what is MSU

July 17, 2005

Over the years there has often been rancorous debate here about what

constitutes the valid tradition of CM. Splits arise between

classicists and modernists, but also between those who are primarily

practitioners and those who would fancy themselves scholars. On this

list, it has been a familiar refrain (often mine) to dismiss anything

outside the textual transmission as suspect. In a nutshell, if it

wasn't written down and passed on for inspection by many physicians

in future generations, then how could it be trusted. On its face,

quite logical. CM has not been empirically proven to my satisfaction

in modern terms, so its value must lie in the broad consensus that

developed over the centuries. And that there was indeed a consensus

seemed evident in a survey of the contents of the classic texts that

stood the test of time. Much of what has been written on CM has only

ever been read by a few. And much of what has been practiced as CM

has never been written down at all. I was always aware of both these

latter points, but still my working assumption was that this database

of written material was still the sole repository of valid knowledge,

even when compared to this likely much vaster set of oral teachings.

Sure, the ins and outs of practicing medicine are learned by

apprenticeship and story, but that any valid story had to be rooted

in an accepted text. Otherwise, it seemed to be a pretty much

anything goes scenario, pure relativism, no truths.

But here's the rub, you see. The textual material is only more valid

than the oral teachings if it actually reflects the experience and

practice of the physicians who saw large numbers of patients. But

many of the writers in the confucian tradition of scholarship

apparently looked with disdain on the actual practice of medicine.

It was their filial responsibility to learn to care for their

families,but it was not a respected way of making a living. Certainly

those who advertised their services or nostrums were widely held in

contempt by the literati physicians, who frequently railed against

the unlearned masses in their tomes. Yet as we all well know, most

of those who write most practice least (myself included and there are

exceptions to every rule). There is only time for so much. I am

sure this has always been the case. In addition, less than 1% of the

population of ancient china could read, so really very few people

were actually working from the classical tradition as the scholars

would have it. And those scholars saw so few patients, it is unlikely

that their supposed insights are anything of the sort. Arguably,

just as the Galenic professors of medieval europe manipulated theory

endlessly without ever practicing, the same was true for many of

these chinese scholars.

In light of this, I really have to back off my longheld position on

these matters. In fact, since the bulk of chinese medical practice

was not in the scholarly tradition, the only way to find out what

actually works (short of controlled research) would be ethnographies

of local practice. But when TCM was formed, there was no way the

elitest confucians transformed into comrades were going to embrace

the folk traditions. Of course, during the past 50 years, there was

a period of elevating the peasants and denouncing the academics. But

asking illiterates with no training or family traditions to practice

medicine is completely different than following a thousand year old

oral tradition. So we have to consider that so-called TCM and the

classical tradition from which it was derived may not be the most

efficacious form of CM. This would explain in part why CM seems to

be equally effective when practiced and researched using a wide range

of models, including allopathic biomedical. Scholars of old might

bemoan this observation, but they do not have the hindsight of all

the research that pretty much proves the scholarly approach to CM is

just one approach and not necessarily the best.

There is a concept in the cognitive sciences called procedural

rationality. Procedural rationality is different than objective

rationality. Objective rationality is when one surveys and explores

a huge range of options before making a decision. In medicine, this

might take the form of having to consult a dozen classic texts plus

case studies before writing a formula for a case. Being thorough in

this way seems quite rational. Procedural rationality is common

amongst nonscholar practitioners in any field. In this type of

rationality, one may ignore lots of data because experience and the

ability to perceive patterns allows one to cut to the chase. This is

not mystical in any way. If you know the solution to a problem that

has worked 9 of every other 10 times, it is actually highly

irrational to spend hours poring through texts until you understand

the technicalities of a concept as well as a researcher or scholar

does. And your solution might even be one that a scholar would scoff

at. It may even have mystical aspects, which while anathema to the

scholar doctors, was apparently very popular with the rank and file.

