The Future of Chinese Medicine
Guangzhou University of Chinese Medicine · Deng Tietao
After Liberation, Chinese medicine awoke from a state of near-death, but the weakened body did not soon recover. During the ten-year calamity, the future of TCM was worrying. After the Party's Third Plenum of the Eleventh Central Committee, TCM's spring came too. The new Constitution passed by the Sixth NPC explicitly required developing our traditional medicine — legally protecting this national jewel. TCM's dawn appeared; the future is bright.
But which way forward? In the 1980s, where to develop? A question worth deep thought.
Some say: without sorting TCM by Western methods, development is hard. Some say: continue along TCM's original road. Some say: on the basis of strong inheritance, combine with modern natural science. I think one must first ask history.
Historical retrospect
All agree the Huangdi Neijing laid a fine foundation for TCM, establishing its theoretical system. Across the dynasties, every famous physician took the classics as method, deeply studying the Neijing. The Neijing holds a vigorous life-force; two thousand years on, its academic light has not dimmed. What is that life-force? In my view: the crystallization of plain dialectics and medicine.
The Neijing's compilation date — most historians side with Liang Qichao: begun in Warring States, finished in the Han, not the work of one time or one person. Spring-Autumn–Warring-States was a time of many schools, when philosophy bloomed. Plain dialectical materialism then was already advanced. Note also the deep influence of the Yijing on ancient philosophy. Though a divination book, it contains spontaneous dialectical elements. TCM yin-yang doctrine roots in the Yijing. Though the Yijing lacks the characters yin and yang, the concept of yin-yang opposition is there.
The Yijing's "—" and "--" lines later became "yang line" and "yin line." Guoyu · Zhouyu (Spring-Autumn): "Yin lies hidden and cannot come out; yang presses and cannot rise; hence earthquakes." The Zuo Zhuan (early Warring States) uses six qi — yin, yang, wind, rain, dark, light — to explain disease cause. The Yizhuan (late Warring States) discusses yin-yang more: "One yin, one yang is the Way; what continues it is the good; what completes it is the nature."
Late Shang / early Zhou was the era of King Wu's revolution — sharp social and class change, reflected in the Yijing, bringing plain dialectical factors. Most experts: though a divination book and thus listed under idealist theology, the Yijing holds primitive dialectical elements — opposition, motion-and-change, continuous rising, contradiction-transformation. The Yizhuan's dialectics, of late Warring States, far exceeds the Yijing's.
The Yijing author held change as the universal law — the Way of change. The Way has the sense of law. Nature has opposing contradictions; one side is primary; sides transform into each other; quantitative accumulation precedes transformation. The Yizhuan author first recognized contradiction's unity, that struggle-and-unity together produce the ten thousand things. This is the Yizhuan's basic jiao-gan (mutual-influence) thought.
The Yizhuan's plain dialectics had a great influence on Chinese philosophy. By time and class limits, its dialectics did not run through everywhere — and on some points fell into metaphysics. But the Yizhuan also held a materialist epistemology: it acknowledged an objective material world existing apart from consciousness; advocated observation by the senses; held the world is knowable. Observation is sense-knowing; knowing contains rational knowing. The Yizhuan author already touched the edge of rational knowing.
In Warring States — many schools, many voices — Laozi, Mozi, Sunzi all had dialectical thought. Hui Shi and Gongsun Long had logic-and-dialectics. The Neijing was born in this great age. It absorbed the dialectics of the Yijing, Yizhuan, and the schools; also the Five-Phase doctrine of the Shangshu Hongfan; and the period's astronomy, calendar, mathematics, earth science, agriculture — joined with medical practice to lay the foundation of TCM theory. The Neijing's essence: dialectical content; a medical theory of dialectical-materialist thought.
From the Mawangdui medical books — earlier than the Neijing — the Neijing's fixing in the Han is confirmed. Likely it integrated the Han Shu · Yi Wen Zhi's seven medical-canon schools, taking the Huangdi Neijing as main blueprint (my inference).
The Han famous physician Zhang Zhongjing took the Neijing as guide, worked diligently with the old teachings; on the formula-school works, under theoretical guidance, broadly chose many formulas — sifted, organized — and wrote the great Shanghan Zabing Lun. By then TCM had a built system from foundation to clinic — an age of brilliant achievement.
The Song was strong in natural science. The government organized people to collate medical books and print them widely; medicine spread and rose. Especially: philosophical contention between idealist and materialist schools brought medical contention; the Four Great Masters of Jin-Yuan arose (Liu Hejian, Zhang Zihe, Li Dongyuan, Zhu Danxi). I do not favor classing them as Hejian School and Yishui School, because that captures only lineage and misses contention and breakthrough. This contention also tied to Wang Bing's including the Seven Great Discourses in the Suwen, restoring the lost seventh volume. Under the Seven Great Discourses' influence, qi-fortune doctrine flourished in the Song — six qi all transform from fire and Zhang Yuansu's qi-fortunes are not the same; antiquity and today move on different tracks.
