It occurs to me that some basic context needs to be established for this blog to make sense. It reminds me of the part of any thesis or dissertation where you state outright your terms and definitions, as well as the assumptions you won’t be arguing for in the paper. Before you read this content in a thesis or dissertation, it’s hard to fully understand the theory being advanced. While I won’t be providing “a theory” in this blog – there are certainly things that are important to understand at the get-go.
I will talk a lot about Classical Chinese Medicine (CCM) as the program I’m in is devoted to the study of that particular form of Chinese Medicine (CM). This is distinguished from Traditional Chinese Medicine in a number of ways, some of which I will try to make clear here. The first and most fundamental difference between CCM and Traditional Chinese Medicine (TCM) is that the former draws most deeply from the Classical literature of CM when interacting with patients. The intake process, the patient-doctor interaction, the methods used for diagnosis and the form of the diagnosis, the application of acupuncture, herbs and other modalities, the reasoning out of prognosis – all of these should be primarily (if not completely) based on Classical sources and their most faithful commentaries. TCM, although it does pay lip service to the Classics – and some TCM practitioners take it on themselves to delve more deeply into the canon – does not rely primarily on these sources in its practice.
What are these Classics? This is open to some degree of interpretation. Most would agree that the Huang Di Nei Jing 皇帝內經 (Yellow Emperor’s Internal Classic), the Nan Jing 難經 (Classic of Difficulties) and the Shen Nong Ben Cao Jing 神 農 本 草 經 (Divine Farmer’s Herbal Classic) and the Shang Han Lun 傷寒論 (Treatise on Cold Damage) are the foundational texts of this medicine. Others might add other medical texts and all would certainly include commentaries and further developments of these basic works. All of these books were written during or before the Han dynasty. You may be wondering what possible relevance books written 220 A.D. and prior could have for contemporary medicine… a fair question. This is an issue I will certainly be discussing on this blog, but for now let me just say that my empirical relationship with this medicine has led me to believe that a nearly rigid adherence to the Classics produces excellent clinical results. Let that be okay for now.
CCM simply takes its historical and cultural roots very seriously. It pays attention to the fact that many medical classics thought it of vital importance that practitioners cultivate themselves using the arts, contemplation, interaction with nature and various esoteric practices. It asserts that the Classical texts are not the mistaken ramblings of a primitive people but a record of (parts of) a sophisticated medical system that has vital relevance for contemporary people. CCM does not make its primary aim to justify itself in the language and method of Western scientific materialism. It does not sacrifice the knowledge that comes from grappling with difficult, often symbolic, literature for the sake of quick and easy one-size-fits-all treatment protocols. For further information about the development of TCM and its deep differences with CCM, please see the article by one of my respected mentors, Heiner Fruehauf. You can find it, and the rest of his fine website here.
My personal experience of the difference between TCM and CCM has been profound. While TCM has some approaches that have clinical effectiveness and while its insistence on becoming closely entwined with Western medicine has had a few positive impacts on the profession, it doesn’t come close to transforming people’s situations in the way that CCM can and often does. I believe this has to do with CCM practitioners’ acceptance of and ability to work with complexity. The human body is an unbelievably complex thing and a medicine that seeks to simplify relentlessly in diagnosis and treatment can’t hope to keep up. Things will be missed, and those missed things always have the potential to grow into a problem as big or bigger than the original issue. I also believe that the way that learning this medicine works on its practitioners produces consistently excellent people. I will be developing my thoughts on this as time goes on – I am currently writing a thesis in Applied Ethics at Oregon State University that will cover this topic in depth. I hope to post chapters and thoughts from it as it develops.
Eric
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Hi all,
I am just about to begin my studies so I haven’t formed an opinion about formal TCM education yet. But does anyone have opinion on this? I took a look at my curriculum, and I’m pretty sure that most if not all of what I am going to learn draws from the classics. Aren’t all the TCM theories from these texts?
I’ve posed this same question elsewhere and I’ve gotten responses that indicate TCM is more or less a 50 year old tradition that was heavily influenced by the Chinese government, Western theory and eradication of anything that seemed superstitious.
I was under the assumption that TCM is wildly different from Western med and that’s what initially captured my interest. I sat in on one class before I initially applied to my school just to get a feel for the material; and it was completely over my head. It was a real shock to hear some of the things that were said in class because my undergrad degree was in psych and bio.
Any thoughts?
Thanks!
Katrina
was wondering if tiger penis soup is taught in CCM. serious question..
Christopher,
Assuming you are serious…
I have never been taught about using endangered animal parts. All reputable herbalists omit the use of endangered ingredients in their practices. That being said, some herbal teachers may discuss the use of these items while highlighting that they are no longer available.
There are plenty of alternatives available.
Eric
I am enjoying reading your posts. However, I would caution against acquiring 2nd hand prejudices about what may or may not be taught at different Chinese Medicine schools in the US, and then passing those opinions on to others. Unless you have actually been through the entire program at any type of school, and I say this with all respect, you can’t possibly know what the entire experience is. There is a wide array of instructors, and they are all, ultimately, rooted in the classics.
Sara,
I appreciate your comment but confess I am a little confused by it. I have investigated many programs of CM across the US and talked with countless students and even some professors at those institutions. I have also talked with my own teachers, several of which got their education at various US institutions (the balance receiving theirs in other countries). I trust their opinons, which are not monolithic, but tend to agree within a certain degree of deviation from one another. While many schools have classes in the Classics, while many professors pay lip service to the classics – few actually teach from the classics or delve deeply enough into them to be really helpful. That’s why I’m going to the school I’m going to.
Regardless, that’s not really what this post is about. Suggesting that because all of Chinese medicine is – trivially – based in the Classics I think is beside the point. Western medicine is, in this way, based on the Classics of its medicine but I don’t think we would talk about it this way. There is a lot that has been lost in TCM and Zang Fu theory and I’m not really sure why I shouldn’t be passing this opinion on to others – particularly on my own blog.
I have seen and felt the clinical superiority of medicine that takes the Classics as their soil, root and flower and I’m happy to share that experience with anyone who is willing to listen.
My best,
Eric
Can you recommend a good CM school in the Houston area?
Imelda,
I’m not familiar with that part of the country. A good resource, if you haven’t yet visited it, is tcmstudent.com — go to the message boards (accessed along the left sidebar) and into the student section of the website. There are often good threads for any area that you can read through. If you don’t find an answer to your question, go ahead and ask in the appropriate section of the boards.
Good luck!
Eric Grey
Hi Eric,
Have you heard anything about the classical Chinese medicine program at Jung Tao School of Classical Chinese Medicine (www.jungtao.edu) in North Carolina or Jeffrey Yuen’s program at Swedish Institute School of Acupuncture and Oriental Studies (http://www.swedishinstitute.org/Acupuncture/index.htm) in New York?
—David
Hey David,
I’m sort of familiar with both, but not enough to make any extensive recommendations. My advice would be to call both schools (and any others you are interested in) and get as many materials as they will send you. Of course, ultimately, a visit is key. I know that over at tcmstudent.com you can find discussions about both schools in the forums (access the forums through a link somewhere on the left side of the page).
Good luck!
Eric
Eric,
I would also urge caution in making judgments about so-called TCM/CCM. I’ve been practicing CM for 15 years, lived in China for 6 years (still do), am fluent in Chinese, doing a PhD on Shang Han Lun at a TCM University in China, follow CM docs in clinic, and practice at a hospital here in China (I’m licensed in China and the US). I therefor have a bit of experience and have gotten around a fair amount.
To say that “TCM” is not heavily rooted in the classics is just plain ridiculous. Of course, some docs pay more attention to them than others, but it is unfair and incorrect to make such blanket statements. In my TCM education I’ve taken hundreds of hours of classes on classics, including Neijing, Shang Han, Jin Gui, Wen Bing, Wang Xugao, Ding Ganren, Qin Bowei, Gejia Xueshuo (CM Scholars), etc. It may be true that curriculum in the US vary, some spending more time on the classics, but is this a proper way to assess the content of TCM? What about schools in China?
In fact, these denotations, TCM, CCM, etc, are somewhat arbitrary and false- in Chinese there are NO SUCH TERMS, Chinese medicine is just called Chinese medicine. Do you think Qin Bowei, one of the founders of the modern CM universities in PRC, didn’t know the classics? His nickname was Qin “Neijing” because he had virtually memorized the entire Neijing Su Wen. My main teacher, a graduate of the first class of Beijing CM College, class of 1962, was a student of Qin Bowei, as well as Shi Jinmo, Pu Fuzhou, Wang Xichun, etc., all of whom knew the classics better than pretty much anyone alive today. His knowledge and application of the classics in clinic is phenomenal. Is he a TCM practitioner?
