How I Read Medical Books
I now own a fairly large number of medical books. For a long stretch I spent over 5,000 yuan a month on average buying them—considering that this was the diamond-member price I paid ordering online, that amount would have bought roughly 8,000-plus yuan worth of books in a physical bookstore. At the prices I paid, my home collection of medical books is now worth around 100,000 RMB.
It may take me a lifetime to finish reading all these books, and only if I maintain the same diligent drive to study medicine that I have now and am granted enough lifespan. Having read so many medical books, I have gradually gained some insights. Seeing that many fellow patients' children, like me, are also buying medical books to study on their own, I would like to share some of my thoughts on how I read them.
Medical books—and Chinese medicine books in particular—are not easy to understand, and the ancient editions of TCM texts are even harder. Moreover, the various schools of Chinese medicine have always feuded fiercely: one school attacks another, that school slanders this one, and such conflicts have been endless throughout history. When learning medicine and treating illness, the last thing one should do is get drawn into these sectarian disputes. Once a doctor becomes locked into a particular school, they inevitably cannot see the forest for the trees.
Most Chinese medical books were written by practicing physicians, and every clinician's experience is limited—including the great masters of history such as Zhang Zhongjing, Sun Simiao, Qian Yi, Zhang Yuansu, Li Dongyuan, Zhu Danxi, Zhang Zihe, Xue Lizhai, Gong Tingxian, and Xu Lingtai; for all their fame, what each saw and heard was limited.
No matter how boundless a doctor's energy, the clinical opportunities they encounter over a lifetime are limited. Human diseases are truly too numerous to count, and no single doctor can master the treatment of them all. It is therefore perfectly normal that their writings are skewed in one direction; if a reader studies a particular author and then becomes dogmatically attached to that school's viewpoint, applying it to every disease, they are being impractical and pedantic.
Some readers have seen articles of mine criticizing doctors of a certain school and then, taking my words out of context, conclude that I oppose that school—this is completely contrary to the facts. What I oppose is these doctors' cookie-cutter approach to prescriptions: no matter what patient walks in, it is either "clearing heat and resolving toxicity," or "warming and tonifying," or huge doses of Aconite (Fuzi), as if these herbs can treat every disease. This approach is repeatedly disproven by the eventual results, and such doctors are worrying to behold. Even worse are those who cling to a single folk remedy and apply it to every patient. These doctors' personal dogmatism ultimately costs patients their lives. Personally, I am flexible in my therapeutic approach: if one route doesn't work, I absolutely do not linger on it for long. Why stubbornly insist?
Some medical books were written by amateur rather than professional physicians, so their lifetime of clinical experience is even slimmer. Most of their works are compilations and syntheses of other people's views. The most typical examples are Wang Tao, author of the Waitai Miyao (Arcane Essentials from the Imperial Library), and Wang Kentang, author of the Zhengzhi Zhunsheng (Standards for Diagnosis and Treatment). Their official careers were what we would today call civil service, and both rose to very high rank, at the provincial-ministerial level. Most of their energy was devoted to official duties, and they only pursued Chinese medicine as a hobby in their spare time.
Yet it is precisely their works that are the thickest: both the Waitai Miyao and the Zhengzhi Zhunsheng rank as monumental masterpieces in medical history. Few clinicians with rich hands-on experience have produced such weighty tomes. It takes quite some time just to read through them. These authors were essentially compiling medical materials; their contribution to medicine lies in preserving and gathering a vast body of medical literature, rather than in any brilliant discoveries of their own.
I think most of these medical books can be used as reference material. When encountering a certain disease, one can look it up book by book; after consulting several times, you will find that most of the records are repetitive—every author keeps repeating the same platitudes. Some authors are more generous, weaving in their own clinical experiences among the commonplaces, writing down how they treated similar diseases in the past; that is genuinely useful. From such records we can actually observe the process of treating certain diseases, which is no different from apprenticing at a master's side.
