Chinese Medicine in Crisis: Science, Politics and the Making of TCM (2)

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3) In the Name of Progress: The Introduction of "Superior Methodology," "Scientific Standards," and "Research Axioms" During the 1980s and 1990s

Another blow to the integrity of the traditional system, or what was left of it, occurred during the period of 1980-85. At this time, the concept of "Chinese medicine improvement by methodology research" (zhongyi fangfa lun yanjiu) was introduced. The political leaders of TCM colleges, i.e. the communist party secretaries who are generally more influential than the president, selected several fashionable theories of Western science and applied them to the domain of Chinese medicine -- once again motivated by the habituated resolve to "further evolve" the field. These endeavors were generally characterized by the attempt to sanctify the "scientific character" of selected aspects of Chinese medicine, and consequently, by denying scientific validity (and the ensuing right to be preserved and transmitted) to others. During the period in question, the theories elected for this purpose were cybernetics (kongzhi lun), system science (xitong lun), and information theory (xinxi lun).

The result of this "assistance" was the affirmation of the TCM system on theoretical grounds. The methodologists concluded that Chinese medicine classics such as the Yellow Emperor's Classic of Medicine (Huangdi Neijing) already contain evidence of these progressive theories in embryonic form, apparently recommending an affirmative stance toward the tradition of Chinese medicine. On the other hand, this position always implied that the classics were like dinosaurs -- interesting to look at in a museum, but, in terms of their pragmatic value in a contemporary environment, vastly inferior to the eloquent treatises of information theory, cybernetics, and other domains of modern science. As a result, many TCM colleges actually established museums, and many publishers dared again to issue reprint editions of classical texts. The original regard for the classics as the primary source of clinical information, however, dwindled as the presence of original texts in the curriculum became minimized. Again, it was a situation where a group of individuals with no traditional medical background attempted to "reform" Chinese medicine-motivated by ideological rather than clinical considerations. The 1990s, in the opinion of many of my more classically oriented teachers and myself, have seen the most severe erosion of traditional core values. I will cite the following reasons for this assessment:

Due to market driven priorities, none of the numerous TCM journals make an effort anymore to cover the philosophical foundations of Chinese medicine. The government, furthermore, provides no money for the traditional category of textual research (which had been a possible area of specialization for graduate students until 1988), and no graduate research projects are permissible that involve only Chinese medicine theory.
The new market economy obliges TCM hospitals to be profitable. The subject of profitability is intimately tied to a standardized fee structure that is based on an official ranking system -- which, in turn, is defined by Western medicine values, such as the quantity of modern diagnostic equipment and the amount of available beds. The hospitals thus devote a tremendous amount of effort to the acquisition and application of paraphernalia that will boost both their quality ranking and their diagnostic income. As one TCM physician put it, "little money is to be made by just feeling the pulse." This tendency is echoed in private street clinics, where doctors are encouraged, even required, by the herbal pharmacies that employ them to prescribe large amounts of preferably expensive herbs to maximize profits.
In 1994-95, the ministry of health published a host of official guidelines aimed at standardizing the mandatory process of researching the effect of new patent remedies.⁹ Along with the establishment of a Chinese FDA, it was decreed that the research of Chinese medicine patents must be conducted according to the standards of Western pharmaceutical research. Most consequentially, this meant that the traditional system of differential diagnosis (bianzheng) had to be completely replaced by allopathic diagnostics (bianbing). According to these guidelines, research on the constitutional multi-purpose remedy Four Frigid Extremities Powder (Sini San), for instance, must be conducted and marketed in the context of only one diagnostic category, i.e. "cholecystitis." Theoretical background research into the traditional rationale of a remedy is confined to 10% of the proposal, while disease oriented research has to account for 70%. Another point that mirrors the research protocol of Western medicine is the obligatory focus on laboratory animal research. This development has started to turn the broadly defined clinical science of Chinese medicine into a discipline that is dominated by the narrowly defined and, most importantly, completely disparate parameters of modern pharmacology. It finalizes the process of "evolution by integration" that Mao had originally prescribed for Chinese medicine 40 years ago -- a process that involves gutting the indigenous art of its spirit and essence, and subsequently appropriating its material hull (i.e. herbs and techniques) into the realm of a medicine that declares itself scientifically superior.
A new class of graduate students is developing who cannot diagnose in differential terms at all anymore, but are completely steeped in the allopathic system of medical terminology and diagnosis. Virtually all of the doctoral theses presently produced in China fall into the field of Chinese-Western integration research, or laboratory animal research related to the ratification of new patent remedies. Integrated standards for students of Chinese and Western medicine, moreover, have produced the grotesque situation where Chinese medicine researchers are required to utilize unwarranted equipment such as electron microscopes to achieve doctoral level approbation. In addition to the conceptual crisis outlined in this paper, the bastion of Chinese TCM is thus also facing a grave financial crisis. Most institutions simply cannot keep up with the steeply rising cost of the very narrowly defined type of research that the system prescribes.
Of an impressive sounding five years in the present bachelor curriculum, much is taken up by classes in foreign language, physical education, political studies, and computer training. By far the most extensive classes are dedicated to Western medicine contents such as anatomy, physiology, immunology, parasitology, and other topics that are unrelated to the diagnostic and therapeutic procedures of classical Chinese medicine. From both a quantitative and a qualitative perspective, therefore, it would not be entirely inappropriate to state in slightly dramatized terms that the Chinese medicine portion in the contemporary TCM curriculum has been reduced to the status of a peripheral supplement -- approximately 40% or less of the total amount of hours. This issue is compounded by the ongoing division of students into Western-style areas of specialization, such as acupuncture or bone disorders. None of the specialty students, including acupuncture department graduates, are required anymore to familiarize themselves with the realm of original teachings, not even in the radically abridged form of classical quotations that still serve to bestow an air of legitimacy on most official TCM textbooks.

