Value Real Results, Not Empty Talk—Preface to Reflections on TCM Cancer Research by Zhou Zhiyuan

Goethe called the "insight" of discussing art "able to enter, able to penetrate everywhere, able to go through." To penetrate everywhere is to be unbiassed; to go through is to be unobstructed; to enter and yet be able to exit, one may thus avoid being blinded by insight.

—Qian Zhongshu, Guan Zhui Bian (Limited Views)

The laws of the ancient kings were not followed because they were not worthy; they could not be taken as law. The laws of the ancient kings came down to us through the ages; some added to them and some diminished them—how could they be taken as law? Even had they not been added to or diminished, they still could not be taken as law. ... The scholars of the world are many and glib; their words are specious and convoluted, seeking not the truth but only to destroy one another, taking victory as their aim. How can the laws of the ancient kings be taken as law? Even if they could, they still ought not to be taken as law.

—Lü Buwei, Lü's Annals of Spring and Autumn

The idiom "losing a sheep by a forked road" describes TCM most aptly. Study TCM long enough, and you find its divergent views and self-contradictions number beyond count. Even within a single Huangdi Neijing (Yellow Emperor's Inner Canon) there is no shortage of self-contradictions.

Reading and studying medicine, one becomes muddled as one reads. The more widely one reads, the harder it is to choose. From ancient times to today, many TCM scholars have put forward many mutually contradictory academic views. It is like walking: ahead lies one fork after another, leaving one bewildered and at a loss.

Easterners have always had a tradition of valuing the past over the present. Professor Atul Gawande of Harvard Medical School is a renowned surgeon as well as a scholar of deep insight. He is of Indian descent; his father was a surgeon born in India who practiced in America.

In reflecting on Eastern culture, Professor Gawande holds that in the farming societies of the East, children had to inherit land from their fathers. This key economic factor determined that patriarchal authority wielded considerable power in our society.

So in Eastern agrarian societies, revering fathers and ancestors was a tradition rooted first in economic factors, which over time developed into a moral and cultural tradition.

I believe this view is basically correct. As Mr. Fei Xiaotong put it, China is a rural society; the values and morals of the rural world are the mainstay of traditional Chinese culture. When rumor is repeated enough times it becomes truth; when the force of public opinion is too great, people consciously or unconsciously choose superstition toward tradition.

Of course, every Chinese dynasty has had its reformers. But reform is always very hard, whether in social governance or in academia. Reformers must always brave the risk of incurring the condemnation of all under heaven and face the siege of conservative forces.

In the field of TCM too, reformers have appeared from time to time, injecting fresh blood into ancient TCM. But many TCM reformers have also faced the siege of conservative forces.

It is just that, compared with political and ideological reforms that could affect the stability of the regime, the backlash stirred by reform in the medical field is far milder.

Overall, I am a TCM supporter who advocates reform. With respect to many TCM basic theories that have hardened into dogma, I genuinely find it hard to agree, and even harder to obey.

I originally took up medicine because my mother and I ourselves suffered from chronic, unhealing illness. After my mother developed a cerebral hemorrhage and stomach cancer, I sought out famous doctors everywhere to treat her. I sought out every eminent doctor of both Chinese and Western medicine in these two fields that could be found. Because of medicine's limitations, many of her problems were never solved, and she finally died of the aftereffects of cancer and cerebral hemorrhage.

Some of my own health problems remain unsolved to this day, and I am still striving to find better ways to solve them.

These years, apart from seeking medical treatment, what I have done most is read the literature and study under masters everywhere. Some of my own firsthand experiences have made me lose faith in most TCM textbooks from ancient times to the present.

I doubt that, apart from passing exams, I will ever in my life treat the classics or textbooks of ancient and modern TCM as infallible authorities.

Take the herb Croton (badou), for instance. It has always been listed as absolutely contraindicated during pregnancy. Yet a certain TCM doctor I followed up with, whose family has treated obstetric disease for generations, uses Croton to treat infertility, and uses such herbs to prevent miscarriage when the placenta is unstable in a pregnant woman. Its efficacy surpasses that of any TCM or Western expert in treating obstetric and gynecological infertility that I know of.

