Written by Huang Xuhua, Class of 2011. She obtained her Masters (Acupuncture & Tuina) from TJUTCM in year 2015, worked thereafter as a TCM physician in Singapore for 3 years, and is now doing her first year PhD (TCM) at TJUTCM.
This article describes the views of China’s TCM Great Master, Professor Wang Qi, on the importance of TCM theory innovation and the ways to go about doing it. The seminar was held on 16 October 2018 in Tianjin University of TCM. Contents of this article are translated off the presentation slides of the seminar. Readers interested in the original presentation slides may obtain it from the writer through CMAA.
1. The need for TCM theory innovation
Survival of TCM
The current state of TCM’s survival depends much on TCM theory innovation to stay onboard. Currently, TCM hospitals in China see a total of 4.38 billion patient visits, accounting up till about 17.5% of the total number of patient visits in all hospitals within China. Also, about 70% of the total income in TCM hospitals in China comes from their western medications and services. As seen, TCM services are not exactly faring as well as compared to their counterparts.
The history of medical developments reflects the change in (TCM) theoretical thinking over times. Prof. Wang Qi believes that the vitality of our ancient TCM discipline is attributed much to the ever-changing theoretical thinking of TCM. He advocates that “for TCM to prosper, there has to be vigorous academic developments; and for vigorous academic developments, there has to be vigorous developments in its theory”. (“欲求中医之振兴，必求学术之振兴，欲求学术之振兴，必求理论之振兴”)
Insufficiency of TCM theory
As a medical science, TCM also has its unknowns. In terms of TCM etiology and pathology, diseases causation is almost always attributed to external pathogenic factors (六淫) and internal pathogenic factors such as harmful emotions, improper eating habits, etc. Little is known about the physical, chemical, biological, and genetic aspects of diseases causation. For example, there are currently more than 6600 types of monogenic disorders such as colour blindness, haemophilia, albinism etc, and this number is increasing by 10-50 each year, but TCM is currently lacking the theoretical explanation for such diseases.
In terms of disease classification, TCM theory has unclear classifications of many clinical diseases. The TCM etiological and pathological standpoint of different diseases is insufficient to distinguish the unique characteristics of each disease.
Clinically, TCM theory also lacks the theoretical explanation for drug allergies, toxic side effects, various hereditary diseases, and metabolic diseases. This greatly hinders TCM guidelines in clinical practice.
Resolve new clinical problems
The spectrum of diseases has changed over time and new clinical problems have emerged, but the basic theory of TCM has not developed accordingly. TCM theory lacks newly refined theoretical generalization based on new clinical facts.
For example, in vertigo, TCM summarizes its etio-pathology into phlegm, weakness, wind, and liver imbalances. However, in Western medicine, vertigo is classified based on its etiology into central vertigo (including intracranial vasculopathy, intracranial space-occupying lesion, intracranial infectious diseases, vestibular migraine), peripheral vertigo (including benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuropathy, otosclerosis), and others possible causes of vertigo such as cardiogenic vertigo, hematological disorders, metabolic disorder, toxic-induced vertigo, ocular vertigo, etc.
Development of TCM discipline
The establishment of a particular discipline lies in the construction of its theoretical system, and the depth of its theoretical research reflects the overall standard of this discipline, which helps drive the development of this whole discipline. The importance of theoretical construction to a discipline is that its scientific theory holds universal patterns and is valued as practical guidelines.
Over the past 100 years since the Republic of China, new theories output in TCM has not significantly increased in value and volume. Only the 9th edition of “TCM Basic Theory” has “TCM constitutions” added to it. From the end of Qing Dynasty till now, TCM textbooks have seen new developments when compared with traditional TCM theories. Firstly, TCM textbook mediums have been changed from classic to modern Chinese language. Secondly, a division of TCM theory for modern day significance has been formed. Thirdly, integrated Chinese and Western medicine theory has been incorporated into TCM textbooks.
As seen, the construction of sub-disciplines from the TCM theory system awaits further strengthening. The branching out of a discipline marks the maturity of one’s theory. Hence, in the development of TCM, theoretical innovation is necessary for cultivations of new TCM disciplines.
Stand against western culture
Over the past century, Chinese medicine has been questioned and criticized. Of the people who questioned Chinese medicine, some call it empiricism, some call it metaphysics, and some simply believe that Chinese medicine is pseudoscience.
For any nation to stand amongst other nations, it needs to have the ideology of oneself and independence. Similarly, for any academic discipline to stand amongst the other disciplines, it needs to also have the ideology of oneself and independence.
The foothold of ideology is theory, which branches out and lead through the times.
Key to the gold of Chinese civilisation
TCM is the accumulation of profound philosophical wisdom and thousands of years of healthcare knowledge and its real-world experiences, and is considered the key to the treasure of Chinese civilization. Further developments and scientific summarization of TCM helps enrich global medical industries and promote life sciences researches.
