SCIENCE, POLITICS, AND THE MAKING OF “TCM”

CHINESE MEDICINE
IN CRISIS
by Heiner Fruehauf

This article1 is based on the conviction that the traditionalart of Oriental medicine is dying - both in mainland China,home of the mother trunk of the field, and, consequently overseas where branches of the tree are trying to grow. It may be an anachronistic piece, written at a time when TCM administrators around the world are celebrating major advances in the field, such as increasing numbers of students, practitioners, patients, colleges, universities and hospitals, which all appear to reflect a booming state of Oriental medicine. But if we truly respect our tradition as a living organism and listen intently to the deeper layers of its pulse, it becomes evident that the original vitality of the system is expiring, although its true
condition may be obscured by a steroidal glow on the surface.
The following is primarily an epitomised narrative of the development of “TCM,” the medical system that has monopolised the practice of riental medicine in mainland China, and that has come to serve as the main could for the budding profession of Oriental medicine around the globe. It exposes a system that has been conditioned by a distinctly political agenda, and reveals its logo “TCM” (Traditional Chinese Medicine) as a grave misnomer - designating a medicine that is not at all aiming to preserve the traditional characteristics of Chinese medicine, but on the contrary, to expurgate, reform, and control the classical and folkloric texture of the traditional record in the name of progress. Between the
lines of this argument resides the warning that the progressive removal of the unique foundations of Chinese medicine is far more than just a hilosophical issue. It affects the heart of our medicine itself, namely the nature of the clinical encounter and the quality and the results of therapy. It greatly diminishes, moreover, the unique edge that the traditional science of Chinese medicine has over allopathic medicine and its various offshoots. Mine is thus an urgent call for a re-evaluation of the direction and the fundamental convictions that we set for ourselves as individual Oriental medicine practitioners.
Otherwise we may become thoroughly entrapped in the spiritless
mechanisms of state agencies, insurance companies, and most of all, our
modern mind that has been conditioned to fancy the unambiguous, standardised, packaged approach. It is admittedly an opinionated warning,
but a sincere and, I believe, reasonably informed one. From both my
own perspective and that of my most respected teachers in China (including high ranking administrators within the TCM system), modern
TCM in East and West is about to reach the “fall height” of the classical
tragedy - featuring the vainglorious protagonist luxuriating at lofty
heights (i.e. mainstream acceptance and doctoral level ratification), while
blindly cutting into the life supply line without having a clue of the consequences.
First Impact: The Modernization of China During the Late 19th and Early 20th Century The end of dynastic China marked a peak season for Chinese medicine. Although nearly every other aspect of society was in a state of collapse and disarray by the middle of the 19th century, the culture of traditional medicine was alive with the multihued color and texture of a 2,500 year-old art. There was the stimulating discourse between the newly founded fever school and the school of the neo-classicists, there were numerous scholar physicians publishing influential discourses, and there was the arcane realm of esoteric discipleship, alchemical experimentation, and the kaleidoscopic facets of folk wisdom that have always characterised the sensuous heart of the profession.
The advent of Western medicine presented the traditional healing tradition with its first major challenge from which it never completely recovered. It lost its rank as the one and only “medicine” (yixue) and became “Chinese
medicine” (zhongyi), defined in contrast to “Western medicine” (xiyi). Immediately, however, there developed an early brand of progressive physicians who did not lament this situation, but attempted to integrate some of the paraphernalia of modern medicine into the traditional system.
These pioneers are now collectively referred to as the Chinese- Western Integration School (zhong xi huitong pai).
Main representatives are Wang Qingren (1768-1831), Tang Zonghai (1851-1908), Zhang Xichun (1860-1933), and Zhang Shouyi (1873-1934). It is important to note that these initial “integrators,” often cited by TCM administrators as early visionaries of their own system of integrated medicine, were not proponents of the hierarchical superiority of Western
medicine, but rather tried to embody the traditional ideal of the broadly educated master physician. It was their erudite skills in the art, hilosophy and science of the traditional thought process that allowed them to break new ground by, for instance, categorising Western drugs in energetic terms, or by relating the Triple Warmer to certain anatomical tissues described by Western medicine. Although it was their declared goal to incorporate some of the useful mechanics (yong) of Western medicine into the traditional mother body (ti) of Chinese medicine, their arameters remained clearly “traditional at the core” - as the programmatic title of Zhang Xichun’s collected writings announces, Chinese at Heart But Western Where Appropriate: Essays Investigating An Integrated Form of Medicine (Yixue Zhong Zhong Can Xi Lu, 1933).