I don’t mean to sound harsh, and I realize you are new to the field, but you should be careful about spreading false or misleading information since there is still a lot you don’t know and understand. This is a bit of a pet peeve of mine since the same type of thing is happening with so-called 5-element practitioners claiming to be ther true, classical form of Chinese medicine and putting down “TCM”. This is ignorant and unfair, and causes divisions and hurt feelings. CM is a rich and broad medicine, and there are many strains. All of them are rooted in the classice, however.
Respectfully,
Greg Livingston
Hey Greg,
I appreciate your comment. I am new to the field, however I don’t think that means I cannot call things as I see them. And as for it being “misinformation,” it’s possible that I don’t state things perfectly every time (I’m a student afterall, and state that clearly in many places) – but I don’t think it’s misinformation. Neither do my professors, neither do our patients.
It is a semantic distinction to some extent. It’s true, many doctors who would enthusiastically endorse themselves as TCM are much better read in the classics than I am ever likely to be. When we talk about Classical Chinese Medicine, what we mean is that our style of Chinese Medicine takes the classics to be our primary – and in some cases only – guide in treatment and practice. We do not adhere closely to the standards set out by the Maoist efforts to simplify and streamline the medicine.
You cannot deny that there are a great many practitioners who do live by those standards, particularly in the United States. This is cookie cutter medicine and in all of my experience with it I have found it lacking in form and substance.
Anyway – in the end what I mean to say is simply this: while all Chinese medicine is, trivially, rooted in the Classics – not all Chinese medicine takes this rootedness to be the primary focus. In my experience, Chinese medical practitioners who do take the Classics to be their primary guide, who seek to read, understand, and dive deeply into them are generally better able to treat disease.
I’m quite comfortable in this opinion, but do so appreciate your willingness to express yours.
My best,
Eric
Greg,
One clarifying note: I’m not trying to denigrate the hard work and brilliance of so many people who might have “TCM” in their title, on their diploma, or in their descriptions of themselves. I’m not trying to imply that all people who call themselves “Classical” are somehow automatically better practitioners than those who do not.
I’m simply expressing my understanding of a distinction between two general groups of people. One the one hand, those who may (or may not) know the Classics, but mostly disregard those classics in favor of a simplified, standardized and (ultimately) Westernized Chinese medicine. On the other hand, those who not only KNOW the classics (or are on the path to knowing them) but also seek constantly to understand them and embody them deeply – in short – who bring them into practice.
Just knowing a text or a body of work isn’t the gold standard, here. Classical Chinese Medicine as I (and many others) define it asks us to not only know the texts and the knowledge they impart but to practice with them as our constant guide.
Eric
Agreed, emphasis is the key. The academic dean at my school-who is also currently my classes Herbology instructor-is a TCM PhD from China (don’t ask me what school, I don’t remember) who seem sto be pretty much the pinnacle of what TCM is looking to achieve. I base this on there being 2 more TCM doctors from China (OMDs) -one older, one younger-who approach the medicine in much the same way but without Dr. Chai’s sheer mastery of the method. (There is also another Doctor from China on staff who is very probably the best of the bunch but he was primarily a “folk medicine” style doctor in China and has adopted TCM more as a means of communication than his real method, which he doesn’t allow students to observe) She certainly knows things from the Classics (to what extent is hard to say because she honestly seems to know everything possible) but I wouldn’t say that she adheres to them, more like respectfully acknowledges them (while being able to quote chapter and verse) but attacks things from a different method, that method being Zang Fu and Pattern diagnosis. The surest stamp of TCM is its usage of Zang Fu theory (particularly the herbalogical approach to treatment “this to tonify Qi, these to tonify Blood”) in Acupuncture, which is a sharp deviation from, say, the Ling Shu. Truthfully, I think TCM’s use for the Nei Jing starts and stops with the Su Wen, as the Ling Shu is very specific in its instructions and doesn’t fit very well into the IPD model. The second thing is that TCM really does cut out a lot of approaches in its (essential) standardization. The best example I can think of for this is the fact that a couple hours up the road we have a school run by a fellow who happens to be a descendant of the Menghe-Ding lineage, which teaches concepts that TCM doesn’t accept and frequently doesn’t know what to do with, like pre-birth trauma, Heart Shock, inherited and acquired vulnerability as a disease vector, a significantly more detailed pulse model, and any number of other things. We could go on much longer if we discussed the Master Tung lineage or Richard Tan. My point in all this is that TCM is a defined style and is NOT the aggregate of Chinese medicine, nor is it the profoundest or most effective form as it simply cuts off and throws away too much to be able to lay claim to that distinction and is also far too reliant on Western medicine to save its ass in difficult situations and to provide differential diagnosis. Definitely not the sort of things put forth in the Classics. If there is still disagreement that there is a fundamental difference between TCM and CCM, well then, let’s start talking about things like Jing Shen and Tong Qi and the proper way to use the Back Shu points and the safety of needling LI-13 and any number of arcane things that have been written in the classics, and I think the differences will make themselves very readily apparent.
Hi Eric,
I understand your point, and agree that CM study and practice needs to
be firmly grounded in the classics. My main problem with these
distinctions, however, is how they can be divisive and misleading.
Obviously not all people who call themselves “TCM” are ignorant of the
classics, and not all people who claim to be “Classical” have a deep
understanding of the classics. This creates tensions in the CM
profession, and also misleads western patients who often are more
attracted to the notion of a pure form of CM. Again, in China these
terms don’t exist. Every doc here has their own style with varying
degrees of knowledge and application of classical knowledge. But
without a doubt, the best I’ve studied with have had deep
understanding of the classics.
Regarding M. Reynolds comment about Menghe, my main teacher is also in
this lineage, as are many others. Ding Ganren, a Menghe stream
physician, had a school in Shanghai in the 20’s and 30’s and trained
many of the most influential 20th century CM docs. These people went
on to train large numbers of people in China and abroad. They also
helped set up the “Maoist” CM education, although they suffered during
the Cultural Revolution for their criticism of the Ministry of Health
for the way it was pushing the educational system. Despite its flaws,
education in China is just like in the west, a stepping-off point for
entrance into the profession and preofessional development. To label
oneself Classical or TCM just based on these few years in school is
somewhat ridiculous. It matters more what you do after school, and
thus these distinctions don’t always reflect reality.
In any case, I applaud your passion for the classics, as I am the
same. But I don’t label myself TCM or CCM, just CM, since that is the
Chinese term, and the only Chinese term. How about your Chinese
language ability? Any real study of the classics needs to be done in
Chinese, agreed?
Best wishes,
Greg
How’s my Chinese? Developing slowly but surely. Rome wasn’t built in a day. Is it necessary to study the classics in Chinese? Depends on which classics you’re studying. Not all of them have retained the same amount of authenticity due to the occasional political climate upheavals throughout Chinese history. Until such time that my classical Chinese is up to snuff I am quite content to rely upon the late Nguyen Van Nghi and Tran Viet Dzung. I really hope this doesn’t turn into a Bob Flaws “If you don’t read Chinese you’re of no account” diatribe, and I also feel that the statement that you aren’t any style until you’re in practice is, well, wrong. That distinction lies with the individual student, and assuredly God didn’t make us all the same.
M Reynolds,
I assume Jingshen is 精神？ What are the characters for Tongqi? Pinyin is not a useful tool for communication due to the countless homonyms present in Chinese language.
Again, I agree that CM needs to be based on the classics, and that cookbook CM is not very effective. But to suggest that people trained at so-called TCM schools only follow such methods is absurd. These standardized educations are a jumping off place, not a final destination, and they make no claim to be perfect or suggest they teach all you should know. If one stops studying after finishing school, or only ever studies textbooks, one is doomed to mediocrity regardless of original schooling.
In any case, I do not mean to defend the inadequacies of “TCM” education, but rather mean to point out the problems with such distinctions as TCM and CCM.
Best,
Greg
M. Reynolds,
I never said, “you aren’t any style until you’re in practice.” I just said that I call myself CM, as tha best reflects my practice, and I don’t see the need to call myself “Classical”, although I have studied the classics a lot, and apply that knowledge in clinic every day.
