chinese medicine: a science in its own right (written in 1977)

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chinese medicine: a science in its own right

 

by Manfred Porkert

 

 

Scientific discoveries and inventions should eventually benefit all

mankind. However, even in our age, historical conditions may for a

long time inhibit or delay the diffusion of even the most mature and

incontrovertible findings of an exact science.

 

Chinese medicine or, to use the more precise term, " traditional

Chinese medicine " , is perhaps the most outstanding example in point.

To understand this paradoxical situation, a few historical facts

should be reviewed briefly.

 

Chinese medicine, as all sciences of nature in China, had been

fostered and brought to maturity by what, for want of a better term,

we may call Daoist consciousness—implying a vivid yet serene

awareness of all cosmic phenomena including the diverse functions of

a human personality (we intentionally say `personality' since the

Daoists never divorce mental and physical processes). Before this

background, Chinese medicine as early as the third century BC, by

the diffusion of the Huang Di Nei Jing (the Inner Classic of the

Yellow Sovereign) accomplished the transmission from an empirical

formative stage to a true healing science, logically stringent in

method, highly effective in practice. This healing science,

apparently since the beginning of the Christian era until the 11th

century AD, was superior in nearly every respect to anything

available elsewhere in this world. Unfortunately, this development

did not persist.

 

For during the 11th century, the Confucian administration had

definitely taken over the training, examination and to a large

extent even the employment of doctors and pharmacists.

 

At the outset, the result of this change appeared to be quite

beneficial. Concentration of the most competent physicians and of

all the organized training facilities in the provincial centers and

at the capital fostered a more intense exchange of ideas as well as

wholesome competition among different medical traditions. This in

turn led to an extraordinary expansion of medical research and

theorizing. The 12th and 13th centuries witnessed a dramatic

increase in medical publications. Then, the deleterious influence of

Confucian values upon medical thought became evident, an influence

that had been latently effective for quite some time. It should here

be recorded that the salient trait of Confucian thought through more

than two millennia consisted in an unswerving concentration upon the

social phenomena, i.e. upon the perception and systematic control of

human relations. In comparison to the social issues, in the eyes of

the Confucianists, all other problems dwindled to mere trifles,

unfit to occupy the minds of any serious scholar. Upon such

premises, the integration of medical education and research into the

Confucian administrative system gradually yet ineluctably caused

humanistic and sociological methods to be applied to the solution of

biological and medical problems, a tendency which, in the long run,

lead to a perversion of theoretical speculation and to an erosion of

clinical and empirical research.

 

This degenerative process of medical empirical science in China

reached rock-bottom during the l9th century. In practice Chinese

medicine then consisted only of an odd assortment of proven and

fairly crude techniques between which most practitioners could

hardly grasp, let alone reconstruct, the guiding ideas. Worse still,

the widening gaps in what formerly had been a highly consistent

scientific system had been filled with a host of paramedical, i.e.

magical or exorcist, procedures. When, at this critical juncture, to

top it all, Western medicine appeared upon the scene in the wake of

Western civilization and political influence, the total demise of

indigenous Chinese medicine seemed to be imminent.

 

At the turn of the century, what many outside observers believed to

be the agony of Chinese medicine was apparently protracted only by

the utter destitution of the country and by political chaos.

Consequently, it was a matter of general surprise when, after the

founding of the People's Republic since the early fifties, the

better part of China's traditional medical literature was again made

available in excellent editions, and when gradually an increasing

number of spoken language translations of the medical classics as

well as of modern studies and textbooks appeared.

 

The policy of the new government regarding traditional Chinese

medicine culminated in the November 1958 decision of the Central

Committee which explicitly stipulated that traditional Chinese

medicine should be employed side by side with Western medicine. As a

consequence, in the People's Republic doctors of Western medicine

also received what is considered a grounding in Chinese medicine and

doctors of Chinese medicine are urged to familiarize themselves with

the fundamentals of Western medicine.

 

The implementation of this at first sight most judicious directive

led to numerous improvements in health care within China and to some

new discoveries such as acupuncture anaesthesia. Yet viewed from a

distance of almost two decades since its issuance, there is ample

evidence that since the mid-sixties it is jeopardizing and might

even destroy the very tradition which it intended to preserve.

