Only by Innovating TCM Basic Theory Can Traditional Chinese Medicine Gain New Vitality
The basic theory of TCM has existed for more than two thousand years; in historical development it has been continuously improved and updated, gradually growing into a vast theoretical system. This theoretical system contains both the essential and the dross.
Limited by historical conditions, the overwhelming majority of TCM theory arose from idealistic "conjecture" or "inner observation." The Tang-dynasty physician Sun Simiao said, "The physician is intent; he who is skilled in using intent becomes an excellent physician." Valuing "intent" became a hallmark of TCM. This tendency gradually developed into an excessive idealism, to the point where later the saying arose that "medicine and the Changes are not to be separated." Linking TCM theory to the simplistic and error-ridden logical system of ancient China built on the Book of Changes produced much window-dressing divorced from clinical effectiveness. Some went further, developing this window-dressing into a word game. Thus TCM theory became a runaway horse, impractical.
Even now, this window-dressing still wields enormous influence in the TCM circle and among the public. Personally, I believe this is a major stumbling block to TCM's development. TCM originated as empirical medicine among the people and should return to the essence of empirical medicine. We should value clinical-practice data, not be bound by TCM basic theory, use new thinking and new methods to study the true principles by which TCM and acupuncture and other traditional treatments cure disease, summarize new experience, and provide more reliable clinical guidance for practice, so that the TCM theoretical system develops in a more precise and more operable direction. Only thus can TCM radiate new vitality in the new era.
I have met some TCM PhDs who, after studying TCM for years, grow increasingly despairing of it. Because the theory they learned sounds eloquent, but in clinical practice they find they cannot obtain ideal results. Not only do they themselves achieve no efficacy in treating disease, but the mentors they followed have no great efficacy either. Several PhDs want to do clinical work with me; they want to see whether TCM really has efficacy in treating disease.
I can fully understand this feeling: completing a PhD costs enormous energy and devotion. If in the end you find the knowledge you learned is impractical in clinical practice, it is deeply discouraging. Sometimes I also read papers in TCM journals, and reading them I always feel a strange sensation. Most TCM papers are neither pure academic papers nor the mystical talk of traditional TCM, but a freak produced by blending the two. When writing, the authors seem to feel that without those flashy TCM-industry "fine words," they cannot persuade their peers.
Students usually have no practical experience and believe whatever the teacher says in class. Barring major upheaval, the set of thinking methods the teacher teaches will also take root in their academic careers. This problem exists in both TCM and Western-medicine education. Many Western and TCM lecturers are basic-research people rather than experienced clinicians. They easily idealize a theory, ignoring the complexity of clinical practice. Any idealized theory is essentially a biased and defective cognition.
For example, during my study of Western medicine, the phrase I heard most was, "If all else fails, operate." I only once heard an anatomy lab teacher strongly oppose surgery in class; he said the body's organs were the product of years of evolution and must not be casually cut away. The other teachers (whether encountered in practice or in online classes) readily let the word "surgery" slip from their mouths. This is obviously a lazy thinking habit formed in teaching: over-idealizing surgery and ignoring the reality that surgery can solve only very limited problems.
Moreover, the complex problems of surgical complications and doctor-patient disputes are ones who teach full-time actually do not have to face; some teachers frankly say they chose teaching precisely because they feared clinical disputes. But frontline clinicians have to face them, and if mishandled, they may even brew into major medical disputes. If the teachers at medical schools teach students this way, the current grassroots-medical habit of operating at every turn is not hard to understand.
So lately, sometimes listening to lectures I feel disheartened, doubting whether such study really helps me. After all, I am 46; even if I have never eaten pork, I have seen pigs run. I have probably seen far more iatrogenic-trauma problems caused by surgery than the school teachers have, and I am not as enthusiastic about surgery as they are.
TCM-college teachers, for their part, over-idealize theories such as six-meridian pattern differentiation, eight-principle differentiation, yin-yang and five-phase theory, and the zang-fu doctrine, and this is exactly what students absorb at school. But once they enter clinical practice, TCM students find that few patients get sick according to the classic symptoms described in textbooks. During the inquiry, the new doctor's own mind is already in turmoil: what on earth is wrong with this patient? What pattern should be diagnosed? Which formula should be the base? It seems diagnosing it as the left works, and diagnosing it as the right also works.
Traditional TCM theory was mostly created by TCM physicians who were scholars, or failed scholars, by background. This is not invented; go look at the biographies of the famous TCM masters in history, and almost all had this background. In their first half of life they did not study medicine; they studied writing eight-legged essays and Confucianism. After failing the civil-service exams, they turned to medicine, so naturally and habitually they brought the thinking habits formed by studying Confucianism into TCM.
An ancient saying goes, "For a scholar to study medicine is like catching a chicken inside a cage." This saying perfectly captures the relationship between Confucianism and TCM. A scholar studies the Confucian classics and then reads medical writings by other Confucians—isn't that as easy as catching a chicken in a cage? But the entry of Confucian scholars or failed scholars probably did more harm than good to the development of TCM. Because the Confucian theory they cherished gradually led TCM away from practice.
In Japanese Kampo medicine (the Japanese call TCM "Kampo medicine"), there is a school called the "Ancient Formulas school," whose representative figure was Yoshimasu Todo. His greatest lifelong contribution was peeling TCM away from the complex Confucian theoretical system and restoring it to empirical medicine. His representative work was the book Yakucho (Evidence of Drugs), which mainly sets out the indications for each medicinal.
