The place of research in TCM (ideas)

[Guest guest]

Thu, 23 Mar 2006 10:26:07 EST, DrGRPorter wrote:

>Without the extensive training that you or

other members of this group have had, even I have had similar experiences.

 

While acknowledging the respect, my training is

not that extensive, and in the presence of people

like Drs. Shen, Hammer, Jeffery, etc., and many

in this forum, " expert " is a term I would not use

to describe myself. What Guy points to above is,

though, crucial. At any level of training,

experience, or " mastery " , those experiences (if

I'm interpreting his words correctly) are what

puts us all in the same boat, and motivates us to

investigate further, and communicate about it

( " stand on each others' shoulders " , to quote a

famous depiction of knowledge/science across history).

 

>In order to determine if this experience is

significant, it would be important to look at all

the myriad things that did not get detected.

 

I'm reminded of a young MD I once met, fresh out

of medical school, who was fascinated by the

notion of holistic medicine, but intimidated in

that his training led him to interpret this as

meaning becoming expert in all the myriad

specialties of Western medicine, i.e. to be able

to see and understand the " whole " . Agreeing with

Paul Unschuld (and my own Western education),

biomedicine is the best (read: " most rationally

convincing " ) medicine so far in human history.

Gilded as it may be, it's a cage. (In the words

of one of Ted Kaptchuk's article titles Gold

Standard (DB-RCT) or Golden Calf?) Anything that

enables also implies limitations (as in the Buddhist proverb Guy mentioned).

 

>Thus, this one experience (that perhaps most

have had at one time or another) is dramatic and

might point us in the wrong direction regarding the conclusion we take from it.

 

From the pure (perhaps " naïve " Western mindset,

any mode of knowledge other than " objective "

validation might well be seen as a wrong

direction. Second-guessing your own experience

could also be the self-judging proprioception of the rational mind.

 

Diversion on multiple viewpoints: There was a

theory (mid-20th century) I once came across that

cultural history can be seen in large scale

phases, namely from " magical " , to " religious " , to

" rational " and then a new (currently emerging)

age of the " aperspective " . The rational, which

still dominates, can be epitomized by perspective

in painting the focus of objects and relative

sizes such that everything is properly placed and

proportioned relative to a single focal point off

in the distance. Then everything appears real,

objective, and socio-culturally proper. In art,

cubism and abstract expressionism marked the

beginnings of moving beyond the rational, and

simultaneously relativity and quantum mechanics

in physics. The term " aperspective " means " free

from perspective " . The " a- " here is called

alpha-privitive, as in 'agnostic' or 'amoral', as

well as numerous medical terms. It means not that

having a fixed perspective is wrong, but rather

that one discovers it is not the whole story.

Note this theory, like the shifts in art and

physics, accompanied the early phases (e.g.

" world wars " ) of what we now call globalization

-- the confrontation of the major cultural

traditions (on terms other than colonialization).

So that theory's idea of the aperspective makes

sense in a world now where different world-views

need to be mutually acknowledged. Each is

self-evidently true in its own context, but must

face the fact nowadays that for other cultures truth appears differently.

 

> Clearly an aortic aneurysm is not an

abstraction. Neither is a large lump in a breast.

In the continuum of things regarded as " real " v

" abstract, " belief systems, spirituality and

cognition are far more abstract. This isn't to

say that they cannot be explored, but rather that

we should be careful with our words since we're on shaky ground, so to speak.

 

Admittedly, distention in an artery, or 'aortic

aneurysm,' and a lump in the breast, or

'neoplasm,' can be taken as descriptions of

phenomena. I was referring to them as technical

terms. The point about the terms (abstract vs

concrete) is subtle but defensible. A datum of

objective evidence is an abstraction in that it

requires a mindset, a belief system, to

appreciate its significance. The significance of

(scientific) objective data is an abstraction of

meaning from the phenomena. The setting has to be

rigidly controlled by the methodology in order to

isolate analytical meaning, a sort of rigorously defined perspective.

