Bottlenecks and breakthroughs in the modern development of Chinese medicine-中医药现代发展的瓶颈及突破

In recent years, especially since the outbreak of this year’s epidemic, it seems that there has been a Chinese medicine fever throughout the country and around the world. However, as people in the industry, we calm down and think about it. After this so-called Chinese medicine fever, we also have a lot of sadness and helplessness.

why do you say so? For example, when the epidemic broke out in Wuhan, the government, the people, and in many cases refused the intervention of traditional Chinese medicine at the beginning, and even the sick patients. A large number of people refused to take traditional Chinese medicine preparations. When they saw such reports, they gave them to others. A very bleak, very sad feeling.

Why is this happening? Why did the local officials at the time be in a state of mind that rejected the intervention of traditional Chinese medicine? Why do local infected people reject the use of Chinese medicine in such a large proportion? There are no more than three reasons.

Three Bottlenecks Facing the Modern Development of Traditional Chinese Medicine

First, in the current cultural atmosphere, there are a large number of people propagating this statement-Chinese medicine is unscientific, and Chinese medicine is superstitious. It can be said that because of this, a kind of “Chinese medicine is witchcraft, Chinese medicine is unscientific and anti-scientific” has been planted in many people’s hearts. Under such circumstances, it is difficult to convince people to use Chinese medicine. .

Second, from the current point of view, historically, the clinical effectiveness of traditional Chinese medicine has not been high enough, at least in the last 100 years, it is almost at the lowest point of clinical effectiveness of traditional Chinese medicine. Just because the efficiency is not too high, it has also caused some people and some government officials to distrust Chinese medicine.

Third, the current Chinese medicine can be said to be not a complete medical system. Why can it be said that Chinese medicine is not a complete system now? Because the evaluation of the clinical efficacy of Chinese medicine does not have the qualifications for evaluation, and there is no method of evaluation. Just like an athlete, you can only participate in sports. As for the good and bad of sports, there is no qualification and no method of judging. It is entirely up to others to say you are good or bad. Of course, this is not caused by Chinese medicine itself, but for a medicine, this is a very sad thing. It can also be said that because of this, Chinese medicine in today’s society is a lame medicine, not a complete medical system.

I personally believe that the above three points are the biggest bottleneck in the development of Chinese medicine in modern society. To develop and promote Chinese medicine, these three items must be effectively solved. If these three problems cannot be solved effectively, the revival of Chinese medicine and the development of Chinese medicine can be said to be empty words, and it will never be realized.

Thoughts on Breaking Through the Bottleneck of Modern Development of Traditional Chinese Medicine

In response to the several questions raised above, I have some thoughts as follows.

The first is to organize some people with lofty ideals to explain the traditional Chinese medicine principles in a modern context. Because, after all, the traditional Chinese medicine that is passed down today is left over from the works of Chinese sages thousands of years ago. The context and way of thinking in today’s Chinese society are very different from those of thousands of years. Especially in the current situation, almost Chinese people are born in this kind of Western education. According to the past, they came from the foreign school, not the traditional culture of the Four Books and Five Classics. So a problem arises. Western-style education pays attention to science. If traditional Chinese medicine cannot effectively connect and explain with the current scientific context, then there will be no way for the general public to understand and further accept Chinese medicine. . Once a doctrine is judged to be an unscientific and superstitious thing, people will instinctively reject it and it is impossible to approach it. Therefore, it should be necessary to explain the traditional Chinese medicine thousands of years ago in this modern context.

For the modern contextual interpretation of traditional Chinese medicine principles, we can refer to some current method concepts. For example, Einstein’s theory of relativity, now thrown out, almost no one in the world thinks it is superstition or pseudoscience. But they can really understand what Einstein’s theory of relativity is about, so there are very few people, and most people don’t even understand the connotation of the theory of relativity, but they will admit that it is science and truth. We can also use some of these methods to sort out and explain ancient Chinese medicine, and carry out some propaganda to the people through the modern context.

