Chinese Medicine is the Exchange of One Natural Life with Another Natural Life (20120804)
Chinese Medicine is the Exchange of One Natural Life with Another Natural Life
Guan Qingwei
2012.8.4
I was born into a TCM family — grandfather, uncle, father, elder brother, all in TCM work. I myself have been in TCM work for over thirty years, soaked in clinical work all those years, soaked in the most traditional TCM environment of Tongrentang, witnessing with my own ears and eyes the cultural drift of TCM in the past century. I bring many thoughts and doubts to exchange with you all.
Though I lived in a TCM family, from childhood I was at odds with TCM culture. As a boy I read Lu Xun's Medicine — seeing TCM use human-blood bun to treat — and I felt TCM was especially backward and ignorant; so what my father taught I resisted. Though I memorized what he had me memorize, in my heart I did not want this calling. After my teens, a few of my father's cases shocked me; gradually I took interest in TCM, and finally entered the trade. I have done nothing else this life — only TCM work; I feel I have grasped something from clinic, and wish to pass on what I have grasped.
Disease and Pattern
In clinic I often meet this: a patient reports dry eyes, lumbar ache and weak legs, dry mouth and tongue, dizziness with a swollen head, neck stiffness. Pulse-taking and tongue-reading — it is liver-and-kidney yin-deficient. I tell him: "You are liver-and-kidney yin-deficient. I will write a formula to lift this deficient state, restore yin-yang balance, and the symptoms will vanish." He: "Doctor, what disease do I have?" I: "Liver-and-kidney yin-deficient." He: "Doctor, what disease?" I: "Liver-and-kidney yin-deficient." … He is seeking the Western-medicine words — hypertension, cerebral underperfusion, cervical spondylosis — names he understands. But these are not what TCM attends to.
TCM is pattern-discerning medicine; Western is disease-discerning medicine. When we speak of body yin-yang imbalance in TCM's idiom, people often do not catch it.
Western medicine is antagonistic — in treatment it takes the antagonistic mode: find a pathogen in the body's structure, fight by war-mode, kill it; if cannot kill, cut it out. This is the Western notion.
TCM is not so. TCM treats the human, not the disease; reads the body's zheng. The human, as living life, like all life lives in nature's qi-and-climate motion; in the integral interaction of Heaven-Earth-and-human, the body's yin-yang loses balance, falls out of accord. Once the doctor catches these imbalances, with herbs' leaning he corrects the body's leaning — the balance is restored. Once balance is restored, the body cures the disease itself. Every TCM medicine-use direction is to adjust yin-yang balance. So TCM is balance medicine. The TCM phrases — liver-and-kidney yin-deficient, liver-yang ascending, heart-blood insufficient, heart-and-kidney not interacting — all describe yin-yang imbalances within the body's zang-xiang functional systems.
Form-above and Form-below
TCM's decline in nearly a century has been at the clash of Chinese and Western culture. Western industrial-revolution success dazzled us Easterners with its splendor; we worshipped Western culture without limit. China's century of education used both hands to take in Western culture wholesale, throwing the essence of our national culture in the corner — none reads, none recognizes.
Today's children read Western science from young — this form-below science with its very simple thinking mode: only one lab to study drugs, another to diagnose disease — so simple, so easy, that people slip that way. And modern medical research's object is basically already-disease: pathogen found, biochemical markers off, ratios changed, then a drug is made to kill. This thinking has us recognize only what can be seen and touched, or extended sense (instrument-observable); the unobservable is hard to accept.
What TCM studies is exactly the unobservable, form-above — jing, qi, shen; wei-fen, qi-fen, ying-fen, xue-fen, and so on. TCM attends to imbalance at the form-above level — at qi level, jing level, shen level — to bring people to the treating-what-is-not-yet-disease state. If imbalance is found at the material plane, the disease is already 70–80% along. The form-above mode TCM upholds is the highest cultural inheritance our ancestors left us.
