Walk Our Own Road — A Conversation with Professor Deng Tietao
On January 20, 2002, Professor Deng Tietao (hereafter Elder Deng) generously gave us nearly four hours of conversation in his busy schedule. His earnest words bear deep meaning for us, for Guangxi University of Chinese Medicine, and for Chinese medicine as a whole. What follows is the transcribed conversation, reviewed by Elder Deng himself. The visit was arranged by Dr. Mo Feizhi, fellow alumnus, who came specially from Hong Kong to organize everything. Our thanks.
Liu Lihong: Elder Deng, hello. We know you have long watched our college's traditional TCM class (hereafter traditional class), opened in 1999, a first nationally. That such a first came from Guangxi was, one can imagine, not easy. It was largely due to the strong advocacy and support of our president, Prof. Wang Naiping. President Wang is a Japan-trained PhD in modern pharmacology — not a TCM specialist. Precisely for that reason, he can step back and see. Many in TCM are already numb to the question; in Su Shi's line, because we are within the mountain, we do not see its true face. President Wang can play the clear-eyed bystander. At the moment of crossing into the new century, with the TCM modernization call ringing ever louder, he proposed and saw through the traditional class. Without deep insight into TCM modern education, the move would be unimaginable.
The traditional class begins in the second year, after one year of regular study has given a first sense of TCM, by two-way selection. Class of '98 selected 20; '99 selected 15; 2000 selected 20. So the '98 traditional class began real operations only in 1999's second half. The traditional class shows its difference most in curriculum — fewer Western courses (five core subjects only), but TCM courses, especially the classics, are substantially expanded. In the regular class, all the classics are elective; in the traditional class, all are required. Shanghan Lun, for example, is 70 class-hours in the regular class but 100 in the traditional class.
Last year a new item was added — mentor-and-apprentice. The 20 students of '98 traditional class were divided among our First and Second Affiliated Hospitals, with 20 mentors selected for one-to-one apprenticeship lasting half a year — from the second half of year three through year four. The student is entirely with the mentor — clinic, ward-rounds, even off-site lectures and meetings. The fifth year is regular practicum.
Elder Deng: The design is good. Chinese-medicine education must walk its own road, not the Western pattern. You combine TCM's mentor-and-apprentice tradition with modern education. Very good.
Our work here is similar. I am helping the Provincial TCM Hospital turn its direction. In the past, the wards were Western-dominated; the academics tilted Western. I suggested walking our own road. To do so, I first joined their Heart Center — whose lead came from America and runs the world's most cutting-edge cardiac surgery (an American-trained Chinese PhD), with off-pump coronary surgery. Working with a TCM chief, I help with the perioperative period. Not every cardiac patient is solved by surgery — some with poor heart function cannot be operated on; we give TCM to lift heart function so surgery becomes possible. Post-op complications Western means cannot solve, TCM helps. With this initial recognition of TCM at the Western-most-cutting-edge center, I worked further: in time, gradually no surgery — because after surgery, the coronary may narrow again. If TCM keeps it from narrowing, TCM replaces surgery.
In that process I felt the in-center TCM practitioners needed mentoring; I alone cannot mentor the whole hospital. Before, I had done coronary research, so I started at the Heart Center. I proposed: I would invite national TCM masters to mentor. Last year first half I formally invited 10 (with me, 11). One mentor takes two apprentices — 20 apprentices total. By October I invited 15 mentors. The apprentices are the wards' backbones — associate chiefs, chiefs, attendings — 30 in total.
Our Second Affiliated Hospital has a seven-year integrated TCM/Western class. Last year second half, the 30 apprentices took on mentoring that class — 2 each = 60, nearly two cohorts. So old mentors middle, middle mentor young — at once medical and educational reform. With apprenticeship in, students reach the clinic earlier, and a teacher answers their questions in time. Influence is far greater.