Second, from the perspective of historical development, we have lost a lot of things in the principles of traditional Chinese medicine. Today’s Chinese medicine is no longer the Chinese medicine of two thousand years ago, or even the Chinese medicine of a hundred years ago. In the Republic of China, in order to survive, Chinese medicine can go to the clinical arena under certain circumstances. Just imagine, if there is such an opportunity now, is it possible for us in the Chinese medical field to organize such personnel to compete in the arena? If such personnel cannot be organized, then in this case, our Chinese medicine practitioners are very sad. Therefore, the current traditional Chinese medicine, historically speaking, can be said to have fallen into decline. People of insight in the Chinese medical field should do more to excavate and sort out the principles of traditional Chinese medicine, so as to make traditional Chinese medicine theoretical and self-consistent, including The clinical effectiveness is truly improved. This is where the action is taken to solve the urgent problem, and it is also a process of rebuilding the core of traditional Chinese medicine.

Now we can see a problem. The loss and dissolution of traditional Chinese medicine is very serious. Basically, we have lost our independent and complete method and academic system. Many basic concepts of Chinese medicine have been imaginary and have no real and substantial connotations, and a relationship between various concepts is also fragmented and decomposed. For example, under the most basic concepts of Chinese medicine, there are the theory of essence, qi and spirit, the theory of yin and yang and the five elements, the system of the eight channels of odd meridians, and the system of twelve channels. The meridians and the twelve meridians are very vague concepts. It can be said that in the current clinical practice of Chinese medicine, it is very rare for Chinese doctors who can truly use the fundamental concept of essence, energy and spirit to guide the clinic to achieve satisfactory results; the theory of yin and yang and five elements is now completely transformed into philosophy. Doctrine has lost its fundamental grasp as a TCM methodology and worldview. Its connotation is also blurred. After philosophizing and virtualizing, it becomes useless. It is useless in clinical practice. This is also a very Sad things; what is the system behind the theory of the eight meridians and the theory of the twelve meridians? Which level of the system of Chinese medicine does the eight meridians of odd meridians represent? What are the twelve meridians? What are the connections and differences between the eight meridian system and the twelve meridian system? Now they are basically swallowing dates and being blurred. So, what is the original meaning of the most basic concepts of similar Chinese medicine? What is the source? What are the connections and differences between each other? It should be the work we must do to further excavate, sort and reconstruct modern Chinese medicine theory.

The third one, I just talked about, why is Chinese medicine called lame medicine? It is because Chinese medicine is only an athlete and has no qualifications for referees. This is a terrible thing. In other words, when a Chinese medicine practitioner contacts a patient, from the beginning of the clinical trial, until the improvement, until the end of the treatment of the condition, what basis do you judge? This is a very real problem. If an athlete does not have any qualifications for refereeing, there is no so-called standardized sport, just for sports, there are no rules, and no qualifications for judging, this athlete is very sad, and it can be said that it should not exist. No, the qualifications for existence have already been lost. Similarly, if we Chinese medicine does not have its own judgment system, it can be said to be very sad. It is almost equivalent to cooking Chinese food with Western recipes. This will inevitably be Chinese or Western, and it seems to be a combination of Chinese and Western medicine. Yes, it turned out to be four different things, nothing. For a medicine that is no longer medicine, it can also be said that it is no longer qualified to stand in the world of medicine. Therefore, we must internally perfect the concept of “we are a complete medicine”, restore the lame medicine to a complete Chinese medicine system, and establish a system for judging the clinical efficacy of Chinese medicine.

Can the experience of relying entirely on Western medicine meet our clinical requirements of Chinese medicine? This is a question worthy of consideration by the majority of Chinese medicine practitioners. I personally think that although for a medicine, regardless of Chinese and Western medicine, the research target is for the human body, but there are still many differences in subdivision. Western medicine mainly focuses on human body shape, while traditional Chinese medicine is just different. Traditional Chinese medicine divides the body qi into the main foothold. This is a four-in-one research system that studies the human body’s shape, qi and spirit. Existing Western medicine laboratories and imaging examinations, basically, are some biochemical and imaging analysis based on the body shape by Western medicine, while traditional Chinese medicine is mainly based on the separation of qi, not completely considering the shape of the device. Problem, so this will inevitably have some differences with the needs of TCM clinics and some final judgments. I personally believe that this indicator of the Western medicine form and quality test is of reference for the clinical identification and outcome of traditional Chinese medicine. However, it is incomplete to use the Western medicine form and quality test to guide and judge the effectiveness of Chinese medicine. It is not able to cover and complete a kind of support for the evaluation of the TCM system.

