A Plain Discussion of *Chinese-Western Cooperation*
School of Chinese Medicine, Hong Kong Baptist University · Li Zhizhong
For more than a hundred years since Western learning came East, the Chinese cultural sphere has had both Chinese and Western medicine. This is undoubtedly a great good for the Chinese — beyond any other country or region. Yet the relation between the two has been an endless dispute in our cultural sphere. For over twenty years I have studied this from the science-studies and soft-science angles and published several papers. Last year's experience in Hong Kong fighting SARS made me feel deeply that Chinese-Western cooperation (中西醫配合) is the better term.
1. On Chinese-Western integration (中西醫結合)
The phrase has been current in China for nearly fifty years. Like Chinese-Western unity, it evolved from Mao Zedong's call. Earliest both meant: Chinese and Western workers unite; the two medicines learn from each other; serve the people's health together. After 1958, Chinese-Western integration took on more meanings — by rough count, at least nine. (My Revival of Chinese Medicine, China Medicine Press, 2004, p. 68.)
In Chinese, one character carrying many meanings is common; one term with many meanings, rare. With nine glosses for one phrase, even teachers are stumped. So in 1982 I began studying this.
Coming from authoritative lips and spreading across China and to neighbors, the phrase had already inspired new medicine, integrated medicine. I treated it as both a term to be defined and a discipline to be compared in history, culture, science, and medicine. The article Research on the Definition of Chinese-Western Integration went through ten drafts over 14 years before public release in 1995.
My definition: Chinese-Western integration is the practical process in which Chinese and Western workers cooperate, and the two medicines coordinate — aimed at lifting clinical efficacy. Four inner contents: (1) workers' cooperation is the precondition; (2) academic coordination is the real core; (3) the goal is each medicine's strength — to lift clinical efficacy; (4) "practical process" — practice is the bedrock; from practice to theory is epistemology.
Looking back, in defining integration, my inner content is in fact cooperation. I have always felt integration is not the apt word. (1) The 50s political habit politicized integration; using it to describe two medicines, the meaning blurs. (2) Integration weights make-one; the two medicines need to stress the difference. Cooperation is more neutral, fits harmony with difference.
2. The word learning (學) weighs a thousand jin
Today's world is flighty. Even guasha, pedicure, fortune-telling drop the technique (術) for learning (學) to sound deep. Learning is everywhere. But medicine is the art of saving lives — a clinical error misjudges a life; a theoretical error misleads forever. So with the word learning, more caution.
Many wish to create Chinese-Western integrated medicine — but wish and reality are different things, oceans apart. As Yan Fu wrote in the 1930s: "Learning seeks natural rule, sets necessary law; technique uses known rule for achievable success. Learning is knowing; technique is doing." Science is foundational principle; experience and technique are not science. Miao Litian (Taiwan), translator of Metaphysics: "Science is goal, not means." (Metaphysics, Zhi-Shu-Fang, 2001, p. 9.) Science is the truth-seeking; technique its functional use. So whether integrated medicine has formed should be measured by this standard; defining it requires natural rule and necessary law.
I wrote Chinese-Western Integration Urgently Needs a Definition (Taipei Natural Therapeutics 2000 No. 4, p. 10), proposing first to define integration, then to discuss how to define integrated medicine.
Definitions seen in papers: "Chinese-Western integration is comprehensively unifying Chinese and Western medicine's knowledge to create new medicine" — a circular definition. Logicians won't accept it; new medicine is just renaming.
Compare ten foundational disciplines from secondary or first-year university:
- Mathematics — the science of spatial form and quantity relations in the real world.
- Chemistry — the science of substances' composition, structure, properties, change, and energy at the molecular, atomic, ionic levels.
- Physical geography — Earth's surface environment, distribution, and developmental laws.
- History — the specific process and laws of human social development.
- Biology — structure, function, origin, and developmental laws of living beings.
- Human anatomy — human body's form, structure, origin, development.
- Human physiology — the body's normal functional activity and laws.
- Histology (microscopic anatomy) — by microscope, section, stain — cells and tissues' form and connection.
- Molecular biology — at the molecular level, biomolecules (protein, nucleic acid) — structure and function, revealing life's laws.
- Biochemistry — chemical molecules and reactions in cells and organisms.
All defined by research object's essential nature (sometimes also method). To note: integrated medicine takes both mature TCM and Western medicine as research object; the "new medicine" wished is still being created, nowhere near a mature category-system. No scientific precedent for this; perhaps that is why the circular definition has to be used.
3. Today is the time for Western medicine to bid farewell to modern scientism
Modern scientism makes modern physics-and-chemistry concepts and methods the supreme criterion of all science. People used them to build unprecedented modern material civilization in non-life domain, and to explain organ-tissue-cell-molecule levels of life. But — even today — we cannot connect a few gene fragments into a virus. The simplest life cannot be man-made. So modern physics-and-chemistry does not explain all life-phenomena; it should not be medical science's only standard.
Descartes' Animals are machines and La Mettrie's Man is a machine are products of modern scientism. The 1970s American Engel proposed the bio-psycho-social model, accepted by WHO. People interpret it differently, but in medicine humankind has at least come to recognize modern scientism's limits. That alone is an epochal advance.
