Joy....No Strings Attached

In a brief departure from the more objective, hard lines of the formal TCM theory of previous posts, I would like to share some recent insights into the more spiritual or psychological elements of the practice.

Critics of the tradition say that even if one recognizes the validity of TCM, its basic theoretical system has evolved very little in comparison with other forms of science and technology over the centuries. Therefore, it is hopelessly out of touch with the state of modern man and the high-paced lives we now live. And while I would counter that much like the underlying principles of nature itself, the tenants of existential truth remain constant in spite of the passage of time (as opposed to mere theory), this question is worth consideration in the ways that we apply TCM in the modern era.

This question of how TCM techniques need to be adapted to man, the modern animal, first arose in regards to the use of ShangHanLun prescriptions. Thanks to some fortuitous archeological discoveries over the last 20 years, particularly the uncovering of many medical treasures in the MaWangDui Catacombs, we now know the exact modern equivalents for common measurements of the Han dynasty. As a handful of enlightened practitioners nodded their heads in vindication, the collective jaw of the TCM world gaped in astonishment to learn that there is hard evidence to prove that one liang was equal to approximately 15 grams! By this standard the primary weapon of choice in ZhangZhongJing's herbal arsenal, GuiZhiTang, would call for a startling 45 grams of GuiZhi!

This type of a prescription represents a far cry from the slow and often subtle adjustments that TCM is widely known for in the modern day.
Each ShangHanLun prescription is designed to completely reorient the SanJiao Qi structure of the patient from a downward slide into illness back to the path of physical (and psychological) harmony. It is safe to assume that the diagnostic confidence of the caregiver to calmly proceed and "smack his patient upside the head with a slightly blunted axe" as one ShangHan expert so eloquently described it, had to be nothing short of absolute (which is also why it comes as no surprise that such a large portion of the ShangHanLun is devoted to correcting misdiagnoses). In other words, this type of medical practice demanded an extreme level of clarity not only on behalf of the practitioner, but also on behalf of the patient.

Yes, the patient. Contemplation of the larger signifcance of the ShangHanLun suggests that people of this era were also incredibly "clear" in the way they got ill, and by means of logical extension, very "clear" in the way they lived. By this I mean that they are free from much of the psychological muddle, and resulting physical degeneration, that we of the modern world tend to suffer from. Most of which, ironically enough, is of our own design. I am by no means saying that their lives were stress free. However, they stressed over simple matters of great importance and, in contrast to our own lives, largely out of their own control. Thus, in order to appease the external powers that be as well as the anxiety within their own hearts, cultures developed devotional practice. The simple act of prayer in whatever form is an opportunity for the individual to understand what is most important to them and in turn to give voice to these emotions in a straight-forward, well-defined manner. If you have traveled extensively in under-developed rural areas of the world and experienced this "refreshing simplicity" or "joy of poverty" first hand, you probably know exactly what I am talking about.

In contrast, a vast majority of modern men and women lead "lives of quiet desperation", to borrow Therau's insightful observation of his city-dwelling contemporaries. Our lives today are characterized by an on-going internal dialogue often over matters that in the larger scheme of things, are of little import. This continual "mental chatter" from which so many of us seem unable to escape has a profound impact on our health over time. According to NeiJing theory, the spleen is the domain of the 意 yi, or intention. This intention is the directed application of the 志 zhi, or the unfocused primal will of the human system that resides within the shadowy confines of the kidney system. In addition to its physical transformative function in directing digestion and assimilation of food, the spleen also works on a psychological level as well, drawing out the will from the recesses of the kidney system and transforming it into conscious thought. This is the meaning behind the spleen's associated emotional state of 思 si, or contemplation.

This type of contemplation is often synonymous with 忧 you in the Chinese language, a character that can be translated as worry or anxiety, a problem Western culture is only too familiar with. We often liken this unfettered mental wandering, or anxiety, to a "mental haze", a metaphor I find quite interesting in its proximity to TCM theory. Overly taxing the transformative properties of the spleen through excessive contemplation, leads to spleen yang deficiency, and in turn, qi stagnation and the rise of 湿 shi, or dampness, in the middle burner. In other words, haze.

