TCM and SARS — Questions and Lessons
Jin Liang
"The ancients truly do not deceive me"
The reporter sought out Professor Fan Zhenglun after hearing a marvelous story about him: in April he had already forecast that after Grain Full (21 May), the SARS outbreak in Beijing would swiftly turn for the better. The article, titled TCM Does Not Fear SARS, appeared around 20 April on the website of the Cui Yueli Center for Traditional Medicine. On the Beijing SARS-trend chart the reporter saw that on the 19th the number of new SARS cases confirmed in Beijing first dropped into single digits; on the 21st it was 8; after four days of "rebound," from 26 May the number fell swiftly; on 2 June and 4 June daily new cases were zero. Not a clean drop from 21 May onward — but the general trend was as said.
It sounded incredible — like a fortune-teller's heretic talk, not the theory of a TCM with nearly 40 years of practice. Professor Fan Zhenglun, now director of the Ancient Texts Office of the China TCM Press, told the reporter: "It is not I who say it — the ancients say it."
Fan said: TCM divides pestilence by cause into two classes — those from Heaven (abnormal climate making one disease epidemic) and those of human making (after a great disaster, great pestilence). The SARS outbreak is plainly not the latter but the former; nature's abnormal climate gave the SARS virus its growing conditions.
He noted: first, the SARS virus arose in Guangdong, the southernmost province. Guangdong people are fond of tonifying — fond of every kind of stewed broth, of morning tea — because of the climate, summer without winter. TCM holds this climate makes the body spreading-out-rich, gathering-in-poor (the body's energy is over-spent); so this diet is needed to supply energy and regulate balance. Last winter, before SARS, Guangdong was unusually cold — some thought they would freeze. Cold outside, the tonifying foods stagnated inside, forming an inner-heat environment.
Second, by the five-movements-six-qi theory, this year is a guiwei year, fire-movement deficient. Fire deficient, cold leans heavy — so early this spring stayed cool.
Third, by the same theory, this year's first half has taiyin damp-earth ruling-Heaven, second half taiyang cold-water at-the-spring. First half is damp-led; second cold-led. SARS appeared in the first half — hence with damp.
In sum: SARS's bodily growth condition is cold, damp, stagnant-heat coexisting. Guangdong was hit first and hardest, so it was the place of first outbreak.
Beijing's SARS occurred March–May — the second qi of the five-movements-six-qi, i.e., 21 March to 21 May, Spring Equinox to Grain Full. The host qi and guest qi are both shaoyin sovereign-fire — heat. The first half is taiyin damp-earth ruling-Heaven; damp condition present. Spring's cold this year was clear. So cold, damp, heat coexisting again gave SARS's growth condition.
Why does it turn after 21 May? Fan: because the third qi rises. The guest qi of the third qi is still taiyin damp-earth — damp still there — but the host qi is shaoyang minister-fire; shaoyang governs wind; from Grain Full on, nearly every afternoon has been windy; wind is the best draught for dispelling damp. Wind broke SARS's growth condition.
One proof: in past Beijing flu outbreaks, taxi drivers always made up at least a third — the pathogen of those flus loves warm, moist, windy. This time taxi drivers infected were very few — because they live every day in moving wind.
This explanation is wholly drawn from Chinese tradition — TCM-related, but not confined to TCM proper. Fan said: TCM is the representative of Chinese tradition; she is deeply rooted in tradition's soil. The Huangdi Neijing: "In the year when taiyin rules Heaven … in the second qi … warm-pestilence (epidemic) spreads widely; near and far are alike." It can be said that millennia ago the ancients already forecast the cause of this epidemic.
In conversation with Fan, the reporter was always wrapped in a rich aura of tradition, learning many small but flavorful things. For instance, the origin of the character yi (pestilence): it derives from yi (military conscription); in old times, whether poor or rich, every household had to send a son to service — and pestilence too struck rich and poor alike.
Fan repeatedly stressed one line: "The ancients truly do not deceive me."