 

I just came across (during " Spring cleaning " ) an

article by Z'ev that fills in gaps in this

discussion(1). I will paraphrase the main

metaphor with a (briefer) anecdote of a New

England farmer and his axe " this axe's been in

the family for 5 generations; we replaced the

handle 4 times and the axe head 3 times but it's

the same axe. " Is a particular piece of wood (the

handle) more real (concrete) than the its

belonging to the functional reality of the axe?

Is an " object " really more concrete than its

usage? It's a matter of perspective. One of

Z'ev's points in the article is the importance of

functional relationships (e.g. Sx etc. in

medical Dx), and that Chinese medicine is more

about relationships than objective particulars.

Maybe, aspects of Chinese medicine can be key to

a more exact science of relationships.

 

Scientific findings re cultural relativity:

 

One of the bits of current science I alluded to

earlier is a study of the cognitive dimension of

visual perception. A picture of a tiger in some

setting is presented to two groups of subjects.

One group consists of persons educated in Asian

cultures (say group A), the other educated in

Western cultures (say Group W) -- the independent

variables. The dependent variables were mined

from the descriptive comments when the subjects

were asked to relate what they saw in the

picture. Statistically significant differences

were discovered: group A tended to relate

observations about the relationship of the tiger

to the rest of the picture; group W tended to

relate particulars about the tiger itself.

(Spring cleaning notwithstanding, I've not yet

located this article to be able to supply the reference.)

 

The other bit of science I ran across(2): Most

human languages do not distinguish between the

colors blue and green, i.e. have only one word

for it. Investigators at Univ. Chicago and

UCBerkeley found native English speakers

(English, Germanic languages in general, have

" blue " and " green " words) were faster at

distinguishing (the colors) when they appeared

within the right visual field. The effect

vanished if the subjects were given left-brain

(mathematical) challenges (distractions)

simultaneously. Right visual field goes to the

left brain, as we know, and left brain processes

language, usually. The somewhat surprising

conclusion is that language appears to condition

perception neurologically. There's nothing here

about Chinese, per se, but I doubt that anyone

reading this in this forum wasn't reminded right

off the bat that Chinese " qing " , the color

associated usually with the liver, is somehow

blue-green. In fact, after this article, I

noticed in a Chinese art work on the wall in my

clinic an uncannily beautiful shade of blue-green

used for the foliage it's distinctly blue and

green to the same degree (to my perception!).

 

Scientific method is leading us even into

understanding of " reality " , ie as culturally

influenced and physiologically conditioned

perception of meaning. Research, once we figure

out how (with a little help from our friends,

like Ted Kaptchuk), can become a powerful

validation for aspects of Chinese medicine, as

long as we keep our perspectives in perspective, so to speak.

 

To extend Guy's thought " it would be important

to look at all the myriad things that did not get

detected " it's also important to look at the how we detect things.

 

References:

 

(1) " The DELPHIC BOAT and the YELLOW EMPEROR:

Thoughts on " ; except from

" Reflections on the Nan Jing " [published?]; PCOM

newsletter " Oriental Medicine " , Summer 2005 [accessible on the internet?]

 

(2) " What You See Is What You Say " , by Charles Q.

Choi [sic]; Scientific American, March 2006, p.

32. (synopsis of a report in " Proceedings of the

National Academy of Sciences USA " , January 10th

issue. [i tried on the internet, but you have to pay to get the full text.]

 

 

[Guest guest]

More on CM and the use of scientific research:

 

Few of us here are in a position to stage full-blown research

studies. In Europe large institutional-coalitions execute studies

like the HA studies. Here in the USA the NIH metes out some ($50-100

millions per year, last I read) to organizations like AOM schools for

studies. The results I've seen so far are not overwhelming.

 

While Ted Kaptchuk is participating in the design and execution of

studies, he's dedicated a lot of effort over the last several years

toward mining the data and analyses already there (meta-analysis), to

help gain perspective and point out directions for AOM validation.

 

Something similar any of us can do, in terms of sifting through the

vast preexisting databanks of studies and analyses, e.g. through

PubMed. Some of us have mentioned here earlier that CM's long

experience exploring relationships and patterns can at times provide

organizational overview that helps make sense out of the often

scattered tidbits of Western research ( " indigestible knowledge

stones " as one of my early teachers called them).

