How We Should Learn from the Japanese When It Comes to Chinese Medicine
To assert something as certain without examination is folly. To rely on what cannot be made certain is fraud. Therefore those who expressly rely on the former kings and declare Yao and Shun certain are either fools or frauds.
— Han Feizi, "Xianxue" (Having Schools)
What Han Feizi means in this passage is that to declare some matter or doctrine certain without having tested it is foolish. To take as one's basis a truth that cannot be verified is nonsense. So those who are forever invoking the former kings and ancient sages are either fools or frauds. This passage really delivers a satisfying blast.
The Chinese have always treasured the past and disparaged the present, and whenever they speak they invoke the former kings. Chinese medicine has its theoretical root in the Huangdi Neijing (Yellow Emperor's Inner Canon). A considerable number of people firmly believe that the Neijing was truly written by the Yellow Emperor—one of the legendary Three Sovereigns and Five Emperors—and his minister Qibo. In fact, the Neijing was compiled no earlier than the Warring States period; its authors merely borrowed the Yellow Emperor's tiger's skin to lend weight to their own views. It contains no shortage of correct ideas, but also no shortage of chapters riddled with errors. It is fine for airy speculation, but absolutely not to be relied upon for guiding clinical treatment.
After Chinese medicine was introduced into Japan, the Japanese—with the Yamato spirit that prizes practice over theory—reworked it into Japan's Kampo medicine. Today, Kampo formulas built on Chinese medicine have spread far more widely around the world than Chinese materia medica themselves. Japanese society is quite accepting of Kampo medicines; even Prime Minister Shinzo Abe, when he developed ulcerative colitis, treated it with Kampo formulas.
Japanese Kampo physicians recognize Chinese medicine as their source, yet they accepted it selectively rather than taking TCM theory wholesale. Professor Tu Youyou made a similar remark when receiving the Nobel Prize in Physiology or Medicine: Chinese medicine is a treasure house, but it is not something you can simply take off the shelf and use. Looking at the history of the antimalarial research in which Tu Youyou took part, China at the time organized a great many TCM doctors into the effort, collecting several thousand formulas for treating malaria; acupuncture and moxibustion were also tried. But they achieved very little. It was in Ge Hong's Zhouhou Beiji Fang (Handbook of Prescriptions for Emergency), written in the Jin dynasty, that Tu Youyou found the record of qinghao (Artemisia annua) treating malaria; after repeated experiments, she discovered artemisinin, whose efficacy against malaria reached one hundred percent, and only then was it widely applied.
What is interesting is that Ge Hong himself, when writing the Zhouhou Beiji Fang, was already vexed by the Chinese tradition of prizing the past over the present. In the preface he wrote: "If only people will believe in these, they may escape sudden misfortune. The world suffers from valuing the distant and despising the near, praising the past and condemning the present. I fear that, seeing these formulas, those who lack the discerning eye of the Yellow Emperor, of Bian Que, He and Tuo, or Yufu will not adopt them—how can I force them?" If Ge Hong had known that, more than a thousand years later, this Zhouhou Beiji Fang would inspire a Nobel laureate, he would surely have felt deeply comforted in the netherworld.
When Hu Shi wrote his Outline of the History of Chinese Philosophy, he used meticulous historical evidence to show that nine-tenths of the writings of China's Hundred Schools were forgeries. Similarly spurious are the various Daoist classics, a great many Buddhist sutras, and numerous TCM canons. A major reason for these forgeries is that many authors, while alive, lacked standing and had to attribute their works to some ancient sage to make them credible. Thus many physicians, when writing their own medical treatises, would claim they had encountered some immortal who had transmitted to them this or that art of healing; only then would the common people believe them.
Over time, once this fashion took hold, a great many Chinese medical writings became exactly what Han Feizi called "either folly or fraud." Chinese writers created the wretched custom of borrowing sages to lend authority to their own words, so that later scholars, without a discerning eye, could scarcely sift true gold from the sand of their predecessors' works.
