Following the recent spate of controversies surrounding inappropriate content in primary school textbooks, universities across the country have tightened their textbook review processes. We too undertook a sweeping update of our teaching materials for the new semester, essentially adopting the latest 11th-edition national planned textbooks for higher TCM institutions. As the final arbiter of textbook selection, I had assumed that nationally planned textbooks required no additional vetting on my part. Yet the numerous concerns raised by faculty members of late have left me genuinely baffled.

I. Western Medicine Content Surges While TCM Authors Show Troubling Gaps

A textbook titled TCM Gynecology should, by rights, foreground the distinctive features of Chinese medicine — understanding and analyzing gynecological disease patterns through a TCM lens. Yet while this new edition is more voluminous than its predecessor, its TCM content is proportionally thinner, less detailed, and in some places simply wrong.

Take Chapter 7, Section 1, on advanced menstruation (月经先期). Under the “Diagnosis” heading, the text states “不妄寒凉” (do not recklessly use cold and cooling therapies) — a glaring error. Classical TCM commonly employs phrases like “不妄劳作” (do not overexert oneself); here, the meaning has been inverted, betraying the author’s misreading of classical language. This mistake is inexcusable. The passage in question occupies a critical position — advanced menstruation identifies only five etiological factors, each indispensable. How could the author miss this? Could the section reviewer miss it? The associate editor in charge? The editor-in-chief?

Furthermore, a key innovation of this edition is the addition of “Differential Diagnosis” sections — a welcome improvement and an important teaching focus. Yet in a considerable number of chapters, the differential diagnosis is Western in character rather than Chinese. What meaningful comparison is there between a TCM disease pattern and a Western diagnosis? Even granting some overlap — and Western knowledge is certainly worth mastering — can it really be entirely Western differentials? Are we truly unable to identify even a single TCM pattern for differentiation? Frankly, I find this puzzling. It suggests either that the author’s grounding in TCM is insufficient, or that they have grown so accustomed to integrated practice that their perspective has become one-sided — a pattern that bodes ill for the long term.

The current university system produces graduates with a pronounced deficit in TCM thinking. The root cause, in my view, is the excessive intermingling of Western medical content, which is conceptually easier to absorb. During graduate thesis defenses earlier this year, I asked one student how TCM understands gastric acid. He had no idea. In his mind, acid regurgitation was simply excess stomach acid — HCl, as in chemistry — and certain Chinese herbs merely neutralized it. Is this TCM? It most certainly is not. I am not dismissing the idea of disease-specific remedies; if certain mineral preparations work well for acid regurgitation, then hydrotalcite (达喜) would work equally well. And if hydrotalcite fails, those minerals likely will too — leading to the conclusion that “TCM is useless,” when the real problem is an inability to practice proper TCM. This loss of TCM thinking, coupled with the belief that discarding theory while keeping the herbs is correct, stems overwhelmingly from Western medical influence.

II. Disorganized Structure Leaves Readers Baffled

The new edition’s table of contents has undergone significant restructuring — presented as an important innovation and presumably a guiding signal for the discipline’s development trajectory. Yet the organizational logic eludes us. Consider the section on perimenstrual disorders (经行前后诸病), which should encompass conditions such as perimenstrual oral ulceration, perimenstrual epistaxis, and perimenstrual urticaria. For reasons unclear, these three conditions have been spun off into independent subsections. This complicates syllabus design and gives students the impression that these conditions fall outside the category of perimenstrual disorders. I have myself edited textbooks, and my instinct is that the allocation of writing assignments proved difficult and the editor-in-chief was reluctant to make hard calls. This is the sort of issue that should receive careful attention during manuscript consolidation, with an explanatory note in the editorial guidelines. This book does neither, leaving readers at a loss.

III. Western Gynecology Content Promoted to Main Chapters — Is Major Curriculum Reform Afoot?

The single biggest change in this edition is the promotion of Western gynecology content — previously relegated to supplementary appendices — into the main body of the text, effectively placing Chinese and Western medicine on equal footing. To me, this is a significant signal. Does it mean that Western gynecology will become a primary assessment component of TCM Gynecology courses?

In the current TCM education system, the vast majority of institutions list Western Obstetrics and Gynecology as either a compulsory course or a recommended elective for TCM majors. In truth, the question of how much Western medicine to include has been debated for years, with broad agreement on the principles — yet implementation remains enormously difficult. If TCM Gynecology takes the lead in incorporating Western content as a core teaching and assessment element, could we then eliminate standalone Western medicine courses when we next revise our professional training programs? We could devote one-fifth of our TCM Gynecology study time to essential Western fundamentals, then pick up additional clinical Western OB/GYN knowledge during hospital rotations — might this not raise the quality of our training?

