Reflections on Medicine
Questions Worth Thinking About
TCM has many things modern medicine cannot empirically verify — what is cold, what is heat, what is deficiency, what is repletion? Modern medical indicators give no definition. This does not show TCM is unscientific. The problem is that many TCM research units have not in fact used modern scientific means to verify TCM theory's scientific character. Many seek TCM modernization, but in epistemology and methodology they head in opposite directions. In fact TCM and Western medicine have different methods and epistemologies. Western medicine knows the body from physical structure and constituent composition — knows the whole through the parts. TCM knows the body from its life-activity (behavior) and the laws of life-motion. Western medicine attends to formal matter only; TCM attends to function and the connection of parts. Western medicine recognizes formal-material exchange; TCM also recognizes the formless-immaterial exchange. So the two have different scientific frameworks. Seeking TCM modernization can be done only within TCM's frame, with modern scientific means, by qualitative and quantitative description. It absolutely must not force Western frame's content to interpret TCM, must not measure TCM's scientificness by the Western frame. This is a plain truth.
Take a small example, to provoke thought:
Catching cold easily brings fever — this is common Chinese knowledge, and probably foreigners' too. English calls a cold got cold. TCM calls catching cold shanghan (cold-injury), and the Shanghan Lun became a TCM classic. Shanghan Lun discusses the layered transmission of cold-evil from surface to interior, and gives prescriptions for each layer. Western medicine does not recognize catching cold; it attributes febrile diseases to inflammation, bacteria, virus — because cold qi is not a formal entity and cannot have quantitative indicators. Yet Western medicine here leaves a great gap: it has not found the link between catching cold and bacterial-viral invasion, has not explained why catching cold lets bacteria and viruses in. After receiving cold, what changes occur in the body's parts and organs that admit infection? At each layer of cold-transmission, what changes? How do the prescriptions act on the body and organs at each layer? Why does Guizhi Tang treat only the taiyang surface and not the half-surface-half-interior shaoyang? Why does Xiao Chaihu Tang treat the half-surface-half-interior shaoyang? And why does shaoyin shanghan need Mafu Xixin Tang? These are TCM modernization's important topics. Sadly, some who pursue TCM modernization have not put attention here; they fix on Western antipyretic-antibacterial models and pursue clearing-heat resolving-toxin formulas. Practice is the sole criterion of truth: under Shanghan Lun, with correct pattern-discernment, one dose lowers fever; within three doses, cure. This has stood the test of millennia. From receiving cold to fever, from medicine to cure — the physiological and pathological process, and the mechanism of formula action — modern science cannot yet explain; so research is needed, hence TCM modernization. Western medicine from the start focused on formal-material entities; observing only bacteria and viruses, it has only antipyretic-antibacterial methods. That is its right. The problem: TCM has its own road, but does not walk it, and switches to the Western frame. The one-dose-fever-down formula is not used; the patient is given ten-plus doses of clearing-heat resolving-toxin — is this TCM modernization? Guizhi Tang, Xiao Chaihu Tang, Mafu Xixin Tang — none are heat-toxin-resolving, but with accurate application fever drops fast. Why must we hang from the anti-inflammatory, antibacterial tree? Different tunes, same effect — what is the matter?
TCM holds: substances causing fever are evil; the means of expelling evil are three — sweat, vomit, purge. To take sweat-vomit-purge as three channels is correct; as three methods is questionable. By my clinical experience, after taking Guizhi Tang, Xiao Chaihu Tang, some sweat, some vomit, some purge. After Guizhi Tang, sweat is not always the means; some vomit, some purge — and after the vomit or purge, fever falls. Guizhi Tang cannot be called a sweat-inducer, though it can sweat. Banxia in Xiao Chaihu Tang is an antiemetic, yet Xiao Chaihu Tang can make patients vomit. What is the mechanism of sweat-vomit-purge after medication? What are the evils expelled? Not bacteria and viruses, surely? These too are important TCM-modernization topics. I also believe urine is a channel of evil-expulsion — some high-fever patients pass dark-tea-colored urine and quickly defervesce. Conversely, pure emetics or purgatives do not by themselves expel evil and reduce heat. Most common — known to all Chinese — using ginger soup to sweat off cold. In fact ginger is not a sweat-inducer; its function is to dispel cold-evil. Does ginger itself dispel cold-evil, or does it mobilize the body's own ability to dispel? If ginger has the expel function, where does the sweat come from? Worth study. Those who have not caught cold drink ginger soup and do not sweat. So sweat-vomit-purge are three channels for evil-expulsion, the body's own ability; calling them three methods is not apt.
