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TCM masters pass the torch of ancient wisdom to new generation

FAN Daili, a 32-year-old traditional Chinese medicine doctor, has gone back to school as an apprentice to sharpen her diagnostic and prescription skills with a master.

Fan, who herself is a chief TCM doctor, sits beside her more experienced tutor and carefully notes the conversation with patients, taking the patients' pulse after her tutor and copying down the herbal prescriptions.

Her course is known as chao fang (prescription copying) and she has been learning in two weekly half-day sessions since October.

Fan has been working as a TCM doctor of internal medicine for five years since graduating from the Shanghai University of Traditional Chinese Medicine.

She is one of 42 promising young TCM doctors chosen as the first group of disciples who will hone their skills with 27 top - and elderly - doctors. The aim is to turn them into torchbearers of the distinguished tradition of TCM in Shanghai.

Though the city was once famous for its many legendary TCM practitioners, today there are few acclaimed masters.

To preserve the tradition, the TCM Inheritance Program was launched in September by the Shanghai Modern TCM School Clinic Inheritance Center, based in Yueyang Hospital in Hongkou District. It aims to turn out TCM inheritors who will not only absorb the essence of various TCM schools but also apply it and adapt it to modern medical issues.

Fan and other doctors are studying TCM internal medicine, gynecology, tuina (massage), surgery, traumatology and other schools of treatment.

The young doctors study the characteristics of each TCM school, compare their differences, question their effectiveness in treating the current disease spectrum, and develop their own treatment ideas.

Chao fang with a tutor is a fundamental course.

"Finding inheritors for various schools of TCM is an essential and urgent task today," says 67-year-old Dr Xu Minhua, Fan's tutor. Xu is vice president of Yueyang Hospital in charge of the inheritance program.

Dr Xu herself is an inheritor of the Lu School, founded by Lu Yuanlei, a famous TCM doctor in Shanghai in the early 20th century. He was considered a master in treating epidemic disease at that time.

"There is a huge shortage of TCM talents in Shanghai and China," says Dr Xu.

For the past dozens of years, few TCM masters have emerged, due to emphasis on Western medicine, science and changed teaching methods, as well as the "cultural revolution" (1966-76), during which many Chinese traditions were rejected.

Today, most TCM masters are more than 60 years old and some have passed away, taking their wisdom with them. Many emigrated to countries where TCM was more hospitably received at one time.

"If we delay any longer in selecting inheritors for TCM, it will be too late when all the masters have left us," says Dr Xu.

In the early 20th century many famous TCM doctors and their families moved to Shanghai, attracted by its open atmosphere and environment of intellectual discourse on medicine.

"The TCM families in Shanghai at that time were very open-minded," says Dr Xu. "Masters would pass on their wisdom and skills not only to their children but also to non-family students."

They were known for sharing wisdom, not guarding it jealously and taking it to their graves.

TCM masters also encouraged their students to learn from other well-known TCM schools, so they could broaden their own knowledge and embrace various effective treatments, she says. They could develop their own ideas and even initiate their own TCM schools.

In the 1950s, there were around 50 famous TCM schools in Shanghai, including internal medicine, surgery, gynecology, traumatology, pediatrics, acupuncture and ophthalmology. Each had its own characteristic treatments.

For example, the Ding School initiated by Ding Ganren, emphasizes the principle of qing, qing, lian, xiao (light, clear, cheap and effective). The Lu School of treating infectious disease and epidemics calls for immediately halting the invasion of pathogenic energy, then gradually reinforcing and balancing healthy energy.

"However, many of the schools withered in the past dozens of years," says Xie Jianqun, Party secretary of the Shanghai University of TCM. "No more than 20 schools survive today."

The talent shortage results from changed teaching methods and emphasis on Western medicine that often treats symptoms before addressing underlying issues. TCM treatments are generally gradual and may take several months to correct systemic energy imbalances and problems.

The tutor-and-apprentice approach is the traditional education system for TCM. A TCM doctor usually accepts only one or two apprentices at a time.

Chao fang (closely observing the tutor and copying the prescription) is fundamental. Supervised apprentices also diagnose and suggest prescriptions. They learn diagnostic skills, treatment ideas (herbal, acupuncture, and so on) and ethics from their tutor.

Modern TCM classroom education teaches the basics to many practitioners today, but there's no substitute for practical, clinical experience as TCM is hands-on, based on practice.

"Most of the symptoms described in textbooks are simple and straightforward, but real cases are much more complicated, with many factors," says Dr Fan, the inheritor-in-training. "At the beginning I always found it hard to match my cases to categories in the textbooks."

Most patients suffer from more than one kind of energy disorder, which makes cases hard to classify.

"Modern classroom education is important as it provides basic knowledge, but without hands-on experience, the knowledge is like armchair strategy," says Dr Xu, Fan's tutor.

Many young TCM doctors in hospitals may not have had enough clinical experience, she says.

TCM herbal soups were widely prescribed for acute or serious ailments such as epidemic encephalitis and epidemic hemorrhagic fever when Dr Xu worked as an apprentice 40 years ago. "But now antibiotics have replaced them," she says.

These days in such cases, few patients would consider herbal soup - everyone wants fast-working antibiotics - and few TCM doctors dare to prescribe herbal treatments, as they might be considered negligent in terms of Western medical treatment, which emphasizes fast relief.

The new TCM inheritance program involves patients who are real TCM believers; they come seeking TCM solutions, says Dr Fan.

"They have the patience for herbal soup to take effect and they will keep visiting so that we can see the effect of treatment and make adjustments in the prescription as needed," she says.

"Simply learning the ideas of the famous TCM schools is not the goal of the inheritance program," says Dr Xu, the tutor. "We hope candidates will absorb the essence of the masters' thoughts and thus create and develop their own approaches and treatments, just like the masters.

"Only in this way can TCM thrive again, just as it did thousands of years ago," she adds.


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