Sunday, August 23, 2009

Traditional Chinese Medicine

I sometimes hear from people who assume that because I am a Daoist that I am a fan of Traditional Chinese Medicine (TCM). I suspect that the hidden assumption is that TCM must be grounded in Daoism, so anyone who studies the Dao should have some affinity to it. While I will admit that I haven't done a lot of study of TCM, but that doesn't mean that I don't have a negative opinion about it.

The first thing that I think people should understand is that not everything that comes from Chinese culture is "Daoist". Both Roman Catholicism and Western medicine have their origins in Europe, yet we would never assume that Roman Catholicism would have anything to do with Western medicine, or vice-versa, would we?

More importantly, I think we need to understand that TCM comes from a pre-scientific tradition. That means that none of it has fallen under the careful, collective scrutiny that our Western medicine has. Some parts of it probably works, but most of it is probably about as effective as medieval European medicine was. Lest people take issue with this, I would direct their attention to the following URLs.

The first, "Be Wary of Acupuncture, Qigong and Traditional Chinese Medicine", comes from the excellent medical website known as "quackwatch" and gives a very good overview of TCM. The next two come from the excellent publication known as the "Skeptical Inquirer", and are titled "Traditional Medicine and Pseudo-Science in China" , and a second part article in another issue. At least from these three essays, it seems that there are very good reasons to suspect that a large amount of TCM is worthless or worse.

Some folks might be scandalized to hear someone who calls himself a Daoist---and a religious Daoist at that---being so dismissive of this sort of thing. I would argue, however, that this is because so many people have fallen for the fallacious idea that the age of an idea gives it merit. "Ancient Chinese wisdom" is probably the phrase that comes to mind. But the fact of the matter is that this appeal to age is not much more than an old-fashioned appeal to authority. And Daoists have always been notorious for deflating appeals to authority.

The other thing to remember is that contrary to what people might think, Daoism is not really that ancient. Confucianism---which really is a faith that revers the old---existed long before Daoism. And its real claim to fame (i.e. as "the school of Ru", or "rujia"----which is the better way of describing Confucians---is based upon their knowledge of ancient esoterica, most notably the rites and rituals of the Zhou and Shang.) In fact the rujia existed before there was, by definition, any sort of "Ancient Chinese Wisdom" simply because it was only later, after the ascendency of the Chin empire, that the word "China" came to describe the area and civilization complex.

And if we are going to be totally honest, China is not even the oldest civilisation on Earth. That honour goes to Europe, which can trace its written history back to the Egyptians and Sumerians---both of which have literature that exists to this day because our scholars have learned how to read both some types of cuneiform and Egyptian hieroglyphs. People who might balk at this assertion have to realise that "China" has gone through as many dramatic changes as Europe has. The geography has changed back and forth (hence the debate about whether or not Tibet is part of "China".) Its written language has changed so much that modern Chinese readers have about as much hope of understanding Zhuangzi in the original text as I had in reading "Beowulf" when I was at university.

In the face of this extensive history, "Daoism" only stretches back a small way. For example, tradition gives the dates for Laozi in the 6th century BC---about four hundred years after the founding of the Zhou dynasty and over a thousand after the founding of the Shang. Moreover, the founder of the Celestial Master movement, Zhang Daoling, was extant in the second century of the present era---which makes the religion slightly younger than Christianity and only slightly older than Islam.

Moreover, the Immortal most associated with the development of internal alchemy, Zhang Sanfeng, and the legendary creator of taijiquan, is said to have been born as either as early as 960 or as late as 1279 AD. By definition, this makes him not an "ancient", but rather a "medieval". In effect, the founder of neidan was a contemporary of Saint Boniface, Thomas Aquinas or someone who lived between them.

In contrast, if we were to look at the roots of "traditional Western Medicine" (if such a thing existed), we would probably go back to people like Hippocrates (460-370 BC), who coined the oath that Western doctors take to this day. We should also include rationalists like Socrates (469-399 BC) and Aristotle (384-322 BC), who are often called the inventors of the scientific method. So if age is the only criteria to use for accepting something, then "Ancient European wisdom" has as much right to our allegiance as "Ancient Chinese wisdom". And given the choice, I'll opt for double-blind studies over the Yellow Emperor's Classic.


The thing to remember is that Daoism is not about preserving tradition. Instead, it is about finding the truth.

13 comments:

David said...

I find your position very curious. I am a Daoist and practitioner of CCM (classical chinese medicine). This means I augment my understanding and practice with the classics, rather than discarding them as in TCM. Yes, the philosophy behind chinese medicine is nearly identical to that of Daoism. Yes, one led to the other for me, but I don't assume that to be the rule.

