It is apparent that, unlike Western medicine, Chinese medicine is based on thousands of years of accumulated experience (jingyan经验) and its clinical efficacy is substantiated by years of trial on the human body (ren ti jingyan). Thus, the theory of Chinese medicine is not based on the result of scientific research.
During the first half of the 20th century, Chinese medicine was politicized as a symbol of everything old and backward. It became the target of many reformers who rigorously campaigned for the abolition of Chinese medicine. In 1929 The Chinese National Board of Health passed a proposal by western-trained medical doctor Yu Yue (俞樾) 1879-1954 to abolish the practice of Chinese medicine. Dr. Yu Yue and a group of Western medicine sympathizers and reform-bent Chinese medicine practitioners used the concept of “jingyan” to attack the efficacy of Chinese medicine, saying that every possible step should be taken to modernize Chinese medicine. The events of 1929 gave rise to an idea that Chinese medicine was based on jingyan (experience).
Dr. Yu Yue started taking a critical stance towards Chinese medicine while studying Western medicine in Osaka, Japan. Subsequently he became an outspoken opponent of Chinese medicine, rejecting its theory and arguing that Chinese medicine is unscientific, unteachable and backward. His view point had significant influence on many reform-minded medical specialists such as Lu Yuan Lei陆渊雷 (1894-1955), Tan Cizhong (1897-1955), Yu Yun Xiu(余云岫), etc. Lu Yuan Lei was asked by the Chinese Institute of National Medicine (which was established by the KMT Kuomintang in 1931) to draft a proposal for sorting out Chinese medicine and pharmaceutical learning. Lu Yuan Lei postulated that there should be a crucial division between the Chinese medicine lilun (theory) and fanfa (method). According to Lu, the medical canons (Nei Jing, Yijing and Nanjing) belong to theory and the prescription of formulas (jingfang) and Chinese materia medica (bencao) belong to fangfa (method).This concept originated from Yu Yue’s jingyan-based characterization of Chinese medicine. Yu more than anyone else, articulated the notion that Chinese medicine was based completely on jingyan (experience).He repudiated the fundamental theoretical concepts of yinyang, the five elements, the twelve jing-mai etc. In his reply to the most frequently asked questions about Chinese medicine, Yu offered four possibilities: (1) the efficacy of Chinese medicinals; (2) Chinese doctors’ jingyan of prescribing herbal treatments; (3) spontaneous recovery; (4) the psychological effect of the doctors’ diagnosis and prediction. In regard to the curative effects of Chinese medicine, Yu asserted that “ theories and facts are two distinctly different things.” Paradoxically, every Chinese doctor knew that in practice, it was very difficult to separate jingyan (experience) from the Chinese medical theories. Instead of valorizing the subtlety of Chinese medicine, these reform-minded advocates regarded the Chinese medical theories as being incomprehensible.
During the Spring and Autumn period (770-476 BC), many Chinese practitioners already understood the toxicity of many poisonous herbs, and what is more, they understood that the dosage was critical, and if increased to a certain level, death would ensue. To cite an example, A Jin dynasty marquis wanted to poison a Wei noble man and he asked one of his physicians to perform the act. Paradoxically, the physician did not want to be seen as disobeying his lordship, and so he used the Zhen Du (鴆毒) which was a legendary bird with poisonous feathers, and he soaked its feathers in wine just below the lethal dosage and in this way spared the Wei nobleman’s life. This is an example of ancient understanding of toxicity. The “Shang Shu 尚书”, a historical text from the Spring and Autumn period, recorded that medicinals such as Wu Tou and Fu Zi used for the treatment of bi syndrome, may cause side effects such as headache, dizziness and numbness.
“Shen Nong Ben Cao” (300 BC- 200 AD) categorised a detailed technique for the combination of herbs such as mutual enhancement; mutual counteraction; mutual suppression, mutual antagonism, mutual incompatibility, mutual accentuation, etc, to guide practitioners when prescribing herbal formulas.
In 2006, Zhang Gong Yao (张功耀), a professor with the Chinese Central South University in Hunan launched an on-line petition calling for the removal of traditional Chinese medicine from China’s healthcare system. In rebuttal, the State Administration of Traditional Chinese Medicine (SATCM) said people who denied the historical achievements and scientific basis of Chinese medicine were clearly ignorant of history.
Zhang maintained that a lot of traditional Chinese culture was backward and should be abolished, and that included Chinese medicine and herbs. In his view, there were no major Chinese medicine breakthroughs in the treatment of disease and that TCM patterns such as “heart qi deficiency” or “kidney yin deficiency” could not be defined as diseases. What is more, he queried the diagnostic criteria for “heart qi deficiency” and “kidney yin deficiency”.
As for the issue of Chinese medicine targeting the root of disease, while Western medicine targets only the branch, he used the example of appendicitis, saying that in this case, the surgery of Western medicine actually treats the ‘root’, whereas Chinese medicine offers only herbal decoctions to ease pain and does not address the root problem. He quoted a statement by Lu Yuan Lei: “Chinese medicine in crisis comes from its own intrinsic failings and is not caused by any slogan to abolish it”.