Regarding Chinese, I don’t mean to discount you for not knowing Chinese well. However, the vast majority of literature is not translated, so without Chinese you can’t access it. That is the main problem with being illiterate in Chinese. The other problem is that many translations are less than perfect, and there is much confusion arising from translation. There is no substitute for directly accessing these books on one’s own. So while I don’t mean to sound condescending, there is some truth to this argument.
Best,
Greg
Hey Greg,
Lots of studying over here, so will have to put forth a quick comment for now. I hope that you will stick around on the blog, as your views are quite valuable.
I do not mean to be divisive, neither do the professors that inspire me. Labels are always a little misleading, and yes they can inspire a certain amount of bad feeling. But as a way to identify one’s self as different from a particular mainstream, they can be helpful. I do my best to try to avoid oversimplification and certainly to respect my elders, regardless of their styles of practice. On the other hand, I don’t mind stirring the pot a bit if it gets conversations going about what this medicine is that we’re practicing. If that’s the folly of my scant 31 years – well, so be it.
Re: Chinese language. God, yes, I agree the classics should be read in Chinese. Failing that, the best available English translations and the close guidance of mentors who are equal parts superior clinician, devoted scholar and multi-linguist will have to suffice. :) I am fortunate to have the latter while I work on the former. I expect that it will take me some time to get my linguistic skills up to snuff, but it one of my many constant projects. There are several students at my school who do have a grasp of Chinese, and they are a great asset to the rest of us.
I think excellent discussion can be had regardless – particularly with aforementioned guidance.
Anyway – I continue to welcome your thoughts as you are clearly someone who practices Chinese medicine with a spirit I admire.
Eric
Hi,
I’m late in jumping into this conversation, but it is a strong one, so I thought I’d try to join it to keep it going. Greg, I am pleased to see your input, since I think it is important for us students to see the broader scope and extent of CM.
Still, I think something big is happening in the CM movement and I personally believe that this notion of what is the difference between TCM and CCM is at the forefront of it. But, let’s not get sidetracked by the names and labels. What is more important is What we are defining. It seems to me that what we are trying to define in the “CCM” community is the standard established by the classics (and yes, not only do we need to be able to read the classics in classical/ literary Chinese, we also need to understand the historical context of the classics, for they themselves were laid down to establish something distinct).
This standard at its core stands to preserve Yang and to follow the nature of the body’s own healing processes rather than to overpower this natural ability. This standard comes from a scientific understanding of physiology and the relationship between humans and nature.
To have all of this memorized and to quote liberally from it does not necessarily reveal an understanding of the core principles, because the established understanding of the core of this standard established by the Han dynasty classics has been influenced by the changing historical and cultural consciousness.
I’d like to say more about this, but I think I’ll stop here. My point is that what we are defining in the conversation of the difference between CCM and TCM is what matters: there is a key difference of how the classics are used and understood and of what is most essential. I believe Chinese medicine should be defined by a classical standard that is prior or outside of the developments the occured after the Han dynasty. This is not to say that what is after the Han is not within this standard of course, but that the standard should be applied to everything that comes after the Han as a means of evaluating it.
Thanks,
Michael
Hi Michael, Eric, et al,
I’m unable to access the blog lately, probably due to the Chinese
firewall, but I set the blog to send posts to my email, so I’ve been
receiving them.
First of all, I too appreciate this conversation, and think it’s
important. I would like reiterate that I completely agree with you all
that CM study and practice needs to be rooted in the classics. I also
firmly agree that “cookbook” CM, which I believe is what you more or
less mean by “TCM”, is a far cry from and indeed inferior to CM
practice based on traditional methods. So I believe we more or less
agree on these main, important points. That said, I think it is unfair
to suggest that people who don’t use the “CCM” label are somehow only
giving “lip service” to the classics, as was stated in Eric’s original
post. I realize, Eric, that you may not have meant that in such a
strict sense, and that you were probably referring to cookbook CM as
taught in some schools, but it was there on your blog and is what
prompted me to comment. I, too, take issue with that “style” of CM,
and would be loathe to defend it. I have always just labeled myself as
CM, since that is the only term in Chinese, but suppose I might fit
into the CCM category, depending on how it’s defined.
Michael, as for how to define “CCM”, I’m not qualified to do that. I
have spent years studying classical texts in Chinese, on my own and in
literally many hundreds of hours of classes with some phenomenal
teachers (mostly in China), but CM is so huge and I remain very humble
about my knowledge and abilities and would defer to my own teachers to
make such judgements. It may be OK to define CCM according to
standards of Han dynasty classics, but even though I’m a great fan of
Zhang Zhongjing’s works, and of course Neijing, I feel the importance
and benefit of studying later scholars as well, and in particular
Wenbing scholars such as Ye Tianshi, Wang Xugao, Xu Lingtai, Wu Tang,
and even late Qing and Min Guo scholars such as the Menghe scholars,
Ding Ganren, Pu Fuzhou, Qin Bowei, etc. Of course, all of these
scholars were thoroughly rooted in Han dynasty classics, and the
influence of these texts on their own works is obvious, so the
importance of thorough and correct understanding of Han classics is
indisputable. That is why my PhD is centered on Zhang Zhongjing.
As for your comment, “I believe Chinese medicine should be defined by
a classical standard that is prior or outside of the developments the
occurred after the Han dynasty. This is not to say that what is after
the Han is not within this standard of course, but that the standard
should be applied to everything that comes after the Han as a means of
evaluating it.” I think this is more or less the trend of CM
throughout its history. All the great post-Han scholars were solidly
rooted in the 四大经典, and based their own theories on ideas found in
these works, particularly Neijing. Even Zhang Zhongjing’s works are
firmly rooted in Neijing. So there is indeed precedence for what you
say, and CM, if nothing else, is about precedence. :-) That said, one
would be remiss to not give weight to later scholars, and in
particular I feel the Wenbing scholars, especially Ye Tianshi, are
hugely important for modern clinical practice. While I use Shanghan
and Jingui formulas often in the clinic, I see more patients that are
fit for Ye Tianshi’s style of medicine, and in fact apply that more
often than straight Shanghan or Jingui formulas. I’m not suggesting
that one can’t evaluate Ye’s works according to an ancient standard- I
think that would be easy as one can see the influence all over his
work- but times have changed, and for the most part people have
different living conditions and somewhat different factors causing
disharmony in their bodies than in the Han dynasty, so I think Qing
dynasty scholars are in some ways, both literally and figuratively,
closer to modern clinical practice than Zhang Zhongjing. Neijing, I
feel, is more timeless than Zhang Ji, so I don’t have this same
feeling about it. But Zhang Ji’s formulas are mostly warm, often
drying, somewhat sledgehammer-like, and for a lot of modern people,
not entirely suitable. That said, there are plenty of his formulas
that ARE well suited for modern practice, and I use them all the time,
but I don’t think I’ve ever seen or treated a patient that was fit for
straight Ma Huang Tang :-). In any case, there’s a lot to be said for
Qing, and especially Menghe, medicine, which addresses so much of the
pathologies that, at least I personally, find in clinic all the time.
In any case, even though I have a bit more experience than those of
you who are just beginning in the field, I am hardly an expert, and my
opinions are liable to change and hopefully will change, preferably
for the better, as my knowledge and experience grow. Just a few
thoughts. Now, as you all, back to studying…
Best wishes,
Greg
Greg,
Thanks for your comment. A quick note: my master, if you will, is a SHL/JG expert (as much as such a thing is possible) and uses SHL/JG formulas exclusively with great results. In fact, fantastic results. So, while I hear that your experience is otherwise I just want to make sure that it is noted that this isn’t everyone’s experience. But, of course, you know that.
It also helps to know one of the major streams of thought pouring into this blog is very much from this perspective. I hope it helps contextualize the things that many of us (Michael G and myself, especially) are saying.
Eric
Greg,
I long for the day when I have enough experience and knowledge, language skills and clinical trials to be able to study everyone you listed. We are so fortunate to have so many centuries of masters who tested and lived the principles of the Neijing and the Shanghan. Yet, for me, especially in that we are at a school whose two most influential teachers are Shanghan Lun scholars, I am still in my formative years as a practioner and am not interested in pursuing an eclectic style until I feel rooted in these four true classics. (We are in the midst of an informal debate as to which four are really the true classics, so I’d love to hear your perspective).
However, I have been studying Chinese medical theory, philosophy and history for about 10 years now and am pretty convinced that there is a major distinction in the concept of “What is the role of medicine?” and “What is healing?” from the time of the SHL and the time of the Tang scholars and later. It doesn’t seem to be a major distinction, but a crucial one. It parallels a general shift in consciousness that I believe has occured on a global level.