Both TCM and Western medicine speak of organ-function imbalance, but TCM's object is a functional system, not an organ. In our present concept organs are well known; at organ-function people immediately think of the anatomy organs of Western medicine, because the heart, liver, spleen, etc. are anatomically located, visible and touchable. TCM goes by grasp the meaning, forget the form — it studies a functional system. For instance, the liver: modern medicine sees it only as a detoxification organ, a chemical factory; TCM holds: the functional system that governs coursing-and-discharging, free-flow, blood-storage is the liver. This is zang-xiang (storehouse-image) theory. Our ancestors could scrape bone to remove poison long ago, could do surgery; why did they not study anatomy? Why must they make zang-xiang? Because TCM holds life is an integral state, not a pile of organs. Anatomy tells you the stomach digests; but ask further: with the stomach alone, can it digest? Without the endocrine, the nervous system, it cannot. So digestion is a systemic task, not one organ's. TCM's systems theory is deeper and higher.
Those trained in modern science find the form-above system hard to grasp; but through many years of TCM clinical practice we have truly felt that form-above governs form-below. The functional system governs the organ; the mood governs the body; jing-qi-shen studied by TCM governs life. Ask a biologist what life is, has he found life in studying matter? — the answer is no. Having dissected life completely, no definition of life, no trace of its existence. A German biology scholar said today's biologists are not biologists — they are deadologists; their method is first to kill the life, dissect it, take it down to organ, cell, DNA, step by step — what they study is life's material basis; life itself has vanished.
Food-nature and Herb-nature
In my left hand a piece of ginger, in my right a bean — are they Chinese medicines? Yes and no. The same thing, used within TCM's biàn zhèng lùn zhì whole, is Chinese medicine; if you extract an active ingredient from it, it is no longer Chinese medicine but natural plant drug. So I divide today's market drugs into three. First, Chinese medicines proper, used within biàn zhèng lùn zhì — Liuwei Dihuang Wan for kidney-yin deficiency, Jingui Shenqi Wan for kidney-yang deficiency, Qiju Dihuang Wan for liver-and-kidney yin deficiency, and so on — all regulating yin-yang balance. Second, natural plant drugs — ginkgo-leaf extracts, danshen extracts (like compound danshen drip-pills), the now-worshipped artemisinin — these are natural plant drugs, not Chinese medicines, for they are used within the Western theoretical system, having left the biàn zhèng lùn zhì whole; they are chemically simple Western drugs to conquer pathogens, like antibiotics. Third, nutritional supplements — vitamins, supplying substances — also of the modern-medicine direction.
A patient yesterday — pale tongue, tender body, fond of cold food, but cold food only soothed her throat and was uncomfortable in her stomach; stool unformed, several times daily — at a glance, spleen-and-kidney yang-deficient with spleen damp. Modern people basically do not know food-nature or herb-nature; they eat by pharmacology-thinking. TV says lotus-leaf cuts weight; Tongrentang sells two-plus tons a day; the herb-clerks are worn out — a packet for a few mao, two-plus tons makes how many packets? Sanqi beautifies — sanqi sells out at once. Bian-stone helps health — bian-stone vanishes. Some TCM celebrity says ginger helps health — everyone soaks ginger at noon; many stomach-hot, spleen-yang-not-deficient people start eating ginger and feel terrible. Modern people, used to nutritional thinking, do not know nature — cold, hot, warm, cool. Kiwifruit has the most vitamin C, but a vitamin-C-deficient person doesn't necessarily fit kiwifruit; a stomach-cold person eats it and feels unwell, with weakened digestion. Once nature is stripped out of nutritional thinking, many people fail to gain nourishment, even harm health. Microscopic guidance for body regulation is often absurd. Hormones, they say, delay female menopause — two years later, uterine fibroids, breast hyperplasia, breast cancer. In the late 1980s β-carotene was great anti-cancer, even cancer-preventive; twenty years later, it raised cancer by over 20%.
