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Preface
Many people often ask me, how to learn traditional Chinese medicine (TCM)? Everyone studies similar content for roughly the same number of years, so why can you prescribe and treat effectively even before graduation, while I cannot? I always comfort them that it’s not that you’re incapable, but that most people are not capable.
Most TCM students still do not use TCM thinking to diagnose and treat after graduation, which has become the norm. As a result, people like me appear as anomalies to those who are fully westernized, and as outstanding representatives to those who are confused and struggling. I once saw a publication at a standardized training base for a certain hospital anniversary, which mentioned that a TCM expert had very strict requirements for students; the graduation exam involved the master and apprentice seeing patients together, and the student’s prescription had to align with the master’s before they could graduate. This should be the graduation requirement of this major; I was only barely meeting the passing line and far from excellent.
A small number of students failing this requirement is their own problem. But when the majority cannot meet this standard, the school should reflect. If a school keeps reducing the hours of TCM courses, does not assess teaching quality, and lets teachers without real skills and clinical experience just read PPTs in class, then setting a long study system for recruiting research manpower from childhood to laboratories, it is extremely difficult to cultivate TCM talents. Even if such talents arise, it has little to do with the school.
Although undergraduate education has imperfections, at least there are TCM courses and corresponding textbooks, and a considerable number of responsible teachers. At the end of each term with intensive exams, TCM education still exists. But the effect achieved after five years of undergraduate education is only literacy. It’s like the students know all the numbers (basic concepts, syndromes, Chinese herbs, formulas) and symbols (differentiation system) but do not know how to solve application problems through calculation. Then how to solve application problems? Generally, people may think that this is taught at the graduate level.
Unfortunately, generally speaking, TCM education at the graduate stage is lacking. Professional master’s students undergo hospital training, learning Western diagnostic and treatment methods and operational skills. Academic master’s students do experiments, write papers and projects at schools. Hospitals get labor, schools get papers, but few care that the character “中” (Chinese) still exists in front of “医” (medical). Some say that graduate students following mentors to outpatient clinics is also TCM education. Copying prescriptions during ward rounds can be done by graduate students, undergraduates, and even TCM enthusiasts with no foundation — this is indeed TCM education, but not exclusive to the graduate stage.
Under such an environment, learning TCM still depends on oneself. Someone may say, isn’t this obvious? Every profession is “the master leads you to the door, cultivating yourself depends on you.” But the particularity of TCM is that there might be masters who themselves have not yet entered the doorway, and masters who lead to the wrong door. Therefore, relying on oneself, maintaining an independent spirit and critical thinking is even more important.
Next, I share some relatively correct learning experiences summarized from the standardized training stage. They may also be useful for academic master’s students. These experiences are only for the group “truly wanting to apply TCM pragmatically.” Opinions are inevitably one-sided, so please view dialectically.
Choosing a Mentor
There are two aspects to consider when choosing a mentor:
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Is the mentor’s TCM level high?
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Can the mentor provide time and space to learn TCM?
Regarding the first point, mentors from TCM or integrated Chinese and Western medicine backgrounds generally have higher levels than those primarily trained in Western medicine. Among the former, mentors who only practice outpatient clinics rather than wards have purer TCM thinking.
Regarding the second point, try to choose mentors who do not manage students too tightly. “Not managing” means aside from controlling key graduation milestones, allowing freedom of development, minimizing students doing miscellaneous work, PPTs, writing papers, doing experiments, or applying for projects.
If the mentor satisfies both, definitely choose them. If only one, I tend to choose the latter.
Note this is a general situation; some Western-trained mentors may have higher levels than TCM mentors, and some mentors still improving respect student choices. Specific situations need to be investigated yourself.
But one thing is certain: if a mentor’s student advises you not to choose that mentor, then really don’t choose.
Choosing a Specialty
When choosing a specialty, mainly consider whether it provides more practical opportunities.
