Chinese Medicine is Mortally Ill — Where is the Root of the Sickness?
"Save Chinese Medicine," Part Two
Chinese medicine is mortally ill — where is the root of the sickness?
Modern Education News reporter — Hao Guangming
Upper: school education "without a sound skin"
"Textbooks worse and worse"
After the Cultural Revolution, TCM textbooks have been compiled several times. Comrades within TCM circles, especially the elders, share a great worry — that the quality of these textbooks is worsening. Professor Chen Guoquan of Hubei TCM College told the reporter: "The TCM disciplines in the sixth-edition national TCM-school textbooks, compiled in the early and middle 1990s, were widely criticized — most of all the classics, distorted beyond their nature, hard for the teacher to teach and the student to learn, beyond laughable and weeping."
Professor Zhang Cancun of Shandong University of Chinese Medicine told the reporter: "Even the theory courses — though in TCM language — are full of Western concepts secretly slipped in. The TCM classic courses are taught very simply, with few hours. Looking back, we find: since the Cultural Revolution, TCM textbook-building has failed to actively preserve and bring out TCM's character, has failed to actively preserve TCM's theoretical system. In inheriting and developing our medicine, it is not satisfactory. It is not growth but shrinkage."
"Foundation teaching: empty over empty"
Professor Li Zhizhong of Hong Kong Baptist University told the reporter: if TCM is a fruit-laden tree, then traditional culture is its root; the foundational medicine represented by the Huangdi Neijing is its trunk; clinical medicine the main branches; formulas, drugs, and outcomes the flower, leaf, and fruit. For decades TCM undergraduate education has, from the first year, taught a great deal of Western physiology, anatomy, and so on. Plainly stones from another hill, they have been called medical foundations. Since people widely hold that Chinese and Western medicines are two different theoretical systems, surely their foundational medicines are not the same. Yet TCM undergraduate education has long made Western foundational medicine the common medical foundation.
When Western foundational medicine, with its experimental teaching, has filled and replaced TCM foundational medicine, the student in studying TCM foundational theory is like watching fire across a mountain — fluent talk in class, but on going deeper, empty and hard to grasp. Because the student has no root in Chinese traditional culture, no basic training in image-and-number thinking; and the Western trunk, lab-reproducible, has taken the foundational seat. So TCM's trunk cannot take root in the student's mind.
When TCM foundational medicine is teaching-wise hollowed out, the student's TCM clinical and formula-drug knowledge becomes water without source — withered branch, broken leaf, dry apple — cut off from root and trunk. Such a student, in clinic, will surely have poor outcomes.
Teachers themselves do not believe TCM
Professor Zhang Cancun: "The TCM teaching ranks, in their own growth, have met too much interference; they grow more Westernized. Today's mid-career and senior TCMs — indeed the whole TCM teaching force — can be said: their TCM grows thinner; their Western grows thicker; their faith in TCM grows weaker. The teacher's own grasp is not high; how then can high-quality students be trained? I have even heard of teachers openly spreading non-belief in TCM in the classroom."
"Who runs today's TCM schools? Worker-peasant-soldier students, plus the graduates we trained after the Cultural Revolution. Compared with the '56–'59 graduates, they are far more Westernized. As reform and opening deepens, with the tie to tradition ever thinner and Western medicine's impact ever stronger, the TCM-Westernizing trend grows worse. These people now rarely read the classics. So-called teaching is teaching that very poor textbook."
"There is the still more critical question: do you yourself believe TCM? If the teacher does not believe TCM, how can the student? Not only does this fail to strengthen the student's professional thought; it makes it ever more shaky. This phenomenon is widespread in TCM schools nationwide — not isolated."
The better in math-and-science, the harder to accept TCM
Professor Zhang Cancun said in interview: "Today the Ministry of Education classifies medicine as a science subject. TCM, rooted in traditional culture, is hard to fix as arts or science. And TCM without arts foundation is hard to learn well."
"Now we let science students learn TCM. Their arts base is poor; they cannot read the ancient medical texts. Math-physics-chemistry breeds a logical, conceptual thinking very different from TCM's image-number thinking. Every year when freshmen are first taught yin-yang five-phases, they find it hard to accept — it clashes with their formed thinking."
"So the student doubts TCM: can yin-yang five-phases be believed? They cannot have confidence in TCM's theoretical system. Long trained in math-and-science, they think by concept, judgment, deduction — TCM is not like that."
