Heiner Fruehauf’s Introduction to Liu Lihong’s book, Classical Chinese Medicine

(Continued from here)

Buy your copy of Classical Chinese Medicine

We live at a most interesting point in history when pioneering scholars are actively exploring a more unbiased look at “the Other,” arguably a prerequisite for all endeavors of true science and informed integration. It is one of the unfortunate characteristics of humanity that we all too easily become limited and determined by habitual patterns. After two centuries of donning the lenses of scientific materialism, mainstream views of reality have come to disregard the subtle domains of process and function, dynamic energy transformation, spirit, and the invisible threads that bind us to our ancestors in the transmission of knowledge—in essence, the core elements of classical Chinese Medicine. While these lenses have brought the gifts of logic, order and precision, they have also come with the qualities of arrogance, prejudice and, in a better scenario, esoteric amusement. We have become largely ignorant of the enormous potential that the ancient wisdom traditions offer for the task of healing the complex maladies of our time.

During the twentieth century, therefore, modern science all too often became an instrument that confirmed what we wished to see. When the first Egyptologists explored the treasures and mysteries of the pyramids, the Great Sphinx and the Valley of the Pharaohs, most of them described what their modern identity longed to corroborate: that these edifices, despite being built close to five millennia ago with engineering methods that mechanized building modes could not achieve until the 1980s, reflect nothing more than the fantastic belief system of stone-age barbarians. With a slightly different twist, late-nineteenth-century explorers of East Asia described what they longed to see: Japan was a land of geishas and ukiyo-e prints, mirroring the aesthetic preference of European authors such as the exoticist Pierre Loti. In turn, when Chinese artists went to the West during the 1920s, they tended to depict a two-dimensional landscape replete with flower-filled alcoves, blond women and romantic love, as in the work of the Japanese painter Tsuguharu Foujita (1886–1968) or the Chinese poet Li Jinfa (1900–1976).

A more productive and integrative approach to the Other was modeled by the symbolist authors R. A. Schwaller de Lubicz (1887–1961) and René Guénon (1886–1951), who independently coined the term “sacred science” during the 1920s. The concept of sacred science is based on the premise that ancient civilizations and their cultural legacy are containers of ageless wisdom, sorely needed at a time when all higher knowledge and the promise of enlightenment were assumed to lie exclusively in the future. The premise: in order to access and extract the acumen of these ancient traditions, we must first adopt an attitude of deep respect. When the labyrinth of seemingly nonsensical code—snakes and water lilies and scarab beetles; wood, fire, earth, metal, and water; taiyang, yangming, shaoyang, taiyin, shaoyin, jueyin; the hexagrams of the Yijing (Classic of Changes)—bewilder us, we should assume that this sentiment reflects our own ignorance on the subject matter, not that of its creators. As Liu Lihong points out, this vital piece of advice for the research of all ancient subject matter had been issued by China’s primordial classic itself: “When you approach this book with the eyes of wisdom and compassion, all it will mirror back to you is wisdom and compassion,” states one of the major commentaries of the Yijing.[3]

The implied meaning for modern readers: “When you approach this repository of ancient wisdom with the eyes of ignorance, you will most likely see nothing but senseless scribbles created by superstitious barbarians”— hardly a constructive attitude for the effective study of Chinese Medicine.

Once we have fully immersed ourselves in the symbol language of the ancient world and come to understand its concepts from within (as Schwaller attempted during his twelve-year studies of the hieroglyphs and the structural design of the Temple of Luxor in Egypt), true transmission of knowledge can take place and we begin to recognize its timeless meaning and modern significance. This is, perhaps, the most essential recommendation that Classical Chinese Medicine proposes for the study and practice of Chinese Medicine in the modern age. Liu Lihong employed this method himself when writing his doctoral dissertation on the Shanghanlun (Treatise on Cold Damage)—he meditated on the lines of the classic over and over again, and thus allowed the inner meaning to reveal itself, without consulting a single academic work on the subject.

In the epistemology of Western science, it took until the end of the twentieth century before this type of deeper integrative approach to the study of foreign or ancient Other made inroads into the realm of academic credibility. A throng of scholars from various fields spent their careers arguing vigorously against the limited view of human cognition that the materialist worldview of the Scientific Enlightenment had cast over most professional fields, including the domain of Chinese Medicine. Such scholars include the biologist and neuroscientist Francisco Varela, the authority on ancient mysticism Frits Staal, the physicist Fritjof Capra, the philosopher and cultural ecologist David Abram, the consciousness researcher B. Allan Wallace, the Daoism and Contemplative Studies expert Harold D. Roth, and many others. Liu Lihong’s Classical Chinese Medicine echoes the multidisciplinary voices of these pioneering thought leaders. It exposes the scientist viewpoint as an obstacle rather than a liberating condition for the effective clinical practice of Chinese Medicine.

