chinese medicine: a science in its own right (rebuttle)

[Guest guest]

the quandary of chinese medicine

 

by Manfred Porkert

 

This article is Dr. Porkert's response to Dr. Plummer's response.

 

 

I was rather pleased to read Dr. Jane Plummer's repartee

entitled `— Does it have a Scientific Basis?' in the

May 1977 issue of Eastern Horizon—in reply to my 1st article on

Chinese medicine printed there in February 1977. I frankly admit

that compared to many other contributions printed in Eastern

Horizon, my first article; as Dr. Plummer rightly points out, as

regards `clarity and conciseness, leaves much to be desired.' Yet,

in spite of some misgivings I had about disturbing the literary

homogeneity of a publication medium, my primary motive in developing

certain arguments was their completeness and coherence; I never

expected that they would directly facilitate the comprehension of

the issue at stake. For, surely, incomplete arguments invite

refutation. Complicated but fairly complete arguments may

momentarily delay comprehension due to the increased mental effort

required on the part of the readers. On the other hand, by this very

effort, they are liable to generate new insights in the process.

 

Anyway, since in my February 1977 article perfectly ample

consideration has been given to the theoretical and epistemological

background of the problem involved, viz. as to how in this modern

world that we are in the habit of calling `traditional Chinese

medicine' can be properly understood and practically applied, I have

now the freedom to speak on concrete and specific points without

exposing myself to the danger of being imputed only a fragmentary or

partial view of the issue.

 

Before taking up some of these crucial points, I must reply to some

of Dr. Plummer's `objections`.

 

I very much respect Dr. Plummer's personal integrity and

intellectual engagement; still, I cannot avoid the conclusion that

her complete argumentation constitutes no exception to the rule

that, during the past decade, practically all attempts to question

the validity of my interpretation and presentation of Chinese

medicine are based upon specious assumptions: My critics `succeed `

in refuting me by `disproving' assertions I never made or, more

curious still, by refuting statements I expressly excluded.

 

Dr. Plummer's critique culminates thus:

 

" 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 and methods evolved by and only applicable to

Western medical science. "

 

Patently, Dr. Plummer here, by cutting up and reshuffling the words

of one of my statements, is imputing something diametrically opposed

to what I said—which was: `Thus in stead 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 and methods evolved by and only applicable to Western medical

science.'

 

Clearly, Dr. Plummer, as all those who out of habit and convenience

persist in moving in beloved ruts of thought, here simply continues

to confuse `methods' and `criteria'.

 

Is such confusion unavoidable?— In the article in question, I open

my theoretical expose with the heading: The Pitfall of

Confusing " Methods " with " Criteria " and the phrases: `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

are sometimes liable to confuse " methods " and the " criteria " at the

basis of these methods . . .'

 

I already admitted that such exposition lacks conciseness as well as

directness. So let me now couch it in more direct and blunt terms:

 

Medicos, the impersonators of today's medical science, evidently

confuse the methods they employ with the criteria to which these

methods comply. Criterion is a standard, something established by

authority, custom or general consent as a model or example— the

gauge or goal of activity. Methods is the procedure or process for

attaining an objective, for reaching a goal, the mode of activity

used to reach certain ends.

 

Methods or means depend not only upon the goal to be reached but, to

no lesser extent, upon the point of departure, the concrete problems

to be overcome on the way to the goal. Confusion of methods with the

criteria to be attained is the bane of modern medicine (and some

other disciplines). It corresponds to the irrational and absurd

belief that a given method may be labelled a `scientific method'

because it proved to yield `scientific results' within a given

empirical context (in other words permitted to attain to certain

standards). From here it is but a small step to the habit of

attempting to reach similar goals by similar methods—irrespective of

the different real and concrete conditions at the point of departure.

 

I have devoted the better part of the quoted article to give the

reader a more precise idea of the problems involved, and I shall not

repeat this here. Instead let me take Dr. Plummer's cue in brushing

the problem of universal science:

 

" 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, scientific truth is absolute, provided all factors

are taken into account. "

 

In the first part of this statement, Dr. Plummer is affirming what I

am affirming all the time; in the second part, she is relapsing into

the Kantian attempt to divorce truth and reality; in the third she

stipulates conditions which Western medicine, of all would-be

sciences, is most hard pressed to meet. Science results from the

application of methods; it is the product of methods. Clearly, when

I use the qualifier " Chinese " and " Western " in respect to science, I

am not using them in the manner of indicators of possession; " our

science " and " their science " instead, I mean to denote differences

in method, procedure, pathfinding.