This connection between anxiety, or stress, and symptoms of spleen deficiency such as lack of appetite, lethargy, irregular bowel movements, hyperactive dreaming, etc. is something that we can all attest to through personal experience. It is one of the most important factors in determining the general state of deficiency that most modern people find themselves living in today. While our material standards of health have improved greatly, the complications of modern life leave many of us in need of a vacation from our own minds. And to return to the original thread of this post and the applications of TCM in the modern era, I would therefore propose that the lack of clarity in the way many of us now live, and consequently, the way in which we become ill, requires a more subtle application of techniques such as ShangHan prescriptions. An initial strong blow from the herbal hatchet should be followed by some exacting scalpel work in order to clear accumulated "junk" within the energetic system.
And while Fuzi and GanJiang go a long way to helping patients find relief from symptoms, unless the underlying psychological cause of anxiety is resolved, a true cure is very difficult to attain. Thus, the theory espoused by most TCM texts that illnesses associated with dampness are prone to chronic relapse.

It is therefore, vitally essential that a patient become involved in the healing process through the creation of what I refer to as "joy with no strings attached". This is the simple ability to create and maintain a feeling of pure joy in our daily lives independent of external conditions. We all know and have experienced this state of mind briefly from time to time, when, suddenly, we are confident and relaxed, unattached to the outcome of whatever the situation we find ourselves in, and for a fleeting moment, the worries of life seem to melt away into a feeling of pure calm. Then, without warning, it is gone and we find ourselves trying to recreate it through memory, recounting it to our friends and loved ones. And in doing so, only succeed in putting more and more distance between us and that moment of happiness.

The problem then, is how to create this feeling with any regularity in our daily lives, a question that I believe is a uniquely individual one that lies at the very heart of the healing process. Our role as practitioners is to encourage and foster this process, to stimulate the 君火 junhuo, of the heart system such that the spirit may flourish. If we liken this process of contemplation as an opening of the energetic system, through which mental and physical energy is slowly bled out into the world at large, then psychological sustainability requires a counterbalancing process of closing, or as Sogyal Rinpoche says in The Tibetan Book of Living and Dying, one of "welcoming the mind home". When the mind is absent and at rest such as when we sleep, meditate, or become fully engrossed in physical exercise, the intention is directed inwardly, thus activating the post-natal power of the stomach/spleen system to replenish kidney essence, rather than constantly depleting it. Just like the circular energy dynamics of the natural world, we too must complete the circle of energy flow in our everyday lives or risk suffering the consequences of one-way living.

二零零八年九月廿一

Essentials of Qi Dynamics: Part 1


In preparation for forthcoming translations from Peng ZiYi's The Circular Dynamics of Ancient Chinese Medicine, I would first like to 'get down on paper' some key aspects of classical Chinese thought that have been relegated to the fringes of modern TCM education. Considering that the ancient world view of the Chinese lies at the very heart of the conceptual framework of TCM, I believe it is worth re-examining some concepts that are familiar to most of us, through the lens of traditional qi dynamics.

In the opening lines of his chapter on TCM theory, Peng writes:
“欲学中医须先认识十二经名词的所以然。欲认识名词,须先认识阴阳五行六气的所以然,欲认识阴阳五行六气,须先认识二十四节气地面上所受太阳射到的热降沉升浮中的圆运动。”
-Those who would like to study Chinese medicine must first understand the reasoning for the names of the 12 meridians; in order to understand the names of the 12 meridians, one must first understand the concepts of Yin/Yang, Wu Xing, and Liu Qi; and in order to understand these concepts of Yin/Yang, Wu Xing, and Liu Qi, one must first understand the concept of the 24 jieqi and the circular movement of the sun's energy as it strikes the earth, the point which corresponds to "center", and descends, sinks, rises and floats.

Seeing these words on page 1 of the text, I knew this book was going to fundamentally change my understanding of TCM as I recalled my 'Basic TCM Theory' instructor's offhand dismissal of my question regarding the names of the meridians as essentially "insignificant" several years earlier. And here is Peng ZiYi placing this very question in the opening lines of his book, stressing its tantamount importance!


