Thoughts on Chinese-Western Integration and TCM Modernization
President Jiang Zemin in his address at the Ninth CPPCC's education-health joint session said: "TCM is the characteristic of our country's medical science, and an important part of our excellent culture." In today's economic globalization, all peoples' cultures must clash and exchange. Each people must hold its cultural character, selectively take other peoples' advanced cultures, and merge them with tradition to promote the development of its traditional culture.
1. On Chinese-Western Integration
Around 1953, Chairman Mao Zedong put forth: "Combining TCM-herb knowledge with Western-medicine-drug knowledge, to form our country's unified new medical-pharmacological science."
Around 1958, papers carried "Chinese-Western confluence"; soon Chinese-Western integration replaced it. The definition of Chinese-Western integration has never been discussed; the concept remains unclear, recognition not unified — so practice is greatly blind. Chinese-Western integration in practice usually means:
(1) Clinical Treatment
1. Chinese and Western doctors together treat the same patient;
2. Chinese or Western doctor combines IV infusion with Chinese drugs, or Western drugs with acupuncture, anmo, daoyin, xingqi, taiji etc.;
3. In Western treatment, first use Chinese drugs then surgery;
4. Chinese and Western drugs used together;
5. Acupuncture or Chinese-herb anesthesia in Western surgery;
6. Small-splint fixation for fracture — motion-and-stillness combined;
7. So-called disease-discernment-and-pattern-discernment combined.
(2) On Paper
8. Western disease name and theory, with one Chinese-medicine prescription appended, or with several typed prescriptions by pattern;
9. A few sentences of Western theory plus a few of TCM theory thrown together.
(3) Education
10. Setting up Chinese-Western integration specialty programs.
Note: Lunyu · Zilu: "Names must be rectified ... If names not rectified, words do not follow; words not following, things do not get done." It is time to check the name by the real. Of the clinical, points 1, 4, 6 are cooperation between Chinese and Western doctors in work; 2, 3, 5, 7 are use of two methods by Chinese or Western doctor. Both are fine in clinical work as needed. If only to sell more drugs and make money for personal gain — wrong. But none of these are Chinese-Western integration scholarship.
As for the definition of Chinese-Western integration: it is, as Chairman Mao put forth, "combining TCM-herb knowledge with Western-medicine-drug knowledge to form a unified new medical-pharmacological science." Combination is a philosophical concept; recently people use fusion. It is not piecing together two unrelated things. Points 8 and 9 — Chinese and Western contents are internally unconnected, share nothing with TCM-Western integration. Such paper integration lacks dialectical thinking content, has no scholarly or therapeutic meaning — does not lift effect, does not advance theory a step; just waste of ink and paper.
Chinese-Western integration as a phrase, long-term and broad-view, is right. But by 40+ years of practice, the time to reach this aim is still long — 30 years, 50? I don't know. It must wait for TCM and Western medicine to continue developing, the two models to transform; then naturally come ripe melon falling, true scholarly dialectical integration. So overstressing it now does no good. By clinical need, two-method use is acceptable — but should not be called Chinese-Western integration. Absolutely not: Western theory plus one or several Chinese prescriptions; or two theoretical systems' contents internally unconnected and pieced together.
As for point 10 — Chinese-Western integration education: in the 1970s during the Cultural Revolution, under the false slogan Chinese-Western integration is the sole path of our medical development, TCM colleges reopened and admitted worker-peasant-soldier students, with Chinese-Western integration as the training goal. But there was no true Chinese-Western integration content to teach; Chinese and Western teachers each taught their own — TCM teachers TCM, Western Western. Students complained: "Teachers each speak on the platform; let the students do the integrating." Today Chinese-Western Integration programs in undergraduate education: TCM and Western courses roughly half each, taught separately. This produces a two middle-school-level graduate. Two halves of vinegar combined in one vessel make a full vessel of vinegar — but TCM and Western medicine are different theoretical systems; two middle-schools of them, added, does not lift either theory or treatment effect. Both remain at middle-school level — one Chinese, one Western, not complementary. 1 + 1 is not 2; nor 1; it equals 2 × 0.5. Recall the 1950s Western-medicine-leaves-post-to-learn-TCM class: high-medical-school graduates with several years' clinical experience as attending physicians, were drawn nationwide for two to two-and-a-half years' systematic study of TCM theory and practice — no PE, no foreign-language, no extras; political courses fewer than now — training high-level integrators. After graduation, they returned to clinic for integration work; some focused on research. 40+ years on, no true scholarly result of integrated theory has appeared, no improvement in effect. Western-learn-Chinese sighed: "Crossing the two, the head is empty at both ends — using Western methods, no match for the specialist; using TCM, no match for the senior practitioner." For real Chinese-Western integration in our country, both must continue to develop, both medical models thoroughly transform; only then is it possible. Marx-Engels Selected Works: "To scorn dialectics is to suffer punishment unfailingly." The reckless violators of medical-scientific law will in the end pay the price!
