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APPROACHING CHINESE MEDICINE FROM AN ANTHROPOLOGICAL STANCE
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T. HOR
Unlike that of the other speakers, my speech will not focus on the
subject of our symposium-pneumoconiosis. 1 have indeed been asked to
introduce Chinese medicine generally in order to get western medicine
to 'rotate' its view of this subject towards that of Chinese medicine
itself. The task appears difficult. Apart from the considerable scope
of the subject and the enonnous distance between the two visions, such
a speech could well cause, in the context of present-day society, controversies
that would make us lose our impartiality and move us away from our goal.
So as to create above all an atmosphere of complicity and not of rivalry,
I intend to, use an anthropologic method: this introduction will therefore
begin by simple observation, like that made by anthropologies arriving
in new terrain.
This idea is based on the fact that, whatever our identity or intelligence,
regarding this so-called 'ancient' medicine formed by the knowledge
and know-how of the ancient Chinese, we are all conteraporaries and
this temporal simultaneity unites us. Together we are going to observe
an 'object' outside our time. We will therefore fmd a basis allowing
us to work together in our adventurous discovery of a différent
world, and we will also obtain insight into ourselves, shedding light
on the system of refèrences by which we interpret this world.
1 have asked Mrs Wang to present us with a typical Chinese medicine
consultation. At this first level we will simply note what we see without
trying to understand, as if we were making a phonetic recording of a
foreign language.
Consultation by Mrs Wang:
Listen (questioning), Sée (tongue examination), Touch (pulse
taking), Feel.
Diagnosis: kidney kin deficiency
The therapeutic methods of Chinese medicine are mainly plant decoctions
(the pharmacopoeia), cutaneous stimulations by needles (acupuncture)
or its variations (moxibustion, massages), diets (dietetics), and physical
and mental exercises (Qi Gong for example). These visible elements have
built the image of Chinese medicine we have in France. This vision should
be completed by the other lesser known disciplines-Waike (treatment
of fractures, of skin diseases ... ) for instance.
These methods and diagnostic techniques such as pulse taking, tongue
observation, etc. ..., remind us of the old days when the new technologies
still did not exist. Therefore Chinese medicine has been called traditional,
natural or unconventional. medicine, etc. ..., but these images do not
suffice to define Chinese medicine strictly speaking.
During our initial observation we observed that, using these special
techniques, Mrs Wang discovered a 'kidney Yin deficiency' in the patient,
which leads to the choice of a medicinal formula (or of a series of
acupuncture points). This is the very heart of this practice.
Following her examination, Mrs Wang stated a 'syndrome' (Zheng in Chinese).
The main point is to know how to distinguish, among a hundred or so
syndromes, that which corresponds to the patient's state. Each syndrome
is linked to treatments, which merely have to be memorised. Therefore,
if he does not make a diagnosis with a distinction of syndromes, a practitioner
cannot be considered to be initiated in Chinese medicine even if his
instruments are highly exotic or his actions extremely natural and gentle.
This deflinition helps us to understand the character of Chinese medicine,
yet two steps still appear unclear to us. How is a syndrome determined?
How is it linked to the treatments that can cure it? By raising these
questions we enter a second level at which we discern the internal logic
of this 'object' we are observing as if were trying to understand the
meaning of each word and the grammatical rules of a foreign language.
The theory of Chinese medicine has borrowed greatly from. Taoist philosophy,
mainly from the principle of universality. According to that philosophy,
the world originated from a single Qi (blast, often translated by 'energy').
This Qi is divided into Yin character and Yang character, the meeting
of which generates the various elements of the universe, including living
beings. Each of these, according to its nature, belongs to a given class
and follows the 'five movements' principle.
ANNEX 1 a The Yin-Yang symbol
ANNEX 1 b The five movements
Man too is divided into five parts (five 'organs' and five associated
viscera), each of which has a specific function via the Yin-Yang balance.
