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Apart from Buddhism, philosophical influences on Chinese medicine for over two thousand years were mostly indigenous. Nevertheless, as China’s economic and political power and cultural vigor declined in the Qīng Dynasty, the globally expanding power of Western civilization increasingly influenced the Chinese world economically, politically, and culturally. The introduction of Western medicine both weakened support for Chinese medicine and influenced its development.

Western medicine made its first major inroads into China in the nineteenth century at a time when China was amid a traumatic political, economic, and intellectual crisis. The collapse of the Qīng Dynasty coincided with a series of military defeats by the Western powers and, even more humiliatingly, by Japan. Contrasting starkly with the decay and corruption of traditional Chinese culture at this time, the apparently irresistible success and progress of Western civilization served as proof for the superiority of Western learning and caused the Chinese intelligentsia to embrace it wholeheartedly.

Western medicine gained supremacy in China in the early part of the 20^th century and traditional Chinese medicine was nearly outlawed. This was because Western science was able to challenge Chinese medicine as a valid and acceptable system of medicine. Although Chinese medicine resisted the threat and survived, it lost its place as the main form of health care to the Western rival. In China today, Chinese medicine is judged by the standards of modern science, in some ways even more so than in the West.

Before investigating the ways in which current Chinese medical knowledge is now handed down to posterity has been influenced by Western medical ideas, it is valuable to consider how Chinese medicine measures up to the standards of modern science. By evaluating Chinese medicine in these terms, we can then understand why and how Chinese medicine came to be dubbed as unscientific.

Our word science derives from the Latin word scientia, meaning knowledge. Originally, science referred to any branches of learned knowledge. In modern times, the word is mostly used in the specific sense of learned knowledge based on the scientific method, which can be summed up in five fundamental principles: materialism, empiricism, quantification, progress, and integration. The five principles are defined as follows:

• Materialism: The notion that every phenomenon can be explained exclusively in terms of matter. This can also be called the mechanical principle.
• Empiricism: The notion that observation precedes hypothesis, hypothesis precedes experiment, and that experiment, in turn, is followed by renewed observation. One way of ensuring that knowledge conforms to the empirical principle is by performing a repeatable experiment.
• Quantification: The notion that processes can and must be measured.
• Progress: The notion that present knowledge is incomplete, that knowledge progresses from the past through the present into the future, and that any knowledge may be questioned.
• Integration: The notion that the existence of two or more conflicting theories to explain one phenomenon is untenable and therefore leads to the validation of one theory and rejection of the other. This notion is also implicit in the search for the simplest explanatory model for any given phenomenon.

Although Chinese medicine is fundamentally deterministic in nature and constitutes a science in the traditional sense of a body of knowledge, it is lacking on all five of the above counts as a science in the modern sense.

Materialism

Many aspects of Chinese medical knowledge are based on observation of activity in relation to physical substrates. Examples include the digestive function of the stomach, the respiratory function of the lung, and the urine-storing function of the bladder. Others are not based on this principle. For example, notions such as the kidney governing reproduction, the spleen absorbing nutrients, and the liver having the function of free coursing (ensuring the smooth flow of qì around the body) are all derived from the doctrine of the five phases. Furthermore, Chinese medicine discusses organs whose physical substrates are questionable, e.g., the channels, the triple burner, the essence chamber, the life gate).

In general, Chinese medicine is not overly concerned with physical substrates. Lung qì governs regulation of the waterways, while the kidney distills the fluids of the body. These theories disregard all need to explain the physical substrates such as structures to channel fluids. In general, activity within the body is attributed to the action of the ethereal substance called qì. Nevertheless, qì has not been isolated from the body and is not explicable in scientific terms as a single entity or single phenomenon.

Empiricism

The dialectical style of argumentation where concrete, objective, and indisputable proof is required to promote one’s claims and discredit an opponent’s claims has been the vehicle of advancing Western science since the early Greeks. For a variety of reasons, the Chinese intellectual climate has always been very different. Though it is true that is empirical in the sense that treatments are tried and tested in clinical practice, its empiricism never advanced to controlled clinical trials. In basic theory, the lack of empirical rigor prevented speculative elements from being challenged and either eliminated or verified by repeatable experiments.

