Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 I was reading Volker Scheid's chapter on plurality in medicine in modern china. One thing struck my attention (and I am reporting here again unless I state otherwise). He writes that the state sanctions three types of primary medical practices and has schools and infrastructure for each: 1. western med (WM) 2. chinese med. (CM) 3. integrated western chinese med (IM) the fact that the state sanctions CM and IM independently would lead one to believe they are quite different in their application. I suspect this is part of the reason there is a lot of fear of IM in this country amongst those who advocate a purer CM. In theory, CM would be unadulterated by western ideas, while the goal of IM would be some kind of synthesis that leaves pure CM in the past as a relic. However, according to Scheid, the reality is much greyer. Both IM and CM are controlled by practitioners of CM, not WM, so integration is not WM dominated. On the other hand, CM practitioners are just as likely as IM practitioners to prescribe drugs or make WM dx. So all medicine has an integrative aspect in China, it is just a matter of emphasis. WM docs use CM and IM all the time, so it even extends to them. So when I speak of integrative medicine, I mean what is called CM in china today. the goal is to preserve the roots of CM and develop new theories, incorporate new ideas and medicinals as the chinese always have. the goal of IM is to create a " new medicine " . And WM definitely looks at all other therapies as secondary. Personally, IM interests me and I would not be surprised if this is what history has in store for us. But currently, I am more interested in understanding TCM as it is before moving on, if at all. Scheid does make the point over and over again that some form of integration between WM and CM was considered the cutting edge of future developments by all his informants, despite having widely differing views on many other topics. If he is right, then it behooves us as a profession to consider what will happen if we choose to try and obstruct some inevitable form of integration. It is somewhat analogous to herb regulation. Things are moving in a particular direction, so we can either try and guide them to a place we can work with or we can sit on the sidelines and watch those who are not sympathetic to our profession make the rules about how we practice. Chinese Herbs " Great spirits have always found violent opposition from mediocre minds " -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 I like this! It is nice to hear this sentiment from the mainland Chinese perspective! On Saturday, May 3, 2003, at 09:26 PM, rey tiquia wrote: > Or perhaps we can look at Western pharmaceutical drugs xi yao and > research them from the perspective of TCM materia medica zhong yao . > This is using things foreign to serve China yang wei zhong yong ! > Misters and Mrs. modern TCM practitioners must use the' creative and > innovative spirit' kai tuo jing shen of the Divine Farmer Shen > Nong of those ancient years who tasted a hundred plants. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 , " rey tiquia " < rey@a...> wrote: > May 4,2003 > > Dear Todd and Listmembers, > > To understand the complex health system in China and the nature of > contemporary TCM over there and its relationship with biomedicine or Western > medicine, I think it will be instructive to understand the notion of > 'integration' or jie he > > Following the Marxist epistemological dogma of dichotomizing theory > from practice, Mao developed the concept (which later evolved into a party > and state policy ) of ' integrating' or jie he of the 'theory of > biomedicine' with the 'theory of TCM ' i.e. Zhong Xi Yi Jie He , the common > English translation of which is 'integrated traditional and Western > medicine . In contemporary Chinese communist jargon the term jie he is > commonly used to " combine " , " integrate " , " unite " entities, " humans " (as in > " integrating with the workers, peasants and soldiers " ) concepts or " theories " > in a decontextualized manner. It is used as in " integrating " or > " combining " ; " theory with practice " or lilun yu shijian xiang jiehe; or in > 'integrate(ing ) the universal theory of Marxism with the concrete practice > of the Chinese revolution " as in ba Makesizhuyi de pubian zhenli yu > Zhongguo de juti shijian xiang jiehe. In terms of referring to the > integration of TCM and biomedicine , Mao used the term jiehe in l956 in a > formal meeting he had with a team of Chinese musicians. However, the content > of this meeting was made public only in l977 in the Guang Ming Daily. > Mainland Chinese TCM historian Si Yuan Yi , in his review of the work of > 'integrating of TCM and biomedicine ' (which he pointed out as a duchuang or > " original creation " quoted Mao as saying: > > We have to learn contemporary foreign things. After studying > them, then we study > Chinese things. . We have to accept the strong points that > foreign things have.This > will create a 'leap' yuejin in our own things. Chinese and foreign > things must be > organically integrated youji de jiehe We must not apply > mechanically taoyong > foreign things (on to the Chinese situation ). > > In an earlier essay On New Democracy written in January l940, Mao in an > elaboration of the notion of a " national scientific and mass culture " > deployed a vivid food-digestive process metaphor to picture this process of > " organic integration " . Mao said: > " To nourish her own culture China needs to assimilate a good deal > of foreign progressive > culture, not enough of which was done in the past. We should > assimilate whatever is useful > to us today not only from the present-day socialist and > new-democratic cultures but also from > the earlier cultures of other nations.For example, from the > culture of the various capitalist > countries in the Age of Enlightenment. However, we must not gulp > any of this foreign > material down uncritically, but must treat it as we do our food- > first chewing it, then > submitting it to the working of the stomach and intestines with > their juices and secretions, > and separating it into nutrients to be absorbed and waste matter > to be discarded before it > can nourish us. To advocate 3wholesale westernization2 is wrong. > China has suffered a > great deal from this mechanical absorption of foreign material. > Similarly in applying > Marxism to China, Chinese communists must fully and properly > integrate the universal > truth of Marxism with the concrete practice of the Chinese > revolution. " > > But the ultimate aim of 'reforming TCM through the " integration of > biomedicine and TCM " is to elevate it to a 'scientific' level . As the TCM > historian Si Yuan Yi pointed out as a background to quoting Mao's > instructions: > " As for study of medicine, we have to use Western contemporary > science to research > ('study' , yan jiu) the guilu pattern of development of China1s > traditional medicine , > and thus develop China1s own 'new medicine' . > > In communist China, when laboratory experimental technique was first > introduced into TCM research in l959 , the program of scientising TCM > began. In l960, with the use of of Western pharmaceutical drug cortisone, a > Chinese researcher developed a laboratory animal model replicating the TCM > clinical pattern zheng of Yang deficiency yang xu . The efficacy of a > traditional herbal