CCM - TCM Labels, traditional medical taxonomy

June 7, 2000

I think that one of the difficulties discussing modern Chinese practices is the social, political, economic and intellectual scale of the Chinese-speaking world. China is immense and there is no more reason that Chengdu and Beijing should be exactly the same than there is for Bangor and Los Angeles to mirror one another's cultures. Add Taiwan and the overseas Chinese who see themselves as belonging to China, and the scale further dwarfs Western cultures whose medical systems we would never even think to describe with a couple of labels as general as ``CCM'' or ``TCM.'' Medicine partakes of everything from thought to money and both the ancient and modern history of traditional Chinese medicines reflects all of these influences throughout.

Yet, in modern sinology there is enough congruence among the observations of sinologists to say that it is broadly agreed that China has been responding to the West for a couple of hundred years and that the pervasive demand of the Chinese people today is for the advantages of Western technologies, both military and civilian. Indeed, this demand is so strong that one cannot fairly say that traditional Chinese ways of knowing something are of much more interest to most educated Chinese than to the average educated Westerner. Paul Unschuld expresses this clearly by saying that Chinese medicine is a `tree the roots of which have been severed,' noting that Chinese medical students must struggle with traditional concepts as vigorously as their counterparts in Europe or the U.S. because they have been educated since birth to the same Western notions of truth, particularly science.

However, recognizing that China is an immense intellectual space, as well as an immense geographical place, and keeping in mind a vast pesantry that is closer to the 17th than the 21st century, it is understandable that within this dominant culture there is now, as there have always been in Chinese intellectual history, people who are articulate proponents of things traditional, including medicine in considerable variety. Indeed, this has been a recurring theme in Chinese society and I would not be very surprised to learn that the heads of different departments within the same TCM hospital had different opinions of traditional systems. I would personally be surprised if we will have seen a full representation of ideas from these traditional proponents in my lifetime, considering their likely numbers and the lack of a Western structure to support this depth or variety. There is no more one traditional Chinese medicine than there is one Western medicine or Western cinema. Beyond sharing philosophical and epistemological roots, Chinese medicine is far too various and far too rooted in Chinese language, culture, history, politics, economics and social policy to be discussed without some idea of the who, what, when, where and why of its source.

Dr. Porkert is one of the most urbane and literate persons I have met and I think some important ideas have been lost because few people are sufficiently educated to deal with his terminology. Although I am sure that integrated medicine is a debasement from Dr. Porkert's perspective, the reason it is the centerpiece of the P.R.C. policy has everything to do with what the Chinese want for themselves - including the submission of traditional thought to Western science. We are picking and choosing from an immense intellectual inventory, a library the shelves of which are not simply wide and numerous, but long, stretching through intellectual time. There is nothing wrong with taking what we want provided we grant it the study it deserves, but whether or not that library is immense enough to be called an `ocean',' we cannot grab something that looks good to us and decide we know something about what is on all the other shelves. Steve Birch and I developed a taxonomy that we stole from Dan Kenner that - in my opinion - allows for meaningful labelling, that is, we can talk meaningfully about traditional systems by considering a continuum (from more to less traditional):

1. Adherence to and belief in traditional (East Asian) concepts only. Complete rejection of the biomedical (scientific) model.

2. Adherence to and belief in traditional concepts with a limited utilization of biomedical concepts.

3. An interweaving and mixing of traditional and biomedical concepts.

4. Adherence to and belief in biomedical concepts with the subsuming of traditional concepts where they can be subsumed.

5. Adherence to and belief in only biomedical concepts with complete rejection of traditional models.

This is particularly useful clinically because issues such as contraindications, point/herb selection, insertion depth and retention, stimulation/dose, are as much the result of belief systems as clinical experience. For example, on another list today someone questions the shorter needle retention periods noted in Bob Flaw's very useful translation of Ching Tan An's works. Interestingly, I would place Ching Tan An (in the 30's) and his direct student Tin Yao So (in the 40's and 50's) at #'s 2-3 as this is generally a period of increasing attachment of neurological concepts to acupuncture. The shorter duration is accompanied by an emphasis on specific needle techniques and stimulus -- ideas rooted in the qi paradigm concept of de qi -- and thus, as Steve Birch's research has shown, are historically typical. By the Shanghai text in 1954 the association of nerves and acupuncture is so strong that de qi has become the deeper, longer, and more powerful stimulus associated with nerve responses. According to some Chinese thinkers today, all of acupuncture is neurological, and all of herbal medicine is pharmacological.

In sum, I think labels like `CCM' and `TCM' are more or less useful as badges of `belonging' to one or another school of thought in the Western world. But, to make clinically-useful distinctions, a finer level of historical and technical

detail is required.

bob (AT) paradigm-pubs (DOT) com Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

June 7, 2000

Bob,

What a beautiful essay! I marvel at your ability to express and lay out an overview of a difficult subject. Thank you for helping clarify the issues for me. Your work is very important to the CM community.

>>>>

> I think that one of the difficulties discussing modern Chinese practices is the social, political, economic and intellectual scale of the Chinese-speaking world. China is immense and there is no more reason that Chengdu and Beijing should be exactly the same than there is for Bangor and Los Angeles to mirror one another's cultures. Add Taiwan and the overseas Chinese who see themselves as belonging to China, and the scale further dwarfs Western cultures whose medical systems we would never even think to describe with a couple of labels as general as ``CCM'' or ``TCM.'' Medicine partakes of everything from thought to money and both the ancient and modern history of traditional Chinese medicines reflects all of these influences throughout.

>