Modern TCM: partly traditional, partly unique in history
Even today, TCM in China is still based upon the TCM classics. Thus it can be called "traditional" indeed. But in many aspects, the actual situation is totally different from the times of HUANGDI NEIJING, SHANGHANLUN, NANJING or BENCAO GANGMU. Let's just think about some basic differences:
- An environment of advanced biological knowledge: TCM was never practiced in a society where nearly everyone had a basic a medical knowledge different from TCM (and even anatomically and biologically more correct).
- TCM as a secondary system: TCM during most of its history was not a secondary medical system, but the only one.
- No longer dealing with life-threatening conditions. In ancient times, the doctor was only called in severe cases. Nowadays, the really severe diseases are treated by modern medicine, at least in the initial stage. Never before did TCM have such a shelter of another medical system which takes care of highly acute and life-threatening diseases.
- A different spectrum of diseases: Due to the new situation, TCM usually deals with a different spectrum of pathological conditions. As to acupuncture, these include pain syndromes, arthritis, head ache, allergies, neurological diseases including paralysis and hemiplegia, functional and psychosomatic conditions. Besides, TCM can be helpful in many chronic diseases, and it can ease the side effects of modern therapies, e.g. increasing appetite and wellness under chemotherapy or radiation therapy. If we want to make full use of TCM's actual possibilities, we have to start from this new situation.
- Modern anatomy entering TCM descriptions: Only after contact with modern anatomy, there are descriptions of acupoints speaking of arteries, veins, nerves, muscles, tendons or inner organs.
- No ear acupuncture before 1959: Before 1959, no one in China ever talked about "ear acupuncture" and Mr. Nogier's interesting (but still unproved) hypothesis of the ear representing the whole body.
- TCM taught at medical colleges or TCM universities: Never before 1949, nearly every medical practitioner had to pass several years of TCM college or TCM university.
- A nationwide TCM curriculum: Before 1949, there was never such a thing like a common TCM curriculum for the whole country.
- TCM practiced in hospitals and clinics: Never before in history did the vast majority of TCM practitioners work in hospitals and clinics. Never before there were written documentations open to the colleagues, or a working environment side to side with colleagues of modern medicine.
- Using disinfection and sterilization: Apart from castrations (which were done outside TCM tradition), there was never such a thing like disinfection or sterilization.
- Common supply of basic needs: Never before there was more or less the same supply of literature, herbs and instruments in the whole country.
- Permanent supply of fresh fruit and vegetables: Never in TCM history there was a national transport system supplying the whole country (or at least the cities) with fruit and vegetables from the south during all the four seasons.
- People well nourished: During most of China's history, the majority of the population (just like in Western countries as well) was scarcely nourished or under-nourished. Nowadays, people in the cities (as well as in the Western countries people) have enough to eat and even tend to obesity.
- TCM as "cultural heritage": Neither the HUANGDI NEIJING nor HUATUO or LI SHIZHEN would have thought that the medical system they described should stay forever unchanged because it was "cultural heritage".
Tradition and history. - There can be no "Tradition" without thorough research of history. Unfortunately, the most extensive history of Chinese medicine published for foreigners in China still is the "History of Chinese Medicine" by Wong&Wu (2. edition Shanghai 1936). This book contains many errors. But we still prefer it to recent books where every statement from the classics is considered as historical fact. This is not the attitude we need. We don't need a TCM history which is mainly an addition of names and publications. Nor do we need the attitude of praising TCM without admitting its actual limitations and its historical shortcomings.
What we need is a kind of history that asks what is fact and what is legend. We need a history which asks about the real situation of doctors, patients and medical knowledge at a given place and a given time. We need much more information about knowledge, resources, medical careers, income and everyday life of patients and doctors in former times.
So, who is willing to tell us more about the real TCM history? Not only the history of achievements, famous doctors and famous books, but also the history of problems, failures, mistakes, controversies and unsolved problems?
