Zhong Yixue and modern medicine

[MagusYanam]

We were having some discussion of this topic earlier in the Christianity subforum (which I don't think was particularly appropriate), but I would like to continue this discussion here.

At the moment, I am writing from an Internet Cafe in Guilin, Guangxi Province, China. I am here attending a two-week-long seminar in Traditional Chinese Medicine, or Zhong Yixue or just TCM. While I've been here I have seen and heard some things that have made me look twice at practises I thought at one time to be rather sketchy in their medicinal merit.

I've seen, however, what acupuncture, moxibustion, Chinese herbology and tuina (therapeutic massage) can do for a patient and what sort of maladies have been helped by traditional practises. I'm not quite convinced as yet that TCM is a 'science', so to speak, but it is certainly a methodology with certain scientific qualities. For example, it is based in observation of patients under many different sets of conditions. Many if not most TCM practices are replicable under different conditions and applicable to many patients.

I tend to view TCM as a bit like classical E&M. Early in its study (that is, before quantum electrodynamics were developed), no one really knew what magnetism and electricity 'were' per se, but the effects were clearly noticeable, capable of being studied, and capable of being systematised. Likewise, I still don't know what qi is per se (other than how it is described by Chinese traditional texts), but I can feel what it does after practising qigong, for example. Study and systemisations of TCM do exist (otherwise I wouldn't be here).

Thoughts on this topic? I might not get back to this thread for about a week, but I invite discussion until that time.

[MagusYanam]

Rather than talking about "alternative therapies", we should be speaking of therapies that work and therapies that don't work, and herbal remedies (such as echinnacea) do rather poorly when subjected to the same rigorous tests as conventional drugs.

What is 'conventional'? Just because something is 'conventional' doesn't mean it works - in the Middle Ages, letting a leech bleed you dry was the medical convention, but we threw it out when we saw that it didn't work. Chinese medicinal practise at its best puts the same emphasis on pragmatism that Western medicine does - that's one of the reasons why medicinal practise varies from region to region in China. People in Hebei don't suffer the same ailments as people in Guangdong do, and neither suffer the same ailments as people in Guangxi do - the environments differ; so should the treatments. Scientists know this all too well - in science one must always try to control the environmental variables.

There seems to be an almost religious, dogmatic belief in the superiority of "natural" remedies. This, IMO, is pure German romanticism. Plants are made up of chemical compounds too, and they can kill you! The hemlock Socrates drank was just as "natural" as a soy milk.

I agree with you there, and so would probably any traditional Chinese doctor worth his salt. The New-Age 'if-it's-natural-it-can't-hurt-you' mentality gets no sympathy from me and from what I can tell has very little basis in Chinese medicinal practise. In Chinese herbology there is a very careful methodology concerning the use of each herb which should not be dismissed out-of-hand. For example, monk's-hood leaves contain an extremely dangerous poison, but the roots are medicinally useful, apparently, in small doses.

The same can be said of most Western medicines, too: each has its own proper use, but can also be misused. Quinine (which actually has an herbal origin in chinchona bark) is useful for treating and preventing malaria in small doses, but large doses can blind you or even kill you, just as surely as hemlock can (a condition known as cinchonism).

I don't see how needles stuck into traditional acupuncture points on imaginary "meridians" which do not correspond to anything anatomically speaking, and which supposedly carry a substance or energy called "qi" can help anyone except as a case of the placebo effect.

Tell me first what 'anatomy' is. Is it anything more than a system based on an experiential analysis? How is it we know blood vessels carry blood? We know it because we've seen the blood vessels in action, carrying blood toward and away from the various parts of the body.

Likewise, the Chinese of old created a system of meridians and collaterals based on experience - when a particular point on the body is pressed or punctured (the zusanli below the knee, for example), one can feel a kind of energetic sensation running down the leg toward the foot. Other points on that route elicit the same sensation and were observed to have similar effects on the patient.

I'm sure a lot of people had the same attitudes toward electricity in the years preceding quantum electrodynamics. What exactly is it? Classic E&M is silent: there is no reference for it. We know what this 'electricity' can do, we've seen the effects when one passes a compass needle over a wire with current running through it. When Benjamin Franklin coined the terms 'positive charge' and 'negative charge', I'm sure it sounded just as ethereal as yang and yin do to Western ears nowadays.

Anecdotal evidence is not reliable, doctors are not necessarily scientists (most are not, and medicine is not a science anyway), tradition and folklore are not reliable, and a single scientific study is not sufficient to establish a causal relation.

So what do you consider 'reliable'? What do you want to see from Chinese medicine?

Also, what do you consider medicine to be, if not a science?