So far: the Provincial TCM Hospital's westernization has stopped; everyone trends toward TCM. The middle backbone now run a Qi-Huang Academic Society, discussing TCM regularly. The TCM atmosphere is forming. Your class is a good beginning. TCM must be mentored; reading textbooks alone is not enough. Some senior TCM practitioners cannot lecture a whole frame, but with them you can sense the reasoning. Mentorship transmits by heart and mouth; sometimes without speech, you grasp the point. Not always grand discourse — talk on the way to the hospital can be its own lesson. Pursuit of TCM, deep understanding — much of it grows there. My influence on Dr. Mo was mostly in the car: in the rides to fetch me he gained much.
Chinese medicine has walked many crooked roads in the 20th century. First, government was unfriendly; TCM sat subordinate. Since the State Administration of TCM was founded, that subordination has shifted into self-subordination — TCM not believing in itself. Why no faith? Because real craft is not mastered, real skill not learned. The doctor feels uncertain with patients. So he chases Western things — internal medicine? open Practical Internal Medicine. He finds some road. But TCM-side, his heart is empty. If he follows a master and sees TCM solve problems, confidence rises. With faith set, he reads, sees patients, and is on the road. Entry matters — enter the door is to believe TCM can solve problems.
A patient of ours with brain contusion — they used Demerol per Western protocol; pain killed for hours, then back. How much Demerol a day? Heavy doses build addiction. Yan Dexin from Shanghai came to consult — one dose helped, two cured. That educates. By such cases TCM's recognition grows.
The problem now: how to build TCM confidence — that is key. To build confidence, lift academic level. Why did level drop? Demoting the Four Great Classics to elective is the greatest mistake. To use 1,700-year-old classics — Shanghan, Jinkui — as textbook has no parallel in the world. But people forget West Point still teaches Sun Tzu.
Chinese culture is not Western. Without the Four Great Classics, TCM's pattern-discernment thinking cannot stand. The TCM has no Western disease name for cardiac disease — and at once people doubt TCM. Take aphasia: we did not call it a cerebrovascular disease, yet after treatment the patient speaks. Then a brain CT calls it stroke. We did treat stroke; they say we misdiagnosed. The patient is well, speaking. Some use Western disease names as a ruler: you didn't diagnose it, so how did you treat it? They forget that to Rome there are many roads — by France, by Germany, by Turkey. Chinese medicine has its own road; we have ignored it and copied others, so level drops.
So long as our pattern-discernment-treatment and TCM systemic theory are well mastered, any new disease can be researched and, in time, root-cured.
My 7-5 attack project was myasthenia gravis. TCM has no name for it; nor the Western theory of pathology and physiology — they are clear on those. They are clear, yet they cannot root-cure; relapse is common. Steroid doses grow; side effects come; breathing crisis, femoral-head necrosis. We say spleen governs muscle; this is a deficiency-pattern; deficiency relapses easily — so after symptoms gone, two more years of medicine root-cures it. We are macroscopic; they are microscopic — their microscopic has not reached bottom, so they cannot root-cure; we can. Many female patients I have cured marry and have children; mild relapse after birth, more medicine settles it. Western medicine has more and more lost faith in the disease. Big steroid pulse — breathing crisis — tracheostomy. Thymectomy I strongly oppose. The thymus is the victim, not the criminal. The criminal is deficiency — and Western drugs do not supplement deficiency; they use steroids — an overdraft therapy; overdraft injures the kidney; kidney governs bone — hence femoral-head necrosis.
By TCM theory the process is clear; Western medicine cannot explain it, only call it side effect. They use the whip on the thin horse — a few steps, again the whip, until the horse dies. We supplement, let the horse grow back; so our effect is slow. Neostigmine works in 30 minutes; injection in 5; gone in minutes. We can borrow it too — treat the manifest in breathing crisis so the patient can swallow our medicine; once down it works. With neostigmine alone, by day five it slows; with my medicine, by day five we taper the neostigmine. We do not exclude Western medicine; we can borrow. But we are the host.
In education the same — we host. Integration the future world will reach. But without level yourself, what do you integrate? Done in two-three days. As the other side lifts, we must lift; only then do we meet.