The term “integrative” has become a fashionable buzzword that has come to be used liberally in the brochures of both allopathic and alternative medicine colleges in East and West. Liu Lihong reminds us that true bridges of integration can only be built when both bridgeheads stand solidly grounded in their own foundation. As Chinese Medicine practitioners enter into the doctoral age, his challenge posits, it is vital for the integrity of the profession that we deepen our insights about the unplumbed depths of the
past rather than the familiar minutiae of Western Medicine.

In order to understand the historical background upon which Liu Lihong’s effort was conceived, it is important that we first understand the monolithic influence that the PRC brand of Chinese Medicine has exerted on the field during the last six decades. The following represents a synthesis of the development of TCM, the medical system that has monopolized the practice of Oriental medicine in mainland China, and that has come to serve as the primary mold for the evolving profession of Oriental medicine around the globe. It exposes a system that has been conditioned by a distinctly political agenda, and reveals its logo “TCM” as a grave misnomer— designating a medicine that is not at all aiming to preserve the traditional characteristics of Chinese Medicine, but, on the contrary, to expurgate, reform, and control the classical and folkloric texture of the traditional
record in the name of progress.[4]

First Impact: The Modernization of China During the Late Nineteenth and Early Twentieth Century

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

At the beginning of the nineteenth century, the profession of Chinese Medicine was in peak season. Although many aspects of Chinese society were entering into a state of collapse and disarray by 1841, the culture of traditional medicine was alive with the multihued color and texture of a 2,500-year-old art. There was the stimulating discourse between the newly founded fever school and the school of the neo-classicists, there were numerous scholar physicians publishing influential discourses, and there was the arcane realm of esoteric discipleship, alchemical experimentation, and the kaleidoscopic facets of folk wisdom that always characterized the sensuous heart of the profession. The advent of Western Medicine presented the traditional healing system its first major challenge, from which it never completely recovered. It lost its rank as the one and only
“medicine” (yixue) and became “Chinese Medicine” (Zhongyi), defined in contrast to “Western Medicine” (Xiyi). Immediately, however, there developed an early brand of progressive physicians who did not lament this situation, but attempted to integrate some of the paraphernalia of modern medicine into the traditional system. These pioneers are now collectively referred to as the Chinese-Western Integration School (zhong xi huitong pai). Main representatives are Wang Qingren (1768–1831), Tang Zonghai (1851–1908), Zhang Xichun (1860–1933), and Zhang Shouyi (1873–1934). It is important to note that these initial “integrators,” often cited by TCM administrators as early visionaries of their own system of integrated medicine, were not proponents of the hierarchical superiority of Western Medicine, but rather tried to embody the traditional ideal of the broadly educated master physician. It was their erudite skill level in the art, philosophy, and science of the traditional thought process that allowed them to break new ground by, for instance, categorizing Western drugs in energetic terms, or by relating the Triple Warmer to certain anatomical tissues described by Western Medicine. Although it was their declared goal to incorporate some of the useful mechanics (yong) of Western Medicine into the traditional mother body (ti) of Chinese Medicine, their parameters
remained clearly “traditional at the core”—as the programmatic title of Zhang Xichun’s collected writings announces in 1933, Yixue zhongzhong canxi lu (Chinese at Heart But Western Where Appropriate: Essays Investigating an Integrated Form of Medicine).

The period during which curious Chinese physicians could explore the phenomenon of Western Medicine from an equal footing was soon eclipsed by a (still extant) period in which the Western scientific worldview dominates. During the first half of the twentieth century, a variety of events politicized Chinese Medicine as the despicable symbol of everything old and backward. It became a pawn that reformers from all political camps sought to abolish. When this endeavor failed due to vehement public protest, the new stewards of the Chinese Republic settled for banishing the unruly gargoyle of Chinese Medicine into a controlled existence that was subject to not only a rigorous purge of diagnostic methods and therapeutic modalities, but—most damaging to its integrity as a system in its own right—the gradual replacement of its essential standards with the “correct” parameters of modern science.

