A Hundred Years from Now, Will There Still Be Chinese Medicine?
"Save TCM!" — Part 1
A hundred years from now, will there still be Chinese medicine?
Hao Guangming, reporter, Modern Education News
Contradiction
On 4 March this year, Jiang Zemin, at the CPPCC sports-and-health sub-group meeting, stressed: Chinese medicine and pharmacy is a distinctive character of our medical science, an important part of our fine culture; it has made an important contribution to Chinese civilization, and has positively influenced world civilization. Rightly handle the relation of inheritance and development; press forward the modernization of TCM. Equal stress on Chinese and Western medicine — common development, mutual complement — gives better health-care to the people.
Prof. Jiao Shude of China-Japan Friendship Hospital and Prof. Deng Tietao of Guangzhou TCM University told me: "Jiang's 4 March remarks are a non-critical critique of TCM work." Both stressed: "If higher TCM education is not radically reformed now, in another decade, doctors able to treat with traditional method like the old TCM masters will be gone."
We see that, while the Party and state leaders affirm TCM's value and place, authorities in the TCM world are deeply worried — even feel a crisis. Why? To better understand the present, let us briefly look back.
A bitter recent history
In modern times TCM has been called idealism, a national shame, even equated with sorcery and treated as something to be abolished — common knowledge. As Prof. Deng Tietao says: "In the past hundred years TCM has been beaten to the bone."
In 1912 the national provisional education conference set the higher-school curriculum with only Western-medicine courses, refusing TCM. Nineteen provincial medical associations petitioned in Beijing; the then-Minister of Education Wang Daxie refused.
The Republican-era struggle of TCM for survival climaxed in 1929. The Nationalist government formally founded the Health Ministry and held the First Central Health Committee meeting — without a single TCM person. Four motions to abolish or restrict TCM were tabled; first, Yu Yunxiu's Motion to Abolish Old Medicine to Clear the Way for Medical Health — flying the flag of medical revolution. The motion: "As long as the old medicine is not removed, the people's thought will not change for a day; the new-medicine work cannot rise for a day; medical-health administration cannot progress for a day." When the motion passed, the TCM world was inflamed; the famed 3-17 Struggle. The motion was finally withdrawn — but policies of contempt, discrimination, and exclusion of TCM continued.
Through the Republican era, the TCM world held meetings, protests, petitions, marches, strikes, hunger-strikes — endless struggle for TCM's survival.
After PRC founding, TCM's road was not smooth. Early on, Yu Yunxiu's thinking still influenced health authorities; Yu himself was still valued. Yu said TCM works because of psychological comfort. Wang Bin, a health-ministry leader, said TCM only gives the peasants psychological comfort that a doctor is treating, called TCM the feudal medicine of feudal society, and set up measures to limit and remove it. Later the Party Center detected and criticized this — but this was not one person's thought but a whole current, and turning a current is hard. So TCM's development was very slow. By count, the assets of 24 TCM colleges together fall millions of yuan short of those of one Nanjing Engineering Institute. The fundamental reason: TCM is not valued.
The ten-year calamity raised the slogan "Integration is the only road" — in effect denying TCM's own character. Under this slogan, TCM institutions were merged or cut; old TCM doctors sent down; the salvage of clinical techniques and elder experience all failed. As former Minister of Health Cui Yueli said: "TCM has in fact been nearly wiped out."
Excellent situation; crises lurk
After the Cultural Revolution, under the attention of Deng Xiaoping and other leaders, in 1978 the Party Center forwarded the Ministry of Health Party Group's Report on Earnestly Implementing the Party's TCM Policy and Solving the Problem of TCM's Successor Shortage. In 1982 our traditional medicine was written into the Constitution. In 1985 the Party Center and the State Council issued the directive "Put TCM and Western medicine on equal footing." In 1986 the State Council decided to set up the State TCM Administration with funds. In 1988 it again decided to set up the State Administration of TCM and Pharmacy. TCM appeared to flourish.