Food-nature is the four natures — cold, hot, warm, cool. Herb-nature is the same, plus rising-falling-floating-sinking and others. Example: take a mountain ginseng from Changbaishan, with two seeds; plant one at Changbaishan, another on Hainan; 10–20 years on, the two ginsengs differ in nature. Genetically the same; by modern bio-research of material basis, little difference; but different climates forge different energy-information. Our Huairou-grown American ginseng and Canadian American ginseng look alike; ours scores higher on constituents — yet Huairou ginseng tends to raise fire, Canadian does not. Herb properties, qi-flavor, channel-entry — these form-above things — cannot be studied by science's test-tube, culture-medium, animal. Throw dry ginger into a test-tube and shake — you cannot shake out its warmth. So herb-nature is lost in modern scientific research, for the lab cannot attend to it. TCM, with this attention lost, cannot observe its therapeutic action.
Many TCM-research methods today look at a few herbs' antagonism and killing of bacteria, viruses, microbes in culture medium, to gauge efficacy. This makes Chinese medicine into Western drug. It is not TCM's job. TCM always uses living life to study; the living human meets nature's animals, plants, minerals — and so produces rising-falling-floating-sinking, cold-hot-warm-cool functions. So this is a medical system that studies with life. TCM is life-life medicine: the first life a verb — to promote the growth and adjustment of nature's force. TCM most respects life's own function; studies living life as it changes with nature's climate, with mood. So TCM stresses grasping this present moment, this person's constitution and imbalance, using herb-nature to mobilize the body's living-living capacity. What medicine is more excellent and safer than that which uses the body's own function to heal!
Life-Life Exchange
When a disease goes from zero to a hundred, it is in fact the body's function falling — what TCM calls right qi insufficient; only then can bacteria-viruses find you. Countless bacteria-viruses are around us, but we do not fall ill — because right qi is full, evil cannot strike. The human functional state has balance with nature and society. Some sneeze, run, and cough the moment they meet air-conditioning — defensive qi not firm, imbalance with the natural environment. Some, on entering the work environment, get dizzy and have right-flank pain — imbalance with the social environment. If one knows how to read one's body and corrects the balance at once, or seeks the doctor's repair, more serious problems do not occur. Yesterday someone invited you to abalone and shark-fin; after eating, bloating, a whole night undigested, today still bloated, no appetite — what does this say? Your own visceral transformation has dropped; it cannot form a digestion-relation with the food eaten. Read it — either avoid such food, or strengthen digestion. Many women's uterine fibroids and ovarian cysts come from imbalance in social relations — tension, pressure, a tense and discordant mind in one's own environment — leading to TCM's qi-stagnation and blood-stasis, or generating phlegm, damp, heat; in this state body tissues gradually change. When the five storehouses and six bowels match and balance, the body is healthy; if one organ system fails, disease will arise.
The deep relation of yin-yang and the five phases is hard for modern people to know. Today we also use Western experimental method to study TCM; in truth we are replacing TCM's system with Western plant-pharmacology. Nearly 100% of our national TCM funding goes to this; the real TCM has no funding, no one to practice TCM's effect. Today's TCM trainees are basically unfamiliar with this system, interpreting everything by biochemistry and physics, not by the life-relation theoretical system. The policies, cultural direction, and yinpian quality standards in force are micro-governs-macro — by an herb's active ingredient (shanzhuyu has shanzhuyu-acid; raw huangqi has astragaloside; renshen has ginsenosides; etc.) one micro-marker controls the whole product's quality. Many excellent herbs cannot be used because they fail the constituent; the broken, dirty, rotten leaves that pass the micro-marker enter clinical use — and in TCM clinic they have no effect.
So in this century our country's TCM direction has been entirely twisted. Look at Tongrentang ads — Tongrentang Lipid-Lowering Tea, Diabetes, Hypertension — how far is this from TCM culture? When TCM lowers lipids, it does not use one molecule-level substance; it improves the body's functional balance: some lower lipids via blood-stasis, some via phlegm-heat, some via phlegm-damp, some via raising spleen function and metabolism. Each person's method differs. How can we make one drug for all humanity to take to lower lipids? Yet at TCM-university museums we are told sanqi lowers lipids.