I think it is also important to point out that our school has two programs: a CCM program with a heavy SHL influence, and a Naturopathic program (which makes up the majority of the school). Another of our most influential teachers is also an ND (as well as an Anthroposophical Doc), and so we, at least in some ways, are given a glimpse of really a vastly different understanding of health and healing. I believe that our school is quite uniquely ahead of its time, though ironically through its adherence to classical philosophy of both the East and the West. At the crux of this is the philosophy in which both of these “natural medicines” are rooted, which revolves supporting the body’s natural healing process and never sacrifice the yang, the warmth of being, the spirit, to achieve an improvement of symptoms. For this reason, some of our teachers strictly adhere to the use of SHL and warm formulas to treat all diseases.
I feel honored to be able to converse with you and other experienced practitioner-scholars, and in no way assume that I really know what is best. I am really coming from a strictly theoretical perspective (though of course I’ve been following my teachers in clinic for a few years now, and have seen results both for myself and our patients).
Here is the question I am currently working with: When do we know that a true “pestilential epidemic” is present? In the SHL preface we see quite clearly that ZZJ is motivated to practice medicine due to an epidemic which killed of 200 of his family members, yet the result of his efforts is a manual on the six qi. It seems that for a warm wind to really attack it would have to be warmer than the normal body temp and striking in the front (which symbolically seems to mean coming from the south or possibly southeast of southwest). Or, the disease is a material pathogen, but this is where Naturopathy helps us in its concepts of the body’s “terrain” rather than falling back on Pastuer’s model, which flies in the face of classical Chinese theory and which is hotly debated in both programs at our school.
So, what I’m getting at is that I am (especially at this very naive and early stage in my career) much more interested in seeing how the SHL formulas can work with a more consitent understanding of the nature of pathology, than experimenting with other developments in the Chinese medicine that seem to me to be more inconsitent in their concepts of the nature of pathology. My inquiry then is within this dilemma of the nature of pathology.
Thanks for reading this long comment!
Michael
Hi Michael,
I think you are wise to begin with 四大经典 and not spread yourself too
thin to begin with. To study wenbing it’s imperative to have sound
knowledge of these works- it’s much easier and makes more sense after
this. Regarding what are the 四大经典, of course there is and may always
be debate. My own opinion is of little consequence. I tend to side
with 内经，伤寒，金匮，神农, or if you prefer to put jingui and shanghan
together, then can add 难经. I know some people prefer to include
wenbing, but wenbing is a later development that takes these other
classics as its foundation, so is it right to put it in this group?
Maybe, maybe not. Like I said, I’m a big fan of wenbing and think it
deserving of such status. Of course, neijing could be said to be the
ultimate classic, since all these other books are derived from it, so
is Zhangji’s work any different from Ye Tianshi’s work in this regard?
Well, I suppose so, since a lot of Ye’s ideas come from Zhangji.
Anyway, I don’t think about this too much- I’m a clinician and shy
away from this kind of debate as it doesn’t necessarily help me in
clinic much.
>
> However, I have been studying Chinese medical theory, philosophy and history for about 10 years now and am pretty convinced that there is a major distinction in the concept of “What is the role of medicine?” and “What is healing?” from the time of the SHL and the time of the Tang scholars and later. It doesn’t seem to be a major distinction, but a crucial one. It parallels a general shift in consciousness that I believe has occured on a global level.
This is interesting stuff, but I’m not well enough educated to offer
much insight or debate.
>
> I think it is also important to point out that our school has two programs: a CCM program with a heavy SHL influence, and a Naturopathic program (which makes up the majority of the school). Another of our most influential teachers is also an ND (as well as an Anthroposophical Doc), and so we, at least in some ways, are given a glimpse of really a vastly different understanding of health and healing. I believe that our school is quite uniquely ahead of its time, though ironically through its adherence to classical philosophy of both the East and the West. At the crux of this is the philosophy in which both of these “natural medicines” are rooted, which revolves supporting the body’s natural healing process and never sacrifice the yang, the warmth of being, the spirit, to achieve an improvement of symptoms. For this reason, some of our teachers strictly adhere to the use of SHL and warm formulas to treat all diseases.
I don’t think it’s necessary to only use jingfang to care for the yang
qi. Zhang Jingyue’s “Da Bao Lun” 大宝论 speaks directly to this, and I
don’t think this idea was lost on the great physicians of later
periods. I agree preserving yang qi is essential, I agree with Zhang
Jingyue’s treatise, but I think using warm formulas exclusively would
be a bit tricky, at least for me- I certainly don’t have this skill.
For example, today I saw for the second time a patient who’s main
problem is severe night sweating. After using Dang Gui Liu Huang Tang
for one week, at a mild dose, her sweats are almost gone. I cannot
think of any jingfang that I could have used, although that may very
well be my own ignorance in play. Yet I’ve studied jingfang a lot, and
no appropriate jingfang comes to mind for this patient. That’s not to
say there is no jingfang that is suitable, I just can’t think of one,
or my understanding of clinical application of jingfang is too
limited, which I am the first to admit is absolutely true.
>
> I feel honored to be able to converse with you and other experienced practitioner-scholars, and in no way assume that I really know what is best. I am really coming from a strictly theoretical perspective (though of course I’ve been following my teachers in clinic for a few years now, and have seen results both for myself and our patients).
I also make no claim to know what’s best. I have taken what I liked
from a handful of really good teachers and practice in ways similar,
but no doubt inferior, to them. I have a long way to go, and am quite
aware of my limitations!
>
> Here is the question I am currently working with: When do we know that a true “pestilential epidemic” is present? In the SHL preface we see quite clearly that ZZJ is motivated to practice medicine due to an epidemic which killed of 200 of his family members, yet the result of his efforts is a manual on the six qi. It seems that for a warm wind to really attack it would have to be warmer than the normal body temp and striking in the front (which symbolically seems to mean coming from the south or possibly southeast of southwest). Or, the disease is a material pathogen, but this is where Naturopathy helps us in its concepts of the body’s “terrain” rather than falling back on Pastuer’s model, which flies in the face of classical Chinese theory and which is hotly debated in both programs at our school.
>
> So, what I’m getting at is that I am (especially at this very naive and early stage in my career) much more interested in seeing how the SHL formulas can work with a more consitent understanding of the nature of pathology, than experimenting with other developments in the Chinese medicine that seem to me to be more inconsitent in their concepts of the nature of pathology. My inquiry then is within this dilemma of the nature of pathology.
Michael, these are huge and complicated questions, and I am not very
qualified to answer. I also don’t really have time to discuss as I’m
so busy here, and you can get better insight from someone more
knowledgeable than myself.
In any case, I think it’s fantastic that you all are studying like
this- far to many westerners ignore the classics, and it’s a real
pity. I look forward to having more people like yourselves as
colleagues!
Best wishes,
Greg
Hi Michael,
I’ve been giving the following passage of yours some thought:
>
> Here is the question I am currently working with: When do we know that a true “pestilential epidemic” is present? In the SHL preface we see quite clearly that ZZJ is motivated to practice medicine due to an epidemic which killed of 200 of his family members, yet the result of his efforts is a manual on the six qi. It seems that for a warm wind to really attack it would have to be warmer than the normal body temp and striking in the front (which symbolically seems to mean coming from the south or possibly southeast of southwest). Or, the disease is a material pathogen, but this is where Naturopathy helps us in its concepts of the body’s “terrain” rather than falling back on Pastuer’s model, which flies in the face of classical Chinese theory and which is hotly debated in both programs at our school.
Michael, this is a very profound, interesting, and important question.
Not that I have the answer. But it has provoked me thinking, and I
thank you for that.
First, I’m not sure that it’s correct to think of warm wind or warm
pathogen in terms of relation to body temperature. This may be fine,
but I’ve never seen or heard it discussed in this way previously. I
tend to think of these pathogens, cold or warm, more in terms of the
effect on and/or response of the body. If you have some ideas about
this I’d be interested to hear them.
Regarding material pathogen, again I’m not sure this is the “correct”
traditional way to view wenbing or other external pathogen. Wenbing is
mentioned in neijing, but at that time as a part of 广义伤寒. Therefore,
it is a concept as old, albeit not as well developed, as shanghan.
What ming and qing wenbing scholars actually meant or thought when
using the term I’m unable to say, but I think we should be careful to
draw conclusions, at least I know I personally would hesitate.
