article by Volker Scheid

February 25, 2007

Dear group,

I recently learned about this discussion group from

as a result of a discussion that

transpired back in December and January on Volker

Scheid’s recent article of menopause. Apparently, one

of the troubling terms in this article was the word

“colonization,? for which Volker cites my Ph. D.

dissertation. At the risk of reviving an already

out-of-date topic with a very long-winded message, I

thought I should clarify a few things concerning this

term and share some of my thoughts on Chinese medicine

textbooks in general.

Like Volker, I am both an anthropologist and a

practitioner of Chinese medicine. As part of my Ph. D.

research (and medical training), I went through the

standard medical school program at the Beijing

University of (5 years). Chinese

medicine textbook production became a central part of

my research, and I was able to interview more than 2

dozen editors of current and past editions of the

textbooks, with a special emphasis on the Chinese

Internal Medicine textbook. When Volker uses the term

“colonization? to describe the textbook production

process, I believe he is trying to point to the fact

that a large amount of biomedical knowledge has been

“smuggled? into these textbooks. Why, he asks, does a

term for menopause have to be invented for the

gynecology textbook? It is probably a fairly safe

assumption that previous generations of Chinese

medicine doctors were quite competent at treating what

we now call “menopause? without ever calling it by

such a name. Furthermore, the introduction of this

term, he argues, can have some detrimental

consequences on clinical practice.

Although Volker’s current research looks specifically

at menopause, similar revisions can be found

throughout the textbooks. For example, certain

“disease? categories have been dropped, such as “Foot

Qi? (jiaoqi & #33050; & #27668;) or “Lung Atrophy?

(feiwei & #32954; & #30207;). Others have been modified

to be more consistent with biomedical disease

categories. For example “Wasting and Thirsting?

(xiaoke & #28040; & #28212;) is now almost universally

equated with diabetes. (I apologize if these

translations are unfamiliar. I don’t know what the

standard English glosses are.) As Volker also tries to

show, the changes are not just cosmetic. Sometimes the

pathogenesis, the diagnosis, the treatment principles,

and so on have been influenced by Western medicine

standards.

I don’t actually use the term “colonization? to

describe this process (despite Volker’s citation) and

I think it doesn’t quite capture the complexities of

what’s going on in this situation for several reasons.

I don’t know how most of you interpreted this term,

but here are my thoughts. First, “colonization?

suggests compulsion by an external political force.

Since perhaps the 1920s and 1930s, Western medicine

has been the hegemonic form of medical practice in

China. Chinese medicine doctors have been forced to

adapt to a world in which the dominant categories for

understanding health and the human body are derived

from Western medicine. So in this sense, colonization

is an appropriate metaphor, and I like its emphasis on

power asymmetries. One of the problems with this term,

however, is that it tends to erase the agency of those

doctors and scholars who were responding to these new

conditions. Developing Chinese medicine treatments for

Western medicine diseases can be seen as a strategic

and innovative response to the hegemony of

biomedicine. But the word “colonization? seems to

suggest that it is simply the result of coercion or

capitulation. I think Volker does a good job of

showing the limitations of textbook therapies for

menopause, but I think he goes too far in dismissing

the whole project. Yes, it is probably too simplistic

to just tonify Kidney yin for most menopause patients

(although I have found it helpful, as one component of

the treatment principle, in some of my menopause

cases). But for a host of social, political and

historical reasons, Chinese medicine doctors in China

simply cannot afford to exclude the Western medicine

disease categories in their clinical practice. Their

response ? to develop Chinese medicine therapies for

Western medicine diseases ? is, in my opinion, an

important response to a difficult situation. It may

not have been the only possible response, but I think

it needs to be understood within the context of the

times. (By the way, I call this situation

“postcolonial? not “colonial?; I can explain the

important distinction between these two terms later if

people are interested.)

Second, I think that Volker fails to appreciate how

textbooks are actually used in practice. He correctly

points to their rigidities. As many of you may have

discovered, if we strictly follow the treatment

paradigms as laid out in our textbooks, we are not

likely to meet with great clinical success. But this

is not news to anyone in China! None of my teachers in

China ever expected us to treat the textbooks as an

actual guide for clinical practice. They thought the

textbooks were supposed to orient us to the challenges

of clinical medicine, not give all the answers to

those challenges. As I’m sure most of you know, the

actual range of therapies for any one disease varies

immensely across doctors. The textbook therapies

represent compromises of editorial committees that

attempt to gesture towards important treatment

approaches. I doubt that anyone on those editorial

committees would actually treat their patients

according the standards of their own textbooks! (A

look at some of their published clinical cases ?

probably not available in English unfortunately -

would confirm this.) But that is not because these

doctors are trying to hoodwink us poor, ignorant

students. Rather it is a reflection of the tension

between the need for standardization and the diversity

inherent in Chinese medicine practice. As far as I can

tell, most of my Chinese classmates have packed away

their textbooks (especially the clinical ones) and are

developing their clinical skills by learning from

senior doctors and reading the innumerable other

medical sources (classical and modern) that are

available to them.

The first Chinese medicine textbooks were written for

new private schools in the early Republican period.