Taking respiratory medicine as an example, upper respiratory tract infections occur year-round in all ages and genders. Therefore, among students training together, these are very common. Patients generally think colds are minor illnesses and initially see general physicians. So I have had many opportunities to treat colds for classmates. Allergic rhinitis, gastrointestinal dysfunction, constipation, sleep disorders, and similar diseases have comparable characteristics.
Of course, TCM thinking is not specialty-specific; any specialty can be practiced, but patients tend to trust specialists more.
Conversely, some specialties either have diseases with low incidence, or difficult treatment, or patients only trust highly experienced doctors. Specialties with few practical opportunities are not recommended.
Copying Effective Prescriptions
Copying prescriptions under a mentor in outpatient clinics is an important way to accumulate clinical experience. Even the most skilled doctor encounters diseases they cannot cure, even if they are not actually difficult. Even the most confused doctor has magical cures. Once a mentor is chosen, it generally does not change, and their level will not significantly improve over three years. If a chosen mentor’s level is average, rather than focusing on cases they cannot cure and suffer for three years, it’s better to concentrate on effective cases. Effective cases surely have their reasoning. This reasoning is objective, and interpretation rights may not lie with the original prescription’s creator.
Most mentors, after many years of experience, summarize standardized prescriptions for certain diseases, used in outpatient clinics with high effectiveness. But when students use these, often no effect. Why? Because patients who don’t respond no longer come, and cured patients recommend similar patients. Through the long-term two-way screening between doctor and patient, the group of patients matching the standardized prescription’s corresponding syndrome is highly concentrated. When students use it, their patients are unscreened with a spectrum of syndromes, naturally difficult to be effective. For example, a TCM once said “among yang deficiency with cold dampness, nine out of ten cases are this; yin deficiency with heat syndrome is invisible among hundreds.” This wrongly treats local outpatient experience as an overall truth. If the outpatient syndromes are concentrated, first reflect on whether your own differentiation system has problems, your vision is limited, and thoughts are rigid, rather than treating this as general experience.
Therefore, standardized prescriptions are not panaceas, and their limitations arise with their appearance. Does a standardized prescription still have learning value? As long as effective, it does. If worshipped, one thinks it sacred and unchangeable. If looked down upon, when seeing it, one can infer roughly what syndromes it addresses and its limitations. By copying prescriptions in outpatient clinics, observing efficacy, you summarize which patient features fit the prescription, at which disease stage it works best, and how to simplify it to reduce herbal items while retaining efficacy. Only then can similar effects be reproduced.
Some mentors never set standardized prescriptions, seeming higher level, but actually have a standardized thinking, i.e., preconceptions about certain diseases. This standardized thinking also needs caution.
Dare to Practice
With senior doctor’s permission, seize opportunities to prescribe Chinese medicine (or acupuncture) for inpatients. Before prescribing, be sure to check patient history, go bedside to collect detailed four diagnostic information. Never casually prescribe based only on looking at the tongue or feeling the pulse during ward rounds. When prescribing, better to be a bit conservative than overdose. Don’t imagine you’ve found a secret and use large doses of certain herbs. After prescribing, you must follow up promptly to get patient feedback. If effective, summarize experience; if ineffective, review and reflect. Don’t just prescribe and then leave silently; seemingly graceful, but actually leaving the diagnostic and treatment loop incomplete.
Without feedback, TCM practice is wasted time and effort, only solidifying narrow understanding.
Of course, inpatient treatment is mainly Western medicine, so distinguishing Chinese medicine effects is difficult. For example, during Chinese medicine treatment, patients’ fever may not subside because antibiotics or steroids were added, vomiting patients may have an injection of metoclopramide, pain patients get painkillers. If arrogantly assuming it’s the herbal effect, wrong cognition is likely.
Some say, as long as the patient gets better, do we have to separate Western and Chinese medicine effects? It’s very necessary. Without clear source of effect, no real feedback can be gained, so the practice cannot promote TCM growth. Patient’s efficacy is the premise, but TCM’s growth is also important.