The political voice of Sun Yat-sen, the leader of the Republican revolution that toppled the dynastic system in 1911, was shaped by his Western science education, and reflected a deep suspicion of the old system of medicine. Later on, Kuomintang public health officials took this personal bias into the legislative arena and presented the radical proposal, Feizhi jiuyi yi saochu yishi weisheng zhi zhang’ai an (A Case for the Abolishment of Old Medicine to Thoroughly Eliminate Public Health Obstacles).[5] Authored by Yu Ai and Wang Qizhang, the proposition aggressively inferred that “the theories of yin and yang, the five elemental phases, the six atmospheric influences, the zang-fu systems, and the acupuncture channels are all illusions that have no basis in reality,” and warns that “old medicine is still conning the people with its charlatan, shamanic, and geomancing ways.”[6] The proposal, containing three major clauses (severely restrict the practice of Chinese Medicine; prohibit Chinese Medicine advertisements; bar the establishment of Chinese Medicine schools), passed the first legislative session of the Central Ministry of Public Health on February 26, 1929.[7] Although the proposition was not implemented due to thousands of protesting doctors and patients who took their passionate disapproval to the streets, the production of anti-traditional sentiment in an official document
had a tremendous impact on the general mood of Chinese Medicine practice during the 1930s and 1940s.

Around the same time, the outlawed “communist bandit” Mao Zedong promulgated thoughts that were very similar to those of his nationalist adversaries. In 1942, he instructed his guerilla government to uproot all shamanic beliefs and superstitions in the Yan’an area and establish model public health villages.[8] Around the same time, he wrote that “old doctors, circus entertainers, snake oil salesmen, and street hawkers are all of the same sort.”[9] This terse statement would have a truly devastating impact twenty-five years later when Mao’s works became the one and only source for the country’s definition of political truth. It was quoted in millions of copies of red “Mao Bibles” (Mao Zhuxi yulu), serving as the Red Guard’s main license for the uncompromising persecution of the rich culture of traditional medicine and its unique modes of practice, education, and theoretical discourse.

Chinese Communism and the Conception of TCM, 1953–1976

The years 1953–1959 witnessed what appears like a remarkable reversal of Mao’s earlier views on Chinese Medicine. Having graduated from the task of creating national respect for the “rural outlaw” who now donned the emperor’s robes, he began to gradually advance his private ambition of asserting leadership over the legion of budding communist countries around the world. This objective required the conception of a socialist model that distinguished itself from the Russian paradigm of Marxist-Leninism by incorporating the regional attributes of third-world countries. Chinese Medicine fit well into this general scheme, since it embodied a medicine that was “self-reliant,” “among the people,” “native,” and “patriotic”— all slogans that had been used to promote Mao’s unique brand of communism. Mao sensed, furthermore, that China was beginning to
become overly dependent on the influx of Soviet goods and expertise, especially in the areas of modern medical equipment and pharmaceutics. The catastrophic famines and the far-reaching collapse of infrastructure that followed the Russian walkout in 1961 were to dramatically confirm his premonitions.

It was for primarily political reasons, therefore, that Mao began to publicly embrace Chinese Medicine during the mid-1950s. This was the time when he issued the famous calligraphy that graces the front pages of so many TCM publications: “Zhongguo yiyao xue shi yige weida baoku, yingdang nuli fajue, jiayi tigao” (Chinese Medicine is a grand cache of knowledge that we should actively bring to light and further evolve). In the wake of this apparently new direction, two ministers of health, Wang Bing and He Cheng, had to resign due to their exclusive loyalty to the Western medical system that had made them trustworthy candidates for the position in the first place. In 1956, premier Zhou Enlai signed papers that authorized the immediate establishment of the first four colleges of Chinese Medicine, namely Chengdu College of TCM, Beijing College of TCM, Shanghai College of TCM, and Guangzhou College of TCM, followed by Nanjing College of TCM the following year. At the same time, a group that was to become the influential voice of the first generation of institutional TCM teachers— all of them still trained under the pre-institutional model of discipleship education—assembled in Beijing. They are generally referred to as the “five elders” (wulao), including Qin Bowei from Shanghai, Cheng Shenwu from Beijing, and Ren Yingqiu, Li Chongren, and Yu Daoji from Sichuan.

As if to set a good example for the new course that he had outlined, Mao publicly ingested the traditional remedy Yin Qiao San (Lonicera and Forsythia Powder) when he fell ill during the historic announcement of the Great Leap Forward at the Chengdu Conference in 1957. He restrained his one-time prejudice against “snake oil salesmen” and allowed Li Shizhi and Peng Lüxiang, both first-generation elders of Chengdu College of TCM, to be present at his bedside for an entire night.

