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TraditionalChineseMedicine–atraditionbuiltonmyths,orsciencewithadifferentapproach?

AurelijaPlonyte

LokaverkefnitilBA-gráðuíMannfræði

Leiðbeinandi:HelgaÖgmundardóttir

Félags-ogmannvísindadeild

FélagsvísindasviðHáskólaÍslandsMaí2017

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RitgerðþessierlokaverkefnitilBA-gráðuíMannfræðiogeróheimiltaðafritaritgerðinaánokkurnháttnemameðleyfirétthafa.

©AurelijaPlonyte2017

Reykjavík,Ísland2017

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Abstract

ThisthesisdiscussestheimageofTraditionalChineseMedicine(TCM)bothinChina

andaroundtheglobe,inpresentdayandhistorically.

In the first part, the main ideas and theories of TCM, as well as its origins and

development, are introduced. Later discussion includes criticism from the West,

biomedicaljudgmenttowardsTCM,andacomparisonofbiomedicineandTCM.

Itwas concluded thatWesternmedicine (WM)andTCMcannotbemeasuredand

comparedbythesamemethods:whiletheformerisquantitative,thelatterisrather

qualitativeandmeasuringitusingquantitativemethodsmayproveinaccurate.

Keywords:TCM,WM,Biomedicine,Placebo,efficacy,healing,medicine.

TableofContents

Chapter 1 - Introduction 4

Chapter 2 – History and Origins of TCM 5 Chinese history and development of TCM 5 Myths and Yin-Yang theory 7

Chapter 3 - Challenges and Criticism 11 Struggles in Modern Era 11 Placebo effect 14

Chapter 4 - Image of TCM Today 18 Backlash to Criticism 18 The Western Dominance 21 Comparing Biomedicine and TCM 22

Chapter 5 - Conclusion 26 Works Cited 29

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Chapter 1 - Introduction

AccordingtoChinesebeliefs,ChinesemedicinestartedfromthetimeofShen

Nong – a mythical sage ruler in prehistoric China who tasted hundreds of herbs,

amongwhichseventytypeswerefoundtobepoisonous(Jiuzhang&Guo,2009).The

practiceofusingherbscontinued,bookswerewrittenaboutthebenefitsofvarious

plants, and formulae were created in order to cure all kinds of illnesses. Chinese

medicineisnotonlyaboutherbs,however,itbeginswithphilosophicaltheoriesthat

date back to ancient China, including some religious beliefs and various treating

therapiessuchasacupuncture,moxibustion,massage,exercise,dietandmore.Such

practiceshavepersistedthroughthecenturiesandarestillusedtoday,andnotonly

inChina–theknowledgeandusageofChinesemedicinehasspreadthroughother

countriesofAsiaandhasalsoreachedcountriesintheWesternworld.Asinterestin

Chinesemedicine increased, so toodid the scepticismand criticism surrounding it

grow.TodaytheimageofTraditionalChineseMedicine(TCM)isquitecontroversial.

WhilesomepeoplechoosetotrustthepractitionersofTCMandclaimtobehealed

by it, others see it as a traditional or cultural practice based on pseudoscience,

consider its practices as a sham,or evenmagic.Myriadsof tests andexperiments

have been carried out in an effort to find out how such practices as acupuncture

work, or how herb tea eliminates various illness symptoms. However, scientists

struggletofindarightwaytotestTCM’sefficacy.Americanmedicalanthropologist

Linda B. Barnes argues that acupuncture in the US is seen as either a traditional

system,amodalityrelatedtoculturallygroundedapproachestoreligioushealing,or

alternative medicine that is complementary to biomedicine (Barnes, 2005).

However,inheropinion,theterm‘traditional’maynolongerbethebestdescriptor,

assuchtraditionalpracticesashomeopathy,yoga,ortherapeutictouchhavebeen

usedalongsidebiomedicineforalongtimeandtodayacupunctureisalsoincludedin

the practices of biomedical physicians. From her point of view, both traditional

medicineandbiomedicinehavebeen influenced“through thecultural influenceof

other systems”and theyhaveeventually lost theirborders (Barnes,2005,p.242).

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ButwhoisinchargeofdeterminingTCM’sefficacy?

In this essay I amgoing to introduce shortly theorigins, development and

strugglesofTCM, its influenceontheWestand its imagebothwithinChinaandin

theWest.Thediscussionwill includeboththecriticismtowardsTCMpracticesand

thebacklashtosuchscepticideas.Westernmedicinewillbevariouslyreferredtoas

WM,Orthodoxmedicine,biomedicine,modernmedicineorconventionalmedicine;

Traditional Chinese medicine will be referred to as TCM, CM, complementary

medicine,alternativemedicineorjustChinesemedicine.

