Learning TCM Requires a Solid Cultural Foundation

A sophomore student wanted to study TCM with me. Because my own learning is still shallow, I always felt unworthy of being someone's teacher, so I politely declined. But after declining several times, he was still very sincere in wanting to study medicine with me and asked me to take him on.

So I casually chatted with him to get a sense of his cultural foundation. I asked him what the main component of lime is, how to write its molecular formula, and how to write the molecular formula of water. I asked him who Mendel was, what the main content of the genetic laws he discovered was, and what Darwin's main contributions were. He could not answer any of these. I asked him who the Eight Great Prose Masters of the Tang and Song dynasties were; he could only name Su Shi. I asked him about the relationship between sets and elements, and he could not say; I asked him which period of Chinese history the Northern and Southern Dynasties was, and he could not say. He said he was a liberal-arts student who scored 535 on the college entrance exam. I then asked him, choosing liberal-arts history: which dynasty did the Rule of Wen and Jing belong to? He could not say; under which emperors did the Zhenguan Era of Good Government and the Kaiyuan Golden Age respectively occur? He could not say. I asked him what the idiom "Fang's strategy and Du's decisiveness" (Fang mou Du duan) meant and what its allusion was, and he could not say.

He said his best subject on the college entrance exam was Chinese, so I quizzed him on who Xin Qiji was. He could answer that. When I asked him to recite a classic work by Xin Qiji, he could only recite one line, "In youth I knew not the taste of sorrow," and then could not go on. He retorted, "Do you remember it?" I then recited the entire poem word-for-word. When we moved on to representative works of other writers, he basically could not answer any of them.

I was somewhat astonished that college students' cultural foundation could be so weak, and even suspected whether he was really a college student. He said that by his sophomore year, almost everything he learned in high school had been forgotten, and that in their exam-oriented education, chemistry and biology were courses that liberal-arts students simply did not study seriously.

I then asked several of my friends who work in high school education whether this situation was normal; the surprising thing was that most of them said it was normal. This answer was far beyond my expectations. I still vividly remember these things I learned over twenty years ago; why is students' knowledge now so shallow?

I told him, not very politely, that with such a weak cultural foundation, he would not learn TCM well. TCM is not something that anyone can learn just because they want to. Studying medicine ultimately means treating patients; without a solid cultural foundation, it is easy to cause medical accidents in future clinical practice, and medical accidents harm not only patients but also the doctor.

I have always felt my own level is not high; in the process of self-studying both Chinese and Western medicine and engaging in clinical practice, I often feel that my abilities fall short. Therefore I dare not slack off: I read and take notes every day, consult other teachers, and continuously improve myself. I at least have some cultural foundation, can read classical Chinese, and occasionally can write in classical prose; what I write is not too outrageous. If I myself find learning TCM difficult, then someone far behind me will find it very hard to achieve an especially high level.

It is true that in the past, people with little book learning also studied TCM, but times have changed. With the development of science and technology, the public's demands for medical quality are much higher than before. People starting to study TCM now are destined to face the future. People's demands for medical quality in the future will only be higher than they are now. This is understandable: when ill, everyone hopes for safer and more effective treatment; after all, life is precious. To be safe and effective, a doctor must be erudite. Otherwise, one faces complex doctor-patient disputes and unpredictable risks. I believe most clinicians now can personally feel that being a doctor is getting harder, because patients' demands are much higher than in the past.

Recently a breast cancer patient from Jiangxi consulted me. Before coming to me, she had seen several TCM physicians—some prescribing decoctions, some doing acupuncture—all swearing they could cure her disease and intimidating her about how severe the consequences would be if she had surgery. She was so frightened that she did not dare have surgery, and even her mother, who had another type of gynecological tumor, was too frightened to have surgery.

But unfortunately, the several TCM physicians who treated her all, without exception, made her worse and worse. When she came to consult me, she told me a long list of symptoms and problems. After listening, I felt she should still prioritize surgery first, then undergo TCM treatment afterward. I also judged that her symptoms such as aversion to cold were related to hypothyroidism, and suggested she go to the endocrinology department to have a doctor order a thyroid function five-test panel to rule it out first.

After her surgery, she improved a great deal, and none of the severe consequences that the previous TCM physicians had frightened her about materialized. The thyroid function five-test panel also confirmed that she was indeed hypothyroid. Her treatment approach was thus straightened out, and my TCM adjunctive treatment recommendations had a basis; the treatment was both safe and effective. If I did not have a certain cultural foundation and the ability to keep learning, I could not have helped this patient. We went to college before enrollment expansion, and I scored many points above the key university cutoff line; perhaps college students at that time did indeed have a more solid foundation than those now.

Some people mistakenly think that studying TCM leads to good employment and a stable job in the future, which is why they want to study it. Those who think this way might as well look on Zhihu at how TCM majors talk about their employment prospects. In reality, many TCM college graduates I have encountered have difficulty finding jobs, and in many places TCM departments have few patients. Those with truly many patients are TCM physicians whose therapeutic efficacy is recognized by patients; these people make up only a minority within the TCM community. So those who just want to make a living need not study TCM; many majors have better employment prospects.

The most important thing in studying medicine is self-study. To succeed in self-study in the medical field, a certain cultural foundation is indispensable. A doctor spends a great deal of time throughout life reading literature and self-studying medical knowledge. In my own clinical practice, I have always advocated multidisciplinary cooperation, multi-target anti-cancer treatment, combining multiple methods and approaches, strictly controlling side effects within a range tolerable to the patient. The benefit of this approach is that it wins time for the patient and reduces occupational risk for the doctor.

But understanding all this is truly not easy; the only way is to read more books. I have three tips for reading: First, never let anything slide—don't gloss over anything you don't understand, even if it means re-learning an entire course. Go from not understanding to half-understanding, and then to complete understanding. Second, look things up frequently—when reading technical books, there will always be many unfamiliar terms; when you encounter one, look it up and take notes in the book, and over time you accumulate a lot. Third, follow the vine to find the melon—when reading a book, you will inevitably learn about other books from the author; if interested, find and read them. So if someone is truly serious about studying medicine and enjoys reading, they don't need anyone to give them a reading list, or even a teacher to teach them. As they read, they themselves will know what books to read next. In the end, they will only feel that time is insufficient, never that there are no books to read, or not know where to start.

I have a saying that may offend some people: I believe that whether studying TCM or anything else, anyone who is lost is not a truly dedicated person. A truly dedicated person will always be able to find their own way forward.