traditional chinese medicine – a tradition built on myths ... · traditional chinese medicine...
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TraditionalChineseMedicine–atraditionbuiltonmyths,orsciencewithadifferentapproach?
AurelijaPlonyte
LokaverkefnitilBA-gráðuíMannfræði
Leiðbeinandi:HelgaÖgmundardóttir
Félags-ogmannvísindadeild
FélagsvísindasviðHáskólaÍslandsMaí2017
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RitgerðþessierlokaverkefnitilBA-gráðuíMannfræðiogeróheimiltaðafritaritgerðinaánokkurnháttnemameðleyfirétthafa.
©AurelijaPlonyte2017
Reykjavík,Ísland2017
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Abstract
ThisthesisdiscussestheimageofTraditionalChineseMedicine(TCM)bothinChina
andaroundtheglobe,inpresentdayandhistorically.
In the first part, the main ideas and theories of TCM, as well as its origins and
development, are introduced. Later discussion includes criticism from the West,
biomedicaljudgmenttowardsTCM,andacomparisonofbiomedicineandTCM.
Itwas concluded thatWesternmedicine (WM)andTCMcannotbemeasuredand
comparedbythesamemethods:whiletheformerisquantitative,thelatterisrather
qualitativeandmeasuringitusingquantitativemethodsmayproveinaccurate.
Keywords:TCM,WM,Biomedicine,Placebo,efficacy,healing,medicine.
TableofContents
Chapter 1 - Introduction 4
Chapter 2 – History and Origins of TCM 5 Chinese history and development of TCM 5 Myths and Yin-Yang theory 7
Chapter 3 - Challenges and Criticism 11 Struggles in Modern Era 11 Placebo effect 14
Chapter 4 - Image of TCM Today 18 Backlash to Criticism 18 The Western Dominance 21 Comparing Biomedicine and TCM 22
Chapter 5 - Conclusion 26 Works Cited 29
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Chapter 1 - Introduction
AccordingtoChinesebeliefs,ChinesemedicinestartedfromthetimeofShen
Nong – a mythical sage ruler in prehistoric China who tasted hundreds of herbs,
amongwhichseventytypeswerefoundtobepoisonous(Jiuzhang&Guo,2009).The
practiceofusingherbscontinued,bookswerewrittenaboutthebenefitsofvarious
plants, and formulae were created in order to cure all kinds of illnesses. Chinese
medicineisnotonlyaboutherbs,however,itbeginswithphilosophicaltheoriesthat
date back to ancient China, including some religious beliefs and various treating
therapiessuchasacupuncture,moxibustion,massage,exercise,dietandmore.Such
practiceshavepersistedthroughthecenturiesandarestillusedtoday,andnotonly
inChina–theknowledgeandusageofChinesemedicinehasspreadthroughother
countriesofAsiaandhasalsoreachedcountriesintheWesternworld.Asinterestin
Chinesemedicine increased, so toodid the scepticismand criticism surrounding it
grow.TodaytheimageofTraditionalChineseMedicine(TCM)isquitecontroversial.
WhilesomepeoplechoosetotrustthepractitionersofTCMandclaimtobehealed
by it, others see it as a traditional or cultural practice based on pseudoscience,
consider its practices as a sham,or evenmagic.Myriadsof tests andexperiments
have been carried out in an effort to find out how such practices as acupuncture
work, or how herb tea eliminates various illness symptoms. However, scientists
struggletofindarightwaytotestTCM’sefficacy.Americanmedicalanthropologist
Linda B. Barnes argues that acupuncture in the US is seen as either a traditional
system,amodalityrelatedtoculturallygroundedapproachestoreligioushealing,or
alternative medicine that is complementary to biomedicine (Barnes, 2005).
However,inheropinion,theterm‘traditional’maynolongerbethebestdescriptor,
assuchtraditionalpracticesashomeopathy,yoga,ortherapeutictouchhavebeen
usedalongsidebiomedicineforalongtimeandtodayacupunctureisalsoincludedin
the practices of biomedical physicians. From her point of view, both traditional
medicineandbiomedicinehavebeen influenced“through thecultural influenceof
other systems”and theyhaveeventually lost theirborders (Barnes,2005,p.242).
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ButwhoisinchargeofdeterminingTCM’sefficacy?
In this essay I amgoing to introduce shortly theorigins, development and
strugglesofTCM, its influenceontheWestand its imagebothwithinChinaandin
theWest.Thediscussionwill includeboththecriticismtowardsTCMpracticesand
thebacklashtosuchscepticideas.Westernmedicinewillbevariouslyreferredtoas
WM,Orthodoxmedicine,biomedicine,modernmedicineorconventionalmedicine;
Traditional Chinese medicine will be referred to as TCM, CM, complementary
medicine,alternativemedicineorjustChinesemedicine.
Chapter 2 – History and Origins of TCM
History and development of TCM
Chinesehistoryisseenasacombinationofdifferentperiodsthatwereruled
bydifferentdynasties.ForChinesemedicine,duringsomedynastiesitwasaglorious
timeandatothertimesthetraditionofChinesemedicinewasdying.Politicalregime
and philosophical ideas played an important role in forming TCM into what it is
today. It is believed that some techniques of TCM, such as usage of herbs,
acupunctureandmoxibustion,werealreadypracticed thousandsof years ago. For
example, acupuncture originated from the stone-needle practice of the Neolithic
Age(around8000BC),whereancientChineseusedasharpstonetobreakabscesses,
dischargebloodandpus(Jiuzhang,&Lei,2009).Thiskindofsharpstonetoolwasthe
predecessor of today's knife-like needle used in acupuncture. Another healing
technique,moxibustion, is believed to have been invented as a result of the cold
livingconditionsinNorthChina,wherepeoplewarmedacertainpartofthebodyby
burning, ironing, or fumigating with ignitedmaterials like moxa – a burning herb
(Jiuzhang&Lei,2009).However,theearliestdynastythathasmoreevidence(such
asoraclebonescripts)thanmythsisthedynastyofShang,whichdatesbackto1600
BC(Tanner,2010).Fromthattimeon,Chinesephilosophersandscholarshavebeen
collecting a vast amount of knowledge regarding TCMpractices. Firstly, the Shang
periodmarks the timewhenalcoholwas introduced to themedical field. Itwas a
great discovery for the people when they realised that wine could be used as a
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solvent, stimulant, an anaesthetic, as well as for promoting blood circulation and
enhancing thecurativeeffectsofmedications.Another inventionduring theShang
dynastywasdecoction.AphysiciancalledYiYindecodedvariouscrudedrugswith
waterinthisway,makingliquidmedicine(Jiuzhang&Lei2009).Soonafter,theZhou
dynasty (1046-256 BC) followed, in this period the medical system in China was
formed.Duringthisperiodtheroyaldoctorsweredividedintodieticians,physicians,
surgeons,andveterinarians.Inaddition,asetofmedicalexamswasestablished,as
wellasassessingandmedicalservicesystems(Jiuzhang,&Lei,2009). Intheirbook
“AGeneralIntroductiontoTraditionalChineseMedicine”(2009),MenJiuzhangand
GuoLeimentiontwobooksthatwerewrittenduringthisperiodthatwereofgreat
importancetoChinesehistoryandChinesemedicine.Theyweretheearliestworks
containingrecordsofthemedicinalherbsextantinChina,withmorethanfiftykinds
of plant medicines, describing the gathering, habitat and edible properties. They
weretitled“TheBookofSongs”and“TheClassicofMountainsandRivers”(Jiuzhang,
& Lei, 2009, p. 3). Further achievements in diagnosis, treatment (massage,
orthopaedic treatment),medical systems,pharmacology, gynaecologyandmedical
educationweremadeduring thedynastiesof Tang, SongandYuan (618-1368AD)
TheseweregreatdevelopmentsofmedicineinChina,butTCMwouldnotbewhatit
istodaywithouttheancientChinesethinkers,philosophyandmyths.
