Picking Fights with Luminaries?

A few weeks ago, a friend wrote an email to me after reading my initial posting on studying Neijing in Chinese. He was concerned that I might undermine my attempt to educate our profession by ‘picking fights with luminaries,’ before I was ready to make my case. I assured him that I’ve done my ‘homework,’ and am ready to share and defend (if necessary) my beliefs about Chinese medicine. While it’s true that I haven’t translated the entire Neijing, I’ve done some of it carefully enough to clearly identify how those two classic texts of Chinese medicine ‘encode’ their most profound teachings. Some teachings are clearly available for anyone to read, while others are ‘hidden in plain sight’ by means of some ambiguity or alternate reading. These obscure ‘hidden teachings’ can be found by readers who had already received practical instruction in the teachings represented by the text, but are generally glossed over by other literate readers. While this suggestion may shock our modern egalitarian sensibilities, and challenge our understanding of scholarship, it is also consistent with academic work on the transmission of classical medical teachings.

Yet, I wonder if he’s right that many readers may perceive my points as ‘personal’ attacks, rather than well reasoned scholarly arguments. I’ve discussed two fine examples of this ‘encoding’ process in some detail in my blog — one in that first long essay, and the other in a shorter essay on the challenges of studying Neijing about a week later. I believe those two examples alone suggest our profession look more carefully at Neijing. Might there be more to the classics than most contemporary practitioners realize? Might the classics suggest a very different approach to Chinese medicine than our contemporary clinical doctrine based on differentiating patients into symptom-sign complexes of the 藏府 (zàngfǔ)? How might our sense of Chinese medicine grow and even transform through studying Neijing?

And, I wonder…who are these ‘luminaries,’ and why would their followers be polarized by my comments and questions? I don’t believe I’ve attacked anyone, though I’m aware others — with different points of view — may see it differently. I don’t believe I’m ‘attacking’ anything that illuminates, but rather clarifying confusions and misunderstandings. Since most practitioner’s don’t study classical Chinese sufficiently well to study Neijing themselves, they must use the work of others. Whose reading of the classics does one trust, and what characteristics does one look for in a translation?

Regarding the ‘luminaries’ my friend was so concerned I had attacked, I mentioned the work of only two individuals in that essay. However, I’ve also been reminded recently that many teachers of Chinese medicine, especially ones trained in China, are rather touchy about having their approach to Chinese medicine characterized as “the modern clinical doctrine,” rather their preferred name of “Traditional Chinese Medicine.” There is an unspoken assumption among many contemporary practitioners that understanding of Chinese medicine has improved over time, and that we should trust the Chinese to provide us the theory and practice of Chinese medicine. Most practitioners simply trust the translators of historical material who step forward, because doing this work themselves would require they master another substantial specialty in the language. There has generally been an emphasis on ‘practical’ information, which accentuates the huge volume of works generated since the advent of mechanical printing, and virtually no discussion of philosophical exploration of the classics of Chinese medicine. Aside from practical their interest, relatively modern texts are much easier to translate than the classics, especially Neijing.

On Paul Unschuld’s translations and scholarship on the Chinese medicine classics:

The most highly respected translations of two of the three primary classic texts of Chinese medicine (Suwen and Nanjing) were done by the academic specialist Paul Unschuld, who considers the aspiration to practice ‘classical Chinese medicine’ foolish. While he can read the texts, he considers them only historical artifacts, rather than inspiration for a living inquiry. He doesn’t understand the medicine, and failed to mention there is clear historical evidence that classical Chinese medical texts were intended only for students who were also receiving their practical teachings. While Unschuld’s translations certainly help me with some of the difficult grammar and usage, I think he gets some passages very wrong, and his lack of interest in the use of the material in the classics prevents him from accurately understanding their content.

Suwen and Lingshu are primarily brief snippets of dialogue intended to stimulate thought, rather than complete discussions of theory. They stimulate practitioners to deepen their understanding of Chinese medicine by fermenting their practical teachings and experience, rather than describing the theoretical framework or thinking process. While they contain much important information, they generally fail to describe how to integrate it into one’s thinking process and practical work. That was left to the practical instruction one received from a lineage, so why would one trust the conclusions of someone who has only a literary relationship with the texts?

Unschuld’s work on these classics should certainly be consulted, but it should not be trusted uncritically, especially by practitioners seeking inspiration from the classics. Learn from his superior understanding of the language, but leave conclusions about the content and import of the classics to people who know them through use. Neijing is unlike more modern texts, and especially ‘western’ texts and references. While it contains much information, its purpose is not primarily to organize a body of doctrine. Rather, it is philosophical poetry intended to stimulate thought, especially contemplation on one’s experience. In that regard, it is much like Dao De Jing or Yi Jing; while these slightly older classics consists of brief poems, the medical classic consists primarily of short exchanges of dialogue.

