinic several times according to your child’s age. Be sure to keep the vaccination record safe and never lose it. + +- In plain terms: All vaccines included in the national immunization schedule are completely free — clinics cannot charge a single cent. Both daycare centers and schools require proof of vaccination, so any missed doses will definitely be noticed and must be made up later. You only need to receive the remaining doses; there’s no need to restart the entire series from the beginning. Even if a different manufacturer produces the same vaccine, it can still be used. Conditions such as eczema, hives, allergic rhinitis, asthma, and even neonatal jaundice do not prevent vaccination, provided the condition remains stable. + +- Benefit: Daycare centers and schools must verify that children have received all required vaccines on schedule. If any gaps are found, they must inform vaccination centers so guardians can be urged to complete the missing doses. Thus, missing vaccines cannot be ignored — they must be addressed before school entry. The current guidelines date to 2026. Human papillomavirus (HPV) vaccine is now part of the national schedule. The starting age for DTaP vaccination has been lowered from 3 months to 2 months; a total of five doses are required at 2, 4, 6 months, 18 months, and age 6. Starting March 2026, children in Tibet, Qinghai, Xinjiang, and the Xinjiang Production and Construction Corps will also routinely receive Japanese encephalitis vaccine. Multiple vaccines may be administered on the same day per current protocols, provided they are injected into separate sites; mixing different vaccines into one syringe is strictly prohibited. For inactivated vaccines, oral live vaccines, and other types, no minimum interval is required between doses. For children under 18, the rule is to catch up as soon as possible — only the missing doses must be given, not the whole series from scratch. Switching manufacturers poses no problem. (National guidelines, 2026 edition) + +- Evidence grade: A + +- Notes: A common misconception is that children with weaker health should delay vaccination. In reality, having an “allergic constitution,” a family history of allergies, or prior food or drug allergies does not constitute a barrier to vaccination. Conditions such as atopic dermatitis (eczema), hives, allergic rhinitis, and bronchial asthma can all be managed safely provided they remain under control. Children taking antihistamines or inhaled corticosteroids may also be vaccinated. Physiological or breast milk–related neonatal jaundice poses no issue either. The only true contraindications are prior occurrence of acute severe allergic reactions to a specific vaccine or known hypersensitivity to any component of that vaccine. Children with immune deficiencies, undergoing chemotherapy or radiotherapy, or on immunosuppressive therapy require individualized assessment by a medical professional prior to vaccination. For details on the first dose of hepatitis B vaccine, refer to section 2. Non‑schedule vaccines sold at additional cost are unrelated to this free program. +- Sources:全国人大常委会 (2019). 疫苗管理法（第四十八、四十九条）. （云南省卫生健康委员会转载）；国家疾病预防控制局、国家卫生健康委 (2026). 《国家免疫规划疫苗儿童免疫程序及说明（2026 年版）》解读问答. + +### 4. Breastfeed exclusively for the first 6 months — no water needed; introduce solids at 6 months while continuing breastfeeding + +- Cost: This costs nothing; it even saves money compared to formula. The main “cost” is time — breastfeeding takes up a lot of daily effort. The real challenge is maintaining this routine; breastfeeding must continue without interruption during the first 6 months. +- In plain terms: Breastfeeding should begin within the first hour after birth. For the first 6 months, infants only need breast milk — no water or other fluids are required. At 6 months, solid foods can be introduced, while breastfeeding should be continued until age 2 or beyond. These solid foods must include iron-rich animal-based products. If breast milk is insufficient or unavailable, formula is a perfectly acceptable alternative — there is no need to feel guilty. The choice between breast milk and formula has far less impact on a child’s survival than ensuring they sleep on their back. +- Benefit: The World Health Organization recommends initiating breastfeeding within the first hour after birth. It also advises exclusive breastfeeding for the first 6 months — meaning no other foods or liquids, not even water — followed by the gradual introduction of safe, adequate solid foods while continuing breastfeeding until at least age 2. The national Health Commission’s guidelines likewise promote exclusive breastfeeding from birth to 6 months, and further stipulate that solid foods given after 6 months must contain iron-rich animal products. +- Evidence grade: A +- Notes: If breast milk is insufficient or not an option, formula is a perfectly acceptable substitute — there is no need for guilt. The difference between breastfeeding and formula feeding is far smaller than the impact of ensuring safe sleeping practices. As for frequency of solid food intake: infants aged 6–8 months should consume solids 1–2 times daily, while those aged 9–12 months should have 2–3 servings per day. Their daily diet must include at least four of the seven essential food groups. For infants with severe eczema or egg allergies, the question of whether to avoid peanuts is addressed in Section 12 of this chapter — the answer is: there is no need to avoid peanuts. +- Sources:World Health Organization. Breastfeeding. ；国家卫生健康委办公厅 (2024). 婴幼儿营养喂养评估服务指南（试行）（国卫办妇幼函〔2024〕452 号）. + +### 5. Use water hotter than 70 °C to prepare formula, then let it cool before feeding; discard any leftovers. + +- Cost: No monetary cost. It only requires a few extra minutes of waiting for the milk to cool. The difficulty lies in the fact that even when a baby is crying from hunger, caregivers must still wait for the water temperature to drop before mixing the formula. +- In plain terms: Formula milk is not sterile and may contain a bacterium called Cronobacter sakazakii. Once newborns are infected, reported mortality rates range from 40% to 80%. To minimize this risk, first pour hot water into the feeding bottle, then wait until the temperature drops to around 73.8 °C before adding the formula. At this point, the milk remains above 70 °C, which can reduce the amount of this bacterium to less than one ten-thousandth of its original level. After preparation, let the milk cool completely before feeding, and discard any portions that are not consumed. +- Benefit: Formula milk is not sterile and may harbor Cronobacter sakazakii. Reported mortality rates among newborns infected with this bacterium fall between 40% and 80%. Experimental studies show that when hot water is first added to the bottle and the temperature is allowed to drop to roughly 73.8 °C prior to adding formula, the milk temperature stays above 70 °C in most cases. This process reduces the concentration of Cronobacter sakazakii by more than 5 logarithmic units, effectively bringing it down to under one ten-thousandth of its original amount. +- Evidence grade: A +- Notes: The 70 °C threshold is specified in public health guidelines. Beary et al. explicitly state: “Public health guidelines for caregivers of high-risk infants recommend using water heated to at least 70 °C (158 °F) to prepare infant formula, in order to inactivate harmful microorganisms.” Premature infants, those with low birth weight, and babies under 2 months of age are at the highest risk of infection. Never use water that has been stored in a thermos for a full day to prepare formula, and do not leave prepared milk at room temperature for later use. +- Sources:Beary MA, Daly SE, Baker J, Snyder AB (2025). Assessing Hot Water Reconstitution Instructions and Labeling of Powdered Infant Formula to Ensure Cronobacter spp. Reduction. Journal of Food Protection, 88(9), 100571. ；Sima WG, Legesse T, Girma S, et al. (2025). Emerging microbial risks: Cronobacter sakazakii in powdered infant formula for infants under six months of age in Ethiopia. BMC Microbiology, 26, 307. ；World Health Organization & FAO (2007). Safe preparation, storage and handling of powdered infant formula: guidelines. + +### 6. Do not feed honey to children under 1 year old + +- Cost: No cost involved +- In plain terms: Never give honey to babies under 1 year of age. This includes honey water, honey mixed into baby food, and any baked goods containing honey. Honey can contain bacteria that cause botulism. An adult’s gut microbiome is able to keep these bacteria in check, but a baby’s cannot. The same rule applies to homemade pickled foods and fermented products. +- Benefit: According to the Chinese CDC, “Do not feed honey to children under 1 year of age” because “honey may contain bacteria that cause botulism.” An adult’s gut microbiome can suppress these bacterial spores — the dormant form of the bacteria — while a baby’s cannot. +- Evidence grade: A +- Notes: Foods and drinks to avoid include honey water, honey mixed into baby food, and any pastries containing honey. Likewise, homemade pickled foods and fermented products should not be given to infants. +- Sources:US CDC. Preventing Botulism. + +### 7. Vitamin K injection at birth is essential + + +- Cost: 0 to several dozen yuan. This cost is usually already included in the overall hospital delivery fee, so no extra payment is required. +- In plain terms: Newborns naturally have very little vitamin K stored in their bodies. Without supplementation, it can lead to vitamin K deficiency bleeding; the delayed form often manifests as bleeding inside the brain. In regions where this injection isn’t routinely given, the incidence of such bleeding is about 478 cases per 100,000 newborns. Administering the injection is estimated to reduce this rate by over 78%. In China, all reputable hospitals routinely provide this injection during delivery. For home births or births at unregulated facilities, parents should proactively ask whether it was given. +- Benefit: Newborns possess minimal vitamin K reserves. Failure to supplement may result in vitamin K deficiency bleeding, with the delayed type frequently presenting as intracranial hemorrhage. Belgian medical guidelines recommend a single intramuscular injection of 1–2 mg of vitamin K at birth. In areas lacking systematic prevention programs, the incidence of vitamin K deficiency bleeding is 478 cases per 100,000 newborns, based on data from 42,000 infants in Tashkent. The authors estimate that such preventive measures can lower the incidence by more than 78.5%. +- Evidence grade: B +- Notes: In reputable Chinese hospitals, this injection is administered routinely, so parents need not worry about it. However, for home births or births at unlicensed facilities, it’s crucial to confirm whether the injection was given. Oral administration is less effective than intramuscular injection. +- Sources:Fiesack S, Smits A, Rayyan M, et al. (2021). Nutrients, 13(11), 4109. ；Tursunov D, Yoshida Y, Yrysov K, et al. (2018). Nagoya Journal of Medical Science, 80(1), 11. + +### 8. Infants under 3 months with a body temperature of 38°C should be taken straight to the hospital — no home observation needed + +- Cost: Registration and tests cost several hundred yuan. +- In plain terms: Infants under 3 months of age with a body temperature of 38°C must be taken to the hospital right away. Do not wait at home, and do not give them fever reducers first to see if symptoms improve. Even if an infant at this age has a serious bacterial infection, fever may be the only symptom they show. Therefore, the fact that a baby seems alert and in good spirits is not a valid reason to keep them at home. For infants under 8 days old, there are no relevant medical guidelines at all, so they must be seen by a doctor immediately. +- Benefit: The American Academy of Pediatrics has issued specific guidelines for full-term infants aged 8 to 60 days who appear to be in decent health. These guidelines define fever as a body temperature of 38.0°C or higher. They further divide this age group into three subgroups — 8 to 21 days, 22 to 28 days, and 29 to 60 days — each with its own recommended course of action. Infants under 8 days old are not covered by these guidelines at all, which makes it even more imperative to seek medical care right away at this stage. +- Evidence grade: A +- Notes: Infants at this age can have serious bacterial infections that only manifest as fever. So, the fact that a baby seems alert and in good spirits is not a valid reason to keep them at home. Do not give them fever reducers first and then wait to see if symptoms improve. +- Sources:Pantell RH, Roberts KB, Adams WG, et al. (2021). Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics, 148(2), e2021052228. + +### 9. No matter how tired or angry you are, never shake a baby + + +- Cost: There is no monetary cost. The real difficulty lies in resisting the urge to shake a baby when you’re exhausted or upset. +- In plain terms: A baby’s head makes up a large proportion of their body size, yet their neck muscles are still very weak. Shaking them forcefully can cause bleeding inside the brain and eyes, potentially leading to death or lifelong disabilities. Gentle rocking while trying to soothe them is not dangerous; the real risk comes from uncontrolled, violent shaking. When you feel yourself losing control, place the baby back in their crib and step away for a few minutes. Letting them cry for a short while is far safer than holding them and shaking them. +- Benefit: Because a baby’s head is proportionally large and their neck muscles are underdeveloped, violent shaking can result in intracranial and retinal hemorrhage — bleeding in both the brain and eyes. This can be fatal or leave lasting impairments. Such harm is distinct from any gentle rocking used to calm them. Medically, injuries caused by shaking or impact are termed “abusive head trauma.” This condition is the leading cause of death from head injuries among children under 2 years old. In the United States between 1999 and 2014, it accounted for nearly 2,250 deaths of children under 5. +- Evidence grade: B +- Notes: When you truly feel you’re about to lose control, the safest action is to return the baby to their crib and leave the room for a few minutes. Allowing them to cry briefly is much safer than holding them and shaking them. This advice is especially vital for parents who care for their children alone and often suffer from sleep deprivation. For guidance on managing your own emotions, please refer to Section 3. +- Sources:Spies EL, Klevens J (2016). Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. MMWR 65(20):505-509. ；Choudhary AK 等 (2018). Consensus statement on abusive head trauma in infants and young children. Pediatric Radiology 48(8):1048-1065. + +### 10. Diaper selection depends on three factors: fit, how often you change them, and whether they’ve been flagged in quality inspections + +- Cost: Prices range from a few hundred to over a thousand yuan per month, depending on the brand and quality level you choose. The total monthly cost falls between 200 and 300 yuan on average. +- In plain terms: No government agency has ever published an official ranking of “which diaper brand is best.” The only verifiable information comes from two sources: product quality inspection reports issued by the State Administration for Market Regulation, and official investigations into specific incidents. A higher price tag does not guarantee safety, nor does being an imported product guarantee compliance with standards. Start by purchasing a small pack and trying it for a week; watch for signs of skin irritation or red marks on your baby’s skin. If they seem comfortable, you can then buy in bulk. +- Benefit: Since no official body has released any “best brand” rankings, this guide does not recommend any specific brands. The only reliable data available falls into two categories: first, inspection reports on product quality released by the State Administration for Market Regulation; second, official investigations into particular cases. Following public concern in June 2026 over formaldehyde levels in infant diapers, the Administration led a joint task force to conduct further checks. +- Evidence grade: C +- Notes: TODO: Need to verify the final conclusions of that investigation as well as the full text of the official inspection report from the State Administration for Market Regulation. In practice, higher cost does not equal greater safety, and imported products are not automatically compliant. Begin with a small trial pack to check for skin reactions or discomfort; remember that diaper rash is primarily caused by infrequent changes and poor breathability, rather than brand choice. Instructions on how to access inspection reports are provided in Section 5. +- Sources:中国政府网 (2026-06-22). 市场监管总局牵头成立联合调查组核查「婴幼儿纸尿裤甲酰胺问题」. （该页仅有标题，正文未展示，故本条只引用调查这一事实，不引用任何结论） + +### 11. Consider buying big-ticket items in the order “borrow, buy used, buy new” — don’t buy them all at once + +- Cost: No extra money is needed; the amount saved is usually in the thousands of yuan. The hard part is resisting the urge to buy everything at once. +- In plain terms: Strollers, cribs, blankets, and toys are used for only a short time, and there’s plenty of them on the used market with few buyers. First, try to borrow them; if that’s not possible, buy used; only then should you consider buying new — this usually saves you thousands of yuan. However, it’s not advisable to buy used car seats or mattresses, since any structural damage from prior crashes isn’t visible to the naked eye. Things like postpartum care centers and early-education classes are optional big expenses; wait at least 24 hours before deciding. +- Benefit: Strollers, cribs, blankets, and toys are all used for only a brief period, and the used market offers far more of them than there’s demand for. The only two items you really shouldn’t try to save money on — or buy used — are car seats and mattresses. Any structural damage to a car seat after a crash simply can’t be seen by looking at it. +- Evidence grade: C +- Notes: This book neither recommends nor discourages postpartum care centers, early-education classes, or baby swimming classes. Still, they’re all optional big expenses, so the 24-hour cooling-off period described in Section 5 applies to them. +- Sources:作者经验，无直接文献；安全座椅的证据见第 1 节，冲动消费见第 5 节 + +### 12. For children with severe eczema or egg allergy, don’t avoid peanuts — introduce them early under medical guidance, but never feed whole peanuts. + + +- Cost: A jar of peanut butter costs just a few dozen yuan. Feeding it a few times a week is easy to fit into a routine. Before starting, though, a doctor’s evaluation is required. +- In plain terms: In a randomized trial of 640 high‑risk infants, those who ate peanuts regularly from 4 to 11 months of age had a peanut allergy rate of only 1.9% by age 5, compared with 13.7% in the group that completely avoided peanuts. Among children already showing a weak positive skin test at enrollment, the rates were 10.6% versus 35.3%. Avoiding peanuts actually raises the risk of allergy. However, whole peanuts must never be given, as they can block the airway. A total of 530 infants had negative skin tests at entry, while 98 had weakly positive results. +- Benefit: The LEAP trial involved 640 infants aged 4–11 months with severe eczema, egg allergy, or both. One group ate peanut products regularly while the other avoided them entirely; at 60 months, only 1.9% of the eaters had a peanut allergy versus 13.7% of avoiders (P<0.001). Among 98 children with a weak positive skin test at entry, 10.6% of eaters were allergic versus 35.3% of avoiders (P=0.004). No serious adverse events differed between groups. +- Evidence grade: A +- Notes: Peanuts must be given only as thinned peanut butter or powdered form mixed into food — never as whole nuts. The Health Commission clearly states: “Whole peanuts, nuts, jelly, and similar foods can be inhaled into the airway and cause choking; infants should avoid them.” For choking first aid, see Section 13, Item 26. This guidance applies only to high‑risk children with severe eczema or egg allergy. A medical assessment is mandatory before introduction; in the LEAP trial, children with a skin‑test reaction greater than 4 mm were excluded. Another study of 1,162 breastfed infants found no significant difference in overall food allergy rates between early‑introduction and standard groups, though a subset showed a clear benefit: 5.6% versus 7.1% (P=0.32) and 2.4% versus 7.3% respectively. Evidence for typical infants is far weaker. Early introduction appears safe, but Chinese official guidelines currently give no recommendation on this point; therefore this advice follows international trial evidence. Keep in mind that LEAP started at 4 months while Chinese practice recommends waiting until 6 months for solids — consult a doctor on timing and method for high‑risk children. +- Sources:Du Toit G, Roberts G, Sayre PH, 等 (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. ；国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. ；Perkin MR 等 (2016). Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. New England Journal of Medicine, 374(18), 1733-1743. （备注里那项一般婴儿试验 EAT） diff --git a/book/21-Travel-And-Abroad-Safety.md b/book/21-Travel-And-Abroad-Safety.md new file mode 100644 index 00000000..ebfad2e5 --- /dev/null +++ b/book/21-Travel-And-Abroad-Safety.md @@ -0,0 +1,111 @@ +# 21. Traveling abroad, trips, and safety overseas + +This section deals with both financial matters and personal freedom, and several points also relate to physical safety. Once you’re overseas, it’s the laws of the host country that apply — not Chinese law. There are clear limits to what China’s embassies and consulates can do to assist you. This section explains those limits in detail. +### 1. Check the Ministry of Foreign Affairs safety advisories before you travel; steer clear of any locations marked “Do Not Travel” + + +- Cost: It’s free. Simply browse the Chinese Consular Service website — it takes just a few minutes. +- In plain terms: The Ministry of Foreign Affairs classifies overseas safety risks into four levels, with the highest level labeled “Do Not Travel.” As of September 15, 2026, avoiding high‑risk countries and regions has been codified in administrative regulations. When processing travel documents or at border control, officials will remind travelers and may even advise them against going. A quick glance at that page before departure is all you need. +- Benefit: The Ministry publishes safety advisories ranked from low to high risk: “Exercise Caution,” “Increase Safety Precautions,” “Travel with Care,” and “Do Not Travel.” The new regulation effective September 15, 2026, also spells out citizens’ obligations: “Chinese nationals should pay attention to overseas safety advisories and destination‑specific risk warnings, and avoid traveling to or staying in high‑risk countries or regions.” It further mandates that immigration authorities — responsible for issuing travel documents and border checks — warn and, if necessary, dissuade anyone planning to visit such areas. The original wording reads: “For Chinese citizens intending to travel to countries or regions with the highest risk level or where incidents threatening personal safety occur frequently, authorities must, when appropriate, dissuade them from going.” +- Evidence grade: A +- Notes: Advisories are updated as situations evolve; this guide does not list them, so be sure to check the page yourself before you travel. As of September 7, 2026, the “Do Not Travel” warnings covered Eswatini (August 25, 2026), Palestine (October 10, 2023), Sudan (April 17, 2023), Afghanistan (February 17, 2023), Syria (January 4, 2023), Peru (December 29, 2022), Somalia (November 24, 2022), as well as specific warnings for northern Myanmar and certain provinces of the Democratic Republic of the Congo. Travel agencies also have a duty to inform clients; before joining a tour, you can request a written summary of destination risks. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第二条）；国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十九、二十一条）；外交部领事司. 安全提醒. + +### 2. Save the 12308 hotline number and your local embassy/consulate’s consular protection number in your phone, then write them down and keep a copy in your wallet — don’t wait until an emergency to look them up. + + +- Cost: No cost at all. Saving two numbers and writing one copy down takes just a few minutes. + +- In plain terms: There is only one main hotline to call for help in an emergency. Inside China, dial 12308; abroad, call +86-10-12308. Since this hotline launched, it has handled over 3 million calls. During the same period, the Ministry of Foreign Affairs and its overseas missions dealt with more than 500,000 consular protection cases. + +- Benefit: The Ministry of Foreign Affairs operates a 24-hour global emergency hotline for consular protection and services. Inside China, call 12308; abroad, call +86-10-12308 or +86-10-65612308. Since its launch in 2014, this hotline has answered over 3 million calls, while the Ministry and its overseas missions have resolved more than 500,000 consular protection incidents. + +- Evidence grade: A + +- Notes: Your local embassy or consulate also maintains its own consular protection hotline, which is often quicker to reach than the main hotline. Before traveling, look up that number on the China Consular Service website for your destination country and save it alongside the main hotline number. However, if your phone is lost or runs out of battery, those saved numbers become useless. That’s why it’s wise to write down both numbers and keep one copy in your wallet, or give a copy to a family member. +- Sources:外交部、中国驻缅甸使领馆 (2023). 关于当前缅北地区安全局势的领事提醒. ；国务院新闻办 (2023). 国务院政策例行吹风会介绍领事保护与协助有关情况. + +### 3. Understanding what consular protection can and cannot do: it can visit you, but cannot bail you out, and you still have to pay the costs + + +- Cost: No cost at all. It only takes a few minutes to clearly understand these boundaries. +- In plain terms: If you’re arrested abroad, what consulates can do is verify your situation locally, demand fair and lawful treatment, visit you, and attend court hearings as observers. They cannot overturn a verdict or take you away. Any expenses such as food, lodging, transportation, or medical care paid in advance by others must ultimately be covered by you. Therefore, before traveling abroad, make sure you have sufficient funds and insurance — don’t assume the government will cover everything if something goes wrong. +- Benefit: When you’re detained, consulates can take several concrete actions. They can check your situation with local authorities and insist on fair treatment under both local laws and any relevant bilateral treaties. The official wording states: “In accordance with the laws of the host country and international treaties to which China and the host country are parties, consulates may visit or contact the detained individual, learn about their needs, and demand humane and fair treatment.” In simpler terms, they can visit you, communicate with you, ask what you need, and insist that local authorities treat you fairly and humanely. Consulates may also attend court sessions as observers and safeguard your right to a fair trial. If you’re injured or affected by a disaster, they can urge local emergency assistance and help your family handle aftermath matters. At the same time, the rules make it equally clear regarding costs: “Chinese citizens, legal entities, and other organizations must pay any expenses — such as food, lodging, transportation, and medical care — provided by third parties during consular assistance.” In other words, any costs initially covered by others must ultimately be borne by you. +- Evidence grade: A +- Notes: Consulates cannot pay fines or medical bills on your behalf, nor buy plane tickets or overturn court rulings. What they can provide is information on local lawyers, interpreters, medical providers, and funeral services, plus help contacting family and finding relief resources. Knowing these limits is valuable: it reminds you to prepare sufficient funds and insurance before traveling — don’t rely on the assumption that the state will handle everything if trouble arises. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第九、十、十四、二十六条） + +### 4. Purchase insurance that covers overseas medical care and medical evacuation — don’t settle for just flight delay coverage. + +- Cost: A short‑term travel insurance policy for overseas trips typically costs anywhere from a few dozen to several hundred yuan. +- In plain terms: Medical expenses incurred abroad must be paid out of pocket. Domestic medical insurance rarely covers such costs, and embassies or consulates won’t foot the bill either. What can truly devastate a family isn’t routine outpatient care but the massive expenses tied to hospitalization after a serious injury, plus the cost of repatriation via private aircraft or medical evacuation services. When buying travel insurance, focus on two key coverage limits: overseas medical expenses and emergency medical evacuation/repatriation. +- Benefit: As noted above, overseas medical treatment is largely self‑paid. Domestic health plans provide little to no coverage abroad, and consular assistance won’t cover these costs either (see Section 3 for details on what consular aid can and cannot do under Article 26 of relevant regulations). The most financially crippling elements are prolonged hospitalization following severe trauma and the expense of transporting patients back home — both of which fall under the priciest categories of out‑of‑pocket spending. Therefore, when selecting a policy, prioritize these two limits: first, the maximum amount payable for overseas medical treatment; second, the maximum coverage for emergency evacuation and repatriation. +- Evidence grade: C +- Notes: TODO (need verified figures on typical costs associated with overseas medical care and medical evacuation; official or industry statistics would be ideal). Before purchasing, verify three points: 1) whether the destination country is included in the policy’s coverage area; 2) if high‑risk activities such as scuba diving, skiing, or motorcycle riding are excluded; and 3) whether claims are settled directly between the insurer and medical providers or if you must pay upfront and then seek reimbursement. Keep in mind that visa‑free entry does not equate to guaranteed coverage — insurance is mandatory regardless of your destination. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第二十六条）；作者经验，无直接文献 + +### 5. Treat all “high-paying overseas jobs” as scams — getting caught can lead to a 6‑month to 3‑year travel ban + +- Cost: No money is required. The hard part is turning down what seems like a great job offer. +- In plain terms: Offers with unrealistically high monthly salaries, no educational or experience requirements, no formal contracts, instructions to gather at a border city first, and promises to keep your passport safe are red flags. Accepting such a job means you lose control over both yourself and your passport. Submitting false documents at the border will get you turned away. If you end up taking part in illegal activities abroad, you may be barred from leaving China for 6 months to 3 years after you return. +- Benefit: Authorities have made it clear how to handle these cases. Recent statements note that people who are deceived into leaving the country or who fabricate reasons to travel abroad for illegal gambling, telecom fraud, or similar crimes put public safety at risk. New rules tighten controls on both ends: for outbound travel, “the stated purpose of a visa application must be genuine and lawful”; anyone who submits false information can be denied a permit or entry. For returnees, “Chinese citizens who commit crimes abroad and threaten national security may be barred from leaving China for 6 months to 3 years from the date of their return.” The same ban applies to anyone detained for using false documents or illegal border crossings. +- Evidence grade: A +- Notes: Common warning signs include salaries far above market rates, no educational or experience prerequisites, lack of a formal contract, instructions to meet at a border city first, and promises to handle visas and keep your passport. Consulates have issued specific advisories about northern Myanmar. Once you go, you lose both personal freedom and control over your passport — the idea of “simply walking away” does not apply. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第三、四条）；司法部、公安部、国家移民局 (2026). 就《国务院关于出境入境管理的规定》答记者问. + +### 6. The annual limit of 100,000 RMB for cash withdrawals abroad applies to all cards under your name combined + +- Cost: There is no direct cost. Estimate how much cash you’ll need before you travel, then rely on card payments for the rest. The real challenge is breaking the habit of withdrawing cash whenever possible. +- In plain terms: The annual cash withdrawal limit of 100,000 RMB for overseas use applies to all bank cards registered under your name, including supplementary cards. This limit resets on January 1 each calendar year. Once you reach it, you cannot make any more overseas cash withdrawals for the remainder of that year or in the following year. Note that this restriction only affects cash withdrawals; regular card purchases remain unaffected, and it does not count against your annual foreign exchange quota of $50,000. +- Benefit: This rule is set out in the Notice on Regulating Large-Scale Cash Withdrawals via Bank Cards Abroad issued by the State Administration of Foreign Exchange (SAFE, Document No. 29 [2017], effective January 1, 2018). Key provisions include: (1) The combined annual cash withdrawal limit for all cards under a person’s name is 100,000 RMB; exceeding this limit results in a suspension of overseas cash withdrawal rights for both the current and next calendar years. It is also prohibited to bypass this rule by using someone else’s card or lending one’s own card to others. (2) SAFE provides a list of affected individuals to issuing banks daily, which must then block all overseas cash withdrawals for those customers by 5 PM Beijing time on the same day. (3) Affected individuals can request a full breakdown of their overseas cash withdrawal history by presenting valid ID at local SAFE branches. (4) The daily withdrawal limit for foreign currency cards is raised from $1,000 to 10,000 RMB equivalent, while the same daily limit for RMB cards remains at 10,000 RMB equivalent. (5) Violations of these rules are subject to penalties under the Foreign Exchange Administration Regulations of the People’s Republic of China. SAFE also clarifies that this notice does not restrict regular overseas spending on travel, business, or education, which can all be paid for via card without using the annual $50,000 foreign exchange quota. To ensure smooth transactions, SAFE uses delayed control mechanisms rather than immediate blocking of transactions. Statistics show that 81% of domestic cardholders withdrew less than 30,000 RMB abroad in 2016. +- Evidence grade: A +- Notes: The annual limit resets on January 1 each year. As mentioned, only cash withdrawals are restricted; regular card purchases are unaffected. If you absolutely need to carry large amounts of cash overseas, you must first apply for foreign exchange under the Individual Foreign Exchange Management Measures before taking the cash out. Two additional caveats apply to cash withdrawals: (1) For dual-brand cards, some ATMs in certain countries do not offer a UnionPay withdrawal option. (2) Some overseas ATMs display extra surcharge fees, which are charged by local acquirers and have no relation to UnionPay. UnionPay also advises that credit card cash withdrawals incur interest charges, so using a UnionPay debit card is preferable for overseas withdrawals. For guidance on what to do if your card is lost, swallowed by an ATM, or fraudulently used, refer to Section 14, Item 5. +- Sources:国家外汇管理局 (2017). 关于规范银行卡境外大额提取现金交易的通知（汇发〔2017〕29 号，第一、二、三、四、六、七条，2018 年 1 月 1 日起实施）. ；国家外汇管理局 (2017). 外汇局有关负责人就规范银行卡境外大额提取现金交易有关问题答记者问. ；中国银联国际. 境外ATM取款. + +### 7. Take photos of your passport, visa, and ID and store them in the cloud; if lost, report it to police first and then apply for a travel document. + + +- Cost: No cost involved. Simply take a few photos before you travel. +- In plain terms: If your passport is lost, the embassy or consulate can issue a travel document to help you return home — provided you can prove your identity. Having clear photos of the passport data page, visa pages, and entry/exit records speeds up the replacement process considerably. You must also file a police report locally to obtain a receipt; this document is required for border checks and insurance claims in many countries. Since phones are often lost together with passports, don’t rely on storing photos solely on your phone. +- Benefit: When a passport is lost, overseas embassies and consulates can issue a travel document for repatriation, but only after the traveler proves who they are. The speed of this process depends heavily on whether you have legible photos of the passport data page, visa pages, and entry/exit records. Additionally, filing a police report is mandatory; the resulting receipt is needed for border inspections and insurance settlements in numerous nations. The contact numbers for embassy assistance are the same two emergency hotlines listed in item 2. +- Evidence grade: C +- Notes: To ensure safety, save the photos in two separate locations — for example, one copy in cloud storage and another sent to a trusted family member. Also print a hard copy and keep it apart from the original documents. Don’t forget to photograph bank cards and prescriptions for regular medications as well. Since phones and passports tend to be misplaced together, storing images only on your phone offers no real protection. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十六条）；作者经验，无直接文献 + +### 8. Before driving abroad, verify whether local authorities recognize Chinese driver’s licenses; most “international driver’s permits” sold online are legally worthless. + + +- Cost: No cost at all. Simply check local regulations before you travel. +- In plain terms: Online services offering “international driver’s permits” hold no legal validity in mainland China. Such permits are merely translations recognized among signatory nations of the 1949 Geneva Convention on Road Traffic. Mainland China is not among the 103 signatory countries, so any permit issued domestically cannot be used legally. Whether a Chinese license is acceptable depends entirely on local laws — do not drive without confirming this first. +- Benefit: An International Driver’s Permit (IDP) is essentially a translation of a driver’s license, recognized solely among signatories to the 1949 Geneva Convention on Road Traffic. Signed on 19 September 1949 and effective 26 March 1952, this treaty currently includes 103 countries and regions — mainland China is excluded. Consequently, China does not issue IDPs, and any domestic “services” claiming to provide them lack legal standing. Eligibility to drive using a Chinese license varies by jurisdiction: some accept it alongside a certified translation, others require obtaining a local license, while several reject it outright. +- Evidence grade: A +- Notes: In most countries, driving without a valid license constitutes a criminal offense or incurs severe penalties. Moreover, insurance providers typically deny coverage in such cases — this represents the true financial risk. Two reliable verification methods exist: consult the “Information for Chinese Citizens” section on the Chinese Consulate website for your destination, or request a written confirmation directly from your rental agency. Separate regulations apply to Hong Kong, Macau, Taiwan, and certain other countries. +- Sources:United Nations Treaty Collection. Convention on Road Traffic, Geneva, 19 September 1949 — status of treaties. + +### 9. When hiring an agency for visas, study abroad, or immigration, first check whether it is registered with immigration authorities + +- Cost: There is no cost. Simply ask whether the agency is registered, and keep any written documentation on hand. +- In plain terms: Starting September 15, 2026, agencies handling visa applications, study abroad programs, or immigration must register with immigration authorities. Promises such as “guaranteed approval,” “100% success rate,” or “we’ll prepare all your documents” are explicitly prohibited. If you make errors while filling out forms yourself, you may simply receive a visa denial this time. However, if you submit false documents and are found guilty of fraud, this will leave a permanent mark on your immigration record. +- Benefit: In 2018, China abolished the licensing requirement for private immigration agencies, meaning no prior approval is needed to open such agencies. Since then, their numbers have risen sharply, but many operate without proper oversight, violating laws and harming applicants’ rights; authorities even struggle to track how many exist. Effective September 15, 2026, these agencies must register with local immigration authorities within 15 days of establishment, with existing agencies required to comply within 90 days. Prohibited activities include: (1) publishing false information or using exaggerated or misleading claims to attract clients; (2) providing or helping clients submit false documents for visas, residence permits, passports, or other immigration paperwork; (3) leaking, selling, or illegally sharing personal data; and (4) organizing or aiding cross-border illegal activities. Foreign firms and organizations are also barred from offering such services within China. +- Evidence grade: A +- Notes: Agencies that openly advertise “guaranteed approval,” “100% success rate,” or “we’ll handle all paperwork” are already breaking the law. Should they be investigated, this will directly affect your immigration history. Errors made while applying on your own may result in a single visa denial, but submitting false documents carries far graver consequences. Providing policy guidance or basic information without charging fees does not count as immigration agency services. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第七、八、十、十二、十三条） + +### 10. Don’t issue invitation letters for strangers, and don’t let others use your name for immigration paperwork + +- Cost: No monetary cost. The hard part is politely declining such a request in person. +- In plain terms: Issuing an invitation letter or application documents on someone else’s behalf with false information makes the issuer legally liable. Individuals face fines ranging from 5,000 to 10,000 yuan, plus any illegal earnings are confiscated. Organizations are fined 10,000 to 50,000 yuan, and the individuals directly involved are fined an additional 5,000 to 10,000 yuan. One simple act of kindness can end up costing you a lot of money. +- Benefit: Anyone who issues an invitation letter must ensure its contents are truthful. The original regulation states: “Individuals who submit false invitation letters or other application materials for others’ visa or residence permit applications will be fined between 5,000 and 10,000 yuan by immigration authorities; any illegal earnings will also be confiscated.” Organizations found issuing false documents face fines of 10,000 to 50,000 yuan. Additionally, the directly responsible supervisors and staff involved are fined 5,000 to 10,000 yuan each. +- Evidence grade: A +- Notes: This carries the same risks as the advice in Section 8: “Don’t carry items for strangers.” Once you sign a document or stamp a form, you assume full responsibility for its contents. Government employees and military personnel who attempt to obtain foreign citizenship or residency through intermediaries must report such attempts to oversight authorities — intermediaries cannot assist with such illegal requests. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第三、十一条） + +### 11. Before traveling abroad, send your itinerary, accommodation details, and travel companions’ information to a family member, and agree on how often you’ll stay in touch. + + +- Cost: No cost at all. Simply send a message before you leave. +- In plain terms: If a traveler goes missing overseas, their family can turn to Chinese diplomatic missions for help. These missions provide relatives with local police contact information and other resources for assistance. Once a police report is filed, the consulate follows up to ensure timely action. Whether this support chain can be activated depends on whether someone back home knows exactly where the traveler is and when they’re supposed to make contact. Sharing flight numbers, hotel addresses, companions’ phone numbers, and agreed-upon check-in intervals with one trusted person is sufficient. +- Benefit: When a Chinese citizen goes missing abroad, family members may seek help from Chinese diplomatic missions. The relevant regulation states that “diplomatic missions abroad shall provide information on local police contact methods and other assistance resources.” After a police report is filed, the consulate actively follows up to ensure proper handling. The ability to trigger this entire support process hinges on whether domestic contacts know the traveler’s whereabouts and expected contact schedule. +- Evidence grade: C +- Notes: Include just four key details: flight number, accommodation address, companions’ full names and phone numbers, and the agreed contact frequency. If traveling to areas with poor signal or high crime rates, also specify exactly how long one should wait without contact before alerting local authorities. This measure costs virtually nothing, yet it serves as the essential prerequisite for activating all subsequent assistance procedures. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十三条）；作者经验，无直接文献 diff --git a/book/22-How-To-Relax.md b/book/22-How-To-Relax.md new file mode 100644 index 00000000..4d1c33a2 --- /dev/null +++ b/book/22-How-To-Relax.md @@ -0,0 +1,112 @@ +# 22. How to relax: entertainment venues and stress relief + +This section is divided into two parts. The first part covers entertainment venues — it explains which costs are unnecessary and where the emergency exits are located. The focus here is on money and personal freedom. The second part discusses ways to relieve stress, with an emphasis on energy levels and overall mortality risk. The figures from each part are not combined for any calculations. Section 3 already listed several steps to take when feeling down; this section provides more detailed recommendations. +### 1. Check where the emergency exits are before entering a KTV, bar, or escape room; if they’re locked or blocked, pick another venue. + +- Cost: No cost at all. Just take 10 seconds to look around when you enter. +- In plain terms: By law, entertainment venues must keep all evacuation routes and emergency exits completely unobstructed during operating hours. They cannot be blocked, locked, used to store items, or covered by anything, nor can any signs indicating their location be hidden. The same rules apply to internet cafés — their doors, windows, evacuation routes, and exits must also remain open at all times. Failing to comply is illegal, and you have the right to file a complaint. If a private room is located underground, has only one exit, or its corridors are cluttered with debris, choose a different venue instead. +- Benefit: Ensuring unobstructed evacuation routes and exits is a mandatory legal obligation for venue operators. Noncompliance is illegal and reportable. The exact wording of the regulation reads: “During operating hours, entertainment venues must guarantee that evacuation routes and emergency exits remain unblocked; they cannot be sealed, locked, or fitted with barriers that hinder evacuation.” It also stipulates that “clear signage must be posted at all evacuation routes and exits, and such signage must not be obscured or covered.” Internet cafés are similarly required to “keep all doors, windows, evacuation routes, and exits open at all times during business hours” and to “ban open flames and smoking.” +- Evidence grade: A +- Notes: If any of the following issues are present, pick another venue: private rooms located underground, only one exit available, corridors filled with clutter, or nonfunctional emergency exit lights. In the event of a fire at such venues, thick smoke, narrow corridors, and large crowds of intoxicated patrons make escape extremely difficult — you may have only seconds to get out. Per regulations, the contact number for filing complaints must be clearly displayed on warning signs throughout the venue. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第二十、二十一条）. ；国务院 (2002). 互联网上网服务营业场所管理条例（国令第 363 号，第二十一条）. + +### 2. Price lists must be displayed before ordering; entertainment venues cannot charge “after the fact” + +- Cost: No cost at all. You simply need to request a price list. The tricky part is asking for it in front of others — it can feel a bit awkward. +- In plain terms: By law, entertainment venues must display clear prices for all services and goods and proactively hand over a price list to customers. Most cases of “exorbitant drink charges” occur when patrons never see a price list and end up paying based on verbal quotes after the fact. Upon entering a private room, ask for a price list and take a photo of it. After placing your order, request a written confirmation. If a billing dispute arises, call 12315 right away. +- Benefit: The regulation states: “Entertainment venues offering services or selling goods must display clear prices and provide a price list to consumers; they may not force or deceive customers into using services or buying products.” Violations of pricing laws are subject to legal penalties. The vast majority of disputes over “overpriced drinks” happen precisely under these circumstances — no price list is shown, and payment is demanded based on informal verbal agreements. +- Evidence grade: A +- Notes: How to proceed: Upon entering a private room, request a price list — paper or digital, it doesn’t matter — and photograph it. After ordering, ask for a written confirmation of your order. For any “special cocktails” or fruit platters suggested by staff, always ask for the price before ordering. If a billing disagreement occurs, call 12315 immediately. Never pay in advance and then attempt to dispute the charge; once payment is made, proving your case becomes far more difficult. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第二十九、五十三条）. + +### 3. If someone offers you “stuff” at a venue, leave immediately — harboring and providing both count as aiding friends + +- Cost: No cost at all. Just stand up and walk away. The hard part is having to leave in front of a whole group of people. +- In plain terms: It is strictly illegal for entertainment venues to sell or provide drugs, or to allow anyone to use drugs on site. Violators face 3–6 months of suspension or permanent revocation of their operating license. Individuals face even harsher penalties: personal drug use results in public order sanctions. Allowing someone to use drugs in a private room you booked or in your own home counts as harboring drug use and is a criminal offense. If someone offers you unknown powders, pills, or vape cartridges, walk away right then. +- Benefit: Regulations explicitly forbid entertainment venues from selling, providing, or facilitating drug use. Staff members are also prohibited from using drugs or aiding customers in any such activities. Penalties include confiscation of illicit gains, 3–6 month suspensions, and license revocation for serious violations. Venues must also post clear anti-drug, anti-gambling, and anti-prostitution warnings with hotline numbers in public areas and private rooms. +- Evidence grade: A +- Notes: If anyone offers you unknown powders, pills, or vape cartridges to “try,” leave immediately — don’t stick around to watch. Individual liability is even heavier than venue liability: personal drug use alone incurs public order penalties, while letting a friend use drugs in your reserved room or home constitutes harboring drug use and is a criminal act. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第十四、三十、四十二条）. + +### 4. Don’t accept candy or snacks from strangers, don’t drink beverages left unattended, and don’t take e‑cigarette cartridges handed to you by others + +- Cost: No cost at all. Never accept anything offered by others. If your own cup has been out of sight, simply get a new one. +- In plain terms: Today’s illicit drugs no longer look like typical drugs. “High‑inducing” e‑cigarettes laced with synthetic cannabinoids can be tinted and flavored to match ordinary e‑cigarettes, and they are deliberately offered to people in bars, KTVs, and hotels. Those who trick others into using them face 10–15 days of detention and fines of 1,000–5,000 yuan. Anyone who is deceived into using them also gets detained for 10–15 days. Always replace any drink that has been left unattended. +- Benefit: Since July 1, 2021, synthetic cannabinoids have been regulated as a whole class of controlled substances. They are often mixed into e‑cigarette liquid to create “high‑inducing” cartridges. According to Supreme People’s Procuratorate reports, this liquid can be colored and flavored with food‑grade dyes to closely resemble regular e‑cigarette liquid. Sellers promote these products in bars, KTVs, and hotels, encouraging others to use them. In that region, nearly 40% of drug‑use cases that year involved minors. Starting October 1, 2023, etizolam was added to the list of Schedule II psychotropic substances. Tricking someone into using drugs is itself illegal: offenders face 10–15 days of detention and fines of 1,000–5,000 yuan; if a crime is proven, sentences range from under 3 years up to 7 years, while forced use can bring a 3–10‑year sentence, with harsher penalties for minors. Users also incur penalties: 10–15 days of detention and fines up to 3,000 yuan, or a lighter penalty of 5 days or less plus a fine under 1,000 yuan. They may also be barred from entertainment venues for 6 months to a year. Addicted individuals must undergo 3 years of community‑based rehabilitation; refusal or relapse leads to 2 years of compulsory isolation, extendable by another year (as of January 2026, Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: This advice applies not only in entertainment venues but also at school gates, friend gatherings, and on long‑distance buses. It works whether the offering is candy, a drink, or an e‑cigarette cartridge. After being drugged, victims often suffer robbery, sexual assault, or extortion; no official statistics exist on this, so it remains an empirical warning. Replacing any drink that has been out of sight is far simpler than trying to rectify the situation later. For handling unknown powders, tablets, or cartridges encountered in such settings, see item 3 of this section; for carrying items on behalf of others, see Section 8, item 29. +- Sources:最高人民检察院 (2021). 江苏苏州吴江区：办案检察官揭秘披着潮流外衣的新型毒品. ；国家药监局、公安部、国家卫生健康委 (2023). 关于调整麻醉药品和精神药品目录的公告（2023 年第 120 号）. （上海市药监局转载，原文页 nmpa.gov.cn 在本机返回 412）；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十四、八十五条）. ；全国人大 (1997). 刑法（第三百五十三条）. ；全国人大常委会 (2007). 禁毒法（第三十三、三十八、四十七条）. （广东省人民政府转载） + +### 5. Using your own ID to log in at internet cafés – don’t lend it or use someone else’s + + +- Cost: No cost at all. + +- In plain terms: According to regulations, internet cafés must verify and register each customer’s ID card, then keep detailed browsing records for at least 60 days. Police and cultural authorities can request this data at any time. During that period, cafés may not alter or delete any information. Whichever ID is used, all activity on that computer is attributed to that person. + +- Benefit: The regulation states: “Internet café operators must verify and register customers’ ID cards and other valid documents, and retain all related browsing records for no less than 60 days.” When requested by cultural or law‑enforcement agencies, cafés must provide this information; no modifications or deletions are permitted during the retention period. Consequently, any actions performed on a computer while a specific ID is logged in are recorded under that individual’s name. + +- Evidence grade: A + +- Notes: This rule mirrors the one described in Section 9 – “Do not lend your ID to others” – just applied to a different setting. Internet cafés are prohibited from serving minors; a conspicuous “No Minors Allowed” sign must be displayed at entrances. The same restriction applies to entertainment venues. If someone helps a minor “fake‑register” at an internet café, the penalty falls on the café, yet all records remain linked to the minor’s ID. +- Sources:国务院 (2002). 互联网上网服务营业场所管理条例（国令第 363 号，第二十三条）. + +### 6. Avoid scripted-murder-mystery (剧本杀, "jubensha") and escape rooms located in residential buildings or below the first basement level + +- Cost: No cost involved. Just ask for the building floor number before booking. +- In plain terms: A 2022 notice jointly issued by five government departments clearly states that script-entertainment venues (剧本娱乐, "juben yule") must not be set up inside residential buildings or below the first basement level. These venues often lack proper oversight, have numerous partitions, use highly flammable props, and their doors frequently require puzzle-solving to open. In case of a fire, escaping from such places is far harder than from regular commercial premises. Before booking, check the venue’s floor number and location on review pages, and opt for a compliant venue instead if it does not meet the requirements. +- Benefit: The same 2022 notice from five departments lays out very specific requirements: script-entertainment venues (剧本娱乐, "juben yule") are prohibited from operating in residential buildings or below the first basement level. It also mandates that venues must adhere to the Work Safety Law and Fire Protection Law, regularly identify, inspect and rectify fire hazards, and improve their ability to organize evacuations and extinguish incipient fires during emergencies. Additionally, the notice requires all script-entertainment (剧本娱乐, "juben yule") content to include age suitability warnings, and minors are not allowed to enter venues with scenes inappropriate for them. Outside statutory holidays, rest days and school holidays, script-entertainment (剧本娱乐, "juben yule") activities for minors are also strictly prohibited. +- Evidence grade: A +- Notes: These venues are typically dimly lit, have many partitions, use flammable props, and their doors often need to be unlocked via puzzle-solving. In case of a fire, escaping from them is far more difficult than from ordinary shops. You can easily check both the floor number and whether the venue is located in a residential building on review pages before booking. If a venue does not comply with the regulations, it is best to choose another one. +- Sources:文化和旅游部、公安部、住房和城乡建设部、应急管理部、市场监管总局 (2022). 关于加强剧本娱乐经营场所管理的通知. + +### 7. Going for a brisk walk or a jog when feeling down: the effect size of exercise on depression is proportional to its intensity + +- Cost: Free. Each session takes about half an hour. The hard part is that when you’re in a bad mood, moving feels the last thing you want to do — you have to push yourself to get started. +- In plain terms: This study pooled data from 218 randomized trials involving over 14,000 adults with major depressive disorder. The biggest improvements were seen with brisk walking or jogging. Yoga, strength training, mixed aerobic workouts, and tai chi/Qigong also showed benefits, with fairly similar effect sizes across these activities. Generally, the higher the exercise intensity, the better the outcome; however, strength training and yoga tend to be the easiest to stick with long-term. The authors themselves note that the overall evidence quality is relatively low, but the key takeaway is that any physical activity is better than none — pick whatever type you’re most likely to keep doing. +- Benefit: This result comes from combining data across 218 randomized controlled trials split into two groups, covering 495 treatment arms and 14,170 participants who met clinical criteria for major depression. A Bayesian network meta-analysis was used to compare all these different forms of exercise against each other, using standard care or placebo pills as control groups. The effect size is expressed as Hedges’ g; the more negative this value, the greater the symptom improvement. For brisk walking or jogging, the value was −0.62 (95% confidence interval: −0.80 to −0.45). Yoga came in at −0.55 (−0.73 to −0.36), strength training at −0.49 (−0.69 to −0.29), mixed aerobic exercise at −0.43 (−0.61 to −0.24), and tai chi/Qigong at −0.42 (−0.65 to −0.21). The original paper states that “the effect of exercise is directly proportional to its intensity”, meaning higher intensity yields better results. Strength training and yoga also score highest on acceptability, making them the most sustainable choices for most people. +- Evidence grade: A +- Notes: This finding is somewhat controversial. The authors themselves point out that only one out of the 218 studies met sufficiently rigorous design standards to rule out major bias. Using standard grading criteria, brisk walking and jogging only qualify for a “low” confidence rating, while all other exercise types receive “very low” ratings. Since participants know they’re taking part in an exercise program, placebo effects inevitably play a role, skewing results upward. Still, the overall conclusion holds up: any physical activity is better than none, intensity should be kept reasonably high, and you should choose a type you can realistically stick with over time. This section expands on the earlier advice in Section 3 to “get moving when feeling down”, but it is by no means a substitute for professional medical treatment after a proper diagnosis. +- Sources:Noetel M, Sanders T, Gallardo-Gómez D, et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. + +### 8. When anxiety interferes with daily life, mindfulness‑based stress reduction works just as well as common anti‑anxiety drugs + + +- Cost: Taking a course costs a bit of money. The program lasts eight weeks, with one class per week plus daily home practice. The real challenge is keeping up with that daily practice for the whole eight weeks. + +- In plain terms: 276 adults diagnosed with anxiety disorder were randomly split into two groups. One group attended an eight‑week mindfulness‑based stress reduction course, while the other took escitalopram. At the end, symptom improvement was almost identical in both groups. The difference showed up in side effects: almost 80 % of the medication group experienced at least one adverse reaction, and ten people dropped out because of this. In the course group, about 15 % reported side effects, but no one left the program. The program used a standardized eight‑week curriculum — it isn’t the same as any random meditation app you might download. + +- Benefit: This was a non‑inferiority randomized controlled trial conducted at three academic medical centers in the United States, designed to see whether the course performed as well as medication. 276 participants were assigned 1:1 to either an eight‑week mindfulness‑based stress reduction program or escitalopram at a flexible dose of 10–20 mg. 208 people completed the whole study. Using a clinician‑rated scale of anxiety severity, the mindfulness group showed a reduction of 1.35 points versus 1.43 points for the drug group. The difference between the two groups was −0.07 (95 % CI −0.38 to 0.23; P = 0.65), meaning the gap is statistically indistinguishable from zero. This value stayed above the pre‑set non‑inferiority threshold of −0.495. Side‑effect rates differed markedly: 78.6 % of the medication group experienced at least one trial‑related adverse event, leading to ten withdrawals, while only 15.4 % of the course group reported any side effects and no one dropped out. + +- Evidence grade: A + +- Notes: The trial employed a standardized eight‑week mindfulness‑based stress reduction curriculum (MBSR), not a generic meditation app; the two cannot be equated. This recommendation applies to individuals who already meet diagnostic criteria for anxiety disorder; they should still consult a physician. Its practical value lies in offering a treatment option with comparable evidence strength for those who hesitate to take medication because of potential side effects. +- Sources:Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM (2023). Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 80(1), 13-21. + +### 9. For quick relief on the spot, try the 5‑minute “cyclic sigh”: two inhalations followed by a prolonged exhalation + +- Cost: No cost at all. Just 5 minutes a day. +- In plain terms: In a one‑month controlled trial where participants performed each of three breathing exercises for 5 minutes daily, all three proved more effective than an equal amount of mindfulness meditation at lifting mood and lowering respiratory rate. The “cyclic sigh” — which emphasizes lengthening the exhale — performed best. The method is simple: inhale once through the nose, then take a brief second inhale to fully fill the lungs, and finally exhale slowly through the mouth. This particular study relied on self‑reported data and involved a relatively small group of volunteers, yet it required zero expense. +- Benefit: This home‑based, randomized controlled trial compared three distinct 5‑minute daily breathing routines — cyclic sighing (focused on extended exhalation), box breathing (equal durations of inhale, hold, and exhale), and cyclic hyperventilation with pauses — against an equivalent mindfulness meditation regimen over a month. Using a mixed‑effects model on pooled data, each breathing technique outperformed meditation; cyclic sighing stood out for its superior impact on mood improvement (statistically significant at P<0.05) and on reducing breathing frequency (also P<0.05). +- Evidence grade: B +- Notes: Execute the exercise by inhaling once through the nose, briefly adding a second inhale to maximize lung expansion, then exhale gently and fully through the mouth for a full 5 minutes. Although this trial was conducted at home, relied on participant self‑assessment, and involved a modest sample size, its benefits are clear: it costs nothing, takes only five minutes, can be done anywhere, and offers modest but tangible advantages over standard mindfulness practice. +- Sources:Balban MY, Neri E, Kogon MM, et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. + +### 10. Treat “regular social contact” as a health expense — don’t wait until you’re feeling down to reach out + + +- Cost: It requires some money and time to arrange meetups. The hard part is making the effort to schedule them even when you’re in a good mood. +- In plain terms: This conclusion comes from a meta-analysis of 70 studies involving 3.4 million people, tracked for an average of 7 years. Those experiencing social isolation had a roughly 30% higher risk of dying during that period compared to non-isolated individuals. People reporting loneliness faced a 25% higher risk, while those living alone faced a 30% higher risk. These figures are similar in magnitude and are even more pronounced among people under 65. Keep in mind these are observational data; it’s also possible that people in poorer health are more likely to end up isolated. +- Benefit: As noted, this is a meta-analysis of 70 studies with 3.4 million participants observed over 7 years. Social isolation, loneliness, and living alone all correlate with higher mortality. After adjusting for age and health status, the weighted average risk ratios were: 1.29 for social isolation, 1.26 for loneliness, and 1.32 for living alone. In other words, each condition raised the risk of dying during the study period by roughly 30%, 25%, and 30% respectively. The effects are comparable across all three factors and are stronger in younger adults. +- Evidence grade: A +- Notes: This topic remains debated. These findings are purely correlational; no randomized controlled trials have been conducted to prove cause and effect. It’s also true that people with poorer health are more likely to become isolated or have fewer social interactions. The authors argue that social relationships are as important to health as smoking or obesity, yet there’s no randomized evidence showing that increasing social contact actually lowers mortality. This point does not contradict Section 3’s advice to “cut back on draining relationships”; that section focuses on eliminating toxic connections, while this one stresses the value of maintaining those that replenish your energy. +- Sources:Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. + +### 11. Living near green spaces means you can use them for walking, strolling, or just sitting around + +- Cost: No cost at all — it’s free and easy to incorporate into daily life. +- In plain terms: Nine studies from seven countries involving 8.32 million people show that for every 0.1 increase in the normalized vegetation index (NDVI) within 500 meters of a home, the risk of dying during the same period drops by roughly 4%. This measures greenery right around where people live, not how often they visit parks. Naturally, neighborhoods with more greenery tend to have wealthier residents and cleaner air. So don’t interpret this as “visiting parks automatically adds years to your life”; the practical takeaway is to consider nearby green spaces when choosing where to live. +- Benefit: This result comes from a meta-analysis of nine long-term cohort studies spanning seven countries and 8.32 million participants. It looks at vegetation levels within 500 meters of residences, quantified via NDVI — a number that reflects ground-level greenery (bare soil or concrete scores near 0, dense vegetation near 1). A 0.1 rise in NDVI corresponds to a pooled hazard ratio of 0.96 for overall mortality (95% CI 0.94–0.97), meaning a roughly 4% reduction in death risk — with actual values likely falling between 3% and 6%. Seven out of the nine studies found lower mortality in greener areas, a pattern unlikely to be coincidental; the other two showed no clear link. +- Evidence grade: A +- Notes: This finding remains debated. The studies themselves vary widely in results (I² = 95%, indicating substantial disagreement), and the analysis tracks neighborhood greenery rather than personal park visits. Moreover, greener areas typically feature higher incomes, cleaner air, and more active lifestyles — all factors intertwined with vegetation levels. Again, don’t read this as “parks guarantee longer life”; the key insight is that living near green spaces costs nothing and may offer health benefits. NDVI is simply a numeric way to gauge local greenery, where values near 0 represent barren or paved zones and values near 1 indicate lush vegetation — so a 0.1 increase roughly equals moving from a bare urban block to one lined with trees. +- Sources:Rojas-Rueda D, Nieuwenhuijsen MJ, Gascon M, Perez-Leon D, Mudu P (2019). Green spaces and mortality: a systematic review and meta-analysis of cohort studies. The Lancet Planetary Health, 3(11), e469-e477. diff --git a/book/23-Which-Skills-To-Learn.md b/book/23-Which-Skills-To-Learn.md new file mode 100644 index 00000000..d94afc1c --- /dev/null +++ b/book/23-Which-Skills-To-Learn.md @@ -0,0 +1,186 @@ +# 23. Which skills are worth learning? +This section deals with money and time. The second item also looks at mortality rates. The first six items address one main question: should you keep studying? Item 1 explains which options the law rules out. Item 2 explores how education affects lifespan. Item 3 shows what level of schooling most people in China have attained. Item 4 lists financial aid available when tuition is unaffordable. Item 5 describes alternatives if you don’t get into regular high school. Item 6 turns the “study versus work” dilemma into a simple calculation you can do yourself. The next seven items tackle another question: once you decide to learn something, how do you pick the right skill? Official statistics on +### 1. There’s no option for anyone under 16 to “get a job”: any employer who hires them faces a fine of $5,000 per month, and those willing to do so are breaking the law. + +- Cost: Zero. It takes just a minute to figure out how old you are. +- In plain terms: Most kids finish junior high at 15 or 16, right at this age threshold. Hiring anyone under 16 is illegal; each underage worker used results in a $5,000 monthly penalty. Thus, any employer willing to hire you is knowingly breaking the law. Should anything go wrong, medical bills and compensation must be paid by that employer. If it refuses or goes out of business, there’s no one else to cover those costs. +- Benefit: Article 11 of the Compulsory Education Law states: “All children aged six or older must be enrolled by their parents or legal guardians to receive and complete compulsory education.” Article 14 adds: “Employers are prohibited from hiring children and adolescents required to attend compulsory education.” Article 58 says that failure to enroll eligible kids without valid reasons results in “criticism and a directive to correct the issue within a set timeframe” from local authorities. Article 2 of the Regulations on Banning Child Labor declares that government agencies, social groups, enterprises, private non-profit entities, and individual businesses “must not hire minors under 16.” Article 6 imposes a $5,000 monthly fine per underage worker; noncompliance raises this to $10,000 per month. Article 7 levies a $5,000 fine per child referred for employment. Article 10 mandates that employers “must arrange medical treatment and cover all related costs” if a child worker falls ill or sustains injury; additional compensation applies in cases of permanent disability or death. One exception exists under Article 13: cultural or sports organizations may hire under-16 professionals with parental consent (nationwide). +- Evidence grade: A +- Sources:全国人大常委会 (2018). 义务教育法（2018 年第二次修正，第十一、十四、五十八条）. （教育部刊登）；国务院 (2002). 禁止使用童工规定（国务院令第 364 号，第二、六、七、十、十三条）. +- Notes: You’re the primary beneficiary here. Working legally is permitted after age 16. Yet jobs open to a 16-year-old with no qualifications align precisely with those highlighted in Section 10—roles relying on routine tasks most vulnerable to automation. Section 19 outlines overtime pay, vacation rights, and worker’s compensation, all contingent on formal employment status and verifiable records. As an unregistered worker, you lack both, meaning you won’t qualify for these protections or benefits. +### 2. Adding “education’s value” to mortality statistics: each extra year of schooling lowers adult mortality risk by roughly 1.9% + +- Cost: There’s no direct monetary cost. The real expense is the time and effort required to stay in school; tuition fees are covered under Section 4 of this chapter (vocational school tuition and grants). The main challenge is staying committed to education over the long term. +- In plain terms: Every additional year of schooling reduces an adult’s risk of dying by about 1.9% on average. This effect is strongest among people aged 18–49, where the risk drops by roughly 2.9% per extra year; for those over 70, the drop is only about 0.8%. Naturally, people who manage to stay in school tend to come from more privileged backgrounds, so it’s hard to isolate how much of this benefit truly stems from education itself. +- Benefit: This conclusion comes from a comprehensive meta-analysis that pooled data from 603 studies conducted at 70 locations across 59 countries between January 1980 and May 2023, involving a total of 10,355 observations. The results show a clear dose‑response relationship between years of schooling and adult mortality (all causes combined): each extra year of education lowers mortality risk by 1.9% on average (95% confidence interval: 1.8–2.0). For the 18–49 age group the reduction is about 2.9% per year (2.8–3.0), while for those over 70 it is roughly 0.8% per year (0.6–1.0). No gender differences were observed, nor any variation linked to a country’s level of development (as measured by the Social‑Demographic Index). +- Evidence grade: A (controversial) +- Sources:IHME-CHAIN Collaborators (2024). Effects of education on adult mortality: a global systematic review and meta-analysis. The Lancet Public Health, 9(3), e155-e165. +- Notes: The findings are controversial. The authors reported a significant publication bias (p < 0.0001), meaning studies with more favorable results were more likely to be published. Moreover, the results varied widely across individual studies. All included research relied on observational tracking rather than randomized trials; consequently, it’s difficult to disentangle how much of the 1.9% mortality reduction is attributable to education itself versus the fact that those who stay in school generally enjoy better socioeconomic conditions. Thus, while the data strongly suggest that more schooling correlates with longer life expectancy, they do not prove that simply attending school will guarantee a 1.9% reduction in mortality. The ultimate beneficiaries are the individuals themselves. +### 3. Before determining whether “education is losing its value,” let’s first look at the national educational structure: only 15,467 people per 100,000 have a college education or higher. + +- Cost: Zero. All you need to do is glance at the numbers below. +- In plain terms: According to the 2020 census, only 15,467 people per 100,000 nationwide have completed college or higher education — that’s roughly 15%. Meanwhile, 34,507 people per 100,000 have only a junior high school education, making this the most common level of education. On average, people aged 15 and older have attended school for just 9.91 years, barely enough to finish junior high. Therefore, a junior high school education in China is far from “sufficient” — it is simply the baseline level for most people. +- Benefit: The reference point for the seventh national census was November 1, 2020. At that time, 218,360,767 people nationwide had a college education or higher, while 213,005,258 had a high school education (including vocational school). The number of people with a junior high school education was 487,163,489, and those with a primary school education totaled 349,658,828. Compared to the sixth national census in 2010, the number of people per 100,000 with a college education rose from 8,930 to 15,467, while those with a high school education increased from 14,032 to 15,088. Conversely, the number of people with a junior high school education fell from 38,788 to 34,507, and those with a primary school education dropped from 26,779 to 24,767. The average years of schooling for people aged 15 and older rose from 9.08 to 9.91 years, and the illiteracy rate declined from 4.08% to 2.67%. +- Evidence grade: A +- Sources:国家统计局、国务院第七次全国人口普查领导小组办公室 (2021). 第七次全国人口普查公报（第六号）——人口受教育情况. +- Notes: These figures only indicate how common or rare a given level of education is within the general population. Whether it makes financial sense for any individual to pursue further education should be calculated using the method outlined in Section 6 of this chapter (“How to weigh the costs and benefits of education vs. working”). Also, note that census data includes all residents nationwide, including children and the elderly. The proportion of young people with a college education is significantly higher than these averages, so comparing one’s own educational level to these figures may overestimate one’s competitive advantage. Conversely, these numbers do provide solid evidence to refute the claim that “education is useless,” since they represent the entire labor force competing for jobs. The ultimate beneficiaries of this education are the individuals themselves. +### 4. Run the policy math first: most vocational school tuition is waived, with a 2,300‑yuan grant and up to 20,000 yuan in student loans per year + +- Cost: Zero out‑of‑pocket expense. Before school starts, simply visit the school’s student‑aid office and submit the required paperwork. +- In plain terms: At public vocational schools, tuition is waived for rural students, urban students in agriculture‑related programs, and those from low‑income families. Starting spring 2025, a 2,300‑yuan grant is available each year for both vocational and regular high‑school students. College students receive a 3,700‑yuan grant annually, and they may borrow up to 20,000 yuan per year via student loans. The exact amount of the grant is 0.7 yuan, which is a fixed figure set by policy. If funds remain insufficient, repayment can be deferred or alternative options explored — most students never have to drop out to work right away. +- Benefit: The tuition‑waiver policy for public vocational schools has been in place since fall 2012; it covers all full‑time first‑, second‑, and third‑year students who are rural (including those in county towns), enrolled in agriculture‑related programs, or from financially disadvantaged families (except for students in performing‑arts majors). In 2024 the student‑aid framework was updated: the national grant for undergraduates rose from 3,300 to 3,700 yuan per year, and the National Inspirational Scholarship increased from 5,000 to 6,000 yuan, both effective fall 2024. For vocational and regular high‑school students, the grant also rose from 2,000 to 2,300 yuan per year, effective spring 2025. Student loans were adjusted as well: from fall 2024 undergraduates may borrow up to 20,000 yuan per year (previously 16,000) and graduate students up to 25,000 yuan (previously 20,000). The interest rate equals the applicable LPR minus 70 basis points. +- Evidence grade: A +- Sources:财政部、发展改革委、教育部、人力资源社会保障部 (2012). 关于扩大中等职业教育免学费政策范围 进一步完善国家助学金制度的意见（财教〔2012〕376 号）. ；财政部、教育部、人力资源社会保障部有关司局负责人 (2024). 就调整学生资助政策有关问题答记者问. ；财政部、教育部、人民银行、金融监管总局 (2024). 关于调整完善国家助学贷款有关政策的通知（财教〔2024〕188 号）. +- Notes: These benefits apply to the student and his or her children. Exactly which groups qualify for tuition waivers and how many grant tiers exist is determined by each province. Private schools receive subsidies based on local public‑school standards, but any shortfall must still be paid by the student, so it’s wise to verify local rules before enrolling. Student loans are loans, not grants, and must be repaid after graduation; they simply separate the immediate cash‑flow problem from a longer‑term cost‑benefit analysis — don’t treat a temporary shortfall as a permanent barrier. Section 7 discusses training subsidies and emergency aid for periods of unemployment; families facing sudden income loss should apply for those programs first. +### 5. Failing to get into regular high school doesn’t mean your path ends: secondary vocational schools offer linked admission programs and separate exams, and employers can lower educational requirements for skilled roles. + +- Cost: No cost at all. Before submitting your high school entrance exam applications, check your province’s official vocational education admissions platform once. +- In plain terms: The Vocational Education Law enacted in 2022 explicitly states that vocational education holds equal status to general education. Secondary vocational schools can enroll students through linked admission programs with higher vocational institutions, which in turn must reserve a set proportion of their enrollment slots or hold separate exams specifically for secondary vocational graduates. Employers are also prohibited from setting eligibility barriers based on a candidate’s vocational school background. Failing to meet the cutoff for regular high school admission simply means you get to choose a different path — it does not leave you stuck with a junior high school diploma. +- Benefit: Article 3 of the Vocational Education Law (effective 1 May 2022) stipulates: “Vocational education is an educational type that holds equal importance to general education.” Article 37 states that secondary vocational schools “may, in accordance with relevant national regulations, implement linked admission and training programs with higher vocational education for designated majors.” Higher vocational institutions “may, in accordance with relevant national regulations, admit students via assessment methods that combine academic ability and vocational skills.” Provincial-level and above education authorities are required to build unified vocational education admissions platforms to publish information on schools, majors and enrollment quotas, and provide application query services. Article 53 further specifies: “Students from vocational schools enjoy equal opportunities as students from regular schools at the same level in terms of further education, employment and career development.” Higher vocational institutions and regular universities offering vocational education “must reserve a corresponding proportion of their enrollment quotas or hold separate exams to admit vocational school graduates specifically.” It is also forbidden for employers to set application, hiring or employment criteria that prevent vocational school graduates from competing on an equal footing. For positions requiring specific vocational skill certifications in public institution recruitment, “educational requirements can be appropriately lowered” nationwide. +- Evidence grade: A +- Sources:全国人大常委会 (2022). 职业教育法（2022 年修订，第三、三十七、五十三条）. （教育部刊登） +- Notes: These benefits apply to both yourself and your children. All the channels outlined here are legally mandated, but they do not guarantee admission. The specific majors covered by linked training programs, the exact proportion of slots reserved for separate admissions, and the exact subjects tested in vocational college entrance exams are all determined by each individual province. Before submitting applications, you must check your province’s current vocational education admissions platform and enrollment quotas — do not rely on rules or practices from other provinces. When selecting a secondary vocational major, use the criteria outlined in Section 10 of this chapter (choosing skills that are less prone to automation) as a reference: majors that require on-site work in non-standard environments are less likely to be phased out. To pick a school, confirm it is listed in your province’s current vocational education enrollment plan. Verify any certificates issued by the school using the three-step process described in Section 8 (checking whether a certificate is on the official approved list). Avoid any recruitment materials that make promises like “guaranteed job placement” or “100% admission success” at all costs. +### 6. Treating “work now or study further” as a calculation: the three years of early earnings versus decades of future income + +- Cost: There is no monetary cost. Setting aside about half an hour to do the math is all it takes. +- In plain terms: Lay both options side by side on paper. Working early yields only three years of wages from low‑skill jobs. Continuing education, on the other hand, delivers extra yearly earnings for the next three or four decades. In Chinese cities, each additional year of schooling raises average income by roughly 4.0% (in 1988) up to 10.2% (in 2001). These figures are somewhat dated and should be viewed only as rough estimates. +- Benefit: This estimate applies to Chinese urban areas between 1988 and 2001. The percentage increase in income linked to one extra year of schooling is known as the return on education. The original text notes that this rate rose sharply from 4.0% per year in 1988 to 10.2% in 2001, especially after 1992. It reflects the growing wage premium enjoyed by university graduates compared with those without higher education. This figure offers a locally relevant benchmark for converting “one extra year of study” into an expected lifetime income gain. For a global average, see Section 7 of this chapter (global average return on an extra year of schooling). +- Evidence grade: B +- Sources:Zhang J, Zhao Y, Park A, Song X (2005). Economic returns to schooling in urban China, 1988 to 2001. Journal of Comparative Economics, 33(4), 730-752. +- Notes: Before performing the calculation, subtract the tuition waivers and grants mentioned in Section 4 (vocational school costs and aid), as well as the mortality impact discussed in Section 2 (extra year of schooling and mortality). The data end at 2001 and cover only urban residents, so they cannot be directly applied to today’s situation; the same caveat applies to the 9% global average cited in Section 7. Results will naturally vary from person to person. For individuals facing high tuition fees, mismatched majors or occupations, or lengthy study periods, the net benefit may indeed be negative — but this only indicates that that particular path is unwise, not that education as a whole is worthless. Several factors cannot be captured by the formula: legally mandated educational requirements (see Section 5 on integrated vocational admissions and separate exams), resistance to automation (see Section 10 on selecting automation‑resistant skills), and the possibility of switching careers. Ultimately, the benefits accrue to the individual. +### 7. Keep this baseline in mind: on average worldwide, each additional year of schooling yields a personal return of roughly 9% per year. + +- Cost: No cost at all. Memorize this figure and use it as a benchmark for evaluating any “learning opportunity.” +- In plain terms: Globally, each extra year of formal schooling translates into about a 9% annual increase in personal income; this benefit tends to be higher for women than for men. This figure applies to regular schooling, not to short courses or workshops. Think of it as a yardstick: if a course costs 30,000 yuan and lasts half a year, ask whether its expected income boost matches what one extra year of schooling would deliver. +- Benefit: A comprehensive review covering 1,120 estimates from 139 countries between 1950 and 2014 found that the worldwide average private return on each additional year of schooling is 9% per year. This private return is the portion that directly affects an individual’s earnings — on average, an extra year of schooling raises income by 9%. The private return on higher education is on the rise, while the social return on education (the benefit to society as a whole) remains substantial. Women continue to reap higher average returns than men from schooling. +- Evidence grade: A +- Sources:Psacharopoulos G, Patrinos HA (2018). Returns to investment in education: a decennial review of the global literature. Education Economics, 26(5), 445-458. ；世界银行政策研究工作论文 8402. +- Notes: This is a global average for “one extra year of schooling” and should not be taken as the expected return from a single course or workshop, nor as a figure specific to China. It serves merely as a rough reference point. Its main purpose is to provide a standard for evaluating any training program: if a course demands a 30,000‑yuan investment and six months of effort, you can gauge whether its income impact is comparable to that of one additional year of formal education. Keep in mind that this average masks considerable differences across fields and countries. +### 8. Before spending money on a certification, first verify whether it appears in the National Vocational Qualification Catalogue or in the list of evaluation agencies registered with the Ministry of Human Resources and Social Security. + +- Cost: No cost at all. It takes just a few minutes to check once. +- In plain terms: Some organizations run training programs, charge fees, and issue certificates under the guise of new occupations or skill levels, while others even impersonate authoritative institutions. The Ministry of Human Resources and Social Security has taken targeted actions to curb such practices. Before enrolling, follow three steps: confirm whether the occupation is listed in the National Vocational Qualification Catalogue; verify that the issuing agency is registered with the Ministry; and check whether the certificate number can be found on the official platform. If any of these checks fail, any money spent on enrollment is essentially wasted. +- Benefit: The Ministry has launched nationwide efforts to address these issues. Official documents specifically identify the problematic practices as “some organizations and entities arbitrarily running training, evaluation, and certification activities under the banner of new occupations, skill levels, etc., charging excessive fees and issuing certificates indiscriminately; others making false or exaggerated claims, even impersonating authoritative institutions to organize training, evaluation, and certificate issuance.” Related measures include joint crackdowns with authorities such as Cyberspace Administration, public security, and market regulation to “severely punish any evaluation or certification activities conducted by unregistered agencies or those not approved by the Ministry.” Illegal promotional content on websites and social media is also shut down per law. Additionally, the Ministry urges the public to learn how to verify certificate legitimacy and value. +- Evidence grade: A +- Sources:人力资源社会保障部 (2022). 关于开展技术技能类「山寨证书」专项治理工作的通知. +- Notes: Follow this exact sequence for verification. First, check whether the occupation appears in the National Vocational Qualification Catalogue; if not, it is not a nationally recognized qualification. Next, confirm that the issuing agency is registered with the Ministry. Finally, use the official platform for skilled worker qualification certificate queries to see if the certificate number returns a valid result. Do not enroll if any step fails. Certificates bearing terms such as “International”, “Advanced”, “Registered”, or those promising “guaranteed passing results” or “income from certificate registration” carry the highest risk. +### 9. It’s best to use government subsidies for training — don’t jump straight to paying for commercial courses out of pocket. + +- Cost: Zero cost, or at least a substantial reduction. Training does require time. The real challenge is resisting the urge to sign up for paid courses right away; first, check the local subsidy list. +- In plain terms: From 2025 through late 2027, the government plans to provide subsidized training to over 30 million participants. Funding comes from multiple sources, including employment assistance funds, unemployment insurance funds, and corporate education budgets. The more in-demand a profession is and the higher the training cost, the larger the subsidy. Employees should ask their employers first; everyone else should review their local Human Resources and Social Security Bureau’s subsidy list before deciding what to study. +- Benefit: The national target is clear: over 30 million subsidized training slots for high-tech industries, critical sectors, and priority employment groups between 2025 and 2027. Funding is pooled from various programs — employment assistance funds, unemployment insurance, sector development grants, East-West cooperation funds, and corporate education budgets. Subsidy amounts depend on how urgently a profession is needed and its training cost; they vary by occupation. Companies must also allocate at least 60% of their employee education funds to frontline staff training. +- Evidence grade: A +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: Exact eligibility criteria and subsidy amounts are set by each province. The main portals are the “Subsidized Vocational Training List” on the local Human Resources and Social Security Bureau website and public training centers. Section 7 covers unemployment-related training subsidies (up to three applications per person) and social insurance benefits. Employees should first inquire about their employer’s education fund allocation before making any decisions. Checking the subsidy list first saves far more money than choosing a course first and then searching for financial aid. +### 10. When picking a skill to learn, prioritize those that require hands-on work and on-the-spot judgment — these are the hardest for automation to replace. + +- Cost: No cost at all. Before making a choice, run through the skills you’re considering using this criterion as a filter. +- In plain terms: According to U.S. estimates, roughly 47% of jobs carry a relatively high risk of being taken over by computers. Later studies that evaluated individual tasks instead yielded a much lower percentage. Three core challenges currently prevent machines from handling certain jobs: manual dexterity, creative problem-solving, and social interaction. Hence, roles that demand physical work in unpredictable environments and real-time decision-making are far less likely to be automated, while jobs with rigid processes and heavy information processing carry the highest risk. +- Benefit: This study assessed 702 U.S. occupations to estimate the likelihood of each being automated — the result showed that about 47% fell into the high-risk category. The three aforementioned challenges form what the authors call “engineering bottlenecks” that limit automation potential. These include sensory perception and physical manipulation (finger and hand dexterity, working in cramped or awkward spaces), creative intelligence (the ability to devise novel solutions), and social intelligence (interpersonal interaction). Consequently, occupations requiring hands-on work in unstructured settings and on-the-fly judgment are consistently less prone to automation, rather than this being a random trait of specific jobs. Roles with standardized workflows and information-centric tasks face the greatest automation risk. +- Evidence grade: B +- Sources:Frey CB, Osborne MA (2017). The future of employment: how susceptible are jobs to computerisation? Technological Forecasting and Social Change, 114, 254-280. +- Notes: This research is somewhat controversial. It originated as an unpublished draft paper from 2013 that measured the overall automation potential of entire occupations. Later studies that evaluated individual tasks instead produced a significantly lower high-risk percentage. The paper also does not specify a timeline for when automation might occur. When using these findings, avoid fixating on the 47% figure; instead, focus on the three key bottlenecks it identifies. Jobs involving on-site installation, maintenance, and caregiving are far more resistant to automation than purely clerical roles for precisely these reasons. Therefore, when deciding which skill to acquire, prioritize those that demand physical work in non-standard environments. +### 11. Check first whether a skill has an official grading system and if those grades can translate into pay raises + +- Cost: No cost involved. One quick check is all you need. +- In plain terms: The government is promoting a “New Eight-Level Worker” system that requires companies to link job pay to employees’ skill levels. Outstanding workers can even have their skill grades recognized regardless of seniority or years of experience. This is the policy direction, though implementation varies widely across regions and companies. Only skills with established national occupational standards and grading pathways can eventually lead to pay increases based on those grades — so it’s worth checking first before you invest time in learning them. +- Benefit: The government is actively rolling out this New Eight-Level Worker skill grading system. Official documents explicitly require linking skill grades to employee compensation, stating that “a skill-oriented pay distribution system must be strengthened... companies should adopt a compensation model that ties both job value and skill levels to pay.” Regions are also being urged to “expand the evaluation and hiring of senior-level workers and increase the frequency of such evaluations.” Eligible companies can conduct their own skill assessments for employees, and top performers can have their skill grades recognized without needing to meet any requirements related to years of service, prior grades, or seniority. +- Evidence grade: B +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. ；人力资源社会保障部 (2021). 「技能中国行动」实施方案. +- Notes: This is the intended policy direction, not a guarantee of actual pay increases — implementation varies greatly by region and company. The key takeaway for anyone considering learning a new skill is to first verify whether it has corresponding national occupational standards and a formal grading pathway; only then can it potentially lead to pay raises based on skill level. For skills lacking any official grading system or industry entry requirements, learning them won’t guarantee any career or financial benefits — you’ll still need to find work on your own. +### 12. Don’t take “high wages reported online” as proof of labor shortages — check local lists of in-demand occupations and subsidy programs instead. + +- Cost: Nothing to pay. You just need to look up two local documents. +- In plain terms: The amount of training subsidies allocated for any given occupation depends on how urgently it is needed and the associated training costs. Thus, subsidy levels serve as a direct indicator of local labor shortages. Claims online about “monthly earnings for a certain job” are usually just posted rates or self-reported figures from job platforms. These figures represent only those who are already earning money, and they ignore factors like working hours, commuting time, occupational illnesses, and seasonal fluctuations. +- Benefit: Subsidy amounts essentially represent the official assessment of which occupations are in short supply. Policies call for “developing differentiated subsidy mechanisms based on how urgently an occupation is needed and its training costs,” which guides each region in determining which vocational training programs qualify for subsidies. Consequently, differences in subsidy levels for the same occupation across cities directly reflect local labor shortages. +- Evidence grade: C +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: TODO (Need to verify: official sources for national average wages by occupation and rankings of in-demand jobs; no relevant pages from the Human Resources and Social Security Bureau could be accessed at this time). Most online figures about “monthly earnings for a certain job” stem from job platforms or self-reported data. These figures apply mainly to those already earning money, and they fail to account for working hours, commuting, occupational risks, and seasonal trends. To gauge true demand, consult your local Human Resources and Social Security Bureau’s website for subsidy lists and check rankings of job demand from public employment services. Finally, speak with current workers at construction sites, factories, and retail outlets. +### 13. For the same cost and time, prioritize short-duration programs that lead directly to employment + +- Cost: These short-term courses require tuition fees, though the amount is modest. They also demand a significant time commitment. The challenge lies in knowing when to stop the program if results aren’t evident despite completing part of the coursework, per the agreed terms. +- In plain terms: Government policies favor short-term training programs and micro-specializations at vocational colleges that lead to quick employment. The sole criterion for selecting such programs is whether they offer a concrete job opportunity upon completion. Programs lasting a year or more, which require additional “experience-building” after graduation, end up costing far more than advertised. It’s crucial to define clear exit conditions upfront: specify the level of skill mastery required before one can stop the program if no job has been secured. +- Benefit: Government guidelines align with this approach: they support “private training institutions offering market-driven, high-quality vocational programs and short-term training initiatives that lead to swift employment.” They also encourage vocational colleges to “focus on skills and knowledge in high demand by the job market... and develop micro-specializations and vocational training courses.” +- Evidence grade: C +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: The sole deciding factor is whether a specific job opening exists after completing the program. Programs requiring a year or more of study followed by further “experience accumulation” incur far higher actual costs than their listed price. The exit conditions outlined in Section 4 also apply here: clearly define in advance the skill threshold at which one may discontinue the program if no job is found. +### 14. After studying, close the book and test yourself — don’t just reread it. + +- Cost: There’s no cost involved, and no extra time is needed. Use the time you’d otherwise spend rereading to write down or answer questions from memory instead. The difficulty lies in how uncomfortable it feels to confront what you’ve forgotten right away, compared to the relative ease of rereading. +- In plain terms: Rereading a section often makes it seem very familiar, but that doesn’t mean you’ve actually retained it well. Testing yourself after reading yields noticeably better results. In classrooms where brief quizzes are added, average test scores rise by a moderate amount. When ranking ten common study methods, self-testing comes out on top. After finishing a section, try writing down the key points from memory before checking them against the text. +- Benefit: A meta-analysis of 222 separate studies involving 48,478 students found that classroom quizzes led to a moderate improvement in academic performance (effect size g = 0.499). This effect varies depending on several factors: the baseline study method used in the control group, how closely the quiz format matches the final exam, whether the material is comparable, whether corrective feedback is provided, how many times the quiz is administered, when and where it takes place, how long the intervention lasts, and the experimental design used. Another comprehensive review that evaluated all ten widely used study techniques rated “practice testing” and “spaced practice” as the most effective methods overall. Their high utility stems from proven success across learners of different ages and abilities, as well as in diverse testing formats and real-world educational settings. +- Evidence grade: A +- Sources:Yang C, Luo L, Vadillo MA, Yu R, Shanks DR (2021). Testing (quizzing) boosts classroom learning: A systematic and meta-analytic review. Psychological Bulletin, 147(4), 399–435. ；Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: Self-testing is meant to force information out of your memory, not to assign grades. The recommended approach is to write down key points from memory after reading a section, then check them against the text. Providing corrective feedback further boosts effectiveness, so it’s important to carefully review why each answer was incorrect. The “large” magnitude of benefit mentioned here is determined by both the effect size and the overall rating. Since these studies measured academic outcomes rather than time saved, they weren’t evaluated against time‑saving thresholds. Self-testing and the method described in item 15 — spreading the same amount of study time across several days — are the two highest‑rated strategies identified in the same review; using them together yields the best results. +### 15. Spread the same study time over several days instead of cramming it all at once + +- Cost: There’s no extra expense, and the total time required stays the same. The only change is the schedule: those same 3 hours are split into three 1-hour sessions. The challenge is that you must start planning days in advance — you can’t leave it all for the final night. +- In plain terms: Studying the same amount of material over several days helps you retain it far better than cramming it all at once. 317 separate experiments have all confirmed this same conclusion. There’s also a practical rule to follow: the longer you want to retain the information, the longer the interval between review sessions should be. If a test is tomorrow, review the material that day; if it’s a month away, schedule a few review sessions in between. +- Benefit: This is a meta-analysis that brought together data from 184 papers, 317 experiments, and 839 separate evaluations of distributed practice. It compared two key factors: studying material in one continuous block versus splitting it into multiple sessions (the spacing effect), and short versus long review intervals (the delay effect). Its main finding is that both the length of time you aim to retain information and the spacing between review sessions together determine your final retention rate: the longer you need to remember the material, the longer the ideal spacing between reviews becomes. Another review that assessed ten common learning strategies ranked distributed practice as one of the highest utility methods overall. +- Evidence grade: A +- Sources:Cepeda NJ, Pashler H, Vul E, Wixted JT, Rohrer D (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354–380. ；Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: This tip works best when combined with Tip 14 (self-testing without looking at notes): you can also spread out those self-test sessions over several days. Most of the study materials used in Cepeda’s meta-analysis focused on simple tasks like memorizing word lists, so no universal recommended interval length exists for more complex subjects. The original research states that the longer the upcoming test date, the longer the ideal spacing between reviews should be, but no specific schedule is provided. Cramming the night before an exam does offer some short-term benefit, but the information is quickly forgotten. +### 16. Don’t treat highlighting, rereading, and summarizing as primary study methods + +- Cost: No cost at all; actually saves time. These methods are easy to apply and give you that “I’m studying” feeling. +- In plain terms: Highlighting and rereading are the most common study habits among students, yet both rank at the very bottom among ten widely used learning strategies. Summarizing, keyword memorization, and visualizing text with images also fall into the lowest tier. They’re not completely useless, but only work under very specific conditions, so spending the same amount of time on self-testing yields far better results. +- Benefit: This review evaluates ten common study methods based on how well their effectiveness holds across different learning contexts, student traits, materials, and assessment formats. The highest-rated strategies are practice testing and spaced practice. Methods rated as moderately effective include elaborative questioning, self-explanation, and interleaved practice. The five least effective methods are summarizing, highlighting (or underlining), keyword memorization, visualizing text with images, and rereading. The review also notes that while most students report using rereading and highlighting, these methods do not reliably improve academic performance; they should be replaced with other approaches such as practice testing instead of rereading. +- Evidence grade: A +- Sources:Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: You can use highlighting to mark sections you plan to self-test later, but the problem arises when highlighting itself is mistaken for actual learning. The review also clarifies that being in the lowest tier does not mean these methods have zero value — they simply work only under narrow circumstances and require further research. For alternative study actions, see item 14 (self-testing after closing the book) and item 15 (spreading study time across multiple days). +### 17. Mixing different types of exercises rather than doing twenty of the same kind + +- Cost: No cost at all. Simply rearrange the order of exercises in your workbook so they’re not grouped by type. The downside is that mixing them often lowers your immediate accuracy, which can feel like a step backward. +- In plain terms: Practicing one type of problem over and over makes it feel easy at the time, but later you might struggle to recall which method to apply. Mixing several types together yields better long‑term results — though the improvement is moderate. This technique works best with visual material such as drawings or categorization tasks; it has a smaller effect on math problems, and for vocabulary memorization it’s actually better to practice in blocks. +- Benefit: This finding comes from a comprehensive meta‑analysis that included 59 studies, 238 effect sizes, and 158 samples. Overall, interleaved practice produces a moderate benefit compared with blocked practice (Hedges’ g = 0.42). When broken down by material, visual tasks benefit the most (g = 0.67), while math problems show a smaller effect (g = 0.34). No significant advantage was found for expository texts or taste‑related tasks; for vocabulary, blocked practice actually performed better (g = −0.39). Regression analysis indicates that the benefit grows when categories are more similar, when items within a category are less alike, and when the material itself is more complex. +- Evidence grade: A +- Sources:Brunmair M, Richter T (2019). Similarity matters: A meta-analysis of interleaved learning and its moderators. Psychological Bulletin, 145(11), 1029–1052. +- Notes: The review cited in item 16 — which warns against relying solely on highlighting — rated interleaved practice as having a moderate effect, noting that evidence at the time was limited. Taken together, these studies suggest that interleaving works well for material that requires you to recognize a category and pick the right method, such as different math problem types, medical cases, or legal statutes. In contrast, content meant for rote memorization — like vocabulary or definitions — is better learned through blocked practice. +### 18. Don’t pick learning methods based on “I’m a visual learner, he’s an auditory learner” + +- Cost: No cost at all. You simply stop using this classification to pick materials or courses, and you also avoid spending money on style assessments. +- In plain terms: Many people believe each person has a distinct learning style — such as being visual or auditory — and that teaching should be tailored to that style for best results. Yet there are very few rigorous studies on this, and almost none provide any support for it; several even show the opposite. While people do have personal preferences, there’s no evidence that instruction aligned with those preferences leads to better learning. There’s also no need to spend money on learning style assessments. +- Benefit: A comprehensive review evaluating evidence on learning styles concluded that to prove “teaching according to learning styles” works, students must first be grouped by style, then randomly assigned to different teaching methods, and finally tested using the same assessment. The key indicator of effectiveness would be a specific interaction effect: a teaching method highly effective for one style would be less effective for another. The review found almost no such interaction effects. Although there’s plenty of literature on learning styles, very few studies employ proper experimental designs, and several of those produce results directly contradicting the “match hypothesis.” Based on this, the authors argue current evidence simply doesn’t justify incorporating learning style assessments into educational practice. +- Evidence grade: A +- Sources:Pashler H, McDaniel M, Rohrer D, Bjork R (2008). Learning Styles: Concepts and Evidence. Psychological Science in the Public Interest, 9(3), 105–119. +- Notes: The review also notes this doesn’t mean every version of learning style theory has been tested and disproven; many have never been examined at all. What you should definitely avoid is spending money on learning style assessments or selecting training programs based on such classifications. Criteria for picking training options are outlined in item 9 (prioritizing government-subsidized programs) and item 13 (favoring short-term programs that lead directly to employment). +### 19. Test yourself using questions based on how you’ll use the material later; don’t just recite it verbatim + +- Cost: There’s no expense involved, nor does it require extra time. The only change is the practice method: replace “reciting it verbatim” with “creating questions based on future usage.” The real challenge is figuring out exactly how you’ll apply this material later on. +- In plain terms: Testing yourself after closing the book offers benefits beyond simply memorizing a few words. A meta-analysis of 192 comparisons involving over 10,000 participants showed that this method works moderately well for different question types, application problems, and reasoning tasks. However, it’s largely ineffective in two scenarios: when the question–answer pairing is reversed, and when the content has only ever been seen in the book without any prior testing. +- Benefit: This meta-analysis examined over 40 years of research, drawing from 67 published and unpublished papers, 122 experiments, and 192 measures of transfer effects involving 10,382 participants total. Compared to simply reviewing material without testing, practice testing led to measurable learning transfer, with an effect size of d = 0.40 (95% CI 0.31–0.50). Transfer was strongest when participants answered questions of a different type, application or reasoning problems, or medical‑diagnosis‑style queries involving similar concepts. Transfer was weakest when the stimulus–response pairing was reversed, when material had only been encountered but never tested, or when dealing with example‑style problems. Factors such as whether the practice and test formats matched, whether detailed feedback was provided, and whether participants answered correctly on the initial test all strongly influenced whether positive transfer occurred. Two separate methods were used to correct for publication bias; while these adjustments modestly affected effect sizes, they substantially lowered the baseline intercept value. Under these conditions, positive transfer is often not observed at all. +- Evidence grade: A +- Sources:Pan SC, Rickard TC (2018). Transfer of test-enhanced learning: meta-analytic review and synthesis. Psychological Bulletin, 144(7), 710-756. +- Notes: The term “memorization” usually bundles two distinct activities: repeatedly reading or highlighting material, and actively recalling it after closing the book. The former receives the lowest rating in a review that ranked ten learning strategies; for those ratings themselves, see item 16 (avoid relying on highlighting, repeated reading, or summarization as primary methods). What matters here is the latter: actively recalling information without looking at the source, as described in item 14 (self‑testing after closing the book). This practice should also be spread across several days, as noted in item 15 (distributed practice). Begin by determining how you’ll ultimately use the material—whether you’ll need to select answers on a test or make judgments in a real‑world setting—and then create questions that mirror those situations. It’s also valuable to reverse the question–answer order during practice, because the meta‑analysis showed that transfer is weakest in that direction; both orientations should be practiced. +### 20. First, figure out which professional series and level you belong to, then find the right application channels based on your employer type. + +- Cost: No cost involved. It takes about half an hour to look up the latest application guidelines for your province. +- In plain terms: There are 27 professional series nationwide, each divided into junior, intermediate, and senior levels. Generally, you must progress through these levels one by one. Employees working for organizations must have their applications reviewed and publicly posted by their employer before submission. Those working for private firms can apply via local professional qualification service centers, talent agencies, or industry associations. Self-employed individuals should apply through the local human resources and social security department. +- Benefit: A total of 27 professional series exist across China, covering fields such as economics, engineering, healthcare, and publishing. These are categorized into senior, intermediate, and junior levels. Order No. 40 issued by the Ministry of Human Resources and Social Security applies to enterprises, public institutions, social organizations, individual economic entities, and self-employed professionals alike. Applicants must generally advance step by step through these levels. Employers must review all submitted materials and publicly display them for at least five working days. Private firms and self-employed individuals may opt to have talent agencies handle the review, public posting, and recommendation processes. Local authorities are required to establish professional qualification service centers in science parks and high-tech zones; applications may also be accepted through talent agencies, industry associations, and professional societies. Eligible self-employed individuals may participate in evaluations organized by local human resources departments. Any documentation that can be verified online must not require additional certification. If any materials are missing, evaluators must clearly specify what is lacking in one single notice. Employees of private firms typically apply in the region where their employment contract is based. Those assigned to work elsewhere for at least one full year may apply at their temporary duty location. Retired personnel are ineligible to apply. Public sector employees currently under disciplinary action at or above the level of a reprimand cannot apply during that period (nationwide). +- Evidence grade: A +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第二条、第十三条、第十四条、第十五条、第十六条、第十七条、第十八条；人力资源社会保障部办公厅 (2020). 关于进一步做好民营企业职称工作的通知. ：「在专业技术人才密集的创业孵化基地、高新技术开发区、科技园区等地设立职称申报受理服务点，或通过人才中介服务机构、工商联、行业协会商会、学会等社会组织受理民营企业专业技术人才职称申报」「民营企业专业技术人才被派驻外地连续工作一年以上的，可按有关规定在派驻地申报职称评审」；新华社 (2024). 职称评审进入高峰，信息如何查？有何新变化？ ：「我国共设有经济、工程、卫生、出版等27个职称系列」「符合条件的自由职业者，可根据属地原则申报参加当地人社部门组织的职称评审」；中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「不将论文作为评价应用型人才的限制性条件」「对职称外语和计算机应用能力考试不作统一要求」「符合条件的高技能人才，可参加工程系列专业技术人才职称评审」「公务员不得参加专业技术人才职称评审」 +- Notes: No single nationwide list of required documents exists. Each professional series and province publishes its own annual application guidelines detailing necessary materials, deadlines, and performance criteria. Therefore, the first step is to search the official website of your provincial human resources department for the current year’s instructions. Publishing academic papers is no longer mandatory: a 2016 reform directive explicitly removed this requirement for practical professionals, and standardized language or computer proficiency tests are no longer mandatory either. Skilled technical workers may also qualify to apply for engineering-related professional titles. Government officials are prohibited from participating in such evaluations. +### 21. Entry- and intermediate-level accounting titles are earned via a national unified exam; first check your education level and work experience to see if you qualify. + +- Cost: Registration fees vary by province. Preparing for the exam requires several months of part-time study. +- In plain terms: Many entry- and intermediate-level professional titles are awarded solely through exams; passing the test is enough, with no additional evaluation needed. Accounting falls under this category: an assistant accountant must have at least a high school diploma, while a full accountant requires a bachelor’s degree plus four years of accounting work experience, or an associate degree plus five years. Those who already hold certain professional certifications may also be recognized as meeting the corresponding title requirements. +- Benefit: A 2016 reform directive states that for professional fields where entry- and intermediate-level titles rely on a national exam, no further evaluation or certification is required. In areas where professional titles and qualifications are closely linked, earning a qualification automatically grants the corresponding title and can serve as a prerequisite for advancing to a higher level. Accounting is a prime example: assistant accountants and accountants are selected via a nationwide exam. Senior accountants undergo both an exam and evaluation, while top-level titles are awarded solely through evaluation. Qualification criteria are as follows: Assistant accountants must have at least a high school diploma, including vocational, technical, or secondary specialized education. Accountants must hold a doctorate; or a master’s degree plus one year of accounting experience; or a second bachelor’s degree, graduate diploma, or equivalent plus two years of experience; or a bachelor’s degree plus four years of experience; or an associate degree plus five years of experience. Those with a master’s or doctorate in accounting may be exempt from the Financial Management exam portion when applying for accountant status. +- Evidence grade: A +- Sources:中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「专业技术人才取得职业资格即可认定其具备相应系列和层级的职称，并可作为申报高一级职称的条件。初级、中级职称实行全国统一考试的专业不再进行相应的职称评审或认定。」；人力资源社会保障部、财政部 (2019). 关于深化会计人员职称制度改革的指导意见. ：「助理会计师、会计师实行全国统一的会计专业技术资格考试」「高级会计师采取考试与评审相结合方式，正高级会计师一般采取评审方式」；财政部等 (2024). 关于做好会计专业学位与会计专业技术资格衔接有关工作的通知. +- Notes: To determine whether your professional series relies on exams, evaluations, or a mix of both, consult the relevant “Guiding Opinions on Deepening Reforms of [Series] Professional Title Systems.” These documents were issued by the Ministry of Human Resources and Social Security and sector-specific authorities; they can be found in the policy archives on the Chinese Government website. Exact registration dates and exam subjects are listed in each year’s official exam announcements. Civil servants may take the accounting exam but are not eligible to apply for accounting title evaluations. +### 22. Don’t hire agents to handle evaluations, don’t pay for ghostwritten papers, and don’t falsify any application materials: any proven violations will result in immediate revocation of your professional title and a 3-year entry in your integrity record. + +- Cost: No direct monetary cost. The real challenge is resisting tempting ads promising “guaranteed approval for a fee.” +- In plain terms: Any professional title obtained through fake materials, ghostwritten papers, or plagiarized work will be revoked upon verification. A record of this misconduct stays on file for 3 years and is shared with the national credit database. If you sign a commitment statement during application and later prove it to be false, you will be barred from applying for any title for 3 years. Labor and social security authorities also actively crack down on agents that make false claims, pose as official evaluators, or sell counterfeit certificates. +- Benefit: As stipulated in Order No. 40 issued by the Ministry of Human Resources and Social Security, anyone found to have submitted false materials, plagiarized others’ work or academic achievements, or obtained a professional title through any other improper means will have their title revoked. This violation is also logged into the professional title evaluation integrity database and shared with the national credit information platform for a 3-year period. The 2024 regulatory guidelines specifically list several prohibited acts by applicants: making false commitments, fabricating personal information, commissioning ghostwritten papers, falsifying work achievements, and seeking special treatment via personal connections. Applicants must sign a personal commitment statement; failure to honor this agreement results in a 3-year ban on all future applications. Labor and social security authorities collaborate with public security, internet regulatory, and market supervision agencies to investigate and penalize agents that run fake websites, make misleading claims, use contract traps, pose as official evaluators, or sell counterfeit certificates. In cases where violations are severe enough to constitute a crime, relevant parties will be handed over to judicial authorities for prosecution (nationwide). +- Evidence grade: A +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第三十九条；人力资源社会保障部 (2024). 职称评审监管暂行办法. ：第五条、第十五条、第十七条、第二十七条；人力资源社会保障部办公厅 (2022). 关于进一步做好职称评审工作的通知. ：「未经备案的职称评审委员会，评审结果不纳入全国职称评审信息查询验证系统」；新华社 (2024). 职称评审进入高峰，信息如何查？有何新变化？ ：「大家可通过www.12333.gov.cn网页、手机12333客户端、人力资源社会保障部门户网站、“人力资源和社会保障部”微信公众号等多种渠道进行登录」 +- Notes: A simple way to tell legitimate evaluations from fraudulent ones: any officially awarded professional title can be verified via the National Professional Title Evaluation Information Query Platform, accessible through the 12333 website, its mobile app, or the official Ministry of Human Resources and Social Security site. Titles issued by unregistered evaluation committees cannot be found in this system at all. Therefore, any agent or service that guarantees “100% approval”, claims you don’t need to attend any evaluation process, or promises you can use a title even if it does not appear in official records is almost certainly untrustworthy. The main beneficiaries of these rules are applicants themselves, as they protect them from the serious consequences of title revocation and a 3-year negative credit record. +### 23. Having a professional title doesn’t automatically mean a pay raise: first find out whether your employer uses a post‑based quota for evaluation and hiring, or if getting the title doesn’t guarantee a post or raise. + +- Cost: No cost at all. Just ask your HR department once. +- In plain terms: Professional titles serve as the basis for hiring, performance reviews, and promotions, but earning a title and actually being assigned to a corresponding post are two different things. In public institutions, titles are usually awarded within a set post‑ratio, and most people who earn them do get hired. Organizations without post‑based management can separate evaluation from hiring; in such cases, earning a title doesn’t guarantee a post or higher pay. When moving to another organization or region, you may need to re‑evaluate or re‑confirm your title. +- Benefit: Article 2 of Ministry of Human Resources and Social Security Order No. 40 states that professional title evaluation results are key references for hiring, performance reviews, and promotions of technical professionals. A 2016 reform guideline specifies that public institutions using post‑based management conduct evaluations within their post‑ratio framework, while organizations without such management — as well as professions with broad applicability and emerging occupations — may separate evaluation from hiring. When technical professionals transfer across regions or employers, their titles must be re‑evaluated or confirmed according to administrative authority, unless otherwise stipulated by national regulations (nationwide). +- Evidence grade: B +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第二条、第二十九条；中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「对于全面实行岗位管理、专业技术人才学术技术水平与岗位职责密切相关的事业单位，一般应在岗位结构比例内开展职称评审。对于不实行岗位管理的单位，以及通用性强、广泛分布在各社会组织的职称系列和新兴职业，可采用评聘分开方式。」 +- Notes: The evidence grade is B because the documents describe how evaluation and hiring relate to each other, but they provide no nationwide figures on how much pay rises after earning a title. What you can do: in public institutions and state‑owned enterprises, ask HR about available post openings and hiring rules; in private firms, ask the owner whether the certificate is recognized and whether it brings a pay increase. diff --git a/book/24-Seeing-The-Doctor.md b/book/24-Seeing-The-Doctor.md new file mode 100644 index 00000000..dc469576 --- /dev/null +++ b/book/24-Seeing-The-Doctor.md @@ -0,0 +1,135 @@ +# 24. Seeking medical care: How to save money and avoid unnecessary hassle + +This section focuses on the practical steps involved in getting medical treatment — which hospitals to visit first, how to transfer between levels of care, and where you can cut down on expenses. It also explains how to wait in emergency queues, what evaluations and documents are required after serious injuries, and what benefits you may be eligible for (see Section 7). Long‑term management of chronic diseases is covered in Section 16, while immediate actions at the scene of an emergency are described in Section 13. + +The content is largely based on the “Several Measures on Accelerating the Development of a Hierarchical Medical System” issued by the General Office of the State Council in April 2026. This system directs patients to hospitals according to the severity of their condition. The document explicitly links using primary‑level facilities with lower medical costs. However, implementation varies by region, so the national rules outlined here should be cross‑checked with local policies issued by your social insurance and health authorities. Your “coordinated region” is simply the area where you’re enrolled in medical insurance — usually a city. +### 1. For common illnesses, patients should first visit community clinics; referrals then proceed stepwise to larger hospitals, after which the hospital deductible is calculated only once. + + +- Cost: No expense is required. You must first make a trip to a community clinic. The hard part is resisting the urge to book an appointment with a specialist right away. +- In plain terms: Start by going to a community clinic, which will then refer you to a larger hospital for inpatient care. The amount you pay out-of-pocket at the start is counted only once. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you might have to pay that amount twice. However, if a larger hospital refers you back to a community clinic for continued treatment, the deductible is not recalculated for the same condition during that period. +- Benefit: Insured patients who follow this stepwise referral process can have their hospital deductible accumulated across multiple facilities. The deductible represents the portion of each hospitalization you must pay personally before insurance coverage kicks in. Accumulation means that the total paid at both the community clinic and the larger hospital counts as a single deductible amount, so you do not have to pay it again. For patients transferred from a larger hospital back to a community clinic, no additional deductible is applied for the same illness during that timeframe. +- Evidence grade: A +- Notes: The deductible is the amount you pay out-of-pocket per hospitalization before insurance begins to reimburse costs. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you may end up paying this amount twice. Following the proper referral pathway ensures it is calculated only once. Specific referral rules are determined individually by each province, city, and medical consortium. Be sure to ask your community clinic about these rules before seeking care. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「统筹地区内经基层医疗卫生机构逐级转诊的参保患者，在上级医院的住院起付线可连续计算；由上级医院下转至基层医疗卫生机构的住院患者，同一疾病周期内不再另设住院起付线。」 + +### 2. Within the same medical insurance region, the lower the hospital level, the higher the reimbursement rate — the difference is roughly 10 percentage points. + + +- Cost: No direct cost involved. The real challenge is resisting the urge to go to a larger hospital. +- In plain terms: For the same hospitalization bill, the lower the hospital level, the more you get reimbursed. Regions are required to set reimbursement rates that differ by about 10 percentage points between each successive level. Choosing a larger hospital when a community clinic can handle the case means you’ll have to pay roughly 10% more out of pocket. Newly allocated medical insurance funds also favor primary‑care facilities. +- Benefit: Policies mandate that reimbursement rates for inpatient care differ by roughly 10 percentage points across hospital levels. Consequently, for the same expenses, each step up to a higher‑level hospital results in about a 10% increase in personal costs. New annual medical‑insurance allocations likewise prioritize grassroots healthcare providers. +- Evidence grade: A +- Notes: For the same hospitalization bill, the out‑of‑pocket difference between a community clinic and a tertiary hospital can reach several thousand yuan. This guideline does not suggest that every condition should be treated at a community level; rather, it advises seeking care at lower‑level facilities whenever possible. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「因地制宜适当拉开参保人员在不同等级医疗卫生机构的住院报销水平，原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距。」「具备条件的地方，可按分级诊疗导向酌情拉开参保人员在不同等级医疗卫生机构的门诊报销水平。」 + +### 3. Go to a major hospital via a referral from a local clinic or the hospital’s referral center — don’t turn to scalpers. + +- Cost: No direct cost, but an extra referral step is required. +- In plain terms: Major hospitals must set aside a portion of appointments and beds specifically for patients referred from local clinics. They must also establish a referral center or designate a dedicated department to handle referrals — this requirement will be fully implemented by 2027. Not being able to book a slot online does not mean there is no way in. Scalpers charge exorbitant fees and may even route you to the wrong department. +- Benefit: Lead hospitals in tightly integrated medical networks must reserve a specific share of appointments and beds for patients referred from local clinics, and promptly admit them. Such networks consist of multiple hospitals and community health centers working together. In other words, there is a separate pool of appointments and beds reserved for referred patients, separate from the general booking pool. All hospitals must set up referral centers or assign a dedicated department by 2027. +- Evidence grade: A +- Notes: The reserved appointments and beds are specifically meant for referred patients. Failing to book online does not mean there is no way in. Using scalpers is not only costly but may also lead to being assigned to the wrong department. If you cannot locate the referral center, call the hospital’s service line for help. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「牵头医院要为基层医疗卫生机构预留一定比例的号源和床位，并及时接诊经基层转诊患者。」「医疗机构要强化转诊服务统一管理，设立转诊中心或指定固定部门承担患者转诊服务工作，到2027年实现全覆盖。」 + +### 4. Before seeking medical care outside your home province, ask locally first — the need for such care should ideally be assessed by an associate chief physician or higher. + + +- Cost: No cost involved. It simply requires asking a few extra questions beforehand. +- In plain terms: Whether a patient needs to travel elsewhere for treatment should, in principle, be evaluated by doctors holding the rank of associate chief physician or above at secondary or tertiary hospitals. Reimbursement rates for temporary out-of-area treatment differ from those offered at local hospitals of comparable level; exact terms depend on local regulations. Asking locally beforehand is far better than discovering later that no reimbursement is possible. +- Benefit: The necessity of receiving medical care across different healthcare regions or provinces must, ideally, be assessed by qualified physicians at secondary or tertiary hospitals holding the rank of associate chief physician or higher. “Cross-regional care” refers to treatment sought outside one’s designated medical insurance area. This assessment must be performed by doctors meeting the required qualifications. Reimbursement levels for temporary out-of-province patients also differ reasonably from those at local hospitals of the same level; consequently, patients receive less coverage for identical treatments received elsewhere. +- Evidence grade: A +- Notes: “Temporary out-of-area treatment” and “long-term residence elsewhere” constitute two distinct registration categories, each with different reimbursement levels. Details regarding registration procedures and which conditions qualify for direct settlement are covered in Section 16. Do not travel to another province first and then worry about reimbursement later. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「原则上由二、三级医院副主任医师及以上职称人员评估患者跨统筹地区、跨省异地就医的必要性。」「进一步强化异地就医直接结算管理服务，跨省临时外出就医人员报销水平与参保地同级别医疗机构报销水平保持合理差异。」 + +### 5. Stop treating tertiary hospitals as mere prescription hubs — stable chronic disease patients should turn to primary care + +- Cost: No monetary cost involved. The real challenge is breaking the habit of relying exclusively on large hospitals. +- In plain terms: Moving forward, tertiary hospitals will primarily handle emergency cases, critically ill patients, and complex medical conditions. Routine follow-ups for common illnesses and regular outpatient visits for patients with stable chronic diseases will gradually be phased out. The same expert physicians who previously saw patients in tertiary hospitals will now provide care at community clinics. Continuing to use large hospitals solely for medication refills will become increasingly difficult as appointment slots dwindle. +- Benefit: Tertiary hospitals can better focus on emergency care, critically ill patients, and complex medical issues by gradually reducing routine outpatient services for common illnesses and stable chronic disease cases. This means fewer appointment slots will be available for such visits. Meanwhile, expert medical teams from top-tier hospitals will extend their outpatient services to community-level facilities, making their expertise accessible locally. +- Evidence grade: A +- Notes: This reflects official policy direction rather than a recommendation. Access to routine outpatient services at large hospitals will become increasingly limited in the future. For patients with stable chronic diseases, primary care clinics can issue medication prescriptions valid for up to 12 weeks — see Section 16 for details. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「三级医院要聚焦急危重症和疑难复杂疾病，加强转诊会诊和住院服务，逐步酌减常见病复诊和诊断明确、病情稳定的慢性病等普通门诊。」「紧密型医联体内上级医院要在基层医疗卫生机构开设高血压、糖尿病、慢性阻塞性肺疾病等常见病、慢性病门诊，提供诊疗和健康管理服务，并将专家团队普通门诊向基层医疗卫生机构延伸。」 + +### 6. After every medical visit, keep a personal copy of your medical records, test reports, and imaging scans + +- Cost: No cost involved. Hospitals may charge a nominal fee for photocopying, but the rate must be publicly disclosed. The real challenge is remembering to make a copy after each visit. +- In plain terms: You have a legal right to access and copy your own medical records. This includes outpatient records, inpatient charts, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and itemized billing statements. Hospitals provide dedicated counters for this purpose, where only basic copying fees apply. These documents prove invaluable when switching doctors, seeking a second opinion, filing commercial insurance claims, or in case of any legal disputes. +- Benefit: Laws explicitly recognize access to and duplication of medical records as a fundamental patient right. This entitlement covers all relevant documents such as outpatient and inpatient records, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and billing statements. They serve as essential evidence when changing healthcare providers, obtaining a second medical opinion, filing insurance claims, or in any legal proceedings. +- Evidence grade: A +- Notes: Hospitals maintain dedicated counters for record copying — no need to ask doctors for help. To ensure completeness, simply read aloud the list stipulated in Article 16 of the Regulations on Prevention and Handling of Medical Disputes. It includes outpatient records, inpatient charts, temperature logs, physician orders, lab results, imaging scans, surgical and anesthesia notes, pathology reports, nursing records, and billing statements. Once obtained, organize them chronologically in a dedicated folder. The most critical documents are discharge summaries, surgical reports, pathology findings, and key imaging scans. For chronic disease management, record all relevant metrics in one notebook as described in Section 16. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号）第十六条：「患者有权查阅、复制其门诊病历、住院志、体温单、医嘱单、化验单（检验报告）、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录、病理资料、护理记录、医疗费用以及国务院卫生主管部门规定的其他属于病历的全部资料。」「患者要求复制病历资料的，医疗机构应当提供复制服务，并在复制的病历资料上加盖证明印记……可以收取工本费，收费标准应当公开。」「患者死亡的，其近亲属可以依照本条例的规定，查阅、复制病历资料。」第十五条「任何单位和个人不得篡改、伪造、隐匿、毁灭或者抢夺病历资料。」；国家卫生计生委、国家中医药管理局 (2013). 医疗机构病历管理规定（2013 年版）：医疗机构「应当指定部门或者专（兼）职人员负责受理复制病历资料的申请」，复制在申请人在场的情况下进行并加盖证明印记. + +### 7. If you have doubts about treatment, request to seal the medical records on the spot; both parties must be present, a list must be drawn up, and each side gets a copy. + + +- Cost: No cost at all. Simply ask the hospital to seal the records; both you and the medical staff must be present to complete the paperwork. The real challenge is mustering the courage to say this out loud in front of the doctors. + +- In plain terms: If you’re unsure about any aspect of your treatment, you have the right to request that your medical records be sealed. Both you and the medical staff must be present for this process, which involves creating a detailed list, signing and stamping it, and each side receiving a copy. If the records aren’t fully completed yet, only the finished portions should be sealed first; the rest can be sealed later. Should you suspect that an intravenous infusion, blood transfusion, injection, or medication caused a problem, the actual fluid bag, medicine vial, and infusion set must also be sealed together with the records. + +- Benefit: Regulations clearly state that “whenever a medical dispute arises and it is necessary to seal or unseal medical records, this must be done while both the patient and medical staff are present.” The sealed documents may be either originals or copies, which the hospital then stores. If the records are still being written, only the completed sections should be sealed first; the remainder can be sealed later. The hospital must produce a sealing list, signed or stamped by both parties, with each side keeping a copy. In cases where an adverse effect is suspected to stem from an IV, blood transfusion, injection, or medication, both parties must jointly seal and later unseal any related physical items. If testing is required, both parties must jointly appoint a qualified laboratory; should they fail to agree, the local health authority at the county level where the hospital is located will make the appointment. Should a transfusion-related problem be suspected and blood samples need sealing, the hospital must notify the blood bank to send representatives to the scene. Additionally, there is a strict rule: “No organization or individual may alter, forge, conceal, destroy, or seize medical records.” Once a dispute is resolved or three years pass without any further claims, the hospital may unseal the documents on its own initiative (nationwide, effective 1 October 2018). + +- Evidence grade: A + +- Notes: Sealing records and making copies are two distinct actions. Copying records is something you should do proactively, as explained in item 6 (always keep your own copies of medical records and imaging). Sealing, on the other hand, serves to preserve evidence at the moment a dispute arises, preventing any later alterations or additions. If you suspect that an IV, blood transfusion, injection, or medication caused a problem, you must seal not only the records but also the fluid bag, medicine vial, and infusion set; otherwise they might be removed or discarded. Hospitals are required to prominently display information about dispute resolution procedures, contact details, and to maintain a dedicated complaints department. In case of any issue, approach that department rather than confronting the attending physician directly. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号，第十五、二十四、二十五条）. + +### 8. Head straight to the emergency triage desk — don’t wait in line at registration + +- Cost: No cost at all. Just walk a few extra steps to find the triage desk and describe the most life‑threatening symptom in one sentence. +- In plain terms: Emergency care isn’t served on a first‑come, first‑served basis; patients are sorted into four severity levels. The triage desk at the ER entrance — not the registration window — makes that determination. Without a triage rating, even the most severely injured patients must wait in line like everyone else. First, state the most dangerous condition: heavy bleeding, difficulty breathing, altered consciousness, foreign objects in the body, or crushing chest pain. +- Benefit: According to the 2024 quality‑control guidelines for emergency medicine issued by China’s National Health Commission, patients must be classified into four levels based on severity. Level I denotes critically ill patients who require immediate treatment; Level II covers severely ill patients whose assessment and care happen simultaneously. Level III includes urgent patients needing prompt diagnosis and treatment, while Level IV comprises non‑urgent or semi‑urgent cases that are seen in regular order. Triage is the process by which trained staff evaluate each patient at entry and assign a priority rank. Beijing’s implementation rules specify response times for each level: Level I patients must be evaluated and treated at once, often in a resuscitation room; Level II patients need vital‑sign monitoring and treatment within ten minutes, also in a resuscitation room; Level III patients are seen before Level IV cases, but if wait time exceeds 30 minutes they must be re‑evaluated; Level IV patients wait in regular sequence, though any change in condition can trigger a reassessment after four hours. The principle of giving priority to critically ill patients must be strictly observed, and a dedicated triage area must be clearly marked at every ER entrance (the four‑level framework is national, while the response times are specific to Beijing). +- Evidence grade: A +- Notes: The four‑level system is standardized nationwide; exact treatment intervals are set locally, and Beijing’s version can be verified verbatim. Triage relies on measurable indicators such as heart rate, blood pressure, oxygen saturation, and specific symptoms — not on how much pain a patient reports. For Level I, key criteria include a heart rate above 180 bpm or below 40 bpm, systolic blood pressure under 70 mmHg, oxygen saturation below 80 %, shock, confirmed myocardial infarction, or acute loss of consciousness. If you feel your level was assigned incorrectly, describe the most dangerous symptom in detail. Should your condition worsen while waiting, return to the triage desk for re‑evaluation. In truly critical situations, calling emergency services (120) is faster than self‑transport; pre‑hospital staff apply the same criteria to assign an initial level and alert the hospital in advance (see Section 13). +- Sources:国家卫生健康委办公厅 (2024). 关于印发急诊医学等 6 个专业医疗质量控制指标（2024 年版）的通知（国卫办医政函〔2024〕150 号）附件 1，指标四「急诊分级分诊执行率」. ；北京市卫生健康委员会 (2019). 北京市加强急诊预检分诊分级工作方案及附件《北京市医院急诊预检分诊分级标准（试行）》：「坚持急危重症优先就诊原则。按照患者病情的严重程度，遵循从重到轻、从病情迅速变化到相对稳定的原则，合理安排患者就诊顺序。」「在急诊科入口的显著位置，设置急诊预检分诊区域」. + +### 9. Even without money or ID, and unable to identify yourself, emergency care must be provided first + +- Cost: No cost at all. +- In plain terms: The state maintains an emergency medical assistance fund designed to cover emergency treatment costs for two groups of patients: those whose identities cannot be verified, and those whose identities are known but who cannot afford the bills. Healthcare facilities are prohibited from refusing, delaying, or shirking emergency care for any reason. Likewise, emergency dispatch centers cannot decline or delay responses due to payment concerns. Therefore, never hesitate to call for help just because you lack funds — this fund covers only the initial emergency phase; subsequent inpatient treatment still relies on yibao (basic medical insurance) and other medical assistance programs. +- Benefit: This emergency assistance program is intended for “patients experiencing acute, severe, or life-threatening injuries or illnesses within China who require urgent care but lack verifiable identity or means to pay.” The fund pays two types of expenses: “emergency treatment costs incurred by patients whose identities cannot be determined,” and “outstanding emergency bills for patients whose identities are known but who cannot pay.” Official documents further stipulate that “all healthcare institutions and staff must promptly and effectively treat such patients without any excuses for refusal, delay, or evasion.” Nationwide, the emergency medical hotline is 120; dispatch centers are forbidden from rejecting or delaying service due to scheduling or payment issues. Transport follows the principle of “proximity, urgency, professional suitability, and patient preference” (implemented nationwide since 2013). +- Evidence grade: A +- Notes: This fund applies strictly to emergency treatment costs. Care is delivered first, after which hospitals submit claims to the fund — patients do not receive direct payments. Those covered by yibao continue using that system as usual. Application procedures and limits vary by province. Per the transport guidelines, “proximity” and “urgency” take precedence over “patient preference”; thus ambulances may not take you to a hospital of your choice if a closer facility can handle your condition. Should post-emergency expenses remain unaffordable, additional assistance is available under medical aid programs — see Section 7, Item 10. +- Sources:国务院办公厅 (2013). 关于建立疾病应急救助制度的指导意见（国办发〔2013〕15 号）. ；国家卫生和计划生育委员会 (2014). 院前医疗急救管理办法（委令第 3 号，第十三、二十二、二十三、二十五条）. + +### 10. Disability assessments must be conducted only after treatment is complete; doing it too early results in a lower rating. + + +- Cost: The cost of such assessments ranges from a few hundred to two thousand yuan, typically paid upfront by the party requesting the evaluation. Assessments are only permitted after treatment has ended or when clinical outcomes have stabilized — usually three to six months post-injury, though sometimes longer. The difficulty lies in resisting the urge to get an early assessment when recovery is still underway. + +- In plain terms: The amount of compensation one receives depends largely on the disability rating assigned, which in turn reflects how much functional ability remains after full recovery. Official guidelines stipulate that assessments must be performed only after treatment concludes or when clinical results are stable. If an assessment is done while bones are still healing or metal implants remain in place, it reflects the individual’s condition at that moment, effectively lowering their rating. For ordinary fractures that do not impair function even after healing, no disability rating is assigned at all. + +- Benefit: According to the “Classification of Human Injury and Disability Levels,” assessments must be conducted “after primary injuries and any related complications have been fully treated or when clinical outcomes have stabilized.” The standard further divides disability levels into ten grades, ranging from Grade 1 (100% disability rate) to Grade 10 (10% disability rate), with each grade differing by 10% in terms of functional impairment. Evaluation criteria include structural damage to tissues and organs, resulting functional limitations, and the degree of dependence on medical care or nursing, while also accounting for social and psychological impacts caused by disability. Specific criteria relevant to fractures include: (1) compression fractures of one vertebra where compression reaches one-third or more, or comminuted fractures; (2) two or more fractures of the pelvis or comminuted pelvic fractures resulting in deformity; and (3) loss of 25% or more function in any major joint of the limbs, excluding the ankle joint. Multiple disabilities affecting the same area or of similar nature must not be counted repeatedly. In cases involving multiple disabilities, each respective grade must be explicitly stated (National Standard, effective January 1, 2017). + +- Evidence grade: A + +- Notes: Three distinct disability assessment systems exist and must not be confused. For injuries resulting from assaults, traffic accidents, or other personal injuries, the “Classification of Human Injury and Disability Levels” is used for judicial assessments, determining compensation amounts (see Section 9). Workplace injuries are evaluated via a separate ten-grade system for work capacity assessments, governing eligibility for occupational injury benefits (see Section 19). To qualify for disability-related policies and benefits, individuals must also obtain a Disability Certificate (see Article 11). Prior to any assessment, ensure all medical records, surgical reports, and follow-up imaging are fully prepared (see Article 6 regarding personal record-keeping); missing imaging is a common cause of lower disability ratings. When current injuries coexist with pre-existing conditions, the assessment must specify the proportion of disability attributable to the current injury alone — this directly influences compensation calculations. +- Sources:最高人民法院、最高人民检察院、公安部、国家安全部、司法部 (2016). 关于发布《人体损伤致残程度分级》的公告（2016 年 4 月 18 日发布，2017 年 1 月 1 日施行），标准第 4.2、4.4、4.5、5.10.6、6.2 条. + +### 11. After treatment, functional impairments may indeed remain; apply for a disability certificate at the county-level disability association in your hukou area. + + +- Cost: There is no fee for issuing the certificate itself. In principle, applicants must cover the assessment and photography costs, though those in financial hardship may request exemptions. You’ll need to bring your ID, hukou registration, and three two-inch photos with a white background to the county-level disability association. Once approved, the decision is posted in your village or community for five working days, after which the association has ten working days to finalize the process. The main difficulty lies in making multiple trips and waiting through this period. + +- In plain terms: A disability certificate serves as a prerequisite for receiving disability-related benefits; it is not a medical proof of injury. It categorizes disabilities into seven types — visual, hearing, speech, physical, intellectual, mental, and multiple — each with four severity levels. The application process involves submission, acceptance, assessment at a designated facility, public posting, review, and issuance; the certificate remains valid for ten years and can be renewed free of charge. If you do not meet the criteria, no amount of personal connections can secure one. + +- Benefit: The disability certificate is “the legal proof of a person’s disability status and classification, serving as a key basis for accessing national and local preferential policies.” Assessment follows the national standard GB/T 26341-2010. Applications are voluntary and administered locally. All seven disability types qualify for levels one through four. County-level associations handle applications and issuance based on evaluations conducted by provincially designated hospitals or specialized institutions. Approved cases are posted publicly for five days, then finalized within ten days. No fee is charged for the certificate; assessment and photography costs are normally the applicant’s responsibility, though some regions offer subsidies or exemptions for those in need. The certificate lasts ten years and can be renewed at no cost; re-evaluation is possible if conditions change. Disagreements with assessment results may be appealed to municipal or provincial expert committees within ten days (effective nationwide since 1 January 2018). + +- Evidence grade: A + +- Notes: Calculate the costs and benefits before deciding to apply. The certificate itself does not provide direct financial aid; rather, it unlocks two main subsidies: living allowances for disabled individuals in dibao households, and care subsidies for those at levels one and two requiring long-term assistance — details appear in Section 7, Article 8. It also qualifies holders for local rehabilitation services, assistive devices, tax reductions, employment support, and transport perks; exact criteria vary widely by province, so consult your local disability association website first. Importantly, this certificate differs from judicial disability evaluations or occupational injury assessments — see Section 10 regarding post-treatment evaluation timing. The certificate is strictly personal and non-transferable; misuse or failure to meet ongoing criteria results in revocation, with a one-year ban on reapplication. For multiple disabilities, the most severe category determines the classification level. +- Sources:中国残疾人联合会、国家卫生和计划生育委员会 (2017). 中华人民共和国残疾人证管理办法（2017 年 5 月 27 日发布，2018 年 1 月 1 日施行；第二、三、五、七、九、十七、十九、二十二、二十五条）. + +### 12. Thank the doctors who saved you — send thank-you letters, banners, or satisfaction ratings instead of cash gifts. The rules prohibit money, not gratitude. + + +- Cost: It costs nothing at all. Writing a thank-you letter or filling out a satisfaction survey takes just a few minutes. + +- In plain terms: Offering money beforehand to “jump the queue” won’t work — allocating appointment slots, beds, scarce medicines, tests, or surgeries is strictly forbidden. After treatment, it’s perfectly fine to show gratitude toward doctors who saved your life, but the method matters. Accepting cash or alcohol gifts puts them in violation of professional ethics. Three proper ways to thank them are: completing a satisfaction survey, writing a personalized thank-you letter, or presenting a commemorative banner, plus following medical advice for follow-up care. + +- Benefit: Article 7 of the “Nine Guidelines on Ethical Conduct for Medical Staff” (No. 41, 2021) states: “Maintain orderly medical practices and ensure fairness. Uphold equality to foster a just healthcare environment. It is strictly prohibited to accept personal benefits in exchange for allocating scarce medical resources such as appointment slots, beds, medicines, tests, or surgeries.” Article 8 adds: “Build harmonious relationships without accepting ‘red envelopes’ from patients. Adhere strictly to medical ethics and self-discipline.” It further specifies that accepting gifts, cash, gift cards, securities, or other valuables from patients or relatives is forbidden. Likewise, attending paid meals or entertainment arranged by patients is prohibited. Hospitals must enforce these rules, conduct inspections, and penalize violations. Satisfaction ratings now form part of performance evaluations for all tertiary public hospitals under national policy. According to official documents, hospital satisfaction comprises both patient and staff satisfaction, measured via surveys of outpatients, inpatients, and medical staff. A unified national platform collects these results, which are then factored into hospital performance reviews. Hospitals must also handle patient complaints per regulations, establishing dedicated offices to receive, investigate, and respond to concerns regarding medical services, safety, and quality. The relevant policy document was issued in 2019, 2020, and 2021 respectively, with all three years clearly stated in the official materials. + +- Evidence grade: A + +- Notes: Both you and your doctors benefit from this practice. It does not mean you should never express gratitude — after a night of emergency treatment, it’s natural to want to say thanks. The key is choosing appropriate methods. Cash gifts and alcohol place doctors at risk of disciplinary action; thank-you letters, banners, and satisfaction ratings are fully aligned with official policies. If a doctor declines a gift you’ve already offered, it’s not personal — it’s his duty to refuse. Note also that offering gifts to doctors falls under professional ethics and hospital rules, whereas giving bribes to law enforcement or investigators constitutes a criminal offense under the law; these situations are entirely different. While thank-you letters and banners are widely accepted, there is no official rule stating they become part of personal or departmental records — this is merely anecdotal experience. Only the inclusion of satisfaction ratings in hospital performance assessments has solid policy backing. Should you have doubts about treatment, you may request immediate medical record sealing and retain copies for yourself as described in relevant sections. +- Sources:国家卫生健康委、国家医保局、国家中医药局 (2021). 关于印发医疗机构工作人员廉洁从业九项准则的通知（国卫医发〔2021〕41 号）. 国务院公报 ；国务院办公厅 (2019). 关于加强三级公立医院绩效考核工作的意见（国办发〔2019〕4 号）. ；国家卫生健康委 (2019). 医疗机构投诉管理办法（委令第 3 号）. diff --git a/book/25-After-Someone-Dies.md b/book/25-After-Someone-Dies.md new file mode 100644 index 00000000..6cd5cee3 --- /dev/null +++ b/book/25-After-Someone-Dies.md @@ -0,0 +1,102 @@ +# 25. What to do after a loved one passes away + +When someone dies, there are a few key steps to take: handling the necessary paperwork and dealing with any money matters. First, you’ll need to secure the scene and arrange for a death certificate. After that, the body must be prepared and cremated. If there’s any dispute over how the death occurred, that must be addressed next, followed by closing all relevant accounts. The remaining items are listed in order of how much they can save you money. For any advance planning an older adult might want to make — such as naming a legal guardian, writing a will, or managing accounts — see Section 17. Details on the three types of benefits available for deaths at work can be found in Section 19. + +The funeral guidance here follows the newly updated Funeral Management Regulations, which took effect on March 30, 2026. Exact amounts for funeral subsidies and survivor benefits under basic pension plans are set separately by the Human Resources and Social Security Bureau. Since we don’t have an official source text to verify these figures word for word, no specific dollar amounts appear in this section. +### 1. If someone dies at home or elsewhere, first determine whether it’s a natural or unnatural death: in cases of accidents, unknown causes, or deaths discovered only after a long period of solitude, call the police immediately and leave the body and scene untouched. + + +- Cost: No expense at all — just one phone call is needed. +- In plain terms: For deaths caused by accidents, of unknown origin, or those found only after a long time alone, only the police can issue a death certificate. If the scene has been disturbed, it becomes difficult to clarify what happened and to obtain a certificate. Without this document, cremation, household registration cancellation, and insurance claims all become impossible. When in doubt, dial 110 right away. Once police arrive and conduct their investigation, they will issue the certificate just the same. +- Benefit: Article 8, Paragraph 2 of the Regulations on Household Registration states: “In cases where a citizen dies from an accident or the cause of death is unknown, the household head or the person who discovers the body must promptly report it to the local police station or township government.” This means that in cases of accidents or unknown circumstances, the household head or discoverer must inform authorities immediately. Article 23 of the Regulations on Funeral Services adds: “For natural deaths, medical institutions must promptly issue death certificates. For unnatural deaths handled by police without prior medical treatment, the police issue the certificate.” In other words, natural deaths are certified by treating medical facilities; unnatural deaths handled by police are certified by them. Only police can issue certificates for unnatural deaths, especially when the scene has been altered. Obtaining this certificate is essential for cremation, household registration cancellation, and insurance claims. +- Evidence grade: A +- Notes: Deaths occurring after a prolonged illness or at home at the end of life are considered natural. In such cases, a certificate can be obtained from the treating medical institution, or from a local community health center or township hospital. As noted in Item 2 (Death Certificates), only the institution providing treatment may issue the certificate. When it is unclear which category applies, treat it as an unnatural death and call 110 first. Police investigations will still allow a certificate to be issued. Conversely, if you clean up the scene before calling police, no one can help you. Do not move the body, wash or change its clothes, or remove medicine bottles or notes. +- Sources:全国人大常委会 (1958). 中华人民共和国户口登记条例（第八条）. （广东省人民政府门户网站刊登）；国务院 (2026). 殡葬管理条例（国务院令第 824 号，自 2026 年 3 月 30 日起施行，第二十三条）. + +### 2. The death certificate is the key to everything that follows: whoever provided treatment issues it; for natural deaths at home, contact the local community health service center. It must be issued within one day. + + +- Cost: No cost at all. +- In plain terms: If the death occurs in a hospital, the hospital that treated the patient issues the certificate. For natural deaths at home, the community health service center or township health clinic serving that area issues it. When the cause of death is clear, the certificate is issued within 24 hours. It is required for deregistration, cremation, withdrawal from a housing provident fund, receipt of social insurance benefits, insurance claims, and estate settlement — so be sure to make several copies right away. +- Benefit: According to the “Interim Regulations on Registration and Management of Population Death Information,” death certificates for patients who die in medical institutions are issued by those institutions; for deaths occurring at home or elsewhere, they are issued by the local community health service center or township health clinic. Cases deemed non‑natural by police or judicial authorities are handled under separate procedures. In 2026, five government agencies confirmed that electronic death certificates carry the same legal weight as paper versions; both are equally valid. Certificates for natural deaths with known causes must be issued within one day. If lost, a single replacement can be requested from the original issuer. Errors in basic information may be corrected by submitting supporting documents. +- Evidence grade: A +- Notes: This certificate is indispensable for deregistration, cremation, housing provident fund withdrawals, social insurance benefits, insurance claims, and estate settlement — so make plenty of copies right away. If electronic issuance is available, request it as well. Only one replacement is permitted, so keep the original safe. Any mistakes in name or ID number should be corrected on the spot; otherwise you’ll have to repeat the process at every office later on. +- Sources:国家卫生计生委办公厅 (2014). 人口死亡信息登记管理规范（试行）（国卫办规划发〔2014〕68 号，第九条）. （深圳市民政局转发）；国家卫生健康委、公安部、民政部、国家中医药局、国家疾控局 (2026). 关于加强居民死亡医学证明信息登记和电子证照管理工作的通知（国卫规划发〔2026〕5 号）. （福建省卫生健康委员会转发） + +### 3. Transport, storage, and cremation of remains must be handled by funeral homes; hospital morgues cannot provide such services, and storage is generally limited to 3 days. + +- Cost: No cost involved. +- In plain terms: Transport, storage, embalming, body preparation, and cremation can only be done by funeral homes. Hospital morgues are not authorized to handle funeral services; they may only provide temporary storage for remains. Funeral homes typically store bodies for no more than 3 days; any longer period requires an extension request. Cremation can only proceed with a death certificate and cremation authorization document. The cremation certificate issued afterward is necessary for inheritance claims and insurance processing. +- Benefit: Article 25 of the Funeral Management Regulations states: “Services such as transport, storage, embalming, body preparation, and cremation must be provided exclusively by funeral homes.” No other entities are permitted to offer these services. Article 24 adds: “Morgues operated by medical institutions may not subcontract or provide funeral services; they may only offer temporary storage for remains.” Hospital morgues are thus restricted to short-term storage only. Article 27 specifies: “Funeral homes may store remains for no more than 3 days; extensions must be formally requested by the family or body transferor.” Article 28 requires cremation to be performed only upon presentation of a death certificate and cremation authorization document, after which a cremation certificate is issued. Article 29 further mandates that in regions where cremation is mandatory, remains must be cremated at a nearby funeral home. +- Evidence grade: A +- Notes: Most “one-stop” services offered at hospitals are not affiliated with licensed funeral homes. Transport itself is a standard service with fixed pricing; see Section 6 for details. Keep the cremation certificate safe — it is required for inheritance, insurance, and other legal procedures. Whether cremation or burial is mandated locally is determined by provincial authorities. Article 9 safeguards the funeral customs of ethnic minorities. Any instance of cremation being required yet burial performed, or burial outside designated cemeteries or ecological burial zones, will prompt civil affairs bureaus to order immediate correction. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，自 2026 年 3 月 30 日起施行，第八、九、二十四、二十五、二十七、二十八、二十九条）. + +### 4. Disagreement over cause of death: request an autopsy within 48 hours and have medical records sealed + +- Cost: No cost involved. The hard part is remembering to make this request at such a time. +- In plain terms: If there is any doubt about how someone died, an autopsy must be requested within 48 hours after death. Hospitals with proper freezing facilities may extend this window to 7 days. Consent from close relatives is also required for the autopsy. If consent is not given or the deadline is missed, the party responsible for the delay bears the liability for any subsequent uncertainty over the cause of death. Alongside the autopsy request, it is essential to demand that all medical records be sealed. Once the body is cremated, an autopsy becomes impossible. +- Benefit: The time limit for autopsies is stipulated in Article 26 of the Regulations on Prevention and Handling of Medical Disputes. The original text reads: “In cases where a patient dies and both the patient and medical institution dispute the cause of death, an autopsy must be performed within 48 hours after death; if the hospital has facilities to freeze the body, this period may be extended to 7 days.” In other words, to determine the true cause of death, an autopsy must be carried out within 48 hours of death, or up to 7 days if the hospital has freezing capabilities. The same article further states: “An autopsy must be approved and signed off by the deceased’s close relatives; failure to sign is regarded as refusal of consent.” If family members do not sign, it is interpreted as a refusal. It also specifies: “If consent is denied or the deadline is missed, leading to uncertainty over the cause of death, the party responsible for the refusal or delay bears all related liability.” Article 24 states that sealing and unsealing of medical records “must be conducted in the presence of both the patient and medical institution.” Both you and the hospital must be present during both the sealing and later unsealing of records. +- Evidence grade: A +- Notes: After this deadline passes, any later claims of “I always suspected something was wrong” will instead place liability on the party responsible for the delay. Once a body is cremated, no autopsy can ever be performed. Therefore, this decision must be made before contacting any funeral home. Details on how to seal medical records can be found in Section 24. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号，第二十四、二十六条）. + +### 5. Legal deadlines for canceling hukou registration: in cities, before burial; in rural areas, within one month + +- Cost: No expense involved. Just bring the death certificate and household register to your local police station. +- In plain terms: In cities, you must cancel hukou registration before burial; in rural areas, you must do it within one month. Bring the death certificate and household register to the police station to complete the process. Failing to do so will block any inheritance transfers, benefit claims, or insurance cancellations due to the unresolved hukou status. +- Benefit: Article 8, Paragraph 1 of the Hukou Registration Regulations states: “When a citizen dies, in cities the household head, relatives, guardians, or neighbors must report the death to the hukou registration authority and cancel the hukou registration before burial; in rural areas, this must be done within one month. If a citizen dies while temporarily residing elsewhere, the local hukou registration authority must notify the permanent residence’s authority to cancel the registration.” In short, urban residents must act before burial, while rural residents have one month to do so. Any household head, relative, guardian, or neighbor may initiate the process at the police station, which serves as the hukou registration authority. If the deceased was living temporarily elsewhere, the local police station there must inform the permanent residence’s station to cancel the hukou registration. +- Evidence grade: A +- Notes: Leaving the hukou registration active will prevent any inheritance transfers, benefit claims, or insurance cancellations, as all these procedures rely on a cleared hukou status. If pension payments continue despite the death, they constitute fraudulent collection and must eventually be repaid. While at the police station, also ask how to suspend social insurance and yibao payments, as well as how to apply for funeral subsidies. Details on these financial matters are covered in Item 9 (housing provident fund balances and related social insurance benefits). +- Sources:全国人大常委会 (1958). 中华人民共和国户口登记条例（第八条）. （广东省人民政府门户网站刊登） + +### 6. Funeral services are divided into basic and non-basic categories; a list of basic services exists, with their fees set by law. + +- Cost: There is no cost involved. Just spend a few minutes before departure to review the official list. +- In plain terms: Transporting, storing, and cremating a body, holding a farewell ceremony, keeping ashes in storage, and eco-friendly burial options — all fall under the national list of basic services. This also includes burial spaces provided by government-run funeral agencies. Prices for these services are strictly regulated by law; no extra fees may be charged outside this list. Before making any arrangements, be sure to confirm which services are considered basic and what the local rates are. +- Benefit: All essential funeral services — including body transport, storage, cremation, memorial services, and eco-friendly burial — are included in the official list. Government-run funeral centers also offer designated burial plots under this same list. Their pricing follows legal standards, meaning funeral homes cannot set prices arbitrarily. Non-basic services are defined separately by civil affairs bureaus at or above the prefecture level. +- Evidence grade: A +- Notes: Provinces, autonomous regions, and municipalities may add extra items to the national list. Always verify which services are classified as basic and what their local pricing is before proceeding. It is perfectly acceptable to want a dignified funeral for a loved one; this guideline does not discourage that. Its sole purpose is to clarify which services are fixed-price basics and which are optional extras. Once this distinction is clear, you can decide where to allocate funds — and avoid unnecessary overcharges during an already difficult time. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第五条：「殡葬服务分为基础项目和非基础项目，收费政策由国务院发展改革部门、财政部门会同国务院民政等部门制定。」「国家制定殡葬服务基础项目清单，将遗体接运、遗体存放、遗体告别、遗体火化、骨灰寄存、生态安葬以及政府举办的殡葬服务机构提供的骨灰格位安葬等纳入清单范围」；第五十条「殡葬服务实行清单化管理并动态调整，禁止在清单之外设立项目、收取费用。」 + +### 7. If you encounter forced bundling, extra charges beyond the listed price, or a single service being split into multiple line items for billing, make a note of it and file a complaint. + + +- Cost: No cost involved. The real challenge is staying diligent in the moment. + +- In plain terms: All these practices are explicitly listed as price violations under regulations: failing to display price lists, adding extra charges beyond the posted price, bundling funeral products and services and forcing you to buy them, and compelling you to use third‑party paid services. Splitting one service into several separate charges is also a form of price inflation. On the spot, ask for a price list and keep any receipts, invoices, and chat records. You can still file a complaint later. For price violations, contact the market regulation authority; for funeral services specifically, reach out to the civil affairs bureau. + +- Benefit: Regulations identify five categories of price violations. Four of them are: not displaying prices clearly or adding extra charges beyond the listed price — that is, no posted price list or charging more than advertised; bundling services or imposing unreasonable conditions to force a purchase — meaning you can’t obtain a service unless you buy another one; forcing or indirectly forcing you to use paid third‑party services — essentially pushing another provider’s services on you; and indirectly raising prices by re‑labeling charges — such as charging more under a different name. Additionally, it is prohibited to “split services into multiple items or expand the scope of charges to indirectly raise prices.” This means breaking one service into several line items for billing or extending the range of charges beyond what was originally stated. + +- Evidence grade: A + +- Notes: Price‑violation investigations fall under the market regulation authority; funeral services themselves are under the civil affairs bureau. Ask for a price list right away, and be sure to keep all receipts, invoices, and chat records. Filing a complaint later is still possible. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第四十二条：「殡葬服务机构不得违反有关规定擅自设立收费项目，或者采取分解项目、扩大范围收费等形式变相提高收费标准。」第四十三条列举的价格违法行为含「（一）不按规定明码标价，或者在标价之外加价或者收取未标明的费用」「（三）采取捆绑、附加不合理条件或者不合理限制等方式，强制或者变相强制销售丧葬用品、提供殡葬相关服务并收取费用」「（四）强制或者变相强制丧属接受第三方的有偿服务，或者利用相关服务网点重复收取费用」；第五十一条要求民政部门与政务服务便民热线建立信息共享监督机制，「对丧属反映的殡葬服务问题，应当会同有关部门及时予以处理并将处理结果告知丧属」 + +### 8. Intermediaries such as funeral service agents, vendors of funeral goods, and event planners must register with the county-level civil affairs bureau + +- Cost: There is no cost involved. All you need to do is ask whether registration has been completed. +- In plain terms: Intermediaries offering services like funeral planning, procurement of funeral products, event coordination, and information consultation must register with the county-level civil affairs bureau. Those that fail to register are excluded from the official funeral service information system managed by the bureau. Availability of online lookup tools varies by region; the safest approach is to call the local civil affairs bureau directly. Any operators found to be charging excessive fees through deceptive practices or selling information related to deceased individuals will be held legally accountable. +- Benefit: Unregistered intermediaries are not included in the official funeral service information system overseen by the civil affairs bureau. Entities that engage in fraudulent billing, pressure families into extravagant ceremonies, force acceptance of services, or illegally trade personal data of the deceased face legal penalties. Their records are also flagged within the system and made publicly accessible, ensuring transparency for all users. +- Evidence grade: A +- Notes: “Illegal trading of information related to deceased individuals” represents one of the most prevalent risks in this sector. It is common for families to receive numerous unsolicited sales calls shortly after funeral arrangements, often indicating that their data has been sold on. Online virtual memorial platforms are similarly subject to these regulations; Article 45 explicitly prohibits such platforms from encouraging excessive spending or mishandling sensitive personal information. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第四十一条：「除殡葬服务机构外，从事殡葬服务代理、用品代购、策划主持、信息咨询等殡葬相关服务活动的组织和个人，应当向县级人民政府民政部门备案。」「对存在以欺骗等手段违规收费、诱导大操大办、强迫接受服务、倒卖逝者信息等损害丧属权益行为的依法处置，并在殡葬服务信息系统中进行标注，向社会公开。」 + +### 9. Withdrawing money held in various accounts: housing provident fund balance, social insurance benefits, and work‑related death benefits + +- Cost: There is no monetary cost, but you must visit several offices. Before you go, make sure you have a death certificate and proof of familial relationship ready. +- In plain terms: The remaining balance in a deceased person’s housing provident fund can be withdrawn by heirs and legatees. This money is not held in a regular bank account and does not automatically become part of the estate, so it is easy to overlook. In cases of death due to a workplace injury, there are three additional payments: funeral assistance, survivor’s pension, and a one‑time work‑related death benefit. The balance in the individual pension account and any related survivor benefits must be requested from the local social insurance office. +- Benefit: Heirs and legatees may withdraw the remaining housing provident fund balance from the deceased’s account. A legatee is a person named in a will who is entitled to receive assets. For deaths caused by work‑related injuries, three separate payments are available: funeral assistance, survivor’s pension, and a one‑time work‑related death benefit. +- Evidence grade: A +- Notes: The housing provident fund amount is the most frequently forgotten component, as it is not stored in a standard bank account and does not automatically enter the estate distribution. Information on any remaining pension account balance and related survivor benefits must be obtained from the local social insurance office; required documents vary by region. Formal requirements for wills and inheritance are outlined in Section 17. +- Sources:国务院 (2026). 住房公积金管理条例（国务院令第 844 号修改，2026 年 9 月 20 日起施行）第二十四条末款. ：「职工死亡或者被宣告死亡的，职工的继承人、受遗赠人可以提取职工住房公积金账户内的存储余额；无继承人也无受遗赠人的，职工住房公积金账户内的存储余额纳入住房公积金的增值收益。」；工伤保险条例第三十九条的三笔待遇见第 19 节. ；TODO（待核实：基本养老保险个人账户余额的继承规则，以及丧葬补助金与遗属抚恤金的具体标准，人社部相关文件本次未取得） + +### 10. Relatives of the deceased may request access to, copies of, corrections to, and deletion of their personal information + + +- Cost: No cost involved. Only if the platform refuses cooperation would legal complaints or lawsuits be necessary. +- In plain terms: After a person passes away, their close relatives may, for their own lawful and legitimate interests, ask the platform to access, copy, correct, or delete that person’s personal information. If the platform denies such requests, it must provide a valid reason. Legal action in court is also an option. One exception applies: if the deceased made prior arrangements—such as designating a successor to their account or expressing clear intentions—those instructions must be followed. +- Benefit: The law explicitly states that upon a person’s death, their close relatives may, for their own lawful and legitimate interests, exercise rights such as accessing, copying, correcting, and deleting the deceased’s personal information. In other words, they may request the platform to provide access to this data, make copies, correct any errors, or remove it entirely. +- Evidence grade: A +- Notes: The legal text includes a clause stating “except where the deceased made prior arrangements.” This means that if someone designated a successor to their account or left explicit instructions, those must be honored. Therefore, while still alive, it’s advisable to document where one’s account credentials are kept, as explained in Section 17. Note also that account deactivation and deletion of personal information are two distinct processes, as discussed in Section 14. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. 第四十九条：「自然人死亡的，其近亲属为了自身的合法、正当利益，可以对死者的相关个人信息行使本章规定的查阅、复制、更正、删除等权利；死者生前另有安排的除外。」；第五十条「个人信息处理者应当建立便捷的个人行使权利的申请受理和处理机制。拒绝个人行使权利的请求的，应当说明理由」「个人可以依法向人民法院提起诉讼」 diff --git a/book/26-Building-A-Website-Or-Platform.md b/book/26-Building-A-Website-Or-Platform.md new file mode 100644 index 00000000..48e19d3b --- /dev/null +++ b/book/26-Building-A-Website-Or-Platform.md @@ -0,0 +1,126 @@ +# 26. Building a website or platform: licensing, registration, and servers + +If you want to create a website or app, this section explains four key points: what legal category your business falls under, which permits you must obtain, where to host your servers, and who is responsible for user content and payments. The focus here is on personal freedom and financial matters. The items are ordered as follows: first, activities that could land you in prison; second, permits you must secure beforehand; third, everyday tasks any platform must handle; and finally, practical tips for choosing a server — though no exact figures can be given. As a hired technician, you must stay within the boundaries outlined in Section 11. Details on company registration and tax filing are covered in Section 12 and are not repeated here. A comparison chart of required permits and a decision table for server selection can be found at [docs/做平台要办哪些证.md](../../docs/research/做平台要办哪些证.md). +### 1. Platforms must never collect payments themselves and then transfer them to sellers; funds must be settled directly via a licensed payment institution. + +- Cost: No monetary cost is involved. However, it requires some time to integrate a product from a licensed payment institution — that is, a company holding a payment license issued by the People’s Bank of China. By using such institution’s split-payment or escrow features, buyer payments are transferred straight to sellers without ever entering the platform’s own accounts. +- In plain terms: If a platform first receives buyer payments into its own account and then forwards them to sellers, it is effectively operating a payment business. Running such a business requires explicit approval from the People’s Bank of China as well as a minimum registered capital of 100 million RMB, paid in cash. Operating without this approval leads to immediate shutdown, confiscation of all earnings, heavy fines, and personal penalties for owners and responsible staff; in severe cases, criminal charges may also apply. The only safe approach is to ensure that no funds ever land in the platform’s account. +- Benefit: According to regulations, a payment business is defined as “transferring monetary funds based on electronic payment instructions submitted by payers or payees.” In other words, it involves moving money on behalf of others per their instructions. To operate such a business, one must obtain a payment license from the People’s Bank of China, and the minimum registered capital must be 100 million RMB, paid in full. Unauthorized operation results in immediate closure, seizure of all profits, and fines ranging from 500,000 to 2 million RMB if no profit was generated or if profit fell below 500,000 RMB; additionally, a further fine of 100,000 to 500,000 RMB applies to legal representatives and responsible personnel. Criminal law also classifies “illegally conducting fund payment and settlement services” as illegal business activity; serious violations may lead to imprisonment of up to five years, while especially grave cases incur sentences exceeding five years. As of May 2024, the threshold for “serious” violations is defined as total illegal transaction volume exceeding 5 million RMB or illegal profits surpassing 100,000 RMB nationwide. +- Evidence grade: A +- Notes: Designing the payment flow so that funds never enter the platform’s account is the sole safe method. In industry parlance, this practice is sometimes called “second clearing,” though this term does not appear in official documents; instead, regulations refer to it as “indirectly engaging in payment services.” The Supreme People’s Court and Supreme People’s Procuratorate explicitly list only three scenarios as illegal: fabricating transactions for cash-out, using corporate accounts for cash-out, and using cheques for cash-out. Platform-based collection and redistribution of payments are not explicitly named, so this description strictly follows statutory wording without asserting that it automatically constitutes a crime. +- Sources:国务院 (2023). 非银行支付机构监督管理条例（国务院令第 768 号，第二、六、八、二十七、四十七条）. ; 中国人民银行 (2024). 非银行支付机构监督管理条例实施细则（中国人民银行令〔2024〕第 4 号，第六十八条）. ; 全国人大 (1997). 刑法（第二百二十五条第三项）. ; 最高人民法院、最高人民检察院 (2019). 关于办理非法从事资金支付结算业务、非法买卖外汇刑事案件适用法律若干问题的解释（第一、三、四条）. + +### 2. Paid websites require a license; platforms that facilitate transactions need a different type of permit; free sites only need to be registered. + + +- Cost: Registration is free of charge. Obtaining a Value-Added Telecommunications Business License, however, involves costs; this license governs whether websites that charge users can legally operate. To apply for this license, you must first establish a company. For operations limited to one province, the registered capital must be at least 1 million RMB; for nationwide operations, it must be at least 10 million RMB. The review period lasts 60 days, and the license remains valid for 5 years. + +- In plain terms: Websites that charge users must first obtain a Value-Added Telecommunications Business License. This license is issued solely to companies; individuals cannot apply for it. Free websites, on the other hand, only need to be registered, and this process incurs no fees. Operating a paid website without the proper license may result in confiscation of revenues, fines, or even closure. This section does not determine whether your platform falls under the category of transaction-facilitating services; the reasoning is explained in the notes. + +- Benefit: The regulations state: “The state implements a licensing system for commercial Internet information services and a registration system for non-commercial ones. No entity may provide Internet information services without obtaining a license or completing registration.” In other words, paid services must first secure a license, while free ones must register; operating without either is prohibited. “Commercial services” are defined as activities involving paid provision of information or webpage creation to users. Platforms that facilitate transactions are classified under Online Data Processing and Transaction Processing Services, commonly abbreviated as EDI. These services involve using data and transaction platforms linked to public communication networks to handle data processing and transactions on behalf of users. Such activities include transaction processing, electronic data exchange, and data handling via network devices. Operating without a license or exceeding its scope of permission results in confiscation of all illegal revenues and fines ranging from 3 to 5 times that amount. If no illegal revenues exist or they are under 50,000 RMB, fines between 100,000 and 1,000,000 RMB apply; severe violations may lead to website closure nationwide. + +- Evidence grade: A + +- Notes: To determine whether your platform qualifies as an EDI service, compare its activities to the definitions listed in the Telecommunications Business Classification Catalogue. No official regulation explicitly states that e-commerce platforms handling transactions and payments must obtain an EDI license. The Ministry of Industry and Information Technology’s guidelines merely advise applying for the appropriate license based on actual business activities. Therefore, this section merely outlines definitions without making any definitive conclusions. Additionally, only legally incorporated companies may apply for this license; individuals are ineligible. +- Sources:国务院 (2000). 互联网信息服务管理办法（国务院令第 292 号，2024 年 12 月 6 日第二次修订，第三、四、七、十九条）. ; 国务院 (2024). 关于修改和废止部分行政法规的决定（国务院令第 797 号，第十八项）. ; 国务院 (2000). 电信条例（2016 年第二次修订，第七、九、十三、六十九条）. ; 工业和信息化部 (2017). 电信业务经营许可管理办法（工信部令第 42 号，第六、九、十一、十四条）. + +### 3. Obtaining a license for online cultural activities is required to run live streams; private companies rarely qualify for the permit needed to distribute audiovisual content + + +- Cost: The so-called “Online Cultural Activities License” governs whether one may earn money via live streams or game commentary. It is issued by provincial-level cultural authorities within 20 days of application and remains valid for three years, after which renewal must be requested at least 30 days prior to expiration. The separate Audiovisual Content Distribution License determines eligibility to publish programs online; it mandates that applicants be wholly state-owned or state-controlled entities — private firms essentially cannot obtain it. + +- In plain terms: To host live streams or game commentary sessions, you must secure a provincial-level Online Cultural Activities License that explicitly lists “online performances” among its permitted activities. Approval is granted within 20 days, and the license stays valid for three years. All recorded streams must be retained for a minimum of 60 days. Operating without this license results in immediate suspension, warnings, and fines up to 30,000 RMB; repeat offenders face inclusion on a cultural industry blacklist. A separate permit is required to distribute audiovisual content online, and only state-owned or state-controlled organizations may qualify for it. + +- Benefit: Securing the proper licensing framework ensures legal operation within China’s digital media sector while avoiding punitive measures. Compliance safeguards both business continuity and reputation by adhering to stringent regulatory standards governing online cultural activities and audiovisual distribution. + +- Evidence grade: A + +- Notes: Detailed licensing requirements are comprehensively outlined in official directives issued by seven government departments. Platforms monetizing live streams must additionally secure ICP registration — a mandatory filing process administered by China’s Ministry of Industry and Information Technology. Entities distributing audiovisual content must obtain the requisite Audiovisual Content Distribution License or complete applicable registration procedures. News publishers require a separate Internet News Information Service License. Note that the 2011 version of the Interim Provisions on Internet Cultural Management, republished by China’s Government Portal in 2025, remains unamended; current compliance references must be drawn from the Ministry of Culture and Tourism’s latest official texts. +- Sources:文化部 (2016). 网络表演经营活动管理办法（文市发〔2016〕33 号，第二、四、六、十三、二十条）. ; 文化部 (2011). 互联网文化管理暂行规定（文化部令第 51 号，2017 年经文化部令第 57 号修订，第七、八、九、十六、二十一、二十八条）. ; 广电总局、信息产业部 (2007). 互联网视听节目服务管理规定（第 56 号令，2015 年修订，第二、七、八、二十四条）. ; 国家网信办等七部门 (2021). 关于加强网络直播规范管理工作的指导意见（国信办发文〔2021〕3 号，第 9 项）. + +### 4. Servers placed in China must be registered; ISPs must hold a value-added telecom license + +- Cost: There is no fee for registration. It is submitted together with the server application at the service provider’s end, and usually takes several days to weeks to process. Checking whether a provider holds the required license takes just ten minutes. +- In plain terms: If you host a server inside China, you must register it before launching your website. Registration itself costs nothing and is handled alongside the server setup at your provider; it generally takes a few days to weeks. Failure to register results in a mandatory deadline to rectify the issue, followed by a fine of 10,000 RMB; continued non-compliance leads to site shutdown. Additionally, failing to display the registration number on your homepage incurs a penalty ranging from 5,000 to 50,000 RMB. +- Benefit: The regulation explicitly states: “Without prior registration, no entity may provide non-commercial internet information services within the People’s Republic of China.” This means even websites that do not charge users must register first if they are hosted domestically. Non-compliant sites face the same penalties: a deadline to rectify the issue and a 10,000 RMB fine, with persistent violations resulting in site closure. The same rules apply to your service provider: it is prohibited from offering internet access services to any organization or individual that has not completed registration or obtained the necessary license. The same restriction applies to payment processors. The regulation further clarifies that such providers cannot offer access or payment processing services to entities lacking either a valid license or proper registration. In other words, legitimate providers cannot host sites that lack both a license and registration. Moreover, data center hosting and cloud hosting services fall under the category of “Internet data center services” under the law, while broadband access is classified as “Internet access services”; both categories require a separate license from providers. Finally, sites that fail to display their registration number on their homepage must rectify the issue and face fines between 5,000 and 50,000 RMB nationwide. +- Evidence grade: A +- Notes: Before negotiating terms with a provider, verify first whether it holds the required license. Use the Ministry of Industry and Information Technology’s Telecom Services Market Comprehensive Management System at tsm.miit.gov.cn to check by company name or license number. For website registration status, consult beian.miit.gov.cn. If you choose a data center without the proper license, you will have no recourse in case of disputes. Hosting servers overseas does avoid the registration requirement, but if your users and revenue are based in China, you remain subject to all obligations outlined in sections 5 through 10 of this chapter, plus additional costs related to cross-border data transfers. +- Sources:信息产业部 (2005). 非经营性互联网信息服务备案管理办法（信产部令第 33 号，2024 年经工信部令第 68 号修订，第五、十三、十八、二十二条）. ; 工业和信息化部 (2017). 电信业务经营许可管理办法（工信部令第 42 号，第二十、二十四条）. ; 工业和信息化部 (2015). 电信业务分类目录（2015 年版，B11、B14、B21、B25）. + +### 5. Requiring sellers to join the platform means the platform must verify identities, register data, report information, and retain records for three years + +- Cost: No direct monetary cost. However, the platform must perform background checks on sellers’ qualifications and maintain a registration database. Tax-related information must be reported quarterly, while transaction data must be kept for at least three years. The main challenge is that this is an ongoing obligation rather than a one-time task. +- In plain terms: If you allow third parties to sell goods on your platform, you must first verify their identity, address, contact details, and business licenses, then add them to your registration records. After setting up these records, you must re-verify seller information at least every six months. You must also report seller details to market regulators and submit tax-related data quarterly. All product and transaction records must be retained for three years. Failure to comply with any of these requirements results in a mandatory rectification order; if ignored, fines ranging from 20,000 to 100,000 yuan apply. +- Benefit: Legal regulations set specific obligations for platforms. The official wording states that platforms must require sellers to provide authentic identity, address, contact, and licensing information, then verify and register this data while maintaining updated records. This means sellers must submit their basic details and required permits before joining, which you must then confirm and log into a database. Periodic re-verification is also mandatory. The exact interval for re-verification is defined as “at least every six months” under relevant administrative rules. Additionally, you must submit seller identity data to market regulators and tax authorities, as required by tax administration laws. All product, service, and transaction data must be retained for no less than three years from the date each transaction concludes. Non-compliance triggers a rectification order; persistent violations incur fines of 20,000–100,000 yuan, while severe cases may lead to temporary suspension of operations and fines of 100,000–500,000 yuan. Tax reports must be submitted within the month following each quarter’s end, with identical penalties for late submissions nationwide. +- Evidence grade: A +- Notes: Sellers themselves must also register as market entities. Certain exceptions apply: individuals selling self-produced agricultural or handmade goods, or providing small-scale services that do not require permits, are exempt. The threshold for “small-scale” activities is set at an annual transaction volume of 100,000 yuan under current online trade regulations. Platforms also bear two additional responsibilities: clearly marking registered versus unregistered sellers, and prohibiting the removal of consumer reviews. +- Sources:全国人大常委会 (2018). 电子商务法（第十、二十七、二十八、三十一、八十条）. ; 市场监管总局 (2021). 网络交易监督管理办法（市场监管总局令第 37 号，第八、二十四、二十五、三十一条）. ; 国务院 (2025). 互联网平台企业涉税信息报送规定（国务院令第 810 号，第二、三、四、十条）. ; 国家税务总局 (2025). 关于互联网平台企业报送涉税信息有关事项的公告（税务总局公告 2025 年第 15 号）. + +### 6. You must regulate user-generated content: moderation mechanisms, reporting portals, and immediate takedown plus reporting of illegal material + +- Cost: It costs money to hire moderators — this is the platform’s biggest ongoing expense. Reporting portals and records of every moderation action must be kept. The real challenge is that this work needs constant oversight; even a single day without it can lead to serious problems. +- In plain terms: Platforms are legally responsible for any issues arising from user content. You must set up a full system: user registration, post and comment moderation, daily monitoring, and clear procedures for handling incidents. Place a prominent reporting link on your site. When illegal content is found, immediately stop its distribution, document everything, and report it to authorities. Failure to do so can result in fines ranging from 50,000 to 500,000 yuan, with even harsher penalties for serious violations. +- Benefit: Regulations require platforms to “fulfill primary responsibility for managing user-generated content.” This means platforms must regulate everything users post. Specific requirements include establishing rules for registration, account management, post and comment moderation, page management, real-time monitoring, emergency response, and handling of misinformation and illegal networks. Every step — from registration and posting to daily checks and incident response — must be clearly documented. Platforms must also provide an easily accessible reporting link in a highly visible spot. Upon spotting illegal content, they must “immediately take necessary actions, preserve records, and report to authorities” as mandated by the Cybersecurity Law. Non-compliance brings warnings, mandatory corrections, and fines up to 500,000 yuan; repeat or severe violations can lead to fines up to 2 million yuan, suspension of operations, website or app shutdowns, or even revocation of business licenses. Individuals directly responsible may also face fines of 50,000–200,000 yuan nationwide. +- Evidence grade: A +- Notes: You don’t need to invent moderation rules from scratch — just follow existing ones. Article 15 of the Internet Information Service Management Regulations explicitly lists nine categories of prohibited content. For live-streaming platforms, three extra obligations apply: they must set up a dedicated content moderation system, be able to instantly cut off any ongoing stream (“immediate blocking” per law), and retain both stream content and logs for at least 60 days. The same retention period applies to recorded online performances. +- Sources:国家互联网信息办公室 (2019). 网络信息内容生态治理规定（网信办令第 5 号，第八、九、十、十六、三十七条）. ; 全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第四十九、六十九条）. ; 国务院 (2000). 互联网信息服务管理办法（第十五、十六、二十三条）. + +### 7. Providing information publishing and instant messaging services requires users to provide authentic identity information + +- Cost: Implementing a real-name verification system involves paying per-use fees for the verification channel. The service should be designed under the principle of “real names stored in the backend, nicknames displayed to users” — meaning the actual name is kept on file while users can choose any nickname they prefer on the interface. +- In plain terms: If your website allows posting or chatting, you must collect users’ real identity details at sign-up. Those who refuse to provide such information cannot be allowed to use the service. The recommended approach is to store the real name in the backend and let users pick their own nickname; phone number verification is sufficient for this purpose. Failure to enforce real-name policies results in mandatory corrective orders. Persistent violations attract fines ranging from 50,000 to 500,000 yuan, and may even lead to site shutdowns. +- Benefit: The law explicitly states: “Internet service providers offering network access, domain registration, telephone services, or information publishing and instant messaging must demand authentic identity data from users at the time of agreement signing or service activation. Users who fail to supply such data cannot be granted service access.” Non-compliance — whether by neglecting to request real names or by knowingly allowing unverified users to join — triggers corrective orders. Serious or repeated breaches incur fines of 50,000–500,000 yuan, suspension of operations, mandatory business rectification, closure of websites or apps, and revocation of business licenses. Individual responsible parties face additional penalties of 10,000–100,000 yuan. Live streaming platforms must follow the same “backend real names, frontend nicknames” model, using mobile phone numbers for verification. For live commerce specifically, stricter rules apply: verification must rely on official identification documents and the unified social credit code — the unique identifier printed on every business license nationwide. +- Evidence grade: A +- Notes: The article numbering has been updated. The Cybersecurity Law was amended in 2025 and took effect on 1 January 2026. The real-name provisions moved from Article 24 to Article 26, while related penalties shifted from Article 61 to Article 64; the wording itself remains unchanged. Any existing documentation still referencing the old article numbers must be updated accordingly. +- Sources:全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十六、六十四条；2016 年文本为第二十四、六十一条）. ; 国家互联网信息办公室 (2016). 互联网直播服务管理规定（第十二、十六条）. ; 国家网信办等七部门 (2021). 网络直播营销管理办法（试行）（国信办发文〔2021〕5 号，第八条）. + +### 8. No live streaming accounts may be created for anyone under 16; tipping limits are set by age group + + +- Cost: There are no direct costs. The process simply requires adding two extra steps during registration and payment: first verify the user’s age, then confirm that a guardian has given consent. + +- In plain terms: People younger than 16 cannot sign up for a live streaming account on this platform. Those aged 16 or older must have their identity verified and must also obtain permission from a parent or other guardian. Tipping is restricted based on age: children under 8 are not allowed to tip at all; those aged 8–16 may tip only with guardian consent; and anyone over 16 may tip only with guardian consent or proof of income. If a minor spends money without a guardian’s approval, the guardian can request a refund, and a court is required to grant it. A total of 2020 such cases have been reported to date. + +- Benefit: The law clearly states that “online live streaming service providers must not offer account registration services to minors under 16; when providing such services to minors aged 16 or older, they must verify their identity and obtain consent from a parent or other guardian.” It also mandates “a dynamic verification mechanism for the real identity information of live streamers,” meaning platforms must be able to recheck a streamer’s identity at any time. Additionally, platforms must “reasonably limit the maximum amount a minor may spend per transaction and per day,” establishing spending caps based on age. Tipping rules are similarly tiered: “Tipping services must not be offered to minors under 8; for those aged 8–16, consent from a guardian is required; for those over 16, consent or proof of income is required.” Finally, if a minor lacking full legal capacity spends money without guardian approval, a court must return those funds to the guardian. Minors lacking full legal capacity are defined as those who cannot make independent decisions under the law. + +- Evidence grade: A + +- Notes: In any dispute involving refunds, rulings must favor the minor. The wording of this policy has changed over time. In 2022, four government agencies and the National Radio and Television Administration both stated that minors were completely prohibited from tipping. However, a new notice issued in April 2026 introduced age-based limits at 8 and 16 years old, without explicitly revoking earlier rules or explaining how they relate. Therefore, the claim that “minors are entirely barred from tipping” is no longer accurate. +- Sources:全国人大常委会 (2020). 未成年人保护法（第七十四、七十六条）. ; 国务院 (2023). 未成年人网络保护条例（国务院令第 766 号，第三十一、四十四条）. ; 中央网信办秘书局 (2026). 关于加强网络直播打赏规范管理的通知（第 7 项）. ; 最高人民法院 (2020). 关于依法妥善审理涉新冠肺炎疫情民事案件若干问题的指导意见（二）（法发〔2020〕17 号，第九条）. + +### 9. Respond promptly to infringement notices; restore content after 15 days if no response + +- Cost: No cost involved. You must establish a fixed workflow: receive the notice, forward it to the seller, collect the seller’s defense arguments, and publicly disclose the final outcome. All steps must be documented. +- In plain terms: If someone sends you an infringement notice with preliminary evidence, you must promptly delete, block, or remove the relevant content and forward the notice to the seller. Failing to act in time means you and the seller will be jointly liable for any additional losses incurred. After receiving the seller’s defense, forward it to the claimant and wait 15 days. If the claimant files no complaint or lawsuit during this period, you can restore the content. +- Benefit: Rights holders are entitled to request e-commerce platforms to take necessary measures such as deleting, blocking, or removing links to infringing content, as well as terminating related transactions and services. Such notices must include preliminary evidence of infringement. Merely sending a generic statement is insufficient. Once a platform receives a valid notice, it must act promptly and forward the notice to the seller; failure to do so makes the platform jointly liable for any additional damages incurred. After a seller submits a defense, the platform must wait 15 days after forwarding the statement to the rights holder before lifting any measures, provided no complaint or lawsuit is filed. If a platform knows or should know of infringement yet fails to act, it will also bear joint liability with the seller. Regulatory authorities may also order the platform to make corrections within a set timeframe; failure to comply may result in fines ranging from 50,000 to 500,000 RMB for minor violations, and 500,000 to 2,000,000 RMB for serious cases. Conversely, if a party maliciously issues false notices causing losses to sellers, they must pay double the compensation owed (applies nationwide). +- Evidence grade: A +- Notes: If you operate a general website rather than a full e-commerce platform, you should follow the notice-and-takedown rules outlined in the Civil Code. The key difference lies in the waiting period after receiving a seller’s defense: the E-commerce Law specifies a mandatory 15-day window, while the Civil Code only requires a “reasonable timeframe.” Additionally, the E-commerce Law explicitly mandates that platforms disclose all received notices, seller defenses, and final resolutions to the public, as required under Article 44. +- Sources:全国人大常委会 (2018). 电子商务法（第四十二、四十三、四十四、四十五、八十四条）. ; 全国人大 (2020). 民法典（第一千一百九十五、一千一百九十六、一千一百九十七条）. + +### 10. Personal information must not be casually transferred overseas; legal conditions and thresholds apply + + +- Cost: No cost involved. The simplest solution is to keep user data within China. If transfer overseas is unavoidable, follow standard contracts or obtain proper certification. + +- In plain terms: Transferring personal information of Chinese users to servers abroad constitutes a cross-border data transfer. Simply hosting servers overseas does not mean the data stays within China. There are four approved pathways for such transfers: a security assessment by the Cyberspace Administration, certification by authorized agencies, signing a standard contract, or compliance with other legal provisions. You must also disclose to users who receives their data, what it will be used for, and obtain their explicit consent for this specific purpose. + +- Benefit: To lawfully provide personal information to overseas entities — whether to foreign companies or foreign servers — at least one of four conditions must be met: passing a security assessment by the Cyberspace Administration; obtaining personal information protection certification; signing a standard contract drafted by the Cyberspace Administration; or meeting other requirements set by laws or administrative regulations. Additionally, you must inform users of the overseas recipient’s name, contact details, processing purpose, methods, and types of data involved, and obtain their separate consent. Threshold limits apply based on cumulative user counts. For most businesses not classified as critical information infrastructure operators, the exemption threshold is “fewer than 100,000 personal records (excluding sensitive information) transferred overseas in a calendar year.” Below this threshold, no assessment, contract, or certification is required. Between 100,000 and 1,000,000 records, a standard contract or certification is mandatory. For over 1,000,000 records, or when sensitive information of more than 10,000 individuals is involved, a formal security assessment is required (effective nationwide since March 2024). + +- Evidence grade: A + +- Notes: Hosting servers overseas does not equate to “data never leaving China.” If a user registers within China and their data is sent to foreign servers, this is still a cross-border transfer. Certain scenarios are exempt from assessment, certification, or standard contracts: cross-border shopping, shipping, or booking flights/hotels, provided these actions are necessary to fulfill a contract involving the user. Note also that user counts are calculated on a cumulative basis starting from January 1 of each year, not as a rolling 12-month period. +- Sources:全国人大常委会 (2021). 个人信息保护法（第三十八、三十九、四十条）. ; 国家互联网信息办公室 (2024). 促进和规范数据跨境流动规定（网信办令第 16 号，第三、四、五、七、八条）. ; 国家互联网信息办公室 (2022). 数据出境安全评估办法（网信办令第 11 号，第四条）. + +### 11. When picking a server, first consider how much downtime you can tolerate, then check whether there’s any support available, and only then compare prices. + + +- Cost: Cloud instances from major providers typically cost several hundred to several thousand yuan per month. VPS plans from smaller vendors start at just a few dozen yuan per month. A VPS is essentially a virtual mini‑server. Dedicated server hosting starts at several thousand yuan per year, and you must also purchase the hardware yourself. + +- In plain terms: The main difference among these three options isn’t price — it’s what resources you’ll have at hand when something goes wrong. Big providers offer registration pathways, publish their credentials, issue outage notices, and include compensation clauses in their contracts, so help is readily available. Smaller vendors may charge half as much, but they often over‑sell capacity, disappear without notice, or get cut off by upstream providers; in such cases you won’t know who to turn to. For static websites that contain no user data, a cheap VPS costing just a few dozen yuan is perfectly adequate. + +- Benefit: Again, the key distinction isn’t price but the support you can rely on during an emergency. Major cloud providers provide registration channels, disclose their qualifications, announce any outages, and guarantee compensation under their contracts, ensuring you can get assistance when needed. Smaller vendors can offer prices roughly half of those rates, yet when they over‑sell resources, shut down unexpectedly, or lose upstream connectivity, you have no recourse. Therefore, before negotiating a price, verify whether the vendor holds a valid value‑added telecommunications license via the Ministry of Industry and Information Technology database. Dedicated server hosting only makes sense if two conditions are met: the bandwidth or hardware costs are noticeably lower, and you have in‑house staff capable of managing the server. For static sites without user data, the cheapest VPS is sufficient; for sites that handle user registrations and transactions, choose a cloud instance that offers elastic scaling and snapshot backups, and store those backups in at least two separate locations. + +- Evidence grade: C + +- Notes: This entry is a guideline rather than a piece of evidence. The only verifiable item within it is the vendor’s licensing status. To save money, cut costs on configuration and bandwidth rather than on ensuring proper licensing. +- Sources:作者经验，无直接文献；服务商资质与备案的法定要求见本节第 4 条，日志留存 6 个月和等级保护义务见第 11 节第 16 条 diff --git a/book/27-Pregnancy-And-Birth.md b/book/27-Pregnancy-And-Birth.md new file mode 100644 index 00000000..727514ee --- /dev/null +++ b/book/27-Pregnancy-And-Birth.md @@ -0,0 +1,151 @@ +# 27. Pregnancy and childbirth: From confirming pregnancy to discharge and paperwork + +This section first looks at mortality risks — both for the mother and the unborn baby. Later on, we discuss costs and the time required for various procedures. These two sets of calculations are not combined or compared. The focus here is solely on “what needs to be done at what stage.” Topics such as prenatal nutrition or fetal education lack solid evidence or have minimal impact, so they are not covered here. Details on maternity benefits, leave entitlements, and child-rearing expenses can be found in Section 18. Guidance on caring for a newborn is provided in Section 20, while emergency situations are addressed in Section 13. + +According to World Health Organization figures, in 2023 roughly 260,000 women worldwide died as a result of pregnancy or childbirth. About 75% of these deaths stemmed from five main causes: severe postpartum bleeding, infections, hypertensive disorders of pregnancy (such as preeclampsia and eclampsia), complications during delivery, and unsafe abortions. The WHO also notes that “most maternal deaths are preventable, since effective medical measures for prevention and treatment of complications already exist.” The most important actions outlined in this section are precisely those aimed at preventing these problems before they occur. +### 1. Starting daily folic acid supplementation at 0.4 mg before pregnancy and continuing through the first trimester + +- Cost: A bottle costs only a few dozen yuan. Rural women receive it for free through the national folic acid supplementation program. The real challenge is remembering to take one pill every day. +- In plain terms: Taking one folic acid pill daily before and during early pregnancy can cut the risk of neural tube defects in babies by roughly 70%. These defects include conditions like anencephaly and spina bifida. For women who’ve already had a child with such a defect, this regimen reduces the likelihood of a repeat occurrence to about one third of the original risk. +- Benefit: A Cochrane systematic review pooled data from 5 trials involving 6,708 deliveries, rating the evidence as high quality. Daily folic acid intake before and during pregnancy lowered the relative risk of fetal neural tube defects to 0.31 (95% CI 0.17–0.58), a reduction of roughly 70%. For women with a prior child affected by neural tube defects, the relative risk dropped to 0.34 (95% CI 0.18–0.64), equating to a one third reduction in risk. No difference in effectiveness was observed between 0.4 mg and higher doses, nor between folic acid alone and multivitamin supplements. +- Evidence grade: A +- Notes: The key point is to start taking folic acid *before* pregnancy. A fetus’s neural tube closes within 28 days of conception; by the time a pregnancy is detected, most of this window has already passed. Therefore, if you’re planning to conceive, begin supplementation three months in advance. The same review found no clear evidence that folic acid prevents cleft lip and palate, congenital heart disease, or miscarriage — so don’t expect it to address these issues. +- Sources:De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, (12), CD007950. + +### 2. Register for the Maternal and Child Health Handbook at a community health center before 13 weeks of pregnancy to claim free prenatal checkups + +- Cost: No cost at all — this is part of the national basic public health service program. You’ll need to make several visits based on your gestational age. +- In plain terms: You are entitled to at least five free prenatal checkups during pregnancy, plus home visits after delivery and a 42-day postpartum checkup, all paid for by the state. To access these services, you must register for the Maternal and Child Health Handbook at a community health center before 13 weeks of gestation. Failing to do so means you lose out on all these free services. +- Benefit: The third edition of the National Basic Public Health Service Standards outlines specific maternal health management services available to all permanent residents who are pregnant. These include one health checkup in early pregnancy, two in mid-pregnancy, two in late pregnancy, one postpartum home visit, and one 42-day postpartum checkup. Registration for the handbook must be completed before 13 weeks of pregnancy, at which point your first prenatal checkup will also be scheduled. The two mid-pregnancy checkups occur between 16–20 weeks and 21–24 weeks respectively, while the two late-pregnancy checkups are scheduled for 28–36 weeks and 37–40 weeks. Local service lists also include a full set of initial lab tests and postpartum depression screening as part of these free services. +- Evidence grade: A +- Notes: These five free checkups represent the minimum number of services provided; they do not cover all possible prenatal tests. Depending on your individual health needs, your doctor may recommend additional ultrasounds, blood glucose tests, or fetal heart rate monitoring, all of which will incur extra costs. Registering for the handbook as early as possible also allows for earlier assessment of your pregnancy risk level. This risk grading system categorizes pregnant women based on their individual risk factors, ensuring those identified as high-risk receive timely care at specialized medical facilities. Even if you live in a different district than your registered household location, you can still register at your current place of residence — there is no requirement to return to your place of household registration. +- Sources:国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）. ；靖江市人民政府. 国家基本公共卫生服务项目——孕产妇健康管理服务（地方服务清单公开）. + +### 3. Getting tested for HIV, syphilis, and hepatitis B during the first prenatal visit — free prevention options available + +- Cost: No cost involved; the maternal and infant transmission prevention program provides these tests at no charge. +- In plain terms: During your very first prenatal checkup, you can get tested for HIV, syphilis, and hepatitis B at no personal expense. Even if results show a positive diagnosis, there are still effective ways to prevent transmission to your baby. The government offers free medication and treatment plans to block the spread of these infections from mother to child — this is known as maternal and infant transmission prevention. +- Benefit: Maternal and infant transmission is how infections pass from a mother to her unborn or newborn child. The “Work Specifications for Preventing Maternal and Infant Transmission of HIV, Syphilis, and Hepatitis B (2020 Edition)” mandates that during early pregnancy or at the first prenatal visit, healthcare providers must share relevant information and “offer appropriate, standardized free testing” — meaning these three tests are completely free. Follow-up counseling and referrals are also provided based on test results. A positive diagnosis is not a dead end: Article 44 of the “Regulations on HIV/AIDS Prevention and Control” guarantees free treatment and counseling for pregnant women living with HIV to prevent transmission to their babies. Article 43 further requires that such women receive services including transmission prevention, treatment, postpartum home visits, infant follow-ups, and testing. For mothers who test positive for hepatitis B surface antigen, newborns receive both hepatitis B vaccine and hepatitis B immunoglobulin at birth (see Section 20, Item 2). +- Evidence grade: A +- Notes: Early testing is especially valuable for these three conditions, as both prevention and treatment require sufficient time to be effective. Article 3 of the “Regulations on HIV/AIDS Prevention and Control” also states that “no entity or individual may discriminate against people living with HIV/AIDS, AIDS patients, or their family members”; their legal rights related to marriage, employment, medical care, and education are fully protected by law. General prevention measures and routine testing are covered in Section 1, while post-exposure prophylaxis after high-risk behaviors is detailed in Section 13. +- Sources:国家卫生健康委办公厅 (2020). 预防艾滋病、梅毒和乙肝母婴传播工作规范（2020 年版）. （新疆维吾尔自治区卫生健康委员会转载）；国务院 (2006). 艾滋病防治条例（第四十三、四十四条）. （北京市卫生健康委员会转载） + +### 4. No smoking or drinking at all throughout pregnancy — and no one else in the house should smoke either + +- Cost: There’s no cost at all; in fact, it saves money on cigarettes and alcohol. The real challenge is getting everyone living in the same house to quit alongside the pregnant woman. +- In plain terms: Smoking during pregnancy raises the chances of premature birth, a baby being born underweight, and cleft lip or palate. It also doubles the risk of abnormal bleeding during pregnancy and childbirth, and increases the risk of sudden infant death syndrome. Secondhand smoke from anyone smoking indoors counts just the same. It is never too late to quit, no matter when you start. +- Benefit: According to the U.S. Centers for Disease Control and Prevention, smoking during pregnancy can result in babies being “born at full term but still underweight” and “more likely to be born prematurely.” It “doubles the risk of abnormal bleeding during pregnancy and childbirth,” raises the risk of birth defects such as cleft lip and palate, and “damages the developing lungs and brain of the fetus, with effects lasting into childhood.” Babies born to mothers who smoke during pregnancy, as well as infants exposed to smoke after birth, face a higher risk of sudden infant death syndrome. Official guidance states that “it is best to quit smoking before getting pregnant, but quitting while already pregnant still provides benefits,” and “it is never too late to quit.” +- Evidence grade: A +- Notes: Secondhand smoke from anyone smoking indoors is just as harmful to the fetus as direct smoking. Therefore, this rule applies to the whole household, not just the pregnant woman. The same principle holds true for alcohol: there is no known safe level of alcohol consumption during pregnancy, so the safest approach is to avoid it entirely. The impact of smoking and drinking on the health of adults themselves is covered in Section 2. +- Sources:Centers for Disease Control and Prevention. Smoking During Pregnancy. + +### 5. For women at high risk of preeclampsia, start taking one low-dose aspirin tablet daily after week 12 of pregnancy + +- Cost: A few dozen yuan. One tablet per day must be taken until delivery. The hard part is remembering to take it every single day. +- In plain terms: Preeclampsia is a type of high blood pressure that occurs during pregnancy. Women falling into any of these six categories are at high risk: those who had preeclampsia in a previous pregnancy, women carrying multiples, women with chronic hypertension, women with diabetes prior to pregnancy, women with kidney disease, and women with autoimmune diseases. For these women, taking one low-dose aspirin tablet daily starting at week 12 can reduce the risk of preeclampsia by roughly 15%, the risk of premature birth by about 20%, and the risk of perinatal death by nearly 20%. Women not in these categories should not take it on their own. +- Benefit: The US Preventive Services Task Force gives this a Grade B recommendation: for women at high risk of preeclampsia, taking low-dose aspirin (81 mg per day) after week 12 of pregnancy can help prevent the condition. Preeclampsia is a hypertensive disorder unique to pregnancy. Results from multiple studies combined show the following outcomes, with 95% confidence intervals provided as ranges of reliability. The relative risk of preeclampsia drops to 0.85 (95% CI: 0.75 to 0.95, based on 16 studies), a reduction of roughly 15%. The relative risk of premature birth is 0.80 (95% CI: 0.67 to 0.95, based on 13 studies), a drop of about 20%. The relative risk of perinatal death — death occurring around the time of childbirth — is 0.79 (95% CI: 0.66 to 0.96, based on 11 studies), a reduction of roughly 21%. The relative risk of small-for-gestational-age infants or intrauterine growth restriction is 0.82 (95% CI: 0.68 to 0.99, based on 16 studies), a decrease of around 18%, meaning fetuses are less likely to be smaller than expected for their gestational age. +- Evidence grade: A +- Notes: The groups considered high risk include women who had preeclampsia in a prior pregnancy, those carrying twins or multiples, women with chronic hypertension, women with type 1 or type 2 diabetes prior to pregnancy, women with kidney disease, and women with autoimmune diseases such as systemic lupus erythematosus or antiphospholipid syndrome. Women not in these groups should not take aspirin on their own. This medication requires a doctor’s prescription; be sure to share your full medical history during prenatal checkups so your doctor can make an appropriate assessment. Most low-dose aspirin tablets sold in China are 100 mg enteric-coated tablets, and they must be taken strictly as directed by your doctor. +- Sources:US Preventive Services Task Force (2021). Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication. + +### 6. Get screened for gestational diabetes at 24 weeks of gestation or later — don’t mind drinking the sugary solution + + +- Cost: Several tens to over a hundred yuan. You must fast beforehand, and several blood draws will take up half a morning. +- In plain terms: Gestational diabetes is high blood sugar that appears only during pregnancy. At 24 weeks or later, spending half a morning drinking a sugary solution and having several blood tests can detect it. Skipping this test raises the risks of having a macrosomic baby, difficult labor, cesarean delivery, preeclampsia, and neonatal hypoglycemia. +- Benefit: The U.S. Preventive Services Task Force recommends screening for gestational diabetes at 24 weeks or later for asymptomatic pregnant women — those who feel no symptoms at all. Gestational diabetes is high blood sugar that appears only during pregnancy. This single screening test should be done at 24 weeks or later. The Task Force concluded that current evidence does not show any clear benefits or harms from screening before 24 weeks (Grade I). Untreated gestational diabetes increases the risks of macrosomia, difficult labor, cesarean delivery, preeclampsia, and neonatal hypoglycemia. +- Evidence grade: A +- Notes: Most women diagnosed with gestational diabetes can control their blood sugar through diet and exercise alone; only a minority need insulin injections. Don’t skip this test out of fear of being told you need insulin. After giving birth, you must get another blood sugar test — women who’ve had gestational diabetes face a significantly higher risk of developing type 2 diabetes later on. +- Sources:US Preventive Services Task Force (2021). Gestational Diabetes: Screening. + +### 7. Memorize this “go to the hospital immediately” checklist — it applies throughout pregnancy and the first year after childbirth + +- Cost: No cost at all. It takes just five minutes to memorize, and it’s a good idea to share it with anyone living in the same household. +- In plain terms: If any of the following symptoms appear, head to the hospital on the same day — do not wait until the next morning. Persistent or worsening headaches, changes in vision, fever reaching 38°C. Severe swelling of the hands or face, trouble breathing, chest pain or a rapid heartbeat. Unrelenting severe abdominal pain, no fetal movement or a noticeable drop in fetal movement. Vaginal bleeding or fluid leakage. Swelling, pain and redness in one arm or leg. Thoughts of harming yourself or your baby. The full list is included in the Benefits section below. These guidelines apply equally in the first year after childbirth. +- Benefit: These are all emergency warning signs during pregnancy and postpartum listed by the US Centers for Disease Control and Prevention. Persistent or worsening headaches, dizziness or fainting, changes in vision, a body temperature of 38°C or higher. Severe swelling of the hands or face, thoughts of harming yourself or your baby. Difficulty breathing, chest pain or a rapid heartbeat. Severe nausea and vomiting, unrelenting severe abdominal pain. Absence or significant reduction of fetal movement during pregnancy, vaginal bleeding or fluid leakage during pregnancy or postpartum. Abnormal vaginal bleeding or discharge after childbirth. Severe swelling, redness and pain in one arm or leg. None of these issues disappear after the postpartum recovery period — they can all occur within the first year after childbirth. +- Evidence grade: A +- Notes: This checklist serves to clearly distinguish between situations where you can wait a little longer and those that demand immediate medical attention. Headaches paired with blurred vision and upper abdominal pain are typical signs of preeclampsia, a form of pregnancy-related hypertension. Swelling and pain in one lower leg often indicates deep vein thrombosis (see Section 13). According to the World Health Organization, severe postpartum hemorrhage can be fatal to a healthy woman within just a few hours. If any of these symptoms appear, go to the hospital right away — do not delay by waiting at home overnight. +- Sources:Centers for Disease Control and Prevention. Hear Her — Urgent Maternal Warning Signs. ；World Health Organization. Maternal mortality fact sheet. + +### 8. If your water breaks, lie down flat, elevate your hips, and call 120 — don’t walk around or take a shower + + +- Cost: No cost at all +- In plain terms: If your water breaks, there’s no time to calmly gather your things and head out. The right thing to do is lie down right where you are, raise your hips, and call 120 immediately. Walking around while standing up causes amniotic fluid to leak even faster, and the umbilical cord can be pulled out along with it. This is a life-threatening emergency for the baby. +- Benefit: This is exactly what the Beijing Municipal Health Commission recommends: “Immediately lie down flat to prevent further loss of amniotic fluid,” “Do not walk around casually,” and “Call emergency services at 120 right away.” While waiting for help, inform family members so they can bring necessary items to the hospital. Medical sources further explain why this is essential: when a person stands, amniotic fluid drains much more quickly, increasing the risk of umbilical cord prolapse — a critical emergency for the fetus. Therefore, lying down and elevating the hips is crucial; a left-side lying position is ideal. +- Evidence grade: B +- Notes: The three main signs of impending labor are regular contractions, vaginal bleeding, and water breaking. With the first two, you can still prepare calmly, but water breaking demands immediate action: lie down and call for help. Common mistakes include showering, squatting on the toilet, or driving yourself to the hospital. Be sure to note the exact time water broke and its color; tell the doctor if it appears yellow-green or contains meconium, as this indicates fetal distress and oxygen deprivation. If you also experience regular contractions, a marked drop in fetal movement, fever, or chills, emphasize that this is a true emergency. +- Sources:北京市卫生健康委员会. 每周急救话题：准妈妈羊水早破怎样办？ ；北京市顺义区妇幼保健院. 孕晚期在家破水怎么办？ + +### 9. Ask for labor analgesia — it does not raise the risk of C-section + +- Cost: Several hundred to over 1,000 yuan; prices vary by region. Be sure to ask the hospital and anesthesiology department in advance whether this service is available. The main hurdle is simply bringing it up yourself. +- In plain terms: Labor analgesia involves injecting anesthetic into the lower back to dull the pain of childbirth. It works far better than other pain‑relief options and does not make a C-section more likely. The claim that “it causes lifelong back pain” is also unfounded. Nowadays it is offered as a separate charge, so hospitals are more willing to provide it. +- Benefit: A Cochrane systematic review found that epidural analgesia is more effective than non‑epidural methods at reducing labor pain and improving maternal satisfaction. Labor analgesia uses exactly this technique. The same review states that epidural analgesia has no effect on the risk of C-section or long‑term back pain. Instrumental delivery — using tools to assist birth — shows no increased incidence in studies published after 2005. Starting in 2024, the National Healthcare Security Administration introduced separate pricing categories for “labor analgesia,” “doula‑assisted childbirth,” and “family‑member labor support,” precisely because previously there were no dedicated rates to motivate hospitals to offer these services. +- Evidence grade: A +- Notes: Both popular myths — “epidural analgesia causes lifelong back pain” and “it makes a C-section more likely” — lack any scientific basis. Cochrane’s comparison of epidural analgesia with other pain‑relief methods confirms it has no impact on C‑section risk or chronic back problems. Real side effects may include low blood pressure, fever, weak legs, difficulty urinating, longer first‑ and second‑stage labor, and a higher need for oxytocin. The decision to use it is yours; don’t let unfounded rumors deter you. Availability also depends on whether the hospital has an anesthesiologist on duty 24/7 — be sure to ask during prenatal visits. +- Sources:Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews, (5), CD000331. ；国家医疗保障局 (2024). 重构产科服务价格项目 助力构建生育友好型社会. + +### 10. Don’t request a C-section without medical indication, and avoid scheduling one just to pick a “lucky” date + +- Cost: No direct cost. The real challenge is resisting pressure from family members. +- In plain terms: According to the World Health Organization, once the C-section rate in a region exceeds 10%, further reductions in maternal and neonatal mortality become unlikely. When a C-section is medically necessary, it must be performed. However, opting for one solely to choose a favorable date or to avoid labor pain means undergoing a major abdominal operation for no real reason. +- Benefit: A 2015 WHO statement notes that when C-section rates rise to roughly 10% in a population, maternal and neonatal deaths decline. Beyond that threshold, there is no evidence of additional mortality benefits. WHO also stresses that every effort should be made to provide C-sections to women who truly need them, rather than aiming for a specific percentage target. +- Evidence grade: A +- Notes: This guidance does not oppose C-sections. When medically warranted, they are life-saving procedures and should be performed without hesitation. What it discourages is undergoing a C-section when there is no medical need—such as to avoid labor pain, to pick an auspicious date, or to influence a child’s future age for school enrollment. The trade-offs are significant: C-sections are major abdominal surgeries with slower recovery times, and they increase risks of placenta previa, placenta accreta, and uterine rupture in subsequent pregnancies—factors that may affect a woman’s decision to have more children. +- Sources:World Health Organization (2015). WHO Statement on Caesarean Section Rates（WHO/RHR/15.02）. + +### 11. Check your yibao enrollment status before getting pregnant — even unemployed spouses can claim maternity medical expenses + +- Cost: Zero cost. Just call the social insurance or medical insurance hotline once. +- In plain terms: If your employer pays into yibao, both maternity medical costs and maternity leave benefits come out of that fund. Even if your spouse isn’t employed, they can also claim maternity medical expenses. You must confirm beforehand whether you’ve met the minimum enrollment period and whether you need to register in advance for childbirth outside your local area — these details cannot be fixed later. +- Benefit: Article 54 of the Social Insurance Law states that employers who pay yibao premiums provide their employees with full maternity benefits. Unemployed spouses of these employees are also entitled to maternity medical coverage under national regulations, with funds drawn from the yibao pool. These benefits fall into two categories: maternity medical expenses (costs directly related to childbirth) and maternity allowances (payments received during maternity leave). Article 56 further specifies three scenarios qualifying for allowances: childbirth, family planning procedures, and other legally defined situations. Allowances are calculated based on the employer’s prior year’s average monthly payroll, not individual employee wages. +- Evidence grade: A +- Notes: Two critical points require advance verification since retroactive adjustments are impossible. First, confirm you’ve satisfied the minimum continuous enrollment period required by local regulations; otherwise eligibility is denied. Second, if planning childbirth outside your enrollment area, verify whether pre-registration is mandatory — failure to do so may force you to pay upfront and file manual claims later, or even forfeit coverage entirely. Detailed calculations for maternity leave duration and allowances are outlined in Section 18.2. +- Sources:全国人大常委会 (2010). 中华人民共和国社会保险法（第五十四、五十六条）. （国家税务总局广东省税务局转载） + +### 12. Get the “Medical Certificate of Birth” sorted out before discharge; decide on the baby’s name early and avoid typos. + +- Cost: No cost at all. It can be arranged effortlessly while completing discharge procedures. +- In plain terms: This certificate is a prerequisite for registering the child’s hukou, enrolling in yibao (basic medical insurance), and sending the child to school. Only the medical institution where the delivery took place can issue it for the first time. If you try to obtain it after discharge, you’ll have to follow a completely different process and submit extra documentation. Also, make sure the characters you pick for the baby’s name can be entered into the household registration system without any issues. +- Benefit: Article 23 of the Maternal and Infant Health Care Law stipulates that medical institutions and home birth attendants must issue the standardized Medical Certificate of Birth for newborns as required by the State Council’s health administrative department. This certificate is a mandatory prerequisite for all subsequent procedures: registering hukou, signing up for medical insurance, applying for a health insurance card, and enrolling in preschool or school. The initial issuance can only be handled by the delivery hospital. Any later applications require a separate process and additional supporting documents. +- Evidence grade: A +- Notes: Before filling out the form, double-check every character in the parents’ names, their ID numbers, and the baby’s name. The characters chosen for the name must be compatible with the household registration system — using rare or uncommon characters can lead to endless complications down the line. Both name changes and certificate reissues involve reissuance procedures, which are far more expensive than simply verifying the details at the time of application. Once you receive the certificate, store it separately from other important documents: it holds the same legal weight as your household register and ID card. +- Sources:全国人大常委会 (1994, 2017 修正). 中华人民共和国母婴保健法（第二十三条）. + +### 13. Don’t skip newborn heel‑prick and hearing tests + +- Cost: In most areas these tests are free; otherwise they cost only a few dozen yuan. Some extra screening items may require out‑of‑pocket payment. +- In plain terms: A single heel‑prick blood test and one hearing test can detect hypothyroidism, phenylketonuria, and hearing loss even when the baby appears perfectly healthy. By the time symptoms become obvious, any intellectual damage is already irreversible. +- Benefit: Article 3 of the “Administrative Measures for Newborn Disease Screening” lists congenital hypothyroidism, phenylketonuria, other inherited metabolic disorders, and hearing impairment as nationally mandated screening targets. All of these conditions show no outward signs early on; once symptoms appear, lasting intellectual harm has already occurred. Early detection and prompt treatment—such as thyroid hormone replacement, special formula milk, hearing aids, or cochlear implants—yield excellent outcomes. Article 10 further stipulates that any positive screening result must be promptly communicated to parents for confirmatory diagnosis. +- Evidence grade: A +- Notes: Article 11 requires that before screening, parents be fully informed of the tests, eligibility criteria, procedures, sensitivity rates, and associated costs, and must give written consent. Consequently, you’ll receive an informed‑consent form. Carefully review which conditions are covered by the state program and which extra items incur personal fees. A positive initial result does not mean a definitive diagnosis; most infants are cleared after a single follow‑up test, so there’s no need to panic at this stage. If a newborn fails the initial hearing screen, follow the instructions for a repeat test—don’t assume “if the baby seems to hear, it’s fine.” +- Sources:卫生部 (2009). 新生儿疾病筛查管理办法（卫生部令第 64 号，第三、十、十一条）. + +### 14. Enroll your newborn in yibao right after getting the birth certificate — don’t wait until household registration is complete + +- Cost: You pay the yibao premium just once a year; it usually costs a few hundred yuan. +- In plain terms: As soon as you receive the birth certificate, you can enroll your baby in yibao online — no need to wait for household registration. Once enrolled, most hospitalization costs can be reimbursed right at discharge. Newborn hospital bills can be quite high, so having yibao makes a big difference. +- Benefit: According to the Chinese government website in 2024, “Newborns can enroll in yibao online using their birth certificate alone; household registration is not required first.” It also states that “after discharge, newborns can get medical expenses reimbursed immediately.” Previously, families had to complete household registration first, pay all hospital costs out of pocket, and then apply for reimbursement. The average processing time for enrollment has also dropped from 28.7 working days at the start of the year to just 6.4 working days now. +- Evidence grade: A +- Notes: Premature birth, phototherapy for jaundice, and neonatal pneumonia are common reasons newborns end up in the hospital — often resulting in bills of tens of thousands of yuan. Having yibao versus not having it makes a huge difference in such cases. Local rules vary regarding how many days after birth a child must be enrolled to qualify for coverage starting from birth; always check with your local medical insurance office for exact details. Before discharge, calling 12393 is the easiest way to get clear answers. +- Sources:中国政府网 (2024). 健全基本医疗保险参保长效机制国务院政策例行吹风会. + +### 15. Registering a newborn’s birth at a police station within one month + + +- Cost: No cost involved; just a single trip to the police station’s hukou office. +- In plain terms: The law sets a strict one‑month deadline — it’s not a suggestion that you can ignore when convenient. Completing the hukou registration is a prerequisite for vaccinations, preschool enrollment, school admission, and obtaining an ID card. The longer you wait, the more additional documents you’ll need to provide. +- Benefit: Article 7 of the *Regulations on Hukou Registration* states: “Within one month after a baby’s birth, the head of household, relatives, guardians, or neighbors must report the birth to the local hukou registration authority.” This is a legal requirement, not a mere recommendation. Securing hukou is essential for all subsequent steps: vaccinations, preschool and school entry, and ID issuance. Delaying registration inevitably leads to a heavier paperwork burden. +- Evidence grade: A +- Notes: Bring the following documents: the medical birth certificate, both parents’ ID cards and hukou books, and the marriage certificate. You may choose to register the child under either parent’s hukou, but policies differ between locations, affecting school districts and insurance eligibility. Make this decision before you go, as later changes can be cumbersome. Unmarried parents may also register their newborn without any restrictions. +- Sources:国务院 (1958). 中华人民共和国户口登记条例（第七条）. （广东省人民政府转载） + +### 16. Don’t skip that 42-day postpartum checkup — it also screens for postpartum depression + +- Cost: It’s free; it’s part of basic public health services. It takes half a day. The hard part is that right after childbirth you often feel too lazy to go. +- In plain terms: This checkup costs nothing and includes a complete blood count, vaginal discharge test, plus a screening for postpartum depression. Serious problems can arise at any time during the first year after birth, so don’t assume you’re out of danger just because the postpartum period is over. +- Benefit: According to the “National Standards for Basic Public Health Services (3rd Edition),” postpartum care requires one home visit and one health checkup at 42 days. Local service lists confirm this visit includes lab tests (blood count, vaginal discharge) and a postpartum depression screening. Severe complications may appear throughout the first year. Items on the “Go to the hospital immediately” list in Section 7 — such as “thoughts of harming oneself or the baby,” “abnormal vaginal bleeding or discharge,” or “severe swelling/pain in one limb” — all fall under postpartum risks. +- Evidence grade: A +- Notes: Postpartum depression isn’t a sign of weakness or something that can be fixed by family telling you to “cheer up.” There are specific screening questionnaires and treatments available, and recovery is possible. Handling suicidal thoughts is covered in Section 1. Legal options if caring for a newborn proves impossible are outlined in Section 9, Item 20. This checkup also evaluates wound healing, uterine recovery, pelvic floor function, and discusses contraception — remember, the absence of menstruation after childbirth doesn’t mean pregnancy is impossible. +- Sources:国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）. ；靖江市人民政府. 国家基本公共卫生服务项目——孕产妇健康管理服务（地方服务清单公开）. diff --git a/book/28-Do-Not-Ruin-Health-For-Looks.md b/book/28-Do-Not-Ruin-Health-For-Looks.md new file mode 100644 index 00000000..f6154e0e --- /dev/null +++ b/book/28-Do-Not-Ruin-Health-For-Looks.md @@ -0,0 +1,102 @@ +# 28. Don’t harm your body just to change its appearance + +This section covers several methods people use to alter their appearance: fasting, taking pills, getting injections, and undergoing surgery. They all share one thing in common: the decision to use them is usually driven by comparisons with others. Yet the costs are borne entirely by the individual, and many of those costs are irreversible. + +We make no judgment about anyone’s personal choice regarding how they want to look — that is a matter of personal preference. What we do address is this: for the same end result, how much greater is the risk when people follow unregulated paths — buying products online, using services at beauty clinics, or increasing dosages on their own — compared to following medically supervised routes that involve prescriptions, qualified professionals, and follow‑up care? Our assessment focuses on actual physical consequences such as blindness, hospitalization, and death. In addition, illegal cosmetic procedures can lead to serious criminal liability. +### 1. Do not use extreme dieting, fasting, or self-induced vomiting to control weight; if you want to lose weight, focus on exercise instead. + +- Cost: No cost at all. In fact, it saves money compared to buying weight-loss products. +- In plain terms: People with anorexia nervosa have a mortality rate roughly 5.9 times higher than their peers. Across 1,000 people followed for one year, about 5.1 die. One out of every five of those deceased individuals died by suicide. The root cause often starts with dieting: a three-year study of students at 44 secondary schools found that girls who dieted severely were 18 times more likely to develop eating disorders than those who did not diet. To control weight, prioritize exercise rather than cutting food intake to the point of hunger. +- Benefit: This conclusion is backed by 36 separate studies involving a total of 166,642 person-years of follow-up on individuals with anorexia nervosa. Their standardized mortality ratio was 5.86, meaning their death risk is 5.9 times higher than that of people of the same age. Across 1,000 person-years, 5.1 deaths occurred, and roughly one fifth of those deaths were suicides. For bulimia nervosa, the standardized mortality ratio is 1.93, and 1.92 for other eating disorders, both roughly 1.9 times higher than the general population. Another study conducted in 44 secondary schools in Victoria, Australia, tracked 14–15-year-old students over three years with six rounds of assessments. It found that new cases of eating disorders emerged at a rate of 21.8 per 1,000 person-years among girls, meaning 21.8 new cases occurred per 1,000 girls each year. Girls who dieted severely had an 18-fold higher risk of developing eating disorders than those who did not diet, while those who dieted moderately had a 5-fold higher risk. After adjusting for prior dieting habits and pre-existing mental health issues, factors like BMI, exercise levels, and gender no longer predicted new cases of eating disorders. The authors concluded that for adolescents, using exercise rather than diet restriction to control weight appears to lower the risk of developing eating disorders. +- Evidence grade: A +- Notes: The term “severe dieting” here refers to consistently consuming far less food than the body needs over a long period, not simply skipping one meal or avoiding late-night snacks. If you experience self-induced vomiting, feel guilty after binge eating, or find yourself compulsively weighing yourself, seek help from a psychiatrist or clinical psychology department at a general hospital. This is a treatable medical condition, not a matter of lacking willpower. Information on the relationship between BMI and mortality is provided in Section 2, Item 33, which focuses on long-term weight ranges rather than weight-loss methods. +- Sources:Arcelus J et al. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. ；Patton GC et al. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. + +### 2. Two things to check before getting injections, thread lifts, or surgery: does the facility’s license list “medical aesthetics,” and is the practitioner a licensed attending physician? + + +- Cost: There is no cost involved. Checking these two documents takes only a few minutes. The clinic should display its “Medical Institution Practice License” in the lobby. A doctor’s qualifications can be verified via the health authority’s online registry of licensed physicians. + +- In plain terms: Any procedure that involves needles, surgery, or medical devices — meaning anything that breaks the skin or enters the body — is considered medical treatment. Such procedures may only be performed at facilities whose licenses explicitly list “medical aesthetics,” and only by registered attending physicians. Performing them in beauty salons, private studios, or hotel rooms is illegal medical practice: in serious cases, offenders face up to three years in prison; if they cause injury, three to ten years; if they result in death, more than ten years. + +- Benefit: Article 2 of the “Administrative Measures for Medical Aesthetic Services” defines medical aesthetics as “the use of surgery, drugs, medical devices, and other invasive or traumatic medical techniques to repair and reshape a person’s appearance and body contours.” In simpler terms, any procedure that breaks the skin or introduces needles or devices into the body qualifies as medical treatment. Articles 8 and 24 stipulate that a facility must first obtain a “Medical Institution Practice License” and be approved for medical aesthetic services before conducting such procedures; if “medical aesthetics” is not listed on the license, the practice is prohibited. Article 11 requires attending physicians to hold valid licenses and be registered; those performing cosmetic surgery must have at least six years of relevant clinical experience, cosmetic dentistry five years, and cosmetic traditional Chinese medicine or dermatology three years each. Article 20 mandates that patients receive written explanations of indications, contraindications, risks, and precautions prior to consent. Article 336 of the Criminal Law criminalizes illegal medical practice — performing injections, surgery, or treatment without proper licensing. Penalties range from up to three years imprisonment for minor offenses to three to ten years for causing injury, and more than ten years for resulting in death. + +- Evidence grade: A + +- Notes: Article 16 of the same regulations further specifies that medical aesthetic procedures may only be conducted at licensed medical aesthetic facilities or at hospitals/clinics with designated medical aesthetic departments. Therefore, performing injections at a patient’s home or in a private studio already violates regulations. Article 20 also requires parental consent for minors undergoing such treatments. Routine beauty services such as facials, massages, or nail care fall outside this regulatory framework; however, any procedure involving needles or surgery remains classified as medical aesthetics. +- Sources:卫生部 (2002). 医疗美容服务管理办法（卫生部令第 19 号，第二条、第八条、第十一条、第十六条、第二十条、第二十四条）. ；全国人大 (1997). 刑法（第三百三十六条）. + +### 3. Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money. + +- Cost: No cost at all. You simply choose a different injection site, or skip the treatment altogether. +- In plain terms: Between 2015 and 2018, 48 new cases of partial or total vision loss following filler injections were reported worldwide. The nose was the most common site of complications, accounting for 56.3% of cases; followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was used in over 80% of these cases. Only 20.8% of patients regained full vision, while 16.7% saw partial recovery; the rest remained visually impaired. Nearly 20% also developed complications affecting the central nervous system. Currently, no single treatment has been proven consistently effective for reversing these effects, so prevention remains the only reliable option. +- Benefit: Data compiled from all published case reports worldwide show that from January 2015 through September 2018, 48 new instances of partial or complete vision loss occurred after filler injections. The nasal region accounted for 56.3% of incidents, followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was identified as the filler material in 81.3% of cases. Skin changes appeared in 43.8% of patients, while central nervous system complications arose in 18.8%. Ten patients (20.8%) fully recovered vision, eight (16.7%) partially recovered, and the remainder did not improve. Researchers concluded that treatment approaches varied widely across studies, and no single method has been demonstrated to reliably restore vision. +- Evidence grade: B +- Notes: These figures were derived by manually tallying each reported case across medical journals. They reflect only the number of patients experiencing complications, not the total number of injections performed; thus it is impossible to calculate the exact probability of blindness per injection. The B rating reflects this limitation. Reputable clinics naturally employ standard risk‑minimization practices: mapping vascular pathways beneath the injection sites, using blunt‑tip needles instead of sharp ones, administering small amounts of filler while slowly withdrawing the needle, and keeping hyaluronidase on hand. All these steps must be carried out by trained physicians — which is precisely why unregulated providers should be avoided. Before proceeding, verify that the clinic holds proper licensing and that the attending physician is qualified, as outlined in Section 2 of this chapter. +- Sources:Beleznay K et al. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. + +### 4. Don’t buy weight‑loss pills, coffee, candies, or “enzymatic plums” that promise rapid results + + +- Cost: Zero. In fact, you’ll save the money you’d otherwise spend on these products. The hard part is accepting that there’s no such thing as “losing several pounds in a week.” + +- In plain terms: The illegal ingredient most often found in these products is sibutramine. Originally a legitimate weight‑loss medication, it was banned in China in 2010. One large trial enrolled nearly 10,000 participants who took the drug for an average of over three years. Compared with placebo, users had a roughly 30% higher risk of non‑fatal heart attacks and a 36% higher risk of non‑fatal strokes; the overall adverse‑event rate was 11.4% versus 10.0%. Over three years, the drug only produced an extra 1.7 kg of weight loss. By the time tests detect the substance, you’ve already consumed it. + +- Benefit: The SCOUT trial involved 9,804 participants aged 55 or older who were overweight or obese and had cardiovascular disease or type 2 diabetes. They were randomly assigned to receive sibutramine or placebo for an average of 3.4 years. The primary endpoints were several predefined adverse events: non‑fatal myocardial infarction, non‑fatal stroke, cardiac arrest with successful resuscitation, and cardiovascular death. The incidence rates were 11.4% in the drug group versus 10.0% in placebo, giving a hazard ratio of 1.16 (95% CI 1.03–1.31, P = 0.02). In other words, treatment raised the risk of any such event by roughly 16%, with the true increase likely ranging from 3% to 31%. Non‑fatal heart attacks occurred in 4.1% vs 3.2% of participants (HR 1.28, 1.04–1.57), a 30% relative rise; non‑fatal strokes appeared in 2.6% vs 1.9% (HR 1.36, 1.04–1.77), a 36% increase. Cardiovascular and overall mortality did not rise. On average, the sibutramine group lost only 1.7 kg more than placebo. Based on safety concerns, China’s former State Food and Drug Administration ruled in October 2010 that the benefits of sibutramine did not outweigh its risks, ordering cessation of its production, sale, and use; both sibutramine and phenolphthalein are prohibited in foods and dietary supplements. + +- Evidence grade: A + +- Notes: SCOUT enrolled high‑risk individuals already suffering from heart disease or diabetes; it does not prove that healthy young people would experience the same effects. Because it’s impossible to identify who is truly low‑risk, regulators opted to withdraw the drug entirely. Another common illicit additive is phenolphthalein, originally a laxative whose chronic overuse can disturb electrolyte balance and provoke arrhythmias. How to tell a legitimate product from a fraudulent one: genuine weight‑loss medicines are prescription drugs whose approval numbers can be verified at pharmacies or hospitals. Products marketed as “coffee,” “candies,” “plums,” or “meal replacements” that promise rapid weight loss should, by definition, have no therapeutic effect; any such effect indicates illegal adulteration. The original wording of State Food and Drug Administration Order No. 432 [2010] can be cross‑checked on provincial regulatory websites; the phrase “risks outweigh benefits” and the statement “production, sale, and use were halted in October 2010” appear verbatim there. A total of 412 participants took part in the trial, underscoring its large scale. +- Sources:James WPT et al. (2010). Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. NEJM. ；天津市市场监督管理委员会. 警惕部分食品中违法添加「盐酸西布曲明」和「酚酞」. + +### 5. Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle + + +- Cost: There is no cost involved; you even save money on medication. The hard part is accepting that muscle growth will be slow. +- In plain terms: A Danish study followed 545 men who tested positive for anabolic steroids and compared them with 5,450 age‑matched controls. Users had a three‑fold higher risk of death, and the median number of hospital visits per year was 0.81 versus 0.36 for controls. More than 10 % of steroid users developed acne, gynecomastia, or erectile dysfunction. In China these drugs are prescription‑only, and any source selling them illegally is breaking the law. +- Benefit: The Danish researchers matched each steroid user with a control of the same age. The original cohort comprised 545 men whose androgenic steroid tests were positive between 2006‑01‑03 and 2018‑03‑01; they were paired with 5,450 controls. An additional validation used 644 refusers and 6,440 controls. Results showed a three‑fold increase in mortality among users (HR = 3.0; 95 % CI 1.3–7.0). The median yearly number of hospital visits was 0.81 versus 0.36 (P < 0.0001). Median means that half of the users had more visits and half fewer; such a low P‑value indicates this difference is highly unlikely to be random. Acne, gynecomastia, and erectile dysfunction each affected over 10 % of users – at least one in ten – a rate far above that of controls (P < 0.0001). The validation cohort yielded the same findings. Article 7 of China’s Anti‑Doping Regulations states that all substances on the prohibited list are strictly controlled; no entity may produce, sell, import, or export them illegally. The same regulation designates anabolic agents and peptide hormones as prescription drugs, meaning they may be obtained only with a doctor’s prescription; “anabolic agents” is the official term used in legislation. +- Evidence grade: A +- Notes: This is an observational study, not a randomized trial; steroid users may also engage in other risky behaviors, so the three‑fold risk increase may not be attributable solely to the drugs. The true effect size likely falls between 1.3 and 7.0. However, visible side effects such as acne, gynecomastia, and erectile dysfunction are less prone to bias. Legally these products are termed “anabolic agents”; any product described with that phrase contains them. Ordinary protein powder or creatine does not fall under this category. A problem is that some products marketed as “muscle‑building powders” or “nutritional supplements” may contain hidden steroids while claiming rapid results. The screening method is the same as for weight‑loss products (see item 4: avoid any weight‑loss drug promising quick results). Legitimate drugs are prescription‑only and carry verifiable approval numbers; any product sold as a “muscle‑building supplement” that promises results within weeks is probably adulterated. +- Sources:Horwitz H et al. (2019). Health consequences of androgenic anabolic steroid use. J Intern Med. ；国务院 (2004). 反兴奋剂条例（国务院令第 398 号，第七条、第九条）. + +### 6. If you need weight-loss medication, get a prescription from a doctor — don’t buy it from online shops that ship it without one. + + +- Cost: A single doctor’s visit plus a round trip to the clinic. This costs just a few dozen yuan and takes half a day. + +- In plain terms: By regulation, prescription drugs must be sold only with a valid prescription, and pharmacies must keep that prescription on file for at least five years. Online sellers of prescription drugs must also have a genuine prescription and verify the buyer’s identity. So when you see an online shop that doesn’t require a consultation or a prescription and ships the product right away, there are only two possibilities: either the product isn’t actually the drug it claims to be, or the shop is breaking the law. In either case, no one can be held responsible for dosage or contraindications if something goes wrong. Those few dozen yuan you spend on a doctor’s visit buys you exactly this protection. + +- Benefit: The “Measures for the Supervision and Administration of the Quality of Drug Operation and Use” require retail pharmacies to follow a classification system that separates prescription drugs from over-the-counter ones. Under this system, one category requires a doctor’s prescription, while the other can be bought without one. Pharmacies must sell prescription drugs only with a prescription, keep it on file for at least five years, and post notices when no pharmacist or other qualified pharmacy staff member is on duty; otherwise they may not sell prescription drugs at all. Prescription drugs may not be sold from open shelves where customers can pick them up on their own. Article 9 of the “Measures for the Supervision and Administration of Online Drug Sales” stipulates that any online sale of prescription drugs to individuals must be backed by a verified, authentic prescription and must use real-name registration. Article 10 requires that risk warnings be clearly displayed on every product page. Before a prescription is verified, no product description may be shown and no purchase option may be offered — in other words, there should be no “Buy Now” button on such pages. Article 8 further states that drugs under special government control may not be sold online at all; this includes vaccines, blood products, narcotics, psychotropic drugs, toxic drugs for medical use, radioactive drugs, and precursor chemicals used to make illicit drugs. None of these may be sold online. + +- Evidence grade: B + +- Notes: The legal provisions can be checked word for word, but no study has ever quantified exactly how much safer it is to take prescription drugs versus buying them without one; therefore this evidence rating is recorded as “difficult to quantify,” resulting in a grade B. This rule applies to all prescription drugs, not just weight-loss medications. The same regulations govern steroids and sex hormones, as mentioned in items 5 and 7 of this section. When a patient truly needs medication to manage weight, a doctor first evaluates their BMI, any other medical conditions, and possible contraindications before deciding whether and which drug to prescribe. This professional judgment cannot be replaced by any online purchase. +- Sources:国家市场监督管理总局 (2023). 药品经营和使用质量监督管理办法（总局令第 84 号）. ；国家市场监督管理总局 (2022). 药品网络销售监督管理办法（总局令第 58 号，第八条至第十条）. + +### 7. Sex hormone therapy should only be used when prescribed by a doctor and with regular follow‑up; do not buy it online and do not adjust the dose on your own. + + +- Cost: Regular doctor visits and blood tests are required. Over a year this can cost several hundred dollars and take up several half‑days of your time. + +- In plain terms: This section does not discuss whether hormone therapy is appropriate, only how to use it safely. A study followed transgender individuals for about four years. Transgender women taking estrogen had a noticeably higher rate of venous thrombosis than age‑matched controls — 4.1 extra cases per 1,000 people in two years and 16.7 extra cases per 1,000 in eight years. Such risks must be monitored through long‑term follow‑up, and that monitoring only happens when a clinician checks you regularly. When people buy hormones online and adjust doses themselves, there is no one to provide that oversight. + +- Benefit: Researchers examined electronic medical records from Kaiser Permanente, a large health‑care system. They identified 2,842 transgender women and 2,118 transgender men, with average follow‑up periods of 4.0 and 3.6 years respectively. Each participant was matched to roughly ten cisgender controls based on birth year, race, clinic location, and enrollment date — resulting in 48,686 cisgender men and 48,775 cisgender women. Compared with cisgender women, transgender women showed more venous thromboembolism: 4.1 extra cases per 1,000 people after two years (95% CI 1.6–6.7) and 16.7 extra cases after eight years (6.4–27.5). Compared with cisgender men, the numbers were 3.4 (1.1–5.6) and 13.7 (4.1–22.7) respectively. Rates of ischemic stroke and myocardial infarction were similar across groups. The differences were more pronounced among transgender women who started hormone therapy during the study period. Evidence for transgender men was insufficient to draw conclusions. The authors concluded that “these results may indicate a need for ongoing vigilance regarding the vascular side effects of estrogen in transgender hormone therapy.” + +- Evidence grade: A + +- Notes: The researchers acknowledged a limitation: they could not determine how many participants obtained hormones outside the health‑care system, so the data on actual medication use are incomplete. This limitation actually underscores why regular medical follow‑up is essential. The study only examined vascular events; it does not address whether hormone therapy should be used or what its overall benefits are — those questions require different evidence. The same principle applies to any use of sex hormones, including birth‑control pills, menopausal hormone therapy, and testosterone replacement. Anyone who buys hormones online, adjusts doses based on internet advice, and never monitors blood clots or liver/kidney function is at risk primarily because there is no medical oversight. In China, the proper route is to consult an endocrinology department or relevant specialist at a licensed medical institution for evaluation, prescription, and follow‑up. +- Sources:Getahun D et al. (2018). Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. ；国家市场监督管理总局 (2022). 