But, as Prof. Chen Guoquan of Hubei TCM College says: "Good times did not last. From the mid-late 1980s, and especially the 1990s, TCM has been daily more in decline — neither living well nor dying. Those committed to TCM are deeply worried." The Ministry of Health TCM Department director Lü Bingkui says: "TCM's character, strength, and scholarly level have not been inherited and developed as the Party and people hoped; instead, TCM has entered a severe crisis and chaos. Under the surface flourish, TCM's substance and character are rapidly mutating and dying. As the old doctors say, Excellent situation, crises lurk." Cui Yueli, in remarks at a Beijing TCM work conference, said: "In our country there is a problem of TCM dying out — long-term, mid-term, or short-term." The root reason for TCM's dying out is the shortage of TCM successors.
In recent decades, no real TCM has been trained
National-famed old TCM doctors Jiao Shude and Deng Tietao told me: On 30 May this year was Jiao's 80th birthday. A high official came to China-Japan Friendship Hospital to wish him birthday, and invited a few old TCM doctors to talk on TCM education. Beyond Jiao and Deng, Ren Jixue and Wang Yongyan (President of Beijing TCM University), and others. In this meeting a consensus formed: in recent decades, no real TCM has been trained. All agree: in recent decades no doctor has been trained who can see patients using TCM thinking and method.
In the past ten-plus years, scholars from 100+ countries studying TCM in China have widely reported: TCM level in China is dropping. A German scholar: among the young-middle-aged TCM doctors in China, the real ones are few. A French scholar: many young-and-middle-aged TCM doctors do not know the TCM questions French scholars care about.
Prof. Chen Guoquan, after reading the 10 August Modern Education News article "Can TCM Colleges Still Train Competent TCM Doctors?", wrote: "The answer is no. Long since not. For some years to come, still no." Chen also noted: at Hubei TCM College, same 5-year program as Western: the 19 Western courses in the TCM major take 31.12% of total class-hours 3,106 — five-to-ten times the TCM courses in Western schools; the 19 TCM courses only 42.88%; the rest 26% are general courses. The graduates are mocked as two mid-tech-school students. TCM-college graduates entering the workforce in heavy Westernized atmosphere feel not just inferior, but shamed; they have to bow to Western. Forced into Western, into pharma, into politics, or commerce — many. The Beijing scholar's prophecy that very likely in the next century there will be no TCM is not idle words. The succession-shortage, and especially the lack of orthodox TCM technique, is even more serious than before the implementation of Document No. 56. The crisis is hidden under TCM's surface flourish.
Students: "Successors, or grave-diggers?"
Prof. Li Zhizhong of Hong Kong Baptist University told me: "In 1981, when the first post-Cultural-Revolution intake at Beijing TCM University (my alma mater) Medical Department graduated, my survey of student professional identity: those loving and earnestly studying TCM less than 10%; those loving Western and holding that TCM majors must learn Western well about 30%; those indifferent — learn a bit of both, useful at work — about 60%."
In 1996, a self-organized survey by graduating BUCM students (in BUCM's Campus Paper 25 January 1996, p. 3, "Where Are We Going in 1996") showed: 92.9% feel no advantage over Western-college students; 98% feel their competitiveness in the job market is weak or average; 82.5% chose BUCM as first preference but, after years of study, doubt that choice's rightness; 67.7% feel Western-medicine courses are too few, 9.9% feel them too many; 72.7% feel that on the eve of graduation they need to supplement Western-medicine knowledge; 51.5% feel that if things continue thus, the outlook for TCM is not optimistic; another 26.3% are indifferent to TCM's outlook. The students feel the current education leaves them unable to learn TCM, unable to learn Western. A common problem at TCM colleges nationwide.
A teacher at Shandong TCM University: "In a year, you meet only one or two students who truly love TCM."
Some scholars also note: the dissertations of one's graduate students must be experimental, must showcase Western methods; ten years on, when they are professors, TCM will be all changed.
