Today, five months later, the award ceremony for the Fourth Cohort of National TCM Masters and the Second Cohort of National Renowned TCM Physicians was finally held. I extend my heartfelt congratulations to all these venerable seniors.

From the excitement of the first National TCM Masters selection to the indifference surrounding the fourth, insiders and outsiders see entirely different landscapes. Whether veteran TCM doctors can still deliver has ceased to be the real question. What truly matters is how much one has contributed to the profession — and whether one’s descendants possess sufficient “energy” to carry the legacy forward. That last part borders on metaphysics.

Evaluating TCM’s therapeutic efficacy has always been a conundrum. We’ve explored this problem for years with precious little to show for it. Most experts refuse to touch it. Many articles, whenever they venture near the question of how to assess a TCM doctor’s competence, simply dodge and deflect — which is infuriating.

There’s a telling saying in society: “It’s not that old people have gone bad — it’s that bad people have grown old.” A TCM practitioner who didn’t work hard in youth will be equally clueless in old age.

Ever since I entered the world of Chinese medicine, people around me have constantly come for medical advice. The single most common question: “Do you know which old TCM doctor is good for this condition?”

I have never been willing to answer this question, for three reasons:

1. Traditional Chinese medicine has never emphasized specialization. True masters can integrate and synthesize — at the very least, they’re competent in internal medicine, surgery, gynecology, and pediatrics. Judging TCM’s medical scope through a Western medical lens is profoundly unreasonable. Take the simplest example: Western hospitals typically have only a single TCM department or an integrative medicine department, whereas TCM hospitals are subdivided into cardiology, hepatology, gastroenterology, pulmonology, nephrology, and so on. Does that mean the TCM doctor in a Western hospital’s TCM department treats “TCM diseases,” while the doctor in a TCM hospital’s cardiology department can only treat heart conditions?

2. A TCM doctor’s competence has little to do with hospital ranking or professional title — truly, very little. For Western medicine, hospital tier matters enormously because it directly affects equipment. Better hospitals have better equipment, and the operators of that equipment can be trained to standardized competency — at minimum, reaching an acceptable baseline. But TCM has nothing to do with any of this. In her later years, the Empress Dowager Cixi fell ill, and the Imperial Medical Academy failed to cure her. Doctors had to be conscripted from among the common people, and ultimately it was a physician from a modest grassroots clinic who successfully treated her. So one cannot claim that a TCM doctor in a small county clinic is inferior to an imperial physician.

Professional titles are equally problematic. Everyone wants to see a “Chief Physician,” as though the title guarantees better outcomes. But anyone within the system understands that hospital title promotions have little correlation with actual medical skill. One can become a Chief Physician without ever having successfully treated a single difficult case — this is especially true at local TCM hospitals. It’s well known that before 2003, Chinese medicine had low social status, few wanted to study it, and graduates were mostly assigned to TCM hospitals that had precious few patients. Yet as the years passed, their titles kept rising anyway. This is a problem of resource allocation — and the implications are chilling when you think about it.

3. Seeking out veteran TCM doctors comes with numerous practical problems. First, getting an appointment is difficult — especially in Beijing, where you might secure one visit but have no idea when the next will be, leaving the patient helplessly anxious while the disease progresses. Second, efficacy is never guaranteed. Any TCM doctor with a functioning brain knows that no one dares promise outcomes. If I recommend someone and your condition worsens after the consultation, wouldn’t I feel terrible?

Are young TCM doctors no good? On the contrary — young TCM doctors are a treasure. Throughout history, all the great physicians achieved remarkable results from a young age. Shandong University of Traditional Chinese Medicine published a classic book, The Path of Renowned Veteran TCM Physicians, whose first volume contains autobiographies of senior TCM experts who became famous before the founding of the People’s Republic. Without exception, they all achieved early recognition — from the day they opened their practices, they possessed profound insight into Chinese medicine, backed by genuine, tangible clinical results. In that era, large hospitals didn’t crowd out the market. Physicians served local communities, competing on relatively equal footing with other doctors in the area. Those with genuine skill survived naturally — they didn’t need the safety net of an institutional position.

Yet reality is often cruel. People still prefer to believe in old TCM doctors. They still believe in that convenient excuse — born not of competence but of its absence — that “TCM works slowly” and that “TCM is just for gradual conditioning.”

时隔五个月，今天终于正式举行了第四届国医大师和第二届全国名中医的颁奖仪式，对各位老前辈表示衷心的祝福。

从评选第一届国医大师的兴奋到公示第四届的无感，业内业外不同人看到的是不一样的景色，老中医能不能打已不是关键，关键的评价体系是为行业做了多少贡献，还得看子孙后代能量是否充足，这是个玄学问题。

中医的疗效评价始终是难题，我们在这个问题上探索了多年，成效寥寥，绝大多数专家不愿意触碰这个问题，许多文章一旦涉及到评价中医看病水平时往往顾左右而言他，令人愤恨不已。

引用社会上一句很有意思的话：”不是老人变坏了，而是坏人变老了”。年轻时候不努力的中医，年纪大了应该是照样不懂。

自从我踏入中医这个门以来，周围许多人都会来咨询病情，其中问的最多的就是：你知道哪个老中医会看这个病？

我从头到尾就不愿意回答这个问题，原因有三：

1.中医自古不强调分科，真正的大师都能融会贯通，至少内外妇儿都是能搞定的，如果用西医的眼光评价中医的医疗视域，十分不合理。举个最简单的例子，西医院里基本上仅有中医科或者中西医结合科，但是中医院里会非常详细地分为心肝脾肺肾等等，难道西医院里中医科的中医大夫看的是中医的病？而中医院里心病科的医生就只能看心病么？

2.中医的水平跟医院和职称关系不大，真不大。对于西医来说医院等级很重要，因为这直接关系到设备问题，好的医院往往有好的设备，而设备的操作工基本上可以标准化培养，至少达到及格线没有问题。但是中医跟这个没有任何关系，慈禧晚年生病太医院医治无效，最终还是得从民间征召医生，最后还是民间小诊所的医生给治好的，所以不能说县城小诊所的中医就不如御医。

职称也是个大问题，大家都想找主任，仿佛主任的效果有多好，其实体制内的同志都很明白，医院的职称晋升与医术高低关系不大，一个病没看好照样能当主任医师，地方中医院尤其如此。众所周知，中医在2003年前地位不高，没有人愿意学，学了大部分能分到中医院，那时候中医院大概率也没啥病人，但是随着年龄的增长职称照样增长，这是资源分配的问题，细思极恐。

3.找老中医看病会面临诸多问题，首先是挂号难，京城的挂号尤其难，往往是吃了上顿没下顿，这病看的是干着急；其次是疗效没有保证，但凡有点脑子的中医都知道，谁都不敢对疗效打包票，如果我推荐了，你看了之后病情加重了，我岂不是会很懊恼？

年轻中医不好么？年轻中医很香。自古以来所有的名医大家都是从小就疗效很好，山东中医药大学有一本《名老中医之路》非常经典，第一辑中记载了建国前成名的多位老中医专家的自传，无一例外都是年少成名，从开业起就对中医有着很深的感悟，这是实打实的疗效。那个时期，没有大医院挤兑市场，往往就是服务一方百姓，跟一个范围内的医生相对平等地比试医术，有水平的自然能生存下来，不需要编制兜底。

然而现实往往很残酷，人们还是愿意相信老中医，愿意相信那套因为没有水平而提出的中医见效慢，中医就是慢慢调理的”托辞”。