This is a seminal piece that reveals shocking news to most Americans: that Traditional Chinese Medicine is NOT traditional, but a Maoist creation of the 1950’s. TCM is today distinguished from Classical Chinese Medicine, which would include the type of chi kung and alchemical healing taught by the Healing Tao community. TCM was carefully disemboweled of anything Taoist and spiritual, in order to put a modern scientific face on old China. This is a 1984 George Orwell scenario in which history books are suddenly re-written by the government. Most acupuncture schools don’t want this information disseminated, as it undercuts their raison d’etre. This is not to say that TCM has no value; it has simply lost its highest level of spiritual healing theory and practice. Not to worry, they are all still alive and well in the Healing Tao.
This article is based on the conviction that the traditional art of Oriental medicine is dying–both in mainland China, home to 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 epitomized narrative of the development of TCM, the medical system that has monopolized the practice of Oriental medicine in mainland China, and that has come to serve as the main mold 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 philosophical 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 reevaluation 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, standardized, 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. All of these concerns, however, are accompanied by the sincere hope that my findings on TCM politics in mainland China do not necessarily reflect the true state of Oriental medicine in the West, and that thus directed concerns are due to the limited quality of my own personal experience.
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 characterized 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 intial 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 skill level in the art, philosophy, and science of the traditional thought process that allowed them to break new ground by, for instance, categorizing 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 parameters 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 characterized by the through-and through hierarchically structured relationship 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 politicized 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 banishing the unruly gargoyle of Chinese medicine into a controlled existence that was subject to not only 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 before the backdrop of his Western science education, and always rumbled with the deep suspicion that its master harbored against the old system of medicine. Sun?s successor, Jiang Kai-shek, took this personal bias into the legislative arena and presented the radical proposal, A Case for the Abolishment of Old Medicine (feizhi jiuyi an).1 Although Jiang?s 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 Mao Zedong promulgated thoughts that were very similar to those of his nationalist adversary. In his Yan?an hideout, he wrote that old doctors, entertainers, snake oil salesmen, and street hawkers are all of the same sort.2 This brief line should have a truly devastating impact twenty-five years later when Mao?s works became the one and only source for the country’s definition of political truth. It served 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 hinterland thug 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 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 Western medicine 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 authorized 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 1959, the political motives of Mao?s actions fully revealed themselves when he published his decreeing vision about the concept of Chinese-Western medicine integration (zhong xi yi jiehe). This edict, 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 marxist-materialist ideology. Mao announced a nationwide search for 2,000 first rate Western medicine physicians who are to assist in the evolvement of Chinese medicine.3 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 standardized 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 memorization of scientific 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 deep-seated suspicions against 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, still and all, 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 recognized 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 standardized 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 institutionalized 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 realized 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 summarized 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 memorization 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 neutralize 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. In paraphrased terms, he said that medicine needs to be changed, it is unnecessary for any doctor to read so many books. Hua Tuo, Li Shizhen, and other traditional doctors did not spend much time studying, but learned their trade in a clinical environment. Most of our hospitals are in the city, while the heart of China is in the countryside. The focal point of medicine practice and medicine education thus needs to be directed toward rural areas.4
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 maxime 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 to Siberia–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, 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 informatics, 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.5 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 hasstarted 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, spirit and all, 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.