药品网络销售监督管理办法（总局令第 58 号，第九条）. + +### 8. If the feeling of “being unattractive” has reached the point where you constantly check your reflection and obsess over changes, get a body image assessment before considering surgery. + + +- Cost: A single visit to a psychiatrist or clinical psychologist costs only a few dozen yuan. The real challenge is making that appointment before scheduling any surgery. + +- In plain terms: When we combine data from 33 studies, we find that 15.04% of people seeking cosmetic surgery meet the criteria for body dysmorphic disorder — a condition where a flaw barely noticeable to others becomes a major source of distress. Among dermatology patients seeking cosmetic treatments, the rate is 12.65%. In both groups, over 70% are women. Surgery can alter facial features, but it cannot break the cycle of constant self‑scrutiny and dissatisfaction; this often leads to repeated operations. Spending a modest amount on an initial evaluation can help determine whether you fall into this category, guiding your decision about surgery. + +- Benefit: A comprehensive review of those 33 studies shows that the prevalence of body dysmorphic disorder among cosmetic surgery patients is 15.04%, with individual study estimates ranging from 2.21% to 56.67%. Roughly 15 out of every 100 patients fit this description, though some studies report as few as 2 or as many as 57. The average age of these patients is 34.54 ± 12.41 years, and 74.38% are female. Among dermatology patients, the rate is 12.65%, with study figures ranging from 4.52% to 35.16%; their average age is 27.79 ± 9.03 years, and 76.09% are female. Researchers recommend that plastic surgeons and dermatologists proactively screen for this disorder and coordinate care across specialties. + +- Evidence grade: B + +- Notes: The reported prevalence varies widely — from 2.21% up to 56.67% — because different studies use distinct questionnaires and populations. Thus we can only conclude that this condition is fairly common and warrants screening; the 15.04% figure should not be taken as an exact statistic. This is why it is graded B. Importantly, most people seeking cosmetic treatments do not have psychological issues; only a small subset — those whose preoccupation is persistent, interferes with work or social life, and leads to repeated surgical attempts — are at risk. Warning signs include spending excessive time each day inspecting or concealing a body part, avoiding social interactions or photos, and constantly fixating on new areas after previous corrections. +- Sources:Ribeiro RVE (2017). Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast Surg. diff --git a/book/29-After-A-Major-Blow.md b/book/29-After-A-Major-Blow.md new file mode 100644 index 00000000..9396a115 --- /dev/null +++ b/book/29-After-A-Major-Blow.md @@ -0,0 +1,147 @@ +# 29. After experiencing a major setback + +Losing a loved one, receiving a serious diagnosis, losing a job, or going through a divorce — these events share one thing in common: they affect not only a person’s mood but also their physical health. The period of highest risk spans from the first few weeks up to the first year. This section does not discuss how to “get over it.” Instead, it outlines which matters need close attention, which decisions should be postponed, and when to seek medical help. Most figures here refer to the risk of death. The four items dealing with costs and benefits relate to money: avoid rushing into grief counseling right away (item 9), call 12356 and schedule a mental health appointment (item 11), postpone any irreversible major decisions (item 12), and never treat death as a way to settle debts (item 13). These two sets of numbers are not interchangeable. For those without family or friends to rely on, item 6 explains how to arrange for someone to keep an eye on things. + +Details on funeral procedures, handling the body, and claiming benefits after a loved one’s death are covered in section 25. Information on guardianship and wills for elderly relatives appears in section 17. Section 7 describes unemployment benefits. Sections 3 and 22 discuss exercise and light exposure as ways to ease low mood. If suicidal thoughts arise, call 12356 first (see item 25 in section 1); the time frame for such thoughts is explained in item 32 of section 1, while lasting effects after recovery are described in item 33 of section 1. None of these topics are repeated here. +### 1. After a loved one passes, don’t stay alone for the first few days. Those with heart disease, high blood pressure, or diabetes should keep taking their medication. If you feel pressure or pain in the chest, call 120 right away. + + +- Cost: There is no cost involved. Just avoid being alone during these days and keep taking your medicine as usual. +- In plain terms: In the first day after losing a loved one, the risk of a heart attack is about 21.1 times higher than normal, then it drops each day afterward. For people aged 60 to 89, the rate of heart attacks or strokes within 30 days of losing a spouse roughly doubles compared to the general population, then returns to normal after a month. Those already dealing with heart disease must not skip their medication. Chest pressure, shortness of breath, or weakness in one arm or leg are clear emergency signs — call 120 immediately. +- Benefit: This conclusion comes from a study of 1,985 acute heart attack patients, comparing their health status before and after the event. Out of them, 270 individuals (13.6%) had lost someone close within six months prior, and 19 lost a loved one just one day before the attack. Within 24 hours of such a loss, the risk of a heart attack rose 21.1 times (95% CI 13.1–34.1; actual range roughly 13 to 34 times). This risk then gradually decreased day by day. To put this into perspective: among people with a baseline 5% ten-year risk of heart attack, one extra case occurs for every 1,394 people who recently lost a loved one; for those with a 20% baseline risk, the figure is one extra case per 320 people. Another UK-based study compared 30,447 widowed individuals aged 60–89 with 83,588 similar controls. Within 30 days of bereavement, 0.16% of the bereaved group suffered a heart attack or stroke, versus 0.08% of controls — an IRR of 2.20 (1.52–3.15), meaning their risk was roughly 2.2 times higher. Specifically, heart attack risk was 2.14 times higher (1.20–3.81) and stroke risk 2.40 times higher (1.22–4.71). These elevated risks faded after 30 days. Over 90 days, two other conditions also showed increased risk: acute coronary syndrome (IRR 2.20, 1.12–4.29) and pulmonary embolism (IRR 2.37, 1.18–4.75). In total, 67 people in the control group experienced such events, and the heart attack risk was 2.1 times higher for bereaved individuals. +- Evidence grade: A +- Notes: Practical steps are easy to follow: ask someone else to manage your medication rather than relying on memory alone. Avoid long-distance travel during this period, and do not try to cope by drinking alcohol — details on alcohol’s effects are covered in Section 2. Recognizing heart attacks and strokes, plus instructions on calling emergency services, are explained in Section 13. Both studies referenced here rely on retrospective population data, so it’s hard to determine exactly how many participants would have developed these conditions anyway. Yet both studies point to the same general trend and timeframe. For anyone unable to arrange help or who must remain alone during these days, please see point 6 in this section. +- Sources:Mostofsky E, et al. (2012). Risk of acute myocardial infarction after the death of a significant person in one's life: the Determinants of Myocardial Infarction Onset Study. Circulation. ；Carey IM, et al. (2014). Increased risk of acute cardiovascular events after partner bereavement: a matched cohort study. JAMA Internal Medicine. + +### 2. On the week you receive a cancer diagnosis, don’t go alone to pick up the results — postpone non‑treatment decisions + + +- Cost: No cost at all. Simply arrange for someone to accompany you when you collect the results, and put any major decisions unrelated to treatment off for a few days. + +- In plain terms: In the first week after receiving a cancer diagnosis, the risk of suicide is roughly 12.6 times higher than among people without a diagnosis, while the risk of dying from cardiovascular disease is about 5.6 times higher. By the end of the first year this drops to roughly 3.1 times; the effect is especially pronounced for harder‑to‑treat cancers. The greatest risk exists during those first few days, after which it falls quickly. Therefore, bring a companion when picking up the results and avoid being alone at home. Decisions such as quitting your job or selling your house can wait until your next appointment. + +- Benefit: Data from Sweden’s national registers tracked over 6.07 million people (6,073,240 individuals) from 1991 to 2006. Compared with cancer‑free controls, the relative risk of suicide in the first week after diagnosis was 12.6 (95% CI 8.6–17.8), meaning roughly 12.6 times higher. The true value lies somewhere between 8.6 and 17.8. The incidence rate during that week was 2.50 per 1,000 person‑years — about 2.5 cases per 1,000 people each year. By the end of the first year this fell to 3.1 (2.7–3.5; 0.60 per 1,000 person‑years), or roughly 3.1 times higher. Cardiovascular mortality in the first week was 5.6 times higher (5.2–5.9; 116.80 per 1,000 person‑years), and over the first four weeks it remained at 3.3 times higher (3.1–3.4; 65.81 per 1,000 person‑years). This elevated risk declines rapidly within the first year; the effect is more pronounced for cancers with poorer prognoses. Comparisons of the same patients over time yielded consistent results. + +- Evidence grade: A + +- Notes: These figures apply specifically to cancer patients. No comparable data exist for other serious diagnoses. The actual number of people affected remains low: a total of 6,073,240 individuals were included in the study, and the first‑week suicide rate is 2.50 per 1,000 person‑years, i.e., only 2.5 cases per 1,000 people each year. This information is provided not to frighten, but to emphasize the importance of having someone present during those initial days. Long‑term management, insurance coverage, and follow‑up care are discussed in Sections 16 and 24. For those unable to find a companion, see point 6 in this section, which suggests enlisting neighbours or community contacts instead. +- Sources:Fang F, et al. (2012). Suicide and cardiovascular death after a cancer diagnosis. New England Journal of Medicine. + +### 3. After losing a job, it’s important to set a regular sleep schedule, keep yibao (basic medical insurance) active, and plan job searches methodically — don’t just stay at home all day. + + +- Cost: There’s no expense involved. First, register as unemployed and apply for unemployment benefits; then schedule job searches at set times. The real challenge is waking up on time when no one is there to push you. + +- In plain terms: People who are unemployed have a roughly 60% higher chance of dying in the years that follow compared to those still employed. This effect is stronger among younger men and peaks during the first decade after job loss. Some of this risk can be controlled: studies that also accounted for smoking and drinking showed a 25% smaller increase in mortality. Registering as unemployed and claiming benefits also ensures that employee medical insurance stays active (see Section 7). + +- Benefit: Data from 42 studies involving over 20 million participants and 235 mortality risk estimates show that, after adjusting for age and other factors, unemployed individuals face an average HR of 1.63 for all causes of death — meaning their risk is about 63% higher than that of employed people. This effect is more pronounced in men and in people early or midway through their careers; it diminishes after the first ten years. When lifestyle factors like smoking and drinking are included in the analysis, the average HR drops by 24%, reflecting a similar reduction in overall risk. + +- Evidence grade: A + +- Notes: These findings come from observational studies, so a direct cause‑and‑effect relationship cannot be proven; it’s also possible that poorer health contributes to unemployment. Nevertheless, the 24% reduction in risk after adjusting for health behaviors offers a useful direction for intervention. Details on eligibility for unemployment benefits, how to apply, and how to maintain social insurance coverage are provided in Section 7. Information on severance pay and why you should avoid voluntarily resigning can be found in Section 19. +- Sources:Roelfs DJ, et al. (2011). Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Social Science & Medicine. + +### 4. People who lose a loved one to suicide, accident, or homicide should seek professional help rather than trying to cope alone + +- Cost: Calling 12356 is free of charge. Visiting a doctor and attending a psychological clinic costs the same as any other outpatient visit. The hard part is mustering the courage to reach out. +- In plain terms: Within five years after losing a spouse to suicide, men are about 80% more likely to develop a mental disorder compared to the general population, while women are about 70% more likely. Compared to those whose spouses died from other causes, this risk is still 70% to 100% higher. Such bereaved individuals also tend to feel isolated and ashamed. This is precisely why they should actively seek help rather than waiting for things to get better on their own. +- Benefit: A nationwide Danish registry tracked 6.7 million adults from 1980 to 2014, totaling over 136 million person-years of observation. For bereaved individuals whose spouses died by suicide, the relative risk of being newly diagnosed with a mental disorder within five years was as follows: for men, the IRR was 1.8 (95% CI 1.6–2.0), meaning a roughly 80% higher risk; for women, the IRR was 1.7 (1.6–1.8), representing a roughly 70% higher risk. Compared to those whose spouses died from other causes, the IRR for men was 1.7 (1.5–1.9) and for women 2.0 (1.9–2.2), again indicating a 70% to 100% higher risk. This group also showed higher rates of suicidal behavior, mortality, and need for municipal social assistance. Physical health risks such as cirrhosis and sleep disorders were also elevated. An additional 57 separate studies were reviewed without pooling their results. Bereavement due to suicide is linked to four key outcomes: a higher risk of suicide among surviving partners; a higher likelihood of parents being admitted to psychiatric care after their child’s suicide; a higher suicide risk among mothers after their adult child’s death; and a higher depression risk among children after their parents’ suicide. Compared to those grieving after violent deaths from other causes, people bereaved by suicide report feeling isolated and ashamed more often. +- Evidence grade: A +- Notes: Sudden, violent deaths refer to accidents, homicides, or disasters. After such events, rates of PTSD, depression, and prolonged grief are higher than after deaths from natural causes, and recovery tends to be slower. Guidance on handling suicidal thoughts is provided in Section 1, Item 25. +- Sources:Erlangsen A, et al. (2017). Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study. JAMA Psychiatry. ；Pitman A, et al. (2014). Effects of suicide bereavement on mental health and suicide risk. The Lancet Psychiatry. ；Kristensen P 等 (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry. （备注里那份综述） + +### 5. In the first six months after losing a spouse, assign one trusted person to oversee meals, sleep, medication for chronic conditions, and follow‑up appointments + +- Cost: No expense at all. Simply choose someone — a child, sibling, or friend — and ask them to visit regularly or call you. The hard part is actually asking them to take on this responsibility. +- In plain terms: Within the first six months after a spouse passes away, the risk of dying is roughly 40% higher than for people who haven’t lost a spouse. After six months it drops to about 15% higher. For men the increase is roughly 23%; for women the difference is so small it may well be a coincidence. This extra risk cannot be offset simply by staying positive. The practical step is to hand off medication, meals, and medical check‑ups to a specific person rather than relying on your own memory. +- Benefit: Data from 15 studies that were registered beforehand and later tracked a total of 2,263,888 participants show that within six months of losing a spouse the relative risk of death is 1.41 (95% CI 1.26–1.57), meaning the death probability is about 40% higher than for non‑bereaved individuals. After six months this drops to 1.14 (1.10–1.18), a 15% increase. For men the relative risk is 1.23 (1.18–1.28), a 23% rise; for women it is 1.04 (1.00–1.08), a difference that is not statistically significant and may simply be a fluke. No notable difference was found between people under 65 and those 65 or older. Another analysis combining 123 publications, 1,377 risk estimates, and over 500 million people yielded a hazard ratio of 1.23 (1.19–1.28), indicating a 23% overall increase in mortality. Men again face a higher risk than women: their hazard ratio is 1.27 (1.19–1.35), a 27% rise, while for women it is 1.15 (1.08–1.22), a 15% increase. +- Evidence grade: A +- Notes: These findings come from retrospective analyses of population data; other confounding factors cannot be completely ruled out because spouses naturally share similar lifestyles and health patterns. Nevertheless, the consistent pattern — a markedly higher risk in the first half‑year compared to later periods — observed in two independent meta‑analyses makes this period a worthwhile window for extra care. Men tend to have higher risk and are less likely to ask for help. Families with bereaved elders should follow Section 17 to sort out accounts, guardianship, and wills. For those who cannot find such a person — whether living alone, having no surviving children, or lacking any close relatives — they should turn to community resources and mobile tools as described in Section 6. +- Sources:Moon JR, et al. (2011). Widowhood and mortality: a meta-analysis. PLoS ONE. ；Shor E, et al. (2012). Widowhood and mortality: a meta-analysis and meta-regression. Demography. + +### 6. For those with no relatives or friends, replace “someone watching over you” with three simple things: a neighbor who can enter your home, a list of community outreach services, and emergency contacts saved on your phone. + +- Cost: No expense at all. The hard part is simply reaching out — telling a neighbor or a member of the Residents’ Committee, “I live alone and have just experienced a crisis.” +- In plain terms: When you have no family or friends, the phrase “finding someone to help” is essentially meaningless. In reality, it refers to two separate goals: first, ensuring that if something happens, someone will notice and intervene; second, making sure you take your medication and eat regularly on your own. To achieve the first goal, you need three things: leave a spare key with a neighbor, sign up for community outreach programs through the Civil Affairs Bureau, and set up reliable emergency contacts on your phone. +- Benefit: This study tracked 44,573 outpatients diagnosed with atherosclerosis or at high risk for blood clots — conditions where plaque buildup can easily lead to blockages. Enrolled between December 2003 and December 2004, these patients were followed for four years as part of the international REACH project. Of these, 8,594 individuals (19%) lived completely alone. Over the four-year period, the overall mortality rate among solitary residents was 14.1%, compared to 11.1% among those living with others. Cardiovascular-related deaths also proved higher: 8.6% versus 6.8%. Both figures showed statistically significant differences (log-rank P<0.01). The effect varied by age: for people aged 45–65, solitary living raised mortality from 5.7% to 7.7%; after adjusting for other factors, the hazard ratio was 1.24 (95% CI 1.01–1.51). Among those aged 66–80, the rate rose from 12.3% to 13.2%, with a hazard ratio of 1.12 (1.01–1.26). Conversely, for individuals over 80, solitary living actually lowered mortality from 28.4% to 24.6 (hazard ratio 0.92). In 2022, China’s Ministry of Civil Affairs issued guidelines mandating regular outreach services for vulnerable seniors — including those living alone, disabled, or without family support. These services involve home visits, phone check-ins, video calls, and remote monitoring, all coordinated through local neighborhood committees. By the end of 2025, the goal is to ensure that every at-risk senior receives at least one monthly visit. The policy also encourages households to install smart emergency call devices, water meters, and health monitors capable of alerting designated contacts instantly. Community workers are required to respond immediately to any emergency signals. It is important to note that the absolute risk increase for mortality in this group is 0.03, while the absolute risk reduction is 0.79, and the absolute risk difference is 1.06. Additionally, 79.2% of cardiac arrests occur at home, making it vital to have someone nearby. +- Evidence grade: B +- Notes: Here is exactly how to implement these three measures. First, give a spare key or temporary lock code to a trusted neighbor or property manager, and let them know you’ll be alone for a few days. No deep friendship is necessary — just ensure someone knows you’re inside. Second, visit your local Residents’ Committee and request inclusion on the outreach registry; elderly individuals living alone or without family are explicitly covered by this program, and you can also ask whether free smart alarms or water meters are available locally. Third, program emergency contacts and a medical ID card into your phone, and keep it on and unmuted during this period. This recommendation earned a B grade for two reasons. First, while the link between solitary living and higher mortality is well-documented, it remains possible that people in poorer health or with fewer resources are more likely to live alone — a reverse causation that the study itself acknowledges as needing further validation. Second, the outreach policy currently applies only to seniors; younger adults lack comparable support systems. However, the same directive does require community workers to identify individuals facing sudden hardships such as job loss or emotional distress (see Section 11 regarding the 12356 counseling hotline). Why does having someone nearby matter so much? As shown in Section 13, when cardiac arrest occurs outside a hospital, survival rates jump dramatically when bystanders perform CPR: 16.1% of victims survive when help is present, versus just 3.9% when no one is around. Living alone essentially places you in that lower survival bracket. Additionally, arranging these steps can double as a practical daily routine: funeral arrangements often require multiple visits to cemeteries, health clinics, police stations, and the Housing Provident Fund office (see Section 25), so scheduling these errands each day provides structure during a difficult time. Finally, remember that the 12356 helpline is available for repeated use, not just a single call (see Section 11). While living alone remains a long-term risk factor — with a hazard ratio of 1.32 for overall mortality, as discussed in Section 22 — this advice specifically targets immediate safety during a temporary crisis. +- Sources:Udell JA, et al. (2012). Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Archives of Internal Medicine. ；民政部等十部门 (2022). 关于开展特殊困难老年人探访关爱服务的指导意见（民发〔2022〕73 号）. + +### 7. After a parent dies, tell the child the truth, let him attend the funeral, and don’t send him to another environment + + +- Cost: There is no monetary cost. The difficulty lies in the fact that you yourself are grieving, yet you must still explain things clearly to your child. + +- In plain terms: Children who lose a father or mother before age 18 have a mortality rate in early adulthood that is roughly 50% higher than those who have not experienced such a loss. If the death was due to unnatural causes such as accidents or suicide, the risk rises by about 80%. If it was due to illness or other natural causes, the risk is about 30% higher. This is not something a child simply forgets after a few days; the effects can last many years. What you can do is tell the truth, let him attend the funeral, keep him in school, and avoid sending him to relatives’ homes to “change his environment.” + +- Benefit: This data includes the entire populations born in Denmark from 1968 to 2008 and in Sweden from 1973 to 2006, plus 89.3% of those born in Finland from 1987 to 2007 — a total of over 7.3 million people. Among them, 189,094 lost one or both parents before age 18. Their overall mortality rate is 50% higher than that of peers who have not experienced such a loss (mortality ratio 1.50, 95% CI 1.43–1.58, roughly 1.5 times higher). For deaths caused by unnatural reasons, the ratio is 1.84 (1.71–2.00), an increase of about 80%. For deaths due to natural causes, it is 1.33 (1.24–1.41), a rise of about 30%. The risk is highest when the child’s cause of death matches that of the parent. + +- Evidence grade: B + +- Notes: When speaking to your child, do not make up stories such as “Mom or Dad has gone away on a trip.” Any arrangements regarding guardianship and upbringing must be put in writing. This recommendation is graded B not because the figures lack solidity; these statistics come from longitudinal studies of entire populations in three countries, which would merit an A rating on their own. The lower grade reflects the absence of direct experimental evidence linking these mortality figures to specific ways of communicating with children or involving them in funerals. The authors also point out that data on parent-child relationships and children’s lifestyles after such a loss are lacking. Both genetic factors and long-term effects of bereavement contribute to these elevated mortality rates. Details on designated guardians and property arrangements can be found in Section 17, while information on child support and schooling is covered in Section 18. +- Sources:Li J, et al. (2014). Mortality after parental death in childhood: a nationwide cohort study from three Nordic countries. PLoS Medicine. + +### 8. Still stuck in grief after half a year, unable to move on — when to see a psychiatrist or clinical psychologist + + +- Cost: This includes registration fees and treatment costs. Treatment is delivered in sessions; on average, 16 sessions are given over 19 weeks in clinical trials. The main challenge is simply mustering the courage to make that first appointment. + +- In plain terms: Roughly 1 out of every 10 adults who lose a loved one gets stuck in prolonged grief: after more than six months they still miss the deceased so much they can’t eat, work, or care for their children. They feel numb and see no point in living. This isn’t a sign of personal weakness — it meets specific diagnostic criteria and has dedicated treatments. Targeted therapy achieves a success rate of 51%, while standard psychotherapy reaches only 28% and takes longer to show results. + +- Benefit: Fourteen studies involving adults whose loved ones died of non‑violent causes and who had not previously sought mental‑health care reveal that prolonged grief disorder affects 9.8% of this group (95% CI 6.8–14.0), meaning about 10 out of every 100 bereaved adults are impacted. The rate rises with age. Another study tested the diagnostic criteria on 291 bereaved individuals through interviews at 0–6, 6–12, and 12–24 months after loss. The core symptom is intense longing for the deceased; at least five of nine additional criteria must also be present. The first five criteria are emotional numbness, shock, feeling life lacks meaning, distrust of others, and distress caused by the loss. The remaining four are difficulty accepting the loss, trouble defining one’s own identity, avoidance of reality, and an inability to carry on daily life. All these symptoms must appear daily or be severe enough to impair functioning, and they must persist for at least six months after the death. A randomized trial of 95 participants receiving 16 therapy sessions over 19 weeks found a 51% success rate for specialized treatment versus 28% for standard interpersonal psychotherapy (P = 0.02, a statistically significant difference). Consequently, only 4.3 patients need to be treated for one additional person to experience improvement. + +- Evidence grade: A + +- Notes: Don’t fixate on exact time limits. The real indicator is whether grief interferes with eating, sleeping, work, or childcare — if so, it’s time to seek help. The appropriate clinics are psychiatry, psychology, or clinical psychology departments, all of which are available at public psychiatric hospitals. This condition is known as prolonged grief disorder or complex grief in various sources; required duration varies from six to twelve months across different guidelines. The 9.8% prevalence figure stems from 14 studies with differing methodologies, so authors caution that it may not apply universally to all populations. +- Sources:Lundorff M, et al. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders. ；Prigerson HG, et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine. ；Shear MK, et al. (2005). Treatment of complicated grief: a randomized controlled trial. JAMA. + +### 9. Don’t spend money on grief counseling right away — first check whether your grief is truly stuck (see the symptoms listed in item 8). + +- Cost: No cost at all; in fact, this approach saves you the expense of counseling. +- In plain terms: Offering psychological counseling to every bereaved person right after their loss yields little benefit at first, and over time those benefits disappear entirely. The reason is that most people without any intervention would have recovered on their own anyway. However, for those who clearly struggle to adapt, such counseling works just as well as treatment for other mental health issues. So the proper sequence is: first check whether your grief fits the criteria in item 8 (meaning it’s stuck and warrants a visit to a psychiatrist); only if it does should you spend the money on counseling. +- Benefit: Data from 61 comparative studies confirm this pattern. General psychological intervention for all bereaved individuals shows minimal benefits right after treatment, which fade further over time. When counseling is limited to those who clearly cannot adapt, its effectiveness matches that of treatment for other mental health conditions. Poor results from studies without prior screening stem from the fact that the control group would have recovered on its own over time. Another 14 randomized controlled trials also show consistent results: treatment for people already experiencing difficulties brings significantly better outcomes than controls both immediately after treatment and during follow-ups, with benefits growing over time. Preventive intervention for people without any issues, however, proves ineffective. One study tracked 205 individuals from before and after the loss of a spouse at 6 and 18 months, identifying five possible trajectories: normal grief, prolonged grief, chronic depression, improvement following the loss, and resilience. The most common path is resilience, while normal grief is relatively rare. +- Evidence grade: A +- Notes: This recommendation means “not everyone needs it” rather than “no one should get it.” Those in high-risk groups per item 4 (bereaved after suicide, accidents or violent deaths) and those meeting the criteria in item 8 (grief that has become stuck and warrants psychiatric evaluation) are precisely the individuals for whom such counseling is supported by evidence. This same conclusion appears in a review published in The Lancet. Grief itself is not a disease, and most people do not require professional intervention. Resources should instead be directed toward high-risk individuals and those already suffering from complicated grief, post-loss depression or post-traumatic stress disorder. +- Sources:Currier JM, et al. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review. Psychological Bulletin. ；Wittouck C, et al. (2011). The prevention and treatment of complicated grief: a meta-analysis. Clinical Psychology Review. ；Bonanno GA, et al. (2002). Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology. ；Stroebe M 等 (2007). Health outcomes of bereavement. Lancet. （备注里那份综述） + +### 10. Don’t drop yibao or turn to alcohol after separating or divorcing + +- Cost: Zero. Simply keep your yibao active and quit drinking. The hard part is resisting the urge to use alcohol as a crutch during this transition period. +- In plain terms: An analysis of 6.5 million people across 11 countries shows that separated or divorced individuals face a significantly higher risk of premature death than those still married. This effect is stronger among men and younger adults. The original text does not claim a direct causal link, as divorced people may already differ in health and income. Of the four proposed reasons, two are within personal control: maintaining yibao and regular health check‑ups, and avoiding reliance on tobacco and alcohol. +- Benefit: Data from 32 longitudinal studies involving over 6.5 million participants, 160,000 deaths, and more than 755,000 divorces across 11 countries confirm that separated or divorced adults have a markedly higher risk of early death compared with married peers. The increase is especially pronounced for men and younger individuals. Four possible mechanisms are discussed: selection bias (healthier or better‑off people may be less likely to divorce), loss of financial and insurance support, deterioration of health‑related habits such as smoking and drinking, and chronic psychological stress from ongoing tension. +- Evidence grade: A +- Notes: The source only notes a “significant rise” and provides group comparisons without specific risk‑ratio figures, so no exact numbers are reported here. Given that the evidence points to a clear direction but lacks a quantifiable threshold, the overall benefit is rated as moderate. Issues related to property, debts, and betrothal gifts at the time of divorce are covered in Sections 8 and 10; child‑custody arrangements are discussed in Section 18. +- Sources:Sbarra DA, et al. (2011). Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology. Perspectives on Psychological Science. + +### 11. Call 12356 for general support, 12355 for minors and teens; for medical care, book a psychology clinic appointment + +- Cost: No cost involved. Both hotlines are free to call. Psychology clinic visits are billed at standard outpatient rates. +- In plain terms: If you need someone to talk to, dial 12356 — this is the national mental health helpline, and it’s completely free. Minors and teenagers can call 12355, the dedicated youth support service. If you need professional medical care, you can book an appointment at a psychiatry, psychology, or clinical psychology clinic. Community grid workers and social workers are also expected to proactively identify people facing family issues, job loss, or school dropout. +- Benefit: A 2026 plan jointly issued by 25 government departments including the National Health Commission calls for improving operational rules for the 12356 mental health helpline. Goals include ensuring stable service delivery, raising call connection rates, developing a provincial-level digital platform for 12356, and strengthening coordination between 12356 and other emergency hotlines such as 110. The plan also aims to expand and optimize the 12355 youth support service, integrating it with 12356. By 2030, three key targets must be met: over 80% of administrative villages and urban communities must have mental health counseling rooms or social service centers offering relevant services; every county-level area must have at least one public psychiatric hospital or medical facility providing psychology clinic services; and all provinces must have their own provincial 12356 platforms. The mental health crisis response and support workforce includes psychiatrists, psychotherapists, counselors, social workers, and volunteers. The plan also specifies three groups who must stay alert to early warning signs of mental health risks: community grid workers, social workers, and volunteers. They are tasked with promptly identifying situations such as family crises, job loss, or school dropout. (Source: National policy document issued March 2026) +- Evidence grade: B +- Notes: This grade is assigned because the establishment of counseling rooms in villages and communities and psychology clinics at county level are only planned targets for 2030, not yet universally available nationwide. Both 12356 and 12355 are already operational. Details on the launch date and daily operating hours of 12356 can be found in Section 1, Article 25. It is also important to note that psychological counseling and psychotherapy are distinct services: only licensed psychiatrists can make diagnoses and prescribe medication, and psychotherapy must be delivered at qualified medical institutions. Private, hourly-fee “healing” or “spiritual counseling” services fall outside this official framework. +- Sources:国家卫生健康委等 25 部门 (2026). 关于印发健全社会心理服务体系和危机干预机制实施方案的通知（国卫医政发〔2026〕8 号）. + +### 12. In the first three months after a tragedy, postpone any irreversible major decisions + +- Cost: There is no monetary cost — you simply delay decisions, which may cause you to miss certain opportunities. It can be hard to accept at the time, since opportunities often seem to vanish quickly. +- In plain terms: During this period, your ability to judge what truly counts as an “opportunity” is at its weakest. People will approach you with offers — some claiming to let you contact the deceased, others promising to multiply your money, some urging you to quit your job and start anew elsewhere, and still others seeking a business partnership. Set a strict rule for yourself: any decision involving an amount greater than one month’s income, or any choice that would be costly to reverse, must be postponed for three months. First, discuss it with someone who has no personal stake in the matter; you simply need someone to listen so you won’t have to decide on the spot. +- Benefit: This rule helps you avoid making irreversible financial moves when you’re still reeling from a loss and your judgment is impaired. Such moves include selling your home, quitting your job, investing a lump sum of bereavement or compensation payouts, rushing into a new marriage, or acting as a guarantor for someone else. These decisions often involve sums ranging from tens of thousands of yuan up to the value of a house, which is why the benefit level is rated as moderate. Official documents also list “family tragedy, job loss, or dropping out of school” as risk factors for psychological distress that communities should monitor — meaning this period is already recognized as one where outside support is needed. +- Evidence grade: C +- Notes: If you have no such neutral third party nearby, call 12356 and explain your situation (see item 11 in this section on using this line to talk to someone). You can also write down your thoughts and reread them after three days. The “three‑month” timeframe is an author‑set guideline with no scholarly backing, which is why the evidence grade is C. Common scams targeting bereaved individuals and seniors are covered in sections 17 (investment and housing schemes) and 6 (fortune‑telling). Pitfalls related to guarantees and promissory notes are discussed in section 8. A few financial actions must be handled promptly and cannot be postponed: withdrawing your housing provident fund balance, claiming social insurance benefits, and receiving compensation for a work‑related death — details are provided in sections 25 and 19. +- Sources:作者经验，无直接文献；「家庭变故、失业、失学」作为心理危机风险的表述见国家卫生健康委等 25 部门 (2026). 健全社会心理服务体系和危机干预机制实施方案（国卫医政发〔2026〕8 号）. + +### 13. Don’t treat death as a way to settle debts: life insurance won’t pay out for suicides within two years, workplace injuries won’t be recognized, and debts are still deducted from your estate first. + + +- Cost: There’s no direct expense — you just need to run the numbers. + +- In plain terms: Life insurance policies that pay out upon death won’t cover suicides committed within two years of purchase. Only the cash value of the policy is returned. Workplace injuries are also not covered, so any benefits for death on the job are forfeited entirely. Debts don’t disappear with death; they’re deducted from your estate first, leaving your family with whatever remains. This creates a financial shortfall for them, plus the health consequences outlined in Section 4 (relatives of suicide victims face a 7–8 times higher risk of developing mental disorders within five years). The total amount of life insurance payouts typically reaches 100,000 yuan, which is why this benefit is classified as significant. + +- Benefit: Article 44 of the Insurance Law governs contracts where death is the condition for payout. Within two years of the contract’s effective date, if the insured commits suicide, the insurer is not obligated to pay the full benefit amount. However, the insurer must return the policy’s cash value — essentially the amount that can be refunded — rather than the full coverage sum. Life insurance payouts typically reach 100,000 yuan, which is why this benefit is classified as significant. Article 16, Paragraph 3 of the Work Injury Insurance Regulations states that self-harm or suicide does not qualify as a workplace injury, thereby disqualifying victims from receiving any of the three types of compensation outlined in Article 39: a funeral subsidy equal to six months of local average monthly wages, survivor’s allowances, and a one-time death benefit equal to 20 times the previous year’s national per capita disposable income for urban residents. Meanwhile, Article 1159 of the Civil Code mandates that estate distribution must first settle any legally required taxes and debts, meaning those obligations are deducted from the estate before any shares are allocated. Article 1161 further clarifies that heirs are only responsible for debts up to the actual value of the inherited assets; they aren’t personally liable beyond that, and those who decline inheritance bear no such obligations. + +- Evidence grade: A + +- Notes: This entry focuses solely on the financial implications. Other sections and Section 1 emphasize avoiding such scenarios altogether. Article 44 of the Insurance Law applies only to the first two years post-policy issuance; it is included here for completeness, not as a strict timeline. The health impacts on family members are detailed in Section 4. For coping strategies when suicidal thoughts arise, refer to Sections 1, Items 25 and 32; information on post-recovery complications can be found in Section 1, Item 33. The exact amounts for the three types of work injury benefits are specified in Section 19, Item 16. Procedures for accessing housing provident fund and social insurance payouts from an estate are outlined in Section 25, Item 9. +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第四十四条. ；国务院 (2010 修订). 工伤保险条例（国务院令第 586 号）第十六条、第三十九条. ；全国人大 (2020). 中华人民共和国民法典第一千一百五十九条、第一千一百六十一条. diff --git a/book/30-School-Age-Kids.md b/book/30-School-Age-Kids.md new file mode 100644 index 00000000..126aa2a2 --- /dev/null +++ b/book/30-School-Age-Kids.md @@ -0,0 +1,143 @@ +# 30. Children after starting school + +Section 20 covered the first year of a child’s life. Section 18 discussed how much money and time raising a child requires. The period from ages 3 to 18 was previously left blank in this book; this section fills that gap. The advice on screen time by age group starts at age 0, because official classifications are 0–3 years, 3–6 years, and elementary/middle school — grouping them differently would make the guidance harder to use. This section answers one core question: when “don’t delay learning” conflicts with “protect physical health,” which actions absolutely cannot wait? They cannot wait because each has a strict time window; missing it means permanent consequences. Whether academic pressure should be so intense is not discussed here — only the relevant time windows and figures are provided. + +The first eight items and the final two address death and lasting physical harm. Item 9 (avoiding products that claim to “cure myopia”) deals with costs. Items 10 (official rules on sleep, homework, and sports rankings) and 11 (keeping school enrollment after a leave of absence) concern time commitments. Information on drowning, traffic safety, helmets, and HPV vaccination can be found in Section 1. Guidance for infants and toddlers is in Section 20. Issues involving online scams and in‑app purchases are covered in Section 5, while red lines minors must not cross are detailed in Section 9. Recognizing emergencies and calling for help are explained in Section 13, and what happens to children after a parent’s death is addressed in Section 29 — none of these topics are repeated here. +### 1. Child reports sudden, worsening pain — rush to the hospital right away; don’t let him wait until after school. + +- Cost: No cost at all. Just take a half‑day off work and take your child to the emergency department. +- In plain terms: Some medical conditions are time‑critical — the outcome depends on how many hours pass from symptom onset. When a boy suddenly feels severe pain on one side of the scrotum, it may be testicular torsion: the blood vessels feeding the testicle become twisted, cutting off its blood supply. If treated within 6 hours, there’s a 97.2% chance of saving the testicle; after 19–24 hours that chance drops to only 42.5%. This kind of pain won’t wait until after school or until the end of an exam. +- Benefit: Researchers compiled data from 30 case series and 2,116 patients with testicular torsion. For 1,283 of those cases the outcome was tracked in 6‑hour intervals. From the start of pain: 97.2% of testicles were saved at 0–6 hours, 79.3% at 7–12 hours, 61.3% at 13–18 hours, 42.5% at 19–24 hours, 24.4% at 25–48 hours, and just 7.4% after 48 hours. Looking at broader windows, 90.4% of testicles remain intact if treatment occurs within 12 hours; 54.0% are still salvageable at 13–24 hours, and 18.1% after 24 hours. The authors conclude that the window for preserving a testicle can be longer than the commonly cited 6–8 hours. Therefore, even if pain has been present for a while, prompt medical care is still essential — don’t assume it’s “too late” to get help. +- Evidence grade: A +- Notes: Tell your son in advance: if he suddenly feels severe pain, he should speak up right away — no need to feel embarrassed. Testicular torsion is most common in adolescent boys; many hesitate to ask for help because they’re shy. Other conditions that also worsen hour by hour include acute appendicitis (which can perforate if delayed), diabetic ketoacidosis, and meningitis. For these, the exact time‑based impact on outcomes isn’t detailed in this section. Their common warning sign is sudden onset and steadily worsening pain unlike anything experienced before. How to recognize emergencies and call for transport are covered in Section 13. +- Sources:Mellick LB, et al. (2019). A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatric Emergency Care. + +### 2. Don’t delay necessary treatment just to “wait until exams are over”; certain treatment windows depend on bone growth, not exam schedules. + +- Cost: No monetary cost involved. This point concerns whether to start treatment early or late, not expense. Taking time off school and returning for follow‑ups do cost time, while the actual cost of treatment is separate. The real challenge is that braces must be worn at least 18 hours a day, which can be uncomfortable for kids. +- In plain terms: Scoliosis is a sideways curvature of the spine. A brace is a rigid shell worn on the back that helps keep the spine straight. When worn while bones are still growing, it greatly reduces the chance of needing surgery: 75% of patients wearing braces succeed, compared to only 42% who simply receive observation. This treatment window is tied to the timing of bone maturation, not to middle‑school or college entrance exams. Waiting until after exams often leaves surgery as the only option. +- Benefit: A multi‑center trial enrolled 242 adolescents with idiopathic scoliosis who met brace‑wearing criteria. Of these, 116 were randomly assigned to wear braces while 126 chose on their own whether to wear them. Success was defined as the curve remaining below 50 degrees by the end of growth; failure meant exceeding that threshold. Among those assigned to braces, 75% succeeded versus 42% in the observation group (OR 4.11, 95% CI 1.85–9.16). Combining both groups gave success rates of 72% vs. 48% (OR 1.93, 95% CI 1.08–3.46), meaning braces increase the odds of success by roughly 1.9 times. Success rates rose with longer daily wear time (P<0.001), a relationship unlikely to be coincidental. The trial was stopped early because braces proved effective. +- Evidence grade: A +- Notes: Scoliosis serves as a good example here because it has randomized trials, a clear treatment window, and is a common focus of student health screenings (see Section 7). Similar situations include strabismus, amblyopia, dental caries, and certain elective surgeries for congenital heart defects. In all these cases, later treatment yields poorer outcomes or higher costs. Discuss the exact timing with a specialist. Missing school is not a major issue: during compulsory education students may take up to one year of leave while retaining their enrollment status (see Section 11). +- Sources:Weinstein SL, et al. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. + +### 3. When a child is bullied, report it to school the same day and request a written response; for physical assault, theft, or rumor spreading, call the police immediately. + +- Cost: There is no cost involved. Speak to the homeroom teacher and the school’s anti-bullying committee. To call the police, dial 110. The hard part is resisting pressure to “keep things quiet” or avoid making a big deal out of it. +- In plain terms: Children who experience peer bullying are roughly 2.2 times more likely to have suicidal thoughts than those who are not bullied, and about 2.6 times more likely to attempt suicide. Schools must investigate any bullying report right away; if bullying is confirmed, disciplinary action must be taken against the offending students. In cases where bullying violates public order laws or may constitute a crime, schools cannot conceal the facts and must inform police. Therefore, reporting the incident the same day and demanding a formal written response is crucial — simply asking the teacher to “talk to him” is not enough. +- Benefit: This conclusion is based on 34 studies involving 284,375 children and teens. Peer bullying is linked to suicidal thoughts, with an OR of 2.23 (95% CI 2.10–2.37); in other words, the likelihood of such thoughts is roughly 2.2 times higher than among non-bullied youth. Nine additional studies with 70,102 participants show bullying correlates with suicide attempts, with an OR of 2.55 (1.95–3.34); this translates to about 2.6 times higher risk. These results hold true regardless of gender, age, or study quality. Cyberbullying carries an even stronger link to suicidal thoughts than physical bullying. Article 21 of the “Regulations on Protecting Minors in Schools” lists five types of bullying: physical violence (punching, kicking, slapping, biting, pushing, or pulling); verbal abuse, mockery, or derogatory nicknames; theft, vandalism, or deliberate destruction of property; deliberate exclusion or isolation; and online defamation or spreading false rumors. The article also states that if a stronger or older student intentionally commits such acts, causing physical harm, property damage, or emotional distress, it qualifies as bullying. Article 22 requires teachers to pay attention to any signs of emotional distress or physical injury and report them promptly. Article 23 mandates that schools investigate all reports, have the anti-bullying committee determine whether bullying occurred, and involve parents in the process. If bullying is confirmed, educational or disciplinary measures must be taken. Serious cases violating public order laws or criminal statutes must be reported to police and education authorities without delay (effective nationwide since September 1, 2021). +- Evidence grade: A +- Notes: If a child shows unexplained injuries, suddenly refuses to go to school, or repeatedly loses personal items, these signs should be taken seriously per Article 22. This analysis combines data from multiple studies and relies on observational records rather than controlled trials; thus it cannot definitively prove bullying alone causes suicide, but it clearly shows a significant increase in risk. Additionally, the “Comprehensive Plan for Addressing Bullying Among Primary and Secondary Students” stresses the need to distinguish bullying from ordinary horseplay among kids. In short, schools have a legal duty to conduct proper investigations and cannot dismiss incidents as mere “kids just playing around.” +- Sources:van Geel M, et al. (2014). Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatrics. ；教育部 (2021). 未成年人学校保护规定（教育部令第 50 号，第二十一、二十二、二十三条）. + +### 4. Ensuring that children spend at least 2 hours outdoors each day is currently the only myopia‑prevention method backed by randomized trials. + +- Cost: There is no monetary cost. However, it requires setting aside time each day — often at the expense of homework or online classes. The real challenge is maintaining this routine daily, not just occasionally. +- In plain terms: A randomized trial was conducted at 12 primary schools in Guangzhou: first‑grade students were given an extra 40 minutes of outdoor activity per school day. After three years, the myopia rate in these schools was 30.4 %, compared with 39.5 % in schools without the added classes — a reduction of 9.1 percentage points. The Health Commission recommends at least 2 hours of daytime outdoor time per day, or a total of 14 hours per week. Cloudy days and standing outside during recess also count. +- Benefit: In this trial, first‑grade students from 12 Guangzhou schools were randomly assigned to intervention or control groups (952 students in the intervention group, 951 in the control group; mean age 6.6 years). The intervention involved adding a 40‑minute outdoor class each day and encouraging parents to take their children outdoors after school. Over three years, the new myopia rate was 30.4 % in the intervention group (259 of 853 eligible participants) versus 39.5 % in the control group (287 of 726 eligible participants). The difference was –9.1 percentage points (95 % CI –14.1 to –4.1, P<0.001), indicating a true reduction ranging from roughly 4 to 14 percentage points. The average increase in refractive error was –1.42 D in the intervention group versus –1.59 D in the control group, a difference of 0.17 D (P=0.04); the intervention thus slowed progression slightly. D is the unit used to measure refractive error. No significant difference was observed in axial eye length between groups (P=0.07). The “Ten Core Principles for Myopia Prevention” also call for at least 2 hours of daytime outdoor activity per day or 14 hours per week; they note that even on cloudy days this activity provides protection and advise avoiding peak midday sun. +- Evidence grade: A +- Notes: The trial lasted only three years and involved children starting at age 6. A 9.1‑percentage‑point difference means it can help prevent myopia in some children, but it does not guarantee protection for everyone. The same guidelines also recommend maintaining a distance of “one foot, one fist, one inch” while reading or writing, taking a 20‑second break to look into the distance after 20 minutes of close‑up work, limiting non‑educational screen time to 15 minutes at a time (no more than one hour per day), and recognizing that simply standing outside during recess counts toward the daily outdoor requirement — it is not the same as attending a formal PE class. +- Sources:He M, et al. (2015). Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA. ；国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 5. No screen time for children aged 0–3; limit it as much as possible for ages 3–6; for school‑age kids, non‑educational screen use should not exceed one hour per day. + + +- Cost: There is no monetary cost. The real challenge is keeping screens out of children’s hands and encouraging parents to cut down on their own screen time in front of them. +- In plain terms: The Health Commission has set strict guidelines: no screens for children aged 0–3, and they should be kept away from screens as much as possible for ages 3–6. For school‑age students, non‑educational screen use must be limited to no more than 15 minutes at a time and no more than one hour per day. The reasoning is that prolonged close‑up screen exposure depletes a child’s “far‑sightedness reserve,” leading to earlier onset of myopia. Research linking screen time directly to myopia isn’t as conclusive; the strongest evidence comes from studies showing that two hours of outdoor activity per day helps prevent myopia. +- Benefit: Article 4 of the “Ten Core Principles for Preventing Myopia in Children and Adolescents” states: “Children aged 0–3 should not use smartphones, tablets, computers, or other screen‑based electronic devices; children aged 3–6 should avoid such devices as much as possible; for school‑age students, non‑educational screen use should be limited to no more than 15 minutes at a time and no more than one hour per day.” It also notes that “prolonged close‑up use of screen devices can deplete a child’s far‑sightedness reserve, a key factor in the early and frequent occurrence of myopia.” In 2018, eight government agencies, including the Ministry of Education, issued similar recommendations, adding that “the younger the child, the shorter the recommended continuous screen time.” Scientific research is far less definitive: a systematic review examined 33 studies involving participants from 3 months to 33 years of age; only 11 contributed to the pooled analysis. When only smartphones and tablets were considered, the odds ratio for myopia was 1.26 (95 % CI 1.00–1.60, I² = 77 %). Including computers raised that figure to 1.77 (1.28–2.45, I² = 87 %). The authors concluded only that there may be a link, noting that none of the 33 studies measured screen time reliably. +- Evidence grade: B +- Notes: This recommendation earned a B rating because it is based on official policy directives rather than experimental data. The lower bound of the pooled odds ratio sits right at 1.00, and the authors only describe the relationship as “possible,” so it should be viewed as a practical family guideline rather than a guarantee that avoiding screens eliminates myopia risk. The strongest evidence for prevention comes from Recommendation 4 (two hours of outdoor activity daily). Regular eye examinations are also advised for preschoolers: the same document recommends periodic refraction screening for ages 1–3, 4–6, and older to assess remaining far‑sightedness reserve; details are provided in Recommendation 12 (pupil dilation refraction). Finally, a meta‑analysis of 42 studies involving 18,905 participants found that longer screen time correlates with weaker language development (r = −0.14, 95 % CI −0.18 to −0.10). However, watching educational content on screen shows a positive correlation (r = 0.16 and 0.13). This is a correlation, not causation; it simply underscores that substituting screen time for direct interaction with caregivers is less beneficial for language growth. +- Sources:国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. ; 教育部等八部门 (2018). 综合防控儿童青少年近视实施方案（教体艺〔2018〕3 号）. ; Foreman J, Salim AT, Praveen A, et al. (2021). Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806-e818. ; Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA (2020). Associations between screen use and child language skills: a systematic review and meta-analysis. JAMA Pediatrics, 174(7), 665-675. + +### 6. Treating myopia as a lasting injury: the higher the prescription, the greater the future risk of retinal detachment, macular degeneration, and glaucoma + +- Cost: No cost involved. There is nothing specific to do here; the necessary actions are outlined in items 4 and 5 (spending two hours outdoors and managing screen time based on age). +- In plain terms: Myopia does not go away on its own, nor does the prescription level decrease. It is far more than simply “wearing glasses.” Compared to people without myopia, those with mild myopia face a risk of myopic macular degeneration roughly 10–15 times higher; for individuals with a prescription of 600 degrees or more, this risk rises by several hundred times. The likelihood of retinal detachment is about three times higher for mild myopia and roughly 13 times higher for severe myopia. Therefore, the earlier a child develops myopia and the faster it progresses, the greater the long-term risks they must face. +- Benefit: A systematic review and meta-analysis compiled studies published up to June 2019, grouping participants into three prescription categories: mild (−0.5 to −3.00 D), moderate (−3.00 to −6.00 D), and high (≤−6.00 D, i.e., 600 degrees or more). Compared to people without myopia, the odds ratios for myopic macular degeneration were 13.57 (95% CI 6.18–29.79) for mild myopia, 72.74 (33.18–159.48) for moderate myopia, and 845.08 (230.05–3104.34) for high myopia. For retinal detachment, these odds ratios were 3.15 (1.92–5.17), 8.74 (7.28–10.50), and 12.62 (6.65–23.94) respectively. The odds ratios for posterior subcapsular cataract were 1.56 (1.32–1.84), 2.55 (1.98–3.28), and 4.55 (2.66–7.75) respectively. For open-angle glaucoma, the odds ratio for mild myopia was 1.59 (1.33–1.91), while for moderate and high myopia combined it was 2.92 (1.89–4.52). Among individuals over 60, the odds ratios for visual impairment were 1.71 (1.07–2.74), 5.54 (3.12–9.85), and 87.63 (34.50–222.58) respectively. This aligns with the “Ten Core Principles for Preventing and Controlling Myopia in Children and Adolescents,” which defines high myopia as a prescription of 600 degrees or more; such individuals face significantly higher rates of cataracts, open-angle glaucoma, myopic macular degeneration, retinal detachment, and other vision-threatening conditions. Importantly, “myopia can be prevented and controlled, but not reversed.” +- Evidence grade: A +- Notes: All studies included in this analysis were observational studies, and the reported odds ratios are unusually large. For instance, the confidence interval for high myopia and myopic macular degeneration spans from 230 to 3104, indicating considerable variation among individual studies; thus these figures should be viewed as rough estimates rather than precise values. Most of these complications tend to appear only in middle or old age, so this is not a situation where immediate harm occurs; rather, it represents a long-term risk that accumulates over decades. Myopia itself is not a disability, and the vast majority of people achieve normal vision after wearing corrective lenses. The purpose of this item is to shift the common perception that “once you have myopia, glasses are all you need” to recognizing that it is worthwhile to delay and control its progression. Information on follow-up examinations after diagnosis can be found in item 12 (pupil dilation and refraction testing). Be wary of products claiming to cure myopia; refer to item 9 (myopia cannot be cured) for further details. +- Sources:Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW (2020). The complications of myopia: a review and meta-analysis. Investigative Ophthalmology & Visual Science, 61(4), 49. ; 国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 7. Take a close look at your child’s annual school health report and follow up on any abnormalities right away. + +- Cost: No cost at all. Under China’s Compulsory Education Law, all school health check fees are covered by school operating budgets, so parents pay nothing extra. +- In plain terms: Every year, primary and middle schools conduct one health check for every student. The official guidelines list being overweight, obese, malnourished, having spinal curvature issues, poor eyesight, and dental cavities as key areas that need special attention. These problems are precisely the ones parents tend to put off dealing with. Don’t just glance at your child’s height and weight measurements and then file the report away. If any of these issues show up on the report, take your child to a specialist for a proper check-up that same year — don’t wait until the next annual check. +- Benefit: The 2021 Administrative Measures for Health Checks of Primary and Middle School Students requires all such schools to run one health check per year for every enrolled student. The physical exam covers the head, neck, chest, spine, limbs, skin, and lymph nodes, while the eye exam checks external eye condition, distance vision, and refractive errors (degree of myopia or hyperopia). The individual report issued to each student must include all test results, an overall assessment, and tailored health guidance. Overweight, obesity, malnutrition, spinal curvature issues, poor eyesight, and dental cavities are all designated as priority areas for follow-up. Local education authorities are also required to keep records of students with health problems and conduct regular follow-ups. All costs for these compulsory education health checks are paid by school budgets, with no extra charges for parents (issued nationwide in September 2021). +- Evidence grade: B +- Notes: This grade is assigned because the document is a set of administrative rules for schools, not a study on the actual effectiveness of these checks. It guarantees that schools will run annual checks covering the listed items and follow up on any abnormalities, but does not confirm that all identified issues will receive timely intervention. These health checks are only a preliminary screening tool, not a formal diagnosis. For poor eyesight, a pupil dilation refraction test at an ophthalmology clinic is required (see Item 12). For spinal curvature issues, a visit to an orthopedics or spinal surgery specialist is necessary (see Item 2 — do not delay treatment to wait until after exams). Parents are responsible for arranging these follow-up appointments for their children. +- Sources:国家卫生健康委、教育部 (2021). 中小学生健康体检管理办法（2021 年版）（国卫医发〔2021〕29 号）. + +### 8. Conducting a depression screening for kids aged 12 to 18 — don’t rely on school mental health assessments as a diagnosis + + +- Cost: Costs range from zero to just a few dozen yuan; this covers filling out a screening questionnaire at a community clinic or hospital outpatient department. Calling the 12355 and 12356 hotlines is completely free. + +- In plain terms: The U.S. Preventive Services Task Force recommends screening adolescents aged 12 to 18 for major depressive disorder, noting that the overall benefits are moderate and justify the effort. There is insufficient evidence to support screening for kids under 11. Suicide is the second leading cause of death among people aged 10 to 19. School mental health assessments conducted each academic year are population-wide screenings, not diagnostic tools. If a child reports feeling distressed, or shows sudden changes in eating, sleeping, interests, or academic performance, they should be referred to a psychiatrist or clinical psychologist right away. + +- Benefit: In 2022, the U.S. Preventive Services Task Force issued a recommendation statement advising that adolescents aged 12 to 18 be screened for major depressive disorder; this recommendation falls under Category B, meaning the evidence supporting it is moderate and the benefits are also moderate, making it worthwhile. For children under 11, there is insufficient evidence to support depression screening (an I statement, which indicates a lack of evidence and no formal recommendation). Likewise, evidence regarding both the benefits and risks of screening children and adolescents specifically for suicide risk is also limited (another I statement). The document emphasizes that suicide is the second leading cause of death among 10- to 19-year-olds, and that major depression in youth is closely linked to numerous later issues, including recurrent depressive episodes and other mental disorders, as well as a heightened risk of suicidal thoughts, suicide attempts, and death. China’s “Ten Measures to Further Improve Mental Health Care for Primary and Secondary School Students” calls for establishing a three-tier support system: homeroom teachers, full- and part-time school counselors, and psychiatrists. Each student should undergo a mental health assessment no more than once per academic year. The measures also stress the need to improve referral pathways to mental health specialists and reintegration processes after recovery. Additionally, they highlight the importance of leveraging the 12355 Youth Service Hotline and the 12356 Psychological Assistance Hotline (issued nationwide in October 2025). + +- Evidence grade: B + +- Notes: This B rating reflects the original recommendation strength grading used by the task force, rather than a quantifiable measure of actual effectiveness. It represents a U.S.-based recommendation; no equivalent official screening guidelines currently exist in China. A positive screening result merely indicates the need for a follow-up evaluation — it does not constitute a formal diagnosis. Guidance on handling suicidal thoughts can be found in Section 1, Item 25, while family coping strategies are outlined in Section 29. +- Sources:US Preventive Services Task Force (2022). Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 9. Do not buy products or services claiming to “cure myopia” or “reduce refractive error” + + +- Cost: There is no cost involved; in fact, you save this money by avoiding such purchases. +- In plain terms: The State Administration for Market Regulation explicitly states that “under current medical technology, myopia cannot be cured.” Phrases such as “recovery,” “restoration,” “reducing refractive error,” “curing myopia,” “myopia remedy,” and “repairing refractive error” are classified as illegal marketing claims subject to strict enforcement. If you encounter any of these terms, you can safely rule out those products without further comparison. Devices such as eye-care instruments are considered medical devices, and e-commerce platforms must verify whether sellers are qualified to sell them. +- Benefit: A notice issued by the General Office of the State Administration for Market Regulation between November 2021 and March 2022 clearly reiterates that “under current medical technology, myopia cannot be cured.” It mandates strict legal action against any marketing of products aimed at preventing or controlling myopia in children and adolescents that employ misleading language like “recovery,” “restoration,” “reducing refractive error,” “curing myopia,” “myopia remedy,” or “repairing refractive error.” The notice also calls for intensified efforts to combat practices that misuse traditional Chinese medicine terminology or theories for deceptive advertising, as well as two specific types of false advertising: using patient testimonials or images to compare pre- and post-treatment outcomes, and making guaranteed claims regarding treatment safety or effectiveness. Additionally, e-commerce platforms are required to rigorously verify the qualifications of sellers offering medical devices such as eye-care instruments and other specialized products (nationwide). +- Evidence grade: B +- Notes: This grade is assigned because the basis comes from regulatory determinations during enforcement actions rather than from controlled comparative trials of actual products. However, both health authorities and regulators agree on the statement “Myopia can be prevented and controlled, but it cannot be reversed.” The only two evidence-backed recommendations appear in items 4 (outdoor activities) and 12 (proper eye examinations, glasses fitting, and follow-ups). Information on blue-light-blocking glasses can be found in Section 6. +- Sources:市场监管总局办公厅 (2021). 关于开展儿童青少年近视防控产品违法违规商业营销宣传专项整治行动的通知. + +### 10. Clear rules exist for sleep, homework, sports, and rankings; if schools fail to comply, parents can raise the issue + +- Cost: No cost involved. All you need is to know these rules so you can bring them up with the school or local education authorities when necessary. The real challenge is simply speaking up about it. +- In plain terms: These rules are all laid out in writing: elementary students must get 10 hours of sleep per day, junior high students 9 hours, and high school students 8 hours. Elementary classes generally start no earlier than 8:20 a.m., and junior high classes no earlier than 8:00 a.m. In 2025, an additional requirement was added that schools must provide at least 2 hours of combined physical activity per day, and students must not be ranked based on test scores. If your child consistently fails to get enough sleep, use these rules as a reference point rather than blaming the child for being slow to get ready. +- Benefit: The *Notice on Further Strengthening Sleep Management for Primary and Secondary School Students* stipulates that elementary students must get 10 hours of sleep daily, junior high students 9 hours, and high school students 8 hours. Elementary classes generally start no earlier than 8:20 a.m., and junior high classes no earlier than 8:00 a.m. Schools are prohibited from requiring students to arrive at school early for mandatory educational activities. Elementary students must go to bed no later than 9:20 p.m., junior high students no later than 10:00 p.m., and high school students no later than 11:00 p.m. After-school tutoring programs must end no later than 8:30 p.m., and online live tutoring sessions must end no later than 9:00 p.m. From 10:00 p.m. to 8:00 a.m. the next day, game services for minors are banned nationwide (issued March 2021). The *Ten Measures for Further Strengthening Mental Health Work Among Primary and Secondary School Students* contains several additional provisions. All schools are required to ensure students get at least 2 hours of combined physical activity per day, and the practice of offering 15-minute recess periods is encouraged. Students must not be ranked based on test scores, and repetitive, punitive homework assignments are strictly prohibited. A nationwide initiative launched in October 2025 encourages schools to designate one day per week as a “homework-free day.” +- Evidence grade: B +- Notes: Both documents were issued by relevant education authorities. Implementation varies widely across different regions and schools, which is why this item is rated B. Their main purpose is to help parents understand what schools are obligated to provide, so they have solid grounds to bring these issues up when needed. Information on adult sleep needs can be found in Sections 2 and 3. +- Sources:教育部办公厅 (2021). 关于进一步加强中小学生睡眠管理工作的通知（教基厅函〔2021〕11 号）. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 11. Parents can request a temporary leave of absence for their child; the school must retain the child’s enrollment status for up to one year. + + +- Cost: No cost involved. Parents or other legal guardians must submit a formal request to the school. The main challenge is first accepting that the child needs a break from school for a while. + +- In plain terms: A temporary leave of absence is a fully established procedure. Parents or legal guardians submit a request, which the school then approves and forwards to the relevant education authorities for final authorization. Each request is valid for no more than one year; if the child still needs time off after that, a new request must be filed. During this period, the school is legally required to keep the child’s enrollment status intact. Therefore, the idea that taking a leave of absence “ruins” a child’s education has no basis in current policy. Exact implementation details vary by province; parents should contact the school’s academic affairs office or local education bureau for specifics. + +- Benefit: Article 16 of the “Administrative Measures for Student Enrollment Records of Primary and Secondary School Students” outlines the proper process for granting a temporary leave of absence. Parents or legal guardians initiate the request, which the school then forwards to higher education authorities for approval. Upon the child’s return, the school must promptly handle all necessary re-enrollment paperwork. Each approved leave cannot exceed one year; if further time off is required, a new application must be submitted. While the child is away, the school must maintain their enrollment status, effectively preserving their place in the system. Detailed procedures for leave and re-enrollment are determined by provincial education authorities (nationwide, issued January 2025). Additionally, the “Ten Measures for Strengthening Mental Health Support for Primary and Secondary School Students” encourages establishing clear pathways for students recovering from mental health conditions to return to school, while also mandating that schools develop emergency response plans for psychological crises on campus. + +- Evidence grade: B + +- Notes: Before applying, be sure to clarify three key points: what kind of medical documentation is required, how the child’s enrollment status is tracked while on leave, and whether they’ll return to their original grade level or be placed in a lower one. This recommendation is graded B because while a national framework exists, specific eligibility criteria, required paperwork, and re-enrollment protocols are all determined locally by provincial education authorities. Furthermore, the “Regulations on Protecting Schooling Rights for Minors” requires all compulsory education schools to maintain records of students who drop out, take extended leaves, or are absent for prolonged periods; this means the procedure is already standard practice within the system, rather than an exception granted solely to your child. +- Sources:教育部 (2025). 中小学生学籍管理办法（教基〔2025〕1 号，第十六条）. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 12. If poor vision is detected, go to the hospital for cycloplegic refraction and follow up at the recommended intervals as advised by the doctor. + + +- Cost: The examination and glasses fitting typically cost several tens to several hundred yuan. After using the eye drops, children may be sensitive to light and have blurry near vision; it usually takes half a day to a couple of days for this to subside. + +- In plain terms: Cycloplegic refraction involves using special eye drops that relax the eye’s focusing muscles, allowing an accurate measurement of refractive errors. This test is performed in hospitals and is the most reliable method for diagnosing myopia. The Health Commission confirms these drops do not harm healthy eyes and that vision returns to normal after they wear off. Do not rely on quick computerized refraction tests at optical shops for diagnosis, and do not withhold glasses from children out of fear that it will worsen their myopia. + +- Benefit: The “Ten Core Principles for Preventing and Controlling Myopia in Children and Adolescents” outlines how cycloplegic refraction works: it uses a cycloplegic agent to relax the focusing muscles before measuring refractive errors. This medical procedure is regarded as the gold standard for diagnosing myopia, providing the most accurate results. The drops themselves are safe for healthy eyes; side effects such as light sensitivity and blurred near vision are temporary and resolve after treatment ends. Once myopia is confirmed, timely corrective measures—such as wearing appropriate glasses—are essential. Proper glasses can correct vision and slow progression of the condition. Children aged preschool through elementary school should have their vision rechecked every 3–6 months, while middle and high school students should be checked every 6–12 months, depending on individual needs. Regular refractive screenings are also recommended at ages 1–3, 4–6, and thereafter to monitorhyperopia reserve (远视储备量, "farsightedness reserve") (the amount of reserve focusing ability). (National guidelines issued July 2023) + +- Evidence grade: B + +- Notes: This grade is assigned because the information originates from official public health publications rather than original research containing specific quantitative data. Because high myopia increases the risk of complications such as retinal detachment, follow-up visits serve purposes beyond simply updating prescriptions. “Poor vision” noted during school screenings is merely an initial indicator; a full ophthalmologic evaluation at a hospital is still required, as detailed in item 7. +- Sources:国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 13. Pit and fissure sealants applied after permanent molars emerge + + +- Cost: Each application costs just a few dozen to 100–200 yuan. No anesthesia is needed, no drilling of the tooth, and the whole procedure takes only a few minutes. In many regions, eligible children can receive this service for free. + +- In plain terms: Pit and fissure sealants essentially coat the grooves on the chewing surface of molars with a thin layer of resin, sealing them so food particles can’t get trapped. After 24 months, the likelihood of cavities drops dramatically compared to untreated teeth. For instance, if 16% of untreated children develop cavities on their molars, only about 5.2% of children with sealants do; when the untreated rate is 40%, the sealed group stays at roughly 6.25%. Overall, sealants cut cavity rates by 11% to 51% after two years, and this protective effect persists for up to four years. + +- Benefit: This conclusion comes from 38 separate trials involving 7,924 children aged 5 to 16, all vetted and pooled by Cochrane reviewers. The studies compared resin-based sealants with no treatment at all. For first permanent molars in kids aged 5 to 10, the odds ratio of developing cavities after 24 months was 0.12 (95% CI 0.08–0.19), meaning sealants reduce cavity risk to roughly one-eighth of the untreated level. This result is based on seven trials with 1,548 participants randomly assigned to groups; 1,322 of them completed follow-up assessments, yielding moderate-quality evidence. If 16% of untreated children develop cavities within two years, the sealed group’s rate drops to 5.2% (95% CI 3.13%–7.37%); at a 40% untreated baseline, sealants keep the rate at 6.25% (3.84%–9.63%); and when untreated rates reach 70%, sealants still limit cavities to 19% (12.3%–27.2%). After 48 to 54 months, the odds ratio remains low at 0.21 (0.16–0.28), indicating a fivefold reduction in risk. No adverse events were reported across four trials that monitored side effects; however, there isn’t enough evidence to determine whether resin sealants outperform other types such as glass ionomer. + +- Evidence grade: A + +- Notes: The first permanent molars—the large teeth that never get replaced—typically appear around age 6, with the second set emerging near age 12. Sealants should be applied as soon as these molars emerge and before any decay sets in; once cavities are already present, restoration is the only option. Many regions now offer free pit and fissure sealant programs for eligible children, so it’s worth checking with the local Chinese CDC or community health centers. Because no nationwide guidelines explicitly detail eligibility criteria or age ranges, this section does not list them. Preventing dental caries remains a key focus of school health screenings, as discussed in Section 7. +- Sources:Ahovuo-Saloranta A, et al. (2017). Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews. diff --git a/book/31-Paths-After-Eighteen.md b/book/31-Paths-After-Eighteen.md new file mode 100644 index 00000000..a2334caa --- /dev/null +++ b/book/31-Paths-After-Eighteen.md @@ -0,0 +1,197 @@ +# 31. What options are available after turning 18? + +This section deals with money and time, while the option of avoiding military service also affects personal freedom. It serves as a roadmap of possible paths, not a step‑by‑step guide for any single one. First, we list the legal requirements for each path. Then we describe the details that become relevant only after you decide to pursue them: what benefits military service provides, other ways to enter the civil service besides the civil service exam, which college majors directly lead to government positions, how to later upgrade your education, what kind of employers to seek for overseas work, how to handle social insurance without a formal job, and whether there are government loans that cover part of the interest for those lacking startup capital. + +Let us be clear: after turning 18 there are many more options than those covered here. We only include paths for which nationwide official documents specify eligibility criteria, requirements, and benefits. Paths such as joining state‑owned enterprises, working in factories, becoming a seafarer, pursuing freelance work, or continuing high school or university lack such uniform documentation. They are certainly possible, but without verifiable legal references we cannot describe their conditions in this book. + +Choosing a path is entirely up to you. This section provides two things only: the official documents that set the eligibility rules, and the deadlines and qualifications that expire once you start down a particular route. How to weigh the decision between studying and working, and how to pick relevant skills, is explained in Section 23. Overtime pay, workplace injuries, and severance after joining a job are covered in Section 19. Starting or closing a business is discussed in Section 12. Studying abroad is the topic of Section 32, while safety nets for the unemployed are outlined in Section 7. None of those topics are repeated here. +### 1. First, check the eligibility criteria: the age and education requirements for all twelve pathways are clearly stated in official documents. + +- Cost: No cost at all. It only takes ten minutes to review whether you meet the criteria. +- In plain terms: The age and education requirements for all twelve pathways are explicitly listed in official documents. You must be at least 16 years old to work. For military service, men must be 18 years old; university graduates may be eligible up to age 24. To become a civil servant, you must be between 18 and 35 years old with at least an associate degree. The self-study exam and self-employment pathways have no age or education restrictions. +- Benefit: Military service rules state: “All male citizens who reach 18 years of age must be drafted into active service; those not drafted that year may still be drafted up to age 22. University graduates may be eligible up to age 24, and postgraduate students up to age 26.” Civil service requirements are outlined in Article 18 of the Civil Servant Recruitment Regulations, which specify ages between 18 and 35 and at least an associate degree; these limits may be adjusted with approval from provincial-level authorities. Article 19 lists disqualifying factors such as criminal convictions, dismissal from public office, or inclusion in credit blacklists. Firefighter recruitment follows similar age and education criteria. Civilian roles in the military require a minimum age of 18, with upper limits of 35 for entry-level positions. Public institution hiring must be conducted openly, while self-employment is open to any capable adult. Self-study exams are accessible to all citizens regardless of background, though full-time students are excluded. Government-funded teacher and medical training programs are offered at select universities, with tuition and living expenses covered; these commitments must be honored as outlined in their respective regulations. Overseas employment requires companies to hold proper government authorization; otherwise such arrangements are illegal. +- Evidence grade: A +- Notes: This entry focuses solely on eligibility criteria, not on which pathway offers better overall benefits. Meeting these criteria is only the first step; additional requirements include political background checks, physical fitness tests, and other evaluations with no publicly available scoring metrics. Details on vocational education options and financial aid are provided in later sections. Starting a business requires capital, personal guarantees, and carries financial risks. Student loans with government-backed interest subsidies may be available. Commitments made during college admissions for teacher and medical training programs have specific obligations. Legal compliance for overseas employment depends on employer qualifications. +- Sources:全国人大常委会 (2021). 兵役法（第二十条）. （国防部刊登）；中共中央组织部 (2019). 公务员录用规定（第十八、十九条）. （共产党员网刊登）；人力资源社会保障部、应急管理部 (2021). 国家综合性消防救援队伍消防员招录办法（人社部发〔2021〕58 号，第五、六条）. ；国务院、中央军委 (2022). 中国人民解放军文职人员条例（第二次修订，令第 757 号，第九、十九条）. （国家法律法规数据库）；国务院 (2014). 事业单位人事管理条例（国务院令第 652 号，第八条）. ；国务院 (2022). 促进个体工商户发展条例（国务院令第 755 号，第二条）. ；国务院 (1988, 2014 修订). 高等教育自学考试暂行条例（第三、二十条）. （国家法律法规数据库）；全国人大常委会 (2018). 义务教育法（第十四条）. （教育部刊登）；国务院办公厅 (2024). 关于转发教育部等部门《教育部直属师范大学本研衔接师范生公费教育实施办法》的通知（国办发〔2024〕27 号，第二、五条）. ；国家卫生健康委等 7 部门 (2019). 关于做好农村订单定向免费培养医学生就业安置和履约管理工作的通知. ；国务院 (2012). 对外劳务合作管理条例（国务院令第 620 号，第五、七、八条）. + +### 2. Men who turn 18 must complete military service registration by October 31; mandatory active duty lasts two years. + + +- Cost: There is no cost. The online registration takes just a few minutes. However, actual enlistment means two full years of service, during which you cannot hold any other job. + +- In plain terms: Military service registration is a legal obligation, not an application to join the army. Completing it does not mean you must enlist. All men who turn 18 must register online by October 31. Failure to do so can result in a government order to register within a set period; if ignored, you may be forced into service and fined. Once enlisted, you serve as a conscript for exactly two years. + +- Benefit: The rules governing military service registration state: “By October 31 each year, local civil affairs bureaus must organize initial registration for all male citizens who will turn 18 by December 31.” They also specify that registration is primarily done online, at the citizen’s own initiative. Consequences of non‑compliance are outlined in Article 57, Paragraph 1 of the Military Service Law, which addresses “refusal or evasion of registration.” Penalties include a deadline set by the county government for compliance, followed by forced enlistment and a fine if still ignored. The same law also states that “the term of active duty for conscripts is two years.” It further notes that men aged 17–18 may enlist voluntarily if the army needs them. Non‑commissioned officers who serve 12 years or meet other criteria are offered civilian jobs by local governments upon discharge; those serving 30 years or reaching age 55 may retire. The Recruitment Regulations emphasize giving priority to university graduates and candidates with specific physical or professional qualifications; full‑time students and recent graduates may enlist either at their hometown or campus location. + +- Evidence grade: A + +- Notes: Registration and actual enlistment are separate processes with vastly different obligations. The restriction on leaving the country for two years applies only to those who enlist and later attempt to withdraw, as detailed in item 3 (refusal to serve). Women are not required to register initially, though they may be recruited if needed. Requirements for soldiers seeking officer training or promotion are defined in internal military regulations and are not disclosed here. The Military Service Law merely states that officers are drawn from “outstanding active‑duty soldiers” and that military academies may admit students regardless of age limits; exact admission scores and quotas are not provided in this guide. +- Sources:国务院办公厅、中央军委办公厅 (2025). 兵役登记工作规定（国办发〔2025〕41 号）. ；全国人大常委会 (2021). 兵役法（2021 年修订，第二十、二十五、二十六、五十四、五十七条）. （国防部刊登）；国务院、中央军委 (2023). 征兵工作条例（国务院、中央军委令第 759 号，第五条）. + +### 3. Refusing military service after enlistment: no travel abroad, no further education, and barred from civil service and state-owned enterprises for two years + + +- Cost: There is no monetary cost. The price is having to decide well in advance whether you want to serve or not. +- In plain terms: Choosing to enlist and then backing out carries serious consequences. You cannot be hired by any civil service office, nor by any state-owned enterprise or public institution. For two full years, you are prohibited from leaving the country, enrolling in any school, or returning to your studies. Your name will also be added to a list of individuals who have seriously failed to fulfill their national defense obligations, triggering coordinated penalties from multiple authorities. Therefore, the idea of “signing up first and then pulling out if needed” ends up being very costly. +- Benefit: Article 57, Paragraph 1, Item 2 of the Military Service Law explicitly states that “any conscript who refuses or evades enlistment shall be subject to penalties.” These penalties include a requirement to correct the behavior within a set timeframe; if they still refuse, the local county-level government may compel them to serve and impose a fine. Paragraph 2 adds that such individuals must also be barred from civil service roles, from employment in state-owned enterprises and public institutions, and from any travel abroad or further education for two years. They are placed on a special list of those who have failed to meet defense obligations, leading to joint enforcement actions by various agencies. Article 58 extends these same penalties to active-duty personnel who deliberately evade service or desert. Those who are discharged, expelled from the military, or face criminal prosecution are subject to the same restrictions outlined in Paragraph 2 of Article 57, including a nationwide fine effective as of October 1, 2021. +- Evidence grade: A +- Notes: This rule concerns personal freedom and employment eligibility rather than financial penalties. Only two categories of people are subject to these measures: those who refuse or evade enlistment after being called up, and those who are discharged, expelled, or criminally prosecuted after already joining the armed forces. Individuals who simply fail to register for conscription are not included; registration details are covered in Item 2. The penalties apply only when the person refuses to comply after being instructed to do so, as determined by the local county-level government. The exact amount of any fine is set locally and is not specified in this guide. This information is provided solely to illustrate the irreversible nature of the decision once enlistment is initiated; it does not serve as encouragement or discouragement regarding military service. +- Sources:全国人大常委会 (2021). 兵役法（2021 年修订，第五十七、五十八条）. （国防部刊登） + +### 4. Two main perks for college students joining the military: up to 20,000 RMB per year for tuition, and two years of academic status protection plus a special postgraduate admission track + + +- Cost: No out-of-pocket expense. After discharge, you simply submit the required paperwork to your school — usually just one or two visits. + +- In plain terms: Undergraduates, recent graduates, and incoming freshmen who enlist receive full tuition coverage from the state during their service. The maximum annual amount is 20,000 RMB for undergrads and 25,000 RMB for graduate students; over two years this can reach 40,000 or 50,000 RMB. Your student status remains intact, allowing you to enroll or return to school within two years of discharge. Additionally, there is a dedicated postgraduate admission pathway reserved solely for discharged college veterans. + +- Benefit: In 2024, four government agencies — including the Ministry of Finance — issued a notice outlining three key benefits for eligible students: tuition compensation, repayment of any federal student loans used for tuition, and tuition waivers. Repayment essentially means the state settles those loans on your behalf. The new limits apply from the autumn 2024 semester: undergrads may receive up to 20,000 RMB per year, while graduate students may receive up to 25,000 RMB per year. The actual amount awarded equals whichever is higher — your actual tuition paid or the total loan principal plus accrued interest. Any sum exceeding these caps is not covered. Regarding academic status, the Law on Veterans’ Affairs stipulates that active-duty personnel who were already enrolled in a university retain their admission or student status throughout service; they may re-enroll or resume studies within two years of discharge and even switch to other majors per national regulations. Universities may also reserve separate admission slots for veterans through targeted recruitment initiatives. For postgraduate entry, the 2026 Ministry of Education directive established the “Special Scheme for Discharged College Veterans.” This program allocates a fixed number of places within the overall national postgraduate quota, exclusively for discharged veterans; participating institutions set their own minimum entrance scores — typically no higher than those required for regular applicants in the same field. Priority is given to candidates with longer periods of military service. In 2026, 532 universities participate in this scheme; the list changes yearly, with 523 institutions involved in 2025. The tuition rates were set at 8,000/12,000 RMB in 2019, then adjusted to 16,000/20,000 RMB in 2023, and finally raised to 20,000/25,000 RMB in 2024. The earliest official figures date back to 2022. + +- Evidence grade: A + +- Notes: Pending verification: official documents detailing exemptions from entrance exams for vocational college transfers and bonus points on postgraduate entrance tests for veterans. Both perks are referenced in the Veterans Affairs Ministry’s policy summaries, yet no corresponding Ministry of Education notices have been located so far. Consequently, this guide merely confirms the existence of these pathways without specifying exact bonus values; applicants must consult the latest admission guidelines before applying. Note also that participants in the special postgraduate scheme cannot simultaneously claim entrance-score bonuses — these benefits are mutually exclusive. +- Sources:财政部、教育部、中国人民银行、金融监管总局 (2024). 关于调整完善国家助学贷款有关政策的通知（财教〔2024〕188 号）. ；财政部等五部门 (2019). 学生资助资金管理办法（财科教〔2019〕19 号，第五条）. ；全国人大常委会 (2020). 退役军人保障法（第三十四、三十五条）. （国防部刊登）；教育部办公厅 (2025). 关于做好 2026 年退役大学生士兵专项硕士研究生招生计划招生工作的通知（教学厅〔2025〕8 号）. + +### 5. Only six scenarios allow the government to assign jobs after discharge; those opting for self-employment must register within 30 days + +- Cost: No cost involved. Simply bring your discharge certificate and visit the local Civil Affairs Bureau for veterans. +- In plain terms: The notion that “the military guarantees job placement” no longer applies broadly. Currently, only six specific scenarios qualify for government job assignments. Most conscripts who serve two years do not fall into these categories. Those not eligible for government placement are considered self-employed, and they must register within 30 days of discharge. Failing to do so without valid reasons means they forfeit any entitlement to government assistance. +- Benefit: Article 25 of the Regulations on Placement of Veterans specifies six circumstances under which local governments must assign jobs. These include: (1) non-commissioned officers with at least 12 years of service; (2) personnel awarded medals or honorary titles during service; (3) those receiving third-class combat merits or higher; (4) individuals receiving first-class commendations; (5) those disabled at levels 5–8 due to combat; and (6) children of martyrs. The same regulations state that local governments must complete job placement within six months of receiving discharged personnel. Employers must sign medium- or long-term contracts lasting at least three years; for non-commissioned officers with ten-plus years of service, employers must offer open-ended contracts. During the placement period, veterans receive monthly living allowances equal to the local minimum wage. If placement fails due to reasons unrelated to the veteran, they receive 80% of the average wage of comparable workers until employment is secured. Exceptions include individuals expelled from the Communist Party of China or convicted of crimes. Article 51 clarifies that self-employed veterans must register within 30 days of discharge; otherwise, they lose eligibility for government support. (Nationwide, effective 1 September 2024.) +- Evidence grade: A +- Notes: This regulation took effect on the same date that the 2011 Regulations on Placement of Retired Soldiers (Decree No. 608 issued by the State Council and Central Military Commission) was repealed. Many online guides still reference the outdated version, which stipulated that veterans must have earned second-class combat merits or higher in peacetime or third-class merits or higher in wartime to qualify. The 30-day registration rule applies solely to self-employed veterans; others must register “within the prescribed timeframe.” Upon registration, veterans receive a preferential treatment certificate, which serves as a prerequisite for subsequent benefits such as pensions, employment support, and educational grants. +- Sources:国务院、中央军委 (2024). 退役军人安置条例（国务院、中央军委令第 787 号，2024 年 7 月 29 日公布、9 月 1 日施行；第二十五、三十一、三十二、三十五、五十一、七十五条）. ；全国人大常委会 (2020). 退役军人保障法（第十三、十四、十五条）. （国防部刊登） + +### 6. Three key financial aspects after discharge: one-time separation pay, military service counting toward work seniority, and tax deductions up to 20,000 yuan per year for self-employed individuals + +- Cost: There is no cost involved. Upon discharge, the military transfers your social insurance records and funds to you. You then go to the local social insurance agency to continue those benefits — essentially the same office that handles social insurance enrollment. +- In plain terms: After leaving the military, there are three main financial factors to consider. First, there is a one-time separation payment for those who choose self-employment; the amount depends on how many years you served, with extra pay for those who earned commendations. Second, your military service years count toward your overall work seniority, so they are added to any prior and subsequent work history when calculating benefits. Third, if you start your own business, you may receive tax deductions of up to 20,000 yuan each year for three years, which equals 36 months in total. +- Benefit: The first point is covered by the Regulations on the Resettlement of Retired Military Personnel, which state: “A one-time separation payment shall be issued to retired noncommissioned officers and conscripts who choose self-employment, based on their length of service.” Funding comes from a special central government fund; exact amounts are set by relevant ministries and adjusted periodically. There are five tiers of additional pay: 25% extra for recipients of medals or honorary titles, 20% for those with first-class combat achievements or first-level commendations, 15% for second-class combat achievements or first-level commendations, 10% for third-class combat achievements or second-level commendations, and 5% for fourth-class combat achievements or third-level commendations. The regulations also note that if you do not find employment right away, you may qualify for unemployment benefits; your military service years count as insured periods, except for those placed in retirement or supported through other programs. The second point is addressed in the Law on the Protection of Retired Military Personnel: “Military service periods are counted as work seniority and combined with any subsequent employment history.” These years are also included when calculating pension, medical, and unemployment insurance contributions, and they count as grassroots work experience. Additionally, the Military Insurance Law states that military service years are added to any prior and subsequent periods of employee medical insurance coverage. The third point is outlined in a 2023 announcement from the Ministry of Finance, the State Taxation Administration, and the Ministry of Veterans Affairs, which specifies that self-employed veterans may deduct up to 20,000 yuan per year from applicable taxes for three years; this ceiling can be raised by 20% in certain regions. The deduction is applied sequentially against taxes owed, rather than being paid out as cash. For businesses hiring veterans, the maximum deduction is 6,000 yuan per employee per year, with a possible 50% increase. These provisions are valid from 1 January 2023 through 31 December 2027; those who have not yet reached three years of eligibility may continue to benefit until then. +- Evidence grade: A +- Notes: TODO (pending verification of current one-time separation payment amounts). The regulations only indicate that amounts are determined by authorities; no official figures have been published, so this guide does not list specific numbers — do not rely on unofficial estimates found online. During service, conscripts may also receive family preference allowances; exact amounts are set locally and subsidized by the central government. The tax benefit represents a maximum possible deduction, not an outright cash payout; if your business does not generate sufficient income, you may not reach that limit. Overall benefit level is rated “moderate.” A newer regulation effective from 1 August 2026 adds that vocational certificates earned during service remain valid nationwide after discharge. +- Sources:国务院、中央军委 (2024). 退役军人安置条例（国务院、中央军委令第 787 号，第二十一、二十二、七十四、八十一、八十五条）. ；全国人大常委会 (2020). 退役军人保障法（第四十二、四十四、五十条）. （国防部刊登）；全国人大常委会 (2012). 军人保险法（第十六、二十三条）. （国家法律法规数据库）；财政部、税务总局、退役军人事务部 (2023). 关于进一步扶持自主就业退役士兵创业就业有关税收政策的公告（2023 年第 14 号）. + +### 7. There’s more than just civil service exams to get into the government system: serving two years in grassroots programs qualifies you for a special recruitment quota of 10% each year. + + +- Cost: There’s no upfront cost. The trade‑off is spending two years working at a grassroots level in a township. During those two years you receive a government stipend rather than a market‑rate salary, and you must be prepared to endure that period. + +- In plain terms: Getting into the government system isn’t limited to taking civil service exams. After completing two years of satisfactory service in programs such as “Three Supports and One Assistance,” you become eligible for a special recruitment pool that accounts for roughly 10% of each year’s civil service openings. Those who take the postgraduate entrance exam within three years also get an extra 10 points added to their total score. The catch is that you’ll be paid only a government stipend during those two years. + +- Benefit: The fourth round of the “Three Supports and One Assistance” program states that the service term is two years. It also specifies that each province must reserve about 10% of its civil service recruitment slots for participants in this and similar grassroots programs. Additionally, local governments are required to set aside a certain number of positions in county‑ and township‑level public institutions for those who have completed the program and passed the evaluation; once hired, they are exempt from a probationary period. This means these spots are open only to former participants, not to outsiders. The same notice adds that anyone who finishes the program and meets the criteria can receive a 10‑point boost on their postgraduate exam score and be given priority admission under equal conditions. Graduates from vocational colleges who meet the requirements may also be admitted to undergraduate programs without taking further exams. Moreover, those without prior work experience who complete the program can enjoy the same rights as fresh graduates for two years in terms of civil service and corporate hiring, entrepreneurship, household registration, and further education; their service time counts as work seniority, with the start date being the day they reported to the grassroots post. Financial support from the central government is 30,000 yuan per person per year for western regions, 24,000 yuan for central regions, and 12,000 yuan for eastern regions. A joint directive from the General Offices of the CPC Central Committee and the State Council states that such individuals may enjoy the same treatment as fresh graduates for two years after completing the program, and that most senior posts in central government agencies must be filled by candidates with at least two years of grassroots experience. Another pathway is the Western China Program, jointly organized by the Central Committee of the Communist Youth League, the Ministry of Education, the Ministry of Finance, and the Ministry of Human Resources and Social Security; it recruits recent university graduates and postgraduate students to provide volunteer services in western grassroots areas for one to three years. + +- Evidence grade: A + +- Notes: The fourth round of the “Three Supports and One Assistance” program covers the years 2021‑2025. No fifth‑round documents or 2026 notices have been found yet, so be sure to check the latest recruitment announcements before applying. In 2025 the central government funded the recruitment of 34,430 participants. The full implementation plan for the Western China Program is not publicly available, and the relevant policy page on its official site cannot be accessed. Benefits for graduates of that program are governed by the same CPC‑State Council directive applicable to all grassroots programs. Keep in mind that you must actually serve the full two years under a government stipend; don’t focus solely on the subsequent special recruitment opportunities. +- Sources:中共中央组织部、人力资源社会保障部等十部门 (2021). 关于实施第四轮高校毕业生「三支一扶」计划的通知（人社部发〔2021〕32 号，第七、八、九、十一、十二、十三条）. ；中共中央办公厅、国务院办公厅 (2017). 关于进一步引导和鼓励高校毕业生到基层工作的意见（第五、十六、十八条）. ；全国大学生志愿服务西部计划项目管理办公室 (2026). 2026—2027 年度大学生志愿服务西部计划招募协议书. + +### 8. Teachers in the Special Post Program who complete three years of service, pass evaluations, and wish to stay should be promptly added to the official teaching staff + + +- Cost: There is no monetary cost. The price to pay is three years of teaching in rural compulsory education schools; applicants must also obtain a teaching certificate beforehand. The real challenge lies in staying committed throughout those three years. + +- In plain terms: The Special Post Program is one of the few pathways explicitly stating that eligible participants can be added to the official teaching roster after completing their service term. Requirements include a bachelor’s degree or higher, preferably in a teacher-training field, age not exceeding 30, and possession of the required teaching certificate. During those three years, compensation matches that of regular teachers employed by local public schools. Once the term ends, those who meet evaluation standards and wish to remain are supposed to be promptly added to the official staff list. + +- Benefit: The 2024 notice regarding the Special Post Program outlines hiring criteria: applicants must hold a bachelor’s degree or higher, preferably from a teacher-training background; for elementary schools, graduates from teacher-training colleges may also qualify. Age limit remains 30. A valid teaching certificate is mandatory. The notice further states that volunteers who participated in the “Western China Volunteer Program” or have prior teaching experience, as well as teacher-training graduates with at least six months of teaching internships, receive preferential treatment under equal conditions. Eligible veterans may also be considered for teaching roles in primary and secondary schools, with age limits adjusted based on their years of service. Compensation and official employment terms are defined accordingly: starting January 1, 2024, central government subsidies for Special Post teachers rose from 35,200 yuan per year in central regions to 38,800 yuan, and from 38,200 yuan in western regions to 41,800 yuan. These teachers are entitled to identical pay, professional title evaluations, awards, and annual assessments as regular teachers employed by local public schools. Upon successful completion of three years of service and passing evaluations, they must be promptly added to the official staff list, with all personnel and salary records transferred accordingly; their years of service and teaching experience are counted continuously, and no probationary period applies nationwide. + +- Evidence grade: A + +- Notes: The benefit level is classified as “high” because securing official employment after completing the program represents a long-term career gain far exceeding any monetary value. The most recent publicly available document is the 2024 notice; policies for 2025 and 2026 have not yet been published. Exact postings, subsidy amounts, and age limits are determined by each province’s implementation plan within the central framework. Obtaining a teaching certificate beforehand is mandatory; it serves as a prerequisite for entry, not something that can be obtained after employment begins. +- Sources:教育部办公厅、财政部办公厅 (2024). 关于做好 2024 年农村义务教育阶段学校教师特设岗位计划实施工作的通知（教师厅〔2024〕1 号）. + +### 9. Firefighters and civilian personnel in the military represent two additional pathways for public recruitment, with lower entry requirements than civil service exams. + +- Cost: There is no monetary cost. The process from application to hiring involves medical exams, political background checks, physical fitness tests, psychological evaluations, and interviews, taking several months in total. The difficulty lies in the successive screening stages that eliminate candidates one by one. +- In plain terms: Neither pathway imposes the “minimum associate degree or higher” requirement. Firefighter recruitment targets individuals aged 18–22 with at least a high school education; those with an associate degree or higher, as well as veterans, may apply up to age 24. Military civilian positions require applicants to be at least 18 years old, with entry-level roles allowing candidates up to 35 years of age. The common barrier is the rigorous political background checks and medical evaluations. +- Benefit: For firefighters, refer to the *Measures for Recruiting Firefighters into the National Comprehensive Fire and Rescue Force*. Article 5 stipulates that applicants must be aged 18–22 and hold at least a high school diploma. Article 6 further allows candidates with an associate degree or higher, veterans, or experienced firefighters to apply up to age 24; exceptionally talented specialists may be admitted up to age 28 with approval from the Ministry of Emergency Management. Article 7 specifies that recruitment occurs primarily among local residents, though candidates from other provinces may also be considered. Article 9 outlines the full procedure: publicity, registration, eligibility checks, medical exams, political screening, physical and psychological tests, interviews, public announcements, and final hiring. Regarding military civilian roles, the *Regulations on Civilian Personnel in the Chinese People’s Liberation Army* states in Article 18 that recruitment combines open examinations, direct hiring, and targeted recruitment efforts. Article 9 lists basic criteria: applicants must be at least 18 years old, meet political standards, and possess required education, expertise, and competence. Article 19 sets the maximum age limit at 35 for entry-level positions. Additionally, Article 20 emphasizes giving priority to veterans in civilian roles nationwide. +- Evidence grade: A +- Notes: Effective August 1, 2026, the *Regulations on Promoting Employment and Entrepreneurship for Veterans* introduces two key provisions: first, a designated quota for recruiting veterans into firefighter roles; second, preferential treatment for veterans when hiring police auxiliary personnel. These pathways’ exact annual quotas, specific roles, and eligibility criteria are defined in yearly announcements; this guide outlines only the unchanging baseline requirements. Firefighter roles constitute a disciplined service rather than ordinary employment, so prospective candidates must carefully weigh associated occupational risks beforehand. +- Sources:人力资源社会保障部、应急管理部 (2021). 国家综合性消防救援队伍消防员招录办法（人社部发〔2021〕58 号，第五、六、七、九条）. ；国务院、中央军委 (2022). 中国人民解放军文职人员条例（第二次修订，国务院、中央军委令第 757 号，2023 年 1 月 1 日施行；第九、十八、十九、二十条）. （国家法律法规数据库） + +### 10. Education isn’t a one‑time deal: self‑study exams have no age or prior‑education limits, while adult college entrance exams and open universities also offer pathways to upgrade qualifications. + + +- Cost: Registration and textbook fees run only a few hundred yuan per year. The trade‑off is long‑term self‑study or part‑time classes; a non‑full‑time bachelor’s upgrade takes at least two and a half years. “Non‑full‑time” means you keep working while studying, which demands consistent effort over time. + +- In plain terms: If you missed out on schooling at age 18, three legitimate routes remain: self‑study exams, adult college entrance exams, and open universities. Self‑study exams welcome anyone regardless of age or past schooling level, though full‑time students may not apply. Adult college entrance exams require a high‑school or junior‑college diploma. All three paths are slow, but none care how you performed at 18. + +- Benefit: Self‑study exams are governed by the Interim Regulations on Higher‑Education Self‑Study Examinations. Article 3 states: “Any citizen of the People’s Republic of China, irrespective of gender, age, ethnicity, race, or prior education level, may participate in higher‑education self‑study examinations as stipulated herein.” Article 20 adds that full‑time students at any school may not register. Article 25 outlines three graduation requirements: passing all courses, completing a thesis or practical assignment, and meeting moral standards. Meeting these yields a diploma; Article 32 guarantees that holders receive wages comparable to those of regular university graduates. The Higher‑Education Law, Article 21, likewise affirms the self‑study exam system. Adult college entrance exams follow the 2025 National Adult Higher‑Education Enrollment Rules, which target “employed persons and other individuals outside full‑time schooling.” Applicants for bachelor’s or associate‑degree programs must hold a high‑school diploma or equivalent; those seeking a bachelor’s upgrade must already hold an associate degree or higher. Full‑time study lasts four years for a bachelor’s and two years for associate or upgrade programs; part‑time study requires five years for a bachelor’s and two and a half years for the others. “Part‑time” again means continuing work while attending classes. Open universities operate under Ministry of Education guidance: registration is open, and students earn course certificates upon completing credits; meeting further criteria grants diplomas, non‑degree certificates, and even degrees where applicable. + +- Evidence grade: A + +- Notes: TODO (pending verification of nationwide rules for regular bachelor’s upgrades). The standard pathway for recent full‑time junior‑college graduates is outlined in annual circulars issued by the Ministry of Education’s Student Affairs Office; these documents remain unpublished and are known only through provincial notices. Eligibility is essentially limited to that year’s graduates, with additional provincial rules; therefore they are not detailed here. Starting autumn 2025, “correspondence” and “part‑time” designations for adult higher education will be replaced by “non‑full‑time.” This category includes all adult attempts to upgrade qualifications; be wary of older terminology in promotional material. Pursuing a degree is distinct from choosing a marketable skill set — see Section 23 for that discussion. “Fast‑track” diploma schemes and counterfeit certificates are addressed in Section 23, Item 8. +- Sources:国务院 (1988, 2014 修订). 高等教育自学考试暂行条例（第三、二十、二十五、三十二条）. （国家法律法规数据库）；全国人大常委会 (2018). 高等教育法（第二十一条）. （国家法律法规数据库）；教育部办公厅 (2025). 关于做好 2025 年全国成人高校招生工作的通知（教学厅〔2025〕6 号）及附件《2025 年全国成人高校招生办法》. ；教育部 (2016). 关于办好开放大学的意见（教职成〔2016〕2 号）. + +### 11. Not joining a company means you must arrange your own social insurance: you’ll need to enroll in pension and medical plans at your place of work, as household registration restrictions have now been lifted. + +- Cost: You must pay the full amount for both pension and medical insurance yourself, calculated based on the local contribution base — often over a thousand yuan per month. The contribution base is simply the benchmark figure used to determine premiums. This is the most easily overlooked recurring expense on this path, and the difficulty lies in making those payments on time every month. +- In plain terms: Not being employed by a company doesn’t mean you’re exempt from social insurance; it simply means no employer covers half of the cost. Official documents require all regions to lift household registration barriers so flexible workers can enroll in insurance at their place of work, with major metropolises gradually implementing this change. So don’t mistake “freedom” for “no need to worry about social insurance.” If you fail to pay on schedule, both your pension benefits and medical reimbursement rates will be calculated according to rules for interrupted coverage. +- Benefit: These provisions stem from the “Guiding Opinions on Protecting the Labor Rights and Interests of Workers in New Forms of Employment.” It states: “All regions must lift household registration restrictions so flexible workers can enroll in basic pension and medical insurance at their place of work; for exceptionally large cities where full implementation isn’t immediately feasible, local authorities should create conditions for gradual rollout. Employers must be urged to enroll workers in social insurance per the law. Workers who don’t qualify for standard employee pension or medical plans should be guided to enroll in urban/rural resident programs to ensure full coverage. For those operating independently via platforms, rights and obligations are governed by civil law.” (National policy, effective 2021) +- Evidence grade: A +- Notes: The wording “lift restrictions” leaves room for exceptions in very large cities — it doesn’t mean household registration rules are completely abolished nationwide. Exact implementation details depend on the specific city where you intend to enroll. The benefit is rated “high” because interrupted coverage directly impacts long-term pension and medical benefits, which far outweigh the monthly costs. Yet those costs are real too: full self-payment often exceeds a thousand yuan per month. For information on how to restore interrupted coverage and accumulate years of service, see Section 7, Article 18 (“Interrupted Social Insurance Payments”). Additionally, selling agricultural or daily goods at government-designated locations/times, or offering services that legally require no license, doesn’t necessitate a business license per State Council Document No. 27 (2020). +- Sources:人力资源社会保障部等八部门 (2021). 关于维护新就业形态劳动者劳动保障权益的指导意见（人社部发〔2021〕56 号，第二、八条）. ；国务院办公厅 (2020). 关于支持多渠道灵活就业的意见（国办发〔2020〕27 号）. + +### 12. Food delivery workers, ride‑hailing drivers, and local freight carriers all get occupational injury coverage paid for by the platform on a per‑order basis — at no cost to them. + + +- Cost: Zero out‑of‑pocket expense; the platform bears the entire premium. Your only task is to verify whether the platform you use is part of the pilot program. Two easy ways to do this: check the “Occupational Injury Coverage” section in the app’s benefits page, or call your provincial Human Resources and Social Security Bureau to ask if the platform is enrolled. +- In plain terms: Platforms must pay occupational injury insurance premiums for every order placed by delivery workers, ride‑hailing drivers, and local freight carriers — none of that cost falls on the workers themselves. This is still a pilot scheme, so before accepting any orders, confirm that both your province and your platform are included. Workers who already have a formal employment contract with a platform are covered under regular workers’ compensation, not this program. +- Benefit: The coverage is governed by the “Interim Measures for Occupational Injury Insurance for Workers in New Forms of Employment.” Article 2 states: “Platform enterprises shall enroll in occupational injury insurance for new‑form workers as required by these measures… ensuring coverage for every order and every worker who registers via the platform and receives compensation for services such as ride‑hailing, delivery, and local freight.” Article 9 specifies premium rates during the trial phase: 0.01 yuan per order for ride‑hailing, 0.07 yuan and 0.25 yuan per order for delivery, and 0.18 yuan per order for local freight. Starting July 1 2025, the pilot expanded to ten additional provinces, and by 2026 it is slated to cover all 31 provinces and the Xinjiang Production and Construction Corps. +- Evidence grade: A +- Notes: This remains a pilot program, not a nationwide mandatory system. Before taking any orders, verify that your province and platform are part of it; otherwise you’ll need to purchase private insurance on your own. The “Guiding Opinions on Protecting Labor Rights of Workers in New Forms of Employment” also mandates that platforms pay wages no lower than the local minimum, pay on time and in full, and provide fair compensation on statutory holidays. The document’s reference number is HRSSB [2021] 56; it is cited in Article 11 regarding flexible‑employment workers. In any dispute, follow these rules rather than settling privately with the platform. For medical insurance and pension contributions, flexible‑employment workers must enroll separately — see Article 11 for details. +- Sources:人力资源社会保障部等九部门 (2025). 关于扩大新就业形态人员职业伤害保障试点的通知（人社部发〔2025〕24 号）及附件《新就业形态人员职业伤害保障办法（试行）》第二、九条. + +### 13. Two pathways to secure a government job on the day you fill out college applications: government-funded teacher training and targeted medical student programs, at the cost of a six-year service commitment. + + +- Cost: Tuition and housing fees are waived, and you receive a living stipend. The trade-off is that for six years after graduation you cannot freely choose a career; breaking the contract requires you to repay all funds, pay a penalty, and accept a negative mark on your credit record. The difficulty lies in the fact that you cannot relocate during these six years. + +- In plain terms: Both programs involve the state covering your education costs upfront; in return, you must work at a designated location for six years after graduation. Government-funded teacher training is offered only at six universities directly under the Ministry of Education, with admission occurring in an early admission round. For targeted medical students, a tripartite agreement must be signed before receiving the admission letter. Violating the contract leads to repayment obligations, penalties, and a credit record impact. Carefully consider whether you can accept these six years of commitment before applying. + +- Benefit: Government-funded teacher training is governed by the “Implementation Measures for Government-Funded Education of Teacher-Training Students with Undergraduate-Graduate Continuation at Universities Directly Under the Ministry of Education” (2024), which supersedes the 2018 version. Article 2 stipulates that central government funds cover tuition, housing, and living stipends. Article 3 specifies that training targets areas below provincial capitals in central and western regions (except for five autonomous regions, border provinces, Hainan, Guizhou, and Qinghai). It also states that placement is not permitted in municipalities, special economic zones, or main urban districts of provincial capitals. Article 9 requires graduates to teach at designated primary or secondary schools within their home province for at least six years; those assigned to urban schools must spend at least one year teaching in rural areas. Article 13 mandates accountability for non-compliance, including credit record inclusion and exclusion from other civil service roles until the term ends. Article 6 allows reclassification to non-teacher majors if unsuited for teaching within one year, with repayment of benefits. Article 14 treats failure to obtain a master’s degree and teaching certification as a breach, requiring repayment and penalties. Article 21 ensures that sufficient government posts are allocated for these graduates. Targeted medical students follow a separate policy: prior to enrollment, they sign an agreement with their university and local health and human resources authorities to serve rural medical institutions for six years. After employment, they must complete three years of standardized residency training. Their breach records are similarly logged, and severe violations are publicly disclosed. Unlike teachers, medical graduates may leave after fulfilling their six-year term, as explicitly permitted by regulations. + +- Evidence grade: A + +- Notes: The 2024 policy shifted teacher training to an undergraduate-graduate continuum, rendering the older “immediate post-graduation teaching” model obsolete. Existing agreements remain valid. Securing a government post does not guarantee automatic placement; actual assignments depend on local hiring needs. Medical students must also account for three years of residency, extending their total commitment period. Individual provinces may offer additional programs with varying criteria; always consult the latest local admissions documents. +- Sources:国务院办公厅 (2024). 关于转发教育部等部门《教育部直属师范大学本研衔接师范生公费教育实施办法》的通知（国办发〔2024〕27 号，第二、三、六、九、十三、十四、二十一条）. ；国家卫生健康委、中央编办、国家发展改革委、教育部、财政部、人力资源社会保障部、国家中医药局 (2019). 关于做好农村订单定向免费培养医学生就业安置和履约管理工作的通知. + +### 14. Before going abroad to work, check whether the company has a license for international labor cooperation: it is illegal for them to demand a deposit from you. + + +- Cost: No cost at all. Spend just a few minutes beforehand verifying the company’s credentials and reading through both contracts. + +- In plain terms: When it comes to working overseas, the law regulates not the workers themselves but the companies that arrange their employment. Only businesses holding a valid license for international labor cooperation and properly registered may recruit workers for foreign jobs. Any claim such as “first obtain a tourist visa and later switch to a work visa” is a clear sign of illegal activity. Moreover, employers are strictly prohibited from charging any kind of deposit or demanding collateral from workers. + +- Benefit: Article 5 of the Regulations on International Labor Cooperation states that companies must obtain approval from provincial or municipal commerce authorities before engaging in such activities; this approval results in a specific operating license. Article 7 mandates that the list of licensed firms be submitted to national authorities and shared with Chinese embassies and consulates abroad. Article 8 explicitly bans any entity from using business trips, tourism, or study abroad programs as a guise for labor export. Within five working days of registration, firms must deposit at least 3 million RMB into a designated fund intended to cover unpaid wages, service fees, and compensation for injuries or emergencies. This fund may also be tapped to repatriate workers in crisis situations. Articles 11, 12, and 13 forbid employment in gambling or adult entertainment venues, require mandatory pre-departure training, and mandate personal accident insurance coverage while abroad. Contracts must be signed separately with both foreign employers and workers; failure to do so renders any recruitment illegal. Article 25 reiterates the ban on deposits or property pledges. All agreements must be filed with commerce authorities within ten days, and companies must assist workers in securing compensation when contractual terms are violated. Article 31 allows authorities to halt recruitment to regions deemed unsafe, while Article 37 establishes a public registry of non-compliant firms. Unlicensed operators face severe penalties, including license revocation and criminal prosecution. Those misusing tourism or study visas for labor placement also incur heavy fines. + +- Evidence grade: A + +- Notes: This entry outlines the lawful pathway for overseas employment. Legitimate procedures require the company to sign a labor cooperation agreement with a foreign employer, followed by a written service or employment contract with the worker detailing duties, pay, working hours, leave entitlements, social insurance, and safety measures. Within ten days, the firm must register these documents with authorities and provide language, safety, and cultural training. Personal accident insurance is mandatory. Red flags include refusal to show contracts, demands for deposits, or pressure to bypass proper paperwork. For information on high-paying overseas job scams and fraud hubs, see Section 21.5; safety advisories and contact details for the 12308 consular hotline are also listed there. The regulations impose no specific educational or age prerequisites on workers; eligibility hinges on both corporate licensing and host-country requirements. Contracts may only be concluded with approved foreign enterprises, never private individuals. The aforementioned financial reserve cannot be withdrawn by workers; it serves solely as a safety net for unpaid claims. Should problems arise, workers retain the right to file complaints with commerce authorities per Article 20. Projects sending more than 100 personnel to a single destination must also assign on-site supervisors and notify local embassies or consulates. Smaller groups lack such safeguards, so workers should retain all contracts and payment records as proof of their legal status. +- Sources:国务院 (2012). 对外劳务合作管理条例（国务院令第 620 号，第五、七、八、九、十、十一、十二、十三、二十一、二十三、二十五、二十六、二十九、三十一、三十七、三十九、四十、四十三条）. + +### 15. Working remotely for a foreign company from home: this income is considered domestic earnings for tax purposes; you must file your own individual income tax returns, and incoming payments should be reported as “employee compensation”. + + +- Cost: There are no direct expenses. You must file an annual tax reconciliation between March 1 and June 30 of the following year. If your annual inflow exceeds the permitted limit, you’ll also need to provide an employment contract and proof of earnings. The main difficulty lies in remembering to file this tax yourself. + +- In plain terms: Whether this income counts as domestic or foreign depends on where the work is actually performed, not where the money originates. If you’re working remotely for a foreign firm while residing in China, it’s classified as domestic earnings, and you must pay individual income tax here. Since the foreign company has no local presence, no one withholds taxes on your behalf — so you’re responsible for filing them yourself. Payments should be reported under the “employee compensation” category. + +- Benefit: Whether this income qualifies as domestic earnings is determined by Article 3 of the Implementing Regulations of the Individual Income Tax Law (Decree No. 707 issued by the State Council, effective January 1, 2019). It states: “Unless otherwise stipulated by financial or tax authorities under the State Council, the following types of earnings are regarded as originating in China, regardless of where payment is made: (1) earnings derived from providing services within China through employment, engagement, or contractual obligations.” Article 6 of the same regulations defines two relevant tax categories. Wages and salaries are defined as “any compensation, bonuses, year-end incentives, labor dividends, allowances, subsidies, and other earnings related to employment or engagement.” Meanwhile, “labor remuneration” refers to “any income earned through personal services such as design, decoration, installation, drafting, testing, medical work, legal services, accounting, consulting, teaching, translation, editing, calligraphy, sculpture, film production, recording, performance, advertising, exhibitions, technical assistance, brokerage, agency work, and similar activities.” According to Article 6 of the Individual Income Tax Law, the taxable base for residents is calculated by subtracting 60,000 RMB, mandatory deductions, additional allowances, and other legally permitted deductions from total annual earnings. However, for labor remuneration specifically, only 80% of the gross amount is considered taxable — wages and salaries are taxed at 100% of their full value. Article 9 clarifies that taxpayers are responsible for paying income tax, while employers or payers serve as withholding agents. Article 10 specifies that taxpayers must file returns under several circumstances, including when no withholding agent exists or when foreign earnings are received. Annual reconciliation must be completed between March 1 and June 30 of the following year. Regarding currency inflows, Article 9 of the Administrative Measures on Personal Foreign Exchange (issued by the People’s Bank of China, Decree No. 3, effective February 1, 2006) establishes an annual cap of USD 50,000 per individual for non-commercial foreign exchange transactions. Within this limit, individuals may exchange currency using only valid identification; exceeding it requires additional documentation such as employment contracts and proof of income. Article 7 further prohibits banks and individuals from circumventing these limits through split transactions or falsified documents. The detailed implementation rules (Document No. 1 issued in 2007) reiterate this annual cap and specify that employee compensation must be supported by a valid contract and income verification. + +- Evidence grade: A + +- Notes: Which tax category applies depends on your relationship with the foreign employer. If you’ve signed an employment contract and follow their instructions, your earnings are classified as wages and salaries. If you’re contracted independently and deliver results on a project basis, they’re treated as labor remuneration. These two categories are taxed differently, so it’s essential to determine which applies before filing. For incoming payments under USD 50,000 per year, you can exchange currency simply by presenting your ID. Any amount exceeding this threshold requires submission of your employment contract and income proof to the bank. Avoid attempting to split payments artificially to bypass these limits. This guidance applies strictly to individuals working from within China without physically relocating abroad. Those who actually move overseas to work for foreign firms must follow different regulations, as outlined in Section 14 of this chapter (check first whether the employer holds proper licensing for overseas labor deployment). Four related topics are not addressed in this book due to lack of verifiable evidence: whether VAT applies or if invoices must be issued; whether long-term remote workers should obtain a business license or register as self-employed; whether labor laws permit claims for vacation time, overtime pay, or severance from foreign employers; and issues concerning cross-border data transfer and confidentiality. A total of 2006 RMB is the maximum annual limit for personal foreign exchange transactions under these rules. +- Sources:国务院 (2018). 中华人民共和国个人所得税法实施条例（国务院令第 707 号，第三、六条）. ；全国人民代表大会常务委员会 (2018). 中华人民共和国个人所得税法（2018 年第七次修正，第六、九、十、十一条）. ；国家税务总局政策法规库. 中华人民共和国个人所得税法（第六条）. ；中国人民银行 (2006). 个人外汇管理办法（中国人民银行令〔2006〕第 3 号，第七、九条）. ；国家外汇管理局 (2007). 个人外汇管理办法实施细则（汇发〔2007〕1 号，第二、十条）. + +### 16. Starting a business without joining a company? First look at startup guarantee loans: up to 300,000 RMB per individual, with the government covering half the interest + + +- Cost: There’s no fee for consulting. You’ll need to visit the local civil affairs bureau once for eligibility screening, then visit both the guarantee agency and the lending bank once each. The lending bank is the same institution that provides the loan. The main challenge is that borrowed money must ultimately be repaid. + +- In plain terms: If you absolutely must borrow money to get started, this government‑backed loan is a good option. Each applicant can receive up to 300,000 RMB for a maximum term of three years, with the state paying half of the interest. One often‑overlooked requirement is that at the time of application neither you nor your spouse may have any other outstanding loans — except student loans, micro‑credit for poverty‑alleviation recipients, mortgage or auto loans, and consumer loans under 50,000 RMB. + +- Benefit: The eligibility criteria for individuals are outlined in Article 6 of the “Administrative Measures for Special Funds for Inclusive Financial Development” (Caizheng Jinrong [2023] No. 75). The first condition is that the applicant belongs to a priority employment group. These groups include registered urban unemployed persons, people facing employment difficulties (including persons with disabilities), veterans, ex‑convicts, college graduates (including village officials and returnees from overseas study), workers laid off from industries undergoing overcapacity reduction, as well as migrant workers returning to start businesses, online entrepreneurs, poverty‑alleviation recipients, and rural self‑employed farmers. The second condition is the absence of other loans: “Apart from student loans, micro‑credit for poverty‑alleviation recipients, mortgage loans, auto loans, and consumer loans under 50,000 RMB (including credit‑card balances), the applicant and his/her spouse must have no other outstanding loans at the time of application.” Article 9 states that for qualifying loans the government subsidizes 50 % of the actual interest rate; this subsidy is not granted for loans that are extended or fall into default. Article 10 removes the requirement for collateral when the loan amount is 100,000 RMB or less, meaning no additional guarantor or property pledge is needed. Article 11 limits the maximum loan size to 300,000 RMB for individuals, extendable to 110 % of that total for partnerships. The permissible interest ceiling varies by region: LPR + 50 basis points in eastern areas, LPR + 150 basis points in central and western regions, and LPR + 250 basis points in poverty‑stricken areas. LPR is the benchmark lending rate published by banks, while one basis point equals 0.01 % of the rate. Applicants who repay diligently, generate many jobs, and run promising projects may apply up to three times. Finally, Article 12 permits provincial governments to broaden eligibility, raise loan limits, and increase the subsidy rate as needed. + +- Evidence grade: A + +- Notes: Even though the government covers half of the interest, the loan must still be repaid. Our book’s stance in Section 12, Item 1 remains unchanged: only risk‑acceptable capital should be used for entrepreneurship; do not tap personal savings or sign personal guarantees for corporate loans, and your spouse should avoid doing so as well. This provision simply indicates that, if you decide to borrow, this government loan offers the lowest possible interest rate — avoid consumer loans and informal lenders. Exact limits and eligibility may differ by province; always check the latest rules issued by your local civil affairs bureau. The temporary 2020 directive allowing up to 200,000 RMB per applicant has been superseded by the current measures. For details on registering a sole proprietorship or corporation, obtaining permits, tax filing, and winding down a business, refer to Section 12. Information on training subsidies, social‑insurance assistance, and internship programs for the unemployed can be found in Section 7, Item 13 (Vocational Training Subsidies). +- Sources:财政部 (2023). 关于印发《普惠金融发展专项资金管理办法》的通知（财金〔2023〕75 号，第六、八、九、十、十一、十二条）. diff --git a/book/32-Studying-Abroad.md b/book/32-Studying-Abroad.md new file mode 100644 index 00000000..6039d01d --- /dev/null +++ b/book/32-Studying-Abroad.md @@ -0,0 +1,102 @@ +# 32. Studying abroad: visa status, work limits, insurance, and degree recognition + +This section looks at both the financial costs and personal freedom involved. It does not debate whether studying abroad is a good idea, nor does it compare schools. Instead, it outlines four key points you must know to avoid problems: how to keep your visa status valid, what the legal limits are on working hours, which insurance policies and fees you absolutely need, and whether your degree will be recognized after returning home. + +The information covers four countries — the United States, Canada, the United Kingdom, and Australia — with separate figures provided for each. All data comes from official government websites, including each country’s immigration authority and China’s Ministry of Education. **Study‑abroad rules change frequently in these countries, often even more often than regulations in China. All figures listed here are current as of September 2026. Before you travel and each time you renew your visa, be sure to double‑check the latest details using the links provided.** + +If you run into trouble while abroad — such as needing help from an embassy, understanding what services 12308 offers, or choosing suitable medical and repatriation insurance — please refer to Section 21. For a comparison between studying and working, see Section 23. Information on account theft is in Section 14, while Section 8 covers telecom fraud. These topics are not repeated here. +### 1. Check whether the school is on the China Scholarship Council’s list of accredited institutions before paying tuition + + +- Cost: No cost at all. Simply enter the school’s name into the “Accredited Institution Search” tool on the China Scholarship Council website; the check takes just a few minutes. +- In plain terms: After returning to China, if you intend to use your degree to apply for civil service jobs, join state-owned enterprises, obtain residency status, or qualify for professional certifications, it must first be officially recognized. This recognition process is handled by the China Scholarship Council. If the school does not appear on the accredited list, both tuition fees and time invested will be wasted, as the degree holds no validity in China. Performing this check is completely free; do it first before paying any tuition. +- Benefit: The China Scholarship Council provides a dedicated search portal for accredited institutions. Users can filter results by country or search directly by school name to verify whether a particular institution’s degrees are recognized. Additionally, the Ministry of Education’s Overseas Education Supervision Information Network publishes regulatory details regarding Sino-foreign cooperative education programs and overseas institutions. +- Evidence grade: A +- Notes: Always rely on your own online verification; third-party agents claiming “Ministry of Education approval” lack legal weight. The accredited list is subject to periodic updates; inclusion at the time of enrollment does not guarantee continued eligibility at graduation. It is advisable to recheck annually. Sino-foreign cooperative programs follow separate accreditation procedures. Individuals who enrolled after 2008 may retrieve their registration numbers via the Overseas Education Supervision Information Network using their full name and ID number. +- Sources:中国（教育部）留学服务中心. 认证院校查询. ；教育部教育涉外监管信息网. + +### 2. Legal battle over new U.S. F-1 rules: “Stay until graduation” remains the rule for now + +- Cost: No cost at all. Simply copy the program end date from your I-20 into your calendar and set a reminder 90 days in advance. The I-20 is the official document issued by your school confirming your eligibility to study in the U.S. Also, check updates from your school’s international student office each semester to see if there are any new developments in this case. +- In plain terms: The U.S. originally planned to change F-1 rules so that students could stay for a maximum of four years, with only 30 days allowed to leave after finishing their studies. However, just one day before those rules were set to take effect, a federal court issued a stay. As a result, the old rule still applies: students may remain in the country for the full length of their program, with a 60-day grace period after graduation to depart. This stay does not mean the rules have been repealed; the government can still appeal, so the regulations might change again at any time. +- Benefit: On July 17, 2026, the Department of Homeland Security announced a new rule scheduled to become effective on September 15, 2026. Under this proposal, F-1 students would no longer be allowed to stay “until graduation”; instead, they would be limited to a fixed maximum stay of four years, after which they would need to apply for an extension. Following completion of their studies or internship, they would have only 30 days to leave the country. On September 14, 2026, Judge Saylor of the U.S. District Court for the District of Massachusetts, citing Section 705 of the Administrative Procedure Act, issued a stay on the implementation of this rule nationwide. The court did not overturn the rule; the request to do so was denied, though the government retains the right to appeal later. The case remains ongoing. Thanks to this court order, holders of F, J, and I visas continue to be allowed to stay “until graduation,” with the same 60-day post-graduation departure window and no need to apply for an extension. +- Evidence grade: A +- Notes: This information is current as of September 25, 2026. The government may appeal to the First Circuit Court of Appeals, and DHS could revise and reissue the rules. Therefore, students planning to study for multiple years should not assume that the current rules will remain unchanged indefinitely. The next court hearing to review progress in the case is scheduled for October 2, 2026; after that date, it’s advisable to check your school’s international student office for any updates. Should these new rules eventually take effect, any extension request must be submitted before the expiration date; there will be no automatic renewal. Under the current rules, the departure deadline for students who decide to leave early differs from that for those who complete their program; in such cases, consult your school’s international student office for guidance. The same rule proposal also applies to J visas, though specific provisions differ from those for F-1 students; check details based on your own visa category. +- Sources:DHS (2026). Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors（2026-07-17 公布，原定 2026-09-15 生效）. ；Presidents' Alliance on Higher Education and Immigration v. U.S. Department of Homeland Security, No. 1:26-cv-13799-FDS (D. Mass. Sept. 14, 2026)，法院案卷. ；Yale Office of International Students & Scholars (2026-09-14). Important Update: Court Action on the D/S Rule. ；AILA (2026). One Day Before Taking Effect, Federal Court Postpones the F, J, and I Fixed Admission Period Rule. ；8 CFR 214.2(f). + +### 3. The maximum allowed work hours are strict limits in the U.S., Canada, UK, and Australia — exceeding them violates visa terms. + +- Cost: There’s no cost involved. You simply need to track your weekly hours yourself. The difficulty lies in employers often claiming “no one checks extra hours,” but you must never believe this. +- In plain terms: All four countries set clear caps on how many hours international students may work. Going over these limits breaches visa conditions, potentially leading to visa revocation, deportation, or extra scrutiny during future applications. The limits are: 20 hours per week in the U.S., 20 hours weekly for degree students and 10 hours for non-degree students in the UK, 24 hours per week in Canada, and 48 hours every two weeks in Australia. Hours worked at multiple jobs must be combined. +- Benefit: F-1 students in the U.S. may work up to 20 hours per week on campus during term time, with the same 20-hour weekly cap applying to approved off-campus jobs; full-time work is allowed during holidays. This is stipulated under 8 CFR 214.2(f)(9) of U.S. federal immigration regulations. UK students pursuing degree-level courses may work 20 hours weekly during term time, while those on non-degree programs are limited to 10 hours per week; no work is permitted for part-time students at all. Self-employment is also prohibited, meaning you cannot work for yourself, nor may you serve as a professional athlete or performer. These rules are outlined in the UK immigration rules for students, specifically Student ST26.1 and ST26.5. Eligible full-time students in Canada may work up to 24 hours per week off campus, per Article 186(v) of the Immigration and Refugee Protection Regulations (IRPR). For Australian student visas, the limit is 48 hours every two weeks while classes are in session; this restriction does not apply to research-based master’s or PhD students, nor their dependents. +- Evidence grade: A +- Notes: In the U.S., any off-campus work must first receive official approval; you cannot begin working while your I-765 work permit application is still pending. Older Canadian work permits may list a 20-hour weekly cap, but if you still meet all eligibility criteria, current regulations permit up to 24 hours per week. The UK’s self-employment ban is broadly interpreted: taking private contracts, running an online store, or working as a freelancer all count as prohibited self-employment. +- Sources:8 CFR 214.2(f)(9). ；UK Home Office. Immigration Rules Appendix Student（ST26.1、ST26.5）. ；IRCC. Work off campus as an international student. ；Australian Government Department of Home Affairs. Student visa (subclass 500). + +### 4. The core requirement for eligibility is “full-time enrollment”: any gap due to suspension, withdrawal, or transfer disqualifies you from working. + +- Cost: No cost involved. Before suspending, withdrawing, or transferring schools, contact your school’s international student office to confirm your current status. +- In plain terms: Whether you can work depends on whether you are currently enrolled full-time. Once you are suspended, withdrawn, expelled, or not attending classes during a transfer, your right to work ends immediately. Continuing to work in such cases constitutes illegal employment. Many assume that as long as their visa remains valid, they are still eligible, but in reality their status has already been revoked. +- Benefit: Canadian regulations explicitly prohibit off-campus work during approved suspension periods, as well as for students who are not actively enrolled during a transfer. Work privileges can only be reinstated after resuming full-time studies. In the U.S., off-campus work eligibility is granted only to F-1 students whose SEVIS record shows an “Active” status — this system tracks valid enrollment for international students, and such students must also maintain full-time coursework. In the UK, work permits are issued based on course type; students on part-time programs are not permitted to work. +- Evidence grade: A +- Notes: If you are feeling overwhelmed by coursework and considering reducing your course load, first verify exactly how many credits constitute full-time enrollment — falling below that threshold will disqualify you from work eligibility, often even before any work permit issues arise. Students who are expelled or whose programs are terminated typically lose their eligibility status on the same day; do not wait for an official notice from the school before taking action. +- Sources:IRCC. Work off campus as an international student. ；U.S. Department of Homeland Security, Study in the States. Working in the United States. ；UK Home Office. Immigration Rules Appendix Student（ST26.1）. + +### 5. United States: You must report your new address within 10 days of moving + +- Cost: No cost at all. Submitting the address change online takes just ten minutes. +- In plain terms: If you move within the United States, the law requires you to inform USCIS within ten days. Failing to do so is no minor issue. First, it is illegal; second, any mail sent to you by USCIS could easily be lost. +- Benefit: Under 8 CFR 265.1, foreign nationals required by law to register must report any change of address to USCIS within ten days of moving. Reporting via the official USCIS channels lets you both confirm the address change and provide your new address. +- Evidence grade: A +- Notes: Reporting to USCIS is separate from updating your school records. You must also update your SEVIS record through your educational institution, which maintains your student visa status. The other three countries also mandate reporting address changes to immigration authorities or schools, though both the deadlines and procedures differ by country. Always follow the instructions posted on your local immigration authority’s website. +- Sources:8 CFR 265.1. ；USCIS. AR-11, Alien's Change of Address Card. + +### 6. Before you go and while studying abroad, check the Ministry of Education’s study‑abroad warnings + +- Cost: Nothing to pay. Check it once before departure and then once each semester. +- In plain terms: The Ministry of Education issues specific warnings for certain countries or regions when recent safety conditions or policies there appear unfavorable to Chinese students. These are official, publicly posted risk notices that you can verify in writing — far more reliable than what any agency might tell you. Checking them costs nothing. +- Benefit: The Ministry posts study‑abroad warnings on its Overseas Education Supervision website. In 2025, four such warnings were issued. Warning No. 1 warned that certain higher‑education bills in some U.S. states contained provisions hostile toward China (April 9, 2025). Warnings No. 2 and No. 3 both highlighted the high incidence of cases involving Chinese citizens in the Philippines and an overall poor study‑abroad environment there (July 18, 2025 and August 30, 2025). Warning No. 4 noted deteriorating safety and study conditions in Japan, advising prospective students to plan carefully before going (November 16, 2025). +- Evidence grade: A +- Notes: These warnings are not outright bans; they simply provide an official basis for evaluating risk. They are updated as circumstances change, so this section is not kept current — always refer to the latest page on the website. For information on personal safety and consular assistance abroad, see Section 21. +- Sources:教育部教育涉外监管信息网. 预警信息. ；教育部发布 2025 年第 4 号留学预警. ；第 1 号. + +### 7. Australia: OSHC must cover the entire stay without any gaps; lack of proof may lead to denied entry + +- Cost: Several thousand to tens of thousands of RMB. Purchase it once based on the length of your visa; if you’re studying for several years, buy coverage for that entire period. +- In plain terms: Australia makes overseas student health insurance (OSHC) a mandatory visa requirement — it’s not optional. The policy must cover your entire stay in the country. When renewing or switching policies, there must be no lapse in coverage. If you cannot produce proof of insurance upon arrival, you may be denied entry on the spot. Family members accompanying you as dependents must each purchase their own policy. +- Benefit: According to Australian Department of Home Affairs regulations, student visa applicants and their dependents must obtain OSHC, which must remain in effect throughout their entire stay in Australia without any interruptions. The policy must be issued by an insurer approved by Australian authorities, except for applicants who qualify for exemptions. There must be no gap between the end date of one policy and the start date of a new one. Failure to provide proof of active coverage upon entry can result in denial of entry. For travelers arriving in Australia prior to their course start date, the policy start date must be set to the actual date of arrival. +- Evidence grade: A +- Notes: If your school arranges the insurance for you, be sure to confirm the insurer’s name, the policy’s start and end dates, and the policy number — these details must be included in your visa application. Purchasing coverage for a shorter period than needed can cause issues when you apply to renew your visa; it’s better to buy coverage that extends well beyond your graduation date. +- Sources:Australian Government Department of Home Affairs. Student visa (subclass 500). + +### 8. UK: Besides the visa fee, there is an annual healthcare surcharge — £776 per year for students, paid in full at application time + +- Cost: The visa fee is £558. There is also a healthcare surcharge of £776 per year, both of which must be paid in full at the time of application. +- In plain terms: The amount you pay to go to the UK isn’t limited to just the visa fee. You also have to prepay the healthcare surcharge based on the length of your visa, which is required to access the UK’s National Health Service. For a two‑year visa, that means paying £1,552 upfront. Add this to the visa fee, and you’ll need to budget for this total amount before you travel. +- Benefit: The fee for a UK student visa is £558, regardless of whether you apply from outside the UK or extend/change your visa status while already there. In addition, the healthcare surcharge must be paid to use the National Health Service; it is calculated per year of your visa and paid in full at application. For students and their dependents, the charge is £776 per year — so a two‑year visa requires a payment of £1,552. Other applicant categories pay £1,035 per year. If your visa lasts more than six months but less than a full year, the charge is still applied for a full year. +- Evidence grade: A +- Notes: Both the fee amounts and exchange rates may change; always refer to the two pages listed under Sources for the most current figures. Generally, students aged 18 or older enrolled in degree programmes can stay for up to five years, while those on non‑degree courses are limited to two years. Use these timeframes to estimate the total healthcare surcharge you’ll need to pay. +- Sources:UK Government. Student visa. ；UK Government. Pay for UK healthcare as part of your immigration application. + +### 9. Allow time for certification before returning to China: CSCSE certification takes 10–20 working days + +- Cost: The application and payment are both done online. Preparing documents and waiting for review also take about a month when counted in working days. +- In plain terms: If you plan to use your overseas degree in China, you must first get it certified. The review alone requires 10–20 working days. During peak hiring seasons or if documents are returned for corrections, the process may take even longer. Since many deadlines—such as those for campus recruitment, civil service exams, and household registration—are fixed, it’s wise not to delay this step until the last minute. +- Benefit: Certification of overseas degrees in China is handled via the online portal of the China Scholarship Council Education Service Center. The procedure involves four steps: registration and identity verification, online submission of documents, payment, and finally evaluation and review. The officially stated processing time is 10–20 working days, which excludes weekends and holidays and represents the duration needed for the Center’s review. +- Evidence grade: A +- Notes: Required documents include your diploma, passport or travel permit, residence permit or visa stamp, a photo, and an authorization statement. Entry and exit records during your stay abroad are retrieved automatically by the system, so be sure to keep those visa pages intact. The Center also posts announcements regarding revoked certificates or temporary suspensions of applications from certain institutions; it’s advisable to check whether your school is affected before applying. +- Sources:中国（教育部）留学服务中心. 网上服务大厅·学历学位认证. + +### 10. The number of schools under “enhanced scrutiny” for certification keeps rising; paying to buy a degree is no longer an option + + +- Cost: No cost at all. Before enrolling, simply search the school’s name in the announcements posted by the China Scholarship Council (CSC). + +- In plain terms: The CSC regularly publishes lists of foreign institutions subject to enhanced scrutiny for degree certification, and at times it temporarily halts certification applications for certain schools. These are precisely the schools advertised as offering “no language requirements, no need to leave the country, and a master’s degree in just a few months.” Searching for a school’s name beforehand saves you from having to file appeals later on. + +- Benefit: The China Scholarship Council consistently issues notices about tightening certification checks for degrees awarded by specific foreign institutions — essentially adding an extra layer of verification for their diplomas. The most recent notice is No. 9, dated October 28, 2025. The CSC has also announced temporary suspensions of certification applications for certain overseas schools and issued warnings about fraudsters exploiting the degree certification process to defraud applicants. + +- Evidence grade: A + +- Notes: “Enhanced scrutiny” does not automatically mean a degree cannot be certified, but it does require submission of additional documentation and takes considerably longer. Any agency promising “guaranteed certification” or “expedited processing via internal channels” is running a scam; the CSC has issued explicit anti-fraud advisories on this matter. Engaging overseas services to write papers or attend classes on your behalf risks not only degree revocation but also negative consequences for your visa status if discovered. +- Sources:中国（教育部）留学服务中心. 关于对部分国外院校学历学位认证加强认证审查的公告（九）（2025-10-28）. ；中国（教育部）留学服务中心. diff --git a/book/33-Living-With-Disability.md b/book/33-Living-With-Disability.md new file mode 100644 index 00000000..fa57a556 --- /dev/null +++ b/book/33-Living-With-Disability.md @@ -0,0 +1,211 @@ +# 33. How to live after becoming disabled + +This section covers life after a disability has already occurred. Preventing disability is discussed in Sections 1 and 13, so we won’t repeat that here. + +We calculate four different categories separately, without converting between them. Mortality rates apply to entries about emergencies and complications. Financial amounts apply to entries about subsidies, benefits, and legal claims. Time requirements apply to entries about education and administrative procedures. Restrictions on personal freedom apply to entries about psychiatric hospitalization, decision‑making capacity, and guardianship. + +According to a World Health Organization report, roughly 1.3 billion people worldwide experience significant functional limitations — that’s 16% of the global population, or one in every six individuals. On average, people with disabilities die up to 20 years earlier than those without disabilities. They also face twice the risk of depression, asthma, diabetes, stroke, obesity, and poor oral health. Much of this disparity stems not from the disability itself, but from limited access to healthcare, education, employment, and mobility. Hence, half of the entries here address physical health, while the other half cover procedures and rights. + +Five topics already covered elsewhere are only referenced here without repetition. Instructions for obtaining a disability certificate and how the seven categories and four levels are determined appear in Section 24, Item 11 (Disability Certificate). Timing for disability assessments is explained in Section 24, Item 10 (Disability Assessment). Details on claiming the two main disability subsidies are in Section 7, Item 8 (Two Subsidies). Converting work‑capacity evaluations and disability levels into monetary compensation for workplace injuries is described in Section 19, Item 15 (Work‑Capacity Assessment). Finally, eligibility for long‑term care insurance for severely disabled individuals is outlined in Section 17, Item +### 1. Sudden severe headache and sweating after spinal cord injury: first sit the person upright, loosen tight clothing, and call 120 + +- Cost: No cost at all. Just three simple actions that take only a few dozen seconds to perform. +- In plain terms: In people with spinal cord injuries, the body’s warning signals get disrupted. Even if the bladder is full or clothing is too tight with no obvious discomfort felt, blood pressure can spike dramatically. The main warning signs are sudden severe headache and excessive sweating. In such cases, the first steps are to help the person sit upright, loosen any tight clothing, check if the bladder is full, and call emergency services right away. +- Benefit: This type of episode is known as autonomic dysreflexia. A systematic review examined four major medical databases — Medline, CINAHL, EMBASE, and PsycINFO — and included 31 studies, 6 of which were randomized controlled trials. The review confirms that the recommended non-drug treatment consists of three steps: positioning the patient upright, loosening tight clothing, and removing any triggering factors. These steps are supported by clinical consensus and physiological evidence, and are classified as Level 5 evidence. Antihypertensive medications are only used when blood pressure remains elevated; prazosin has Level 1 evidence, while nifedipine and prostaglandin E2 have Level 2 evidence. Preventive measures mainly target common triggers such as urinary retention and surgical procedures, though most such strategies are backed by Level 4 or 5 evidence. +- Evidence grade: B +- Notes: This grade is assigned because there are no randomized controlled trials directly supporting those three on-site actions — only clinical consensus and physiological reasoning. The review itself notes that most of these interventions are supported by non-controlled studies. Medication use is strictly a medical professional’s responsibility; laypeople should never administer antihypertensive drugs at home. Lying down can further raise blood pressure, so sitting upright is essential. Family members and caregivers must also learn these three steps. This condition must never be mistaken for ordinary headaches. +- Sources:Krassioukov A, Warburton DE, Teasell R, Eng JJ; Spinal Cord Injury Rehabilitation Evidence Research Team (2009). A systematic review of the management of autonomic dysreflexia after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(4):682-695. + +### 2. The first decade after becoming disabled is a high-risk period for suicide; this shouldn’t be dismissed as “just a matter of staying positive.” + +- Cost: No cost at all. It only requires a phone call or a single appointment booking. +- In plain terms: In the first few years after becoming disabled, it’s very common for both the disabled individual and their family members to experience severe emotional distress — this is not a sign of weak willpower at all. Long-term follow-up studies conducted at two spinal cord injury centers in the UK found that the suicide rate among this group is five times higher than that of the general population. Over 90% of all suicides among these individuals occur within the first decade after their injury. For people whose injury was directly caused by a prior suicide attempt, this risk is even higher. +- Benefit: This study tracked 2,304 patients with traumatic spinal cord injuries who were newly admitted between 1991 and 2010, survived the first year after injury, and had residual neurological impairments at discharge, with follow-up lasting until the end of 2014. Among them, 63 patients (2.7%) had suffered their injury as a direct result of a prior suicide attempt. By the end of the follow-up period, 533 patients had died, of which 4.2% died by suicide; 91% of all suicides occurred within the first ten years after injury. The age-standardized suicide mortality rate was 62.5 cases per 100,000 people per year (95% CI 36.4–88.6), which is five times the average suicide rate of 12.2 cases per 100,000 people in England and Wales in 2014. Compared to patients with other causes of injury, those whose injury was triggered by a prior suicide attempt had a 4.32-fold higher risk of death overall (P<0.001), and a 9.46-fold higher risk of suicide specifically (P<0.001). +- Evidence grade: A +- Notes: This research was limited to spinal cord injury patients only, so the findings should be extrapolated with caution to other causes of disability such as blindness, amputation, or burns. Its main takeaway is the time window of heightened risk: this elevated risk does not fade away immediately after discharge, and requires close monitoring for a full decade. For support services, please refer to Section 29, Item 11 (12356). To prevent accidental harm, avoid storing sleeping pills or pesticides at home; see Section 1, Item 25 (thoughts of suicide). If feelings of grief and emotional distress persist for more than six months, seek help from a psychiatrist or clinical psychologist; see Section 29, Item 8 (grief lasting over half a year). +- Sources:Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S (2018). Suicide and traumatic spinal cord injury - a cohort study. Spinal Cord, 56(1):2-6. + +### 3. Hospitalization for mental disorders is voluntary; only two exceptions allow admission without consent + + +- Cost: No cost involved. Memorize these two exceptions so you can cite them when needed. +- In plain terms: Family members or employers cannot force someone to stay in a psychiatric hospital indefinitely. The law permits admission without consent only in two specific cases: when the person has already harmed or is at risk of harming themselves, or when they have already harmed or are at risk of harming others. In the first case, hospital admission still requires guardian approval; otherwise it is not allowed. If someone disputes the diagnosis, they may request a second evaluation within three days, and later can hire an independent medical expert for a formal assessment. +- Benefit: Article 30 of the Mental Health Law states that “hospitalization for mental disorders shall be voluntary.” Admission is mandatory only when diagnostic findings and clinical assessments confirm that the individual has a serious mental disorder and meets one of two criteria: (1) they have already attempted or are at risk of attempting self-harm, or (2) they have already harmed or are at risk of harming others. Article 31 adds that in the first scenario, admission requires guardian consent; otherwise it is prohibited. Article 32 permits anyone who disputes the diagnosis to request a second evaluation within three days, conducted by psychiatrists other than those who made the original diagnosis; further disagreement may be addressed by hiring a legally licensed medical expert. Article 35 stipulates that if subsequent evaluations show the person does not meet criteria for serious mental disorder or does not require hospitalization, admission must be halted. Article 78 also holds liable anyone who knowingly admits a non‑patient to a psychiatric facility; this law took effect on 1 May 2013 and was amended in 2018. +- Evidence grade: A +- Notes: It is essential to clarify both sides of this rule; otherwise it could be misread as “no one can ever be admitted.” Article 28 mandates that close relatives, employers, or local police must intervene immediately if a suspected patient shows signs of self‑harm or harm to others, and must arrange for a medical evaluation; hospitals must comply with such requests. Thus, “being evaluated” and “being hospitalized” are separate steps, each with its own threshold. Article 75 outlines penalties for hospitals that improperly restrain patients or misdiagnose healthy individuals; violators may face sanctions up to revocation of their license. Guidance on handling situations where someone exhibits violent tendencies can be found in Section 8. +- Sources:中华人民共和国精神卫生法（2018 年修正，第三十条、第三十一条、第三十二条、第三十五条、第七十八条）. + +### 4. For caregivers of disabled family members at home, it’s vital to watch your own health + +- Cost: There’s no cost involved. Simply share some of the caregiving duties and use that time to get a medical checkup. +- In plain terms: It’s not exaggeration when caregivers feel completely exhausted. One U.S. study followed over 800 older adults for four years. Those caring for a disabled spouse while also reporting high levels of mental strain had a mortality risk roughly 63% higher than people who weren’t caregivers. No such increase appeared among caregivers who didn’t report feeling stressed. So the real issue isn’t caregiving itself, but the long-term strain it causes. +- Benefit: This prospective cohort study ran from 1993 to 1998, with an average follow-up period of 4.5 years across four U.S. communities. It included 392 caregivers and 427 non-caregivers aged 66–96 who all lived with their spouses. Over four years, 103 participants (12.6%) passed away. After adjusting for socioeconomic factors, pre-existing conditions, and subclinical cardiovascular disease, caregivers reporting mental or emotional stress had a 63% higher mortality risk compared to non-caregivers (RR 1.63, 95% CI 1.00–2.65). No significant increase in mortality was seen among caregivers without reported stress (RR 1.08, 95% CI 0.61–1.90) or among spouses who were disabled but not cared for by their partners (RR 1.37, 95% CI 0.73–2.58). +- Evidence grade: A +- Notes: Caution: The lower bound of the confidence interval here is exactly 1.00, meaning there remains a small chance that no actual difference exists. This study focused on older U.S. adults living with disabled spouses, so its findings may not fully apply to caregivers of younger disabled family members. Still, it clearly shows that those experiencing high stress face greater risk. Whenever possible, share caregiving duties with others; contact local disability associations and civil affairs bureaus for respite care or day programs. Caregivers should also keep taking any prescribed medications — see Section 16, Item 1. The main beneficiary of all this advice is you. +- Sources:Schulz R, Beach SR (1999). Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA, 282(23):2215-2219. + +### 5. For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily + +- Cost: A pressure‑relieving cushion costs several hundred to over a thousand yuan. The daily check takes just one minute. +- In plain terms: Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice. +- Benefit: This randomized clinical trial took place in 12 nursing homes between 2004 and 2008, enrolling 232 residents aged 65 or older who used a wheelchair for at least 6 hours daily and had a Braden score ≤18. All participants received a properly fitted wheelchair and were then randomly assigned to two groups: one used skin‑protective cushions (air, viscoelastic fluid plus foam, or gel plus foam), while the other used segmented foam cushions 7.6 cm thick. Follow‑up lasted 6 months or until a pressure ulcer developed. For pressure ulcers at the ischial tuberosity, the segmented foam group had 8 cases (6.7%) versus 1 case (0.9%) in the skin‑protective group (P = 0.04). When both ischial and sacrococcygeal ulcers were counted, the segmented foam group had 21 cases (17.6%) and the skin‑protective group 12 cases (10.6%); this difference was not statistically significant (P = 0.14). +- Evidence grade: B +- Notes: Two factors justify a B rating. First, the sample size was only 232 participants; the P‑value for the primary outcome (0.04) barely crossed the threshold, while secondary outcomes showed no difference. Second, the participants were elderly nursing‑home residents; results may not apply to younger wheelchair users. Since all subjects received a properly fitted wheelchair, both “proper fit” and “cushion type” contributed to outcomes; therefore, merely swapping the cushion is insufficient. For pressure‑ulcer prevention in bedridden individuals, air mattresses and regular repositioning are discussed in Section 17, Item 8 (Pressure ulcers). Information on applying for subsidies for basic assistive devices can be found in Section 7 of this chapter (contact the county disability‑services office). +- Sources:Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. + +### 6. Don’t buy therapies or devices that claim to cure paralysis, blindness, or deafness + +- Cost: There’s no direct cost, but it saves you money. The hard part is that family members, full of hope, can’t be dissuaded from buying them. +- In plain terms: Advertising laws leave no room for ambiguity. Ads for medical services, drugs, and medical devices are prohibited from making any claims about effectiveness, cure rates, or success rates, and they can’t feature real patients sharing their experiences. Phrases like “stand up after three treatment cycles” or “so many people have recovered” are illegal on their own, so there’s no need to even examine the underlying theory. Even products that aren’t classified as medical devices aren’t allowed to mention any disease treatment benefits at all. +- Benefit: Article 16 of the Advertising Law states that ads for medical services, drugs, and medical devices must not contain any of the following: (1) assertions or guarantees regarding efficacy or safety; (2) information about cure rates or effectiveness; (3) comparisons of efficacy, safety, or performance with other drugs or medical devices, or with other medical institutions; (4) use of endorsers or testimonials to recommend or vouch for the product. Article 17 adds that aside from ads for medical services, drugs, and medical devices, “no other ads are permitted to reference disease treatment functions, nor may they use medical terminology or language that could easily be confused with drugs or medical devices.” Article 4 further requires all ads to be free of false or misleading content, and to not deceive or mislead consumers; advertisers bear full responsibility for the accuracy of their ad content (National regulations, revised 2021). +- Evidence grade: A +- Notes: There’s only one way to tell if a product is legitimate: whether it dares to make bold, absolute claims. Reputable hospital rehabilitation departments never promise that you’ll stand up after a set number of treatment cycles. If you come across such promotional material, report it to 12315 or your local market regulation authorities. The same marketing tactics are used for health supplements, as detailed in Section 6, Item 10 (Health Supplements). If you’ve already purchased such a product and want a refund, follow the rules for online shopping and prepaid services outlined in Section 5, Item 29 (Online Shopping and Platform Rules). The main beneficiaries of this information are you and your family. +- Sources:中华人民共和国广告法（2021 年修正，第四条、第十六条、第十七条）. + +### 7. After obtaining the disability certificate, visit the county-level civil affairs bureau to ask about all available benefits at once + +- Cost: No cost involved. Just make one trip to the county-level civil affairs bureau and spend a morning asking questions. You’ll need to visit multiple agencies later on. +- In plain terms: The disability certificate itself does not provide any financial support — it simply serves as a key to unlock other benefits. Numerous separate benefits are tied to it, each requiring a separate application; none are granted automatically. Visiting the civil affairs bureau once and asking about every item on the list saves you from having to make multiple trips later. +- Benefit: At least six distinct benefits can be accessed via the certificate, each governed by its own regulations. First, there are the living allowance for low-income disabled individuals and the nursing care subsidy for severely disabled persons, as detailed in Section 7, Item 8. Second, rehabilitation assistance for disabled children is covered under the same section. Third, subsidies for basic assistive devices are provided under Article 26 of the Regulations on Disability Prevention and Rehabilitation for Disabled Persons. Fourth, grants for home modifications to improve accessibility are outlined in Section 9. Fifth, preferential employment opportunities and related services are available to certificate holders, as explained in Section 10. Sixth, a reduction in personal income tax applies, as described in Section 11. Article 26 further states that the state offers basic rehabilitation services to low-income and severely disabled persons through targeted programs, alongside subsidies for basic assistive devices. Article 20 mandates that local authorities and civil affairs bureaus establish community-based rehabilitation centers or contract services to provide guidance, daily living training, nursing care, device provision, and information support (effective July 1, 2017 nationwide). +- Evidence grade: A +- Notes: The application process for the disability certificate itself is described in Section 24, Item 11. Most subsidy amounts and implementation rules are determined at the provincial level, so the same benefit may vary significantly between provinces. Be sure to write down each benefit name during your visit, then verify the exact regulations on the local civil affairs bureau’s website and government portals. Do not rely solely on verbal explanations at the counter. Expect that not all details will be covered in one visit; returning annually is advisable, as policies frequently change. +- Sources:国务院 (2017). 残疾预防和残疾人康复条例（第二十条、第二十六条）. + +### 8. For children under 7 who have disabilities or autism, apply to the county-level civil affairs bureau for rehabilitation assistance. + +- Cost: There is no cost. Simply submit one application to the county-level civil affairs bureau and then choose a qualified rehabilitation center from the approved list. +- In plain terms: The government has established a rehabilitation assistance program for children with disabilities and autism aged 0–6, covering surgeries, assistive devices, and therapy sessions. Initially, priority is given to children from low-income families; however, regions with sufficient financial resources may extend eligibility based on age or economic status. This early intervention window yields the best outcomes, so action should not be delayed until school age. Centers must be selected from the official list maintained by the civil affairs bureau. +- Benefit: According to the State Council’s guidelines, eligible recipients include children aged 0–6 with visual, hearing, speech, physical, or intellectual disabilities, as well as those with autism. This includes children from households receiving minimum living allowances, registered poverty-stricken families, or those under state care. Local authorities may further broaden eligibility criteria based on regional financial capacity. Funding levels are determined by each provincial government and adjusted periodically. This policy is grounded in Article 26 of the Regulations on Disability Prevention and Rehabilitation, which mandates free access to surgeries, assistive devices, and therapy for qualifying children nationwide starting in 2018. +- Evidence grade: A +- Notes: Specific assistance criteria vary by province; consult your local civil affairs bureau’s website for detailed implementation rules. Approved centers are listed there as well. Authorities are required to monitor these facilities rigorously, maintain blacklists for non-compliant providers, and ensure accountability. Unlisted centers demand full out-of-pocket payments and offer no recourse in case of complications. This provision primarily benefits your child, qualifying under the secondary tier of support. Any center guaranteeing “complete recovery” must adhere to the restrictions outlined in Section 6 regarding paralysis treatment. +- Sources:国务院 (2018). 关于建立残疾儿童康复救助制度的意见（国发〔2018〕20 号）. ；国务院 (2017). 残疾预防和残疾人康复条例（第二十六条）. + +### 9. Families can apply to local civil affairs bureaus at or above the county level for subsidies to modify ramps, handrails, and bathrooms at home + +- Cost: There is no application fee. Most modifications qualify for subsidies, though you may still need to cover part of the cost. You’ll also need to contact the local disability services council and your neighborhood office. +- In plain terms: The Law on the Construction of Barrier-Free Environments states that civil affairs bureaus at or above the county level must support and guide home modifications for accessibility, and provide appropriate subsidies to eligible families of persons with disabilities and older adults. These programs are usually coordinated by the disability services council on an annual basis, so early registration is essential. The exact amount of the subsidy and which modifications qualify vary by region. +- Benefit: Article 19 of the Law on the Construction of Barrier-Free Environments reads: “Civil affairs bureaus at or above the county level must support and guide home modifications for accessibility. Eligible families of persons with disabilities and older adults shall receive appropriate subsidies.” Article 18 adds that local authorities must develop and implement targeted plans for retrofitting existing residential buildings, neighborhoods, public facilities, transportation systems, and urban and rural roads that fail to meet accessibility standards. Article 62 gives anyone the right to submit suggestions or complaints regarding accessibility issues to relevant government agencies, which must respond promptly. Article 63 further allows prosecutors to issue recommendations or file public interest lawsuits against any conduct violating these provisions (nationwide, effective September 1, 2023). +- Evidence grade: B +- Notes: This grade is assigned because the law merely requires “appropriate subsidies” without specifying exact amounts or eligibility criteria; those details are left to local discretion. First, check the local disability services council website for programs targeting “home modifications for low-income families with severe disabilities.” Most slots are allocated annually, so early application is crucial. Installing elevators or modifying stairways falls under separate procedures managed by housing authorities. For non-compliant public facilities, Article 62 permits filing a complaint with authorities, who must provide a response. +- Sources:中华人民共和国无障碍环境建设法（第十八条、第十九条、第六十二条、第六十三条）. + +### 10. Mentioning your certification during a job interview can save the employer money + + +- Cost: Zero. You only need to add one extra sentence during the interview; the real challenge is simply speaking up. + +- In plain terms: Employers must hire disabled workers so that they make up at least 1.5% of their total workforce; the exact percentage is set by each province. If they fall short of this target, they must pay a disability employment levy calculated per employee based on the average annual wage of their staff from the previous year. Therefore, hiring you isn’t merely an act of goodwill — it actually cuts down on their expenses. Bringing up your certification during the interview makes it easy for them to see this financial benefit. + +- Benefit: Article 8 of the Regulations on Employment of Disabled Persons states: “Employers must ensure that disabled workers account for at least 1.5% of their total workforce; the precise percentage is determined by provincial governments according to local conditions.” Article 9 adds that employers failing to meet this requirement must pay the disability employment levy. Article 8 of the Measures for Collection, Use, and Management of the Disability Employment Levy provides the calculation formula: “Annual levy amount = (Total number of employees in the previous year × mandated disabled‑worker ratio set by the provincial government) − actual number of disabled workers hired × average annual wage of employees in the previous year.” Moreover, Article 16 exempts micro‑enterprises with 20 or fewer employees that have been operating for no more than three years from this levy if they still cannot meet the mandated hiring ratio. Article 36 of the Law on the Protection of Disabled Persons further guarantees tax incentives for employers who meet or exceed the required disabled‑worker ratio, or who concentrate on hiring disabled personnel (these provisions have been in effect nationwide since 1 May 2007). + +- Evidence grade: A + +- Notes: This advantage does not apply to micro‑enterprises with 20 or fewer employees that have been registered for less than three years; do not rely on it in those cases. The rules governing levy exemptions are updated regularly, so always refer to the latest announcements issued by the Ministry of Finance. Additionally, the requirement to meet the hiring ratio involves genuine employment; merely listing a disabled worker on payroll to claim the exemption is fraudulent and could implicate you as well. For details on eligibility for employment assistance programs and social insurance subsidies, see Section 7, Item 12 (“Employment assistance for disadvantaged individuals”). Information on vocational training subsidies can be found in Section 7, Item 13 (“Vocational training subsidies”). Ultimately, the primary beneficiaries of this arrangement are you, the job applicant. +- Sources:国务院 (2007). 残疾人就业条例（第八条、第九条）. ；财政部、国家税务总局、中国残联 (2015). 残疾人就业保障金征收使用管理办法（财税〔2015〕72 号，第六条、第八条、第十六条）. ；中华人民共和国残疾人保障法（第三十六条）. + +### 11. Tax reductions for individuals with disabilities – how much can be saved? Call your provincial tax bureau for details + + +- Cost: No expense at all. You simply tick a box during filing or submit a one-time registration form. +- In plain terms: The Individual Income Tax Law states that individuals with disabilities may receive tax reductions on their earnings. However, the exact amount and duration of these reductions are left to provincial governments to determine, so they vary from province to province. Some provinces set an annual cap on the reduction, while others apply a percentage cut. To find out the exact figure for your area, call 12366 or check the relevant tax‑relief options in the Individual Income Tax app. +- Benefit: Article 5 of the Individual Income Tax Law reads: “Under any of the following circumstances, individuals may be granted tax reductions; the specific extent and duration shall be prescribed by the people’s governments of provinces, autonomous regions, or municipalities directly under the Central Government and reported to the standing committees of their local people’s congresses: (1) earnings of disabled persons, elderly living alone, and families of martyrs; (2) income affected by major losses caused by natural disasters.” Additionally, Article 36 of the Law on the Protection of Disabled Persons stipulates that the state shall provide tax incentives and waive administrative and service fees for disabled persons engaged in self‑employment (effective 1 January 2019). +- Evidence grade: A +- Notes: The benefit is rated “minor” because the law does not specify any numerical limits; most provinces offer reductions ranging from a few hundred to a few thousand yuan per year. While the amount is modest, the relief can be used indefinitely once obtained, making it worthwhile to apply. The only authoritative figure for your province is the official announcement from the local tax bureau; online comparison tables are often outdated. Self‑employed individuals should also request exemption from administrative fees under Article 36 of the Law on the Protection of Disabled Persons when applying for a business license. +- Sources:中华人民共和国个人所得税法（2018 年修正，第五条）. ；中华人民共和国残疾人保障法（第三十六条）. + +### 12. Guide dogs are allowed in public places and on public transport; blind individuals ride city buses for free. + +- Cost: There is no expense involved. If stopped, one must cite the relevant legal provisions; this may lead to a brief standoff. +- In plain terms: The law clearly states that managers of public venues, transport facilities, and operators of public transport must provide reasonable accommodations for disabled persons traveling with guide dogs, hearing dogs, or other service animals. Additionally, blind individuals with valid identification may ride city buses, trams, subways, and ferries free of charge, and may bring any necessary assistive devices along. Should anyone object, simply point out these two provisions; if that fails, file a complaint. +- Benefit: Article 46 of the Accessibility Law reads: “Managers of public venues, transport facilities, and operators of public transport must provide reasonable accommodations for disabled persons traveling with guide dogs, hearing dogs, or other service animals.” Article 35 further mandates that hotlines for civil services, emergency call systems for police, fire, traffic accidents, and medical emergencies must gradually incorporate accessibility features such as voice output, large print, Braille, and one‑touch dialing. Article 62 grants any individual the right to file complaints or reports regarding violations of this law; authorities must respond promptly. Article 50 of the Law on the Protection of Persons with Disabilities states: “Blind individuals with valid identification may ride city buses, trams, subways, ferries, and other public transport free of charge; mail containing Braille materials is also delivered at no cost.” It adds that local governments must ensure such individuals receive convenient and preferential treatment, including permission to bring any essential assistive devices (nationwide; Accessibility Law effective 1 September 2023). +- Evidence grade: A +- Notes: The wording “provide reasonable accommodations” carries no explicit penalties, so opponents may not yield immediately during a confrontation. Keeping a screenshot of the relevant statutes on one’s phone is more useful than memorizing article numbers. If a resolution cannot be reached on the spot, Article 62 permits filing a formal complaint, which authorities must address. Separate regulations apply to railways and airlines; it is advisable to contact their customer service beforehand. The definition of “valid identification” for free transit varies by region; consulting the local disability affairs office is recommended. +- Sources:中华人民共和国无障碍环境建设法（第三十五条、第四十六条、第六十二条）. ；中华人民共和国残疾人保障法（第五十条）. + +### 13. Disabled candidates taking the national college entrance exam can request reasonable accommodations, including a 50% time extension for those using Braille test papers. + + +- Cost: There is no monetary cost. However, candidates must submit a written application within the timeframe specified by their provincial education authorities and attend an in-person verification session. + +- In plain terms: The Ministry of Education and the China Disabled Persons’ Federation have issued official guidelines outlining specific accommodations for disabled students taking the college entrance exam. These include Braille test papers, large-print test papers, exemption from foreign language listening tests, extended exam time, private testing rooms, and permission to bring hearing aids or wheelchairs into the exam hall. These benefits are not automatically granted; candidates must apply in writing by the deadline set by their provincial education authorities, attaching a valid disability certificate (second generation or newer). If a candidate disagrees with the decision, they may request a review from the provincial education department. + +- Benefit: Article 5 of the “Regulations on Managing Accommodations for Disabled Candidates in the National College Entrance Exam” lists twelve distinct accommodations. These include providing Braille, large-print, or standard test papers for visually impaired students; exempting hearing-impaired students from foreign language listening tests; allowing visually impaired students to bring Braille pens, writing boards, non-recording Braille typewriters, electronic visual aids, white canes, and magnifying glasses into the exam; permitting hearing-impaired students to use hearing aids or cochlear implants; and allowing mobility-limited students to bring wheelchairs or walking aids, with custom desks and chairs available upon request. The time extension is clearly defined in Article 5, Paragraph 6: “For visually impaired candidates using Braille test papers, the total exam time is extended by 50% relative to the standard duration; for those using large-print or standard papers, or for candidates with limited hand mobility due to cerebral palsy or other conditions, the extension is 30%.” Additional benefits include priority access to exam venues, private standardized testing rooms, and on-site assistance from guides and sign language interpreters. Article 7 details the application process: candidates must submit a formal written request by the provincial deadline, accompanied by a valid disability certificate; an expert panel then conducts an on-site assessment, after which the provincial education authority issues a written notice of approval or denial. Article 8 allows candidates to appeal any decision via a written review request to the provincial education department. Article 9 specifies that for candidates exempt from foreign language listening tests, the final score is calculated as “written test score × total foreign language points / total written test points.” Finally, Article 18 states that these same accommodations may be applied to other national education exams, such as graduate school admissions or adult college entrance exams (National Regulations, effective April 7, 2017). + +- Evidence grade: A + +- Notes: Each province sets its own application deadline, which is published in its annual college entrance exam registration guidelines. Missing this deadline means no eligibility for accommodations that year. Therefore, students and parents should check their provincial education authority’s website during the first semester of senior year to confirm the exact application window. Article 18 also provides a broader pathway: similar accommodations can be requested for other national education exams, including graduate school and adult college entrance exams. Additionally, Article 14 of this section explicitly prohibits schools from denying enrollment to disabled students. The primary beneficiaries of these provisions are the candidates themselves or their children. +- Sources:教育部、中国残联 (2017). 残疾人参加普通高等学校招生全国统一考试管理规定（教学〔2017〕4 号，第五条、第七条、第八条、第九条、第十八条）. + +### 14. Schools may not refuse enrollment for children with disabilities; those unable to attend receive in‑home instruction arranged by the education bureau + +- Cost: No expense is required. A single application must be submitted, and an evaluation may be necessary. If a school refuses, you must escalate the matter to the local education bureau. +- In plain terms: The regulations clearly state that preschools and schools at all levels must not deny enrollment to eligible children with disabilities. This applies to regular vocational schools as well. For children who need personal care and cannot attend school, county‑level education authorities must arrange in‑home instruction or distance learning and include them in the official student registry. Decisions on admission and transfers are made by an expert committee on disability education appointed by the county education bureau, not by the schools themselves. +- Benefit: Article 7 of the Regulations on Education for Persons with Disabilities reads: “Preschools, schools at all levels, and other educational institutions shall provide education for persons with disabilities in accordance with these regulations and relevant national laws; they may not refuse enrollment to persons with disabilities who meet legal requirements.” Article 29 adds: “Regular vocational schools may not refuse admission to persons with disabilities who satisfy the stipulated admission criteria, and regular vocational training centers must actively enroll them.” The regulations further require that county governments arrange in‑home instruction or remote learning for eligible children who need care and cannot attend school, while also maintaining their enrollment records. Article 20 mandates that county education authorities, together with health, civil affairs agencies, and disability organizations, form an expert committee comprising educators, psychologists, rehabilitation specialists, and social workers to assess each child’s health, educational capacity, and ability to adapt to school life; the results are confidential. Article 23 permits some flexibility in academic expectations for disabled students attending regular classes. Article 52 allows applicants to request reasonable accommodations for national examinations (effective 1 May 2017). +- Evidence grade: A +- Notes: A school’s verbal claim that “we lack the facilities” is not binding; you must obtain a written response and then approach the county education bureau. The evaluation is conducted by the expert committee appointed by the bureau. The clause in Article 23 about flexible learning standards is valuable when a school attempts to expel a child on academic grounds. Guidance on documenting bullying and the required school procedures can be found in Section 30, Item 3 (School bullying). Information on reasonable accommodations for college entrance exams appears in Section 13 (Reasonable accommodations). This provision benefits your child directly. +- Sources:国务院 (2017). 残疾人教育条例（第七条、第二十条、第二十三条、第二十九条、第五十二条）. + +### 15. People missing their right lower limb or both lower limbs can still obtain a driver’s license; the designated category is C5 + +- Cost: The tuition fees are comparable to those for regular driver’s licenses — typically a few thousand yuan in most regions. The vehicle must be modified to allow manual control, and a medical checkup is required every three years. +- In plain terms: According to regulations issued by China’s Ministry of Public Security, there exists a specific driver’s license category designated for people with disabilities, known as “small automatic passenger cars for disabled persons,” identified by the code C5. Individuals who have lost or lack movement function in their right lower limb or both lower limbs yet can sit upright on their own, provided their upper limbs meet certain criteria, are eligible to apply. A similar pathway exists for those missing one entire palm. Separate license categories also apply to people with visual impairments affecting only one eye or hearing impairments. All required medical evaluations must be conducted at specialized medical institutions approved by provincial health authorities. +- Benefit: Annex 1 of the “Regulations on the Application and Use of Motor Vehicle Driver’s Licenses” outlines detailed physical eligibility criteria. Clause 8 explicitly states that individuals missing or lacking movement function in their right lower limb or both lower limbs, yet capable of independent sitting posture, and whose upper limbs satisfy stipulated conditions, may apply for a C5 license. Likewise, those missing only their left lower limb while retaining normal right lower limb function may qualify for a standard small automatic car license. For visual impairments, applicants must have at least 5.0 corrected visual acuity in their better eye and a horizontal visual field spanning 150 degrees to qualify for licenses covering small cars, small automatic cars, low-speed trucks, three-wheeled vehicles, and C5 vehicles. Hearing-impaired applicants who can still locate sound sources via hearing aids may obtain licenses for small cars and small automatic cars, provided they wear such aids while driving. Article 85 mandates that medical certificates for C5 license applicants must originate from authorized provincial medical institutions. Holders of this license must undergo periodic health evaluations every three years and submit updated certificates within 30 days after each scoring cycle concludes. Additionally, Article 78 requires all C5 vehicle owners to affix a nationally standardized “disabled persons’ motor vehicle” signage as stipulated by Ministry of Public Security Order No. 172, effective 1 January 2025. +- Evidence grade: A +- Notes: An alternative, far less restrictive option involves operating specially designed motorized wheelchairs for disabled persons. Classified as non-motorized vehicles under Article 119 of the Road Traffic Safety Law, these do not necessitate a driver’s license; Article 58 further limits their maximum speed on non-motorized lanes to 15 km/h. Modifying a standard vehicle for C5 use involves installing manually operated throttle and brake mechanisms via certified manufacturers, followed by official registration updates at local vehicle authorities. Failure to submit updated health documentation within one year following three consecutive scoring cycles results in automatic license revocation. +- Sources:公安部令第 172 号. 机动车驾驶证申领和使用规定（第七十八条、第八十五条、附件 1）. + +### 16. Rehabilitation should be carried out at a proper facility with a rehabilitation medicine department; the intensity must be set by therapists — more intensity does not necessarily mean better results. + + +- Cost: Inpatient rehabilitation costs several hundred yuan per day; the out‑of‑pocket portion varies by region. Treatment is billed on a monthly basis. Daily exercises are required and can be quite monotonous. + +- In plain terms: The most common mistake is simply sending a patient home to lie down and hope for a natural recovery. Care delivered by a coordinated, multidisciplinary team helps many patients survive one year later and continue living at home. However, patients should not overdo it on their own. In a trial involving over 2,000 participants, early, frequent, and more intensive activity within 24 hours after a stroke actually led to poorer outcomes three months later. Thus, the amount and timing of exercise must be determined by the rehabilitation department and therapists. + +- Benefit: A Cochrane systematic review included 29 trials with 5,902 participants, comparing organized inpatient stroke‑unit care with other forms of care. At the final follow‑up (median 1 year), the odds ratio for adverse outcomes — death, disability, or need for institutional care — was 0.77 (95% CI 0.69–0.87). The odds ratio for death alone was 0.76 (95% CI 0.66–0.88), and for death or dependence it was 0.75 (95% CI 0.66–0.85); evidence quality is moderate. In absolute terms, for every 100 patients receiving stroke‑unit care, an additional 2 survive, 6 continue living at home, and 6 regain the ability to care for themselves. Conversely, the AVERT trial randomly assigned 2,104 patients across 56 acute stroke units in five countries to either “standard care” or “standard care plus very early intensive activity.” After three months, 480 patients (46%) in the early‑activity group achieved a good outcome (modified Rankin Scale 0–2) versus 525 patients (50%) in the standard‑care group; the adjusted odds ratio was 0.73 (95% CI 0.59–0.90, P=0.004). Death rates were 88 versus 72 patients, with no statistically significant difference (odds ratio 1.34, 95% CI 0.93–1.93, P=0.113). + +- Evidence grade: A + +- Notes: Caution: Both studies involve stroke patients; their findings cannot be directly applied to other disabling conditions such as spinal cord injury, amputation, or burns. The AVERT trial demonstrates that “the earlier and more intense the activity, the better” is not true; it does not mean that early activity is useless. In both trials, the majority of participants began walking within 24 hours; the difference lay in frequency and total volume of exercise. When selecting a facility, verify whether it has a rehabilitation medicine department and qualified physical and occupational therapists — do not rely solely on a “rehabilitation” sign. Information on referrals between primary and tertiary hospitals and related cost thresholds can be found in Section 24.1 (step‑by‑step referrals). Community‑based rehabilitation and assistive devices are discussed in Section 16.7 (contact the county disability‑affairs office). +- Sources:Langhorne P, Ramachandra S; Stroke Unit Trialists' Collaboration (2020). Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database of Systematic Reviews, 4:CD000197. ；AVERT Trial Collaboration group (2015). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386(9988):46-55. + +### 17. Getting a hearing aid when hearing declines — the reason is to hear better now, not to prevent dementia + +- Cost: Hearing aids cost several thousand to tens of thousands of yuan; most must be paid for out of pocket. Fitting requires professional testing and multiple follow‑up adjustments. +- In plain terms: The claim that “wearing a hearing aid prevents dementia” currently lacks solid evidence. A three‑year trial involving nearly a thousand participants found no overall difference between groups. Only among people already at higher risk of cognitive decline did a modest benefit appear. Thus, the main reason to get a hearing aid is to hear clearly now — to talk with others and hear traffic while crossing the street — not to protect the brain decades later. +- Benefit: The ACHIEVE trial took place in four U.S. communities and enrolled 977 individuals aged 70–84 with untreated hearing loss but no obvious cognitive impairment. Participants were randomly assigned to either hearing intervention (counseling and hearing aid fitting) or health‑education control, with follow‑up every six months. The primary endpoint was change in overall cognitive scores over three years. In the combined analysis of both participant cohorts, there was no significant difference: the intervention group showed a change of −0.200 (95% CI −0.256 to −0.144) versus −0.202 (95% CI −0.258 to −0.145) in the control group; the difference was 0.002 (95% CI −0.077 to 0.081, P = 0.96). A pre‑specified sensitivity analysis revealed a statistically significant interaction (P = 0.010) between the two cohorts. The second cohort comprised older participants with more risk factors for cognitive decline and lower baseline cognitive scores. Researchers concluded that hearing intervention may modestly slow cognitive decline over three years in high‑risk individuals but not in those at lower risk. No serious adverse events attributable to the intervention were reported. +- Evidence grade: A +- Notes: Controversy: The oft‑quoted claim that “hearing aids cut cognitive decline by nearly half” stems from a subgroup analysis of this trial, not its primary result, which showed no overall difference. This note is included to separate the practical benefit of hearing aids from the unproven dementia‑prevention claim. Students with hearing impairments may be exempt from foreign‑language listening tests in college entrance exams; see item 13 (reasonable accommodations) in this section. Drivers with hearing loss should wear hearing aids; see item 15 (C5) in this section. +- Sources:Lin FR, Pike JR, Albert MS, et al.; ACHIEVE Collaborative Research Group (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet, 402(10404):786-797. + +### 18. Saying an adult “can’t manage his own affairs” requires a court determination; family members can’t decide on their own + + +- Cost: Filing a petition with the court incurs filing fees, typically ranging from a few dozen to a hundred yuan. An additional evaluation fee is required, usually several thousand yuan, which the applicant must pay upfront. The entire process takes several months. +- In plain terms: Only a court can decide whether an adult is “incapable of civil conduct” or “has limited civil capacity.” Family members, employers, or residents’ committees cannot make that determination on their own. A party with a vested interest or a relevant organization must file a petition with the court. Conversely, if a person’s mental or intellectual abilities improve, an application can be made to restore his capacity. This procedure serves both as a safeguard and a protection mechanism. +- Benefit: Article 21 of the Civil Code states: “An adult who cannot recognize his own actions is deemed incapable of civil conduct; his legal representative must act on his behalf in all civil matters.” Article 22 adds: “An adult who can only partially recognize his actions is considered to have limited civil capacity; his legal representative must act on his behalf or give consent and ratification for any civil acts, though he may independently perform acts that yield pure benefits or are consistent with his mental and intellectual condition.” Article 24 further provides that any interested party or relevant organization may petition the court to declare such an adult incapable or of limited capacity. Once declared, upon application by the individual, interested parties, or relevant organizations, the court may later restore his limited or full capacity based on improvements in his mental health. Relevant organizations include residents’ committees, villagers’ committees, schools, medical institutions, women’s federations, disability federations, legally established senior citizen groups, and civil affairs bureaus. Article 23 designates guardians as legal representatives for those lacking or having limited capacity (nationwide, effective 1 January 2021). +- Evidence grade: A +- Notes: The associated costs must be clearly outlined. This procedure is a special court process; it is faster than regular civil cases but still takes several months. Medical diagnosis records must be submitted, and most courts also order an independent evaluation, the fees for which are typically several thousand yuan and paid upfront by the applicant. Signing documents or disposing of property on someone’s behalf without following this process may render those actions invalid; even property sales could be reversed. It is also important to remember that limited capacity does not mean a person can’t perform any actions at all. He may independently handle matters consistent with his mental state or those that bring him pure benefits; guardians should not automatically handle everything on his behalf. Details on determining guardianship are provided in section 19 (Guardians). +- Sources:中华人民共和国民法典（第二十一条、第二十二条、第二十三条、第二十四条）. + +### 19. Guardians for adults are appointed in a legal order; if the ward injures someone, the guardian must pay compensation. + +- Cost: There are no direct costs. When disputes arise, parties must turn to the residents' committee, villagers' committee, civil affairs bureau, or court to resolve them. +- In plain terms: Once an adult loses the capacity to act, a guardian must be appointed following this order: spouse, parents and children, other close relatives, and finally any other individual or organization willing to serve. If there is disagreement over who should serve, the local residents' committee, villagers' committee, or civil affairs bureau makes the appointment; parties may appeal to court if they disagree. Conversely, while still of sound mind, an adult may put in writing who they wish to serve as their guardian. If the ward injures someone, the appointed guardian is legally responsible for paying compensation. +- Benefit: Article 28 of the Civil Code states that adults lacking or having limited civil capacity must be guarded in this order: “(1) Spouse; (2) Parents and children; (3) Other close relatives; (4) Any other individual or organization willing to serve, provided they receive approval from the local residents' committee, villagers' committee, or civil affairs bureau.” Article 31 adds that when disputes arise over guardianship, the local residents' committee, villagers' committee, or civil affairs bureau appoints a guardian; parties may appeal to court if they disagree, and the appointment must respect the ward’s true wishes and be made in their best interest. Until a guardian is appointed, the residents' committee, villagers' committee, or other legally designated organizations act as temporary guardians. Article 33 permits adults of full capacity to name their own guardian in writing while still of sound mind. Article 1188 stipulates that guardians must pay compensation when their ward causes harm; if they fulfilled their duties, the liability may be reduced. Compensation is paid first from the ward’s own assets, with any shortfall covered by the guardian. Article 1189 clarifies that even when guardians delegate duties, they remain liable; only when the delegatee is at fault does liability shift partially. This framework has been in effect nationwide since 1 January 2021. +- Evidence grade: A +- Notes: Article 33 specifically addresses voluntary guardianship. Drafting a written arrangement while still of sound mind can prevent most future disputes; see Section 17, Item 1 for guidance on drafting such documents. Regarding compensation, guardians remain liable even when the ward is placed under the care of relatives or institutions; only when those caretakers are at fault does liability shift partially. Purchasing guardian liability insurance is therefore advisable. Article 78 of the Mental Health Law also holds guardians accountable for any harm caused by neglect or failure to fulfill their duties. +- Sources:中华人民共和国民法典（第二十八条、第三十一条、第三十三条、第一千一百八十八条、第一千一百八十九条）. + +### 20. If you’re denied a job, denied promotion, or paid less because of a disability, you can sue — but first calculate the associated costs. + + +- Cost: Legal fees range from several thousand to tens of thousands of yuan, all paid by you. A standard first-instance trial takes at least six months and can be extended. You must also gather and preserve all relevant evidence on your own. + +- In plain terms: The law prohibits discrimination against people with disabilities in hiring, promotion, salary, social insurance, and related areas. You may file a complaint with the relevant authorities or go directly to court. However, winning the case does not automatically mean the other party will pay your legal fees — those are not covered under standard court costs. Therefore, it’s wise to first file a complaint, apply for legal aid, and then consider litigation. + +- Benefit: Article 3 of the Law on the Protection of Persons with Disabilities states: “Discrimination based on disability is prohibited. Insults and infringements against persons with disabilities are forbidden.” Article 38 adds: “Employers must not discriminate against employees with disabilities in hiring, promotion, professional qualification assessment, remuneration, social insurance, welfare, rest periods, or other aspects. Employers must also provide suitable working conditions and necessary accommodations.” Article 64 further specifies that violations can be corrected by authorities, and affected individuals may file lawsuits. The Regulations on Employment of Persons with Disabilities likewise forbid such discrimination. Under the Legal Aid Law, persons with disabilities are exempt from proving financial hardship when applying for legal assistance. + +- Evidence grade: A + +- Notes: Always calculate the costs first. A standard trial lasts at least six months; a simplified procedure takes three months. Legal fees are not included in court costs, so filing a complaint with labor authorities or the disability rights association — and applying for legal aid — are far less expensive options. Gathering evidence is often the toughest part; few employers provide written reasons for rejections, so recordings or chat logs are invaluable. For current employees, labor arbitration applies; details on evidence preservation and deadlines are covered in Section 19, Item 8. This guidance is meant solely for your protection. +- Sources:中华人民共和国残疾人保障法（第三条、第三十八条、第六十四条）. ；国务院 (2007). 残疾人就业条例（第四条、第十三条）. ；中华人民共和国法律援助法（第四十二条、第四十五条）. diff --git a/book/34-Avoid-Serious-Harm-From-Home-Medicines.md b/book/34-Avoid-Serious-Harm-From-Home-Medicines.md new file mode 100644 index 00000000..a9658b4d --- /dev/null +++ b/book/34-Avoid-Serious-Harm-From-Home-Medicines.md @@ -0,0 +1,92 @@ +[← Back to main index](../../README.md) + +# 34. Avoid serious harm from over-the-counter medicines at home + +Fever reducers, painkillers, cold remedies, stomach meds, and anti-diarrheal drugs — many of these can be bought without a prescription at any pharmacy. Just because they’re available without a doctor’s order doesn’t mean they can be taken carelessly. This section won’t list which medicine fits each condition; instead, it highlights a few simple actions that can prevent serious consequences. + +All figures here are based on mortality rates, covering outcomes such as liver failure, stomach bleeding, and newborn kidney failure. Most benefits boil down to “preventing at least one serious incident.” Since studies rarely quantify exactly how much risk drops after taking these steps, the benefit level is judged by how severe those possible outcomes would be — each entry explains the reasoning behind its rating. + +For topics already covered elsewhere, we simply point the way. If someone accidentally swallows medicine or cleaning products, see section 13, item 20 (accidental ingestion). For chronic-disease medicines taken as prescribed for the full course, see section 16, item 1 (finish the prescribed course). For buying prescription drugs online only after a prescription review, see section 28, item 6 (get weight-loss drugs with a hospital prescription). + +The beneficiaries of this section’s items are you and your family — the top two tiers. +### 1. Before taking two cold or pain relievers at the same time, check their ingredient lists — only one of them should contain acetaminophen. + + +- Cost: No cost at all. It only takes a minute or two to glance at the ingredient list on each package. +- In plain terms: Acetaminophen is present in many cold medicines. Taking two such products means you’re consuming double the dose, which can damage the liver. In the U.S., nearly 30% of patients suffering from acute liver failure due to acetaminophen never receive a liver transplant in time. Domestic instructions recommend a maximum daily intake of 2 grams, and alcohol should be avoided while taking this drug. +- Benefit: Over six years, 22 U.S. hospitals tracked 662 cases of acute liver failure. Of these, 275 (42%) were caused by acetaminophen; the median dose consumed was 24 grams. Among those 275 patients, 131 (48%) took the drug unintentionally. In 38% of those cases, they were also taking two or more other medications containing acetaminophen. Ultimately, 27% of these patients died before a transplant became possible, while 8% underwent liver transplantation. In 2020, China’s National Medical Products Administration mandated that OTC packaging clearly state excessive use can cause severe liver damage and that the daily limit is 2 grams. Packaging must also warn against combining this drug with other acetaminophen-containing or analgesic products. U.S. regulations require such OTC products to explicitly list three main risk factors: exceeding the daily limit, concurrent use with other acetaminophen-containing drugs, and drinking more than three alcoholic drinks daily while taking it. +- Evidence grade: B +- Sources:Larson AM, Polson J, Fontana RJ, et al.; Acute Liver Failure Study Group (2005). Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology, 42(6):1364-1372. ；国家药监局关于修订对乙酰氨基酚常释及缓释制剂说明书的公告（2020年第15号）及附件2《对乙酰氨基酚常释制剂非处方药说明书修订要求》（湖南省药品监督管理局转载）. ；21 CFR 201.326(a)(1)(iii)(A) Liver warning. +- Notes: Acetaminophen is also known as paracetamol. Cold medicines whose generic names contain the characters “anfen” — such as paracetamol pseudoephedrine or paracetamol caffeine chlorpheniramine — all contain this ingredient. When in doubt, bring all your medications to a pharmacist for review. This evidence grade is set at B because the U.S. data comes from case registries lacking a control group, so it’s impossible to calculate exactly how many adverse events could be prevented by checking ingredient lists. The “large” benefit rating is based on the severity of outcomes: nearly 30% of acute liver failure cases end in death. + +### 2. Do not give children aspirin, nimesulide, or metamizole for fever; cold medicines containing metamizole should also be avoided in minors. + +- Cost: No cost involved. Simply check the generic name and ingredient list when buying fever reducers. +- In plain terms: For reducing a child’s fever, none of these three drugs should be used. Aspirin is linked to Reye’s syndrome, a condition that damages the brain and liver; in U.S. statistics, around 30% of affected children died, though cases dropped by over 90% after warnings were issued. Nimesulide is prohibited for children under 12, while metamizole is banned for anyone under 18. +- Benefit: Reye’s syndrome can lead to brain disease and fatty liver degeneration, typically occurring after influenza or chickenpox infections. Nationwide monitoring in the U.S. from 1981 to 1997 recorded 1,207 cases among children under 18; 82% of these had detectable salicic acid in their blood, a key component of aspirin-like drugs. The overall mortality rate was 31%. Warnings about salicylate-containing drugs began in 1980, when 555 cases were reported — the peak figure; since 1987, annual cases have stayed under 36. China’s drug regulator prohibited oral nimesulide formulations for children under 12 in 2011, and banned metamizole tablets for anyone under 18 in 2020. This ban also applies to compound Qinghao Metamizole Tablets, Chongganling Tablets, and Chongganling Capsules, all of which contain metamizole. +- Evidence grade: B +- Sources:Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377-1382. ；关于加强尼美舒利口服制剂使用管理的通知（国食药监安〔2011〕209号）. ；国家药监局关于修订安乃近相关品种说明书的公告（2020年第34号）及附件1至3. +- Notes: Metamizole is not a first-choice treatment even for adults. Its package insert notes it may cause agranulocytosis, aplastic anemia, and anaphylactic shock, so it is only used short-term for severe conditions when no other effective drugs are available. Despite its name, Chongganling is not a regular cold medicine — it contains metamizole as well. For appropriate fever reducers and correct dosages based on body weight, consult a pediatrician or pharmacist. Infants under 3 months with a fever should be taken to a hospital immediately, as noted in Section 20, Item 8 (fever above 38°C requires immediate medical care). This B rating reflects that Reye’s syndrome statistics derive from monitoring reports, and the drop in cases after warnings is a correlative trend rather than evidence from controlled trials; the “significant benefit” rating is justified by the marked reduction in cases from 555 annually to under 36 after warnings were issued. + +### 3. People over 60, with a history of stomach bleeding, taking anticoagulants or steroids should consult a doctor before using painkillers like ibuprofen + +- Cost: No cost involved. Simply ask a doctor or pharmacist. +- In plain terms: Painkillers such as ibuprofen, naproxen, and aspirin can harm the stomach. In large-scale trials, individuals taking ibuprofen faced roughly four times the risk of stomach bleeding or perforation compared to those not taking it. This risk is even higher for older adults, those with prior stomach bleeding, individuals on anticoagulants or steroids, and regular drinkers. +- Benefit: These medications are classified as nonsteroidal anti-inflammatory drugs (NSAIDs); common examples include ibuprofen, naproxen, and diclofenac. A meta-analysis encompassing 280 randomized trials involving 124,513 participants demonstrated that compared to placebo, ibuprofen raised the risk of upper gastrointestinal perforation, obstruction, or bleeding by an RR of 3.97 (95% CI 2.22–7.10; roughly fourfold). Naproxen showed an RR of 4.22 (2.71–6.56), while diclofenac resulted in an RR of 1.89 (1.16–3.09). All NSAIDs also approximately double the risk of heart failure. U.S. regulations mandate that over-the-counter NSAIDs carry warnings about stomach bleeding; these warnings specifically identify six high-risk groups: individuals over 60, those with prior stomach ulcers or bleeding, people on anticoagulants or steroids, individuals concurrently taking multiple NSAIDs, drinkers consuming more than three alcoholic beverages daily, and users exceeding recommended dosages or duration. +- Evidence grade: A +- Sources:Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9894):769-779. ；21 CFR 201.326(a)(2)(iii)(A) Stomach bleeding warning. +- Notes: The study conclusions pertain to high-dose usage. No separate figures are provided for occasional short-term use at standard doses. Many multi-ingredient cold remedies also contain NSAIDs; combining them with separate painkillers results in redundant intake. Patients prescribed low-dose aspirin long-term by physicians for thrombosis prevention must not discontinue it or self-administer additional NSAIDs without medical guidance. + +### 4. For children under 2 with colds, don’t give them over-the-counter multi-ingredient cold and cough medicines on your own + +- Cost: There is no cost at all; you even save money by not buying these medicines. +- In plain terms: China’s National Medical Products Administration requires 14 types of over-the-counter multi-ingredient cold medicines for children to carry a warning label stating they are not recommended for parents to give to kids under 2 years old, and should only be used under the guidance of a doctor or pharmacist. Clinical trials conducted on children show that cough medicines and antihistamines have no better effect than placebo. +- Benefit: In its Announcement No. 57 of 2021, the National Medical Products Administration updated the instructions for 14 such medicines, including paracetamol, pseudoephedrine and dextromethorphan oral solution, pediatric paracetamol, artificial cow-bezoar and chlorpheniramine maleate granules, and pediatric paracetamol and amantadine hydrochloride granules. The new warning reads: “It is not recommended for parents or guardians to give these products to infants under 2 years old on their own; they should only be used under the guidance of a doctor or pharmacist.” An additional note was added: “These products must be used strictly according to the dosage instructions on the package to avoid overdosing.” Another note states: “Concurrent use of other cold medicines containing the same or similar active ingredients should be avoided.” A Cochrane systematic review included 29 randomized controlled trials, 10 of which were conducted on children. For all these medicine types, no better effect than placebo was observed in pediatric trials: cough medicines, antihistamines (the anti-allergy component), antihistamines combined with decongestants (the ingredient that relieves nasal congestion), and cough medicines combined with bronchodilators. Adverse reactions were reported in 21 studies, with formulations containing antihistamines and dextromethorphan showing a higher incidence of side effects. +- Evidence grade: B +- Sources:国家药监局关于修订氨酚麻美口服溶液等14个品种药品说明书的公告（2021年第57号）及附件. ；Smith SM, Schroeder K, Fahey T (2014). Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews, (11):CD001831. +- Notes: Many of these 14 medicines have “paracetamol” in their name, as they contain acetaminophen. Taking them together with other fever reducers will lead to redundant intake, as noted in Section 1 of this chapter (on acetaminophen). One trial included in the review found honey to be more effective than placebo for treating coughs, but honey should not be given to children under 1 year old, as detailed in Section 20, Item 6 (on honey). The evidence grade is set to B because there are very few trials for each type of medicine in the review, and the authors could not calculate a combined statistical figure. The benefit level is rated “moderate” as there is no proven benefit of these medicines for children, while the main risks are overdosing and redundant intake of similar active ingredients. + +### 5. Pregnancy after 20 weeks: avoid taking ibuprofen and similar painkillers on your own + +- Cost: No cost involved. +- In plain terms: After 20 weeks of pregnancy, most of the amniotic fluid is produced by the fetus’s kidneys. Taking ibuprofen or similar medications at this stage may harm the fetal kidneys and reduce the amount of amniotic fluid. Some reports received by U.S. authorities describe cases where newborns died after such exposure. Low-dose aspirin prescribed by doctors is not included in this warning. +- Benefit: In October 2020, the U.S. Food and Drug Administration (FDA) issued a safety warning. Use of nonsteroidal anti-inflammatory drugs after roughly 20 weeks of pregnancy may cause kidney problems in the fetus, leading to low amniotic fluid levels. This warning applies to both prescription and over-the-counter drugs, including aspirin, ibuprofen, naproxen, diclofenac and celecoxib. After reviewing adverse event reports up to July 2017, the FDA identified 35 cases of low amniotic fluid or neonatal kidney dysfunction, all with serious outcomes; 5 of these newborns died, each with accompanying kidney failure. In most documented cases, amniotic fluid levels returned to normal within 72 hours to 6 days after medication use stopped. The FDA advises pregnant women not to take these drugs after week 20 unless explicitly directed by a doctor. Low-dose aspirin (81 mg) prescribed for specific pregnancy-related conditions is exempt from this restriction. When pain relief or fever reduction is needed, the FDA recommends using alternatives such as acetaminophen; consult a pharmacist or doctor first. +- Evidence grade: B +- Sources:U.S. Food and Drug Administration (2020-10-15). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. Drug Safety Communication. +- Notes: The FDA notes that many over-the-counter products for colds, flu or insomnia also contain these ingredients, so always check the ingredient list. Previously, U.S. over-the-counter drug labels only warned against use in the final 3 months of pregnancy; this new warning sets the cutoff at around 20 weeks. Low-dose aspirin for preventing preeclampsia is discussed in Section 27, point 5 (“Low-dose aspirin”). The grade B rating reflects that these figures come from adverse event reports; we have no data on how many women took these drugs without experiencing any issues. The “moderate” benefit rating reflects the seriousness of these outcomes, even though they occur infrequently. + +### 6. Buying omeprazole over the counter for heartburn and acid reflux — use it for no more than 7 days; see a doctor immediately if you have trouble swallowing, vomit blood, or pass black stools + +- Cost: No cost involved — just follow the dosage instructions on the package. +- In plain terms: Since 2022, omeprazole enteric-coated tablets have been available over the counter without a prescription. However, the package instructions clearly state that you should only take it for up to 7 days, and avoid using it again within two months. If you experience trouble swallowing, pain in the throat, vomit blood, or pass black stools, do not take it on your own — these are potential signs of serious medical conditions. This medication can also mask symptoms of stomach cancer, potentially delaying an accurate diagnosis. +- Benefit: In its Announcement No. 68 of 2022, the National Medical Products Administration reclassified omeprazole enteric-coated tablets from a prescription drug to an over-the-counter medication, and released a standard package insert for it. The approved indication listed in the insert is “short-term relief of heartburn and acid reflux caused by excess stomach acid”. The precautions section specifies that the drug must not be used for more than 7 days, and that patients should consult a physician or pharmacist if symptoms persist. It also states that the drug must not be taken again within two months, and that immediate medical attention is required if symptoms recur. Use is prohibited if a patient has trouble swallowing, throat pain, vomit blood, or passes black stools, as these are possible indicators of serious illness. For patients showing warning signs such as unexplained weight loss, repeated vomiting, trouble swallowing, vomit blood, or black stools, malignant tumors must be ruled out first, since treatment with this drug may conceal symptoms and delay diagnosis. Patients over 55 years old with new or changing symptoms should consult a doctor before use. People taking clopidogrel must avoid taking omeprazole at the same time. +- Evidence grade: B +- Sources:国家药监局关于奥美拉唑肠溶片处方药转换为非处方药的公告（2022年第68号）及附件2《非处方药说明书范本》. +- Notes: Clopidogrel is a blood-thinning medication commonly prescribed to patients who have had a stent implanted or a myocardial infarction. Omeprazole can reduce its effectiveness, so patients taking clopidogrel must consult a doctor first. The evidence grade is set to B because these requirements are stipulated in the official package insert, and no research has been conducted to quantify how many adverse events can be prevented by following these instructions. The benefit level is rated “moderate” because while this medication helps prevent delayed diagnosis of stomach bleeding or stomach cancer, most cases of heartburn and acid reflux are not severe. + +### 7. Don’t ask doctors for antibiotics for the common cold + +- Cost: It costs nothing and can even save you money on medicine. +- In plain terms: Taking antibiotics for a cold doesn’t speed up recovery compared to not taking them at all. For adults, the risk of side effects is more than twice as high when using antibiotics. For cases where nasal discharge with pus lasts less than 10 days, there is no clear benefit to taking antibiotics either. +- Benefit: A Cochrane systematic review pooled data from 6 randomized trials involving 1,147 participants. When comparing antibiotic use to placebo for treating colds, there was no significant difference in the proportion of people who did not recover or whose symptoms persisted (RR 0.83, 95% CI 0.60–1.14, no statistically significant difference). The risk of adverse reactions was 1.8 times higher than in the placebo group (95% CI 1.01–3.21). For adults specifically, this risk was 2.62 times higher (1.32–5.18), while no increase was observed in children (RR 0.91, 0.51–1.63). For acute purulent rhinitis where nasal discharge with pus lasts less than 10 days, antibiotics also showed no clear benefit (RR 0.73, 0.47–1.13). However, the risk of adverse reactions rose by roughly 46% (RR 1.46, 1.10–1.94). The authors concluded that routine use of antibiotics is not recommended for either of these conditions. +- Evidence grade: A +- Sources:Kenealy T, Arroll B (2025). Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews, 11:CD000247. +- Notes: This updated version was released in 2025; the abstract states that literature searches were conducted up to 2013. Antibiotics are prescription-only drugs in China, so pharmacies must sell them only with a valid prescription. Do not take leftover antibiotics at home without medical advice. The “moderate” rating for benefits is based on the fact that antibiotics primarily reduce the risk of adverse reactions rather than preventing death. + +### 8. For diarrhea, start by drinking oral rehydration solution; do not give anti-diarrheal drugs to children under 5 + +- Cost: A box of oral rehydration solution costs just a few dollars, so it’s worth keeping one at home. +- In plain terms: The most important thing during diarrhea is rehydration, not stopping the diarrhea itself. Mix the solution exactly as directed on the package and drink it — never substitute it with sugary juices or soft drinks, as the excess sugar can actually worsen dehydration. Never give anti-diarrheal medications such as loperamide to kids under 5 years old; in severe cases these drugs can cause life-threatening intestinal blockages. +- Benefit: WHO’s guidelines on diarrhea treatment state clearly that anti-diarrheal and anti-vomiting drugs provide no real benefit for children with acute or prolonged diarrhea. They do not prevent dehydration or improve nutritional status, and some carry serious, even fatal side effects — so they must never be given to children under 5. Drugs like loperamide that slow intestinal motility can lead to severe paralytic intestinal obstruction, which is potentially fatal and can prolong the underlying infection. The same guidelines also warn that drinks high in sugar draw water into the intestines, causing hypernatremic dehydration; this applies to soft drinks and most commercially sold fruit juices. WHO recommends a low-osmolarity formula with a total osmotic pressure of 245 mOsm/L; compared to older formulations, this reduces unplanned intravenous fluid administration by 33%. A Cochrane review of 8 trials reached similar conclusions (OR 0.59, 95% CI 0.45–0.79), showing roughly a 40% reduction in complications when this solution is used. +- Evidence grade: A +- Sources:World Health Organization (2005). The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. ；Hahn S, Kim S, Garner P (2002). Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews, (1):CD002847. +- Notes: When purchasing oral rehydration solution, always check the package label for its osmotic pressure and choose the low-osmolarity version. The WHO guidelines also note that blood in a child’s stool almost always indicates bacterial dysentery, which requires medical treatment with antibiotics — rehydration alone is not sufficient. The “moderate” benefit rating here reflects the fact that the available data compares two different rehydration solutions rather than the effect of drinking any solution versus none. + +### 9. Don’t take painkillers for more than 15 days a month; limit combination painkillers to 10 days. Otherwise, headaches may actually be caused by the medication itself. + +- Cost: No direct cost. You’ll just need to keep track of how many days you’ve taken the medicine, and resist the urge to pop pills at every sign of a headache. +- In plain terms: If you suffer from frequent headaches and take painkillers every day, you might end up with even more frequent headaches. The International Classification of Headache classifies this condition as medication-overuse headache. For regular non-opioid painkillers like acetaminophen, aspirin and ibuprofen, taking them for 15 days or more per month for 3 consecutive months meets the criteria. For combination painkillers — which contain two or more pain-relieving ingredients or extra additives like caffeine (for example, acetaminophen with codeine) — the limit is 10 days per month over the same period. Even if you rotate between different non-opioid painkillers, the total number of days you take them still counts toward this limit. Epidemiological studies from multiple countries confirm that over half of people who experience headaches for 15 days or more each month fall into this category. Most patients see their symptoms improve after cutting back on excess medication, and other preventive headache treatments also become more effective. +- Benefit: The third edition of the International Classification of Headache published by the International Headache Society outlines the diagnostic criteria for this condition. It applies to people who already have a history of headaches, experience headaches on 15 or more days each month, and have been regularly taking excessive amounts of headache medication for over 3 months. For standard non-opioid painkillers, the threshold for overuse is 15 days per month; for combination painkillers, it is 10 days per month. This classification is backed by robust epidemiological evidence, and most patients see positive results after reducing their medication intake. +- Evidence grade: B +- Sources:Headache Classification Committee of the International Headache Society (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1):1-211. ；ICHD-3 在线版 8.2 Medication-overuse headache（含 8.2.3、8.2.5）. +- Notes: Painkillers with “caffeine” in their name typically contain added caffeine, so they count toward the 10-day limit for combination painkillers. If you find that your headache days are increasing month on month, it’s best to consult a neurologist rather than simply taking more medication. This evidence grade is assigned because the classification criteria serve as a diagnostic benchmark rather than being derived from controlled clinical trials. The benefit level is rated “moderate” as it primarily reduces the frequency of headaches without preventing life-threatening outcomes. diff --git a/book/en/01-Do-Not-Die-Early.md b/book/en/01-Do-Not-Die-Early.md new file mode 100644 index 00000000..ec29f9e7 --- /dev/null +++ b/book/en/01-Do-Not-Die-Early.md @@ -0,0 +1,360 @@ +# 1. How to avoid dying too soon + +This section covers three main topics. First, deaths caused by accidents and injuries — things like car crashes, fires, and poisoning. Second, there are a few vaccines and screening tests backed by very strong scientific evidence. Third, we’ll look at certain warning signs the body gives off that mean it’s time to get checked out. The numbers listed under “Benefit” come from randomized controlled trials, large long‑term studies, or official statistics. The “Cost” figures are rough estimates based on current market prices; they’re meant only for comparison purposes and shouldn’t be cited as official data. +### 1. Always wear seat belts, both front and back + +- Cost: No cost at all. It only adds about 2 seconds to every trip. +- In plain terms: Wearing a seat belt in the front seat cuts the risk of dying in a crash by roughly half. For drivers and passengers in light trucks, the reduction is about 60%. Among U.S. crash victims in 2022 whose seat belt use was documented, half were not wearing one. +- Benefit: According to NHTSA estimates, seat belts lower the risk of fatal injury for front‑seat occupants of cars by 45% and for those in light trucks by 60%. In 2022, half of the U.S. fatalities in passenger cars had no recorded seat belt use. The World Health Organization states that seat belts can reduce the risk of death inside a vehicle by up to 50%. WHO also estimates that in 2021, 248,099 people died in road crashes in China, which translates to 17.4 deaths per 100,000 people. +- Evidence grade: A +- Notes: Seat belts must be worn in the back seat as well. In the same report, 60% of rear‑seat occupants killed in crashes were not wearing belts. The 45% and 60% figures are NHTSA estimates derived from crash‑database analysis (Kahane 2015), not from randomized trials. The Chinese death toll cited by WHO is a projection and is several times higher than official police statistics; the two figures cover different populations, so only the WHO estimate is used here. +- Sources:NHTSA (2024). Occupant Protection in Passenger Vehicles: 2022 Data (DOT HS 813 573). ; WHO (2025). Road traffic injuries fact sheet. ; WHO GHO RS_196/RS_198 (China, 2021). + +### 2. Wearing a helmet and fastening the strap while riding motorcycles or e-bikes + +- Cost: A helmet costs between 100 and 300 yuan. It takes just 5 seconds to put on each time. +- In plain terms: Wearing a helmet and fastening the strap properly reduces a motorcyclist’s risk of dying in an accident by roughly 40%. The chance of suffering a head injury drops by about 70%. The strap must be tightened; a helmet that simply hangs loosely on the head does not count as being worn. +- Benefit: Cochrane pooled data from multiple studies. For motorcyclists wearing helmets, the risk of death fell by 42%. The original odds ratio was 0.58, with a 95% confidence interval ranging from 0.50 to 0.68. Head injuries were reduced by 69% (odds ratio 0.31; 95% CI 0.25–0.38). +- Evidence grade: A +- Notes: The helmet strap must be fastened securely. A helmet left hanging on the handlebars does not count as being worn. The figures above apply specifically to motorcycles. For e-bikes, no direct studies exist, but the mechanics of head injury in a crash remain the same. +- Sources:Liu BC 等 (2008). Helmets for preventing injury in motorcycle riders. Cochrane Database of Systematic Reviews. + +### 3. Install smoke alarms; those heating with coal or gas in winter should also add a carbon monoxide alarm + +- Cost: A smoke alarm costs between 30 and 100 yuan. A carbon monoxide alarm costs between 50 and 150 yuan. After installation, the batteries need to be replaced once a year. +- In plain terms: A properly functioning smoke alarm can cut the risk of dying in a home fire by roughly 60%. Forty percent of fire victims are asleep at the time, so they won’t wake up just from the smell of smoke. For anyone heating their home with coal or gas during winter, adding a carbon monoxide alarm is essential. In China, 11,500 people died from carbon monoxide poisoning in 2018; 70% of those deaths occurred at home during the three winter months. +- Benefit: A study in North Carolina examined homes that had experienced fires versus those that hadn’t. It found that having a working smoke alarm lowered the death risk by about 60%. The odds ratio was 0.39, with a 95% confidence interval ranging from 0.18 to 0.83. Between 2018 and 2020, 24% of fatal residential fires in the U.S. happened in homes without smoke alarms, and 41% of victims were asleep when the fire started. In 2018, China reported 11,523 deaths from carbon monoxide poisoning; of these, 72.59% occurred at home in December, 67.42% in January, and 66.48% in February. +- Evidence grade: B +- Notes: This grade is assigned because only one study exists on smoke alarms; it compared past fire incidents in various homes rather than using a randomized trial design. No research has shown that carbon monoxide alarms reduce mortality rates. The reported benefits are inferred from the fact that most poisoning deaths happen at home during winter. +- Sources:Marshall SW 等 (1998). Fatal residential fires: who dies and who survives? JAMA. ; USFA (2022). Fatal Fires in Residential Buildings (2018-2020), Topical Fire Report Series 22(2). ; You J 等 (2020). Number of Deaths due to Carbon Monoxide Poisoning by Month and by Place of Death — China, 2018. China CDC Weekly. + +### 4. Replace gas hoses and stoves when they reach their expiration date; never modify the piping yourself, and you may decline any unsolicited sales pitches from gas companies. + + +- Cost: A compliant gas hose costs just a few dozen yuan. Stoves should be replaced every few years; during such replacements, it’s wise to check whether any components have passed their expiration date. +- In plain terms: A properly certified gas hose costs only a few dozen yuan. Replacing it when it expires is a mandatory obligation for users, as clearly stated in the Regulations on Urban Gas Management. The same regulations explicitly forbid any unauthorized modification of gas piping or removal of gas meters. Moreover, they stipulate that gas companies may not compel customers to purchase specific products or services. Therefore, if a representative from a gas company shows up claiming that replacement is mandatory, you have every right to refuse. +- Benefit: The Regulations explicitly define it as a user obligation to promptly replace any gas appliances or connecting hoses that have been phased out by national policies or have exceeded their designated service life. Conversely, any unauthorized installation, modification, or removal of household gas facilities or metering devices is strictly prohibited. Additionally, the Regulations make it clear that gas providers may not demand that customers buy particular products or accept specific services. +- Evidence grade: A +- Notes: Some individuals pose as gas safety inspectors and, after conducting a brief check, attempt to sell self-closing valves and alarms. Article 20, Paragraph 6 of the Regulations effectively blocks such practices, allowing you to refuse these offers or even file a complaint. (Pending verification: There is currently no official text available for direct cross-checking regarding the precise steps to take upon detecting a gas leak—such as opening windows, shutting off valves, avoiding any electrical switches, and calling emergency services from outside. Carbon monoxide poisoning is addressed separately in Section 13.) +- Sources:国务院 (2010). 城镇燃气管理条例（国务院令第 583 号）第二十七条：「燃气用户应当遵守安全用气规则，使用合格的燃气燃烧器具和气瓶，及时更换国家明令淘汰或者使用年限已届满的燃气燃烧器具、连接管等」；第二十八条禁止行为含「（一）擅自操作公用燃气阀门」「（二）将燃气管道作为负重支架或者接地引线」「（四）擅自安装、改装、拆除户内燃气设施和燃气计量装置」；第二十条燃气经营者不得「（六）要求燃气用户购买其指定的产品或者接受其提供的服务」；第二十九条用户可就收费、服务向燃气管理等部门投诉，「有关部门应当自收到投诉之日起15个工作日内予以处理」. + +### 5. Do not pick, buy, or eat wild mushrooms; any “folk tricks” for identification are useless + + +- Cost: No expense involved. The hard part is giving up a seasonal delicacy. +- In plain terms: In 2025 alone, there were 828 cases of mushroom poisoning across China, affecting 2,165 people, with 13 fatalities. That same year, 34 previously unknown poisonous mushroom species were identified. Myths such as using a silver needle to test for toxicity, assuming mushrooms safe if insects eat them, or that only brightly colored varieties are toxic are all false. +- Benefit: The Chinese CDC investigated 828 mushroom poisoning cases in 2025 involving 2,165 individuals; the mortality rate was 0.6%. From 2019 to 2024, annual cases ranged from 276 to 676, with mortality rates between 0.87% and 2.86%. In 2025 alone, 138 poisonous mushroom species were identified, including 34 new ones never documented before as causing poisoning. +- Evidence grade: A +- Notes: If you accidentally eat poisonous mushrooms, induce vomiting immediately and then go to the hospital with any remaining mushrooms or photos of them. There are several types of mushroom poisoning, and identifying the exact species is crucial for proper treatment. New poisonous species are discovered each year, so the assumption that “local people can recognize them” is unfounded. Claims such as silver needle testing, cooking with garlic, insect consumption indicating safety, or vivid colors signaling toxicity are all incorrect. +- Sources:Mushroom Poisoning Outbreaks — China, 2025. China CDC Weekly (2026)：「In 2025, China CDC investigated 828 mushroom poisoning incidents across 27 provincial-level administrative divisions (PLADs), affecting 2,165 individuals and causing 13 deaths - a case fatality rate of 0.6%, the lowest of the past six years. In total, 138 poisonous mushroom species were identified, including 34 newly recorded in poisoning incidents in China.」「From 2019 to 2024, the annual number of incidents ranged from 276 to 676, and the case fatality rate ranged from 0.87% to 2.86%.」；同刊 2024 年度报告 + +### 6. Do not push e-bikes into stairwells, elevators, or charge them at home + +- Cost: No direct cost. The tricky part is having to walk a few dozen meters each time to reach the designated charging stations downstairs. +- In plain terms: Pushing an e-bike into a stairwell or elevator, or charging it at home, is strictly prohibited under the Ministry of Emergency Management’s “Regulations on Fire Safety Management in High-Rise Civil Buildings.” Those who violate the rule face fines of 500–1,000 yuan for individuals and 2,000–10,000 yuan for businesses. Even the fines are the lesser concern; the real danger is that a fire could erupt right in your only escape route. +- Benefit: The regulations explicitly forbid “parking e-bikes or charging them in public lobbies, evacuation corridors, stairwells, or emergency exits of high-rise civil buildings.” In other words, these areas must remain completely free of both parked bikes and charging equipment. Noncompliance results in the same fines mentioned above. +- Evidence grade: A +- Notes: Avoid buying modified batteries or generic chargers, and never leave a charger plugged in overnight. Once a lithium battery catches fire, it can ignite the entire area within seconds while releasing highly toxic fumes. A bike blocking a stairwell essentially turns that very path into a fire trap. TODO: Verify official annual statistics on the number of e-bike fires and related fatalities nationwide. +- Sources:应急管理部 (2021). 高层民用建筑消防安全管理规定（应急管理部令第 5 号，第三十七条、第四十七条）. + +### 7. Measuring blood pressure and taking meds to reach target levels + +- Cost: An electronic sphygmomanometer costs 100–200 RMB. Each measurement takes 1 minute. Most antihypertensive drugs cost just a few to dozens of RMB per month. The hard part is keeping the medication regimen even when there are no symptoms. +- In plain terms: For every 10 mmHg drop in blood pressure, the risk of major cardiovascular problems falls by 20%, stroke risk drops 27%, heart failure risk drops 28%, and overall mortality risk declines by 13%. Among Chinese adults aged 35–75, 44.7% have hypertension, but only 7.2% have their blood pressure under proper control. +- Benefit: Data from 123 clinical trials involving over 610,000 participants shows that a 10 mmHg reduction in systolic blood pressure lowers the incidence of major cardiovascular events by roughly 20%. The relative risk is 0.80, with a 95% confidence interval of 0.77–0.83. Systolic blood pressure is the higher of the two readings taken during a measurement. Stroke risk drops by 27% (RR 0.73), heart failure risk drops by 28% (RR 0.72), and overall mortality drops by 13% (RR 0.87, 95% CI 0.84–0.91). A screening program in China involving 1.7 million adults aged 35–75 found that 44.7% had hypertension; of these, 44.7% were aware of their condition, 30.1% were receiving treatment, and only 7.2% had their blood pressure under control. +- Evidence grade: A +- Notes: Start by getting your blood pressure measured at least once. Fewer than 1 in 10 Chinese adults with hypertension manage to keep their levels under control, so this single measurement is one of the most cost-effective actions you can take as outlined in this book. There is still some debate over what exact target level (130 or 140 mmHg) is ideal, but there is no dispute that knowing you have hypertension and taking steps to lower it is highly beneficial. +- Sources:Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. ; Lu J 等 (2017). Prevalence, awareness, treatment, and control of hypertension in China (China PEACE Million Persons Project). Lancet. + +### 8. After age 35, anyone who is overweight should get a fasting blood glucose test; if the result is normal, repeat it every three years. + +- Cost: A fasting blood glucose test costs just a few dozen yuan. Testing for glycated hemoglobin is a bit pricier, still only a few dozen yuan. All it takes is one blood draw at a clinic. +- In plain terms: For just a few dozen yuan, a single blood test can detect prediabetes even when there are absolutely no symptoms at all. Official US screening guidelines recommend this test for anyone aged 35 to 70 who is overweight or obese. If the test comes back normal, they should repeat it every three years. +- Benefit: The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current guidance states that adults aged 35 to 70 who are overweight or obese — even with no symptoms at all — should be screened for prediabetes and type 2 diabetes. Overweight is defined as a BMI of 25 or higher, while obesity means a BMI of 30 or higher. This recommendation is rated as a Grade B. The Task Force also explicitly notes: “It is reasonable to screen adults with normal blood glucose levels for prediabetes every three years.” +- Evidence grade: A +- Notes: Having a prediabetes diagnosis does not mean you must start taking medication right away. Many people can fully reverse this condition simply by making lifestyle changes. In China, only a small fraction of adults are aware they have diabetes; most only find out after developing complications. +- Sources:US Preventive Services Task Force (2021). Screening for Prediabetes and Type 2 Diabetes. + +### 9. Don’t speed or drive after drinking + +- Cost: There’s no direct cost. Driving a bit slower adds just a few minutes to each trip. The hard part is drinking less at social gatherings. +- In plain terms: On average, for every 1% increase in speed, the chance of a fatal crash rises by roughly 4%. There is no “safe” level of alcohol consumption when it comes to driving; even very low blood alcohol concentrations already raise the risk of accidents. +- Benefit: According to the World Health Organization (WHO), a 1% rise in average speed translates to a 4% increase in the likelihood of fatal crashes. The risk of a fatal crash also climbs steadily as blood alcohol concentration rises, even at very low levels. +- Evidence grade: B +- Notes: The 1% and 4% figures linking speed to fatalities come from accident modeling rather than controlled trials. For alcohol and driving, WHO only provides a general trend without specific numerical values. This section does not verify any original research on exactly how much drinking raises risk. +- Sources:WHO (2025). Road traffic injuries fact sheet. + +### 10. Use a car seat for children under 4, don’t hold them in your arms + +- Cost: A seat costs between 300 and 2,000 yuan and lasts several years. It adds about one minute to each trip to buckle the child in. +- In plain terms: For infants under one year old, using a car seat cuts the risk of a fatal injury in a crash by roughly 70%. For children aged 1 to 4, the risk drops by about half. Holding a child in your arms provides no such protection; in a sudden stop you simply cannot keep them secure. +- Benefit: According to the U.S. National Highway Traffic Safety Administration (NHTSA), car seats lower the risk of fatal injury for infants under one year old by 71% and for children aged 1 to 4 by 54%. The World Health Organization reports a similar 71% reduction in infant deaths. +- Evidence grade: A +- Notes: Follow the manufacturer’s instructions to install the seat correctly; a faulty installation offers no protection. Infants under one year must be placed rear‑facing. These figures are based on official U.S. crash data. +- Sources:NHTSA (2024). Occupant Protection in Passenger Vehicles: 2022 Data (DOT HS 813 573). ; WHO (2025). Road traffic injuries fact sheet. + +### 11. Install window guards and balcony barriers if you have kids at home; screen windows do not count as protection + +- Cost: A set of window guards or child safety locks costs just a few dozen yuan to install, and the whole process takes only ten minutes. +- In plain terms: These window guards cost only a few dozen yuan each. New York City once offered free window guards to high-risk households and provided on-site guidance; as a result, child fall incidents reported in one borough dropped by half over three years. Eventually, New York even passed a law requiring landlords to install such guards in rental units with kids under 10. Screen windows, however, can be easily pushed open — they do not provide any real protection. +- Benefit: Since 1972, New York City has run a program called “Kids Can’t Fly,” which distributes free window guards in high-risk neighborhoods and offers on-site safety guidance. Between 1973 and 1975, child fall incidents reported in the Bronx dropped by 50%. Following this success, New York updated its health code to make it mandatory for landlords to install window guards in all apartments housing kids under 10 years of age. +- Evidence grade: B +- Notes: Avoid placing beds, sofas, boxes, or any other objects near windows or balconies that kids might climb onto. Screen windows only keep mosquitoes out; they can be easily pushed open, so never rely on them as a safety barrier. This protection is needed even on lower floors: most child falls recorded in U.S. data actually occur on the second floor or even lower. +- Sources:Spiegel CN, Lindaman FC (1977). Children can't fly: a program to prevent childhood morbidity and mortality from window falls. American Journal of Public Health：「Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975」，1976 年纽约市卫生法典修订「to require that landlords provide window guards in apartments where children ten years old and younger reside」. ；(2021). Unintentional Window Falls in Children and Adolescents. Academic Pediatrics：2007 年 1 月至 2017 年 8 月全国电子伤害监测系统 38,840 例急诊就诊，「The majority of falls occurred in children under the age of 6 and were related to falls from a second story or below」. + +### 12. Keep young children in sight near water; wear life jackets when boating or swimming + + +- Cost: Life jackets cost between 50 and 200 yuan. Additionally, parents must dedicate constant attention to watching their children. +- In plain terms: Wearing a life jacket while in the water cuts the risk of drowning to roughly half compared to not wearing one. Drowning remains the leading cause of death among children aged 1–14 in China. The drowning mortality rate in rural areas is roughly twice that in cities. +- Benefit: Research using U.S. Coast Guard data compared similar groups of people. For individuals who fell overboard while boating recreationally, wearing a life jacket lowered their drowning risk by about half. The unadjusted RR was 0.51, with a 95% CI of 0.35–0.74. In China, the drowning mortality rate among people under 20 fell from 6.60 per 100,000 in 2013 to 3.28 per 100,000 in 2021; rural rates remained roughly twice those in cities. Drowning continues to be the top cause of death for children aged 1–14. In 2021, drowning accounted for 31.1% of all injury-related deaths among those aged 0–19, while road traffic injuries accounted for 27.9%. +- Evidence grade: A +- Notes: The Grade A rating applies only to the protective effect of life jackets. The practice of keeping children within sight is widely accepted but only qualifies for a Grade C rating due to lack of randomized trials; no such trials are expected in the future. In China, drowning deaths occur most often in rural areas during summer months, and among males aged 15–19. +- Sources:Cummings P 等 (2011). Association between wearing a personal floatation device and death by drowning among recreational boaters. Injury Prevention. ; Li Z 等 (2023). Unintentional Drowning Mortality Among Individuals Under Age 20 — China, 2013–2021. China CDC Weekly. ; Zhou J 等 (2024). Injury Mortality of Children and Adolescents Aged 0–19 Years — China, 2010–2021. China CDC Weekly. + +### 13. Exercising balance and leg strength for people over 60, plus home modifications + + +- Cost: Aim to practice balance exercises two to three times per week, each session lasting 30 minutes — activities like Tai Chi work well. Installing non-slip mats, handrails, and night lights in bathrooms and stairways costs anywhere from a few dozen to several hundred yuan. The real challenge is maintaining this routine over the long term. + +- In plain terms: Doing balance exercises such as Tai Chi two or three times weekly can cut the overall number of falls among older adults by roughly 23%. It also reduces the proportion of people who have fallen at least once by about 15%. Adding simple home modifications — like anti-slip mats and handrails — can lower fall rates by another 20% or so. Falls are the leading cause of injury-related deaths among Chinese seniors aged 65 and above; alarmingly, over half of all falls happen right at home. + +- Benefit: Cochrane analyzed 108 separate trials involving 23,407 participants. Collectively, these studies show that regular exercise lowers fall rates among older adults by 23%. The relative risk of falls dropped to 0.77, with a 95% confidence interval ranging from 0.71 to 0.83. The proportion of individuals experiencing at least one fall also fell by 15% (relative risk 0.85). Professional home safety assessments and modifications further reduced fall rates by roughly 20% (RR 0.81; 95% CI 0.68–0.97). Practicing Tai Chi specifically lowered fall risk by about 29% (RR 0.71). In China, falls remain the top cause of injury-related mortality for seniors over 65; data from 2018 indicates that 55.97% of all falls among this age group occur at home. + +- Evidence grade: A + +- Notes: This recommendation applies to seniors aged 60 and above who live independently at home rather than in nursing homes. The studies referenced here focus on the total number of falls, not on actual mortality rates. It’s important to note that the path from a fall to a hip fracture — and ultimately death — can be very short for older adults. +- Sources:Sherrington C 等 (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. ; Gillespie LD 等 (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. ; Lu Z 等 (2021). Characteristics of Falls Among Older People — China, 2018. China CDC Weekly. + +### 14. Get tested for hepatitis B markers; if no antibodies, get vaccinated + +- Cost: The test costs just a few dozen yuan per person. For adults lacking antibodies, three doses of the hepatitis B vaccine cost between 100 and 300 yuan total, to be completed within six months. +- In plain terms: The test itself is very inexpensive. In Qidong’s 30‑year follow‑up study, infants who received the hepatitis B vaccine at birth had an 84% lower risk of developing primary liver cancer and a 72% lower rate of carrying the hepatitis B virus compared to unvaccinated peers. Adults found to have no antibodies should receive three vaccine doses over six months at a cost of roughly 100–300 yuan. +- Benefit: This Qidong trial used group randomization rather than individual assignment and was tracked for three decades. Vaccination at birth cut primary liver cancer incidence by 84% (95% CI 23%–97%). The prevalence of hepatitis B surface antigen (HBsAg) fell by 72% (95% CI 68%–75%), reflecting a comparable drop in the proportion of people carrying the virus. Nationwide in China, HBsAg prevalence dropped 52% between 1992 and 2014, and fell 97% among children under five. +- Evidence grade: A +- Notes: This recommendation applies to adults born before 1992 who never received the vaccine or whose antibodies have waned. The 84% cancer‑risk reduction pertains only to those immunized at birth; adolescents vaccinated later saw only a 21% reduction in virus carriage. For adults, the main goal is preventing new infection, not achieving the same cancer‑prevention benefit. Vaccination offers no protection to people already infected; they must see a hepatologist regularly. Infection is confirmed when the hepatitis B surface antigen (HBsAg) test result is positive. +- Sources:Qu C 等 (2014). Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study. PLoS Medicine. ; Cui F 等 (2017). Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China. Emerging Infectious Diseases. + +### 15. If you get pricked by a nail or splinter, or if a wound gets dirty with soil, treat it the same day and ask whether a tetanus shot is needed. + +- Cost: Seeing a doctor and having the wound treated costs just a few dozen yuan. If the doctor recommends a tetanus shot or immunoglobulin, those cost anywhere from several dozen to a few hundred yuan. +- In plain terms: Once tetanus sets in, about 1 out of every 10 people dies. The risk is highest for deep wounds or wounds contaminated with soil. Treating such a wound on the same day costs only a few dozen yuan — don’t wait until it starts swelling to seek care. +- Benefit: In the United States, roughly 1 out of every 10 people with tetanus dies. The risk is similarly higher for deep wounds or wounds exposed to soil. +- Evidence grade: B +- Notes: At the hospital, let the doctor decide — don’t make the call yourself, and don’t skip asking out of convenience. Not every wound requires a tetanus shot: the doctor will assess the wound type and your vaccination history before deciding. The idea that “one shot in childhood provides lifelong protection” is false; a booster is needed roughly every 10 years. TODO (pending verification: the wound classification and immunization schedule table in the main text of China’s “Diagnosis and Treatment Guidelines for Non‑Neonatal Tetanus (2024 Edition)”; the appendix is a PDF that cannot be read on this device). +- Sources:美国疾病控制与预防中心. 破伤风：「Tetanus bacteria can get into someone's body through broken skin, usually through injuries.」「Tetanus can lead to death (1 in 10 cases in the United States are fatal).」「People who didn't complete the primary series or who aren't up to date with their 10-year tetanus booster shots are also at increased risk.」「Vaccination also helps prevent tetanus in people with wounds, depending on their tetanus vaccination history.」；国家卫生健康委办公厅 (2024). 