The Cultural Conflict of Contemporary TCM Education
First Affiliated Hospital, Jiangxi Medical College
Kuang Cuizhang
Counting from the late 1950s, contemporary TCM education is now over forty years old. Opinions in the TCM field are split. Those who affirm it can cite figures: so many undergraduates, masters, and doctors trained; so many made professors, chief physicians, master- and doctoral-advisors, and academicians — a magnificent record. Those who deny even sigh: "Forty years' bitter labor — to raise the gravediggers of Chinese medicine!" Why does such opposition arise? What problems does it pose for the reform of contemporary TCM education? This paper tries to explore the question through the lens of the conflict between traditional culture and modern culture.
1. "From age to age the talent rises"
From the 1950s through the 1970s, the TCM ranks had their outstanding figures: Pu Fuzhou, Yue Meizhong, Qin Bowei. In today's term, academic leaders. They became models in TCM clinical care and scholarship; under their training, a new generation of thousands of TCM physicians grew up. Of these new physicians the most outstanding may be represented by Academician Wang Yongyan — truly from age to age the talent rises. But compare the two generations' knowledge structure and academic orientation, and one finds them very different. In their command and use of modern scientific knowledge and method, the students far surpass their teachers. But in TCM clinical level and traditional-scholarship accomplishment, are the students surpassing the masters, somewhat short, or going their separate way? And if we extend the gaze to Wang's own students' generation, we see their academic trajectories already drifting away from Pu, Yue, and Qin. If the best among them become academic leaders in turn, how far will their trajectory have moved from Pu, Yue, and Qin?
Hence the pessimists' lament is no idle word. How does this decay-within-flourishing come about? Why does contemporary TCM education breed such a serious contradiction, leading to such strong alienation? The answer should be sought in the conflict between traditional and modern culture.
2. The traditional-cultural character of Chinese medicine
Chinese medicine is rooted in the soil of Chinese traditional culture — it is a science grown from that soil and bears the essential character of that culture. This character is consistently expressed at every level: worldview, epistemology, methodology, logical reasoning, conceptual system, technical means. In worldview, traditional culture sees the world as a whole; the human is born of the qi of Heaven and Earth, formed in the way of the four seasons. And the human is known as an indivisible whole: the ten-thousand things shoulder yin and embrace yang; the rushing qi attains harmony. TCM seeks to grasp and regulate this shoulder-yin-embrace-yang, rushing-qi-attains-harmony human life as a whole. To know the world and the human, the knowing subject cannot stand above world and life and gaze down; he can only, as a member of world and life, feel them, infer them, comprehend them. The epistemology is therefore not subject-object split with stress on objectivity, but self-and-world as one, feel-with-the-heart, infer-from-inside-to-outside, infer-from-outside-to-inside — a world-and-self fused inner-landscape. So the methodology must use integral connection, dialectical complement, system-and-harmony — integral method — and not the mechanical, the dissected, the reductive. In reasoning, traditional culture uses containing-the-middle (not excluding-the-middle), complementary (not bound by the law of non-contradiction) dialectical logic. So traditional-culture concepts and conceptual systems carry an integral, dialectical, complementary, fuzzy character. And in technical means the unique strength of integral regulation shows — from the prime minister's harmonizing yin and yang in politics to TCM's observe where yin and yang lie and regulate, taking balance as the goal. The distinctive character of traditional culture is thus determined by these genes of worldview, epistemology, methodology. By the same token, the distinctive character of Chinese medicine, as traditional medicine, is determined by those genes.
The distinctive character of traditional culture and traditional medicine is plain. TCM uses yin-yang, exterior-interior, cold-heat, deficiency-excess as coordinates to discern human disease patterns — no parallel to modern medicine's etiology, pathology, and focus classification. TCM seeks the maximum (efficacy) of the system (the formula) through compounding; modern pharmacy seeks effective single entities through deep analysis of single drugs — opposite directions. TCM's eight principles, four qi, five flavors run in one line with the Yijing's one yin and one yang is called the Dao; modern pharmacy's analytic method runs in one line with atomism, molecular theory, and Mendeleev's periodic law. That is the fundamental difference between tradition and modernity.