Quantification

Traditionally, quantification was restricted in medicinal therapy to giving weights and measures for standard formulas, and in acupuncture to body measurement (the body inch, 寸 cùn). Given the nature of individually tailored treatments, weights and measures in medicinal therapy were only ever meant as rough guidelines rather than as cast-iron standards. The cùn, the body inch, used in finding certain acupuncture points only functions in relativity to an individual body. In diagnosis also, deviation from norms is traditionally identified in terms of subjective quality rather than as an absolute quantity. Polyuria, for example, is typically described in terms such as long voidings of clear urine, which means that a subjectively felt lengthening of voiding time suggests that urine is more copious than normal. Substances internal to the body, such as qì and blood, were never measured in traditional Chinese medicine.

Progress

The history of Chinese medicine shows that although the body of Chinese medical knowledge continually expanded, it never developed procedures for evaluating contradictory elements of knowledge and categorically discarding the elements considered obsolete. For example, the theories of the corporeal and ethereal souls, stored by the lung and liver respectively, are still mentioned in modern textbooks, even though they are considered by most to have no clinical value. The early classics such as the Nèi Jīng, Nàn Jīng, Shāng Hán Lùn, and Jīn Guì Yào Lüè are still revered as seminal works. New theories were based on the classics and often expressed in the guise of commenting on or returning to an older and more accurate understanding of the original knowledge of the ancients. Generally, acceptance of old theories was justified by the classics and their rejection was avoided or ignored, whenever possible, to circumvent the appearance of conflict and contradiction.

In practice, however, peripheral theories have continuously been discarded from agreed mainstream standards. Many ideas from different periods are now considered ineffective, inaccurate, or obsolete. For example, poor dissection technique led to the notion of a house of blood (血府 xuè fǔ), or a chamber where blood pools in the chest. This is now considered an obsolete theory that nonetheless led to the discovery of effective treatments for blood stasis in the chest.

All in all, though, the fundamental premises of Chinese medicine have not been re-evaluated and questioned systematically. The theory of the five phases is the perfect example. While it is still one of the most fundamental notions for understanding processes in the body and the macrocosm, its systematic use to explain relationships between the viscera did not survive in medicinal therapy.

Integration

As stated already above, Chinese medicine never developed any notion of a single truth. It has allowed conflicting doctrines to exist without any battle between them. The classic example of this is seen in two similar, but in some respects conflicting, systems in the analysis of externally contracted disease: cold damage and warm disease. No effort was made either to prove the viability of one system over the other or to synthesize the two into a single, all-encompassing theory. Way back in the formative period of Chinese medicine, two different approaches were applied to understand the workings of the internal organs: the analytic approach and the analogical approach of the systems of correspondence. However, these two approaches were never isolated and compared.

The reasons for this lack of integration lie in Confucian reverence for the authorities of the past, which allowed for new ideas to be introduced provided the innovators did not try to demolish the ideas of antiquity. A further reason may be the Chinese religious preferences for the polytheism seen in religious Daoism and Buddhism. It has been argued that the single truth goal of modern science may have been influenced by the monotheistic nature of Christianity.

From the above brief analysis, it is clear, therefore, that, although Chinese medicine is a sophisticated body of theoretical and practical knowledge, it fails to meet the strict principles of science as described above.

The ways in which Western medicine has influenced the body of knowledge that is now presented to students as Chinese medicine have not been systematically studied. Nevertheless, clear tendencies can be discerned, in two specific areas. On the one hand, one can observe limited efforts to assert the mechanical principle of materialism. On the other hand, there is an effort toward integration.

Asserting Materialism

The influence of Western medicine in the realm of materialism has not led to an all-out effort to correct errors. It is confined mostly to the search for a mechanical basis of both acupuncture and medicinal therapy and to the rewriting of etiologies.

Western medicine has challenged the validity of Chinese medicine by asserting that if Chinese medicine works, it should be explicable in material terms. This challenge has given rise to an immense research effort in the scientific community, not only within China but also abroad, to demonstrate the mechanical bases of Chinese therapeutic modalities, principally medicinal therapy and acupuncture.

Despite this, the Chinese have been reluctant to engage in a complete revision of basic physiological and pathological theory. Students of Chinese medicine are well aware that the ancient explanations of physiology and pathology they are required to learn often contradict the biomedical notions they had received in their previous general education. However, no attempts at a comprehensive revision of traditional explanations have been made. All the items of knowledge that have no basis in biomedicine, such as the spleen as a digestive tract organ, reproduction as a facet of kidney function, or the liver as the viscus that governs free coursing have been left in place. The organs are regarded as groups of functions that despite the lack of clear physical substrates can nevertheless be reliably influenced by treatments.

