TCM's Decline Should Be Explained by Looking Within
In his retirement, my father likes to study all kinds of social phenomena. For a while he got a whim and set up long-term observation beside several TCM clinics in our county town, watching each for at least a week and carefully recording the number of patients each clinic saw per day. He found that most clinics were lucky to see one or two patients a day, and some went three or four days without a single visitor.
My father had been an accountant when young; when our local bank recruited cadres, they specifically wanted him, because the cadre in charge of recruitment had once been stationed in my village and lived at our house, and he admired my father's mathematical talent. Mathematical thinking seems to be heritable: from my father, to my brother and me, to my son, we all do well at math; at school my son was always called the "math prince" by his classmates. My father's way of investigating TCM clinics is interesting; among the people I know, only those trained in scientific thinking have that kind of awareness, but he, limited by his times, only finished primary school.
What he observed was no coincidence. When I studied under a teacher at our county TCM hospital, I often wandered through the departments. In the TCM hospital, aside from the doctors trained in acupuncture and tuina (mainly the orthopedics/trauma and acupuncture departments, which are not separated in small hospitals), the other doctors had very few patients. Some might see only one or two patients in a whole morning, and these doctors held the title of associate chief physician. They were idle, sitting around chatting; the studious ones had a book or two on their desks to leaf through in spare moments, while the unstudious just gossiped.
The TCM department at the People's Hospital has also lost many patients compared with before. Aside from a few renowned veteran doctors, the other TCM physicians have hardly any patients. Even the renowned veterans see far fewer patients than they used to. On a street outside the old county People's Hospital, there has long been a shabby TCM clinic; its billboard has yellowed, and its sign is covered in tiny handwriting listing a jumble of classics—the Yellow Emperor's Inner Canon, the Book of Changes, bagua, qimen dunjia—with no punctuation. It was there when I was in middle school, and it is still there now. It looks the same, and business remains as dismal as ever.
Granted, the massive outflow of population from China's rural areas has had some impact on these TCM doctors' practices, but that is not the main reason. At our county People's Hospital the queues are still very long, especially in popular departments like pediatrics and cardiovascular and cerebrovascular medicine; sometimes you wait a whole morning just to be seen. So it is not that there are no patients, but that patients no longer choose TCM.
Many TCM fans blame TCM's decline on the state's failure to support it, or accuse interest groups hijacked by Western medicine of suppressing it. I do not accept that. I am a country person, and I know how country people think; their view of medicine comes from the results they see in people around them.
Rural China is an acquaintance society. Which doctor is skilled and good at solving problems determines who gets a good reputation. Country people do not judge local doctors through apps like Haodf; they get medical information from the gossip of neighbors. We country folk may be unsophisticated, but we are not fools; interest groups cannot wash our brains.
When my sister was renting a place in the county town to bring up her child at school, the landlord's daughter, after getting a master's in TCM from some TCM university, struggled to find a job and sat at home worrying. She kept wondering why so many patients came to me rather than to a TCM master's like her. Of course, it is common now for medical graduates to be unemployed, especially without a secured position; it is not just TCM graduates who struggle, Western-medicine graduates do too. Medicine is fiercely competitive, and many medical-university graduates refuse to work anywhere but public hospitals, and refuse township health centers, so finding a job is hard.
TCM physicians in tier-one and tier-two cities fare somewhat better; I do better in Beijing, because Beijing is where China's best medical resources concentrate, and patients from all over the country come to Beijing to see doctors. So Beijing's medical market is always lively, and Beijing TCM doctors of some reputation never lack patients.
But if you look down into grassroots society, you can see just how far TCM has declined. If an industry needs heavy policy support just to survive, its future is worrying.
Shi Jinmo, a senior master of TCM, once worried deeply about whether TCM would even have a market a hundred years on. He was one of the rare far-sighted figures in TCM; he pushed the Chinese government to establish an academy for TCM science, demanding that the scientific basis of TCM be studied, using modern scientific thinking to sift the dross from the essence. His efforts preserved much of TCM's living strength.
After I opened the textbooks of modern nine-year compulsory education, I too began to worry about TCM's survival in China twenty or thirty years hence. Our children are receiving a full scientific education; starting with junior-high biology they learn controlled experiments (such as those with woodlice and mealworms), while TCM still cannot accept controlled trials. When this generation grows up, the great majority of Chinese will regard traditional TCM theory as absurd.
Modern life science, represented by biology and Western medicine, is advancing at a dizzying pace. I bought a set of Practice of Internal Medicine (13th ed., edited by Shanghai Medical College of Fudan University) a few years ago; this year I bought the 15th edition. Comparing them, I found the changes so vast it was almost like reading a new book. Yet TCM still remains mired in veneration of the two-thousand-year-old Yellow Emperor's Inner Canon, in the fog of metaphysics like the Book of Changes; even the so-called jingfang (classic formula) school has hardly advanced beyond a fairly primitive stage of empirical medicine.