This day in which curious Chinese physicians could explore the phenomenon of Western medicine from an equal footing was soon eclipsed by a period characterised by the hierarchical structure which still defines the relationship between modern medicine and any traditional system of life science today. During the first half of the 20th century, a variety of events politicised Chinese medicine as the despicable symbol of everything old and backward. It became a pawn that reformers from all political camps sought to abolish. When this endeavor failed due to vehement
public protest, the new stewards of state settled for
forcing the unruly gargoyle of Chinese medicine into a
controlled existence that was subject not only to a rigorous
purge of diagnostic methods and therapeutic modalities,
but - most damaging to its integrity as a system in its own
right - the creeping replacement of its essential standards
with the “correct” parameters of modern science.
The political voice of Sun Yat-sen, the leader of the
Republican revolution that toppled the dynastic system in
1911, had been shaped against the backdrop of his Western
science education, and always rumbled with the deep suspicions
that its master harboured against the old system of
medicine. Later on, Kuomintang public health officials took
this personal bias into the legislative arena and presented
the radical proposal “A Case for the Abolishment of Old
Medicine to Thoroughly Eliminate Public Health Obstacles”
(feizhi jiuyi yi saochu yishi weisheng zhi zhangai an)2.
Authored by Yu Ai and Wang Qizhang, the proposition
aggressively infers that “the theories of yin and yang, the
five elemental phases, the six atmospheric influences, the
zang-fu systems, and the acupuncture channels are all
illusions that have no basis in reality” and warns that “old
medicine is still conning the people with its charlatan,
shamanic, and geomancing ways”3. The proposal, containing
three major clauses (severely restrict the practice of
Chinese medicine; prohibit Chinese medicine advertisements;
bar the establishment of Chinese medicine schools),
passed the first legislative session of the Central Ministry of
Public Health on February 26, 19294. Although the proposition
was not implemented due to thousands of protesting
doctors and patients who took their passionate disapproval
to the streets, the production of anti-traditional sentiment in
an official document had a tremendous impact on the
general mood of Chinese medicine practice during the
1930s and 1940s.
Around the same time, the outlawed “communist bandit”
(gongfei) Mao Zedong promulgated thoughts that
were very similar to those of his nationalist adversaries. In
1942 he instructed his guerilla government to uproot all
shamanic beliefs and superstitions in the Yan’an area and
establish model public health villages5. Around the same
time, he wrote that “old doctors, circus entertainers, snake
oil salesmen, and street hawkers are all of the same sort”6.
This brief line would have a truly devastating impact twentyfive
years later when Mao’s works became the one and only
source for the country’s definition of political truth. It was
quoted in millions of copies of red “Mao Bibles” (Mao Zhuxi
yulu), serving as the Red Guard’s main license for the
uncompromising persecution of the rich culture of traditional
medicine and its unique modes of practice, education,
and theoretical discourse.
In Servitude at Mao’s Court: Chinese Communism
and the Conception of TCM, 1953-1976
The years 1953-59 witnessed what appears like a remarkable
reversal of Mao’s earlier views on Chinese medicine.
Having graduated from the task of creating national respect
for the “communist bandit” who now donned the emperor’s
robes, he began to gradually advance his private ambition
of asserting leadership over the legion of budding
communist countries around the world. This objective required
the conception of a socialist model that distinguished
itself from the Russian paradigm of Marxist-Leninism by
incorporating the regional attributes of third world countries.
Chinese medicine fit well into this general scheme,
since it embodied a medicine that was “self-reliant,” “among
the people,” “native,” and “patriotic” - all slogans that had
been used to promote Mao’s unique brand of communism.
Mao sensed, furthermore, that China was beginning to
become overly dependent on the influx of Soviet goods and
expertise, especially in the areas of modern medical equipment
and pharmaceutics. The catastrophic famines and the
far-reaching collapse of infrastructure that followed the
Russian walkout in 1961 were to dramatically confirm his
premonitions.
