Thoughts on TCM Research Work
Over decades, many TCM workers have done a great deal of research to develop TCM. Among these results (or conclusions), some have played a positive role in TCM's development; but many results have come to little more than painted cakes, taken into the belly of TCM not at all — naturally they could not push TCM forward. Why? In my view, it is because the features of TCM research, the threads of its thinking, and the modes of research, have not been clear and appropriate enough. Hence the following discussion, for the consideration of colleagues.
1. Clarify the difference between Chinese and Western medicine; correct the research mode
**1. Don't plant a fruit that cannot be eaten.**
The basic aim of TCM research is to serve TCM's development. If a piece of research cannot serve TCM and only has meaning for Western medicine, then it should be called a Western-medicine research result. If a piece of research uses other scientific methods as base and end-point to study TCM, that too cannot count as a TCM research result. Such work may be necessary (even important), but for TCM's own elevation it may be unimportant — even useless. Real TCM research results should set their sights on TCM's elevation and development and produce corresponding effect.
**2. Don't take Western medicine as the standard.**
Western medicine, built on modern science and technology, has developed greatly. People are used to comparing past and present and so see Western medicine as daily more advanced, constantly progressing. This impression is not in itself wrong. But if from this impression we simply hold up TCM by the same yardstick, feel TCM backward, and want to take Western medicine as model and forcibly adopt Western research methods on TCM — we have fallen into a thinking error. Because most of TCM's classical theory has been verified through repeated clinical practice — and practice is the sole criterion of truth. Though these theories are older than Western medicine, because they are close to the clinic and fitted to reality, they are not only old without aging but often show many points of forward-seeing recognition. In the TCM canon, from antiquity to today, there have always been many things Western medicine or modern science cannot explain. Some of these were once denied or criticized in history, and these denials and criticisms have later been shown wrong. History's lesson firms our faith in their forward-seeing character. These unexplained, unregulable things may well be where TCM's treasure lies. From another angle: looking forward, Western medicine and modern science are both immature. What now looks advanced may in the future become backward, incorrect, eliminated; today's enforced standards may be revised tomorrow. If we hastily take today's standards and standardize TCM, ignoring its forward-seeing feature, we will toss away sweet flesh for coarse grain — hardly to be avoided.
2. Build a solid research foundation; develop TCM along its ancestral course
If TCM research cannot simply copy Western standards and should aim at TCM's own development, then how should it be done? Several thousand years of TCM development give us good reference.
1. Take the clinic as ground; build on solid, deep TCM knowledge; let development reside in inheritance.
The ancients had no research in name but did have it in fact. Through history, almost all famous physicians did great research on TCM and brought it forward. Though their points of focus and areas of work differed, they shared these things: first, they all valued clinical practice; second, they all had a solid TCM base. Because they inherited well, they prepared full conditions for TCM's development.
2. Environment plus effort gave birth to TCM's new fruits.
The great shanghan epidemic of the Han gave many physicians ample conditions for practice. At the same time, mass mortality brought pressure and motivation: physicians diligently sought the old teachings, broadly chose many formulas, gave their full effort, sought effective treatments in clinic. So a Zhang Zhongjing arose at the demand of the age, and TCM was enriched and advanced. History tells us: developing TCM needs environmental basis, and rests on the joint hard work of TCM workers across the board. A TCM physician should have a meet difficulty and press on, never give up spirit. To change course at every difficult case, abandon TCM for Western medicine — such a one will accomplish little in TCM.
3. Hold to four principles; clarify the features of research
By the lessons of history, what principles should TCM research follow to develop TCM?
1. Principle of self-direction. Research must firmly follow TCM methodology. Believe firmly that practice is the sole criterion of truth. Do not let Western research methods replace TCM's; do not measure and discard TCM by modern science. Because these seemingly ancient, abstract, deep, fluid theories, in the hand of a true TCM practitioner, are powerful weapons. Western medicine has not yet correctly and fully understood many of these diseases — they wait for future discovery and revision. By comparison, TCM stands the higher.