They were experimental texts that tried to adapt

Chinese medicine education to a totally new context ?

the classroom. Most Chinese medicine education at this

time was still carried out through apprenticeships.

But medical schools were seen as essential to the

development of the field, because school education was

already the standard for every other facet of

education in China. As best I can tell, the early

textbooks (I haven’t been able to find very many of

them) were closer to the medical classics than

contemporary textbooks but they also contained a

certain amount of biomedical knowledge. In the 1950s,

a major shift in Chinese medicine education took

place, when Chinese medicine was incorporated into the

state-run health care system. New state-run medical

schools needed high quality, standardized textbooks.

Leading doctors were brought together to write these

new textbooks. The results, in my opinion, have been

mixed. On the one hand, they often have limited

clinical applicability - a point that Volker’s article

makes quite well ? and the influence of biomedicine is

pervasive, even if it is not immediately apparent.

But on the other hand, they have been immensely

important as the foundation of the Chinese medicine

educational system, not only in China but around the

world. In my encounters and discussions with these

editors, I developed a deep appreciation of the great

challenges they faced. Whether we were educated in

China or in the West (I don’t know much about Chinese

Medicine schools in the West but what I have heard

suggests that they are closely modeled on the schools

in China), I think it is safe to say that we are all

products of this school-based, textbook-based

educational system. Although I concur with Volker

about the limitations of the textbooks, these

limitations don’t prevent us from deepening our own

knowledge through the many, many rich resources in

Chinese medicine that are already out there.

For those of you that are still with me, I hope you

have found this helpful. There is much, much more that

could be said, and I would be happy to discuss this

matter further.

I also have a separate request to make: a patient of

mine is looking for a practitioner for her sister in

Cincinnati and Savannah (the two cities where she

lives), who has been diagnosed with progressive

supranuclear palsy. (Perhaps here’s a good example

where a biomedical diagnosis might be quite helpful.)

Please pass on the names of some good practitioners in

these cities, if you happen to know any.

Regards,

Eric Karchmer

--- wrote:

February 25, 2007

Way back when, a few months ago, I downloaded the Scheid article and looked at

the citation

for his use of colonization. It was Eric Karchmer that he cited and so I

contacted him to

respond. His post preceeds this one. I still think it is a fascinating and

worthwhile discussion

for us to have.

doug

February 26, 2007

Eric,

Thanks for the informative post.

-Jason

_____

On Behalf Of Eric Karchmer

Monday, February 26, 2007 12:23 AM

article by Volker Scheid

Dear group,

I recently learned about this discussion group from

as a result of a discussion that

transpired back in December and January on Volker

Scheid's recent article of menopause. Apparently, one

of the troubling terms in this article was the word

" colonization,? for which Volker cites my Ph. D.

dissertation. At the risk of reviving an already

out-of-date topic with a very long-winded message, I

thought I should clarify a few things concerning this

term and share some of my thoughts on Chinese medicine

textbooks in general.

Like Volker, I am both an anthropologist and a

practitioner of Chinese medicine. As part of my Ph. D.

research (and medical training), I went through the

standard medical school program at the Beijing

University of (5 years). Chinese

medicine textbook production became a central part of

my research, and I was able to interview more than 2

dozen editors of current and past editions of the

textbooks, with a special emphasis on the Chinese

Internal Medicine textbook. When Volker uses the term

" colonization? to describe the textbook production

process, I believe he is trying to point to the fact

that a large amount of biomedical knowledge has been

" smuggled? into these textbooks. Why, he asks, does a

term for menopause have to be invented for the

gynecology textbook? It is probably a fairly safe

assumption that previous generations of Chinese

medicine doctors were quite competent at treating what

we now call " menopause? without ever calling it by

such a name. Furthermore, the introduction of this

term, he argues, can have some detrimental

consequences on clinical practice.

Although Volker's current research looks specifically

at menopause, similar revisions can be found

throughout the textbooks. For example, certain

" disease? categories have been dropped, such as " Foot

Qi? (jiaoqi & #33050; & #27668;) or " Lung Atrophy?

(feiwei & #32954; & #30207;). Others have been modified

to be more consistent with biomedical disease

categories. For example " Wasting and Thirsting?

(xiaoke & #28040; & #28212;) is now almost universally

equated with diabetes. (I apologize if these

translations are unfamiliar. I don't know what the

standard English glosses are.) As Volker also tries to

show, the changes are not just cosmetic. Sometimes the

pathogenesis, the diagnosis, the treatment principles,

and so on have been influenced by Western medicine

standards.

I don't actually use the term " colonization? to

describe this process (despite Volker's citation) and

I think it doesn't quite capture the complexities of

what's going on in this situation for several reasons.

I don't know how most of you interpreted this term,

but here are my thoughts. First, " colonization?

suggests compulsion by an external political force.

