Choosing TCM as a Career Means Facing Reality and Looking to the Future

I chose TCM as my career purely out of fate and temperament. There was a Japanese TCM physician (in Japan called a Kampo doctor) named Otsuka Keisetsu; in the preface to his book Thirty Years of Kampo Medicine, he said much the same thing about why he studied Kampo.

Compared with stuffy Western medicine, a TCM physician's way of life is more flexible and closer to nature, which suits someone like me who loves freedom and simplicity. Practicing TCM lets me fulfill my wish to heal the wounded and rescue the dying while preserving a flexible, free lifestyle to the greatest extent.

In today's world of advanced modern medicine, the pressure on TCM physicians is not what it once was. TCM doctors of old had to face critically ill patients; Zhao Wenkui, father of Professor Zhao Shaoqin, was the last director of the Imperial Medical Academy in the Qing dynasty (equivalent to today's health minister) and died on the front lines during an epidemic. Today's TCM doctors need not face that, because most critically ill patients go to Western doctors, which greatly eases the mental burden on TCM practitioners.

TCM has become, in substance, a complementary medicine; this is undeniable. I am already considered a TCM doctor brave enough to handle serious illness, and I have been invited by families to join resuscitation efforts for patients given last-rites. But compared with doctors in a modern hospital ICU, I am a small fry.

Over the last hundred or two hundred years, in competition with modern medicine, TCM has retreated step by step, becoming today's niche medicine. Although the Chinese government strongly promotes TCM's revival, I personally believe that over the next two or three decades traditional TCM will continue to slide, becoming even more niche. Without strong government support, it may not even hold on to niche status. The reason is simple: human society keeps moving forward, and public common sense changes with it; once today's middle-aged and elderly pass on, TCM's base of believers will be far thinner than today.

But TCM will not die out. It will not die out because, fundamentally, it works. Though its efficacy does not meet the standard of precision medicine, it remains an effective way to treat disease. And as long as humans live, they will fall ill. No matter how advanced medicine becomes, there will always be problems it cannot solve that TCM happens to be able to. So TCM will ultimately develop into a niche medicine focused on difficult, complicated, and chronic diseases—it already is, and will become more so.

No one can stop the tide of history. Society is made of people; look at what students learn under today's nine-year compulsory education, and you can predict the shape of the future. Humanity is growing more rational and more science-oriented, so the space left for a fuzzy medicine like TCM will only shrink.

It is the adaptable who survive. We can only survive by adapting to social development; any hope of rolling society backward is unrealistic. So if we want to spend our lives in TCM, we must keep pace with the times. Alongside TCM, we should seriously study modern clinical medicine, psychology, biology, and chemistry—disciplines closely tied to the life sciences—borrowing new medical knowledge, ideas, and ways of thinking, sifting TCM's essence from its dross, raising our clinical diagnostic and therapeutic skill, and advancing TCM.

TCM fans often hype how respected Japanese Kampo medicine is, making much of TCM's market outside China. In fact, since the Meiji Restoration, Japanese Kampo has been in steady decline, at one point nearly extinct. The truth is that Japanese Kampo doctors greatly envy the treatment of Chinese TCM physicians. For the history of Japanese Kampo, interested readers may read The Spring and Autumn of Japanese Kampo by Liao Yuqun, director of the Institute for the History of Natural Sciences, Chinese Academy of Sciences.

I have visited Japan and seen that Japan has far fewer Kampo hospitals and clinics than China. Japan in substance follows a "abolish medicine, preserve drugs" (feiyi cunyao) policy: Kampo medicines are sold everywhere in Japan, but there are very few true Kampo physicians. Japan's Kampo-drug industry thrives more because of its advanced modern pharmaceutical technology and commerce than because of the practice. The Chinese government's support for TCM remains the strongest in the world; TCM lovers should be grateful for that.

Otsuka Keisetsu studied under the great Japanese Kampo doctor Tsumura Kampaku (Tsumura Dochu). Chinese TCM learners know Tsumura's book Ko-Kan Medical Classic (Huanghan Yixue), which has a large readership in China. Even a Kampo master like Tsumura, in his lifetime, could only live and practice in a "small, old bungalow" in Tokyo (in Otsuka's words); one can imagine the circumstances of other Kampo doctors.

Both Tsumura and Otsuka practiced Western medicine for a while before feeling it did not suit their temperament and switching to TCM. Tsumura graduated top of his class from Kanazawa Medical University (roughly the status in Japan that Zhejiang University has in China) as a Western doctor; Otsuka graduated from Kumamoto Medical School. Both gave up Western clinical work after a period to study TCM. There was fate in this, and also personality.

So under today's social conditions, those who want to spend their lives in TCM should think carefully before choosing. If TCM is truly what we love, then it is undoubtedly worth doing, and lovers of TCM will not fear whatever difficulties come.

If you hope TCM will give you a very comfortable life, or even make you rich, that is harder. TCM graduates struggle to find jobs; TCM's room to practice is narrowing, and competition is fierce. It is not easy for a TCM bachelor's graduate to find a secured position. For a young TCM doctor without a family tradition of medicine, leaving a medical institution to practice independently is unrealistic, because building a patient base will be a major problem.

Famous doctors are a minority, and most possess composite abilities beyond ordinary people; they would excel at anything they did. Ordinary TCM doctors are doomed to many years on the cold bench: Tsumura, switching from Western to TCM, endured eighteen years of hardship. Nowadays a TCM doctor probably cannot establish a stable practice until after age thirty-five.

In modern society, TCM does not get "more valuable with age." Only a few doctors are still swamped with patients in old age, and those were already famous while young. Moreover, the reputation of most famous doctors is highly local; outside their home region, patients do not seek them out. Most TCM doctors, in old age, live like everyone else on their pensions. A scattering of patients will come for treatment, offering a little inner comfort, but not many.

So unless you have a love for TCM you cannot put aside, those who enter TCM because of rumors that "medicine is easy to get into" or "TCM doctors get more valuable with age" almost always regret it; Zhihu is full of TCM physicians who regret their choice. Those with high expectations of medicine's power are also unsuited to medicine, and especially to TCM, because medicine's power is so limited that it crushes learners' confidence. Compared with modern medicine, TCM is inferior in most situations; it has the edge mainly in difficult, complicated, and chronic diseases that stump Western medicine.

TCM suits those who have made peace with the long years and the external world, and can study and practice it unhurriedly. Ambitious, glory-seeking young people often feel overwhelming frustration when practicing TCM, while the even-tempered find their place in reality without rushing, and in the process make their own bodies and minds healthier. TCM's preventive medicine was already quite mature over two thousand years ago; many veteran TCM doctors have hair like cranes and complexions like children, still vigorous in old age.

Acknowledge our limits, do what we can that others cannot, and we can, neither humble nor pushy, find our favorite place and way of being in the real world. If, on top of that, we have broad-mindedness and wide horizons, learn widely and study deeply, and strive for excellence, so much the better.