Let us then begin with this question of the 24 jieqi, or "24 qi periods" of the traditional Chinese calendar. This is the earliest meaning of the character qi, simply a period of 15 days. Based upon the subtle characteristics of each season, beginning with Spring, the year is broken down as follows: 立春LiChun (Beginning of Spring), 雨水YuShui, 惊蛰JingZhe, 春分ChunFen (Mid-Spring),清明QingMing,谷雨GuYu,立夏LiXia (Beginning of Summer),小满XiaoMan,芒种MangZhong,夏至XiaZhi (Summer Solstice),小暑XiaoShu,大暑DaShu,立秋LiQiu (Beginning of Autumn),处暑ChuShu,白露BaiLu,秋分QiuFen (Mid-Autumn),寒露HanLu,霜降ShuangJiang,立冬LiDong (Beginning of Winter),小雪XiaoXue,大雪DaXue,冬至DongZhi (Winter Solstice),小寒XiaoHan,大寒DaHan

Each season has its associated direction and dynamic motion. In keeping with the above image of the sun's energy reaching the earth, we can follow the cycle of energy through the four seasons. The warmth of the summer sun reaches the surface, a point in three dimensional space we will refer to as "center", and during Autumn is absorbed into the earth in an action known as "descending". This energy continues to descend into the earth, where it meets with water deep within the ground and is stored as potential energy during Winter through an action known as "sinking/condensing". As Spring approaches, energy begins to rise toward the surface in an action known as "ascending". It eventually reaches the earth's surface and is returned to the Summer sky in a movement known as "floating". This process is represented in the illustration above.

Each motion is associated with a season as well as a direction. The Winter Solstice lies at true North and represents the transition from sinking to ascending. Ascending continues to grow in strength until its climax at LiChun waning as it approaches Mid-Spring, where it transitions to floating, and so on through the cycle. It is important to remember that this cycle traces the movement of the sun's heat, or in other words, YangQi, through its annual progession. Therefore, at Mid-Autumn and Mid-Spring, the amount of heat above and below the surface are relatively equal, while the Summer and Winter Solstices represent the apex of heat both above and below respectively. Peng informs us that this central dividing line on the human body is 2 cun above the belly button, or XiaWanXue(RN10).

The last 2 lines of this section are particularly worth noting. He states:
"热性本来升浮,不能降沉,热之降沉,秋气收敛之力降沉之也。热降,为生物有生之始,热不降,为生物致死之因。"
-Heat naturally ascends and floats and cannot descend and sink of its own. Therefore, the descending and sinking motion of heat depends upon the gathering power of Autumn
qi. Descending heat is the basis for all life; if heat does not descend, the organism will die.

This line of thought leads directly to a fundamentally different understanding of
Yin/Yang and WuXing theory. The left half of this diagram represents the process of Yang as heat stored dormant beneath the ground begins to move and ascend; the right half, the process of yin, where heat that has reached its apex of motion begins to slow and descend. This also corrects the common misunderstanding of WuXing. Often translated as "five elements", as we see from this diagram, the character 行 xing refers to the dynamic properties of each element, and so may be better translated as "five motions".

Though seemingly very abstract, returning this concept of motion to TCM is crucial to eventually understanding the clinical applications of various herbs and acupuncture techniques. This is an analogy that can be directly applied to the understanding of the human system. Each of the five organ systems has its associated action. Illness is thus a manifestation of the breakdown in this dynamic model. Treatment is simply a matter of identifying the breakdown in movement and applying proper therapy to restore it to an even, harmonious state. We must break free from the Western notion of medical materialism and begin to envision TCM as an energetic science that places the human system within this larger natural context.


More on
qi dynamics and the theories of Peng ZiYi to follow.

二零零八年九月初八 ・ 寒露

Zheng QinAn's "Exposition on the Nature of 'ShangHan'"

From ZhengQinAn's Collected Works

Chapter entitled "伤寒溯源解", or "Exposition on the Nature of 'ShangHan'"
Note: The two characters 伤寒 from the title of the classic work by Zhang ZhongJing can be literally translated as "damage or injury" and "cold", a concept that Zheng QinAn broadens to explain the physiological breakdown in energy flow through the invasion of a pathogenic factor, as we will see below. This is radically different from the way it is commonly rendered in English as referring to the resulting "febrile disease"

仲景为医林之祖,著《伤寒》一书,以开波世津梁,提出三阳三阴,包含乾坤二气之妙,后贤始有步趋。注家日多,纷纷聚讼,舍本逐末,以至于今,故读《伤寒》书 者寡矣,亦并不知伤寒何所取义也。即注伤寒者,亦只是照原文敷衍几句,并未道及伤寒宗旨,与万病不出伤寒宗旨,教后人何由得入仲景之门,余特直解之。夫曰 伤寒者,邪伤于寒水之经也,太阳为三阳三阴之首,居于寒水之地,其卦为坎,坎中一阳,即人身立极真种子,至尊无二,故称之曰太阳,如天之日 也。太阳从水中而出,子时一阳发动,真机运行,自下而上,自内而外,散水精之气于周身,无时无刻无息不运行也。故《经》云:"膀胱者州都之官,津液藏焉, 气化则能出焉。"气化二字,乃伤寒书一部的真机。要知气化行于外,从皮肤毛窍而出水气,气化行于内,从溺管而出水气。外出者,轻清之气,如天之雾露也;内 出者,重浊之气,如沟XX之流水也。