Chinese society has been significantly influenced by the ideas of great
philosophers such as Confucius or Laozi, as well as religious leaders. At the time,
each individual’s (in China) views and understanding of the world and how
everythingworkswerebasedonthoseideas.Chinesemedicinewasnoexception.If
wegobacktotheAxialageinChina(around500BC),wefindthatatthattimemany
contendingschoolsofthoughtemerged,includingConfucianism,Daoism(orTaoism)
and Yin-yang (Gamer, 2012).While Confucianism focuses on the social aspects of
humanlife,Daoismpertainsmoretonatureandtheindividual.Itwasquitecommon
for the people to take on both Confucian and Daoist outlooks simultaneously,
combining them together and in that way creating a balance between the two.
Meanwhile, the yin-yang school systemised some of the magical practices from
earlier primitive religion. In the beginning it was seen as less important than
ConfucianismandDaoism,however,lateronithelpedreconcilethesetwodoctrines.
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TheconceptofYinandYangisrepresentedastheoppositionandcomplementarity
of light and dark, which are inherently different but related to one another in
essence (Gamer,2012).This theory isadialecticbasedon theancientmaterialism
that studies the law of occurrence, motion, development, and variation in the
cosmos.Theideaofthistheoryisthattheworldistheunityoftheopposingyinand
yang, and that the interaction of yin and yang “promotes the occurrence and the
developmentofthings”(Jiuzhang&Lei,2009,p.59).Thisphilosophicaldoctrineof
yinandyanghadpermeatedthemedicalfieldinChina,whereitwascombinedwith
TCM theories. The result was, as Men Jiuzhang calls it, “peculiar TCM’s yin-yang
view” that has been guidingmedical cognition and practice in China for centuries
(Jiuzhang&Lei,2009,p.59).
Myths and Yin-Yang theory
Chinahasa rich traditionofmyths, someofwhichmayhavebegunasoral
tradition. Somemyths explain the origins of the universe and others describe the
origins of human society, culture, and government. These kinds of myths often
involvestoriesaboutculturalheroeswhotaughtthecommonpeopleusefulthings,
suchashow tobuild ahouseordistinguishanedibleplant fromapoisonousone
(Tanner, 2010). Probably themost important hero tomention herewould be the
mythicalrulerHuangDi–TheYellowEmperor.Thisrulernotonlysupposedlyruled
over vast territories, but also was said to have “invented bureaucracy, writing,
sericulture,medicine,boats,andwheeledvehicles”(Tanner,2010,p.34).Thereisa
book called “Yellow Emperor’s Classic ofMedicine” that is believed to have been
writtenbyHuangDi.The textdatesback to206BC -220AD (HanDynasty–over
2000 years after the reign of Huang Di) and became themain source of medical
theory. In her book “Chinese Civilization” (1993), Patricia B. Ebrey quotes this old
text,whichtalksabouttheideasofyinandyanginmedicaltheoryinChina.“Illness
wasseenasadisturbanceinthebalanceofYinandYangorFiveAgentscausedby
emotions,heatorcold,orotherinfluences”(Ebrey,1993,p.77).Accordingtothese
quotes,theprincipleofyinandyangisthefoundationofthewholeuniverseandit
underlieseverythingincreation.Heavenwascreatedbytheconcentrationofyang–
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theforceoflightthatstandsforpeace,serenityanddestruction.Earthwascreated
by the concentration of yin – the force of darkness that stands for confusion,
turmoil,andconservation.Thequotesgoontoexplainthattheembodimentofyang
isfireandtheembodimentofyiniswater.Whileyangcreatestheair,yincreatesthe
sensesof thephysicalbody.And in thecaseof illness, thecauseof it iseither the
disharmony in the spirit that “has done harm to the body” or “dysfunction in the
body has injured the spirit” (Ebrey, 1993, pp. 77-78). The text also explains that
nature has four seasons and five elements and in order to grant long life, these
seasons andelementsmust storeup thepowerof creation in cold, heat, dryness,
moistureandwind.Meanwhile,amanhasfiveviscera inwhichthesefiveclimates
aretransformedintojoy,anger,sympathy,grief,andfear.Thetextexplainsthatthe
emotions of joy and anger are injurious to the spirit just as cold and heat are
injurious to thebody.Andwhen joyandangerarewithoutmoderation, thencold
andheatexceedthemeasure,andlifeisnolongersecure.Inotherwords,allofthis
meansthatbothyinandyangshouldberespectedtoanequalextent(Ebrey,1993,
p. 78). The practitioners of traditional medicine examine the patients by judging
their general appearance and taking their pulse. This helps the practitioner to
determinewhetheritisyinoryangthatcausesthedisease:
To determine whether Yin or Yang predominates, one must be able to
distinguishalightpulseoflowtensionfromahard,poundingone.Withadiseaseof
Yang,Yinpredominates.WithadiseaseofYin,Yangpredominates.Whenoneisfilled
withvigorandstrength,YinandYangareinproperharmony.(Ebrey,1993,p.79).
WongLai-Yi,apractitionerofTCMtoday,explainsthispeculiarviewindetail:
“ThephilosophybehindChineseMedicinewasthatmanlivesbetweenheavenand
earth,andcomprisedaminiatureuniverse inhim”(Wong,2005,p.11),wherethe
materialsandlivingthingsbelongtotheyinandyang.Thefunctionsoflivingbeings
aredescribed in termsof the “Heart”or “Mind”, “Lungs”or “Respiratory system”,
“Liver”,“Spleen”and“Kidneys”(fivecentresofthebody).The“Heart”isseenasthe
“commandcentre”, consciousnessand intelligence, and “Lungs” is the system that
maintains cyberneticbalanceand regulates various intrinsic functionsof thebody.
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The “Liver” is seen as “the mechanism for emotional response to the external
environment”(Wong,2005,p.12),the“Spleen”distributesthenutritionthroughout
thebody,andthe“Kidneys”areseenasacrucialsystemonwhichhumanlifeforce
depends.Thissystemregulatesthestorageofnutritionandtheuseofenergy.Allof
thisiscalled“latentphenomena”(Wong,2005,p.12).Wongalsomentionsthatthe
changes inseasonsandweathercould influenceandharmthehumanbody.Wind,
cold, heat, moisture, dryness and internal heat are said to have the most
pronouncedeffectandarecalled the“sixexternaldisease-causing factors” (Wong,
2005,p.12).Emotionssuchashappiness,anger,worry,pensiveness,grief,fear,and
surprise are also seen as harmful, in the case of extreme change; they are called
“sevenemotions”(Wong,2005,p.13).Aroundthetimeof179-104BC,thenotions
oftheworkingsofthecosmosintermsofyinandyangandthefiveagents(wood,
metal, fire, water, and earth) were combined with the ideas of Confucius about
humanvirtueandsocialorder (Ebrey,1993,Ch.13).Throughouthistory, these ‘six
externaldisease-causingfactors’and‘sevenemotions’werealsocombinedandthe
theoreticalfoundationofdiseasepathologywasformed(Wong,2005,p.13).
