“Medicine Is a Matter of Intuition” That Holds Back TCM Development

Liang Qichao said: every branch of Chinese learning carries a kind of mystery that can be apprehended but not put into words, which is the greatest obstacle to expanding knowledge. As part of traditional Chinese culture, TCM is closely tied to ancient Chinese philosophy, and so shares this feature.

TCM often says the physician art is a matter of intuition. Granted, at times this intuition has some reasonableness. But more often, this low-level intuition thinking makes some TCM scholars explanations of medical principles and herbal pharmacology full of subjectivity and arbitrariness, with very low accuracy and credibility.

In expounding herbal pharmacology, some TCM scholars fully unleash this intuition quality. For example, Wang Ang Bencao Beiyao says the reason Fuping (Duckweed) induces sweating and promotes diuresis is that it is pungent-dispersing and light-floating, enters the lung channel, reaches the skin, and can raise and disperse pathogen-sweat.

If Wang Ang had merely recorded that Fuping induces sweating and promotes diuresis, that would have been objective. But he had to use Fuping light-floating quality to explain its pharmacology, which is the fault of subjective speculation. Explaining herbal actions this way is a very low-level way of thinking and is quite unconvincing.

Of course, Wang Ang was by no means the only one in history to do this. The long passage at the opening of the Jingui Yaolue on liver disease, supplement with sour, burnt bitter enters the heart, sweet enters the spleen, and the spleen restrains the kidney, is a typical example of this intuition talk.

Another example: in the Shanghan Lun, the treatment of yinyang yi, a strange disease supposedly caused by sex after illness, uses burned-underpants powder. You take the part of a woman undergarment near the genitals, burn it to ash, and wash it down. This is also typical intuition thinking at work. I do not believe it really works, but many TCM practitioners say it is useful and attach their own cases. Personally, I am skeptical.

Through the dynasties, there have been plenty of TCM scholars who used this intuition attitude to interpret the principles of Chinese medicine at will. TCM zang-fu theory and meridian theory, and the properties and pharmacology of herbs, can all be called products of this intuition thinking.

Herbs, massage, tuina, acupuncture, and bian-stone therapy can all cure disease, yet without understanding the true principles by which these methods expel disease, TCM scholars through the ages forced far-fetched, self-evident explanations onto them, which in the end made some TCM theories sound more or less like nonsense.

When people today read such writing, they cannot help becoming deeply suspicious: can such absurd and laughable theories really cure disease? Even many TCM scholars with basic common sense can hardly be convinced. The opening of the Jingui Yaolue says one can treat the liver by injuring the kidney and lung, which is quite absurd; one fears that before the liver is cured, the kidney and lung will be sacrificed.

But the Confucian cultural sphere has an extremely strong tradition of antiquarianism, and most people dare not question the works of their predecessors revered as classics. In fact, very often this is merely a restaging of the emperor new clothes. Of course, some people genuinely and devoutly believe everything in the classics, even though they cannot understand or interpret them. Over time, errors in some TCM classics cannot be corrected even when they exist.

I have met many graduates of TCM colleges who also lack confidence in TCM. The reason is that TCM basic theory is simply too unpersuasive. Such vague basic theory often says nothing at all, leaving learners at a loss in clinical practice. What is more, some mystical types go on about elusive comprehension and spiritual insight, or drag gods and ghosts into medicine, turning it into witchcraft.

But from ancient times to the present, it is an undeniable fact that TCM has had vigorous vitality among the common people. TCM will inevitably have many adherents for a long time to come, especially while humanity is still unable to solve every disease.

As a Chinese person, few have not heard of TCM, and few families have never sought TCM treatment. This is because there have always been TCM learners who, sifting for gold in the sand from the vast TCM classics, learned what is genuinely useful and served patients with it, achieving real results and earning some dignity for TCM.

For example, Wang Ang record of Fuping actions is of great practical value. Most of the Jingui Yaolue is also of great practical value. Ge Hong Baopuzi and Biographies of the Immortals are naive and laughable, yet some folk prescriptions in his Handbook of Prescriptions for Emergencies can also cure disease. Of course, that handbook is not Ge Hong work alone; later figures such as Tao Hongjing augmented it, so which parts are Ge Hong cannot be verified.

