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QIN BOWEI'S 56 TREATMENT METHODSCommentary by Wu BopingTranslated and edited with further commentary byJason BlalackReviewed by Volker Scheid

Qin Bowei’s 56 Treatment Methods: WritingPrecise Prescriptions. Clinical Commentary byWu Boping. Translated and Edited by JasonBlalack. Seattle: Eastland Press, 2011.

I should begin this review by saying somethingabout my own relationship to the three peoplewhose joint effort has produced this book: to QinBowei (1901-1970), whose New Guidelinesfor Treatment forms the core around whichthe book is constructed; to Wu Boping ,whose engagement with Qin's work provides mostof the commentary and explanations; and to JasonBlalack, who acts as translator, editor, andsecondary commentator.

I first met Prof. Wu Boping, the man in the middleas it were, in 1994 whilst carrying out fieldwork formy PhD in Beijing. Prof. Wu was then the Directorof the Information Institute on TCM at the ChineseAcademy of Chinese Medicine (now theAcademy of Chinese Medical Science ).He was also running a clinic at the Academy severalmornings a week, which I attended together withhis Chinese students. Prof. Wu specialised in skindiseases but patients came to him with any kind ofproblem and so the conditions we saw rangedacross the entire field of Chinese medicine. It wasapparent on the very first day that Prof. Wu's styleof prescribing was quite different from that of any

other doctor I had studied with until then. Mostnoticeably, he used very small dosages, usually3-6g and sometimes as little as 0.5g of individualherbs, compared with 9-15g as the average dose inthe other clinics I observed. Compared to mostother doctors, Prof. Wu had a broader view of theworld, having spent time in Tibet, Xinjiang andTanzania, and a more subtle understanding ofeffectiveness. To give an instructive example, themajority of Prof. Wu’s formulas at that timeconsisted of eleven herbs. When I asked him whythis was so, he told me that it was generallyconsidered good practice to use twelve herbs.Written down in the traditional style, starting fromthe left and writing from top to bottom, thisproduced a prescription made up of three lines,each line listing four herbs. In his opinion, elevenherbs - yielding two lines of four and one line ofthree - produced a more aesthetically pleasing and,by implication, more powerful prescription thatvisibly embodied a dynamic absent in theapparently more balanced three times fourarrangement.

Prof. Wu recommended that I study the Confucianclassics before reading more medical texts; and hedemanded of his Chinese students to produce forhim written commentaries on the two hundredmost important medical texts, starting with theInner Canon and finishing with the works of his ownteachers, including Qin Bowei. Over subsequentmonths and then years, Prof. Wu became for me animportant teacher, mentor and eventually friendwhose influence on my own understanding andpractice of Chinese remains profound. We regularlymet in China, the US and Europe, where he becamean influential teacher in the late 1990s/early 2000s,and he even visited me in my own “ancestralhome” in Germany (a great honour for all of us) tocelebrate my mother's 70th birthday. To metherefore, Prof. Wu is without doubt one of themost open-minded, engaging, knowledgeable,sophisticated and, indeed, fun teachers andphysicians of Chinese medicine I have had theprivilege to meet.

In his later years, Prof. Wu returned to Hangzhou,where he ran an extremely busy practice andmentored a number of western students. One ofthe most accomplished of these students is JasonBlalack. Having studied Chinese medicine andChinese language in the US, mainland China andTaiwan and running a busy practice in Boulder,Colorado, Jason belongs to a younger generation ofpractitioners engaged in what appears to me the

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next phase of introducing Chinese medicine to theWest. Rather than simply translating existingChinese texts, Jason and others like him (JasonRobertson working with Wang Zhuyi comes tomind) bring to us a more personalisedunderstanding of that medical tradition derivedfrom many years of intensive engagement withindividual teachers.