In the 1930s, Luo Zhixi (a Chinese student in Europe) wrote in Science and Metaphysics: "A major advance in the modern scientific concept is the recognition that science is descriptive." (Beijing Commercial Press, 1999, p. 17.) Descriptive — using modern science-and-technology to record and describe phenomena not before visible; "descriptive" stresses that what is recorded at another level is still phenomenon. Seeing today what we did not see yesterday does not mean grasping the causal relations behind.
Even before Luo, late 19th-century philosophical scientists — Kirchhoff, Mach, Poincaré, Pearson — criticized the principles of science are nature's law, absolute… determine cause and effect, and nature obeys as dogmatic superstition. Hume's critique cut deeper: "All our knowledge comes from sense impressions, which become ideas. Our knowledge is only the agreement or disagreement of our ideas. Beyond, we cannot know."
These match Aristotle's science / technology / experience. Using modern science-and-technology to describe phenomena, facts, relations is mostly technological invention, not scientific discovery. Einstein cried: "Causality must exist." Because he understood that phenomena are effects; only revealing the principle behind — the essential cause — is science.
In spring 2003, during SARS, I saw an interview with Dr. Wang Chen, deputy director of Beijing's Chaoyang Hospital — a Western-trained physician returned from study abroad — who said: modern science is descriptive; modern medicine is not really science in the strict sense — mainly modern technology and experience. The only person I saw say this during SARS. I was thrilled.
My understanding: as modern Western medicine — by physics-chemistry tools — goes deeper into cell to molecular levels, similarity between human life-phenomena and those of animals and even plants at those levels grows ever greater. Several new problems follow: (1) Western medicine drifts ever further from medicine's true research object — the integral, in-the-world person. (2) Deep diagnosis amazes the world, but treatment falls into unprecedented difficulty; specific effective drugs ever harder. (3) Drugs targeted at cells, molecules, bacteria, viruses produce more and more inevitable side effects on the real person. I call this modern-Western-medicine's paradox.
Aquinas and Aristotle, in their form and matter discussion, already explained the paradox: "All things are composed of matter and form." So with the human: the integral-level person is form; cells and molecules are matter. Matter is potency; form is actuality. Matter has potency to compose form, but form constrains matter. Matter without form cannot stand alone.
By this, Western medicine focuses on matter-human, Chinese medicine on form-human. Without the matter-side, no Western medicine; without the form-side, no Chinese medicine. Human disease-prevention-and-treatment must be jointly borne. So long as the form-and-matter principle holds, the coexistence of TCM and Western medicine cannot change. Wisely: Western medicine must bid farewell to modern scientism, must not reject and reshape Chinese medicine. Western medicine cannot cover all medical science, as matter cannot replace form.
4. Today is the time to re-recognize Chinese medicine
"Since the Opium War, China has lost sovereignty and acquired a severe cultural-inferiority complex. Modern history has been one of ceaseless self-denial of cultural tradition. Not only no cultural superiority — even the ability and will to recognize our own culture seemed lost." (Wu Qinghui, Globalization, Chinese Culture, and Hong Kong Education, Monthly Reports 2003 No. 3.) So Chinese doubting and denying TCM's scientific character began after the Opium War. Take yin-yang and five-phase as example.
Yin-yang and five-phase is the methodological base by which TCM left empirical-medicine and entered the rational-theoretical stage. Without it, there is no Chinese medicine.
The doctrine is not exclusive to TCM. The Zhouyi is the earliest extant classic discussing yin-yang. Warring-States Zou Yan founded the five-phase doctrine — his Zouzi and Zouzi Beginning-and-End lost. The Huangdi Neijing came after Zou Yan; yin-yang and five-phase's full embodiment in the Neijing should be seen as the specific working-out of Zou Yan's thought in Chinese medicine. For 2,000-plus years, the Neijing has remained TCM's authoritative classic.
From the 19th century, first Chinese cultural figures with Western contact disparaged yin-yang and five-phase — Liang Qichao, Kang Youwei, Yu Yue, Zhang Taiyan, Lu Xun. Then Yu Yunxiu and other Western doctors. The charges: feudal, backward, superstitious. But feudal is a political concept, backward a temporal sense — irrelevant to medical science. As to superstition: to believe without knowing is superstition. Those who, by ignorance-bred bias, do not know and yet do not believe TCM's yin-yang — are themselves the more arbitrary, more ignorant superstition. The cultural-inferiority complex at work.
With dialectical materialism's spread and rise to supreme ideology after the 40s, yin-yang has been called subjective idealism, now objective idealism. In the 1930s, Yang Zemin of the Zhejiang TCM School wrote Philosophical Examination of the Huangdi Neijing — by his understanding of dialectical materialism, a gloss on the Neijing. By his work, yin-yang and five-phase kept the two laurels of plain materialism and spontaneous dialectical thought — but became locked in a new dogma; his interpretation later became the model for Neijing Lecture Notes and Foundational TCM Theory in colleges nationwide. So TCM's yin-yang and five-phase was largely restricted to dialectical-materialist gloss, and its real general systems theory meaning is hard to bring out.
