You don't need a credit card to create a US Apple account, and you don't need a VPN either. I don't live in China, I live in Europe, but I have a US account because everything is better about Apple US accounts.

You can use it for free (you get 5GB of iCloud space, IIRC), but to be able to pay for services I buy US iTunes gift cards from ebay (mark-up about 1%). I can pay all Apple services with this, including iCloud storage and apps and music and movies.

It's a hassle, but it's totally worth it for me.

I would just stock up on USA iTune gift cards when I lacked a US credit card. Its not hard really, the real problem are Chinese apps that you might need for your day to day life (e.g. the dedicated Didi dache app if you didn't want to go native and use WeChat). Even then, Apple seems to let you change your app store easily, you can even have apps from both the US and Chinese app stores on your phone (or at least, that was true a couple of years ago).