Can TCM Literature Guide Clinical Practice?

I recently received several peer review reports, and I confess they left me rather disheartened. The consensus among some established experts in the field can be summed up quite bluntly: studying Traditional Chinese Medicine (TCM) literature has no scientific value.

I have always maintained that TCM should be studied alongside both the natural sciences and the humanities. Ever since my university days, I could never quite fathom what research overflowing with Protein AA, Target BB, Pathway CC, and Compound DD had to do with Chinese medicine. When I finally stepped through the doors of TCM proper, I discovered something even more baffling: the very “TCM authorities” who had risen through the ranks on the back of such research were now solemnly exhorting everyone to study the classical texts, to uncover their hidden wisdom and apply it in clinical practice — all without a word about how modern medicine might illuminate these traditional teachings.

There are many layers to this problem.

After China’s reform and opening-up, the government championed the modernization of TCM, and people gradually accepted the idea of substituting mice for humans in TCM research — a shift that, for better or worse, was revolutionary. Academician Li Lianda documented in his memoirs the resistance he faced when introducing animal experiments at Xiyuan Hospital. In that era, TCM was still largely traditional; research centered on textual exegesis — what I would call pure TCM scholarship from a humanities perspective. To be fair, some clinical studies were conducted after 1949, but as late as the mid-1990s, the design of TCM clinical research remained so primitive that reading those papers today inspires no confidence whatsoever. Some of the conclusions are simply baffling. That path, alas, was effectively dead-ended.

As horizons broadened, applying modern science and technology to TCM became the royal road. Physics, chemistry, and biology offered rigorous logic, visual clarity, and reproducibility. It was an easy road to walk, and it yielded impressive results at remarkable speed — artemisinin being the crowning achievement. The overwhelming majority of TCM research has concentrated here. The overwhelming majority of TCM graduate students now work exclusively with modern technology. To earn a doctorate, you need not know how to diagnose patients or memorize a single classical passage; you need only run experiments and publish papers.

Yet these studies have done precious little to nourish TCM in return. They may have taken a few tentative steps down the road of verification, but what impact this will ultimately have on the development of TCM remains anyone’s guess.

The primary cause of this situation is policy orientation. The National Natural Science Foundation would never fund pure TCM theoretical research — it would not support investigating how a particular TCM theory might be explained in TCM terms and applied clinically, because there is no so-called “scientific question” involved. The National Social Science Foundation, for its part, would not support research directed at guiding TCM clinical practice either, since it considers medicine a natural science matter. Having now straddled both literary studies and library and information science, I have found that social science experts prefer to support TCM research through the lens of intangible cultural heritage — which still misses the point. When the trajectory veers off course, people stop delving into the classics, stop thinking about TCM, and, ultimately, stop thinking like TCM practitioners.

Veteran TCM physicians recognized these problems long ago, but they could do little beyond calling for a return to the classics and to clinical practice. I personally believe that the best solution is to establish more equitable national research funds with adequate support, focused on TCM theory and clinical practice. Only then can scholars who genuinely immerse themselves in studying, contemplating, and practicing TCM find fertile ground to grow — and only then will the revival of Chinese medicine cease to be an empty slogan.

最近收到了几份评审报告，不是很开心，总结一下业内一些专家的意见，无非就是说研究中医文献没有科学价值。

我是始终坚持要把中医放在自然科学与人文社会科学一同研究，自打上大学那会就不明白，充斥着AA蛋白BB靶点CC通路DD成分的XXXXX研究跟中医有半毛钱关系？当真正踏入中医大门的时候我又发现，这些通过XXXXXX研究上位的”中医大家”们，竟然堂而皇之地说要读经典，发现经典中的奥秘去指导临床实践，丝毫不提如何用现代医学诠释传统经典知识。

这里面涉及了很多问题。

改革开放后，国家提出中医药现代化口号，人们逐渐接受了用老鼠替代人来研究中医，这不可不说是一场革命。李连达院士在回忆录中非常完整地记载了他在西苑医院开展动物实验时遭受的排斥，那个年代的中医还是比较传统，主要研究集中在解析文献，也就是我所谓的人文社会科学角度下的纯中医研究。当然，建国后也开展了一些临床研究，直到九十年代中期，中医的临床研究设计仍然停留在非常原始落后的阶段，现在读起来完全不可靠，其中一些结论让人感到不可思议，这条路就这么被玩死了。

在人们的眼界逐渐开阔后，运用现代科技研究中医成为了一条康庄大道。物理化学生物技术逻辑性强，直观可视可重复，这条路非常好走，出成果又快又好，青蒿素就是其中的杰出代表。绝大部分中医药研究都集中于此，绝大部分中医研究生都在跟现代科技打交道，博士毕业不需要你会看病，也不需要会背几条古文，只要会做实验写论文就行了。

但是，这些研究并没有太多地反哺中医，可能是在验证的道路上走出了几步，但这样对中医发展究竟会有什么影响，现在不得而知。

造成这一现象的主要原因还是政策导向。”自然科学基金”不可能资助纯中医理论研究，不会支持你去研究某个中医理论如何用中医理论解释以及如何在临床上使用，因为这里面没有所谓的”科学问题”。”社会科学基金”更不会去支持这些指导中医临床的研究方向，因为他们认为这是医学问题，而医学问题在理论是属于自然科学范畴的。我现在横跨文学和图情档，发现社科专家更喜欢从非遗和文化角度去支持中医研究，这样仍然偏离了道路。偏离了道路，人们就不会去钻研经典，不会去思考中医，更不会有中医思维。

老中医们早就发现了这些问题，但是他们也只能呼吁大家去读经典做临床。我个人认为，解决这个问题最好的方法是设立更加公平、支持力度足够的国家级科研基金，重点支持中医理论和临床实践研究，这样能让真正静下心来品读中医、思考中医、实践中医的学者们得到一片成长的沃土，复兴中医药才不会成为一句空话。