Regarding body terrain, I think this is largely the key. The body’s
response to any given pathogenic factor is what CM looks at, not the
pathogen itself. In the case of wenbing, the pathogens do in fact act
differently than shanghan, which is what prompted Ye Tianshi to craft
wei/qi/ying/xue theory. While it may be possible to treat wenbing with
shanghan formulas, I think the fact that Ye, arguably one of the best
CM physicians of all time, devised other methods to diagnose and treat
these conditions already speaks volumes. He no doubt had mastery of
Shanghan Lun (he often used straight SHL rx’s, and many of his own
rx’s were based SHL rx’s), so if it was possible to treat these
conditions with SHL rx’s, I think he would have been capable. At some
point, when your Chinese is up to speed, I highly recommend reading
临证指南. You will see Ye’s mastery and flexibility there, and I imagine
it will inspire you as it has me!
Regarding the nature of the pathogens and how they enter the body,
Neijing describes wenbing as shanghan which was contracted in the
winter, with wenbing illness appearing in the spring or summer. This
shows that the cold has entered the body and over time transformed
into heat which later shows at a time when yang qi is rising (spring
and summer) as a warm disease. Of course, at this time wenbing theory
was poorly developed and was included as part of 伤寒. Now people talk
about 伤寒 and 广义伤寒, the former referring to true shanghan, the latter
to all externally contracted afflictions, including shanghan and
wenbing. Of course, Ye Tianshi described wenbing as entering through
the nose and mouth and first affecting taiyin lung vessel. As far as I
know, there is no precedent for this idea, but I may be wrong.
In any case, I don’t think Ye was thinking in terms similar to
Pasteur, or if he was, then he still remained true to CM principles by
diagnosing according to CM methodology and treating accordingly. While
many of the herbs in wenbing have antimicrobial properties, it is
rather their ability to clear heat which was considered by wenbing
scholars. They were still treating the body’s terrain, not just going
after pathogen. In further support of that argument, I believe their
is a general trend in the change of body terrain in the last 2000
years towards a hotter constitution. This is likely the result of
changes in lifestyle, including diet, housing, physical activities,
etc., and especially in the last fifty years with the abundance of
rich foods, central heating and air conditioning, stressful lifestyle
and irregular sleeping habits, I think many people have yin deficiency
and heat, along with dampness, etc. I’m not suggestion cold is not a
factor, but these other factors are probably more prevalent now than
in the past. I agree that preservation of yang qi is also key,
strengthening the body’s ability to fight of infection and ward off
invasion, and it would be a mistake to treat allopathically, going
after virus and bacteria with antimicrobial herbs. So while I agree
terrain is key, I would argue that wenbing is not a departure from
this.
Just some thoughts, now back to work.
Best wishes,
Greg
Greg,
Thanks for your well-informed response. I certainly have centuries to go in terms of studying the development of CM. I also have no intention of writing off Wen Bing. However, though I am far from a peer of yours, I have a few thoughts and questions still on this matter.
In response to the idea of heat and cold and the body’s response to it, I am under the impression that the body can only respond to an external temperature as it is different from it’s own. So, it would theoretically take a warmth (carried of course by a wind) that is warmer than 98.6 to be a true wind-warmth pathogen.
This doesn’t have to be the case in our day and age though since people generally have lower temperatures than they used to. I wish I had a reference for this in front of me right now, but I have seen in the clinic and have been taught in numerous lectures (especially in the ND lectures I’ve sat in on) that people in general (especially in the US) have a lower body temperature on average than was the case in the past, and the temperature is lowering. In other words, it appears that people are running colder than is normal, which goes against what you are saying. Also, if you look at the diseases of our times, they are more of a “colder” type. Viruses and cancer are much more of a cold type of disease, whereas bacterial invasions and diseases like TB that were much more prevalent in ancient times are more of a “hotter” type. I say this because of the manifestations of these diseases and the general image of them. This is at least how we have been looking at disease in our school and community.
You actually said something along these lines in an earlier comment when you admitted that you haven’t seen a Ma Huang Tang pattern in the clinic. It seems that modern people do not have the immune strength, the true Yang, to mount a Ma Huang pattern.
The heat that we notice in today’s patients is real heat and it does seem that you are right when you say that we generally have a richer and hotter, more congested, stagnant lifestyle. But this to mean is the reason why so many people manifest Shaoyang patterns. The body’s yang is not in the right place and is stuck or on its way out; we see red in the face, heat in the San Jiao and in the Stomach, but what about the Spleen? What about the Taiyin, Shaoyin and Jueyin? They seem to be more cold, and is why we see so many chronic diseases.
In terms of the concept of 伤寒 and 广义伤寒, I still, being in my student years, want to defer to the Neijing and the Nanjing. I admit that I have much to study and learn in terms of the Wen Bing scholars, (so thank you for the reading suggestion! I hope to be able to break through my language barrier someday soon!). In the Nanjing, chapter 58, we see that there are five types of Shang Han, of which Wen Bing is a unique subset. Yet, Shang Han is also a subset of Shang Han. These two concepts, that Wen Bing is seen at this time as a subset of Shang Han and that there seems to be two different understandings of the term Shang Han are very important I believe. I take this to mean that Shang Han, in the general sense, means “Cold Injury” in the sense of what is injured by cold, namely Yang. Thus, Shang Han can, in my opinion, and in the opinion of my teachers, mean “Injury to Yang”. The five types are the five ways in which the body’s yang is injured and the way the body manifests this injury. That Wen Bing is a result of a disease that did not manifest right away shows that in this sense it was indeed originally cold, as you also seem to agree. This idea that it transforms in to wind warmth or warm disease with the seasons shows the deep connection we have to the changes in the seasons, and it shows that disease manifests according to the terrain in which it finds itself in the body (meaning the confirmations). Nonetheless, the body’s Yang was injured first, this is the damage. I believe the Shang Han Lun addresses this very process.
When the disease manifest immediately as a warm disease, that seems to be a true warm pathogen, and the symptoms are much more like a noxious material pathogenic disease. Material pathogens would damage material substances in the body, which is why they pass from one physical layer to the next, consuming each one until they fall into the next. When the disease follows the seasons or changes in relation to the seasons, this is Qi, is it not?
I am much more interested in learning from you than I am in debating with you, so I am presenting my perspective as a student’s response so that it may be challenged and so that I may learn something. Thank you for taking your time to discuss this with me.
Michael
Hi Michael,
You have some interesting ideas, and I’m enjoying the exchange. I’m
also not really interested in a debate, but rather think we can learn
from each other. After all, I am forever a student, and far from being
a master of CM. Unfortunately, I don’t have a lot of time for this, so
will have to keep it brief. I have tons of work here….
>
> In response to the idea of heat and cold and the body’s response to it, I am under the impression that the body can only respond to an external temperature as it is different from it’s own. So, it would theoretically take a warmth (carried of course by a wind) that is warmer than 98.6 to be a true wind-warmth pathogen.
I’ve never considered the actual temperature of pestilent pathogens,
and not sure this is a correct way to look at CM pathogens. This seems
like a modern idea (temperature) superimposed on a traditional one-
kind of like mixing apples and oranges. That said, I may be wrong
about this one. I do tend to think of the 六淫 as real environmental
factors- that dampness does have something to do with high humidity,
dryness low humidity, heat with hot weather, cold with cold weather,
etc. So, for example, when someone lives or works in a cold damp
place, they may in turn suffer from cold and damp illness, and that
the cold and damp have affected the vessels, and transmission of the
affect of the pathogens is through the vessels. Using that logic, I
can see where you get this idea, and am not sure why I’ve never
thought to apply this logic to 瘟疫. However, maybe not all pathogens
need to be thought of in this way, and rather should be considered in
light of the affect they have one the body and the body’s response to
them. This one I can’t give a definitive answer, just have some of my
own thoughts. I will ask some of my teachers here when I have the
chance, and get back to you. One other thing I’ve considered in light
of this, is do any of the pestilent pathogens really have a
temperature, in the same way the 六淫 factors of hot and cold do? Is it
really not just the way the body reacts to the invasion? Some
presenting with cold sx’s, some with heat sx’s? On another note,
Neijing classifies wenbing as a subset of Shanghan. Is it not possible
that 温疫 are in fact cold pathogens that cause a heat reaction in the
body? And further, it seems impossible to me to verify the temperature
or nature of a pathogen, so even Neijing’s authors may have just been
describing the effect of the pathogens, and not their nature, cold in
this case. Likewise, Ye Tianshi couldn’t have made this objective
measurement either, so how can we say wenbing pathogen is really warm
in terms of its temperature? Clearly they cause heat sx’s, but that is
really another matter, no? Just some ideas….