So while I may think it is a serious error of judgment to associate

modern TCM with any shred of god, I can't deny that non-rational

approaches to medicine may have even dominated ancient China as they

dominated all the rest of the world. And if both the patient and px

are inclined towards this model, then it quite likely has powerful

effects. So in terms of what might work, I no longer thinks the

scholars really have any claim on validity. I do still think much of

what people call mystical is placebo effects (in other words,

something of remarkable healing potential that works through the

human brain, not an outside entity of some sort). But that is

besides the point. If it works, it works. So in the future,I would

ask all listees to refrain from using the epithet MSU if the concept

is actually part of chinese medical history, whether you consider it

valid or not. But be clear, this is not license to actually make

things up. I am still not interested in your homeopuncture

experiments or chakra balancing. These things are most definitely

MSU and I will not relent on that point unless someone proves it to

be part of some written or oral tradition, however idiosyncratic.

But I won't stop you from posting on such topics, either.

Chinese Herbs

July 17, 2005

While your new openness to discussion of a broader range of ideas on

CHA is refreshing, your posting reminds me of the old dichotomy in

medicine described by Harris Coulter in Divided Legacy of rational

and empirical medicine.

In a nutshell, the greatest contribution of the classical scholar-

physicians as I see it was the development of a rational approach to

medicine based on theory/philosophy. CM theory allows one to

construct treatment strategies that can be engaged over the longer

term, very important for chronic disease management. Empirical

medicine was also a large part of Chinese medicine, and, yes, more

available to the common people, everything from bone-setting to

cupping to empirical herbal remedies. However, clinical skill alone

and the observations gained thereof do not allow a broad view of

lifestyle and regaining health beyond removing diseases and symptoms

from the individual patient.

Certainly there are advantages and disadvantages to both approaches.

However, the rational system based on yin-yang theory and the Nei

Jing still is the heart and soul of Chinese medicine.

On Jul 17, 2005, at 3:36 PM, wrote:

> So while I may think it is a serious error of judgment to associate

> modern TCM with any shred of god, I can't deny that non-rational

> approaches to medicine may have even dominated ancient China as they

> dominated all the rest of the world. And if both the patient and px

> are inclined towards this model, then it quite likely has powerful

> effects. So in terms of what might work, I no longer thinks the

> scholars really have any claim on validity. I do still think much of

> what people call mystical is placebo effects (in other words,

> something of remarkable healing potential that works through the

> human brain, not an outside entity of some sort). But that is

> besides the point. If it works, it works. So in the future,I would

> ask all listees to refrain from using the epithet MSU if the concept

> is actually part of chinese medical history, whether you consider it

> valid or not. But be clear, this is not license to actually make

> things up. I am still not interested in your homeopuncture

> experiments or chakra balancing. These things are most definitely

> MSU and I will not relent on that point unless someone proves it to

> be part of some written or oral tradition, however idiosyncratic.

> But I won't stop you from posting on such topics, either.

July 17, 2005

Todd states,

" In light of this, I really have to back off my longheld position on

these matters. "

Welcome aboard, now we can get somewhere!

Mike W. Bowser, L Ac

July 17, 2005

So in the future,I would

ask all listees to refrain from using the epithet MSU if the concept

is actually part of chinese medical history, whether you consider it

valid or not.

>>>>>> that is also the only way we can communicate current experience. If

we are to look for validation from Chinese sources for everything we do we will

loose in the long run. What I would suggest however is that clinical discussions

should be based on true experience and not on imagination and so-called rational

theory.

Oakland, CA 94609

July 17, 2005

Very unreasonable, grouping 'imagination' together with rational theory.

If a practitioner develops a treatment plan based on rational theory,

shouldn't that be discussed? Without a rational structure, how are

you going to develop treatment plans, diagnosis, and followup?

On Jul 17, 2005, at 4:33 PM, wrote:

> So in the future,I would

> ask all listees to refrain from using the epithet MSU if the concept

> is actually part of chinese medical history, whether you consider it

> valid or not.

>

>>>>>>> that is also the only way we can communicate current

>>>>>>> experience. If we are to look for validation from Chinese

>>>>>>> sources for everything we do we will loose in the long run.

