“最危险的时候”: TCM in its "Most Critical Hour"
There is an ongoing debate in the Western Chinese medical community regarding the distinctions between Ancient or Classical Chinese medicine and the modern system of TCM. Looking back, it is overwhelmingly clear how unaware of such discussions I was going into the Chinese educational system as a young and motivated student back in 2004. I simply felt that if you want to learn something, its always best to go to the source. And while I appreciate the incredible benefits I reaped living and studying in China for over ten years, I think it would have made for a much smoother experience had I known a bit more about what I was getting myself into. I originally composed the following post in 2008 for a blog that I maintained while still a student in Beijing. It speaks to many of the concerns surrounding Chinese medicine in the modern world in the words of one of its founding fathers, who observed his own contributions, and those of many other great practitioners, to the formation of a viable syncretic system slowly erode away due to uninformed top-down administration. In the many discussions on this topic over the years, I have insisted that the modern system was created with the best of intentions by many able practitioners faced with the impossible task of taking a traditional apprenticeship based system and transforming it into an academic one under intense political pressure; the problem has always been one of execution, sentiments I found reflected in Dr. Lü alarming letter…
Here is that original post:
Returning for my fouth year as an undergraduate student in the Department of Acupuncture and Tuina of the Beijing University of Traditional Chinese Medicine this past week, I have once again come face to face with the abysmal state of institutional TCM education here in modern China. Don't get me wrong - I am not sure that it is any better anywhere else in the world, as I know many curricula and textbooks are modeled after this very system. But after a summer spent working with several realized practitioners, it is both shocking and disappointing to see what TCM has been reduced to under the Chinese Ministry of Health's grand scheme for the 'Modernization of TCM'. In my opinion, this is nothing but an empty title used to conceal the true agenda, which is undoubtedly the subjugation of TCM to Western biomedical standards, that in all essence, has stripped away the spirit of one of the oldest extant systems of medicine and doomed one of the truly miraculous accomplishments of human culture to the dustbin of our collective future.
In an audacious letter to President Hu Jintao, Lü BinKui, one of the founders of the modern TCM curriculum, expressed his frustrations with the present condition of state oversight. He eloquently gives voice to the dismay that I have heard expressed in many circles (far removed from academia) here in China. As a veteran of Maoist era politics, a respected veteran of the Japanese War, and a renowned physician who has worked within the system his entire life, his letter lends a certain gravity to opinions that have hitherto seemed to fall on deaf ears. Below are some selections together with my translation.
对文物保护有整旧如旧、原汁原味的要求，这个要求，同样适用于中医药学。现今，卫生部等部委对中医药采取了以现代化的道路去改造它，要对中医药 进行创新，这将给中医药的原汁原味彻底破掉，这是个错误的路线。中医药学在现今，不存在创新的问题，而只有继承、发扬和提高之路。原因很简单，中医药学在 高等教育上已完全被西医化，继承都已经成为问题，如何去创新？
There is a duty in protecting our cultural heritage to maintain its original flavor and integrity that must be applied to Traditional Chinese Medicine. The present proposition of the Ministry of Health and its associated committees for the modernization of TCM and its alteration is a mistake in policy that has completely destroyed the integrity of our medical tradition. There is no such question of 'modernization' in the present state of TCM, there is only those of succession, implementation and improvement. The reason is quite simple. TCM has been completely Western medicalized under the modern educational system. Its very succession has already become a problem, let alone a question of 'modernization'.
由于中医药学在中国人心目中有着极其重要的地位，是中国人的民族感情的促发剂。当今，中国在世界的影响开始增大，在许多国家政府以及人民也开始承认和接纳中医...消 灭中医药学,这不光是广大中医药从业者所不能容忍的，一旦真相大白，全中国人民也是不能容忍的。故针对当今这种打着发展中医药学，中医现代化的旗号... 党中央及中央政府应当顺应中医药界以及中国人民的心声，采取有利于中医药自身发展的行政措施，即将中西医在行政上分开，各自独立管理.
Due to the paramount importance that TCM holds in the collective spirit of the Chinese people, it is truly an emotional catalyst for the people of this country. As China's influence continues to increase on the international scene and as the governments and peoples of many countries begin to recognize TCM, its extinction is something that is not only unacceptable to the extensive network of TCM practitioners, but is also unacceptable to the country as a whole. In developing TCM under the flag of 'modernization', the central Party and government should enact policies that are in touch with the TCM community as well as the voices of the Chinese people. This should include policies that will enable TCM to develop organically of its own accord, completely separating the government and administration of Western and Chinese medicines.