formula traditionally used to address this clinical > pattern was supposedly successfully 'tested' using this animal model. > This signaled the emergence in PRC China of the so-called school of > " integrated Chinese and Western Medicines " Zhong Xi Yi Jiehe. The > standardized universal yardsticks generated in the laboratory became the > criteria upon which traditional Chinese medicine (TCM) has to be measured > and accepted as scientific. Without due regard for the different contextual > requirements of TCM as a body of medical knowledge with a long ancient > history, a whole set of research projects were undertaken to make the > parameters of TCM more 'scientifically objective'. > > Recently, in my quest to trace 'On-line' the footprints of the SARS > pestilential Qi in Southern China and Hongkong, I came accross the TCM Forum > based in the Chinese Medical School of the Hongkong Baptist University. The > Forum has been in existence since l999 and in it are articles in the Chinese > language written by invited TCM scholars, TCM Experts and TCM students. > > One of the pieces that caught my attention was an article below > submitted and published recently by a TCM student. .I have translated the > article into English and I have an original hard copy of the Chinese > version of it. As far as I can gather, this is hisitorically one of the > first critique of the policy of integrating CM with WM in Mainland China (if > we go by the recent Sino-British agreement on the reversion of HK to > Mainland Chinese rule). As you can see, some prominent veteran TCM > practitioners like Jiao Shu De , Yang Wei Yi and Deng Tie Tao have been > quoted in this article. > > Regards. > > Rey Tiquia > Phd Candidate > Dept. of History and Philosophy of Science > University of Melbourne > Melbourne, Australia > > > > What is the 'Haste ' About Integrating Chinese > Medicine With > Western Medicine > > Chen Hai Yong - Undergraduate > Student > School , Hongkong Baptist > University > > Since the years of the fifties In Mainland China, the movement for TCM > zhong yi to go down the path of integrating Chinese medicine (CM) and > Western medicine or biomedicine (WM) zhong xi yi jie took off . The > tide at that time was considered as 'surging ' xiong yong peng pai ; and > the debate as to whether to integrate CM with WM was not limited to being > featured in major newspapers and magazines. The focus of the polemics was > --can CM and WM really be integrated . Up to now, people are still unable > to agree as to what is is right (or wrong) ' mo zhang yi shi . It is really > very difficult to form a unified view. > > Although the integration of CM and WM have been going on for more than > half a century, its feasibility and orientation are still pretty blurred. > Hence, under this state of affairs, the integration of CM and WM must > develop. However, this development must be under the direction of TCM > theory. At the same time, this (integration of CM with WM) should not be > taken to be the only pathway towards the development of TCM. The > integration of CM with WM must be based upon reality xian shi . It should > not be 'integration at all cost.' > > Originally, the purpose of 'integration' was very good i.e. integrating > or combining the strong points of both medical systems . This is combining > the strength of both i.e. through ' a bit of compulsion' to integrate' > qiang qiang lian he and achieve the highest level of medicine and medical > therapy , and in this way enriching humanity. Of course, this is a dream > of all people in the medical circles . It is also something that society > hopes for. > > In actuality, fifty years since the proposal to integrate CM with WM > was put forth, the work in this direction ' like a raging fire' ru h uo ru > tu , the great majority of TCM has taken this integrated road. > Unfortunately up to this time, the accurate content of this integration ; > the feasibility of this integration; whether can they be merged into an > outstanding new type of medical system; the question on how this integration > should take place; all these questions are still hanging on the balance. > Under this very confused situation, we must not act with undue haste cao > zhi guo ji to do this integration and do these things blindly. > > In addition, probably, this integration is Chinese medicine's > 'unrequited love dan xiang si i.e Chinese medicine's 'one- sided wish' yi > xiang qing yuan . On the other hand, The great majority of colleagues from > Western medicine had never thought of integrating with Chinese medicine. > Some of them (Western medicine) who have walked into the ranks of TCM > research-- I could not speak on their behalf and say that they are not > thinking of developing TCM; however, due to a lack of complete and > thorough wan zheng understanding of TCM, the fruits of their research > became the fruits of WM research and bears no relation whatsoever with TCM. > At least, they have no connections with the theory of TCM. > > At the same time, as TCM uses Western medical discipline to develop the > discipline of integrating CM with WM, there also emerged the problem of > dovetailing xian jie the fruits of integrated CM and WM research with the > theory of TCM. As as result, the materia medica Qing Hao (Artemeisia > apiacea) has become Qing Hao Su (Arteannuin). The materia medica Huang > Lian (Coptis chinensis) has become Huang Lian su (berberine) . Are these > entities still TCM's materia medica zhong yao ? Can these entities still > be used under the theoretical frame of TCM ? > > Western medicine has used berberine to achieve major therapeutic > effects . On the other hand, the materia medica Huang Lian is still being > used (in its raw form) clinically by TCM. And still with very good clinical > therapeutic results. Of course, if there are people who will research the > Four Qi Si Qi , Five Flavors Wu Wei and Acupuncture meridian association > Gui Jing of these TCM materia medica under the theoretical frame of TCM , > generate positive research outcomes and give due credit to TCM theory. This > is also possible. If this can be real, this can be a great service to > mankind gong de wu liang . Or perhaps we can look at Western pharmaceutical > drugs xi yao and research them from the perspective of TCM materia medica > zhong yao . This is using things foreign to serve China yang wei zhong yong > ! Misters and Mrs. modern TCM practitioners must use the' creative and > innovative spirit' kai tuo jing shen of the Divine Farmer Shen Nong of > those ancient years who tasted a hundred plants. > > Western medicine is still developing its own theory. They are still > doing their own research. As for us TCM practitioners, however, we cannot > contain ourselves to 'form an alliance of marriage' lian yin with the hope > of giving birth to a vigorous new baby . The 'creative and innovative > spirit ' is already there you le However, poor TCM. On the one hand, it > has to play the role of a TCM practitioner ; while on the other , it has to > play the role of a biomedical practitioner. Biomedical practitioners can > focus on doing Western medicine alone, while TCM practitioners have to > think of taking the benefits from both. > > Humans are not sages and men of virtues sheng xian . In both CM and > WM, both study medicine for a number of years. In both, the level of Western > medicine studied are more or less the same. About the level of CM that CM > students learn compared