On How to Learn Traditional Chinese Medicine

From time to time people ask me how one should study TCM. I am flattered that these readers think me qualified to offer guidance; some even hope I would launch online courses to teach TCM. But I am well aware of my own limited ability, and what I should do most is conceal my shortcomings rather than be fond of playing the teacher.

I take the liberty of writing this article today merely to exchange a few of my own immature reflections, in the hope that experts may correct me. I have no intention whatsoever of playing the teacher and lecturing others.

I study TCM out of love, but what I love is not limited to TCM—I also love modern medicine, as well as the philosophy of mind and psychology related to the human psyche. It is just that I have no opportunity to practice modern medicine or psychiatry, so in my writing I dare not stray too far into matters beyond TCM. Medicine is a practical discipline; writing carelessly without practical experience easily misleads readers. Some readers, after reading an article, may try the treatment schemes it contains on themselves, and that would harm them.

My official account has over 50,000 followers, and my website has regular readers; some articles have very high readership, so I am careful about what I write. What I know is limited; what I do not know is boundless. What I write is more like reading notes: I write primarily to deepen my own memory, and only secondarily to share with readers.

The reflections on learning TCM mentioned by certain senior predecessors are words to the very point. In the past I could not understand them; now, as I grow older, I appreciate them ever more deeply.

Professor Ren Yingqiu once said that only after a person turns sixty does he truly understand TCM. I used to be unconvinced and felt Dr. Ren was perhaps leaning on his age to condescend. Only as my own bodily ailments have multiplied have I deeply appreciated that Dr. Ren's words make good sense. Only after living through childhood, adulthood, prime and old age does one understand how the human body works and what TCM is about.

We often say that TCM is a holistic medicine. In the past this wholeness was mostly interpreted on three levels: that the body's zang-fu organs and meridians form an organic whole; that humans and society form an organic whole; and that humans and nature form an organic whole.

Allow me to add one further point: a person's whole lifetime is also an organic whole. What TCM studies is precisely the whole of a person's life. TCM's idea of "treating the undiseased" requires a person, while young, to lay preventive groundwork for his health in old age.

There is a saying in Caigentan (Vegetable Root Discourse): "Illnesses in old age are all invited in prime; wrongs committed after decline are all done in the season of abundance." This is a maxim of the highest order. Many people seem to develop "old-age diseases" only in later years, but in fact these so-called old-age diseases are caused by the accumulation of bad habits formed over the entire course from birth to old age. Bad habits are insidious: like an airliner deviating by a tiny angle off course, that small deviation can mean that our intended destination is Guangzhou but we end up in Shanghai. We usually cannot feel the harm of bad habits; only after a serious illness do we realize it.

So Dr. Ren's remark that one must be over sixty to understand TCM is well founded. TCM emphasizes that a person should guard his spirit within, restrain sexual desire, not exhaust his original qi, and live in accord with the seasons. To young people this seems unacceptable; they awaken only when old and when their bodies have suffered.

Only through direct personal experience can one fully grasp the whole process of growth and aging in one's own body, and understand that the various health-preserving views in the TCM classics are by no means empty threats. Only by personally experiencing this growth and the transition from flourishing to decline can we know that a patient's body varies from person to person and from time to time. Wu Jutong, the great TCM warm-disease specialist, in his youth championed the study of warm diseases and favored cold-cooling medicinals; in old age he valued warm supplementation. Because his own body told him that, as the human body ages, it increasingly needs the support of warm-supplementing medicinals to boost vitality.

Studying TCM requires patiently observing changes in one's own body; treating illness requires patiently tracing the patient's whole life. I hope that in future, when we speak of TCM as holistic medicine, we will also bear this in mind: taking the whole lifetime as the whole, searching for the root cause of disease in the patient's life course, and then prescribing accordingly.

The words of other senior predecessors also impress me. For example, the late veteran TCM physician Yue Meizhong once said that in studying TCM one must constantly review the foundational knowledge. Mr. Zhu Liangchun also said that he kept a Dictionary of Chinese Materia Medica and a Chinese Materia Medica at his desk at all times, leafing through them at every moment. These are all maxims. I myself now keep reference works on formulology and Chinese materia medica constantly in hand; for particularly useful ones I buy several copies, because if you leaf through them every day, they wear out.

When I go out I like to carry a pocket book. In the past I often carried 500 Clinical Formulas for Reference and 500 Clinical Chinese Medicinals for Reference; I wore out several sets of each. These are foundational TCM knowledge. "Reviewing the old to learn the new"—by repeatedly reading these books in spare moments, one will not be at a loss when practicing clinically.

Some people are ashamed to study foundational knowledge repeatedly and always want to delve into profound learning; as a result, they master neither the profound learning nor the foundations, and are at a loss in clinical practice. I have no other gift. Certain foundational works—for example, Professors Liu Duzhou and Hu Xishu's teachings on the Shanghan Lun, and Professor Zhang Tingmo's works on clinical Chinese materia medica—I basically read through once every year or two, and reread them against the case records of their treatments. Sometimes in conversation I can recall which chapter of which professor said what, and when I send people to look it up, I am basically right.