Chinese medicine has not responded to the challenge of biomedicine as European herbology, for example, has done, namely by abandoning all theoretical knowledge that has no basis in scientific fact and by realigning treatment to the Western medical understanding of illness. The general appreciation of Chinese medicine in China is that its treatments can be highly effective, even though the theory on which they are based is unscientific, particularly regarding the mechanical principle. Chinese treatments are so inextricably bound up with theory that it might be impossible to reapply them to the modern Western understanding of sickness and disease without tremendous loss.

Despite this, the practice of a modernized form of Chinese medicine that integrates both Chinese and Western medicine frequently entails basing diagnosis on a combination of Western disease categories and Chinese patterns.

Certain changes have taken place in etiological explanations, but not many. The traditional explanation for jaundice in terms of damp-heat or cold-damp affecting the spleen has now been reworked to include a disturbance of the liver and gallbladder causing bile to spill into the skin. So strong is the new understanding of this condition that modern Shāng Hán Lùn commentators have introduced the notion of the gallbladder to explain Zhāng Jī’s approach to treatment. Wind stroke (中风 zhòng fēng, apoplexy) is still explained in traditional terms of internal wind (or wind-phlegm) and various complications, but its Western medical understanding as a cerebrovascular disease has encouraged the use of blood-quickening stasis-transforming agents (活血化瘀药 huó xuè huà yū yào) in its treatment.

Promoting Empiricism

The empirical principle entails that any theory must be demonstrable by repeatable experiment. An experiment is only valid if it can be performed under the same conditions by any other experimenter. A specific application of this principle in medicine is that any treatment should be repeatable. That is, every treatment should produce a reliable effect under given conditions. The safe practice of medicine in particular requires that potentially harmful treatments can only be allowed if the conditions for their successful application are clearly delineated.

As we have already explained, Chinese medicine identifies not only diseases but also disease patterns. The principle of identifying patterns as the basis for determining treatment is regarded as one of the chief features of Chinese medicine and one of its strongest points. This notion embodies a holistic conception of sickness in which successful treatment depends upon treating the whole person affected by a disease rather than, as Western medicine tends to do, merely eliminating the disease. In trying to determine pathological conditions that could be reliably and repeatedly treated, it was natural to choose the pattern. Modern diagnostic literature has gone to great lengths to narrow the criteria for specific patterns. Some literature distinguishes between chief signs and secondary signs and even suggests that a specific number of the chief signs and a specific number of the secondary signs need to be present for a given patient’s condition to be classed as a specific pattern. Nevertheless, the identification of patterns is still problematic in practice, since few patients present all and only the classic signs of a specific pattern. Most conditions involve multiple patterns.

Promoting Quantification

Chinese medical diagnostic procedures are difficult to quantify. Some studies have attempted to objectify and quantify symptoms. However, these have not been carried over into health-care practice. TCM avails itself of the Western medical diagnostic tools, such as X-rays and blood tests. Nevertheless, these practices are considered as parallel references, not integral to Chinese medicine itself. Overall, in its general practice, Chinese medicine has little more emphasis on quantification than it ever had. The area in which quantification has increased in practice is in a more stringent control of the constituents of pharmaceutical preparations, such as the powdered forms commonly used in the West.

Promoting Progress

Largely under the influence of Confucianism, which emphasizes reverence for elders and superiors, Chinese culture traditionally accorded respect for the thinkers of ancient times. In education, great emphasis was placed on study and memorization of classical literature, which formed the basis of the state examinations for officials. Chinese medicine was no exception to this. Although it has constantly evolved over its history, the founding classics were always considered authoritative. Progress came primarily in the form, not of discoveries that entailed a break with the past, but rather the elaboration and development of classical theories.

The introduction of the Western sciences brought the notion of progress to China and led to a reevaluation of traditional knowledge and its role in society. The traditionalism and backward focus of Chinese civilization were blamed for its grave failure to withstand the onslaught of Western culture in the nineteenth and early twentieth centuries. The excesses of the Cultural Revolution (1966–1976) as the most extreme reaction against the traditional respect for family hierarchy, elder generations, and past wisdom associated with Confucianism did not last long. Yet the drive to Westernize, modernize, and scientize, or in other words, to forge a new culture in pursuit of progress and to leave the ignorance and backwardness of the past behind continues, although it has lessened somewhat over the recent decades of liberalization.