>
> This doesn’t have to be the case in our day and age though since people generally have lower temperatures than they used to. I wish I had a reference for this in front of me right now, but I have seen in the clinic and have been taught in numerous lectures (especially in the ND lectures I’ve sat in on) that people in general (especially in the US) have a lower body temperature on average than was the case in the past, and the temperature is lowering. In other words, it appears that people are running colder than is normal, which goes against what you are saying. Also, if you look at the diseases of our times, they are more of a “colder” type. Viruses and cancer are much more of a cold type of disease, whereas bacterial invasions and diseases like TB that were much more prevalent in ancient times are more of a “hotter” type. I say this because of the manifestations of these diseases and the general image of them. This is at least how we have been looking at disease in our school and community.
Michael, I think it may be a mistake to correlate CM notions of heat
and cold with WM notions of body temperature. I may be wrong to say
that, but I tend to think this doesn’t pan out. People with yin
deficiency and deficient heat don’t necessarily have higher body
temperatures, I would guess, than people with yang deficiency. Of
course I have no data to support that statement and am just guessing.
But again, I think it’s a mistake to mix CM ideas and WM ideas so
freely- they are not correlate. For example, 太阳伤寒 is an external cold
pathogenic attack, yet it may produce a measurable fever, and
simultaneously the patient feels subjectively chilled. So CM calls
this cold, but there is elevated body temperature. So I wasn’t trying
to say people have higher body temperatures in the present(this is a
WM idea, and I am strictly coming from a CM view), but rather that
many have heat related conditions. Regarding the nature of disease,
I’m not sure it is accurate to say there are more cold disease than
hot diseases- many modern illnesses present with heat and/or yin
deficiency. Of course there are cold diseases as well. As for ancient
and modern trends, I really can’t say, but I tend to think both are
equally present today. Furthermore, I again take issue with your
characterization of viruses and cancer as cold disease- in my
experience they can be cold or hot or both. Again, I am not an expert
or suggesting that my ideas are totally correct. Just considering the
issues with you.
>
> You actually said something along these lines in an earlier comment when you admitted that you haven’t seen a Ma Huang Tang pattern in the clinic. It seems that modern people do not have the immune strength, the true Yang, to mount a Ma Huang pattern.
This I would agree with. I would not debate that people also suffer
from yang deficiency in modern times. But can that be the only reason
that 麻黄汤证 is so rare nowadays? Is it also possible that the body’s
terrain is different than 2000 years ago? I think the latter can’t be
discounted, and that aside from your suggestion of yang deficiency,
yin deficiency and heat (a type of terrain) causes the body to respond
in a different way to external pathogen, present often with heat, or
if really attacked by cold on the taiyang, then this stage is passed
quickly and the pathogen goes deeper faster, changing into heat as in
either yangming or shaoyang illness. Any thoughts?
>
> The heat that we notice in today’s patients is real heat and it does seem that you are right when you say that we generally have a richer and hotter, more congested, stagnant lifestyle. But this to mean is the reason why so many people manifest Shaoyang patterns. The body’s yang is not in the right place and is stuck or on its way out; we see red in the face, heat in the San Jiao and in the Stomach, but what about the Spleen? What about the Taiyin, Shaoyin and Jueyin? They seem to be more cold, and is why we see so many chronic diseases.
Interseting ideas. Gives me something to mull over….
>
> In terms of the concept of 伤寒 and 广义伤寒, I still, being in my student years, want to defer to the Neijing and the Nanjing. I admit that I have much to study and learn in terms of the Wen Bing scholars, (so thank you for the reading suggestion! I hope to be able to break through my language barrier someday soon!). In the Nanjing, chapter 58, we see that there are five types of Shang Han, of which Wen Bing is a unique subset. Yet, Shang Han is also a subset of Shang Han. These two concepts, that Wen Bing is seen at this time as a subset of Shang Han and that there seems to be two different understandings of the term Shang Han are very important I believe. I take this to mean that Shang Han, in the general sense, means “Cold Injury” in the sense of what is injured by cold, namely Yang. Thus, Shang Han can, in my opinion, and in the opinion of my teachers, mean “Injury to Yang”. The five types are the five ways in which the body’s yang is injured and the way the body manifests this injury. That Wen Bing is a result of a disease that did not manifest right away shows that in this sense it was indeed originally cold, as you also seem to agree. This idea that it transforms in to wind warmth or warm disease with the seasons shows the deep connection we have to the changes in the seasons, and it shows that disease manifests according to the terrain in which it finds itself in the body (meaning the confirmations). Nonetheless, the body’s Yang was injured first, this is the damage. I believe the Shang Han Lun addresses this very process.
I agree with these ideas, and of course, that SHL addresses this
process very nicely. That said, this is still all 伤寒, not 广义伤寒. The
latter includes all pestilent disease, and considers warm pathogens to
be a different type of pathogen than shanghan pathogens. The former
are warm and enter through the nose and mouth, first attacking the
Lung Taiyin, and the latter cold and entering via Taiyang Bladder. The
wenbing mentioned in neijing and nanjing (of course nanjing is
referring to the neijing passages) is actually part of shanghan, not
广义伤寒, since it is initially shanghan that transforms into heat.
>
> When the disease manifest immediately as a warm disease, that seems to be a true warm pathogen, and the symptoms are much more like a noxious material pathogenic disease. Material pathogens would damage material substances in the body, which is why they pass from one physical layer to the next, consuming each one until they fall into the next. When the disease follows the seasons or changes in relation to the seasons, this is Qi, is it not?
I don’t understand what you mean by “material” pathogenic disease. Can
you explain?
>
> I am much more interested in learning from you than I am in debating with you, so I am presenting my perspective as a student’s response so that it may be challenged and so that I may learn something. Thank you for taking your time to discuss this with me.
I think we can learn from each other. You have some interesting ideas.
Best wishes,
Greg
Hi Michael and Eric,
You’ve prompted me to review neijing’s chapters on 热病. 热论篇(chapter 31,
Suwen) begins by stating that all 热病 are a type of shanghan. It goes
on to describe transmission of pathogen through the six-stages (this
is where Zhang Ji got his initial inspiration), day one in taiyang,
day 2 in yangming, day 3 in shaoyang, day 4 in taiyin, day 5 in
shaoyin, and day six in jueyin. But here is where it gets interesting.
When discussing treatment, it states that after 3 days (meaning when
the pathogen has reached the yin vessels), treatment should be 泄,
implying that these stages belong in fact to heat and excess. And
after perusing several neijing books with commentaries, the general
consensus seems to be that 泄 here does imply draining heat. I wonder
then if that would imply no damage to the yang qi, as in Zhang Ji’s
model? Interesting.
Another book of commentaries has this to say (this is why you have to
work on your Chinese- without it you can’t access all these great
books!): views from some major scholars. first, from Yang Shang-Shan,
《太素，热病决》, who suggests 热病 is due to 寒邪 (my rough translation here)
“shanghan, wintertime, warm room and warm clothing, warm drink and
warm food, the pores open, quickly cold is caught, the pores are
obstructed, cold resides and becomes heat, the three yin and three
yang vessels and the 5 viscera and six bowels catch heat disease.”
Second, from Zhang Zhi-Cong, “all external evil pathogen begin by
damaging the superficial yang, taking the yang qi and transforming it
into heat, therefor Neijing says all disease that is warm, these all
belong to shanghan category.” Finally, Zhang Qi, “heat disease, also
known as wenbing. winter fail to store the essence, heat arises on its
own internally, disease begins in spring when exposed to wind dew,
this is a different cause than shanghan, therefore neijing says it
belongs to shanghan category”.
Some food for thought….
Greg
Michael, Eric, and Greg,
I hope Im not too late in joining this discussion! It is of great intrest to me as I am doing my thesis research into education of TCM past and present. I am a traditionalist by nature and at first resisted the recent standardization of TCM feeling that the classical ways were being lost, not just in theory but more so in the clinical practice and the emphasis of fitting tcm into the western medical world. However, Greg, your initial comment struck a true chord in my opinion. I agree and have begun to look deeper at my opinions. In truth, there has been such a long tradition in these arts that there can be no one correct way. The education, flourishing and suppression has come and gone many times through the ages. There are some excellent works on this such as Medicine in China by Paul Unschuld and Celestial Lancets by By Gwei-Djen Lu and Joseph Needham.