2. Reasons hindering TCM’s progress
TCM theoretical distortion
There has been an over-emphasis on “辨证论治” (which means to administer treatment based on syndrome differentiation), and as a result, the importance of diseases diagnosis and TCM constitution differentiation during treatment is overlooked. It is noted that in TCM classics, disease comes first before syndrome.
Fading out of certain TCM theories
Certain TCM theories such as “五运六气” (a study of the universal flow of the five TCM elements in accordance to the six periods within each season) and “子午流注” (a study of TCM that involves taking the time of the day into consideration while administering treatment for its best effect) have been fading out from practice over the years. This is due to the lack of funding and support from China in these fields of research, and also the lack of researchers interested in these areas. Hence, the survival of such theories depends much on its spontaneous research.
Fixation to TCM theories
The disease spectrum has been increasing over the years as new clinical phenomena floods in, but TCM theories remain firmly grounded to the pre-existing theories. For example, aplastic anemia, iron deficiency anemia, thalassemia, megaloblastic anemia, and various blood disorders are classified as “blood deficiency” in TCM, but this hardly relates well to modern clinical practice.
Overly long-standing stability of TCM theoretical structure
Although the basic theoretical system of TCM stretches into a long river of history, it appears very slow when compared to the vigorous advancement of the modern scientific system. Some people term this phenomenon as the “super-stable structure” of TCM, which results in the lag between TCM and modern medicine, where the latter timely keeps up with scientific advancements.
For example, comparing the medical development of insomnia, TCM Internal Medicine has always regarded insomnia as a sleep disorder attributed to heatiness due to liver-depression, disturbance from internal heat-phelgm, heart-kidney imbalances, weakened heart-spleen system, etc. However, modern sleep medicine attributes sleep disorder to insomnia, daytime sleepiness, restless lower extremity syndrome, narcolepsy, sleep behaviour disorders, apnea, etc. and the list goes on.
Heavy reliance on TCM Classics citation in TCM theory development
Looking back into the academic development of TCM theory, certain academic problems are not resolved with core investigations or actual evidence presentation, but rather through TCM Classics citations from various academics. As a result, no conclusions can be arrived upon when research discussion is replaced by academic citations, or where actual evidence is replaced by superficial ones.
This becomes a situation whereby classical TCM quotes becomes a necessity for academic conversations, and academic TCM citations becomes a necessity for TCM literatures. As seen, academic discussions are mostly represented by the dead instead of the living, if anything were to go wrong with the theory, the fault lies with the dead.
TCM theory stays primordial due to the lack of modern technology for its development
Certain TCM theories have been proven by western medicine research. For example, the human biological clock as per western medicine can be correlated to the TCM cyclical pattern of the human body in accordance with time. Another example would be the article “The lung is a site of platelet biogenesis and a reservoir for haematopoietic progenitors” which reflects the TCM physiology of lungs as an organ which all blood vessels converge into.
3. How to go about with TCM theory innovation?
With the development of times, TCM theory research methods is not just based on TCM classic literature research, but also involves observational studies, animal laboratory research, computational methods etc.
TCM theories formed under present conditions should now have sufficient support from modern scientific experiments. For example, the analgesic principle of acupuncture is explained with endorphin secretion in the hypothalamus, which acts on nerves, resulting in local analgesia.
Therefore, innovations in TCM theory needs to be anchored in its traditional theoretical core and be subjected to modern interpretation, so as to adapt to the changing needs of time and to enhance its self-worth.
There are three levels to TCM theory: one that can influence the entire TCM academia and become a theoretical pillar of TCM, another that has academic influence in a particular field or discipline branch, or one that provides theoretical understanding of a particular disease, its syndrome treatment and prescriptions.
Extend and develop pre-existing TCM theories
For example, “藏象概说” (a TCM book on the concepts of visceral manifestations, 1980) was developed into “中医藏象学” (a TCM book on the study of visceral manifestations, 2012) over the years. The theoretical system constructed in the latter book, including its systems of concepts, epistemology, methodology and values, were based on the pre-existing theories in the former book. A great amount of original work was involved in the standardization of definitions, terms, and concepts in the latter book. The concept of disease diagnosis and its syndrome differentiation based on the visceral manifestation system was also put forth in the latter book, which is an enhancement and development of the TCM theory of visceral manifestation in the former book.
Saving endangered TCM theories
The study of TCM abdominal diagnosis in China has filled the long-existing gaps in its field, and ended the debate between the Chinese and Japanese academia on the ownership rights of this invention. The contents of the book “TCM abdominal diagnosis” were re-organised and published in a new book called “The study of TCM abdominal diagnosis and its clinical application” in 2012.