Chapter 2 – History and Origins of TCM

History and development of TCM

Chinesehistoryisseenasacombinationofdifferentperiodsthatwereruled

bydifferentdynasties.ForChinesemedicine,duringsomedynastiesitwasaglorious

timeandatothertimesthetraditionofChinesemedicinewasdying.Politicalregime

and philosophical ideas played an important role in forming TCM into what it is

today. It is believed that some techniques of TCM, such as usage of herbs,

acupunctureandmoxibustion,werealreadypracticed thousandsof years ago. For

example, acupuncture originated from the stone-needle practice of the Neolithic

Age(around8000BC),whereancientChineseusedasharpstonetobreakabscesses,

dischargebloodandpus(Jiuzhang,&Lei,2009).Thiskindofsharpstonetoolwasthe

predecessor of today's knife-like needle used in acupuncture. Another healing

technique,moxibustion, is believed to have been invented as a result of the cold

livingconditionsinNorthChina,wherepeoplewarmedacertainpartofthebodyby

burning, ironing, or fumigating with ignitedmaterials like moxa – a burning herb

(Jiuzhang&Lei,2009).However,theearliestdynastythathasmoreevidence(such

asoraclebonescripts)thanmythsisthedynastyofShang,whichdatesbackto1600

BC(Tanner,2010).Fromthattimeon,Chinesephilosophersandscholarshavebeen

collecting a vast amount of knowledge regarding TCMpractices. Firstly, the Shang

periodmarks the timewhenalcoholwas introduced to themedical field. Itwas a

great discovery for the people when they realised that wine could be used as a

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solvent, stimulant, an anaesthetic, as well as for promoting blood circulation and

enhancing thecurativeeffectsofmedications.Another inventionduring theShang

dynastywasdecoction.AphysiciancalledYiYindecodedvariouscrudedrugswith

waterinthisway,makingliquidmedicine(Jiuzhang&Lei2009).Soonafter,theZhou

dynasty (1046-256 BC) followed, in this period the medical system in China was

formed.Duringthisperiodtheroyaldoctorsweredividedintodieticians,physicians,

surgeons,andveterinarians.Inaddition,asetofmedicalexamswasestablished,as

wellasassessingandmedicalservicesystems(Jiuzhang,&Lei,2009). Intheirbook

“AGeneralIntroductiontoTraditionalChineseMedicine”(2009),MenJiuzhangand

GuoLeimentiontwobooksthatwerewrittenduringthisperiodthatwereofgreat

importancetoChinesehistoryandChinesemedicine.Theyweretheearliestworks

containingrecordsofthemedicinalherbsextantinChina,withmorethanfiftykinds

of plant medicines, describing the gathering, habitat and edible properties. They

weretitled“TheBookofSongs”and“TheClassicofMountainsandRivers”(Jiuzhang,

& Lei, 2009, p. 3). Further achievements in diagnosis, treatment (massage,

orthopaedic treatment),medical systems,pharmacology, gynaecologyandmedical

educationweremadeduring thedynastiesof Tang, SongandYuan (618-1368AD)

TheseweregreatdevelopmentsofmedicineinChina,butTCMwouldnotbewhatit

istodaywithouttheancientChinesethinkers,philosophyandmyths.

Chinese society has been significantly influenced by the ideas of great

philosophers such as Confucius or Laozi, as well as religious leaders. At the time,

each individual’s (in China) views and understanding of the world and how

everythingworkswerebasedonthoseideas.Chinesemedicinewasnoexception.If

wegobacktotheAxialageinChina(around500BC),wefindthatatthattimemany

contendingschoolsofthoughtemerged,includingConfucianism,Daoism(orTaoism)

and Yin-yang (Gamer, 2012).While Confucianism focuses on the social aspects of

humanlife,Daoismpertainsmoretonatureandtheindividual.Itwasquitecommon

for the people to take on both Confucian and Daoist outlooks simultaneously,

combining them together and in that way creating a balance between the two.

Meanwhile, the yin-yang school systemised some of the magical practices from

earlier primitive religion. In the beginning it was seen as less important than

ConfucianismandDaoism,however,lateronithelpedreconcilethesetwodoctrines.

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TheconceptofYinandYangisrepresentedastheoppositionandcomplementarity

of light and dark, which are inherently different but related to one another in

essence (Gamer,2012).This theory isadialecticbasedon theancientmaterialism

that studies the law of occurrence, motion, development, and variation in the

cosmos.Theideaofthistheoryisthattheworldistheunityoftheopposingyinand

yang, and that the interaction of yin and yang “promotes the occurrence and the

developmentofthings”(Jiuzhang&Lei,2009,p.59).Thisphilosophicaldoctrineof

yinandyanghadpermeatedthemedicalfieldinChina,whereitwascombinedwith

TCM theories. The result was, as Men Jiuzhang calls it, “peculiar TCM’s yin-yang

view” that has been guidingmedical cognition and practice in China for centuries

(Jiuzhang&Lei,2009,p.59).