TCM Techniques and Influence on the West
TCMincludesvarioushealingpractices,suchasherbaltherapy,acupuncture,
moxibustion,massageandmore.Regardlessofwhatstylesortechniquesarebeing
usedforcuringtheillness,inChinesemedicineeverythingstartswiththeconceptof
‘qi’–“theoriginalsubstanceofallthingsinthenaturalworld”(Jiuzhang&Lei,2009,
p.9),or“theflowoflifeenergy/vitality”(Wong,2005,p.14).Thetheoreticalbase
ofacupunctureistheadjustmentof‘qi’thatflowsthroughthebodyviaasystemof
channelscalledMeridians(经络)(Wong,2005,p.14).Whenthereisablockageor
imbalance of ‘qi’ flow, the practitioner of TCM may either insert acupuncture
needles or burn Chinese mugwort in moxibustion at certain points along the
channels in order to fix this problem (Wong, 2005, p. 14). The practitioners of
acupuncturebelievethatwhileusingtheneedlesyouneedtousethemwith‘qi’and
puttheenergyintothepatient.Theylearntodothisin‘qigong’classes,whichthey
compare to classes in neurology (Barnes, 2005, p. 274). Barnes interviewed a
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numberofTCMpractitioners,oneofwhomclaimsthattherearethreetechniquesto
move theenergyand shebelieves that the treatmentsof thosewhodonotknow
thesetechniquesdonotwork(Barnes,2005,p.247).
SomehealingtechniquesandinventionsoftraditionalChinesemedicinehave
beenquitesignificantandwereevenheardofabroad.Forexample,takingapulseis
avery importantdiseasedeterminingtechniqueofTCM.Thistechniquewashighly
developedduringtheJindynasty(265-420AD)FamousphysicianWangShuheinhis
book “The Pulse Classic” wrote about the methods of pulse differentiation and
classifiedallpulseconditionsintotwenty-fourtypes.AccordingtoJiuzhangandLei,
inthisbookyoucanfindalmostallphysiologicalandpathologicalpulseconditionsof
thecirculatorysystemtoday (asdefinedbyWM).The techniquesdescribed in this
book greatly influenced the development of sphygmology worldwide. It was first
introduced inKoreaand Japan, later theArabworld,Persiaandwestcountries. In
the 17th century British doctor John Floyer translated this book into English and
inventedthemethodofcountingthepulseusingawatch(Jiuzhang,&Lei,2009,p.
6).JiuzhangandLeimakegreatcomparisonsbetweenChinaandEuropeintermsof
howmuchearlierChinesepeoplehadachievedsomethingsthanEuropeans:“inthe
Tang and Song dynasties, the Chinese medical system, medical education, and
medicalservicesystemstooktheleadintheworldmedicine”(Jiuzhang,&Lei,2009,
p. 8). In the 9th century the earliest monograph on traumatology in China was
written and itwas discovered that neonatal tetanus and adult tetanus (amedical
condition that causesmuscle spasms)were the same kind of disease. Thismeans
thattheChinesehaddiscoveredit600yearsearlierthanEuropeans(Jiuzhang&Lei,
2009,p.7).Similarly,theancientrecordsshowthatvaccinationandantisepticswere
firstdevelopedinChina,centuriesaheadofWesterndoctors(Wei,2013).Moreover,
Li Shizhen’s “TheCompendiumofMateriaMedica” (1596)was themostadvanced
botanic classification in theworld at that time, again, 200 years earlier than that
written by European botanist Carolus Linnaeus (1707-1778). This book has been
translated intomany languages, such as Latin, Korean, Japanese, Russian, English,
Frenchandothers.ItwasevenquotedbyCharlesDarwininhiswork“TheOriginsof
Mankind”, where he described Li Shizhen’s work as “the encyclopedia of ancient
China”(Jiuzhang,M.&Lei,G.2009,p.8).Thesefactsimply,therefore,thatChinese
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medicinewas influential in thepastand itsdiscoveriesand inventionswerehighly
respected. However, the perception of Chinese medicine today is not quite the
same.
Chapter 3 - Challenges and Criticism
Struggles in Modern Era Inthe18thcentury,biomedicine(WM)becamethedominantmedicalsystem
worldwide and herbal medicine almost ceased to exist in many industrialised
countries. From 1839, China underwent a century of profound challenge to its
traditions.Thereweremoreandmoreforeignerscomingin,gainingmorerightsto
establishsettlementsandbusinessesduetotheOpiumWar.Bytheyear1919there
was a political movement (May Fourth movement) opposing the weakness of
Chinesegovernment,wherestudentsandwritersjoinedtogethertorepresent“the
culmination of groundswell of youthful anti-traditionalism” and “the literary
revolution” (Gamer,2012,p.431).AsGamer states, “Chinawasa republic,but its
culturewasnotyetmodern”(Gamer,2012,p.431).Bythe1920sthismovementled
totheestablishmentofaNewCulturebasedonhumanism,scienceanddemocracy,
in opposition to traditional orthodox culture (Gamer, 2012, p. 432). When the
communiststookover,therefore,theGovernmenthadanti-traditionalistviewsand
sought tomakeChinamoremodern.Thismeant thatall the ideas thatcamefrom
traditions, such as Confucianism and practices of TCM, were seen as “being
backward”.TheGovernmentadoptedstrictstandardsagainstTCM,whichresultedin
onlyasmallnumberofTCMpractitionersbeingdeemedasqualified.Bythe1930s,
the two disciplines of medicine (WM and TCM) in China had become highly
contentious(Wei,2013, p.262).ChairmanMaoZedong,afounderofthePeople’s
Republic of China,was initially against TCMbecausehewas against traditionalism
and Confucianism. However, he later “reversed his anti-TCM policies to prevent
ChinafrombecomingoverlydependantontheSovietUnion”(Wei,2013,p.262).In
1958 the Government of China proclaimed equal status for TCM and Western
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medicine.Around the timeof theCulturalRevolution (1966), inorder tobuild“an
economical and effectivemethod to popularize rural health care”, ChairmanMao
initiated a “nation-wide integration of part-part time peasant healthworkers into
thecooperativemedicalclinics” (Wei,2013,p.263).Thesepractitionerseventually
were named “barefoot doctors” (Wei, 2013). The training that these doctors
undertook had an innovative strategy that combined both TCM and WM (Wei,
2013).TheMaoerawasanimportantoneinTCM’shistory.Notonlydidthefocuson
TCMmodernise traditional acupuncture, but it also helped this ancient technique
spreadthroughboththeWestandotherthirdworldcountries(Wei,2013,p.269).
After the reign of Mao, the practice of barefoot doctors died, the collection of
medicalplantscollapsed,andbythe1980sthesalesofWMquicklysurpassedthose
ofTCM.By2010,Westernmedicine’smarketsharehadgrowntothreetimesthatof
TCM(Wei,2013).