Since perhaps the 1920s and 1930s, Western medicine

has been the hegemonic form of medical practice in

China. Chinese medicine doctors have been forced to

adapt to a world in which the dominant categories for

understanding health and the human body are derived

from Western medicine. So in this sense, colonization

is an appropriate metaphor, and I like its emphasis on

power asymmetries. One of the problems with this term,

however, is that it tends to erase the agency of those

doctors and scholars who were responding to these new

conditions. Developing Chinese medicine treatments for

Western medicine diseases can be seen as a strategic

and innovative response to the hegemony of

biomedicine. But the word " colonization? seems to

suggest that it is simply the result of coercion or

capitulation. I think Volker does a good job of

showing the limitations of textbook therapies for

menopause, but I think he goes too far in dismissing

the whole project. Yes, it is probably too simplistic

to just tonify Kidney yin for most menopause patients

(although I have found it helpful, as one component of

the treatment principle, in some of my menopause

cases). But for a host of social, political and

historical reasons, Chinese medicine doctors in China

simply cannot afford to exclude the Western medicine

disease categories in their clinical practice. Their

response ? to develop Chinese medicine therapies for

Western medicine diseases ? is, in my opinion, an

important response to a difficult situation. It may

not have been the only possible response, but I think

it needs to be understood within the context of the

times. (By the way, I call this situation

" postcolonial? not " colonial?; I can explain the

important distinction between these two terms later if

people are interested.)

Second, I think that Volker fails to appreciate how

textbooks are actually used in practice. He correctly

points to their rigidities. As many of you may have

discovered, if we strictly follow the treatment

paradigms as laid out in our textbooks, we are not

likely to meet with great clinical success. But this

is not news to anyone in China! None of my teachers in

China ever expected us to treat the textbooks as an

actual guide for clinical practice. They thought the

textbooks were supposed to orient us to the challenges

of clinical medicine, not give all the answers to

those challenges. As I'm sure most of you know, the

actual range of therapies for any one disease varies

immensely across doctors. The textbook therapies

represent compromises of editorial committees that

attempt to gesture towards important treatment

approaches. I doubt that anyone on those editorial

committees would actually treat their patients

according the standards of their own textbooks! (A

look at some of their published clinical cases ?

probably not available in English unfortunately -

would confirm this.) But that is not because these

doctors are trying to hoodwink us poor, ignorant

students. Rather it is a reflection of the tension

between the need for standardization and the diversity

inherent in Chinese medicine practice. As far as I can

tell, most of my Chinese classmates have packed away

their textbooks (especially the clinical ones) and are

developing their clinical skills by learning from

senior doctors and reading the innumerable other

medical sources (classical and modern) that are

available to them.

The first Chinese medicine textbooks were written for

new private schools in the early Republican period.

They were experimental texts that tried to adapt

Chinese medicine education to a totally new context ?

the classroom. Most Chinese medicine education at this

time was still carried out through apprenticeships.

But medical schools were seen as essential to the

development of the field, because school education was

already the standard for every other facet of

education in China. As best I can tell, the early

textbooks (I haven't been able to find very many of

them) were closer to the medical classics than

contemporary textbooks but they also contained a

certain amount of biomedical knowledge. In the 1950s,

a major shift in Chinese medicine education took

place, when Chinese medicine was incorporated into the

state-run health care system. New state-run medical

schools needed high quality, standardized textbooks.

Leading doctors were brought together to write these

new textbooks. The results, in my opinion, have been

mixed. On the one hand, they often have limited

clinical applicability - a point that Volker's article

makes quite well ? and the influence of biomedicine is

pervasive, even if it is not immediately apparent.

But on the other hand, they have been immensely

important as the foundation of the Chinese medicine

educational system, not only in China but around the

world. In my encounters and discussions with these

editors, I developed a deep appreciation of the great

challenges they faced. Whether we were educated in

China or in the West (I don't know much about Chinese

Medicine schools in the West but what I have heard

suggests that they are closely modeled on the schools

in China), I think it is safe to say that we are all

products of this school-based, textbook-based

educational system. Although I concur with Volker

about the limitations of the textbooks, these

limitations don't prevent us from deepening our own

knowledge through the many, many rich resources in

Chinese medicine that are already out there.

For those of you that are still with me, I hope you

have found this helpful. There is much, much more that

could be said, and I would be happy to discuss this

matter further.

I also have a separate request to make: a patient of

mine is looking for a practitioner for her sister in

Cincinnati and Savannah (the two cities where she

lives), who has been diagnosed with progressive

supranuclear palsy. (Perhaps here's a good example

where a biomedical diagnosis might be quite helpful.)

Please pass on the names of some good practitioners in

these cities, if you happen to know any.

Regards,

Eric Karchmer

--- @ <%40>

wrote:

February 26, 2007

Eric,

Thanks for the very thoughtful reply.

Bob

, Eric Karchmer

<eikarchmer wrote:

>

> Dear group,

>

> I recently learned about this discussion group from

> as a result of a discussion that

> transpired back in December and January on Volker

> Scheid's recent article of menopause. Apparently, one

> of the troubling terms in this article was the word

> " colonization,? for which Volker cites my Ph. D.

> dissertation. At the risk of reviving an already

> out-of-date topic with a very long-winded message, I

> thought I should clarify a few things concerning this

> term and share some of my thoughts on Chinese medicine

> textbooks in general.