Which research lifts TCM, which shrinks it — a great question for those concerned.
Is TCM Science (I)
In the May Fourth movement, patriots called for Mr. Sai (science) and Mr. De (democracy). It was implied that ancient China had no science — because slave-and-feudal society's productivity cannot produce science, only ignorance and superstition! TCM embodies traditional Chinese culture fully; so it naturally met the same fate. To this day under the unscientific hat it gasps for breath, at the critical moment of survival. Has Chinese traditional culture any science? Is TCM science?
To answer: first clarify what science is. Whatever correctly states the relations among things, the essence of things, and correctly describes their laws of change, is science. By this, is there science in Chinese traditional culture? Is TCM science? Hold a truthful attitude — no great difficulty. Practice is the sole criterion. Do not call science only what one understands; what one does not understand is not science.
Our farmer's almanac still correctly guides farming time. Ancient Chinese knew the relation between stars and weather; in the Three-Kingdoms march against Shu, Zhuge Liang looked at stars and seeing the Bull star near the moon, concluded heavy rain would stop Cao's army. Today Weng Wenbo, master of earthquake and severe-weather prediction, has confirmed the rule. Meteorologists found outer-space gravity affects weather — further confirming the science of ancient sky-observation. In military science, Sunzi's Art of War is studied not only by Western generals but by Japanese businessmen. Ancient Chinese architecture astonishes today's architects. Yu zhou: yu is space, zhou is time — China had the four-dimensional concept several thousand years earlier than the West. With a truth-seeking attitude one sees that the low productivity = no science view does not stand. TCM theory contains nearly every aspect of Chinese tradition; thousands of years of medical practice have proved its correctness. How can it not be science?
TCM's Heaven and Human as One was once called unscientific; today we recognize that the cosmos has no closed systems, only open ones; Heaven and Human as One is reasonable. Modern medicine recognizes the connection between psychological and physical health; TCM stated this 2,000 years ago, pointing out emotion's specific influence on organs — joy injures heart, thought spleen, sorrow lung, anger liver, fear kidney. How is this unscientific? Some say TCM is unscientific because its repeatability is less than Western medicine — once a Western diagnosis is made, any doctor writes the same prescription; in TCM each doctor gives differing prescriptions. In fact this only shows TCM is more scientific. Same appearances may have different essences. Insomnia may come of heart, stomach, anemia, kidney. So TCM has bianzheng shizhi, same disease different treatment. Better than always giving sleeping pills! Chinese herbs are over a thousand; many have similar action — each doctor masters a hundred or several dozen and can treat many conditions; one favors these, another those. The wide selection is a strength, not a reason to call TCM unscientific. People in Sichuan eat Sichuan food; Cantonese eat Cantonese; Beijingers Beijing food — all healthy. Would one say Chinese eating is unscientific because not one unified menu?
Some say TCM is unscientific because it knows that it is so but not why. By that standard, little of world science remains. In mechanics, why must there be gravity between two bodies? Why electrons make electric fields, moving electrons magnetic, cutting field lines current? Modern medicine's recognition of mind-body connection is also that it is so, not why — less concrete than TCM. That it is so shows objective regularity tested by practice; not why is the topic we explore. To call all not-why unscientific is to block science. Some say TCM is unscientific yet cannot give reasons, and stubbornly want to remake TCM by Western medicine — what then is the real motive?
Is TCM Science (II)
Productivity-only theorists say slave society had no productive base for science; so ancient China had none, and TCM is not science. They do not know: by difference of epistemology and methodology two human cultures emerged. One — knowing the objective world from form and structure, by division — produced Western empirical science and Western medicine. The other — knowing the objective world from the laws of motion, by observation, induction, summary, and thought; far take from things, near from oneself — finds the general law of all things, then uses it to study each aspect. This produced Chinese traditional culture and TCM.
Western medicine divides the body into systems, then cells, then macromolecules, then ions. The method makes things clear, easy to quantify; what is observed is real. Its weakness: parts and parts, parts and whole — connection is cut, and the substances of connection are missed. Observations tend to be isolated and static. In dividing, some unseen, uncaught content escapes. The sum of parts is always less than the whole.
TCM's method: by the general law of all things, from the whole, study the body's parts' functions and mutual relations. The method depends on observation, thought, summary; hard to quantify; only qualitative. Because observed motions are joint results affected by other bodies, TCM holds the integral view and is dynamic. It draws on astronomy, geography, meteorology, music, sexagenary calendar, etc.