The West is moving toward TCM theory: the medical model has shifted from biological to bio-psycho-social — toward TCM. Some TCM practitioners don't know their own thing — and use this new Western frame to teach themselves. Wrong. Our model is person-centered, human and Heaven in correspondence. We see by time, place, person. The Western bacterial doctrine is high but incomplete: it ignores the most important factor — the person. Only the germ. When the right qi is held within, evil cannot encroach — higher than them. So we have many precious things and don't notice; on seeing the West, we retreat three she and lose. Wrong.
Wu Jutong's etiological doctrine is most complete: pestilential qi — the pathogen; time-and-season — the qi-fortune doctrine; and storing-essence — the one who stores essence falls not ill of warmth in spring — that is, the human. Two spouses — one gets hepatitis, the other may not. The pathogen is one side; whether I can resist is the other. The West sees only one. TCM's etiology is therefore complete — Nature, pathogen, and one's own right qi. Don't think Western fine-detail means complete. In the 21st century we must bring out TCM's essence and let it shine via tech — that is your generation's responsibility; ours has set into evening.
What we most need now is what we have not raised well — high-level clinical TCM practitioners. Why has TCM not been pushed down? Because it cures. Practice is the criterion of truth — Deng's saying. Past cures were also called unscientific — because we couldn't explain. In our hearts we explain — but you have not studied TCM; how do I tell you yin-yang and the five storehouses? So the most important task is to lift confidence. How? Have efficacy; command TCM theory and experience; cure by TCM means.
Liu Lihong: Hearing your words moves us; it also brings up our worries and difficulties. President Wang has often asked me to be the traditional class's chief mentor. Each time I declined. Why? Because of what you just touched on: to raise truly traditional, truly real TCM, you must first have truly traditional, truly real teachers. To raise a traditional egg you must first have a traditional hen. Without the hen, no egg. The hen is hard to find. Truly — firm faith, high theoretical level, clinical capability — at least so much, then students gain confidence. We rarely find such people. So once the class moves to the substantive stage — mentorship — the problem looms. Students who want tradition meet mentors who are not traditional — the line breaks. In earlier years we poured heart and method to build a little confidence; meeting a wrong mentor, that work is undone. The shortage of teacher-trainers for tradition is what worries us most.
Elder Deng: What do clinics there use more — Chinese or Western medicine?
Liu Lihong: Let Prof. Tang Nong answer — he's the First Affiliated Hospital's director.
Tang Nong: Our First Affiliated Hospital, also Guangxi Provincial TCM Hospital — outpatient TCM prescriptions are 30–40%; if we count Chinese patent medicines and TCM-related preparations, about 50%. Another issue: beyond a few who use real TCM, many doctors prescribe by which drug carries the higher commission. That is serious.
Elder Deng: Prescribing for cash.
Tang Nong: I have asked hospital heads at national meetings about this; it is widespread. Administratively this is forbidden — but the drug sellers find every crack.
On what Elder Deng said — Dr. Liu and I share the feeling: the teacher cohort is in the worst trouble. Inheritance — the teacher — is the unsolved problem. Four years of study and students still hold rational confidence in TCM. After one year of clerkship, that confidence is overturned.
Elder Deng: Yes — that's where it lies. So at the Provincial TCM Hospital I first grab the backbones — backbones change, then the rest. I have long said: TCM education's failure is TCM clinical education's failure. Why? Heavy West, light Chinese. Why heavy West? Historical. In the 50s–60s many senior TCM practitioners were alive, but TCM-education hospitals had few beds — could only hold a few people. Then Western-doctors-learning-TCM graduates came first, after only two years' study; they entered the hospitals first, forming a Western-main-TCM-auxiliary model. Things flowed on like that, with the thought TCM has acupuncture, massage, the three treasures… and not enough without Western medicine. So the trouble is here. Clinic must change first. How?
