THE STATE OF CHINESE MEDICAL EDUCATION IN AMERICA
I see Chinese Medicine in America as analogous to a fairly young tree whose roots are not all that deep or strong and which has been growing crooked (xie). Nonetheless, the soil in which it finds itself is rich, nutritious, deep, fertile, and healthy, although it is being contaminated even as we speak with pollutants.
That tree needs to be replanted and tended so that it can grow straight and tall. The soil is good and the tree is quite healthy, but we must make the nutrients more accessible and we must not allow the toxification to continue.
Before I translate what all this means, I want to look back for a moment: There is a wonderful historical novel called "The Physician" by Noah Gordon, in which the great Persian physician, Ibn Sina (or the anglicized Avicenna), is introduced as the "prince of physicians," who establishes the first formal medical school, The Madrassas, in Isfahan. To become a physician in the madrassas, one needed to be an expert in surgery, herbalogy, theology, jurisprudence, languages and philosophy, among other subjects. Ibn Sina insisted upon a very high level and breadth of scholarship, skill, and experience in order to qualify as a physician, and the finest doctors in the world were his students and graduates. I believe that this same model of excellence needs to be applied to our doctors and doctors to be.
Translation and transition to a new model:
1. Current licensees: those who have graduated and are licensed should maintain their status quo but should also be required to take an increased amount of Continuing Education Units (CEU's).
2. Schools: must raise their standards of grades and admissions. It is much to easy to get into Oriental Medical School Master's programs, and grades of C or D should not be acceptable and passing. Students that have difficulty but who are really motivated need to retake courses until they master the material. Forget attrition--start with quality, require a Bachelor's degree, carefully evaluating undergraduate grades, more thoroughly interviewing candidates and considering more carefully their written and oral communication skills.
3. Master's programs: The course of study must be more rigorous and students should not be allowed to graduate without demonstrating their practical and technical skills-- again, they need to do well in order to be allowed to graduate. If this means that the course of study is extended, then so be it, but the key must be proficiency not hours of time spent.
4. Mentorships: are a sorely needed priority for our students. I would love to take a student under my wing, be available for him, teach him, answer questions that he has from his studies and have him challenge me. In my view this should not be just a nice option, but rather the sunlight without which the tree cannot flourish.
5. Autonomy: We need to make a massive effort to prove our efficacy as a profession and enforce ourselves just like the MDs and Chiropractors do. It is absurd that individuals and agencies that know next to nothing about what we do have been placed in governing and enforcing positions. Our profession has been poisoned by mediocrity. Our governance and enforcement should not be directly linked together with the FDA and DEA, because we use and treat food and medicinal substances differently than MDs. Though there does need to be enforcement, instead there needs to be subdivisions of these agencies in which standards are high, and officers are knowledgeable in what we do and what we use, and therefore wise as to what real abuses are. Yes, there are problematic substances in our prarmacopeia, but it is absurd that so many important substances and useful substances are not available to us because of ignorance as to how we have been educated to use them. Having our own divisions would resolve this problem.
Again, we are young, vibrant and find ourselves in flourishing terrain. Our tree has grown crooked and yes, wild, because it was not attended to properly, (and no, wildcrafted is not always better!).
I really believe that by raising the bar, we can affect an enormous change in the success of our profession. I would suggest that as with Ibn Sina, students need to get much more practical tutelage and experience. They need to get a much stronger foundation both relative to the past and to the present, by being taught a much broader survey of classics. They also need to take more than just one course in Chinese medical language in order to be able to open Chinese medical journals to continue learning cutting edge developments in our profession internationally, and they need to learn to be much more competent in Western medical diagnosis and how to use WELL the tools that Western physicians use. Ultimately, I think that if didactic course studies were more rigorous and if clinical training was more interactive and challenging we would produce graduates who had greater confidence in their knowledge and greater competence in their abilities. I am absolutely certain that with this greater proficiency, as well as going into the world guided by mentor: a successful and experienced senior colleague, there is just no way that someone couldn't make a good living doing what we do, as long as they have drive and desire to make it.
We have so many brilliant colleagues. Just as the process is thorough and detailed in writing and developing good educational programs, why can't a "constitutional congress" of sorts convene in order for us to reclaim our profession? And to where should we look to for our model? Perhaps we can get an idea by looking backward.
A MODEL OF HEALING
I believe that it is a serious a flaw in judgment to consider simply amelioration of symptoms to be healing, Unfortunately, this is precisely the goal of many allopathic physicians (biomedical and naturopathic): to consider pain relief as therapeutic success. Among the many other strengths that the writings of the ancients teach us is the importance of treating the whole person, body, spirit, mind and emotions, and that if one aspect remains out of balance, invariably the physician's "success" with the patient will only be temporary. This is the problem that with using wonderful modern technological devices such as Scenar or effective therapies such as EFT. Used independently they relieve pain, but as an end in and of themselves, they discourage looking deeper within to adduce what the pathogenesis of that pain might be and what other manifestations are underlying. The great Chassidic master, Rabbi Dov Ber of Mezeritch substantiates this idea when he says: "If one has a small hole in his body, he has a big hole in his soul." The point is that the great masters of Chinese medicine recognized the indivisibility of the whole person, as reflected in their writings of theory and therapeutics.
This solid foundation requires two paradoxical approaches from us: On the one hand, it is incumbent upon us to delve as deeply as possible into ancient sources, learning from masters throughout the centuries how to understand them, and how to apply that wisdom to our practices, while on the other hand, we need to use modern technological tools to confirm, reinforce and expedite diagnosis and treatment.
One final thought into ancient healing that supposedly "doesn't work" We find in Jewish Talmudic, Midrashic and medieval texts many healings and therapies. Why for the most part, are these medical practicies ignored? It is from the great legal commentator, Rabbi Akiva Eiger, who lived 200 years ago, that we find the answer. Rabbi Akiva Eiger ruled that one may not rely on these ancient healings, for both man and nature have changed, and as such, those healings no longer work!
As a student of Chinese Medical history, in all humility, that ruling bothered me, for how can one say that medicine written about in the fertile crescent 2000 to 3000 years ago no longer works, whereas we know that medicine written about in the far East, during the same period, clearly does, as therapeutics are as valid today as they were when the Nei Jing and the Shang Han Lun were written?! How can we reconcile , the wisdom and enormous erudition of the Jewish sages in light of this inconsistancy?
Perhaps, though, we can consider this approach: The Chinese written tradition consists of characters or pictograms which are understood the same throughout the far east, so that and that a reader in Mongolia, though speaking a completely different language, will be able to read a text from Southeast China, Japan, Korea or Vietnam, Within the Jewish tradition, on the other hand, substances have changed names over time. For example, Maimonides uses a term which today means cucumber to describe a melon in the laws of temperaments, written 900 years ago. As such, I humbly suggest that neither man nor nature at their root have changed, (although the potency and strength of each have certainly diminished from pollution and improper use), but that our understanding of substances found in ancient Jewish texts is not always correct.
May we merit a time soon, when ancient knowledge will again be readily available, and the role of doctors will be, as the great sage and physician, Nachmanides tells us, that of educators, teaching us how to maintain vibrant health in body and soul.