I particularly like reading medical case records (of course, many case records are fabricated, which is maddening; some people accuse even famous physicians like Yu Jiayan of heavily fabricating his case collection Yuyi Cao, and other doctors are even less trustworthy—but these are the only ancient texts we have access to, so we have to pan for gold in the sand ourselves). I believe a doctor's greatest contribution to the medical profession lies in their case records; authentic cases offer invaluable lessons to later generations.
These lessons are certainly not meant to have us copy prescriptions and treat disease, but rather to learn how other doctors perform pattern differentiation, how they think, and how they adjust medication according to changes in the patient's constitution and condition. Each doctor has their own prescribing style: some like to target the principal contradiction, some like to grasp everything at once and treat both the exterior and interior together, some prefer heavy treatment first and light afterward, others light first and heavy afterward. Reading such cases is deeply inspiring to us readers. Gradually, as you read and practice, your own style takes shape.
Reading case records gives us a deeper understanding of TCM medical theory. Through the recorded clinical practice of predecessors, we can study medical theory more deeply and gradually internalize it into our own medical worldview. Every doctor inevitably develops their own medical perspective in the end, and this directly guides their clinical prescribing.
I am a fairly typical example of someone who studied medicine and practiced on their own, self-taught. I had no master guiding me (although I did formally sign on with a master, that was only to qualify under the national system to sit for the medical licensing exam), no teacher lecturing to me; everything relied on my own reading and practice. Therefore, during my practice I was heavily dependent on the written records of predecessors, prescribing on the basis of their insights. Many who study Chinese medicine on their own to save themselves probably cannot avoid this path.
Whoever takes this path to study medicine must read widely, read without prejudice. You may as well gather books of the same category and read them together—see what this physician says and that physician says; do not be overly swayed by any single one of them.
Generally speaking, works in which one physician annotates and explains the famous medical classics are not worth taking at face value. In medicine there can be no one who has mastered all of heaven and humanity, because clinical experience is finite and therapeutic means are finite; no doctor in a lifetime can possibly encounter the complete set of classic cases described in other physicians' books. Therefore many of their theoretical explanations are pure speculation. Being speculation, they need not be taken as gospel. But their clinical experience, on the other hand, deserves serious study.
Read a book a hundred times and its meaning reveals itself. Studying medicine by reading medical books requires nothing else: read widely, without any sectarian bias, broadly explore all kinds of books. Read enough, and gradually your own medical thought will take shape. Question every medical book boldly; do not be superstitious about any single person's views. It is certain that in medicine no one's views are entirely right, nor are anyone's entirely wrong. Believing everything or doubting everything will both poison you.
As for modern TCM research, whether it has value is hard to say for now. I feel it needs at least another hundred years of sedimentation before the research that today's TCM practitioners are doing will bear fruit; drawing conclusions too early would be biased. But the pharmacology component of modern medical research—especially the part about drug toxicity—must be taken seriously.
Let the ancients be forgiven for not knowing; but now that we know some Chinese herbs have severe side effects—for example, that Asarum (Xixin) is carcinogenic, that Aristolochial-related Guanmutong causes renal failure—we can no longer close our eyes and stop our ears. If a doctor pursues a momentary effect just to show the patient something working, while disregarding the future harm the medication inflicts on the patient, that is highly improper. To put it bluntly, such a doctor will sooner or later face retribution.
Reading medical books and practicing clinically must be done cautiously and carefully, verifying for yourself what you have learned. If you are not confident about a medication, start with a safe small dose and gradually increase it, rather than rashly using a large dose at once. Prescribing this way, after a single dose you may not see the "immediate effect like a drum answering the drumstick" (the saying describes a response as swift as a drum sounding the instant it is struck) but rather disaster arriving before you can turn around. I say this because I myself have had such a failure. Though it did not trigger a life-threatening situation, one more step might well have.