I believe the real debate is not on labels of the schools of thought here in the west but on the actual methodology involved in the training, practice, and results. A debate on the scientific method being used in traditional medicine vs. the cultural philosophies upon which it was based. And where results and records in traditional models fit into the scientific model. For in truth, the last 200 years of science has brought about a major change in scociety and TCM has always changed within its cultural context.
So, a good point has been raised; what is the difference in training and practice between modern TCM and the great sage practitioners of history?
I would like to add one other comment. As my Chinese is poor at best, I use all english sources right now. It is my opinion that there are infact adequate sources in Chinese Medicine with the recent work of translating done in the last 20 years. It is also my understanding that even people that read Traditional Chinese would have great difficulty understanding many of the earlier classics without proper instruction where the (good) translated versions in english have already had that thought and understanding put into them.
I would be interested in any other blogs, books or sites that any of you may have to offer on this discussion. I am especially interested in different methods of training before the institutionalizing of TCM in the last 50 years.
Thanks all and keep investigating the natures of the universe through your medicine!
Dylan
I recently discovered Eric’s wonderful blogs so am just coming to read this discussion. I have been a licensed acupuncturist for 10 years.
First, a big THANK YOU to Greg for taking so much time to graciously share his knowledge and experience!! I greatly respect what he has to say since he has extensive training in China.
I cringe at the use of the terms “Classical” and “Traditional.” I don’t blame you students for using the terms and being enthusiastic about the Classics since you’ve been trained, apparently, into this perspective. I don’t know who started it, but it’s divisive to define CM into 2 categories, one good, the other, bad. Since this duality doesn’t exist in China, what purpose does it serve to put it forth? The folks calling themselves “Classical” clearly present their approach as superior and the ignorant public are not able to distinguish what it means. (We in the field don’t agree on what it means.) The practice of CM in the West is in its infancy and, as such, should be nurtured with as much open-mindedness as we can muster. Naming can be damaging and shouldn’t be used casually.
Another resource on this topic is Bob Flaws podcast available on the Blue Poppy website. If you don’t know, Flaws has translated and published more Classics than anyone else alive. I feel greatly indebted to his work for our profession for the last 30 years. In particular his podcasts named: the Myth of Orientalism and The Issue of Spirituality in CM, are particularly pertinent to this discussion. They are very interesting!
And thank you, Greg, for your great blog!
Hi Sammy,
I’m glad to see this topic opening up again. In response to your comment, I’d like to say that there actually IS a classical divisive undercurrent in China, though it of course is small and on dangerous territory. One of the leading figures of this movement is Dr. Liu Lihong, who recently lectured at our school about the very important difference between classical Chinese medicine and traditional Chinese medicine. He even at one point said how sad it made him feel that what we are doing at our school is so much more aligned with the classics than anything going on in his China today; he wished the Chinese could reclaim their own medicine, but sadly, he lamented that they were far from it. He has written a book about reviving classical Chinese medicine, which actually has become a best seller in China, so there is something happening over there for sure. I’m not saying that we are Liu Lihong’s school or that we follow his way, but that we all agree on what classical Chinese medicine is.
Shouldn’t we all get along and agree that we’re all based on the Neijing? Well, if that were true, I would feel much better about the future of Chinese medicine, especially in the west!
I began my studies at one of the best TCM schools in the country (or so I’ve heard) and I feel very confident to say that certainly what they are teaching there is in fact TCM. But that is not what we are learning at our school, though we do learn enough of it to practice TCM if we so desire. Some of our students feel that TCM is more suitable for them, so that’s what they do. They use Zang-fu diagnosis, predominantly Wenbing formulas and standard points for the standard reasons, and yet, since they have been taught the basic concepts of the classical approach, they are nonetheless able to come up with unique approaches.
Then there are those of us who have chosen to not use zangfu diagnosis, to not use Wenbing formulas, to use channel palpation and quite a different approach to acupuncture, to work from the model of preserving the yang, of following the wisdom of the wuyun liuqi theory in the Neijing, of working with patients as unique individuals with their own internal climate, geography and directional movement, within their own lives, which are within a bigger picture of space, time and direction, which we take seriously.
Chinese scholars know what the Neijing says, for sure; some our our best TCM teachers can without a doubt quote the entire Neijing. But sadly something was lost during the cultural revolution. We have found that only those who were taught by teachers who come from prior to the cultural revolution seem to have a deeper understanding of what a “classisist” approach really is.
It’s really the same in the west. I studied classical chinese literature and philosophy at a “classisist” school based on the Socratic Method prior to studying Chinese medicine, and it was a completely different way of learning from any other approach to studing the classics or philosophy. Thus there is something to the methodology of teaching, the focus and ultimate goal, as well as the shear content, that differentiates a classical Chinese medicine education from that of traditional Chinese medicine.
What differentiates it in practice? I’ve seen remarkable differences. Being on the verge of graduation, I will tell you that what I will be doing in clinic will be fundamentally different from what is done by TCM practitioners, so why shouldn’t I express and label that as so? I call it classical, because that is my first and only focus. I was taught in a way akin to the classics, I am steeped heavily in the classics and I plan on practicing as close to the way of the classics as I can. This only includes for us, by the way, the Shennong bencao jing, the Neijing suwen and lingshu, and the Shanghan za bing lun. Are other texts useful for us? Of course they are. I’ve been thoroughly enjoying reading Xu Lingtai lately (of the 18th century), in fact. But only the classics listed above are our core texts we refer to as our guides in the clinic as we are seeing patients.
I mean seriously, have you seen a TCM clinic where the students are looking in the Jingui yaolue for formulas, or the Suwen to understand a disease pattern, or the Lingshu to recall the exact channel pathways as their primary sources?
Is our way better? Who knows? That depends on the practitioner, doesn’t it? We aren’t saying that. We are trying to emphasize that we believe the classical way is important and is forgotten in TCM, and, we are trying to say that this is what makes us CCM practitioners.
As for Bob Flaws, well, he certainly has translated a lot of classical and literary period texts…and he is the epitome of the TCM practitioner. But I don’t read his translations or books, because, I’m not studying TCM.
I hope this clarifies what Eric has been working hard to accomplish in terms of defining CCM for the public, and that, rather than offend you, it offers you something to think about in terms of what is TCM.
Michael G
Since my name has been mentioned in this discussion, I might as well chime in. Frankly, I think the division between CCM and TCM, with one being the good, real Chinese medicine and the other being a lesser, inferior version, is bogus. There is only erudite, thoughtful, and insightful practice and less erudite, less thoughtful, less insightful practice.
To be erudite in Chinese medicine means to be well-read in the classics. Period. Full stop. However, this whole recent enthusiasm for the classics (in particular the SHL/JGYL) in some North American and European quarters is but a resurgence of the Han Xue Pai (Han Learning school) of the early Qing dynasty. As the Qing dynasty progressed, Chinese medicine as a whole absorbed many of the good points of the Han Xue Pai critique but then went on to create a newer, bigger, better synthesis which, ironically, led to what, in English, is often disparagingly called TCM but which, in Chinese, is simply zhong yi, Chinese medicine.
The problem is mediocrity, not some supposed difference between CCM and TCM. There are good and bad schools, good and bad teachers, good and bad students, and the average of any of these is, by definition, mediocre (whether in China or the U.S.). Should we push for more erudite and intelligent schools, teachers, and students? Absolutely. But to do so using an essentially bogus, divisive, romantic dichotomy is ultimately not very helpful. Personally, I want access to all the great books of Chinese medicine and the ideas and techniques they contain, from Warring States up to and including April 2009. I also want to know what does and does not work in clinic based on valid evidence.
By the mid Qing dynasty, scholar-doctors realized that the Han Xue Pai fostered within it the seeds of fundamentalism, a fundamentalism that stifled new ideas and advances. Similarly, I detect the sound of fundamentalism in CCM’s true-believers.
Ironically, in my experience, those that are drawn to such a romantic point of view are often the brightest and most enthusiastic students. It is these students who are always critical of mediocrity and are primed to look for the best. Therefore, I don’t think it is these students’ fault that they are attracted to an elitist version of Chinese medicine. On the other hand, I do fault their teachers for fostering such romantic Golden-ageism.
Oh, by the way, I was one of the first, if not the first, Western practitioner (as opposed to sinologist) to promote the idea of CCM as opposed to TCM in print back in the early 80s. You can check the record on this. At the time, I was very vocal about this when I was still a young and inexperienced practitioner who made the mistake of publishing his opinions prematurely.
