Historian Pi Guoli: Traditional Chinese Medicine Needs to Find Its Own Battlefield and Rectify Itself with Evidence

“People need to understand Chinese medicine first, before they conduct Western-style research.”

Photo: VCG

Photo: VCG

By LIN Ziren

On February 14, Dahuashan Fangcang Hospital, a makeshift hospital for coronavirus (COVID-19) patients in Jiangxia District of Wuhan was officially opened and put under the direction of Traditional Chinese Medicine (TCM) professionals.

The next day, Wang Hesheng, deputy director of the National Health Commission, said that treating patients with both TCM and Western medicine was an important feature of the epidemic treatment.

The TCM remedy qingfei paidutang (a respiratory treatment) has been used with coronavirus patients in Hebei, Heilongjiang and Shaanxi and other provinces, and has shown itself as having “good efficacy and promising prospects” according to the National Administration of TCM.

With modern medicine failing to identify the exact pathology and best treatment of coronavirus, many were skeptical about TCM. When Xinhua News Agency and “People’s Daily” reported that shuanghuanglian (an TCM herbal remedy) could inhibit the virus which triggered a shopping frenzy of the oral liquid, doubts peaked.

TCM and modern, Western medicine have collided and contradicted one another throughout the modernization of Chinese medicine. In 1929, the abolition of TCM was proposed. One year before, the Kuomintang government had established a Health Ministry, members of which were all Western medicine professionals. In Nanjing, the Ministry announced proposals to abolish TCM on the grounds that it "hindered the development of the nation’s health care."

Yu Yan, one of the supporters of the proposal, vehemently criticized TCM as a superstition: “TCM is based on delusion and deceives people. The government teaches people about sterilizing equipment and that viruses and bacteria are the source of disease. But TCM tells people that catching cold in winter will lead to sickness in spring, or that overheating in summer will bring malaria in autumn, which is holding back medical science.”

There was public outcry! The TCM community successfully campaigned to quash abolition, and when People’s republic of China was born in 1949, TCM received strong support of the central government and became an important part of the public health system.

Pi Guoli is a medical historian and associate professor of center for general education at Chung Yuan Christian University in Taiwan. Pi argues that the modern history of the TCM practice in China commenced with the abolition debate.

It was then that TCM started to learn from systematic Western medicine. If the traditional was to survive, it would have to become more scientific and verifiable. In his research, Pi found that during the late Qing Dynasty (1944-1911), there was open debate between TCM and Western practitioners about anatomy and physiology, which turned to bacteriology and pathology during the Republic of China. In fact, it was only after major Western breakthroughs in bacteriology that the decline of TCM in China began.

American historian William McNeill argues in his book “Plagues and People” that openness to new therapies and emphasis on clinical observation are the central tenets of Western medicine, and why Western medicine quickly overtook others in the 19th century. In contrast, it was hard for traditional Asian medicine to innovate, stymied by adherence to ancient authorities.

McNeill's view is key to the clash between Chinese and Western medicine, and now, internationalism, politics, and economic interests have further complicated the modernization of TCM, while, to some extent, deepening the mystery.

In an extensive interview with Jiemian News, Pi described the coronavirus epidemic as providing TCM with a "battlefield" to prove itself, but ultimately the responsibility of TCM practitioners is to rectify the ancient skill’s pharmacology and research methods as well as to discover new drugs.

The shadow of antibiotics

Jiemian Culture: The debate between Chinese and Western medicine has been going on for years. Why do we accept other Western science so easily but baulk at medicine?

Pi: Interestingly, TCM may be the “last man standing” among traditional Chinese sciences. Despite the theories and inventions of physics and mathematics in ancient China, what we learn in school today is completely based on western methodologies, and our own disciplines barely exist: Only TCM survived.

This is down to the intellectuals in the early years of Republic of China. Those who advocated abolishing TCM back then believed in abandoning Chinese medical theories while preserving the actual medicine. If we had followed that path, Chinese medicine would have gone the way of our other sciences. The intellectuals helped the academic backdrop of TCM to endure.

Jiemina Culture: Do you think that’s why TCM has lasted until now?

Pi: Physics and mathematics emphasize abstract facts. But in medicine, curing patients is the actual fact. Some people argued that although Chinese medicine cured patients, it didn’t matter, because it was not done scientifically.

The coronavirus is a heat illness in the TCM system, which should have been its specialty. Before antibiotics were discovered, Chinese medicine was probably more advanced than Western. However, with advances in antibacterial drugs and infusion technology, Chinese medicine fell behind. Of course, TCM still has its specialties, but something was lost.

During the Republic of China, Yu Yan argued, bizarrely, that if you were treated by a Western doctor, at least you knew how you would die. If a TCM doctor treated you, you wouldn’t even know that! He believed that Chinese doctors could not even identify symptoms and did not have proper equipment, so there was no way to say what ailed you. TCM doctors used empty old concepts of cold and hot, wet and dry, to describe conditions, and this is still the case today.

