*Westernization* — the Fatal Error of TCM Research (Anatomy of the *Kidney Study*)
— An Anatomy of the Kidney Study —
Li Zhizhong
Abstract
Using Western biomedicine's concepts, theories, and methods to make Chinese medicine the object of research and "reshape" it through westernization has been the mainstream of TCM research for nearly half a century. In contemporary China, taking the doctrines of substance, structure, and morphology from the natural sciences as the absolute creed and only standard for the life-science domain has been one of the major causes of this error. The TCM "kidney study" is representative. By analyzing the project's self-set springboard, castration-in-advance, abandon-Chinese-for-Western, want-Western-yet-not-Western, experiments-not-real, hypothesis-still-falser, misfortune-to-others, and the Way is not alone — eight problems — this paper shows that the kidney study has trapped itself in compounding self-contradictions. The facts show: using political-grade beliefs and methods to set the direction, path, and method of TCM scholarship is another root of this error. It is of the same nature as the early-20th-century Soviet Academy's wrong handling of Mendelian-Morganian genetics. By today, the wound to TCM scholarship is mortal. We must lift up the scientific spirit, clarify the error with truth-seeking, and revive Chinese medicine — without delay.
Introduction
The kidney study (including kidney-deficient, kidney-yang-deficient, kidney-yin-deficient) began in the late 1950s. The project started from kidney-yang-deficient — proposing that TCM "kidney-yang-deficient" patients show, in Western terms, "low excitability of the pituitary-adrenal-cortex system." Over the decades, the project pursued the hypothalamic-pituitary-adrenal-cortex, thyroid, and gonad three-axis endocrine systems. Praised as a model of TCM research nationally, it still misleads the direction of TCM research today.
In the late 1980s, voices in TCM began to question the methodology of the kidney study. Professor Lu Guangshen said: "We want TCM research — not researching TCM." The point: setting out from TCM's own theory and practice to enrich and perfect its scientific research is TCM research; researching TCM sets TCM's theory and practice aside and takes the TCM system as an object for Western methods. Recently Professor Yang Weiyi's Chinese Medicine — A Functional Medicine of Macroscopic Regulation (Hong Kong, Qiu-Hai-Tang Cultural Enterprise, June 30, 2001) said sharply: "The integration of Chinese and Western medicine has not succeeded in theoretical research; we must reconsider." "Decades of time, the effort of how many, money flowing like water… If the old way is kept and we keep paying tuition to a bottomless pit, will TCM research have a bright future?"
From the day I read Yang's book, I felt thorough, honest reflection on TCM research is the urgent task. Below, drawing on The Kidney Study (Shanghai Science and Technology Press, 1981 second ed.) and The Kidney Study, Continued (May 1990), I analyze the kidney study in eight aspects: self-set springboard, castration-in-advance, abandon-Chinese-for-Western, want-Western-yet-not-Western, experiments-not-real, hypothesis-still-falser, misfortune-to-others, the Way is not alone.
1. Self-set springboard
The Kidney Study opens with the authors' own Comprehensive Review of Past Literature on "Kidney" in Our Country's Medicine — a "review" that distorts the zàng-xiàng meaning of "kidney" and sets a self-prepared springboard for the planned experiments.
The "review"'s introduction: "In zàng-xiàng — heart, liver, spleen, lung, kidney — kidney is the body's most important organ, called 'root of the pre-Heaven.' Because the kidney's role is special, through clinical practice the theory of 'kidney' and 'mingmen' has gradually developed, until 'kidney' far exceeds the other storehouses-and-bowels — it has the concept of governing life." The implication: if research on this kidney that far exceeds the other storehouses-and-bowels, governing life yields results, then it can almost govern all of TCM.
**1. Distorting the zàng-xiàng meaning of kidney**
To show continuity, the review surveys Qin-Han, Han-Tang, Northern Song, Jin-Yuan, Ming on the kidney. Indisputably, Spring-Autumn–Qin-Han is the founding-and-mature period of TCM theory; the Huangdi Neijing, Shanghan Zabing Lun, Shennong Bencao Jing, Nanjing — all from this era. Its frame is still TCM's basic content. From the zàng-xiàng angle, by Neijing, the review names 9 functions of the kidney: bring forth craft, store essence, store will, govern growth-development-aging, govern bones and produce marrow opening to the brain, its bloom in the hair, govern the ear, open into the two yins, conjoin with sanjiao and bladder. 11 ill-states: fear; over-labor and bedchamber injure the kidney; rage injures will, fright injures essence; gathering water into disease; yawning, sneezing; lumbar-spine disease; abdominal enlargement, distention; black face, dry teeth; reverse-cold; lustreless hair; channel-vessel patterns. Broadly aligned with the Neijing, with the first five editions of TCM-college Neijing Lecture Notes, Foundational TCM Theory, and Foundational TCM Theory coursebooks.
