Question for Unschuld

November 10, 2003

Emmanuel,

I hope you'll continue to drive these points home.

I expect that people will be reporting what Unschuld said in more

detail after you left., and I'll be very interested in the various

comments reported, as well as people's reactions and responses.

Should be interesting...!

The point you're making about the CM profession being in the driving

seat of its own development is very important. We've got to

distinguish between what input is intrinsic to our development, and

what is extrinsic. I regard the 'scientific evaluation', as for

example expressed by Straus of the NIH, of CM as extrinsic - it's

purpose is to answer questions in a manner that is relevant to an

audience working with radically different presuppositions and

methodology. What is threatening to the CM community is that this

project is presented in society as an authoritative assessment, the

presupposition being that CM will come in line with that assessment.

In fact, as Straus has suggested, CM may cease to exist as a discrete

discipline in that evaluation. [ " As a result of rigorous scientific

investigation, several therapeutic and preventive modalities

currently deemed elements of complementary and alternative medicine

will have proven effective. Therefore, by 2020, these interventions

will have been incorporated into conventional medical education and

practice, and the term " complementary and alternative medicine " will

be superseded by the concept of " integrative medicine. " " Marsha F.

Goldsmith (ed.). 2020 Vision: NIH Heads Foresee the Future. JAMA Vol.

282 No. 24, December 22/29, 1999]

Statistics, alongside other issues, are of crucial significance in

this. As a practitioner of CM, my development has been informed of

theory that I have learned, but this has been modified by my personal

clinical experience in the course of many years. I would suggest that

isolated experiences, perhaps never repeated, have a very important

formative effect in the development of a CM practitioner. For

example, I once gave a patient the K'an herbal version of Xiao Yao

San. That person felt that it was on the right track, but he conveyed

a discomfort with the pills that I was able to interpret as the

formula having a superfluous, and therefore inappropriate, blood and

qi moving effect in his chest, which I further interpreted as due to

the inclusion of Xiang Fu and Chuan Xiong in the pills. (All CM

herbalists in this forum will be aware that Xiao Yao San courses the

LIV, but does not include these two medicinals.) That one experience

taught me a great deal about Xiao Yao San as an integral formula, and

about the effects of adding additional qi and blood moving herbs,

etc. I choose this small example to illustrate a phenomenon that

occurs repeatedly in one's development as a practitioner, which one

builds upon. This type of knowledge, which is grounded in practical

experience, and as such can be regarded as having an objective basis,

is disregarded and invalidated in the ethos of statistical evaluation

of medicinals as a basis for practice.

I don't have time at the moment to elaborate these thoughts, but in

brief, if CM professionals want to be in the driving seat of their

style of medicine, much more work than I'm aware of as having been

done, needs to be done to explore the values, needs etc. of the

intrinsic development of CM, and this must be accompanied by a

developed critique of science and biomedicine as is relevant to CM

practice.

Best wishes,

Wainwright

-

" Emmanuel Segmen " <susegmen

Monday, November 10, 2003 11:15 PM

Re: Question for Unschuld

> Paul made a prediction about statistics, and I don't remember his

exact words here. It was a commentary that was a bit off the point

of the thesis he was discussing (Daoism versus Confucianism as a

bifurcation of CM thought leading up to the Song Dynasty ...

respectively, herb use versus acupuncture as CM modalities). He

basically noted that future historians will see our extreme reliance

upon it as an embarrassment of our current scientific thought. He

left it at that without digging into specific examples. This is a

topic that is much debated in my own area of science as well as

teaching. My own sense of it is that moderate and appropriate use of

anything maintains that thing's usefulness. To make it a requirement

of every step one takes is when it becomes absurd ... like driving

your car to the corner to buy something. Also applying it to things

outside of its paradigm is another aspect of misuse. So much of

current academia seeks to become authoritative by finding a way

> to perform studies and then misapply statistics. One of the

questions that I am asked when applying for teaching positions

is " how will I apply technology " to my classroom and laboratory

setting. Generally, I reply that I will do my best to not be

distracted by it ... except to help my students learn to use

appropriate technologies like microscopes and surgical tools. You

might hire a bookkeeper to help you with your business, and that

bookkeeper might then generate statistics about your business. That

person might logically persuade you that you should carry out certain

duties or actions at certain times and not at other times. At some

point the bookkeeper owns your business, and you are simply a

technician with a bit of knowledge working for the person you

originally hired. I see this happen in my daily business all the

time. I see it happen in the college setting all the time. In fact

it is not the exception. It is the rule.

>

> Emmanuel Segmen

November 10, 2003

Wainwright,

Thank you for " driving home " my points with even better points of your own.

Your concluding comments that Chinese medicine must create its own paradigm of

self-study is precisely on the mark regarding its development. CM investigators

must establish their own criteria of self-study and clinical development apart

from and undistracted by Western science's self-development. The two paradigms

may develop at their own rate on parallel tracks. CM has it's own historical

momentum and methods of development. It is up to the " experts " in CM to define

the methodologies of development and not be distracted nor invaded by the

" cultural substrate " outside their door. A true artist works within themselves

to render into their medium in their own style and undistracted by the cultural

forces in their midst. If they are distracted by the forces in their midst,

then their meditation has been broken and they are merely a technician and tool

of their times. They have lost their art.

Emmanuel Segmen

-

wainwrightchurchill

Monday, November 10, 2003 10:37 PM