2. On TCM Modernization
(1) Modernization of TCM theory. Use modern scientific knowledge and method, by TCM's internal regularity and features, carry out objective, real, careful study of TCM theory, reveal the scientific essence within, explain in modern language, give it the features of the era, bring it into the orbit of modern science to advance science. For this, never take Western medicine's existing theory as standard. TCM modernization is absolutely not TCM westernization. Without true preserving-TCM-character modernization, Chinese-Western integration is absolutely impossible.
(2) Modernization of TCM diagnostics. Besides traditional methods, use all modern scientific tests — from thermometer, stethoscope, lab tests up to CT, color B-ultrasound, MRI — to extend our sense organs, see deep pathology. But never be led by the nose by Western medicine's existing conclusions. Accumulate large objective data; then with TCM theory as guide, organize and summarize carefully, with creative work find new regularities, bring them into biàn zhèng lùn zhì, develop biàn zhèng lùn zhì.
In using modern technical means, beware of westernization; do not be led by Western existing conclusions; do not lose one's strength, thinking, soul. Decades prove that TCM westernization harms others and self — no future — only ends the people's traditional culture, serves Western cultural hegemony.
(3) Modernization of hospital management.
1. Use computers to monitor the whole hospital:
- (1) Outpatient: doctor's visit, prescription, pricing, fees, registration, exam, drug — all entered into computer and to relevant departments' screens; patient goes directly to take exams and drugs.
- (2) Inpatient: departments use computer to monitor wards; the hospital to monitor all wards.
- (3) Pharmacy: computer-monitor pharmacy and preparation room.
2. From historical data find the regions' high-incidence and common diseases and their seasonality; find each hospital's treatment strengths and drug-use patterns; so develop the special departments, and schedule needed drug production and stocking.
(4) Modernization of Chinese-herb planting. For each herb, by its requirement, standardize planting season, seed selection, planting method, environment (mountain, plain, marsh), soil, climate, watering, fertilizing, field management, harvesting, initial processing, storage (packaging, transport, keeping).
**(5) Modernization of Chinese-herb processing into yinpian.** In processing — except fresh — washing, moistening, soaking all require clean water. For each herb, standardize how large a vessel, how much water, how long the soak in spring, summer, autumn, winter; cross-cut, straight-cut, or oblique-cut by features; thickness, uniformity — so the appearance is neat and decoction extracts evenly, ensuring effect.
For each herb's best use and traditional processing, standardize: e.g., if dry-frying to yellow, how yellow? Specify which herb, how much, how big a wok, how big a flame, how long, how yellow — even a color comparator to compare, so qualified processed yinpian are produced.
For herbs requiring excipients (wine, vinegar, salt water, honey) — set how much herb, how much excipient, wok size, flame, time, degree — all standardized.
(6) Modernization of dosage form. Traditional decoction is inconvenient; under the principle of guaranteed effect, push dosage-form reform and add new dosage forms. In recent years, factories make concentrated granules — convenient but with less effect, because (1) the raw herbs were not processed traditionally before granulation; (2) single-herb granules are mixed and dissolved separately, never co-decocted, so cannot undergo the synthetic change for reduced toxicity and enhanced effect. Also, granules cost three times decoction — many cannot afford it; uneconomical.
(7) Modernization of formula-combination theory. Health News, Nov 30, 2001, p. 1, Early Signs in Formula Composition Theory: "In studying the material base of five model formulas — Liuwei Dihuang Tang, Qingkailing — under different yinpian combinations, drug constituents were extracted in different ways; new peaks appeared, suggesting combination may change the active components, producing new chemical species — possibly the basis of combination effect. Drug-effect studies, from whole-organ-cell levels, on different systems and targets, found yinpian combinations can synergistically increase effect and reduce toxicity."
This proves combinatorial science but is only a sprout. Research must go on: the unique functions of each combination; the change in effect with proportion change among the herbs; the ruler-minister-aide-courier theory of combination.
April 25, 2002. Written at Hubei TCM Association.