Not only mainland China — TCM worldwide faces this. A Taiwan TCM-university president said they did modern research and developed paclitaxel extract for cancer. I asked only one question: TCM treats pattern — but this is disease treatment, isn't it? He said: "What is treating pattern?"
In these 30-plus years I have come more and more to hold: TCM is a great science of biological relations. Research results on animals often do not transfer to humans, especially molecule-level drugs from test tube to life state. Example: a fisherman lifts two large salmon from the sea; the first he cuts at once for everyone to eat — fresh, tasty. The second he keeps in salt water for three days, then serves — like salt-cured vegetable. Westerners invented from this the diffusion principle: substance moves from high concentration to low. Published as law. A scientist objected: but the first fish was also from salt water (the sea) — why not salty? Because the first was alive, the second dead. Living life refuted the law. Drugs derived from dead things, transferred to living people — are they safe?
TCM is the exchange of one natural life with another natural life — not a molecule-molecule relation. This macroscopic should govern the microscopic. Through clinical use we find: microscopic research has no guiding meaning at all for TCM clinical practice.
Restoring to a Hundred Years Ago
What is zhongyi? People generally take it as the medicine of the Chinese nation. In truth, in Chinese culture: the upper physician treats the state; the middle physician (zhongyi) treats the human; the lower physician treats the disease. The learning of treating the human is zhongyi.
TCM's model is to treat the human who has fallen ill; Western medicine treats the human's disease — therefore it researches pathogens and disease-survival-states, then conquers them. Many doctors today combine pattern-discernment and disease-discernment, since disease-discernment can find disease location, severity, and pathogen state. But TCM, having gained such information, must drop it and return to TCM's yin-yang balance — must again read Heaven, read Earth, read the human; read his endowment, his interest, his emotion, the bodily features brought by his geography — and deeper, his morality and ethics — so the patient finds health.
We had little knowledge of guoxue (Chinese learning) from young; only after coming to love TCM did we return to Chinese thinking. Once corrected, our recognition of disease and our speed in seeing patients accelerated; the results are on another level. Though steeped in TCM from young, I truly learned to see patients only after forty; before then on the crooked road, like most people now — using Western consciousness to read TCM, using Western consciousness to guide TCM action, causing many non-TCM-direction errors. After fully returning to the TCM platform, the mindset in practice, the grasp of various diseases, the comfort patients feel after taking the medicine — all on another level. Because by this mode of raising the patient's self-nature function to solve disease, body function rises higher and higher, and the patient feels more and more comfortable.
So in clinic we treat all kinds of disease excellently. A Thai health minister, playing badminton, suffered a large thigh-muscle tear; over half a year of massage and physical therapy could not heal it. I gave him a half-hour subscapular massage; he no longer limped or used a stick; by dinner the next day he had wholly recovered. In Saudi Arabia, a patient with leg edema — modern medicine could not find the cause; no protein or occult blood in urine, no microbes — kidney function normal. It was a functional problem; Westerners could not get the cause. TCM warmed his kidney-yang; he was well in two weeks. Seven years ago I treated a hepatic-coma patient — Western hospital said three months left to live; daily lactulose for diarrhea, so much that he could not stand. They said no other way — go find TCM. After my treatment, seven years on, he has not gone into coma again.
What a green medical system TCM is — born of nature, after boiling and taking it returns to nature, with no damage to nature. Where Chinese medicines have a leaning not fitting our body, we correct it by paozhi; this paozhi science is excellent, developed over two thousand years. But now no one inherits it. The old herb-workers at Tongrentang, lifting a herb, knew its place of origin and month of harvest; smelling it, knew its potency; with the sack closed, a kick told what was inside; squeezing a handful and listening to the sound, knew which channel it entered. Such talent is no more.