In 1958, the political motives of Mao’s actions fully revealed themselves when he issued his decreeing vision about the concept of “Chinese-Western Medicine integration” (Zhong xi yi jiehe).[10] The integration movement, in essence, mandated the establishment of “TCM”—a medical system which restrains the “wildness” and the “feudal elements” of the traditional art by taking it out of the hands of its lineage holders and assigning it to the control of modern science, one of the most trusted tools of Marxistmaterialist ideology. Mao announced a nationwide search for “2,000 firstrate Western Medicine physicians who are to assist in the evolvement of Chinese Medicine.” Special Seminars for the Study of Chinese Medicine by Western Medicine Physicians On Leave (Xiyi lizhi xuexi Zhongyi ban) were established, administering pieces of a highly standardized extract of traditional knowledge over a period of one to two years. Qualifying participants were required to hold or exceed the “physician in chief” rank within the Western medical system. Of 2,000 doctors who initially entered into the program, only about 10 percent graduated. This low success rate may in part be due to the fact that the study of Chinese Medicine, even in abridged form, involves the memorization of scientific detail which all participants, including the successful graduates, had previously been conditioned to condemn as the nefarious byproduct of a social system riddled with feudalist superstition. Nevertheless, these Western doctors who participated in the  “traditional medicine reform” efforts of the years 1959–1962 came to provide the main pool for TCM administrative positions in later years. Most top-level TCM administrators of the 1980s and 1990s were, in fact, Western Medicine graduates of the reform/integration seminars.

This situation is the primary reason for the plight of Chinese Medicine under the TCM system. Traditional medicine in mainland China continues to be managed by individuals who for the most part, and often openly, entertain deep-seated suspicions against the field that they are supposed to represent. In a radical sense, the history of TCM can be described as the history of implementing anti-traditional sentiments into the general atmosphere of Chinese Medicine education and practice. I personally know of very few TCM administrators who resort to traditional modalities when they fall ill themselves. TCM students and faculty, moreover, regularly take antibiotics when contracting a cold—”because it is more convenient and works faster and better.” One of the personal memories I associate with this topic is a conversation with the grandson of Li Shizhi (the founding elder of Chengdu College of TCM who once prescribed Yin Qiao San to Mao Zedong)—himself a TCM doctor, scholar, and administrator at the College that is generally regarded as the “most traditional” among TCM institutions in China—in which he expressed concern about my enthusiasm for traditional herbology. He flatly admonished me to curb my faith in the efficacy of Chinese Medicine. In light of this situation, all of my more classically oriented teachers thus cautiously asserted that the “integration” project marked the beginning of a process that ruined the true nature of traditional medicine.

On the surface, however, this course of events caused a boost to the status of Chinese Medicine. The government had encouraged individuals of high scientific regard to immerse themselves in the subject of indigenous medicine and foster the betterment of the field. Furthermore, for the first time, TCM departments were established in many city hospitals. The actual result, though, was the genesis of a situation in which the old, clinically experienced Chinese Medicine practitioners were barred from participating
in the domain of major league TCM. All of the doctors in charge were “Western doctors with Chinese knowledge” (Xi xue Zhong)—experts who styled their diagnosis entirely in Western terms, but sporadically included some cookbook-style Chinese Medicine modalities in their approach. Distinguished “folk” physicians, unable to practice privately under the communist system, were accessible only in outpatient departments, or occasionally summoned for a second opinion. Many observers of this practice bitterly
remark that if a remedy prescribed by one of these elders resulted in a cure, it was most likely that all the credit was given to the Western modalities— even though it was their ineffectiveness that had initiated the traditional consultation. Chinese Medicine, after all, was not recognized anymore as a clinical science in its own right, and the traditional diagnostic approach of bianzheng (diagnosis by synthesis of pulse, tongue, and symptom profile) was progressively becoming eclipsed by the standardized procedure of bianbing (diagnosis by Western disease name).

In the aftermath of these events, the status of Western Medicine became dramatically elevated with regard to institutionalized TCM education. Planned in 1961 and executed in 1962, all TCM colleges adopted a curriculum that required incoming students to first study Western Medicine for two and a half years, then Chinese Medicine for two and a half
years, until finally entering into an “integrated” clinical internship for one year. The five elders immediately realized that this educational setup was responsible for an increasing loss of respect for the fundamental principles of Chinese Medicine, and composed a letter to the central government that summarized their concerns. Their protest led to an abolishment of the new curriculum and ushered in a brief revival of classical values—spawning a college program that started out with three years of exclusive Chinese Medicine training, including the reading and memorization of all major classics in their entirety, as well as palpation of 10,000 pulses and inspection of 2,000 tongues. However, the exigencies of the political sphere were soon to interfere in a most severe manner again.

In 1966, Mao Zedong found himself locked in an internal power struggle and unleashed the “Great Cultural Revolution” to neutralize his antagonists. For ten years, all forms of  higher education came to a screeching halt. In the field of Chinese Medicine, only the entering class of 1963 was able to complete a TCM curriculum that for the first time truly reserved the label “traditional.” Since it was the main rallying cry of the Cultural Revolution to eradicate every trace of feudalist influence, all of the old master practitioners of Chinese Medicine, including the Five Elders, became subject to criticism, ridicule, and in some instances, public humiliation. As many physicians frantically burned their stitch-bound volumes and other old fashioned belongings to avoid persecution, and as others died from grief or physical abuse, much of the physical legacy of Chinese Medicine perished irretrievably.