When we treat disease clinically, we do not consider Wang Ang explanation of Fuping pharmacology or the tall tales in Ge Hong Biographies of the Immortals; we only consider whether the actions of Fuping and Qinghao (Artemisia annua) can solve a particular patient problem, and on that basis decide whether to prescribe these herbs.

I believe that herb syndromes (indications for a given herb) and formula syndromes (indications for a given formula) are the core of TCM vitality. TCM learners must firmly grasp herb syndromes and formula syndromes, achieving first know the disease, second know the herbs. That way, when treating disease clinically, at the very least one will not be bewildered and become a muddlehead.

When Li Dongyuan took on disciples, the first thing he had them study was the actions of Chinese herbs, and only afterward did they study the various TCM theories.

This was because Li Dongyuan had two bitter personal lessons. First, his mother developed a stomach illness; he sought out famous physicians everywhere, and they could discourse glibly, yet until his mother died they still did not know what disease she had. Second, he had personally witnessed a great plague epidemic in the late Jin dynasty after warfare. The famous physicians in the capital argued endlessly about its pathology, yet everyone was helpless; every day no fewer than two thousand coffins of plague victims were carried out through the capital gates.

These experiences left Li Dongyuan heartbroken and furious at the backwardness and pedantry of TCM, and he resolutely decided to study and practice medicine himself and change the face of the TCM world of his time.

I too have some such experiences. When I was a child, I saw at home how my father, a farmer with little schooling, gathered local wild herbs from the fields and cured people with them.

He had never learned inspection, auscultation-inquiry, or palpation, but relying on the medication experience handed down by generations, he used one herb to treat acute infectious diseases of the throat, curing the patient in a single night, with a 100% cure rate.

I also saw him use another herb, crush it, mix it with egg white and glutinous rice, and apply it externally to treat acute infectious diseases like cellulitis, again curing the patient in a single night. Whether that cellulitis cure rate reached 100% I do not know, because he did not treat enough cellulitis cases to say.

Not only could my father not explain the principle behind these treatments; even now that I have had a higher education, I cannot explain the principle by which these herbs he used cure disease.

Later, when I myself studied TCM, I could not find any record of the herbs my father used in large herbal dictionaries like the Bencao Gangmu, the Zhonghua Bencao, or the Chinese Materia Medica Dictionary. I asked many professionals in botany or herbal research about these herbs, and they did not even recognize them. These herbs were so humble that, though I asked many people, I could not even find out a scientific name.

I used to look down on my father two little tricks, but after I myself took up medical practice, I was filled with the utmost admiration for them. Because now, not only is my success rate treating cancer not high, but even treating minor ailments, I cannot approach a 100% cure rate. Of course, there are not many therapies in medicine that achieve a 100% cure rate. My father was like Cheng Yaojin with his three battle-axes; he could treat only a limited number of diseases.

Artemisinin, which Professor Tu Youyou extracted from Qinghao, also achieves a 100% effect against malaria. To many people, Professor Tu invention does not seem like much; some feel she merely inherited a little something from ancient TCM texts. But for malaria patients and clinicians, Qinghao and artemisinin are worlds apart. The original method of using Qinghao cured only a minority of patients; a malaria patient had only a fifty-fifty chance of survival. But purified artemisinin can cure all malaria patients, which is truly remarkable.

I have long wished that, like Professor Tu extracting artemisinin, I could extract active components from my father empirical herbs to benefit patients with throat diseases and cellulitis, but my personal ability is limited, and I have not yet produced results.

If I were to record my father medication experience, I would only record the indications and dosage of the herb, not make intuition-style speculative explanations of its pharmacology. I would leave the pharmacology I cannot yet understand for later generations to study.