How to distinguish Chinese medicine effect on inpatients? 1. Basic knowledge of disease course, prognosis, and Western medicine onset and action time. 2. If unclear, select diseases and timing with Chinese medicine intervention to control variables from the source. For example, diseases with symptoms but unclear diagnosis and no targeted treatment; diagnosable diseases without treatment methods; stage with treatment but no obvious effect.
An example:
An elderly man with asthma and heart failure history admitted on December 26, 2023 due to back burning sensation, not asthma exacerbation. Treated symptomatically with anti-inflammatory and antispasmodic, nebulization, antihypertensives, diuretics. No antibiotics or steroids used. I checked bedside and collected diagnostic info: patient had cold with fever and chills a week ago without sweating, felt heat at tailbone spreading to whole back, persistent. Currently feels back burning, burning nasal airflow, migratory pain, dry mouth with thirst, little appetite without hunger sensation, constipation (dependent on laxatives), and years of difficulty sleeping. Thin and emaciated. Tongue pale purple with thick greasy slippery coating, pulse thin wiry weak.
Consider yin deficiency, external damp-heat, further yin damage, rising minister fire. Treat by dispersing lung dampness, restraining yin, subduing yang. Formula:
淡豆豉 10g, 炒苍术 9g, 炒蒺藜 10g, 焦栀子 10g
青蒿 15g, 牡丹皮 15g, 生白芍 18g, 制大黄 6g
炙紫菀 10g, 豆蔻 5g, 通草 10g, 生牡蛎 15g
3 doses, decoction substitute, twice daily.
Feedback on December 29: back burning and nasal heat significantly reduced, migratory pain gone, appetite improved, still constipated (bowel movement smooth after laxatives), difficulty sleeping remains. Tongue pale purple, coating peeled and slippery, pulse thin wiry weak. Although constipation and insomnia not resolved, main symptoms relieved; patient discharged with prescription.
Patient’s back burning undiagnosed and had no targeted treatment. After Chinese medicine, both main and secondary symptoms improved, confirming effect from Chinese medicine.
Also seize opportunities to prescribe for family, relatives, classmates, etc., non-inpatients. These patients trust you more and provide error tolerance. Also free from Western medicine interference, effects easier to observe, experiences easier to summarize, greatly promoting TCM level.
Early in standardized training, although I often prescribed for inpatients, often coincided with changes in Western treatment. Without feedback, I didn’t know if prescriptions were correct, my level stayed theoretical for a long time.
The turning point was November 2022, during a rotation in gastroenterology. A junior classmate caught a cold; since I was in respiratory medicine, I felt responsible and the classmate agreed to take Chinese medicine, so I reluctantly treated; fortunately effective. At that time, no flu outbreak, but many classmates caught cold, I treated several cases effectively. Since then, I’ve treated many colds, some with better effect, some poorer. Through practice and feedback, I analyze different syndromes and sense differences among similar herbs. These experiences significantly promoted my TCM level. Writing this, I feel deep gratitude; if the classmate hadn’t given me chance, if I hadn’t stepped forward by coincidence, what would I be now?
Defend Your Position
As a TCM major, you should hold your ground in TCM. Both Chinese and Western medicine have strengths and weaknesses. Don’t deny TCM because of Western medicine’s advantages and TCM’s shortcomings and go to Western medicine’s position. Western medicine’s position will be defended by others. Self-abasement invites ridicule. Western medicine excels at surgery, but under TCM perspective, surgery when necessary reflects “treating the branch when acute, the root when chronic.” Western medicine has many diseases with symptoms but unknown causes, diagnosed but no treatment, treatment but unstable effects. Western medicine’s difficulties are where TCM can exercise, like the previously mentioned back burning case.