4) Voices of Dissent: The Call for a Renaissance of Classical Chinese Medicine

Taoist Cauldron Similar to earlier waves of elder physician protest, the increasingly declining depth of teaching and practice modes during the 1990s brought about polarization and internal dissent. While policy makers were interested in the appearance of a united front, a group of concerned scholars and administrators wrote letters to government leaders and editors of TCM journals, and circulated critical memorandums at scholarly meetings. In a communique entitled "A Call to Correct the Developmental Direction of Chinese Medicine and to Preserve and Cultivate the Unique Characteristics of Our Field," Lu Bingkui, former director of the TCM section of the P.R.C. Ministry of Health, wrote in 1991:

In recent years, the unique characteristics of Chinese medicine, its advantages over Western medicine, and its standards of academic excellence have not been developed according to the wishes of the people, but have rather been tossed into a state of severe crisis and chaotic actions. Underneath the bright and cheap glitter at the surface, the essence and the characteristics of Chinese medicine are being metamorphosed and annihilated at a most perturbing rate. The primary expression of this crisis is the Westernization of all guiding principles and methodologies of Chinese medicine.¹⁰

Other notable members of this critical group were Cui Yueli (Ministry of Health), Fang Yaozhong (Chinese TCM Research Academy), Deng Tietao (Guangzhou University of TCM), Fu Jinghua (Chinese TCM Research Academy), Li Zhichong (Chinese TCM Association), and Zhu Guoben (National Ministry of TCM).

In 1997, the topic of the erosion of Chinese medicine integrity had become prevalent enough for a major publisher to bring these dissenting voices from the obscurity of back door communications to the fore by publishing them in a two volume set, entitled Pondering Core Issues of Chinese Medicine (Zhongyi Chensi Lu). Scholars of lower administrative rank, however, remained careful to voice their opinion in public. Advising me on the details of this essay in 1999, for instance, one of my Chinese mentors encouraged me to publish the facts of the century-long "TCM Crisis" abroad, while choosing to circulate the Chinese translation of the article among students and colleagues at his institutions only in unpublished form.

In recent years, however, the critical examination of the present TCM model has reached a level of unprecedented openness in China. In the year 2002, from the safe haven of a Hong Kong teaching position and backed by the preface of Deng Tietao, by now the most prominent sponsor of the classical essence movement, the scholar Li Zhichong published a volume of essay collections entitled Advocating the Renaissance of Chinese Medicine (Zhongyi Fuxing Lun). Featuring highly provocative section headings such as "Liberating Ourselves From the Century Old Straightjacket of Delusion in Chinese Medicine" or "Westernization -- the Mortal Wound of Chinese Medicine," these essays distinguish themselves not only by way of candor, but also by delineating clear guidelines for a renaissance of the classical science of Chinese medicine. Here is a sample of the new tone introduced by Li's book:

It is sad to see that because of several decades of wasted efforts and misguided energy, the core essence of Chinese medicine has virtually been lost by the ignorant people who, from the top of their lungs, have been chanting the mantra of 'modernization.' Even though the outer shell of Chinese medicine education is still there -- the tall buildings, the books and the students and the instructors, and the herbs that fill the markets in abundance -- the real science of our medicine, especially the true essence of our theoretical foundations has been lost almost in its entirety, or has become little more than an empty slogan. As an old Chinese saying goes, "When seeking the longevity of a tree one must safeguard its roots -- this 'root,' that is the theoretical foundation of our field. A 'flourishing' without root...is like an empty shell without hun or po."¹¹

During the following year, my colleague and friend Liu Lihong (Guangxi University of TCM) published his passionate plea for a return to the medical values delineated in the classics. Deeply motivated by his Buddhist ethics and the spiritual debt he felt he owed his teachers, he further articulated the newfound stance of the classicist reformer and has since emerged as China's most popular voice expressing the sense of cultural loss surrounding the traditional knowledge system of Chinese medicine as well as other time-honored arts and sciences. While Liu's publisher was originally doubtful to be able to sell the 2,000 copies of the first edition, his book has since experienced the printing of eight editions within one year. In addition, several Chinese medicine universities in China and the United States, including Guangzhou University of TCM and my own school, National College of Natural Medicine, have required their faculty members to read Contemplating Chinese Medicine. Here are two examples of the author's fervent style:

Let us be honest and examine what are the motivating factors for the average student to enter the field of Chinese medicine-primarily not reaching a high enough score during the university entrance exam to be accepted at good modern science colleges such as Qinghua University or Beijing University, or worse, not even making it into the average trade school. Out of the disappointed "oh, what to do now?" then comes the decision to enter Chinese medicine training. Is there anybody anywhere whose exam scores were good enough to go to Beijing or Qinghua but then chose to study Chinese medicine instead? I don't know of a single person! This is how most of our students come into the field nowadays -- without an ounce of positive motivation. How could someone like this ever become a master in our field?¹²

My recommendation is the following: if we really intend to move the profession of Chinese medicine forward and bring out its precious potential, we need to go beyond the status quo of memorizing the medical technicalities of TCM, and be open to becoming illuminated to the deeper layers of its scientific paradigms, its philosophy, and its art. This cannot be achieved without a deep understanding of the teachings transmitted in the classics.¹³

Liu's forthright approach has since met with approval in the leadership of his home province, Guangxi. In the fall of 2004, he received permission to start an educational research institute with the goal of inviting exceptional Chinese medicine elders ignored by the institutionalized TCM system to transmit their clinical knowledge to motivated disciples, many of them experienced physicians, doctoral level students, and practitioners returning from abroad. The first "resident elder" of the institute is Dr. Li Ke, a physician known for his successful track record of treating acute stages of heart attack, stroke, kidney failure, and other emergency disorders with Chinese herbs (administered through nasal tubes).¹⁴

See Classical Chinese Medicine vs Traditional Chinese Medicine

Notes:
1) This article, in shorter form, was first published in the October 1999 issue of the Journal of Chinese Medicine. I owe the inspiration for this essay, as well as much of the detail information contained in it, to my mentor Prof. Deng Zhongjia, Dean of the College of Medical Theory at Chengdu University of TCM.
2) Wa Zhiya, ed., Zhongguo Yixue Shi (A History of Chinese Medicine), Nanchang: Jiangxi Kexue Jishu, 1987, p. 278.
3) Wa Zhiya, ed., Zhongguo Yixue Shi (A History of Chinese Medicine), Beijing: Renmin Weisheng, 1991, p. 488.
4) Ibid., p. 489.
5) Wa Zhiya, 1987, p. 288.
6) Mao Zhuxi Yulu (Sayings by Chairman Mao), no editor, no publisher, p. 54.
7) See a series of articles published in 1958 in China's official newspaper, Renmin Ribao (The Peoples' Daily); i.e., "Dali kaizhan xiyi xuexi zhongyi yundong" (Let Us Give Strong Momentum to the Western Doctors Studying Chinese Medicine Movement). See Yu Zhenchu, Zhongguo Yixue Jianshi (A Brief History of Chinese Medical Science), Fuzhou: Fujian Kexue Jishu, 1983, p. 446.
8) Mao Zedong, "Dui weishengbu gongzuo de zhishi" (Instructions Regarding the Work of the Ministry of Public Health), in Ziliao Xuanbian (A Collection of Materials), no editor, no publisher, 1967, p. 312.
9) See the authoritative work in two volumes published by the Chinese Ministry of Health in 1994-95, Zhongyao Xinyao Linchuang Yanjiu Zhidao Yuanze (Guidelines for Clinical Research Pertaining to New TCM Remedies).
10) Cui Yueli, ed., Zhongyi Chensi Lu (Pondering Core Issues of Chinese Medicine), 2 vols., Beijing: Zhongyi Guji, 1997, vol.1, p.25.
11) Li Zhichong, Zhongyi fuxing lun (Advocating the Renaissance of Chinese Medicine), Beijing: Zhongguo Yiyao Keji, 2002, p.344.
12) Liu Lihong, Sikao Zhongyi (Contemplating Chinese Medicine), Guilin: Guangxi Shifan Daxue, 2003, p.40.
13) Ibid., p.34.
14) See Li Ke Lao Zhongyi Jiwei Zhongzheng Yinan Bing Jingyan Zhuanji (A Collection of Case Histories of Chinese Medicine Elder Dr. Li Ke's Treatments of Acute Emergency Disorders and Recalcitrant Diseases), Taiyuan: Shanxi Kexue Jishu, 2002.
15) The issue of respect for the Chinese scientific tradition as a stand-alone body of science -- and its demise at the hands of P.R.C. administrators -- was first introduced by the prolific work of Joseph Needham, and more recently, specified for the field of Chinese medicine by Manfred Porkert, Leon Hammer, and Bob Flaws. See Leon I. Hammer, "Duelling Needles: Reflections on the Politics of Medical Models," American Journal of Acupuncture (AJA), 19/3 (1991); Bob Flaws, "Thoughts on Acupuncture, Internal Medicine, and TCM in the West," Journal of Chinese Medicine, 38 (1992); Manfred Porkert, Chinese Medicine Debased, Phainon, 1997.
16) In an interview with the author at his Chengdu home on September 4, 1999.