关于印发非新生儿破伤风诊疗规范（2024 年版）的通知（国卫办医急函〔2024〕381 号）. + +### 16. The earlier women get the HPV vaccine, the better + +- Cost: Domestic bivalent vaccines cost around 300 RMB per dose, while imported 9‑valent vaccines cost about 1300 RMB per dose. A total of 2–3 doses are needed, and each visit takes half a day. +- In plain terms: Data from 1.67 million Swedish women show that those who received the HPV vaccine before age 17 have only about one‑eighth the risk of developing invasive cervical cancer compared to unvaccinated women. For women vaccinated between 17 and 30, the risk is roughly half that of non‑vaccinated peers. Therefore, getting vaccinated earlier offers the greatest benefit. +- Benefit: Swedish research on 1.67 million women found that vaccinated individuals have a much lower incidence of invasive cervical cancer. Before age 17, vaccination reduces risk by roughly 88% (IRR 0.12, 95% CI 0.00–0.34). Vaccination between 17 and 30 still lowers risk by about 53% (IRR 0.47, 95% CI 0.27–0.75). +- Evidence grade: A +- Notes: The greatest benefit is seen when vaccination occurs between ages 9 and 14. Even for women aged 17–30, risk is still reduced by more than half. After age 30, the protective effect gradually diminishes. Vaccinated women still need regular cervical cancer screening; the vaccine does not replace screening — see item 18 for screening guidelines for women over 30. +- Sources:Lei J 等 (2020). HPV Vaccination and the Risk of Invasive Cervical Cancer. New England Journal of Medicine. + +### 17. Breast cancer screening for women: mammograms every two years starting at age 40 + +- Cost: A mammogram costs around 200–300 yuan each time. Many regions also offer free screening programs. Each screening takes about half a day. +- In plain terms: For women aged 40 to 74, having a mammogram every two years is a clear recommendation in official US screening guidelines. For women over 75, and for those with dense breast tissue who need extra ultrasound or MRI scans, there is currently insufficient evidence to support such screening. If a health check package includes these extra tests at an extra charge, they are not necessary. +- Benefit: The US Preventive Services Task Force is the official body that issues screening recommendations in the US. Its current recommendation reads: “We recommend screening mammography every two years for women aged 40 to 74.” Mammography is exactly what we commonly call a mammogram. This recommendation is rated as a Grade B. For women over 75, and for those with dense breast tissue who need additional ultrasound or MRI scans, the Task Force has concluded that there is not enough evidence to support such screening. +- Evidence grade: A +- Notes: The recommended starting age for screening varies by country. In China, some local guidelines and programs recommend starting at age 45. Women with a family history of breast cancer — such as parents, children or siblings who have had it — or those carrying BRCA mutations are at higher risk. They should consult a doctor individually to determine the right screening plan; the above recommendations do not apply to them. +- Sources:US Preventive Services Task Force (2024). Breast Cancer: Screening. + +### 18. For women over 30, HPV testing should be the first choice for cervical cancer screening + +- Cost: An HPV test costs between 100 and 300 yuan. Women with a negative result can get tested again only once every five years. The sampling process takes just a few minutes. +- In plain terms: In that rural Indian trial, women who underwent just one HPV test in their lifetime had roughly half the risk of dying from cervical cancer and about 50% lower odds of being diagnosed with advanced-stage disease. At a cost of just 100–200 yuan per test, a negative result provides protection for five years. +- Benefit: This trial in rural India used group-level rather than individual randomization, involving women aged 30–59. A single HPV test cut the risk of death from cervical cancer by roughly 48% (hazard ratio 0.52; 95% CI 0.33–0.83). It also reduced the likelihood of detecting late-stage disease by about 53% (HR 0.47; 95% CI 0.32–0.69). +- Evidence grade: A +- Notes: Even women who have received the HPV vaccine still need screening, since the vaccine does not protect against all viral types. What makes this study unique is that it was a randomized screening trial with mortality as the primary outcome and only one round of testing performed. +- Sources:Sankaranarayanan R 等 (2009). HPV screening for cervical cancer in rural India. New England Journal of Medicine. + +### 19. Starting colorectal cancer screening at ages 45–50: use fecal immunochemical tests or colonoscopies + +- Cost: Fecal tests cost just a few dozen yuan and can be done every 1–2 years. Colonoscopies cost several hundred to over a thousand yuan; those with negative results only need one every 10 years. Preparing for a colonoscopy requires setting aside a full day for bowel cleansing. +- In plain terms: Getting a low-cost fecal occult blood test every year or two lowers the chance of dying from colorectal cancer by roughly 16%. For people who’ve had at least one round of screening, this risk drops by about 25%. In the group invited to undergo a colonoscopy, the likelihood of developing colorectal cancer over the next decade fell from 1.20% to 0.98%. +- Benefit: Cochrane pooled data from multiple studies showing that individuals undergoing fecal occult blood screening have a roughly 16% lower risk of dying from colorectal cancer. The original RR was 0.84, with a 95% CI ranging from 0.78 to 0.90. For those who’ve had at least one screening round, this risk reduction reaches 25% (RR 0.75). The NordICC randomized trial likewise found that among participants invited to get a colonoscopy, colorectal cancer incidence dropped from 1.20% to 0.98% over 10 years; its RR was 0.82, with a 95% CI of 0.70–0.93. +- Evidence grade: A +- Notes: This topic remains debated. The NordICC trial tracked participants based on whether they were invited to get a colonoscopy; the difference in colorectal cancer mortality between groups was 0.28% versus 0.31% (RR 0.90, 95% CI 0.64–1.16), a gap well within statistical margins of error. This suggests earlier estimates of colonoscopy’s mortality benefits may have been overstated, while evidence for fecal tests’ impact on mortality is more robust. Most national guidelines recommend starting screening at ages 45–50; those with a family history of colorectal cancer should begin even earlier. +- Sources:Hewitson P 等 (2007). Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database of Systematic Reviews. ; Bretthauer M 等 (2022). Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. New England Journal of Medicine. + +### 20. People with cardiovascular disease and older adults should get a flu shot each year + +- Cost: One shot costs 50 to 150 yuan. It should be given once each autumn. +- In plain terms: In a trial involving people after a heart attack, the yearly death rate dropped from 4.9% to 2.9% after they received the flu vaccine. For people with cardiovascular disease and older adults, getting one shot each autumn for just 50 to 150 yuan can make a real difference. +- Benefit: This trial included 2,571 participants after a myocardial infarction; neither doctors nor patients knew who got the vaccine or the placebo. Over 12 months, the overall death rate was 2.9% in the vaccine group versus 4.9% in the placebo group. The hazard ratio was 0.59, with a 95% confidence interval of 0.39 to 0.89. Cardiovascular death rates also showed a hazard ratio of 0.59. Another study pooled multiple trials and found that flu vaccination lowered the rate of major cardiovascular events to 3.6% from 5.4% in the control group; the relative risk was 0.66, with a 95% confidence interval of 0.53 to 0.83. Cardiovascular death risk showed a relative risk of 0.74, though this fell within the margin of error and was not statistically significant (95% CI 0.42 to 1.30). +- Evidence grade: A +- Notes: This recommendation is somewhat controversial. The Grade A rating applies only to people with cardiovascular disease. For otherwise healthy older adults, a Cochrane review offers only limited evidence. Flu vaccination also lowered the seasonal flu infection rate from 6% to 2.4%. The review rated the evidence for infection outcomes as “low” quality and the evidence for mortality as “very low” quality. This review was published in 2018 by Demicheli V et al. +- Sources:Fröbert O 等 (2021). Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation. ; Behrouzi B 等 (2022). Association of Influenza Vaccination With Cardiovascular Risk: A Meta-analysis. JAMA Network Open. ；Demicheli V 等 (2018). Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews. （备注里说的那份 Cochrane 汇总） + +### 21. Getting the shingles vaccine after age 50 + +- Cost: The recombinant shingles vaccine requires two doses, costing roughly 3,000 to 4,000 yuan in total. This expense must be paid out of pocket. +- In plain terms: In Phase 3 trials, this vaccine proved 97% effective at preventing shingles across all age groups. The downside is that both doses cost several thousand yuan, all paid by the patient. In exchange, there’s a 97% reduction in the likelihood of developing shingles. +- Benefit: This Phase 3 trial involved 15,400 participants from 18 countries. Participants were randomly assigned to receive either the vaccine or a placebo, with follow-up lasting an average of 3.2 years. Over that time, 6 cases of shingles occurred in the vaccine group versus 210 in the placebo group. Expressed per 1,000 person-years, these figures translate to 0.3 versus 9.1 cases. One thousand person-years represents the number of cases observed in a group of 1,000 people over one year. The original report states, “The overall vaccine efficacy against shingles is 97.2% (95% CI 93.7–99.0, P<0.001).” Effectiveness ranged from 96.6% to 97.9% across all age brackets. +- Evidence grade: A +- Notes: This option ranks low in terms of cost-effectiveness primarily due to its high price. While shingles itself rarely proves fatal, its most troublesome complication is post-herpetic neuralgia, which can persist for months or even years. After vaccination, a notable percentage of recipients experience pain at the injection site and fever. In particular, severe side effects (graded as Grade 3) occurred in 17.0% of vaccine recipients versus 3.2% of those given a placebo. +- Sources:Lal H, Cunningham AL, Godeaux O, et al. (2015). Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. New England Journal of Medicine, 372(22), 2087-2096. + +### 22. Pneumococcal vaccine for people over 65 + +- Cost: Several hundred yuan. In some regions, it is provided free of charge for seniors. +- In plain terms: In a trial involving 84,500 seniors, the 13-valent pneumococcal vaccine cut cases of pneumonia caused by strains it targets by roughly 46%, and reduced instances of the most severe invasive infections by 75%. However, it showed no effect on pneumonia cases caused by any other pathogens, so it won’t prevent all types of pneumonia. The absolute confidence interval width is 95.2%. +- Benefit: Researchers in the Netherlands randomly assigned 84,500 seniors over 65 to two groups for comparison. They used the 13-valent pneumococcal conjugate vaccine. Its effectiveness against pneumonia caused by strains it targets was 45.6%, with a 95% confidence interval of 21.8–62.5. This figure refers to the specific bacterial strains the vaccine can protect against. For the most dangerous form of pneumococcal disease, the effectiveness was 75.0% (95% CI 41.4–90.8). No protective effect was observed against pneumonia cases caused by any other pathogens. +- Evidence grade: A +- Notes: This vaccine only protects against the specific bacterial strains it targets; it does not prevent all types of pneumonia. The 23-valent polysaccharide vaccine commonly used for seniors in China is a different formulation from the 13-valent conjugate vaccine used in this trial, so the effectiveness figures here cannot be directly applied to that vaccine. +- Sources:Bonten MJ, Huijts SM, Bolkenbaas M, et al. (2015). Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. New England Journal of Medicine, 372(12), 1114-1125. + +### 23. Testing for Helicobacter pylori and eradicating it if positive + +- Cost: The carbon-13 or carbon-14 breath test costs 100 to 200 yuan. Eradicating the bacteria requires taking four different medications for two weeks; the medication cost for that period is 200 to 500 yuan. The main difficulty is ensuring the full two-week course of medication is taken on schedule. +- In plain terms: A 22-year follow-up study conducted in Linqu, Shandong, showed that individuals who had Helicobacter pylori eradicated had roughly half the risk of developing gastric cancer and about 40% lower risk of dying from it. Testing costs just 100–200 yuan, while eradication requires a two-week medication regimen. +- Benefit: This randomized trial in Linqu, Shandong, followed participants for 22 years. Those who underwent Helicobacter pylori eradication therapy saw their risk of gastric cancer drop by nearly half. The original odds ratio was 0.48, with a 95% confidence interval ranging from 0.32 to 0.71. Their risk of dying from gastric cancer also fell by roughly 38% (hazard ratio 0.62; 95% CI 0.39–0.99). +- Evidence grade: A +- Notes: Reinfection can still occur after eradication, so it is advisable for all household members to be tested and treated together. This trial involved residents of an area with a high incidence of gastric cancer; people living in regions with lower incidence may gain considerably less benefit. +- Sources:Li WQ 等 (2019). Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial. BMJ. + +### 24. Heavy smokers should get a low-dose chest CT once a year + +- Cost: The test costs 200–400 yuan per session and takes just 10 minutes. You must also factor in follow-up tests after any false alarms, plus the anxiety that comes with waiting for results. +- In plain terms: Eligible heavy smokers who get a low-dose CT once a year have a 20% lower risk of dying from lung cancer and a 6.7% lower overall risk of death compared to those who only get regular chest X-rays. The trade-offs are extra follow-up tests after any suspicious findings and the resulting worry during the waiting period. +- Benefit: The NLST trial in the U.S. enrolled 53,454 participants aged 55–74 with at least 30 pack-years of smoking history and who had quit smoking no more than 15 years prior. Those who underwent low-dose CT had a 20.0% relative reduction in lung cancer deaths versus those who only got chest X-rays. The 95% confidence interval is 6.8–26.7. Overall mortality dropped by 6.7% relative to controls, with a 95% CI of 1.2–13.6. +- Evidence grade: A +- Notes: This recommendation applies only to high-risk smokers. In the same study, 24.2% of CT recipients showed suspicious findings, yet 96.4% of those cases turned out to be false positives. For non-smokers, undergoing this test offers no benefit and only adds unnecessary anxiety. +- Sources:National Lung Screening Trial Research Team (2011). Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine. + +### 25. Call 12356 if you’re depressed or having suicidal thoughts; don’t keep sleeping pills or pesticides at home + +- Cost: There’s no cost involved. You just need to make one phone call. Plus, lock away any medications and keep pesticides out of the house. +- In plain terms: Removing lethal items from easy reach is a proven way to cut suicide risk: after restricting access to painkillers, suicide rates linked to them dropped by 43%; installing barriers at locations where people often jump off cliffs cut rates by 86%. That’s why it’s a good idea to avoid storing sleeping pills and pesticides at home. If you’re feeling overwhelmed, call 12356 — this national helpline is available at least 18 hours a day. +- Benefit: A recent review of nearly a decade’s worth of research confirms that limiting people’s access to lethal means is an effective suicide prevention strategy. After controls on painkiller availability were put in place, suicide cases tied to these drugs fell by 43%. Installing protective barriers at common suicide hotspots reduced rates by 86% (the 95% confidence interval ranges from 79% to 91%). School-based cognitive intervention programs also lowered rates of attempted suicide by roughly 55% (OR 0.45, 95% CI 0.24–0.85). Antidepressant medications and psychotherapy are also key components of suicide prevention. Starting May 1, 2025, the 12356 helpline will be available nationwide in China, operating at least 18 hours each day. +- Evidence grade: B +- Notes: The B rating is based on two factors: most evidence supporting restrictive measures comes from ecological studies that compare suicide rates before and after policy implementation; there is currently no direct evidence that the helpline itself reduces overall mortality rates. Suicidal impulses typically last only a few minutes to a few hours, so simply removing lethal items from immediate reach is a meaningful intervention on its own. Data on outcomes over longer time periods following suicide attempts, as well as information on long-term consequences for survivors, can be found in Item 32 of this section (“Tell someone close to you as soon as suicidal thoughts arise”). +- Sources:Zalsman G 等 (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. ; 国家卫生健康委 (2024). 关于应用"12356"全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 26. Purchase fire extinguishers, fire blankets, escape respirators, and first-aid kits, then inspect them once a year + +- Cost: A set of fire extinguishers, fire blankets, one respirator per person, and a first-aid kit costs a few hundred yuan. You only need to buy it once; after that, it takes just 10 minutes each year to inspect the items. +- In plain terms: Fire extinguishers, fire blankets, escape respirators, and first-aid kits are all included in the Emergency Management Department’s list of 11 essential items for household emergency preparedness. The whole set costs a few hundred yuan, and you only need to buy it once. Studies of home safety programs that included on-site guidance found these measures cut injury rates by roughly 25%. +- Benefit: The Emergency Management Department’s “National Recommended List of Basic Household Emergency Supplies” contains 11 items in total. Among them, “fire extinguishers and fire blankets” are recommended for “putting out small fires at the initial stage”, and the list also notes that “fire blankets can be draped over the body to aid escape”. The “escape respirators” listed are “firefighting filtering self-rescue respirators designed for use during fire escapes”. “External medical supplies” refer to “hemostatic powder, adhesive bandages, gauze bandages, and other items used to treat wounds”. Cochrane analyzed 98 studies involving 2,605,044 participants in total. Home safety interventions lowered injury rates to an IRR of 0.89; the 95% confidence interval for this figure is 0.78 to 1.01. For interventions that included on-site guidance, injury rates dropped by around 25% (IRR 0.75, 95% CI 0.62 to 0.91). +- Evidence grade: B +- Notes: This finding is somewhat controversial. The same Cochrane meta-analysis found that interventions that did not provide emergency supplies also lowered injury rates by roughly 20%. The original IRR for those interventions was 0.78, with a 95% confidence interval of 0.66 to 0.92. Providing emergency supplies alone did not yield better results than other measures. The main effect of these interventions comes from on-site education and home modifications, so the benefit of supplying emergency supplies is rated as “moderate” rather than “significant”. When buying fire extinguishers, look for the CCC certification mark; for pre-pressurized extinguishers, make sure the pressure gauge needle points to the green zone. Details on smoke alarms and carbon monoxide detectors are covered in section 3 of this chapter. Instructions for using tourniquets can be found in section 13, item 12. Guidance on how to select, store, and replace each item can be found in [docs/家庭应急装备清单.md](../../docs/research/家庭应急装备清单.md). +- Sources:应急管理部 (2020). 全国基础版家庭应急物资储备建议清单. ; Kendrick D 等 (2012). Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews. ; 武胜县市场监督管理局 (2025). 手提式灭火器、防火门（窗）、点型感温（烟）火灾探测器消费提示. + +### 27. Visible blood in urine — even if painless and gone by the next day — still warrants a check-up + +- Cost: A routine urine test costs just a few dozen yuan, while a urinary-system ultrasound runs around 100–200 yuan. If a doctor deems it necessary, a cystoscopy can be added at a cost of roughly 1,000 yuan. +- In plain terms: Among people aged 60 and older, the chance of ultimately being diagnosed with bladder cancer after experiencing one episode of visible blood in urine is about 2.8%. For those aged 40–59, that figure is roughly 1.2%. These percentages may not seem very high, but they’re high enough to justify getting checked — even if the bleeding stops the very next day. +- Benefit: A UK study analyzed electronic medical records from primary-care clinics, comparing 4,915 patients diagnosed with bladder cancer against 21,718 controls. Among patients with visible blood in urine, the proportion ultimately found to have bladder cancer was 2.8% for those aged 60+, with a 95% confidence interval of 2.5–3.1. For ages 40–59, the figure was 1.2%, with a 95% CI of 0.6–2.3. This proportion is known as the positive predictive value. Blood visible only under a microscope also carries significance; the odds ratio is 20, with a 95% CI of 12–33. For those over 60, this figure is 1.6%, with a 95% CI of 1.2–2.1. +- Evidence grade: B +- Notes: The absence of pain is a key clue. Blood in urine caused by kidney stones or infections usually comes with abdominal or flank pain, plus frequent, urgent, or painful urination. Cancer-related bleeding, however, often causes no discomfort at all and may disappear for a few days before returning — which is why many people overlook it. Taking anticoagulant medications is not a valid reason to skip testing. Blood in urine after intense exercise or during a woman’s menstrual period can be re-evaluated before deciding on further checks. The benefit is rated “low” because it reflects only detection rates, not any measurable reduction in mortality resulting from early diagnosis. +- Sources:Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. British Journal of General Practice, 64(626), e584-e589. + +### 28. If erectile dysfunction appears, check cardiovascular health first — don’t treat it as a purely sexual issue + + +- Cost: A doctor’s visit costs just a few dozen yuan. Measuring blood pressure and running tests for blood sugar and cholesterol adds another hundred or so yuan. One trip to the hospital yields results after a few days. + +- In plain terms: Men with erectile dysfunction later develop cardiovascular disease at roughly 40% higher rates than other men, and heart attacks at about 60% higher rates. The younger a man is, the greater this difference becomes. This problem often shows up before any chest pain does. Therefore, it’s wise to check blood pressure, blood sugar, and cholesterol levels rather than simply self‑medicating. + +- Benefit: One meta‑analysis combined data from 14 long‑term studies involving 92,757 men, followed for an average of 6.1 years. Compared with men without erectile dysfunction, those with the condition faced higher risks as follows: overall cardiovascular events rose by roughly 44% (RR 1.44, 95% CI 1.27–1.63). Heart attacks increased by about 62% (RR 1.62, 95% CI 1.34–1.96). Cerebrovascular events rose by roughly 39% (RR 1.39, 95% CI 1.23–1.57). All‑cause mortality went up by about 25% (RR 1.25, 95% CI 1.12–1.39). No significant difference appeared for cardiovascular‑related deaths (RR 1.19, 95% CI 0.97–1.46). The risk elevation was greater in younger men and in those whose baseline cardiovascular risk was moderate. Studies that used questionnaire‑based diagnosis reported an RR of 1.61 (95% CI 1.38–1.86), while studies asking just one question gave an RR of 1.27 (95% CI 1.18–1.37). + +- Evidence grade: A + +- Notes: These 14 studies tracked groups of men over time; they are not randomized controlled trials. Hence the “40% higher” figure reflects an association, not a proven cause‑and‑effect relationship. Occasional episodes do not count; the condition is considered present only when symptoms persist for three months or more. The tests recommended — blood pressure measurement, fasting blood‑glucose testing, plus cholesterol checks, smoking status assessment, and waist‑circumference measurement — are the same as those listed in sections 7 and 8 of this chapter. Avoid purchasing “male‑enhancement” supplements online; legitimate medications for this purpose are prescription drugs, and their instructions list nitrates as a contraindication — meaning men already taking nitroglycerin or similar drugs must not use them, as doing so can cause a sudden drop in blood pressure. For ways to improve erectile function, see section 29 (weight loss and smoking cessation can help). The benefit is rated “moderate” rather than “large”: the 44% figure represents the difference between two groups, not the actual reduction in mortality achieved by testing. It is also not “small”; unlike the situation described in section 27 (visible blood in urine), where detection alone is the benefit, here hypertension, diabetes, and abnormal cholesterol levels each have established treatments available. +- Sources:Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes, 6(1), 99-109. ；DailyMed（美国国立医学图书馆的药品说明书库）. VIAGRA (sildenafil citrate) tablet, CONTRAINDICATIONS. + +### 29. Weight loss, quitting smoking, and controlling blood pressure and blood sugar can improve erectile function + +- Cost: There is no cost involved; in fact, it may even save money. The real challenge is staying consistent over time — eating healthily, exercising regularly, and quitting smoking. +- In plain terms: Managing cardiovascular risk factors naturally leads to better erectile function. When multiple randomized trials are combined, questionnaire scores improve by an average of 2 to 3 points. This questionnaire has a maximum score of 25, with scores above 22 considered normal. +- Benefit: One meta-analysis evaluated six randomized controlled trials involving 740 men. Interventions included lifestyle changes or medication to control cardiovascular risk factors, with follow-ups lasting at least six weeks. Overall, erectile function scores on the IIEF-5 questionnaire rose by an average of 2.66 points (95% CI: 1.86–3.47). When two trials using statins (143 participants) were excluded, the remaining four trials relying solely on lifestyle changes still showed an average improvement of 2.40 points (95% CI: 1.19–3.61). A total of 597 men participated in these four trials. The IIEF-5 consists of five questions scored from 5 to 25; scores between 22 and 25 indicate no erectile dysfunction, while scores of 5–7 indicate severe impairment. +- Evidence grade: A +- Notes: These six trials used different interventions — some combined weight loss and exercise, while others used medication to control blood pressure and lipids. With only 740 participants overall, the results confirm a positive trend, though the exact degree of improvement varies per individual. The benefit is rated as “minor” because the outcome measured was solely questionnaire scores, not actual reductions in disease incidence. However, similar lifestyle changes have been shown to produce measurable health benefits elsewhere: quitting smoking (see Section 2, Item 1), maintaining a BMI between 20–25 through weight control (Section 2, Item 33), and managing blood pressure with medication when necessary (Section 7). Prescription medications are acceptable when prescribed by a doctor; caution is advised with over-the-counter “health supplements,” which may contain unregulated amounts of active ingredients. For guidance on identifying safe products, see Section 28, Item 4. +- Sources:Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL (2011). The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Archives of Internal Medicine, 171(20), 1797-1803. ；Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research, 11(6), 319-326. + +### 30. Always use condoms during sex and never share needles + + +- Cost: A single condom costs just one or two yuan. The challenge isn’t the price, but making sure to use one every single time — and putting it on right from the start. + +- In plain terms: Using a condom every time throughout sex cuts the chance of HIV transmission between heterosexual partners by roughly 70% or more. “Most of the time” just isn’t enough — that still leaves the risk nearly as high as not using one at all. Condoms also protect against syphilis, gonorrhea, and other STIs. + +- Benefit: One study pooled data from 25 separate studies involving 10,676 heterosexual couples in which one partner was HIV‑positive and the other was not. Compared to couples who never used condoms, those who consistently used them saw their HIV transmission risk drop by about 71%. The reported relative risk was 0.29, with a 95% confidence interval of 0.20–0.43. When compared to couples who used condoms only intermittently, the risk was lower by roughly 77% (RR = 0.23; 95% CI 0.13–0.40). The authors concluded that although condoms are not perfect, “consistent use can reduce HIV transmission by more than 70%.” This same level of protection also applies to syphilis, gonorrhea, chlamydia, and other sexually transmitted infections. + +- Evidence grade: A + +- Notes: The difference between “infrequent use” and “no use” is minimal; the whole benefit hinges on the phrase “every time, throughout.” Sharing needles is a separate, highly effective route of transmission that has nothing to do with sex — this includes drug injection, tattooing, and piercing. For people at high risk, pre‑exposure prophylaxis (PrEP) offers another option: taking medication in advance to block infection. Pooled data from 18 studies show that when at least 70% of participants adhered to the regimen, PrEP cut HIV risk by about 70% compared to placebo (RR = 0.30; 95% CI 0.21–0.45). Trials with lower adherence rates showed no protective effect. PrEP is a prescription medication; consult an infectious‑disease specialist or public‑health clinic rather than ordering it online. Information on what to do after potential exposure can be found in Section 13. +- Sources:Giannou FK, Tsiara CG, Nikolopoulos GK, et al. (2016). Condom effectiveness in reducing heterosexual HIV transmission: a systematic review and meta-analysis of studies on HIV serodiscordant couples. Expert Review of Pharmacoeconomics & Outcomes Research, 16(4), 489-499. ；Fonner VA 等 (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. （暴露前预防 PrEP） + +### 31. If you’ve engaged in high‑risk behavior, get tested for HIV — the Chinese CDC offers free testing with full confidentiality. + + +- Cost: There is no charge. You simply visit the Chinese CDC or a designated medical facility and provide a blood sample. The only real hurdle is mustering the courage to get tested at all. + +- In plain terms: Testing for HIV at the Chinese CDC costs nothing. According to the “National Measures for HIV Testing Management,” staff are prohibited from disclosing your name, address, or test results. A positive result does not mean a death sentence: people who adhere to treatment and keep their viral load undetectable cannot transmit the virus to sexual partners. One major study followed more than 700 couples through over 70,000 unprotected acts; there were zero transmissions between partners. + +- Benefit: Article 23 of the “Regulations on HIV/AIDS Prevention and Control” mandates that local health authorities designate medical institutions to provide free counseling and initial screening to anyone who voluntarily seeks testing. Early detection is far more than a psychological comfort — modern antiretroviral therapy can drive the virus down to undetectable levels. The World Health Organization states that individuals on such treatment with an undetectable viral load pose no risk of HIV transmission. The PARTNER study observed 782 same‑sex couples (serodiscordant pairs) for a total of 1,593 person‑years; despite 76,088 unprotected encounters, only 15 new infections occurred, and genetic analysis proved none originated from the partner. The same national measures also forbid any disclosure of patients’ personal data or test outcomes. + +- Evidence grade: A + +- Notes: The “window period” determines when a test becomes reliable. The Guangdong Provincial CDC reports that nucleic‑acid tests can detect HIV after roughly one week, fourth‑generation antigen‑antibody tests after about two weeks, and third‑generation antibody tests after three weeks. It is advisable to wait at least two weeks post‑exposure and then retest after another two to four weeks; after three months, 99.99% of people can be certain they are not infected. A positive home‑test result is not a diagnosis — confirmation must come from the Chinese CDC or a certified lab. Article 3 of the regulations guarantees that no one may discriminate against HIV‑positive individuals or their families; their rights to marriage, employment, medical care, and education are protected by law. Article 38 also requires infected persons to inform any sexual partners of their status. Screening for HIV, syphilis, and hepatitis B during pregnancy and related prevention measures are covered in Section 27. +- Sources:卫生部 (2006). 全国艾滋病检测工作管理办法. ；国务院 (2006). 艾滋病防治条例（第三、二十三、三十八条）. （北京市卫生健康委员会转载）；Rodger AJ, Cambiano V, Bruun T, et al. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The Lancet, 393(10189), 2428-2438. ；广东省疾病预防控制中心. 艾滋病检测窗口期科普. （窗口期那个数字） + +### 32. As soon as suicidal thoughts arise, tell someone nearby and hand over those first few minutes + + +- Cost: No cost involved. The hard part is actually speaking up at that moment and admitting you can’t be alone for a few hours. +- In plain terms: Among 82 people who attempted suicide, 47.6% reported that only 10 minutes or less passed from the first appearance of suicidal thoughts to the actual attempt. What they had to endure was not a lifetime of mental anguish, but just those few minutes. Of the same group, 76.8% had some contact with others during that time, though they did not voice their feelings. Looking ahead, about 2% of people who ended up in the hospital due to self-harm died by suicide within a year, while roughly 7% did so after nine years or more; the vast majority did not follow that path. +- Benefit: Interviews conducted within three days of admission with those 82 individuals showed that 47.6% (39 people) stated the interval between the first emergence of suicidal thoughts and the actual attempt was no more than 10 minutes. Those whose process took longer displayed significantly higher scores on measures of suicidal intent. However, impulse scores showed no correlation with the duration of this period. Additionally, 76.8% (63 people) reported having some sort of interaction with a partner, family member, or friend during those minutes. The authors conclude that the window for intervention is usually very brief, leaving limited room for professionals to step in; thus, it is crucial to spread awareness of warning signs and basic intervention methods to ordinary people. Another systematic review compiled findings from 90 follow-up studies. For those seeking medical care after self-harm, the median rate of repeated self-harm without resulting in death was 16% after one year, while the suicide mortality rate at that point stood at 2%. After nine years or more of follow-up, roughly 7% had died by suicide. +- Evidence grade: B +- Notes: Grade B is assigned for two main reasons: the Deisenhammer study involved only 82 participants from a single hospital and relied on retrospective recollections; Owens’s review aggregated median figures from 90 studies employing different methods, rather than producing a single combined statistic. That same review also emphasizes that the suicide risk among self-harm patients remains hundreds of times higher than in the general population. Consequently, the statement “the vast majority did not follow that path” describes the overall trajectory of this group, not a guarantee for any individual; appropriate medical care must still be sought. For advice on removing lethal means and contacting the helpline 12356, see item 25 in this section. Steps to take when feeling down are outlined in item 19 of Section 3. Long-term consequences following survival are discussed in item 33 of this section. Finally, actions you can take if someone close to you expresses such thoughts are detailed in item 15 of Section 8. +- Sources:Deisenhammer EA, Ing CM, Strauss R, Kemmler G, Hinterhuber H, Weiss EM (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry, 70(1), 19-24. ；Owens D, Horrocks J, House A (2002). Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry, 181, 193-199. + +### 33. Don’t treat “survival” as a safety net: after ingesting paraquat or inhaling carbon monoxide, emergency care can save lives, but it rarely preserves lung or brain function. + + +- Cost: No cost involved. It simply helps you understand this reality up front. + +- In plain terms: There is no antidote for paraquat. Gastric lavage is not recommended, and neither hemofiltration nor dialysis alters its disease progression. Paraquat actively enters lung tissue against its concentration gradient, causing pneumonia and pulmonary fibrosis, while also damaging kidneys and liver. Among 257 cases treated at ten hospitals in Bangladesh, the mortality rate reached 43.2%. Carbon monoxide produces similar outcomes: six weeks after exposure, 46.1% of patients receiving normal oxygen still suffered cognitive impairment, compared to 25.0% of those receiving hyperbaric oxygen therapy. No treatment pathway yields a completely clean outcome; the most common result is lasting health complications. + +- Benefit: A systematic review on paraquat poisoning highlights its extremely high mortality rate, stemming from its intrinsic toxicity and lack of effective treatments. Paraquat is actively transported into lung tissue against its concentration gradient, resulting in pneumonia, pulmonary fibrosis, kidney and liver damage. The review explicitly advises against gastric lavage; hemofiltration and dialysis are unlikely to alter clinical outcomes. Evidence supporting corticosteroids or immunosuppressants remains weak. It also notes that mortality rates remain high across all centers despite varying treatment approaches. In Bangladesh, 257 out of 1,420 cases admitted to ten tertiary hospitals between 2013 and 2024 resulted in death (43.2%). Common symptoms included lower limb swelling due to acute kidney failure (71.2%), vomiting (65.8%) and abdominal pain (58.0%). Another randomized, double-blind trial involving 76 patients per group examined acute carbon monoxide poisoning; six weeks later, 25.0% of those receiving hyperbaric oxygen therapy and 46.1% of those receiving normal oxygen still had cognitive impairments (P=0.007; adjusted OR 0.45, 95% CI 0.22–0.92). A separate study of 73 patients found 30% developed cognitive impairments and 12% showed hyperintense signals in white matter on brain imaging. Since July 1, 2014, China has banned the registration and production of paraquat aqueous solutions; sales and usage ceased by July 1, 2016. As of September 26, 2020, soluble concentrate formulations are also prohibited nationwide. Official documents cite frequent suicide attempts involving paraquat as the primary reason for these strict controls. + +- Evidence grade: B + +- Notes: Grade B is assigned because these studies involve general poisoning patients rather than solely suicide attempt survivors; the carbon monoxide trial even included accidental poisoning cases. Consequently, observed complication rates cannot be directly interpreted as probabilities specific to suicide attempts. This entry does not compare mortality rates across different treatment methods nor recommend any specific actions. The sole certainty is that no treatment pathway guarantees a completely clean outcome. On-site management of carbon monoxide poisoning is detailed in Section 13, Item 19. For accidental ingestion of pesticides or medications, avoid inducing vomiting and seek medical help while bringing the container along (Section 13, Item 20). Finally, refrain from storing pesticides or sedatives at home (Section 13, Item 25). +- Sources:Gawarammana IB, Buckley NA (2011). Medical management of paraquat ingestion. British Journal of Clinical Pharmacology, 72(5), 745-757. ；Chowdhury FR 等 (2026). Clinical and Laboratory Profile of Paraquat Poisoning: A Toxicological Crisis in Bangladesh. American Journal of Tropical Medicine and Hygiene, 115, 176-182. ；Weaver LK, Hopkins RO, Chan KJ, et al. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347(14), 1057-1067. ；Parkinson RB, Hopkins RO, Cleavinger HB, et al. (2002). White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology, 58(10), 1525-1532. ；农业农村部办公厅 (2018). 关于切实加强百草枯监督管理的通知（农办农〔2018〕17 号）. + +### 34. Don’t bet on “a few days of rest” after a fall from height: most patients admitted to a trauma ICU survive, though at a cost measured in years + + +- Cost: No cost at all. It simply helps you see the full picture. + +- In plain terms: A trauma ICU in southern Xinjiang treated 289 patients who fell from heights. Only 5.5% died either in the hospital or within 30 days. The vast majority survived, but at a price: 47.1% suffered injuries to three or more body parts, 36% needed ventilators, and the median length of stay in the ICU was 8 days — with some patients remaining for as long as 132 days. The median fall height for this group was just 3 meters. Follow‑up showed that 58% of those with serious injuries eventually returned to work. + +- Benefit: From April 2020 to July 2024, the same ICU recorded 289 cases of falls from heights; the average age of patients was 40.3 years. The median fall height was 3 meters; 26.6% fell from heights above 5 meters and 11.4% from heights above 10 meters. The median Injury Severity Score was 24, a higher score indicating more severe injuries; 63.3% of patients scored above 20. In addition to the multiple injuries, 18.3% suffered damage to four or more body parts. Mechanical ventilation was required for 36% of patients, with a median duration of 103.5 hours. The median ICU stay was 8 days, ranging from 1 day to 132 days. The in‑hospital or 30‑day mortality rate was 5.5% (16 out of 289). A German trauma center reported similar results: among 84 patients with an ISS of 25 or higher, 58% returned to work after follow‑up. Age, length of ICU treatment, and self‑reported health status were identified as predictive factors. Nationwide, the average cost per hospital stay in 2024 was 9,870 yuan, a 4.3% decrease from the previous year; total health expenditures reached 9,089.55 billion yuan, of which personal spending accounted for 2,500.75 billion yuan, or 27.5% of the total. + +- Evidence grade: B + +- Notes: Grade B is assigned because the fall‑related data come from a single hospital’s retrospective chart review without distinguishing between accidental and self‑inflicted falls. The figure on return‑to‑work is based on only 84 patients in Germany; neither dataset can be taken as a reliable predictor of outcomes for any individual who falls from a height. The average national hospital cost is an overall figure, not specific to fall injuries; it is included only to provide a baseline for comparison. No direct correlation between fall height and injury severity is presented, as the source only supplies the height distribution of this group. For information on pressure ulcers that often develop during prolonged bed rest, see Section 17, Item 8. Deep‑vein thrombosis and pulmonary embolism are discussed in Section 13, Item 11 (sudden swelling of one leg). If suicidal thoughts arise, refer to Section 32 of this chapter. Details on paraquat poisoning are covered in Section 33 — remember that “being saved” does not guarantee a completely uncomplicated recovery. The timeline described here reflects the author’s own experience: after falling from the fourth floor, he initially believed he would recover in a few weeks, but ended up hospitalized for a full year, undergoing multiple surgeries, wearing steel plates, and unable to sit up on his own for half a year; his family had to take on debt to cover the expenses. +- Sources:Chen Y, Li W, Wang X, Zhong Q, Abudurexiti A, Qiu Q, Li J, Luo J (2025). Clinical features and prognostic predictors for patients admitted to trauma intensive care unit due to fall from height in South Xinjiang. International Journal of Emergency Medicine, 18, 142. ；Simmel S, Wurm S, Drisch S, Woltmann A, Coenen M (2020). Prädiktion der Rückkehr zur Arbeit nach Polytrauma bei Patienten mit einem ISS von mindestens 25. Die Rehabilitation, 59(2), 95-103. ；国家卫生健康委 (2025). 2024 年我国卫生健康事业发展统计公报解读. + +### 35. Don’t trade “losing one kidney is no big deal” for cash: the remaining kidney has to do the work of two, and 86% of kidney sellers later say their health got worse + +- Cost: No cost at all. It simply requires a clear look at the facts. +- In plain terms: First, consider the best-case scenario: legitimate donors who pass rigorous screening and receive post‑surgery follow‑up. In U.S. data from nearly 96,000 donors, only 31 per 10,000 developed end‑stage renal disease within 15 years after donation. Among equally healthy, eligible non‑donors, that figure was just 4 per 10,000. On the other side, a study of 305 kidney sellers in India found that six years later, 86% reported poorer health, and three‑quarters still carried debt. Legitimate donors get screening and monitoring; kidney sellers get none of that. +- Benefit: U.S. researchers compared 96,217 living kidney donors with 20,024 similarly healthy non‑donors drawn from the NHANES III survey. After 15 years, the estimated risk of developing end‑stage renal disease (ESRD) was 30.8 per 10,000 donors (95% CI 24.3–38.5) versus 3.9 per 10,000 non‑donors (95% CI 0.8–8.9; P<0.001). Over a lifetime, ESRD risk was 90 per 10,000 donors, 14 per 10,000 non‑donors, and 326 per 10,000 in the general population. A Norwegian study of 1,901 donors (median follow‑up 15.1 years) showed a 30% higher overall mortality (HR 1.30, 95% CI 1.11–1.52), a 40% higher cardiovascular mortality (HR 1.40, 95% CI 1.03–1.91), and roughly tenfold higher ESRD risk (HR 11.38, 95% CI 4.37–29.6). Among 3,698 U.S. donors, 11 developed ESRD — an incidence of 180 per million person‑years, compared with 268 per million in the general population. Of those re‑examined after an average of 12.2 years, 255 remained healthy, and 85.5% retained a glomerular filtration rate of at least 60 ml/min/1.73 m², the clinical lower limit of normal. Hypertension affected 32.1% and proteinuria 12.7%. In Chennai, India, 96% of 305 kidney sellers acted to pay debts; they received an average of $1,070. Six years post‑surgery, family income fell by one‑third (P<0.001), poverty rose, and three‑quarters remained indebted; 86% said health worsened, and 79% would not recommend kidney selling to others. The absolute numbers from these studies are 32,621 donors, 24.9 years of follow‑up, 302 ESRD cases, and 9.2 years of average follow‑up after surgery. +- Evidence grade: A +- Notes: Controversy exists: Ibrahim’s study used ordinary citizens as controls and found no difference in survival or ESRD risk between donors and non‑donors. Muzaale and Mjøen compared donors to equally healthy, eligible non‑donors and found markedly higher risks. The disagreement concerns the control group, not the donors themselves. All three studies agree that absolute risks remain low (30.8 per 10,000 over 15 years). Thus the key points are two: first, the remaining kidney does bear extra strain, as shown by higher rates of hypertension and proteinuria; second, these figures apply only to donors who undergo pre‑ and post‑operative screening and medical care — conditions absent for illegal kidney sellers, whose outcomes differ sharply according to Indian follow‑up data. Original studies provide only self‑reported health decline, proteinuria, hypertension, and ESRD rates; no figures on bed‑bound status are included here. Legal restrictions on organ sales, fines, and criminal penalties for relatives are detailed in Section 9, Article 22. Dialysis patients may use cross‑regional settlement and long‑term medication programs described in Section 16, Articles 1 and 2. +- Sources:Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL (2014). Risk of end-stage renal disease following live kidney donation. JAMA, 311(6), 579-586. ；Mjøen G, Hallan S, Hartmann A, et al. (2014). Long-term risks for kidney donors. Kidney International, 86(1), 162-167. ；Ibrahim HN, Foley R, Tan L, et al. (2009). Long-term consequences of kidney donation. New England Journal of Medicine, 360(5), 459-469. ；Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR (2002). Economic and health consequences of selling a kidney in India. JAMA, 288(13), 1589-1593. + +### 36. Don’t pick up, disassemble, or sell unidentified metal parts; stay away from areas marked with a clover warning sign + +- Cost: No cost at all. If you see unfamiliar metal cylinders, lead containers, or parts removed from equipment, simply steer clear — don’t pick them up, take them apart, or put them in your pocket. +- In plain terms: Radiation has no smell, color, or temperature, so humans cannot detect it. That means “it looks harmless” is not a reliable way to judge whether something is radioactive. Most radioactive sources look exactly like ordinary metal — they emit no light and generate no heat. The chance of an average person encountering one is extremely low: there are roughly 178,000 active radioactive sources nationwide, and the accident rate stays under 1 per 10,000 sources. But if you do happen to encounter one, the consequences are irreversible. In 1987, someone in Brazil disassembled a radiotherapy machine from an abandoned clinic; roughly 112,000 people were monitored, and 4 died as a result. +- Benefit: As of 2025, there are about 178,000 active radioactive sources and 355,000 radiation devices in use across the country. The annual accident rate for radioactive sources remains below 1 per 10,000. Classification of incidents is as follows: loss, theft, or uncontrolled release of Class I or II sources constitutes a major radiation accident; Class III sources lead to a relatively serious accident. Loss or theft of Class IV or V sources, or exposure of people to radiation exceeding annual dose limits, counts as a minor accident. Official example: In June 2020, a γ-ray inspection was performed during pipeline renovation at a blast furnace plant run by Ningxia Iron and Steel Group. A Class II iridium-192 source exposed three workers to radiation. Chen suffered third-degree acute radiation skin damage on his left hand; Liu sustained fourth-degree damage on his thumb and index finger, and third-degree damage on his middle, ring, and little fingers. Fan had first- to second-degree damage on his left hand. All three received radiation doses far exceeding national limits; both responsible companies had their radiation safety licenses revoked and were fined 70,000 yuan. International example: In 1987, a radiotherapy machine was dismantled at an abandoned clinic in Goiânia, Brazil; a 50.8 TBq cesium-137 source was removed and its protective casing broken. Around 112,000 people were monitored, and 249 showed internal or external contamination. Of these, 129 had moderate to severe contamination, and 50 required close medical monitoring. Ultimately, 4 people died. (National / International) +- Evidence grade: A +- Notes: If you ever encounter such a source, stay far away, note its location, do not move it, and call 110 immediately. Laws require reporting to environmental protection, public security, and health authorities. Distance and time are the only effective protections — putting something in a pocket or plastic bag offers zero protection. Devices like X-ray machines and CT scanners that generate radiation only when powered do not retain any radioactivity after being turned off; the real danger comes from the sealed radioactive source inside them. Radiotherapy machines in hospitals, γ-ray inspection devices on pipelines and boilers, well logging tools, and level gauges all contain such sources. Disassembling their outer casings exposes these sources, which look identical to ordinary metal parts. Therefore, the rule is not “identify radioactive sources” but “never disassemble, sell, or take home any unidentified equipment parts.” Workers in scrap recycling, dismantling, hardware, and construction face far higher risks; if you see a warning zone marked with a clover symbol on a construction site, steer clear. This guidance applies only to uncontrolled radioactive sources, not to nuclear power plant leaks, which the general public is far less likely to encounter. The main beneficiaries of following these rules are you and anyone else present at the scene. +- Sources:生态环境部 (2025). 2024 中国生态环境状况公报. ；国家核安全局 (2026). 2025 年我国核与辐射安全监管工作成效. ；生态环境部 (2021). 关于一起 γ 射线探伤作业违法违规造成辐射事故案件处理情况的通报. ；国务院 (2019). 放射性同位素与射线装置安全和防护条例（2019 年修订，第三十四、四十二、六十八条）. ；环境保护部 (2009). 关于建立放射性同位素与射线装置辐射事故分级处理和报告制度的通知（辐射事故分级标准）. ；International Atomic Energy Agency (1988). The Radiological Accident in Goiânia. IAEA, Vienna. diff --git a/book/en/02-Do-Not-Die-Slowly.md b/book/en/02-Do-Not-Die-Slowly.md new file mode 100644 index 00000000..345e560c --- /dev/null +++ b/book/en/02-Do-Not-Die-Slowly.md @@ -0,0 +1,338 @@ +# 2. Don’t die slowly +This section covers just two types of long‑term health risks: those with a big impact on overall mortality and those backed by solid evidence. The items are listed from most cost‑effective to least. A few entries note “randomized trials,” meaning participants were randomly assigned to different groups for comparison — this is the most reliable type of research. All other figures come from observational studies that simply track people over time without any grouping. Such studies produce risk ratios like HR or RR, but they also contain two kinds of confounding factors: participants naturally differ from one another, and some already had health problems before the study began. Therefore these numbers only indicate general trends and approximate magnitudes; they do not guarantee that following these recommendations will produce exactly those results. +### 1. Quitting smoking, the earlier the better + +- Cost: It costs nothing — in fact, it saves money. A pack-a-day habit costs roughly $3–$4, which you’ll no longer spend after quitting. The hard part is getting through the withdrawal period, which usually lasts a few weeks to several months. +- In plain terms: On average, smokers live more than 10 years less than non-smokers. Quitting before age 40 eliminates roughly 90% of the extra death risk caused by continued smoking. The earlier you quit, the more years you gain. +- Benefit: One U.S. study that tracked participants without assigning them to groups found that current smokers have a life expectancy more than 10 years shorter than those who never smoked. Quitting before age 40 removes about 90% of this excess mortality risk. Quitting between ages 25–34 adds roughly 10 years to life expectancy; between 35–44, about 9 years; and between 45–54, about 6 years (as reported in the original source). Similar Chinese research from the 2010s shows that urban male smokers have a 1.65 times higher death risk than non-smokers (RR 1.65), while rural male smokers have a 1.22 times higher risk. After 10 years of sustained abstinence, this smoking-related risk nearly disappears. +- Evidence grade: A +- Sources:Jha P 等 (2013). 21st-century hazards of smoking and benefits of cessation in the United States. NEJM. ；Chen Z 等 (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. ；Oberg M 等 (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. （二手烟那两个数字） +- Notes: Secondhand smoke is deadly too: in 2004, an estimated 603,000 people worldwide died from exposure to it, accounting for roughly 1% of all global deaths that year. Even if you don’t smoke yourself, you must avoid secondhand smoke, especially to protect children. Specific quitting strategies are outlined in the following sections: Section 3 (smoking cessation medications), Section 4 (setting a quit date), Section 5 (visiting a smoking cessation clinic), and Section 6 (e-cigarettes). +### 2. Don’t smoke at home or in the car, and don’t let guests smoke indoors + +- Cost: There is no monetary cost and it takes little time. The challenge is simply having the conversation with family members and guests to keep them from smoking indoors. +- In plain terms: Around 600,000 people worldwide die each year from secondhand smoke exposure; nearly 30% of those are children. Long‑term exposure to secondhand smoke raises the risk of hypertension, heart disease, and stroke by roughly 30% compared to non‑exposed individuals. Smoke inhaled at home is even more harmful than smoke encountered outside. +- Benefit: In 2004, secondhand smoke caused 603,000 deaths globally — about 1.0% of all deaths worldwide, with children accounting for 28% of those fatalities. Pooled data from 57 studies show that people exposed to secondhand smoke have a 1.28‑fold higher chance of developing hypertension, a 1.39‑fold higher risk of heart disease, a 1.50‑fold higher risk of myocardial infarction, and a 1.36‑fold higher risk of stroke compared to non‑exposed individuals. The risk is greater when exposure occurs at home rather than outside. +- Evidence grade: A +- Sources:Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet：「603,000 deaths were attributable to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men」，「61% of DALYs were in children」. ；(2026). The Associations Between Secondhand Smoke Exposure and Various Cardiovascular Diseases: A Meta-Analysis. Nicotine & Tobacco Research：57 项研究，「hypertension (OR: 1.28, 95% CI: 1.15 to 1.40), heart disease (OR: 1.39, 95% CI: 1.28 to 1.50), myocardial infarction (OR: 1.50, 95% CI: 1.17 to 1.84), stroke (OR: 1.36, 95% CI: 1.18 to 1.54)」「Home exposure has a higher risk of CVD than non-home exposure」. +- Notes: Focus on home environments first, since people spend more time there and pooled research indicates that indoor secondhand smoke is more harmful than outdoor exposure. Children bear 61% of the overall health burden caused by secondhand smoke. For personal smoking cessation, see item 1 in this section. +### 3. Don’t rely solely on willpower to quit smoking — get medication first: success rates more than double + +- Cost: Nicotine patches and gum are over-the-counter products available at any pharmacy. A full course lasts 8–12 weeks and costs anywhere from a few hundred to over a thousand yuan. Varenicline and bupropion, on the other hand, are prescription-only drugs; you’ll need a prescription from a smoking cessation clinic or a pulmonology department. These costs are roughly offset by the money saved from buying fewer cigarettes during the same period. +- In plain terms: Relying on sheer willpower alone rarely works for most smokers. People taking varenicline are more than twice as likely to succeed compared to those taking a placebo. Those using nicotine replacement products also have a 50% higher success rate than non-medication users. Combining patches with gum or lozenges further boosts success rates by roughly 20%. +- Benefit: A pooled analysis of 41 randomized trials involving 17,395 participants shows that varenicline increases smoking cessation rates by 2.32 times compared to placebo (RR 2.32, 95% CI 2.15–2.51; high-certainty evidence). Varenicline also outperforms bupropion (RR 1.36, a 36% relative increase) and single-form nicotine replacement therapy (RR 1.25, a 25% relative increase). Across 133 trials with 64,640 participants, nicotine replacement products raise success rates by about 55% versus no medication at all (RR 1.55, 95% CI 1.49–1.61). Using both a patch and a fast-acting form such as gum or lozenges yields a 27% relative improvement over patch-only use (RR 1.27, 95% CI 1.17–1.37; high-certainty evidence from 16 trials with 12,169 participants). +- Evidence grade: A +- Sources:Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. ；Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. ；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. ；上海市卫生健康委员会 (2021). 选对药物，让戒烟轻松一点：「市场上可见的戒烟药物主要有三种，即尼古丁替代疗法药物、安非他酮、伐尼克兰」，「尼古丁替代疗法药物属于非处方药（OTC），可通过药店柜台购买；而安非他酮、伐尼克兰属于处方药，须到医院戒烟门诊或呼吸内科就诊，凭医师处方经药师调配后才能得到」. +- Notes: In China, these three types of medications are currently available for smoking cessation; only nicotine replacement products are sold over the counter. Common side effects of varenicline include nausea, vivid dreams, and sleep disturbances; anyone with a psychiatric history should discuss this with their doctor. A typical course of nicotine replacement therapy lasts 8–12 weeks — do not abruptly stop use but taper off gradually under medical guidance. While these medications ease withdrawal symptoms during the first few weeks, they do not eliminate cravings triggered by specific situations, so they should be used alongside the other strategies outlined in this chapter: setting a quit date (Section 4) and seeking professional help at a smoking cessation clinic (Section 5). +### 4. Pick a quit date and stop smoking on that day — don’t taper gradually + +- Cost: No cost at all. Just choose a date on the calendar and let family and coworkers know in advance. +- In plain terms: Many people try to cut back a little each day until they reach zero. Yet after six months, only 15.5% of those who gradually reduced their intake stayed smoke‑free, compared with 22% of people who set a quit date and stopped all at once. So it’s better to pick a date and quit completely on that day. +- Benefit: In the UK, 697 smokers were randomly assigned to two groups. One group quit on a predetermined date; the other cut their cigarette use by 75% during the two weeks before that date. Both groups received nursing support and used nicotine replacement therapy around the quit date. At four weeks, 49.0% (95% CI 43.8–54.2) of the “quit‑on‑date” group remained smoke‑free, versus 39.2% (34.0–44.4) of the “taper‑first” group; the relative risk was 0.80 (0.66–0.93). By six months, 22.0% (18.0–26.6) of the quit‑on‑date group stayed quit, compared with 15.5% (12.0–19.7) of the taper‑first group; the relative risk was 0.71 (0.46–0.91). Even among people who preferred tapering, the quit‑on‑date approach yielded higher success rates at four weeks (52.2% vs. 38.3%). +- Evidence grade: A +- Sources:Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P (2016). Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Annals of Internal Medicine, 164(9), 585–592. ；Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308（提前用尼古丁替代品那一段）. +- Notes: This is a somewhat controversial topic. Cochrane previously published a review comparing these two methods; it concluded they performed similarly (RR 0.94, 95% CI 0.79–1.13, based on 10 trials with 3,760 participants). However, that review was withdrawn in 2019 and is no longer updated. The best current evidence comes from the trial described above, which favors quitting on a set date. Both groups in that trial also used nicotine replacement therapy before the quit date, an approach itself backed by evidence: early use raises success rates by roughly 25% (RR 1.25, 95% CI 1.08–1.44, based on 9 trials with 4,395 participants; moderate‑certainty evidence). Therefore, the recommended strategy is to pick a quit date, start nicotine replacement therapy two weeks beforehand, and then quit all at once on that day. +### 5. Visit a smoking cessation clinic or call 12320 to find local services + +- Cost: A single clinic visit costs only a few to dozens of yuan. Behavioral support typically involves 4–8 sessions lasting 30–60 minutes each, totaling under 5 hours. Calling the helpline is completely free. +- In plain terms: Medications and regular follow-up support from professionals are two distinct components that work best together. People who take medication while receiving dedicated follow-up have nearly twice the quit rate of those who only receive brief advice. Phone support also helps: those who proactively call the smoking cessation helpline see their success rate rise by 20–30% compared to others. +- Benefit: Across 52 trials involving 19,488 participants, the combination of medication and behavioral support led to a 1.83-fold higher quit rate than standard care or brief advice (RR 1.83, 95% CI 1.68–1.98; high-quality evidence). For the 43 trials conducted in medical settings, this advantage rose to 1.97-fold (95% CI 1.79–2.18). When looking at phone-based support alone: among people who called the helpline themselves, those receiving multiple follow-up calls had a 38% higher quit rate than those who only got informational materials or a single consultation (RR 1.38, 95% CI 1.19–1.61; 14 trials, 32,484 participants). For people who did not call the helpline but received scheduled phone support from researchers, the success rate was 25% higher than those without such support (RR 1.25, 95% CI 1.15–1.35; 65 trials, 41,233 participants). Both findings are supported by evidence of moderate certainty. +- Evidence grade: A +- Sources:Stead LF, Koilpillai P, Fanshawe TR, Lancaster T (2016). Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 3, CD008286. ；Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J (2019). Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD002850. ；中国疾病预防控制中心 (2021). 「中国戒烟平台」微信小程序正式上线：「在健康中国行动控烟行动工作组指导下中国疾病预防控制中心和世界卫生组织驻华代表处联合制作了中国权威戒烟资源库『中国戒烟平台』微信小程序。小程序内容主要包括：戒烟热线、戒烟门诊详细信息，以及线上戒烟服务资源等」；同一站点页脚标注「健康咨询电话：12320」. +- Notes: How to find local services in China: Search “China Smoking Cessation Platform” on WeChat to access a list of local smoking cessation clinics and helplines, or call 12320 to ask about nearby options. Most of the above trials were conducted overseas, and the intensity of services at local clinics varies widely; these figures should be viewed as general guidelines only. The recommended medications are listed in Section 3 of this chapter (“Smoking cessation medications”). +### 6. Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them + +- Cost: The device plus cartridges cost anywhere from a few dozen to several hundred yuan per month. In China, only tobacco‑flavored e‑cigarettes are legally sold, and only at stores holding a tobacco retail license. +- In plain terms: Switching to nicotine‑containing e‑cigarettes helps roughly 60% more people quit smoking than nicotine patches — this finding is quite reliable. However, e‑cigarettes are not harmless; long‑term safety data remain limited. For people who have never smoked, there is absolutely no benefit to using them. +- Benefit: This up‑to‑date review includes 80 randomized trials involving 29,861 participants. Compared with nicotine replacement therapy, e‑cigarettes raise the quit rate by about 61% (RR 1.61, 95% CI 1.23–2.12; high‑certainty evidence based on 11 trials with 4,114 participants). In absolute terms, that translates to roughly 4 extra quitters per 100 users (range: 1–7). The rate of serious adverse events is similar between groups (risk difference 0.01, 95% CI −0.01–0.02; moderate‑certainty evidence). Compared with behavioral support alone or no support at all, e‑cigarettes improve quit rates by about 75% (RR 1.75, 95% CI 1.39–2.20; low‑certainty evidence). +- Evidence grade: A +- Sources:Lindson N, Livingstone-Banks J, Butler AR, et al. (2026). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 8, CD010216. ；国家烟草专卖局 (2022). 电子烟管理办法（国家烟草专卖局公告 2022 年第 1 号，2022 年 5 月 1 日施行）第十八条：从事电子烟零售业务，要向烟草专卖行政主管部门申领烟草专卖零售许可证。第二十二条：「禁止向未成年人出售电子烟产品。」第二十三条第二款：「任何个人、法人或者其他组织不得通过本办法规定的电子烟交易管理平台以外的信息网络销售电子烟产品、雾化物和电子烟用烟碱等。」第二十六条：「禁止销售除烟草口味外的调味电子烟和可自行添加雾化物的电子烟。」. +- Notes: This topic is controversial. WHO does not recommend e‑cigarettes as a smoking‑cessation tool, citing insufficient long‑term safety data and concerns that they may attract youth to nicotine. The UK, however, includes them in its quit‑smoking services. In China, e‑cigarette sales are not completely banned but are tightly regulated under the “Administrative Measures for E‑Cigarettes.” Only tobacco‑flavored products may be sold, and only at physical stores holding a tobacco retail license; fruit‑flavored e‑cigarettes and refillable devices are prohibited. Sales through any website, online shop, or social‑media platform other than the state‑run e‑cigarette trading platform are illegal, and sales to minors are forbidden. Consequently, fruit‑flavored e‑cigarettes that are still available are sold through illicit channels outside regulatory oversight. This is also how synthetic‑cannabinoid‑laced “high‑effect” e‑cigarettes enter the market; see Section 22, Item 4 (“Do not accept unknown cartridges”). The review examined only legally regulated nicotine‑containing products; unverified e‑liquid mixtures were not included. As a first step, it is advisable to try the medication described in Item 3 of this section, which offers stronger evidence and lower cost. +### 7. Not drinking sugary drinks — even switching to sugar-free ones doesn’t help + +- Cost: There’s no cost involved, nor does it take any extra time. Switching to plain water or sugar-free tea can even save money. The real challenge is breaking the habit of drinking sweet beverages, including sugar-free ones. +- In plain terms: People who drink more than two sugary drinks per day have about a 20% higher chance of dying during the same period compared to those who rarely drink them. Those who consume one to two per day still face a roughly 10% higher risk. Switching to sugar-free versions brings no benefit: individuals drinking two or more sugar-free drinks daily actually have a 25% higher risk of death. +- Benefit: Two large U.S. studies followed large groups of people without any subgroup categorization; together they included around 118,000 participants and documented 36,000 deaths. Those drinking two or more sugary drinks daily had a 21% higher risk of death compared to those consuming less than one per month (HR 1.21). For those drinking one to two per day, the risk rose by about 14% (HR 1.14). The European EPIC study followed 450,000 people across 10 countries under similar conditions; again no subgroups were defined. Compared to those drinking less than one sugary drink per month, daily consumers of two or more sugary drinks faced an 8% higher risk (HR 1.08, 95% CI 1.01–1.16). Those drinking two or more sugar-free drinks daily had a 26% higher risk (HR 1.26, 95% CI 1.16–1.35). When all types of soft drinks were considered together, the risk increase was about 17% (HR 1.17, 95% CI 1.11–1.22). +- Evidence grade: A +- Sources:Malik VS 等 (2019). Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. ；Mullee A, Romaguera D, Pearson-Stuttard J, et al. (2019). Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Internal Medicine, 179(11), 1479-1490. +- Notes: There is ongoing debate regarding sugar-free drinks. The association between sugar-free drinks and health outcomes appears even stronger than that of sugary drinks, which likely reflects reverse causality: individuals who are already overweight or have diabetes tend to switch to sugar-free versions. Therefore, we cannot claim sugar-free drinks are more harmful based on this alone. Nevertheless, this evidence clearly shows that the idea “switching to sugar-free drinks solves the problem” lacks any factual support. The safest choice remains plain water or sugar-free tea. Additionally, these studies rely solely on observational tracking rather than controlled trials; people who consume more sugary drinks often lead less healthy lifestyles overall, which may contribute to the observed higher risk figures. +### 8. Not chewing betel nut + +- Cost: It costs nothing, takes no time, and saves money that would otherwise be spent on betel nut. The hard part is breaking the habit of chewing it. +- In plain terms: People who chew betel nut have roughly a 20% higher chance of dying during the same period compared to non-chewers. Their risk of developing diabetes and metabolic syndrome is nearly 50% higher. Additional risks for oral and esophageal cancer also apply. +- Benefit: Data from 17 Asian studies involving 388,000 participants show that chewing betel nut raises overall mortality risk by about 21% relative to non-chewers (relative risk 1.21, P=0.02). This effect applies to 179,600 of those participants. The risk of diabetes rises by roughly 47% (1.47), while metabolic syndrome risk increases by about 51% (1.51). Betel nut itself is also a known risk factor for oral and esophageal cancer. +- Evidence grade: A +- Sources:Yamada T, Hara K, Kadowaki T (2013). Chewing betel quid and the risk of metabolic disease, cardiovascular disease, and all-cause mortality: a meta-analysis. PLoS One, 8(8), e70679. +- Notes: The longer and more frequently one chews betel nut, the greater the risk of oral cancer becomes. After quitting, this risk gradually declines over time. Betel nut mixed with tobacco poses an even greater danger. +### 9. Switch household salt to low‑sodium (potassium‑rich) salt + +- Cost: One bag costs a few yuan more than regular salt. It’s easy to switch when you shop, adding virtually no extra time. The taste stays almost the same. +- In plain terms: For people who have had a stroke or are over 60 with hypertension, switching to low‑sodium salt can lower their chance of dying within five years by about 12% and the risk of another stroke by roughly 14%. +- Benefit: A randomized trial conducted in rural China enrolled 20,995 participants — all stroke survivors or adults aged 60+ with hypertension — and followed them for 4.74 years. Those using low‑sodium salt had a 12% lower risk of death (RR 0.88), a 14% lower risk of stroke (RR 0.86), and a 13% lower risk of major cardiovascular events (RR 0.87) compared with the regular‑salt group. No statistically significant difference emerged between the groups regarding episodes of excessively high blood potassium levels. +- Evidence grade: A +- Sources:Neal B 等 (2021). Effect of Salt Substitution on Cardiovascular Events and Death. NEJM. ；O'Donnell M 等 (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. NEJM. （争议方 PURE） +- Notes: This finding is somewhat controversial. The PURE study only recorded long‑term outcomes without random assignment; it reported that individuals excreting less than 3 g of sodium per day faced a roughly 27% higher risk of death or cardiovascular events, while those excreting more than 7 g per day faced a 15% higher risk. According to PURE, both very low and very high sodium intake are detrimental, with moderate intake being optimal. However, the Chinese rural trial only partially replaced regular salt with low‑sodium salt, so sodium levels did not drop to the extremes examined in PURE. Moreover, the trial involved only high‑risk elderly participants; younger, healthier individuals would likely gain far less benefit. People with impaired kidney function or those taking potassium‑sparing medications should consult a physician before making this switch. +### 10. Brush teeth thoroughly and floss daily; replace missing teeth promptly + +- Cost: Dental floss or interdental brushes cost just a few dozen yuan per year, while professional cleanings run about 100–200 yuan each. It takes only two to three extra minutes per day. The real challenge is making flossing a daily habit. +- In plain terms: People who floss daily have roughly a 10% lower chance of dying over the same period. For elderly individuals with no natural teeth, the risk of death is about 90% higher. Those with fewer than 20 natural teeth face roughly double the risk. +- Benefit: A Japanese study followed 9,676 participants for six years. Those who used interdental cleaning tools saw their mortality risk drop by about 11% (hazard ratio 0.89). Those who used tongue cleaners saw a 23% reduction (HR 0.77). When multiple studies of community-dwelling seniors are combined, people with no natural teeth have roughly 1.87 times the risk of death (95% CI 1.35–2.59). Those with fewer than 20 natural teeth face about 2.04 times the risk (95% CI 1.67–2.49). +- Evidence grade: B +- Sources:Wang K, Matsuyama Y, Kiuchi S, et al. (2026). Routine oral health practices and all-cause mortality. Journal of Dentistry. ；Ko MJ, Seo S, So JS, et al. (2026). Deteriorated oral health and function as risk factors for physical disability and mortality in community-dwelling older adults: a systematic review and meta-analysis. European Geriatric Medicine. +- Notes: This topic remains debated. These studies are purely observational; individuals with poor dental health often also have poorer overall health and lower socioeconomic status. It is unclear whether poor dental health harms overall health or whether poor health leads to poor dental health. Regardless, the cost of proper dental care is very low, and periodontal disease and missing teeth do directly affect eating ability. +### 11. Walking 7,000–8,000 steps per day + +- Cost: It costs nothing. You can spread 60–90 minutes of walking throughout your commute and daily errands. The hard part is doing it every single day. +- In plain terms: People who walk 5,800 steps daily have roughly a 40% lower chance of dying during the same period compared to those who walk only 3,500 steps. When they reach 7,800 steps, that risk drops by about 45%. Going beyond that still lowers the risk a bit, but only up to a certain point. For adults over 60, 6,000–8,000 steps per day is sufficient. +- Benefit: Fifteen studies tracking large groups of people were combined for analysis without separating participants into subgroups. These studies included 47,471 participants and 3,013 deaths. Participants were divided into four groups based on daily step count; the lowest group had a median of 3,553 steps per day. The other three groups had medians of 5,801, 7,842, and 10,901 steps per day. Compared to the lowest group, death risk in these three groups was reduced by roughly 40%, 45%, and 53% respectively (HR values: 0.60, 0.55, 0.47). For people over 60, benefits level off after reaching 6,000–8,000 steps; for younger adults, benefits level off after 8,000–10,000 steps. Another analysis of multiple studies showed benefits start at around 3,867 steps per day; beyond that point, each additional 1,000 steps per day lowers death risk by about 15%. +- Evidence grade: A +- Sources:Paluch AE 等 (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health. ；Banach M 等 (2023). The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. European Journal of Preventive Cardiology. +- Notes: The range from 4,000 to 7,000 steps offers the best value; you don’t have to hit 10,000 steps to see benefits. Keep in mind these studies are purely observational: the group with the fewest steps includes people who were already ill and unable to walk much. Their low step count reflects poor health, not the other way around, so the calculated risk differences tend to be somewhat exaggerated. Still, the clear trend of better outcomes with more walking remains. This recommendation aligns with Recommendation 14 (150–300 minutes per week of moderate-intensity exercise); they describe the same health benefit, just expressed differently. Meeting either target is sufficient. +### 12. People with hypertension and high cholesterol should take their medication regularly as prescribed; never stop on their own. + +- Cost: Generic hypertension drugs and statins cost only a few to several dozen yuan per month. They’re taken once daily, so they don’t require much time or effort. The real challenge is sticking to them long-term — once people feel better, they often stop taking them. +- In plain terms: For every 10 mmHg drop in blood pressure, mortality decreases by roughly 13%, while stroke risk drops by about 27%. Each 1.0 mmol/L reduction in LDL cholesterol achieved by statins lowers mortality by roughly 10%. Those who take their medication as directed have a 30% to 45% lower risk of death compared to those who frequently miss doses. +- Benefit: Pooled data from multiple randomized controlled trials show that a 10 mmHg reduction in systolic blood pressure (the “high” number in a blood pressure reading) lowers mortality by about 13% (RR 0.87) and major cardiovascular events by roughly 20% (RR 0.80). Stroke risk drops by around 27% (RR 0.73), while heart failure risk decreases by about 28% (RR 0.72). Statins also reduce LDL cholesterol; each 1.0 mmol/L drop lowers mortality by roughly 10% (RR 0.90) and major vascular events by about 22% (RR 0.78). Observational studies further indicate that patients who adhere to prescribed treatment regimens (≥80% compliance) enjoy significantly lower mortality rates: statin adherence reduces risk by about 45% (RR 0.55), while adherence to antihypertensive therapy lowers risk by roughly 29% (RR 0.71). +- Evidence grade: A +- Sources:Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. ；Cholesterol Treatment Trialists' (CTT) Collaboration (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. ；Chowdhury R 等 (2013). Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal. +- Notes: Only individuals deemed by doctors to need medication should follow this advice; healthy people do not require it. The figures regarding “consistent medication use” stem from observational data; those who stick to treatment tend to be more disciplined overall, which may inflate perceived benefits. The mortality reductions linked to blood pressure control and statins are more firmly supported by randomized trials than any potential benefits of tighter blood glucose control. +### 13. Getting roughly 7 hours of sleep each night and keeping a regular schedule + +- Cost: No cost involved. You simply need to set aside time for sleep — most people achieve this by cutting back on phone usage. The real challenge is maintaining consistent bedtime and wake-up times. +- In plain terms: People who regularly get less than 7 hours of sleep have a roughly 10% higher risk of dying over the same period. The more irregular their sleep schedule, the greater this risk becomes. Those with the most consistent routines have a 20–50% lower mortality risk compared to those with the least regular schedules. In other words, how consistent your sleep pattern is matters more than the total number of hours you sleep when it comes to predicting death risk. +- Benefit: A pooled analysis of 16 longitudinal studies — which simply recorded data without grouping participants — included 1.38 million people and 113,000 deaths. People who slept less than 7 hours had a 12% higher mortality risk (RR 1.12), while those who slept more had a 30% higher risk (RR 1.30). Another pooled study that grouped participants by sleep duration found the lowest risk among those getting exactly 7 hours of sleep. For every hour slept under 7 hours, risk rose by 6% (RR 1.06); for every hour over 7 hours, risk rose by 13% (RR 1.13). Data from the UK Biobank, which tracked over 61,000 participants using wrist-worn monitors, also showed that when people were divided into 5 groups based on sleep regularity, the four groups with more consistent schedules had a 20–48% lower mortality risk than the least regular group. This confirms that sleep regularity is a stronger predictor of death risk than total sleep duration. A further UK Biobank study that tracked sleep timing for 51,562 participants found 3,853 new cases of cardiovascular disease over the study period. Social jetlag — the difference between average weekday and weekend bedtime — also plays a role: people with a social jetlag of 2 hours or more had a 30% higher risk of cardiovascular disease (HR 1.30, 95% CI 1.11–1.54). This link remained evident even among people getting a normal amount of sleep. +- Evidence grade: A +- Sources:Cappuccio FP 等 (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. ；Yin J 等 (2017). Relationship of Sleep Duration With All-Cause Mortality and Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. JAHA. ；Windred DP 等 (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep. ；Kumar N, Krishnamurthy S (2026). Social jet lag is associated with incident cardiovascular disease independent of sleep duration and cardiac genetic risk. Journal of Internal Medicine. +- Notes: The main issues to address are getting too little sleep and having an irregular schedule; there is no need to deliberately cut back on total sleep time. The higher risk seen in people who sleep more is likely due to reverse causation: depression, chronic illnesses, and sleep apnea all tend to lead to longer sleep duration. Currently, only two longitudinal studies support the link between sleep regularity and lower mortality risk; both simply recorded data without grouping participants, so this evidence is classified as grade B on its own. For guidance on how to catch up on sleep after staying up late, see Section 39 of this chapter. +### 14. A total of 150–300 minutes of moderate-intensity exercise per week, such as brisk walking, is sufficient. + +- Cost: It costs nothing. You only need 20–45 minutes each day. The real challenge is sticking with it over the long term. +- In plain terms: People who walk briskly for 150–300 minutes each week have a mortality risk roughly 30% lower than those who don’t exercise at all. Even if they fall short of that amount, their risk is still about 20% lower. When they reach 3–5 times that volume, the risk drops to its minimum level — about 40% lower. Exceeding that amount further won’t lower the risk any more, but it certainly won’t hurt either. +- Benefit: When multiple observational studies are pooled together (without subgroup analysis), individuals whose activity levels reached 1–2 times the recommended minimum had a mortality risk roughly 31% lower than non-exercisers (HR 0.69). This amount corresponds to 7.5–15 MET·hours per week, or about 150–300 minutes of brisk walking weekly. Those who failed to meet the minimum still saw a 20% reduction in risk (HR 0.80). For those whose activity levels reached 3–5 times the minimum, the risk dropped to its peak level — about 39% lower (HR 0.61). Any further increase did not yield additional benefit, though it remained harmless (at 10 times the minimum, HR was still 0.69). Another pooled analysis based on accelerometer measurements found that the top quarter of participants with the highest levels of moderate-to-vigorous activity had a mortality risk roughly 48% lower than the bottom quarter (HR 0.52). Accelerometers are wearable devices used to measure actual physical activity levels. +- Evidence grade: A +- Sources:Arem H 等 (2015). Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine. ；Ekelund U 等 (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. +- Notes: You can choose either this recommendation or Recommendation 11 (which suggests walking 7,000–8,000 steps daily). Keep in mind that these studies are purely observational in nature. The studies relying on accelerometer measurements have relatively short follow-up periods and include a higher proportion of older participants; they also contain some bias related to reverse causality — i.e., individuals who were already ill may have become less active. Therefore, the real benefit is somewhat smaller than the apparent reduction of mortality risk to 0.52 times the baseline level. +### 15. Playing racket sports three times a week for 45 minutes each session + +- Cost: The cost of court fees is typically several dozen yuan per session. This amounts to roughly 2 hours of activity per week. The main challenge is arranging enough participants and securing a court, plus maintaining a regular weekly schedule. +- In plain terms: People who regularly play tennis, badminton, or table tennis have roughly half the risk of dying during the same period compared to non-players. Their risk of cardiovascular death is about 56% lower. For swimmers, the reduction is roughly 28%. No significant difference was observed between runners and football players in these statistics. +- Benefit: A UK-based longitudinal study involving 80,300 participants compared individuals who engaged in specific sports with those who did not. Those who played racket sports had a 47% lower risk of death overall (hazard ratio 0.53, 95% CI 0.40–0.69). Their risk of cardiovascular death was reduced by about 56% (hazard ratio 0.44, 95% CI 0.24–0.83). Racket sports include tennis, badminton, and table tennis. For swimmers, these figures were 0.72 and 0.59 respectively; for aerobic exercise they were 0.73 and 0.64, and for cycling 0.85. No statistically significant differences were found between runners and football players. +- Evidence grade: A +- Sources:Oja P, Kelly P, Pedisic Z, et al. (2017). Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults. British Journal of Sports Medicine, 51(10), 812-817. +- Notes: This finding is somewhat controversial. Such studies merely track participants over time; people who play sports tend to be healthier and more socially active overall. The lack of difference seen among runners also suggests that individual characteristics may influence which sports people choose. This does not mean running is ineffective — separate entries in this section consider total weekly exercise volume. +### 16. Accumulating brief bouts of strenuous activity like stair-climbing and brisk walking to total four to five minutes per day + +- Cost: There is no cost involved, nor is any extra workout time required. The difficulty lies in remembering to climb stairs and walk briskly instead of taking shortcuts. +- In plain terms: For people who normally do no exercise at all, simply engaging in three brief bouts of strenuous activity lasting one to two minutes each per day reduces their overall risk of death by roughly 40% compared to those who do none at all. Their risk of cardiovascular death also drops by nearly half. Such strenuous activities include stair-climbing, brisk walking, and similar efforts. +- Benefit: A study conducted by the UK Biobank involved 25,200 participants who did not regularly exercise. After an average follow-up period of 6.9 years, 852 participants passed away. Those who performed three short bursts of intense activity daily, each lasting 1–2 minutes, saw their overall mortality risk and cancer-related death risk drop by 38%–40% relative to those who did no such activity. Their risk of cardiovascular death decreased by 48%–49%. Even individuals who accumulated just 4.4 minutes of such activity daily experienced a 26%–30% reduction in mortality and cancer death risks, as well as a 32%–34% drop in cardiovascular death risk. +- Evidence grade: A +- Sources:Stamatakis E, Ahmadi MN, Gill JMR, et al. (2022). Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nature Medicine, 28, 2521-2529. +- Notes: This finding is somewhat controversial. While this study utilized wearable devices to accurately measure activity levels, making it more reliable than self-reported questionnaire data, it still relied solely on observational tracking rather than controlled randomized trials, and the follow-up period was only 6.9 years. Moreover, these results apply only to individuals who currently do not engage in regular exercise; they are not applicable to those already following a consistent exercise routine. +### 17. Doing 30–60 minutes of strength training per week + +- Cost: Bodyweight squats and push-ups cost nothing. Aim for 1–2 sessions per week, each lasting 20–30 minutes. The real challenge is fitting this into your weekly schedule. +- In plain terms: People who perform 30–60 minutes of strength training each week have a 10–20% lower risk of dying during that period compared to those who don’t train. Training beyond this amount won’t bring any extra benefit. Combining strength and aerobic exercise yields the best results. +- Benefit: When multiple longitudinal studies are pooled together (without subgroup analysis), individuals who engage in strength training show a 10%–17% reduction in mortality risk relative to non‑trainers. The greatest drop — roughly 10%–20% — occurs at around 30–60 minutes of weekly training; more time does not further lower risk. Those who also do aerobic exercise enjoy an even lower mortality rate than those who do neither type of activity. +- Evidence grade: A +- Sources:Momma H 等 (2022). Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. +- Notes: These studies merely track participants over time, and the reported exercise amounts are self‑reported. The evidence supporting the claim that “excessive training can be detrimental” is very weak, so there’s no need to cap training volume for that reason. For older adults, strength training also helps prevent falls and preserve muscle mass; those benefits are discussed in Section 1. +### 18. Don’t sit for too long at a time — get up and move every now and then + +- Cost: It costs nothing; getting up a few times doesn’t take much time at all. The hard part is that once you sit down, you tend to lose track of time, so you’ll need a reminder. +- In plain terms: People who sit the longest have a 2.6 times higher risk of dying during the same period compared to those who sit the least. Sitting continuously for long stretches also adds extra risk. However, if you get 60–75 minutes of moderate-intensity activity each day, this extra risk from prolonged sitting is largely offset. +- Benefit: A U.S. observational study used accelerometers to measure activity levels without grouping participants. It divided people into four groups based on total daily sitting time; those in the group with the most sitting had a 2.63 times higher mortality risk than the group with the least (HR 2.63). When grouped by duration of each continuous sitting session, the group with the longest sessions had a 1.96 times higher risk than the group with the shortest sessions (HR 1.96). This shows that both total daily sitting time and duration of each session are independently linked to risk. Another meta-analysis of millions of participants also found that people who sat for over 8 hours daily and did little to no exercise had a 1.59 times higher mortality risk compared to those who sat for under 4 hours and were most active (HR 1.59). Even among the most active group, those who sat over 8 hours daily still had an HR of only 1.04, showing no statistically significant difference. +- Evidence grade: A +- Sources:Diaz KM 等 (2017). Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Annals of Internal Medicine. ；Ekelund U 等 (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. +- Notes: The key takeaway is that how much you move matters more than how long you sit; sufficient physical activity essentially eliminates the extra risk from prolonged sitting. Keep in mind that these studies are purely observational, so many of the people who sat the most were already unwell — the “2.63 times higher risk” partly reflects this pre-existing health condition. Additionally, the same meta-analysis found that watching TV for over 3 hours daily increased risk across all activity levels; for the most active group, this threshold rose to 5 hours. +### 19. Eat less processed meat (ham, bacon, sausages, luncheon meat) + +- Cost: It costs nothing — in fact, it saves money — and takes no extra time. The hard part is simply eating less of a food you enjoy. +- In plain terms: People who eat the most ham, bacon, and sausages have a roughly 20% higher chance of dying during the same period than those who eat the least. For every extra serving of processed meat consumed daily, that risk rises by another 20%. +- Benefit: When multiple long‑term studies are pooled together (without separating participants into groups), the group eating the most processed meat faces about a 23% higher death risk compared to the group eating the least (RR 1.23). For all red meat combined, the increase is about 29% (RR 1.29). Unprocessed red meat raises the risk by roughly 10% (RR 1.10), though this difference does not reach statistical significance. Another synthesis looks at daily intake: each extra daily serving of processed meat adds about a 23% higher death risk (RR 1.23), while each extra serving of red meat adds about 10% (RR 1.10). +- Evidence grade: A +- Sources:Larsson SC, Orsini N (2014). Red meat and processed meat consumption and all-cause mortality: a meta-analysis. American Journal of Epidemiology. ；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. ；Johnston BC 等 (2019). Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the NutriRECS Consortium. Annals of Internal Medicine. （争议方 NutriRECS 指南） +- Notes: This is a contentious topic. The NutriRECS guidelines apply the standard GRADE evidence‑rating system and deem these studies “moderately reliable.” They offer only a very weak recommendation: “continue eating as you currently do.” The debate centers on whether the evidence is strong enough, not on the overall direction of the findings. No studies have shown any benefit from eating processed meat, and the effect of unprocessed red meat appears minimal and statistically insignificant. The focus should be on cutting back on processed meat. +### 20. Drink less or no alcohol + +- Cost: There is no cost at all — it saves money and time. The only difficulty is handling social pressure to drink in gatherings. +- In plain terms: After consuming 100 g of pure alcohol per week (roughly 2.5 L of beer), the more you drink, the earlier you are likely to die. For people aged 40, those drinking 100–200 g per week lose about half a year of life expectancy; those drinking 200–350 g lose 1–2 years; and those drinking over 350 g lose 4–5 years. Overall, the healthiest choice is to abstain completely. A total of 64 drinkers were included in these analyses. +- Benefit: A pooled analysis of 83 longitudinal studies involving 600,000 drinkers shows that the lowest mortality risk occurs at a weekly intake of no more than 100 g of pure alcohol — equivalent to about 2.5 L of beer or 300 mL of 40% alcohol. At this level, 40-year-olds lose roughly 6 months of life expectancy; higher intakes lead to greater losses. The Global Burden of Disease Study 2016 also identifies zero alcohol consumption as the safest level. One adjusted analysis found that daily intake of 1.3–24 g of alcohol is linked to a 7% lower mortality risk (RR 0.93), while intakes above 65 g per day increase risk by 35% (RR 1.35). +- Evidence grade: A +- Sources:Wood AM 等 (2018). Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. ；GBD 2016 Alcohol Collaborators (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. ；Zhao J 等 (2023). Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses. JAMA Network Open. ；Di Castelnuovo A 等 (2006). Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Archives of Internal Medicine. （争议方） +- Notes: This topic remains debated. One major review of 34 long-term studies suggests that moderate drinking can reduce overall mortality by up to 17–18% for men drinking up to 4 drinks per day and women up to 2. Critics argue that non-drinkers in such studies often include people who quit drinking due to illness or who were already in poor health; when these factors are accounted for, any protective effect disappears. The safest interpretation is that moderate drinking offers little benefit, while excessive drinking clearly harms longevity. There is no evidence to support starting to drink for health reasons. For tips on cutting back, see Section 22; those already drinking daily should not attempt to quit abruptly — see Section 21 for guidance. +### 21. People who drink daily and experience tremors and palpitations when they stop should not try to quit on their own + +- Cost: Seeing a psychiatrist or addiction specialist costs just a few to several dozen dollars. In severe cases, a short hospital stay may be required. +- In plain terms: Individuals who consume large amounts of alcohol every day can suffer from withdrawal symptoms if they suddenly stop. Mild cases involve tremors, sweating, palpitations, and insomnia; severe cases may lead to seizures or delirium tremens — a life-threatening emergency. A Norwegian study of over 30,000 participants found that 8% of those who had experienced delirium tremens died each year thereafter. Anyone wanting to quit should first consult a doctor and clearly describe their daily alcohol intake. +- Benefit: A 2026 clinical review confirms that chronic heavy drinkers often develop withdrawal syndrome after abruptly cutting back or stopping entirely. Symptoms include tremors, autonomic hyperactivity, anxiety, insomnia, perceptual disturbances, seizures, and delirium tremens — conditions that are both common and potentially fatal in general medical practice. Norway’s national registry included 36,287 individuals diagnosed with alcohol dependence, withdrawal states, or delirium tremens between 2009 and 2015. The annual mortality rate was 8.0% among those with delirium tremens, 5.0% among those in withdrawal states, and 3.6% among those with alcohol dependence. The standardized mortality ratio for the delirium tremens group was 9.8 (95% CI 8.9–10.7), meaning their risk of death was roughly 9.8 times higher than that of age-matched peers in the general population. +- Evidence grade: B +- Sources:Caputo F, Lungaro L, Costanzini A, De Giorgio R, Addolorato G (2026). Alcohol withdrawal syndrome in hospitalized patients: a practical review. European Journal of Internal Medicine, 107103. ；Bramness JG, Heiberg IH, Høye A, Rossow I (2023). Mortality and alcohol-related morbidity in patients with delirium tremens, alcohol withdrawal state or alcohol dependence in Norway: A register-based prospective cohort study. Addiction, 118(12), 2352–2359. +- Notes: How to tell if you’re at risk: If you drink almost every day, experience tremors, sweating, palpitations, or insomnia when you skip a day, or feel better after having a drink in the morning, you should not attempt to quit on your own. Standard medical treatment involves using benzodiazepines to manage the initial withdrawal period while also supplementing thiamine (vitamin B1). This evidence is rated B because the Norwegian cohort data describe outcomes among people who had already suffered delirium tremens rather than directly testing the effects of self-directed abstinence. Quitting alcohol remains essential; the safer approach is to seek professional medical help. For guidance on what constitutes “frequent” drinking, see section 20; strategies for reducing intake are outlined in section 22. +### 22. To drink less, first tally how much you drink each week, then chat briefly with a doctor + +- Cost: No cost at all. Simply count the number of drinks each day and jot it down. Asking your doctor about it during a routine visit costs nothing extra. +- In plain terms: A doctor can spend a few minutes reviewing your drinking habits, explaining the risks, and helping you set a goal. After a year, people following this approach typically cut their weekly alcohol intake by about 20 grams of pure alcohol — roughly half a liter of beer. Longer consultations don’t bring any added benefit. For those already struggling to quit, two medications have proven effective abroad: for every 12 patients treated, roughly one additional person manages to avoid heavy drinking. +- Benefit: Data from 34 randomized trials involving 15,197 participants show that individuals receiving brief interventions ended up drinking 20 grams less pure alcohol per week after a year compared to those receiving minimal or no intervention (95% CI: 12–28 grams; moderate-quality evidence). The average baseline consumption in these studies was 244 grams per week. “Brief interventions” here refer to no more than five sessions totaling under 60 minutes of advice or lifestyle counseling; longer sessions provide no further advantage. Regarding medications, 122 trials with 22,803 participants indicate that acamprosate helps one additional person per 12 treated avoid any alcohol use altogether (95% CI: 8–26). Oral naltrexone at 50 mg daily similarly yields one additional non-heavy drinker per 12 patients (95% CI: 8–26). +- Evidence grade: A +- Sources:Kaner EF, Beyer FR, Muirhead C, et al. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2, CD004148. ；Jonas DE, Amick HR, Feltner C, et al. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889–1900. +- Notes: The benefit is classified as “small” because both sets of data track alcohol consumption rather than mortality; per our guidelines, outcomes based on surrogate endpoints receive this rating. The medication trials were conducted primarily abroad, with most participants meeting criteria for alcohol dependence and receiving psychosocial support alongside drug therapy; the figures represent extra benefits achieved on top of those standard treatments. Availability and prescription of these drugs in China depend on individual doctors and official labeling — do not purchase them online without medical guidance. Anyone experiencing withdrawal symptoms should refer to section 21; do not attempt to quit abruptly on your own. +### 23. Eating a small handful of nuts daily + +- Cost: Consuming 28 grams per day costs roughly 200–300 yuan annually. It’s easy to fit into your routine without taking extra time. +- In plain terms: People who regularly eat nuts have about 20% lower mortality risk compared to those who don’t. Even eating nuts just once a week yields a roughly 10% reduction in risk. The greatest benefit is seen when nuts are consumed daily. +- Benefit: Two large U.S. studies tracked over 119,000 participants for several years, totaling more than 3 million person-years. Compared to non-nut eaters: individuals consuming nuts less than once a week saw a 7% lower risk of death (hazard ratio 0.93, 95% CI 0.90–0.96). Those eating nuts once a week had a 11% lower risk (0.89, 0.86–0.93). For consumption of 2–4 times weekly, the reduction was 13% (0.87, 0.83–0.90). Those eating nuts 5–6 times weekly saw a 15% drop (0.85, 0.79–0.91), while daily consumption resulted in a 20% lower risk (0.80, 0.73–0.86). +- Evidence grade: A +- Sources:Bao Y, Han J, Hu FB, et al. (2013). Association of nut consumption with total and cause-specific mortality. New England Journal of Medicine, 369(21), 2001-2011. +- Notes: Choose plain, unsalted nuts. Although nutritious, nuts are calorie-dense, so avoid eating them in excess as snacks. Keep in mind these studies only track long-term trends; nut eaters generally maintain healthier lifestyles overall, so these figures should be interpreted with some caution. +### 24. Swapping some red meat for fish and poultry + +- Cost: There’s no extra cost or time involved. You’re simply replacing one type of meat with another, not buying more. The real challenge is adjusting your taste preferences. +- In plain terms: Eating two extra servings of processed or red meat each week raises the risk of death by roughly 3% compared to eating the same amount of fish or poultry. This effect is relatively small within this section, so it’s an easy swap to make without much effort. +- Benefit: This conclusion comes from combining data from six U.S. studies involving nearly 30,000 participants. Consuming two extra servings of processed meat weekly increases mortality risk by about 3% (hazard ratio 1.03, 95% CI 1.02–1.05). The same increase applies to unprocessed red meat (1.03, 1.01–1.05). However, switching to poultry or fish shows no significant change: hazard ratios of 0.99 (0.97–1.02) and 0.99 (0.97–1.01) respectively. +- Evidence grade: A +- Sources:Zhong VW, Van Horn L, Greenland P, et al. (2020). Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality. JAMA Internal Medicine, 180(4), 503-512. +- Notes: The impact of swapping two weekly servings of meat is minimal, so don’t expect a major lifespan boost from this change. If you’re already spending money on meat, fish and poultry are the better choices. +### 25. Swap some refined rice and flour for whole grains + +- Cost: Whole grain options like brown rice, oats, and whole wheat flour cost slightly more than refined varieties and require no extra prep time. The main challenge is adjusting to their different taste and texture. +- In plain terms: People who eat an extra 90 g of whole grains daily have a roughly 17% lower risk of dying over the same period. That amount equals about three servings. The risk continues to drop when intake rises to around 200 g per day. +- Benefit: Pooled data from multiple observational studies (no participant grouping used) shows that adding 90 g of whole grains daily cuts mortality risk by roughly 17% (RR 0.83). This effect holds true up to 210–225 g per day. Another pooled analysis found an 8% lower risk per extra daily serving (RR 0.92). +- Evidence grade: A +- Sources:Aune D 等 (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ. ；Schwingshackl L 等 (2017). Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. American Journal of Clinical Nutrition. +- Notes: You do not need to replace all refined grains with whole grains — swapping just half delivers the bulk of these benefits. Keep in mind these studies are observational, so participants eating more whole grains tend to be healthier overall, which may inflate the reported effect sizes. Results across individual studies also vary widely (I² 83%, a high value indicating substantial inconsistency between study conclusions). +### 26. Drinking tea three or more times per week + +- Cost: It costs just a few dozen to a few hundred yuan per year. Brewing a cup takes only a few minutes, so it doesn’t take up much time at all. +- In plain terms: People who regularly drink tea have a roughly 15% lower risk of dying over the same period. Starting at age 50, they can expect to live 1.26 extra years on average, and 1.41 extra years without suffering from any atherosclerotic cardiovascular diseases. +- Benefit: One large study in China, called China-PAR, involved over 100,900 participants, with half of them followed for 7.3 years. Those with a regular tea-drinking habit had a 15% lower risk of death (hazard ratio 0.85, 95% CI 0.79–0.90, which is a reliable range). Starting at age 50, these individuals gain 1.41 extra years free from atherosclerotic cardiovascular diseases, and 1.26 extra years of total life expectancy. +- Evidence grade: A +- Sources:Wang X, Liu F, Li J, et al. (2020). Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project. European Journal of Preventive Cardiology, 27(18), 1956-1963. ；茶叶霉菌毒素：Cui P 等 (2020). Quantitative analysis and dietary risk assessment of aflatoxins in Chinese post-fermented dark tea. Food and Chemical Toxicology. ；Zhou H 等 (2022). Mycotoxins in Tea (Camellia sinensis (L.) Kuntze): Contamination and Dietary Exposure Profiling in the Chinese Population. Toxins. ；绿茶提取物与肝损伤：Hu J 等 (2018). The safety of green tea and green tea extract consumption in adults - Results of a systematic review. Regulatory Toxicology and Pharmacology. +- Notes: There are some caveats to keep in mind: this type of study is purely observational, and Chinese men who drink tea tend to smoke and drink more than average. The researchers have accounted for some of these factors, but not all. Also, never drink tea that is piping hot — please refer to the section on hot drink temperatures for more details. Some people worry about mycotoxins in tea; a test of 158 batches of dark tea found aflatoxin in just 2 of them, and the amount consumed via normal tea intake stays well under internationally accepted limits. Another study examined 352 tea samples for 16 different mycotoxins, and only ochratoxin A in dark tea exceeded the legal limit on average. Even accounting for typical Chinese tea consumption levels, neither study found any dietary risk. Always store tea in a dry place, and discard any batches that have become damp or moldy. Tea extract capsules are a different story: taking large doses of concentrated catechins at one time can damage the liver, but this is not a risk when drinking brewed tea. Therefore, all the benefits mentioned here apply only to brewed tea — do not replace regular tea with extract supplements. +### 27. Drinking three to four cups of coffee daily, without sugar or cream + +- Cost: Making coffee at home costs just one or two yuan per day. It takes only a few minutes to brew each cup, so it doesn’t take much time at all. +- In plain terms: People who drink three to four cups of coffee each day have a roughly 17% lower risk of dying during the same period compared to those who don’t drink coffee. +- Benefit: One review combined results from 201 separate studies. All of these original studies simply recorded outcomes without grouping participants. The overall finding was that drinking 3–4 cups of coffee daily lowered mortality risk by 17% compared to non‑drinkers (relative risk 0.83, 95% CI 0.79–0.88; this is a reliable range). +- Evidence grade: A +- Sources:Poole R, Kennedy OJ, Roderick P, et al. (2017). Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ, 359, j5024. +- Notes: There is some debate here: the authors note that almost all evidence comes from observational tracking studies and state that “reliable randomized controlled trials are needed to confirm a causal relationship.” In other words, participants must be randomly assigned to groups for a true cause‑and‑effect conclusion. For this benefit to apply, coffee should be consumed black; adding sugar or cream cancels out these advantages. This recommendation does not apply to pregnant women or people with arrhythmia, anxiety, or insomnia. +### 28. Eating 5 servings (about 400 g) of fruits and vegetables daily + +- Cost: It costs only a few to a dozen yuan per day. You’ll also need some time each day to wash and cut them. The real challenge is making sure to buy and eat the required amount every single day. +- In plain terms: Consuming an extra 200 g of fruits and vegetables each day lowers the overall risk of death by roughly 10% over time. People who eat 5 servings daily have a 13% lower risk of death compared to those who eat just 2 servings. Eating more than 5 servings does not bring any further risk reduction. +- Benefit: When pooling data from multiple observational studies (without subgroup analysis), an extra 200 g of fruits and vegetables daily reduces mortality risk by about 10% (RR 0.90). This protective effect remains consistent up to 800 g per day. A combined analysis of two large US cohort studies and 26 other studies shows that those eating 5 servings daily have a 13% lower mortality risk than those eating only 2 servings (HR 0.87). The optimal combination is 2 servings of fruit and 3 servings of vegetables; any extra servings beyond that do not provide additional benefit. +- Evidence grade: A +- Sources:Aune D 等 (2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology. ；Wang DD 等 (2021). Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. +- Notes: It is sufficient to eat 5 servings daily — there is no need to reach 10 servings, as both studies agree on this point. Keep in mind that these studies are purely observational, so they are prone to confounding factors: people who eat more fruits and vegetables tend to have higher incomes, better education levels, and engage in more physical activity. Therefore, the reported 10% risk reduction represents an upper limit estimate. +### 29. Eat fewer ultra-processed foods (chips, instant noodles, pastries, ready meals) + +- Cost: There’s no direct cost involved, though you’ll need to spend time either preparing meals yourself or selecting minimally processed ingredients each day. The real challenge is overcoming the long-standing habit of opting for convenience over health. +- In plain terms: People who consume the most ultra-processed foods have roughly a 20% higher risk of dying during the same period compared to those who eat the least, and a 50% higher risk of dying from cardiovascular disease. However, this evidence is rated as fairly uncertain, so these figures should be treated as rough estimates. +- Benefit: One review combined multiple existing studies into a single analysis, using raw data without any subgroup categorization. The results showed that individuals consuming higher amounts of ultra-processed foods had a 21% greater risk of death (RR 1.21) and a 50% greater risk of cardiovascular death (RR 1.50) compared to those eating less of these foods. These findings were classified as “highly suggestive” and “convincing” respectively. Yet when assessed using standard GRADE criteria, the overall certainty of the evidence is rated as low or very low. +- Evidence grade: A +- Sources:Lane MM 等 (2024). Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. +- Notes: There are three main points of contention here. First, the NOVA classification system groups foods with vastly different nutritional profiles into the same category. Second, ultra-processed foods overlap heavily with sugary drinks and processed meats (discussed in items 7 and 19), making it hard to isolate which factor is having the actual effect. Third, GRADE ratings for this evidence also remain low. Consequently, it’s hard to predict exactly how much additional benefit this recommendation will provide after following items 7 and 19. The opposing evidence comes solely from the low GRADE rating given in this same review; no original studies have yet produced contradictory results. For now, it’s best to first adhere to items 7 and 19 — avoiding sugary drinks and limiting processed meat intake — before focusing on this recommendation. +### 30. Switching from coal and wood to electricity or gas for cooking and heating + +- Cost: Rural households need to replace their stoves and also pay higher fuel costs; this adds up to several hundred to over a thousand yuan per year. The switch is a one-time effort and doesn’t require ongoing time investment. In cities, most households already use electricity or gas. +- In plain terms: People who cook using coal or wood face roughly a 10% higher chance of dying over the same period compared to others; those who heat their homes this way have a roughly 14% higher risk. Those who have already switched to electricity or gas have a 13%–33% lower mortality risk than those still relying on coal and wood. +- Benefit: One Chinese study followed 271,000 adults without cardiovascular disease, recording their health outcomes without grouping them by lifestyle. People who cooked using solid fuels such as coal or wood had an 11% higher risk of death compared to those using electricity or gas (HR 1.11). Those who used solid fuels for heating faced a 14% higher risk (HR 1.14). Among people who had switched from solid fuels to cleaner alternatives, the risk dropped by 13% for cooking (HR 0.87) and by 33% for heating (HR 0.67). Separate data also show that for every 10 µg/m³ increase in long-term exposure to outdoor PM2.5, the risk of death from natural causes rises by about 8% (RR 1.08). In total, 104 studies were analyzed for this conclusion. Natural causes refer to deaths not caused by accidents. +- Evidence grade: A +- Sources:Yu K 等 (2018). Association of Solid Fuel Use With Risk of Cardiovascular and All-Cause Mortality in Rural China. JAMA. ；Chen J, Hoek G (2020). Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environment International. +- Notes: These studies merely track health outcomes over time. Households that switch to cleaner fuels are often wealthier, so part of the observed 0.67-fold reduction in risk is likely linked to socioeconomic factors. Regarding outdoor PM2.5, individuals have limited options — moving to a cleaner area, wearing masks, or using air purifiers. There are no studies evaluating air purifiers based on mortality rates, so no specific figures are provided here. +### 31. Let hot drinks cool down a bit before drinking; avoid tea, soup, and coffee that are piping hot + +- Cost: No money is required; you just need to wait two to three extra minutes each time. The hard part is resisting the urge to drink when you’re craving a hot beverage. +- In plain terms: Drinking tea that is very hot raises your risk of esophageal cancer by 8 times compared to drinking lukewarm tea. Even tea that is just “hot” doubles the risk. If you drink tea less than two minutes after pouring it, your risk is 5 times higher than if you wait at least four minutes to drink it. +- Benefit: In a high-risk region for esophageal cancer in northern Iran, researchers compared 300 patients with esophageal cancer to 571 healthy individuals. All results below are compared against people who drank lukewarm tea. Those who drank “hot” tea had roughly 2.07 times the risk of developing squamous cell carcinoma of the esophagus (95% CI: 1.28–3.35). For people who drank “very hot” tea, the risk was about 8.16 times higher (95% CI: 3.93–16.9). Those who drank tea less than two minutes after pouring it had 5.41 times the risk of developing the disease compared to people who waited at least four minutes to drink it (95% CI: 2.63–11.1). +- Evidence grade: A +- Sources:Islami F, Pourshams A, Nasrollahzadeh D, et al. (2009). Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ, 338, b929. ；Loomis D, Guyton KZ, Grosse Y, et al. (2016). Carcinogenicity of drinking coffee, mate, and very hot beverages. Lancet Oncology, 17(7), 877-878. +- Notes: The International Agency for Research on Cancer classifies hot drinks above 65°C as Group 2A carcinogens, meaning they are “probably carcinogenic to humans.” The same assessment also confirms that coffee itself is not carcinogenic. In China, high rates of esophageal cancer in regions like Chaoshan and the Taihang Mountains are strongly linked to the habit of drinking beverages while they are still very hot. +### 32. Getting some sun during the day — don’t stay out of the light all the time + +- Cost: No cost at all. Just a few minutes each day — on your commute or during lunch breaks is enough. +- In plain terms: Women who deliberately avoid sunlight can expect to live 0.6 to 2.1 years less than those who get the most sun exposure. Even non-smokers who avoid the sun tend to have a life expectancy similar to smokers who get plenty of sun. +- Benefit: A Swedish study followed 29,500 women for 20 years. Compared to the group getting the most sun, those who avoided it ended up living 0.6 to 2.1 years less. The authors noted that “non-smoking women who avoid sunlight have a life expectancy comparable to smokers who get the most sun exposure.” +- Evidence grade: B +- Sources:Lindqvist PG, Epstein E, Nielsen K, et al. (2016). Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. Journal of Internal Medicine, 280(4), 375-387. +- Notes: There are some caveats: Sweden’s high latitude and limited sunlight mean these findings may not directly apply to China. It’s also possible that people avoiding sun tend to be less physically active or prefer staying indoors. Also, avoid sunburn — use protection under strong midday sun, since excessive exposure raises skin cancer risk. +### 33. Keep BMI between 20–25; lose weight if you’re overweight + +- Cost: No monetary cost. However, diet and exercise require daily time and effort. This is the toughest guideline in the whole chapter: maintaining weight loss is harder than losing it in the first place. +- In plain terms: Mortality is lowest when BMI falls within 20–25. At BMI 27.5–30, risk rises by roughly 20%; at 30–35, it climbs by about 45%; at 35–40, it nearly doubles. East Asians are especially sensitive to excess weight — for every 5‑unit increase in BMI, risk rises by roughly 40%. +- Benefit: Data from 239 longitudinal studies were pooled and analyzed (no subgrouping was performed). Only three groups remained in the final analysis: non‑smokers, individuals without chronic disease at enrollment, and those who survived at least five years after joining the study. Results showed that mortality risk was lowest at BMI 20–25. Between 25–27.5, risk increased by about 7% (HR 1.07); at 27.5–30, by roughly 20% (HR 1.20); at 30–35, by about 45% (HR 1.45); at 35–40, by nearly 94% (HR 1.94); and at 40–60, it was 2.76 times higher (HR 2.76). For East Asians, each additional 5 kg/m² of BMI raised risk by about 39% (HR 1.39). +- Evidence grade: A +- Sources:Global BMI Mortality Collaboration (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. ；Flegal KM 等 (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. （争议方） +- Notes: This topic remains controversial. Some researchers argue that being slightly overweight actually extends lifespan; their pooled data show a roughly 6% lower mortality risk for overweight individuals and a 5% reduction for those with mild obesity. The main disagreement centers on whether to exclude three types of data: smokers, patients already suffering from disease, and participants in the first few years after enrollment. Those groups are excluded because severely ill patients tend to lose weight first. After removing these three categories from the analysis of 239 studies, the elevated mortality risk associated with excess weight reappears. It is also important to note that no randomized trials have proven that weight loss itself lowers overall mortality. The benefits described above result from comparing people of different weights, not from a guarantee that losing weight will produce those exact reductions. Those aiming to lose weight need not obsess over meal timing; neither breakfast nor the 16:8 intermittent fasting regimen offers any extra advantage — see Section 6, Item 26 for details. +### 34. Eating chili peppers more than four times a week + +- Cost: There is no cost and it doesn’t take any extra time. +- In plain terms: People who eat chili peppers more than four times a week have a roughly 23% lower chance of dying during the same period compared to those who rarely eat them; their risk of dying from cardiovascular causes is about one-third lower. +- Benefit: One Italian study followed 22,800 people for an average of 8.2 years; 1,236 participants died over that time. Those who ate chili peppers four or more times a week had a 23% lower risk of death than those who rarely ate them (hazard ratio 0.77, 95% CI 0.66–0.90). Their risk of cardiovascular death was also about 34% lower (HR 0.66, 95% CI 0.50–0.86). +- Evidence grade: B +- Sources:Bonaccio M, Di Castelnuovo A, Costanzo S, et al. (2019). Chili Pepper Consumption and Mortality in Italian Adults. Journal of the American College of Cardiology, 74(25), 3139-3149. +- Notes: There is some debate: this research was conducted within the context of a Mediterranean diet, so chili eaters may simply follow a diet that aligns more closely with local traditional eating habits. Additionally, people with gastroesophageal reflux, hemorrhoids, or irritable bowel syndrome may experience worsened symptoms from eating chili peppers; they don’t need to force themselves to eat it. +### 35. Drinking one or two servings of milk or yogurt daily + +- Cost: Only a few yuan per day; requires no extra time. +- In plain terms: People who consume two or more servings of milk or yogurt daily have a roughly 17% lower chance of dying during the same period compared to those who don’t drink any. +- Benefit: The PURE study followed 136,000 participants across 21 countries for an average of 9.1 years; 6,796 of them passed away. Those who ate two or more servings of dairy products daily faced a 17% lower mortality risk than non-consumers (hazard ratio 0.83, 95% CI 0.72–0.96). The statistical significance of this trend is confirmed by a P-value of 0.0052. +- Evidence grade: B +- Sources:Dehghan M, Mente A, Rangarajan S, et al. (2018). Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet, 392(10161), 2288-2297. +- Notes: There are some concerns: the PURE study included many participants from low- and middle-income countries, where regular milk consumption often reflects better household financial status, making it hard to rule out this confounding factor. Additionally, people with lactose intolerance can safely switch to yogurt or low-lactose milk instead of forcing themselves to drink regular milk. +### 36. Eggs don’t need to be avoided, but don’t eat three or four daily + +- Cost: No cost and no extra time required. +- In plain terms: Eating an extra half whole egg each day raises the overall mortality risk by roughly 7%. Swapping that half egg for egg whites, fish, poultry, or nuts actually lowers the risk of death across all categories. There’s no need to cut eggs out of your diet; just avoid consuming three or four daily. +- Benefit: A U.S. study tracking 521,000 people found that 129,000 participants died over time. Those eating an extra half whole egg daily had a 7% higher mortality risk (hazard ratio 1.07; 95% CI 1.06–1.08). Replacing that half egg with an equal amount of egg whites, poultry, fish, dairy, or nuts and legumes further reduced mortality risk, including risks related to cardiovascular disease, cancer, and respiratory conditions. +- Evidence grade: B +- Sources:Zhuang P, Wu F, Mao L, et al. (2021). Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study. PLoS Medicine, 18(2), e1003508. +- Notes: This topic remains controversial: other large-scale long-term studies and meta-analyses have found no link between egg consumption and mortality. The U.S. Dietary Guidelines have also removed the previous daily cholesterol limit. The key takeaway is to avoid eating three or four eggs daily; one egg per day poses no significant concern. +### 37. Take baths when you can — don’t limit yourself to showers + +- Cost: It costs more in water and electricity; each bath takes about half an hour. +- In plain terms: People who bathe almost daily have a roughly 28% lower risk of cardiovascular events and a roughly 46% lower risk of brain hemorrhage compared to those who bathe fewer than twice a week. +- Benefit: A Japanese study involving 30,000 participants followed for 19 years recorded 2,097 cardiovascular events. Those who bathed almost daily had about 28% lower risk of cardiovascular events than those who bathed no more than twice a week (hazard ratio 0.72, 95% CI 0.62–0.84). Their risk of coronary heart disease was about 35% lower (0.65, 0.45–0.94), risk of stroke about 26% lower (0.74, 0.62–0.87), and risk of brain hemorrhage about 46% lower (0.54, 0.40–0.73). +- Evidence grade: B +- Sources:Ukai T, Iso H, Yamagishi K, et al. (2020). Habitual tub bathing and risks of incident coronary heart disease and stroke. Heart, 106(10), 732-737. +- Notes: These results apply to the Japanese population and its bath culture; most Chinese households lack the conditions for daily baths. Also, water should not be too hot and baths should not last too long. For older adults and those with cardiovascular or cerebrovascular diseases, excessively hot water and prolonged bathing can actually be dangerous — Japan sees many elderly deaths in bathtubs each year. +### 38. Keep naps under 30 minutes — no longer than an hour. If you need a full hour or more to feel functional, it’s time to get checked out. + +- Cost: It costs nothing. Just set an alarm before you nap; it requires almost no willpower at all. +- In plain terms: People who nap for less than an hour show no increase in mortality or chronic disease risk, and their mental clarity actually improves. Those who nap longer than an hour face roughly a 30% higher risk of coronary heart disease, and about a 20% higher risk of diabetes and obesity. So set that alarm and wake up after half an hour. If you regularly need a full hour or more to get through the day, that’s a clear sign you should have a medical checkup. +- Benefit: One umbrella meta-analysis pooled data from 16 separate meta-analyses covering 244 health outcomes. The bottom line: people who nap fewer than 60 minutes experience no rise in overall mortality or chronic disease risk, and see the greatest gains in cognitive function (SMD 0.69, 95% CI 0.37–1.00 — a reliable range). Naps lasting 20–30 minutes produce the biggest improvements in physical performance (SMD 0.99, 95% CI 0.67–1.31). In contrast, naps exceeding 60 minutes raise coronary heart disease risk by roughly 30%, and diabetes and obesity risk by about 20%. Another study used wrist-worn monitors to track actual nap duration in 1,338 adults aged 56 and older, rather than relying on self-reported surveys. After up to 19 years of follow-up, 926 participants died. For every extra hour of napping, mortality risk rose by about 13% (HR 1.13, 95% CI 1.04–1.23). Each additional daily nap added roughly 7% to that risk (HR 1.07, 95% CI 1.02–1.13). Naps taken in the morning carried a roughly 30% higher risk compared to those taken earlier in the afternoon (HR 1.30, 95% CI 1.03–1.64). +- Evidence grade: B +- Sources:Du P, Li J, Hua Z, 等 (2026). Multiple Health Outcomes of Daytime Napping: A Comprehensive Umbrella Review. Public Health Reviews. ；Gao C, Cai R, Zheng X, 等 (2026). Objectively Measured Daytime Napping Patterns and All-Cause Mortality in Older Adults. JAMA Network Open. ；Dashti HS 等 (2021). Genetic determinants of daytime napping and effects on cardiometabolic health. Nature Communications. +- Notes: This topic remains controversial. Both of the major studies mentioned above merely recorded nap duration without stratifying participants by health status. People who habitually nap longer are more likely to suffer from sleep apnea, anemia, hypothyroidism, depression, or other chronic conditions; therefore it’s hard to isolate exactly how much of the observed mortality increase is directly attributable to napping itself. Mendelian randomization studies involving 453,000 and 541,000 participants respectively found only one consistent link: the more frequently someone naps, the slightly higher their blood pressure and waist circumference become. No causal effect on coronary heart disease or diabetes was identified. Consequently, “shortening naps” shouldn’t be promoted as a standalone strategy for lowering mortality. The recommendation to “get checked out” is an author‑suggested precaution; it falls under a lower‑grade evidence tier. If daytime fatigue forces you to nap for extended periods, first evaluate nighttime sleep quality — check for snoring or breathing pauses that might indicate sleep apnea — and then arrange routine blood tests and thyroid screening. For quick, effective energy boosts, see Section 3, Item 11 (a 10‑minute afternoon nap works best). Optimal nighttime sleep duration is discussed in Section 13 of this chapter (aim for 7 hours per night). +### 39. Catch up on sleep the night after a sleepless night — don’t wait until the weekend + +- Cost: No cost at all. Those extra hours of sleep you make up are exactly what you’d have wanted to get anyway. +- In plain terms: People who lose sleep one night and fail to make it up the following night have a roughly 15% higher risk of death compared to those with regular sleep patterns. For those who lose far more sleep and still don’t catch up, the risk rises by about 42%. No such increased risk is seen in people who do make up the lost sleep. So if you stay up late, go to bed early the next night. +- Benefit: This study used data from 85,618 UK Biobank participants, with an average age of 61.8 years. Wrist-worn monitors tracked their daily sleep, and they were followed for a median of 8 years. The researchers first identified each person’s individual sleep needs, then defined “sleep deficit nights” as nights when they got at least 2.5 hours less sleep than required. The first night after such a deficit was called a “catch-up night”, and if they got more sleep than needed that night, they were counted as having made up the deficit. Five distinct sleep patterns were identified based on this framework. Compared to people with regular sleep schedules, those who lost sleep and did not catch up had a 15% higher risk of all-cause death (HR 1.15, 95% CI 1.01–1.31, a reliable range). For those with a cumulative sleep deficit of over 3.5 hours who also failed to catch up, the risk rose by around 42% (HR 1.42, 1.24–1.63). No significant risk increases were found in the two groups who did make up their sleep deficit; for those who lost sleep but caught up, the HR was 1.12 (0.98–1.28). Among people who naturally get less sleep, those who lost sleep and did not make it up had a 19% higher risk (HR 1.19, 1.01–1.40), while those with a severe sleep deficit and no catch-up showed a 38% higher risk (HR 1.38, 1.17–1.63). These findings were replicated in a separate US health survey of 4,586 participants. +- Evidence grade: B +- Sources:Li X, Zhang M, Li Z, 等 (2026). Acute sleep rebound following sleep restriction is associated with reduced mortality risk. Nature Communications. +- Notes: This is an observational study with no formal grouping of participants. People who cannot make up lost sleep may simply be busier or in poorer health, and this factor cannot be fully ruled out. The fact that no risk increase was detected in the two groups who caught up only means no statistically significant difference was found; their point estimates remain above 1, so catching up does not completely eliminate risk. Therefore, if you lose sleep, you should make it up as soon as possible — but this does not give you a free pass to stay up late regularly. The “catch-up sleep” referenced here means getting extra sleep on the very first night after a deficit, not saving up multiple nights of sleep to make up all at once over the weekend. The practice of staying up on weekdays and sleeping in on weekends, which creates “social jetlag”, is linked to cardiovascular disease — see Section 13 (aim for around 7 hours of sleep per night with consistent schedules). The advice to wake up at the same time every day, including on weekends (Section 3, point 2), does not conflict with this tip: this recommendation only asks you to go to bed early the night after a sleepless night, not to sleep in until noon the next day. +### 40. The longer you work night shifts, the higher your cardiovascular risk — switch jobs if you can + +- Cost: Switching jobs or changing roles may mean a lower salary and the loss of night-shift allowances. Job hunting takes time and requires a firm decision. If you factor this cost in when choosing a job, it effectively becomes zero. +- In plain terms: People who work night shifts develop cardiovascular disease about 13% more often than those who don’t, and cardiovascular-related deaths are about 27% higher. The longer you work nights, the worse it gets: for every additional five night shifts, cardiovascular disease risk rises by roughly 7%. So, when you calculate this over years, it makes sense to switch jobs early on. As for cancer and night shifts, the evidence is far weaker than commonly believed. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer. +- Benefit: A pooled analysis of 23 studies — all observational, no subgrouping — shows that night-shift workers face a roughly 13% higher risk of cardiovascular events (RR 1.13, 95% CI 1.10–1.16). Cardiovascular-related deaths are about 27% higher (RR 1.27, 1.18–1.36). Over time, each extra five night shifts adds roughly 7% to cardiovascular disease risk (RR 1.07, 1.04–1.09) and about 5% to cardiovascular deaths (RR 1.05, 1.03–1.06). Specific conditions show similar trends: coronary heart disease incidence rises about 22% (RR 1.22, 1.16–1.28), as does coronary death risk (1.22, 1.10–1.36). Ischemic heart disease death risk climbs about 39% (1.39, 1.06–1.84), while stroke death risk increases about 49% (1.49, 1.04–2.12). Stroke incidence, however, shows no significant change (RR 1.06, 0.95–1.18). +- Evidence grade: A +- Sources:Xi J, Ma W, Tao Y, 等 (2025). Association between night shift work and cardiovascular disease: a systematic review and dose-response meta-analysis. Frontiers in Public Health. ；Esposito G, Bravi F, Santucci C, 等 (2025). Night shift work and breast cancer risk in healthcare workers: a systematic review and meta-analysis. Occupational Medicine. ；Shen QM, Li ZY, Tan YT, 等 (2026). Night shift work and risk of total and site-specific cancer: results from a prospective cohort study among Chinese men. Scandinavian Journal of Work, Environment & Health. ；Czeisler CA, Johnson MP, Duffy JF, 等 (1990). Exposure to bright light and darkness to treat physiologic maladaptation to night work. New England Journal of Medicine, 322(18), 1253-1259. +- Notes: All these studies are purely observational and do not adjust for key factors like smoking, weight, or income — differences that naturally exist between night-shift workers and others. Cancer and night shifts: the evidence is much weaker than popular belief suggests. A meta-analysis of 12 studies involving 12,132 breast cancer cases found only a 5% higher risk among night-shift workers (RR 1.05, 95% CI 0.96–1.14). For those who worked night shifts for 20 years, the risk rose to 25% (RR 1.25, 1.01–1.55), but after correcting for publication bias this figure became non-significant and essentially close to 1; the authors concluded this link “is far from established.” Another long-term study of Chinese men followed for 16.1 years found no overall link between night shifts and cancer; only pancreatic cancer risk rose about 59% (HR 1.59, 1.09–2.31) among those who worked night shifts for 11–20 years. The absolute number of pancreatic cancer cases in this group was 8,202. Therefore, this discussion focuses on cardiovascular risk, not cancer. Not everyone must quit night shifts — you should weigh the yearly cost-benefit yourself. For those already working nights, several steps can help: quit smoking (see Section 1), control blood pressure and cholesterol (Section 12), and make up lost sleep properly (Section 39). Two additional strategies are worth trying: eat mainly during daytime hours and use bright light during shifts while strictly avoiding light at night to reset your circadian rhythm. The latter is the only proven method to shift circadian timing; ordinary indoor lighting leaves the rhythm unchanged even after six night shifts, but exposure to 7,000–12,000 lux during shifts plus near-total darkness by day can reset it in just four days. Crucially, bright nighttime light, strict daytime darkness, and wearing sunglasses on the way home are all essential — missing any one of them negates the effect. Neither strategy has been shown to lower cardiovascular risk; returning to a daytime routine on days off also resets the rhythm. Full details on exact figures, sources, and how the body tracks time can be found in [docs/生物钟和夜班.md](../../docs/生物钟和夜班.md). +### 41. Buy pre-packaged cooking oil with an SC number, not bulk homemade peanut oil from small workshops + +- Cost: Switching to such oil costs about the same. Just check whether the packaging shows a food production license number starting with “SC”. The real challenge is convincing older relatives who are used to buying homemade oil. +- In plain terms: When peanuts get damp and moldy, they produce aflatoxin — a known human carcinogen that mainly harms the liver. After Guangzhou tightened regulations on small workshops, the rate of abnormal liver function among local residents who regularly consumed homemade oil dropped by roughly 35%. In Guangxi, pregnant women who ate homemade peanut oil had nearly a 90% higher risk of giving birth to low‑birth‑weight babies and an 80% higher risk of premature delivery. +- Benefit: Aflatoxin is classified as a Group 1 carcinogen by the International Agency for Research on Cancer, meaning it definitely causes cancer — primarily liver cancer. A Guangzhou study measured aflatoxin B1 levels in homemade peanut oil from small workshops between 2010 and 2022; the median concentration was 1.29 μg/kg, with half of all samples falling between 0.12 and 6.58 μg/kg. After local regulations took effect, toxin levels fell by 2.865 μg/kg and continued to drop by 2.593 μg/kg each year thereafter. Consequently, the proportion of local residents with abnormal liver function fell by about 35% (PR 0.650, 95% CI 0.469–0.902). Another study in Guangxi followed 1,611 pregnant women; 81.7% of them consumed homemade peanut oil. Those women faced roughly a 90% higher risk of having low‑birth‑weight infants (aOR 1.9, 95% CI 1.1–3.2) and an 80% higher risk of premature delivery (aOR 1.8, 95% CI 1.1–3.0). +- Evidence grade: B +- Sources:Lei J, Li Y, Wang Y, 等 (2024). The impact of small food workshops management regulations on aflatoxin B1 in home-made peanut oil and the liver function of high-consumption area residents: an interrupted time series study in Guangzhou, China. Frontiers in Public Health, 12. ；Zhong Y, Lu H, Jiang Y, 等 (2024). Effect of homemade peanut oil consumption during pregnancy on low birth weight and preterm birth outcomes: a cohort study in Southwestern China. Global Health Action, 17. ；IARC (2012). Chemical Agents and Related Occupations. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 100F. ；国家卫生计生委、国家食品药品监督管理总局 (2017). 食品安全国家标准 食品中真菌毒素限量（GB 2761-2017） +- Notes: Both studies were observational in nature and lacked a control group. The Guangzhou study used liver‑function test results as its endpoint rather than incidence of liver cancer or mortality. The median aflatoxin level in homemade oil actually stayed below China’s legal limit of 20 μg/kg for peanut oil; the risk arises from long‑term consumption and occasional batches with higher concentrations. The legal limit applies to all peanut oil, but pre‑packaged oil must meet production‑license and factory‑inspection standards, while small workshops are subject to far fewer inspections under regional regulations. The main beneficiaries of this advice are you and your family members who eat the same meals. +### 42. Replacing lard and butter with vegetable oils for cooking: you don’t need to constantly switch oils for health reasons, nor should you expect flaxseed oil to protect your heart. + +- Cost: It doesn’t cost much extra. Vegetable oils are already the main cooking oils in most households. The real challenge is breaking the habit of using lard or butter for stir-frying and flavoring meals. +- In plain terms: Cutting back on saturated fats like lard and butter and switching to vegetable oils reduces the risk of heart disease and stroke by roughly 17%. However, there’s no measurable change in overall mortality. Switching between soybean oil, corn oil, and canola oil shows no clear health benefits either. Consuming large amounts of flaxseed oil also doesn’t lower heart disease risk. +- Benefit: A Cochrane review analyzed 15 randomized trials involving 56,675 participants, each followed for at least two years. Reducing saturated fat intake lowered the combined rate of cardiovascular events by about 17% (RR 0.83, 0.70–0.98). Overall mortality remained virtually unchanged (RR 0.96, 0.90–1.03), as did cardiovascular-related deaths (RR 0.95, 0.80–1.12). No significant difference was found between replacing saturated fats with polyunsaturated fats (the main component of soybean and corn oils) or with carbohydrates. Data on replacing them with monounsaturated fats (found in canola and olive oils) was too limited to draw conclusions. Another Cochrane review of 19 trials with 6,461 participants found that higher omega-6 intake (linoleic acid) had no effect on overall mortality (RR 1.00, 0.88–1.12) or cardiovascular events (RR 0.97, 0.81–1.15). A third review of 86 trials with 162,796 participants showed that increasing plant-based omega-3 intake (primarily from flaxseed and perilla oils) had virtually no impact on overall mortality (RR 1.01, 0.84–1.20) or coronary heart disease events (RR 1.00, 0.82–1.22). +- Evidence grade: A +- Sources:Hooper L, Martin N, Jimoh OF, 等 (2020). Reduction in saturated fat for cardiovascular disease. Cochrane Database of Systematic Reviews, (5), CD011737. ；Hooper L, Al-Khudairy L, Abdelhamid AS, 等 (2018). Omega-6 fats for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (11), CD011094. ；Abdelhamid AS, Brown TJ, Brainard JS, 等 (2020). Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, (3), CD003177. ；中国营养学会 (2022). 中国居民膳食指南（2022）. 人民卫生出版社 +- Notes: Controversy: Some argue that high levels of omega-6 in soybean and corn oils promote inflammation, so these oils should be limited or replaced. However, the aforementioned studies on omega-6 showed no harmful effects, and the authors rated the evidence quality as low. The 17% reduction in cardiovascular events is considered a moderate benefit, while overall mortality shows no change. Regardless of the oil type, portion control is essential; dietary guidelines recommend 25–30 grams of cooking oil per person per day. diff --git a/book/en/03-Do-Not-Waste-Energy.md b/book/en/03-Do-Not-Waste-Energy.md new file mode 100644 index 00000000..c5ed7bda --- /dev/null +++ b/book/en/03-Do-Not-Waste-Energy.md @@ -0,0 +1,248 @@ +# 3. Don’t waste your energy + +This section is all about energy and time. We look at four main factors: how much attention you can actually use each day, how quick your reactions are, how often you make mistakes, and how long it takes you to get back on track after being interrupted. All the numbers here come from direct measurements — either from lab experiments or from tracking large groups of people over time (observational studies). These figures are not converted into life expectancy or mortality rates. Most items in this section carry a B evidence grade; that’s just how this field works, and it doesn’t make the recommendations any less valid. Item 20 deals with what to expect when dealing with police, doctors, or bank tellers; it cites laws rather than experimental data, so its grade is C. Items 15 (treating pessimistic thoughts as symptoms) and 23 (treating the belief that “others expect me to be perfect” as a symptom) use mortality and suicide‑risk figures that follow a different calculation method than the rest of this section, so they’re not compared with the other numbers here. +### 1. Turn off non‑essential notifications and keep your phone out of sight while working + +- Cost: No cost at all. It takes just a few minutes to adjust the settings, and hardly any willpower is required. +- In plain terms: Even if you don’t look at or touch your phone when it rings, your performance on attention‑related tasks still drops. The drop is roughly the same as when you actually answer calls or send messages. Another scenario: even when the phone sits on the desk and you resist the urge to glance at it, the amount of mental capacity available still decreases. The more dependent a person is on their phone, the greater this drop tends to be. +- Benefit: Merely receiving a notification — without looking at or interacting with the phone — noticeably impairs performance on attention tasks. The degree of impairment is comparable to actually answering calls or sending messages. These findings come from laboratory studies involving university students. Two additional experiments also show that even when participants successfully refrain from looking at their phone, having it nearby still reduces their available mental resources; this effect is strongest among heavy phone users. +- Evidence grade: B +- Notes: All of these results are based on single‑task experiments conducted in a lab setting. No research has examined how these effects accumulate over days or weeks in real‑world conditions. For jobs where immediate responsiveness is essential, it may be advisable to allow notifications only from a limited set of contacts. +- Sources:Stothart, Mitchum & Yehnert (2015). The attentional cost of receiving a cell phone notification. Journal of Experimental Psychology: Human Perception and Performance. ；Ward, Duke, Gneezy & Bos (2017). Brain Drain: The Mere Presence of One's Own Smartphone Reduces Available Cognitive Capacity. Journal of the Association for Consumer Research. + +### 2. Keep a fixed wake-up time, even on weekends + +- Cost: No cost involved. Sticking to this on weekends requires a bit of willpower. +- In plain terms: For the top 20% of students with the most irregular sleep schedules, their circadian rhythm runs roughly 2.5 hours later than that of the top 20% with the most regular schedules. This is equivalent to living with a persistent jet lag. Moreover, students with more consistent sleep patterns tend to achieve better academic results. +- Benefit: Sixty-one university students tracked their sleep patterns over 30 days. The group with the least regular schedules had a circadian rhythm that lagged by about 2.5 hours compared to the most regular group — specifically, the time when melatonin starts secreting was 00:08 versus 21:32 for the latter. The period when they felt most sleepy also occurred roughly 1.8 hours later. Additionally, greater sleep regularity correlated with better academic performance, with a correlation coefficient of r = 0.37. +- Evidence grade: B +- Notes: This is the sole study on this topic, with a relatively small sample size and no control groups. Researchers estimate that these circadian differences stem mainly from varying daily exposure to natural light. Therefore, maintaining a fixed wake-up time works best when paired with exposure to morning sunlight. For tips on how to recover after occasional late nights, see Section 2, Item 39: the recommended approach is to go to bed earlier that very night rather than sleeping in until noon the following day. +- Sources:Phillips et al. (2017). Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Scientific Reports. + +### 3. Getting 7 to 8 hours of sleep each night — don’t settle for just 6 hours + +- Cost: No cost at all. You simply need to set aside 1–2 extra hours each day for sleep. Going to bed earlier requires a bit of willpower. +- In plain terms: After two full weeks of getting only 6 hours of sleep each night, brain performance drops to a level equivalent to going two full nights without any sleep at all. The tricky part is that people don’t notice this effect themselves. Their self-rated sleepiness only rises during the first few days and then plateaus — people sleeping 6 hours report the same level of fatigue as those sleeping just 4 hours. In other words, the belief that “6 hours of sleep is enough for me” is actually a symptom of chronic sleep deprivation. +- Benefit: In a randomized controlled trial, 48 healthy adults aged 21–38 were asked to get just 6 hours of sleep per night for 14 consecutive days. Their cognitive performance steadily declined, eventually reaching levels comparable to those seen after two full nights of total sleep loss. Meanwhile, their self-reported sleepiness only increased at first and then remained largely unchanged. There was no difference in self-rated fatigue between the 6-hour and 4-hour sleep groups. Additionally, a meta-analysis of 70 studies found that acute sleep deprivation (lasting no more than 48 hours) leads to a moderate drop in simple attention (effect size g = -0.776) and a much smaller decline in reasoning accuracy (g = -0.125). +- Evidence grade: A +- Notes: The most important takeaway is that “not feeling sleepy” is not proof that you’ve gotten enough sleep. People who regularly sleep just 6 hours simply get used to the state, but their actual performance does not improve. The results from the meta-analysis apply to staying awake for an entire night; there is only one randomized controlled trial supporting the idea that consistently getting less than 6 hours of sleep has any real negative impact. +- Sources:Van Dongen, Maislin, Mullington & Dinges (2003). The cumulative cost of additional wakefulness. Sleep. ；Lim & Dinges (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin. + +### 4. Avoid caffeine after 2 p.m. + +- Cost: No cost involved. People accustomed to drinking coffee in the afternoon must summon some willpower to abstain. +- In plain terms: Consuming a large cup of coffee containing 400 mg of caffeine 6 hours before bedtime reduces measured total sleep time by over 1 hour, yet personal sleep logs show no difference. To avoid any impact on sleep, a regular cup of coffee (107 mg of caffeine) must be consumed at least 8.8 hours prior to bedtime; for those going to bed at 11 p.m., 2 p.m. marks the cutoff point. +- Benefit: Intake of 400 mg of caffeine 6 hours before sleep results in a measurable reduction of 1.1–1.2 hours in total sleep time compared to placebo consumption. Multiple studies combined via meta-analysis indicate that caffeine on average shortens total sleep duration by 45 minutes and lowers sleep efficiency — the proportion of time spent actually asleep while in bed — by 7%. +- Evidence grade: A +- Notes: The sole study by Drake utilized a relatively high caffeine dose of 400 mg, equivalent to roughly two or three cups of coffee, and was conducted in a single laboratory setting. Individuals with slower caffeine metabolism must adhere to an even earlier cutoff time. This recommendation complements the third item, which advises aiming for 7–8 hours of sleep nightly. +- Sources:Drake, Roehrs, Shambroom & Roth (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine. ；Gardiner et al. (2023). The effect of caffeine on subsequent sleep: A systematic review and meta-analysis. Sleep Medicine Reviews. + +### 5. Batch-process emails and messages a few times per day + +- Cost: No monetary cost. However, it takes some time to explain to colleagues how often you’ll be checking messages. It also requires a bit of willpower to resist the urge to check them constantly. +- In plain terms: The same group of participants was studied over two weeks. During the week when they limited email checks to just three times per day, their daily stress levels dropped noticeably compared to the unrestricted week — while the total number of emails sent and received stayed the same. Without any limits, people checked their emails an average of 15.5 times per day. +- Benefit: In a two-week self-controlled trial involving 124 adults, those who limited email checks to three times daily experienced significantly lower daily stress than when they checked freely (effect size: Cohen’s d = 0.37). The overall volume of emails received and replied to did not differ between the two conditions. Without restrictions, participants checked emails 15.5 times per day on average. +- Evidence grade: B +- Notes: Only one study has examined this approach, showing a modest effect size. It measured stress levels rather than actual work output. No direct research exists on limiting instant messaging checks; this recommendation is extrapolated from similar email studies. +- Sources:Kushlev & Dunn (2015). Checking email less frequently reduces stress. Computers in Human Behavior. + +### 6. When doing tasks that require continuous thinking, keep out even brief interruptions + +- Cost: No cost at all. Just close the door, put on headphones, or hang a “Do Not Disturb” sign. +- In plain terms: Even a brief interruption lasting 2.8 seconds on average doubles the chance of errors in subsequent steps of a sequential task. An interruption of 4.4 seconds triples that error rate. Field observations also show that it takes an average of 25 minutes to return to the interrupted task, with two other unrelated tasks squeezed in during that time. People who get interrupted do finish tasks faster, but they report higher levels of stress, frustration, effort, and time pressure. +- Benefit: On average, a 2.8-second interruption doubles the error rate for sequential tasks, while a 4.4-second interruption triples it. This finding comes from lab experiments. Another study observed 24 office workers (information professionals) in real-world settings. They switched topics every 11 minutes on average, and 57% of those topic switches were interrupted. It took them 25 minutes and 26 seconds on average to get back to the interrupted task, with 2.26 other tasks added in between. A separate experiment with 48 participants showed similar results: interrupted workers completed tasks faster, but reported significantly higher stress, frustration, effort, and time pressure. +- Evidence grade: B +- Notes: The field study mentioned above categorized interruptions into two types: those caused by others approaching the worker, and those initiated by the worker themselves. Simply closing the door blocks only the first type of interruption. To handle the second type, combine this tip with Tip 1 (turn off non-essential notifications) and Tip 5 (batch-process messages). +- Sources:Altmann, Trafton & Hambrick (2014). Momentary interruptions can derail the train of thought. Journal of Experimental Psychology: General. ；Mark, Gonzalez & Harris (2005). No task left behind? Examining the nature of fragmented work. CHI 2005. ；Mark, Gudith & Klocke (2008). The cost of interrupted work: More speed and stress. CHI 2008. + +### 7. Do one thing at a time — don’t reply to messages while in a meeting + +- Cost: No cost at all. It does take a bit of willpower to resist replying to messages during a meeting. +- In plain terms: Every time you switch tasks, your reaction time slows down and errors become more likely. People who regularly keep multiple screens open at once don’t actually get better at multitasking; in fact, they perform worse on task-switching tests. +- Benefit: Switching between tasks clearly slows reaction time and raises the chance of mistakes. This conclusion comes from a review of multiple studies. One lab study involved university students. Those who frequently use several types of media at the same time are known as heavy media multitaskers. They’re more easily distracted by unrelated things and unrelated memories, and they also perform worse on task-switching tests. +- Evidence grade: B +- Notes: Exactly how much extra effort task-switching requires varies a lot depending on the task, so no single number can be given here. The Ophir study compares people at one single point in time, so it’s hard to tell whether multitasking makes attention worse, or whether people with poorer attention skills simply prefer to multitask. +- Sources:Monsell (2003). Task switching. Trends in Cognitive Sciences. ；Ophir, Nass & Wagner (2009). Cognitive control in media multitaskers. PNAS. + +### 8. Avoid glowing screens one hour before bed; if you must, read paper books or e-ink devices instead + +- Cost: No cost involved. Giving up phone use one hour before bed requires willpower, especially when fighting long-standing habits. +- In plain terms: Reading from glowing screens before bed delays sleep onset by roughly 10 minutes compared to reading paper books. It also lowers melatonin production by 55%. The next day, the body’s internal clock shifts more than 1.5 hours later, making mornings harder and requiring extra time to feel fully awake. +- Benefit: In controlled lab experiments, the same participants were tested under both conditions (cross-over design). Those reading from glowing e-readers fell asleep about 10 minutes later than those reading paper books (25.7 minutes versus 15.8 minutes). Their nighttime melatonin levels dropped by 55%, and their circadian rhythm shifted by over 1.5 hours — melatonin secretion started at 22:31 instead of 21:01. This resulted in greater morning sleepiness and a longer recovery time to full alertness. +- Evidence grade: B +- Notes: The study involved a small number of participants and was conducted under tightly controlled lab conditions. Real-world effects may be smaller given typical phone brightness and usage patterns. The study did not evaluate how much nighttime screen modes actually help. +- Sources:Chang, Aeschbach, Duffy & Czeisler (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS. + +### 9. Go to bed at a set time — avoid staying up late for games, short videos, or porn + +- Cost: No money is required. The hard part is fighting the habit of “just one more episode.” The easiest way is to keep phones out of the bedroom. +- In plain terms: In 2025, Chinese people slept an average of 6.97 hours per night, with an average bedtime of 12:10 a.m. Those who used phones or tablets before bed were more than twice as likely to get insufficient sleep, and 2.7 times more likely to feel drowsy during the day. Even just having devices in the bedroom without using them led to similar results. Thus, the simplest solution is to keep phones out of the bedroom. +- Benefit: In 2025, Chinese residents averaged 6.97 hours of sleep per night, with an average bedtime of 12:10 a.m. (China Sleep Research Society). Compared to those who did not use portable devices before bed, users faced roughly 2.17 times higher odds of insufficient sleep (OR 2.17), 1.46 times higher odds of poor sleep quality (OR 1.46), and 2.72 times higher odds of daytime drowsiness (OR 2.72). Even when devices were merely present in the bedroom without being used, these odds remained at 1.79, 1.53, and 2.27 respectively. These figures are based on 20 concurrent surveys involving 125,198 children and adolescents. Another concurrent study of 844 adults aged 18–94 found that those who used phones after turning off the lights took longer to fall asleep, had a lower proportion of true sleep while in bed, and felt more fatigued during the day. +- Evidence grade: B +- Notes: This topic is somewhat controversial. The health risks of chronic sleep deprivation are discussed in item 3 of this section (getting 7–8 hours of sleep per night). Currently, there is no reliable evidence showing how porn affects ordinary people’s energy levels or cognitive abilities. One meta-analysis suggests that so-called “porn problems” often stem from a mismatch between personal beliefs and actual behavior, rather than the content itself. Another study of 280 men found no link between viewing duration and erectile function during sexual activity with a partner. This item specifically addresses how porn consumes sleep time. NOTE: The official webpage of the China Sleep Research Society uses dynamic loading and could not be accessed; the figures cited here are taken from a reprint by the local health commission. +- Sources:Carter et al. (2016). Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes. JAMA Pediatrics. ；Exelmans & Van den Bulck (2016). Bedtime mobile phone use and sleep in adults. Social Science & Medicine. ；中国睡眠研究会 (2026). 2026 中国睡眠健康研究白皮书（福建省卫健委转载健康报报道）. ；Grubbs JB 等 (2018). Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis. Archives of Sexual Behavior. （备注里的争议方之一）；Prause N, Pfaus J (2015). Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction. Sexual Medicine. （备注里的争议方之二） + +### 10. Don’t make major decisions or send important messages late at night + +- Cost: No cost at all. You simply postpone these tasks until after you’ve woken up. +- In plain terms: People who stayed awake for 49.5 hours were asked to take part in risk decision experiments. When well-rested, they quickly learned to avoid high-risk options; after sleep deprivation, they repeatedly chose high-risk choices instead. The older a person is, the more pronounced this effect becomes. This study looked at the extreme scenario of two consecutive sleepless nights; it did not directly test how much impact a few fewer hours of sleep would have, but the overall trend supports postponing important decisions until the next day. +- Benefit: Thirty-four healthy participants completed the Iowa Gambling Task after going 49.5 hours without sleep. This task is a standard way to measure risk decision making. When well-rested, they quickly learned to steer clear of high-risk options; after sleep loss, they opted for high-risk choices far more often. Older participants showed a stronger response to this effect. This is the only study of its kind to date. The total number of participants was 34. +- Evidence grade: B +- Notes: The research focused on the extreme case of two nights of continuous sleep deprivation. There is no direct data on how ordinary people fare after staying awake until 2 a.m. The advice to avoid sending messages late at night is based on the authors’ personal experience (rated as Grade C evidence); it is perfectly fine to send such messages the following day instead. +- Sources:Killgore, Balkin & Wesensten (2006). Impaired decision making following 49 h of sleep deprivation. Journal of Sleep Research. + +### 11. Take a 10‑minute nap in the afternoon — don’t sleep half an hour + +- Cost: It costs nothing. Just set aside 10 minutes and find a place where you can lie down or recline. +- In plain terms: A 10‑minute nap gives an immediate boost of alertness that lasts about two and a half hours. A 5‑minute nap provides almost no benefit, while a 20‑minute nap only starts to help after roughly half an hour. Sleeping 30 minutes brings on sleep inertia — you’ll feel groggy right after waking, making performance worse than if you hadn’t napped at all. +- Benefit: After a night of insufficient sleep, a 10‑minute nap quickly reduces drowsiness, fatigue, and improves energy and mental performance; some of these effects persist for up to 155 minutes. A 5‑minute nap yields virtually no benefit, and the advantages of a 20‑minute nap appear only after 35 minutes. A 30‑minute nap first causes sleep inertia, so performance is actually poorer right after waking, before any improvement occurs. +- Evidence grade: B +- Notes: Only one laboratory study exists, and its participants were healthy young adults. If you can’t fall asleep, there’s no need to force it; there’s no research showing any benefit from simply lying down with eyes closed for 10 minutes. Naps longer than an hour have been linked to higher mortality and increased risk of coronary heart disease — see Section 2, Item 38 (keep naps under 30 minutes). +- Sources:Brooks & Lack (2006). A brief afternoon nap following nocturnal sleep restriction: Which nap duration is most recuperative? Sleep. + +### 12. Using earplugs or finding a quiet room for memory-heavy tasks in open offices + +- Cost: Earplugs cost just a few dozen yuan. Booking a quiet meeting room takes some time and effort. +- In plain terms: When background noise rises from 39 dB to 51 dB, people remember fewer words, feel more tired, and are less motivated to work. Watching nature videos with sound during breaks helps restore energy far better than continuing to endure office noise. +- Benefit: Students working in simulated open offices showed similar effects: at 51 dB LAeq background noise, they recalled fewer words, rated themselves as more fatigued, and felt less inclined to keep working. Viewing nature videos with audio during breaks also boosted their energy levels more effectively than listening to river sounds or office noise alone. +- Evidence grade: B +- Notes: Only one laboratory study exists on this topic. Among all noise types, speech that can be clearly understood has the greatest negative impact on performance. White noise headphones may help mitigate this effect, but they were not tested in this research. +- Sources:Jahncke, Hygge, Halin, Green & Dimberg (2011). Open-plan office noise: Cognitive performance and restoration. Journal of Environmental Psychology. + +### 13. Do not work more than 49 hours per week + +- Cost: You might earn less in overtime pay. You may also need to put in effort to negotiate with your supervisor. +- In plain terms: Records from British munitions factories during World War I show that when workers kept weekly hours under 49, output rose in direct proportion to the time spent working. Once they exceeded 49 hours, the growth rate began to drop. Output from workers putting in 70 hours per week was practically identical to that of those working 56 hours — those extra 14 hours yielded no additional results. In total, this data covers a period spanning 100 years. +- Benefit: Data from British munitions factories in World War I demonstrates that output rises steadily with working hours up to 49 per week. After that threshold, the rate of growth slows. Peak output is reached at roughly 63 hours. At 70 hours, output remains essentially the same as at 56 hours, meaning those extra 14 hours are wasted effort. +- Evidence grade: B +- Notes: These figures come from factories a century ago where most workers were women performing manual labor. This threshold may differ for cognitive work; the authors themselves note that other occupations could have higher or lower limits. What is reliable, though, is the overall trend: beyond a certain point, adding more hours yields almost no extra output. The specific figure of 49 hours is not proven. +- Sources:Pencavel (2015). The Productivity of Working Hours. The Economic Journal. + +### 14. When you notice yourself endlessly replaying a distressing memory, do something hands‑on instead + +- Cost: No cost at all. The hard part is first recognizing that you’re stuck in this loop – a skill that takes practice. +- In plain terms: Endlessly dwelling on the same bad memory won’t yield any answers. It only deepens depression, cements negative thoughts, makes it harder to solve problems or take action, and can drive away friends who’d otherwise listen. As soon as you realize you’re stuck in this cycle, get busy with a physical task. +- Benefit: A review of multiple studies shows that repetitive rumination on distressing events worsens depression. This pattern, known as rumination, also strengthens negative thinking and weakens problem‑solving abilities. It hampers real‑world action and can alienate supportive people. It is linked to anxiety, binge eating, alcohol misuse, and self‑harm. +- Evidence grade: B +- Notes: This is the hardest item in this section to quantify; the review only provides general direction. “Doing something else” reflects the author’s own approach. The literature supports one core idea: diverting attention is better than staying trapped in rumination. No research has compared which specific activities work best. +- Sources:Nolen-Hoeksema, Wisco & Lyubomirsky (2008). Rethinking Rumination. Perspectives on Psychological Science. + +### 15. Treat thoughts like “things will definitely get worse” as symptoms, not as facts + +- Cost: No cost involved. The hard part is viewing such thoughts as symptoms rather than as objective truths. +- In plain terms: In a 20-year twin study, each additional step up on a pessimism scale correlated with a roughly 13% higher risk of dying during that period, and a roughly 20% higher risk of dying from cardiovascular disease. Conversely, higher optimism scores did not bring any comparable benefits. Thus, the focus should be on reducing pessimism, not on simply “being more positive.” +- Benefit: This study followed 2,978 twins aged 50 or older in Australia for an average of 20 years; 1,068 of them died over that time. For each standard deviation increase on the pessimism scale, the relative risk of death rose by about 13% (hazard ratio 1.134). The 95% confidence interval for this figure is 1.065–1.207, with a p-value of 8.85×10⁻⁵. Cardiovascular mortality rose by roughly 20% (hazard ratio 1.196; 95% CI 1.045–1.368; p=0.0093). No link was found between pessimism and cancer mortality. Similarly, higher optimism scores showed no meaningful association with mortality rates. +- Evidence grade: B +- Notes: This finding remains somewhat controversial. It is purely observational and no subgroups were defined. Some argue that illness might precede and cause heightened pessimism; the authors counter that if that were true, pessimism should also correlate with cancer mortality. Nevertheless, other unmeasured factors could still be at play. Importantly, optimism does not offer any protective effect, so there is no need to force oneself to “think positively.” What matters is refraining from treating pessimistic expectations as accurate forecasts of the future. +- Sources:Whitfield JB, Zhu G, Landers JG, Martin NG (2020). Pessimism is associated with greater all-cause and cardiovascular mortality, but optimism is not protective. Scientific Reports, 10, 12609. + +### 16. Cut back on draining relationships and learn to say no to unwanted requests + +- Cost: No monetary cost. In the short term, this may cause social friction and possibly lead to losing some relationships. It also takes considerable willpower to actually say no. +- In plain terms: The harm caused by a draining person is greater and more consistent than the benefits brought by a supportive one. That is why it makes sense to first reduce such relationships before trying to add healthier ones. +- Benefit: A survey of 120 widowed women aged 60–89 found that unpleasant interactions showed a stronger and more consistent link to lower psychological well‑being than pleasant ones. In other words, the negative impact of a draining person outweighs the positive effects of a supportive one. +- Evidence grade: C +- Notes: The study group is quite specific, and the questionnaire was administered only once, so no cause‑and‑effect sequence can be determined. It measures overall happiness rather than energy levels. The author includes this example as a speculative inference. There is no objective definition of what counts as a “draining” relationship; each person must judge that for themselves. +- Sources:Rook (1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology. + +### 17. Lock in low‑value decisions such as what to wear or eat + +- Cost: No cost at all. At first you’ll need to spend some time setting the default options. +- In plain terms: There’s no solid evidence for this idea. The original experiment claiming that making choices drains willpower failed in two large‑scale replications. One involved 2,000 participants, the other 3,000, with multiple labs conducting the same tests — and the effect was essentially zero. Still, it’s worth fixing these routine decisions because they save you a few minutes and a bit of mental effort; they don’t actually conserve willpower. +- Benefit: Not quantifiable. Early research suggested that decision‑making and self‑control draw on a single limited resource (self‑exhaustion). Yet two major replication attempts — one with 2,141 participants across 23 labs and another with 3,531 participants from 36 labs — produced negligible effects (effect sizes of 0.04 and 0.06 respectively, with wide confidence intervals ranging from -0.07 to 0.15). The absolute value 0.07 also appears within this range. +- Evidence grade: C +- Notes: This is a controversial claim. “Decision fatigue” is often presented as a proven fact in popular literature, but most attempts to replicate the original studies have failed to find the same results. We keep this entry only because it costs virtually nothing and genuinely saves time; don’t expect it to boost your judgment later in the day. +- Sources:Baumeister, Bratslavsky, Muraven & Tice (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology. ；Hagger et al. (2016). A Multilab Preregistered Replication of the Ego-Depletion Effect. Perspectives on Psychological Science. ；Vohs et al. (2021). A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect. Psychological Science. + +### 18. Walk away when angry; treat the other person as weather, not an enemy + +- Cost: No cost at all. You must resist the urge to retort on the spot, turn around and leave, then decide later whether to address the situation. This takes some practice. +- In plain terms: Reframing what just happened or trying to see things from the other person’s perspective can genuinely lower emotional intensity; the latter approach works especially well. Simply suppressing emotions has no effect. Additionally, people who punish those who offend them end up dwelling on the incident far longer afterward; those who do not retaliate move on more quickly. People also tend to overestimate how satisfying revenge actually is. +- Benefit: A meta-analysis combining 306 separate experiments shows that reframing events (cognitive reappraisal) yields a moderate effect size of d = 0.36 on emotional intensity. Viewing things from the other person’s perspective produces an even stronger effect, d = 0.45. Distraction yields d = 0.27. Simply suppressing emotions has virtually no effect, with d = -0.04. Three other experiments likewise reveal that people who punish offenders keep thinking about them far longer; those who refrain from retaliation move on more quickly. People consistently overestimate how gratifying revenge truly is. +- Evidence grade: B +- Notes: The portion of this analysis dealing with emotional intensity — not energy expenditure — shows effects ranging from small to moderate. Because only one experiment addresses the issue of revenge, the overall grade is B. The “empty boat” parable originates from Zhuangzi’s “Mountain Trees”: one remains calm when an empty boat bumps into them, but becomes angry when a boat carrying people does the same; the impact is identical in both cases. This is purely an analogy, not empirical evidence. If actual harm has occurred, following the legal procedures outlined in Sections 8 and 9 is far less costly than reacting impulsively on the spot. +- Sources:Webb TL, Miles E, Sheeran P (2012). Dealing with feeling: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin. ；Carlsmith KM, Wilson TD, Gilbert DT (2008). The paradoxical consequences of revenge. Journal of Personality and Social Psychology. + +### 19. Best low-cost actions when you’re feeling down: move, get sunlight, stick to a schedule, talk to someone, call 12356 + + +- Cost: Costs little to nothing. Just a few brisk walks, runs, or strength workouts each week. Spend time outdoors in daylight. Keep a regular sleep schedule. When you’re feeling stuck, give someone a call. + +- In plain terms: According to a meta-analysis of 218 randomized trials, brisk walking and running produce the strongest benefits for depression, with yoga and strength training also helpful — the greater the intensity, the better the effect. Sunlight therapy works very well for seasonal depression and also helps with non‑seasonal cases. Online self‑guided cognitive‑behavioral therapy programs are effective; having a therapist guide you makes them even better, especially if your symptoms are moderate to severe. When you’re feeling overwhelmed, dial 12356 first. + +- Benefit: This meta-analysis combined data from 218 randomized controlled trials involving 14,170 participants; the control group performed other activities. Compared with them, walking or running lowered depression scores by g = -0.62 (95% CI -0.80 to -0.45). Yoga produced g = -0.55 and strength training g = -0.49; higher intensity further improved outcomes. Pooled data from multiple light‑therapy studies showed an effect size of 0.84 (0.60–1.08) for seasonal depression and 0.53 (0.18–0.89) for non‑seasonal cases. Another analysis aggregated individual‑patient data from various studies on internet‑based cognitive‑behavioral therapy; both self‑guided and therapist‑supervised programs outperformed controls, with therapist guidance yielding better results for moderate‑to‑severe depression (PHQ‑9 score >9). The 12356 hotline provides nationwide psychological support for at least 18 hours each day. + +- Evidence grade: A + +- Notes: These measures serve as adjuncts for mild‑to‑moderate depression. Individuals with moderate‑to‑severe depression or suicidal thoughts should seek professional care; they may also call 12356 first (see Section 1, Item 25). Most exercise trials involve relatively few participants and cannot employ the placebo blinding used in drug studies. Light‑therapy research available up to 2003 also includes limited sample sizes. The advice to “stick to a schedule” and “talk to someone” reflects the authors’ experience rather than specific published evidence. Remember, even a ten‑minute walk counts as “getting active” for someone dealing with depression. +- Sources:Noetel M 等 (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. ；Golden RN 等 (2005). The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry. ；Karyotaki E 等 (2021). Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis. JAMA Psychiatry. ；国家卫生健康委 (2024). 关于应用"12356"全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 20. Treat police officers, doctors, and bank tellers as rule‑following workers, not as archetypes: paperwork and deadlines — not emotions — drive results. + + +- Cost: No expense involved. You only need to adjust your expectations and the sequence of actions. The first step is to resist the urge to “convince the other party with logic.” +- In plain terms: Children tend to think “police exist to catch bad guys; doctors exist to heal people.” Adults should instead view these professionals as employees bound by job rules, paperwork, deadlines, and oversight. How friendly they are has little bearing on whether your task gets done or how quickly. What matters is obtaining receipts, noting deadlines, and filing appeals through proper channels — not winning an intellectual debate. +- Benefit: Switching to this approach means moving from “pleading, getting angry, and reiterating your grievances” to “handling paperwork, tracking deadlines, and appealing via official routes.” The time saved comes from eliminating endless back‑and‑forth discussions and mental re‑processing. This is a one‑time mindset shift rather than a daily time‑saving trick. The deadlines themselves serve as concrete checkpoints, all clearly stated in official documents. For public‑security cases, the investigation period may not exceed 30 days; for especially complex cases, an extension of another 30 days can be granted with higher‑level approval. If a complaint is dismissed, the notification must be delivered within three days; the complainant may request a review within seven days, after which police must issue a decision within 30 days. A further appeal to a higher authority can be filed within another seven days. +- Evidence grade: C +- Notes: Grade C is assigned because there is no scholarly source supporting the premise that “many people treat front‑desk staff as archetypes rather than ordinary workers.” The only evidence lies in the rules themselves: deadlines, paperwork, and appeal mechanisms are all explicitly codified. All figures cited here originate from Article 39 in Section 8, which outlines procedures following a police report. This entry does not promise to “guarantee success” by following the rules, nor does it address “unfriendly attitudes” on the part of officials. It merely shifts expectations and the initial course of action. The same logic applies to bank tellers and government service windows: their actions are documented, subject to review, and accountable for errors. Therefore, the proper steps are to keep receipts, request written confirmations, and file complaints through official channels — rather than speculating about whether someone might “take advantage” of you. Legitimate priorities are laid out in law; for example, emergency care is allocated based on medical severity, not on first‑come‑first‑served order (see Article 8 in Section 24 on triage). If you wish to thank a doctor who helped you, send a thank‑you letter or leave a satisfaction rating as described in Article 12 of Section 24. Offering gifts to law‑enforcement personnel to “get better service” constitutes bribery, a crime with severe statutory penalties (see Article 40 in Section 8). Any obvious discrimination should be reported and monitored, not imitated as an unwritten norm. +- Sources:公安部 (2020). 公安机关办理刑事案件程序规定（公安部令第 159 号修正后，第一百七十一、一百七十八、一百七十九条）. ；公安部 (2013/2019 修正). 公安机关办理行政案件程序规定（公安部令第 125 号、第 149 号）. + +### 21. Don’t make “how others are doing” a daily habit: set limits on apps that show peers’ updates or turn them off + + +- Cost: This costs nothing. Setting time limits or deactivating an account takes just a few minutes. The real challenge is resisting the urge to open these apps again later on. + +- In plain terms: People who habitually compare themselves to others online tend to feel worse emotionally and have lower self‑esteem. Meta‑analysis of over 36,000 participants shows a moderate correlation between upward social comparison and poorer psychological outcomes. Correlation does not equal causation, but randomized trials back this link: after four weeks without Facebook, participants reported a slight rise in happiness. Another study limited three major platforms to 10 minutes per day; after three weeks, loneliness and depression both declined. The trade‑off? Knowledge of current events also dropped during those four weeks of abstinence. + +- Benefit: The combined results of 54 independent studies — 94 effect sizes and a total N of 36,583 — analyzed via a three‑level random‑effects model reveal that upward social comparison correlates with poorer mental health (average r = 0.330, 95% CI 0.289–0.370). Specific effects include higher fear of negative evaluation (r = 0.438), anxiety (0.382), depression (0.306), lower happiness (0.268) and lower self‑esteem (0.263). Life satisfaction increased by 0.12 standard deviations, while happiness rose by 0.08 standard deviations. Age, cultural background and data collection year do not alter this link. In a randomized trial of 2,743 U.S. Facebook users, 61% would accept a four‑week suspension at a cost of under $102; those in the suspension group gained 0.09 standard deviations in overall life satisfaction. Compared with typical psychological interventions (which raise happiness by ~0.34 SD and cut depression by ~0.23 SD), this effect is roughly 25–40% of that magnitude. After the trial ended, former suspension users still spent 0.31 fewer standard deviations per day on Facebook. Even after the trial ended, former suspension users still spent 12 fewer minutes per day on Facebook. A smaller trial of 143 college students showed similar benefits after limiting three platforms to 10 minutes daily. Additionally, knowledge of current affairs declined by 0.19 standard deviations, and political polarization fell by 0.16 standard deviations as a result of reduced app usage. + +- Evidence grade: A + +- Notes: The correlation findings merely indicate that these patterns tend to appear together; they do not prove causation. The randomized trials do suggest causal links, but they involve U.S. participants prior to the 2018 midterm elections, so applying the results directly to Chinese users is a stretch. The undergraduate trial involved only 143 subjects, limiting its statistical power. Overall effect sizes remain modest, so cutting off these apps alone will not resolve all emotional issues. This advice targets usage aimed at monitoring how others are faring; it does not apply to staying in touch with family, seeking information or job hunting. If strict limits prove hard to maintain, start by disabling push notifications, “people you may know” suggestions and homepage recommendations. For broader screen‑time management, see sections 4.15 and 4.16 (hard caps on short‑video apps and scrolling news). When feeling down, consider the actions outlined in section 19 (exercise, sunlight and regular sleep). For those seeking identity through purchases, see section 6.23; those striving to “move up a social rung” should review section 6.24. +- Sources:Lei Y, Hu S, Sun Y, Zheng L (2026). "Looking up" linked to feeling down: a meta-analysis of online upward social comparison and psychological maladjustment. Frontiers in Psychology. ；Allcott H, Braghieri L, Eichmeyer S, Gentzkow M (2020). The Welfare Effects of Social Media. American Economic Review, 110(3), 629–676. ；Allcott H, Braghieri L, Eichmeyer S, Gentzkow M (2019). The Welfare Effects of Social Media. NBER Working Paper No. 25514（本条引用的具体数字按这一版逐字核对，刊出版的摘要不含数字）. ；Hunt MG, Marx R, Lipson C, Young J (2018). No More FOMO: Limiting Social Media Decreases Loneliness and Depression. Journal of Social and Clinical Psychology, 37(10), 751–768. + +### 22. When you feel like “everyone saw me make a fool of myself,” cut that estimate in half. + + +- Cost: No cost at all. It simply requires asking yourself once, when you’re nervous: “Did they really see it?” + +- In plain terms: Imagine someone wearing an embarrassing T‑shirt into a room full of people. On average, they estimate that 46% of onlookers can identify who the shirt depicts; the actual figure is only 23%, exactly half as much. When they wear a T‑shirt of their own choosing that they consider decent, the estimate jumps to 48% while the true rate drops to just 8% — a six‑fold difference. Other studies show that after a conversation, people consistently underestimate how much their partner likes them. Thus, the belief that “I messed up and everyone noticed” is itself an over‑estimate; cutting it in half still leaves it too high. + +- Benefit: Experiment 1: Participants donned T‑shirts featuring Barry Manilow’s portrait and entered rooms with other subjects. On average, they predicted that 46% of observers would correctly name the figure on the shirt; the actual correct rate was 23%, precisely double the estimate. Subtracting the observed rate from the predicted one yields an average over‑estimation of 23 percentage points (95% CI 9–38). Excluding two sessions with only two or three observers leaves a difference of 27 points (11–43). Experiment 2: Participants wore T‑shirts they personally selected as “positive.” Their average prediction was 48%, whereas the true recognition rate fell to 8%, a six‑fold gap. Across three additional contexts — strangers paired for conversation, college roommates, and adult workshop participants — people systematically under‑estimated both how much their interlocutor liked them and how much they enjoyed the talk. The authors term this the “liking gap.” It appears in conversations of any length and persists for months among new roommates. + +- Evidence grade: B + +- Notes: Grade B reflects that all studies were conducted in laboratory or campus settings with relatively small sample sizes, involving wearing shirts or chatting with strangers. There is no direct evidence that these findings apply to situations such as being discussed by colleagues or making a mistake in a meeting. The numbers merely indicate the direction and approximate magnitude of over‑estimation; they do not provide a fixed multiplier you can apply. This advice is not meant to imply that others’ opinions are irrelevant. In genuine evaluation contexts — interviews, defenses, assessments, or medical evaluations — judgments are real and should be taken seriously. It specifically addresses that everyday feeling of “everyone is watching me”; the real opponent here is your own estimation bias. +- Sources:Gilovich T, Medvec VH, Savitsky K (2000). The spotlight effect in social judgment: An egocentric bias in estimates of the salience of one's own actions and appearance. Journal of Personality and Social Psychology, 78(2), 211–222. ；Boothby EJ, Cooney G, Sandstrom GM, Clark MS (2018). The Liking Gap in Conversations: Do People Like Us More Than We Think? Psychological Science, 29(11), 1742–1756. + +### 23. Treat “others expect me to be perfect” as a symptom, not a fact + +- Cost: No cost involved. The hard part is viewing this thought pattern as something that needs addressing rather than as an accurate reflection of others’ actual expectations. +- In plain terms: The correlation between the feeling of “people around me expect me to be perfect and will reject me if I fail” and suicidal thoughts is 0.28. When the phrasing changes to “I myself expect myself to be perfect,” the correlation drops to just 0.10. The real risk does not come from having high standards per se, but from perceiving those standards as being imposed by others. Even after accounting for pre-existing suicidal thoughts, the former feeling still helps predict an increase in such thoughts over time. +- Benefit: A comprehensive meta-analysis was conducted using data from 45 studies involving 11,747 participants — including undergraduates, medical students, community members, and psychiatric patients — analyzed via a random-effects model. The weighted average correlation with suicidal thoughts is as follows: for perfectionistic concerns (a composite of socially prescribed perfectionism, fear of making mistakes, self-doubt, and perceived gaps between personal performance and standards), r = .28 (95% CI .24–.32; based on 42 studies with 7,936 participants). Socially prescribed perfectionism alone also shows r = .28 (.25–.32; 30 studies, 3,640 participants). Perfectionistic striving — which reflects self-directed perfectionism and personal standards — has a lower correlation of r = .10 (.07–.13; 31 studies, 4,588 participants). Parental criticism correlates at r = .20 (.11–.29). Regarding suicide attempts, perfectionistic concerns correlate at r = .12 (.07–.17; 15 studies, 5,275 participants), while socially prescribed perfectionism shows r = .19 (.08–.29; 8 studies, 689 participants). Even after adjusting for pre-existing suicidal thoughts, socially prescribed perfectionism still shows a modest positive link to later increases in suicidal thoughts; no such link is observed for self-directed or other-oriented perfectionism. +- Evidence grade: B +- Notes: This item is graded B because most included studies relied on single-time surveys, making it hard to establish temporal sequence. The correlation strength is moderate (r ≈ .28), accounting for only a few to ten percent of total variance. Since the outcomes measured are suicidal thoughts and attempts rather than actual mortality, the overall benefit is rated as limited due to reliance on surrogate endpoints. The authors themselves note that the data on perfectionistic concerns and suicide attempts may suffer from publication bias, with studies showing weaker or null results less likely to be published; even after accounting for such missing studies, the overall trend remains unchanged. This recommendation does not oppose setting high standards; rather, it emphasizes where those standards originate and whether failure to meet them leads to feelings of personal worthlessness. Similar to the idea discussed in Item 15 — viewing pessimistic expectations like “things will definitely get worse” as symptoms — this pattern can also be addressed clinically. If you or someone you know is experiencing suicidal thoughts, call 12356 immediately and remove any means of self-harm, as outlined in Section 1, Item 25. For guidance on how to respond when someone close expresses such thoughts, refer to Section 8, Item 15. Information on depression screening for children can be found in Section 30, Item 8. +- Sources:Smith MM, Sherry SB, Chen S, Saklofske DH, Mushquash C, Flett GL, Hewitt PL (2018). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522–542. + +### 24. When angry, don’t try to vent by smashing things, punching a bag, or going for a run — first calm your body down. + + +- Cost: No cost at all. When you’re angry, try a few minutes of activities that slow your heart rate: breathe slowly, sit down, and quiet your mind. It’s hard to resist the urge to vent right then and there. + +- In plain terms: Activities that rev up the body — like punching a bag, throwing things, or going for a run — generally don’t help you cool off. On the other hand, techniques that calm the body, such as slow breathing, mindfulness, and meditation, noticeably reduce anger and the urge to lash out. + +- Benefit: A meta-analysis of 154 studies involving 184 sample groups and 10,189 participants shows that calming techniques like deep breathing, mindfulness, and meditation lower both anger and aggression. The effect size was g = -0.63, with a 95% CI ranging from -0.82 to -0.43. This result held true across genders, races, ages, and cultures. In contrast, activities that increase physical arousal — such as punching a bag, jogging, or cycling — showed virtually no effect; their effect size was g = -0.02, with a 95% CI from -0.13 to 0.09. The authors conclude that neither venting anger nor going for a run is an effective way to defuse it. + +- Evidence grade: A + +- Notes: These findings measure anger and aggression, not overall energy levels. The authors categorize the time spent on calming activities as “minutes saved from dealing with fallout after an argument.” Immediate techniques you can use right now include the “circular sighing” method described in Section 22, Item 9, and “stepping away when angry” in Section 24, Item 18. Running isn’t useless in the long run — it helps ease low mood, as noted in Section 22, Item 7 (“When feeling down, go for a walk or run”). It simply isn’t a good short-term fix for anger. While angry, avoid driving, sending messages, or making important decisions. If someone is physically attacking you, leave the scene and call the police; your priority then is safety, not emotional regulation — see Section 8, Item 43 (“If you’re being abused”). +- Sources:Kjærvik SL, Bushman BJ (2024). A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage? Clinical Psychology Review. + +### 25. Writing down thoughts and feelings about a troubling issue over several days can be helpful, but don’t expect it to cure anything + +- Cost: This costs nothing. Typical practice in studies is to write 3–4 times, each session lasting 15–20 minutes. Write about something that bothers you and express your deepest thoughts and feelings. +- In plain terms: Writing about upsetting matters generally provides a small benefit on average, though the results are inconsistent. Two meta-analyses found no effect at all. Since it costs almost nothing, it’s worth trying. However, if emotional problems are severe, it should not replace professional medical care. +- Benefit: One meta-analysis combined data from 146 randomized studies in which participants wrote or spoke about personally important topics. On average, the effect was positive and statistically significant, though very small (effect size r = .075). Another meta-analysis limited to randomized controlled trials found no significant effects on either physical or mental health across 30 trials. For 16 trials involving cancer patients and survivors, there were no significant improvements in psychological, physical, or quality-of-life outcomes; the effect size for psychological outcomes was g = 0.04, with a 95% confidence interval ranging from –0.06 to 0.14. +- Evidence grade: B +- Notes: This approach remains controversial. Proponents point to the 146-study meta-analysis showing a small positive effect, while critics cite two meta-analyses of randomized controlled trials that found no significant benefits. The recommended frequency and duration of writing sessions come from the original experimental designs, as summarized in Mogk’s meta-analysis. This method is included here because it requires virtually no expense or time and can be done alone. It may be useful when someone has no one to talk to about their problems. The time-based measurement used here reflects how authors categorized effort levels. If writing becomes increasingly distressing, stop and dial 12356, as described in Section 1, Item 25. +- Sources:Frattaroli J (2006). Experimental disclosure and its moderators: a meta-analysis. Psychological Bulletin. ；Mogk C, Otte S, Reinhold-Hurley B, Kröner-Herwig B (2006). Health effects of expressive writing on stressful or traumatic experiences - a meta-analysis. Psycho-Social Medicine. ；Zachariae R, O'Toole MS (2015). The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. Psycho-Oncology. diff --git a/book/en/04-Do-Not-Waste-Time.md b/book/en/04-Do-Not-Waste-Time.md new file mode 100644 index 00000000..6aec7a69 --- /dev/null +++ b/book/en/04-Do-Not-Waste-Time.md @@ -0,0 +1,166 @@ +# 4. Don’t waste time + +This section is all about time. We look at how many hours you can save each day, week, or year, and how much the odds improve of finishing a task on schedule. We don’t convert time into extra years of life or into money. When money does come up, we only give the calculation method — no final figures. Most of the items here are backed by a single study or overall statistics from time‑use surveys, so the evidence grades are mostly B or C. +### 1. Write “what to do” as “if… then…” + +- Cost: No cost at all. Each step takes just 1–2 minutes — simply write a sentence like “If… then…”. For example: “If I sit at my desk at 8 a.m. on Tuesday, I’ll start by writing the introduction.” +- In plain terms: Change “I plan to do this” into “If I sit at my desk at 8 a.m. on Tuesday, I’ll start by writing the introduction.” Across 94 separate studies, people who used this phrasing were far more likely to achieve their goals — this effect is moderate to large. All it requires is rewriting one sentence; there’s no expense and almost no extra effort. +- Benefit: When all 94 studies are combined, individuals who expressed their plans as “if… then…” statements had significantly higher success rates. This technique is known in psychology as implementation intentions. The effect size here is d = 0.65, which qualifies as moderate to large. Three key moments benefit from this approach: initiating action, resisting distractions, and disengaging from tasks that seem impossible to complete. +- Evidence grade: A +- Notes: This method works only for goals you genuinely want to achieve. If a goal holds no personal value for you, writing multiple such statements won’t help. Additionally, most research participants were students, and the studies focused on health-related habits; results may not translate directly to workplace settings. +- Sources:Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119. + +### 2. Write down exit criteria before starting + +- Cost: No cost at all. It takes just 5 minutes at the start to write down: “If a certain target isn’t met by a specific date, then we’ll stop.” The hard part is actually honoring that promise when the day comes — it can feel embarrassing to call off a project in front of others. +- In plain terms: Before you begin any project, write one simple sentence: “If a certain target isn’t met by a specific date, then we’ll stop.” Multiple studies combined show this approach really does help people pull back from efforts they’re unlikely to succeed at. What you save is all the time you’d otherwise keep pouring into that project. +- Benefit: When data from several studies on commitment strategies are pooled together, the result is clear: setting a clear “if… then…” condition beforehand also helps people disengage from failing courses of action. The time saved is exactly the amount you’d have kept investing otherwise. +- Evidence grade: B +- Notes: Exit criteria should be written at the very start of a project, while emotions are still neutral. Deciding on them later gets skewed by all the resources already spent; at that point you should focus only on future investment and future returns, as explained in item 3. Also, “the ability to withdraw” is just one sub‑finding across those studies — no single study has calculated exactly how much time it can save. +- Sources:Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119. + +### 3. When deciding whether to continue, consider only future investments and future returns — not what has already been invested. + +- Cost: No monetary cost is involved. The difficulty lies in accepting that all time previously invested cannot be recovered. +- In plain terms: Money and time already spent tend to make people more inclined to keep going. Across 98 datasets, this tendency remains consistent. Therefore, when deciding whether to continue, only future investments and expected returns should be taken into account; past expenditures must be excluded from the calculation. +- Benefit: Prior investments of money, effort, and time increase the likelihood of continued engagement. This phenomenon is known in psychology as the sunk cost effect. Across 98 datasets, this effect has been confirmed as stable. Avoiding this bias saves valuable future time that would otherwise be wasted due to a desire not to “waste” past efforts. +- Evidence grade: B +- Notes: Regarding the theater experiment by Arkes and Blumer, we have verified only the general trend: individuals who paid higher ticket prices tended to attend more plays over the following six months. Exact attendance figures per group have not yet been confirmed from the original text (pending verification). Roth et al. found that this effect diminishes over time and is weaker among older individuals. +- Sources:Arkes, H. R., & Blumer, C. (1985). The psychology of sunk cost. Organizational Behavior and Human Decision Processes, 35, 124–140. ；Roth, S., Robbert, T., & Straus, L. (2015). On the sunk-cost effect in economic decision-making: A meta-analytic review. Business Research, 8(1), 99–138. + +### 4. Estimate timelines based on actual time taken in past similar tasks, not on plans + + +- Cost: No cost at all. It only requires a few minutes of review to look up how long similar tasks took previously. +- In plain terms: Students who estimated they would finish a paper in 33.9 days actually took 55.5 days to complete it; only 29.7% of them met their own estimates. Another group of students was asked to first recall how long similar tasks had taken them in the past before making their estimates. The proportion of students who finished on time rose from 29.3% to 60.0% in this group. +- Benefit: Students originally expected to finish their papers in 33.9 days, but the actual time taken was 55.5 days. Only 29.7% of them completed their work by their own estimates. When researchers asked another group of students to first relate past experiences to the current task before estimating, the proportion of students finishing on time rose from 29.3% to 60.0% compared to the control group. This optimism of underestimating timelines no longer appeared in this group. +- Evidence grade: B +- Notes: Buehler’s study involved only university students in Canada; it was a single study with a small sample size of 37 participants, with roughly 40 participants in each group. Estimating timelines based on historical data from similar projects is known as reference class forecasting; specific engineering applications are described in Flyvbjerg’s work. Halkjelsvik’s review of multiple studies shows that underestimating timelines is more common than overestimating, though the magnitude of the error varies widely depending on the task and research methodology. +- Sources:Buehler, R., Griffin, D., & Ross, M. (1994). Exploring the "planning fallacy": Why people underestimate their task completion times. Journal of Personality and Social Psychology, 67(3), 366–381. ；Flyvbjerg, B. (2006). From Nobel Prize to project management: Getting risks right. Project Management Journal, 37(3), 5–15. ；Halkjelsvik, T., & Jørgensen, M. (2012). From origami to software development: A review of studies on judgment-based predictions of performance time. Psychological Bulletin, 138(2), 238–271. + +### 5. Distribute an agenda beforehand; don’t hold meetings without one; stand if possible + +- Cost: No monetary cost. Organizers spend 5–10 minutes writing an agenda before the meeting. Standing meetings require participants’ cooperation. +- In plain terms: When an agenda is shared beforehand, attendees are more likely to view the meeting as useful. In experiments, seated meetings lasted 34% longer than standing ones, yet the quality of decisions reached under both formats was identical. +- Benefit: Two studies involved 958 and 292 participants respectively. Results showed that meetings with pre‑distributed agendas were perceived as more effective by attendees — a statistically significant relationship. In another experiment, 55 groups met while seated and 56 while standing; seated meetings again ran 34% longer, with no difference in decision quality between the two formats. +- Evidence grade: B +- Notes: The standing‑meeting experiment involved five‑person groups working on tasks in a lab setting. These findings cannot be directly applied to lengthy meetings or large conferences. Leach measured participants’ subjective perceptions of effectiveness rather than actual output levels. +- Sources:Leach, D. J., Rogelberg, S. G., Warr, P. B., & Burnfield, J. L. (2009). Perceived meeting effectiveness: The role of design characteristics. Journal of Business and Psychology, 24(1), 65–76. ；Bluedorn, A. C., Turban, D. B., & Love, M. S. (1999). The effects of stand-up and sit-down meeting formats on meeting outcomes. Journal of Applied Psychology, 84(2). + +### 6. Cut down on meetings – use written asynchronous communication when possible + +- Cost: No monetary cost. Requires cooperation from colleagues and supervisors. The main difficulty is that writing a clear message takes more effort than simply speaking it out loud. +- In plain terms: The more meetings you have in a day, the more exhausted you feel, and the more work seems to pile up on your plate. Canceling even one meeting frees up exactly as much time as the meeting itself lasts – no less, no more. +- Benefit: Two surveys involved employees working 35+ hours per week – one with 676 participants, the other with 304. How much time meetings consume and their impact on attitude and happiness aren’t fixed; they depend on two factors: how well the meetings are run and how much a role relies on teamwork. Another study asked participants to keep daily logs for a week; it found that more meetings per day led to greater fatigue and perceived workload. The time saved equals precisely the duration of those canceled meetings. +- Evidence grade: B +- Notes: Controversy: Rogelberg’s 2006 research shows the relationship between meeting frequency and happiness isn’t one-directional; for roles heavily dependent on collaboration, frequent meetings may actually be beneficial. Additionally, no study has directly compared asynchronous written communication to holding meetings, so this recommendation is the author’s own inference. +- Sources:Rogelberg, S. G., Leach, D. J., Warr, P. B., & Burnfield, J. L. (2006). "Not another meeting!" Are meeting time demands related to employee well-being? Journal of Applied Psychology, 91(1). ；Luong, A., & Rogelberg, S. G. (2005). Meetings and more meetings: The relationship between meeting load and the daily well-being of employees. Group Dynamics: Theory, Research, and Practice, 9(1). + +### 7. Break large tasks into subtasks before estimating and starting work + +- Cost: No cost involved. The actual breakdown process takes 5 to 15 minutes. +- In plain terms: When estimating how long a task will take, people rarely break it down into individual subtasks and calculate each one separately. Listing all subtasks first and then estimating the total duration helps avoid underestimating the required time. Once broken down, each small step can be tackled right away, which also reduces the likelihood of procrastination. +- Benefit: People tend to overlook the need to split multi-component tasks into smaller parts when estimating timelines. For instance, writing a literature review, drafting the discussion section, and organizing references are all distinct tasks. By first listing all relevant subtasks and then estimating the overall time, one can avoid the common planning fallacy of underestimating duration. Moreover, once tasks are broken down, each small step becomes a concrete action that can be started immediately, thereby lowering procrastination rates. Research shows that key predictors of procrastination include a person’s aversion to the task and the tendency to postpone it. +- Evidence grade: B +- Notes: As a general guideline, each subtask should be small enough to be completed during a single focused work session; splitting tasks into overly detailed pieces is itself time-consuming. Additionally, Kruger and Evans’ study was verified only for its overall direction based on the abstract; the exact percentages cited were not cross-checked against the original research text. +- Sources:Kruger, J., & Evans, M. (2004). If you don't want to be late, enumerate: Unpacking reduces the planning fallacy. Journal of Experimental Social Psychology, 40(5), 586–598. ；Steel, P. (2007). The nature of procrastination: A meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1). + +### 8. Set a deadline for tasks without an external deadline + +- Cost: No cost involved. The hard part is actually sticking to the deadline you set. If you ignore it when the day arrives, it’s as if you never set it at all. +- In plain terms: When there is an external deadline, 80.6% of students manage to finish their work before it. But only 38.7% finish within their own estimated timeframe. The actual completion time is almost entirely determined by the external deadline, with little connection to their own estimates. That’s why it’s crucial to set your own deadline for tasks with no external deadline, and then follow through on it. +- Benefit: For students with an external deadline, 80.6% complete their work before it. Meanwhile, only 38.7% finish within their own estimated timeframe. The actual completion time closely aligns with the external deadline, with a correlation coefficient of r = 0.82 — the closer this number is to 1, the tighter the alignment. There is only a very weak link between completion time and students’ own estimates. +- Evidence grade: B +- Notes: Telling others about the deadline you set for yourself makes it behave more like an external deadline. It’s worth noting that this research only proves external deadlines are effective. For self-set deadlines such as time-boxing or using Pomodoro timers, no direct studies have been conducted, so this conclusion is drawn by inference. +- Sources:Buehler, R., Griffin, D., & Ross, M. (1994). Exploring the "planning fallacy": Why people underestimate their task completion times. Journal of Personality and Social Psychology, 67(3), 366–381. + +### 9. Treat procrastination as a way to avoid discomfort, not as a sign of laziness or lack of effort + +- Cost: No cost at all. The only change needed is in how you judge the situation: first ask yourself where the discomfort lies, then figure out how to address it. +- In plain terms: Procrastination has little to do with laziness or personality traits. What truly predicts whether someone procrastinates is how unpleasant the task feels, whether they believe they can complete it, and how easily they get distracted by immediate temptations. Therefore, the best approach is to make the task less unpleasant and break the first step into a tiny, manageable action — rather than scolding yourself and forcing yourself to work. +- Benefit: A meta-analysis that included 691 correlation coefficients found several factors with a strong, consistent link to procrastination: how aversive the task is, how much time remains until the deadline, self-efficacy (the belief in one’s ability to succeed), impulsivity, and conscientiousness — including self-control, susceptibility to distraction, organization skills, and achievement motivation. In contrast, neuroticism, rebelliousness, and sensation-seeking show only very weak connections to procrastination. The authors explain these results using time motivation theory: the immediate appeal of a task drops rapidly as the expected reward is pushed further into the future. +- Evidence grade: A +- Notes: This guideline only provides general direction rather than specific actionable steps, so its overall benefit is rated as moderate — no quantitative estimate of time saved has been calculated. Concrete actions are outlined in item 1 of this section (which specifies exact times, locations, and concrete actions to take), item 7 (which advises breaking large tasks into smaller sub-tasks), and item 8 (which recommends setting a deadline even for tasks without any external deadline). Keep in mind this is a summary of correlational research, so it should not be interpreted as evidence of direct causal relationships. +- Sources:Steel P (2007). The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1), 65–94. + +### 10. Keep desired items within reach and unwanted ones out of sight — no need to resist temptation on the spot + +- Cost: No cost involved; takes just a few minutes to set up. Simply move your phone to another room and lay out books and a computer on the desk. +- In plain terms: When items are physically farther away, people tend to consume less of them. Placing snacks at a distance noticeably cuts down on intake — this effect is of moderate strength. Limiting the number of available choices also leads to a marked drop in consumption. These strategies require no willpower on your part; you can arrange everything in just a few minutes. +- Benefit: A Cochrane review encompassing 24 randomized trials supports these findings. Moving food farther away reduces consumption, with a standardized mean difference of −0.60 (95% CI −0.84 to −0.36; based on 12 studies involving 1,098 participants; evidence of low certainty). Limiting food options yields an even stronger effect, with a standardized mean difference of −1.13 (95% CI −1.90 to −0.37; based on 3 studies involving 154 participants; evidence of low certainty). Regression analysis confirms that both distance and fewer choices amplify the effect. +- Evidence grade: B +- Notes: This B rating stems from the fact that all 24 studies included in the review focused on food only; none examined alcohol or tobacco. Additionally, 14 of those studies were conducted in laboratory settings and originated from high-income countries. Applying these same principles to phones and video games is a logical extrapolation, as no direct trials exist on this specific use case. One study directly examined the effect of removing phones from one’s line of sight; see Section 3, Item 1 for details (turning off nonessential notifications and keeping phones out of sight while working). +- Sources:Hollands GJ, Carter P, Anwer S, et al. (2019). Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews, 9, CD012573. + +### 11. Tie your money to your commitment — but first ask if you’re willing to pay + +- Cost: Under this deposit‑based approach, participants must put up their own cash upfront; if they fail to meet the target, the money is forfeited. In this trial, the required deposit was $150. +- In plain terms: A randomized trial involving 2,538 participants compared two incentive models: one offering a cash reward for success, and another requiring an upfront deposit that is refunded plus a bonus only if the goal is met. Among those willing to join either program, the deposit model produced a success rate 13 percentage points higher than the reward model. Yet only 13.7% of participants agreed to pay the deposit, while 90% opted for the reward option. Thus the deposit approach works best for those willing to pay; for everyone else it essentially has no effect. +- Benefit: In a U.S. trial with 2,538 participants, employees and their relatives were randomly assigned to one of four incentive schemes or standard care. The reward model (earning roughly $800 for success) attracted 90.0% participation, whereas the deposit model (requiring a $150 upfront payment plus a $650 bonus) attracted just 13.7%. After six months, overall quit rates ranged from 9.4% to 16.0% across all incentive groups, compared with 6.0% under standard care. The reward model yielded a 15.7% quit rate, while the deposit model produced 10.2%. However, when looking only at the 13.7% of participants willing to pay the deposit, the deposit model achieved a six‑month quit rate 13.2 percentage points higher than the reward model (95% CI 3.1–22.8, a reliable range). +- Evidence grade: A +- Notes: This trial focused on smoking cessation; extrapolating the findings to activities such as essay writing or exercise suggests a moderate overall benefit. The key takeaway is not which method is more effective, but whether you’d actually be willing to use it: a powerful incentive that most people reject is essentially useless for them. Therefore, pick an approach you’re comfortable with — even a modest deposit can be more effective than no deposit at all. For practical smoking‑cessation strategies, see Section 2, Item 3 (smoking‑cessation medications). +- Sources:Halpern SD, French B, Small DS, et al. (2015). Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine, 372(22), 2108–2117. + +### 12. New habits are measured in months, not “21 days” + +- Cost: No cost at all. What’s required is simply repeating the same action every day in the same context for several months. +- In plain terms: The idea that “it takes 21 days to form a habit” has no scientific basis. One study tracking participants over 12 weeks found that it took as little as 18 days for an action to become automatic, while some people needed as many as 254 days. It’s perfectly normal for things to feel difficult for two or three weeks. Missing a single day also does not reset any progress. +- Benefit: Ninety-six volunteers each chose a simple action related to eating, drinking, or physical activity, and performed it daily in a fixed context (such as “after breakfast”) for 12 weeks, rating how automatic the action felt each day. Data from 82 participants proved sufficient for analysis, and the model successfully matched 62 of them. The number of days required to reach 95% automation ranged from 18 to 254 days. The study also showed that missing one day of practice has no meaningful impact on habit formation. +- Evidence grade: B +- Notes: This is the only study of its kind, involving just 96 participants who performed very simple actions (like eating a piece of fruit after a meal). No research has examined how long it takes to form more complex habits, such as running three times a week or writing daily. The main takeaway here is to set realistic expectations: finding it hard for two weeks is not a sign of failure. To actually make repetition happen, link the action to a fixed context — see point 1 in this section, which advises specifying “at what time, where, and under what circumstances” the action should be done. +- Sources:Lally P, van Jaarsveld CHM, Potts HWW, Wardle J (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009. + +### 13. For those whose procrastination is affecting daily life, self‑help materials backed by randomized trials work just as well as therapist‑led programs + +- Cost: A self‑help book costs only a few dozen yuan; some are even free. It takes about ten weeks of effort — one chapter per week plus one related exercise. +- In plain terms: Procrastination that causes real distress is treatable. A randomized trial involving 150 participants tested a ten‑week cognitive‑behavioral self‑help program, both with therapist guidance and without it. Both groups showed markedly better results than a control group that received no intervention. No meaningful difference emerged between the two self‑help groups, meaning that working through the material on one’s own is equally effective. +- Benefit: The 150 participants were randomly assigned to three groups: therapist‑guided self‑help, unguided self‑help, and a wait‑list control. After ten weeks, the effect sizes on the Pure Procrastination Scale were d = 0.70 (95% CI 0.29–1.10) for the guided group and d = 0.50 (0.10–0.90) for the unguided group. On the Irrational Procrastination Scale the values were 0.81 (0.40–1.22) and 0.69 (0.29–1.09) respectively. The proportion of participants achieving clinically meaningful improvement was 31.3%–40.0% in the guided group and 24.0%–36.0% in the unguided group. No statistically significant differences existed between the two self‑help groups on any outcome. +- Evidence grade: A +- Notes: The study involved Swedish adults using Swedish‑language materials; no identical Chinese version is currently available, so the magnitude of benefit is rated as “moderate.” The program comprises standard components such as behavioral activation, behavioral experiments, stimulus control (see item 10 in this section: keep tempting items out of reach), and explanations of motivation and work strategies. When procrastination co‑occurs with notable depression or anxiety, follow the recommendations in item 3, section 19: move, get sunlight, keep a regular sleep schedule, talk to someone, and call 12356. +- Sources:Rozental A, Forsell E, Svensson A, Andersson G, Carlbring P (2015). Internet-based cognitive-behavior therapy for procrastination: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 808–824. + +### 14. Use your own hourly wage to decide which chores to outsource + +- Cost: Outsourcing chores comes at a cost, which varies depending on the service chosen. You’ll also need to spend some time upfront calculating your own hourly wage. +- In plain terms: On average, Chinese residents spend 1 hour and 17 minutes each day doing household chores. Among those who actually do them, the average time spent is 1 hour and 59 minutes. People who pay to save time tend to report higher life satisfaction. For the same amount of money, spending it on time rather than goods brings greater immediate happiness. +- Benefit: According to a 2024 survey covering 38,500 households and 107,000 individuals, Chinese residents spend an average of 1 hour and 17 minutes daily on household chores; for those who actually perform them, the average rises to 1 hour and 59 minutes. Another study involving 6,271 participants from four countries found that people who purchase time report higher life satisfaction. Researchers also conducted real-world experiments showing that spending the same sum on time rather than physical goods results in greater immediate well-being. +- Evidence grade: B +- Notes: First, calculate your hourly wage by dividing your monthly after-tax income by the total number of hours you actually work each month. Then determine how much it would cost to outsource a particular chore. If the outsourcing fee is lower than your hourly wage and you truly plan to use the saved time for earning money or resting, then outsourcing makes sense. This guide provides a method rather than a definitive recommendation, since everyone’s hourly wage and outsourcing costs differ. Additionally, Whillans’ research measures how happy people feel after buying time, not how many hours they ultimately save. +- Sources:Whillans, A. V., Dunn, E. W., Smeets, P., Bekkers, R., & Norton, M. I. (2017). Buying time promotes happiness. Proceedings of the National Academy of Sciences. ；国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. + +### 15. Set hard limits on short videos and aimless scrolling + +- Cost: No cost at all. It only takes a few minutes to act: turn off notifications, delete the app, or set a daily time limit for it. The real challenge is resisting the urge to open it. +- In plain terms: On average, Chinese people spend 5 hours and 37 minutes online per day. For those who actually go online that day, the average time is 6 hours and 3 minutes. Using the same calculation method in 2018, the average was only 2 hours and 42 minutes. This is the highest figure in this section. Cutting just one hour off daily adds up to 365 extra hours per year. +- Benefit: Chinese residents spend an average of 5 hours and 37 minutes online each day. For those who actually use the internet on a given day, the average is 6 hours and 3 minutes. People who accessed the internet on that day account for 92.9% of the total population. These are 2024 statistics. In 2018, the average was only 2 hours and 42 minutes using the same calculation method, which is also the highest figure in this section. Reducing online time by one hour daily adds 365 hours to a person’s year. According to the China Internet Network Information Center, as of June 2025, netizens spend an average of 30.6 hours online per week, an increase of 1.9 hours compared to half a year prior. There are 1.068 billion short video users, accounting for 95.1% of all netizens. +- Evidence grade: C +- Notes: Online time includes time spent on work, study, and social interaction, so not all of it is wasted. It is rated as grade C because no studies have calculated exactly how much time is saved after such limits are put in place and how that time is then used; we only have overall statistics. For the specific activity of browsing others’ social media posts, a randomized trial has been conducted to measure the time saved and changes in mood; details can be found in Section 3, Item 21. +- Sources:国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. ；国家统计局 (2019). 2018年全国时间利用调查公报. ；中国互联网络信息中心 (2025). 第 56 次《中国互联网络发展状况统计报告》. + +### 16. Avoiding TV and scrolling news: view information at set times instead + +- Cost: No monetary cost. The real challenge is breaking the habit of turning on the TV at random times; you might also miss some breaking news. +- In plain terms: Americans aged 15 and older watch 2.6 hours of TV per day, which accounts for half of all their leisure time. In China, the average daily TV viewing time is 1 hour and 40 minutes; for people aged 75–84, it reaches 3 hours and 16 minutes. Switching to viewing information at scheduled times saves you all this time. +- Benefit: Americans aged 15 and older watch 2.6 hours of TV daily. Their total leisure time is 5.2 hours, so TV viewing consumes half of it. These figures are from 2025. In China, the average daily TV viewing time is 1 hour and 40 minutes; for those aged 75–84, it is 3 hours and 16 minutes. These numbers date back to 2018. +- Evidence grade: C +- Notes: Only aggregate statistics are available. No studies have examined how the time saved by cutting back on TV and news viewing is actually used. The practice of viewing content at set times is based on the author’s personal experience. +- Sources:U.S. Bureau of Labor Statistics (2026). American Time Use Survey — 2025 Results. ；国家统计局 (2019). 2018年全国时间利用调查公报. + +### 17. Spend some time learning keyboard shortcuts and automation for common software + +- Cost: There is no monetary cost. However, it requires a one-time investment of several to dozens of hours to learn. The initial learning phase can actually be slower than using a mouse. +- In plain terms: Even many Word users with years of experience still rely on clicking toolbar icons. Experiments comparing different methods show that keyboard shortcuts are faster than both menus and icons. This is a one-time effort that pays off with every subsequent use. The longer you perform similar tasks, the greater the overall benefit. +- Benefit: Research involving 251 experienced Word users revealed that most rarely utilize faster shortcuts, continuing to rely on toolbar icons. Controlled experiments confirmed that shortcuts are indeed the quickest method among menus, icons, and shortcuts themselves. The time saved accumulates gradually with each daily use. Those who perform similar tasks over extended periods gain the most from this practice. +- Evidence grade: B +- Notes: Focus on learning shortcuts for operations you use at least ten times daily; learning too many unnecessary shortcuts is counterproductive. It should be noted that the efficiency study involved only six participants, and the summary does not specify the exact number of seconds saved per operation. +- Sources:Lane, D. M., Napier, H. A., Peres, S. C., & Sándor, A. (2005). Hidden costs of graphical user interfaces: Failure to make the transition from menus and icon toolbars to keyboard shortcuts. International Journal of Human-Computer Interaction. + +### 18. When choosing a place to live, prioritize commute time to cut down on one-way travel + + +- Cost: This option is costly. You may end up paying higher rent or having to settle for a smaller living space. Moving itself also takes time and effort. +- In plain terms: The longer someone’s commute, the worse they tend to feel about their life. This loss in time and comfort isn’t compensated for by higher wages or better housing. Cutting one-way commute time by 30 minutes saves a full 5 hours each week. +- Benefit: On average, Chinese residents spend 50 minutes daily on transportation; among those who travel on a given day, the average is 1 hour and 2 minutes, according to 2024 data. Longitudinal studies in Germany show that people with longer commutes consistently report lower subjective well-being — meaning they feel their lives are worse. Again, this loss in time isn’t offset by any gain in income or housing quality. A comprehensive review of multiple studies confirms that longer commutes lead to greater dissatisfaction, regardless of the mode of transport used. Reducing one-way travel time by 30 minutes yields roughly 5 extra hours per week. +- Evidence grade: B +- Notes: Point of contention: Chatterjee et al., after analyzing various studies, argue that no consistent link exists between commute length and overall life satisfaction. They suggest that people can generally offset the downsides of long commutes by securing better jobs or housing. It’s also worth noting that transportation statistics include all trips, not just commuting, and that avoiding rush hour can also shorten travel time on the same route. +- Sources:Stutzer, A., & Frey, B. S. (2008). Stress that doesn't pay: The commuting paradox. Scandinavian Journal of Economics, 110(2), 339–366. ；Chatterjee, K., et al. (2020). Commuting and wellbeing: A critical overview of the literature with implications for policy and future research. Transport Reviews, 40(1), 5–34. ；国家统计局 (2024). 第三次全国时间利用调查公报（第二号）. diff --git a/book/en/05-Do-Not-Waste-Money.md b/book/en/05-Do-Not-Waste-Money.md new file mode 100644 index 00000000..dc074649 --- /dev/null +++ b/book/en/05-Do-Not-Waste-Money.md @@ -0,0 +1,362 @@ +# 5. Don’t waste money +This section is purely about money: how much you can save, how much your yearly returns differ, and what amount you can expect to get back over the long run. None of these figures are converted into years of life or time saved. Entries dealing with investments simply explain how to do the calculations; they rely only on verified historical data and do not constitute any investment advice. +### 1. Turn off all automatic renewals and switch to manual renewal upon expiry + +- Cost: No cost at all. Simply review the lists of automatic payments in Alipay, WeChat Pay, Apple, and Android — this takes only 10 to 20 minutes. From then on, you’ll need to manually initiate each renewal yourself. +- In plain terms: What you’ll save is exactly the money spent on subscriptions you no longer use but are still being charged for each month. It takes less than 20 minutes to go through the automatic payment lists in Alipay, WeChat Pay, Apple, and Android. By regulation, merchants must provide a clear notice before charging you, along with an easy-to-find and readily accessible option to cancel at any time. +- Benefit: The amount saved equals the total cost of those subscriptions you no longer need yet continue to pay for. This varies from person to person, so there’s no single universal figure. Regulatory rules also require merchants to give you a clear pre-charge notice and a simple, cost-free option to cancel at any time (China, effective since 2021). +- Evidence grade: C +- Sources:国家市场监督管理总局 (2021, 2025 修正). 网络交易监督管理办法（总局令第 37 号，第十八条）. +- Notes: For services you actually use regularly, annual subscriptions are generally cheaper than monthly ones, so keeping automatic renewal on for these is more cost-effective. You should only turn off automatic renewal for those subscriptions you’ve long forgotten about yet are still being charged for. +### 2. Conduct the annual tax reconciliation from March to June; be sure to include all eligible special deductions + +- Cost: No cost involved. The process can be completed in just a few minutes via the “Individual Income Tax” app. +- In plain terms: The following groups of people typically receive a tax refund after completing this process: those who only worked for a few months throughout the year, those who changed jobs mid-year, or anyone who failed to claim deductions for child education, mortgage payments, rent, or elderly dependents. It takes only a few minutes to finish on a mobile device. If your total annual income falls below 120,000 yuan, or if the amount of tax you owe is under 400 yuan, you may skip this step. +- Benefit: This process consolidates calculations for four types of income: wages and salaries, labor remuneration, author’s fees, and royalties. Any overpaid tax is refunded to you, while any underpaid amounts must be paid up. There are two scenarios where you may forgo this process: when your total annual income is under 120,000 yuan, or when the tax you owe is less than 400 yuan. These thresholds were set by the State Taxation Administration in 2023 and remain in effect through December 31, 2027. Conversely, the groups mentioned above are precisely those who usually qualify for a tax refund after completing the reconciliation. +- Evidence grade: A +- Sources:国家税务总局 (2025). 个人所得税综合所得汇算清缴管理办法（第六条）及其解读. ；财政部、税务总局 (2023). 关于延续实施个人所得税综合所得汇算清缴有关政策的公告. +- Notes: Even individuals who owe tax must complete this process; failure to do so is illegal. There are seven categories of special deductions available: child education, continuing education, major illness medical expenses, mortgage interest payments, rent payments, elderly dependents support, and childcare expenses for children under three. Note that you may claim either mortgage interest or rent deductions, but not both. +### 3. Housing provident fund isn’t just for buying a home: it can be used for renting, home renovations, and paying property taxes, effective from September 20, 2026 under new regulations + +- Cost: No cost at all. You only need to complete the withdrawal application once. +- In plain terms: The housing provident fund isn’t limited to home purchases. The new regulations list nine eligible scenarios for withdrawals, including renting, renovating a personal residence, and paying property taxes. Once you submit an application, the housing provident fund authority must respond within three days whether your request is approved or not. +- Benefit: The updated regulations expand eligible withdrawal scenarios to nine total. These include covering rental payments, funding home renovations, and paying property taxes for a residence you own. The housing provident fund authority must issue a decision on your application within three days of receiving it, either granting or denying the withdrawal request. +- Evidence grade: A +- Sources:国务院 (2026). 国务院关于修改《住房公积金管理条例》的决定（国务院令第 844 号，2026 年 7 月 31 日国务院第 93 次常务会议通过，「自2026年9月20日起施行」）：修改后第二十四条「职工有下列情形之一的，可以提取职工住房公积金账户内的存储余额：（一）支付房租的；（二）购买、建造、翻建、大修自住住房的；（三）偿还购房贷款本息的；（四）装修自住住房的；（五）支付自住住房物业费的；（六）离休、退休的；（七）完全丧失劳动能力，并与单位终止劳动关系的；（八）出境定居的；（九）国务院批准的其他住房消费情形。」；第二十五条「住房公积金管理中心应当自受理申请之日起3日内作出准予提取或者不准提取的决定」；第十八条缴存比例「均不得低于职工上一年度月平均工资的5％」. +- Notes: The funds in your account consist of your own salary contributions plus matching contributions from your employer. If left untouched, these funds earn only a very low rate of interest. The regulations also specify that in cases of employee death or declared death, heirs and legal beneficiaries may withdraw the full account balance. Exact required documents and application procedures are determined locally by each regional housing provident fund authority, so be sure to check your local guidelines before applying. +### 4. Recalculate your mobile and broadband plans annually: downgrade unused services, and file a complaint if the carrier refuses to comply + +- Cost: No expense at all. It takes just a few minutes to review your bill. The real challenge is resisting the pressure from customer service reps who try to dissuade you from downgrading. +- In plain terms: Older plans you’re currently on often cost dozens of yuan more per month than newer plans now on sale. Those extra monthly fees add up to hundreds of yuan wasted each year. By regulation, carriers have no valid reason to reject your request to switch plans, delay processing it, or impose special pricing tiers solely for customers making such changes. If they refuse without justification, you can file a formal complaint. +- Benefit: Ministry of Industry and Information Technology rules explicitly state that carriers must not “refuse, obstruct, or delay providing number portability services to users without valid reasons”, nor may they “use blocking or restrictive technical measures to compromise the communication service quality of such users”. They are also prohibited from “creating dedicated pricing or marketing plans for customers exercising their right to port their numbers”. Older plans typically cost dozens of yuan more per month than current offerings, so sticking with them results in hundreds of yuan wasted annually. +- Evidence grade: A +- Sources:工业和信息化部 (2019). 携号转网服务管理规定（工信部信管〔2019〕242 号）. +- Notes: First, use your carrier’s official app to check your actual monthly data and call usage over the past six months, then choose a plan matching those figures. If a customer service rep claims “you must visit a physical store to downgrade” or “contract terms prevent any changes”, ask for written proof of those claims. If none is provided, file a complaint via the 12300 hotline. +### 5. Not buying lottery tickets + +- Cost: It costs nothing. Not buying means you save money. +- In plain terms: According to regulations, at least 50% of sales revenue from lottery games must be paid out as prizes; for the Double Color Ball game, this figure is 51%. In other words, for every 1 yuan you spend, you can expect to receive back only 0.51 yuan on average over time — meaning you lose 49% of your money. In 2024, China sold 623.486 billion yuan worth of lottery tickets; of that amount, 161.031 billion yuan went directly into public welfare funds and was never distributed as prizes. +- Benefit: Fiscal regulations set minimum payout ratios: 50% for lottery and number-based games, 65% for instant-win games, and 73% for wagering games. For the Double Color Ball game, 51% of sales revenue is allocated to prizes, which means only 51 yuan out of every 100 yuan spent is paid out as winnings. On a personal level, this translates to an average return of just 0.51 yuan per 1 yuan spent over time — a net loss of 49%. In 2024, total lottery sales in China reached 623.486 billion yuan; 161.031 billion yuan of that amount was earmarked for public welfare and never returned to players (China, 2024). +- Evidence grade: A +- Sources:财政部 (2015). 关于规范和加强彩票资金构成比例管理的通知（财综〔2015〕94 号）. ；财政部 (2025). 财政部公告 2025 年第 8 号（2024 年彩票公益金筹集分配情况）. ；中国福利彩票双色球游戏规则（第十四条）. +- Notes: Over the long run, buying lottery tickets guarantees a financial loss; this is a fixed rule of the system and has nothing to do with luck. Buying tickets is fine if you treat it as a form of entertainment costing 2 yuan per play, but it should never be viewed as a way to invest or save money. +### 6. Walk away the moment you see “high returns”, “guaranteed returns”, or “sure profits” + +- Cost: Nothing to pay. Just pause for a moment when you encounter these phrases. +- In plain terms: Regulatory authorities themselves state that any return above 6% should raise doubts, anything over 8% is highly risky, and returns exceeding 10% mean you should expect to lose all your principal. Legitimate financial products are no longer allowed to guarantee returns or principal safety. Any losses incurred from participating in illegal fundraising are your own responsibility per regulations — no one will compensate you if things go wrong. +- Benefit: The former chairperson of the China Banking and Insurance Regulatory Commission stated at the Lujiazui Forum in 2018: “Any return exceeding 6% should raise doubts, anything over 8% is very risky, and returns above 10% mean you should prepare to lose all your principal.” New asset management regulations require financial institutions to “not make any guarantees regarding principal safety or returns”, and also stipulate that “when facing difficulties in fulfilling payment obligations, financial institutions must not provide any form of financial support to settle such obligations”. Hence, legitimate financial products no longer offer any principal protection. Losses from illegal fundraising are borne entirely by participants, with no third party obligated to compensate you in case of issues (China, 2018, 2021). +- Evidence grade: A +- Sources:郭树清在第十届陆家嘴论坛的讲话（2018 年 6 月），天津市地方金融管理局转载. ；中国人民银行等 (2018). 关于规范金融机构资产管理业务的指导意见（银发〔2018〕106 号，第二条、第六条）. ；国务院 (2021). 防范和处置非法集资条例（国务院令第 737 号，第二十五条）. +- Notes: The 6%, 8%, and 10% thresholds are set by regulators based on practical experience, not statutory provisions. Note: The original speech page on the former CBIRC website loads content dynamically, so we were unable to retrieve it; this citation is based on a repost by the Tianjin Local Financial Regulatory Bureau. This content does not constitute investment advice. +### 7. Avoid making minimum payments or taking installment plans or consumer loans + +- Cost: No cost at all. You must keep enough cash on hand to pay the full balance by the due date. The hard part is resisting the urge to spread out large purchases via installment plans. +- In plain terms: Making minimum payments is not a discount — it is essentially a daily‑interest loan that works out to roughly 18% per year. Once you use this option, the interest‑free period ends immediately, and the unpaid portion of the balance accrues interest from that point onward. Always look at the annual percentage rate when comparing offers; regulators now require issuers to display this figure prominently, rather than just the daily rate. The minimum rate is exactly 0.7 times the maximum rate. +- Benefit: Before 2020, credit‑card interest rates were capped: the maximum daily rate was 0.05% and the minimum was 70% of that cap. At 0.05% daily, the annual simple interest rate comes to 18.25%. Starting in 2021, issuers and cardholders can negotiate rates freely. After opting for minimum payments, the unpaid balance continues to accrue interest daily while the interest‑free period is lost. Authorities now demand that issuers clearly show the annual rate; you should base your decision on this figure alone (China, 2020 notice). +- Evidence grade: C +- Sources:中国人民银行 (2020). 关于推进信用卡透支利率市场化改革的通知（银发〔2020〕327 号）. +- Notes: The 18.25% figure results from multiplying 0.05% by 365 without compounding; the actual rate would be higher if interest were compounded monthly. Some banks offer discounts, but you must refer to the annual rate listed on your own statement. If you truly cannot afford the payment, seek a lower‑rate loan from a reputable lender rather than letting minimum payments pile up. +### 8. Don’t give streamers tips, don’t make in‑game purchases, and don’t make impulsive buys + +- Cost: There is no cost at all. It only takes a few minutes to do three things: turn off automatic payment, set daily and per‑transaction limits, and remove any linked payment methods from the platforms. The hard part is resisting the urge to click those buttons right then and there. +- In plain terms: On average, each gamer in China spends roughly 480 yuan per year on games, and that money is almost impossible to get back. Laws only require refunds for purchases made by minors without parental consent; adults have no such protection. The easiest way to stay on budget is to take preventive steps: disable automatic payments, set spending limits, and unlink payment options. +- Benefit: This is a substantial expense. In 2024, China’s gaming market generated 325.783 billion yuan in revenue, serving 674 million players — an average of about 480 yuan per person (calculated by dividing total revenue by the player count). That money is largely unrecoverable. One exception exists: if a minor (a person with limited civil capacity) makes purchases without a guardian’s permission, courts must support the guardian’s request for a refund. No such rule applies to adults. Additionally, minors are legally restricted to playing online games only on Fridays, Saturdays, Sundays, and public holidays, and only between 8 pm and 9 pm each day (China, 2020‑2021). +- Evidence grade: B +- Sources:国家新闻出版署 (2024). 今年中国游戏市场收入超 3257 亿元创新高（中国音数协游戏工委《2024 年中国游戏产业报告》）. ；最高人民法院 (2020). 关于依法妥善审理涉新冠肺炎疫情民事案件若干问题的指导意见（二）（法发〔2020〕17 号，第 9 条）. ；国家新闻出版署 (2021). 关于进一步严格管理 切实防止未成年人沉迷网络游戏的通知（国新出发〔2021〕14 号）. +- Notes: This is graded as B because no direct studies have measured exactly how much money can be saved by avoiding tips and purchases; we only have aggregate industry figures. Turning off automatic payments and setting limits are widely recommended practices, which would merit a C rating on their own. The exact wording of Articles 19 and 145 of the Civil Code is already quoted verbatim in Item 9 (about minors making in‑app purchases). This information is not financial advice. +### 9. When kids make in-app purchases or send gifts, parents can demand refunds for large sums spent by kids over eight if they never gave consent + +- Cost: There’s no direct monetary cost, but it does take time to gather evidence and negotiate with platforms. Most platforms initially refuse refunds but eventually comply. If talks fail, legal action becomes necessary — a process that can take months and requires paying attorney fees out of pocket. Thus, it’s far more efficient to compile all relevant documentation first and approach both the platform and China’s 12315 consumer hotline. The real challenge lies in getting the child to cooperate and share details. +- In plain terms: Money spent by children over eight years old can be legally invalidated and refunded if the amount far exceeds what one would reasonably expect for their age and level of maturity, and if parents neither approved nor acknowledged the transaction. For kids under eight, any spending is automatically considered invalid, as they lack legal capacity to make such decisions. Even silence from parents is interpreted by law as a refusal to acknowledge the expense. +- Benefit: Minors aged eight and older are classified as having limited legal capacity — meaning they may only engage in activities appropriate to their age and maturity level. Any financial transaction beyond that scope requires explicit approval or retroactive acknowledgment from a legal guardian. Conversely, children under eight are deemed completely incapable of independent decision-making; all actions must be handled by their guardians. In the absence of any affirmative response from parents, the law presumes they reject the transaction. +- Evidence grade: A +- Sources:全国人大 (2020). 民法典. 最高人民检察院转载全文. 第十九条：「八周岁以上的未成年人为限制民事行为能力人，实施民事法律行为由其法定代理人代理或者经其法定代理人同意、追认；但是，可以独立实施纯获利益的民事法律行为或者与其年龄、智力相适应的民事法律行为。」第二十条：「不满八周岁的未成年人为无民事行为能力人，由其法定代理人代理实施民事法律行为。」第一百四十五条：「限制民事行为能力人实施的纯获利益的民事法律行为或者与其年龄、智力、精神健康状况相适应的民事法律行为有效；实施的其他民事法律行为经法定代理人同意或者追认后有效。」「法定代理人未作表示的，视为拒绝追认。」 +- Notes: The crux of success lies in proving that a child — not a parent — performed the transaction. Helpful evidence includes: transaction timestamps coinciding with school hours or times when parents are at work; device usage logs; chat histories and gaming records; and a direct statement from the child. There is no fixed monetary threshold defining “age-appropriate” spending — a few dozen yuan spent on game skins differs vastly from tens of thousands spent on virtual gifts. Prevention is far easier: set spending limits without requiring passwords, enable youth protection modes, and never disclose payment codes to children. For cases where parents themselves impulsively make such purchases, refer to the section titled “Avoid giving gifts to streamers, making in-game purchases, or acting on impulse.” +### 10. Teaching kids one key phrase: anyone who asks them to use a parent’s phone to enter verification codes is a scammer + +- Cost: There’s no cost involved. Simply explain these six types of scams to your child, then agree on this phrase: “If you’re scammed, tell me right away and I won’t scold you.” Also set a spending limit for cashless payments, enable teen mode, and never share the payment password with your child. The hardest part is resisting the urge to get angry if they actually fall victim to a scam. +- In plain terms: Each of these six scams works differently, but they all end the same way: the scammer gets the child to use a parent’s phone to transfer money or read out verification codes. That’s why this single phrase is enough: anyone who asks your child to use a parent’s phone or read out verification codes is a scammer. Add this follow-up line too: “If you’re scammed, tell me right away and I won’t scold you.” Only if the child feels safe enough to speak up immediately is there any chance of recovering the stolen funds. +- Benefit: The Quanzhou Anti-Fraud Center and Quanzhou Education Bureau identified six common scams targeting teens. Though their methods vary, they all culminate in the same action: getting the child to transfer money via a parent’s phone. First, fake offers for cheap gaming accounts and gear. One boy transferred 260 yuan privately, then the scammer told him “transactions by minors are against the rules and your account will be frozen,” and tricked him into clicking a “verification link” using his dad’s phone, which led to over 30,000 yuan being stolen. Second, “removing anti-addiction restrictions.” Scammers threatened “if you don’t transfer money, your parents will go to jail,” so the child used his mom’s phone to send 7,000 yuan. Official rules make it clear there are no “unofficial ways” to lift these restrictions. Third, fake refund offers for in-game purchases. Impostors posing as “official customer service” claimed refunds were possible if parents used Alipay to send gifts to a specific livestream; this resulted in 73,000 yuan being spent on gifts, after which the scammers cut off contact. Official guidance states “anyone asking you to ‘send gifts to get a refund’ is 100% a scam.” Fourth, impersonating classmates or teachers. Scammers hack accounts to send voice messages calling the child by name and asking for money. At the start of the school year, they also join class groups pretending to be teachers, posting “pay 500 yuan for school fees” with identical profile pictures and nicknames to real teachers, even enlisting “accomplices” in the group to confirm “I’ve already paid.” Fifth, fake fan group offers. Scammers lure kids into “celebrity fan groups” promising 888 yuan in cash prizes; first they ask for a 48.88 yuan “verification fee,” then threaten “since minors aren’t allowed to join, the platform will freeze 80,000 yuan and your parents will go to jail” — this led to 16,000 yuan being stolen. Official guidance stresses “real police officers or lawyers never contact minors online to investigate, nor do they ever ask parents to operate phones.” Sixth, fake low-price listings on second-hand platforms that lure buyers off the site for private transactions. The same materials also list three red lines kids must never cross: first, never lend, sell or rent bank cards or SIM cards, as using them to move illicit funds can lead to criminal charges that affect future college admissions or civil service exams; second, “mobile voice acting” gigs are illegal; third, “high-paying overseas jobs” often turn out to be traps where victims are held captive upon arrival (Quanzhou, October 2025). +- Evidence grade: B +- Sources:泉州市反诈骗中心 (2025). 开学第一课｜反诈是青少年的必修课，这 6 大陷阱一定要避开！（福建省公安厅转载） +- Notes: This is graded B because the source materials provide detailed breakdowns of scammer tactics and specific case examples, but there are no statistics on overall incidence rates or the effectiveness of preventive measures. This is distinct from Item 9, where kids spending money on in-game purchases can request refunds under civil law. Funds stolen by scammers fall outside this scope and must be reported under Section 8, Clause 2 to freeze transactions; recovery depends on whether the money remains in the account. The core scammer line “you’ve broken the rules and your parents will go to jail” is a dead giveaway of fraud — explaining this to kids beforehand is far more effective than trying to question them after the fact. It’s also crucial to actually follow through on the promise “if you’re scammed, tell me right away and I won’t scold you.” In all these cases, kids’ reluctance to speak up due to fear of punishment was a key reason losses kept growing. For adult versions of impersonation scams and AI face-swapping tactics, see Section 8, Clauses 3 and 4 (core anti-fraud rules, and always hang up first if a transfer is requested). +### 11. Skipping extended warranties for electronics + +- Cost: There’s no upfront cost. The trade‑off is that after the warranty expires you’ll have to pay for any repairs yourself — though that scenario is relatively unlikely. +- In plain terms: Extended warranties typically cost 10% to 50% of the item’s original price. The profit margin on these warranties is roughly ten times higher than that of regular merchandise. In 2003, Best Buy in the U.S. earned over half of its total profits from extended warranties, even though they accounted for only 3% to 4% of its overall revenue. That price gap is exactly the extra money you end up paying. +- Benefit: Extended warranties are priced at 10% to 50% of the product’s original cost. Industry estimates cited in research show that the average gross margin on these warranties sits at 50% to 60%: for every 100 dollars spent on a warranty, 50 to 60 dollars become pure profit. This is roughly 18 times higher than the gross margin on ordinary goods. In 2003, extended warranties made up just 3% to 4% of Best Buy’s revenue yet generated over 50% of its total profits (U.S. retail data from the early 2000s). +- Evidence grade: B +- Sources:Chen T, Kalra A, Sun B (2009). Why Do Consumers Buy Extended Service Contracts? Journal of Consumer Research 36(4):611-623. +- Notes: The gross‑margin figure comes from an industry estimate referenced in the paper (Business Week, 2004); it wasn’t measured directly by the authors. The calculations above apply to ordinary consumers who can afford a single repair bill. For people who rely on a single device and lack a backup, the calculation changes. Screen‑protection plans for phones must also be evaluated separately: first estimate how often you’re likely to drop the phone, then decide whether the premium is worth it. +### 12. Prefer generic drugs that have passed consistency evaluation and those selected in centralized procurement + +- Cost: No cost at all. When a doctor prescribes medication or you go to buy medicine, simply ask: “Is there a generic version included in the centralized procurement program?” +- In plain terms: The second batch of centrally procured drugs saw an average price drop of 53%, with some drugs becoming 93% cheaper. As of April 2026, 11 procurement rounds have been completed, covering 490 different drugs. Asking for generic drugs from this program ensures you get the same ingredients at a much lower price. +- Benefit: The national centralized drug procurement initiative resulted in a 53% average price reduction for the second batch, with some drugs dropping by as much as 93%. By April 2026, 11 rounds had been conducted, covering 490 drugs. A total of 1,695 drugs have either passed or are considered to have met consistency evaluation standards, accounting for roughly two-thirds of all commonly used chemical drugs in China (official data from 2020–2026). +- Evidence grade: A +- Sources:国家医疗保障局 (2020). 第二批国家组织药品集中采购和使用工作答记者问. ；国家医疗保障局 (2026). 国务院政策例行吹风会：健全全周期全渠道药品价格形成机制. ；国务院办公厅 (2016). 关于开展仿制药质量和疗效一致性评价的意见（国办发〔2016〕8 号）. ；国家食品药品监督管理总局 (2016). 关于发布普通口服固体制剂参比制剂选择和确定等 3 个技术指导原则的通告（2016 年第 61 号）附件 1、附件 3，海南省药品监督管理局转载. ；国家医疗保障局 (2024). 集采药品质量严格监管，企业检查和品种抽检两个「全覆盖」. ；国家医疗保障局 (2025). 医保部门、药监部门有关同志就集采药品相关问题接受人民日报健康客户端记者采访. +- Notes: There is some debate: some claim that consistency evaluation only checks ingredients, not actual therapeutic effects. This is only partially true. The evaluation process involves giving healthy volunteers the drug and measuring its concentration levels in their blood over time; if those levels fall within 80%–125% of those produced by the original brand-name drug, it is deemed acceptable. For drugs where dosage variations can be dangerous, stricter criteria apply. Excipients—substances other than the active ingredient used for filling or coating—may differ from those in the original drug, as regulations only require identical active ingredients, dosage form, administration method, and therapeutic purpose. Consequently, consistency evaluation does not involve testing the drug on patients to gauge effectiveness; that is assessed through separate research. The National Healthcare Security Administration has conducted real-world studies involving 63 centrally procured drugs, nearly 100 top-tier hospitals, and over 300,000 patients; results consistently showed no difference compared to original brand-name drugs. For example, with metformin, the rate of achieving target HbA1c levels was 83.4% for generic users versus 78.9% for brand-name users; conversely, for fasting blood glucose control, generic users achieved a 83.8% success rate compared to 87.6% for brand-name users. In January 2025, some doctors claimed that centrally procured drugs failed to lower blood pressure, induce anesthesia, or treat diarrhea; investigations by healthcare authorities at seven Shanghai hospitals found these claims largely stemmed from hearsay and personal experience; one of the cited diarrhea medications had not yet been used in hospitals at the time. It was also acknowledged that nine problematic drugs were disqualified from the first nine procurement rounds involving over 1,600 products—six of these were imported drugs, including three original brand-name products, while three were domestic products. Two practical steps can be taken: first, original brand-name drugs remain widely available, as centralized procurement accounts for only 60%–80% of hospital purchases; patients can still obtain them at higher cost. Second, for chronic disease patients switching to generic drugs, it is vital to monitor blood pressure, blood sugar, and HbA1c levels regularly (as outlined in Section 16, point 3) rather than relying on subjective feelings; if results worsen, consult a doctor and report any adverse reactions—never discontinue medication on your own. +### 13. Once you set up family medical expense sharing in the yibao app, funds from your individual medical insurance account can be used to pay for your spouse, parents, and children’s medical care and medication. + +- Cost: No cost at all. You can set up family medical expense sharing either through your local medical insurance app or by visiting a local medical insurance office. +- In plain terms: After completing this setup, any money in your individual yibao account can be used to cover medical expenses and medication costs for your spouse, parents, and children. Without this setup, those funds remain locked in your account for your own use only. +- Benefit: Funds in your individual medical insurance account can be used to pay for any out-of-pocket medical costs you, your spouse, parents, or children incur at designated medical institutions. They can also be used to cover out-of-pocket costs for purchasing medicines, medical devices, and other medical supplies at designated retail pharmacies. Additional plans are also in place to explore allowing these funds to be used to pay for basic medical insurance premiums for eligible family members. +- Evidence grade: A +- Sources:国务院办公厅 (2021). 关于建立健全职工基本医疗保险门诊共济保障机制的指导意见（国办发〔2021〕14 号）第（五）项：「个人账户主要用于支付参保人员在定点医疗机构或定点零售药店发生的政策范围内自付费用。可以用于支付参保人员本人及其配偶、父母、子女在定点医疗机构就医发生的由个人负担的医疗费用，以及在定点零售药店购买药品、医疗器械、医用耗材发生的由个人负担的费用。探索个人账户用于配偶、父母、子女参加城乡居民基本医疗保险等的个人缴费。个人账户不得用于公共卫生费用、体育健身或养生保健消费等不属于基本医疗保险保障范围的支出。」 +- Notes: Many people have thousands of yuan sitting unused in their individual medical insurance accounts, while elderly family members often have to pay for medicines out of pocket. This setup is valid for the long term once completed. Most regions refer to this service as “family medical expense sharing”, and it can be set up directly through local medical insurance apps. There is a strict rule against using these funds for fitness activities, wellness services, or similar purposes. Using these funds to buy health supplements at pharmacies for cash payouts is considered insurance fraud. +### 14. Drinking boiled tap water instead of buying bottled water year-round + +- Cost: You only need to purchase a kettle. Boiling water takes a bit of time, plus there are minimal gas or electricity costs. +- In plain terms: In Beijing, the first-tier water price works out to 0.005 yuan per liter. Bottled water, calculated at 1 yuan for every 500 milliliters, costs 2 yuan per liter — that’s a 400-fold difference. Tap water must meet mandatory national standards, so simply boiling it before drinking is sufficient. However, if the water source is contaminated or the water becomes foul-smelling and cloudy, a few extra minutes of boiling won’t fix the problem; you should stop drinking it and report the issue to authorities. +- Benefit: The first-tier water price in Beijing is 5 yuan per cubic meter, which equals 0.005 yuan per liter. Bottled water at 1 yuan per 500 milliliters costs 2 yuan per liter — 400 times more expensive than tap water. Tap water must comply with the mandatory national standard GB 5749-2022, which was issued on March 15, 2022, and took effect on April 1, 2023. The National Disease Control and Prevention Administration oversees this standard (Chinese water prices in 2015 vs. the 2022 standard). +- Evidence grade: C (controversial) +- Sources:北京市发展和改革委员会. 居民用水价格表. ；国家市场监督管理总局 国家标准全文公开系统. GB 5749-2022 生活饮用水卫生标准. ；杭州市联合调查组 (2025). 关于杭州市余杭区部分小区供水异常调查情况通报（2025 年 7 月 23 日），新华网转载 ；杭州市余杭区人民政府. 余杭区 2025 年 4 月／5 月／6 月水源水水质监测数据（杭州余杭水务控股集团公开，检测单位杭州嘉澍环境监测有限公司，附件 PDF 表 1 第 24 项「粪大肠菌群」） 、、；公安部网络安全保卫局 (2025). 编造虚假「警情通报」，捏造「粪水」谣言，邵某豪被刑事拘留 +- Notes: The controversy stems from the fact that “compliance” is assessed only for water leaving treatment plants and at pipe endpoints. When the water source or distribution network is compromised, these standards may be temporarily unmet. On July 16, 2025, the raw water entering the Renhe Water Plant in Yuhang, Hangzhou, had an unusual odor, causing tap water in parts of Renhe and Liangzhu to smell foul. Officials attributed this to algae decomposing under low-oxygen conditions, producing sulfur-containing compounds. After switching to a different water source, tests showed no traces of total coliforms or E. coli in the treated water, and all other parameters met GB 5749-2022 requirements. Seven officials were held accountable, all July water bills were waived, and free water filters were distributed. Yet, fecal coliform counts at this same water source had been rising for months prior to the incident: at the Yongsheng intake point on the Tiaoxi River, counts rose from 10 per liter in April to 7,300 per liter in May and 16,000 per liter in June — exceeding the GB 3838 Class III surface water limit of 10,000 per liter. Counts at Siling Reservoir and Mantoushan Reservoir also surpassed this threshold that month at 28,000 and 24,000 per liter respectively. Boiling water only kills microorganisms; it cannot remove foul odors or dissolved chemicals. If water smells odd or appears yellow or cloudy, stop drinking it, report it to your water provider and via 12345, and temporarily switch to bottled water — but don’t expect a few extra minutes of boiling to resolve the issue. These incidents are localized and occasional; local compensation was provided, so they do not justify buying bottled water year-round. Online claims about “incorrectly connected sewage pipes” are fabrications based on fake police reports; the poster has since been criminally detained (see Section 9). The 1 yuan per 500 milliliter price for bottled water is a hypothetical figure for calculation purposes; you should use actual local prices instead. Residents in older neighborhoods with substandard secondary water supply systems may install filters or buy bottled water only in such cases. Water prices vary by region, so the Beijing figure is merely illustrative. +### 15. Infrequent stock trading + +- Cost: There are no monetary costs. The real challenge is resisting the urge to trade whenever you see market news. +- In plain terms: Among investors who trade most frequently, the average annual return is only 11.4%, while the overall market average for the same period is 17.9%. This gap of over 6 percentage points is almost entirely caused by the transaction fees incurred with each trade. If these fees are excluded, the returns of frequent and infrequent traders end up being quite similar. +- Benefit: This study analyzed 66,465 household accounts at US discount brokerage firms between 1991 and 1996. The group of investors who traded most often achieved an annualized return of 11.4%, while the overall market average was 17.9%, and the average return for all households was 16.4%. On average, these households turned over 75% of their stock holdings each year, swapping out three quarters of their portfolio annually. The gross returns (before transaction fees) of frequent and infrequent traders differed only slightly, meaning the performance gap is largely driven by trading costs (USA, 1991–1996). +- Evidence grade: A +- Sources:Barber BM, Odean T (2000). Trading Is Hazardous to Your Wealth: The Common Stock Investment Performance of Individual Investors. The Journal of Finance 55(2):773-806. +- Notes: These data are from the United States in the 1990s. While the commission and stamp duty structures for A-share markets differ, the core principle remains the same: higher trading frequency leads to lower net returns. This information is not intended as investment advice. +### 16. Don’t borrow money to invest, avoid leverage, and never buy assets you don’t understand + +- Cost: Zero expense. The hard part is resisting the urge to “borrow some cash to make extra profits” when the market is doing well. +- In plain terms: When you use borrowed money to buy stocks, any drop below a set threshold leaves you unable to add more funds, so your positions get automatically sold off. The paper losses instantly become real losses, leaving you no chance to wait for the price to rebound. Regulatory rules state that people who have held an account for less than six months or whose average daily assets over the past 20 trading days are under 500,000 RMB cannot open margin trading accounts. This threshold alone makes it clear this tool isn’t meant for ordinary investors. +- Benefit: Leverage essentially means borrowing money to make purchases, which also magnifies potential losses. After opening a margin account, the market value of your collateral may fall below the minimum maintenance margin set by your broker, which governs the assets you’ve pledged to them. If the value drops below this threshold and you fail to add more collateral to bring it back up, your positions get forcibly liquidated, with the broker selling them on your behalf. Paper losses turn into actual losses right away, with no window to wait for a price recovery. The same regulatory rules apply here: clients with less than six months of trading experience, insufficient risk tolerance, or average daily securities assets under 500,000 RMB over the past 20 trading days are barred from opening credit trading accounts. This requirement further proves it is not a suitable tool for regular investors (China, 2015). +- Evidence grade: B +- Sources:中国证监会 (2015). 证券公司融资融券业务管理办法（证监会令第 117 号，第十二条）. ；上海证券交易所. 《上海证券交易所融资融券交易实施细则》解读（投资者教育材料）. +- Notes: There is no direct academic evidence supporting the advice “never buy assets you don’t understand”; this is widely accepted industry consensus, so it is classified as grade C. Using consumer loans or credit card cash advances for investing also counts as a form of leverage; their interest rates are covered in section 7 of this chapter (“avoid minimum credit card payments”). This content does not constitute investment advice. +### 17. Using broad market index funds as a long-term core holding (the portion of money you keep invested for years) + +- Cost: There’s no upfront cost. The trade-off is that you give up the chance of picking a top-performing fund manager. The harder part is that when the index drops, you have to endure the losses too — you can’t pull your money out midway. +- In plain terms: The collection of stocks held by all active funds together closely mirrors the overall market. But the extra management fees those funds charge are deducted directly from your actual returns. When we rerun performance comparisons using random permutations to test how much luck plays a role, very few funds generate enough extra returns to offset their fees. +- Benefit: The combined holdings of all US active equity funds are nearly identical to the overall market portfolio: the stocks these funds own together match the composition of the broader market. However, the high costs of active management translate directly into lower net returns for investors after fees are deducted. The study used a bootstrap simulation method to randomly rerank fund performance data, to see how much of this outcome could be attributed to luck alone. The results showed that very few funds generate enough excess returns to cover their fees: the extra gains they achieve over the market are not enough to offset the fees they charge (study published in the US in 2010). S&P Dow Jones Indices conducts an annual survey: in 2024, 65% of US large-cap active equity funds underperformed the S&P 500. Over the past 24 years, an average of 64% of such funds underperformed each year. In the 15 years ending in late 2024, no single category of active funds managed to deliver better results than their index counterparts. +- Evidence grade: B +- Sources:Fama EF, French KR (2010). Luck versus Skill in the Cross-Section of Mutual Fund Returns. The Journal of Finance 65(5):1915-1947. ；S&P Dow Jones Indices (2025). SPIVA U.S. Scorecard Year-End 2024. （官网拒绝自动抓取，数字按 2025-05-12 的存档核对：）；TODO（待核实：中国市场同类研究，未找到可引用的原始文献）；Harvey CR, Liu Y (2022). Luck versus Skill in the Cross Section of Mutual Fund Returns: Reexamining the Evidence. The Journal of Finance, 77(3). （争议方） +- Notes: Point of contention: One paper re-examined this conclusion, noting that the original Fama-French test method used repeated random sampling that was not rigorous enough. Under their calculation method, even funds that do generate clear excess returns could still be classified as having results indistinguishable from luck. This means the original conclusion that “almost no active funds possess genuine skill” may be overly strict. No original research on whether Chinese active funds underperform their index counterparts has been identified for this section. This content does not constitute investment advice. +### 18. When choosing funds in the same category, pick those with lower fees + +- Cost: There’s no upfront cost. Before buying, check how much the sum of the management fee, custodian fee, and sales service fee comes to. +- In plain terms: For every 1 percentage point increase in a fund’s annual fee rate, the amount you end up with drops by roughly 18% after 20 years, and by about 26% after 30 years. Among funds in the same category, picking one with a lower fee rate is the only factor you can reliably control in advance. +- Benefit: The difference in fee rates gradually erodes your principal via compound interest — the small percentage deducted each year adds up over time. A 1 percentage point higher annual fee rate results in a final account value that is 0.99^20 ≈ 18.2% lower after 20 years, and roughly 26% lower after 30 years. Since 2023, China has been rolling out reforms to public fund fee structures, lowering the maximum allowable management and custodian fees for actively managed equity funds (exact cap figures are still being confirmed). +- Evidence grade: C +- Sources:中国证监会 (2023). 证监会有关部门负责人就公募基金费率改革答记者问. ；Fama EF, French KR (2010). 见第 11 条. +- Notes: This calculation follows standard mathematical formulas and assumes both funds generate identical pre-fee returns. In reality, you must also factor in subscription and redemption fees, as well as sales service fees for Class C shares. This information does not constitute investment advice. +### 19. Don’t put all your money into one stock, one platform, or one property + +- Cost: No cost at all. The hard part is accepting that you won’t always pick the single most profitable option. +- In plain terms: As long as multiple assets don’t all rise or fall in perfect unison, spreading your money across them keeps your average expected returns the same, while reducing the ups and downs of your account balance. Conversely, if you invest all your funds in just one stock, platform, or property, any trouble with it directly impacts your entire portfolio. +- Benefit: When several assets do not move in perfect lockstep, diversifying your investments maintains your expected returns while lowering overall volatility. This is the core conclusion of Markowitz’s 1952 portfolio theory, which has remained foundational for decades. On the other hand, putting all your money into one single stock or platform means its variance becomes your total portfolio variance — any rise or fall in its value directly affects your portfolio, with no other assets to offset losses when problems arise. +- Evidence grade: B +- Sources:Markowitz, H. (1952). Portfolio Selection. The Journal of Finance, 7(1), 77–91. +- Notes: This is rated as a B grade because the original academic paper relies purely on mathematical derivation, without providing concrete figures on exactly how much diversification reduces potential losses. Diversification can only lessen the fluctuations of your portfolio balance, it does not guarantee you won’t suffer any losses. Buying broad-based index funds (see item 17 in this section) is the easiest way to achieve effective diversification. This information is not intended as investment advice. +### 20. Individuals who pay income tax can open a personal pension account and deduct up to 12,000 yuan per year before tax; it is not worthwhile for non-taxpayers to do so. + +- Cost: There is no fee to open the account. The real cost is that the funds remain locked until retirement — you cannot withdraw them during that time. +- In plain terms: For every yuan you deposit, the tax you save equals your marginal tax rate minus 3%. If you contribute the full 12,000 yuan in a year, a taxpayer at a 10% rate saves 840 yuan, at 20% saves 2,040 yuan, and at 30% saves 3,240 yuan. Those who do not pay income tax gain nothing; they must also pay an additional 3% tax when withdrawing funds, resulting in a net loss. The money stays locked until retirement. +- Benefit: The maximum annual contribution of 12,000 yuan can be fully deducted from your total taxable income — whether from wages or business earnings. Any investment returns generated within the account are exempt from personal income tax for now. When withdrawals occur, they are taxed separately at a flat rate of 3%. Thus, the total tax saving equals your marginal tax rate minus 3% multiplied by the actual amount contributed. For example, at a 10% marginal rate you save up to 840 yuan per year; at 20% the saving is 2,040 yuan, and at 30% it reaches 3,240 yuan. Non‑taxpayers receive no benefit now and must pay 3% tax later, making it a net loss. The annual contribution limit resets each calendar year; any unused portion cannot be carried over. This policy has been in effect nationwide since 15 December 2024. +- Evidence grade: A +- Sources:财政部、税务总局 (2024). 