Looking at the West, according to Wong Lai-Yi, in the late 1960s many
American people started turning back to herbal medicine as they decided to pay
attentiontopreventingtheillnessratherthantreatingitafterithappens.Asaresult,
alternativemedicinebecameincreasinglypopular.In1974eventheUnitedNations
WorldHealthOrganizationwasencouragingtheuseoftraditionalherbalhealingin
order to achieve adequate worldwide healthcare (Wong, 2005). However, the
techniquesthatwereadoptedinEuropeandNorthernAmericamaynotnecessarily
portray the same understanding of TCM as seen in China. In his article “Chinese
Medicine: Nature versus Chemistry and Technology” (year unknown), Unschuld
arguesthat inChina, fromtheverybeginning,drugtherapyandacupuncturewere
separate healing traditions and that the former eventually developed into a
dominantmethodoftreatingillness(Unschuld,n.d.,p.6).Heexplainsthatfromthe
Chinesepointofview,theterm“Chinesemedicine”meansthedrugtherapythathas
developedovertwothousandyears.Meanwhile,acupunctureisseenasaseparate
formoftherapy,withonlya“second-orthird-rankingsignificance”(Unschuld,n.d.,
p.7).However,itisinterestingthattheperceptionofTCMintheWestisquitethe
opposite. People in theWest associate the term “Chinese medicine” mainly with
acupuncture. Unschuld even argues that the acupuncture of today is respected
merelybecauseoftheregarditisgivenintheWest(Unschuld,n.d.,p.7).However,
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inhisopinion,theinterestfromtheWestinTCMisnotbecauseitismoreeffective
thanWesternmedicine(andhestatesthatitisclearlynotthecase).Hebelievesthis
interestcomesfromtheworldviewofanxietiesandfears(Unschuld,n.d.,p.10).He
speculates thatpoisoningof theenvironmentwithall kindsofartificial substances
evokes negative associations with the poisoning of the body through such
treatments as chemotherapy. In contrast, Chinese medicine does not have any
chemical effect on the body and does not leave any long-term consequences.
ThereforepatientsthatfearthepollutionoftheorganismwouldratherseekaTCM
doctor.
In1997,theNational InstituteofHealth(NIH)acknowledgedtheefficacyof
acupuncture in treating various conditions of pain, such as “headache, menstrual
cramps, fibromyalgia,myofascial pain, osteoarthritis, low back pain, carpal tunnel
syndrome,asthma,postoperativeandchemotherapy-includednauseaandvomiting,
andpostoperativedentalpain”(Sutherland,2000,p.41),aswellasintreatingdrug
addiction.However,despitethis,theNIHstatedthat“thedefinitionofacupuncture
continues to be controversial, and it couldn’t determine a scientific basis for key
concepts inChinesemedicine, including thecirculationofqi” (Sutherland,2000,p.
41). Instead of embracing the Chinese theory of ‘qi’, therefore, some researchers
tried to interpret the efficacy of acupuncture and meridian therapy in a rather
Westernway.KaptchuknotesthatacupuncturistswithaWesternbackgroundtend
to see acupuncture from the Western point of view “based on western
understandingofmyofascial triggerpoints, thenervoussystem,orrecentscientific
discoveries about the likelymechanism of acupuncture” (Kaptchuk, 2002, p. 376).
According to Barnes, in one of his articles he even suggests that vibrant medical
systems should adopt certain techniques or strategies of acupuncture without
understandingthetheory(Barnes,2005,p.258).Barnesnotesthat“Suchinstances
may entail abandoning the core paradigm, substituting a changeling that may
representonlyatechnologicalintervention.Suchisoftenthecaseinbiomedicaluses
of acupuncture” (Barnes, 2005, p. 258). Barnes believes that pluralism within
acupuncture intersects with the medical pluralism in American culture that is “a
largerculturalprocess–refractedthroughlensesoftraditional,religious,CAM,and
biomedicalunderstandingsofmeaningfulchange”(Barnes,2005,p.259).
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PsychologistandresearcherBrucePomeranzspeculates thatpainpathways
in thebrain could beblockedby peripheral nerve stimulation,whichwould direct
the brain to release endorphins (Barnes, 2005). After conducting sixteen different
experimentsbasedonsixteendifferenthypotheses thisspeculationwasconfirmed
(Barnes,2005).Someotherphysiciansalsoclaimthatmanipulationofpointsalong
the meridians (the points in the body where TCM practitioners insert needles)
stimulatesneuropeptidesinthecentralnervoussystem:“Becausetheyareadjacent
tonervefibersandnerveroots,thesepointsarebelievedtosendmessagestothe
spinalcord,mid-brain,cortex,andthehypothalamuswhenstimulated, resulting in
the release inneuropeptides” (Sutherland,2000,p.41). Inotherwords, scientists
that cannot grasp how acupuncture works in TCM terms try to find a logical
explanation in Western scientific terms. Barnes sees this way of acupuncture’s
adoption by Western physicians through history as a type of hybridity (Barnes,
2005).
Daniel Keown is a doctorwho is a practitioner of TCM and has aWestern
background.Hehasbeenworkingasaregistered(Western)doctorsince1998and
completedadegreeinChineseMedicineandAcupuncturein2008.Inhisbook“The
Spark in theMachine: How the Science of Acupuncture Explains theMysteries of
Western Medicine” (2014), he talks about acupuncture and tries to explain in
Westerntermshowitworks.Unlikethephysiciansmentionedabove,however,this
doctortriestogivereadersaninsightintothemeaningofTCMandalsoexplainsthe
functions of the body from a TCM point of view. He pays a lot of attention to
anatomy, which, in his opinion, is highly neglected by Western doctors (Keown,
2014). Fromhisunderstanding, thepartof thebodycalled fascia– the tissue that
holdsourorgans inshapeandseparatefromeachother, iscrucial inacupuncture.
AndbecauseWesternmedicine ignores thispartof thebody, it cannotgrasphow
acupuncture works. He implies that the collagen in our body produces electricity
whichguidesthegrowthofbonesandarguesthatthiskindofelectricityisalsobeing
producedinfascia.Thisfasciaenableselectricitytoreachanypartofthebodyand
accordingtoKeown,thisfactonceagainiscompletelyignoredbyWesternmedical
doctors (Keown, 2014). From his perspective, this kind of “living electrical web”
(Keown, 2014, p. 21) in our bodies resembles the Chinese descriptions of
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acupuncturechannelsand‘qi’.
Placebo effect
In the 19th century it was already questioned whether the therapeutic
effects of acupuncture were caused by stimulating a change in either magnetic,
nervous or galvanic fluid. Some discussions ofmore recent days are not far from
these.AccordingtoBarnes,TCMtherapiesareoftenusedtotreatthoseconditions
thatresearchersidentifyasthemostresponsivetoplaceboeffect,whichareusually
chronic conditions. This allows the critics to argue thatmany of the TCM treated
conditionsaresusceptibletofrequentspontaneousremissionsandthehealingisjust
adupe(Barnes,2005,p.257).SuchscholarsasUnschuldraisethequestionsofhow
TCM works, whether it works at all, and tend to lean towards biomedicine,
preferring its methodologies over those of TCM (Unschuld, 2009, p. 19). In fact,
UnschuldreferstoTCMasahealingpracticeratherthanmedicineandregardsitasa
traditionwhich has no scientific proof of efficacy: “Medicine is the link of healing
with science. Healing that lacks a scientific basis is not medicine in this sense”
(Unschuld, 2009, p. 19). In his article “ChineseMedicine:Nature versus Chemistry
andTechnology” (nodate),Unschuldexpressesaconcern regarding the increasing
interestcomingfromtheWesttowardstraditionalChinesemedicine.Heisopposing
theideaofestablishingChinesemedicineasasubjectofstudyinthemedicalfaculty.
Hestatestwicethat“thereisnosuchthingasChinesemedicine”(Unschuld,p.3,6).
