Chinese Medicine and Pharmacy Must Be Deepened in Reform
Western medicine is microscopic; Chinese medicine is macroscopic. Both are science. But through the 20th century, Chinese medicine was pushed aside, kept outside the gate of "science" — which was a mistake. The reasons are many; the chief one is that only the Western pattern of science is acknowledged as science, and whatever does not fit it is "unscientific." Chinese medicine, not being a microscopic science — even when curing what Western medicine could not — could not be called "science." Some have lately called this cultural Western hegemony. The French philosopher Derrida, even today, says: "China has no philosophy; only thought."
Some in our country's 20th-century cultural-academic world held an incomplete view of traditional culture, and formed the position: that for Chinese medicine to develop, one must use Western-medical patterns and theories to help. Under this view, Chinese medicine's treatment, education, and research have borrowed Western patterns for over half a century. But Chinese medicine and Western medicine are two different systems, and Western patterns have brought more restriction than help. History has begun to bear this out. Today is the time to wake up.
In 1979 Minister Cui Yueli visited Japan, where the President of the Japan Medical Association Takeda told him: "You in China have traditional medicine. We do not. This traditional medicine is the medicine of the 21st century. By the 21st century it will be recognized and valued in many countries." Minister Cui said: "He has reason. Japan's abolition of traditional medicine was a tragedy and a mistake. We must never wipe out Chinese medicine. The line 'unscientific' will not stand. We must acknowledge that Chinese medicine is science, and research that science — and not use so-called 'integration of Chinese and Western medicine' as a way of replacing Chinese medicine. If we wipe out Chinese medicine, we walk Japan's tragic road." (Yueli — Cui Yueli's Self-Account and Memorial Articles, p. 81.) Under Cui's leadership, with hard effort, the State Administration of Traditional Chinese Medicine was founded in December 1986. But how do we truly carry forward Minister Cui's last wish? If the idea that Chinese medicine needs to be reshaped is not changed, the goal of reviving Chinese medicine will never be reached.
Recently I received a letter from a master's student at a TCM university. He wrote:
In the first year of theory courses, among more than ten graduate courses, TCM courses are pitifully few; most are Western-medicine courses. Even what TCM courses there are run like a horse past flowers — no different from undergraduate. How is a graduate's TCM level to be lifted?
> In the second-year clinical clerkship, the hospital uses Western drugs and methods almost entirely. Some departments still use a little Chinese herbal medicine; some, none at all. We are truly TCM-college students of Western medicine — yet for Western medicine too we are far from polished.
> English study… time and effort given to it run enormous. How are we to reach even a small share of you senior practitioners?
> In the third year, doing a research topic, raising white mice, using Western-medical assays to validate Chinese-medicine effects — how is Chinese medicine to be developed by this?
> Next year we start work, and we know our own strength. Chinese medicine has not advanced; in fact, we know less than three years ago. Western medicine — we know only enough to get by in the clinic. Students are now applying for PhDs in great numbers for the sake of advancement; but to be admitted is not easy, because most apply to Western-medicine schools' specialties, hoping to shed the TCM coat and put on a Western one to fit the current. Even classmates who used to praise Chinese medicine think the same way. How is this not a worry? Where is the future of Chinese medicine? Are we letting Chinese medicine die from within? Some TCM hospitals even say they do not want TCM graduate students — they want Western-medicine bachelor graduates. What has Chinese medicine become! How are we students to face it? I dare not imagine: if a few decades hence there comes another abolition-event like the Kuomintang's, will there still be senior practitioners with the courage, spirit, and level of the seniors of that day?
This is a denunciation. As I read it, my hairs stood on end. But it is a widespread reality — and a frightening one. The high-level talents whom TCM education has trained are not actually Chinese-medicine practitioners — and not willing to be, or not wanted by the very TCM hospitals. Meanwhile the academic successors who spent three years apprenticing to senior masters, inheriting both thought and clinical skill, count as a lower educational level than master's or doctoral degrees. This is a major problem for national TCM education that must be reformed.
At the same time, I received a letter from a student in Sydney, Australia: "We are glad to see Western countries' TCM development run hot. Last month the second New South Wales Department of Health released a draft of TCM registration, indicating Australia's TCM registration is at hand. Other countries will follow. In the not-distant future, Chinese medicine will root and bloom across the world."