 

For instance, I often clip out articles from newspapers, magazines

etc. (and then sometimes trace down the source material through

PubMed) which I find interesting in mapping to CM ideas, and use

these in patient encounters, to help them feel more confident that

the CM theories have some legitimacy.

 

Examples:

 

1) It has been found that flora in the GI tract can influence URT

sinus conditions. I frame that in terms of Earth nurturing Metal,

Sp/St status relating to Lu/LI conditions. As in Western

folklore feed a cold (and starve a fever). This comes up in allergy

cases, which are plentiful here in Santa Clara Valley (Silicon

Valley), due to the agricultural richness of the area, the fog/damp

air off San Francisco Bay, plus the more recent build-up of air

pollution. Intake evaluation often uncovers GI issues in patients who

come in for allergy conditions. In many cases, directing treatment to

Sp/St leverages positive results in the Lu/LI area (alla Li

DongYuan). And it's often locked into a neat 5-phase pattern: Liver

stress excess over-controlling the Sp in its deficiency (high-tech

workers, so busy, no time to eat), which then can't feed its child

Lu/Metal in deficiency, which is then too weak to properly control

the grandchild Liver, and around it goes. In many patients, often in

accordance with constitutional factors, attending to the Sp/St or

also Lr/GB, is more effective that limiting Tx to the Lu dynamics.

 

2) Research finds good breakfast, good lunch is crucial for weight

regulation. They found indication that digestion is more efficient in

the A.M., less so in the P.M. So eating well early in the day

satisfies the body, which is then less hungry later on when the

tendency would be to put that big late dinner into storage (weight)

because it can't be immediately utilized. I see here Yang rising with

the morning sun, St eating time, Sp digestion (and study) time.

Eating well early to stoke the Sp fire, helping it build to its

flourishing with the midday fire/Ht.

 

3) A NYTimes front-page article a while ago: recent epidemic of

serious sports injuries in youth, middle-school through college.

Kids, going all-out to excel, coming down with over-use degenerative

conditions which the specialists are accustomed to finding only in

late 30's and 40's y/o professional athletes. This can be seen as

damage in the constitutional channels (8-extraordinary), specifically

in the Wei channels, which represent sensitivity to taxation or

trauma at the major developmental articulations of life (the 7/8-year

cycles). Or in the terminology of Dr. John Shen's, damaging " body

condition " , which is how one develops from birth to ca. 20 y/o, i.e.

not genetic or congenital Jing, but it's unfolding to maturity. Who

of us has not seen those cases of injuries in youth which resurface

later in life. Being not totally resolved initially, these conditions

have entered the constitutional, or Jing level.

 

(This depiction of the 8-extra, the Wei Mai, is inspired by Jeffery

Yuen's interpretation: illustrated for example by a photo album of

one's baby pictures, childhood, youth etc. There one sees the state

of YinWeiMai, how the Jing is unfolding in stages through bodily

form. And YangWeiMai expresses as the activities of those various

times of life, how the YangQi of the Jing expresses in developing the

individual.)

 

4) The famous recent study of interaction between Ginseng and

warfarin (Coumadin). Young, healthy subjects (probably college or med

school students) were given warfarin and Ginseng. It was found that

Ginseng countered the effects of warfarin, i.e. it's affect on blood

coagulation. The popular conclusion in the media was to

contraindicate use of Ginseng in patients with coagulation issues,

e.g. stroke risk or sequellae. By extention, no Ginseng for anyone,

and many extrapolated to advise no CM herbs, for anyone.

 

Another interpretation of the study could be that Ginseng, with its

adaptogenic properties, actually helped the subjects back towards

homeostasis in the presence of the toxin warfarin (also known as " rat

poison " ). Non of the reviews I've seen (WM medical newsletters, the

media, etc.) managed to notice this possibility.

 

Opportunities like these arise often, and are useful in helping

patients understand that CM can be validated. And I believe there's

the larger opportunity of mining this field of disparate scientific

tidbits and drawing relationships into larger, coherent patterns

using schema found in Chinese medical traditions. (As been touched on

also previously in this forum.)