War and surgery. - As we said above: the interesting question is not what kind of surgery HUATUO did - but why, if he really did it, nobody tried to follow or re-invent it. As there were so many wars in ancient China, there must have been many wounded soldiers. The idea to amputate a crushed leg or to mend a superficially wounded belly must have been close at hand. There must be documents about wounded soldiers and how they were treated. We'd like to know more about this.
Which were the mistakes LI SHIZHEN corrected? - All TCM books confirm that LI SHIZHEN corrected many errors. But this statement is not sufficient. First, we'd like to know: Which were the aspects he corrected? Which were the books and authors whose scripts and thoughts contained so many mistakes? And how do we judge the fact that in 2000 years of China's written medical history nobody found these mistakes? Doesn't this fact make it probable that many more errors were not discovered either?
What if LI SHIZHEN had died young? - This is really an unpleasant thought: What if LI SHIZHEN had died young or chosen a different profession? Wouldn't this mean that all the mistakes he found would still be common opinion today?
We are afraid that this would have been the case, indeed. Or ist there any possibility that anyone else would have done this work? Or that modern TCM would have the courage to discuss errors as openly as LI SHIZHEN did? We have some doubts, but maybe someone else has a different oponion.
LU XUN's contempt for the old medicine. - If modern TCM would be as confident as it should be, it should be eager do deal with LU XUN's contempt for the old medicine, or GUO MORUO's position, when he was still without political job. Today's TCM specialists might prove that LU XUN was wrong at his time. Or they might admit that his contempt was justified at this time, but wrong today. They might prove that any speculative thoughts or obscure practices have been definitely excluded from modern TCM, and that they never will have the slightest chance to find any followers again.
Why don't they do this? Why don't they ever mention LU XUN's position in their books for us foreigners? Do they really believe we don't know? Or do they believe they can manage taking the bell by closing their own eyes and ears?
Or is possible that they don't mention LU XUN because in fact there are still obscure practices and speculative thoughts left in TCM?
Advertisement, Exaggeration, Cheating. - These aspects are closely related. Some TCM representatives give us the impression that they are merchants more than doctors or scientists, advertising health products, training courses or their own abilities. But once you start advertising there is a natural tendency to exaggerate, and from exaggeration it is not far away to cheating. We have been witness of a Beijing TCM professor who gave a speech stating that his institute had cured AIDS with TCM herbs, obtaining “Seroconversion”. We never heard of it again, so probably this was an exaggeration. But if this gentleman would have started to advertise his herb mixture it would have been cheating.
There have been a lot of “exaggerations” during the Cultural Revolution, for example the marvelous results of acupuncture anesthesia. The “Outline of Chinese Acupuncture” still told us that acupuncture could treat “Deaf-Mutism” - surely an exaggeration. But even recent books are full of announcements hard to believe, like curing malaria with acupuncture. Is this an “exaggeration”, too? But what if people believe it? Aren’t they “cheated” if they believe in an exaggeration? We think that all these books should be checked if there are more examples of such “exaggerations”.
Nowadays, there are many TV spots in China advertising health products. Most of them are clearly exaggerating, but to us many seem quite near to cheating. And this is the question: Does modern TCM have a sharp eye upon anyone trying to make use of the people’s belief in traditional medicine? Do the TCM professors stand up and warn people not to believe that some cheap copper ring might “balance their YIN and YANG”? Do they think it their duty to check the value of some electric device claiming to make an end to all pains? Do they check the reports of colleagues about wonderful successes in treating certain diseases? Do they protest in public when some clinic announces to cure cancer or AIDS?
Or does anyone suppose that this is none of their task? That everyone is responsible for himself, and that it serves him right if he falls for some cheater?