Healthy man is protected by "Zheng qi" ('right Qi')-the latter
unifies man in his totality by means of the canals system (meridians).
ANNEX 2
ANNEX 2: Meridians and points
But man also belongs to a global environment and 'perverse qi', of
external or intemal origin, can perturb the 'right Qi' and cause diseases.
ANNEX 3.
ANNEX 3: External perverse Qi
and internal perverse Qi
This perturbation of Qi can appear in the whole body, particularly
by a change in the tongue and pulse. ANNEX 4 a
and ANNEX 4 b.
These observable manifestations allow a doctor to distinguish the syndrome,
in other words locate the perturbation and identify its nature.
To do so, diagnostic methods are essential. The two most current methods
refer to the 'eight principles', to 'organs' and to 'viscera'.
ANNEX 5: The two most used diagnostic methods.
The final aim of treattnent consists in eliminating perverse Qi and
regulating right Qi. To do so it is necessary either to directly tonify
Qi at certain places on the meridians concerned, or make it react indirectly
by taking advantage of the différent types of Qi in the various
elements. This is how the therapeutic system. came into being which,
with highly sophisticated methods, claims to rebalance Yin-Yang so as
to prevent or cure diseases.
Listening to all this account of the theory we feel as though we have
entered a sacred world, a world of Qi invisibly connecting all the elements
of the universe. We have understood that, thanks to, this miraculous
Qi, Mrs Wang has found the syndrome and that, thanks to the same Qi
again, all her treatments are therapeutically effective.
A practitioners behaviour thus fmds its legitimacy in this perfect
Qi logic. For an old Chinese man or for a contemporary imbued with orientalism.
or even esoterism, literary proof in the original classical texts is
sufficient to make this sacred world credible. But obviously many of
us are going to ask ourselves if this world really exists.
This question brings us to the third level of our perspective: we now
wish to interpret and assess what the ancient Chinese have bequeathed
to us. Thafs how the controversy began: some people consider that accepting
such a superstitious system in the medical profession is an intellectual
insult, whereas others feel that this age-old intelligence had discovered
a truth that has been lost and that we should today decode the mystical
language comprising terins such as Qi, Yin-Yang, meridian, etc...
All the attempts at decoding: translating Qi by 'energy', comparing
the Yin-Yang relationship with the properties of certain molecules of
the human body (particularly cAMP' and cGMP') or else using various
techniques to offer evidence of the 'meridian' canals ... have scarcely
stifled the controversy--quite the contrary.
To fmd common ground, we must look inwards following the precepts of
anthropology. In effect, the controversy stems from the refèrence
system. we customarily use to assess the world. When we ask: 'Is Chinese
medicine real?', there is a faith and an apriorism behind this question,
in other words the truth can be known only by objective proof based
on observations (by the bare eye or using instruments), which show us
clear and reliable cause-effect relationships ; 'real' medicine-capable
of preventing and curing diseases-must build its physiopathological,
diagnostic and therapeutic system on this absolute truth.
4 cyclic adenosine monophosphate
5 cyclic quanidine monophosphate (a component of DNA)
Probably because of this faith, modem western medicine has become 'official',
'conventional'; nobody can have any doubt about its legitimacy based
on anatomic, biological or genetic knowledge. However this scientific
basis is absent in Chinese medicine. 'Scientific or not', that is the
heart of the controversy.
Let us now retum to what we have seen of this medicine. Unlike western
medicine, Chinese medicine neglects to observe directly what happens
inside the human body. It stresses the extemal expression of the body:
the healthy state, the sick state and the cured state. With this empirical
method it has accumulated a very rich clinical experience determining
the relationship between a disease and effective treatment; this relationship
is a de facto 'truth'. However the explanation of these relationships
is speculative and philosophical. In this sense the theoretical system
of Chinese medicine has nil value as a &science' strictly speaking.