 

If two teams of mountaineers set out to scale a peak and, after

having drawn lots, decide that one team is to make the attempt via

the southern slope, the other via the northern approaches, of

necessity there will be multifarious differences in the difficulties

encountered and overcome, in the hardships endured and, more likely

than not, in the respective times taken by each group to finally

attain the set goal. These differences will be even greater if

different teams set out toward peaks of similar altitude. When I

speak of Western science and Chinese science, I state that two

different teams have set out to scale the same peak; exact science,

via different routes.

 

But I am also talking about the maturity of scientific methods and,

consequently, about the stringency of the results of a given

discipline. I call mature a science that has attained the goal of

exact systematization of empirical data, in other words the stage

where its statements may be checked and verified with identical

results by all interested, and where predictions of effects are

possible with a probability near to 1. A mature science is a team

that has reached the peak.

 

Nobody questions the fact that physics first attained to such

maturity in the West during the 18th and 19th centuries. Or, to stay

in the picture, it fell to the lot of Western physicists to discover

and plot out a route which today enables men of all nations to go up

to the peak of `exact physics' with greatest dispatch and security

and with a minimum of effort and wastage.

 

Clearly, only few teams setting out from the base camps of different

civilizations to scale the peaks of physics or other disciplines

have met with such shining success. Thus an increasing number of

people realize that the team setting out from the base camp West to

conquer the peak of exact medicine has got stuck a long way from the

summit after occupying — already at the turn of this century — some

minor promontories called biochemistry, microbiology, etc. But,

strange to say, nobody, and least of all the Chinese them selves,

seem to take notice of the fact that this peak of exact medicine has

been scaled and occupied for many centuries by a team setting out

from the base camp China. More startling still, today's teams in

that camp, along with the teams from all other cultures, have become

hypnotized by the Western notion:

 

a. that the peak of exact medicine scaled by the Chinese team was

not a real peak at all but only a fata morgana;

 

b. that now and in the future peak conquests will only then be

recognised officially if the venturing team has set out from the

base camp West and has first taken its way across the route and peak

of exact physics.

 

Nobody seems to care that on this condition many mountaineers have

completely lost sight of the goal, and that legions of young

scientists, doctors and patients as well as enormous amounts of

human happiness and natural resources are sacrificed in this

process. Am I exaggerating or construing an utterly fictitious

situation? — Let us examine the case of pharmacology — an example

close to my mind since I am just winding up work on a book on

Clinical Chinese Pharmacology.

 

The success and development of modern pharmacotherapy is an almost

perfect replica of the development of modern Western medicine. In

other words there exists group I— a small number of diseases for

which Western medicine has a fairly precise diagnosis and hence

remedies of unprecedented effectiveness: the great infectious

diseases.

 

Then we have—group Il—a somewhat larger assortment of diseases,

those with clear somatic changes yet multifactoral etiology, where

the effectiveness of remedies is comparable to what had been

available through the empirical medicine of former generations.

 

There follows a very large group of diseases where either the

striking somatic manifestations (e.g. in cancer, diabetes, multiple

sclerosis) cannot in any stringent way be correlated to effective

causes; or, worse still, the vast group of the so called

psychosomatic or mental diseases, where Western medicine can

ascertain no somatic changes at all to account for the symptoms

observed.

 

Hence, in this group III comprising perhaps half of all complaints

calling for treatment, only unspecific `scrapshot' remedies,

palliative, symptomatic medication or fake (placebo) treatment

exists. And, it should not be overlooked that unspecific as well as

palliative prescriptions administered upon nothing resembling a

specific diagnosis or any scientific knowledge of the

pharmacodynamic mechanisms set in motion account for a large

proportion of the secondary suffering caused by unpredictable side-

effects of drugs, fake therapy, etc. Throughout the Far East and in

the People's Republic of China in particular, the material tradition

of the indigenous Chinese pharmacopeia has remained fairly intact to

this day. For even during the period of its worst trials at the

beginning of this century, nobody could shake the evidence of the

practical effectiveness of many of its remedies. Still, during the

19th century, the apparent superiority of Western technology and

Western guns gradually caused the Chinese to accept the idea of the

methodological superiority of Western science. Was it not a

necessary inference to draw parallels with medicine as well? And

label Chinese medicine folk medicine, empirical medicine, herbal

medicine, magic medicine as opposed to Western medicine which could

not only be called modern but—this seemed decisive—scientific'? I

shall not rehash what I had said in my previous article to show up

the arbitrary and absurd nature of this distinction. Instead let me

drive home the argument put forward there by pointing out two

amazing discrepancies in present day China, viz.