Myths and Yin-Yang theory

Chinahasa rich traditionofmyths, someofwhichmayhavebegunasoral

tradition. Somemyths explain the origins of the universe and others describe the

origins of human society, culture, and government. These kinds of myths often

involvestoriesaboutculturalheroeswhotaughtthecommonpeopleusefulthings,

suchashow tobuild ahouseordistinguishanedibleplant fromapoisonousone

(Tanner, 2010). Probably themost important hero tomention herewould be the

mythicalrulerHuangDi–TheYellowEmperor.Thisrulernotonlysupposedlyruled

over vast territories, but also was said to have “invented bureaucracy, writing,

sericulture,medicine,boats,andwheeledvehicles”(Tanner,2010,p.34).Thereisa

book called “Yellow Emperor’s Classic ofMedicine” that is believed to have been

writtenbyHuangDi.The textdatesback to206BC -220AD (HanDynasty–over

2000 years after the reign of Huang Di) and became themain source of medical

theory. In her book “Chinese Civilization” (1993), Patricia B. Ebrey quotes this old

text,whichtalksabouttheideasofyinandyanginmedicaltheoryinChina.“Illness

wasseenasadisturbanceinthebalanceofYinandYangorFiveAgentscausedby

emotions,heatorcold,orotherinfluences”(Ebrey,1993,p.77).Accordingtothese

quotes,theprincipleofyinandyangisthefoundationofthewholeuniverseandit

underlieseverythingincreation.Heavenwascreatedbytheconcentrationofyang–

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theforceoflightthatstandsforpeace,serenityanddestruction.Earthwascreated

by the concentration of yin – the force of darkness that stands for confusion,

turmoil,andconservation.Thequotesgoontoexplainthattheembodimentofyang

isfireandtheembodimentofyiniswater.Whileyangcreatestheair,yincreatesthe

sensesof thephysicalbody.And in thecaseof illness, thecauseof it iseither the

disharmony in the spirit that “has done harm to the body” or “dysfunction in the

body has injured the spirit” (Ebrey, 1993, pp. 77-78). The text also explains that

nature has four seasons and five elements and in order to grant long life, these

seasons andelementsmust storeup thepowerof creation in cold, heat, dryness,

moistureandwind.Meanwhile,amanhasfiveviscera inwhichthesefiveclimates

aretransformedintojoy,anger,sympathy,grief,andfear.Thetextexplainsthatthe

emotions of joy and anger are injurious to the spirit just as cold and heat are

injurious to thebody.Andwhen joyandangerarewithoutmoderation, thencold

andheatexceedthemeasure,andlifeisnolongersecure.Inotherwords,allofthis

meansthatbothyinandyangshouldberespectedtoanequalextent(Ebrey,1993,

p. 78). The practitioners of traditional medicine examine the patients by judging

their general appearance and taking their pulse. This helps the practitioner to

determinewhetheritisyinoryangthatcausesthedisease:

To determine whether Yin or Yang predominates, one must be able to

distinguishalightpulseoflowtensionfromahard,poundingone.Withadiseaseof

Yang,Yinpredominates.WithadiseaseofYin,Yangpredominates.Whenoneisfilled

withvigorandstrength,YinandYangareinproperharmony.(Ebrey,1993,p.79).

WongLai-Yi,apractitionerofTCMtoday,explainsthispeculiarviewindetail:

“ThephilosophybehindChineseMedicinewasthatmanlivesbetweenheavenand

earth,andcomprisedaminiatureuniverse inhim”(Wong,2005,p.11),wherethe

materialsandlivingthingsbelongtotheyinandyang.Thefunctionsoflivingbeings

aredescribed in termsof the “Heart”or “Mind”, “Lungs”or “Respiratory system”,

“Liver”,“Spleen”and“Kidneys”(fivecentresofthebody).The“Heart”isseenasthe

“commandcentre”, consciousnessand intelligence, and “Lungs” is the system that

maintains cyberneticbalanceand regulates various intrinsic functionsof thebody.

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The “Liver” is seen as “the mechanism for emotional response to the external

environment”(Wong,2005,p.12),the“Spleen”distributesthenutritionthroughout

thebody,andthe“Kidneys”areseenasacrucialsystemonwhichhumanlifeforce

depends.Thissystemregulatesthestorageofnutritionandtheuseofenergy.Allof

thisiscalled“latentphenomena”(Wong,2005,p.12).Wongalsomentionsthatthe

changes inseasonsandweathercould influenceandharmthehumanbody.Wind,

cold, heat, moisture, dryness and internal heat are said to have the most

pronouncedeffectandarecalled the“sixexternaldisease-causing factors” (Wong,

2005,p.12).Emotionssuchashappiness,anger,worry,pensiveness,grief,fear,and

surprise are also seen as harmful, in the case of extreme change; they are called

“sevenemotions”(Wong,2005,p.13).Aroundthetimeof179-104BC,thenotions

oftheworkingsofthecosmosintermsofyinandyangandthefiveagents(wood,

metal, fire, water, and earth) were combined with the ideas of Confucius about

humanvirtueandsocialorder (Ebrey,1993,Ch.13).Throughouthistory, these ‘six

externaldisease-causingfactors’and‘sevenemotions’werealsocombinedandthe

theoreticalfoundationofdiseasepathologywasformed(Wong,2005,p.13).