Indeed, TCM is pre-scientific insofar as it predates current scientific methods, which themselves are <200 years old. The founding philosophy from Hippocrates is nearly identical to chinese medicine. Hippocrates said to first treat pathogens with diet, which is illegal to say in the USA. The foundation of western science/mathematics at this time is very different than that of Hippocrates and ancient Greece, in that it negates symmetrical complimentary opposing harmonics. It has evolved to oppose yin and yang.

I treat people who have used to the mainstream medical system without resolution. In one case, I helped resolve a 100% vascular blockage in 2 months where doctors couldn't in 1.5 years and were planning surgery. Those doctors were shocked by the progress, and promptly cancelled the surgery. At the same time, I never claim "I" fix something -- rather, I help the patient fix themselves. Yes, I use CCM terminology, which some presume means I know nothing of current physiology, however, I do so because it allows the practitioner to simplify complex issues without losing the detail. This is right out of the TTC, and is taught.

There have been thousands of credible scientific studies to validate the process. Most aren't published here in North America, and many are in a foreign language (than English).

Most people I've found who oppose TCM have either never experienced it, or have experienced it from a western medical professional who decided to cross-train with a few weekend courses. If your medical and mathematical training opposes yin and yang, then trying to correlate is damn near impossible. It's very easy to find a GP doctor who does nothing more than treat symptoms with pills. If that's all I saw, I might have a very jaded view of western doctors.

The Cloudwalking Owl said...

David:

People often don't understand what the scientific method really is. Ultimately, it is just a way of separating out charlatans and people who fool themselves into thinking that they are doing something more than offering a placebo effect. It is very easy to fool yourself and others (and nothing to be ashamed of.) That is why people submit to their theories to the double-blind and peer review.

Medical "ghettos" like TCM only preserve practices that do not work. Anything that really does work simply needs to be tested, at which point it will move into mainstream medicine.

I have seen the damage that quacks can cause, which is why I feel so strongly about this.

Wizard Smoke said...

TCM, at least in North America, has always seemed to be taught in a packaged format, sold to anyone who wants to learn it. Whereas there are high standards for being accepted into study of many western medical sciences -- like say... neuroscience and surgery. There is no equivalent test of competence for TCM practitioners to weed them out. There are some good ones out there, and what they are doing is not bogus, but (as in Taijiquan) the ratio of hacks is too high.

Also, I thought formal Daoism was created in Chinese court as a formalized version of folk rites in order to compete with the influx of Indian and Tibetan Buddhism.

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The Cloudwalking Owl said...

Wizard Smoke:

Yes indeed, there are no doubt some good practitioners of TCM. That is because it is still in the realm of "art" instead of "science". When Western medicine was still an art, there was often an enormous difference between the value of various physicians. A big part of the value of Western medicine is the system of checks and balances that tries to push up the "bare minimum" of service that you can get from a practitioner.

Angelina:

Thanks for the vote of support. I looked at your service and it certainly seems to be worth checking out.

Wizard Smoke said...

So why isn't a nutritionist, a chiropractor or a physical therapist, coming from a western medical tradition, just practicing an art? I don't understand where the distinction lies, unless you are specifically talking about surgery.

The Cloudwalking Owl said...

Wizard Smoke:

Mostly, the issue comes down to the idea of collegiality. The educational program that Western doctors go through involves training at Universities that are regularly evaluated in order to maintain their certification. (The University where I work once had its certification threatened for its Veterinary school and they had to "pull up their socks" to keep it. So this is not just a theoretical thing.)

The doctor then goes through a rigorous evaluation program that involves passing various tests to be certified himself. And once he is admitted to the college of physicians, then he has to maintain a certain level of competency or risk having his license revoked.

It is possible to set up an alternative system of regulation, which, for example, the chiropractors have done. But as you mentioned before in your previous comment, this sort of thing can be abused by colleges that simply want to sell position in their school. That is why the whole medical edifice has to float on top of the foundation of the international scientific community. And this is the dividing line: Chiropracty has no scientific validity except, perhaps, as a form of primitive massage.

The thing about science is that it is a structure for seeking the truth. If an institutional practise simply cannot fulfil its basic idea of proving efficacy using double-blind studies, etc. It is simply not worth pursuing---period. And the collegiality of both the teaching system and scientific research are essential parts of the method.

The old way of spreading Chinese medicine was through lineages, and not colleges. This means that there was no mechanism for developing the collegial approach. This put most of the emphasis on the individual. Of course, there are now schools of TCM. But I would suggest that if what they taught really worked, it would be accepted by mainstream medicine.