Recently I told the First Affiliated Hospital's head my view: promote review of the classics — do not skip the review. Look at TCM history since Liberation. TCM was almost dead before Liberation; many practitioners stopped their own children from studying TCM, no future. After Liberation, after the Wang Bin event, came the call to learn TCM. There was a TCM Advanced School in Nanjing recruiting nationally — under Lü Binggui — the method was to review the classics together: not enough teachers, so the students self-organize — some on Shanghan, some on Wenbing, some on Neijing, some on Miscellaneous Diseases — all from across the country, study together, edit, lecture. From it came people like Dong Jianhua; Cheng Xinnong, Wang Mianzhi — many Beijing famous practitioners came from that review class. Of course they had family transmissions before; but undeniably, the review lifted them. So the review must be done.
This year I work with the First Affiliated Hospital on another model: review-class model. Middle backbones come to teach — speeches, case discussions — using the TCM frame. Case discussion may touch the Western, but bring out TCM theory and treatment. Backbones move in that direction. In three to five years, the situation changes.
Our First Affiliated Hospital — many college teachers and senior TCM doctors see patients there — has trained many. Guangdong has had several TCM colleges; this education has produced talents. Guangdong TCM is many; the mass base good. Why so many patients at our TCM hospitals? Do Guangdong people specially love bitter herbs? Without effect, who wants to drink them? Trouble decocting. So you must have effect — and outpatient is mostly TCM prescriptions. This says: the review must be done — review the Four Great Classics. Nanjing made it work. Then Yue Meizhong's research class — still based on review. After the Cultural Revolution, Yue ran a graduate class at Xiyuan Hospital, recruiting nationally. Another batch came through. So review trains.
The treasure-house is where it is. The question is: do you go in for the treasure? Do you face it right? First, turn people's thinking. Hard, but not too hard. If your TCM college, your TCM hospital, always heads West, you are always a third-class citizen — Western medicine will not look at you. The patient will not pick you first. People come to a TCM hospital hoping you solve what Western medicine cannot. If you have already knelt, what Western medicine cannot solve you also cannot — and what you can't, they can — what life-force do you have left? Put the questions to everyone: where is our future, does this road work? First do that work. To turn the situation — is TCM helpless? On hard diseases — is it I who am helpless or TCM that is helpless? Does your level represent all of TCM? One person — represent all? Boldness without ground. So first turn the backbones' thinking. The backbones need a class. The class members selected carefully, interviewed; without spirit, do not take them. Start small as pilot; you have two affiliated hospitals — pilot in one.
I once coined phrases. Self-subordination: one's own willingness to subordinate to Western medicine — teachers tell students to study Western instead, urgently. Foam-Chinese-medicine: TCM has research academies, hospitals, universities, master's, PhDs, post-docs — looks pretty but empty inside; the TCM core is missing. Return to Chinese medicine: revive Chinese medicine by returning to Chinese medicine. TCM-doctor-at-60: study TCM in your twenties, go practice Western for a decade — forty-something; some Western things don't work either — try TCM again — taste some sweetness — circle back to TCM for ten years — hair white — sixty — retire — talent-at-60.
Today's TCM is lacking practitioners and lacking craft. Saying so offends the first three cohorts of TCM-college graduates — what do you take us for? But lacking practitioners and lacking craft includes us elders too. World medicine moves fast; TCM, for many reasons, slow — can you be satisfied? Can you say you have much craft? So today: still lacking, getting worse. People appear — sign says TCM — but inside, foam. Must grab the backbones.
This class of yours is on the right track — use the bottom to push the top. You can write the article on it. Originally a disadvantage — to run a traditional class — you must have rock-solid traditional teachers; on opening the class, at the key moment, you find them missing. Without opening the class, you would not have realized how serious the teacher shortage is. With the class open, it's clear. Opening the class is good — it turns a disadvantage into an advantage: with the problem raised, hope of solving it appears. A bad thing becomes good.
Originally published in Journal of Guangxi University of Chinese Medicine, 2002 Vol. 5 No. 2