2. Principle of integrality. TCM uses an integrated method to observe the human integrally. So the method that takes one point and dissects-and-analyzes does not suit it. Hence one cannot measure TCM's development by the degree of micro-resolution. To use an electron microscope to bring TCM down to the supramolecular level does not equal an advance of TCM — rather it makes people feel TCM is running behind Western medicine, that Western medicine is advanced. In fact, macro-grasp and whole-picture analysis are TCM's essence, and the root of clinical work. Only with accurate macro-grasp can treatment be accurate and effective.
3. Principle of specificity. TCM's emphasis on the whole by no means slights individual difference. Treat by the individual: under the guidance of basic theory, accurately grasp the individual features — this is the key to clinical effect. From this angle, the one formula to one disease approach may sometimes work, work in part, but lacking accuracy, it cannot meet the changing complexity of individual cases with high effect. To excessively praise such results and crown them as cutting-edge is over-reward. TCM in fact attends to commonality — its integrated view and the main content of the classics speak of commonality. But commonality is principle, the li, not the tool. The forebears prepared many formulas, but mainly to teach by rule; only one who grasps the reason of composition and changes it flexibly catches the true intent. From this angle, many clinical-report research papers' chief meaning is to teach li by formula. An experienced TCM reader focuses on this; copy the formula without seeking the reason and the effect cannot match the author's. There is much complaint that TCM clinical reports cannot be repeated; we should analyze: counterfeit or watery work surely exists, but it must be stressed that we should not expect simple repetition — because TCM's treatment varies with time, place, and individual. This is not like Western medicine: once a new drug for a disease is invented, every doctor can use it by the instructions.
4. Principle of multidimensionality. The world is complex; no one scientific theory can cover its every angle. The human body is complex; no one medical theory can cover it. Not only can Western medicine not replace TCM — within TCM itself, one theory cannot replace another. Zhang Zhongjing used six-channel theory to treat cold-damage; Ye Tianshi used wei-qi-ying-xue theory to treat warm-disease — theories differ, both effective. Times change, diseases differ; TCM's biàn zhèng lùn zhì must also develop and innovate on the basis of inheritance, following the ancestral course. Today a new spectrum of diseases sets us stark challenges. Every TCM worker should put heart and blood into deep research and diligent practice, into excavation and innovation, to form new biàn zhèng lùn zhì systems fit for modern disease, difficult and complex disease, and epidemic disease.
4. Broaden three great areas; hold five great keys
TCM's main areas of application: treatment of disease, group preventive care, guidance to other disciplines. Broadening these three is a great task. For treatment, the many difficult, modern, epidemic, geriatric, and critical illnesses await our research, for systematic and effective treatments. To this end, we should research and summarize, seeking the regular and forming systematic theory, achieving major breakthroughs. For group preventive care, we should organically combine TCM's yangsheng theory, qi-fortune theory, and constitution theory; make them orderly; and, in light of the features of age, society, and individual constitution, target each person with a fit, all-round preventive plan — from diet and routine to exercise and spirit-cultivation. Since TCM gathers the essentials of biology, medicine, philosophy, astronomy, geography, meteorology, and many other fields, its value is not limited to medicine; we should also note its value in other disciplines and let it play a guiding role.
The famous Northern Song scientist Shen Kuo held that there are five difficulties in treating illness: discerning the disease, treating the disease, taking the medicine, prescribing the formula, distinguishing the drugs. In modern terms: analysis and diagnosis of disease; deciding the method and steps of treatment; the dosage form and use of Chinese drugs; the combination and application of formulas; knowledge of and theory on Chinese drugs and new findings (the recognition, understanding, and discovery starting from and returning to TCM theory). These five are the keys deciding therapeutic effect. Because TCM research aims at lifting TCM's level — and elevation finally rests on real effect — these five are also the five great keys of TCM research.
From China Traditional Chinese Medicine News, April 4, 2001.