with those from previous times when they just learn > 'pure CM'-- it is hard to say. It is not surprising that both veteran TCM > professors Jiao Shu De and Deng Tie Tao in a lecture on August 8, 2001 and > featured in the journal Modern Education Journal xian dai jiao yu bao > said: " In the past several decades ji shi nian we haven't trained real > TCM practitioners zhen zheng de zhong yi . " Studying medicine is like > this. Being a medical practitioner zuo yi , generally is also like this. > Teachers from both TCM and biomedicine teach to students their respective > disciplines . And we the students 'integrate' jie he them . > > This way of integrating Chinese and Western medicines clearly is being > done in a hurry. On the one hand, the conditions are not ripe for it. > Western medicine is very reluctant to be part of it. Whether integration is > a feasibility, we do not know. However, on the other hand, the work of > integrating CM with WM like a honeycomb is unfolding . It is something that > we cannot hold ourselves back from doing. LIke building a house, the > various construction projects are still being discussed and debated. While > the site of construction has not yet been decided , the house is already > being hurriedly built. We can imagine the result of all of these. If we say > that the results of these several decades of construction projects --the > integration of CM with WM, if we say that his project has no achievements at > all , then that is treating unjustly yuan wang those industrious and > diligent workers. At least one of their achievement is the simultaneous use > and application of both TCM and WM. In addition, this integration made TCM > a contemporary and fashionable therapy . These benefits (resulting from the > integration work) is obvious to everyone. The 'simultaneous use and > application of CM and WM' zhong xi yi he yong perhaps can best describe > the present state of TCM . Can we also say that this is the essence of the > present state of integrating CM with WM? > > TCM needs A TCM-type of modernization in order to continuously develop > itself and satisfy the needs of society . In this way, TCM can have a ' > living space ' sheng cun de kong jian. If there comes a time that no one > wants it anymore, then society will abandon it. This is the law of social > development she hui de biran gui lu . Just like the development of the > machine industry. If society does not need the blacksmith, then it > disappears from society and enters the museum of history. > > TCM needs to modernize. However developing its modernization is not > equal to developing the notion of integrating CM with WM. Hence > modernizing TCM is not equivalent to developing the integration of CM and > WM. Prof. Li Zhi Zhong from the School of of the Hongkong > Baptist University has a good idea on the modernization xian dai hua of > TCM. He once said: > > " 'Modernity' xian dai is a concept of time. It refers > specifically to a state of backwardness and > slow development. Hua is a concept of space. It refers > to multiplicity of viewpoints points duo jiao du and > all-directionality > quan fang wei . " > > In his book The Discipline of TCM- Macro Regulative Functional > Medicine zhong yi xue- hong guan tiao kong gong neng yi xue Prof. Yang > Wei Yi thinks that " the leading discipline in TCM is its foundational > theory " . However due to the imperfection of contemporary TCM theory " the > present TCM theory cannot shoulder this sort of task at hand " . > > Everybody is clear about the importance of TCM foundational theory. > However, this important foundation gen ji still has many problems. > However, many people are busying themselves in building the structure of the > building. From my perspective, this building structure is not stable. > Everyone who does TCM must clearly see this problem. People should not one > sidedly build the structure above ground and forget about the necessity of > a strong foundation underground. And the integration of CM with WM must > gradually proceed under the direction of TCM's foundational theory. If one > takes the wrong road and walks very very far, can TCM still preserve its > original nature ? > > TCM requires an all-sided development. There is no hurry in integrating > CM with WM. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 Dear Zev, Thanks for your swift and generous response. I wish there was a similar swift critical response to the Maoist policy of integration of CM and WM. Instead it took more than half a decade to fire the fist salvo. The policy as you know led not only to the fragmentation of TCM practice but also prevented a healthy dialogue with biomedicine. So in essence, there was no plurality and equal co-existence of the various health traditions and practices over there. Integration in essence meant another word for 'domination' . Regards, Rey Tiquia , " Z'ev Rosenberg " <zrosenbe@s...> wrote: > Thanks, Rey, for translating this article. It is the best discussion > on the subject of CM/WM integration I have seen yet. It certainly > enriched my perspective and confirmed many of my feelings about the > issue. > > > On Saturday, May 3, 2003, at 09:26 PM, rey tiquia wrote: > > > Everybody is clear about the importance of TCM foundational > > theory. However, this important foundation gen ji still has many > > problems. However, many people are busying themselves in building the > > structure of the building. From my perspective, this building > > structure is not stable. Everyone who does TCM must clearly see this > > problem. People should not one sidedly build the structure above > > ground and forget about the necessity of a strong foundation > > underground. And the integration of CM with WM must gradually proceed > > under the direction of TCM's foundational theory. If one takes the > > wrong road and walks very very far, can TCM still preserve its > > original nature ? > > > > TCM requires an all-sided development. There is no hurry in > > integrating CM with WM. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 I'm intrigued by your analysis and your position as an American CM advocate. I'm also supportive of your stated pro-active position. There are those in my industry who have taken pre-emptive moves to get herbs to meet American government protocols. I for one am also in favor of spending some thought, imagination and energy to modify the government protocols as they apply to herbs. No one in the industry from small importers to Merck Pharmaceutical can afford to treat crude herbs as drugs. We need to provide clinics and extraction manufacturers with affordable herbs. Hopefully a middle ground can be carved out. Emmanuel Segmen Things are moving in a particular direction, so we can either try and guide them to a place we can work with or we can sit on the sidelines and watch those who are not sympathetic to our profession make the rules about how we practice.Chinese Herbshttp://www..orgvoice: fax: "Great spirits have always found violent opposition from mediocre minds" -- Albert Einstein Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2003 Report Share Posted May 3, 2003 Perhaps Ken, Bob Felt, Z'ev and Fernando would also like to add their input into how these paradigms might find the path to a dynamic harmony. >>>I think by always keeping all discussion patient centered. The aliments are still the same alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 There is an interesting quote