3. The rise and fall of traditional culture
Traditional culture flourished in ancient China to the fullest. The 5,000-year unbroken Chinese civilization is the clearest fact. Pre-Qin love songs "Cast me a quince, I return jade" can still be read directly today; oracle-bone characters share form with today's Chinese characters — a source of pride. In medicine, all the more: TCM is the world's most complete, most fully functioning, most widely covering traditional medicine. The Confucian Dao tradition supported the imperial system for over 2,000 years and created the splendor of ten-thousand nations bringing tribute caps in Han and Tang, all the way to Kangxi and Qianlong; from First Emperor Qin and Wu of Han to Taizong of Tang and Taizu of Song, down to the 19th century with its model inner-sage-outer-king statesman Zeng Wenzheng-gong.
Yet just as the Confucian Dao tradition was at its peak and the learning-for-oneself was being pursued in great depth, the Western barbarian lands developed a new culture or modern culture with atomism, positivism, and reductionism as features. This culture differs from traditional culture at the gene level. The capital-desire it bred used strong ships and powerful guns to knock at the gate again and again, posing a challenge that traditional culture had never met — an unprecedented change. At first the Celestial Empire thought the difference lay only in tools and aimed to learn the foreigners' techniques to control them. Then to Chinese learning as essence, Western learning as use. Finally, facing the crisis of extinction of nation and race, it broke with tradition. As they smashed the shop of Confucius, the New-Culture elite condemned Chinese medicine in the same breath. Around the May Fourth era, celebrities such as Hu Shi and Ding Wenjiang made it fashionable to scold TCM and Peking opera. Lu Xun's most painful line: "Our pressing tasks today are: first, to live; second, to develop. If anything stands in the way — ancient or modern, human or ghost, the Three Tombs and Five Canons, the Hundred Songs and Thousand Yuan-editions, the heavenly globe and the river-chart, golden statues and jade Buddhas, ancestral pills and powders, secret pastes and elixirs — trample them all." Then in the 1920s came Yu Yunxiu's Proposal to Abolish Chinese Medicine — not without cause. Ding Wenjiang was a geologist; that he scolded TCM is forgivable, but he scolded Peking opera too — showing that his lash was aimed at the whole of traditional culture, even traditional art. There was also Qian Xuantong, who would even abolish Chinese characters and the Chinese language — showing how at the life-and-death moment of saving the nation the spirit of the age was anxiety and dread. TCM, like Peking opera, hung on by the slenderest thread; that the line of transmission did not break was only because people still came to watch. To the rulers, let the new medicine flourish and the old wither away — non-action governance, no need for an outright ban. The yielding of tradition to modernity, the replacing of old culture by new culture, looked the natural law of evolution, the trend of the times. How could the traditionalists hold?
4. The great treasure-house and cultural confidence
Mao Zedong said: "Chinese medicine and pharmacy are a great treasure-house. We must work hard to mine and elevate it." On what basis did Mao — a revolutionary teacher and political leader, not scientist, not physician — make this judgment? Looking back nearly half a century later, with the founding of the People's Republic of China as the mark — and with the task of saving the nation complete — the anxiety and dread of the 20s–30s lifted, and a Chinese intellectual like Mao, who had deep understanding of traditional culture, recovered confidence in national tradition. It is said the defeated Chiang Kai-shek opposed almost everything Mao did — except the preservation of Chinese medicine. That shows the non-political, cultural significance of the move. But by what tool and by whose hand should this treasure-house be organized and elevated? Mao turned to the Western physicians who commanded modern scientific tools, called on them to study Chinese medicine, hoping to train among them a number of theoreticians. This also shows that cultural confidence is not the same as scientific confidence — for traditional culture has, after all, too little science. Hu Shi said: Western medicine knows the cause and cannot cure; it is scientific. Chinese medicine cures and does not know the cause; therefore not scientific. (To this day some hold that TCM is a cultural phenomenon and not science.) Against this background, TCM colleges were founded; contemporary TCM education set out.
5. The road is long
In 1956 the first batch of TCM university students entered. They, and every cohort after, had received modern cultural and scientific education from primary school through high school; master maths-physics-chemistry and you can roam the world was their creed. Scientific organizing-and-elevating of TCM was their mission; inheritance was only means and prior work. So in study they regarded TCM's theory, classics, concepts, and logic with skepticism and a scrutinizing eye — all the more as these clashed with the modern scientific thought-pattern built up from primary through high school. At the same time, the parallel modern-medical courses kept reinforcing the prior modern thought-pattern. TCM could thus give the students only technique-of-treating-with-formulas; the Dao on which the technique rests was put aside, or dismissed in one word — experience. From the outset, the weak position of traditional culture and traditional medicine was set: a position of being scrutinized, studied, organized, elevated.