Fromhispointofview,thisisbecauseindifferentperiodsoftimeChinesemedicine
meant different things and because there are various versions of it, it has to be
agreedonwhichoneofthemshouldbestudiedatthemedicalfaculty.Inthisarticle
heoncemoredisregardsTCMasnon-scientific:“Ifwewantedtoadoptonlythose
elementsofChinesemedicinethatcouldbeprovenscientifically,notmuchwouldbe
left. Yet we do not have any other criterion” (Unschuld, n.d., p. 6). While TCM
practitioners,suchasDanielKeown(2014)believethatTCMhasnotchangedmuch
throughthelast2000ofyearsbecauseitdoesnotneedtochange(Keown,2014),in
Unschuld’sview,Chinesemedicinehadsimplystagnatedovertheseyears(Unschuld,
n.d.,p.3).He relatesTCM’sdevelopment to thatof thestateandexplains thatas
long as the political principles did not change, TCM remained the same; in other
16
words, both politics and medicine relied on the same principles. In contrast, in
Europe therehavebeen constant changesbothpolitically and in themedical field
(Unschuld,n.d.,p.3).“NeitherinEuropenorinChinahasmanbeenabletointerpret
diseaseofhispersonalorganisminawaydifferentfromthatinwhichheinterprets
crisesinthesocialorganism”(Unschuld,n.d.,p.4).HegoesontostatethatChinese
medicinehadnotchangeduntil1911,whentheworldviewoftheimperialagecame
toanend.
These theories lead some scholars to thequestion– if there isnoproofof
howacupunctureworks,doesitmeanitworksbyplaceboeffect?Americanmedical
anthropologist Daniel E. Moerman defines placebo effects as “the desirable
psychological andphysiological effects ofmeaning in the treatmentof illness.”He
arguesthatifapatientparticipatesinahealingprocess,nomatterwhatwillbethe
healingcontent,hemaystillbehealed(Moerman,2000,p.52).Similarviewswere
expressedbyWelch(2003)–inhisarticle“WesternMedicineandItsRoleinPlacebo
Healing” (2003), he suggests thatWesternpractitioners interactwithpatients in a
“highly ritualized manner” and it plays an important role in healing the patients
(Welch,2003,p.21).Hecomparesbiomedicineofthisdaytoancientritualpractices
ofNativeAmericanIndiansorshamansinAfricawhousedto“mobilizetheplacebo
effect in their patients throughahealing ritual” (Welch, 2003,p. 21). Just like the
priestorotherspiritualleaderwelcomesyouintohistempleandtakescareofyou,
theWesterndoctorwelcomesyouintothehospital,diagnosesyourillnessandtries
to help younomatterwho you are.Welch believes that nearly all disease is self-
limitingandthebodycanusuallyhealitbyitself(Welch,2003,p.26).Toaccelerate
thehealingprocesswecanapplysome“activetherapeutic”[sic](Welch,2003,p.26),
butaccordingtoWelchit isnotalwaysnecessary.Sometimestheactof‘givingthe
medicine’ or ‘giving affection’ could be evenmore important than the drug itself,
whenthe“act,thoughnotthecontentofmedicine,somehowtriggersthebodyto
autonomoushealing”(Welch,2003,p.26).Welchdiscussesvariousstudiesthathave
beenmade in aneffort to findoutwhether such factors as empathy and concern
couldinfluenceapatient’scondition.Thesestudieshaveshownthatphysicianswho
provide empathy and concern “can positively influence the patient’s clinical
outcome”(Welch,2003,p.28)andthattheuseofaplaceboinadoubleblindtrialof
17
morphine canbeevenmoreeffective than theuseof aweakbut activeanalgesic
(for example, aspirin) (Welch, 2003). Double blind trial heremeans that both the
patient and the doctor do not knowwhether the drug is active or a placebo and
assumethatitisapowerfuldrug.Tosummarise,thesestudiessuggestthattheritual
of receiving a pill from a trusted physician can improve a patient’s health “in
proportion to the physician’s promise”, even without the use of the active
pharmaceutical (Welch, 2003, p. 26). Kaptchuk, in his speech about his tests on
placebo effect for TedMed (2014), expressed very similar ideas. After testing the
patients in different ways he came to the conclusion that “human dimensions of
providinghealthcarecanalleviatesymptomsandchangethecourseofillnesseven
withoutpharmaceuticals”(Kaptchuk,2014,16:22).Thereareevenstudiesthathave
concludedthat“elderlypersonswhoperceivetheirhealthaspoorare6timesmore
likely todiethanthosewhoperceivetheirhealthasexcellent, regardlessofactual
healthstatus”(Crum&Langer,2007,p.166).
Ifitisnotanactivedrugthathelpsthepatienttorecover,therefore,whatis
it? Tilburt and Kaptchuk believe that “cultural familiarity with many traditional
Chinese herbal medicines in China may promote a familiarity bias, accepting a
widespreadculturalassumptionofsafety,basedonthehistoricaluseoftheherbal
medicines”(Tilburt.&Kaptchuk,2008,p.597).Thismayapplyforsomeoftheherbs,
buttherearesomefactsthatcannotbeignored.DennisNormileinhisarticle“The
New Face of Traditional Chinese Medicine” tells us an interesting story about
Chinese pharmacologist Li Dapeng, who in 1975 began trying to coax anticancer
compounds out of the plant’s seed (Normile, 2003, p. 188). Twenty years later, Li
DengreceivedtheGovernment’sapprovaltomarkethisresearchfindings.Heuseda
drug that he calls “Kanglaite” to help cancer patients fight their disease and also
reduce the side effects from the other treatments. The article states that by that
time(in2003)thedrughadbeeninjectedintomorethan200,000patientsandwas
China’sbest-sellingtreatment.Despitethis,thescientistsstilldidnotknowhowthe
drug worked.Moreover, this was the first drug that was derived from traditional
Chinese herbal remedy andwent into clinical trials in theUnited States (Normile,
2003).
Regardingthepracticeofacupuncture,hundredsoftestshavebeendonein
18
ordertofindoutwhetheritistrulyeffectiveoriftherearesomeotherfactorsthat
causetherecovery.OneexamplecouldbetheexperimentconductedbyDilli,Childs
and Berk in 2014. A group of scholars conducted an experiment in an outpatient
clinicattheColoradoSchoolofTraditionalChineseMedicine.Thereweresixty-one
acupuncture-exposed and fifty-nine acupuncture-naive (never had acupuncture
before)participants,whoseageswerebetweeneighteenandninetyyearsold.The
resultsshowedthat“perceptionsoftherealtreatmentwereratedasmorerealthan
sham treatments for all participants” and “prior acupuncture exposure did not
influenceratingsofrealtreatments,butexposedparticipantsratedshamtreatments
assignificantly lessrealthannaiveparticipants”(Dilli,Childs&Berk,2014,p.155).
However, even though the resultsmay imply that acupuncture is effective, it just
raises furtherquestions. In theirarticle “AdvancingAcupunctureResearch” (2005),
Andrew and Kaptchuk address three issues concerning their research. The first is
questioning whether acupuncture is studied appropriately; second, whether the
studiesfocusontherightstyleofacupuncture(sincethereareavarietyofstyles);
and third, why is there a discrepancy between animal and human studies of
acupuncture.Theyarguethateventhoughtherehavebeenhundredsofattemptsto
scientifically evaluate acupuncture, little has been achieved (Andrew & Kaptchuk,
2005).