If you were to tell Western medicine doctors that TCM could cure coronavirus, they would immediately ask ‘how’? ‘Tell me the biochemistry and endocrinology.’ If all you can say is that gypsum can bring down a fever, or that ephedra is a cardiotonic, professionally trained Western doctors will not be very impressed.

Jiemian Culture: Historian Yang Nianqun pointed out in his book “Remaking Patients” that one of the main motives behind criticism of TCM is that it is only for individual treatment, and not a public health measure. You, however, believe that TCM has a role to play in epidemiology.

Pi: During the Republic of China, Chinese medicine was used to treat fever and infectious diseases. It was not 100 percent successful, of course, but based on classical TCM training, patients were cured. But during a large-scale infectious outbreak, when Western public health concentrates on prevention, TCM has nothing to contribute.

TCM doctors at that time were a motley crew, some lacking in even the most basic medical knowledge. TCM knew nothing about disinfection, a major reason why it came under fire.

But in ancient Chinese literature, prescriptions against epidemics are commonplace. Western medicine finds an antibiotic or a bactericide to control an epidemic. TCM does not have the concept of bacteria but attempts to reconcile the relationship between the body and the qi, or energy flowing through your body. They are two different ways of thinking.

Jiemian Culture: TCM was introduced into the national health system, principally because of the lack of medical resources in vast rural areas in the early days, and the traditional relationship between doctors and patients. Medical practitioners without official qualifications then had a strong nationalist backing. Do you think this was a mere historical expediency?

Pi: To some extent it was a convenience. As you said, rural areas needed some kind of medical system. I studied schistosomiasis (Bilharzia), which was a very serious disease in the 1950s in China. Many TCM practitioners said that they could treat it. In the mid-1950s, China strongly supported the integration of traditional Chinese and Western medicine and required western-style doctors to learn from TCM doctors.

After my paper was published, a professor said he had schistosomiasis when he was young, and had used all the prescriptions I mentioned in the paper, but none worked. In the 1950s, criticizing TCM was politically incorrect and forbidden. Historical materials at that time were biased, the professor said. Both Chinese medicine and Western medicine put effort in treating schistosomiasis, but only traditional Chinese medicine was given credit, even though it was actually Western medicine that cured the disease. Due to the political environment we could not say anything negative about TCM.

On a visit to a village in rural Shanghai where schistosomiasis was raging, an old lady told me that a Chinese medicine practitioner had cured it. But when I went back to Taiwan, my professor argued that this case was ambiguous as the patient might have been treated by both Chinese and Western medicine simultaneously.

Chinese medicine needs a battlefield to prove itself, the coronavirus epidemic can be a chance, otherwise it will never be trusted. If all outbreaks are handled by Western medicine, then TCM is over. This is what happened in Taiwan. TCM in Taiwan has no discursive power.

“Miracles” bring tension

Jiemian Culture: During the current epidemic, TCM has controversially been used in clinical treatment. If Western medicine cannot solve the problem, how can TCM?

Pi: This is the crux of the matter. The National Administration of TCM should identify all the cases that were successfully treated by TCM, explain which methods were used, and how effective the combination of Chinese and Western medicine was. During SARS, use of TCM in Guangzhou was quite successful, but not very good in Beijing. Some people argued that in Guangzhou TCM treated people with mild symptoms, while Western medicine treated severely ill patients.

Jiemian Culture: How, then, must Chinese medicine change to be integrated into a modern national health system?

Pi: Through at least two kinds of people: doctors and researchers, who use Western research methods to test the principles of Chinese medicine. They need to show both that it works, and how it works. For example, it has been reported that TCM has significant effects on severe cases, but how? You can't just simply say that we cured a few people. It does not mean a thing. What we need is a pathological explanation.

Jiemian Culture: Is that also the only way? Using the standards of Western medicine to confirm traditional Chinese ways? In 1596, Li Shizhen prescribed tea made from qinghao (wormwood) to treat malaria in his “Compendium of Materia Medica,” and around 400 years later, Tu Youyou isolated artemisinin. Is that the future for TCM research?

Pi: Tu Youyou is obviously the best example. Some claim she is not even a TCM doctor at all, as during the process of discovery, only the use of artemisinin was known to Chinese medicine. All her arguments and research methods were Western. But we should not ignore that Tu found many Chinese drug properties from TCM books. People need to understand Chinese medicine first, before they conduct Western-style research.

The current dispute between Chinese medicine and Western medicine started in the early days of the last century, and since then, Western medicine has been progressing. What progress has Chinese medicine made? We cannot rely on the “Compendium of Material Medica” forever. We need new medicinals, new herbal medicines, and to expand the Chinese system, based on the theory and philosophy of Chinese medicine. We can find more, effective medicinals.