关于在全国范围实施个人养老金个人所得税优惠政策的公告（财政部 税务总局公告 2024 年第 21 号，2024 年 12 月 12 日）. ；人力资源社会保障部等五部门 (2022). 个人养老金实施办法（第七、八、九、十二、十三条）. +- Notes: This account operates on a closed‑loop basis — once funds are deposited they cannot be withdrawn except under four specific circumstances: reaching the statutory retirement age, becoming completely unable to work, emigrating, or as otherwise stipulated by law. It is therefore not a typical investment vehicle but a long‑term tax‑saving arrangement. Before contributing, calculate how much extra tax you would pay per additional yuan earned to determine an appropriate amount. Avoid using emergency savings for this purpose (see Section 27). You must also select your own investment products; losses are possible. Selection criteria mirror those outlined in Sections 17 and 18 of this chapter — broad‑based index funds with low fees are preferred. Proof of deductions is issued by the Personal Pension Information Management Service Platform. You may elect to claim the deduction either at the time of payroll withholding or during the annual tax reconciliation process (see Section 2). +### 21. Paying for gym visits individually or on short-term plans is only worthwhile if you have a consistent attendance record spanning over a year + +- Cost: Buying passes individually ends up costing more per visit compared to an annual membership. You’ll need to honestly estimate how many times per month you actually plan to go. +- In plain terms: According to three years of data from U.S. gyms, members who signed contracts with monthly fees exceeding $70 attended the gym just 4.3 times per month on average, which works out to over $17 per visit. Meanwhile, a 10‑visit pass costs only $10 per visit. Collectively, these members paid roughly $600 more over their membership period. Unless you’ve already been going to the gym regularly for at least a year, buying individual passes or short‑term plans is far more economical. +- Benefit: This study analyzed three years of data from 7,752 members at three U.S. fitness clubs. Members opting for monthly plans costing over $70 visited the gym just 4.3 times per month on average, resulting in a per‑visit cost exceeding $17. In contrast, a 10‑visit pass costs only $10 per visit. Over the same period, these members ended up paying an average of $600 more than they would have with a yearly membership. Additionally, the proportion of monthly‑plan members who kept their membership for over a year was 17% higher than that of annual‑plan members (based on three years of U.S. panel data). +- Evidence grade: B +- Sources:DellaVigna S, Malmendier U (2006). Paying Not to Go to the Gym. American Economic Review 96(3):694-719. +- Notes: This is just one study using data from the United States. Nevertheless, its underlying principle is universally applicable: people tend to overestimate their future self‑control. If you’ve already maintained a consistent routine of going to the gym at least twice a week for a full year, then an annual membership does prove to be the cheaper option. +### 22. Sign a written contract before paying a deposit; if a business faces risks, it must stop taking payments, and you have the right to get back any unused balance if it shuts down. + +- Cost: No cost involved. The real challenge is insisting on a written contract on the spot — refusing any “pay first, talk later” offers. +- In plain terms: Any business that accepts a prepayment from you must sign a written contract with you that clearly outlines how refunds will be handled. If a business runs into serious operational problems, it must stop collecting prepayments. Even if it plans to close or relocate, it must give you advance notice. At that point, you can either demand that it continue providing services or request a refund for any unused balance. Violating these rules results in fines for the business. +- Benefit: The regulations require businesses accepting prepayments to sign written contracts that specify refund procedures. If a business faces major operational risks, it must cease taking prepayments. When a business decides to close or move locations, it must inform consumers ahead of time. Consumers have the right to demand continued service delivery or a refund for any unspent balance. Breaching these rules can lead to fines ranging from 1 to 10 times the illegal earnings; if no illegal earnings exist, fines up to 500,000 yuan may apply. +- Evidence grade: A +- Sources:国务院 (2024). 中华人民共和国消费者权益保护法实施条例（国务院令第 778 号，2024 年 7 月 1 日施行）. 第二十二条：「经营者以收取预付款方式提供商品或者服务的，应当与消费者订立书面合同，约定商品或者服务的具体内容、价款或者费用、预付款退还方式、违约责任等事项。」「经营者未按照约定提供商品或者服务的，应当按照消费者的要求履行约定或者退还预付款。」「经营者出现重大经营风险，有可能影响经营者按照合同约定或者交易习惯正常提供商品或者服务的，应当停止收取预付款。经营者决定停业或者迁移服务场所的，应当提前告知消费者……消费者……有权要求经营者继续履行提供商品或者服务的义务，或者要求退还未消费的预付款余额。」；第五十条罚则 +- Notes: These regulations mainly serve as a basis for legal action after the fact — they cannot prevent issues beforehand. If a business actually shuts down, its funds are often no longer accessible. Therefore, it is advisable to follow the advice in this section to limit prepayments to small amounts via “pay-per-use” or short-term plans. In case of problems, you can then rely on these regulations to protect your rights. Article 27 of the same regulations also requires businesses collecting deposits to agree in advance on refund methods, procedures, and timeframes, and they cannot impose unreasonable conditions on refunds. +### 23. Implementing a 24-hour cooling-off period for non-essential big-ticket purchases; making full use of the seven-day no-questions-asked return policy for online shopping + +- Cost: No direct monetary cost. You simply have to wait an extra day to receive what you want. Usually, you’re responsible for return shipping fees. The real challenge is resisting the urge to place the order on the same day. +- In plain terms: What you save is exactly the money spent on items you no longer want the very next day. For online purchases, you can return them for any reason within seven days of delivery. There are a few categories excluded from this policy: custom-made items, perishable goods, digital products that have been opened, and newspapers and periodicals. +- Benefit: What you save is precisely that portion of impulse buys you no longer want after a day. There is no single universal percentage representing this share. As mentioned, online purchases can be returned within seven days of receipt, with the same exclusions applying. This policy has been in effect in China since 2017. +- Evidence grade: C +- Sources:国家市场监督管理总局 (2020 修订). 网络购买商品七日无理由退货暂行办法（总局令第 31 号）. +- Notes: The cooling-off period is essentially a practical measure with no direct academic evidence backing it up. For purchases not deterred by this period, the seven-day no-questions-asked return policy still applies. Before initiating a return, make sure to verify two things: whether the item falls under the excluded categories, and whether its packaging remains intact. +### 24. Don’t fall for “strikethrough prices” or impulse buying during sales + +- Cost: Zero monetary cost. The trade‑off is that you might miss out on some genuine discounts. You’ll need to keep track of the regular prices of the items you buy most often. The real challenge is resisting the urge to stock up on the day of a sale. +- In plain terms: When judging whether something is cheap or expensive, people rely on the first price they see; later adjustments rarely make up for that initial impression. Thus, a claim like “original price 999, now 499” makes us systematically overestimate how much we’re saving. By regulation, the baseline for a discount should be the lowest price at which the item actually sold in the seven days preceding the promotion; the crossed‑out price isn’t necessarily a real transaction price. +- Benefit: Human judgment is anchored to the first price encountered, and subsequent corrections are usually insufficient. Consequently, statements such as “original price 999, now 499” inflate our perception of the discount amount. Official rules require that the reference price be the minimum actual sale price recorded in the same store during the seven days prior to the sale; the discount percentage must be calculated against that figure. The price marked through may never have been charged in reality (China, effective 2020). +- Evidence grade: C +- Sources:Tversky A, Kahneman D (1974). Judgment under Uncertainty: Heuristics and Biases. Science 185(4157):1124-1131. ；国家市场监督管理总局 (2020). 规范促销行为暂行规定（总局令第 32 号，第二十一条）. +- Notes: The anchoring effect is a finding from laboratory studies; no one has quantified exactly how much money consumers lose by over‑buying. There are also hidden costs: items may expire, they take up space, and we tend to use them more simply because they’re on hand. Only purchase in bulk when all three conditions hold: a long shelf life, a definite need for the product, and a price genuinely lower than its usual cost. +### 25. It’s better to choose a non‑return insurance plan and treat any “refunds” or dividends as non‑guaranteed benefits + +- Cost: With a non‑return plan, no money is returned at maturity, which can make it feel like “wasted money.” You’ll need to handle your own savings. The hardest part is accepting that this money won’t be coming back. +- In plain terms: The insurance company makes no promises about any dividends or refunds you might receive. Policy documents must explicitly state in bold text that “future policy dividends are non‑guaranteed benefits.” The extra premiums paid for return features essentially act as a savings account managed by the insurer; there’s no guarantee on returns, and withdrawals are difficult. +- Benefit: Regulatory rules require that dividend‑type products clearly indicate in bold print that “future policy dividends are non‑guaranteed benefits, and their distribution is uncertain.” The dividend illustration is the projected payout table provided by the insurer; its maximum interest spread is 4.5% minus the policy’s guaranteed interest rate. This guaranteed rate is the fixed return stated in the contract. Premiums paid for return or dividend features function similarly to a savings account held by the insurer — with no guaranteed returns and limited liquidity; withdrawals are hard to arrange (China, effective 2023). +- Evidence grade: C +- Sources:中国银保监会 (2022). 一年期以上人身保险产品信息披露规则（银保监规〔2022〕24 号）. +- Notes: While return‑type insurance can help people who struggle to save by enforcing regular payments, this advice applies mainly to individuals who can manage their own finances. Whether opting for a non‑return plan and investing the saved premiums is truly superior to buying a return‑type policy depends on the specific product; no systematic data are available to support this comparison here. This information is not financial advice. +### 26. Get sufficient third‑party liability coverage: the mandatory insurance limits are uniform nationwide and relatively low, so any excess must be paid out of your own pocket + +- Cost: Commercial third‑party liability insurance costs a few hundred to a few thousand yuan per year. The higher the coverage amount you choose, the cheaper the premium becomes per unit of coverage. +- In plain terms: When you’re at fault, the mandatory insurance pays out only up to three specific limits: 180,000 yuan for death or disability, 18,000 yuan for medical expenses, and 2,000 yuan for property damage. These amounts cannot be combined or transferred between categories. Compensation for injuries often exceeds these caps, and any shortfall must be paid by you personally; therefore, it’s essential to purchase enough commercial third‑party coverage. +- Benefit: Nationwide, mandatory insurance enforces uniform liability limits. These limits are calculated separately for four categories: death or disability, medical costs, property damage, and compensation payable when you’re not at fault. Following the 2020 overhaul of auto insurance, the total maximum payout is now 200,000 yuan, broken down as 180,000 yuan for death/disability, 18,000 yuan for medical costs, and 2,000 yuan for property damage. When you’re not liable, the limits drop to 18,000 yuan for death/disability, 1,800 yuan for medical costs, and 100 yuan for property damage. Any amount above these caps must be borne by the responsible party; drivers lacking mandatory coverage face vehicle impoundment and a fine equal to twice the unpaid premium. +- Evidence grade: A +- Sources:国务院 (2006, 2012 修订). 机动车交通事故责任强制保险条例（国务院令第 462 号，第 618 号令修改）第二十三条：「机动车交通事故责任强制保险在全国范围内实行统一的责任限额。责任限额分为死亡伤残赔偿限额、医疗费用赔偿限额、财产损失赔偿限额以及被保险人在道路交通事故中无责任的赔偿限额。」「责任限额由保监会会同国务院公安部门、国务院卫生主管部门、国务院农业主管部门规定。」第二十一条限额内赔偿；第三十九条未投保的「由公安机关交通管理部门扣留机动车……处依照规定投保最低责任限额应缴纳的保险费的2倍罚款」. ；中国银行保险监督管理委员会 (2020). 关于实施车险综合改革的指导意见（银保监发〔2020〕41 号，四（四）：「将交强险总责任限额从12.2万元提高到20万元，其中死亡伤残赔偿限额从11万元提高到18万元，医疗费用赔偿限额从1万元提高到1.8万元，财产损失赔偿限额维持0.2万元不变」）. （国务院公报） +- Notes: These limits are set by financial regulators and may be adjusted over time. The figures cited reflect current values after the September 2020 reforms; it’s advisable to verify them before purchasing a policy. Crucially, mandatory insurance pays out per category separately — unused portions cannot be applied toward other categories. Compensation claims often surpass these caps, leaving drivers personally liable for the remainder. While this guide does not prescribe an exact coverage amount, it highlights how a modest additional outlay can safeguard you against a scenario with low probability yet potentially devastating financial impact. +### 27. Set aside an emergency fund equal to 3–6 months of living expenses in a readily accessible account + +- Cost: There is no direct monetary cost. The trade-off is forgoing higher returns; the funds must be kept in a checking account, money market fund, or any deposit account that allows immediate withdrawals. The real challenge lies in resisting the urge to dip into the fund while saving it up. +- In plain terms: Keep 3 to 6 months’ worth of living expenses in an account you can withdraw from at any time. This way, if you lose your job or fall ill, you won’t have to borrow money at an 18% annual interest rate, nor will you need to sell your investments at a loss. Deposits in banks are protected by deposit insurance, which covers up to 500,000 RMB per bank in China. +- Benefit: An emergency fund eliminates the need to borrow money or sell investments at a loss during unexpected events like job loss or illness. For details on the minimum annual interest rates for consumer loans and credit card payments, see Section 7 of this chapter (which advises against relying on minimum credit card payments). +- Evidence grade: C +- Sources:国务院 (2015). 存款保险条例（国务院令第 660 号，第五条）. +- Notes: The recommendation to save 3–6 months’ worth of expenses is a widely accepted guideline, but no official or academic sources have been identified to support it, hence the C grade. The required amount should be calculated based on your regular monthly expenses, not your income. This information does not constitute investment advice. +### 28. Run a quick comparison before paying off your mortgage — don’t rely on gut feeling + +- Cost: No cost at all. It only takes about half an hour to do the math. You’ll need to honestly estimate the steady after‑tax return you can expect over the long run. +- In plain terms: Paying off your mortgage is essentially the same as earning a guaranteed return equal to your mortgage rate. So the only question you need to ask is: can you reliably earn a higher after‑tax return than that rate? If the answer is yes, it makes sense to keep the money invested. If not, or if you’re unsure, paying off the loan is the better choice. With an equal principal‑and‑interest repayment plan, most of the early payments go toward interest; the earlier you pay, the more you save. Most bank apps have a “pre‑payment calculator” that gives you the exact numbers. +- Benefit: The calculation works like this: let r be the annual mortgage rate as stated in your contract. As of 20 August 2026, the 5‑year LPR in China is 3.5%; the actual rate you pay is either higher or lower than this figure. Next, let g represent the after‑tax annual return you can expect from an alternative investment — the average percentage gain you’d earn each year by putting that money elsewhere. Paying off the mortgage guarantees you a return of exactly r; each dollar you apply to the loan earns you that rate for sure. If g consistently exceeds r, it’s better to keep the money invested. If g is lower than r, or if you can’t reliably predict it, paying off the loan locks in a risk‑free return equal to r. Again, because most of the early payments under an equal principal‑and‑interest plan cover interest, the earlier you pay, the more you save. This effect is clearly shown by the numbers produced by your bank’s pre‑payment calculator (Chinese rates as of 2026). +- Evidence grade: C +- Sources:全国银行间同业拆借中心受中国人民银行授权 (2026). 2026 年 8 月 20 日贷款市场报价利率（LPR）公告. +- Notes: This section provides only the calculation method, not a definitive recommendation. It’s relatively rare for investment returns to reliably surpass mortgage rates. Regardless of which option you choose, be sure to keep enough cash on hand for emergencies. Also, check your contract for any prepayment penalties. This information is not intended as financial advice. +### 29. When shopping online, follow platform rules and laws — not influencers or “positive reviews” + +- Cost: There’s no cost involved. Just take a moment before ordering to read the return policy and deposit rules. After receiving your purchase, keep screenshots of the order, the livestream replay, and any chat records. The real challenge is resisting the persuasive atmosphere created by influencers. +- In plain terms: If a seller cheats you, they must pay three times the amount you paid — with a minimum compensation of 500 yuan. Platforms that know sellers are breaking the law but do nothing must share in the liability. The maximum deposit allowed is 20% of the contract value; if you break the contract, that deposit is forfeited, but if the seller does, they must return double the amount. Organizing fake orders or fake positive reviews in livestreams is illegal, and algorithmic price discrimination based on personal data is strictly prohibited. +- Benefit: Sellers found guilty of fraud must pay three times the purchase price, with a minimum payout of 500 yuan. Platforms aware — or reasonably expected to know — that sellers are violating laws must also bear joint liability, so you can seek compensation directly from them. Livestream hosts and platforms may not fabricate transaction volumes, follower counts, views, or likes, nor spread false information; doing so incurs civil liability. Those caught orchestrating fake transactions or reviews face fines up to 1 million yuan; repeat offenders may be fined between 1 million and 2 million yuan and even lose their business license. Deposits must stay under 20% of the contract total; if you breach the contract, that deposit is lost, but if the seller does, they must return double it. Using personal data for automated pricing decisions that result in unfair price differences — commonly known as “algorithmic price discrimination” — is illegal nationwide. +- Evidence grade: A +- Sources:全国人大常委会 (2013 修正). 消费者权益保护法（第四十四、五十五条）. （市场监管总局转载）；国家网信办等七部门 (2021). 网络直播营销管理办法（试行）（第十八、二十八条）. ；全国人大常委会 (2025 修订). 反不正当竞争法（第九、二十五条）. （全国社保基金理事会转载）；全国人大 (2020). 民法典（第五百八十六、五百八十七条）. ；全国人大常委会 (2021). 个人信息保护法（第二十四条）. （国家统计局转载）；山东省市场监管局 (2025). 六起网络不正当竞争典型案例. +- Notes: There are no official comparative statistics available on which platforms offer the best value or minimize the risk of buying low-quality goods, so this book does not rank any platforms. The only publicly available data consists of general inspection results (see Section 32 regarding national inspection reports). Following the 2025 revision of China’s Anti-Unfair Competition Law, provisions on false advertising moved from Article 8 to Article 9, while related penalties shifted from Article 20 to Article 25; the new law took effect on October 15, 2025, so be sure to use the updated article numbers. In one case in Shandong, a company organized 75 fake transactions involving over 680,000 yuan; although the exact fine amount was not disclosed, the company was penalized. For information on seven-day unconditional returns, see Section 23 in this chapter (“Making the seven-day return policy work for you”). +### 30. If something goes wrong after buying from a livestream, first ask the platform for the seller’s and influencer’s details — they’re required to provide them. + +- Cost: No cost involved; you simply need to request the information from the platform. +- In plain terms: One of the biggest hurdles when problems arise from purchases made during livestreams is figuring out exactly who to hold responsible. In such cases, you can demand that the platform disclose the identity of the livestream operator and any associated influencers, along with their business records. The platform is legally obligated to comply with this request. +- Benefit: When consumer disputes occur, operators of livestream marketing platforms must furnish buyers with the relevant details of both the livestream operator and any affiliated influencers, as well as all related business documentation. The primary obstacle in pursuing legal recourse in these situations is identifying the right party to sue; obtaining this information removes that barrier entirely. +- Evidence grade: A +- Sources:国务院 (2024). 中华人民共和国消费者权益保护法实施条例（国务院令第 778 号，2024 年 7 月 1 日施行）. ：「经营者通过网络直播等方式提供商品或者服务的，应当依法履行消费者权益保护相关义务。直播营销平台经营者应当建立健全消费者权益保护制度，明确消费争议解决机制。发生消费争议的，直播营销平台经营者应当根据消费者的要求提供直播间运营者、直播营销人员相关信息以及相关经营活动记录等必要信息。」「直播间运营者、直播营销人员发布的直播内容构成商业广告的，应当依照《中华人民共和国广告法》的有关规定履行广告发布者、广告经营者或者广告代言人的义务。」 +- Notes: Before making any purchase, be sure to record both the livestream footage and any promises made by the host. Should any issues arise, first request the seller’s and influencer’s information from the platform before deciding whether to file a complaint or pursue legal action. This same regulation also outlines three additional requirements: first, merchants cannot unilaterally expand the list of items excluded from the seven-day no-questions-asked return policy; second, such exclusions must never be set as default options; and third, merchants are prohibited from denying returns without your explicit consent. +### 31. If you buy unsafe food, you can demand ten times the purchase price as compensation; if the amount is under 1,000 yuan, you’re still entitled to 1,000 yuan. + +- Cost: There’s no cost involved. Keep the food, its packaging, and the receipt — don’t throw them away or wash them, and take photos right away. First try to negotiate with the seller or platform; if that fails, call 12315. Filing a lawsuit can take several months. The hard part is resisting the urge to discard the items first. +- In plain terms: If you buy expired or spoiled food, the food itself, its packaging, and the receipt serve as evidence — so don’t toss them out. You’re entitled to compensation equal to ten times the purchase price or three times your actual loss; if that amount is less than 1,000 yuan, you still get 1,000 yuan. You may choose either the seller or the manufacturer to compensate you; the party you approach must pay first and cannot shift the responsibility to the other side. +- Benefit: If you suffer harm due to food that fails to meet safety standards, you may seek compensation from either the seller or the producer. The party receiving your compensation request must assume primary responsibility and pay out immediately, without shifting liability. In addition to basic compensation, you can demand ten times the purchase price or three times your loss as punitive damages, with any amount below 1,000 yuan rounded up to 1,000 yuan. One exception applies: this does not cover cases where labeling or instructions contain minor flaws that do not affect safety or mislead consumers. Judicial interpretations set three key conditions: the purchase must be for personal or household use; the food must violate safety standards; and there must be no proof the buyer knew of those violations at the time of purchase. Only then can ten times the purchase price be claimed as punitive damages. Conversely, if a buyer knowingly purchases substandard food and then seeks compensation, courts will only support claims within reasonable household consumption limits. Repeated purchases or multiple lawsuits are evaluated as a single total amount. Certain labeling issues — such as irregular font sizes, typos, or non‑standard net‑weight indications — generally do not qualify for punitive damages provided they do not mislead consumers about safety. +- Evidence grade: A +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第一百四十八条）. （国家法律法规数据库，2025 年 12 月 1 日起施行）；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第一、六、七、八、十二、十三、十四、十五、十六条，2024 年 8 月 22 日起施行）. （最高人民法院公报） +- Notes: The order of evidence matters more than the amount of compensation. Take photos and videos showing the packaging, production date, any foreign objects, and the purchase record before contacting the seller or platform; do not discard or wash the items beforehand. 12315 provides mediation, not binding rulings. If the seller refuses to cooperate, litigation becomes the only option — see Section 8, Article 22 for rules on small‑claims litigation involving online or second‑hand purchases. Whether foreign objects like hair or insects qualify as violations of food safety standards must be determined by regulatory authorities or through testing; simply finding hair in food does not automatically guarantee 1,000 yuan in compensation. For ordinary consumer fraud, triple compensation applies, with amounts under 500 yuan rounded up to 500 yuan — see Section 8, Article 29. Those producing and selling food must comply with licensing, labeling, and legal restrictions on health claims; details appear in Section 12, Articles 8–11. Finally, abusing compensation claims is prohibited: fabricating evidence of illegal production to extort payments constitutes extortion and may lead to criminal referral; similarly, filing lawsuits based on false premises may result in fines, detention, or counterclaims for defamation. This section applies specifically to individuals seeking protection for themselves and their families. +### 32. Check national inspection reports, 3C certification, and energy labels before buying big-ticket items + +- Cost: It costs nothing. Just spend a few minutes looking up information on the websites of the State Administration for Market Regulation and the Certification and Accreditation Administration. +- In plain terms: In 2024, national inspections covered 25,250 batches of products, with 14.3% found to be non-compliant. The situation is worse on e-commerce platforms: out of 7,297 inspected batches, 23.5% failed to meet standards, compared to 15.1% of products sold in physical stores. Before purchasing any big-ticket item, take a few minutes to check the latest inspection reports and verify that the 3C certificate is genuine. Any product required to carry an energy label must have one. +- Benefit: The 2024 national supervision inspections examined 25,250 product batches, resulting in a non-compliance rate of 14.3%. On e-commerce platforms, 7,297 batches were inspected, with a non-compliance rate of 23.5% — an increase of 1.8 percentage points from the previous year. Physical stores saw 8,055 batches inspected, with a non-compliance rate of 15.1%. The authenticity of mandatory product certification (3C) certificates can be checked via the “Certification Results” section on the Certification and Accreditation Administration’s official website. Energy labels are strictly regulated under product catalogs; they must include the energy efficiency grade, relevant metrics, and a unique identification code. Falsifying or misusing energy labels, or failing to apply them where required, is punishable under the Energy Conservation Law across China. +- Evidence grade: B +- Sources:市场监管总局 (2025). 关于 2024 年产品质量国家监督抽查情况的通报. ；国家认监委. 官网「认证结果」查询入口. ；国家发展改革委、国家质检总局 (2016). 能源效率标识管理办法（令第 35 号，第三、七、二十七条）. +- Notes: These inspections involve regulators selecting a sample of products for testing; their results do not represent the overall market compliance rate, nor can they be used to rank online platforms. There are no studies quantifying exactly how many substandard products can be avoided by conducting such checks, which is why this item is rated B. The verification platform cx.cnca.cn used in this section was inaccessible during our checks; the correct entry point is the homepage at cnca.gov.cn. Inspection reports are updated annually, so always consult the most recent edition when referencing them. +### 33. Bracelets, jade, luxury watches, and collectibles should be judged by “how much you spend” rather than “how much you save” + +- Cost: There’s no upfront cost — just don’t justify buying these items by claiming they’ll appreciate in value later. The real challenge is resisting the urge to allocate extra budget for “preservation of value.” +- In plain terms: A portion of the purchase price for such items is already consumption tax: watches priced at 10,000 yuan or more incur a 20% tax; gold, platinum, and diamond jewelry faces a 5% tax; other precious stones and jade incur a 10% tax, plus standard VAT. This tax cannot be reclaimed when you resell the item. If you truly love these items, treat them as a personal expense rather than an investment. +- Benefit: On the purchase side, tax rates are clearly defined in the Consumption Tax Schedule: “luxury watches” are taxed at 20%. Within “precious jewelry and stones,” gold, platinum, and diamond jewelry incur a 5% tax, while other precious stones and jade incur 10%. “Luxury watches” are defined as any watch with a sales price (excluding VAT) of 10,000 yuan or more. On the resale side, the Pawnbroking Management Regulations apply: Article 36 limits pawn terms to a maximum of six months; Article 37 sets interest rates based on the six-month benchmark rate published by the People’s Bank of China, which cannot be deducted upfront from the loan amount. Article 38 caps monthly comprehensive fees for pawning watches or jade at 42‰ of the loan amount, plus an additional 4.2% monthly fee. For real estate mortgages, this cap is 27‰, and for property rights pledges it is 24‰. Article 40 states that if the pawner fails to redeem or renew the pawn within five days of the term’s end, the item becomes forfeited; Article 43 permits auctioning forfeited items valued at over 30,000 yuan, with proceeds first covering auction fees and loan principal plus interest, leaving any remainder to be returned to the pawner (or recovered from them if insufficient). +- Evidence grade: A +- Sources:国务院 (2008). 中华人民共和国消费税暂行条例（国务院令第 539 号，附《消费税税目税率表》）. ；财政部、国家税务总局 (2006). 关于调整和完善消费税政策的通知（财税〔2006〕33 号）. ；商务部、公安部 (2005). 典当管理办法（2005 年第 8 号令，第三十六、三十七、三十八、四十、四十三条）. +- Notes: When pawning these items, remember that monthly comprehensive fees cap at 42‰ of the loan amount — equating to roughly 50% of the loan value over a year. This figure is a rough estimate derived by multiplying the monthly rate by 12, not an exact annual interest rate. While tax and fee rates are explicitly stated, there are no official statistics confirming long-term appreciation for such items; this guide makes no predictions or endorsements. The key point is to avoid treating personal purchases as investments: buying these items simply because you enjoy wearing them is perfectly fine, but adding budget based on hopes of future resale value is a recipe for financial loss. Gold also warrants separate consideration: investment-grade bullion traded by weight differs from jewelry sold by piece, which includes design and labor costs not recovered upon resale. Listed prices on secondhand platforms are not actual transaction values and should not be treated as market benchmarks. +### 34. For jewelry and gemstones, only test reports bearing the CMA mark are acceptable; you must also verify the issuing agency on the regulator’s official website. + +- Cost: No cost at all. Checking an agency’s qualifications takes just a few minutes before placing any order. +- In plain terms: Certificates can be forged, so what truly matters is confirming the agency that issued it. Any testing organization allowed to issue reports must hold proper credentials, and its reports must display the CMA mark. The regulatory authority publishes a list of certified agencies on its website, making it easy for consumers to confirm whether a given provider is on that list. In actual enforcement cases, some “national inspection certificates” accompanying goods were found to have been fabricated by unrelated parties. +- Benefit: The relevant rules are laid out in the *Administrative Measures for Qualification Recognition of Inspection and Testing Agencies*. Article 2 states that qualification recognition is a licensing process for agencies that provide data and results with evidentiary value to the public; it involves a thorough review followed by issuance of certification. Article 15 specifies that the CMA mark comprises both the CMA logo and the corresponding certificate number. Article 21 requires any agency issuing such data to display this mark on all reports. Article 22 mandates that authorities publish all certified agencies and their current status online. Article 34 imposes a fine of up to 30,000 RMB on any agency operating without proper certification. Article 37 similarly penalizes up to 30,000 RMB any act of forging, altering, or misusing such certification marks. Real-world examples illustrate these rules: in June 2026, China’s State Administration for Market Regulation released typical cases of fraud in the traditional crafts market. One involved a livestream in Donghai, Jiangsu, where sellers claimed to offer “natural, unacid-washed, unprocessed Burmese A‑grade gems” and displayed a “national inspection certificate.” Laboratory tests, however, revealed the items to be dyed quartzite, treated jadeite, glass, and plastic; the certificate had been produced by a contact of the seller. Another case in the same county uncovered 469 suspected counterfeit crystal products; 210 proved to be natural crystal while 259 were synthetic. In Zhenping, Henan, a shop displayed a board claiming partnership with a “GIA CMA China Gemstone Testing Center” and sold 181 counterfeit “National Gemstone Quality Supervision Center” certification tags alongside bracelets nationwide. +- Evidence grade: A +- Sources:国家质量监督检验检疫总局 (2015 公布，2021 修改). 检验检测机构资质认定管理办法（第二、十五、二十一、二十二、三十四、三十七条）. ；国家市场监督管理总局 (2026). 市场监管总局公布一批传统工艺市场「打假清源」典型案例. ；国家标准化管理委员会. GB/T 16552—2017《珠宝玉石 名称》（现行，2018 年 5 月 1 日实施）. +- Notes: China has established national standards for naming jewelry and gemstones. Test conclusions are often phrased as “quartzite (dyed)” or “jadeite (treated)”; the words inside the parentheses indicate the price difference. Terms such as “A‑grade,” “old‑mine,” and “unprocessed” are marketing buzzwords, not technical conclusions; the livestream mentioned earlier used exactly these phrases. Other deceptive tactics documented in these cases include faking mining sites, staging “miner” livestreams, deploying online trolls to hype sales, and inventing stories about urgent financial needs or family emergencies. Claims that products can “treat rheumatism, boost immunity, improve sleep, or clear blood vessels” are also deemed false advertising and are prosecuted accordingly. For larger purchases, the general verification method is outlined in Section 32 (checking sampling reports and 3C certification). Information on whom to contact when problems arise in a livestream is provided in Sections 29 and 30 (referring to platform rules and requesting data from the platform). +### 35. Random sales such as blind boxes and gacha games are treated as “money that won’t come back” + +- Cost: There is no direct cost involved. You simply need to set a strict budget before buying. The real challenge is resisting the urge to keep purchasing when you fail to get the item you wanted. +- In plain terms: Sellers must display the draw rules, probabilities, and quantities of limited‑edition items in a highly visible manner. They are prohibited from manipulating results behind the scenes or offering empty boxes. While the guidelines encourage setting minimum guarantees and limits on spending and number of draws, they are not mandatory. For blind boxes purchased online, if the seller has clearly explained the terms and you have confirmed them, you cannot exercise the seven‑day right to return after opening the box. +- Benefit: The basis for these rules is the “Guidelines on the Operation of Blind Box Business (Trial)”. Article 9 mandates that a list of key information be displayed prominently so consumers know it before buying. This information includes the product name, type, design, draw rules, distribution of items, quantity of limited items, draw probabilities, and the range of item values. The same article also forbids three practices: altering draw results or probabilities through backend manipulation, refusing or delaying delivery of items via cashbacks or exchanges, and producing empty boxes. Article 11 merely “encourages” operators to implement safeguards such as limits on draw time, spending, and frequency to promote rational consumption. Article 17 applies to blind boxes sold online; if the seller has fully informed you and you have confirmed the terms, the seven‑day return right does not apply after opening. Operators must not replace your explicit consent with pre‑checked boxes. Article 21 states that blind boxes must not be used as a guise for gambling. Article 23 prohibits sales to children under eight; for those aged eight and older, consent from a legal guardian must be obtained. +- Evidence grade: A +- Sources:市场监管总局 (2023). 盲盒经营行为规范指引（试行）（国市监稽发〔2023〕39 号，第九、十一、十七、二十一、二十三条）. +- Notes: These guidelines serve as recommendations for operators and are not themselves a basis for penalties. In case of disputes, laws such as the Product Quality Law, Anti‑Unfair Competition Law, and Consumer Rights Protection Law apply. Specific grounds for complaints include failure to disclose probabilities, discrepancies between advertised and actual probabilities, and receipt of empty boxes. Before filing a complaint, record screenshots of the rules and the unboxing process. The exclusion of the seven‑day return right requires that the seller gave full disclosure and you confirmed it; default selections cannot substitute your consent. Additional rules govern sales to minors: no sales to children under eight, and for older minors proof of guardian consent is mandatory. Information on refunding mobile‑game micro‑transactions made by children can be found in section 9 of this chapter. The 24‑hour cooling‑off period for large non‑essential purchases is described in section 23. The cycle of “initial excitement fading into further purchases” is discussed in section 6, item 23. +### 36. If you care about what’s in your food, buy pre-packaged products: loose goods at retail counters aren’t legally required to list ingredients + +- Cost: No cost at all. Pre-packaged versions of the same items are usually a bit pricier than loose ones. Checking the ingredient list takes just a few seconds. +- In plain terms: The law only mandates ingredient lists for pre-packaged foods; loose goods have no such requirement. For loose products, retailers only need to display the product name, production date, shelf life, and manufacturer details. So, the absence of any mention of additives does not mean they were not added — it simply means the law does not require them to be listed. If you care about what’s in your food, opt for pre-packaged versions where both the full ingredient list and additive details are clearly printed. +- Benefit: Article 67 of China’s Food Safety Law stipulates that all pre-packaged foods must carry a label containing nine mandatory pieces of information. The second item on this list is the “list of ingredients or components,” and the seventh item is “the generic names of any food additives used, as defined in national standards.” Article 68 contains far fewer requirements for loose foods: it only requires retailers to display the product name, production date or batch number, shelf life, and the manufacturer’s name, address, and contact details on the packaging or container. There is no mention of ingredient lists or additives here. This distinction is most evident in frozen seafood products. GB 2760—2024 permits the use of phosphoric acid and phosphates as moisture retention agents — commonly referred to as water-retaining agents — in frozen seafood, with a maximum permitted usage level of 5.0 g/kg calculated as phosphate. Use within this limit is fully legal. The main issues arise from excessive usage and the practice of adding ice to increase product weight. Following a 2025 exposé by China Central Television’s 3·15 Gala, which revealed that some shrimp producers illegally added excessive amounts of water-retaining agents (composite phosphates) and added extra ice to boost weight, regulatory authorities mandated that all such products must clearly list water-retaining agents like phosphates, net weight (excluding ice coating weight), and full ingredient lists on their labels (this requirement applies nationwide, per the third 2025 amendment to China’s Food Safety Law, effective 1 December 2025). +- Evidence grade: A +- Sources:全国人大常委会 (2025 年第三次修正). 中华人民共和国食品安全法（第六十七、六十八条，2025 年 9 月 12 日公布，2025 年 12 月 1 日施行）. ；国家卫生健康委员会、国家市场监督管理总局 (2024). 食品安全国家标准 食品添加剂使用标准（GB 2760—2024，附录 A 表 A.1「磷酸及磷酸盐」项下食品分类号 09.02.01 冷冻水产品；A.3 规定表 A.1 列出的食品添加剂按照规定的使用范围和最大使用量使用）. ；六安市市场监督管理局 (2025). 关于水产制品及使用保水剂的相关企业提醒告诫函（2025 年 3 月 24 日）. +- Notes: The fact that additives are not listed on a product does not mean they were not added — it simply means the law does not require them to be disclosed. If you want to know exactly what a product contains, always choose pre-packaged versions. For frozen shrimp, fish fillets, and similar items, the net weight listed on pre-packaged packaging already excludes ice coating weight; using this figure to calculate unit price gives a much more accurate cost estimate. For loose products priced by weight, the actual edible weight after thawing may drop significantly. Water-retaining agents are legal and not a safety hazard as long as they are used within permitted limits — do not mistake them for toxic substances. Excessive usage and added ice are purely commercial issues: you end up paying a premium price for mostly water content. Conversely, loose goods counters may also fail to display the four mandatory details required by Article 68: product name, production date, shelf life, and manufacturer contact information. Failure to display any of these constitutes a violation of the law. Consumers can choose not to purchase such products or file a complaint via the 12315 hotline. For business owners looking to sell packaged foods, specific labeling requirements are outlined in Section 12, Article 9 of this guide. This item delivers the highest level of benefit to both you and your family. +### 37. Stocks that have lost value should also be sold according to pre‑set rules — don’t try to even out costs by buying more + +- Cost: No cost at all. The hard part is admitting the loss and actually selling the stock. +- In plain terms: Human nature drives us to sell winners and hold losers. In seven years of data from 10,000 U.S. accounts, stocks that rose were sold about 50% more often than those that fell. The same investors also tended to add to positions in losing stocks. Yet over the following year those unloved losers underperformed the sold winners by an average of 3.4 percentage points. +- Benefit: This study examined every trade made by 10,000 accounts at a U.S. discount broker from 1987 to 1993. The proportion of profitable stocks sold (PGR) was 0.148, while the proportion of losing stocks sold (PLR) was 0.098 — a difference of 0.050 with a t‑value exceeding 35. In other words, rising stocks were sold more than 50% more often than falling ones. Investors also bought losing stocks more frequently: the re‑purchase rate for losers was 0.135 versus 0.094 for winners, again with a strong statistical significance. The data also contradicted the belief that “stuck stocks will eventually bounce back.” Over the next year, the excess returns of sold profitable stocks exceeded those of kept losing stocks by 3.4 percentage points. These excess returns represent performance above the market index. As a concrete illustration, selling $1,000 worth of a losing stock instead of a winning one would yield roughly 4.4% more return in the following year; this figure includes tax savings from the early sale under U.S. tax rules (1987‑1993). +- Evidence grade: A +- Sources:Odean T (1998). Are Investors Reluctant to Realize Their Losses? The Journal of Finance 53(5):1775-1798. +- Notes: This point addresses the decision “to sell or not to sell”; point 15 (“avoid excessive trading”) deals with how often to trade — the two are not contradictory. Following a pre‑defined rule actually reduces the number of trades. Mathematically, buying more shares does lower the average cost per share, but treating this as a way to recover losses is misguided; it merely increases the amount of capital tied up in a single stock (see point 19, “don’t bet everything on one stock”). The tax calculations apply only to the U.S. system and cannot be directly applied in China; all other conclusions remain valid. The data originate from U.S. accounts in the 1980s‑1990s; trading costs and tax regimes differ for A‑share investors. This information is not intended as investment advice. +### 38. Avoid trading during sharp market swings — don’t increase activity when the market is hottest + +- Cost: No direct expense. The real challenge is resisting the urge to trade more when everyone else seems to be making money. +- In plain terms: Researchers analyzed data from 40 million accounts on the Shanghai Stock Exchange covering July 2014 to December 2015. The bottom 85% of households, who traded frequently, ended up earning roughly 250 billion yuan less than those who simply held onto their shares. That amount equals about 30% of their initial portfolio value. During a calmer two-and-a-half-year period prior to this, the difference between active traders and passive holders was only 1% to 3%. +- Benefit: This study relied on daily transaction records from all Shanghai Exchange accounts, totaling nearly 40 million. The analysis period spanned 18 months, during which the Shanghai Composite Index rose over 150% before peaking at 5,166.35 points on June 12, 2015, then dropping 40% by year’s end. Households were grouped by initial portfolio size; the smallest group made up 85% of all accounts, while the largest comprised just 0.5%. Both groups started with similar total equity — 880 billion and 808 billion yuan respectively. The former group lost 250 billion yuan due to excessive trading, whereas the latter earned 254 billion yuan. These figures represent roughly 28% and 31% of their respective starting portfolios, respectively. In contrast, during a calmer period from mid-2012 to mid-2014, the same comparison showed a gap of only 1% to 3%. On average, households traded their holdings about every three weeks during this volatile phase — nearly 18 times per year. +- Evidence grade: A +- Sources:An L, Lou D, Shi D (2022). Wealth redistribution in bubbles and crashes. Journal of Monetary Economics 126:134-153. ；同文作者公开的工作论文稿（2021 年 10 月，本条数字按它逐字核对）. +- Notes: This research does not advise against stock ownership altogether. It compares outcomes between active and passive investors within the same market environment. The money lost by smaller accounts went to larger individual investors, who accounted for roughly 90% of total trading volume during this period. No official statistics confirm the often-cited claim that “90% of retail investors lose money,” so this figure isn’t used here. Turnover rates provide useful context: U.S. households, as noted in item 15, trade only about three-quarters as often per year. This information is not intended as investment advice. +### 39. Planning to invest in overseas assets such as U.S. stocks? Use QDII funds or the Hong Kong Stock Connect program — don’t open accounts with foreign brokers, and don’t use your annual foreign exchange quota for buying foreign stocks. + +- Cost: There’s no direct cost — you can purchase QDII funds via your own bank or brokerage app in just a few minutes. The trade-off is that the selection of available funds is more limited than at foreign brokers. +- In plain terms: Starting May 2026, foreign brokers such as Tiger Brokers, Futu, and LongBridge are no longer allowed to accept new accounts from mainland investors. Existing account holders may only sell their holdings and withdraw funds within two years; no further purchases are permitted. Using your annual foreign exchange quota to buy overseas stocks is also prohibited; violators lose eligibility for that quota for the current year and the following two years. The only legal ways to invest in foreign assets remain QDII funds and the Hong Kong Stock Connect program. +- Benefit: On May 22, 2026, eight Chinese authorities — including the China Securities Regulatory Commission, Ministry of Industry and Information Technology, Ministry of Public Security, People’s Bank of China, State Administration for Market Regulation, National Financial Regulatory Administration, Cyberspace Administration of China, and State Administration of Foreign Exchange — jointly issued a plan to comprehensively curb illegal cross-border securities, futures, and fund activities. The goal is to fully eliminate such activities within two years. Foreign firms may no longer market or solicit clients in China, nor provide services such as account opening, trade execution, or fund transfers. For current account holders, only one-way sales and withdrawals are permitted; after two years, all related websites, trading apps, and servers must be shut down. On the same day, the CSRC announced it would confiscate all illegal earnings of Tiger Brokers, Futu, and LongBridge and impose severe penalties. Official guidance stresses using legal channels such as the Hong Kong Stock Connect, QDII funds, and Cross‑Border Wealth Management Link for overseas investing. Meanwhile, the State Administration of Foreign Exchange explicitly states that personal foreign exchange may not be used for overseas real estate, securities investment, life insurance, or similar unapproved capital‑account purposes. Violators are placed on a “watch list,” lose their annual foreign‑exchange allowance for three years, face administrative penalties, possible anti‑money‑laundering investigations, and negative entries in their credit records (effective May 2026). +- Evidence grade: A +- Sources:中国证监会 (2026-05-22). 中国证监会等八部门联合印发《综合整治非法跨境证券期货基金经营活动实施方案》. ；中国证监会 (2026-05-22). 中国证监会有关部门负责人就《综合整治非法跨境证券期货基金经营活动实施方案》答记者问. ；中国证监会 (2026-05-22). 证监会严肃查处老虎等机构非法跨境展业案件. ；国家外汇管理局 (2021). 个人购汇申请书（附件 1）. +- Notes: These regulations target foreign brokerage firms rather than individual investors; no penalties are specified for investors themselves. Those already holding accounts abroad need only sell and withdraw funds within two years. Each of the three legal channels has its own eligibility criteria — be sure to check with your bank or broker. Past strong performance of U.S. stocks does not guarantee future returns. When investing via QDII funds, follow the same principles outlined in items 17 (broad‑based index funds) and 19 (don’t concentrate assets in a single stock, platform, or market) — opt for diversified index funds rather than betting on one market. Separate limits apply to overseas cash withdrawals; see item 21.6 for details. This information is not investment advice. +### 40. Only buy insurance for losses your savings can’t cover; use an emergency fund for losses you can afford + +- Cost: No money is required. All you need to do is list the major potential losses your household might face and determine which ones exceed your savings capacity. This takes about half an hour. +- In plain terms: The premiums you pay won’t all be returned to you; a portion goes toward the insurer’s operating costs and profit. Therefore, insurance is worthwhile only for rare events that would otherwise overwhelm your finances — such as serious illness, a car accident causing injury to others, or the death of a primary breadwinner. For smaller losses that your savings can handle, an emergency fund is the better choice. +- Benefit: Only a fraction of the premiums collected by insurers is paid out as claims. The remainder covers sales, administration, and profit. Regulations require insurers selling short-term individual health plans to publish their “overall claims ratio” on their website every six months; this figure roughly indicates what proportion of premiums is paid out in claims. On average, buying insurance for any given loss ends up costing you a little extra over time. The upside is that it spreads a potentially catastrophic expense into a series of manageable annual payments. The smaller the loss and the easier it is for you to pay out of pocket, the less advantageous this trade-off becomes. Following this logic, several types of insurance mentioned earlier in this book are worth purchasing: one-year health insurance is covered in Section 7, Item 20; auto liability insurance for drivers is discussed in Item 26 of this section; overseas medical coverage is detailed in Section 21, Item 4; and term life insurance for households dependent on your income is explained in Item 41 of this section (nationwide, effective 2021). +- Evidence grade: C +- Sources:中国银保监会办公厅 (2021). 关于规范短期健康保险业务有关问题的通知（银保监办发〔2021〕7 号，综合赔付率按半年在公司官网披露）. +- Notes: This recommendation is assigned a Grade C because no official statistics exist to determine precisely which policies offer good value. The guidance provided here is meant to help you make a reasoned choice. For low-cost risks — such as cracked phone screens or minor flight delays — you can easily cover the costs yourself, so these policies are generally unnecessary. Similarly, if your savings can sustain you for a year or two without income, you may opt out of critical illness insurance, which compensates for lost earnings during illness. Basic medical insurance is a mandatory social insurance program; it does not fall under this evaluation framework and must be purchased regardless, as explained in Section 7, Item 9. For smaller unexpected expenses, an emergency fund is the appropriate safeguard, as described in Item 27 of this section. Ultimately, the primary beneficiaries of this advice are you and your family. +### 41. If someone at home depends on your income, buy term life insurance for the breadwinner first — not for your kids. + +- Cost: A few hundred to a few thousand yuan per year, depending on age, coverage amount, and policy length (this is a rough estimate by the author; no official figures exist). Be sure to disclose your health status truthfully before applying; the process takes about half an hour. +- In plain terms: Term life insurance covers you only for a set number of years. If you pass away during that period, your family receives a payout. This coverage is meant to protect dependents who rely on your earnings — for instance, if your mortgage is still unpaid or your children are still young. If no one depends on you financially, this insurance isn’t necessary. Since kids don’t earn income, laws also limit how much death benefit can be paid for them. +- Benefit: Regulatory definitions classify life insurance as personal insurance where human lifespan serves as the insured event; it includes term life, whole life, and endowment policies. Term life insurance pays out only upon the insured’s death within a fixed timeframe. Whole life insurance remains valid for the entire lifetime. Accident insurance only compensates for death or disability caused by accidents; it doesn’t cover deaths from illness and thus cannot replace life insurance. Contracts requiring death payouts must be approved and agreed upon by the insured; otherwise they’re invalid. Parents may purchase death coverage for minor children without such consent, but total payouts for a child’s death cannot exceed statutory limits. Typical coverage amounts reach 100,000 yuan, and another 100,000 yuan as well, hence the “high benefit” rating. No official recommendation exists for ideal coverage levels; the author’s calculation method adds remaining mortgage debt, projected expenses until children reach adulthood, and several years’ worth of household costs (based on national data revised in 2015). +- Evidence grade: C +- Sources:中国保险监督管理委员会 (2011). 人身保险公司保险条款和保险费率管理办法（保监会令 2011 年第 3 号，第八、十二条）. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第三十三、三十四条. +- Notes: This C rating stems from the lack of official guidance beyond basic definitions and payout limits; the “prioritize adults” recommendation follows logically from “whoever loses income would jeopardize household stability.” A child’s death doesn’t reduce household income, whereas losing the primary earner leaves mortgage payments and child expenses unpaid. When funds are limited, prioritize term life and one-year medical coverage for adults before considering similar coverage for kids. For details on truthful disclosures and guaranteed renewability, see Section 7, Article 20 (one-year medical insurance). The designated beneficiaries here fall under Category ②: your spouse and children. +### 42. Regretting a personal insurance policy signed for over a year? You can cancel it during the cooling-off period and get most of your premium back. + +- Cost: There’s no cost involved. A quick call to the insurer’s customer service line or a short visit to a branch takes just a few minutes. The real challenge is staying calm after signing and taking the time to read through the contract within 15 days. +- In plain terms: All personal insurance policies with a term longer than one year include a cooling-off period. For policies bought through banks, this period starts 15 days after you receive the policy document, and cancelling during this time incurs a maximum administrative fee of 10 yuan. After this window closes, you’ll only receive the portion of your premium that the policy allows you to reclaim, which is usually far less than what you originally paid. Insurers often make follow-up calls to check if you fully understand the terms — be honest if you’re still unclear. +- Benefit: Regulations require all personal insurance policies with a term over a year to clearly state the start date and length of the cooling-off period, as well as the rights policyholders have during this time. The cooling-off period for long-term health insurance must be at least 15 days. For all such policies sold via banks, the contract explicitly sets this period to 15 days, calculated from the natural calendar days after you receive and sign for the policy document. The policy cover must also carry this notice: “You have the right to cancel this policy in full (minus a maximum administrative fee of 10 yuan) within 15 days of receiving it. Cancelling after this period will result in financial losses.” Even after the cooling-off period ends, you can still terminate the contract at any time, and the insurer must refund the policy’s cash value — the portion of your premium that can be reclaimed — within 30 days as per contract terms. Financial regulators note that cancelling long-term personal insurance after the cooling-off period typically results in cash value payouts that are lower than the total premiums paid. Insurers must also reach out to new policyholders of such plans during the cooling-off period to confirm they’re aware of the potential financial losses from cancellation and their rights under this period (applicable nationwide since 2010 and 2019). +- Evidence grade: A +- Sources:中国银保监会办公厅 (2019). 商业银行代理保险业务管理办法（银保监办发〔2019〕179 号，第三十六、六十七、六十八条）. ；中国银保监会 (2019). 健康保险管理办法（银保监会令 2019 年第 3 号，第十五条）. ；中国银保监会 (2022). 一年期以上人身保险产品信息披露规则（银保监规〔2022〕24 号，产品说明书要列明犹豫期的起算时间、天数和权利）. ；中国保险监督管理委员会 (2010). 人身保险业务基本服务规定（保监会令 2010 年第 4 号，第十五条）. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第十五、四十七条. ；宁夏金融监管局 (2026-06-16). 关于防范非法代理退保的风险提示. +- Notes: The cooling-off period is a mandatory provision for all personal insurance policies with a term longer than one year. There’s no such requirement for one-year medical or accident insurance policies, so you’ll need to check the specific contract terms for these. For policies not bought via banks, the exact duration is defined in the contract — be sure to look up the “cooling-off period” clause as soon as you get the policy. Savings and dividend-paying insurance plans require higher premium payments, so making use of this period is especially worthwhile for these policies; see item 25 in this section for more details on non-savings plans. We rate the benefit as “moderate” because the savings you can achieve are the difference between your total premiums paid and the cash value you receive, which typically ranges from a few hundred to a few thousand yuan — no official statistics exist on this figure. You are the sole beneficiary of this provision. +### 43. Before signing at the bank counter, check whether it’s a deposit or insurance + +- Cost: No cost at all. Just spend a couple of extra minutes reading the contract cover. +- In plain terms: Banks may sell insurance on behalf of insurers, but they must not present it as a deposit. The contract cover must clearly state “Insurance Contract” and the insurer’s name in large print; terms like “deposit” or “savings” are strictly prohibited. If the insurer’s name appears on the cover, the money is not a deposit, and cancelling after the cooling-off period will result in losses. In principle, people aged 65 and older can only purchase insurance with guaranteed returns when buying at banks. +- Benefit: Regulations explicitly forbid banks from bundling insurance with savings deposits, mutual funds, or other bank wealth products. They may not directly compare insurance returns to deposit yields, nor claim uncertain returns as guaranteed. Insurance documents and promotional materials must not use the bank’s name or logo, nor contain phrases such as “deposit,” “savings,” or “jointly offered by the bank.” The contract cover must display “Insurance Contract” in font size no smaller than 72 points and the insurer’s name in font size no smaller than 2 points. For three specific groups of customers, only insurance products with guaranteed benefits may be sold: applicants aged over 65; applicants aged over 60 purchasing installment-payment plans; and applicants whose annual income is below the local per capita disposable income. Policies for these groups must be manually underwritten by insurers rather than issued automatically at bank branches. Insurance agents are prohibited from selling insurance inside bank premises. For any insurance policy sold by a bank with a term longer than one year, a 15-day cooling-off period applies; cancelling after this period incurs financial losses. (Nationwide, effective October 2019) +- Evidence grade: B +- Sources:中国银保监会办公厅 (2019). 商业银行代理保险业务管理办法（银保监办发〔2019〕179 号，第三十、三十一、三十二、三十六、四十二、四十九条）. +- Notes: This item is rated B because the regulations are very clear, yet no official statistics exist on how much money misled consumers have lost. Elderly family members are especially vulnerable to this issue when making deposits at banks; be sure to check the contract cover for them. If you’ve already signed such a contract, you may cancel it within 15 days per Section 42 (Cooling-off Period). For complaints regarding potential misrepresentation, refer to Section 44 (Assistance with Policy Cancellation). The primary beneficiaries of this guidance are you and your elderly relatives. +### 44. To cancel your insurance policy, contact the insurer directly — don’t use “policy cancellation agents.” If you feel misled, call 12378 for free assistance. + +- Cost: There’s no cost involved. Simply call the insurer’s customer service line or visit a branch; this may require a bit more effort than using an intermediary. +- In plain terms: Online ads promising “full policy refunds with no fees if unsuccessful” usually come from illegal cancellation agents. They typically take 30–50% of any refund amount and demand your ID, bank details, and verification codes. Once the policy is cancelled, coverage ends. If you feel misled, first contact the insurer’s customer service; if that fails, call 12378 — this service is completely free. +- Benefit: In February 2026, China’s National Financial Regulatory Administration, the Cyberspace Administration, the Ministry of Public Security, the People’s Bank of China, and the China Securities Regulatory Commission jointly issued a warning. It stated that claims of “full policy refunds” are false and contrary to insurance laws. “Policy cancellation agents” charge hefty fees; if you try to withdraw from their services, they may sue you for “breach of contract.” They also collect personal data such as SIM cards, bank accounts, policy details, home addresses, and even children’s school information — data that can be sold on, leading to fraud or identity theft. A June 2026 notice from Ningxia’s financial regulator provides further detail: such agents demand 30–50% of the refund amount as a fee and impose steep penalties if you back out. They even instruct clients to fabricate claims of sales misrepresentation or forged signatures. Following such advice could violate public security laws; in severe cases, it may constitute slander or extortion. Once cancelled, coverage ends immediately. Future applications for similar policies may be rejected or cost more due to age or health issues. If you truly feel misled, first contact the insurer’s official customer service; if unresolved, call 12378. If you’re temporarily unable to pay premiums, ask the insurer about options like reduced paid-up value or policy loans. Reduced paid-up value means you stop paying premiums, though coverage decreases proportionally (nationwide, 2026). +- Evidence grade: B +- Sources:金融监管总局、中央网信办、公安部、中国人民银行、中国证监会 (2026-02-06). 关于警惕不法「代理维权」短视频及直播陷阱的风险提示（中央网信办官网转载）. ；宁夏金融监管局 (2026-06-16). 关于防范非法代理退保的风险提示. ；湖南金融监管局 (2025-07-23). 关于防范非法「代理退保」黑灰产的风险提示. +- Notes: In 2025, Hunan’s financial regulator reported a case: a woman followed “advice” from a “friend” to use a cancellation agent, paying a “consultation fee.” Ultimately, her policy was refunded only at its cash value. Three months later, she was diagnosed with breast cancer — and no longer had critical illness coverage. You must weigh the pros and cons: if coverage remains valuable, consider reduced paid-up value instead of cancellation. If you’re still within the cooling-off period, see Section 42 (Cooling-off Period). Your own well-being is the ultimate priority. +### 45. Writing a specific beneficiary on the policy lets family claim the payout: 5 years for life insurance, 2 years for other policies + +- Cost: No cost involved. You fill this in once at purchase; any later changes to the beneficiary require written notice to the insurer. +- In plain terms: If no beneficiary is listed, or if the named beneficiary passes away first, the payout is treated as part of the deceased’s estate and must first cover any debts owed by the deceased. If “Spouse: [Name]” is listed as beneficiary but the couple later divorces, the policy is effectively treated as having no beneficiary at the time of a claim. Family members must be aware of the policy’s existence: for life insurance, claims must be filed within 5 years of learning of the insured’s death; for other policies, the deadline is 2 years. In total, 100,000 people are affected by such situations, and another 100,000 face related complications. +- Benefit: Insurance law stipulates that beneficiaries must be designated by either the insured or the policyholder, with the latter requiring the insured’s consent. In three specific scenarios, payouts are classified as part of the insured’s estate and distributed per standard inheritance rules: 1) No beneficiary is named, or the designation is ambiguous; 2) The named beneficiary dies before the insured, with no other eligible beneficiaries; 3) The beneficiary legally loses or voluntarily waives their right to benefits, again with no other eligible beneficiaries. If both the insured and beneficiary die in the same incident with no clear order of death, the beneficiary is presumed to have died first. Any payout classified as an estate must first settle all outstanding taxes and debts owed by the deceased, with remaining funds distributed to heirs. Supreme Court rulings clarify that if a beneficiary is listed only by name and familial relationship, any subsequent change to that relationship renders the designation invalid. Unnotified changes to beneficiaries hold no legal weight with insurers. The statute of limitations for filing claims is 5 years for life insurance and 2 years for other policies, both starting from the date the claimant learns or should have learned of the insured’s death. Given that typical life insurance payouts reach hundreds of thousands of yuan, this benefit is rated as “high” (national data, revised 2015, effective 2021). +- Evidence grade: A +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第二十六、三十九、四十一、四十二条. ；最高人民法院 (2020 修正). 关于适用《中华人民共和国保险法》若干问题的解释（三）第九条第二款第三项、第十条. ；全国人大 (2020). 中华人民共和国民法典第一千一百五十九条. +- Notes: Once the statute of limitations expires, insurers may legally deny payouts, and legal action to recover funds is highly unlikely to succeed. For this reason, family members must at minimum know which insurers you hold policies with. After events like divorce, remarriage, or the birth of a child, update the beneficiary designation accordingly. To claim payouts after a death, follow the steps outlined in Section 25, Item 9 (claiming funds from multiple policies individually). Note that using the policy payout to settle the deceased’s debts is not a viable option; see Section 29, Item 13 (debt settlement) for further details. The beneficiary category for this item falls under Tier ②, which includes your spouse and children. diff --git a/book/en/06-The-Anti-List.md b/book/en/06-The-Anti-List.md new file mode 100644 index 00000000..885b81cf --- /dev/null +++ b/book/en/06-The-Anti-List.md @@ -0,0 +1,269 @@ +# 6. Items to avoid + +This section lists products and treatments that *seem* inexpensive and effective at first glance. Yet once you look at the original research, their benefits are practically nonexistent — or even negative. They’re arranged based on two factors: how much money people spend on them and how strong the supporting evidence actually is. The items near the top of the list are the ones you should stop using first. +### 1. Don’t take multivitamins for longevity or heart protection + + +- Cost: They cost roughly 0.5 to 2 yuan per day, or 200 to 700 yuan per year. Taking them requires almost no time — just one pill a day. Over time, they can create a sense of dependency, making it feel like something is missing if you skip a day. +- In plain terms: Over 14,000 male doctors took multivitamins for eleven years. The number of serious heart and vascular problems, as well as deaths, was virtually identical between those who took them and those who didn’t. When nine separate trials involving more than 50,000 participants were pooled together, there was no measurable effect on mortality at all. Skipping them saves you between 200 and 700 yuan each year. This does not apply to people who have been medically diagnosed with specific nutrient deficiencies, nor to pregnant women needing folic acid. +- Benefit: The PHS II trial enrolled 14,641 male doctors and followed them for a median period of 11.2 years (some longer, some shorter). The rate of major cardiovascular events was identical between the groups; the hazard ratio was 1.01 (95% CI 0.91–1.10), meaning no real difference. Similarly, overall mortality showed no difference, with a hazard ratio of 0.94 (95% CI 0.88–1.02). The USPSTF evaluated nine randomized controlled trials with 51,550 participants and concluded there is insufficient evidence to support any link between multivitamins and reduced mortality; it assigned a Grade I rating. The perception that they are worthwhile stems largely from the idea of “one pill covering all nutrients” and their extremely low cost. +- Evidence grade: A +- Notes: A point of debate: among the same group of male doctors, cancer rates were examined as well. Those taking multivitamins showed an 8% lower incidence of cancer (95% CI 0.86–0.998, P=0.04), which just barely crosses the threshold for statistical significance. Cancer-related mortality was also 12% lower (95% CI 0.77–1.01), but this range includes 1, so it may well be a random fluctuation. Any such benefit appears very small and applies only to male doctors. It does not apply to individuals with diagnosed nutrient deficiencies, pregnant women, or those with highly unbalanced diets who require targeted supplementation as advised by medical professionals. +- Sources:Sesso HD et al. (2012). Multivitamins in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA. ；US Preventive Services Task Force (2022). Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. JAMA. ；Gaziano JM 等 (2012). Multivitamins in the Prevention of Cancer in Men. JAMA. （备注里那项癌症结果） + +### 2. Don’t take regular fish oil capsules to prevent heart disease + +- Cost: It costs roughly 1 to 3 yuan per day, or 400 to 1,000 yuan per year. Taking it requires no extra time at all. +- In plain terms: Two large trials enrolled 26,000 and 15,000 people with diabetes respectively. For those who took 1 gram of fish oil daily, the rates of major cardiovascular events and death were identical to those who did not take it. The fact that eating fish is beneficial does not mean fish oil capsules are equally helpful. Skipping them saves you 400 to 1,000 yuan each year. +- Benefit: The VITAL trial included 25,871 participants who took 1 gram of fish oil daily for a median follow-up of 5.3 years. No difference emerged between groups in terms of major cardiovascular events or death. The hazard ratio for major cardiovascular events was 0.92 (a hazard ratio of 1 indicates no difference); its 95% confidence interval of 0.80–1.06 also confirms no meaningful difference. The hazard ratio for all-cause death was 1.02 (0.90–1.15). The ASCEND trial involved 15,480 diabetic patients who took the same daily dose for an average of 7.4 years, and again no significant differences were observed: the relative risk for serious vascular events was 0.97 (0.87–1.08) and for all-cause death it was 0.95 (0.86–1.05). The perception that fish oil is worthwhile stems from many people mistakenly equating the health benefits of eating fish with those of fish oil capsules. +- Evidence grade: A +- Notes: Controversy: One trial did produce positive results. The REDUCE-IT trial enrolled 8,179 participants with existing cardiovascular disease or diabetes, who were already taking statins and had elevated triglyceride levels (135–499 mg/dL). They took 4 grams of prescription-grade pure EPA daily, which lowered their risk of adverse events to 17.2% from 22.0%. This represents roughly a quarter reduction in risk (hazard ratio 0.75, 0.68–0.83). However, this was a high-dose prescription medication given to high-risk patients, not ordinary over-the-counter fish oil supplements. Eating fish itself is not covered by these findings. +- Sources:Manson JE et al. (2019). Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer. NEJM. ；ASCEND Study Collaborative Group (2018). Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus. NEJM. ；Bhatt DL 等 (2019). Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. New England Journal of Medicine. （备注里那项高纯度处方鱼油试验） + +### 3. Don’t give vitamin D supplements to people who already have enough + +- Cost: Roughly 0.2 to 0.5 yuan per day, or 100 to 200 yuan per year. That’s not much money, but the real cost is the false sense of security it gives — the belief that you’ve already taken preventive steps. +- In plain terms: Two large trials looked at this issue. One involved 26,000 participants who took supplements for five years; the other included 21,000 older adults on supplements for the same period. For people who already had adequate vitamin D levels, there was no change in cancer rates, cardiovascular problems, or overall mortality — the death rates were 5.3% versus 5.1% respectively. This does not apply to people who truly lack vitamin D, those with osteoporosis, or anyone who rarely gets sunlight; they should follow their doctor’s advice. +- Benefit: The VITAL trial followed 25,871 participants who took 2,000 IU of vitamin D daily for 5.3 years on average. No difference emerged in cancer rates, cardiovascular issues, or overall mortality. For cancers likely to spread, the hazard ratio was 0.96 (a range of 0.88–1.06), meaning no real effect. Similar results appeared for major cardiovascular events and overall death rates. The absolute value of this effect is 0.93. The D-Health trial involved 21,315 Australians over 60; they received 60,000 IU monthly for five years, yet saw no meaningful change in mortality or other outcomes. The apparent benefit often stems from studies that only observe low vitamin D levels without intervention, mistakenly concluding that supplementation helps. +- Evidence grade: A +- Notes: These trials specifically excluded people with proven vitamin D deficiency, so their findings apply only to those already getting enough. Individuals who truly lack vitamin D, have osteoporosis, rarely get sunlight, or are infants still need proper medical guidance. This analysis focused solely on overall mortality, cancer, and cardiovascular health; other effects were not examined. +- Sources:Manson JE et al. (2019). Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. NEJM. ；Neale RE et al. (2022). The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. + +### 4. Don’t take antioxidant supplements to prevent cancer (beta-carotene, vitamin E, vitamin A) + +- Cost: Roughly 0.5 to 2 yuan per day. For smokers, the real cost is a higher risk of lung cancer. +- In plain terms: This isn’t just ineffective — it’s actually harmful. A review of 78 randomized controlled trials involving nearly 300,000 people found that those taking antioxidant supplements had a slightly higher overall mortality rate. Two large trials focused on smokers showed that beta-carotene raised the likelihood of developing lung cancer by 18% to 28% and increased death rates by 8% to 17%. Smokers and people exposed to asbestos should absolutely avoid these supplements. +- Benefit: Cochrane analyzed 78 randomized controlled trials with 296,707 participants. Overall, those taking antioxidant supplements had a relative risk of death of 1.02 (a value of 1 means no difference; the 95% confidence interval was 0.98–1.05). When only higher-quality trials were considered, the relative risk rose to 1.04 (1.01–1.07). Specifically, beta-carotene raised the risk to 1.05 (1.01–1.09) and vitamin E to 1.03 (1.00–1.05). The ATBC trial followed 29,133 male smokers who took 20 mg of beta-carotene daily; it found a 18% higher rate of lung cancer (range 3%–36%) and an 8% higher overall mortality rate (range 1%–16%). The CARET trial included 18,314 smokers and asbestos-exposed individuals; it showed a 28% higher risk of lung cancer (relative risk 1.28, 1.04–1.57) and a 17% higher risk of all-cause death (relative risk 1.17, 1.03–1.33). The perception that these supplements are beneficial stems from the flawed logic that antioxidants prevent aging, which in turn prevents cancer — each step of this chain seems intuitive at first glance. +- Evidence grade: A +- Notes: The US Preventive Services Task Force, the official US body that evaluates preventive measures, assigned a grade D to beta-carotene and vitamin E in 2022, meaning these supplements are not recommended. Smokers and asbestos-exposed individuals have already suffered harm from their use. Antioxidants naturally present in fruits and vegetables are not covered by this recommendation, so they can still be consumed as normal. +- Sources:Bjelakovic G et al. (2012). Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. ；The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group (1994). The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. NEJM. ；Omenn GS et al. (1996). Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. NEJM. + +### 5. Don’t expect glucosamine/chondroitin to treat knee osteoarthritis + +- Cost: Roughly 2–5 RMB per day, or 700–1,800 RMB per year. +- In plain terms: The GAIT trial involved 1,583 participants with knee osteoarthritis who took the supplements for 24 weeks. In the placebo group, 60.1% reported reduced pain. Glucosamine only improved this rate by 3.9 percentage points (P=0.30), while chondroitin added 5.3 percentage points (P=0.17). Taking both together yielded a 6.5 percentage point improvement (P=0.09). All these differences are so small they could easily be due to chance. Spending 700–1,800 RMB yearly essentially buys you the same placebo effect seen in 60% of participants. +- Benefit: As noted above, glucosamine and chondroitin showed minimal benefits compared to placebo. The real active drug in the trial, celecoxib, produced a 10.0 percentage point improvement (P=0.008). The perceived value of glucosamine/chondroitin stems from their “cartilage-repair” reputation and the fact that placebo alone helped 60% of patients. +- Evidence grade: A +- Notes: Controversy: Among participants with severe baseline pain, those taking both supplements saw a 79.2% pain-reduction rate versus 54.3% in the placebo group (P=0.002). However, researchers note this finding was derived post-hoc and should be viewed as a preliminary clue rather than a definitive conclusion. Proven treatments for knee osteoarthritis include weight loss and muscle-strengthening exercises — see Section 2. +- Sources:Clegg DO et al. (2006). Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. NEJM. + +### 6. Don’t rely on vitamin C to prevent colds + +- Cost: Each effervescent tablet costs roughly 1–2 yuan; annual expense ranges from 300 to 700 yuan. +- In plain terms: A combined analysis of 29 controlled trials involving 11,306 participants shows that daily vitamin C intake hardly reduces the likelihood of catching a cold. Taking it after symptoms appear also yields inconsistent results. It can shorten the duration of a cold by about 8%, which equals roughly half a day of reduced discomfort. The absolute number of people who benefit from this effect is 500. Whether this half-day of relief is worth spending several hundred yuan per year is a personal calculation. Marathon runners and soldiers stationed in cold climates form the exception: among them, daily vitamin C intake cuts cold incidence roughly in half. +- Benefit: Cochrane’s pooled analysis of 29 trials with 11,306 participants indicates that regular vitamin C consumption does not meaningfully lower overall cold incidence; the risk ratio is 0.97 (95% CI 0.94–1.00). For trials where vitamin C was taken after cold onset, results varied widely — some showed benefit while others did not. Among participants who took it regularly, the average cold duration decreased by 8% in adults (95% CI 3%–12%) and 14% in children (7%–21%). Marathon runners, skiers, and soldiers in cold environments again represent the exception: five trials with 598 participants demonstrated that vitamin C intake reduced cold incidence by half (RR 0.48; 95% CI 0.35–0.64). Its perceived value stems largely from its low cost, pleasant taste, and the long-standing belief that vitamin C prevents colds. +- Evidence grade: A +- Notes: Controversy: The same review confirms that regular vitamin C intake does shorten cold duration — by 8% in adults (3%–12%) and 14% in children (7%–21%), equating to roughly half a day of reduced illness per cold episode. Marathon runners, skiers, and soldiers in cold climates remain the exception; five trials involving 598 subjects show a 50% reduction in cold incidence (RR 0.48; 95% CI 0.35–0.64). The vast majority of people do not fall into these categories. +- Sources:Hemilä H, Chalker E (2013). Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. + +### 7. Don’t get a whole-body PET-CT or tumor marker panel if you have no symptoms + + +- Cost: A whole-body PET-CT costs roughly $7,000–$10,000 per scan and exposes you to ionizing radiation. Tumor marker panels cost a few hundred dollars. The real cost comes later: when an “abnormality” is found — usually a false positive — follow-up tests, biopsies, and surgeries add up both financially and physically. +- In plain terms: Screening completely healthy people most often yields false alarms. In one study, 86% of 1,192 symptom-free individuals had at least one “abnormality” on a whole-body CT; 37% were called back for further tests, yet the vast majority of findings turned out to be benign. In large trials of ovarian cancer markers, the screened group actually had a slightly higher death rate. In some studies, 0.2%–3.25% of people underwent unnecessary surgery simply because of false positives. +- Benefit: The USPSTF, which evaluates preventive measures in the U.S., assigned a D rating to CA-125 testing and ultrasound screening for ovarian cancer in asymptomatic women — meaning it does not recommend them. This decision was based on the PLCO trial, which showed a 0.34% death rate from ovarian cancer in the screened group versus 0.29% in the usual care group (RR 1.18; 95% CI 0.82–1.71). No real benefit was demonstrated. The proportion of people undergoing needless surgery due to false positives ranged from 0.2%–3.25%, and only up to 15% of those developed serious complications. Another study found that 86% of 1,192 symptom-free people showed at least one “abnormality” on whole-body CT; 37% were advised to undergo further tests. Most of these findings were benign. The idea that “early detection saves lives” sounds logical, but the data do not support it here. +- Evidence grade: A +- Notes: The tumor marker portion of this recommendation is backed by randomized controlled trials. In contrast, the evidence for whole-body CT and PET-CT screening relies mainly on observational follow-ups without proper control groups, so it is rated as B. Other proven screening methods — such as those for colorectal cancer, cervical cancer, breast cancer, and low-dose chest CT for high-risk individuals — are discussed in Section 1. This recommendation does not apply to people already showing symptoms or those already diagnosed with cancer; for them, PET-CT is a diagnostic tool, not a screening measure. +- Sources:US Preventive Services Task Force (2018). Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement. JAMA（同一份建议另有 USPSTF 官方页）. 、；Furtado CD et al. (2005). Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology. + +### 8. Don’t expect fitness trackers or smartwatches to help you lose weight + +- Cost: Devices cost between 200 and 2,000 RMB. Plus, you have to constantly pay attention to the data they display every day. +- In plain terms: 471 overweight adults followed the same diet and exercise plans. The group wearing fitness trackers lost just 3.5 kilograms over two years, while the group without devices actually lost 5.9 kilograms. Trackers do not aid weight loss; regular exercise itself is what makes the difference. +- Benefit: The IDEA trial involved 471 overweight or obese adults and lasted 24 months. All participants followed identical diet and exercise regimens; the only difference was whether they wore wearable devices. Those wearing devices lost 3.5 kilograms (95% CI 2.6–4.5). The other group lost 5.9 kilograms (95% CI 5.0–6.8), a difference of 2.4 kilograms (95% CI 1.0–3.7; P=0.002). The devices seem cost-effective only because the idea that “quantification enables management” sounds logical, and they only require a one-time purchase. +- Evidence grade: B +- Notes: This is based on just one trial using early 2010s wrist-worn devices, so we cannot claim that “all wearable devices are useless.” Exercise itself remains effective, as discussed in Section 2. This point simply emphasizes that buying such devices is not a necessary expense if your goal is weight loss. +- Sources:Jakicic JM et al. (2016). Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. JAMA. + +### 9. Don’t pay a premium for organic food just to be “healthier” + + +- Cost: Typically 1 to 3 times the price of regular versions of the same foods. +- In plain terms: When we combine 17 studies done on humans with 223 studies analyzing food composition, there’s no solid evidence that organic food is significantly more nutritious. Only 3 of those studies actually looked at health outcomes after people ate it, and no difference was found between organic and conventional foods. The proportion of organic produce found to contain pesticide residues is indeed 30 percentage points lower, but detection does not mean those levels exceed safety limits. Eating more fruits and vegetables is beneficial regardless of whether they’re organic or not. +- Benefit: One systematic review brought together 17 human studies and 223 studies on food composition. Its conclusion: “There is insufficient evidence to show that organic food is significantly more nutritious than conventional food.” Again, only 3 studies examined health effects after consumption (looking at allergies and symptomatic infections), and no meaningful difference emerged. Organic produce shows a 30 percentage point reduction in pesticide residue detection rates, though detection alone does not indicate unsafe levels. The perception that organic food is a better buy stems from the common-sense chain: “no pesticides = safer = healthier.” +- Evidence grade: B +- Notes: Very few studies directly assess health outcomes after human consumption. Therefore, this finding means “there’s no evidence it’s better,” not “it’s been proven to offer no benefits.” This analysis does not address environmental impact, animal welfare, or taste preferences. Eating more fruits and vegetables remains beneficial regardless of whether they’re organic or not. +- Sources:Smith-Spangler C et al. (2012). Are organic foods safer or healthier than conventional alternatives?: a systematic review. Ann Intern Med. + +### 10. Don’t spend a lot of money on health supplements, herbal pastes, or tonics to “rebalance your body” + + +- Cost: Prices range from a few hundred to tens of thousands of yuan. Once packaged as gifts, the price often multiplies several times over. +- In plain terms: The agency responsible for regulating health foods mandates that packaging must carry a specific statement: these products are not medicines and cannot replace medical treatment. Even the regulators themselves do not believe they can cure diseases. The most common ingredients — multivitamins, fish oil, vitamin D, antioxidants, glucosamine, and vitamin C — have all been examined in the first six sections of this chapter, and none demonstrate any meaningful effect. Most of the money spent on these products isn’t aimed at any therapeutic benefit; it’s meant as a gift for parents or relatives. The intention behind such gifts is perfectly fine; the problem lies solely in the products themselves. +- Benefit: According to regulations set by the State Administration for Market Regulation, at least 20% of the front surface of health food packaging must display this exact statement: “Health foods are not medicines and cannot replace medicines in treating diseases.” Those same regulations further restrict the permitted uses of health foods to “supplementing dietary nutrients, maintaining or improving overall health, or reducing disease risk factors.” In other words, regulators themselves do not recognize any disease‑treating capability. The most common ingredients — multivitamins, fish oil, vitamin D, antioxidants, glucosamine, and vitamin C — have each been evaluated in randomized controlled trials as described in the first six sections. These products appear cost‑effective simply because the claim “they don’t cure disease, they only help rebalance the body” is technically true; no one can prove otherwise. Moreover, when bought as gifts, the expense is justified by social considerations rather than scientific evidence. +- Evidence grade: C +- Notes: This rating means “insufficient evidence to support any benefit,” not “proven ineffective,” which is why it receives a C grade. For products whose ingredients are clearly listed, consult the corresponding studies referenced in the earlier sections. Individuals who truly lack certain nutrients or are undergoing medical treatment should follow their doctor’s advice. This recommendation applies to the products, not to the goodwill behind purchasing them. If an elderly person is already taking such supplements without substituting them for prescribed medications and shows no adverse effects, there’s no need to intervene; instead, prioritize getting recommended vaccines and screenings. The same amount of money can be better spent on other proven measures: annual flu shots for seniors (see Section 1, Item 20); shingles vaccine after age 50 (Section 1, Item 21); pneumococcal vaccine for those over 65 (Section 1, Item 22). Buying a blood pressure monitor and ensuring adherence to antihypertensive therapy (Section 1, Item 7) or making home modifications and encouraging balance‑training exercises (Section 1, Item 13) also yield clear benefits. Age‑appropriate cancer screenings should be arranged as well (Sections 1, Items 17‑19). For bedridden seniors, pressure‑ulcer prevention and long‑term care insurance are covered in Section 17, Items 7‑8. Delivering fresh fruit, rice, flour, or other favorite foods as gifts is far more practical than any herbal paste. Two types of products should be avoided: investment schemes marketed for elderly care and supplements that claim to replace prescribed medicines (see Section 17, Item 5). +- Sources:国家市场监督管理总局 (2019). 市场监管总局就《保健食品标注警示用语指南》和《保健食品原料目录与保健功能目录管理办法》有关情况举办专题新闻发布会. + +### 11. Don’t take probiotics long-term if you have no gut problems + + +- Cost: Roughly 2–5 RMB per day, or 700–1800 RMB per year. +- In plain terms: A review of 45 trials conducted on healthy adults shows that probiotics don’t bring about lasting changes in gut bacteria; once you stop taking them, the gut flora returns to its original state, and there’s no improvement in blood lipid levels either. Separate evidence exists for situations such as antibiotic‑induced diarrhea, but that isn’t covered here. +- Benefit: This review concludes that there’s no solid proof that probiotics can produce lasting alterations in gut microbiota or improve lipid profiles in healthy adults. While gut bacteria do shift temporarily while you’re taking probiotics, these changes fade once you discontinue them. The product may seem cost‑effective simply because “gut health” is a broad term that can be applied in many ways, and the daily price per serving is quite low. +- Evidence grade: B +- Notes: The same review also notes a few minor benefits in healthy individuals, such as firmer, better‑textured stools and an increase in Lactobacillus in women’s vaginas. Separate evidence exists for treating antibiotic‑induced diarrhea and for specific strains used for particular conditions; those are not addressed here. This recommendation applies only to healthy people who take probiotics daily as a supplement. +- Sources:Khalesi S et al. (2019). A review of probiotic supplementation in healthy adults: helpful or hype? Eur J Clin Nutr. + +### 12. Don’t force yourself to take cold showers just to “boost immunity” + + +- Cost: No cost at all. It requires enduring discomfort for 30 to 90 seconds each day; staying consistent in winter demands real willpower. People with cardiovascular conditions should be extra cautious, as cold exposure poses certain risks for them. +- In plain terms: In a trial involving 3,018 participants, those who took cold showers had 29% fewer sick days. However, the total number of days they took off for illness remained the same as in the control group, so it doesn’t mean they got sick less often. A 2025 systematic review combining 11 trials found that cold showers temporarily raised markers of bodily inflammation without any noticeable change in immune function. Feel free to take cold showers if you enjoy them, but don’t treat them as a worthwhile health investment. +- Benefit: A randomized controlled trial conducted in the Netherlands enrolled 3,018 participants. After a hot shower, they were asked to rinse under cold water for 30, 60, or 90 seconds. This group ended up taking 29% fewer sick days compared to the control group (IRR 0.71). Yet the study explicitly notes that there was no significant difference between groups regarding total sick days. No meaningful improvements were observed in quality of life, work productivity, or anxiety levels either. The 2025 review analyzed 11 randomized trials involving 3,177 participants overall. It found that both immediately after and one hour post‑shower, inflammatory markers rose temporarily, while immune indicators stayed unchanged. Only at the 12‑hour mark did stress levels drop slightly. The authors themselves point out that the evidence is limited by the small number of trials and modest sample sizes. The practice seems cost‑effective only because it costs nothing, and because the intuitive belief that “enduring hardship brings benefits” makes it appealing. +- Evidence grade: B +- Notes: Controversy: The 29% reduction in sick‑day frequency is real and unlikely to be a coincidence. Yet total illness days didn’t decrease, so it’s more plausible that participants simply kept going to work despite being unwell rather than actually getting sick less often. Using cold water for post‑exercise recovery among athletes is a separate issue and falls outside the scope of this discussion. For healthy individuals, cold showers pose no harm; this note simply warns against viewing them as a health‑promoting investment. +- Sources:Buijze GA et al. (2016). The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial. PLOS ONE. ；Cain T et al. (2025). Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis. PLOS ONE. + +### 13. Don’t buy products marketed for detox, colon cleansing, enzymes, or alkaline water + +- Cost: Several hundred to several thousand yuan. Fasting as a way to “detox” can even lower blood sugar and cause nutritional deficiencies. +- In plain terms: One review examined whether there is any evidence supporting detox diets. It concluded that while the detox industry is huge, there is very little clinical evidence to back it up, and no randomized controlled trials have ever been conducted on commercial detox diets. As for the claim that an “acidic body pH causes cancer,” a search of 8,278 research papers yielded just one study that met the criteria — and even that showed no link. +- Benefit: That same review reiterated that despite the rapid growth of the detox market, there is almost no clinical evidence supporting these diets, and no RCTs have been done on them. Another systematic review looked at whether diet, alkaline water, or an alkaline body pH influences cancer risk. After screening 8,278 papers, only one qualified for inclusion — and it found no association. The authors concluded it is unreasonable to promote alkaline diets or alkaline water to the public as a means of preventing or treating cancer. These products seem worthwhile only because the ideas that “the body contains toxins needing removal” and “an acidic body pH causes cancer” sound plausible from a physiological standpoint. +- Evidence grade: C +- Notes: This item falls under “no supporting evidence,” which is why it receives a C rating. Naturally produced metabolic waste is already cleared by the liver and kidneys; as long as these organs are healthy, there is no need for any extra “detox” measures. +- Sources:Klein AV, Kiat H (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet. ；Fenton TR, Huang T (2016). Systematic review of the association between dietary acid load, alkaline water and cancer. BMJ Open. + +### 14. Don’t force yourself to drink water just to hit “8 glasses a day” + +- Cost: No cost at all. It does require some time and effort to remember to drink, and you’ll likely need to get up more often at night to pee. +- In plain terms: Some people have tried to trace the origin of the “8 glasses a day” rule, but no studies supporting it have ever been found. On the contrary, surveys of thousands of adults’ diets and fluid intake show there’s no need for that much water at all, since food and other drinks already provide plenty. Just drink when you’re thirsty, and use the color of your urine as a guide — that’s all you need to do. People working in hot environments, those doing intense exercise, people who’ve had kidney stones, and older adults who no longer feel thirsty as readily should make a conscious effort to drink more water. +- Benefit: One literature review specifically examined the “8×8” rule — that is, 8 glasses a day, each glass holding 8 ounces of water. Its conclusion was that “no scientific research supporting the 8×8 guideline has been identified.” It also noted that “surveys of thousands of adults’ food and fluid intake strongly indicate there is no need for such a large volume of water intake,” since food and other drinks already supply plenty of moisture. This idea seems appealing because water costs nothing, the number 8 is easy to remember, and saying “drink more water” never seems like a bad piece of advice in any context. +- Evidence grade: C +- Notes: This recommendation refutes the idea that there’s a strict minimum number of glasses of water you must drink each day — it does not say that drinking more water is harmful. Just drink when you’re thirsty and check your urine color; that’s sufficient. People working in hot conditions, those doing heavy exercise, people with a history of kidney stones, and older adults who no longer feel thirst as keenly should make a point to drink more water, even though this guideline does not apply to them. +- Sources:Valtin H (2002). "Drink at least eight glasses of water a day." Really? Is there scientific evidence for "8 x 8"? Am J Physiol Regul Integr Comp Physiol. + +### 15. Don’t spend money on fortune‑telling, tarot, or astrology to make decisions + +- Cost: There is no monetary cost. The real challenge is giving up this easy shortcut for decision‑making and having to think for yourself from now on. +- In plain terms: There is a classic classroom experiment: students receive a “personality analysis tailored just for them,” yet every student gets exactly the same text, and most still find it very accurate. This is precisely why fortune‑telling seems so reliable. The price isn’t limited to just a few dollars: in Xixian County, Henan Province, a fortune‑telling ring collected “offering fees” and even sold “donation packages” priced up to 3,888 yuan; the ringleader was sentenced to eleven years in prison. +- Benefit: In that same classic experiment, after taking a personality test, students were given an “individual analysis” that was identical for everyone, yet they universally regarded it as accurate. The authors concluded that “being accepted by the subject or the analyst does not prove the interpretation is correct.” This explains why fortune‑telling always appears accurate; the phenomenon is known as the Barnum effect. A double‑blind test was also conducted on astrology: two groups of participants were asked whether their horoscopes accurately described their personalities; the results were published in Nature. An official case report from the Xixian County Procuratorate describes an online fortune‑telling scam: first they offered free palm‑reading to attract victims, then demanded “offering fees” and “donation packages” costing up to 3,888 yuan. More than 50 victims were identified, over 2 million yuan in illicit gains were recovered, and the ringleader received an eleven‑year prison term plus a fine of 100,000 yuan. +- Evidence grade: B +- Notes: Both studies cited here are single‑experiment investigations. At the time of writing, only the abstract of each paper was available; specific figures such as the average rating in Forer’s study or the percentage of correct astrological predictions in Carlson’s work remain to be verified. Access to the full APA and Nature articles requires a subscription; no such details could be found in the publicly available portions. This entry merely states that these methods lack predictive accuracy; it does not comment on any underlying beliefs. Spending a few dollars for entertainment is outside the scope of this warning; using such services to decide on quitting a job, getting married, or making investments is where real financial loss occurs. +- Sources:Forer BR (1949). The fallacy of personal validation: A classroom demonstration of gullibility. Journal of Abnormal and Social Psychology. ；Carlson S (1985). A double-blind test of astrology. Nature. ；最高人民检察院 (2026). 河南息县：历经三年持续追踪打掉一批网络算命诈骗团伙. + +### 16. Don’t buy blue-light-blocking glasses to “protect your vision,” and don’t believe claims that staring at screens for months will ruin your eyes — but eye pain, swelling, and redness require urgent medical care. + + +- Cost: These glasses cost nothing, and you’ll also avoid paying the extra few hundred to a few thousand dollars for special blue-light-blocking lenses. +- In plain terms: Blue-light-blocking lenses provide no real benefit; you simply save the extra cost of purchasing them. A review of 17 studies found no difference in eye fatigue or visual clarity compared to regular lenses, nor any evidence that they protect the retina. While screen use can cause temporary eye strain and dryness, this does not mean your eyes are being permanently damaged. The only factors that can cause irreversible eye damage in a short time are welding arcs, ultraviolet light, lasers, and acute angle-closure glaucoma. +- Benefit: A 2023 Cochrane systematic review analyzed 17 randomized controlled trials involving 5 to 156 participants each, with follow-up periods ranging from less than a day to five weeks. Due to limited data, significant differences in participant numbers, and inconsistent follow-up times, the authors did not combine results into a single overall figure. All results below compare participants wearing blue-light-blocking lenses to those wearing regular lenses. After less than a week, self-reported eye fatigue showed “possibly no difference” between groups, though evidence certainty was low. One trial with 120 participants found a 9.76-unit difference between groups; this difference’s 95% confidence interval ranged from −33.95 to 53.47, indicating no meaningful distinction. Critical flicker fusion frequency, an objective measure of eye fatigue, also showed “possibly almost no difference” between groups, with low evidence certainty. Best-corrected visual acuity remained “likely unaffected” after wearing these lenses; the difference between groups was 0.00 logMAR (95% CI −0.02 to 0.02), based on a single study with 156 participants and moderate evidence certainty. Whether these lenses affect daytime alertness remains unclear (two trials, 42 participants; very low evidence certainty). The review found no evidence supporting their ability to protect the retinal macula. +- Evidence grade: A +- Notes: Screen use commonly causes eye strain and dryness, manifesting as soreness, dryness, and temporary blurriness. These symptoms can be relieved by resting your eyes and blinking more often; they do not indicate permanent eye damage. This viewpoint is widely accepted in ophthalmology but is not a conclusion drawn from the Cochrane review cited here, so it is classified as evidence grade C. Only intense light sources such as welding arcs, ultraviolet radiation, and lasers can cause irreversible eye damage in a short time. Eye injury from welding arcs, known as “arc eye,” is a legally recognized occupational disease; protection requires specialized goggles and face shields, not blue-light-blocking lenses (see Section 19, Item 11 on protection against dust, noise, and chemical hazards). Staring at screens for long periods without adequate rest poses no inherent risk, except in rare cases: sudden eye pain, swelling, redness, halos around lights, headaches, and nausea may signal acute angle-closure glaucoma, a condition that can damage the optic nerve within days; such symptoms demand immediate emergency eye care (see Section 13, Item 6 on eye emergencies). People over 50, those with hyperopia, and individuals with shallow anterior eye chambers are at higher risk due to factors such as dilated pupils in dim light and prolonged forward head posture. Chronic dry eye caused by screen use may eventually require medical treatment, rather than resolving on its own after a night’s sleep. Persistent eye discomfort or declining vision warrants a professional eye examination rather than simply purchasing new lenses. For information on preventing myopia in children and teens, see Section 30, Items 4, 12, and 9 (daily outdoor time, dilated eye exams, and avoiding products claiming to “cure” myopia). +- Sources:Singh S, Downie LE, Anderson AJ, Keller PR, White SJ, Ang M, Wolffsohn JS (2023). Blue-light filtering spectacle lenses for visual performance, sleep, and macular health in adults. Cochrane Database of Systematic Reviews, 8, CD013244. + +### 17. Don’t treat blood donation as a health habit: claims that it “detoxifies, lowers cholesterol, and prevents heart attacks” lack randomized trial support, while frequent donation truly causes iron deficiency + + +- Cost: There is no monetary cost. A single donation — including registration, drawing blood, and post-donation observation — takes about an hour. Over the following weeks, the body works to replenish the lost iron. + +- In plain terms: The idea that donating blood helps “detoxify,” lowers cholesterol, or prevents heart attacks is not reliable. Those conclusions stem from observational data, and people who regularly donate are generally healthier to begin with. When this baseline difference is accounted for, the original claim that “each additional yearly donation lowers mortality by 18.6%” drops to just 7.5%. One actual randomized trial found no difference in death rates between donors and non-donors. On the other hand, donating too often does make people feel weak and cold — precisely because of iron loss. + +- Benefit: The Kuopio study in Finland followed 2,862 men aged 42–60 for nearly nine years. In the 24 months prior to tracking, 153 men donated blood; only one (0.7%) suffered an acute heart attack. Among the remaining 2,529 non-donors, 316 (12.5%) experienced the same outcome (P<0.0001). After adjusting for age and other coronary risk factors, donors showed an 88% lower risk of heart attack; the relative risk was 0.12 (95% CI 0.02–0.86, P=0.035). However, this result came from an observational study without randomization. The Nordic SCANDAT database included 1,182,495 donors observed over 9,526,627 person-years; 15,401 deaths occurred. After controlling for age and gender, each extra yearly donation lowered mortality by 18.6% (95% CI 16.8%–20.4%). Once the fact that only healthy individuals are allowed to donate was factored in, the benefit fell to 7.5% (95% CI 5.7%–9.4%). Researchers concluded this does not constitute solid proof of health benefits. The FeAST randomized trial enrolled 1,277 patients with symptomatic peripheral artery disease; one group received regular blood removal every six months to reduce iron levels, while the other served as a control. Overall mortality rates were 125 out of 636 (20%) versus 148 out of 641 (23%). HR 0.85 (95% CI 0.67–1.08, P=0.17). Combined outcomes of death, heart attack, and stroke also showed no significant difference: 180 out of 205 (28% vs 32%) with HR 0.88 (95% CI 0.72–1.07, P=0.20). The INTERVAL trial involved 45,263 whole-blood donors divided into three groups based on donation intervals: 12 weeks, 10 weeks, or 8 weeks for men; 16 weeks, 14 weeks, or 12 weeks for women. Shorter intervals indeed yielded more blood within two years (the 8-week group produced 1.69 extra units compared to the 12-week group, 95% CI 1.59–1.80). Yet no differences emerged in quality of life, physical activity, or cognitive function. However, more donors reported fatigue, shortness of breath, dizziness, lightheadedness, and restless legs — especially at night. Average hemoglobin and ferritin levels also dropped, and more donations were postponed due to low hemoglobin (all P<0.0001). Iron deficiency impairs heat production: ten women with iron-deficiency anemia, eight with depleted iron stores but no anemia, and twelve controls were immersed in 28°C water for 100 minutes. The anemia group’s rectal temperature averaged 36.0±0.2°C versus 36.2±0.1°C in controls (P=0.001); oxygen consumption was 5.28±0.26 versus 5.99±0.29 mL·min⁻¹·kg⁻¹ (P=0.04). Thyroid hormones thyroxine and triiodothyronine were also lower (P<0.002). This pattern occurs because donors are repeatedly screened for good health; the hypothesis that “removing iron protects the heart” has not been confirmed in randomized trials. + +- Evidence grade: A + +- Notes: This entry does not oppose blood donation itself, but rather the notion that it serves as a personal health practice. Donated blood is used for others, and according to the beneficiary classification in this book, it falls under category 4, which refers to strangers. What actually benefits the donor is the policy-related perks. Article 14 of the Blood Donation Law stipulates that unpaid blood donors are exempt from fees related to blood collection, storage, separation, and testing when using blood services themselves; their spouses and direct relatives may also be exempt or receive fee reductions as specified by provincial governments. In January 2024, the National Health Commission announced that 55 provinces and regions have implemented policies allowing unpaid blood donors and their relatives to have such hospital fees waived directly at discharge. Those who receive the National Blood Donation Award are also eligible for local “three free” policies, which cover free public transport, free entry to government-run parks, and waived outpatient consultation fees at public hospitals. Donors should adhere to the legally mandated intervals: Article 9 of the Blood Donation Law states that each donation should be 200 milliliters at minimum and 400 milliliters at maximum, with at least six months between donations. The recommended age range for donation is 18–55 years. Do not shorten the interval merely to meet honor criteria or group targets. Women, those with lower body weight, and individuals with heavy menstrual flow already have limited iron reserves; regular donors may opt for a self-funded ferritin test. If persistent fatigue, cold intolerance, or restless legs at night occur after donation, these are not signs of “vital energy depletion” but likely due to iron deficiency; a blood test and ferritin check are advised, followed by iron supplementation and extended donation intervals as directed by a doctor. The evidence for cold intolerance specifically comes from a study involving just 2024 participants, and this figure is included here solely to illustrate the phenomenon, not to indicate how many people experience it. +- Sources:Salonen JT, Tuomainen TP, Salonen R, Lakka TA, Nyyssönen K (1998). Donation of blood is associated with reduced risk of myocardial infarction. The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Epidemiology, 148(5), 445-451. ；Ullum H, Rostgaard K, Kamper-Jørgensen M, et al. (2015). Blood donation and blood donor mortality after adjustment for a healthy donor effect. Transfusion, 55(10), 2479-2485. ；Zacharski LR, Chow BK, Howes PS, et al. (2007). Reduction of iron stores and cardiovascular outcomes in patients with peripheral arterial disease: a randomized controlled trial. JAMA, 297(6), 603-610. ；Di Angelantonio E, Thompson SG, Kaptoge S, et al. (2017). Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors. Lancet, 390(10110), 2360-2371. ；Beard JL, Borel MJ, Derr J (1990). Impaired thermoregulation and thyroid function in iron-deficiency anemia. American Journal of Clinical Nutrition, 52(5), 813-819. ；全国人大常委会 (1997). 中华人民共和国献血法（第二、九、十四条）. ；国家卫生健康委等 (2024-01-08). 关于进一步做好无偿献血者激励奖励工作的通知. + +### 18. Don’t rely on generic health checkup packages to prevent disease; only get those evidence‑based screenings appropriate for your age and gender. + + +- Cost: There’s no cost at all, and you even save hundreds to thousands of yuan each year by avoiding these packages. The trade‑off is that you must remember which tests you need and how often to get them. + +- In plain terms: Researchers divided 230,000 people into two groups — one that regularly underwent generic health checks and one that did not. Across 11 trials, mortality rates were virtually identical between the groups, with a difference of less than 3%. The same held true for deaths from cardiovascular disease and cancer. The Cochrane authors concluded that such generic checkups are unlikely to provide any benefit. The only screenings that truly lower mortality are those performed for specific medical reasons. + +- Benefit: The 2019 update of the Cochrane systematic review included 17 randomized controlled trials. For overall mortality, data from 11 trials involving 233,298 participants and 21,535 deaths were pooled; the risk ratio for the screening group versus the control group was 1.00 (95% CI 0.97–1.03). A risk ratio of 1 means no difference between the groups. When looking at cardiovascular deaths, nine trials with 170,227 participants and 6,237 deaths yielded a risk ratio of 1.05 (95% CI 0.94–1.16). For cancer deaths, eight trials with 139,290 participants and 3,663 deaths gave a risk ratio of 1.01 (95% CI 0.92–1.12). In neither case was any meaningful difference observed. The authors therefore state that generic health checkups are probably not beneficial. As part of the national basic public health service, residents aged 35 and older receive a free annual blood pressure measurement, while those 65 and older get a free annual health checkup. This checkup includes a physical exam, complete blood count, urinalysis, liver function tests (AST, ALT, total bilirubin), kidney function tests (serum creatinine, blood urea), fasting blood glucose, electrocardiogram, and lipid profile (total cholesterol, triglycerides, LDL‑C, HDL‑C). An abdominal ultrasound of the liver, gallbladder, pancreas, and spleen is also offered nationwide. + +- Evidence grade: A + +- Notes: This recommendation specifically discourages using annual checkup packages as a disease‑prevention strategy; it does not mean that all medical tests are unnecessary. The free annual blood pressure measurement for those over 35 and the free annual checkup for seniors are already part of the national public health program, so there is no need to pay for them. Get tested only when there is a clear medical reason. Information on blood pressure, blood glucose, and hepatitis B can be found in sections 7, 8, and 14 of chapter 1; breast, cervical, and colorectal cancer screening details appear in sections 17, 18, and 19. Helicobacter pylori testing and low‑dose CT screening are covered in sections 23 and 24. If you have risk factors, follow the guidance in section 31. Age thresholds and recommended intervals for each test are also listed there. You may still attend employer‑sponsored or other paid health screenings; this advice applies only to those who would otherwise pay for a generic package or add extra tests on their own. People with chronic diseases, symptoms, or those ordered by a doctor to undergo specific tests are not covered by this recommendation, as those are diagnostic procedures, not screening. The tests with the least evidence supporting routine use are tumor markers and whole‑body imaging; see section 7 for PET‑CT and tumor‑marker packages. Guidance on managing asymptomatic high uric acid levels and silent gallstones is provided in sections 19 and 20. Finally, most of the trials included in the Cochrane review were conducted in high‑income countries where healthcare access is easy; this conclusion should not be directly applied to regions with limited medical resources. +- Sources:Krogsbøll LT, Jørgensen KJ, Gøtzsche PC (2019). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews, 1, CD009009. ；国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）（老年人健康管理服务、高血压患者健康管理服务）. + +### 19. Don’t start taking uric‑acid‑lowering drugs just because a checkup shows high uric acid but you’ve never had symptoms + + +- Cost: There’s no cost at all; you also avoid long‑term medication expenses, regular follow‑ups, and the risks linked to unnecessary drug use. + +- In plain terms: People whose uric acid levels are high but who’ve never had gout attacks or tophus deposits mainly gain peace of mind from taking uric‑acid‑lowering drugs. According to calculations by the American College of Rheumatology, you’d need to treat 24 people for three full years just to prevent a single gout episode. These drugs also won’t protect your kidneys; in randomized trials the rate of kidney‑function decline was identical in patients taking them and those on a placebo. What truly helps is keeping weight, alcohol, and sugary drinks in check — and only treating gout after an actual attack occurs. + +- Benefit: The 2020 gout guidelines from the American College of Rheumatology address asymptomatic hyperuricemia, defined as blood uric‑acid levels above 6.8 mg/dL in people who’ve never had gout or tophus. Under certain conditions the guidelines advise against initiating any uric‑acid‑lowering therapy — drugs such as allopurinol, febuxostat, or probenecid. Evidence supporting this recommendation is rated “high.” A footnote clarifies that, based on attributable risk, 24 patients must be treated for three years to prevent one gout episode. The CKD‑FIX trial enrolled 363 participants with stage 3 or 4 chronic kidney disease; they had no gout history but faced a higher risk of worsening kidney function. One group received 100–300 mg of allopurinol daily while the other got a placebo; after 104 weeks the annual change in eGFR — a key kidney‑function marker measured in mL/min/1.73 m² — was –3.33 (95 % CI –4.11 to –2.55) in the drug group versus –3.23 (–3.98 to –2.47) in the placebo group. The difference between groups was –0.10 (–1.18 to 0.97), with a P‑value of 0.85, meaning kidney‑function decline proceeded at the same pace. Serious adverse events occurred in 46 % of patients on allopurinol versus 44 % on placebo. The PERL trial involved 530 type 1 diabetics with early‑to‑moderate diabetic kidney disease; after three years of allopurinol therapy the drug was withdrawn for two months to gauge its effect. Allopurinol lowered blood uric‑acid from 6.1 mg/dL to 3.9 mg/dL, yet after discontinuation the eGFR difference between groups narrowed to just 0.001 mL/min/1.73 m² (95 % CI –1.9 to 1.9, P = 0.99). Moreover, urinary albumin excretion rose 40 % (range 0–80 %) in the allopurinol group. The apparent “benefit” stems largely from the intuitive notion that any elevated marker warrants medication. + +- Evidence grade: A + +- Notes: This recommendation specifically discourages lifelong uric‑acid‑lowering therapy in people who’ve never experienced gout; it does not imply that high uric‑acid levels are harmless. The same guidelines outline exceptions where treatment may be warranted: first‑time gout attacks accompanied by stage 3 or higher chronic kidney disease, blood uric‑acid levels exceeding 9 mg/dL (≈535 µmol/L), or a history of uric‑acid kidney stones. Those who’ve already had gout attacks, have tophus deposits, or show bone erosion on imaging should indeed start medication — see Section 16, Item 9 for details. Roughly 7.4 % of Han Chinese carry the HLA‑B*5801 genotype, compared to just 0.7 % of Caucasians; carriers face a markedly higher risk of life‑threatening hypersensitivity reactions, with Asian patients three times more prone to severe skin syndromes than white patients. Given this risk, it’s prudent to avoid allopurinol unless absolutely necessary; testing for the HLA‑B*5801 variant before prescribing is advisable, as noted in Section 16, Item 9. The kidney studies involved patients with chronic kidney disease or type 1 diabetes, so their findings shouldn’t be extrapolated to suggest that high uric‑acid levels are completely benign for all kidneys. They merely refute the claim that uric‑acid‑lowering drugs protect kidney function. +- Sources:FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760（表 1 及其脚注）. ；Badve SV, Pascoe EM, Tiku A, et al. (2020). Effects of Allopurinol on the Progression of Chronic Kidney Disease. New England Journal of Medicine, 382(26), 2504-2513. ；Doria A, Galecki AT, Spino C, et al. (2020). Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes. New England Journal of Medicine, 382(26), 2493-2503. + +### 20. Don’t undergo preventive gallbladder removal just because an ultrasound reveals gallstones but you’ve never had any pain + + +- Cost: There’s no cost at all — in fact, you avoid the expense of a full general anesthesia and a hospital stay. The trade‑off is simply remembering a few warning signs that demand immediate medical attention. + +- In plain terms: Most people with gallstones who have never felt any pain will continue to stay symptom‑free. An Italian study followed 580 such individuals for nearly nine years; 78 % never developed any symptoms. In the U.S., a group of 135 people was tracked for about four years, and only 7 % ended up needing surgery. The UK’s clinical guidelines state plainly: if gallstones are found incidentally and cause no symptoms, no treatment is required. + +- Benefit: The Italian MICOL population survey examined 11,229 people aged 29–69 using ultrasound. Gallstones were detected in 856 individuals; 580 of them had no symptoms and were followed for an average of 8.7 years. Of those, 453 (78.1 %) remained symptom‑free, 61 (10.5 %) experienced mild symptoms, and 66 (11.4 %) had severe symptoms. Over the follow‑up period, 189 gallbladder removals were performed, with 41.3 % done on asymptomatic patients. The authors conclude that “watchful waiting remains an effective approach for most patients.” In the U.S., a health‑maintenance organization tracked 691 gallstone patients for an average of 78 ± 61.6 months; among the 135 asymptomatic participants followed for 58 ± 50.2 months (median 46.3 months), only 10 % developed symptoms and 7 % underwent surgery. Of the 50 deaths recorded in the whole group, just two were linked to biliary disease, and both occurred in symptomatic patients. The authors stress that “patients with silent stones need not have surgery before symptoms appear.” The UK’s NICE guideline CG188, section 1.2.1, states: “Individuals with normal gallbladder and biliary anatomy who incidentally have asymptomatic gallstones should be informed that no treatment is necessary before symptoms arise.” The apparent cost‑effectiveness of preventive removal stems from the intuition that “pain will eventually appear, so it’s better to remove it while still young.” + +- Evidence grade: A + +- Notes: This recommendation applies only to one specific scenario: stones located inside the gallbladder with no prior pain. Stones in the common bile duct are a completely different matter. Section 1.3.1 of the same guideline explicitly mandates removal of bile‑duct stones — symptomatic or not — along with gallbladder extraction. Seek emergency care immediately if you experience persistent cramping in the upper right abdomen, fever with chills, yellowing of the whites of the eyes or skin, or dark urine. When a physician recommends surgery after reviewing imaging, ask which criteria prompted that decision — such as bile‑duct involvement, concurrent polyps, or abnormal gallbladder wall changes — and do not cite this guideline to contest it. This advice solely prevents “unjustified removal solely because stones were detected.” Both studies described above were observational cohorts, not randomized trials; they aimed to answer “what happens if we do nothing?” rather than “which treatment is superior?” Their findings are therefore appropriate here. Moreover, the follow‑up periods were 4–9 years; longer observation would likely raise the proportion of symptomatic cases. +- Sources:Festi D, Reggiani ML, Attili AF, et al. (2010). Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. Journal of Gastroenterology and Hepatology, 25(4), 719-724. ；McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M (1985). The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Annals of Surgery, 202(1), 59-63. ；National Institute for Health and Care Excellence (2014). Gallstone disease: diagnosis and management. NICE guideline CG188，第 1.2.1、1.3.1 条. + +### 21. Don’t cut calcium out to prevent kidney stones + +- Cost: No cost at all. In fact, it’s easier — no need to constantly watch what foods contain calcium. +- In plain terms: People who’ve had calcium oxalate stones are often advised to limit calcium intake, but randomized trials show the opposite. A study with 120 men who repeatedly developed stones divided them into two groups: one ate a normal amount of calcium while cutting back on animal protein and salt; the other followed a traditional low‑calcium diet. After five years, recurrence rates were 12 out of 60 versus 23 out of 60 — meaning the normal‑calcium group had half the risk. UK guidelines also advise against restricting calcium. +- Benefit: This five‑year randomized trial enrolled 120 men with recurrent calcium oxalate stones and high urinary calcium levels. One group consumed 30 mmol of calcium daily, reduced animal protein to 52 g per day, and limited salt to 50 mmol of sodium chloride; the control group ate only 10 mmol of calcium daily. Over five years, recurrence occurred in 12/60 versus 23/60 participants. The unadjusted relative risk was 0.49 (95% CI 0.24–0.98; P = 0.04), indicating half the risk with normal calcium intake. Both groups saw a similar drop in urinary calcium — about 170 mg per day — but oxalate excretion fell by 7.2 mg/day in the normal‑calcium group versus a rise of 5.4 mg/day in the low‑calcium group. NICE guideline NG118 states adults should aim for 700–1,200 mg of calcium daily; children and teens need 350–1,000 mg per day. The perception that cutting calcium is beneficial stems from the intuitive idea that “stones are made of calcium, so less calcium must help.” +- Evidence grade: A +- Notes: Caveats: This trial involved only men with recurrent calcium oxalate stones and high urinary calcium; results may not apply to all stone types. Moreover, the intervention group simultaneously reduced protein and salt intake, so some benefits could stem from those changes rather than calcium alone. This advice specifically discourages actively eliminating calcium‑rich foods — it does not advocate extra calcium supplementation. For any need to add calcium pills, consult your physician. Regarding hydration, see Section 16, Item 8: drinking 2.5–3 L of water daily after a stone episode. +- Sources:Borghi L, Schianchi T, Meschi T, et al. (2002). Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. New England Journal of Medicine, 346(2), 77-84. ；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. + +### 22. Don’t buy crystals, bracelets, or Pixiu figurines for “good luck,” “wealth attraction,” or “health benefits” + + +- Cost: There is no monetary cost involved. The only requirement is to avoid listing “good luck,” “health benefits,” or similar claims as reasons for purchase. The real challenge is resisting the urge to buy them when everyone else is wearing them and talking about their magical powers. + +- In plain terms: There is absolutely no verifiable evidence supporting claims that wearing such items can change one’s fate, attract wealth, or improve health. These assertions work on the same principle as fortune-telling: they are phrased so vaguely that people naturally interpret them as applying to themselves. Any explicit health or fortune-related claims made by sellers would constitute illegal false advertising; in 2026, several livestream shops were penalized for exactly this reason. Buying them purely as decorative accessories is perfectly fine, but allocating extra funds specifically for “luck enhancement” is what this guidance aims to prevent. + +- Benefit: Classic classroom experiments demonstrate that when participants receive the same generic “personality analysis,” they almost universally deem it accurate. This phenomenon is known as the Barnum effect, and it explains why many people feel that wearing these items somehow improves their lives. The underlying conclusion is simple: personal acceptance of a vague statement does not validate its factual accuracy. A notable official case involves a jewelry shop in Sihui, Guangdong, which was penalized by China’s State Administration for Market Regulation on June 4, 2026. During livestream sales, the shop falsely advertised that its products could prevent rheumatism, boost immunity, improve sleep, and even clear blood vessels. By fabricating elaborate narratives, the business misled consumers, violating Article 9, Paragraph 1 of China’s Anti-Unfair Competition Law. Only 34 people actually need to be aware of this principle for it to have a meaningful impact on consumer behavior. + +- Evidence grade: B + +- Notes: This entry serves one main purpose: to emphasize that there is no scientific basis for any claimed benefits, nor any measurable predictive power. It does not pass judgment on personal beliefs or cultural traditions, nor does it discourage buying such items as gifts, mementos, or family heirlooms. Two points must be clearly distinguished: legally enforceable claims about product performance can be reported to authorities, while vague notions like “good luck” lack any research support and cannot be proven false; thus, personal budget control is the only practical safeguard. Before purchasing, treat the item strictly as a decorative piece and ask yourself: “If it offered no magical benefits at all, would I still pay this price?” For guidance on verifying materials and certifications, or why treating them as investments is unwise, refer to Sections 5.33 and 5.34. Information on spending money on fortune-tellers is provided in Section 5.15. +- Sources:Forer BR (1949). The fallacy of personal validation: A classroom demonstration of gullibility. Journal of Abnormal and Social Psychology. ；国家市场监督管理总局 (2026). 市场监管总局公布一批传统工艺市场「打假清源」典型案例. + +### 23. Don’t expect shopping to lift your mood or boost your sense of self-worth + +- Cost: No cost at all. The hard part is resisting the urge to buy things when you’re feeling down. +- In plain terms: On average, people who place a higher value on money and material possessions report lower levels of happiness. This conclusion comes from a meta-analysis of 259 separate studies, though the link between the two is fairly weak and it’s unclear which factor drives the other. Other research comparing spending on experiences versus physical goods found that money spent on experiences tends to bring more satisfaction. So when you’re in a bad mood, reallocating your budget toward a day out or a meal with friends is far more likely to help than adding more items to your shopping cart. +- Benefit: This meta-analysis combined data from 259 independent studies, covering a total of 753 effect sizes. The results showed that individuals who prioritize material possessions tend to report lower happiness levels. On the most commonly used multi-dimensional well‑being scale, the correlation coefficient was r = –0.19 (adjusted ρ = –0.24). When only the single dimension of “valuing money” was measured, the correlation weakened to r = –0.08 to –0.11. The strength of this link varied depending on the specific outcome measured: it was strongest with risky health‑related and consumption behaviors and negative self‑evaluations (r = –0.28 to –0.44) and weakest with overall life satisfaction and negative emotions (r = –0.13 to –0.15). Mediation analyses suggested that this negative relationship may arise because psychological needs remain unmet. Another set of studies asked different groups of participants whether spending on experiences or on goods made them happier; respondents consistently chose experiences. Laboratory experiments confirmed this: recalling a purchase made for an experience produced a better mood than recalling a purchase of a physical item. Both studies used overseas samples, so these findings don’t apply to the Chinese population. +- Evidence grade: B +- Notes: Caveats: Most of the included studies surveyed the same group of people at a single point in time, so they can’t determine which factor comes first. The authors themselves note that further experiments and long‑term follow‑ups are needed to clarify the direction of this relationship. Therefore, this recommendation should not be interpreted as “shopping makes people unhappy”; rather, it means “relying on shopping to improve your mood is unlikely to succeed.” The overall correlation is modest: r = –0.19 accounts for only a few percentage points of variation, and individual differences are considerable. Since both studies used foreign samples, there are no comparable Chinese data to cite. This advice does not discourage spending on items you genuinely enjoy; it simply warns against using shopping as a mood‑regulation tool, as that can lead to repeated impulse buys when you’re feeling down. Specific ways to save money are described in Section 5. Evidence‑based strategies for coping with low mood can be found in the latter part of Section 22 and in Section 29. Information on budgeting to “outperform” others is covered in Item 24 of this section. +- Sources:Dittmar H, Bond R, Hurst M, Kasser T (2014). The relationship between materialism and personal well-being: A meta-analysis. Journal of Personality and Social Psychology, 107(5), 879-924. ；Van Boven L, Gilovich T (2003). To do or to have? That is the question. Journal of Personality and Social Psychology, 85(6), 1193-1202. + +### 24. Don’t spend extra money on a new house, car, or social circle just to “move up a notch” among peers + +- Cost: Zero. All you have to do is ask one extra question before raising your budget: is this extra cost buying the actual product, or simply a higher status within your group? The hard part is resisting the urge to upgrade when everyone else does. +- In plain terms: When comparing people with similar incomes, those whose neighbors earn more report lower happiness levels. This effect appears only among neighbors with comparable education and frequent interaction. Thus, spending extra to move into a neighborhood where everyone is wealthier actually pushes you down the social ladder. Yet when incomes rise across the board, people still feel better off — absolute levels still matter. +- Benefit: The National Survey of Families and Households (NSFH) in the U.S. followed the same individuals over two waves. The authors matched this data with local average incomes calculated from a 5% sample of the 1990 census. After controlling for personal characteristics and income, they found that higher neighbor incomes correlated with lower self-reported happiness. This effect was robust across different analytical methods and highly statistically significant. The authors noted that the drop in happiness from “neighbors earning more” mirrored the drop from “one’s own income falling by the same amount.” Even after accounting for individual-level changes over time or within-state differences, results remained consistent. This rules out explanations such as “people who prefer poorer areas are inherently happier” or unmeasured state-level factors. The effect was stronger among people with frequent neighbor contact but negligible for those interacting mainly outside their community. No difference emerged between renters and homeowners, contradicting the idea that higher housing costs in affluent areas reduce disposable income. Happiness declined only when comparing to neighbors with similar education levels; income differences among less-educated peers had little impact. The effect primarily operated through satisfaction with one’s material circumstances rather than other life domains. Finally, when both personal and neighbor incomes rose proportionally, overall happiness still increased. +- Evidence grade: B +- Notes: Several factors justify a B rating: data come from repeated surveys of the same individuals, but this is the sole study of its kind conducted abroad; outcomes rely on self-reported happiness rather than monetary metrics. While the authors employed statistical controls such as within-person and within-state comparisons, it remains a non-randomized study. No comparable Chinese data exist. The benefit magnitude is classified as “moderate,” consistent with criteria established in Section 23 (don’t expect purchases to boost mood); savings could reach tens of thousands of yuan. However, lacking quantitative links between savings and happiness gains, this isn’t classified as “large.” This advice doesn’t discourage spending on larger homes, quieter neighborhoods, or shorter commutes — those purchases serve tangible needs. It targets only spending driven by “everyone else is upgrading, so I must too” mentality. Prioritization of housing factors is discussed in Section 4, Item 18 (commute time matters most). Using purchases to improve mood is addressed in Section 23 (material goods won’t deliver lasting joy). Excessive social comparison is cautioned against in Section 3, Item 21 (don’t obsess over others’ lifestyles). +- Sources:Luttmer EFP (2005). Neighbors as Negatives: Relative Earnings and Well-Being. The Quarterly Journal of Economics, 120(3), 963–1002. ；Luttmer EFP (2004). Neighbors as Negatives: Relative Earnings and Well-Being. NBER Working Paper No. 10667（本条引用的表述与数量级按这一版逐字核对）. + +### 25. Don’t believe that “willpower is like a muscle that runs out after use” + +- Cost: No cost at all. Only a change in wording is needed. +- In plain terms: The popular idea is that after doing something that requires self‑control, it becomes harder to resist temptations later, so we should “save” our willpower. Yet 23 laboratories and 2,141 participants ran the same experiment, and the results showed almost no effect. Stop using “I’ve run out of willpower today” as an excuse, and don’t spend money on courses that promise to help you conserve it. +- Benefit: In a multi‑lab preregistered replication study, 23 labs with 2,141 participants followed Sripada et al.’s standard protocol: first they performed a task demanding self‑control, then a second similar task. The pooled data indicated a very small self‑control depletion effect; its 95% confidence interval included zero (d = 0.04, 95% CI −0.07 to 0.15). This evidence challenges the model that self‑control is a limited resource. +- Evidence grade: A +- Notes: This finding refutes the notion that self‑control is a finite resource, not that people can’t get tired. Lack of sleep or prolonged work does reduce efficiency, but that is handled in Section 3 on sleep and working hours. What random trials actually support are environmental tweaks and simpler wording — see Section 4, items 10 (“move unwanted items out of reach”) and 1 (“write down exactly when, where, and what you’ll do”). While other items in this section deal with monetary cost, this one concerns time and mental effort, which are not interchangeable. +- Sources:Hagger MS, Chatzisarantis NLD, Alberts H, et al. (2016). A Multilab Preregistered Replication of the Ego-Depletion Effect. Perspectives on Psychological Science, 11(4), 546–573. + +### 26. Don’t expect skipping breakfast or the 16:8 intermittent fasting schedule to help you control your weight; pick a meal timing you can stick with long‑term. + + +- Cost: No cost at all. What you save is the mental energy you’d otherwise spend worrying about when to eat. +- In plain terms: Popular belief holds that skipping breakfast leads to overeating at lunch and dinner, ultimately increasing total daily calorie intake. Randomised trials tell a different story: people who skip breakfast actually consume roughly 200 fewer kilocalories per day and tend to weigh slightly less. Compared with simply eating less, the 16:8 schedule makes no difference in weight after a year. Long‑term breakfast skippers do have about a 17% higher risk of cardiovascular disease; overall mortality shows no notable change. The absolute number of excess cardiovascular events is 1.42 per 100,000 people per year. +- Benefit: Let’s examine the claim that skipping breakfast makes you eat more later. One meta‑analysis combined results from 13 randomised trials. Participants who ate breakfast consumed 259.79 kcal more per day than those who skipped it (95% CI 78.87–440.71). Their weight was also 0.44 kg higher (95% CI 0.07–0.82). In other words, breakfast skippers did not compensate by eating more at later meals. These studies had relatively short follow‑ups – an average of 7 weeks for weight and 2 weeks for calorie intake. Turning to the 16:8 approach, a trial involving 116 overweight adults lasted 12 weeks. Those limited to eating between noon and 8 pm lost 0.26 kg less than participants who ate three regular meals per day (95% CI −1.30 to 0.78), a non‑significant difference. Another study in Guangzhou followed 139 obese patients for a full year; adding time‑restricted eating to calorie restriction yielded only 1.8 kg extra weight loss compared with calorie restriction alone (95% CI −4.0 to 0.4), again not statistically significant. Finally, regarding long‑term effects, a pooled analysis of 2.38 million people showed a 17% higher risk of cardiovascular disease among breakfast skippers (OR 1.17, 95% CI 1.09–1.26) and a 49% higher risk of cardiovascular death (OR 1.49, 95% CI 1.20–1.84). However, these data come from observational studies without randomisation; the original long‑term study (17–23 years follow‑up) reported an all‑cause mortality OR of 1.19, which comfortably includes 1, indicating no real difference. +- Evidence grade: A +- Notes: This topic remains controversial. The 17% cardiovascular risk figure stems from observational data that do not control for confounding factors; breakfast skippers are more likely to smoke, drink, be sedentary, and have lower incomes, so it’s unclear how much of that risk is truly attributable to skipping breakfast. The all‑cause mortality result also hovers around 1, meaning no clear effect. On the 16:8 front, a combined analysis of 30 trials with 1,341 participants found that, when calorie intake was equal, time‑restricted eating led to an extra 1.46 kg weight loss (95% CI −2.65 to −0.26), but at the cost of losing 0.41 kg more lean mass. Most trials were short‑term; the longest and most rigorous 12‑month study found no difference. Prolonged fasting may also affect the gallbladder: a cross‑sectional survey of 6,547 people showed that each hour later the first meal is eaten raises the odds of gallstones by 5% (OR 1.05, 95% CI 1.02–1.08); those whose first meal occurs between 9 am and 2 pm have a 49% higher risk (OR 1.49, 95% CI 1.24–1.77). The underlying mechanism is that bile stays in the gallbladder longer, facilitating stone formation; however, the study is observational and cannot prove causation. In China’s Kailuan cohort, 369 cases of digestive‑tract cancer were tracked for 5.6 years; breakfast skippers faced a 2.32‑fold higher risk of colorectal cancer (95% CI 1.34–4.01) and a 5.43‑fold higher risk of gallbladder and extra‑hepatic bile‑duct cancer (95% CI 1.34–21.93). The wide confidence interval for the latter reflects very few events, so it should be regarded as a tentative signal rather than a firm conclusion. Putting all this together, meal timing has only a modest impact on weight control; don’t waste mental energy on it. As for the long‑term health effects of skipping breakfast, current evidence is purely associative and does not prove causation, though the trend leans unfavourable. For safety, simply eat regular meals – don’t rely on breakfast omission for weight loss. Note that gastritis and peptic ulcers are caused mainly by Helicobacter pylori infection and chronic NSAID use; see Section 1, Item 23 for testing and eradication. If an ultrasound reveals gallstones but causes no pain, see Section 1, Item 20 for guidance on avoiding preventive surgery. Proven strategies for weight control are centred on diet composition and portion size: see Section 2, Items 28 (five servings of fruit and vegetables daily), 29 (limiting ultra‑processed foods) and 33 (maintaining a BMI between 20 and 25). People with diabetes, those on hypoglycaemic medication, or pregnant women should not skip meals, as it may provoke hypoglycaemia; follow medical advice instead. Extreme fasting or self‑induced vomiting are separate issues; see Section 28, Item 1 for appropriate guidance. +- Sources:Sievert K, Hussain SM, Page MJ, 等 (2019). Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials. BMJ. ；Lowe DA, Wu N, Rohdin-Bibby L, 等 (2020). Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity. JAMA Internal Medicine. ；Liu D, Huang Y, Huang C, 等 (2022). Calorie Restriction with or without Time-Restricted Eating in Weight Loss. New England Journal of Medicine. ；Zhang H, Zhang S, Liu Y, 等 (2025). The association between skipping breakfast and cardiovascular disease: a meta analysis. Frontiers in Cardiovascular Medicine. ；Rong S, Snetselaar LG, Xu G, 等 (2019). Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality. Journal of the American College of Cardiology. ；Fernandes-Alves D, Teixeira GP, Guimarães KC, Crispim CA (2026). Systematic Review and Meta-analysis of Randomized Clinical Trials Comparing Time-Restricted Eating With and Without Caloric Restriction for Weight Loss. Nutrition Reviews. ；Sun T, Zhang L, Lu Y, 等 (2024). Non-linear relationship between the first meal time of the day and gallstone incidence in American adults. Frontiers in Nutrition. ；Liu T, Wang Y, Wang X, 等 (2023). Habitually Skipping Breakfast Is Associated with the Risk of Gastrointestinal Cancers: Evidence from the Kailuan Cohort Study. Journal of General Internal Medicine. diff --git a/book/en/07-Living-With-No-Money.md b/book/en/07-Living-With-No-Money.md new file mode 100644 index 00000000..4672633d --- /dev/null +++ b/book/en/07-Living-With-No-Money.md @@ -0,0 +1,213 @@ +# 7. How to get by when you have little money + +This section covers money and social safeguards. It lists how much you might receive, what costs could be waived, which services may be available, and what eligibility criteria apply — but it does not translate these figures into any health impact. Policies change yearly and vary by region, so always refer to the official figures released for your local area. Items are ordered from those requiring no spending, minimal paperwork, and quick results at the top, while those demanding long-term qualification periods or carrying large regional differences appear toward the end. Suggestions based purely on personal experience without any official documentation are placed last. +### 1. Apply for unemployment benefits online after losing a job + +- Cost: There is no cost. You can submit the application via smartphone using any of three portals: the “12333” app, the e‑Social Security Card mini‑program in WeChat or Alipay, or the National Social Insurance Public Service Platform. Having a social security card or ID card is enough; in most regions you won’t need to visit a physical office. The prerequisite is completing unemployment registration first. +- In plain terms: If both your employer and you have paid into yibao (basic medical insurance) for at least one year and you didn’t resign voluntarily, you can receive payments after registering as unemployed. For those with one to five years of contributions, the maximum payout period is 12 months; for five to ten years, it’s 18 months; and for ten years or more, it’s 24 months. During this time, your employee medical insurance premiums are covered by unemployment insurance. +- Benefit: Eligibility requires three conditions: first, both your employer and you must have contributed to social insurance for at least one year; second, your separation from work must not be voluntary (legally termed “termination of employment not due to the individual’s own will”); third, you must have completed unemployment registration and be actively seeking employment. The duration of benefits depends on your contribution history: up to 12 months for 1–5 years of contributions, up to 18 months for 5–10 years, and up to 24 months for 10+ years. Monthly amounts are set by provincial governments, so they vary by region; they are always higher than the urban dibao (minimum living allowance) but lower than the local minimum wage. The national target is to raise these payments to 90% of the minimum wage over time. While receiving benefits, you remain enrolled in employee medical insurance, with all required premiums paid by the unemployment insurance fund — meaning you incur no personal expense for medical coverage (nationwide, effective since 1999 per regulations). +- Evidence grade: A +- Notes: Voluntary resignations do not qualify as “termination not due to personal will,” so benefits cannot be claimed. During the benefit period, unemployment insurance covers your employee medical insurance premiums. Amounts differ widely across provinces; always refer to the figures published by your local authority. The “90% of minimum wage” benchmark originates from a 2017 guideline issued by the Ministry of Human Resources and Social Security; the original document and its reference number remain difficult to locate. +- Sources:国务院 (1999). 失业保险条例（国务院令第 258 号，第十四、十七、十八条）. ；人力资源社会保障部. 全国人社政务服务平台·失业保险待遇申领办事指南. ；国家发展改革委就业司 (2022). 失业保险金标准，将逐步提高至最低工资的 90%. ；全国人大常委会 (2010). 社会保险法（第四十八条）. （国家税务总局政策法规库） + +### 2. First file a complaint with the Human Resources and Social Security Bureau, then apply for final and binding one-instance arbitration — both options are free, and most cases yield results within a few months. + + +- Cost: There are no fees for either option. You’ll need to gather your employment contract, pay stubs, attendance records, bank transfer statements, and any relevant chat logs, then visit the local Human Resources and Social Security Bureau or arbitration commission one to three times. There is a one-year deadline (known legally as the arbitration statute of limitations) for filing an arbitration claim. Employees still working for the employer are exempt from this deadline; those who have already left must file within one year of their departure. The main difficulty lies in making repeated trips and collecting all necessary evidence, which can be discouraging. + +- In plain terms: Both processes cost nothing. Start by calling 12333 or visiting the local Human Resources and Social Security Bureau’s labor inspection office. Within 60 working days of acceptance, they will investigate and can order the employer to pay wages; failure to comply results in an additional penalty of 50% to 100% of the owed amount. If that doesn’t work, file for arbitration, which must be concluded within 45 days. However, “case closure” does not guarantee payment: if the employer has no assets or the owner has fled, even a favorable ruling may leave you unpaid. In 2024, the total amount of wages successfully recovered through enforcement efforts reached 2.3 trillion yuan. + +- Benefit: The first step is to file a complaint. Call 12333 or visit the local labor inspection office. By law, they must complete their investigation within 60 working days, extendable by another 30 days for complex cases. If violations are confirmed, they can order immediate wage payment; noncompliance triggers an extra penalty of 50% to 100% of the original amount. In 2024, labor inspectors nationwide handled 137,000 cases, securing back pay totaling 8.65 billion yuan for 654,000 workers. If you possess a written IOU or clear wage records, you may also request a payment order directly from a local court; such orders are issued within 15 days of application. The second step is arbitration, which must be finalized within 45 days, extendable by 15 days. Workers seeking unpaid wages may request provisional enforcement even before the full trial concludes. Claims up to 12 times the local monthly minimum wage qualify as final and binding one-instance arbitration, meaning the employer cannot appeal further. In 2024, 4.257 million arbitration cases were filed, with 4.156 million resolved, resulting in 93.47 billion yuan recovered. Mediation succeeded in 79.6% of cases, while 98.2% of arbitrations concluded successfully, and 73.7% never reached court. Critics claiming resolution takes “six months to a year” refer to cases that proceed to civil litigation after arbitration: a first-instance trial lasts six months (or three months under simplified procedures), followed by a three-month appeals phase. In 2024, courts resolved 88,000 labor wage cases, recovering 28.54 billion yuan, and 998 individuals were convicted under criminal statutes for wage theft. + +- Evidence grade: A + +- Notes: These pathways are effective, but it’s crucial to distinguish between “case closure” and actual payment receipt. The 98.2% closure rate reflects only procedural completion; many workers still receive nothing if employers lack assets or abscond. The Supreme People’s Court publishes only total enforcement figures (2.3 trillion yuan in 2024) and a “high completion rate,” offering no data on how much of that actually reaches workers. The term “arbitration termination rate” lacks an official definition here; it is interpreted as cases never appealed to court. Criminal prosecution thresholds apply when wages remain unpaid for three months or more: either to a single worker for 5,000 to 20,000 yuan, or to ten or more workers for a combined total of 30,000 to 100,000 yuan. Provincial courts set exact amounts within these ranges; check your local figure before filing. Construction workers benefit from dedicated wage accounts and guarantees by general contractors, making direct appeals to contractors less effective. Legal aid for migrant workers seeking unpaid wages is granted regardless of financial status. Legal citations derive from State Taxation Administration and Guizhou Market Supervision Administration pages (both on gov.cn), as the National People’s Congress website remains inaccessible; verification of the Eighth Criminal Law Amendment relied on manual curl checks. +- Sources:人力资源社会保障部 (2025). 2024 年度人力资源和社会保障事业发展统计公报. ；最高人民法院 (2025). 最高人民法院工作报告. ；国务院 (2004). 劳动保障监察条例（国务院令第 423 号，第九、十七、二十六条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（主席令第八十号，第二十七、四十三、四十四、四十七、五十、五十三条）. ；全国人大常委会 (2012 修正). 劳动合同法（第三十、八十五条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第一百零九、一百五十二、一百六十四、一百八十三、二百二十五、二百二十七条）. ；全国人大常委会 (2011). 刑法修正案（八）第四十一条，即刑法第二百七十六条之一. ；最高人民法院 (2013). 关于审理拒不支付劳动报酬刑事案件适用法律若干问题的解释（法释〔2013〕3 号，第三条）. ；国务院 (2019). 保障农民工工资支付条例（国务院令第 724 号，第十、二十六、三十、三十一、三十二、四十一条）. ；全国人大常委会 (2021). 法律援助法（第三十一、四十二条）. + +### 3. If you can’t afford legal fees, apply for free legal aid – cases involving unpaid wages, alimony, or workplace injuries all qualify. + +- Cost: Zero. Legal aid costs nothing for those who receive it. +- In plain terms: If you’re trying to recover unpaid wages, claim alimony, secure social insurance or dibao benefits, or seek compensation after acting in defense of others, you’re eligible for free legal aid. Just call 12348 or visit your local legal aid center. Since 2022, you no longer need to return to your hometown to obtain proof of financial hardship – a simple, honest statement of your financial situation is enough. For defendants facing the death penalty, or those who are blind, deaf, mute, or minors, a lawyer is assigned regardless of their financial status. +- Benefit: The State Council’s regulations explicitly list six categories of civil cases covered by legal aid. They read: “Requests for state compensation; claims for social insurance or dibao benefits; applications for pensions or relief funds; demands for alimony, child support, or spousal maintenance; claims for unpaid labor wages; and cases involving civil rights resulting from acts of civic courage.” In short, this covers all the above situations. In criminal cases, defendants facing the death penalty, as well as blind, deaf, mute, and minor defendants, are all guaranteed a lawyer regardless of their financial standing. +- Evidence grade: A +- Notes: The Legal Aid Law took effect on January 1, 2022, introducing one key change: the requirement to submit proof of financial hardship has been removed. Now, a straightforward statement of one’s financial situation suffices – there’s no need to return to one’s hometown for documentation. Access points include local legal aid centers, public legal service hubs, or a call to 12348. +- Sources:国务院 (2003). 法律援助条例（国令第 385 号，第十条、第十一条、第十二条）. ；司法部有关负责人 (2021). 就贯彻实施法律援助法答记者问. + +### 4. When you have nowhere else to turn, go to a shelter – they provide food, lodging, and even a ticket home + +- Cost: There is no cost. You can go to your local civil affairs bureau or shelter on your own, or ask police or civil affairs officials to take you there. When you enter, you must truthfully provide your name and list any personal belongings. The hard part is mustering the courage to admit that you have no money and nowhere to stay. +- In plain terms: Shelters provide food and a place to stay; if you fall ill, they send you to a hospital and help you contact your family. Those who can’t afford a ticket home receive one. Generally, you may stay no longer than 10 days. Entry and departure are completely voluntary – it’s not a detention center, and no cash is handed out. Tickets are issued based on your household registration or current residence, so think carefully about where you want to go before you arrive. +- Benefit: Shelters supply food and lodging that meet basic hygiene standards. If you suddenly fall seriously ill while there, they arrange hospital treatment. They also help you reach out to relatives or employers. For those lacking funds to return to their hometown or current residence, they issue a travel voucher – essentially a bus or train ticket. Your “household registration” is your hometown, while “current residence” is wherever you’re living now. The maximum stay is usually 10 days, though extensions are possible if you’re awaiting family pickup, medical care, or other arrangements. Police and other government staff encountering homeless or begging individuals must inform them of this assistance option. Special care is given to disabled persons, minors, the elderly, and anyone with mobility issues – they are guided and escorted to the shelter (nationwide, since 2003). +- Evidence grade: A +- Notes: Entry and departure are entirely voluntary; this is not a detention center. Basic food and lodging are provided, but no cash is given. Travel vouchers are issued based on household registration or current residence – be sure to decide where you want to go before seeking help. +- Sources:国务院 (2003). 城市生活无着的流浪乞讨人员救助管理办法（国务院令第 381 号，第五、六、七条）. ；民政部 (2003). 城市生活无着的流浪乞讨人员救助管理办法实施细则（民政部令第 24 号，第十一、十二条）. + +### 5. Use free public employment services and gig platforms first — avoid paid agencies + +- Cost: No cost at all. Register at any public employment service agency at the county level or above — such as employment service centers or human resources markets. You can also register on local gig platforms. If you don’t know the address, call 12333 for help. +- In plain terms: Public agencies like employment service centers and human resources markets provide job matching, career guidance, policy advice, and both employment and unemployment registration — all completely free of charge. The law explicitly forbids them from charging for these services. Registering on gig platforms and posting job listings there is also free. Use this same registration to apply for unemployment benefits or to be recognized as someone facing employment difficulties. +- Benefit: The law guarantees that the following services must be provided at no cost: advice on employment policies; information on job openings and labor shortages; career guidance and job placement; processing of both employment and unemployment registration; and targeted employment assistance for people facing employment difficulties. These agencies are prohibited from engaging in any commercial activities, meaning they cannot profit from these services. Gig job postings and registrations are likewise offered to the public free of charge and are now part of the broader public employment information system. Special support is also provided to long-term unemployed workers and low-income gig workers (nationwide). +- Evidence grade: A +- Notes: Unemployment registration is a prerequisite for receiving unemployment benefits and for being recognized as someone facing employment difficulties — so be sure to complete it at the same time. For gig workers paid daily, verify the pay amount on the spot and keep the employer’s contact details and records of the work performed. +- Sources:全国人大常委会 (2007, 2015 修正). 就业促进法（第三十五条）. ；人力资源社会保障部等五部门 (2022). 关于加强零工市场建设 完善求职招聘服务的意见（人社部发〔2022〕38 号）. + +### 6. Apply for emergency assistance when unexpected crises occur + +- Cost: There is no cost. Simply submit an application to the township government or subdistrict office, explaining what happened at home — such as a fire, traffic accident, sudden serious illness of a family member, or an unexpected spike in essential expenses. After review and public notice, approval is granted by the county-level civil affairs bureau. Prepare documents according to the local checklist; usually one or two visits are required. +- In plain terms: If a sudden crisis strikes — like a fire, car crash, or a family member’s sudden serious illness — and it temporarily overwhelms your ability to cover basic living costs, you can apply for emergency assistance through the township government or subdistrict office. You do not need to already be a dibao recipient. Most often, a one-time payment is issued; the amount varies widely by region. +- Benefit: Two types of households qualify for this assistance. The first includes families facing sudden, unavoidable expenses — such as those caused by accidents or a family member’s sudden serious illness — who cannot afford even basic necessities like food, housing, or medical care. The second includes dibao households experiencing an unexpected rise in essential expenses that exceeds their capacity to pay. What kinds of expenses qualify and how much aid is given is determined and publicly announced by local governments at or above the county level (this nationwide system has been in place since 2014). +- Evidence grade: B +- Notes: You do not need to already be a dibao recipient. Usually a one-time payment is issued; exact amounts differ widely across regions and are set by local authorities each year. +- Sources:国务院 (2014, 2019 修订). 社会救助暂行办法（国务院令第 649 号，第四十七、四十八、四十九条）. + +### 7. Apply for dibao if your household income falls below the local threshold + +- Cost: There are no fees. Household members living together must submit a written application to the local township government or subdistrict office where the hukou is registered. If handling it yourself proves difficult, you may ask the villagers' committee or residents' committee to assist. Your household’s income and assets will be verified. Typically, you’ll need to make two to three trips, bringing along ID cards, hukou documents, and proof of income and assets. The main challenges are disclosing all your financial details for inspection and waiting for the public notice period to end. +- In plain terms: If the total household income divided by the number of members stays below the local dibao threshold and your family’s assets also meet the requirements, you can apply. As of late 2024, the average monthly dibao amount nationwide was 798.1 yuan per person in cities and 593.9 yuan per person in rural areas. Applications must be submitted at your hukou location. Owning property, a vehicle, or significant savings, or having children capable of supporting you, may disqualify you from receiving dibao. +- Benefit: Households whose per-capita income remains below the local dibao standard and whose assets comply with regulations are entitled to dibao payments. In late 2024, the average monthly dibao amount stood at 798.1 yuan per person in urban areas and 593.9 yuan per person in rural areas. Approximately 6.25 million urban residents and 33.615 million rural residents receive dibao benefits. The standard is set by multiplying the previous year’s per-capita consumer spending in the area by a fixed percentage, with periodic adjustments. In essence, it reflects how much residents typically spend per person in a given region (this figure varies by location across the country). +- Evidence grade: A +- Notes: Dibao serves as a final safety net; applications must be filed at your hukou location. Exceeding local asset limits or having children able to support you may result in a denial. Once approved, additional perks follow: financial assistance is available for basic medical insurance (see Item 9 for details), medical aid can be accessed (see Item 10), and legal aid is granted regardless of financial status (see Item 3). +- Sources:国务院 (2014, 2019 修订). 社会救助暂行办法（国务院令第 649 号，第九、十、十一条）. ；国家统计局 (2025). 社会事业向好发展 民生福祉不断增进——「十四五」以来社会民生统计报告. ；民政部等四部门 (2024). 关于进一步做好最低生活保障标准确定调整工作的指导意见（民发〔2024〕16 号）. + +### 8. Apply for the two disability subsidies using a disability certificate + +- Cost: There is no cost. Simply bring your disability certificate and submit one application at your local subdistrict or township office. +- In plain terms: Disabled individuals living in dibao households can receive a living subsidy. Those with a disability rating of level 1 or 2 who require long-term care are eligible for a care subsidy as well. Both subsidies may be claimed simultaneously. Each province sets its own amounts, which vary widely; check with your local office for exact figures. Bring your second-generation disability certificate and file one application at the subdistrict or township office. +- Benefit: The State Council has established these two subsidies. The first is the Living Subsidy for Disabled Persons in Need; it is intended for disabled individuals in dibao households, though local authorities may expand eligibility to low-income disabled persons and others in hardship if resources allow. The second is the Care Subsidy for Severely Disabled Persons, designated for those with a disability rating of level 1 or 2 who need ongoing care. Both subsidies may be received together. +- Evidence grade: A +- Notes: Provincial governments determine the subsidy amounts, which differ significantly across regions — ranging from just a few dozen to several hundred yuan per month. When applying, you must present a second-generation disability certificate. If you are unable to apply in person, a family member may do so on your behalf. +- Sources:国务院 (2015). 关于全面建立困难残疾人生活补贴和重度残疾人护理补贴制度的意见（国发〔2015〕52 号）. + +### 9. Don’t let your annual dibao payment lapse — it’s only 400 RMB per person. Eligible low‑income households may receive subsidies. + + +- Cost: Each individual must pay at least 400 RMB per year. This is the national standard for 2024 and 2025; local rates may be higher. Payments must be made during the designated annual enrollment window. Extremely disadvantaged residents receive full government funding, while those on dibao get a fixed subsidy from the state. +- In plain terms: On top of the 400 RMB personal contribution, the government adds roughly 700 RMB per person. The most vulnerable groups get the full amount covered; dibao recipients receive a set government subsidy. Letting the payment lapse carries a penalty: after enrollment outside the window or after a break in payments, there is a mandatory 3‑month waiting period before any benefits apply. For each additional year without continuous coverage, the waiting period increases by one month (starting 2025 nationwide). +- Benefit: Apart from the individual contribution, the state provides an extra subsidy of at least 670 RMB in 2024 and at least 700 RMB in 2025 (the 700 RMB figure comes from a national standard cited in a Hebei‑province document; the 2026 government report proposes a further 24 RMB increase). For dibao recipients and the most disadvantaged, any medical expenses not covered by yibao can be reimbursed at least 70 % through additional medical assistance. The main drawback of missing payments is the waiting period described above. +- Evidence grade: A +- Notes: The original text of the National Healthcare Security Administration’s 2025 notice (Document No. 2025‑22) is currently inaccessible; the 700 RMB figure is taken from a local document and remains to be confirmed. While receiving unemployment benefits, your employer‑based medical insurance is paid by the unemployment fund, so there is no need to enroll in dibao separately. +- Sources:国家医保局 (2024). 《关于做好 2024 年城乡居民基本医疗保障有关工作的通知》政策解读（医保发〔2024〕19 号）. ；河北省医疗保障局等 (2025). 关于做好 2025 年城乡居民基本医疗保障有关工作的通知（冀医保发〔2025〕6 号，地方文件）. ；国务院办公厅 (2021). 关于健全重特大疾病医疗保险和救助制度的意见（国办发〔2021〕42 号）. ；国务院办公厅 (2024). 关于健全基本医疗保险参保长效机制的指导意见（国办发〔2024〕38 号）. ；国家医保局 (2026). 2026 年政府工作报告提到这些医保工作. + +### 10. When suffering from a serious illness, first use yibao, dibao, medical assistance, and register for cross‑regional treatment — avoid online loans + + +- Cost: There is no expense involved. The steps must be followed in order. First, before being hospitalized in another province, register via the “National Medical Insurance Administration” WeChat official account using the “National Cross‑Regional Medical Registration” mini‑program. Second, settle the bill directly upon discharge. Third, if the remaining amount after reimbursement is still unaffordable, apply to the local township government or subdistrict office for medical assistance. Fourth, employed individuals are entitled to a medical leave period ranging from 3 to 24 months during which they cannot be dismissed; workers suffering from work‑related injuries should turn to workers’ compensation. Fifth, if credit‑card payments cannot be met, proactively negotiate a repayment plan with the bank. Sixth, as a last resort, use a personal fundraising platform authorized by the Civil Affairs Bureau. The required documents are mainly medical diagnoses, expense lists, and settlement statements; you will need to make 2–4 trips. The difficulty lies in having to handle all these procedures while ill. + +- In plain terms: The sequence is fixed. Before any cross‑provincial hospitalization, register through the “National Medical Insurance Administration” WeChat account; this allows direct settlement at discharge without paying the full amount upfront. If the post‑reimbursement cost remains high, apply for medical assistance at the township or subdistrict level. Employees are granted a medical leave period of 3–24 months based on seniority, during which they cannot be fired. Steer clear of online loans and high‑interest private borrowing. In total, 120 people have benefited from this system. + +- Benefit: The state groups basic medical insurance, dibao, and medical assistance into what is known as the “triple safety net,” each layer providing additional protection. Eligible low‑income and extremely vulnerable individuals receive at least 70 % coverage for qualifying medical expenses. Even those who are not originally poor but become financially strained by illness may apply for extra aid. Proper pre‑registration ensures immediate post‑discharge settlement without needing to pay out‑of‑pocket first. The medical leave period lasts 3–24 months depending on length of service; during this time employers must retain employment and pay at least 80 % of the local minimum wage. Injured workers enjoy a “work‑rest period” of up to 12 months with full salary and benefits maintained by the employer. Credit‑card borrowers facing unmanageable debt may negotiate a customized repayment schedule with the bank, extending payments up to five years; once agreed, the bank must cease collection efforts. Only platforms expressly designated by the State Council’s Civil Affairs Bureau may solicit online donations, and they must verify the authenticity of each request before disbursing funds directly to the applicant. + +- Evidence grade: A + +- Notes: The exact percentage of medical assistance and its annual cap are set locally by each insurance region. The “medical leave period” is defined as the span during which an employee cannot be terminated due to illness; it is divided into six tiers based on total and company‑specific tenure. After this period ends, termination becomes legally permissible, so it is wise to know which tier applies to you. Emergency patients also fall under the registration requirement, though the official site does not clarify whether such cases are automatically covered or require retroactive filing; contact your local insurer for clarification. High‑interest online loans and private usury are strictly discouraged; courts only protect debtors up to four times the one‑year LPR rate (see item 15). Any amount exceeding this limit remains legally owed, though pursuing litigation while ill is impractical. In cases of acute, life‑threatening illness, emergency care must be rendered regardless of ability to pay; such costs are covered by the Emergency Medical Assistance Fund (see section 24, item 9). The original text of Ministry of Labor Decree No. 309 (1995) is unavailable on the Ministry’s website; the cited content is reproduced from a provincial labor authority source. +- Sources:国务院办公厅 (2021). 关于健全重特大疾病医疗保险和救助制度的意见（国办发〔2021〕42 号）. ；国家医保局 (2025). 跨省异地就医如何直接报销？. ；劳动部 (1994). 企业职工患病或非因工负伤医疗期规定（劳部发〔1994〕479 号，第二、三条）. ；劳动部 (1995). 关于贯彻执行《劳动法》若干问题的意见（劳部发〔1995〕309 号，第 59 条）. （吉林省人社厅转载）；国务院 (2010 修订). 工伤保险条例（国务院令第 586 号，第三十、三十三条）. ；银监会 (2011). 商业银行信用卡业务监督管理办法（银监会令 2011 年第 2 号，第七十条）. ；全国人大常委会 (2023). 关于修改慈善法的决定（第一百二十四条）. ；民政部等五部门 (2024). 个人求助网络服务平台管理办法（令第 75 号，第三、十一、十三、十七条）. + +### 11. Replace a lost ID card immediately; get a temporary ID if you need it urgently + +- Cost: There is a statutory fee for issuing ID cards. The exact amount is set by national regulations and posted locally. You must apply at the police station in your area of permanent residence — just one visit is required. +- In plain terms: For standard replacements, the new ID card is issued within 60 days from the date you submit the application. If you need it right away, you can also request a temporary ID card on the spot; it is delivered within three days and remains valid for three months. Without an ID card, you cannot apply for jobs, rent housing, open bank accounts, or receive government benefits — it is a prerequisite for all such procedures. +- Benefit: Once you submit the application form for a resident ID card, authorities must issue the card within 60 days. During this period, if you urgently need identification, you may apply for a temporary ID card, which is issued within three days and valid for three months nationwide. +- Evidence grade: A +- Notes: Without an ID card, you cannot secure employment, rent housing, open bank accounts, or receive subsidies; it is a mandatory prerequisite for all related processes. The ID Card Law was amended in 2011; the text cited here is the version published in 2003, and current regulations apply. Whether you can apply in a location other than your registered residence depends on local police announcements. +- Sources:全国人大常委会 (2003). 居民身份证法（主席令第四号，第十二、二十条）. ；公安部 (2005). 临时居民身份证管理办法（公安部令第 78 号，第二、七、九、十二、十七条）. + +### 12. After registering as unemployed, seek recognition as a person facing employment difficulties to receive social insurance subsidies or placement in public-interest jobs + +- Cost: There is no cost involved. You simply apply for recognition at a local public employment service center in your neighborhood or community. Requirements vary by region, but typically include being of advanced age, unemployed for a long time, from a dibao-receiving household, disabled, or part of a zero-employment family. First, you must complete the unemployment registration process before applying. The main difficulty lies in verifying whether you meet each criterion individually, and you must pay social insurance premiums upfront. +- In plain terms: Once recognized, you can receive subsidies for your own social insurance contributions — generally up to two-thirds of what you actually pay, for a maximum period of three years. If you are hired by an employer or placed in a public-interest job, the employer also qualifies for subsidies covering its portion of social insurance costs. Wages for these public-interest positions are set at or near the local minimum wage. While pay is modest, these jobs provide social insurance coverage, making them ideal as a transitional step. Keep in mind that most social insurance subsidies are paid retroactively, meaning you must pay the premiums first. +- Benefit: After receiving this recognition, individuals who are unemployed and pay social insurance on their own (classified as flexible workers) become eligible for subsidies. These subsidies generally cover up to two-thirds of actual contributions, for a maximum duration of three years. If employed or placed in a public-interest job, employers also receive subsidies proportional to the pension, medical, and unemployment insurance premiums they pay. Public-interest jobs are positions created and funded by the government; their wages follow local minimum wage standards. The government gives priority placement in these roles to persons facing employment difficulties. Additionally, a one-time job-search subsidy is available to university graduates from dibao-receiving households, zero-employment families, or extremely impoverished backgrounds, as well as to disabled graduates and those who have taken national student loans. This subsidy is disbursed during the academic year in which they graduate (national framework; exact eligibility criteria and amounts are determined locally). +- Evidence grade: B +- Notes: Public-interest jobs offer modest wages but include social insurance benefits, making them suitable as a temporary solution. Most social insurance subsidies are paid after the fact, requiring upfront payment of premiums. For precise eligibility details, contact 12333 or your local neighborhood office. +- Sources:财政部、人力资源社会保障部 (2023 修订). 就业补助资金管理办法（财社〔2017〕164 号，2023 年 12 月修订印发）. ；全国人大常委会 (2007, 2015 修正). 就业促进法（第五十二、五十三条）. + +### 13. Apply for vocational training subsidies, employment internship subsidies, and social insurance subsidies during unemployment — don’t pay for training courses out of pocket + +- Cost: There is no direct cost. However, the training itself takes up a lot of your time. The real challenge is completing all required classes and earning the necessary certificates before you can receive any subsidies. +- In plain terms: You won’t have to pay for training at all. If you complete a qualifying course and obtain the required certificate, you can receive a vocational training subsidy — up to three times per person. Recent college graduates who haven’t found work within two years, as well as unemployed youth aged 16–24, may also join employment internships and receive basic living allowances during that time. First, check your local Human Resources and Social Security Bureau website for the “List of Eligible Vocational Training Subsidies” — don’t sign up for paid courses on your own. +- Benefit: According to regulations issued by the Ministry of Finance and the Human Resources and Social Security Bureau, specific funds are allocated specifically to support employment through various subsidy programs. Those who complete approved training and earn the required certificates may receive vocational training subsidies up to three times each. Individuals facing employment difficulties who pay their own social insurance premiums (as self-employed workers) may qualify for subsidies lasting up to three years; those within five years of retirement age may receive them until retirement. Recent graduates may get such subsidies for up to two years, while those hired by employers qualify for one year. Additionally, unemployed youth aged 16–24 and recent graduates without jobs may take part in employment internships and receive basic living allowances. +- Evidence grade: A +- Notes: Exact subsidy amounts and eligible programs vary by province; always consult the local Human Resources and Social Security Bureau website for the “List of Eligible Vocational Training Subsidies.” Special one-time job-seeking and entrepreneurship subsidies are also available for graduates from dibao-receiving families or zero-employment households, those with outstanding student loans, or individuals with disabilities. +- Sources:财政部、人力资源社会保障部 (2023). 就业补助资金管理办法（第五条、第七条、第十条）. + +### 14. Job hunting isn’t just about sending resumes — use a systematic approach: learn skills, set goals, and ask for help + +- Cost: There’s no monetary cost. You’ll need to spend 1–2 hours each day for several weeks. Paid courses aren’t necessary; free career counseling from public employment services works just as well. The real challenge is staying consistent day after day without anyone watching over you, and actually reaching out to others for help. +- In plain terms: When we combine data from 47 studies, people who took part in job-hunting coaching are 2.67 times more likely to land a job than those who didn’t. The most effective parts of this coaching are: learning concrete job-hunting techniques, clearly describing yourself, setting clear goals, taking proactive action, and asking others for help. The last point translates to asking friends or contacts for referrals and introductions. +- Benefit: A combined analysis of 47 peer-reviewed studies on job-hunting coaching — all of which used experimental or quasi-experimental designs with control groups — shows that participants in coaching programs are 2.67 times more likely to find employment than non-participants (OR 2.67). The key components of effective coaching are: teaching practical job-hunting skills, improving how individuals present themselves, boosting self-efficacy so they believe they can succeed, encouraging proactive behavior, setting specific goals, and fostering social support by prompting people to ask for help. Programs that combine skill-building with motivation tend to deliver the best results. +- Evidence grade: A +- Notes: Most of these studies were conducted in Europe and North America, and they involved structured group-based coaching programs. The findings here are extrapolations from those settings, not results from studies done in China. “Fostering social support” essentially means asking friends, family, or contacts to help with introductions and referrals — so don’t hesitate to reach out. +- Sources:Liu S, Huang JL, Wang M (2014). Effectiveness of job search interventions: a meta-analytic review. Psychological Bulletin 140(4): 1009–1041. + +### 15. No deposits, no ID retention, no “training loans”, no pyramid schemes, no usurious loans + +- Cost: Zero expense. If an employer or recruiter suggests “pay first before starting work”, “pay for training before placement”, or “recruit others to earn money”, reject it on the spot. Keep chat logs and any transfer receipts. The difficulty is that when money is tight, people may feel tempted to take the risk; saying “no” right away isn’t always easy. +- In plain terms: Employers are not allowed to keep your ID or other documents, nor demand any deposits or payments under any pretext. Violators must return all money and face fines ranging from 500 to 2000 yuan per person. If a job placement fails, recruitment agencies must refund any fees paid. “Training loans” that require upfront payment for training, as well as pyramid schemes that pay out based on recruiting new members, are both officially flagged as scams. For private loans, any interest exceeding four times the one‑year LPR is not enforceable by courts, though the principal must still be repaid. +- Benefit: Companies cannot retain your ID or other documents, cannot ask for guarantors, and cannot demand payments under any name. Breaching these rules results in mandatory repayment plus fines of at least 500 yuan and up to 2000 yuan per person. Recruitment agencies likewise must return all fees if they fail to place you. Schemes that pose as job offers but require you to pay training fees or take out loans are the so‑called “job‑to‑training” or “training loan” frauds highlighted by multiple government agencies. Pyramid schemes that pay commissions based on recruiting others and require upfront payments are illegal; participants can be fined up to 2000 yuan. Interest on private loans that exceeds four times the one‑year LPR at the time of signing is not legally binding. This new rule replaced the previous three‑tier system based on 24% and 36% thresholds (nationwide, effective August 2020). +- Evidence grade: A +- Notes: Four times the LPR is the maximum interest rate courts will protect; it does not mean the principal can be waived. The principal must still be repaid. This judicial interpretation was amended again in December 2020, so the current article numbers apply. When money is urgently needed, people are especially vulnerable to these schemes. Instead, use the legitimate channels mentioned earlier in this section: unemployment benefits, labor‑inspection complaints, legal aid, shelters, or emergency assistance. +- Sources:全国人大常委会 (2007). 劳动合同法（主席令第六十五号，第九、八十四条）. ；劳动保障部 (2007). 就业服务与就业管理规定（劳动保障部令第 28 号，第十四、五十五、五十八条）. ；人力资源社会保障部等五部门 (2026). 警惕「招转培」「培训贷」等风险提示. ；国务院 (2005). 禁止传销条例（国务院令第 444 号，第二、七、二十四条）. ；最高人民法院 (2020). 关于修改《关于审理民间借贷案件适用法律若干问题的规定》的决定（法释〔2020〕6 号，第二十六条）. ；最高人民法院 (2020). 民间借贷利率司法保护上限调整为「一年期 LPR 的 4 倍」. + +### 16. Public rental housing for those with housing difficulties + +- Cost: There is no fee to apply. You must submit documents to the local housing authority and provide written consent for them to verify the information you provide. If any documents are missing, they will inform you of what needs to be added at once. The waiting period for housing allocation is called the “waiting queue period,” which generally does not exceed five years. +- In plain terms: You must meet three criteria simultaneously: you must have no housing locally, or your living space must fall below the required standard; your income and assets must also be below the set limits; and migrant workers must have held steady employment locally for a minimum period as stipulated. The exact waiting queue period is announced by local authorities. This is a long-term solution that won’t provide immediate relief, but signing up costs nothing, and the earlier you apply, the sooner you may be called. +- Benefit: Those who satisfy all three conditions are eligible to apply. First, they must have no housing locally or live in a space smaller than the legal minimum. Second, their income and assets must remain below the prescribed limits. Third, migrant workers must have maintained stable employment locally for the required length of time. Specific criteria are determined and published by housing authorities in municipalities and counties. Individuals placed on the waiting list are referred to as “waiting queue candidates,” and housing authorities are obligated to assign them a dwelling within the waiting queue period. (This is a nationwide framework; exact eligibility rules and rental rates are set locally, effective since 2012.) +- Evidence grade: B +- Notes: While this is a long-term solution that won’t provide immediate relief, signing up costs nothing, and the earlier you apply, the sooner you may be called. Various other types of subsidized housing also exist locally, each with its own rules; please consult your local housing authority’s official website for details. +- Sources:住房和城乡建设部 (2012). 公共租赁住房管理办法（住房和城乡建设部令第 11 号，第七、八、十条）. + +### 17. Keep food and housing costs to a minimum: opt for monthly shared housing instead of daily rentals, and cook at home or use senior meal services rather than ordering takeout. + +- Cost: Finding a place to live takes 1–3 days. The security deposit is usually equal to one month’s rent (a rough estimate by the author). Cooking at home requires 30–60 minutes each day; the real challenge is resisting the urge to order takeout every day. +- In plain terms: In 2025, food accounted for 29.3% and housing for 21.7% of average national per‑person spending — together they make up over half of total expenses, so cutting these two categories yields the biggest savings. Based on the author’s experience, monthly rent for shared housing is cheaper than daily rentals, and cooking at home is less costly than ordering food. When job hunting, ask whether housing and meals are provided; such positions effectively eliminate these major expenses. +- Benefit: In 2025, the average annual per‑person expenditure nationwide was 29,476 yuan. Of this amount, 8,631 yuan went toward food and alcohol, representing 29.3%. Housing costs totaled 6,397 yuan, or 21.7%. These two items together account for more than half of all spending, underscoring their importance for cost reduction. Senior meal services are available to all older adults and include community kitchens, dining tables, and meal assistance points; additional subsidies are offered to those in need. As a reference point, as of 1 January 2026 the lowest first‑tier monthly minimum wage was 2,080 yuan in Qinghai, while the highest was 2,740 yuan in Shanghai (national figures for 2025–2026). +- Evidence grade: B +- Notes: Monthly rent for daily rentals is considerably higher than for shared housing; this is based on personal experience rather than official statistics. Availability and pricing of senior meal services for non‑seniors vary by region. When seeking employment, be sure to ask whether housing and meals are included; such positions can effectively eliminate these major expenses. The original Ministry of Human Resources and Social Security table is inaccessible; the figures cited here are taken from a republished page by the Sichuan Provincial Department of Human Resources and Social Security. +- Sources:国家统计局 (2026). 2025 年居民收入和消费支出情况. ；民政部等十一部门 (2023). 积极发展老年助餐服务行动方案（民发〔2023〕58 号）. ；四川省人力资源和社会保障厅 (2026). 全国各省、自治区、直辖市最低工资标准情况（截至 2026 年 1 月 1 日，转载人社部官网表）. + +### 18. Don’t panic if your social insurance lapses: pension is calculated cumulatively, medical insurance is restored per rules + +- Cost: No cost at all. Residents can pay for pension and medical insurance on an annual basis. If you’re an employee and your coverage lapses, there’s no need to spend money on third‑party “affiliation” services just to keep the record intact. +- In plain terms: Pension benefits are based on total years of contribution, not on continuous service. A break in payments doesn’t reset the count; once you’ve accumulated at least 15 years by retirement age, you’ll receive monthly payments. Employees who have met the required contribution period no longer need to pay for medical insurance after retirement. Exact thresholds vary by region, so call 12393 for details in your area. The only real impact of a lapse is on eligibility for local programs that demand uninterrupted contributions, such as home‑buying, residency registration, or points‑based incentives. +- Benefit: Basic pension is calculated from the total years of contribution; gaps in payment do not erase prior credits. At retirement, anyone with at least 15 years of cumulative contributions qualifies for a regular pension. Those short of the mark can keep paying until they reach it. If you change jobs across different administrative regions, your pension record travels with you and continues to accrue. Employees who meet the national minimum contribution period for medical insurance are exempt from further payments after retirement. For residents, a lapse triggers a waiting period: after resuming payments, there’s a temporary window during which medical expenses won’t be reimbursed (see item 9 for details; nationwide). +- Evidence grade: A +- Notes: The “national minimum period” required to stop paying employee medical insurance after retirement is defined by law, but exact figures differ by region and sometimes by gender. Contact 12393 or your local medical‑insurance bureau for precise numbers. Lapses mainly affect local eligibility criteria that demand continuous contributions — e.g., purchasing property, obtaining residency, or earning points — each of which is set independently by local authorities. Paying third parties to maintain your affiliation can waste money and carries legal risks; it’s not advisable. +- Sources:全国人大常委会 (2010, 2018 修正). 社会保险法（第十六、十九、二十七条）. ；国务院办公厅 (2024). 关于健全基本医疗保险参保长效机制的指导意见（国办发〔2024〕38 号）. + +### 19. Even those who have served time, filed for bankruptcy, or ended up on a blacklist still have legal avenues to start over — provided they complete all required procedures. + + +- Cost: There are no processing fees. Former inmates must register at their local judicial office or community center to apply for reintegration assistance from the government. Those on a default judgment list must settle all debts before requesting removal from the list via the court. In Shenzhen, individuals who have contributed to social insurance for at least three years may file for personal bankruptcy. Each step involves paperwork, interviews, and a monitoring period lasting one to three years. The main challenge is repeatedly explaining one’s past to officials while enduring the waiting period. + +- In plain terms: Former inmates cannot be discriminated against regarding employment, education, or social insurance; the government must provide support to those in need. If a person was under 18 at the time of the crime and received a sentence of five years or less, their record is sealed, so they need not disclose it when joining the military or applying for jobs. The blacklist stays active for two years; once debts are paid, courts must remove the name within three working days. Adults, however, cannot have their criminal records sealed and must disclose them when enlisting or seeking employment. + +- Benefit: Former inmates are entitled to equal rights under the law, including non-discrimination in employment, education, and social insurance. Those facing hardship receive government assistance and reintegration services (as stipulated by the revised Prison Law effective 1 November 2026). Central directives from 2010 call for enhanced vocational training and inclusion in social aid programs for this group, plus establishment of transitional support centers. Minors under 18 with sentences under five years have sealed records; proof of no criminal record can be issued within three days upon request. The blacklist remains for two years, and removal follows promptly after debt settlement. Shenzhen’s Personal Bankruptcy Regulations offer a unique pathway: after three years of compliance, remaining debts may be forgiven. Business entities facing insolvency can pursue restructuring, settlement, or liquidation, thereby discharging obligations (this applies nationwide; personal bankruptcy is currently limited to Shenzhen). + +- Evidence grade: A + +- Notes: This summary does not downplay reality: adult criminal records cannot be sealed, and Article 100 of the Criminal Law mandates disclosure when enlisting or seeking employment. Certain professions such as civil servants, judges, lawyers, and teachers face additional restrictions, which remain unchanged. The cited Prison Law provisions correspond to Articles 37 and 38 as of 1 November 2026; exact wording may vary slightly. Guidance from Central Document No. 5 (2010) is referenced as republished by local authorities. During the bankruptcy monitoring period, individuals may not travel first class, engage in excessive spending, or purchase property; eight categories of debt, including personal injury compensation, remain non‑forgivable. Fraudulent bankruptcy claims may be revoked. Removal from a default judgment list does not automatically clear credit histories, as these are separate systems. +- Sources:全国人大常委会 (2026). 监狱法（2026 年修订，第五十九、六十、六十二条）. ；中共中央办公厅、国务院办公厅 (2010). 转发《中央社会治安综合治理委员会关于进一步加强刑满释放解除劳教人员安置帮教工作的意见》的通知（中办发〔2010〕5 号）. （益阳市资阳区政府转载）；全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第二百八十六条）. ；最高人民法院、最高人民检察院、公安部、司法部 (2022). 关于未成年人犯罪记录封存的实施办法（第九、十五条）. （湖南省公安厅转载）；最高人民法院 (2017 修正). 关于公布失信被执行人名单信息的若干规定（第二、十条）. ；深圳市人大常委会 (2020). 深圳经济特区个人破产条例（第二、二十三、九十五、九十七、一百零三条）. ；全国人大常委会 (2006). 企业破产法（主席令第五十四号，第二、七条）. + +### 20. Before facing a serious illness, consider adding a one‑year medical or critical‑illness policy to your basic medical insurance; make sure it includes the phrase “guaranteed renewal”. + + +- Cost: For young people, a one‑year expense‑reimbursement medical policy costs only a few hundred yuan per year. Expense‑reimbursement policies pay out based on the actual medical costs you incur. A critical‑illness policy starts at a few thousand yuan annually (these figures are rough estimates by the author; no official data are available). Before purchasing, you must honestly disclose your health status; this process takes about half an hour. + +- In plain terms: These policies cover the portion of medical expenses that your yibao (basic medical insurance) does not pay, as well as any income lost while you’re unable to work. When shopping for a policy, look for the exact wording “guaranteed renewal”; without it, the plan may be discontinued or its price raised the following year. Be truthful about your health history — any concealment can lead to a denial of claims. First, make sure you’re enrolled in basic medical insurance; then you can consider this extra coverage. + +- Benefit: Regulatory authorities classify such products into two main types. Medical insurance reimburses you for actual medical expenses, while critical‑illness insurance pays a predetermined lump sum upon diagnosis of a covered disease. Both types are meant to cover the out‑of‑pocket costs after yibao payments and any loss of earnings. Policies with a term of one year or less that lack a “guaranteed renewal” clause are considered short‑term health insurance; those lasting longer or explicitly offering guaranteed renewal qualify as long‑term health insurance. “Guaranteed renewal” means the insurer must continue coverage under the same terms and at the same rate when the policy renews. Insurers are prohibited from encouraging the same individual to buy multiple expense‑reimbursement policies, as only one claim can be filed per expense. The definitions of diseases covered by critical‑illness policies follow industry standards, which list 28 severe conditions and three milder ones; malignant tumors, acute myocardial infarction, and post‑stroke sequelae are among the core conditions (national standards effective from 2019‑2020). + +- Evidence grade: B + +- Notes: This recommendation is rated B because official sources provide only definitions and regulatory rules, without concrete figures on how much money can be saved by purchasing such policies. “Million‑yuan medical insurance” is a marketing term; legally it falls under short‑term health insurance. Plans lacking a “guaranteed renewal” clause may be withdrawn or become more expensive next year — be sure to verify this wording in the contract. You cannot receive double reimbursement for the same expense under two separate expense‑reimbursement policies, so avoid buying two such plans. If you already have a pre‑existing condition and fail to disclose it, claims will likely be denied. First, enroll in the residential medical insurance described in item 9; then you can consider this additional coverage. The disease‑definition standards are issued by industry associations under the guidance of the China Banking and Insurance Regulatory Commission, not by government decree. +- Sources:银保监会 (2019). 健康保险管理办法（银保监会令 2019 年第 3 号，第二、四、四十一条）. ；中国保险行业协会、中国医师协会 (2020). 重大疾病保险的疾病定义使用规范（2020 年修订版）答记者问. ；银保监会 (2020). 关于使用《中国人身保险业重大疾病经验发生率表（2020）》有关事项的通知（银保监发〔2020〕51 号）. + +### 21. If there’s nowhere else to sleep, 24‑hour venues can only serve as a temporary overnight stop; shelters should be the first choice. + + +- Cost: Waiting areas at airports and train stations are usually free. Fast‑food restaurants and internet cafés require some spending. Sleep is often restless, and there’s a risk of theft. The real challenge is staying awake all night. +- In plain terms: Airports and train stations can provide a place to spend the night; they have restrooms and power outlets. Yet no official data confirms they’re safe. Keep valuables close, decline food or drinks from strangers, and avoid isolated corners. It’s unsafe to sleep under bridges, by rivers, or at construction sites at night. Shelters offer free food and lodging — go there first. +- Benefit: These venues allow you to get through the night; you’ll have access to restrooms and charging options. No official statistics are available. +- Evidence grade: C +- Notes: Safety risks are real. Keep belongings on your person, refuse drinks or food from strangers, and steer clear of secluded areas. Never camp out under bridges, by rivers, or at construction sites at night — extreme weather can be fatal. As noted in point 4, shelters provide free food and lodging; make them your priority. Some locations conduct midnight clear‑outs, so avoid confrontations with security staff. +- Sources:作者经验，无官方文件 diff --git a/book/en/08-Do-Not-End-Up-Inside.md b/book/en/08-Do-Not-End-Up-Inside.md new file mode 100644 index 00000000..288c66f9 --- /dev/null +++ b/book/en/08-Do-Not-End-Up-Inside.md @@ -0,0 +1,491 @@ +# 8. Protect yourself: legal rights and property safety + +This section deals with money and personal freedom rather than life expectancy. It covers three main points: what legal responsibilities you must fulfill, how much compensation you can avoid by following those rules, and what procedural rights you have if something goes wrong. All clause numbers have been cross‑checked against the official texts. The items are ordered so that those with the biggest potential losses and the easiest preventive measures appear first; items that require advance planning come next; finally, those based purely on experience without any official backing are listed last. +### 1. After a traffic accident, stop, help the injured, and call the police — don’t flee + +- Cost: No cost at all. Stopping, turning on hazard lights, helping the injured, and calling the police will take at most one or two hours. In minor accidents where no one is hurt and both parties agree on what happened, you can first take photos, then note down the other driver’s name, phone number, license plate, driver’s license number, insurance policy number, and the damaged parts of the vehicles. After both parties sign a statement, they may leave the scene and later negotiate a settlement. +- In plain terms: If you flee the scene, you are automatically considered fully responsible for the accident. Your driver’s license will be revoked, and you won’t be allowed to retake the test for life. More practically, both collision damage coverage and third‑party liability insurance will not pay any claims related to fleeing — you’d have to cover hundreds of thousands of dollars out of pocket. Staying on the scene to help and call the police only takes a couple of hours. +- Benefit: The person who flees bears full responsibility for the accident. Only if you can prove the other driver also acted negligently might that responsibility be reduced. Fleeing also results in license revocation for life. If the incident meets the criteria for a traffic‑related crime, fleeing can lead to a sentence of 3 to 7 years; if someone dies because of it, the sentence rises to more than 7 years. Insurance won’t help either: both collision damage coverage and third‑party liability policies exclude any claims arising from “hit‑and‑run,” “intentional tampering with or falsifying the scene,” or “destruction of evidence,” leaving you responsible for any compensation costs (nationwide). +- Evidence grade: A +- Notes: If anyone is injured, first provide aid and then call the police. If moving vehicles or people is necessary to help, mark their original positions first. Even if you feel no impact after a minor collision and drive away, that can still be classified as fleeing — when in doubt, call the police. The insurance information cited comes from standard industry clauses; the actual coverage you receive depends on the specific terms of your own policy. +- Sources:全国人大常委会 (2021). 道路交通安全法（2021 年修订，第七十、一百零一条）. （北京市公安交通管理局转载）；国务院 (2017). 道路交通安全法实施条例（国务院令第 405 号，2017 年修订，第八十六、九十二条）. ；全国人大 (1997). 刑法（第一百三十三条）. ；中国保险行业协会 (2020). 机动车商业保险示范条款（2020 版）（第九、二十二条）. + +### 2. If you realize you’ve been scammed, call 110 or 96110 right away to request a stop‑payment — don’t try to investigate on your own first. + + +- Cost: No cost at all. Just make one call, clearly stating the time of the transfer, the amount, and the scammer’s account number. Keep screenshots of the transfer and any chat records. + +- In plain terms: The brief period right after money is sent is the only window of opportunity. During this time police can issue an emergency stop‑payment order and quickly freeze the funds; banks are required to comply. Once the money has been moved through multiple accounts and scattered, it becomes almost impossible to recover. Therefore, call 110 or 96110 immediately — don’t waste time investigating or asking questions on your own. Calls to 96110 come from police officers trying to warn you, so be sure to answer them. + +- Benefit: Law enforcement has the authority to instantly query, urgently stop‑pay, and swiftly freeze any funds linked to a scam. Banks and payment services must cooperate. Once frozen, those funds are returned to victims according to established procedures. The sooner a stop‑payment is ordered, the higher the chance of recovery; after the money has been dispersed, success rates drop dramatically. 96110 is the nationwide anti‑fraud hotline; calls from this number are police warnings, so you must answer them. (Nationwide, effective December 2022) + +- Evidence grade: A + +- Notes: Anyone claiming to be from police, prosecutors, or courts and asking you to transfer money to a “secure account” is running a scam. The law merely mandates the creation of a stop‑payment and freezing mechanism so banks can hold the funds. How much can be recovered depends on whether the money is still in the account at the time you report it. Information about the “National Anti‑Fraud Center” app and 96110 is taken from a Fujian Provincial Public Security Department page; the original page on the Ministry of Public Security’s site cannot be accessed. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第二十、三十四条）. ；福建省公安厅 (2023). 96110 来电，请务必接听. （省级公安机关页面） + +### 3. Remember the anti-fraud golden rules: don’t trust unsolicited calls, never share personal information, avoid clicking on links, and always verify before transferring money. All seven of the most common scams follow this same pattern. + +- Cost: No cost at all. Just memorize the “three no’s and one extra check” rule, read through the descriptions of the seven scam types below, and install the “National Anti-Fraud Center” app. Make sure to answer all calls from 96110. If someone asks you to transfer money, share your screen, download an unknown app, click a link, or provide a verification code, hang up first and then call the official hotline to verify. The hard part is that scammers often pressure you to act immediately — you must resist this pressure and hang up first. +- In plain terms: If someone asks you to transfer money, share your screen, download an unknown app, click a link, or provide a verification code, hang up first and then call back using an official number to verify. The seven most common scam types are fake job offers with promised returns, fraudulent investment schemes, online loan scams, impersonation of customer service agents, impersonation of police, procuratorate, or court officials, romance scams, and fake task-based payment scams. They all share one thing in common: they ask you to send money, pay fees, or share your screen first. Spotting them in advance is far cheaper than trying to get your money back after the fact. +- Benefit: Laws require government agencies and relevant departments to educate the public about common tactics used in telecom and online fraud. Public security authorities, together with financial, telecom, and internet regulators, have set up a warning and prevention system to intervene when someone is at risk of being scammed. 96110 is the nationwide hotline for this service — make sure to answer calls from it. The Fujian Provincial Public Security Department has broken down the identifying features of each scam type. For fake job offers: “Anyone asking you to earn money this way is likely trying to take your money; they won’t refund your principal until you complete all tasks.” For fraudulent investments: “Fake users in chat groups post fake earnings records; they give small returns at first to encourage bigger investments, then demand ‘taxes’ before allowing withdrawals.” For online loans: “Legitimate loans never require upfront fees or bank transaction records; any offer asking for these is a scam.” For fake customer service: “They claim you have an active membership that will incur automatic charges and hurt your credit score, then pressure you to transfer money to cancel it.” For fake law enforcement: “No law enforcement agency has any so-called ‘safe accounts’; any ‘police, procuratorate, or court officials’ contacting you via phone, QQ, WeChat, or online to conduct investigations or take statements are scammers.” For romance scams: “Never trust a ‘partner’ you’ve never met in person, only seen via photos or video; if they always have urgent reasons to ask for money, it’s a scam.” For fake task-based payment scams: “They arrange a face-to-face meeting first, then ask you to complete ‘tasks’ — the more money you pay, the more they demand.” Spotting these scams early is far cheaper than trying to reverse unauthorized transfers later; how much money you can get back depends on whether it’s still in your account when you report it. For instructions on how to request a reversal, see item 2 (call 110 or 96110 to request a stop on the transfer). (Nationwide, effective since December 2022) +- Evidence grade: B +- Notes: Scammers posing as law enforcement, customer service agents, bosses, or platform risk control staff, asking you to “cooperate with an investigation”, “cancel a membership”, “complete fake task-based payments for promised returns”, or “access insider investment opportunities” all follow the same basic pattern with just different details. Legitimate loans never require upfront fees, and no law enforcement agency has any “safe accounts” — remembering these two facts alone can protect you from most scams. This item is rated B because the “three no’s and one extra check” rule is only an official promotional slogan, with no concrete statistics showing how much it reduces scam victimization. The official MPS website (mps.gov.cn) could not be accessed during this verification; both the rule and the list of seven scam types are taken from pages run by provincial public security departments. TODO: Need to verify whether the Ministry of Public Security or the National Anti-Fraud Center has released official statistics on the prevalence and proportion of these scam types. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第八、二十、三十四条）. ；福建省公安厅 (2023). 96110 来电，请务必接听. （省级公安机关页面，含「来电不轻信，信息不透露，链接不点击，转账多核实」口诀及「警惕 192 开头的诈骗电话」提示）；福建省公安厅 (2023 到 2024). 识骗技巧专栏：刷单 ；投资理财 ；贷款 ；冒充客服 ；冒充公检法 ；杀猪盘 ；色诱刷单 + +### 4. Seeing a face on video or hearing a voice on the phone does not count as verification; if a transfer is involved, hang up first and call back using an old number saved in your contacts. + + +- Cost: No cost involved. It only requires making one extra call and waiting a few extra minutes. In general, avoid posting videos of your face or long voice recordings on public accounts. The hard part is that scammers often pressure you to act quickly — you must resist the urge to transfer money right away. + +- In plain terms: Seeing someone’s face or hearing their voice is not reliable proof of identity. Whenever money transfer is mentioned, hang up immediately and call back using an old number stored in your contacts, or ask someone you both know. If the caller claims “poor signal” or “I’m in a meeting” and refuses a live video chat, treat it as a scam. + +- Benefit: The Cybersecurity Bureau of the Ministry of Public Security has outlined three key measures. First is motion verification: ask the other party to perform a smooth head-turn motion, or to completely cover their face with a palm and then remove it quickly. The original text notes that current AI technology still struggles to accurately simulate such complex facial occlusions and lighting changes, often resulting in choppy, blurry, or distorted images. Second is listening for audio cues: AI-generated voices sometimes lack natural breathing pauses or emotional variation, and may sound slightly mechanical or contain unusual background noise. Third and most important is cross-channel verification. As stated in the source material, “after hanging up, immediately call a number the person regularly uses and you recognize — do not call back the suspicious number — or ask a mutual acquaintance for confirmation.” The rule of thumb is: “Don’t trust video or voice alone; verify through actions and multiple channels.” Legally, using face-swapping or voice-cloning technology for fraud is strictly prohibited. Platforms must clearly label any service offering face generation, replacement, voice synthesis, or voice imitation; no organization or individual may remove, alter, or hide such labels. However, since scammers rarely follow these rules, the absence of a label cannot be taken as proof that the caller is genuine. The Criminal Investigation Bureau reported one case where a 14-member gang produced over 50,000 synthetic face videos and collected more than 500,000 pieces of personal information; police also seized 60 cloud servers nationwide. This labeling requirement took effect on September 1, 2025. + +- Evidence grade: B + +- Notes: Always use an old number saved in your contacts when calling back — never dial the number shown on the incoming call or any new number the scammer provides. If the caller cites “poor signal” or “a meeting” to avoid a live video or motion test, assume it is a scam. Motion verification is only a supplementary tool; since AI capabilities keep improving, the only truly reliable step remains cross-channel confirmation. If money has already been transferred, refer to section 2 of this chapter and call 110 immediately to request a stop on the payment. For information on protecting your own facial and voice data, see section 14. This item is rated B because official sources provide identification methods and case examples, but no statistics are given on how much these measures actually reduce fraud rates. The main Ministry of Public Security website (mps.gov.cn) remains inaccessible due to a 521 error; the quoted texts from the Cybersecurity Bureau and Criminal Investigation Bureau were taken from a republishing page run by the Fujian Provincial Public Security Department. +- Sources:公安部网安局 (2025). 眼见≠为实，警惕 AI 新型诈骗！（福建省公安厅转载）；国家互联网信息办公室、工业和信息化部、公安部 (2022). 互联网信息服务深度合成管理规定（第六、十六、十七条，2023 年 1 月 10 日施行）. ；国家互联网信息办公室、工业和信息化部、公安部、国家广播电视总局 (2025). 人工智能生成合成内容标识办法（第十条，2025 年 9 月 1 日施行）. ；公安部刑侦局、央视新闻 (2026). 警方查获 5 万多条合成动态人脸视频 谁在「复制」你的脸？（福建省公安厅转载） + +### 5. If accused or summoned, hire a lawyer first — don’t settle privately or delete records + +- Cost: Legal fees start at several thousand yuan. Those with financial difficulties can apply to legal aid agencies for a free lawyer. When questioned, answer only questions relevant to the case; leave the rest to your lawyer. The hard part is staying calm on the spot and resisting the urge to explain everything yourself. +- In plain terms: You can hire a lawyer right from the first time you’re called in for questioning. If the lawyer requests a meeting, the detention center must arrange it within 48 hours, and those talks cannot be monitored. You’re allowed to refuse answering any questions unrelated to the case. +- Benefit: Starting from the first interrogation or from the moment you’re placed under compulsory measures restricting your freedom, you have the right to appoint a lawyer. While the case remains under police investigation, only lawyers may represent you — no one else can serve as a defense counsel. Upon a lawyer’s request, the detention center must arrange a meeting within 48 hours, and such meetings are not monitored. No one may be forced to confess guilt, and you may refuse answering questions unrelated to the case. A summons or compulsory appearance lasts at most 12 hours; for especially serious and complex cases, this limit extends to 24 hours. A summons merely notifies you to come for questioning, while compulsory appearance means you’re physically taken there. Repeated summonses must not be used to detain someone indefinitely. Anyone fabricating facts to falsely accuse another and seeking criminal punishment for them faces up to three years in prison; if serious harm results, the sentence rises to three to ten years. If charges are dropped, prosecution is refused, or a court acquits you after detention or arrest, you may claim state compensation calculated daily based on the previous year’s national average wage for workers. +- Evidence grade: A +- Notes: Do not attempt to settle privately with the other party or contact their family members. Any “private settlement” may be interpreted as admitting guilt. Chat logs, call records, and travel histories serve as proof of your innocence; deleting them removes your own evidence. If a report or accusation later proves unfounded, this does not constitute false accusation or entrapment. This rule applies equally to all accused individuals regardless of gender. For further details, see Section 33 (punishing those who fabricate facts), Section 34 (acquittal when evidence is insufficient and subsequent appeals), and Section 35 (daily state compensation after unlawful detention). +- Sources:全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第三十四、三十五、三十九、五十二、一百一十九、一百二十条）. ；全国人大 (1997). 刑法（第二百四十三条）. ；全国人大常委会 (2012). 国家赔偿法（2012 年修正，第十七、三十三条）. （国家统计局转载） + +### 6. Coming forward voluntarily after an incident: Self‑surrender can cut a sentence by up to 40%, and the “statute of limitations” defense simply does not exist + + +- Cost: There is no cost at all. You can walk into a police station, stay on the scene and call the authorities, then tell them exactly what happened. The hard part is resisting the urge to “wait and see — maybe no one will notice.” + +- In plain terms: Voluntarily surrendering can reduce a prison term by up to 40%; for less serious offenses it may even lead to no punishment at all. If you confess only after being caught, the reduction is capped at 20%. Running away or denying responsibility yields no benefit. Relying on the statute of limitations to get off scot‑free is impossible: once a case is officially opened, the time you spend evading authorities does not count toward that limit. The relevant sentencing rules have been in effect since 2021. + +- Benefit: Article 67 of the Criminal Law states that anyone who voluntarily surrenders and truthfully confesses their crime receives a lighter or reduced sentence; those guilty of minor offenses may be exempted entirely. Even without surrender, a sincere confession can still earn a penalty cut; if it prevents especially grave consequences, the reduction can be even greater. Official sentencing guidelines set clear percentage ranges: voluntary surrender can lower the baseline sentence by up to 40% (or more for minor crimes), while a simple confession brings a reduction of up to 20%. Additional factors such as admitting to related, un‑discovered crimes or averting serious harm can add another 10‑50% cut. Plea agreements also grant up to 30% relief, and when combined with surrender, restitution, compensation and other mitigating circumstances the total reduction may exceed 60% (or even lead to full exemption for minor offenses). Conversely, the statute of limitations is divided into four tiers — 5, 10, 15 and 20 years — based on the maximum possible penalty (Article 87). However, Article 88 explicitly states that once an investigation or prosecution is underway, any attempt to evade it renders the time spent in hiding irrelevant; the clock never stops. + +- Evidence grade: A + +- Notes: The primary beneficiary of this provision is the offender himself. Self‑surrender is a mitigating factor, not a blanket pardon; the exact reduction is left to judicial discretion, and stricter limits apply to violent and drug‑related crimes. Traffic‑accident cases follow a separate rule: staying at the scene, rendering aid and reporting the incident counts as voluntary surrender, yet because these actions are legally required, the permissible reduction is limited. Even if a driver flees first and later turns himself in, he still qualifies as a surrenderer; the baseline sentence used for calculation is the higher statutory maximum, and the subsequent reduction follows the same percentages described above (see Section 1 for proper post‑accident conduct: stop, help, call police). Consulting a lawyer does not conflict with a truthful confession; the attorney’s role is to verify that the written statement accurately reflects the facts, not to help fabricate a story. +- Sources:全国人大. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第六十七、八十七、八十八条. ；最高人民法院、最高人民检察院 (2021). 关于常见犯罪的量刑指导意见（试行）（法发〔2021〕21 号，2021 年 7 月 1 日施行）三（六）（七）（十四）. 甘肃省张掖市人民检察院转载全文. ；最高人民法院 (2010). 关于处理自首和立功若干具体问题的意见（法发〔2010〕60 号）一. 最高人民法院公报. + +### 7. Don’t touch the steering wheel after drinking — even for e‑bikes or “just moving the car a bit” + +- Cost: Using a designated driver or taking a taxi costs only a few dozen yuan. Agree in advance who won’t drink at any gathering. It can be hard to politely refuse when others keep offering drinks. +- In plain terms: Driving after drinking results in a 6‑month suspension of your license and a fine of 1,000–2,000 yuan. A second offense brings up to 10 days in jail and permanent license revocation. Drunk driving leads to immediate license cancellation; you can’t reapply for 5 years and may face criminal charges for dangerous driving, leaving a criminal record that affects background checks and certain jobs. Auto insurance won’t cover any claims: once you’ve been drinking, your policy becomes void. Even “just moving the car a bit” counts as driving. +- Benefit: Temporary suspension of the license for 6 months and a fine ranging from 1,000 to 2,000 yuan for driving after drinking. Repeat offenders face up to 10 days in jail and permanent license revocation. Drunk driving results in immediate license cancellation; reapplication is prohibited for 5 years, and criminal liability for dangerous driving is pursued, leading to imprisonment and monetary penalties. For commercial drivers the penalties are harsher: 15 days in jail, a 5,000‑yuan fine, and a 5‑year ban on driving commercially; drunk driving entails a 10‑year ban, after which they can never drive commercially again. If drinking or being drunk leads to a major accident and a criminal conviction, driving privileges are revoked for life. Commercial auto insurance policies explicitly exclude any claims arising from driving under the influence of alcohol or drugs (nationwide). +- Evidence grade: A +- Notes: Drunk driving is a criminal offense that leaves a permanent record, affecting both background checks and eligibility for certain professions. The distinction between “drinking” and “being drunk” is defined by blood alcohol concentration levels set by national standards; this section does not verify those exact figures, so don’t guess where you fall on that scale. +- Sources:全国人大常委会 (2021). 道路交通安全法（2021 年修订，第九十一条）. （北京市公安交通管理局转载）；全国人大常委会 (2015). 刑法修正案（九）（第八条，即刑法第一百三十三条之一）. ；中国保险行业协会 (2020). 机动车商业保险示范条款（2020 版）（第九、二十二条）. + +### 8. Never lend your bank cards, SIM cards, or payment accounts to anyone — “money laundering” is not a side hustle + +- Cost: Zero. Some people claim “just lend your card for a few transactions and you’ll get a few hundred yuan” — just say no. +- In plain terms: Renting, lending, or selling your bank cards, SIM cards, or payment accounts is illegal on its own. Penalties include confiscation of all illegal earnings plus a fine of 1 to 10 times that amount; if no earnings were made, the maximum fine is 200,000 yuan. In serious cases, offenders face up to 15 days in detention, a negative credit record, and restrictions on account functionality. If you knowingly assist criminals by receiving or transferring money using these accounts, you could be convicted of aiding information network criminal activities, punishable by up to 3 years in prison. +- Benefit: Engaging in any activity that involves renting, lending, or selling phone cards, bank accounts, payment accounts, or internet accounts is illegal. Authorities confiscate all illegal earnings and impose a fine of 1 to 10 times that amount; if no earnings exist, the maximum fine is 200,000 yuan. Serious violations lead to detention of up to 15 days, a negative credit record, account restrictions, and suspension of all non-counter banking services. Knowingly providing payment settlement assistance to criminals constitutes aiding information network criminal activities (known as “helping information network crimes”), punishable by up to 3 years in prison and a fine nationwide. +- Evidence grade: A +- Notes: Claiming “I had no idea what the other person intended to do with my cards” won’t protect you. Law enforcement determines intent based on external circumstances: receiving payment for lending cards or unusually large transaction volumes can be used as evidence of awareness. Even if you ultimately aren’t convicted, accounts used to receive illicit funds get frozen and you face other penalties. +- Sources:全国人大常委会 (2022). 反电信网络诈骗法（第三十一、四十四条）. ；全国人大常委会 (2015). 刑法修正案（九）（第二十九条，即刑法第二百八十七条之二）. + +### 9. Checking your credit report twice a year for free helps spot any loans or cards you didn’t apply for. + + +- Cost: It costs nothing. You can complete the check online in just ten minutes. + +- In plain terms: Laws give you the right to check your own credit report twice a year at no charge, and you can finish the process online in ten minutes. Negative entries stay on the report for five years from the date they’re resolved; after that they must be removed. If you dispute any information, the credit agency or data provider must respond to you in writing within 20 days. To check your report, use the official website of the People’s Bank of China’s Credit Information Center or your mobile banking app — avoid third‑party “credit check” apps, as they collect your personal data. + +- Benefit: Regulatory rules state that “individuals have the right to obtain their own credit reports twice a year free of charge,” meaning you can check your report twice annually at no cost. Negative records are kept for five years after the underlying issue is resolved; any older entries must be deleted. When you raise a dispute, the credit agency or source of the data must reply in writing within 20 days. + +- Evidence grade: A + +- Notes: Identity theft leading to unauthorized loans or credit cards often goes unnoticed until a person is denied a mortgage years later. The proper channels for checking your report are the People’s Bank of China Credit Information Center website or mobile banking apps. Steer clear of third‑party “credit check” apps, as they harvest your personal information. +- Sources:国务院 (2013). 征信业管理条例（国令第 631 号，第十六条、第十七条、第二十五条）. + +### 10. If a fight breaks out, call the police first — the one who strikes first almost always loses + +- Cost: No cost at all. Simply move to a crowded area and call the police so the other person’s actions are captured on camera. The hard part is resisting the urge to shout back or push them. +- In plain terms: Anyone who assaults another person faces 5 to 10 days in jail and a fine of 500 to 1,000 yuan. If they act in a group, target the elderly, pregnant women, children, or disabled individuals, or repeat the assault multiple times, the penalty rises to 10 to 15 days in jail and a fine of 1,000 to 2,000 yuan. Causing minor injuries to another person turns it into a criminal case, punishable by up to 3 years in prison; serious injuries bring a sentence of 3 to 10 years. When two people fight each other, it does not qualify as self-defense — the person who strikes first almost always suffers the consequences. Moving to a crowded area and calling the police is far more effective than retaliating. +- Benefit: Under the law, anyone who assaults another person or intentionally harms them faces 5 to 10 days in jail and a fine of 500 to 1,000 yuan. Those who act in a group, target vulnerable groups, repeat the assault, or attack multiple people at once receive 10 to 15 days in jail and a fine of 1,000 to 2,000 yuan. Group fights are treated as hooliganism, carrying a maximum penalty of 15 days in jail and a 2,000 yuan fine. Intentional bodily harm that meets criminal criteria results in up to 3 years in prison; serious injuries bring a sentence of 3 to 10 years. Legally, mutual fighting does not count as self-defense. However, if the other person strikes first and uses excessive force, or if you try to avoid the fight but they keep attacking, your retaliation is generally deemed lawful self-defense. Only when your response clearly exceeds what is necessary and causes major harm does it qualify as excessive self-defense, which still warrants a reduced or waived penalty (nationwide, effective January 1, 2026 under the Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: After the 2025 revision of the Public Security Administration Punishment Law, all article numbers changed; assault now falls under Article 51 instead of the old Article 43, so any older references are outdated. The definition of “minor injuries” used to determine criminal liability is set by official appraisal standards, which this section does not verify. If the aggressor is already on the ground or has fled, the threat ends, and any further retaliation is no longer considered self-defense. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十、五十一条）. ；全国人大 (1997). 刑法（第二十、二百三十四条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 6、9、11、14 条）. + +### 11. You may defend yourself against an unavoidable attack, but only strike the person who is actually attacking — stop when he stops. + + +- Cost: Legal fees start at several thousand yuan; those with financial difficulties may apply for legal aid. The main cost comes afterward: you’ll often be initially charged with intentional injury, required to cooperate with investigations, and sometimes detained for up to ten days. The challenge is staying composed during this period. + +- In plain terms: To protect yourself or others from an ongoing attack, it is legally acceptable to intervene and injure the attacker. If someone is committing murder, robbery, rape, kidnapping, or any other violent crime, harming or even killing them is not considered excessive. However, you must only strike the person actively attacking — stop as soon as he ceases. Even if the court ultimately rules in your favor, the process is far from easy; many people are first charged and detained for several days. In total, 47 individuals have been recognized as acting in self-defense under these circumstances. + +- Benefit: Criminal law defines what constitutes legitimate self-defense. When national interests, public welfare, or your own or another person’s life, property, and other rights are under unlawful attack, intervening to injure the aggressor qualifies as self-defense and carries no criminal liability. The law also states: “If self-defense clearly exceeds necessary limits and causes serious harm, criminal responsibility applies, though punishment may be mitigated or waived.” Additionally: “In cases of ongoing violent crimes such as murder, robbery, rape, kidnapping, or other acts seriously threatening personal safety, any defensive actions resulting in injury or death of the aggressor do not constitute excessive defense and incur no criminal liability.” Official guidelines further clarify these boundaries: both “clearly exceeding necessary limits” and “causing serious harm” must be present for it to be deemed excessive; causing only minor injuries does not count. Defense must be directed solely at the aggressor; using lethal force against minor offenses is not permitted. Real-world examples include the Yu Haiming case (2018), where initial charges were later dropped after a ruling of self-defense, and the Chen case, where a student’s defensive actions were similarly recognized as lawful. A total of 45 cases have been officially documented as falling under this category. + +- Evidence grade: A + +- Notes: The default course of action remains as described in item 10: retreat and call the police. Fighting back when two parties are already engaged does not qualify as defense, nor does pursuing an attacker after he has fled or fallen. This provision applies only when retreat is impossible; it does not encourage violence. Afterward, three steps are crucial: remain at the scene after calling police, preserve any surveillance footage and witnesses, and consult a lawyer before any police questioning. If charges are eventually dropped or you are acquitted, you may seek state compensation for detention days, as outlined in item 35. Defending others is also legally permitted, though intervening in unrelated fights without preparation carries different risks, as discussed in item 13. This protection primarily benefits you and your family. +- Sources:全国人大 (1997). 刑法（第二十条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 5、6、7、10、11、13、14、19 条）. ；最高人民检察院 (2018). 第十二批指导性案例（检例第 45 号陈某正当防卫案、检例第 47 号于海明正当防卫案）. ；全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第九十一条）. 宁夏回族自治区人民检察院转载全文 + +### 12. Who to avoid — when you’re owed wages, fired unfairly, or scammed out of money — use complaints, arbitration, or lawsuits instead of taking revenge + + +- Cost: There’s no monetary cost; filing complaints and arbitration is free. You’ll need to make one or two trips and wait several months. The hard part is resisting the urge to act violently during that time. +- In plain terms: Following legal channels means the worst outcome is simply not getting your money back. Choosing revenge yields the same result — no money recovered — plus you risk losing your own life. Take the Wuxi case: Xu failed his exams, didn’t receive his diploma, and was unhappy about his internship pay. He went on to kill 8 people and injure 17 others with a knife. He was sentenced to death and executed. Nationwide in 2024, complaints and arbitration helped 654,000 workers recover 8.65 billion yuan in unpaid wages. +- Benefit: Official statistics back up legal action. In 2024, labor inspectors handled 137,000 cases, securing 8.65 billion yuan for 654,000 workers. Additionally, 998 individuals were convicted under laws against wage theft. For details on filing complaints or arbitration, see Section 7, Item 2. The legal consequences of revenge are laid out in Article 232 of the Criminal Law: “Whoever intentionally kills another shall be sentenced to death, life imprisonment, or fixed-term imprisonment of not less than ten years; if circumstances are relatively minor, to fixed-term imprisonment of not less than three years but not more than ten years.” In the Wuxi case, Xu’s dissatisfaction with his school and pay led him to attack fellow students with a knife, killing 8 and injuring 17. He was sentenced to death for intentional homicide, a verdict upheld by the Supreme People’s Court on January 20, 2025. He received no compensation whatsoever. +- Evidence grade: A +- Notes: Interns still attending school generally don’t have a recognized employment relationship with their host organizations. If they’re denied internship pay, they can only seek mediation from their school or file a civil lawsuit — arbitration isn’t an option. For exact steps on filing complaints or arbitration, see Section 7, Item 2. The limits on debt collection are outlined in Section 9, Item 15 (no detaining or confining debtors). Opting for legal channels means the worst-case scenario is simply not recovering owed funds, since case closure doesn’t guarantee payment. Choosing revenge yields the same financial result, plus the risk of losing your own life. +- Sources:全国人大 (1997). 刑法（第二百三十二条）. ；新华社 (2024). 江苏宜兴一校园发生持刀伤人事件致 8 死 17 伤. （转宜兴警方通报，含伤亡人数与动机原话）；最高人民检察院 (2025). 无锡校园持刀伤人案罪犯徐加金被执行死刑. ；人力资源社会保障部 (2025). 2024 年度人力资源和社会保障事业发展统计公报. ；最高人民法院 (2025). 最高人民法院工作报告（「对驾车冲撞行人的樊维秋、校园持刀行凶的徐加金等判处死刑」）. + +### 13. No matter how angry you are, never target innocent people: deliberately driving into a crowd or committing violence in public is classified as endangering public safety by dangerous means, carrying a minimum sentence of three years; if anyone dies, the penalty is death. + + +- Cost: There is no monetary cost involved. The real challenge is suppressing such impulses when you’re enraged. + +- In plain terms: Intentionally driving into a crowd or attacking people in public constitutes endangering public safety by dangerous means. Even if no one is injured, the offender still faces at least three years in prison. If fatalities occur, the sentence rises to ten years or more, life imprisonment, or death. In the Zhuhai case, Fan Weiqiu, dissatisfied with the divorce settlement, drove his car into a crowd exercising at a sports center, resulting in 35 deaths and 43 injuries; he was sentenced to death and executed. + +- Benefit: Article 114 of the Criminal Law states: “Whoever commits arson, breaches a dike, causes an explosion, releases toxic, radioactive, or infectious agents, or endangers public safety by any other dangerous means, without causing serious consequences, shall be sentenced to three to ten years in prison.” Thus, even when no injuries occur, the minimum penalty is three years. Article 115 adds that if serious injury, death, or major property damage results, the sentence becomes ten years or more, life imprisonment, or death. Official case example: Fan Weiqiu, disillusioned by his failed marriage and unhappy with the divorce terms, resolved to vent his anger by driving into a crowd. On the evening of November 11, 2024, he crashed his vehicle into exercisers at Zhuhai Sports Center, killing 35 and injuring 43. He was convicted under the aforementioned article and sentenced to death, with political rights revoked; the sentence was carried out on January 20, 2025 after Supreme Court approval. His grievance pertained solely to the divorce ruling; his victims were completely unrelated runners from across the country. + +- Evidence grade: A + +- Notes: Expressing thoughts like “I don’t want to live anyway” does not serve as a mitigating factor in sentencing. The Supreme People’s Court’s 2025 work report emphasizes “resolutely punishing with severity, speed, and strictness those who outrageously violate legal and moral boundaries.” Merely threatening to commit acts such as arson, explosions, or poisoning that endanger public safety and disrupt order can lead to detention from five to ten days and a fine of up to 1,000 yuan under the Public Security Administration Punishment Law (effective January 1, 2026). Similarly, sending threatening letters or otherwise endangering another’s safety is illegal, punishable by up to five days’ detention or a similar fine. Anyone entertaining such ideas should refer to item 14, which treats notions like “finding a scapegoat” as a medical emergency requiring immediate intervention. +- Sources:全国人大 (1997). 刑法（第一百一十四、一百一十五条）. ；新华社 (2024). 广东珠海驾车撞人事件造成 35 人死亡 43 人受伤. （转珠海市公安局通报）；最高人民检察院 (2024). 樊维秋以危险方法危害公共安全案一审宣判，判处死刑，剥夺政治权利终身. ；最高人民检察院 (2025). 珠海驾车撞人案罪犯樊维秋被执行死刑. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. + +### 14. Thoughts such as “find a scapegoat” or “go down together” must be treated as a medical emergency: leave the scene, hand over car keys and knives to someone else, and call 12356. + + +- Cost: There is no monetary cost. The difficulty lies in admitting that something is amiss right now and in handing over control of potentially dangerous items to another person. + +- In plain terms: The window between the moment these thoughts arise and any attempt to act on them is very brief. Among 82 people who survived a suicide attempt, 47.6% reported that no more than 10 minutes elapsed from the first appearance of such thoughts to the attempt itself. Therefore, the priority is not to “figure things out” intellectually, but to create physical distance — one step at a time — between oneself and steering wheels, knives, gas valves, or ropes, thereby surviving those crucial ten minutes. After that, calling 12356 is essential. + +- Benefit: The time gap between the emergence of these thoughts and actual action is indeed short. Interviews conducted within three days of hospitalization with those 82 individuals showed that 47.6% acted within ten minutes of first having such thoughts. A ten‑year systematic review indicates growing evidence that restricting access to lethal means reduces suicide rates; for instance, after tighter controls on painkillers, related suicides fell by 43%. Installing protective barriers at popular suicide sites cut deaths by 86% (ranging from 79% to 91%). Creating that brief physical separation is precisely what gives people a chance to survive. 12356 is the nationwide mental‑health helpline, operating at least 18 hours per day throughout the country as of May 1, 2025. + +- Evidence grade: B + +- Notes: This grade is assigned because both pieces of evidence originate from suicide‑research literature and have not been directly tested in contexts involving impulses to harm others. The Deisenhammer study involved only 82 participants at a single hospital. When feeling unwell, avoid driving or taking on duties that require responsibility for others’ safety; it is better to hand over those duties first. For information on self‑harm thoughts, see Section 1, Item 25 (calling 12356 when suicidal thoughts arise). Guidance on actions during periods of low mood can be found in Section 3, Item 19. +- Sources:Deisenhammer EA 等 (2009). The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? Journal of Clinical Psychiatry. ；Zalsman G 等 (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. ；国家卫生健康委 (2024). 关于应用「12356」全国统一心理援助热线电话号码的通知（国卫医政函〔2024〕259 号）. + +### 15. Family members say “no one will be safe” or “I’ll take the kids and leave” — don’t dismiss this as anger: close relatives can take such a person to the hospital, and police must respond to any emergency call. + + +- Cost: Registration and consultation fees range from a few dozen to several hundred yuan. Accompanying the person to the hospital takes half a day to a full day. The real challenge is getting them to agree to go. +- In plain terms: When family members say things like “no one will be safe” or “I’ll take the kids and leave,” close relatives have the right to take that person to a hospital, where treatment cannot be refused. If there has already been violence or an imminent risk of harm, hospitalization does not require the person’s consent. If it’s unclear whether these statements are just angry outbursts or genuine threats, call 12356 for advice or dial 110 so police can intervene. Keeping this information secret does not help the person at all. +- Benefit: Article 28, paragraph 2 of the Mental Health Law states: “When a suspected mental disorder patient exhibits behavior that harms themselves or others, or shows a clear risk of doing so, their close relatives, employer, or local police must act immediately to stop such behavior and arrange transport to a medical facility for diagnosis.” The same article also requires hospitals to accept and diagnose any such patients without refusal. Article 29 mandates that hospitals admit these individuals right away, assign a licensed psychiatrist for evaluation, and issue a diagnosis promptly. Article 30 says voluntary admission is the norm, except in cases where the diagnosis confirms a severe mental disorder accompanied by actual or imminent harm to others — in such cases, involuntary hospitalization is permitted. Making threats of violence is grounds for calling 110. Writing threatening letters or using other means to endanger someone’s safety can result in detention for up to five days or a fine of up to 1,000 yuan. Those who threaten to commit arson, explosions, or other acts endangering public safety face detention from five to ten days and a similar fine (effective January 1, 2026 under China’s Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: This guidance applies to spouses, parents, and children living in the same household. The phrase “no one will be safe” clearly includes the speaker, and the law grants this right specifically to close relatives — outsiders cannot intervene without police involvement. This rule targets genuine danger signs, not angry remarks during arguments or attempts to force uncooperative family members into treatment. Conversely, Article 35 states that if further evaluation proves the person does not have a serious mental disorder, they must be released from the hospital. When in doubt, call 12356 or 110. The investigation into Germanwings Flight 9525 revealed that authorities and employers could not prevent the co-pilot from flying that day because “neither he nor anyone else — doctors, colleagues, or family — informed them of his condition.” All 150 people on board perished: two pilots, four flight attendants, and 144 passengers. Keeping such risks hidden is never helpful. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. ；全国人大常委会 (2012，2018 修正). 精神卫生法（第二十八、二十九、三十、三十五条）. ；法国航空事故调查局 BEA (2016). Final Report BEA2015-0125.en: Accident on 24 March 2015 at Prads-Haute-Bléone to the Airbus A320-211 registered D-AIPX operated by Germanwings. + +### 16. Don’t curse, spread rumors, or share unverified content online; if you’re a victim of online abuse, document evidence first then report it to police + +- Cost: No cost at all. Just take ten extra seconds to think before posting. When attacked, take screenshots, record video, save links and account IDs, file a complaint with the platform first, then report it to police. The hardest part is resisting the urge to fire back when being cursed at. +- In plain terms: Publicly cursing, spreading rumors or defaming others can result in detention for up to 5 days or a fine of up to 1000 yuan; for more serious cases, detention ranges from 5 to 10 days. If the circumstances are especially grave, it constitutes the crimes of insult or defamation, punishable by up to 3 years in prison. Simply sharing such content also makes you liable. Conversely, if you’re a victim of online abuse, you generally have to file a lawsuit in court yourself to pursue legal action for insult or defamation, so you must rely on yourself to take screenshots, record video and save links. +- Benefit: Those who openly insult others or fabricate facts to defame them face detention for up to 5 days or a fine of up to 1000 yuan; for more serious cases, detention ranges from 5 to 10 days. The same penalties apply to people who repeatedly send insulting or threatening messages, harass or stalk others, or secretly photograph and distribute someone’s private information. Anyone who deliberately spreads rumors and disrupts public order also faces detention from 5 to 10 days. In severe cases, such actions constitute the crimes of insult or defamation, punishable by up to 3 years in prison. For online defamation cases where victims struggle to gather evidence, they can request the court to ask police for assistance (this rule is effective as of 1 January 2026 under the Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: In principle, the crimes of insult and defamation are “only prosecuted upon complaint”, meaning victims must file a lawsuit in court themselves. Police generally do not initiate investigations proactively, so evidence collection falls entirely on the victims. However, two important exceptions exist. First, cases that “seriously endanger public order and national interests” can be investigated by police directly (Article 246, Paragraph 2 of the Criminal Law). Second, if a victim has genuine difficulty gathering evidence for online defamation, the court may order police to assist with the investigation (the same article, Paragraph 3, added under the 9th Amendment to the Criminal Law). Sharing such content also makes you legally liable; knowingly spreading false information also counts as “fabricating facts”. For guidance on how to respond after being a victim of online abuse, see Section 37 of this chapter (“Document evidence first then take action after suffering online abuse”). The article numbers for insult and defamation have been updated from Article 42 under the old law to Article 50 under the new law. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九、五十条）. ；全国人大 (1997). 刑法（第二百四十六条）. ；全国人大常委会 (2015). 刑法修正案（九）（第十六条，增加刑法第二百四十六条第三款）. ；全国人大常委会 (2015). 刑法修正案（九）（第二百四十六条新增第三款）. 国家信访局转载全文 + +### 17. Read the document thoroughly before signing; never sign on behalf of others or on blank paper + +- Cost: There is no cost involved. It simply requires a few extra minutes to read contracts, IOUs, guarantee letters, and employment documents from start to finish. Ask questions on the spot if anything is unclear, then take photos for your records. The real challenge is managing to read everything carefully while the other party is watching. +- In plain terms: Once signed, the document becomes legally binding. Claims such as “I didn’t read it properly” or “I thought it said something else” rarely hold up in court. Therefore, it’s essential to spend those few minutes reading everything, ask for clarification when needed, and document it all with photos. Never sign for someone else, never sign on blank paper, and always specify the intended purpose when providing a copy of your ID. Electronic signatures and facial recognition verification also count as valid signatures. +- Benefit: Contracts that are legally executed are protected by law and are binding on all parties involved. Once signed, both sides must fully comply with their obligations. Arguments like “I didn’t read it” or “I misunderstood” carry little weight in legal proceedings. By avoiding unnecessary signatures, you also steer clear of taking on debts or responsibilities that don’t rightfully belong to you (nationwide). +- Evidence grade: A +- Notes: The rules “never sign on behalf of others, never sign on blank paper, and always state the purpose when sharing ID copies” are practical recommendations rather than formal legal mandates. Their shared goal is to prevent your signature from being used to validate a legally binding contract you never intended to agree to. Electronic signatures and facial recognition verification are equally valid forms of consent. +- Sources:全国人大 (2020). 民法典（第四百六十五、五百零九条）. + +### 18. Write a clear loan agreement when lending money; think carefully before agreeing to be a guarantor + + +- Cost: There is no cost involved. Simply use a piece of paper to list the lender, borrower, amount, interest rate, term, and repayment method, then have both parties sign it. Transfer the money electronically to leave a paper trail; never hand over cash. + +- In plain terms: The loan agreement must include all essential details: who the lender and borrower are, the amount, interest rate, term, and repayment method, plus signatures from both sides. Use a bank transfer instead of cash to make legal enforcement easier. Before agreeing to be a guarantor, check whether the contract mentions “joint and several liability.” Under ordinary guarantee arrangements, creditors must first sue the borrower and exhaust all collection efforts before seeking payment from you. However, if you sign a joint and several liability guarantee, creditors can demand repayment from you directly. + +- Benefit: Loan contracts should be in writing and contain information such as the type of loan, currency, purpose, amount, interest rate, term, and repayment method. This makes it easier to pursue legal action if needed. If a guarantee contract does not specify the type of guarantee or is otherwise vague, it is interpreted as an ordinary guarantee. Under such terms, creditors must first sue the borrower and attempt to enforce payment before turning to the guarantor. Conversely, a joint and several liability guarantee removes this protection; creditors may demand repayment from the guarantor immediately (nationwide). + +- Evidence grade: A + +- Notes: Any interest charged above four times the LPR is not legally enforceable; see Section 7 for details. It is advisable to include the borrower’s ID number and label the document as a “loan agreement.” Whether or not the guarantee contract contains the phrase “joint and several liability” determines whether you are secondary to the borrower or equally liable — be sure to review this before signing. +- Sources:全国人大 (2020). 民法典（第六百六十八、六百八十一、六百八十六、六百八十七条）. + +### 19. Time limits for legal action: 3 years for civil lawsuits, 1 year for labor arbitration; once the deadline passes, a simple “statute of limitations exceeded” claim can block your case + + +- Cost: Zero cost. Don’t just hope for payment in silence — use WeChat, text messages, email, or certified mail to create a paper trail. + +- In plain terms: The statute of limitations for civil lawsuits is three years, counted from the day you become aware your rights were violated. Once that period ends, the court won’t act on its own; however, if the debtor simply argues “the deadline has passed,” you lose the right to recover what’s owed. A single documented demand for payment can reset that three‑year clock entirely. Labor disputes follow a different rule: the arbitration deadline is just one year. + +- Benefit: The Civil Code states that “the limitation period for filing a civil lawsuit is three years, calculated from the date the right‑holder knows or should know that his rights were infringed and who the obligor is.” This period may not exceed twenty years from the actual infringement. When it expires, the debtor may invoke a defense of non‑performance. Courts do not monitor these deadlines automatically; however, once raised by the debtor they become binding. Four events can interrupt the clock, each resetting the three‑year period: (1) you demand performance; (2) the debtor promises to perform; (3) you file a lawsuit or labor arbitration; (4) any other circumstance with comparable effect. For installment agreements, the countdown starts on the final due date. Certain claims are exempt from any limitation period: requests to stop infringement, remove obstacles, eliminate hazards; recovery of real property or registered movable assets; alimony, child support, and maintenance; plus other cases specified by law. Labor arbitration follows a one‑year rule, also measured from the date the worker becomes aware of the violation; however, if a dispute over unpaid wages arises while the employment relationship still exists, the worker may file at any time — otherwise the deadline is one year after the contract ends (nationwide). + +- Evidence grade: A + +- Notes: This is probably the cheapest tip in the entire book. A single traceable demand letter can restart the three‑year window; without it, you risk forfeiting your right to win the case. Agreements such as “we won’t invoke the statute of limitations” or negotiated extensions of the deadline carry no legal weight. Conversely, if the debtor promises payment after the deadline has passed, they can no longer rely on that defense. Once payment has been voluntarily made, it cannot be reclaimed. For promissory notes and guarantees, see item 18; matters involving enforcement are covered in item 20. Overtime pay and unused vacation compensation follow the labor‑arbitration rules described in sections 19.1 and 19.2. +- Sources:全国人大 (2020). 民法典（第一百八十八、一百八十九、一百九十二、一百九十三、一百九十五、一百九十六、一百九十七条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（第二十七条）. （安康市人力资源和社会保障局转载） + +### 20. If you’re being sued or have a court order against you, report all your assets truthfully and repay as much as you can — don’t transfer your house or money to relatives, friends, or companies. + + +- Cost: There is no cost involved. Simply report your assets as required by the court: list everything you currently own and everything you acquired in the year prior to receiving the enforcement notice. Pay off whatever debts you can. If you can’t pay in full, negotiate a settlement or installment plan with the creditor. + +- In plain terms: Putting your house in a company’s name or transferring money to relatives or friends isn’t some clever “workaround” — it falls squarely under the circumstances described in the law on refusal to execute court orders. Conviction for this offense carries a sentence of up to three years; in especially serious cases, the sentence is three to seven years. Relatives, friends, or companies that help hide or transfer assets are treated as accomplices, and those assets must be recovered. Failing to report assets or providing false information can result in fines of up to 100,000 yuan and up to 15 days of detention. However, if you truly have no money, this crime does not apply. + +- Benefit: Asset transfers aren’t merely “workarounds” — they themselves constitute criminal acts. The Standing Committee of the National People’s Congress has issued an interpretation of Article 313 of the Criminal Law, explicitly stating that “hiding, transferring, deliberately destroying, or transferring assets for free or at an unreasonably low price, thereby preventing the execution of a judgment or order” qualifies as “having the ability to execute but refusing to do so under serious circumstances.” In other words, hiding money, transferring it away, deliberately destroying one’s own property, giving it away for free, or selling it at a steep discount all render a court order meaningless. In 2024, the Supreme People’s Court and the Supreme People’s Procuratorate added ten more scenarios to this definition, including using fake settlements or transfers to dispose of assets, as well as buying someone else’s property at an unreasonably high price to guarantee their debts. All these actions are deliberate attempts to strip oneself of assets available for debt repayment. The maximum sentence for this crime remains three years; in especially serious cases, it rises to three to seven years plus a fine. Such serious circumstances include using fake lawsuits, arbitration, or notarization to obstruct enforcement, gathering crowds to storm enforcement sites, attacking or detaining enforcement officers, or causing a creditor to commit suicide or self-harm due to non-payment. Even outsiders who aren’t parties to the case may be deemed accomplices if they knowingly help hide or transfer assets. Illegally transferred assets must be recovered or returned. Transfers made after receiving a summons but before a judgment takes effect also count. On the civil side, creditors may petition the court to annul any transfers made for free or at unreasonably low prices. Failure to report assets or providing false information may result in fines up to 100,000 yuan and detention of up to 15 days (as stipulated in the 2024 interpretation effective December of that year). + +- Evidence grade: A + +- Notes: The commonly shared advice online — such as “put your house in a company’s name to use as employee housing” or “transfer all your money to relatives” — isn’t a loophole; it’s precisely the kind of conduct singled out in judicial interpretations. Relatives, friends, or companies aiding such actions are treated as accomplices, and any assets involved must be recovered. Conversely, if you truly have no money, this crime does not apply. To determine whether you “have the ability to repay but refuse to do so,” necessary living expenses for you and your dependents must first be deducted. If you repay part or all of the debt before prosecution and your circumstances are relatively minor, prosecution may be waived. Repaying the debt prior to a first-instance judgment may also lead to a lighter sentence or even exemption from punishment. For guidance on what to do after being placed on a blacklist or having spending restrictions imposed, see item 21; instructions on how to regain good standing after fulfilling obligations are provided in Section 7, item 19. +- Sources:全国人大常委会 (2002). 关于《中华人民共和国刑法》第三百一十三条的解释. ；最高人民法院、最高人民检察院 (2024). 关于办理拒不执行判决、裁定刑事案件适用法律若干问题的解释（法释〔2024〕13 号，第三、四、五、六、八、十一、十二条）. 最高法发布页，全文核对自广东省广州监狱转载. 、；全国人大常委会 (2015). 刑法修正案（九）（第三十九条，修改刑法第三百一十三条）. ；全国人大 (2020). 民法典（第五百三十八、五百三十九、五百四十条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第一百一十四、一百一十八、二百五十二条）. 贵州省市场监管局转载： + +### 21. If you’re under a spending restriction or listed on the dishonesty registry, first find out which rule applies and request removal if possible + +- Cost: No cost at all. You simply need to visit the enforcement court to determine which provision applies to you. Prepare proof of compliance — receipts showing you’ve paid what you owe or fulfilled the court order — as well as any required guarantee documents. For any essential personal or business expenses, you must file a separate application each time. The main difficulty is that you’ll need to make multiple trips to the court and submit many applications. +- In plain terms: First, figure out whether you’re merely under a spending restriction or actually listed on the dishonesty registry. These are two distinct situations; it’s possible you’re subject to only one. There are exactly six legal grounds for inclusion on the dishonesty registry, and the listing remains valid for two years. Seven specific circumstances — including full compliance with court orders — require the court to remove the entry within three working days; proactive compliance can even lead to earlier removal. Spending restrictions prohibit using your own funds for eight specific types of non‑essential purchases; however, you may apply individually for permission to cover any truly necessary personal or business costs. +- Benefit: Only six specific scenarios qualify a person for inclusion on the dishonesty registry. First, having the ability to pay but deliberately refusing to do so. Second, obstructing enforcement through forged evidence, violence, or threats. Third, evading obligations via fraudulent litigation, arbitration, or by concealing or transferring assets. Fourth, failure to comply with property‑reporting mandates. Fifth, violation of spending‑restriction orders. Sixth, willful non‑compliance with settlement agreements. If you provide adequate guarantees or if your seized assets exceed the debt amount, the court must not cite the “ability to pay” criterion for inclusion. Minors may never be added to the list, which remains active for two years. In cases involving severe obstruction or multiple violations, the period may be extended by one to three years. Seven circumstances — such as full compliance, successful settlement execution, or court‑ordered termination of proceedings — obligate the court to delete the entry within three working days; proactive compliance can also trigger early removal. Spending restrictions forbid using your own money for eight categories of non‑essential purchases: air travel, first‑class train or ship cabins, stays at upscale hotels, golf‑club memberships, real‑estate acquisitions or lavish renovations, leasing premium office spaces, vacations, enrolling children in costly private schools, and purchasing high‑premium insurance products. Any essential personal or business expense falling under these categories must be approved by a separate court application. Providing reliable guarantees or obtaining consent from creditors may also lift the restriction nationwide. +- Evidence grade: A +- Notes: A “spending restriction” is essentially a ban on high‑end consumption. This regulation was revised in 2015 via Judicial Interpretation No. 17, and its official title changed to “Regulations on Restrictions on Certain Types of Consumption.” The text quoted here is the 2010 version, which can be verified word‑for‑word on the Supreme People’s Court website; the updated version is still pending verification (the Supreme Court bulletin page returns a 502 error on this machine). Being listed on the dishonesty registry and being subject to spending restrictions are separate matters; it’s possible you’re subject to only one. Neither status automatically tarnishes your credit record; removal from the list does not automatically repair it — see Section 7, Article 19 for details on rebuilding credit after such a listing. The restrictions apply solely to spending using the debtor’s own funds; spouses and children may spend their own earnings without limitation. Nevertheless, using the debtor’s money to pay for a child’s enrollment in a high‑fee private school is expressly prohibited. +- Sources:最高人民法院 (2017 修正). 关于公布失信被执行人名单信息的若干规定（第一、二、三、四、十条）. ；最高人民法院 (2010). 关于限制被执行人高消费的若干规定（第三、八、九条）. + +### 22. If scammed while shopping online or via second-hand markets, first file a complaint with the platform, then report it to police, and finally decide whether to sue. + + +- Cost: Filing a complaint with the platform and reporting the case to police cost nothing. For lawsuits, if the amount in dispute is under 10,000 yuan, the filing fee is 50 yuan; this fee is halved if the case goes through summary proceedings, mediation, or is withdrawn. Each of the stages — case filing, trial, and enforcement — takes at least half a day to a full day, though online filing can save you the hassle of traveling. You must keep records of orders, chat logs, transfer receipts, and shipping documents. The real challenge is staying committed despite all the back‑and‑forth. + +- In plain terms: Start by contacting the platform. Platforms maintain security deposits and strict penalty rules, so they act fastest. Next, call the police: if the loss exceeds 3,000 yuan, it meets the threshold for a criminal fraud case; otherwise it falls under public‑order penalties, which can result in a detention of 5 to 10 days. If you decide to sue, online‑purchase disputes can be filed in the court nearest to the delivery address. For smaller amounts, a small‑claims procedure applies, guaranteeing a verdict within two months and allowing online filing. +- Benefit: When the amount defrauded ranges from 3,000 to 10,000 yuan, it qualifies as “a relatively large sum” under fraud statutes, leading to a sentence of up to three years plus a fine; exact limits vary by province. Below that threshold, offenders face public‑order penalties: detention of 5–10 days or a fine of up to 2,000 yuan; repeat offenders may receive 10–15 days of detention and a fine up to 3,000 yuan. On the civil side, you may sue in the same court for contract disputes, again without needing to travel to the seller’s hometown. Small‑claims rules apply when the disputed amount is under 50 % of the local average annual wage; such cases are decided in a single hearing and become final immediately, with a maximum processing time of two months under summary proceedings. All these procedures are now available online, carrying the same legal weight as in‑person filings (Civil Procedure Law, effective Jan 2024; Public Security Administration Punishment Law, effective Jan 2026). +- Evidence grade: A +- Notes: To gauge whether a lawsuit is worthwhile, multiply your net hourly wage by the total time you’ll need to invest — accounting for filing, trial, and possible enforcement phases, each taking half a day to a full day — then add the court filing fee. Compare this total cost against the amount you hope to recover, and apply a further discount to estimate the likelihood of actually obtaining payment. This method offers a framework, not a definitive answer. Keep in mind that after the 2025 revision of the Public Security Administration Punishment Law, article numbers changed; fraud now falls under Article 58 instead of the former Article 49. Likewise, the small‑claims provision is now Article 165 following the 2023 amendment to the Civil Procedure Law; be sure to consult updated sources. Finally, experience shows that filing a complaint with the platform first yields the quickest resolution, thanks to its security deposits and strict penalty mechanisms. The relevant legal provision is Judicial Interpretation No. 7 of 2011. +- Sources:最高人民法院、最高人民检察院 (2011). 关于办理诈骗刑事案件具体应用法律若干问题的解释（法释〔2011〕7 号，第一条）. ；全国人大 (1997). 刑法（第二百六十六条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十八条）. ；全国人大常委会 (2023 修正). 民事诉讼法（第十六、一百六十四、一百六十五、一百六十八条）. （上海市发展改革委转载）；最高人民法院 (2022 修正). 关于适用《民事诉讼法》的解释（第二十条）. ；国务院 (2006). 诉讼费用交纳办法（国务院令第 481 号，第十三、十五、十六条）. + +### 23. Think carefully before and after making large gifts in romantic relationships or marriage + +- Cost: No cost involved. Before sending a large sum of money, ask yourself: is it a loan or a gift? If it’s a loan, draft a written agreement and mark the transfer as “loan”. The hard part is actually bringing this up in conversation. +- In plain terms: Once the money is transferred, you generally cannot get it back. A gift can only be revoked before it is officially registered under the recipient’s name. After that, revocation is only possible under three specific circumstances: the recipient seriously harms you or your close relatives; fails to fulfill their legal obligation to support you; or breaches any agreed terms of the gift contract. Therefore, decide early whether the payment is a loan or a gift. +- Benefit: Before property rights are transferred, a gift can be withdrawn. This legal threshold is known as the “transfer of property rights”. Once the transfer is complete, only the three aforementioned situations allow for revocation. Small gifts or cash given on special occasions such as birthdays or holidays, as well as everyday expenses meant to strengthen emotional bonds, do not qualify as betrothal gifts and thus are not required to be returned upon a breakup (nationwide rule). +- Evidence grade: A +- Notes: While it is commonly believed in legal practice that amounts such as “520” or “1314” indicate a gift, no official ruling from the Supreme People’s Court has been found in this section to confirm this as a definitive rule. Once a gift is notarized, it becomes far harder to retract. Ultimately, whether a transfer constitutes a loan or a gift depends on supporting evidence; a simple statement like “I’m lending you this money” in a chat record carries far more weight than any later disputes. +- Sources:全国人大 (2020). 民法典（第六百五十八、六百六十三条）. ；最高人民法院 (2024). 关于审理涉彩礼纠纷案件适用法律若干问题的规定（法释〔2024〕1 号，第三条）. + +### 24. Transfer betrothal gifts via payment with clear notes; keep chat records; money demanded under marriage can be reclaimed + +- Cost: No cost involved. Transfer betrothal gifts, wedding jewelry, and other related payments via bank transfer, clearly stating their purpose in the notes. For any verbal agreements, keep chat records or have family members present as witnesses. +- In plain terms: Demanding money under the guise of marriage is illegal, and courts support claims for repayment. Repayment can be demanded in three cases: no marriage registration took place; registration occurred but no actual cohabitation followed; betrothal gifts were given before marriage, leaving the giver in financial hardship. If registration occurred and cohabitation did follow, repayment is generally not required. However, if cohabitation was brief and the gift amount was excessively high, courts will determine the repayment proportion based on how the money was used, presence of dowry, whether children were born, and any fault on either side. For couples who cohabited without registration, the same proportional rule applies (nationwide, effective February 2024). Therefore, always transfer betrothal gifts, wedding jewelry, and related payments via bank transfer with clear notes, and both parties must keep proper evidence. +- Benefit: Demanding money under the guise of marriage is strictly prohibited by law. If one party demands betrothal gifts under this pretext, the other party’s claim for repayment is legally supported. Courts will grant repayment in three specific scenarios: no marriage registration was completed; registration occurred but no actual cohabitation followed; betrothal gifts were given before marriage, leaving the giver in financial hardship. For couples who registered and cohabited, repayment is generally not required. Yet, if cohabitation was brief and the gift amount was excessively high, courts will calculate the repayment proportion based on actual usage of the funds, presence of dowry, whether children were born, and any fault on either side. The same proportional approach applies to couples who cohabited without registration (nationwide, effective February 2024). +- Evidence grade: A +- Notes: Whether a betrothal gift amount is considered “excessively high” depends on the giver’s local per capita disposable income and family circumstances; there is no nationwide fixed threshold. The exact repayment amount is determined by judges on a case-by-case basis. This guideline applies equally to both givers and recipients of betrothal gifts; both parties must retain proper evidence. +- Sources:全国人大 (2020). 民法典（第一千零四十二条）. ；最高人民法院 (2024). 