Since arriving in Portland to study acupuncture and Chinese herbalism, I have been unbelievably lucky with regards to the teachers to which I have been exposed. In fact, not a day goes by that I don’t find myself pretty much floored when I consider my good luck. You know that old adage that “When the student is ready, the teacher will come?” Well, I must be ready – because I’ve got some pretty incredible teachers. I’ve talked about only a few of them on the blog, but hope to feature more about them – even in their own words – in the coming year.
We have been blessed to have the presence of a true modern day master, Dr. Liu Lihong, at NCNM for the past couple of weeks. He gave a public lecture along with his colleague, Dr. Tang Nong, about the state of Classical Chinese Medicine in China and has since lectured on a number of other topics in an impromptu fashion.
He also gave a more structured lecture to a small group of people with connections to Heiner Fruehauf and NCNM on the topic of the “Fire Spirit” school of herbalism of which he is a part. Every single opportunity I have had to listen to Dr. Liu has been a treasure. As someone new to the field, I appreciated his simple, yet deep, explanations on topics that mean a lot to me such as: What is a lineage and what is its meaning? What does it mean to be a physician in this day and age? What is the meaning of calling one way of practicing Chinese Medicine “Classical?” He also discussed more in depth topics such as the appropriate use of Fu Zi, the essential salient features of treating in a “Fire spirit” school way and a way to understand the theories of the five elements and six conformations.
To tell you the truth, it’s been so much information, I’ve almost willfully avoided going back over it because I’ve got so much on my plate already! But, I would like to share with you some of what I’ve learned and what it has sparked in me in terms of new ways of looking at Chinese medicine. It will likely take a few articles. I’ll try not to make you wait. 🙂
I’ll actually have to start with first things first – the series of talks was kicked off by Dr. Tang Nong, who is the chair of the Institute at Guangxi College of Traditional Chinese Medicine, where Dr. Liu is a senior professor, medical director and co-chair. The Institute they co-chair is the only of its kind – solely devoted to research into the clinical applications of Classical Chinese Medicine. Here patients are treated with Chinese medicine only.
In other hospitals, even those that seem to be “Chinese medicine” oriented, patients are often treated more with Western medicine with Chinese medicine only as adjunct or supportive therapy. How then, are we supposed to know what Chinese medicine can do in a clinical context? This is the very question that Dr. Tang Nong addressed throughout his lecture.
Dr. Tang was a very charismatic speaker, full of energy and clearly very passionate about the medicine. I understand he is a skilled clinician in his own right and, further, understands the basic philosophical principles underlying the medicine in a nuanced way. I really enjoyed hearing him speak.
I was particularly interested in his discussion of the essential failing of TCM as it is often practiced. Dr. Tang told us that the trend in Chinese medicine research and development is towards increasing:
2) Standardization, and
These three words aren’t inherently bad. Certainly moving forward and keeping our minds open to greater efficiency and clarity are all good things. It’s the way that these principles are understood and executed that creates problems – at least that what Dr. Tang seemed to be communicating to us. He spoke most against the effort towards standardization. In standardization of Chinese medicine, efforts are made to create “standard” diagnoses based on “typical” symptom pictures. These diagnoses are attached to “standard” formulas and point prescriptions. I expect that even the modifications are standardized (if x, then y). Thus, anyone with skill enough to understand the basics can simply match up a + b + c and come up with a treatment plan that can easily be supported by everyone else trained in the system.
What is the point of standardization? Dr. Tang didn’t address this much during the lecture, but I found myself thinking about it quite a bit. Often, things that don’t turn out well started out as good ideas. The road to Hell, as they say, is paved with good intentions. I think the reasons behind wanting to standardize are many, but I feel that it all comes down to expediency and fear for safety. When the numbers of patients you are seeing increase dramatically, you need a quicker way to cycle through them. Further, you can see even more patients if you can quickly and easily teach others how to treat safely. This is expediency. With a standard system you can see more people in a shorter amount of time. Admirable.
Additionally, there is a fear for safety of patients. This is still related to an increase in numbers of patients coming through the system. If you want to train ever larger numbers of physicians, to see ever larger numbers of patients, ultimately a quick way to do this is to reduce standards for entry into the profession. While some people would say that standards are still quite high for entry into the highest levels of Chinese medicine education in China, others would strenuously disagree.
Certainly everyone can agree that it takes less to become accepted as a physician in China today compared to a couple of hundred years ago. Regardless, when you reduce the standards for entering into a potentially dangerous profession, you have to build safety valves into the essence of the system to avoid costly errors. In all, if we reduce professional standards and standardize sufficiently to ensure patient safety, we can see huge numbers of patients in a relatively short period of time. Why NOT standardize, one might ask…
Because Chinese medicine doesn’t work very well when it’s standardized. In fact, the system relies pretty heavily on individualization. While we can agree on certain basic sets of symptoms as emblematic of particular disease states or formula patterns, ultimately each person’s manifestation is likely to be slightly different and thus take a slightly different formula. Ultimately the creation of a formula or point prescription needs to be highly individual, based on the interaction between doctor and patient, the particular manifestation of the patient on that day, the particular weather patterns current and expected, the tendencies in any given year, the dietary habits of the patient and so on. While a “standard” prescription may lessen symptoms, it’s unlikely to have the kind of dramatically positive impact that a more individualized treatment would have. I’ve seen this in clinic many times, and I’ve experienced it myself.
But more importantly, these eminent physicians have seen this in thousands upon thousands of clinical cases and are adamant that standardization (as it is currently practiced) is a degradation of our medicine.
Dr. Tang talked about many other things, but it will have to wait for another post. For now, I’d be interested to hear folks’ thoughts about what I’ve said here. Why do you think people are so eager to standardize Chinese medicine? How do you see the benefits and costs? What are the alternatives? What are their benefits and costs?