Tongrentang has 400-plus formulations; only 100-plus are still made; the other 300 are no longer made — no one knows how to use them. Many excellent children's medicines — for cough, asthma, food-stagnation — could solve a child's illness for a few mao; but because they are cheap and not profitable, the factories stopped — not for poor results but commercial elimination. TCM also faces resource-integration. Some herbs should be grown three years but are dug in less than two — they pass the constituent test but in TCM herb-nature they have not met the treatment standard, so efficacy is affected. Past prescriptions used seven or eight herbs to treat; today's run to ten, twenty, thirty — why? Because of herb-nature and herb-efficacy. Once any drug store had no medicine smell? Open the door and the herbal fragrance struck you; now still? Some herbs are not the plant the ancients used; some lack herb-nature, do not reach therapeutic action; so TCM cannot deliver its outcome. By constituent analysis, jinyinhua leaves have higher constituent content than the flower; what to do? But in TCM theory the flower and the leaf are wholly different drugs. So the micro-rules-macro method cannot restore TCM's true face. Modern science is just a small pouch; it cannot hold the great Heaven-Earth-human culture of TCM. So Western consciousness studying TCM is in truth destruction of TCM's integral view.
And real TCM results cannot become productive force. Our trigeminal-neuralgia drug — in six or seven years I have nearly cured every case — but to register it as a finished drug requires animal test results, and there is no trigeminal-neuralgia model in mice. Modern TCM observation is even more amusing: cut two-thirds of a mouse's kidney, then call it kidney-yang-deficient. Place a mouse in a tub of water and chase it until breathless — call it qi-deficient. These are the modern-science-fabricated pathology models.
This past century TCM culture has been cut into shreds. So at the Tongrentang expert committee I said: restore Tongrentang's medicines to how they were used a hundred years ago; using them rightly is the greatest contribution to TCM.
Four Levels of Doctor
In medical practice I have summed up four levels of TCM doctor:
First, the disease-discerning doctor. One doctor pulses then says the patient has prostatitis; the patient goes to a Western clinic for tests — no pathogen, no inflammation focus; Western says no prostatitis; the patient complains. Many doctors today discern only by disease, like Western, requiring a heap of tests, not taking pulse, not reading tongue — writing a formula and saying it kills bacteria, viruses. This is the lowest level — in truth, a person who does not understand TCM is operating TCM.
Second, the pattern-discerning doctor. By the classics: wind-cold cold uses Jingfang Baidu San; but no matter the region, no matter the weather, he prescribes Jingfang Baidu San. Such a doctor has entered pattern-thinking mode but cannot yet read the influence of region, body rhythm, sixty-time, five-movements-six-qi; he cannot match constitution and climate well, so the patient is often not as comfortable as he should be after the medicine.
Third, the doctor who reads natural rhythm. He reads body endowment — qi-deficient constitution, qi-stagnant constitution, phlegm-damp constitution — combined with four-season climate and the features of north and south, and prescribes accordingly. The patient takes it and feels comforted and cured, moistening things silently, the disease cured.
A few days back a patient caught wind-cold, coughed. We used jingjie, fangfeng. Seven doses; the third coincided with Beginning of Autumn. The rhythm changed; he felt mouth and nose dry, and asked why the first three doses had been very good but the last four made the nose drier and drier. Considering — the seasonal rhythm changed — we added yin-nourishing, dryness-moistening drugs; one dose and well again. Body and climate-rhythm have such close relation; one careless point and the outcome tells.
Fourth, the doctor who, by words alone, can prevent disease. He tells the patient his temperament, that this temperament will surely bring such-and-such trouble; if changed, the disease will not occur. This is TCM's upper-craft treats what has not become disease. So TCM holds the highest doctor is the one who treats what has not yet become disease — who does not let disease occur.
TCM's Thinking Mode Will Influence the Future, the World
Today's TCM-education model wants to train one who knows both micro and macro, both pattern-discernment and disease-discernment, both form-above and form-below. But TCM and Western medicine are two wholly different medical models, incommensurable. One kills; one balances; can both live in one drug? Surely not. We greatly respect Western medicine; in pathogen science, in surgery, in vaccines, it has very fine influence and control over human health. But the two medicines are not at one level; their points of attention, points of entry, angles of treatment, cultural directions, complement each other — cannot be joined.
