The shallowness of modern TCM

January 24, 2006

With current computer technology and easy availability of reference

texts, the elitism of TCM in its former Chinese days can be overcome.

With access to computerized training tools and reference databases,

practitioners have few excuses not to learn bian-zheng diagnostic

skills well, except the limitations in their own abilities. After

several years of having students and practitioners use our TCM Herbal

Tutor software, of which a key component is teaching bian-zheng

pattern differentiation by means of an unlimited number of randomly

generated " puzzles " or brain-twisters, I believe that the limiting

factor is the practitioner's intelligence and puzzle-solving ability.

It's like the difference between memorizing the rules of chess (or

memorizing the pattern definitions and TCM materia medica) and

playing a game of chess skillfully. Ability to play the game

skillfully cannot be gained regardless of how perfectly one has

memorized the rules, but only by practice actually playing games.

(Chess-playing software has now become so good that all but the most

skilled players will benefit by pitting their skills against such

software.)

I've written numerous articles on this subject, but it seems that

most schools insist upon the old-style focus on rote memorization as

a training tool, when there are now ways to go far beyond this level

of ability.

See the following article which discusses some of the logical

problems in bian-zheng pattern differentiation in complex (multi-

syndrome) cases:

http://www.rmhiherbal.org/review/2002-2.html

There is nothing wrong with cookbook techniques and methods that are

statistically likely to help a majority of people. In the interest of

maximizing health care to all levels of society, there will always be

a demand for this. What frustrates me is the almost anti-intellectual

trends I see in the profession and in the schools that enforce the

lowest common denominator on everyone who wishes to become part of

the profession. There are plenty of students who wish to go beyond

this, and I feel that these students should be allowed to tailor

their own educations, utilize apprenticeships, and be able to

circumvent the tyranny of mediocrity that is now imposed by many TCM

colleges. If the profession is to progress and develop, these people

should be encouraged. Instead, independent study and apprenticeships

are under attack by the schools and accrediting bodies who obviously

make more money by forcing everyone down the standard assembly line,

which has been shown in most cases to be a miserable failure at

teaching bian-zheng skills. I've had plenty of students who have

already graduated from TCM colleges and have listened to their

complaints.

I also agree with your's and Heiner's perspectives about the broader

implications of TCM as a philosophical system, whose import goes far

beyond herbs and acupuncture. In fact I warn potential students that

if they are interested in becoming merely an herbal technician, they

will probably not be happy at our school. Looking at the broader

implications of the traditional Chinese system of thought on science

and society at large is an exercise that can only deepen one's

understanding. It saddens me when people fear to do this; it's almost

as if they are afraid to shake off their chains, which have become

comfortable after years of wearing.

---Roger Wicke PhD

Rocky Mountain Herbal Institute

website: www.rmhiherbal.org

email: www.rmhiherbal.org/contact/

On Jan 24, 2006, at 12:37, " bianzhengnazi " <lionel.y.chan

wrote:

> Hello fellow CHA-ers,

>

> I am seeking your feedback on my essay below. Please keep in mind

> that it is only draft and may need to double check on some things, so

> if you see anything obviously wrong with it then I am happy to hear

> eveything you have to say. Please also note that throughout the

> article, I refer to " TCM " in the narrow sense as Fruehauf is using.

>

> Cheers!

>

> ----------------

>

> I am sympathetic to the concerns of individuals such as Heiner

> Fruehauf, that are ardent critics of existing trends in modernization

> of CM and the " institutionalized phenomenon presently known as " TCM "

> (traditional Chinese medicine) " . The perspective is well summarized

> in an introduction to one of Fruehauf's pieces on this topic here

> (http://www.classicalchinesemedicine.org/ccm/tcmgermany05.htm):

>

> " This article is based on the conviction that the traditional art of

> Oriental medicine is dying--both in mainland China, home of the mother

> trunk of the field, and consequently overseas where branches of the

> tree are trying to grow. ...

>

> As I have written

> (http://forums.acupuncture.net.au/viewtopic.php?t=267), what is truly

> revolutionary about CM and Chinese philosophy generally is in the way

> of seeing and relating it encourages, not just of the practitioner in

> diagnosing the patient, but of all of us in relation to the world. At

> its root, it shows us how and why it is vitally important for our

> health and happiness that the subjective immediacy of all that we

> experience be not just immediately written off as unimportant unless

> there is a way to objectively verify it (and/or an authority has done

> so for us). It suggests that our over-reliance on an undeniably

> useful intellectual/conceptual filter in interpreting the world, when

> we forget that there is and always has been something before the

> filter, leaves a world that is much less worthwhile living in. And as

> the TCM community slowly but surely detaches itself from deeply

> understanding this basic philosophy from which it itself originally

> sprung, it too is in danger of become a lackey (albeit a troublesome

> one) of this cold objectifying worldview.

