Perspectives On “TCM” and Classical Chinese Medicine—A Comparative Outlook

Heiner Fruehauf, founder of the College of Classical Chinese Medicine at NUNM has written the introduction to Liu Lihong’s book, Classical Chinese Medicine, which represents the culmination of a 10 year project that Heiner has been overseeing. This influential book has been translated into English and communicates what is so unique and special about the nature of NUNM’s College of Classical Chinese Medicine. Read Heiner’s introduction and explore the difference in education from a classical Chinese medicine (CCM) program, compared to a traditional Chinese medicine (TCM) program.

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It is with much excitement and gratitude that I (Heiner Fruehauf) am announcing the English edition of Liu Lihong’s milestone work, which represents a much-needed beacon for the profession of Chinese Medicine in the twenty-first century. Classical Chinese Medicine delivers a straightforward critique of the severe predicament that the “integration” of the traditional healing arts with Western science has spawned during the last 60 years, as well as a fervent call for the preservation of classical Chinese medical wisdom. Professor Liu’s open and pointed style of presentation has made this book a bestseller that is read not only by medical students and doctors in China, but by multiple strata of the general population who long for a state of health and well-being founded in a deeper sense of cultural identity. Most importantly, Professor Liu’s ardent appeal to regard Chinese Medicine as a science in its own right has inspired a mainland grassroots movement that is beginning to draw talented students to a field that was long regarded as a bleak second rate destination for professional development.

Eighteen years after its initial publication, it is more than time to bring this seminal work to Western readers. Oriental medicine education has made great strides since the 1970s in North America, Europe, and Australasia, but clear guidelines regarding the “traditional” nature of Traditional Chinese Medicine (TCM) remain murky and undefined. Classical Chinese Medicine not only delineates the educational and clinical problems the profession faces today in both East and West (despite quantitative “upgrades” such as doctoral-level status, extensive licensure, and the accreditation of ampler and larger schools), but also transmits concrete and inspiring guidance on how to effectively engage with ancient texts and designs in the postmodern age.

While Professor Liu’s published voice represents one of the earliest objections to the direction that the standardized form of Chinese Medicine has taken since the foundation of the People’s Republic of China (PRC) in 1949, it must be seen as the culmination of a cultural movement that first reacted to the sustained influx of Western science and medical modalities into China more than one and a half centuries ago. To cite an example, the medical philosopher Meng Jin wrote provocatively in Yi yi yi (Prescriptions for Healing the Present State of Medicine) in 1902:

Most of today’s Chinese Medicine doctors are utterly ill-advised—tens of thousands of miles removed from the advanced craftsmanship of the ancient sages. . . . As a result, the time-honored wisdom tradition of Chinese Medicine that once studied the microcosm of the body before the sophisticated backdrop of all macrocosmic sciences has now become an escapist haven for the ignorant and apathetic.[1]

Meng Jin goes on to lament the change from a medicine that was intrinsically founded upon functional and holistic parameters to an institution dominated by the presumptions of Western science—defined by the material eyes of anatomy and a diagnostic perspective based exclusively on structural changes in the body. Clinical outcomes, he declared exactly 100 years before Professor Liu published his book, were noticeably deteriorating.

Classical Chinese Medicine articulates the essence of this long-standing intellectual movement aiming to preserve the unique theories and techniques behind the clinical efficacy of Chinese Medicine. After other scholars in contemporary China realized that it was politically acceptable to share their genuine opinions about the government-issued doctrine of “modernizing,” “integrating” and “unfeudalizing” Chinese Medicine, the dam broke and a flood of articles and books on the subject emerged. A pertinent example of the passionate tone adopted in the wake of Professor Liu’s pioneering publication is provided by Mao Jialing, editor of the China Agency for Chinese Medicine and Pharmacology News. In 2005, he wrote in the preface to his influential essay collection Zheyan kan Zhongyi (Chinese Medicine in the Eye of Philosophy):

If the field of Chinese Medicine continues to develop according to the fashionable directive of “glorious surface, collapsed interior,” it won’t be long before the chain of genuine knowledge transmission will be broken, before the market share of Chinese Medicine will dwindle down to zero, and until no more but an empty shell will remain of the profession of Chinese Medicine. In slightly more pessimistic and maybe exaggerated terms, one could say that the age-old profession of Chinese Medicine is presently facing a quiet death. Thousands of years of accumulated experiential knowledge gone in a flash—by finally having become “one with the rest of the world,” by having become “scientific.” The price: the sacrifice of its unique flavor and clinical benefits. Is this now a “revolution” that gives us reason to rejoice, or is it a “tragedy” or even a “sin”? However way we look at it, the development of Chinese Medicine has reached a state of extreme crisis! These may sound like empty words, overblown perhaps, but I believe that history will be the true judge of this statement. . . .[2]

