Chinese Medicine: Does It Have A Scientific Basis?

 

by Janet Plummer

This article is a response to Dr. Porkert's previous article


I was rather concerned to read Professor Manfred Porkert's article “Chinese Medicine — a Science in its own Right” in the February 1977 issue. I fear I would have had even greater difficulty in understanding his article had I not attended a similar lecture given by Professor Porkert at the University of Hong Kong in 1976, and later discussed it with him at some length. Did any other readers have the same problem?

As it was, I hurried to my dictionary in order to try and fully understand what was being said, for I felt I could not let his article go unchallenged.

My first point is that the style of such an article does not further the author's argument. The lack of clarity and conciseness leaves much to be desired. In fact it brought to my mind the speech delivered by the late Mao Tsetung at a cadres meeting in Yunan on February 8, 1942, and entitled ‘Oppose Stereotyped Party-Writing’ in which he said among other things:

The fifth indictment against stereotyped Party writing is that it arranges items under a complicated set of headings, as if starting a Chinese pharmacy.

For all its verbiage, an article that bristles such symbols that does not pose, analyze or solve problems...is devoid of real content and nothing but a Chinese pharmacy.

(Quoting Dimitrov:) We must learn to talk to the masses, not in the language of book formulas. . .

When writing or speaking always have in mind the rank-and-file worker who must understand you. . .

The fourth rule of the eight rules of writing set out by Lu Hsun is:

After writing something, read it over twice at least, and do your utmost to strike out nonessential words, sentences and paragraphs, without the slightest compunction.

(Rule 6:) Do not coin adjectives or other terms that are intelligible to nobody but yourself.

We have ‘coined’ too many expressions that are ‘intelligible to nobody’. Sometimes a single clause runs to forty or fifty words and is packed with ‘adjectives or other terms that are intelligible to nobody ‘.

However the article speaks for itself and my purpose in writing is actually to challenge some of Professor Porkert's basic statements. I have to admit I am at a great disadvantage for I also am one of those ‘unfortunate’ people mentioned by the Professor: ‘practically everybody making a claim to a scientific opinion on Chinese medicine has, to start with, been thoroughly inculcated with the essentials of Western medicine.’

I should like to take issue with Dr. Porkert on several points:


1. WESTERN SCIENCE VERSUS CHINESE SCIENCE

We are told that ‘in recent times, the failure to correctly “assess” the role of yin and yang and the Wuxing has led to endless, fruitless debates about the very essence of medical science in China. This failure is in turn only the result of a very imperfect perception of the complementary and polar roles of Chinese and Western Science.’ There follows a discussion on ‘The Polarity of Chinese and Western Science’.

Is it a valid concept to talk of Western Science and Chinese Science? My little dictionary defines ‘Science’ as ‘systematic knowledge of natural or physical phenomena; truth ascertained by observation, experiment and induction...’

This ‘systematic knowledge’, this ‘truth ascertained’, is the same the world over and indeed one of the ratifying factors for scientific truth is surely that these observations or experimental results can be reproduced anywhere (under the same conditions) by anyone with sufficient scientific know-how.

Science is science the world over and should not be identified with the West, nor does it belong to the West or anywhere else, because scientific fact, i.e. scientific truth, is absolute, provided all factors are taken into account. It will stand up to the light of critical examination no matter where the scrutiny is carried out and by whom.

Is the Professor claiming that Chinese medicine is a Science in its own right, but scientific method (as understood In the West) cannot be applied to Chinese medicine? If this is his claim, I must heartily disagree, and I fear such a claim will only bring further discredit to Chinese medicine.


2. CAUSAL ANALYSIS AND ITS LIMITATIONS

Professor Porkert then proceeds to describe the limitations of Western medicine and points out that Western medicine is not an exact science because it is a biological science — the observations are made on human beings and not inanimate objects and there is therefore room for variation.