A student-friend of Beijing University of Chinese Medicine told the reporter: "Why are TCM students uninterested in TCM, unwilling to study it well? I think the chief cause is the great lack of education in tradition. Before university, children scarcely meet anything of TCM. Not just TCM — but all of tradition. From primary on, the whole Western system trains math-physics-chemistry quality students; the higher the quality, the harder, at the sudden meeting of yin-yang five-phases, to accept. Worshipping science, they have long classed this into non-science and so non-correct. With no understanding, where does interest come from? How would they then choose it as a lifelong calling?"
"TCM differs from Western medicine: it descends in line with Chinese tradition, with traditional culture as backdrop. Without knowing Heaven, Earth, and the human, one cannot speak of medicine. A student strong in science may lack the insight for TCM. TCM needs deep cultural roots and broad knowledge — no formula to apply, no math-like step-by-step deduction. By this measure, the better in science, the harder to accept TCM's image-number mode. Recruiting only science students for TCM — this is worth reconsidering."
"In a few more years — the TCM hospital is just an empty sign"
The student's knowledge is verified and consolidated in clinical practice.
Yet Professor Li Zhizhong of Hong Kong Baptist University tells the reporter: "Today's TCM-school affiliated hospitals are largely filled by Western doctors, Western equipment, Western diagnosis, Western treatment, Western hospital management. By the rate of TCM clinical herb use alone, many affiliated hospitals fail to reach 50%, some sink to 20%. If this clinical teaching, Western for Chinese situation is not changed, how can the student be trained in biàn zhèng lùn zhì?"
Some scholars also note: today, TCM hospital emergency care is nearly all Westernized; the preparations promoted for TCM emergencies are nearly all coordinated with Western emergency drugs — TCM's real things are little seen. So all worry, in a few more years TCM hospitals will all become Western hospitals — because the academic content and the path of treatment have changed; only an empty sign will be left.
A teacher at Shandong University of Chinese Medicine: "TCM hospitals are ever more Westernized. However much the teachers have built up the student's confidence in school, a few days at hospital and the student's thought is wholly changed."
Carrying fear in saving life
Professor Li Zhizhong further told the reporter: "After TCM university, the doctor needs a process of digestion and learning in clinical practice — only after 5–10 years can he hope to become an expert clinician. So 5–10 years after graduation is another important stage of every doctor's growth and maturing. The young doctor entering a hospital fears medical disputes most."
"In our country, though 'develop modern medicine and our traditional medicine' and 'equal weight for Chinese and Western medicine' have entered the Constitution and the master health policy, the national TCM law is still not enacted. TCM hospital management still copies the Western model. The standards for judging medical disputes (whether technical or responsibility) still follow Western standards. However high one's TCM biàn zhèng lùn zhì, without legal cover and support — old hand or not — before acute, grave, complex disease, one will look before and behind, even worry deeply. What young, inexperienced TCM dares risk dismissal or punishment to plunge into biàn zhèng lùn zhì to save life? Long in such climate, the young TCM either fails to advance in biàn zhèng lùn zhì, or with the situation slips into Westernization. Today's scarcity of TCM masters — this cannot be set aside."
Lower: under the name of "scientific-ization," TCM itself wipes TCM out
"TCM is unscientific"
Professor Zhang Cancun: "In the early founding period, the slogan TCM scientific-ization was raised. Once you propose scientific-ization, do you not say TCM is unscientific? Later the Center corrected the error and no longer used the slogan. But in the whole TCM administration, Western tools are used to test TCM, forcing TCM to study Western medicine — that is forcing TCM Westernization. In my view, the correct words for TCM are inheritance and carrying forward. Applied to any branch of science, this attitude would not go wrong. TCM scientific-ization hides a premise: that TCM is unscientific."
The trap of the "TCM modernization paradox"
Professor Zhang Qicheng of Beijing University of Chinese Medicine: "TCM modernization has now become a paradox: to modernize means to scientificize, which means to discard one's own character. Not to modernize — and TCM cannot hold its character before modern science and technology. End-of-twentieth-century TCM stands in that dilemma."
The starting point of TCM modernization / scientific-ization is the assumption that TCM is unscientific — hence scientific-ization. Is TCM scientific or not?
