Brief History of TCM

As an acupuncturist, you may not need to know in detail the history of the Traditional Chinese Medicine (TCM), but if you claim that you are a TCM doctor, you must know it. The history of the TCM, we mean here, is not as you are taught that the TCM is developed through the natural life of old Chinese, or it is the summary of the Chinese through random experience in the heeling….

What we mean the TCM history that you must know is: you should know which book is the TCM bible and which book is the clinic guide that work before, now and in future too. What you learned from the textbook TCM is not at all a good summery of the TCM. It is not enough to allow you have enough knowledge to handle daily clinic work. If you practice TCM based mostly on whatever you learned from the textbook TCM, you are still a beginner of TCM. Current TCM textbook, no matter it is published in China or published out of China in English, omits and neglects very important knowledge part of the TCM. There could be many reasons for this. One of the important facts is: the editor and the teacher them selves are not skillful enough to apply the TCM bible in their own clinic.

(1). The TCM bible – Huang Di Nei Jing

In brief, the bible of TCM, we call it TCM bible, is the book named “Huang Di Nei Jing”. The exact author of the book is unclear actually, but it is known that it is written about 2000 years ago and may authors worked for the writing. This book tells the reasons for a disease and the principles for the treatment of diseases. It tells the structure and the function of the organs in the body and how the organs work. It tells how to prevent disease and how to match the nature to keep healthy. It also tells how to predict the disease and how a doctor should prepare to prevent it. The principle told in the book is well admitted by many famous TCM doctors in the history to be true. It is still the principle used by many famous TCM doctors nowadays. However, the weakness of this book is that it does not tell in detail how to use herb exactly for the treatment. It has been said that there is another sister book to tell more in detail, but it is missing though we know its name.

So, did you learn this book when you are in TCM school?

(2). Shang Han Lun

The second most important TCM book is named “Shang Han Lun”. It is written by Dr. Zhang Zhong-Jing 2000 years ago. It is a summery of clinic experience of many doctors before that time. It is the earliest systematic summery of clinic treatment in TCM history. It tells exactly how to make a diagnosis, how to monitor the progress of a disease and how to use herbs for the treatment. It tells in which condition a disease it is cured and in which condition it is hardly be cured. This book is so important that we call it  the practical bible of TCM. Doctors who practice clinic using mostly the herbal formula of this book are called “Jing Fang Pai”. Jing means bible in Chinese; Fang means formula, and Pai means group.

The contribution of Dr. Zhang Zhong-Jing is the introduction of diagnosis principle: Liu Jing Bian Zheng. Liu means six; Jing means meridian, or stage of the diseases; Bian Zheng means diagnosis. This is the earliest TCM book that separate the stages of a disease into 6. It tells that if a disease-causing factor comes into the body, it can attack the surface of the body then deeper into the organs; it can also come into the body directly affecting the organs. It also gives the herbal formula to use in each stage (each Jing), and tells how to use and to modify the formula, according to the clinic situation. It is known that the kinds of the herbs introduced by Dr. Zhang Zhong-Jing in each formula is less, but the dose is more, than used by later doctors in their own formula. I suspect that, just because the clinic effect of the later doctor’s formula is not so good when they use low dose of herbs, so that they have to use more kinds of herbs in each formula.

In my clinic, I use mostly the herbal formula of this Shang Han Pai. I like it very much and believe what it is touched that, once the diagnosis is correct and following the introduction by this group of doctor, the clinic effectiveness is very high.

The Liu Jing Bian Zheng system has been modified or abstracted into the later Ba Gang Bian Zheng in textbook. Ba Gang Bian Zheng. Ba means eight, Gang means principle, and Bian Zheng means diagnosis. The eight principles is: Ying, Yang, Biao (surface), Li (inner), Xu (deficiency), Shi (extra condition), Han (cold) and Re (hot). In this diagnosis, the Yin and Yang is easy to tell. Biao, Shi and Re belong to Yang and Li, Xu and Han belong to Yin. The Yin and Yang becomes a concept rather than a clinic useful guide. This is one of the biggest mistakes by the textbook TCM. We have an article to discuss this mistake in detail.

(3). Wen Bin Pai

Later on there is a new TCM group called Wen Bin Pai. The master of this group is Dr. Zhang Jing-Yue. At his time, there comes a big epidemiologic disease, called Wen Bin in TCM. When doctors use the herbs introduced by the Shang Han Pai above, it seems not work well. Dr. Zhang Jing-Yue developed a new diagnosis system, called Wei, Qi, Ying Xue Bian Zheng system. He also introduced to use herbs that belongs to Cold in herbal nature for the treatment. It works well.

