What Paul Unschuld says

[Guest guest]

Good afternoon,

 

What Paul Unschuld says is that Chinese medicine did not change in response to

evidence of efficacy but instead to socio-political, economic and other cultural

trends that formed the Chinese sense of what was reasonable and expected.

Chinese history describes clinical failures, for example, the 1641 to 1644

epidemic in which Li Gao's spleen and stomach school proved a public failure

and declined in relation to Wu Hu-xing's appreciable success with ideas

recorded as the Wen Yi Lun or `Theory of Warm-Induced Disorders.' As a

historian, Prof. Unschuld's point is not that efficacy was not considered or but

that efficacy cannot be the basis for explaining change in medical thought

throughout Chinese history. Further, he notes that the Chinese did not develop

an excusionary logic for eliminating ideas that were in some way contrary to one

another the way one Western concept supplants another when newer methods

for testing truth arise. Rather than denying any cosmologic influence, Paul

traces the influences of cosmological thinking on what the Chinese people

believed to be reasonable and likely. Thus, Chinese medicine's literary edifice

is

just that, a literary edifice, what my Orientalist colleague Mr. Rose notes was

described by the Chinese literati themselves as ``congealed qi.'' In other

words,

we cannot delve into the classics like Jack Horner expecting to pull out a plum

of clinical efficacy, nor can we dismiss them as merely ancient intellectual

artifacts. We must instead consider them as literature, an access point to the

cultural influences that inform us how the Chinese viewed things, and thus how

they believed they were able to intervene medically.

 

 

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

[Guest guest]

At 3:01 PM -0500 11/28/00, Robert L. Felt wrote:

> In other words,

>we cannot delve into the classics like Jack Horner expecting to pull

>out a plum

>of clinical efficacy, nor can we dismiss them as merely ancient intellectual

>artifacts. We must instead consider them as literature, an access

>point to the

>cultural influences that inform us how the Chinese viewed things, and thus how

>they believed they were able to intervene medically.

---

 

Thanks for clarifying Paul Unschuld's views. Although I agree with

the above statement, I'm still not sure that quite does justice to

the value of reading the classics. Unlike literature as fiction or

poetry, Chinese medicine is a practice with a theory that can be

tested by each practitioner with each patient. The foundation of that

theory was laid down, at least as it is available to us, in the

classics. A great deal of the theory we read in the classics is as

relevant today as it was 2000 years ago; some of it has been

modified, improved and added to. Very little has been discarded

completely.

 

Rory

[Guest guest]

on 11/28/00 2:36 PM, Rory Kerr at rorykerr wrote:

 

>

> Thanks for clarifying Paul Unschuld's views. Although I agree with

> the above statement, I'm still not sure that quite does justice to

> the value of reading the classics. Unlike literature as fiction or

> poetry, Chinese medicine is a practice with a theory that can be

> tested by each practitioner with each patient. The foundation of that

> theory was laid down, at least as it is available to us, in the

> classics. A great deal of the theory we read in the classics is as

> relevant today as it was 2000 years ago; some of it has been

> modified, improved and added to. Very little has been discarded

> completely.

>

> Rory

>

 

I agree. While I greatly appreciate and admire Paul Unschuld's work, what I

most appreciate about the classics is the incredible continuity of yin yang

theory from the time of the Yi Jing, through the Ma Wang Tui manuscripts

through the Nei Jing up to the present era. This paradigmatic (have I made

up a new word here?) continuity is the source of the continued relevance of

the texts.

 

 

[Guest guest]

, " Robert L. Felt " <bob@p...>

wrote:

 

>Chinese history describes clinical failures, for example, the 1641 to 1644

epidemic in which Li Gao's spleen and stomach school proved a public failure and

declined in relation to Wu Hu-xing's appreciable success with ideas recorded as

the Wen Yi Lun or `Theory of Warm-Induced Disorders.' As a historian, Prof.