Professor Zhang stresses: we should dare admit TCM is not science in the strict — that is, modern natural-science — sense, since it cannot be described by mathematics, cannot be tested in the lab. This is fact; no need to hide it. But we should see TCM is science in a broad sense — a model science. (For details see his paper Model and Prototype: The Essential Difference of Chinese and Western Medicine, Medicine and Philosophy 20.12, December 1999.)
How to escape the modernization paradox? Professor Zhang stresses: TCM in the end can only grow by her own laws and strengths. The pressing task is not to verify whether TCM is scientific or not, nor to seek by modern methods her material basis to compete with Western medicine — but to think soberly, what are her strengths and character; what are her weaknesses; and how to bring out the strengths.
So — has TCM brought out her strengths?
Discarding theoretical "dross," keeping experiential "essence"
Researcher Fu Jinghua of the China Academy of Chinese Medical Sciences: "Since modern times, TCM has been excluded, shamed, beaten, ruined. TCM theory, especially the philosophical theory represented by yin-yang and five-phases, has been the first and chief victim of this. To live, the TCM academic community has labored hard, trying to use Western philosophy and medicine to prove TCM is also scientific, not idealism and metaphysics. People explain yin and yang into definite matter or material elements — even electrons, ions — at any rate material. Then they take yin and yang as the two sides of contradiction, hence dialectical. But they admit it is plain and spontaneous."
"But plain and spontaneous are almost synonyms of primitive and backward, so they are seen as outdated. Hence TCM is not science. Hence one can only peel out its practical medical knowledge and replace its theory with new — that is, drop the dross of its theory and keep the essence of its experience."
For long, the view that TCM has only some scattered formulas and that TCM is no complete theoretical system has been a current. Some hold TCM is unscientific and even block its growth. In January 1989 the State Science Commission listed Jingluo Research as one of twelve national key foundational science projects. But some at the Shanghai Institute of Physiology and the Biology Section of the Academy of Sciences argued the project had no scientific basis, trying to overturn the State Science Commission's decision. The project was held up for long. In fact those who oppose jingluo research do not understand TCM theory, do not humbly learn from TCM, and yet rudely interfere with and deny another field's major research. Though Jingluo Research has now been restored as a national key project, the problem it shows is still telling.
As Fu Jinghua said: "In the past century, in TCM theoretical building, people have labored to replace concepts and shift theory, trying to fit it into Western medicine — that is, TCM scientific-ization. But this strong wish recalls a story of meaning from Zhuangzi: the emperors of South Sea and North Sea, wishing to repay the kindness of Hundun (Chaos), said: people all have seven openings, by which to see, hear, eat, breathe; this one alone has none — let us try to chisel them. Day by day they chiseled one opening; on the seventh day, Hundun died."
A line from the German scholar Manfred Porkert is striking: I oppose using Western terms to wantonly wipe out and blur TCM's information. I hope the value of TCM is evaluated and established by TCM's own face.
Five thousand years of culture has guarded our land
Professor Chen Guoquan of Hubei TCM College, in a letter: "Tradition is TCM's root."
A student-friend of Beijing University of Chinese Medicine: "TCM is deeply rooted in Chinese tradition. But under the impact of Western culture and technology, our tradition is moving away from us bit by bit. People today neglect — even reject — what is traditional, not knowing what treasure they cast away. Without the support of tradition, TCM is water without source, wood without root; with no skin, where shall the hair adhere."
"To speak of reviving TCM, of inheriting and bringing out — not empty words; not the gift of a few elders' wish to give all, or a few students' wish to study and devote a life. It needs joint effort from many sides. How does the channel keep so clear? — because at the head living water comes. With deep cultural roots, with a fine humanistic environment, why fear TCM lacks successors, why fear our medicine cannot grow?"
As Fu Jinghua put it: "TCM is not only an applied science; she is also a cultural phenomenon. Rooted in long Chinese civilization, her thinking and theoretical system descend in line with Chinese tradition — share its fortunes. Without the revival of tradition, without the living spirit of Chinese ancient learning showing again in the present, TCM can only exist as something explained, verified, remade. We sincerely await a great revival of tradition, the showing again of the millennial soul of China. Only then, when TCM walks as a messenger of Eastern culture into the hall of future science, will humanity begin truly to recognize Eastern culture and TCM, and — in humanity's grand spiritual setting — realize the harmony of ancient-and-young, founded-and-renewed, masculine-and-feminine."
Originally in Modern Education News, 28 September 2001, page B1.