Perspectives On “TCM” and Classical Chinese Medicine—A Comparative Outlook

© The Chinese University of Hong Kong Press / Photo by Anthony Kwan

In addition to underscoring the immense significance of this book, it is a declared purpose of my introduction to make “TCM” transparent as a historically and politically conditioned system that is fundamentally different from the multifaceted traditions that constitute traditional Chinese Medicine. In this process, I am attempting to establish a defining line that helps individual Oriental medicine practitioners, schools, and agencies to clarify their own philosophical position. It is, however, not my point to denounce the phenomenon of “TCM.” The standardization procedures of “TCM” are perhaps the main reason that Chinese Medicine is still a thriving profession today, after a prolonged period during which China and the rest of the modernizing world were willing to forsake their own traditions in exchange for the power of Western Medicine. The TCM barefoot doctor approach, moreover, did save many lives when expert healthcare was not available in the Chinese countryside. It is my intention, however, to expose the common
practice of advertising the education and clinical practice of “TCM” under traditional insignia that suggest the transmission and application of an ancient Eastern healthcare system based entirely on holistic principles.

The general discourse on Oriental medicine in the West appears to have reached the realm of the 10,000 details (i.e. “what points work best for diabetes,” “how to treat headaches with Chinese herbs”), while leaving the basic parameters of its scientific approach unexplored. To help stimulate a broader discussion on Chinese Medicine methodology, I have created a table (below) that contrasts the characteristics of “TCM” with those of traditional Chinese Medicine—here labeled “classical Chinese Medicine” in order to distinguish it more clearly from its modern cousin—as Liu Lihong and my own teachers have described it. This table is meant to be a starting point, a tool that may help Oriental medicine practitioners and institutions assess their inner mode of teaching and practice. It may be incomplete and, due to the nature of the black-and-white table format, overstate some of the differences that set the two systems apart.