I first met Jason at a seminar in Shanghai in 2007.I had just spent two weeks in Hangzhou, whileJason was on his way there to work with Prof. Wuon the present book. I had a feeling then that thiswas a book to look forward to and the final productmore than delivers on that early promise. It notonly disseminates Prof. Wu's clinical experiences toa wider audience but also reflects his teachingstyle. That style, in turn, can be traced back to hisown teachers, which is where the voice of QinBowei, the most important of all in this book,enters the text and our story. If Wu Boping, whograduated from the first class of students enrolledat the Beijing College (now University) of TCM

in 1956, embodies the developmentand globalisation of TCM in late 20th China, QinBowei stands for a generation of remarkablephysicians who enabled TCM to be born through thework of modernisation they carried out in theRepublican and early Maoist eras. I have writtenabout this process at length in Currents of Traditionin Chinese Medicine (Eastland Press, 2007), whichalso includes a lengthy biography of Qin Bowei. Iwill therefore only sum up here a few key factsabout the man and physician that may help readersappreciate the true value of the present text.

Qin Bowei was educated in traditional Confucianfashion during the last years of empire and theearly Republic, while his grandfather was a well-known Chinese medicine physician in what is nowthe Pudong area of Shanghai. Following in hisgrandfather’s footsteps Qin enrolled at theShanghai Technical College of Chinese Medicine

, founded in 1916 by Ding Ganren (1860-1926). Ding Ganren was one of

Shanghai’s most eminent physicians at the timeand the College the most important and influentialschool of its kind. At the College Ding apprenticedwith both Ding Ganren and Cao Yingfu(1866-1938), one of the greatest scholars of thecold damage tradition in Republican China. Hisschoolmates included such luminary figures asCheng Menxue (1902-1972), Zhang Cigong

(1903-1959) and Huang Wendong(1902-1981). Upon graduating, Qin involvedhimself in the modernisation of Chinese medicinethrough a variety of activities besides his ownpractice. He edited a famous collection of Qingdynasty case records as well as one of the mostinfluential journals of the period, The ChineseMedicine World ; he engaged inprofessional politics at both local and nationallevels; but most important of all to himself, he

dedicated his life to education and teaching. Inhonour of his achievements, Qin Bowei was calledto work at the Academy of Chinese Medicine uponits foundation in 1954 to help build up aninfrastructure for Chinese medicine in the NewChina. Qin remained at the Academy until theoutbreak of the Cultural Revolution in 1967 anddied shortly thereafter.

In all of these activities Qin attempted to find a wayof holding fast to what he perceived to be essentialaspects of the Chinese medical tradition even as heopen-mindedly embraced modern ways of teaching,publishing and practicing. To put this another way,contrary to the simplistic impact/response modelthat dominates Western understandings of Chinesemedical modernisation, where Chinese medicine isseen as being shaped (positively or negatively) byideas and practices imposed on it from outside,physicians like Qin Bowei self-consciously employedsuch ideas and practices as tools to solve problemsthey perceived to be endemic in their own tradition.One of the biggest of these problems was thequestion of how one should study, teach andeffectively employ the many different tools passedon by past generations. The text that constitutesthe core of the book reviewed here, Qin Bowei'sNew Guidelines for Treatment, presents one suchsolution. On one level, it is a simple yet highlysophisticated clinical manual. On another, it is anattempt at systematising the teaching and practiceof Chinese medicine that feeds into the productionof contemporary TCM textbooks even as itconstitutes a potential alternative.

As a manual for clinical practice, Qin's text isorganised around 56 core treatment strategies.Intended to cover the terrain of internal medicinethese strategies can also be applied to areas suchas gynaecology or external medicine as well. 56 isapproximately half of 113, the number of treatmentstrategies commonly associated with the Discussionof Cold Damage , as well as a small bookletby Qin's own teacher: Ding Ganren's 113Treatment Strategies 113 . Numbers areimportant in China and condensing the strategies ofQin's two most important medical ancestors signalsat least three things: the on-going development oftradition by way of teasing out its very essence; anattempt to integrate its competing strands(specifically cold damage and warm pathogentherapeutics) into a single framework; and themodernisation of tradition by way of itssystematisation.