TCM Techniques and Influence on the West

TCMincludesvarioushealingpractices,suchasherbaltherapy,acupuncture,

moxibustion,massageandmore.Regardlessofwhatstylesortechniquesarebeing

usedforcuringtheillness,inChinesemedicineeverythingstartswiththeconceptof

‘qi’–“theoriginalsubstanceofallthingsinthenaturalworld”(Jiuzhang&Lei,2009,

p.9),or“theflowoflifeenergy/vitality”(Wong,2005,p.14).Thetheoreticalbase

ofacupunctureistheadjustmentof‘qi’thatflowsthroughthebodyviaasystemof

channelscalledMeridians(经络)(Wong,2005,p.14).Whenthereisablockageor

imbalance of ‘qi’ flow, the practitioner of TCM may either insert acupuncture

needles or burn Chinese mugwort in moxibustion at certain points along the

channels in order to fix this problem (Wong, 2005, p. 14). The practitioners of

acupuncturebelievethatwhileusingtheneedlesyouneedtousethemwith‘qi’and

puttheenergyintothepatient.Theylearntodothisin‘qigong’classes,whichthey

compare to classes in neurology (Barnes, 2005, p. 274). Barnes interviewed a

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numberofTCMpractitioners,oneofwhomclaimsthattherearethreetechniquesto

move theenergyand shebelieves that the treatmentsof thosewhodonotknow

thesetechniquesdonotwork(Barnes,2005,p.247).

SomehealingtechniquesandinventionsoftraditionalChinesemedicinehave

beenquitesignificantandwereevenheardofabroad.Forexample,takingapulseis

avery importantdiseasedeterminingtechniqueofTCM.Thistechniquewashighly

developedduringtheJindynasty(265-420AD)FamousphysicianWangShuheinhis

book “The Pulse Classic” wrote about the methods of pulse differentiation and

classifiedallpulseconditionsintotwenty-fourtypes.AccordingtoJiuzhangandLei,

inthisbookyoucanfindalmostallphysiologicalandpathologicalpulseconditionsof

thecirculatorysystemtoday (asdefinedbyWM).The techniquesdescribed in this

book greatly influenced the development of sphygmology worldwide. It was first

introduced inKoreaand Japan, later theArabworld,Persiaandwestcountries. In

the 17th century British doctor John Floyer translated this book into English and

inventedthemethodofcountingthepulseusingawatch(Jiuzhang,&Lei,2009,p.

6).JiuzhangandLeimakegreatcomparisonsbetweenChinaandEuropeintermsof

howmuchearlierChinesepeoplehadachievedsomethingsthanEuropeans:“inthe

Tang and Song dynasties, the Chinese medical system, medical education, and

medicalservicesystemstooktheleadintheworldmedicine”(Jiuzhang,&Lei,2009,

p. 8). In the 9th century the earliest monograph on traumatology in China was

written and itwas discovered that neonatal tetanus and adult tetanus (amedical

condition that causesmuscle spasms)were the same kind of disease. Thismeans

thattheChinesehaddiscoveredit600yearsearlierthanEuropeans(Jiuzhang&Lei,

2009,p.7).Similarly,theancientrecordsshowthatvaccinationandantisepticswere

firstdevelopedinChina,centuriesaheadofWesterndoctors(Wei,2013).Moreover,

Li Shizhen’s “TheCompendiumofMateriaMedica” (1596)was themostadvanced

botanic classification in theworld at that time, again, 200 years earlier than that

written by European botanist Carolus Linnaeus (1707-1778). This book has been

translated intomany languages, such as Latin, Korean, Japanese, Russian, English,

Frenchandothers.ItwasevenquotedbyCharlesDarwininhiswork“TheOriginsof

Mankind”, where he described Li Shizhen’s work as “the encyclopedia of ancient

China”(Jiuzhang,M.&Lei,G.2009,p.8).Thesefactsimply,therefore,thatChinese

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medicinewas influential in thepastand itsdiscoveriesand inventionswerehighly

respected. However, the perception of Chinese medicine today is not quite the

same.