Let me offer some contrasts. Old-fashioned European herbalists used to treat arthritis with willow bark. This was not rejected by Western medicine, but absorbed in the form of ASA---which is the active ingredient in the willow bark. Similarly, TCM prescribed "the bark" for malaria and plaster casts for broken bones long before the West did. But when the scientific Western scientists saw the results of these two strategies, they almost immediately adopted them. Similarly, modern Western doctors routine tell people with various physical ailments to start doing taijiquan---I know, I've had people recommended to me.

These all originated in TCM, but have migrated out of it into mainstream Western medicine because they passed the double-blind tests of scientific collegiality. This leaves increasingly TCM with just the stuff that really doesn't work---like acupuncture and moxibustion.

disinformation debunker said...

"While I will admit that I haven't done a lot of study of TCM, but that doesn't mean that I don't have a negative opinion about it."

In other words you have formed a negative opinion of something you don't know much about. To me, that doesn't sound very open-minded, or scientific, but more like a conclusion based more on personal prejudice, than on any scientific method.

"This leaves increasingly TCM with just the stuff that really doesn't work---like acupuncture..."

Huh?

Just do a Google search for acupuncture double blind study.

And check out: ClinicalTrials.gov search of: acupuncture

And: http://www.mayoclinic.org/medical-edge-newspaper-2008/dec-26b.html

I definitely agree with you on the value of conducting double blind clinical trials, however that isn't necessarily a guarantee of a products safety or efficacy, either. Numerous drugs have passed double blind clinical trials have later down the road been determined to be either ineffective or even dangerous. Why? Flawed interpretations, or criminal corruption. Most clinical trials are funded by the very same pharmaceutical companies who stand to benefit from the approval and sale of the drug they are testing.

"Anything that really does work simply needs to be tested, at which point it will move into mainstream medicine."

Not necessarily, if there's not much money to be made from it, like if it can't be patented, or if it would lead to a major loss of profits, by replacing an expensive pharmaceutical treatment with one that costs next to nothing, there is a good chance the pharmaceutical companies effected would do everything in their power to suppress the information, or embark on a disinformation campaign to falsely discredit it - A LOT OF THAT GOING ON, and not just in the medical field. They can easily suppress it when they are the one's funding most of the studies, and when they bankroll key regulatory agents.

That being said, I'm not writing this comment as an endorsement of TCM, as you say, some of it may work and some of it may not, but the same could also be said of western medicine.

I take issue with 1) you forming your conclusions, without even thoroughly studying the subject. 2) your statement that acupuncture doesn't work. (the reality is that it has been demonstrated to work for some conditions, not all)
3) and lastly I take issue with, what I perceive to be your belief that western conventional medicine is a superior form of medicine to to all else, and therefore is to be the supreme judge in all health care matters.

The fact is that because medicine and science are constantly evolving fields, the people of the future, may very well look upon our medicine as primitive quackery, similar to how we view medieval blood letting today.

The Cloudwalking Owl said...

Well, Mr. "Disinformation Bunker", I seem to have annoyed you.

It's true that I haven't studied TCM. I haven't studied palmistry, astrology or numerology either. But I'm still pretty sure that they're bunk.

I am sure that there are published reports that suggest that acupuncture works. I've seen them. I've also seen papers that suggest most of them are bogus for one reason or another. We get back to the collegiality thing again. The papers not only have to be published, they have to be published in reputable journals, by people who's credibility is assured, etc.

I'm not a doctor or a medical researcher, which is why I admitted that I am not an expert on the subject. I do know a fair number of scientists and they really do not have any conspiratorial axe to grind against TCM. They just want to see the facts. And until the majority of them believe that there is something to TCM, I will not support it. Period.

As someone who has spent a lot of time studying Daoism, and who is, dare I say, a bit of an expert, I do feel a responsibility to try and cut through some of the "new age" fudge that obscures most people's understanding of this philosophy and religion. And, unfortunately, some of the fudge is a belief in a medical system that I feel fails the best tests available in our age.

I knew that this would upset people when I wrote the post, but if a hermit cannot bear to tell unpopular truths, who can?

Wizard Smoke said...

Well, I'd wager an analogy might be useful here.

You claim to be a teacher of Taijiquan, which is first and foremost a martial art. The best proof that someone is an effective martial arts teacher is that they have tested their art in the ring or in a real-life scenario -- such as in law enforcement, personal security work, etc.

This is certainly the best public proof of someone being a capable martial arts teacher, but it is not the basis by which most are gauged. I know many skilled teachers who do not have tangible evidence of their skills in a completely uncontrolled environment. Are they hacks?

Furthermore, modern scientific minded personal trainers, military trainers and martial artists would claim Krav Maga or Mixed Martial Arts are faster and more effective ways of learning self-defense. I don't think this is true, but I don't have the scientific evidence to back it up. Am I wrong to study TJQ because I don't have a valid scientific study that says it's the most effective way, when that's what I want to learn instead of the "healing benefits"?