 

a. the discrepancy between political theory and actual practice in

medicine;

 

b. The discrepancy between the vast amount of so-called scientific

activity bearing on what is purportedly traditional Chinese

medicine, and the meager results not to say ludicrous trickle that

has filtered out from these efforts to enrich universal medical

knowledge.

 

In the People's Republic, medical workers as well as political

minds, wondering what attitude to take toward Chinese medicine, may

fall back on a statement of Mao Tse tung's saying: Chung-kuo i yao-

hsueh shih i-ko wei-ta-te pao-ku [wade-giles]: `China's medicine and

pharmacology is a great treasure house.'

 

Since this statement has been widely quoted before, during and after

the Cultural Revolution, my guess is that Mao Tse-tung here, as in

many other instances, had carefully chosen his words. And he had

said: `treasure house', not: `diamond mine, coal mine, compost

heap. `

 

A treasure house contains precious works of art, intricate products

of science and craftsmanship. In order to deploy or appreciate the

merits of these sophisticated skills, a certain amount of training

and, consequently, familiarity with the expressive conventions of

the artists and scientists and a thorough knowledge of the

intentions of the technicians is indispensable. To exploit a mine,

even one containing diamonds, the primary concern is plenty of

brawn, not intelligence or sensibility—because what is being

exploited comes in bulk or in unworked form.

 

After the collapse of the Roman Empire, some of the most wondrous

architectural monuments of Antiquity—including the Colosseum—for

many centuries were used as quarries because the downtrodden and

barbarian inheritors of Roman glory were blind to the original

beauty of these buildings.

 

Today's Chinese physicians, abetted by the gross ignorance and

indifference of Western medicine in regard to the scientific

tradition of China, more than ever treat the stupendous heritage of

Chinese medicine not as a `treasure house' but at best as a quarry,

a compost heap, which they grudgingly admit `contains some quite

remarkable and useful elements.'

 

Thus, let me repeat, what Chinese medicine to this very day

continues to be subjected to are not acts of cultural piety or the

humanitarian concern for the welfare of all mankind but acts of

dogmatic conceit and cultural vandalism perpetrated, more than by

anybody else, by Chinese members of the medical profession who, out

of inertia and conceit, refuse to admit that in China proper, since

the l9th century and to this day, absolutely no decisive effort has

been made to assess and establish the value of Chinese medicine on

its own terms.

 

Is this the language of blind exaggeration? Would some people like

to call me a fanatic glorifier of the past?

 

Let me wind up this sally with a piece of evidence that is above all

controversy or suspicion. Already in 1963, the Science Publishing

House in Peking (Ko hsueh chu-pan-she) brought out a fine and neat

example of modern scholarship and a most useful research tool

entitled Chung yao yen-chiu wen-hsien chai-yao 1820—1961 (Gleanings

from Research on Chinese Drugs between 1820 and 1961). Under the

editorship of Liu Shoujen, 24 editors and their assistants had

sifted through almost 400 scientific periodicals in Chinese,

Japanese and Western languages (English, German, French, Russian),

in order to summarize what during the most eventful years of medical

history has been contributed by researchers of all nations toward a

so called scientific assessment of the Chinese pharmacological

tradition. In other words, this book brings together the essential

results of such modern disciplines as pharmacology, pharmaceutics,

biochemistry, physiology, botany.... employing exclusively the

methods of Western science, and it contains more than 4,000

abstracts bearing on 502 drugs prominent in the traditional

pharmacopeia.

 

Needless to say that all these researchers have acted and continue

to act upon the gratuitous assumption that Chinese medicine

is " folk " and " empirical " , not scientific, a " quarry " or " mine " , not

a `treasure house'. Consequently, they have hardly ever made an

effort, let alone showing evidence of familiarity with the

methodological and scientific context within which Chinese drugs

have been defined and within which they must be used and examined if

they are to show the effects attributed to them.

 

What has been the net increment to scientific therapy as the result

of this screening?

 

Less than a dozen fairly plain but exotic substances, one new

substance of medium importance (ephedrine), not a single one

comparable to the great antibiotics.

 

Judged by these results, Chinese medicine, under scrutiny by Western

science for more than 150 years, surely looks more like an abandoned

coal mine than a full treasure house. Consequently, the Chinese

would be better advised to go to the small effort of proving the

truth of Mao Tse-tung's citation instead of only paying lip service

to it. They will of course have to realize that, by making the

methods and terminology of Western medicine the sole vehicle and

yardstick for interpreting their own scientific tradition, the

coherent system of Chinese medicine which could serve as the

inspiration and as an example to the whole scientific community, has

been degraded into a subject of controversy and derision, into an

object of brainless exploitation.