But the review's real aim lay elsewhere. To argue views on kidney varied through the ages, only unifying in the Ming, in the Jin-Yuan and Ming sections, it twists the period's debates on kidney and mingmen into theory unifying. Not a fact.
First, in Jin-Yuan and Ming nearly 70 monographs annotated the Neijing; Liu Wansu, Luo Tianyi, Zhu Danxi, Hua Renbo, Wang Ji, Sun Yingkui, Xu Chunfu, Ma Yuantai, Wu Kun, Zhang Jingyue, Zhao Xianke, Li Shicai, Wang Jiuda — their interpretations of kidney are the mainstream.
Second, in the Qing over 170 monographs. Chen Shiduo, Ke Yunbo, Yao Zhi'an, Wang Ang, Zhang Zhicong, Gao Shishi, Xu Dachun, Xue Shengbai, Wei Litong, Huang Yuanyu, Shen Yaofeng, Chen Nianzu, Zhang Xugu, Lu Jiuzhi, Zhou Xuehai — likewise consistent.
Third, the Ming debate over kidney and mingmen was at core about whether zàng-xiàng is physical or formless. Now we see it was confusion bound to a one-sided structural-substantial view — an episode of working through that confusion. After clarifying the kidney governs true yang, mingmen governs true yin dispute's substance, it is still the Neijing's kidney.
Fourth, contemporary TCM-college textbooks across editions also show: the recognition of kidney… only basically unified by the Ming is not historical fact.
Fifth, the true yin and true yang championed by the researchers was already plain in Neijing's kidney functions: storing essence, governing water, producing marrow and brain — true yin; bringing forth craft, storing will, governing reproduction and development, controlling the two passages — true yang. True yin/yang and kidney yin/yang are originally classifications by attribute of the kidney's function-governed. Every storehouse has yin/yang divisions — not the kidney alone. Each storehouse's function-governed and the yin-yang attribute of the function-governed are one — two inseparable sides of zàng-xiàng content. The yin-yang of the body, of each storehouse, of bowels and storehouses, of qi and blood — have different content. Yin-yang must always be discussed under the premise of function-governed.
Sixth, to discuss yin-yang apart from kidney's nine concrete functions is to simplify and abstract the kidney. Abstracted yin/yang of the kidney dilutes the function-governed content; then talking yin/yang again simplifies the kidney. The review's kidney's status far exceeds the others is the researchers' own illusion. By the same logic — heart is sovereign-office, spleen is post-Heaven root, lung is minister-office, root of qi, governs orderly regulation, liver is general-office, governs whole-body qi-and-blood — every storehouse is governing life. That is not the meaning of zàng-xiàng.
**2. On kidney-related illness-patterns**
The review then leaves the function-governed of Neijing's kidney aside, and dismisses the elaborations of later medical works. From only Suwen · Discourse on Bone-Hollow, it lifts a single short line — kidney-deficient brings shoulder pain and not-easy-to-lift; pain in spine, thigh, knee, hip — to attempt to capture all kidney-deficient clinical patterns. From Suwen · Discourse on Flaccidity it picks the kidney-related bone-flaccidity; from Suwen · Discourse on Cough, kidney-cough; from Lingshu · Treatise on Channel-Vessels, the kidney-channel symptoms. This selectively and falsely reduces kidney-pattern to a few skeletal complaints — self-set springboard. The researchers then test the low excitability of pituitary-adrenal-cortex hypothesis on patients who happen to fit a few back-and-bone symptoms, and call the rest kidney-yang-deficient. They missed that kidney-pattern in TCM clinical practice covers far more — reproductive, urinary, growth-development, mental-will, bone-and-marrow, ear, lumbar — and they substituted a thin Western frame for the rich TCM zàng-xiàng.
2. Castration in advance
1. Castration of TCM's etiology-and-pathogenesis. The researchers detached their kidney-yang-deficient concept from the rest of TCM pathogenesis. In TCM clinic, kidney-yang-deficient is one pivot in a network of zàng-xiàng relationships — interconnected with heart, spleen, lung, liver via generation-and-restraint relations. Detaching it from this network and treating it as a free-standing entity to be matched to Western endocrine findings castrates TCM's pathogenesis.