by Harris Coulter, the famous medical historian on integration (of homeopathy and other 'alternative' approaches with biomedicine): " Why is this incessant desire to fuse the two systems, to take the best from each and synthesize them, etc., etc., ad nauseum? The answer is, of course, as in most things medical, that these are political and economic issues, questions of sovereignty. Allopathic physicians will never willingly relinquish their sovereignty over medical practice in all of its aspects. Hence, they call for fusion and convergence, for bringing (homeopathy) into the mainstream. But when one percent of the profession fuses with the remainder, we know who will be doing the fusing and who will be fused. The result will be the restructuring of (homeopathy) along allopathic lines. " While I understand the socio-economic scenario is different in China and the West, and we are talking about a much smaller phenomenon (homeopathy compared with WM in the West as opposed to CM and WM in China), and his point is a bit overstated (there are Western physicians who are very supportive of alternative medicine) , he does make a good case here against rushing into integration until our own foundation in Chinese medicine is more secure. On Saturday, May 3, 2003, at 10:01 PM, rey tiquia wrote: > Integration in essence meant another word > for 'domination' . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 Emmanuel, > I would like to encourage you to add any further commentary that comes to mind. I've also challenged my own brother a bit who is a Jungian therapist to think of the dynamics of Apollonian versus Confucian or Taoist. This allows me to reintroduce my own pet topic of paradigm collision versus paradigm harmony. Perhaps Ken, Bob Felt, Z'ev and Fernando would also like to add their input into how these paradigms might find the path to a dynamic harmony. > All the Best, > Emmanuel Segmen I have no idea how paradigms might find a path to dynamic harmony. But I think it is an interesting speculation. I tend to distrust " harmony, " especially harmony between paradigms. In my experience, what many people mean when they " harmony " is " silence " or perhaps more accurately lack of the noise that arises from discord. I believe that discord is actually quite productive. Opposition, as I've quoted Blake many times on this list, is true friendship. And I think it is quite fitting and proper, for example, for their to be a constant struggle between the Chinese medical people and the Western medical people here in China and everywhere else on earth. I think that people from both camps should be dogged in their determination to bring the foibles and fallacies of both systems to the public's attention. I am utterly opposed to the harmony of things which should be constantly in turmoil. In other words, in terms of your pet topic, I favor the collision over the harmony of paradigms. It is, after all the ongoing collision and mutual destruction of elementary particles that results in the stuff of life. If we are going to harmonize with something in nature, let's get down to basics. I fully agree with and endorse Alon's call for patient centered reasoning when it comes to guiding pubic discussion and public policy on medical matters. I believe that this is one of the great lessons that Western medicine has to learn from Chinese medicine, i.e., the prevalence of the patient in all matters in the clinic. Clearly each and every medical intervention should be undertaken for only one reason: to help the particular patient in question. I was taught very early on in my training in Chinese medicine, back in the early 70's in fact, that one of the curious characteristics of traditional Chinese medicine is that you could take the same patient to see ten different doctors and each one might come up with entirely different ways of understanding the patient's condition and approaches to treating the patient. And many if not all of them could succeed. In any case, I believe it is far, far too early to imagine any serious effort at integration of Chinese and Western medicine since the cohort of professionals who thoroughly understand both is so small. When it comes to such integration, I believe that it will probably be a judgment of historians rather than researchers. I believe that the bulk of research and investigation resources should be channeled towards education effective practitioners who can help patients and effective educators who can educate more and more. In China, patients have a great deal of discretion over how they want to deal with their diseases. Many hospitals have both TCM and WM departments, and patients participate quite actively in many decisions regarding the " integration " of the two in their own cases. And I think that is the direction in which we should focus and move. Let the differing views and approaches compete and collide and let the patients benefit from the results. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , " dragon90405 " wrote: > In China, patients have a great deal of > discretion over how they want to deal > with their diseases. Many hospitals have > both TCM and WM departments, and patients > participate quite actively in many decisions > regarding the " integration " of the two in > their own cases. > > And I think that is the direction in which > we should focus and move. Let the differing > views and approaches compete and collide > and let the patients benefit from the > results. Ken: The situation is similar here. Patient choices---market forces--- have provided the initial demand that has brought CM from obscurity in the 70s into the mainstream now. That demand, underscored by its effectiveness in areas where WM provides no benefit, secures its social role and helps create the impulse to further integrate it into the general culture by WM. That notion of CM's effectiveness is being challenged by SARS. The peoples' choice in China, when they are critical or actually have SARS, seems to be for WM. But there are probably stories of people going to their TCM doctor before it is diagnosed as SARS and improving. Any stories along that line? It would be interesting to know how CM historically faired against other epidemics by comparison---whether it actually helped cure it, improved immune function in the population until the epidemic passed, or did not make any real contribution and the epidemic passed of its own natural course. How well CM helps in these situations may provide a criteria in how it is integrated into WM. Anyone know any real numbers? Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , " rey tiquia " wrote: >> TCM requires an all-sided development. There is no hurry in integrating CM with WM. >>> I like Todd's notion of trying to help steer the process because the hurry and the way CM is integrated is not a real choice to make. It will be the collective result of many disparate motives and agendas from both WM and CM. It has to be seen not merely an ideological project but as a political one: 1. what the controls will be on herbs, and 2. if insurance and medicare pay all providers and not only MDs. When considering real integration, it is required that we first follow the money. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , " " wrote: >>> he does make a good case here against rushing into integration until our own foundation in Chinese medicine is more secure. >>> Which foundation is he speaking of? CM has been demonstrated as effective---if not scientifically at least anecdotally---but sufficiently enough to be brought into the cultural mainstream here. Since it already is a choice for the public, I think the real problem of integration answers the question as to where control and payment come from. That is, how herbs will be regulated and will insurance or medicare pay all who provide the service. The paradigm changes are secondary issues, and require a greater historical perspective. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 Rey, Thank you for translating this article. It is indeed a very coherent discussion. My experience of China and " integration " was that rather than using the theory of TCM as a basis for integration, most of the younger CM physicians and students of CM were using CM as a stepping stone to " integrate " the practice (read techniques) of CM with the " scientific reality " of WM. Most of the students that I interacted with and interviewed felt that CM really had very little to offer in terms of theory. My research also showed that at least 60% (probably more) of the students in colleges of CM were not there because they wanted to study CM. They were there either because they did not get in to colleges of CM or because they did not get in to some other school that they wanted to attend and their parents decided for them. It is these students especially who see little value in CM theory but only in the techniques. If, as Alon (and most of us) advocates we are working for a patient-centered medicine the integration of CM technique into the practice of WM is an intriguing idea (although not one that I necessarily advocate). On one hand, indeed the techniques are quite useful. On the other hand, and this for most of us is the crux, do the techniques have any or as much effect without the theory? I believe they do not (and this brings us back to the issue of pattern differentiation) but the culture to which we look for the knowledge of CM seems to be headed in that direction. All of us place high value on studying with older practitioners of CM from China. But these older practitioners are becoming fewer and fewer - will we or our students place the same value on studying with the new generation of chinese practitioners when they become the older generation? And, even with the current " older generation " we must stop and ask ourselves about their training - if they are in their 60's, 70's or 80's they were trained in the 50's 60's and 70's - a time of great unrest in Chinese education and a time when in fact despite " graduating " from schools many people received little real training of any sort (no matter what sort of school they attended). Granted these individuals now have 30, 40 or 50 years experience under their belt - and a type of clinical experience that it is hard for us to attain - but the move toward " integration " began when they were studying and has continued under their leadership. And those who were trained in the 80's and 90's were trained in programs that definitely espoused the Chinese idea of integration. One can look at the various versions of the State CM Textbooks to see how the changes have occurred over the past 40 years or so. There has been an up and down process concerning the educational focus and the amount of time devoted to CM vs WM while in school. Just some musings. Marnae At 02:26 PM 5/4/2003 +1000, you wrote: May 4,2003 Dear Todd and Listmembers, To understand the complex health system in China and the nature of contemporary TCM over there and its relationship with biomedicine or Western medicine, I think it will be instructive to understand the notion of 'integration' or jie he Following the Marxist epistemological dogma of dichotomizing theory from practice, Mao developed the concept (which later evolved into a party and state policy ) of Œintegrating¹ or jie he of the Œtheory of biomedicine¹ with the Œtheory of TCM Œ i.e. Zhong Xi Yi Jie He , the common English translation of which is Œintegrated traditional and Western medicine¹ . In contemporary Chinese communist jargon the term jie he is commonly used to Œcombine¹ , Œintegrate¹, Œunite¹ entities,¹humans¹(as in Œintegrating with the workers, peasants and soldiers¹) concepts orŒtheories¹ in a decontextualized manner. It is used as in Œintegrating¹ or Œcombining; Œtheory with practice¹ or lilun yu shijian xiang jiehe; or in ³integrate(ing ) the universal theory of Marxism with the concrete practice of the Chinese revolution ³ as in ba Makesizhuyi de pubian zhenli yu Zhongguo de juti shijian xiang jiehe. In terms of referring to the integration of TCM and biomedicine , Mao used the term jiehe in l956 in a formal meeting he had with a team of Chinese musicians. However, the content of this meeting was made public only in l977 in the Guang Ming Daily. Mainland Chinese TCM historian Si Yuan Yi , in his review of the work of ³integrating of TCM and biomedicine ¹ (which he pointed out as a duchuang or Œoriginal creation¹ quoted Mao as saying: We have to learn contemporary foreign things. After studying them, then we study Chinese things. ³ .. We have to accept the strong points that foreign things have.This will create a Œleap¹ yuejin in our own things. Chinese and foreign things must be organically integrated youji de jiehe We must not apply mechanically taoyong foreign things (on to the Chinese situation ). ² In an earlier essay On New Democracy written in January l940, Mao in an elaboration of the notion of a ³national scientific and mass culture² deployed a vivid food-digestive process metaphor to picture this process of Œorganic integration¹. Mao said: ³To nourish her own culture China needs to assimilate a good deal of foreign progressive culture, not enough of which was done in the past. We should assimilate whatever is useful to us today not only from the present-day socialist and new-democratic cultures but also from the earlier cultures of other nations.For example, from the culture of the various capitalist countries in the Age of Enlightenment. However, we must not gulp any of this foreign material down uncritically, but must treat it as we do our food- first chewing it, then submitting it to the working of the stomach and intestines with their juices and secretions, and separating it into nutrients to be absorbed and waste matter to be discarded before it can nourish us. To advocate ³wholesale westernization² is wrong. China has suffered a great deal from this mechanical absorption of foreign material. Similarly in applying Marxism to China, Chinese communists must fully and properly integrate the universal truth of Marxism with the concrete practice of the Chinese revolution.² But the ultimate aim of Œreforming¹ TCM through the Œintegration of biomedicine and TCM¹ is to elevate it to a Œscientific¹ level . As the TCM historian Si Yuan Yi pointed out as a background to quoting Mao¹s instructions: ³ As for study of medicine, we have to use Western contemporary science to research (Œstudy¹ , yan jiu) the guilu pattern of development of China¹s traditional medicine , and thus develop China¹s own Œnew medicine¹ .