太阳之气化无乘,一切外邪,无由得入,太阳之气化偶衰,无论何节何侯中不正之气干之,必先从毛窍而 入,闭其太阳运行外出之气机,而太阳之经证即作,故曰伤寒。今人只知冬月为伤寒,不知一年三百六十日,日日皆有伤寒。太阳为六经之首,初为外邪所侵,邪尚 未盛,正未大衰,此际但能按定太阳经旋治,邪可立去,正可立复。因近来不按经旋治,用药不当,邪不即去,正气日衰,邪气日盛,势必渐渐入内,故有传经不传 腑,传腑不传经,二阳并病,三阳并病,两感为病,渐入厥阴,邪苟未罢,又复传至太阳,迁延日久,变证百出,邪盛正衰,酿成阴阳脱绝,种种危候,仲景立三百 九十七法,一百一十三方,以匡其失,而扶其正。

As one of the founding fathers of Chinese medicine, Zhang ZhongJing authored the ShangHanLun as a tool for the clinical treatment of human afflictions. He outlined the three Yang/three Yin meridian theory of diagnosis, representing the subtleties of Qian and Kun(1), so that generations of physicians to come might deepen their understanding of medicine. Over time, there have been many commentaries, all with different opinions that argue over key points of the original text. The overall result has been to branch out away from its original meaning, so that now there are few people who even bother to read the ShangHanLun, and those that do, are confounded as to how to understand its true meaning. In their perfunctory work on the text itself, these commentators have failed to grasp the deeper essence of the ShangHanLun, which extends to all forms of disease. How, then, can those who come after gain access to the genius of Zhang ZhongJing? I shall explain here in no uncertain terms.

The concept of 'shanghan' begins with the introduction of a pathogen to the meridian of cold and water. The TaiYang meridian lies at the head of the three Yang and three Yin channels, and is the domain of cold and water. Its associated trigram is Kan, whose single Yang element is the primary source of all human life. In this, it resembles the awesome life-giving power of the sun and is thus referred to as 'TaiYang'(2). The sun rises out of the water and during the Zi period, the single Yang element comes to life, and the dynamics of the qi mechanism begin, moving upwards and outwards, it spreads water and essence to the surface of the body, constantly moving without rest. The NeiJing states, "The bladder is the official of the central capital, fluids are stored there and emerge with qi transformation."(3) This process of "qi transformation" lies at the heart of the ShangHanLun. One must be familiar with the process of qi transformation in the surface of the body, where water vapor is expelled from the skin and pores; and with qi transformation in the interior of the body where water is expelled through the urinary ducts. Vapor at the surface of the body is light, arid qi, much like mist or fog; water expelled from within the body is heavy and turbid, much like the flow of a drainage stream.

If the qi transformation of the TaiYang meridian remains unimpaired, then there is no avenues through which pathogenic qi may enter the body. When TaiYang qi transformation is weakened, no matter what the season or time of day, pathogenic qi will invade. It must first enter through the pores and block the expulsion process of TaiYang qi transformation. This leads to the development of the TaiYang meridian condition, thus, referred to as 'shanghan'.(4) Practitioners today believe that cold damge is limited to only the winter months, and do not realize that it can occur at any time throughout the year. The TaiYang meridian is the first of the six meridian stages to be afflicted by cold damage. At this stage, the pathogen is still relatively weak and the vital qi (zheng qi) is still very strong. If the practitioner is able to correctly diagnose and provide treatment according to the TaiYang meridian condition, the pathogen can be immediately dispelled and zheng qi can immediately recover. However, because people no longer practice this system of meridian diagnosis, they use herbs incorrectly and the pathogen is not dispelled, thus further weakening zheng qi and increasing the strength of the pathogen. The illness will gradually grow deeper and transform from meridian to meridian or from fu to fu, leading to an overlapping TaiYang, YangMing complex, TaiYang, YangMing, ShaoYang complex, or simultaneous complex of two meridians. Eventually, it reaches the JueYin stage, with its roots still intact, it reemerges at the TaiYang stage and slowly over time develops into various diseases. In the end, this leads to the separation of Yin and Yang and various life-theatening conditions. Therefore, Zhang ZhongJing established the 397 methods and 113 prescriptions of the ShangHanLun in order to dispell pathogens and tonify zheng qi.

