The classics

[Guest guest]

All,

 

I would like to make a couple of points about `the classics' and our

understanding of them.

 

First, when a Chinese doctor, certainly one who is not literate in English,

says something like `book wrong,' it is not appropriate to argue the issue as

if the point in question is absolutely clinically irrelevant or erroneous. For

example, in many hours of interviewing Chinese acupuncturists and

physicians in English, as well as through expert speakers of Chinese, similar

statements have, upon follow-up questioning, been meant to transmit a

range of opinions. Sometimes it does mean that the speaker believes the

statement in question to be wrong (even knowing that others accept it).

However, in many instances it has meant that the doctor believes it to be a

misprint, a post-facto addendum, less useful than something else,

situationally incorrect, or even that it is a point made important by a rival

with whom they do not agree. It may also be a polite way of saying `I'm not

going to talk about it with you,' of refusing to teach something, or even `I

don't understand it myself so lets move on.' Thus, while the voice of Chinese

experience certainly deserves our attention, I don't think it is appropriate to

treat these incidences of conflicting opinion as matters of conflicting clinical

truth.

 

As regards these pulse inconsistencies specifically, unless the resulting

treatment choices are part of the assessment, it is difficult to judge the

difference. I am sure I have over-used this expression but it makes the

point:

 

Never ask your teacher `what is a slippery pulse.' Always ask `what

do you call a slippery pulse and what do you do when you feel one?'

The pulse can only be known by the response.

 

In other words, pulse-taking does not describe an absolute condition of

being; pulses are not unique facts of the universe, they are part of a system

for understanding what is happening to a patient and need to be understood

in that context.

 

Secondly, the classics are not books. You do not run down to your Beijing

book store and buy an original Chinese edition of the Nei Jing from the

wizened proporietor. They are collation projects not unlike the dead sea

scrolls, or ancient western literature. Current editions, including those in

the Chinese language, are assemblages made from studying silk and bamboo

fragments, references to the text in other books in later eras, extant

commentaries and the philological and linguistic evidence found in

acheological artifacts. Take, for example, the SHL. It was essentially

ignored in China until the 1100's. I hope I am not misquoting the number

but I believe Paul Unschuld stated at his PCOM lecture that there were only

seven authors known to have followed its systematic approach in the

thousand year interim. The Song edition, which is now generally regarded

to be authoritative, exists because it was preserved in a Japanese library.

Thus, arguing whether a classic is correct is like arguing whether it was

right for Dante to put the Pope at the center of Hell -- there's no way to

understand the matter without looking at the circumstances surrounding

what we have and the what we know of the text.

 

Finally, the classics are not stacks of words immune to the influences of time

and culture, they are part of and must be understood through the

intellectual surround created by ages of commentary and practical

instruction, as well as through socio-economic and political events. The

classics are not out-of-date clinical manuals in need of our modernizations.

They are windows on the thought process and the root ideas of the medicine

we wish to understand and adopt. Do we rewrite Galen to accommodate

biochemistry, why? There are plenty of modern manuals. Should we

correct the MaWangDui scripts because there are only 11 unconnected

channels? To return to the SHL, the fact that a first century document

contains useful clinical instruction is (at least to me) truly awesome.

However, that it fails to give adequate instructions for the alterations of the

medicinals in formulas based on the pulse qualities has to be understood by

knowing that it precedes the first significant attempts to standardize pulse

qualities, and, indeed, that the emphasis on physician-altered prescriptions

appears a millennium later starting in 1047 after a government mandate for

public pharmacies took control of medicinal sales from physicians. Zhang

Ji may have or may not have been a pulse master, but whatever he was, it

was in the first century.

 

The fact that there are differing and sometimes contradictory ways to

approach a problem, or that opinions on everything from dose to modern

applicability vary, does not mean that these are inconsistencies that must be

eliminated and replaced with correct interpretations. On the contrary, it

means that we must study and understand these notions in their broader

context.

 

Bob

 

 

 

 

 

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664