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

[Guest guest]

chinese medicine: does it have a scientific basis?

 

by Janet Plummer

 

This article is a response to Dr. Porkert's previous article

 

 

I was rather concerned to read Professor Manfred Porkert's

article " — a Science in its own Right " in the

February 1977 issue. I fear I would have had even greater difficulty

in understanding his article had I not attended a similar lecture

given by Professor Porkert at the University of Hong Kong in 1976,

and later discussed it with him at some length. Did any other

readers have the same problem?

 

As it was, I hurried to my dictionary in order to try and fully

understand what was being said, for I felt I could not let his

article go unchallenged.

 

My first point is that the style of such an article does not further

the author's argument. The lack of clarity and conciseness leaves

much to be desired. In fact it brought to my mind the speech

delivered by the late Mao Tsetung at a cadres meeting in Yunan on

February 8, 1942, and entitled `Oppose Stereotyped Party-Writing' in

which he said among other things:

 

The fifth indictment against stereotyped Party writing is that it

arranges items under a complicated set of headings, as if starting a

Chinese pharmacy.

 

For all its verbiage, an article that bristles such symbols that

does not pose, analyze or solve problems...is devoid of real content

and nothing but a Chinese pharmacy.

 

(Quoting Dimitrov:) We must learn to talk to the masses, not in the

language of book formulas. . .

 

When writing or speaking always have in mind the rank-and-file

worker who must understand you. . .

 

The fourth rule of the eight rules of writing set out by Lu Hsun is:

 

After writing something, read it over twice at least, and do your

utmost to strike out nonessential words, sentences and paragraphs,

without the slightest compunction.

 

(Rule 6:) Do not coin adjectives or other terms that are

intelligible to nobody but yourself.

 

We have `coined' too many expressions that are `intelligible to

nobody'. Sometimes a single clause runs to forty or fifty words and

is packed with `adjectives or other terms that are intelligible to

nobody `.

 

However the article speaks for itself and my purpose in writing is

actually to challenge some of Professor Porkert's basic statements.

I have to admit I am at a great disadvantage for I also am one of

those `unfortunate' people mentioned by the Professor: `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.'

 

I should like to take issue with Dr. Porkert on several points:

 

 

1. WESTERN SCIENCE VERSUS CHINESE SCIENCE

 

We are told that `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. This failure is in turn only the result of a very imperfect

perception of the complementary and polar roles of Chinese and

Western Science.' There follows a discussion on `The Polarity of

Chinese and Western Science'.

 

Is it a valid concept to talk of Western Science and Chinese

Science? My little dictionary defines `Science' as `systematic

knowledge of natural or physical phenomena; truth ascertained by

observation, experiment and induction...'

 

This `systematic knowledge', this `truth ascertained', is the same

the world over and indeed one of the ratifying factors for

scientific truth is surely that these observations or experimental

results can be reproduced anywhere (under the same conditions) by

anyone with sufficient scientific know-how.

 

Science is science the world over and should not be identified with

the West, nor does it belong to the West or anywhere else, because

scientific fact, i.e. scientific truth, is absolute, provided all

factors are taken into account. It will stand up to the light of

critical examination no matter where the scrutiny is carried out and

by whom.

 

Is the Professor claiming that Chinese medicine is a Science in its

own right, but scientific method (as understood In the West) cannot

be applied to Chinese medicine? If this is his claim, I must

heartily disagree, and I fear such a claim will only bring further

discredit to Chinese medicine.

 

 

2. CAUSAL ANALYSIS AND ITS LIMITATIONS

 

Professor Porkert then proceeds to describe the limitations of

Western medicine and points out that Western medicine is not an

exact science because it is a biological science — the observations

are made on human beings and not inanimate objects and there is

therefore room for variation.

 

No one will disagree, but the Professor is going too far when he

says `the stringency and significance of statements based upon

causal analysis show a clear decline in the field of human

physiology.' We are perhaps left with the impression that Western

medicine is not scientific after all! The problem (if there is one)

of biological variation is overcome by ascertaining a range of

normal, e.g. pulse rate, blood pressure, respiratory rate, serum

sodium level, etc. Moreover there are very predictable consequences

should the normal range of values be exceeded in either direction.