 

The two principal factors bringing about this most regrettable shift

are easy to define:

 

1) In China, already during the years after 1911, and even more so

since 1949, constant preference has been given to practice-oriented

research, leaving little room for basic investigations into the

premises of China's scientific heritage and none at all for the

advanced philological and epistemological research that is

indispensable to accomplish the amalgamation of traditional Chinese

science with modern Western science.

 

2) The—at first bona-fide, now quite often dogmatic—advocacy of the

premise that Chinese medicine at best represents an empirical

discipline whereas, by contradistinction, Western medicine

constitutes scientific medicine. This latter premise, if left

unrefuted, would eventually wreak the extinction of Chinese medicine

as a distinctive science.

 

 

THE PITFALL OF CONFUSING " SCIENTIFIC METHOD " AND " SCIENTIFIC

CRITERIA "

 

In order to be used today and in the future, traditional Chinese

medicine, as any other discipline, must be assessed, evaluated and

redefined in accordance with the `criteria' of modern science. But,

of course, these criteria must not be confused or identified with

the `methods' used in different fields of modern science. Since even

scientists sometimes are liable to confuse `methods' and

the `criteria' at the basis of these methods, let us simply recall

that the essential criteria of exact science in the modern sense

(e.g. physics, chemistry or astronomy) are:

 

1 Positive experience,

2 Univocality of statements,

3 Stringent rational integration (systematization) of empirical data.

 

It should also be noted that different from these essential criteria

are a number of other criteria such as notably the causality nexus,

controlled experiment and quantification of data. These constitute

accidental criteria whose application is limited to some specific

disciplines or fields of research only.

 

The question of paramount interest is to what extent does Chinese

medicine comply with the essential criteria of exact science as

enumerated.

 

There is practically no controversy about the fact that Chinese

medicine is based upon positive empirical data, upon close and

skillful observation of natural and social phenomena. Admission of

this is implicit even in the most dilettante accounts of Chinese

medicine appearing today in the Far East and in the West, which

label Chinese medicine an `empirical medicine'. Most students with

only moderate familiarity with the original sources of Chinese

medical literature agree that these show stringent systematization

of collected data. The only issue that baffles modern advocates and

critics of Chinese medicine alike is the application of the second

essential criterion of science, namely the achievement of

univocality of statements. Univocality of statements denotes that in

a given context every single statement must only be employed and

accepted with one single, precisely defined meaning, to the

exclusion of all others, with even slightly similar meanings. (This

criterion distinguishes `scientific' from `common' and even

from `philosophical' statements which, as a rule, can be understood

or interpreted in more than one way.)

 

Univocality of statements is achieved by, the expression of data

with reference to conventional standards. The best-known and today

most widely applied conventional standards of Western science are

those of the so-called metric system (c.g.s. system) and its

technical derivations.

 

These standards are called conventional because their application

rests solely upon the tacit or even express agreement of all

contributors to a science to formulate all findings with reference

to these standards. In other words the standards are not themselves

the outcome of any discovery or invention; even less are they the

expression of natural law or necessity. Instead they have to comply

with the methodological and technical requirements of the science

which they serve.

 

Why this lengthy description? Because in Chinese science the

qualitative standards of Yin and Yang and the Five Phases play a

role quite parallel to the c.g.s. standards of Western science;

because in recent times the failure to correctly assess the role of

Yin and Yang and the wuxing has led to endless fruitless debates

about the very essence of medical science in China. I doubt, this

failure is in turn only the result of a very imperfect perception of

the complementary and polar roles of Chinese and Western science.

 

 

THE POLARITY OF CHINESE AND WESTERN SCIENCE

 

After what has just been stated, if we use the term " polarity " , we

do not do so because the expression may be en vogue in certain

contexts. Rather are we motivated by its strong and basic

implications, namely, polar statements are mutually exclusive, at

the same time mutually perfectly complementary.

 

Polarizing filters perfectly shut off light of one plane of

oscillation, letting pass that of all other planes with different

intensities. Any scientific method and its concomitant terminology

produces effects similar to that of a polarizing filter: it gives

unimpeded passage to cognate data, more or less modifies most other

information and hermetically precludes directly polar statements.

