"Thoughts on International TCM Education”

TCM Education outside China

Chinese medicine is being taught outside china, almost in every country, but discrepancy in academic programs is still current due to various factors.
First of all we must acknowledge that full integration of TCM in the mainstream medical education is unique to china and cannot be found anywhere else because of remaining resistance on behalf of medical education institutions.
Scarceness of translated TCM educational material is another great factor that hinders the development of full academic program.
Comprehensive hospital internship for TCM students is also lagging way behind the Chinese medical system, as for most countries it is confined to outpatient private practice observation.
Finally and not the least, didactic methodology as used in China is mostly unsuitable in a non Chinese environment.

Translation and glossary
The first major obstacle to proper TCM education is language related and in the past decades there has been a tremendous advance in this field.
Difficulties remain as far as translation and glossary structure is concerned. Interpreting of text or words meaning, used in the specific field of TCM, remains difficult when it it has been corrupted or simplified from its original form thus becoming a sequence of unintelligible words or phrases. This is where the relevance of a proper adapted Multilanguage glossary remains the key component of proper translation for Chinese medicine. Complexity arises as it is necessary to depart from the relatively simple structure of bilingual glossary, where terms and concepts are defined in a second language with adaptation according to syntax and vocabulary rules proper to the receiving language. In a Multilanguage environment it is necessary, on the one hand to replicate the bilingual glossary organization as the originating terms will always come from Chinese language and there should be a direct translation to the target language, but on the other hand multilanguage vocabulary inconsistency should be avoided in such an international field as TCM.
In order to assemble the various criteria necessary to create this international project, standard agreement should be reached between the different actors. Chinese terminology of course remains the source data, therefore labeling or designating of concepts particular to TCM subjects has to be undertaken as we are dealing with a specific field, traditionally only present in china. One of the key decisions remains the choice of vocabulary in designating of concepts and obviously medical terminology should be preferred to literary register in order to convey to the reader a clear meaning related to medicine. So we have seen that terms used to explain the same concept should not vary extensively from one language to another, in order to avoid contradictory designation of the same concept. As for example the TCM concept of 虚 ”Xu” is usually being translated with the term “deficiency” in English and with the term “empty” in Spanish or French which brings about a confusing discrepancy. Quite a few Chinese terms used in TCM have remained unchanged in the actual medical terminology, such as便秘 “Bian Mi” for constipation or黄疸 “Huang Dan” for jaundice, but caution should be used in borrowing current medical terminology to designate concepts that are specific to TCM. As an example, the concept 辨证论治 “Bian Zheng Lun Zhi” is being translated in French as “differential diagnosis” which could be confusing as this term is used in the specific medical context of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness, therefore indicating a totally different meaning departing from the original concept.
TCM nosology is again definitely lagging in most of textbooks outside china. Particular attention should be paid to have nosological correspondence between TCM and western medicine disease classification criteria. TCM nosology focus on grouping diseases by their symptoms as where in western medicine the grouping follows the anatomy and etiology involved. This discrepancy in classification criteria brings about difficulty in having a “one to one” correspondence between the two disciplines, as diseases in TCM often cannot be defined and classified clearly in western medicine and thus will correspond to one or more diseases in western medicine and vice versa. As for an example, acute gastroenteritis would correspond to three TCM diseases “vomiting”, “addominal pain” and “diarrhea”.

Adapting didactic methodology
One of the main differences that can be encountered in TCM teaching courses or textbooks in Chinese, compared to their analog in foreign language, is the introduction. In western didactical system, introduction is a beginning section which states the purpose and goals of the following course or writing, as for Chinese instructional custom, introduction is the synthesis defining all the different elements and concepts of the course. The habit of foreign students is to dedicate superficial reading or attention to introduction and concentrate on the body that contains the main core of teaching.
The introduction of the clinical acupuncture course is supposed to give students the tools to understand diagnosis and treatment for every disease. As a matter of fact it covers extensively acupuncture treatment principle, function, prescription and point’s action, thus certainly not being optional to proper understanding of the following chapter. Proper adjustment should thus be made, in textbooks redaction and course design, to correct what can lead to poor comprehension from the student.
Listing is another important divergence as for layout habits, where in Chinese context it always follows a descending pattern from most to less significant and with gradually decreasing subgroups. If we take the example of diarrhea, the description will follow a thread that takes stools symptoms into account first, followed by digestive symptomatology, then general state symptoms in addition of tongue and pulse. This procedure that follows a logical sequence has not been fully endorsed in TCM schools outside china which brings unorthodox understanding of diagnosis and treatment protocols, where for an acute lumbar pain, as an example, diagnosis and treatment would not consider the lumbar area

Major omissions
Missing Chinese medicine concepts are being perpetuated by lack of information or improper understanding of the original Chinese concept.
One of the missing concepts in many teaching programs is pathogenesis and vigorous step should be taken to amend this shortcoming. If we take the example of dermatology, it is necessary for students to understand the TCM pathological mechanisms that bring about the different types of skin lesion such as erythema, desquamation or lichen.
Another major neglect is the status of “disease” in the diagnostic process, which brings the student to consider that there is no such entity, as disease, in TCM and that diagnosis only rest on clinical pattern differentiation 辩证“Bian Zheng”.

Sectorial grouping
Global presentation of data can be confusing to the student and difficult to memorize, therefore sectorial grouping, whenever it is possible, should be preferred in the course design. Difficulties are often encountered in the study and memorization of meridians topography, which pathways are usually taught through exhaustive anatomical description for every single meridian. A good suggestion would be to present the meridian pathways grouped according to anatomical areas, describing for example the meridians located in the external face of the forearm.
Acupuncture point study is often considered an overwhelming assignment because of the extensive number of points. Again grouping can be made according to anatomical or action mechanism criteria.


If we look back at the seventies, when Chinese medicine started its sporadic divulgation abroad, we remain in wonder of the present fast course, but there is still a long way to go in order to achieve its international development.
To achieve this goal, collaboration is important, in order to adapt and standardize Chinese medicine education and clinical practice.