Under dialectical guidance, Ming-Qing medicine kept developing. The Wenbing school's Qing achievements — for infectious disease prevention and treatment — were far ahead of the world until the early last century, and still hold value. Tang-Song-Yuan-Ming-Qing development, rather than from other-science effects, comes more from TCM's continued dialectical-materialist current. Yin-yang, five-phase; etiology's inner-and-outer cause; integral view, inner-outer environment view, eternal-motion view, biàn zhèng lùn zhì — all deepened, yielding rich results across the clinical disciplines. Our plain dialectical-materialist element. Take TCM pattern-discernment's Eight Outlines: yin-yang, surface-inner, cold-hot, empty-full — four pairs of opposites. Every pattern can be discerned by them. The Eight Outlines also distinguish the main and secondary side of a contradiction; cold-hot and empty-full have true and false. How to see through appearance to essence — the Eight Outlines stress it. Right qi and evil qi struggling, yin-yang and storehouses' rise-fall-rise — disease moves and changes; the Eight Outlines also stress transformation and connection of contradictions. All of this proves the Eight Outlines have the unity-of-opposites view — TCM has developed the ancient plain dialectics; it is a medicine fitting dialectical materialism.
The Opium War brought disaster; TCM was not spared. Under national nihilism, TCM stalled. Yu Yunxiu, a Republican-era comprador-bourgeois representative, attacked TCM dialectics with mechanical materialism — wrote Lingsu Shangdui. Some TCM with vision proposed Chinese-Western integration, under reformist influence, but without dialectical materialism as weapon, found no road. Some fell into the abolish-medicine, keep-the-herbs error. "If Chinese medicine survives, there is no Heaven's principle; if Chinese herbs die, there is no Earth's principle" — that line is a striking representative; faith in TCM theory had been lost. Works of head-and-body Western medicine, hands-and-feet TCM prescription appeared — a tragedy. The integrationists, though well-intentioned to find a way for TCM, in fact came up against a wall. We must note: this integrationist school was not the mainstream of TCM at the time. Many wise practitioners still used the Neijing, Shanghan, Wenbing, the various schools' theory and method — not aspirin plus gypsum. Take Zhang Xichun: his main thought was biàn zhèng lùn zhì; his main achievement was on herbal study.
After Liberation, under Party leadership, many TCM accepted Marxism and learned dialectical materialism.
With TCM colleges built, textbooks were needed; mining and sorting TCM theory became the focus. Much human and material force was put in. The publication of TCM textbooks was a great event of the past century — many senior practitioners (not yet old) lifted theoretical level; the TCM theoretical system was rebuilt; a new generation was raised. These new TCM, especially the "old five graduating classes," became the backbone.
Without hiding: with Western hospitals built large and TCM hospitals near blank — our Guangdong's TCM hospital, founded in the 30s, was renamed after Liberation as Experimental TCM Hospital — only experimental. So in practice the whole TCM field held only the outpatient front and lost the front of saving critical conditions, because under public medical care, the critically ill went to Western hospitals. TCM colleges had thin foundations, few students; affiliated hospitals were ill-matched, few beds — clinical-skill transmission was interrupted in the old-new turnover. By the time beds gradually grew, the old were too old, the generation was retiring; the middle-aged had to grope for the elders' critical-case experience without hand-in-hand transmission; the elders' skills, no longer ground by frequent challenge, also dropped. Hence lack of practitioners, lack of craft. Lack of craft — do not narrow it to the middle-aged and young; in the angle of disciplinary cycle and the elders' due 30-year growth, both can be called lack of craft. Lack includes old, middle, young — many middle-aged practitioners bristle at lack of craft. We are Marxists — face reality.
Disciplinary cycles run faster now. Are we satisfied with TCM's 30-year development? The ten-year calamity's slogan Chinese-Western integration is the only road — that ultra-left slogan brought consolidation and downsizing of TCM units, sent old practitioners to the countryside, heavy losses. After 20-plus years of nationwide TCM-hospital construction, beds still under tens of thousands; under the integration call, more was damaged. TCM clinical-skill mining and elder experience-rescue fell empty. TCM clinical textbooks' theory and practice came unlinked — li-fa-fang-yao in the textbook cannot be found in the ward; the students raised come out with low TCM clinical level. Of course, our responsibility too.
Looking at our 30 years of TCM: in TCM theory research, results are better; in clinical practice, level is dropping. Some places surpass predecessors; overall, in TCM skill development, level is dropping.