Teaching someone a self-defense system that does not actually embed the student with an effective self-defense toolkit is dangerous in a way similar to providing "fake" medical skills to a student.

Traditional Chinese Medicine is not in the same category as high-fallutin' western scientific medicine. No one is claiming that, except crazy people. I don't have much of an investment in the stuff personally, but to say we should do away with it completely is pretty brash.

The Cloudwalking Owl said...

Wizard Smoke:

I don't think your analogy is completely apropos. People study taijiquan for a wide variety of reasons. In fact, I would suggest most do so for health reasons rather than as a martial art. Since the odds of dying early from lack of exercise are much, much greater than from a physical assault, this is hardly surprising.

Having said that, I do think that there is a place for sparring in taijiquan specifically for the reasons you cite. If you are teaching it as a martial art, you should be able defend yourself not only against other taijiquan players, but also others from other arts. It is one of the great failings of my own practice that I have never been able to connect up with others who feel the same in order to develop that side of the art. I probably would be a much better practitioner if I had had that opportunity.

In contrast, people who seek medical help often have significant health issues at stake. Even if they simply have a minor chronic issue, they still run the risk of wasting significant amounts of money on bogus treatment.

I am not suggesting that we "do away with" TCM. I am, however, suggesting that people should not be patronizing people who practice it. Moreover, I am not suggesting that we totally throw out TCM. After all, in a sense everyone who is treated with Quinine or has a broken limb made up in a plaster cast is being treated with "TCM"---because both of those treatments originated in that tradition.

All I am saying is that no particular "tradition" deserves a "free ride". If your treatment cannot survive the double-blind process and not be picked to pieces in a peer reviewed journal, I don't think it should be followed.

disinformation debunker said...

"If your treatment cannot survive the double-blind process and not be picked to pieces in a peer reviewed journal, I don't think it should be followed."

So I'm curious, since you claim to be a practitioner of taijiquan and qigong, how do you suppose those two activities would hold up to that criteria stated above? How about daoist internal alchemy exercises?

I would suspect that all three of those websites you recommend: Skeptical Inquirer, Quackwatch, and the Skeptics dictionary, would dismiss your daoist internal alchemy exercises as quackery as well, seeing as those all three clearly dismiss the concept of chi itself.

So you talked to a few doctors who have concluded that acupuncture doesn't work? Were they actually personally involved in any studies? If so, which ones?

For every doctor who says it doesn't work, there is another who says it does. Double blind clinical trials have been and are currently being conducted on TCM, and acupuncture specifically, and the results are available online. There have been favorable results achieved and they are posted online in reputable medical journals. Why do you continue to dismiss the facts?

And yes I am irritated whenever I encounter someone spreading false information online. If you're going to reject TCM, you may as well reject qigong, and your other daoist exercises as well.

MedlinePlus - Search Results for acupuncture

MedlinePlus - Search Results for: traditional chinese medicine

ClinicalTrials.gov - Search results: acupuncture

ClinicalTrials.gov - Search results: traditional chinese medicine

ClinicalTrials.gov - Search: qigong

Chinese Medicine: a peer-reviewed open access journal for evidence-led Chinese medicine

I'd also recommend searching PubMed database. There are currently thousands of peer reviewed research studies involving these topics.

The Cloudwalking Owl said...

So I'm curious, since you claim to be a practitioner of taijiquan and qigong, how do you suppose those two activities would hold up to that criteria stated above? How about daoist internal alchemy exercises?

As a matter of fact, I have almost as many problems with claims about taijiquan and qigong as I do with TCM. People make the most outlandish claims about both of them. The value is Taijiquan comes from its use as a martial art (for the extremely few who want to and actually do develop some proficiency in it on that level), exercise, and, as a form of meditation. With regard to other forms of "qigong" (which is a modern term developed by the Republican government), a huge amount of the claims for it are bunk. But there are so many different forms and statements about them that I would have to deal with a specific type.

So you talked to a few doctors who have concluded that acupuncture doesn't work? Were they actually personally involved in any studies? If so, which ones?

No, I've read several essays from journals I follow and trust that have suggested that TCM---and especially acupuncture---was heavily promoted by the Communist government in China as a way of looking like they were offering healthcare to the people even though real healthcare was completely beyond the financial ability of the government. These essays then went on to suggest that a great deal of the medical research that comes from China dealing with TCM has been influenced by politics. Moreover, they also suggested that a great deal of pseudo-research gets churned-out regarding acupuncture but has very little credibility.

I believe that Quackwatch and The Skeptical Inquirer have made their cases.

Beyond that, I have many friends who believe fervently in things like TCM, chiropracty, naturopathy, etc. I have never been impressed with their grasp of science or the world around them.

Ultimately, "you pays your money, you takes your chances".