典藏书目

Thinking about Traditional Chinese Medicine (Zhongyi)

Author: Liu Lihong

Preface

The author of this book is one of my students who possesses distinctive characteristics. This distinctiveness does not refer to other aspects, but rather to his extraordinary love and pursuit of Traditional Chinese Medicine (TCM), especially regarding the classical texts. In a context where the emphasis on classics is declining and higher-level TCM colleges are increasingly making classical courses elective, this attitude is rare and commendable, and it is what brings me the greatest comfort. The author's persistence and love for the classics, as well as the realm he has achieved in classical TCM, are fully demonstrated in this manuscript. I believe that after reading this book, every reader will have some insights and gains. As the author states, the classics are the foundational discipline of TCM, and to date, no other thing can replace this foundation. Therefore, to learn TCM well and to reach a high level in this field, one must value the classics and must value this foundational discipline. To reach Fusang (Japan), a boat is indispensable. This is the recognized path by masters past and present, with no alternative route. What kind of book is *Shanghan Lun* (Treatise on Cold Damage)? It is a classic, a work of sages, a monumental work that connects the past and future in the history of TCM, the most important canonical text revered by almost all renowned physicians, an axe for clearing mountains, and a bridge to entering the Dao. In my view, it is even more a monograph discussing difficult and complicated diseases. The importance of *Shanghan Lun* in TCM is undeniable and obvious to all. Precisely because of its unique significance in the field of TCM, it has attracted the joint attention of physicians from ancient and modern times, both in China and abroad. Regarding commentaries and studies on *Shanghan Lun*, they remain unsurpassed in the TCM community to this day. Among the numerous works, it is truly rare to find someone like the author who can so plainly and gently expound the profound meanings of the classics. Confucius said, "The younger generation is to be regarded with respect. How do we know that the coming generation will not be the same as our own?" I firmly believe this statement, and thus I write this preface.

October of the Xinsi Year, Chen Yiren in Nanjing

Chapter 1: A Brief Discussion on the Study and Research of TCM

I. Establishing Correct Understanding

1. The Importance of Theoretical Understanding

My belief and affection for TCM naturally instill in me a sense of inescapable mission, believing that the rise and fall of TCM is the responsibility of every common person. The writing of this book may well stem from such a sense of mission and responsibility. Therefore, I sincerely hope that through the writing of this book, I can practically solve some problems for TCM, particularly those related to understanding. The preparation for this book underwent nearly ten years of incubation, and one could say the preparation was sufficient. However, when it came time to actually start writing, I did not know where to begin. I always felt that TCM issues were myriad; which one was more important? Which one was more critical? In the eyes of ordinary people, TCM is used to treat chronic diseases, or conversely, Western medicine treats symptoms while TCM treats the root. What does treating the root mean? In reality, it often means that for severe or critical illnesses, Western medicine helps the patient pass through acute, critical, and heavy stages, after which TCM is brought in to conclude the treatment and provide recuperation. Therefore, ultimately, TCM is only used to treat diseases that are not fatal. In the eyes of others, TCM is merely a crowing rooster. If you crow, the sky brightens; if you do not crow, the sky still brightens. Is TCM really like this? I think resolving this cognitive issue should be key.

