Chinese Medicine at the Crossroads

Sometimes rapidly, and sometimes slowly, Chinese medicine has made its way towards a Western model of medicine over the past 60-odd years specifically, and the past 100 years in general. I am certain that this will destroy its relevance to the health care system now and in the future. I am also, and perhaps more importantly, convinced that this movement will undermine the aspect of Chinese medicine that enhances our being: its inherent unifying harmony. My thesis in particular is that specialty boards are an anathema to the body and spirit of Chinese medical practice.

Many mainland TCM practitioners have told me that the process of modernization accelerated just over 60 years ago. At this time, there was a movement which equated to “throwing out all that garbage”: all of the subtle diagnostic methodologies of Chinese medicine (such as sophisticated pulse systems), and anything alluding to the beautiful uniqueness of the human spirit that might therefore challenge the materialism of a communist regime. Because pulse diagnosticians of diverse systems did not agree on methodologies, they discarded their tools without appreciating that their variances in practice involved accessing a variety of information from the pulse, rather than proving its unreliability.

The move towards a Western model is predicated on the ubiquitous belief that Western medicine and science are ‘real’ and that Chinese medicine is a ‘meta-medicine’: a crude allegorical expression of reality by people ignorant of expressing their clinical experience in terms of ‘real’ science. Therefore, Chinese medicine must prove itself according to the Western medical research norms of standard deviation, statistical significance and double-blind studies, and resemble the biomedical model in all of its formal structure, to be considered literally and genuinely ‘real’.

Thus, we observe the seemingly inexorable reshaping of Chinese medicine into the ‘real thing’. Along with this transformation comes not only the effort to fit the knowledge and experience of Chinese medicine into the Western model, but an equally powerful drive to adopt all of Western medicine’s formalities, based on increasing differentiation into unrelated entities and categories. A patient consulting his oncologist recently was told that a suspected metastasis was only an infection, and when he requested treatment for this, the oncologist replied that he did not treat infection, only cancer. Likewise, another patient referred to an orthopedist for treatment of a shoulder problem was subsequently told by the doctor that he did only knees.

This fragmentation of allopathic medicine into specialties and sub-specialties has not enhanced the value of the medicine to the average consumer. To a great extent, my practice consisted of those alienated from their conventional practitioners by specialization. The right hand no longer knew what the left hand was doing, and patients suffered. Why do increasing numbers of people seek an ‘alternative’? Many (if not most) patients are dissatisfied with the specialization, segmentation and disintegration of Western medical practice. Is it in the best interests of our patients, the health care system, or even of our own relevance to either, to replicate what they are fleeing?

Chinese medicine is round, and not linear. The Chinese medical model works best where there are many diverse events occurring simultaneously, since it is concerned with relationships. The terms are exact, but the measure (Yin-Yang, Five Elements (Phase) etc., is inexact). We have a body of knowledge that has been rigorously tested over a long period of time. It tells us how each organ and area of the body affects another, and how that body interfaces with the human mind and its evolution through life. We have learned that without that understanding of these relationships, our medicine is superficial and the results short-lived.

Think of abdominal pain and regurgitation. Here are symptoms that cannot be successfully treated unless we consider the input of the Liver (Qi stagnation or deficiency), Spleen Qi deficiency and Stomach Qi stagnation, Kidney Yang deficiency (underlying Spleen Qi deficiency), Triple Burner deficiency (reduced ability of the Internal Duct to separate the pure from the impure) and the Lung’s ability to descend the fluid it receives from the Spleen, to say nothing of Lifestyle issues. These factors may all be involved at once.

Chinese medicine is inherently a medicine that operates successfully through relationships, between organs and etiologies. To be successful, it requires the presence of many variables at the same time, and therefore is not measurable, nor is its value determined by a statistical system that relies on studying one variable at a time.

In contrast, the biomedical model operates best with deductive, digital thinking – easily measurable in linear (metric) terms – with few or no diverse events, and where reliability depends on the homogeneity and materiality of data. In its experimental mode, biomedicine requires the elimination of all but one variable. This is the antithesis of Chinese medicine, which flourishes in the simultaneous relationships of the many variables we call patterns. How can we gainfully apply the biomedical modality to the rough example of abdominal pain mentioned above?

Furthermore, statistical significance and standard deviations – the modus vivendi of biomedical research – is our modern mythology, and our new faith is “probability.” If a factor is statistically significant, it means it could not have happened by chance. However, if an observation is not statistically significant, it simply means the recorded event might have happened by chance. It does not mean it isn’t real, or that it is necessarily the result of chance.

The statistician who invented the standard deviation regretted it as the greatest information disaster of all time, lamenting the loss of the amount of meaningful material that has been discarded purely because it might have occurred by chance. I heard this with my own ears in 1949, at Cornell Medical College. Is this how we wish to assess the worth of our precious heritage?

Research projects are springing up in many hospitals. These are similar to one of which I’m aware at a major medical center, where they are treating asthma with a simple single protocol: one treatment for all the endless variations of asthma. Is this Chinese medicine? Do we treat asthma, or do we collaboratively assist each individual patient on his journey to better health?

One cannot isolate the single factor that makes for illness or for healing: that single magic bullet of etiology and cure with which biomedicine is obsessed. People are a complicated expression of the interaction of genetics, life experience and Lifestyle, and are best studied by a methodology that can address this complexity.

With the ubiquitous loss of the tools of Chinese medical diagnosis, the capacity of the Chinese medical practitioner to appreciate that complexity, and to perceive the earliest stages of patterns of disharmony and therefore process of disease, is sharply curtailed. As a result, Chinese medicine has also increasingly lost the ability to serve its highest purposes, beyond even the power to treat individuals rather than biomedical diseases: it has lost the ability to prevent illness.

Chinese medicine practitioners, driven by the need to be accepted by biomedicine – the culturally stronger medicine – and through a hope that they will increase their earnings through that association, are abolishing their unique diagnostic system in favor of biomedicine’s diagnostic model. Without Chinese diagnostics, Chinese medical physicians become biomedical technicians.

It is natural for one culture to assimilate, and thereby reduce, the logic and concepts of another culture into its own. Reductionism is as old as human history. It would seem to be unnatural for the weaker culture to seek to be absorbed by the stronger one, and lose its unique identity. However, those who were the targets for destruction by biomedicine for seventy-five years have chosen to “identify with the aggressor”, and imitate it. Chinese medicine practitioners are choosing to take this road to ruin.

In this instance, we are faced with the reduction of the analogue, inductive Chinese model into the digital, binary, deductive system of logic which is characteristic of biomedicine, and the eagerness of Chinese medical practitioners to be absorbed as accepted partners to the more powerful culture, biomedicine.

We are at a crossroads in the profession. We may choose to embrace the everlasting mystery of the ancient medicine, or escape into the certainties of a Western-style paradigm that has taken the heart out of its medicine, its practitioners and its patients. People desperately need the humanity of our medicine as an alternative to the mechanical cadence of technology. They need the touch of warmth from our imperfect hearts.