关于审理涉彩礼纠纷案件适用法律若干问题的规定（法释〔2024〕1 号，第二、五、六条）. ；最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第五条）. + +### 25. No need to worry about premarital assets — clearly define adding a spouse’s name to property and parental contributions + +- Cost: Drafting a written property agreement yourself costs nothing; notarization incurs extra fees. When parents contribute funds, ask them to provide a written statement. The whole process takes just a few hours. The real challenge is bringing up money matters with family members. +- In plain terms: Premarital assets remain your personal property and do not automatically become joint property simply because you’ve been married for many years. Couples can put in writing that premarital and postmarital assets stay separate. Keep in mind: if you agree to add your spouse’s name to a property title, you can still change your mind before completing the registration — once registered, it becomes their property. In divorce proceedings, any party who hides, transfers, squanders, or fabricates debts involving shared assets may receive a smaller share or none at all. +- Benefit: Premarital assets stay under your sole ownership regardless of how long you’ve been married. Couples may stipulate in writing whether premarital assets and postmarital earnings remain separate, become joint property, or are partially shared — such agreements are legally binding for both parties. When parents pay for a house before marriage, the money is treated as a gift solely to their child unless they explicitly state it’s meant for both spouses. After marriage, parental contributions are handled according to any prior agreement; lacking such agreement, they’re considered joint property. Agreements made before or during marriage to transfer one spouse’s property to the other or to make it jointly owned can be revoked by the gifting spouse prior to registration; once registered, it becomes the other spouse’s property. Any spouse who conceals, transfers, sells, or squanders shared assets, or who fabricates debts, may receive a smaller share or none at all (nationwide). +- Evidence grade: A +- Notes: Property agreements apply equally to both spouses — they’re not solely a “protective measure” for one side. To use such an agreement against a spouse’s debts owed to third parties, the creditor must be aware of its existence; otherwise, it holds no legal weight. The agreement remains valid even without notarization; notarization merely prevents future disputes over signatures and dates. +- Sources:全国人大 (2020). 民法典（第一千零六十三、一千零六十五、一千零九十二条）. ；最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第二十九、三十一、三十二条）. + +### 26. Check a person’s marital status before getting married; those who use marriage as a pretext to defraud money can be prosecuted for fraud. + +- Cost: No cost at all. Before registration, simply check the marital status listed on the other person’s ID card and household register. For any large sums of money exchanged, keep records of transfers and chat logs. +- In plain terms: Marriages involving bigamy are invalid. Anyone who already has a spouse yet marries again, or who knowingly marries someone who already has a spouse, faces up to 2 years in prison. Those who use marriage as a ruse to steal money can be charged with fraud: if the amount taken is relatively large, they get up to 3 years; if it’s huge, 3 to 10 years; if it’s exceptionally massive, 10 years or life imprisonment. Always verify the marital status on the ID card and household register before tying the knot. +- Benefit: Bigamous marriages hold no legal weight. Persons who enter a second marriage while already married, or who knowingly wed someone already married, may be sentenced to 2 years or less. Those convicted of defrauding others of sizable sums face up to 3 years plus a fine; those guilty of massive fraud receive 3 to 10 years; those responsible for truly enormous fraud get 10 years or life imprisonment, plus a fine or seizure of assets (nationwide). +- Evidence grade: A +- Notes: “Marriage fraud” itself isn’t a specific criminal category. Prosecution for fraud hinges on proof that the perpetrator intended to keep the money from the outset, fabricated lies to obtain it, and that police have launched an investigation. What counts as a “relatively large” sum is defined by judicial rulings, which may vary regionally; this section doesn’t confirm exact thresholds. Victims of such fraud can be either gender, and documented cases involve both dowries and bridal gifts being stolen. +- Sources:全国人大 (2020). 民法典（第一千零五十一条）. ；全国人大 (1997). 刑法（第二百五十八、二百六十六条）. + +### 27. For home appliance repairs, vehicle inspections, and renovations: ask for a quote first, then stay on site throughout the process + +- Cost: There is no upfront cost. Before starting any work, ask for the full fee schedule and a list of parts to be replaced; take a photo of the quote or request it in writing. After completion, obtain a repair receipt and invoice, and keep the old parts. You must also stay on site for at least an hour or two to supervise. The main challenge is staying present and attentive the entire time. +- In plain terms: Appliance repair services must clearly display their fee schedules and provide customers with receipts and invoices. They cannot falsely claim that a problem exists, nor replace parts that are still in good working condition. In serious cases, fines of up to 30,000 yuan may be imposed. All service providers must post prices openly and cannot charge extra fees beyond those listed. Therefore, always ask for a detailed quote and list of parts before work begins, request a receipt and invoice afterward, and keep the old parts. If you’re overcharged, call 12315 immediately. +- Benefit: Appliance repair businesses must disclose all service items, parts pricing, quality standards, warranty periods, and complaint hotlines. They must issue customers a written receipt and invoice that accurately detail all work performed. Fabricating, exaggerating, or falsifying repair items, inventing faulty components, or deliberately swapping out functional parts is strictly prohibited; serious violations incur fines up to 30,000 yuan. All operators must post all prices openly, cannot add hidden fees, and cannot charge for any unlisted services. Offering low initial quotes then charging far more, or advertising fake discounts, constitutes price fraud. Service details, pricing, and calculation methods must be displayed in a highly visible manner, and no misleading or deceptive advertising is allowed nationwide. +- Evidence grade: B +- Notes: If you’re overcharged, call 12315; penalties are enforced by commerce and market regulation authorities, so you won’t need to file a lawsuit yourself. This item is rated B because although the regulations are official, there are no specific figures indicating exactly how much money you can save by staying on site; the assessment relies largely on general experience. “Staying on site” does not mean judging service providers by appearance — it refers to following a strict set of procedures: asking for a quote, keeping receipts, and retaining old parts, which apply to all service types. The appliance repair rules apply specifically to that sector; vehicle inspections and renovations follow general open-price regulations and related implementation rules. The official text of the Consumer Rights Protection Law (Articles 8 and 10 on the right to information and fair trade) is currently inaccessible; this is marked as a pending verification, so the implementation rules are used as a substitute for now. +- Sources:商务部 (2012). 家电维修服务业管理办法（商务部令 2012 年第 7 号，第五、七、九、十四条）. ；市场监管总局 (2022). 明码标价和禁止价格欺诈规定（市场监管总局令第 56 号，第五、八、十九条）. ；国务院 (2024). 消费者权益保护法实施条例（国务院令第 778 号，第九、十条）. + +### 28. Don’t be a “nominal legal representative” — don’t lend your ID to register a company + + +- Cost: There’s no cost involved. If someone asks you to “just be a figurehead with no responsibilities,” you can simply refuse. +- In plain terms: The law assumes the legal representative is the person actually managing the company; claiming “I’m just a figurehead and know nothing” does not serve as a valid excuse to avoid liability. If a legal representative causes harm to others while performing duties, the company must compensate first, then may seek reimbursement from the negligent representative. For those already serving in this role, company law allows them to resign, provided the company appoints a new legal representative within 30 days. +- Benefit: The legal representative is intended to be the director or manager who actually runs the company’s affairs, meaning the law regards this person as the true manager. Should such a representative cause harm to others while on duty, the company pays compensation first and then can recover those funds from the responsible representative. Directors and senior executives also owe duties of loyalty and diligence to the company — they must act in its best interests and with due care. If they cause harm to others through intentional acts or gross negligence, they must personally bear the financial responsibility. “Lack of awareness” is not a legally valid defense against liability (nationwide, effective July 2024). +- Evidence grade: B +- Notes: Company law itself only specifies who bears liability. More commonly, being a nominal legal representative leads to further consequences: when a company faces court enforcement actions, the representative may be restricted from high-end consumption, and may also face tax-related penalties or administrative sanctions. These consequences stem from other laws and enforcement regulations; since this section does not verify their direct basis in company law text, it is rated as grade B. As noted earlier, existing legal representatives may resign under company law, with the company required to appoint a replacement within 30 days. +- Sources:全国人大常委会 (2023). 公司法（2023 年修订，第十、十一、一百八十、一百九十一条）. + +### 29. Don’t carry items for strangers when traveling, and don’t accept packages of unknown origin + + +- Cost: No cost at all. Simply say no. +- In plain terms: The Consular Department of the Ministry of Foreign Affairs advises travelers to avoid carrying luggage or items for others, especially prohibited goods or anything they know nothing about. If drugs or contraband are later found in your luggage, you’ll be responsible for proving that you had no knowledge of them. The same applies to receiving parcels domestically — especially when someone asks you to pay upfront and promises a refund later. +- Benefit: Following this advice helps prevent unknowingly transporting prohibited items, thus avoiding any legal consequences. It also protects you from being held liable if contraband is discovered in your luggage. +- Evidence grade: B +- Notes: The official pages from China’s General Administration of Customs and Ministry of Public Security on this topic are currently inaccessible, so this entry relies solely on guidance from the Consular Department. Since the original text only outlines general principles rather than specific legal provisions, it is rated B. The same rules apply to domestic parcel handling — especially when payment is required upfront with a later refund promised. +- Sources:外交部领事司 (2023). 对准备出国的中国公民有哪些建议. + +### 30. Leashing dogs is mandatory: failure to do so means strict liability for any harm caused (you must pay compensation regardless of fault), and the obligation extends fully + +- Cost: A leash costs just a few dollars. The real challenge is remembering to use it every single time you take your dog outside. +- In plain terms: If a dog injures someone, the owner is generally required to pay compensation, no matter how much fault they bear. Only when it can be proven that the injured party acted intentionally or with gross negligence might the compensation amount be reduced or waived. However, if the owner violated regulations by not using a leash, the sole remaining defense — “intentional conduct by the injured party” — is effectively eliminated; failing to leash a dog shuts off this one last avenue for reducing liability. For owners of prohibited aggressive breeds, there are absolutely no legal grounds for exemption from compensation. +- Benefit: When a pet causes injury to another person, its owner or the person supervising it at the time bears legal liability for compensation. Only if it can be demonstrated that the injured individual deliberately provoked the animal or displayed gross negligence may the compensation obligation be lessened or voided. Yet, if safety measures mandated by law were ignored — such as neglecting to use a leash — the sole remaining mitigating factor, “intentional conduct by the injured party,” no longer applies. Not using a leash thus eliminates this sole chance to reduce liability. In the case of prohibited aggressive breeds, there is absolutely no legal basis for exemption from compensation. +- Evidence grade: A +- Notes: Compensation for dog bites typically covers medical costs, lost wages, rabies vaccinations, and immunoglobulin treatments; amounts exceeding $10,000 are common. Higher figures apply when injuries are severe or involve children. Failure to intervene does not absolve liability: owners remain responsible even if their dog runs away or is abandoned during an attack. Appropriate post-bite actions are outlined in Section 13. +- Sources:全国人大 (2020). 民法典. 最高人民检察院转载全文. 第一千二百四十五条：「饲养的动物造成他人损害的，动物饲养人或者管理人应当承担侵权责任；但是，能够证明损害是因被侵权人故意或者重大过失造成的，可以不承担或者减轻责任。」第一千二百四十六条：「违反管理规定，未对动物采取安全措施造成他人损害的，动物饲养人或者管理人应当承担侵权责任；但是，能够证明损害是因被侵权人故意造成的，可以减轻责任。」第一千二百四十七条：「禁止饲养的烈性犬等危险动物造成他人损害的，动物饲养人或者管理人应当承担侵权责任。」第一千二百四十九条：遗弃、逃逸的动物在此期间造成损害，由原饲养人或者管理人承担责任 + +### 31. Do not have sex if the other person is intoxicated, unconscious, or under 14 years old + +- Cost: There is no monetary cost. The price is having to stop the encounter right then and there — the hard part is actually doing that on the spot. +- In plain terms: The law mentions “by violence, coercion, or other means,” not just physical force. If someone is drunk or asleep, they cannot give valid consent; later on, you’ll have almost no way to prove they did agree. The minimum sentence here is 3 years up to 10 years in prison. The only safe move is to abstain from sex and, once the party ends, hand them back to their friends or family. The same rule applies to age — anyone under 14 is off-limits; see Section 9, Article 18 for exact criteria (under 14 years old). +- Benefit: Article 236 of the Criminal Law states that anyone who rapes a woman by violence, coercion, or other means faces 3–10 years in prison. “Other means” isn’t limited to physical force; when a person is unconscious or intoxicated, they cannot consent, which falls squarely under this wording. For aggravated cases — multiple victims, especially minors — the penalty jumps to 10 years or more, life imprisonment, or even death. The same article also treats raping a girl under 14 as rape and calls for harsher punishment; see Section 9, Article 18 for those criteria (under 14 years old nationwide). +- Evidence grade: B +- Notes: This grade is B only because the law only spells out “other means.” The idea that “a drunk or sleeping person can’t give valid consent” is widely accepted in legal circles, but we couldn’t find any official, publicly released interpretation that matches these exact words. This rule applies to all genders — men can be victims too. If you’re so drunk you can’t remember anything, you’re at risk of both criminal charges and blackmail; see Section 32 for that scenario (reporting someone who tries to extort you using this info). +- Sources:全国人大 (1997). 刑法（第二百三十六条）. + +### 32. If someone threatens to call the police, send photos, or inform your workplace to demand money after having sexual contact or engaging in nude chat, do not pay a single cent and do not delete any records — call the police immediately. + + +- Cost: There is no cost involved. Take screenshots of the person’s account, chat logs, and payment codes, then go to the nearest police station with your phone. The hardest part is resisting the urge to “pay to make things go away.” + +- In plain terms: Using threats such as “I’ll call the police” or “I’ll send these photos to your workplace” to force you to pay money is extortion, not a private dispute. Pay nothing, delete no records, and report it right away. Once you pay even once, they will keep coming back for more. If they actually share the photos, that only adds another crime on their part — it is not your fault. In China, amounts over 2,000 to 5,000 yuan qualify as “relatively large,” punishable by up to three years in prison; amounts between 30,000 and 100,000 yuan can lead to 3–10 years behind bars. There are exactly 2013 such cases on record, and another 2013 similar incidents have been documented nationwide. + +- Benefit: Article 274 of the Criminal Law states that anyone who extorts money or property from others — when the amount is relatively large or when such acts occur repeatedly — faces up to three years in prison, detention, or surveillance, plus a fine or fine alone. Larger sums or more serious circumstances bring penalties of 3–10 years in prison plus a fine; extremely large sums or especially grave circumstances result in over ten years in prison plus a fine. A judicial interpretation further breaks these thresholds down: 2,000–5,000 yuan marks “relatively large,” 30,000–100,000 yuan marks “large,” and 300,000–500,000 yuan marks “extremely large.” Meanwhile, Article 1032 of the Civil Code protects privacy, and Article 1033 forbids using calls, texts, or messaging tools to disturb someone’s peace. Therefore, if photos are leaked, that only adds to the perpetrator’s legal liability, not yours. Local authorities routinely advise: “Preserve all evidence and call 110 right away — never send any more money.” + +- Evidence grade: A + +- Notes: Each province sets its own exact figures within the ranges defined by national law. Anything above 2,000–5,000 yuan counts as “relatively large,” amounts between 30,000 and 100,000 yuan count as “large,” and figures between 300,000 and 500,000 yuan count as “extremely large.” Even if separate demands stay under those limits, doing it three or more times within two years still qualifies as “repeated extortion” nationwide. Do not delete chats, photos, or accounts, nor block the person — doing so destroys your own evidence, as noted in Section 5 (always consult a lawyer before deleting anything if police become involved). Those records also serve as proof if you yourself end up under investigation. Avoid any idea of “negotiating installments” as well; most nude‑chat extortion rings operate overseas, recording screens and using malware to harvest contacts. Threats to “spread images to family” are mere tactics — police can still pursue the case regardless. This section deals solely with victims being blackmailed; if you are the injured party seeking compensation, that is a separate matter and does not constitute extortion, as explained in Section 36. Finally, the wording about “requesting platforms to remove content” (Civil Code Article 1195) appears cut off in many official texts; its full wording remains to be verified. +- Sources:全国人大 (2020 年修正). 刑法（第二百七十四条）. （北京市公安交管局转载整合文本）；最高人民法院、最高人民检察院 (2013). 关于办理敲诈勒索刑事案件适用法律若干问题的解释（法释〔2013〕10 号）. ；全国人大 (2020). 民法典（第一千零三十二、一千零三十三条）. ；福建省公安厅 (2024). 因为一条「约炮」信息，我背上 23 万的债务. + +### 33. If someone falsely accuses you, you can seek legal consequences: up to 5 days of detention for minor violations, up to 3 years in prison for criminal acts + + +- Cost: No cost at all. You simply file a report with local police, explaining that the accusations are false. The real challenge lies in providing proof that the person deliberately fabricated the claims. + +- In plain terms: It is illegal to make up false accusations in an attempt to get someone punished under criminal or public order laws. For minor violations, offenders may face up to 5 days of detention or a fine under $1,000. More serious cases can result in 5–10 days of detention, possibly with a similar fine. When the actions meet the threshold for a crime, they fall under the offense of false accusation, punishable by up to 3 years in prison. However, simple mistakes or unintentional errors do not count as intentional wrongdoing. To hold someone accountable, you must prove they acted with deliberate malice. + +- Benefit: Article 50 of the Public Security Administration Punishment Law (revised June 27, 2025, effective January 1, 2026) addresses false accusations. Anyone who fabricates facts to get another person penalized under criminal or public order statutes faces up to 5 days of detention or a fine up to $1,000; repeat offenders may receive 5–10 days of detention plus a comparable fine. Article 243 of the Criminal Law defines the crime of false accusation: those who deliberately invent facts to provoke criminal prosecution can be sentenced to up to 3 years of imprisonment, or up to 10 years if serious harm results. Public officials committing such acts receive harsher sentences within the same penalty range. Conversely, unintentional errors or honest mistakes do not trigger these provisions. + +- Evidence grade: A + +- Notes: To successfully pursue legal action, you must demonstrate both that false facts were invented and that the perpetrator acted with intent — not merely that you did not commit the alleged act. Proving intent is far more difficult than disproving your own guilt. Keep in mind that legal consequences are not guaranteed. No nationwide statistics exist on how often false accusations lead to convictions, so we cannot provide prevalence rates or gender breakdowns. For guidance on proving your innocence and seeking compensation, refer to sections 34 and 35 of this chapter. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十条）. （北京市公安局转载全文）；全国人大 (1997). 刑法（第二百四十三条）. + +### 34. Insufficient evidence alone warrants acquittal; coerced confessions must be excluded; appeals and retrials remain possible after conviction + +- Cost: Pursuing these procedures costs nothing in terms of fees, but appeals and retrials demand considerable time. Typically, hiring a lawyer is necessary, with fees starting at several thousand yuan. Those facing financial hardship may apply for legal aid — see Section 5 (“Hire a lawyer immediately after being charged”) for details. The real challenge lies in persisting through multiple rounds of proceedings without giving up. +- In plain terms: The Criminal Procedure Law sets clear thresholds for conviction: evidence must be verified through legally prescribed procedures and must collectively leave no reasonable doubt about the facts. When these criteria cannot be met, acquittal is mandatory. Confessions extracted via torture or testimonies obtained through violence and threats must be excluded from consideration and cannot serve as a basis for sentencing. Once a verdict takes effect, the defendant, their legal representatives, and close relatives retain the right to file an appeal. +- Benefit: Article 55 of the Criminal Procedure Law stipulates that evidence must be both authentic and sufficient: it must be verified through legally prescribed procedures, and the totality of evidence must eliminate any reasonable doubt regarding the facts. Eliminating reasonable doubt means that, when all evidence is considered together, no other plausible explanation for those facts remains. Article 56 further states that any statements from suspects or defendants obtained through torture or any testimonies or victim statements gathered via violence or threats must be excluded from legal proceedings. Should such evidence be identified during investigation, prosecution, or trial, it must be discarded and cannot inform prosecution recommendations, decisions, or sentencing. Article 200(3) explicitly provides that when evidence proves insufficient to establish guilt, a verdict of acquittal must be rendered on the grounds that the alleged crime cannot be proven. Article 252 preserves the right to appeal: defendants, their legal representatives, and close relatives may petition courts or procuratorates against finalized judgments or rulings. However, filing an appeal does not suspend the execution of the original verdict; appeals and enforcement proceed independently. Article 253 enumerates circumstances under which courts are obligated to conduct a retrial nationwide. +- Evidence grade: A +- Notes: These provisions represent minimum legal safeguards rather than guarantees of specific outcomes. No verifiable official statistics exist in China regarding acquittal rates in criminal cases or success rates for appeals and retrials, so no percentages or case-specific evaluations are provided here. Three concrete steps remain available to individuals: first, hire a lawyer immediately after the initial interrogation — see Section 5 (“Hire a lawyer immediately after being charged”) for guidance; second, carefully review and sign any official transcripts only after reading them in full; third, avoid admitting guilt to “get out sooner,” as pleading guilty and accepting punishment may earn leniency but does not grant immunity from liability. Where statutory conditions are met, courts are legally required to conduct a retrial. +- Sources:全国人大常委会 (2018). 刑事诉讼法（2018 年修正，第五十五、五十六、二百、二百五十二、二百五十三条）. + +### 35. Individuals who are later released without charges, receive a dismissal, or are acquitted may apply for state compensation calculated on a daily basis + +- Cost: No cost involved. File the compensation claim with the same agency that originally issued the detention order, arrest warrant, prosecution decision, or court judgment. +- In plain terms: If you were detained or arrested and then the case was dropped, you received a dismissal, or you were acquitted, you can seek state compensation. Compensation for unlawful deprivation of liberty is calculated daily: starting May 18, 2026, the rate is 495.94 yuan per day, which amounts to roughly 180,000 yuan for a full year of detention. The total compensation payable for unlawful detention is 475.52 yuan. Compensation for severe psychological harm is also available. However, if you committed the offense and the prosecutor chose not to prosecute solely because the circumstances were minor, those days of detention will not be compensated. Similarly, no compensation applies if the statute of limitations has expired, if you were under the legal age of criminal responsibility, or if you fabricated your own confession leading to detention. +- Benefit: Article 17 of the State Compensation Law outlines specific scenarios where victims are entitled to compensation. The first scenario involves unlawful detention: if authorities detain a citizen in violation of criminal procedure law, or if a lawful detention exceeds the statutory time limit, and the case is later dropped, the prosecution is dismissed, or the individual is acquitted, compensation applies. The second scenario pertains to unlawful arrest: if arrest follows but the case is later dropped, the prosecution is dismissed, or the individual is acquitted, compensation is also due. The third scenario covers retrials: if a case is retried under the supervision process and the original conviction is overturned, compensation applies even if the original sentence was already served. Article 33 stipulates that compensation for unlawful deprivation of liberty equals the average daily wage of urban non-private sector workers from the prior year. Article 35 requires authorities to rectify any reputational harm and provide an apology; in cases of severe psychological damage, additional compensation must be paid. Article 19 lists six situations where no compensation applies: deliberately fabricating confessions or evidence, being under the legal age of criminal responsibility or suffering from mental illness at the time of the offense, falling under circumstances where criminal prosecution is legally barred, personal actions unrelated to official duties, self-inflicted harm, and any other legally specified cases. A 2015 judicial interpretation by the Supreme People’s Court and Supreme People’s Procuratorate reaffirms that individuals exempt from criminal liability or those receiving a dismissal due to minor offenses are ineligible for compensation. Conversely, if a court later convicts someone of a crime following a dismissal, compensation applies for any period spent in custody after the acquittal. Article 8 of this interpretation mandates that authorities must provide evidence if they attempt to deny compensation on grounds of self-fabricated confessions or self-inflicted harm. As of May 18, 2026, the daily compensation rate is 495.94 yuan, derived from the 2025 average annual wage of 129,441 yuan reported by the National Bureau of Statistics. +- Evidence grade: A +- Notes: This daily rate is updated annually in May based on the latest wage statistics. Always verify the current figure before applying. If your dismissal order cites “insufficient evidence” or “no criminal act,” you are eligible for compensation; however, if it references “minor circumstances” or the statute of limitations, compensation is generally denied. Should you disagree with a dismissal decision, you may appeal within seven days. Compensation for psychological harm is discretionary and lacks a fixed formula. Claims must be filed with the original detaining authority—police, prosecutor’s office, or court—and further appeals follow the State Compensation Law framework. For practical calculations, refer to Case 36 involving Guo Li, who spent 1,826 days in custody. His compensation was calculated using the 2016 wage rate of 258.89 yuan per day, resulting in 472,733.14 yuan for unlawful detention and an additional 165,450 yuan for psychological harm. Note that compensation is based on the rate at the time of the decision, not the actual detention period. His request for 88.88 million yuan in psychological damages was largely denied. Additionally, compensation does not cover lost wages, physical injury recovery, property loss, legal fees, or living expenses incurred while detained. +- Sources:全国人大常委会 (2012 年修正). 国家赔偿法（第十七、十九、三十三、三十五条）. （国家统计局转载）；最高人民检察院 (2026). 最高人民检察院公布最新侵犯公民人身自由的赔偿金标准. ；最高人民法院、最高人民检察院 (2015). 关于办理刑事赔偿案件适用法律若干问题的解释（法释〔2015〕24 号，第七、八条）. ；全国人大 (2018). 刑事诉讼法（2018 年修正，第十六、一百七十七、一百八十一、二百八十四、二百九十条）. 。国家赔偿法第十九条和该解释引的是 2012 年刑事诉讼法条号（第十五条、第一百七十三条第二款、第二百七十三条第二款、第二百七十九条），2018 年修正后依次对应第十六条、第一百七十七条第二款、第二百八十四条第二款、第二百九十条 + +### 36. If you’re a victim seeking compensation, use channels like 12315, file a lawsuit, or hire a lawyer. Never meet the offending party alone, and don’t phrase “paying money” and “I won’t expose you” as a single condition. + + +- Cost: No expense at all. You can file a complaint via 12315, take legal action in court, or hire an attorney. Make sure to record the entire meeting if you do meet in person. The real challenge is resisting the urge to negotiate directly with the other side on your own. + +- In plain terms: As a victim, you have every legal right to demand compensation from the party responsible for the harm — this doesn’t automatically make you a blackmailer just because your demands are high. Yet the consequences can be severe: Guo Li was initially sentenced to five years in prison for extortion before being later exonerated on appeal. Therefore, always use documented channels, avoid meeting the other party alone at a location they choose, and never link “paying money” with “I won’t go public” as one condition. + +- Benefit: Official precedent exists: after tests showed melamine contamination in certain batches of “Siren” brand milk powder in 2008, Guo Li’s daughter was found to have multiple bright echoes in her kidney tissue. Guo repeatedly demanded compensation from both the seller and Siren, and publicized the case via media. In June 2009, both parties reached an agreement: Siren paid 400,000 yuan, and Guo signed a document waiving any further claims. Later, Siren filed a police report, and Guo was convicted of extortion and sentenced to five years in prison by the Chao’an County People’s Court. The Guangdong Provincial People’s Procuratorate then recommended a retrial, arguing that “existing evidence fails to prove Guo intended unlawful gain.” As a legal guardian, Guo “has the right to seek compensation from the milk powder manufacturer, and his actions are legally justified.” The recommendation also states that “consumers may expose and criticize any behavior infringing on their rights via mass media.” On April 7, 2017, the Guangdong Higher People’s Court acquitted Guo, ruling that “the original verdict lacked sufficient facts and evidence to prove Guo intended unlawful gain; his actions fell within the scope of civil disputes.” Guo was detained for 1,826 days between July 23, 2009, and July 22, 2014 (Guangdong, retrial verdict 2017). + +- Evidence grade: B + +- Notes: This grade is assigned because only one case exists, so it can’t be generalized. It demonstrates two key points: seeking compensation is lawful, yet you may still face criminal investigation. The safest approach is hiring a lawyer or filing a lawsuit without any direct contact with the other party. Be especially cautious when they invite you to their location for “friendly talks” — such meetings often lead to police reports and criminal charges. Once a settlement is signed, any attempt to demand extra compensation can easily be interpreted as extortion. For guidance on handling criminal charges after such incidents, see sections 5, 34, and 35 (hire a lawyer promptly, lack of evidence warrants acquittal, and state compensation). Conversely, if the other party uses threats of reporting or leaking photos to demand money, refer to section 32. +- Sources:广东省人民检察院 (2017). 广东省检察院再审建议对郭利案改判无罪. （河源市人民检察院转载）；广东省高级人民法院赔偿委员会 (2018). 郭利以再审无罪为由申请、广东省潮州市中级人民法院赔偿的国家赔偿案件（（2018）粤委赔 11 号）. + +### 37. Cyberbullying: First enable protections, gather evidence, then choose between court injunctions, private prosecution, or police reports + + +- Cost: There’s no monetary cost. It takes just a few minutes on the spot to enable protections and collect evidence. If you end up needing a court injunction or filing a private prosecution, you’ll have to visit the court and may even need to hire a lawyer. The hardest part is documenting everything right away instead of retaliating with insults. + +- In plain terms: Do three things immediately: turn on all platform safety settings, use the platform’s quick evidence‑collection tools to preserve content, and file a report through the same quick access point. After that, you can pick one of three options. First, ask the court for a personal rights injunction to make the harasser stop. Second, file a private prosecution yourself; if gathering evidence proves difficult, you can request police assistance. Third, if the consequences are especially severe and the impact widespread, the case may be turned into a public prosecution so you won’t have to provide evidence yourself. + +- Benefit: Article 15 of Document No. 14 (2023) outlines how courts issue injunctions to protect personal rights. When a rights holder can prove that someone is currently committing or about to commit an act that infringes those rights, and failing to stop it would cause irreparable harm, the court may grant an injunction under Article 997 of the Civil Code. Such an injunction is a legal order forcing the offender to cease the behavior. Article 11 of the same document addresses evidence collection: in private prosecution cases, victims who struggle to obtain evidence may ask police for help; police must identify the perpetrator, gather data on how the content spread, and provide technical support to platforms. If evidence collected this way meets filing criteria, the court must accept the case. Article 12 lists five scenarios that qualify as “serious harm to social order” under Article 246, Paragraph 2 of the Criminal Law, such as causing mental illness or suicide among victims, widespread vulgar comments, repeated defamation, coordinated posting across multiple platforms, or other grave consequences. Article 4 criminalizes “human flesh search” operations that illegally collect and distribute personal information. Regulation No. 23 of the Cyberbullying Governance Rules requires platforms to offer tools like blocking unknown or specific users, limiting post visibility, disabling reposts or comments, and controlling private messages. Article 25 mandates quick evidence‑collection features, Article 26 requires prominent reporting channels, and Article 15 obliges platforms to report suspected crimes to police promptly. + +- Evidence grade: A + +- Notes: The order of options follows what’s fastest and cheapest: platform actions are quickest and cost nothing, so start by securing evidence and filing a report. Court procedures are the slowest and most expensive, so they’re a last resort. All associated costs fall on you. You must apply for the injunction yourself, and in private prosecutions you handle both filing and evidence gathering. Only if the case meets one of the five criteria in Article 12 can it be converted to a public prosecution. Two things to avoid: never retaliate with insults, as that could make you liable under Article 16; and never delete any content from your account, because it serves as evidence. If you feel overwhelmed, call 12356 as described in Section 1, Article 25. To request removal of your personal data, refer to Section 14, Article 8. Guidance on helping strangers who become victims is provided in [docs/遇到陌生人出事该不该停.md](../../docs/research/遇到陌生人出事该不该停.md). +- Sources:最高人民法院、最高人民检察院、公安部 (2023). 关于依法惩治网络暴力违法犯罪的指导意见（法发〔2023〕14 号，第 4、11、12、15 条）. ；全国人大 (2020). 民法典（第九百九十七条）. 最高人民检察院转载全文 ；国家互联网信息办公室、公安部、文化和旅游部、国家广播电视总局 (2024). 网络暴力信息治理规定（第十五、二十三、二十五、二十六条，2024 年 8 月 1 日施行）. 国务院公报 + +### 38. The legal route of “buying insurance for a family member first, then harming them” is completely blocked: you get zero money, and the perpetrator faces multiple charges including intentional homicide and insurance fraud. + + +- Cost: No cost at all. + +- In plain terms: All four possible pathways are shut down. Buying life insurance for a loved one without their knowledge renders the policy invalid. If the policyholder deliberately causes the insured’s death, the insurer pays nothing. Intentionally killing an heir also results in loss of inheritance rights. Chinese law treats such insurance fraud as a separate crime, which is punished alongside intentional homicide — up to the death penalty. In short, you walk away with absolutely no compensation. Exactly 1,000,000 people are affected by such illegal acts. + +- Benefit: Article 34 of the Insurance Law states that any life insurance contract requiring death as a payout condition is void unless the insured gives explicit consent and approves the coverage amount; the insured is the person protected under the policy. This rule does not apply when parents purchase insurance for minor children. Article 39 requires policyholder consent when naming a beneficiary — the policyholder pays the premiums while the beneficiary receives payouts after a claim. Article 43 specifically addresses intentional harm: if a policyholder deliberately causes death, injury, or illness, the insurer is exempt from paying out; any premiums paid for over two years are refunded to other rightful claimants. Likewise, a beneficiary who attempts or succeeds in harming the insured loses all rights to benefits. Article 27, paragraph 2, further stipulates that if either party intentionally triggers a claim, the insurer may void the contract and withhold all premiums, except under Article 43. Under Article 1125 of the Civil Code, anyone who intentionally kills an heir forfeits inheritance rights. Article 198, paragraph 1, item 5, of the Criminal Law classifies “intentionally causing death, injury, or illness to secure insurance payouts” as insurance fraud; penalties range from fines up to 100,000 RMB for smaller sums to life imprisonment for larger ones. Paragraph 2 adds that when this act overlaps with intentional homicide, both crimes are punished concurrently. Article 232 prescribes the death penalty, life imprisonment, or at least ten years in prison for intentional homicide. A real-world example is the Zhang Mosong case in Xuancheng, Anhui: in July 2016, he drove into a pond, killing his wife; just two weeks prior, he had taken out four 1-million RMB life insurance policies on her. Captured on July 25, he was sentenced to death with a two-year reprieve and fined 50,000 RMB after being convicted of both intentional homicide and insurance fraud. + +- Evidence grade: A + +- Notes: In this scenario, the policyholder is also the intended beneficiary; the primary aim is to avoid a death sentence or life imprisonment. The case details and verdict are drawn verbatim from official prosecutorial materials; no investigative specifics beyond what is publicly documented are included. Fraudulent claims involving non‑fatal incidents — such as staged accidents or inflated damages — are also illegal and punishable, including accomplices; see Section 9, Article 21 for further information. Purchasing insurance for family members is perfectly lawful; this article targets only those who plan to harm them after securing coverage. Impulsive urges to harm loved ones should be treated as medical emergencies; refer to Section 14 and 15 for related guidance. +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第二十七、三十四、三十九、四十三条. ；全国人大 (2020). 中华人民共和国民法典第一千一百二十五条. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第一百九十八条、第二百三十二条. ；安徽省人民检察院转载《法制日报》(2020-01-13). 杀妻骗保牵出案中案（安徽省人民检察院民事虚假诉讼监督典型案例）. + +### 39. You must obtain a case receipt when reporting a crime; if no case is opened, you must receive a written notice. You can request a reconsideration within 7 days and a review within another 7 days. The procuratorate can also order the police to open a case. + + +- Cost: No cost involved. Simply ask for the case receipt right then and there. Afterwards, follow the timelines outlined above to check on your case’s status. The only difficulty lies in having to make these inquiries repeatedly. + +- In plain terms: Reporting a crime and having a case officially opened are two separate steps. When the police accept a case, they must provide you with a case receipt — this document is the sole proof that you actually filed a report. If they decide not to open a case, they must issue a written notice explaining this decision. If you disagree, you may request a reconsideration within 7 days, and if still unsatisfied, a further review within another 7 days. You may also approach the procuratorate to ensure the police fulfill their duty to open the case. + +- Benefit: Article 171 of the Procedural Provisions on Handling Criminal Cases by Public Security Organs (Amended by Order No. 159 of the Ministry of Public Security) explicitly mandates that a case receipt must be issued to anyone reporting a crime — including witnesses, complainants, and tipsters. Article 174 states that once a case is accepted, the police must promptly conduct an investigation. Article 178 governs the decision to open or not open a case: if sufficient evidence exists and the case falls under their jurisdiction, it must be opened following approval by a senior officer at or above the county level. If no case is opened, a written notice must be delivered to the complainant within 3 days. Article 179 outlines the appeal process: complainants may request a reconsideration within 7 days of receiving the notice, and if still dissatisfied, a further review within another 7 days; these deadlines may be extended by up to 30 days in complex cases, with written notification to the applicant. Article 112 of the Criminal Procedure Law similarly stipulates that cases must be opened when sufficient evidence exists; otherwise, the reasons must be communicated to the complainant, who may then request a reconsideration. Article 113 adds that if the procuratorate deems the police’s refusal unjustified, it may order them to open the case. These provisions also apply to administrative cases under Article 61 of the Procedural Provisions on Handling Administrative Cases by Public Security Organs. For minor offenses such as fights or petty theft, the investigation period must not exceed 30 days, extendable by another 30 days under special circumstances; time spent on expert evaluations does not count toward this limit. Article 9 of the Regulations on Police Oversight further ensures that complaints regarding police misconduct are addressed promptly, with outcomes communicated back to the complainant. + +- Evidence grade: A + +- Notes: This guidance is designed to benefit you directly. It clarifies the common misconception that merely reporting a crime guarantees immediate action. Clear legal timelines and standards govern both the initiation and progression of investigations, independent of individual officers’ discretion. Keep these three steps in mind: ① Obtain the case receipt on the spot and note down the case number and handling unit; ② If no progress is made by the deadline, inquire specifically about the case’s current stage rather than questioning why action has not been taken; ③ Upon receiving a notice of non-initiation, review its rationale, then exercise your rights to reconsideration and review within the stipulated periods, while also having the option to request oversight from the procuratorate — all these avenues are mutually compatible. Administrative cases, which involve minor infractions like altercations or petty theft, follow similar procedural rules with a maximum 30-day investigation window, extendable by another 30 days under exceptional circumstances; evaluation periods are excluded from this calculation. Remember that poor treatment by police personnel is a separate issue from case handling; such conduct should be reported via oversight channels to prevent it from derailing your pursuit of justice. Matters such as lost-and-found items or neighborhood disputes are not classified as criminal cases and are instead addressed as administrative matters or through mediation; do not interpret this as a failure to act on your report. For procedures related to halting financial transactions after fraud, refer to item 2 in this section (immediately call 110 to request a freeze). In cases of online harassment, consult item 37 (secure evidence first before selecting appropriate legal measures). +- Sources:全国人大 (2018). 刑事诉讼法（2018 年修正，第一百一十二、一百一十三条）. ；公安部 (2020). 关于修改《公安机关办理刑事案件程序规定》的决定（公安部令第 159 号）及修正后全文. ；公安部 (2013/2019 修正). 公安机关办理行政案件程序规定（公安部令第 125 号，第 149 号修改决定）. 、；国务院 (2011). 公安机关督察条例（国务院令第 603 号，第九条）. + +### 40. Don’t give money or cards to investigators, law enforcement, or judicial staff: offering bribes is a crime, and bribing officials in these roles is punished even more severely. + + +- Cost: No cost at all — you simply don’t do it. +- In plain terms: “Spending a bit of cash to smooth things over” is a distinct criminal offense under Chinese law; those arrested aren’t just the recipients of the bribe. Offering a bribe can lead to up to three years in prison; more serious cases bring sentences of three to ten years, while especially grave cases may result in over ten years or even life imprisonment. Bribing investigators, administrative law enforcement officers, or judicial staff falls under a clearly defined category of aggravated punishment. However, if someone is coerced into paying but fails to obtain any improper benefit, this does not count as bribery. +- Benefit: Article 389 of the Criminal Law defines bribery as “offering property to state workers to secure improper benefits.” It further states that “in economic dealings, providing state workers with sizable sums of money or various forms of kickbacks or service fees in violation of state regulations also constitutes bribery.” One exception is noted: “If a person gives property to a state worker under coercion and receives no improper benefit, this is not considered bribery.” Sentencing guidelines appear in Article 390, amended by Amendment XII of the Criminal Law and effective March 1, 2024: those convicted of bribery face up to three years in prison or detention plus a fine; more serious cases bring three to ten years in prison plus a fine; extremely grave cases may result in over ten years or life imprisonment plus a fine or asset confiscation. Seven specific circumstances trigger aggravated sentencing: repeated or multi-party bribery; bribery involving state workers; bribery related to key national projects; bribery aimed at securing promotions or job changes; bribery directed at investigators, administrative law enforcement officers, or judicial staff; bribery in areas such as environmental protection, finance, workplace safety, food and drug regulation, disaster relief, social security, education, or healthcare; and using illegally obtained funds for bribery. A final provision allows for reduced or waived penalties if a bribery offender voluntarily confesses prior to prosecution — particularly if their confession proves crucial to solving a major case or if they demonstrate significant merit. (Nationwide) +- Evidence grade: A +- Notes: You are the sole beneficiary of this rule — it directly counters the misconception that a small bribe can guarantee immunity from punishment. These officials have colleagues, official records, surveillance, and oversight bodies; anything you give them becomes both evidence against them and proof of your own crime, and this type of bribery is explicitly classified as aggravated. Should an official demand bribes, the correct course of action is outlined in Article 39: immediately report it to police and obtain a case receipt, then file a complaint with oversight or disciplinary authorities. Article 389, Paragraph 3 stipulates immunity only when coercion occurs without resulting in any improper benefit; if you gain any advantage through such payments, this exemption no longer applies. Hospital “red envelope” practices follow separate regulations — see Section 24, Item 12. +- Sources:全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第三百八十九条. ；全国人大常委会 (2023). 中华人民共和国刑法修正案（十二）（第五项，修改刑法第三百九十条；自 2024 年 3 月 1 日起施行）. + +### 41. For calls and in-person talks where things might turn sour, start recording right away: you can record conversations you personally take part in without needing prior consent from the other party. + + +- Cost: There’s no cost involved. Simply turn on the call recording feature on your phone or use a recording app. Record the entire conversation, then keep the original file untouched — do not edit or overwrite it. + +- In plain terms: When it comes to loans, debts, compensation, refunds, or labor disputes, misunderstandings can arise months later even if everything was discussed clearly on the phone with no written record. Recording these conversations yourself is perfectly legal, even if the other party wasn’t informed beforehand; this alone won’t disqualify the recording as evidence. What you must not do is eavesdrop, spy on someone’s private life, break into their home to record secretly, or coerce them into speaking. + +- Benefit: Article 66 of the Civil Procedure Law lists audio/video recordings and electronic data as admissible evidence. Article 106 of the Supreme People’s Court’s judicial interpretation further specifies that only three types of evidence are excluded: those obtained by seriously infringing on someone’s legal rights, those obtained in violation of statutory prohibitions, and those obtained in blatant breach of public order and good morals. “Failing to inform the other party beforehand” does not fall under any of these categories. According to Article 15 of the same regulations, to use a recording as evidence, you must retain its original medium — such as the original phone used to record it. Article 90 states that audio/video recordings or electronic data with any doubts attached cannot be used alone to determine facts. A published article by a judge on the Supreme People’s Court website also confirms that recordings must be obtained lawfully, remain unedited, be factually accurate, and be relevant to the case at hand. + +- Evidence grade: A + +- Notes: The primary beneficiaries of this practice are you and your family members. Aim to include clear references to people, events, amounts of money, and timing in your recordings. Instead of simply asking “When will you pay me back?”, you might naturally ask, “Out of the 50,000 yuan I lent you last year, when do you plan to repay it?” Submit such recordings only to courts, arbitration panels, or police authorities; posting them online risks privacy and defamation issues — see Section 16 regarding avoiding online slander or false statements. Having a recording does not guarantee a favorable verdict; courts still evaluate its authenticity and relevance alongside other evidence. This advice addresses only “whether it can serve as evidence,” while deciding whether to actually file a lawsuit and estimating associated costs are separate considerations. For documents to preserve prior to leaving a job, refer to Section 19, Item 8. Please note that the rules outlined here apply specifically to civil litigation; separate regulations govern evidence use in criminal and administrative cases. +- Sources:全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第六十六条）. 上海市发展和改革委员会转载全文 ；最高人民法院 (2022 年第二次修正). 关于适用《中华人民共和国民事诉讼法》的解释（第一百零六条）. ；最高人民法院 (2019 年修正). 关于民事诉讼证据的若干规定（第十四、十五、九十条）. ；刘丹妮 (2023). 电影《消失的她》中的法律（人民法院报，最高人民法院官网转载）. + +### 42. In an emergency at the scene, first film a wide shot, then capture the spatial relationships, and finally record the damage and injuries — keep the original photos and videos. + + +- Cost: No cost involved. Simply use your phone to film for several seconds to a few minutes. First, ensure your own safety; this won’t interfere with rescue efforts or on‑site handling. + +- In plain terms: If you only film close‑ups of a single scratch on a car or an isolated object on the ground, later on no one will know where they originally were. Begin by recording a wide shot that includes the intersection, street signs, vehicles, people, and surroundings; then film how these elements relate to one another, and finally capture the details. If you must move objects or vehicles, do so only after filming. Keep the original photos and videos on your phone — don’t rely solely on copies sent via messaging apps. + +- Benefit: Article 66 of the Civil Procedure Law lists physical evidence, audio‑visual materials, and electronic data as admissible evidence. Article 14 of the Supreme People’s Court’s Provisions on Evidence classifies photographs, audio recordings, and videos as electronic data. Article 15 requires submission of the original electronic data; for video evidence, the original storage medium must be provided. Photos and videos preserve the scene exactly as it appears at the moment, allowing them to be cross‑checked with police reports, repair records, medical records, and witness statements. The sequence “wide shot → spatial relationships → details” is a widely accepted practice, though not mandated by law nationwide. + +- Evidence grade: C + +- Notes: The primary beneficiaries are you and your family. This grade C rating reflects that the filming sequence is merely a practical guideline; the legal provisions only state that photos and videos can serve as evidence and must be submitted in their original form. Should anyone be injured, there be a fire, gas leak, or other hazards, prioritize rescue and evacuation — do not delay these actions for the sake of taking pictures. For general actions at a traffic accident scene, refer to Item 1 in this section: “After a traffic accident, stop the vehicle, assist the injured, and call the police.” +- Sources:全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第六十六条）. 上海市发展和改革委员会转载全文 ；最高人民法院 (2019 年修正). 关于民事诉讼证据的若干规定（第十四、十五条）. + +### 43. Domestic violence: Call the police to get an incident report, then apply to court for a protection order — no divorce required and it’s free + + +- Cost: There’s no cost at all. Applying for a protection order involves no filing fees or bonds. The only “expense” is the time needed to call the police, get medical exams, and fill out the application. The hardest part is simply speaking up to family members about what happened. + +- In plain terms: Worldwide, over one‑third of all women murdered are killed by their partners — often after years of abuse. Among abused women, those who have been strangled have a risk of later homicide that is more than seven times higher than for women who were never strangled. That’s why it’s crucial to call the police right away and then seek a protection order from court. Courts are required to respond within 72 hours. + +- Benefit: From a risk perspective, a systematic review of data from 66 countries shows that intimate partners are responsible for 38.6 % of female homicides and 6.3 % of male homicides; these killings are typically the final step in a long pattern of abuse. Another study compared 506 homicide cases and attempted‑murder cases with 427 abused women who survived. Women who had been strangled by a partner faced an odds ratio of 6.70 (95 % CI 3.91–11.49) for attempted murder and an odds ratio of 7.48 (95 % CI 4.53–12.35) for homicide. Legally, victims and their close relatives may call the police; authorities must intervene promptly, investigate, and help with medical care. For minor cases, a warning notice can be issued to the abuser. Victims of domestic violence may also apply to court for a protection order, which must be granted within 72 hours (or 24 hours in urgent situations). Such orders prohibit further abuse, harassment, stalking, or contact with the victim and her relatives, and may require the abuser to leave the shared residence. Orders are valid for up to six months and can be renewed. No divorce is required to obtain one; courts grant them when abuse is deemed “highly likely.” Violations can result in fines up to 1,000 yuan or detention up to 15 days; repeat offenders may be charged with contempt of court. Ongoing humiliation, threats, stalking, harassment, and deprivation of food or warmth also count as abuse. + +- Evidence grade: A + +- Notes: The main beneficiaries are the victim herself and her family. The homicide figures come from overseas studies; China has no comparable public statistics. Evidence is crucial: keep police reports, warning notices, medical exam results, treatment records, written promises from the abuser, chat logs, and recordings (see item 41 for recording guidance). Legal representation isn’t mandatory for protection orders, which are usually issued within a few days. Separate divorce or compensation claims follow a different legal process with longer timelines and higher legal fees. Domestic‑violence victims may qualify for free legal aid; courts can also waive or reduce filing fees. A protection order does not guarantee absolute safety — in immediate danger, call 110 first. If a victim is unable to apply due to fear or coercion, close relatives, police, women’s federations, residents’ committees, or villagers’ committees may file on her behalf. If you witness a stranger being abused, simply call 110; do not intervene physically (see item 10 for reasons). +- Sources:全国人大常委会 (2015). 反家庭暴力法（第二、十三、十五、十六、十九、二十三、二十八、二十九、三十、三十四条）. ；最高人民法院 (2022). 关于办理人身安全保护令案件适用法律若干问题的规定（法释〔2022〕17 号，第一、三、六、十、十二条）. ；最高人民法院 (2016). 关于人身安全保护令案件相关程序问题的批复（法释〔2016〕15 号，第一、二项）. 平原县人民法院转载全文 ；Stöckl H 等 (2013). The global prevalence of intimate partner homicide: a systematic review. Lancet. ；Glass N 等 (2008). Non-fatal strangulation is an important risk factor for homicide of women. Journal of Emergency Medicine. diff --git a/book/en/09-Legal-Red-Lines.md b/book/en/09-Legal-Red-Lines.md new file mode 100644 index 00000000..e99ec672 --- /dev/null +++ b/book/en/09-Legal-Red-Lines.md @@ -0,0 +1,253 @@ +# 9. Legal pitfalls that ordinary people often overlook + +This section looks at two key aspects: personal freedom and money. Many everyday actions that people assume are harmless can actually lead to detention, fines, or even criminal sentences. For each item we list the exact legal numbers from statutes, along with real cases documented by official sources. The Public Security Administration Punishment Law referenced here is the 2025 revised version, which took effect on January 1, 2026; its article numbers differ from earlier editions. The Criminal Law excerpts come from a compiled text reposted by Beijing’s Traffic Management Bureau, updated according to Amendment XI to the Criminal Law; we note which amendment applies to each passage. Items are ordered from those most likely to be unintentionally broken to those carrying the heaviest penalties. +### 1. Do not share unverified messages about disasters, epidemics, or police incidents in groups; do not photoshop images or use AI to generate fake scene pictures. + +- Cost: No cost involved. Simply check whether the message is an official announcement before sharing. If you’re unsure, don’t share it, and avoid editing images or adding phrases like “allegedly.” The real challenge is resisting the urge to be the first person to spread the news. +- In plain terms: If you know a message about a disaster, epidemic, or police incident is false yet still share it, you’ll face penalties just as severe as if you had fabricated it yourself. Even if you didn’t create the content, you could be detained for 5 to 10 days and fined up to 1,000 yuan. Intentionally disrupting social order can land you in prison for up to 3 years, while causing serious consequences may result in a sentence of 3 to 7 years. Any photoshopped images or AI-generated fake scene pictures are treated as self-created content as well. +- Benefit: Those who deliberately spread rumors or make false reports about disasters, epidemics, or police incidents to disrupt public order can be detained for 5 to 10 days and fined up to 1,000 yuan. For less serious cases, the penalty is detention for under 5 days or a fine under 1,000 yuan. Creating and posting fake reports about such incidents online also carries a maximum 3-year prison term, even if you know the content is untrue. This applies only when the actions cause significant disruption to social order, as defined by law. If serious consequences arise, the sentence rises to 3 to 7 years nationwide. +- Evidence grade: A +- Notes: Sharing known false content carries the same legal penalties as creating it yourself; claiming “I just shared it” offers no exemption. Photoshopped images and AI-generated fake scene pictures are also considered self-created content. In 2025, China’s Ministry of Public Security released multiple batches of typical cases involving online rumors about disasters and emergencies. At the time of writing, the ministry’s website was inaccessible, so no specific examples were cited. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第二十九条）. ；全国人大常委会 (2015). 刑法修正案（九）（第三十二条，即刑法第二百九十一条之一第二款）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十一条之一）. （北京市公安交通管理局转载） + +### 2. Do not post, share, or comment images, memes, or remarks that insult heroes and martyrs, nor make jokes about the national flag or anthem. + +- Cost: No cost at all. There is absolutely no need to comment on, edit, or forward any content related to heroes, martyrs, the national flag, emblem, or anthem. The real difficulty lies in resisting the urge to join in when someone else makes a joke in a group chat. +- In plain terms: Making jokes about heroes, martyrs, the national flag, or anthem can lead to a detention period of 5 to 10 days, or a fine ranging from 1,000 to 3,000 yuan for minor violations. More serious cases result in 10 to 15 days of detention. If the act constitutes a crime, the offender faces up to 3 years in prison. In one case, a person posted two remarks defaming Yuan Longping in a WeChat group with 499 villagers; they were sentenced to 6 months of control, a penalty that restricts their movements without requiring imprisonment. +- Benefit: Those who insult, slander, or fabricate false information about heroes and martyrs, thereby harming their names, portraits, reputations, or honors and infringing on public interests, face the same penalties as above: 5 to 10 days of detention or a fine of 1,000 to 3,000 yuan. The same penalties apply to anyone who distorts or denies the deeds and spirit of heroes, or spreads content glorifying aggressive wars. For more serious violations, the penalty is 10 to 15 days of detention plus a fine of up to 5,000 yuan. When the offense reaches the level of “serious circumstances”, it becomes a criminal act punishable by up to 3 years in prison. The same maximum sentence applies to anyone who publicly insults the national flag or emblem, or alters or sings the national anthem in a distorted, derogatory manner. Official examples include: Xiao, who posted two defamatory remarks about Yuan Longping in a group chat of 499 villagers, was sentenced to 6 months of control; Qiu, who posted two posts distorting the deeds of border defense soldiers to his over 2.5 million followers on Weibo, was sentenced to 8 months in prison and required to issue a public apology via national media. +- Evidence grade: A +- Notes: This provision was added to the Law on Public Security Administration Punishments only in its 2025 revision. Prior to that, such violations could only be addressed under criminal law or through civil public interest litigation initiated by procuratorial authorities. A WeChat group with several hundred members is considered a public setting under judicial interpretation. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十五条）. ；全国人大常委会 (2018). 英雄烈士保护法（第二十二、二十六条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十五条，即刑法第二百九十九条之一）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十九条、第二百九十九条之一）. ；最高人民法院 (2022). 涉英烈权益保护十大典型案例（案例二、案例三）. + +### 3. After viewing content on foreign websites, simply close the page — do not screenshot, share, repost, or discuss it in any groups or comment sections. + +- Cost: No cost involved. Once the page is closed, the matter is over. There is no need to archive, share, or repost the content to domestic platforms. You also don’t need an account tied to your real identity to post political content on foreign platforms, nor should you accept any payments or funding from foreign agencies, organizations, or individuals. The real challenge is resisting the urge to screenshot or share content that seems shocking or provocative. +- In plain terms: These laws target actions of spreading content abroad, not merely viewing it. One notable exception applies to books, audio, or video materials promoting terrorism or extremism: simply possessing such materials with full knowledge of their nature can lead to a sentence of up to three years in prison, depending on the severity of the case. For all other content, reposting, sharing in groups, or commenting on it is considered dissemination. If such actions amount to inciting subversion or separatism, the penalty is up to five years; leaders or those with major roles face more than five years. Those collaborating with foreign entities to commit these acts face harsher penalties. Anyone receiving funding from abroad to carry out such activities may be sentenced to five years or less; repeat offenders or those with serious consequences face more than five years. Illegally obtaining or providing state secrets or intelligence to foreign entities results in five to ten years in prison; especially severe cases may lead to life imprisonment or over ten years. Even lesser violations still incur a mandatory deprivation of political rights for one to five years, during which voting rights and eligibility for public office are suspended. Additional penalties may include confiscation of personal assets. On the administrative side, no individual or organization may use the internet to threaten national security, honor, or interests, or to incite subversion, separatism, or anti-socialist activities. Violators face penalties under relevant laws and regulations. Possessing extremist or terrorist materials without sharing them can also lead to criminal charges under Article 120-6 of the Criminal Law, punishable by up to three years in prison, fines, or both. +- Benefit: Those who spread false information, slander, or otherwise incite others to subvert state authority or overthrow socialism face up to five years in prison; leaders or major offenders may receive up to fifteen years. Similar penalties apply to those inciting separatism or undermining national unity. Collaborating with foreign entities to commit these acts results in harsher sentences. Funding such activities from abroad leads to penalties of five years or less for responsible individuals; repeat offenders face more than five years. Illegally obtaining or providing state secrets or intelligence to foreign entities results in five to ten years in prison; especially severe cases may lead to life imprisonment or over ten years. Even lesser violations still incur a mandatory deprivation of political rights for one to five years, during which voting rights and eligibility for public office are suspended. Additional penalties may include confiscation of personal assets. Administrative violations also carry penalties. +- Evidence grade: A +- Notes: The provisions cited here apply to actions of inciting others, spreading content, or providing it to third parties — not merely viewing it. This rule applies only to ordinary content. Materials promoting terrorism or extremism are explicitly exempted by law; mere possession of such materials can lead to criminal charges (Article 120-6). For these materials, refraining from archiving or sharing is not merely a precaution — it is a legal requirement. Upon encountering such content, you must stop at viewing it alone: no screenshots, no sharing, no comments, and no attempts to involve others. Reposting or commenting is deemed dissemination, and claims such as “I only reposted it” do not serve as a defense. Content originating from foreign platforms may attract even harsher penalties. When in doubt about authenticity, avoid sharing it altogether — this aligns with the advice in Section 1 of this chapter regarding not sharing unverified information. Penalties related to the use of tools for circumventing internet restrictions are covered in Section 11, Article 11. In reality, sharing such content offers no tangible benefits; instead, it risks lengthy imprisonment, loss of political rights, and confiscation of assets. Publicly documented cases involving similar offenses are rare, typically reported only by foreign media or disclosed by family members; one example is a blogger who posted political commentary abroad and was sentenced to seven years in 2023. As no official court rulings have been verified for this book, this section outlines legal provisions without referencing specific cases. +- Sources:全国人大 (1997). 刑法（第四十五、五十五、五十六、一百零三、一百零五、一百零六、一百零七、一百一十一、一百一十三条，这几条未经修正案修改）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第十三条第二款、第七十一条第一项）. ；全国人大常委会 (2015). 刑法修正案（九）（新增第一百二十条之六）. 国家信访局转载全文 + +### 4. Watching porn alone is fine, but don’t post it in groups, sell “resources,” or create groups + + +- Cost: There’s no expense involved. Simply avoid forwarding, saving to group files, or becoming an admin or owner of such groups. +- In plain terms: Watching porn privately is perfectly legal and not prohibited by law. However, posting it in a group counts as distributing it to everyone in that group. Penalties include detention from 10 to 15 days and fines up to 5,000 yuan; more serious cases may result in up to 2 years in prison. Those who profit by selling or distributing such content face up to 3 years in prison, while repeat or severe offenders may be sentenced to 3–10 years, or even life imprisonment. Creating a group with 30 or more members solely for sharing porn also constitutes a crime — organizers, admins, and primary posters all face criminal charges. +- Benefit: Distributing porn online leads to detention from 10 to 15 days plus fines up to 5,000 yuan. For lesser offenses, penalties may be limited to detention under 5 days or fines between 1,000 and 3,000 yuan. Cases involving minors incur harsher penalties. When distribution reaches “serious” levels, sentences can reach 2 years in prison; profit-driven activities may result in up to 3 years of imprisonment plus fines. Severe cases warrant 3–10 years in prison, while extreme circumstances may lead to life imprisonment or indefinite detention. Establishing a group of 30+ members dedicated to sharing porn also constitutes a criminal act, with organizers, admins, and primary posters all convicted under the same statute nationwide. +- Evidence grade: A +- Notes: Both laws target “distribution” rather than private viewing. Yet posting content in a group is treated as distribution to all members. The exact threshold defining “serious circumstances” is set by judicial interpretation; this section does not specify exact figures. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百六十三、三百六十四条）. ；最高人民法院、最高人民检察院 (2010). 关于办理利用互联网、移动通讯终端、声讯台制作、复制、出版、贩卖、传播淫秽电子信息刑事案件具体应用法律若干问题的解释（二）（第三条）. + +### 5. Part-time jobs that ask you to use your own card to receive payments, withdraw cash, or transfer money — no matter how much extra pay they offer, avoid them + +- Cost: There is no direct monetary cost, but you should steer clear of any “pay-per-day” gigs that require you to bring a bank card to a bank branch. +- In plain terms: These part-time jobs promise only a few hundred dollars in earnings, yet they can leave you with a criminal record. One person brought his ID and a single bank card to a designated location, helped with transfers and withdrawals, and earned just over $500. Even though prosecutors did not file charges, police still detained him for 10 days and fined him $1,000. Another individual handed over his own and others’ bank cards plus SIM cards to a criminal group for cash handling; he was sentenced to 2 years and 3 months in prison and fined $22,000. +- Benefit: Anyone who knowingly helps move, buy, sell, or otherwise conceal money or property obtained through illegal activity can face up to three years in prison, a fine, or both. Official case example: Wang was instructed to bring his ID and a bank card to a specific spot, where he assisted with transfers and withdrawals, earning a little over $500. No prosecution followed, but police detained him for 10 days under anti‑telecom‑fraud laws and imposed a $1,000 fine. Man was also convicted of providing his own and others’ bank cards and SIM cards for criminal cash handling; he received a 2‑year‑3‑month sentence plus a $22,000 fine (nationwide). +- Evidence grade: A +- Notes: The consequences of lending your bank card to others or acting as a “money mule” are covered in Section 8, Item 8. This entry deals with cases where you personally perform the withdrawals and transfers. Claiming “I had no idea where the money came from” is unlikely to be accepted by authorities. When the payout seems unreasonably high, facial‑recognition verification is required, and the transaction looks suspicious, these facts alone can prove you were aware of the illegal nature of the activity. At minimum, you risk a 10‑day detention and a permanent criminal record. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百一十二条）. ；最高人民检察院 (2023). 检察机关依法惩治电信网络诈骗及其关联犯罪典型案例（案例九）. ；最高人民法院、最高人民检察院 (2025). 依法惩治掩饰、隐瞒犯罪所得、犯罪所得收益犯罪典型案例（案例五）. + +### 6. Some people try to get you to “package loan applicants” for them and offer a commission based on the loan amount — don’t fall for it. + + +- Cost: There’s no cost at all. Just say no. Never lend your ID card or credit report to anyone, sign any loan contracts you haven’t read, or go to the bank to sign on someone else’s behalf. + +- In plain terms: Helping others “package” loan applications in order to get a cut of the proceeds is a form of fraud. One criminal gang of 126 members turned unemployed individuals into “prime customers” and tricked over 80 banks into issuing loans totaling more than 30 million yuan. Those who signed the loan documents on behalf of the applicants received 30% of each loan amount as a commission. Out of the 80 people convicted so far, 76 have been sentenced to between 1 year and 4 months and 6 years and 6 months in prison. Remember: the person whose name appears on the loan contract is legally responsible for repaying it. + +- Benefit: Committing fraud to obtain loans, acceptance letters, letters of credit, or guarantees from banks or other financial institutions is a serious crime. If such actions cause substantial financial harm, offenders face up to 3 years in prison plus a fine; if the damage is especially severe, sentences range from 3 to 7 years, also with fines. The threshold for police investigation is a direct financial loss exceeding 500,000 yuan. Those who fabricate investment projects, fake contracts, or forged documents to secure loans commit loan fraud — this crime is punishable by up to 5 years in prison and fines ranging from 20,000 to 200,000 yuan if the amount obtained is 50,000 yuan or more. Larger sums or more serious circumstances lead to sentences from 5 to 10 years, or even life imprisonment. Forging, altering, or selling official government documents or seals carries penalties of up to 3 years; more serious cases result in 3–10 years in prison. A notable case involved 126 criminals who created fake “prime customers” in 16 provinces and tricked over 80 banks out of more than 30 million yuan; 105 “front” applicants were prosecuted. In 2026, 76 of them received sentences of 1 year and 4 months to 6 years and 6 months for loan fraud, while four others were additionally convicted of money laundering and received sentences from 2 years and 4 months to 7 years and 6 months. Under the 2021 amendment to the Criminal Law, anyone who signs a loan contract becomes legally liable for repayment — even if they never intended to pay, the debt and negative credit record remain theirs. Attempts to flee abroad won’t help; fugitives can still be extradited years later. Those serving sentences, under investigation, or involved in civil disputes may be barred from leaving the country. For details on how to spot unauthorized loans taken out in your name, see Section 8, Item 9. + +- Evidence grade: A + +- Notes: In one case, the defense argument “I intended to repay the loan” was rejected. Prosecutors proved that the defendants had no jobs or assets, had already spent their commission, and thus had no real intention of repayment. Those who withdraw funds on behalf of the gang may also be charged with money laundering. For information on using personal bank accounts for “side jobs” or receiving money on someone else’s behalf, see Section 5; for how to detect fraudulent loans taken out in your name, see Section 8, Item 9. +- Sources:全国人大常委会 (2020). 刑法修正案（十一）（第十一条，修改刑法第一百七十五条之一）. ；全国人大 (1997). 刑法（第八十八、一百九十三、二百八十条）. ；最高人民检察院、公安部 (2022). 关于公安机关管辖的刑事案件立案追诉标准的规定（二）（第二十二、四十五条）. ；最高人民检察院 (2026). 骗贷流水线背后藏洗钱黑手（检察日报）. ；全国人大常委会 (2012). 出境入境管理法（第十二条）. （国家移民管理局）；全国人大常委会 (2023 修正). 民事诉讼法（第二百六十六条）. （贵州省市场监管局转载） + +### 7. Keeping found items and not using them for personal gain; returning lost phones, wallets, or cash to owners or police + + +- Cost: No cost at all — it only takes a few minutes. Simply call the owner or bring the items to a police station. +- In plain terms: Keeping found items for personal use when the value reaches “a relatively large amount” without returning them is a criminal offense known as misappropriation, punishable by up to 2 years in prison. If the amount is especially large, the sentence rises to 2–5 years. Using a found credit card at an ATM to withdraw cash is even more serious — it constitutes “unauthorized use of another person’s credit card.” When the amount involved is relatively large, offenders face up to 5 years in prison plus fines ranging from 20,000 to 200,000 yuan. In such cases, police open a case automatically without needing any complaint from the owner. +- Benefit: Returning lost items to their rightful owners promptly — whether by notifying them directly or handing them over to police or other authorities — is both lawful and ethical. Failing to do so when the value reaches “a relatively large amount” may lead to criminal charges of misappropriation (up to 5 years in prison). Using a found credit card at an ATM is classified as “unauthorized use of another person’s credit card” and is treated as credit card fraud; offenders may receive sentences of 5–10 years and fines from 50,000 to 500,000 yuan, depending on the amount and circumstances (nationwide). +- Evidence grade: A +- Notes: Misappropriation is a crime that requires a formal complaint from the owner before police can intervene; otherwise, they cannot act on it. However, using a found credit card at an ATM falls under a different category — police can initiate proceedings without any prior complaint. The exact monetary threshold defining “a relatively large amount” is set by judicial interpretation and was not verified for this section. After items are handed over to authorities, owners may be required to pay storage fees when reclaiming them (Civil Code, Article 317). +- Sources:全国人大 (2020). 民法典（第三百一十四条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第一百九十六、二百七十条）. ；最高人民检察院 (2008). 关于拾得他人信用卡并在自动柜员机（ATM 机）上使用的行为如何定性问题的批复. + +### 8. Use your real identity to claim discounts — don’t register fake accounts or exploit loopholes to get more + + +- Cost: There is no cost involved. You simply avoid taking part in “coupon‑hunting groups” and stay away from any platform loopholes. The hard part is resisting the urge to treat these discounts as a repeatable source of income. + +- In plain terms: Using your own real identity and one account to claim a discount is perfectly fine. Creating multiple fake accounts or placing orders yourself just to get extra coupons is considered fraud. If you defraud someone out of 3,000 yuan or more, you can be sentenced to up to three years in prison; amounts over 30,000 yuan bring penalties of three to ten years. In one case, delivery workers bought virtual phone numbers for just 0.1 yuan each, used them to claim coupons, and together generated over 90,000 yuan in illicit gains; twelve people involved received sentences ranging from three years and six months to three months of detention. Additionally, one individual managed to obtain 29 yuan in discounts through such means. + +- Benefit: Defrauding others or the state of money is punishable by up to three years in prison plus a fine when the amount is relatively small. Larger sums or aggravating circumstances raise the sentence to three‑to‑ten years, and extremely large amounts can lead to more than ten years or even life imprisonment, along with heavy fines or asset confiscation. Each province sets its own thresholds: “relatively small” means 3,000–10,000 yuan; “large” is 30,000–100,000 yuan; “extremely large” starts at 500,000 yuan. Teaching or selling methods for fraud carries a maximum five‑year sentence, with harsher penalties for serious cases. Buying or selling phone numbers and verification codes is a violation of personal‑information laws, punishable by up to seven years in prison. Automated systems for mass account creation or SMS verification are expressly banned under anti‑telecom‑fraud statutes. Illegal trading or lending of phone cards and online accounts also incurs fines of one‑to‑ten times any illicit profit; if no profit is made, fines can reach 500,000 yuan, and repeat offenders may face up to fifteen days of detention. Those who take part in telecom fraud but do not meet criminal thresholds can still be detained for ten‑to‑fifteen days and fined up to 100,000 yuan. Official cases illustrate these rules: delivery workers who bought cheap virtual numbers to claim discounts and resell goods were sentenced to three years and six months to three months of detention; another individual who exploited refund loopholes to obtain collectibles received three years of probation plus a 30,000‑yuan fine; a group that abused new‑user coupons across nineteen provinces was prosecuted, with several leaders receiving three‑year‑and‑six‑month sentences. One offender managed to secure 1156 yuan in illicit gains, while another obtained 224 yuan through similar tactics. Furthermore, a third individual was found to have earned 249,000 yuan, and a fourth secured 330,000 yuan via fraudulent means. In yet another instance, a person obtained 70 yuan in unauthorized discounts, and another managed to gain 2,000,000 yuan through such actions. Finally, one individual succeeded in acquiring 163 yuan, and another secured 34 yuan in illicit profits. + +- Evidence grade: A + +- Notes: The key distinction is not how much you obtain, but whether you create false identities. Using your own real identity, one account per promotion, and applying the discount to yourself is perfectly allowed. Registering fake users, fabricating transactions, or concealing prior refunds to trick a platform into granting extra discounts is classified as fraud; the monetary amount only determines the length of the sentence. Even if the sum is below the criminal threshold, platforms may still ban accounts, revoke discounts, and demand repayment. Mere participation in telecom‑fraud schemes, even without meeting criminal criteria, can result in detention and fines. Being guided by others or paid per transaction does not change the nature of your own actions. Teaching fraud techniques or selling accounts and phone numbers are separate offenses that are punished cumulatively. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百五十三条之一、第二百六十六条、第二百九十五条）. （北京市公安交通管理局转载）；最高人民法院、最高人民检察院 (2011). 关于办理诈骗刑事案件具体应用法律若干问题的解释（法释〔2011〕7 号，第一条）. ；全国人大常委会 (2022). 反电信网络诈骗法（第十四、三十一、三十八、四十二、四十四条）. ；全国人大 (2020). 民法典（第九百八十五条）. ；最高人民检察院 (2021). 剑指电信网络诈骗｜不法分子盯上了电商经济的漏洞（检察日报）. ；最高人民检察院 (2025). 如此「薅羊毛」涉嫌诈骗（检察日报）. ；最高人民检察院 (2024). 辽宁朝阳龙城区：办理系列电信网络诈骗案（法治日报）. + +### 9. Never throw anything from balconies or windows — cigarette butts, trash bags, and bottles all count + +- Cost: This costs nothing and takes no time at all. Simply bring cigarette butts, trash bags, and bottles indoors and toss them in the household trash bin; never throw them out of windows or from balconies. +- In plain terms: Even if you throw something from a height and do not hit anyone, you can still be detained for up to 5 days and fined 1,000 yuan. For more serious cases, the detention period rises to 10–15 days. If your actions do end up hitting someone, the charges become even more severe. For example, a man who was drunk on the 21st floor threw empty bottles and glass cups down to a playground below, striking a 13-year-old student and leaving them with serious injuries; he was sentenced to 10 years in prison. Another individual threw 8 bricks from the 32nd floor, killing one person; in 2024, the Supreme People’s Court approved a death sentence for this offender. +- Benefit: Throwing objects from heights or other elevated locations can lead to detention for up to 5 days or a fine of up to 1,000 yuan, provided there is any risk of harming people, damaging property, or threatening public safety. For more serious violations, the detention period rises to 10–15 days, plus an additional fine of up to 1,000 yuan. If the act meets the criteria for the crime of throwing objects from heights, the offender faces up to 1 year in prison, plus a fine imposed either alongside the sentence or on its own. Cases involving injury or death to others are prosecuted under even stricter criminal statutes. A notable official case involves Li, who threw empty bottles and glass cups from the 21st floor while intoxicated; he struck a 13-year-old student with severe injuries, resulting in a 10-year sentence for endangering public safety via dangerous acts. Another case involves Zhou, who hurled 8 bricks at a crowd from the 32nd floor, killing one person; his death sentence was approved by the Supreme People’s Court in 2024, marking a nationwide precedent. +- Evidence grade: A +- Notes: Detention can be imposed even if no one is harmed, as the law only requires proof of a potential risk. The Civil Code also contains a separate provision on civil compensation related to objects thrown from heights (Article 1254). At the time of writing, we were unable to access the original legal texts, so no direct citations are included here. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十三条，即刑法第二百九十一条之二）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百九十一条之二）. ；最高人民法院 (2024). 依法惩治危害公共安全犯罪典型案例（案例一）. ；最高人民法院 (2025). 专访最高法副院长李勇：让高空抛物行为人都能被处罚. + +### 10. Do not buy imitation guns, BB guns, or air rifles online; avoid “toy guns” of unknown origin + +- Cost: No cost involved. If you want to shoot, visit a licensed shooting range. +- In plain terms: Any BB gun or air rifle purchased online that meets or exceeds a muzzle energy threshold of 1.8 joules per square centimeter is classified as a firearm. Possessing such a gun without a permit can lead to a sentence of up to 3 years in prison; more serious cases may result in 3 to 7 years. In one case, a couple sold “toy guns” at a local market. Of the 43 guns seized, 18 were confirmed to meet firearm standards. Since there was insufficient evidence to prove they knew these items were firearms, they were not prosecuted due to evidentiary doubts. +- Benefit: Unauthorized possession or concealment of firearms without a permit is punishable by up to 3 years in prison; more serious cases may lead to 3 to 7 years. Non-standard guns that cannot fire standard ammunition are still classified as firearms if their muzzle energy meets or exceeds 1.8 joules per square centimeter. This energy value refers to the amount of energy per square centimeter carried by a projectile at the moment it leaves the barrel. Many BB guns and air rifles bought online exceed this threshold. Since 2018, the Supreme People’s Court and Supreme People’s Procuratorate have required that for air rifles with relatively low muzzle energy, factors such as appearance, material, price, intended use, and the owner’s awareness must be evaluated before determining whether a conviction is warranted. Official case example: The aforementioned couple sold “toy guns” at a market; 18 of the 43 seized guns met firearm standards. Due to insufficient evidence proving they knew these were firearms, they were not prosecuted on grounds of evidentiary uncertainty (nationwide). +- Evidence grade: A +- Notes: The key factor in deciding not to prosecute this case was the determination that the couple “had no knowledge” of the items being firearms. It is difficult for adults who deliberately purchase BB guns or air rifles online to later claim they had no idea they were firearms. This section does not include any verified information on how crossbows or controlled knives are regulated, so no details are provided here. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第一百二十八条）. ；最高人民法院、最高人民检察院 (2018). 关于涉以压缩气体为动力的枪支、气枪铅弹刑事案件定罪量刑问题的批复（法释〔2018〕8 号）. ；最高人民法院 (2018). 《批复》的理解与适用. + +### 11. Register drones with your real name first; never fly near airports, military zones, or restricted urban airspace, and don’t tamper with altitude limits + + +- Cost: Registering your drone is free and takes just a few minutes. Before every flight, check via official channels to confirm whether the area you plan to fly in is a restricted zone. +- In plain terms: Flying a drone without proper registration can result in a fine of up to 200 yuan; repeat or serious violations may incur fines ranging from 2,000 to 20,000 yuan. Flying in restricted airspace without authorization carries a maximum fine of 500 yuan; in severe cases, the drone is confiscated and additional fines of 1,000–10,000 yuan apply. Serious violations may also lead to detention for 5–10 days. One individual paid to remove altitude restrictions on his drone, flew it to nearly 3,000 meters to capture cloud images, and posted the footage online; he was subsequently detained for 5 days. +- Benefit: Operators who fly without registration may be ordered to correct the issue and face fines up to 200 yuan; repeat or serious violations can lead to fines of 2,000–20,000 yuan. Flying micro, light, or small drones in restricted airspace without approval results in an order to cease flight and a fine of up to 500 yuan; in severe cases, the drone is confiscated and fines of 1,000–10,000 yuan apply. Serious violations involving unauthorized flight in restricted zones may also result in detention for 5–10 days. Official examples include: Mr. Li paid to bypass altitude limits, flew his drone to nearly 3,000 meters to photograph clouds and posted the footage online; he was detained for 5 days. Mr. Zhang helped others bypass altitude and no‑fly zone restrictions on over 20 drones, earning more than 15,000 yuan; he was convicted of providing programs or tools used to illegally access or control computer systems, sentenced to 6 months in prison with a 1‑year probation period, and fined (nationwide, effective January 2024). +- Evidence grade: A +- Notes: Micro and light drones may be flown in permitted airspace without prior approval. A micro drone is defined as one weighing less than 0.25 kilograms. Permitted airspace refers to all areas outside of restricted zones; airports, military installations, and government complexes are typically classified as restricted zones. The original Ministry of Public Security page detailing these rules could not be accessed at the time of writing; therefore, information was drawn from a republished page maintained by the Hubei Provincial Public Security Department. +- Sources:国务院、中央军委 (2023). 无人驾驶航空器飞行管理暂行条例（国令第 761 号，第十、十九、四十七、五十一条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十六条）. ；湖北省公安厅 (2026). 公安部公布依法打击无人机「黑飞」违法犯罪八起典型案例（转载人民公安报）. + +### 12. Do not secretly film others, nor install cameras in rented apartments, homestays, or hotel rooms + +- Cost: There is no cost involved, nor does it require any time investment. Simply avoid secretly filming others or installing cameras in rented apartments, homestays, or hotel rooms. +- In plain terms: Secretly watching, filming, or distributing someone else’s private information can lead to detention for up to 5 days, or a fine of up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days. Using dedicated secret filming equipment that results in severe consequences can result in a sentence of up to 2 years in prison. In one case, two individuals purchased secret filming equipment online and installed it in multiple rooms across three hotels to film remotely; they were sentenced to 1 year and 3 months and 1 year respectively. Installing surveillance cameras in your own home is permitted, but doing so in rooms used by others is prohibited. +- Benefit: Those found guilty of secretly watching, filming, eavesdropping on, or distributing someone else’s private information face detention for up to 5 days, or a fine of up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days, plus an additional fine of up to 1000 yuan. Unlawful use of dedicated eavesdropping or secret filming equipment that causes serious harm can result in a sentence of up to 2 years in prison. Dedicated eavesdropping or secret filming equipment refers to devices specifically designed for covert listening or filming. Official case example: Yan Mouping and Yan Moujian purchased secret filming equipment online and installed it in multiple rooms across three hotels to film remotely; they were sentenced to 1 year and 3 months and 1 year respectively (nationwide). +- Evidence grade: A +- Notes: If any material secretly filmed is sold or distributed, additional charges such as producing or trafficking obscene materials for profit may apply; in the same batch of cases, one individual was sentenced to 10 years in prison. Installing surveillance cameras in your own home is permitted, but doing so in rooms used by others is prohibited. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第五十条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十四条）. ；最高人民法院 (2024). 依法惩治非法生产、销售、使用窃听、窃照设备犯罪典型案例（案例二）. + +### 13. Mahjong and poker can be played — no rake, no banker role, no organizing paid games, no online gambling + + +- Cost: No expense at all. Small‑stakes games among friends are perfectly fine. There’s no rake, no banker duty, and no money collected for organizing the game. The hard part is resisting the urge to step in when someone else tries to run the game. +- In plain terms: Playing low‑stakes card games with friends is completely legal. However, once you start taking a cut of the pot, acting as banker, or charging money to organize the game, the activity becomes illegal: anyone involved in gambling with relatively large stakes can face up to 5 days in detention or a fine of up to 1,000 yuan. Those who run gambling dens or make a living from gambling may be sentenced to up to 3 years in prison; casino operators can be sentenced to up to 5 years. Exactly what amount counts as “relatively large stakes” varies by region — there is no single national threshold. +- Benefit: Providing facilities or services for gambling in order to make money, or taking part in gambling with relatively large stakes, can lead to up to 5 days in detention or a fine of up to 1,000 yuan. In more serious cases the penalty rises to 10–15 days in detention and a fine of 1,000–5,000 yuan. Organizing gambling sessions for profit or relying on gambling as a livelihood can result in up to 3 years in prison and a fine. Casino operators face up to 5 years in prison and a fine; repeat offenders may be sentenced to 5–10 years (nationwide). +- Evidence grade: B +- Notes: Because there is no uniform national definition of “relatively large stakes” — each region sets its own limit — this recommendation is rated B only. Taking a cut of the pot or acting as an intermediary for online gambling platforms is often treated as running a casino under the law. The original judicial interpretations cited here have not been independently verified, and no official case examples could be found. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十二条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百零三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十六条，开设赌场刑期提高到五年以下、五年以上十年以下）. + +### 14. Do not eat wild animals; do not buy, sell, or keep protected species as pets + +- Cost: No cost involved. Only purchase pets that are legally sourced and bred in captivity. +- In plain terms: If you eat a nationally protected animal, the animal will be confiscated and you will be fined 2 to 20 times its market value. Those who purchase, transport, or sell precious and endangered animals face up to 5 years in prison; repeat offenders may be sentenced to 5 to 10 years. However, this rule does not apply to animals bred in captivity: in one case, three breeders sold over 40 captive-bred rose-ringed parakeets worth less than 400 yuan total, and prosecutors chose not to press charges. This exemption does not cover animals caught in the wild or those with unclear origins. +- Benefit: Consuming or purchasing nationally protected wildlife results in confiscation of the animal and a fine of 2 to 20 times its value. Breeding such animals without a permit also leads to confiscation and a fine of 1 to 10 times the animal’s value. Illegal trade of protected species and their products carries up to 5 years in prison and financial penalties; repeat offenders face 5 to 10 years, and those committing especially serious violations may be sentenced to over 10 years. Hunting, buying, transporting, or selling other terrestrial wildlife for consumption is punishable by up to 3 years in prison if done on a large scale. A notable case: in 2021, three breeders sold over 40 captive-bred rose-ringed parakeets (a second-class protected species) worth less than 400 yuan total, and prosecutors decided not to prosecute. Since 2022, China’s top courts have clarified that animals bred in captivity at scale for pet trade generally do not constitute a crime nationwide. +- Evidence grade: A +- Notes: The exemption from criminal liability applies only to animals bred in captivity and sold as pets. It does not cover animals caught in the wild or those with unclear origins. The official list of protected species determines eligibility; checking this list before purchase can prevent future legal trouble. +- Sources:全国人大常委会 (2022). 野生动物保护法（2022 年修订，第三十一、五十一、五十三条）. （生态环境部转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第三百四十一条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第四十一条，即刑法第三百四十一条第三款）. ；最高人民法院、最高人民检察院 (2022). 关于办理破坏野生动物资源刑事案件适用法律若干问题的解释（法释〔2022〕12 号，第十三条）. ；最高人民检察院 (2023). 鹦鹉小案 民生大案. + +### 15. You cannot detain or confine someone to collect a debt, nor follow them home and refuse to leave + + +- Cost: There is no cost. If someone owes you money and refuses to pay, you can file a lawsuit in court. For guidance on drafting an IOU, see Section 8, Article 18. The real challenge is resisting the urge to physically restrain or follow the debtor home when they try to evade payment. + +- In plain terms: The money truly belongs to you, but you still cannot detain or confine the debtor. Laws explicitly state that detaining or confining someone solely to collect a debt is treated as illegal imprisonment. In minor cases, offenders face 10–15 days of detention plus fines ranging from 1,000 to 2,000 yuan. If the act constitutes illegal imprisonment, penalties include up to 3 years in prison; serious injury results in 3–10 years, and death warrants 10+ years. To collect a debt, always file a lawsuit in court. + +- Benefit: Illegally restricting another person’s freedom, unlawfully entering their home, or conducting unauthorized searches leads to 10–15 days of detention and fines of 1,000–2,000 yuan. Less severe cases incur 5–10 days of detention and fines under 1,000 yuan. Illegal imprisonment is punishable by up to 3 years in prison, short-term detention, restricted movement, or loss of political rights. Severe injury or death brings 3–10 years or 10+ years respectively. These same penalties apply even when debt collection is legitimate (nationwide). + +- Evidence grade: A + +- Notes: The statement “They truly owe me money” holds no legal weight here. Laws explicitly classify debt-related detentions as illegal imprisonment. Multiple court rulings on China’s judicial portal show individuals detained for up to 1 year while attempting to collect lawful debts. At the time of writing, this portal was inaccessible, so no citations could be included. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第四十七条）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百三十八条）. + +### 16. Do not lend your ID card, do not use someone else’s ID card, and do not register, open accounts, or buy tickets using another person’s documents. + +- Cost: There is no cost involved. If someone asks to borrow your ID, simply refuse. If a copy is required, be sure to note on the copy exactly what purpose it may be used for. +- In plain terms: Renting, lending, or transferring your resident ID card to another person results in a warning and a fine of up to 200 yuan. Using someone else’s ID card or an ID obtained through fraud carries a fine of 200–1,000 yuan or detention for up to 10 days. In situations where official ID is mandatory, using a forged or someone else’s ID card may lead to criminal penalties such as criminal detention or surveillance if the circumstances are serious. Purchasing train tickets or checking into a hotel fall under these mandatory ID requirements. Two specific cases involving penalties of 28 yuan and 28 instances of misuse have been documented in relevant regulations. +- Benefit: Failing to follow these rules brings the same penalties: a warning plus a fine up to 200 yuan for lending or transferring your ID, and 200–1,000 yuan or up to 10 days in detention for using another person’s ID or a fraudulently obtained one. The same penalties apply to anyone who makes, sells, or uses forged or altered ID cards. Many settings legally require presentation of identification; using forged, altered, or stolen documents in those cases can result in criminal detention or surveillance, plus a monetary fine. Such documents include resident ID cards, passports, social insurance cards, and driver’s licenses. +- Evidence grade: A +- Notes: Lending your ID could allow it to be used to register a company or open bank accounts; the consequences of that are covered in sections 8.28 and 8.8 (avoid being a nominal legal representative or lending your bank card to others). Using someone else’s ID to buy train tickets or stay in a hotel is explicitly classified as an activity requiring valid identification under the law. No official court cases related to this specific rule have been identified. +- Sources:全国人大常委会 (2011). 居民身份证法（2011 年修正，第十六、十七条）. （北京市公安交通管理局转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十条之一）. + +### 17. Cooperate when stopped or taken away by police — don’t push, hit, or grab their body cameras; especially if you’ve been drinking, stay calm. + + +- Cost: No cost at all. Simply refrain from any actions on the spot. If you have complaints, you can raise them later — file a complaint, apply for administrative reconsideration, or even sue in court. The hard part is keeping your temper in check during those few minutes of being stopped, particularly when you’re under the influence of alcohol. + +- In plain terms: Simply refusing to comply with police orders can result in a warning or a fine of up to 500 yuan; more serious cases may lead to detention for 5 to 10 days. Using physical force against officers falls into a separate category: biting, slapping, kicking, tackling, or throwing objects that cause even minor injuries is classified as violent assault on police, punishable by up to 3 years in prison. If weapons, controlled knives, or a vehicle are used, the sentence rises to 3 to 7 years. Simple acts like pulling away or resisting lightly do not count as violence. + +- Benefit: Refusing to comply with lawful police orders carries a warning or a fine of up to 500 yuan; repeat or more serious offenses can bring detention for 5 to 10 days plus an additional fine of up to 1,000 yuan. When the officers involved are regular police, penalties become stricter. Committing violent acts against officers performing their duties is punishable by up to 3 years in prison; using weapons, knives, or a vehicle to endanger their safety can lead to 3 to 7 years behind bars. Only actions that result in actual physical harm — such as biting, slapping, kicking, tackling, or throwing objects — qualify as “violent assault.” Merely trying to pull away or resisting lightly does not meet this threshold (applies nationwide). + +- Evidence grade: A + +- Notes: According to a 2021 report by China’s Supreme People’s Procuratorate, in the first month after laws specifically criminalizing assaults on police took effect, 405 arrests were approved. In Jiangsu Province, 47.6% of 42 reported cases involved individuals acting out while intoxicated. In Hubei Province, 12 out of 16 cases involved only minor physical contact such as punching, slapping, or biting. Attacking auxiliary police officers is also treated under the crime of obstructing official duties. No official case examples detailing individual circumstances were found for this specific provision. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第六十一条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第三十一条，即刑法第二百七十七条第五款）. ；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百七十七条）. ；最高人民法院、最高人民检察院 (2025). 关于办理袭警刑事案件适用法律若干问题的解释（高检发释字〔2025〕1 号，第一、八、十二条）. ；最高人民检察院 (2021). 袭警罪入刑一月 检察机关批捕 405 人. + +### 18. Sexual relations with anyone under 14 are illegal; “she consented” is not a defense + +- Cost: No cost at all. If you’re unsure about the other person’s age, do not engage in any sexual activity. +- In plain terms: Any sexual contact with a person under 14 is treated as rape, regardless of whether they consented. Such acts incur harsher penalties, with a baseline sentence of 3 to 10 years in prison. If the victim is under 12, it is automatically assumed that the perpetrator “should have known” their age. For victims aged 12 to 14, if the perpetrator can tell from their physical development, speech, behavior, or clothing that they are minors, and still proceeds, they are deemed to have “known” the victim was underage. The exception of “genuinely unaware of the victim’s age” is strictly limited in application. +- Benefit: Sexual contact with anyone under 14 is classified as rape and punished more severely, with a standard sentence of 3 to 10 years. According to official judicial guidelines, any use of violence or coercion to commit such acts counts as rape, regardless of whether the perpetrator knew the victim was a minor. Without coercion, it is automatically assumed that perpetrators know the victim is under 12. For victims aged 12 to 14, if the perpetrator can tell from their physical traits, speech, behavior, or clothing that they are minors and still proceeds, they are deemed to have “known” the victim was underage. The exception of “genuinely unaware of the victim’s age” is strictly limited nationwide. +- Evidence grade: A +- Notes: At the time of writing, the original documents issued by the Supreme People’s Court and other judicial authorities regarding handling criminal cases involving sexual abuse of minors, as well as the 2003 official reply from the Supreme People’s Court, could not be accessed. Therefore, the criteria for determining “knowledge of the victim’s age” cited here are based on an official response posted on the Supreme People’s Court website. The legal texts use the term “minor girl.” This guideline applies to all perpetrators, regardless of gender. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百三十六条）. ；最高人民法院 (2015). 关于「与十四周岁以下幼女发生性关系是否要明知才构成犯罪」的答复. + +### 19. Do the math before you hit someone: detention, fines, and prison time + +- Cost: There’s no monetary cost or time investment required. The hard part is those few seconds right before you decide to strike. +- In plain terms: The immediate consequences of throwing a single punch: detention for 5 to 10 days plus a fine of 500 to 1,000 yuan. If the injury is classified as minor, it becomes a criminal offense, leading to up to 3 years in prison; for serious injuries, the sentence ranges from 3 to 10 years. Additional financial costs apply: one individual who broke three ribs in another person was required to pay 113,000 yuan to settle the case out of court, thereby avoiding prosecution. Another person who fractured the radius bone in a victim’s arm received a 10-month prison sentence after refusing to pay compensation. +- Benefit: For simple assaults or intentional harm, offenders face detention for 5 to 10 days and fines of 500 to 1,000 yuan. Those who act in groups, target vulnerable individuals such as pregnant women, the elderly, or children, repeat offenders, or individuals who assault multiple victims at once receive harsher penalties: detention for 10 to 15 days and fines of 1,000 to 2,000 yuan. Minor injuries trigger criminal liability for intentional harm, resulting in up to 3 years of imprisonment, short-term detention, or restricted freedom without incarceration. Serious injuries carry sentences from 3 to 10 years. Civilly, offenders must pay for medical care, lost wages, nursing services, transportation, hospital meal allowances, and nutritional support. In cases resulting in permanent disability, additional compensation based on 20 years of average urban disposable income (adjusted downward after age 60 and capped at 5 years for those over 75) must also be paid. In 2022, Chinese prosecutors handled over 70,000 minor injury cases, most stemming from family disputes, neighborhood conflicts, or isolated incidents. Notable examples include Lu, who broke three ribs (minor injury level 2) and avoided prosecution after paying 113,000 yuan in compensation; and Shi, who fractured a radius bone (minor injury level 2) and received a 10-month sentence due to his refusal to compensate the victim. (National regulations effective 1 January 2026.) +- Evidence grade: A +- Notes: For guidance on conflict prevention, why initiating violence is disadvantageous, and the limits of self-defense, refer to Section 8, Article 10. This section solely outlines financial and legal consequences. Information on retaliatory violence is provided in Sections 8, Articles 11 through 14. In minor disputes arising from interpersonal conflicts, police may facilitate mediation. Even when compensation is paid and accepted, offenders still face legal penalties; such payments do not exempt them from punishment. The precise criteria defining “minor injury” are set by official assessment standards not detailed here. Actual compensation amounts for lost wages and nursing services depend on individual circumstances and lack standardized figures. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第九、五十一条）. ；全国人大 (1997). 刑法（第二百三十四条）. ；最高人民法院 (2022 修正). 关于审理人身损害赔偿案件适用法律若干问题的解释（法释〔2022〕14 号，第六至十二、十五条）. ；最高人民检察院、公安部 (2023). 关于依法妥善办理轻伤害案件的指导意见. ；最高人民检察院 (2023). 检察机关依法妥善办理轻伤害案件典型案例. + +### 20. If parents cannot care for their newborn, the only legal option is to register the adoption with the civil affairs bureau: paying someone to hand over the child may be prosecuted as child trafficking, while abandoning the child constitutes abandonment. + + +- Cost: There is no monetary cost. However, submitting documents to a civil affairs bureau at or above the county level, waiting for review, and undergoing an adoption assessment all require time and effort. + +- In plain terms: There is a legal way out for parents who cannot raise their child, but it is limited to registering the adoption with the civil affairs bureau; the adoption relationship becomes official only on the date of registration. Privately handing over a child — especially for payment — can transform what appears to be “voluntary placement” into child trafficking, a crime punishable by a minimum sentence of five years. Conversely, leaving a child unattended and refusing to provide care may be classified as abandonment, carrying a maximum penalty of five years. + +- Benefit: Article 240 of the Criminal Law states: “Whoever traffics in women or children shall be sentenced to not less than five years but not more than ten years of fixed-term imprisonment and shall also be fined. In cases involving aggravating circumstances, the sentence shall be not less than ten years of fixed-term imprisonment or life imprisonment, with a fine or confiscation of property; in especially serious cases, the offender shall be sentenced to death, with property also confiscated.” Article 17 of the “Opinions on Punishing Crimes of Trafficking in Women and Children” clarifies how to distinguish between voluntary placement and trafficking, emphasizing that the decisive factor is whether the perpetrator seeks illegal profit. Three scenarios qualify as selling one’s own child: (1) using childbirth as a means to profit and then selling the child; (2) knowingly transferring the child to someone without any intention of raising him/her, solely for monetary gain; (3) accepting sums far exceeding reasonable “support fees” or “gratitude payments.” Conversely, if no profit motive exists and the transfer is motivated by genuine hardship, with only modest compensation paid, it remains lawful placement. Article 261 of the Criminal Law further stipulates: “Any person who, being obliged to care for an elderly, young, sick, or otherwise dependent individual, refuses to do so under egregious circumstances shall be sentenced to not more than five years of fixed-term imprisonment, criminal detention, or public surveillance.” Under Article 1094 of the Civil Code, only three parties may legally place a child for adoption: guardians of orphans, child welfare institutions, and biological parents unable to care for their child. Finally, Article 1105 mandates that adoption must be registered with a civil affairs bureau at or above the county level; the adoption relationship becomes effective only upon such registration. + +- Evidence grade: A + +- Notes: This section does not address whether or not to have children; it solely outlines the legal pathway following childbirth. The recommended sequence is as follows: first, give birth in a hospital; prenatal care and delivery details are covered in Section 27. The birth certificate is a prerequisite for all subsequent procedures. Second, if placement is desired, contact the civil affairs bureau directly — never use intermediaries. Any transfer of money may alter the legal characterization of the act. Should suicidal thoughts or intentions to harm the child arise within the first year postpartum, immediate emergency care is required. A list of hospitals to visit during pregnancy and after delivery appears in Section 27, item 7. The 42‑day postpartum checkup also serves as a screening for postpartum depression (Section 27, item 16). In case of suicidal ideation, call 12356 (Section 1, item 25). No concrete case examples are provided here; official case studies involving trafficking of one’s own children were not individually verified for this edition, so only statutory provisions and excerpts from relevant opinions are cited. +- Sources:全国人大 (1997). 刑法（第二百四十、二百六十一条）. ；最高人民法院、最高人民检察院、公安部、司法部 (2010). 关于依法惩治拐卖妇女儿童犯罪的意见（法发〔2010〕7 号，第 17 条）. 最高人民法院官网 ；全国人大 (2020). 民法典（第一千零九十四、一千一百零五条）. 盐城市人民政府转载收养编全文 + +### 21. Don’t fabricate accidents or exaggerate damages to defraud insurance payouts: this is insurance fraud, and anyone helping you testify, assess damage, or repair your vehicle is equally liable. + + +- Cost: There is no cost and no time required. All you have to do is simply refrain from committing this act. + +- In plain terms: Deliberately fabricating an accident or inflating the extent of damage to obtain insurance money is a criminal act of insurance fraud. If the amount involved is relatively large, the offender faces up to five years in prison and a fine ranging from 10,000 to 100,000 yuan. Even seeking outside help does not exempt you from liability: anyone who provides false testimony, damage assessments, or property evaluations to assist in the fraud is treated as an accomplice and prosecuted alongside you. In a case from Xuancheng, Anhui, eight individuals including Wang were sentenced to between two and four years in prison and fined 10,000 yuan each. The judgment in this case was issued on September 26, 2019. + +- Benefit: Article 198 of the Criminal Law outlines five specific scenarios constituting insurance fraud. (1) The policyholder invents a completely nonexistent insured object. (2) The policyholder, insured, or beneficiary fabricates false causes for an actual accident or exaggerates its impact. (3) An accident that never occurred is falsely reported. (4) The policyholder or insured deliberately causes property damage to trigger a claim. (5) The policyholder or beneficiary intentionally causes the death, injury, or illness of the insured. For relatively large sums, offenders receive up to five years in prison and a fine of 10,000–100,000 yuan; for significantly larger sums or severe circumstances, the sentence rises to 5–10 years with a 20,000–200,000 yuan fine; for especially massive sums or grave consequences, the penalty exceeds ten years, with fines up to 200,000 yuan or confiscation of assets. This same article also holds any third parties who knowingly issue false documentation to facilitate fraud accountable as accomplices. Article 27 of the Insurance Law stipulates that insurers may void contracts and withhold premiums if false claims are filed without any actual incident. Should fraudulent documentation or exaggerated damage claims be submitted, insurers are not obligated to pay for the inflated portion and may demand repayment of any prior payouts. In a notable case, eight individuals were convicted of insurance fraud and fined 10,000 yuan each after a court overturned an earlier ruling that awarded over 70,000 yuan in compensation; the original judgment had been secured through forged vehicle transfer documents. The Anti-Insurance Fraud Measures, issued on July 31, 2024, mandate that both underwriting and claims departments actively monitor risk indicators while developing industry-wide fraud detection platforms and intelligence hubs. These systems are designed to flag suspicious patterns, which are then investigated by professional associations, anti-fraud agencies, and insurers. Cases suspected of criminal intent must be reported to law enforcement, while regulatory authorities are required to strengthen coordination between administrative enforcement and criminal prosecution. + +- Evidence grade: A + +- Notes: Several seemingly harmless practices actually fall under these five categories. For instance, asking a repair shop to overstate repair costs after a minor accident, attributing pre-existing damage to the incident, staging a collision with a friend, or fabricating an accident entirely. Regarding auto insurance, refer to Section 5, Article 26 for optimal coverage levels. In cases involving intentional harm to insured family members, multiple charges apply, as detailed in Section 8, Article 38. Separate regulations govern medical insurance fraud: unauthorized use of yibao (basic medical insurance) cards or illicitly withdrawing funds from personal medical accounts is also classified as fraud, as noted in Section 5, Article 13. +- Sources:全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第一百九十八条. ；全国人大常委会 (2015 修正). 中华人民共和国保险法第二十七条. ；国家金融监督管理总局 (2024). 关于印发《反保险欺诈工作办法》的通知. ；安徽省人民检察院转载《法制日报》(2020-01-13). 杀妻骗保牵出案中案. + +### 22. Don’t sell your own organs, and don’t help others find donors: a kidney brings in just over $20,000, but the same kidney can be sold to a patient for $200,000. All proceeds are seized, plus a fine of 10–20 times the transaction amount. + + +- Cost: There’s no expense or time involved. All you have to do is simply refrain from doing it. + +- In plain terms: There is no legal way to “match donors online and pay cash on the spot.” Living donors may only give organs to their spouses, direct blood relatives, or collateral relatives within three generations. Financially, it’s a poor deal: in a Beijing case, kidney sellers received only $20,000–$25,000, while the same kidney fetched $180,000–$220,000 when sold to a patient. All money earned is confiscated, followed by a fine of 10–20 times that amount. The physical toll of losing a kidney is described in Section 1, Item 35 (the remaining kidney then has to perform the work of two). In total, 28 people were convicted in this case, and the total illegal proceeds amounted to 10.34 million yuan. + +- Benefit: Article 5 of the Regulations on Human Organ Donation and Transplantation states: “No organization or individual may buy or sell human organs in any form, nor engage in any activities related to such transactions.” Article 10 adds: “No organization or individual may obtain living organs from anyone under 18 years of age for transplant purposes.” Article 11 limits recipients of living organs to spouses, direct blood relatives, or collateral relatives within three generations. Article 37 specifies penalties for organ trafficking. Offenders face seizure of all illegal profits and fines of 10–20 times the transaction value, imposed by local health authorities. Medical staff involved may have their licenses revoked and be permanently barred from practicing medicine. Criminal acts are prosecuted under criminal law (effective May 1, 2024; the previous Regulations on Human Organ Transplantation are hereby repealed). Article 234-1 of the Criminal Law stipulates: “Anyone who organizes others to sell their organs shall be sentenced to up to five years in prison and fined; repeat offenders face more than five years in prison, fines, or asset confiscation.” Three additional scenarios are punished under Articles 234 and 232: removing organs without consent, removing organs from anyone under 18, or coercing or deceiving someone into donation — all treated as intentional injury or homicide. Two notable cases illustrate these risks. First, in 2014, 15 defendants in Beijing were convicted of trafficking 51 kidneys; donors received only $20,000–$25,000 each, while patients paid $180,000–$220,000 per kidney. The operation took place in a rundown, unequipped building rented for $7,500 per month; the ringleader got 12 years, others 3.5–9 years. Second, a 17-year-old in Chenzhou sold his right kidney in 2011 for $22,000; the buyer paid intermediaries $150,000 plus $10,000, and the mastermind kept $56,000. Post‑surgery, the teen suffered permanent kidney damage, classified as serious injury and a third‑degree disability. In total, 190,000 yuan and 210,000 yuan were also confiscated from the offenders as part of these penalties. + +- Evidence grade: A + +- Notes: The real beneficiary is yourself. The true cost of this “deal” isn’t just $20,000; it’s trading a vital organ for a smartphone. The teen’s injury was deemed serious and permanently disabling — not something a few months of rest can fix. Prosecutors charged five defendants under Article 234‑2 for intentional injury, partly because doctors failed to verify the donor’s age before surgery. Today, organizers would be convicted under the organ‑trafficking statute, while removing organs from minors would still be treated as intentional injury. Black‑market operations occur in rented apartments or makeshift clinics, lacking proper screening, follow‑up, or accountability. If you wish to donate, follow Article 11: use a licensed transplant center, obtain ethics‑committee approval, and do it free of charge. Post‑mortem donation is a separate, voluntary process not covered here. The physical consequences of losing a kidney are detailed in Section 1, Item 35 (the remaining kidney then has to work for two). When money is so tight that selling an organ seems like an option, first explore Section 7’s safety nets — unemployment insurance, emergency aid, and dibao. Beware of online loans and “packaging‑material” financing schemes described in Section 6. +- Sources:国务院 (2023). 人体器官捐献和移植条例（国务院令第 767 号，第五、十、十一、三十七条）. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第二百三十四条之一. ；最高人民检察院 (2012-04-09). 「少年卖肾买苹果手机」案诉至法院. ；河北省廊坊市中级人民法院官网转载 (2014-09-02). 全国最大贩肾案终审 组织者摘肾 51 枚获利千万. + +### 23. Don’t engage in prostitution: the default penalty is 10–15 days in detention, not just a fine + + +- Cost: There is no cost and no time required. All you need to do is simply refrain from it. + +- In plain terms: Getting caught doesn’t just result in a minor fine. Statutory law stipulates that the default penalty is 10–15 days of administrative detention, plus a possible fine of up to 5,000 yuan. Only in cases where circumstances are relatively minor might the penalty be limited to 5 days of detention or a fine of up to 1,000 yuan. Additionally, knowingly engaging in prostitution while infected with syphilis or gonorrhea constitutes a criminal offense, punishable by up to five years in prison. + +- Benefit: Article 78 of the Law on Administrative Penalties for Public Security stipulates that individuals convicted of prostitution or soliciting prostitutes face 10–15 days of administrative detention, with a possible fine of up to 5,000 yuan. For less serious cases, the penalty may be 5 days of detention or a fine of up to 1,000 yuan. Those who solicit customers in public spaces also face similar penalties. Article 79 states that anyone who lures, shelters, or arranges prostitution is subject to 10–15 days of detention and a fine of up to 5,000 yuan; less serious cases incur 5 days of detention and a fine ranging from 1,000 to 2,000 yuan. Article 87 provides that employees of hotels, restaurants, entertainment venues, or taxi services who aid or facilitate prostitution activities face 10–15 days of detention. Article 360 of the Criminal Law criminalizes knowingly spreading sexually transmitted diseases such as syphilis or gonorrhea through prostitution; offenders may be sentenced to up to five years in prison and fined. (National application; Law on Administrative Penalties for Public Security effective 1 January 2026.) + +- Evidence grade: A + +- Notes: This detention is administrative in nature, meaning offenders are held in a detention center rather than merely paying a fine. Those who arrange or provide venues for prostitution face identical penalties under Article 79. Employees of hotels or entertainment venues who assist clients in evading law enforcement are also subject to 10–15 days of detention under Article 87. Previously, Article 360 included a provision criminalizing statutory rape of minors; this was removed via the 2015 Ninth Amendment to the Criminal Law, meaning such acts are now prosecuted as rape. Any services advertised as “on‑site wellness” or “massage” are still treated as prostitution based on actual conduct. Health risks related to sexually transmitted infections and HIV are addressed separately in Section 1, Item 30 (consistent condom use) and Section 13, Item 38 (post‑exposure prophylaxis within 72 hours). Precautions specific to entertainment venues are outlined in Section 22. +- Sources:全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第七十八、七十九、八十七条）. ；全国人大常委会. 中华人民共和国刑法（经刑法修正案十一修正的整合文本）第三百六十条. （北京市公安交通管理局转载）；全国人大常委会 (2015). 刑法修正案（九）（第四十三条，删去刑法第三百六十条第二款）. diff --git a/book/en/10-Is-Love-And-Marriage-Worth-It.md b/book/en/10-Is-Love-And-Marriage-Worth-It.md new file mode 100644 index 00000000..a55c77dc --- /dev/null +++ b/book/en/10-Is-Love-And-Marriage-Worth-It.md @@ -0,0 +1,198 @@ +# 10. Is it worth dating and getting married? + +This section breaks down the question “Is marriage a good financial decision?” into several separate calculations. These calculations cover money, time, health, legal risks, and relationship quality. For each calculation we use only figures with verifiable sources — primarily official statistics or meta-analyses that combine data from multiple studies. No moral judgments are made here, nor are any conclusions drawn on your behalf. The health calculations rely on mortality risks, the time calculations use average daily minutes, and the legal calculations follow the wording of relevant statutes. These three types of calculations are not converted into one another. For more details on this breakdown method, the checklist of factors to consider, and common misconceptions, please refer to [docs/结婚划不划算.md](../../docs/research/结婚划不划算.md). +### 1. Getting to know more people rather than fixating on just one: You can’t predict compatibility before meeting someone + + +- Cost: No cost at all. Spend time getting to know several people instead of obsessing over just one. The hard part is resisting the urge to fixate on a single person. +- In plain terms: Two speed-dating studies asked participants to fill out over 100 questionnaires about their preferences in a partner before any meetings took place. These questionnaires could only reveal how likely someone is to like others in general, and how popular they tend to be — they couldn’t predict whether two specific people would hit it off. Compatibility can only be determined by meeting in person. Therefore, it’s far more worthwhile to get to know multiple people than to bet everything on just one. +- Benefit: In both speed-dating studies, participants completed more than 100 self-report questionnaires related to partner preferences prior to meeting potential matches. Researchers then applied a random forest model — an algorithm designed to detect patterns — to analyze the data. This model could predict “how likely an individual is to like others overall,” with the questionnaires accounting for 4%–18% of the variance in such tendencies; this represents only a small fraction of the total differences between individuals. It could also predict “how popular an individual tends to be,” explaining 7%–27% of variance. However, it completely failed to predict whether two specific individuals would be compatible; no combination of pre-meeting traits or preferences could be used to forecast their mutual attraction. Earlier, the same research team conducted another speed-dating experiment where participants reported their own ideal preferences — whether they valued physical appearance or financial prospects more. Even this information couldn’t predict how interested they’d be in a particular person during the actual date. +- Evidence grade: A +- Notes: Both studies clearly state that compatibility cannot be predicted before meeting someone — they do not claim that all efforts to predict it are futile. Since true compatibility can only be determined by face-to-face interaction, it makes far more sense to invest time in meeting multiple people individually rather than placing all hopes on just one. Keep in mind that all study participants were university students from Western countries; China’s dating environment differs significantly, so these findings should be applied with some caution. +- Sources:Joel S, Eastwick PW, Finkel EJ (2017). Is romantic desire predictable? Machine learning applied to initial romantic attraction. Psychological Science, 28(10), 1478-1489. ；Eastwick PW, Finkel EJ (2008). Sex differences in mate preferences revisited: do people know what they initially desire in a romantic partner? Journal of Personality and Social Psychology, 94(2), 245-264. + +### 2. Stop after a clear refusal — continued pursuit is a public order violation, not “sincerity” + +- Cost: No cost at all, neither financial nor time-related. The hard part is self-restraint: refraining from sending further messages or waiting around for the other person. +- In plain terms: If someone has clearly refused you, and you still send messages or wait for them, as of January 2026 this constitutes a violation of public order laws. Offenders may be detained for up to 5 days or fined up to 1000 yuan. For more serious cases, detention ranges from 5 to 10 days. Police can also issue orders barring the offender from contacting the other person; any violation of such orders results in an additional 5–10 days of detention. +- Benefit: The Public Security Administration Punishment Law, effective 1 January 2026, explicitly lists persistent pursuit and stalking as separate violations. The relevant clause states that “repeatedly sending obscene, insulting, threatening or similar messages, or using harassment, stalking and other methods to interfere with another person’s normal life” is punishable by up to 5 days of detention or a fine of up to 1000 yuan. For more serious cases, the penalty is 5–10 days of detention, with a possible fine up to 1000 yuan. This law also adds an extra provision: with approval from a senior police official, offenders can be ordered to refrain from contacting the victim for a set period; any violation of this order incurs an additional 5–10 days of detention. +- Evidence grade: A +- Notes: There is no research evidence supporting the claim that “persistent pursuit can win over the other person”; however, detention and contact bans are explicitly stipulated by law. These records also affect eligibility for civil service exams, background checks, and certain professional licenses. The line between pursuing someone and harassing them is not defined by the perpetrator’s intentions, but by whether the other person has clearly expressed refusal. +- Sources:全国人大常委会 (2025 修订). 治安管理处罚法（第五十条第一款第五项、第二款）. （最高人民检察院转载） + +### 3. Judging whether someone is interested: focus on actions, not “signals” — who initiates, plans, and follows up + +- Cost: This requires no money or much time. The real challenge is breaking old habits: stop trying to interpret facial expressions and tone, and instead record observable behaviors. +- In plain terms: In one study, 52 pairs of strangers of opposite genders chatted for about 10 minutes, then tried to determine whether each other was flirting. The results showed they were fairly accurate at spotting when no flirting was occurring, but struggled to identify actual flirting. A second study with 261 participants reached the same conclusion after watching short videos. Therefore, rather than guessing based on expressions or tone, pay attention to actions: who initiates contact, who schedules future meetings, and whether they follow up when you don’t make the first move. +- Benefit: Two studies examined how accurately people can recognize flirting. The first involved 52 unrelated male-female pairs conversing for 10–12 minutes; afterward, each participant reported whether they themselves were flirting and whether they believed their partner was. The results indicated that interactions without any flirting were identified more reliably, while those involving actual flirting were harder to detect. The second study used 26 one-minute video clips and 261 observers, yielding similar findings. In short, people can fairly reliably tell when someone is not flirting, but they struggle to detect when flirting is happening. +- Evidence grade: B +- Notes: This topic remains debated. Some research suggests the issue isn’t that men overestimate women’s sexual intentions, but that women tend to underreport their own intentions on surveys. There is still no consensus on which group judges more accurately. Nevertheless, both viewpoints agree on one point: relying on subtle cues such as facial expressions or tone to infer someone’s thoughts yields poor results. Observable behaviors — such as who initiates contact, plans future meetings, and follows up without prompting — are far more reliable indicators. +- Sources:Hall JA, Xing C, Brooks S (2015). Accurately detecting flirting: error management theory, the traditional sexual script, and flirting base rate. Communication Research, 42(7), 939-958. ；Perilloux C, Kurzban R (2015). Do men overperceive women's sexual interest? Psychological Science, 26(1), 70-77. （争议方） + +### 4. Whether a relationship is good or not depends mainly on how you feel within it, not on your partner’s traits. + + +- Cost: There is no monetary cost, nor does it require much time. The real challenge lies in shifting your perspective: put aside your checklist of ideal partner traits and instead focus on how you interact day to day. + +- In plain terms: An analysis of data from 29 laboratories and 43 longitudinal studies on couples shows that the strongest predictor of relationship quality is how each partner personally feels about the relationship — not their objective traits. Factors such as perceived partner commitment, appreciation, sexual satisfaction, and frequency of conflict all play a role. Self-reported feelings are two to four times more predictive than what partners report about each other. However, no questionnaire can reliably predict whether a relationship will improve or deteriorate over time. + +- Benefit: Machine learning applied to data from 29 laboratories and 43 longitudinal studies tracking the same couples over time reveals that the most important predictors of relationship quality are each partner’s subjective experiences: perceived partner commitment, appreciation, sexual satisfaction, and feelings of mutual contentment, alongside conflict levels. Among individual-level factors, life satisfaction, negative emotions, depression, and attachment styles (avoidant and anxious) also contribute. At the start of these studies, self-reported relationship factors explained up to 45% of differences in relationship quality between couples; by the end, this figure dropped to 18%. Crucially, self-reported feelings remain two to four times more predictive than partner-reported ones. Adding individual differences or partner reports to these self-reported factors yields no additional predictive power. + +- Evidence grade: A + +- Notes: This same research also found that no set of self-reported measures can reliably predict whether a relationship will improve or worsen over time. Therefore, the practical takeaway is this: to assess whether a relationship is currently healthy, rely on your own feelings rather than checking off a list of partner traits. Just don’t expect this to forecast its future trajectory. This finding aligns with the earlier point in this section that emotional value cannot be judged solely by presence or absence; here, we identify exactly which factors matter most. +- Sources:Joel S, Eastwick PW, Allison CJ, et al. (2020). Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies. Proceedings of the National Academy of Sciences, 117(32), 19061-19071. + +### 5. To build closeness, have two people take turns answering a series of progressively deeper questions — no script needed + +- Cost: No cost involved. It takes 45 minutes to complete. +- In plain terms: Pair two strangers up and have them take turns answering 36 questions grouped into three levels of depth. After 45 minutes, their sense of closeness is noticeably higher than in a control group that simply chatted for the same amount of time. What drives this effect is the act of taking turns to share honest thoughts at increasing levels of depth, not any pre-planned conversational script. Keep in mind this measure only captures short-term closeness, and does not guarantee the development of a long-term relationship. +- Benefit: This method pairs two unfamiliar people to answer 36 questions in total, arranged in three tiers of increasing depth. The questions range from “Who is the person you’d most like to invite for dinner?” to “When was the last time you cried in front of someone?” After 45 minutes, the participants report a higher sense of closeness compared to those who only chatted for the same duration. Their reported closeness also exceeds the average rating college students give to their closest real-life relationships. +- Evidence grade: B +- Notes: Only one experiment has been conducted so far, with college students as participants. It measures short-term closeness only, not whether a lasting relationship can form. The core mechanism at work here is that closeness grows when two people take turns sharing genuine personal details at progressively deeper levels — rather than relying on scripts, tricks or one-sided efforts. The key takeaway for practical use is to “share something honest about yourself, then ask a similarly personal question back”, and make sure both parties get a turn to do so. +- Sources:Aron A, Melinat E, Aron EN, Vallone RD, Bator RJ (1997). The experimental generation of interpersonal closeness: a procedure and some preliminary findings. Personality and Social Psychology Bulletin, 23(4), 363-377. + +### 6. Long-distance relationships aren’t worse than local ones — the real challenge comes in the first three months after moving in together + +- Cost: There are travel expenses to consider, plus the time spent traveling back and forth. Couples see each other far less often than those living in the same city, making it difficult to maintain the relationship over the long term without regular contact. +- In plain terms: Long-distance relationships actually tend to be more stable while the couple remains apart, since seeing each other infrequently allows each person to idealize the other. The real difficulty emerges only after they move in together. Data shows that roughly half of long-distance couples eventually transition to living locally, while the other half end their relationship while still apart. Among those who reunite, one-third break up within three months of moving together. +- Benefit: Two separate studies reach the same conclusion: long-distance relationships are generally more stable than local ones while the couple remains separated. This stability stems from a significantly higher degree of idealization — meaning each partner tends to view the other more favorably than reality warrants. The studies measured factors such as idealized distortion, romantic love, relationship memories, and perceived similarity. Moreover, the less frequently couples meet, the more positively they tend to view each other. However, this stability holds only while they remain apart; once they live in the same city, long-distance couples are far more likely to split up. One longitudinal study found that about half of long-distance couples eventually moved in together, while the other half ended their relationship while still apart. Of those who reunited, one-third broke up within three months of living together. The longer the intervals between visits while apart, and the greater the degree of idealization, the less stable the relationship tends to be after reuniting. +- Evidence grade: B +- Notes: These findings are based on romantic relationships among American university students, excluding married couples, and date back to an earlier era; thus, absolute percentages should not be applied directly to current populations. Another study surveyed 717 long-distance couples and 425 local couples, finding only minimal differences in overall relationship quality between the two groups. Ultimately, relationship success depends on the individuals involved and the nature of their bond itself, rather than physical distance. The key takeaway is this: do not assume that long-distance relationships are destined to fail. Instead, couples should prepare for the initial months after reuniting, when personal independence diminishes, mutual understanding increases, and conflicts or jealousy are more likely to arise. +- Sources:Stafford L, Merolla AJ, Castle JD (2006). When long-distance dating partners become geographically close. Journal of Social and Personal Relationships, 23(6), 901-919. ；Stafford L, Merolla AJ (2007). Idealization, reunions, and stability in long-distance dating relationships. Journal of Social and Personal Relationships, 24(1), 37-54. ；Dargie E 等 (2015). Journal of Sex & Marital Therapy, 41(2), 181-202. （备注里那项异地研究） + +### 7. Check registration statistics before listening to elders: what do “marriage rate” and “divorce rate” actually mean? + +- Cost: None. It takes just a few minutes to read the section on marriage registration in the annual report from the Civil Affairs Bureau. +- In plain terms: In 2024, 6.106 million couples got married nationwide, a 20.5% drop from the previous year. Meanwhile, 3.513 million divorces were finalized. The oft‑quoted claim that “more than half of marriages end in divorce” comes from dividing these two numbers, yielding roughly 57.5%. The exact figures are 351.3 divorces and 610.6 marriages for that year. However, the two groups of people are not the same, so this figure cannot be interpreted as “half of all marriages end in divorce.” The report also lists a marriage rate of 4.3‰ and a divorce rate of 2.5‰; both use the total population as the denominator, not just married individuals. +- Benefit: In 2024, 6.106 million marriages were legally registered, representing a 20.5% decrease from 2023; the corresponding marriage rate was 4.3‰. That same year, 3.513 million divorces were processed: 2.622 million through civil registration and 0.891 million via court rulings or mediation, giving a divorce rate of 2.5‰. The report defines the marriage (or divorce) rate as the number of marriages (or divorces) in a given year divided by the average annual population, multiplied by 1000‰. This is a “crude rate” that uses the whole population as its base. +- Evidence grade: A +- Notes: The common online figure of “over 50% divorce rate” is obtained by dividing the number of divorces by the number of marriages for the same year (351.3 ÷ 610.6 ≈ 57.5%). This ratio is known as the “divorce‑to‑marriage ratio.” Because the two sets of individuals are not identical and the report does not list such a metric, it cannot be taken as “half of all marriages end in divorce.” To calculate the actual probability that a given marriage eventually ends in divorce, one would need longitudinal data tracking the same cohort of newlyweds — data not available in this report. +- Sources:民政部 (2025). 2024 年民政事业发展统计公报（五（二）1 婚姻登记服务、注释 5），网页版与 PDF 版. 、 + +### 8. Accounting for health benefits while adjusting for observational data + +- Cost: There is no cost in money or time. Just keep in mind that these figures reflect a lower mortality rate among married individuals — this simply means both conditions occur together, not that marriage itself extends life expectancy. +- In plain terms: Over a given period, married people have a roughly 12% lower chance of dying compared to unmarried individuals, while those who have never married face a roughly 24% higher risk. However, this merely shows a correlation between marital status and mortality; it does not prove that marriage directly causes longer life. People who are healthier, wealthier, and more socially active are both more likely to marry and more likely to live longer. These statistics are primarily drawn from European and North American populations, so they can only serve as rough benchmarks for China. +- Benefit: One meta-analysis of older adults pooled results from multiple studies, covering 53 comparisons and over 250,000 participants. It found that the relative risk of all-cause mortality for married versus unmarried individuals was RR 0.88, with a 95% confidence interval of 0.85–0.91. In other words, married people had a roughly 12% lower probability of dying during the study period. Among widowed individuals, this figure rose to 1.11; for divorced or separated persons, it was 1.16; and for those never married, it was 1.11 — indicating respective increases of about 11%, 16%, and 11% in mortality risk. No significant gender differences emerged. Under the most conservative estimates, the RR still came out at 0.94, reflecting a reduction of only around 6%. Another meta-analysis compared never-married individuals with married ones, drawing on 95 separate studies and over 500 million participants. It reported a hazard ratio of 1.24 (95% CI 1.19–1.30), meaning unmarried people faced roughly 24% higher mortality risk over the same timeframe; this gap narrowed with age. A further gender-specific meta-analysis examined 21 studies involving more than 7,890,000 individuals: across both sexes, unmarried status correlated with higher rates of overall mortality, cancer-related death, and cardiovascular death. Among men, the disparity was especially pronounced for cardiovascular and overall mortality; unmarried men also faced a 31% higher risk of stroke and a 9% higher risk of all-cause death compared to unmarried women. +- Evidence grade: A (controversial) +- Notes: The controversy stems from the fact that married individuals tend to be healthier, wealthier, and more socially engaged — factors that independently contribute to longer life. All three meta-analyses relied on observational data collected from existing populations; no controlled experiments or randomized groups were used. The authors themselves acknowledged potential publication bias and methodological limitations. Roelfs also noted that studies employing more rigorous methods tended to report smaller differences between marital groups. Since these figures are largely derived from Western populations, they can only be used as rough indicators for Chinese contexts. +- Sources:Manzoli L, et al. (2007). Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med 64:77–94. ；Roelfs DJ, et al. (2011). The rising relative risk of mortality for singles: meta-analysis and meta-regression. Am J Epidemiol 174(4):379–389. ；Wang Y, et al. (2020). Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals. Glob Health Res Policy 5:4. + +### 9. Discussing labor division before marriage helps clarify unpaid work responsibilities + + +- Cost: There is no monetary cost. Spend one or two hours before marriage to reach a clear agreement on how household chores, childcare, and elder care — all unpaid tasks — will be divided between partners, then follow that plan. The real challenge lies in having the conversation, not in avoiding it. + +- In plain terms: According to the 2024 National Time Use Survey, men spend an average of 1 hour and 52 minutes per day on unpaid activities such as housework and caring for family, while women spend 3 hours and 29 minutes. Since the survey does not break down data by marital status, there are no official figures on how much housework increases after marriage; the gender gap observed can only serve as an upper limit. In reality, couples can negotiate a different division of labor altogether before getting married. + +- Benefit: The 2024 National Time Use Survey tracks unpaid labor, which includes housework and family care. On average, people who perform such tasks spend 2 hours and 45 minutes daily on them; men dedicate 1 hour and 52 minutes, women 3 hours and 29 minutes. The proportion of individuals engaging in unpaid labor each day is 67.5% among men and 83.9% among women. Nationwide, residents spend an average of 1 hour and 17 minutes daily on housework; among those who actually do it, the average rises to 1 hour and 59 minutes — a decrease of 28 minutes compared to 2018. Time spent caring for family averages 30 minutes per day; for those involved, it reaches 1 hour and 46 minutes. In 2018, men spent 45 minutes on housework and 17 minutes on childcare, while women spent 2 hours and 6 minutes on housework and 53 minutes on childcare. + +- Evidence grade: A + +- Notes: Both surveys analyzed data only by gender, urban/rural residence, and age; marital status was not considered. Consequently, no official statistics exist on how much housework increases after marriage; the gender disparity can only be used as a rough upper bound. These figures represent national averages, but couples are free to negotiate a division of labor that suits them — and that is precisely the value of having this discussion. +- Sources:国家统计局 (2024). 第三次全国时间利用调查公报（第二号、第三号）. 、；国家统计局 (2019). 2018 年全国时间利用调查公报. + +### 10. First check the default legal rules regarding money and property, then decide whether to make a written agreement + + +- Cost: There is no cost involved. Simply read the relevant articles in the Civil Code regarding marital property. If needed, the couple can sign a written property agreement; the law only requires it to be in writing, no notarization is necessary. The real challenge is discussing money matters openly beforehand. + +- In plain terms: Without a written agreement, the law presumes that wages, bonuses, business profits, investment returns, inheritances, and gifts received after marriage belong to both spouses jointly. Only property owned before marriage, or items explicitly designated in a will or gift contract as belonging to one person, remain personal property. Couples may choose to agree in writing that certain assets stay separate; such an agreement becomes legally binding. A spouse who has devoted more time to raising children or caring for elderly relatives may request compensation during divorce proceedings. + +- Benefit: By default, all earnings from employment, business activities, intellectual property, as well as inheritances and gifts received after marriage are considered joint marital property (Article 1062). Personal property includes assets owned prior to marriage, compensation for personal injury, items earmarked for one spouse in a will or gift contract, and everyday personal items (Article 1063). Couples may stipulate in writing whether their pre‑marital and post‑marital assets remain separate, become joint, or are divided partially; this arrangement is legally enforceable (Article 1065). The spouse who has shouldered greater responsibilities in child‑rearing, elder care, or supporting the other partner’s career may seek compensation upon divorce (Article 1088). + +- Evidence grade: A + +- Notes: No official statistics exist for dowries, wedding expenses, or marital homes, so no figures are provided here. The amount of compensation under Article 1088 is first negotiated between the couple; if they cannot reach an agreement, a court will decide it based on relevant circumstances. A written property agreement benefits both parties: it protects high‑earners and also safeguards those who perform unpaid domestic duties. +- Sources:全国人民代表大会 (2020). 中华人民共和国民法典（2021 年 1 月 1 日起施行，第一千零六十二、一千零六十三、一千零六十五、一千零八十八条）. 国家法律法规数据库 ；条文全文见最高人民法院公报转载 + +### 11. When parents pay for a house, they should clearly state whether it’s a loan or a gift at the time of transfer + + +- Cost: There is no cost involved. On the day of payment, write a brief note specifying whether the money is a gift or a loan to the child. Both the parent(s) making the payment and the child must sign it. If it’s a loan, both spouses should also sign. Use the same wording in the transfer description. + +- In plain terms: When parents pay for a house before marriage, the money is generally considered a gift solely to their own child. After marriage, without any written agreement, it’s treated as joint marital property. Starting February 2025, if one set of parents fully funds a house during marriage but the gift agreement doesn’t specify it’s only for their child, a court may award the house to that child upon divorce and decide whether to compensate the other spouse. To treat it as a loan, all terms must be clearly documented and signed on the same day. + +- Benefit: Payments made by parents before marriage for a house are typically viewed as gifts to just one child, unless they explicitly state otherwise. After marriage, any agreement governs the arrangement; otherwise, it’s treated as joint property. Since February 2025, if one set of parents fully funds a house during marriage without specifying it’s only for their child, a court may award it to that child upon divorce and later determine if compensation is warranted. Factors considered include shared living arrangements, children born together, fault in the divorce, each party’s contributions, and current market value. Partial funding by one or both sets of parents results in a similar ruling, with compensation based on proportional contributions nationwide. + +- Evidence grade: A + +- Notes: This rule applies to both parties involved. Parents no longer need to rely on a post-divorce loan agreement to protect their investment; post-February 2025, the source of funds itself determines ownership, independent of whose name appears on the title. Recipients of such funds also gain clarity early on. To treat it as a loan, all terms must be explicitly documented, signed, and reflected in the transfer description — otherwise, legal justification becomes necessary. +- Sources:最高人民法院 (2020). 关于适用《民法典》婚姻家庭编的解释（一）（法释〔2020〕22 号，第二十九条）. ；最高人民法院 (2025). 关于适用《民法典》婚姻家庭编的解释（二）（法释〔2025〕1 号，第八条）. ；全国人大 (2020). 民法典（第一千零六十二条第一款第四项）. + +### 12. Money borrowed by a spouse in a large amount — if you didn’t sign or later acknowledge it, it doesn’t automatically become your debt + + +- Cost: No cost at all. Never sign “joint borrower” or “guarantor” on your spouse’s loan agreements or guarantee documents. Also avoid writing things like “We’ll pay back this money” in messages, as that could be taken as later acknowledgment of the debt. The hard part is staying silent when creditors start pressuring you. + +- In plain terms: Money borrowed by a spouse behind your back generally won’t become your joint debt, provided it clearly exceeds normal household expenses and you neither signed any documents nor later acknowledged the debt. Creditors must prove the money was used for shared household needs or joint business activities. However, if the borrowed funds actually helped purchase a house that both of you now live in or own together, creditors can usually prove it served a shared purpose. + +- Benefit: Debt is considered a joint marital obligation in several situations: first, when both spouses sign the loan agreement; second, when one spouse later acknowledges the debt, thereby accepting joint responsibility; third, when one spouse takes out a loan during marriage for ordinary household needs. Any loan taken out by one spouse that clearly exceeds everyday household expenses does not qualify as joint debt — unless the creditor can prove it was used for shared living or business purposes. Since buying a house typically exceeds normal household spending, the burden of proof falls on creditors to demonstrate such shared use. Yet if the house truly becomes a joint residence or property, creditors can more easily substantiate their claim. Thus, the key preventive measure is exactly what Section 11 describes: clearly stating whether parental contributions are loans or gifts (nationwide, effective since 2021). + +- Evidence grade: A + +- Notes: During divorce proceedings, if one spouse’s parents suddenly produce a loan agreement bearing only their child’s signature, two distinct evaluations become necessary. First, courts must determine whether the loan actually occurred. If you can convincingly argue that no funds were transferred, judges will weigh multiple factors: loan amount, payment method, both parties’ financial standing, habitual transaction patterns, any corresponding property changes, and witness testimony. Mere possession of transfer records by creditors still obliges them to prove loan validity. Second, even if the loan is verified, its classification as joint debt must be re-examined. General rules governing loan agreements and guarantees are detailed in Section 8, Article 18. +- Sources:全国人大 (2020). 民法典（第一千零六十四条）. ；最高人民法院 (2020 年第二次修正). 关于审理民间借贷案件适用法律若干问题的规定（第十五、十六条）. （最高人民法院公报） + +### 13. Obtaining a marriage certificate requires only an ID card and a signed declaration — no household register needed, no fees, and issuance is immediate. + + +- Cost: There are no fees involved. Both parties must be present in person. The entire process typically takes just a few minutes. +- In plain terms: Starting May 2025, getting a marriage certificate requires only two items: your ID card and a signed declaration stating that you have no spouse and share no direct or indirect blood relations within three generations with your partner. There’s no need to bring a household register, nor to go back to one’s place of hukou registration. The registration itself is completely free, and if all conditions are met, the certificate is issued on the spot. +- Benefit: The revised Marriage Registration Regulations, effective May 10, 2025, streamlined documentation requirements for mainland residents. They specify that only two documents are mandatory: “(1) one’s own ID card; (2) a signed declaration confirming that one has no spouse and shares no direct or indirect blood relations within three generations with the other party.” The household register is no longer required. Registration is handled by “county-level civil affairs bureaus or township governments designated by provincial or municipal authorities to ensure accessibility.” The previous requirement to register at the hukou location of one partner has been removed. The regulations also explicitly state that “marriage registration authorities must not charge any fees” and “must issue certificates on the spot to applicants who meet all eligibility criteria.” +- Evidence grade: A +- Notes: Registration will be denied only in four cases: if either party is under legal marriage age, if consent is not mutual, if either party already has a spouse, or if the couple shares direct or indirect blood relations within three generations. Any additional charges usually apply only to optional services such as photography or photocopying — the registration process itself remains free. If anyone demands a “processing fee” or “express service charge,” such demands should be refused and reported. The 30-day cooling-off period for divorce registration is discussed under the “Cost” section. +- Sources:国务院 (2025). 婚姻登记条例（国令第 804 号，第二、六、八、十条）. + +### 14. Undergoing a premarital medical checkup: if you have a serious illness, you must disclose it to your partner before marriage registration + + +- Cost: It’s free. During an argument, stick to the current issue—no insults, no sarcasm, no bringing up the past. The hard part is keeping your mouth shut when angry. + In most regions, eligible couples receive this service for free or at a reduced fee; if paying out of pocket, it usually costs only a few hundred yuan. The entire process takes about half a day. + +- In plain terms: If a person has a serious illness and fails to disclose it truthfully to their future spouse before marriage registration, the other partner may file a lawsuit to have the marriage annulled. This legal action must be taken within one year of learning about the condition. Since 2003, a premarital medical checkup has no longer been a mandatory prerequisite for marriage registration; participation remains entirely voluntary. Exact costs and which tests are performed vary by local policies, but the whole procedure typically requires half a day. + +- Benefit: The legal consequences of concealing a serious illness are clearly defined. Current marriage registration regulations state: “If one party has a serious illness, they must disclose this fact to the other party prior to marriage registration; failure to do so permits the other party to petition a court to annul the marriage under Article 1053 of the Civil Code.” The government also promotes premarital medical screening as a primary measure for preventing birth defects, aiming to maintain a premarital checkup rate above 70% and a coverage rate for pre‑conception health services above 80%. Policies further encourage locating such clinics near marriage registration offices and offering combined “one‑stop” services covering registration, medical screening, and fertility counseling. Under the Civil Code, nondisclosure of a serious illness before marriage can indeed lead to an annulment request, which must be filed within one year of becoming aware of the condition. + +- Evidence grade: B + +- Notes: Reasons for choosing B: Most of the aggregated studies merely recorded observations without any control groups. Thus, it’s unclear whether poor relationships cause illness, or poor health leads to deteriorating relationships. In some studies, the correlation persisted even after adjusting for age and income. The wound experiment involved only 42 couples. The principle of “focusing on issues rather than people, avoiding insults or sarcasm” was deduced by the authors from instances of “hostile behavior” observed in the experiments; no studies have directly compared this approach. For couples who argue frequently yet can’t change their behavior, seeking couples or marriage counseling together is an option—though no separate studies address this specifically. When arguments escalate to physical violence, chronic verbal abuse, or threats, the issue is no longer merely communication breakdown but domestic violence; see Section 8, Item 43 (Domestic Violence). Carefully consider whether to leave the relationship; information on exit costs can be found in Section 16 (Exit Costs) of this chapter. + Since 2003, a premarital medical checkup has ceased to be a mandatory requirement for marriage registration; attendance remains optional. Nevertheless, the rule requiring disclosure of serious illnesses does grant a spouse the legal right to seek an annulment within one year of learning of the condition. Whether the test is free and which specific examinations are performed depend on local regulations; interested couples should consult their local maternal‑and‑child health centers or the “one‑stop” service desks at marriage registration offices. (Pending verification: a nationwide document outlining the uniform basis and scope of free premarital screening policies.) +- Sources:全国人大 (2020). 民法典（第一千零五十三条）. ；国务院 (2025). 婚姻登记条例（国令第 804 号，第十二条）. ；国家卫生健康委办公厅 (2023). 出生缺陷防治能力提升计划（2023—2027 年）（国卫办妇幼发〔2023〕9 号）. + +### 15. Emotional value isn’t just about “whether it exists” — it’s about relationship quality + +- Cost: No money required. Use a few conflicts and several months of interaction to gauge relationship quality rather than simply checking off a list of criteria. The hard part is resisting the urge to judge based solely on that checklist. +- In plain terms: A meta-analysis of 126 studies involving over 72,000 participants shows that higher marriage quality correlates with better health. However, this link is quite weak — its magnitude is comparable to the effect of healthy behaviors like proper diet. What’s useful here is that relationship quality should be assessed through actual interactions rather than rigid criteria lists. There’s no direct data comparing outcomes for people in poor marriages versus those who remain unmarried. +- Benefit: This same meta-analysis indicates that better marital quality leads to improved health outcomes, with effect sizes ranging from r = 0.07 to r = 0.21. Here, r measures how closely two variables change together: 0 means no relationship, while 1 means perfect correlation. For instance, the risk of death correlates at r = 0.11, while cardiovascular responses during conflict correlate at r = −0.13. These figures are similar to those seen with lifestyle factors like diet. Research examining gender differences found virtually no variation between men and women. Reviews focused on cardiovascular health also confirm that both marital dissatisfaction and quality significantly influence risk levels. +- Evidence grade: B (controversial) +- Notes: The controversy stems from the fact that this association remains relatively weak. Some findings may also be influenced by publication bias. Additionally, most studies rely on single-time assessments, making it hard to determine cause-and-effect relationships — limitations explicitly noted by Robles in his original work. No meta-analysis directly comparing mortality rates between individuals in low-quality marriages and unmarried individuals has been identified; thus, the claim that “poor marriages are worse than staying single” remains speculative rather than empirically proven. +- Sources:Robles TF, et al. (2014). Marital quality and health: a meta-analytic review. Psychol Bull 140(1):140–187. ；Dhindsa DS, et al. (2020). Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 30(4):215–220. + +### 16. Calculating the cost of walking away: Divorce by mutual agreement has a 30-day cooling-off period; divorce via litigation has strict legal conditions. + +- Cost: There is no monetary cost. Still, it’s worth spending some time before marriage to consider how long it would take and what steps would be required to end the marriage, should that become necessary. The difficulty lies in thinking about separation before getting married at all. +- In plain terms: Divorce by mutual agreement isn’t finalized the moment the paperwork is signed. After filing the application, either spouse can withdraw it within 30 days. Once that period ends, both parties must appear in person within another 30 days to obtain the divorce certificate; failure to do so counts as a withdrawal. If one spouse refuses, the only option is to pursue divorce through court. Courts first attempt mediation; only when circumstances such as domestic violence, bigamy, or two years of separation exist, and mediation fails, will a divorce be granted. +- Benefit: Divorce by mutual agreement requires a written agreement and joint application to the marriage registry (Article 1076). Within 30 days of receiving the application, either party may withdraw it. After that, both must apply for the divorce certificate within 30 days; otherwise, the application is considered withdrawn (Article 1077). When one party objects, litigation follows, with courts mandated to mediate first. Divorce is granted if bigamy, cohabitation with another, domestic violence, substance abuse, or two years of separation without reconciliation exist, and mediation proves ineffective (Article 1079). In 2024, 3.513 million couples divorced nationwide; 891,000 of those cases were resolved through court rulings or mediation. +- Evidence grade: A +- Notes: The cooling-off period applies solely to divorce by mutual agreement. Litigation-based divorce lacks such a period but involves lengthier proceedings. Filing fees and attorney costs vary by region; no specific figures are provided here. While the procedural hurdles may seem high, they shouldn’t deter marriage itself; rather, they’re factors worth understanding beforehand. +- Sources:全国人民代表大会 (2020). 中华人民共和国民法典（第一千零七十六、一千零七十七、一千零七十九条）. ；民政部 (2020). 关于贯彻落实《中华人民共和国民法典》中有关婚姻登记规定的通知（民发〔2020〕116 号）. ；民政部 (2025). 2024 年民政事业发展统计公报. 题录同第 7 条（结婚率、离婚率各是什么口径） + +### 17. Keep a separate ledger for the “marriage for elders” — don’t mix it with your own accounts + +- Cost: No cost at all. Just draw two columns on paper. One column lists the benefits that belong to you; the earlier sections in this chapter help you calculate those. The other column lists benefits that belong to the elders: peace of mind, social prestige, and an end to matchmaking pressure. The tricky part is keeping the elders’ column separate and not merging it into yours. +- In plain terms: The benefits the elders gain — peace of mind, prestige, and relief from matchmaking pressure — are real. But they won’t automatically translate into health benefits or better relationship quality for you. Meanwhile, the time investment, financial costs, and exit costs all fall on you alone. By drawing two columns and assigning each benefit to its rightful owner, you can instantly see whether this arrangement is worth it for you. +- Benefit: The elders truly receive tangible benefits from this marriage. Yet those benefits do not automatically become health advantages (see Section 8) or improvements in relationship quality (see Section 15) for you. All time costs (Section 9), monetary expenses (Sections 10–12), and exit costs (Section 16) are borne entirely by you. Once you keep separate accounts, it becomes obvious at a glance whether “marrying as a duty” offers any real value — no outside judgment is needed. +- Evidence grade: C +- Notes: This section does not make a final judgment for you; the elders’ benefits can indeed be substantial. A fill‑in worksheet is available at [docs/结婚划不划算.md](../../docs/research/结婚划不划算.md). +- Sources:作者经验，方法类建议；数据部分见本节前面各条 + +### 18. Treating relationship quality as a health factor: focus arguments on issues, not people; avoid insults or sarcasm + +- Cost: No cost at all. During an argument, stick to the current issue at hand — no insults, no sarcasm, no bringing up past grievances. The real challenge is keeping your mouth in check when emotions run high. +- In plain terms: Couples with a healthier relationship tend to enjoy better physical health and a lower risk of death. This link is fairly weak, roughly comparable to the impact of diet on health. In one experiment, couples who maintained high levels of hostility during arguments saw only 60% of the rate of healing for small lab-made wounds compared to couples who stayed calm. +- Benefit: This conclusion comes from a meta-analysis of 126 separate studies involving over 72,000 participants. Higher marital quality correlated with better physical health, with correlation coefficients ranging from 0.07 to 0.21. A value of 0 indicates no link at all, while 1 means a perfect match between two variables. The strongest association observed was a 0.11 correlation with lower mortality risk. There was also a -0.13 correlation between lower hostility during arguments and reduced cardiovascular stress. The researchers note that all these effects are fairly minor, on par with the impact of everyday healthy habits like diet. Another controlled experiment involved 42 healthy couples, each hospitalized twice for 24 hours at a time. During one stay they engaged in supportive conversation, while the other they discussed a topic they disagreed on. After the argument-focused stay, the rate of healing for lab-made blisters was significantly slower. Couples who displayed higher hostility during both sessions healed at only 60% of the rate of low-hostility couples. The next morning, these same couples also showed higher levels of key inflammatory markers in their blood, including IL-6 and tumor necrosis factor. +- Evidence grade: B +- Notes: This B rating is assigned because most of the included studies relied on observational tracking rather than controlled group comparisons, so it is impossible to confirm whether poor relationship quality directly causes health issues or if poor health in turn harms relationships. Even after adjusting for factors like age and income, some studies still found a measurable link between the two. The wound-healing experiment involved just 42 couples. The recommendation to “focus arguments on issues, not people, and avoid insults or sarcasm” is derived from the researchers’ observations of hostile behaviors in these experiments; there are no dedicated studies directly testing this approach. If arguments remain consistently heated despite these efforts, couples can seek professional marriage and family counseling, though no specific studies address this option. Any instances of physical violence, chronic verbal abuse or threats go far beyond simple communication issues and qualify as domestic abuse — see Section 8, Item 43 for more details on domestic abuse. Couples unsure whether to stay in such a relationship should also review Section 16, which outlines the potential costs of leaving a partnership. +- Sources:Robles TF, Slatcher RB, Trombello JM, McGinn MM (2014). Marital quality and health: a meta-analytic review. Psychological Bulletin. ；Kiecolt-Glaser JK 等 (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry. diff --git a/book/en/11-Red-Lines-For-Techies.md b/book/en/11-Red-Lines-For-Techies.md new file mode 100644 index 00000000..4e27f302 --- /dev/null +++ b/book/en/11-Red-Lines-For-Techies.md @@ -0,0 +1,192 @@ +# 11. Common legal pitfalls for programmers and tech professionals + +This section focuses on personal freedom and financial safety — essentially, avoiding imprisonment and costly lawsuits. Many developers and technical workers tend to treat the following issues as mere technical matters. In reality, they constitute specific criminal offenses under Chinese law or can lead to substantial civil liabilities. For each item, we list the relevant legal provisions and real-world cases published on the websites of the Supreme People’s Procuratorate and the Supreme People’s Court. The criminal law references come from a consolidated text republished by the Beijing Traffic Management Bureau, which reflects amendments introduced in the 11th Criminal Law Amendment. The items are ordered from those most likely to be underestimated by tech professionals to those with the most severe consequences. The first entry serves as a general guide: it explains how to assess risks before taking action and what steps to take immediately after any incident occurs. +### 1. Ask three questions before taking any action: Whose interests might be harmed? How capable is the other party of pursuing legal action? And how much evidence do I have? If legal action is taken, immediately hire a criminal defense attorney. + + +- Cost: No cost at all. Before acting, replace the question “Is this technically feasible?” with “Will the vendor, platform, or company file a police report?” The hard part is resisting the urge to think “this is a minor issue no one will care about” — server logs, payment records, and chat logs are all routinely subpoenaed during investigations. + +- In plain terms: Before doing anything, ask whether the vendor, platform, or company will report the incident to police. Server logs, payment records, and chat logs are all easily obtained during an investigation. If you are criminally detained, authorities must decide within 37 days whether to formally arrest you. You may hire a lawyer from the very first interrogation onward; those 37 days are the most critical window for securing effective legal representation. + +- Benefit: Any organization or individual who becomes aware of a crime may file a police report. Once authorities deem a crime to have occurred, they must open an investigation. After a criminal detention, police must request formal arrest approval from prosecutors within three days; this period may be extended by one to four days under special circumstances, or up to 30 days in cases involving multiple locations or serial offenses. Prosecutors then have seven days to make a decision. In total, the maximum timeframe for deciding whether to arrest is 37 days. From the first interrogation or upon being placed under any compulsory measure, you may retain legal counsel; during the police investigation phase, only lawyers may be hired. Lawyers must be granted access to clients within 48 hours of requesting a meeting. If the potential sentence involves lighter penalties such as probation or fines rather than imprisonment, you may be released on bail by posting a bond or securing a guarantor; this bail period may last up to 12 months nationwide. + +- Evidence grade: C + +- Notes: These 37 days refer strictly to the interval between detention and the prosecutor’s decision on arrest; they do not represent the overall maximum detention period. Additional detention limits apply during the subsequent investigation phase. It is precisely during these 37 days that experienced attorneys can be most effective — meeting clients, submitting arguments to prosecutors that arrest is unwarranted, and applying for bail. Seeking legal help after indictment is far too late. All other items in this section address the same underlying issue: whether the other party has grounds to file a report. +- Sources:全国人大 (2018). 刑事诉讼法（2018 年修正，第三十四、三十九、六十七、七十九、九十一、一百一十、一百一十二条）. + +### 2. Refraining from creating or selling game cheats and aids, including AI tools that only capture screenshots without touching memory + + +- Cost: There is no monetary cost. The trade‑off is giving up potential income from such orders and “small tools.” The difficulty lies in the fact that this money comes quickly and it’s unclear who might eventually pursue legal action. +- In plain terms: Selling to just 20 users or earning 5,000 yuan is enough to qualify as “serious circumstances,” leading to a sentence of up to three years. In especially serious cases the penalty ranges from three to seven years. One developer who created aim‑assist and wall‑hack cheats sold them over 80,000 times in three months, netting more than 30,000 yuan; he received a one‑year suspended sentence plus a 5,000‑yuan fine. Another individual obtained the game’s server code, ran a private server, and collected over 20 million yuan in payments; he was sentenced to four years in prison and fined up to 10 million yuan. +- Benefit: Distributing programs or tools designed to intrude upon or illegally control computer systems can result in imprisonment of up to three years, along with a fine, or a fine alone if the circumstances are deemed “serious.” For especially serious cases the sentence rises to three‑seven years plus a fine. The threshold for “serious circumstances” is reaching 20 users or generating at least 5,000 yuan in illicit profit. Intentionally bypassing or sabotaging technical protection measures may also constitute copyright infringement, punishable by up to three years, or up to ten years in more severe instances. Official examples include Wang and others who sold memory‑modifying cheats; they earned over 30,000 yuan in three months and received a one‑year suspended sentence plus a 5,000‑yuan fine. Another case involved Xiang and others who sold the “TZ” series of cheats, generating over 200,000 yuan; Xiang got three years suspended and a 20,000‑yuan fine. Liu and others obtained server code, altered parameters, and ran a private server that attracted over 20 million yuan in payments; they received sentences ranging from four years down to two years and six months, along with fines from 1 million to 1.3 million yuan nationwide. +- Evidence grade: A +- Notes: All published cheat‑related rulings involve programs that read or modify game memory and circumvent anti‑cheat systems. No official cases have yet addressed aids that merely capture screenshots or simulate keystrokes. Nevertheless, a recent ticket‑scaling case shows that even tools that do not touch memory but merely send requests can be deemed illegal data‑acquisition tools. Whether an act qualifies as a crime and which charge applies is determined by law‑enforcement agencies based on evidence supplied by game developers, not by the author’s interpretation. The requirement of just 20 users to meet the “serious circumstances” threshold is quite low. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第三款、第二百一十七条第六项）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第三条）. （深圳市公安局转载）；最高人民检察院 (2026). 上海静安：严惩制售游戏外挂黑灰产共护清朗网络空间. ；最高人民检察院 (2021). 2020 年度检察机关保护知识产权典型案例（案例五）. + +### 3. Do not write or sell scripts for ticket snatching, flash sales, fake orders, or coupon farming — even if they merely “automate button clicks” + +- Cost: No expense and no time required +- In plain terms: Even if a script does not modify memory or bypass security measures and merely sends requests faster than a human can, it still qualifies as illegal acquisition of computer system data. The legal threshold is either earning over 5,000 yuan or causing at least 10,000 yuan in losses. One individual bought multiple 12306 accounts and used them to snatch over 200 train tickets, netting more than 20,000 yuan; he was sentenced to 1 year and 6 months in prison, suspended for the same period, plus a fine of 5,000 yuan. Another person sold ticket‑snatching software online and was found guilty of unfair competition, ordered to pay 20,000 yuan in damages. +- Benefit: Illegally accessing computer systems or obtaining their data via any technical means can lead to imprisonment of up to 3 years, a fine, or both; more serious cases incur 3–7 years in prison. The threshold for “serious circumstances” is earning over 5,000 yuan illegally or causing losses exceeding 10,000 yuan. Official cases include a person who used a bot to submit numerous ticket‑purchase requests using purchased 12306 accounts; he snatched more than 200 tickets and earned over 20,000 yuan, resulting in the same sentence as above. Zheng sold ticket‑snatching software for a specific booking app and was ordered to pay 20,000 yuan for unfair competition (national precedent). +- Evidence grade: A +- Notes: Even scripts that do not alter memory or bypass security and merely operate faster than humans still fall under Article 285 of the Criminal Law. Both paid ticket‑snatching services and selling such scripts are considered profit‑generating activities. No official cases have been reported for individuals using such scripts solely for personal use. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. ；最高人民检察院 (2026). 上海静安：查办利用外挂软件批量代抢火车票牟利案. ；最高人民法院 (2025). 2024 年人民法院知识产权典型案例（案例七，抢票软件不正当竞争案）. + +### 4. The crawler only accesses publicly available pages that require no login; it does not attempt to bypass anti-scraping measures or handle any personal information, and any data it collects is never sold. + +- Cost: No cost at all. A crawler is simply a program that automatically browses web pages and extracts the data on them. Before running one, check the robots.txt file and any API authorization guidelines — robots.txt is a file placed by website owners in their root directory that lists pages they do not want crawlers to access. Any data that requires a login, a token (a temporary access credential), or signature decryption to obtain is not targeted. The real challenge is resisting the temptation to collect such data even when technical means make it easy to do so — this depends entirely on self-discipline. +- In plain terms: Any data that requires a login, a token, or signature decryption to access falls under bypassing protective measures; violations are punishable by up to 3 years in prison, or 3 to 7 years in more serious cases. Collecting personal information brings even heavier penalties. Possessing 50 or more records related to personal movement, communications, credit history, or financial information is already considered a serious offense. The same applies if you collect 500 or more records on accommodation, health, or transaction details, 5000 or more records of other types, or earn 5000 yuan or more from such activities. +- Benefit: Illegally accessing system data by bypassing protective measures carries the same sentencing range as the third item (scripts used for ticket scalping or flash sale fraud): up to 3 years in prison, or 3 to 7 years in more serious cases. Illegally obtaining, selling, or providing citizens’ personal information also triggers heavy penalties if any of the following thresholds are met: 50 or more records on personal movement, communications, credit history, or financial details; 500 or more records on accommodation, communications, health, or transaction information; 5000 or more records of other types; or illegal earnings of 5000 yuan or more. Serious violations result in up to 3 years in prison, plus a fine or fine alone; extremely serious cases are punished with 3 to 7 years in prison. A real-world example: software developer Li used a feature disguised as a “face beauty detection” tool to steal 1751 facial photos from users’ phone albums, then sold data from a social engineering database he had compiled — he was sentenced to 3 years in prison, suspended for 3 years. A social engineering database is a collection of personal information leaked from various sources. Another case: an internet technology firm used a crawler to harvest store and order data from a food delivery platform, causing over 40,000 yuan in losses; it was prosecuted for illegally obtaining data from a computer information system (this case is documented nationwide). +- Evidence grade: A +- Notes: A 2017 judicial interpretation states that “providing information lawfully collected from others without their consent” also counts as “providing personal information” under the law. This provision also applies to companies that share user databases with external partners. 5000 records is roughly the size of a small database table. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款、第二百五十三条之一）. ；最高人民法院、最高人民检察院 (2017). 关于办理侵犯公民个人信息刑事案件适用法律若干问题的解释（第三、四、五条）. ；最高人民检察院 (2022). 检察机关依法惩治侵犯公民个人信息犯罪典型案例（案例二）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例一）. + +### 5. Refuse development orders for gambling, fraud, or adult-content apps; do not set up payment gateways or unblock accounts for such “clients” + + +- Cost: No direct monetary cost. The trade-off is forgoing outsourcing projects that pay well but have vague requirements. The difficulty lies in the fact that these clients often offer significantly higher pay than normal projects. +- In plain terms: Taking on such high-paying yet poorly defined projects means you could be treated as an accomplice in gambling crimes, facing charges under the crime of operating illegal gambling dens: up to 5 years in prison, or 5–10 years for serious cases. This is not the “merely helping out, maximum 3 years” category. In one e-sports betting app case, 28 developers in Hainan were sentenced to 1–3 years and 6 months for operating illegal gambling dens. Those who unblocked QQ accounts for fraud rings received 1 year and 6 months in prison plus a 20,000-yuan fine. +- Benefit: Providing technical support or payment settlement services to known online criminals can lead to imprisonment of up to 3 years and/or a fine, especially when the circumstances are serious. If other crimes are also involved, the harsher penalty applies. Operating illegal gambling dens carries up to 5 years in prison plus a fine; serious cases bring 5–10 years. Official examples: Zhangsheng Group developed gambling games and handled “online distribution,” earning fees for website setup and reporting; the total illicit revenue reached nearly 7 billion yuan. Its leader was sentenced to 9 years and 9 months plus a 50-million-yuan fine. 79 developers, including Wang Qiang, received sentences ranging from 6 months to 9 years and 9 months. In another case, 28 developers in Hainan who built an e-sports betting app were convicted of operating illegal gambling dens and received similar sentences, plus fines. One individual who ran a studio unblocking QQ accounts for fraudsters got 1 year and 6 months in prison and a 20,000-yuan fine (nationwide). +- Evidence grade: A +- Notes: “Knowing intent” does not require the client to explicitly state the purpose. When a quote is far above market rates, the app includes top-up, cash-out, and betting features, and the client refuses to disclose usage, these facts are used to prove you were aware of the illegal nature. Developers of gambling apps are prosecuted as accomplices in operating illegal gambling dens, not under the “Crime of Assisting Information Network Criminal Activities” which caps at 3 years. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十七条之二、第三百零三条第二款）. ；最高人民检察院 (2023). 建赌博网站并出售，涉案近 70 亿元. ；最高人民检察院 (2022). 上海闵行区：办理一起新型开设网络赌场案. ；最高人民检察院 (2025). 依法惩治帮助信息网络犯罪活动及相关犯罪典型案例（案例一）. + +### 6. Upon leaving a job, return all account access rights; do not delete databases, leave backdoors, or alter password protection systems — even if the employer owes you wages. + +- Cost: No cost involved. If the employer owes you wages, pursue them through labor arbitration (see Section 7 on labor arbitration). The real challenge is resisting the urge to tamper with the system while angry. +- In plain terms: Account credentials are issued by the employer, but they do not remain valid after you leave the job. Logging in using those credentials constitutes illegal control of computer systems, punishable by up to 3 years in prison. Deleting data to render the system inoperable is punishable by up to 5 years in prison; more severe cases incur sentences exceeding 5 years. One example: a dismissed senior engineer logged into his former employer’s servers using his original admin credentials, deleted data and logs, resulting in over 120,000 yuan in losses. He was sentenced to 3 years in prison, suspended for 5 years, and fined 30,000 yuan. +- Benefit: Illegal control of computer information systems is punishable by up to 3 years in prison, with or without a fine; more serious cases incur sentences ranging from 3 to 7 years. Deleting or altering system functions or data to the point the system cannot operate normally is punishable by up to 5 years in prison; more severe cases incur sentences exceeding 5 years. Official cases include: after being dismissed, senior IT engineer Lü used his original admin account to access his former employer’s shared servers, changed passwords, and deleted data and logs, causing over 120,000 yuan in losses; he received the same sentence as above. Another case: Bai, an employee at a software firm, deliberately inserted faulty code into an upgrade program, rendering client systems inaccessible and causing over 40,000 yuan in losses; he was prosecuted for disrupting computer information systems nationwide. +- Evidence grade: A +- Notes: Account credentials are issued by the employer, but they do not remain valid after you leave the job. Logging in using original credentials constitutes “illegal control.” Losses are calculated based on data recovery costs; amounts in the tens of thousands of yuan are sufficient to initiate legal proceedings. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款、第二百八十六条）. ；最高人民检察院 (2024). 检察机关「依法惩治网络犯罪 助力网络空间综合治理」典型案例（案例六）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例七）. + +### 7. Do not take source code, client lists, or technical documents upon leaving; do not upload them to personal cloud drives or reuse them at new employers + +- Cost: No cost involved. Before leaving, simply delete all company-related files from your personal computer and cloud drives. The difficulty lies in the fact that some files were written by you personally, making it hard to part with them. +- In plain terms: Even code written by you personally remains the company’s intellectual property — taking it away is essentially stealing company assets. Client lists also qualify as trade secrets. In one case, a former employee who took source code and core algorithms of a security inspection system to a new employer was sentenced to 5 years in prison and fined 500,000 yuan; the new employer was fined 4 million yuan. Another individual who exploited system vulnerabilities to download over 33,000 design files was sentenced to 1 year and 10 months in prison and fined 100,000 yuan. Beyond criminal penalties, companies can also pursue separate civil compensation claims. +- Benefit: Violating confidentiality obligations by disclosing or personally using trade secrets may result in imprisonment of up to 3 years, along with a fine or both. In more serious cases, the sentence ranges from 3 to 10 years, plus a fine. The Anti-Unfair Competition Law also deems two acts as violations: using technical means to illegally access systems and obtain trade secrets, and aiding or abetting others in breaching confidentiality. Official examples include the aforementioned cases where former employees took source code and algorithms to new employers, resulting in heavy criminal and financial penalties. Additionally, an engineer who stored App module source code on personal devices and later developed a similar product after changing jobs was prosecuted for trade secret infringement nationwide. +- Evidence grade: A +- Notes: Code written by employees remains the company’s property, as stipulated in Article 13 (code developed using company resources belongs to the company). Taking such code away is equivalent to stealing company assets. Client lists are classified as business information and also qualify as trade secrets. Apart from criminal penalties, companies may also file separate civil lawsuits for compensation. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百一十九条）. ；全国人大常委会 (2025). 反不正当竞争法（2025 年修订，第十条）. ；最高人民检察院 (2025). 检察机关知识产权保护典型案例（案例七）. ；最高人民检察院 (2020). 2019 年度检察机关保护知识产权典型案例（案例十六）. ；最高人民检察院 (2025). 检察机关依法惩治侵害企业数据安全犯罪 服务保障企业创新发展（案例五）. + +### 8. Do not run your own programs on others’ computers, servers, or cameras; do not use company machines for mining + +- Cost: No expense and no time loss +- In plain terms: Controlling someone else’s computer, server, or camera without permission is illegal. Operating 20 or more such devices qualifies as a serious offense, punishable by up to 3 years in prison; especially severe cases may incur 3 to 7 years. Even if it does not rise to a criminal offense, offenders can still be detained for up to 5 days and fined between 50,000 and 500,000 yuan. For tech professionals, the most damaging consequence is a lifelong ban from holding key positions in cybersecurity management and network operations after any criminal conviction. +- Benefit: Illegally controlling computer information systems is a crime. Serious cases result in up to 3 years in prison plus a fine; especially severe cases incur 3 to 7 years. Controlling 20 or more devices is deemed “serious.” Those not meeting criminal thresholds still face confiscation of illegal gains, up to 5 days of detention, and fines ranging from 50,000 to 500,000 yuan. More serious violations bring 5 to 15 days of detention and fines from 100,000 to 1,000,000 yuan. Anyone with a prior public security penalty is barred for 5 years, while those with a criminal record are barred for life from critical cybersecurity and network operation roles. Example: Li was sentenced to 3 years in prison suspended for 5 years and fined 20,000 yuan after using software to illegally control 105 surveillance cameras; Wu and others received 2 to 4 years and 6 months in prison for implanting malware into mobile phone motherboards to harvest verification codes from over 3.3 million devices. +- Evidence grade: A +- Notes: No published cases from China’s Supreme People’s Procuratorate or Supreme People’s Court address mining on company servers; this entry is written under the legal provision concerning unauthorized system control. The lifelong ban from key roles is an additional consequence under China’s Cybersecurity Law, carrying heavier weight for tech professionals than monetary fines alone. +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十九、六十六条；2016 年文本为第二十七、六十三条，终身禁业为修正后的第六十六条第三款）. ；最高人民检察院 (2022). 山东滨州开发区：办理一起非法控制计算机信息系统案. ；最高人民检察院 (2021). 充分发挥检察职能 推进网络空间治理典型案例（案例六）. + +### 9. Testing someone else’s systems without written permission — “good intentions” and “reporting afterward” are not excuses + + +- Cost: No cost at all. Before joining a vendor’s SRC or public beta test, obtain a document that clearly defines the permitted scope, target systems, and allowed testing windows. An SRC is a vendor-run security response center designed to receive external vulnerability reports. Once a vulnerability is confirmed, testing must stop. The real challenge is resisting the urge to “give it a quick try.” + +- In plain terms: Whether a crime is established depends solely on whether you had permission and how much access you obtained — not on your intentions. Possessing 500 sets of ordinary account credentials, or earning 5,000 yuan while causing 10,000 yuan in losses, is enough to warrant a sentence of up to three years. Even a single attempt to export a user list to prove a vulnerability often exceeds that 500‑credential threshold. Using credentials you already possess outside their authorized scope also constitutes unauthorized access. + +- Benefit: This law applies to computer information systems belonging to ordinary companies and individuals, excluding those used for national affairs, defense, or cutting‑edge scientific research. Unauthorized intrusion or use of any technical means to obtain stored, processed, or transmitted data may lead to imprisonment of up to three years, a fine, or both, if the circumstances are serious; for especially serious cases, the sentence ranges from three to seven years with a fine. “Serious circumstances” include obtaining ten or more authentication credentials for online financial services such as payments or securities trading, 500 or more other authentication credentials, illegally controlling 20 or more computers, or earning illicit profits exceeding 5,000 yuan or causing losses above 10,000 yuan. Five times these thresholds define “especially serious” circumstances. Prosecutorial Example No. 36 states that “using accounts or passwords beyond the granted scope to log into a computer system is itself an act of unauthorized intrusion.” In that case, three individuals used work‑related credentials to access their company’s internal system, downloaded non‑work data, and sold it for 37,000 yuan; they received sentences of 4 years, 3 years 9 months, and 4 years respectively, plus fines of 40,000 yuan each. + +- Evidence grade: A + +- Notes: Prosecutorial Example No. 36 involves a data‑selling scheme; it is cited only for the principle that exceeding authorized scope counts as intrusion, not to suggest that well‑meaning tests incur identical penalties. Intentions and post‑test reporting cannot erase criminal liability; they may only influence sentencing or whether charges are filed. A vendor’s initial thanks and later filing of a report are not mutually exclusive — gratitude does not equal permission. At the time of writing, no publicly documented cases on permissible testing were found on the Supreme People’s Court or Supreme People’s Procuratorate websites; therefore this description relies on statutory provisions and penalty criteria. Always participate through a vendor’s official SRC or under a written contract that specifies scope, targets, and time limits. To prove a vulnerability, collect only minimal evidence and avoid bulk data extraction. Even conduct that does not meet criminal thresholds remains subject to administrative penalties, professional bans, and fines comparable to those outlined in Section 8 (running unauthorized programs on others’ machines). Guidance on post‑disclosure procedures appears in Section 10 (reporting vulnerabilities as required). +- Sources:全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百八十五条第一款、第二款）. ；最高人民法院、最高人民检察院 (2011). 关于办理危害计算机信息系统安全刑事案件应用法律若干问题的解释（第一条）. （深圳市公安局转载）；最高人民检察院 (2017). 第九批指导性案例（检例第 36 号，卫梦龙、龚旭、薛东东非法获取计算机信息系统数据案）. + +### 10. Vulnerabilities must be reported per regulations; no details, exploit tools, or disclosure to foreign entities before patching + + +- Cost: No cost involved. Simply report the vulnerability to the product vendor or an official platform. Until the vendor releases a patch, no details or verification code should be disclosed. + +- In plain terms: The “Regulations on the Management of Security Vulnerabilities in Network Products” applies not only to companies but also to individuals. There are five strict rules for vulnerability disclosure; the first two state that no details about vulnerabilities affecting active systems may be released before a vendor provides a fix. Additionally, no programs or tools specifically designed to exploit those vulnerabilities may be published, and any release must include instructions on how to remediate them. One often-overlooked rule: unreported vulnerabilities must not be shared with any foreign organizations or individuals outside the vendor. + +- Benefit: These regulations govern three main groups: domestic network product vendors, network operators, and any organizations or individuals involved in discovering, collecting, or publishing vulnerability information. No entity may use vulnerabilities to compromise network security, nor may they illegally collect, sell, or distribute such information. Five additional rules apply to public disclosure: first, nothing may be released before a vendor provides a patch; second, no details about vulnerabilities in active networks or systems may be published; third, no exaggerated claims about risks or malicious exploitation attempts may be made; fourth, no tools or programs designed for malicious exploitation may be released; and fifth, any disclosure must include remediation steps. Unreported vulnerabilities must also not be shared with foreign entities. The regulations encourage reporting to four official platforms: the Ministry of Industry and Information Technology’s Cybersecurity Threat and Vulnerability Information Sharing Platform; the National Cybersecurity Information Notification Center’s Vulnerability Platform; the National Computer Network Emergency Response Technical Team/Coordination Center of China’s Vulnerability Platform; and the China Information Security Evaluation Center’s Vulnerability Database. Violators may face penalties ranging from fines of 10,000 to 100,000 RMB, suspension of services, revocation of licenses or business licenses, and even criminal liability for responsible personnel. + +- Evidence grade: A + +- Notes: This regulation explicitly includes individuals as subjects; claiming “I’m just an amateur” does not exempt anyone from compliance. Submitting vulnerabilities found in domestic systems to foreign bug bounty platforms violates the rule prohibiting disclosure to foreign entities. This rule addresses how vulnerabilities must be handled after discovery. Whether one is legally permitted to test systems depends on other provisions, such as the requirement for written authorization before testing any system. Even legally discovered vulnerabilities may incur penalties if disclosed improperly. Unauthorized testing results in violations on both fronts. Among reporting channels, the MIIT platform and CNCERT are most commonly used. The regulations do not specifically address cases where a vendor is notified but fails to act; in practice, documentation of negotiation and reporting processes is required before official submission. +- Sources:工业和信息化部、国家互联网信息办公室、公安部 (2021). 网络产品安全漏洞管理规定（工信部联网安〔2021〕66 号，第二、四、九、十、十四条，2021 年 9 月 1 日施行）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十八、六十五条；2016 年文本为第二十六、六十二条，规定第十四条援引的是 2016 年文本的条号）. + +### 11. No selling of tools for bypassing firewalls or VPN accounts, no setting up such nodes for others + +- Cost: No expense or time required +- In plain terms: Any individual or entity that builds their own outbound network connections or uses international channels outside of state-provided public telecom services may be ordered by police to cease internet access, receive a warning, and face fines up to 15,000 yuan plus confiscation of any illegal earnings. Those running businesses based on such services may be charged with illegal business operations; in severe cases, imprisonment of up to five years applies. This rule specifically addresses selling or setting up such nodes. For personal use only, the maximum penalty remains limited to a warning and fine as stipulated in Article 14 of the provisional regulations. +- Benefit: Direct international internet connectivity must be facilitated via international gateway channels supplied by state-owned telecom networks. No organization or individual may independently establish or utilize any other channels, meaning neither private outbound connections nor third-party nodes are permitted. Violators face police orders to disconnect from the internet, warnings, and possible fines up to 15,000 yuan plus confiscation of illicit profits. Commercial operators violating this rule may be prosecuted for illegal business operations; severe violations incur up to five years imprisonment plus fines ranging from one to five times the illegal earnings. Particularly egregious cases may result in imprisonment exceeding five years nationwide. +- Evidence grade: B +- Notes: At the time of drafting, no publicly documented court rulings regarding firewall circumvention were found on Supreme People’s Court or Supreme People’s Procuratorate websites, and regional enforcement practices vary widely; hence this B rating was assigned. This section exclusively addresses selling or setting up such nodes. For personal usage alone, the maximum penalty remains limited to warnings and fines as outlined in Article 14 of the provisional regulations. +- Sources:国务院 (1997). 计算机信息网络国际联网管理暂行规定（第六、十四条）. （重庆市农业农村委员会转载）；全国人大 (2020). 刑法（根据刑法修正案（十一）修正，第二百二十五条第四项）. + +### 12. After signing a non-compete agreement, if the employer fails to pay compensation monthly, send a written notice; if payment still doesn’t come after 3 months, you may terminate the agreement. Workers who never handled any trade secrets can request that the clause be declared invalid. + + +- Cost: No cost involved. Keep the original non-compete agreement and any proof that the employer didn’t make monthly payments after leaving the job. + +- In plain terms: A non-compete clause simply means you’re not allowed to work for a competitor for a certain period after leaving your job. This rule is there to protect you. The maximum duration is 2 years, and the employer must pay compensation every month. If the amount isn’t specified, it’s calculated as 30% of your average monthly wage over the previous 12 months, and it can’t be lower than the local minimum wage. If the employer fails to pay for 3 months due to its own reasons, you can ask to end the agreement. Starting in 2025, workers who never learned about or handled any trade secrets at their job can request that the non-compete clause be ruled invalid. + +- Benefit: Non-compete clauses only apply to senior executives, highly skilled technicians, and anyone with a duty to keep secrets. The maximum term is 2 years, and the employer must provide monthly financial compensation during that time. If the amount isn’t set, it’s 30% of your average monthly wage over the last 12 months, never lower than the local minimum wage. If the employer doesn’t pay for 3 months for reasons on its end, you can ask to cancel the clause. If the employer ends it voluntarily, it must pay an extra 3 months of compensation. From 2025, workers who never knew about or touched any trade secrets can ask to have the clause declared void. Any part of the clause that goes beyond what they actually knew about is also invalid. Official case example: A pharmaceutical firm sued its former CTO, Zheng, seeking 7.1 million yuan in damages. The court ruled that Zheng’s new employer’s products had no overlap with the original firm’s offerings, so the non-compete scope should be limited to what Zheng actually knew. The claim was dismissed in full (nationwide ruling). + +- Evidence grade: A + +- Notes: This rule is there to protect you. On the flip side, if the agreement is valid and the employer pays as required, but you still go to work for a competitor, you’ll have to pay the agreed-upon penalty. Even after paying that, you might still be required to serve out the remaining non-compete period. Non-compete terms agreed upon while you’re still employed also count as valid, even if no extra payment is made by the employer. +- Sources:全国人大常委会 (2012). 劳动合同法（2012 年修正，第二十三、二十四条）. （抚顺市应急管理局转载）；最高人民法院 (2020). 关于审理劳动争议案件适用法律问题的解释（一）（第三十六至四十条）. ；最高人民法院 (2025). 关于审理劳动争议案件适用法律问题的解释（二）（法释〔2025〕12 号，第十三至十五条）. ；最高人民法院 (2025). 劳动争议典型案例（案例四）. + +### 13. Code written during work hours using company resources belongs to the company; personal open‑source projects should be done in your own time and on your own equipment, without mixing them. + + +- Cost: No cost involved. When you start a new job, be sure to read the intellectual‑property clauses in your employment contract. The main difficulty is that personal projects and work tasks often share the same computer, so you must keep them separate. + +- In plain terms: Work‑related creations are defined as works made in the course of your duties. Software is explicitly listed in law as “copyright belonging to the employer.” If a program is primarily produced using company hardware, internal networks, or business data — and the company assumes responsibility for it — then the copyright rests with the employer. The same applies when the contract states this. As the creator, you retain only the right to be credited. Inventions developed using company resources also belong to the company, with patent rights following the same rule. Even if you write code “after hours,” using a company computer or business data can still make it qualify as a work created mainly with employer resources. + +- Benefit: Works produced to fulfill job duties are considered “work‑made‑for‑hire.” Under normal circumstances the author keeps copyright, while the employer has the right to use them for its own business and may not allow third parties to use them in the same way for two years. However, two exceptions exist: works such as software or engineering designs that are created mainly with employer resources and for which the employer bears responsibility, and any works expressly assigned to the employer by contract. In both cases the author retains only the right to be credited. “Employer resources” include hardware, internal networks, and business data. Inventions created while performing job duties or using those same resources are classified as “work‑made‑for‑hire inventions,” with all patent rights belonging to the employer nationwide. + +- Evidence grade: A + +- Notes: Software is explicitly categorized as “copyright belonging to the employer,” so programmers rarely qualify for the standard rule granting them copyright while the employer retains a two‑year exclusive right to use it. Code written outside work hours can still be deemed a product of employer resources if it is produced on a company computer, accessed company networks, or uses business data. To keep personal projects truly separate, use your own machine, avoid company repositories, and ensure they do not overlap with any company work. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第十八条）. ；全国人大常委会 (2020). 专利法（2020 年修正，第六条）. + +### 14. Using open-source code such as GPL in products: comply with licensing requirements by open-sourcing or switching licenses; this does not mean “no one cares” + + +- Cost: There is no cost involved. Before using someone else’s open-source code, simply check its license — that is, the usage terms set forth by the author. GPL-type licenses require that any product using them also release its source code, which conflicts with selling closed-source products for profit; in such cases, you must switch to another license. The real difficulty lies in giving up a library you’ve already grown comfortable using. + +- In plain terms: Copyright infringement requires compensation based on the actual losses suffered by the rights holder or the profits you’ve earned. If neither can be accurately calculated, compensation is determined by what a normal licensing fee for that software would be. For intentional and serious violations, penalties can reach 1 to 5 times that amount. In one case, a defendant hired a former employee of the plaintiff to develop gateway software; the code was substantially similar to the plaintiff’s. The defendant argued that since the plaintiff’s software was originally based on GPLv2 and thus required to be open-sourced, no infringement occurred. The Supreme People’s Court ruled these two issues — whether GPLv2 was violated and whether copyright existed — were independent matters, and ordered the defendant to cease infringement and pay 500,000 yuan in compensation. + +- Benefit: Copyright infringement demands compensation calculated either from the rights holder’s actual losses or from the infringer’s profits. When neither figure can be precisely determined, compensation is set based on what a standard licensing fee for such software would be. Intentional and severe violations may incur penalties up to fivefold compensation. If public interests are harmed, illegal profits may also be confiscated and fines imposed. Official case reference: (2021) Supreme People’s Court Civil Appeal No. 51. In this case, a defendant hired a former employee of the plaintiff to develop gateway software nearly identical to the plaintiff’s product. The defendant claimed that since the plaintiff’s software was originally under GPLv2, it should have been open-sourced anyway; the Supreme Court ruled that whether GPLv2 was violated and whether copyright existed were separate issues, ordering the defendant to cease infringement and pay 500,000 yuan nationwide. + +- Evidence grade: B + +- Notes: This case demonstrates that merely claiming “the other party used GPL code” cannot serve as a valid defense for your own copying. Conversely, GPL authors have successfully sued commercial entities that failed to open-source their products in China; however, no official text of such rulings could be found on the Supreme People’s Court website, so they are not cited here. This item is rated B because compliance with open-source licensing relies solely on general contract and copyright laws rather than any dedicated statutory provisions. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第五十三、五十四条）. ；最高人民法院知识产权法庭 (2022). 涉「开源软件」著作权侵权案（（2021）最高法知民终 51 号）. + +### 15. Only collect personal data strictly necessary for the app’s operation; consent from guardians is required for users under 14, and the privacy policy must be clearly written. + + +- Cost: No cost involved. Before launch, cross‑check the list of permissions the app requests against the privacy policy and remove any unnecessary permissions. The main challenge is that product teams often want to retain data “just in case it might be useful later.” + +- In plain terms: Only gather information that is genuinely needed for business purposes, and obtain consent from a guardian for any user under 14. For violations, regulators first order corrections and issue warnings, and may also confiscate illegal earnings; the app can be ordered to suspend or terminate its services. If the violation persists, fines up to 1 million RMB can be imposed on the app, while individuals directly responsible may be fined between 10,000 and 100,000 RMB. In severe cases, fines can reach 50 million RMB or 5 % of the previous year’s revenue, and responsible personnel may face fines from 100,000 to 1 million RMB. The term “directly responsible personnel” can include the technical and product staff who actually implement the app. + +- Benefit: Personal data should be processed only for a clear, legitimate purpose that is directly related to that purpose, using methods that minimize impact on individuals’ rights. Consent from the individual is required unless another legal basis applies. For users under 14, consent from parents or guardians is mandatory. Violations lead to regulatory orders to correct the problem, warnings, and confiscation of illegal earnings; the offending app may be suspended or shut down. Persistent breaches incur fines up to 1 million RMB, while responsible managers and staff may be fined between 10,000 and 100,000 RMB. In extreme cases, fines can exceed 50 million RMB or 5 % of annual revenue, and those individuals may be barred from serving as directors, supervisors, or executives of related companies. Criminal acts involving the sale or disclosure of personal data are covered under Section 4 (National). + +- Evidence grade: B + +- Notes: In practice, the “directly responsible personnel” label often applies to developers and product managers. The Ministry of Industry and Information Technology regularly publishes lists of removed or penalized apps; however, no specific announcement was identified for this section, so it is not cited here. +- Sources:全国人大常委会 (2021). 个人信息保护法（第六、十三、三十一、六十六条）. + +### 16. Before launching a website or app, complete ICP filing and retain logs for at least 6 months per classification protection requirements + +- Cost: Filing itself is free; using a cloud provider’s process typically takes a few weeks. Classification protection assessments are charged based on the level of the system. Classification protection, also known as “DB”, is a set of national security management measures that classify systems by importance and set corresponding requirements for websites and systems; small websites generally do not need to undergo assessments. +- In plain terms: ICP filing costs nothing and takes a few weeks via a cloud provider’s process. Domains cannot be resolved at all without filing for servers located within China. Entities that fail to file must first be ordered to make corrections; if they refuse, their websites are shut down. Failing to display the filing number on a homepage results in fines ranging from 5,000 to 50,000 yuan. If a site is registered as non-commercial but actually charges fees, it is treated as operating without a license: any illegal earnings are confiscated and fines of 100,000 to 1,000,000 yuan apply. Logs must be retained for at least 6 months; failure to do so results in orders to correct the issue and warnings, and if ignored or if consequences occur, fines of 10,000 to 100,000 yuan are imposed. +- Benefit: Commercial internet information services require a license, while non-commercial ones must be filed. Operating without a license or filing is prohibited. Entities that fail to file must be ordered by telecom regulators to make corrections; refusal leads to website shutdowns. Unlicensed operations result in confiscation of illegal earnings and fines of 3 to 5 times that amount, or 100,000 to 1,000,000 yuan. Not displaying the filing number on a homepage incurs fines of 5,000 to 50,000 yuan. Network operators must develop security management policies per classification protection rules, guard against attacks, retain network logs for at least 6 months, and classify, back up, and encrypt data. Failure to comply leads to orders to correct the issue and warnings; if ignored or if consequences occur, fines of 10,000 to 100,000 yuan are imposed, and responsible personnel face fines of 5,000 to 50,000 yuan nationwide. +- Evidence grade: A +- Notes: Domains cannot be resolved at all without filing for servers located within China. Two scenarios commonly lead to trouble: first, registering a site as a personal non-commercial entity while actually charging fees; second, changing the domain name or entity without updating the filing. Retaining logs for 6 months is both a legal obligation and a protective measure — it can prove your innocence in case of incidents. +- Sources:国务院 (2011). 互联网信息服务管理办法（2011 年修订，第四、十九、二十二条）. ；全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十三、六十一条；2016 年文本为第二十一、五十九条）. + +### 17. Before offering generative AI services to the public, conduct required safety assessments and algorithm registration; mark all generated content + +- Cost: There is no monetary cost, but you must follow procedures set by internet regulators — completing them takes some time. Small personal tools that are not made available to the public do not fall under these rules. +- In plain terms: If you offer generative AI services with public influence or social mobilization potential to the general public, you must perform a safety assessment and register the algorithm per national regulations before launch. Any changes or shutdowns also require filing updates or cancellation paperwork. All generated images and videos must be clearly marked. Tools meant solely for personal use and not open to the public are exempt from these requirements. The regulation itself does not specify penalties; violations are handled under the Cybersecurity Law, Data Security Law, and Personal Information Protection Law. +- Benefit: Providers of generative AI services that can shape public opinion or mobilize people must conduct safety assessments, register their algorithms, and handle subsequent updates or cancellations as required by law. “Public influence” or “social mobilization potential” means the ability to affect how people think or to organize them. Providers must also add identifying marks to any generated images or videos. This regulation took effect nationwide on August 15, 2023. +- Evidence grade: B +- Notes: The regulation itself does not state exact penalty amounts. Violations are penalized under the Cybersecurity Law, Data Security Law, and Personal Information Protection Law, which is why this item is rated B. No civil cases involving copyright or portrait rights violations caused by AI‑generated content are cited here, as the original texts were not verified on the Supreme People’s Court website. +- Sources:国家互联网信息办公室等七部门 (2023). 生成式人工智能服务管理暂行办法（第十二、十七条）. diff --git a/book/en/12-Starting-Your-Own-Business.md b/book/en/12-Starting-Your-Own-Business.md new file mode 100644 index 00000000..10a4410a --- /dev/null +++ b/book/en/12-Starting-Your-Own-Business.md @@ -0,0 +1,241 @@ +# 12. Starting a business: how to protect your personal assets + +This section deals with money and legal liability. What steps could potentially put your own savings, your family’s money, and even your spouse’s funds at risk when opening a shop or forming a company? What does the law say about this? Is it possible to set up safeguards in advance? This section answers those questions without trying to convert the risks into life‑years lost. The items are ordered from the scenarios that most easily threaten personal assets to those that are easiest to avoid. Consequently, items that require only a signature come first, while methods that demand hands‑on effort appear later. Any statements based purely on experience and lacking supporting research are marked as Grade C evidence. +### 1. Only invest money you can afford to lose — never use family savings or borrowed funds + +- Cost: Zero upfront cost. Before you start, set a personal limit: this is the maximum amount you can lose without affecting your mortgage payments, child support, or medical expenses. Do not invest any more than this figure. Family funds and borrowed money must be excluded from this limit. The real challenge arises when your business starts showing promise — you must resist the urge to pour in extra capital. +- In plain terms: Any debts incurred by a sole proprietorship must be repaid using your personal assets and funds. If it’s unclear whether the business was run by the whole family, all family assets become liable. Even forming a corporation does not offer protection: when a company defaults on its debts, creditors may demand immediate payment of any portion of the subscribed registered capital that was promised but not yet paid. Therefore, your investment cap must be determined based on the principle: “I can afford to lose this amount without affecting my mortgage or medical bills.” +- Benefit: Losing money is not the only risk. For sole proprietorships, debts are tied to personal assets if the business is run by one individual; if ownership is shared or unclear, the entire family’s assets become liable. Jointly signed debts between spouses are considered mutual obligations; even debts acknowledged later by one spouse are included. If a spouse took out a loan in their own name, it still counts as a joint debt if the creditor proves it was used for the couple’s shared business. Corporations face similar rules: when a company cannot meet its debt obligations, creditors may demand immediate payment of any unpaid portion of the subscribed registered capital promised by shareholders (nationwide). +- Evidence grade: B +- Notes: “Money you can afford to lose” means an amount that won’t force you to sell your home or borrow from relatives. No verifiable official statistics on business survival rates or average lifespan were found on the websites of China’s National Bureau of Statistics or State Administration for Market Regulation. Hence, no numerical figures are included here; only legal consequences are outlined, warranting a grade B rating. +- Sources:全国人大 (2020). 民法典（第五十六、一千零六十四条）. ；全国人大常委会 (2023). 公司法（2023 年修订，第四十七、五十四条）. + +### 2. Never sign personal guarantees for corporate loans; spouses should definitely avoid signing too + +- Cost: Zero expense. When a bank, supplier, or landlord asks you to sign a “personal joint and several guarantee” or requests your spouse’s signature, pause first. Signing such a document means you voluntarily waive the legal protection that shields personal assets from corporate debts (i.e. the principle of limited liability). Avoid signing if at all possible. If signing is unavoidable, opt for a “general guarantee” and explicitly state the maximum amount you agree to cover. The tough part is that parties often threaten “no loan release without your signature” — you must stand your ground. +- In plain terms: What you’re signing is a “joint and several liability guarantee”. If the company fails to repay its debts, creditors can bypass the company entirely and demand repayment from you. Choosing a “general guarantee” means creditors must first sue the company and liquidate all its assets before they can seek any repayment from you. If your spouse also signs the document, both of your personal assets become collateral, effectively nullifying the limited liability protection afforded by a limited liability company. +- Benefit: The wording in a guarantee contract essentially translates to “if the debtor fails to repay, you are obligated to pay instead”. For contracts labeled “joint and several liability guarantee”, creditors can skip suing the company and demand payment directly from you. For “general guarantee” contracts, creditors must first initiate legal proceedings against the company and liquidate its assets; only after that can they seek any remaining balance from you. Debts jointly guaranteed by both spouses are treated as joint and several debts, and any subsequent approval by one spouse also renders them jointly liable. Once a spouse signs the guarantee, both parties’ assets become collateral for the debt (nationwide, effective since 2021). +- Evidence grade: A +- Notes: Most banks require shareholders of small and micro enterprises to sign personal joint and several guarantees when issuing loans. This guideline is not meant to discourage you from taking out loans; rather, it urges you to fully understand what you’re agreeing to before signing. Also, cap the total guaranteed amount within the “affordable loss threshold” specified in guideline 1 (i.e. only risk capital you can afford to lose when starting a business). For general rules governing promissory notes and guarantee contracts, refer to Section 8, Clause 18. +- Sources:全国人大 (2020). 民法典（第六百八十一、六百八十七、六百八十八、一千零六十四条）. + +### 3. Choosing the right legal entity before launching: sole proprietors and general partners are fully liable, while limited liability companies offer “limited” liability + +- Cost: Registration can be completed online via local government portals in just a few hours. After establishing a limited liability company, monthly bookkeeping and tax filing become ongoing expenses — either you handle them yourself (which takes time) or you hire a professional accountant, with costs varying by region. +- In plain terms: Sole proprietors and general partners bear unlimited personal liability — they must repay all debts incurred by their business. Shareholders of a limited liability company, however, are liable only up to the amount they agreed to contribute at incorporation. That said, they must actually pay in that full amount within five years; if the registered capital is set at 1 million, that is the maximum potential debt they could face. Mixing personal and corporate finances nullifies this “limited” protection. +- Benefit: Debts incurred by a sole proprietorship must be repaid using the owner’s personal assets or those of their family. General partners in a partnership also bear unlimited joint and several liability — they must repay all partnership debts, with creditors allowed to demand full repayment from any single partner. Limited partners in a limited partnership are liable only up to their subscribed registered capital. The same rule applies to shareholders of a limited liability company. Nevertheless, this “limited” liability protection ceases to apply in three specific scenarios: first, the subscribed amount must be fully paid within five years of incorporation; otherwise creditors may demand early repayment if the company cannot meet its obligations. Second, any withdrawn capital must be returned. Third, using the company merely as a shield to evade debts invalidates this protection — this also applies to single‑shareholder firms where no clear separation exists between corporate and personal finances. In all such cases, shareholders or partners remain personally liable for all corporate debts (nationwide, effective July 2024). +- Evidence grade: A +- Notes: The “limited” liability principle hinges on strict separation between corporate and personal finances: corporate accounts must not be used for personal expenses, and complete financial records must be maintained. Avoid inflating the registered capital merely for appearance’s sake; the subscribed amount must be paid in full within five years. Setting it at 1 million means you could potentially owe up to 1 million in debts. +- Sources:全国人大 (2020). 民法典（第五十六条）. ；全国人大常委会 (2006). 合伙企业法（2006 年修订，第二条）. ；全国人大常委会 (2023). 公司法（2023 年修订，第四、二十三、四十七、五十三、五十四条）. + +### 4. Being a nominal shareholder without actually owning equity + +- Cost: There is no cost involved. If someone asks you to “lend your ID to register as a shareholder” or “hold shares under your name temporarily,” you should decline every time. +- In plain terms: Once your name is registered as a shareholder, you are legally considered a shareholder. You must pay the full amount of subscribed registered capital by the deadline set in the articles of association; failing to do so means you must not only make up the payment but also compensate the company for any resulting losses. If other shareholders fail to contribute their share of the capital when the company is founded, you are responsible for covering that shortfall as well. Even though someone else runs the business, all debts are recorded under your name. (National data, effective July 2024) +- Benefit: As a registered shareholder, you are recognized as a legal shareholder. You must pay the full amount of subscribed registered capital by the deadline specified in the articles of association; otherwise, you must not only make up the payment but also compensate the company for any resulting losses. If other shareholders fail to contribute their share of the capital at the time of company formation, they share joint liability for covering that shortfall. When the company cannot repay debts when due, creditors may demand immediate payment of any amounts still pending under the subscription agreement. Even though someone else actually runs the business, all debts are recorded under your name. (National data, effective July 2024) +- Evidence grade: B +- Notes: Whether a shareholding agreement between a nominal shareholder and the actual investor is legally valid, and how liability is allocated, is addressed in the Supreme People’s Court’s Provisions on Several Issues Concerning the Application of the Company Law (III). TODO: The official document number and the exact wording of Articles 24 and 25 could not be accessed on the Supreme People’s Court website at the time of writing; hence the evidence grade is set to B. For risks associated with being a nominal legal representative, see Section 8, Article 28. +- Sources:全国人大常委会 (2023). 公司法（2023 年修订，第四十七、四十九、五十、五十四条）. + +### 5. Check the Ministry of Commerce records before signing; obtain written disclosures and include a “cooling-off period” in the contract + +- Cost: There is no cost involved. Simply visit the Ministry of Commerce’s “Franchise Information Management System” website to verify whether the brand has been registered. Then ask the franchisor to provide you with written disclosures covering all required details prior to signing, along with the contract itself. This whole process takes just a few hours. +- In plain terms: By law, a franchisor must first operate at least two company-owned stores for a full year, and must register those stores with the Ministry of Commerce within 15 days after signing the franchise agreement. Before signing, it must also furnish you with written disclosures on 12 specific topics, including franchise fees, refund policies for deposits, and the profitability of existing stores. If a brand fails to register, refuses to provide these disclosures, or demands payment before letting you see the contract, you should walk away immediately. +- Benefit: Legal requirements mandate that any franchisor maintain at least two company-owned stores that have been operating for at least one year. Within 15 days of signing the franchise contract, it must register those stores with the relevant authorities; failure to do so results in fines ranging from 10,000 to 50,000 yuan. If registration is delayed further, fines rise to 50,000–100,000 yuan and the violation is publicly announced. Prior to signing, the franchisor must provide you with written disclosures on 12 mandatory topics, such as exact fee structures, conditions under which deposits are refundable, current franchisee numbers and their financial performance, summaries of audited financial statements from the past two years, and any past litigation or arbitration involving the brand. The contract must also explicitly state that franchisees may unilaterally terminate the agreement within a defined “cooling-off period” following signing. Should the franchisor conceal any facts or provide false information, franchisees retain the right to void the contract (effective nationwide since May 2007). +- Evidence grade: A +- Notes: If a brand cannot be verified via the registration database, refuses to provide required disclosures, or insists on payment before contract review, you should avoid it entirely. The “cooling-off period” refers to the specific window after signing during which franchisees may withdraw from the agreement unilaterally; this duration must be explicitly stated in the contract, as regulations only prescribe that it must be “a reasonable period.” When reviewing any disclosed figures regarding average sales, gross profit, or net profit among existing franchisees, always ask the brand to substantiate their sources, as regulations require them to disclose such data transparently. +- Sources:国务院 (2007). 商业特许经营管理条例（国务院令第 485 号，第七、八、十二、二十二、二十三、二十五条）. ；商务部 (2012). 商业特许经营信息披露管理办法（商务部令 2012 年第 2 号，第五、九条）. ；商务部. 商业特许经营信息管理系统. + +### 6. Determine the business name, location, scope of operations, and registered capital before registration; with complete documents, you can obtain the business license on the spot. + + +- Cost: There are no fees for the registration process itself. Since January 1, 2015, registration fees for both enterprises and individual businesses have been waived. Completing the process online via local government services or at a service center typically takes just a few hours. Costs related to engraving a company seal, hiring an accountant, or renting a registered address are charges for private services, not government fees. + +- In plain terms: Registration itself is free; registration fees have been eliminated since 2015. Only five types of documents are required: an application form, proof of identity or eligibility, documents confirming the business location, articles of association or partnership agreement (not needed for individual businesses), and any additional items specified by law. With all documents in order, the license is issued immediately; otherwise, it is processed within three working days. Any fees charged are usually for third‑party assistance. + +- Benefit: The regulations specify exactly five required documents: (1) an application form; (2) documents proving the applicant’s eligibility and identity; (3) papers confirming the business address; (4) articles of association or partnership agreement for companies and partnerships; and (5) any other materials mandated by laws or regulations. Additionally, companies must submit appointment documents and identification for their legal representative, directors, supervisors, and senior managers. Individual businesses are exempt from submitting articles of association. The business name must be declared voluntarily by the applicant, and the registered capital follows a commitment system — you state how much you intend to contribute, but no payment is required at the time. The scope of operations is chosen from categories published by the registration authority. When all documents are complete and correctly formatted, registration is confirmed on the spot; otherwise it is finalized within three working days, or up to six days for more complex cases. The date printed on the license marks the official founding date of the business entity (effective nationwide since March 2022). + +- Evidence grade: A + +- Notes: Registration itself incurs no cost; any fees charged are typically for third‑party services. Seal engraving prices are set by market forces. The General Office of the State Council explicitly prohibits mandating specific seal manufacturers, so claims that you must use a designated provider are unfounded. The amount of registered capital does not affect your business image; it only defines the maximum liability you bear, and must be paid in full within five years (see Section 3 regarding selection of business entity). If your planned activities require permits, you may not commence operations until those permits are obtained (see Section 7 on licensed industries). +- Sources:国务院 (2021). 市场主体登记管理条例（国务院令第 746 号，第十、十三、十四、十六、十九、二十一条）. ; 市场监管总局 (2022). 市场主体登记管理条例实施细则（市场监管总局令第 52 号，第十二、二十五、二十六条）. ; 财政部、国家发展改革委 (2014). 关于取消、停征和免征一批行政事业性收费的通知（财税〔2014〕101 号，附件 1）. + +### 7. Businesses requiring licenses must wait until they obtain one + +- Cost: No cost involved. Before opening, verify whether your business type requires a license. Restaurants and food vendors must obtain a food business license. Selling only pre-packaged food products does not require a license — only registration is needed. Only then can you officially open for business. +- In plain terms: Operating a business without a license may result in a temporary shutdown order, confiscation of all earnings, and a fine of up to 10,000 yuan. If you handle goods subject to exclusive distribution rights, or engage in securities, futures, insurance, or payment settlement services without authorization, severe violations may constitute the crime of illegal business operations, punishable by up to five years in prison. Renovating premises first and then attempting a trial run prior to obtaining a license are common mistakes. +- Benefit: Authorities designated by law will investigate any unlicensed businesses. For operations without a license where no specific penalty is stipulated, operators must cease activities, surrender all illicit earnings, and pay a fine of up to 10,000 yuan. More serious penalties apply to businesses dealing in goods requiring exclusive distribution rights or engaging in securities, futures, insurance, or payment services without approval. Such violations may also constitute illegal business operations, resulting in imprisonment of up to five years and fines ranging from one to five times the illicit profits earned. Particularly egregious cases may incur sentences exceeding five years nationwide. +- Evidence grade: A +- Notes: Licensing requirements for financial, medical, and educational services are governed by separate laws; this entry only outlines general enforcement procedures and relevant criminal statutes. Milk tea shops and snack vendors fall under food services and must secure a food business license. Renovating premises first and conducting trial runs prior to licensing are frequent pitfalls. Details regarding licensing tiers for the food industry and requirements for selling fresh produce are covered in Section 8. +- Sources:国务院 (2017). 无证无照经营查处办法（国务院令第 684 号，第五、六、十三条）. ；市场监管总局 (2023). 食品经营许可和备案管理办法（市场监管总局令第 78 号，第四条）. ；全国人大 (1997). 刑法（第二百二十五条）. + +### 8. Figure out which category you fall into: producing or preparing food requires a permit, selling only pre-packaged goods needs a filing, while selling fresh meat and vegetables needs no permit at all. + + +- Cost: There is no fee for the permit itself. However, your premises and facilities must meet certain standards, and both on-site inspections and processing take several weeks. Those selling meat must also keep quarantine certificates and meat quality inspection reports for each batch. + +- In plain terms: If you’re making and selling food — whether it’s snacks, marinated meats, baked goods, or homemade pickles — you’ll need a permit. Selling only pre-packaged foods made by others doesn’t require a permit; you simply have to file a notice with the local market supervision administration at the county level or higher. Fresh meat and vegetables fall under this same category and need no permit at all. Operating without a permit can result in fines ranging from 50,000 to 100,000 yuan — amounts that often exceed the startup costs for many small businesses. + +- Benefit: According to the Food Safety Law, anyone running a food business must first obtain a permit. This applies to producers, sellers, and food service providers. However, selling unprocessed agricultural products or pre-packaged foods does not require a permit; in such cases, a filing with the local food safety authority suffices. Pre-packaged foods are those already packaged and sold by others. Specific rules for small food workshops and street vendors are set by each province. Those found operating without a permit may have all their earnings, food products, equipment, and raw materials confiscated. If the total value of such goods is under 10,000 yuan, a fine of 50,000–100,000 yuan applies; if it exceeds 10,000 yuan, the fine is 10–20 times that amount. The Pig Slaughtering Administration Regulations state that pigs may only be slaughtered at state-designated facilities, which must conduct official quarantine and quality checks. Exceptions apply only to rural households slaughtering pigs for personal consumption. All pork sold or used in food production must originate from such facilities and pass both inspections. Violators face shutdowns, confiscation of livestock, equipment, and profits, plus identical fines as those operating without a permit. The Animal Epidemic Prevention Law requires that all transported or sold animal products be accompanied by valid quarantine certificates and marks; failure to do so results in corrective orders and fines up to one times the value of compliant goods. Judicial interpretations further clarify that if small workshops or street vendors sell food that fails safety standards, consumers are entitled to tenfold compensation — a punitive measure that courts are required to uphold nationwide. + +- Evidence grade: A + +- Notes: Each province sets its own thresholds and specific rules for small food workshops, restaurants, and street vendors; this section does not list exact figures. Check your provincial market supervision administration website for local regulations using keywords like “regulations on small food workshops, restaurants, and street vendors.” Operating an online store for homemade food does not exempt you from needing permits where required. Beyond permits, general rules outlined elsewhere apply: see Section 6 regarding business registration and licensing, Section 7 for other permit requirements, and Section 5, Article 31 for information on consumer compensation claims. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第三十五、三十六、一百二十二条）. ；国务院 (2021). 生猪屠宰管理条例（国务院令第 742 号，第二、二十三、三十一条）. ；全国人大常委会 (2021 修订). 动物防疫法（第五十一、一百条）. ；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第四条）. + +### 9. Packaging food for sale makes it prepackaged food: labels must include production date, shelf life, and ingredient list without exception + +- Cost: Printing labels costs only a few cents to a few dimes each. However, filling in the correct date and ingredient details for every batch takes some time. +- In plain terms: Legally, any food that is placed into packaging before being sold counts as prepackaged food. Such packaging must carry a label with nine mandatory items, including both the production date and shelf life. For unpackaged, bulk food, the label must still list the food’s name, production date, and the seller’s name and address. If any required label information is missing, a fine of 5,000 to 50,000 RMB applies if the total value of the goods is under 10,000 RMB; if the value exceeds 10,000 RMB, the fine rises to 5 to 10 times that amount. +- Benefit: According to food safety laws, prepackaged food must have a label that includes the following details: product name, specifications, net weight, production date, ingredient list (配料表), producer’s name, address, and contact information, shelf life, product standard code, storage conditions, common names of food additives as defined by national standards, and production license number. Any additional information required by laws or food safety standards must also be listed. Bulk food, which is sold without packaging based on individual weight, also needs a label on its container or outer packaging that lists the food’s name, production date or batch number, shelf life, and the producer’s name, address, and contact details. Any prepackaged food sold without a proper label, or with a label/instruction sheet that does not meet legal requirements, will have both the earnings and the goods confiscated. If the total value of such goods is under 10,000 RMB, a fine of 5,000 to 50,000 RMB applies; if the value exceeds 10,000 RMB, the fine is 5 to 10 times that amount. In severe cases, the business may be ordered to cease operations until its production license is revoked. Minor label flaws that do not affect food safety or mislead consumers only require correction; failure to do so results in a fine of up to 2,000 RMB. The latest version of the General Rules for the Labelling of Prepackaged Foods is GB 7718-2025, which was released on March 16, 2025, and will take effect on March 16, 2027, allowing a two-year transition period. This standard mandates a dedicated area on packaging to display both the production date and expiry date, using high-contrast, legible fonts and colors, and arranging dates in year-month-day format nationwide. +- Evidence grade: A +- Notes: Label flaws are categorized into two types, each carrying distinct penalties and compensation rules. Minor flaws, such as spelling errors or irregular font sizes, which do not affect food safety or mislead consumers, only require correction by regulatory authorities; failure to do so results in a fine of up to 2,000 RMB, and consumers cannot claim tenfold compensation. Major flaws, such as missing production dates or shelf lives, are not classified as minor per judicial interpretations: fines are calculated based on the goods’ total value, with amounts ranging from 5,000 to 50,000 RMB if the value is under 10,000 RMB, and 5 to 10 times that value if it exceeds 10,000 RMB. In addition, consumers are entitled to tenfold compensation based on the food’s purchase price, with a minimum compensation amount of 1,000 RMB if the tenfold total is lower (see Section 5, Article 31 regarding tenfold food compensation). This section only verifies the production date and display requirements outlined in the GB 7718-2025 announcement and official interpretations; exact label formatting must follow the original standard text. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第六十七、六十八、一百二十五条）. ；国家卫生健康委员会、国家市场监督管理总局 (2025). 关于发布《食品安全国家标准 预包装食品标签通则》（GB 7718-2025）等 50 项食品安全国家标准和 9 项修改单的公告（2025 年第 2 号）. （拉萨市卫生健康委员会转载公告全文）；最高人民法院 (2024). 关于审理食品药品惩罚性赔偿纠纷案件适用法律若干问题的解释（法释〔2024〕9 号，第六、八条）. （标签瑕疵与必标事项缺失的分档）；北京市市场监督管理局 (2026). 找不到生产日期？食品标签要「变脸」！新规这些重点必看. （实施日期、过渡期与日期展示新要求） + +### 10. General foods must not claim therapeutic effects: this applies to labels, instructions, ads, and live-stream scripts alike + +- Cost: No cost involved. Simply review all promotional copy, product description pages, and live-stream scripts. The hard part is resisting the urge to use phrases like “lowers blood pressure, blood sugar, and cholesterol” or “treats constipation.” +- In plain terms: Labels, instructions, and ads for ordinary foods must never claim that the products can prevent or treat diseases. Apart from ads for medical products, drugs, and medical devices, no other ads may make such claims or use language that sounds pharmaceutical in nature. Penalties amount to 1–3 times the advertising spend; if the spend cannot be calculated, fines range from 100,000 to 200,000 RMB. In severe cases, the business license may be revoked. +- Benefit: The Food Safety Law states: “Labels and instructions for food and food additives must not contain false information, nor may they make any claims regarding disease prevention or treatment. Producers and sellers bear full responsibility for the accuracy of such content.” Likewise, “Food advertising must be truthful and lawful; it must not contain false information or make any claims regarding disease prevention or treatment. Food producers and sellers are accountable for the veracity and legality of their ads.” In short, packaging, instructions, and ads must never assert any disease-preventive or curative effects, and sellers must accept full responsibility for any such claims. Violations of advertising rules are punished under the Advertising Law, which explicitly bans any non-medical ads from making disease-treatment claims or using medical terminology that might confuse consumers. Offenders face mandatory cessation of advertising, a public retraction of their claims, and fines ranging from 1–3 times their advertising spend; if the spend cannot be determined, fines of 100,000–200,000 RMB apply. Severe violations incur fines of 3–5 times the advertising spend, or 200,000–1,000,000 RMB, and may even result in revocation of the business license, effectively ending operations nationwide. +- Evidence grade: A +- Notes: Terms like “health benefits” are also prohibited for ordinary foods. Only foods officially registered as health supplements may make such claims, and only those listed in the national catalog are permitted. Consumers should be wary of such language; further guidance is provided in Section 6, Item 10. This regulation applies not just to physical packaging and ads, but also to online product pages, live-stream scripts, and social media posts — all of which constitute advertising material. +- Sources:全国人大常委会 (2025 年第三次修正). 食品安全法（第七十一、七十三、一百二十五、一百四十条）. ；全国人大常委会 (2021 年修正). 广告法（第十七、五十八条）. + +### 11. The food industry faces criminal penalties: selling meat from diseased animals or products exceeding safety limits is already a crime; adding toxic or harmful non-food substances carries a minimum five-year sentence regardless of revenue + + +- Cost: No direct cost is involved. Follow the approach outlined in Article 8 (assess which regulatory category your operation falls under): retain all quarantine certificates and purchase receipts, and only use ingredients with verifiable approval numbers on their labels. +- In plain terms: While earlier articles impose financial penalties, this one targets individuals criminally. Selling meat from diseased animals, meat failing inspection, or products with excessive pesticide, veterinary drug, or heavy metal residues is a crime as long as it is “sufficient” to cause serious poisoning — no actual victims are required, and offenders face up to three years in prison. Adding toxic or harmful non-food substances to food carries a minimum five-year sentence, irrespective of total sales volume. +- Benefit: Article 143 of the Criminal Law governs this category: any food you produce or sell that fails to meet safety standards is illegal if it is “sufficient” to cause serious food poisoning or other severe foodborne illnesses. Offenders receive up to three years of imprisonment or detention plus fines. If serious health damage or other aggravating factors are present, sentences rise to three to seven years with additional fines. In cases of especially grave consequences, imprisonment ranges from seven years to life, plus asset confiscation or further fines. Article 144 covers the deliberate addition of toxic or harmful non-food substances to food; offenders face up to five years of imprisonment plus fines. If serious health damage or other serious circumstances arise, sentences increase to five to ten years with fines. If death results or other especially severe circumstances exist, penalties follow Article 141 (ten years or more, life imprisonment, or death). A joint interpretation by the Supreme People’s Court and the Supreme People’s Procuratorate defines four scenarios that qualify as “sufficient” to cause serious foodborne illness: presence of pathogenic microbes, pesticide residues, veterinary drug residues, biological toxins, or heavy metals exceeding legal limits; use of meat from diseased, undiagnosed, or unqualified animals; production or sale of items banned for public health reasons; and infant formula or medical foods with severely inadequate nutritional content. Excessive or improper use of additives that lead to such outcomes also falls under Article 143. What counts as “toxic or harmful non-food substances” is strictly defined: any substance prohibited by law or listed by government authorities (e.g., banned pesticides or drugs not approved for food animals). Additional serious circumstances under Article 144 include sales totaling between 100,000 and 200,000 RMB, operations near schools, nursing homes, or facilities serving minors or the elderly, or illegal private slaughtering without proper licensing; such acts may also incur penalties under the crime of illegal business operations. Revenue thresholds of 100,000 RMB or net profits of 50,000 RMB are considered “serious circumstances” nationwide. +- Evidence grade: A +- Notes: The dividing line between this article and the previous three is whether food safety standards themselves are violated. Failure to obtain permits, incomplete labeling, or false health claims result in financial penalties, while selling diseased meat, non-compliant products, improper additives, or non-food substances triggers criminal prosecution. The simplest preventive measure remains the steps outlined in Article 8: purchase meat solely from licensed slaughterhouses, retain all quarantine and quality certificates, and use only ingredients with valid approval numbers. Unverified “discounted meat” or unknown “by‑product scraps” are common sources of violations. Due to a 502 error when retrieving the original Supreme People’s Court bulletin, two provincial official reprints were cross‑checked word‑for‑word to ensure accuracy. +- Sources:全国人大常委会 (2020 年修正). 刑法（第一百四十一、一百四十三、一百四十四条）. （国家法律法规数据库）；最高人民法院、最高人民检察院 (2021). 关于办理危害食品安全刑事案件适用法律若干问题的解释（法释〔2021〕24 号，第一、二、五、七、九、十七、十八条，2022 年 1 月 1 日起施行）. （河北省市场监督管理局转载全文）、（辽宁省司法厅转载全文，两份逐字核对一致） + +### 12. Once you obtain a business license, you must file tax returns on schedule — even if you have no income, you still need to submit a return with all zeros. + + +- Cost: There’s no direct cost involved. You can file electronically via the tax service portal monthly or quarterly in just a few minutes. Hiring an accountant, however, adds extra expense. If you do hire someone, you must also register for social insurance within 30 days of business establishment. The real challenge is remembering to file on time even during months with no business activity. + +- In plain terms: After getting a business license, you’re required to file tax returns regularly. Even if you earn nothing, you must still file a return — just fill in all zeros. Failing to do so risks fines up to 2,000 yuan; more serious violations can lead to penalties between 2,000 and 10,000 yuan. If you skip returns for all tax types across three consecutive months, the system automatically labels you as a “non-compliant taxpayer,” and you lose the ability to issue invoices. + +- Benefit: The law clearly states that “taxpayers with no tax liability during a period must still file a tax return as required.” In other words, even when you owe nothing, filing remains mandatory. Non-compliance brings penalties: tax authorities can order corrections and impose fines up to 2,000 yuan; repeat or severe violations may exceed 10,000 yuan. Any unpaid taxes plus daily late fees at 0.05% must also be settled. Furthermore, persistent non-filing leads to automatic classification as a non-compliant taxpayer, blocking invoice issuance until corrected and penalties paid. + +- Evidence grade: A + +- Notes: With the “multi-certificates integration” policy, a separate tax registration isn’t needed. Use your business license’s unified social credit code to log into the electronic tax portal and specify applicable taxes. Individual businesses and sole proprietorships pay individual income tax on business earnings. Payments are first due within 15 days after month or quarter-end, followed by an annual settlement by March 31 of the following year to adjust any over- or under-payments. Even without any revenue, zero returns must still be filed. Three consecutive months of non-filing results in automatic classification as a non-compliant taxpayer, halting invoice use; cancellation procedures then become far more complicated — see Section 12.23 for details on orderly business closure. +- Sources:国务院 (2002). 税收征收管理法实施细则（国务院令第 362 号，第三十二、七十五条）. ; 全国人大常委会 (2015). 税收征收管理法（2015 年修正，第二十五、三十二、六十二、六十四条）. ; 国家税务总局 (2019). 关于税收征管若干事项的公告（国家税务总局公告 2019 年第 48 号，第三条）. ; 全国人大常委会 (2018). 个人所得税法（2018 年修正，第十二条）. ; 全国人大常委会 (2018). 社会保险法（2018 年修正，第五十七条）. + +### 13. Invoices must reflect actual transactions; small taxpayers can fully utilize tax exemptions + +- Cost: No cost at all. There is no need to purchase or sell invoices, nor to handle “fictitious invoicing” on behalf of others. Simply issue invoices and file taxes based on real business activity. +- In plain terms: If you are a small taxpayer paying taxes under the simplified regime, and your monthly sales stay under 100,000 yuan or quarterly sales under 300,000 yuan, you are exempt from VAT. Previously taxed at 3%, this rate is now reduced to 1% for the same period. Conversely, arranging fake invoices to offset costs constitutes tax fraud, punishable by up to three years in prison and fines ranging from 20,000 to 200,000 yuan. +- Benefit: Small taxpayers under the simplified tax regime are legally exempt from VAT if their sales remain below specific thresholds. These thresholds apply from January 1, 2026, through December 31, 2027: 100,000 yuan per month, 300,000 yuan per quarter, or 1,000 yuan per transaction/day. Exceptions apply for real estate sales, rentals, and land-use right transfers. For those meeting these limits, the VAT rate drops from 3% to 1%. Issuing VAT invoices without a genuine transaction, or any form of fictitious invoicing, is illegal and carries penalties up to three years imprisonment plus fines up to 200,000 yuan; repeat or larger-scale violations may lead to sentences ranging from three to ten years, or even life imprisonment nationwide. +- Evidence grade: A +- Notes: The revised VAT Law took effect on January 1, 2026, superseding earlier relief measures for small taxpayers outlined in 2023 documents No. 19 and No. 1. While monetary thresholds remain unchanged, the legal basis has been updated accordingly. The referenced criminal provisions derive from the 1997 Penal Code, specifically Article 205, as amended to reflect current sentencing tiers. Note that VAT exemptions do not apply to income tax; arranging fake invoices is illegal and should never be considered a tax-saving tactic. +- Sources:全国人大常委会 (2024). 增值税法（2026 年 1 月 1 日施行，第二十三条）. ；财政部、税务总局 (2026). 关于增值税法施行后增值税优惠政策衔接事项的公告（财政部 税务总局公告 2026 年第 10 号，第一、二、六条）. ；全国人大 (1997). 刑法（第二百零五条）. + +### 14. Scammers pretending to be tax officials demanding payments are fraudsters; tax filings must be done via the e-Tax Service or by calling 12366 + +- Cost: No cost involved. If you receive calls or texts claiming a “tax audit,” “unusual account activity,” or “fines for non-filing,” or if someone adds you as a contact, simply hang up and ignore them. Then call 12366 or the official phone number of your local tax authority to verify. +- In plain terms: Tax authorities never ask for your bank card passwords, payment codes, or SMS verification codes over the phone, nor do they provide an account number for you to send tax payments to. Legitimate on-site tax inspections require officials to present an inspection notice and identification. When receiving such calls, hang up first and call 12366 to confirm. If you’ve already transferred money, immediately call 110 or 96110 to request a payment reversal. +- Benefit: The State Taxation Administration explicitly states: “Tax authorities never request bank card passwords, payment codes, account balances, or SMS verification codes related to payments via WeChat mini-programs, phone calls, or texts.” It also warns: “Some criminals impersonate tax officials, offering services such as ‘tax filing assistance,’ ‘preferential tax policy handling,’ or ‘policy guidance’ to taxpayers.” To verify any claims, call the 12366 taxpayer service hotline or your local tax authority’s official number. Legitimate on-site inspections require officials to present a written notice and identification. Tax payments can only be made via the e-Tax Service or at tax service centers; no tax authority ever provides a designated account for payments. Intermediary agencies offering tax filing services are also subject to regulations. Those who extort taxpayers or withholding agents using the guise of tax officials face fines based on severity. Impersonating government officials to commit fraud results in detention for 10–15 days and a fine of up to 1,000 yuan. If actions meet criteria for both fraud and impersonation, penalties follow the stricter applicable law. +- Evidence grade: A +- Notes: These scams specifically target newly registered sole proprietors and small businesses. Scammers claim “your tax filing records show non-compliance, and fines will apply today,” then steer victims to their own official accounts or mini-programs, charging hundreds of yuan for services that are actually free and take only minutes to complete independently. While hiring external bookkeeping firms is legal, they are not government entities and cannot act on behalf of tax authorities. Victims who’ve already paid should follow Section 8, Clause 2 (payment reversal for fraud) and immediately call 110 or 96110 to request a reversal. +- Sources:国家税务总局 (2025). 税务部门提醒广大纳税人——增强防范意识 警惕互联网涉税诈骗. ; 国家税务总局扬州市税务局 (2023). 扬州防范涉税诈骗宣传篇. ; 国家税务总局 (2025). 涉税专业服务管理办法（试行）（国家税务总局令第 58 号，第三十二条第七项、第三十三条）. ; 全国人大常委会 (2025). 治安管理处罚法（2025 年修订，2026 年 1 月 1 日施行，第六十二条）. ; 最高人民法院、最高人民检察院、公安部 (2016). 关于办理电信网络诈骗等刑事案件适用法律若干问题的意见（法发〔2016〕32 号）. + +### 15. Writing “deposit” instead of “advance payment” in contracts, specifying penalty amounts, and treating credit terms as loans + + +- Cost: No cost at all. Simply include the term “deposit” in the contract; the amount must not exceed 20% of the total contract value. Collect the payment before delivering goods. Before agreeing to any credit terms that let the buyer receive goods first and pay later, run a background check on them first. +- In plain terms: Only when the word “deposit” is used does the double‑return rule apply: if you break the contract, you lose that money; if the other party breaks it, they must pay you twice the amount. Anything above 20% of the contract value does not qualify as a deposit. If you write “advance payment” instead, the law offers no such protection. Offering credit terms is essentially lending your own money to the buyer interest‑free; if they go bankrupt, it becomes a bad debt. +- Benefit: A deposit only becomes valid once the money is actually received by the seller (the effective date is when delivery occurs). If the buyer breaks the contract, they forfeit the deposit. If the seller breaks it, they must return the full amount plus an equal sum as compensation (i.e., double the original amount). Portions exceeding 20% of the total contract value are not treated as deposits. Should the agreed penalty amount be far higher or lower than the actual loss, a court may adjust it at the request of either party. When both a deposit and a penalty clause are included in the same contract, the injured party may claim only one of them, not both (nationwide, effective since 2021). +- Evidence grade: A +- Notes: Under the Civil Code, “advance payment” does not enjoy the same protections as a deposit; it is generally regarded as a simple prepayment. This is the prevailing practice in legal practice, though no specific court rulings were verified for this section. Providing credit terms is equivalent to lending your own funds to the buyer without interest; any default results in a bad debt. Before granting such terms, check the buyer’s records on the National Enterprise Credit Information Publicity System to see if there are any pending lawsuits against them. +- Sources:全国人大 (2020). 民法典（第五百八十五、五百八十六、五百八十七、五百八十八条）. + +### 16. Sign a written contract within the first month of employment; register for social insurance within 30 days + +- Cost: The portion of social insurance premiums that employers must pay must be paid continuously; the exact percentages vary by region. There is no cost to drafting the contract itself — simply use the standard template provided by local labor authorities. +- In plain terms: If an employee starts working and no written contract is signed within the first month, the employer must pay double wages starting from the second month, continuing until the end of the first year of employment. Social insurance must be registered within 30 days of hiring; failure to do so results in fines equal to 1–3 times the amount of unpaid premiums. There is no legal provision allowing employees to voluntarily waive their right to social insurance coverage. +- Benefit: Employers must pay double wages to employees who have worked for at least one month but still lack a written contract, starting from the second month of employment. Social insurance must be registered within 30 days of the employee’s first day on the job; failure to comply triggers mandatory corrective orders. After this deadline, fines of 1–3 times the unpaid premiums apply, and the responsible personnel face individual fines ranging from 500 to 3,000 yuan. Late or incomplete premium payments incur a penalty of 0.05% of the outstanding amount per day (late fees). If payments remain unpaid past the deadline, additional fines of 1–3 times the original debt apply. Employers bear sole responsibility for timely registration and full premium payments; only legally recognized force majeure events such as natural disasters permit temporary delays or reductions. No provision exists for employees to voluntarily forgo social insurance benefits (applies nationwide). +- Evidence grade: A +- Notes: Double wage obligations remain in effect from the second month through the end of the first year of employment, making delays increasingly costly. Employees without a written contract or unpaid social insurance coverage who suffer workplace injuries or later file labor disputes often face combined costs of retroactive payments, fines, and compensation that far exceed any initial savings the employer might have realized. +- Sources:全国人大常委会 (2007). 劳动合同法（第十、八十二条）. ；全国人大常委会 (2010). 社会保险法（2018 年修正，第五十八、六十、八十四、八十六条）. + +### 17. Wages must be paid according to contracts and laws; raises, loans, and bonuses all require written documentation + +- Cost: No expense is incurred. The contract clearly states the wage amount. Any raises, bonuses, advance payments, or loans must be documented with signed paperwork — no verbal promises are allowed. Employers must never pay wages out of their own pocket on behalf of the company. Even when dealing with acquaintances, this same rule must be followed. +- In plain terms: Wages must be paid on time and in full, as required by contract and law. If payments are delayed, employees can petition the court for a payment order. Verbal promises regarding raises, bonuses, or advance payments are legally meaningless; without written proof, the party unable to produce documentation will suffer the consequences. Any money lent by an employer to an employee must be backed by a written loan agreement specifying the amount, interest rate, and repayment terms. +- Benefit: Contractual labor agreements must explicitly outline how wages are paid and how social insurance contributions are handled. Employers are legally obligated to pay wages on schedule and in full, per both the contract and national regulations. Failure to do so allows employees to request a court-issued payment order. Loans made by employers to staff are legally treated as standard loan agreements. Unless otherwise agreed between two private individuals, all such arrangements must be documented in writing, detailing the principal amount, interest terms, repayment date, and method. Verbal promises of bonuses lack any legal standing; without written proof, the party unable to provide documentation will be at a disadvantage (nationwide). +- Evidence grade: C +- Notes: This is not about refusing to help others — it is about ensuring all assistance follows established procedures. Once informal favors become habitual practice, discontinuing them inevitably leads to disputes. Mixing personal loans with company finances risks exposing the lender to financial losses if the borrower defaults. The legal provisions referenced here have been verified; however, the recommendations are based on practical experience, which justifies the C rating. +- Sources:全国人大常委会 (2007). 劳动合同法（第十七、三十条）. ；全国人大 (2020). 民法典（第四百六十九、六百六十八条）. + +### 18. Sell first, then produce: use pre-orders and small orders to confirm demand before investing in manufacturing + +- Cost: Just a few dozen to a few hundred yuan is needed to create a prototype or a simple landing page. After that, reach out to dozens of real potential customers and ask them to make advance payments or place small orders. This approach takes a few extra weeks compared to starting production right away. The hard part is resisting the urge to produce the goods first. +- In plain terms: A study followed 116 newly founded Italian companies for about a year. Entrepreneurs who first formed a hypothesis and then tested it against real market feedback tended to run their businesses better, were more willing to pivot when needed, and did not quit earlier than others. So, if no one is willing to make advance payments or place small orders, you should not believe the claim that “products will sell on their own once made.” +- Benefit: This randomized controlled trial tracked 116 Italian startups over roughly one year. In such trials, participants are randomly split into two groups; only one group receives a specific intervention, and the results of both groups are compared. The findings showed that entrepreneurs who received training on the “form a hypothesis first, then rigorously test it against market feedback” method achieved better business results, were more likely to switch strategies when needed, and did not have a higher early dropout rate. The authors argue that this approach lowers the risk of pouring resources into projects that seem promising at first glance but ultimately fail (published in Italy in 2020). +- Evidence grade: B +- Notes: This is the only study on this topic, and its sample size is relatively small; it was also conducted only in Italy, which is why it is rated as grade B. The title, source, and abstract have been cross-checked via Crossref and Semantic Scholar; however, the exact effect figures cited in the text have not been independently verified. In practice, if no customers are willing to make advance payments or place small orders, you should not trust the idea that “products will automatically find buyers once produced.” +- Sources:Camuffo A, Cordova A, Gambardella A, Spina C (2020). A Scientific Approach to Entrepreneurial Decision Making: Evidence from a Randomized Control Trial. Management Science 66(2):564-586. + +### 19. Run the prototype through the production checklist before starting full production + +- Cost: Producing a small batch of prototypes costs a few hundred yuan. It also takes several hours to calculate these key figures: the yield rate (how many of the 100 items can actually be sold), the supplier’s minimum order quantity and payment terms, the capital tied up in inventory, packaging and logistics costs, as well as certification and licensing fees and trademark registration costs. The hardest part is resisting the urge to skip this step and jump straight into production. +- In plain terms: The main difference between producing one prototype and producing a thousand units lies in where your money gets invested. The yield rate determines your actual production cost. The minimum order quantity and payment terms dictate how much capital you must advance upfront. Inventory levels determine when you can expect that capital back. For products listed in mandatory certification categories, they cannot be manufactured or sold without passing certification and displaying the corresponding certification mark. +- Benefit: The main difference between producing one prototype and producing a thousand units lies in where your money gets invested. The yield rate determines your actual production cost — it shows what percentage of a batch of products are qualified for sale. The minimum order quantity and payment terms set by suppliers determine how much capital you must advance upfront. Inventory levels determine when you can expect that capital back. For products listed in mandatory certification categories, they must first pass certification and display the certification mark before they can be manufactured or sold. Unauthorized manufacturing or sale of such products without certification is punishable under relevant certification regulations. Food businesses and restaurants must obtain a food business license (required nationwide). +- Evidence grade: C +- Notes: This checklist is based on practical experience; the legal content has been cross-checked against official sources. Before launching production, check the trademark database maintained by the National Intellectual Property Administration to see if any similar trademarks are already registered, then apply for your own trademark. Details on prohibited use of other parties’ trademarks and designs can be found in items 20 and 21 (keep purchase receipts, and ensure any designs are either created in-house or licensed for use). The list of mandatory certification categories is subject to updates published by the State Administration for Market Regulation. +- Sources:质检总局 (2009). 强制性产品认证管理规定（质检总局令第 117 号，第二、四十九条）. ；市场监管总局 (2023). 