In the 1960s I was a TCM undergraduate. When Jiang Chunhua and Shen Ziyin's paper on kidney-yang deficiency appeared in the TCM Journal, I remember my excitement and admiration. I thought then that Jiang and Shen's research direction was the academic orientation for us new-generation TCM physicians. From this one sees: the new-generation TCM stand was, from the outset, on the modern side; not because they were at TCM colleges did they return to tradition. A 1960s graduate, in self-evaluation, said TCM-college graduates are in fact Chinese-Western integrated; after a decade of growth they could replace the Western-physicians-learning-TCM who had first launched TCM research (more properly, the study of TCM). These honest words objectively reflect the actual track of contemporary TCM education.
Most TCM undergraduates went on to clinical TCM. Their academic course is worth tracking. The new-generation TCM doctor carries two crosses in his deep mind — two sets of coordinates. One is modern medicine's: disease diagnosis and efficacy judgment. The other is TCM's: pattern-discernment by the eight principles, six channels, and so on. Compared, the modern coordinate is always heavier, more solid, harder; the traditional, lighter, emptier, softer.
A case of hemoptysis admitted to inpatient: the first thought is clear diagnosis — pneumonia, tuberculosis, bronchiectasis, blood disorder, lung cancer, or other? From this flow a battery of tests, analysis, and treatment. As for the TCM diagnosis — wind-heat invading the lung, autumn dryness injuring the lung, wood-fire scorching metal, qi failing to contain blood — it has plainly stepped down to a secondary, subordinate position, or been entirely dimmed. In time the traditional coordinate, in the new-generation TCM's academic mind, is not strengthened but weakened, forgotten, even denied. In clinical TCM level the new generation will not easily surpass the old. It is not that they are slower than their teachers; it is that, from the start of TCM study, the belittled-as-empirical-technique traditional cultural science never stepped out of the shadow of the modern coordinate. Traditional culture has not taken root in the new generation, let alone flowered or fruited.
In the late 1970s, TCM graduate education began. Modeled on the studies of the kidney, the spleen, and stasis-and-blood-quickening, it threw up indicators, models, statistics, deep micro-analysis, the molecular level, genes and post-genes… cohort after cohort of masters and doctors took the baton from the Western-learning-TCM generation, studying TCM. In their minds the modern thought-pattern was further strengthened; could traditional ideas not wane? It is said that the great majority of the TCM doctorates trained these years go on to research institutes to study TCM (Lu Guangshen holds that TCM research and studying TCM are two different things). These facts show: the talents trained in upper-level TCM education grow more modern with each generation, less traditional. No wonder the lament — "Forty years' bitter labor — to raise the gravediggers of Chinese medicine!"
6. Rebuilding the confidence of traditional science
No doubt modern culture is today's dominant culture. In China's pursuit of the four modernizations, the spread and strengthening of modern culture is absolutely necessary. "Fresh leaves push the old aside", "the later wave pushes the front wave" — the triumph of dialectics, worth cheering. What is it that the senior TCM specialists cannot let go of? The question returns us to the late-19th-century essence-versus-use debate.
When Zhang Zhidong put forward Chinese learning as essence, Western learning as use, Yan Fu rebutted: "Essence and use must speak of one thing. The ox's body has the use of carrying; the horse's body has the use of going-far. None has ever heard of 'the ox as essence with the horse as use.' Chinese and Western learning are as different as men's faces — they cannot be made alike by force. Chinese learning has its essence and use; Western learning has its essence and use. Separated, they stand together; merged, they perish together." Today we recognize TCM's use and not TCM's essence. So-called TCM modernization and studying TCM are in effect Western essence, Chinese use — the ox as essence with the horse as use — manifestly self-contradictory.
For years, TCM research has been little fruitful for this reason. The half-century of contemporary TCM education has gone toward alienation for this reason. The senior TCM specialists' grief is at this. "Chinese medicine is a great treasure-house" — and the treasure is not only artemisinin in qinghao, corydalis-yi-su in yanhusuo, indirubin in qingdai. The treasure lies in the TCM academic system itself; that system is TCM's essence, the supreme treasure.