CLASSICAL CHINESE MEDICINE"TCM"
Based on naturalist philosophy (Daoism,
Confucianism)
Based on pragmatist philosophy (scientific
materialism, communism)
Alchemical (synthetic) approach: scientific
endeavor defined as acknowledgement and
exploration of the complexity and multidimensionality
of nature and the body
Analytical approach: scientific endeavor
defined as elimination of complicating
factors and unpredictable occurrences
Based on traditional parameters of Daoist
and Confucian science (yin yang, wuxing,
bagua, wuyun liuqi, jing-qi-shen, etc.)
Primarily based on parameters of
modern science (virus, inflammation,
blood pressure, etc.)
Views medicine as a branch of the Daoist
and Confucian mother sciences (Huang
Lao, zhouyi, fengshui, etc.)
Views medicine as a branch of modern
science
Source-oriented: reliance on tradition
(experience)
Branch-oriented: reliance on progress
(experiments)
Requires broad base of knowledge due to
intimate relationship to other traditional
arts and sciences
Technical and highly specialized trade
Body is treated as a microcosm that follows
macrocosmic laws and is continually informed
by macrocosmic influences (totality of cosmic/
calendric/seasonal patterns created by
conjunctions of sun, moon, and stars)
Body is treated as an independent entity
Based on experience of human "subject" in
environment of geocentric universe
Based on "objectivist" heliocentric
worldview
Based on dualistic cosmology of becoming
(process-oriented worldview observing the
continuous change of physical phenomena,
symbolized by the changing pattern of the
moon)
Based on cosmology of being (concept of
singular, metaphysical truth, symbolized
by fixed position of the sun)
Impartial view of reality as continuous
interplay between heaven and earth,
light and shadow, "demons" (gui: lunar
influences) and "spirits" (shen: solar
influences), birth and death, male and
female, yin and yang
Materialist method of dividing heavenly and
earthly spheres and "rectifying the names"
(zheng ming: convert the binary symbols
of lunar mythology into the immutable
and one-sided terminology of the solar
perspective, and dignify an absolute
position as "right/good/correct")
Communicates through symbols which contain
and correlate multiple layers of meaning
Communicates through words and terms
which refer to narrowly defined contents
Preserves the lunar element of complexity
and "obscuring" mystery that defies
exacting definition (wuwei maxim:" do
not define categorically")
Demystifies and demythologizes the
traditional record by "illuminating"
aspects of lunar ambivalence, and by
creating "clear and simple" textbook
definitions (youwei maxim: "define as
firmly and precisely as possible")
Views body as field (traditional zang-xiang
theory: zang-fu are primarily viewed as
functional systems)
Views body as material entity (influence
of modern anatomy: zang-fu are primarily
viewed as structural organs)
Body—mind—spirit medicineBody—(mind) medicine
Physician is intermediary to the sacred,
cultivating the dual roles of the Daoist
shaman (master of intuited knowledge)
and the Confucian sage (master of
scholarly knowledge), connecting above
and below, inside and outside, energy and matter
Physician is skilled technician who rectifies
imbalances between bodily humors and
calibrates the structural composition of
the body (eliminate viruses, etc.)
Physician aspires to the Dao of medicine,
a process which requires the actualization
of his/her individual path by working to
become a self-realized being (zhenren)
Physician is part of a legally defined
profession with standardized ethical
standards
Major tools: qigong meditation, music, calligraphy, painting, poetry, ritual journeysMajor tools: standardized courses/tests on
legal responsibility and liability issues
Highly individualized discipleship-based
training
Highly standardized institutionalized
training
Teachers are individual "master" figures
who emphasize the creation of a lineage
inspired atmosphere/culture
Teachers are assigned to standardized
curriculum items, and thus in principle
exchangeable
Transmission of "understanding" (may
include qi transmission from master to
disciple)
Transmission of data through "words" and
"terms"
Multidirectional memorization: Memorization of classical texts that are
interpreted situationally according to
individual circumstances
Mono-directional memorization: Use of standardized textbooks that prepare
for testing of knowledge in multiple choice
format; classics are placed in museum
Health is defined as the active process of
refining body essences and cultivating
vital forces: concept of "nourishing life"
(maximizing physiological functions)
Health is defined as the absence of
pathology
Clinical diagnosis is primarily based on
"subjective" experience of the senses
Clinical diagnosis is primarily informed by
"objective" instrumental data (as provided
by prior Western Medicine diagnosis)
Clinical outcome is primarily based on
patient's subjective feeling of well-being
and physician's collation of sensory
information (tongue, pulse, etc.)
Clinical outcome is primarily monitored
through instrumental data (reduction of
viral load in blood, disappearance of lump
on x-ray, etc.)
Highly individualized diagnosis: emphasizes
bianzheng (diagnosis by symptom pattern)
Standardized diagnosis: emphasizes
bianbing (diagnosis by disease name)
Highly individualized treatment: favors
flexible therapeutic approach which freely
chooses from a wide variety of modalities,
and within them, favors a flexible usage of
prescription items
Standardized treatment: favors fixed
modalities (herbs or acupuncture), and
within them, promotes fixed herb regimens
(patent medicines) and fixed-point
prescriptions
Use of wide range of clinical modalities,
including the external application of herbs
to acupuncture points, umbilical therapy,
qigong exercises, waiqi emission, five-phase
emotional therapy, alchemical dietetics,
ziwu liuzhu acupuncture, etc.
Selective ratification of certain modalities
that have a measurable effect on the
physical body and that can be explained
from the perspective of modern science,
such as the internal administration of antibacterial
herbs and ashixue acupuncture
All-inclusive scope of practice (includes
emergency medicine, bone fractures,
serious diseases such as cancer, etc.)
Selective scope of practice (chosen areas
in which modern studies have shown an
advantage of TCM over Western Medicine,
such as chronic pain or allergies)
All-encompassing training (may lead to
clinical specialization in a traditional field,
such as external medicine, if inspired by
the clinical expertise of a specific teacher)
Progressive clinical specialization according
to the model of Western Medicine
(acupuncture, internal medicine, external
medicine, gynecology, pediatrics, tumors,
cardiovascular diseases, digestive diseases,
etc.)
Combination of Western and traditional
modalities, if employed, is performed
according to Chinese Medicine criteria (i.e.
Zhang Xichun's method of energetically
classifying aspirin and integrating it as
an alchemical ingredient into traditional
formulas)
Combination of Western and traditional
modalities is recommended in most cases;
combination follows Western Medicine
criteria (i.e. abdominal surgery plus postoperative
administration of herbs with
anti-adhesive effect such as magnolia bark)

With regard to the positions outlined in the table above, most of us will find that our own convictions and modes of practice follow propositions that can be found on both sides of the dividing line. In particular, it is my experience that Oriental medicine practitioners in the West often proclaim to embrace the principles stated on the left, while their modus operandi in terms of diagnosis and treatment is much more closely aligned with the attitudes outlined on the right—much like Chinese officials used to aspire to the image of the philosopher-poet in their private life, while adhering to pragmatist values when acting in public. Others, after surveying this table, might find that although they were not aware of a “TCM issue” in the past, they certainly like the premises of “TCM” better than the mystifying conjectures of the classical path.