30-plus years on, TCM is the dry tree meeting spring — but in sum still has not shaken off lack of practitioners, lack of craft; today at the crossroads of rise or ruin. Why? Worth deep thought.
Looking ahead
TCM has been declining over a hundred years yet still holds high prestige among the people; recently it has won attention from advanced countries. TCM has struggled out of the dead place. It should rise as China rises and take an important seat in scientific modernization.
Contradiction develops and transforms with conditions. What are TCM's conditions?
(1) Party Central attention; constitutional basis. (2) Popular need. (3) Health Ministry's correct leadership. (4) Education, research, treatment — a system of institutions initially built. The conditions are not strong, but with the first three, the overall is set. The root factor of development is the inner cause.
TCM's rise-or-fall depends on today's TCM. With one aim, with unity, by hard work, revival is achievable. The old are old; the burden of rise-or-perish rests on today's middle-aged, especially the backbones. May they recognize the weight and grasp direction — taking on TCM's rapid growth as theirs. A decisive factor. Direction — since we are called Chinese medicine, we must keep raising our TCM level, not Western, not integrated. The Yangtze's later waves push the earlier — may middle-aged and young TCM far surpass us elders; if not, our eyes will not close in death.
How TCM should develop
1. Talent is the root. Hundred-year tree of people — TCM education must be done well. Build conditions; expand enrollment. Reform curriculum to raise real high-level TCM talent — different from the elders, not integrated-medical. Also: large-scale secondary-level training for TCM specialties. Rescue elder-experience. Methods can vary: in coming decade, allow elders to mentor apprentices; with state exam, recognize the credential.
2. Hospitals are the key. TCM's weakest link is hospitals — few and small, mismatched to a billion-strong population. Few beds means no internship place; clinical study suffers; lack of craft unfixed. Also: a few graduates' placement is a problem because no TCM hospitals exist to take them. The contradiction — small ranks yet hard graduate placement — is laughable-and-sad. The greatest obstacle to TCM. So TCM hospitals must steadily mature and grow.
3. TCM character is direction. TCM colleges and hospitals must run with TCM character. Else why exist? Drift, and TCM is name without substance — we will be history's criminals. The lost years must be won back; with one heart, mine, inherit, summarize, raise clinical level. If TCM cannot relieve suffering, it has no reason to exist. To use Western drugs and force a TCM prescription beside them is waste of national funds and self-deception. How will TCM scientific level rise that way?
Some say: after antibiotics, TCM fell behind on pneumonia; with furosemide, TCM fell behind on diuresis. A Hong Kong herbal chemist asked me: do we still use TCM for pneumonia? — as if whatever Western medicine has, TCM can scrap. I say: antibiotics have strengths, but the more they are used and the more they are abused, the more bacterial-killing power comes with side effect. So this does not deny TCM's role; on the contrary, research and develop TCM the better.
How TCM scholarship should develop
1. Take Marxist philosophy as guide. Pre-Qin plain dialectical-materialism gave TCM millennia of life. Marxism is the most scientific modern philosophy; learn it, use it to guide inheritance and development — TCM will leap again. TCM education must strengthen this — see it as TCM's lifeline.
**2. Develop biàn zhèng lùn zhì; use TCM's comprehensive treatment; reference Western diagnostics.** TCM acupuncture, tuina, plus pills, powders, pastes, dan, were the historical means of saving critical conditions. Today's young physicians slight needling and massage, prizing surgery. TCM medicines often run short; pills-powders-pastes-dan for emergency near-blank. TCM is set in extremity. Change must come. Western diagnostics — many drawn from biochemistry and physics — can serve TCM biàn zhèng lùn zhì; we should not refuse them. They can help develop TCM. E.g., blood rheology and hemodynamics for blood-stasis pattern. Equipment of TCM hospitals: the newer the better. But: borrowing Western tools is to develop TCM theory and skill, so our experience is easier accepted.
3. Inheritance and development are dialectically related. Without inheritance, development has no source. Only inheriting without developing — TCM's life stops. Today: inheritance is poorly done, especially clinical losses many; urgently catch up. Rescue is the priority. For all of TCM, inheritance now is principal — not denying that some units or persons may emphasize development.
4. Joining natural science (including Western medicine) is the future direction. To use experimental science to solve TCM theoretical problems, Chinese-Western integration alone cannot do — often gives opposite results: e.g., the White Tiger Decoction's fever-clearing — Western pharmacology cannot prove it. Zàng-xiàng, jingluo, qi-fortune — even harder for current Western experimental means. To leap, drawing on multi-disciplinary newest achievements — guided by Marxism, inheriting TCM systemic theory — is the way.
In sum: TCM's future has higher chance of advance, but the hidden danger of gradual extinction is real. Caution. Things must first rot, then worms breed. May those with hearts for our medicine unite and step forward.
(Originally in Medical Works of Deng Tietao.)