 

It is well to keep in mind these effects when we are faced with the

fact that today throughout the world, and including China and Japan,

practically everybody making a claim to a scientific opinion on

Chinese medicine has, to start with, been thoroughly inculcated with

the essentials of Western medicine. This fact by itself, would

suffice to explain why modern medical authors either flatly are at a

loss to conceive any scientific system different from, yet on a par

with, Western medicine, or, if they suspect that there might be more

to Chinese medicine than some drug and acupuncture recipes, why they

experience extreme difficulties in substantiating such a

hypothesis. — Why should this concern us? — Because to the extent

that the exact sciences of the West implement their criteria for

heuristic methods of unprecedented stringency and effectiveness,

there is, in recent times, increasing evidence showing that

precisely these criteria and truly scientific methods are really

applicable and produce impressive results only within a few clearly

defined sections of medical endeavour—leaving others on the level of

proto-scientific empiricism.

 

Every physician has been taught that the specificity of diagnoses

and therapy as well as the precision of prognoses is in direct

proportion to the rational elaboration, hence to the scientific

stringency of any statement. Consequently, in his daily practice, he

is constantly reminded of the steep gradient existing in Western

medicine between very precise and very vague statements. But he will

lack the leisure as well as the intellectual tools to explain this

gradient. This leads us to the question of the limitations of the

specific method of Western medicine: causal analysis.

 

 

CAUSAL ANALYSIS AND ITS LIMITATIONS

 

Everybody is aware that not each and every object or effect may be

completely perceived from a single vantage point or out of one

single perspective. And surely this truth applies not only to

particular professions such as astronomers, who are obliged to erect

their observatories in the Northern and Southern hemisphere as well

as in favorable climates – but to absolutely every scientific

discipline.

 

It also applies to heuristic methods and to epistemological modes.

Thus in order to perceive and control matter, substratum causal

analysis is required. Causal analysis implies that all relations of

an observed effect to other simultaneous effects are consciously

severed or suppressed and the relation to its cause is explicitly

established. Causes axiomatically precede their effects in time,

hence, by definition, lie in the past. Past effects constitute

materialized effects, hence matter.

 

Inversely, causal analysis confines positive perception and control

to concrete, material, somatic objects. Not even the most

judiciously chosen real vantage point will let our eye sight (or the

perception of instruments invented to boost their power) take in all

the things that may be seen; similarly, no single mode of cognizance—

which also implies a finite cognizable horizon—will enable us to

perfectly perceive all cognizable effects. The limiting factor of

the significance (and applicability of causal analysis is what) from

the vantage point of human perception is the decrease of the

homogeneity of substrata (matter). This homogeneity of substrata

appears to be the greatest in elementary particles whence we observe

a steady decrease as we proceed from these in the direction of

atoms, molecules, cells, tissues of primitive and higher organisms,

animals, human beings, social, political, cultural communities,

planetary and galactic systems......

 

The information that any textbook gives, for example, on the oxygen

atom is not merely the result of the observation of one single and

particular oxygen atom; rather is it based upon the observation of a

statistical number of such atoms.

 

This procedure will yield statements of a probability almost equal

to 1 because of the high homogeneity of the atoms. In other words,

as a consequence of the fact that the oxygen atoms involved show

practically no significant individual differences. Similar

consequences apply to other phenomena, with the evident restriction

that a decrease in homogeneity (increasingly significant individual

differences) will reduce the stringency, the probability, hence the

positive quality of statements based upon causal analysis.

 

Due to the continuous decrease of the homogeneity of substrata

(material objects), the limit of significance of statements based

upon causal analysis is evidently situated in the center of the

scale occupied by biological phenomena where human medicine

exercises its functions. In other words, in the vicinity of this

borderline, causal statements approach and finally attain the

average probability of all aleatory procedures. Or, put still

differently, the greater the differentiation and complication of

biological organisms (decrease in homogeneity), the less probability

attaches to inferences drawn from the observation of one single

individual as regards the reactions of all others. Less stringency

also attaches to statistical data obtained from the observation of

large number of similar individuals if used to prognosticate in

detail individual and specific changes. In brief, the stringency and

significance of statements based upon causal analysis show a clear

decline in the field of human physiology; and they fade away into

utter indetermination when psychological or social phenomena are

involved.