Unschuld's point is not that efficacy was not considered or but that efficacy

cannot be the basis for explaining change in medical thought throughout Chinese

history. Further, he notes that the Chinese did not develop

 

 

I replied:

But from our modern TCM perspective, Li gao's ideas failed because they

were applied inappropriately. Physicians mistook an external attack

for an internal attack. Perhaps this was because cultural factors

blinded many physicans of the day to this error. I would suggest that

not all were blinded or why would have the wen yi lun have been written

in the first place. Further, it would seem that the lack of clinical

efficacy was exactly the motivation to try something new. Cultural

factors may have determined what direction these new ideas took, but it

seems that clinical success of lack thereof was a very strong

motivator. If not, why do the SHl, the piwei lun, the worksof wang

qing ren on blood stasis, the works of zhu dan xi and the wen bing

theorists all make reference to the failure of older ideas or poorly

trained physicians as the explicit motivation for their own

developments. I think the form of TCM is most certainly decided by the

context, but the impetus for change seems strongly rooted in clinical

efficacy. Judith Farquhar stresses the centrality of clinical

experience in her tome, Knowing Practice. And despite Unschuld's

position on this subject, he also writes at length about the taoist

pragmatism that always infected herbalism and eschewed theory in the

favor of empiricism.

 

Bob wrote:

>Rather than denying any cosmologic influence, Paul traces the influences of

cosmological thinking on what the Chinese people believed to be reasonable and

likely.

 

 

I replied:

I should clarify my point about cosmology. I did not mean to suggest

that chinese cosmology did not influence the development of TCM. In

fact, the influence is quite overwhelming, by any account. My point

was, and this is based on my understanding of Unschuld, that we should

not read too much cosmological significance into the ideas espoused in

the literature. It seems that prevailing cosmological concepts as well

as political and social factors were used as metaphors for functioning

of the human body. But these concepts have perhaps no significance

other than their descriptive, metaphorical nature and their relevance

to clinical practice. They do not reveal anything profound and

timeless about the nature of the human existence, per se, no moreso

than the tridosa of ayurveda or the four humors of unani.

 

For example, the modern channel system was one of several that

developed in ancient China. Yet it was the politically sanctioned Nei

jing version that took prevalence rather than the work of master tong

or the system described in the ma wang tui texts. Why? Because the

nei jing system closely paralleled the nature of imperial government at

the time. I might argue, as I believe Unschuld essentially does, that

acupuncture was much more influenced by cultural constraints than

herbalism and that cultural factors played a far greater role in

determining clinical needle practice in any era than the much more

pragmatically oriented works of the herbalists. Zhu dan xi, for

example, seems strongly focused on clinical efficacy and much less so

on cosmological reasoning.

 

Similarly, the form of modern TCM clearly was impacted by communist

atheism and marxist hegelian dialectic, but I have no doubt that the

impetus for these changes was firmly rooted in the desire for clinical

efficacy inthe face of a major health crisis (just like the crises that

led to the SHL, pi wei lun and wen bing). Communist TCM was merely

another permutation in the inherently pragmatic methodology of chinese

herbalists that had influenced their practice for generations. Thats

why I have little sympathy for the position that TCM lost so much of

its value during this period. The same argument could be made about

the transition from demonology to naturalism during the han. Why not

practice based on ideas of chasing evil spirits with celestial lancets

and to hell with concerns about climate and internal emotions? So

while cultural factors clearly played a significant role in the

development of TCM, we should be not too quick to discount the euqaly

important role of clinical efficacy. Unschuld, for whom I have the

deepest respect, is, after all, a cultural anthropologist and thus

biased by his own predilections. Farquhar's take is decidedly

different. She is, of course, influenced by the Nathan Sivin faction

of sinology, a group that does not give complete credence to Unschuld's

bias.

 

[Guest guest]

Todd: " That's

why I have little sympathy for the position that TCM lost so much of

its value during this period. "

 

This is an interesting discussion to which I add little. However, this sentence

struck a chord with me. I often get frustrated when talking with students and

colleagues about this. TCM is a way for people to learn some reasonable amount

of medicine in a short amount of time. Western students (as was myself) are able

to essentially pay our ways into being an acupuncturist whereas the " ancient "

traditions of apprenticeship would be inaccessible to most all of us. (That is

assuming our families are not in the tradition, which is

maybe 90% of TCM students I know in Los Angeles.) So the pragmatism of communist

reality ironically meets the needs of the pragmatism of capitalist life.

 

my 2 cents.

 

doug