Reading Medical Cases Extensively Is the Key to Improving TCM Clinical Efficacy
In recent years, colleagues in Chinese medicine have often discussed with me how to improve clinical efficacy. Based on my own experience, my answer is: read medical cases (yi'an) extensively. From ancient times to the present, many physicians have left behind precious medical cases, which are the most valuable textbooks for learning Chinese medicine. Unfortunately, many people do not read cases; they prefer to mull over various theories, hoping to find a shortcut.
True knowledge comes from practice; the vitality of Chinese medicine has always lain in real clinical effect. However good a theory may be, without therapeutic effect it is empty talk. In the early stage of study we cannot possibly see large numbers of patients, especially patients with the same disease, which makes it hard to accumulate clinical experience quickly; reading other physicians' cases helps us make up for this shortfall.
I read medical cases every day, a habit I have kept for over a decade. In recent years I have also enjoyed writing articles appreciating medical cases. After learning the basic theory of Chinese medicine, we must put it into practice; medical cases show us the entire process by which other physicians apply basic TCM theory to treat illness. Just as students who solve many problems develop rich approaches, we who read many cases gradually develop sound clinical reasoning.
Although studying under a master also builds practical experience, its biggest drawback is low efficiency. Many physicians see a bewildering variety of patients in practice, and newly minted students copying prescriptions can easily get lost. Moreover, modern apprenticeship makes it hard to follow a single patient's complete treatment course; before long the teacher is transferred and the trail is lost. Not to mention that some masters have limited clinical skill, and many patients come for only one visit and never return, so it is hard to tell whether the treatment worked.
Reading medical cases avoids this problem. We can systematically read a large number of cases for a single disease category; for example, by reading Surgical Medical Cases we can focus on how TCM physicians treat surgical diseases. Works such as Ancient and Modern Medical Cases Annotated (Gujin Yi'an An) arrange cases by disease, helping us learn treatment approaches across the whole spectrum of general practice. We can also systematically study all the effective cases of a particular physician—through works such as Zhu's Selection of Shi Jinmo's Medical Cases, Ding Ganren's Medical Cases, or Xie Yinglu's Medical Cases—and thus learn that physician's clinical experience across many diseases.
Under the traditional apprenticeship system, the TCM student studies full-time with the master, and that teaching model is actually more effective than today's medical-school education. I myself have benefited from it; we apprenticed students start seeing patients from day one, learning theory in tandem with clinical work and comparing the two, which makes study far more targeted.
Today's academic training is like cooking in a big communal pot—a large crowd of students learning theory from a teacher, with weak clinical mentoring. During residency, students rotate rapidly through departments, skimming the surface rather than following one teacher long and deeply, as in the traditional apprenticeship. Hence the strange phenomenon today: many medical doctors, five or six years after getting licensed, still lack hands-on clinical experience. When they cannot produce results treating patients, they easily become discouraged, feeling that what they learned is impractical. I have met several medical PhDs who sought out masters to retrace the apprenticeship path we TCM students took. That takes courage and resolve; given time, such doctors will become excellent clinicians.
Under the apprenticeship model, the master guides the student through large amounts of hands-on practice; usually we were actually practicing within three months. When I first began, my master made me practice acupuncture every day on a thick stack of paper, driving the needle through the pile to build wrist and finger strength. Another master had me buy pork to practice on. Once we reached a certain level, they arranged for us to needle ourselves, and gradually to needle patients in the department. In this way, under the teachers' guidance, we overcame our fear.
Once, after needling Weizhong (BL40) on a patient with low back and leg pain, his pain eased instantly; the mnemonic "for low back and leg pain, seek Weizhong" was memorized for a lifetime without even trying. The apprenticeship model integrates theory and practice beautifully, which is why Chinese law recognizes it as a legitimate path to studying medicine and allows TCM apprentices to sit the physician licensing exam just as TCM university graduates do—not without reason.
Apprenticeship teaches real skill; indeed, its teaching effect can surpass that of formal schooling. Many of the TCM masters still active in China today, including some academicians, came up through apprenticeship—for example, the national TCM master Professor He Puren. China is now vigorously promoting apprenticeship in vocational education, precisely because educators have recognized that modern classroom teaching is less effective than traditional apprenticeship for skills training.
For apprenticeship education to produce masters, the apprentice must study under several teachers. One teacher offers limited clinical experience, which is why famous physicians of the past studied under multiple masters. Professor Zhao Shaoqin was such a case: his father Zhao Wenkui was head of the Qing Imperial Medical Academy (equivalent to today's director of the National Health Commission) and the most renowned TCM physician of the late Qing. While studying with his father, Zhao also studied under Wang Fengchun, Zhai Wenlou, and other famous doctors. After learning from several masters, by around age twenty Zhao Shaoqin was achieving excellent clinical results, and his reputation spread quickly.
It is hard for us today to study under multiple masters, but reading the cases of multiple physicians is much easier. Libraries, bookstores, and online shops make case anthologies easy to find; we can buy several and read them again and again, absorbing and learning how these physicians approached illness. From case after case we can not only see how others think but also strengthen our memory of pathology, formulas, and herbs.
This kind of reading is like learning a language through reading: it gradually develops a feel for the material while, almost unconsciously, we memorize a large vocabulary and master grammar. Memorizing herbs and formulas by rote is dry and inefficient, but after reading many medical cases, those formulas and herbs keep appearing before our eyes until they stick; medical cases are far more interesting than the Yaoxing Fu (Ode to Medicinal Properties) or Tangtou Gejue (Formula Songs).
Besides reading cases, I also collect other physicians' cases. How? I know many patients; when a patient goes to another physician and gets good results, I ask the patient or family to photocopy the prescriptions. I keep the complete set of prescriptions from the whole course of treatment and review them from time to time, which lets me learn how other physicians think. Of course this requires a solid grounding in TCM basic theory, Chinese materia medica, and formulaology; otherwise we cannot understand how others compose their formulas.
Today many patients receive integrated Chinese-Western treatment, so we must read not only medical cases but also medical records. We should see how patients, through cooperation between Chinese and Western medicine, find relief and live longer. The objective reality is that the overwhelming majority of patients today cannot rely on Chinese medicine alone, and as society develops, that will be even less possible in future. TCM physicians therefore need some grounding in Western medicine and familiarity with its basics; this improves the care we provide. Mutual denigration between Chinese and Western medicine is pointless; my own decision to retake the college entrance exam and study clinical medicine is also meant to raise my own overall level.
Reading cases and records requires patience; it is work that must be kept up day after day, year after year. But if you have decided to devote your life to medicine, you must be prepared to be a bookworm.