 

 

INDUCTIVE SYNTHESIS AND ITS LIMITATIONS

 

The fact just described that statements based upon causal analysis

will completely lose all stringency and significance is by no means

tantamount to a complete blurring of stringent rational statements

bearing on the phenomena concerned; after all, causal analysis is

not the only mode of cognizance, not the sole perspective permitting

the rational expression of positive statements on reality.

 

In order to perceive and control functions, movement, dynamic or

psychic phenomena, inductive synthesis is required. Inductive

synthesis implies that agents actually inducing effects in each

other are consciously maintained or assembled. Induction implies the

simultaneous presence of agent and effect (and perception). Present

effects constitute dynamic effects functions, movement.

 

Inversely put, inductive synthesis confines positive perception and

control to dynamic, functional effects or phenomena.

 

Needless to insist, just as causal analysis, inductive synthesis has

its natural and axiomatic limitations. The significance of

statements based upon inductive synthesis out of the human cognitive

perspective appears to be limited by the stability of functions, in

other words, by the relative duration within which a given function

is maintained in the same quality or direction. This stability of

function appears as being great in galaxies and shows a continuous

decline in planetary systems, cultural, political, social

communities, human individuals, higher and lower animals... In other

words, the stability of function varies in inverse proportion to the

homogeneity of corresponding substrata.

 

[Our use of the terms inductive, induction, inductivity derives from

and extends the meaning these terms have in Electrodynamics.]

 

In practice, this theorem establishes the complementary validity,

significance and applicability of causal analysis and inductive

synthesis: to the extent that the positive quality of statements

based upon causal analysis decreases, that of statements based upon

in inductive synthesis increases—and vice versa.

 

At this juncture we should have little difficulty in realizing that

the thematic over lapping of the positive results of causal analytic

science and inductive and synthetic science may occur only in a

small central area, that, consequently, aside from this, both will

furnish equally positive and significant data on utterly different

aspects of reality.

 

 

THE MESSAGE OF CHINESE MEDICINE OBSCURED BY THE FASHIONABLE USE OF

WESTERN TERMINOLOGY

 

Resuming the preceding comparisons we should bear in mind,

 

la. the adequate perception of movement is dependent upon its

duration;

lb. the adequate perception of matter is dependent upon its

homogeneity.

 

2a. Similar movements (functions) show qualitative differences;

2b. similar material bodies show quantitative differences.

 

3a. The choice either of a causal and analytic or of an inductive

and synthetic approach is neither an indifferent nor a personal and

arbitrary one; instead it will determine which part of reality will

be defined positively;

3b. similarly — conventional standards being intellectual tools for

achieving univocality of statements — the choice of either

quantitative conventional standards (the metric system) or

qualitative conventional standards ( Yin, Yang and the wuxing, the

five Evolutive phases) is determined solely by the aspect of reality

that is to be dealt with.

 

4a. The refusal to use these tools will thwart any attempt at

achieving any degree of scientific stringency.

4b. The use of the inappropriate tools (e.g. of quantitative

standards applied to the functional statements of Chinese medicine,

or qualitative standards used on the material data of Western

science) will obliterate or destroy existing scientific data.

 

What applies in a strict and narrow way to the conventional

standards applies in a wider sense to scientific terminology in

general. It is a well-known fact that the massive influx and

acceptance of Western science and technology into China and Japan

since the 19th century in these countries gradually lead to contempt

for, if not outright ostracism of, all traditional learning,

including medicine. And, to be sure, this disdain was only to a

small extent justified by the real shortcomings of indigenous

science; it was (and in fact still is) preponderantly motivated by

the trauma and inferiority complexes in the wake of the political

and cultural collapse following Western expansion into East Asia.

 

In Japan the government flatly ruled that Western medicine

constitutes the only scientifically acceptable and proven kind of

medicine and is consequently prerequisite to the training and to the

licensing of every physician. In China, the struggle between both

systems is still on. The sympathies of the Chinese medical

establishment are clearly going to Western medicine with its

cosmopolitan and modern flavor. In this situation the practitioners

and advocates of traditional medicine fell to what they thought was

the best expediency for convincing everybody of the value of the

traditional craft: they tried to explain it in terms of Western

medicine. From what precedes it should be clear that those well-

intentioned native defenders of their medical heritage are in

reality jettisoning and destroying what they set out to preserve. As

a highly instructive example let us consider the case of anatomy

versus Zangxiang, orbisiconography.