The method my own father used to treat acute throat disease has, to date, never failed in a single case; and his treatment completely abandoned the inherited TCM pattern differentiation of the six meridians, the eight principles, the triple burner, and defense-qi-nutrient-blood.

The area I follow most closely is TCM anti-cancer therapy. Over the years I have followed up on nearly a hundred academic and folk practitioners whose patients reported anti-cancer effects, quietly observing their methods and actual results.

Among them are quite a few anti-cancer practitioners whose results are outstanding, yet whose treatment logic and herbs are utterly different from what the TCM classics and textbooks record.

I have followed up on many folk TCM doctors who use no more than thirty kinds of herbs in a lifetime, yet with these fewer than thirty Chinese herbs they treat the stubborn disease of cancer, and get real results.

Of course, such practitioners are often helpless when cancer patients develop complications; this is because the medical knowledge they have learned is too narrow.

But their clinical experience is extremely valuable. Compared with doctors whose theoretical foundations are deep but whose results on certain particular diseases are inferior, these practitioners are in truth more worthy of a patient's trust and entrusting. Their experience is also more worth unearthing.

In these years of medical practice I have no way back. A considerable number of my patients have placed their last hope in me; they neither will nor can allow me to give up on them.

Many times I have been dejected and discouraged by failure, but before I could collapse, their desperate cries for help pulled me back into the fight.

Breaking with convention, breaking with tradition, breaking with myself—each time, only through breaking through can I solve a tiny bit of a problem amid all the hardship.

Many TCM theories are flawless in themselves, but as soon as they are used to guide practice they fall apart, unable to solve a single practical problem.

A clinician's lifetime and a theorist's lifetime are utterly different. Those who focus on theoretical research need only rely on reasoning. But often, truth one step forward is error; the over-extension of theory can only produce metaphysics, and does not help solve practical problems.

Much of the literature in TCM, whether in explaining the pathology of disease or the nature of drugs, is far too arbitrary, because TCM holds that "the physician's intention is what matters." In the end it is riddled with errors and harms people badly.

Truly solving problems can only rely on practice. Only through countless acts of practice, summarizing experience and lessons, recording data, and improving again and again, can we find protocols with higher clinical efficacy.

I have in practice worked out some experiences in composing formulas, and some anti-cancer formulas that genuinely work. But even now I am still not satisfied with these experiences and formulas, because they have not yet solved the problems of many patients. Patients keep dying while under my care, and their deaths remind me that I must keep exploring forward.

Open the great dictionary of TCM formulas, and there are no fewer than a hundred thousand formulas across the dynasties, but few famous formulas have come down to us. A famous transmitted formula must be an effective formula that has withstood countless repeatable clinical trials.

Every famous transmitted formula is in fact the result of one doctor—or even several doctors—exhausting a lifetime of effort, and continuously refining it in clinical practice. Never was a famous formula created easily.

Some formulas and drugs require hundreds of refinements before they successfully treat a certain disease. In the early twentieth century, Paul Ehrlich, devoted to finding a treatment for syphilis, made a drug against the syphilis germ which he called 606, because he had mixed and tested 605 drugs before it without success. But he kept going until he found a way to solve the problem.

I believe that true medical discoveries are basically arrived at as Ehrlich's was—through constant failure, recording data, analyzing the causes of failure, seeking ways to improve, and gradually arriving at the answer—not through instant so-called "awakening."

If, with all the effort of my life, I can create one or a few formulas of outstanding efficacy, which can solve or relieve the suffering a certain disease brings to people, I will be fully satisfied.

Having studied medicine long, the goal I pursue grows ever smaller and more concrete. For the deeper one delves into the study of disease, the more one understands that human ability is so limited and disease so stubborn; that for a person to achieve even a little progress in treating a certain disease, exhausting a lifetime's effort, is already truly remarkable.

Much confuses; little attains. To study seeking breadth is also to court grandiosity, and in the end one accomplishes nothing. Only through deep accumulation and slow release may one achieve late maturity.