[ST88]

What is 'conventional'? Just because something is 'conventional' doesn't mean it works - in the Middle Ages, letting a leech bleed you dry was the medical convention, but we threw it out when we saw that it didn't work.

To be fair, leeches did work for some causes. And leeches are currently being used with some success in treating some rheumatoid disorders and other joint inflammations whose primary symptom is pain. I'm sure that it was effective at this in earlier times, but the error made was one of generalization -- if leeches are effective at alleviating pain, they must be effective at other blood-borne poisons as well. I don't think it's quite fair to say that "conventional medicine" = Western medicine at any time in history. I would tend to think that conventional medicine includes actual studies of how different substances affect the body, instead of merely observing the effects. That is, conventional medicine is rather young when compared to homeopathic medicine because there was just no means of knowing how certain chemicals could kill or cure you -- there was only the knowledge that they did.

[Curious]

...And that would be the fulcrum (the peroxide bridge) which, as I said, is sometimes accidentally found, even if the ancient Chinese didn't know precisely how or why it worked. Unfortunately, most of the time there is no fulcrum to be found.

Even in western medicine we use many drugs that work for unknown reasons. Why for example does aspirin have such an effect on the body in quantities that are so small that our science can't quite figure out. Yet western doctors have no compunction in prescribing it. Viagra is an example of a drug with an unthought of side-effect which has been exploited. Thalidomide, originally used as a treatment for morning sickness had terrible side-effects but is used in some parts of the world to treat cancer and leprosy even today.
One argument against homeopathy is that the dilutions involved make it so that the final dilution contains none of the original substance. This is incorrect. If a solution containing 1 gram of substance is diluted a hundred times and each undiluted part is diluted one hundred times then eventually it would be unbelievably weak. It would not contain nothing however as all the dilutions when put together would contain 1 gram of substance. Western doctors suggest though that the final dilution contains none of the original substance, which is patently untrue. You might say that each dilution would contain less than 1 molecule on average so some would contain some while others would contain nothing but this assumes that it is the molecule rather than some smaller "string or EM element" that might actually make it effective. I am not saying that this is the case or that homeopathy even works, but Western medicine uses many cures that it doesn't really understand the mechanics of, but at the same time it rejects many other treatments because they can't see how they might work.

[Dilettante]

Magus Yanam wrote:

What is 'conventional'? Just because something is 'conventional' doesn't mean it works

You're right, and that's because the word "conventional" does not help much. In China, "conventional therapies" would include acupuncture, for example, which from a western perspective I have classified as "unconventional". But I think most people understood that by "conventional" I was referring to modern medicine as a set of healing techniques based on biology, chemistry, and other sciences. If bloodletting, with or without leeches, made a comeback, it would now be listed among the "alternative therapies".

Tell me first what 'anatomy' is.

Anatomy is the study (normally through dissection) of the structure of human and animal bodies. Due to the old Chinese taboo which forbade dissection, it is safe to assume that the ancient Chinese did not possess the same knowledge of anatomy as people like Leonardo da Vinci did. Modern doctors, of course, know even more about the internal structure of the human body, and no meridians carrying the alleged vital fluid "Qi" have ever been found. You're right that electricity seemed equally mysterious when it was discovered, but at least it could be measured. "Qi" can't be measured, probably because it has no material existence, and is merely an idea.

So what do you consider 'reliable'? What do you want to see from Chinese medicine?

I would like Chinese remedies and therapies pass the same kind of tests used by the FDA, for example, with regular drugs and therapies. I would like the scientific method to be applied to exotic medicine as rigorously as it is applied in ordinary cases. I'm sure traditional Chinese doctors try to be pragmatic also, but I'm not sure they are accustomed to using double-blind tests and control groups in their experiments.

Also, what do you consider medicine to be, if not a science?

Medicine is a set of techniques for healing and alleviating different disorders, illnesses and ailments. It is not a science, although its techniques are often based on the cumulative and testable body of knowledge of sciences such as chemistry, biology, etc.
I won't deny that certain traditional folk remedies and therapies had some value. As I said, even primitive cultures can and have at times found a "fulcrum" hidden in some of their curative practices even if they don't fully understand all the principles involved. Sometimes these primitive healers have behaved almost like scientists. But as a rule I would much sooner trust modern science to find cures for diseases.
ST88 wrote:

I would tend to think that conventional medicine includes actual studies of how different substances affect the body, instead of merely observing the effects.

Exactly! Very well put! I would add that, if you don't know exactly how something works, it will be hard to prove that it really works, and that it is not a case of the "false cause" fallacy.
Curious wrote:

Even in western medicine we use many drugs that work for unknown reasons. Why for example does aspirin have such an effect on the body in quantities that are so small that our science can't quite figure out. Yet western doctors have no compunction in prescribing it.