Because the herbs used in this group is much less in dose, so it is believed much safe (and cheaper) than the herbs used by Shang Han Pai. This fact affected much more later doctors who tend to apply this Wen Bin Pai herbs and less herbs introduced by Shang Han Pai.

It is now believed by some doctors that the Wen Bing Pai is actually developed from one major Jing in the Shang Han Pai. It means that the major herbs used is to treat the epidemiologic disease that belongs to one of the Jing in the Shang Han Pai, e.g. Yang Ming Jing. It does not mean that the Wen Bin Pai is complete different Pai from the Shang Han Pai. However, the new diagnosis system and the way to use herbs in the Wen Bin Pai make the influence of the Shang Hai Pai much less to the later doctors.

Now we also know that when applied to the treatment of most other diseases, the herbs used in the Wen Bin Pai works much less effective than the Shang Han Pai. It needs much more kinds of herbs in a formula and needs longer time for the treatment. The cure rate for most diseases, is also low. If you know how a pain killer works for your pain, you would know how the Wen Bin Pai herbs works for most ordinary diseases. Even though, many doctors nowadays use the herbs of Wen Bin Pai much more than that of Shang Han Pai.

(4). Other TCM groups (Pai)

In the history of TCM, there are different other TCM group more or less different from above Shang Han Pai and Wen Bin Pai, such as Huo Sheng Pai, Wen Yang Pai, and Pi Wei pai. All of these TCM groups have their own clinic advantage and disadvantage. For us as TCM beginner, we should learn their difference and learn when to use each of them in our own clinic.

(5). Textbook TCM

Strictly, the textbook TCM is not a group. It is not as any of above groups which are developed from clinic work and has their own styles in diagnosis and herbal therapy. The textbook TCM means an introduction of TCM with its own modifications. For instance, it introduce Ba Gang Bian Zhen, but the diagnosis of Yin and Yang becomes more theory and a concept, rather than a clinic obligation (though it claims it is very important).

It focuses more as Five Element diagnosis combined with the Wei, Qi, Yin and Xue diagnosis. It lists mostly a symptom as a TCM “disease”, rather than a clinic syndrome[1] as used in Shang Han Lun. For example, it uses Cough as a “disease”, then diagnose subgroup of the cough as “Fen Han Xiu Fei”, or “Fen Re Fan Fei”, or “Zao Xie Shang Fei”, or “Yin Xue Huo Wang”… the question in clinic is that many times a patient does not show such typical clinic picture to allow a diagnosis. Secondly, even if the diagnosis is clear, if the herbs introduced does not work, students do not learn what should be the next. In the textbook TCM, the diagnosis seems easy, since to link the disorder to one or two of the Five Element, so to the organs, is easy. However, in clinic, such diagnosis seems less useful compared with the Liu Jing Bian Zhen system above. This is my own experience at least. I believe I am not the only one with this experience.

In all, the textbook TCM is a scattered information that being picked up from various TCM groups in TCM history. It seems a summery, seems better than ever. But it is not. It broken the consistence of TCM system, and broken each TCM style too. The common phenomenon is: when in TCM school, a student feels very confidence to practice TCM. In his heart, it seems no disease that cannot be diagnosed or treated. However after graduate for two to three years, he feel hard to treat any diseases[2]. Why? Why should we ask if it is due to the misleading by the textbook TCM system?

What we believed so important books, such as Huang Di Nei Jing and Shang Han Lun is no longer teach in the TCM school as obligation courses. They are turned into an option now. Check your TCM school lecture list, see if they teach you these two books, or they leave them to you to learn by your willingness? What you need urgent from your TCM teacher is to let them tell you how to understand and to apply the knowledge in these two books.

(6). What you should do

Certainly, if you have learned TCM in a TCM school, you are only a beginner. You need to learn the TCM bible and the Shang Han Lun, since they are not touch in TCM schools. It is a tough task for everyone, even for us who speak Chinese. Speak Chinese does not mean that you can really understand the meaning in the books or to use them in your clinic, even if you can read every word in it. IT NEEDS YOUR WHOLE LIFE TO LEARN.

To really understand the meaning of the two books, you need to read books by other authors telling their own experience in using the two books. This is another way to learn. You may realize that you have to learn Chinese first, since most of the books are not in Chinese.