The new worldview has affected Chinese medicine. Study of the classics is increasingly accorded less importance in education. In the modern literature, all elements of traditional medicine stamped as backward and superstitious have been discarded. Emphasis has been placed on developing rational elements that can be explained. This has notably led to the elaboration of pathomechanisms (病机 bìng jī), i.e., the mechanisms by which disease arises and develops.

Despite this, Chinese medicine continues to be defined by its traditional theories of physiology, pathology, diagnosis, and treatment. Progress is understood in terms of elaboration and elucidation of the traditional corpus on the one hand and substantiation in modern scientific knowledge on the other. Progress in the modern scientific sense could only be achieved by abandoning all the speculative theories of the past, an act that would destroy Chinese medicine’s defining characteristics.

Promoting Integration

Until the twentieth century, Chinese medicine was a loose conglomeration of different treatment modalities (e.g., acumoxatherapy, medicinal therapy, tuī-ná), each with different schools of thought. Confucian tolerance of new ideas that did not come with a refutation of ancient ideas allowed all manner of practices to flourish. Those wishing to study medicine would seek a teacher, often serving as an apprentice, helping the master by performing menial tasks while learning. The teacher would recommend the literature representative of his particular style of practice. This system resulted in practitioners having different kinds and different levels of skill.

All this changed in the 20^th century when, with the influence of the West, mass education was identified as the means to social progress. This revolutionary change eventually shifted the teaching of Chinese medicine into large university classrooms. What was to be taught was now decided not by a single teacher but by committees of professors who devised curricula that would provide the basis for comprehensive instruction. Scholars created textbooks that presented all the knowledge and practices they considered to be the most useful, in a clear and systematic fashion. This effort culminated in periodically revised sets of textbooks issued by competing publishing companies. Each volume is devoted to separate subjects, including basic theories, diagnostics, internal medicine, materia medica, medicinal formulas, acupuncture, Nèi Jīng, Nàn Jīng, Shāng Hán Lùn, Jīn Guì Yào Lüè, warm disease, theories of prominent physicians, ancient medical Chinese, history of Chinese medicine, gynecology, pediatrics, external medicine, and others.

These changes, of course, concerned the selection of material presented rather than the content. An arguable exception to this was the expansion and refinement of the pattern identification system, which has made the teaching of diagnosis much easier. However, the new teaching framework led to an unprecedented broadening and standardization of medical knowledge and practice. Modern curricula now provide all students with a comprehensive overview of the various traditions and styles of Chinese medical practice, at least those that do not involve magical practices.

The impetus for the new packaging of Chinese medicine came, of course, from social policy makers rather than from biomedicine. One might imagine that the scientific method would have had a considerable effect in the integration of traditional Chinese medical knowledge, but it has not. Science’s dictum that the existence of conflicting theories requires a new hypothesis has had little effect on Chinese medical theory. As previously stated, even the latest standard textbooks present the two febrile disease systems as alternative ways of analyzing febrile disease. None of them has ever presented a synthesis of the two (beyond including amongst lung disease patterns wind-cold fettering and the lung and wind-heat invading the lung from cold and warm disease respectively). Nevertheless, university academics have put their heads together with some success to resolve long-standing controversies, such as the nature of the life gate and the triple burner, and the interpretation of anomalies of the tongue and its fur.

Another kind of integration has come through resonance. Several decades ago, the practice of describing a medicinal as having a specific action as well as particular indications was carried over to acupuncture points. The attempt apparently failed since recent literature of acupuncture does not include actions for acupoints.

The Western scientific love of integration in knowledge has deep implications for the linguistic expression of knowledge. A given concept should always be referred to by one name alone. Because Chinese medicine was always a conglomerate of loosely related treatment modalities and different schools of thought, terminology lacked systematization. Thus, for example, different books from different schools of thought or from different periods over history might refer to one and the same disease by different names. As a result, educators and administrators see a pressing need for standardization of the terminology of Chinese medicine. However, the latest literature reveals that there is still a long way to go before a level of terminological standardization such as is found in Western medicine is reached. As long as the literature of the past is valued, students will be unable to avoid dealing with the vagaries of terminology.

Terminological standardization in English and other languages has attracted as much, if not greater, interest in Chinese academic and political circles. This is partly because the English terminology is far less standardized than the Chinese terminology of modern Chinese medicine and partly because the lack of term standardization is believed to damage the image of Chinese medicine and hamper its acceptance in the international theater.

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