To recognize that TCM has essence is, in effect, to recognize the scientific quality of the worldview, epistemology, and methodology from which TCM's academic system arose. In Chinese scholarship this remains a question mark. In Dushu 2001 No. 9, Tian Song's article The Contest for Scientific Discourse and Its Strategies introduces a large symposium Did Ancient China Have Science? held on August 20, 2000, at the Institute for the History of Natural Sciences, CAS; and gives an introduction and comment on the yes and no sides. One line from Tian deserves TCM colleagues' deep thought: "Take TCM: because it is high and effective, we say it is scientific; but the moment we call it scientific, it should obey the basic principles of science, and we must use science's — that is, Western medicine's — theory and methods to regulate it. The result of this 'Chinese-Western integration' is that TCM-college graduates can no longer take a pulse, and TCM will inevitably die out, leaving only Chinese herbs gasping or thriving inside the Western-medicine system. So even from love of traditional culture, I firmly oppose calling TCM scientific." Tian points sharply to TCM being regulated into the verge of extinction. But why must science have only one essence? Why cannot science be Chinese has Chinese essence and use, Western has Western essence and use?
The push to TCM's near-extinction is not the fault of science but of scientific monism — scientific hegemonism. The great success of modern science has remade every face of human life and made people half-worship science. As if there is no truth outside science, no science outside modern science. The contest for scientific discourse is born.
From TCM's standpoint, the strategy should be: One — you have your dairy cow, I have my yellow ox. Two — your dairy cow makes much milk; my yellow ox makes tender beef. Three — bring in your dairy cow, and my home has two oxen. Four — do not artificially inseminate or "dairy-cow-ify" the yellow ox and lose its "genetic advantage". Five — if the yellow ox is not in the "lineage" of the dairy cow, and we "symposium" on whether our home ever had an ox at all, would we not be laughed at?
Know: outside modern science there is science — traditional science. Traditional science is the knowledge system built in the early period of human knowing, starting from the whole to know the world. TCM is its most typical representative. The integral worldview-epistemology-methodology is most concentrated in the Confucian classic Yijing. As Jung said: "China indeed has a science. Its standard work is the Yijing. Only this science's principles, like many other Chinese things, are entirely different from the principles of our science." Other ancient sciences that knew the world by one yin and one yang is called the Dao have all died out; only Chinese medicine remains. The reasons: (1) clinical-efficacy testing and feedback gave TCM the practical base to develop and self-correct; (2) the human has the greatest integrality of any object of knowledge — so the strength of this principle is fully played out, while modern science with reductionist method is blind to integrality.
In sum: TCM has its own principles — its own essence — namely holism. Modern science has its own essence — reductionism. To regulate holistic TCM by reductionist method is to drive TCM to extinction. To preserve and bring forth TCM is to strengthen TCM's grasp and use of its own principles and essence.
7. Strengthen the essence of tradition; broaden the use of Chinese medicine
Pu Fuzhou, Yue Meizhong, Qin Bowei spent their lives in study, application, and research of TCM. They did not see inheritance only as prior work; their academic track was strengthen the essence of tradition, broaden the use of Chinese medicine — essence and use as one. The 1960s-graduate generation began to drift from this track; the essence of tradition weakened, the use of Chinese medicine could not broaden. The later experiment-research-driven masters and doctors are: the essence of modernity steadily strengthens, the use of Chinese medicine is not even discussed. The track of alienation is plain to see.
The cause of alienation is first the hidden scientific monism, the denial of traditional science's essence, leading on to using Western theory and method to regulate TCM in teaching, research, and even clinic. (Look at the successive editions of TCM-college textbooks: each new edition drifts farther from tradition.) Trained students cannot take a pulse (more, they do not believe in, do not want, do not deign to take a pulse). Or they follow the Japanese Xiao Chaihu model: Western diagnosis with TCM drugs — the ox's body, the horse's use. So today's TCM ranks have misshaped academically — neither ox nor horse; how can they be used? This is the conflict between traditional and modern culture as expressed in contemporary TCM education.
Momentum is a powerful force. At the turn of the 19th–20th centuries, the great powers wielded the force of modern culture to threaten the Chinese nation with extinction; and the citizens, while smashing the Confucian shop, would sweep TCM, Peking opera, Chinese characters and language away with it. Mid-century, preserving TCM became the sign of recovering national cultural confidence. Over the next near half-century, the pursuit of modernization produced the tides of Chinese-Western integration and TCM modernization. Now, in the 21st century, with national fortunes rising, the Chinese should face their once-splendid tradition with greater confidence. They should reread Yan Fu: "Chinese learning has its essence and use; Western learning has its essence and use; separated they stand, merged they perish." TCM workers should awaken first, stand strong first. With conceptual awakening, the right road can be found.
May 21st-century TCM education become an essence-and-use-as-one education: strengthen the essence of tradition, broaden the use of Chinese medicine.