On Ed Neal’s work with Neijing:

Dr. Neal is a medical doctor, who became interested in acupuncture more than twenty years ago. He studied with an Italian doctor, who had trained with a Chinese doctor that practiced a ‘pre-TCM’ version of Chinese medicine. The Chinese doctor frequently referred to Neijing, and Dr. Neal’s mentor consequently did so as well. While Dr. Neal refers to his ‘Italian lineage,’ those references primarily recall the leisurely and congenial lifestyle he experienced during visits with his teacher. He declares quite clearly that his methodology for studying the text is based solely on reading, compiling, and organizing the information, then experimenting with applying what it seems to instruct. As he reads the text, he recognizes there are many questions that will require further research and experimentation, and he shared the results of one example of that experimentation. Dr. Neal proudly characterizes his work to restore interest in Neijing starts by reading the classic from scratch to start using its teachings.

To his credit, Dr. Neal clearly taught that acupuncture based on Neijing is much more about needling the proper channel(s), rather than needling points according to functions and indications that were articulated much later in Chinese medical history. Unfortunately, his knowledge of classical Chinese falls short of a well-trained academic, and his reading of the classic includes some fundamental errors. Two of these ‘fundamental errors’ involve his translation of the names of two ‘secondary vessels’ in chapters 10 and 11 of Lingshu. Those mistakes are ‘fundamental,’ because they lead to secondary errors in attributing information about these ‘secondary vessels’ from many other chapters. While Dr. Neal claims his unique names for those systems of channels and vessels are evidence of his rediscovering the classic, they are errors that introduce pervasive confusions into his teachings.

I agree that ‘modern’ Chinese medicine, since at least the Song Dynasty (960-1279), has moved a long way from its classical roots. We certainly have a lot of work to do in ‘rediscovering’ classical medicine, and I believe Dr. Neal’s methodology is fatally flawed. Beyond much of it being difficult to decipher, when Neijing was recorded the written text was understood to be a only companion for students who were receiving practical instruction in medicine. It provided ongoing stimulation and inspiration, by challenging the reader with many cognitive puzzles, which I’ve called ‘conundrums’ in other essays. Before the advent of mechanical printing, which allowed relatively broad distribution, the written texts were the source of ongoing inspiration that the student copied by hand and took with him (or her), after completing initial training with a teacher.

On other ‘luminaries’ of Chinese medicine:

I certainly don’t blame any particular individual for the sad state of contemporary acupuncture theory. The recent history of Chinese medicine has been tumultuous, and it has been profoundly impacted by modern ‘scientific’ thinking and worldview. I’m sure most acupuncture teachers are doing their best in this difficult situation; many seek out and find wonderful empirical acupuncture teachings such as those of many Japanese teachers or for instance Susan Johnson’s work with Master Tung’s lineage. None the less, I believe contemporary acupuncture education has severe systemic shortcomings, including its ‘professional’ focus with a strong emphasis on standardized and consistent information (that can be tested on licensing exams), rather than ‘academic’ focus that emphasizes students developing their critical thinking. Rich understanding of clinical Chinese medical relies on study of both Chinese ‘philosophy’ and the history of Chinese medicine, and especially through contemplating the meanings of various groups of symbolic images. It cannot be divined solely from organizing information in contemporary textbooks.

Yet, regardless of how wonderful or lacking one’s initial training may be, the depth of each individual’s understanding of Chinese medicine depends on both conceptual training and practical experience. Ideally, these two components ferment each other to deepen one’s relationship with Chinese medicine, and one learns throughout one’s entire career. The most important opportunity for profound learning occurs after a practitioner has five or ten, or even twenty or more years of experience — after one has a clear understanding of both the strengths and weakness of ‘textbook’ Chinese medicine. Yet, one of the key standards of our required continuing education is that the participant can apply what one learn over the weekend in the clinic on Monday. How can one hope to probe the depths of Chinese medicine, while fulfilling that standard?

Might it be time for a next generation of acupuncture education, based in study of Neijing and focused on stimulating participants to develop their Chinese medical thinking and problem solving?


Whatever Happened to Neijing?

There are MANY ways to study Chinese medicine. The practical desire to assure adequate training in China early in the Song (960-279) led to the standardization of the basic modern clinical doctrine. Many clinical differentiations had already been ‘worked out’ by that time, and they were organized into the familiar syndromes of the 藏府 (zàngfǔ). This process of standardization certainly accelerated with the advent of mechanical printing about a thousand years ago, which allowed relatively wide distribution of the vast textbooks of the Ming (1368-1644) and even simpler handbooks of the Qing (1644-1911). We now have SO MUCH information to learn, and students of Chinese medicine are generally expected to memorize many disparate ‘facts.’ There is little appreciation for clinical thinking to discern the dynamic responsive nature of an individual’s pathology, because there is so much emphasis on accurately classifying its manifestations.