 

 

ANATOMY VERSUS ORBISICONOGRAPHY

 

Anatomy is rightly considered one of the mainstays of modern medical

science. Any graduated MD today treating a patient in any corner of

this world will have a neat array of anatomical knowledge operative

at the back of his mind.

 

So what should there be wrong with the statement that anatomy is

prerequisite to curing sick people'? Chinese doctors, so we are

told, at times have been very successful in curing disease; And

their recent accomplishments in the People's Republic of China

certainly offer ample evidence of the effectiveness of their

techniques. So why not grant that they must have at least some basic

notions about anatomy? This is precisely what we find rehashed today

in all the popular and not so popular accounts of the theories of

Chinese medicine not only in the West but also in modern China. A

simple experience should put us on guard. Any Chinese doctor who,

speaking English, may blithely perorate on `Chinese Anatomy `(with

an apologetic shrug sometimes: `It: is very primitive'), will

unfailingly avoid the equivalent of the Western term (Jie pou xue,

Anatomy; literally " The Study of Dissection " ) as soon as he talks in

Chinese on Chinese medicine. Why? Because his language has a

different term for what he and his Western colleagues, out of habit

or convenience, have persistently called " Chinese anatomy. "

 

This term is Zangxiang, and its English normative equivalent

is `orbisiconography'. It is under this term — Zangxiang — that the

body of knowledge in question is dealt with in all except the most

recent Chinese textbooks of Chinese medicine.

 

Consulting the usual dictionaries for the usual meanings of the

terms Zang and xiang will advance us but slightly. Xiang is given

as `picture', `image', `outward appearance'. Hence, since we deal

with a descriptive discipline, the notion `imagery' and, from the

Greek eikon equal to `picture', iconography may appear justified.

The term Zang, however, is only given as `intestine', an equivalent

perfectly acceptable if it occurs in the speech of a butcher or an

ancient Chinese executioner. It makes next to no sense in the texts

of traditional Chinese medicine.

 

With the sole exception of the Nan-jing, a slim book, probably

compiled during the second or third century AD, positively no

influential medical treatise produced during the more than two

millennia of the indigenous Chinese tradition gives anything that

could be generously admitted as `anatomical data' beyond the

statement that certain Zang are situated above, others below the

diaphragm.

 

But what then do the compendious chapters on the Zang, found in

almost every treatise, contain? They are filled with wild

speculation and insipid theories, we are told by the self-

appointed `experts'. These `experts' point to the pictures with

which some of the Chinese authors had rashly chosen to illustrate

their Zangxiang theories.

 

These pictures are revealing indeed. To bring them in to full

relief, let us recall that, in the course of history, Chinese

butchers have slaughtered millions of pigs and Chinese executioners

have slashed open or cut to pieces tens of thousands of criminals.

How then did the Chinese medicos envisage and depict the Zang? A

Zang called `heart' connected through the `lung pipe' (trachea) with

a Zang called lungs'; the same Zang connected by three (or four)

separate ducts with other Zang called

respectively `liver', `spleen', `kidneys' and again `lungs'; a Zang

called `urinary bladder' connecting by its upper orifice to a Zang

called `large intestine', etc.

 

May we conclude that Chinese doctors did only take a most

perfunctory look at the intestines when they had a chance to inspect

them? — It is probably more correct to state that they did not look

at them at all!

 

This persistent refusal of Chinese doctors to perceive the

macroscopic configurations of the vitals before their eyes will

amaze us only if we very much underrate the decisive influence of

the perceptive modes (i.e. inductive versus causal) which produces a

complete polarization of reality already on the level of empirical

description.

 

To make the picture complete, Western doctors to this day manage to

ignore almost completely a host of quite significant functional

changes that they might clearly discern without the aid of an

instrument every hour of the day, upon their own and their patients'

organisms. It is these functions and their changes which form the

meat and marrow of Chinese medicine. It is the description of these

functions which constitutes the fundamental data coming under the

heading of Zang-xiang, orbisiconography.