In this vacuum, Western Medicine reasserted its defining influence on TCM, while it had to adapt to a political environment that despised erudite learning of any kind itself. Already during the previous year, in a speech given to healthcare professionals in Beijing on June 26, 1965, Mao had set the stage for the anti-intellectual direction of the new medicine to come: “Medical education needs to be reformed—it is completely unnecessary to engage in so much studying. How many years of formal education, after all,
did Hua Tuo have? And how many Li Shizhen? There is no need to restrict medical education to people with high school diplomas; middle school and elementary school pupils will do. The real learning will happen during actual practice. If this type of lowly educated doctor is then sent to the countryside, he will always be able to do a better job than the charlatan shamans; and the peasants, moreover, will be able to afford such care. Studying is a stupid endeavor for a doctor.”[11]

During the years 1966–1971, therefore, no new students were admitted by educational institutions, including schools of Chinese Medicine. In 1972, so-called Colleges for Workers, Peasants, and Soldiers (gong nong bing 11  xueyuan) were established, offering three-year vocational programs under the maxim of “open door schooling.” This meant that there were no entry exams; the admission of students was entirely based on their political status as well as the social background of their parents. Textbooks were filled with quotes from Mao Zedong’s Collected Works. The doctors produced by this system received a very rudimentary training in both Chinese and Western modalities, and provided the human resource for the well-known Barefoot Doctor Movement (chijiao yisheng yundong). The barefoot doctors, naturally, were never introduced to the essential concept of differential diagnostics. Meanwhile, the generation of Chinese Medicine elders was either dead or locked up as “bovine demons and snake-like goblins” (niugui sheshen) in so-called “ox stalls” (niupeng). Of the five elders, only Ren Yingqiu was still alive. He was banished to Qinghai province, China’s equivalent to Siberia—allowed to bring only one cherished book, Li Shizhen’s Bencao gangmu (Outline of the Materia Medica).

In the Name of Progress: The Introduction of  “Superior Methodology,” “Scientific Standards,” and “Research Axioms” During the 1980s and 1990s

Another blow to the integrity of the traditional system, or what was left of it, occurred during the period of 1980–1985. At this time, the concept of “Chinese Medicine  improvement by methodology research” (Zhongyi fangfa lun yanjiu) was introduced. The political leaders of TCM institutions, i.e. the communist party secretaries who are generally more influential than the college presidents, selected several fashionable theories of Western science and applied them to the domain of Chinese Medicine—once again motivated by the resolve to “further evolve” the field. These endeavors were generally characterized by the attempt to sanctify the “scientific character” of selected
aspects of Chinese Medicine, and consequently, by denying scientific validity (and the ensuing right to be preserved and transmitted) to others. During the period in question, the theories elected for this purpose were cybernetics (kongzhi lun), system science (xitong lun), and information theory (xinxi lun).

The result of this “assistance” was the affirmation of the TCM system on theoretical grounds. The methodologists concluded that Chinese Medicine classics such as the Huangdi neijing (Yellow Emperor’s Classic of Medicine) already contain evidence of these progressive theories in embryonic form, apparently recommending an affirmative stance toward the tradition of Chinese Medicine. On the other hand, this position implied that the classics were to be viewed like dinosaurs—interesting to look at in a museum, but, in terms of their pragmatic value in a contemporary environment, vastly inferior to the eloquent treatises of information theory, cybernetics, and other domains of modern science. As a result, many TCM colleges actually established museums, and many publishers dared again to issue reprint editions of classical texts. The original regard for the classics as the primary source of clinical information, however, dwindled as the presence of original texts in the curriculum became minimized. Again, it was a situation where a group of individuals with no traditional medical background attempted to “reform” Chinese Medicine—motivated by ideological rather than clinical considerations.