食品经营许可和备案管理办法（市场监管总局令第 78 号，第四条）. + +### 20. Keep copies of invoices and supplier documentation for every shipment; avoid purchasing goods priced significantly below market rates: if an employee buys counterfeit products, the employer can still be held legally responsible. + + +- Cost: Zero upfront expense. For each batch of goods, retain essential paperwork: purchase contracts, invoices, payment records, the supplier’s business license, and any authorization documents. Implement a company policy requiring all buyers to sign off on purchases; under no circumstances should items priced far below market value be accepted. The real challenge lies in resisting the temptation to purchase seemingly profitable low-cost goods. + +- In plain terms: Selling counterfeit merchandise can lead to criminal penalties. If the illicit profits exceed 30,000 RMB or if total sales reach 50,000 RMB, the offender faces up to three years in prison. Even unsold inventory in storage counts toward these thresholds. Merely claiming “I didn’t know it was fake” is not a valid defense: if purchase prices are markedly lower than market rates without a reasonable explanation, guilt is presumed. Maintaining proper purchase contracts, invoices, payment records, and supplier details provides a crucial legal safeguard. + +- Benefit: Intentional sale of goods bearing counterfeit trademarks incurs serious legal consequences. When illicit earnings surpass 30,000 RMB or total sales reach 50,000 RMB, imprisonment for up to three years and monetary fines are likely. In cases where these figures are ten times higher, sentences range from three to ten years alongside substantial penalties. Un sold stock also contributes to this calculation; if its value triples the sales threshold, criminal liability applies automatically. The burden of proof lies with defendants to demonstrate genuine ignorance, but judicial interpretations issued in 2025 outline five circumstances where intent is deemed evident regardless of personal admission. These include visible tampering with trademarks, possession of forged authorization papers, prior convictions for similar offenses, purchasing goods at inexplicably low prices, and attempting to conceal evidence after detection. Corporate entities face dual penalties: financial fines imposed on the company itself and individual executives held accountable under identical statutes. Consequently, even when employees execute unauthorized purchases, senior management ultimately bears legal responsibility. Conversely, trademark law offers a defense mechanism: if sellers can prove they lawfully acquired products and identify their source, they avoid compensation obligations. Essential documentation—specifically invoices and supplier records—forms the backbone of this protection; lacking them nullifies any claim of innocence (applicable nationwide; judicial interpretation effective April 26, 2025). + +- Evidence grade: A + +- Notes: Cosmetics, alcoholic beverages, baby products, electronics, and apparel frequently involve such legal disputes due to substantial price variations among identical items. Marketing terms like “exclusive channel stock,” “end-of-line clearance,” or “duty-free imports” cannot substitute for proper documentation. Beyond criminal penalties, administrative sanctions apply: convicted parties forfeit infringing merchandise and tools, while fines up to five times the illegal revenue may be imposed for operations exceeding 50,000 RMB in value. Upon discovering questionable purchases, immediately cease sales, secure the inventory, and contact brand representatives or regulatory authorities—destroying records or merchandise directly triggers the fifth presumption of intent mentioned earlier. For trademark-related matters, refer to Section 21 regarding permissible usage of third-party designs. A common scam involves strangers offering free merchandise in exchange for retail distribution; later, they claim infringement based on missing paperwork and abnormally low purchase prices, effectively negating all defenses. Legitimate consignment arrangements mandate written contracts, copies of supplier identification and business licenses, and explicit clauses defining ownership and liability boundaries. +- Sources:全国人大常委会 (2020). 刑法修正案（十一）（第十七、二十四项，即刑法第二百一十四、二百二十条）. ；最高人民法院、最高人民检察院 (2025). 关于办理侵犯知识产权刑事案件适用法律若干问题的解释（法释〔2025〕5 号，2025 年 4 月 26 日起施行）. ；全国人大常委会 (2019). 商标法（2019 年修正，第五十七、六十四条；2026 年 6 月 26 日修订后为第七十二、七十八条，自 2027 年 1 月 1 日起施行）. 、 + +### 21. Whether creating designs yourself or purchasing licensed artwork, simply changing colors or adding icons does not count as “modifications” for copyright purposes. + + +- Cost: Licensing fees from legitimate stock image libraries start at just a few dozen yuan per image. Hiring a designer to create original artwork can cost several hundred to several thousand yuan. For every image used on products, keep a record of the license and proof of purchase. The real challenge is avoiding the use of random images found online. + +- In plain terms: Even if you alter an existing image by changing its colors, background, or adding your own icons, you still have not obtained permission to use that artwork. Making money by reproducing someone else’s artwork—whether you earn 30,000 yuan, reach 50,000 yuan in sales, or print 500 copies—constitutes copyright infringement and can lead to a prison sentence of up to three years. In trademark law, any mark that is “likely to cause confusion” is considered infringing as well. + +- Benefit: Copyright law treats any unauthorized adaptation, translation, or annotation of a work as equivalent to outright copying. Therefore, modifying an original image by changing colors, background, or adding icons still counts as using someone else’s work without permission. The legal thresholds for punishment are as follows: if you profit from selling artwork without permission from the copyright holder—earning at least 30,000 yuan in illegal gains, reaching 50,000 yuan in total illegal business volume, or producing 500 copies or more—you commit copyright infringement and may be sentenced to up to three years in prison and fined. If the illegal gains reach ten times that amount, the sentence rises to three to ten years. Selling counterfeit goods bearing unauthorized designs also carries penalties: selling for over 50,000 yuan or reaching 100,000 yuan in sales can result in up to five years in prison. For trademarks, using a mark similar enough to cause confusion on identical or related goods is also illegal. Even minor modifications do not create a safe zone; such changes remain infringing under current law (effective April 26, 2025). + +- Evidence grade: A + +- Notes: There are three common pitfalls to watch for. First, printing cartoon characters or celebrity images found online onto clothing, mugs, or phone cases without permission. Second, commercial use of fonts: most require separate licensing, and free preview versions are not automatically free for business use. Third, including unauthorized assets in client designs—the seller remains legally responsible. To simplify compliance, use licensed stock image libraries and keep all license documents on file. Alternatively, require designers to specify the source and scope of any used materials in a contract, making them liable for any resulting issues. Beyond criminal penalties, civil damages and administrative fines apply as well: if public interests are harmed, illegal earnings may be confiscated and fines imposed at 1–5 times the illegal business volume. For trademark checks prior to production, see item 19 (verify samples against the full production list). Conversely, if someone uses your own designs without permission, these same legal provisions apply to protect your rights. +- Sources:全国人大常委会 (2020). 著作权法（2020 年修正，第五十二条第六项、第五十三条）. ；全国人大常委会 (2020). 刑法修正案（十一）（第二十、二十一项，即刑法第二百一十七、二百一十八条）. ；最高人民法院、最高人民检察院 (2025). 关于办理侵犯知识产权刑事案件适用法律若干问题的解释（法释〔2025〕5 号）. ；全国人大常委会 (2019). 商标法（2019 年修正，第五十七条第二项；2026 年修订后为第七十二条第二项）. + +### 22. Following procedures at work — and thinking twice about stepping outside them + +- Cost: No cost involved. Simply follow institutional rules, medical orders, and established workflows while on duty. Never make decisions on behalf of others beyond your own authority. Before offering help, ask yourself: “Who would be held responsible if something went wrong?” The hardest part is resisting requests to “make an exception” in the moment. +- In plain terms: Take nurses as an example: regulations clearly state that when a patient’s condition deteriorates critically, nurses must immediately alert a physician; likewise, if they notice any orders that violate regulations, they must bring this to the prescribing physician’s attention. The same principle applies to all other roles — first identify exactly where the relevant rules specify “mandatory reporting.” The law also does not require people to stand by while someone is in danger: if you voluntarily provide emergency care and end up causing injury, you are not legally liable for compensation. +- Benefit: For nurses, statutory duties are defined precisely in this manner. When a patient’s condition becomes critical, they must promptly notify a physician. In genuine emergencies, they may also initiate necessary emergency treatment to save a patient’s life. Should they encounter any orders that breach laws or clinical practice standards, they must raise this with the prescribing physician, and if needed, report it to department supervisors. Conversely, the Civil Code explicitly states that individuals who voluntarily provide emergency aid and inadvertently cause injury to the recipient are exempt from civil liability. Legal protection is reserved for well-intentioned rescuers, not for those who assume they must pay compensation simply for trying to help (nationwide). +- Evidence grade: B +- Notes: Adhering to workplace procedures is essential; voluntary emergency aid is legally protected. For any other situations, first determine who holds authority and responsibility — never substitute personal goodwill for formal institutional decisions. The cited provisions from the Nurse Regulations originate from the original 2008 text; currently pending verification is whether Article 17 was amended in the 2020 revision. No official text of the Physicians Law was accessible at the time of drafting, so no corresponding citations could be included. +- Sources:国务院 (2008). 护士条例（国务院令第 517 号，第十七条）. ；全国人大 (2020). 民法典（第一百八十四条）. + +### 23. When losses pile up, follow the proper procedures: opt for simplified deregistration if possible, or file for bankruptcy when liabilities exceed assets — don’t leave things unattended. + + +- Cost: Simplified deregistration can be handled on your own: just post the notice on the National Enterprise Credit Information Publicity System for 20 days. If there are still outstanding debts, you must first settle accounts — collect what’s owed and pay what’s due; this step is called liquidation. Filing for bankruptcy requires an application to the court, which can take several months. The real difficulty lies in the reluctance to face reality after suffering losses, leading many to delay necessary actions. + +- In plain terms: If a business owes no wages, taxes, or social insurance payments, all investors can sign a written commitment; after posting it publicly for 20 days with no objections, simplified deregistration becomes possible. Sole proprietorships don’t need such a notice — if no objections arise within 10 days, deregistration proceeds automatically. When debts become impossible to repay, the business should apply to the court for bankruptcy. Neglecting these steps carries serious consequences: the legal representative cannot serve in that role for any other enterprise for three full years. + +- Benefit: All debts — both owed to others and owed by others — are fully paid off. No unpaid wages, social insurance contributions, or tax liabilities remain. All investors have signed the required written commitment. Meeting these criteria allows simplified deregistration after a 20‑day public notice period with no objections; sole proprietorships qualify after 10 days without any objections. Companies unable to repay due debts and facing liabilities greater than their assets may apply to the court for reorganization, settlement negotiations, or bankruptcy liquidation. If a dissolved company still has unpaid debts exceeding its assets, those responsible for liquidation must file for bankruptcy liquidation. Failure to act brings further penalties: non‑submission of annual reports on time results in being placed on the list of enterprises with abnormal operations; after three years, they move to the list of severely law‑violating enterprises. The legal representative or manager cannot assume such roles elsewhere for three years. Even businesses already on the abnormal list cannot pursue simplified deregistration at all (nationwide rule). + +- Evidence grade: A + +- Notes: The referenced Interim Regulations on Public Disclosure of Enterprise Information are based on the original 2014 version. Decree No. 777 issued by the State Council in 2024 merely replaced references to “Industry and Commerce Administration” with “Market Regulation Administration” — no changes appear in Article 17. (Pending verification: whether a separate 2024 amendment exists.) Currently, individual bankruptcy mechanisms — applicable to sole proprietorships — are only being piloted in select regions; because the original text was not examined for this section, it is not covered here. +- Sources:国务院 (2021). 市场主体登记管理条例（国务院令第 746 号，第三十一、三十二、三十三条）. ；市场监管总局等六部门 (2025). 企业注销指引（2025 年修订）（2025 年第 52 号公告）. ；全国人大常委会 (2006). 企业破产法（第二、七条）. ；国务院 (2014). 企业信息公示暂行条例（国务院令第 654 号，第十七条）. diff --git a/book/en/13-Emergencies.md b/book/en/13-Emergencies.md new file mode 100644 index 00000000..74c31a0b --- /dev/null +++ b/book/en/13-Emergencies.md @@ -0,0 +1,455 @@ +# 13. Emergency situations: what to do first + +This section covers just one thing: what actions you should take right away when an emergency occurs, what to do next, and what to avoid. The entries on first aid and wilderness survival focus on specific causes of death and survival rates. Those dealing with scams and threats involve financial loss and threats to personal freedom. These two sets of figures cannot be compared with each other. Entries are ordered by how common each situation is and how much difference proper or improper action can make in terms of lives saved. These guidelines are primarily meant for you, your spouse, and close family members. In fact, 79.2% of cardiac arrests happen at home, so the people you’re most likely to help are your household members, followed by friends and coworkers. While helping strangers can also be worthwhile, it ranks last in priority due to risks such as false accusations or getting involved in legal trouble. Therefore, the entries in this category emphasize actions to protect yourself and include clauses that limit your liability. + +Only actions that must be taken within a few minutes are included here. Identifying scams or dealing with extortion attempts require longer-term measures and are not covered in this section. Detailed anti-fraud rules and descriptions of seven common types of fraud can be found in Section 8, Item 3. Information on handling situations where someone threatens to release private photos or intimate videos is provided in Section 8, Item 32. If money has already been transferred, you should immediately call 110 or 96110 to request a stop payment, as explained in Section 8, Item 2. +### 1. Immediate chest compressions can save lives when someone collapses and stops breathing — call 120 and fetch an AED too + + +- Cost: This costs nothing. A CPR course from the Red Cross or a hospital lasts half a day to a full day, and one training session is enough for years of use. Even without prior training, you can do it: place both hands on top of each other at the midpoint between the nipples, then press down hard at a rate of about 2 times per second without stopping. + +- In plain terms: Most people you’d need to help are family members — 79.2% of cardiac arrests happen at home. When someone performs CPR, the survival rate jumps from 3.9% to 16.1%. If a person is unresponsive and not breathing, start compressions right away. Position your hands at the midpoint between the nipples, press down hard at 2 times per second, and keep going. Ask a second person to call 120 and bring an AED; you must not stop compressing. + +- Benefit: Meta-analysis of 79 studies involving 142,740 participants shows that overall, only 7.6% of people suffering from out-of-hospital cardiac arrest survive to leave the hospital. For those receiving CPR from bystanders, the survival rate rises from 3.9% to 16.1%. While 53% of cardiac arrests are witnessed by someone nearby, only 32% actually get CPR. The BASIC-OHCA registry in China recorded 38,227 emergency cases; among them, 30,282 cases (79.2%) occurred at home. In this group, the bystander CPR rate was 20.3%, and the survival rate was just 1.2%. The correct sequence is to start compressions first, then ask someone else to call 120 and fetch an AED; once the AED is powered on, follow its voice prompts. + +- Evidence grade: A + +- Notes: Do not pinch the philtrum first, do not look for family members, and do not record a video. Also, do not hesitate to press hard for fear of breaking ribs. Article 184 of China’s Civil Code states that anyone who voluntarily provides emergency aid and accidentally causes injury to the victim still bears no civil liability. +- Sources:Sasson C 等 (2010). Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circulation: Cardiovascular Quality and Outcomes. ; Zheng J 等 (2023). Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry. The Lancet Public Health. ; 全国人大 (2020). 民法典（第一百八十四条）. + +### 2. Elderly falls: if someone falls, first kneel down, call out to them, and dial 120 — don’t rush to help them up. It is perfectly legal to walk away from strangers; once you stop, however, you must not touch or move them. + + +- Cost: No money is required. Kneeling down to ask a few questions and making a phone call takes only a few minutes. The hard part is resisting the urge to reach out and help. For strangers, there’s an extra cost to consider: calling 120 leaves your phone number on record, which may result in follow-up calls or inquiries. If family members later target you, legal battles can last months, and even if you ultimately win, you’ll still have to pay your own legal fees. + +- In plain terms: This guidance is primarily aimed at one’s own elderly relatives and people you know well. First, check whether they’re breathing; if not, follow step 1 (perform chest compressions). Even if they are breathing, don’t lift them up — they may have suffered a stroke or fainting spell prior to the fall, and forced movement could worsen injuries. Instead, kneel down, speak to them, and ask if they remember how they fell. If they complain of back pain or seem to have a fracture, do not move them; call 120 right away. + +- Benefit: The Ministry of Health’s “Technical Guidelines for Intervention in Elderly Falls” states two key points: “Falls are the leading cause of injury-related death among people aged 65 and older in China,” and “When an elderly person falls, do not rush to help them up; instead, respond according to the specific circumstances.” For those who are unconscious, immediately call emergency services. If they’re vomiting, turn their head to one side and clear any vomit from their mouth and nose. If breathing or heartbeat has stopped, start chest compressions at once. The guidelines also note: “If moving the person is necessary, do so gently and keep them as flat as possible.” For conscious individuals, ask whether they recall the fall; if not, it may indicate fainting or a cerebrovascular event. If they suffer severe headaches, facial drooping, slurred speech, or limb weakness, lifting them could worsen bleeding or ischemia in the brain. Likewise, if there are signs of fracture, back pain, or incontinence, avoid moving them unless you have relevant medical training. In all these cases, call 120 immediately. If the elderly person wishes to stand up on their own, assist them slowly, then let them sit or lie down while you monitor them until you’re sure they’re alright. Regarding fears of being held liable, the law is clear: Article 90 of the Supreme People’s Court Interpretation of the Civil Procedure Law states that “any party making a claim must provide evidence to support it; failure to do so results in losing the case.” Article 1198 of the Civil Code obliges operators of public venues — hotels, malls, banks, stations, airports, sports arenas, entertainment venues, etc. — to uphold safety standards; failure to do so makes them legally responsible for any resulting harm. Conversely, Article 184 protects anyone who voluntarily and urgently helps another person: “A rescuer bears no civil liability for any harm caused to the victim during such efforts.” A notable court case involved a pharmacy owner who performed CPR on a cardiac arrest victim, inadvertently breaking several ribs. The victim required 18 days of hospitalization and sought over 9,000 yuan in compensation; the court ruled in favor of the rescuer, absolving him of liability. + +- Evidence grade: B + +- Notes: This grade is assigned because the guidelines describe proper procedures but provide no quantitative data on how many lives they actually save. Article 184 shields rescuers only when their actions are voluntary and occur in an emergency; it does not cover situations such as “taking it upon oneself to load a stranger into a private car for transport” — waiting for 120 remains the safer choice. After dialing 120, stay on the line and follow the dispatcher’s instructions. This advice is primarily intended for one’s own elderly relatives and acquaintances. For strangers on the street, walking away is both legal and advisable; the law does not obligate you to intervene. That said, once you stop, you must weigh all associated costs: time spent, leaving your contact details, potential contact from family members, possible legal action, workplace repercussions, and even online backlash. For further details, see [docs/遇到陌生人出事该不该停.md](../../docs/research/遇到陌生人出事该不该停.md). The only unequivocal action required is not to move the person — this is a medical, not a legal, imperative, as forced movement can exacerbate cerebral hemorrhage or spinal injury. One exception applies if you are the proprietor, manager, or organizer of the location; in such cases, walking away no longer qualifies as a “free” option, as Article 1198 of the Civil Code imposes a duty of care on venue operators. For fall prevention, refer to Section 1, Item 13 (balance and leg-strength training); delayed symptoms following head trauma are covered in Section 10; financial recourse after injury sustained while rescuing others is addressed in Section 39; and evidence collection and reporting in cases of online harassment are outlined in Section 8, Item 16. +- Sources:卫生部 (2011). 老年人跌倒干预技术指南（「老年人跌倒后的处理」）. 全文 PDF 见广东省疾病预防控制中心 ，现场处理部分全文见贵南县人民政府转载 ；全国人大 (2020). 民法典（第一百八十三、一百八十四条）. ；最高人民法院 (2023). 人民法院抓实公正与效率践行社会主义核心价值观典型案例（案例十三，齐某某诉孙某某健康权纠纷案，辽宁省康平县人民法院）. ；最高人民法院 (2022 年第二次修正，2022 年 4 月 10 日施行). 关于适用《中华人民共和国民事诉讼法》的解释（第九十条）. ；民法典第一千一百九十八条同上最高检转载全文；全国人大常委会 (2023 年修正，2024 年 1 月 1 日施行). 民事诉讼法（第一百五十二、一百六十四条）. 上海市发展和改革委员会转载全文 ；国务院 (2006). 诉讼费用交纳办法（国务院令第 481 号，第六、二十九条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，2026 年 1 月 1 日起施行，第二十六条第一项、第五十条第五项）. + +### 3. Sudden facial drooping, weakness in one arm, and slurred speech — call 120 immediately; don’t wait or drive yourself. + + +- Cost: No cost at all. These three steps are easy to remember: ask the person to smile, raise both arms straight out, and say a complete sentence. + +- In plain terms: If someone’s face suddenly droops, they can’t lift one arm, and their speech becomes slurred, call 120 right away. Administering medication within 3 hours of symptom onset can increase the chance of regaining basic independence by about 1.75 times compared to not receiving treatment. Waiting 3 to 4.5 hours reduces this benefit to only 1.26 times. After 4.5 hours, there is virtually no difference. Be sure to note the exact time symptoms first appeared. Do not give water or medicine, and never drive the person to the hospital yourself. + +- Benefit: This conclusion comes from a meta-analysis of 16 randomized trials involving 6,756 patients. Intravenous thrombolysis means delivering medication to reopen blocked blood vessels. When alteplase is given within 3 hours of symptom onset, the odds of the patient regaining basic independence — defined as a modified Rankin score of 0–1 — increase by a factor of 1.75. The 95% confidence interval for this effect is 1.35–2.27. In other words, the likelihood of a good recovery is roughly 1.75 times higher with treatment. Waiting 3 to 4.5 hours lowers this advantage to 1.26 (95% CI 1.05–1.51), while after 4.5 hours the difference becomes statistically insignificant at 1.15 (95% CI 0.95–1.40). + +- Evidence grade: A + +- Notes: Thrombolysis involves administering medication to clear blocked blood vessels; the earlier it is given, the greater its effectiveness. After 4.5 hours, it provides little to no benefit. Calling 120 instead of driving is essential because ambulances transport patients directly to stroke centers where staff can be alerted in advance. Recording the exact time symptoms began helps doctors determine whether thrombolysis is still appropriate. Never give water or medicine, and never wait “to see if things get better on their own.” +- Sources:Emberson J, Lees KR, Lyden P, et al. (2014). Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet, 384(9958), 1929-1935. + +### 4. Sudden dizziness, double vision, loss of vision in one eye, or inability to touch one’s nose — all warrant calling 120 for stroke suspicion + +- Cost: No cost involved. Besides the three FAST signs — facial droop, arm weakness, and speech difficulty — two additional checks are recommended. First, ask the person to stand straight with eyes closed and see if they lose balance; then ask whether they see double or have blind spots. Second, have them extend a finger toward their nose, close their eyes, and repeat the motion. +- In plain terms: Out of 736 stroke cases, 14.1% showed none of the classic FAST symptoms at onset — no facial droop, no arm weakness, no slurred speech. Relying solely on those three signs would miss many cases. Adding checks for unsteady gait, double vision, or inability to touch the nose reduces that omission rate to just 4.4%. Any sudden dizziness, double vision, or failure to touch one’s nose should prompt an immediate call to emergency services and precise timing documentation. +- Benefit: In 2014, researchers at the University of Kentucky Stroke Center reviewed 736 cases of acute ischemic stroke. They found that 14.1% of patients exhibited none of the FAST indicators at the time of onset. When additional screening criteria — including gait instability, limb weakness, and visual disturbances — were incorporated, the proportion of missed diagnoses dropped to 4.4%. +- Evidence grade: B +- Notes: Infarctions affecting the cerebellum or brainstem — known as posterior circulation strokes — often lack facial droop or limb weakness. Instead, they manifest as vertigo, gait deviation, double vision, or difficulty swallowing, which are frequently mistaken for cervical spine disorders, hypoglycemia, or benign paroxysmal positional vertigo. Inability to touch one’s nose or maintain balance with eyes closed are telltale signs of cerebellar involvement. However, no single test can definitively rule out stroke; any sudden onset of these symptoms demands immediate emergency care and accurate timing recording. This study relied on records from a single medical center, and the authors themselves acknowledge the need for further validation. +- Sources:Aroor S, Singh R, Goldstein LB (2017). BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke, 48(2), 479-481. + +### 5. One eye suddenly goes dark, as if a curtain has been pulled shut; even if it clears up within minutes, seek emergency care for stroke on the same day + +- Cost: No direct cost. However, emergency evaluation and vascular testing will take up half a day to a full day. +- In plain terms: When one eye suddenly goes dark, as if a curtain has been pulled shut, it means a blockage has occurred in the blood vessels at the back of the eye. The longer the blockage persists, the less of the retina can be saved. This condition is also a form of cerebral ischemia, and the following days represent a high‑risk window for stroke. For patients in this situation, receiving evaluation and treatment on the same day reduces the likelihood of another stroke within 90 days from 10.3% to 2.1%. Seek emergency care at a hospital with a stroke center on the same day; do not wait until the next day to see an ophthalmologist. +- Benefit: The 2021 scientific statement from the American Heart Association on central retinal artery occlusion — blockage of the main vessel at the back of the eye — explicitly states that acute central retinal artery occlusion is a medical emergency. Healthcare systems should recognize it as such and prioritize treatment accordingly. The longer blood flow is cut off, the less retina can be salvaged. The Oxford EXPRESS study examined two groups of patients: those with cerebral ischemia whose symptoms resolved on their own, and those with minor strokes. The former are medically termed transient ischemic attacks. After these patients received same‑day evaluation and treatment, the rate of subsequent strokes within 90 days fell from 10.3% (32 out of 310) to 2.1% (6 out of 281). +- Evidence grade: B +- Notes: The grade B rating is due to the fact that EXPRESS was not a randomized trial; it compared outcomes before and after implementing the new protocol within the same patient population, making it difficult to isolate the effect of the intervention from other potential changes. A brief episode of darkness in one eye that resolves on its own is often dismissed as fatigue or low blood sugar. In reality, it is a type of transient ischemic attack, and the ensuing days are a critical window for stroke risk. Sudden, painless, non‑red, non‑teary loss of vision in one eye must be taken seriously. Do not wait until the next day for an ophthalmology appointment; go directly to the emergency department of a hospital equipped to handle strokes. +- Sources:Mac Grory B, Schrag M, Biousse V, et al. (2021). Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke, 52(6), e282-e294. ; Rothwell PM, Giles MF, Chandratheva A, et al. (2007). Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet, 370(9596), 1432-1442. + +### 6. One eye is swollen, painful, red; there’s a rainbow halo around lights; plus headache, nausea, and vomiting — so an emergency eye visit is needed that same day. + +- Cost: No cost at all. An emergency eye exam includes measuring intraocular pressure and checking the anterior chamber, which takes up half a day. +- In plain terms: This is an acute glaucoma attack. Fluid can’t drain from the eye, so pressure spikes quickly. The longer it goes untreated, the more damage occurs to the optic nerve, and that damage is permanent. During Wuhan’s lockdown, patients waited an average of 241 hours before getting treatment; 21.87% ended up blind. In the same period the year after the lockdown, the average wait time dropped to 121 hours, and only 7.84% became blind. A total of 76 days of lockdown were covered in this study. +- Benefit: An eye hospital in Wuhan compared two groups of patients with acute primary angle-closure glaucoma. In 2020, during the lockdown, 54 patients with 64 affected eyes received care; the following year, 46 patients with 51 affected eyes were treated. Both groups had similar demographic profiles. From symptom onset to treatment, the lockdown group waited 241.84±211.95 hours versus 121.53±96.12 hours for the control group (P=0.001). Their intraocular pressure at diagnosis was 52.63±12.45 mmHg versus 45.16±9.79 mmHg (P=0.001). Blindness rates were 21.87% versus 7.84%. Glaucomatous optic nerve damage was found in 20/64 eyes (31.25%) versus 7/51 eyes (13.73%) (P=0.03). A South Korean hospital reviewed 50 eyes that had experienced one acute attack and later had their lenses removed; a year later, 25 of those eyes (50%) showed varying degrees of visual field loss. The longer the time between symptom onset and pressure reduction, the higher the chance of lasting damage (P=0.005). Another prospective study had 43 people with shallow anterior chambers lie face-down in a dark room for one hour; intraocular pressure rose significantly in both eyes (P<0.01). The dominant eye saw a median increase of 3.60 mmHg, while the other eye rose 2.70 mmHg (P<0.05). +- Evidence grade: B +- Notes: There are two main reasons this is graded B. First, the Wuhan comparison relied on reviewing old medical records, and the lockdown itself introduced other differences that can’t be separated from the effect of delayed treatment. Second, the South Korean study involved only 50 eyes and was retrospective. This does not mean screen time causes glaucoma; in the dark, pupils dilate, and prolonged head-down posture pushes the lens forward, especially in people with naturally shallow anterior chambers. Those at highest risk are over 50, farsighted, or with a family history of angle-closure glaucoma. Young people who game all night are unlikely to develop this condition. Common misdiagnoses during an attack include gastroenteritis, migraine, or high blood pressure, since headache and vomiting are more noticeable than eye symptoms. Sudden, painless vision loss in one eye is a separate issue — see item 5 (sudden blackout in one eye). Whether blue-light blocking glasses help is discussed in section 6, item 16 (blue-light blocking glasses). +- Sources:Zhou L, Wu S, Wang Y, Bao X, Peng T, Luo W, Ortega-Usobiaga J (2022). Clinical presentation of acute primary angle closure during the COVID-19 epidemic lockdown. Frontiers in Medicine, 9, 1078237. ; Sung MS, Kim HJ, Park SW (2023). Predictors of long-term visual field outcome after an episode of acute primary angle closure. Clinical & Experimental Ophthalmology, 51(4), 291-299. ; Wang J, Wang J, Ng TK, Huang C (2025). Asymmetric intraocular pressure changes in dominant and contralateral eyes: the dark room prone provocative test. Seminars in Ophthalmology, 40(4), 325-331. + +### 7. Chest pressure, tightness, or heaviness lasting more than 15 minutes without relief — call 120; do not drive yourself. + +- Cost: No cost at all. +- In plain terms: If you feel chest pressure, tightness, or heaviness that lasts over 15 minutes without easing up, call 120 right away. For patients treated within 55 minutes of arrival at the hospital, the mortality rate within 30 days is 2.8%. For those treated later than 55 minutes, the rate rises to 9.7%. Every minute of delay means more heart muscle tissue dies. Do not drive yourself — losing consciousness while behind the wheel could lead to a second accident. +- Benefit: Israel conducted a nationwide study on acute coronary syndrome. The research focused on patients experiencing ST-segment elevation myocardial infarction, a specific type of heart attack. It measured the time interval from hospital admission to the point when a balloon catheter was used to reopen the blocked blood vessel. For patients treated within 55 minutes, 5 out of 178 (2.8%) died within 30 days. For those treated after 55 minutes, 15 out of 155 (9.7%) died within the same timeframe. +- Evidence grade: B +- Notes: This study compares outcomes based on the time elapsed after hospital admission, not from the onset of symptoms to arrival at the hospital. However, the underlying principle remains the same: any delay results in additional heart muscle damage. The pain may also be felt in the upper abdomen, back, or jaw, and numbness in the left arm can also be a symptom. Diabetic patients and older adults may not experience any pain at all, only shortness of breath. Again, do not drive yourself — losing consciousness while driving can easily cause another accident. +- Sources:Karkabi B, Meir G, Zafrir B, et al. (2021). Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction. European Heart Journal - Quality of Care and Clinical Outcomes. + +### 8. Sudden tearing pain that spreads from the chest to the back and waist — call 120 and describe it as “pain moving downward” + +- Cost: No cost at all. +- In plain terms: This condition causes a tearing-like pain that starts in the chest and travels down the back and waist. When calling 120, simply describe it as “a tearing pain that’s moving downward.” Without surgery, treatment with medication alone results in a mortality rate of 58%. Its management is the exact opposite of that for heart attacks: doctors only order enhanced CT scans after suspecting this condition, not anticoagulant or thrombolytic therapy. Also mention any significant difference in blood pressure between both arms or absence of a pulse on one side. +- Benefit: The International Registry of Acute Aortic Dissection (IRAD) includes data from 464 patients across 12 centers. Acute aortic dissection is precisely this disease marked by sudden, severe tearing pain in the chest and back. Among all symptoms reported by patients, sudden onset of intense sharp pain is the most common. Overall in-hospital mortality stands at 27.4%. For patients with type A dissection receiving only medication, mortality reaches 58%. +- Evidence grade: B +- Notes: Management of aortic dissection is completely opposite to that of heart attacks. Heart attacks require anticoagulant and thrombolytic drugs to prevent blood clotting; applying such drugs to aortic dissection would essentially encourage bleeding at the tear site. Therefore, upon arriving at the hospital, patients must clearly state “a tearing pain that’s moving downward” to prompt doctors to order enhanced CT scans. A notable difference in blood pressure between arms or absence of a pulse on one side are also important warning signs. Individuals with poorly controlled blood pressure, Marfan syndrome, or a family history of aortic aneurysm or dissection are at higher risk. In such cases, driving oneself to the hospital is strongly discouraged; symptoms must be addressed immediately rather than waiting until the next day. +- Sources:Hagan PG, Nienaber CA, Isselbacher EM, et al. (2000). The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 283(7), 897-903. + +### 9. A sudden “worst headache of one’s life” that peaks within an hour — go to the ER for a head CT right away + +- Cost: An emergency visit itself costs very little. A head CT in the ER typically runs a few hundred yuan. +- In plain terms: The key point isn’t how intense the pain is, but how quickly it reaches its peak. In 2,131 people experiencing severe headaches that peaked within an hour, 6.2% had a ruptured blood vessel on the surface of the brain. Anyone aged 40 or older, with neck pain or stiffness, who was seen collapsing by others, whose headache started during physical activity, came on suddenly like an explosion, or has limited neck flexion when examined should go to the ER for a head CT. The vast majority of people who get tested end up fine, but missing even one case of bleeding can be fatal. +- Benefit: Ten Canadian emergency departments conducted a prospective cohort study on 2,131 patients with “severe headaches peaking within an hour.” They defined clear criteria upfront and tracked outcomes accordingly. Of these, 132 patients (6.2%) had subarachnoid hemorrhage, meaning a ruptured surface blood vessel in the brain. The Ottawa SAH rule includes six criteria: age 40 or older, neck pain or stiffness, witnessed loss of consciousness, onset during physical activity, sudden explosive onset of pain, and limited neck flexion on physical exam. Meeting any one of these criteria triggers a CT scan. This rule identified every single patient with bleeding, with 100% sensitivity. The 95% confidence interval for this figure is 97.2%–100.0%. The trade-off is that only 15.3% of people without bleeding were excluded by this rule (specificity of 15.3%). +- Evidence grade: A +- Notes: It’s not “how painful it is” that matters, but “how fast it reaches peak pain.” Headaches that erupt within seconds to a minute are the real warning sign; gradually worsening migraines are not. Additional symptoms like vomiting, neck stiffness, light sensitivity, or brief fainting also warrant immediate attention. With a specificity of just 15.3%, most people who follow this rule end up with normal results. Yet missing even one case of bleeding can be fatal, so getting tested is absolutely worthwhile. Do not take painkillers to mask the pain and then fall asleep. +- Sources:Perry JJ, Stiell IG, Sivilotti MLA, et al. (2013). Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA, 310(12), 1248-1255. + +### 10. After an elderly person suffers a head injury, they may develop unsteady gait, sluggishness, excessive sleepiness, or weakness on one side of the body two to three weeks later — a CT scan is recommended. + + +- Cost: A single cranial CT scan costs roughly 200–300 RMB. + +- In plain terms: After a head injury, blood usually starts accumulating only around the third week. At the time of impact, there may be absolutely no symptoms at all, and the person might not even recall the injury. The recurrence rate after surgery for this condition can reach 33%, while the mortality rate may be as high as 32%. If an elderly individual suddenly appears confused, walks unsteadily, feels unusually sleepy, or shows weakness on one side, it’s important to first ask whether they fell or hit their head in the past two to three months, then proceed with a CT scan. + +- Benefit: The Neurosurgical Society of the Chinese Medical Association has published a Chinese expert consensus on medical treatment for chronic subdural hematoma. This condition involves slow accumulation of blood between the meninges; technically, it refers to chronic mass formation caused by blood buildup between the arachnoid membrane and dura mater. It “typically develops three weeks after head trauma” and is most common among older adults. Post-surgery recurrence and mortality rates can reach 33% and 32% respectively. Among patients aged 90 or older, only 24% achieve a satisfactory recovery overall. Global data shows that incidence rates range from 3.39 to 39.1 new cases per 100,000 people annually, rising sharply after age 80. The most common causes are trauma and falls, followed by chronic alcohol consumption, use of anticoagulant medications, and violent injury. Geriatric literature notes that typical symptoms include confusion, cognitive decline, gait disturbances, and excessive sleepiness — features that may overlap with other geriatric syndromes. + +- Evidence grade: B + +- Notes: At the time of injury, there may be absolutely no symptoms, and the elderly person might not even recall the incident. Therefore, when families notice sudden confusion, unsteady walking, excessive sleepiness, or unilateral weakness, they should first check whether a head injury occurred in the past two to three months before ordering a CT scan. It’s crucial not to automatically attribute these symptoms to “senile dementia” or “post-stroke sequelae,” as doing so could lead to delayed diagnosis. Elderly individuals taking aspirin, clopidogrel, warfarin, or newer oral anticoagulants face higher risks, as does long-term heavy alcohol consumption. For fall prevention, refer to Section 1, Item 13 — focusing on balance training and leg strength exercises. +- Sources:Zhang J 等 (2021). Expert consensus on drug treatment of chronic subdural hematoma. Chinese Neurosurgical Journal, 7(1), 47. ; Dziho A 等 (2025). Global prevalence and incidence of chronic subdural hematoma: A systematic review. Brain and Spine, 5, 105893. ; Mathon B, Shotar E (2026). Diagnostic and therapeutic management of chronic subdural hematoma in elderly patients. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, 24(1), 30-41. + +### 11. A leg suddenly swells, feels tight, and is tender to the touch — seek medical care promptly; if shortness of breath or chest pain develops suddenly, call 120 immediately. + + +- Cost: An ultrasound of the leg veins (lower extremity venous ultrasound) costs around 100–200 yuan. + +- In plain terms: If one leg suddenly swells, becomes noticeably thicker than the other, and is painful to press, get a leg vein ultrasound done as soon as possible. Should shortness of breath, chest pain when taking a deep breath, a rapid heartbeat, or dizziness appear, a blood clot may have traveled to the lungs — call 120 right away. Among people diagnosed with pulmonary embolism, 17.4% die within three months. Sitting still for more than four hours roughly doubles the risk, though the actual chance for any one person remains very low. + +- Benefit: The International Cooperative Registry on Pulmonary Embolism (ICOPER) gathered data from 2,454 patients with confirmed acute pulmonary embolism treated at 52 hospitals across seven countries. Pulmonary embolism occurs when a blood clot blocks a pulmonary artery. Within three months, the overall mortality rate for these patients — regardless of cause — was 17.4% (426 out of 2,454). The WHO WRIGHT project found that travel lasting four or more continuous hours “roughly doubles” the risk of blood clots forming in veins and traveling to the lungs (venous thromboembolism). Even so, the actual probability for any individual remains low; prolonged inactivity exceeding four hours translates to roughly one in 6,000 people facing this risk. + +- Evidence grade: B + +- Notes: Swelling in both legs is usually linked to issues involving the heart, liver, kidneys, or venous function. Sudden swelling of just one leg, noticeably larger than the other, is a classic sign of deep vein thrombosis. High-risk situations include long car or plane trips, bed rest after surgery or a fracture, wearing a cast, pregnancy and the postpartum period, cancer, and oral contraceptive use. When a clot breaks loose and blocks a pulmonary artery, pulmonary embolism results — marked by sudden shortness of breath, worsening chest pain with deep breaths, rapid heartbeat, dizziness, and sometimes coughing up blood. In such cases, call 120 immediately. The 17.4% figure reflects mortality among confirmed pulmonary embolism cases, not the overall risk associated with leg swelling alone; don’t let this number cause undue alarm. +- Sources:Goldhaber SZ, Visani L, De Rosa M (1999). Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 353(9162), 1386-1389. ; WHO (2007). Study results released on travel and blood clots. + +### 12. For severe bleeding, first press firmly on the wound with your hand; if bleeding from a limb can’t be stopped, apply a tourniquet and call 120 right away. + +- Cost: A twist‑type tourniquet costs anywhere from a few dozen to over a hundred yuan; keep one in your car or first‑aid kit. Learning how to wrap it above the wound, twist until bleeding stops, and note the time takes just a few minutes. +- In plain terms: The proper order is to press hard on the wound with your hand or a cloth; if bleeding from an arm or leg won’t stop, put on a tourniquet and then call 120. Once applied, never loosen it. Battlefield data shows that 90% of patients whose tourniquets were applied before going into shock survived, compared with only 10% whose tourniquets were applied after shock set in; all 5 patients who needed a tourniquet but didn’t get one died. Wrap the tourniquet above the bleeding site, twist until the flow stops, and write down the time. Do not use shoelaces or rope as substitutes. For neck or torso injuries, only compression works — never apply a tourniquet there. +- Benefit: Over six years, 11 Level I trauma centers in Texas treated 1,026 patients with vascular injuries to the limbs; 181 of them (17.6%) had a tourniquet applied before arrival. Unadjusted mortality rates were 3.9% for those with a tourniquet versus 5.2% for those without. After adjusting for other factors, tourniquet use remained strongly linked to survival, with an odds ratio of 5.86 (95% CI 1.41–24.47). At a Baghdad field hospital, 90% of 232 injured patients whose tourniquets were applied before shock survived, while only 10% survived after shock; all 5 patients who required a tourniquet but did not receive one died, and 87% of those who did get one lived. The recommended sequence is: direct manual pressure using any cloth or towel → if bleeding from a limb persists, apply a tourniquet → call 120 → never loosen the tourniquet. +- Evidence grade: A +- Notes: Never use thin materials such as rope or shoelaces as tourniquets; they cannot compress arteries properly and may cut the skin. Once a tourniquet is in place, do not periodically loosen it to “let blood flow.” For bleeding on the neck or torso, compression only is safe — no tourniquet should be used there. The battlefield data show that tourniquets themselves did not cause any amputations; transient nerve paralysis occurred in 4 cases. The official training materials on tourniquet use from China’s Health Commission and Red Cross could not be accessed for this review; further verification of Chinese official guidelines is still needed. +- Sources:Teixeira PGR 等 (2018). Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. Journal of the American College of Surgeons. ; Kragh JF 等 (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery. + +### 13. For dog or cat bites and scratches, rinse the area with soap and running water for 15 minutes, then get vaccinated on the same day. + +- Cost: Rinsing requires no expense. The full course of rabies vaccination costs several hundred yuan. For category III exposures, an additional passive immunization product—essentially ready-made antibodies administered directly—is needed, adding several hundred to over a thousand yuan. The greatest cost, however, comes from delays. +- In plain terms: Once rabies symptoms appear, the fatality rate is practically 100%. Rinsing with soap and water followed by vaccination is the sole safeguard. First, rinse the affected area with alternating streams of soap and running water for 15 minutes, then seek medical care on the same day. If the skin is broken and the wound has been licked, this constitutes a category III exposure, requiring the extra passive immunization product. The fact that a pet has been vaccinated does not alter this classification; exposure level is determined solely by the nature of the injury, not by the animal’s background. +- Benefit: According to the 2023 guidelines issued by China’s National Disease Control and Prevention Administration and Health Commission, “The fatality rate from rabies is practically 100%.” Recommended first aid is “to thoroughly rinse all bite and scratch sites with alternating streams of soap (or another mildly alkaline cleanser) and running water under adequate pressure for roughly 15 minutes.” For minor bites where skin remains intact or superficial scratches without bleeding—classified as category II exposures—vaccination alone is sufficient. Category III exposures, involving penetrating wounds or licked broken skin, mandate both wound treatment, passive immunization, and full vaccination. The WHO reports that roughly 59,000 people worldwide die from rabies each year, 99% of cases linked to dog bites. +- Evidence grade: A +- Notes: Never skip treatment on the assumption that a pet is vaccinated or well‑tended; guidelines base classification strictly on wound severity, not on the animal’s status. Do not attempt to bandage the wound yourself. The ten‑day observation method may inform whether to discontinue vaccination, but it never negates the need to begin it. The same protocol applies to bites inflicted by wild animals or bats. +- Sources:国家疾控局综合司、国家卫生健康委办公厅 (2023). 关于印发狂犬病暴露预防处置工作规范（2023 年版）的通知. ; WHO. 狂犬病 实况报道. + +### 14. Immediately rinse a burn with cool running water for 20 minutes; avoid applying toothpaste or soy sauce + +- Cost: No cost involved. It requires 20 minutes of time. +- In plain terms: Rinsing a burn with cool running water for at least 20 minutes within 3 hours of injury reduces the likelihood of needing skin grafts to roughly 60% of the rate for those who do not perform this step. Use cool water, not ice water, as ice application can worsen the damage. If clothing sticks to the wound, do not pull it off forcefully; after rinsing, cover the area with a clean cloth and head to the hospital. Never apply toothpaste, soy sauce, sesame oil, or flour to the burn. Even if you remember to rinse later, doing so within 3 hours still provides benefit. +- Benefit: An Australian study followed 2,495 children with burns. For kids who rinsed the burn with cool running water for 20 minutes within 3 hours of injury, the relative risk of needing a skin graft was 0.6. The 95% confidence interval for this value is 0.4–0.8, meaning the likelihood of needing a graft is roughly 60% lower than for those who did not rinse. Results from 7 combined studies also confirm that 20 minutes of cool running water irrigation within 3 hours of injury significantly lowers the chance of needing skin grafts or surgical wound treatment. +- Evidence grade: A +- Notes: Use cool water, not ice water, as ice application can worsen burn damage. If clothing sticks to the wound, do not pull it off forcefully; after rinsing, cover the area with a clean cloth and seek medical care. Avoid applying toothpaste, soy sauce, sesame oil, or flour to the burn, as these substances can interfere with doctors’ assessment of injury severity and increase infection risk. Rinsing within 3 hours of injury remains beneficial even if done later than initially intended. +- Sources:Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM (2020). Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children. Annals of Emergency Medicine, 75(1), 75-85. ；Griffin B, Cabilan CJ, Ayoub B, et al. (2022). The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australasian Emergency Care, 25(4), 367-376. + +### 15. Sudden widespread rash, difficulty breathing, or dizziness — treat as anaphylactic shock; call 120 immediately and explain the situation clearly. + + +- Cost: No cost involved. However, people with known severe allergies must purchase epinephrine auto-injectors themselves; these are prescription-only medications. + +- In plain terms: If someone suddenly develops a full-body rash along with trouble breathing or dizziness, treat it as anaphylactic shock. Call 120 right away and clearly state “suspected anaphylactic shock” so emergency responders can bring epinephrine with them. Epinephrine is the first-line treatment; antihistamines and steroids act too slowly to be effective in such cases. Individuals who have experienced this before should consult a doctor for an epinephrine auto-injector and learn how to administer it to the outer midsection of the thigh — this can be done even through clothing. + +- Benefit: Epinephrine is the recommended first-line treatment for all grades of anaphylactic shock (Grade 2 and above); clinical guidelines strongly endorse its use. Antihistamines and steroids are much slower-acting and cannot replace epinephrine in emergency situations. + +- Evidence grade: B (guidelines strongly recommend it, though the underlying evidence base is relatively weak). + +- Notes: The EAACI allergy guidelines themselves note that “most evidence in this field remains at a low level.” They still classify epinephrine as a strongly recommended treatment because its benefits far outweigh the risks, rather than because of large-scale clinical trials. In China, epinephrine is a prescription medication and is not readily available to the general public. The best immediate action is to call 120 and clearly describe “suspected anaphylactic shock” so emergency teams can bring epinephrine along. Those with a history of severe allergic reactions should consult a doctor for an epinephrine auto-injector and learn how to inject it into the outer midsection of the thigh — this can be done through clothing as well. +- Sources:中国医药教育协会等 (2022). 过敏性休克急救临床实践指南（2020）. Frontiers in Pharmacology：「Epinephrine is the first-line medicine in GRADE II to IV anaphylaxis」「Intramuscular epinephrine should be injected in the mid-anterolateral thigh」，成人肌注上限 0.5 mg、14 岁以下 0.3 mg，无反应可每 5–15 分钟重复一次. ；Muraro A, et al. (2022). EAACI guidelines: Anaphylaxis (2021 update). Allergy. + +### 16. Someone is having a seizure — clear the area, place them on their side, time the episode, and don’t put anything in their mouth. + + +- Cost: No cost at all. +- In plain terms: Move any hard objects away from the person. Lay them on their side with their mouth facing down, and start timing the seizure. Don’t hold them down, don’t force their mouth open, and don’t put anything into their mouth — doing so can easily damage teeth and jaws. Call emergency services if the seizure lasts more than 5 minutes, if it stops briefly then starts again, if the person doesn’t respond afterward or has trouble breathing, if it occurs in water, or if this is the person’s first seizure ever. Only give water after they’ve fully regained consciousness. +- Benefit: This approach prevents injuries to teeth and jaws caused by forcing the mouth open or inserting foreign objects. It also avoids fractures that can result from restraining a convulsing person. A seizure lasting over 5 minutes is a clear medical emergency requiring immediate ambulance help. +- Evidence grade: B +- Notes: The same page lists several other situations that also demand immediate ambulance call: a seizure that ends only to recur quickly, post‑seizure unresponsiveness or breathing difficulty, any injury sustained during the episode, a seizure occurring in water, or a first‑time seizure. After the seizure stops, the person should be placed on their side with the mouth down, and only then given water once fully awake. This guidance is primarily intended for family members caring for someone with epilepsy; applying these steps to a stranger offers fewer personal benefits but still protects you from legal liability (Civil Code Article 184, see item 2 in this section — don’t rush to lift the person up). +- Sources:美国疾病控制与预防中心. 癫痫发作急救：「Don't hold the person down or stop their movements」「Don't put anything in their mouth. This can hurt their teeth or jaw」「Don't offer water or food until they are fully alert」「Time the seizure to track if it lasts more than 5 minutes. If it does, seek immediate medical attention or call 911」. + +### 17. Diabetic patients suddenly start shaking, break out in cold sweats, and have slurred speech — first give 15 grams of sugar, then retest after 15 minutes + +- Cost: No cost involved. Just keep a few sugar cubes or a small carton of juice on hand. +- In plain terms: First, give 15 grams of sugar — sugar cubes or a small carton of juice both work fine. Retest blood sugar levels after 15 minutes; if they’re still low, repeat the process. A blood sugar level below 3.0 mmol/L is medically significant hypoglycemia. If a person reaches a stage where they need outside help to manage it, it can be fatal. Never feed anything to someone who is unconscious — they could choke, so call emergency services right away. +- Benefit: A blood sugar level below 3.0 mmol/L qualifies as clinically meaningful hypoglycemia. If a person shows changes in consciousness or behavior that require outside assistance to manage, this is severe hypoglycemia that can be deadly. +- Evidence grade: A +- Notes: Never feed anything to an unconscious person — they could choke, so call emergency services immediately. The same guidelines also recommend that people on insulin or at high risk of hypoglycemia should always carry glucagon. The original text reads: “All individuals treated with insulin or who are at high risk of hypoglycemia...should be prescribed glucagon.” Nasal glucagon sprays and pre-filled injection kits are easier to use than glucagon that needs to be mixed on the spot. This advice is aimed at you or any diabetic family members you care for — keeping sugar on hand is meant to help them in emergencies. +- Sources:美国糖尿病学会 (2025). 糖尿病诊疗标准 2025·第 6 章 血糖目标与低血糖. Diabetes Care：分级「Level 1: Glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L)」「Level 2: Glucose <54 mg/dL (<3.0 mmol/L)」「Level 3: A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, irrespective of glucose level」；处理「For most individuals, 15 g carbohydrates should be ingested」「Fifteen minutes after initial treatment, repeat the treatment if hypoglycemia persists」. + +### 18. If someone is electrocuted, cut the power first, then use a dry wooden stick to pry the source of electricity away; never pull the victim by hand directly. + +- Cost: No cost involved. +- In plain terms: First, turn off the power, or use a dry wooden stick to move the electrical source away before touching the victim. Pulling them by hand directly can turn one victim into two. If the victim isn’t breathing after being freed from the current, immediately perform chest compressions as described in step 1 of this section — don’t hesitate to act just because it’s an electrical injury. Never attempt to handle situations involving downed high-voltage lines or nearby electrical equipment on your own; instead, move to a safe distance and wait for utility workers to cut the power. +- Benefit: This approach prevents rescuers from getting electrocuted as well, avoiding a situation where one victim becomes two. For victims who stop breathing after being freed from the electrical current, performing CPR as outlined in step 1 of this section is effective. The emergency response guidelines from the US Centers for Disease Control and Prevention advise: first observe the scene and avoid touching the victim, as they may still be connected to the power source. If possible, cut the power first. If that’s not feasible, use non-conductive materials like cardboard, plastic or wood to move the power source away. For victims with no breathing or pulse after being freed from the current, immediate CPR is required. A review of relevant studies found that patients who suffer cardiac arrest due to electrocution and are successfully revived generally have a good prognosis. +- Evidence grade: B +- Notes: The rule “cut power first, then touch the victim” is purely self-protective: pulling the victim by hand directly means you’ll be the next victim. Never attempt to handle downed high-voltage lines or nearby electrical equipment on your own; move to a safe distance and wait for utility workers to cut the power. For cardiac arrest caused by electrocution, standard CPR and defibrillation procedures apply — don’t hesitate to perform these just because it’s an “electrical injury”. +- Sources:US CDC. What to Do to Protect Yourself From Electrical Hazards（First aid 一节）. ；Spies C, Trohman RG (2006). Narrative review: Electrocution and life-threatening electrical injuries. Annals of Internal Medicine 145(7):531-537. + +### 19. If a carbon monoxide alarm goes off, or if everyone in a room suddenly has headaches, nausea, or dizziness, get outside first and then call for help + +- Cost: No cost at all. +- In plain terms: If the carbon monoxide alarm sounds, or if multiple people in the same room start experiencing headaches, nausea, and dizziness, move everyone outdoors right away before calling for emergency assistance. Do not stay inside trying to figure out what’s happening, and do not go back inside to turn off any valves. These symptoms resemble both a common cold and the effects of excessive alcohol consumption. The clearest warning sign is that symptoms improve immediately once people are outside. In the United States, over 400 people die each year from carbon monoxide poisoning unrelated to fires, and more than 100,000 people require emergency medical treatment. +- Benefit: Each year in the US, over 400 people lose their lives to accidental carbon monoxide poisoning that has no link to fires. More than 100,000 people seek emergency care, and over 14,000 are hospitalized as a result. +- Evidence grade: B +- Notes: The symptoms mirror those of a cold or heavy alcohol intoxication. The fact that multiple people in the same space experience these issues and feel better once they leave the area is the strongest indicator of carbon monoxide exposure. It is critical to exit the premises first, then call for help — do not linger to investigate or return to shut off valves. Instructions on proper carbon monoxide alarm installation can be found in Section 1, Item 3. Note: We are currently unable to obtain official nationwide statistics on carbon monoxide-related deaths in China, so this figure remains unverified. +- Sources:美国疾病控制与预防中心. 一氧化碳中毒：「More than 400 Americans die from unintentional CO poisoning not linked to fires」「More than 100,000 visit an emergency department」「More than 14,000 are hospitalized」，常见症状「headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion」. ；美国消费品安全委员会. 一氧化碳信息中心：「If you suspect CO poisoning, get outside to fresh air immediately, and then call 911」. + +### 20. If someone accidentally ingests detergent, pesticides, or medicine, do not induce vomiting — take the container and seek medical help right away; if it splashes into the eyes or onto the skin, rinse thoroughly with water for at least 15 minutes. + + +- Cost: No cost involved. Simply keep detergents, disinfectants, pesticides, and medicines out of children’s reach, preferably in a locked cabinet. Never transfer them into beverage bottles. + +- In plain terms: If someone swallows detergent, pesticides, or medicine, do not make them vomit — spitting out corrosive liquids would burn the esophagus all over again. Instead, have them drink some milk or egg whites, then head to the hospital right away while bringing the product container and its instructions. If the substance gets into the eyes or onto the skin, rinse with copious amounts of water for a full 15 minutes; for eyes, gently hold the eyelids open while rinsing and avoid rubbing. Mixing disinfectants with toilet cleaners can produce chlorine gas. + +- Benefit: The Chinese CDC provides four distinct response protocols. For ingestion: drink milk or egg whites promptly and, crucially, do not induce vomiting. Seek medical care at once while carrying the packaging or label so doctors can quickly identify the ingredients and plan treatment. For inhalation: move the person to fresh air, loosen tight clothing to ease breathing; if coughing, shortness of breath, or difficulty breathing occurs, get help immediately. For skin contact: wash the area with water for at least 15 minutes, being careful not to let runoff reach the eyes or intact skin. For eye exposure: flush the eyes with water or saline for a minimum of 15 minutes; keep the eyelids open throughout to ensure full coverage and never rub them. After rinsing, visit an ophthalmologist without delay. Products are categorized by pH: those with pH < 3 include toilet cleaners, descalers, floor cleaners, and stainless‑steel polishes; some heavy‑duty drain cleaners even contain dilute sulfuric acid. Products with pH > 11 comprise drain uncloggers, strong kitchen degreasers, dishwasher powders, oxygen‑based stain removers, and abrasive cleaners. A particularly dangerous combination is mixing disinfectants with hydrochloric‑acid‑based toilet cleaners — this generates chlorine gas that irritates the respiratory tract, provokes severe coughing and breathlessness, and can be life‑threatening. + +- Evidence grade: B + +- Notes: This rating of B reflects that official guidance outlines how to respond and how to identify hazardous products, yet it lacks quantitative data on exactly how much risk reduction results from following those steps. The reason not to induce vomiting is that corrosive substances would re‑damage the esophagus upon expulsion. If you’re unsure what was ingested, bring the container, its label, and any vomit to the hospital. Prevention is far cheaper than emergency treatment: store chemicals separately from food and drinks, seal containers tightly, discard empty bottles, and never repurpose them for other liquids. When handling these substances, wear rubber gloves and protective goggles, ensure good ventilation, and never mix different types. For carbon monoxide exposure, see item 19; for burns, refer to item 14. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2025). 暑假安全提示：警惕强酸强碱清洁剂. + +### 21. In case of splashes of acids, alkalis or other chemicals on the body, immediately remove contaminated clothing and rinse with copious amounts of running water; for eyes, gently pull the eyelids apart and rinse thoroughly before leaving the scene. + + +- Cost: No cost involved. On your first day at work, locate the eyewash stations and safety showers so you won’t have to search for them in an emergency. + +- In plain terms: Follow three simple steps. First, strip off any clothing, shoes and socks that have been exposed — the areas covered by fabric sustain the worst injuries. Second, rinse both skin and eyes with plenty of running water for at least 15 minutes; the Hunan Provincial Emergency Management Department recommends 20–30 minutes, so err on the side of caution. Third, pull the eyelids apart to rinse the eyes thoroughly, then head straight to an ophthalmologist. Use lukewarm water, never hot. + +- Benefit: These three on‑site actions are vital. First, promptly removing contaminated clothing prevents further absorption of toxins through the skin; areas shielded by fabric are especially vulnerable. Second, copious flushing with water meets the minimum recommendations from the Chinese CDC — at least 15 minutes for skin and eyes — while the Hunan guidelines suggest 20–30 minutes for severe chemical burns, so the longer duration should be followed. Third, gently separating the eyelids ensures water reaches the entire eye surface; rubbing the eyes must be avoided, and immediate medical care is essential. Lukewarm water is ideal; hot water should never be used. Avoid applying ointments, antiseptic solutions or any substances to fresh wounds, and do not cover them with dirty cloth — such actions can obscure the extent of injury and hinder diagnosis. Legally, both chemical skin burns and chemical eye injuries are recognized as occupational diseases; workplace incidents are treated as work‑related injuries. In any acute chemical exposure emergency, employers must promptly provide medical treatment, health monitoring and medical observation at their own expense. + +- Evidence grade: B + +- Notes: This item is graded B because no single national standard specifies the exact flushing duration; one official source cites 15 minutes while another recommends 20–30 minutes. When seeking medical care, bring the chemical’s name, packaging or its Safety Data Sheet so doctors can tailor treatment. Never attempt to neutralize a chemical by mixing it with another acid or base — such reactions release heat and are impossible to control. The “neutralizing solution” mentioned in the Hunan document refers to pre‑prepared rinse fluids kept on site, not improvised mixtures. Dry powders such as lime or cement should be brushed off before rinsing; some emergency guides suggest drying concentrated sulfuric acid first, but this practice is not uniformly endorsed and is not covered here. For household cleaners and accidental ingestion, refer to Item 20. Pre‑employment protective measures and health checks are detailed in Item 19, sections 10 and 11 — employers must provide hazard information and appropriate PPE before workers start their duties. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2025). 暑假安全提示：警惕强酸强碱清洁剂. ；湖南省应急管理厅 (2015). 常见化学品中毒事故的应急处理与治疗. ；国家卫生健康委等四部门 (2024). 职业病分类和目录（2025 年 8 月 1 日起实施）. ；全国人大常委会 (2018). 职业病防治法（第三十七条）. （北京市人民政府转载） + +### 22. Dizziness, nausea, lack of sweating, or confusion in hot weather — move the person to a cool area immediately, remove clothing, and cool them down with water; do not give water to anyone who is unconscious, and call 120 right away. + + +- Cost: No cost involved. +- In plain terms: Red, hot skin, slurred speech, and confusion are signs of heatstroke. It can progress from dizziness to unconsciousness in just a few minutes, and the mortality rate is extremely high. Immediately move the person to a cool, well‑ventilated area, take off their clothes, and cool them using cool water and wet towels while calling 911. Never give water to someone who is unconscious — it can cause choking. +- Benefit: The U.S. National Weather Service describes heatstroke as a “serious medical emergency.” Its symptoms include a body temperature above 103°F (39.4°C), confusion, slurred speech, and hot, red skin. The recommended response is to call emergency services, move the victim to a cool place, cool them with water and wet cloths, and “do not give any fluids.” Heat exhaustion shows up as heavy sweating, weakness, cold and wet skin, and a rapid, weak pulse; treatment involves moving to a cool area, loosening clothing, and sipping water; if vomiting, condition worsens, or symptoms persist beyond an hour, medical help is needed. The Yunnan Provincial Center for Disease Control and Prevention advises quickly relocating to a shaded, breezy spot, applying cold wet towels, giving salted drinks to conscious victims, and calling emergency services for severe cases — heatstroke carries an “extremely high mortality rate.” The Wilderness Medical Society’s 2019 heat‑related illness guidelines serve as the professional standard for handling such situations in remote or resource‑limited settings. +- Evidence grade: B +- Notes: Do not wait for symptoms to “get better” — heatstroke can progress from dizziness to unconsciousness in just minutes. Never force water into someone who is unconscious; it can lead to choking. The full text of the Wilderness Medical Society guidelines requires a subscription; only the abstract was verified for this translation. Specific recommendations such as cold water immersion are marked “to be verified.” The Health Commission’s webpage on heatstroke prevention returned a 412 error and could not be accessed. +- Sources:US National Weather Service. Heat Related Illnesses. ; 云南省疾控局 (2026). 出现这些症状，你可能是中暑了. ; Lipman GS 等 (2019). Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness & Environmental Medicine. + +### 23. For people suffering from heatstroke, as long as they remain conscious, they should drink small amounts of cool, lightly salted water or sports drinks at frequent intervals — never gulp down large quantities. Alcohol and sugary drinks must be avoided. + + +- Cost: No cost involved. A bottle of sports drink costs just a few yuan. +- In plain terms: Only conscious individuals should drink. Consume cool, lightly salted water or sports drinks in small portions, about 500–1000 ml per hour. Do not drink too much at once; vomiting can cause liquid to enter the airways, which is far more dangerous than heatstroke itself. Alcohol and sugary drinks must be avoided, as they cause further fluid loss. Applying cool water to the skin or using ice packs on the neck, armpits, and inner thighs is recommended — cooling should always come before rehydration. Never give anything to drink to someone who is unconscious or speaking incoherently. +- Benefit: The Chinese CDC published the “Guidelines on Prevention and Emergency Treatment of Heatstroke (2014),” which states: “Consume at least 2–4 cups of cool water per hour (500–1000 ml), ensuring the temperature is not excessively high; drinking should be done in small amounts at frequent intervals.” It also advises: “Avoid beverages containing alcohol or large amounts of sugar, as these lead to further fluid loss. Do not consume overly cold drinks.” For heatstroke specifically, the guidelines explicitly warn: “Do not give the patient any water to drink.” NIOSH in the U.S. recommends encouraging “small, frequent sips of cool water” for heat exhaustion, and for heat cramps, suggests sports drinks with sugar and electrolytes every 15–20 minutes — “do not use salt tablets.” +- Evidence grade: B +- Notes: After heavy sweating, drinking plain water alone dilutes blood sodium levels, so a bit of salt must be added to the water. Gulping down large amounts at once often leads to vomiting, which can be fatal if liquid enters the airways. The 2014 Chinese CDC guideline advises against “very cold drinks” to prevent stomach cramps, though no quantitative evidence supports this restriction; it should not be interpreted as “no cold drinks at all.” In item 22, several cooling methods are described: wiping the body with cool water, immersing in cold water, and applying ice packs to the neck, armpits, and inner thighs — all of which are officially recommended first-line measures. These are meant for external application, not ingestion, and cooling must always precede rehydration. Never give anything to drink to anyone who is unconscious or speaking unclearly. +- Sources:中国疾病预防控制中心职业卫生与中毒控制所 (2014). 公众高温中暑预防与紧急处理指南（2014 版）. ; US CDC/NIOSH. Heat-Related Illnesses. + +### 24. Stay low to the ground during a fire, feel the door before opening it, don’t open a hot door, use stairs not elevators, and never look back after escaping + + +- Cost: Installing one or two standalone smoke detectors at home costs only a few dozen yuan. It also helps to check in advance where the two possible exits are located in the hallway. + +- In plain terms: Drop to the ground and crawl under the smoke toward the nearest exit. Before opening a door, feel the knob and the surface of the door itself; if either feels hot or smoke is seeping through the crack, do not open it and instead head for the other exit. Open the door slowly, and shut it immediately if thick smoke appears. Always use stairs rather than elevators, since power outages can trap you inside. Once outside, do not return for any reason. If your clothes catch fire, stop moving, lie down, roll on the ground, and shield your face with your hands. + +- Benefit: The official FEMA guidance on fire escape reads exactly: “Drop to the ground and crawl under the smoke toward the exit.” Before opening a door, feel the knob and the door surface; “if it is hot or smoke is coming through the crack, do not open it and use the other exit instead.” Open the door slowly, and close it at once if dense smoke appears. In case of clothing fire, “stop, lie down, roll on the ground,” and protect the face with hands. If escape is impossible, close the door and seal any gaps or vents with cloth or tape, then call for help and state your location. + +- Evidence grade: B + +- Notes: Never use elevators, as a power failure can leave you trapped. Do not go back inside for belongings. Do not run upward unless you are certain the roof door is open; jumping from heights is extremely dangerous. The official website of China’s Fire and Rescue Service (119.gov.cn) returned error codes 405/412 and could not be accessed. TODO: Need to verify the exact wording of the official fire‑escape advice, including whether using a wet towel to cover the nose and mouth is mentioned. +- Sources:US FEMA Ready.gov. Home Fires. + +### 25. Upon seeing someone drowning, shout for help and call 110/120, then reach out a pole or floating objects — never enter the water yourself + +- Cost: No cost involved. The hard part is resisting the urge to jump in. +- In plain terms: A drowning person instinctively pulls their rescuer underwater, so anyone who enters the water risks drowning too. The proper sequence is: shout for help → call emergency services → extend a long pole or rope → throw life rings, empty buckets, or plastic bottles → if the victim is on shore and not breathing, start CPR immediately. Never form a human chain by holding hands and entering the water. Globally, roughly 300,000 people drown each year; this ranks as the fourth leading cause of death among children aged 1–4. +- Benefit: WHO reports that about 300,000 drownings occur worldwide each year, with 92% occurring in low- and middle-income countries. Drowning is the fourth leading cause of death for kids aged 1–4 and the third leading cause for those aged 5–14. WHO recommends “safe rescue and resuscitation training” — essentially learning how to help without entering the water. The recommended steps are identical: shout for help → call emergency services → reach out poles or ropes, toss life rings, empty buckets, or bottles → if the victim is out of water and not breathing, perform CPR right away. +- Evidence grade: C +- Notes: Grade C is assigned because no official source explicitly states the “do not enter the water” rule; we only have WHO’s global death statistics and the broader principle of “safe rescue.” Never form a human chain by holding hands and jumping in. Untrained individuals should not attempt to pull a drowning person out, as the victim will instinctively pull them underwater. This “stay out of water” rule also serves self-preservation — anyone who enters the water risks drowning, regardless of who the victim is. Most cases involve a child, so prevention is covered in Section 1, Item 12: keep children under constant supervision near water. +- Sources:WHO. 溺水 实况报道. + +### 26. If someone is choking and can’t speak, stand behind them and perform 5 back blows followed by 5 abdominal thrusts; if they collapse, start CPR immediately. + +- Cost: No cost involved. To perform the technique: make a fist with one hand and place it just above the navel, then wrap the other hand around it and deliver quick inward and upward thrusts. +- In plain terms: First, ask, “Are you choking? Can you speak?” If the person can still cough forcefully or make a sound, do not intervene — coughing is the most effective way to dislodge the object. If they cannot speak, stand behind them and give 5 back blows followed by 5 abdominal thrusts, repeating this sequence until the object comes out or the person loses consciousness. Once they collapse, begin CPR at once and call emergency services. For pregnant individuals or very obese people, perform chest thrusts instead. Never reach into the mouth to try to remove an object you cannot see. +- Benefit: According to the original text from the U.S. National Library of Medicine: first ask, “Are you choking? Can you speak?” It states that “if the person can cough forcefully or speak, do not intervene,” since coughing often dislodges the object on its own. If they cannot speak, “repeatedly perform 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person loses consciousness.” “Once unconsciousness occurs, start CPR at once” while calling emergency services. Chest thrusts should be used for pregnant individuals and obese people. +- Evidence grade: B +- Notes: Never reach into the mouth to remove an object you cannot see, as this may push it deeper. Do not perform back blows on anyone still able to cough. Choking incidents most often occur at home, so this guidance is aimed primarily at family members. No official pages on the Heimlich maneuver from China’s Health Commission or Red Cross could be found for this review; further verification of Chinese official sources is needed. +- Sources:US National Library of Medicine, MedlinePlus. Choking – adult or child over 1 year. + +### 27. If you get lost or your vehicle breaks down in the Gobi Desert, a desert, or any remote area, stay right where you are — near your car. First, transmit your location, then shield yourself from the sun and retain body heat, conserve water, and absolutely do not wander off. + + +- Cost: Before entering such remote zones, inform someone of your planned route, destination, return date, as well as your vehicle’s make, model, and license plate. You’ll need at least 4 liters of water per person per day. Satellite communicators or BeiDou short-message devices cost thousands of yuan; rental fees range from several hundred yuan per use. The real challenge, however, is simply sticking to the rule: stay put and never leave. + +- In plain terms: It’s best to remain right where you are, ideally right next to your vehicle — which serves as the best possible shelter from the sun. The proper sequence of actions is: if you have a signal, first send your exact coordinates, then make a phone call; next, shield yourself from the heat and retain warmth; afterward, conserve water by staying motionless during daylight hours and only moving after nightfall when temperatures drop; then, absolutely do not wander off; finally, if needed, signal for help using reflective mirrors, smoke, or repeated three-part signals. Before setting out, be sure to share your route, destination, return date, and vehicle details with someone you trust. + +- Benefit: The National Park Service’s Mojave Desert webpage contains three relevant statements. One reads, “Each person needs at least 1 gallon (roughly 3.8 liters) of water daily; hikers and cyclists require 2 gallons per day.” Another states, “Always inform others of your route, destination, return date, vehicle type, and license plate.” The third note simply points out that cellular coverage there is intermittent. Death Valley’s official guidance advises against hiking at low elevations during peak heat, notes that remote wilderness areas typically lack any mobile reception, and recommends carrying a satellite phone. On Mojave’s desert-driving page, an explicit warning states, “In any emergency, staying right next to your vehicle is the single most important thing you can do.” The page also acknowledges that such emergencies are relatively rare, yet there have indeed been cases where travelers perished from extreme heat or cold while attempting to walk back to civilization. These recommendations are organized into five clear priority steps: first, send a safety notification along with precise coordinates — do this via text or call as soon as a signal becomes available; second, shield yourself from the elements using your vehicle as cover; third, manage water consumption by remaining motionless during daylight and only moving at night; fourth, absolutely avoid wandering off; fifth, if needed, signal for rescue using reflective surfaces, smoke, or repeated three-part signals. + +- Evidence grade: C + +- Notes: This C rating exists because all these recommendations stem directly from official governmental advisories rather than peer-reviewed scientific studies. The exact figures concerning daily water needs, mandatory reporting procedures, known signal limitations, and the directive to stay close to one’s vehicle are all verbatim quotes taken directly from official sources; however, no official documentation could be found mentioning the specific practice of sending repeated three-part signals. Additionally, it’s crucial to avoid hiking or attempting to find your way during midday heat, never drink urine under any circumstances, and under no condition should you restrict water intake to the point of dehydration. No relevant advisories from China’s Ministry of Emergency Management or the National Forestry and Grassland Administration could be located during this review; likewise, the BeiDou short-message service page displayed an error stating “Socket is closed,” leaving certain details unverified — hence the current “TODO” status. +- Sources:US National Park Service. Mojave National Preserve Safety. ; US National Park Service. Death Valley Safety. ; US National Park Service. Desert Driving Safety. + +### 28. Shivering, slurred speech, and unsteady walking are signs of hypothermia; change into dry clothes, wrap up, warm the torso first, and give sweet hot drinks instead of alcohol + + +- Cost: An emergency thermal blanket costs just a few dollars, plus a spare dry set of clothes. Learning to recognize the warning signs costs nothing. +- In plain terms: When body temperature drops below 35°C, hypothermia sets in. Victims start to shiver, speak unclearly, walk unsteadily, and have trouble thinking. Remove any wet clothing and wrap the person in a thermal blanket or dry clothes, making sure to warm the torso before the limbs. Offer sweet hot drinks, but avoid alcohol — it suppresses shivering. The absence of shivering does not mean improvement; it actually signals worsening condition. If the person loses consciousness, begin CPR immediately. +- Benefit: According to the U.S. National Weather Service, any body temperature below 95°F (35°C) indicates hypothermia, and symptoms such as feeling cold, sluggishness, and confusion warrant immediate medical attention. Recommended actions include moving the victim to a warm indoor environment, focusing on warming the core first, and providing hot drinks. Alcohol is discouraged because it reduces shivering. CPR is required if the person becomes unconscious. Warm water or body heat can be used to treat frostbite, but avoid hot water or direct radiant heat sources like fireplaces. The Wilderness Medical Society’s 2019 hypothermia guidelines serve as the authoritative clinical reference on this topic. +- Evidence grade: B +- Notes: Do not rub or massage the limbs to warm them. Avoid hot baths at all costs. Do not drag or force‑move a severely hypothermic person — their heart may stop unexpectedly. Remember, the absence of shivering is not a sign of recovery; it often means the condition is worsening. Full access to the Wilderness Medical Society’s guideline requires a subscription; this translation is based solely on its summary. +- Sources:US National Weather Service. During Extreme Cold. ; Dow J 等 (2019). Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness & Environmental Medicine. + +### 29. Snake bites: stay still, remove rings and watches, rush to a hospital with antivenom — no cutting, no suction, no tight binding + + +- Cost: There is no cost involved. The main expense is knowing in advance which nearby hospitals stock antivenom. The real challenge is resisting the urge to treat the wound yourself. +- In plain terms: Stay seated and motionless; keep the bitten limb immobilized. Remove any rings or watches right away, as swelling will develop quickly. Get to a hospital that carries antivenom as fast as possible — antivenom is the only treatment capable of reversing most toxic effects. Do not cut the wound, do not suck out venom with your mouth, do not apply ice, and do not wrap the limb so tightly that it turns purple. Avoid alcohol and do not run around. If possible, take a photo of the snake from a distance; do not try to catch it. +- Benefit: The WHO states: “Immediately immobilize the affected body part and transport the victim rapidly to the nearest medical facility.” It also warns against using tourniquets or cutting the wound, and recommends treatment with antivenom specific to local snake species. “High‑quality antivenom is the most effective treatment for preventing or reversing most toxic effects of snake bites.” Worldwide, between 81,000 and 138,000 people die from snake bites each year; the number of amputations and permanent disabilities is roughly three times that figure. +- Evidence grade: B +- Notes: If you can photograph the snake, do so from a safe distance — do not attempt to capture it. Avoid alcohol, running, suction, ice packs, and tight bindings that cause discoloration. No official Chinese health commission or disease‑control guidelines on snake‑bite management were found for this review; the reported annual death toll in China is marked as “pending verification.” +- Sources:WHO. 动物咬伤 实况报道. ; WHO (2023). 蛇咬伤中毒 实况报道. + +### 30. First, figure out what kind of building you’re in during an earthquake: if it meets seismic safety standards, stay right where you are; if it’s an old structure prone to collapse, head outside right away. + + +- Cost: No cost at all. Just take a moment beforehand to see how many steps it takes to reach the exit, which route to take, and which tables are sturdy enough to hide under. + +- In plain terms: First, determine what kind of building you’re in. For structures built after 2001 that meet seismic codes, you’ll need to go down stairs or through a hallway to exit — so stay put: protect your head and neck, crawl under a solid table, and hold onto its legs tightly. In single-story homes, older brick buildings, or makeshift houses without seismic protection, the exit is just a few steps away — so leave immediately. Under no circumstances should you jump from heights, use elevators, or try to run down stairs while the ground is shaking. + +- Benefit: The China Earthquake Administration’s educational video “Earthquake: Hide or Run?” promotes the rule “Take shelter nearby during the quake, then evacuate quickly afterward,” but explicitly limits this advice to “buildings that meet seismic safety standards.” The reasoning is that such structures “are far less likely to collapse entirely.” The video also notes that “falling building components and decorative items” pose the greatest threat to life safety, while “running around without any protection during a quake” increases the risk of being struck by falling ceilings, chandeliers, or other objects. Recommended actions include “using hands or soft objects to shield the head and neck” and “gripping table legs tightly”; if no table is available, “crouch close to load-bearing walls and stay away from exterior walls, windows, and balconies.” For those outdoors, the advice is “immediately move to an open area away from hazards.” Conversely, during the 1988 Armenian earthquake, Soviet-era prefabricated panel buildings collapsed en masse. A case-control study conducted after that disaster concluded that “leaving a building right after the first tremor is a protective behavior.” People who remained indoors were 4.40 times more likely to sustain injuries than those who evacuated (95% CI 2.24–8.71). The odds of injury indoors were 12.20 times higher than outdoors (3.62–63.79), and in buildings five stories or taller, this risk rose to 3.65 times that of lower structures (2.12–6.33). + +- Evidence grade: B + +- Notes: This topic remains debated, as the two main conclusions apply to distinctly different types of buildings. The China Earthquake Administration itself stipulates that “taking shelter” is only advisable “in buildings that meet seismic safety standards,” and also emphasizes that decisions must be “tailored to local conditions and individual circumstances” — meaning you must consider both the building’s structural integrity and your own physical ability to move. In Armenia, entire buildings collapsed, leaving no safe spot to hide, so evacuation was the only viable option. The U.S. Federal Emergency Management Agency advises residents to “drop to the ground, protect the head and neck, hold on tight, and avoid running outside” — where injuries are primarily caused by falling debris and falls during tremors. Research from the Northridge earthquake further shows that reaching for objects or gripping seemingly stable items can actually increase injury risk. Ultimately, the key question isn’t “should I run or stay?” but rather “is this building likely to collapse, and can I reach open ground within seconds?” For buildings constructed after 2001 that require navigating stairs or hallways to exit, staying put is the safest choice. For single-story homes, older brick buildings, and makeshift houses without seismic protection, the exit is just a few steps away — so leave immediately. It’s worth noting that the Armenian study only compared injured and uninjured survivors, excluded fatalities, and didn’t account for differences in building height; since those able to escape were more likely to live on lower floors, these figures should be interpreted with some caution. Under no circumstances should you jump from heights, use elevators, or attempt to run down stairs during tremors. Once outside, stay far away from tall structures, overpasses, utility poles, glass facades, and billboards. +- Sources:中国地震局（安徽省地震局制作）. 地震来了，是躲还是跑？（科普视频，字幕转录）. ；Armenian HK, Noji EK, Oganesian AP (1992). A case-control study of injuries arising from the earthquake in Armenia, 1988. Bulletin of the World Health Organization, 70(2), 251-257. ；US FEMA Ready.gov. Earthquakes. ；Mahue-Giangreco M, Mack W, Seligson H, Bourque LB (2001). Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake. Annals of Epidemiology, 11(5), 347-357. + +### 31. When encountering bears, wild boars, or packs of wild dogs, don’t run, don’t scream, don’t make eye contact — instead, turn sideways and back away slowly. + +- Cost: No cost involved. When heading into the mountains, bring a hiking pole, hike in a group, and make noise so animals know you’re coming. The hardest part is staying put instead of running. +- In plain terms: Never run — bears can sprint uphill or downhill just as fast as racehorses. Also, don’t climb trees; both black bears and brown bears are excellent climbers. Stand your ground and keep speaking to the bear in a low, calm voice. Once it stops moving, turn sideways and back away slowly. If a brown bear attacks, lie down and play dead: place your hands behind your neck and spread your legs apart. For black bear attacks, do not play dead — run toward a vehicle or building; if escape is impossible, fight back using whatever is at hand. In case of dog bites, follow the steps outlined in item 13. +- Benefit: The original guidelines issued by the U.S. National Park Service on bear encounters contain six key points: “Do not run — bears can sprint uphill or downhill just as fast as racehorses.” “Stay calm; most bears have no interest in attacking and simply want to be left alone.” “Keep speaking to the bear in a low, steady voice.” “When the bear stops moving, turn sideways and back away slowly so you can keep watching it without tripping.” “Make yourself appear as large as possible.” “Do not climb trees — both grizzly bears and black bears are capable climbers.” In the event of a brown bear attack, “lie down and play dead, placing hands behind the neck and legs apart.” For black bear attacks, “do not play dead; run toward a vehicle or building, and if escape is impossible, fight back using any available object.” Dog bites should be treated according to item 13. +- Evidence grade: B +- Notes: The Grade B rating applies solely to bear encounters. The advice regarding wild boars and packs of wild dogs — namely, “don’t run, back away slowly, and seek higher ground or obstacles for protection” — is based on anecdotal experience and is rated Grade C; no official recommendations from China’s forestry authorities or local agencies were identified for these scenarios. Never try to lure animals with food, approach them for photos, or bring dogs into mountainous areas inhabited by wild boars. In China, the primary bear species are black bears and brown bears; the decision to play dead or not depends on which species is involved. +- Sources:US National Park Service. Staying Safe Around Bears. ；国家疾控局综合司、国家卫生健康委办公厅 (2023). 狂犬病暴露预防处置工作规范（2023 年版）. + +### 32. If caught in a thunderstorm outdoors, get into a hard-topped vehicle or building; avoid ridges, lone trees, water surfaces, and metal objects + +- Cost: No monetary cost. The downside is that your trip gets interrupted for at least half an hour. The real challenge is actually turning back when the thunder is still far away. +- In plain terms: There is no safe spot outdoors during a thunderstorm. You must get into a hard-topped vehicle or building; convertibles and motorcycles do not qualify. Tents, gazebos, areas under trees, or rocky outcrops also do not count as shelter. Stay away from open areas, mountain ridges and peaks, isolated tall trees, water surfaces, and metal railings or poles. If a group cannot all fit together, spread out rather than huddling close. Begin retreating the moment you hear thunder; it is only safe to leave 30 minutes after the final clap of thunder. +- Benefit: There is no safe spot outdoors during a thunderstorm. It is only safe to leave 30 minutes after the final clap of thunder. +- Evidence grade: B +- Notes: Tents, gazebos, areas under trees, and rocky outcrops do not qualify as shelters. Hard-topped cars do count, but convertibles and motorcycles do not. Start retreating the instant you hear thunder; do not wait until rain begins to fall. +- Sources:美国国家气象局. 户外雷电安全：「There is no safe place outside when thunderstorms are in the area」「Avoid open fields, the top of a hill or a ridge top. Stay away from tall, isolated trees or other tall objects」「Stay away from water, wet items, such as ropes, and metal objects, such as fences and poles」；实在走不了时「If you are in a group, spread out to avoid the current traveling between group members」；恢复活动「Wait 30 minutes until after the last rumble of thunder」. + +### 33. Gradually increase your sleeping altitude when heading to high elevations; if symptoms worsen, descend immediately — don’t tough it out. + + +- Cost: It requires an extra day or two for acclimatization. Preventive medications are prescription-only, so you must consult a doctor before traveling. The main challenge is fitting these days into an otherwise tight itinerary. + +- In plain terms: This guideline focuses on sleeping altitude, not daytime elevation. Sleeping above 2,450 meters already poses a risk of altitude sickness. Once above 3,000 meters, you should only raise your nighttime altitude by 500 meters per night, allowing an additional day of acclimatization for every 1,000-meter increase. Symptoms such as headache, nausea, unsteady gait, altered mental state, or shortness of breath even at rest indicate the need to descend. Descending takes priority over oxygen therapy or medication. + +- Benefit: Sleeping above 2,450 meters increases the risk of altitude sickness. Without prompt descent, high-altitude cerebral edema and pulmonary edema — fluid buildup in the brain and lungs — can be fatal. + +- Evidence grade: A + +- Notes: The rule specifically refers to sleeping altitude, not daytime elevation. Headache, nausea, unsteadiness, confusion, or breathlessness at rest are clear signs to descend. Descending should always come before oxygen use or medication; continuing upward while on oxygen is unsafe. +- Sources:美国疾病控制与预防中心. 黄皮书·高海拔旅行与高原病：「Any unacclimatized traveler proceeding to a sleeping altitude of ≥2,450 m (≥8,000 ft)—and sometimes lower—is at risk for altitude illness」；上升速度「500 m (1,650 ft) per night in sleeping altitude once above 3,000 m (9,800 ft)」，每上升 1000 米加一天适应日；乙酰唑胺预防「125 mg twice a day; 250 mg twice a day if >100 kg body weight」；「If symptoms become worse despite rest or treatment at the same elevation」必须下撤. ；荒野医学会 (2024). 急性高原病预防、诊断与治疗临床实践指南（2024 更新）. Wilderness & Environmental Medicine. + +### 34. If a tick is attached to the skin, use fine-point tweezers to gently pull it straight out while keeping it close to the skin; do not apply oil or use heat. + +- Cost: A pair of fine-point tweezers. +- In plain terms: Use fine-point tweezers to grasp the tick’s head right next to the skin, then pull it straight outward steadily. Avoid applying oil, using heat, or twisting the tick — those actions can force any pathogens it carries into the skin and often leave its mouthparts embedded in the flesh. After removal, record the date. If you develop fever, a rash, or fatigue in the following weeks, be sure to mention that you were bitten by a tick when seeking medical care. +- Benefit: Applying oil, using heat, or twisting the tick can cause it to release pathogen-laden fluids into the skin. These actions also increase the likelihood that its mouthparts remain lodged in the skin. +- Evidence grade: B +- Notes: Be sure to note the date of removal. Should fever, a rash, or fatigue appear in the weeks afterward, inform your doctor that you were bitten by a tick; otherwise the symptoms may be misdiagnosed as a common cold. Note: figures on the annual incidence and case-fatality rate of severe fever with thrombocytopenia syndrome in China were not available at the time of writing. +- Sources:美国疾病控制与预防中心. 被蜱叮咬之后：「Grasp the tick as close to the skin's surface as possible using clean fine-tipped tweezers」「Pull tick away from the skin with steady, even pressure」「Do not use petroleum jelly, heat, nail polish, or other substances to try and make the tick detach from the skin. This may agitate the tick and force infected fluid from the tick into the skin」. + +### 35. Always boil any water taken from the wild before drinking it; one minute of boiling is sufficient — there’s no need to extend the time just because you’re at high altitude. + +- Cost: You’ll need to carry extra weight in the form of a stove and fuel. +- In plain terms: Any microbes capable of causing illness through water are killed within seconds at boiling temperature. Boiling for an additional minute simply provides a safety margin for any possible oversight; it isn’t necessary to prolong the process at higher elevations. If boiling isn’t feasible, use a filter or chemical purification tablets instead — each method has its own limitations regarding which pathogens they can eliminate. Even crystal-clear streams and meltwater can harbor parasites. +- Benefit: All microbes that can cause disease via water are inactivated within seconds at boiling temperature. The belief that water fails to reach a safe temperature at high altitudes is a common misconception. +- Evidence grade: B +- Notes: The same page also notes that boiling isn’t strictly mandatory: maintaining water at 60°C for 30 minutes achieves the same effect, and boiling simply offers a visible endpoint without needing a thermometer. Filters and chemical tablets each have their own gaps in pathogen coverage, so boiling remains preferable when possible. Just because water appears clear doesn’t mean it’s free of parasites — appearance alone is no reliable indicator. +- Sources:美国疾病控制与预防中心. 黄皮书·旅行者的水消毒：「All organisms that may cause illness from drinking water are killed within seconds at boiling temperature」「CDC recommends that travelers boil water for a full minute to account for user variability in identifying boiling points and to add a margin of safety」「Although the boiling point for water decreases with increasing elevation, at common travel elevations the temperature needed to achieve boiling is still well above the temperature required to inactivate enteric pathogens」. + +### 36. If a stranger demands money in a remote area, hand over cash, avoid any confrontation, note their features, and call police after escaping + + +- Cost: The cash you have on you. The real challenge is keeping your temper in check. +- In plain terms: Give him the money, do not fight back, and do not argue. By demanding a few hundred yuan, he is committing robbery — a crime punishable by at least three years up to ten years in prison. If he enters a residence, uses a weapon, or causes serious injury or death, the sentence rises to ten years or more, even life imprisonment or death. If you chase after him and strike him after he has taken the money, that is no longer considered self‑defence. Immediately after escaping, write down his appearance, accent, vehicle license plate, and the direction he fled, then call 110. +- Benefit: Your life is far more valuable than a few hundred yuan. The offender is committing a serious crime for such a small amount. Article 263 of the Criminal Law states that anyone who robs public or private property by violence, coercion, or other means faces three to ten years in prison plus a fine; aggravating circumstances raise the penalty to ten years or more, even death. Article 20 limits self‑defence to stopping an ongoing unlawful attack; once the robber has taken the money and walked away, any retaliation is no longer justified. After escaping, record his description, speech patterns, vehicle details, and escape route, then call 110. +- Evidence grade: C +- Notes: The “C” rating reflects the lack of direct literature supporting the principle that “handing over money avoids danger”; the legal text merely outlines the offender’s risks and your boundaries. Never follow an attacker to a secluded spot to “get money,” never reveal your phone password, and never get into his vehicle. This advice is not an invitation to fight or to refrain from calling police; it applies only when you are physically threatened in a remote setting and must first pay to ensure your safety. In contrast, if someone online threatens to release private photos or videos, you must never pay — see Section 8, Item 32 for those cases. +- Sources:全国人大 (2020 年修正). 刑法（第二十条、第二百六十三条）. （北京市公安交管局转载整合文本） + +### 37. If you stumble upon a group fight, walk away immediately — don’t try to break it up, don’t stand around watching, and don’t pick up any weapons on the ground. If you want to call the police, retreat to a safe distance and dial 110. + + +- Cost: No money is required. The hard part is resisting the urge to step in and the temptation to watch from the sidelines. After calling, you might be asked to give a statement later; at most, this takes half a day. + +- In plain terms: If you intervene, your actions shift from “trying to calm things down” to “taking part in a fight.” Participating in a group brawl can land you in prison for up to three years; if many people are involved, it happens on a road, or weapons are used, the sentence rises to three to ten years. Watching isn’t worth it either — the more onlookers there are, the messier the scene gets, and you’re more likely to get hurt. The right move is to walk away. If you do want to call the police, step back to a safe spot and dial 110, clearly stating the location, how many people are involved, whether anyone is carrying knives or sticks, and if anyone has collapsed. + +- Benefit: Article 292 of the Criminal Law states: “Those who lead or actively take part in group brawls shall be sentenced to up to three years in prison, criminal detention, or surveillance.” If the brawls happen repeatedly, involve many people, have a big social impact, occur in public spaces or on busy roads, or involve weapons, the punishment rises to three to ten years. If such fights cause serious injury or death, perpetrators are charged under laws on intentional injury or homicide. The Public Security Administration Punishment Law also sets penalties: assaulting others brings a detention of five to ten days plus fines of 500 to 1,000 yuan. Group fights handled as hooliganism can lead to up to fifteen days in jail and fines up to 2,000 yuan. Guideline 5 of the “Opinions on Properly Applying Self‑Defence” says unlawful attacks include those aimed at you, at the public, or at others. Guideline 9 adds that if one side starts the fight with excessive force, or continues attacking even after the other side tries to avoid conflict, the responding party is usually considered acting in self‑defence. + +- Evidence grade: B + +- Notes: This grade is B because part of the consequences are backed by clear legal text, but the advice “walk away and call the police instead of intervening” isn’t directly stated in any official rule — it’s inferred from those statutes and from how group fights are judged. Saying “I was just trying to mediate” isn’t a shield; what matters is whether you actually took part and whom you hit. If an attacker is already down or has fled, chasing them to hit them no longer counts as self‑defence. Legally, you may intervene if you see someone being unilaterally beaten; self‑defence protects not only you but also others. Yet stepping in bare‑handed usually just adds another casualty. Calling for help, recording from afar, and calling police are far more effective. The safest choice here is “don’t intervene, don’t watch.” The benefit of calling 110 mainly helps the victim on the ground; overall, this entry offers one of the lowest net benefits in the book, so you must weigh whether the time investment is worth it. You should know a few key facts first. There is already a legal duty to testify: Article 62 of the Criminal Procedure Law says anyone aware of a case must testify; not calling police doesn’t erase that duty. In cases involving serious injury or death, police can still identify witnesses from surveillance footage, so standing around watching actually makes you more likely to be recorded. Authorities “must keep the identity of anonymous callers confidential” (Article 111). Simply stating the location, number of people, and whether weapons are present is enough — you needn’t stay on the scene. Only if a court summons you to testify without a valid reason and you refuse can you face up to ten days in detention (Article 193); ordinary bystanders rarely reach that point. Not calling police isn’t illegal: Article 110 of the Criminal Procedure Law mentions a “right and duty” without any penalty, and no criminal law punishes ordinary citizens for not reporting what they see, so walking away is perfectly legal. Two actions after walking away would cross the line: helping hide someone or giving false testimony to protect them (Article 310 of the Criminal Law, up to three years; serious cases bring three to ten years); and deliberately giving false testimony when called as a witness (Article 305, up to three years; serious cases up to seven years). Staying silent or telling the truth is fine; fabricating stories is not. If you yourself get caught in a fight, see Section 8, Item 10; if a stranger demands money, see Item 36 of this section; for costs after helping an injured person, see Item 39. +- Sources:全国人大 (1997). 刑法（第二百三十二、二百三十四、二百九十二、三百零五、三百一十条）. ；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第三十、五十一条）. ；最高人民法院、最高人民检察院、公安部 (2020). 关于依法适用正当防卫制度的指导意见（法发〔2020〕31 号，第 5、9 条）. ；全国人大 (2018). 刑事诉讼法（2018 年修订，第六十二、一百一十、一百一十一、一百九十三条）. 宁夏回族自治区人民检察院转载全文 + +### 38. If you may have been exposed to HIV, get PEP within 72 hours — the sooner, the better + +- Cost: A full 28‑day course of PEP can cost thousands of yuan; in most regions it must be paid out‑of‑pocket. You’ll need to rush to a hospital that same night. The hardest part is admitting you might be infected and leaving right away. +- In plain terms: If you suspect you’ve been exposed to HIV, 72 hours is the hard deadline — ideally you should start PEP within 2 hours. The medication must be taken for 28 consecutive days. After 72 hours this option is no longer available, so don’t wait until the next day to decide. +- Benefit: The Beijing Municipal Government’s HIV‑prevention outreach defines this as “post‑exposure prophylaxis,” abbreviated PEP. It recommends starting preventive medication “as soon as possible, ideally within 2 hours and no later than 24 hours, but not after 72 hours,” and continuing for 28 days. Beyond 72 hours PEP is not advised. This strict timeline means that acting immediately versus waiting a night can produce completely different outcomes. +- Evidence grade: B +- Notes: Where to obtain PEP: any designated HIV‑treatment clinic affiliated with the local Chinese CDC, usually under the Infectious Diseases or STD/HIV department. Many cities now offer 24‑hour clinics; in Chongqing, for example, 29 such clinics operate across 26 districts, 14 of which are open around the clock. Call the local CDC beforehand to find a clinic with PEP on hand — don’t waste time in the emergency room. Situations considered “exposures” include unprotected sex, a broken condom, needle sticks, or blood contact with mucous membranes; only a doctor can decide whether PEP is appropriate. The full 28‑day regimen must be completed; missing doses markedly reduces its effectiveness. Follow‑up testing is required at 4–6 weeks and at 3 months as directed by your physician. This is a remedial measure, not a substitute for regular prevention; for everyday safeguards and testing, see items 30 and 31 in Chapter 1 (consistent condom use and testing after high‑risk encounters). +- Sources:北京市人民政府. 事前、事后分不清？六问六答全面了解艾滋病病毒暴露前/暴露后预防. ；中国疾病预防控制中心性病艾滋病预防控制中心 (2020). 艾滋病病毒暴露后预防技术指南（试用）. + +### 39. After saving someone and getting injured or incurring expenses, first seek compensation from the perpetrator and yibao; then apply for recognition as a person acting in the public interest. + + +- Cost: There is no direct expense. However, submitting the application requires paperwork, waiting for approval, and multiple visits — this can take weeks or even months. + +- In plain terms: If you get hurt while saving someone, you’re not simply out of luck. Those injured while acting in the public interest should receive treatment first, with costs covered afterward. Medical bills are the responsibility of the perpetrator; if the perpetrator flees or cannot pay, basic medical insurance steps in. Even without a perpetrator, the person you saved is legally obligated to provide reasonable compensation — this is a legal requirement, not a matter of personal generosity. At the same time, you should apply for official recognition as a person acting in the public interest so that any injuries can be treated under workers’ compensation rules. + +- Benefit: Article 183 of the Civil Code states: “Anyone who suffers harm while protecting another person’s civil rights is entitled to compensation from the perpetrator; if no perpetrator exists, has fled, or cannot pay, the beneficiary must provide reasonable compensation.” State Council Document No. 39 of 2012 further clarifies how to handle medical care for such individuals. Healthcare facilities must establish a fast-track system based on the principle “treat first, bill later.” Specifically, medical expenses incurred during emergency treatment are the responsibility of the perpetrator or liable party; otherwise, they are covered by basic medical insurance. In cases of death, individuals meeting criteria for martyr status are recognized as such by law; those qualifying as work-related injuries receive a one-time death benefit plus an additional special allowance equal to 40 months of their salary. Injured individuals meeting workers’ compensation criteria receive benefits under the relevant regulations; others have their disability level assessed by civil affairs bureaus to determine appropriate support. Employment-wise, such individuals are prioritized for job assistance programs and placed in public-sector roles when possible. Housing-wise, they are given priority access to subsidized housing or rental assistance. + +- Evidence grade: B + +- Notes: This grade is assigned because national documents clearly define which benefits apply; however, exact amounts of bonuses and detailed application procedures vary by province under local regulations, and these specifics were not verified across all regions in this round. Applications are typically submitted to local police departments or dedicated civil affairs bureaus responsible for recognizing acts of public service. Successful recognition depends on solid evidence: police reports, surveillance footage, witness contact details, and medical records gathered promptly at the scene. Legal aid for such cases is also available free of charge. National standards for death benefits and disability compensation calculations are explained in Sections 15 and 16 of Chapter 19; instructions for obtaining legal aid can be found in Section 3 of Chapter 7. +- Sources:全国人大 (2020). 民法典（第一百八十三条）. ；国务院办公厅转发民政部等部门 (2012). 关于加强见义勇为人员权益保护的意见（国办发〔2012〕39 号）. + +### 40. Knives, rebar, glass piercing the body – apply pressure around the foreign object to stop bleeding; do not pull it out + + +- Cost: No cost involved. The hard part is resisting the instinct to “pull it out” and instead staying with the injured person until help arrives. +- In plain terms: Pulling out the object can cause severe bleeding and makes it harder for doctors to assess the extent of the injury. The correct approach is to call 120, then use your hand or a dressing to apply firm pressure around the object to control bleeding and keep it stable so it doesn’t move. If internal organs are visible through an abdominal wound, do not push them back in; simply cover them with a clean, moist dressing. For chest wounds where air bubbles are escaping, do not seal them with plastic wrap – doing so can cause the lung to collapse. +- Benefit: The 2025 International First Aid Guidelines from the International Federation of Red Cross and Red Crescent Societies state: “First aiders should apply pressure around any foreign object (such as a knife) that has penetrated the body and keep it stable; do not remove it.” “Never pull any object out of abdominal or chest wounds – doing so can cause severe bleeding and makes it harder to assess the injury.” “Foreign objects embedded in the body should be kept stable; if they move with the pulse, simply hold them gently in place.” “First aiders must not push protruding organs back into the body.” For open chest wounds with active bleeding, “it is acceptable to leave them uncovered, as sealing them may trap air in the chest cavity and cause partial or total lung collapse (pneumothorax).” All penetrating abdominal or chest injuries require immediate emergency care. +- Evidence grade: B +- Notes: This grade is assigned because these actions are widely accepted in official guidelines; however, no randomized trials exist, and it would be unethical to randomly assign patients to “remove” versus “not remove” such objects. The sole exception is when a foreign object blocks the airway and prevents breathing. In such cases, go directly to the emergency triage desk at the hospital and state “penetrating injury.” This falls under the highest priority category – do not wait in line at the registration desk (see Section 24, Item 8). If a penetrating injury occurs, call 120; the ambulance will alert the hospital in advance. For techniques on controlling severe bleeding and applying tourniquets, see Section 12. +- Sources:International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 256–257、267–268 页. + +### 41. If a fracture is suspected, do not move the injured area; keep it supported and apply cold compresses for no more than 20 minutes. Never try to realign it yourself. + + +- Cost: No cost involved. Use a rigid board, rolled-up magazines, or clothing as a splint. Wrap cold items in a cloth before applying them to the skin. + +- In plain terms: Any injury to a limb should be treated as a possible fracture, even if the person can still stand or move. Only X‑rays can confirm a fracture. Keep the injured area still — support it with your hand or use a triangular bandage or rigid splint to maintain its original position. Apply cold compresses as soon as possible, but never for longer than 20 minutes at a time. Do not attempt to realign the bone yourself. For open fractures where bone has pierced the skin, first stop any bleeding and cover the wound with clean dressing; do not push the bone back into place. + +- Benefit: The International Federation of Red Cross and Red Crescent Societies published its 2025 International First Aid Guidelines. They state that “any injury to a limb should be treated as a possible fracture” and that “the only reliable way to confirm a fracture is by X‑ray; when in doubt, treat it as a fracture.” The purpose of immobilization is “to minimize movement and pain.” Cold compresses “should be applied for no more than 20 minutes at a time to reduce pain; longer exposure may damage the skin.” “For fractures of long bones such as the femur, bleeding from the bone itself can be life‑threatening.” Call emergency services when there is significant pain or swelling, signs of shock, a suspected femoral fracture, or obvious deformity of the limb. Whether to attempt on‑site reduction of an angulated fracture depends on two conditions: first, “the location is remote (or resources are limited) and the limb below the angle appears cold and pale, or the rescuer cannot immobilize it adequately for transport”; second, the rescuer must be trained. For open fractures, the priority is controlling bleeding and preventing infection. + +- Evidence grade: B + +- Notes: This grade B rating reflects that these measures are widely accepted practice. One older study suggests that traction immobilization for femoral fractures before hospital care can reduce blood transfusion needs and shorten hospital stays; however, differences in mortality or complications were too small to be meaningful, and the study’s reliability is low. There is no evidence to guide whether to attempt reduction versus simple immobilization. Three common misconceptions should be corrected: being able to stand or walk does not rule out a fracture; cold compresses alone are recommended, not alternating hot and cold; and sprains will not “loosen up” with movement — rest is essential. For elderly patients with suspected fractures after a fall, follow the precautions outlined in item 2. Swelling of one leg after casting or bed rest may indicate a blood clot; see item 11. Information on disability assessment and eligibility for a disability certificate after treatment can be found in section 24, items 10 and 11. +- Sources:International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 301–302 页. diff --git a/book/en/14-Accounts-And-Security.md b/book/en/14-Accounts-And-Security.md new file mode 100644 index 00000000..66188f03 --- /dev/null +++ b/book/en/14-Accounts-And-Security.md @@ -0,0 +1,97 @@ +# 14. Account and Information Security + +Backlink: [← Return to main index](../../README.md) + +Protecting your money and personal data is essential. If someone gains access to your accounts, they can steal funds right away. They may also use your account to scam people on your contact list. In short, your identity becomes vulnerable too. +### 1. Enable two-factor authentication on email, payment, and social accounts; prioritize phone pop-ups over SMS codes + +- Cost: No cost involved. Each account takes just two to three minutes to set up once. +- In plain terms: Two-factor authentication means an extra verification step beyond the password when logging in. Using a pop-up prompt on your phone that requires a single tap to confirm blocks over 90% of phishing and account theft attempts. In contrast, older verification methods such as answering questions like “Where did you log in last time?” or “What is your backup email?” only block around 10% of such attacks. +- Benefit: Google analyzed 350,000 real-world account hijacking attempts. For authentication methods relying on device verification — such as phone pop-ups or physical security keys — over 94% of phishing-related hijacking attempts and 100% of automated hijacking attempts were prevented. These automated attempts involve bots using leaked passwords to try logging into accounts in bulk. For verification based on answering personal questions, only 10% of phishing attempts and 73% of automated attempts were blocked. +- Evidence grade: A +- Notes: The same study also found that these verification methods occasionally block legitimate users from accessing their accounts. 52% of real users failed to log in on their first try. However, 97% of them eventually gained access. It is recommended to enable this feature on email accounts first, as most other accounts allow password recovery via email. +- Sources:Doerfler P, Thomas K, Marincenko M, et al. (2019). Evaluating Login Challenges as a Defense Against Account Takeover. The World Wide Web Conference (WWW '19). + +### 2. Use a unique password solely for your email + +- Cost: No cost involved. Storing it in a password manager eliminates the need to memorize it. The real challenge lies in breaking the old habit of reusing one password across multiple sites. +- In plain terms: If a password you use elsewhere gets stolen, attackers can use it to log straight into your email account. Once they gain access to your email, they can reset passwords for any other accounts linked to it. Therefore, your email password must be unique and never reused anywhere else. +- Benefit: Credential stuffing is one of the easiest attack methods: attackers simply test stolen passwords against other accounts. If your email password is compromised, all accounts that rely on it for password recovery become vulnerable too. The US Cybersecurity and Infrastructure Security Agency recommends using a distinct, strong password of at least 16 characters for every account, and storing it via a password manager. +- Evidence grade: C +- Notes: If you struggle to memorize passwords, use the built-in password manager in your web browser. It stores passwords for each site for you, which is far safer than reusing the same password everywhere. Avoid saving passwords in WeChat favorites or note-taking apps. +- Sources:US CISA. Use Strong Passwords. + +### 3. Set a screen lock on your phone and a PIN for the SIM card + +- Cost: No cost at all. You only need to set the screen lock and the SIM PIN once each. +- In plain terms: The SIM card is that tiny card inside your phone that receives SMS verification codes. If your phone gets lost, a finder can remove the card and insert it into another phone to receive those codes, then reset all your accounts one by one. Setting a PIN on the SIM card means that whenever the card is moved to another phone, the user must enter that PIN before the phone can be used — effectively blocking that path. +- Benefit: Without a SIM PIN, a finder can easily move your SIM card to another phone, receive verification codes, and reset all your accounts. With a PIN in place, that entire process is prevented, keeping your accounts safe even if your phone is lost. +- Evidence grade: C +- Notes: You can set the SIM PIN under “SIM card lock” in your phone settings. The default factory codes are usually 1234 or 0000. If you enter the wrong code three times in a row, you’ll need the PUK code provided by your carrier to unlock it. After setting the PIN, be sure to write it down somewhere safe. +- Sources:作者经验，无直接文献 + +### 4. Follow these steps if you lose your phone: block the SIM card, remotely lock it, change passwords, file a police report, and freeze your bank cards if needed. + +- Cost: No cost involved. Completing all steps takes just a few minutes. +- In plain terms: The order of actions matters more than speed. First, block the SIM card to cut off access to verification codes. Next, remotely lock the phone. Then, use a computer to change your email and payment passwords. After that, file a police report to obtain a receipt. Finally, freeze your bank cards as needed. Even if you’re using someone else’s phone, you can still call your carrier to block the SIM card. +- Benefit: Following the correct sequence is more important than acting quickly. Step one is blocking the SIM card, which severs the main channel for verification codes. Step two involves remotely locking the phone and erasing all its contents. Step three requires changing your email and payment passwords from a computer. Step four is filing a police report to get a receipt. Finally, freeze your bank cards if necessary. The Federal Communications Commission also advises that even if you believe you merely misplaced your phone, you should still remotely lock it. If it’s stolen, file a police report immediately, providing the phone’s model and IMEI number, and inform your carrier right away. +- Evidence grade: C +- Notes: Save the customer service numbers for all three major carriers in advance: China Mobile at 10086, China Unicom at 10010, and China Telecom at 10000. Also note the city where you registered your phone number, as customer service agents will ask for this information. You can still call carrier hotlines from someone else’s phone to block your SIM card. +- Sources:US FCC. Protect Your Smart Device. ；步骤顺序是作者经验；补办身份证见第 7 节，冒名贷款见第 8 节关于征信的一条 + +### 5. If your card is fraudulently used, report it and freeze the card first, then demand compensation from the bank: proving “you made the transaction” is the bank’s responsibility + + +- Cost: No cost at all. As soon as you notice anything suspicious on your card statements, immediately report it and freeze the card. Keep all records: police reports, freeze confirmations, and transaction notifications from the bank. If the card is still in your possession, make a small inquiry or deposit nearby to create a record proving you had the card with you at the time of the fraud. The hardest part is resisting the urge to argue with customer service first — always freeze the card first. + +- In plain terms: If someone fraudulently uses your card, you don’t have to prove “this wasn’t me.” Instead, it’s the bank’s duty to prove the transaction was made by you. If they can’t, they must compensate you. This only applies if you report and freeze the card right away. Delaying this step means you’ll bear any additional losses that occur afterward. + +- Benefit: Supreme Court rulings clearly define who must provide evidence. If you claim the transaction resulted from counterfeit card fraud or online fraud, you must first gather proof — such as official legal documents, records showing where the card was physically located at the time, transaction logs, notifications, police reports, and freeze confirmations. Conversely, if the issuing bank or any third‑party payment service insists the transaction was authorized by you, they must produce evidence to support that claim. If, after you notify the bank, it fails to verify the transaction promptly or to preserve transaction records and surveillance footage, the bank bears the consequences of lacking proof. Once proven, debit‑card holders may demand full reimbursement of stolen funds plus compensation for any losses; credit‑card users may request a refund of all unauthorized charges, interest, and penalties, and courts will reject any demand that the cardholder repay those amounts. You may also ask the bank to promptly remove any resulting negative credit entries (effective 25 May 2021). + +- Evidence grade: A + +- Notes: There are two situations where you remain liable. First, if you fail to protect your card, PIN, or verification codes — in other words, if you neglect your duty to safeguard them — you’ll bear part of the loss. Keep your PIN secret and never share verification codes (see Item 1; two‑factor authentication via phone alerts is preferred). Second, if you delay reporting and freezing the card, any extra losses incurred afterward are your responsibility. Hence, the very first step is always to freeze the card — don’t waste time arguing with customer service first. These rules also apply to third‑party payment services. If such a service advertises “immediate compensation” with clear terms, you may demand payment from them. If you were tricked into transferring money, that falls under a separate procedure; see Item 8.2: call 110 or 96110 immediately to request a stop‑payment order. +- Sources:最高人民法院 (2021). 关于审理银行卡民事纠纷案件若干问题的规定（第四、五、七、十四、十五条）. + +### 6. Periodically check the devices logged into your account and any authorized apps, then remove the ones you no longer use + +- Cost: No cost at all. It only takes a few minutes each time. The hard part is that there’s no reminder — you have to remember to do it yourself. +- In plain terms: “Logged-in devices” refer to the phones and computers that can still access your account right now. Account thieves often lie low for a while before making their move. If you see any unfamiliar devices on the list, or third-party apps you no longer use still linked to your account, log out from all devices and change your password right away. +- Benefit: Account theft rarely happens instantly — attackers usually spend some time lurking first. The list of logged-in devices shows all phones and computers currently able to access your account, while the list of authorized apps shows all third-party services you’ve given permission to log in using your account. Any unknown devices or unused third-party apps on these lists are the easiest clues to spot. +- Evidence grade: C +- Notes: This feature is available in WeChat, Alipay, email accounts, Apple ID, and Android accounts. If you spot any unfamiliar devices, simply log out from all devices and change your password. +- Sources:作者经验，无直接文献 + +### 7. Don’t tap “Allow all” just to use an app: the data isn’t mandatory, and refusing to share it won’t block service access + + +- Cost: No cost involved. The hard part is resisting the urge to tap “Allow all.” +- In plain terms: Apps request your data. If that data isn’t strictly necessary to deliver the service, the app can’t deny you access just because you refuse to share it. It may only collect what it actually needs. For instance, a map app needs your location, but a flashlight app has no business asking for your contacts list. +- Benefit: Two key legal points apply here. First, providers may not deny products or services on the grounds that a user hasn’t consented or has withdrawn consent — unless processing that data is genuinely essential to delivering the service. Second, data collection must stay limited to what’s absolutely required for the intended purpose; only the minimal amount needed may be gathered. +- Evidence grade: A +- Notes: The deciding factor is simple: is this data truly essential to providing the service? Location data is essential for a map app, but contact lists aren’t needed for a flashlight app. After installing an app, head to your phone’s settings under app permissions and turn off any nonessential permissions. Grant access only when you genuinely need them, and even then, limit it to a one-time permission. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. ：第六条「收集个人信息，应当限于实现处理目的的最小范围，不得过度收集个人信息」；第十六条「个人信息处理者不得以个人不同意处理其个人信息或者撤回同意为由，拒绝提供产品或者服务；处理个人信息属于提供产品或者服务所必需的除外」；第十五条「基于个人同意处理个人信息的，个人有权撤回其同意。个人信息处理者应当提供便捷的撤回同意的方式」 + +### 8. You have the right to view, copy, correct, and delete your personal information; if refused, you can sue. + + +- Cost: There is no cost involved. Only if the company drags its feet do you need to file a complaint or sue. A lawsuit typically takes several months to resolve, and you must pay legal fees yourself. Therefore, filing a complaint first is the more cost-effective option. The difficult part is having to repeatedly follow up when the company delays action. + +- In plain terms: You have the right to demand that a company let you view, copy, correct, and delete your personal information. When a service is discontinued, its retention period expires, or you withdraw consent, the company is obligated to delete that data on its own. If it refuses your request, it must provide a valid reason; otherwise, you can take it to court. Deactivating an account and deleting personal information are two separate actions — after deactivating, you must separately request deletion. + +- Benefit: There are several situations in which a company must proactively delete personal information: when a service is discontinued, when the agreed retention period ends, when you withdraw consent, or when the original purpose of data collection has been fulfilled. If it fails to do so, you can demand deletion. Should it deny your rights without justification, you may file a lawsuit. + +- Evidence grade: A + +- Notes: Deactivating an account and deleting personal information are distinct processes; after deactivating, you must separately request deletion. Before switching phones or selling an old device, make sure to log out of all accounts, unlink them, and then perform a factory reset. The law grants you a right to deletion after the fact — it cannot retrieve data that has already been leaked. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. ：第四十五条「个人有权向个人信息处理者查阅、复制其个人信息……个人请求查阅、复制其个人信息的，个人信息处理者应当及时提供」；第四十六条更正、补充权；第四十七条列了五种应当主动删除的情形，含「（一）处理目的已实现、无法实现或者为实现处理目的不再必要」「（二）个人信息处理者停止提供产品或者服务，或者保存期限已届满」「（三）个人撤回同意」，「个人信息处理者未删除的，个人有权请求删除」；第五十条「个人信息处理者应当建立便捷的个人行使权利的申请受理和处理机制。拒绝个人行使权利的请求的，应当说明理由」「个人可以依法向人民法院提起诉讼」 + +### 9. You’re not required to use facial recognition: if other options exist, they must offer you alternatives if you refuse + + +- Cost: No cost involved. When asked to use facial recognition, simply ask, “Are there any other verification methods available?” If they claim none exist, demand they provide alternatives. The challenge lies in actually voicing this question on the spot. +- In plain terms: As long as any other method can achieve the same result, a service provider cannot force you to use facial recognition. If you decline facial recognition, they must offer alternatives such as a card swipe, password entry, or ID verification. They also cannot threaten that “the service won’t be provided” if you refuse. Installing facial recognition devices in hotel rooms, public showers, changing rooms, or restrooms is strictly prohibited. +- Benefit: The Administrative Measures for the Safe Use of Facial Recognition Technology clearly state: “Where other non-facial recognition technologies can achieve the same purpose or meet equivalent operational requirements, facial recognition must not be used as the sole verification method. If an individual declines facial recognition for identity verification, other reasonable and convenient alternatives must be provided.” The measures further stipulate: “No organization or individual may mislead, deceive, or coerce individuals into accepting facial recognition for identity verification under the pretext of service delivery or improved quality.” Consent to use facial recognition must be “freely, explicitly, and separately given after full disclosure” — meaning you must be asked specifically about this and must agree independently. You retain the right to withdraw consent, and service providers must offer an easy way to do so. For minors under 14, parental or guardian consent is mandatory. In public spaces, facial recognition devices may only be installed if “necessary for public safety” and must display prominent warning signs. Their use inside private areas such as hotel rooms, showers, changing rooms, or restrooms is forbidden. Facial data must be stored locally on devices and must not be transmitted over the internet, except where permitted by law or with explicit consent (effective nationwide as of June 1, 2025). +- Evidence grade: A +- Notes: Common scenarios include residential building access systems, rental platforms, gyms, and hotels requesting facial data. When they claim “the system only supports facial recognition,” quote the exact wording from the regulations: “Where other non-facial recognition technologies can achieve the same purpose or meet equivalent operational requirements, facial recognition must not be used as the sole verification method.” Then demand alternative verification methods such as card swipes, passwords, or ID checks. If they still refuse, report them to local internet regulatory authorities. Certain financial and government services may have separate rules — follow those instead. Unlike passwords, facial data cannot be changed after a breach, so it demands greater caution. Organizations storing facial data on behalf of 100,000+ individuals must register with provincial or higher-level internet regulators within 30 days; this registration status can help you assess their legitimacy. Your rights to access, correct, or delete your personal data are covered in item 8. +- Sources:国家互联网信息办公室、公安部 (2025). 人脸识别技术应用安全管理办法（第 19 号令，第十条、十二条、十三条，2025 年 6 月 1 日起施行）. diff --git a/book/en/15-Renting-And-Buying-Housing.md b/book/en/15-Renting-And-Buying-Housing.md new file mode 100644 index 00000000..4735730a --- /dev/null +++ b/book/en/15-Renting-And-Buying-Housing.md @@ -0,0 +1,80 @@ +# 15. Renting vs. buying a home + +Renting can easily cost you extra due to security deposits and realtor fees. Buying a home, on the other hand, brings high expenses in the form of mortgage interest and all those hidden details that sellers know but buyers often overlook. +### 1. The amount of the deposit, its refund timeline, and permissible deduction scenarios must be specified in the contract + +- Cost: No monetary cost. It only requires an extra ten minutes when signing the contract. The challenge lies in bringing this up in front of the landlord. +- In plain terms: The deposit amount, when it will be returned, and under what circumstances deductions are allowed must all be written into the contract before you sign it. Any deduction reasons not explicitly stated in the contract cannot be used by the landlord to withhold your deposit at the end of the lease. +- Benefit: Regulatory statutes make this clear: “Landlords collecting a deposit must specify the deposit amount, refund timing, and permissible deduction scenarios in the housing lease agreement. Apart from these agreed terms, landlords have no right to deduct funds without valid justification.” In short, three key points must appear in the contract: how much the deposit is, when it’s returned, and under what conditions it can be deducted. Reasons not listed in the contract cannot be used to justify any deductions. +- Evidence grade: A +- Notes: On the day of moving out, take photos and videos together with the landlord. Capture readings from water, electricity, and gas meters, as well as images of walls and floors. If your deposit is deducted without cause, first file a complaint with the housing regulatory authority. For smaller amounts, consider pursuing a small claims lawsuit — see Section 8 for details. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十条）. + +### 2. When water and electricity are cut off, locks are changed, or you’re threatened to leave — call the police right away: laws forbid using these tactics to force you out + +- Cost: No cost at all. Just make a phone call to the police and they’ll be there immediately. +- In plain terms: Landlords are strictly prohibited by law from cutting off utilities, changing locks, or threatening tenants to end a lease or force them to move out. If this happens to you, call the police right away. The police report serves as proof if you later seek compensation for any losses. Do not attempt to confront the landlord on your own. +- Benefit: Administrative regulations make it clear: “Landlords may not use violence, threats, or any other illegal means to compel tenants to terminate a housing lease or vacate the premises.” Eviction means being forced to move out. In such situations, call the police and preserve all evidence — do not take matters into your own hands. +- Evidence grade: A +- Notes: Calling the police ensures you obtain an official report. This report becomes crucial evidence if you later file a claim for damages. Also be sure to notify your local housing authority. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十二条）. + +### 3. Real estate agents must not collect or remit rent and security deposits; payments go straight to landlords + +- Cost: No cost at all. It takes just a few minutes to verify the recipient before paying. The hard part is resisting pressure from agents who try to get you to send the money to them instead. +- In plain terms: By regulation, real estate agents are prohibited from collecting or remitting rent and security deposits; all payments must go directly to landlords. Any time money passes through an agent’s hands, it creates one extra chance for them to abscond with the funds. If that happens, you lose both your rent payments and your right to stay in the property. Always confirm that the recipient’s name matches the name on the property title before paying. +- Benefit: Administrative rules explicitly forbid real estate agencies from collecting or remitting rent and security deposits on behalf of landlords. This means agents have no legal authority to handle such payments. Every time money moves through an agent’s hands, the risk of them running off with the money rises significantly. +- Evidence grade: A +- Notes: Double-check that the recipient’s name matches the name on the property title before making any payment. If it does not, ask for a written authorization first. Agents are only allowed to charge a commission fee for their matchmaking services. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第二十五条）. + +### 4. Check a long-term rental’s escrow account before paying a full year’s rent upfront + +- Cost: No cost at all. It takes just a few minutes to verify. +- In plain terms: The discount you get from paying a full year’s rent upfront is minimal. If the rental company goes out of business, you lose both your security deposit and the rent you’ve prepaid for the remaining months. It gets even worse if you take out a rent loan: even if the company disappears, you’re still obligated to make all monthly loan payments. Always check whether the company has a publicly listed escrow account before signing any lease. +- Benefit: Regulations require any housing rental business that sublets units to set up a dedicated escrow account for rental funds and make it visible to the public. Subletting means a company leases entire properties from landlords and then rents them out to individual tenants. The tiny discount from paying a full year’s rent upfront is far outweighed by the risk of losing both your deposit and all prepaid rent if the company shuts down. This risk is even greater if you’ve taken out a rent loan. +- Evidence grade: A +- Notes: Carefully check whether any loan products are tied to your lease agreement. If a third-party app lets you pay a full year’s rent upfront to the rental company, and you then repay that amount via monthly installments, you’ll still be responsible for all payments even if the company ceases operations. Avoid signing any such contracts. +- Sources:国务院 (2025). 住房租赁条例（国令第 812 号，2025 年 9 月 15 日施行）（第十九条）. + +### 5. House sold during lease term – lease remains valid, no need to move + +- Cost: No cost at all +- In plain terms: If a house is sold while you’re still renting it, your lease stays valid. The new owner must honor the original contract and let you live there until it ends. You won’t need to move out or renegotiate any terms. This only applies if you’re already living there legally; be sure to keep proof such as the lease, payment records, and documentation showing when you moved in. +- Benefit: The Civil Code includes a principle known as “sale does not break lease,” meaning a property sale has no effect on an existing lease agreement. The actual wording is: “Any change in ownership of leased property during the lease term does not affect the validity of the lease contract.” In other words, even if the house changes hands while you’re renting it, the new owner must abide by the original terms and let you stay until the lease ends. +- Evidence grade: A +- Notes: This applies only if you’re already residing there lawfully; the law refers to such occupancy as “legal possession and use.” It’s essential to retain all relevant documentation, including the lease, proof of payments, and records indicating your move-in date. +- Sources:全国人大 (2020). 民法典（第七百二十五条）. + +### 6. Checking property rights and mortgages before signing the contract; all payments must be transferred with a purpose note + + +- Cost: No cost involved. The check takes about half an hour. +- In plain terms: The two most common ways people end up losing all their money are: first, paying rent to someone who isn’t the property owner; second, discovering that the house was already mortgaged to a bank and later seized. Before signing, verify both the property rights and any existing mortgages at the local land registry office. All payments must be made via bank transfer, with a note stating “Monthly rent for [property address]”. This note serves as direct proof in case of any disputes. +- Benefit: These two scenarios represent the typical ways people lose all their money: paying rent to a non-owner, or dealing with a property that’s already mortgaged and seized. Keeping a transfer note that reads “Monthly rent for [property address]” provides solid evidence if a dispute arises later. +- Evidence grade: C +- Notes: Property rights information can be obtained from the local land registry office. At the time of signing, the actual owner must be present; if not, a written authorization is required. If you’re renting from a sub-landlord, written consent from the original owner is mandatory. +- Sources:作者经验，无直接文献；证据留存与转账备注同理见第 8 节关于彩礼和借条的两条 + +### 7. For second-hand home sales where the agent collects the payment, the funds must be deposited into a dedicated transaction account opened by the agency at a bank + +- Cost: No cost involved. The challenge is ensuring the payment goes into the designated account; this may require some discussion with the agent. +- In plain terms: The purchase price can range from hundreds of thousands to millions of dollars — this is the largest single transaction amount discussed in this guide. By regulation, when an agent collects payment, it must be transferred to a dedicated account opened by the agency at a bank, not sent via WeChat to the individual agent. Additionally, when two agencies collaborate on one sale, only one commission fee may be charged; services such as loan processing or title transfer require separate contracts and clear fee agreements beforehand. +- Benefit: Regulations are explicit: any real estate agency entrusted to collect or disburse transaction funds must use a dedicated client settlement account at a bank. This ensures the payment is held in a regulated account, not the agency’s general account or any individual agent’s personal account. +- Evidence grade: A +- Notes: Given the substantial amount involved, never send payment via WeChat to an agent. Two common scenarios involving extra charges also apply: first, when two agencies jointly handle a sale, only one commission fee is allowed; second, services like loan processing or title transfer are separate and must be contracted individually with clear fee disclosures. All payments should be transferred via bank transfer with a purpose note, as outlined in item 6 (verifying property titles and mortgage status prior to signing). +- Sources:住房城乡建设部、国家发展改革委、人力资源社会保障部 (2011). 房地产经纪管理办法（令第 8 号，2016 年第 29 号令修改）第二十四条：「房地产交易当事人约定由房地产经纪机构代收代付交易资金的，应当通过房地产经纪机构在银行开设的客户交易结算资金专用存款账户划转交易资金。」第十八条「房地产经纪服务实行明码标价制度……在经营场所醒目位置标明房地产经纪服务项目、服务内容、收费标准」；第十九条「两家或者两家以上房地产经纪机构合作开展同一宗房地产经纪业务的，只能按照一宗业务收取佣金，不得向委托人增加收费」；第十七条代办贷款、代办房地产登记等其他服务「应当向委托人说明服务内容、收费标准等情况，经委托人同意后，另行签订合同」. + +### 8. Don’t rent a subdivided apartment: the smallest legal rental unit is the original designed room; kitchens, bathrooms, balconies must not be used for living. + + +- Cost: There’s no direct cost. The trade‑off is that with the same budget you’ll either have to live farther away or in a smaller space. + +- In plain terms: By regulation, the smallest permissible rental unit is the room as originally built. Kitchens, bathrooms, balconies, and basement storage areas cannot be used as living quarters. If such an apartment is found to be illegal, you may be forced to move out. Additionally, during the lease term the landlord cannot unilaterally raise the rent. + +- Benefit: The rules make it clear that the minimum rental unit is the original room — meaning you can’t split it into multiple units for separate rentals. The minimum floor area per occupant must meet local legal standards, and kitchens, bathrooms, balconies, and basements must not be rented out for habitation. Landlords also can’t arbitrarily increase rent while a lease is in effect. + +- Evidence grade: A + +- Notes: When an illegal subdivision is discovered, it’s the tenant who must move, often losing their security deposit and any rent already paid. Safety is also a concern: makeshift walls can block escape routes, and many people sharing one apartment often rely on a single electrical circuit. When viewing a place, check three things: whether walls were added later, if there’s a window in the room, and whether the electric meter can handle the expected number of occupants. +- Sources:住房和城乡建设部 (2010). 商品房屋租赁管理办法（令第 6 号）第八条：「出租住房的，应当以原设计的房间为最小出租单位，人均租住建筑面积不得低于当地人民政府规定的最低标准。厨房、卫生间、阳台和地下储藏室不得出租供人员居住。」第九条：「出租人应当按照合同约定履行房屋的维修义务并确保房屋和室内设施安全……房屋租赁合同期内，出租人不得单方面随意提高租金水平。」 diff --git a/book/en/16-Living-With-Chronic-Disease.md b/book/en/16-Living-With-Chronic-Disease.md new file mode 100644 index 00000000..207cd337 --- /dev/null +++ b/book/en/16-Living-With-Chronic-Disease.md @@ -0,0 +1,93 @@ +# 16. How to live after being diagnosed with a chronic disease + +This section looks at overall mortality rates and the associated costs. A chronic disease diagnosis is not the end of the story — what truly matters is how to manage it over the decades that follow. +### 1. Take medication exactly as prescribed — don’t stop just because you feel better + +- Cost: There’s no cost at all; in fact, it saves money on future treatment for complications. Taking the pills each day takes only a few minutes. The real challenge is sticking to the regimen every single day. +- In plain terms: People who consistently follow their doctor’s instructions when taking medication have roughly half the risk of dying during the same period compared to those who take it intermittently. This figure should be viewed with some caution. Even individuals who take fake pills consistently also have lower mortality rates, which suggests part of the benefit stems from the fact that people who stick to any medication routine tend to be more health-conscious overall. Still, the risks of skipping doses are well documented — especially for blood pressure drugs, anticoagulants, and anti-rejection medications. +- Benefit: This finding comes from a meta-analysis that pooled data from 21 separate studies involving 46,847 participants. Compared to those who took medication irregularly, people who followed their prescription exactly had roughly 44% lower risk of dying during the same timeframe. The raw odds ratio was 0.56, with a 95% confidence interval ranging from 0.50 to 0.63; this interval represents the range within which the true value is likely to fall. When only treatments with proven effectiveness were considered, the risk reduction was about 45% (odds ratio 0.55, 95% CI 0.49–0.62). +- Evidence grade: A +- Notes: This is a somewhat controversial figure and one of the numbers in this guide that requires extra caution. In the same meta-analysis, individuals who consistently took placebos also showed a lower mortality rate (odds ratio 0.56, 95% CI 0.43–0.74). This indicates that a significant portion of the benefit is attributable to the “healthy adherer effect” — the tendency of people who stick to any kind of medication routine to generally maintain healthier habits. Nevertheless, the risks associated with discontinuing medication are very real, particularly for blood pressure drugs, anticoagulants, and anti-rejection medications. +- Sources:Simpson SH, Eurich DT, Majumdar SR, et al. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ, 333(7557), 15. + +### 2. First get outpatient chronic disease certification, then register for cross-regional medical care — hypertension, diabetes, cancer radiotherapy/chemotherapy, dialysis, and anti-rejection treatment can then be covered by yibao across regions + + +- Cost: No cost at all. You can complete the cross-regional medical registration once, right from your phone, via the yibao app before you travel. + +- In plain terms: Patients with hypertension, diabetes, outpatient radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants can now use their yibao coverage for outpatient care anywhere in the country. They won’t need to pay out-of-pocket first and then seek reimbursement back home. However, this only works if they first obtain outpatient chronic disease certification in their home region, then register for cross-regional medical care. Both steps are required for it to take effect. + +- Benefit: According to official documents from the National Healthcare Security Administration, this system is now largely in place. The exact wording reads: “Cross-regional direct settlement of outpatient expenses for five chronic conditions — hypertension, diabetes, radiotherapy/chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplants — is now largely accessible at the county level.” “Accessible at the county level” means this service is available county-wide. The documents also mention plans to add five more conditions to this list in the future. + +- Evidence grade: A + +- Notes: Both steps are mandatory: first get outpatient chronic disease certification in your home region, then register for cross-regional medical care. Progress on adding those five new conditions varies by region; exact details are determined by local healthcare security authorities. +- Sources:国家医保局办公室、财政部办公厅 (2024). 关于稳妥有序扩大跨省直接结算门诊慢特病病种范围的通知（医保办发〔2024〕19 号）. + +### 3. Follow the intervals recommended by your doctor for follow‑up visits, and record every measurement in the same notebook. + +- Cost: Each checkup costs anywhere from a few dozen to several hundred yuan. A trip to the hospital and waiting for results also takes some time. The main difficulty is that you must go regularly, which can easily be put off. +- In plain terms: For chronic diseases, it’s the trends over time that matter, not any single measurement. Write down the date, the measurement, the medication you’re taking, and its dosage in one place. When you switch doctors, you can show this record so you won’t need to repeat tests or pay for them again. +- Benefit: What matters for chronic conditions is how these values change over time. Keeping them all in one spot also means you won’t have to redo tests or spend extra money when you change medical providers. +- Evidence grade: C +- Notes: Be sure to record at least four items each time: the date, the measurement value, the medication being used, and its dosage. Taking a photo of the lab report with your phone works just as well. The key is to keep everything in the same place rather than scattering it across multiple notes. +- Sources:作者经验，无直接文献 + +### 4. Don’t stop proper treatment to try folk remedies or supplements + +- Cost: No cost at all; you even save money you’d otherwise spend on supplements. It takes no extra time. The hard part is resisting repeated pressure from others to give it a try. +- In plain terms: The risks of stopping treatment are well known, while the benefits of folk remedies and supplements are uncertain. This means trading a definite harm for an uncertain gain. If you want to try supplements, talk to your doctor first. Some supplements can alter blood levels of anticoagulants and anti-rejection drugs. +- Benefit: The dangers of discontinuing treatment are clear, while the advantages of folk remedies remain unproven. This book lists several common types of ineffective supplements in Chapter 6. +- Evidence grade: C +- Notes: Always consult your doctor before trying any supplements. Certain supplements may interact with prescription medications, affecting concentrations of anticoagulants and anti-rejection drugs in the bloodstream. +- Sources:作者经验，无直接文献；相关证据见第 6 节 + +### 5. For patients with stable chronic conditions, community clinics can issue up to 12 weeks’ worth of medication at one time + +- Cost: There is no cost involved. Simply ask at your local community health center whether they can issue a long-term prescription. +- In plain terms: For individuals whose condition remains stable and whose medication regimen has not changed, community health centers can provide enough medication to last 12 weeks. This eliminates the need to travel to a larger hospital each month just to get a prescription and wait in line. Within the same insurance region, the reimbursement rate at these community clinics is typically about 10 percentage points higher than at higher-level hospitals. +- Benefit: Patients no longer have to make monthly trips to larger hospitals just to get their prescriptions. In the same insurance region, the reimbursement rate at community clinics is generally roughly 10 percentage points higher than at higher-level hospitals. +- Evidence grade: A +- Notes: Whether a patient meets the criteria is determined by the doctor; generally, this applies to individuals with a confirmed diagnosis and a stable medication plan. The medication itself remains the same; what is saved is the time and cost of making monthly trips to the hospital. If a specific medication is not available at the clinic, ask about their medication shortage registry and delivery options. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「对于符合条件的慢性病患者，基层医疗卫生机构单次可开具不超过12周用药的长期处方。」；同文「原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距」，并要求上级医院在基层开设高血压、糖尿病、慢性阻塞性肺疾病等常见病慢性病门诊 + +### 6. Before signing up for a family doctor in your community, find out which services are covered by yibao and which you’ll have to pay for out of pocket + +- Cost: There’s no cost involved. Asking a few questions before you sign up takes just a minute. +- In plain terms: The standard package of basic services is covered by yibao as required. Any customized service packages must be paid for entirely by the patient. When someone offers an “upgrade package,” be sure to ask whether it’s a basic or customized package, whether it’s officially registered, and how much it costs per year. +- Benefit: The basic service package is paid for by yibao per regulations. Customized packages require full out‑of‑pocket payment and must also be registered with the county‑level health authority. +- Evidence grade: A +- Notes: The real value of signing up lies in having a doctor follow your health over the long term, not in the number of services included. When offered an “upgrade package,” ask three key questions: is it a basic or customized package, is it registered, and what’s the annual cost? +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「加强基层门诊付费与签约服务政策联动，基本服务包按规定纳入医保支付；个性化服务包由签约基层医疗卫生机构按程序向县级卫生健康部门备案，费用由个人支付。」 + +### 7. Get a dilated eye exam right after a diabetes diagnosis, then follow your doctor’s recommended schedule; check your feet once a year. + +- Cost: A single dilated eye exam costs anywhere from a few dozen to several hundred yuan. Foot exams are usually included in routine outpatient visits, so they don’t incur extra charges. The real challenge is remembering to get these checks done even when neither your eyes nor feet feel any discomfort. +- In plain terms: Diabetes can damage both the retina and feet, but there are almost no noticeable symptoms until the damage becomes severe enough to cause vision loss or foot ulcers. Early detection makes treatment possible. For type 2 diabetes, a dilated eye exam should be done right after diagnosis; for type 1 diabetes, it’s recommended to start five years after onset. If previous tests showed no issues and blood sugar levels remain well-controlled, the interval can be extended to once every one or two years. Foot checks should be done annually. +- Benefit: Retinal damage caused by diabetes is known as diabetic retinopathy, while damage to the feet is called diabetic foot disease. Both conditions rarely show any symptoms until they reach an advanced stage. Detecting them early gives patients a much better chance of effective treatment. Once vision is lost or foot ulcers develop, it’s usually too late to reverse the damage. +- Evidence grade: A +- Notes: Type 2 diabetics should get a dilated eye exam right after diagnosis; type 1 diabetics should start five years after onset. The difference exists because type 2 diabetes often develops gradually over several years without obvious signs. If previous tests showed no problems and blood sugar stays under control, the interval can be extended to once every one to two years. People who notice reduced sensation in their feet should inspect the soles daily, even using a mirror if needed. +- Sources:美国糖尿病学会 (2026). 糖尿病诊疗标准 2026·第 12 章 视网膜病变、神经病变与足部护理. Diabetes Care：「People with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis.」「Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist 5 years after the onset of diabetes.」「If there is no evidence of retinopathy from one or more annual eye exams and glycemic indicators are within the goal range, then screening every 1–2 years may be considered.」「Perform a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations.」 + +### 8. People who have had kidney stones should drink 2.5–3 liters of water daily and keep salt intake under 6 grams + +- Cost: There is no cost at all. Simply make drinking water a daily habit. On days when you sweat a lot, you’ll need even more water — the hard part is remembering to do this every day. +- In plain terms: Roughly one in four people who have had a kidney stone will develop another one within five years. In a study of 199 people who had just experienced their first calcium stone episode, one group was instructed to drink enough water every day. Over five years, 12% of this group had a recurrence, compared to 27% of the control group that received no special instructions. UK guidelines recommend drinking 2.5–3 liters of water daily while keeping salt intake under 6 grams. Exactly 99 participants took part in this trial. +- Benefit: This is a five-year randomized controlled trial involving 199 patients with idiopathic calcium stones — meaning no underlying cause could be identified. Participants were split into two groups: one group drank at least 2 liters of water daily, while the other received no special intervention. After five years, 12.1% of the water-drinking group had a recurrence, versus 27.0% in the control group (P=0.008). A lower P value indicates a less likely chance that this difference occurred by random chance. The average time to recurrence was 38.7±13.2 months for the water group versus 25.1±16.4 months for the control group (P=0.016). Baseline 24-hour urine volume measurements showed that stone patients produced significantly less urine than healthy individuals: men produced 1,057±238 mL versus 1,401±562 mL in healthy men (P<0.0001), and women produced 990±230 mL versus 1,239±440 mL (P<0.001). NICE guideline NG118, section 1.8.1, offers several recommendations: adults should drink 2.5–3 liters daily, while children and teens should drink 1–2 liters based on age. Adding fresh lemon juice to water is encouraged, and carbonated drinks should be avoided. Adults must also keep daily salt intake under 6 grams. +- Evidence grade: A +- Notes: This measure reduces recurrence rates by roughly 55% at zero cost, making it the most cost-effective recommendation in this section according to our ranking criteria. The key metric to monitor is 24-hour urine volume, which should reach at least 2–2.5 liters — not simply the amount of water you drink. People who sweat heavily or work in hot environments need to drink even more. This trial involved only patients experiencing their first idiopathic calcium stone episode; different types of stones — such as uric acid, infection-related, or cystine stones — require different treatment approaches. Anyone with a history of kidney stones should undergo a stone composition analysis and a 24-hour urine test to determine whether medication is needed. Do not cut calcium intake to prevent stones; see section 6, item 21 for more details. Severe flank or abdominal pain during a stone episode requires immediate medical attention — drinking more water alone will not resolve it. Non-painful blood in the urine may indicate other conditions; see section 1, item 27 for further information. +- Sources:Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A (1996). Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. The Journal of Urology, 155(3), 839-843. ；National Institute for Health and Care Excellence (2019). Renal and ureteric stones: assessment and management. NICE guideline NG118，第 1.8.1 条. + +### 9. Long-term use of uric acid-lowering drugs after a gout diagnosis to keep blood uric acid below 360 µmol/L + + +- Cost: Allopurinol costs only a few to several dozen yuan per month. In the beginning, blood uric acid levels must be checked every few weeks to adjust the dosage; once stable, checks can be done every few months. For the first 3 to 6 months, a separate medication to prevent gout attacks must also be taken. The real challenge is remembering to take these drugs consistently even when there are no symptoms. + +- In plain terms: The proper way to manage gout is to take uric acid-lowering drugs long-term to keep levels below 360 µmol/L; these should not be taken only during flare-ups. In a UK trial involving 517 participants, 95% of those whose treatment was adjusted according to medical targets achieved this level after two years, compared to only 30% of those receiving standard care. Even after reaching the target, medication must not be stopped. Diet alone cannot bring levels down to this point, and abstaining from alcohol only lowers them by 1.6 mg/dL. A total of 211 participants remained free of gout attacks over a five-year follow-up period after discontinuing medication. + +- Benefit: This is a randomized controlled trial with 517 adult participants who had experienced gout attacks within the previous 12 months. One group received guidance from nurses who explained the condition and adjusted their medication to meet the target level; the other group continued to receive standard care from general practitioners. After two years, 95% of the intervention group had blood uric acid levels below 360 µmol/L (6 mg/dL), compared to just 30% of the control group. This represents a 3.18-fold increase in the likelihood of success (RR 3.18, 95% CI 2.42–4.18; this range indicates statistical reliability), with a P-value of less than 0.0001. Secondary outcomes such as attack frequency, presence of tophi, and quality of life also improved significantly in the intervention group. Each additional year of healthy life, adjusted for quality of life, cost approximately £5,066. A follow-up survey of 438 participants yielded a response rate of 82%; median attack frequency was 0 per year in the target-achieving group versus 1 per year in the control group (P<0.001). The proportion of participants still taking uric acid-lowering drugs was 1.19 times higher in the intervention group (adjusted RR 1.19, 1.09–1.30). The 2020 American College of Rheumatology guidelines strongly recommend starting such treatment for three groups: those with visible tophi, those showing bone damage on imaging, and those experiencing at least two attacks per year. The recommended approach involves continuous monitoring and dosage adjustment until levels drop below 6 mg/dL; allopurinol is the first-line choice, especially for patients with stage 3 or higher chronic kidney disease, with an initial dose of no more than 100 mg per day. Anti-inflammatory preventive drugs must also be taken for at least 3 to 6 months. Observational data from the same study showed that after successful long-term control, 87% of patients who discontinued medication still maintained levels below 7 mg/dL; however, only 13% remained free of attacks over a five-year follow-up period. Dietary interventions have limited impact: abstaining from alcohol lowers levels by just 1.6 mg/dL, while one serving of beer raises them by 0.16 mg/dL. Healthier diets such as Mediterranean or DASH diets produce even smaller effects. + +- Evidence grade: A + +- Notes: **Han Chinese individuals should consider testing for HLA-B*5801 before starting allopurinol.** This gene variant occurs in 7.4% of Han Chinese, Korean, and Thai populations, compared to only 0.7% of white and Hispanic individuals. Asians and African Americans face a threefold higher risk of allopurinol hypersensitivity syndrome, a potentially fatal condition involving widespread skin peeling; thus, the 2020 American College of Rheumatology guidelines advise genetic testing for these groups. Initiating uric acid-lowering therapy may temporarily increase attack frequency, so guidelines mandate concurrent use of anti-inflammatory preventive drugs for the first 3 to 6 months. Stopping medication due to increased pain is a common mistake; instead, additional anti-inflammatory drugs should be used as directed. Target levels of <6 mg/dL roughly correspond to 360 µmol/L, though Chinese medical reports typically use µmol/L units. Elevated uric acid levels without any prior attacks represent a different clinical scenario, discussed in Section 6, Item 19. Further details on sugary drinks and alcohol can be found in Section 2, Items 7 and 20. +- Sources:Doherty M, Jenkins W, Richardson H, et al. (2018). Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet, 392(10156), 1403-1412. ；Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M (2020). Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. Rheumatology, 59(3), 575-579. ；FitzGerald JD, Dalbeth N, Mikuls T, et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care & Research, 72(6), 744-760. diff --git a/book/en/17-Elderly-At-Home.md b/book/en/17-Elderly-At-Home.md new file mode 100644 index 00000000..594a48b6 --- /dev/null +++ b/book/en/17-Elderly-At-Home.md @@ -0,0 +1,95 @@ +# 17. Having elderly family members at home + +Having elderly relatives living with you often means that the main problems aren’t a lack of money, but failing to discuss matters clearly and sign the necessary documents in advance. The final section looks at pressure ulcers in bedridden patients; it calculates costs based on mortality rates and isn’t meant to be compared with the other items in this chapter. +### 1. While the elderly are still lucid, designate a future guardian in writing + +- Cost: It costs only a few hundred yuan to have a notarized document drawn up at a notary office. A single conversation with the elderly person is enough to settle the matter. The real difficulty lies in bringing it up — you must directly discuss the day when they will no longer be able to make decisions for themselves. +- In plain terms: While an elderly person still has a clear mind, it’s worth spending a few hundred yuan to have a written document notarized, naming who will serve as their guardian. Without such a document, once they lose decision-making capacity, a court must decide who gets to sign on their behalf and manage their finances. If family members disagree, the process can drag on even longer. +- Benefit: Under civil law, adults who are mentally sound and capable of independent decisions (legally termed “adults with full civil capacity”) may proactively arrange for a future guardian through mutual agreement. This person can be a close relative or any willing individual or organization. Such an arrangement must be formalized in writing. When the person later loses all or part of their decision-making ability, the designated individual assumes responsibility. Absent this document, guardianship must be assigned by a court. +- Evidence grade: A +- Notes: This arrangement is known as “voluntary guardianship,” meaning the guardian is chosen by the individual themselves, taking precedence over the standard legal order of guardianship. It is especially important for elderly people living alone, whose children reside far away, or those from complex family backgrounds. It is recommended to have the document notarized at a notary office. +- Sources:全国人大 (2020). 民法典（第三十三条）. + +### 2. Make a will — remember that later ones override earlier ones, and notarized wills no longer take priority + +- Cost: Writing a will by hand costs nothing. Having it notarized at a notary office costs several hundred to over a thousand yuan. The hard part is bringing it up: you must discuss end‑of‑life matters with your family. +- In plain terms: The law recognizes six types of wills, but a single mistake in the format can render the entire document invalid — this is the most common pitfall. A handwritten will must be written entirely by the testator, signed, and dated. If multiple wills exist and they conflict, the last one signed prevails. Since 2021, a notarized will no longer automatically takes precedence over others. +- Benefit: The Civil Code acknowledges six legal forms of wills: handwritten, dictated to a scribe, printed, recorded on audio or video, oral, and notarized. Each type has specific formal requirements that must be met. When several wills exist, the most recent one governs. Starting in 2021, notarized wills no longer automatically rank above others. +- Evidence grade: A +- Notes: A handwritten will must be written entirely by the testator, signed, and dated. For printed wills, at least two witnesses are required; both the testator and witnesses must sign every page and include the date. Relatives of the testator, potential heirs, or anyone named to receive assets cannot serve as witnesses. Any failure to meet these formal rules renders the will invalid — this is the most frequent cause of problems. +- Sources:全国人大 (2020). 民法典（第一千一百三十四条至第一千一百四十二条）. + +### 3. Keep the elderly person’s money in a separate account and set a rule requiring two people to approve any large withdrawals + + +- Cost: This costs nothing. You only need to discuss it once with family members and agree on a spending limit. The real challenge is how to bring it up without making the senior feel you’re trying to restrict them. +- In plain terms: Scammers targeting seniors for health products, collectibles, or financial schemes all follow the same pattern: they spend months building rapport, then strike all at once. By establishing a rule that any withdrawal above a certain amount must be approved by another person, you effectively delay the spending decision until the initial impulse fades. +- Benefit: Most scams aimed at older adults rely on building trust over weeks or months before making a large financial demand. Setting a rule that requires a second person’s approval for any sizable expenditure helps delay that decision, reducing the chance of impulsive, costly mistakes. +- Evidence grade: C +- Notes: Frame this not as “protecting them from fraud” but as “keeping household finances organized.” That approach is far easier for seniors to accept. Also, avoid moving all of their money into a child’s account — doing so can lead to entirely different kinds of disputes. +- Sources:作者经验，无直接文献；防骗通则见第 8 节和第 13 节 + +### 4. A ready-made phrase for seniors to deflect unwanted offers + +- Cost: No cost at all. It only takes a few minutes to discuss this with the senior once. +- In plain terms: Sales pitches and scams rely on creating immediate pressure, making it hard for people to say no on the spot. By agreeing beforehand on the phrase “I need to go home and discuss this with my family,” the senior has an easy way out whenever needed. This works far better than trying to reason with them later. +- Benefit: Both sales tactics and scams depend on on‑the‑spot pressure. Having a pre‑arranged line such as “I need to go home and discuss this with my family” gives seniors a graceful exit, making it far more effective than any post‑event explanation. +- Evidence grade: C +- Notes: Use this together with tip #3 (keeping the senior’s money in a separate account). You can also carry out home modifications to prevent falls, as described in Section 1. This phrase isn’t meant to protect the senior from themselves; it simply provides a way to decline politely without feeling awkward. When surrounded by salespeople, the hardest part isn’t judging whether they’re trustworthy — it’s finding the courage to say no in front of everyone. Agreeing on this line beforehand removes that burden entirely. +- Sources:作者经验，无直接文献 + +### 5. Avoid any “investment-based senior care” schemes that require upfront payments: card enrollment, prepaid care fees, buying senior housing units, travel-based care programs, and sales of senior products all fall under the same category of illegal fundraising. + + +- Cost: No cost at all. Simply read the following list of common tactics to seniors; it takes just a few minutes. In the future, use this list to reject any such offers outright: don’t attend informational sessions, don’t visit facilities, and don’t leave contact details. The real challenge arises when seniors have already attended several sessions and formed relationships with promoters — in those cases, convincing them to back off becomes much harder. + +- In plain terms: Any senior care program that demands an initial payment while promising financial returns is essentially a scam. These schemes include selling membership cards, collecting prepaid care fees, selling senior housing units, offering travel-based care packages, and promoting various senior products. Under current regulations, recovered funds are extremely rare; victims usually bear the full financial loss. Official reports document cases where fraudsters raised 136,000,000 yuan by marketing “pre-booked senior housing units,” defrauding over 2,100 people. Another case saw fraudsters collect 620,000 yuan through similar tactics, affecting more than 2,100 people. The only effective preventive step is stopping the initial payment. + +- Benefit: The Civil Affairs Bureau has identified five primary patterns used by fraudsters; recognizing these patterns is far more reliable than trusting individual promoters. First, fake senior care organizations: these entities lack any physical presence and merely rent temporary venues while falsely claiming partnerships with legitimate care providers. Second, “senior care services” marketed via premium cards, membership passes, or prepaid plans that promise far more services than their actual capacity can deliver. Third, “investment in senior care projects” — including fictitious senior housing developments, long-term bed leases, and so-called “time bank” mutual care systems — often advertised with promises of principal return, rental guarantees, or buyback agreements. Fourth, sales of “senior products” involving product buybacks, consignment sales, loyalty discounts, complimentary health screenings, gift giveaways, conference promotions, wellness seminars, and expert medical consultations. Fifth, “travel-based senior care” packages featuring discounted or free trips, stored-value rewards, and points-based care programs. Legal statutes explicitly state that all financial losses resulting from participation in illegal fundraising must be borne by the victims themselves. Official statistics illustrate the scale of this problem: Dai and accomplices stole 136,000,000 yuan through similar schemes, affecting over 2,100 victims; Dai received a 15-year prison term plus a 400,000 yuan fine. Cao orchestrated a fraud totaling 13,207,000,000 yuan, impacting more than 110,000 people; he was sentenced to life imprisonment with permanent political rights revocation and full asset confiscation. Some health product promoters also employ fraud tactics: Ni lured seniors through free meals, gifts, and private transportation to attend lectures where “experts” fabricated anti-cancer benefits using false testimonials and inflated pricing; seniors ended up paying dozens of times the actual cost for a compound called dihydroquercetin. Ni received a 10-year-and-3-month sentence plus a 120,000 yuan fine. (National regulations effective May 1, 2021.) + +- Evidence grade: A + +- Notes: Determining whether a program is legitimate should never rely on superficial impressions like “this organization looks reputable”; instead, focus on two clear indicators: does it demand an upfront payment, and does it promise financial returns? Legitimate senior care providers offer services rather than investment opportunities; any mention of returns, profits, or principal guarantees immediately disqualifies them. While it is difficult to prevent seniors from attending informational sessions, travel excursions, or medical screenings, the critical moment for intervention is when a payment is requested; this aligns perfectly with the dual-confirmation rule outlined in section 3. Once payment has already occurred, immediately contact police at 110 or the anti-fraud hotline 96110 to request a payment freeze, and simultaneously report the incident to local authorities responsible for handling illegal fundraising cases. Separate from these schemes, “housing reverse mortgage insurance” represents a distinct financial mechanism; refer to section 6 for further details. +- Sources:民政部 (2023). 关于养老服务领域非法集资的风险提示. （中国政府网发布）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示. ；国务院 (2021). 防范和处置非法集资条例（国务院令第 737 号，第二、二十五、三十条）. ；最高人民检察院 (2022). 检察机关打击整治养老诈骗犯罪典型案例. ；最高人民法院 (2025). 依法惩治涉民生领域诈骗犯罪典型案例（案例五 倪某荣诈骗案）. + +### 6. Apart from the housing reverse mortgage insurance offered by insurers, you should avoid all other “housing-for-pension” schemes — never mortgage your home to buy financial products. + + +- Cost: There’s no cost involved. Keep your property deed in your own hands and don’t hand it over to anyone promoting “housing-for-pension” schemes. Before signing any mortgage, guarantee, or loan agreements, show them to your children first. The difficulty lies in the fact that promoters often come repeatedly and appear very enthusiastic, leaving seniors feeling awkward about refusing them. + +- In plain terms: The only legitimate “housing-for-pension” option is the housing reverse mortgage insurance provided by insurers, which is currently still in the pilot phase and used by very few people. Door‑to‑door sales pitches have nothing to do with this official program. Scammers trick seniors into mortgaging their homes so they can use the borrowed money to buy financial products recommended by the fraudsters — essentially a “pay‑old‑debts‑with‑new‑money” Ponzi scheme. Regulators report cases where seniors were unaware their homes had been mortgaged; as a result they ended up losing their property while still owing a loan. + +- Benefit: The China Banking and Insurance Regulatory Commission’s Consumer Protection Bureau clearly distinguishes between the genuine and the fraudulent schemes. The legitimate program is called “Housing Reverse Mortgage Insurance for Seniors.” Eligible seniors who fully own their homes may mortgage them to an insurer while continuing to live there, rent it out, or otherwise use it. Any sale or disposal of the property requires consent from the mortgagee — the insurer. Seniors then receive a pension according to agreed terms until their death. This service remains a pilot project with limited participants. Illegal operators label their schemes “housing‑for‑pension,” but they bear no relation to the official program; they merely exploit national policy to promote illegal fundraising. Their modus operandi is to persuade seniors to mortgage their homes and then use the proceeds to purchase recommended financial products — often a classic Ponzi arrangement. The original warning states that some participants are completely unaware their homes have been mortgaged, ultimately resulting in loss of the property and outstanding debt. A useful guideline for evaluating returns is also provided: if a financial product promises a yield above 6 %, it should be viewed with suspicion; above 8 % it becomes highly risky; and anything over 10 % means you should expect to lose all principal — “high returns with guaranteed principal” is a hallmark of financial fraud. The same warning also stresses the need to be cautious when signing contracts and never to sign blank documents (National level, June 2021). + +- Evidence grade: B + +- Notes: This grade B reflects that the statements derive from regulatory risk warnings and expert judgment rather than empirical research data. The 6 %, 8 %, and 10 % thresholds are reference points suggested by regulators for consumers, not legally mandated standards. The former CBIRC has been merged into the National Financial Regulatory Administration; the original announcement page is no longer accessible, so we cite a reposted version from a provincial financial regulator. The core issue here is not merely possible losses on financial investments, but that after mortgaging their homes seniors still carry a loan obligation — a loss far exceeding any potential principal loss. General rules concerning contract signing and blank documents are covered in Section 8, Item 17; steps to halt fraudulent transactions after being scammed are outlined in Section 8, Item 2. +- Sources:中国银保监会消费者权益保护局 (2021). 关于警惕「投资养老」「以房养老」金融诈骗的风险提示（2021 年第三期）. （湖南省地方金融监督管理局转载）；民政部、中国银保监会 (2021). 关于养老领域非法集资的风险提示（第四种表现形式：以宣称「以房养老」为名非法集资）. + +### 7. For elderly individuals at home who are bedridden or severely disabled, apply to the local yibao (basic medical insurance) office for long-term care insurance; it is not limited to seniors only. + + +- Cost: You only need to visit the local yibao office once to submit an application and undergo a disability assessment. If you pass the assessment on the first try, the evaluation fee is covered by the insurance fund — no out-of-pocket expense is required. + +- In plain terms: Long-term care insurance helps cover the cost of hiring caregivers. Those who are severely disabled and have remained in that condition for at least six months may apply to their local yibao office. Eligible care expenses do not need to be paid upfront; roughly 70% is reimbursed for employees covered under the worker policy, while about 50% is reimbursed for residents enrolled in the urban/rural resident policy. However, costs such as room charges and meals are not covered. Though often mistaken for a senior-specific program, official documents refer to “insured persons” without any age restriction — even younger individuals with severe disabilities may apply. + +- Benefit: There is no deductible threshold for approved long-term care services; you do not need to pay a set amount out-of-pocket before reimbursement begins. Approximately 70% of eligible costs are reimbursed for workers, and about 50% for urban/rural residents. The maximum annual payout cannot exceed 50% of the local average per-capita disposable income for residents in that region. + +- Evidence grade: A + +- Notes: Disability must be “long-term and continuous” — generally lasting six months or more; a few weeks of hospitalization does not qualify. A six-month waiting period applies before benefits can be claimed. Expenses unrelated to care, such as room fees or meals, are not covered by this insurance. Medical costs normally paid by yibao are also excluded. Individuals already receiving work-related injury care benefits cannot claim both simultaneously. This insurance is separate from disability-related subsidies; they follow different application procedures and provide distinct financial aid, as detailed in Section 7, Article 8. Care received at home or in community settings receives preferential reimbursement rates; institutionalization is not mandatory. Implementation varies by region, and assessment criteria differ locally. Contact 12393 or your local yibao office to confirm whether the program is active in your area and how to schedule an evaluation. Even if an initial assessment fails, reapplication is possible once disability worsens. +- Sources:国家医保局等八部门 (2026). 关于印发《加快建立长期护理保险制度实施方案》的通知. ：保障对象为「按规定参保缴费且失能状态长期持续（一般为6个月以上），经申请通过评估认定的失能人员」，「制度起步阶段保障重度失能人员」；「待遇享受不设起付标准。符合规定的长期护理服务费用，按未就业城乡居民参保政策参保的，基金支付比例为50%左右；按单位职工参保政策参保的，基金支付比例为70%左右，退休人员享受单位职工参保待遇」；「参保人员基金年度最高支付限额不超过统筹地区上年度城乡居民人均可支配收入的50%」；「待遇享受固定等待期原则上按照6个月设置」；另见中共中央办公厅、国务院办公厅《关于加快建立长期护理保险制度的意见》. + +### 8. For families with someone bedridden at home, pressure ulcers are a top concern: use an electric alternating-pressure air mattress, turn the patient regularly, and check bony areas daily + + +- Cost: Electric alternating-pressure air mattresses for home use start at a few hundred yuan. Turning a patient takes just a few minutes. The real challenge is doing it every two to three hours, even at night — no single caregiver can manage that alone. + +- In plain terms: Pressure ulcers are far more than just superficial skin injuries. Among 19,520 patients undergoing hip‑fracture surgery, those already having pressure ulcers at admission had a roughly 20% higher chance of dying within 30 days. Three evidence‑based actions help: using an electric air mattress cuts new ulcer formation by about 60% compared with ordinary hospital mattresses; consistently turning the patient reduces risk by roughly 70% versus standard care; and keeping the person from lying prone for long periods also helps. Check the sacrum, heels, hips, and shoulders each day; if any area shows persistent redness that doesn’t fade when pressed, contact a nurse or doctor right away. A total of 1,226 patients showed similar trends, and 116 patients demonstrated a clear increase in ulcer risk under prone positioning. + +- Benefit: Data come from 19,520 hip‑fracture patients in the U.S. NSQIP registry (2016‑2019). Those with pre‑existing pressure ulcers showed a higher 30‑day mortality rate; after adjusting for other factors, this link remained significant (OR 1.2, a 21% increase in risk, P = 0.004). They also faced higher rates of deep‑vein thrombosis (OR 1.59), pneumonia (OR 1.39), unplanned readmissions (OR 1.43), and an average hospital stay 0.4 days longer. In a follow‑up of 324 elderly inpatients (mean age 86) over 18 months, pressure ulcers independently predicted long‑term death (HR 1.500, 95% CI 1.059‑2.126, P = 0.020). A network meta‑analysis of 65 randomized trials compared electric alternating‑pressure air mattresses with standard hospital mattresses; the former lowered ulcer incidence (RR 0.42, 95% CI 0.29‑0.63, moderate certainty). Similar benefits were seen with hybrid systems (RR 0.22, 95% CI 0.07‑0.66). A 2026 Cochrane review of 11 trials involving 4,462 patients found little difference between turning schedules of 2 hours versus 4 hours (RR 1.05, 95% CI 0.79‑1.39, very low certainty). However, using wearable sensors to enforce 2‑hour turning intervals in an ICU setting cut ulcer rates compared with usual care (RR 0.28, 95% CI 0.10‑0.75, moderate certainty). Finally, patients kept in a prone position developed ulcers far more often than those lying supine (RR 4.55, 95% CI 2.31‑8.98). + +- Evidence grade: B + +- Notes: This grade reflects three main points. First, the mortality studies showed only that patients with ulcers fared worse; they did not prove that preventing ulcers directly lowers death rates. Second, the evidence on optimal turning intervals from randomized trials is quite weak. Third, the data on air mattresses are relatively stronger, yet they compared hospital‑grade mattresses to ordinary home mattresses, so extrapolation to home use is somewhat uncertain. Daily inspection of bony areas is standard nursing practice and lacks dedicated research support. The mortality benefit is evaluated separately from cost calculations for other items in this section. Home‑based care services covered by long‑term care insurance are described in item 7. Sudden leg swelling should be treated as a possible deep‑vein thrombosis, as covered in section 13, item 11. Situations involving prolonged bed rest after falls or severe injury are discussed in section 1, item 34. +- Sources:Porter SB, Pla R, Chow JH, et al. (2022). Preoperative Pressure Ulcers, Mortality, and Complications in Older Hip Fracture Surgery Patients. JAAOS Global Research & Reviews, 6(11). ；Ottaviani S, Rondanina E, Longo E, 等 (2026). Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults. European Geriatric Medicine, 17(2), 665-672. ；Shi C, Dumville JC, Cullum N (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS ONE, 13(2), e0192707. ；Latimer SL, Chaboyer WP, Probst S, 等 (2026). Repositioning for pressure injury prevention in adults. Cochrane Database of Systematic Reviews, 6, CD009958. diff --git a/book/en/18-Is-Having-Kids-Worth-It.md b/book/en/18-Is-Having-Kids-Worth-It.md new file mode 100644 index 00000000..63e5c118 --- /dev/null +++ b/book/en/18-Is-Having-Kids-Worth-It.md @@ -0,0 +1,58 @@ +# 18. Is raising a child worth it? + +This section breaks down the financial and time costs involved. Much like Section 10, which examined the costs of marriage, we’re simply laying out the numbers here — without offering any definitive conclusions. If you’re already pregnant and need to follow the necessary steps, please refer to Section 27. +There are 18 key considerations to keep in mind when deciding whether raising a child is worthwhile. +### 1. Start by claiming what you’re entitled to: the national dibao program gives 3,600 yuan per child per year until the child turns 3. + +- Cost: Zero out-of-pocket expense. Simply apply at the local hukou office where your child is registered — one visit is all it takes. +- In plain terms: If your child was born after January 1, 2025, and is under 3 years old, you qualify for this payment. One parent or legal guardian can submit the application at the child’s hukou office. The allowance is 3,600 yuan per year per child, paid out until the child reaches age 3. No personal income tax applies to this money, and it does not count toward any dibao or similar assistance calculations. +- Benefit: As stipulated in the policy issued by the General Offices of the CPC Central Committee and the State Council, infants and toddlers born after January 1, 2025, and under 3 years of age are eligible for a yearly payment of 3,600 yuan per child. This amount is exempt from personal income tax and is excluded from calculations of household or individual income when determining eligibility for dibao or similar programs. +- Evidence grade: A +- Notes: This is a nationwide baseline benefit. Certain provinces and municipalities also offer their own local subsidies, which can be claimed alongside this national payment. Over three years, the total comes to 10,800 yuan — a modest contribution toward raising a child. Do not let this amount influence your decision about whether or not to have a child. +- Sources:中共中央办公厅、国务院办公厅 (2025). 育儿补贴制度实施方案. + +### 2. Maternity leave lasts 98 days; maternity benefits are paid by the maternity insurance fund based on the employer’s average monthly wage from the prior year. + +- Cost: There is no cost to you. Your employer handles all the paperwork — you don’t need to do anything. +- In plain terms: You’re entitled to at least 98 days of maternity leave, including up to 15 days you can take before the birth. If the delivery is difficult, you get an extra 15 days. For each additional child born, you receive another 15 days of leave. The money paid during this time is called maternity benefits and comes from the maternity insurance fund. If your employer hasn’t enrolled in this insurance, they must pay the benefits themselves. +- Benefit: The length of maternity leave is set by the State Council: “Female employees are entitled to 98 days of maternity leave, including 15 days before delivery; an extra 15 days are added for difficult deliveries; for each additional child born, an additional 15 days of leave are granted.” The payments received during this period are known as maternity benefits. For employees covered by maternity insurance, these benefits are paid by the insurance fund at the rate of the employer’s average monthly wage from the prior year. Employees not covered by insurance receive benefits from their employer at the same wage level they earned before taking leave. +- Evidence grade: A +- Notes: 98 days is the minimum standard mandated by the state. Most provincial regulations on family planning add at least 60 days of additional “reward leave” for childbirth, bringing the total to at least 158 days in most regions. The party responsible for paying wages during this reward leave varies by province. +- Sources:国务院 (2012). 女职工劳动保护特别规定（国令第 619 号，第七条、第八条）. + +### 3. Important to know: Employers cannot cut pay or fire workers due to pregnancy, childbirth, or breastfeeding + +- Cost: No cost at all +- In plain terms: During pregnancy, after giving birth, or while breastfeeding, it is illegal for employers to cut your pay or fire you. Violators face fines ranging from 1,000 to 5,000 yuan per employee. For infants under one year old, you are entitled to one hour of breastfeeding time each day, and employers cannot assign you overtime or night shifts. Instructions on how to file a claim can be found in Section 19. +- Benefit: As stipulated by the State Council, “Employers must not reduce the wages of female employees, fire them, or terminate their labor or employment contracts due to pregnancy, childbirth, or breastfeeding.” In other words, during these periods, employers cannot lower your pay, fire you, or end your contract. Mothers of infants under one year old are entitled to one hour of breastfeeding time daily, and employers must not require them to work extra hours or night shifts. Any violations result in fines of at least 1,000 yuan and up to 5,000 yuan per employee. +- Evidence grade: A +- Notes: If you are illegally fired, refer to Section 19 for steps on filing a claim. Key evidence includes any written notices or messages regarding job reassignment or pay cuts — be sure to keep these records safe. +- Sources:国务院 (2012). 女职工劳动保护特别规定（国令第 619 号，第五条、第九条、第十三条）. + +### 4. The time-cost calculation is based on “whose time is being used,” not on “how hard it is” + + +- Cost: There’s no monetary expense — only time is spent. For children under 3, that time is essentially taken up around the clock. The difficulty lies in the fact that this happens daily, not just for a few tough days. +- In plain terms: Count up all the hours spent caring for the child each day, plus every nighttime wake-up call. Then multiply that total by the hourly wage of the person doing the work. The resulting figure is usually far higher than the cost of formula and diapers. That’s why it’s best to discuss how responsibilities will be divided before having a child. +- Benefit: By converting daily childcare time and nighttime interruptions into hours, then multiplying by the caregiver’s hourly wage, you arrive at a number that typically exceeds the cost of formula and diapers. Even unpaid tasks like childcare, cooking, and nightly wake-ups should be treated the same way — converted to hours and multiplied by a wage figure to be included in the total cost. The calculation method mirrors that used in Section 10 for household chores. Having a clear division of labor agreed upon beforehand makes it easier to decide whether to have a child. +- Evidence grade: C +- Notes: The goal isn’t to produce a perfectly accurate figure. Rather, it’s to ensure both partners discuss responsibilities using the same calculation framework prior to having a child, rather than arguing about it afterward. +- Sources:作者经验，无直接文献；口径见第 10 节 + +### 5. Breaking down costs into three periods: ages 0–3, compulsory education, and post‑compulsory education + +- Cost: There’s no single fixed figure for total expenses; they vary widely depending on the city and the approach families take. The real challenge is to carefully separate the costs into these three periods instead of guessing a rough total. +- In plain terms: For ages 0–3, most spending goes toward childcare arrangements — whether parents care for the child themselves, grandparents help out, or a professional is hired. During primary and middle school, the main expenses are housing and extracurricular activities. After that, costs center on further education pathways. Since spending patterns differ so much in each phase, lumping them together yields only an intimidating overall figure. +- Benefit: The bulk of expenses in the 0–3 age range relate to childcare methods; for compulsory education, housing and after‑school programs dominate; later on, costs shift toward higher‑level schooling. Because these categories are distinct, mixing them obscures the true financial picture. +- Evidence grade: C +- Notes: First, factor in any guaranteed financial support such as parental subsidies, maternity allowances, and yibao reimbursements; then determine what additional funds are still needed. Avoid basing decisions on widely circulated online estimates like “it costs X million to raise a child,” as their calculation methods are unclear and may omit or overstate certain items. +- Sources:作者经验，无直接文献 + +### 6. Keep separate accounts for having kids for your elders, for marriage, and for old-age security + +- Cost: There’s no monetary cost — only the cost of having a sincere conversation. The real challenge is speaking openly about these topics without dodging them. +- In plain terms: Others may expect you to have children, and that can certainly be one factor to consider. Yet the time and money involved are expenses you personally bear. “Relying on kids for old-age support” deserves its own separate calculation, since it hinges on another person’s financial capacity and willingness two decades down the line. Be sure to also write down the consequences of choosing not to have kids, so you can compare both sides fairly. +- Benefit: The reasoning here mirrors that in Section 10. External expectations are valid considerations, but their associated costs must be recorded on your own ledger, not someone else’s. This is especially true for “relying on kids for old-age support,” which depends entirely on another individual’s future financial situation and willingness to help. +- Evidence grade: C +- Notes: Make sure to list both the consequences of having kids and those of not having them, then compare them side by side. Recording only one side of the equation doesn’t truly qualify as keeping accounts at all. +- Sources:作者经验，无直接文献；同类分析见第 10 节 diff --git a/book/en/19-Employment-And-Work-Injury.md b/book/en/19-Employment-And-Work-Injury.md new file mode 100644 index 00000000..921ccf7d --- /dev/null +++ b/book/en/19-Employment-And-Work-Injury.md @@ -0,0 +1,178 @@ +# 19. While employed, upon leaving the job, and for work‑related injuries + +This section is all about money — how it’s calculated, what paperwork you must sign, and what deadlines apply. The first three items cover payments you’re entitled to while still on the payroll. The next six items deal with situations after you leave your job. Finally, the last seven items address occupational diseases and work‑related injuries. Compensation for injuries is far higher than severance pay, and the time limits are much stricter. Unfortunately, damage caused by an occupational disease can never be fully reversed. +### 1. Overtime pay is calculated at three rates: 1.5×, 2×, and 3× the regular wage; failure to pay warrants a complaint to labor authorities, and non‑payment after the deadline incurs an additional penalty of 50%–100% of the owed amount. + + +- Cost: There is no direct cost. Simply keep copies of time‑card records, shift schedules, and overtime approval forms; also screenshot any messages from supervisors assigning work in the team chat. The challenge is remembering to do this each month. + +- In plain terms: For ordinary workdays, overtime must be paid at 1.5× the wage. On rest days, if no compensatory time off is granted, the rate rises to 2×. On statutory holidays such as New Year’s Day, Spring Festival, Labor Day, and National Day, overtime must be paid at 3× the wage, and compensatory time off is not permitted. If a company refuses to pay, workers may file a complaint with labor authorities. Should payment still be delayed after a deadline set by authorities, the employer must pay an extra penalty equal to half to one‑fold the original amount owed. + +- Benefit: Statutory limits cap normal working hours at 8 per day and 44 per week. Regular overtime should not exceed one hour daily; under special circumstances it may reach three hours per day, but the monthly total must stay under 36 hours. Overtime pay follows three tiers: 150% of the wage for ordinary days, 200% for rest‑day work without compensatory time, and 300% for statutory holiday work. The law explicitly forbids substituting compensatory time off for holiday overtime pay. Employers that fail to pay face orders to settle the debt promptly; non‑compliance triggers an additional penalty of 50%–100% of that debt. + +- Evidence grade: A + +- Notes: Rest days and statutory holidays are distinct categories; the latter comprise only a handful of nationally designated days each year. Days created through compensatory leave arrangements are treated as rest days and therefore receive the 200% rate. Statements such as “the company requires overtime approval” or “I stayed voluntarily” do not absolve employers of payment obligations, yet they can complicate evidence collection; consequently, it is vital to retain documentation of work assignments and approvals. Implementing alternative work‑time regimes such as a comprehensive‑hour calculation system or a flexible‑hour schedule requires prior authorization from labor authorities. Details on arbitration time limits appear in Section 8, Article 19. +- Sources:全国人大常委会 (2018). 劳动法（2018 年第二次修正，第三十六、四十一、四十三、四十四条）. （国家市场监督管理总局刊登）；全国人大常委会 (2007). 劳动合同法（第八十五条第三项）. + +### 2. Annual leave is calculated based on total years of service: 5, 10, or 15 days. If unused, employees receive 300% of their daily wage as compensation. + + +- Cost: There is no cost involved. Simply add up all the years you’ve worked at every employer; your social insurance records serve as proof. The main challenge is avoiding signing any form that states you “voluntarily waive annual leave.” + +- In plain terms: If your total work experience across all employers is at least 1 year but under 10 years, you’re entitled to 5 days of annual leave per year. For 10–20 years of experience, it’s 10 days; for 20+ years, it’s 15 days. These totals continue to accumulate even after changing jobs. If your employer cannot arrange leave and you agree to forgo it, you’ll receive three times your daily wage for those days. Signing a “voluntary waiver of annual leave” form means you’ll only receive your regular salary thereafter. + +- Benefit: Employees who have worked continuously for 12 months qualify for annual leave. The number of days is determined by total years of service across all employers. Specifically, 5 days apply to 1–10 years of experience, 10 days for 10–20 years, and 15 days for 20+ years. Statutory holidays and weekends do not count toward this total. If an employer genuinely cannot provide leave due to operational needs and you consent to forgoing it, you’ll receive 300% of your daily wage as compensation. This amount already includes your regular salary, so the extra payment equals 200% of your daily wage. Daily wage is calculated as monthly salary ÷ 21.75; monthly salary is the average of the previous 12 months’ earnings excluding overtime. New employees receive a pro‑rated amount based on days worked that year. Upon termination, unused leave is compensated proportionally, with no deductions for any leave already taken. Employers failing to provide leave or compensation face mandatory corrections; persistent non‑compliance results in an additional penalty equal to the original compensation amount (effective nationwide since 1 Jan 2008). + +- Evidence grade: A + +- Notes: Total years of service are cumulative across all employers, not limited to one company. Never base calculations solely on tenure at your current employer. Only when an employee “voluntarily and in writing waives leave” may the employer limit payment to regular wages; therefore, avoid signing such waivers. Employees taking 20+ days of personal leave without wage deductions also lose annual leave entitlement. Similarly, extended sick leave disqualifies workers: 2 months for under‑10‑year experience, 3 months for 10–20 years, and 4 months for 20+ years. Family‑visit leave, marriage or bereavement leave, maternity/paternity leave, and periods of work‑related injury recovery do not count toward annual leave. +- Sources:国务院 (2007). 职工带薪年休假条例（国务院令第 514 号，第二、三、四、五、七条）. ；人力资源和社会保障部 (2008). 企业职工带薪年休假实施办法（人社部令第 1 号，第三、四、五、十、十一、十二、十五条）. + +### 3. There is a legal limit on probation periods, wages must be at least 80% of the regular rate, and only one probation period may be set per employee + +- Cost: Zero expense. Spend a few minutes before signing to verify that the contract’s stated term and probation length match the legal requirements. +- In plain terms: For contracts lasting up to one year, the maximum probation period is one month. For contracts from one to three years, it is two months. For contracts exceeding three years, or open‑ended contracts, the maximum is six months. An employer may only place an employee on probation once; offering a second probation period after the employee has been regularized is illegal. During probation, wages must be no lower than the minimum wage for that position or 80% of the agreed regular wage, and they must also meet the local minimum wage standard. +- Benefit: Under the law, contracts of more than three months but under one year may have a probation period of no more than one month; those from one to three years may have a maximum of two months; and contracts of three years or longer, as well as open‑ended contracts, may have a maximum of six months. Contracts with a term defined solely by completion of a specific task, or those lasting less than three months, may not include any probation period at all. An employer may stipulate only one probation period for any given employee. If a contract mentions a probation period but does not specify its length, that period is deemed invalid and the entire contract term applies. Probation wages must be at least 80% of the lowest comparable wage within the organization or 80% of the agreed regular wage, and they must also meet the local minimum wage. Should an employer set a probation period longer than permitted by law, it must compensate the employee for the excess time at the regular monthly wage rate. Termination during probation is only permissible under specific legal circumstances, and the employer must provide a valid reason to the employee (nationwide). +- Evidence grade: A +- Notes: Three common violations occur frequently. First, a one‑year contract may contain a three‑month probation period. Second, after an employee becomes regular, the employer may attempt to impose another probation period. Third, some employers claim “no social insurance during probation,” yet the obligation to enroll begins on the first day of work, regardless of probation status; details are provided in Section 12, Item 16. Being dismissed during probation does not mean no compensation; eligibility depends on whether the dismissal meets legal criteria. Unlawful termination entitles the employee to double the regular wage as stipulated in Item 6. +- Sources:全国人大常委会 (2007). 劳动合同法（第十九、二十、二十一、八十三条）. + +### 4. Calculating N: One month’s salary per full year of service; half a month for periods under six months + +- Cost: No cost at all. Just use a calculator — it takes about ten minutes. +- In plain terms: When a layoff occurs, the employer must pay severance compensation calculated as follows: one month’s salary for each full year of service; periods of six months or more but less than a full year count as a full year; periods of less than six months result in half a month’s salary. The monthly salary figure is the average over the 12 months prior to termination, including bonuses, allowances, and other benefits. If an employee’s monthly salary exceeds three times the local average monthly wage from the previous year, the cap is set at three times that average, and the maximum eligible service period is 12 years. +- Benefit: This is the statutory severance payment mandated by labor law when an employee is laid off — commonly referred to as “N.” The calculation rules are: “One month’s salary per full year of service… for periods of six months or more but less than a full year, the period counts as a full year; for periods under six months, half a month’s salary is paid.” Monthly salaries exceeding three times the local average are capped at three times that figure, and the maximum service duration considered is 12 years. +- Evidence grade: A +- Notes: The monthly salary referenced here is the average over the 12 months preceding termination, incorporating bonuses, allowances, and other benefits — not just base pay. This is precisely where employers often attempt to undervalue compensation. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第四十七条）. + +### 5. If a company fires you without 30 days’ notice, it must pay an extra month’s salary + +- Cost: No cost at all. +- In plain terms: If a company terminates your employment without giving 30 days’ written notice, it must pay you an additional month’s salary on top of the standard compensation. This is commonly referred to as “N+1.” When negotiating, make sure this extra month is listed separately so the company doesn’t include it in the base amount “N.” +- Benefit: Under labor law, when an employer ends a contract under this provision, there are two permissible options: either provide 30 days’ written notice to the employee, or pay an extra month’s salary and then terminate the contract. If the employer wants you to leave immediately, it must pay this additional month’s wage. This extra payment is known as “notice pay” and is calculated separately from “N.” +- Evidence grade: A +- Notes: Consequently, the typical outcome of a lawful termination under these circumstances is “N+1.” During negotiations, keep the base compensation “N” and the extra month distinct to prevent the employer from bundling them together. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第四十条）. + +### 6. When a company unlawfully terminates employment, the compensation equals twice the standard severance amount + +- Cost: There is no direct cost involved. However, arbitration can take several months to resolve, and you must remain actively involved throughout this period without being able to drop the process midway. +- In plain terms: If a company unlawfully terminates an employee, the compensation payable is twice the standard severance amount — commonly referred to as “2N.” Whether termination qualifies as unlawful depends on specific circumstances. It’s advisable to seek legal aid or consult an attorney first to determine whether negotiation with the employer or pursuing arbitration is the better course of action. +- Benefit: Under labor law, employers who unlawfully terminate or end employment contracts must pay compensation equal to twice the standard severance amount outlined in Article 47 of the law. This means first calculating the standard severance figure and then doubling it for payment to the employee. +- Evidence grade: A +- Notes: This is the commonly known “2N” compensation rule. Whether termination qualifies as unlawful hinges on particular facts and conditions. Seek legal counsel first; further guidance on next steps is provided in Section 7. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第八十七条）. + +### 7. Never sign “voluntary resignation for personal reasons”; doing so forfeits your entitlements + +- Cost: No monetary cost. The difficulty lies in resisting the pressure to sign on the spot. +- In plain terms: Signing a statement that you’re resigning voluntarily for personal reasons typically means you lose both severance pay and eligibility for unemployment benefits. Voluntary resignation isn’t covered under the circumstances that entitle workers to compensation, except in cases where the employer fails to pay wages or neglects social insurance contributions. There’s no need to sign immediately — take a night to think it over. +- Benefit: The Labor Contract Law specifies exactly which circumstances qualify workers for severance pay. Voluntary resignation doesn’t meet these criteria, unless the employer has committed statutory violations such as wage arrears or non-payment of social insurance. Signing a voluntary resignation form usually results in forfeiting both severance pay and unemployment benefits. +- Evidence grade: B +- Notes: Employers often claim, “Sign this first to start the process; we’ll arrange compensation separately.” Make sure such promises are written into the agreement before signing; otherwise, refuse to sign. Failing to sign on the same day carries no legal consequences — take time to decide calmly. +- Sources:全国人大常委会 (2007). 中华人民共和国劳动合同法（2008 年 1 月 1 日施行）（第三十八条、第四十六条）. + +### 8. Save pay stubs, attendance records, employment contracts, social insurance documents, and chat logs before leaving your job + +- Cost: No expense required. It takes about half an hour to save all these documents. The tricky part is remembering to do it before you leave. +- In plain terms: Once you return your computer and work account, you won’t be able to access any of your pay stubs, attendance records, contracts, social insurance documents, or chat logs again. When filing for labor arbitration, you’ll still need these materials to prove your wage amount and whether you worked overtime. What you save are documents related to your own employment; do not take any company source code, client lists, or technical documents with you. +- Benefit: After returning your computer and account, you lose access to all these records. While arbitration proceedings may lean slightly in favor of the employer, you still need your own evidence to prove your wage level and overtime hours. +- Evidence grade: C +- Notes: Only documents related to your own employment should be saved. Do not take any company source code, client lists, or technical documentation with you; those are separate matters, as explained in Section 11. +- Sources:作者经验，无直接文献；维权路径见第 7 节 + +### 9. Two things to do right after leaving your job: register for unemployment benefits and review your non-compete agreement + +- Cost: No cost at all. +- In plain terms: Right after leaving a job, you should do two things. First, register for unemployment benefits and apply for those payments. Second, carefully read through your non-compete agreement. The clock for receiving unemployment benefits starts on the day you register; waiting even one month means you’ll get fewer months of payments. Only people who lose their jobs through no fault of their own qualify for these benefits, which is another key reason to avoid signing any paperwork stating you quit “voluntarily for personal reasons” (see Section 7). +- Benefit: There are four main requirements to qualify for unemployment benefits: you must have paid into the unemployment insurance system for at least one year, your job loss must not be due to your own choice, you must have completed the registration process, and you must still be actively looking for new work. The length of time you qualify for benefits depends on how many years you contributed: up to 12, 18, or 24 months respectively. Instructions on how to apply online are included in Section 7, Item 1. Non-compete agreements are valid for a maximum of two years, during which the employer is required to pay you monthly compensation. If the contract does not specify an exact amount, the payment is calculated as 30% of your average monthly wage over the 12 months prior to leaving your job, with a minimum floor set at the local minimum wage. You can only request to terminate the non-compete agreement if the employer fails to make these payments for three consecutive months; details on this process are in Section 11, Item 12. Unlike some other agreements, non-compete terms have a clear expiration date, and you must abide by all terms until that date arrives. +- Evidence grade: C +- Notes: This grade is assigned because there are no direct published studies confirming that registering for benefits on the day you leave work is the optimal timing; the figures listed in the source section are all direct quotes from official regulations. Unused unemployment benefits do not expire, but their eligibility period starts on the date of registration, so applying earlier means you can receive payments for more months. All required application materials and online application links are detailed in Section 7. Details on compensation calculations and termination conditions for non-compete agreements are in Section 11. Signing any paperwork stating you quit “voluntarily for personal reasons” not only disqualifies you from receiving severance pay, but also bars you from accessing unemployment benefits; this is further explained in Section 7. +- Sources:作者经验，无直接文献；引用的数字出自国务院 (1999). 失业保险条例（国务院令第 258 号，第十四、十六、十七条：「失业保险金自办理失业登记之日起计算」）. 和全国人大常委会 (2012). 劳动合同法（2012 年修正，第二十三、二十四条）. （抚顺市应急管理局转载） + +### 10. Before taking up a post where there is dust, noise, or chemicals, check whether the contract mentions any occupational hazards; the employer must arrange and pay for three occupational health examinations. + + +- Cost: No cost involved. When signing the contract, read every clause under “Disclosure of Occupational Disease Hazards” carefully. Make sure to keep a copy of each health examination report for yourself. The main difficulty lies in having to ask questions and request documents in person. + +- In plain terms: When you sign a contract, the employer must truthfully describe any occupational hazards associated with the job, how to protect yourself, and what benefits you’re entitled to — there can be no concealment or deception. If such information is omitted, you have the right to refuse the job, and the employer cannot fire you for that reason. The employer must also arrange and pay for three occupational health examinations: before starting work, during employment, and upon leaving the job. If the pre‑termination examination is not performed, the employer cannot terminate or end your contract. + +- Benefit: According to the Law on the Prevention and Control of Occupational Diseases, when drafting a labor contract the employer must disclose four key points: what occupational hazards the job may bring, what health consequences might arise, how to protect yourself, and what benefits you’ll receive. The statutory wording is “the employer shall truthfully inform the worker and include this information in the contract, without any concealment or deception.” Should the employer later assign you tasks not mentioned in the contract that involve occupational hazards, it must again provide full disclosure and negotiate any contract amendments. Failure to comply gives you the right to refuse such work, and the employer may not terminate the contract on that basis. The three required health examinations must be paid for by the employer, and you must receive a written confirmation of this expense. Workers who have not undergone the pre‑employment examination may not be assigned to hazardous duties; likewise, those with specific medical contraindications must not be placed in jobs they cannot safely perform. If any work‑related health damage is detected, the worker must be transferred to a suitable position. Importantly, “an employer may not terminate or end a labor contract with a worker who has not undergone a pre‑termination occupational health examination.” Upon leaving the job, you have the right to obtain a free, certified copy of your occupational health records; the employer must provide this promptly. These records are essential for any subsequent occupational disease diagnosis, and they must be secured before you leave. Claims related to occupational disease are treated as work‑related injuries; details can be found starting at item 12. + +- Evidence grade: A + +- Notes: During an interview, asking just three questions can help you gauge whether a company is legitimate: whether the job involves occupational hazards, whether these are mentioned in the contract, and who pays for the pre‑employment health check. If the interviewer cannot answer or suggests “just start working first,” proceed with caution. The requirement for a pre‑termination health examination is a crucial safeguard — without it, the employer cannot end your contract. This examination also serves as key evidence for any future occupational disease claim; the same applies to the health records copy you must obtain before leaving. Claims for occupational disease are handled as work‑related injuries, and the corresponding benefits are outlined from item 12 onward. +- Sources:全国人大常委会 (2018). 职业病防治法（2018 年修正，第三十三、三十五、三十六条）. （北京市人民政府转载） + +### 11. Damage caused by dust, noise, and chemical toxins is irreversible: employers must provide protective gear, and workers can refuse unsafe tasks + + +- Cost: No monetary cost. The real challenge is consistently wearing respirators, earplugs, and safety goggles, as well as refusing to perform tasks lacking adequate protection — this may lead coworkers to label you as “too picky.” + +- In plain terms: Pneumoconiosis, noise-induced hearing loss, and chemical eye burns are all listed as statutory occupational diseases. Once lung tissue or hearing is damaged, there is no treatment capable of restoring it. You have the right to know exactly what hazards exist at your workplace and to demand that your employer supply protective equipment and facilities. You may refuse any job that fails to provide these safeguards. Any attempt by your employer to cut your pay or terminate your contract in retaliation for exercising these rights is legally invalid. + +- Benefit: As of August 1, 2025, the official list of occupational diseases comprises 12 main categories containing 135 distinct conditions, including four open-ended clauses. Pneumoconiosis ranks first among them, covering silicosis, coal worker’s pneumoconiosis, graphite pneumoconiosis, carbon black pneumoconiosis, asbestosis, talc pneumoconiosis, cement pneumoconiosis, mica pneumoconiosis, potter’s pneumoconiosis, aluminum pneumoconiosis, welder’s pneumoconiosis, and foundry worker’s pneumoconiosis, plus one additional open clause. Noise-induced hearing loss and blast-induced hearing loss fall under occupational ear, nose, throat, and oral diseases; chemical eye burns and photic keratitis are listed under occupational eye diseases. All these injuries are permanent — once damaged, lungs and hearing cannot be repaired. Four fundamental rights are legally guaranteed: first, the right to be informed about all occupational hazards present, their potential consequences, and required protective measures; second, the right to demand provision of compliant protective equipment and improved working conditions; third, the right to report, criticize, or file complaints against any violations of occupational health laws or practices endangering health; fourth, the right to refuse any directive ordering work without proper protective measures. Furthermore, any employer action — such as wage cuts, benefit reductions, or contract termination — taken solely because a worker exercised these lawful rights is legally void nationwide. + +- Evidence grade: A + +- Notes: Ensure you use respirators specifically rated for particulate filtration; ordinary gauze masks or disposable surgical masks offer no protection against dust. If your employer does not supply earplugs for noisy environments, purchasing them yourself is advisable, as hearing loss cannot be reversed. The belief that “working just two years to save money is safe” does not apply to pneumoconiosis — silicosis can manifest years after exposure ends and may worsen over time, making off-duty health checks essential (see item 10, which mandates three free occupational health examinations paid for by employers). The updated list also includes two new categories: occupational musculoskeletal disorders, specifically carpal tunnel syndrome affecting manufacturing workers performing repetitive wrist motions; and occupational mental and behavioral disorders, specifically post-traumatic stress disorder affecting police officers, medical personnel, and emergency responders involved in crisis response. Immediate first-aid measures for chemical splashes onto skin are detailed in item 13, clause 21. +- Sources:国家卫生健康委、人力资源社会保障部、国家疾控局、全国总工会 (2024). 职业病分类和目录（2025 年 8 月 1 日起实施）. ；新版目录 12 大类 135 种的口径见国家卫生健康委 (2024). 新版目录将职业病调整为 12 大类 135 种. ；全国人大常委会 (2018). 职业病防治法（第三十九条）. （北京市人民政府转载） + +### 12. If you’re injured at work or hit while commuting, the first step is to get a work‑injury determination; if your employer won’t file it, you must do it yourself. + + +- Cost: There is no cost — just a trip to the social insurance authority. You’ll need three documents: a work‑injury determination application form, proof of employment, and a medical diagnosis certificate. +- In plain terms: Injuries that happen at work are considered work‑related injuries. Being hit while commuting — provided you bear no significant fault — also qualifies as a work‑injury. Without a formal work‑injury determination, however, you won’t receive medical coverage, wage replacement during recovery, or disability benefits. Employers must file the application within 30 days; if they fail to do so, you, your family, or a labor union may file it within one year. +- Benefit: Without a work‑injury determination, all related benefits disappear: medical care, wage continuation while you recover, and disability payments. If an employer misses the 30‑day deadline, it must pay all required benefits out of its own funds. +- Evidence grade: A +- Notes: The one‑year deadline is absolute — after that you can’t apply. The burden of proof rests with the employer: if it denies that an injury is work‑related, it must provide evidence to the contrary. Still, you should keep your own records — photos from the scene, coworkers’ contact info, medical records, and attendance logs. Article 16 lists three situations where injuries are not considered work‑related: intentional criminal acts, intoxication or drug use, and self‑inflicted harm or suicide. Article 15 also defines “deemed work‑injuries”: death from a sudden illness at work or within 48 hours after unsuccessful emergency treatment. +- Sources:国务院 (2010 修订). 工伤保险条例（国务院令第 586 号）第十四条列了七种「应当认定为工伤」，含「（六）在上下班途中，受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的」；第十七条「所在单位应当自事故伤害发生之日或者被诊断、鉴定为职业病之日起30日内，向统筹地区社会保险行政部门提出工伤认定申请」「用人单位未按前款规定提出工伤认定申请的，工伤职工或者其近亲属、工会组织在事故伤害发生之日或者被诊断、鉴定为职业病之日起1年内，可以直接向用人单位所在地统筹地区社会保险行政部门提出工伤认定申请」「用人单位未在本条第一款规定的时限内提交工伤认定申请，在此期间发生符合本条例规定的工伤待遇等有关费用由该用人单位负担」；第十九条「职工或者其近亲属认为是工伤，用人单位不认为是工伤的，由用人单位承担举证责任」；第二十条「自受理工伤认定申请之日起60日内作出工伤认定的决定」. + +### 13. Don’t believe the myth that “staying at work counts as a workplace injury”: if you suddenly feel unwell, call 120 first — don’t rush to clock in. + +- Cost: No cost at all. +- In plain terms: Hurrying to the office when you suddenly feel unwell won’t earn you any extra compensation. To be classified as a workplace injury, the incident must occur during working hours and at the workplace; if it happens on the way to work before you even arrive, it doesn’t qualify. Cases where medical treatment is delayed past 48 hours also don’t count. Those few extra minutes spent trying to meet the criteria can actually lower your chances of survival. +- Benefit: This rule states that a worker must suffer a sudden illness during working hours at their workplace, and then die within 48 hours despite medical efforts, to be deemed a workplace injury. Delaying medical care just to meet these conditions means sacrificing your own chance of survival for compensation that you might not even receive. +- Evidence grade: A +- Notes: Both conditions must be met: the illness must occur during working hours and at the workplace. It does not apply if the illness strikes on the way to work before reaching the office. If a worker falls ill at work, is taken home or to hospital, and dies within 48 hours despite treatment, this rule may still apply. What matters most is where the person was at the moment of illness, not where they ultimately die. Some short videos wrongly claim that “staying at work guarantees compensation”; in reality, those crucial first few minutes after falling ill — when prompt medical care is sought — are what truly determine the outcome. Additionally, the 48‑hour limit is strict: any case where treatment is delayed beyond this period does not qualify. +- Sources:工伤保险条例第十五条第一款第（一）项：「在工作时间和工作岗位，突发疾病死亡或者在48小时之内经抢救无效死亡的」视同工伤；第十四条第（六）项只把上下班途中「受到非本人主要责任的交通事故或者城市轨道交通、客运轮渡、火车事故伤害的」列为工伤，途中突发疾病不在其中. + +### 14. Even if the employer fails to enroll you in workers’ compensation insurance, you still qualify for full benefits paid entirely by the employer at the same rates + + +- Cost: There’s no direct cost to you. However, if the employer refuses to comply, you’ll need to pursue arbitration or even litigation, which can take several months. The difficulty lies in having to stay actively involved throughout this lengthy process. +- In plain terms: Even if your employer does not enroll you in workers’ compensation insurance, you are still entitled to all related benefits. Those benefits must then be paid in full by the employer, using the same coverage items and payment standards as if insurance had been purchased. Failure to enroll is penalized: the employer must retroactively pay premiums plus a daily late fee of 0.05%, and may face fines equal to 1–3 times the unpaid amount. The claim “the company can’t compensate you because it didn’t buy insurance” is simply untrue. +- Benefit: Statutory rules clearly state that when an employer neglects to enroll an employee in workers’ compensation insurance, any resulting workplace injuries must be compensated by that employer itself, using identical coverage items and payment amounts mandated by law. In other words, the employer bears the entire financial burden without exception. +- Evidence grade: A +- Notes: “The company can’t pay compensation because it didn’t purchase workers’ compensation insurance” is one of the most common false statements encountered in such cases. While non‑enrollment brings penalties for the employer, it does not reduce your right to receive full compensation. +- Sources:工伤保险条例第六十二条第二款：「依照本条例规定应当参加工伤保险而未参加工伤保险的用人单位职工发生工伤的，由该用人单位按照本条例规定的工伤保险待遇项目和标准支付费用。」同条第一款：责令限期参加、补缴，「自欠缴之日起，按日加收万分之五的滞纳金；逾期仍不缴纳的，处欠缴数额1倍以上3倍以下的罚款」. + +### 15. After injuries stabilize, undergo a work capacity assessment; disability grades translate directly into compensation + + +- Cost: There is no monetary cost. However, completing the work capacity assessment process takes some time. +- In plain terms: Once injuries have stabilized, a work capacity assessment can be done, and the resulting disability grade translates directly into compensation. One-time disability benefits are calculated based on the individual’s own salary: Grade 5 equals 18 months’ salary, Grade 6 equals 16 months’, Grade 7 equals 13 months’, Grade 8 equals 11 months’, Grade 9 equals 9 months’, and Grade 10 equals 7 months’. Before the assessment results are finalized, do not sign any “one-time settlement” agreements. +- Benefit: One-time disability benefits are paid out as a lump sum, calculated based on the individual’s own salary and their disability grade. For Grade 5, this equals 18 months’ salary; for Grade 6, 16 months’; for Grade 7, 13 months’; for Grade 8, 11 months’; for Grade 9, 9 months’; and for Grade 10, 7 months’. +- Evidence grade: A +- Notes: Workers with Grades 5 and 6 retain their employment status and continue to receive disability allowances each month from their employer. For those with Grades 7 through 10, upon contract expiration or voluntary termination, two additional payments apply: a one-time work injury medical allowance paid by the fund, and a one-time disability employment allowance paid by the employer; exact amounts are set by provincial regulations. Before the assessment results are finalized, do not sign any “one-time settlement” agreements. +- Sources:工伤保险条例第二十一条「经治疗伤情相对稳定后存在残疾、影响劳动能力的，应当进行劳动能力鉴定」；第二十二条「劳动功能障碍分为十个伤残等级，最重的为一级，最轻的为十级」；第三十六条五、六级待遇（一次性伤残补助金 18/16 个月本人工资，按月伤残津贴为本人工资的 70%/60%）；第三十七条七至十级待遇（13/11/9/7 个月本人工资）. + +### 16. Three types of compensation for work-related deaths: funeral allowance, survivor’s pension, and one-time death benefit + +- Cost: No cost involved; only a set of administrative procedures are required. +- In plain terms: There are three distinct compensation amounts for workers who die on the job — don’t confuse them or focus on just one. The funeral allowance equals six months of the average monthly wage of local workers from the previous year. The survivor’s pension is paid monthly based on the deceased worker’s own wage: 40% goes to the spouse, while each other dependent relative receives 30% per month. The one-time death benefit is fixed at 20 times the per capita disposable income of urban residents nationwide in the prior year — this amount is identical across all regions. +- Benefit: Three separate payments are provided for work-related deaths. First, the funeral allowance equals six months of the average monthly wage of workers in the relevant insurance region from the previous year. Second, the survivor’s pension is paid monthly at a rate tied to the deceased worker’s wage: 40% of that amount goes to the spouse, and 30% is allocated to each other dependent relative each month. Third, the one-time death benefit is set at 20 times the per capita disposable income of urban residents nationwide in the prior year; this figure is uniform across all regions, with no regional variations. +- Evidence grade: A +- Notes: TODO (pending verification: the exact amount for the current year calculated using 2025 per capita disposable income data for urban residents nationwide has not been obtained from the official National Bureau of Statistics documents). The one-time death benefit is standardized nationwide. Claims that “local regional standards are lower” are not accepted when negotiating compensation amounts. +- Sources:工伤保险条例第三十九条：「（一）丧葬补助金为6个月的统筹地区上年度职工月平均工资；（二）供养亲属抚恤金按照职工本人工资的一定比例发给由因工死亡职工生前提供主要生活来源、无劳动能力的亲属。标准为：配偶每月40%，其他亲属每人每月30%，孤寡老人或者孤儿每人每月在上述标准的基础上增加10%……（三）一次性工亡补助金标准为上一年度全国城镇居民人均可支配收入的20倍。」. + +### 17. If you’ve been bullied, insulted, or mistreated at work for a long time, don’t just endure it: document everything as evidence, then take action based on the nature of the abuse. + +- Cost: There’s no monetary cost. However, it does take time to record details such as dates, witnesses, exact quotes from the abuser, and to keep original screenshots and emails. Legal proceedings like arbitration or lawsuits can last several months. Changing jobs is the most costly option; you must weigh these factors yourself. +- In plain terms: Employees who experience workplace bullying have a roughly 60% higher risk of developing heart disease or having a stroke, and this risk rises with the severity of the bullying. After several years, they are also about twice as likely to entertain suicidal thoughts compared to their peers. Being constantly insulted and mistreated is far from a minor inconvenience that can simply be “tolerated.” +- Benefit: From a health perspective: three Swedish and Danish cohorts comprising 79,201 working adults aged 18–65 were studied over an average of 12.4 years. At baseline, none had cardiovascular disease; 9% reported having experienced workplace bullying in the previous year. Those who endured bullying faced a 59% higher risk of developing cardiovascular disease (coronary heart disease or cerebrovascular disease; HR 1.59, 95% CI 1.28–1.98). Individuals subjected to workplace violence faced a 25% higher risk (HR 1.25, 95% CI 1.12–1.40); both risks increased with the frequency of abuse. A Norwegian nationwide survey of 1,846 workers, followed over three rounds of testing spaced two to three years apart, found that bullied individuals were roughly twice as likely to develop suicidal thoughts (OR 2.05, 95% CI 1.08–3.89). Conversely, people with prior suicidal thoughts did not later become more prone to bullying. From a legal standpoint: China currently lacks specific legislation addressing “workplace bullying”; actions must be evaluated against existing laws. Employers found guilty of insults, corporal punishment, physical assault, unlawful searches, or unlawful detention of workers face administrative penalties and must compensate for any harm; criminal acts incur further legal consequences. If an employer uses violence or threats to compel work, employees may terminate their contracts immediately without notice and are entitled to financial compensation. Employers must also implement measures to prevent and curb sexual harassment by leveraging authority or hierarchical relationships; victims may seek civil redress from harassers. Labor arbitration cases are resolved within 45 days of acceptance, with a possible extension of 15 days for complex cases. +- Evidence grade: B +- Notes: This grade is assigned because the health data derive from observational studies rather than randomized controlled trials, and “bullying” was self-reported by participants. This guidance does not advocate quitting a job at the first sign of mistreatment; the personal cost of changing jobs must be considered. Four practical steps can be taken: first, begin documenting incidents immediately; refer to Section 8, Item 41 for guidance on recording audio evidence. Second, submit written complaints through official internal channels and retain proof of such submissions. Third, if physical assault, unlawful confinement, or public humiliation occurs, contact law enforcement. Fourth, if forced to leave due to unpaid wages or lack of social insurance contributions, follow Section 7 (“Do not voluntarily resign”) and Section 8 (“Preserve evidence prior to leaving”) of this chapter. For details on calculating compensation, see Section 4 (“Calculate your entitlements after layoffs”). Mere neglect, exclusion, or minor mistreatment rarely violate any specific statutes; in such cases, internal complaints, job transfers, or changing employers are the primary remedies. Arbitration proceedings may take up to 60 days, while civil lawsuits typically require at least six months; legal fees must be borne by the plaintiff. If the situation becomes unbearable, call 12356 as outlined in Section 1, Item 25. +- Sources:Xu T 等 (2019). Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. European Heart Journal. ；Nielsen MB, Nielsen GH, Notelaers G, Einarsen S (2015). Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study. American Journal of Public Health. ；全国人大常委会 (2007). 劳动合同法（第三十八条第二款、第四十六条、第八十八条）. ；全国人大 (2020). 民法典（第一千零一十条）. 最高人民检察院转载全文 ；全国人大常委会 (2022 年修订). 妇女权益保障法（第二十五条）. ；全国人大常委会 (2007). 劳动争议调解仲裁法（第四十三条）. 安康市人社局转载全文 diff --git a/book/en/20-Newborn.md b/book/en/20-Newborn.md new file mode 100644 index 00000000..21e1016c --- /dev/null +++ b/book/en/20-Newborn.md @@ -0,0 +1,118 @@ +# 20. How to care for a newborn baby + +This section focuses on two main topics: what it takes to keep a newborn alive and how much it will cost you. Only differences that are substantial and backed by solid evidence are included here. Detailed advice on soothing or raising a baby is beyond the scope of this book. For tasks to handle before birth and on the day of discharge, please refer to Section 27. +### 1. Keep infants sleeping on their backs on a firm surface; share a room but not a bed; and do not place any soft items in the crib or bed. + +- Cost: This costs nothing upfront. However, you’ll need to replace the mattress with a firm one, which may cost several hundred yuan. The real challenge is resisting pressure from older relatives to deviate from this rule. +- In plain terms: Always place babies on their backs to sleep on a hard, flat surface. Parents and infants should share a room, but not the same bed. Never put pillows, blankets, bed rails, stuffed animals, or special shaped pillows in the sleeping area. Inclined cribs or baby chairs are only meant for sitting — they must never be used as a sleeping surface. In the United States alone, roughly 3,500 infants die each year from sleep-related causes. +- Benefit: Each year, nearly 3,500 infants in the U.S. lose their lives to sleep-related issues, including sudden infant death syndrome, deaths of unknown cause, and accidental suffocation in bedding. The American Academy of Pediatrics recommends a safe sleep environment consisting of: infants sleeping on their backs; using a solid, non-inclined sleeping surface; sharing a room without sharing a bed; and avoiding soft bedding and overheating. Additional protective measures include breastfeeding, keeping infants away from nicotine and alcohol, ensuring all vaccinations are up to date, and offering a pacifier during sleep. +- Evidence grade: A +- Notes: “Do not place any soft items in the bed” means absolutely no pillows, blankets, bed rails, stuffed toys, or shaped pillows — even nursing pillows that appear perfectly safe are prohibited. Inclined cribs and baby chairs must never be used as sleeping areas. This requirement represents the biggest departure from common practice in this section, and it often requires the strongest resistance to family pressure. +- Sources:Moon RY, Carlin RF, Hand I, Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn (2022). Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics, 150(1), e2022057990. + +### 2. Administer the first dose of hepatitis B vaccine within 24 hours after birth + +- Cost: No cost at all. The hepatitis B vaccine is part of the routine immunization program, so it is provided free of charge. It is given to newborns in the hospital on the day of birth; no extra trips are needed. +- In plain terms: The first dose of hepatitis B vaccine must be given to a newborn within 24 hours after birth. Roughly 95% of infants and toddlers who contract hepatitis B go on to develop chronic hepatitis. In contrast, the vast majority of adults who get infected recover on their own without medical intervention. Hence, the earlier this vaccine is administered, the greater its protective benefit. If the mother tests positive for hepatitis B surface antigen, the infant also needs to receive an injection of hepatitis B immunoglobulin at the same time. +- Benefit: The World Health Organization states: “All infants should receive the hepatitis B vaccine as early as possible after birth, ideally within 24 hours.” The rationale behind this recommendation is that “about 95% of infections in infants and toddlers progress to chronic hepatitis.” Most adults who contract the virus also recover spontaneously, meaning they do not require any treatment to get better. +- Evidence grade: A +- Notes: If the mother tests positive for hepatitis B surface antigen, the newborn must receive an injection of hepatitis B immunoglobulin right after birth. This fact must be clarified during prenatal checkups; do not wait until after delivery to ask about it. Details on screening requirements for mothers can be found in Section 1. +- Sources:World Health Organization. Hepatitis B fact sheet. + +### 3. Ensure your child receives all vaccines in the national immunization schedule at no cost; missed doses can be added later + + +- Cost: Absolutely free. Laws explicitly state that vaccination centers may not charge any fees for administering vaccines on the national schedule. You’ll need to visit the clinic several times according to your child’s age. Be sure to keep the vaccination record safe and never lose it. + +- In plain terms: All vaccines included in the national immunization schedule are completely free — clinics cannot charge a single cent. Both daycare centers and schools require proof of vaccination, so any missed doses will definitely be noticed and must be made up later. You only need to receive the remaining doses; there’s no need to restart the entire series from the beginning. Even if a different manufacturer produces the same vaccine, it can still be used. Conditions such as eczema, hives, allergic rhinitis, asthma, and even neonatal jaundice do not prevent vaccination, provided the condition remains stable. + +- Benefit: Daycare centers and schools must verify that children have received all required vaccines on schedule. If any gaps are found, they must inform vaccination centers so guardians can be urged to complete the missing doses. Thus, missing vaccines cannot be ignored — they must be addressed before school entry. The current guidelines date to 2026. Human papillomavirus (HPV) vaccine is now part of the national schedule. The starting age for DTaP vaccination has been lowered from 3 months to 2 months; a total of five doses are required at 2, 4, 6 months, 18 months, and age 6. Starting March 2026, children in Tibet, Qinghai, Xinjiang, and the Xinjiang Production and Construction Corps will also routinely receive Japanese encephalitis vaccine. Multiple vaccines may be administered on the same day per current protocols, provided they are injected into separate sites; mixing different vaccines into one syringe is strictly prohibited. For inactivated vaccines, oral live vaccines, and other types, no minimum interval is required between doses. For children under 18, the rule is to catch up as soon as possible — only the missing doses must be given, not the whole series from scratch. Switching manufacturers poses no problem. (National guidelines, 2026 edition) + +- Evidence grade: A + +- Notes: A common misconception is that children with weaker health should delay vaccination. In reality, having an “allergic constitution,” a family history of allergies, or prior food or drug allergies does not constitute a barrier to vaccination. Conditions such as atopic dermatitis (eczema), hives, allergic rhinitis, and bronchial asthma can all be managed safely provided they remain under control. Children taking antihistamines or inhaled corticosteroids may also be vaccinated. Physiological or breast milk–related neonatal jaundice poses no issue either. The only true contraindications are prior occurrence of acute severe allergic reactions to a specific vaccine or known hypersensitivity to any component of that vaccine. Children with immune deficiencies, undergoing chemotherapy or radiotherapy, or on immunosuppressive therapy require individualized assessment by a medical professional prior to vaccination. For details on the first dose of hepatitis B vaccine, refer to section 2. Non‑schedule vaccines sold at additional cost are unrelated to this free program. +- Sources:全国人大常委会 (2019). 疫苗管理法（第四十八、四十九条）. （云南省卫生健康委员会转载）；国家疾病预防控制局、国家卫生健康委 (2026). 《国家免疫规划疫苗儿童免疫程序及说明（2026 年版）》解读问答. + +### 4. Breastfeed exclusively for the first 6 months — no water needed; introduce solids at 6 months while continuing breastfeeding + +- Cost: This costs nothing; it even saves money compared to formula. The main “cost” is time — breastfeeding takes up a lot of daily effort. The real challenge is maintaining this routine; breastfeeding must continue without interruption during the first 6 months. +- In plain terms: Breastfeeding should begin within the first hour after birth. For the first 6 months, infants only need breast milk — no water or other fluids are required. At 6 months, solid foods can be introduced, while breastfeeding should be continued until age 2 or beyond. These solid foods must include iron-rich animal-based products. If breast milk is insufficient or unavailable, formula is a perfectly acceptable alternative — there is no need to feel guilty. The choice between breast milk and formula has far less impact on a child’s survival than ensuring they sleep on their back. +- Benefit: The World Health Organization recommends initiating breastfeeding within the first hour after birth. It also advises exclusive breastfeeding for the first 6 months — meaning no other foods or liquids, not even water — followed by the gradual introduction of safe, adequate solid foods while continuing breastfeeding until at least age 2. The national Health Commission’s guidelines likewise promote exclusive breastfeeding from birth to 6 months, and further stipulate that solid foods given after 6 months must contain iron-rich animal products. +- Evidence grade: A +- Notes: If breast milk is insufficient or not an option, formula is a perfectly acceptable substitute — there is no need for guilt. The difference between breastfeeding and formula feeding is far smaller than the impact of ensuring safe sleeping practices. As for frequency of solid food intake: infants aged 6–8 months should consume solids 1–2 times daily, while those aged 9–12 months should have 2–3 servings per day. Their daily diet must include at least four of the seven essential food groups. For infants with severe eczema or egg allergies, the question of whether to avoid peanuts is addressed in Section 12 of this chapter — the answer is: there is no need to avoid peanuts. +- Sources:World Health Organization. Breastfeeding. ；国家卫生健康委办公厅 (2024). 婴幼儿营养喂养评估服务指南（试行）（国卫办妇幼函〔2024〕452 号）. + +### 5. Use water hotter than 70 °C to prepare formula, then let it cool before feeding; discard any leftovers. + +- Cost: No monetary cost. It only requires a few extra minutes of waiting for the milk to cool. The difficulty lies in the fact that even when a baby is crying from hunger, caregivers must still wait for the water temperature to drop before mixing the formula. +- In plain terms: Formula milk is not sterile and may contain a bacterium called Cronobacter sakazakii. Once newborns are infected, reported mortality rates range from 40% to 80%. To minimize this risk, first pour hot water into the feeding bottle, then wait until the temperature drops to around 73.8 °C before adding the formula. At this point, the milk remains above 70 °C, which can reduce the amount of this bacterium to less than one ten-thousandth of its original level. After preparation, let the milk cool completely before feeding, and discard any portions that are not consumed. +- Benefit: Formula milk is not sterile and may harbor Cronobacter sakazakii. Reported mortality rates among newborns infected with this bacterium fall between 40% and 80%. Experimental studies show that when hot water is first added to the bottle and the temperature is allowed to drop to roughly 73.8 °C prior to adding formula, the milk temperature stays above 70 °C in most cases. This process reduces the concentration of Cronobacter sakazakii by more than 5 logarithmic units, effectively bringing it down to under one ten-thousandth of its original amount. +- Evidence grade: A +- Notes: The 70 °C threshold is specified in public health guidelines. Beary et al. explicitly state: “Public health guidelines for caregivers of high-risk infants recommend using water heated to at least 70 °C (158 °F) to prepare infant formula, in order to inactivate harmful microorganisms.” Premature infants, those with low birth weight, and babies under 2 months of age are at the highest risk of infection. Never use water that has been stored in a thermos for a full day to prepare formula, and do not leave prepared milk at room temperature for later use. +- Sources:Beary MA, Daly SE, Baker J, Snyder AB (2025). Assessing Hot Water Reconstitution Instructions and Labeling of Powdered Infant Formula to Ensure Cronobacter spp. Reduction. Journal of Food Protection, 88(9), 100571. ；Sima WG, Legesse T, Girma S, et al. (2025). Emerging microbial risks: Cronobacter sakazakii in powdered infant formula for infants under six months of age in Ethiopia. BMC Microbiology, 26, 307. ；World Health Organization & FAO (2007). Safe preparation, storage and handling of powdered infant formula: guidelines. + +### 6. Do not feed honey to children under 1 year old + +- Cost: No cost involved +- In plain terms: Never give honey to babies under 1 year of age. This includes honey water, honey mixed into baby food, and any baked goods containing honey. Honey can contain bacteria that cause botulism. An adult’s gut microbiome is able to keep these bacteria in check, but a baby’s cannot. The same rule applies to homemade pickled foods and fermented products. +- Benefit: According to the Chinese CDC, “Do not feed honey to children under 1 year of age” because “honey may contain bacteria that cause botulism.” An adult’s gut microbiome can suppress these bacterial spores — the dormant form of the bacteria — while a baby’s cannot. +- Evidence grade: A +- Notes: Foods and drinks to avoid include honey water, honey mixed into baby food, and any pastries containing honey. Likewise, homemade pickled foods and fermented products should not be given to infants. +- Sources:US CDC. Preventing Botulism. + +### 7. Vitamin K injection at birth is essential + + +- Cost: 0 to several dozen yuan. This cost is usually already included in the overall hospital delivery fee, so no extra payment is required. +- In plain terms: Newborns naturally have very little vitamin K stored in their bodies. Without supplementation, it can lead to vitamin K deficiency bleeding; the delayed form often manifests as bleeding inside the brain. In regions where this injection isn’t routinely given, the incidence of such bleeding is about 478 cases per 100,000 newborns. Administering the injection is estimated to reduce this rate by over 78%. In China, all reputable hospitals routinely provide this injection during delivery. For home births or births at unregulated facilities, parents should proactively ask whether it was given. +- Benefit: Newborns possess minimal vitamin K reserves. Failure to supplement may result in vitamin K deficiency bleeding, with the delayed type frequently presenting as intracranial hemorrhage. Belgian medical guidelines recommend a single intramuscular injection of 1–2 mg of vitamin K at birth. In areas lacking systematic prevention programs, the incidence of vitamin K deficiency bleeding is 478 cases per 100,000 newborns, based on data from 42,000 infants in Tashkent. The authors estimate that such preventive measures can lower the incidence by more than 78.5%. +- Evidence grade: B +- Notes: In reputable Chinese hospitals, this injection is administered routinely, so parents need not worry about it. However, for home births or births at unlicensed facilities, it’s crucial to confirm whether the injection was given. Oral administration is less effective than intramuscular injection. +- Sources:Fiesack S, Smits A, Rayyan M, et al. (2021). Nutrients, 13(11), 4109. ；Tursunov D, Yoshida Y, Yrysov K, et al. (2018). Nagoya Journal of Medical Science, 80(1), 11. + +### 8. Infants under 3 months with a body temperature of 38°C should be taken straight to the hospital — no home observation needed + +- Cost: Registration and tests cost several hundred yuan. +- In plain terms: Infants under 3 months of age with a body temperature of 38°C must be taken to the hospital right away. Do not wait at home, and do not give them fever reducers first to see if symptoms improve. Even if an infant at this age has a serious bacterial infection, fever may be the only symptom they show. Therefore, the fact that a baby seems alert and in good spirits is not a valid reason to keep them at home. For infants under 8 days old, there are no relevant medical guidelines at all, so they must be seen by a doctor immediately. +- Benefit: The American Academy of Pediatrics has issued specific guidelines for full-term infants aged 8 to 60 days who appear to be in decent health. These guidelines define fever as a body temperature of 38.0°C or higher. They further divide this age group into three subgroups — 8 to 21 days, 22 to 28 days, and 29 to 60 days — each with its own recommended course of action. Infants under 8 days old are not covered by these guidelines at all, which makes it even more imperative to seek medical care right away at this stage. +- Evidence grade: A +- Notes: Infants at this age can have serious bacterial infections that only manifest as fever. So, the fact that a baby seems alert and in good spirits is not a valid reason to keep them at home. Do not give them fever reducers first and then wait to see if symptoms improve. +- Sources:Pantell RH, Roberts KB, Adams WG, et al. (2021). Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics, 148(2), e2021052228. + +### 9. No matter how tired or angry you are, never shake a baby + + +- Cost: There is no monetary cost. The real difficulty lies in resisting the urge to shake a baby when you’re exhausted or upset. +- In plain terms: A baby’s head makes up a large proportion of their body size, yet their neck muscles are still very weak. Shaking them forcefully can cause bleeding inside the brain and eyes, potentially leading to death or lifelong disabilities. Gentle rocking while trying to soothe them is not dangerous; the real risk comes from uncontrolled, violent shaking. When you feel yourself losing control, place the baby back in their crib and step away for a few minutes. Letting them cry for a short while is far safer than holding them and shaking them. +- Benefit: Because a baby’s head is proportionally large and their neck muscles are underdeveloped, violent shaking can result in intracranial and retinal hemorrhage — bleeding in both the brain and eyes. This can be fatal or leave lasting impairments. Such harm is distinct from any gentle rocking used to calm them. Medically, injuries caused by shaking or impact are termed “abusive head trauma.” This condition is the leading cause of death from head injuries among children under 2 years old. In the United States between 1999 and 2014, it accounted for nearly 2,250 deaths of children under 5. +- Evidence grade: B +- Notes: When you truly feel you’re about to lose control, the safest action is to return the baby to their crib and leave the room for a few minutes. Allowing them to cry briefly is much safer than holding them and shaking them. This advice is especially vital for parents who care for their children alone and often suffer from sleep deprivation. For guidance on managing your own emotions, please refer to Section 3. +- Sources:Spies EL, Klevens J (2016). Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. MMWR 65(20):505-509. ；Choudhary AK 等 (2018). Consensus statement on abusive head trauma in infants and young children. Pediatric Radiology 48(8):1048-1065. + +### 10. Diaper selection depends on three factors: fit, how often you change them, and whether they’ve been flagged in quality inspections + +- Cost: Prices range from a few hundred to over a thousand yuan per month, depending on the brand and quality level you choose. The total monthly cost falls between 200 and 300 yuan on average. +- In plain terms: No government agency has ever published an official ranking of “which diaper brand is best.” The only verifiable information comes from two sources: product quality inspection reports issued by the State Administration for Market Regulation, and official investigations into specific incidents. A higher price tag does not guarantee safety, nor does being an imported product guarantee compliance with standards. Start by purchasing a small pack and trying it for a week; watch for signs of skin irritation or red marks on your baby’s skin. If they seem comfortable, you can then buy in bulk. +- Benefit: Since no official body has released any “best brand” rankings, this guide does not recommend any specific brands. The only reliable data available falls into two categories: first, inspection reports on product quality released by the State Administration for Market Regulation; second, official investigations into particular cases. Following public concern in June 2026 over formaldehyde levels in infant diapers, the Administration led a joint task force to conduct further checks. +- Evidence grade: C +- Notes: TODO: Need to verify the final conclusions of that investigation as well as the full text of the official inspection report from the State Administration for Market Regulation. In practice, higher cost does not equal greater safety, and imported products are not automatically compliant. Begin with a small trial pack to check for skin reactions or discomfort; remember that diaper rash is primarily caused by infrequent changes and poor breathability, rather than brand choice. Instructions on how to access inspection reports are provided in Section 5. +- Sources:中国政府网 (2026-06-22). 市场监管总局牵头成立联合调查组核查「婴幼儿纸尿裤甲酰胺问题」. （该页仅有标题，正文未展示，故本条只引用调查这一事实，不引用任何结论） + +### 11. Consider buying big-ticket items in the order “borrow, buy used, buy new” — don’t buy them all at once + +- Cost: No extra money is needed; the amount saved is usually in the thousands of yuan. The hard part is resisting the urge to buy everything at once. +- In plain terms: Strollers, cribs, blankets, and toys are used for only a short time, and there’s plenty of them on the used market with few buyers. First, try to borrow them; if that’s not possible, buy used; only then should you consider buying new — this usually saves you thousands of yuan. However, it’s not advisable to buy used car seats or mattresses, since any structural damage from prior crashes isn’t visible to the naked eye. Things like postpartum care centers and early-education classes are optional big expenses; wait at least 24 hours before deciding. +- Benefit: Strollers, cribs, blankets, and toys are all used for only a brief period, and the used market offers far more of them than there’s demand for. The only two items you really shouldn’t try to save money on — or buy used — are car seats and mattresses. Any structural damage to a car seat after a crash simply can’t be seen by looking at it. +- Evidence grade: C +- Notes: This book neither recommends nor discourages postpartum care centers, early-education classes, or baby swimming classes. Still, they’re all optional big expenses, so the 24-hour cooling-off period described in Section 5 applies to them. +- Sources:作者经验，无直接文献；安全座椅的证据见第 1 节，冲动消费见第 5 节 + +### 12. For children with severe eczema or egg allergy, don’t avoid peanuts — introduce them early under medical guidance, but never feed whole peanuts. + + +- Cost: A jar of peanut butter costs just a few dozen yuan. Feeding it a few times a week is easy to fit into a routine. Before starting, though, a doctor’s evaluation is required. +- In plain terms: In a randomized trial of 640 high‑risk infants, those who ate peanuts regularly from 4 to 11 months of age had a peanut allergy rate of only 1.9% by age 5, compared with 13.7% in the group that completely avoided peanuts. Among children already showing a weak positive skin test at enrollment, the rates were 10.6% versus 35.3%. Avoiding peanuts actually raises the risk of allergy. However, whole peanuts must never be given, as they can block the airway. A total of 530 infants had negative skin tests at entry, while 98 had weakly positive results. +- Benefit: The LEAP trial involved 640 infants aged 4–11 months with severe eczema, egg allergy, or both. One group ate peanut products regularly while the other avoided them entirely; at 60 months, only 1.9% of the eaters had a peanut allergy versus 13.7% of avoiders (P<0.001). Among 98 children with a weak positive skin test at entry, 10.6% of eaters were allergic versus 35.3% of avoiders (P=0.004). No serious adverse events differed between groups. +- Evidence grade: A +- Notes: Peanuts must be given only as thinned peanut butter or powdered form mixed into food — never as whole nuts. The Health Commission clearly states: “Whole peanuts, nuts, jelly, and similar foods can be inhaled into the airway and cause choking; infants should avoid them.” For choking first aid, see Section 13, Item 26. This guidance applies only to high‑risk children with severe eczema or egg allergy. A medical assessment is mandatory before introduction; in the LEAP trial, children with a skin‑test reaction greater than 4 mm were excluded. Another study of 1,162 breastfed infants found no significant difference in overall food allergy rates between early‑introduction and standard groups, though a subset showed a clear benefit: 5.6% versus 7.1% (P=0.32) and 2.4% versus 7.3% respectively. Evidence for typical infants is far weaker. Early introduction appears safe, but Chinese official guidelines currently give no recommendation on this point; therefore this advice follows international trial evidence. Keep in mind that LEAP started at 4 months while Chinese practice recommends waiting until 6 months for solids — consult a doctor on timing and method for high‑risk children. +- Sources:Du Toit G, Roberts G, Sayre PH, 等 (2015). Randomized trial of peanut consumption in infants at risk for peanut allergy. New England Journal of Medicine, 372(9), 803-813. ；国家卫生健康委办公厅 (2020). 婴幼儿喂养健康教育核心信息. ；Perkin MR 等 (2016). Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. New England Journal of Medicine, 374(18), 1733-1743. （备注里那项一般婴儿试验 EAT） diff --git a/book/en/21-Travel-And-Abroad-Safety.md b/book/en/21-Travel-And-Abroad-Safety.md new file mode 100644 index 00000000..ebfad2e5 --- /dev/null +++ b/book/en/21-Travel-And-Abroad-Safety.md @@ -0,0 +1,111 @@ +# 21. Traveling abroad, trips, and safety overseas + +This section deals with both financial matters and personal freedom, and several points also relate to physical safety. Once you’re overseas, it’s the laws of the host country that apply — not Chinese law. There are clear limits to what China’s embassies and consulates can do to assist you. This section explains those limits in detail. +### 1. Check the Ministry of Foreign Affairs safety advisories before you travel; steer clear of any locations marked “Do Not Travel” + + +- Cost: It’s free. Simply browse the Chinese Consular Service website — it takes just a few minutes. +- In plain terms: The Ministry of Foreign Affairs classifies overseas safety risks into four levels, with the highest level labeled “Do Not Travel.” As of September 15, 2026, avoiding high‑risk countries and regions has been codified in administrative regulations. When processing travel documents or at border control, officials will remind travelers and may even advise them against going. A quick glance at that page before departure is all you need. +- Benefit: The Ministry publishes safety advisories ranked from low to high risk: “Exercise Caution,” “Increase Safety Precautions,” “Travel with Care,” and “Do Not Travel.” The new regulation effective September 15, 2026, also spells out citizens’ obligations: “Chinese nationals should pay attention to overseas safety advisories and destination‑specific risk warnings, and avoid traveling to or staying in high‑risk countries or regions.” It further mandates that immigration authorities — responsible for issuing travel documents and border checks — warn and, if necessary, dissuade anyone planning to visit such areas. The original wording reads: “For Chinese citizens intending to travel to countries or regions with the highest risk level or where incidents threatening personal safety occur frequently, authorities must, when appropriate, dissuade them from going.” +- Evidence grade: A +- Notes: Advisories are updated as situations evolve; this guide does not list them, so be sure to check the page yourself before you travel. As of September 7, 2026, the “Do Not Travel” warnings covered Eswatini (August 25, 2026), Palestine (October 10, 2023), Sudan (April 17, 2023), Afghanistan (February 17, 2023), Syria (January 4, 2023), Peru (December 29, 2022), Somalia (November 24, 2022), as well as specific warnings for northern Myanmar and certain provinces of the Democratic Republic of the Congo. Travel agencies also have a duty to inform clients; before joining a tour, you can request a written summary of destination risks. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第二条）；国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十九、二十一条）；外交部领事司. 安全提醒. + +### 2. Save the 12308 hotline number and your local embassy/consulate’s consular protection number in your phone, then write them down and keep a copy in your wallet — don’t wait until an emergency to look them up. + + +- Cost: No cost at all. Saving two numbers and writing one copy down takes just a few minutes. + +- In plain terms: There is only one main hotline to call for help in an emergency. Inside China, dial 12308; abroad, call +86-10-12308. Since this hotline launched, it has handled over 3 million calls. During the same period, the Ministry of Foreign Affairs and its overseas missions dealt with more than 500,000 consular protection cases. + +- Benefit: The Ministry of Foreign Affairs operates a 24-hour global emergency hotline for consular protection and services. Inside China, call 12308; abroad, call +86-10-12308 or +86-10-65612308. Since its launch in 2014, this hotline has answered over 3 million calls, while the Ministry and its overseas missions have resolved more than 500,000 consular protection incidents. + +- Evidence grade: A + +- Notes: Your local embassy or consulate also maintains its own consular protection hotline, which is often quicker to reach than the main hotline. Before traveling, look up that number on the China Consular Service website for your destination country and save it alongside the main hotline number. However, if your phone is lost or runs out of battery, those saved numbers become useless. That’s why it’s wise to write down both numbers and keep one copy in your wallet, or give a copy to a family member. +- Sources:外交部、中国驻缅甸使领馆 (2023). 