Chapter 3 - Challenges and Criticism

Struggles in Modern Era Inthe18thcentury,biomedicine(WM)becamethedominantmedicalsystem

worldwide and herbal medicine almost ceased to exist in many industrialised

countries. From 1839, China underwent a century of profound challenge to its

traditions.Thereweremoreandmoreforeignerscomingin,gainingmorerightsto

establishsettlementsandbusinessesduetotheOpiumWar.Bytheyear1919there

was a political movement (May Fourth movement) opposing the weakness of

Chinesegovernment,wherestudentsandwritersjoinedtogethertorepresent“the

culmination of groundswell of youthful anti-traditionalism” and “the literary

revolution” (Gamer,2012,p.431).AsGamer states, “Chinawasa republic,but its

culturewasnotyetmodern”(Gamer,2012,p.431).Bythe1920sthismovementled

totheestablishmentofaNewCulturebasedonhumanism,scienceanddemocracy,

in opposition to traditional orthodox culture (Gamer, 2012, p. 432). When the

communiststookover,therefore,theGovernmenthadanti-traditionalistviewsand

sought tomakeChinamoremodern.Thismeant thatall the ideas thatcamefrom

traditions, such as Confucianism and practices of TCM, were seen as “being

backward”.TheGovernmentadoptedstrictstandardsagainstTCM,whichresultedin

onlyasmallnumberofTCMpractitionersbeingdeemedasqualified.Bythe1930s,

the two disciplines of medicine (WM and TCM) in China had become highly

contentious(Wei,2013, p.262).ChairmanMaoZedong,afounderofthePeople’s

Republic of China,was initially against TCMbecausehewas against traditionalism

and Confucianism. However, he later “reversed his anti-TCM policies to prevent

ChinafrombecomingoverlydependantontheSovietUnion”(Wei,2013,p.262).In

1958 the Government of China proclaimed equal status for TCM and Western

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medicine.Around the timeof theCulturalRevolution (1966), inorder tobuild“an

economical and effectivemethod to popularize rural health care”, ChairmanMao

initiated a “nation-wide integration of part-part time peasant healthworkers into

thecooperativemedicalclinics” (Wei,2013,p.263).Thesepractitionerseventually

were named “barefoot doctors” (Wei, 2013). The training that these doctors

undertook had an innovative strategy that combined both TCM and WM (Wei,

2013).TheMaoerawasanimportantoneinTCM’shistory.Notonlydidthefocuson

TCMmodernise traditional acupuncture, but it also helped this ancient technique

spreadthroughboththeWestandotherthirdworldcountries(Wei,2013,p.269).

After the reign of Mao, the practice of barefoot doctors died, the collection of

medicalplantscollapsed,andbythe1980sthesalesofWMquicklysurpassedthose

ofTCM.By2010,Westernmedicine’smarketsharehadgrowntothreetimesthatof

TCM(Wei,2013).

Looking at the West, according to Wong Lai-Yi, in the late 1960s many

American people started turning back to herbal medicine as they decided to pay

attentiontopreventingtheillnessratherthantreatingitafterithappens.Asaresult,

alternativemedicinebecameincreasinglypopular.In1974eventheUnitedNations

WorldHealthOrganizationwasencouragingtheuseoftraditionalherbalhealingin

order to achieve adequate worldwide healthcare (Wong, 2005). However, the

techniquesthatwereadoptedinEuropeandNorthernAmericamaynotnecessarily

portray the same understanding of TCM as seen in China. In his article “Chinese

Medicine: Nature versus Chemistry and Technology” (year unknown), Unschuld

arguesthat inChina, fromtheverybeginning,drugtherapyandacupuncturewere

separate healing traditions and that the former eventually developed into a

dominantmethodoftreatingillness(Unschuld,n.d.,p.6).Heexplainsthatfromthe

Chinesepointofview,theterm“Chinesemedicine”meansthedrugtherapythathas

developedovertwothousandyears.Meanwhile,acupunctureisseenasaseparate

formoftherapy,withonlya“second-orthird-rankingsignificance”(Unschuld,n.d.,

p.7).However,itisinterestingthattheperceptionofTCMintheWestisquitethe

opposite. People in theWest associate the term “Chinese medicine” mainly with

acupuncture. Unschuld even argues that the acupuncture of today is respected

merelybecauseoftheregarditisgivenintheWest(Unschuld,n.d.,p.7).However,

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inhisopinion,theinterestfromtheWestinTCMisnotbecauseitismoreeffective

thanWesternmedicine(andhestatesthatitisclearlynotthecase).Hebelievesthis

interestcomesfromtheworldviewofanxietiesandfears(Unschuld,n.d.,p.10).He

speculates thatpoisoningof theenvironmentwithall kindsofartificial substances

evokes negative associations with the poisoning of the body through such

treatments as chemotherapy. In contrast, Chinese medicine does not have any

chemical effect on the body and does not leave any long-term consequences.

ThereforepatientsthatfearthepollutionoftheorganismwouldratherseekaTCM

doctor.

In1997,theNational InstituteofHealth(NIH)acknowledgedtheefficacyof

acupuncture in treating various conditions of pain, such as “headache, menstrual

cramps, fibromyalgia,myofascial pain, osteoarthritis, low back pain, carpal tunnel

syndrome,asthma,postoperativeandchemotherapy-includednauseaandvomiting,

andpostoperativedentalpain”(Sutherland,2000,p.41),aswellasintreatingdrug

addiction.However,despitethis,theNIHstatedthat“thedefinitionofacupuncture

continues to be controversial, and it couldn’t determine a scientific basis for key

concepts inChinesemedicine, including thecirculationofqi” (Sutherland,2000,p.