Is this not what yin and yang is all about, viz. a tendency for a

physiological function or value to be too high or too low?

 

Of course what does vary is the ability of the individual to adapt

to these potentially lethal changes and this I believe is the core

of the theoretical basis of Chinese medicine — the concept of

homeostasis, known to practitioners of Chinese medicine many

centuries ago but a concept which only really began to come to light

in the West in the 18th century. The Nei Jing states if the `body

resembles burning charcoal...the (sickness) can. be dispersed only

through perspiration', i.e. if one develops a high fever it will

only fall through perspiration. In the West, Charles Blagden, born

in Edinburgh in 1748, wrote an article in 1774 entitled `Experiments

and observations in a heated room' in which he discusses the

constancy of body temperature and mechanisms of control.

Other `Western scientists' who helped to develop this theme of `the

constancy of man's internal environment despite broad variations in

his external surroundings' include John Hunter, Claude Bernard, J.

S. Haldane and the famous Walter B. Cannon, whose articles were

published in 1778, 1854-1865, 1929 and 1917-1919 respectively.

However, more of this concept of homeostasis in relation to

acupuncture later.

 

 

3. THE MESSAGE OF CHINESE MEDICINE OBSCURED BY THE FASHIONABLE USE

OF WESTERN TERMINOLOGY

 

This I feel is an unfortunate choice of words, but if the Professor

is once again implying that attempts to explain Chinese medicine in

terms of scientific knowledge will obscure the `message' of Chinese

medicine, then I must strongly disagree with him again. However,

isn't the use of the term Chinese medicine rather too broad a term;

since it would presumably include Chinese herbal medicine and the

Chinese pharmacopeia with its foxglove (digitalis, Ephedra sinica

(ephedrine), Papaver somniferium (opiates) and other plants and

preparations long since proven by scientific method to contain very

active pharmaceutical principles indeed.

 

As the article points put, there is a struggle still going on

between both systems (Chinese and Western medicine). No doubt each

can learn from the other, but it requires a spirit of humility

without which there can only be a head-on collision, resentment,

jealousy and suspicion.

 

So Dr. Porkert tells us 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. I am

glad he says `tried to explain it.' Far from decrying what `those

well-intentioned native defenders of their medical heritage' are

doing, I would only like to add that the need still remains for the

efficacious parts of traditional medicine to be explained fully on a

scientific (not Western science) basis, and here I find myself in

part agreeing with what the Professor says, that in some cases at

any rate those `defenders.... are in reality jettisoning and

destroying what they set out to preserve.' There remains the need

for more controlled scientific research including controlled double-

blind studies.

 

 

4. THE CASE OF ANATOMY VERSUS ZANGXIANG, ORBISICONOGRAPHY

 

I must agree that the Zangxiang is referring to functions and not

anatomical organs, but aren't the orbs, etc. referring to basic

physiological systems in the body? This is where some difficulty

lies because it is not possible to allocate one anatomical organ to

one particular physiological system. In fact every organ in the body

is involved in far more than one system, for the human organism is

just not that simple.

 

Here I must return to the point I made earlier that Chinese medicine

is basically concerned with the maintenance and restoration of

homeostasis. It is true to say that no matter what stress or disease

inflicts itself on the body, providing the body can maintain its

internal environment within certain limits by all the reactive and

compensatory mechanisms available to it, then there will be no

manifestation of disease and the person will remain symptomless

(e.g. the so called `subclinical attacks' of disease).

 

The following is a list of some of the main systems which must be

kept in delicate equilibrium if man is to survive, but I think it

would be very rash of me at this stage to attempt to pair them up

with orbs or meridians.