The 1990s, in the opinion of my more classically oriented teachers and myself, have seen the most severe erosion of traditional core values. I will cite the following reasons for this assessment:

  1. Due to market-driven priorities, none of the numerous TCM journals made efforts to cover the philosophical foundations of Chinese Medicine. The government, furthermore, provided no money for the traditional category of textual research (which had been a possible area of specialization for graduate students until 1988), and no graduate research projects involving only Chinese Medicine theory were permissible.
  2. The new market economy obliged TCM hospitals to be profitable. The subject of profitability was and still is intimately tied to a standardized fee structure based on an official ranking system— which, in turn, is defined by Western Medicine values, such as the quantity of modern diagnostic equipment and the amount of available beds. The hospitals thus devote a tremendous amount of effort to the acquisition and application of paraphernalia that will boost both their quality ranking and their diagnostic income. As one TCM physician put it: “little money is to be made by just feeling the pulse.” This tendency is echoed in private street clinics, where doctors are encouraged, even required, by the herbal pharmacies that employ them to prescribe large amounts of preferably expensive herbs to maximize profits.
  3.  In 1994–1995, the Ministry of Health published a host of official guidelines aimed at standardizing the mandatory process of researching the effect of new patent remedies.[12] Along with the establishment of a Chinese FDA, it was decreed that the research of Chinese Medicine patents must be conducted according to the standards of Western pharmaceutical research. Most consequentially, this meant that the traditional system of differential diagnosis (bianzheng) had to be completely replaced by allopathic diagnostics (bianbing). According to these guidelines, research on the constitutional multipurpose remedy Four Frigid Extremities Powder (Sini San), for instance, must be conducted and marketed in the context of only one diagnostic category, i.e. “cholecystitis.” Theoretical background research into the traditional rationale of a remedy is confined to 10 percent of the proposal, while diseaseoriented research has to account for 70 percent. Another point that mirrors the research protocol of Western Medicine is the obligatory focus on laboratory animal research. This development has started to turn the broadly defined clinical science of Chinese
    Medicine into a discipline that is dominated by the narrowly defined and, most importantly, completely disparate parameters of modern pharmacology. It finalizes the process of “evolution by integration” that Mao had originally prescribed for Chinese Medicine 60 years ago—a process that involves eviscerating the indigenous art of its spirit and essence, and subsequently appropriating its material hull (i.e. herbs and techniques) into the realm of an integrated medicine that declares itself scientifically superior.
  4. A new class of graduate students began to develop who cannot diagnose in differential terms anymore, and who instead are  steeped in allopathic terminology and diagnosis. Virtually all of the doctoral theses presently produced in China fall into the field of Chinese-Western integration research, or laboratory animal research related to the ratification of new patent remedies. Integrated standards for students of Chinese and Western Medicine, moreover, have produced a situation where Chinese Medicine researchers are required to utilize unwarranted equipment such as electron microscopes to achieve doctoral-level approbation. In addition to the conceptual crisis outlined in this article, the system of state-sponsored TCM is also facing a grave financial crisis. Most institutions simply cannot keep up with the rising cost of the narrowly defined type of research prescribed by the system.
    (e) Of an impressive-sounding five years in the TCM bachelor curriculum, much was (and still is) taken up by classes in foreign language, physical education, political studies, and computer training. By far, the most extensive classes are dedicated to Western Medicine contents such as anatomy, physiology, immunology, parasitology, and other topics that are unrelated to the diagnostic and therapeutic procedures of classical Chinese Medicine.  From both a quantitative and a qualitative perspective, therefore, it would not be entirely inappropriate to state that the Chinese Medicine portion in the contemporary TCM curriculum has been reduced to the status of a peripheral supplement—approximately 40 percent or less of the total amount of hours. This issue is compounded by the ongoing division of students into Western-style
    areas of specialization, such as acupuncture or bone disorders. None of the specialty students, including acupuncture department graduates, are required anymore to familiarize themselves with the realm of original teachings, not even in the radically abridged form of classical quotations that still serve to bestow an air of legitimacy
    on most official TCM textbooks.

Voices of Dissent: The Call for a Renaissance of Classical Chinese Medicine

Similar to earlier waves of elder physician protest, the increasingly declining depth of teaching and practice modes during the 1990s brought about polarization and internal dissent. While policy makers were interested in the appearance of a united front, a group of concerned scholars and administrators wrote letters to government leaders and editors of TCM journals, and circulated critical memorandums at scholarly meetings. In a communiqué entitled “A Call to Correct the Developmental Direction of Chinese Medicine and to Preserve and Cultivate the Unique Characteristics of Our Field,” Lü Bingkui, former director of the TCM section of the PRC Ministry of Health, wrote in 1991:

In recent years, the unique characteristics of Chinese Medicine, its advantages over Western Medicine, and its standards of academic excellence have not been developed according to the wishes of the people, but have rather been tossed into a state of severe crisis and chaotic actions. Underneath the bright and cheap glitter at the surface, the essence and the characteristics of Chinese Medicine are being metamorphosed and annihilated at a most perturbing rate. The primary expression of this crisis
is the Westernization of all guiding principles and methodologies of Chinese Medicine.[13]