It was for primarily political reasons, therefore, that Mao
began to publicly embrace Chinese medicine during the
mid-1950s. This was the time when he issued the famous
calligraphy that graces the front pages of so many TCM
publications: “zhongguo yiyao xue shi yige weida baoku,
yingdang nuli fajue jiayi tigao” (Chinese medicine is a
grand cache of knowledge that we should actively bring to
light and further evolve). In the wake of this apparently
new direction, two ministers of health, Wang Bing and He
Cheng, had to resign due to their exclusive loyalty to the
Western medical system that had made them trustworthy
candidates for the position in the first place. In 1956 premier
Zhou Enlai signed papers that authorised the immediate
establishment of the first four colleges of Chinese medicine,
namely Chengdu College of TCM, Beijing College of TCM,
Shanghai College of TCM and Guangzhou College of TCM,
followed by Nanjing College of TCM the following year. At
the same time, a group that was to become the influential
voice of the first generation of institutional TCM teachers -
all of them still trained under the pre-institutional model of
discipleship education - formed in Beijing. They are generally
referred to as the “five elders” (wu lao), including Qin
Bowei from Shanghai, Cheng Shenwu from Beijing, and
Ren Yingqiu, Li Chongren and Yu Daoji from Sichuan.
As if to set a good example for the new course that he had
outlined, Mao publicly ingested the traditional remedy Yin
Qiao San (Lonicera and Forsythia Powder) when he fell ill
during the historic announcement of the Great Leap Forward
at the Chengdu Conference in 1957. He restrained his
onetime prejudice against “snake oil salesmen” and allowed
Li Shizhi and Peng Luxiang, both first generation
elders of Chengdu College of TCM, to be present at his
bedside for an entire night.
In 1958, the political motives of Mao’s actions fully revealed
themselves when he issued his decreeing vision
about the concept of “Chinese-Western medicine integration”
(zhong xi yi jiehe)7. The integration movement, in
essence, mandated the establishment of “TCM” - a medical
system which restrains the “wildness” and the “feudal
elements” of the traditional art by taking it out of the hands
of its lineage holders and assigning it to the control of
modern science, one of the most trusted tools of marxistmaterialist
ideology. Mao announced a nationwide search
for “2,000 first rate Western medicine physicians who are to
assist in the evolvement of Chinese medicine.” Special
“Seminars for the Study of Chinese Medicine by Western
Medicine Physicians On Leave” (xiyi lizhi xuexi zhongyi
ban) were established, administering bite-size pieces of a
highly standardised extract of traditional knowledge over
a period of 1-2 years. Qualifying participants were required
to hold or exceed the “physician in chief” rank within the
Western medical system. Of 2,000 doctors who initially
entered into the program, only about 10% graduated. This
low success rate may in part be due to the fact that the study
of Chinese medicine, even in abridged form, involves the
memorisation of specific detail which all participants, including
the successful graduates, had previously been conditioned
to condemn as the nefarious byproduct of a social
system riddled with feudalist superstition. Nevertheless,
these Western doctors who participated in the “traditional
medicine reform” efforts of the years 1959-62 came to
provide the main pool for TCM administrative positions in
later years. Most top level TCM administrators of the 1980s
and 1990s are, in fact, Western medicine graduates of the
reform/integration seminars.
This situation is the primary reason for the woeful plight
of Chinese medicine under the TCM system - traditional
medicine in mainland China is managed by individuals
who for the most part, and often openly, entertain deepseated
suspicions of the field that they are supposed to
represent. In a radical sense, the history of TCM can be
described as the history of implementing anti-traditional
sentiments into the general atmosphere of Chinese medicine
education and practice. I personally know of very few
TCM administrators who resort to traditional modalities
when they become sick. TCM students and faculty, moreover,
regularly take antibiotics when contracting a cold -
“because it is more convenient and works faster and better.”
One of the shocking personal memories that I associate
with this topic is a conversation with the grandson of Li
Shizhi (the founding elder of Chengdu College of TCM who
once prescribed Yinqiao San to Mao Zedong) - himself a
TCM doctor, scholar, and administrator at the College
which is generally regarded as the “most traditional” among
TCM institutions in China - in which he expressed concern
about my enthusiasm for traditional herbology. He flatly
admonished me to curb my faith in the efficacy of Chinese
medicine. Many of my more classically oriented teachers,
therefore, cautiously asserted that Mao may have had good
intentions at the time, but that the “integration” project
marked the beginning of a process that ruined the true
nature of traditional medicine.
On the surface, however, this course of events gave a
boost to the status of Chinese medicine. The government
had encouraged individuals with scientific expert status to
immerse themselves in the subject of indigenous medicine
and foster the betterment of the field. Furthermore, for the
first time TCM departments were established in many city
hospitals. The actual result, though, was the genesis of a
situation in which the old, clinically experienced Chinese
medicine practitioners were barred from participating in
major league TCM. All of the doctors in charge were “Western
doctors with Chinese knowledge” (xi xue zhong) -
experts who styled their diagnosis entirely in Western
terms, but sporadically included some cookbook-style Chinese
medicine modalities in their approach. Distinguished
“folk” physicians, unable to practice privately under the
communist system, were accessible only in outpatient departments,
or occasionally summoned for a second opinion.
