Preface to *Stone for Crossing*, Third Volume
Chinese medicine and pharmacy are a jewel of Chinese culture. Yet to truly recognize their value — for the world's people, for the medical community, even for some TCM practitioners — is not easy.
Over twenty years ago at a TCM academic conference, a Western-trained-in-TCM specialist said: "After antibiotics were invented, Chinese medicine fell behind in treating pneumonia; after furosemide was invented, Chinese medicine fell behind in treating edema." A few years ago a younger TCM practitioner wrote: "Change-it-must-change; not-change-it-must-also-change" — change toward Western medicine. Last year a senior practitioner wrote a survey article that TCM's clinical strength diseases are fewer and fewer. Such articles are not few; most stand on criticizing TCM theory for error or deficiency, or affirm in the abstract while denying in the particular. All reflect: among some scholars, confidence in Chinese medicine and pharmacy is wavering. A trust-crisis is taking root and spreading — a dangerous current.
Many start by deciding TCM is ancient; an ancient science must be backward; while TCM may cure, it has no lab proof and is out of step with modern science — therefore not science; Western medicine develops together with the other sciences — therefore advanced. No wonder one senior practitioner says: "Now Western medicine can see into the finest detail, do everything; in treatment, it transplants hearts and livers, capable of anything." Compared, Chinese medicine is reduced to a third-class citizen.
How should we see Chinese and Western medicine? I hold that we must take historical materialism and dialectical materialism as guides and look deeply at Chinese medicine.
1. By the materialist view of history
In the half-century before 1949, Chinese medicine was slighted, discriminated against, excluded — that it was not wiped out was great luck. After Liberation, Wang Bin's thought ran deep, and Chinese medicine sat in the "to be reshaped" seat. Although Mao, Zhou, and others publicly criticized Wang and removed him, and the Center repeatedly stressed proper TCM policy, founding the TCM Research Academy and several TCM colleges, the development of TCM made no large advance — until the State Administration of TCM was founded in December 1986, after which TCM enterprise had organizational guarantee. In a hundred years of TCM, 50 were oppression, 30-plus were lukewarm, and only 15 were of real great strides. Against the global Western-medicine fortune of the 20th century, this is sky-and-earth difference. Even so, by the 1980s Chinese medicine began going to the world — first acupuncture, then TCM more broadly. The developed countries progressively recognize TCM professional status; acupuncture is in insurance systems. Londoners queue at TCM clinics; Germans wait for beds in TCM hospitals — no longer a wonder. Three thousand American physicians have studied and now command TCM acupuncture. (How many Chinese Western doctors know acupuncture?)
The 20th century was an astonishing age for science; the world's Western medicine sailed before fair wind, while Chinese medicine fought wind and water and shallows. If TCM had no time-transcendent scientific deposit, could it stand together with Western medicine at the century's end before the world's people? Is this history not worth a hurrah from Yan-Huang's children?
To those low on TCM confidence: do not be one who sees the tiniest tip and misses the cartload of firewood.
2. By materialist dialectics
1. Practice is the sole criterion of truth. TCM has stood a hundred-plus years of pushing without falling. Why? Because treatment works. If TCM did not cure, the people would have thrown it away long since. But TCM-disdainers also say TCM is empirical, and its experience cannot be repeated. Those without TCM theory and experience, copying formulas, indeed have trouble repeating precious experience. A TCM physician's level rises in proportion to theoretical base, clinical experience, and cultural cultivation. Flip the works of named physicians across the dynasties and of contemporary named TCM doctors — the proof is there. To call TCM empirical has no foundation.
2. Microscopic is science; macroscopic is also science. Western medicine is microscopic — cell, molecule, gene, finer and finer. TCM theory is the opposite — macroscopic, placing the person between Heaven and Earth. Western medicine cures disease; TCM cures the sick person. By practice as criterion, the two cannot exclude each other — they complement, are both opposed and unified. Microscopic and macroscopic combined create higher, better theory and outcome. That is the direction of post-modern science.
Nobel laureate Yang Chen-Ning, in his 2002 May 8 talk Beauty and Physics at the Century Forum, said: "In the last ten or twenty years, a new physics between micro and macro has been developing — mesoscopic physics. It studies what falls between the macroscopic (everyday-size or larger) and the microscopic (atomic physics) — sizes like 10^-6 or 10^-7 angstrom. This field is surging — not because so many want to study quantum-mechanical interpretation, but because it is closely tied to industry… In twenty or thirty years, driven by industry, mesoscopic physics may bring revolutionary new development to the interpretation of quantum mechanics."
Yang speaks of quantum mechanics, seemingly unrelated to medicine. But from philosophical height, the reasoning is the same. The human grows within the great natural environment of Heaven and Earth; how can the human exist apart from nature? How can disease ignore nature's influence? From biology to the human is nature's millennia-long shaping; archeology answers in detail — and archeology too cannot leave macroscopic study. It develops only by macroscopic and microscopic combined.
Take myasthenia gravis: Western micro-research is deep, with animal models; neostigmine acts fast; prednisone is the trump card — but they only treat the manifest, not the root. Thymectomy is called specific; most cases still relapse. From the macroscopic, we see myasthenia as deep-stubborn deficiency of spleen-and-stomach with the five-storehouses interlinked; we use raising-spleen-yang and large-supplementing-of-spleen-and-stomach, with five-storehouse adjustment. It is a deficiency — after symptoms remit, two more years of TCM medicine root-cures it. When breathing crisis appears and the patient cannot eat, we use neostigmine injections to treat the manifest, so the patient can take oral TCM and food — through the crisis. That is macroscopic-and-microscopic combined.