>

> Like Volker, I am both an anthropologist and a

> practitioner of Chinese medicine. As part of my Ph. D.

> research (and medical training), I went through the

> standard medical school program at the Beijing

> University of (5 years). Chinese

> medicine textbook production became a central part of

> my research, and I was able to interview more than 2

> dozen editors of current and past editions of the

> textbooks, with a special emphasis on the Chinese

> Internal Medicine textbook. When Volker uses the term

> " colonization? to describe the textbook production

> process, I believe he is trying to point to the fact

> that a large amount of biomedical knowledge has been

> " smuggled? into these textbooks. Why, he asks, does a

> term for menopause have to be invented for the

> gynecology textbook? It is probably a fairly safe

> assumption that previous generations of Chinese

> medicine doctors were quite competent at treating what

> we now call " menopause? without ever calling it by

> such a name. Furthermore, the introduction of this

> term, he argues, can have some detrimental

> consequences on clinical practice.

>

> Although Volker's current research looks specifically

> at menopause, similar revisions can be found

> throughout the textbooks. For example, certain

> " disease? categories have been dropped, such as " Foot

> Qi? (jiaoqi & #33050; & #27668;) or " Lung Atrophy?

> (feiwei & #32954; & #30207;). Others have been modified

> to be more consistent with biomedical disease

> categories. For example " Wasting and Thirsting?

> (xiaoke & #28040; & #28212;) is now almost universally

> equated with diabetes. (I apologize if these

> translations are unfamiliar. I don't know what the

> standard English glosses are.) As Volker also tries to

> show, the changes are not just cosmetic. Sometimes the

> pathogenesis, the diagnosis, the treatment principles,

> and so on have been influenced by Western medicine

> standards.

>

> I don't actually use the term " colonization? to

> describe this process (despite Volker's citation) and

> I think it doesn't quite capture the complexities of

> what's going on in this situation for several reasons.

> I don't know how most of you interpreted this term,

> but here are my thoughts. First, " colonization?

> suggests compulsion by an external political force.

> Since perhaps the 1920s and 1930s, Western medicine

> has been the hegemonic form of medical practice in

> China. Chinese medicine doctors have been forced to

> adapt to a world in which the dominant categories for

> understanding health and the human body are derived

> from Western medicine. So in this sense, colonization

> is an appropriate metaphor, and I like its emphasis on

> power asymmetries. One of the problems with this term,

> however, is that it tends to erase the agency of those

> doctors and scholars who were responding to these new

> conditions. Developing Chinese medicine treatments for

> Western medicine diseases can be seen as a strategic

> and innovative response to the hegemony of

> biomedicine. But the word " colonization? seems to

> suggest that it is simply the result of coercion or

> capitulation. I think Volker does a good job of

> showing the limitations of textbook therapies for

> menopause, but I think he goes too far in dismissing

> the whole project. Yes, it is probably too simplistic

> to just tonify Kidney yin for most menopause patients

> (although I have found it helpful, as one component of

> the treatment principle, in some of my menopause

> cases). But for a host of social, political and

> historical reasons, Chinese medicine doctors in China

> simply cannot afford to exclude the Western medicine

> disease categories in their clinical practice. Their

> response ? to develop Chinese medicine therapies for

> Western medicine diseases ? is, in my opinion, an

> important response to a difficult situation. It may

> not have been the only possible response, but I think

> it needs to be understood within the context of the

> times. (By the way, I call this situation

> " postcolonial? not " colonial?; I can explain the

> important distinction between these two terms later if

> people are interested.)

>

> Second, I think that Volker fails to appreciate how

> textbooks are actually used in practice. He correctly

> points to their rigidities. As many of you may have

> discovered, if we strictly follow the treatment

> paradigms as laid out in our textbooks, we are not

> likely to meet with great clinical success. But this

> is not news to anyone in China! None of my teachers in

> China ever expected us to treat the textbooks as an

> actual guide for clinical practice. They thought the

> textbooks were supposed to orient us to the challenges

> of clinical medicine, not give all the answers to

> those challenges. As I'm sure most of you know, the

> actual range of therapies for any one disease varies

> immensely across doctors. The textbook therapies

> represent compromises of editorial committees that

> attempt to gesture towards important treatment

> approaches. I doubt that anyone on those editorial

> committees would actually treat their patients

> according the standards of their own textbooks! (A

> look at some of their published clinical cases ?

> probably not available in English unfortunately -

> would confirm this.) But that is not because these

> doctors are trying to hoodwink us poor, ignorant

> students. Rather it is a reflection of the tension

> between the need for standardization and the diversity

> inherent in Chinese medicine practice. As far as I can

> tell, most of my Chinese classmates have packed away

> their textbooks (especially the clinical ones) and are

> developing their clinical skills by learning from

> senior doctors and reading the innumerable other

> medical sources (classical and modern) that are

> available to them.

>

> The first Chinese medicine textbooks were written for

> new private schools in the early Republican period.

> They were experimental texts that tried to adapt

> Chinese medicine education to a totally new context ?

> the classroom. Most Chinese medicine education at this

> time was still carried out through apprenticeships.