Furthermore, diseases with Western medicine’s clear treatment and effect can still be improved. For example, bacterial pneumonia can usually be resolved with sensitive antibiotics, but clinical observation shows some patients, although fever drops, sputum decreases, inflammation lessens and lung lesion absorbs after antibiotics, experience night sweats, insomnia, fatigue, diarrhea. Western medicine considers pneumonia cured, these discomforts disappear at home. From TCM’s standpoint? Antibiotics kill pneumonia bacteria but their cold nature plus fluid infusions block lung qi spreading, causing heat stagnation. At night qi movement slows, heat intensifies, forcing sweat (night sweats), disturbing heart and mind (insomnia), exhausting qi (fatigue), and heat descending causes diarrhea (just an example; clinical practice analyzes individually). Patients recover at home because suppression by “cause” antibiotic is removed, and lung qi spreads normally. Some patients with weak constitution never recover by rest alone, needing TCM’s help.
Further, Western and Chinese treatment concepts differ in some diseases. For refractory skin diseases, Western medicine uses steroids to suppress lesions, which relapse after stopping. TCM’s concept? Based on cases I encountered, patients sometimes experience increased lesions worsening before improvement to normal skin with continuous treatment. TCM’s concept is dispersal, not suppression.
TCM students often hear the discipline that “modern TCM practitioners must understand Western medicine.” Obviously, this succeeds: they know Western medicine but lose TCM, even giving up their own ground. Looking at a disease, first wonder about Western medicine’s method. If Western medicine has solutions, no need TCM; if no solution, TCM can’t either.
But I rarely hear Western medical students trained that “as Chinese Western medicine practitioners, you must understand TCM.” Communication and understanding between Chinese and Western medicine, collision and cooperation of both fields ultimately aim for patients to gain maximum health benefit at minimal cost.
I heard a cancer patient undergoing chemotherapy in a provincial top-tier Western hospital felt extremely fatigued, short of breath, anorexic, emaciated after multiple chemotherapy rounds, asked the attending whether they could take Chinese medicine but was sternly refused. Later, upon submitting to a TCM hospital, the patient gradually improved.
Both Chinese and Western medicine have strengths and weaknesses. If biased to lock patients in one field, named “protecting life,” practically harms life.
Connect with Like-minded People
Most peers I met experienced declining TCM level during standardized training because their undergraduate foundation was weak and during standardized training stopped learning TCM (except coping with licensing and graduation exams), never practicing. Maintaining the original level was rare; improving was rarer. In three years, I only saw five or six achievement cases of peers who continued TCM study during training. Continuing to study TCM during training is lonely. Meeting another like-minded person is precious.
If you meet one, seize the opportunity for discussion on theory and skills. Everyone’s vision and expertise in syndrome types or diseases differ; exchanging complements weaknesses and corrects biases. If you meet several like-minded people, form a TCM group to create a learning atmosphere. If you can’t find like-minded peers offline, look online on Weibo, WeChat, but online friendships have risks. If no matches either online or offline, better not to seek.
There is another kind of like-minded peers obviously standing there but overlooked — the ancient medical masters. Rather than calling them predecessors, call them peers. They were climbing TCM peaks thousands of years ago, finally staying somewhere on the summit, leaving works as guideposts for aspirants to climb higher. Theoretically, as long as you haven’t reached the summit, these ancient masters will always accompany you in another time-space.