Chapter 4 – The Image of TCM Today
Response to Criticism SinceTCMgainedworldwidefamiliarity,forthosewhodidnotgrowupina
culturewheretheconceptof‘qi’isconsideredtobeselfunderstood,ithasnotbeen
easy to accept TCM as a valid and efficient method of treatment. In the 1970s,
becausenobody in theWest coulddefinehowacupuncture actuallyworks, itwas
classifiedbyphysiciansasaplacebo,bywhichtheyoftenmeant“quackery”(Barnes,
2005,p.251).Inthe“JournalofChineseMedicine”(2010),CharlesBuck,aWestern
practitioner of Chinesemedicine, talks about the criticism towards TCM from the
West. In his opinion, to criticise TCM one has to have some knowledge and
19
understandingofitfirst.HenoticedhowoftendevaluationofTCMiscausedbythe
lackofunderstandingofitsterminology.WhilesomepeoplemightthinkthatTCMis
pragmaticandrational,othersmayclaimthatitisacompletenonsense.Heusesthe
word “outlandish” to describeWesterners’ feeling about the terminology of TCM
and explains thatwhile in China those termsmay seemmore self-evident, in the
West different interpretations of it lead to greater polarisation between
‘traditionalists’and‘biomedicalists’(Buck,2010,p.27).InBuck’sview,thereisalot
ofvalueinTCM,howeveritis“mixedtogetherwiththebeliefsthatareuntenablein
themodernword”(Buck,2010,p.26).HebelievesthatChinesemedicinecouldbe
improvedthroughtheuseofscienceandcriticalreflection.AndinordertobringCM
intothemodernworld,fromhispointofview,adeeperlinguisticandsemioticstudy
must be carried out to make sure that the traditions are interpreted accurately.
Carryingoutbiomedicalresearchonlyisnotenoughtomakesurethatthetraditions
areunderstoodcorrectly(Buck,2010,p.28).Buckarguesthatbiomedicalorthodoxy
“doesnotlikethelanguageofCM”becausetothemitappearsasalien,prosaicand
metaphysical(Buck,2010,p.28).ThereforepractitionerslikeBuckhavetofacethe
fact that TCM to outsiders sounds like “oriental astrology” (Buck, 2010, p. 28).
However,hestressesthatwhenCMphysicianstalkabout‘qi’oryinandyang,these
terms are used specifically in the context of medicine and are not necessarily
congruentwiththeiruseineitherphilosophy,astrologyormetaphysics(Buck,2010,
p.28).InBuck’sview,“CMisatsomeleveluntranslatable;tofullyunderstandityou
have tounderstandChinese language” (Buck,2010,p.29). Forexample, regarding
theconceptof‘qi’–likemanyotherTCMpractitionersDanielKeownthinksthatthis
is the most misunderstood and mistranslated term of TCM (Keown, 2014). He
describes‘qi’asan“intelligentmetabolism”andtriestoexplainthemeaningofthis
word that is a good dealmore thanmetabolism or energy (Keown, 2014, p. 26).
Chinesewordsarewrittenincharactersthatcanalsobebrokendownintoradicals
andeachofthemhasameaning.Thecharacter‘qi’(氣)consistsoftheradicals‘air’
and ‘rice’ which combined could mean “food+air=energy”. However, Keown
concludes that ‘qi’ is too broad to be a substance and that it is rather a concept
(Keown, 2014). And that is only one concept. Looking from an anthropological
20
perspective, Buck’s opinion sounds like the great ideas of the so-called ‘father of
anthropology’. In his famous book “Argonauts of the Western Pacific” (1984),
Bronislaw Malinowski suggests that in order to learn about foreign culture, the
researcherhastolearnthenativelanguage(Malinowski,1984).Sincethepracticeof
TCM is a tradition that has been shaped through the centuries and has great
importanceinpeople’slives,itisdefinitelyapartofChineseculture.Soifweapply
Malinowski’s rule of studying the local language in order to learn the culture, the
personthatwantstounderstandTCMhastolearntheChineselanguage.Onlythen
canhe/shefullyunderstandit.
AnotherpointofviewregardingtheefficacyofTCMwasexpressedbyTCM
practitionerPeterEckman. Inhisarticle“TraditionalChineseMedicine–Scienceor
Pseudoscience? Response to Paul Unschuld” (2014), Eckman questions whether
Chinese medicine should be subject to verification by the methods of Western
biomedicine.Hebelievesthatthereisacommonbeliefthat“scienceislimitedtoits
Westerntraditionandthattherecanbenootherkindsofscience”(Eckman,2014,p.
40).EckmanarguesthatbecauseofthedifferencesinEasternandWesternscience,
theinvestigationnecessarytovalidatepropositionsineachwillalsobedifferent.He
explainsthatwhileWesternscienceisanalytical,quantitativeanddeductive,Eastern
science issynthetic,qualitativeand inductive.EckmannotesthatUnschuldaccepts
thelawsofWesternthoughtasscientificbuttheonesoftheEasthecharacterisesas
‘magical thinking’ and thus implies that they are not scientific in nature. Eckman
disagreeswith thisnotionandargues that “thedifference is thatWestern science
laws may be tested quantitatively, while Eastern scientific ‘laws’ tend to be
qualitative in nature, and thus cannot be proven by the same methods used by
Westernscience” (Eckman,2014,Endnotes,2).Heconcludes thatwhile traditional
Orientalmedicine (including TCM) is a branchof Eastern science, biomedicine is a
branchofWesternscience:“Bothrevealtruths,bothareusefulguidesforhealthcare
providers,butneither isreducibletotheother.Likesomanyotherchallengesthat
facehumanity,thesolutiontothisquandaryispeacefulcoexistence”(Eckman,2014,
p.42).Barnesalsosuggeststhateffortsindefiningwhetheracupunctureiseffective
ornotarebasedonmethodologiesofbiomedicineandareself-limiting.Thiskindof
approach is asking a question of whether acupuncture is “effective biomedical
21
treatment” (Barnes,2005,p.250).AndrewandKaptchukdescribe theseeffortsas
theprocesswhich“canbeequatedtoaskingasculptortosculptwithapaintbrushto
proveheisan‘artist’”(Andrew&Kaptchuk,2005,p.41).
Western Dominance
The idea that TCM cannot be measured by Western science quantitative
measuresraisesthequestionastowhytherearenotdifferentkindsofmethodsto
evaluatetheefficacyofTCM.SinceTCMisstillbeingpractisedinChinaandaround
theglobe,thisimpliesthatitmustworkforatleastsomepeople.Manypeoplethat
sufferfromchronic illnessesturntotraditionalorso-calledcomplementaryhealing
practices,sincethepillsprescribedbyWesterndoctorscanonlyeliminatethepain
but not the illness itself. According to Barnes, some people keep coming back to
acupuncturetreatmentseventhoughtheirsymptomshavenotdisappeared–thisis
because their whole quality of life improves (Barnes, 2005). Since these kinds of
practices do help for some people, therefore, why are they often disregarded as
non-scientificorevenassomethingmagical?WhyistheefficacyofTCMbeingtested
endlesslybybiomedicinebutnottheotherwayround?
ThestatusofbiomedicinecomparedtoTCMisclearlysuperior,eventhefact
thatoneiscalled“conventionalmedicine”andtheother“complementarymedicine”
indicate this.Talkingabout theWestandEast, it isnotonlymedicine that reflects
this superior versus inferior relationship. Inhis book “Orientalism” (2003), Edward
W.SaidtalksabouthowthroughhistorytheWestviewedtheEastinasuperiorway.
Europe continuously maintained the “position of strength” and dominance in
relationtotheOrient(Said,1985,p.40).Forinstance,atthetimeofcolonisationthe
superiority of Britain over Egypt was taken for granted and the British even saw
occupyingEgyptasanactofdoingafavourforEgypt(Said,2003).Saidtalksabout
works of such British intellectuals as Cromer and Balfour, who talked about the
differencesbetweenEuropeansandthepeople fromtheEast.TheOrientalpeople
wereportrayedasirrational,childlike,deprived,“different”andunintelligentpeople
whose “disordered minds fail to understand what the clever Europeans grasps
immediately”(Said,2003,pp.38,40).TheEuropeansincontrastwereshowntobe
22
“rational,virtuous,mature,and ‘normal’” (Said,2003,p.40).FromSaid’spointof
view, such Europeans as British and French shared not only the land (that they
occupiedtogether),profit,or rule,butalsothe“intellectualpower” (Said,2003,p.