If we integrate Physiology and Pathology into Fundamentals of TCM Theory, fold Diagnostics into TCM Diagnostics, and merge Internal Medicine into TCM Internal Medicine, we could save at least 20% of instructional hours, substantially reducing the burden on students. I believe the benefits would outweigh the drawbacks. After all, we are training TCM practitioners. Western medical knowledge sufficient to pass the medical licensing examination, combined with continued learning during standardized residency training, should be entirely adequate.

由于近期小学毒教材问题频发，各大高校均加强了对教材的审核，我们也对新学期的教材进行了大范围更新，基本上全部采用最新的全国高等中医药院校十一版规划教材。作为教材选用的最终审定者，我觉得全国规划教材完全不需要我去审核是否能够使用，但是最近老师们提出的诸多问题还是让我感觉匪夷所思。

一、西医内容大幅增加，中医写作者功底堪忧

作为《中医妇科学》，按道理应当突出中医特色，从中医的角度理解并分析妇科相关疾病证候，但是本教材虽然比前版教材内容丰富，但是中医内容相对更少，而且不够详尽，甚至出现错误。

例如，第七章第一节月经先期病，在【诊断】条目中出现了”不妄寒凉”的观点，这是绝对的低级错误，中医素来有”不妄劳作”等说法，此处明显是说反了，而且属于硬伤，应该就是作者对古文理解有误。这个错误非常不应该出现，首先这段话的位置很关键，月经先期总共就提出了5个病因，各个都很重要，怎么能错呢，作者看不出来，章节的审核者看不出来么？分管的副主编看不出来么？主编等等看不出来么？

再者，本书的一个关键创新是增加了【鉴别诊断】条目，这个内容是很好的，应该增加，也是教师授课的重点之一，但是有相当多的章节内容中鉴别诊断姓西不姓中，拿一个中医的病证跟西医的病有什么可比的？纵然有一些可比性，也确实应该掌握西医的相关内容，那也不能全是西医鉴别吧？难道我们中医的病证一个都挑不出来么？说实话我不是很理解，只能说明这个作者中医功底不够深厚，或者临床上已经惯用中西结合了，全为一家之言，并非长远之计。

目前大学培养的中医思维非常不足，最大的问题就是西医内容杂糅过多，而且太容易理解。今年上半年组织研究生答辩时，我问一位同学胃酸中医到底是怎么认识的，他完全不知道，在他的认知里反酸就是胃酸过多造成的，就是物理中的Hcl，然后某些中药有中和胃酸的作用。这叫中医么？这肯定不是中医。我们不能否认专病专药，如果说某些石头治疗反酸的效果很好，那么达喜的效果也不会差，达喜治不好的，那些石头也够呛，最后就该怪中医没用了，其实是不会治。这种丢失了中医思维，自认为废医存药很正确的思想，绝大多数都是受到西医影响造成的。

二、编次混乱，摸不到头脑

新版教材在目录上变动较大，这是一个重要的创新，也应该是这个学科发展路径的重要指示灯。在这版教材中，目录的编排也让我们感到难以理解，譬如经行前后诸病一节，该节内容本就应该包含经行口糜、经行吐衄、经行风疹块等病证，但不知为何这三个病居然独立成了三个小节，这会增加教学大纲设计的难度，也会让学生觉得这三个病不属于经行前后诸病，着实不明白要为什么这样设计。我也编撰过教材，从我的直觉看可能是任务不好分配主编难以决断，这个问题应该在统稿时慎重考虑，并且应该在体例中予以说明，但是本书并没有这么做，让人摸不到头脑。

三、西医妇科内容进入正篇，是否要有大的教改动作？

这版教材最大的改动是将原来位于附篇的西医妇科内容全部列为了正篇，相当于中西医地位等同，在我眼里这是一个重大的信号，是不是要把西医妇科学内容作为中医妇科学的主要考核内容？

在当前的中医学教育体系中，绝大多数学校都将西医《妇产科学》列为中医专业的必修课，或者是推荐选修的选修课。说实话大家对西医的比重问题一直有探讨，观点似乎也都一致，但是操作起来仍然非常有难度。如果说《中医妇科学》带个头把西医内容列为课程的主要教学和考核内容之一，我们在下一步专业培养方案的修订时是不是就能够撤掉西医的课程。这样我们在学习中医妇科学的时候拿出五分之一的时间学习必要的西医基本知识，然后在医院实习的时候再学医一部分临床常见的西医妇产科知识，是不是会提高我们的培养水平？如果把《生理学》《病理学》纳入《中医基础理论》，把《诊断学》纳入《中医诊断学》，把《内科学》纳入《中医内科学》，就至少能节省出20%的学时，极大的减轻学生负担，我觉得这是利大于弊的。毕竟我们培养的是中医人才，西医的知识能够满足执业医师考试，在进行住院医师规范化培训的时候继续学习应该完全够用。