Other notable members of this critical group were Cui Yueli (Ministry of Health), Fang Yaozhong (Chinese TCM Research Academy), Deng Tietao (Guangzhou University of TCM), Fu Jinghua (Chinese TCM Research Academy), Li Zhichong (Chinese TCM Association), and Zhu Guoben (National Ministry of TCM). In 1997, the topic of the erosion of Chinese Medicine integrity had become prevalent enough for a major publisher to bring these dissenting voices from the obscurity of back door communications to the fore by publishing them in a two-volume set, entitled Zhongyi chensi lu (Pondering Core Issues of Chinese Medicine). Scholars of lower administrative rank, however, remained cautious of voicing their opinions in public. While consulting with me about the details of a similar essay for the Journal of Chinese Medicine in 1999, for instance, one of my Chinese mentors encouraged me to publish the facts of the century-long “TCM Crisis” abroad, while choosing to circulate the Chinese translation of the article among students and colleagues at his institutions only in unpublished form.

In 2002, the critical examination of the TCM model reached a level of unprecedented openness in China. From the safe haven of a Hong Kong teaching position and backed by the preface of Deng Tietao, by now the most prominent sponsor of the classical essence movement, scholar Li Zhichong published a volume of essay collections entitled Zhongyi fuxing lun (Advocating for a Renaissance of Chinese Medicine). Featuring highly provocative section headings such as “Liberating Ourselves From the Century-Old straightjacket of Delusion in Chinese Medicine” or “Westernization—The Mortal Wound of Chinese Medicine,” these essays distinguish themselves not only by way of candor, but also by delineating clear guidelines for a revival of the science of classical Chinese Medicine. Here is a sample of the new tone introduced by Li’s book:

It is sad to see that because of several decades of wasted efforts and misguided energy, the core essence of Chinese Medicine has virtually been lost by the ignorant people who, from the top of their lungs, have been chanting the mantra of “modernization.” Even though the outer shell of Chinese Medicine education is still there—the tall buildings, the books and the students and the instructors, and the herbs that fill the markets in abundance—the real science of our medicine, especially the true essence of our theoretical foundations has been lost almost in its entirety, or has become little more than an empty slogan. As an old Chinese saying goes: “When seeking the longevity of a tree, one must safeguard its roots”—this “root,” that is the theoretical foundation of our field. A “flourishing” without root . . . is like an empty shell without hun or po.[14]

It was at this opportune time that Liu Lihong issued his passionate and comprehensive plea for a return to the medical values delineated in the classics. Since the publication of Classical Chinese Medicine, Professor Liu has emerged as China’s leading voice expressing the sense of cultural loss surrounding the knowledge system of Chinese Medicine as well as other time-honored arts and sciences. While the publisher was originally doubtful that he could move the 2,000 copies of the first edition, the Chinese version of this book has since sold more than one million copies and become one of the best-selling non-fiction books in modern China. In addition, several Chinese Medicine universities in China and the United States, including Guangzhou University of TCM and the College of Classical Chinese Medicine at National University of Natural Medicine in Portland, Oregon, have integrated the principles delineated in Classical Chinese Medicine into their core curriculum.

Professor Liu’s thoughtful and forthright approach promptly elicited official leadership support in his home province of Guangxi. In the fall of 2004, he received permission to establish a state-funded educational research institute with the goal of inviting exceptional Chinese Medicine elders who had been ignored by the institutionalized TCM system to transmit their clinical knowledge to motivated disciples, many of them experienced physicians, doctoral-level students, and practitioners returning from abroad. The first “resident elder” of the Institute for the Clinical Research of Classical Chinese Medicine was Dr. Li Ke, a physician known for his successful track record of treating acute stages of heart attack, stroke, kidney failure, and other emergency disorders with Chinese herbs (administered through nasal tubes).[15] Since then, Liu Lihong has developed the Institute into an influential platform that has reintroduced multiple classical lineages to contemporary scholarly discourse, most notably the Fire Spirit School of Sichuan herbalism (huoshen pai), the traditional system of emotional healing synthesized by the Confucian educator Wang Fengyi (1864–1937), and classical five-element-style acupuncture. Each one of these efforts has had a considerable impact on the grassroots momentum of Chinese Medicine education in China.

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

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.

Based on naturalist philosophy (Daoism, Confucianism)Based on pragmatist philosophy (scientific materialism, communism)
Alchemical (synthetic) approach: scientific endeavor defined as acknowledgment and exploration of the complexity and multidimensionality of nature and the bodyAnalytical 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 a broad base of knowledge due to intimate relationship to other traditional arts and sciencesTechnical 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 universeBased 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 yangMaterialist 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 meaningCommunicates 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 journeys Major tools: standardized courses/tests on legal responsibility and liability issues
Highly individualized, discipleship-based trainingHighly standardized, institutionalized training
Teachers are individual "master" figures who emphasize the creation of a lineage inspired atmosphere/cultureTeachers 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"
Multi-directional memorization: Memorization of classical texts that are interpreted situationally according to individual circumstancesMono-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 sensesClinical 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 itemsStandardized 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.