41). Instead of embracing the Chinese theory of ‘qi’, therefore, some researchers

tried to interpret the efficacy of acupuncture and meridian therapy in a rather

Westernway.KaptchuknotesthatacupuncturistswithaWesternbackgroundtend

to see acupuncture from the Western point of view “based on western

understandingofmyofascial triggerpoints, thenervoussystem,orrecentscientific

discoveries about the likelymechanism of acupuncture” (Kaptchuk, 2002, p. 376).

According to Barnes, in one of his articles he even suggests that vibrant medical

systems should adopt certain techniques or strategies of acupuncture without

understandingthetheory(Barnes,2005,p.258).Barnesnotesthat“Suchinstances

may entail abandoning the core paradigm, substituting a changeling that may

representonlyatechnologicalintervention.Suchisoftenthecaseinbiomedicaluses

of acupuncture” (Barnes, 2005, p. 258). Barnes believes that pluralism within

acupuncture intersects with the medical pluralism in American culture that is “a

largerculturalprocess–refractedthroughlensesoftraditional,religious,CAM,and

biomedicalunderstandingsofmeaningfulchange”(Barnes,2005,p.259).

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PsychologistandresearcherBrucePomeranzspeculates thatpainpathways

in thebrain could beblockedby peripheral nerve stimulation,whichwould direct

the brain to release endorphins (Barnes, 2005). After conducting sixteen different

experimentsbasedonsixteendifferenthypotheses thisspeculationwasconfirmed

(Barnes,2005).Someotherphysiciansalsoclaimthatmanipulationofpointsalong

the meridians (the points in the body where TCM practitioners insert needles)

stimulatesneuropeptidesinthecentralnervoussystem:“Becausetheyareadjacent

tonervefibersandnerveroots,thesepointsarebelievedtosendmessagestothe

spinalcord,mid-brain,cortex,andthehypothalamuswhenstimulated, resulting in

the release inneuropeptides” (Sutherland,2000,p.41). Inotherwords, scientists

that cannot grasp how acupuncture works in TCM terms try to find a logical

explanation in Western scientific terms. Barnes sees this way of acupuncture’s

adoption by Western physicians through history as a type of hybridity (Barnes,

2005).

Daniel Keown is a doctorwho is a practitioner of TCM and has aWestern

background.Hehasbeenworkingasaregistered(Western)doctorsince1998and

completedadegreeinChineseMedicineandAcupuncturein2008.Inhisbook“The

Spark in theMachine: How the Science of Acupuncture Explains theMysteries of

Western Medicine” (2014), he talks about acupuncture and tries to explain in

Westerntermshowitworks.Unlikethephysiciansmentionedabove,however,this

doctortriestogivereadersaninsightintothemeaningofTCMandalsoexplainsthe

functions of the body from a TCM point of view. He pays a lot of attention to

anatomy, which, in his opinion, is highly neglected by Western doctors (Keown,

2014). Fromhisunderstanding, thepartof thebodycalled fascia– the tissue that

holdsourorgans inshapeandseparatefromeachother, iscrucial inacupuncture.

AndbecauseWesternmedicine ignores thispartof thebody, it cannotgrasphow

acupuncture works. He implies that the collagen in our body produces electricity

whichguidesthegrowthofbonesandarguesthatthiskindofelectricityisalsobeing

producedinfascia.Thisfasciaenableselectricitytoreachanypartofthebodyand

accordingtoKeown,thisfactonceagainiscompletelyignoredbyWesternmedical

doctors (Keown, 2014). From his perspective, this kind of “living electrical web”

(Keown, 2014, p. 21) in our bodies resembles the Chinese descriptions of

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acupuncturechannelsand‘qi’.

Placebo effect

In the 19th century it was already questioned whether the therapeutic

effects of acupuncture were caused by stimulating a change in either magnetic,

nervous or galvanic fluid. Some discussions ofmore recent days are not far from

these.AccordingtoBarnes,TCMtherapiesareoftenusedtotreatthoseconditions

thatresearchersidentifyasthemostresponsivetoplaceboeffect,whichareusually

chronic conditions. This allows the critics to argue thatmany of the TCM treated

conditionsaresusceptibletofrequentspontaneousremissionsandthehealingisjust

adupe(Barnes,2005,p.257).SuchscholarsasUnschuldraisethequestionsofhow

TCM works, whether it works at all, and tend to lean towards biomedicine,

preferring its methodologies over those of TCM (Unschuld, 2009, p. 19). In fact,

UnschuldreferstoTCMasahealingpracticeratherthanmedicineandregardsitasa

traditionwhich has no scientific proof of efficacy: “Medicine is the link of healing

with science. Healing that lacks a scientific basis is not medicine in this sense”

(Unschuld, 2009, p. 19). In his article “ChineseMedicine:Nature versus Chemistry

andTechnology” (nodate),Unschuldexpressesaconcern regarding the increasing

interestcomingfromtheWesttowardstraditionalChinesemedicine.Heisopposing

theideaofestablishingChinesemedicineasasubjectofstudyinthemedicalfaculty.