 

1. Temperature

2. pH—acid/base

3. Fluid balance

4. Electrolyte balance, sodium, potassium, chloride, including

intracellular and extra cellular balance

5. Oxygen — carbon dioxide

6. Caloric balance

7. Carbohydrate metabolism, and blood- sugar lever

8. Protein metabolism/absorption/breakdown

9. Fat metabolism/storage/utilization

10. Calcium balance – as distinct from sodium, potassium and chloride

11. Osmotic pressure

12. Cardiovascular adjustments such as blood pressure and pulse,

cardiac output and peripheral circulation versus splanchnic

circulation

13. Maturation, reproduction and aging

 

These homeostatic systems are mediated via both the autonomic

nervous system and the endocrine system, the latter also being

greatly influenced by the autonomic nervous system especially via

the hypothalamic—pituitary axis. It must not be forgotten that just

a small change in any one of these systems sets up a whole reactive

chain of events in an attempt to restore the equilibrium or

compensate for the imbalance. The traditional fright/fight/flight

example is typical of a whole set of events set off by one trigger

and causing far-reaching effects throughout virtually all

physiological systems in the body.

 

Supposing your temperature rises above normal, then your metabolic

rate rises. This requires an increased demand for oxygen, and

increased production of carbon dioxide, with an increased cardiac

output, a need for increased energy, resulting in changes in

carbohydrate, protein and fat metabolism, not to mention the

eventual onset of greatly increased sweat loss with its resultant

effects on fluid and electrolyte balance, and so it goes on and on.

 

In the delicately balanced physiology of the human body, there is

not a static equilibrium but an extremely active ongoing process

with ions darting in and out of cells all over the place, and a

myriad of messages flying back and forth through the autonomic,

peripheral and central nervous systems. All these are going on

beneath the level of consciousness until a state of uncompensated

imbalance is reached, when one suddenly feels cold, and gets up to

close the window and puts on a cardigan, or feels thirsty, and goes

to get a drink of water. The homeostatic mechanisms are at work!

 

Cannot yin and yang in particular be explained in these terms of

variation to either side of the ideal level of equilibrium? Is all

the emphasis on `harmony with the seasons' and other aspects of the

environment just a philosophical idea or is it rather a clear

insight into the need for homeostasis if the body is to survive?

 

Western medicine's knowledge and understanding of the autonomic

nervous system is still in its infancy. Virtually all attempts to

restore homeostasis in the human body are made through external

interference rather than through direct action on the body's own

homeostatic mechanisms, although these could in theory be influenced

by direct action on various parts of the autonomic nervous system.

The wonderful fact is that as the practitioner of `Western medicine'

begins to alter the state of imbalance, and in particular turns the

tide from the point of no return, then the body's own homeostatic

mechanisms begin to work again and often remarkable recovery

follows .

 

Most of Western medicine aims at treating the cause of the disease

or imbalance that has resulted, and in this way it is unconsciously

relying on the body's own homeostatic mechanisms to restore health

and strength. In many instances the more attempts the practitioner

makes at restoring equilibrium by external interference, the more

trouble he gets into as he throws other systems off balance. There

are, however, some notable exceptions such as the dehydrated infant

with severe diarrhoea who only needs his fluids and electrolytes

replaced. It was interesting to read recently of a case of a child

with rabies who was kept alive by anticipating the imbalances which

would occur, and thus maintaining homeostasis. The child survived.

 

More scientific research needs to be done on the autonomic nervous

system before it will reveal its hidden secrets of action, reaction

and interaction, a system designed to maintain homeostasis, i.e..

the constancy of man's internal environment despite broad variations

in his external surroundings. Survival is based on homeostasis, and

this is what Chinese medicine is all about.

 

In conclusion I must disagree with Professor Porkert's statement

that `applying to Chinese medicine the universal criteria of exact

science' results in `the absurd and of necessity abortive attempt to

reassess it by means of methods evolved by and only applicable to

Western medical science.'

 

Let us rid ourselves of the association " Western " , for there is only

one universal science, but may every attempt be made to discover the

scientific basis of Chinese medicine, especially acupuncture, so

that it may be further developed and used in forms which will

benefit the whole of mankind.

 

 

Dr. Janet Plummer, a medical graduate from the University of Sydney,

is a practicing physician, and Research Associate of the Department

of Anatomy, University of Hong Kong.