Many observers of this practice bitterly remark that if
a remedy prescribed by one of these elders resulted in a
cure, it was most likely that all the credit was given to the
Western modalities - even though it was their ineffectiveness
that had initiated the traditional consultation. Chinese
medicine, after all, was not recognised anymore as a clinical
science in its own right, and the traditional diagnostic
approach of bianzheng (diagnosis by synthesis of pulse,
tongue, and symptom profile) was progressively becoming
eclipsed by the standardised procedure of bianbing (diagnosis
by Western disease name).
In the aftermath of these events, the status of Western
medicine became dramatically elevated with regard to
institutionalised TCM education. Planned in 1961 and executed
in 1962, all TCM colleges adopted a curriculum
according to which incoming students first studied Western
medicine for 2 years, then Chinese medicine for 2 years,
and finally entered into an “integrated” clinical internship
for one year. The five elders immediately realised that this
educational setup was responsible for an increasing loss of
respect for the fundamental principles of Chinese medicine,
and composed a letter to the central government that summarised
their concerns. Although their protest led to an
abolishment of the new curriculum and ushered in a brief
revival of classical values - spawning a college program that
started out with three years of exclusive Chinese medicine
training, including the reading and memorisation of all
major classics in their entirety, as well as palpation of 10,000
pulses and inspection of 2,000 tongues - the exigencies of the
political sphere were soon to interfere in a most severe
manner again.
In 1966, Mao found himself locked in an internal power
struggle and unleashed the “Great Cultural Revolution” to
neutralise his antagonists. For ten years, all forms of higher
education came to a screeching halt. In the field of Chinese
medicine, only the entering class of 1963 was able to complete
a TCM curriculum that for the first time truly deserved the
label “traditional.” Since it was the main rallying cry of the
Cultural Revolution to eradicate every trace of feudalist
influence, all of the old master practitioners of Chinese medicine,
including the five elders, became subject to criticism,
ridicule, and in some instances public thrashing. As many
physicians frantically burned their stitch-bound volumes
and other old-fashioned belongings to avoid persecution,
and as others died from grief or physical abuse, much of the
physical legacy of Chinese medicine perished irretrievably.
In this vacuum, Western medicine reasserted its defining
influence on TCM, while itself having to adapt to a political
environment that despised erudite learning of any kind.
Already during the previous year, in a speech given to
health care professionals in Beijing on June 26 1965, Mao
had set the stage for the anti-intellectual direction of the
new medicine to come: “Medical education needs to be
reformed - it is completely unnecessary to engage in so
much studying. How many years of formal education, after
all, did Hua Tuo have? And how many Li Shizhen? There is
no need to restrict medical education to people with high
school diplomas, middle school and elementary school
pupils studying for three years will do. The real learning
will happen during actual practice. If this type of lowly
educated doctor is then sent to the countryside, he will
always be able to do a better job than the charlatan shamans;
and the peasants, moreover, will be able to afford such care.
Studying is a stupid endeavor for a doctor”8.
During the years 1966-1971 therefore, no new students
were admitted by any educational institution, including
schools of Chinese medicine. In 1972, so-called Colleges for
Workers, Peasants and Soldiers (gong nong bing xueyuan)
were established, offering three year vocational programs
under the maxim of “open door schooling.” This meant that
there were no entry exams; the admission of students was
entirely based on their political status as well as the social
background of their parents. Textbooks were filled with
quotes from Mao Zedong’s Collected Works. The doctors
produced by this system received a very rudimentary training
in both Chinese and Western modalities, and provided
the human resource for the well-known Barefoot Doctor
Movement (chijiao, yisheng, yundong). The barefoot doctors,
naturally, were never introduced to the essential concept
of differential diagnostics. Meanwhile, the generation
of Chinese medicine elders was either dead or locked up as
“bovine demons and snake-like goblins” (niugui sheshen)
in so called “ox stalls” (niupeng). Of the five elders, only
Ren Yingqiu was still alive. He was banished to Qinghai
Province, China’s equivalent of Siberia, and was allowed to
bring only one cherished book, Li Shizhen’s Outline of the
Materia Medica (Bencao Gangmu).