Hestatestwicethat“thereisnosuchthingasChinesemedicine”(Unschuld,p.3,6).

Fromhispointofview,thisisbecauseindifferentperiodsoftimeChinesemedicine

meant different things and because there are various versions of it, it has to be

agreedonwhichoneofthemshouldbestudiedatthemedicalfaculty.Inthisarticle

heoncemoredisregardsTCMasnon-scientific:“Ifwewantedtoadoptonlythose

elementsofChinesemedicinethatcouldbeprovenscientifically,notmuchwouldbe

left. Yet we do not have any other criterion” (Unschuld, n.d., p. 6). While TCM

practitioners,suchasDanielKeown(2014)believethatTCMhasnotchangedmuch

throughthelast2000ofyearsbecauseitdoesnotneedtochange(Keown,2014),in

Unschuld’sview,Chinesemedicinehadsimplystagnatedovertheseyears(Unschuld,

n.d.,p.3).He relatesTCM’sdevelopment to thatof thestateandexplains thatas

long as the political principles did not change, TCM remained the same; in other

16

words, both politics and medicine relied on the same principles. In contrast, in

Europe therehavebeen constant changesbothpolitically and in themedical field

(Unschuld,n.d.,p.3).“NeitherinEuropenorinChinahasmanbeenabletointerpret

diseaseofhispersonalorganisminawaydifferentfromthatinwhichheinterprets

crisesinthesocialorganism”(Unschuld,n.d.,p.4).HegoesontostatethatChinese

medicinehadnotchangeduntil1911,whentheworldviewoftheimperialagecame

toanend.

These theories lead some scholars to thequestion– if there isnoproofof

howacupunctureworks,doesitmeanitworksbyplaceboeffect?Americanmedical

anthropologist Daniel E. Moerman defines placebo effects as “the desirable

psychological andphysiological effects ofmeaning in the treatmentof illness.”He

arguesthatifapatientparticipatesinahealingprocess,nomatterwhatwillbethe

healingcontent,hemaystillbehealed(Moerman,2000,p.52).Similarviewswere

expressedbyWelch(2003)–inhisarticle“WesternMedicineandItsRoleinPlacebo

Healing” (2003), he suggests thatWesternpractitioners interactwithpatients in a

“highly ritualized manner” and it plays an important role in healing the patients

(Welch,2003,p.21).Hecomparesbiomedicineofthisdaytoancientritualpractices

ofNativeAmericanIndiansorshamansinAfricawhousedto“mobilizetheplacebo

effect in their patients throughahealing ritual” (Welch, 2003,p. 21). Just like the

priestorotherspiritualleaderwelcomesyouintohistempleandtakescareofyou,

theWesterndoctorwelcomesyouintothehospital,diagnosesyourillnessandtries

to help younomatterwho you are.Welch believes that nearly all disease is self-

limitingandthebodycanusuallyhealitbyitself(Welch,2003,p.26).Toaccelerate

thehealingprocesswecanapplysome“activetherapeutic”[sic](Welch,2003,p.26),

butaccordingtoWelchit isnotalwaysnecessary.Sometimestheactof‘givingthe

medicine’ or ‘giving affection’ could be evenmore important than the drug itself,

whenthe“act,thoughnotthecontentofmedicine,somehowtriggersthebodyto

autonomoushealing”(Welch,2003,p.26).Welchdiscussesvariousstudiesthathave

beenmade in aneffort to findoutwhether such factors as empathy and concern

couldinfluenceapatient’scondition.Thesestudieshaveshownthatphysicianswho

provide empathy and concern “can positively influence the patient’s clinical

outcome”(Welch,2003,p.28)andthattheuseofaplaceboinadoubleblindtrialof

17

morphine canbeevenmoreeffective than theuseof aweakbut activeanalgesic

(for example, aspirin) (Welch, 2003). Double blind trial heremeans that both the

patient and the doctor do not knowwhether the drug is active or a placebo and

assumethatitisapowerfuldrug.Tosummarise,thesestudiessuggestthattheritual

of receiving a pill from a trusted physician can improve a patient’s health “in

proportion to the physician’s promise”, even without the use of the active

pharmaceutical (Welch, 2003, p. 26). Kaptchuk, in his speech about his tests on

placebo effect for TedMed (2014), expressed very similar ideas. After testing the

patients in different ways he came to the conclusion that “human dimensions of

providinghealthcarecanalleviatesymptomsandchangethecourseofillnesseven

withoutpharmaceuticals”(Kaptchuk,2014,16:22).Thereareevenstudiesthathave

concludedthat“elderlypersonswhoperceivetheirhealthaspoorare6timesmore

likely todiethanthosewhoperceivetheirhealthasexcellent, regardlessofactual

healthstatus”(Crum&Langer,2007,p.166).