If Qin Bowei’s original text is quite terse, JasonBlalack, guided by Wu Boping, does an excellentjob at making it accessible to a Western audience ina manner that at every step focuses on applicationto clinical practice. Following the source text, thebook is divided into thirteen chapters, eachfocusing on a pathogen or disease process such aswind, fire, cold, qi and blood disorders. Qin's own

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text is clearly distinguished from Wu Boping'scommentary by its grey shading. Each chapter firstsummarises key concepts regarding the pathogenor pathology under discussion, its aetiology andclinical presentation. This is followed by thediscussion of the treatment methods that can beused to address the pathogen or pathology. Forinstance, the chapter on wind discusses thefollowing three treatment methods: (i) Diffuse theLungs and Disperse Wind ; (ii) Harmonizethe Nutritive and Protective ; (iii) PursueWind and Thrust Out the Pathogen

The presentation of each treatment method isdivided into a number of recurrent sections thathelp readers follow the discussion with ease and, inthe long run, to use the text as a reference inactual practice. First, the pathology and keysymptoms relevant for a specific method aresummarised in a single sentence. Next, the possiblepresentation is discussed in more detail payingattention to both root and branch manifestations.This is followed by a key formula that embodies thestrategy discussed. This formula is generally avariation of a "classical" (i.e. well-known) formula,which is also cited, explaining why Qin chose tomodify this. Qin's own formula is then analysed interms of its composition, clearly explicating thefunction of each ingredient and their synergisticactions. Detailed suggestions are also made as tohow the formula might be further adjusted to coverother possible manifestation of the core pattern.Each section concludes with a question and answersection, which helps readers to grasp the subtletiesof Qin Bowei's approach and explicates Wu Boping'sown extensive clinical experience. Finally, theauthors have added an appendix that suggestsvarious options as to how the book might be used.This may be particularly useful to students orbudding practitioners, for whom the wealth ofmaterial presented here may initially seemdaunting or somewhat unfamiliar when comparedto standard TCM textbooks.

Particularly noteworthy, in my opinion, are thediscussions of pathology with their emphasis onunderstanding and diagnosing the location ofdisease processes in specific locations within thebody, and the sophisticated use of medicinals. BothQin Bowei and Wu Boping were masters in the artof paozhi , exploiting to the full the many waysof preparing individual medicinals in order toachieve specific effects. This is particularly relevantin order to make sure that medicinals work uponthe body regions they are intended to. To give asimple example, according to Qin Bowei thecharring of a medicinal such as ZingiberisRhizoma preparata allows it to enter thedeeper collaterals and deeper blood level of organs.In other words, sophistication in diagnosis and theunderstanding of disease process is matched withequal sophistication at the level of therapeutics.There is nothing else available in the English

language literature that I know of that comes evenclose and this information alone makes the book a"must buy" for any serious practitioner. Add to thisthe clinical experience of two master physicians,the clarity with which Jason Blalack makes thatexperience accessible, and the immediatetranslatability of what is discussed to virtually anysituation one might encounter in clinical practiceand it becomes an absolute bargain.

At the same time, readers should be aware thatwhat is presented here is not "Chinese medicine"but one possible attempt to make Chinese medicinework that embodies the experiences of a group ofpractitioners related to each other by way ofmaster/disciple relationships and to the widertradition within historically specific contexts ofpractice. For instance, when Qin Bowei states that"All qi disorders are a result of emotionalproblems", then this represents a distinctinterpretation of these problems that has a clearlytraceable line of descent going back to Chen Yan

in the Yuan, but that does not speak for theentire tradition. Likewise, Qin's treatment strategiesare best understood when placed into the contextof the development of a distinctly "southernmedicine" in late imperial China. For reasons thatcannot be discussed here in detail, starting in theSouthern Song Chinese living south of the Jiangziriver came to perceive of themselves asconstitutionally weaker and more fragile than thoseliving in the north. Over time, this translated into astyle of medicine that emphasised the use of gentleand moderate treatment. Examples of this style inthe present text include the use of Fructus Tribuli

, rather than Radix Bupleuri , as the mainherb in Qin's formula for "dredging and facilitatingthe movement of stagnant qi" ; the use ofSemen Sojae preparatum as a key herb inthe treatment of wind-cold as well as wind-heat; orthe low dosages used throughout, including 4.5gonly of Radix Astragali in Qin's formula for“tonifying, augmenting and strengthening themiddle” . For those who know their Chinesemedicine, it is possible to tie Qin's approach evenmore specifically to distinctive lineages within"southern medicine." The use of Radix Acquilariae

to direct blood downward, for instance, issignature Ye Tianshi (1667-1746), the mostemblematic physician of the Suzhou style ofChinese medicine that dominated medical practicein Jiangsu, including Shanghai, in the 19th century.Yet, as stated above, Qing also studied withrenowned cold damage practitioners, and throughhis teacher Ding Ganren was affiliated to theMenghe current , defined by its efforts tosynthesise all the various schools within Chinesemedicine.