In the Name of Progress: The Introduction of
“Superior Methodology,” “Scientific Standards” &
“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 characterised by the attempt to sanctify the “scientific
character” of selected aspects of Chinese medicine,
and consequently deny scientific validity (and the ensuing
right to be preserved and transmitted) to other aspects.
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 minimised. 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:
a. 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.
b. The new market economy obliges TCM hospitals to be
profitable. The subject of profitability is intimately tied
to a standardised 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 number 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.
c. 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
remedies9. Along with the establishment of a Chinese
FDA, it was decreed that the research into 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.
d. A new class of graduate students is developing who
can no longer diagnose in differential terms at all, 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 utilise 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.
e. 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.
Perspectives On “TCM” and Classical Chinese
Medicine - A Comparative Outlook
It has been the main purpose of this article to characterise
the framework of “TCM,” a system which presently is the
standard model of Chinese medicine in mainland China,
and which increasingly influences the practice of Oriental
medicine in the West. By creating a record that makes
“TCM” transparent as a historically and politically conditioned
system that is fundamentally different from the
multifaceted traditions that constitute traditional Chinese
medicine, I have attempted to draw a base line that helps
individual practitioners, schools and agencies to determine
what their own position in this matter is. In this process, it
is not my point to denounce the phenomenon of “TCM.”
The trademark standardisation procedures of “TCM” are
perhaps the main reason that Chinese medicine is still alive
and thriving today, after a prolonged period in which
China and the rest of the modernising world was willing to
forsake everything in exchange for the power of Western
medicine. Its barefoot doctor approach, moreover, did save
many lives when expert healthcare was not available in the
Chinese countryside. It is my intention, however, to expose
the common practice of advertising the education and
clinical practice of “TCM” under traditional insignia that
suggest the transmission and application of an ancient
Eastern healthcare system that is based entirely on holistic
principles.
The general discourse on Oriental medicine in the West
appears to have reached the realm of the 10,000 details (i.e.
“what points work best for diabetes,” “how to treat headaches
with Chinese herbs”), while leaving the basic parameters
of its scientific approach unexplored. To help stimulate
a broader discussion on Chinese medicine methodology,
I have created a table that contrasts the characteristics
of “TCM” with those of traditional Chinese medicine - here
labeled “classical Chinese medicine” in order to distinguish
it more clearly from its modern cousin - as I and my
senior Chinese teachers describe it. This table is simply
meant to be a starting point, a tool that may help Oriental
medicine practitioners and institutions assess their mode
of teaching and practice. It may be incomplete and, due to
the nature of the black-and-white table format, overstate
some of the differences that set the two systems apart (see
Table).
With regard to the positions outlined in this table, most of
us will find that our own convictions and modes of practice
follow propositions that can be found on both sides of the
dividing line. In particular, it is my experience that Oriental
medicine practitioners in the West often proclaim to embrace
the principles stated on the left, while their modus
operandi in terms of diagnosis and treatment is much more
closely aligned with the attitudes outlined on the right -
much like Chinese officials used to aspire to the image of the
Daoist philosopher-poet in their private life, while adhering
to pragmatist Confucian values when acting in public.
Others, after surveying this table, might find that although
they were not aware of a “TCM issue” in the past, they
certainly like the premises of “TCM” better than the mystifying
conjectures of the classical path.
It is therefore not my goal to dignify the classical way(s)
of Oriental medicine and malign “TCM,” although it has
become clear in the course of this essay where my own
biases are. Neither do I suggest that any deviation from pre-
20thth century ways of diagnosis and treatment automatically
establishes the practice of “TCM.” The use of modern
equipment to measure electric resistance on acupuncture
points, for instance, perfectly adheres to traditional zangxiang
theory (“examine the surface to determine the hidden
factors inside”). The traditionalist school of Japanese Kanpo
medicine, on the other hand, with its unrelenting insistence
on the prescription of unmodified Shanghan Lun formulas
and its formulaic way of interpreting the zheng (symptom
picture) concept, shares many aspects of standardised
“TCM” as I have outlined it in this paper.
Due to the flexible and change-oriented nature of the
truly traditional approach, therefore, the term “classical”
does not mean to turn the clock back to the times of Zhang
Zhongjing or Sun Simiao, but rather to utilise the unchangeable
principles of the art and science of Chinese medicine to
assess, appreciate, and potentially incorporate new information
from all branches of knowledge.