> But medical schools were seen as essential to the

> development of the field, because school education was

> already the standard for every other facet of

> education in China. As best I can tell, the early

> textbooks (I haven't been able to find very many of

> them) were closer to the medical classics than

> contemporary textbooks but they also contained a

> certain amount of biomedical knowledge. In the 1950s,

> a major shift in Chinese medicine education took

> place, when Chinese medicine was incorporated into the

> state-run health care system. New state-run medical

> schools needed high quality, standardized textbooks.

> Leading doctors were brought together to write these

> new textbooks. The results, in my opinion, have been

> mixed. On the one hand, they often have limited

> clinical applicability - a point that Volker's article

> makes quite well ? and the influence of biomedicine is

> pervasive, even if it is not immediately apparent.

> But on the other hand, they have been immensely

> important as the foundation of the Chinese medicine

> educational system, not only in China but around the

> world. In my encounters and discussions with these

> editors, I developed a deep appreciation of the great

> challenges they faced. Whether we were educated in

> China or in the West (I don't know much about Chinese

> Medicine schools in the West but what I have heard

> suggests that they are closely modeled on the schools

> in China), I think it is safe to say that we are all

> products of this school-based, textbook-based

> educational system. Although I concur with Volker

> about the limitations of the textbooks, these

> limitations don't prevent us from deepening our own

> knowledge through the many, many rich resources in

> Chinese medicine that are already out there.

>

> For those of you that are still with me, I hope you

> have found this helpful. There is much, much more that

> could be said, and I would be happy to discuss this

> matter further.

>

> I also have a separate request to make: a patient of

> mine is looking for a practitioner for her sister in

> Cincinnati and Savannah (the two cities where she

> lives), who has been diagnosed with progressive

> supranuclear palsy. (Perhaps here's a good example

> where a biomedical diagnosis might be quite helpful.)

> Please pass on the names of some good practitioners in

> these cities, if you happen to know any.

>

> Regards,

> Eric Karchmer

>

> --- wrote:

>

February 26, 2007

Yes, your post was very informative, and I for one would love to hear

more.

On Feb 25, 2007, at 11:22 PM, Eric Karchmer wrote:

>

> For those of you that are still with me, I hope you

> have found this helpful. There is much, much more that

> could be said, and I would be happy to discuss this

> matter further.

February 26, 2007

Eric, thanks for posting this. There are a number of things that have

implications for our

educational practices if not clinical practices in the West. I'm curious as to

your sense of

how the older doctors saw their writing of the textbooks. The picture I have is

of Western

trained supervisors twisting the classic doctors writings into Western thought.

I've always

wondered as to how the doctors attempted to make it work given the task ahead of

mass

education. Were any of these doctors taken from the earlier private schools

(which I hadn't

been aware of)?

Many of my Chinese colleagues say that they can easily sniff out the

academically

produced books. The " real " doctors don't have time to write books and when they

do in

their old age, they tend to be small volumes with none of the background review

materials

we see so often. Our educational, or should I say licensing task, is to memorize

these

books review, something I found and now my students find sufficiently daunting.

So as we proceed with a homogenous understanding, given the mass nature of TCM,

we

more or less speak the language of TCM. Certainly, we need to tease the

knowledge out

of those with " older " knowledge, as Jason Robertson is doing with Dr. Wang in

Beijing and

Al Stone is attempting to do with Tiande Yang in Santa Monica. Perhaps more

controversially, is Jeffery Yuan doing.

doug

> The first Chinese medicine textbooks were written for

> new private schools in the early Republican period.

> They were experimental texts that tried to adapt

> Chinese medicine education to a totally new context ?

> the classroom. Most Chinese medicine education at this

> time was still carried out through apprenticeships.

> But medical schools were seen as essential to the

> development of the field, because school education was

> already the standard for every other facet of

> education in China. As best I can tell, the early

> textbooks (I haven't been able to find very many of

> them) were closer to the medical classics than

> contemporary textbooks but they also contained a

> certain amount of biomedical knowledge. In the 1950s,

> a major shift in Chinese medicine education took

> place, when Chinese medicine was incorporated into the

> state-run health care system. New state-run medical

> schools needed high quality, standardized textbooks.

> Leading doctors were brought together to write these

> new textbooks. The results, in my opinion, have been

> mixed. On the one hand, they often have limited

> clinical applicability - a point that Volker's article

> makes quite well ? and the influence of biomedicine is

> pervasive, even if it is not immediately apparent.

> But on the other hand, they have been immensely

> important as the foundation of the Chinese medicine

> educational system, not only in China but around the

> world. In my encounters and discussions with these

> editors, I developed a deep appreciation of the great

> challenges they faced. Whether we were educated in

> China or in the West (I don't know much about Chinese

> Medicine schools in the West but what I have heard

> suggests that they are closely modeled on the schools

> in China), I think it is safe to say that we are all

> products of this school-based, textbook-based

> educational system. Although I concur with Volker

> about the limitations of the textbooks, these

> limitations don't prevent us from deepening our own

> knowledge through the many, many rich resources in

> Chinese medicine that are already out there.

