Do No Harm7 min read

Christopher Magoon reviews Classical Chinese Medicine by Liu Lihong 

As anyone who has lived there can attest, Traditional Chinese Medicine (TCM) remains a force in modern China. Call in sick and hear blame from your colleagues for drinking cold water. Find yourself with a stomach ache and prepare for wrinkly herbs from eager good Samaritans. The Chinese government is also bolstering TCM: pouring money into Chinese medicine centers, censoring critical articles, even jailing skeptics.

In China, modern medicine and TCM coexist mostly peacefully. Nearly every public hospital I’ve visited in China – big and small, urban and rural – has a TCM ward, nestled between the floors of modern services such as neurology, surgery and pediatrics. Most patients in China shift back and forth between traditional and modern medicine, with a seemingly intuitive understanding of the strengths and limitations of each. For chronic pain or fatigue, they lean on TCM; when they need an appendix out, they see a modern surgeon.

As an American physician who has spent significant time in China, I have been curious about the workings of TCM.  So I was glad to see that Liu Lihong’s popular 2006 work Classical Chinese Medicine (思考中医) had been translated into English, published last summer. I was excited to dive into TCM’s philosophy, evidence and theory, designed for the modern reader. Or as the book jacket sells it, “concrete and inspiring guidance on how to effectively engage with ancient texts and designs in the postmodern age.” What I found, unfortunately, was a slipshod polemic woven through a tedious overview of a two thousand year old textbook.

Classical Chinese Medicine is organized around the third century AD work Shanghanlun (伤寒论) or Treatise on Cold Damage.  Liu’s first four chapters serve as his preamble to Shanghanlun, with the remaining 400-plus pages offering commentary on each of the six sections of the ancient text – one chapter per section – offering ancillary guidance from other classical texts, such as Classic of Changes, Yellow Emperor’s Classic, and Plain Questions. Liu employs Shanghanlun as a case study to advance his fundamental argument: that the diagnosis and treatment of human disease requires a profound grasp of classical Chinese texts. “When our prescriptions fail,” Liu writes, “we can seek the shortcoming in our own understanding rather than blame Chinese Medicine theory.”

The battlelines of this argument are fought on two fronts. Liu takes aim at both Western-style medicine, and at TCM as practiced in China today. TCM, he argues, has strayed too far from the classical texts by adopting shreds of empiricism. The word “classical” rather than “traditional” in the English translation of the title emphases this distinction, and reflects his view that TCM suffers from the “overbearing influence of Western Medicine.”

Unfortunately, it is a slipshod polemic woven through a tedious overview of a two thousand year old textbook”

Liu begins by arguing that empirical testing is not required to understand the true nature of the human body. Rather, “internal experimentation” is more appropriate. “No part of internal experimentation can be observed objectively,” he writes. “There are no white mice to be observed, nothing to be seen, nothing tangible … The proof that this theory actually works relies entirely on our own ability to make this knowledge our own.” In other words, the truth cannot be tested, it can only be used. According to Liu, this process of untestable observation represents the most useful form of science.

The justification for this immateriality relies on the transcendence of the Dao: “The study of Chinese medicine is a discipline that puts Dao before matter, regards spirit as primary to and superior to form, and esteems the metaphysical more than the physical.” Liu regards this metaphysical notion, as told in the classical Chiense texts, with fundamentalist devotion. “I strongly advise those who wish to criticize the classics to think twice before speaking,” he writes. “Otherwise, your perspective will reveal your ignorance … It is simply the case that those who have not benefited from the classics have failed to comprehend their usefulness.”

From Liu’s introduction to the Shanghanlun, it is clear that he is proffering the words of the two thousand year old text as the truth, the whole truth and nothing but the truth. The wisdom of the ancients, in his eyes, must not be interpreted with an eye towards metaphor or a la carte incorporation. “All diseases,” he says, “arise from wind, cold, summer-heat, damp-dryness, and fire.” When it comes to human health, the classics are the alpha and the omega.

This zealotry becomes especially difficult to swallow when Liu swerves into a territory that contradicts basic anatomy, physiology and epidemiology. A few examples. “How are we able to see the world around us with our eyes?” Liu asks, then answers: “The liver opens into the orifice of the eyes.” Anatomically speaking, no connection exists, and Liu offers no further explanation.  He similarly asserts: “Memory is a function of the heart and kidney. The kidneys rule  hibernation, and so the storing of memory is ruled by the kidney.” I’ve met scores of people with kidney failure on dialysis who have perfectly fine memories. Later Liu claims: “All pain with itch and sores belongs to the heart,” then goes on to explain how this is a literal truth, a claim that anyone with a functioning heart who has brushed up against poison ivy could dispute.

Liu claims that no classical Chinese remedies can be disproven because metaphysical truth is too profound to be understood on a cellular level”

Some claims are even more brazen in their disprovability. “The number of breaths allotted to an individual is commensurate to the length of his or her life,” Liu declares, and then continues, “Why is it that athletes that participate in vigorous sports, such as soccer, tend to live shorter lives than average? For the very same reason: they breath faster while playing.” (Data from hundreds of thousands of people show that those who participate in vigorous sports live longer on average.)

This example brings up the larger point of statistics. Liu claims that no classical Chinese theories or remedies can be disproven because metaphysical truth is far too profound to be understood or observed on a cellular level. He consistently mocks modern medicine’s assertion that lab mice could tell us anything about humans. This notion overlooks the basic fact that any intervention is testable, independent of lab mice. Randomized trials – where a group is split into one test group that receives an intervention and one test group that does not – are powerful tools whose results demonstrate efficacy, not underlying mechanism. Mindfulness, acupuncture,  and even ancient Thai boxing have been shown to be effective for various ailments using randomized controlled trials. After reading all 600-plus of Liu’s pages with an open mind, I am still left with the opinion that “our interventions are untestable” is an irresponsible foundation for medicine.

Liu’s stance on the testability of Chinese medicine interventions is particularly disappointing because many useful alternative medicine treatments have been shown to be effective. One acupuncture study showed the technique to be effective for insomnia; another study showed TCM herbs to be helpful in patients after a stroke; yet another found the TCM practice of moxibustion to be effective for premenstrual pain. (It is worth mentioning that trials of TCM interventions have thus far been predominantly low quality). Moreover, Liu’s puritanism is off-putting because classical Chinese texts do have a lot to offer. The concept of yin and yang makes a compelling argument for the necessity of rest and balance in life. Some of the ancients were also remarkably prescient in their understanding of physiology, as with the assertion, “in Chinese Medicine theory, the kidneys rule the bones.” The kidneys do indeed help regulate calcium levels in the body, affecting bone growth.

Still, I finished the book wishing I had just read an article on the Dao and Shanghanlun. Unless you are already a diehard convert of salvation through Classical Chinese Medicine, I recommend you skip this book and find a more open-minded approach. ∎

Liu Lihong, Classical Chinese Medicine, ed. Heiner Fruehauf, trans. Gabriel Weiss, Henry Buchtel, Sabine Wilms (Chinese University of Hong Kong Press, June 2019)
Header: TMC apothecary (Garry Knight/Flickr)