² In communist China, when laboratory experimental technique was first introduced into TCM research in l959 , the program of scientising TCM began. In l960, with the use of of Western pharmaceutical drug cortisone, a Chinese researcher developed a laboratory animal model replicating the TCM clinical pattern zheng of Yang deficiency yang xu . The efficacy of a traditional herbal formula traditionally used to address this clinical pattern was supposedly successfully Œtested¹ using this animal model. This signaled the emergence in PRC China of the so-called school of ³integrated Chinese and Western Medicines² Zhong Xi Yi Jiehe. The standardized universal yardsticks generated in the laboratory became the criteria upon which traditional Chinese medicine (TCM) has to be measured and accepted as scientific. Without due regard for the different contextual requirements of TCM as a body of medical knowledge with a long ancient history, a whole set of research projects were undertaken to make the parameters of TCM more Œscientifically objective¹. Recently, in my quest to trace 'On-line' the footprints of the SARS pestilential Qi in Southern China and Hongkong, I came accross the TCM Forum based in the Chinese Medical School of the Hongkong Baptist University. The Forum has been in existence since l999 and in it are articles in the Chinese language written by invited TCM scholars, TCM Experts and TCM students. One of the pieces that caught my attention was an article below submitted and published recently by a TCM student. have translated the article into English and I have an original hard copy of the Chinese version of it. As far as I can gather, this is hisitorically one of the first critique of the policy of integrating CM with WM in Mainland China (if we go by the recent Sino-British agreement on the reversion of HK to Mainland Chinese rule). As you can see, some prominent veteran TCM practitioners like Jiao Shu De , Yang Wei Yi and Deng Tie Tao have been quoted in this article. Regards. Rey Tiquia Phd Candidate Dept. of History and Philosophy of Science University of Melbourne Melbourne, Australia What is the 'Haste ' About Integrating With Western Medicine Chen Hai Yong - Undergraduate Student School , Hongkong Baptist University Since the years of the fifties In Mainland China, the movement for TCM zhong yi to go down the path of integrating Chinese medicine (CM) and Western medicine or biomedicine (WM) zhong xi yi jie took off . The tide at that time was considered as 'surging ' xiong yong peng pai ; and the debate as to whether to integrate CM with WM was not limited to being featured in major newspapers and magazines. The focus of the polemics was --can CM and WM really be integrated . Up to now, people are still unable to agree as to what is is right (or wrong) ' mo zhang yi shi . It is really very difficult to form a unified view. Although the integration of CM and WM have been going on for more than half a century, its feasibility and orientation are still pretty blurred. Hence, under this state of affairs, the integration of CM and WM must develop. However, this development must be under the direction of TCM theory. At the same time, this (integration of CM with WM) should not be taken to be the only pathway towards the development of TCM. The integration of CM with WM must be based upon reality xian shi . It should not be 'integration at all cost.' Originally, the purpose of 'integration' was very good i.e. integrating or combining the strong points of both medical systems . This is combining the strength of both i.e. through ' a bit of compulsion' to integrate' qiang qiang lian he and achieve the highest level of medicine and medical therapy , and in this way enriching humanity. Of course, this is a dream of all people in the medical circles . It is also something that society hopes for. In actuality, fifty years since the proposal to integrate CM with WM was put forth, the work in this direction ' like a raging fire' ru h uo ru tu , the great majority of TCM has taken this integrated road. Unfortunately up to this time, the accurate content of this integration ; the feasibility of this integration; whether can they be merged into an outstanding new type of medical system; the question on how this integration should take place; all these questions are still hanging on the balance. Under this very confused situation, we must not act with undue haste cao zhi guo ji to do this integration and do these things blindly. In addition, probably, this integration is Chinese medicine's 'unrequited love dan xiang si i.e Chinese medicine's 'one-sided wish' yi xiang qing yuan . On the other hand, The great majority of colleagues from Western medicine had never thought of integrating with Chinese medicine. Some of them (Western medicine) who have walked into the ranks of TCM research-- I could not speak on their behalf and say that they are not thinking of developing TCM; however, due to a lack of complete and thorough wan zheng understanding of TCM, the fruits of their research became the fruits of WM research and bears no relation whatsoever with TCM. At least, they have no connections with the theory of TCM. At the same time, as TCM uses Western medical discipline to develop the discipline of integrating CM with WM, there also emerged the problem of dovetailing xian jie the fruits of integrated CM and WM research with the theory of TCM. As as result, the materia medica Qing Hao (Artemeisia apiacea) has become Qing Hao Su (Arteannuin). The materia medica Huang Lian (Coptis chinensis) has become Huang Lian su (berberine) . Are these entities still TCM's materia medica zhong yao ? Can these entities still be used under the theoretical frame of TCM ? Western medicine has used berberine to achieve major therapeutic effects . On the other hand, the materia medica Huang Lian is still being used (in its raw form) clinically by TCM. And still with very good clinical therapeutic results. Of course, if there are people who will research the Four Qi Si Qi , Five Flavors Wu Wei and Acupuncture meridian association Gui Jing of these TCM materia medica under the theoretical frame of TCM , generate positive research outcomes and give due credit to TCM theory. This is also possible. If this can be real, this can be a great service to mankind gong de wu liang . Or perhaps we can look at Western pharmaceutical drugs xi yao and research them from the perspective of TCM materia medica zhong yao . This is using things foreign to serve China yang wei zhong yong ! Misters and Mrs. modern TCM practitioners must use the' creative and innovative spirit' kai tuo jing shen of the Divine Farmer Shen Nong of those ancient years who tasted a hundred plants. Western medicine is still developing its own theory. They are still doing their own research. As for us TCM practitioners, however, we cannot contain ourselves to 'form an alliance of marriage' lian yin with the hope of giving birth to a vigorous new baby . The 'creative and innovative spirit ' is already there you le However, poor TCM. On the one hand, it has to play the role of a TCM practitioner ; while on the other , it has to play the role of a biomedical practitioner. Biomedical practitioners can focus on doing Western medicine alone, while TCM practitioners have to think of taking the benefits from both. Humans are not sages and men of virtues sheng xian . In both CM and WM, both study medicine for a number of years. In both, the level of Western medicine studied are more or less the same. About the level of CM that CM students learn compared with those from previous times when they just learn 'pure CM'-- it is hard to say. It is not surprising that both veteran TCM professors Jiao Shu De and Deng Tie Tao in a lecture on August 8, 2001 and featured in the journal Modern Education Journal xian dai jiao