To treat and to cure. - Some TCM authors (as well as some dictionaries) don't know the difference between "treat" and "cure". ZHI can mean both: to treat a disease with a certain drug or method in the sense of just using it, or to cure a disease meaning it disappears und health is restored. The difference is important. You cannot cure cancer with acupuncture, but you can treat some of its aspects, for example nausea or the lack of appetite in case of chemotherapy. Still, many Chinese authors, when translating into English, prefer to speak of "cure". As a result, their books sound like collections of miracles. Each and every point or herb seem to be able to "cure" coronary heart disease, rheumatoid arthritis, hepatitis B, hypertension and so on. As none of these books give any information about how often these points or herbs are actually used in everyday clinic, they are nearly useless, at least concerning the needs of foreigners.
Plagiarism. - This is a common disease which TCM is definitely not able to cure, because so many Western and Chinese TCM authors suffer from it equally. Instead of thinking for themselves, they copy from other books without mentioning the source. This would be okay if the things copied were really checked and proved knowledge. But often they are not.
French authors copied an early error of Soulié der Morant stating that “Tonification and sedation points of each meridian are the most important acupoints”. German authors copied it from the French, and American authors from both, and even today this misunderstanding (derived from the “5 SHU-Points” and the concept of “Mother”- and “Son”-Points) has not yet totally disappeared.
Chinese authors copied Dr. Nogier’s theory of the auricle representing the human body without ever checking it in broad clinical studies. There were German authors copying from the Ceylonese Mr. Yayasuriya, who according to a local habit had made Du20-BAIHUI the most important of all acupoints. There was a Vietnamese Mr. Nguyen (called Van Nghi by the Westerners, which is like speaking of “William” when meaning Shakespeare) who misunderstood his Vietnamese translation of the HUANGDI NEIJING, claiming that “the LUO-Point of a Meridian has a connection to the YUAN-Point of the coupled Meridian” - and generations of German, French and American authors copied it. There was a German plagiarist who copied a book for Chinese barefoot doctors, including the advice that broken needles could be resharpened using sand-paper, and that used needles should be boiled in salted water for disinfection - but still putting himself on the book cover as “author”.
Chinese and Western authors copy the ancient pulse lore of different organs being felt at the CUN, GUAN and CHI position without mastering it themselves. Nowadays, Western authors try to copy as much as possible from Chinese books, using pen, scanner and PC instead of their brain. And Chinese authors, finding their own stuff in Western books, take this fact as a proof that their books must be precious. But we can tell them that this, again, is just an intercultural misunderstanding.
We think that this all this copying without thinking and checking is a shameful habit which should be criticized wherever it is found, in China as well as abroad.
What did Norman Bethune (BAI QIUEN) write to MAO ZEDONG? - When Chairman MAO held his speech at Norman Bethune's funeral, he mentioned that Bethune had written him "many letters", but he (MAO) hadn't had time to answer them. Have these letters been published? We should like to know more about them. What about the medical situation at this difficult time? How did TCM and modern medicine (which MAO, though criticizing the attitude of many modern doctors, thought to be "naturally superior" to the old medicine) cooperate?
Who decided the actual TCM curriculum? - For the development of modern TCM, the time after 1949 (or let’s say, after 1954) must have been quite thrilling. 15,000 ancient scripts about TCM had to be condensed into some twenty thick volumes. Who were the people who achieved this immense task? Which were their aims? Their criteria? Their biggest problems? Who decided which elements had to be taught in future times, and which ones not? Which were the most severe contradictions and controversies? There must be some documentation about these discussions. But where?
The "Outline" and the absence of TCM theory. - The first book published for foreigners in the People's Republic was the "Outline of Chinese Acupuncture" (Beijing 1975). Western TCM friends were eager to study it. To their surprise they didn't find much TCM theory there, apart from introducing the YIN-YANG concept. Maybe, someone can tell us about the discussions concerning this book, and about the different positions struggling with each other at that time.