(1) The two trigrams from the Book of Changes representing pure Yang and pure Yin repsectively.
(2) In addition to its Chinese medical meaning of the 'greater Yang' channel, TaiYang also means 'sun'.
(3) This passage from the NeiJing is and often quoted piece used to explain the formation and excretion of urine. However, if you carefully consider it under the lense that Zheng QinAn has provided here, this emergence of fluids is not referring merely to urination. It points to the transformation of water into light, arid qi that is then transported to the surface and extremities of the body primarily through the TaiYang meridian and eventually excreted through the skin.This clearly explains why patients suffering from Yang qi deficiency have frequent, clear urinations. dry mouth and constant thirst, dry skin etc. - the driving force of qi transformation is insufficient and therefore fluids are passed directly out of the body without reaching the TaiYang meridian.
(4) Zheng QinAn uses the parallelism of this passage to indicate that the 'han' or 'cold' being damaged does not refer to the external pathogen as is commonly mistaken. It refers, instead, to the basic cold nature of the TaiYang meridian and the damage that is incurred upon the dynamics of the TaiYang qi mechanism. Therefore the first stage of all illnesses, regardless of the nature of the external pathogen, falls by necessity within the scope of 'shanghan'. This point is essential for cutting through the ongoing debate of modern TCM over cold-wind invasion versus warm-wind invasion. The nature of the pathogen is secondary in regards to its effect on the qi mechanism of the patient. According to Zheng QinAn, what is referred to as 'WenBing' is nothing more than the transmission of this damage to the qi mechanism from the initial TaiYang stage to that of the YangMing stage.

二零零八年重阳节

Recommended Reading for all Practitioners of TCM: Part 1


With the current air of dissatisfaction surrounding the modern Chinese medical curriculum, I have spoken at some length with various practitioners and instructors on the subject of what a true reading list of traditional Chinese medicine should look like. Like a sampling of 'Greatest Jazz Albums' or any other such compilation, this list is by no means exclusive, though I feel that these works combine to create a fairly thorough picture of genuine TCM.

1. 《黄帝内经》, The Yellow Emperor's Classic of Internal Medicine: An obvious lead off choice, this is the classic that started it all. Compiled by a series of authors from hundreds of years of oral tradition, most researchers date it as a work of the Eastern Han period. It provides the theoretical framework for TCM right down to the present day. Often disregarded as outdated and overly esoteric, a thorough understanding of the NeiJing is not something that comes easily.
2. 《难经》, The Classic of Questioning: In classical form, the NanJing picks up where the NeiJing leaves off with a series of 81 expositions on difficult or incomplete portions of the text in question and answer format. Its authorship is unclear, though historically attributed to the legendary Warring States period physician BianQue, otherwise known as 秦越人 QinYueRen.
3. 《伤寒杂病论》, The Classic on Febrile and other Various Diseases: Often sited as the grandfather of clinical Chinese medicine, Zhang ZhongJing's classic work is now divided into two sections known as The Classic on Febrile Diseases and The Synopsis of the Golden Chamber. The former, as the more celebrated of the two, outlines the six meridian system of diagnosis and their associated prescriptions. More importantly, careful reading reveals it to be an invaluable resource for understanding the qi mechanism of the human body and its flow (which I will cover in a separate post). The contents of this work are essential for understanding the clinical application of all areas of Chinese medicine.
4. 《圆运动的古中医学》, The Circular Dynamics of Ancient Chinese Medicine by Peng ZiYi (Qing): Unavailable in English to the best of my knowledge, this book blew my mind from page 1. Heavily recommended by modern day master of TCM, Dr. Li Ke, this treatise places TCM back into its original context of the energy dynamics of the natural world. Drawing heavily upon theory from the Book of Changes, Circular Dynamics is a manual that seeks to help students grasp critical concepts, from theory to application, in as concise a manner as possible. Check back for selected translations in the future.
5. 《郑钦安医理真传,医法圆通,和伤寒恒论》, The Collected Works of Zheng QinAn (Qing): The founding works of the HuoShenPai (Fire Spirit School of TCM) that has recently come under national scrutiny with the publication of Lu ChongHan's Treatise in Support of YangQi, Zheng QinAn is considered by many of those in the know to be the most important TCM figure of the last 200 years. His system of thought rightfully places YangQi and its associated physiological functions at the forefront, faithfully following NeiJing/ShangHanLun theory. Both provocative and thought-provoking in their critique of the all too common misunderstandings of TCM theory, these works were used as texts for training some of the best TCM minds of the previous century. It is my sincere hope to see these profound works rendered into English someday.
6. 《神农本草经》, Shen Nong's Classic of Materia Medica: The founding work on the Chinese pharmacopoeia, the majority of herbs and their associated descriptions are still in use today. The classification of Upper/Middle/Lower herbs is of particular interest.