Mencius has a classic saying: "If one believes everything in books, it were better to have no books at all." This exposes the shortcoming of a great many Chinese writers: dishonesty. The Japanese, in studying Chinese medicine, adopted precisely this attitude of Mencius. They learned much from the Chinese medical canons, but they did not transplant every theory wholesale; instead they "removed the dross and selected the essence," and on that basis further raised the practical value of Chinese medicine. They used empirical methods to verify actual clinical effects, accumulated large amounts of clinical data to determine the indications range of each drug, scientized the basis for medication, and raised the efficacy of Chinese medicine. That is why Japanese Kampo medicine, born of Chinese medicine, has such vigorous vitality in Japan and throughout the world.
Medicine is an empirical science and must value real clinical experience. The great Japanese Kampo physician Dōsaku Tōmoto said: "In any field of learning, where theory and fact are expected to correspond without the least discrepancy, as in mathematics, one need only study theory and empirical knowledge is unnecessary. But medicine cannot be resolved by theory alone; it must therefore be sought in the union with experience. If theory is divorced from experienced fact, it cannot truly be called theory at all. Hence the experienced facts of the human body must come first, and theory second."
This attitude of Dr. Tōmoto—prizing practice and placing clinical experience before medical theory—is exactly the scholarly stance a rigorous physician should hold. Medicine is not validated by logic but by human experimentation. The Chinese often overemphasize the logical and philosophical character of Chinese medicine while neglecting its clinical evidence; over time, the clinical efficacy of Chinese medicine has declined sharply, until TCM eventually developed, in the eyes of the common people, into a kind of witting or unwitting charlatanry. That is a sad thing.
Those of us who study Chinese medicine should learn from the Japanese this spirit of valuing practice, not superstition in theory, and not falling readily into the trap of philosophical sophistry. Doctors work long on the clinical front line; they should not always pursue some fixed mode of thinking at the expense of practice. Li Dongyuan, one of the Four Great Masters of the Jin-Yuan period, when teaching his disciples, first required them to memorize the nature of drugs, rather than study various medical theories. For once one sinks into all manner of medical theory, one easily becomes a dogmatist taken captive by theory.
I myself have always studied medical theory as hypothesis rather than truth; I absolutely refuse, because some theory is authoritative, to "assert it without examination" (to confirm it without practical trial). Only when I have verified in clinical practice that a theory is one hundred percent correct am I willing to believe it is truth; otherwise I treat it only as a reference.
This attitude of doubting every medical theory allows me to study both Chinese and Western medicine broadly without prejudice, and, in light of the clinic, to select what is more credible to believe. Over time I have shed all sectarian bias, as well as the prejudice opposing Chinese and Western medicine. What afflicts the doctor is his own meager knowledge, narrow range, and few tools when treating disease; what afflicts the patient is that illness is many and hard to treat, and good doctors are hard to find.
The Japanese attitude toward Chinese medicine is highly rational. In China, an ordinary layperson may already hold forth on the metaphysics of TCM, diagnosing his own "yin deficiency with effulgent fire," "kidney deficiency," or "spleen deficiency." After picking up a bit of superficial jargon from television or from shallow bestsellers on street corners, they think they have glimpsed the mysteries of TCM and spread around what is merely error compounding error, until TCM terminology has largely dwindled into the stock phrases of charlatans. This is quite improper.
When my father treated throat disorders, he never took the pulse and never did pattern differentiation; he simply squeezed the juice of one wild herb and dropped it into the patient's nose, and within a few hours the illness was gone—a hundred-percent cure. To this day I have not met a single throat specialist in Beijing, whether a TCM professor or a Western-medicine professor, whose results were this fast and this reliable. I have read the monograph on throat disease by the great Chinese throat specialist Professor Geng Tingjian, Geng Shi Houke Chuandeng Lu, and have used its formulas to treat throat ailments; their effect is not only slow but unreliable, and they cannot in the least compare with the clinical experience my father accumulated in the fields. Such experiences have further confirmed my attitude of doubting every medical theory as I study.
To doubt the medical legacy left by our ancestors is not to reject it, but to extract its essence and discard its dross; when practice shows that an ancestral theory is not workable, boldly improving it is not heresy but the creation of new knowledge. Without this spirit of valuing evidence and innovation, even if Chinese medicine is now valued by the government and promoted through its power, it will in the end be spurned by the people—because it prizes metaphysical theory while its clinical results are not high.