how chinese medicine became german€¦ · •systems theory (von bertalanffy, ludwig, (1974)...

How Chinese Medicine Became GermanHolism, Systems and Free Flow

Chinese medicineHolismSystems

https://holisticsecurity.wordpress.com/2008/06/13/what-is-holism/

“The ancient Chinese had no need of systems theory. They possessed it already, because they cared above all for the commonwealth of creatures and things.”

How did Chinese medicine become holistic?

Dialectics

自然辯證法

Holistic

Medicine

Cybernetics

Systems

Theory

Systems

biology

Integrated

Medicine

Post-

Kantian

Philosophy

Modernity

Germany

Holism

Vitalism

Gestalt

The

Interwar

Years

Traditiona

l

Chinese

Medicine

Cultural/conservativ

e holismKant, Herder, Humbolt

OrganicismJoseph Needham (1900-1995)

The Invention of HolismEcology, systems & empire

Scientific/progressi

ve holismHegel, Engels, Lenin

Friedrich EngelsDialectics of Nature

“The whole of nature accessible to us forms a system, an interconnected totality of bodies, and by bodies we understand here all material existences extending from stars to atoms, indeed right to particles, in so far as one grants the existence of the last named.”

Holism in Nazi Germany

№

How Chinese medicine became holisticPart I: China

整體觀念zhengti guannian

1950sThe Institutionalisation of Chinese Medicine

• 1955: first application of the idea

of holism in the Chinese medical

literature

• 1956: eleven papers on topic of

holism in Chinese medicine

published in Chinese medical

journals

• 1959: Qin Bowei’s Introduction to

Chinese Medicine (中醫入門

Zhongyi rumen) places holism at

the very core of Chinese

medicine

Qian Xuesen 錢學森

writes letter to Lü Bingkui

呂炳奎, Director of the

Chinese Medicine

Bureau at the Ministry of

Health arguing that

traditional western

science “breaks apart the

original wholeness of

things” while Chinese

medicine is part of

Chinese science’s

holistic perspective.

• Systems dialectics 自然辯證法: optimising all aspects of society,

from economics and social coherence to ideology and culture,

war and peace, via a newly powerful understanding of systems

• Systems biology as emergent interface of Chinese medicine and

systems science

№

How Chinese medicine became holisticPart II: The West

• 1951: J Otto - ‘On the holistic perspective in the Chinese healing

art’ (Über Ganzheitsbetrachtung in der chinesischen Heilkunst)

• Chinese medicine as expression of Chinese culture

• Holism as a concern specifically for the integration of body,

mind and spirit.

The San Francisco Renaissance

American Academy of Asian Studies (AAAS)founded 1951 https://soundcloud.com/integraleducation/5-michael-murphy-on-

aaas/recommended

Frederic Spiegelberg1897-1994

Alan Watts1915-1973

Esalenfounded 1961

№

Holistic scienceSystems theory, cybernetics & systems biology

C.G. JungChinese metaphysics and quantum science

“The ancient Chinese mind contemplates the cosmos in a way comparable to that of the modern physicist, who cannot deny that his model of the world is a decidedly psychophysical structure. The microphysical event includes the observer just as much as the reality underlying the I Ching comprises subjective, i.e., psychic conditions in the totality of the momentary situation.”

- C.G. Jung, Forword to the English edition of Wilhem’s Yijing

Ludwig von Bertalanffy (1901-1972)

Cybernetics

‘Stewart Brand once called the Tao Te Ching, written by the Chinese sage

Lao Tzu, the “first systems theory book.” And today,“ Taoism for managers” is

considered a natural part of the ideological furniture of neoliberalism.’

(The Whole Earth: California and the disappearance of the outside, HKW, 2013)

Integrated medicine “maximizes the potential of the physical and social environment, so that healing and better health can thrive.”

Systems biology

But is Chinese medicine really holistic?

Tito Tonietti

• Western science, specifically since the

scientific revolution, predicated on

attempting “to introduce order into that

which changes, by fixing its static, eternal

foundations.”

• Chinese sciences are not holistic because

they do not seek to describe, regulate or

analyse complexity

“Skilful action relies on customary rules [of practice]. Reality, however, is never constrained by such rules.”Fei Boxiong 費伯雄 (1800-1879)

Calculating life orNourishing the vital 養生

Dr Jens Foell Senior Clinical Teaching Fellow School of Public Health Imperial College London

What is in the tin, when holistic is written on the package?

The H wordFreeman J. Towards a definition of holism. British Journal of General Practice. 2005;55(511):154.

The H Word

“Research suggests that interventions that successfully reduce inequalities in health outcomes are generally multi faceted and 'holistic' in approach, and align with local priorities, local ways of working and existing services.”

The H Word

“My diabetes, my care”, CQC Report 2015

…”MDT – a team of healthcare professionals with the full spectrum of clinical skills to

deliver holistic care

to patients with complex problems” (NICE guideline 83 Rehabilitation after critical illness)

“The holism of chinesemedicine did not develop psychology as a separate realm of discourse” (Kirmayer and Young, Psychosomatic Medicine 60:420-430 (1998)

Holistic principle: “The diagnostic task in dysfunction is to determine the pathogeneticchain and to assess the correlation and relevance of its individual links” (Lewit J Orthop Med 1993 16 73-76)

“…clinically appropriate onward referral..as might be applicable to support high quality holisticpatient management” (H&F MSK Tender document 2008)

The Peckham Experiment “They

adopted a holisticapproach to medicine by encouraging a healthy lifestyle long before it became fashionable” (BMJ Vol 338 4/09 pg 790)

“It also gives due consideration to health care providers who should be enabled and supported to provide

effective, holistic and compassionate care.” (People at the centre of health care: harmonizing mind and body, people and systems.Geneva:World Health Organization, 2007)

The H word

Brief overview

Reductionist hermeneutic strategy• Reduction of complexity

• Reduction into compartments or single entities

• Templates and protocols

• Specialisation

• Bureaucratisation

• Standardisation

Goodwin C. Professional Vision. American Anthropologist. 1994;96(3):606-33.