What makes Qin Bowei a distinctly modernphysician, however, are his efforts to create anational medicine that transcended its endemictendency towards regionalism and factionalism. As

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his journal The Chinese Medicine World and it'ssubtitle "Making Chinese medicine a worldmedicine" demonstrate, throughout his life Qinengaged in creating a "Chinese medicine" thatmatched western medicine in terms of organisationand reach. Hence, his Guidelines for Treatment aredeliberately not "traditional" but "new", mirroringthe “New China” that was co-contemporaneouslycreated by Mao Zedong and the CCP. These newguidelines draw not only on Ye Tianshi but equallyon Zhang Zhongjing (even if in a somewhat"southern" fashion); and they seek to overcomeemblematic divisions within Chinese medicine -specifically that between the "six warps" andthe "wei/qi/ying/xue" or "Triple Warmer"

models of diagnosis - by utilising acomprehensive approach that is centred on organsand channels and thus first and foremost on theInner Canon. This unitary focus, of course, is whatinforms TCM as a historical project more widely, aproject of which Qin Bowei as a member of theAcademy of Chinese Medicine was very much apart. If there are differences between what we arefamiliar in TCM textbooks and Qin's own approach,these are therefore differences in emphasis but notof the ultimate goal pursued. And still, suchdifferences matter in the end.

In 1935, Xie Guan (1880-1950), another ofQin Bowei's teachers at the Shanghai TechnicalCollege, published an influential history of Chinesemedicine that defined its essence in four words:principles strategies or methods formulas

and medicinals Slightly reinterpreting XieGuan, we might say that while any Chinesemedicine will make use of all of these four

resources, each will tend to do so in different ways;and these differences in emphasis may come tosignify very different conceptions of what Chinesemedicine is. Many modernisers, mostpharmacologists and biomedical practitioners butalso traditionalists who emphasise the use of one ortwo specific herbs point to medicinals and theiractions as the true source of Chinese medicine'seffectiveness. Others, certain proponents of theCold Damage style for instance, define formulasand formula patterns to be the key focus ofstudy and clinical practice. TCM textbooks, in myopinion, choose principles (in their moderninstantiation of “theory” ) as the foundation.Qin Bowei, following Ding Ganren, Ye Tianshi andultimately Zhu Danxi, emphasised methods or, as Iprefer to translate fa, strategies. This was adeliberate choice. It anchors effectiveness inpersonal effort, understanding and self-development rather than received knowledge,books or specific teachers while honouring all ofthem at the same time; and it holds open thepossibility of developing tradition in ever-newdirections without insisting on the necessity ofdoing so for its own sake.

In our own efforts to study Chinese medicine andtranslate it into new contexts of practice it behovesus to pay attention to these different choices andtheir possible implications. Beyond the clinical valueof this text, Wu Boping and Jason Blalack make asignificant contribution in bringing to us the kind oforiginal material that is necessary for engaging inthese discussions. For all those reasons, this is myChinese medicine book of the year.

AWARDS FOR CHINESE HERBAL MEDICINE RESEARCH

The RCHM has an annual research fund, for members who intend to pursue or are alreadypursuing research in the field of Chinese herbal medicine. Criteria include: clinical practice(will the project change or improve clinical practice related to either the efficacy or safety (orboth) of CHM treatment?); research quality (type of study proposed, level of evidence basedcontent, and will it stand up to critical review by conventional researchers and scientists?);ethical review (does the project have ethical review approval?); commitment (what are thechallenges and is it likely to be completed in the proposed timeframe?); publication (likely topublished in a quality journal?); contribution (overall how will the project contribute to thepromotion of Chinese herbal medicine in the UK?); developing research skills (how will theproject contribute to developing the research skills of the applicant and how might it be usedfor the benefit of other RCHM members?)

Applications are invited at any time in the year. Allocation of funds will depend on the numberof applicants in each quarter as well as the quality of applications. Deadlines for applications in2011-2012 are as follows: 1 June (for assessment on 17 June); 1 September (for assessmenton 16 September); 1 December (for assessment on 16 December); 1 March (for assessmenton 16 March)

For further information, contact Sarah Price, Chair of the research awards panel, atresearch.awards@rchm.co.uk