Traditional Culture Is a Great Mountain Pressing Down on TCM

Ancient Chinese medicine originally arose from the practice of the working people; practice yields true knowledge. The therapeutic experience groped out in the course of practice was fairly reliable. Early medical classics were also very plain: a certain herb treats a certain disease, relieves a certain symptom—that was all, no gimmicks.

But, for better and for worse, ancient Chinese philosophy stuck its foot into medicine.

It was for the better because ancient philosophy was not entirely without merit for medicine. Ancient philosophy was itself built on naive materialism, so it played a certain role in promoting the development of TCM. Moreover, because most students of ancient Chinese philosophy were intellectuals of relatively outstanding intelligence and ability, their participation once gave a positive impetus to medical innovation.

It was for the worse, because once philosophy was used to interpret medical principles, ancient Chinese medicine drifted further and further from practice, eventually evolving into treating disease by deduction and reasoning rather than by practical experience. The talk grew more and more eloquent, yet the curative effect grew worse and worse. Moreover, many intellectuals or charlatans were arrogant and self-opinionated, valuing deduction over practice and believing that deduction and reasoning could solve every disease; in the end they developed TCM into an arrogant, self-important discipline.

Indeed, through deductive reasoning we can seemingly solve every problem in the world, but what is theoretically correct, when tested in practice, has only about a one-in-ten chance of being right. Unfortunately, not only the theorists but also a considerable portion of ordinary people believe that logical reasoning alone can cure their diseases. This is partly because ordinary people lack the ability to discriminate, and partly because, when people fall ill, they harbor hopeful expectations: they prefer to believe positive conclusions and instinctively reject dispiriting ones.

Over time, what had been deduced became a heavy mountain pressing on TCM's back, and it is not easy to dislodge, because it has so many believers. If we told loyal TCM fans that the theory of yin-yang and the five phases has done great harm, they would furiously denounce us as complete laymen slandering Chinese medicine. I often encounter such TCM fans, who think I am undermining TCM and breaking its rice bowl.

From ancient times to today, TCM has split into many schools. In essence, there are only two sharply divided factions: the practical school and the theoretical school. The practical school does not boast empty talk but values summarizing actual therapeutic experience; the theoretical school values deductive reasoning and stresses that "medicine is a matter of intuition." Compared with the theoretical school, the practical school speaks more objectively and conservatively, while the theoretical school gradually degenerates into abstract speculation, its talk floating high. In their view, there is no disease under heaven that cannot be cured; the famous line, "those who say a disease cannot be cured have not yet mastered the technique," comes from their mouths.

Physicians such as Zhang Zhongjing and Sun Simiao were outstanding representatives of the practical school. Although their works inevitably adopted some terminology of the theoretical school, we can clearly see from their writings how highly they valued practical experience, and they were also very sincere.

Zhang Zhongjing wrote in Treatise on Cold Damage (Shanghan Lun) that two-thirds of his clan died from cold damage (the plague epidemic in the Han dynasty); Zhang, who made medicine his profession, could do nothing to save them from their tragic deaths. Sun Simiao frankly admitted in Thousand-Gold Formula (Qianjin Fang): "Of those born under my hands, only one or two in ten [survive]; of those who die under my hands, seven or eight in ten."

But times changed. After their deaths, Zhang Zhongjing was revered as the "Medical Sage" and Sun Simiao as the "Medicine King." Later biographers shamelessly launched a deification campaign on their behalf.

For example, later biographers of Zhang Zhongjing claimed he predicted that Wang Can, one of the Seven Masters of the Jian'an era, would lose all his eyebrows at forty and die. The author has published an article textual-critically showing that Wang Can died in a great plague of the twenty-second year of Jian'an, rather than dying of "falling eyebrows" as Zhang's biographers boasted. This historical fact is recorded in the writings of contemporaries such as Cao Pi; readers may check for themselves.

Of course, this blame cannot be laid on Zhang Zhongjing. Zhang was a very sincere clinician; his Shanghan Lun and Jin Gui Yao Lue are of high clinical value, and he was not as mystical as later talkers of yin-yang and the five phases, let alone as absurd as today's TV experts who casually discourse on yin deficiency and yang deficiency.

Ordinary people are skilled at deification, and it was inevitable that admirable physicians like Zhang Zhongjing would be deified. Einstein spent his whole life detesting deification and did his utmost to avoid being regarded after death as an authority hindering science. But not long after his death—even while he was still alive—the deification campaign over him went into full swing. The public's love of deification is evident from this.

Any theory must pass the test of practice before it can be regarded as truth. Medicine is a discipline that particularly values practice; whether a treatment works has nothing to do with whether the theory sounds flawless. In the past, the ancients used traditional culture to interpret how TCM cures disease; in fact it was full of errors, yet it sounded very plausible.

For example, today we know that Artemisia annua treats malaria because the artemisinin it contains acts against the malaria parasite. But ancient TCM held that Artemisia annua is bitter and pungent in taste and cold in nature; because bitter-cold substances clear heat and drain fire, it has the effect of clearing heat and steaming effusion, and therefore can treat malaria. According to TCM theory, a disease like malaria involves cold-heat toxin; following the therapeutic principle set out in the Yellow Emperor's Inner Canon that "what is hot should be cooled," bitter, cold Artemisia annua that clears heat can be used.

Such explanations satisfied people's psychological needs in a given historical period, because everyone wants to know why a certain drug treats a disease; otherwise they dare not take it lightly—after all, every medicine is three parts poison. When someone sent medicine to Confucius, he said, "Qiu did not understand it, so I did not dare taste it." Confucius meant that, because he had not fathomed how the medicine cured, he did not dare try it lightly. This psychology of Confucius was extremely common among the public, so in the past many people truly needed a plausible explanation before daring to take medicine. To meet this psychological need of patients and families, medical and pharmaceutical authors have throughout history striven to work out how drugs cure disease, giving rise to various explanations.

These explanations had the limitations of their age. Seen today, many of TCM's traditional-culture-based explanations are wrong, and we should find more realistic explanations for how Chinese medicine works. Of course, our present-day explanations of how drugs work cannot be said to be entirely correct; perhaps our descendants will overturn our conclusions when new evidence appears. But regardless, we must, supported by evidence, deeply investigate the principles behind medical techniques. Why? Because under the guidance of unreliable theories we easily make mistakes. When doctors err, it harms not only patients but themselves as well; from antiquity to the present, medicine has been a high-risk profession. Did the miraculous physician Hua Tuo not, after all, die at the hands of his patient Cao Cao?

How can we tell which explanation is reliable and which is not? Through comparative research, letting the data speak. If treating disease is gambling, patients will of course prefer the option with the better odds. One of a physician's great tasks is to keep refining, constantly exploring more effective treatments and more reliable medical theories. And this exploration should be carried out in practice, not remain at the level of logical deduction.