There is a saying in the old ancient law called internal calculation and external calculation. I talked about this term to talk about my personal understanding of the possibility of establishing a system for evaluating the clinical efficacy of Chinese medicine. Ancient Chinese medicine has internal and external arithmetic. What is internal arithmetic? It can be interpreted as the induction judgment under the multi-factor set, and the external calculation is the result of the superposition of different factors under the linearity. We can look at it this way. In the methods of Chinese medicine, most of them are based on a combination of multiple factors. Therefore, the establishment of some of our constructive evaluation systems should also be based on the internal calculation of the ancient method. But how should this matter be done? For example, in the simplest example, one point is a point, two points are lines, three points are faces, one dimension is a line, two dimensions are faces, and three dimensions are three dimensions. We can draw on some of these forms to plan and judge. , To measure our clinical needs and needs of Chinese medicine.

For example, the ancients measured the shadows to fix the day, and watched the Big Dipper at night to fix the hour. You see, this is the wisdom and wisdom of our ancients. It does not say what angle or degree the sun is at or what time. Instead, it uses an eight-foot pole, the so-called sundial, to fix the position of the sun with the shadow of the sun. So as to determine the difference of the time of day. Of course, there is a trick here, that is, the oblique angle of the sundial is different at different latitudes, so it has a corrected data. There is another, in the use of sundial, there is a rule, that is, the equinox and vernal equinox will turn over, that is, the front and back flips. We can now completely learn from the current science and technology, especially the current western medical examination technology, under a combination of different shapes and images and laboratory examinations, to refine the shape and quality of the target. A mathematical relationship. Therefore, from this example, the establishment of our TCM curative effect evaluation system is feasible.

Of course, this does not mean that someone can do it, it needs to be done in an organized way. But for the long-term development of Chinese medicine, I personally think it is necessary. Without the assistance and escort of the judging system, Chinese medicine should be in the grave, because it is just a person who does not understand the rules of the game and is not qualified. A blind athlete who judges the right or wrong of the game, this kind of identity and this kind of position cannot last long.

to sum up

To sum up, we should make some breakthroughs in dealing with the bottlenecks faced by the modern development of Chinese medicine: the first is to explain and promote Chinese medicine in a modern context, which is convenient for the public to understand; A kind of reorganization of the core of theory and law; third, our traditional Chinese medicine should restore the current lame medicine into a complete and independent complete traditional Chinese medicine with its own clinical curative effect evaluation system.

I personally think that under the current situation of high fever in Chinese medicine in and outside the world, as Chinese medicine practitioners, we should see the bottleneck of our Chinese medicine in the modern development, and combine with a large number of people of insight to break these bottlenecks. So that the development of Chinese medicine can grow smoothly.

Okay, that’s all for my report, thank you everyone.

This article is based on Mr. Shen Qianyi’s speech at the “Second Chinese Medicine Experts Forum” on September 12, 2020, organized by Chen Jiancheng

最近这些年,尤其从今年疫情发生以后,在全国和世界各地好像都掀起了一个中医药热。但是,我们作为一个业内人士,静下来思考一下,这种所谓的中医热之后,也有了很多的悲凉和无奈。

为什么这样讲呢?比方说,在武汉发生疫情的时候,一开始政府、民众,很多情况下是拒绝中医药的介入,甚至于得病的患者,一大批的人拒绝服用中药制剂,看到这种报道,就给人一种很凄凉、很悲伤的感觉。

为什么会这样?为什么当地官员当时的时候是一种比较排斥中医介入的心态?为什么当地感染的民众,这么大比例的排斥中医药的使用?原因不外乎三个。

中医药现代发展面临的三大瓶颈

第一个,在当今文化氛围之下,有一大批的人宣传这种说法——中医是不科学的,中医是迷信的。可以说,因为这样,在很多人心里面种下了一种“中医是巫术,中医是不科学,是反科学的”种子,在这种情况下,很难叫人去信服,去使用中医药。

第二个,从目前来讲,从历史上看,中医药在临床上这种临床有效率还不够高,至少在最近百年之内,几乎是在中医临床有效率的最低点。就因为有效率不是太高,也导致了一些民众和一些政府官员对中医药的不信任。

第三个,现在的中医可以说不是一个完整的医学体系。为什么说中医现在可以说不是一个完整的体系?因为中医临床疗效的评判,没有评判资格,也没有评判的方法。就像一个运动员,你只能去参加运动,至于运动的好和坏,没有评判的资格,也没有评判的方法,完全是靠别人说你好和坏。当然,这不是中医本身造成的,但对于一个医学来讲,这是个很可悲的事情。也可以说,就因为如此,当今社会下中医就是一个瘸腿的医学,不是一个完整的医学体系。