We do know how aspirin relieves headaches. And we know in what cases it can be harmful (pharmaceutical companies don't want to risk being sued). Aspirin happens to be a unique case of a drug which has many more uses than originally imagined (it has been called a "miracle drug", certainly a bit of an exaggeration). Doctors (who are not scientists as a rule) make their own calculations. If the benefits of aspirin far outweigh the potential risks, they will prescribe it. If not, they won't. Scientists in labs worldwide will continue with their research and may one day tell us why aspirin has so many other beneficial effects. Traditional Chinese doctors did not ( as far as I am aware of) engage in quite the same kind of research. They were probably quite content with mythical explanations.

Thalidomide, originally used as a treatment for morning sickness had terrible side-effects but is used in some parts of the world to treat cancer and leprosy even today.

True, but it is no longer prescribed to pregnant women.

One argument against homeopathy is that the dilutions involved make it so that the final dilution contains none of the original substance.

I don't know of a single chemistry or physics major who trusts homeopathic medicine (often their reasons for distrust have to do with Avogadro). Homeopaths have argued that the water has a "memory" of the vibrations of the original substance. This has been proved wrong. It also claims that the smaller the dilution, the stronger the effect. Recently a group of Belgian skeptics attempted a homeopathic mass suicide by ingesting a variety of deadly poisonous substances in infinitesimal dilutions. Apparently, they are all alive and well.

[Curious]

Even in western medicine we use many drugs that work for unknown reasons. Why for example does aspirin have such an effect on the body in quantities that are so small that our science can't quite figure out. Yet western doctors have no compunction in prescribing it.

We do know how aspirin relieves headaches. And we know in what cases it can be harmful (pharmaceutical companies don't want to risk being sued). Aspirin happens to be a unique case of a drug which has many more uses than originally imagined (it has been called a "miracle drug", certainly a bit of an exaggeration). Doctors (who are not scientists as a rule) make their own calculations. If the benefits of aspirin far outweigh the potential risks, they will prescribe it. If not, they won't.

But the fact remains that aspirin is still prescribed for conditions in which we are uncertain of the particular mechanisms involved. It is prescribed solely on effect.

Thalidomide, originally used as a treatment for morning sickness had terrible side-effects but is used in some parts of the world to treat cancer and leprosy even today.

True, but it is no longer prescribed to pregnant women.

Not knowingly prescribed to pregnant women but it happens.

I don't know of a single chemistry or physics major who trusts homeopathic medicine (often their reasons for distrust have to do with Avogadro). Homeopaths have argued that the water has a "memory" of the vibrations of the original substance. This has been proved wrong. It also claims that the smaller the dilution, the stronger the effect. Recently a group of Belgian skeptics attempted a homeopathic mass suicide by ingesting a variety of deadly poisonous substances in infinitesimal dilutions. Apparently, they are all alive and well.

It might have been an idea for the scientists involved to have studied the claims of homeopaths more rigourously in this instance. Such an experiment could show nothing concerning the claims of homeopaths and really shows the stupidity of the scientists involved.
Homeopathy is based on the premise that the weaker the dilution, the stronger the effect upon the body. Weak homeopathic dilutions are supposed to REVERSE or cause the opposite effect on the body of strong concentrations. A weak dilution used for treating fever for example would be "proved" by causing a fever in strong concentrations. The fact that all the scientists survived could in the case of your above example be used as very very weak evidence for homeopathy, but never against it.

[Dilettante]

Curious wrote:

But the fact remains that aspirin is still prescribed for conditions in which we are uncertain of the particular mechanisms involved. It is prescribed solely on effect.

That may be because those doctors make some sort of cost-benefit calculation (they feel there is no risk but only a potential benefit), although I'm not sure which conditions you are referring to. Again, doctors are not necessarily scientists, and even scientists make mistakes.

Not knowingly prescribed to pregnant women but it happens.

Then that would be an accident or a mistake.

Such an experiment could show nothing concerning the claims of homeopaths and really shows the stupidity of the scientists involved.

Actually the people involved were not necessarily scientists, just some doctors (at least one of them a former homeopathic doctor), some college professors, a publicist, and an ordinary guy who used to believe in homeopathy (23 people in total). Rather than a serious experiment, it was done more as a humorous publicity stunt protesting a decision by the major insurance companies in Belgium to cover part of the costs of homeopathic remedies.
The homepathic principle they were focusing on was the one which asserts--contrary to scientific evidence--that the smaller the dose, the more powerful the medicine. They sure got the attention of the media, which was what they wanted.