Bob,
I appreciate your perspectives and look forward to hearing more from you in the years to come. I will put forward one question of the many that come to mind. You say, “I also want to know what does and does not work in clinic based on valid evidence.”
What do you mean by valid evidence?
Respectfully,
Eric Grey
Blog owner
PS: I’m sorry if you felt attacked by either my post or any ensuing comments. I assume that you felt this way, as a scholar of your standing seems unlikely to resort to the ad hominem use of “romantic golden ageism.” I should note that here’s been remarkably little romanticism in my education – just a lot of very hard work and a lot of very happy patients who have been to a lot of doctors with a lot of approaches before finding success with us. If that’s romantic, I’ll take it.
As a recent appointment to the full-time faculty of NCNM, I echo Eric’s sentiments. I have found something quite unique in this institution: a group of committed faculty representing not one or another set of techniques (such as those systems that can be learned in highly commercialized one-off weekend seminars for example), but rather practicing the time-honored tradition of transmitting one’s own unique lineage, both in the classroom and the clinic. I have never seen a more committed faculty, representing a broader spectrum of sophisticated, lineage-based, highly erudite, and focused clinical efficacy. Indeed, in place of romanticism, I perceive scholarship, and collegiality. I daresay, after 8 years of successful `practice, and 11 years of study with one masterful Doctor myself, that the students at NCNM are more sophisticated in their understanding, and more erudite in their scholarship than the vast majority of practicing acupuncturists whom I have met, and taught, over the years. An important element of this as well, is that the program does not foster a blind adherence to a set of texts. In fact, if anything, the school recognizes that medicine is best learned through adherence to the oral transmission through which it has been largely preserved in practice for millennia. The Classics function as the guideposts for our growth, practically like mnemonic devices that create the discourse for classical learning to flourish. But up until our times, much of this learning was preserved within families and “currents of tradition.” Nevertheless, I know of no other student body as well-versed in the Classics, and who seem so engaged with proving the texts and practices valid and efficacious in practice.
In my last post, I meant to thank ERIC for his great blog but mistakenly wrote Greg.
Eric, Have you listened to Bob Flaws’ 2 podcasts? In one of them he defines the terms Golden Ageism and Romanticism so I don’t see his use of those terms as ad hominem. I would love to hear a more substantive discussion on this topic, where you address the specific points Bob Flaws makes in those podcasts and why you think the CM he’s referring to is inferior.
For 10 years I have attempted to learn the most clinically efficacious theories and methods in our field. Sadly, that effort has resulted in: diddleysquat. In other words, I feel like one of those ‘mediocre’ practitioners Bob Flaws refers to. (Yes, I’m feeling a bit sorry for myself at the moment.) Despite being intelligent, I wasn’t well-suited (psychologically) to find my way in a muddled field. I think it’s muddled because it’s recently transplanted and is based on a massive body of literature and practice. I’m very happy to hear that there are pockets of erudition, competence and efficacy out there. You students give me hope for our profession.
For the “classicists”: I understand the importance of studying the classics … but what is it about all the scholarship of the last thousand+ years that makes it seem inferior? What makes you believe that the authors of the classics were at the pinnacle of their art(?) form–that the medicine was basically completed then and subsequent work was irrelevant?
Thank you for the stimulating discussion,
Sammy
With respect, if this indeed is the question then I contend that you do not in fact understand the importance of learning the classics. If you’ve truly seen and apprehended them, this is no longer a question as they become self evident once applied in practice. However, you MUST have the oral tradition in order to fill in the huge gaps left by the classics, especially the Su Wen. There simply is no replacement for the correct approach. Please know that I did not attend a classical school but rather a TCM school, and the difference between good medicine and bad medicine quite literally saved my life. TCM, even in the hands of PhD’s from Beijing, had me on my way out the door. A doctor with an understanding of the Shang Han Lun is why I’m still here. For me personally, I know all about the TCM methods and anyone can say whatever they like about inexperience or erudition and make themselves the gold standard as much as they please but none f that changes the fact that you simply cannot conceive the difference in efficacy between the way we were all taught in the best intentions of TCM vs. simply doing things the way laid out by Zhang Zhong Jing. Bob himself in his book “The Successful Chinese Herbalist” points out that his favorite and most useful formula is Xiao Chai Hu Tang. Where did that come from? What’s the possibility that the mind that spawned that formula may have had some other good ideas? Considered the possibility that maybe the new ways aren’t necessarily the best ways? Don’t take my word for it. Who am I? Go digging for yourself. Make your own decisions. There are folks out there who are still part of extant SHL lineages who can make very clear what it is that’s between the lines, both in China and the West. But until you’ve seen the power and efficacy of the Other approach, you don’t really understand what it is that you are questioning. So go find out!
Sammy, I have spent over 10 years studying pulse with Dr. Hammer, and been continually rewarded by this single-minded pursuit. And then, in the manner of a role-model of mine, Cheng Menxue, I sought to also work hard to grow from “a specialist in one area to widely acquainted with the entire field 由專而博“ and then again, to return to another style of single-minded study of the Shang Han Lun tradition, that is 上 溯 到 根 本。 I am not in the habit of deriding the contributions of Bob Flaws in bringing translations of texts to the public, nor do I doubt his sincerity. But he has published a book called “the secret of Chinese pulse diagnosis” or something like that, suggesting that simply memorizing the definitions of the pulses is the key to using the pulse well. And he has written an article suggesting that because my teacher does not read Chinese, that this obviates about 25 years of close association between Dr. Shen and Hammer. He purports to understand Dr. Shen’s ideas based on sending some patients to Dr. Shen and reviewing the prescriptions. I have several hundred pages of Dr. Shen’s hand-written formulas, and about 9,000 documents from Dr. Hammer. And so I can safely say that the statements he makes about the “systems model” of Dr. Shen are conjecture, and erroneous. All of that is to say that indeed the oral tradition of transmission is a more sound guarantor of depth and rectitude. And that when Dr. Shen would say, “book wrong” he was not denigrating the Classics as a resource but elevating the direct transmission. So the “secret” to efficacy is not found in seminars, or cheap books. It is only found in hard work, discipleship, constant revision, practice from a set of principles, and self-cultivation (including treating one’s elders with respect). These are the elements that distinguish the Classical model from the non-classical. As the Annals of the Historian says, “all doctors who diagnose according to the pulse are disciples of Bian Que.” So there can be no less aspiration on my part than to be a worthy student, and to know that what was possible in the past can be possible now, if only we embody the principles that enlivened such sages. They did not rely on mass market publications, or 2-day seminars. They relied on determined swimming upstream to the roots of the tradition; they relied on the transmission from their teachers as a guide to the classic texts. Without guidance it is no surprise that people feel cheated and mediocre.
As I am a recent graduate of a TCM Medical College and am in the process of studying classical Chinese language, I found these comments to be quite interesting and thank all for providing leads and insights. Having done work with Japanese back in the 1980’s, many of the Hanzi are simply old friends with new names with whom I am becoming reacquainted.
Bob Flaws books are a major source of both inspiration and knowledge and I use them a lot. I do wish that Blue Poppy would provide some newer books for the Chinese Medical language student – I have avoided buying the one they offer because of the lack of PinYin accents, which is a constant source of frustration for me when I read Maccocia and other TCM books which omit this.
But otherwise it looks like it is quite useful for learning medical Chinese and I may get it later. If anyone has other suggestions, they are welcome. I do have Goodman’s recent book, an ideal intro to Classical Medical Chinese and he has VERY wisely provided the mp3 sound files for the textual passages, an essential for any Oriental language.
Though the reading is quite difficult with a rather curious Latin derived nomenclature, I am finding Manfred Porkert’s books to be quite intriguing and, might I say, eye opening. As a distinguished Sinologist, his comments seem authoritative and for me, this seems to be a good route to get some feel of what CCM is about. Obviously, these are things which are learned over months and years.
Hey James,
All of those are good resources, particularly Goodman’s texts. Porkert is a good read, of course. While not necessarily language focused, for a feel of Classical Chinese medicine with a language inspired spin, you can’t beat Heiner Fruehauf. While he doesn’t have any commercially available books, his Associates Forum is a wealth of information. I know they are thinking about working with monthly memberships and other options, so if the current price point is a little too rich, I’d visit again soon. (www.classicalchinesemedicine.org).
I can also recommend anything written by Unschuld – I assume you’ve already found him, though.
Good luck! I hope to see you back here commenting – we can always use more folks in the community.
Eric