A physician is a skilled trade. The degree of mastery of foundational knowledge and the classics directly determines a TCM physician's clinical efficacy. If I go several years without reviewing the foundations, I forget almost everything. I admire colleagues who stop reading once they leave school and still dare to treat people; I feel my own skill is inferior in this regard. Only by repeatedly reviewing foundational knowledge do I dare to practice. Even so, my clinical effective rate is not yet ideal; without doing so, it would be far worse. Year after year of reviewing the foundations, year after year of accumulating experience in practice—only then does the clinical effective rate gradually rise.

Professor Zhu Chenyu said something else: in studying medicine one should read widely, for opening a book is always beneficial; one should not look down on any medical book or journal. If we learn one formula from some book and it works in clinical practice, that is a great gain. So Dr. Zhu urged medical students to read more.

I also regard these words of Dr. Zhu as a maxim. I have bought many books; in earlier years I bought more paper books. But my modest home was too cramped; after books filled seven or eight bookcases, my family protested my excessive occupation of space. The bookshelves also protested—overwhelmed. My shelves all work under overload, stacked three layers deep. Most books are medical, and many are heavy tomes. In recent years I have switched to e-books. Although some people feel that professional books are better read in print, I have still bought a large number of medical e-books; once accustomed, they are no different from print, and note-taking is convenient.

Sometimes one gains only a point or two from a book, but if those points are repeatedly verified as effective in practice, the book was well worth buying. I buy so many books that it is impossible to read them all—they would outlast my lifetime. Many books I merely leaf through; when something catches my eye, I jot it down. Over time, this accumulates a great deal.

My income is not low, but neither is it high; with such a money-burning hobby, I never have much spare. Luckily I dislike shopping, dress casually, and do not care much about food. Once, on a trip to Shanghai, a patient's family member noticed a large hole worn below the knee in my trousers, rummaged through his own wardrobe for unworn clothes, and insisted on giving them to me. I was not wearing rags to feign poverty—I can afford clothes; I simply do not care about such things at all.

I grew up in the countryside. In the 1970s and 1980s material scarcity was the norm, and my generation grew accustomed to simple fare, so we do not crave gourmet food. Only after studying medicine did I realize that this dietary habit is very healthy, and that dietary habits must be formed in childhood; by the time most people reach adulthood, it is already too late to change. So this simple, plain diet is also a gift from heaven to my generation.

I have one further personal reflection: in studying TCM one must not play the mystic or affect profundity. At first one does not realize the harm of such playacting, but over time one ends up deceiving oneself. Some people like to affect profundity; the theories they talk about and the articles they write are full of such obscurity and seem baffling. Whether such people can learn TCM well, I personally doubt.

If you read enough medical works, you may find that the writings of all the great physicians are extremely plain; their medical discussions and case records are easy to understand, like the poems of Bai Juyi—just very straightforward, plain speech.

Another personal reflection is to value the study of medical case records. The essence of TCM lies in case records; reading them serves the same purpose as following a mentor in clinical practice. I spend half my daily reading time on case records, which broaden our horizons. The foundational knowledge we study is verified in case records, and other things not learned in daily study can also be gained from them. Publishing is flourishing now, and many monographs of case records have been published; these can all be bought and read.

One more point not everyone can achieve: diligent writing, never ceasing. Many physicians have remarked on this. The exchange and transmission of medical experience depends chiefly on physicians' writing. Both Chinese and Western medicine value writing. Asada Sohaku, the giant of Japanese kampo medicine, wrote every day, reportedly for fifty or sixty years; that perseverance is admirable.

Writing systematizes one's knowledge, deepens memory, and allows exchange of medical experience among colleagues. But honestly, I see very few doctors who enjoy writing; some get a headache just picking up a pen. This is truly a matter of temperament and cannot be forced.

Studying medicine is a lifelong endeavor—learn until you are old, and even then you have not learned it all. Medical knowledge seems dry to most people, but only one who loves studying medicine can persevere. As long as you persevere, there is really no special trick. When the fire is hot enough, the pig's head cooks; the so-called ten-thousand-hour rule also applies to studying medicine, though perhaps medicine requires longer—fifteen thousand, twenty thousand, thirty thousand hours. The more you learn, the higher your level; once the accumulated learning reaches a certain point, you naturally have it. Rome was not built in a day; those who fish for three days and sun their nets for two will not learn TCM well.

Confucius long ago summed up the general principles of learning quite aptly: simply "learning and reviewing from time to time," "reviewing the old to learn the new," "to know is not as good as to love it, and to love it is not as good as to delight in it," and "learning without thought is perilous; thought without learning is perplexing." If a person spends most of his life joyfully persisting in one thing, there is no reason he should not do it well.