No one will disagree, but the Professor is going too far when he says ‘the stringency and significance of statements based upon causal analysis show a clear decline in the field of human physiology.’ We are perhaps left with the impression that Western medicine is not scientific after all! The problem (if there is one) of biological variation is overcome by ascertaining a range of normal, e.g. pulse rate, blood pressure, respiratory rate, serum sodium level, etc. Moreover there are very predictable consequences should the normal range of values be exceeded in either direction. Is this not what yin and yang is all about, viz. a tendency for a physiological function or value to be too high or too low?

Of course what does vary is the ability of the individual to adapt to these potentially lethal changes and this I believe is the core of the theoretical basis of Chinese medicine — the concept of homeostasis, known to practitioners of Chinese medicine many centuries ago but a concept which only really began to come to light in the West in the 18th century. The Nei Jing states if the ‘body resembles burning charcoal...the (sickness) can. be dispersed only through perspiration’, i.e. if one develops a high fever it will only fall through perspiration. In the West, Charles Blagden, born in Edinburgh in 1748, wrote an article in 1774 entitled ‘Experiments and observations in a heated room’ in which he discusses the constancy of body temperature and mechanisms of control. Other ‘Western scientists’ who helped to develop this theme of ‘the constancy of man's internal environment despite broad variations in his external surroundings’ include John Hunter, Claude Bernard, J. S. Haldane and the famous Walter B. Cannon, whose articles were published in 1778, 1854-1865, 1929 and 1917-1919 respectively. However, more of this concept of homeostasis in relation to acupuncture later.


3. THE MESSAGE OF CHINESE MEDICINE OBSCURED BY THE FASHIONABLE USE OF WESTERN TERMINOLOGY

This I feel is an unfortunate choice of words, but if the Professor is once again implying that attempts to explain Chinese medicine in terms of scientific knowledge will obscure the ‘message’ of Chinese medicine, then I must strongly disagree with him again. However, isn't the use of the term Chinese medicine rather too broad a term; since it would presumably include Chinese herbal medicine and the Chinese pharmacopeia with its foxglove (digitalis, Ephedra sinica (ephedrine), Papaver somniferium (opiates) and other plants and preparations long since proven by scientific method to contain very active pharmaceutical principles indeed.

As the article points put, there is a struggle still going on between both systems (Chinese and Western medicine). No doubt each can learn from the other, but it requires a spirit of humility without which there can only be a head-on collision, resentment, jealousy and suspicion.

So Dr. Porkert tells us the practitioners and advocates of traditional medicine fell to what they thought was the best expediency for convincing everybody of the value of the traditional craft: they tried to explain it in terms of Western medicine. I am glad he says ‘tried to explain it.’ Far from decrying what ‘those well-intentioned native defenders of their medical heritage’ are doing, I would only like to add that the need still remains for the efficacious parts of traditional medicine to be explained fully on a scientific (not Western science) basis, and here I find myself in part agreeing with what the Professor says, that in some cases at any rate those ‘defenders.... are in reality jettisoning and destroying what they set out to preserve.’ There remains the need for more controlled scientific research including controlled double-blind studies.


4. THE CASE OF ANATOMY VERSUS ZANGXIANG, ORBISICONOGRAPHY

I must agree that the Zangxiang is referring to functions and not anatomical organs, but aren't the orbs, etc. referring to basic physiological systems in the body? This is where some difficulty lies because it is not possible to allocate one anatomical organ to one particular physiological system. In fact every organ in the body is involved in far more than one system, for the human organism is just not that simple.

Here I must return to the point I made earlier that Chinese medicine is basically concerned with the maintenance and restoration of homeostasis. It is true to say that no matter what stress or disease inflicts itself on the body, providing the body can maintain its internal environment within certain limits by all the reactive and compensatory mechanisms available to it, then there will be no manifestation of disease and the person will remain symptomless (e.g. the so called ‘subclinical attacks’ of disease).

The following is a list of some of the main systems which must be kept in delicate equilibrium if man is to survive, but I think it would be very rash of me at this stage to attempt to pair them up with orbs or meridians.