>>>>>>> What I would suggest however is that clinical discussions

>>>>>>> should be based on true experience and not on imagination and

>>>>>>> so-called rational theory.

>>>>>>>

>

July 17, 2005

>

> On Behalf Of

>

> But here's the rub, you see. The textual material is only more valid

> than the oral teachings if it actually reflects the experience and

> practice of the physicians who saw large numbers of patients. But

> many of the writers in the confucian tradition of scholarship

> apparently looked with disdain on the actual practice of medicine.

> It was their filial responsibility to learn to care for their

> families,but it was not a respected way of making a living. Certainly

> those who advertised their services or nostrums were widely held in

> contempt by the literati physicians, who frequently railed against

> the unlearned masses in their tomes. Yet as we all well know, most

> of those who write most practice least (myself included and there are

> exceptions to every rule). There is only time for so much. I am

> sure this has always been the case.

Interesting post... But to shed a different light on the issue, I have

lately been translating Bio's of famous authors and doctors, and actually

for a brief moment in time thought about putting together a book... but

anyway... I am actually amazed to read the stories and how involved their

lives were in the medicine and specifically actually healing people. Most

of these famous authors became famous not from their words per se, but

because they acquired an incredible reputation healing either very serious

diseases, a large amount of people, or sometimes (but less common) a famous

figure / like a high government official... Maybe all these stories are

made up, but such famous doctors IMO seem to bring much to the table when

you read their books, and I don't think this is the exception in CM. I have

a couple of books of about 100 famous doctors and it is quite interesting.

Even the 'major texts' authors, like ZZJ, LiDongYuan, ZhuDanxi etc.. all saw

many patients. Have you heard different?

BTW - Do you have some translation websites you can share?

-

In addition, less than 1% of the

> population of ancient china could read, so really very few people

> were actually working from the classical tradition as the scholars

> would have it. And those scholars saw so few patients, it is unlikely

> that their supposed insights are anything of the sort. Arguably,

> just as the Galenic professors of medieval europe manipulated theory

> endlessly without ever practicing, the same was true for many of

> these chinese scholars.

>

> In light of this, I really have to back off my longheld position on

> these matters. In fact, since the bulk of chinese medical practice

> was not in the scholarly tradition, the only way to find out what

> actually works (short of controlled research) would be ethnographies

> of local practice. But when TCM was formed, there was no way the

> elitest confucians transformed into comrades were going to embrace

> the folk traditions. Of course, during the past 50 years, there was

> a period of elevating the peasants and denouncing the academics. But

> asking illiterates with no training or family traditions to practice

> medicine is completely different than following a thousand year old

> oral tradition. So we have to consider that so-called TCM and the

> classical tradition from which it was derived may not be the most

> efficacious form of CM. This would explain in part why CM seems to

> be equally effective when practiced and researched using a wide range

> of models, including allopathic biomedical. Scholars of old might

> bemoan this observation, but they do not have the hindsight of all

> the research that pretty much proves the scholarly approach to CM is

> just one approach and not necessarily the best.

>

> There is a concept in the cognitive sciences called procedural

> rationality. Procedural rationality is different than objective

> rationality. Objective rationality is when one surveys and explores

> a huge range of options before making a decision. In medicine, this

> might take the form of having to consult a dozen classic texts plus

> case studies before writing a formula for a case. Being thorough in

> this way seems quite rational. Procedural rationality is common

> amongst nonscholar practitioners in any field. In this type of

> rationality, one may ignore lots of data because experience and the

> ability to perceive patterns allows one to cut to the chase. This is

> not mystical in any way. If you know the solution to a problem that

> has worked 9 of every other 10 times, it is actually highly

> irrational to spend hours poring through texts until you understand

> the technicalities of a concept as well as a researcher or scholar

> does. And your solution might even be one that a scholar would scoff

> at. It may even have mystical aspects, which while anathema to the

> scholar doctors, was apparently very popular with the rank and file.