Self-Cultivation in East Asian Medicine - Part 4 - Standardized Knowledge (2010)by Hyoun Bae on 01/12/19
Zhang Zhongjing’s art stems from academic learning, while Hua Tuo’s was the gift of enlightenment. When the heart awakens, the waves of change become maneuverable--this way of practicing is unique and may appear strange to others, and only a few may be able to follow the likes of Hua Tuo when studying his techniques. Realistically, therefore, academic instruction needs to begin with those essential details that can be a standard for generations of physicians. The archetype for this style of transmission is, of course, Zhang Zhongjing. His way within the Dao of medicine is the way of the constant. Hua Tuo, on the other hand, exemplifies the way of change that puts the constant to use. -Guo Yong, “Supplementation of What Has Been Lost from the Shanghan lun” (Shanghan buwang lun, 1181) tr. Fruehauf, Heiner.
Curiously, historian Paul U. Unschuld proceeds in his discussion on pragmatic drug therapy in Chinese medicine, in his foundational work Medicine in China: A History of Ideas, without referencing the works of Zhang Zhongjing. Rather, he begins his historical overview in this chapter with reference to Shen Nong Ben Cao Jing and the Nei Jing. The former is one of the earliest foundational works on Chinese pharmacology, the latter the seminal classic on acupuncture and Chinese medical theory in general. Zhang Zhongjing’s works form the foundations of Chinese internal medicine and herbal pharmacology. The two works annotated as the Shang Han Za Bing Lun was one of the earliest systematic treatments of herbal medicine, and serves as a basis of treatment in the classical method. His approach can be said to be a decisive move towards pragmatic, clinical framing of medical methods.
medical knowledge stems from the clinical methods and interventions discussed
in the canonical literature. The advent of printing in the Song dynasty paved
the way for further refinements of medical discourse among literate circles,
while the elaboration of medical ideas and practices have been prevalent amidst
a thriving commentarial traditions for centuries. The scholarly activity in the
medical traditions of China, witnessed in developments during the Tang, Song,
Jin Yuan period, Ming and Qing dynasties, were also followed by modernization
and development of standardized curriculum since the middle of the twentieth
Formal academic learning based upon institutionalized models or frameworks serve as standards in modern and contemporary education in Chinese medicine. Aside from secret transmission whose arbitrary method has involved processes of imitation and repetition, and learning of personal styles of practice through proximity with accomplished and experience teacher/clinicians, the transmission of standard knowledge involves explanation (jieshi) as its key component (Hsu, 1999:165).
Hsu remarks, “The formulation of a theory that can be comprehended more or less in isolation from medical practice is among the most important steps in the standardization of knowledge. In theory, standards are easily established. (1999:228). This is also a difficulty in the standardization of practice, just as individualized treatment, at the heart of traditional Chinese medical rationale, stands in contrast with the modern emphasis on formulaic treatment based on standard protocols. Hsu continues, “In medical practice, even if it is institutionalized in clinics and thereby becomes more standardized, the particular problems a practitioner is faced with slow down any process of standardization.” Pragmatism and sophistication go hand in hand in actual clinical decision-making.
Hsu offers that (1999:128) standardization is related to institutionalization, professionalization and modernization of medical knowledge. Through didactic training according to modern models of education, alongside practical clinical methods, clinicians are trained in traditional and contemporary methods. The line between what is traditional and what may be deemed modern is blurred by the fact that tradition is always based on interpretation and application of theories and methodologies in the present (p.167). Standardized modes of transmission are based on explanatory models that are represented in modern TCM medical education.
Standard knowledge appears public (Hsu, 1999:164), yet there is an intention of a way of life being shared, and that is private. “The standardized transmission of knowledge is based on the belief that the complexities of knowing can be ‘explained; and that there is a ‘method’ of learning. (p.167).” This method involves explanation and concrete demonstration of clinical skills, memorization of texts, information and theories. It is learned through didactic models and classroom education, standardized in the formal curriculum of contemporary medical institutions. Didactic modes of education are public by nature, qualifications to acquire such are predominantly professional. (p.127).
All of these modes of acquiring knowledge deal with private to extended social networks.
Scheid’s (2007) recent work sheds light on the development of contemporary Chinese medical practice, situating as it were, the struggle of major individuals involved in updating and transforming medical traditions that have a direct influence on the training of professionals in present day educational institutions. He mentions Zhang Cigong who explicitly leaned toward modernization and engagement with modern scientific and technological developments. Alternately he mentions, Qin Bowei, who was gifted with extraordinary talents in classical scholarship and exegesis, as well as being one of contemporary China’s most gifted clinicians. Qin Bowei contributed to the shaping of modern education by relying on the canonical heritage as a fresh source of clinical inspiration. In either case, both influenced the standardization of contemporary Chinese medical education and the “remodeling of tradition.” Clinicians must exercise practicality. Demonstration of classical norms can never supercede patient needs.
Standardized medical knowledge itself was the result of cultural and political forces and was meant to synopsize various currents and perspectives on medical treatment. Modern students may take up a flatland approach to medical decision-making, and miss the various shades and depths of which a clinical presentation is revealed and can be understood and engaged. Scheid cites Fei Boxiong(1800-1879), a renowned menghe physician, “You must enter [Chinese medicine] via all the different schools [of thought] and then leave them behind. Grasp their quintessence and merge them into one single treatment [strategy that is appropriate the presenting condition](2007:160).” Such was the aspiration of many pioneers who were engaged in the standardization of Chinese medical knowledge, a fact that may not be clearly visible through reading modern textbooks on various subjects.