While the most recent round of modernization during the second half of the 20th century stressed consistent and coherent theory, it did not completely eliminate the inherently heterogeneous nature of Chinese medical theory. We all learn differential diagnosis, according to the zàngfǔ, which has been standard for the past thousand years, yet many individuals continue to supplement that basic theory with other systems such as the ‘six stages’ of Shanghanlun. Indeed, throughout the history of Chinese medicine there have been MANY schools of thought that have accentuated various aspects of Chinese medical theory. While we have seen the effort to integrate ‘the best’ of many disparate historical ideas into the contemporary clinical doctrine (‘TCM’), that process has neither completely integrated those historical ideas nor always preserved them with perfect fidelity.

The process of modernization and standardization began MANY centuries before Chinese medicine was imported to the West, so a very large portion of ‘historical texts’ implement that program. Certainly, these included the The Best of Acupuncture and Moxibustion, by Gao Wu (1523) The Great Accomplishments of Acupuncture and Moxibustion, by Yang Jizhou (1601), many other texts of the Ming and Qing Dynasties (1368-1911), and the more recent Chinese Acupuncture, by George Soulie de Morant (translated into English by Grinnell, et. al.). Many scholarly practitioners dive into this nearly limitless sea of information, seeking specific options for treating patients who have not responded well to their initial treatments. While this is laudable research, as many historical texts provide more detailed information than the standard texts of “TCM,” these texts do not substantially broaden the modern doctrine’s clinical theory. Emphasis on information, including specific differentiations and treatment strategies, brings most focus to clearly discerning the expression of distress, rather than the complex process of ‘sorting out’ the individual’s dynamic process.

In response to being overwhelmed by information, many acupuncturists choose to learn ’empirical’ systems of evaluation and treatment, ranging from a wide variety of Japanese approaches to the lineage of Master Tung. While learning the craft of acupuncture can certainly make one a more effective practitioner, these teachings generally work around TCM acupuncture, rather than helping one understand how to resolve the contemporary doctrine’s shortcomings. Virtually all of the empirical teachings highlighted by various teachers have their theoretical foundations in Neijing, though this broader theory is not clearly elucidated — neither in the texts of the classics themselves, nor by the teachers. Empirical schools are generally much more about ‘how to do it,’ rather than ‘how to think about it.’

All students and practitioners of acupuncture and Chinese herbal medicine learn these are ancient arts/sciences, based on a pair of fundamental classic texts — Suwen (Simple Questions) and Lingshu (The Spiritual Pivot), which together are called Neijing (The Inner Classic [of Medicine]). This invocation is repeated so often; it has become a mantra and an article of faith. Often, it is one of the main reasons people — both within and outside the profession — are inclined to believe in our work. And, it is only partially true!

So, what is true about the relationship between modern TCM and Neijing? Well, most of the basic theory of contemporary Chinese medicine can be found in specific chapters of Neijing. For instance:

  • Many of the Five Phase associations we all learn are delineated in Suwen, chapter 5
  • Much of the basic theory of zàngfǔ (sometimes translated as “viscera and bowels”) comes from Suwen, chapter 8
  • The idea that we can treat a primary channel to effect the zàng or  for which it is named is implied by from Lingshu, chapter 2

Isn’t that enough? The ‘TCM’ we learn in acupuncture school comes from Neijing. Well…it’s not that simple. Each of the two texts of Neijing consists of eighty-one (81) chapters, and almost all of them are relatively short snippets of dialogue between the Yellow Emperor and one of his advisers (medicine teachers). Each of these short dialogues centers around a few themes; the entire texts of Suwen and Lingshu are each like tapestries of these dialogues. Each text exhibits MANY themes, and their information is NOT logically consistent. Indeed, they are both are riddled with discrepancies and apparent contradictions, and that creates their beauty and depth.

Suwen and Lingshu are NOT textbooks or handbooks!

The classic texts of Neijing are filled with a wide variety of thought provoking conundrums. They are designed to stimulate inquiry — into the nature of life in general, and the subtle dynamics of each individual’s struggles with it. They focus a reader’s attention on many aspects of life,  some being rather obvious, and they lead to some startling conclusions, especially for people trained in the modern clinical doctrine of Chinese medicine. The suggest a profound transformation in our perception of life, including a framework for understanding the nature of transformational healing for people with chronic degenerative diseases.

How does one resolve the apparent contradictions and mysteries in the texts? Working with patients allows practitioners to delve into the subtle and responsive dynamics of the individually embodied spirit. Contemplation on one’s experience as a practitioner is the ultimate teacher, as it informs one’s ability to probe the depths of the text.

Why were the classics written in conundrums? Seems like a great topic for another blog posting