No wonder Prof. Li Jinyong of Hubei TCM College once wrote a mournful poem on today's TCM education: "My nature is too dull; I am ashamed of inability in developing TCM. Thirty years' teaching is hard work — I am training my own grave-diggers."
The famed German sinologist and TCM-scholar Manfred Porkert too has said: "Traditional TCM lacks successors; as the older generation passes, TCM's scientific core and essence will likely be submerged."
Those who wish to study TCM truly find no door to enter, no road to walk
BUCM student "Xiao Tong" told me: "As a TCM-college student, with hopes to study TCM in earnest, in the current setting I often feel disappointed, helpless, sad. After some years in school, I see classmates of no original interest sinking themselves into foreign-language and computer studies; those originally interested or wishing to do something for TCM also lose ambition gradually, drifting. It is not that they don't want to study — they cannot find a door to enter or a road to walk."
"When I first entered, I thought all were of one mind. Going deeper I found everyone came for different reasons: parents wanting a doctor in the family; this being a way into Beijing; reshuffled from another school by score. Few came truly for TCM. The college-entrance choice has many accidents, of course; interest can be cultivated. But two years on, ask around — those determined to be TCM doctors are few. If now this, what after graduation? Some classmates don't even believe in TCM; when ill they never take Chinese herbs, judging Western drugs better. Years in the school, and still this mind — what did our education do?"
A letter from a BUCM student says: "We came to study TCM. Why do the teachers in class so seldom share clinical experience, instead repeating drug-effects verified in mice and rabbits? Why does the teacher tell us the textbook will not cure disease in clinic, while at exam time you must answer by the textbook or get no points? Why is it that, when a patient is harmed because Western means were not used in a TCM hospital, it is the doctor's fault — while a TCM doctor who writes no TCM but writes a pile of expensive Western drugs is not called unprofessional? A friend told me: walking on campus, seeing classmates pass, he felt utterly hopeless — because among these nominal future successors of TCM, none can shoulder carry on the lost learning for the sages and open peace for ten thousand generations. The Nationalists once tried to abolish TCM, the worst external blow TCM ever took — and yet TCM was still vigorous. Will several thousand years of tradition end in our hands, who shout the slogan revive TCM?"
Old TCM masters: "We are a finished generation"
Prof. Chen Guoquan of Hubei TCM College, on the present world's neglect of the famous-old-TCM effect, told me: from mid-late 1980s and especially the 1990s, the old TCM doctors with a real skill, even with secret techniques, who came from the old society, have retired in waves; many have died. In Beijing alone, between 26 January and 3 February this year three of these — Dong Jianhua, Zhao Shaoqin, Liu Duzhou — passed away. Those who entered school 1956–1959 and graduated by 1965, with solid TCM grounding and some Western training, the bridging new TCM doctors — most have also retired. To say a Great Empty-City is being staged in TCM is no exaggeration. Last November at the Sixth Zhang Zhongjing Conference in Guangzhou, Prof. Chen Ruichun, a Shanghan scholar from Jiangxi, said to me with sadness: "Today our country has more than 300 pandas; truly first-rate famed old TCM doctors (out-patient 3–5 half-days a week, 30–50 patients per half-day) are fewer than pandas." Chen Guoquan also noted painfully: "In another ten years or so, when central leaders or foreign presidents have serious illness untreatable by Western, we will hardly produce famed old TCM doctors of the calibre of Pu Fuzhou, Ye Xinqing, Yue Meizhong, who can treat independent of Western medicine."
In an interview at Shandong TCM University, the famed old doctor Prof. Zhang Canjia told me in pain: "We old TCM doctors, in private, often say: We are a generation of finished people. — that is, a generation of finished men. Meaning: when our generation passes, TCM will have no one, and very likely die out." In a letter to Jiang Zemin, Cui Yueli also said: "Many old TCM doctors say: when this generation passes, TCM may be digested by Western and walk to death."
Originally in Modern Education News, 21 September 2001, A1.