(1) The Current Status of TCM

The above-mentioned understanding is not accidental, nor is it baseless. Among graduates from various cohorts, many like to come to me to share their experiences. Many of them share a common feeling: during their four years of university study, they remained enthusiastic and confident about TCM, hoping to have opportunities to test their skills in their final year. However, after one year of clinical internship, they were almost completely despairing, and their enthusiasm for TCM had dwindled to almost nothing. Why? A very important aspect is that the TCM they saw in clinical practice was not what they had originally imagined. Whether in TCM hospitals or the TCM departments of Western medicine hospitals, TCM has almost become a decoration. Practitioners of TCM lack confidence in TCM; upon encountering any minor difficulty, they rush to use Western medicines, or add a bit of TCM to conventional Western medical treatments just for show. Meanwhile, those who genuinely wish to practice TCM lack institutional guarantees. I remember when I first graduated, I worked clinically at a TCM hospital. This hospital had a clear regulation: for patients with fever treated with TCM, if the fever did not subside within three days, Western medicine must be administered. I still do not understand why a TCM hospital would make such a regulation. Why doesn't the hospital stipulate that if Western antipyretics fail to reduce fever within three days, Chinese herbal medicine must be used? For TCM to fall into such a situation inevitably raises doubts. Yesterday, a pregnant woman nearing delivery visited me with the purpose of thanking me in person before giving birth. When she was seven months pregnant, due to fatigue, she experienced symptoms of threatened abortion, such as abdominal pain and vaginal bleeding. After one week of Western medical treatment, there was no improvement. Furthermore, given her history of previous abortions, she was particularly afraid. Introduced by a friend, she sought my diagnosis and treatment. After examining her tongue and pulse, I prescribed Huangqi Jianzhong Tang (Astragalus Decoction to Build the Middle). After the first dose, the bleeding decreased; after three doses, both the abdominal pain and bleeding ceased, and her appetite opened up significantly. Afterwards, she called her mother in the north to recount the experience. Upon hearing this, the mother's first question was: "Is using TCM okay?" This doubt from the patient's mother reflects the psychology of ordinary people towards TCM. In May this year, I was invited to attend a TCM academic seminar, where I gave a report titled "A Brief Discussion on the Study and Research of TCM." After the report, a doctoral student attending the conference approached me to talk. On one hand, he expressed admiration for my continued great enthusiasm for studying and promoting classics in such an era; on the other hand, he found my behavior puzzling. It is said that among a group of TCM doctoral students, very few read the classics anymore. If a doctoral student had a copy of *Huangdi Neijing* (Yellow Emperor's Inner Canon) on their desk, it would absolutely be laughed at. What books are on the desks of these doctoral students? They are forced to read modern books such as molecular biology. The doctoral group is undoubtedly a high-level group. They bear the mission of modernizing TCM, so reading modern books is natural. But why are they unwilling to read TCM books, especially not the classics? I think there can only be one answer: in their minds, TCM is only so much, and the classics are only so much; is there anything more worth looking at? Compared to the many problems mentioned above, this issue appears particularly serious. As everyone knows, this doctoral group will soon and naturally become the decision-makers and leaders of the TCM profession. When this group truly holds power, what will TCM look like? This is not hard to imagine. Therefore, this question must be raised: Does the TCM we see now, and the TCM we currently understand, truly represent authentic TCM? Can the level of doctors we see in various TCM medical institutions truly represent the true level of TCM? Where lies the true level of TCM? Where is the commanding height of TCM? In modern times, or in ancient times? Different answers to this question will form radically different perceptions of TCM. If authentic TCM is exactly what we see today, is it worth spending a lot of time learning it? Is it worth dedicating one's life to researching and practicing it? I certainly would not! Why trap oneself in a dead end? Spending much energy only to play a supporting role. Therefore, I raise the question of "How to Correctly Understand" in order to hope that everyone will not be confused by the current situation, thereby losing confidence in TCM.

(2) Is TCM Theory Lagging Behind Clinical Practice?