以上的三点,我个人认为,也就是中医药在现代社会发展中最大的瓶颈所在,要想发展中医、弘扬中医,这三项必须有效地去解决。如果不能有效地解决这三个问题,中医的复兴、中医的发展,可以说就是一句空话,那是永远不可能实现的。

对突破中医药现代发展瓶颈的思考

针对上面提出的几个问题,我有如下的一些思考。

第一个,就是要组织一些有志之士,进行传统中医理法的现代语境的解释。因为毕竟现在传承的中医,都是几千年前中国先贤们的一些作品留下来的,当今中国社会的语境和思维方式和几千年的一些情况有很大的不同。尤其当下情况下,几乎中国人都是在这种西式教育出身,按过去说,是洋学堂出来的,并不是说四书五经学传统文化出身。这样就出现了一个问题,西式教育张口闭口讲究科学,如果传统的中医没有办法和现在的科学语境进行一个有效的对接和解说,那么就没有办法使广大的民众去了解,进一步地去接受中医。一旦一个学说被评判为是一个不科学和迷信的东西,人们就会本能地排斥它,不可能去接近它。所以,对几千年前的传统中医进行这种现代语境的解释,应该是必须的。

针对传统中医理法的现代语境解释,我们可以参考现在的一些方法概念。比如说,爱因斯坦的相对论,现在扔出来这句话,全世界几乎是没有人认为它是迷信、是伪科学。但真正能明白爱因斯坦的相对论讲的是什么,这样人少之又少,绝大部分人连相对论的内涵都不明白,但他们就会承认它是科学、是真理。我们也可以用这样的一些方法来梳理、解说古中医,通过现代语境对民众进行一些宣传。

第二个,从历史的发展来看,在传统中医理法上我们丢掉了很多东西,现当今的中医已经不是两千年前的中医,甚至于说已经不是百年前的中医。在民国年间,中医为了生存,在某些情况下可以去临床打擂台,试想,如果现在还有这样的机会,我们中医界还有没有可能组织起来这样的人员去进行擂台赛?如果这样的人员不能组织,那么在这种情况下,我们中医就是很悲哀的。所以说,现在的中医,在历史来讲,可以说是沉沦了,中医界的有识之士,应该更加去做挖掘整理传统中医理法的工作,使传统中医的理论性、自洽性,包括临床的有效性,真正地提高,这是解决燃眉之急问题的行动所在,也是中医学术理法内核重建的一个过程。

现在我们可以看到一个问题,中医传统理法的丢失和被支解是非常严重的,基本上来讲,已经失去了自己独立完整的那种方法和学术体系。中医的很多基本概念被虚化,已经都没有真正的实质的内涵,而且各种概念之间的一种关系,也支离分解化。比方说,中医的最基本概念下,有精气神学说,有阴阳五行学说,有奇经八脉体系,有十二经脉体系,在我们的教科书上,精气神、阴阳五行、奇经八脉、十二经脉,都是很模糊的概念。可以这样说,在现在的中医临床上,能够真正用到精气神这样的根本理念,指导临床达到满意疗效的中医生,是非常罕见的;对于阴阳五行学说,现在完全被拔高虚化为哲学学说,而失去了作为一个中医方法论和世界观的一种根本的把握,它的内涵也是一样被虚化,哲学化、虚化之后,就变成了无用,在临床是无用的,这也是一个很悲凉的事情;奇经八脉学说、十二经脉学说,背后分别是什么体系?奇经八脉,代表了中医哪层范围的体系?十二经脉又是什么?奇经八脉体系和十二经脉体系又有什么联系和不同?现在基本上也都是囫囵吞枣,被虚化掉。所以,类似的这些中医的最基本概念,它们的本意是什么?来源是什么?互相之间又有什么联系和分别?应该是我们进一步挖掘整理和重建现代中医理论必须进行的工作。