After the 1960s — three discussions about abandon yin-yang and five-phase at least. In 1974, the senior TCM Yue Meizhong, a NPC Standing Committee member, stood against the tide and published "To Criticize Five-Phase, First Know It" — settling the wave.
Qian Xuesen, a famed Chinese scientist and a recognized founder of cybernetics, after coming to know TCM in the 1980s, said many times: "TCM contains much systems thought — which is a grave lack of Western medicine." He directly stated: TCM is a typical open, complex, large system.
In 1998, Taiwan's Kuang Zhiren published Yin-Yang and Five-Phase and Its System, placing TCM's yin-yang and five-phase on the same plane as Bertalanffy's General Systems Theory of the 1970s. Thanks to Kuang for clearing yin-yang and five-phase's name — reconnecting the Neijing and general-systems theory.
Methodology is the engine of any discipline. For a hundred-plus years TCM's methodology was facing being abolished, demoted. How then could TCM advance? That it has not vanished is great fortune. We thank the generations of senior TCM who held the line.
Science has no borders. We need not contend for the invention rights of systems theory in Zou Yan or the Neijing. So long as we honestly reflect on a century of ignorance that nearly destroyed a national cultural jewel, and ache and repent — that is enough. For TCM, struggling for life — now is the time for China to re-recognize TCM; now is the time for TCM's revival.
5. Now is the time for Chinese-Western cooperation and common flourishing
From Aristotle's form and matter, 2,300 years have passed. Chinese medicine, starting from form-human, took the integral-level zheng as object and comprehensive (systems) methods; by comprehensive-deductive logic, formed its theory. Western medicine, starting from matter-human, took organ-tissue-cell-molecule structure-and-function as object and analytic (reductionist) methods; by analytic-inductive logic, formed biomedical theory. When form and matter, comprehensive and analytic methods, deduction and induction can be united into one — whether in another 2,300 years — I don't know. I know only that this question has not been raised by anyone today; it goes beyond present rational capacity. Each medicine has plenty of present problems to solve.
In 1991, I read Foundations of Modern Chinese-Medical Physiology — its thinking-disorder startled me. It said of TCM's spleen-stomach: "Spleen-stomach function is broadly the digestive function in modern physiology" (i.e., Western physiology) (Ji Zhongfu, Beijing Yu-Yuan Press, 1991, p. 178). In 1994, Discussion on Spleen-Deficiency Research Methodology (Wei Beihai, China TCM News, April 15, 1994, p. 3), using Western methods to study TCM spleen-stomach, summed: in domestic animal-model studies, over 60 observation indicators have been used; the relatively specific objective indicator agreed upon is two. The two views are nearly opposite. By the latter summary, the former's broadly is should be broadly is not.
I do not understand how the Foundations of Modern Chinese-Medical Physiology's author — long-time chair of the Chinese Society of Integrated TCM and Western Medicine — could lack scholar's rigor on so serious a foundational-science question. Especially on the foundation: do not give in to wordplay; do not swap concepts. In science I keep: right is right; wrong is wrong — no fuzziness. After reading Foundations, I cannot lightly assent to the integrated medicine he has led.
To pin TCM as empirical medicine by impression alone is, in Hume's words, to make sense impressions into ideas — a misconception. Chinese-Western integration setting out from there is a great error.
In foundational theory, TCM and Western medicine's chapters differ utterly. TCM's jingluo, zàng-xiàng, etiology, pathogenesis, diagnostics, treatment principles, formulas, herbs — each its own. Western physiology, anatomy, histology-embryology, pathology, pharmacology, epidemiology, biochemistry, biophysics, cellular biology, molecular biology, microbiology — each its own. Even cellular and molecular biology naturally coordinate — but creating cellular-and-molecular integrated biology is neither needed nor possible.
I have worked in medicine 40+ years. In youth I worked closely with the Western doctor Yang Wancheng for 12 years on TCM-Western clinical coordination — treating encephalitis B, meningococcal meningitis, viral pneumonia, suppurative appendicitis, biliary roundworm, lung abscess, and non-surgical treatment of ectopic pregnancy. When and how to coordinate — vivid still. In Beijing later, I worked beside the Western doctor Liu Tielin for 16+ years — we still polish each other on theory; we co-wrote Chinese Medicine Must Bid Farewell Once and for All to the Yu-Yunxiu Phenomenon. Once we summed up our years together in a few lines: Respect history; face the present; two systems, one aim; develop scholarship independently, coordinate clinically.
Twenty years ago I read Ye Tianshi's deathbed words to his son: "Medicine may be done and may not be done. Without keen wit, without ten-thousand-book reading, none may by craft save the world. Otherwise, few are not killers — medicine becomes blade." I am dull and shallow; I worry I will fail and become a blade. Before entering the clinic I silently repeat his line. Writing this Plain Discussion — likewise.
A final note. In ancient times plain discussion was Chinese scholars' habit — represent oneself only, force on no one; useful or not, just speak. Take this as my plain discussion of Chinese-Western cooperation.
March 14, 2004