Having absolute faith in this world of Qi appears ridiculous and even
harinful. But this criticism does not prevent it from being useful and
even necessary in certain circumstances, particularly in the practice
of Chinese medicine. Its value is to help the practitioner find the
relationship between a disease and its treatment on the basis of empirical
experience.
Referring back now to, the consultation by Mrs Wang, the expression
'kidney Yin deficiency' merely stands for a series of symptoms and clinical
signs comprising buzzing of the ears, night sweating, lumbar stiffness,
red tongue, faint and rapid pulse, etc... Among these manifestations,
some are considered proof of Yin deficiency, whereas others indicate
that this deficiency is located in the kidney. A medicinal formula will
therefore be prescribed to tonify the kidney Yin, or perhaps the subject
will be needled mainly on the points located on the kidney meridian
line, for tonification purposes. Don't bother asking yourself whether
the kidney is really deficient or really tonified by these treatments.
Indeed the kidney Qi is merely an ideological notion expressed by a
series of physiological fanctions. Each anomaly of these functions is
designated by a naine (syndrome) by referrîng to phenomena observed
in nature such as light-dark, heat-cold, plenitude-deficiency ... Once
the property of the treatment to, eliminate this anomaly has been proven,
the treatinent is classified in certain categories according to the
antagonism principle. For instance the formula prescribed by Mrs Wang
eliminates (as a rule) kidney Yin deficiency. But in actual facts its
justification stems from the disappearance of the syndrome. It is therefore
classified in the tonification category.
Clinical manifestations as a whole (symptoms and signs) constitute
one of the keys to understand the Qi world of Chinese medicine. Whatever
the name used-Yin-Yang and the five movements or naines of the syndromes
and categories of treatinents-the basis of all these sophisticated descriptions
focuses on symptoms and clinical signs, elements that are more concrete
than Qi.
Therefore we should not be surprised when we hear in the doctors' speeches
that pneumoconiosis is characterised by the deficiency of lung Qi or
blood stagnation, and that the treatment of these two syndromes is the'lung
tonif~ing decoction and liver dispersing powder. Instead of calling
for images proving the existence of this deficiency or this stagnation,
we should remember that these are not an objective reality like pathological
changes (that really exist in an organ or a tissue, a cell or a molecule)
on which the reasoning of western medicine is based. These weird terms
are merely naines, each indicating a series of symptoms and signs that
appear globally in a subject in the various stages of pneumoconiosis.
Similarly the tonification or dispersal capacity of the treatment is
confirmed by the improvement or disappearance of each of the series
of symptoms and signs but is not necessarily linked to laboratory data
which is the only definitive proof showing the efficacy of a treatment
in western medicine.
In conclusion, with the anthropological approach we have seen that
Chinese medicine is very différent frorn western medicine. Leaving
aside the diagnostic and therapeutic methods which are no doubt very
special, curiosity and controversy focus on the Qi theory.
Our research has shown that we can address this sacred Qi world other
than by basing ourselves on its real existence: it can be shnply a systera
of reasoning, derived from Taoist philosophy and then developed in medical
practice.
This perspective, sacrilegious for some, could however stifle the main
controversy on the scientific character of Chinese medicine, particularly
its theory.
Lacking the precision and reliability of the scientific method applied
in western medicine, Chinese medicine is condenmed because of its empirical
and speculative method to a 'parallel' place in our world-a haven for
charlatans. Shouldn't we replace this dubious method with the scientific
method?
It would certainly be a scientific victory if the kidney Yin deficiency
and its tonification could be demonstrated anatomically, biochemically
or genetically instead of remaining defmed, according to custom, by
a series of clinical manifestations. But would that also be a medical
victory? That appears less true. Where cause-effect relationships are
very complicated, as in many so-called functional diseases, at least
two factors lirait the use of the scientific method: the consuraption
of natural resources and the lapse of time between diagnosis and treatment.
Chinese medicine in all probability is going to continue operating
with its own method and efficacy, even if science will shed more and
more light on the enigma of its efficacy.