>

February 27, 2007

Doug,

I think we really need to get past this idea that CM was better pre-

TCM and that, some how, post-TCM we are lacking something. A better,

more insightful practice of CM comes from a huge, all-consuming

passion for this medicine which then results in wide reading, lots of

clinical practice, and the desire plus perserverance to examine every

facet of this medicine from every possible angle until one truly gets

to the bottom of things. However, all of the foregoing must also be

coupled with superior intelligence. It is an unfortunate, politically

incorrect truth that all persons are not created equal. In every

generation, there have been and will be the three levels of CM

practice, understanding, and insight (shang/superior, zhong/mediocre,

and xia/inferior). Because it takes so much time to learn and

integrate all that needs to be understood in the superior practice of

Chinese medicine, really good Chinese doctors tend to be " old Chinese

doctors. " However, age alone does not make a superior practitioner of

CM. At this point in time, both inside China and out, I believe we all

have potential access to all the information which would allow us to

become superior practitioners. (I say " potential access " because such

access requires the ability to read primary source materials in their

original language, i.e., Chinese.)

Thinking that past generations had some secret, now lost knowledge is,

IMO, pure romantic Orientalism and Golden Ageism. I believe this

attitude has been extremely harmful to our profession in the past and

continues to be a stumbling block to our maturation in the future. It

is also my opinion that people who consciously trade on this kind of

naive belief (I won't name names) are charlatans. There simply are no

secrets or short-cuts to a superior, truly masterful practice of CM.

There is only innate intelligence coupled with wide erudition, a

passion and perserverance for studying and understanding this

medicine, and wide clinical experience. Any other attempt to shift the

blame for our own lack of understanding and clinical success is

hypocrisy (albeit usually unconscious hypocrisy).

In closing, let me be absolutely clear. I am not saying you, Doug, are

a hypocrit. I am talking about a pervasive trend in our profession

which, I believe, were implicit in your closing statements. Also,

before anyone else says it, my statements are explicitly and

intentionally judgemental. What we are talking about is superior

judgement in looking at and weighing all the potential information

about CM and then choosing what we believe to be the best. If we

somehow demonize the act of judging in our attempt to be politically

correct, then there is absolutely no way to becoming the superior CM

physician. Every single great Chinese doctor I have ever read has been

judgemental of his or her peers, and that is exactly why they were

able to come to some superior understanding of their own for which we

remember them.

Bob

, " "

wrote:

>

> Eric, thanks for posting this. There are a number of things that

have implications for our

> educational practices if not clinical practices in the West. I'm

curious as to your sense of

> how the older doctors saw their writing of the textbooks. The

picture I have is of Western

> trained supervisors twisting the classic doctors writings into

Western thought. I've always

> wondered as to how the doctors attempted to make it work given the

task ahead of mass

> education. Were any of these doctors taken from the earlier private

schools (which I hadn't

> been aware of)?

>

> Many of my Chinese colleagues say that they can easily sniff out the

academically

> produced books. The " real " doctors don't have time to write books

and when they do in

> their old age, they tend to be small volumes with none of the

background review materials

> we see so often. Our educational, or should I say licensing task, is

to memorize these

> books review, something I found and now my students find

sufficiently daunting.

>

> So as we proceed with a homogenous understanding, given the mass

nature of TCM, we

> more or less speak the language of TCM. Certainly, we need to tease

the knowledge out

> of those with " older " knowledge, as Jason Robertson is doing with

Dr. Wang in Beijing and

> Al Stone is attempting to do with Tiande Yang in Santa Monica.

Perhaps more

> controversially, is Jeffery Yuan doing.

>

> doug

>

> > The first Chinese medicine textbooks were written for

> > new private schools in the early Republican period.

> > They were experimental texts that tried to adapt

> > Chinese medicine education to a totally new context ?

> > the classroom. Most Chinese medicine education at this

> > time was still carried out through apprenticeships.

> > But medical schools were seen as essential to the

> > development of the field, because school education was

> > already the standard for every other facet of

> > education in China. As best I can tell, the early

> > textbooks (I haven't been able to find very many of

> > them) were closer to the medical classics than

> > contemporary textbooks but they also contained a

> > certain amount of biomedical knowledge. In the 1950s,

> > a major shift in Chinese medicine education took

> > place, when Chinese medicine was incorporated into the

> > state-run health care system. New state-run medical

> > schools needed high quality, standardized textbooks.

> > Leading doctors were brought together to write these

> > new textbooks. The results, in my opinion, have been

> > mixed. On the one hand, they often have limited

> > clinical applicability - a point that Volker's article

> > makes quite well ? and the influence of biomedicine is

> > pervasive, even if it is not immediately apparent.

> > But on the other hand, they have been immensely

> > important as the foundation of the Chinese medicine

> > educational system, not only in China but around the

> > world. In my encounters and discussions with these

> > editors, I developed a deep appreciation of the great

> > challenges they faced. Whether we were educated in

> > China or in the West (I don't know much about Chinese

> > Medicine schools in the West but what I have heard

> > suggests that they are closely modeled on the schools

> > in China), I think it is safe to say that we are all

> > products of this school-based, textbook-based

> > educational system. Although I concur with Volker

> > about the limitations of the textbooks, these

> > limitations don't prevent us from deepening our own

> > knowledge through the many, many rich resources in

> > Chinese medicine that are already out there.