Most of all, this article is yet another call for respecting the
art of Oriental medicine as a science in its own right10. In my
opinion, it is one of the most tragic problems of 20th century
Oriental medicine that it feels compelled to scour for legitimacy
by conducting “scientific” tests that conform to the
parameters of Western medicine. To illustrate the absurdity
that can spring from this situation, I would like to relate an
incident that I witnessed at the teaching hospital of the
Chengdu College of Traditional Chinese Medicine in 1990.
A famous doctor at the hospital was widely known for
prescribing a herbal remedy that appeared to be highly
effective in bringing about the speedy and painless delivery
of babies by first-time mothers. Expecting mothers sometimes
came to the hospital from as far as fifty miles away to
obtain a prescription. After two decades of consistently
positive feedback, a local pharmaceutical company decided
to produce his formula as a patent. Before “modernization”
had become an issue, the positive testimonies of
hundreds of patients would have sufficed to get the project
started, but now new codes demanded that direct action of
the herbal solution on the uterus must first be verified in a
laboratory setting. The lab director went through great pains
to exclude factors that could potentially effect the outcome of
the experiment. He put a female rabbit in a sterile incubator,
stabilised the temperature and light exposure, surgically
isolated the uterus and placed it outside of the rabbit’s abdomen,
and finally injected the herbal solution directly into the
carefully extrapolated organ. To the researcher’s surprise,
nothing happened, even when he repeated the experiment
with a number of other animals. In a second series of experiments,
he injected a variety of other substances into rabbit
uteri and, after observing that some of them induced contractions,
proclaimed that they were more suitable for mass
production. However, when the newly “discovered” herbs,
which in traditional pharmacopoeias are not at all related to
uterine effects, were tested on eager mothers by the old
obstetrician, they failed to produce any clinical results. Thoroughly
confused, the managers of the company decided to
withdraw from the project.
To me, this incident exemplified how the elaborate procedures
of reductionist science can project a highly distorted
picture of the reality of the human body, producing results
that are essentially non-scientific. The traditional doctor
and most of his colleagues seemed undisturbed by the
outcome of the experiment, since they adhered to a set of
entirely different scientific principles which demand verification
through non-sedated, intact people who deliver
babies in an uncontrolled real-life environment. According
to their reasoning, a) rabbits are different from humans, b)
human beings usually do not give birth in completely
controlled conditions with their own uterus hanging from
their bellies, and c) the remedy in question is designed to
work via the digestive process of metabolic transformation
rather than through direct injection into an isolated part of
the organism.
Does not the prolific depth of Chinese medicine present
a scientific approach that bears the power and the promise
to work the other way round? Do we always have to wait for
a related discovery in Western medicine before we sanctify
Qigong or other aspects of Chinese medicine that were
previously deemed “unscientific”? Could we not utilise so
far inexplicable Neijing concepts such as wuyun liuqi (cosmic
cycles) and ziwu liuzhu (chrono-acupuncture) to actively
inspire the nature and direction of modern scientific
experiments? As the profession of Oriental medicine is
stepping into maturity, it needs the inner respect for its own
wisdom, which no gloss of doctoral level ratification and
other marks of progress can deliver from the outside.
If we must look to China as a model, we should pay
attention to the fact that the main problem raised in this
article - the demise of traditional Chinese medicine under
the “TCM” system - has not gone unnoticed in the People’s
Republic itself. In recent years, for instance, the concept of
the lab-oriented TCM doctorate has been matched by a
degree program that systematically facilitates the succession
of traditional knowledge from “famous doctor” (ming
lao zhongyi) to “master disciple” (jicheng ren). Chengdu
University of TCM, moreover, has just launched an educational
pilot project for a segment of its incoming class that
is modelled after the 1963 curriculum - teaching the fundamental
concepts of Chinese medicine through the classics,
reading the major medical classics in their entirety, and
studying Western medicine only in a rudimentary fashion.
“If we don’t do this,” the program director Prof. Deng
Zhongjia says, “very soon there won’t be much left of
traditional Chinese medicine”11.

Table
CLASSICAL CHINESE MEDICINE
Based on naturalist philosophy (Daoism)
Alchemical (synthetic) approach: scientific endeavor defined as
acknowledgement and exploration of the complexity and multidimensionality
of nature and the body
• Based on traditional parameters of Daoist science (yin/yang,
wuxing, bagua, wuyun liuqi, jing-qi-shen, etc.)
• Views medicine as a branch of the Daoist mother sciences (HuangLao,
zhouyi, fengshui, etc.)