第三个,我刚才谈到,中医为什么被称为是瘸腿的医学?就是因为中医只是一个运动员,没有裁判资格,这是一个很可怕的事情。换句话说,中医接触一个病人,从临证开始,一直到好转,一直到病情的治疗结束,你凭什么来判定?这是一个非常现实的问题。如果一个运动员没有任何裁判资格,没有所谓的标准化的一种运动,只是为了运动而运动,没有规则,也不掌握评判资格,这个运动员是很可悲的,也可以说就不应该存在,从存在与否的那种资格上,已经失去了存在的资格。同样,如果我们中医没有自己的评判体系,可以说是很悲凉的,几乎相当于拿着西餐的菜谱去做中餐,这样出来的必然是中不中、西不西,看着好像是中西医结合的,结果变成了四不像,什么都不是,对于一个已经不是医学的医学,也可以说它就没有资格再立足于世界医学之林。所以,我们要在内部完善“我们是完整医学”的概念,把瘸腿的医学恢复为完整的中医学体系,建立中医药临床疗效的评判体系刻不容缓。

对于完完全全依靠西医的体验,是否可以满足我们中医临床的要求?这是一个值得广大中医人去思考的问题。我个人认为,尽管对一个医学来讲,无论中西医,研究标的都是针对于人体,但是细分起来,还是有很多的不同。西医主要的着眼点在于人体形质方面,而中医恰恰不同,中医是以人体气分为主要的落脚点,这又是以研究人体的形气神灵为四位一体的研究体系。现有的西医实验室和影像的检查,从基本上来讲,是西医立足于人体形质做的一些生化和影像分析,而中医主要是以气分立脚,不是完全地以形器形质来考虑问题,所以这样就和中医临证的需要和最后的一些评判,不可避免地产生了一些分歧。个人认为,西医形质检测的这种指标,对于中医临床的鉴别和转归的判断,还是有借鉴意义的,但是完完全全用西医形质的这种检测来指导和评判中医疗效是不完整的,不能够涵盖和完成中医体系评判的一种支撑。

在过去的古法里面有一种说法,叫内算和外算之说,我谈到这个词,是为了谈到我个人对于建立中医药临床疗效评判体系的这种可能性的理解。古中医有内算和外算之术,什么叫内算?可以把它解释为多因素集合下的感应判断,外算是线性下的不同因素叠加的结果。我们可以这样看,在中医的方法里面,大部分是在多因素集合下,所以我们的一些建评判体系的建立,也应该建立在古法的内算之下。但是这个事情要应该怎么做呢?比方说,最简单的一个例子,一点为点,两点为线,三点就是面,一维为线,二维为面,三维就是一个立体,我们可以借鉴这样的一些形式去谋划、去评判、去计量我们中医临床的所需所要。

举个例子,古人立竿测影以定日,夜观北斗以定辰。你看,这是我们古人的聪明智慧,并没有说太阳在什么角什么度,就是什么时间,而是借助了一个立八尺之杆,所谓的日晷,以日影来去定日的位置,从而来确定每日的时辰的不同。当然,这里面有一个技巧,就是在不同的纬度下,日晷的斜角是不同的,所以它有一个校正的数据。还有一个,在日晷的运用中,有一个规则,就是秋分春分定翻转,也就是正面反面的翻转。我们现在完完全全就可以借鉴于现在的科学技术,尤其是现在的西医检查技术,在不同的这种形质影像和实验室检查的一种集合下,来标的形质之上的细化的一种数理关系。所以,从这个例子来讲,我们的这种中医药疗效评判体系的建立是可行的。

当然,这不是说某个人能够进行的,需要有组织地去做。但对于中医的那种长远发展来讲,我个人认为这是必须的,如果没有评判体系的辅助和保驾,中医可以说就应该是进坟墓的,因为它只是一个不懂游戏规则,也没有资格评判游戏对错的盲目的运动员,这种身份、这种位置是不可能长久下去的。

总 结

总结一下,关于应对中医药现代发展面临的瓶颈,我们应该进行一些突破:第一个,就是用现代语境来解释和宣传中医药,方便于社会大众的理解;第二个,是对于我们中医理法内核的一种重新梳理;第三个,我们中医药要把现在的瘸腿的医学,恢复成一个完整独立的有自己临床疗效评判体系的完整中医学。

我个人认为,在目前这种世界内外中医普遍高热的情况下,我们作为中医人士,应该看到我们中医药在现代发展下的这种瓶颈,结合大量的有识之士,把这些瓶颈打破,从而使中医药的发展能够顺利成长。

好,我的汇报就到这儿,谢谢大家。

本文根据沈谦益先生2020年9月12日在“第二届国医名家论坛”的演讲整理,整理者/陈剑城

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