> >

>

February 27, 2007

Bob,

Reading your post brings up lots of feelings and thoughts for me. Being only a

recent

graduate in 2005 and now having practised for only 2 years on my own I, of

course, still

have lots to learn and discover about the true depths of CM. This limited

experience does

not prevent me from developing an opinion though, as I feel the need to

communicate and

learn through discusion.

My views of CM has changed a lot since graduating. I think that while I was in

school I was

really drawn to the more passionate teachers who would quote the classics all

the time

and could put up a good argument. The intelectual pursuit of CM was fun and I

easily got

caught up in the dreamy world of what you call " romantic Orientalism " . Many of

my

teachers were very strong in there opinions that the Shang Han Lun was the

climax of CM

history and everything since is a fallen version. Some teachers have taken the

theories of

cold attack and applied it towards every possible situation, ie instead of

giving Yin Qiao

San for a sore throat in an acute attack of wind heat, blast it with some yang

school style

formula with Fu Zi in it. The idea being that the sore throat will worsen but

then go away

quickly and not linger around for days and days. They believed that the cold

medicinals

were too hard on the spleen and that they led to a worse prognosis later in

time.

I have also trained with teachers like Mazin Al Khafaji who believes the total

opposite. He

says that people are very resiliant and that we should not be afraid to give

large doses of

herbs to clear heat, especially in the beginning of treatment for chronic skin

disorders. He

doesn't put any spleen tonics in most of his formulas and actually is looking

for the stools

to become loose so that heat may be purged. Saying that the proper dose of Sheng

Di

Huang for clearing blood heat is when the stools become loose, ie. comfortable

diarrhea.

Now what I am getting at here is that I am always a bit confused with the

differing views

and ideals. Some rely on old classical quotes and argue to the tenth degree,

while others

rely on pure clinical practise. This is where I am at now in my practise. I tend

to listen

more to the ones who can back up their ideas with sound clinical evidence,

rather than

some intelectual ideal based upon some old classic. I have strong faith in the

classics, but

they are meant to be prooved not followed blindly.

So the difference between what my early teachers preached and what I saw with

Mazin's

practise is that I found my early teachers were good at preaching,but maybe not

so good

in the clinic. Where as Mazin has thousands of pictures to back up the results

he

experienced with thousands of patients over a couple of decades. I tend to trust

his advice

over the preachers, because he has the evidence to back up his claims. He

teaches purely

from his clinical practise.

So anyways I agrre with you that the modern practice of CM is one of collecting

a variety of

materials from both literature and clinical practise. What it really comes down

to in the

end, for me, is results, that the patient gets better, both in the short and

long term.

Trevor

, " Bob Flaws " <pemachophel2001

wrote:

>

> Doug,

>

> I think we really need to get past this idea that CM was better pre-

> TCM and that, some how, post-TCM we are lacking something. A better,

> more insightful practice of CM comes from a huge, all-consuming

> passion for this medicine which then results in wide reading, lots of

> clinical practice, and the desire plus perserverance to examine every

> facet of this medicine from every possible angle until one truly gets

> to the bottom of things. However, all of the foregoing must also be

> coupled with superior intelligence. It is an unfortunate, politically

> incorrect truth that all persons are not created equal. In every

> generation, there have been and will be the three levels of CM

> practice, understanding, and insight (shang/superior, zhong/mediocre,

> and xia/inferior). Because it takes so much time to learn and

> integrate all that needs to be understood in the superior practice of

> Chinese medicine, really good Chinese doctors tend to be " old Chinese

> doctors. " However, age alone does not make a superior practitioner of

> CM. At this point in time, both inside China and out, I believe we all

> have potential access to all the information which would allow us to

> become superior practitioners. (I say " potential access " because such

> access requires the ability to read primary source materials in their

> original language, i.e., Chinese.)

>

> Thinking that past generations had some secret, now lost knowledge is,

> IMO, pure romantic Orientalism and Golden Ageism. I believe this

> attitude has been extremely harmful to our profession in the past and

> continues to be a stumbling block to our maturation in the future. It

> is also my opinion that people who consciously trade on this kind of

> naive belief (I won't name names) are charlatans. There simply are no

> secrets or short-cuts to a superior, truly masterful practice of CM.

> There is only innate intelligence coupled with wide erudition, a

> passion and perserverance for studying and understanding this

> medicine, and wide clinical experience. Any other attempt to shift the

> blame for our own lack of understanding and clinical success is

> hypocrisy (albeit usually unconscious hypocrisy).

>

> In closing, let me be absolutely clear. I am not saying you, Doug, are

> a hypocrit. I am talking about a pervasive trend in our profession

> which, I believe, were implicit in your closing statements. Also,

> before anyone else says it, my statements are explicitly and

> intentionally judgemental. What we are talking about is superior

> judgement in looking at and weighing all the potential information

> about CM and then choosing what we believe to be the best. If we

> somehow demonize the act of judging in our attempt to be politically

> correct, then there is absolutely no way to becoming the superior CM

> physician. Every single great Chinese doctor I have ever read has been

> judgemental of his or her peers, and that is exactly why they were

> able to come to some superior understanding of their own for which we

> remember them.

