What exactly constitutes a "classic" (and by extension "classical" Chinese medicine)? Is it limited to The Yellow Emperor's Inner Canon? The Divine Husbandmen's Herbal Foundation Canon? The Pulse Canon? Central Treasury Canon? The Systematized Canon of Acupuncture and Moxibustion? On Cold Damage and Miscellaneous Diseases, which is no longer extant and was subsequently compiled into two books, On Cold Damage and Essential Prescriptions of the Golden Coffer, during the Song dynasty? Herbal Foundation Compendium, a relatively late arrival in the Ming dynasty?
Aren't the "classics" the extant treatises and compendiums presenting the most advanced and up-to-date knowledge of the day (at least 4,000 years ago, but most likely a lineage that extends back since the human inhabitants of what is now called China were able to communicate with each other)?
For lack of a better word, or to simply call a spade a spade, isn't the accumulated knowledge and practices the textbook definition of science? It appears the answer is yes; it was the vanguard science of the day!
Everyone who has done a bit of studying on the matter knows that most, if not all, of these "classics" passed down through millennia have been reworked and reorganized, with extrapolations, supplemental material, and embellishments included, as well as annotations to interpret and explain the nuances and intricacies of the meaning of these sacred historical texts.
So, are the texts we are reading today presented in the above-mentioned altered format still considered "classics"? What about all of the subsequent insights and reflections practitioner-scholars have gleaned through the application of their predecessors' teachings, methods and approaches in clinical practice? Some have been faithfully documented and published in what, for lack of a better term, can be called contemporary classics. Are these texts considered "classics," too?
The point of all this banter is to demonstrate that Chinese medicine, just like any other science, profession or art form, has always been fluid and dynamic. There is no official starting or ending point. It is a developmental process influenced by the surrounding natural, social, political, and economic environment.
As long as the fundamental concepts and principles of Chinese medicine (CM) are clearly understood and effectively applied to achieve clinical efficacy, then all of the analysis involving debates on what is or is not "traditional" Chinese medicine (TCM) or "classical" Chinese medicine (CCM) is simply a matter of opinion and semantics.
A Little (Political) History...
Chinese history is riddled with the strife of clan fighting and outright civil wars; the torture, pain, anguish and death. And in some ways the Chinese Communist Revolution was just another wrinkle in the long lineage of Han history. However, despite there being heated disputes and disagreements over different types of traditional thought and practices (e.g., Confucianism, Buddhism,* Daoism), up until the revolution there had never been an all-out assault and outright mandate to eradicate Chinese traditional ways of thinking.
What would replace the cronyism and corruptness of the Republican era? The antiquated idea of an ideal proletariat state, and what better way to christen the revolutionary spirit with an "out with the old and in with the new" campaign.
The Chinese People's War of Liberation caused all sorts of havoc and disruption of traditional ways. First, the Chinese Communist Party interjected a Marxist template into reality, and then aggressively promoted the concept of "modernization," which usually entailed violent ostracization and/or outright banning of many traditional ways of thought and practices, including Chinese medicine.
The institution of Chinese medicine was relegated to "folk" medicine status, unworthy of patronage and advancement (except for the barefoot doctors, with little or no formal education or training, still practicing in rural communities), while Western medicine and the biomedical sciences were in the midst of making rapid progress and "revolutionary" advances of their own.
I guess under that guise it was a "no brainer": We can institute our Chinese-style proletariat utopia, plus reap the benefits of adopting the most innovative scientific advancements.
Although that didn't work out so smoothly at the onset, recently the regime seems to have turned the corner and is actually making headway in establishing the Peoples Republic of China as an international superpower.** Chinese medicine has also seen somewhat of a revival in recent decades, mostly via an "integrative" approach.
The Present: CM's Position
There are very real and important questions and concerns over the types of education Chinese medicine practitioners are receiving – particularly about which "classics" are being taught in schools and to what extent they are being taught; what types of biomedical sciences are being taught and to what extent; and how the foundations for the clinical application of integrative Chinese and Western medicine are being taught, if at all. These are all very worthwhile topics of analysis and debate.
Just the entire concept of Chinese medicine (regardless of the above-mentioned acronym one chooses to call it) somehow being able to survive on the fringes of some sort of alter-reality unaffected and influenced at all by modern biomedicine – Western medicine – seems foolhardy, lightheaded and absurd. After all, Western medicine has long been firmly established as the de facto primary health care provider. Virtually every patient in need who is even remotely in contact with modern civilization will be examined, diagnosed or treated at a Western medicine medical facility of some sort. The term conventional medicine is universally associated with Western medicine – modern biomedicine. It would seem we are all in this together.
A Glimpse at the Future
The sustainable future of Chinese medicine as a viable medical system will depend on its ability to not only take advantage of existing therapeutic "niches," such as pain management, infertility, neuropathy, arthritis, insomnia, gastrointestinal problems, anxiety and stress; but also to continue making headway into expanding therapeutic applications into the entire pathological spectrum.
This may mean Chinese medicine assumes the role of a primary care provider without Western medicine therapeutic intervention, or the role of complementary, neoadjuvant, adjuvant, or palliative therapy.
We must all remember that our ultimate goal as Chinese medicine practitioners is to provide the most effective treatment possible for our patients. By doing so, we will be able to continue applying the "classics" and building on the subsequent developments of our more "contemporary" predecessors, gleaning insights and making new discoveries of our own to pass down to future generations.
Author Notes
* The origins of these beliefs and concepts ("doctrines and disciplines") were not autochthonous. Buddhism originated in ancient India between 600 BCE and 400 BCE, and was subsequently introduced to China sometime in late 200 BC to 100 BC.
** This leaves one to wonder how the dramatic growth leading up to the turn of the 21st century has had anything at all to do with the ideal of a proletariat utopia. This evolution has been more in line with a hybrid socialist approach heavily guided by capitalist forces under the direction of autocratic rule with strict oversight and restrictions on civil liberties and individual freedom.
Scott Herbster graduated with a bachelor's degree in Chinese medicine from China Medical University in Taiwan. He has worked as a clinical practitioner for more than 20 years and authored the three-volume book series Integrative Chinese Herbal Therapy (available on Amazon.com).