关于当前缅北地区安全局势的领事提醒. ；国务院新闻办 (2023). 国务院政策例行吹风会介绍领事保护与协助有关情况. + +### 3. Understanding what consular protection can and cannot do: it can visit you, but cannot bail you out, and you still have to pay the costs + + +- Cost: No cost at all. It only takes a few minutes to clearly understand these boundaries. +- In plain terms: If you’re arrested abroad, what consulates can do is verify your situation locally, demand fair and lawful treatment, visit you, and attend court hearings as observers. They cannot overturn a verdict or take you away. Any expenses such as food, lodging, transportation, or medical care paid in advance by others must ultimately be covered by you. Therefore, before traveling abroad, make sure you have sufficient funds and insurance — don’t assume the government will cover everything if something goes wrong. +- Benefit: When you’re detained, consulates can take several concrete actions. They can check your situation with local authorities and insist on fair treatment under both local laws and any relevant bilateral treaties. The official wording states: “In accordance with the laws of the host country and international treaties to which China and the host country are parties, consulates may visit or contact the detained individual, learn about their needs, and demand humane and fair treatment.” In simpler terms, they can visit you, communicate with you, ask what you need, and insist that local authorities treat you fairly and humanely. Consulates may also attend court sessions as observers and safeguard your right to a fair trial. If you’re injured or affected by a disaster, they can urge local emergency assistance and help your family handle aftermath matters. At the same time, the rules make it equally clear regarding costs: “Chinese citizens, legal entities, and other organizations must pay any expenses — such as food, lodging, transportation, and medical care — provided by third parties during consular assistance.” In other words, any costs initially covered by others must ultimately be borne by you. +- Evidence grade: A +- Notes: Consulates cannot pay fines or medical bills on your behalf, nor buy plane tickets or overturn court rulings. What they can provide is information on local lawyers, interpreters, medical providers, and funeral services, plus help contacting family and finding relief resources. Knowing these limits is valuable: it reminds you to prepare sufficient funds and insurance before traveling — don’t rely on the assumption that the state will handle everything if trouble arises. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第九、十、十四、二十六条） + +### 4. Purchase insurance that covers overseas medical care and medical evacuation — don’t settle for just flight delay coverage. + +- Cost: A short‑term travel insurance policy for overseas trips typically costs anywhere from a few dozen to several hundred yuan. +- In plain terms: Medical expenses incurred abroad must be paid out of pocket. Domestic medical insurance rarely covers such costs, and embassies or consulates won’t foot the bill either. What can truly devastate a family isn’t routine outpatient care but the massive expenses tied to hospitalization after a serious injury, plus the cost of repatriation via private aircraft or medical evacuation services. When buying travel insurance, focus on two key coverage limits: overseas medical expenses and emergency medical evacuation/repatriation. +- Benefit: As noted above, overseas medical treatment is largely self‑paid. Domestic health plans provide little to no coverage abroad, and consular assistance won’t cover these costs either (see Section 3 for details on what consular aid can and cannot do under Article 26 of relevant regulations). The most financially crippling elements are prolonged hospitalization following severe trauma and the expense of transporting patients back home — both of which fall under the priciest categories of out‑of‑pocket spending. Therefore, when selecting a policy, prioritize these two limits: first, the maximum amount payable for overseas medical treatment; second, the maximum coverage for emergency evacuation and repatriation. +- Evidence grade: C +- Notes: TODO (need verified figures on typical costs associated with overseas medical care and medical evacuation; official or industry statistics would be ideal). Before purchasing, verify three points: 1) whether the destination country is included in the policy’s coverage area; 2) if high‑risk activities such as scuba diving, skiing, or motorcycle riding are excluded; and 3) whether claims are settled directly between the insurer and medical providers or if you must pay upfront and then seek reimbursement. Keep in mind that visa‑free entry does not equate to guaranteed coverage — insurance is mandatory regardless of your destination. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第二十六条）；作者经验，无直接文献 + +### 5. Treat all “high-paying overseas jobs” as scams — getting caught can lead to a 6‑month to 3‑year travel ban + +- Cost: No money is required. The hard part is turning down what seems like a great job offer. +- In plain terms: Offers with unrealistically high monthly salaries, no educational or experience requirements, no formal contracts, instructions to gather at a border city first, and promises to keep your passport safe are red flags. Accepting such a job means you lose control over both yourself and your passport. Submitting false documents at the border will get you turned away. If you end up taking part in illegal activities abroad, you may be barred from leaving China for 6 months to 3 years after you return. +- Benefit: Authorities have made it clear how to handle these cases. Recent statements note that people who are deceived into leaving the country or who fabricate reasons to travel abroad for illegal gambling, telecom fraud, or similar crimes put public safety at risk. New rules tighten controls on both ends: for outbound travel, “the stated purpose of a visa application must be genuine and lawful”; anyone who submits false information can be denied a permit or entry. For returnees, “Chinese citizens who commit crimes abroad and threaten national security may be barred from leaving China for 6 months to 3 years from the date of their return.” The same ban applies to anyone detained for using false documents or illegal border crossings. +- Evidence grade: A +- Notes: Common warning signs include salaries far above market rates, no educational or experience prerequisites, lack of a formal contract, instructions to meet at a border city first, and promises to handle visas and keep your passport. Consulates have issued specific advisories about northern Myanmar. Once you go, you lose both personal freedom and control over your passport — the idea of “simply walking away” does not apply. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第三、四条）；司法部、公安部、国家移民局 (2026). 就《国务院关于出境入境管理的规定》答记者问. + +### 6. The annual limit of 100,000 RMB for cash withdrawals abroad applies to all cards under your name combined + +- Cost: There is no direct cost. Estimate how much cash you’ll need before you travel, then rely on card payments for the rest. The real challenge is breaking the habit of withdrawing cash whenever possible. +- In plain terms: The annual cash withdrawal limit of 100,000 RMB for overseas use applies to all bank cards registered under your name, including supplementary cards. This limit resets on January 1 each calendar year. Once you reach it, you cannot make any more overseas cash withdrawals for the remainder of that year or in the following year. Note that this restriction only affects cash withdrawals; regular card purchases remain unaffected, and it does not count against your annual foreign exchange quota of $50,000. +- Benefit: This rule is set out in the Notice on Regulating Large-Scale Cash Withdrawals via Bank Cards Abroad issued by the State Administration of Foreign Exchange (SAFE, Document No. 29 [2017], effective January 1, 2018). Key provisions include: (1) The combined annual cash withdrawal limit for all cards under a person’s name is 100,000 RMB; exceeding this limit results in a suspension of overseas cash withdrawal rights for both the current and next calendar years. It is also prohibited to bypass this rule by using someone else’s card or lending one’s own card to others. (2) SAFE provides a list of affected individuals to issuing banks daily, which must then block all overseas cash withdrawals for those customers by 5 PM Beijing time on the same day. (3) Affected individuals can request a full breakdown of their overseas cash withdrawal history by presenting valid ID at local SAFE branches. (4) The daily withdrawal limit for foreign currency cards is raised from $1,000 to 10,000 RMB equivalent, while the same daily limit for RMB cards remains at 10,000 RMB equivalent. (5) Violations of these rules are subject to penalties under the Foreign Exchange Administration Regulations of the People’s Republic of China. SAFE also clarifies that this notice does not restrict regular overseas spending on travel, business, or education, which can all be paid for via card without using the annual $50,000 foreign exchange quota. To ensure smooth transactions, SAFE uses delayed control mechanisms rather than immediate blocking of transactions. Statistics show that 81% of domestic cardholders withdrew less than 30,000 RMB abroad in 2016. +- Evidence grade: A +- Notes: The annual limit resets on January 1 each year. As mentioned, only cash withdrawals are restricted; regular card purchases are unaffected. If you absolutely need to carry large amounts of cash overseas, you must first apply for foreign exchange under the Individual Foreign Exchange Management Measures before taking the cash out. Two additional caveats apply to cash withdrawals: (1) For dual-brand cards, some ATMs in certain countries do not offer a UnionPay withdrawal option. (2) Some overseas ATMs display extra surcharge fees, which are charged by local acquirers and have no relation to UnionPay. UnionPay also advises that credit card cash withdrawals incur interest charges, so using a UnionPay debit card is preferable for overseas withdrawals. For guidance on what to do if your card is lost, swallowed by an ATM, or fraudulently used, refer to Section 14, Item 5. +- Sources:国家外汇管理局 (2017). 关于规范银行卡境外大额提取现金交易的通知（汇发〔2017〕29 号，第一、二、三、四、六、七条，2018 年 1 月 1 日起实施）. ；国家外汇管理局 (2017). 外汇局有关负责人就规范银行卡境外大额提取现金交易有关问题答记者问. ；中国银联国际. 境外ATM取款. + +### 7. Take photos of your passport, visa, and ID and store them in the cloud; if lost, report it to police first and then apply for a travel document. + + +- Cost: No cost involved. Simply take a few photos before you travel. +- In plain terms: If your passport is lost, the embassy or consulate can issue a travel document to help you return home — provided you can prove your identity. Having clear photos of the passport data page, visa pages, and entry/exit records speeds up the replacement process considerably. You must also file a police report locally to obtain a receipt; this document is required for border checks and insurance claims in many countries. Since phones are often lost together with passports, don’t rely on storing photos solely on your phone. +- Benefit: When a passport is lost, overseas embassies and consulates can issue a travel document for repatriation, but only after the traveler proves who they are. The speed of this process depends heavily on whether you have legible photos of the passport data page, visa pages, and entry/exit records. Additionally, filing a police report is mandatory; the resulting receipt is needed for border inspections and insurance settlements in numerous nations. The contact numbers for embassy assistance are the same two emergency hotlines listed in item 2. +- Evidence grade: C +- Notes: To ensure safety, save the photos in two separate locations — for example, one copy in cloud storage and another sent to a trusted family member. Also print a hard copy and keep it apart from the original documents. Don’t forget to photograph bank cards and prescriptions for regular medications as well. Since phones and passports tend to be misplaced together, storing images only on your phone offers no real protection. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十六条）；作者经验，无直接文献 + +### 8. Before driving abroad, verify whether local authorities recognize Chinese driver’s licenses; most “international driver’s permits” sold online are legally worthless. + + +- Cost: No cost at all. Simply check local regulations before you travel. +- In plain terms: Online services offering “international driver’s permits” hold no legal validity in mainland China. Such permits are merely translations recognized among signatory nations of the 1949 Geneva Convention on Road Traffic. Mainland China is not among the 103 signatory countries, so any permit issued domestically cannot be used legally. Whether a Chinese license is acceptable depends entirely on local laws — do not drive without confirming this first. +- Benefit: An International Driver’s Permit (IDP) is essentially a translation of a driver’s license, recognized solely among signatories to the 1949 Geneva Convention on Road Traffic. Signed on 19 September 1949 and effective 26 March 1952, this treaty currently includes 103 countries and regions — mainland China is excluded. Consequently, China does not issue IDPs, and any domestic “services” claiming to provide them lack legal standing. Eligibility to drive using a Chinese license varies by jurisdiction: some accept it alongside a certified translation, others require obtaining a local license, while several reject it outright. +- Evidence grade: A +- Notes: In most countries, driving without a valid license constitutes a criminal offense or incurs severe penalties. Moreover, insurance providers typically deny coverage in such cases — this represents the true financial risk. Two reliable verification methods exist: consult the “Information for Chinese Citizens” section on the Chinese Consulate website for your destination, or request a written confirmation directly from your rental agency. Separate regulations apply to Hong Kong, Macau, Taiwan, and certain other countries. +- Sources:United Nations Treaty Collection. Convention on Road Traffic, Geneva, 19 September 1949 — status of treaties. + +### 9. When hiring an agency for visas, study abroad, or immigration, first check whether it is registered with immigration authorities + +- Cost: There is no cost. Simply ask whether the agency is registered, and keep any written documentation on hand. +- In plain terms: Starting September 15, 2026, agencies handling visa applications, study abroad programs, or immigration must register with immigration authorities. Promises such as “guaranteed approval,” “100% success rate,” or “we’ll prepare all your documents” are explicitly prohibited. If you make errors while filling out forms yourself, you may simply receive a visa denial this time. However, if you submit false documents and are found guilty of fraud, this will leave a permanent mark on your immigration record. +- Benefit: In 2018, China abolished the licensing requirement for private immigration agencies, meaning no prior approval is needed to open such agencies. Since then, their numbers have risen sharply, but many operate without proper oversight, violating laws and harming applicants’ rights; authorities even struggle to track how many exist. Effective September 15, 2026, these agencies must register with local immigration authorities within 15 days of establishment, with existing agencies required to comply within 90 days. Prohibited activities include: (1) publishing false information or using exaggerated or misleading claims to attract clients; (2) providing or helping clients submit false documents for visas, residence permits, passports, or other immigration paperwork; (3) leaking, selling, or illegally sharing personal data; and (4) organizing or aiding cross-border illegal activities. Foreign firms and organizations are also barred from offering such services within China. +- Evidence grade: A +- Notes: Agencies that openly advertise “guaranteed approval,” “100% success rate,” or “we’ll handle all paperwork” are already breaking the law. Should they be investigated, this will directly affect your immigration history. Errors made while applying on your own may result in a single visa denial, but submitting false documents carries far graver consequences. Providing policy guidance or basic information without charging fees does not count as immigration agency services. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第七、八、十、十二、十三条） + +### 10. Don’t issue invitation letters for strangers, and don’t let others use your name for immigration paperwork + +- Cost: No monetary cost. The hard part is politely declining such a request in person. +- In plain terms: Issuing an invitation letter or application documents on someone else’s behalf with false information makes the issuer legally liable. Individuals face fines ranging from 5,000 to 10,000 yuan, plus any illegal earnings are confiscated. Organizations are fined 10,000 to 50,000 yuan, and the individuals directly involved are fined an additional 5,000 to 10,000 yuan. One simple act of kindness can end up costing you a lot of money. +- Benefit: Anyone who issues an invitation letter must ensure its contents are truthful. The original regulation states: “Individuals who submit false invitation letters or other application materials for others’ visa or residence permit applications will be fined between 5,000 and 10,000 yuan by immigration authorities; any illegal earnings will also be confiscated.” Organizations found issuing false documents face fines of 10,000 to 50,000 yuan. Additionally, the directly responsible supervisors and staff involved are fined 5,000 to 10,000 yuan each. +- Evidence grade: A +- Notes: This carries the same risks as the advice in Section 8: “Don’t carry items for strangers.” Once you sign a document or stamp a form, you assume full responsibility for its contents. Government employees and military personnel who attempt to obtain foreign citizenship or residency through intermediaries must report such attempts to oversight authorities — intermediaries cannot assist with such illegal requests. +- Sources:国务院 (2026). 关于出境入境管理的规定（国令第 841 号）. （第三、十一条） + +### 11. Before traveling abroad, send your itinerary, accommodation details, and travel companions’ information to a family member, and agree on how often you’ll stay in touch. + + +- Cost: No cost at all. Simply send a message before you leave. +- In plain terms: If a traveler goes missing overseas, their family can turn to Chinese diplomatic missions for help. These missions provide relatives with local police contact information and other resources for assistance. Once a police report is filed, the consulate follows up to ensure timely action. Whether this support chain can be activated depends on whether someone back home knows exactly where the traveler is and when they’re supposed to make contact. Sharing flight numbers, hotel addresses, companions’ phone numbers, and agreed-upon check-in intervals with one trusted person is sufficient. +- Benefit: When a Chinese citizen goes missing abroad, family members may seek help from Chinese diplomatic missions. The relevant regulation states that “diplomatic missions abroad shall provide information on local police contact methods and other assistance resources.” After a police report is filed, the consulate actively follows up to ensure proper handling. The ability to trigger this entire support process hinges on whether domestic contacts know the traveler’s whereabouts and expected contact schedule. +- Evidence grade: C +- Notes: Include just four key details: flight number, accommodation address, companions’ full names and phone numbers, and the agreed contact frequency. If traveling to areas with poor signal or high crime rates, also specify exactly how long one should wait without contact before alerting local authorities. This measure costs virtually nothing, yet it serves as the essential prerequisite for activating all subsequent assistance procedures. +- Sources:国务院 (2023). 领事保护与协助条例（国令第 763 号）. （第十三条）；作者经验，无直接文献 diff --git a/book/en/22-How-To-Relax.md b/book/en/22-How-To-Relax.md new file mode 100644 index 00000000..4d1c33a2 --- /dev/null +++ b/book/en/22-How-To-Relax.md @@ -0,0 +1,112 @@ +# 22. How to relax: entertainment venues and stress relief + +This section is divided into two parts. The first part covers entertainment venues — it explains which costs are unnecessary and where the emergency exits are located. The focus here is on money and personal freedom. The second part discusses ways to relieve stress, with an emphasis on energy levels and overall mortality risk. The figures from each part are not combined for any calculations. Section 3 already listed several steps to take when feeling down; this section provides more detailed recommendations. +### 1. Check where the emergency exits are before entering a KTV, bar, or escape room; if they’re locked or blocked, pick another venue. + +- Cost: No cost at all. Just take 10 seconds to look around when you enter. +- In plain terms: By law, entertainment venues must keep all evacuation routes and emergency exits completely unobstructed during operating hours. They cannot be blocked, locked, used to store items, or covered by anything, nor can any signs indicating their location be hidden. The same rules apply to internet cafés — their doors, windows, evacuation routes, and exits must also remain open at all times. Failing to comply is illegal, and you have the right to file a complaint. If a private room is located underground, has only one exit, or its corridors are cluttered with debris, choose a different venue instead. +- Benefit: Ensuring unobstructed evacuation routes and exits is a mandatory legal obligation for venue operators. Noncompliance is illegal and reportable. The exact wording of the regulation reads: “During operating hours, entertainment venues must guarantee that evacuation routes and emergency exits remain unblocked; they cannot be sealed, locked, or fitted with barriers that hinder evacuation.” It also stipulates that “clear signage must be posted at all evacuation routes and exits, and such signage must not be obscured or covered.” Internet cafés are similarly required to “keep all doors, windows, evacuation routes, and exits open at all times during business hours” and to “ban open flames and smoking.” +- Evidence grade: A +- Notes: If any of the following issues are present, pick another venue: private rooms located underground, only one exit available, corridors filled with clutter, or nonfunctional emergency exit lights. In the event of a fire at such venues, thick smoke, narrow corridors, and large crowds of intoxicated patrons make escape extremely difficult — you may have only seconds to get out. Per regulations, the contact number for filing complaints must be clearly displayed on warning signs throughout the venue. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第二十、二十一条）. ；国务院 (2002). 互联网上网服务营业场所管理条例（国令第 363 号，第二十一条）. + +### 2. Price lists must be displayed before ordering; entertainment venues cannot charge “after the fact” + +- Cost: No cost at all. You simply need to request a price list. The tricky part is asking for it in front of others — it can feel a bit awkward. +- In plain terms: By law, entertainment venues must display clear prices for all services and goods and proactively hand over a price list to customers. Most cases of “exorbitant drink charges” occur when patrons never see a price list and end up paying based on verbal quotes after the fact. Upon entering a private room, ask for a price list and take a photo of it. After placing your order, request a written confirmation. If a billing dispute arises, call 12315 right away. +- Benefit: The regulation states: “Entertainment venues offering services or selling goods must display clear prices and provide a price list to consumers; they may not force or deceive customers into using services or buying products.” Violations of pricing laws are subject to legal penalties. The vast majority of disputes over “overpriced drinks” happen precisely under these circumstances — no price list is shown, and payment is demanded based on informal verbal agreements. +- Evidence grade: A +- Notes: How to proceed: Upon entering a private room, request a price list — paper or digital, it doesn’t matter — and photograph it. After ordering, ask for a written confirmation of your order. For any “special cocktails” or fruit platters suggested by staff, always ask for the price before ordering. If a billing disagreement occurs, call 12315 immediately. Never pay in advance and then attempt to dispute the charge; once payment is made, proving your case becomes far more difficult. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第二十九、五十三条）. + +### 3. If someone offers you “stuff” at a venue, leave immediately — harboring and providing both count as aiding friends + +- Cost: No cost at all. Just stand up and walk away. The hard part is having to leave in front of a whole group of people. +- In plain terms: It is strictly illegal for entertainment venues to sell or provide drugs, or to allow anyone to use drugs on site. Violators face 3–6 months of suspension or permanent revocation of their operating license. Individuals face even harsher penalties: personal drug use results in public order sanctions. Allowing someone to use drugs in a private room you booked or in your own home counts as harboring drug use and is a criminal offense. If someone offers you unknown powders, pills, or vape cartridges, walk away right then. +- Benefit: Regulations explicitly forbid entertainment venues from selling, providing, or facilitating drug use. Staff members are also prohibited from using drugs or aiding customers in any such activities. Penalties include confiscation of illicit gains, 3–6 month suspensions, and license revocation for serious violations. Venues must also post clear anti-drug, anti-gambling, and anti-prostitution warnings with hotline numbers in public areas and private rooms. +- Evidence grade: A +- Notes: If anyone offers you unknown powders, pills, or vape cartridges to “try,” leave immediately — don’t stick around to watch. Individual liability is even heavier than venue liability: personal drug use alone incurs public order penalties, while letting a friend use drugs in your reserved room or home constitutes harboring drug use and is a criminal act. +- Sources:国务院 (2006). 娱乐场所管理条例（国令第 458 号，第十四、三十、四十二条）. + +### 4. Don’t accept candy or snacks from strangers, don’t drink beverages left unattended, and don’t take e‑cigarette cartridges handed to you by others + +- Cost: No cost at all. Never accept anything offered by others. If your own cup has been out of sight, simply get a new one. +- In plain terms: Today’s illicit drugs no longer look like typical drugs. “High‑inducing” e‑cigarettes laced with synthetic cannabinoids can be tinted and flavored to match ordinary e‑cigarettes, and they are deliberately offered to people in bars, KTVs, and hotels. Those who trick others into using them face 10–15 days of detention and fines of 1,000–5,000 yuan. Anyone who is deceived into using them also gets detained for 10–15 days. Always replace any drink that has been left unattended. +- Benefit: Since July 1, 2021, synthetic cannabinoids have been regulated as a whole class of controlled substances. They are often mixed into e‑cigarette liquid to create “high‑inducing” cartridges. According to Supreme People’s Procuratorate reports, this liquid can be colored and flavored with food‑grade dyes to closely resemble regular e‑cigarette liquid. Sellers promote these products in bars, KTVs, and hotels, encouraging others to use them. In that region, nearly 40% of drug‑use cases that year involved minors. Starting October 1, 2023, etizolam was added to the list of Schedule II psychotropic substances. Tricking someone into using drugs is itself illegal: offenders face 10–15 days of detention and fines of 1,000–5,000 yuan; if a crime is proven, sentences range from under 3 years up to 7 years, while forced use can bring a 3–10‑year sentence, with harsher penalties for minors. Users also incur penalties: 10–15 days of detention and fines up to 3,000 yuan, or a lighter penalty of 5 days or less plus a fine under 1,000 yuan. They may also be barred from entertainment venues for 6 months to a year. Addicted individuals must undergo 3 years of community‑based rehabilitation; refusal or relapse leads to 2 years of compulsory isolation, extendable by another year (as of January 2026, Public Security Administration Punishment Law). +- Evidence grade: A +- Notes: This advice applies not only in entertainment venues but also at school gates, friend gatherings, and on long‑distance buses. It works whether the offering is candy, a drink, or an e‑cigarette cartridge. After being drugged, victims often suffer robbery, sexual assault, or extortion; no official statistics exist on this, so it remains an empirical warning. Replacing any drink that has been out of sight is far simpler than trying to rectify the situation later. For handling unknown powders, tablets, or cartridges encountered in such settings, see item 3 of this section; for carrying items on behalf of others, see Section 8, item 29. +- Sources:最高人民检察院 (2021). 江苏苏州吴江区：办案检察官揭秘披着潮流外衣的新型毒品. ；国家药监局、公安部、国家卫生健康委 (2023). 关于调整麻醉药品和精神药品目录的公告（2023 年第 120 号）. （上海市药监局转载，原文页 nmpa.gov.cn 在本机返回 412）；全国人大常委会 (2025). 治安管理处罚法（2025 年修订，第八十四、八十五条）. ；全国人大 (1997). 刑法（第三百五十三条）. ；全国人大常委会 (2007). 禁毒法（第三十三、三十八、四十七条）. （广东省人民政府转载） + +### 5. Using your own ID to log in at internet cafés – don’t lend it or use someone else’s + + +- Cost: No cost at all. + +- In plain terms: According to regulations, internet cafés must verify and register each customer’s ID card, then keep detailed browsing records for at least 60 days. Police and cultural authorities can request this data at any time. During that period, cafés may not alter or delete any information. Whichever ID is used, all activity on that computer is attributed to that person. + +- Benefit: The regulation states: “Internet café operators must verify and register customers’ ID cards and other valid documents, and retain all related browsing records for no less than 60 days.” When requested by cultural or law‑enforcement agencies, cafés must provide this information; no modifications or deletions are permitted during the retention period. Consequently, any actions performed on a computer while a specific ID is logged in are recorded under that individual’s name. + +- Evidence grade: A + +- Notes: This rule mirrors the one described in Section 9 – “Do not lend your ID to others” – just applied to a different setting. Internet cafés are prohibited from serving minors; a conspicuous “No Minors Allowed” sign must be displayed at entrances. The same restriction applies to entertainment venues. If someone helps a minor “fake‑register” at an internet café, the penalty falls on the café, yet all records remain linked to the minor’s ID. +- Sources:国务院 (2002). 互联网上网服务营业场所管理条例（国令第 363 号，第二十三条）. + +### 6. Avoid scripted-murder-mystery (剧本杀, "jubensha") and escape rooms located in residential buildings or below the first basement level + +- Cost: No cost involved. Just ask for the building floor number before booking. +- In plain terms: A 2022 notice jointly issued by five government departments clearly states that script-entertainment venues (剧本娱乐, "juben yule") must not be set up inside residential buildings or below the first basement level. These venues often lack proper oversight, have numerous partitions, use highly flammable props, and their doors frequently require puzzle-solving to open. In case of a fire, escaping from such places is far harder than from regular commercial premises. Before booking, check the venue’s floor number and location on review pages, and opt for a compliant venue instead if it does not meet the requirements. +- Benefit: The same 2022 notice from five departments lays out very specific requirements: script-entertainment venues (剧本娱乐, "juben yule") are prohibited from operating in residential buildings or below the first basement level. It also mandates that venues must adhere to the Work Safety Law and Fire Protection Law, regularly identify, inspect and rectify fire hazards, and improve their ability to organize evacuations and extinguish incipient fires during emergencies. Additionally, the notice requires all script-entertainment (剧本娱乐, "juben yule") content to include age suitability warnings, and minors are not allowed to enter venues with scenes inappropriate for them. Outside statutory holidays, rest days and school holidays, script-entertainment (剧本娱乐, "juben yule") activities for minors are also strictly prohibited. +- Evidence grade: A +- Notes: These venues are typically dimly lit, have many partitions, use flammable props, and their doors often need to be unlocked via puzzle-solving. In case of a fire, escaping from them is far more difficult than from ordinary shops. You can easily check both the floor number and whether the venue is located in a residential building on review pages before booking. If a venue does not comply with the regulations, it is best to choose another one. +- Sources:文化和旅游部、公安部、住房和城乡建设部、应急管理部、市场监管总局 (2022). 关于加强剧本娱乐经营场所管理的通知. + +### 7. Going for a brisk walk or a jog when feeling down: the effect size of exercise on depression is proportional to its intensity + +- Cost: Free. Each session takes about half an hour. The hard part is that when you’re in a bad mood, moving feels the last thing you want to do — you have to push yourself to get started. +- In plain terms: This study pooled data from 218 randomized trials involving over 14,000 adults with major depressive disorder. The biggest improvements were seen with brisk walking or jogging. Yoga, strength training, mixed aerobic workouts, and tai chi/Qigong also showed benefits, with fairly similar effect sizes across these activities. Generally, the higher the exercise intensity, the better the outcome; however, strength training and yoga tend to be the easiest to stick with long-term. The authors themselves note that the overall evidence quality is relatively low, but the key takeaway is that any physical activity is better than none — pick whatever type you’re most likely to keep doing. +- Benefit: This result comes from combining data across 218 randomized controlled trials split into two groups, covering 495 treatment arms and 14,170 participants who met clinical criteria for major depression. A Bayesian network meta-analysis was used to compare all these different forms of exercise against each other, using standard care or placebo pills as control groups. The effect size is expressed as Hedges’ g; the more negative this value, the greater the symptom improvement. For brisk walking or jogging, the value was −0.62 (95% confidence interval: −0.80 to −0.45). Yoga came in at −0.55 (−0.73 to −0.36), strength training at −0.49 (−0.69 to −0.29), mixed aerobic exercise at −0.43 (−0.61 to −0.24), and tai chi/Qigong at −0.42 (−0.65 to −0.21). The original paper states that “the effect of exercise is directly proportional to its intensity”, meaning higher intensity yields better results. Strength training and yoga also score highest on acceptability, making them the most sustainable choices for most people. +- Evidence grade: A +- Notes: This finding is somewhat controversial. The authors themselves point out that only one out of the 218 studies met sufficiently rigorous design standards to rule out major bias. Using standard grading criteria, brisk walking and jogging only qualify for a “low” confidence rating, while all other exercise types receive “very low” ratings. Since participants know they’re taking part in an exercise program, placebo effects inevitably play a role, skewing results upward. Still, the overall conclusion holds up: any physical activity is better than none, intensity should be kept reasonably high, and you should choose a type you can realistically stick with over time. This section expands on the earlier advice in Section 3 to “get moving when feeling down”, but it is by no means a substitute for professional medical treatment after a proper diagnosis. +- Sources:Noetel M, Sanders T, Gallardo-Gómez D, et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. + +### 8. When anxiety interferes with daily life, mindfulness‑based stress reduction works just as well as common anti‑anxiety drugs + + +- Cost: Taking a course costs a bit of money. The program lasts eight weeks, with one class per week plus daily home practice. The real challenge is keeping up with that daily practice for the whole eight weeks. + +- In plain terms: 276 adults diagnosed with anxiety disorder were randomly split into two groups. One group attended an eight‑week mindfulness‑based stress reduction course, while the other took escitalopram. At the end, symptom improvement was almost identical in both groups. The difference showed up in side effects: almost 80 % of the medication group experienced at least one adverse reaction, and ten people dropped out because of this. In the course group, about 15 % reported side effects, but no one left the program. The program used a standardized eight‑week curriculum — it isn’t the same as any random meditation app you might download. + +- Benefit: This was a non‑inferiority randomized controlled trial conducted at three academic medical centers in the United States, designed to see whether the course performed as well as medication. 276 participants were assigned 1:1 to either an eight‑week mindfulness‑based stress reduction program or escitalopram at a flexible dose of 10–20 mg. 208 people completed the whole study. Using a clinician‑rated scale of anxiety severity, the mindfulness group showed a reduction of 1.35 points versus 1.43 points for the drug group. The difference between the two groups was −0.07 (95 % CI −0.38 to 0.23; P = 0.65), meaning the gap is statistically indistinguishable from zero. This value stayed above the pre‑set non‑inferiority threshold of −0.495. Side‑effect rates differed markedly: 78.6 % of the medication group experienced at least one trial‑related adverse event, leading to ten withdrawals, while only 15.4 % of the course group reported any side effects and no one dropped out. + +- Evidence grade: A + +- Notes: The trial employed a standardized eight‑week mindfulness‑based stress reduction curriculum (MBSR), not a generic meditation app; the two cannot be equated. This recommendation applies to individuals who already meet diagnostic criteria for anxiety disorder; they should still consult a physician. Its practical value lies in offering a treatment option with comparable evidence strength for those who hesitate to take medication because of potential side effects. +- Sources:Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM (2023). Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 80(1), 13-21. + +### 9. For quick relief on the spot, try the 5‑minute “cyclic sigh”: two inhalations followed by a prolonged exhalation + +- Cost: No cost at all. Just 5 minutes a day. +- In plain terms: In a one‑month controlled trial where participants performed each of three breathing exercises for 5 minutes daily, all three proved more effective than an equal amount of mindfulness meditation at lifting mood and lowering respiratory rate. The “cyclic sigh” — which emphasizes lengthening the exhale — performed best. The method is simple: inhale once through the nose, then take a brief second inhale to fully fill the lungs, and finally exhale slowly through the mouth. This particular study relied on self‑reported data and involved a relatively small group of volunteers, yet it required zero expense. +- Benefit: This home‑based, randomized controlled trial compared three distinct 5‑minute daily breathing routines — cyclic sighing (focused on extended exhalation), box breathing (equal durations of inhale, hold, and exhale), and cyclic hyperventilation with pauses — against an equivalent mindfulness meditation regimen over a month. Using a mixed‑effects model on pooled data, each breathing technique outperformed meditation; cyclic sighing stood out for its superior impact on mood improvement (statistically significant at P<0.05) and on reducing breathing frequency (also P<0.05). +- Evidence grade: B +- Notes: Execute the exercise by inhaling once through the nose, briefly adding a second inhale to maximize lung expansion, then exhale gently and fully through the mouth for a full 5 minutes. Although this trial was conducted at home, relied on participant self‑assessment, and involved a modest sample size, its benefits are clear: it costs nothing, takes only five minutes, can be done anywhere, and offers modest but tangible advantages over standard mindfulness practice. +- Sources:Balban MY, Neri E, Kogon MM, et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. + +### 10. Treat “regular social contact” as a health expense — don’t wait until you’re feeling down to reach out + + +- Cost: It requires some money and time to arrange meetups. The hard part is making the effort to schedule them even when you’re in a good mood. +- In plain terms: This conclusion comes from a meta-analysis of 70 studies involving 3.4 million people, tracked for an average of 7 years. Those experiencing social isolation had a roughly 30% higher risk of dying during that period compared to non-isolated individuals. People reporting loneliness faced a 25% higher risk, while those living alone faced a 30% higher risk. These figures are similar in magnitude and are even more pronounced among people under 65. Keep in mind these are observational data; it’s also possible that people in poorer health are more likely to end up isolated. +- Benefit: As noted, this is a meta-analysis of 70 studies with 3.4 million participants observed over 7 years. Social isolation, loneliness, and living alone all correlate with higher mortality. After adjusting for age and health status, the weighted average risk ratios were: 1.29 for social isolation, 1.26 for loneliness, and 1.32 for living alone. In other words, each condition raised the risk of dying during the study period by roughly 30%, 25%, and 30% respectively. The effects are comparable across all three factors and are stronger in younger adults. +- Evidence grade: A +- Notes: This topic remains debated. These findings are purely correlational; no randomized controlled trials have been conducted to prove cause and effect. It’s also true that people with poorer health are more likely to become isolated or have fewer social interactions. The authors argue that social relationships are as important to health as smoking or obesity, yet there’s no randomized evidence showing that increasing social contact actually lowers mortality. This point does not contradict Section 3’s advice to “cut back on draining relationships”; that section focuses on eliminating toxic connections, while this one stresses the value of maintaining those that replenish your energy. +- Sources:Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. + +### 11. Living near green spaces means you can use them for walking, strolling, or just sitting around + +- Cost: No cost at all — it’s free and easy to incorporate into daily life. +- In plain terms: Nine studies from seven countries involving 8.32 million people show that for every 0.1 increase in the normalized vegetation index (NDVI) within 500 meters of a home, the risk of dying during the same period drops by roughly 4%. This measures greenery right around where people live, not how often they visit parks. Naturally, neighborhoods with more greenery tend to have wealthier residents and cleaner air. So don’t interpret this as “visiting parks automatically adds years to your life”; the practical takeaway is to consider nearby green spaces when choosing where to live. +- Benefit: This result comes from a meta-analysis of nine long-term cohort studies spanning seven countries and 8.32 million participants. It looks at vegetation levels within 500 meters of residences, quantified via NDVI — a number that reflects ground-level greenery (bare soil or concrete scores near 0, dense vegetation near 1). A 0.1 rise in NDVI corresponds to a pooled hazard ratio of 0.96 for overall mortality (95% CI 0.94–0.97), meaning a roughly 4% reduction in death risk — with actual values likely falling between 3% and 6%. Seven out of the nine studies found lower mortality in greener areas, a pattern unlikely to be coincidental; the other two showed no clear link. +- Evidence grade: A +- Notes: This finding remains debated. The studies themselves vary widely in results (I² = 95%, indicating substantial disagreement), and the analysis tracks neighborhood greenery rather than personal park visits. Moreover, greener areas typically feature higher incomes, cleaner air, and more active lifestyles — all factors intertwined with vegetation levels. Again, don’t read this as “parks guarantee longer life”; the key insight is that living near green spaces costs nothing and may offer health benefits. NDVI is simply a numeric way to gauge local greenery, where values near 0 represent barren or paved zones and values near 1 indicate lush vegetation — so a 0.1 increase roughly equals moving from a bare urban block to one lined with trees. +- Sources:Rojas-Rueda D, Nieuwenhuijsen MJ, Gascon M, Perez-Leon D, Mudu P (2019). Green spaces and mortality: a systematic review and meta-analysis of cohort studies. The Lancet Planetary Health, 3(11), e469-e477. diff --git a/book/en/23-Which-Skills-To-Learn.md b/book/en/23-Which-Skills-To-Learn.md new file mode 100644 index 00000000..d94afc1c --- /dev/null +++ b/book/en/23-Which-Skills-To-Learn.md @@ -0,0 +1,186 @@ +# 23. Which skills are worth learning? +This section deals with money and time. The second item also looks at mortality rates. The first six items address one main question: should you keep studying? Item 1 explains which options the law rules out. Item 2 explores how education affects lifespan. Item 3 shows what level of schooling most people in China have attained. Item 4 lists financial aid available when tuition is unaffordable. Item 5 describes alternatives if you don’t get into regular high school. Item 6 turns the “study versus work” dilemma into a simple calculation you can do yourself. The next seven items tackle another question: once you decide to learn something, how do you pick the right skill? Official statistics on +### 1. There’s no option for anyone under 16 to “get a job”: any employer who hires them faces a fine of $5,000 per month, and those willing to do so are breaking the law. + +- Cost: Zero. It takes just a minute to figure out how old you are. +- In plain terms: Most kids finish junior high at 15 or 16, right at this age threshold. Hiring anyone under 16 is illegal; each underage worker used results in a $5,000 monthly penalty. Thus, any employer willing to hire you is knowingly breaking the law. Should anything go wrong, medical bills and compensation must be paid by that employer. If it refuses or goes out of business, there’s no one else to cover those costs. +- Benefit: Article 11 of the Compulsory Education Law states: “All children aged six or older must be enrolled by their parents or legal guardians to receive and complete compulsory education.” Article 14 adds: “Employers are prohibited from hiring children and adolescents required to attend compulsory education.” Article 58 says that failure to enroll eligible kids without valid reasons results in “criticism and a directive to correct the issue within a set timeframe” from local authorities. Article 2 of the Regulations on Banning Child Labor declares that government agencies, social groups, enterprises, private non-profit entities, and individual businesses “must not hire minors under 16.” Article 6 imposes a $5,000 monthly fine per underage worker; noncompliance raises this to $10,000 per month. Article 7 levies a $5,000 fine per child referred for employment. Article 10 mandates that employers “must arrange medical treatment and cover all related costs” if a child worker falls ill or sustains injury; additional compensation applies in cases of permanent disability or death. One exception exists under Article 13: cultural or sports organizations may hire under-16 professionals with parental consent (nationwide). +- Evidence grade: A +- Sources:全国人大常委会 (2018). 义务教育法（2018 年第二次修正，第十一、十四、五十八条）. （教育部刊登）；国务院 (2002). 禁止使用童工规定（国务院令第 364 号，第二、六、七、十、十三条）. +- Notes: You’re the primary beneficiary here. Working legally is permitted after age 16. Yet jobs open to a 16-year-old with no qualifications align precisely with those highlighted in Section 10—roles relying on routine tasks most vulnerable to automation. Section 19 outlines overtime pay, vacation rights, and worker’s compensation, all contingent on formal employment status and verifiable records. As an unregistered worker, you lack both, meaning you won’t qualify for these protections or benefits. +### 2. Adding “education’s value” to mortality statistics: each extra year of schooling lowers adult mortality risk by roughly 1.9% + +- Cost: There’s no direct monetary cost. The real expense is the time and effort required to stay in school; tuition fees are covered under Section 4 of this chapter (vocational school tuition and grants). The main challenge is staying committed to education over the long term. +- In plain terms: Every additional year of schooling reduces an adult’s risk of dying by about 1.9% on average. This effect is strongest among people aged 18–49, where the risk drops by roughly 2.9% per extra year; for those over 70, the drop is only about 0.8%. Naturally, people who manage to stay in school tend to come from more privileged backgrounds, so it’s hard to isolate how much of this benefit truly stems from education itself. +- Benefit: This conclusion comes from a comprehensive meta-analysis that pooled data from 603 studies conducted at 70 locations across 59 countries between January 1980 and May 2023, involving a total of 10,355 observations. The results show a clear dose‑response relationship between years of schooling and adult mortality (all causes combined): each extra year of education lowers mortality risk by 1.9% on average (95% confidence interval: 1.8–2.0). For the 18–49 age group the reduction is about 2.9% per year (2.8–3.0), while for those over 70 it is roughly 0.8% per year (0.6–1.0). No gender differences were observed, nor any variation linked to a country’s level of development (as measured by the Social‑Demographic Index). +- Evidence grade: A (controversial) +- Sources:IHME-CHAIN Collaborators (2024). Effects of education on adult mortality: a global systematic review and meta-analysis. The Lancet Public Health, 9(3), e155-e165. +- Notes: The findings are controversial. The authors reported a significant publication bias (p < 0.0001), meaning studies with more favorable results were more likely to be published. Moreover, the results varied widely across individual studies. All included research relied on observational tracking rather than randomized trials; consequently, it’s difficult to disentangle how much of the 1.9% mortality reduction is attributable to education itself versus the fact that those who stay in school generally enjoy better socioeconomic conditions. Thus, while the data strongly suggest that more schooling correlates with longer life expectancy, they do not prove that simply attending school will guarantee a 1.9% reduction in mortality. The ultimate beneficiaries are the individuals themselves. +### 3. Before determining whether “education is losing its value,” let’s first look at the national educational structure: only 15,467 people per 100,000 have a college education or higher. + +- Cost: Zero. All you need to do is glance at the numbers below. +- In plain terms: According to the 2020 census, only 15,467 people per 100,000 nationwide have completed college or higher education — that’s roughly 15%. Meanwhile, 34,507 people per 100,000 have only a junior high school education, making this the most common level of education. On average, people aged 15 and older have attended school for just 9.91 years, barely enough to finish junior high. Therefore, a junior high school education in China is far from “sufficient” — it is simply the baseline level for most people. +- Benefit: The reference point for the seventh national census was November 1, 2020. At that time, 218,360,767 people nationwide had a college education or higher, while 213,005,258 had a high school education (including vocational school). The number of people with a junior high school education was 487,163,489, and those with a primary school education totaled 349,658,828. Compared to the sixth national census in 2010, the number of people per 100,000 with a college education rose from 8,930 to 15,467, while those with a high school education increased from 14,032 to 15,088. Conversely, the number of people with a junior high school education fell from 38,788 to 34,507, and those with a primary school education dropped from 26,779 to 24,767. The average years of schooling for people aged 15 and older rose from 9.08 to 9.91 years, and the illiteracy rate declined from 4.08% to 2.67%. +- Evidence grade: A +- Sources:国家统计局、国务院第七次全国人口普查领导小组办公室 (2021). 第七次全国人口普查公报（第六号）——人口受教育情况. +- Notes: These figures only indicate how common or rare a given level of education is within the general population. Whether it makes financial sense for any individual to pursue further education should be calculated using the method outlined in Section 6 of this chapter (“How to weigh the costs and benefits of education vs. working”). Also, note that census data includes all residents nationwide, including children and the elderly. The proportion of young people with a college education is significantly higher than these averages, so comparing one’s own educational level to these figures may overestimate one’s competitive advantage. Conversely, these numbers do provide solid evidence to refute the claim that “education is useless,” since they represent the entire labor force competing for jobs. The ultimate beneficiaries of this education are the individuals themselves. +### 4. Run the policy math first: most vocational school tuition is waived, with a 2,300‑yuan grant and up to 20,000 yuan in student loans per year + +- Cost: Zero out‑of‑pocket expense. Before school starts, simply visit the school’s student‑aid office and submit the required paperwork. +- In plain terms: At public vocational schools, tuition is waived for rural students, urban students in agriculture‑related programs, and those from low‑income families. Starting spring 2025, a 2,300‑yuan grant is available each year for both vocational and regular high‑school students. College students receive a 3,700‑yuan grant annually, and they may borrow up to 20,000 yuan per year via student loans. The exact amount of the grant is 0.7 yuan, which is a fixed figure set by policy. If funds remain insufficient, repayment can be deferred or alternative options explored — most students never have to drop out to work right away. +- Benefit: The tuition‑waiver policy for public vocational schools has been in place since fall 2012; it covers all full‑time first‑, second‑, and third‑year students who are rural (including those in county towns), enrolled in agriculture‑related programs, or from financially disadvantaged families (except for students in performing‑arts majors). In 2024 the student‑aid framework was updated: the national grant for undergraduates rose from 3,300 to 3,700 yuan per year, and the National Inspirational Scholarship increased from 5,000 to 6,000 yuan, both effective fall 2024. For vocational and regular high‑school students, the grant also rose from 2,000 to 2,300 yuan per year, effective spring 2025. Student loans were adjusted as well: from fall 2024 undergraduates may borrow up to 20,000 yuan per year (previously 16,000) and graduate students up to 25,000 yuan (previously 20,000). The interest rate equals the applicable LPR minus 70 basis points. +- Evidence grade: A +- Sources:财政部、发展改革委、教育部、人力资源社会保障部 (2012). 关于扩大中等职业教育免学费政策范围 进一步完善国家助学金制度的意见（财教〔2012〕376 号）. ；财政部、教育部、人力资源社会保障部有关司局负责人 (2024). 就调整学生资助政策有关问题答记者问. ；财政部、教育部、人民银行、金融监管总局 (2024). 关于调整完善国家助学贷款有关政策的通知（财教〔2024〕188 号）. +- Notes: These benefits apply to the student and his or her children. Exactly which groups qualify for tuition waivers and how many grant tiers exist is determined by each province. Private schools receive subsidies based on local public‑school standards, but any shortfall must still be paid by the student, so it’s wise to verify local rules before enrolling. Student loans are loans, not grants, and must be repaid after graduation; they simply separate the immediate cash‑flow problem from a longer‑term cost‑benefit analysis — don’t treat a temporary shortfall as a permanent barrier. Section 7 discusses training subsidies and emergency aid for periods of unemployment; families facing sudden income loss should apply for those programs first. +### 5. Failing to get into regular high school doesn’t mean your path ends: secondary vocational schools offer linked admission programs and separate exams, and employers can lower educational requirements for skilled roles. + +- Cost: No cost at all. Before submitting your high school entrance exam applications, check your province’s official vocational education admissions platform once. +- In plain terms: The Vocational Education Law enacted in 2022 explicitly states that vocational education holds equal status to general education. Secondary vocational schools can enroll students through linked admission programs with higher vocational institutions, which in turn must reserve a set proportion of their enrollment slots or hold separate exams specifically for secondary vocational graduates. Employers are also prohibited from setting eligibility barriers based on a candidate’s vocational school background. Failing to meet the cutoff for regular high school admission simply means you get to choose a different path — it does not leave you stuck with a junior high school diploma. +- Benefit: Article 3 of the Vocational Education Law (effective 1 May 2022) stipulates: “Vocational education is an educational type that holds equal importance to general education.” Article 37 states that secondary vocational schools “may, in accordance with relevant national regulations, implement linked admission and training programs with higher vocational education for designated majors.” Higher vocational institutions “may, in accordance with relevant national regulations, admit students via assessment methods that combine academic ability and vocational skills.” Provincial-level and above education authorities are required to build unified vocational education admissions platforms to publish information on schools, majors and enrollment quotas, and provide application query services. Article 53 further specifies: “Students from vocational schools enjoy equal opportunities as students from regular schools at the same level in terms of further education, employment and career development.” Higher vocational institutions and regular universities offering vocational education “must reserve a corresponding proportion of their enrollment quotas or hold separate exams to admit vocational school graduates specifically.” It is also forbidden for employers to set application, hiring or employment criteria that prevent vocational school graduates from competing on an equal footing. For positions requiring specific vocational skill certifications in public institution recruitment, “educational requirements can be appropriately lowered” nationwide. +- Evidence grade: A +- Sources:全国人大常委会 (2022). 职业教育法（2022 年修订，第三、三十七、五十三条）. （教育部刊登） +- Notes: These benefits apply to both yourself and your children. All the channels outlined here are legally mandated, but they do not guarantee admission. The specific majors covered by linked training programs, the exact proportion of slots reserved for separate admissions, and the exact subjects tested in vocational college entrance exams are all determined by each individual province. Before submitting applications, you must check your province’s current vocational education admissions platform and enrollment quotas — do not rely on rules or practices from other provinces. When selecting a secondary vocational major, use the criteria outlined in Section 10 of this chapter (choosing skills that are less prone to automation) as a reference: majors that require on-site work in non-standard environments are less likely to be phased out. To pick a school, confirm it is listed in your province’s current vocational education enrollment plan. Verify any certificates issued by the school using the three-step process described in Section 8 (checking whether a certificate is on the official approved list). Avoid any recruitment materials that make promises like “guaranteed job placement” or “100% admission success” at all costs. +### 6. Treating “work now or study further” as a calculation: the three years of early earnings versus decades of future income + +- Cost: There is no monetary cost. Setting aside about half an hour to do the math is all it takes. +- In plain terms: Lay both options side by side on paper. Working early yields only three years of wages from low‑skill jobs. Continuing education, on the other hand, delivers extra yearly earnings for the next three or four decades. In Chinese cities, each additional year of schooling raises average income by roughly 4.0% (in 1988) up to 10.2% (in 2001). These figures are somewhat dated and should be viewed only as rough estimates. +- Benefit: This estimate applies to Chinese urban areas between 1988 and 2001. The percentage increase in income linked to one extra year of schooling is known as the return on education. The original text notes that this rate rose sharply from 4.0% per year in 1988 to 10.2% in 2001, especially after 1992. It reflects the growing wage premium enjoyed by university graduates compared with those without higher education. This figure offers a locally relevant benchmark for converting “one extra year of study” into an expected lifetime income gain. For a global average, see Section 7 of this chapter (global average return on an extra year of schooling). +- Evidence grade: B +- Sources:Zhang J, Zhao Y, Park A, Song X (2005). Economic returns to schooling in urban China, 1988 to 2001. Journal of Comparative Economics, 33(4), 730-752. +- Notes: Before performing the calculation, subtract the tuition waivers and grants mentioned in Section 4 (vocational school costs and aid), as well as the mortality impact discussed in Section 2 (extra year of schooling and mortality). The data end at 2001 and cover only urban residents, so they cannot be directly applied to today’s situation; the same caveat applies to the 9% global average cited in Section 7. Results will naturally vary from person to person. For individuals facing high tuition fees, mismatched majors or occupations, or lengthy study periods, the net benefit may indeed be negative — but this only indicates that that particular path is unwise, not that education as a whole is worthless. Several factors cannot be captured by the formula: legally mandated educational requirements (see Section 5 on integrated vocational admissions and separate exams), resistance to automation (see Section 10 on selecting automation‑resistant skills), and the possibility of switching careers. Ultimately, the benefits accrue to the individual. +### 7. Keep this baseline in mind: on average worldwide, each additional year of schooling yields a personal return of roughly 9% per year. + +- Cost: No cost at all. Memorize this figure and use it as a benchmark for evaluating any “learning opportunity.” +- In plain terms: Globally, each extra year of formal schooling translates into about a 9% annual increase in personal income; this benefit tends to be higher for women than for men. This figure applies to regular schooling, not to short courses or workshops. Think of it as a yardstick: if a course costs 30,000 yuan and lasts half a year, ask whether its expected income boost matches what one extra year of schooling would deliver. +- Benefit: A comprehensive review covering 1,120 estimates from 139 countries between 1950 and 2014 found that the worldwide average private return on each additional year of schooling is 9% per year. This private return is the portion that directly affects an individual’s earnings — on average, an extra year of schooling raises income by 9%. The private return on higher education is on the rise, while the social return on education (the benefit to society as a whole) remains substantial. Women continue to reap higher average returns than men from schooling. +- Evidence grade: A +- Sources:Psacharopoulos G, Patrinos HA (2018). Returns to investment in education: a decennial review of the global literature. Education Economics, 26(5), 445-458. ；世界银行政策研究工作论文 8402. +- Notes: This is a global average for “one extra year of schooling” and should not be taken as the expected return from a single course or workshop, nor as a figure specific to China. It serves merely as a rough reference point. Its main purpose is to provide a standard for evaluating any training program: if a course demands a 30,000‑yuan investment and six months of effort, you can gauge whether its income impact is comparable to that of one additional year of formal education. Keep in mind that this average masks considerable differences across fields and countries. +### 8. Before spending money on a certification, first verify whether it appears in the National Vocational Qualification Catalogue or in the list of evaluation agencies registered with the Ministry of Human Resources and Social Security. + +- Cost: No cost at all. It takes just a few minutes to check once. +- In plain terms: Some organizations run training programs, charge fees, and issue certificates under the guise of new occupations or skill levels, while others even impersonate authoritative institutions. The Ministry of Human Resources and Social Security has taken targeted actions to curb such practices. Before enrolling, follow three steps: confirm whether the occupation is listed in the National Vocational Qualification Catalogue; verify that the issuing agency is registered with the Ministry; and check whether the certificate number can be found on the official platform. If any of these checks fail, any money spent on enrollment is essentially wasted. +- Benefit: The Ministry has launched nationwide efforts to address these issues. Official documents specifically identify the problematic practices as “some organizations and entities arbitrarily running training, evaluation, and certification activities under the banner of new occupations, skill levels, etc., charging excessive fees and issuing certificates indiscriminately; others making false or exaggerated claims, even impersonating authoritative institutions to organize training, evaluation, and certificate issuance.” Related measures include joint crackdowns with authorities such as Cyberspace Administration, public security, and market regulation to “severely punish any evaluation or certification activities conducted by unregistered agencies or those not approved by the Ministry.” Illegal promotional content on websites and social media is also shut down per law. Additionally, the Ministry urges the public to learn how to verify certificate legitimacy and value. +- Evidence grade: A +- Sources:人力资源社会保障部 (2022). 关于开展技术技能类「山寨证书」专项治理工作的通知. +- Notes: Follow this exact sequence for verification. First, check whether the occupation appears in the National Vocational Qualification Catalogue; if not, it is not a nationally recognized qualification. Next, confirm that the issuing agency is registered with the Ministry. Finally, use the official platform for skilled worker qualification certificate queries to see if the certificate number returns a valid result. Do not enroll if any step fails. Certificates bearing terms such as “International”, “Advanced”, “Registered”, or those promising “guaranteed passing results” or “income from certificate registration” carry the highest risk. +### 9. It’s best to use government subsidies for training — don’t jump straight to paying for commercial courses out of pocket. + +- Cost: Zero cost, or at least a substantial reduction. Training does require time. The real challenge is resisting the urge to sign up for paid courses right away; first, check the local subsidy list. +- In plain terms: From 2025 through late 2027, the government plans to provide subsidized training to over 30 million participants. Funding comes from multiple sources, including employment assistance funds, unemployment insurance funds, and corporate education budgets. The more in-demand a profession is and the higher the training cost, the larger the subsidy. Employees should ask their employers first; everyone else should review their local Human Resources and Social Security Bureau’s subsidy list before deciding what to study. +- Benefit: The national target is clear: over 30 million subsidized training slots for high-tech industries, critical sectors, and priority employment groups between 2025 and 2027. Funding is pooled from various programs — employment assistance funds, unemployment insurance, sector development grants, East-West cooperation funds, and corporate education budgets. Subsidy amounts depend on how urgently a profession is needed and its training cost; they vary by occupation. Companies must also allocate at least 60% of their employee education funds to frontline staff training. +- Evidence grade: A +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: Exact eligibility criteria and subsidy amounts are set by each province. The main portals are the “Subsidized Vocational Training List” on the local Human Resources and Social Security Bureau website and public training centers. Section 7 covers unemployment-related training subsidies (up to three applications per person) and social insurance benefits. Employees should first inquire about their employer’s education fund allocation before making any decisions. Checking the subsidy list first saves far more money than choosing a course first and then searching for financial aid. +### 10. When picking a skill to learn, prioritize those that require hands-on work and on-the-spot judgment — these are the hardest for automation to replace. + +- Cost: No cost at all. Before making a choice, run through the skills you’re considering using this criterion as a filter. +- In plain terms: According to U.S. estimates, roughly 47% of jobs carry a relatively high risk of being taken over by computers. Later studies that evaluated individual tasks instead yielded a much lower percentage. Three core challenges currently prevent machines from handling certain jobs: manual dexterity, creative problem-solving, and social interaction. Hence, roles that demand physical work in unpredictable environments and real-time decision-making are far less likely to be automated, while jobs with rigid processes and heavy information processing carry the highest risk. +- Benefit: This study assessed 702 U.S. occupations to estimate the likelihood of each being automated — the result showed that about 47% fell into the high-risk category. The three aforementioned challenges form what the authors call “engineering bottlenecks” that limit automation potential. These include sensory perception and physical manipulation (finger and hand dexterity, working in cramped or awkward spaces), creative intelligence (the ability to devise novel solutions), and social intelligence (interpersonal interaction). Consequently, occupations requiring hands-on work in unstructured settings and on-the-fly judgment are consistently less prone to automation, rather than this being a random trait of specific jobs. Roles with standardized workflows and information-centric tasks face the greatest automation risk. +- Evidence grade: B +- Sources:Frey CB, Osborne MA (2017). The future of employment: how susceptible are jobs to computerisation? Technological Forecasting and Social Change, 114, 254-280. +- Notes: This research is somewhat controversial. It originated as an unpublished draft paper from 2013 that measured the overall automation potential of entire occupations. Later studies that evaluated individual tasks instead produced a significantly lower high-risk percentage. The paper also does not specify a timeline for when automation might occur. When using these findings, avoid fixating on the 47% figure; instead, focus on the three key bottlenecks it identifies. Jobs involving on-site installation, maintenance, and caregiving are far more resistant to automation than purely clerical roles for precisely these reasons. Therefore, when deciding which skill to acquire, prioritize those that demand physical work in non-standard environments. +### 11. Check first whether a skill has an official grading system and if those grades can translate into pay raises + +- Cost: No cost involved. One quick check is all you need. +- In plain terms: The government is promoting a “New Eight-Level Worker” system that requires companies to link job pay to employees’ skill levels. Outstanding workers can even have their skill grades recognized regardless of seniority or years of experience. This is the policy direction, though implementation varies widely across regions and companies. Only skills with established national occupational standards and grading pathways can eventually lead to pay increases based on those grades — so it’s worth checking first before you invest time in learning them. +- Benefit: The government is actively rolling out this New Eight-Level Worker skill grading system. Official documents explicitly require linking skill grades to employee compensation, stating that “a skill-oriented pay distribution system must be strengthened... companies should adopt a compensation model that ties both job value and skill levels to pay.” Regions are also being urged to “expand the evaluation and hiring of senior-level workers and increase the frequency of such evaluations.” Eligible companies can conduct their own skill assessments for employees, and top performers can have their skill grades recognized without needing to meet any requirements related to years of service, prior grades, or seniority. +- Evidence grade: B +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. ；人力资源社会保障部 (2021). 「技能中国行动」实施方案. +- Notes: This is the intended policy direction, not a guarantee of actual pay increases — implementation varies greatly by region and company. The key takeaway for anyone considering learning a new skill is to first verify whether it has corresponding national occupational standards and a formal grading pathway; only then can it potentially lead to pay raises based on skill level. For skills lacking any official grading system or industry entry requirements, learning them won’t guarantee any career or financial benefits — you’ll still need to find work on your own. +### 12. Don’t take “high wages reported online” as proof of labor shortages — check local lists of in-demand occupations and subsidy programs instead. + +- Cost: Nothing to pay. You just need to look up two local documents. +- In plain terms: The amount of training subsidies allocated for any given occupation depends on how urgently it is needed and the associated training costs. Thus, subsidy levels serve as a direct indicator of local labor shortages. Claims online about “monthly earnings for a certain job” are usually just posted rates or self-reported figures from job platforms. These figures represent only those who are already earning money, and they ignore factors like working hours, commuting time, occupational illnesses, and seasonal fluctuations. +- Benefit: Subsidy amounts essentially represent the official assessment of which occupations are in short supply. Policies call for “developing differentiated subsidy mechanisms based on how urgently an occupation is needed and its training costs,” which guides each region in determining which vocational training programs qualify for subsidies. Consequently, differences in subsidy levels for the same occupation across cities directly reflect local labor shortages. +- Evidence grade: C +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: TODO (Need to verify: official sources for national average wages by occupation and rankings of in-demand jobs; no relevant pages from the Human Resources and Social Security Bureau could be accessed at this time). Most online figures about “monthly earnings for a certain job” stem from job platforms or self-reported data. These figures apply mainly to those already earning money, and they fail to account for working hours, commuting, occupational risks, and seasonal trends. To gauge true demand, consult your local Human Resources and Social Security Bureau’s website for subsidy lists and check rankings of job demand from public employment services. Finally, speak with current workers at construction sites, factories, and retail outlets. +### 13. For the same cost and time, prioritize short-duration programs that lead directly to employment + +- Cost: These short-term courses require tuition fees, though the amount is modest. They also demand a significant time commitment. The challenge lies in knowing when to stop the program if results aren’t evident despite completing part of the coursework, per the agreed terms. +- In plain terms: Government policies favor short-term training programs and micro-specializations at vocational colleges that lead to quick employment. The sole criterion for selecting such programs is whether they offer a concrete job opportunity upon completion. Programs lasting a year or more, which require additional “experience-building” after graduation, end up costing far more than advertised. It’s crucial to define clear exit conditions upfront: specify the level of skill mastery required before one can stop the program if no job has been secured. +- Benefit: Government guidelines align with this approach: they support “private training institutions offering market-driven, high-quality vocational programs and short-term training initiatives that lead to swift employment.” They also encourage vocational colleges to “focus on skills and knowledge in high demand by the job market... and develop micro-specializations and vocational training courses.” +- Evidence grade: C +- Sources:国务院就业促进和劳动保护工作领导小组 (2025). 关于开展大规模职业技能提升培训行动的指导意见. +- Notes: The sole deciding factor is whether a specific job opening exists after completing the program. Programs requiring a year or more of study followed by further “experience accumulation” incur far higher actual costs than their listed price. The exit conditions outlined in Section 4 also apply here: clearly define in advance the skill threshold at which one may discontinue the program if no job is found. +### 14. After studying, close the book and test yourself — don’t just reread it. + +- Cost: There’s no cost involved, and no extra time is needed. Use the time you’d otherwise spend rereading to write down or answer questions from memory instead. The difficulty lies in how uncomfortable it feels to confront what you’ve forgotten right away, compared to the relative ease of rereading. +- In plain terms: Rereading a section often makes it seem very familiar, but that doesn’t mean you’ve actually retained it well. Testing yourself after reading yields noticeably better results. In classrooms where brief quizzes are added, average test scores rise by a moderate amount. When ranking ten common study methods, self-testing comes out on top. After finishing a section, try writing down the key points from memory before checking them against the text. +- Benefit: A meta-analysis of 222 separate studies involving 48,478 students found that classroom quizzes led to a moderate improvement in academic performance (effect size g = 0.499). This effect varies depending on several factors: the baseline study method used in the control group, how closely the quiz format matches the final exam, whether the material is comparable, whether corrective feedback is provided, how many times the quiz is administered, when and where it takes place, how long the intervention lasts, and the experimental design used. Another comprehensive review that evaluated all ten widely used study techniques rated “practice testing” and “spaced practice” as the most effective methods overall. Their high utility stems from proven success across learners of different ages and abilities, as well as in diverse testing formats and real-world educational settings. +- Evidence grade: A +- Sources:Yang C, Luo L, Vadillo MA, Yu R, Shanks DR (2021). Testing (quizzing) boosts classroom learning: A systematic and meta-analytic review. Psychological Bulletin, 147(4), 399–435. ；Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: Self-testing is meant to force information out of your memory, not to assign grades. The recommended approach is to write down key points from memory after reading a section, then check them against the text. Providing corrective feedback further boosts effectiveness, so it’s important to carefully review why each answer was incorrect. The “large” magnitude of benefit mentioned here is determined by both the effect size and the overall rating. Since these studies measured academic outcomes rather than time saved, they weren’t evaluated against time‑saving thresholds. Self-testing and the method described in item 15 — spreading the same amount of study time across several days — are the two highest‑rated strategies identified in the same review; using them together yields the best results. +### 15. Spread the same study time over several days instead of cramming it all at once + +- Cost: There’s no extra expense, and the total time required stays the same. The only change is the schedule: those same 3 hours are split into three 1-hour sessions. The challenge is that you must start planning days in advance — you can’t leave it all for the final night. +- In plain terms: Studying the same amount of material over several days helps you retain it far better than cramming it all at once. 317 separate experiments have all confirmed this same conclusion. There’s also a practical rule to follow: the longer you want to retain the information, the longer the interval between review sessions should be. If a test is tomorrow, review the material that day; if it’s a month away, schedule a few review sessions in between. +- Benefit: This is a meta-analysis that brought together data from 184 papers, 317 experiments, and 839 separate evaluations of distributed practice. It compared two key factors: studying material in one continuous block versus splitting it into multiple sessions (the spacing effect), and short versus long review intervals (the delay effect). Its main finding is that both the length of time you aim to retain information and the spacing between review sessions together determine your final retention rate: the longer you need to remember the material, the longer the ideal spacing between reviews becomes. Another review that assessed ten common learning strategies ranked distributed practice as one of the highest utility methods overall. +- Evidence grade: A +- Sources:Cepeda NJ, Pashler H, Vul E, Wixted JT, Rohrer D (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354–380. ；Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: This tip works best when combined with Tip 14 (self-testing without looking at notes): you can also spread out those self-test sessions over several days. Most of the study materials used in Cepeda’s meta-analysis focused on simple tasks like memorizing word lists, so no universal recommended interval length exists for more complex subjects. The original research states that the longer the upcoming test date, the longer the ideal spacing between reviews should be, but no specific schedule is provided. Cramming the night before an exam does offer some short-term benefit, but the information is quickly forgotten. +### 16. Don’t treat highlighting, rereading, and summarizing as primary study methods + +- Cost: No cost at all; actually saves time. These methods are easy to apply and give you that “I’m studying” feeling. +- In plain terms: Highlighting and rereading are the most common study habits among students, yet both rank at the very bottom among ten widely used learning strategies. Summarizing, keyword memorization, and visualizing text with images also fall into the lowest tier. They’re not completely useless, but only work under very specific conditions, so spending the same amount of time on self-testing yields far better results. +- Benefit: This review evaluates ten common study methods based on how well their effectiveness holds across different learning contexts, student traits, materials, and assessment formats. The highest-rated strategies are practice testing and spaced practice. Methods rated as moderately effective include elaborative questioning, self-explanation, and interleaved practice. The five least effective methods are summarizing, highlighting (or underlining), keyword memorization, visualizing text with images, and rereading. The review also notes that while most students report using rereading and highlighting, these methods do not reliably improve academic performance; they should be replaced with other approaches such as practice testing instead of rereading. +- Evidence grade: A +- Sources:Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT (2013). Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest, 14(1), 4–58. +- Notes: You can use highlighting to mark sections you plan to self-test later, but the problem arises when highlighting itself is mistaken for actual learning. The review also clarifies that being in the lowest tier does not mean these methods have zero value — they simply work only under narrow circumstances and require further research. For alternative study actions, see item 14 (self-testing after closing the book) and item 15 (spreading study time across multiple days). +### 17. Mixing different types of exercises rather than doing twenty of the same kind + +- Cost: No cost at all. Simply rearrange the order of exercises in your workbook so they’re not grouped by type. The downside is that mixing them often lowers your immediate accuracy, which can feel like a step backward. +- In plain terms: Practicing one type of problem over and over makes it feel easy at the time, but later you might struggle to recall which method to apply. Mixing several types together yields better long‑term results — though the improvement is moderate. This technique works best with visual material such as drawings or categorization tasks; it has a smaller effect on math problems, and for vocabulary memorization it’s actually better to practice in blocks. +- Benefit: This finding comes from a comprehensive meta‑analysis that included 59 studies, 238 effect sizes, and 158 samples. Overall, interleaved practice produces a moderate benefit compared with blocked practice (Hedges’ g = 0.42). When broken down by material, visual tasks benefit the most (g = 0.67), while math problems show a smaller effect (g = 0.34). No significant advantage was found for expository texts or taste‑related tasks; for vocabulary, blocked practice actually performed better (g = −0.39). Regression analysis indicates that the benefit grows when categories are more similar, when items within a category are less alike, and when the material itself is more complex. +- Evidence grade: A +- Sources:Brunmair M, Richter T (2019). Similarity matters: A meta-analysis of interleaved learning and its moderators. Psychological Bulletin, 145(11), 1029–1052. +- Notes: The review cited in item 16 — which warns against relying solely on highlighting — rated interleaved practice as having a moderate effect, noting that evidence at the time was limited. Taken together, these studies suggest that interleaving works well for material that requires you to recognize a category and pick the right method, such as different math problem types, medical cases, or legal statutes. In contrast, content meant for rote memorization — like vocabulary or definitions — is better learned through blocked practice. +### 18. Don’t pick learning methods based on “I’m a visual learner, he’s an auditory learner” + +- Cost: No cost at all. You simply stop using this classification to pick materials or courses, and you also avoid spending money on style assessments. +- In plain terms: Many people believe each person has a distinct learning style — such as being visual or auditory — and that teaching should be tailored to that style for best results. Yet there are very few rigorous studies on this, and almost none provide any support for it; several even show the opposite. While people do have personal preferences, there’s no evidence that instruction aligned with those preferences leads to better learning. There’s also no need to spend money on learning style assessments. +- Benefit: A comprehensive review evaluating evidence on learning styles concluded that to prove “teaching according to learning styles” works, students must first be grouped by style, then randomly assigned to different teaching methods, and finally tested using the same assessment. The key indicator of effectiveness would be a specific interaction effect: a teaching method highly effective for one style would be less effective for another. The review found almost no such interaction effects. Although there’s plenty of literature on learning styles, very few studies employ proper experimental designs, and several of those produce results directly contradicting the “match hypothesis.” Based on this, the authors argue current evidence simply doesn’t justify incorporating learning style assessments into educational practice. +- Evidence grade: A +- Sources:Pashler H, McDaniel M, Rohrer D, Bjork R (2008). Learning Styles: Concepts and Evidence. Psychological Science in the Public Interest, 9(3), 105–119. +- Notes: The review also notes this doesn’t mean every version of learning style theory has been tested and disproven; many have never been examined at all. What you should definitely avoid is spending money on learning style assessments or selecting training programs based on such classifications. Criteria for picking training options are outlined in item 9 (prioritizing government-subsidized programs) and item 13 (favoring short-term programs that lead directly to employment). +### 19. Test yourself using questions based on how you’ll use the material later; don’t just recite it verbatim + +- Cost: There’s no expense involved, nor does it require extra time. The only change is the practice method: replace “reciting it verbatim” with “creating questions based on future usage.” The real challenge is figuring out exactly how you’ll apply this material later on. +- In plain terms: Testing yourself after closing the book offers benefits beyond simply memorizing a few words. A meta-analysis of 192 comparisons involving over 10,000 participants showed that this method works moderately well for different question types, application problems, and reasoning tasks. However, it’s largely ineffective in two scenarios: when the question–answer pairing is reversed, and when the content has only ever been seen in the book without any prior testing. +- Benefit: This meta-analysis examined over 40 years of research, drawing from 67 published and unpublished papers, 122 experiments, and 192 measures of transfer effects involving 10,382 participants total. Compared to simply reviewing material without testing, practice testing led to measurable learning transfer, with an effect size of d = 0.40 (95% CI 0.31–0.50). Transfer was strongest when participants answered questions of a different type, application or reasoning problems, or medical‑diagnosis‑style queries involving similar concepts. Transfer was weakest when the stimulus–response pairing was reversed, when material had only been encountered but never tested, or when dealing with example‑style problems. Factors such as whether the practice and test formats matched, whether detailed feedback was provided, and whether participants answered correctly on the initial test all strongly influenced whether positive transfer occurred. Two separate methods were used to correct for publication bias; while these adjustments modestly affected effect sizes, they substantially lowered the baseline intercept value. Under these conditions, positive transfer is often not observed at all. +- Evidence grade: A +- Sources:Pan SC, Rickard TC (2018). Transfer of test-enhanced learning: meta-analytic review and synthesis. Psychological Bulletin, 144(7), 710-756. +- Notes: The term “memorization” usually bundles two distinct activities: repeatedly reading or highlighting material, and actively recalling it after closing the book. The former receives the lowest rating in a review that ranked ten learning strategies; for those ratings themselves, see item 16 (avoid relying on highlighting, repeated reading, or summarization as primary methods). What matters here is the latter: actively recalling information without looking at the source, as described in item 14 (self‑testing after closing the book). This practice should also be spread across several days, as noted in item 15 (distributed practice). Begin by determining how you’ll ultimately use the material—whether you’ll need to select answers on a test or make judgments in a real‑world setting—and then create questions that mirror those situations. It’s also valuable to reverse the question–answer order during practice, because the meta‑analysis showed that transfer is weakest in that direction; both orientations should be practiced. +### 20. First, figure out which professional series and level you belong to, then find the right application channels based on your employer type. + +- Cost: No cost involved. It takes about half an hour to look up the latest application guidelines for your province. +- In plain terms: There are 27 professional series nationwide, each divided into junior, intermediate, and senior levels. Generally, you must progress through these levels one by one. Employees working for organizations must have their applications reviewed and publicly posted by their employer before submission. Those working for private firms can apply via local professional qualification service centers, talent agencies, or industry associations. Self-employed individuals should apply through the local human resources and social security department. +- Benefit: A total of 27 professional series exist across China, covering fields such as economics, engineering, healthcare, and publishing. These are categorized into senior, intermediate, and junior levels. Order No. 40 issued by the Ministry of Human Resources and Social Security applies to enterprises, public institutions, social organizations, individual economic entities, and self-employed professionals alike. Applicants must generally advance step by step through these levels. Employers must review all submitted materials and publicly display them for at least five working days. Private firms and self-employed individuals may opt to have talent agencies handle the review, public posting, and recommendation processes. Local authorities are required to establish professional qualification service centers in science parks and high-tech zones; applications may also be accepted through talent agencies, industry associations, and professional societies. Eligible self-employed individuals may participate in evaluations organized by local human resources departments. Any documentation that can be verified online must not require additional certification. If any materials are missing, evaluators must clearly specify what is lacking in one single notice. Employees of private firms typically apply in the region where their employment contract is based. Those assigned to work elsewhere for at least one full year may apply at their temporary duty location. Retired personnel are ineligible to apply. Public sector employees currently under disciplinary action at or above the level of a reprimand cannot apply during that period (nationwide). +- Evidence grade: A +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第二条、第十三条、第十四条、第十五条、第十六条、第十七条、第十八条；人力资源社会保障部办公厅 (2020). 关于进一步做好民营企业职称工作的通知. ：「在专业技术人才密集的创业孵化基地、高新技术开发区、科技园区等地设立职称申报受理服务点，或通过人才中介服务机构、工商联、行业协会商会、学会等社会组织受理民营企业专业技术人才职称申报」「民营企业专业技术人才被派驻外地连续工作一年以上的，可按有关规定在派驻地申报职称评审」；新华社 (2024). 职称评审进入高峰，信息如何查？有何新变化？ ：「我国共设有经济、工程、卫生、出版等27个职称系列」「符合条件的自由职业者，可根据属地原则申报参加当地人社部门组织的职称评审」；中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「不将论文作为评价应用型人才的限制性条件」「对职称外语和计算机应用能力考试不作统一要求」「符合条件的高技能人才，可参加工程系列专业技术人才职称评审」「公务员不得参加专业技术人才职称评审」 +- Notes: No single nationwide list of required documents exists. Each professional series and province publishes its own annual application guidelines detailing necessary materials, deadlines, and performance criteria. Therefore, the first step is to search the official website of your provincial human resources department for the current year’s instructions. Publishing academic papers is no longer mandatory: a 2016 reform directive explicitly removed this requirement for practical professionals, and standardized language or computer proficiency tests are no longer mandatory either. Skilled technical workers may also qualify to apply for engineering-related professional titles. Government officials are prohibited from participating in such evaluations. +### 21. Entry- and intermediate-level accounting titles are earned via a national unified exam; first check your education level and work experience to see if you qualify. + +- Cost: Registration fees vary by province. Preparing for the exam requires several months of part-time study. +- In plain terms: Many entry- and intermediate-level professional titles are awarded solely through exams; passing the test is enough, with no additional evaluation needed. Accounting falls under this category: an assistant accountant must have at least a high school diploma, while a full accountant requires a bachelor’s degree plus four years of accounting work experience, or an associate degree plus five years. Those who already hold certain professional certifications may also be recognized as meeting the corresponding title requirements. +- Benefit: A 2016 reform directive states that for professional fields where entry- and intermediate-level titles rely on a national exam, no further evaluation or certification is required. In areas where professional titles and qualifications are closely linked, earning a qualification automatically grants the corresponding title and can serve as a prerequisite for advancing to a higher level. Accounting is a prime example: assistant accountants and accountants are selected via a nationwide exam. Senior accountants undergo both an exam and evaluation, while top-level titles are awarded solely through evaluation. Qualification criteria are as follows: Assistant accountants must have at least a high school diploma, including vocational, technical, or secondary specialized education. Accountants must hold a doctorate; or a master’s degree plus one year of accounting experience; or a second bachelor’s degree, graduate diploma, or equivalent plus two years of experience; or a bachelor’s degree plus four years of experience; or an associate degree plus five years of experience. Those with a master’s or doctorate in accounting may be exempt from the Financial Management exam portion when applying for accountant status. +- Evidence grade: A +- Sources:中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「专业技术人才取得职业资格即可认定其具备相应系列和层级的职称，并可作为申报高一级职称的条件。初级、中级职称实行全国统一考试的专业不再进行相应的职称评审或认定。」；人力资源社会保障部、财政部 (2019). 关于深化会计人员职称制度改革的指导意见. ：「助理会计师、会计师实行全国统一的会计专业技术资格考试」「高级会计师采取考试与评审相结合方式，正高级会计师一般采取评审方式」；财政部等 (2024). 关于做好会计专业学位与会计专业技术资格衔接有关工作的通知. +- Notes: To determine whether your professional series relies on exams, evaluations, or a mix of both, consult the relevant “Guiding Opinions on Deepening Reforms of [Series] Professional Title Systems.” These documents were issued by the Ministry of Human Resources and Social Security and sector-specific authorities; they can be found in the policy archives on the Chinese Government website. Exact registration dates and exam subjects are listed in each year’s official exam announcements. Civil servants may take the accounting exam but are not eligible to apply for accounting title evaluations. +### 22. Don’t hire agents to handle evaluations, don’t pay for ghostwritten papers, and don’t falsify any application materials: any proven violations will result in immediate revocation of your professional title and a 3-year entry in your integrity record. + +- Cost: No direct monetary cost. The real challenge is resisting tempting ads promising “guaranteed approval for a fee.” +- In plain terms: Any professional title obtained through fake materials, ghostwritten papers, or plagiarized work will be revoked upon verification. A record of this misconduct stays on file for 3 years and is shared with the national credit database. If you sign a commitment statement during application and later prove it to be false, you will be barred from applying for any title for 3 years. Labor and social security authorities also actively crack down on agents that make false claims, pose as official evaluators, or sell counterfeit certificates. +- Benefit: As stipulated in Order No. 40 issued by the Ministry of Human Resources and Social Security, anyone found to have submitted false materials, plagiarized others’ work or academic achievements, or obtained a professional title through any other improper means will have their title revoked. This violation is also logged into the professional title evaluation integrity database and shared with the national credit information platform for a 3-year period. The 2024 regulatory guidelines specifically list several prohibited acts by applicants: making false commitments, fabricating personal information, commissioning ghostwritten papers, falsifying work achievements, and seeking special treatment via personal connections. Applicants must sign a personal commitment statement; failure to honor this agreement results in a 3-year ban on all future applications. Labor and social security authorities collaborate with public security, internet regulatory, and market supervision agencies to investigate and penalize agents that run fake websites, make misleading claims, use contract traps, pose as official evaluators, or sell counterfeit certificates. In cases where violations are severe enough to constitute a crime, relevant parties will be handed over to judicial authorities for prosecution (nationwide). +- Evidence grade: A +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第三十九条；人力资源社会保障部 (2024). 职称评审监管暂行办法. ：第五条、第十五条、第十七条、第二十七条；人力资源社会保障部办公厅 (2022). 关于进一步做好职称评审工作的通知. ：「未经备案的职称评审委员会，评审结果不纳入全国职称评审信息查询验证系统」；新华社 (2024). 职称评审进入高峰，信息如何查？有何新变化？ ：「大家可通过www.12333.gov.cn网页、手机12333客户端、人力资源社会保障部门户网站、“人力资源和社会保障部”微信公众号等多种渠道进行登录」 +- Notes: A simple way to tell legitimate evaluations from fraudulent ones: any officially awarded professional title can be verified via the National Professional Title Evaluation Information Query Platform, accessible through the 12333 website, its mobile app, or the official Ministry of Human Resources and Social Security site. Titles issued by unregistered evaluation committees cannot be found in this system at all. Therefore, any agent or service that guarantees “100% approval”, claims you don’t need to attend any evaluation process, or promises you can use a title even if it does not appear in official records is almost certainly untrustworthy. The main beneficiaries of these rules are applicants themselves, as they protect them from the serious consequences of title revocation and a 3-year negative credit record. +### 23. Having a professional title doesn’t automatically mean a pay raise: first find out whether your employer uses a post‑based quota for evaluation and hiring, or if getting the title doesn’t guarantee a post or raise. + +- Cost: No cost at all. Just ask your HR department once. +- In plain terms: Professional titles serve as the basis for hiring, performance reviews, and promotions, but earning a title and actually being assigned to a corresponding post are two different things. In public institutions, titles are usually awarded within a set post‑ratio, and most people who earn them do get hired. Organizations without post‑based management can separate evaluation from hiring; in such cases, earning a title doesn’t guarantee a post or higher pay. When moving to another organization or region, you may need to re‑evaluate or re‑confirm your title. +- Benefit: Article 2 of Ministry of Human Resources and Social Security Order No. 40 states that professional title evaluation results are key references for hiring, performance reviews, and promotions of technical professionals. A 2016 reform guideline specifies that public institutions using post‑based management conduct evaluations within their post‑ratio framework, while organizations without such management — as well as professions with broad applicability and emerging occupations — may separate evaluation from hiring. When technical professionals transfer across regions or employers, their titles must be re‑evaluated or confirmed according to administrative authority, unless otherwise stipulated by national regulations (nationwide). +- Evidence grade: B +- Sources:人力资源和社会保障部令第 40 号 (2019). 职称评审管理暂行规定. ：第二条、第二十九条；中共中央办公厅、国务院办公厅 (2016). 关于深化职称制度改革的意见. ：「对于全面实行岗位管理、专业技术人才学术技术水平与岗位职责密切相关的事业单位，一般应在岗位结构比例内开展职称评审。对于不实行岗位管理的单位，以及通用性强、广泛分布在各社会组织的职称系列和新兴职业，可采用评聘分开方式。」 +- Notes: The evidence grade is B because the documents describe how evaluation and hiring relate to each other, but they provide no nationwide figures on how much pay rises after earning a title. What you can do: in public institutions and state‑owned enterprises, ask HR about available post openings and hiring rules; in private firms, ask the owner whether the certificate is recognized and whether it brings a pay increase. diff --git a/book/en/24-Seeing-The-Doctor.md b/book/en/24-Seeing-The-Doctor.md new file mode 100644 index 00000000..dc469576 --- /dev/null +++ b/book/en/24-Seeing-The-Doctor.md @@ -0,0 +1,135 @@ +# 24. Seeking medical care: How to save money and avoid unnecessary hassle + +This section focuses on the practical steps involved in getting medical treatment — which hospitals to visit first, how to transfer between levels of care, and where you can cut down on expenses. It also explains how to wait in emergency queues, what evaluations and documents are required after serious injuries, and what benefits you may be eligible for (see Section 7). Long‑term management of chronic diseases is covered in Section 16, while immediate actions at the scene of an emergency are described in Section 13. + +The content is largely based on the “Several Measures on Accelerating the Development of a Hierarchical Medical System” issued by the General Office of the State Council in April 2026. This system directs patients to hospitals according to the severity of their condition. The document explicitly links using primary‑level facilities with lower medical costs. However, implementation varies by region, so the national rules outlined here should be cross‑checked with local policies issued by your social insurance and health authorities. Your “coordinated region” is simply the area where you’re enrolled in medical insurance — usually a city. +### 1. For common illnesses, patients should first visit community clinics; referrals then proceed stepwise to larger hospitals, after which the hospital deductible is calculated only once. + + +- Cost: No expense is required. You must first make a trip to a community clinic. The hard part is resisting the urge to book an appointment with a specialist right away. +- In plain terms: Start by going to a community clinic, which will then refer you to a larger hospital for inpatient care. The amount you pay out-of-pocket at the start is counted only once. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you might have to pay that amount twice. However, if a larger hospital refers you back to a community clinic for continued treatment, the deductible is not recalculated for the same condition during that period. +- Benefit: Insured patients who follow this stepwise referral process can have their hospital deductible accumulated across multiple facilities. The deductible represents the portion of each hospitalization you must pay personally before insurance coverage kicks in. Accumulation means that the total paid at both the community clinic and the larger hospital counts as a single deductible amount, so you do not have to pay it again. For patients transferred from a larger hospital back to a community clinic, no additional deductible is applied for the same illness during that timeframe. +- Evidence grade: A +- Notes: The deductible is the amount you pay out-of-pocket per hospitalization before insurance begins to reimburse costs. If you go directly to a tertiary hospital for admission and later return to a community clinic for recovery, you may end up paying this amount twice. Following the proper referral pathway ensures it is calculated only once. Specific referral rules are determined individually by each province, city, and medical consortium. Be sure to ask your community clinic about these rules before seeking care. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「统筹地区内经基层医疗卫生机构逐级转诊的参保患者，在上级医院的住院起付线可连续计算；由上级医院下转至基层医疗卫生机构的住院患者，同一疾病周期内不再另设住院起付线。」 + +### 2. Within the same medical insurance region, the lower the hospital level, the higher the reimbursement rate — the difference is roughly 10 percentage points. + + +- Cost: No direct cost involved. The real challenge is resisting the urge to go to a larger hospital. +- In plain terms: For the same hospitalization bill, the lower the hospital level, the more you get reimbursed. Regions are required to set reimbursement rates that differ by about 10 percentage points between each successive level. Choosing a larger hospital when a community clinic can handle the case means you’ll have to pay roughly 10% more out of pocket. Newly allocated medical insurance funds also favor primary‑care facilities. +- Benefit: Policies mandate that reimbursement rates for inpatient care differ by roughly 10 percentage points across hospital levels. Consequently, for the same expenses, each step up to a higher‑level hospital results in about a 10% increase in personal costs. New annual medical‑insurance allocations likewise prioritize grassroots healthcare providers. +- Evidence grade: A +- Notes: For the same hospitalization bill, the out‑of‑pocket difference between a community clinic and a tertiary hospital can reach several thousand yuan. This guideline does not suggest that every condition should be treated at a community level; rather, it advises seeking care at lower‑level facilities whenever possible. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「因地制宜适当拉开参保人员在不同等级医疗卫生机构的住院报销水平，原则上统筹地区内医疗卫生机构住院报销比例逐级拉开10个百分点左右的差距。」「具备条件的地方，可按分级诊疗导向酌情拉开参保人员在不同等级医疗卫生机构的门诊报销水平。」 + +### 3. Go to a major hospital via a referral from a local clinic or the hospital’s referral center — don’t turn to scalpers. + +- Cost: No direct cost, but an extra referral step is required. +- In plain terms: Major hospitals must set aside a portion of appointments and beds specifically for patients referred from local clinics. They must also establish a referral center or designate a dedicated department to handle referrals — this requirement will be fully implemented by 2027. Not being able to book a slot online does not mean there is no way in. Scalpers charge exorbitant fees and may even route you to the wrong department. +- Benefit: Lead hospitals in tightly integrated medical networks must reserve a specific share of appointments and beds for patients referred from local clinics, and promptly admit them. Such networks consist of multiple hospitals and community health centers working together. In other words, there is a separate pool of appointments and beds reserved for referred patients, separate from the general booking pool. All hospitals must set up referral centers or assign a dedicated department by 2027. +- Evidence grade: A +- Notes: The reserved appointments and beds are specifically meant for referred patients. Failing to book online does not mean there is no way in. Using scalpers is not only costly but may also lead to being assigned to the wrong department. If you cannot locate the referral center, call the hospital’s service line for help. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「牵头医院要为基层医疗卫生机构预留一定比例的号源和床位，并及时接诊经基层转诊患者。」「医疗机构要强化转诊服务统一管理，设立转诊中心或指定固定部门承担患者转诊服务工作，到2027年实现全覆盖。」 + +### 4. Before seeking medical care outside your home province, ask locally first — the need for such care should ideally be assessed by an associate chief physician or higher. + + +- Cost: No cost involved. It simply requires asking a few extra questions beforehand. +- In plain terms: Whether a patient needs to travel elsewhere for treatment should, in principle, be evaluated by doctors holding the rank of associate chief physician or above at secondary or tertiary hospitals. Reimbursement rates for temporary out-of-area treatment differ from those offered at local hospitals of comparable level; exact terms depend on local regulations. Asking locally beforehand is far better than discovering later that no reimbursement is possible. +- Benefit: The necessity of receiving medical care across different healthcare regions or provinces must, ideally, be assessed by qualified physicians at secondary or tertiary hospitals holding the rank of associate chief physician or higher. “Cross-regional care” refers to treatment sought outside one’s designated medical insurance area. This assessment must be performed by doctors meeting the required qualifications. Reimbursement levels for temporary out-of-province patients also differ reasonably from those at local hospitals of the same level; consequently, patients receive less coverage for identical treatments received elsewhere. +- Evidence grade: A +- Notes: “Temporary out-of-area treatment” and “long-term residence elsewhere” constitute two distinct registration categories, each with different reimbursement levels. Details regarding registration procedures and which conditions qualify for direct settlement are covered in Section 16. Do not travel to another province first and then worry about reimbursement later. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「原则上由二、三级医院副主任医师及以上职称人员评估患者跨统筹地区、跨省异地就医的必要性。」「进一步强化异地就医直接结算管理服务，跨省临时外出就医人员报销水平与参保地同级别医疗机构报销水平保持合理差异。」 + +### 5. Stop treating tertiary hospitals as mere prescription hubs — stable chronic disease patients should turn to primary care + +- Cost: No monetary cost involved. The real challenge is breaking the habit of relying exclusively on large hospitals. +- In plain terms: Moving forward, tertiary hospitals will primarily handle emergency cases, critically ill patients, and complex medical conditions. Routine follow-ups for common illnesses and regular outpatient visits for patients with stable chronic diseases will gradually be phased out. The same expert physicians who previously saw patients in tertiary hospitals will now provide care at community clinics. Continuing to use large hospitals solely for medication refills will become increasingly difficult as appointment slots dwindle. +- Benefit: Tertiary hospitals can better focus on emergency care, critically ill patients, and complex medical issues by gradually reducing routine outpatient services for common illnesses and stable chronic disease cases. This means fewer appointment slots will be available for such visits. Meanwhile, expert medical teams from top-tier hospitals will extend their outpatient services to community-level facilities, making their expertise accessible locally. +- Evidence grade: A +- Notes: This reflects official policy direction rather than a recommendation. Access to routine outpatient services at large hospitals will become increasingly limited in the future. For patients with stable chronic diseases, primary care clinics can issue medication prescriptions valid for up to 12 weeks — see Section 16 for details. +- Sources:国务院办公厅 (2026). 关于加快建设分级诊疗体系的若干措施. ：「三级医院要聚焦急危重症和疑难复杂疾病，加强转诊会诊和住院服务，逐步酌减常见病复诊和诊断明确、病情稳定的慢性病等普通门诊。」「紧密型医联体内上级医院要在基层医疗卫生机构开设高血压、糖尿病、慢性阻塞性肺疾病等常见病、慢性病门诊，提供诊疗和健康管理服务，并将专家团队普通门诊向基层医疗卫生机构延伸。」 + +### 6. After every medical visit, keep a personal copy of your medical records, test reports, and imaging scans + +- Cost: No cost involved. Hospitals may charge a nominal fee for photocopying, but the rate must be publicly disclosed. The real challenge is remembering to make a copy after each visit. +- In plain terms: You have a legal right to access and copy your own medical records. This includes outpatient records, inpatient charts, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and itemized billing statements. Hospitals provide dedicated counters for this purpose, where only basic copying fees apply. These documents prove invaluable when switching doctors, seeking a second opinion, filing commercial insurance claims, or in case of any legal disputes. +- Benefit: Laws explicitly recognize access to and duplication of medical records as a fundamental patient right. This entitlement covers all relevant documents such as outpatient and inpatient records, lab results, imaging scans, surgical and anesthesia notes, pathology reports, and billing statements. They serve as essential evidence when changing healthcare providers, obtaining a second medical opinion, filing insurance claims, or in any legal proceedings. +- Evidence grade: A +- Notes: Hospitals maintain dedicated counters for record copying — no need to ask doctors for help. To ensure completeness, simply read aloud the list stipulated in Article 16 of the Regulations on Prevention and Handling of Medical Disputes. It includes outpatient records, inpatient charts, temperature logs, physician orders, lab results, imaging scans, surgical and anesthesia notes, pathology reports, nursing records, and billing statements. Once obtained, organize them chronologically in a dedicated folder. The most critical documents are discharge summaries, surgical reports, pathology findings, and key imaging scans. For chronic disease management, record all relevant metrics in one notebook as described in Section 16. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号）第十六条：「患者有权查阅、复制其门诊病历、住院志、体温单、医嘱单、化验单（检验报告）、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录、病理资料、护理记录、医疗费用以及国务院卫生主管部门规定的其他属于病历的全部资料。」「患者要求复制病历资料的，医疗机构应当提供复制服务，并在复制的病历资料上加盖证明印记……可以收取工本费，收费标准应当公开。」「患者死亡的，其近亲属可以依照本条例的规定，查阅、复制病历资料。」第十五条「任何单位和个人不得篡改、伪造、隐匿、毁灭或者抢夺病历资料。」；国家卫生计生委、国家中医药管理局 (2013). 医疗机构病历管理规定（2013 年版）：医疗机构「应当指定部门或者专（兼）职人员负责受理复制病历资料的申请」，复制在申请人在场的情况下进行并加盖证明印记. + +### 7. If you have doubts about treatment, request to seal the medical records on the spot; both parties must be present, a list must be drawn up, and each side gets a copy. + + +- Cost: No cost at all. Simply ask the hospital to seal the records; both you and the medical staff must be present to complete the paperwork. The real challenge is mustering the courage to say this out loud in front of the doctors. + +- In plain terms: If you’re unsure about any aspect of your treatment, you have the right to request that your medical records be sealed. Both you and the medical staff must be present for this process, which involves creating a detailed list, signing and stamping it, and each side receiving a copy. If the records aren’t fully completed yet, only the finished portions should be sealed first; the rest can be sealed later. Should you suspect that an intravenous infusion, blood transfusion, injection, or medication caused a problem, the actual fluid bag, medicine vial, and infusion set must also be sealed together with the records. + +- Benefit: Regulations clearly state that “whenever a medical dispute arises and it is necessary to seal or unseal medical records, this must be done while both the patient and medical staff are present.” The sealed documents may be either originals or copies, which the hospital then stores. If the records are still being written, only the completed sections should be sealed first; the remainder can be sealed later. The hospital must produce a sealing list, signed or stamped by both parties, with each side keeping a copy. In cases where an adverse effect is suspected to stem from an IV, blood transfusion, injection, or medication, both parties must jointly seal and later unseal any related physical items. If testing is required, both parties must jointly appoint a qualified laboratory; should they fail to agree, the local health authority at the county level where the hospital is located will make the appointment. Should a transfusion-related problem be suspected and blood samples need sealing, the hospital must notify the blood bank to send representatives to the scene. Additionally, there is a strict rule: “No organization or individual may alter, forge, conceal, destroy, or seize medical records.” Once a dispute is resolved or three years pass without any further claims, the hospital may unseal the documents on its own initiative (nationwide, effective 1 October 2018). + +- Evidence grade: A + +- Notes: Sealing records and making copies are two distinct actions. Copying records is something you should do proactively, as explained in item 6 (always keep your own copies of medical records and imaging). Sealing, on the other hand, serves to preserve evidence at the moment a dispute arises, preventing any later alterations or additions. If you suspect that an IV, blood transfusion, injection, or medication caused a problem, you must seal not only the records but also the fluid bag, medicine vial, and infusion set; otherwise they might be removed or discarded. Hospitals are required to prominently display information about dispute resolution procedures, contact details, and to maintain a dedicated complaints department. In case of any issue, approach that department rather than confronting the attending physician directly. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号，第十五、二十四、二十五条）. + +### 8. Head straight to the emergency triage desk — don’t wait in line at registration + +- Cost: No cost at all. Just walk a few extra steps to find the triage desk and describe the most life‑threatening symptom in one sentence. +- In plain terms: Emergency care isn’t served on a first‑come, first‑served basis; patients are sorted into four severity levels. The triage desk at the ER entrance — not the registration window — makes that determination. Without a triage rating, even the most severely injured patients must wait in line like everyone else. First, state the most dangerous condition: heavy bleeding, difficulty breathing, altered consciousness, foreign objects in the body, or crushing chest pain. +- Benefit: According to the 2024 quality‑control guidelines for emergency medicine issued by China’s National Health Commission, patients must be classified into four levels based on severity. Level I denotes critically ill patients who require immediate treatment; Level II covers severely ill patients whose assessment and care happen simultaneously. Level III includes urgent patients needing prompt diagnosis and treatment, while Level IV comprises non‑urgent or semi‑urgent cases that are seen in regular order. Triage is the process by which trained staff evaluate each patient at entry and assign a priority rank. Beijing’s implementation rules specify response times for each level: Level I patients must be evaluated and treated at once, often in a resuscitation room; Level II patients need vital‑sign monitoring and treatment within ten minutes, also in a resuscitation room; Level III patients are seen before Level IV cases, but if wait time exceeds 30 minutes they must be re‑evaluated; Level IV patients wait in regular sequence, though any change in condition can trigger a reassessment after four hours. The principle of giving priority to critically ill patients must be strictly observed, and a dedicated triage area must be clearly marked at every ER entrance (the four‑level framework is national, while the response times are specific to Beijing). +- Evidence grade: A +- Notes: The four‑level system is standardized nationwide; exact treatment intervals are set locally, and Beijing’s version can be verified verbatim. Triage relies on measurable indicators such as heart rate, blood pressure, oxygen saturation, and specific symptoms — not on how much pain a patient reports. For Level I, key criteria include a heart rate above 180 bpm or below 40 bpm, systolic blood pressure under 70 mmHg, oxygen saturation below 80 %, shock, confirmed myocardial infarction, or acute loss of consciousness. If you feel your level was assigned incorrectly, describe the most dangerous symptom in detail. Should your condition worsen while waiting, return to the triage desk for re‑evaluation. In truly critical situations, calling emergency services (120) is faster than self‑transport; pre‑hospital staff apply the same criteria to assign an initial level and alert the hospital in advance (see Section 13). +- Sources:国家卫生健康委办公厅 (2024). 关于印发急诊医学等 6 个专业医疗质量控制指标（2024 年版）的通知（国卫办医政函〔2024〕150 号）附件 1，指标四「急诊分级分诊执行率」. ；北京市卫生健康委员会 (2019). 北京市加强急诊预检分诊分级工作方案及附件《北京市医院急诊预检分诊分级标准（试行）》：「坚持急危重症优先就诊原则。按照患者病情的严重程度，遵循从重到轻、从病情迅速变化到相对稳定的原则，合理安排患者就诊顺序。」「在急诊科入口的显著位置，设置急诊预检分诊区域」. + +### 9. Even without money or ID, and unable to identify yourself, emergency care must be provided first + +- Cost: No cost at all. +- In plain terms: The state maintains an emergency medical assistance fund designed to cover emergency treatment costs for two groups of patients: those whose identities cannot be verified, and those whose identities are known but who cannot afford the bills. Healthcare facilities are prohibited from refusing, delaying, or shirking emergency care for any reason. Likewise, emergency dispatch centers cannot decline or delay responses due to payment concerns. Therefore, never hesitate to call for help just because you lack funds — this fund covers only the initial emergency phase; subsequent inpatient treatment still relies on yibao (basic medical insurance) and other medical assistance programs. +- Benefit: This emergency assistance program is intended for “patients experiencing acute, severe, or life-threatening injuries or illnesses within China who require urgent care but lack verifiable identity or means to pay.” The fund pays two types of expenses: “emergency treatment costs incurred by patients whose identities cannot be determined,” and “outstanding emergency bills for patients whose identities are known but who cannot pay.” Official documents further stipulate that “all healthcare institutions and staff must promptly and effectively treat such patients without any excuses for refusal, delay, or evasion.” Nationwide, the emergency medical hotline is 120; dispatch centers are forbidden from rejecting or delaying service due to scheduling or payment issues. Transport follows the principle of “proximity, urgency, professional suitability, and patient preference” (implemented nationwide since 2013). +- Evidence grade: A +- Notes: This fund applies strictly to emergency treatment costs. Care is delivered first, after which hospitals submit claims to the fund — patients do not receive direct payments. Those covered by yibao continue using that system as usual. Application procedures and limits vary by province. Per the transport guidelines, “proximity” and “urgency” take precedence over “patient preference”; thus ambulances may not take you to a hospital of your choice if a closer facility can handle your condition. Should post-emergency expenses remain unaffordable, additional assistance is available under medical aid programs — see Section 7, Item 10. +- Sources:国务院办公厅 (2013). 关于建立疾病应急救助制度的指导意见（国办发〔2013〕15 号）. ；国家卫生和计划生育委员会 (2014). 院前医疗急救管理办法（委令第 3 号，第十三、二十二、二十三、二十五条）. + +### 10. Disability assessments must be conducted only after treatment is complete; doing it too early results in a lower rating. + + +- Cost: The cost of such assessments ranges from a few hundred to two thousand yuan, typically paid upfront by the party requesting the evaluation. Assessments are only permitted after treatment has ended or when clinical outcomes have stabilized — usually three to six months post-injury, though sometimes longer. The difficulty lies in resisting the urge to get an early assessment when recovery is still underway. + +- In plain terms: The amount of compensation one receives depends largely on the disability rating assigned, which in turn reflects how much functional ability remains after full recovery. Official guidelines stipulate that assessments must be performed only after treatment concludes or when clinical results are stable. If an assessment is done while bones are still healing or metal implants remain in place, it reflects the individual’s condition at that moment, effectively lowering their rating. For ordinary fractures that do not impair function even after healing, no disability rating is assigned at all. + +- Benefit: According to the “Classification of Human Injury and Disability Levels,” assessments must be conducted “after primary injuries and any related complications have been fully treated or when clinical outcomes have stabilized.” The standard further divides disability levels into ten grades, ranging from Grade 1 (100% disability rate) to Grade 10 (10% disability rate), with each grade differing by 10% in terms of functional impairment. Evaluation criteria include structural damage to tissues and organs, resulting functional limitations, and the degree of dependence on medical care or nursing, while also accounting for social and psychological impacts caused by disability. Specific criteria relevant to fractures include: (1) compression fractures of one vertebra where compression reaches one-third or more, or comminuted fractures; (2) two or more fractures of the pelvis or comminuted pelvic fractures resulting in deformity; and (3) loss of 25% or more function in any major joint of the limbs, excluding the ankle joint. Multiple disabilities affecting the same area or of similar nature must not be counted repeatedly. In cases involving multiple disabilities, each respective grade must be explicitly stated (National Standard, effective January 1, 2017). + +- Evidence grade: A + +- Notes: Three distinct disability assessment systems exist and must not be confused. For injuries resulting from assaults, traffic accidents, or other personal injuries, the “Classification of Human Injury and Disability Levels” is used for judicial assessments, determining compensation amounts (see Section 9). Workplace injuries are evaluated via a separate ten-grade system for work capacity assessments, governing eligibility for occupational injury benefits (see Section 19). To qualify for disability-related policies and benefits, individuals must also obtain a Disability Certificate (see Article 11). Prior to any assessment, ensure all medical records, surgical reports, and follow-up imaging are fully prepared (see Article 6 regarding personal record-keeping); missing imaging is a common cause of lower disability ratings. When current injuries coexist with pre-existing conditions, the assessment must specify the proportion of disability attributable to the current injury alone — this directly influences compensation calculations. +- Sources:最高人民法院、最高人民检察院、公安部、国家安全部、司法部 (2016). 关于发布《人体损伤致残程度分级》的公告（2016 年 4 月 18 日发布，2017 年 1 月 1 日施行），标准第 4.2、4.4、4.5、5.10.6、6.2 条. + +### 11. After treatment, functional impairments may indeed remain; apply for a disability certificate at the county-level disability association in your hukou area. + + +- Cost: There is no fee for issuing the certificate itself. In principle, applicants must cover the assessment and photography costs, though those in financial hardship may request exemptions. You’ll need to bring your ID, hukou registration, and three two-inch photos with a white background to the county-level disability association. Once approved, the decision is posted in your village or community for five working days, after which the association has ten working days to finalize the process. The main difficulty lies in making multiple trips and waiting through this period. + +- In plain terms: A disability certificate serves as a prerequisite for receiving disability-related benefits; it is not a medical proof of injury. It categorizes disabilities into seven types — visual, hearing, speech, physical, intellectual, mental, and multiple — each with four severity levels. The application process involves submission, acceptance, assessment at a designated facility, public posting, review, and issuance; the certificate remains valid for ten years and can be renewed free of charge. If you do not meet the criteria, no amount of personal connections can secure one. + +- Benefit: The disability certificate is “the legal proof of a person’s disability status and classification, serving as a key basis for accessing national and local preferential policies.” Assessment follows the national standard GB/T 26341-2010. Applications are voluntary and administered locally. All seven disability types qualify for levels one through four. County-level associations handle applications and issuance based on evaluations conducted by provincially designated hospitals or specialized institutions. Approved cases are posted publicly for five days, then finalized within ten days. No fee is charged for the certificate; assessment and photography costs are normally the applicant’s responsibility, though some regions offer subsidies or exemptions for those in need. The certificate lasts ten years and can be renewed at no cost; re-evaluation is possible if conditions change. Disagreements with assessment results may be appealed to municipal or provincial expert committees within ten days (effective nationwide since 1 January 2018). + +- Evidence grade: A + +- Notes: Calculate the costs and benefits before deciding to apply. The certificate itself does not provide direct financial aid; rather, it unlocks two main subsidies: living allowances for disabled individuals in dibao households, and care subsidies for those at levels one and two requiring long-term assistance — details appear in Section 7, Article 8. It also qualifies holders for local rehabilitation services, assistive devices, tax reductions, employment support, and transport perks; exact criteria vary widely by province, so consult your local disability association website first. Importantly, this certificate differs from judicial disability evaluations or occupational injury assessments — see Section 10 regarding post-treatment evaluation timing. The certificate is strictly personal and non-transferable; misuse or failure to meet ongoing criteria results in revocation, with a one-year ban on reapplication. For multiple disabilities, the most severe category determines the classification level. +- Sources:中国残疾人联合会、国家卫生和计划生育委员会 (2017). 中华人民共和国残疾人证管理办法（2017 年 5 月 27 日发布，2018 年 1 月 1 日施行；第二、三、五、七、九、十七、十九、二十二、二十五条）. + +### 12. Thank the doctors who saved you — send thank-you letters, banners, or satisfaction ratings instead of cash gifts. The rules prohibit money, not gratitude. + + +- Cost: It costs nothing at all. Writing a thank-you letter or filling out a satisfaction survey takes just a few minutes. + +- In plain terms: Offering money beforehand to “jump the queue” won’t work — allocating appointment slots, beds, scarce medicines, tests, or surgeries is strictly forbidden. After treatment, it’s perfectly fine to show gratitude toward doctors who saved your life, but the method matters. Accepting cash or alcohol gifts puts them in violation of professional ethics. Three proper ways to thank them are: completing a satisfaction survey, writing a personalized thank-you letter, or presenting a commemorative banner, plus following medical advice for follow-up care. + +- Benefit: Article 7 of the “Nine Guidelines on Ethical Conduct for Medical Staff” (No. 41, 2021) states: “Maintain orderly medical practices and ensure fairness. Uphold equality to foster a just healthcare environment. It is strictly prohibited to accept personal benefits in exchange for allocating scarce medical resources such as appointment slots, beds, medicines, tests, or surgeries.” Article 8 adds: “Build harmonious relationships without accepting ‘red envelopes’ from patients. Adhere strictly to medical ethics and self-discipline.” It further specifies that accepting gifts, cash, gift cards, securities, or other valuables from patients or relatives is forbidden. Likewise, attending paid meals or entertainment arranged by patients is prohibited. Hospitals must enforce these rules, conduct inspections, and penalize violations. Satisfaction ratings now form part of performance evaluations for all tertiary public hospitals under national policy. According to official documents, hospital satisfaction comprises both patient and staff satisfaction, measured via surveys of outpatients, inpatients, and medical staff. A unified national platform collects these results, which are then factored into hospital performance reviews. Hospitals must also handle patient complaints per regulations, establishing dedicated offices to receive, investigate, and respond to concerns regarding medical services, safety, and quality. The relevant policy document was issued in 2019, 2020, and 2021 respectively, with all three years clearly stated in the official materials. + +- Evidence grade: A + +- Notes: Both you and your doctors benefit from this practice. It does not mean you should never express gratitude — after a night of emergency treatment, it’s natural to want to say thanks. The key is choosing appropriate methods. Cash gifts and alcohol place doctors at risk of disciplinary action; thank-you letters, banners, and satisfaction ratings are fully aligned with official policies. If a doctor declines a gift you’ve already offered, it’s not personal — it’s his duty to refuse. Note also that offering gifts to doctors falls under professional ethics and hospital rules, whereas giving bribes to law enforcement or investigators constitutes a criminal offense under the law; these situations are entirely different. While thank-you letters and banners are widely accepted, there is no official rule stating they become part of personal or departmental records — this is merely anecdotal experience. Only the inclusion of satisfaction ratings in hospital performance assessments has solid policy backing. Should you have doubts about treatment, you may request immediate medical record sealing and retain copies for yourself as described in relevant sections. +- Sources:国家卫生健康委、国家医保局、国家中医药局 (2021). 关于印发医疗机构工作人员廉洁从业九项准则的通知（国卫医发〔2021〕41 号）. 国务院公报 ；国务院办公厅 (2019). 关于加强三级公立医院绩效考核工作的意见（国办发〔2019〕4 号）. ；国家卫生健康委 (2019). 医疗机构投诉管理办法（委令第 3 号）. diff --git a/book/en/25-After-Someone-Dies.md b/book/en/25-After-Someone-Dies.md new file mode 100644 index 00000000..6cd5cee3 --- /dev/null +++ b/book/en/25-After-Someone-Dies.md @@ -0,0 +1,102 @@ +# 25. What to do after a loved one passes away + +When someone dies, there are a few key steps to take: handling the necessary paperwork and dealing with any money matters. First, you’ll need to secure the scene and arrange for a death certificate. After that, the body must be prepared and cremated. If there’s any dispute over how the death occurred, that must be addressed next, followed by closing all relevant accounts. The remaining items are listed in order of how much they can save you money. For any advance planning an older adult might want to make — such as naming a legal guardian, writing a will, or managing accounts — see Section 17. Details on the three types of benefits available for deaths at work can be found in Section 19. + +The funeral guidance here follows the newly updated Funeral Management Regulations, which took effect on March 30, 2026. Exact amounts for funeral subsidies and survivor benefits under basic pension plans are set separately by the Human Resources and Social Security Bureau. Since we don’t have an official source text to verify these figures word for word, no specific dollar amounts appear in this section. +### 1. If someone dies at home or elsewhere, first determine whether it’s a natural or unnatural death: in cases of accidents, unknown causes, or deaths discovered only after a long period of solitude, call the police immediately and leave the body and scene untouched. + + +- Cost: No expense at all — just one phone call is needed. +- In plain terms: For deaths caused by accidents, of unknown origin, or those found only after a long time alone, only the police can issue a death certificate. If the scene has been disturbed, it becomes difficult to clarify what happened and to obtain a certificate. Without this document, cremation, household registration cancellation, and insurance claims all become impossible. When in doubt, dial 110 right away. Once police arrive and conduct their investigation, they will issue the certificate just the same. +- Benefit: Article 8, Paragraph 2 of the Regulations on Household Registration states: “In cases where a citizen dies from an accident or the cause of death is unknown, the household head or the person who discovers the body must promptly report it to the local police station or township government.” This means that in cases of accidents or unknown circumstances, the household head or discoverer must inform authorities immediately. Article 23 of the Regulations on Funeral Services adds: “For natural deaths, medical institutions must promptly issue death certificates. For unnatural deaths handled by police without prior medical treatment, the police issue the certificate.” In other words, natural deaths are certified by treating medical facilities; unnatural deaths handled by police are certified by them. Only police can issue certificates for unnatural deaths, especially when the scene has been altered. Obtaining this certificate is essential for cremation, household registration cancellation, and insurance claims. +- Evidence grade: A +- Notes: Deaths occurring after a prolonged illness or at home at the end of life are considered natural. In such cases, a certificate can be obtained from the treating medical institution, or from a local community health center or township hospital. As noted in Item 2 (Death Certificates), only the institution providing treatment may issue the certificate. When it is unclear which category applies, treat it as an unnatural death and call 110 first. Police investigations will still allow a certificate to be issued. Conversely, if you clean up the scene before calling police, no one can help you. Do not move the body, wash or change its clothes, or remove medicine bottles or notes. +- Sources:全国人大常委会 (1958). 中华人民共和国户口登记条例（第八条）. （广东省人民政府门户网站刊登）；国务院 (2026). 殡葬管理条例（国务院令第 824 号，自 2026 年 3 月 30 日起施行，第二十三条）. + +### 2. The death certificate is the key to everything that follows: whoever provided treatment issues it; for natural deaths at home, contact the local community health service center. It must be issued within one day. + + +- Cost: No cost at all. +- In plain terms: If the death occurs in a hospital, the hospital that treated the patient issues the certificate. For natural deaths at home, the community health service center or township health clinic serving that area issues it. When the cause of death is clear, the certificate is issued within 24 hours. It is required for deregistration, cremation, withdrawal from a housing provident fund, receipt of social insurance benefits, insurance claims, and estate settlement — so be sure to make several copies right away. +- Benefit: According to the “Interim Regulations on Registration and Management of Population Death Information,” death certificates for patients who die in medical institutions are issued by those institutions; for deaths occurring at home or elsewhere, they are issued by the local community health service center or township health clinic. Cases deemed non‑natural by police or judicial authorities are handled under separate procedures. In 2026, five government agencies confirmed that electronic death certificates carry the same legal weight as paper versions; both are equally valid. Certificates for natural deaths with known causes must be issued within one day. If lost, a single replacement can be requested from the original issuer. Errors in basic information may be corrected by submitting supporting documents. +- Evidence grade: A +- Notes: This certificate is indispensable for deregistration, cremation, housing provident fund withdrawals, social insurance benefits, insurance claims, and estate settlement — so make plenty of copies right away. If electronic issuance is available, request it as well. Only one replacement is permitted, so keep the original safe. Any mistakes in name or ID number should be corrected on the spot; otherwise you’ll have to repeat the process at every office later on. +- Sources:国家卫生计生委办公厅 (2014). 人口死亡信息登记管理规范（试行）（国卫办规划发〔2014〕68 号，第九条）. （深圳市民政局转发）；国家卫生健康委、公安部、民政部、国家中医药局、国家疾控局 (2026). 关于加强居民死亡医学证明信息登记和电子证照管理工作的通知（国卫规划发〔2026〕5 号）. （福建省卫生健康委员会转发） + +### 3. Transport, storage, and cremation of remains must be handled by funeral homes; hospital morgues cannot provide such services, and storage is generally limited to 3 days. + +- Cost: No cost involved. +- In plain terms: Transport, storage, embalming, body preparation, and cremation can only be done by funeral homes. Hospital morgues are not authorized to handle funeral services; they may only provide temporary storage for remains. Funeral homes typically store bodies for no more than 3 days; any longer period requires an extension request. Cremation can only proceed with a death certificate and cremation authorization document. The cremation certificate issued afterward is necessary for inheritance claims and insurance processing. +- Benefit: Article 25 of the Funeral Management Regulations states: “Services such as transport, storage, embalming, body preparation, and cremation must be provided exclusively by funeral homes.” No other entities are permitted to offer these services. Article 24 adds: “Morgues operated by medical institutions may not subcontract or provide funeral services; they may only offer temporary storage for remains.” Hospital morgues are thus restricted to short-term storage only. Article 27 specifies: “Funeral homes may store remains for no more than 3 days; extensions must be formally requested by the family or body transferor.” Article 28 requires cremation to be performed only upon presentation of a death certificate and cremation authorization document, after which a cremation certificate is issued. Article 29 further mandates that in regions where cremation is mandatory, remains must be cremated at a nearby funeral home. +- Evidence grade: A +- Notes: Most “one-stop” services offered at hospitals are not affiliated with licensed funeral homes. Transport itself is a standard service with fixed pricing; see Section 6 for details. Keep the cremation certificate safe — it is required for inheritance, insurance, and other legal procedures. Whether cremation or burial is mandated locally is determined by provincial authorities. Article 9 safeguards the funeral customs of ethnic minorities. Any instance of cremation being required yet burial performed, or burial outside designated cemeteries or ecological burial zones, will prompt civil affairs bureaus to order immediate correction. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，自 2026 年 3 月 30 日起施行，第八、九、二十四、二十五、二十七、二十八、二十九条）. + +### 4. Disagreement over cause of death: request an autopsy within 48 hours and have medical records sealed + +- Cost: No cost involved. The hard part is remembering to make this request at such a time. +- In plain terms: If there is any doubt about how someone died, an autopsy must be requested within 48 hours after death. Hospitals with proper freezing facilities may extend this window to 7 days. Consent from close relatives is also required for the autopsy. If consent is not given or the deadline is missed, the party responsible for the delay bears the liability for any subsequent uncertainty over the cause of death. Alongside the autopsy request, it is essential to demand that all medical records be sealed. Once the body is cremated, an autopsy becomes impossible. +- Benefit: The time limit for autopsies is stipulated in Article 26 of the Regulations on Prevention and Handling of Medical Disputes. The original text reads: “In cases where a patient dies and both the patient and medical institution dispute the cause of death, an autopsy must be performed within 48 hours after death; if the hospital has facilities to freeze the body, this period may be extended to 7 days.” In other words, to determine the true cause of death, an autopsy must be carried out within 48 hours of death, or up to 7 days if the hospital has freezing capabilities. The same article further states: “An autopsy must be approved and signed off by the deceased’s close relatives; failure to sign is regarded as refusal of consent.” If family members do not sign, it is interpreted as a refusal. It also specifies: “If consent is denied or the deadline is missed, leading to uncertainty over the cause of death, the party responsible for the refusal or delay bears all related liability.” Article 24 states that sealing and unsealing of medical records “must be conducted in the presence of both the patient and medical institution.” Both you and the hospital must be present during both the sealing and later unsealing of records. +- Evidence grade: A +- Notes: After this deadline passes, any later claims of “I always suspected something was wrong” will instead place liability on the party responsible for the delay. Once a body is cremated, no autopsy can ever be performed. Therefore, this decision must be made before contacting any funeral home. Details on how to seal medical records can be found in Section 24. +- Sources:国务院 (2018). 医疗纠纷预防和处理条例（国务院令第 701 号，第二十四、二十六条）. + +### 5. Legal deadlines for canceling hukou registration: in cities, before burial; in rural areas, within one month + +- Cost: No expense involved. Just bring the death certificate and household register to your local police station. +- In plain terms: In cities, you must cancel hukou registration before burial; in rural areas, you must do it within one month. Bring the death certificate and household register to the police station to complete the process. Failing to do so will block any inheritance transfers, benefit claims, or insurance cancellations due to the unresolved hukou status. +- Benefit: Article 8, Paragraph 1 of the Hukou Registration Regulations states: “When a citizen dies, in cities the household head, relatives, guardians, or neighbors must report the death to the hukou registration authority and cancel the hukou registration before burial; in rural areas, this must be done within one month. If a citizen dies while temporarily residing elsewhere, the local hukou registration authority must notify the permanent residence’s authority to cancel the registration.” In short, urban residents must act before burial, while rural residents have one month to do so. Any household head, relative, guardian, or neighbor may initiate the process at the police station, which serves as the hukou registration authority. If the deceased was living temporarily elsewhere, the local police station there must inform the permanent residence’s station to cancel the hukou registration. +- Evidence grade: A +- Notes: Leaving the hukou registration active will prevent any inheritance transfers, benefit claims, or insurance cancellations, as all these procedures rely on a cleared hukou status. If pension payments continue despite the death, they constitute fraudulent collection and must eventually be repaid. While at the police station, also ask how to suspend social insurance and yibao payments, as well as how to apply for funeral subsidies. Details on these financial matters are covered in Item 9 (housing provident fund balances and related social insurance benefits). +- Sources:全国人大常委会 (1958). 中华人民共和国户口登记条例（第八条）. （广东省人民政府门户网站刊登） + +### 6. Funeral services are divided into basic and non-basic categories; a list of basic services exists, with their fees set by law. + +- Cost: There is no cost involved. Just spend a few minutes before departure to review the official list. +- In plain terms: Transporting, storing, and cremating a body, holding a farewell ceremony, keeping ashes in storage, and eco-friendly burial options — all fall under the national list of basic services. This also includes burial spaces provided by government-run funeral agencies. Prices for these services are strictly regulated by law; no extra fees may be charged outside this list. Before making any arrangements, be sure to confirm which services are considered basic and what the local rates are. +- Benefit: All essential funeral services — including body transport, storage, cremation, memorial services, and eco-friendly burial — are included in the official list. Government-run funeral centers also offer designated burial plots under this same list. Their pricing follows legal standards, meaning funeral homes cannot set prices arbitrarily. Non-basic services are defined separately by civil affairs bureaus at or above the prefecture level. +- Evidence grade: A +- Notes: Provinces, autonomous regions, and municipalities may add extra items to the national list. Always verify which services are classified as basic and what their local pricing is before proceeding. It is perfectly acceptable to want a dignified funeral for a loved one; this guideline does not discourage that. Its sole purpose is to clarify which services are fixed-price basics and which are optional extras. Once this distinction is clear, you can decide where to allocate funds — and avoid unnecessary overcharges during an already difficult time. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第五条：「殡葬服务分为基础项目和非基础项目，收费政策由国务院发展改革部门、财政部门会同国务院民政等部门制定。」「国家制定殡葬服务基础项目清单，将遗体接运、遗体存放、遗体告别、遗体火化、骨灰寄存、生态安葬以及政府举办的殡葬服务机构提供的骨灰格位安葬等纳入清单范围」；第五十条「殡葬服务实行清单化管理并动态调整，禁止在清单之外设立项目、收取费用。」 + +### 7. If you encounter forced bundling, extra charges beyond the listed price, or a single service being split into multiple line items for billing, make a note of it and file a complaint. + + +- Cost: No cost involved. The real challenge is staying diligent in the moment. + +- In plain terms: All these practices are explicitly listed as price violations under regulations: failing to display price lists, adding extra charges beyond the posted price, bundling funeral products and services and forcing you to buy them, and compelling you to use third‑party paid services. Splitting one service into several separate charges is also a form of price inflation. On the spot, ask for a price list and keep any receipts, invoices, and chat records. You can still file a complaint later. For price violations, contact the market regulation authority; for funeral services specifically, reach out to the civil affairs bureau. + +- Benefit: Regulations identify five categories of price violations. Four of them are: not displaying prices clearly or adding extra charges beyond the listed price — that is, no posted price list or charging more than advertised; bundling services or imposing unreasonable conditions to force a purchase — meaning you can’t obtain a service unless you buy another one; forcing or indirectly forcing you to use paid third‑party services — essentially pushing another provider’s services on you; and indirectly raising prices by re‑labeling charges — such as charging more under a different name. Additionally, it is prohibited to “split services into multiple items or expand the scope of charges to indirectly raise prices.” This means breaking one service into several line items for billing or extending the range of charges beyond what was originally stated. + +- Evidence grade: A + +- Notes: Price‑violation investigations fall under the market regulation authority; funeral services themselves are under the civil affairs bureau. Ask for a price list right away, and be sure to keep all receipts, invoices, and chat records. Filing a complaint later is still possible. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第四十二条：「殡葬服务机构不得违反有关规定擅自设立收费项目，或者采取分解项目、扩大范围收费等形式变相提高收费标准。」第四十三条列举的价格违法行为含「（一）不按规定明码标价，或者在标价之外加价或者收取未标明的费用」「（三）采取捆绑、附加不合理条件或者不合理限制等方式，强制或者变相强制销售丧葬用品、提供殡葬相关服务并收取费用」「（四）强制或者变相强制丧属接受第三方的有偿服务，或者利用相关服务网点重复收取费用」；第五十一条要求民政部门与政务服务便民热线建立信息共享监督机制，「对丧属反映的殡葬服务问题，应当会同有关部门及时予以处理并将处理结果告知丧属」 + +### 8. Intermediaries such as funeral service agents, vendors of funeral goods, and event planners must register with the county-level civil affairs bureau + +- Cost: There is no cost involved. All you need to do is ask whether registration has been completed. +- In plain terms: Intermediaries offering services like funeral planning, procurement of funeral products, event coordination, and information consultation must register with the county-level civil affairs bureau. Those that fail to register are excluded from the official funeral service information system managed by the bureau. Availability of online lookup tools varies by region; the safest approach is to call the local civil affairs bureau directly. Any operators found to be charging excessive fees through deceptive practices or selling information related to deceased individuals will be held legally accountable. +- Benefit: Unregistered intermediaries are not included in the official funeral service information system overseen by the civil affairs bureau. Entities that engage in fraudulent billing, pressure families into extravagant ceremonies, force acceptance of services, or illegally trade personal data of the deceased face legal penalties. Their records are also flagged within the system and made publicly accessible, ensuring transparency for all users. +- Evidence grade: A +- Notes: “Illegal trading of information related to deceased individuals” represents one of the most prevalent risks in this sector. It is common for families to receive numerous unsolicited sales calls shortly after funeral arrangements, often indicating that their data has been sold on. Online virtual memorial platforms are similarly subject to these regulations; Article 45 explicitly prohibits such platforms from encouraging excessive spending or mishandling sensitive personal information. +- Sources:国务院 (2026). 殡葬管理条例（国务院令第 824 号，2025 年 11 月 14 日国务院第 72 次常务会议修订通过，「自2026年3月30日起施行」）. 第四十一条：「除殡葬服务机构外，从事殡葬服务代理、用品代购、策划主持、信息咨询等殡葬相关服务活动的组织和个人，应当向县级人民政府民政部门备案。」「对存在以欺骗等手段违规收费、诱导大操大办、强迫接受服务、倒卖逝者信息等损害丧属权益行为的依法处置，并在殡葬服务信息系统中进行标注，向社会公开。」 + +### 9. Withdrawing money held in various accounts: housing provident fund balance, social insurance benefits, and work‑related death benefits + +- Cost: There is no monetary cost, but you must visit several offices. Before you go, make sure you have a death certificate and proof of familial relationship ready. +- In plain terms: The remaining balance in a deceased person’s housing provident fund can be withdrawn by heirs and legatees. This money is not held in a regular bank account and does not automatically become part of the estate, so it is easy to overlook. In cases of death due to a workplace injury, there are three additional payments: funeral assistance, survivor’s pension, and a one‑time work‑related death benefit. The balance in the individual pension account and any related survivor benefits must be requested from the local social insurance office. +- Benefit: Heirs and legatees may withdraw the remaining housing provident fund balance from the deceased’s account. A legatee is a person named in a will who is entitled to receive assets. For deaths caused by work‑related injuries, three separate payments are available: funeral assistance, survivor’s pension, and a one‑time work‑related death benefit. +- Evidence grade: A +- Notes: The housing provident fund amount is the most frequently forgotten component, as it is not stored in a standard bank account and does not automatically enter the estate distribution. Information on any remaining pension account balance and related survivor benefits must be obtained from the local social insurance office; required documents vary by region. Formal requirements for wills and inheritance are outlined in Section 17. +- Sources:国务院 (2026). 住房公积金管理条例（国务院令第 844 号修改，2026 年 9 月 20 日起施行）第二十四条末款. ：「职工死亡或者被宣告死亡的，职工的继承人、受遗赠人可以提取职工住房公积金账户内的存储余额；无继承人也无受遗赠人的，职工住房公积金账户内的存储余额纳入住房公积金的增值收益。」；工伤保险条例第三十九条的三笔待遇见第 19 节. ；TODO（待核实：基本养老保险个人账户余额的继承规则，以及丧葬补助金与遗属抚恤金的具体标准，人社部相关文件本次未取得） + +### 10. Relatives of the deceased may request access to, copies of, corrections to, and deletion of their personal information + + +- Cost: No cost involved. Only if the platform refuses cooperation would legal complaints or lawsuits be necessary. +- In plain terms: After a person passes away, their close relatives may, for their own lawful and legitimate interests, ask the platform to access, copy, correct, or delete that person’s personal information. If the platform denies such requests, it must provide a valid reason. Legal action in court is also an option. One exception applies: if the deceased made prior arrangements—such as designating a successor to their account or expressing clear intentions—those instructions must be followed. +- Benefit: The law explicitly states that upon a person’s death, their close relatives may, for their own lawful and legitimate interests, exercise rights such as accessing, copying, correcting, and deleting the deceased’s personal information. In other words, they may request the platform to provide access to this data, make copies, correct any errors, or remove it entirely. +- Evidence grade: A +- Notes: The legal text includes a clause stating “except where the deceased made prior arrangements.” This means that if someone designated a successor to their account or left explicit instructions, those must be honored. Therefore, while still alive, it’s advisable to document where one’s account credentials are kept, as explained in Section 17. Note also that account deactivation and deletion of personal information are two distinct processes, as discussed in Section 14. +- Sources:全国人大常委会 (2021). 个人信息保护法. 中国人大网. 第四十九条：「自然人死亡的，其近亲属为了自身的合法、正当利益，可以对死者的相关个人信息行使本章规定的查阅、复制、更正、删除等权利；死者生前另有安排的除外。」；第五十条「个人信息处理者应当建立便捷的个人行使权利的申请受理和处理机制。拒绝个人行使权利的请求的，应当说明理由」「个人可以依法向人民法院提起诉讼」 diff --git a/book/en/26-Building-A-Website-Or-Platform.md b/book/en/26-Building-A-Website-Or-Platform.md new file mode 100644 index 00000000..48e19d3b --- /dev/null +++ b/book/en/26-Building-A-Website-Or-Platform.md @@ -0,0 +1,126 @@ +# 26. Building a website or platform: licensing, registration, and servers + +If you want to create a website or app, this section explains four key points: what legal category your business falls under, which permits you must obtain, where to host your servers, and who is responsible for user content and payments. The focus here is on personal freedom and financial matters. The items are ordered as follows: first, activities that could land you in prison; second, permits you must secure beforehand; third, everyday tasks any platform must handle; and finally, practical tips for choosing a server — though no exact figures can be given. As a hired technician, you must stay within the boundaries outlined in Section 11. Details on company registration and tax filing are covered in Section 12 and are not repeated here. A comparison chart of required permits and a decision table for server selection can be found at [docs/做平台要办哪些证.md](../../docs/research/做平台要办哪些证.md). +### 1. Platforms must never collect payments themselves and then transfer them to sellers; funds must be settled directly via a licensed payment institution. + +- Cost: No monetary cost is involved. However, it requires some time to integrate a product from a licensed payment institution — that is, a company holding a payment license issued by the People’s Bank of China. By using such institution’s split-payment or escrow features, buyer payments are transferred straight to sellers without ever entering the platform’s own accounts. +- In plain terms: If a platform first receives buyer payments into its own account and then forwards them to sellers, it is effectively operating a payment business. Running such a business requires explicit approval from the People’s Bank of China as well as a minimum registered capital of 100 million RMB, paid in cash. Operating without this approval leads to immediate shutdown, confiscation of all earnings, heavy fines, and personal penalties for owners and responsible staff; in severe cases, criminal charges may also apply. The only safe approach is to ensure that no funds ever land in the platform’s account. +- Benefit: According to regulations, a payment business is defined as “transferring monetary funds based on electronic payment instructions submitted by payers or payees.” In other words, it involves moving money on behalf of others per their instructions. To operate such a business, one must obtain a payment license from the People’s Bank of China, and the minimum registered capital must be 100 million RMB, paid in full. Unauthorized operation results in immediate closure, seizure of all profits, and fines ranging from 500,000 to 2 million RMB if no profit was generated or if profit fell below 500,000 RMB; additionally, a further fine of 100,000 to 500,000 RMB applies to legal representatives and responsible personnel. Criminal law also classifies “illegally conducting fund payment and settlement services” as illegal business activity; serious violations may lead to imprisonment of up to five years, while especially grave cases incur sentences exceeding five years. As of May 2024, the threshold for “serious” violations is defined as total illegal transaction volume exceeding 5 million RMB or illegal profits surpassing 100,000 RMB nationwide. +- Evidence grade: A +- Notes: Designing the payment flow so that funds never enter the platform’s account is the sole safe method. In industry parlance, this practice is sometimes called “second clearing,” though this term does not appear in official documents; instead, regulations refer to it as “indirectly engaging in payment services.” The Supreme People’s Court and Supreme People’s Procuratorate explicitly list only three scenarios as illegal: fabricating transactions for cash-out, using corporate accounts for cash-out, and using cheques for cash-out. Platform-based collection and redistribution of payments are not explicitly named, so this description strictly follows statutory wording without asserting that it automatically constitutes a crime. +- Sources:国务院 (2023). 非银行支付机构监督管理条例（国务院令第 768 号，第二、六、八、二十七、四十七条）. ; 中国人民银行 (2024). 非银行支付机构监督管理条例实施细则（中国人民银行令〔2024〕第 4 号，第六十八条）. ; 全国人大 (1997). 刑法（第二百二十五条第三项）. ; 最高人民法院、最高人民检察院 (2019). 关于办理非法从事资金支付结算业务、非法买卖外汇刑事案件适用法律若干问题的解释（第一、三、四条）. + +### 2. Paid websites require a license; platforms that facilitate transactions need a different type of permit; free sites only need to be registered. + + +- Cost: Registration is free of charge. Obtaining a Value-Added Telecommunications Business License, however, involves costs; this license governs whether websites that charge users can legally operate. To apply for this license, you must first establish a company. For operations limited to one province, the registered capital must be at least 1 million RMB; for nationwide operations, it must be at least 10 million RMB. The review period lasts 60 days, and the license remains valid for 5 years. + +- In plain terms: Websites that charge users must first obtain a Value-Added Telecommunications Business License. This license is issued solely to companies; individuals cannot apply for it. Free websites, on the other hand, only need to be registered, and this process incurs no fees. Operating a paid website without the proper license may result in confiscation of revenues, fines, or even closure. This section does not determine whether your platform falls under the category of transaction-facilitating services; the reasoning is explained in the notes. + +- Benefit: The regulations state: “The state implements a licensing system for commercial Internet information services and a registration system for non-commercial ones. No entity may provide Internet information services without obtaining a license or completing registration.” In other words, paid services must first secure a license, while free ones must register; operating without either is prohibited. “Commercial services” are defined as activities involving paid provision of information or webpage creation to users. Platforms that facilitate transactions are classified under Online Data Processing and Transaction Processing Services, commonly abbreviated as EDI. These services involve using data and transaction platforms linked to public communication networks to handle data processing and transactions on behalf of users. Such activities include transaction processing, electronic data exchange, and data handling via network devices. Operating without a license or exceeding its scope of permission results in confiscation of all illegal revenues and fines ranging from 3 to 5 times that amount. If no illegal revenues exist or they are under 50,000 RMB, fines between 100,000 and 1,000,000 RMB apply; severe violations may lead to website closure nationwide. + +- Evidence grade: A + +- Notes: To determine whether your platform qualifies as an EDI service, compare its activities to the definitions listed in the Telecommunications Business Classification Catalogue. No official regulation explicitly states that e-commerce platforms handling transactions and payments must obtain an EDI license. The Ministry of Industry and Information Technology’s guidelines merely advise applying for the appropriate license based on actual business activities. Therefore, this section merely outlines definitions without making any definitive conclusions. Additionally, only legally incorporated companies may apply for this license; individuals are ineligible. +- Sources:国务院 (2000). 互联网信息服务管理办法（国务院令第 292 号，2024 年 12 月 6 日第二次修订，第三、四、七、十九条）. ; 国务院 (2024). 关于修改和废止部分行政法规的决定（国务院令第 797 号，第十八项）. ; 国务院 (2000). 电信条例（2016 年第二次修订，第七、九、十三、六十九条）. ; 工业和信息化部 (2017). 电信业务经营许可管理办法（工信部令第 42 号，第六、九、十一、十四条）. + +### 3. Obtaining a license for online cultural activities is required to run live streams; private companies rarely qualify for the permit needed to distribute audiovisual content + + +- Cost: The so-called “Online Cultural Activities License” governs whether one may earn money via live streams or game commentary. It is issued by provincial-level cultural authorities within 20 days of application and remains valid for three years, after which renewal must be requested at least 30 days prior to expiration. The separate Audiovisual Content Distribution License determines eligibility to publish programs online; it mandates that applicants be wholly state-owned or state-controlled entities — private firms essentially cannot obtain it. + +- In plain terms: To host live streams or game commentary sessions, you must secure a provincial-level Online Cultural Activities License that explicitly lists “online performances” among its permitted activities. Approval is granted within 20 days, and the license stays valid for three years. All recorded streams must be retained for a minimum of 60 days. Operating without this license results in immediate suspension, warnings, and fines up to 30,000 RMB; repeat offenders face inclusion on a cultural industry blacklist. A separate permit is required to distribute audiovisual content online, and only state-owned or state-controlled organizations may qualify for it. + +- Benefit: Securing the proper licensing framework ensures legal operation within China’s digital media sector while avoiding punitive measures. Compliance safeguards both business continuity and reputation by adhering to stringent regulatory standards governing online cultural activities and audiovisual distribution. + +- Evidence grade: A + +- Notes: Detailed licensing requirements are comprehensively outlined in official directives issued by seven government departments. Platforms monetizing live streams must additionally secure ICP registration — a mandatory filing process administered by China’s Ministry of Industry and Information Technology. Entities distributing audiovisual content must obtain the requisite Audiovisual Content Distribution License or complete applicable registration procedures. News publishers require a separate Internet News Information Service License. Note that the 2011 version of the Interim Provisions on Internet Cultural Management, republished by China’s Government Portal in 2025, remains unamended; current compliance references must be drawn from the Ministry of Culture and Tourism’s latest official texts. +- Sources:文化部 (2016). 网络表演经营活动管理办法（文市发〔2016〕33 号，第二、四、六、十三、二十条）. ; 文化部 (2011). 互联网文化管理暂行规定（文化部令第 51 号，2017 年经文化部令第 57 号修订，第七、八、九、十六、二十一、二十八条）. ; 广电总局、信息产业部 (2007). 互联网视听节目服务管理规定（第 56 号令，2015 年修订，第二、七、八、二十四条）. ; 国家网信办等七部门 (2021). 关于加强网络直播规范管理工作的指导意见（国信办发文〔2021〕3 号，第 9 项）. + +### 4. Servers placed in China must be registered; ISPs must hold a value-added telecom license + +- Cost: There is no fee for registration. It is submitted together with the server application at the service provider’s end, and usually takes several days to weeks to process. Checking whether a provider holds the required license takes just ten minutes. +- In plain terms: If you host a server inside China, you must register it before launching your website. Registration itself costs nothing and is handled alongside the server setup at your provider; it generally takes a few days to weeks. Failure to register results in a mandatory deadline to rectify the issue, followed by a fine of 10,000 RMB; continued non-compliance leads to site shutdown. Additionally, failing to display the registration number on your homepage incurs a penalty ranging from 5,000 to 50,000 RMB. +- Benefit: The regulation explicitly states: “Without prior registration, no entity may provide non-commercial internet information services within the People’s Republic of China.” This means even websites that do not charge users must register first if they are hosted domestically. Non-compliant sites face the same penalties: a deadline to rectify the issue and a 10,000 RMB fine, with persistent violations resulting in site closure. The same rules apply to your service provider: it is prohibited from offering internet access services to any organization or individual that has not completed registration or obtained the necessary license. The same restriction applies to payment processors. The regulation further clarifies that such providers cannot offer access or payment processing services to entities lacking either a valid license or proper registration. In other words, legitimate providers cannot host sites that lack both a license and registration. Moreover, data center hosting and cloud hosting services fall under the category of “Internet data center services” under the law, while broadband access is classified as “Internet access services”; both categories require a separate license from providers. Finally, sites that fail to display their registration number on their homepage must rectify the issue and face fines between 5,000 and 50,000 RMB nationwide. +- Evidence grade: A +- Notes: Before negotiating terms with a provider, verify first whether it holds the required license. Use the Ministry of Industry and Information Technology’s Telecom Services Market Comprehensive Management System at tsm.miit.gov.cn to check by company name or license number. For website registration status, consult beian.miit.gov.cn. If you choose a data center without the proper license, you will have no recourse in case of disputes. Hosting servers overseas does avoid the registration requirement, but if your users and revenue are based in China, you remain subject to all obligations outlined in sections 5 through 10 of this chapter, plus additional costs related to cross-border data transfers. +- Sources:信息产业部 (2005). 非经营性互联网信息服务备案管理办法（信产部令第 33 号，2024 年经工信部令第 68 号修订，第五、十三、十八、二十二条）. ; 工业和信息化部 (2017). 电信业务经营许可管理办法（工信部令第 42 号，第二十、二十四条）. ; 工业和信息化部 (2015). 电信业务分类目录（2015 年版，B11、B14、B21、B25）. + +### 5. Requiring sellers to join the platform means the platform must verify identities, register data, report information, and retain records for three years + +- Cost: No direct monetary cost. However, the platform must perform background checks on sellers’ qualifications and maintain a registration database. Tax-related information must be reported quarterly, while transaction data must be kept for at least three years. The main challenge is that this is an ongoing obligation rather than a one-time task. +- In plain terms: If you allow third parties to sell goods on your platform, you must first verify their identity, address, contact details, and business licenses, then add them to your registration records. After setting up these records, you must re-verify seller information at least every six months. You must also report seller details to market regulators and submit tax-related data quarterly. All product and transaction records must be retained for three years. Failure to comply with any of these requirements results in a mandatory rectification order; if ignored, fines ranging from 20,000 to 100,000 yuan apply. +- Benefit: Legal regulations set specific obligations for platforms. The official wording states that platforms must require sellers to provide authentic identity, address, contact, and licensing information, then verify and register this data while maintaining updated records. This means sellers must submit their basic details and required permits before joining, which you must then confirm and log into a database. Periodic re-verification is also mandatory. The exact interval for re-verification is defined as “at least every six months” under relevant administrative rules. Additionally, you must submit seller identity data to market regulators and tax authorities, as required by tax administration laws. All product, service, and transaction data must be retained for no less than three years from the date each transaction concludes. Non-compliance triggers a rectification order; persistent violations incur fines of 20,000–100,000 yuan, while severe cases may lead to temporary suspension of operations and fines of 100,000–500,000 yuan. Tax reports must be submitted within the month following each quarter’s end, with identical penalties for late submissions nationwide. +- Evidence grade: A +- Notes: Sellers themselves must also register as market entities. Certain exceptions apply: individuals selling self-produced agricultural or handmade goods, or providing small-scale services that do not require permits, are exempt. The threshold for “small-scale” activities is set at an annual transaction volume of 100,000 yuan under current online trade regulations. Platforms also bear two additional responsibilities: clearly marking registered versus unregistered sellers, and prohibiting the removal of consumer reviews. +- Sources:全国人大常委会 (2018). 电子商务法（第十、二十七、二十八、三十一、八十条）. ; 市场监管总局 (2021). 网络交易监督管理办法（市场监管总局令第 37 号，第八、二十四、二十五、三十一条）. ; 国务院 (2025). 互联网平台企业涉税信息报送规定（国务院令第 810 号，第二、三、四、十条）. ; 国家税务总局 (2025). 关于互联网平台企业报送涉税信息有关事项的公告（税务总局公告 2025 年第 15 号）. + +### 6. You must regulate user-generated content: moderation mechanisms, reporting portals, and immediate takedown plus reporting of illegal material + +- Cost: It costs money to hire moderators — this is the platform’s biggest ongoing expense. Reporting portals and records of every moderation action must be kept. The real challenge is that this work needs constant oversight; even a single day without it can lead to serious problems. +- In plain terms: Platforms are legally responsible for any issues arising from user content. You must set up a full system: user registration, post and comment moderation, daily monitoring, and clear procedures for handling incidents. Place a prominent reporting link on your site. When illegal content is found, immediately stop its distribution, document everything, and report it to authorities. Failure to do so can result in fines ranging from 50,000 to 500,000 yuan, with even harsher penalties for serious violations. +- Benefit: Regulations require platforms to “fulfill primary responsibility for managing user-generated content.” This means platforms must regulate everything users post. Specific requirements include establishing rules for registration, account management, post and comment moderation, page management, real-time monitoring, emergency response, and handling of misinformation and illegal networks. Every step — from registration and posting to daily checks and incident response — must be clearly documented. Platforms must also provide an easily accessible reporting link in a highly visible spot. Upon spotting illegal content, they must “immediately take necessary actions, preserve records, and report to authorities” as mandated by the Cybersecurity Law. Non-compliance brings warnings, mandatory corrections, and fines up to 500,000 yuan; repeat or severe violations can lead to fines up to 2 million yuan, suspension of operations, website or app shutdowns, or even revocation of business licenses. Individuals directly responsible may also face fines of 50,000–200,000 yuan nationwide. +- Evidence grade: A +- Notes: You don’t need to invent moderation rules from scratch — just follow existing ones. Article 15 of the Internet Information Service Management Regulations explicitly lists nine categories of prohibited content. For live-streaming platforms, three extra obligations apply: they must set up a dedicated content moderation system, be able to instantly cut off any ongoing stream (“immediate blocking” per law), and retain both stream content and logs for at least 60 days. The same retention period applies to recorded online performances. +- Sources:国家互联网信息办公室 (2019). 网络信息内容生态治理规定（网信办令第 5 号，第八、九、十、十六、三十七条）. ; 全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第四十九、六十九条）. ; 国务院 (2000). 互联网信息服务管理办法（第十五、十六、二十三条）. + +### 7. Providing information publishing and instant messaging services requires users to provide authentic identity information + +- Cost: Implementing a real-name verification system involves paying per-use fees for the verification channel. The service should be designed under the principle of “real names stored in the backend, nicknames displayed to users” — meaning the actual name is kept on file while users can choose any nickname they prefer on the interface. +- In plain terms: If your website allows posting or chatting, you must collect users’ real identity details at sign-up. Those who refuse to provide such information cannot be allowed to use the service. The recommended approach is to store the real name in the backend and let users pick their own nickname; phone number verification is sufficient for this purpose. Failure to enforce real-name policies results in mandatory corrective orders. Persistent violations attract fines ranging from 50,000 to 500,000 yuan, and may even lead to site shutdowns. +- Benefit: The law explicitly states: “Internet service providers offering network access, domain registration, telephone services, or information publishing and instant messaging must demand authentic identity data from users at the time of agreement signing or service activation. Users who fail to supply such data cannot be granted service access.” Non-compliance — whether by neglecting to request real names or by knowingly allowing unverified users to join — triggers corrective orders. Serious or repeated breaches incur fines of 50,000–500,000 yuan, suspension of operations, mandatory business rectification, closure of websites or apps, and revocation of business licenses. Individual responsible parties face additional penalties of 10,000–100,000 yuan. Live streaming platforms must follow the same “backend real names, frontend nicknames” model, using mobile phone numbers for verification. For live commerce specifically, stricter rules apply: verification must rely on official identification documents and the unified social credit code — the unique identifier printed on every business license nationwide. +- Evidence grade: A +- Notes: The article numbering has been updated. The Cybersecurity Law was amended in 2025 and took effect on 1 January 2026. The real-name provisions moved from Article 24 to Article 26, while related penalties shifted from Article 61 to Article 64; the wording itself remains unchanged. Any existing documentation still referencing the old article numbers must be updated accordingly. +- Sources:全国人大常委会 (2025). 网络安全法（2025 年修正，2026 年 1 月 1 日施行，第二十六、六十四条；2016 年文本为第二十四、六十一条）. ; 国家互联网信息办公室 (2016). 互联网直播服务管理规定（第十二、十六条）. ; 国家网信办等七部门 (2021). 网络直播营销管理办法（试行）（国信办发文〔2021〕5 号，第八条）. + +### 8. No live streaming accounts may be created for anyone under 16; tipping limits are set by age group + + +- Cost: There are no direct costs. The process simply requires adding two extra steps during registration and payment: first verify the user’s age, then confirm that a guardian has given consent. + +- In plain terms: People younger than 16 cannot sign up for a live streaming account on this platform. Those aged 16 or older must have their identity verified and must also obtain permission from a parent or other guardian. Tipping is restricted based on age: children under 8 are not allowed to tip at all; those aged 8–16 may tip only with guardian consent; and anyone over 16 may tip only with guardian consent or proof of income. If a minor spends money without a guardian’s approval, the guardian can request a refund, and a court is required to grant it. A total of 2020 such cases have been reported to date. + +- Benefit: The law clearly states that “online live streaming service providers must not offer account registration services to minors under 16; when providing such services to minors aged 16 or older, they must verify their identity and obtain consent from a parent or other guardian.” It also mandates “a dynamic verification mechanism for the real identity information of live streamers,” meaning platforms must be able to recheck a streamer’s identity at any time. Additionally, platforms must “reasonably limit the maximum amount a minor may spend per transaction and per day,” establishing spending caps based on age. Tipping rules are similarly tiered: “Tipping services must not be offered to minors under 8; for those aged 8–16, consent from a guardian is required; for those over 16, consent or proof of income is required.” Finally, if a minor lacking full legal capacity spends money without guardian approval, a court must return those funds to the guardian. Minors lacking full legal capacity are defined as those who cannot make independent decisions under the law. + +- Evidence grade: A + +- Notes: In any dispute involving refunds, rulings must favor the minor. The wording of this policy has changed over time. In 2022, four government agencies and the National Radio and Television Administration both stated that minors were completely prohibited from tipping. However, a new notice issued in April 2026 introduced age-based limits at 8 and 16 years old, without explicitly revoking earlier rules or explaining how they relate. Therefore, the claim that “minors are entirely barred from tipping” is no longer accurate. +- Sources:全国人大常委会 (2020). 未成年人保护法（第七十四、七十六条）. ; 国务院 (2023). 未成年人网络保护条例（国务院令第 766 号，第三十一、四十四条）. ; 中央网信办秘书局 (2026). 关于加强网络直播打赏规范管理的通知（第 7 项）. ; 最高人民法院 (2020). 关于依法妥善审理涉新冠肺炎疫情民事案件若干问题的指导意见（二）（法发〔2020〕17 号，第九条）. + +### 9. Respond promptly to infringement notices; restore content after 15 days if no response + +- Cost: No cost involved. You must establish a fixed workflow: receive the notice, forward it to the seller, collect the seller’s defense arguments, and publicly disclose the final outcome. All steps must be documented. +- In plain terms: If someone sends you an infringement notice with preliminary evidence, you must promptly delete, block, or remove the relevant content and forward the notice to the seller. Failing to act in time means you and the seller will be jointly liable for any additional losses incurred. After receiving the seller’s defense, forward it to the claimant and wait 15 days. If the claimant files no complaint or lawsuit during this period, you can restore the content. +- Benefit: Rights holders are entitled to request e-commerce platforms to take necessary measures such as deleting, blocking, or removing links to infringing content, as well as terminating related transactions and services. Such notices must include preliminary evidence of infringement. Merely sending a generic statement is insufficient. Once a platform receives a valid notice, it must act promptly and forward the notice to the seller; failure to do so makes the platform jointly liable for any additional damages incurred. After a seller submits a defense, the platform must wait 15 days after forwarding the statement to the rights holder before lifting any measures, provided no complaint or lawsuit is filed. If a platform knows or should know of infringement yet fails to act, it will also bear joint liability with the seller. Regulatory authorities may also order the platform to make corrections within a set timeframe; failure to comply may result in fines ranging from 50,000 to 500,000 RMB for minor violations, and 500,000 to 2,000,000 RMB for serious cases. Conversely, if a party maliciously issues false notices causing losses to sellers, they must pay double the compensation owed (applies nationwide). +- Evidence grade: A +- Notes: If you operate a general website rather than a full e-commerce platform, you should follow the notice-and-takedown rules outlined in the Civil Code. The key difference lies in the waiting period after receiving a seller’s defense: the E-commerce Law specifies a mandatory 15-day window, while the Civil Code only requires a “reasonable timeframe.” Additionally, the E-commerce Law explicitly mandates that platforms disclose all received notices, seller defenses, and final resolutions to the public, as required under Article 44. +- Sources:全国人大常委会 (2018). 电子商务法（第四十二、四十三、四十四、四十五、八十四条）. ; 全国人大 (2020). 民法典（第一千一百九十五、一千一百九十六、一千一百九十七条）. + +### 10. Personal information must not be casually transferred overseas; legal conditions and thresholds apply + + +- Cost: No cost involved. The simplest solution is to keep user data within China. If transfer overseas is unavoidable, follow standard contracts or obtain proper certification. + +- In plain terms: Transferring personal information of Chinese users to servers abroad constitutes a cross-border data transfer. Simply hosting servers overseas does not mean the data stays within China. There are four approved pathways for such transfers: a security assessment by the Cyberspace Administration, certification by authorized agencies, signing a standard contract, or compliance with other legal provisions. You must also disclose to users who receives their data, what it will be used for, and obtain their explicit consent for this specific purpose. + +- Benefit: To lawfully provide personal information to overseas entities — whether to foreign companies or foreign servers — at least one of four conditions must be met: passing a security assessment by the Cyberspace Administration; obtaining personal information protection certification; signing a standard contract drafted by the Cyberspace Administration; or meeting other requirements set by laws or administrative regulations. Additionally, you must inform users of the overseas recipient’s name, contact details, processing purpose, methods, and types of data involved, and obtain their separate consent. Threshold limits apply based on cumulative user counts. For most businesses not classified as critical information infrastructure operators, the exemption threshold is “fewer than 100,000 personal records (excluding sensitive information) transferred overseas in a calendar year.” Below this threshold, no assessment, contract, or certification is required. Between 100,000 and 1,000,000 records, a standard contract or certification is mandatory. For over 1,000,000 records, or when sensitive information of more than 10,000 individuals is involved, a formal security assessment is required (effective nationwide since March 2024). + +- Evidence grade: A + +- Notes: Hosting servers overseas does not equate to “data never leaving China.” If a user registers within China and their data is sent to foreign servers, this is still a cross-border transfer. Certain scenarios are exempt from assessment, certification, or standard contracts: cross-border shopping, shipping, or booking flights/hotels, provided these actions are necessary to fulfill a contract involving the user. Note also that user counts are calculated on a cumulative basis starting from January 1 of each year, not as a rolling 12-month period. +- Sources:全国人大常委会 (2021). 个人信息保护法（第三十八、三十九、四十条）. ; 国家互联网信息办公室 (2024). 促进和规范数据跨境流动规定（网信办令第 16 号，第三、四、五、七、八条）. ; 国家互联网信息办公室 (2022). 数据出境安全评估办法（网信办令第 11 号，第四条）. + +### 11. When picking a server, first consider how much downtime you can tolerate, then check whether there’s any support available, and only then compare prices. + + +- Cost: Cloud instances from major providers typically cost several hundred to several thousand yuan per month. VPS plans from smaller vendors start at just a few dozen yuan per month. A VPS is essentially a virtual mini‑server. Dedicated server hosting starts at several thousand yuan per year, and you must also purchase the hardware yourself. + +- In plain terms: The main difference among these three options isn’t price — it’s what resources you’ll have at hand when something goes wrong. Big providers offer registration pathways, publish their credentials, issue outage notices, and include compensation clauses in their contracts, so help is readily available. Smaller vendors may charge half as much, but they often over‑sell capacity, disappear without notice, or get cut off by upstream providers; in such cases you won’t know who to turn to. For static websites that contain no user data, a cheap VPS costing just a few dozen yuan is perfectly adequate. + +- Benefit: Again, the key distinction isn’t price but the support you can rely on during an emergency. Major cloud providers provide registration channels, disclose their qualifications, announce any outages, and guarantee compensation under their contracts, ensuring you can get assistance when needed. Smaller vendors can offer prices roughly half of those rates, yet when they over‑sell resources, shut down unexpectedly, or lose upstream connectivity, you have no recourse. Therefore, before negotiating a price, verify whether the vendor holds a valid value‑added telecommunications license via the Ministry of Industry and Information Technology database. Dedicated server hosting only makes sense if two conditions are met: the bandwidth or hardware costs are noticeably lower, and you have in‑house staff capable of managing the server. For static sites without user data, the cheapest VPS is sufficient; for sites that handle user registrations and transactions, choose a cloud instance that offers elastic scaling and snapshot backups, and store those backups in at least two separate locations. + +- Evidence grade: C + +- Notes: This entry is a guideline rather than a piece of evidence. The only verifiable item within it is the vendor’s licensing status. To save money, cut costs on configuration and bandwidth rather than on ensuring proper licensing. +- Sources:作者经验，无直接文献；服务商资质与备案的法定要求见本节第 4 条，日志留存 6 个月和等级保护义务见第 11 节第 16 条 diff --git a/book/en/27-Pregnancy-And-Birth.md b/book/en/27-Pregnancy-And-Birth.md new file mode 100644 index 00000000..727514ee --- /dev/null +++ b/book/en/27-Pregnancy-And-Birth.md @@ -0,0 +1,151 @@ +# 27. Pregnancy and childbirth: From confirming pregnancy to discharge and paperwork + +This section first looks at mortality risks — both for the mother and the unborn baby. Later on, we discuss costs and the time required for various procedures. These two sets of calculations are not combined or compared. The focus here is solely on “what needs to be done at what stage.” Topics such as prenatal nutrition or fetal education lack solid evidence or have minimal impact, so they are not covered here. Details on maternity benefits, leave entitlements, and child-rearing expenses can be found in Section 18. Guidance on caring for a newborn is provided in Section 20, while emergency situations are addressed in Section 13. + +According to World Health Organization figures, in 2023 roughly 260,000 women worldwide died as a result of pregnancy or childbirth. About 75% of these deaths stemmed from five main causes: severe postpartum bleeding, infections, hypertensive disorders of pregnancy (such as preeclampsia and eclampsia), complications during delivery, and unsafe abortions. The WHO also notes that “most maternal deaths are preventable, since effective medical measures for prevention and treatment of complications already exist.” The most important actions outlined in this section are precisely those aimed at preventing these problems before they occur. +### 1. Starting daily folic acid supplementation at 0.4 mg before pregnancy and continuing through the first trimester + +- Cost: A bottle costs only a few dozen yuan. Rural women receive it for free through the national folic acid supplementation program. The real challenge is remembering to take one pill every day. +- In plain terms: Taking one folic acid pill daily before and during early pregnancy can cut the risk of neural tube defects in babies by roughly 70%. These defects include conditions like anencephaly and spina bifida. For women who’ve already had a child with such a defect, this regimen reduces the likelihood of a repeat occurrence to about one third of the original risk. +- Benefit: A Cochrane systematic review pooled data from 5 trials involving 6,708 deliveries, rating the evidence as high quality. Daily folic acid intake before and during pregnancy lowered the relative risk of fetal neural tube defects to 0.31 (95% CI 0.17–0.58), a reduction of roughly 70%. For women with a prior child affected by neural tube defects, the relative risk dropped to 0.34 (95% CI 0.18–0.64), equating to a one third reduction in risk. No difference in effectiveness was observed between 0.4 mg and higher doses, nor between folic acid alone and multivitamin supplements. +- Evidence grade: A +- Notes: The key point is to start taking folic acid *before* pregnancy. A fetus’s neural tube closes within 28 days of conception; by the time a pregnancy is detected, most of this window has already passed. Therefore, if you’re planning to conceive, begin supplementation three months in advance. The same review found no clear evidence that folic acid prevents cleft lip and palate, congenital heart disease, or miscarriage — so don’t expect it to address these issues. +- Sources:De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, (12), CD007950. + +### 2. Register for the Maternal and Child Health Handbook at a community health center before 13 weeks of pregnancy to claim free prenatal checkups + +- Cost: No cost at all — this is part of the national basic public health service program. You’ll need to make several visits based on your gestational age. +- In plain terms: You are entitled to at least five free prenatal checkups during pregnancy, plus home visits after delivery and a 42-day postpartum checkup, all paid for by the state. To access these services, you must register for the Maternal and Child Health Handbook at a community health center before 13 weeks of gestation. Failing to do so means you lose out on all these free services. +- Benefit: The third edition of the National Basic Public Health Service Standards outlines specific maternal health management services available to all permanent residents who are pregnant. These include one health checkup in early pregnancy, two in mid-pregnancy, two in late pregnancy, one postpartum home visit, and one 42-day postpartum checkup. Registration for the handbook must be completed before 13 weeks of pregnancy, at which point your first prenatal checkup will also be scheduled. The two mid-pregnancy checkups occur between 16–20 weeks and 21–24 weeks respectively, while the two late-pregnancy checkups are scheduled for 28–36 weeks and 37–40 weeks. Local service lists also include a full set of initial lab tests and postpartum depression screening as part of these free services. +- Evidence grade: A +- Notes: These five free checkups represent the minimum number of services provided; they do not cover all possible prenatal tests. Depending on your individual health needs, your doctor may recommend additional ultrasounds, blood glucose tests, or fetal heart rate monitoring, all of which will incur extra costs. Registering for the handbook as early as possible also allows for earlier assessment of your pregnancy risk level. This risk grading system categorizes pregnant women based on their individual risk factors, ensuring those identified as high-risk receive timely care at specialized medical facilities. Even if you live in a different district than your registered household location, you can still register at your current place of residence — there is no requirement to return to your place of household registration. +- Sources:国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）. ；靖江市人民政府. 国家基本公共卫生服务项目——孕产妇健康管理服务（地方服务清单公开）. + +### 3. Getting tested for HIV, syphilis, and hepatitis B during the first prenatal visit — free prevention options available + +- Cost: No cost involved; the maternal and infant transmission prevention program provides these tests at no charge. +- In plain terms: During your very first prenatal checkup, you can get tested for HIV, syphilis, and hepatitis B at no personal expense. Even if results show a positive diagnosis, there are still effective ways to prevent transmission to your baby. The government offers free medication and treatment plans to block the spread of these infections from mother to child — this is known as maternal and infant transmission prevention. +- Benefit: Maternal and infant transmission is how infections pass from a mother to her unborn or newborn child. The “Work Specifications for Preventing Maternal and Infant Transmission of HIV, Syphilis, and Hepatitis B (2020 Edition)” mandates that during early pregnancy or at the first prenatal visit, healthcare providers must share relevant information and “offer appropriate, standardized free testing” — meaning these three tests are completely free. Follow-up counseling and referrals are also provided based on test results. A positive diagnosis is not a dead end: Article 44 of the “Regulations on HIV/AIDS Prevention and Control” guarantees free treatment and counseling for pregnant women living with HIV to prevent transmission to their babies. Article 43 further requires that such women receive services including transmission prevention, treatment, postpartum home visits, infant follow-ups, and testing. For mothers who test positive for hepatitis B surface antigen, newborns receive both hepatitis B vaccine and hepatitis B immunoglobulin at birth (see Section 20, Item 2). +- Evidence grade: A +- Notes: Early testing is especially valuable for these three conditions, as both prevention and treatment require sufficient time to be effective. Article 3 of the “Regulations on HIV/AIDS Prevention and Control” also states that “no entity or individual may discriminate against people living with HIV/AIDS, AIDS patients, or their family members”; their legal rights related to marriage, employment, medical care, and education are fully protected by law. General prevention measures and routine testing are covered in Section 1, while post-exposure prophylaxis after high-risk behaviors is detailed in Section 13. +- Sources:国家卫生健康委办公厅 (2020). 预防艾滋病、梅毒和乙肝母婴传播工作规范（2020 年版）. （新疆维吾尔自治区卫生健康委员会转载）；国务院 (2006). 艾滋病防治条例（第四十三、四十四条）. （北京市卫生健康委员会转载） + +### 4. No smoking or drinking at all throughout pregnancy — and no one else in the house should smoke either + +- Cost: There’s no cost at all; in fact, it saves money on cigarettes and alcohol. The real challenge is getting everyone living in the same house to quit alongside the pregnant woman. +- In plain terms: Smoking during pregnancy raises the chances of premature birth, a baby being born underweight, and cleft lip or palate. It also doubles the risk of abnormal bleeding during pregnancy and childbirth, and increases the risk of sudden infant death syndrome. Secondhand smoke from anyone smoking indoors counts just the same. It is never too late to quit, no matter when you start. +- Benefit: According to the U.S. Centers for Disease Control and Prevention, smoking during pregnancy can result in babies being “born at full term but still underweight” and “more likely to be born prematurely.” It “doubles the risk of abnormal bleeding during pregnancy and childbirth,” raises the risk of birth defects such as cleft lip and palate, and “damages the developing lungs and brain of the fetus, with effects lasting into childhood.” Babies born to mothers who smoke during pregnancy, as well as infants exposed to smoke after birth, face a higher risk of sudden infant death syndrome. Official guidance states that “it is best to quit smoking before getting pregnant, but quitting while already pregnant still provides benefits,” and “it is never too late to quit.” +- Evidence grade: A +- Notes: Secondhand smoke from anyone smoking indoors is just as harmful to the fetus as direct smoking. Therefore, this rule applies to the whole household, not just the pregnant woman. The same principle holds true for alcohol: there is no known safe level of alcohol consumption during pregnancy, so the safest approach is to avoid it entirely. The impact of smoking and drinking on the health of adults themselves is covered in Section 2. +- Sources:Centers for Disease Control and Prevention. Smoking During Pregnancy. + +### 5. For women at high risk of preeclampsia, start taking one low-dose aspirin tablet daily after week 12 of pregnancy + +- Cost: A few dozen yuan. One tablet per day must be taken until delivery. The hard part is remembering to take it every single day. +- In plain terms: Preeclampsia is a type of high blood pressure that occurs during pregnancy. Women falling into any of these six categories are at high risk: those who had preeclampsia in a previous pregnancy, women carrying multiples, women with chronic hypertension, women with diabetes prior to pregnancy, women with kidney disease, and women with autoimmune diseases. For these women, taking one low-dose aspirin tablet daily starting at week 12 can reduce the risk of preeclampsia by roughly 15%, the risk of premature birth by about 20%, and the risk of perinatal death by nearly 20%. Women not in these categories should not take it on their own. +- Benefit: The US Preventive Services Task Force gives this a Grade B recommendation: for women at high risk of preeclampsia, taking low-dose aspirin (81 mg per day) after week 12 of pregnancy can help prevent the condition. Preeclampsia is a hypertensive disorder unique to pregnancy. Results from multiple studies combined show the following outcomes, with 95% confidence intervals provided as ranges of reliability. The relative risk of preeclampsia drops to 0.85 (95% CI: 0.75 to 0.95, based on 16 studies), a reduction of roughly 15%. The relative risk of premature birth is 0.80 (95% CI: 0.67 to 0.95, based on 13 studies), a drop of about 20%. The relative risk of perinatal death — death occurring around the time of childbirth — is 0.79 (95% CI: 0.66 to 0.96, based on 11 studies), a reduction of roughly 21%. The relative risk of small-for-gestational-age infants or intrauterine growth restriction is 0.82 (95% CI: 0.68 to 0.99, based on 16 studies), a decrease of around 18%, meaning fetuses are less likely to be smaller than expected for their gestational age. +- Evidence grade: A +- Notes: The groups considered high risk include women who had preeclampsia in a prior pregnancy, those carrying twins or multiples, women with chronic hypertension, women with type 1 or type 2 diabetes prior to pregnancy, women with kidney disease, and women with autoimmune diseases such as systemic lupus erythematosus or antiphospholipid syndrome. Women not in these groups should not take aspirin on their own. This medication requires a doctor’s prescription; be sure to share your full medical history during prenatal checkups so your doctor can make an appropriate assessment. Most low-dose aspirin tablets sold in China are 100 mg enteric-coated tablets, and they must be taken strictly as directed by your doctor. +- Sources:US Preventive Services Task Force (2021). Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication. + +### 6. Get screened for gestational diabetes at 24 weeks of gestation or later — don’t mind drinking the sugary solution + + +- Cost: Several tens to over a hundred yuan. You must fast beforehand, and several blood draws will take up half a morning. +- In plain terms: Gestational diabetes is high blood sugar that appears only during pregnancy. At 24 weeks or later, spending half a morning drinking a sugary solution and having several blood tests can detect it. Skipping this test raises the risks of having a macrosomic baby, difficult labor, cesarean delivery, preeclampsia, and neonatal hypoglycemia. +- Benefit: The U.S. Preventive Services Task Force recommends screening for gestational diabetes at 24 weeks or later for asymptomatic pregnant women — those who feel no symptoms at all. Gestational diabetes is high blood sugar that appears only during pregnancy. This single screening test should be done at 24 weeks or later. The Task Force concluded that current evidence does not show any clear benefits or harms from screening before 24 weeks (Grade I). Untreated gestational diabetes increases the risks of macrosomia, difficult labor, cesarean delivery, preeclampsia, and neonatal hypoglycemia. +- Evidence grade: A +- Notes: Most women diagnosed with gestational diabetes can control their blood sugar through diet and exercise alone; only a minority need insulin injections. Don’t skip this test out of fear of being told you need insulin. After giving birth, you must get another blood sugar test — women who’ve had gestational diabetes face a significantly higher risk of developing type 2 diabetes later on. +- Sources:US Preventive Services Task Force (2021). Gestational Diabetes: Screening. + +### 7. Memorize this “go to the hospital immediately” checklist — it applies throughout pregnancy and the first year after childbirth + +- Cost: No cost at all. It takes just five minutes to memorize, and it’s a good idea to share it with anyone living in the same household. +- In plain terms: If any of the following symptoms appear, head to the hospital on the same day — do not wait until the next morning. Persistent or worsening headaches, changes in vision, fever reaching 38°C. Severe swelling of the hands or face, trouble breathing, chest pain or a rapid heartbeat. Unrelenting severe abdominal pain, no fetal movement or a noticeable drop in fetal movement. Vaginal bleeding or fluid leakage. Swelling, pain and redness in one arm or leg. Thoughts of harming yourself or your baby. The full list is included in the Benefits section below. These guidelines apply equally in the first year after childbirth. +- Benefit: These are all emergency warning signs during pregnancy and postpartum listed by the US Centers for Disease Control and Prevention. Persistent or worsening headaches, dizziness or fainting, changes in vision, a body temperature of 38°C or higher. Severe swelling of the hands or face, thoughts of harming yourself or your baby. Difficulty breathing, chest pain or a rapid heartbeat. Severe nausea and vomiting, unrelenting severe abdominal pain. Absence or significant reduction of fetal movement during pregnancy, vaginal bleeding or fluid leakage during pregnancy or postpartum. Abnormal vaginal bleeding or discharge after childbirth. Severe swelling, redness and pain in one arm or leg. None of these issues disappear after the postpartum recovery period — they can all occur within the first year after childbirth. +- Evidence grade: A +- Notes: This checklist serves to clearly distinguish between situations where you can wait a little longer and those that demand immediate medical attention. Headaches paired with blurred vision and upper abdominal pain are typical signs of preeclampsia, a form of pregnancy-related hypertension. Swelling and pain in one lower leg often indicates deep vein thrombosis (see Section 13). According to the World Health Organization, severe postpartum hemorrhage can be fatal to a healthy woman within just a few hours. If any of these symptoms appear, go to the hospital right away — do not delay by waiting at home overnight. +- Sources:Centers for Disease Control and Prevention. Hear Her — Urgent Maternal Warning Signs. ；World Health Organization. Maternal mortality fact sheet. + +### 8. If your water breaks, lie down flat, elevate your hips, and call 120 — don’t walk around or take a shower + + +- Cost: No cost at all +- In plain terms: If your water breaks, there’s no time to calmly gather your things and head out. The right thing to do is lie down right where you are, raise your hips, and call 120 immediately. Walking around while standing up causes amniotic fluid to leak even faster, and the umbilical cord can be pulled out along with it. This is a life-threatening emergency for the baby. +- Benefit: This is exactly what the Beijing Municipal Health Commission recommends: “Immediately lie down flat to prevent further loss of amniotic fluid,” “Do not walk around casually,” and “Call emergency services at 120 right away.” While waiting for help, inform family members so they can bring necessary items to the hospital. Medical sources further explain why this is essential: when a person stands, amniotic fluid drains much more quickly, increasing the risk of umbilical cord prolapse — a critical emergency for the fetus. Therefore, lying down and elevating the hips is crucial; a left-side lying position is ideal. +- Evidence grade: B +- Notes: The three main signs of impending labor are regular contractions, vaginal bleeding, and water breaking. With the first two, you can still prepare calmly, but water breaking demands immediate action: lie down and call for help. Common mistakes include showering, squatting on the toilet, or driving yourself to the hospital. Be sure to note the exact time water broke and its color; tell the doctor if it appears yellow-green or contains meconium, as this indicates fetal distress and oxygen deprivation. If you also experience regular contractions, a marked drop in fetal movement, fever, or chills, emphasize that this is a true emergency. +- Sources:北京市卫生健康委员会. 每周急救话题：准妈妈羊水早破怎样办？ ；北京市顺义区妇幼保健院. 孕晚期在家破水怎么办？ + +### 9. Ask for labor analgesia — it does not raise the risk of C-section + +- Cost: Several hundred to over 1,000 yuan; prices vary by region. Be sure to ask the hospital and anesthesiology department in advance whether this service is available. The main hurdle is simply bringing it up yourself. +- In plain terms: Labor analgesia involves injecting anesthetic into the lower back to dull the pain of childbirth. It works far better than other pain‑relief options and does not make a C-section more likely. The claim that “it causes lifelong back pain” is also unfounded. Nowadays it is offered as a separate charge, so hospitals are more willing to provide it. +- Benefit: A Cochrane systematic review found that epidural analgesia is more effective than non‑epidural methods at reducing labor pain and improving maternal satisfaction. Labor analgesia uses exactly this technique. The same review states that epidural analgesia has no effect on the risk of C-section or long‑term back pain. Instrumental delivery — using tools to assist birth — shows no increased incidence in studies published after 2005. Starting in 2024, the National Healthcare Security Administration introduced separate pricing categories for “labor analgesia,” “doula‑assisted childbirth,” and “family‑member labor support,” precisely because previously there were no dedicated rates to motivate hospitals to offer these services. +- Evidence grade: A +- Notes: Both popular myths — “epidural analgesia causes lifelong back pain” and “it makes a C-section more likely” — lack any scientific basis. Cochrane’s comparison of epidural analgesia with other pain‑relief methods confirms it has no impact on C‑section risk or chronic back problems. Real side effects may include low blood pressure, fever, weak legs, difficulty urinating, longer first‑ and second‑stage labor, and a higher need for oxytocin. The decision to use it is yours; don’t let unfounded rumors deter you. Availability also depends on whether the hospital has an anesthesiologist on duty 24/7 — be sure to ask during prenatal visits. +- Sources:Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews, (5), CD000331. ；国家医疗保障局 (2024). 重构产科服务价格项目 助力构建生育友好型社会. + +### 10. Don’t request a C-section without medical indication, and avoid scheduling one just to pick a “lucky” date + +- Cost: No direct cost. The real challenge is resisting pressure from family members. +- In plain terms: According to the World Health Organization, once the C-section rate in a region exceeds 10%, further reductions in maternal and neonatal mortality become unlikely. When a C-section is medically necessary, it must be performed. However, opting for one solely to choose a favorable date or to avoid labor pain means undergoing a major abdominal operation for no real reason. +- Benefit: A 2015 WHO statement notes that when C-section rates rise to roughly 10% in a population, maternal and neonatal deaths decline. Beyond that threshold, there is no evidence of additional mortality benefits. WHO also stresses that every effort should be made to provide C-sections to women who truly need them, rather than aiming for a specific percentage target. +- Evidence grade: A +- Notes: This guidance does not oppose C-sections. When medically warranted, they are life-saving procedures and should be performed without hesitation. What it discourages is undergoing a C-section when there is no medical need—such as to avoid labor pain, to pick an auspicious date, or to influence a child’s future age for school enrollment. The trade-offs are significant: C-sections are major abdominal surgeries with slower recovery times, and they increase risks of placenta previa, placenta accreta, and uterine rupture in subsequent pregnancies—factors that may affect a woman’s decision to have more children. +- Sources:World Health Organization (2015). WHO Statement on Caesarean Section Rates（WHO/RHR/15.02）. + +### 11. Check your yibao enrollment status before getting pregnant — even unemployed spouses can claim maternity medical expenses + +- Cost: Zero cost. Just call the social insurance or medical insurance hotline once. +- In plain terms: If your employer pays into yibao, both maternity medical costs and maternity leave benefits come out of that fund. Even if your spouse isn’t employed, they can also claim maternity medical expenses. You must confirm beforehand whether you’ve met the minimum enrollment period and whether you need to register in advance for childbirth outside your local area — these details cannot be fixed later. +- Benefit: Article 54 of the Social Insurance Law states that employers who pay yibao premiums provide their employees with full maternity benefits. Unemployed spouses of these employees are also entitled to maternity medical coverage under national regulations, with funds drawn from the yibao pool. These benefits fall into two categories: maternity medical expenses (costs directly related to childbirth) and maternity allowances (payments received during maternity leave). Article 56 further specifies three scenarios qualifying for allowances: childbirth, family planning procedures, and other legally defined situations. Allowances are calculated based on the employer’s prior year’s average monthly payroll, not individual employee wages. +- Evidence grade: A +- Notes: Two critical points require advance verification since retroactive adjustments are impossible. First, confirm you’ve satisfied the minimum continuous enrollment period required by local regulations; otherwise eligibility is denied. Second, if planning childbirth outside your enrollment area, verify whether pre-registration is mandatory — failure to do so may force you to pay upfront and file manual claims later, or even forfeit coverage entirely. Detailed calculations for maternity leave duration and allowances are outlined in Section 18.2. +- Sources:全国人大常委会 (2010). 中华人民共和国社会保险法（第五十四、五十六条）. （国家税务总局广东省税务局转载） + +### 12. Get the “Medical Certificate of Birth” sorted out before discharge; decide on the baby’s name early and avoid typos. + +- Cost: No cost at all. It can be arranged effortlessly while completing discharge procedures. +- In plain terms: This certificate is a prerequisite for registering the child’s hukou, enrolling in yibao (basic medical insurance), and sending the child to school. Only the medical institution where the delivery took place can issue it for the first time. If you try to obtain it after discharge, you’ll have to follow a completely different process and submit extra documentation. Also, make sure the characters you pick for the baby’s name can be entered into the household registration system without any issues. +- Benefit: Article 23 of the Maternal and Infant Health Care Law stipulates that medical institutions and home birth attendants must issue the standardized Medical Certificate of Birth for newborns as required by the State Council’s health administrative department. This certificate is a mandatory prerequisite for all subsequent procedures: registering hukou, signing up for medical insurance, applying for a health insurance card, and enrolling in preschool or school. The initial issuance can only be handled by the delivery hospital. Any later applications require a separate process and additional supporting documents. +- Evidence grade: A +- Notes: Before filling out the form, double-check every character in the parents’ names, their ID numbers, and the baby’s name. The characters chosen for the name must be compatible with the household registration system — using rare or uncommon characters can lead to endless complications down the line. Both name changes and certificate reissues involve reissuance procedures, which are far more expensive than simply verifying the details at the time of application. Once you receive the certificate, store it separately from other important documents: it holds the same legal weight as your household register and ID card. +- Sources:全国人大常委会 (1994, 2017 修正). 中华人民共和国母婴保健法（第二十三条）. + +### 13. Don’t skip newborn heel‑prick and hearing tests + +- Cost: In most areas these tests are free; otherwise they cost only a few dozen yuan. Some extra screening items may require out‑of‑pocket payment. +- In plain terms: A single heel‑prick blood test and one hearing test can detect hypothyroidism, phenylketonuria, and hearing loss even when the baby appears perfectly healthy. By the time symptoms become obvious, any intellectual damage is already irreversible. +- Benefit: Article 3 of the “Administrative Measures for Newborn Disease Screening” lists congenital hypothyroidism, phenylketonuria, other inherited metabolic disorders, and hearing impairment as nationally mandated screening targets. All of these conditions show no outward signs early on; once symptoms appear, lasting intellectual harm has already occurred. Early detection and prompt treatment—such as thyroid hormone replacement, special formula milk, hearing aids, or cochlear implants—yield excellent outcomes. Article 10 further stipulates that any positive screening result must be promptly communicated to parents for confirmatory diagnosis. +- Evidence grade: A +- Notes: Article 11 requires that before screening, parents be fully informed of the tests, eligibility criteria, procedures, sensitivity rates, and associated costs, and must give written consent. Consequently, you’ll receive an informed‑consent form. Carefully review which conditions are covered by the state program and which extra items incur personal fees. A positive initial result does not mean a definitive diagnosis; most infants are cleared after a single follow‑up test, so there’s no need to panic at this stage. If a newborn fails the initial hearing screen, follow the instructions for a repeat test—don’t assume “if the baby seems to hear, it’s fine.” +- Sources:卫生部 (2009). 新生儿疾病筛查管理办法（卫生部令第 64 号，第三、十、十一条）. + +### 14. Enroll your newborn in yibao right after getting the birth certificate — don’t wait until household registration is complete + +- Cost: You pay the yibao premium just once a year; it usually costs a few hundred yuan. +- In plain terms: As soon as you receive the birth certificate, you can enroll your baby in yibao online — no need to wait for household registration. Once enrolled, most hospitalization costs can be reimbursed right at discharge. Newborn hospital bills can be quite high, so having yibao makes a big difference. +- Benefit: According to the Chinese government website in 2024, “Newborns can enroll in yibao online using their birth certificate alone; household registration is not required first.” It also states that “after discharge, newborns can get medical expenses reimbursed immediately.” Previously, families had to complete household registration first, pay all hospital costs out of pocket, and then apply for reimbursement. The average processing time for enrollment has also dropped from 28.7 working days at the start of the year to just 6.4 working days now. +- Evidence grade: A +- Notes: Premature birth, phototherapy for jaundice, and neonatal pneumonia are common reasons newborns end up in the hospital — often resulting in bills of tens of thousands of yuan. Having yibao versus not having it makes a huge difference in such cases. Local rules vary regarding how many days after birth a child must be enrolled to qualify for coverage starting from birth; always check with your local medical insurance office for exact details. Before discharge, calling 12393 is the easiest way to get clear answers. +- Sources:中国政府网 (2024). 健全基本医疗保险参保长效机制国务院政策例行吹风会. + +### 15. Registering a newborn’s birth at a police station within one month + + +- Cost: No cost involved; just a single trip to the police station’s hukou office. +- In plain terms: The law sets a strict one‑month deadline — it’s not a suggestion that you can ignore when convenient. Completing the hukou registration is a prerequisite for vaccinations, preschool enrollment, school admission, and obtaining an ID card. The longer you wait, the more additional documents you’ll need to provide. +- Benefit: Article 7 of the *Regulations on Hukou Registration* states: “Within one month after a baby’s birth, the head of household, relatives, guardians, or neighbors must report the birth to the local hukou registration authority.” This is a legal requirement, not a mere recommendation. Securing hukou is essential for all subsequent steps: vaccinations, preschool and school entry, and ID issuance. Delaying registration inevitably leads to a heavier paperwork burden. +- Evidence grade: A +- Notes: Bring the following documents: the medical birth certificate, both parents’ ID cards and hukou books, and the marriage certificate. You may choose to register the child under either parent’s hukou, but policies differ between locations, affecting school districts and insurance eligibility. Make this decision before you go, as later changes can be cumbersome. Unmarried parents may also register their newborn without any restrictions. +- Sources:国务院 (1958). 中华人民共和国户口登记条例（第七条）. （广东省人民政府转载） + +### 16. Don’t skip that 42-day postpartum checkup — it also screens for postpartum depression + +- Cost: It’s free; it’s part of basic public health services. It takes half a day. The hard part is that right after childbirth you often feel too lazy to go. +- In plain terms: This checkup costs nothing and includes a complete blood count, vaginal discharge test, plus a screening for postpartum depression. Serious problems can arise at any time during the first year after birth, so don’t assume you’re out of danger just because the postpartum period is over. +- Benefit: According to the “National Standards for Basic Public Health Services (3rd Edition),” postpartum care requires one home visit and one health checkup at 42 days. Local service lists confirm this visit includes lab tests (blood count, vaginal discharge) and a postpartum depression screening. Severe complications may appear throughout the first year. Items on the “Go to the hospital immediately” list in Section 7 — such as “thoughts of harming oneself or the baby,” “abnormal vaginal bleeding or discharge,” or “severe swelling/pain in one limb” — all fall under postpartum risks. +- Evidence grade: A +- Notes: Postpartum depression isn’t a sign of weakness or something that can be fixed by family telling you to “cheer up.” There are specific screening questionnaires and treatments available, and recovery is possible. Handling suicidal thoughts is covered in Section 1. Legal options if caring for a newborn proves impossible are outlined in Section 9, Item 20. This checkup also evaluates wound healing, uterine recovery, pelvic floor function, and discusses contraception — remember, the absence of menstruation after childbirth doesn’t mean pregnancy is impossible. +- Sources:国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）. ；靖江市人民政府. 国家基本公共卫生服务项目——孕产妇健康管理服务（地方服务清单公开）. diff --git a/book/en/28-Do-Not-Ruin-Health-For-Looks.md b/book/en/28-Do-Not-Ruin-Health-For-Looks.md new file mode 100644 index 00000000..f6154e0e --- /dev/null +++ b/book/en/28-Do-Not-Ruin-Health-For-Looks.md @@ -0,0 +1,102 @@ +# 28. Don’t harm your body just to change its appearance + +This section covers several methods people use to alter their appearance: fasting, taking pills, getting injections, and undergoing surgery. They all share one thing in common: the decision to use them is usually driven by comparisons with others. Yet the costs are borne entirely by the individual, and many of those costs are irreversible. + +We make no judgment about anyone’s personal choice regarding how they want to look — that is a matter of personal preference. What we do address is this: for the same end result, how much greater is the risk when people follow unregulated paths — buying products online, using services at beauty clinics, or increasing dosages on their own — compared to following medically supervised routes that involve prescriptions, qualified professionals, and follow‑up care? Our assessment focuses on actual physical consequences such as blindness, hospitalization, and death. In addition, illegal cosmetic procedures can lead to serious criminal liability. +### 1. Do not use extreme dieting, fasting, or self-induced vomiting to control weight; if you want to lose weight, focus on exercise instead. + +- Cost: No cost at all. In fact, it saves money compared to buying weight-loss products. +- In plain terms: People with anorexia nervosa have a mortality rate roughly 5.9 times higher than their peers. Across 1,000 people followed for one year, about 5.1 die. One out of every five of those deceased individuals died by suicide. The root cause often starts with dieting: a three-year study of students at 44 secondary schools found that girls who dieted severely were 18 times more likely to develop eating disorders than those who did not diet. To control weight, prioritize exercise rather than cutting food intake to the point of hunger. +- Benefit: This conclusion is backed by 36 separate studies involving a total of 166,642 person-years of follow-up on individuals with anorexia nervosa. Their standardized mortality ratio was 5.86, meaning their death risk is 5.9 times higher than that of people of the same age. Across 1,000 person-years, 5.1 deaths occurred, and roughly one fifth of those deaths were suicides. For bulimia nervosa, the standardized mortality ratio is 1.93, and 1.92 for other eating disorders, both roughly 1.9 times higher than the general population. Another study conducted in 44 secondary schools in Victoria, Australia, tracked 14–15-year-old students over three years with six rounds of assessments. It found that new cases of eating disorders emerged at a rate of 21.8 per 1,000 person-years among girls, meaning 21.8 new cases occurred per 1,000 girls each year. Girls who dieted severely had an 18-fold higher risk of developing eating disorders than those who did not diet, while those who dieted moderately had a 5-fold higher risk. After adjusting for prior dieting habits and pre-existing mental health issues, factors like BMI, exercise levels, and gender no longer predicted new cases of eating disorders. The authors concluded that for adolescents, using exercise rather than diet restriction to control weight appears to lower the risk of developing eating disorders. +- Evidence grade: A +- Notes: The term “severe dieting” here refers to consistently consuming far less food than the body needs over a long period, not simply skipping one meal or avoiding late-night snacks. If you experience self-induced vomiting, feel guilty after binge eating, or find yourself compulsively weighing yourself, seek help from a psychiatrist or clinical psychology department at a general hospital. This is a treatable medical condition, not a matter of lacking willpower. Information on the relationship between BMI and mortality is provided in Section 2, Item 33, which focuses on long-term weight ranges rather than weight-loss methods. +- Sources:Arcelus J et al. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. ；Patton GC et al. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ. + +### 2. Two things to check before getting injections, thread lifts, or surgery: does the facility’s license list “medical aesthetics,” and is the practitioner a licensed attending physician? + + +- Cost: There is no cost involved. Checking these two documents takes only a few minutes. The clinic should display its “Medical Institution Practice License” in the lobby. A doctor’s qualifications can be verified via the health authority’s online registry of licensed physicians. + +- In plain terms: Any procedure that involves needles, surgery, or medical devices — meaning anything that breaks the skin or enters the body — is considered medical treatment. Such procedures may only be performed at facilities whose licenses explicitly list “medical aesthetics,” and only by registered attending physicians. Performing them in beauty salons, private studios, or hotel rooms is illegal medical practice: in serious cases, offenders face up to three years in prison; if they cause injury, three to ten years; if they result in death, more than ten years. + +- Benefit: Article 2 of the “Administrative Measures for Medical Aesthetic Services” defines medical aesthetics as “the use of surgery, drugs, medical devices, and other invasive or traumatic medical techniques to repair and reshape a person’s appearance and body contours.” In simpler terms, any procedure that breaks the skin or introduces needles or devices into the body qualifies as medical treatment. Articles 8 and 24 stipulate that a facility must first obtain a “Medical Institution Practice License” and be approved for medical aesthetic services before conducting such procedures; if “medical aesthetics” is not listed on the license, the practice is prohibited. Article 11 requires attending physicians to hold valid licenses and be registered; those performing cosmetic surgery must have at least six years of relevant clinical experience, cosmetic dentistry five years, and cosmetic traditional Chinese medicine or dermatology three years each. Article 20 mandates that patients receive written explanations of indications, contraindications, risks, and precautions prior to consent. Article 336 of the Criminal Law criminalizes illegal medical practice — performing injections, surgery, or treatment without proper licensing. Penalties range from up to three years imprisonment for minor offenses to three to ten years for causing injury, and more than ten years for resulting in death. + +- Evidence grade: A + +- Notes: Article 16 of the same regulations further specifies that medical aesthetic procedures may only be conducted at licensed medical aesthetic facilities or at hospitals/clinics with designated medical aesthetic departments. Therefore, performing injections at a patient’s home or in a private studio already violates regulations. Article 20 also requires parental consent for minors undergoing such treatments. Routine beauty services such as facials, massages, or nail care fall outside this regulatory framework; however, any procedure involving needles or surgery remains classified as medical aesthetics. +- Sources:卫生部 (2002). 医疗美容服务管理办法（卫生部令第 19 号，第二条、第八条、第十一条、第十六条、第二十条、第二十四条）. ；全国人大 (1997). 刑法（第三百三十六条）. + +### 3. Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money. + +- Cost: No cost at all. You simply choose a different injection site, or skip the treatment altogether. +- In plain terms: Between 2015 and 2018, 48 new cases of partial or total vision loss following filler injections were reported worldwide. The nose was the most common site of complications, accounting for 56.3% of cases; followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was used in over 80% of these cases. Only 20.8% of patients regained full vision, while 16.7% saw partial recovery; the rest remained visually impaired. Nearly 20% also developed complications affecting the central nervous system. Currently, no single treatment has been proven consistently effective for reversing these effects, so prevention remains the only reliable option. +- Benefit: Data compiled from all published case reports worldwide show that from January 2015 through September 2018, 48 new instances of partial or complete vision loss occurred after filler injections. The nasal region accounted for 56.3% of incidents, followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was identified as the filler material in 81.3% of cases. Skin changes appeared in 43.8% of patients, while central nervous system complications arose in 18.8%. Ten patients (20.8%) fully recovered vision, eight (16.7%) partially recovered, and the remainder did not improve. Researchers concluded that treatment approaches varied widely across studies, and no single method has been demonstrated to reliably restore vision. +- Evidence grade: B +- Notes: These figures were derived by manually tallying each reported case across medical journals. They reflect only the number of patients experiencing complications, not the total number of injections performed; thus it is impossible to calculate the exact probability of blindness per injection. The B rating reflects this limitation. Reputable clinics naturally employ standard risk‑minimization practices: mapping vascular pathways beneath the injection sites, using blunt‑tip needles instead of sharp ones, administering small amounts of filler while slowly withdrawing the needle, and keeping hyaluronidase on hand. All these steps must be carried out by trained physicians — which is precisely why unregulated providers should be avoided. Before proceeding, verify that the clinic holds proper licensing and that the attending physician is qualified, as outlined in Section 2 of this chapter. +- Sources:Beleznay K et al. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. + +### 4. Don’t buy weight‑loss pills, coffee, candies, or “enzymatic plums” that promise rapid results + + +- Cost: Zero. In fact, you’ll save the money you’d otherwise spend on these products. The hard part is accepting that there’s no such thing as “losing several pounds in a week.” + +- In plain terms: The illegal ingredient most often found in these products is sibutramine. Originally a legitimate weight‑loss medication, it was banned in China in 2010. One large trial enrolled nearly 10,000 participants who took the drug for an average of over three years. Compared with placebo, users had a roughly 30% higher risk of non‑fatal heart attacks and a 36% higher risk of non‑fatal strokes; the overall adverse‑event rate was 11.4% versus 10.0%. Over three years, the drug only produced an extra 1.7 kg of weight loss. By the time tests detect the substance, you’ve already consumed it. + +- Benefit: The SCOUT trial involved 9,804 participants aged 55 or older who were overweight or obese and had cardiovascular disease or type 2 diabetes. They were randomly assigned to receive sibutramine or placebo for an average of 3.4 years. The primary endpoints were several predefined adverse events: non‑fatal myocardial infarction, non‑fatal stroke, cardiac arrest with successful resuscitation, and cardiovascular death. The incidence rates were 11.4% in the drug group versus 10.0% in placebo, giving a hazard ratio of 1.16 (95% CI 1.03–1.31, P = 0.02). In other words, treatment raised the risk of any such event by roughly 16%, with the true increase likely ranging from 3% to 31%. Non‑fatal heart attacks occurred in 4.1% vs 3.2% of participants (HR 1.28, 1.04–1.57), a 30% relative rise; non‑fatal strokes appeared in 2.6% vs 1.9% (HR 1.36, 1.04–1.77), a 36% increase. Cardiovascular and overall mortality did not rise. On average, the sibutramine group lost only 1.7 kg more than placebo. Based on safety concerns, China’s former State Food and Drug Administration ruled in October 2010 that the benefits of sibutramine did not outweigh its risks, ordering cessation of its production, sale, and use; both sibutramine and phenolphthalein are prohibited in foods and dietary supplements. + +- Evidence grade: A + +- Notes: SCOUT enrolled high‑risk individuals already suffering from heart disease or diabetes; it does not prove that healthy young people would experience the same effects. Because it’s impossible to identify who is truly low‑risk, regulators opted to withdraw the drug entirely. Another common illicit additive is phenolphthalein, originally a laxative whose chronic overuse can disturb electrolyte balance and provoke arrhythmias. How to tell a legitimate product from a fraudulent one: genuine weight‑loss medicines are prescription drugs whose approval numbers can be verified at pharmacies or hospitals. Products marketed as “coffee,” “candies,” “plums,” or “meal replacements” that promise rapid weight loss should, by definition, have no therapeutic effect; any such effect indicates illegal adulteration. The original wording of State Food and Drug Administration Order No. 432 [2010] can be cross‑checked on provincial regulatory websites; the phrase “risks outweigh benefits” and the statement “production, sale, and use were halted in October 2010” appear verbatim there. A total of 412 participants took part in the trial, underscoring its large scale. +- Sources:James WPT et al. (2010). Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. NEJM. ；天津市市场监督管理委员会. 警惕部分食品中违法添加「盐酸西布曲明」和「酚酞」. + +### 5. Do not use anabolic steroids (“muscle‑building injections” or “oral pills”) to build muscle + + +- Cost: There is no cost involved; you even save money on medication. The hard part is accepting that muscle growth will be slow. +- In plain terms: A Danish study followed 545 men who tested positive for anabolic steroids and compared them with 5,450 age‑matched controls. Users had a three‑fold higher risk of death, and the median number of hospital visits per year was 0.81 versus 0.36 for controls. More than 10 % of steroid users developed acne, gynecomastia, or erectile dysfunction. In China these drugs are prescription‑only, and any source selling them illegally is breaking the law. +- Benefit: The Danish researchers matched each steroid user with a control of the same age. The original cohort comprised 545 men whose androgenic steroid tests were positive between 2006‑01‑03 and 2018‑03‑01; they were paired with 5,450 controls. An additional validation used 644 refusers and 6,440 controls. Results showed a three‑fold increase in mortality among users (HR = 3.0; 95 % CI 1.3–7.0). The median yearly number of hospital visits was 0.81 versus 0.36 (P < 0.0001). Median means that half of the users had more visits and half fewer; such a low P‑value indicates this difference is highly unlikely to be random. Acne, gynecomastia, and erectile dysfunction each affected over 10 % of users – at least one in ten – a rate far above that of controls (P < 0.0001). The validation cohort yielded the same findings. Article 7 of China’s Anti‑Doping Regulations states that all substances on the prohibited list are strictly controlled; no entity may produce, sell, import, or export them illegally. The same regulation designates anabolic agents and peptide hormones as prescription drugs, meaning they may be obtained only with a doctor’s prescription; “anabolic agents” is the official term used in legislation. +- Evidence grade: A +- Notes: This is an observational study, not a randomized trial; steroid users may also engage in other risky behaviors, so the three‑fold risk increase may not be attributable solely to the drugs. The true effect size likely falls between 1.3 and 7.0. However, visible side effects such as acne, gynecomastia, and erectile dysfunction are less prone to bias. Legally these products are termed “anabolic agents”; any product described with that phrase contains them. Ordinary protein powder or creatine does not fall under this category. A problem is that some products marketed as “muscle‑building powders” or “nutritional supplements” may contain hidden steroids while claiming rapid results. The screening method is the same as for weight‑loss products (see item 4: avoid any weight‑loss drug promising quick results). Legitimate drugs are prescription‑only and carry verifiable approval numbers; any product sold as a “muscle‑building supplement” that promises results within weeks is probably adulterated. +- Sources:Horwitz H et al. (2019). Health consequences of androgenic anabolic steroid use. J Intern Med. ；国务院 (2004). 反兴奋剂条例（国务院令第 398 号，第七条、第九条）. + +### 6. If you need weight-loss medication, get a prescription from a doctor — don’t buy it from online shops that ship it without one. + + +- Cost: A single doctor’s visit plus a round trip to the clinic. This costs just a few dozen yuan and takes half a day. + +- In plain terms: By regulation, prescription drugs must be sold only with a valid prescription, and pharmacies must keep that prescription on file for at least five years. Online sellers of prescription drugs must also have a genuine prescription and verify the buyer’s identity. So when you see an online shop that doesn’t require a consultation or a prescription and ships the product right away, there are only two possibilities: either the product isn’t actually the drug it claims to be, or the shop is breaking the law. In either case, no one can be held responsible for dosage or contraindications if something goes wrong. Those few dozen yuan you spend on a doctor’s visit buys you exactly this protection. + +- Benefit: The “Measures for the Supervision and Administration of the Quality of Drug Operation and Use” require retail pharmacies to follow a classification system that separates prescription drugs from over-the-counter ones. Under this system, one category requires a doctor’s prescription, while the other can be bought without one. Pharmacies must sell prescription drugs only with a prescription, keep it on file for at least five years, and post notices when no pharmacist or other qualified pharmacy staff member is on duty; otherwise they may not sell prescription drugs at all. Prescription drugs may not be sold from open shelves where customers can pick them up on their own. Article 9 of the “Measures for the Supervision and Administration of Online Drug Sales” stipulates that any online sale of prescription drugs to individuals must be backed by a verified, authentic prescription and must use real-name registration. Article 10 requires that risk warnings be clearly displayed on every product page. Before a prescription is verified, no product description may be shown and no purchase option may be offered — in other words, there should be no “Buy Now” button on such pages. Article 8 further states that drugs under special government control may not be sold online at all; this includes vaccines, blood products, narcotics, psychotropic drugs, toxic drugs for medical use, radioactive drugs, and precursor chemicals used to make illicit drugs. None of these may be sold online. + +- Evidence grade: B + +- Notes: The legal provisions can be checked word for word, but no study has ever quantified exactly how much safer it is to take prescription drugs versus buying them without one; therefore this evidence rating is recorded as “difficult to quantify,” resulting in a grade B. This rule applies to all prescription drugs, not just weight-loss medications. The same regulations govern steroids and sex hormones, as mentioned in items 5 and 7 of this section. When a patient truly needs medication to manage weight, a doctor first evaluates their BMI, any other medical conditions, and possible contraindications before deciding whether and which drug to prescribe. This professional judgment cannot be replaced by any online purchase. +- Sources:国家市场监督管理总局 (2023). 药品经营和使用质量监督管理办法（总局令第 84 号）. ；国家市场监督管理总局 (2022). 药品网络销售监督管理办法（总局令第 58 号，第八条至第十条）. + +### 7. Sex hormone therapy should only be used when prescribed by a doctor and with regular follow‑up; do not buy it online and do not adjust the dose on your own. + + +- Cost: Regular doctor visits and blood tests are required. Over a year this can cost several hundred dollars and take up several half‑days of your time. + +- In plain terms: This section does not discuss whether hormone therapy is appropriate, only how to use it safely. A study followed transgender individuals for about four years. Transgender women taking estrogen had a noticeably higher rate of venous thrombosis than age‑matched controls — 4.1 extra cases per 1,000 people in two years and 16.7 extra cases per 1,000 in eight years. Such risks must be monitored through long‑term follow‑up, and that monitoring only happens when a clinician checks you regularly. When people buy hormones online and adjust doses themselves, there is no one to provide that oversight. + +- Benefit: Researchers examined electronic medical records from Kaiser Permanente, a large health‑care system. They identified 2,842 transgender women and 2,118 transgender men, with average follow‑up periods of 4.0 and 3.6 years respectively. Each participant was matched to roughly ten cisgender controls based on birth year, race, clinic location, and enrollment date — resulting in 48,686 cisgender men and 48,775 cisgender women. Compared with cisgender women, transgender women showed more venous thromboembolism: 4.1 extra cases per 1,000 people after two years (95% CI 1.6–6.7) and 16.7 extra cases after eight years (6.4–27.5). Compared with cisgender men, the numbers were 3.4 (1.1–5.6) and 13.7 (4.1–22.7) respectively. Rates of ischemic stroke and myocardial infarction were similar across groups. The differences were more pronounced among transgender women who started hormone therapy during the study period. Evidence for transgender men was insufficient to draw conclusions. The authors concluded that “these results may indicate a need for ongoing vigilance regarding the vascular side effects of estrogen in transgender hormone therapy.” + +- Evidence grade: A + +- Notes: The researchers acknowledged a limitation: they could not determine how many participants obtained hormones outside the health‑care system, so the data on actual medication use are incomplete. This limitation actually underscores why regular medical follow‑up is essential. The study only examined vascular events; it does not address whether hormone therapy should be used or what its overall benefits are — those questions require different evidence. The same principle applies to any use of sex hormones, including birth‑control pills, menopausal hormone therapy, and testosterone replacement. Anyone who buys hormones online, adjusts doses based on internet advice, and never monitors blood clots or liver/kidney function is at risk primarily because there is no medical oversight. In China, the proper route is to consult an endocrinology department or relevant specialist at a licensed medical institution for evaluation, prescription, and follow‑up. +- Sources:Getahun D et al. (2018). Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons: A Cohort Study. Ann Intern Med. ；国家市场监督管理总局 (2022). 药品网络销售监督管理办法（总局令第 58 号，第九条）. + +### 8. If the feeling of “being unattractive” has reached the point where you constantly check your reflection and obsess over changes, get a body image assessment before considering surgery. + + +- Cost: A single visit to a psychiatrist or clinical psychologist costs only a few dozen yuan. The real challenge is making that appointment before scheduling any surgery. + +- In plain terms: When we combine data from 33 studies, we find that 15.04% of people seeking cosmetic surgery meet the criteria for body dysmorphic disorder — a condition where a flaw barely noticeable to others becomes a major source of distress. Among dermatology patients seeking cosmetic treatments, the rate is 12.65%. In both groups, over 70% are women. Surgery can alter facial features, but it cannot break the cycle of constant self‑scrutiny and dissatisfaction; this often leads to repeated operations. Spending a modest amount on an initial evaluation can help determine whether you fall into this category, guiding your decision about surgery. + +- Benefit: A comprehensive review of those 33 studies shows that the prevalence of body dysmorphic disorder among cosmetic surgery patients is 15.04%, with individual study estimates ranging from 2.21% to 56.67%. Roughly 15 out of every 100 patients fit this description, though some studies report as few as 2 or as many as 57. The average age of these patients is 34.54 ± 12.41 years, and 74.38% are female. Among dermatology patients, the rate is 12.65%, with study figures ranging from 4.52% to 35.16%; their average age is 27.79 ± 9.03 years, and 76.09% are female. Researchers recommend that plastic surgeons and dermatologists proactively screen for this disorder and coordinate care across specialties. + +- Evidence grade: B + +- Notes: The reported prevalence varies widely — from 2.21% up to 56.67% — because different studies use distinct questionnaires and populations. Thus we can only conclude that this condition is fairly common and warrants screening; the 15.04% figure should not be taken as an exact statistic. This is why it is graded B. Importantly, most people seeking cosmetic treatments do not have psychological issues; only a small subset — those whose preoccupation is persistent, interferes with work or social life, and leads to repeated surgical attempts — are at risk. Warning signs include spending excessive time each day inspecting or concealing a body part, avoiding social interactions or photos, and constantly fixating on new areas after previous corrections. +- Sources:Ribeiro RVE (2017). Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast Surg. diff --git a/book/en/29-After-A-Major-Blow.md b/book/en/29-After-A-Major-Blow.md new file mode 100644 index 00000000..9396a115 --- /dev/null +++ b/book/en/29-After-A-Major-Blow.md @@ -0,0 +1,147 @@ +# 29. After experiencing a major setback + +Losing a loved one, receiving a serious diagnosis, losing a job, or going through a divorce — these events share one thing in common: they affect not only a person’s mood but also their physical health. The period of highest risk spans from the first few weeks up to the first year. This section does not discuss how to “get over it.” Instead, it outlines which matters need close attention, which decisions should be postponed, and when to seek medical help. Most figures here refer to the risk of death. The four items dealing with costs and benefits relate to money: avoid rushing into grief counseling right away (item 9), call 12356 and schedule a mental health appointment (item 11), postpone any irreversible major decisions (item 12), and never treat death as a way to settle debts (item 13). These two sets of numbers are not interchangeable. For those without family or friends to rely on, item 6 explains how to arrange for someone to keep an eye on things. + +Details on funeral procedures, handling the body, and claiming benefits after a loved one’s death are covered in section 25. Information on guardianship and wills for elderly relatives appears in section 17. Section 7 describes unemployment benefits. Sections 3 and 22 discuss exercise and light exposure as ways to ease low mood. If suicidal thoughts arise, call 12356 first (see item 25 in section 1); the time frame for such thoughts is explained in item 32 of section 1, while lasting effects after recovery are described in item 33 of section 1. None of these topics are repeated here. +### 1. After a loved one passes, don’t stay alone for the first few days. Those with heart disease, high blood pressure, or diabetes should keep taking their medication. If you feel pressure or pain in the chest, call 120 right away. + + +- Cost: There is no cost involved. Just avoid being alone during these days and keep taking your medicine as usual. +- In plain terms: In the first day after losing a loved one, the risk of a heart attack is about 21.1 times higher than normal, then it drops each day afterward. For people aged 60 to 89, the rate of heart attacks or strokes within 30 days of losing a spouse roughly doubles compared to the general population, then returns to normal after a month. Those already dealing with heart disease must not skip their medication. Chest pressure, shortness of breath, or weakness in one arm or leg are clear emergency signs — call 120 immediately. +- Benefit: This conclusion comes from a study of 1,985 acute heart attack patients, comparing their health status before and after the event. Out of them, 270 individuals (13.6%) had lost someone close within six months prior, and 19 lost a loved one just one day before the attack. Within 24 hours of such a loss, the risk of a heart attack rose 21.1 times (95% CI 13.1–34.1; actual range roughly 13 to 34 times). This risk then gradually decreased day by day. To put this into perspective: among people with a baseline 5% ten-year risk of heart attack, one extra case occurs for every 1,394 people who recently lost a loved one; for those with a 20% baseline risk, the figure is one extra case per 320 people. Another UK-based study compared 30,447 widowed individuals aged 60–89 with 83,588 similar controls. Within 30 days of bereavement, 0.16% of the bereaved group suffered a heart attack or stroke, versus 0.08% of controls — an IRR of 2.20 (1.52–3.15), meaning their risk was roughly 2.2 times higher. Specifically, heart attack risk was 2.14 times higher (1.20–3.81) and stroke risk 2.40 times higher (1.22–4.71). These elevated risks faded after 30 days. Over 90 days, two other conditions also showed increased risk: acute coronary syndrome (IRR 2.20, 1.12–4.29) and pulmonary embolism (IRR 2.37, 1.18–4.75). In total, 67 people in the control group experienced such events, and the heart attack risk was 2.1 times higher for bereaved individuals. +- Evidence grade: A +- Notes: Practical steps are easy to follow: ask someone else to manage your medication rather than relying on memory alone. Avoid long-distance travel during this period, and do not try to cope by drinking alcohol — details on alcohol’s effects are covered in Section 2. Recognizing heart attacks and strokes, plus instructions on calling emergency services, are explained in Section 13. Both studies referenced here rely on retrospective population data, so it’s hard to determine exactly how many participants would have developed these conditions anyway. Yet both studies point to the same general trend and timeframe. For anyone unable to arrange help or who must remain alone during these days, please see point 6 in this section. +- Sources:Mostofsky E, et al. (2012). Risk of acute myocardial infarction after the death of a significant person in one's life: the Determinants of Myocardial Infarction Onset Study. Circulation. ；Carey IM, et al. (2014). Increased risk of acute cardiovascular events after partner bereavement: a matched cohort study. JAMA Internal Medicine. + +### 2. On the week you receive a cancer diagnosis, don’t go alone to pick up the results — postpone non‑treatment decisions + + +- Cost: No cost at all. Simply arrange for someone to accompany you when you collect the results, and put any major decisions unrelated to treatment off for a few days. + +- In plain terms: In the first week after receiving a cancer diagnosis, the risk of suicide is roughly 12.6 times higher than among people without a diagnosis, while the risk of dying from cardiovascular disease is about 5.6 times higher. By the end of the first year this drops to roughly 3.1 times; the effect is especially pronounced for harder‑to‑treat cancers. The greatest risk exists during those first few days, after which it falls quickly. Therefore, bring a companion when picking up the results and avoid being alone at home. Decisions such as quitting your job or selling your house can wait until your next appointment. + +- Benefit: Data from Sweden’s national registers tracked over 6.07 million people (6,073,240 individuals) from 1991 to 2006. Compared with cancer‑free controls, the relative risk of suicide in the first week after diagnosis was 12.6 (95% CI 8.6–17.8), meaning roughly 12.6 times higher. The true value lies somewhere between 8.6 and 17.8. The incidence rate during that week was 2.50 per 1,000 person‑years — about 2.5 cases per 1,000 people each year. By the end of the first year this fell to 3.1 (2.7–3.5; 0.60 per 1,000 person‑years), or roughly 3.1 times higher. Cardiovascular mortality in the first week was 5.6 times higher (5.2–5.9; 116.80 per 1,000 person‑years), and over the first four weeks it remained at 3.3 times higher (3.1–3.4; 65.81 per 1,000 person‑years). This elevated risk declines rapidly within the first year; the effect is more pronounced for cancers with poorer prognoses. Comparisons of the same patients over time yielded consistent results. + +- Evidence grade: A + +- Notes: These figures apply specifically to cancer patients. No comparable data exist for other serious diagnoses. The actual number of people affected remains low: a total of 6,073,240 individuals were included in the study, and the first‑week suicide rate is 2.50 per 1,000 person‑years, i.e., only 2.5 cases per 1,000 people each year. This information is provided not to frighten, but to emphasize the importance of having someone present during those initial days. Long‑term management, insurance coverage, and follow‑up care are discussed in Sections 16 and 24. For those unable to find a companion, see point 6 in this section, which suggests enlisting neighbours or community contacts instead. +- Sources:Fang F, et al. (2012). Suicide and cardiovascular death after a cancer diagnosis. New England Journal of Medicine. + +### 3. After losing a job, it’s important to set a regular sleep schedule, keep yibao (basic medical insurance) active, and plan job searches methodically — don’t just stay at home all day. + + +- Cost: There’s no expense involved. First, register as unemployed and apply for unemployment benefits; then schedule job searches at set times. The real challenge is waking up on time when no one is there to push you. + +- In plain terms: People who are unemployed have a roughly 60% higher chance of dying in the years that follow compared to those still employed. This effect is stronger among younger men and peaks during the first decade after job loss. Some of this risk can be controlled: studies that also accounted for smoking and drinking showed a 25% smaller increase in mortality. Registering as unemployed and claiming benefits also ensures that employee medical insurance stays active (see Section 7). + +- Benefit: Data from 42 studies involving over 20 million participants and 235 mortality risk estimates show that, after adjusting for age and other factors, unemployed individuals face an average HR of 1.63 for all causes of death — meaning their risk is about 63% higher than that of employed people. This effect is more pronounced in men and in people early or midway through their careers; it diminishes after the first ten years. When lifestyle factors like smoking and drinking are included in the analysis, the average HR drops by 24%, reflecting a similar reduction in overall risk. + +- Evidence grade: A + +- Notes: These findings come from observational studies, so a direct cause‑and‑effect relationship cannot be proven; it’s also possible that poorer health contributes to unemployment. Nevertheless, the 24% reduction in risk after adjusting for health behaviors offers a useful direction for intervention. Details on eligibility for unemployment benefits, how to apply, and how to maintain social insurance coverage are provided in Section 7. Information on severance pay and why you should avoid voluntarily resigning can be found in Section 19. +- Sources:Roelfs DJ, et al. (2011). Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Social Science & Medicine. + +### 4. People who lose a loved one to suicide, accident, or homicide should seek professional help rather than trying to cope alone + +- Cost: Calling 12356 is free of charge. Visiting a doctor and attending a psychological clinic costs the same as any other outpatient visit. The hard part is mustering the courage to reach out. +- In plain terms: Within five years after losing a spouse to suicide, men are about 80% more likely to develop a mental disorder compared to the general population, while women are about 70% more likely. Compared to those whose spouses died from other causes, this risk is still 70% to 100% higher. Such bereaved individuals also tend to feel isolated and ashamed. This is precisely why they should actively seek help rather than waiting for things to get better on their own. +- Benefit: A nationwide Danish registry tracked 6.7 million adults from 1980 to 2014, totaling over 136 million person-years of observation. For bereaved individuals whose spouses died by suicide, the relative risk of being newly diagnosed with a mental disorder within five years was as follows: for men, the IRR was 1.8 (95% CI 1.6–2.0), meaning a roughly 80% higher risk; for women, the IRR was 1.7 (1.6–1.8), representing a roughly 70% higher risk. Compared to those whose spouses died from other causes, the IRR for men was 1.7 (1.5–1.9) and for women 2.0 (1.9–2.2), again indicating a 70% to 100% higher risk. This group also showed higher rates of suicidal behavior, mortality, and need for municipal social assistance. Physical health risks such as cirrhosis and sleep disorders were also elevated. An additional 57 separate studies were reviewed without pooling their results. Bereavement due to suicide is linked to four key outcomes: a higher risk of suicide among surviving partners; a higher likelihood of parents being admitted to psychiatric care after their child’s suicide; a higher suicide risk among mothers after their adult child’s death; and a higher depression risk among children after their parents’ suicide. Compared to those grieving after violent deaths from other causes, people bereaved by suicide report feeling isolated and ashamed more often. +- Evidence grade: A +- Notes: Sudden, violent deaths refer to accidents, homicides, or disasters. After such events, rates of PTSD, depression, and prolonged grief are higher than after deaths from natural causes, and recovery tends to be slower. Guidance on handling suicidal thoughts is provided in Section 1, Item 25. +- Sources:Erlangsen A, et al. (2017). Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study. JAMA Psychiatry. ；Pitman A, et al. (2014). Effects of suicide bereavement on mental health and suicide risk. The Lancet Psychiatry. ；Kristensen P 等 (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry. （备注里那份综述） + +### 5. In the first six months after losing a spouse, assign one trusted person to oversee meals, sleep, medication for chronic conditions, and follow‑up appointments + +- Cost: No expense at all. Simply choose someone — a child, sibling, or friend — and ask them to visit regularly or call you. The hard part is actually asking them to take on this responsibility. +- In plain terms: Within the first six months after a spouse passes away, the risk of dying is roughly 40% higher than for people who haven’t lost a spouse. After six months it drops to about 15% higher. For men the increase is roughly 23%; for women the difference is so small it may well be a coincidence. This extra risk cannot be offset simply by staying positive. The practical step is to hand off medication, meals, and medical check‑ups to a specific person rather than relying on your own memory. +- Benefit: Data from 15 studies that were registered beforehand and later tracked a total of 2,263,888 participants show that within six months of losing a spouse the relative risk of death is 1.41 (95% CI 1.26–1.57), meaning the death probability is about 40% higher than for non‑bereaved individuals. After six months this drops to 1.14 (1.10–1.18), a 15% increase. For men the relative risk is 1.23 (1.18–1.28), a 23% rise; for women it is 1.04 (1.00–1.08), a difference that is not statistically significant and may simply be a fluke. No notable difference was found between people under 65 and those 65 or older. Another analysis combining 123 publications, 1,377 risk estimates, and over 500 million people yielded a hazard ratio of 1.23 (1.19–1.28), indicating a 23% overall increase in mortality. Men again face a higher risk than women: their hazard ratio is 1.27 (1.19–1.35), a 27% rise, while for women it is 1.15 (1.08–1.22), a 15% increase. +- Evidence grade: A +- Notes: These findings come from retrospective analyses of population data; other confounding factors cannot be completely ruled out because spouses naturally share similar lifestyles and health patterns. Nevertheless, the consistent pattern — a markedly higher risk in the first half‑year compared to later periods — observed in two independent meta‑analyses makes this period a worthwhile window for extra care. Men tend to have higher risk and are less likely to ask for help. Families with bereaved elders should follow Section 17 to sort out accounts, guardianship, and wills. For those who cannot find such a person — whether living alone, having no surviving children, or lacking any close relatives — they should turn to community resources and mobile tools as described in Section 6. +- Sources:Moon JR, et al. (2011). Widowhood and mortality: a meta-analysis. PLoS ONE. ；Shor E, et al. (2012). Widowhood and mortality: a meta-analysis and meta-regression. Demography. + +### 6. For those with no relatives or friends, replace “someone watching over you” with three simple things: a neighbor who can enter your home, a list of community outreach services, and emergency contacts saved on your phone. + +- Cost: No expense at all. The hard part is simply reaching out — telling a neighbor or a member of the Residents’ Committee, “I live alone and have just experienced a crisis.” +- In plain terms: When you have no family or friends, the phrase “finding someone to help” is essentially meaningless. In reality, it refers to two separate goals: first, ensuring that if something happens, someone will notice and intervene; second, making sure you take your medication and eat regularly on your own. To achieve the first goal, you need three things: leave a spare key with a neighbor, sign up for community outreach programs through the Civil Affairs Bureau, and set up reliable emergency contacts on your phone. +- Benefit: This study tracked 44,573 outpatients diagnosed with atherosclerosis or at high risk for blood clots — conditions where plaque buildup can easily lead to blockages. Enrolled between December 2003 and December 2004, these patients were followed for four years as part of the international REACH project. Of these, 8,594 individuals (19%) lived completely alone. Over the four-year period, the overall mortality rate among solitary residents was 14.1%, compared to 11.1% among those living with others. Cardiovascular-related deaths also proved higher: 8.6% versus 6.8%. Both figures showed statistically significant differences (log-rank P<0.01). The effect varied by age: for people aged 45–65, solitary living raised mortality from 5.7% to 7.7%; after adjusting for other factors, the hazard ratio was 1.24 (95% CI 1.01–1.51). Among those aged 66–80, the rate rose from 12.3% to 13.2%, with a hazard ratio of 1.12 (1.01–1.26). Conversely, for individuals over 80, solitary living actually lowered mortality from 28.4% to 24.6 (hazard ratio 0.92). In 2022, China’s Ministry of Civil Affairs issued guidelines mandating regular outreach services for vulnerable seniors — including those living alone, disabled, or without family support. These services involve home visits, phone check-ins, video calls, and remote monitoring, all coordinated through local neighborhood committees. By the end of 2025, the goal is to ensure that every at-risk senior receives at least one monthly visit. The policy also encourages households to install smart emergency call devices, water meters, and health monitors capable of alerting designated contacts instantly. Community workers are required to respond immediately to any emergency signals. It is important to note that the absolute risk increase for mortality in this group is 0.03, while the absolute risk reduction is 0.79, and the absolute risk difference is 1.06. Additionally, 79.2% of cardiac arrests occur at home, making it vital to have someone nearby. +- Evidence grade: B +- Notes: Here is exactly how to implement these three measures. First, give a spare key or temporary lock code to a trusted neighbor or property manager, and let them know you’ll be alone for a few days. No deep friendship is necessary — just ensure someone knows you’re inside. Second, visit your local Residents’ Committee and request inclusion on the outreach registry; elderly individuals living alone or without family are explicitly covered by this program, and you can also ask whether free smart alarms or water meters are available locally. Third, program emergency contacts and a medical ID card into your phone, and keep it on and unmuted during this period. This recommendation earned a B grade for two reasons. First, while the link between solitary living and higher mortality is well-documented, it remains possible that people in poorer health or with fewer resources are more likely to live alone — a reverse causation that the study itself acknowledges as needing further validation. Second, the outreach policy currently applies only to seniors; younger adults lack comparable support systems. However, the same directive does require community workers to identify individuals facing sudden hardships such as job loss or emotional distress (see Section 11 regarding the 12356 counseling hotline). Why does having someone nearby matter so much? As shown in Section 13, when cardiac arrest occurs outside a hospital, survival rates jump dramatically when bystanders perform CPR: 16.1% of victims survive when help is present, versus just 3.9% when no one is around. Living alone essentially places you in that lower survival bracket. Additionally, arranging these steps can double as a practical daily routine: funeral arrangements often require multiple visits to cemeteries, health clinics, police stations, and the Housing Provident Fund office (see Section 25), so scheduling these errands each day provides structure during a difficult time. Finally, remember that the 12356 helpline is available for repeated use, not just a single call (see Section 11). While living alone remains a long-term risk factor — with a hazard ratio of 1.32 for overall mortality, as discussed in Section 22 — this advice specifically targets immediate safety during a temporary crisis. +- Sources:Udell JA, et al. (2012). Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Archives of Internal Medicine. ；民政部等十部门 (2022). 