The most famous modern Japanese Kampo physician, Tang Ben Qiuzhen (Tsumoto), was an important inheritor of Yoshimasu Todo's thought. Tang Ben was originally a Western doctor, a graduate of the famous Kanazawa Medical College in Japan. His daughter died young from intestinal typhoid despite Western rescue efforts, a blow that deeply affected him; he then turned to studying TCM. He did something much like Yoshimasu Todo's: he summarized the medication indications of many classic TCM formulas, mainly those in Zhang Zhongjing's Treatise on Cold-Damage and Essential Prescriptions of the Golden Cabinet. His representative work was the book Kanpo Igaku (Imperial Han Medicine); writing such a book required a solid Western-medicine foundation.
The renowned Chinese master of the formula-pattern school, Professor Hu Xishu, was deeply influenced by Tang Ben Qiuzhen. Master Hu said that he had formerly been very confused about TCM, but later, by chance, he came across Tang Ben's Kanpo Igaku and, reading it repeatedly, his clinical efficacy greatly increased. Hu Xishu's writings bear the imprint of Tang Ben's book; he almost completely inherited Tang Ben's doctrine that all disease originates from the body's own food poisoning, blood poisoning, and water poisoning, a theory itself evolved from Yoshimasu Todo's doctrine that "all disease is one poison." Master Hu's works are mainly the lecture notes from his time as a professor at Beijing University of Chinese Medicine, compiled and published by his disciples as Hu Xishu's Lectures on the Treatise on Cold-Damage and Hu Xishu's Lectures on the Golden Cabinet.
Works by these three TCM masters are now sold in Chinese editions; those interested in TCM can buy and read them. My older brother previously dismissed TCM, but after I gave him one of Hu Xishu's works, his view of TCM changed greatly. Although Master Hu's surname is Hu, in teaching he disliked talking nonsense and was truly convincing.
The efforts of Yoshimasu Todo, Tang Ben Qiuzhen, and Hu Xishu were a strenuous attempt to fish the essence of TCM out of the mass of mystical dross, using actual clinical data as the basis to guide practice—rather like the "evidence-based medicine" concept in modern medicine. But they did only part of the work; they did not complete the creation of a new TCM theory, still less systematically organize the effective methods and principles by which TCM treats each disease category. They even inevitably had some errors and sectarian prejudices, but their pragmatic, truth-seeking spirit is extremely valuable.
The Medicine King Sun Simiao once said: "After studying medicine for three years, one says there is no disease in the world worth treating; after treating disease for three years, one says there is no formula in the world worth using." This vividly describes the state of mind of medical students. While learning, everyone thinks treating disease is so simple; after treating, they find the textbooks they studied were all nonsense—the great majority of medical books really are this disappointing.
I used to think that, from ancient times to today, the so-called medical masters in TCM were basically all book-copying kings. TCM medical books look numerous, but they are basically repetitive. The content in some Tang-dynasty master's writings would be copied verbatim by a Song-dynasty master, and copied again by yet another Ming-dynasty master, and so on, passed down generation by generation.
I used to love buying books, but as I bought them I gradually felt the investment was not worthwhile: basically buying the same repetitive content over and over, and reading it also costs a great deal of time. It is a pity to throw them away after buying, so they end up piled on the bookshelf, gathering dust and taking up a lot of room at home, to my wife's constant complaint that my personal library alone occupies too much space.
Nowadays, when I look up Western-medicine literature in the library, I find Western medicine is the same: medical books basically all exhibit book-copying, and truly mind-opening works are few. So sometimes some medical PhDs read my articles and shout with delight. They feel what I write is far better than the medical monographs they read, and far better than the eight-legged-essay-style papers they themselves write, because I greatly dislike copying books. Although occasionally I copy, the proportion is small. I also dare to put forward my own views rather than parroting others. Articles produced by copying books make one drowsy as one reads. When cliches and empty talk are said and heard too much, do they not drift ever further from reality?
When we have read too many copied books, we easily form an illusion: since so many doctors say it, it must be right. In fact we overlook their laziness. They are not right; they are merely lazy—lazy to think, substituting copying for creation and parroting others. There is a Chinese idiom, "three men spread the rumor of a tiger," meaning that when enough people say it, a rumor is taken as fact. On medical questions, the phenomenon of "three men making a tiger" is widespread. When enough people parrot, everyone feels a medical doctrine that has existed for years must be right, and so raises no doubt. In truth, truth is born from doubt; without doubt there is no progress.
But the public has never been tolerant toward those who question authority. Bruno was burned at the stake by the Church for advocating so-called heresy; Mendel, the father of genetics, was mocked by the academic establishment of his day when he proposed his theory of inheritance; the great scientist Planck even said that to change social prejudice one can only rely on the natural law of generations dying off. My own articles, in fact, often encounter all kinds of attacks. I used to publish through public channels; now I can no longer be bothered courting trouble and publish on my own personal channels, because arguing with people wastes too much of life.
For TCM to develop better in the new era, relying on inheriting the old TCM theory will not work. I am not the only one who has said this; decades ago, leading clinical TCM physicians Shi Jinmo, Zhao Shaoqin, and others said the same.
Over these years, in researching the treatment of nervous-system and tumor diseases, I have felt this deeply. I have read no small number of past TCM works, but none that truly helps me solve practical problems. In the end, what helps me solve practical problems are the new methods I have tried out myself through constant, unconventional experimentation. I once wrote up my insights on treating such diseases into a long paper; those interested can look through my earlier works.
But I must emphasize that these articles also have many shortcomings, and readers must not over-rely on them. If you can borrow from them the way I think about problems, I believe that harvest will be greater than what my articles themselves offer. You must know that, when solving practical problems, what is most needed is to develop your own ability to solve problems, not to copy others' solutions.
After I finish a few years of school education, what I most want to do is lead a few medical PhDs in innovative work on TCM theory. Such work requires observation and summary over long practice, as well as strong systems-thinking ability. I believe that in this regard I will, in my lifetime, achieve something of note.