Ancient TCM schools. - There have been several famous medical schools in TCM history, each of them propagating a different basic therapeutical principle, like "Reinforce the Spleen", "Promote YIN", and so on. What about the importance of such schools in present TCM? Which was their influence when the curriculum of modern TCM was created after 1949?
Why do we hear so little from the "Combined Chinese-Western Medicine" (ZHONGXIYI JIEHE)? - Concerning TCM in Western countries, our colleagues from the "Combined Chinese-Western Medicine" (ZHONGXIYI JIEHE) should have been the first to start teaching and working with the foreigners. However, it were the representatives of "traditional" TCM who started this cooperation. Not only the international training centers, but also the publications for foreigners were (and still are) nearly entirely dominated by the traditionalists.
Indeed, those teachers and authors gave us valuable knowledge and insights, so that we are glad to continue this cooperation. But we also hope to hear and read more from our "combined Chinese-Western" friends.
Income of TCM practitioners and Western-style doctors. - In 1955, the average income of a Western-style doctor was 4 to 10 times higher than that of a TCM practitioner. How did this relation develop in later years? What about the average income today?
TCM education, old and new. - The old TCM system of teaching was based upon the relationship between one teacher and usually one pupil, or sometimes several ones. After 1949, this system was changed into a school system, though for some time the two systems existed side by side. Who were the first professors of TCM? Who were the men and women who compiled the first TCM curriculum? Which controversies had to be settled? Was every TCM practitioner allowed to teach pupils? How could the health ministry make sure that the one-teacher-one-pupil system resulted in an equal standard of knowledge?
International Terminology: "Vessels" and "Meridians", "Conception Vessel", QI and "energy". - Naturally, Chinese TCM cannot be blamed for the international (mainly English) TCM terminology. Nevertheless, our Chinese friends should not think that this aspect has nothing to do with them. Nor should they accept things too passively.
Translating the JINGMAI as "Meridians" and QI as “energy” was introduced by George Soulié de Morant, who brought Chinese acupuncture to France after 1929. We have reasons to suppose that Soulié de Morant, who claimed to have worked as an acupuncturist in China, did not tell the truth then, but had no knowledge of acupuncture at all when he started writing about it. To make the system more convincing to Western readers, he spoke of QI as "energy" and of the SHIER JING as "Meridians". This is inadequate in several aspects, because a "meridian" is not a natural structure, but just an imagined straight line without material substance. But as the JING and LUO are neither straight nor without substance, this translation is clearly a wrong one.
Translating QI as "energy" seems convincing at first sight, because everyone and everything needs energy, and the consequences of an energy crisis are easily understood. Nevertheless, it is a wrong translation, because QI basically has been considered as a substance.
Nevertheless the WHO recommended the term “Meridian”, and the result is a complete confusion. TCM considers not only the JINGLUO as MAI (“vessels”, including JINGMAI and LUOMAI), but also the “QIJING BAMAI” (“extraordinary vessels”), with DUMAI and RENMAI being the most important ones. Now the WHO translates the 12 JINGMAI as “Meridians” and DUMAI and RENMAI as “vessels”, so that nobody knows what is meant or was meant unless he studies some Chinese.
Probably another result of a misunderstanding, it was again George Soulié de Morant who translated RENMAI as "Conception Vessel" ("Vaisseau de Conception"). We don’t find this meaning in our dictionaries. The REN character of RENMAI is explained as “carry, burden, duty” if pronounced in the second tone, and as “believe, trust, obey, duty, appoint” if pronounced in the fourth tone. There is another character with the same pronounciation but with the “woman” radical instead of the “man” radical, meaning “pregnancy” indeed, so probably Soulié de Morant confused these two characters.
However, even if the REN character of RENMAI would have a second meaning in the sense of “conception” it would be wrong to interpret it this way. Soulié de Morant apparently did not know that the body image of TCM was mainly based upon the male, which made it highly improbable that the name of a central vessel would be chosen according to the image of the female. Besides, RENMAI has to be seen corresponding to the DUMAI, both of them forming a logical couple. On the backside there is the Vessel of the ruling "Governor", on the front side the Vessel of the obeying and executing "Official". So, when the WHO suggested that the translation of RENMAI should be "Conception Vessel", this must have been without thorough discussion with Chinese TCM experts.