In fact 80–90% of all proprietary Chinese medicines are used by Western doctors; but their training in biàn zhèng lùn zhì is poor. The box says Zhike Juhong Wan; he uses it on coughs, regardless of phlegm-damp, phlegm-heat, qi-deficient, yin-deficient, wind-cold, wind-heat. Qiguanyan Kesou Tanchuan Wan — whatever pants, he uses. Hit the pattern, it works; miss, it worsens. Hence many think Chinese drugs don't work; once you take them it worsens. In truth Chinese medicines treat cough very well; pattern-matched, the slightest use is strikingly effective — instant. But TCM is not Western — you cannot read the leaflet and roughly get it; finishing study, apply to patients. TCM training and grasp need long time. My father taught me to treat cough — San Zi Yang Qin Tang, Xing Su San, Yang Yin Qing Fei Wan, Mahuang Xingren Shigao Gancao Tang, what to use in what season for what asthma. To reach his level took me ten years. From my father I learned trigeminal-neuralgia — he gave me the formula early; fifteen years on, I could cure almost every case I saw. As for liver-cirrhosis ascites — too many pattern-types: spleen-deficient, kidney-deficient, yin-deficient, yang-deficient, phlegm-damp, phlegm-heat, yang-water flooding, yin/yang jaundice; dozens of directions, hard to judge. For someone with insight, perhaps ten years; without insight, twenty or thirty may not bring it.
Ancients found TCM easy to learn: my father's generation grew up in private school, learned image-number thinking, the ethics of Chinese Confucianism — these are one with TCM. Today's children learn structural thinking, not generative thinking: see a table, ask what matter composes it; their knowledge and coordinate system are not one with TCM; in becoming TCM they must shed a skin — too hard. And we who study TCM live too tired. See dozens of patients daily, go home and look up books, study the few hard-to-treat diseases — how to get better outcomes next time. The whole life sinks into disease research; the life passes fast. A glance in the mirror — how did I get to look like this? So few children today wish to learn TCM.
In Beijing many famous doctors' experience has vanished. Old Ma's treatment of femoral-head necrosis — no successor, vanished. Wang Pengfei's brilliant treatment of infant jaundice — no successor, vanished. When you finally restore that skill, it will be very far away. Mahuang San has been lost two thousand years; no one has yet restored it. TCM's combinatorial possibilities are vast — among several thousand herbs, the combinations' effects — restoration aside, even study cannot make them clear. I asked our Tongrentang research staff: in a lifetime, can you clarify the chemical relations of two plants? He said: no. Each of two plants has three or four hundred constituents; what chemical changes occur among them, plus gastric juice, plus body temperature — a life of research will not see through. If not seen through, and not grasped as a whole, only as micro — can you grasp it?
In truth the deepest result of modern physics is that matter does not exist — it is vacuum; there is no indivisible matter. In the vacuum there is various information; under different conditions matter is excited out — these matter are nodes of information. Matter is influenced by information, by consciousness. This agrees with our form-above culture. TCM influences the body by treating spirit, treating qi, treating heart — perhaps future science will yield the matching conclusion.
A scientist at Zhejiang University, Zhang Changlin, in molecular biology and physics — he worked in Germany over twenty years. He said the mainstream science system is in fact a democracy system — the direction everyone holds correct is the one promoted. But frontier scientists walk the scientific spirit: they have found consciousness's influence on matter; have found that the vacuum can produce matter, but matter is only a node of information; have found that consciousness and matter are the exchange-relation of form-above and form-below. After our exchange he was astonished at TCM culture; praised Chinese culture as so high. The science system advances by negation of negation; it only upholds an exploring scientific spirit, not truth. Today Western scientists' deepest concerns are information-theory, whole-theory, system-theory. And TCM can precisely influence the world's thinking mode, leading present science back to system-theory, whole-theory, holographic-theory.
We greatly hope you will attend to TCM culture, with your own life and living feel TCM culture, and truly use TCM culture to adjust yourself.