In conclusion, Classical Chinese Medicine represents a fervent call for respecting the art of Chinese Medicine as a science in its own right.[16] It is one of the most visible problems of twentieth-century Oriental medicine that the profession feels compelled to scour for legitimacy by conducting tests and experiments that conform to the parameters of Western Medicine. To illustrate the kind of absurdity that can potentially spring from this situation, I would like to relate an incident that I witnessed at the teaching hospital of the Chengdu College of Traditional Chinese Medicine in 1990. A respected doctor at the hospital was widely known for prescribing an herbal remedy that appeared to be highly effective in bringing about the speedy and painless delivery of babies by first-time mothers. Expecting mothers sometimes came to the hospital from as far as 50 miles away to obtain a prescription. After two decades of consistently positive feedback, a local pharmaceutical company decided to produce his formula as a patent. Before “modernization”  had become an issue, the positive testimonies of hundreds of patients would have sufficed to get the project started, but new codes demanded that  direct action of the herbal solution on the uterus must first be verified in a laboratory setting. The lab director went through great pains to exclude factors that could potentially affect the outcome of the experiment. He put a female rabbit in a sterile incubator, stabilized the temperature and light exposure, surgically isolated the uterus and placed it outside of the rabbit’s abdomen, and finally injected the herbal solution directly into the carefully extrapolated organ. To the researcher’s surprise, nothing happened, even when he repeated the experiment with a number of other animals. In a second series of experiments, he injected a variety of other substances into rabbit uteri and, after observing that some of them induced contractions, proclaimed that they were more suitable for mass production. However, when the newly “discovered” herbs, which in traditional pharmacopoeias are not at all related to uterine effects, were tested on eager mothers by the old obstetrician, they failed to produce any clinical results. Thoroughly confused, the managers of the company decided to withdraw from the project.

This incident exemplifies how the elaborate procedures of reductionist science can project a highly distorted picture of the reality of the human body, producing results that are essentially non-scientific. The traditional doctor and most of his colleagues seemed undisturbed by the outcome of the experiment, since they adhered to a set of principles demanding verification in non-sedated, intact people who deliver babies in an uncontrolled real-life environment. According to their reasoning: (a) rabbits are different from
humans; (b) human beings usually do not give birth in controlled conditions with their uterus hanging from their bellies; and (c) the remedy in question is designed to work via the digestive process of metabolic transformation rather than through direct injection into an isolated part of the organism.

Does not the prolific depth of Chinese Medicine present a scientific approach that bears the power and the promise to work the other way round? Do we always have to wait for a related discovery in Western Medicine before we sanctify qigong or other aspects of Chinese Medicine that were previously deemed “unscientific”? Could we not utilize so far
inexplicable Neijing concepts such as wuyun liuqi (cosmic cycles) and ziwu liuzhu (chrono-acupuncture) to actively inspire the nature and direction of modern scientific experiments? As the profession of Oriental medicine is stepping into a greater stage of maturity in both China and the West, it greatly needs solid respect for its own wisdom traditions, which no gloss of doctoral-level ratification or other marks of progress can deliver from the outside. As Mao Jialing stated pertinently in 2005:

“We need to revitalize Chinese Medicine! We need to bring about a  renaissance of Chinese Medicine! We need to save Chinese Medicine!” For how many decades have we been shouting these slogans now, and how many administrative measures have been passed to support, to protect, and to develop the field of Chinese Medicine, but here we are years later, still talking about the exact same issues. The decade-old problems are still problems, trapped in a vicious circle that loops back and forth in a maze of never-changing questions: “What is science?” “Is Chinese Medicine a science?” “If Chinese Medicine is a science, what type of science is it?” “If Chinese Medicine is not a science, then what is it?” . . . We can only answer this slew of questions appropriately if we advance to a deeper and more fundamental level of discourse, by understanding
the scientific significance of Chinese Medicine, and by seeking out the philosophical foundations that qualify Chinese Medicine as a scientific discipline in its own right. Only then can we generate a set of appropriate administrative measures and directives that can do justice to the unique nature and inherent advantages of Chinese Medicine, and only then can the persistent inequity between the two systems of medicine be resolved. Only in this type of environment can the genuine article prosper again.[17]

These, precisely, are the questions that Classical Chinese Medicine explores, and the task it has set for itself: to outline a timeless working model for the profession of Oriental medicine—a system that is intellectually satisfying in both its study and its practice, and that delivers consistent clinical results.

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

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University Press | All Rights Reserved


  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]