 

If we examine the information laid down in the chapters on

orbisiconography, we rapidly become aware that nearly all the

statements made bear on the imbricated and interdependent vital

functions, on cyclical functional patterns, in other words on `orbs

of functions'.

 

The felicity of this choice of an equivalent is confirmed in

whichever direction we may decide to advance into the complexities

of Chinese medical theory.

 

Take for instance the problem of the sensible interpretation of the

orbisiconographic illustrations already alluded to. If Zang is

understood as an orb of functions then the pictures of orbis-

iconography can only represent graphic models similar to those used,

for example, in nuclear physics. No physicist, building a model of

some specific atom, will believe that he is simply enlarging a

photographic picture of such a structure; and if he represents the

electron by smooth metal balls, and their tracks by metal rings and

the nucleus by a raspberry, he will never pretend that, on a much

smaller scale, the real electrons are smooth balls running on metal

rails, and the nucleus looks like a raspberry. If his model of the

atom incorporates elements more or less resembling known objects,

this is merely because he intends to appeal to the imagination and

to help the memory of those whom he wants to instruct. Similarly,

the medical authors who formerly illustrated the orbisiconographic

treatises did not (and never pretended they meant to) depict what

they had observed in an anatomical theatre. Their unique aim was to

facilitate the mnemonic assimilation by their reading audience of

systematized results of positive observations.

 

This point leads us directly to another point that must be made with

regard to the normative translation of Zang by orb(i)s: Having

constantly stressed the fundamental difference of outlook at the

base of Chinese and Western sciences, we should have no difficulty

comprehending that, not in spite of, but precisely because of, the

high degree of empirical sophistication and logic consistency

achieved in each system, their respective statements can never be

completely congruent.

 

A Chinese " Zang-manifestation " (orbisiconogram) is the logical

integration of the positive observations on a coherent chain of

manifest functional changes of the human being (we do not say `body'

since, let us repeat, the Chinese did not divorce physis and

psyche). And, in spite of the name it may bear (e.g.-cardial

orb) `heart' or `spleen (orb)'..etc., it is only faintly associated

with the somatic organs so designated. No traditional Chinese doctor

will pay greater attention to pulses when dealing with disorders of

the cardial orb than in dealing with those of the `spleen' .

 

By contradistinction, the functions Western physicians attribute to

the elaborately described organs are accessory to the anatomical

definitions of these organs. The Western medical scientist feels

awkward if he has no organ to account for a given vital function;

the Chinese medical scientist would have been worried if he failed

to tie in properly a newly observed function with a stock of

functional observations accumulated by his predecessors. The latter

is, it may be recalled, the attitude of the astronomer from

antiquity to this day.

 

 

CONCLUSIONS

 

There is a worldwide consensus within the medical profession that,

in spite of the significant advances of medicine during the past 100

years, for a large proportion of ordinary health disorders still no

safe and certain treatments exist. Hence the continued search for

new treatments and remedies, hence the interest in medical

traditions beyond the methodological limits of Western medicine.

 

Traditional Chinese medicine constitutes by far the most

comprehensive, coherent and effective body of medical science beyond

these limits. Yet to this date, and despite the most intense efforts

in China as well as in the West, only a small fraction of its

therapeutic potential has really been tapped. Worse still, by the

very efforts made to exploit Chinese medicine, its scientific core

and essence is in danger of obliteration. This danger as well as the

meager results of pertinent research — as our considerations were

intended to demonstrate — are quite patently the consequence of a

confusion between scientific criteria and scientific methods.

 

Thus instead of applying to Chinese medicine the universal criteria

of exact science, the absurd and of necessity, abortive attempt is

constantly repeated to reassess it by means of methods evolved by

and only applicable to Western medical science. This attempt is

tantamount to observing the stars during the day or watching clouds

during a moonless night: no amount of persistence will then produce

the information which could otherwise be obtained quite easily.

 

Consequently respecting and applying the methods of Chinese medicine

in order to verify and apply the mature and rational data of this

very medicine is not a matter of historical style but an ineluctable

necessity of elementary logic. The sooner this is realized, the

sooner hitherto seemingly insuperable obstacles may be overcome.

 

 

Dr. Manfred Porkert is professor at the Institut für Ostasienkunde

der Universität München, West Germany.