Many TCM practitioners, especially the young, do not see this. On meeting Western micro-science, they doubt TCM's yin-yang and five-phase, and stop reading TCM books.
3. Inheritance and innovation. We are a developing country; in tech innovation we lag developed countries. So the State calls on tech workers to innovate hard, to catch the world. But Chinese medicine is different — the highest level in TCM is in China; on integration, foreigners are integrating with us.
Sociologist Tian Sen called TCM "China's fifth great invention." Unlike the other four — which were caught up and surpassed long since — TCM's reach has only begun. It influenced Arab medicine in the 11th century; Chinese variolation stimulated cowpox vaccination; immunology has roots in TCM. But TCM's true going-out, its deep influence on world medicine, has only just begun.
From the world's standpoint, every effective TCM method, in foreign eyes, is new — innovation. Acupuncturing the four-stitches for biliary roundworm-impaction acute abdomen — simple, fast, cheap. To foreign physicians, miraculous. Drop this method into world medicine — that is the result of modernization. What is modernization? In medicine, not form, not the date — but: minimum cost, shortest time, best result. The patient checks into the hospital and is run through every machine head to toe; on discharge owes hundreds of thousands — is that modernization?
Inheritance and innovation are a pair of opposites; neither side neglected. But situations differ; the pair has emphasis. Today on Chinese medicine, inheritance is the main weak side. The Center's directives on TCM begin with Chinese medicine must not be lost. The treasures of millennia have been lost too much. Mining the treasure-house, sorting it, is innovation. But our medicine, education, and research keep pulling in Western things to explain TCM theory, or use Western theory to reshape TCM's essence — and call this innovation. The error has hurt TCM development for decades. Cui Yueli once said: the senior TCM students we are training are at the technical level of two specialty schools, one Chinese, one Western — he sounded the warning long ago. For more effective innovation, all TCM practitioners, especially middle-aged and younger, should first do a great review — re-read the Four Great Classics and the schools of every age — to lift clinical and theoretical level; on this base, combine with the 21st-century newest sciences to walk our own road.
In the 1960s, the head of Tianjin's Infectious Disease Hospital, having studied TCM, learned of a diphtheria outbreak elsewhere needing diphtheria antiserum urgently — and the estimated dose required exceeded half of China's stock. He drew on TCM diphtheria treatment, took the Yang-Yin Qing-Fei Decoction, reduced it to a four-herb water-form, sent it — and stopped the outbreak. Cost per case: 1.5 RMB. And the serum-reaction problem avoided. That is a fine case of inheritance with innovation. But no one carried the work further. Why? Because not invented abroad, certain domestic experts give pushback, not push forward. Heavy West, light Chinese — if this stubborn illness is not root-cured, TCM innovation and promotion are hard.
For TCM today, inheritance is the main weak side; the TCM enterprise must put strength there.
3. Sacred mission — be the backbone of Chinese medicine
A wrong thought: whatever Western medicine can solve, TCM should step aside; before the Western newest achievements, TCM practitioners stand helpless — forgetting that Chinese medicine was won with the lives of countless patients and the wisdom of countless sages. Can the children of Qi-Huang blindly let the jewel of Chinese culture slip from our hands? If this great treasure-house is lost, we wrong our ancestors, our descendants, and the people of the world. TCM belongs to China and to the world.
After antibiotics, is TCM no longer needed for pneumonia? Geriatric pneumonia, deficient-cold pneumonia — TCM saves them. I have often used Guizhi Decoction, Xiao Qinglong Decoction, and the like to help antibiotics. In a Western hospital I consulted on an edema patient swollen like a beer barrel, unable to lie down, sitting in a wooden chair. Heavy furosemide had not reduced the swelling. I used Zhenwu Decoction with modifications — in two weeks the patient was unrecognizable, and went home with the chair empty. My student Yang Yifan, in Sydney, on March 3, 1995, treated a 6-month-old infant with congenital heart disease, four months in special-care ward, awaiting heart transplant in Melbourne. The hospital limited the TCM volume to 10 ml; he used American ginseng then Shengmai San. The infant improved; the hospital allowed 30 ml. Skin pinked, limbs warmed, weight up 100 g, fever no longer above 40°C. He added herbs, volume to 60 ml. By March 12, lung edema kept receding; heart function strengthened; the oxygen tube removed — first natural nose-breath in four months. But the hospital still sent the child to Melbourne. Yang opposed moving her — to no avail. March 20 in Melbourne, the flight stress brought respiratory distress; condition worsened. Heart transplant impossible; flown back; died in Sydney on April 1. The case is told in full only to say: transplant a heart, transplant a liver is not as light as it sounds. TCM values treat what has not yet become illness; treat early so we need not transplant — how good. I do not believe liver fibrosis is irreversible; if early cirrhosis is treated well, why transplant? Granted, those who can transplant are skilled.
The world's medicine fears the day no drug works against resistant bacteria. TCM must step up — research anti-bacterial methods and formulas. Not stand by.
TCM is China's and the world's — but if we do not work, what next? What the world most lacks is high-level Chinese-medicine practitioners — thousands upon thousands of iron-rod TCM doctors with real clinical strength. TCM development needs a great host of backbones.
Finally, on behalf of all the elders here, let me repeat: Stone for Crossing is made to be the stepping-stone by which the 21st century's TCM pillars climb upward.
July 29, 2002