>

> Bob

>

> , " "

> <taiqi@> wrote:

> >

> > Eric, thanks for posting this. There are a number of things that

> have implications for our

> > educational practices if not clinical practices in the West. I'm

> curious as to your sense of

> > how the older doctors saw their writing of the textbooks. The

> picture I have is of Western

> > trained supervisors twisting the classic doctors writings into

> Western thought. I've always

> > wondered as to how the doctors attempted to make it work given the

> task ahead of mass

> > education. Were any of these doctors taken from the earlier private

> schools (which I hadn't

> > been aware of)?

> >

> > Many of my Chinese colleagues say that they can easily sniff out the

> academically

> > produced books. The " real " doctors don't have time to write books

> and when they do in

> > their old age, they tend to be small volumes with none of the

> background review materials

> > we see so often. Our educational, or should I say licensing task, is

> to memorize these

> > books review, something I found and now my students find

> sufficiently daunting.

> >

> > So as we proceed with a homogenous understanding, given the mass

> nature of TCM, we

> > more or less speak the language of TCM. Certainly, we need to tease

> the knowledge out

> > of those with " older " knowledge, as Jason Robertson is doing with

> Dr. Wang in Beijing and

> > Al Stone is attempting to do with Tiande Yang in Santa Monica.

> Perhaps more

> > controversially, is Jeffery Yuan doing.

> >

> > doug

> >

> > > The first Chinese medicine textbooks were written for

> > > new private schools in the early Republican period.

> > > They were experimental texts that tried to adapt

> > > Chinese medicine education to a totally new context ?

> > > the classroom. Most Chinese medicine education at this

> > > time was still carried out through apprenticeships.

> > > But medical schools were seen as essential to the

> > > development of the field, because school education was

> > > already the standard for every other facet of

> > > education in China. As best I can tell, the early

> > > textbooks (I haven't been able to find very many of

> > > them) were closer to the medical classics than

> > > contemporary textbooks but they also contained a

> > > certain amount of biomedical knowledge. In the 1950s,

> > > a major shift in Chinese medicine education took

> > > place, when Chinese medicine was incorporated into the

> > > state-run health care system. New state-run medical

> > > schools needed high quality, standardized textbooks.

> > > Leading doctors were brought together to write these

> > > new textbooks. The results, in my opinion, have been

> > > mixed. On the one hand, they often have limited

> > > clinical applicability - a point that Volker's article

> > > makes quite well ? and the influence of biomedicine is

> > > pervasive, even if it is not immediately apparent.

> > > But on the other hand, they have been immensely

> > > important as the foundation of the Chinese medicine

> > > educational system, not only in China but around the

> > > world. In my encounters and discussions with these

> > > editors, I developed a deep appreciation of the great

> > > challenges they faced. Whether we were educated in

> > > China or in the West (I don't know much about Chinese

> > > Medicine schools in the West but what I have heard

> > > suggests that they are closely modeled on the schools

> > > in China), I think it is safe to say that we are all

> > > products of this school-based, textbook-based

> > > educational system. Although I concur with Volker

> > > about the limitations of the textbooks, these

> > > limitations don't prevent us from deepening our own

> > > knowledge through the many, many rich resources in

> > > Chinese medicine that are already out there.

> > >

> >

>

February 27, 2007

Bob, I truly don't believe that CM was better than TCM. If I was making a

dichotomy I

wanted it to be between that of the textbooks and that of clinical experience.

Perhaps it

was the my misfortunate use of " older knowlege " that disturbed you. Wang and

Yang

certainly have 40, 50 years of experience... Yuan, I don't know much about his

clinical

experience. However, I have taken a course of his " classics " and he undoubtably

knows his

stuff well. His woo-woo (wu-wu?) stuff we can take or leave.

Post revolution TCM has allowed probably all of us in this room and most of my

Chinese

colleagues to study and practice this medicine. I have no doubt that there were

(and are)

crappy family traditions. I do believe TCM brought together the best and

brightest to

create a concensus medicine. That is why I am curious as to Eric's perceptions

of how the

doctors saw their own processes in writing these textbooks.

I asked this question of pre and post TCM this morning to a younger Chinese

colleague.

His explanation was that in the TCM schools you get a " wide " knowledge. The old

days

were " deeper " . A family tradition may be really bad or at best have a couple of

good things

for a disease or two. A family tradition could also be great but not as " wide "

of what TCM

attempts, some acupuncture, herbs, tuina, Western etc...

Despite my TCM appreciation there are things that are left out. Perhaps not the

heart and

soul (and spirituality etc...) that would some claim. And I have only a

beginners knowledge

of TCM so I wouldn't claim that not knowing something else is an impediment to

my

clinical success. But again, if doctors are storing their textbooks after

graduation then I

want to know what they have found out in the intervening years.

In short, Bob, I don't think we are that far apart on our views of TCM.