Etymology

• Jan Smuts “Holism and Evolution” 1926

• Longstanding dissatisfaction with enlightenment project

• Romanticism

• Vitalism

• Revival in 70s

• New Age Boom

Rosenberg CE. The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America. Perspectives in Biology and Medicine. 1977;20(4):485-506.

Ultra brief history of medical models

“The therapeutic paradigm was fundamentally an ancient one: the body was perceived as a complex system connected to the surrounding environment through inputs and outflows and in a state of dynamic equilibrium when healthy.

Illness was a form of imbalance. Therapeutics thus concentrated on re-establishing equilibrium, usually by acting on input and outflow. “

WEISZ, G. 1998. Greater than the parts: holism in biomedicine, 1920-1950, Oxford University Press, USA.

Historical Organismic

Ecological Worldview

Holism

WEISZ, G. 1998. Greater than the parts: holism in biomedicine, 1920-1950, Oxford University Press, USA.

KRIEGER, N. 2005. Embodiment: a conceptual glossary for epidemiology. Journal of Epidemiology and Community Health, 59, 350-355.

The H word

Systemic thinking

• Cybernetics Wiener, O. (1948)Cybernetics: Or the Control and Communication in the Animal and the Machine)

• Systems Theory (von Bertalanffy, Ludwig, (1974) Perspectives on General System Theory)

• Complex adaptive system theory Holland, John H. (1992). Adaptation in natural and artificial systems: an introductory analysis with applications to biology, control, and artificial intelligence

• Emergence (Emergence as a Construct: History and Issues. By: Goldstein, Jeffrey, Emergence, 15213250, 1999, Vol. 1, Issue 1r, Fromm, Jochen (2004),The emergence of complexity, Kassel University Press)

• “The emergent is unlike its components insofar as these are incommensurable, and it cannot be reduced to their sum or their difference." (Lewes 1875 Problems of Life and Mind (First Series), vol. 2, Trübner , p. 412)

• "... the totality is not, as it were, a mere heap, but the whole is something besides the parts ...", i.e., the whole is greater than the sum of the parts. (Aristotle Metaphysics Book 8.6. 1045a Pg 8-10)

Emergence

Narrative turn

• Loss in process of reductionism: Meaning, interactive qualities of caregiver/careseeker relation, sense of coherence

• Opposition against reductionist biomedical paradigm is heterogenous

John Launer, Consultant in family therapy and expert in narrative based primary care

Primary care

Wade/Halligan BMJ 2004

The quest for a contextually sensitive medicine

Wade, D. (2015). "Rehabilitation – a new approach. Part two: the underlying theories." Clinical Rehabilitation 29(12): 1145-1154.

Who is at the centre?

Screenshot QOF target 2014_1_4 SystmOne

NICE (2014). Osteoarthritis - Care and management in adults Clinical guideline CG177 Methods, evidence and recommendations Clinical guidelines, National Clinical Guideline Centre: 505.

The H word

DetachedAttached

Dowrick C, Heath I, Hjörleifsson S, Misselbrook D, May C, Reeve J, et al. Recovering the self: a manifesto for primary care. British Journal of General Practice. 2016;66(652):582.

Do things right Do the right

thing

Dowrick C, Heath I, Hjörleifsson S, Misselbrook D, May C, Reeve J, et al. Recovering the self: a manifesto for primary care. British Journal of General Practice. 2016;66(652):582.

Dowrick C, Heath I, Hjörleifsson S, Misselbrook D, May C, Reeve J, et al. Recovering the self: a manifesto for primary care. British Journal of General Practice. 2016;66(652):582.

Individual self Social self

PhysicalistHumanist

“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place” SONTAG, S. 1978. Illness as metaphor.

activepassive

Dowrick C, Heath I, Hjörleifsson S, Misselbrook D, May C, Reeve J, et al. Recovering the self: a manifesto for primary care. British Journal of General Practice. 2016;66(652):582.

Virtue signalling

Thank you

Acknowledgements

John Launer

Kath Lovell

References

Dowrick, C., et al. (2016). "Recovering the self: a manifesto for primary care." British Journal of General Practice 66(652): 582.

Checkland, K., et al. (2008). "Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract." Sociology of Health & Illness 30(5): 788-803.

Weisz, G. (1998). Greater than the parts: holism in biomedicine, 1920-1950, Oxford University Press, USA.

Freeman, J. (2005). "Towards a definition of holism." British Journal of General Practice 55(511): 154.

Ahluwalia, S. and J. Launer (2014). "Complexity and uncertainty in healthcare." Education for Primary Care 25(4): 181-183.

Wade, D. (2015). "Rehabilitation – a new approach. Part two: the underlying theories." Clinical Rehabilitation 29(12): 1145-1154.•

•