They were using a 30C dynamization, which in homeopathic jargon means that the original substance was diluted 10 to the power of 60 times (a one followed by sixty zeros). They said the earth (at a mere 10 to the power of 50 molecules) was not big enough to hold a single molecule in that dilution. For all intents and purposes, it would be like drinking distilled water and /or alcohol.

Of course, serious, placebo-controlled experiments testing the alleged virtues of homeopathy have been conducted by scientists away from TV cameras many times, and the results were not different from those of the placebo group. Perhaps the Belgians did not design their "experiment" very well, but I don't think their case strengthens the case for homeopathy in any way. If homeopathic theory is correct, and if the effects are reversed, they should have walked out healthier than ever. Such was not the case. Some of them were even dizzy from the alcohol on their empty stomachs.

[Curious]

Actually the people involved were not necessarily scientists, just some doctors (at least one of them a former homeopathic doctor), some college professors, a publicist, and an ordinary guy who used to believe in homeopathy (23 people in total).

As they were performing an experiment I think that to call them scientists would be accurate in the broadest possible sense of the word. Of course, I was joking when I said it might be considered very very weak evidence supporting homeopathy.

[Dilettante]

OK, I understand calling them scientists in that sense. And I imagined you were probably joking, but just in case...

[MagusYanam]

Anatomy is the study (normally through dissection) of the structure of human and animal bodies. Due to the old Chinese taboo which forbade dissection, it is safe to assume that the ancient Chinese did not possess the same knowledge of anatomy as people like Leonardo da Vinci did.

Okay, that's a good definition of anatomy, but you're going to have to realise that the West doesn't have a copyright on the workings of the human body. You're right that the Chinese had some reservations concerning autopsy, but during the Warring States Period (around the 700's BC), the Chinese gained a knowledge of anatomy unrivalled until that time through trying to stitch up wounded (living) bodies. That's how they came up with the theory of the twelve vital organs (the six 'passive' organs - spleen, heart, lungs, liver, kidney and pericardium - and their six 'active' counterparts - stomach, small intestine, large intestine, gallbladder, bladder and sanjiao), as well as a good working knowledge of their functions. Actually, their knowledge of anatomy was advanced enough for there to have been very successful surgeries performed even in the 200's AD (such as those performed by the famous Qin-era doctor Hua Tuo).

Modern doctors, of course, know even more about the internal structure of the human body, and no meridians carrying the alleged vital fluid "Qi" have ever been found. You're right that electricity seemed equally mysterious when it was discovered, but at least it could be measured. "Qi" can't be measured, probably because it has no material existence, and is merely an idea.

Unfortunately, you seem to be making the mistake of equating the TCM concept of qi with the broader philosophical concept, and then applying a Western filter to the ideas where it is inapplicable. We could get into the whole philosophical concept, but I can tell you right now that trying to equate qi with a physical, vital fluid would be a very grievous error. Chinese doctors do not treat qi as a physical phenomenon but in the way Western doctors treat the general concept of 'wellness', which cannot be measured but is real and applicable; qi is used to describe the relation of the various parts of the body with the vital organs that govern them. Like 'wellness' or 'illness' qi of a certain type can be described specifically, but it uses a different terminology than would Western medicine (which would use 'scrofula', for example, rather than 'constrained liver qi'). This terminology, however, is not best seen in terms of less or more accurate, because both 'scrofula' and 'constrained liver qi' pertain to the same illness manifesting itself in a set of specific symptoms. It's all convention, which as you say is not particularly useful except within the sphere in which the convention applies and is recognised.

I would like Chinese remedies and therapies pass the same kind of tests used by the FDA, for example, with regular drugs and therapies. I would like the scientific method to be applied to exotic medicine as rigorously as it is applied in ordinary cases. I'm sure traditional Chinese doctors try to be pragmatic also, but I'm not sure they are accustomed to using double-blind tests and control groups in their experiments.

Perhaps next time you're in the area, you should stop by Hong Kong Baptist University's School of Chinese Medicine. Not to get too much into history, but when the British took control of Hong Kong in 1898, they banned the practise of Chinese medicine, forcing practitioners to go underground or to adopt Western methods. When Chinese medicine was relegalised in 1997, British influence and Western methods were so heavily ingrained in the field of medicine that Chinese medicine practitioners became accustomed to Western-style experimentation and scrutiny. The HKBU's SCM now uses all sorts of modern equipment in the preparation of traditional pharmaceuticals, all of which must conform to a strict standard, and requires all of its students to take courses in Western as well as traditional anatomy and have proficiency in Western emergency procedures.