Having titled this 'Part 1' there will no doubt be additions to this list as time goes along.

The most important thing that I have taken away from my own cursory reading of these works is the need to construct the mind of a TCM practitioner. TCM is a medical science that works on three levels - 物 wu, qi, shen - that is material, energetic, and spiritual. We cannot allow our modern minds to be influenced by the nearly exclusive focus on the material level that pervades the Occidental approach to healing, in which the body is treated something akin to a car engine. You have the driving force of the pistons at the heart of the engine, the carburetor to 'digest' gasoline, a radiaotor to circulate and filter water, and so on and so forth. When once breaks down, simply isolate and replace. However, this model fails to consider the essential nature of the combustion-engine, which is to harness and efficiently utilize the power produced by the combustion of gasoline. In other words, without the introduction of energy in the form of a controlled explosion, or simply, fire, the rest of the engine is essentially meaningless. The human body is much the same. Qi is the energy that drives and unites the processes of the human body. Without it, the physical body is incapable of completing its proper functions, which in turn leads to the manifestation of illness.

Too often I have been witness to this modern, clinical thought process being applied in treatment under the guise of Chinese medicine. "Oh, so you've got pain in your chest? Do an eco-cardiagram to confirm..." after which irregularities revealed through an ECG lead to a TCM diagnosis of some variation of "heart deficiency" and the prescription, some variation of ShengMaiYin, designed to either tonify the blood or invigorate the heart system directly. And when the patient returns with the inevitable, less than ideal results, everyone throws up their hands in bewilderment and resorts to the wonders of modern science to sort out this issue of faulty hardware.

The heavy hitters of Chinese medicine have been beating this dead horse for centuries - and that is simply put that TCM treatment should never be based on physical symptoms alone - much to the unbeknownst of the majortity of practitioners throughout history. In the above example, the next step should be to investigate the energetic state of the patient through information gathered through basic TCM diagnostic techniques, and if necessary, to further consider the lifestyle and emotional factors that may be contributing to this present condition. This leads to so many possible diagnoses that I think perhaps it is sheer intimidation that stops most people from going any further. "What if I get it wrong and someone comes questioning? Better just to stick with the book on this one..." And so it goes, case by case, until the big question of whether Chinese medicine is even effective at treating illness begins to arise in many people's minds.

In my early days as a student of TCM, I was once asked by a teacher to close my eyes and imagine the basic structure of the human body according to the modern biomedical model. Of course, this is not hard for most about any educated person you might ask at random on the street. He then told me to clear my mind, and to construct a model of that same human system, only this time completely utilizing TCM theory to do so. At the time, I was frustrated to say that I simply could not put it together in any concrete, functional manner. Since then, I continue to use this method to check my progress, noting where the grey areas still exist and utilizing the resources listed above to help fill them in.

The TCM model is one of dynamic motion that resists being pinned down through simple anatomical knowledge. Like the flow of a mountain stream, it differs from any one point in time to the next. It is only by abandoning this safety net of Western medicine (at least temporarily) and throwing ourselves headlong into these waters that we can hope to eventually draw near an understanding of the ocean of wisdom that is Chinese medicine.

二零零八年八月廿五

The Current State of TCM in China


Returning for my 4th 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 standard, 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 a recent audacious letter to President Hu Jintao, Lv 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 reknowned 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 he 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 extensice 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. Lv'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 noone 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13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 indiscrimate 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 Eduication. 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 4 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 problematic educational system, I have confounded myself over these points for some time now. Like many others TCM practicitions, 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 philosphies 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