It is, therefore, not my goal to dignify the classical Dao of Oriental medicine and malign “TCM,” although it has become clear in the course of this presentation what the nature of my own bias is. Neither do I suggest that any deviation from pre-twentieth-century ways of diagnosis and treatment automatically establishes the practice of “TCM.” The use of modern equipment to measure the electric resistance of acupuncture points, for instance, thoroughly adheres to traditional zang-xiang theory (“examine the surface
to determine the hidden factors inside”). In accordance with the principles outlined in Liu Lihong’s book, I believe that the term “classical” does not imply that we should turn the clock back to the times of Zhang Zhongjing or Sun Simiao, but rather that we should utilize the timeless principles of the art and science of Chinese Medicine to assess, appreciate, and potentially incorporate new information from all branches of knowledge.

Above is a snipit of Dr. Fruehauf’s full introduction. Read the full introduction.

Heiner Fruehauf, PhD, LAc
Founding Professor, College of Classical Chinese Medicine
National University of Natural Medicine
Portland, Oregon

Copyrighted Material of The Chinese
University Press | All Rights Reserved

References

  1. Meng Jin, Yi yi yi (Prescriptions for Healing the Present State of Medicine), in Miben yixue congshu (A Collection of Esoteric Medical Texts), edited by Qiu Qingyuan,
    reprinted by Shanghai Shudian (Shanghai, 1988), vol. 5, p. 5.[1]
  2. Excerpt from the preface to Chen Guiting and Mao Jialing, eds., Zheyan kan Zhongyi (Chinese Medicine in the Eye of Philosophy), Beijing Keji (Beijing, 2005), p. 1.[2]
  3. See the Xici zhuan (Tradition of the Appended Statements) commentary to the Yijing, chapter 1.5.[3]
  4. This historical synthesis was first published in shorter form in the October 1999 issue of the Journal of Chinese Medicine. I owe the inspiration for the original essay, as well as much of the detail information contained in it, to my mentor Professor Deng Zhongjia, Dean of the College of Medical Theory at Chengdu University of TCM.[4]
  5. Wa Zhiya, ed., Zhongguo yixue shi (A History of Chinese Medicine), Jiangxi Kexue Jishu (Nanchang, 1987), p. 278.[5]
  6. Wa Zhiya, ed., Zhongguo yixue shi (A History of Chinese Medicine), Renmin Weisheng (Beijing, 1991), p. 488.[6]
  7. Ibid., p. 489.[7]
  8. Wa Zhiya (1987), p. 288.[8]
  9. Mao Zhuxi yulu (Sayings by Chairman Mao), no editor, no publisher, p. 54.[9]
  10. See a series of articles published in 1958 in China’s official newspaper, Renmin ribao (The People’s Daily), i.e. “Dali kaizhan Xiyi xuexi Zhongyi yundong” (Let Us Give Strong Momentum to the Western Doctors Studying Chinese Medicine Movement). See Yu Zhenchu, Zhongguo yixue jianshi (A Brief History of Chinese Medical Science), Fujian Kexue Jishu (Fuzhou, 1983), p. 446.[10]
  11. Mao Zedong, “Dui weishengbu gongzuo de zhishi” (Instructions Regarding the Work of the Ministry of Public Health), in Ziliao xuanbian (A Collection of Materials), no editor, no publisher (1967), p. 312.[11]
  12. See the authoritative work in two volumes published by the Chinese Ministry of Health in 1994–1995, Zhongyao xinyao linchuang yanjiu zhidao yuanze (Guidelines for Clinical Research Pertaining to New TCM Remedies).[12]
  13. Cui Yueli, ed., Zhongyi chensi lu (Pondering Core Issues of Chinese Medicine), 2 vols., Zhongyi Guji (Beijing, 1997), vol. 1, p. 25.[13]
  14. Li Zhichong, Zhongyi fuxing lun (Advocating for a Renaissance of Chinese Medicine), Zhongguo Yiyao Keji (Beijing, 2002), p. 344.[14]
  15. See Li Ke lao Zhongyi jiwei zhongzheng yinan bing jingyan zhuanji (A Collection of Case Histories of Chinese Medicine Elder Dr. Li Ke’s Treatments of Acute Emergency Disorders and Recalcitrant Diseases), Shanxi Kexue Jishu (Taiyuan, 2002).[15]
  16. The issue of respect for the Chinese scientific tradition as a stand-alone body of science—and its demise at the hands of PRC administrators—was first introduced
    by the prolific work of Joseph Needham, and more recently, specified for the field of Chinese Medicine by Manfred Porkert, Leon Hammer, and Bob Flaws. See Leon I. Hammer, “Duelling Needles: Reflections on the Politics of Medical Models,” American Journal of Acupuncture (AJA), 19.3 (1991); Bob Flaws, “Thoughts on Acupuncture, Internal Medicine, and TCM in the West,” Journal of Chinese Medicine, 38 (1992); and Manfred Porkert, Chinese Medicine Debased, Phainon, 1997.[16]
  17. See the conclusion of Mao Jialing’s preface to Chen Guiting and Mao Jialing, eds., Zheyan kan Zhongyi, p. 3.[17]