>

....

> The problem with pre-modern Chinese culture, for all its beauty and

> depth and spirituality, is that it was incredibly elitist. The gap

> between rich and poor, both materially and non-materially, was

> probably as large as if not the largest of any other culture in

> existence. This meant that people that were lucky enough to have the

> background, the contacts, the resources, the money, or maybe just the

> sheer individual brilliance, etc to learn and really deeply understand

> Daoist internal alchemy and Classical could use the

> opportunity to work hard and do so, but many could not even really

> begin. For the majority of the population, the culture allowed people

> to see that certain things were important and should be respected, but

> did not have the resources or political structure to provide the tools

> with which the average citizen could really understand why they were

> important. The result of such a gap is a people that on average could

> be very prone to false superstitious beliefs, because as far as they

> could tell the false superstitious and the truly profound looked

> exactly the same. That's why when an equalizing opportunity like

> Communism (modernity) came along, a great fury was unleashed from the

> lowest classes of the Chinese people against that in traditional

> culture they saw they had been long denied real access to.

>

> TCM could be seen in a similar vein. It is fairly well established by

> now that " bian zheng lun zhi " or anything resembling that ideal was

> not what the majority of those that dispensed herbs and practiced

> acupuncture took heed of. It instead was again a mark of the elite –

> the educated scholar-physicians that had the time, resources, and

> access to the texts that allowed them to develop a deep understanding

> of its principles, and those lucky enough to find themselves to be

> able to learn personally from great practitioners and/or Daoist

> masters. There could not have been many of these in number, given

> what we already know, ...

January 25, 2006

I agree with most of the ideas in the following article:

http://www.classicalchinesemedicine.org/ccm/tcmgermany05.htm

The historical details generally match those described to me by one

of my own teachers, C.S. Cheung. He experienced the Cultural

Revolution personally, spending time in a " re-education " camp as one

the intellectuals in need of " reform " . With Heiner's detailed and

thoughtful critique, plus Dr. Chueng's first-hand confirmation of

many of these details, any westerner who questions the accuracy of

this article is under an obligation to state **in detail**, with a

level of scholarly argument to match, why he or she disagrees and

present **evidence**, historical or otherwise. It is disrespectful of

such scholar's work to dismiss it without even giving an explanation,

as if this were merely something we could vote on to decide the

outcome. This smacks of the anti-intellectual climate that Heiner is

criticizing, that has infected " TCM " education both China and the U.S.

I've put the article on a list of recommended reading for my own

students. It should be required reading for all TCM instructors and

administrators.

---Roger Wicke PhD

Rocky Mountain Herbal Institute

website: www.rmhiherbal.org

email: www.rmhiherbal.org/contact/

On Jan 25, 2006, at 13:15, wrote:

> " " <alonmarcus

> Re: The shallowness of modern TCM (and why this is a good

> thing)

>

> I have not read the entire article but looked at the table. Do

> people agree with his characterization of TCM? I do not

>

January 25, 2006

I don't have an issue with the text, it's the assumptions about what pre-Maoist

CM was

that I question. I think it's a good text, not without its prejudices. In

particular I wonder

about what I feel is the collapsing of all pre-TCM CM with ancient texts and

daoism. I do

like the statement at the end of the table that students preport to follow the

left (pre-TCM)

in theory while following the TCM side in practice. I'll note that the article

(I believe) was

brought to our attention by someone who had written a counter article, not as

scholarly

perhaps but as passionate.

To quote Donald Harper about 3rd Century BC texts, " Secrecy, disciples, debates

over the

interpretation of theory, derisive statements about the poor quality of others'

books- all

have a place in the social history of early Chinese medicine. I have not even

discussed

professional competition as a motive for physiciians' conduct, and must leave in

for future

study ( there are many relevant passages in the Huandi Neijing). Early Chinese

Medical

Literature (The Mawandui Medical Manuscripts) P.67

, Roger Wicke <rw2@r...> wrote:

>

> I agree with most of the ideas in the following article:

> http://www.classicalchinesemedicine.org/ccm/tcmgermany05.htm

>

> The historical details generally match those described to me by one

> of my own teachers, C.S. Cheung. He experienced the Cultural

> Revolution personally, spending time in a " re-education " camp as one

> the intellectuals in need of " reform " . With Heiner's detailed and

> thoughtful critique, plus Dr. Chueng's first-hand confirmation of

> many of these details, any westerner who questions the accuracy of

> this article is under an obligation to state **in detail**, with a

> level of scholarly argument to match, why he or she disagrees and

> present **evidence**, historical or otherwise. It is disrespectful of

> such scholar's work to dismiss it without even giving an explanation,

> as if this were merely something we could vote on to decide the

> outcome. This smacks of the anti-intellectual climate that Heiner is

> criticizing, that has infected " TCM " education both China and the U.S.