Some of Dr. Lü's ideas for solving the current crisis:
首先将中医药的教育权从教育部移交给新的中医药行政部门
First and foremost, the administration of TCM education is to be handed over from the Ministry of Education to a newly formed Ministry of TCM Administration.
确立中医药和西医药在行政上，医疗上，地位上的平等原则及法律，使它们在为人民治病上获得同等地位
Confirm the equal legal, medical and social standing of both Western and Chinese medicines as legitimate resources for the treatment of illness.
He continues with a provocative indictment of the current state of TCM, which he describes as “最危险的时候”, "its most critical hour":
在中医药学的教育上，西医化已成为事实，并且中医药学理论被否定，大学里培养出来的学生，已不会用中医的望闻问切方法来诊断疾病了，大多学生毕业后，根本不相信中医，可见中医药学在教育上已到了后继无人的境地了
The Western medicalization of the TCM educational system is already a reality with much of Chinese medical theory negated. Graduates of this system can no longer use the basic TCM diagnostic techniques of observing, listening, questioning and palpating. In fact, most students don't even believe in TCM, leading to a state where there is no-one to inherit the lineage of TCM.
贬低中医药学的学术地位，以及在中医药学教育上的随意性，使中医药学成为一部分人骗医的招牌。如有关部门举办的针灸学习班，时间只有1～3个月，就可以拿到盖有卫生部大章的结业证书，很多学员拿此在国外开起了诊所……，败坏了中医药学的名声
The lowering of standards and general indiscriminate nature of the TCM educational system has led to TCM being heralded as a group of con artists. Certain acupuncture courses require only 1-3 months of education in order to obtain a certificate of proficiency from the Ministry of Education. Many 'graduates' of such courses than use such a certificate to practice medicine abroad, tarnishing the reputation of TCM.
现今中医药学的管理权已被各大部委瓜分...造成中医药学在管理上多头而无序，并且大多部委全是不懂中医药学的人在管
The administrative power over TCM has already been divided among the larger branches of government, creating a problem of too many administrative heads with no order or structure. In the end, the majority are being managed by people who do not understand TCM.
《执业医师法》规定，必须有4年以上医学院校的学历者，方能参加资格考试，而中医药界大量的医师均没有这种学历，基本上是学徒出身，造成大量的中医师失去了行医资格
Medical licensing law mandates only candidates with at least four years of formal academic training in medicine may apply for the licensing examination. However, a large percentage of TCM practitioners have no such formal academic background having been instructed completely through apprenticeship, thus leading to a large number of TCM doctors with no license to legally practice medicine.
中医师临床用的自制药是每个中医师都必须掌握的技术，而对中医师自配药的限制，约束了中医师治病的手脚.
The clinical preparation of prescriptions is a basic skill that all TCM doctors are required to master. External limitations on these prescriptions handcuffs practitioners.
And on the letter continues at some length. You can find a full copy of the letter in the original Chinese here http://bbs.puretcm.com/viewthread.php?tid=756.
As a member of the Chinese medical community and a product of its educational system, I have confounded myself over these points for some time now. Like many others TCM practitioners, I believe that if Chinese medicine is to survive intact, it will take a considerable effort on behalf of the current younger generation to recognize a modern TCM education for what it is, and essentially, discard it in favor of something more substantial. One must question everything presented in the classroom, and seek answers in places often overlooked or discarded as too problematic. Like most everything in this era of quick-fixes, the modern TCM educational system offers us a simplified and standardized approach to questions that run much deeper than most students, or professors for that matter, are willing to go.
The situation, though, is not without hope. The whisperings of a domestic revival in the true arts of China are beginning to be heard. At the forefront of this movement are a host of seasoned veterans with knowledge to pass on as well as a handful of young practitioners who are delving deep into the Classics and proving them more relevant than ever to our modern pandemic of afflictions. The adoption of many Eastern philosophies of wellness in Western countries and its subsequent reimportation to Asia is also playing a role in clearing the dust from the storehouse of cultural know-how. Western students are bringing a much-needed injection of genuine interest and respect for these paths that makes them seem all the more valuable in the eyes of many Chinese.
This blog will be my own small contribution to the development of TCM in the modern era. It will chronicle some of the difficulties and triumphs as I forge ahead on my own path in the TCM world of mainland China. While entirely subject to my own prejudices and shortcomings, with any luck my opinions contained here will challenge textbook explanations, fill in some spaces in theoretical framework and practical application as well as provide a venue for discussion to further the natural arts of healing and understanding.
2008年八月廿四