To hold that only form-structure study with quantitative analysis is science, and law-of-motion study with qualitative analysis is not, is the prejudice of ignorance. Twentieth-century leading science — electronics — studied electron motion law, not structure; electromagnetic-field theory came first as qualitative, then mathematical description and quantitative measurement. Both systems have strengths and limits. Like two legs of a human, each cannot endlessly stride; the two legs cross forward, each preparing for the other. TCM, by its limits, stagnated for centuries; now, with modern electromagnetic theory, mechanics, biophysics, biochemistry, it can go further. E.g.: countless electrons move in the human body; outside the body the electromagnetic field is set up; this is acted on by Earth's and the heavenly bodies' fields, giving a composite field — Heaven and Human as One gains explanation. Different organs of different substances form different fields; these interact — a road for studying organ relations.
Western medicine is also at a stagnation: division has reached its limit; can no longer deepen by division alone — must seek help from the Chinese frame. The many phenomena of human potential show the limits of Western science. The 21st century will be the century of life science; this needs close Chinese-and-Western cooperation, on modern science's basis, by Chinese traditional culture's overall pattern and TCM theory, to propose human-science topics.
A person has his own field outside the body, with all the life-motion information. Why not use modern science to capture, monitor, analyze this information? Why use Western medicine to remake TCM and pull TCM into Western medicine's mire? Why not progress, but regress? Worth deep thought!
Appearance and Essence
Because Western medical research uses division and analysis, the result is finer subdisciplines and more body quantitative indicators. A trend appears: in diagnosis and treatment, all on objective indicators — which is abnormal, correct that — the traditional headache treats head, foot-pain treats foot. TCM uses only inspect-listen-ask-palpate, no quantitative indicators, subjective feeling too involved — so TCM is unscientific, Western medicine very scientific. But how to handle these indicators in treatment is worth deep thought. Western medicine has not conquered many common diseases — let alone the difficult ones. A Japanese MD, Haruyama Shigeo, reports: Western drug cure rate is 20%; almost no drug truly cures; the present pattern is, drugs relieve symptoms, then the body's resistance cures. Why? Because by headache-head, foot-pain-foot, drugs target each abnormal indicator — grasping appearance, not essence.
Many lack vitamins, trace elements — appearance (except partial dieters or local deficiency). The essential illness is malabsorption. Rickets, osteoporosis, calcium- and vitamin-D-deficiency — appearance; essence is kidney trouble. TCM theory: kidney governs bone. Anemia is bone-marrow problem; also treat kidney. Is this correct? Yes — effect proves it.
Worse in Western treatment: some abnormal indicators are not essential disease but the body's self-regulation, remedial measure. To press them down regardless is not to cure but to harm. E.g., if there is poor blood flow or local blockage (inflammation), the heart gets the command to raise pressure, raising velocity to compensate for narrow lumen. Force-lowering blood pressure cuts supply, worsens the blockage — like slow water silting more. If the heart is weak, output drops, the heart raises rate; lowering rate forcibly with sedative keeps the supply low and may stop a weak heart. Haruyama also notes: vasodilator-lowering rate produces active oxygen; active oxygen with vascular fat becomes aged peroxide lipid, attracts calcium — turning the colloidal sludge of fat into something like concrete. Fact: many heart-disease, hypertension patients on Western drugs find pressure down but heart cannot bear; heart steady but pressure up — push down the gourd, lift the dipper. Year after year, worse, no cure.
TCM theory: the heart is the official of ruler; the heart does not take evil. Heart trouble must come from elsewhere. In fact vessel hardening and plaque are not the heart's fault. TCM says heart trouble is caused by liver and kidney abnormality. I have treated many elderly heart-disease, hypertension patients by regulating liver and kidney, no heart-targeted drug. Heart steadies, blood pressure normalizes. Stable for years.
What in the kidney affects bone development or osteoporosis, marrow's blood-making, and when liver-kidney affects the heart — the material base — should be researched and quantitative objective indicators found. This is TCM modernization and standardization of diagnosis-treatment, and also Western medicine's need: if you do not look at liver-kidney, heart disease will not be conquered. Fact: Western medicine has not conquered many common diseases because it has not found the real cause. Neurosis, ××-syndrome, ××-comprehensive symptom — shows only appearance found, not essence.
To say TCM lacks objective indicators and so is unscientific is wrong. TCM only lacks quantitative ones, but has a complete set of qualitative objective indicators. The Eight Outlines (yin-yang, surface-inner, cold-hot, deficient-replete) and dozens of pulse and tongue images are objective indicators. The fewness is its strength — with simple, govern complex. Treatment principle is found in them. To hold only quantitative indicators as science is to lack basic science. Such self-proclaimed science apostles insist on remaking TCM to handle only appearance, calling it TCM modernization — yet they themselves eat without producing a quantitative indicator of hunger first. Is that not unscientific!