The practises themselves have survived eight years of continuous interaction with Western minds and scrutiny by Western eyes, no small feat considering that Hong Kong is probably better described as European than Chinese from a cultural standpoint (heck with it, the people there speak English better than I do!).

Aspirin happens to be a unique case of a drug which has many more uses than originally imagined (it has been called a "miracle drug", certainly a bit of an exaggeration). Doctors (who are not scientists as a rule) make their own calculations. If the benefits of aspirin far outweigh the potential risks, they will prescribe it. If not, they won't. Scientists in labs worldwide will continue with their research and may one day tell us why aspirin has so many other beneficial effects.

Alright, so by this token, doctors should be able to prescribe acupuncture knowing its anaesthetic properties and knowing even from a Western perspective how it works (see the research of Dr. Bruce Pomeranz at the University of Toronto for studies on anaesthetic acupuncture) even for diseases for which the benefits of acupuncture are not fully understood. The side effects of acupuncture are minimal, really, with the most serious side effects being the result of improper use (such as bleeding or bruising from improperly placed needles or cases of hepatitis B or dermatitis from use of improperly sanitised needles). As good Chinese doctors discard needles after a single use and are trained for five to seven years in their study, I would assume risk to be minimal if one went to a reputable practitioner. So would you agree that acupuncture may be used in much the same way as aspirin?

Traditional Chinese doctors did not ( as far as I am aware of) engage in quite the same kind of research. They were probably quite content with mythical explanations.

I would be loath to have made these kinds of generalisations not ever having any Traditional Chinese doctors personally, and even more loath to make these kinds of generalisations now that I have, over the past fortnight. I have met no doctor in China or in Hong Kong who performed his art well who would ever be content with a diagnostic explanation that he couldn't see with his own eyes, hear with his own ears or feel with his own fingers, and I'm sure the same would apply to the more general aspects of his or her practise. I would remind you for further reference that making unfounded generalisations is anathema to the rules of this forum; please be sure in the future to back up claims such as these with evidence.

[Dilettante]

Magus Yanam wrote:

Actually, their knowledge of anatomy was advanced enough for there to have been very successful surgeries performed even in the 200's AD (such as those performed by the famous Qin-era doctor Hua Tuo).

I am aware that ancient Chinese surgeons could be very successful compared with ancient Western ones. But back then Western "doctors" were little more than butchers. Western medicine, however, has made enormous progress. Has TCM changed over the centuries in a comparable way?

Unfortunately, you seem to be making the mistake of equating the TCM concept of qi with the broader philosophical concept, and then applying a Western filter to the ideas where it is inapplicable. We could get into the whole philosophical concept, but I can tell you right now that trying to equate qi with a physical, vital fluid would be a very grievous error. Chinese doctors do not treat qi as a physical phenomenon but in the way Western doctors treat the general concept of 'wellness', which cannot be measured but is real and applicable;

Perhaps I'm making that mistake, as you say. Still, "qi" sounds pretty mystical to me. To be fair, concepts such as "wellness" or "quality of life" (used by western doctors) seem pretty obscure to me as well.

The practises themselves have survived eight years of continuous interaction with Western minds and scrutiny by Western eyes, no small feat considering that Hong Kong is probably better described as European than Chinese from a cultural standpoint (heck with it, the people there speak English better than I do!).

I hope I haven't given the impression that I thought Western eyes somehow can see better than Eastern ones. That was not my intention at all (and it would amount to racism). I don't equate "West" with "science". The French are western and their government endorses homeopathy. Asian scientists are as good as European ones. My question was different. I wanted to know if TCM had been subjected to rigorous scientific tests, whether those tests were done by Westerners or Easterners is irrelevant.

So would you agree that acupuncture may be used in much the same way as aspirin?

If scientists agree that it can help... I am not convinced by traditional acupuncture, but I've heard that needles transmitting mild electrical charges applied to nerves (not acupuncture points) could be beneficial. If that is the case, and if there are no side effects, it may be a good idea to experiment with that. But sooner or later we would need to know how it works and if it really works.

I would remind you for further reference that making unfounded generalisations is anathema to the rules of this forum; please be sure in the future to back up claims such as these with evidence.

I'm sorry if I was blunt or offensive: it wasn't my intention. I write based on what I know: I have never been to China, but I have heard and read many mystical explanations from Chinese acupuncturists here in Europe. Their customers seem to like that kind of talk. I used the words "that I am aware of" and "probably" to indicate that my experience was not extensive. There may be scientific explanations of TCM but I honestly don't know of any. I'm not talking just about "seeing things with their own eyes", I'm talking about scientific studies.