关于开展特殊困难老年人探访关爱服务的指导意见（民发〔2022〕73 号）. + +### 7. After a parent dies, tell the child the truth, let him attend the funeral, and don’t send him to another environment + + +- Cost: There is no monetary cost. The difficulty lies in the fact that you yourself are grieving, yet you must still explain things clearly to your child. + +- In plain terms: Children who lose a father or mother before age 18 have a mortality rate in early adulthood that is roughly 50% higher than those who have not experienced such a loss. If the death was due to unnatural causes such as accidents or suicide, the risk rises by about 80%. If it was due to illness or other natural causes, the risk is about 30% higher. This is not something a child simply forgets after a few days; the effects can last many years. What you can do is tell the truth, let him attend the funeral, keep him in school, and avoid sending him to relatives’ homes to “change his environment.” + +- Benefit: This data includes the entire populations born in Denmark from 1968 to 2008 and in Sweden from 1973 to 2006, plus 89.3% of those born in Finland from 1987 to 2007 — a total of over 7.3 million people. Among them, 189,094 lost one or both parents before age 18. Their overall mortality rate is 50% higher than that of peers who have not experienced such a loss (mortality ratio 1.50, 95% CI 1.43–1.58, roughly 1.5 times higher). For deaths caused by unnatural reasons, the ratio is 1.84 (1.71–2.00), an increase of about 80%. For deaths due to natural causes, it is 1.33 (1.24–1.41), a rise of about 30%. The risk is highest when the child’s cause of death matches that of the parent. + +- Evidence grade: B + +- Notes: When speaking to your child, do not make up stories such as “Mom or Dad has gone away on a trip.” Any arrangements regarding guardianship and upbringing must be put in writing. This recommendation is graded B not because the figures lack solidity; these statistics come from longitudinal studies of entire populations in three countries, which would merit an A rating on their own. The lower grade reflects the absence of direct experimental evidence linking these mortality figures to specific ways of communicating with children or involving them in funerals. The authors also point out that data on parent-child relationships and children’s lifestyles after such a loss are lacking. Both genetic factors and long-term effects of bereavement contribute to these elevated mortality rates. Details on designated guardians and property arrangements can be found in Section 17, while information on child support and schooling is covered in Section 18. +- Sources:Li J, et al. (2014). Mortality after parental death in childhood: a nationwide cohort study from three Nordic countries. PLoS Medicine. + +### 8. Still stuck in grief after half a year, unable to move on — when to see a psychiatrist or clinical psychologist + + +- Cost: This includes registration fees and treatment costs. Treatment is delivered in sessions; on average, 16 sessions are given over 19 weeks in clinical trials. The main challenge is simply mustering the courage to make that first appointment. + +- In plain terms: Roughly 1 out of every 10 adults who lose a loved one gets stuck in prolonged grief: after more than six months they still miss the deceased so much they can’t eat, work, or care for their children. They feel numb and see no point in living. This isn’t a sign of personal weakness — it meets specific diagnostic criteria and has dedicated treatments. Targeted therapy achieves a success rate of 51%, while standard psychotherapy reaches only 28% and takes longer to show results. + +- Benefit: Fourteen studies involving adults whose loved ones died of non‑violent causes and who had not previously sought mental‑health care reveal that prolonged grief disorder affects 9.8% of this group (95% CI 6.8–14.0), meaning about 10 out of every 100 bereaved adults are impacted. The rate rises with age. Another study tested the diagnostic criteria on 291 bereaved individuals through interviews at 0–6, 6–12, and 12–24 months after loss. The core symptom is intense longing for the deceased; at least five of nine additional criteria must also be present. The first five criteria are emotional numbness, shock, feeling life lacks meaning, distrust of others, and distress caused by the loss. The remaining four are difficulty accepting the loss, trouble defining one’s own identity, avoidance of reality, and an inability to carry on daily life. All these symptoms must appear daily or be severe enough to impair functioning, and they must persist for at least six months after the death. A randomized trial of 95 participants receiving 16 therapy sessions over 19 weeks found a 51% success rate for specialized treatment versus 28% for standard interpersonal psychotherapy (P = 0.02, a statistically significant difference). Consequently, only 4.3 patients need to be treated for one additional person to experience improvement. + +- Evidence grade: A + +- Notes: Don’t fixate on exact time limits. The real indicator is whether grief interferes with eating, sleeping, work, or childcare — if so, it’s time to seek help. The appropriate clinics are psychiatry, psychology, or clinical psychology departments, all of which are available at public psychiatric hospitals. This condition is known as prolonged grief disorder or complex grief in various sources; required duration varies from six to twelve months across different guidelines. The 9.8% prevalence figure stems from 14 studies with differing methodologies, so authors caution that it may not apply universally to all populations. +- Sources:Lundorff M, et al. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders. ；Prigerson HG, et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine. ；Shear MK, et al. (2005). Treatment of complicated grief: a randomized controlled trial. JAMA. + +### 9. Don’t spend money on grief counseling right away — first check whether your grief is truly stuck (see the symptoms listed in item 8). + +- Cost: No cost at all; in fact, this approach saves you the expense of counseling. +- In plain terms: Offering psychological counseling to every bereaved person right after their loss yields little benefit at first, and over time those benefits disappear entirely. The reason is that most people without any intervention would have recovered on their own anyway. However, for those who clearly struggle to adapt, such counseling works just as well as treatment for other mental health issues. So the proper sequence is: first check whether your grief fits the criteria in item 8 (meaning it’s stuck and warrants a visit to a psychiatrist); only if it does should you spend the money on counseling. +- Benefit: Data from 61 comparative studies confirm this pattern. General psychological intervention for all bereaved individuals shows minimal benefits right after treatment, which fade further over time. When counseling is limited to those who clearly cannot adapt, its effectiveness matches that of treatment for other mental health conditions. Poor results from studies without prior screening stem from the fact that the control group would have recovered on its own over time. Another 14 randomized controlled trials also show consistent results: treatment for people already experiencing difficulties brings significantly better outcomes than controls both immediately after treatment and during follow-ups, with benefits growing over time. Preventive intervention for people without any issues, however, proves ineffective. One study tracked 205 individuals from before and after the loss of a spouse at 6 and 18 months, identifying five possible trajectories: normal grief, prolonged grief, chronic depression, improvement following the loss, and resilience. The most common path is resilience, while normal grief is relatively rare. +- Evidence grade: A +- Notes: This recommendation means “not everyone needs it” rather than “no one should get it.” Those in high-risk groups per item 4 (bereaved after suicide, accidents or violent deaths) and those meeting the criteria in item 8 (grief that has become stuck and warrants psychiatric evaluation) are precisely the individuals for whom such counseling is supported by evidence. This same conclusion appears in a review published in The Lancet. Grief itself is not a disease, and most people do not require professional intervention. Resources should instead be directed toward high-risk individuals and those already suffering from complicated grief, post-loss depression or post-traumatic stress disorder. +- Sources:Currier JM, et al. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review. Psychological Bulletin. ；Wittouck C, et al. (2011). The prevention and treatment of complicated grief: a meta-analysis. Clinical Psychology Review. ；Bonanno GA, et al. (2002). Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology. ；Stroebe M 等 (2007). Health outcomes of bereavement. Lancet. （备注里那份综述） + +### 10. Don’t drop yibao or turn to alcohol after separating or divorcing + +- Cost: Zero. Simply keep your yibao active and quit drinking. The hard part is resisting the urge to use alcohol as a crutch during this transition period. +- In plain terms: An analysis of 6.5 million people across 11 countries shows that separated or divorced individuals face a significantly higher risk of premature death than those still married. This effect is stronger among men and younger adults. The original text does not claim a direct causal link, as divorced people may already differ in health and income. Of the four proposed reasons, two are within personal control: maintaining yibao and regular health check‑ups, and avoiding reliance on tobacco and alcohol. +- Benefit: Data from 32 longitudinal studies involving over 6.5 million participants, 160,000 deaths, and more than 755,000 divorces across 11 countries confirm that separated or divorced adults have a markedly higher risk of early death compared with married peers. The increase is especially pronounced for men and younger individuals. Four possible mechanisms are discussed: selection bias (healthier or better‑off people may be less likely to divorce), loss of financial and insurance support, deterioration of health‑related habits such as smoking and drinking, and chronic psychological stress from ongoing tension. +- Evidence grade: A +- Notes: The source only notes a “significant rise” and provides group comparisons without specific risk‑ratio figures, so no exact numbers are reported here. Given that the evidence points to a clear direction but lacks a quantifiable threshold, the overall benefit is rated as moderate. Issues related to property, debts, and betrothal gifts at the time of divorce are covered in Sections 8 and 10; child‑custody arrangements are discussed in Section 18. +- Sources:Sbarra DA, et al. (2011). Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology. Perspectives on Psychological Science. + +### 11. Call 12356 for general support, 12355 for minors and teens; for medical care, book a psychology clinic appointment + +- Cost: No cost involved. Both hotlines are free to call. Psychology clinic visits are billed at standard outpatient rates. +- In plain terms: If you need someone to talk to, dial 12356 — this is the national mental health helpline, and it’s completely free. Minors and teenagers can call 12355, the dedicated youth support service. If you need professional medical care, you can book an appointment at a psychiatry, psychology, or clinical psychology clinic. Community grid workers and social workers are also expected to proactively identify people facing family issues, job loss, or school dropout. +- Benefit: A 2026 plan jointly issued by 25 government departments including the National Health Commission calls for improving operational rules for the 12356 mental health helpline. Goals include ensuring stable service delivery, raising call connection rates, developing a provincial-level digital platform for 12356, and strengthening coordination between 12356 and other emergency hotlines such as 110. The plan also aims to expand and optimize the 12355 youth support service, integrating it with 12356. By 2030, three key targets must be met: over 80% of administrative villages and urban communities must have mental health counseling rooms or social service centers offering relevant services; every county-level area must have at least one public psychiatric hospital or medical facility providing psychology clinic services; and all provinces must have their own provincial 12356 platforms. The mental health crisis response and support workforce includes psychiatrists, psychotherapists, counselors, social workers, and volunteers. The plan also specifies three groups who must stay alert to early warning signs of mental health risks: community grid workers, social workers, and volunteers. They are tasked with promptly identifying situations such as family crises, job loss, or school dropout. (Source: National policy document issued March 2026) +- Evidence grade: B +- Notes: This grade is assigned because the establishment of counseling rooms in villages and communities and psychology clinics at county level are only planned targets for 2030, not yet universally available nationwide. Both 12356 and 12355 are already operational. Details on the launch date and daily operating hours of 12356 can be found in Section 1, Article 25. It is also important to note that psychological counseling and psychotherapy are distinct services: only licensed psychiatrists can make diagnoses and prescribe medication, and psychotherapy must be delivered at qualified medical institutions. Private, hourly-fee “healing” or “spiritual counseling” services fall outside this official framework. +- Sources:国家卫生健康委等 25 部门 (2026). 关于印发健全社会心理服务体系和危机干预机制实施方案的通知（国卫医政发〔2026〕8 号）. + +### 12. In the first three months after a tragedy, postpone any irreversible major decisions + +- Cost: There is no monetary cost — you simply delay decisions, which may cause you to miss certain opportunities. It can be hard to accept at the time, since opportunities often seem to vanish quickly. +- In plain terms: During this period, your ability to judge what truly counts as an “opportunity” is at its weakest. People will approach you with offers — some claiming to let you contact the deceased, others promising to multiply your money, some urging you to quit your job and start anew elsewhere, and still others seeking a business partnership. Set a strict rule for yourself: any decision involving an amount greater than one month’s income, or any choice that would be costly to reverse, must be postponed for three months. First, discuss it with someone who has no personal stake in the matter; you simply need someone to listen so you won’t have to decide on the spot. +- Benefit: This rule helps you avoid making irreversible financial moves when you’re still reeling from a loss and your judgment is impaired. Such moves include selling your home, quitting your job, investing a lump sum of bereavement or compensation payouts, rushing into a new marriage, or acting as a guarantor for someone else. These decisions often involve sums ranging from tens of thousands of yuan up to the value of a house, which is why the benefit level is rated as moderate. Official documents also list “family tragedy, job loss, or dropping out of school” as risk factors for psychological distress that communities should monitor — meaning this period is already recognized as one where outside support is needed. +- Evidence grade: C +- Notes: If you have no such neutral third party nearby, call 12356 and explain your situation (see item 11 in this section on using this line to talk to someone). You can also write down your thoughts and reread them after three days. The “three‑month” timeframe is an author‑set guideline with no scholarly backing, which is why the evidence grade is C. Common scams targeting bereaved individuals and seniors are covered in sections 17 (investment and housing schemes) and 6 (fortune‑telling). Pitfalls related to guarantees and promissory notes are discussed in section 8. A few financial actions must be handled promptly and cannot be postponed: withdrawing your housing provident fund balance, claiming social insurance benefits, and receiving compensation for a work‑related death — details are provided in sections 25 and 19. +- Sources:作者经验，无直接文献；「家庭变故、失业、失学」作为心理危机风险的表述见国家卫生健康委等 25 部门 (2026). 健全社会心理服务体系和危机干预机制实施方案（国卫医政发〔2026〕8 号）. + +### 13. Don’t treat death as a way to settle debts: life insurance won’t pay out for suicides within two years, workplace injuries won’t be recognized, and debts are still deducted from your estate first. + + +- Cost: There’s no direct expense — you just need to run the numbers. + +- In plain terms: Life insurance policies that pay out upon death won’t cover suicides committed within two years of purchase. Only the cash value of the policy is returned. Workplace injuries are also not covered, so any benefits for death on the job are forfeited entirely. Debts don’t disappear with death; they’re deducted from your estate first, leaving your family with whatever remains. This creates a financial shortfall for them, plus the health consequences outlined in Section 4 (relatives of suicide victims face a 7–8 times higher risk of developing mental disorders within five years). The total amount of life insurance payouts typically reaches 100,000 yuan, which is why this benefit is classified as significant. + +- Benefit: Article 44 of the Insurance Law governs contracts where death is the condition for payout. Within two years of the contract’s effective date, if the insured commits suicide, the insurer is not obligated to pay the full benefit amount. However, the insurer must return the policy’s cash value — essentially the amount that can be refunded — rather than the full coverage sum. Life insurance payouts typically reach 100,000 yuan, which is why this benefit is classified as significant. Article 16, Paragraph 3 of the Work Injury Insurance Regulations states that self-harm or suicide does not qualify as a workplace injury, thereby disqualifying victims from receiving any of the three types of compensation outlined in Article 39: a funeral subsidy equal to six months of local average monthly wages, survivor’s allowances, and a one-time death benefit equal to 20 times the previous year’s national per capita disposable income for urban residents. Meanwhile, Article 1159 of the Civil Code mandates that estate distribution must first settle any legally required taxes and debts, meaning those obligations are deducted from the estate before any shares are allocated. Article 1161 further clarifies that heirs are only responsible for debts up to the actual value of the inherited assets; they aren’t personally liable beyond that, and those who decline inheritance bear no such obligations. + +- Evidence grade: A + +- Notes: This entry focuses solely on the financial implications. Other sections and Section 1 emphasize avoiding such scenarios altogether. Article 44 of the Insurance Law applies only to the first two years post-policy issuance; it is included here for completeness, not as a strict timeline. The health impacts on family members are detailed in Section 4. For coping strategies when suicidal thoughts arise, refer to Sections 1, Items 25 and 32; information on post-recovery complications can be found in Section 1, Item 33. The exact amounts for the three types of work injury benefits are specified in Section 19, Item 16. Procedures for accessing housing provident fund and social insurance payouts from an estate are outlined in Section 25, Item 9. +- Sources:全国人大常委会 (2015 修正). 中华人民共和国保险法第四十四条. ；国务院 (2010 修订). 工伤保险条例（国务院令第 586 号）第十六条、第三十九条. ；全国人大 (2020). 中华人民共和国民法典第一千一百五十九条、第一千一百六十一条. diff --git a/book/en/30-School-Age-Kids.md b/book/en/30-School-Age-Kids.md new file mode 100644 index 00000000..126aa2a2 --- /dev/null +++ b/book/en/30-School-Age-Kids.md @@ -0,0 +1,143 @@ +# 30. Children after starting school + +Section 20 covered the first year of a child’s life. Section 18 discussed how much money and time raising a child requires. The period from ages 3 to 18 was previously left blank in this book; this section fills that gap. The advice on screen time by age group starts at age 0, because official classifications are 0–3 years, 3–6 years, and elementary/middle school — grouping them differently would make the guidance harder to use. This section answers one core question: when “don’t delay learning” conflicts with “protect physical health,” which actions absolutely cannot wait? They cannot wait because each has a strict time window; missing it means permanent consequences. Whether academic pressure should be so intense is not discussed here — only the relevant time windows and figures are provided. + +The first eight items and the final two address death and lasting physical harm. Item 9 (avoiding products that claim to “cure myopia”) deals with costs. Items 10 (official rules on sleep, homework, and sports rankings) and 11 (keeping school enrollment after a leave of absence) concern time commitments. Information on drowning, traffic safety, helmets, and HPV vaccination can be found in Section 1. Guidance for infants and toddlers is in Section 20. Issues involving online scams and in‑app purchases are covered in Section 5, while red lines minors must not cross are detailed in Section 9. Recognizing emergencies and calling for help are explained in Section 13, and what happens to children after a parent’s death is addressed in Section 29 — none of these topics are repeated here. +### 1. Child reports sudden, worsening pain — rush to the hospital right away; don’t let him wait until after school. + +- Cost: No cost at all. Just take a half‑day off work and take your child to the emergency department. +- In plain terms: Some medical conditions are time‑critical — the outcome depends on how many hours pass from symptom onset. When a boy suddenly feels severe pain on one side of the scrotum, it may be testicular torsion: the blood vessels feeding the testicle become twisted, cutting off its blood supply. If treated within 6 hours, there’s a 97.2% chance of saving the testicle; after 19–24 hours that chance drops to only 42.5%. This kind of pain won’t wait until after school or until the end of an exam. +- Benefit: Researchers compiled data from 30 case series and 2,116 patients with testicular torsion. For 1,283 of those cases the outcome was tracked in 6‑hour intervals. From the start of pain: 97.2% of testicles were saved at 0–6 hours, 79.3% at 7–12 hours, 61.3% at 13–18 hours, 42.5% at 19–24 hours, 24.4% at 25–48 hours, and just 7.4% after 48 hours. Looking at broader windows, 90.4% of testicles remain intact if treatment occurs within 12 hours; 54.0% are still salvageable at 13–24 hours, and 18.1% after 24 hours. The authors conclude that the window for preserving a testicle can be longer than the commonly cited 6–8 hours. Therefore, even if pain has been present for a while, prompt medical care is still essential — don’t assume it’s “too late” to get help. +- Evidence grade: A +- Notes: Tell your son in advance: if he suddenly feels severe pain, he should speak up right away — no need to feel embarrassed. Testicular torsion is most common in adolescent boys; many hesitate to ask for help because they’re shy. Other conditions that also worsen hour by hour include acute appendicitis (which can perforate if delayed), diabetic ketoacidosis, and meningitis. For these, the exact time‑based impact on outcomes isn’t detailed in this section. Their common warning sign is sudden onset and steadily worsening pain unlike anything experienced before. How to recognize emergencies and call for transport are covered in Section 13. +- Sources:Mellick LB, et al. (2019). A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatric Emergency Care. + +### 2. Don’t delay necessary treatment just to “wait until exams are over”; certain treatment windows depend on bone growth, not exam schedules. + +- Cost: No monetary cost involved. This point concerns whether to start treatment early or late, not expense. Taking time off school and returning for follow‑ups do cost time, while the actual cost of treatment is separate. The real challenge is that braces must be worn at least 18 hours a day, which can be uncomfortable for kids. +- In plain terms: Scoliosis is a sideways curvature of the spine. A brace is a rigid shell worn on the back that helps keep the spine straight. When worn while bones are still growing, it greatly reduces the chance of needing surgery: 75% of patients wearing braces succeed, compared to only 42% who simply receive observation. This treatment window is tied to the timing of bone maturation, not to middle‑school or college entrance exams. Waiting until after exams often leaves surgery as the only option. +- Benefit: A multi‑center trial enrolled 242 adolescents with idiopathic scoliosis who met brace‑wearing criteria. Of these, 116 were randomly assigned to wear braces while 126 chose on their own whether to wear them. Success was defined as the curve remaining below 50 degrees by the end of growth; failure meant exceeding that threshold. Among those assigned to braces, 75% succeeded versus 42% in the observation group (OR 4.11, 95% CI 1.85–9.16). Combining both groups gave success rates of 72% vs. 48% (OR 1.93, 95% CI 1.08–3.46), meaning braces increase the odds of success by roughly 1.9 times. Success rates rose with longer daily wear time (P<0.001), a relationship unlikely to be coincidental. The trial was stopped early because braces proved effective. +- Evidence grade: A +- Notes: Scoliosis serves as a good example here because it has randomized trials, a clear treatment window, and is a common focus of student health screenings (see Section 7). Similar situations include strabismus, amblyopia, dental caries, and certain elective surgeries for congenital heart defects. In all these cases, later treatment yields poorer outcomes or higher costs. Discuss the exact timing with a specialist. Missing school is not a major issue: during compulsory education students may take up to one year of leave while retaining their enrollment status (see Section 11). +- Sources:Weinstein SL, et al. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. + +### 3. When a child is bullied, report it to school the same day and request a written response; for physical assault, theft, or rumor spreading, call the police immediately. + +- Cost: There is no cost involved. Speak to the homeroom teacher and the school’s anti-bullying committee. To call the police, dial 110. The hard part is resisting pressure to “keep things quiet” or avoid making a big deal out of it. +- In plain terms: Children who experience peer bullying are roughly 2.2 times more likely to have suicidal thoughts than those who are not bullied, and about 2.6 times more likely to attempt suicide. Schools must investigate any bullying report right away; if bullying is confirmed, disciplinary action must be taken against the offending students. In cases where bullying violates public order laws or may constitute a crime, schools cannot conceal the facts and must inform police. Therefore, reporting the incident the same day and demanding a formal written response is crucial — simply asking the teacher to “talk to him” is not enough. +- Benefit: This conclusion is based on 34 studies involving 284,375 children and teens. Peer bullying is linked to suicidal thoughts, with an OR of 2.23 (95% CI 2.10–2.37); in other words, the likelihood of such thoughts is roughly 2.2 times higher than among non-bullied youth. Nine additional studies with 70,102 participants show bullying correlates with suicide attempts, with an OR of 2.55 (1.95–3.34); this translates to about 2.6 times higher risk. These results hold true regardless of gender, age, or study quality. Cyberbullying carries an even stronger link to suicidal thoughts than physical bullying. Article 21 of the “Regulations on Protecting Minors in Schools” lists five types of bullying: physical violence (punching, kicking, slapping, biting, pushing, or pulling); verbal abuse, mockery, or derogatory nicknames; theft, vandalism, or deliberate destruction of property; deliberate exclusion or isolation; and online defamation or spreading false rumors. The article also states that if a stronger or older student intentionally commits such acts, causing physical harm, property damage, or emotional distress, it qualifies as bullying. Article 22 requires teachers to pay attention to any signs of emotional distress or physical injury and report them promptly. Article 23 mandates that schools investigate all reports, have the anti-bullying committee determine whether bullying occurred, and involve parents in the process. If bullying is confirmed, educational or disciplinary measures must be taken. Serious cases violating public order laws or criminal statutes must be reported to police and education authorities without delay (effective nationwide since September 1, 2021). +- Evidence grade: A +- Notes: If a child shows unexplained injuries, suddenly refuses to go to school, or repeatedly loses personal items, these signs should be taken seriously per Article 22. This analysis combines data from multiple studies and relies on observational records rather than controlled trials; thus it cannot definitively prove bullying alone causes suicide, but it clearly shows a significant increase in risk. Additionally, the “Comprehensive Plan for Addressing Bullying Among Primary and Secondary Students” stresses the need to distinguish bullying from ordinary horseplay among kids. In short, schools have a legal duty to conduct proper investigations and cannot dismiss incidents as mere “kids just playing around.” +- Sources:van Geel M, et al. (2014). Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: a meta-analysis. JAMA Pediatrics. ；教育部 (2021). 未成年人学校保护规定（教育部令第 50 号，第二十一、二十二、二十三条）. + +### 4. Ensuring that children spend at least 2 hours outdoors each day is currently the only myopia‑prevention method backed by randomized trials. + +- Cost: There is no monetary cost. However, it requires setting aside time each day — often at the expense of homework or online classes. The real challenge is maintaining this routine daily, not just occasionally. +- In plain terms: A randomized trial was conducted at 12 primary schools in Guangzhou: first‑grade students were given an extra 40 minutes of outdoor activity per school day. After three years, the myopia rate in these schools was 30.4 %, compared with 39.5 % in schools without the added classes — a reduction of 9.1 percentage points. The Health Commission recommends at least 2 hours of daytime outdoor time per day, or a total of 14 hours per week. Cloudy days and standing outside during recess also count. +- Benefit: In this trial, first‑grade students from 12 Guangzhou schools were randomly assigned to intervention or control groups (952 students in the intervention group, 951 in the control group; mean age 6.6 years). The intervention involved adding a 40‑minute outdoor class each day and encouraging parents to take their children outdoors after school. Over three years, the new myopia rate was 30.4 % in the intervention group (259 of 853 eligible participants) versus 39.5 % in the control group (287 of 726 eligible participants). The difference was –9.1 percentage points (95 % CI –14.1 to –4.1, P<0.001), indicating a true reduction ranging from roughly 4 to 14 percentage points. The average increase in refractive error was –1.42 D in the intervention group versus –1.59 D in the control group, a difference of 0.17 D (P=0.04); the intervention thus slowed progression slightly. D is the unit used to measure refractive error. No significant difference was observed in axial eye length between groups (P=0.07). The “Ten Core Principles for Myopia Prevention” also call for at least 2 hours of daytime outdoor activity per day or 14 hours per week; they note that even on cloudy days this activity provides protection and advise avoiding peak midday sun. +- Evidence grade: A +- Notes: The trial lasted only three years and involved children starting at age 6. A 9.1‑percentage‑point difference means it can help prevent myopia in some children, but it does not guarantee protection for everyone. The same guidelines also recommend maintaining a distance of “one foot, one fist, one inch” while reading or writing, taking a 20‑second break to look into the distance after 20 minutes of close‑up work, limiting non‑educational screen time to 15 minutes at a time (no more than one hour per day), and recognizing that simply standing outside during recess counts toward the daily outdoor requirement — it is not the same as attending a formal PE class. +- Sources:He M, et al. (2015). Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA. ；国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 5. No screen time for children aged 0–3; limit it as much as possible for ages 3–6; for school‑age kids, non‑educational screen use should not exceed one hour per day. + + +- Cost: There is no monetary cost. The real challenge is keeping screens out of children’s hands and encouraging parents to cut down on their own screen time in front of them. +- In plain terms: The Health Commission has set strict guidelines: no screens for children aged 0–3, and they should be kept away from screens as much as possible for ages 3–6. For school‑age students, non‑educational screen use must be limited to no more than 15 minutes at a time and no more than one hour per day. The reasoning is that prolonged close‑up screen exposure depletes a child’s “far‑sightedness reserve,” leading to earlier onset of myopia. Research linking screen time directly to myopia isn’t as conclusive; the strongest evidence comes from studies showing that two hours of outdoor activity per day helps prevent myopia. +- Benefit: Article 4 of the “Ten Core Principles for Preventing Myopia in Children and Adolescents” states: “Children aged 0–3 should not use smartphones, tablets, computers, or other screen‑based electronic devices; children aged 3–6 should avoid such devices as much as possible; for school‑age students, non‑educational screen use should be limited to no more than 15 minutes at a time and no more than one hour per day.” It also notes that “prolonged close‑up use of screen devices can deplete a child’s far‑sightedness reserve, a key factor in the early and frequent occurrence of myopia.” In 2018, eight government agencies, including the Ministry of Education, issued similar recommendations, adding that “the younger the child, the shorter the recommended continuous screen time.” Scientific research is far less definitive: a systematic review examined 33 studies involving participants from 3 months to 33 years of age; only 11 contributed to the pooled analysis. When only smartphones and tablets were considered, the odds ratio for myopia was 1.26 (95 % CI 1.00–1.60, I² = 77 %). Including computers raised that figure to 1.77 (1.28–2.45, I² = 87 %). The authors concluded only that there may be a link, noting that none of the 33 studies measured screen time reliably. +- Evidence grade: B +- Notes: This recommendation earned a B rating because it is based on official policy directives rather than experimental data. The lower bound of the pooled odds ratio sits right at 1.00, and the authors only describe the relationship as “possible,” so it should be viewed as a practical family guideline rather than a guarantee that avoiding screens eliminates myopia risk. The strongest evidence for prevention comes from Recommendation 4 (two hours of outdoor activity daily). Regular eye examinations are also advised for preschoolers: the same document recommends periodic refraction screening for ages 1–3, 4–6, and older to assess remaining far‑sightedness reserve; details are provided in Recommendation 12 (pupil dilation refraction). Finally, a meta‑analysis of 42 studies involving 18,905 participants found that longer screen time correlates with weaker language development (r = −0.14, 95 % CI −0.18 to −0.10). However, watching educational content on screen shows a positive correlation (r = 0.16 and 0.13). This is a correlation, not causation; it simply underscores that substituting screen time for direct interaction with caregivers is less beneficial for language growth. +- Sources:国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. ; 教育部等八部门 (2018). 综合防控儿童青少年近视实施方案（教体艺〔2018〕3 号）. ; Foreman J, Salim AT, Praveen A, et al. (2021). Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806-e818. ; Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA (2020). Associations between screen use and child language skills: a systematic review and meta-analysis. JAMA Pediatrics, 174(7), 665-675. + +### 6. Treating myopia as a lasting injury: the higher the prescription, the greater the future risk of retinal detachment, macular degeneration, and glaucoma + +- Cost: No cost involved. There is nothing specific to do here; the necessary actions are outlined in items 4 and 5 (spending two hours outdoors and managing screen time based on age). +- In plain terms: Myopia does not go away on its own, nor does the prescription level decrease. It is far more than simply “wearing glasses.” Compared to people without myopia, those with mild myopia face a risk of myopic macular degeneration roughly 10–15 times higher; for individuals with a prescription of 600 degrees or more, this risk rises by several hundred times. The likelihood of retinal detachment is about three times higher for mild myopia and roughly 13 times higher for severe myopia. Therefore, the earlier a child develops myopia and the faster it progresses, the greater the long-term risks they must face. +- Benefit: A systematic review and meta-analysis compiled studies published up to June 2019, grouping participants into three prescription categories: mild (−0.5 to −3.00 D), moderate (−3.00 to −6.00 D), and high (≤−6.00 D, i.e., 600 degrees or more). Compared to people without myopia, the odds ratios for myopic macular degeneration were 13.57 (95% CI 6.18–29.79) for mild myopia, 72.74 (33.18–159.48) for moderate myopia, and 845.08 (230.05–3104.34) for high myopia. For retinal detachment, these odds ratios were 3.15 (1.92–5.17), 8.74 (7.28–10.50), and 12.62 (6.65–23.94) respectively. The odds ratios for posterior subcapsular cataract were 1.56 (1.32–1.84), 2.55 (1.98–3.28), and 4.55 (2.66–7.75) respectively. For open-angle glaucoma, the odds ratio for mild myopia was 1.59 (1.33–1.91), while for moderate and high myopia combined it was 2.92 (1.89–4.52). Among individuals over 60, the odds ratios for visual impairment were 1.71 (1.07–2.74), 5.54 (3.12–9.85), and 87.63 (34.50–222.58) respectively. This aligns with the “Ten Core Principles for Preventing and Controlling Myopia in Children and Adolescents,” which defines high myopia as a prescription of 600 degrees or more; such individuals face significantly higher rates of cataracts, open-angle glaucoma, myopic macular degeneration, retinal detachment, and other vision-threatening conditions. Importantly, “myopia can be prevented and controlled, but not reversed.” +- Evidence grade: A +- Notes: All studies included in this analysis were observational studies, and the reported odds ratios are unusually large. For instance, the confidence interval for high myopia and myopic macular degeneration spans from 230 to 3104, indicating considerable variation among individual studies; thus these figures should be viewed as rough estimates rather than precise values. Most of these complications tend to appear only in middle or old age, so this is not a situation where immediate harm occurs; rather, it represents a long-term risk that accumulates over decades. Myopia itself is not a disability, and the vast majority of people achieve normal vision after wearing corrective lenses. The purpose of this item is to shift the common perception that “once you have myopia, glasses are all you need” to recognizing that it is worthwhile to delay and control its progression. Information on follow-up examinations after diagnosis can be found in item 12 (pupil dilation and refraction testing). Be wary of products claiming to cure myopia; refer to item 9 (myopia cannot be cured) for further details. +- Sources:Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW (2020). The complications of myopia: a review and meta-analysis. Investigative Ophthalmology & Visual Science, 61(4), 49. ; 国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 7. Take a close look at your child’s annual school health report and follow up on any abnormalities right away. + +- Cost: No cost at all. Under China’s Compulsory Education Law, all school health check fees are covered by school operating budgets, so parents pay nothing extra. +- In plain terms: Every year, primary and middle schools conduct one health check for every student. The official guidelines list being overweight, obese, malnourished, having spinal curvature issues, poor eyesight, and dental cavities as key areas that need special attention. These problems are precisely the ones parents tend to put off dealing with. Don’t just glance at your child’s height and weight measurements and then file the report away. If any of these issues show up on the report, take your child to a specialist for a proper check-up that same year — don’t wait until the next annual check. +- Benefit: The 2021 Administrative Measures for Health Checks of Primary and Middle School Students requires all such schools to run one health check per year for every enrolled student. The physical exam covers the head, neck, chest, spine, limbs, skin, and lymph nodes, while the eye exam checks external eye condition, distance vision, and refractive errors (degree of myopia or hyperopia). The individual report issued to each student must include all test results, an overall assessment, and tailored health guidance. Overweight, obesity, malnutrition, spinal curvature issues, poor eyesight, and dental cavities are all designated as priority areas for follow-up. Local education authorities are also required to keep records of students with health problems and conduct regular follow-ups. All costs for these compulsory education health checks are paid by school budgets, with no extra charges for parents (issued nationwide in September 2021). +- Evidence grade: B +- Notes: This grade is assigned because the document is a set of administrative rules for schools, not a study on the actual effectiveness of these checks. It guarantees that schools will run annual checks covering the listed items and follow up on any abnormalities, but does not confirm that all identified issues will receive timely intervention. These health checks are only a preliminary screening tool, not a formal diagnosis. For poor eyesight, a pupil dilation refraction test at an ophthalmology clinic is required (see Item 12). For spinal curvature issues, a visit to an orthopedics or spinal surgery specialist is necessary (see Item 2 — do not delay treatment to wait until after exams). Parents are responsible for arranging these follow-up appointments for their children. +- Sources:国家卫生健康委、教育部 (2021). 中小学生健康体检管理办法（2021 年版）（国卫医发〔2021〕29 号）. + +### 8. Conducting a depression screening for kids aged 12 to 18 — don’t rely on school mental health assessments as a diagnosis + + +- Cost: Costs range from zero to just a few dozen yuan; this covers filling out a screening questionnaire at a community clinic or hospital outpatient department. Calling the 12355 and 12356 hotlines is completely free. + +- In plain terms: The U.S. Preventive Services Task Force recommends screening adolescents aged 12 to 18 for major depressive disorder, noting that the overall benefits are moderate and justify the effort. There is insufficient evidence to support screening for kids under 11. Suicide is the second leading cause of death among people aged 10 to 19. School mental health assessments conducted each academic year are population-wide screenings, not diagnostic tools. If a child reports feeling distressed, or shows sudden changes in eating, sleeping, interests, or academic performance, they should be referred to a psychiatrist or clinical psychologist right away. + +- Benefit: In 2022, the U.S. Preventive Services Task Force issued a recommendation statement advising that adolescents aged 12 to 18 be screened for major depressive disorder; this recommendation falls under Category B, meaning the evidence supporting it is moderate and the benefits are also moderate, making it worthwhile. For children under 11, there is insufficient evidence to support depression screening (an I statement, which indicates a lack of evidence and no formal recommendation). Likewise, evidence regarding both the benefits and risks of screening children and adolescents specifically for suicide risk is also limited (another I statement). The document emphasizes that suicide is the second leading cause of death among 10- to 19-year-olds, and that major depression in youth is closely linked to numerous later issues, including recurrent depressive episodes and other mental disorders, as well as a heightened risk of suicidal thoughts, suicide attempts, and death. China’s “Ten Measures to Further Improve Mental Health Care for Primary and Secondary School Students” calls for establishing a three-tier support system: homeroom teachers, full- and part-time school counselors, and psychiatrists. Each student should undergo a mental health assessment no more than once per academic year. The measures also stress the need to improve referral pathways to mental health specialists and reintegration processes after recovery. Additionally, they highlight the importance of leveraging the 12355 Youth Service Hotline and the 12356 Psychological Assistance Hotline (issued nationwide in October 2025). + +- Evidence grade: B + +- Notes: This B rating reflects the original recommendation strength grading used by the task force, rather than a quantifiable measure of actual effectiveness. It represents a U.S.-based recommendation; no equivalent official screening guidelines currently exist in China. A positive screening result merely indicates the need for a follow-up evaluation — it does not constitute a formal diagnosis. Guidance on handling suicidal thoughts can be found in Section 1, Item 25, while family coping strategies are outlined in Section 29. +- Sources:US Preventive Services Task Force (2022). Screening for Depression and Suicide Risk in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 9. Do not buy products or services claiming to “cure myopia” or “reduce refractive error” + + +- Cost: There is no cost involved; in fact, you save this money by avoiding such purchases. +- In plain terms: The State Administration for Market Regulation explicitly states that “under current medical technology, myopia cannot be cured.” Phrases such as “recovery,” “restoration,” “reducing refractive error,” “curing myopia,” “myopia remedy,” and “repairing refractive error” are classified as illegal marketing claims subject to strict enforcement. If you encounter any of these terms, you can safely rule out those products without further comparison. Devices such as eye-care instruments are considered medical devices, and e-commerce platforms must verify whether sellers are qualified to sell them. +- Benefit: A notice issued by the General Office of the State Administration for Market Regulation between November 2021 and March 2022 clearly reiterates that “under current medical technology, myopia cannot be cured.” It mandates strict legal action against any marketing of products aimed at preventing or controlling myopia in children and adolescents that employ misleading language like “recovery,” “restoration,” “reducing refractive error,” “curing myopia,” “myopia remedy,” or “repairing refractive error.” The notice also calls for intensified efforts to combat practices that misuse traditional Chinese medicine terminology or theories for deceptive advertising, as well as two specific types of false advertising: using patient testimonials or images to compare pre- and post-treatment outcomes, and making guaranteed claims regarding treatment safety or effectiveness. Additionally, e-commerce platforms are required to rigorously verify the qualifications of sellers offering medical devices such as eye-care instruments and other specialized products (nationwide). +- Evidence grade: B +- Notes: This grade is assigned because the basis comes from regulatory determinations during enforcement actions rather than from controlled comparative trials of actual products. However, both health authorities and regulators agree on the statement “Myopia can be prevented and controlled, but it cannot be reversed.” The only two evidence-backed recommendations appear in items 4 (outdoor activities) and 12 (proper eye examinations, glasses fitting, and follow-ups). Information on blue-light-blocking glasses can be found in Section 6. +- Sources:市场监管总局办公厅 (2021). 关于开展儿童青少年近视防控产品违法违规商业营销宣传专项整治行动的通知. + +### 10. Clear rules exist for sleep, homework, sports, and rankings; if schools fail to comply, parents can raise the issue + +- Cost: No cost involved. All you need is to know these rules so you can bring them up with the school or local education authorities when necessary. The real challenge is simply speaking up about it. +- In plain terms: These rules are all laid out in writing: elementary students must get 10 hours of sleep per day, junior high students 9 hours, and high school students 8 hours. Elementary classes generally start no earlier than 8:20 a.m., and junior high classes no earlier than 8:00 a.m. In 2025, an additional requirement was added that schools must provide at least 2 hours of combined physical activity per day, and students must not be ranked based on test scores. If your child consistently fails to get enough sleep, use these rules as a reference point rather than blaming the child for being slow to get ready. +- Benefit: The *Notice on Further Strengthening Sleep Management for Primary and Secondary School Students* stipulates that elementary students must get 10 hours of sleep daily, junior high students 9 hours, and high school students 8 hours. Elementary classes generally start no earlier than 8:20 a.m., and junior high classes no earlier than 8:00 a.m. Schools are prohibited from requiring students to arrive at school early for mandatory educational activities. Elementary students must go to bed no later than 9:20 p.m., junior high students no later than 10:00 p.m., and high school students no later than 11:00 p.m. After-school tutoring programs must end no later than 8:30 p.m., and online live tutoring sessions must end no later than 9:00 p.m. From 10:00 p.m. to 8:00 a.m. the next day, game services for minors are banned nationwide (issued March 2021). The *Ten Measures for Further Strengthening Mental Health Work Among Primary and Secondary School Students* contains several additional provisions. All schools are required to ensure students get at least 2 hours of combined physical activity per day, and the practice of offering 15-minute recess periods is encouraged. Students must not be ranked based on test scores, and repetitive, punitive homework assignments are strictly prohibited. A nationwide initiative launched in October 2025 encourages schools to designate one day per week as a “homework-free day.” +- Evidence grade: B +- Notes: Both documents were issued by relevant education authorities. Implementation varies widely across different regions and schools, which is why this item is rated B. Their main purpose is to help parents understand what schools are obligated to provide, so they have solid grounds to bring these issues up when needed. Information on adult sleep needs can be found in Sections 2 and 3. +- Sources:教育部办公厅 (2021). 关于进一步加强中小学生睡眠管理工作的通知（教基厅函〔2021〕11 号）. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 11. Parents can request a temporary leave of absence for their child; the school must retain the child’s enrollment status for up to one year. + + +- Cost: No cost involved. Parents or other legal guardians must submit a formal request to the school. The main challenge is first accepting that the child needs a break from school for a while. + +- In plain terms: A temporary leave of absence is a fully established procedure. Parents or legal guardians submit a request, which the school then approves and forwards to the relevant education authorities for final authorization. Each request is valid for no more than one year; if the child still needs time off after that, a new request must be filed. During this period, the school is legally required to keep the child’s enrollment status intact. Therefore, the idea that taking a leave of absence “ruins” a child’s education has no basis in current policy. Exact implementation details vary by province; parents should contact the school’s academic affairs office or local education bureau for specifics. + +- Benefit: Article 16 of the “Administrative Measures for Student Enrollment Records of Primary and Secondary School Students” outlines the proper process for granting a temporary leave of absence. Parents or legal guardians initiate the request, which the school then forwards to higher education authorities for approval. Upon the child’s return, the school must promptly handle all necessary re-enrollment paperwork. Each approved leave cannot exceed one year; if further time off is required, a new application must be submitted. While the child is away, the school must maintain their enrollment status, effectively preserving their place in the system. Detailed procedures for leave and re-enrollment are determined by provincial education authorities (nationwide, issued January 2025). Additionally, the “Ten Measures for Strengthening Mental Health Support for Primary and Secondary School Students” encourages establishing clear pathways for students recovering from mental health conditions to return to school, while also mandating that schools develop emergency response plans for psychological crises on campus. + +- Evidence grade: B + +- Notes: Before applying, be sure to clarify three key points: what kind of medical documentation is required, how the child’s enrollment status is tracked while on leave, and whether they’ll return to their original grade level or be placed in a lower one. This recommendation is graded B because while a national framework exists, specific eligibility criteria, required paperwork, and re-enrollment protocols are all determined locally by provincial education authorities. Furthermore, the “Regulations on Protecting Schooling Rights for Minors” requires all compulsory education schools to maintain records of students who drop out, take extended leaves, or are absent for prolonged periods; this means the procedure is already standard practice within the system, rather than an exception granted solely to your child. +- Sources:教育部 (2025). 中小学生学籍管理办法（教基〔2025〕1 号，第十六条）. ；教育部办公厅 (2025). 进一步加强中小学生心理健康工作十条措施（教基厅〔2025〕2 号）. + +### 12. If poor vision is detected, go to the hospital for cycloplegic refraction and follow up at the recommended intervals as advised by the doctor. + + +- Cost: The examination and glasses fitting typically cost several tens to several hundred yuan. After using the eye drops, children may be sensitive to light and have blurry near vision; it usually takes half a day to a couple of days for this to subside. + +- In plain terms: Cycloplegic refraction involves using special eye drops that relax the eye’s focusing muscles, allowing an accurate measurement of refractive errors. This test is performed in hospitals and is the most reliable method for diagnosing myopia. The Health Commission confirms these drops do not harm healthy eyes and that vision returns to normal after they wear off. Do not rely on quick computerized refraction tests at optical shops for diagnosis, and do not withhold glasses from children out of fear that it will worsen their myopia. + +- Benefit: The “Ten Core Principles for Preventing and Controlling Myopia in Children and Adolescents” outlines how cycloplegic refraction works: it uses a cycloplegic agent to relax the focusing muscles before measuring refractive errors. This medical procedure is regarded as the gold standard for diagnosing myopia, providing the most accurate results. The drops themselves are safe for healthy eyes; side effects such as light sensitivity and blurred near vision are temporary and resolve after treatment ends. Once myopia is confirmed, timely corrective measures—such as wearing appropriate glasses—are essential. Proper glasses can correct vision and slow progression of the condition. Children aged preschool through elementary school should have their vision rechecked every 3–6 months, while middle and high school students should be checked every 6–12 months, depending on individual needs. Regular refractive screenings are also recommended at ages 1–3, 4–6, and thereafter to monitorhyperopia reserve (远视储备量, "farsightedness reserve") (the amount of reserve focusing ability). (National guidelines issued July 2023) + +- Evidence grade: B + +- Notes: This grade is assigned because the information originates from official public health publications rather than original research containing specific quantitative data. Because high myopia increases the risk of complications such as retinal detachment, follow-up visits serve purposes beyond simply updating prescriptions. “Poor vision” noted during school screenings is merely an initial indicator; a full ophthalmologic evaluation at a hospital is still required, as detailed in item 7. +- Sources:国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. + +### 13. Pit and fissure sealants applied after permanent molars emerge + + +- Cost: Each application costs just a few dozen to 100–200 yuan. No anesthesia is needed, no drilling of the tooth, and the whole procedure takes only a few minutes. In many regions, eligible children can receive this service for free. + +- In plain terms: Pit and fissure sealants essentially coat the grooves on the chewing surface of molars with a thin layer of resin, sealing them so food particles can’t get trapped. After 24 months, the likelihood of cavities drops dramatically compared to untreated teeth. For instance, if 16% of untreated children develop cavities on their molars, only about 5.2% of children with sealants do; when the untreated rate is 40%, the sealed group stays at roughly 6.25%. Overall, sealants cut cavity rates by 11% to 51% after two years, and this protective effect persists for up to four years. + +- Benefit: This conclusion comes from 38 separate trials involving 7,924 children aged 5 to 16, all vetted and pooled by Cochrane reviewers. The studies compared resin-based sealants with no treatment at all. For first permanent molars in kids aged 5 to 10, the odds ratio of developing cavities after 24 months was 0.12 (95% CI 0.08–0.19), meaning sealants reduce cavity risk to roughly one-eighth of the untreated level. This result is based on seven trials with 1,548 participants randomly assigned to groups; 1,322 of them completed follow-up assessments, yielding moderate-quality evidence. If 16% of untreated children develop cavities within two years, the sealed group’s rate drops to 5.2% (95% CI 3.13%–7.37%); at a 40% untreated baseline, sealants keep the rate at 6.25% (3.84%–9.63%); and when untreated rates reach 70%, sealants still limit cavities to 19% (12.3%–27.2%). After 48 to 54 months, the odds ratio remains low at 0.21 (0.16–0.28), indicating a fivefold reduction in risk. No adverse events were reported across four trials that monitored side effects; however, there isn’t enough evidence to determine whether resin sealants outperform other types such as glass ionomer. + +- Evidence grade: A + +- Notes: The first permanent molars—the large teeth that never get replaced—typically appear around age 6, with the second set emerging near age 12. Sealants should be applied as soon as these molars emerge and before any decay sets in; once cavities are already present, restoration is the only option. Many regions now offer free pit and fissure sealant programs for eligible children, so it’s worth checking with the local Chinese CDC or community health centers. Because no nationwide guidelines explicitly detail eligibility criteria or age ranges, this section does not list them. Preventing dental caries remains a key focus of school health screenings, as discussed in Section 7. +- Sources:Ahovuo-Saloranta A, et al. (2017). Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews. diff --git a/book/en/31-Paths-After-Eighteen.md b/book/en/31-Paths-After-Eighteen.md new file mode 100644 index 00000000..a2334caa --- /dev/null +++ b/book/en/31-Paths-After-Eighteen.md @@ -0,0 +1,197 @@ +# 31. What options are available after turning 18? + +This section deals with money and time, while the option of avoiding military service also affects personal freedom. It serves as a roadmap of possible paths, not a step‑by‑step guide for any single one. First, we list the legal requirements for each path. Then we describe the details that become relevant only after you decide to pursue them: what benefits military service provides, other ways to enter the civil service besides the civil service exam, which college majors directly lead to government positions, how to later upgrade your education, what kind of employers to seek for overseas work, how to handle social insurance without a formal job, and whether there are government loans that cover part of the interest for those lacking startup capital. + +Let us be clear: after turning 18 there are many more options than those covered here. We only include paths for which nationwide official documents specify eligibility criteria, requirements, and benefits. Paths such as joining state‑owned enterprises, working in factories, becoming a seafarer, pursuing freelance work, or continuing high school or university lack such uniform documentation. They are certainly possible, but without verifiable legal references we cannot describe their conditions in this book. + +Choosing a path is entirely up to you. This section provides two things only: the official documents that set the eligibility rules, and the deadlines and qualifications that expire once you start down a particular route. How to weigh the decision between studying and working, and how to pick relevant skills, is explained in Section 23. Overtime pay, workplace injuries, and severance after joining a job are covered in Section 19. Starting or closing a business is discussed in Section 12. Studying abroad is the topic of Section 32, while safety nets for the unemployed are outlined in Section 7. None of those topics are repeated here. +### 1. First, check the eligibility criteria: the age and education requirements for all twelve pathways are clearly stated in official documents. + +- Cost: No cost at all. It only takes ten minutes to review whether you meet the criteria. +- In plain terms: The age and education requirements for all twelve pathways are explicitly listed in official documents. You must be at least 16 years old to work. For military service, men must be 18 years old; university graduates may be eligible up to age 24. To become a civil servant, you must be between 18 and 35 years old with at least an associate degree. The self-study exam and self-employment pathways have no age or education restrictions. +- Benefit: Military service rules state: “All male citizens who reach 18 years of age must be drafted into active service; those not drafted that year may still be drafted up to age 22. University graduates may be eligible up to age 24, and postgraduate students up to age 26.” Civil service requirements are outlined in Article 18 of the Civil Servant Recruitment Regulations, which specify ages between 18 and 35 and at least an associate degree; these limits may be adjusted with approval from provincial-level authorities. Article 19 lists disqualifying factors such as criminal convictions, dismissal from public office, or inclusion in credit blacklists. Firefighter recruitment follows similar age and education criteria. Civilian roles in the military require a minimum age of 18, with upper limits of 35 for entry-level positions. Public institution hiring must be conducted openly, while self-employment is open to any capable adult. Self-study exams are accessible to all citizens regardless of background, though full-time students are excluded. Government-funded teacher and medical training programs are offered at select universities, with tuition and living expenses covered; these commitments must be honored as outlined in their respective regulations. Overseas employment requires companies to hold proper government authorization; otherwise such arrangements are illegal. +- Evidence grade: A +- Notes: This entry focuses solely on eligibility criteria, not on which pathway offers better overall benefits. Meeting these criteria is only the first step; additional requirements include political background checks, physical fitness tests, and other evaluations with no publicly available scoring metrics. Details on vocational education options and financial aid are provided in later sections. Starting a business requires capital, personal guarantees, and carries financial risks. Student loans with government-backed interest subsidies may be available. Commitments made during college admissions for teacher and medical training programs have specific obligations. Legal compliance for overseas employment depends on employer qualifications. +- Sources:全国人大常委会 (2021). 兵役法（第二十条）. （国防部刊登）；中共中央组织部 (2019). 公务员录用规定（第十八、十九条）. （共产党员网刊登）；人力资源社会保障部、应急管理部 (2021). 国家综合性消防救援队伍消防员招录办法（人社部发〔2021〕58 号，第五、六条）. ；国务院、中央军委 (2022). 中国人民解放军文职人员条例（第二次修订，令第 757 号，第九、十九条）. （国家法律法规数据库）；国务院 (2014). 事业单位人事管理条例（国务院令第 652 号，第八条）. ；国务院 (2022). 促进个体工商户发展条例（国务院令第 755 号，第二条）. ；国务院 (1988, 2014 修订). 高等教育自学考试暂行条例（第三、二十条）. （国家法律法规数据库）；全国人大常委会 (2018). 义务教育法（第十四条）. （教育部刊登）；国务院办公厅 (2024). 关于转发教育部等部门《教育部直属师范大学本研衔接师范生公费教育实施办法》的通知（国办发〔2024〕27 号，第二、五条）. ；国家卫生健康委等 7 部门 (2019). 关于做好农村订单定向免费培养医学生就业安置和履约管理工作的通知. ；国务院 (2012). 对外劳务合作管理条例（国务院令第 620 号，第五、七、八条）. + +### 2. Men who turn 18 must complete military service registration by October 31; mandatory active duty lasts two years. + + +- Cost: There is no cost. The online registration takes just a few minutes. However, actual enlistment means two full years of service, during which you cannot hold any other job. + +- In plain terms: Military service registration is a legal obligation, not an application to join the army. Completing it does not mean you must enlist. All men who turn 18 must register online by October 31. Failure to do so can result in a government order to register within a set period; if ignored, you may be forced into service and fined. Once enlisted, you serve as a conscript for exactly two years. + +- Benefit: The rules governing military service registration state: “By October 31 each year, local civil affairs bureaus must organize initial registration for all male citizens who will turn 18 by December 31.” They also specify that registration is primarily done online, at the citizen’s own initiative. Consequences of non‑compliance are outlined in Article 57, Paragraph 1 of the Military Service Law, which addresses “refusal or evasion of registration.” Penalties include a deadline set by the county government for compliance, followed by forced enlistment and a fine if still ignored. The same law also states that “the term of active duty for conscripts is two years.” It further notes that men aged 17–18 may enlist voluntarily if the army needs them. Non‑commissioned officers who serve 12 years or meet other criteria are offered civilian jobs by local governments upon discharge; those serving 30 years or reaching age 55 may retire. The Recruitment Regulations emphasize giving priority to university graduates and candidates with specific physical or professional qualifications; full‑time students and recent graduates may enlist either at their hometown or campus location. + +- Evidence grade: A + +- Notes: Registration and actual enlistment are separate processes with vastly different obligations. The restriction on leaving the country for two years applies only to those who enlist and later attempt to withdraw, as detailed in item 3 (refusal to serve). Women are not required to register initially, though they may be recruited if needed. Requirements for soldiers seeking officer training or promotion are defined in internal military regulations and are not disclosed here. The Military Service Law merely states that officers are drawn from “outstanding active‑duty soldiers” and that military academies may admit students regardless of age limits; exact admission scores and quotas are not provided in this guide. +- Sources:国务院办公厅、中央军委办公厅 (2025). 兵役登记工作规定（国办发〔2025〕41 号）. ；全国人大常委会 (2021). 兵役法（2021 年修订，第二十、二十五、二十六、五十四、五十七条）. （国防部刊登）；国务院、中央军委 (2023). 征兵工作条例（国务院、中央军委令第 759 号，第五条）. + +### 3. Refusing military service after enlistment: no travel abroad, no further education, and barred from civil service and state-owned enterprises for two years + + +- Cost: There is no monetary cost. The price is having to decide well in advance whether you want to serve or not. +- In plain terms: Choosing to enlist and then backing out carries serious consequences. You cannot be hired by any civil service office, nor by any state-owned enterprise or public institution. For two full years, you are prohibited from leaving the country, enrolling in any school, or returning to your studies. Your name will also be added to a list of individuals who have seriously failed to fulfill their national defense obligations, triggering coordinated penalties from multiple authorities. Therefore, the idea of “signing up first and then pulling out if needed” ends up being very costly. +- Benefit: Article 57, Paragraph 1, Item 2 of the Military Service Law explicitly states that “any conscript who refuses or evades enlistment shall be subject to penalties.” These penalties include a requirement to correct the behavior within a set timeframe; if they still refuse, the local county-level government may compel them to serve and impose a fine. Paragraph 2 adds that such individuals must also be barred from civil service roles, from employment in state-owned enterprises and public institutions, and from any travel abroad or further education for two years. They are placed on a special list of those who have failed to meet defense obligations, leading to joint enforcement actions by various agencies. Article 58 extends these same penalties to active-duty personnel who deliberately evade service or desert. Those who are discharged, expelled from the military, or face criminal prosecution are subject to the same restrictions outlined in Paragraph 2 of Article 57, including a nationwide fine effective as of October 1, 2021. +- Evidence grade: A +- Notes: This rule concerns personal freedom and employment eligibility rather than financial penalties. Only two categories of people are subject to these measures: those who refuse or evade enlistment after being called up, and those who are discharged, expelled, or criminally prosecuted after already joining the armed forces. Individuals who simply fail to register for conscription are not included; registration details are covered in Item 2. The penalties apply only when the person refuses to comply after being instructed to do so, as determined by the local county-level government. The exact amount of any fine is set locally and is not specified in this guide. This information is provided solely to illustrate the irreversible nature of the decision once enlistment is initiated; it does not serve as encouragement or discouragement regarding military service. +- Sources:全国人大常委会 (2021). 兵役法（2021 年修订，第五十七、五十八条）. （国防部刊登） + +### 4. Two main perks for college students joining the military: up to 20,000 RMB per year for tuition, and two years of academic status protection plus a special postgraduate admission track + + +- Cost: No out-of-pocket expense. After discharge, you simply submit the required paperwork to your school — usually just one or two visits. + +- In plain terms: Undergraduates, recent graduates, and incoming freshmen who enlist receive full tuition coverage from the state during their service. The maximum annual amount is 20,000 RMB for undergrads and 25,000 RMB for graduate students; over two years this can reach 40,000 or 50,000 RMB. Your student status remains intact, allowing you to enroll or return to school within two years of discharge. Additionally, there is a dedicated postgraduate admission pathway reserved solely for discharged college veterans. + +- Benefit: In 2024, four government agencies — including the Ministry of Finance — issued a notice outlining three key benefits for eligible students: tuition compensation, repayment of any federal student loans used for tuition, and tuition waivers. Repayment essentially means the state settles those loans on your behalf. The new limits apply from the autumn 2024 semester: undergrads may receive up to 20,000 RMB per year, while graduate students may receive up to 25,000 RMB per year. The actual amount awarded equals whichever is higher — your actual tuition paid or the total loan principal plus accrued interest. Any sum exceeding these caps is not covered. Regarding academic status, the Law on Veterans’ Affairs stipulates that active-duty personnel who were already enrolled in a university retain their admission or student status throughout service; they may re-enroll or resume studies within two years of discharge and even switch to other majors per national regulations. Universities may also reserve separate admission slots for veterans through targeted recruitment initiatives. For postgraduate entry, the 2026 Ministry of Education directive established the “Special Scheme for Discharged College Veterans.” This program allocates a fixed number of places within the overall national postgraduate quota, exclusively for discharged veterans; participating institutions set their own minimum entrance scores — typically no higher than those required for regular applicants in the same field. Priority is given to candidates with longer periods of military service. In 2026, 532 universities participate in this scheme; the list changes yearly, with 523 institutions involved in 2025. The tuition rates were set at 8,000/12,000 RMB in 2019, then adjusted to 16,000/20,000 RMB in 2023, and finally raised to 20,000/25,000 RMB in 2024. The earliest official figures date back to 2022. + +- Evidence grade: A + +- Notes: Pending verification: official documents detailing exemptions from entrance exams for vocational college transfers and bonus points on postgraduate entrance tests for veterans. Both perks are referenced in the Veterans Affairs Ministry’s policy summaries, yet no corresponding Ministry of Education notices have been located so far. Consequently, this guide merely confirms the existence of these pathways without specifying exact bonus values; applicants must consult the latest admission guidelines before applying. Note also that participants in the special postgraduate scheme cannot simultaneously claim entrance-score bonuses — these benefits are mutually exclusive. +- Sources:财政部、教育部、中国人民银行、金融监管总局 (2024). 关于调整完善国家助学贷款有关政策的通知（财教〔2024〕188 号）. ；财政部等五部门 (2019). 学生资助资金管理办法（财科教〔2019〕19 号，第五条）. ；全国人大常委会 (2020). 退役军人保障法（第三十四、三十五条）. （国防部刊登）；教育部办公厅 (2025). 关于做好 2026 年退役大学生士兵专项硕士研究生招生计划招生工作的通知（教学厅〔2025〕8 号）. + +### 5. Only six scenarios allow the government to assign jobs after discharge; those opting for self-employment must register within 30 days + +- Cost: No cost involved. Simply bring your discharge certificate and visit the local Civil Affairs Bureau for veterans. +- In plain terms: The notion that “the military guarantees job placement” no longer applies broadly. Currently, only six specific scenarios qualify for government job assignments. Most conscripts who serve two years do not fall into these categories. Those not eligible for government placement are considered self-employed, and they must register within 30 days of discharge. Failing to do so without valid reasons means they forfeit any entitlement to government assistance. +- Benefit: Article 25 of the Regulations on Placement of Veterans specifies six circumstances under which local governments must assign jobs. These include: (1) non-commissioned officers with at least 12 years of service; (2) personnel awarded medals or honorary titles during service; (3) those receiving third-class combat merits or higher; (4) individuals receiving first-class commendations; (5) those disabled at levels 5–8 due to combat; and (6) children of martyrs. The same regulations state that local governments must complete job placement within six months of receiving discharged personnel. Employers must sign medium- or long-term contracts lasting at least three years; for non-commissioned officers with ten-plus years of service, employers must offer open-ended contracts. During the placement period, veterans receive monthly living allowances equal to the local minimum wage. If placement fails due to reasons unrelated to the veteran, they receive 80% of the average wage of comparable workers until employment is secured. Exceptions include individuals expelled from the Communist Party of China or convicted of crimes. Article 51 clarifies that self-employed veterans must register within 30 days of discharge; otherwise, they lose eligibility for government support. (Nationwide, effective 1 September 2024.) +- Evidence grade: A +- Notes: This regulation took effect on the same date that the 2011 Regulations on Placement of Retired Soldiers (Decree No. 608 issued by the State Council and Central Military Commission) was repealed. Many online guides still reference the outdated version, which stipulated that veterans must have earned second-class combat merits or higher in peacetime or third-class merits or higher in wartime to qualify. The 30-day registration rule applies solely to self-employed veterans; others must register “within the prescribed timeframe.” Upon registration, veterans receive a preferential treatment certificate, which serves as a prerequisite for subsequent benefits such as pensions, employment support, and educational grants. +- Sources:国务院、中央军委 (2024). 退役军人安置条例（国务院、中央军委令第 787 号，2024 年 7 月 29 日公布、9 月 1 日施行；第二十五、三十一、三十二、三十五、五十一、七十五条）. ；全国人大常委会 (2020). 退役军人保障法（第十三、十四、十五条）. （国防部刊登） + +### 6. Three key financial aspects after discharge: one-time separation pay, military service counting toward work seniority, and tax deductions up to 20,000 yuan per year for self-employed individuals + +- Cost: There is no cost involved. Upon discharge, the military transfers your social insurance records and funds to you. You then go to the local social insurance agency to continue those benefits — essentially the same office that handles social insurance enrollment. +- In plain terms: After leaving the military, there are three main financial factors to consider. First, there is a one-time separation payment for those who choose self-employment; the amount depends on how many years you served, with extra pay for those who earned commendations. Second, your military service years count toward your overall work seniority, so they are added to any prior and subsequent work history when calculating benefits. Third, if you start your own business, you may receive tax deductions of up to 20,000 yuan each year for three years, which equals 36 months in total. +- Benefit: The first point is covered by the Regulations on the Resettlement of Retired Military Personnel, which state: “A one-time separation payment shall be issued to retired noncommissioned officers and conscripts who choose self-employment, based on their length of service.” Funding comes from a special central government fund; exact amounts are set by relevant ministries and adjusted periodically. There are five tiers of additional pay: 25% extra for recipients of medals or honorary titles, 20% for those with first-class combat achievements or first-level commendations, 15% for second-class combat achievements or first-level commendations, 10% for third-class combat achievements or second-level commendations, and 5% for fourth-class combat achievements or third-level commendations. The regulations also note that if you do not find employment right away, you may qualify for unemployment benefits; your military service years count as insured periods, except for those placed in retirement or supported through other programs. The second point is addressed in the Law on the Protection of Retired Military Personnel: “Military service periods are counted as work seniority and combined with any subsequent employment history.” These years are also included when calculating pension, medical, and unemployment insurance contributions, and they count as grassroots work experience. Additionally, the Military Insurance Law states that military service years are added to any prior and subsequent periods of employee medical insurance coverage. The third point is outlined in a 2023 announcement from the Ministry of Finance, the State Taxation Administration, and the Ministry of Veterans Affairs, which specifies that self-employed veterans may deduct up to 20,000 yuan per year from applicable taxes for three years; this ceiling can be raised by 20% in certain regions. The deduction is applied sequentially against taxes owed, rather than being paid out as cash. For businesses hiring veterans, the maximum deduction is 6,000 yuan per employee per year, with a possible 50% increase. These provisions are valid from 1 January 2023 through 31 December 2027; those who have not yet reached three years of eligibility may continue to benefit until then. +- Evidence grade: A +- Notes: TODO (pending verification of current one-time separation payment amounts). The regulations only indicate that amounts are determined by authorities; no official figures have been published, so this guide does not list specific numbers — do not rely on unofficial estimates found online. During service, conscripts may also receive family preference allowances; exact amounts are set locally and subsidized by the central government. The tax benefit represents a maximum possible deduction, not an outright cash payout; if your business does not generate sufficient income, you may not reach that limit. Overall benefit level is rated “moderate.” A newer regulation effective from 1 August 2026 adds that vocational certificates earned during service remain valid nationwide after discharge. +- Sources:国务院、中央军委 (2024). 退役军人安置条例（国务院、中央军委令第 787 号，第二十一、二十二、七十四、八十一、八十五条）. ；全国人大常委会 (2020). 退役军人保障法（第四十二、四十四、五十条）. （国防部刊登）；全国人大常委会 (2012). 军人保险法（第十六、二十三条）. （国家法律法规数据库）；财政部、税务总局、退役军人事务部 (2023). 关于进一步扶持自主就业退役士兵创业就业有关税收政策的公告（2023 年第 14 号）. + +### 7. There’s more than just civil service exams to get into the government system: serving two years in grassroots programs qualifies you for a special recruitment quota of 10% each year. + + +- Cost: There’s no upfront cost. The trade‑off is spending two years working at a grassroots level in a township. During those two years you receive a government stipend rather than a market‑rate salary, and you must be prepared to endure that period. + +- In plain terms: Getting into the government system isn’t limited to taking civil service exams. After completing two years of satisfactory service in programs such as “Three Supports and One Assistance,” you become eligible for a special recruitment pool that accounts for roughly 10% of each year’s civil service openings. Those who take the postgraduate entrance exam within three years also get an extra 10 points added to their total score. The catch is that you’ll be paid only a government stipend during those two years. + +- Benefit: The fourth round of the “Three Supports and One Assistance” program states that the service term is two years. It also specifies that each province must reserve about 10% of its civil service recruitment slots for participants in this and similar grassroots programs. Additionally, local governments are required to set aside a certain number of positions in county‑ and township‑level public institutions for those who have completed the program and passed the evaluation; once hired, they are exempt from a probationary period. This means these spots are open only to former participants, not to outsiders. The same notice adds that anyone who finishes the program and meets the criteria can receive a 10‑point boost on their postgraduate exam score and be given priority admission under equal conditions. Graduates from vocational colleges who meet the requirements may also be admitted to undergraduate programs without taking further exams. Moreover, those without prior work experience who complete the program can enjoy the same rights as fresh graduates for two years in terms of civil service and corporate hiring, entrepreneurship, household registration, and further education; their service time counts as work seniority, with the start date being the day they reported to the grassroots post. Financial support from the central government is 30,000 yuan per person per year for western regions, 24,000 yuan for central regions, and 12,000 yuan for eastern regions. A joint directive from the General Offices of the CPC Central Committee and the State Council states that such individuals may enjoy the same treatment as fresh graduates for two years after completing the program, and that most senior posts in central government agencies must be filled by candidates with at least two years of grassroots experience. Another pathway is the Western China Program, jointly organized by the Central Committee of the Communist Youth League, the Ministry of Education, the Ministry of Finance, and the Ministry of Human Resources and Social Security; it recruits recent university graduates and postgraduate students to provide volunteer services in western grassroots areas for one to three years. + +- Evidence grade: A + +- Notes: The fourth round of the “Three Supports and One Assistance” program covers the years 2021‑2025. No fifth‑round documents or 2026 notices have been found yet, so be sure to check the latest recruitment announcements before applying. In 2025 the central government funded the recruitment of 34,430 participants. The full implementation plan for the Western China Program is not publicly available, and the relevant policy page on its official site cannot be accessed. Benefits for graduates of that program are governed by the same CPC‑State Council directive applicable to all grassroots programs. Keep in mind that you must actually serve the full two years under a government stipend; don’t focus solely on the subsequent special recruitment opportunities. +- Sources:中共中央组织部、人力资源社会保障部等十部门 (2021). 关于实施第四轮高校毕业生「三支一扶」计划的通知（人社部发〔2021〕32 号，第七、八、九、十一、十二、十三条）. ；中共中央办公厅、国务院办公厅 (2017). 关于进一步引导和鼓励高校毕业生到基层工作的意见（第五、十六、十八条）. ；全国大学生志愿服务西部计划项目管理办公室 (2026). 2026—2027 年度大学生志愿服务西部计划招募协议书. + +### 8. Teachers in the Special Post Program who complete three years of service, pass evaluations, and wish to stay should be promptly added to the official teaching staff + + +- Cost: There is no monetary cost. The price to pay is three years of teaching in rural compulsory education schools; applicants must also obtain a teaching certificate beforehand. The real challenge lies in staying committed throughout those three years. + +- In plain terms: The Special Post Program is one of the few pathways explicitly stating that eligible participants can be added to the official teaching roster after completing their service term. Requirements include a bachelor’s degree or higher, preferably in a teacher-training field, age not exceeding 30, and possession of the required teaching certificate. During those three years, compensation matches that of regular teachers employed by local public schools. Once the term ends, those who meet evaluation standards and wish to remain are supposed to be promptly added to the official staff list. + +- Benefit: The 2024 notice regarding the Special Post Program outlines hiring criteria: applicants must hold a bachelor’s degree or higher, preferably from a teacher-training background; for elementary schools, graduates from teacher-training colleges may also qualify. Age limit remains 30. A valid teaching certificate is mandatory. The notice further states that volunteers who participated in the “Western China Volunteer Program” or have prior teaching experience, as well as teacher-training graduates with at least six months of teaching internships, receive preferential treatment under equal conditions. Eligible veterans may also be considered for teaching roles in primary and secondary schools, with age limits adjusted based on their years of service. Compensation and official employment terms are defined accordingly: starting January 1, 2024, central government subsidies for Special Post teachers rose from 35,200 yuan per year in central regions to 38,800 yuan, and from 38,200 yuan in western regions to 41,800 yuan. These teachers are entitled to identical pay, professional title evaluations, awards, and annual assessments as regular teachers employed by local public schools. Upon successful completion of three years of service and passing evaluations, they must be promptly added to the official staff list, with all personnel and salary records transferred accordingly; their years of service and teaching experience are counted continuously, and no probationary period applies nationwide. + +- Evidence grade: A + +- Notes: The benefit level is classified as “high” because securing official employment after completing the program represents a long-term career gain far exceeding any monetary value. The most recent publicly available document is the 2024 notice; policies for 2025 and 2026 have not yet been published. Exact postings, subsidy amounts, and age limits are determined by each province’s implementation plan within the central framework. Obtaining a teaching certificate beforehand is mandatory; it serves as a prerequisite for entry, not something that can be obtained after employment begins. +- Sources:教育部办公厅、财政部办公厅 (2024). 关于做好 2024 年农村义务教育阶段学校教师特设岗位计划实施工作的通知（教师厅〔2024〕1 号）. + +### 9. Firefighters and civilian personnel in the military represent two additional pathways for public recruitment, with lower entry requirements than civil service exams. + +- Cost: There is no monetary cost. The process from application to hiring involves medical exams, political background checks, physical fitness tests, psychological evaluations, and interviews, taking several months in total. The difficulty lies in the successive screening stages that eliminate candidates one by one. +- In plain terms: Neither pathway imposes the “minimum associate degree or higher” requirement. Firefighter recruitment targets individuals aged 18–22 with at least a high school education; those with an associate degree or higher, as well as veterans, may apply up to age 24. Military civilian positions require applicants to be at least 18 years old, with entry-level roles allowing candidates up to 35 years of age. The common barrier is the rigorous political background checks and medical evaluations. +- Benefit: For firefighters, refer to the *Measures for Recruiting Firefighters into the National Comprehensive Fire and Rescue Force*. Article 5 stipulates that applicants must be aged 18–22 and hold at least a high school diploma. Article 6 further allows candidates with an associate degree or higher, veterans, or experienced firefighters to apply up to age 24; exceptionally talented specialists may be admitted up to age 28 with approval from the Ministry of Emergency Management. Article 7 specifies that recruitment occurs primarily among local residents, though candidates from other provinces may also be considered. Article 9 outlines the full procedure: publicity, registration, eligibility checks, medical exams, political screening, physical and psychological tests, interviews, public announcements, and final hiring. Regarding military civilian roles, the *Regulations on Civilian Personnel in the Chinese People’s Liberation Army* states in Article 18 that recruitment combines open examinations, direct hiring, and targeted recruitment efforts. Article 9 lists basic criteria: applicants must be at least 18 years old, meet political standards, and possess required education, expertise, and competence. Article 19 sets the maximum age limit at 35 for entry-level positions. Additionally, Article 20 emphasizes giving priority to veterans in civilian roles nationwide. +- Evidence grade: A +- Notes: Effective August 1, 2026, the *Regulations on Promoting Employment and Entrepreneurship for Veterans* introduces two key provisions: first, a designated quota for recruiting veterans into firefighter roles; second, preferential treatment for veterans when hiring police auxiliary personnel. These pathways’ exact annual quotas, specific roles, and eligibility criteria are defined in yearly announcements; this guide outlines only the unchanging baseline requirements. Firefighter roles constitute a disciplined service rather than ordinary employment, so prospective candidates must carefully weigh associated occupational risks beforehand. +- Sources:人力资源社会保障部、应急管理部 (2021). 国家综合性消防救援队伍消防员招录办法（人社部发〔2021〕58 号，第五、六、七、九条）. ；国务院、中央军委 (2022). 中国人民解放军文职人员条例（第二次修订，国务院、中央军委令第 757 号，2023 年 1 月 1 日施行；第九、十八、十九、二十条）. （国家法律法规数据库） + +### 10. Education isn’t a one‑time deal: self‑study exams have no age or prior‑education limits, while adult college entrance exams and open universities also offer pathways to upgrade qualifications. + + +- Cost: Registration and textbook fees run only a few hundred yuan per year. The trade‑off is long‑term self‑study or part‑time classes; a non‑full‑time bachelor’s upgrade takes at least two and a half years. “Non‑full‑time” means you keep working while studying, which demands consistent effort over time. + +- In plain terms: If you missed out on schooling at age 18, three legitimate routes remain: self‑study exams, adult college entrance exams, and open universities. Self‑study exams welcome anyone regardless of age or past schooling level, though full‑time students may not apply. Adult college entrance exams require a high‑school or junior‑college diploma. All three paths are slow, but none care how you performed at 18. + +- Benefit: Self‑study exams are governed by the Interim Regulations on Higher‑Education Self‑Study Examinations. Article 3 states: “Any citizen of the People’s Republic of China, irrespective of gender, age, ethnicity, race, or prior education level, may participate in higher‑education self‑study examinations as stipulated herein.” Article 20 adds that full‑time students at any school may not register. Article 25 outlines three graduation requirements: passing all courses, completing a thesis or practical assignment, and meeting moral standards. Meeting these yields a diploma; Article 32 guarantees that holders receive wages comparable to those of regular university graduates. The Higher‑Education Law, Article 21, likewise affirms the self‑study exam system. Adult college entrance exams follow the 2025 National Adult Higher‑Education Enrollment Rules, which target “employed persons and other individuals outside full‑time schooling.” Applicants for bachelor’s or associate‑degree programs must hold a high‑school diploma or equivalent; those seeking a bachelor’s upgrade must already hold an associate degree or higher. Full‑time study lasts four years for a bachelor’s and two years for associate or upgrade programs; part‑time study requires five years for a bachelor’s and two and a half years for the others. “Part‑time” again means continuing work while attending classes. Open universities operate under Ministry of Education guidance: registration is open, and students earn course certificates upon completing credits; meeting further criteria grants diplomas, non‑degree certificates, and even degrees where applicable. + +- Evidence grade: A + +- Notes: TODO (pending verification of nationwide rules for regular bachelor’s upgrades). The standard pathway for recent full‑time junior‑college graduates is outlined in annual circulars issued by the Ministry of Education’s Student Affairs Office; these documents remain unpublished and are known only through provincial notices. Eligibility is essentially limited to that year’s graduates, with additional provincial rules; therefore they are not detailed here. Starting autumn 2025, “correspondence” and “part‑time” designations for adult higher education will be replaced by “non‑full‑time.” This category includes all adult attempts to upgrade qualifications; be wary of older terminology in promotional material. Pursuing a degree is distinct from choosing a marketable skill set — see Section 23 for that discussion. “Fast‑track” diploma schemes and counterfeit certificates are addressed in Section 23, Item 8. +- Sources:国务院 (1988, 2014 修订). 高等教育自学考试暂行条例（第三、二十、二十五、三十二条）. （国家法律法规数据库）；全国人大常委会 (2018). 高等教育法（第二十一条）. （国家法律法规数据库）；教育部办公厅 (2025). 关于做好 2025 年全国成人高校招生工作的通知（教学厅〔2025〕6 号）及附件《2025 年全国成人高校招生办法》. ；教育部 (2016). 关于办好开放大学的意见（教职成〔2016〕2 号）. + +### 11. Not joining a company means you must arrange your own social insurance: you’ll need to enroll in pension and medical plans at your place of work, as household registration restrictions have now been lifted. + +- Cost: You must pay the full amount for both pension and medical insurance yourself, calculated based on the local contribution base — often over a thousand yuan per month. The contribution base is simply the benchmark figure used to determine premiums. This is the most easily overlooked recurring expense on this path, and the difficulty lies in making those payments on time every month. +- In plain terms: Not being employed by a company doesn’t mean you’re exempt from social insurance; it simply means no employer covers half of the cost. Official documents require all regions to lift household registration barriers so flexible workers can enroll in insurance at their place of work, with major metropolises gradually implementing this change. So don’t mistake “freedom” for “no need to worry about social insurance.” If you fail to pay on schedule, both your pension benefits and medical reimbursement rates will be calculated according to rules for interrupted coverage. +- Benefit: These provisions stem from the “Guiding Opinions on Protecting the Labor Rights and Interests of Workers in New Forms of Employment.” It states: “All regions must lift household registration restrictions so flexible workers can enroll in basic pension and medical insurance at their place of work; for exceptionally large cities where full implementation isn’t immediately feasible, local authorities should create conditions for gradual rollout. Employers must be urged to enroll workers in social insurance per the law. Workers who don’t qualify for standard employee pension or medical plans should be guided to enroll in urban/rural resident programs to ensure full coverage. For those operating independently via platforms, rights and obligations are governed by civil law.” (National policy, effective 2021) +- Evidence grade: A +- Notes: The wording “lift restrictions” leaves room for exceptions in very large cities — it doesn’t mean household registration rules are completely abolished nationwide. Exact implementation details depend on the specific city where you intend to enroll. The benefit is rated “high” because interrupted coverage directly impacts long-term pension and medical benefits, which far outweigh the monthly costs. Yet those costs are real too: full self-payment often exceeds a thousand yuan per month. For information on how to restore interrupted coverage and accumulate years of service, see Section 7, Article 18 (“Interrupted Social Insurance Payments”). Additionally, selling agricultural or daily goods at government-designated locations/times, or offering services that legally require no license, doesn’t necessitate a business license per State Council Document No. 27 (2020). +- Sources:人力资源社会保障部等八部门 (2021). 关于维护新就业形态劳动者劳动保障权益的指导意见（人社部发〔2021〕56 号，第二、八条）. ；国务院办公厅 (2020). 关于支持多渠道灵活就业的意见（国办发〔2020〕27 号）. + +### 12. Food delivery workers, ride‑hailing drivers, and local freight carriers all get occupational injury coverage paid for by the platform on a per‑order basis — at no cost to them. + + +- Cost: Zero out‑of‑pocket expense; the platform bears the entire premium. Your only task is to verify whether the platform you use is part of the pilot program. Two easy ways to do this: check the “Occupational Injury Coverage” section in the app’s benefits page, or call your provincial Human Resources and Social Security Bureau to ask if the platform is enrolled. +- In plain terms: Platforms must pay occupational injury insurance premiums for every order placed by delivery workers, ride‑hailing drivers, and local freight carriers — none of that cost falls on the workers themselves. This is still a pilot scheme, so before accepting any orders, confirm that both your province and your platform are included. Workers who already have a formal employment contract with a platform are covered under regular workers’ compensation, not this program. +- Benefit: The coverage is governed by the “Interim Measures for Occupational Injury Insurance for Workers in New Forms of Employment.” Article 2 states: “Platform enterprises shall enroll in occupational injury insurance for new‑form workers as required by these measures… ensuring coverage for every order and every worker who registers via the platform and receives compensation for services such as ride‑hailing, delivery, and local freight.” Article 9 specifies premium rates during the trial phase: 0.01 yuan per order for ride‑hailing, 0.07 yuan and 0.25 yuan per order for delivery, and 0.18 yuan per order for local freight. Starting July 1 2025, the pilot expanded to ten additional provinces, and by 2026 it is slated to cover all 31 provinces and the Xinjiang Production and Construction Corps. +- Evidence grade: A +- Notes: This remains a pilot program, not a nationwide mandatory system. Before taking any orders, verify that your province and platform are part of it; otherwise you’ll need to purchase private insurance on your own. The “Guiding Opinions on Protecting Labor Rights of Workers in New Forms of Employment” also mandates that platforms pay wages no lower than the local minimum, pay on time and in full, and provide fair compensation on statutory holidays. The document’s reference number is HRSSB [2021] 56; it is cited in Article 11 regarding flexible‑employment workers. In any dispute, follow these rules rather than settling privately with the platform. For medical insurance and pension contributions, flexible‑employment workers must enroll separately — see Article 11 for details. +- Sources:人力资源社会保障部等九部门 (2025). 关于扩大新就业形态人员职业伤害保障试点的通知（人社部发〔2025〕24 号）及附件《新就业形态人员职业伤害保障办法（试行）》第二、九条. + +### 13. Two pathways to secure a government job on the day you fill out college applications: government-funded teacher training and targeted medical student programs, at the cost of a six-year service commitment. + + +- Cost: Tuition and housing fees are waived, and you receive a living stipend. The trade-off is that for six years after graduation you cannot freely choose a career; breaking the contract requires you to repay all funds, pay a penalty, and accept a negative mark on your credit record. The difficulty lies in the fact that you cannot relocate during these six years. + +- In plain terms: Both programs involve the state covering your education costs upfront; in return, you must work at a designated location for six years after graduation. Government-funded teacher training is offered only at six universities directly under the Ministry of Education, with admission occurring in an early admission round. For targeted medical students, a tripartite agreement must be signed before receiving the admission letter. Violating the contract leads to repayment obligations, penalties, and a credit record impact. Carefully consider whether you can accept these six years of commitment before applying. + +- Benefit: Government-funded teacher training is governed by the “Implementation Measures for Government-Funded Education of Teacher-Training Students with Undergraduate-Graduate Continuation at Universities Directly Under the Ministry of Education” (2024), which supersedes the 2018 version. Article 2 stipulates that central government funds cover tuition, housing, and living stipends. Article 3 specifies that training targets areas below provincial capitals in central and western regions (except for five autonomous regions, border provinces, Hainan, Guizhou, and Qinghai). It also states that placement is not permitted in municipalities, special economic zones, or main urban districts of provincial capitals. Article 9 requires graduates to teach at designated primary or secondary schools within their home province for at least six years; those assigned to urban schools must spend at least one year teaching in rural areas. Article 13 mandates accountability for non-compliance, including credit record inclusion and exclusion from other civil service roles until the term ends. Article 6 allows reclassification to non-teacher majors if unsuited for teaching within one year, with repayment of benefits. Article 14 treats failure to obtain a master’s degree and teaching certification as a breach, requiring repayment and penalties. Article 21 ensures that sufficient government posts are allocated for these graduates. Targeted medical students follow a separate policy: prior to enrollment, they sign an agreement with their university and local health and human resources authorities to serve rural medical institutions for six years. After employment, they must complete three years of standardized residency training. Their breach records are similarly logged, and severe violations are publicly disclosed. Unlike teachers, medical graduates may leave after fulfilling their six-year term, as explicitly permitted by regulations. + +- Evidence grade: A + +- Notes: The 2024 policy shifted teacher training to an undergraduate-graduate continuum, rendering the older “immediate post-graduation teaching” model obsolete. Existing agreements remain valid. Securing a government post does not guarantee automatic placement; actual assignments depend on local hiring needs. Medical students must also account for three years of residency, extending their total commitment period. Individual provinces may offer additional programs with varying criteria; always consult the latest local admissions documents. +- Sources:国务院办公厅 (2024). 关于转发教育部等部门《教育部直属师范大学本研衔接师范生公费教育实施办法》的通知（国办发〔2024〕27 号，第二、三、六、九、十三、十四、二十一条）. ；国家卫生健康委、中央编办、国家发展改革委、教育部、财政部、人力资源社会保障部、国家中医药局 (2019). 关于做好农村订单定向免费培养医学生就业安置和履约管理工作的通知. + +### 14. Before going abroad to work, check whether the company has a license for international labor cooperation: it is illegal for them to demand a deposit from you. + + +- Cost: No cost at all. Spend just a few minutes beforehand verifying the company’s credentials and reading through both contracts. + +- In plain terms: When it comes to working overseas, the law regulates not the workers themselves but the companies that arrange their employment. Only businesses holding a valid license for international labor cooperation and properly registered may recruit workers for foreign jobs. Any claim such as “first obtain a tourist visa and later switch to a work visa” is a clear sign of illegal activity. Moreover, employers are strictly prohibited from charging any kind of deposit or demanding collateral from workers. + +- Benefit: Article 5 of the Regulations on International Labor Cooperation states that companies must obtain approval from provincial or municipal commerce authorities before engaging in such activities; this approval results in a specific operating license. Article 7 mandates that the list of licensed firms be submitted to national authorities and shared with Chinese embassies and consulates abroad. Article 8 explicitly bans any entity from using business trips, tourism, or study abroad programs as a guise for labor export. Within five working days of registration, firms must deposit at least 3 million RMB into a designated fund intended to cover unpaid wages, service fees, and compensation for injuries or emergencies. This fund may also be tapped to repatriate workers in crisis situations. Articles 11, 12, and 13 forbid employment in gambling or adult entertainment venues, require mandatory pre-departure training, and mandate personal accident insurance coverage while abroad. Contracts must be signed separately with both foreign employers and workers; failure to do so renders any recruitment illegal. Article 25 reiterates the ban on deposits or property pledges. All agreements must be filed with commerce authorities within ten days, and companies must assist workers in securing compensation when contractual terms are violated. Article 31 allows authorities to halt recruitment to regions deemed unsafe, while Article 37 establishes a public registry of non-compliant firms. Unlicensed operators face severe penalties, including license revocation and criminal prosecution. Those misusing tourism or study visas for labor placement also incur heavy fines. + +- Evidence grade: A + +- Notes: This entry outlines the lawful pathway for overseas employment. Legitimate procedures require the company to sign a labor cooperation agreement with a foreign employer, followed by a written service or employment contract with the worker detailing duties, pay, working hours, leave entitlements, social insurance, and safety measures. Within ten days, the firm must register these documents with authorities and provide language, safety, and cultural training. Personal accident insurance is mandatory. Red flags include refusal to show contracts, demands for deposits, or pressure to bypass proper paperwork. For information on high-paying overseas job scams and fraud hubs, see Section 21.5; safety advisories and contact details for the 12308 consular hotline are also listed there. The regulations impose no specific educational or age prerequisites on workers; eligibility hinges on both corporate licensing and host-country requirements. Contracts may only be concluded with approved foreign enterprises, never private individuals. The aforementioned financial reserve cannot be withdrawn by workers; it serves solely as a safety net for unpaid claims. Should problems arise, workers retain the right to file complaints with commerce authorities per Article 20. Projects sending more than 100 personnel to a single destination must also assign on-site supervisors and notify local embassies or consulates. Smaller groups lack such safeguards, so workers should retain all contracts and payment records as proof of their legal status. +- Sources:国务院 (2012). 对外劳务合作管理条例（国务院令第 620 号，第五、七、八、九、十、十一、十二、十三、二十一、二十三、二十五、二十六、二十九、三十一、三十七、三十九、四十、四十三条）. + +### 15. Working remotely for a foreign company from home: this income is considered domestic earnings for tax purposes; you must file your own individual income tax returns, and incoming payments should be reported as “employee compensation”. + + +- Cost: There are no direct expenses. You must file an annual tax reconciliation between March 1 and June 30 of the following year. If your annual inflow exceeds the permitted limit, you’ll also need to provide an employment contract and proof of earnings. The main difficulty lies in remembering to file this tax yourself. + +- In plain terms: Whether this income counts as domestic or foreign depends on where the work is actually performed, not where the money originates. If you’re working remotely for a foreign firm while residing in China, it’s classified as domestic earnings, and you must pay individual income tax here. Since the foreign company has no local presence, no one withholds taxes on your behalf — so you’re responsible for filing them yourself. Payments should be reported under the “employee compensation” category. + +- Benefit: Whether this income qualifies as domestic earnings is determined by Article 3 of the Implementing Regulations of the Individual Income Tax Law (Decree No. 707 issued by the State Council, effective January 1, 2019). It states: “Unless otherwise stipulated by financial or tax authorities under the State Council, the following types of earnings are regarded as originating in China, regardless of where payment is made: (1) earnings derived from providing services within China through employment, engagement, or contractual obligations.” Article 6 of the same regulations defines two relevant tax categories. Wages and salaries are defined as “any compensation, bonuses, year-end incentives, labor dividends, allowances, subsidies, and other earnings related to employment or engagement.” Meanwhile, “labor remuneration” refers to “any income earned through personal services such as design, decoration, installation, drafting, testing, medical work, legal services, accounting, consulting, teaching, translation, editing, calligraphy, sculpture, film production, recording, performance, advertising, exhibitions, technical assistance, brokerage, agency work, and similar activities.” According to Article 6 of the Individual Income Tax Law, the taxable base for residents is calculated by subtracting 60,000 RMB, mandatory deductions, additional allowances, and other legally permitted deductions from total annual earnings. However, for labor remuneration specifically, only 80% of the gross amount is considered taxable — wages and salaries are taxed at 100% of their full value. Article 9 clarifies that taxpayers are responsible for paying income tax, while employers or payers serve as withholding agents. Article 10 specifies that taxpayers must file returns under several circumstances, including when no withholding agent exists or when foreign earnings are received. Annual reconciliation must be completed between March 1 and June 30 of the following year. Regarding currency inflows, Article 9 of the Administrative Measures on Personal Foreign Exchange (issued by the People’s Bank of China, Decree No. 3, effective February 1, 2006) establishes an annual cap of USD 50,000 per individual for non-commercial foreign exchange transactions. Within this limit, individuals may exchange currency using only valid identification; exceeding it requires additional documentation such as employment contracts and proof of income. Article 7 further prohibits banks and individuals from circumventing these limits through split transactions or falsified documents. The detailed implementation rules (Document No. 1 issued in 2007) reiterate this annual cap and specify that employee compensation must be supported by a valid contract and income verification. + +- Evidence grade: A + +- Notes: Which tax category applies depends on your relationship with the foreign employer. If you’ve signed an employment contract and follow their instructions, your earnings are classified as wages and salaries. If you’re contracted independently and deliver results on a project basis, they’re treated as labor remuneration. These two categories are taxed differently, so it’s essential to determine which applies before filing. For incoming payments under USD 50,000 per year, you can exchange currency simply by presenting your ID. Any amount exceeding this threshold requires submission of your employment contract and income proof to the bank. Avoid attempting to split payments artificially to bypass these limits. This guidance applies strictly to individuals working from within China without physically relocating abroad. Those who actually move overseas to work for foreign firms must follow different regulations, as outlined in Section 14 of this chapter (check first whether the employer holds proper licensing for overseas labor deployment). Four related topics are not addressed in this book due to lack of verifiable evidence: whether VAT applies or if invoices must be issued; whether long-term remote workers should obtain a business license or register as self-employed; whether labor laws permit claims for vacation time, overtime pay, or severance from foreign employers; and issues concerning cross-border data transfer and confidentiality. A total of 2006 RMB is the maximum annual limit for personal foreign exchange transactions under these rules. +- Sources:国务院 (2018). 中华人民共和国个人所得税法实施条例（国务院令第 707 号，第三、六条）. ；全国人民代表大会常务委员会 (2018). 中华人民共和国个人所得税法（2018 年第七次修正，第六、九、十、十一条）. ；国家税务总局政策法规库. 中华人民共和国个人所得税法（第六条）. ；中国人民银行 (2006). 个人外汇管理办法（中国人民银行令〔2006〕第 3 号，第七、九条）. ；国家外汇管理局 (2007). 个人外汇管理办法实施细则（汇发〔2007〕1 号，第二、十条）. + +### 16. Starting a business without joining a company? First look at startup guarantee loans: up to 300,000 RMB per individual, with the government covering half the interest + + +- Cost: There’s no fee for consulting. You’ll need to visit the local civil affairs bureau once for eligibility screening, then visit both the guarantee agency and the lending bank once each. The lending bank is the same institution that provides the loan. The main challenge is that borrowed money must ultimately be repaid. + +- In plain terms: If you absolutely must borrow money to get started, this government‑backed loan is a good option. Each applicant can receive up to 300,000 RMB for a maximum term of three years, with the state paying half of the interest. One often‑overlooked requirement is that at the time of application neither you nor your spouse may have any other outstanding loans — except student loans, micro‑credit for poverty‑alleviation recipients, mortgage or auto loans, and consumer loans under 50,000 RMB. + +- Benefit: The eligibility criteria for individuals are outlined in Article 6 of the “Administrative Measures for Special Funds for Inclusive Financial Development” (Caizheng Jinrong [2023] No. 75). The first condition is that the applicant belongs to a priority employment group. These groups include registered urban unemployed persons, people facing employment difficulties (including persons with disabilities), veterans, ex‑convicts, college graduates (including village officials and returnees from overseas study), workers laid off from industries undergoing overcapacity reduction, as well as migrant workers returning to start businesses, online entrepreneurs, poverty‑alleviation recipients, and rural self‑employed farmers. The second condition is the absence of other loans: “Apart from student loans, micro‑credit for poverty‑alleviation recipients, mortgage loans, auto loans, and consumer loans under 50,000 RMB (including credit‑card balances), the applicant and his/her spouse must have no other outstanding loans at the time of application.” Article 9 states that for qualifying loans the government subsidizes 50 % of the actual interest rate; this subsidy is not granted for loans that are extended or fall into default. Article 10 removes the requirement for collateral when the loan amount is 100,000 RMB or less, meaning no additional guarantor or property pledge is needed. Article 11 limits the maximum loan size to 300,000 RMB for individuals, extendable to 110 % of that total for partnerships. The permissible interest ceiling varies by region: LPR + 50 basis points in eastern areas, LPR + 150 basis points in central and western regions, and LPR + 250 basis points in poverty‑stricken areas. LPR is the benchmark lending rate published by banks, while one basis point equals 0.01 % of the rate. Applicants who repay diligently, generate many jobs, and run promising projects may apply up to three times. Finally, Article 12 permits provincial governments to broaden eligibility, raise loan limits, and increase the subsidy rate as needed. + +- Evidence grade: A + +- Notes: Even though the government covers half of the interest, the loan must still be repaid. Our book’s stance in Section 12, Item 1 remains unchanged: only risk‑acceptable capital should be used for entrepreneurship; do not tap personal savings or sign personal guarantees for corporate loans, and your spouse should avoid doing so as well. This provision simply indicates that, if you decide to borrow, this government loan offers the lowest possible interest rate — avoid consumer loans and informal lenders. Exact limits and eligibility may differ by province; always check the latest rules issued by your local civil affairs bureau. The temporary 2020 directive allowing up to 200,000 RMB per applicant has been superseded by the current measures. For details on registering a sole proprietorship or corporation, obtaining permits, tax filing, and winding down a business, refer to Section 12. Information on training subsidies, social‑insurance assistance, and internship programs for the unemployed can be found in Section 7, Item 13 (Vocational Training Subsidies). +- Sources:财政部 (2023). 关于印发《普惠金融发展专项资金管理办法》的通知（财金〔2023〕75 号，第六、八、九、十、十一、十二条）. diff --git a/book/en/32-Studying-Abroad.md b/book/en/32-Studying-Abroad.md new file mode 100644 index 00000000..6039d01d --- /dev/null +++ b/book/en/32-Studying-Abroad.md @@ -0,0 +1,102 @@ +# 32. Studying abroad: visa status, work limits, insurance, and degree recognition + +This section looks at both the financial costs and personal freedom involved. It does not debate whether studying abroad is a good idea, nor does it compare schools. Instead, it outlines four key points you must know to avoid problems: how to keep your visa status valid, what the legal limits are on working hours, which insurance policies and fees you absolutely need, and whether your degree will be recognized after returning home. + +The information covers four countries — the United States, Canada, the United Kingdom, and Australia — with separate figures provided for each. All data comes from official government websites, including each country’s immigration authority and China’s Ministry of Education. **Study‑abroad rules change frequently in these countries, often even more often than regulations in China. All figures listed here are current as of September 2026. Before you travel and each time you renew your visa, be sure to double‑check the latest details using the links provided.** + +If you run into trouble while abroad — such as needing help from an embassy, understanding what services 12308 offers, or choosing suitable medical and repatriation insurance — please refer to Section 21. For a comparison between studying and working, see Section 23. Information on account theft is in Section 14, while Section 8 covers telecom fraud. These topics are not repeated here. +### 1. Check whether the school is on the China Scholarship Council’s list of accredited institutions before paying tuition + + +- Cost: No cost at all. Simply enter the school’s name into the “Accredited Institution Search” tool on the China Scholarship Council website; the check takes just a few minutes. +- In plain terms: After returning to China, if you intend to use your degree to apply for civil service jobs, join state-owned enterprises, obtain residency status, or qualify for professional certifications, it must first be officially recognized. This recognition process is handled by the China Scholarship Council. If the school does not appear on the accredited list, both tuition fees and time invested will be wasted, as the degree holds no validity in China. Performing this check is completely free; do it first before paying any tuition. +- Benefit: The China Scholarship Council provides a dedicated search portal for accredited institutions. Users can filter results by country or search directly by school name to verify whether a particular institution’s degrees are recognized. Additionally, the Ministry of Education’s Overseas Education Supervision Information Network publishes regulatory details regarding Sino-foreign cooperative education programs and overseas institutions. +- Evidence grade: A +- Notes: Always rely on your own online verification; third-party agents claiming “Ministry of Education approval” lack legal weight. The accredited list is subject to periodic updates; inclusion at the time of enrollment does not guarantee continued eligibility at graduation. It is advisable to recheck annually. Sino-foreign cooperative programs follow separate accreditation procedures. Individuals who enrolled after 2008 may retrieve their registration numbers via the Overseas Education Supervision Information Network using their full name and ID number. +- Sources:中国（教育部）留学服务中心. 认证院校查询. ；教育部教育涉外监管信息网. + +### 2. Legal battle over new U.S. F-1 rules: “Stay until graduation” remains the rule for now + +- Cost: No cost at all. Simply copy the program end date from your I-20 into your calendar and set a reminder 90 days in advance. The I-20 is the official document issued by your school confirming your eligibility to study in the U.S. Also, check updates from your school’s international student office each semester to see if there are any new developments in this case. +- In plain terms: The U.S. originally planned to change F-1 rules so that students could stay for a maximum of four years, with only 30 days allowed to leave after finishing their studies. However, just one day before those rules were set to take effect, a federal court issued a stay. As a result, the old rule still applies: students may remain in the country for the full length of their program, with a 60-day grace period after graduation to depart. This stay does not mean the rules have been repealed; the government can still appeal, so the regulations might change again at any time. +- Benefit: On July 17, 2026, the Department of Homeland Security announced a new rule scheduled to become effective on September 15, 2026. Under this proposal, F-1 students would no longer be allowed to stay “until graduation”; instead, they would be limited to a fixed maximum stay of four years, after which they would need to apply for an extension. Following completion of their studies or internship, they would have only 30 days to leave the country. On September 14, 2026, Judge Saylor of the U.S. District Court for the District of Massachusetts, citing Section 705 of the Administrative Procedure Act, issued a stay on the implementation of this rule nationwide. The court did not overturn the rule; the request to do so was denied, though the government retains the right to appeal later. The case remains ongoing. Thanks to this court order, holders of F, J, and I visas continue to be allowed to stay “until graduation,” with the same 60-day post-graduation departure window and no need to apply for an extension. +- Evidence grade: A +- Notes: This information is current as of September 25, 2026. The government may appeal to the First Circuit Court of Appeals, and DHS could revise and reissue the rules. Therefore, students planning to study for multiple years should not assume that the current rules will remain unchanged indefinitely. The next court hearing to review progress in the case is scheduled for October 2, 2026; after that date, it’s advisable to check your school’s international student office for any updates. Should these new rules eventually take effect, any extension request must be submitted before the expiration date; there will be no automatic renewal. Under the current rules, the departure deadline for students who decide to leave early differs from that for those who complete their program; in such cases, consult your school’s international student office for guidance. The same rule proposal also applies to J visas, though specific provisions differ from those for F-1 students; check details based on your own visa category. +- Sources:DHS (2026). Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors（2026-07-17 公布，原定 2026-09-15 生效）. ；Presidents' Alliance on Higher Education and Immigration v. U.S. Department of Homeland Security, No. 1:26-cv-13799-FDS (D. Mass. Sept. 14, 2026)，法院案卷. ；Yale Office of International Students & Scholars (2026-09-14). Important Update: Court Action on the D/S Rule. ；AILA (2026). One Day Before Taking Effect, Federal Court Postpones the F, J, and I Fixed Admission Period Rule. ；8 CFR 214.2(f). + +### 3. The maximum allowed work hours are strict limits in the U.S., Canada, UK, and Australia — exceeding them violates visa terms. + +- Cost: There’s no cost involved. You simply need to track your weekly hours yourself. The difficulty lies in employers often claiming “no one checks extra hours,” but you must never believe this. +- In plain terms: All four countries set clear caps on how many hours international students may work. Going over these limits breaches visa conditions, potentially leading to visa revocation, deportation, or extra scrutiny during future applications. The limits are: 20 hours per week in the U.S., 20 hours weekly for degree students and 10 hours for non-degree students in the UK, 24 hours per week in Canada, and 48 hours every two weeks in Australia. Hours worked at multiple jobs must be combined. +- Benefit: F-1 students in the U.S. may work up to 20 hours per week on campus during term time, with the same 20-hour weekly cap applying to approved off-campus jobs; full-time work is allowed during holidays. This is stipulated under 8 CFR 214.2(f)(9) of U.S. federal immigration regulations. UK students pursuing degree-level courses may work 20 hours weekly during term time, while those on non-degree programs are limited to 10 hours per week; no work is permitted for part-time students at all. Self-employment is also prohibited, meaning you cannot work for yourself, nor may you serve as a professional athlete or performer. These rules are outlined in the UK immigration rules for students, specifically Student ST26.1 and ST26.5. Eligible full-time students in Canada may work up to 24 hours per week off campus, per Article 186(v) of the Immigration and Refugee Protection Regulations (IRPR). For Australian student visas, the limit is 48 hours every two weeks while classes are in session; this restriction does not apply to research-based master’s or PhD students, nor their dependents. +- Evidence grade: A +- Notes: In the U.S., any off-campus work must first receive official approval; you cannot begin working while your I-765 work permit application is still pending. Older Canadian work permits may list a 20-hour weekly cap, but if you still meet all eligibility criteria, current regulations permit up to 24 hours per week. The UK’s self-employment ban is broadly interpreted: taking private contracts, running an online store, or working as a freelancer all count as prohibited self-employment. +- Sources:8 CFR 214.2(f)(9). ；UK Home Office. Immigration Rules Appendix Student（ST26.1、ST26.5）. ；IRCC. Work off campus as an international student. ；Australian Government Department of Home Affairs. Student visa (subclass 500). + +### 4. The core requirement for eligibility is “full-time enrollment”: any gap due to suspension, withdrawal, or transfer disqualifies you from working. + +- Cost: No cost involved. Before suspending, withdrawing, or transferring schools, contact your school’s international student office to confirm your current status. +- In plain terms: Whether you can work depends on whether you are currently enrolled full-time. Once you are suspended, withdrawn, expelled, or not attending classes during a transfer, your right to work ends immediately. Continuing to work in such cases constitutes illegal employment. Many assume that as long as their visa remains valid, they are still eligible, but in reality their status has already been revoked. +- Benefit: Canadian regulations explicitly prohibit off-campus work during approved suspension periods, as well as for students who are not actively enrolled during a transfer. Work privileges can only be reinstated after resuming full-time studies. In the U.S., off-campus work eligibility is granted only to F-1 students whose SEVIS record shows an “Active” status — this system tracks valid enrollment for international students, and such students must also maintain full-time coursework. In the UK, work permits are issued based on course type; students on part-time programs are not permitted to work. +- Evidence grade: A +- Notes: If you are feeling overwhelmed by coursework and considering reducing your course load, first verify exactly how many credits constitute full-time enrollment — falling below that threshold will disqualify you from work eligibility, often even before any work permit issues arise. Students who are expelled or whose programs are terminated typically lose their eligibility status on the same day; do not wait for an official notice from the school before taking action. +- Sources:IRCC. Work off campus as an international student. ；U.S. Department of Homeland Security, Study in the States. Working in the United States. ；UK Home Office. Immigration Rules Appendix Student（ST26.1）. + +### 5. United States: You must report your new address within 10 days of moving + +- Cost: No cost at all. Submitting the address change online takes just ten minutes. +- In plain terms: If you move within the United States, the law requires you to inform USCIS within ten days. Failing to do so is no minor issue. First, it is illegal; second, any mail sent to you by USCIS could easily be lost. +- Benefit: Under 8 CFR 265.1, foreign nationals required by law to register must report any change of address to USCIS within ten days of moving. Reporting via the official USCIS channels lets you both confirm the address change and provide your new address. +- Evidence grade: A +- Notes: Reporting to USCIS is separate from updating your school records. You must also update your SEVIS record through your educational institution, which maintains your student visa status. The other three countries also mandate reporting address changes to immigration authorities or schools, though both the deadlines and procedures differ by country. Always follow the instructions posted on your local immigration authority’s website. +- Sources:8 CFR 265.1. ；USCIS. AR-11, Alien's Change of Address Card. + +### 6. Before you go and while studying abroad, check the Ministry of Education’s study‑abroad warnings + +- Cost: Nothing to pay. Check it once before departure and then once each semester. +- In plain terms: The Ministry of Education issues specific warnings for certain countries or regions when recent safety conditions or policies there appear unfavorable to Chinese students. These are official, publicly posted risk notices that you can verify in writing — far more reliable than what any agency might tell you. Checking them costs nothing. +- Benefit: The Ministry posts study‑abroad warnings on its Overseas Education Supervision website. In 2025, four such warnings were issued. Warning No. 1 warned that certain higher‑education bills in some U.S. states contained provisions hostile toward China (April 9, 2025). Warnings No. 2 and No. 3 both highlighted the high incidence of cases involving Chinese citizens in the Philippines and an overall poor study‑abroad environment there (July 18, 2025 and August 30, 2025). Warning No. 4 noted deteriorating safety and study conditions in Japan, advising prospective students to plan carefully before going (November 16, 2025). +- Evidence grade: A +- Notes: These warnings are not outright bans; they simply provide an official basis for evaluating risk. They are updated as circumstances change, so this section is not kept current — always refer to the latest page on the website. For information on personal safety and consular assistance abroad, see Section 21. +- Sources:教育部教育涉外监管信息网. 预警信息. ；教育部发布 2025 年第 4 号留学预警. ；第 1 号. + +### 7. Australia: OSHC must cover the entire stay without any gaps; lack of proof may lead to denied entry + +- Cost: Several thousand to tens of thousands of RMB. Purchase it once based on the length of your visa; if you’re studying for several years, buy coverage for that entire period. +- In plain terms: Australia makes overseas student health insurance (OSHC) a mandatory visa requirement — it’s not optional. The policy must cover your entire stay in the country. When renewing or switching policies, there must be no lapse in coverage. If you cannot produce proof of insurance upon arrival, you may be denied entry on the spot. Family members accompanying you as dependents must each purchase their own policy. +- Benefit: According to Australian Department of Home Affairs regulations, student visa applicants and their dependents must obtain OSHC, which must remain in effect throughout their entire stay in Australia without any interruptions. The policy must be issued by an insurer approved by Australian authorities, except for applicants who qualify for exemptions. There must be no gap between the end date of one policy and the start date of a new one. Failure to provide proof of active coverage upon entry can result in denial of entry. For travelers arriving in Australia prior to their course start date, the policy start date must be set to the actual date of arrival. +- Evidence grade: A +- Notes: If your school arranges the insurance for you, be sure to confirm the insurer’s name, the policy’s start and end dates, and the policy number — these details must be included in your visa application. Purchasing coverage for a shorter period than needed can cause issues when you apply to renew your visa; it’s better to buy coverage that extends well beyond your graduation date. +- Sources:Australian Government Department of Home Affairs. Student visa (subclass 500). + +### 8. UK: Besides the visa fee, there is an annual healthcare surcharge — £776 per year for students, paid in full at application time + +- Cost: The visa fee is £558. There is also a healthcare surcharge of £776 per year, both of which must be paid in full at the time of application. +- In plain terms: The amount you pay to go to the UK isn’t limited to just the visa fee. You also have to prepay the healthcare surcharge based on the length of your visa, which is required to access the UK’s National Health Service. For a two‑year visa, that means paying £1,552 upfront. Add this to the visa fee, and you’ll need to budget for this total amount before you travel. +- Benefit: The fee for a UK student visa is £558, regardless of whether you apply from outside the UK or extend/change your visa status while already there. In addition, the healthcare surcharge must be paid to use the National Health Service; it is calculated per year of your visa and paid in full at application. For students and their dependents, the charge is £776 per year — so a two‑year visa requires a payment of £1,552. Other applicant categories pay £1,035 per year. If your visa lasts more than six months but less than a full year, the charge is still applied for a full year. +- Evidence grade: A +- Notes: Both the fee amounts and exchange rates may change; always refer to the two pages listed under Sources for the most current figures. Generally, students aged 18 or older enrolled in degree programmes can stay for up to five years, while those on non‑degree courses are limited to two years. Use these timeframes to estimate the total healthcare surcharge you’ll need to pay. +- Sources:UK Government. Student visa. ；UK Government. Pay for UK healthcare as part of your immigration application. + +### 9. Allow time for certification before returning to China: CSCSE certification takes 10–20 working days + +- Cost: The application and payment are both done online. Preparing documents and waiting for review also take about a month when counted in working days. +- In plain terms: If you plan to use your overseas degree in China, you must first get it certified. The review alone requires 10–20 working days. During peak hiring seasons or if documents are returned for corrections, the process may take even longer. Since many deadlines—such as those for campus recruitment, civil service exams, and household registration—are fixed, it’s wise not to delay this step until the last minute. +- Benefit: Certification of overseas degrees in China is handled via the online portal of the China Scholarship Council Education Service Center. The procedure involves four steps: registration and identity verification, online submission of documents, payment, and finally evaluation and review. The officially stated processing time is 10–20 working days, which excludes weekends and holidays and represents the duration needed for the Center’s review. +- Evidence grade: A +- Notes: Required documents include your diploma, passport or travel permit, residence permit or visa stamp, a photo, and an authorization statement. Entry and exit records during your stay abroad are retrieved automatically by the system, so be sure to keep those visa pages intact. The Center also posts announcements regarding revoked certificates or temporary suspensions of applications from certain institutions; it’s advisable to check whether your school is affected before applying. +- Sources:中国（教育部）留学服务中心. 网上服务大厅·学历学位认证. + +### 10. The number of schools under “enhanced scrutiny” for certification keeps rising; paying to buy a degree is no longer an option + + +- Cost: No cost at all. Before enrolling, simply search the school’s name in the announcements posted by the China Scholarship Council (CSC). + +- In plain terms: The CSC regularly publishes lists of foreign institutions subject to enhanced scrutiny for degree certification, and at times it temporarily halts certification applications for certain schools. These are precisely the schools advertised as offering “no language requirements, no need to leave the country, and a master’s degree in just a few months.” Searching for a school’s name beforehand saves you from having to file appeals later on. + +- Benefit: The China Scholarship Council consistently issues notices about tightening certification checks for degrees awarded by specific foreign institutions — essentially adding an extra layer of verification for their diplomas. The most recent notice is No. 9, dated October 28, 2025. The CSC has also announced temporary suspensions of certification applications for certain overseas schools and issued warnings about fraudsters exploiting the degree certification process to defraud applicants. + +- Evidence grade: A + +- Notes: “Enhanced scrutiny” does not automatically mean a degree cannot be certified, but it does require submission of additional documentation and takes considerably longer. Any agency promising “guaranteed certification” or “expedited processing via internal channels” is running a scam; the CSC has issued explicit anti-fraud advisories on this matter. Engaging overseas services to write papers or attend classes on your behalf risks not only degree revocation but also negative consequences for your visa status if discovered. +- Sources:中国（教育部）留学服务中心. 关于对部分国外院校学历学位认证加强认证审查的公告（九）（2025-10-28）. ；中国（教育部）留学服务中心. diff --git a/book/en/33-Living-With-Disability.md b/book/en/33-Living-With-Disability.md new file mode 100644 index 00000000..fa57a556 --- /dev/null +++ b/book/en/33-Living-With-Disability.md @@ -0,0 +1,211 @@ +# 33. How to live after becoming disabled + +This section covers life after a disability has already occurred. Preventing disability is discussed in Sections 1 and 13, so we won’t repeat that here. + +We calculate four different categories separately, without converting between them. Mortality rates apply to entries about emergencies and complications. Financial amounts apply to entries about subsidies, benefits, and legal claims. Time requirements apply to entries about education and administrative procedures. Restrictions on personal freedom apply to entries about psychiatric hospitalization, decision‑making capacity, and guardianship. + +According to a World Health Organization report, roughly 1.3 billion people worldwide experience significant functional limitations — that’s 16% of the global population, or one in every six individuals. On average, people with disabilities die up to 20 years earlier than those without disabilities. They also face twice the risk of depression, asthma, diabetes, stroke, obesity, and poor oral health. Much of this disparity stems not from the disability itself, but from limited access to healthcare, education, employment, and mobility. Hence, half of the entries here address physical health, while the other half cover procedures and rights. + +Five topics already covered elsewhere are only referenced here without repetition. Instructions for obtaining a disability certificate and how the seven categories and four levels are determined appear in Section 24, Item 11 (Disability Certificate). Timing for disability assessments is explained in Section 24, Item 10 (Disability Assessment). Details on claiming the two main disability subsidies are in Section 7, Item 8 (Two Subsidies). Converting work‑capacity evaluations and disability levels into monetary compensation for workplace injuries is described in Section 19, Item 15 (Work‑Capacity Assessment). Finally, eligibility for long‑term care insurance for severely disabled individuals is outlined in Section 17, Item +### 1. Sudden severe headache and sweating after spinal cord injury: first sit the person upright, loosen tight clothing, and call 120 + +- Cost: No cost at all. Just three simple actions that take only a few dozen seconds to perform. +- In plain terms: In people with spinal cord injuries, the body’s warning signals get disrupted. Even if the bladder is full or clothing is too tight with no obvious discomfort felt, blood pressure can spike dramatically. The main warning signs are sudden severe headache and excessive sweating. In such cases, the first steps are to help the person sit upright, loosen any tight clothing, check if the bladder is full, and call emergency services right away. +- Benefit: This type of episode is known as autonomic dysreflexia. A systematic review examined four major medical databases — Medline, CINAHL, EMBASE, and PsycINFO — and included 31 studies, 6 of which were randomized controlled trials. The review confirms that the recommended non-drug treatment consists of three steps: positioning the patient upright, loosening tight clothing, and removing any triggering factors. These steps are supported by clinical consensus and physiological evidence, and are classified as Level 5 evidence. Antihypertensive medications are only used when blood pressure remains elevated; prazosin has Level 1 evidence, while nifedipine and prostaglandin E2 have Level 2 evidence. Preventive measures mainly target common triggers such as urinary retention and surgical procedures, though most such strategies are backed by Level 4 or 5 evidence. +- Evidence grade: B +- Notes: This grade is assigned because there are no randomized controlled trials directly supporting those three on-site actions — only clinical consensus and physiological reasoning. The review itself notes that most of these interventions are supported by non-controlled studies. Medication use is strictly a medical professional’s responsibility; laypeople should never administer antihypertensive drugs at home. Lying down can further raise blood pressure, so sitting upright is essential. Family members and caregivers must also learn these three steps. This condition must never be mistaken for ordinary headaches. +- Sources:Krassioukov A, Warburton DE, Teasell R, Eng JJ; Spinal Cord Injury Rehabilitation Evidence Research Team (2009). A systematic review of the management of autonomic dysreflexia after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(4):682-695. + +### 2. The first decade after becoming disabled is a high-risk period for suicide; this shouldn’t be dismissed as “just a matter of staying positive.” + +- Cost: No cost at all. It only requires a phone call or a single appointment booking. +- In plain terms: In the first few years after becoming disabled, it’s very common for both the disabled individual and their family members to experience severe emotional distress — this is not a sign of weak willpower at all. Long-term follow-up studies conducted at two spinal cord injury centers in the UK found that the suicide rate among this group is five times higher than that of the general population. Over 90% of all suicides among these individuals occur within the first decade after their injury. For people whose injury was directly caused by a prior suicide attempt, this risk is even higher. +- Benefit: This study tracked 2,304 patients with traumatic spinal cord injuries who were newly admitted between 1991 and 2010, survived the first year after injury, and had residual neurological impairments at discharge, with follow-up lasting until the end of 2014. Among them, 63 patients (2.7%) had suffered their injury as a direct result of a prior suicide attempt. By the end of the follow-up period, 533 patients had died, of which 4.2% died by suicide; 91% of all suicides occurred within the first ten years after injury. The age-standardized suicide mortality rate was 62.5 cases per 100,000 people per year (95% CI 36.4–88.6), which is five times the average suicide rate of 12.2 cases per 100,000 people in England and Wales in 2014. Compared to patients with other causes of injury, those whose injury was triggered by a prior suicide attempt had a 4.32-fold higher risk of death overall (P<0.001), and a 9.46-fold higher risk of suicide specifically (P<0.001). +- Evidence grade: A +- Notes: This research was limited to spinal cord injury patients only, so the findings should be extrapolated with caution to other causes of disability such as blindness, amputation, or burns. Its main takeaway is the time window of heightened risk: this elevated risk does not fade away immediately after discharge, and requires close monitoring for a full decade. For support services, please refer to Section 29, Item 11 (12356). To prevent accidental harm, avoid storing sleeping pills or pesticides at home; see Section 1, Item 25 (thoughts of suicide). If feelings of grief and emotional distress persist for more than six months, seek help from a psychiatrist or clinical psychologist; see Section 29, Item 8 (grief lasting over half a year). +- Sources:Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S (2018). Suicide and traumatic spinal cord injury - a cohort study. Spinal Cord, 56(1):2-6. + +### 3. Hospitalization for mental disorders is voluntary; only two exceptions allow admission without consent + + +- Cost: No cost involved. Memorize these two exceptions so you can cite them when needed. +- In plain terms: Family members or employers cannot force someone to stay in a psychiatric hospital indefinitely. The law permits admission without consent only in two specific cases: when the person has already harmed or is at risk of harming themselves, or when they have already harmed or are at risk of harming others. In the first case, hospital admission still requires guardian approval; otherwise it is not allowed. If someone disputes the diagnosis, they may request a second evaluation within three days, and later can hire an independent medical expert for a formal assessment. +- Benefit: Article 30 of the Mental Health Law states that “hospitalization for mental disorders shall be voluntary.” Admission is mandatory only when diagnostic findings and clinical assessments confirm that the individual has a serious mental disorder and meets one of two criteria: (1) they have already attempted or are at risk of attempting self-harm, or (2) they have already harmed or are at risk of harming others. Article 31 adds that in the first scenario, admission requires guardian consent; otherwise it is prohibited. Article 32 permits anyone who disputes the diagnosis to request a second evaluation within three days, conducted by psychiatrists other than those who made the original diagnosis; further disagreement may be addressed by hiring a legally licensed medical expert. Article 35 stipulates that if subsequent evaluations show the person does not meet criteria for serious mental disorder or does not require hospitalization, admission must be halted. Article 78 also holds liable anyone who knowingly admits a non‑patient to a psychiatric facility; this law took effect on 1 May 2013 and was amended in 2018. +- Evidence grade: A +- Notes: It is essential to clarify both sides of this rule; otherwise it could be misread as “no one can ever be admitted.” Article 28 mandates that close relatives, employers, or local police must intervene immediately if a suspected patient shows signs of self‑harm or harm to others, and must arrange for a medical evaluation; hospitals must comply with such requests. Thus, “being evaluated” and “being hospitalized” are separate steps, each with its own threshold. Article 75 outlines penalties for hospitals that improperly restrain patients or misdiagnose healthy individuals; violators may face sanctions up to revocation of their license. Guidance on handling situations where someone exhibits violent tendencies can be found in Section 8. +- Sources:中华人民共和国精神卫生法（2018 年修正，第三十条、第三十一条、第三十二条、第三十五条、第七十八条）. + +### 4. For caregivers of disabled family members at home, it’s vital to watch your own health + +- Cost: There’s no cost involved. Simply share some of the caregiving duties and use that time to get a medical checkup. +- In plain terms: It’s not exaggeration when caregivers feel completely exhausted. One U.S. study followed over 800 older adults for four years. Those caring for a disabled spouse while also reporting high levels of mental strain had a mortality risk roughly 63% higher than people who weren’t caregivers. No such increase appeared among caregivers who didn’t report feeling stressed. So the real issue isn’t caregiving itself, but the long-term strain it causes. +- Benefit: This prospective cohort study ran from 1993 to 1998, with an average follow-up period of 4.5 years across four U.S. communities. It included 392 caregivers and 427 non-caregivers aged 66–96 who all lived with their spouses. Over four years, 103 participants (12.6%) passed away. After adjusting for socioeconomic factors, pre-existing conditions, and subclinical cardiovascular disease, caregivers reporting mental or emotional stress had a 63% higher mortality risk compared to non-caregivers (RR 1.63, 95% CI 1.00–2.65). No significant increase in mortality was seen among caregivers without reported stress (RR 1.08, 95% CI 0.61–1.90) or among spouses who were disabled but not cared for by their partners (RR 1.37, 95% CI 0.73–2.58). +- Evidence grade: A +- Notes: Caution: The lower bound of the confidence interval here is exactly 1.00, meaning there remains a small chance that no actual difference exists. This study focused on older U.S. adults living with disabled spouses, so its findings may not fully apply to caregivers of younger disabled family members. Still, it clearly shows that those experiencing high stress face greater risk. Whenever possible, share caregiving duties with others; contact local disability associations and civil affairs bureaus for respite care or day programs. Caregivers should also keep taking any prescribed medications — see Section 16, Item 1. The main beneficiary of all this advice is you. +- Sources:Schulz R, Beach SR (1999). Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA, 282(23):2215-2219. + +### 5. For long‑term wheelchair users, switch to a pressure‑relieving cushion and check the ischial and sacrococcygeal areas daily + +- Cost: A pressure‑relieving cushion costs several hundred to over a thousand yuan. The daily check takes just one minute. +- In plain terms: Regular foam cushions can cause skin breakdown after prolonged pressure. Once broken, the skin heals slowly and is prone to infection. In a trial conducted in nursing homes, the group using pressure‑relieving cushions showed significantly fewer pressure ulcers on the ischial region. Wheelchairs must also be sized to each individual; a generic model does not suffice. +- Benefit: This randomized clinical trial took place in 12 nursing homes between 2004 and 2008, enrolling 232 residents aged 65 or older who used a wheelchair for at least 6 hours daily and had a Braden score ≤18. All participants received a properly fitted wheelchair and were then randomly assigned to two groups: one used skin‑protective cushions (air, viscoelastic fluid plus foam, or gel plus foam), while the other used segmented foam cushions 7.6 cm thick. Follow‑up lasted 6 months or until a pressure ulcer developed. For pressure ulcers at the ischial tuberosity, the segmented foam group had 8 cases (6.7%) versus 1 case (0.9%) in the skin‑protective group (P = 0.04). When both ischial and sacrococcygeal ulcers were counted, the segmented foam group had 21 cases (17.6%) and the skin‑protective group 12 cases (10.6%); this difference was not statistically significant (P = 0.14). +- Evidence grade: B +- Notes: Two factors justify a B rating. First, the sample size was only 232 participants; the P‑value for the primary outcome (0.04) barely crossed the threshold, while secondary outcomes showed no difference. Second, the participants were elderly nursing‑home residents; results may not apply to younger wheelchair users. Since all subjects received a properly fitted wheelchair, both “proper fit” and “cushion type” contributed to outcomes; therefore, merely swapping the cushion is insufficient. For pressure‑ulcer prevention in bedridden individuals, air mattresses and regular repositioning are discussed in Section 17, Item 8 (Pressure ulcers). Information on applying for subsidies for basic assistive devices can be found in Section 7 of this chapter (contact the county disability‑services office). +- Sources:Brienza D, Kelsey S, Karg P, et al. (2010). A randomized clinical trial on preventing pressure ulcers with wheelchair seat cushions. Journal of the American Geriatrics Society, 58(12):2308-2314. + +### 6. Don’t buy therapies or devices that claim to cure paralysis, blindness, or deafness + +- Cost: There’s no direct cost, but it saves you money. The hard part is that family members, full of hope, can’t be dissuaded from buying them. +- In plain terms: Advertising laws leave no room for ambiguity. Ads for medical services, drugs, and medical devices are prohibited from making any claims about effectiveness, cure rates, or success rates, and they can’t feature real patients sharing their experiences. Phrases like “stand up after three treatment cycles” or “so many people have recovered” are illegal on their own, so there’s no need to even examine the underlying theory. Even products that aren’t classified as medical devices aren’t allowed to mention any disease treatment benefits at all. +- Benefit: Article 16 of the Advertising Law states that ads for medical services, drugs, and medical devices must not contain any of the following: (1) assertions or guarantees regarding efficacy or safety; (2) information about cure rates or effectiveness; (3) comparisons of efficacy, safety, or performance with other drugs or medical devices, or with other medical institutions; (4) use of endorsers or testimonials to recommend or vouch for the product. Article 17 adds that aside from ads for medical services, drugs, and medical devices, “no other ads are permitted to reference disease treatment functions, nor may they use medical terminology or language that could easily be confused with drugs or medical devices.” Article 4 further requires all ads to be free of false or misleading content, and to not deceive or mislead consumers; advertisers bear full responsibility for the accuracy of their ad content (National regulations, revised 2021). +- Evidence grade: A +- Notes: There’s only one way to tell if a product is legitimate: whether it dares to make bold, absolute claims. Reputable hospital rehabilitation departments never promise that you’ll stand up after a set number of treatment cycles. If you come across such promotional material, report it to 12315 or your local market regulation authorities. The same marketing tactics are used for health supplements, as detailed in Section 6, Item 10 (Health Supplements). If you’ve already purchased such a product and want a refund, follow the rules for online shopping and prepaid services outlined in Section 5, Item 29 (Online Shopping and Platform Rules). The main beneficiaries of this information are you and your family. +- Sources:中华人民共和国广告法（2021 年修正，第四条、第十六条、第十七条）. + +### 7. After obtaining the disability certificate, visit the county-level civil affairs bureau to ask about all available benefits at once + +- Cost: No cost involved. Just make one trip to the county-level civil affairs bureau and spend a morning asking questions. You’ll need to visit multiple agencies later on. +- In plain terms: The disability certificate itself does not provide any financial support — it simply serves as a key to unlock other benefits. Numerous separate benefits are tied to it, each requiring a separate application; none are granted automatically. Visiting the civil affairs bureau once and asking about every item on the list saves you from having to make multiple trips later. +- Benefit: At least six distinct benefits can be accessed via the certificate, each governed by its own regulations. First, there are the living allowance for low-income disabled individuals and the nursing care subsidy for severely disabled persons, as detailed in Section 7, Item 8. Second, rehabilitation assistance for disabled children is covered under the same section. Third, subsidies for basic assistive devices are provided under Article 26 of the Regulations on Disability Prevention and Rehabilitation for Disabled Persons. Fourth, grants for home modifications to improve accessibility are outlined in Section 9. Fifth, preferential employment opportunities and related services are available to certificate holders, as explained in Section 10. Sixth, a reduction in personal income tax applies, as described in Section 11. Article 26 further states that the state offers basic rehabilitation services to low-income and severely disabled persons through targeted programs, alongside subsidies for basic assistive devices. Article 20 mandates that local authorities and civil affairs bureaus establish community-based rehabilitation centers or contract services to provide guidance, daily living training, nursing care, device provision, and information support (effective July 1, 2017 nationwide). +- Evidence grade: A +- Notes: The application process for the disability certificate itself is described in Section 24, Item 11. Most subsidy amounts and implementation rules are determined at the provincial level, so the same benefit may vary significantly between provinces. Be sure to write down each benefit name during your visit, then verify the exact regulations on the local civil affairs bureau’s website and government portals. Do not rely solely on verbal explanations at the counter. Expect that not all details will be covered in one visit; returning annually is advisable, as policies frequently change. +- Sources:国务院 (2017). 残疾预防和残疾人康复条例（第二十条、第二十六条）. + +### 8. For children under 7 who have disabilities or autism, apply to the county-level civil affairs bureau for rehabilitation assistance. + +- Cost: There is no cost. Simply submit one application to the county-level civil affairs bureau and then choose a qualified rehabilitation center from the approved list. +- In plain terms: The government has established a rehabilitation assistance program for children with disabilities and autism aged 0–6, covering surgeries, assistive devices, and therapy sessions. Initially, priority is given to children from low-income families; however, regions with sufficient financial resources may extend eligibility based on age or economic status. This early intervention window yields the best outcomes, so action should not be delayed until school age. Centers must be selected from the official list maintained by the civil affairs bureau. +- Benefit: According to the State Council’s guidelines, eligible recipients include children aged 0–6 with visual, hearing, speech, physical, or intellectual disabilities, as well as those with autism. This includes children from households receiving minimum living allowances, registered poverty-stricken families, or those under state care. Local authorities may further broaden eligibility criteria based on regional financial capacity. Funding levels are determined by each provincial government and adjusted periodically. This policy is grounded in Article 26 of the Regulations on Disability Prevention and Rehabilitation, which mandates free access to surgeries, assistive devices, and therapy for qualifying children nationwide starting in 2018. +- Evidence grade: A +- Notes: Specific assistance criteria vary by province; consult your local civil affairs bureau’s website for detailed implementation rules. Approved centers are listed there as well. Authorities are required to monitor these facilities rigorously, maintain blacklists for non-compliant providers, and ensure accountability. Unlisted centers demand full out-of-pocket payments and offer no recourse in case of complications. This provision primarily benefits your child, qualifying under the secondary tier of support. Any center guaranteeing “complete recovery” must adhere to the restrictions outlined in Section 6 regarding paralysis treatment. +- Sources:国务院 (2018). 关于建立残疾儿童康复救助制度的意见（国发〔2018〕20 号）. ；国务院 (2017). 残疾预防和残疾人康复条例（第二十六条）. + +### 9. Families can apply to local civil affairs bureaus at or above the county level for subsidies to modify ramps, handrails, and bathrooms at home + +- Cost: There is no application fee. Most modifications qualify for subsidies, though you may still need to cover part of the cost. You’ll also need to contact the local disability services council and your neighborhood office. +- In plain terms: The Law on the Construction of Barrier-Free Environments states that civil affairs bureaus at or above the county level must support and guide home modifications for accessibility, and provide appropriate subsidies to eligible families of persons with disabilities and older adults. These programs are usually coordinated by the disability services council on an annual basis, so early registration is essential. The exact amount of the subsidy and which modifications qualify vary by region. +- Benefit: Article 19 of the Law on the Construction of Barrier-Free Environments reads: “Civil affairs bureaus at or above the county level must support and guide home modifications for accessibility. Eligible families of persons with disabilities and older adults shall receive appropriate subsidies.” Article 18 adds that local authorities must develop and implement targeted plans for retrofitting existing residential buildings, neighborhoods, public facilities, transportation systems, and urban and rural roads that fail to meet accessibility standards. Article 62 gives anyone the right to submit suggestions or complaints regarding accessibility issues to relevant government agencies, which must respond promptly. Article 63 further allows prosecutors to issue recommendations or file public interest lawsuits against any conduct violating these provisions (nationwide, effective September 1, 2023). +- Evidence grade: B +- Notes: This grade is assigned because the law merely requires “appropriate subsidies” without specifying exact amounts or eligibility criteria; those details are left to local discretion. First, check the local disability services council website for programs targeting “home modifications for low-income families with severe disabilities.” Most slots are allocated annually, so early application is crucial. Installing elevators or modifying stairways falls under separate procedures managed by housing authorities. For non-compliant public facilities, Article 62 permits filing a complaint with authorities, who must provide a response. +- Sources:中华人民共和国无障碍环境建设法（第十八条、第十九条、第六十二条、第六十三条）. + +### 10. Mentioning your certification during a job interview can save the employer money + + +- Cost: Zero. You only need to add one extra sentence during the interview; the real challenge is simply speaking up. + +- In plain terms: Employers must hire disabled workers so that they make up at least 1.5% of their total workforce; the exact percentage is set by each province. If they fall short of this target, they must pay a disability employment levy calculated per employee based on the average annual wage of their staff from the previous year. Therefore, hiring you isn’t merely an act of goodwill — it actually cuts down on their expenses. Bringing up your certification during the interview makes it easy for them to see this financial benefit. + +- Benefit: Article 8 of the Regulations on Employment of Disabled Persons states: “Employers must ensure that disabled workers account for at least 1.5% of their total workforce; the precise percentage is determined by provincial governments according to local conditions.” Article 9 adds that employers failing to meet this requirement must pay the disability employment levy. Article 8 of the Measures for Collection, Use, and Management of the Disability Employment Levy provides the calculation formula: “Annual levy amount = (Total number of employees in the previous year × mandated disabled‑worker ratio set by the provincial government) − actual number of disabled workers hired × average annual wage of employees in the previous year.” Moreover, Article 16 exempts micro‑enterprises with 20 or fewer employees that have been operating for no more than three years from this levy if they still cannot meet the mandated hiring ratio. Article 36 of the Law on the Protection of Disabled Persons further guarantees tax incentives for employers who meet or exceed the required disabled‑worker ratio, or who concentrate on hiring disabled personnel (these provisions have been in effect nationwide since 1 May 2007). + +- Evidence grade: A + +- Notes: This advantage does not apply to micro‑enterprises with 20 or fewer employees that have been registered for less than three years; do not rely on it in those cases. The rules governing levy exemptions are updated regularly, so always refer to the latest announcements issued by the Ministry of Finance. Additionally, the requirement to meet the hiring ratio involves genuine employment; merely listing a disabled worker on payroll to claim the exemption is fraudulent and could implicate you as well. For details on eligibility for employment assistance programs and social insurance subsidies, see Section 7, Item 12 (“Employment assistance for disadvantaged individuals”). Information on vocational training subsidies can be found in Section 7, Item 13 (“Vocational training subsidies”). Ultimately, the primary beneficiaries of this arrangement are you, the job applicant. +- Sources:国务院 (2007). 残疾人就业条例（第八条、第九条）. ；财政部、国家税务总局、中国残联 (2015). 残疾人就业保障金征收使用管理办法（财税〔2015〕72 号，第六条、第八条、第十六条）. ；中华人民共和国残疾人保障法（第三十六条）. + +### 11. Tax reductions for individuals with disabilities – how much can be saved? Call your provincial tax bureau for details + + +- Cost: No expense at all. You simply tick a box during filing or submit a one-time registration form. +- In plain terms: The Individual Income Tax Law states that individuals with disabilities may receive tax reductions on their earnings. However, the exact amount and duration of these reductions are left to provincial governments to determine, so they vary from province to province. Some provinces set an annual cap on the reduction, while others apply a percentage cut. To find out the exact figure for your area, call 12366 or check the relevant tax‑relief options in the Individual Income Tax app. +- Benefit: Article 5 of the Individual Income Tax Law reads: “Under any of the following circumstances, individuals may be granted tax reductions; the specific extent and duration shall be prescribed by the people’s governments of provinces, autonomous regions, or municipalities directly under the Central Government and reported to the standing committees of their local people’s congresses: (1) earnings of disabled persons, elderly living alone, and families of martyrs; (2) income affected by major losses caused by natural disasters.” Additionally, Article 36 of the Law on the Protection of Disabled Persons stipulates that the state shall provide tax incentives and waive administrative and service fees for disabled persons engaged in self‑employment (effective 1 January 2019). +- Evidence grade: A +- Notes: The benefit is rated “minor” because the law does not specify any numerical limits; most provinces offer reductions ranging from a few hundred to a few thousand yuan per year. While the amount is modest, the relief can be used indefinitely once obtained, making it worthwhile to apply. The only authoritative figure for your province is the official announcement from the local tax bureau; online comparison tables are often outdated. Self‑employed individuals should also request exemption from administrative fees under Article 36 of the Law on the Protection of Disabled Persons when applying for a business license. +- Sources:中华人民共和国个人所得税法（2018 年修正，第五条）. ；中华人民共和国残疾人保障法（第三十六条）. + +### 12. Guide dogs are allowed in public places and on public transport; blind individuals ride city buses for free. + +- Cost: There is no expense involved. If stopped, one must cite the relevant legal provisions; this may lead to a brief standoff. +- In plain terms: The law clearly states that managers of public venues, transport facilities, and operators of public transport must provide reasonable accommodations for disabled persons traveling with guide dogs, hearing dogs, or other service animals. Additionally, blind individuals with valid identification may ride city buses, trams, subways, and ferries free of charge, and may bring any necessary assistive devices along. Should anyone object, simply point out these two provisions; if that fails, file a complaint. +- Benefit: Article 46 of the Accessibility Law reads: “Managers of public venues, transport facilities, and operators of public transport must provide reasonable accommodations for disabled persons traveling with guide dogs, hearing dogs, or other service animals.” Article 35 further mandates that hotlines for civil services, emergency call systems for police, fire, traffic accidents, and medical emergencies must gradually incorporate accessibility features such as voice output, large print, Braille, and one‑touch dialing. Article 62 grants any individual the right to file complaints or reports regarding violations of this law; authorities must respond promptly. Article 50 of the Law on the Protection of Persons with Disabilities states: “Blind individuals with valid identification may ride city buses, trams, subways, ferries, and other public transport free of charge; mail containing Braille materials is also delivered at no cost.” It adds that local governments must ensure such individuals receive convenient and preferential treatment, including permission to bring any essential assistive devices (nationwide; Accessibility Law effective 1 September 2023). +- Evidence grade: A +- Notes: The wording “provide reasonable accommodations” carries no explicit penalties, so opponents may not yield immediately during a confrontation. Keeping a screenshot of the relevant statutes on one’s phone is more useful than memorizing article numbers. If a resolution cannot be reached on the spot, Article 62 permits filing a formal complaint, which authorities must address. Separate regulations apply to railways and airlines; it is advisable to contact their customer service beforehand. The definition of “valid identification” for free transit varies by region; consulting the local disability affairs office is recommended. +- Sources:中华人民共和国无障碍环境建设法（第三十五条、第四十六条、第六十二条）. ；中华人民共和国残疾人保障法（第五十条）. + +### 13. Disabled candidates taking the national college entrance exam can request reasonable accommodations, including a 50% time extension for those using Braille test papers. + + +- Cost: There is no monetary cost. However, candidates must submit a written application within the timeframe specified by their provincial education authorities and attend an in-person verification session. + +- In plain terms: The Ministry of Education and the China Disabled Persons’ Federation have issued official guidelines outlining specific accommodations for disabled students taking the college entrance exam. These include Braille test papers, large-print test papers, exemption from foreign language listening tests, extended exam time, private testing rooms, and permission to bring hearing aids or wheelchairs into the exam hall. These benefits are not automatically granted; candidates must apply in writing by the deadline set by their provincial education authorities, attaching a valid disability certificate (second generation or newer). If a candidate disagrees with the decision, they may request a review from the provincial education department. + +- Benefit: Article 5 of the “Regulations on Managing Accommodations for Disabled Candidates in the National College Entrance Exam” lists twelve distinct accommodations. These include providing Braille, large-print, or standard test papers for visually impaired students; exempting hearing-impaired students from foreign language listening tests; allowing visually impaired students to bring Braille pens, writing boards, non-recording Braille typewriters, electronic visual aids, white canes, and magnifying glasses into the exam; permitting hearing-impaired students to use hearing aids or cochlear implants; and allowing mobility-limited students to bring wheelchairs or walking aids, with custom desks and chairs available upon request. The time extension is clearly defined in Article 5, Paragraph 6: “For visually impaired candidates using Braille test papers, the total exam time is extended by 50% relative to the standard duration; for those using large-print or standard papers, or for candidates with limited hand mobility due to cerebral palsy or other conditions, the extension is 30%.” Additional benefits include priority access to exam venues, private standardized testing rooms, and on-site assistance from guides and sign language interpreters. Article 7 details the application process: candidates must submit a formal written request by the provincial deadline, accompanied by a valid disability certificate; an expert panel then conducts an on-site assessment, after which the provincial education authority issues a written notice of approval or denial. Article 8 allows candidates to appeal any decision via a written review request to the provincial education department. Article 9 specifies that for candidates exempt from foreign language listening tests, the final score is calculated as “written test score × total foreign language points / total written test points.” Finally, Article 18 states that these same accommodations may be applied to other national education exams, such as graduate school admissions or adult college entrance exams (National Regulations, effective April 7, 2017). + +- Evidence grade: A + +- Notes: Each province sets its own application deadline, which is published in its annual college entrance exam registration guidelines. Missing this deadline means no eligibility for accommodations that year. Therefore, students and parents should check their provincial education authority’s website during the first semester of senior year to confirm the exact application window. Article 18 also provides a broader pathway: similar accommodations can be requested for other national education exams, including graduate school and adult college entrance exams. Additionally, Article 14 of this section explicitly prohibits schools from denying enrollment to disabled students. The primary beneficiaries of these provisions are the candidates themselves or their children. +- Sources:教育部、中国残联 (2017). 残疾人参加普通高等学校招生全国统一考试管理规定（教学〔2017〕4 号，第五条、第七条、第八条、第九条、第十八条）. + +### 14. Schools may not refuse enrollment for children with disabilities; those unable to attend receive in‑home instruction arranged by the education bureau + +- Cost: No expense is required. A single application must be submitted, and an evaluation may be necessary. If a school refuses, you must escalate the matter to the local education bureau. +- In plain terms: The regulations clearly state that preschools and schools at all levels must not deny enrollment to eligible children with disabilities. This applies to regular vocational schools as well. For children who need personal care and cannot attend school, county‑level education authorities must arrange in‑home instruction or distance learning and include them in the official student registry. Decisions on admission and transfers are made by an expert committee on disability education appointed by the county education bureau, not by the schools themselves. +- Benefit: Article 7 of the Regulations on Education for Persons with Disabilities reads: “Preschools, schools at all levels, and other educational institutions shall provide education for persons with disabilities in accordance with these regulations and relevant national laws; they may not refuse enrollment to persons with disabilities who meet legal requirements.” Article 29 adds: “Regular vocational schools may not refuse admission to persons with disabilities who satisfy the stipulated admission criteria, and regular vocational training centers must actively enroll them.” The regulations further require that county governments arrange in‑home instruction or remote learning for eligible children who need care and cannot attend school, while also maintaining their enrollment records. Article 20 mandates that county education authorities, together with health, civil affairs agencies, and disability organizations, form an expert committee comprising educators, psychologists, rehabilitation specialists, and social workers to assess each child’s health, educational capacity, and ability to adapt to school life; the results are confidential. Article 23 permits some flexibility in academic expectations for disabled students attending regular classes. Article 52 allows applicants to request reasonable accommodations for national examinations (effective 1 May 2017). +- Evidence grade: A +- Notes: A school’s verbal claim that “we lack the facilities” is not binding; you must obtain a written response and then approach the county education bureau. The evaluation is conducted by the expert committee appointed by the bureau. The clause in Article 23 about flexible learning standards is valuable when a school attempts to expel a child on academic grounds. Guidance on documenting bullying and the required school procedures can be found in Section 30, Item 3 (School bullying). Information on reasonable accommodations for college entrance exams appears in Section 13 (Reasonable accommodations). This provision benefits your child directly. +- Sources:国务院 (2017). 残疾人教育条例（第七条、第二十条、第二十三条、第二十九条、第五十二条）. + +### 15. People missing their right lower limb or both lower limbs can still obtain a driver’s license; the designated category is C5 + +- Cost: The tuition fees are comparable to those for regular driver’s licenses — typically a few thousand yuan in most regions. The vehicle must be modified to allow manual control, and a medical checkup is required every three years. +- In plain terms: According to regulations issued by China’s Ministry of Public Security, there exists a specific driver’s license category designated for people with disabilities, known as “small automatic passenger cars for disabled persons,” identified by the code C5. Individuals who have lost or lack movement function in their right lower limb or both lower limbs yet can sit upright on their own, provided their upper limbs meet certain criteria, are eligible to apply. A similar pathway exists for those missing one entire palm. Separate license categories also apply to people with visual impairments affecting only one eye or hearing impairments. All required medical evaluations must be conducted at specialized medical institutions approved by provincial health authorities. +- Benefit: Annex 1 of the “Regulations on the Application and Use of Motor Vehicle Driver’s Licenses” outlines detailed physical eligibility criteria. Clause 8 explicitly states that individuals missing or lacking movement function in their right lower limb or both lower limbs, yet capable of independent sitting posture, and whose upper limbs satisfy stipulated conditions, may apply for a C5 license. Likewise, those missing only their left lower limb while retaining normal right lower limb function may qualify for a standard small automatic car license. For visual impairments, applicants must have at least 5.0 corrected visual acuity in their better eye and a horizontal visual field spanning 150 degrees to qualify for licenses covering small cars, small automatic cars, low-speed trucks, three-wheeled vehicles, and C5 vehicles. Hearing-impaired applicants who can still locate sound sources via hearing aids may obtain licenses for small cars and small automatic cars, provided they wear such aids while driving. Article 85 mandates that medical certificates for C5 license applicants must originate from authorized provincial medical institutions. Holders of this license must undergo periodic health evaluations every three years and submit updated certificates within 30 days after each scoring cycle concludes. Additionally, Article 78 requires all C5 vehicle owners to affix a nationally standardized “disabled persons’ motor vehicle” signage as stipulated by Ministry of Public Security Order No. 172, effective 1 January 2025. +- Evidence grade: A +- Notes: An alternative, far less restrictive option involves operating specially designed motorized wheelchairs for disabled persons. Classified as non-motorized vehicles under Article 119 of the Road Traffic Safety Law, these do not necessitate a driver’s license; Article 58 further limits their maximum speed on non-motorized lanes to 15 km/h. Modifying a standard vehicle for C5 use involves installing manually operated throttle and brake mechanisms via certified manufacturers, followed by official registration updates at local vehicle authorities. Failure to submit updated health documentation within one year following three consecutive scoring cycles results in automatic license revocation. +- Sources:公安部令第 172 号. 机动车驾驶证申领和使用规定（第七十八条、第八十五条、附件 1）. + +### 16. Rehabilitation should be carried out at a proper facility with a rehabilitation medicine department; the intensity must be set by therapists — more intensity does not necessarily mean better results. + + +- Cost: Inpatient rehabilitation costs several hundred yuan per day; the out‑of‑pocket portion varies by region. Treatment is billed on a monthly basis. Daily exercises are required and can be quite monotonous. + +- In plain terms: The most common mistake is simply sending a patient home to lie down and hope for a natural recovery. Care delivered by a coordinated, multidisciplinary team helps many patients survive one year later and continue living at home. However, patients should not overdo it on their own. In a trial involving over 2,000 participants, early, frequent, and more intensive activity within 24 hours after a stroke actually led to poorer outcomes three months later. Thus, the amount and timing of exercise must be determined by the rehabilitation department and therapists. + +- Benefit: A Cochrane systematic review included 29 trials with 5,902 participants, comparing organized inpatient stroke‑unit care with other forms of care. At the final follow‑up (median 1 year), the odds ratio for adverse outcomes — death, disability, or need for institutional care — was 0.77 (95% CI 0.69–0.87). The odds ratio for death alone was 0.76 (95% CI 0.66–0.88), and for death or dependence it was 0.75 (95% CI 0.66–0.85); evidence quality is moderate. In absolute terms, for every 100 patients receiving stroke‑unit care, an additional 2 survive, 6 continue living at home, and 6 regain the ability to care for themselves. Conversely, the AVERT trial randomly assigned 2,104 patients across 56 acute stroke units in five countries to either “standard care” or “standard care plus very early intensive activity.” After three months, 480 patients (46%) in the early‑activity group achieved a good outcome (modified Rankin Scale 0–2) versus 525 patients (50%) in the standard‑care group; the adjusted odds ratio was 0.73 (95% CI 0.59–0.90, P=0.004). Death rates were 88 versus 72 patients, with no statistically significant difference (odds ratio 1.34, 95% CI 0.93–1.93, P=0.113). + +- Evidence grade: A + +- Notes: Caution: Both studies involve stroke patients; their findings cannot be directly applied to other disabling conditions such as spinal cord injury, amputation, or burns. The AVERT trial demonstrates that “the earlier and more intense the activity, the better” is not true; it does not mean that early activity is useless. In both trials, the majority of participants began walking within 24 hours; the difference lay in frequency and total volume of exercise. When selecting a facility, verify whether it has a rehabilitation medicine department and qualified physical and occupational therapists — do not rely solely on a “rehabilitation” sign. Information on referrals between primary and tertiary hospitals and related cost thresholds can be found in Section 24.1 (step‑by‑step referrals). Community‑based rehabilitation and assistive devices are discussed in Section 16.7 (contact the county disability‑affairs office). +- Sources:Langhorne P, Ramachandra S; Stroke Unit Trialists' Collaboration (2020). Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database of Systematic Reviews, 4:CD000197. ；AVERT Trial Collaboration group (2015). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386(9988):46-55. + +### 17. Getting a hearing aid when hearing declines — the reason is to hear better now, not to prevent dementia + +- Cost: Hearing aids cost several thousand to tens of thousands of yuan; most must be paid for out of pocket. Fitting requires professional testing and multiple follow‑up adjustments. +- In plain terms: The claim that “wearing a hearing aid prevents dementia” currently lacks solid evidence. A three‑year trial involving nearly a thousand participants found no overall difference between groups. Only among people already at higher risk of cognitive decline did a modest benefit appear. Thus, the main reason to get a hearing aid is to hear clearly now — to talk with others and hear traffic while crossing the street — not to protect the brain decades later. +- Benefit: The ACHIEVE trial took place in four U.S. communities and enrolled 977 individuals aged 70–84 with untreated hearing loss but no obvious cognitive impairment. Participants were randomly assigned to either hearing intervention (counseling and hearing aid fitting) or health‑education control, with follow‑up every six months. The primary endpoint was change in overall cognitive scores over three years. In the combined analysis of both participant cohorts, there was no significant difference: the intervention group showed a change of −0.200 (95% CI −0.256 to −0.144) versus −0.202 (95% CI −0.258 to −0.145) in the control group; the difference was 0.002 (95% CI −0.077 to 0.081, P = 0.96). A pre‑specified sensitivity analysis revealed a statistically significant interaction (P = 0.010) between the two cohorts. The second cohort comprised older participants with more risk factors for cognitive decline and lower baseline cognitive scores. Researchers concluded that hearing intervention may modestly slow cognitive decline over three years in high‑risk individuals but not in those at lower risk. No serious adverse events attributable to the intervention were reported. +- Evidence grade: A +- Notes: Controversy: The oft‑quoted claim that “hearing aids cut cognitive decline by nearly half” stems from a subgroup analysis of this trial, not its primary result, which showed no overall difference. This note is included to separate the practical benefit of hearing aids from the unproven dementia‑prevention claim. Students with hearing impairments may be exempt from foreign‑language listening tests in college entrance exams; see item 13 (reasonable accommodations) in this section. Drivers with hearing loss should wear hearing aids; see item 15 (C5) in this section. +- Sources:Lin FR, Pike JR, Albert MS, et al.; ACHIEVE Collaborative Research Group (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet, 402(10404):786-797. + +### 18. Saying an adult “can’t manage his own affairs” requires a court determination; family members can’t decide on their own + + +- Cost: Filing a petition with the court incurs filing fees, typically ranging from a few dozen to a hundred yuan. An additional evaluation fee is required, usually several thousand yuan, which the applicant must pay upfront. The entire process takes several months. +- In plain terms: Only a court can decide whether an adult is “incapable of civil conduct” or “has limited civil capacity.” Family members, employers, or residents’ committees cannot make that determination on their own. A party with a vested interest or a relevant organization must file a petition with the court. Conversely, if a person’s mental or intellectual abilities improve, an application can be made to restore his capacity. This procedure serves both as a safeguard and a protection mechanism. +- Benefit: Article 21 of the Civil Code states: “An adult who cannot recognize his own actions is deemed incapable of civil conduct; his legal representative must act on his behalf in all civil matters.” Article 22 adds: “An adult who can only partially recognize his actions is considered to have limited civil capacity; his legal representative must act on his behalf or give consent and ratification for any civil acts, though he may independently perform acts that yield pure benefits or are consistent with his mental and intellectual condition.” Article 24 further provides that any interested party or relevant organization may petition the court to declare such an adult incapable or of limited capacity. Once declared, upon application by the individual, interested parties, or relevant organizations, the court may later restore his limited or full capacity based on improvements in his mental health. Relevant organizations include residents’ committees, villagers’ committees, schools, medical institutions, women’s federations, disability federations, legally established senior citizen groups, and civil affairs bureaus. Article 23 designates guardians as legal representatives for those lacking or having limited capacity (nationwide, effective 1 January 2021). +- Evidence grade: A +- Notes: The associated costs must be clearly outlined. This procedure is a special court process; it is faster than regular civil cases but still takes several months. Medical diagnosis records must be submitted, and most courts also order an independent evaluation, the fees for which are typically several thousand yuan and paid upfront by the applicant. Signing documents or disposing of property on someone’s behalf without following this process may render those actions invalid; even property sales could be reversed. It is also important to remember that limited capacity does not mean a person can’t perform any actions at all. He may independently handle matters consistent with his mental state or those that bring him pure benefits; guardians should not automatically handle everything on his behalf. Details on determining guardianship are provided in section 19 (Guardians). +- Sources:中华人民共和国民法典（第二十一条、第二十二条、第二十三条、第二十四条）. + +### 19. Guardians for adults are appointed in a legal order; if the ward injures someone, the guardian must pay compensation. + +- Cost: There are no direct costs. When disputes arise, parties must turn to the residents' committee, villagers' committee, civil affairs bureau, or court to resolve them. +- In plain terms: Once an adult loses the capacity to act, a guardian must be appointed following this order: spouse, parents and children, other close relatives, and finally any other individual or organization willing to serve. If there is disagreement over who should serve, the local residents' committee, villagers' committee, or civil affairs bureau makes the appointment; parties may appeal to court if they disagree. Conversely, while still of sound mind, an adult may put in writing who they wish to serve as their guardian. If the ward injures someone, the appointed guardian is legally responsible for paying compensation. +- Benefit: Article 28 of the Civil Code states that adults lacking or having limited civil capacity must be guarded in this order: “(1) Spouse; (2) Parents and children; (3) Other close relatives; (4) Any other individual or organization willing to serve, provided they receive approval from the local residents' committee, villagers' committee, or civil affairs bureau.” Article 31 adds that when disputes arise over guardianship, the local residents' committee, villagers' committee, or civil affairs bureau appoints a guardian; parties may appeal to court if they disagree, and the appointment must respect the ward’s true wishes and be made in their best interest. Until a guardian is appointed, the residents' committee, villagers' committee, or other legally designated organizations act as temporary guardians. Article 33 permits adults of full capacity to name their own guardian in writing while still of sound mind. Article 1188 stipulates that guardians must pay compensation when their ward causes harm; if they fulfilled their duties, the liability may be reduced. Compensation is paid first from the ward’s own assets, with any shortfall covered by the guardian. Article 1189 clarifies that even when guardians delegate duties, they remain liable; only when the delegatee is at fault does liability shift partially. This framework has been in effect nationwide since 1 January 2021. +- Evidence grade: A +- Notes: Article 33 specifically addresses voluntary guardianship. Drafting a written arrangement while still of sound mind can prevent most future disputes; see Section 17, Item 1 for guidance on drafting such documents. Regarding compensation, guardians remain liable even when the ward is placed under the care of relatives or institutions; only when those caretakers are at fault does liability shift partially. Purchasing guardian liability insurance is therefore advisable. Article 78 of the Mental Health Law also holds guardians accountable for any harm caused by neglect or failure to fulfill their duties. +- Sources:中华人民共和国民法典（第二十八条、第三十一条、第三十三条、第一千一百八十八条、第一千一百八十九条）. + +### 20. If you’re denied a job, denied promotion, or paid less because of a disability, you can sue — but first calculate the associated costs. + + +- Cost: Legal fees range from several thousand to tens of thousands of yuan, all paid by you. A standard first-instance trial takes at least six months and can be extended. You must also gather and preserve all relevant evidence on your own. + +- In plain terms: The law prohibits discrimination against people with disabilities in hiring, promotion, salary, social insurance, and related areas. You may file a complaint with the relevant authorities or go directly to court. However, winning the case does not automatically mean the other party will pay your legal fees — those are not covered under standard court costs. Therefore, it’s wise to first file a complaint, apply for legal aid, and then consider litigation. + +- Benefit: Article 3 of the Law on the Protection of Persons with Disabilities states: “Discrimination based on disability is prohibited. Insults and infringements against persons with disabilities are forbidden.” Article 38 adds: “Employers must not discriminate against employees with disabilities in hiring, promotion, professional qualification assessment, remuneration, social insurance, welfare, rest periods, or other aspects. Employers must also provide suitable working conditions and necessary accommodations.” Article 64 further specifies that violations can be corrected by authorities, and affected individuals may file lawsuits. The Regulations on Employment of Persons with Disabilities likewise forbid such discrimination. Under the Legal Aid Law, persons with disabilities are exempt from proving financial hardship when applying for legal assistance. + +- Evidence grade: A + +- Notes: Always calculate the costs first. A standard trial lasts at least six months; a simplified procedure takes three months. Legal fees are not included in court costs, so filing a complaint with labor authorities or the disability rights association — and applying for legal aid — are far less expensive options. Gathering evidence is often the toughest part; few employers provide written reasons for rejections, so recordings or chat logs are invaluable. For current employees, labor arbitration applies; details on evidence preservation and deadlines are covered in Section 19, Item 8. This guidance is meant solely for your protection. +- Sources:中华人民共和国残疾人保障法（第三条、第三十八条、第六十四条）. ；国务院 (2007). 残疾人就业条例（第四条、第十三条）. ；中华人民共和国法律援助法（第四十二条、第四十五条）. diff --git a/book/en/34-Avoid-Serious-Harm-From-Home-Medicines.md b/book/en/34-Avoid-Serious-Harm-From-Home-Medicines.md new file mode 100644 index 00000000..a9658b4d --- /dev/null +++ b/book/en/34-Avoid-Serious-Harm-From-Home-Medicines.md @@ -0,0 +1,92 @@ +[← Back to main index](../../README.md) + +# 34. Avoid serious harm from over-the-counter medicines at home + +Fever reducers, painkillers, cold remedies, stomach meds, and anti-diarrheal drugs — many of these can be bought without a prescription at any pharmacy. Just because they’re available without a doctor’s order doesn’t mean they can be taken carelessly. This section won’t list which medicine fits each condition; instead, it highlights a few simple actions that can prevent serious consequences. + +All figures here are based on mortality rates, covering outcomes such as liver failure, stomach bleeding, and newborn kidney failure. Most benefits boil down to “preventing at least one serious incident.” Since studies rarely quantify exactly how much risk drops after taking these steps, the benefit level is judged by how severe those possible outcomes would be — each entry explains the reasoning behind its rating. + +For topics already covered elsewhere, we simply point the way. If someone accidentally swallows medicine or cleaning products, see section 13, item 20 (accidental ingestion). For chronic-disease medicines taken as prescribed for the full course, see section 16, item 1 (finish the prescribed course). For buying prescription drugs online only after a prescription review, see section 28, item 6 (get weight-loss drugs with a hospital prescription). + +The beneficiaries of this section’s items are you and your family — the top two tiers. +### 1. Before taking two cold or pain relievers at the same time, check their ingredient lists — only one of them should contain acetaminophen. + + +- Cost: No cost at all. It only takes a minute or two to glance at the ingredient list on each package. +- In plain terms: Acetaminophen is present in many cold medicines. Taking two such products means you’re consuming double the dose, which can damage the liver. In the U.S., nearly 30% of patients suffering from acute liver failure due to acetaminophen never receive a liver transplant in time. Domestic instructions recommend a maximum daily intake of 2 grams, and alcohol should be avoided while taking this drug. +- Benefit: Over six years, 22 U.S. hospitals tracked 662 cases of acute liver failure. Of these, 275 (42%) were caused by acetaminophen; the median dose consumed was 24 grams. Among those 275 patients, 131 (48%) took the drug unintentionally. In 38% of those cases, they were also taking two or more other medications containing acetaminophen. Ultimately, 27% of these patients died before a transplant became possible, while 8% underwent liver transplantation. In 2020, China’s National Medical Products Administration mandated that OTC packaging clearly state excessive use can cause severe liver damage and that the daily limit is 2 grams. Packaging must also warn against combining this drug with other acetaminophen-containing or analgesic products. U.S. regulations require such OTC products to explicitly list three main risk factors: exceeding the daily limit, concurrent use with other acetaminophen-containing drugs, and drinking more than three alcoholic drinks daily while taking it. +- Evidence grade: B +- Sources:Larson AM, Polson J, Fontana RJ, et al.; Acute Liver Failure Study Group (2005). Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology, 42(6):1364-1372. ；国家药监局关于修订对乙酰氨基酚常释及缓释制剂说明书的公告（2020年第15号）及附件2《对乙酰氨基酚常释制剂非处方药说明书修订要求》（湖南省药品监督管理局转载）. ；21 CFR 201.326(a)(1)(iii)(A) Liver warning. +- Notes: Acetaminophen is also known as paracetamol. Cold medicines whose generic names contain the characters “anfen” — such as paracetamol pseudoephedrine or paracetamol caffeine chlorpheniramine — all contain this ingredient. When in doubt, bring all your medications to a pharmacist for review. This evidence grade is set at B because the U.S. data comes from case registries lacking a control group, so it’s impossible to calculate exactly how many adverse events could be prevented by checking ingredient lists. The “large” benefit rating is based on the severity of outcomes: nearly 30% of acute liver failure cases end in death. + +### 2. Do not give children aspirin, nimesulide, or metamizole for fever; cold medicines containing metamizole should also be avoided in minors. + +- Cost: No cost involved. Simply check the generic name and ingredient list when buying fever reducers. +- In plain terms: For reducing a child’s fever, none of these three drugs should be used. Aspirin is linked to Reye’s syndrome, a condition that damages the brain and liver; in U.S. statistics, around 30% of affected children died, though cases dropped by over 90% after warnings were issued. Nimesulide is prohibited for children under 12, while metamizole is banned for anyone under 18. +- Benefit: Reye’s syndrome can lead to brain disease and fatty liver degeneration, typically occurring after influenza or chickenpox infections. Nationwide monitoring in the U.S. from 1981 to 1997 recorded 1,207 cases among children under 18; 82% of these had detectable salicic acid in their blood, a key component of aspirin-like drugs. The overall mortality rate was 31%. Warnings about salicylate-containing drugs began in 1980, when 555 cases were reported — the peak figure; since 1987, annual cases have stayed under 36. China’s drug regulator prohibited oral nimesulide formulations for children under 12 in 2011, and banned metamizole tablets for anyone under 18 in 2020. This ban also applies to compound Qinghao Metamizole Tablets, Chongganling Tablets, and Chongganling Capsules, all of which contain metamizole. +- Evidence grade: B +- Sources:Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377-1382. ；关于加强尼美舒利口服制剂使用管理的通知（国食药监安〔2011〕209号）. ；国家药监局关于修订安乃近相关品种说明书的公告（2020年第34号）及附件1至3. +- Notes: Metamizole is not a first-choice treatment even for adults. Its package insert notes it may cause agranulocytosis, aplastic anemia, and anaphylactic shock, so it is only used short-term for severe conditions when no other effective drugs are available. Despite its name, Chongganling is not a regular cold medicine — it contains metamizole as well. For appropriate fever reducers and correct dosages based on body weight, consult a pediatrician or pharmacist. Infants under 3 months with a fever should be taken to a hospital immediately, as noted in Section 20, Item 8 (fever above 38°C requires immediate medical care). This B rating reflects that Reye’s syndrome statistics derive from monitoring reports, and the drop in cases after warnings is a correlative trend rather than evidence from controlled trials; the “significant benefit” rating is justified by the marked reduction in cases from 555 annually to under 36 after warnings were issued. + +### 3. People over 60, with a history of stomach bleeding, taking anticoagulants or steroids should consult a doctor before using painkillers like ibuprofen + +- Cost: No cost involved. Simply ask a doctor or pharmacist. +- In plain terms: Painkillers such as ibuprofen, naproxen, and aspirin can harm the stomach. In large-scale trials, individuals taking ibuprofen faced roughly four times the risk of stomach bleeding or perforation compared to those not taking it. This risk is even higher for older adults, those with prior stomach bleeding, individuals on anticoagulants or steroids, and regular drinkers. +- Benefit: These medications are classified as nonsteroidal anti-inflammatory drugs (NSAIDs); common examples include ibuprofen, naproxen, and diclofenac. A meta-analysis encompassing 280 randomized trials involving 124,513 participants demonstrated that compared to placebo, ibuprofen raised the risk of upper gastrointestinal perforation, obstruction, or bleeding by an RR of 3.97 (95% CI 2.22–7.10; roughly fourfold). Naproxen showed an RR of 4.22 (2.71–6.56), while diclofenac resulted in an RR of 1.89 (1.16–3.09). All NSAIDs also approximately double the risk of heart failure. U.S. regulations mandate that over-the-counter NSAIDs carry warnings about stomach bleeding; these warnings specifically identify six high-risk groups: individuals over 60, those with prior stomach ulcers or bleeding, people on anticoagulants or steroids, individuals concurrently taking multiple NSAIDs, drinkers consuming more than three alcoholic beverages daily, and users exceeding recommended dosages or duration. +- Evidence grade: A +- Sources:Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9894):769-779. ；21 CFR 201.326(a)(2)(iii)(A) Stomach bleeding warning. +- Notes: The study conclusions pertain to high-dose usage. No separate figures are provided for occasional short-term use at standard doses. Many multi-ingredient cold remedies also contain NSAIDs; combining them with separate painkillers results in redundant intake. Patients prescribed low-dose aspirin long-term by physicians for thrombosis prevention must not discontinue it or self-administer additional NSAIDs without medical guidance. + +### 4. For children under 2 with colds, don’t give them over-the-counter multi-ingredient cold and cough medicines on your own + +- Cost: There is no cost at all; you even save money by not buying these medicines. +- In plain terms: China’s National Medical Products Administration requires 14 types of over-the-counter multi-ingredient cold medicines for children to carry a warning label stating they are not recommended for parents to give to kids under 2 years old, and should only be used under the guidance of a doctor or pharmacist. Clinical trials conducted on children show that cough medicines and antihistamines have no better effect than placebo. +- Benefit: In its Announcement No. 57 of 2021, the National Medical Products Administration updated the instructions for 14 such medicines, including paracetamol, pseudoephedrine and dextromethorphan oral solution, pediatric paracetamol, artificial cow-bezoar and chlorpheniramine maleate granules, and pediatric paracetamol and amantadine hydrochloride granules. The new warning reads: “It is not recommended for parents or guardians to give these products to infants under 2 years old on their own; they should only be used under the guidance of a doctor or pharmacist.” An additional note was added: “These products must be used strictly according to the dosage instructions on the package to avoid overdosing.” Another note states: “Concurrent use of other cold medicines containing the same or similar active ingredients should be avoided.” A Cochrane systematic review included 29 randomized controlled trials, 10 of which were conducted on children. For all these medicine types, no better effect than placebo was observed in pediatric trials: cough medicines, antihistamines (the anti-allergy component), antihistamines combined with decongestants (the ingredient that relieves nasal congestion), and cough medicines combined with bronchodilators. Adverse reactions were reported in 21 studies, with formulations containing antihistamines and dextromethorphan showing a higher incidence of side effects. +- Evidence grade: B +- Sources:国家药监局关于修订氨酚麻美口服溶液等14个品种药品说明书的公告（2021年第57号）及附件. ；Smith SM, Schroeder K, Fahey T (2014). Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews, (11):CD001831. +- Notes: Many of these 14 medicines have “paracetamol” in their name, as they contain acetaminophen. Taking them together with other fever reducers will lead to redundant intake, as noted in Section 1 of this chapter (on acetaminophen). One trial included in the review found honey to be more effective than placebo for treating coughs, but honey should not be given to children under 1 year old, as detailed in Section 20, Item 6 (on honey). The evidence grade is set to B because there are very few trials for each type of medicine in the review, and the authors could not calculate a combined statistical figure. The benefit level is rated “moderate” as there is no proven benefit of these medicines for children, while the main risks are overdosing and redundant intake of similar active ingredients. + +### 5. Pregnancy after 20 weeks: avoid taking ibuprofen and similar painkillers on your own + +- Cost: No cost involved. +- In plain terms: After 20 weeks of pregnancy, most of the amniotic fluid is produced by the fetus’s kidneys. Taking ibuprofen or similar medications at this stage may harm the fetal kidneys and reduce the amount of amniotic fluid. Some reports received by U.S. authorities describe cases where newborns died after such exposure. Low-dose aspirin prescribed by doctors is not included in this warning. +- Benefit: In October 2020, the U.S. Food and Drug Administration (FDA) issued a safety warning. Use of nonsteroidal anti-inflammatory drugs after roughly 20 weeks of pregnancy may cause kidney problems in the fetus, leading to low amniotic fluid levels. This warning applies to both prescription and over-the-counter drugs, including aspirin, ibuprofen, naproxen, diclofenac and celecoxib. After reviewing adverse event reports up to July 2017, the FDA identified 35 cases of low amniotic fluid or neonatal kidney dysfunction, all with serious outcomes; 5 of these newborns died, each with accompanying kidney failure. In most documented cases, amniotic fluid levels returned to normal within 72 hours to 6 days after medication use stopped. The FDA advises pregnant women not to take these drugs after week 20 unless explicitly directed by a doctor. Low-dose aspirin (81 mg) prescribed for specific pregnancy-related conditions is exempt from this restriction. When pain relief or fever reduction is needed, the FDA recommends using alternatives such as acetaminophen; consult a pharmacist or doctor first. +- Evidence grade: B +- Sources:U.S. Food and Drug Administration (2020-10-15). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. Drug Safety Communication. +- Notes: The FDA notes that many over-the-counter products for colds, flu or insomnia also contain these ingredients, so always check the ingredient list. Previously, U.S. over-the-counter drug labels only warned against use in the final 3 months of pregnancy; this new warning sets the cutoff at around 20 weeks. Low-dose aspirin for preventing preeclampsia is discussed in Section 27, point 5 (“Low-dose aspirin”). The grade B rating reflects that these figures come from adverse event reports; we have no data on how many women took these drugs without experiencing any issues. The “moderate” benefit rating reflects the seriousness of these outcomes, even though they occur infrequently. + +### 6. Buying omeprazole over the counter for heartburn and acid reflux — use it for no more than 7 days; see a doctor immediately if you have trouble swallowing, vomit blood, or pass black stools + +- Cost: No cost involved — just follow the dosage instructions on the package. +- In plain terms: Since 2022, omeprazole enteric-coated tablets have been available over the counter without a prescription. However, the package instructions clearly state that you should only take it for up to 7 days, and avoid using it again within two months. If you experience trouble swallowing, pain in the throat, vomit blood, or pass black stools, do not take it on your own — these are potential signs of serious medical conditions. This medication can also mask symptoms of stomach cancer, potentially delaying an accurate diagnosis. +- Benefit: In its Announcement No. 68 of 2022, the National Medical Products Administration reclassified omeprazole enteric-coated tablets from a prescription drug to an over-the-counter medication, and released a standard package insert for it. The approved indication listed in the insert is “short-term relief of heartburn and acid reflux caused by excess stomach acid”. The precautions section specifies that the drug must not be used for more than 7 days, and that patients should consult a physician or pharmacist if symptoms persist. It also states that the drug must not be taken again within two months, and that immediate medical attention is required if symptoms recur. Use is prohibited if a patient has trouble swallowing, throat pain, vomit blood, or passes black stools, as these are possible indicators of serious illness. For patients showing warning signs such as unexplained weight loss, repeated vomiting, trouble swallowing, vomit blood, or black stools, malignant tumors must be ruled out first, since treatment with this drug may conceal symptoms and delay diagnosis. Patients over 55 years old with new or changing symptoms should consult a doctor before use. People taking clopidogrel must avoid taking omeprazole at the same time. +- Evidence grade: B +- Sources:国家药监局关于奥美拉唑肠溶片处方药转换为非处方药的公告（2022年第68号）及附件2《非处方药说明书范本》. +- Notes: Clopidogrel is a blood-thinning medication commonly prescribed to patients who have had a stent implanted or a myocardial infarction. Omeprazole can reduce its effectiveness, so patients taking clopidogrel must consult a doctor first. The evidence grade is set to B because these requirements are stipulated in the official package insert, and no research has been conducted to quantify how many adverse events can be prevented by following these instructions. The benefit level is rated “moderate” because while this medication helps prevent delayed diagnosis of stomach bleeding or stomach cancer, most cases of heartburn and acid reflux are not severe. + +### 7. Don’t ask doctors for antibiotics for the common cold + +- Cost: It costs nothing and can even save you money on medicine. +- In plain terms: Taking antibiotics for a cold doesn’t speed up recovery compared to not taking them at all. For adults, the risk of side effects is more than twice as high when using antibiotics. For cases where nasal discharge with pus lasts less than 10 days, there is no clear benefit to taking antibiotics either. +- Benefit: A Cochrane systematic review pooled data from 6 randomized trials involving 1,147 participants. When comparing antibiotic use to placebo for treating colds, there was no significant difference in the proportion of people who did not recover or whose symptoms persisted (RR 0.83, 95% CI 0.60–1.14, no statistically significant difference). The risk of adverse reactions was 1.8 times higher than in the placebo group (95% CI 1.01–3.21). For adults specifically, this risk was 2.62 times higher (1.32–5.18), while no increase was observed in children (RR 0.91, 0.51–1.63). For acute purulent rhinitis where nasal discharge with pus lasts less than 10 days, antibiotics also showed no clear benefit (RR 0.73, 0.47–1.13). However, the risk of adverse reactions rose by roughly 46% (RR 1.46, 1.10–1.94). The authors concluded that routine use of antibiotics is not recommended for either of these conditions. +- Evidence grade: A +- Sources:Kenealy T, Arroll B (2025). Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews, 11:CD000247. +- Notes: This updated version was released in 2025; the abstract states that literature searches were conducted up to 2013. Antibiotics are prescription-only drugs in China, so pharmacies must sell them only with a valid prescription. Do not take leftover antibiotics at home without medical advice. The “moderate” rating for benefits is based on the fact that antibiotics primarily reduce the risk of adverse reactions rather than preventing death. + +### 8. For diarrhea, start by drinking oral rehydration solution; do not give anti-diarrheal drugs to children under 5 + +- Cost: A box of oral rehydration solution costs just a few dollars, so it’s worth keeping one at home. +- In plain terms: The most important thing during diarrhea is rehydration, not stopping the diarrhea itself. Mix the solution exactly as directed on the package and drink it — never substitute it with sugary juices or soft drinks, as the excess sugar can actually worsen dehydration. Never give anti-diarrheal medications such as loperamide to kids under 5 years old; in severe cases these drugs can cause life-threatening intestinal blockages. +- Benefit: WHO’s guidelines on diarrhea treatment state clearly that anti-diarrheal and anti-vomiting drugs provide no real benefit for children with acute or prolonged diarrhea. They do not prevent dehydration or improve nutritional status, and some carry serious, even fatal side effects — so they must never be given to children under 5. Drugs like loperamide that slow intestinal motility can lead to severe paralytic intestinal obstruction, which is potentially fatal and can prolong the underlying infection. The same guidelines also warn that drinks high in sugar draw water into the intestines, causing hypernatremic dehydration; this applies to soft drinks and most commercially sold fruit juices. WHO recommends a low-osmolarity formula with a total osmotic pressure of 245 mOsm/L; compared to older formulations, this reduces unplanned intravenous fluid administration by 33%. A Cochrane review of 8 trials reached similar conclusions (OR 0.59, 95% CI 0.45–0.79), showing roughly a 40% reduction in complications when this solution is used. +- Evidence grade: A +- Sources:World Health Organization (2005). The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. ；Hahn S, Kim S, Garner P (2002). Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews, (1):CD002847. +- Notes: When purchasing oral rehydration solution, always check the package label for its osmotic pressure and choose the low-osmolarity version. The WHO guidelines also note that blood in a child’s stool almost always indicates bacterial dysentery, which requires medical treatment with antibiotics — rehydration alone is not sufficient. The “moderate” benefit rating here reflects the fact that the available data compares two different rehydration solutions rather than the effect of drinking any solution versus none. + +### 9. Don’t take painkillers for more than 15 days a month; limit combination painkillers to 10 days. Otherwise, headaches may actually be caused by the medication itself. + +- Cost: No direct cost. You’ll just need to keep track of how many days you’ve taken the medicine, and resist the urge to pop pills at every sign of a headache. +- In plain terms: If you suffer from frequent headaches and take painkillers every day, you might end up with even more frequent headaches. The International Classification of Headache classifies this condition as medication-overuse headache. For regular non-opioid painkillers like acetaminophen, aspirin and ibuprofen, taking them for 15 days or more per month for 3 consecutive months meets the criteria. For combination painkillers — which contain two or more pain-relieving ingredients or extra additives like caffeine (for example, acetaminophen with codeine) — the limit is 10 days per month over the same period. Even if you rotate between different non-opioid painkillers, the total number of days you take them still counts toward this limit. Epidemiological studies from multiple countries confirm that over half of people who experience headaches for 15 days or more each month fall into this category. Most patients see their symptoms improve after cutting back on excess medication, and other preventive headache treatments also become more effective. +- Benefit: The third edition of the International Classification of Headache published by the International Headache Society outlines the diagnostic criteria for this condition. It applies to people who already have a history of headaches, experience headaches on 15 or more days each month, and have been regularly taking excessive amounts of headache medication for over 3 months. For standard non-opioid painkillers, the threshold for overuse is 15 days per month; for combination painkillers, it is 10 days per month. This classification is backed by robust epidemiological evidence, and most patients see positive results after reducing their medication intake. +- Evidence grade: B +- Sources:Headache Classification Committee of the International Headache Society (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1):1-211. ；ICHD-3 在线版 8.2 Medication-overuse headache（含 8.2.3、8.2.5）. +- Notes: Painkillers with “caffeine” in their name typically contain added caffeine, so they count toward the 10-day limit for combination painkillers. If you find that your headache days are increasing month on month, it’s best to consult a neurologist rather than simply taking more medication. This evidence grade is assigned because the classification criteria serve as a diagnostic benchmark rather than being derived from controlled clinical trials. The benefit level is rated “moderate” as it primarily reduces the frequency of headaches without preventing life-threatening outcomes. diff --git a/docs/Home-Emergency-Kit.md b/docs/Home-Emergency-Kit.md new file mode 100644 index 00000000..530fcbd7 --- /dev/null +++ b/docs/Home-Emergency-Kit.md @@ -0,0 +1,91 @@ +> Unofficial English translation of [docs/家庭应急装备清单.md](../家庭应急装备清单.md). In case of discrepancies the Chinese original takes precedence. + +# Home Emergency Supplies Checklist: What to Buy, Where to Put It, and How Often to Check + +This corresponds to item 26 of Section 1 of the README. This checklist answers only the question of what a household should keep on hand; it does not repeat how to use any of it. The actions for escaping a fire, cardiopulmonary resuscitation, major bleeding, burns, and carbon monoxide poisoning are all in Section 13; smoke alarms and carbon monoxide alarms are in Section 1, item 3; gas hoses and stoves are in Section 1, item 4. + +The yardstick throughout is mortality and external-cause injury. The evidence that the equipment itself pays off is not strong; the reasoning is in the final section, and you should read that one before this list. + +## 1. The official list, as written + +The Ministry of Emergency Management's National Basic Recommended List of Household Emergency Supplies for Reserve has 11 items; the original descriptions are reproduced below. + +| No. | Item | Original description | +|---|---|---| +| 1 | Drinking water | Covers each person's basic drinking-water needs for 3 days, at least 3 liters per person | +| 2 | Convenience food | Covers each person's basic food needs for 3 days. Convenience food is compact and calorie-dense | +| 3 | Fire extinguisher and fire blanket | For putting out incipient fires. The fire blanket can be draped over the body to escape | +| 4 | Respirator | A filter-type fire self-rescue respirator, for use when escaping a fire | +| 5 | Flashlight | Waterproof and explosion-proof flashlight. Recharge or replace the batteries regularly | +| 6 | Multi-function pocket knife | Combines knife, saw, screwdriver, steel pliers, and other functions | +| 7 | Radio | For receiving emergency broadcasts | +| 8 | Life-saving whistle | Can produce a high-frequency distress signal | +| 9 | External-use medicines | Styptic powder, adhesive bandages, gauze bandages, and so on, for treating wounds | +| 10 | Disinfecting wipes | For personal hygiene | +| 11 | Medical surgical masks | Protection against viruses | + +Source: Ministry of Emergency Management (2020). National Basic Recommended List of Household Emergency Supplies for Reserve. + +Local versions are more detailed. The Beijing Municipal Emergency Management Bureau's list for resident households comes in a basic version and an expanded version. The basic version covers "3 categories — emergency items, emergency tools, and emergency medicines"; its specific items are a hand-crank rechargeable flashlight with radio function, a life-saving whistle, towels/tissues or wet wipes, a respirator, multi-function combination scissors, an emergency escape rope, a fire extinguisher or fire blanket, plus anti-infective and anti-cold medicines, medical materials such as medical surgical masks and gauze bandages, and iodophor cotton swabs. The expanded version covers "5 categories of emergency supplies — food, personal items, escape and self-rescue tools, medical first-aid supplies, and important documents." The Bureau also advises "buying emergency supplies from producers and sellers with lawful qualifications and a good reputation," "stockpiling the basic-version emergency supply items first," and "mastering the correct use of emergency supplies, checking their condition regularly, and promptly replacing any supplies that are past their shelf life." + +Source: Beijing Municipal Emergency Management Bureau (2020). Beijing revises and issues the recommended list of emergency supplies for resident households. ; item-by-item detail as republished by the People's Government of Xicheng District, Beijing. + +There was a 2024 update at the national level: Annex 2 of the Guiding Opinions on Further Strengthening the Emergency Rescue and Disaster Relief Supplies Support System and Capacity Building, issued by the Office of the National Committee for Disaster Prevention, Mitigation and Relief (Guofangjianjiubanfa [2024] No. 13, September 23, 2024), is the Guiding Catalog of Household Emergency Supplies for Reserve, divided into 5 categories — emergency food, daily-living items, emergency tools, emergency medicines and medical supplies, and important documents — with 16 items in the basic version and 31 in the expanded version. TODO (to verify: the item-by-item names of the 16 and 31 items in that annex; the official annex is a WPS file and an image-only PDF, and no text that could be checked verbatim was obtained this time). + +## 2. The three fire-safety essentials + +**Fire extinguisher.** Portable fire extinguishers are a product under mandatory certification and should carry the CCC mark (China Compulsory Certification, China's mandatory product-certification scheme); the applicable standard is GB 4351—2023, Portable Fire Extinguishers. Stored-pressure extinguishers carry a pressure gauge (except carbon dioxide extinguishers); the needle should sit inside the green zone, and if it points into the red or yellow zone the extinguisher is out of service. The disposal ages follow XF 95: 6 years for water-based types, 10 years for dry powder, 12 years for carbon dioxide, counted from the date of manufacture, which can be found in the steel stamp on the cylinder. For home use, ABC dry powder is the usual choice. Keep one at the kitchen door and one at the entryway; do not put it in the cabinet directly above the stove — an extinguisher you cannot reach when something is burning is the same as not having one. + +**Fire blanket.** It appears in the official list alongside the fire extinguisher, with two uses: covering a burning oil pan, and wrapping around yourself to escape. Keep one in a kitchen drawer; it takes up no space and does not expire. When a pot catches fire, turn off the heat first, then cover it, and do not lift the blanket off again right away. + +**Escape respirator.** The official name is the 消防过滤式自救呼吸器 (fire-service filter-type self-rescue respirator), covered by GB 21976.7—2012, Building fire escape and refuge equipment — Part 7: Filter-type fire self-rescue respirator, a mandatory national standard currently in force, implemented on June 1, 2013, whose 2023 review concluded it remains valid. When buying, look for this standard number and the CCC mark; keep one per person according to the size of the household, placed within reach at the bedside in the bedrooms, not locked away in a storage room. It works by adsorbing toxic substances from the smoke in a filter canister; it is single-use, has a rated protection time, and has exactly one purpose: put it on and walk out. TODO (to verify: the standard's exact wording on the lower limit of applicable oxygen content and the rated protection time; this pass obtained only the standard title, status, and implementation date, not the clause text). + +What actually kills in a fire is the smoke. The escape actions are in Section 13, item 25, and the alarms in Section 1, item 3; both sit ahead of these three in priority. + +## 3. What goes in the first-aid kit + +The official list says only: "external-use medicines: styptic powder, adhesive bandages, gauze bandages, and so on, for treating wounds." Based on the first-aid actions already verified in Section 13, a reasonable home first-aid kit contains: + +- Bleeding control: one windlass tourniquet, sterile gauze and bandages, a triangular bandage, medical tape. The tourniquet's use, its contraindications, and the rule "do not loosen it to let blood flow" are in Section 13, item 11 +- Wound cleaning: iodophor cotton swabs, saline solution, adhesive bandages, sterile dressings, disposable gloves, scissors and tweezers +- Burns and scalds: no ointment of any kind is needed; 20 minutes of cool running water is the entire treatment, see Section 13, item 13 +- Records: a card listing each family member's allergies, chronic conditions, and regular medications, to hand directly to the emergency personnel when they arrive + +Someone with a known severe allergy should also keep an epinephrine auto-injector. That is a prescription drug; have a doctor prescribe it, see Section 13, item 14. + +The contents list in this section is grade C: the official document gives only the phrase "external-use medicines," and the specific items are back-derived from the first-aid actions verified in this book, with no direct source behind them. + +## 4. Lighting, communication, and signaling for help + +For the flashlight, follow the official description: waterproof and explosion-proof, with batteries recharged or replaced regularly. The life-saving whistle is for signaling continuously while trapped; it takes less effort than shouting and carries through noise. The radio is for receiving emergency broadcasts. The Beijing version also lists an emergency escape rope and multi-function combination scissors. The phone power bank is the best value-for-money item in this category, and most households already have one. + +## 5. A once-a-year check, ten minutes + +- Fire extinguisher: whether the pressure gauge needle is in the green zone, and whether the manufacture date on the cylinder has reached the disposal age +- Smoke alarms and carbon monoxide alarms: press the test button, change the batteries once a year, see Section 1, item 3 +- Escape respirator: whether the packaging is damaged and whether it is past its stated shelf life +- First-aid kit: whether medicines and dressings have expired, and whether the tourniquet's lock still locks +- Flashlight and power bank: whether they still have charge + +The Beijing bureau's exact words are: "check the condition of emergency supplies regularly, and promptly replace any supplies that are past their shelf life." Pin the check to the same day as the yearly alarm-battery change and do it all in one pass. + +## 6. What not to buy + +- **A home AED.** Costs over 10,000 yuan per unit, and for the household setting there is no evidence supporting buying one yourself. The correct action in cardiac arrest is to start compressions immediately and have someone call 120 (China's medical emergency number) and fetch an AED from the nearest public place, see Section 13, item 1 +- **"Fire masks" and "gas masks" without the CCC mark.** Article 24 of the Fire Protection Law provides that fire products subject to mandatory product certification under the law "may be produced, sold, and used only after being certified as compliant with the mandatory requirements of national and industry standards by a certification body with statutory qualifications." The toxic gases industrial filter canisters protect against are not the same thing as the smoke in a building fire +- **Packaged "emergency gift kits."** These kits are usually filled out with cheap flashlights and masks making up the numbers; buying the fire extinguisher, fire blanket, respirator, and first-aid kit separately costs less and makes certification easier to check +- **Stockpiling more than 3 days of food and water.** The official list's yardstick is 3 days per person; anything beyond that is expiry waste, see Section 5, item 24 + +Source: Standing Committee of the National People's Congress (2021). Fire Protection Law of the People's Republic of China (2021 amendment, Article 24). + +## 7. How much good does this equipment actually do + +The honest answer: the evidence is weaker than for the other entries in Section 1 of this book. + +A Cochrane systematic review of 98 studies covering 2,605,044 people evaluated home safety education and the provision of safety equipment. It found that home safety interventions may reduce injury rates: IRR 0.89 (95% CI 0.78 to 1.01), a confidence interval that crosses 1; interventions delivered in the home had IRR 0.75 (95% CI 0.62 to 0.91); and interventions that did not provide safety equipment had IRR 0.78 (95% CI 0.66 to 0.92). In other words, the effect looks like it comes from the in-home education and modifications, not from handing out equipment. The review also concluded that there is no evidence that home safety interventions reduce the incidence of thermal burns or poisoning. + +In the same review, the interventions did raise the share of safe behaviors: having a working smoke alarm installed OR 1.81 (95% CI 1.30 to 2.52); having an escape plan OR 2.01 (1.45 to 2.77); medicines stored safely OR 1.53 (1.27 to 1.84); stair gates fitted OR 1.61 (1.19 to 2.17). + +Source: Kendrick D, et al. (2012). Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews. + +So the placement of this section is: buying everything on the official list in one pass is a reasonable, low-cost preparation, but do not treat it as safe because you bought it. What research has repeatedly shown to work is smoke alarms, an escape plan, and moving the sources of injury out of the way; none of these three is on the shopping list, or they make up only a small part of it. diff --git a/docs/India-Law-Adaptation-Framework.md b/docs/India-Law-Adaptation-Framework.md new file mode 100644 index 00000000..8189a5ce --- /dev/null +++ b/docs/India-Law-Adaptation-Framework.md @@ -0,0 +1,55 @@ +# India Legal & Regulatory Adaptation Framework + +This file defines the legal baseline for the India edition. It is intentionally separate from the general English translation because an Indian edition must not simply substitute English words for Chinese statutes. + +## Core criminal and procedure laws + +- **Bharatiya Nyaya Sanhita, 2023 (BNS)** — substantive criminal offences; in force from 1 July 2024. +- **Bharatiya Nagarik Suraksha Sanhita, 2023 (BNSS)** — criminal procedure; in force from 1 July 2024. +- **Bharatiya Sakshya Adhiniyam, 2023 (BSA)** — law of evidence; in force from 1 July 2024. +- Where an older source cites the Indian Penal Code, Code of Criminal Procedure, or Indian Evidence Act, the India edition should identify the corresponding current BNS/BNSS/BSA provision where applicable, and retain the older provision only when discussing historical law. + +## Digital, platform and personal-data matters + +- Information Technology Act, 2000 and applicable rules. +- Digital Personal Data Protection Act, 2023, together with its commencement status and subordinate rules as applicable. +- Consumer Protection Act, 2019 for consumer-facing services, unfair trade practices and misleading advertisements. +- Sector-specific regulators and rules must be used where the topic is regulated by a specialist framework. + +## Family, children and vulnerable persons + +- Protection of Women from Domestic Violence Act, 2005. +- Protection of Children from Sexual Offences Act, 2012 (POCSO). +- Rights of Persons with Disabilities Act, 2016. +- Legal Services Authorities Act, 1987 for legal-aid and Lok Adalat references. +- Personal-law questions must not be presented as a single universal rule where Hindu, Muslim, Christian, Parsi, Special Marriage Act, or State-specific rules materially differ. + +## Employment and social protection + +- Maternity Benefit Act, 1961 and applicable amendments/rules. +- Code on Wages, 2019 and other applicable labour codes/notifications, with commencement status verified before publication. +- State-specific Shops and Establishments laws, minimum-wage notifications and employment rules must be identified where the answer depends on the State. +- Employees' State Insurance, EPFO/social-security rules and Employees' Compensation/work-injury provisions should be cited according to the worker's coverage. + +## Housing, transport, business and finance + +- Transfer of Property Act, 1882, Registration Act, 1908, applicable rent/tenancy law and State rules for housing. +- Motor Vehicles Act, 1988 and applicable Central/State rules for traffic and road-accident matters. +- Companies Act, 2013, Limited Liability Partnership Act, 2008, GST law, Income-tax law and applicable registrations for business topics. +- Insolvency and Bankruptcy Code, 2016 where insolvency/restructuring is relevant. +- RBI/SEBI/IRDAI/PFRDA and other regulator rules must be used for regulated financial products instead of importing Chinese financial rules. + +## Human organs and transplantation + +The Transplantation of Human Organs and Tissues Act, 1994 and applicable rules govern organ donation/transplantation in India. Commercial dealing in human organs must not be described using Chinese penalties or thresholds. + +## Adaptation rules + +1. Never convert a Chinese penalty amount directly from yuan into rupees. Replace the underlying legal rule with the applicable Indian provision. +2. Never invent an Indian section number merely because a Chinese section has a similar subject. +3. If India has no direct equivalent, state that explicitly. +4. Replace Chinese agencies, courts, complaint channels, registration systems, benefits, insurance schemes and administrative procedures with Indian institutions only after checking the current official source. +5. Distinguish Central law from State/UT law. +6. Keep medical/scientific evidence separate from jurisdiction-specific legal conclusions. +7. Every legal claim in the India edition should have an Indian official source where practicable. +8. Time-sensitive legal information should state the relevant as-of date or commencement status. diff --git a/docs/Is-Marriage-Worth-It.md b/docs/Is-Marriage-Worth-It.md new file mode 100644 index 00000000..e1970393 --- /dev/null +++ b/docs/Is-Marriage-Worth-It.md @@ -0,0 +1,125 @@ +> Unofficial English translation of [docs/结婚划不划算.md](../结婚划不划算.md). In case of discrepancies the Chinese original takes precedence. + +# Is Marriage Worth It: Breaking One Muddled Ledger into Five Clear Accounts + +The reader is asking one bundled question: whether marriage is, on balance, a loss or a gain; whether the partner will provide emotional value, share the housework, earn money — or whether marrying is just a task performed for one's elders. As a single question it cannot be answered, because it adds together several things that cannot be converted into one another. This article takes it apart. Each account uses only numbers that can be found in official statistics or meta-analyses; wherever a figure cannot be computed, that is said plainly; at the end there is a worksheet you can fill in yourself. The article draws no conclusion about "whether to marry." + +## 1. First, break the question apart + +"Is marriage worth it" contains at least five accounts, each on a different measure: + +1. Money: direct spending (彩礼 (caili — bride price), the wedding, the marital home) and the legal rules on property. The former has no official statistics; the latter has statutory text. +2. Time: housework, caregiving, and unpaid labor such as giving way in one's own work for the partner's sake. The measure is minutes per day. +3. Health: the difference in mortality between married and unmarried people. The measure is relative risk, and it is correlation only. +4. Legal risk: how property is divided, how long an exit takes, which obligations can be compensated. The measure is statute text. +5. Relationship quality: emotional value, conflict, support. The measure is effect size, which cannot be converted into money or time. + +The fifth is the hardest to quantify, and the closest to what the reader is actually asking. + +## 2. The data and sources behind each account + +### Registration data: marriage and divorce rates are two crude rates + +The Ministry of Civil Affairs' 《2024年民政事业发展统计公报》 (2024 Statistical Communiqué on the Development of Civil Affairs): in 2024, 6.106 million couples registered a marriage nationwide in accordance with the law, down 20.5% from the previous year, for a marriage rate of 4.3‰; 3.513 million couples completed divorce proceedings in accordance with the law, of which 2.622 million were registered divorces handled by civil affairs departments and 891,000 were divorces by court judgment or court mediation, for a divorce rate of 2.5‰. A note to the communiqué spells out the formula: the number of couples marrying (or divorcing) in the year, divided by the average total population of the year, multiplied by 1,000‰. + +Both numbers take the entire population as their denominator, which is why they are called crude rates. They answer "how many couples per thousand people registered a marriage or a divorce this year"; they do not answer "will this marriage eventually end in divorce." The latter question needs cohort data, and I did not find it in the official texts. + +### The health account: married people have lower mortality, but this is correlation, not causation + +Three meta-analyses give a consistent order of magnitude: + +- Manzoli et al. (2007) pooled 53 comparisons and more than 250,000 older adults. For all-cause mortality, the RR of the married relative to the unmarried (widowed, divorced or separated, never married) was 0.88 (95% CI 0.85–0.91); widowed 1.11, divorced or separated 1.16, never married 1.11. The result did not vary by sex, study quality, or European/North American region; the most conservative recalculation gave an RR of 0.94. +- Roelfs et al. (2011) pooled 95 studies and more than 500 million people. The HR for all-cause mortality of the never married relative to the married was 1.24 (1.19–1.30). The effect diminished with age, and the higher the study quality, the smaller the effect. +- Wang et al. (2020) pooled 21 studies and more than 7.89 million people. Being unmarried was associated with all-cause, cancer, and cardiovascular mortality in both sexes, with stronger cardiovascular and all-cause associations in men; among the never married, men had a 31% higher risk of death from stroke and 9% higher all-cause mortality than women. + +All three are observational studies. People who are healthy, well off, and socially connected are both more likely to marry and more likely to live long — this is the selection effect. Manzoli found signs of publication bias. These numbers should be read as "mortality is somewhat lower among the married," not as "marriage will make you 12% less likely to die." The samples are mostly European and North American; for China they can serve only as an order-of-magnitude reference. + +### The time account: the gender gap in unpaid labor is an upper-bound reference + +The National Bureau of Statistics' Third National Time Use Survey (May 2024): among those who took part in unpaid labor, the daily average was 2 hours 45 minutes — 1 hour 52 minutes for men, 3 hours 29 minutes for women; the participation rate was 75.6%, men 67.5%, women 83.9%. By activity, the population average for housework was 1 hour 17 minutes per day (1 hour 59 minutes among participants, 28 minutes less than in 2018; participation rate 64.9%); accompanying and caring for family members averaged 30 minutes (1 hour 46 minutes among participants; participation rate 28.4%). + +The second survey, in 2018: the population average for housework was 1 hour 26 minutes — 45 minutes for men, 2 hours 6 minutes for women — with participation rates of 40.4% for men and 75.6% for women. Accompanying and caring for children day to day averaged 36 minutes — 17 minutes for men, 53 minutes for women — with participation rates of 12.3% for men and 25.1% for women. + +Both surveys break results down only by sex, urban or rural residence, and age — not by marital status — so there is no official number for "how much more housework per day after marriage." What can be used is the gender gap: in 2024, unpaid labor differed between men and women by 1 hour 37 minutes per day, which can serve as an upper bound for the gap that may open up when the division of labor is never talked through. + +### The money account: default rules, written agreements, and housework compensation + +There are no official statistics on bride price, weddings, or the marital home, so this article states no numbers. What can be stated are the rules in the Marriage and Family book of the 《民法典》 (Civil Code), in force since January 1, 2021: + +- Article 1,062: Wages, bonuses, and remuneration for labor services acquired during the marriage; income from production, business operations, and investment; income from intellectual property; and property acquired by inheritance or as a gift (except where a will or a gift contract clearly specifies it belongs to one party alone) are community property of the husband and wife, who have equal rights to dispose of it. +- Article 1,063: One spouse's premarital property; compensation or damages received for personal injury; property specified in a will or a gift contract as belonging to one party alone; and articles of daily use for one spouse's exclusive use are that spouse's separate property. +- Article 1,065: A man and a woman may agree that premarital and postmarital property be owned separately, jointly, or in part separately and in part jointly. The agreement must be in writing and is legally binding on both parties. Where there is no agreement or the agreement is unclear, the preceding two articles apply. +- Article 1,088: Where one spouse bears the heavier obligations — raising children, caring for elderly family members, assisting the other spouse's work — that spouse has the right to request compensation from the other at the time of divorce. The specifics are settled by agreement between the two; failing agreement, the court decides. + +These rules work in both directions: the higher-earning side looks at Articles 1,062 and 1,065; the side carrying more of the unpaid labor looks at Article 1,088. An agreement only has to be in writing; notarization is not a statutory requirement. + +### Exit costs: the cooling-off period and the conditions for a court case + +- Article 1,076: Where both spouses agree to divorce, they sign a written divorce agreement and apply in person at the marriage registration office. The agreement must record their agreed positions on the raising of children and on the handling of property and debts. +- Article 1,077: Within thirty days of the day the registration office receives the application, either spouse may withdraw it if no longer willing to divorce. Within thirty days after that period ends, both spouses must apply in person for the divorce certificate; if they do not apply, the application is deemed withdrawn. +- Article 1,079: A spouse who wants a divorce may go through mediation or file suit directly. The court is to mediate first, and is to grant the divorce where the relationship has indeed broken down and mediation has failed. Where mediation fails, divorce shall be granted in cases of bigamy or cohabitation with another person; domestic violence or the mistreatment or abandonment of family members; gambling, drug use, or other vices that persist despite repeated correction; or separation for two full years because the relationship has broken down. Where the court has denied a divorce and the parties have then been separated for one full year and one party sues again, the divorce shall be granted. + +Of the 3.513 million divorces in 2024, 891,000 went through court judgment or court mediation. The cooling-off period applies only to registered divorce. + +### Relationship quality: an account worth more attention than "married or not" + +Robles et al. (2014) pooled 126 studies and more than 72,000 people: the higher the marital quality, the better the health, with effect sizes r between 0.07 and 0.21 — including r = 0.11 for mortality risk and r = −0.13 for cardiovascular reactivity during marital conflict. These effect sizes are small, but comparable in magnitude to the association between health and health behaviors such as diet. Some outcomes showed publication bias. Studies that explicitly tested for sex differences found essentially no difference between men and women. Most of the designs cannot support causal inference. Dhindsa et al. (2020) likewise note in their cardiovascular review that marital dissatisfaction and marital quality have a significant effect on cardiovascular risk. + +This article did not find a meta-analysis that directly compares mortality in a "low-quality marriage" with the unmarried. "A bad marriage is worse than not marrying" is currently an inference, not a numerical conclusion. The statement that holds up is this: the effect of "married or not" carries a selection effect; "good quality or bad" is another independent variable. A decision made on status alone, without looking at quality, leaves the second account out of the calculation. + +## 3. How to run the numbers yourself: a fill-in worksheet + +Fill in each account by its own measure, and do not add numbers across measures. Where a cell cannot be filled, write "don't know" — that is information in itself. + +What the partner can provide (by measure) + +- Money: what the partner's income, debts, and premarital property are; whether marital property follows the default rules or a written agreement, and what the agreement says. +- Time: how much unpaid labor the partner does per day now (national average among participants: men 1 hour 52 minutes, women 3 hours 29 minutes); how it would be divided after marriage; how it would be divided when there are children or elderly to care for; whose work can give way. +- Relationship quality: how many conflicts there have been in the past six months and how they ended; what the partner did when you were ill, unemployed, or low; what you did in the same situations. +- Emotional value: whether your energy increases or drains when you are with the partner. This takes months of time together to judge; a list of conditions will not show it. + +What you will put in (by measure) + +- Money: how much will be spent on the marriage itself (bride price, wedding, marital home), and where that money would go instead if you did not marry. +- Time: how much unpaid labor you expect to add per day, and how much 人情往来 (renqing — reciprocal visits and gifts between families) per week. +- Health: whether your daily routine, diet, and exercise will get better or worse because of the marriage. This line is closer to you than any RR in a meta-analysis. +- Exit cost: registered divorce takes a 30-day cooling-off period plus a further 30 days to apply for the certificate; going to court requires meeting the conditions of Article 1,079. Whether you can bear that timeline is a question only you can answer. + +How the law protects you (applies to both sides) + +- Is there documentation for premarital property (home purchase contract, bank statements, gift contract, will), and can it prove the property is "premarital" or "clearly designated for one party alone"? +- Should there be a written property agreement, and would it cover premarital property, marital acquisitions, or both? +- After marriage, who will bear more of the unpaid labor; does that person know about the right to compensation under Article 1,088; are both of you willing to agree on a compensation method in advance? +- Debts: of money borrowed in one person's name during the marriage, which counts as joint debt, and does each of you know about it? + +Marrying for the elders (fill this column separately) + +- What the elders gain: peace of mind, 面子 (mianzi — social face), an end to the pressure to marry, someone to provide for them in old age. +- Which of these gains belong to the elders, and which are actually your own. +- The costs in the three columns above are borne entirely by you; the elders' gains do not automatically turn into your health or your relationship quality. +- Written out separately, whether this account weighs heavy or light is for the person filling in the sheet to judge. + +## 4. Common mistakes + +Mixing up divorce-rate measures. The crude divorce rate (divorcing couples per thousand people; 2.5‰ in 2024) and the divorce-to-marriage ratio (divorces in the year divided by marriages in the year; 3.513 million / 6.106 million ≈ 57.5%) are two different things. The numerator and the denominator of the ratio are not the same people: most of those divorcing this year married years ago, and a falling number of marriages mechanically pushes the ratio up. It does not mean "half of all marriages end in divorce," and the communiqué contains no such indicator. + +Treating correlation as causation. That the married have mortality about 12% lower is the pooled result of meta-analyses, but health, income, and social life each independently affect both "can one marry" and "can one live long." The account can be computed, but it must be discounted, and it cannot stand in for a judgment about this particular relationship. + +Treating marriage as a task. A task-driven marriage looks only at "status" and not at "quality," while the effect of relationship quality on health is a separate account, independent of marital status, and is usually omitted from task-driven decisions. + +Taking national averages for your own numbers. The gender gap in the time use surveys is a national average; the property rules are default rules that can be changed in writing. National numbers are for magnitude and for a starting point in negotiation, not for conclusions. + +Where there is no official number, do not fill the gap with unofficial ones. Bride price, weddings, and the cost of raising children have no official statistics; this article leaves them blank. A reader's own numbers, filled in by the reader, are more accurate than any institution's estimate. + +## Sources + +- Ministry of Civil Affairs (2025). 《2024年民政事业发展统计公报》 (2024 Statistical Communiqué on the Development of Civil Affairs) (section V(2)1, Marriage Registration Services; note 5). (PDF: ) +- National Bureau of Statistics (2024). 《第三次全国时间利用调查公报》 (Communiqués on the Third National Time Use Survey) (Nos. 1, 2, and 3). , , ; 国家统计局社科文司负责人答记者问 (answers to reporters' questions by the head of the NBS department in charge of social, science-technology, and cultural statistics). +- National Bureau of Statistics (2019). 《2018年全国时间利用调查公报》 (Communiqué on the 2018 National Time Use Survey). +- National People's Congress (2020). 《中华人民共和国民法典》 (Civil Code of the People's Republic of China) (Articles 1,062, 1,063, 1,065, 1,076, 1,077, 1,079, and 1,088). National Laws and Regulations Database ; the full text of the articles as republished in the Supreme People's Court Gazette +- Ministry of Civil Affairs (2020). 《关于贯彻落实〈中华人民共和国民法典〉中有关婚姻登记规定的通知》 (Notice on implementing the marriage registration provisions of the Civil Code of the People's Republic of China) (Minfa [2020] No. 116). +- Manzoli L, Villari P, Pirone GM, Boccia A (2007). Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med 64:77–94. +- Roelfs DJ, Shor E, Kalish R, Yogev T (2011). The rising relative risk of mortality for singles: meta-analysis and meta-regression. Am J Epidemiol 174(4):379–389. +- Wang Y, Jiao Y, Nie J, et al. (2020). Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals. Glob Health Res Policy 5:4. +- Robles TF, Slatcher RB, Trombello JM, McGinn MM (2014). Marital quality and health: a meta-analytic review. Psychol Bull 140(1):140–187. +- Dhindsa DS, Khambhati J, Schultz WM, Tahhan AS, Quyyumi AA (2020). Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 30(4):215–220. diff --git a/docs/Should-You-Stop-To-Help-A-Stranger.md b/docs/Should-You-Stop-To-Help-A-Stranger.md new file mode 100644 index 00000000..80acdc6b --- /dev/null +++ b/docs/Should-You-Stop-To-Help-A-Stranger.md @@ -0,0 +1,57 @@ +> Unofficial English translation of [docs/遇到陌生人出事该不该停.md](../遇到陌生人出事该不该停.md). In case of discrepancies the Chinese original takes precedence. + +[← Back to the main table of contents](../../../README.md) + +# A stranger has an accident on the street: walk away or stop + +This is the long-form version of Section 13, item 2. Under the book's beneficiary yardstick, a stranger is the lowest of the four tiers: the prospect of return is small, and you don't know the person's character. So this article does not urge you to do anything; it lays out the full bill each of the three paths carries, and you choose. + +**This article gives no probabilities.** Every layer of cost below is real and traceable to specific legal provisions, but there is no published statistic for things like "what share of rescuers have actually been hit with one of these," and the book's rule is that uncertain numbers are better left unwritten. Do not read "seven layers are listed" as "all seven will happen." + +## The three paths + +| | Walk away | Stop but don't touch | Stop and see it through | +| --- | --- | --- | --- | +| Legality | Legal. An ordinary person owes a stranger no duty of rescue, and criminal law has no offense of "knowing and not rescuing" | Legal | Legal | +| Time | 0 | A few minutes; calling 120 (China's emergency medical number) leaves your number | Half a day at minimum, possibly up to accompanying them to the hospital | +| Likelihood of being tracked down later | Lowest | You are the one who left a number | Highest | +| Benefit to the other person | 0 | The ambulance arrives sooner | Greatest | + +## Costs that can appear after you stop, from lighter to heavier + +**1. Callbacks and questioning.** Calling 120 or 110 (China's police emergency number) leaves your number. You may get a callback to confirm the location, and you may be questioned once afterwards. Where a criminal-case informant is unwilling to disclose their name, the case-handling organ must keep it secret for them (刑事诉讼法第一百一十一条 — Criminal Procedure Law, Art. 111); 120 has no corresponding provision. + +**2. Being tracked down by the family.** When surveillance footage turns up no trace of the vehicle that caused the accident, the person who left a number and was on the scene is the easiest one for the family to find. Phone pressure and showing up at your door can both happen. + +**3. Being named as a defendant.** The side claiming you hit them bears the burden of proof itself; if it cannot produce evidence, it bears the adverse consequences (民诉法解释第九十条 — Interpretation on the Application of the Civil Procedure Law, Art. 90) — **but this rule guarantees only the outcome of the judgment, not that you stay out of the case**. The time limit for concluding a first-instance case under the ordinary procedure is 6 months, extendable by another 6 months in special circumstances; the simplified procedure is 3 months (民事诉讼法第一百五十二、一百六十四条 — Civil Procedure Law, Arts. 152 and 164). Even if you win outright, only three items can be shifted onto the other side: the case acceptance fee, application fees, and the travel and lost-earnings costs of witnesses, expert examiners and the like appearing in court (诉讼费用交纳办法第六、二十九条 — Measures on the Payment of Litigation Costs, Arts. 6 and 29). **Attorney's fees are not among them.** + +**4. It reaching your employer.** Disturbing the order of an enterprise or public institution so that work cannot proceed normally: a warning or a fine of up to 500 yuan; where circumstances are relatively serious, detention of 5 to 10 days plus a fine of up to 1000 yuan; where it is done by a crowd, detention of 10 to 15 days for the ringleaders (治安管理处罚法第二十六条第一项 — Public Security Administration Punishments Law, Art. 26, item 1). Harassment, pestering, or stalking that interferes with normal life is punished under Art. 50, item 5, and with the approval of the head of the public security organ an order can be issued barring contact for a set period. A company firing you over this generally counts as an unlawful termination, with compensation computed at 2N (Section 19, item 6) — but reporting to the police and filing for arbitration are errands you run yourself, and the loss of the stretch when the job is already gone is not made whole later by eventually collecting 2N. + +**5. Being filmed and posted online.** The most important thing to know at this layer: **you may not be able to stop the filming**. Making, using, or publicizing another person's likeness without consent is prohibited (民法典第一千零一十九条 — Civil Code, Art. 1019), but "making, using, or publicizing the likeness of the right holder where unavoidable for the purpose of news reporting" counts as reasonable use (第一千零二十条第二项 — Civil Code, Art. 1020, item 2). What you can control: no interviews, no appearing on camera, no speaking in front of the lens — whether to consent is your decision; no one can consent for you. + +**6. Re-sharing and cyber-harassment.** Once a video spreads, the comment section is out of your control. The self-help measures available are written into 《网络暴力信息治理规定》 (Provisions on the Governance of Cyberbullying Information, effective August 1, 2024): platforms must provide protective settings such as blocking unknown or specific users, limiting the visibility of your own information, banning reposts or comments, and receiving private messages only from friends or rejecting all private messages (Art. 23); must provide a one-click evidence-preservation function for cyberbullying information (Art. 25); must set up a dedicated quick complaint-and-report entrance in a prominent position (Art. 26); and where suspected unlawful or criminal conduct is found, must promptly report to the public security organs and provide leads (Art. 15). For how to preserve evidence and report to the police, see Section 8, item 14. + +**7. When it gets to be too much.** The six layers above can all be met with legal provisions; the seventh cannot. There is no reliable Chinese data to cite on the emotional impact of sustained online attacks, and the book gives no numbers — only an exit: the psychological-assistance hotline 12356 (China's psychological support hotline), see Section 1, item 25. + +## Two situations in which walking away stops being free + +- **You are the operator or manager of the premises, or the organizer of a mass activity** (hotels, shopping malls, banks, stations, airports, stadiums, entertainment venues and the like): you bear a duty of safety protection; failing to fulfill it makes you bear tort liability, and where a third party caused the harm and you failed your duty, you bear corresponding supplementary liability (民法典第一千一百九十八条 — Civil Code, Art. 1198). For an on-duty employee or the venue operator, walking away is not the same thing as a passerby walking away. +- **The matter involves you**: you hit them, it is your car, or the danger was created by your own prior conduct. Then the question is no longer "whether to get involved with someone else" — it is the traffic-accident handling and hit-and-run question of Section 8, item 1. + +## If you decide to stop, the lowest-hassle way to do it + +1. **Don't move them with your hands.** This is the only action with no second answer, and the reason is medical, not legal — forcing someone upright can worsen brain hemorrhage or spinal injury. On the legal side, harm caused in the course of rescue is exempted by 民法典第一百八十四条 (Civil Code, Art. 184 — voluntary emergency rescue exemption). +2. Call out from a distance and check whether they are breathing; if not, start chest compressions (Section 13, item 1); if yes, call 120 from where you are and report the location. +3. Pull in another passerby and start recording on your phone. Witness testimony and physical evidence beat arguing after the fact. +4. Don't lift them into a car on your own, and don't pay out of pocket to get them to a hospital. This is the highest-cost, lowest-return stretch of the whole road. +5. If you were injured rescuing them or spent your own money, how to get the money back is covered in Section 13, item 40. + +## Sources + +- National People's Congress (2020). 民法典 (Civil Code) (Arts. 184, 1019, 1020, 1198). Full text republished by the Supreme People's Procuratorate. +- Supreme People's Court (second revision 2022, effective April 10, 2022). 关于适用《中华人民共和国民事诉讼法》的解释 (Interpretation on the Application of the Civil Procedure Law of the People's Republic of China) (Art. 90). +- NPC Standing Committee (revised 2023, effective January 1, 2024). 民事诉讼法 (Civil Procedure Law) (Arts. 152 and 164). Full text republished by the Shanghai Municipal Development and Reform Commission. +- State Council (2006). 诉讼费用交纳办法 (Measures on the Payment of Litigation Costs) (State Council Decree No. 481, Arts. 6 and 29). +- NPC Standing Committee (2025). 治安管理处罚法 (Public Security Administration Punishments Law) (2025 revision, effective January 1, 2026; Art. 26 item 1, Art. 50 item 5). +- NPC Standing Committee (revised 2018). 刑事诉讼法 (Criminal Procedure Law) (Art. 111). Full text republished by the People's Procuratorate of the Ningxia Hui Autonomous Region. +- Cyberspace Administration of China, Ministry of Public Security, Ministry of Culture and Tourism, National Radio and Television Administration (2024). 网络暴力信息治理规定 (Provisions on the Governance of Cyberbullying Information) (Arts. 15, 23, 25, 26; effective August 1, 2024). Gazette of the State Council. diff --git a/docs/What-Licenses-A-Platform-Needs.md b/docs/What-Licenses-A-Platform-Needs.md new file mode 100644 index 00000000..f9ffa17e --- /dev/null +++ b/docs/What-Licenses-A-Platform-Needs.md @@ -0,0 +1,71 @@ +> Unofficial English translation of [docs/做平台要办哪些证.md](../做平台要办哪些证.md). In case of discrepancies the Chinese original takes precedence. + +# What Licenses a Platform Needs: A Comparison Table and a Server-Choice Decision Table + +This corresponds to Section 26 of the README. This page holds only two tables and a few notes on points that are easy to get wrong; the entry text and sources live in the README. How to register a company and how to file taxes is covered in Section 12; the red lines for employed tech workers are in Section 11. + +## 1. First, work out which kind of business you are running + +A single site often falls into several of these categories at once. The licenses stack; it is not either/or. + +| What you are doing | Corresponding business category | What you need | Primary legal basis | +|---|---|---|---| +| Free information sites, personal blogs, company official websites | 非经营性互联网信息服务 — non-commercial internet information services | ICP 备案 — ICP filing with MIIT | 互联网信息服务管理办法 — Internet Information Services Administrative Measures, Article 4 | +| Paid memberships, value-added services, or paid content charged to users | 经营性互联网信息服务 — commercial internet information services | 增值电信业务经营许可 — value-added telecom business license (information services business) | Same measures, Articles 3, 4, and 7 | +| Matching buyers and sellers, handling transactions and orders | 在线数据处理与交易处理业务 — online data processing and transaction processing business | 增值电信业务经营许可 — value-added telecom business license (B21) | 电信业务分类目录 — Telecommunications Business Classification Catalogue (2015 edition), B21 | +| Livestreams with hosts on camera, game livestreams | 网络表演 — online performance | 网络文化经营许可证 — Network Culture Business License, with online performance included in the business scope | 网络表演经营活动管理办法 — Measures for the Administration of Online Performance Business Activities, Article 4 | +| Producing or aggregating video programs, or providing a service that lets others upload audio-visual programs | 互联网视听节目服务 — internet audio-visual program services | 信息网络传播视听节目许可证 — License for the Dissemination of Audio-Visual Programs through Information Networks | 互联网视听节目服务管理规定 — Provisions on the Administration of Internet Audio-Visual Program Services, Articles 7 and 8 | +| Selling goods during livestreams | 网络直播营销 — livestream marketing | On top of the licenses above, fulfill the verification and retention obligations | 网络直播营销管理办法（试行） — Measures for the Administration of Livestream Marketing (Trial), Article 8 | +| Providing news and information | 互联网新闻信息服务 — internet news information services | 互联网新闻信息服务许可证 — Internet News Information Service License | 互联网直播服务管理规定 — Provisions on the Administration of Internet Live-Streaming Services, Article 5 | +| Building your own data center to sell hosting or bandwidth | 互联网数据中心业务 — internet data center (IDC) business; 互联网接入服务业务 — internet access service (ISP) business | 增值电信业务经营许可 — value-added telecom business license (B11, B14) | 电信业务分类目录 — Telecommunications Business Classification Catalogue (2015 edition), B11, B14 | + +The mapping of the three licenses is stated most plainly in the 2021 guidance opinion (指导意见) issued by seven departments: "A livestream platform carrying out commercial online performance activities must hold the 《网络文化经营许可证》 — Network Culture Business License and complete ICP 备案 — ICP filing with MIIT; a livestream platform carrying out internet audio-visual program services must hold the 《信息网络传播视听节目许可证》 — License for the Dissemination of Audio-Visual Programs through Information Networks (or complete registration in the 全国网络视听平台信息登记管理系统 — National Network Audio-Visual Platform Information Registration Management System) and complete ICP 备案 — ICP filing with MIIT; a livestream platform carrying out internet news information services must hold the 《互联网新闻信息服务许可证》 — Internet News Information Service License." + +### Three points that are easy to get wrong + +**An individual cannot obtain a value-added telecom license.** The first eligibility condition is "the operator is a company established in accordance with the law"; registered capital must be no less than 1,000,000 yuan for operations within a single province and no less than 10,000,000 yuan for cross-province operations, the review period is 60 days, and the license is valid for 5 years. To run a paid business you need a company first; that step is in Section 12. + +**Private operators can essentially never get the audio-visual program license.** The application conditions state "possesses legal-person status and is a wholly state-owned or state-controlled entity". So the long-video and original-program route is closed to individual founders; livestreaming instead runs through the 网络文化经营许可证 — Network Culture Business License track. + +**No official document explicitly states that "e-commerce platforms must obtain EDI".** MIIT's service guide only says "apply for the corresponding telecommunications business license according to the business definition", and has answered elsewhere that "ride-hailing platforms only need a website filing" and "equity-type and bulk-commodity trading platforms only need a website filing". So this book only quotes the original definition of B21 and leaves the judgment to you and your local 通信管理局 — communications administration; ask the communications administration with jurisdiction over your location once before applying. + +## 2. The platform's own day-to-day obligations + +Getting the license only opens the door. The items below are what you do every day; the fines are in the individual entries of Section 26. + +| Obligation | Hard requirement | Source | +|---|---|---| +| Verify and register on-platform merchants | Verify and update at least once every six months | 网络交易监督管理办法 — Measures for the Supervision and Administration of Online Transactions, Article 24 | +| Report identity information | Report to the market regulation authorities in January and July each year | Same measures, Article 25 | +| Report tax-related information | Report to the tax authorities within the month after each quarter ends | 互联网平台企业涉税信息报送规定 — Provisions on the Reporting of Tax-Related Information by Internet Platform Enterprises, Article 4 | +| Retain transaction information | No less than three years from the date the transaction is completed | 电子商务法 — E-Commerce Law, Article 31 | +| Retain livestream content and logs | Sixty days | 互联网直播服务管理规定 — Provisions on the Administration of Internet Live-Streaming Services, Article 16 | +| Retain online performance videos | No less than sixty days | 网络表演经营活动管理办法 — Measures for the Administration of Online Performance Business Activities, Article 13 | +| Retain network logs | No less than six months | 网络安全法 — Cybersecurity Law, Article 23, Item 3 | +| Handle infringement notices | If nothing happens within fifteen days after the statement is forwarded, restore the listing | 电子商务法 — E-Commerce Law, Article 43 | +| Complaint and report channel | Conspicuous placement, convenient to use | 网络信息内容生态治理规定 — Provisions on the Governance of the Online Information Content Ecosystem, Article 16 | + +The retention periods are four different clocks: three years for transactions, sixty days for livestreams, six months for logs, and three years for the identity information of on-platform merchants, counted from when they leave the platform. Design your storage for the longest of these, not the shortest. + +## 3. Choosing a server: how to pick among the three tiers + +Answer the questions first, then look at prices. + +| Question | If the answer is | Then | +|---|---|---| +| Can you tolerate a day of downtime | Yes | The cheapest VPS is enough | +| Do you have user registration, transactions, or uploads | Yes | A cloud host from a mainstream cloud provider, with snapshots and elastic scaling | +| Do you have someone dedicated to operations | No | Stay away from dedicated server colocation | +| Are bandwidth or hardware costs your main expense | Yes, and you have someone for operations | Only then consider dedicated server colocation | + +**Small providers are not unusable; you have to verify them first.** Data-center colocation and access services are themselves value-added telecom businesses that require a license. Check the provider once by its full company name on MIIT's 电信业务市场综合管理信息系统 — Telecom Business Market Comprehensive Management Information System at tsm.miit.gov.cn, and exclude anyone without a license outright. The ones that can be half the price usually carry risks in overselling, the operator disappearing, and their upstream being blocked. When any of these three happens, with a licensed provider you can still complain to the communications administration; with an unlicensed one you have no one to appeal to at all. + +**Inside China or outside.** If the servers are inside China you must complete a filing (备案), and access providers may not provide access to unfiled sites. Hosting abroad lets you bypass the filing, but your users are in China and your money is in China, so not one of the obligations in items 5 through 10 of Section 26 goes away, and you add a layer of cross-border data transfer compliance cost: transmitting the personal information of users inside China to a machine outside China is a cross-border transfer, which must satisfy one of the four conditions in Article 38 of the 个人信息保护法 — Personal Information Protection Law and obtain the individual's separate consent. The headcount thresholds are counted "cumulatively from January 1 of the current year": under 100,000 people, none of the three pathways applies; 100,000 to 1,000,000 people, a standard contract or certification is required; over 1,000,000 people, a security assessment must be filed. + +**Backups.** Keep backups in at least two places, and do not put them all in the same region of the same provider. This one has no legal basis behind it; it is experience. + +## 4. The limits of this document + +- For all provisions, the source column in Section 26 of the book's README is authoritative; it has the document numbers, article numbers, and links. +- Regulations are updated quickly; this section was verified in September 2026. Before quoting anything, open the original page yourself once more — especially the 网络安全法 — Cybersecurity Law (article numbers were adjusted starting January 1, 2026) and the rules on minors and livestream tipping (changed in April 2026 to age-based tiers). +- The few points where the original text could not be obtained are listed in the [verification notes](../核实记录/追加-第26节做平台.md), including any official wording on whether e-commerce platforms must obtain EDI, and a judicial interpretation that would directly make unlicensed operation of online-culture or audio-visual services the crime of illegal business operations (非法经营罪).