yu bao said: " In the past several decades ji shi nian we haven't trained real TCM practitioners zhen zheng de zhong yi . " Studying medicine is like this. Being a medical practitioner zuo yi , generally is also like this. Teachers from both TCM and biomedicine teach to students their respective disciplines . And we the students 'integrate' jie he them . This way of integrating Chinese and Western medicines clearly is being done in a hurry. On the one hand, the conditions are not ripe for it. Western medicine is very reluctant to be part of it. Whether integration is a feasibility, we do not know. However, on the other hand, the work of integrating CM with WM like a honeycomb is unfolding . It is something that we cannot hold ourselves back from doing. LIke building a house, the various construction projects are still being discussed and debated. While the site of construction has not yet been decided , the house is already being hurriedly built. We can imagine the result of all of these. If we say that the results of these several decades of construction projects --the integration of CM with WM, if we say that his project has no achievements at all , then that is treating unjustly yuan wang those industrious and diligent workers. At least one of their achievement is the simultaneous use and application of both TCM and WM. In addition, this integration made TCM a contemporary and fashionable therapy . These benefits (resulting from the integration work) is obvious to everyone. The 'simultaneous use and application of CM and WM' zhong xi yi he yong perhaps can best describe the present state of TCM . Can we also say that this is the essence of the present state of integrating CM with WM? TCM needs A TCM-type of modernization in order to continuously develop itself and satisfy the needs of society . In this way, TCM can have a ' living space ' sheng cun de kong jian. If there comes a time that no one wants it anymore, then society will abandon it. This is the law of social development she hui de biran gui lu . Just like the development of the machine industry. If society does not need the blacksmith, then it disappears from society and enters the museum of history. TCM needs to modernize. However developing its modernization is not equal to developing the notion of integrating CM with WM. Hence modernizing TCM is not equivalent to developing the integration of CM and WM. Prof. Li Zhi Zhong from the School of of the Hongkong Baptist University has a good idea on the modernization xian dai hua of TCM. He once said: " 'Modernity' xian dai is a concept of time. It refers specifically to a state of backwardness and slow development. Hua is a concept of space. It refers to multiplicity of viewpoints points duo jiao du and all-directionality quan fang wei . " In his book The Discipline of TCM- Macro Regulative Functional Medicine zhong yi xue- hong guan tiao kong gong neng yi xue Prof. Yang Wei Yi thinks that " the leading discipline in TCM is its foundational theory " . However due to the imperfection of contemporary TCM theory " the present TCM theory cannot shoulder this sort of task at hand " . Everybody is clear about the importance of TCM foundational theory. However, this important foundation gen ji still has many problems. However, many people are busying themselves in building the structure of the building. From my perspective, this building structure is not stable. Everyone who does TCM must clearly see this problem. People should not one sidedly build the structure above ground and forget about the necessity of a strong foundation underground. And the integration of CM with WM must gradually proceed under the direction of TCM's foundational theory. If one takes the wrong road and walks very very far, can TCM still preserve its original nature ? TCM requires an all-sided development. There is no hurry in integrating CM with WM. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , Marnae Ergil <marnae@p...> wrote: And, even > with the current " older generation " we must stop and ask ourselves about > their training - if they are in their 60's, 70's or 80's they were trained > in the 50's 60's and 70's - a time of great unrest in Chinese education and > a time when in fact despite " graduating " from schools many people received > little real training of any sort (no matter what sort of school they > attended). Granted these individuals now have 30, 40 or 50 years > experience under their belt - and a type of clinical experience that it is > hard for us to attain - but the move toward " integration " began when they > were studying and has continued under their leadership. Marnae I was thinking a similar thing as I read Volker Scheid. I realized that many of my chinese colleagues over the years, based upon their age, must have been trained just after the cultural revolution. Many senior physicians had been purged and many books burned during this time. Some of my chinese colleagues were thus very western oriented. when they got sick, they took antibiotics and valium, not herbs and acupuncture. Some also practiced a style of TCM that I now suspect reflects more a methodology based upon formulaic patient typing (bian xing) rather than understanding patterns and pathomechanisms (bian zheng) -- as Scheid defines these styles. While many of these doctors are indeed now quite experienced in terms of years in practice, after reading Scheid, I have to ask what did they do during those 20 or 30 years. If you are correct (and I have heard this from numerous sources, including scheid and Fruehauf) that many of those studying TCM in China are doing it is a springboard to a career in western medicine, then perhaps they have spent 20 years prescribing drugs and doing minor surgery before coming to the states. I will now always wonder these things. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 The recent situation with SARS in China, so well described by Rey and Ken, really impressed me with how relatively weak is the standing of Chinese medicine to the Chinese public. If Marnae is correct, and I believe she is, ( " On the other hand, and this for most of us is the crux, do the techniques have any or as much effect without the theory? I believe they do not (and this brings us back to the issue of pattern differentiation) but the culture to which we look for the knowledge of CM seems to be headed in that direction " ), we are in a dilemma. That dilemma is how to build a strong Chinese medical profession in the West with our limited resources, while a WM controlled integration is developing in China . Despite the limits of our past perceptions of 'alternative medicine', I think our hearts were and are in the right place in wanting to create a strong medicine with tools that are useful to all kinds of patients. As I have advocated, along with such teachers as Guohui Liu, the tools of Chinese medicine would be very useful for the colds and flus that are presently being treated not only with often inappropriate antibiotics, but now steroids as well. The results of this mass immuno-suppression can only be disastrous. Finally, Chinese medicine is a lifestyle as much as a medicine. The use of dietetics, therapeutic exercise and meditation, seasonal regulation and behavior is equally important to the use of herbal medicine and acupuncture/moxabustion. It still bothers me to see the students drinking diet cokes and eating junk food while in class, and taking western drugs for colds