Reform inherent TCM theories
With respect to western medicine, the understanding of erectile dysfunction (ED) has been evolving over the years. For example, in 1960s, ED was attributed to psychological problems and patients were administered psychological treatment; in 1970s, low hormonal levels were found to be a cause of ED and hormonal therapies were administered in its treatment; in 1990s, the treatment of ED was newly targeted at insufficient blood supply to the penile cavernous bodies, which resulted in the use of Viagra; and in modern times, researchers are currently looking at genetic repair in the treatment of ED. In TCM, ED is attributed to kidney-deficiency since the past, but TCM scholars have proposed to treat impotence from the liver.
Another example is the TCM saying that illness of the spleen and stomach are due to internal injuries (脾胃内伤). However, Prof. Wang Qi proposed that illness of the spleen and stomach could also be due to the external factors (脾胃外感论) as seen in Helicobacter pylori infections of the stomach, gastric flu, and pollen-induced colitis.
Construct TCM theoretical thinking mode
For TCM theory to develop, there has to be a study of its original thinking model. The study of TCM’s original thinking model is the study of the application of China’s traditional thinking in the field of TCM. This reappearance of oriental thinking is crucial to the inheritance, advancement, and innovation of TCM.
Another TCM Great Master, Lu Zhi Zheng’s view on the above: Prof. Wang Qi creatively puts forward the original thinking mode of TCM as “取象运数，形神一体，气为一元”, which explains the cognitive characteristics of TCM theory and its internal regulations from a scientific viewpoint. It reflects on the process of cognition and affirms the thinking mode of TCM clinical activities, which significantly guides the development of TCM. This is different from the reductionist model of human medical science based on anatomy, biochemistry and physiology, but instead, shows the holistic thinking of man with nature, and man with himself.
Construct TCM clinical thinking mode
“Constitution-disease-syndrome differentiation” is a comprehensive TCM clinical application of the diagnosis and treatment approach, based on the theory of “correlations between body constitution and disease” and “adjustable body constitution”. It is also based on grounds of the internal relationship between constitution, disease and syndrome.
Constitution differentiation forms the core of the “three-differentiation model”. Body constitution is the foundation for disease onset and its syndrome. Disease relates to the state of the entire body, while syndrome relates to the stage of the disease; the deepening differentiation of the disease and syndrome exhibits mutual causation between the two. Body constitution relates to the susceptibility of a body towards a disease or syndrome, and also its subsequent progression once developed.
Specifically, disease differentiation uncovers the pattern of disease onset and its treatment pattern, based on the characteristics and conditions of the body’s constitution; constitution differentiation dictates the pathological characteristics and patterns throughout the entire disease progression; while syndrome differentiation describes the pathological characteristics and patterns of a particular stage of the disease.
Construct a new TCM discipline
Discipline construction is the basic framework of a school’s organizational structure and acts as the carrier body of scientific research and education. A new discipline construction should cover the general trends, characteristics, paradigms and advantageous benefits of its discipline development.
The development of a discipline needs the constant development of new ideas, new theories and new schools of thoughts to stay innovative. For example: “TCM Andrology” published in 1982 was deemed to be the foundation work of its discipline. Prof Wang Qi published “Wang Qi Andrology” in 1997 (revised in 2006), a book which expanded the original 40 types of andrological diseases to 165 types.
4. Final Conclusion
The element of “conservation” and “change” should be handled well in the innovation of TCM theory.
In short, the matrix and main body of TCM should be conserved. To list a few examples, the matrix and main body of TCM includes the holistic approach of TCM, the ecological concept of TCM as seen in the correspondence between man and nature, TCM’s belief in the self-regulatory ability of all lifeforms, the preventive approach of TCM, the imbalance-correcting approach of TCM’s treatment methods, and the health-promoting, anti-aging viewpoint of TCM.
“Conservation” can better drive the development of TCM in future medicine. Only through the conservation of TCM’s matrix and its main body will TCM be able to realize its autonomy and run its own fate. Otherwise, TCM will lose its personal trademark and risks the fate of elimination.
For a traditional culture to come alive, live brilliantly, and to survive through times, it has to be interpreted in a modern way, injected with vitality, and be presented in a way understood and accepted by people of the current times. For example, Mr. Cai Zhi Zhong injected life into traditions through the presentation of Confucius teachings and Lao Tzu teachings in comic forms.
In conclusion, TCM theory needs innovation and the production of new theories so as to enrich its connotation over times and its modern forms of expression, resulting in a new form of TCM theory.
PS: I’m sure we have also entertained thoughts about the inadequacy of TCM theories in current times, but attribute it to our personal lack of knowledge in this discipline, and resist the urge to breakaway from traditions. It is heartening to hear from Professor Wang Qi, the overview of this problem, and that the solution is not to breakaway from tradition, but rather to conserve the essentials of TCM, and further develop TCM theories based on evidence and scientific methods. I hope this translated article can provide some food for thoughts on the development of TCM in Singapore.