Now, the term starts being used in Chinese publications, like many other bad translations. We think that China should pay more attention to this question. More and more Chinese TCM books are published in English or bilingual, and using a wrong terminology is harmful to the further promotion of TCM abroad. So, China should cooperate more with those scientists whose opinion really counts (for example Nigel Wiseman, though we do not agree completely when he translates RENMAI as "Controlling Vessel").
There should be an international commission, revising the actual terminological chaos and defining a basic Chinese-English TCM terminology. And we doubt that the nameless WHO gentlemen really have the competence to do so. So, there is still the question: Which are the most adequate terms? Which Chinese concepts should stay without translation?
Is TCM "Culture"? - After the foundation of the People's Republic, for some years TCM tried to prove that it was basically "scientific", at least in the sense that it was willing to eliminate superstitious elements and to accept the modern body image. But very soon the "Western-style" doctors were considered politically unreliable, because they had studied either abroad or at foreign-run medical schools. For some years it was more important to be red than expert, and the TCM practitioners had the advantage that none of them had studied abroad or at foreign institutions. During the Cultural Revolution, modern doctors still were the Stinking Number Nine, whilst TCM practitioners were perfect examples of "trusting in one's own strength" (ZILI GENGSHENG). In times of DENG XIAOPING, experts and scientists regained their highly-honored status. But by now, Westerners had discovered TCM. These Westerners were scientists themselves, so what they wanted to find in TCM was not science but "holism", "age-old experience" and some of the magic their own medicine had lost among all its machinery and chemistry. Exporting herbs and running international TCM courses became big business. But making business is not a good starting point to discuss one's basic principles. The contempt for the old medicine shown by such eminent persons like LU XUN (and culminating in the GUOMINDANG edict from 1928 to forbid the old practices entirely) was never again discussed in public since WANG BIN was criticized in 1954 for his position concerning TCM. And after 1972, the admiration of the Westerners suffocated the necessary discussion about the spiritual (not the economic!) future of TCM.
We are afraid that labeling TCM as "cultural heritage" will be a further step to avoid this discussion. "Culture" is outside the categories "Right" and "Wrong". You may criticize Heavy Metal music being to loud, but you can't criticize Beijing Opera being too loud - that's culture. The Spanish defend bull fight as "cultural heritage". The Norwegians declare whale hunt as part of their "culture", and for the Italians catching birds flying from north to south and vice versa is "culture". Some African countries insist that the castration of young girls by cutting out the clitoris were part of their "culture". Wherever we meet the argument of "cultural heritage" it means that something cannot be attacked from outside, but only be improved from inside.
So, the question remains: Is TCM really something that cannot be criticized or developed from outside? Or is it common property of the whole world, like any other science or medical art?
Which parts of TCM are "medicine", which are "culture"? - Does the "cultural heritage" allow needles to be sterilized after use, which has never been done before in 4000 years' history? Is it "cultural heritage" to believe that turning a needle to the right means BU, whilst needling it to the left means XIE? Hasn't it been "cultural heritage" for many centuries that anyone who had read some medical scripts or knew some herbs could start treating patients? Is it an offence against "cultural heritage" if TCM doctors use stethoscope and thermometer and wrist watch to count the pulse strokes? Or if they measure blood pressure, check blood cells und urine chemistry?
So, what is "culture" and what is "medicine".
If TCM is more "culture" than "medicine" - which parts of it can Westerners study, master and use? Which parts not? And if we practice TCM in our countries - are we still medical doctors, or in fact "cultural transmitters"? To whom shall we teach TCM in our universities - medical students or the students of philosophy?