**2. Castration of zàng-xiàng and jingluo.** Kidney in TCM is not the anatomical kidney. The Western kidney is one organ in the urinary system; the TCM kidney is a great mode of life-activity including reproduction, water, bones, marrow, brain, hair, ear, two-yin, and is connected through jingluo to all of life. The researchers treated kidney as the Western anatomical organ — castrating the zàng-xiàng concept.
**3. Castration of the wholeness and non-specificity of zheng.** TCM zheng is the integral state of the patient at a moment — wholeness with time, place, person — never a single specific marker. The researchers reduced it to a few Western endocrine indicators — castrating the wholeness.
3. Abandon Chinese for Western
**1. The pattern-cluster diagnostic model**. After castration, the researchers re-built kidney-yang-deficient as a pattern-cluster — list a few signs from the Western framework, and diagnose accordingly. This swaps TCM's biàn zhèng lùn zhì for Western-style sign-checklists.
2. On medicine-property attribution. Tonics in the kidney study are attributed by Western pharmacology — endocrine effects — not by TCM's qi-flavor-rise-fall-channel-entry. The Chinese root is abandoned.
3. Diagnostic indicators bowing to West. All diagnostic indicators in the project are Western — endocrine assays, animal models — replacing TCM's four examinations with Western lab.
4. Want Western — yet not Western
1. Tonic-medicines and Western drugs not on one track. The TCM tonics under study were never developed by the same axioms as Western drugs; using Western criteria to evaluate them is to break their own ground.
2. Logic and clinical-verification problems. When the Western indicator does not move, TCM tonics are called ineffective; but TCM treats pattern, not indicator. Verification fails the logical test.
5. Experiments not real
1. Premise not real. The premise that kidney-yang-deficient = low pituitary-adrenal-cortex excitability was never proved — only assumed. From an unfounded premise, the experiments cannot give real conclusions.
2. Insufficient indicator specificity. Many of the endocrine indicators reported as kidney-yang-deficient signatures are non-specific — they appear in other Western conditions too.
3. Conclusion stated loosely. The papers' conclusions often go beyond what the data support — speculative bridges from indicator to kidney.
4. Self-contradiction. Different papers in the project give contradictory results; the project's reviews do not reconcile them.
5. The one who tied the bell unties it. The researchers who built the kidney study must now untie its knots.
6. Hypothesis still falser
1. Principles of scientific hypothesis. A scientific hypothesis must (i) accord with established facts, (ii) be internally consistent, (iii) be empirically testable, (iv) make new predictions. The kidney-yang-deficient = low HPA axis hypothesis fails several.
2. Three hypotheses in succession. As the project failed at one level, it advanced a new hypothesis at the next — HPA → thyroid → gonadal — chasing the indicator through three axes; each axis raised a fresh hypothesis without anchoring the previous.
3. One line running through. All three hypotheses share the implicit assumption: the TCM kidney is the sum of these Western endocrine systems — an assumption nowhere justified.
7. Misfortune to others
The kidney study's methodology was held up as a model and copied across TCM research — spleen study, liver study, heart study, lung study all followed. Errors in the model propagate. Misfortune to others: TCM research overall lost decades chasing a wrong frame.
8. The Way is not alone
The kidney study did not arise in isolation. It reflected the broader policy frame that took Western methods as the only standard and that placed political directives over scientific judgement. The 1958 double academic standard — affirm TCM's character while running its research on Western terms — is the soil. Similar to the early-20th-century Soviet Academy's mishandling of Mendelian-Morganian genetics.
Closing thoughts
1. On the testing of scientific research. A scientific research line should be tested by (i) whether it accords with its discipline's own first principles; (ii) whether it can be reproduced; (iii) whether it explains and predicts. The kidney study, judged on each, falls short.
2. The harm of misdirection. Decades of TCM research have been steered into the westernization corner. The deepest harm is that a generation of TCM researchers has lost the habit of working from TCM's own theoretical ground. To revive Chinese medicine, this misdirection must be reversed.
To clarify the error in the kidney study is not to attack particular scholars but to lift up the scientific spirit and let TCM research return to its own ground. Truth-seeking is the only road.
(Source text continues in the original article on cuiyueli.com.)