This statement highlights the woeful plight of Chinese medicine under the TCM system in China, where it is a victim to management by individuals who often openly express deep-seated suspicions against the field that they are supposed to represent. TCM administrators rarely resort to traditional modalities when they become sick. TCM students regularly take antibiotics when contracting a cold – because it is more convenient and works faster. Doctors in TCM hospitals often prescribe Western medicine. In this environment, it goes without saying that Western medicine has gained the upper hand and reasserts its defining influence on Chinese medicine.
According to Dr. Zhou Le Ping (周乐平), the present predicament of Chinese Medicine can be seen in the fact that:
- From the early days of the Republic of China in 1912, there were 800,000 Chinese medicine practitioners. By 1949, this number had been gradually reduced to 500,000. At the current time, the surviving Chinese medical practitioners amount to a mere 300,000 with fewer than 30,000 Chinese medicine practitioners remaining who embrace and practice the traditional Chinese medicine philosophy.
- Based on figures from the World Health Organization (WHO), the current consumption of plant extract herbs world wide is worth approx 160 billion US dollars, with Japan consuming 80% and Korea 15%. China, the source of herbs, lags behind both Japan and Korea, with its consumption being a mere 3-5%. Last year, the total export of Chinese herbs amounted to 8 billion US dollars.
- The iconic Dr. Lu Bing Kui吕炳奎 said: “Nowadays, apart from a small number of hospitals in China that use Chinese medicine as a main stream modality for the treatment of patients, the majority of hospitals throughout China practise integrated Western and Chinese medicine, with the exception of the out-patients department where a small quantity of Chinese medicine is prescribed.
- In Chinese medicine education, the westernization of Chinese medicine training is the norm, with some of the traditional core subjects such as the major classics being replaced with Western biomedical subjects. The result is that many of the students enrolled in the doctorate degree of Chinese medicine are not even conversant with “Huang Di Nei Jing”. Deng Tie Tao 邓铁涛said: “The teaching curriculum of Chinese medicine has been extensively modified in order to incorporate more Western medicine subjects. Consequently, there has been a dilution of the teaching of the fundamentals of Chinese medicine. The result is that many students training in Chinese medicine have lost confidence in its efficacy”.
In direct contrast to the above, the Song (960-1279 AD) Imperial government contributed enormous official support to Chinese medicine by establishing the Great Medical Office (Taiyiju), prescribing medical curricula and examinations to regulate medical practice. This in turn elevated the status of Chinese medical practitioners, as well as being a shining and illustrious period for Chinese medicine, which can be largely attributed to the concern of the Song emperors about the level of medical practice and education.
Since the days of my studying Chinese medicine in the 80s, I have witnessed a severe erosion of traditional core values. This trend is somewhat encouraged by the Chinese government in the way it provides funding for TCM researches with the ultimate goal of producing data associated with Chinese medicine research which is acceptable to the West.
In 1994-95, the ministry of health published a plethora of official guidelines aimed at standardizing the process of researching the efficacy of new patent medicines. Because of these guidelines, research into Chinese medicine must be conducted according to the standards of Western pharmaceutical protocols. This means that the traditional system of differential diagnosis (bian zheng) has to be replaced by allopathic diagnostics (bian bing).
The irony of all this is that while in China, there is a movement to modernize Chinese medicine by adopting evidence-based medicine. However, on the contrary Chinese medicine practitioners in many overseas countries are embracing and promoting the core value of Chinese medicine by focusing on the experience of ancient masters.
A Call for the Renaissance of Classical Chinese Medicine:
The increasing decline in the depth of the teaching and practice of Chinese medicine during the 1990s brought about polarization and internal dissent. The policy makers in China would like to present a united front. Meanwhile, there is a group of concerned scholars and administrators who have petitioned government leaders and editors of TCM journals, calling for rectification in the future development and direction of Chinese medicine in order to preserve the unique characteristics of traditional practice. Personally, I find it very sad to see how the core essence of Chinese medicine has gradually been eroded on account of a group of so-called reformers who have been chanting the mantra of “modernization”. There is an old Chinese saying: “When seeking the longevity of a tree, one must safeguard its roots.”
My recommendation is as follows:
In order for Chinese medicine to move forward and reach its fullest potential, it is essential to acquire a deep understanding of the teachings transmitted in the classics.
To this end, there should be a reinstatement of the study of major classics in their entirety, and a reinforcement of traditional teaching.
In my opinion, Chinese medicine must not endeavour to gain legitimacy and recognition by conducting “scientific” tests that conform to the parameters of Western Medicine. Why should a medical tradition of 2000 years standing pander to the modern approach to medicine which has developed only in recent decades? Instead, it should embrace programs where the concept of the lab-oriented TCM doctorate is matched by a degree program that facilitates the transmission of traditional knowledge from “renowned Chinese practitioners” (ming lao zhongyi) to disciples (jicheng ren 继承人). These disciples can then ensure the continuity of the valuable knowledge born of ‘jingyan’ or experience, and passed on from master to disciple. To focus on the famous Chinese doctors’ jingyan will enable even Western-style doctors to take advantage of the “lao zhongyi’s jingyan” or “old doctors’ experience” without needing to actually “experience their experience”.
About Dr Greta Young Jie De
Greta Young Jie De is a registered Chinese Medicine practitioner with the Chinese Medicine Registration Board Australia, with a focus on the treatment of emotional disorders using Chinese medicine. She is an expert in the classic literature of Chinese… Read more »