Inner and Outer Cause
Western medicine, built on dissection, even down to molecules and trace elements, observes always physical entity and chemical change. It has not studied the distribution and laws of various fields and how the separated parts interact. E.g., what force-field drives the rhythmic heart-beat? What governs liver-and-kidney, kidney-and-lung relations? The model from dissection-and-chemistry naturally misses formless substance; the body becomes a complex chemical-plant. Sickness becomes more of this, less of that; treatment: eliminate the excess, cut out what cannot be eliminated; supplement the deficient. This model deals with outer cause only, not inner: only the invading bacteria, not the physiological imbalance that admits the bacteria; only searching for carcinogens in air and food, not the role of bad mood in transforming normal cells. Knows one, not the other — one-sidedness.
All change has inner and outer causes. Inner is basis, outer is condition. Science that handles outer alone is incomplete; problems follow. One: many common diseases unconquered. Two: ever-growing toxicity-and-side-effects of Western drugs — treating disease while making drug-disease. Three: bacterial resistance rises; one day antibiotics may all fail, and humans face a plague.
Western drugs are tested on animals — surely no error? The problem is exactly the animal test. Same grass on the same land: cow eats and grows beef, sheep grows mutton. Same soil: melon plants grow melons, bean plants beans. Fertilizer for plants makes fruit grow; given to cattle and sheep, poisons. The grass that fattens cattle would not fatten humans. Reason: different genes. The species farther apart, the greater the difference. Lives have many chemical plants — but not like chemical equipment giving the same product from the same input. In life, what the same input produces depends on the genes. So testing human drugs on rats and getting their approval is unscientific.
Periodontitis, mouth ulcers — bacteria make them. But invasion requires conditions. Many women get mouth ulcers at menses; 70–80% of pregnant women develop periodontitis, especially wisdom teeth. The facts show: when the body's function weakens in some respect, bacteria get a foothold. Some thin people eat large amounts and cannot put on weight; some fat people eat little and put on fat from drinking cold water. Not a matter of calorie input. A cold has virus, but always tied to chill — especially chill after sweating when pores are open; sweat after sickness ends the cold. One cannot say the virus entered through the pores in the first sweat and rushed back out in the second sweat. These cases show illness has inner causes; the issue is finding them.
The body's physiological functions are very complex; each storehouse and bowel has many functions. Faced with many abnormal functions, how decide which is the essential pathology and which is the secondary change brought by the main disease? Whether periodontitis's inner cause lies in liver or lung? Five storehouses and six bowels have many discovered functions, more yet undiscovered; how to find disease's inner cause? Without a sound theoretical guide, harder than looking for a needle in the sea. Fortunately humans have it — Chinese medicine. Heaven gave the West one method for studying the body and gave China another.
TCM says: getting cold to disease, first the right qi is empty; right qi within, evil cannot encroach. Right qi empty, cold qi can take advantage. First it invades the surface, blocking taiyang channel's qi-and-blood flow, causing headache, chilly aching back. After medicine the cold qi is expelled and disease cured; otherwise it deepens. Deeper, symptoms differ; drugs must change. Drug action only assists right qi; killing bacteria and viruses is done by the body's own functions once restored. TCM says periodontitis' inner cause is in the kidney; in practice, kidney-regulating drugs can resolve inflammation and pain in twenty or thirty minutes, slow in three doses. Mouth ulcers a bit harder — spleen-stomach as well as kidney. Three to five doses work. Holding drugs in the mouth has no effect; must be ingested — so it is not direct bacterial killing by the drug but the body's own. As for obesity: TCM says the spleen governs flesh and transports and transforms. Flesh here is not the anatomical muscle but the skin-and-flesh between skin and bone. Transport-and-transformation means sending digested food to where the body needs it; if it does not arrive and instead converts most nutrition mid-route into fat under the skin, the spleen has failed its function — treat the spleen.
Has TCM conquered some common diseases Western medicine has not? Two answers. One: these diseases are within TCM theory; correctly mastered, the TCM physician can drop the medicine and the disease falls. This shows TCM theory is scientific. So yes, conquered. The other: because TCM theory is not yet quantitative, diagnosis-and-treatment cannot be standardized; not every TCM doctor in every hospital can drop drug and disease. Across the field, one should say not yet conquered. TCM's development needs much work. But unscientific is not the way to negate TCM theory.