Traditional Chinese medicine only survives because the Chinese government is heavily supportive of it. But, let’s embrace Western medicine as well.

Jiemian Culture: Since the 1990s, TCM has often resorted to some kind of "miracle" to prove the effectiveness of Chinese medicine: TCM can cure cancer, for example. Isn’t this a sign that Chinese medicine is marginalized?

Pi: One man’s science is another man’s miracle. Whether TCM can cure cancer is certainly worth discussing. Some time ago, a colleague asked me when Chinese medicine first claimed to treat cancer. This is a good question, because in ancient times there was no concept of cancer. It was not until the late 1950s, when China began to emphasize the need to integrate Chinese and Western medicine, that there was any mention of major diseases such as hypertension or cancer.

I asked some TCM doctor friends in Taiwan why, when facing cancer, they were so unconfident and reserved? One told me that many TCM doctors have also had Western medical education, so whatever they say must be based on science. No doctor would assert a cancer can definitely be cured without research.

Many patients have experienced chemotherapy, surgery, and other treatments that did not exist in ancient times. While TCM practitioners are trying to find ways to participate in cancer treatment, they will not assert that they can cure it either.

The “Miracle" narrative shows how TCM doctors have to convince their patients that TCM is great, you just haven't seen it yet. But seeing is believing.

My current research is into the use of TCM in Taiwan during SARS. At that time, there was no voice from TCM doctors. A Chinese medicine doctor treated his patients with homemade preparations in a Western medicine hospital, and kept all his medical records. None of the people who took his remedies had a nosocomial infection: the infected patients were cured. He told me that people did not see this in the news reports because the media would not report on TCM at that time, but he has published two or three papers.

All TCM practitioners should save and publish their notes on coronavirus. Many people think that the cures on news reports are exaggerated. Only when TCM doctors show evidence will the public believe.

Jiemian Culture: Regarding infectious disease, what lessons can we learn from Chinese medical history?

Pi: During an outbreak, we need clear instructions. For example, Dr. Wu Lien Teh succeed in fighting a plague in Northeast of China in 1910 because he strongly enforced the quarantine policy, cremating the bodies of infected patients, and carrying out disinfection and protection. These measures, especially cremation, were unacceptable to the people at that time, but the Qing imperial government enacted a policy that all corpses of patients who had been infected must be cremated, therefore Wu controlled the epidemic.

The response to the epidemic must be quick. Doctors need to be trained to deal with emergencies.

"TCM is over if it can’t even cure a cold”

Jiemian Culture: When did you first notice this coronavirus epidemic?

Pi: I noticed it in mid-January 2020. I then traced back the news reports and found the first report was published on December 31, 2019, and it said "unknown pneumonia outbreak appeared in mainland China.” The media speculated that it might be a mass flu. The next day’s report sad that it could be H3N2, a new type of influenza. As more cases were reported in mainland China, people in Taiwan did not realize how serious the situation was. I was not until mid-January, when deaths were reported that someone said it was SARS, and the whole society began to panic. When the epidemic broke out in late January, people began snatching up masks.

Jiemian Culture: What is the situation in Taiwan now?

Pi: There are currently 25 cases of infection and one death in Taiwan (as of the time of the interview). It doesn't sound very serious. There are many cases in Japan and Singapore, but because of the 24/7 media reports, everyone is scared.

Jiemian Culture: What public health measures are there in Taiwan?

Pi: The contact history of all 25 patients currently infected can be traced, and those who have been contacted are in isolation. From the perspective of public health, we don't need to worry about community infections at this time. The patient who died recently was a taxi driver. He carried a Taiwanese businessman and got infected, so were five people in his family. They are all in isolation.

Jiemian Culture: Can you tell us more about TCM in Taiwan?

Pi: The KMT military did some research, but the leader of military health system at that time, Dr. Robert Kho-Seng Lim, was one of an elite trained by the American education system, and did not see the point in replacing Western drugs with Chinese medicine. American drugs were cheap and effective. TCM research was suspended.

Health insurance will only pay 5 percent of TCM costs and 95 percent of resources are given to Western medicine. In Taiwan, there is no subsidy for taking “water medicine” (Chinese medicine), so you need to pay for it yourself. People see Chinese medicine doctors only for some specific issues, such as gynecological complaints and teenagers want to grow taller.

Last year, TCM practitioners in Taiwan organized a campaign to put signs in front of clinics, saying “Chinese medicine actually cures a cold." When I taught the history of Chinese medicine, I asked my students whether they would go to see Chinese doctors for a cold. They all said no, because TCM is just for sore bones and massaging. I also joked with my TCM doctor friend: TCM is finished