41)thatSaidcallsOrientalism.FromtheWesterner’spointofview(suchasBalfour),
BritainwashelpingtheOrientbyoccupyingitsterritoriesandestablishingaWestern
stylegovernment.ThiskindofsuperiorthinkingmayhaveledtheWesternscholars
toassumethatWesternscienceistheonlytruescienceandeverythingelsethat is
not testable by its methods must be some kind of quackery or magic. Chunjuan
NancyWei notes that “with the advent of theOpiumWar (1839 - 1941) and the
subsequent Century of Humiliation, Chinese confidence in its own culturewaned.
Chinesemedicinewasbranded‘feudalsuperstition’andWesterneducatedChinese
wanted toexpunge suchevidenceof ’beingbackward’.”(Wei, 2013,p. 262).Many
MayFourth(politicalmovementinChinain1919)intellectualscriticisedTCM–they
werepro-modernistsandanti-traditionalists.In1929therewasevenabanonTCM,
although it was unsuccessful – people could not give up the ancient practices so
suddenly. Eventually, the Government turned back to preserving its culture and
traditions,aswasmentionedinChapter3.
The important point that Sutherland (2000) notes is that although Chinese
medical practice developed alongside Daoism, Confucianism, and Buddhism, and
although it adopted the Eastern religious belief that both physical and mental
exercisecouldbeusedtoachievehealth,ithasalsobeenpractisedaccordingtothe
resultsofpreviouslyusedtherapies(Sutherland,2000).Inotherwords,theefficacy
ofTCMhasbeen tested formore than2000yearsbypeople themselvesbeing,as
WongLai-Yiputit,“guineapigs”(Wong,2005,p.13).OvertheyearsChinesepeople
testedplantsonthemselvesfortheirpropertiesofinducingwarmth,heat,coolness
andcold.Theyclassifiedthemedicinaleffectsoftheplantsonthedifferentpartsof
the body and determined their therapeutic and toxicity dose (Wong, 2005).
Therefore,TCMdidnotsolelyevolveaccordingtoreligiousphilosophy,eventhough
thatplaysasignificantpartinit.Lookingagainfromananthropologicalperspective,
onecouldquestion,whoisinchargeofdefiningscience,orasMeiZhanputsit,“in
everydaydiscourseandpracticeof traditionalChinesemedicine,and, inparticular,
throughtheproductionof ‘clinicalmiracles’,therecurringquestionofwhatcounts
23
asscienceprovesinextricablefromthequestionofwhoisauthorizedtodefineand
craft science and rationality” (Zhan, 2001, p. 475). Zhan suggests that we should
explore“morefluidandparticipatorywaysofenvisioning,producing,andanalyzing
science”, as well as seeing science as “translocal, open-ended processes and
networks forknowledge,andcommunity formation” (Zhan,2001,pp.475). In that
waywecouldmovebeyond theGreatDivide– “between scienceandnonscience,
knowledgeandbelief,rationalandirrational,universalandlocal,natureandculture,
andUsandThem”(Zhan,2001,pp.474).
Comparing Biomedicine and TCM
ItwouldappearthatcuringdiseaseintheWest(inbiomedicine)isallabout
drugs.Oncethereisnoactivepharmaceuticalsubstanceinthepillthatthepatient
takes and after taking it the patient feels better,Western science would call it a
placeboeffect. Butwhat does thatmean?Does thatmean that the condition can
improve by just believing it will? What about other factors, such as diet, mental
healthand lifestyle?There isaChineseproverbthatsays,“Hewhotakesmedicine
andneglectsdietwastes theskillof thephysician” (Wang,Keh,&Bolton,2010,p.
80). Campbell and Campbell question the relationship of diet and health in their
book“TheChinaStudy” (2006).They talkaboutnutrition in theUSAand inChina.
Theyareconcernedaboutpeople’shealth in theUSandaretryingtodiscoverthe
causesof various diseases, such as cancer. Itwas a hugediscovery to themwhen
ChineseauthoritiespublishedanAtlasinwhichyoucouldseetheratesofcancerin
Chinaindifferentregions.ThisAtlasimplicatedthattherearehigherratesofcancer
incertainregions inChina,whichwouldmeanthattheremaybeadditionalcauses
forthisdiseaseapartfromgenetic.Thissuggestedthatitcouldbetheenvironment
or nutritional habits that may cause this disease (Campbell & Campbell, 2006).
Campbell andCampbell conducted research in rural China,where they found that
Chinesepeople’sdietdiffersgreatlyfromtheWesterndiet.Theresearchhasshown
thatAmericansareseventeentimesmorelikelytodiefromcoronaryheartdisease
thanaruralChineseman;andthatthedeathratefrombreastcancerinAmericais
fivetimeshigherthanthatofChina(Campbell&Campbell,2006).Theseresearchers
learntthatpeopleinruralChinaconsumesignificantlymorefibrethanAmericansdo
24
andtheirdietismainlyplantbased.WhyistheChinesedietmorehealthythanthat
ofWesterners?DotheChinesefocusonsomeaspectsofthefoodthatWesterners
donotpayanyattentionto?Intheirarticle“LayTheoriesofMedicineandaHealthy
Lifestyle” (2010), Wang, Keh, and Bolton suggest that “lay theories of medicine”
guidepeople’sbehavioursandpreferences in thedomainofhealth (Wang,Keh,&
Bolton, 2010, p. 80). Such complementary medicines as TCM or AM (Ayurvedic
medicine) often require not only consumption of a medication but also specific
health-promoting habits like diet and exercise. For example, when takingmedical
herbs,oneshouldavoidconsuminggreasy,raw,orcoldfoods(Wang,Keh&Bolton,
2010, p. 83). Health-protective behaviour is even listed as “one of the necessary
conditionstopromotehealing”inthefamousYellowEmperormanual(Wang,Keh&
Bolton,2010,p.83).Wang,KehandBolton’sresearchhasshownthatunlikeTCM,
WM treatment causes a boomerang effect – the remedies have “unintended
consequences that undermine risk avoiding among consumers” (Wang, Keh &
Bolton, 2010, p. 81). Inotherwords, consumersofWMmedicationdonotpay as
muchattentiontohealth-promotinghabitsastheconsumersofTCMmedicationdo:
WM (vs. TCM) undermines perceived importance of, and motivation to
engagein,healthprotectivebehaviors,therebyreducinghealthylifestylebehaviors.
An intervention enhanced perceived importance and motivation to engage in
complementary behaviors, thereby mitigating the boomerang effect of WM (vs.
TCM)(Wang,Keh&Bolton,2010,p.91).
While “WM is closely linked to the scientific method and emphasizes
empiricallymeasurablebiochemicalprocessesthatdrivedisease,itstreatment,and
health”,TCM“isprimarilyconcernedwiththematerialaspectofthebodyandviews
all medical phenomena as cause-effect sequences, relying on rigorous scientific
studies and research that seek empirical proof to all phenomena” (Wang, Keh &
Bolton,2010,p.82).Inordertoremedydisease,WMreliesondrugs,radiationand
surgery.Meanwhile,TCMfavoursaholisticapproach,themindandthebodyisseen
as a whole system, and for treatment it relies on inductive tools and methods
(Wang, Keh & Bolton, 2010). In both Ayurvedic Medicine (AM) and TCM (both
25
complementary medicines) there is a great importance placed on balance and
harmony.Inthecaseofillness,TCMseesitastheimbalanceofthewholebody,asa
‘disharmony’ in thebody: “UnlikeModernmedicine,Chinesemedicine focusedon
the person, not just the illness. In Chinese medical thinking, illness was only one
manifestationofanimbalancethatexistsintheentireperson”(Wong,2005,p.13).