"Harmony as honored" — the core of TCM treatment
The marvel is not only "fortune-telling" but the medical art. For example: three medicines treating ectopic pregnancy. A pregnant woman with twins — one normal, one ectopic. In Western medicine, only surgery, and the normal one might be harmed. Three TCM herbs as a decoction taken once expelled the ectopic, the normal fetus untouched, growing and being born well. Fan, who created this marvel, is a faithful believer of TCM. He said: any disease arising in the world, TCM can find a way to prevent and treat. The greatest difference between TCM and Western is: TCM treats the person, Western looks for disease. That is, TCM does not look for the pathogen but for the conditions of pathogenesis. TCM holds: the pathogen is cause, the disease is effect — but only under conditions does cause become effect. Without those conditions, cause does not become effect. This is TCM's view of disease. So TCM, from the conditions, strips away the conditions on which the pathogen depends; cause does not become effect.
Western medicine's logic: SARS is caused by a coronavirus, so find it and kill it. The Chinese nation has never spoken of kill; she speaks of harmony as honored. Nature gives the human the right to live; she gives bacteria, viruses the same right. To exist is to be reasonable. If one day humans wiped out all bacteria and viruses, humans themselves would likely cease to exist. Humans and other life live in peace, each constrained to its range. For example, every human carries countless bacteria and viruses, yet does not fall ill — because peace is held with them. When the body is struck outside by wind, cold, summer-heat, damp, dryness, fire, and within by joy, anger, worry, thought, grief, fear, fright, the body's balance breaks; a bacterium or virus gets a chance to grow from 10 to 100, then 1,000; at 10 the person did not fall ill, at 1,000 it becomes disease and threatens health. TCM treatment is to correct the conditions on which the evil depends; then naturally it goes from 1,000 to 100 to 10, and is again at peace with humans. This is the core of TCM treatment.
Hence Western medicine sees SARS as severe: first, the cause has not been found — like a precision bomb that does not know where Saddam or Bin Laden is, so it is iron scrap; second, it is contagious; third, untreated it kills. But from TCM's angle, in truth it is not fearsome.
"So," Fan said, "I think TCM's road is different from Western. We must walk our own. If we work out every TCM herb's nature by the chemistry road, we will never catch America. Our ancestors, from the Shennong Bencao Jing's 365 herbs to Bencao Gangmu's 1,892, did not take the chemistry road; they used TCM's concept of cold, hot, warm, cool — the four qi and five flavors — and so brought these substances into the TCM range, to prevent and treat disease. This is China's greatest contribution to the world."
National-level TCM specialist, director of the Jingcheng Famous-Physician Hall, Professor Chen Wenbo, agrees: we cannot keep measuring TCM's scientific character by Western standards. For instance AIDS — China Academy of Chinese Medical Sciences' Guang'anmen Hospital sent specialists to Tanzania; 13 years on, some of the original patients are still alive. But such great results win no attention; rarely is it known that Guang'anmen also has an AIDS clinic. Why? Because, they say, you are unscientific — how do you know it works? How did you treat? How does it explain by Western theory? Cannot explain — unscientific. Chen says: the patient took the medicines, is alive, can work, can care for himself — is that not proof? Is that not a sign of scientific character? Chen says loudly: TCM's science is this — though it does not know which virus, it can defeat it. Next time another virus appears, it can defeat that too. You who claim high-tech — why cannot you solve a single new virus? Because viruses mutate. Just as research yields a result, the virus mutates again, and another few years of research follow — can the patient stand it? At bottom, the patient's life matters more than finding the virus and developing new drugs.
"Each beautiful in its own beauty; great unity under heaven"
Fan said: TCM and Western medicine have different ideas; their entry-points in treating disease differ; how exactly they should combine deserves serious discussion.
He greatly likes the sociologist Fei Xiaotong's line: "Each beautiful in its own beauty, beautiful in another's beauty, beautiful with beauty shared — great unity under heaven." You bring out your strength, I bring out mine; do not look down on each other. Do not let Western medicine tell TCM you are unscientific; do not let TCM tell Western you are too simple. Acknowledge each other's strengths, advance together, in the end great unity.
Fan said: that on the road of science we will at last meet is not strange — different roads, same destination. But to force the graft of Chinese and Western now — what comes out, who knows?
Li Xiuhui, director of the Integrated Chinese-Western Department at Beijing You'an Hospital, holds that we may draw on Western research method to produce something persuasive. So far, our TCM data on SARS have not been recognized by the West because we lack strict controls. We have weakness in research method — we do not value design; we have no control groups. You'an was the earliest in Beijing to use integrated Chinese-Western treatment for SARS; but at the start they did not think of control — all patients got Chinese medicines; only later, by research-project method, did they randomize and control. She holds: applying Western research method to TCM research can make TCM persuasive. Otherwise, you say you are a flower, and others do not believe; nor can you help it — Western medicine could say the same about itself.