• Source oriented: reliance on tradition (experience)
Requires broad base of knowledge due to intimate relationship to
other traditional arts and sciences
Body is treated as a microcosm that follows macrocosmic laws and is
continually informed by macrocosmic influences (totality of cosmic/
calendric/ seasonal patterns created by conjunctions of sun, moon,
and stars)
Based on experience of human “subject” in environment of geocentric
universe
• Based on dualistic cosmology of becoming (process oriented world
view observing the continuous change of physical phenomena,
symbolised by the changing pattern of the moon)
• Impartial view of reality as continuous interplay between heaven
and earth, light and shadow, “demons” (gui: lunar influences) and
“spirits” (shen: solar influences), birth and death, male and female, yin
and yang
• Sexual” world view (life is product of ceaseless intercourse between
heaven and earth; human beings are principally sexual beings)
• Communicates through symbols which contain and correlate
multiple layers of meaning
• Preserves the lunar element of complexity and “obscuring” mystery
that defies exacting definition (wuwei maxim: “do not define categorically”)
Views body as field
(traditional zang/xiang theory: zang/fu are primarily viewed as functional
systems)
Body - mind - spirit medicine
Physician is intermediary to the sacred, cultivating the dual roles of
the shaman (master of intuited knowledge) and the sage (master of
scholarly knowledge), connecting above and below, inside and
outside, energy and matter
• Physician aspires to the Dao of medicine, a process which requires
the actualisation of his/her individual path by working to become a
self-realised being (zhenren)
• Major tools: qigong meditation, music, calligraphy, painting,
poetry, ritual journeys
• Highly individualised discipleship based training
• Teachers are individual “master” figures who emphasise the creation
of a lineage-inspired atmosphere/culture
• Transmission of “understanding” (may include qi transmission from
master to disciple)
Multi-directional memorisation:
Memorisation of classical texts that are interpreted situationally
according to individual circumstances
Health defined as the active process of refining body essences and
cultivating vital forces: concept of “nourishing life” (maximising
physiological functions)
Clinical diagnosis primarily based on “subjective” experience of the
senses
Clinical outcome primarily based on patient’s subjective feeling of
well-being and physician’s collation of sensory information (tongue,
pulse, etc.)
Highly individualised diagnosis: emphasises bianzheng (diagnosis by
symptom pattern)
Highly individualised treatment: favours flexible therapeutic approach
which freely chooses from a wide variety of modalities, and within
them, favors a flexible usage of prescription items
Use of wide range of clinical modalities, including the external application
of herbs to acupuncture points, umbilical therapy, qigong
exercises, waiqi emission, five-phase emotional therapy, alchemical
dietetics, ziwu liuzhu acupuncture, etc.
All-inclusive scope of practice (includes emergency medicine, bone
fractures, serious diseases such as cancer, etc.)
All encompassing training (may lead to clinical specialisation in a
traditional field, such as external medicine, if inspired by the clinical
expertise of a specific teacher)
Combination of Western and traditional modalities, if employed, is
performed according to Chinese medicine criteria (e.g. Zhang Xichun’s
method of energetically classifying aspirin and integrating it as an
alchemical ingredient into traditional formulas)

“TCM”
Based on pragmatist philosophy (Confucianism, scientific materialism,
communism)
Analytical approach: scientific endeavor defined as elimination of
complicating factors and unpredictable occurrences
• Primarily based on parameters of modern science (virus, inflammation,
blood pressure, etc.)
• Views medicine as a branch of modern science
• Branch oriented: reliance on progress (experiments)
Technical and highly specialised trade
Body is treated as an independent entity
Based on “objective” heliocentric world view
• Based on cosmology of being (concept of singular, meta-physical
truth, symbolised by fixed position of the sun)
• Confucian/materialist method of dividing heavenly and earthly
spheres and “rectifying the names” (zheng ming: convert the binary
symbols of lunar mythology into the immutable and one-sided terminology
of the solar perspective, and dignify an absolute position as
“right/good/ correct”)
• Monistic world view (human sphere is separate from heaven; human
beings are principally individuals); astrology, sexuality and ecstasy taboo
• Communicates through words and terms which refer to
narrowly defined contents
• Demystifies and demythologises the traditional record by
“illuminating” aspects of lunar ambivalence, and by creating
“clear and simple” textbook definitions (youwei maxim: “define
as firmly and precisely as possible”)
Views body as materiality
(influence of modern anatomy: zang/fu are primarily viewed as structural
organs)
Body - (mind) medicine
Physician is skilled technician who rectifies imbalances between
bodily humors and calibrates the structural composition of the body
(eliminate viruses, etc.)