Onemore difference betweenMW and TCM is that “Unlike biomedicine, Eastern
therapies such as acupuncture value experience and even intuition over
reproducible and definitive facts” (Andrew & Kaptchuk, 2005, p. 41). The
practitionersareencouragedto“tobuildupontheseexperiencesandcreateastyle
that works best for them” (Andrew & Kaptchuk, 2005, p. 41). For that reason
practitioners have developed a variety of styles – in theUS alone there are eight
differentstylesofacupuncture.
TCMandWMhavecoexistedinChinaforover200years,andHongKongis
probably the most interesting place to study people’s views on TCM. This region
belongedtoChinaforhundredsofyears,andthenforthe lastcenturywasgreatly
influencedbytheEnglishoccupation.TodayHongKongislikeacombinationofAsia
andEuropeinmanysenses.DoctorLam(2001)interviewedtwenty-ninelocalpeople
inHongKongandfoundoutthattheyconsideredbothtypesofmedicinestohave
strengthsandweaknesses.Theyalsousedbothofthemconcurrentlydependingon
what disease they were suffering from. They felt TCMwas good for curing some
milder illnesses like coughs and colds and was better in curing the root of the
problem. It is also often used as a supplement toWesternmedication –Western
medicineissupposedtohaveaquickeffectandtraditionalmedicineisexpectedto
“cutthetailofthe illness”(Lam,2001,pp.762-763).Anotherquestionnairesurvey
thatwasconductedwith100healthypeopleand82breastcancerpatientsinHong
Kong showed thatbothgroupsconsideredTCM“moreholistic,humane, saferand
less invasive than Modern medicine” (Wong, 2005, abstract). Western medicine,
therefore, is seenas aquickway to recoverbecause it ismorepowerful than the
medicine of TCM.However, sometimes it is too powerful and it causes significant
side effects (Lam, 2001). In comparison, Lam suggests that Chinese medicine is
considered tobemilder thanWesternmedicine anddoesnothave as strong side
effects.TCM’sweakness isseenasbeing lessconvenientthanWesternmedicine–
26
while using it youmay have to boil the herbs and see the doctormultiple times,
meanwhiletheWesterndoctormight justprescribeyousomepills,whichareeasy
totake.Inaddition,theherbalteaisusuallyverybitter,slowtoactandthepatient
mayberequiredtoavoidsometypeoffoodaswell–notsoconvenient(Lam,2001).
Normile (2003) notes that the authorities in Hong Kong are making an effort to
restore both global and local faith in the traditional herbal approach. By the year
2003, it had started regulating every aspect of the herbal business. A licencewas
finallyrequiredtobeabletopractiseChinesemedicineandselltheherbs;thetoxic
herbswere no longer availablewithout prescription and the quality of herbs and
formulae began to be regulated (Normile, 2003, p. 190). The institute of Chinese
medicinehopedthatthiskindofscreening,trialsandregulationswouldbringsome
modern scientific rigour to traditional herbal medicine, and that the new, herb-
based formulations would meet “the same standards of safety and efficacy as
conventionalpharmaceuticals”(Normile,2003,p.190).
Chapter 5 - Conclusion
Chinesemedicinehassurvivedwith itsupsanddowns forover2000years.
The gathering and testing of herbs developed into complex herbal formulae that
could treat illnesses; the needles of acupuncture turned into thinner and more
comfortable touse tools,but thewholeessenceand theoryofTCMhas remained
verymuchthesameasitwashundredsofyearsago.WhileWesternsciencebased
medicine,orbiomedicine,hasbeengoingoneway,TCMhasbeengoingtheother.
Whileoneisbasedonscience,isquantitativeandfocusesondisease,separatebody
parts,organs,cellsandmolecules,theotherisratheraholisticapproachofhealing,
is qualitative, traditional, philosophical, and focuses on the whole person, the
harmony in his/her body, which may include physical, psychological and spiritual
wellness. And while orthodoxWesternmedicine is able to cure acute illness in a
short time, TCM ismore valued for healing chronic illnesses that require amuch
longertimetoheal.Conventionalmedicineisfastandstrong,butitalsoquiteoften
causessideeffectsandunderminestheimportanceofhealthprotectivebehaviours.
27
Incontrast,TCMmaytakeamuchlongertimeincuringtheillness,itsmedicationis
notasstrong,but thewholeprocessofhealingmay improvepatients’ life,since it
promotesahealthylifestyle–exerciseandahealthydiet.However,becauseTCMis
valuedforcuringchronicillnesses,itissuspectedtohaveaplaceboeffect,orthatits
patientshealbythemselveswithtime.WMandTCMhaveverydifferentapproaches
tothehumanbody,theoriesofhealthandeventheuniverseitself.Forthatreason,
it isnoteasy forpractitionersofbothWMandTCMtoagreewitheachother.We
growupintheenvironmentthatsurroundsus,withthepeoplearoundusthatare
familiartous;welearnthewaysoflifefromthemandthatwayseemstobetheonly
rational way possible. When we discover other cultures we may feel surprised
becausewe see people doing things thatwewould not expect anyone to do and
their behaviour does not correlate with our standards. So when an American or
European person hears that he has a “qi deficiency”, that may not tell him/her
anything, even if it is explained what it means. So in order to understand the
theories of TCM we have to learn about Chinese history, the ideas of ancient
philosophersandeventheChineselanguage.
Although the efficacy of TCM has been questioned and no conclusion has
beenmade, somepracticesofTCMspreadacross theworld.Acupuncturebecame
quiteapopularhealingtechniqueinbothEuropeandNorthAmerica,wherepeople
wereseekingnewwaysofhealingthataremorenaturalanddonotharmthebody
asmuchas thetechniquesandmedicationofbiomedicinedo.Somepeople find it
helpful, and some consider it a sham. While the efficacy of TCM is still being
questioned in theWest,modernorWesternmedicinehasbeenaccepted inChina
quiteeasilyduringtheperiodofmodernisation.AcceptingWMinChinawasseenas
a great step forward towards building a more modern and advanced China.
Meanwhile, TCM was respected for centuries, with some short periods of
Government opposition to traditionalism and Confucian ideas. Today China is the
onlycountry intheworldwhereTCMandWMarepractisedalongsideeachother,
complementingeachotherforanykindofillnessateverylevelofhealthcaresystem
(Hesketh&Zhu,1997).Suchtraditionaltreatmentsasherbalremedies,acupressure,
massage, acupuncture, andmoxibustion account for around 40% of all healthcare
deliveredinChina(Hesketh&Zhu,1997).Meanwhile, inWesterncountriesTCMis
28
just one more complementary or alternative medicine among many, very often
beingusedonlyinthosecaseswherebiomedicinefails.
And finally, although TCM is becomingmore andmore popular outside of
China,theunderstandingofitisnotexactlythesameasitisinChina.Itseemslike
the theories and techniques of all kinds of medicines – conventional, alternative,
traditionalandcomplementary–aremixingtogethertoday,justastheculturesare.
ThemixtureofTCMandWMisverycommoninChina,anditseemslikehereinthe
Westitisslowlyblendingtogetheraswell.AsBarneshasputit,complementaryand
conventionalmedicinesarelosingtheirborders(Barnes,2005).Andfinally,perhaps
just asEckmanargued,bothof themhave theirownbenefits andmerits, and the
peacefulcoexistenceofbothmaybenefitusall(Eckman,2014).
29
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