Li said: she graduated in 1983 from Beijing University of Chinese Medicine, has worked at You'an's integrated department since, with four years of all-Western research training in Guangzhou and the Beijing Academy of Military Medical Sciences. "Those four years brought me a leap in personal level and influenced my later growth." She holds that today's clinicians are flawed — they know only clinic, not the lab; or the lab people know only lab results, not clinic. Those four years gave her research mindset, unlocking many tightly-set thoughts. TCM doctors with such training, in Beijing, are very few; they are now the backbone of You'an. This may be one reason why You'an's integrated department stood out in this SARS war.
"TCM should review the lesson — learn well from the ancients"
Fan said: this SARS war should make medicine reflect — especially TCM. We should truly stand on TCM's ground and study how the ancients of Chinese medicine treated pestilence; not follow Western medicine like Eastern-Shi imitating beauty. They go for the virus, you go for the virus; they use hormones, you use tonifying drugs — this is Western theory guiding TCM, not real TCM. Fan: "Stiffen your own knees — do not walk on your knees; walk on your feet!"
"TCM is deeply rooted in the soil of Chinese culture. Only by understanding tradition's content, and consciously using that method to recognize and study TCM, can the ancients' specific treatment techniques be brought into the path of the Way — into the path of life's laws. Then one becomes a great physician. To keep only the ancients' technique (formulas), knowing the that but not the why, is forever to gamble — cure if you cure, fail if you fail; never can you stand with calm assurance."
Holding the same view is Professor Deng Tietao of Guangzhou University of Chinese Medicine — the doctoral mentor: "TCM should review the lesson — learn well from the ancients; not focus only on innovation. With the good things thrown away, why innovate? Is that not folly?"
The 87-year-old Deng said: Western and Chinese are different theoretical systems, with different growth roads. But for decades all have held TCM backward, helpless without Western help. Vast Western theory entered the TCM-college curriculum; vast Western-medicine-trained cadres took leadership in TCM colleges. The result: TCM could not grow — because TCM's theoretical system had been displaced by Western. SARS came; first thought, virus; Western had no answer; TCM, even less; nobody thought what TCM theory had to say.
Li Xiuhui: SARS is a chance to bring TCM out. Our medicine, in treatment, has its features — that is why it has survived thousands of years; the people love it dearly. Western has its strengths; TCM has hers; find the right entry-point and TCM can be brought forward. TCM's strengths are not only in herbal decoctions and prevention formulas — yangsheng, dietary regulation are great strengths. TCM is a whole; in a disease like SARS, TCM's strengths should show most. And these strengths foreigners do not have. If we do well, foreigners can only envy.
"TCM's growth is not only an academic question — it is a cultural question, and more, an economic question"
Deng stressed: TCM's growth is not only academic; it is cultural — a treasure of Chinese culture — and more, economic. He gave an example: one of his students treated a patient with trigeminal neuralgia. The patient had pain from her teens to her thirties — over ten years. Four doses of decoction at 11.80 RMB cured her; a month of follow-up showed no recurrence. Deng said proudly: "See — TCM is not only effective; the economic burden is so small."
By report, fully TCM-treated SARS patients averaged 5,000 RMB; Western treatment, at least 30,000 — severe cases 100,000 to 200,000; in Hong Kong about 300,000 HKD. National-level TCM specialist Professor Song Zuomin of Beijing TCM Hospital said: ventilators come in only at SARS's late stage; if TCM intervened before severe, blocking it from going so far, the ventilator would not be needed, and large foreign-exchange spent on imported ventilators saved; TCM could even be spread abroad.
Chen Wenbo gave another example: "AIDS' cocktail therapy — how expensive! Who can afford it? Should we not consider national conditions? TCM treats AIDS at a few thousand RMB a year." "So," Deng said, "reviving TCM, growing TCM, in a country of 1.3 billion is a great matter. American medical burden is 17% of GDP; in 1996 they spent over 130 billion dollars. To link with that is a dead road. So we must walk our own — the road of Chinese medicine."
Originally in China Medical News, 9 June 2003. Health Weekly, page 3 · Special Focus.