>

> I've put the article on a list of recommended reading for my own

> students. It should be required reading for all TCM instructors and

> administrators.

>

> ---Roger Wicke PhD

> Rocky Mountain Herbal Institute

> website: www.rmhiherbal.org

> email: www.rmhiherbal.org/contact/

>

> On Jan 25, 2006, at 13:15, wrote:

>

> > " " <alonmarcus@w...>

> > Re: The shallowness of modern TCM (and why this is a good

> > thing)

> >

> > I have not read the entire article but looked at the table. Do

> > people agree with his characterization of TCM? I do not

> >

>

January 26, 2006

Re: the article:

http://www.classicalchinesemedicine.org/ccm/tcmgermany05.htm

After reading other people's replies, I realize that most of the

disagreement focuses on the table, a small part of the article, and

which I interpret as a theoretical positing of extremes, as in Yin

and Yang. Most practitioners will fall somewhere in between in terms

of their actual practice style. Heiner actually states in a preface

to the table, " 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. "

However, from the text of Heiner's entire article, I think he

presents a solid case that the **trend** in mainland China, at least

from about 1920 to recently, has been steadily toward a world-view

based on scientific materialism (or as I prefer to call it,

" materialistic scientism " ), which has no room for the experience-

focused philosophy of traditional Chinese medicine.

The entire article is worth reading. Heiner is articulate and

methodical in his presentation. If no one else will defend his

article, I will.

Here are a few quotes from the article that I agree with:

" From both my own perspective and that of my most respected teachers

in China (including high ranking administrators within the TCM

system), modern TCM in East and West is about to reach the “fall

height” of the classical tragedy--featuring the vainglorious

protagonist luxuriating at lofty heights (i.e. mainstream acceptance

and doctoral level ratification), while blindly cutting into the life

supply line without having a clue of the consequences.

"

" A new class of graduate students [in China] is developing who cannot

diagnose in differential terms at all anymore, but are completely

steeped in the allopathic system of medical 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.

"

rw: also true in the U.S. - bian-zheng differentiation skills poor

" In a communiqué entitled “A Call to Correct the Developmental

Direction of and to Preserve and Cultivate the

Unique Characteristics of Our Field,” Lü Bingkui, former director of

the TCM section of the P.R.C. 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.11

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). "

rw: same in the U.S. Increasing focus on courses in western medical

diagnosis and integrating with allopathic medicine, the status and

" cheap glitter " of doctoral programs, yet most graduates have poor if

non-existent skills in bian-zheng differentiation, as a diminishing

portion of curriculum is spent on this skill. How can anyone

justifiably call him- or herself a traditional Chinese doctor or

herbalist without knowing this?

" 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 ,”

these essays distinguish themselves not only by way of candor, but

also by delineating clear guidelines for a renaissance of the

classical science of 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.12 "

....

" 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 Daoist philosopher-poet in their private life, while

adhering to pragmatist Confucian values when acting in public. "

rw: I have also met a lot of practitioners and TCM school graduates

who **claim** to adhere to the ideals of traditional Chinese

medicine, but who in the daily course of their practice, think more

like western doctors (what herbs are good for hepatitis-C? What herbs

will lower this patient's cholesterol?, blah blah blah). The

traditional Chinese stuff is merely a facade for an ersatz version of

western medicine.

His criticisms of so-called scientific research of TCM herbal

medicine are devastatingly accurate, in my opinion. Clinical research

that tests effectiveness of herbs in medically defined conditions

without any reference to the bian-zheng characterizations of

individual study participants is highly suspect and of dubious value

to the practitioner. It is for reasons that Heiner outlines in his

article that I have chosen to omit references to Chinese clinical

research in my textbooks, as it is misleading and in many cases of

dubious accuracy, especially given that the criteria for

" effectiveness " in specific medical conditions is rarely defined, not

to mention that control groups are often not even included.

See:

http://www.rmhiherbal.org/review/2003-2.html#t-sing

for my own criticisms of Chinese clinical research studies.

The large number of influential professionals in China who, according

to the article, see these problems is encouraging. The profession

needs a hard kick in the rear to clean up these many abuses, and I am

heartened to see that Chinese professionals are being openly blunt.

