On Improving TCM Education — Speaking from the Structure of Knowledge
In his lifetime, the late Minister Cui Yueli watched the improvement of Chinese-medicine education with the closest care. He often stressed: to revive Chinese medicine, education is the root. He carried out a great deal of investigation and research on the improvement of TCM education, raised his views many times, and wrote to leaders at every level. Building on his views, I offer a few thoughts of my own for the discussion among colleagues.
Curriculum is the basic element by which teaching is delivered. Only when the curriculum reflects, completely and accurately, the knowledge-structure of Chinese medicine and pharmacy can the teacher, working from the textbook and a sound teaching method, train competent senior TCM practitioners.
The TCM knowledge-structure has four layers:
First, the cultural outlook and modes of thought rooted in the literature, history, and philosophy and other branches of knowledge of China's Spring-and-Autumn and Qin-Han period. These are the soil in which Chinese medicine was conceived and formed, and they remain the methodology for later study and research. Therefore TCM education must begin here. No senior Chinese-medicine specialist of the older generation today lacks a solid grounding in Chinese literature, history, and philosophy.
Second, the classical medical works — the Huangdi Neijing, Shennong Bencao Jing, Shanghan Zabing Lun, and the Wenbing school — which established the concepts and categories of Chinese medicine and laid down the principles and paradigms of biàn zhèng lùn zhì (pattern-discernment and treatment). The foundational theory of Chinese medicine is contained within them. These classics are without question the root of Chinese medicine.
Third, the Shanghan Zabing Lun, the Wenbing school, and the representative clinical works from the hands of physicians across the dynasties form the core of TCM clinical medicine. The diagnostic methods, principles of treatment, and theories of prescription and herbs across the TCM clinical branches all rest on this content. Master this core, and the rest follows by analogy.
Fourth, the rich body of integrative regulation built around herbal treatment as the main thread, together with acupuncture, tuina, massage, daoyin and other therapies.
From antiquity medicine has been divided into three grades: the physician of experience, the physician of pattern-and-treatment, and the physician of the union of yin and yang. From an educational standpoint: the "physician of experience" commands only a limited set of formulas and methods, lacks foundational TCM theory, and is poor at pulse-pattern reading at the bedside — prescribing simply against the disease, with limited effect. The "physician of pattern-and-treatment" must be deeply read in the TCM classics and draw also on the strengths of medicine across the dynasties; only then can the medicine vary with the pattern, and the working be active and flexible, showing forth Chinese medicine's clinical character and strength. The "physician of the union of yin and yang" not only commands all the knowledge of the previous grade, but also "knows the heavens above, the earth below, and the affairs of human beings between" — "draws near at hand from the body, far afield from the things of the world" — "is conversant with the virtue of the spirit-and-bright" — "classifies the qualities of the ten thousand things." In this way, he naturally places the person within the great system of society, nature, and the inner life of spirit and emotion. In the rational thought of Heaven and the human in correspondence, he catches the faintest threads of disease development — to the breadth of an autumn-hair, his medicine without misfire. What Zhang Jingyue called the great physician who knows the Yi , the physician whose work is "intuition" — this is what we mean by the physician of the union of yin and yang*, and should be the root goal of the higher education of Chinese medicine.
In the old "apprentice" mode of TCM education, things broadly proceeded by these layers and contents of the knowledge-structure. TCM education has been in the "academy" mode only a short time; whether the curriculum has actually followed Chinese medicine's knowledge-structure and its character is worth honest reflection. Over the past decades, the problem with TCM education has chiefly been that the curriculum has not rigorously followed the knowledge-structure of Chinese medicine. Specifically, three points:
First: when the wide shift from "apprentice" education to "academy" education was made, there was no honest and cool rational summing-up of apprentice education. It was more often denied than affirmed, even simply dismissed as backward. As a result, the "academy" education has shown, to a degree, the phenomena of "form-and-spirit not one" and "reaching for the West but not catching the Chinese center."
Second: an inverted methodology. From the early years of academy education, large numbers of courses called "modern" but in fact analytic and reductionist science have been brought in. Yet the closely related methodology courses — Chinese literature, history, philosophy of antiquity; the history of Eastern and Western philosophy; the latest contemporary systems science — have not (or only rarely) been brought into the curriculum. How are students, working by reductionist methods, to grasp the theory of a systems-science?
Third: the unconscious substitution of "the West for the Chinese center," and even the running of TCM academy education with the question-the-science of Chinese medicine in hand. From the early years of academy education, large numbers of Western-medicine foundation courses are brought in — physiology, anatomy, histology-and-embryology, biochemistry, pathology — while Foundational TCM Theory is given thin content, and even within it, many basic viewpoints are distorted by Westernization. At the same time, the content and class-hours of the classics are cut and cut again. Picture this: if it does not change, can one graft the flower and fruit of Chinese medicine onto the root and trunk of Western medicine? Of course Western-medicine courses are needed — but they should be placed in the higher years of TCM higher education. Chinese-medicine knowledge is comparatively abstract; Western-medicine knowledge is comparatively direct. Only when a student has firmly grasped the pattern-and-treatment system of TCM theory should he move on to the necessary Western medicine and Western pharmacy — that is the scientific and the wise arrangement.
On these grounds, if TCM higher education is improved according to the knowledge-structure of Chinese medicine and its character, the students it raises will become, as the late Minister Cui Yueli hoped, "the cradle of senior Chinese-medicine practitioners."