• Physician is part of a legally defined profession with standardised
ethical standards
• Major tools: mandatory courses/tests on legal responsibility and
liability issues
• Highly standardised institutionalised training
• Teachers are assigned to standardised curriculum items, and thus in
principle exchangeable
• Transmission of cerebral knowledge through “words” and “terms”
Mono-directional memorisation:
Use of standardised textbooks that prepare for testing of knowledge in
multiple choice format; classics are placed in museum
Health defined as the absence of pathology
Clinical diagnosis primarily informed by “objective” instrumental data
(as provided by prior Western medicine diagnosis)
Clinical outcome primarily monitored through instrumental data (reduction
of viral load in blood, disappearance of lump on x-ray, etc.)
Standardised diagnosis: emphasises bianbing (diagnosis by disease
name)
Standardised treatment: favours fixed modalities (herbs or acupuncture),
and within them, promotes fixed herb regimens (patent medicines)
and fixed point recipes
Selective ratification of certain modalities that have a measurable effect
on the physical body and that can be explained from the perspective of
modern science, such as the internal administration of herbs and
ashixie acupuncture
Selective scope of practice (chosen areas in which modern studies have
shown an advantage of TCM over Western medicine, such as chronic
pain or allergies)
Progressive clinical specialisation according to the model of Western
medicine (acupuncture, internal medicine, external medicine, gynaecology,
paediatrics, tumours, cardiovascular diseases, digestive diseases,
etc.)
Combination of Western and traditional modalities is recommended in
most cases; combination follows Western medicine criteria (e.g. abdominal
surgery plus post-operative administration of herbs with antiadhesive
effect such as magnolia bark)



Notes
1 I owe the inspiration for this article, as well as much of the
detailed information contained in it, to my mentor Prof. Deng
Zhongjia, Dean of the College of Medical Theory at Chengdu
University of TCM. In it, I am trying to outline more than just
my own perception of the critical state of TCM education, and
to synthesise a chorus of important voices that is growing
louder and louder in the People's Republic of China itself. In
1997, for instance, the collated publication of a series of
openly critical articles, written by leading Chinese
administrators and scholars between 1985-95, projected the
TCM crisis topic from its hitherto “taboo” status. A sampling
of the reprinted titles, often first published under a
pseudonym or presented as speeches behind closed doors,
may convey a flavor of this steady underground chorus:
“Rectify the Developmental Direction of Chinese Medicine,
Protect and Foster the Uniqueness of Traditional Chinese
Medicine” (by Lu Bingkui, former director of the National
Ministry of TCM Administration); “Chinese Medicine is
Presently Faced by a Serious Crisis - My Urgent
Recommendation to the Responsible Party Leadership to
Address This Crisis” (Lu Bingkui); “On the Gradual
Abolishment of Chinese Medical Theory and the Belief Crisis
in Chinese Medicine” (Fu Jinghua, director of the National
TCM Research Academy), “Some Critical Thoughts on the
Modernisation of Chinese Medicine” (Li Zhichong, director of
the Chinese TCM Association). See Cui Yueli, ed., Zhongyi
Chensi Lu (Pondering Core Issues of Chinese Medicine),
Beijing, Zhongyi Guji, 1997.
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 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.
11 In an interview with the author at his Chengdu home on
September 4, 1999.
Heiner Fruehauf has researched topics related to East Asian civilisation
and Chinese medicine for 19 years. He has studied at the Universities
of Tubingen, Fudan, Hamburg, Chicago and Waseda, and holds a
Ph.D. from the Dept. of East Asian Languages and Civilisation at the
University of Chicago and a post-doctoral degree from Chengdu
University of TCM. During a five year sojourn in China, he studied
Chinese medicine both within the institutionalised TCM model, as
well as the traditional lineage system that continues to function outside
PRC government schools. He has published widely in the fields of
Chinese and Japanese culture, with a specific focus on the traditional
aspects of Chinese medicine. Presently he directs the Classical Chinese
Medicine Program at the National College of Naturopathic Medicine
in Portland, Oregon, and leads annual study tours on classical Chinese
medicine and qigong into the mountains of Western China. He can be
reached at heiner@teleport.com



“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 Westernisation
of all guiding principles and methodologies
of Chinese medicine.”
Lü Bingkui, former director of the PRC's Ministry of
TCM Administration, July 1991