and flus instead of herbs (although this situation has improved recently). On Sunday, May 4, 2003, at 12:09 PM, wrote: > > I was thinking a similar thing as I read Volker Scheid. I realized > that many of > my chinese colleagues over the years, based upon their age, must have > been > trained just after the cultural revolution. Many senior physicians > had been > purged and many books burned during this time. Some of my chinese > colleagues were thus very western oriented. when they got sick, they > took > antibiotics and valium, not herbs and acupuncture. Some also > practiced a > style of TCM that I now suspect reflects more a methodology based upon > formulaic patient typing (bian xing) rather than understanding > patterns and > pathomechanisms (bian zheng) -- as Scheid defines these styles. While > many of these doctors are indeed now quite experienced in terms of > years in > practice, after reading Scheid, I have to ask what did they do during > those 20 > or 30 years. If you are correct (and I have heard this from numerous > sources, > including scheid and Fruehauf) that many of those studying TCM in > China > are doing it is a springboard to a career in western medicine, then > perhaps > they have spent 20 years prescribing drugs and doing minor surgery > before > coming to the states. I will now always wonder these things. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , " " < zrosenbe@s...> wrote: > > That dilemma is how to build a strong Chinese medical profession in the > West with our limited resources, while a WM controlled integration is > developing in China . according to Scheid, practitioners of chinese medicine dominate the integration of CM and WM, NOT practitioners of WM. However this is at the level of discourse. At the level of practice, what is happening is not always sophisticated integration according to Scheid and others. I think what you are describing as the situtation in modern china is not an issue of integration gone amok. It is an issue of the wholesale rejection of the principles of CM by some of its practitioners. Both CM and IM, as described by Scheid, put great emphasis on preserving what is distinct about CM to greater or lesser degrees. What the SARS situation illustrates is not such a lofty model of integration, but rather an allopathic application of chinese herbs by doctors who probably never believed the CM theories anyway. this is the crux. the true spirit of integration in china emphasizes bian zheng as central according to scheid, at least in official discourse. this disease oriented western physiological approach has nothing to do with this spirit of integration. It is the sheer dominance of western ideas over chinese ones. I think it is incorrect to blame this on integration. As I wrote earlier, some degree of integration is inevitable and to many, if not most, desirable. I would argue that it is those who abandon working towards a sophisticated form of integration and hold out for a CM completely uncontaminated by western ideas are: 1. not being true to the evolving spirit of CM. 2. playing right into the hands of the worst of the scientizers and standardizers. by not engaging the process of true integrations as zhang xi chun saw it, we will see integration being handled by those who do not understand CM and then our techniques will be sparated from our theory. If some integration is inevitable and desirable, then we must lead the way in this process. It will happen and if we do nothing, I suspect we will lose big. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 The recent situation with SARS in China, so well described by Rey and Ken, really impressed me with how relatively weak is the standing of Chinese medicine to the Chinese public. If Marnae is correct, and I believe she is, ( " On the other hand, and this for most of us is the crux, do the techniques have any or as much effect without the theory? I believe they do not (and this brings us back to the issue of pattern differentiation) but the culture to which we look for the knowledge of CM seems to be headed in that direction " ), we are in a dilemma. That dilemma is how to build a strong Chinese medical profession in the West with our limited resources, while a WM controlled integration is developing in China. Z'ev: When I wrote earlier about my perception of the lack of confidence the Chinese public has for TCM during this SARS crisis, I suspected the issue was driven more by politcs and culture than ideology. After all, TCM in China still has leaders, institutions even at the hospital level, and a long history of acceptance. But like most Americans, many Chinese now seem to think that new is better and more effective; and this opinion is uninhibited without sufficient history to take into account WM's shortcomings. Or perhaps because they are already familiar with the endless interpretations and debates regarding the theories of CM, WM's scientific perspective offers them a degree of certainty. I would disagree with your and Marnae's point about the techniques of CM not having " as much effect without the theory. " In the long run, that is true. But clearly, in the short run they do; enough for many Chiropractors and MDs to want to add the techniques---if not theory as a whole---to their practices and integrate it into WM. One of the weaknesses of CM is its continued lack familiarity in the minds of the American public. I still get many of the same questions today as I did 30 hears ago. When people ask, " How does it work? " I like to say, " Just like Complexity Theory---do you understand that? " Rarely they do; most are still struggling with Newtonian mechanics. So, like commerial products, it sells because people like it for its reputation of effectiveness. I believe they see it as an alternative to WM's weaknesses in the sense that it makes up for WM's weaknesses without replacing WM's authority and reassurance when it comes to serious illness. So, when in crisis, they will relie on what is most familiar. I suspect another weakness that gives license to WM for its use of CM techniques, while neglecting theories, is that theories in CM are difficult for Western thinkers, very broad, and highly generalized. That many different disorders are diagnosed by the same few CM rubrics---for example, spleen xu and liver stagnation---is a weakness compared to WM's attention to detail in its diagnosis--- more evidence of WM's certainty. To build a stronger Chinese medical profession in our country, we need to focus on the political and cultural issues more than academic ones now. Real integration is not theoretical---how many hormones equal kidney yang---it is a matter of who gets paid, and who controls the public's access to herbs and treatments. Western culture doesn't have to argue with us, they can simply ignore us by setting up their own institutions and test criteria. Just thinking out loud. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 4, 2003 Report Share Posted May 4, 2003 , " " wrote: we will see integration being handled by those who do not understand CM and then our techniques will be separated from our theory. >>> : You are very succinct in making a point that I was trying to make when talking about the politics of the situation. I believe it is this, and not academic standards, that is the issue underscored by the Chinese response to SARS. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
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