Modern life science emphasizes verifying its theories through controlled experiments and constantly correcting its shortcomings, which is why it grows ever stronger. TCM, by virtue of its conservative bent, has steadily declined in competition with modern medicine.
Some utterly mindless authors and readers enthusiastically quote sayings like "TCM lets you live in a blissful fog, Western medicine lets you die in perfect clarity," or "those who say a disease cannot be cured have not mastered the art." This can only be regarded as high-grade defamation of our own TCM. TCM may sometimes let people live in a fog, but more often it lets people die in a fog; Western medicine may indeed sometimes let people die in clarity, but more often it lets them live in clarity. From ancient times to the present, TCM's own classics record countless incurable diseases. How can anyone brag that "those who say a disease cannot be cured have not mastered the art"?
Over the last twenty years I have watched TCM decline with my own eyes. Of course, I have also watched the decline of the rural barefoot doctor. Many people long to return to the era of the barefoot doctor; I would rather die than go back then. I was born in the late 1970s; because barefoot doctors of my childhood reused needles when giving us shots and vaccinations, I was infected with hepatitis B virus and became a carrier—since my parents, brother, and sister were all uninfected, it could not have been a household infection. At our college-entrance physical exam, out of a class of forty-odd students, seven or eight were hepatitis B carriers, most traceable to reused needles. So that cheap barefoot-doctor era of medicine gives me the chills. If China had not reformed and opened up, and health care had not advanced to its present level, who knows how many more people would have died needlessly.
Besides being conservative, TCM also lacks the objectivity and rationality that modern medicine ought to have. In the case records of many TCM physicians one sees extravagant language; after reading too many TCM books, I myself inevitably picked up this habit.
An elder of mine once read one of my case notes, saw the words "the patient recovered and can already walk as swiftly as flying," and directly pointed out that such phrasing would make my writing a laughingstock. He said frankly that if I kept writing this way I would never be admitted to respectable circles. He asked me: what does "walking as swiftly as flying" even mean? Only a young fellow can be described that way; can a healthy sixty-odd-year-old walk as swiftly as flying? The patients I treat are elderly; even in good health they cannot walk as swiftly as flying, let alone after a major illness. So I should only say the patient can now walk on his own; I must not use exaggerated phrases like "walking as swiftly as flying."
His words shamed me. He always urged me to get a formal, systematic medical education to raise my overall medical literacy. His repeated criticisms and corrections showed me the shortcomings of a self-taught TCM practitioner—shortcomings we ourselves easily miss. When I studied the guqin, I learned that without a teacher correcting us, wrong fingerings easily become lifelong habits. Learning medicine is the same: no matter how talented the autodidact, one needs formal training to avoid the arrogance of a frog at the bottom of a well.
I wrote the case that way because, when the patient reported her improvement, she happily told me she could now walk "as swiftly as flying," and I recorded the four characters without thinking. But in fact, such imprecise wording may belong in casual daily conversation, not in the case records and medical notes of a modern physician. A formally trained doctor must describe the patient's condition objectively, rationally, scientifically, and neutrally, avoiding all exaggerated words and phrases.
Such exaggeration is not only in my case records; it can be found in the case records of many TCM doctors, because it is a common failing of the profession. Some TCM physicians pepper both lectures and case records with inflated language. These exaggerations greatly undermine TCM's credibility. People often send me links to lectures by this or that "master," but I cannot be bothered to look. Why? Because I have already heard of those "masters," and saw their lectures years ago—whole lectures packed with inflated language. Such masters have collectively shamed the title of TCM physician, leading people wrongly to assume that all TCM doctors are hucksters like them.
If no doctor in TCM can study, lecture, and write objectively, rationally, scientifically, and neutrally, the profession will degenerate into a camp of swindlers and charlatans. The public may get excited while reading and listening, but when treatment fails to match the hype, they automatically categorize such TCM doctors as frauds and witch doctors—indeed, all TCM doctors as frauds and witch doctors.
I had a patient who was an executive at one of China's top-3 TV stations; near the end of her life she asked me for hospice care. I discussed with her the credit and blame of television in promoting TCM. Having fallen ill, she realized she had done many things wrong; she admitted that before her illness she had not strictly enough censored programs at the station, letting a flood of overblown TCM content reach large audiences. In fact, such publicity does TCM more harm than good: a few people profit while the whole profession is damaged. If TCM were factual, objective, and neutral rather than exaggerated and mystical, the public would actually reject it less.
TCM works, but its efficacy should not be exaggerated. Ancient TCM contains both treasures and dross; things that modern science has proven wrong should no longer be embraced. Many ideas and methods of modern science—evidence-based thinking and controlled clinical trials, for example—are greatly beneficial to TCM's development, to the precision of TCM diagnosis, and to reducing medical uncertainty. We should learn them and accept them. If we refuse to improve while society only rolls forward, never backward, then TCM will only continue its decline.