In the past ten years, a frequently raised issue in the TCM community is whether TCM theory lags behind clinical practice. For any science, theory usually leads, and practical application follows slowly. I will discuss this point in detail later. Why has the situation in TCM failed to break through over these decades? Why does clinical efficacy always fail to improve? When encountering high fever that cannot be reduced, one eventually has to resort to penicillin. Why? Why has this situation arisen? TCM theory has been formed for over two thousand years. During this period, without major breakthroughs or changes, could it be that the backwardness of theory can no longer provide more and effective guidance for clinical practice? Thus, the issue of TCM theory lagging behind clinical practice arises logically. Everyone can ponder: Is our current clinical backwardness and inability to improve our disease-treatment levels caused by theoretical backwardness? My view is completely different. Quite the contrary, theory has not lagged behind; in many areas, it is far ahead. This is similar to other traditional disciplines. The famous modern scholar Liang Shuming proposed: Traditional Chinese culture, such as Confucian culture, Daoist culture, and Buddhist culture, are all precocious products of human culture. I think the situation with TCM is largely the same. Precisely because it is precocious, and the span of this precocity is too large, it remains not backward even in modern times, and may even be ahead. Therefore, within the TCM system, there is absolutely no problem of theory lagging behind clinical practice. If you believe theory lags behind clinical practice, and that theory cannot guide your clinical work, then I must ask you: Have you truly mastered TCM theory? How much of the theory of TCM, and the theory of *Neijing*, have you grasped? Do you have full certainty? If not full certainty, what about twenty or thirty percent? If even less than twenty or thirty percent, and some have practiced TCM their entire lives yet still cannot distinguish Yin and Yang, how can you say theory lags behind clinical practice? People today view TCM theory as too simple and too naive. Because it is too naive, it resembles farmers in the mountains. Actually, what is wrong with being naive? Naivety is the highest realm, because returning to simplicity allows one to return to truth! If you have not truly understood TCM theory, or at best only have a superficial understanding, how can you say whether TCM theory is ahead or behind? The aforementioned issue is very serious. If not properly understood, the crux leading to the current situation of TCM will not be easily identified. What causes the low clinical level we see today? If we mistakenly attribute this cause to theoretical backwardness and seek reasons within theory, we might cause true regression and true backwardness! I remember after graduating from undergraduate studies, I worked clinically at an affiliated hospital. Once, I treated a female patient with pneumonia. She was 60 years old, admitted with a body temperature of 39.5°C, WBC near 20,000, neutrophils 98%, and large shadows in the right lung. According to Western medicine, this was a case of severe pneumonia. Severe pneumonia in the elderly is prone to danger. However, back then, I was like a newborn calf unafraid of tigers, always wanting to try the efficacy of TCM, so I chose TCM treatment. After syndrome differentiation, it belonged to lung heat, so I administered a formula to clear lung heat. Unexpectedly, shortly after taking the medicine, she experienced diarrhea. Initially, it occurred 2 hours after taking the medicine, and gradually progressed to occurring within ten minutes. The excrement resembled medicinal liquid. For three days after admission, her body temperature did not drop at all, and other symptoms showed no relief. According to hospital regulations, if the fever did not subside the next day, Western medicine must be used. At this moment, my mood was more anxious than the patient's. I hurried to my master for advice. After listening to the introduction, the master said this was a simultaneous disease of the Taiyin and Yangming aspects of the root and branch. Yangming was hot and Taiyin was cold. Yangming heat needed clearing, but the clearing herbs were not accepted by Taiyin, hence the diarrhea after ingestion. This illness should be treated separately for Taiyin and Yangming to avoid mutual interference. Internally, continue with the previous formula to clear Yangming; externally, use Lizhong Tang (Regulate the Middle Decoction) added with Amomum fruit (Sharen), ground into powder, mixed with wine, heated, and applied externally to Shenque (CV-8) to warm Taiyin. I quickly prepared it according to these instructions. Applied around 9 PM that night, after about 1 hour, she took the internal medicine again, and surprisingly, no further diarrhea occurred. The next morning during rounds, her body temperature had dropped to normal, and overnight, other symptoms also decreased drastically. Throughout this illness, not a single pill of Western medicine was used. Within a week, the pulmonary inflammation was completely absorbed, and she was discharged. This case had a profound impact on me. For more than ten long years, whenever I encountered unsatisfactory clinical efficacy, I never doubted it was a problem with TCM or theory. Therefore, regarding the question of whether theory lags behind clinical practice, we should think carefully. Once this problem is resolved, regarding theory, we can confidently accept and practice it. When encountering obstacles, we should look for problems in our own comprehension rather than blaming the theory. Of course, if the problem truly lies in the theory itself, and the theory has indeed lagged, we should not rigidly cling to it. However, based on my experience and observation, in most cases, the problem does not lie in the theory, but in our understanding.

(3) Insights from the Development of 20th Century Physics