Two letters — both about the fate of Chinese medicine — one within China, one without — one sorrow, one joy — the gap is too wide. Does this not call for honest reflection? Through reform and opening, in twenty years, our country went from a developing economy to a bold rising power — what was once "the sick man of Asia" stood up before the strong nations of the world. For Chinese medicine — most distinctly Chinese — we must today change our thinking and deepen reform; otherwise the danger is each generation worse than the last, until extinction. The heart of reform is changing the idea of using Western patterns to restrict and reshape Chinese medicine. Today we are using Western chemical-drug regulation to govern natural-medicine Chinese herbs, wholly divorced from TCM theory and experience — and one fears the herbs we may legally use will only grow fewer and fewer. No wonder one senior practitioner said: "The KMT abolished the medicine but kept the herbs; we are now abolishing the herbs but keeping the medicine." "Western administration of Chinese drugs" does not benefit Chinese medicine's development — it greatly benefits the import of foreign TCM. Behind Chinese medicine's image of bloom hides a crisis of decline and lack of successors. We must guard against "foam-Chinese medicine."
The good news is this young master's student, full of love for Chinese medicine, ended: "One day people will recognize Chinese medicine's value. I believe Chinese medicine should walk its own track and develop, no longer driven by others." Reading that, my heart was eased. There are people coming after to revive Chinese medicine.
Some doubt: the age of market economy is here; what cannot keep up with the market should be naturally weeded out. Will Chinese medicine be weeded out by the market? Media keep noting how many in the countryside and city's poor become poor or fall back into poverty from illness. Under the Western medical pattern, even the rich US is bedeviled by astronomical bills — let alone our developing country. Prof. Xu Jiajie of UCLA's School of Medicine wrote in the Proceedings of the '99 Macao International TCM Academic Conference: in 1996 the US spent $103.51 billion on medicine — over 14% of GNP. Prof. Xu said: "Such enormous spending has not effectively resolved many clinical problems, especially chronic and geriatric disease." Because of the cost, over forty million Americans have no medical insurance. Forty million is one-seventh of the population.
Could China sustain such a model? To "integrate with the world" — could we sustain this integration? To deliver healthcare to all, I hold we must vigorously develop Chinese medicine.
Currently, in administering TCM hospitals under the Western pattern, we are forcing the historically united medicine-and-pharmacy of Chinese medicine into separation. TCM hospitals are under-resourced and cannot match Western hospitals' revenue from imaging and expensive surgery. Forcibly separating medicine from herbs forces TCM hospitals into deep financial strain. Some TCM hospitals shift toward becoming Western — preferring undergraduate Western graduates to TCM master's graduates. That is the wrong direction. A TCM hospital's road forward lies in high-level TCM talent. If a hospital has a few well-honed specialty departments with TCM character, and three to five top TCM minds, the whole hospital comes alive. Market competition is talent competition; training real TCM talent is the urgent task. Conversion offers no road.
Chinese and Western medicine are both science; each has its strength; complementary; humankind cannot do without Chinese medicine. With its simple, proven, convenient, inexpensive strengths, Chinese medicine is indispensable for our country, for the Third World, and for the West. With 1.3 billion in China, and six billion in the world, how many TCM practitioners do we need? By statistics, our country has 5,583,900 Western practitioners and only 407,200 TCM. The gap is too large — and what is the share of high-level among that 407,200? 400,000 against six billion is too few. England, 50 million, has 3,000 TCM clinics; the Netherlands, 15 million, has 1,600; Canada, 30 million, has 3,000; Australia, 19 million, has 4,000. And Asia, Africa, Latin America?
If we do not have faith in running TCM hospitals — if we turn all of China's TCM hospitals into second-tier Western hospitals — what good does that do for China's or the world's health? If TCM hospitals raise generation after generation of fine practitioners, Chinese medicine and pharmacy will shine across the world, and the contribution to China and to humankind will be enormous.
To revive Chinese medicine, education comes first. The Chinese people need Chinese medicine; the people of the world cannot do without it. May TCM education be deepened in reform, brought back to its own track, and raise tens of thousands of high-level true TCM practitioners. Let us offer the jewel of Chinese culture — the fifth great Chinese invention, Chinese medicine and pharmacy — to the world. To the middle-aged and young TCM practitioners: the rise or fall of Chinese medicine is everyone's responsibility — heavy and holy. What to do? Beyond seeking out national study programs, set the understanding of Chinese medicine right, hold to faith, set up the spirit of struggle for the revival of Chinese medicine, and under that spirit return to a great review of the TCM classics; apprentice to true high-level TCM masters. The senior practitioners' writings published today are not few; much in them is precious. Read and verify against the clinic, and you become — as it were — a private disciple of the great living masters. How pleasant. Clinic → reading → reflection → clinic → summary and lift (or experimental research): this back-and-forth, this lifelong practice, is the bright road.
I believe that if TCM's medicine, education, and research are reformed in depth and walk their own road, the 21st century will be the century of Chinese medicine's takeoff.
Originally published in China Chinese Medicine News, March 31, 2003