Read the Classics, Learn New Knowledge, Value Safety, Do Clinical Practice

Academician Wang Yongyan issued a call to the TCM community to "read the classics and do clinical practice," arguing that to cultivate outstanding TCM talent one must value "reading the classics and doing clinical practice." This is, admittedly, very sound advice.

But times have changed. Personally I feel that in today's social environment these six characters are not enough; one should add another six: "learn new knowledge and value safety."

Why do I say that? Because some TCM colleagues have gone to an extreme in "reading the classics and doing clinical practice"—they have become far too slavishly devoted to the classics, to the point of causing a great many medical accidents.

I follow news reports about the side effects of Chinese herbs closely. Just in the past few days I read about a hospital in Northeast China where three patients were simultaneously hospitalized for liver damage caused by taking the herb Baixianpi (Cortex Dictamni, dittany bark).

Baixianpi is a commonly used herb for skin disease this season. Reports of liver damage from taking Baixianpi internally are already common, yet many TCM doctors still use it carelessly and cause liver damage in their patients.

Mild abnormal liver function from chemotherapy, targeted drugs, or using TCM "using poison to attack poison" to treat cancer is understandable, but causing liver damage while treating a skin disease is a big loss—because this condition could have been solved by a safer approach.

In the past, science was underdeveloped and such side effects could not be detected. Today's medical conditions are better than before, and the side effects of Chinese herbs are easily detected, so our use of medicine must keep pace with the times. Otherwise, not only is the patient unsafe, the doctor is unsafe as well. Once an accident happens, it easily becomes a medical dispute.

Xixin (asarum, wild ginger) appears frequently in Zhang Zhongjing's Shanghan Lun (Treatise on Cold Damage); classical formulas such as Xiao Qinglong Tang (Minor Bluegreen Dragon Decoction) and Mahuang Fuzi Xixin Tang (Ephedra, Aconite and Asarum Decoction) all use asarum. But asarum has strong carcinogenic effects: animal experiments confirm it can cause liver cancer, and epidemiological follow-up studies show that many liver cancer patients in China have a history of abusing asarum. Using asarum to treat disease may solve the patient's immediate problem, but it also plants a great hidden danger.

Some people always extol asarum just because it is used in classical formulas, and advocate learning Zhang Zhongjing's high-dose use of asarum, which is deeply harmful. If the medical sage Zhang Zhongjing were to practice medicine by his own formulas in modern times, one wonders how many medical accidents there would be; the families of patients would doubtless long since have denounced him as an incompetent quack.

Many articles online are obviously written by TCM enthusiasts who barely do any clinical work. I am not impressed by most TCM enthusiasts: they learn it halfway, care nothing for medical safety, and advocate views they themselves only half understand—doing great harm. If they were made to treat large numbers of patients clinically, their heads would probably be bashed in by the patient families.

People often brag to me about how many cantharides they dare use. These people are truly reckless and have no awareness that they are treating human lives so lightly. Methylcantharidin causes irreversible damage to the human body—not to mention that an overdose can kill, but even a non-overdose leaves endless aftereffects.

Modern cantharis preparations are all made from norcantharidin, which has far fewer side effects. Some people studying TCM, disregarding the patient's safety, use raw cantharis in large doses and as a result cause many patients to die.

Recently there was a patient who had been bitten by a dog; because his sister was a folk TCM practitioner, he went to her for TCM treatment, ended up eating seven cantharides, and died of poisoning. When this news report came out, I wondered what the sister must be feeling in her heart.

Recently another folk TCM practitioner used Chanzi (Strychnos, nux vomica) on a patient with facial paralysis; he used several pieces of nux vomica at once, directly killing the patient, and the practitioner was sent to prison as a result.

Even worse, not long ago a folk TCM practitioner in Guangdong gave a patient with low back pain a kind of powder he had made himself from Gelsemium (Gouweng, poison hemlock). After taking it the patient felt severely unwell and went back to ask the doctor. To prove his medicine was safe, the doctor himself ate a spoonful of it, and unfortunately died of poisoning himself.

There is a joke in the Xiaolin Guangji (a classic collection of jokes) about a man who "first studied letters but failed the exams three years running; then took up martial arts, shot an arrow on the drill ground and hit the drummer, and was chased away; then studied medicine and achieved some skill. He wrote himself a fine prescription, took it, and died." This folk TCM practitioner who died of poisoning is a real-life version of that story's protagonist.

There is a whole cohort of TCM enthusiasts who style themselves guardians of traditional culture, and they are exactly such people. They confidently believe that what they have learned is the true TCM, the real TCM derived from reading the classics, and they put on an air of looking down on everyone, attacking everywhere how Westernized the TCM others study is, calling it unorthodox and a case of forgetting one's roots.

I very much dread dealing with such people; as soon as I catch that tone in their words, I keep a wide berth.

I often see anticancer formulas that use large doses of herbs such as Huangyaozi (rhizoma Dioscoreae bulbiferae), Jixingzi (Semen Impatientis), Langdu (Euphorbia fischeriana), Yuanhua (Genkwa Flos), and Daji (Euphorbiae Radix). Often, within a week of taking the medicine, patients develop severe damage to liver and kidneys: hematuria, generalized edema, jaundice, and so on. I really admire the nerve of these people; they seem utterly unafraid of being sued and jailed.

Humanity's understanding of traditional medicines keeps improving, yet there are always people who refuse to learn new knowledge, always feeling that learning this is useless, that it is too Westernized, that it betrays the TCM classics, that it is not the real TCM.

So what level is the "real TCM"? At the side of the emperors of every dynasty stood the finest imperial physicians in the land. But look at how long the emperors lived, and look at how many of their sons died in infancy, and we will know just how high the peak of pure TCM could reach. To be frank, the quality of medical care enjoyed by an ancient royal noble was worse than that enjoyed by a commoner today.

If all TCM doctors nationwide rejected new knowledge like this, then in an era when medical standards have risen so dramatically, TCM would be eliminated, because it would cause too many medical accidents. I can also understand why some Western doctors are so resistant to patients taking Chinese herbs: just step into the liver and kidney disease wards of any hospital and we will see how many victims of Chinese medicine there are.

Earlier this year a member of my family was hospitalized for gallstones, and in the hepatobiliary surgery department of a certain hospital I encountered a patient who had taken Chinese herbs to treat menstrual irregularity and developed severe liver damage.

This patient had been transferred all the way from a local hospital to a Grade-A tertiary hospital in Beijing, because when she developed severe liver damage the TCM doctor who had written the prescription was helpless, and the local hospital was also unable to cure her liver damage. Western doctors in modern hospitals have seen this kind of thing so often—how could they not oppose TCM?

So the slogan "read the classics and do clinical practice" is outdated. Today, while reading the classics, we must also widely learn new knowledge. Without learning new knowledge, medical safety cannot be guaranteed, and doing clinical work becomes a very dangerous thing.