In the last half year, I revised the composition of one prescription nine times, constantly poring over libraries, checking the literature, and practicing clinically. To raise the efficacy a little and lower the side effects a little, I sat all day poring over materials. Occasionally I looked up at the window: my eyesight had declined, my neck had suffered, and my hands, dealing all day with toxic herbs, had grown increasingly rough.

I have worked at it with single-minded devotion, and have deep hopes for it. Along with me, the patients who walk with me seeking a way of salvation also have deep hopes for it. As long as life goes on, I will keep refining it—once every half month—until its effective rate satisfies me. But speaking of a satisfactory efficacy, how easily it comes.

The effort I have put in has not been wasted; this effort has clearly raised the effective rate of my clinical treatment. I will probably spend my whole life trying along this road. I hope, in a spirit of seeking truth rather than metaphysical talk, to organize my line of trial and the results of my trials into a book, for the reference of later generations—as a body of evidence-based material left for future patients and for doctors researching TCM anti-cancer therapy.

The theoretical part of this book is something I have distilled from reading and clinical practice from 1998 to now, elements that can form a unique theoretical system. This year I have basically thought it through to maturity; I feared that if I missed this moment of inspiration, writing would become hard later on. There are many things in life that, once missed, are gone for good; creation is the same.

This set of theory may be the foundation of my life's medical research. In this life I will strive to make TCM evidence-based. Under this guiding idea I will also create new, effective anti-cancer formulas. TCM treatment of cancer has no way out without innovative trials, because the repeatability of existing methods is too poor.

I believe there is no division between Chinese and Western medicine in the world; there is only one medicine, and that is evidence-based medicine. Ancient TCM was from the outset a model of evidence-based medicine; only in the long river of time it has accumulated too much mystical color, and someone must do the work of clearing the clouds to reveal the sun.

Efficacy is the life of TCM. Without efficacy, TCM becomes a laughingstock. The key to efficacy lies in the proficient mastery of drug-pattern, formula-pattern and disease-pattern correspondences; the fundamental skill of composing formulas lies in the accurate matching of disease-pattern with drug-pattern and formula-pattern. This is the soul of clinical TCM. It is a pity that, for a thousand years, bound by the tradition of revering the past, few have done such research. Most TCM doctors are bound by dogmatism, sunk in the rut of metaphysical talk, and find it hard to innovate.

I believe that restoring TCM's evidence-based character—valuing practice and clinical data analysis—can greatly raise the effective rate of treatment. Some of my own trials have proved this, and I will continue to explore and research under this guiding idea.

There is only one scientific spirit, and it is no different in Chinese and Western medicine. A person who does scientific exploration must have two basic qualities: first, anti-authoritarianism; second, anti-mysticism. Everyone who wears the veil of authoritarianism or mysticism is, intentionally or unintentionally, merely posturing.

This book records my logic of composing formulas, the pharmacology and toxicology of the possibly hundreds of herbs I use, and the various data from my clinical practice. I gather these into a book. Though somewhat presumptuous, I wish, not shrinking from my own meagerness, to form a school of my own. Even if it costs me heart's blood, I will not grudge it.

This book may well exhaust the effort of my lifetime, because such research ends only in death. But its theoretical foundation can be completed within the last year or two.

In this period I have made some sweeping changes, simply because I want to carve out large blocks of time from my daily schedule to finish this book and set up the framework of my medical theory.

In keeping with the principle of seeking truth from facts, for things I have clinically seen to be genuinely effective but cannot explain, I will only record them, without making idealistic explanations; the argumentation left unfinished I leave to later generations.

The principle behind some things cannot be clearly explained by our present scientific conditions.

Some TCM scholars, past and present, in order to make themselves consistent, have given a great deal of idealistic and laughable explanations. Seen now, these explanations have all become laughingstocks. When such laughingstocks pile up, TCM doctors of outstanding clinical efficacy become targets of universal blame. Is this not sad?

This is the preface.

Zhou Zhiyuan, April 12, 2019, aged forty.