1. Temperature
2. pH—acid/base
3. Fluid balance
4. Electrolyte balance, sodium, potassium, chloride, including intracellular and extra cellular balance
5. Oxygen — carbon dioxide
6. Caloric balance
7. Carbohydrate metabolism, and blood- sugar lever
8. Protein metabolism/absorption/breakdown
9. Fat metabolism/storage/utilization
10. Calcium balance – as distinct from sodium, potassium and chloride
11. Osmotic pressure
12. Cardiovascular adjustments such as blood pressure and pulse, cardiac output and peripheral circulation versus splanchnic circulation
13. Maturation, reproduction and aging

These homeostatic systems are mediated via both the autonomic nervous system and the endocrine system, the latter also being greatly influenced by the autonomic nervous system especially via the hypothalamic—pituitary axis. It must not be forgotten that just a small change in any one of these systems sets up a whole reactive chain of events in an attempt to restore the equilibrium or compensate for the imbalance. The traditional fright/fight/flight example is typical of a whole set of events set off by one trigger and causing far-reaching effects throughout virtually all physiological systems in the body.

Supposing your temperature rises above normal, then your metabolic rate rises. This requires an increased demand for oxygen, and increased production of carbon dioxide, with an increased cardiac output, a need for increased energy, resulting in changes in carbohydrate, protein and fat metabolism, not to mention the eventual onset of greatly increased sweat loss with its resultant effects on fluid and electrolyte balance, and so it goes on and on.

In the delicately balanced physiology of the human body, there is not a static equilibrium but an extremely active ongoing process with ions darting in and out of cells all over the place, and a myriad of messages flying back and forth through the autonomic, peripheral and central nervous systems. All these are going on beneath the level of consciousness until a state of uncompensated imbalance is reached, when one suddenly feels cold, and gets up to close the window and puts on a cardigan, or feels thirsty, and goes to get a drink of water. The homeostatic mechanisms are at work!

Cannot yin and yang in particular be explained in these terms of variation to either side of the ideal level of equilibrium? Is all the emphasis on ‘harmony with the seasons’ and other aspects of the environment just a philosophical idea or is it rather a clear insight into the need for homeostasis if the body is to survive?

Western medicine’s knowledge and understanding of the autonomic nervous system is still in its infancy. Virtually all attempts to restore homeostasis in the human body are made through external interference rather than through direct action on the body’s own homeostatic mechanisms, although these could in theory be influenced by direct action on various parts of the autonomic nervous system. The wonderful fact is that as the practitioner of ‘Western medicine’ begins to alter the state of imbalance, and in particular turns the tide from the point of no return, then the body’s own homeostatic mechanisms begin to work again and often remarkable recovery follows .

Most of Western medicine aims at treating the cause of the disease or imbalance that has resulted, and in this way it is unconsciously relying on the body’s own homeostatic mechanisms to restore health and strength. In many instances the more attempts the practitioner makes at restoring equilibrium by external interference, the more trouble he gets into as he throws other systems off balance. There are, however, some notable exceptions such as the dehydrated infant with severe diarrhoea who only needs his fluids and electrolytes replaced. It was interesting to read recently of a case of a child with rabies who was kept alive by anticipating the imbalances which would occur, and thus maintaining homeostasis. The child survived.

More scientific research needs to be done on the autonomic nervous system before it will reveal its hidden secrets of action, reaction and interaction, a system designed to maintain homeostasis, i.e.. the constancy of man’s internal environment despite broad variations in his external surroundings. Survival is based on homeostasis, and this is what Chinese medicine is all about.

In conclusion I must disagree with Professor Porkert’s statement that ‘applying to Chinese medicine the universal criteria of exact science’ results in ‘the absurd and of necessity abortive attempt to reassess it by means of methods evolved by and only applicable to Western medical science.’

Let us rid ourselves of the association “Western”, for there is only one universal science, but may every attempt be made to discover the scientific basis of Chinese medicine, especially acupuncture, so that it may be further developed and used in forms which will benefit the whole of mankind.


Dr. Janet Plummer, a medical graduate from the University of Sydney, is a practicing physician, and Research Associate of the Department of Anatomy, University of Hong Kong.


read Dr. Porkert's response to Dr. Plummer

read Dr. Porkert's original article