If they start squabbling amongst themselves like we cantankerous

Americans, maybe there's hope.

---Roger Wicke PhD

Rocky Mountain Herbal Institute

website: www.rmhiherbal.org

email: www.rmhiherbal.org/contact/

January 26, 2006

Roger,

I don't think anyone is discounting the excesses of the Cultural

Revolution. I have teachers who were also imprisoned, beaten, and

forbidden to teach during those years. However, that was then and this

is now. If one equates TCM with what was promulgated during the

Cultural Revolution, then that's a historically inaccurate view of

this style of Chinese medicine. If you ask Chinese scholars about the

beginnings or foundation of this style, you are sent back to the 1747

publication of the Yi Zong Jin Jian (Golden Mirror of Ancestral [or

Gathered] Medicine) which was a Qing dynasty attempt to winnow out all

that was best in the previous 2,000 years of CM.

Marnae and Kevin are currently writing a history of CM for Blue Poppy

Press which specifically attempts to put the record straight in terms

of the development of TCM. This development began long before the

Cultural Revolution and has continued for decades since. If one reads

the contemporary Chinese medical literature, you will see that no one

is limiting what can and cannot be read or done. In fact, I see a very

definite trend in the CM journal literature to go back and re-explore

the premodern texts and theories. This may be only one trend among

many, but it can be identified.

Bob

January 26, 2006

I agree with Bob 100% here. I have had Chinese teachers that had much

different experiences than what is described in Heiner's article. I

actually find the article a poor read because it is so incredibly biased.

When one has such a strong view, one can easily find quotes and rants to

support their belief. Furthermore, many of his ideas are just that, his

negative views.

Many of my Chinese teachers (Many trained in the 80's) said they were always

encouraged to read the classics and had full access to 1000's of classical

and pre-modern books. They did not practice some cookbook method, but a

rich integrative medicine, with strong classical roots as well newly

understood modern ideas. Large libraries were not kept from the students,

but were there to take from at any time. Many were required to memorize such

classical works. Although much of the article's historical record cannot be

debated, is a large field with a complex history. I think

it is a little too black and white. I also, as Bob mentioned, see many

journal articles coming out of China that do have a strong classical roots.

To sum up: I do not see TCM as shallow, I do not see it as being squished, I

see it flourishing and evolving in many directions. I guess it is all about

perception.

My 2 cents-

-

>

> On Behalf Of Bob Flaws

> Thursday, January 26, 2006 9:00 AM

>

> Re: The shallowness of modern TCM

>

> Roger,

>

> I don't think anyone is discounting the excesses of the Cultural

> Revolution. I have teachers who were also imprisoned, beaten, and

> forbidden to teach during those years. However, that was then and this

> is now. If one equates TCM with what was promulgated during the

> Cultural Revolution, then that's a historically inaccurate view of

> this style of Chinese medicine. If you ask Chinese scholars about the

> beginnings or foundation of this style, you are sent back to the 1747

> publication of the Yi Zong Jin Jian (Golden Mirror of Ancestral [or

> Gathered] Medicine) which was a Qing dynasty attempt to winnow out all

> that was best in the previous 2,000 years of CM.

>

> Marnae and Kevin are currently writing a history of CM for Blue Poppy

> Press which specifically attempts to put the record straight in terms

> of the development of TCM. This development began long before the

> Cultural Revolution and has continued for decades since. If one reads

> the contemporary Chinese medical literature, you will see that no one

> is limiting what can and cannot be read or done. In fact, I see a very

> definite trend in the CM journal literature to go back and re-explore

> the premodern texts and theories. This may be only one trend among

> many, but it can be identified.

>

> Bob

Chinese Herbal Medicine offers various professional services, including

> board approved continuing education classes, an annual conference and a

> free discussion forum in Chinese Herbal Medicine.

>

January 26, 2006

I am sure that things are as diverse in China as they have always been. As Jason

said many of the Dr i studied with in china could resite entire classical books

by heart. To state they did not know pattern dx is ridiculous. I current state

of CM is born out of the difficulties inherent to the system. It is a highly

subjective operator dependent system and therefore leads to diverse roads taken

by different practitioners. Also, to suggest that CM has to stop its timely

development if again a highly romantic stance. As i asked many times which

period of its development is kosher? The idea that we should not look at modern

parameters to see and measure outcome is a highly religious stance and makes no

sense at all.

Oakland, CA 94609

-

Thursday, January 26, 2006 8:24 AM

RE: Re: The shallowness of modern TCM