Read More Books
The importance of reading needs no emphasis. Although syndrome differentiation and treatment is logical and theoretically one can reason from any symptom to corresponding syndromes, even unfamiliar ones, reality is complex—if you never saw it, you never think of it. Take the Jiangnan famous doctor Wang Huo-Bo’s case as an example:
After the war victory, Wang treated his nephew Wang Zuocai. Patient was about 30, in humid season, coughing over one month, phlegm like crab foam, thin, physical wasting, reduced urination and defecation. Abdomen cold and desired hot drinks, even boiling water, causing tongue burns. Foam sometimes overflowing, causing tongue moist and not dry. Patient had many treatments locally using Xiao Qing Long Tang and even warming herbs like Fuzi, but symptoms worsened daily. So Wang was invited. First visit took pulse for over an hour. Pulse thin, intolerant to pressing, right cun guan felt slightly wiry, no countless pulse. Considering pulse, tongue and formula, and recalling Danxi’s saying “cold feeling is not true cold…” formulated:
Mi Ren (Coix seed), Dong Gua Zi (Winter melon seed), Shi Gao (Gypsum), Lu Gen (Reed rhizome), Pi Pa Ye (Loquat leaf), Ban Xia (Pinellia), Xing Ren (Apricot kernel), Ju Hong (Red tangerine peel), Gan Cao (Licorice).
Except Shi Gao 4 qian, Ban Xia 1 qian, others usual doses. After two doses, disease halved, phlegm reduced and cold gone. Medicine hit the spot like a drum. After more than ten days, stabilized.
Analysis: patient is drug store manager, good at socializing, often drinking though not alcohol addicted, causing gastric heat accumulation steaming fluids converting into foam blockage lung and stomach yang qi flow. Thus complained of oral cold despite wanting heat drink even boiling water causing tongue burn but moist.
This “hot drink” disease is rare; Wang met only once in decades. Pulse was deep thin, different from “cold drink” with pulse soft or slippery caused by wind and cold exposure.
The significance of reading is this: broader knowledge gives more mental flexibility, preventing blind use of heat herbs for cold signs or cold herbs for heat signs.
A doctor sees and hears limited things in a lifetime, which limits practice. But if reading more, disease experience can increase hundreds or thousands of times. Without rich knowledge, syndrome differentiation itself is narrow. For example, various disease phenomena are towns, and syndrome differentiation is railway connecting towns. Larger territory, more towns, bigger rail network. Some towns grow due to convenient traffic, but most are still far from talking about this. Mendeleev arranged 63 known elements by physical and chemical properties and, after many failures, discovered the law and predicted “gallium” from empty slots. Imagine if then Mendeleev had only 10 elements, he could find the law and predict accurately?
One tendency must be avoided: only reading the “Treatise on Cold Damage and Miscellaneous Diseases” (“Shang Han Za Bing Lun”). It is the first historical TCM classical with principles, methods and formula all together. It must be studied, but clinical is complex. Even Zhang Zhongjing said in his preface: “Although unable to cure all diseases, it can at least let one see the origin of disease; if one can seek more collection it’s more than half success.” He was a pioneer climbing the TCM peak early, not yet on top. His canonical formulas are to some extent ancient standardized prescriptions (though most modern doctors’ levels can’t be compared). The proper attitude towards standardized prescriptions is stated above.
Today’s so-called debate between classical and contemporary formulas is just the debate between old and new standardized prescriptions. Classical formula enthusiasts tend to attack contemporary formulas as ineffective, which is a causal fallacy. Effectiveness depends on proper syndrome differentiation, not prescription itself (I have made analogy in “Unlock”).
So what to read? How to read? I have read few books and little authority, so I share some trusted resources here.
Weibo user “Zhongjing Sishu (Private study of Zhongjing)” pinned post lists recommended books and details TCM learning and reading methodology.
WeChat public account “Yiyu Mingxin” shares must-read clinical TCM series books (105 volumes), Great Compendium of Famous Doctors from Tang, Song, Jin, Yuan, and Great Compendium of Ming and Qing Famous Doctors PDF versions.
WeChat public account “Zhucan Xin Shao Pan Li Lu” (literal: “Various ginseng, ginger, peony and other medicinal herbs”) is a compilation introducing clinical experience of modern medical masters (the owner is still a TCM professional graduate student, managing wards by day and reading literature by night, updating public account. Judging from the content, hard to imagine they are still only a student).
The above views are for reference only. Welcome everyone to discuss in the comment area.