That way, even if we do not yet understand the principle by which the herb cures disease, we can still use it to treat certain specific diseases, just as my father did. This factual attitude, at the very least, will not leave later learners bewildered as if lost in the clouds, nor will it make patients fearfully try out drugs. After all, the chance to survive vanishes in a flash; an imprecise treatment is too great a gamble for the patient, and the stake of life is far too heavy. I am deeply grateful to those patients willing to bet on me, and I also deeply understand those unwilling.

I think the reason my father medication experience was relatively precise is that he never made speculative theoretical summaries or arbitrary elevations of the principles by which his herbs cured disease, and then, without extensive empirical verification, promoted them broadly for other diseases.

For example, he would not say this herb is bitter-cold in nature, enters the lung and stomach channels, clears heat and detoxifies, and then, according to TCM theory, use it to treat every lung- and stomach-channel disease he thought involved heat-toxin. Had he done that, his therapeutic results would have become mediocre and unreliable.

I believe that a great many Chinese herbs were originally understood in a plain, unadorned way; it was only after scholars like Wang Ang, who subscribed to this intuition approach, intervened that things became complicated, untrustworthy, and not to be believed. And the clinical efficacy of Chinese medicine declined sharply as a result.

If TCM is to regain its vitality and still have many adherents among contemporary and future Chinese people whose scientific literacy grows ever higher, it must strip off this intuition cloak and restore what is truly valuable.

We contemporary TCM scholars should also answer the call of farsighted modern TCM predecessors such as Lu Yuanlei and Shi Jinmo, take the road of factual scientific development, and lead TCM out of metaphysics, making it more persuasive and approachable and more worthy of the trust of the general public.

The scientific spirit is not a spirit of self-importance and self-righteousness; the scientific spirit is precisely a spirit of criticism and self-criticism, a spirit that constantly denies the old self in the light of new understanding, a fact-seeking spirit with the courage to self-renew. I do not believe in ghosts and gods, nor in any authority, which is why I believe in science and have chosen to study Chinese medicine and pharmacology in a scientific spirit.

I began studying TCM at eighteen or nineteen and have now studied it for more than twenty years. In the TCM classics I have read over these two decades, most are documents that mix this intuition-style subjective speculation with real therapeutic effect, and are very easy to confuse.

I deeply feel how hard it is to study TCM under the guidance of such literature, and how difficult it is to achieve definite results in clinical practice guided by a mass of speculative theory. I constantly feel that I have let patients down when treatment fails, so I have been striving to find therapies with more definite effects. The road is hard, but since I have already chosen medicine, I can only exert myself to the death in search of better medical methods.

Many TCM scholars, after studying for years, mouth platitudes about going from breadth to essentials. I am not very interested in going from breadth to essentials; I feel what I truly want to do is separate the false from the true. Without this process of removing the false and preserving the true, the books we read are enough to cloud the mind and do great harm.

Through the ages, many who study national learning have been misled by the written records of their predecessors! The Jin-dynasty Ge Hong mentioned in this article is one of them. This old fellow was poor as a child and made a living working in a bookshop. Ge Hong was a bookworm; after reading some ancient bamboo slips, he actually believed that Pengzu living to over a thousand years old was a factual truth. The ancient fables that we now read as supernatural tales he took as real.

Ge Hong ended up entering Daoism to cultivate and seek the Way, and wrote the Biographies of the Immortals and Baopuzi, which had considerable influence on Chinese Daoism. Ge Hong always believed that through cultivating inner and outer elixirs and taking certain longevity drugs, a person could achieve immortality; perhaps he also took the then-popular Five-Stone Powder. Unfortunately, he himself died at only 61 (some say he lived to 81), rather than living forever.

This, however, did not prevent his Biographies of the Immortals and Baopuzi from being revered by later Daoist priests as classics of the Daoist canon. Even today, there may still be people who believe that, following the longevity theory in the Baopuzi, one can realize the wish of immortality.

It is better to have no books at all than to believe everything in them. If the reader does not have sufficient reason, and cannot verify and question the literature of the ancients through practice, it is hard to learn true knowledge from ancient texts. But reason, as Mr. Wang Xiaobo said, is not something easily obtained; one must work very hard to attain true reason.