Ifitisnotanactivedrugthathelpsthepatienttorecover,therefore,whatis

it? Tilburt and Kaptchuk believe that “cultural familiarity with many traditional

Chinese herbal medicines in China may promote a familiarity bias, accepting a

widespreadculturalassumptionofsafety,basedonthehistoricaluseoftheherbal

medicines”(Tilburt.&Kaptchuk,2008,p.597).Thismayapplyforsomeoftheherbs,

buttherearesomefactsthatcannotbeignored.DennisNormileinhisarticle“The

New Face of Traditional Chinese Medicine” tells us an interesting story about

Chinese pharmacologist Li Dapeng, who in 1975 began trying to coax anticancer

compounds out of the plant’s seed (Normile, 2003, p. 188). Twenty years later, Li

DengreceivedtheGovernment’sapprovaltomarkethisresearchfindings.Heuseda

drug that he calls “Kanglaite” to help cancer patients fight their disease and also

reduce the side effects from the other treatments. The article states that by that

time(in2003)thedrughadbeeninjectedintomorethan200,000patientsandwas

China’sbest-sellingtreatment.Despitethis,thescientistsstilldidnotknowhowthe

drug worked.Moreover, this was the first drug that was derived from traditional

Chinese herbal remedy andwent into clinical trials in theUnited States (Normile,

2003).

Regardingthepracticeofacupuncture,hundredsoftestshavebeendonein

18

ordertofindoutwhetheritistrulyeffectiveoriftherearesomeotherfactorsthat

causetherecovery.OneexamplecouldbetheexperimentconductedbyDilli,Childs

and Berk in 2014. A group of scholars conducted an experiment in an outpatient

clinicattheColoradoSchoolofTraditionalChineseMedicine.Thereweresixty-one

acupuncture-exposed and fifty-nine acupuncture-naive (never had acupuncture

before)participants,whoseageswerebetweeneighteenandninetyyearsold.The

resultsshowedthat“perceptionsoftherealtreatmentwereratedasmorerealthan

sham treatments for all participants” and “prior acupuncture exposure did not

influenceratingsofrealtreatments,butexposedparticipantsratedshamtreatments

assignificantly lessrealthannaiveparticipants”(Dilli,Childs&Berk,2014,p.155).

However, even though the resultsmay imply that acupuncture is effective, it just

raises furtherquestions. In theirarticle “AdvancingAcupunctureResearch” (2005),

Andrew and Kaptchuk address three issues concerning their research. The first is

questioning whether acupuncture is studied appropriately; second, whether the

studiesfocusontherightstyleofacupuncture(sincethereareavarietyofstyles);

and third, why is there a discrepancy between animal and human studies of

acupuncture.Theyarguethateventhoughtherehavebeenhundredsofattemptsto

scientifically evaluate acupuncture, little has been achieved (Andrew & Kaptchuk,

2005).

Chapter 4 – The Image of TCM Today

Response to Criticism SinceTCMgainedworldwidefamiliarity,forthosewhodidnotgrowupina

culturewheretheconceptof‘qi’isconsideredtobeselfunderstood,ithasnotbeen

easy to accept TCM as a valid and efficient method of treatment. In the 1970s,

becausenobody in theWest coulddefinehowacupuncture actuallyworks, itwas

classifiedbyphysiciansasaplacebo,bywhichtheyoftenmeant“quackery”(Barnes,

2005,p.251).Inthe“JournalofChineseMedicine”(2010),CharlesBuck,aWestern

practitioner of Chinesemedicine, talks about the criticism towards TCM from the

West. In his opinion, to criticise TCM one has to have some knowledge and

19

understandingofitfirst.HenoticedhowoftendevaluationofTCMiscausedbythe

lackofunderstandingofitsterminology.WhilesomepeoplemightthinkthatTCMis

pragmaticandrational,othersmayclaimthatitisacompletenonsense.Heusesthe

word “outlandish” to describeWesterners’ feeling about the terminology of TCM

and explains thatwhile in China those termsmay seemmore self-evident, in the

West different interpretations of it lead to greater polarisation between

‘traditionalists’and‘biomedicalists’(Buck,2010,p.27).InBuck’sview,thereisalot

ofvalueinTCM,howeveritis“mixedtogetherwiththebeliefsthatareuntenablein

themodernword”(Buck,2010,p.26).HebelievesthatChinesemedicinecouldbe

improvedthroughtheuseofscienceandcriticalreflection.AndinordertobringCM

intothemodernworld,fromhispointofview,adeeperlinguisticandsemioticstudy

must be carried out to make sure that the traditions are interpreted accurately.

Carryingoutbiomedicalresearchonlyisnotenoughtomakesurethatthetraditions

areunderstoodcorrectly(Buck,2010,p.28).Buckarguesthatbiomedicalorthodoxy

“doesnotlikethelanguageofCM”becausetothemitappearsasalien,prosaicand

metaphysical(Buck,2010,p.28).ThereforepractitionerslikeBuckhavetofacethe

fact that TCM to outsiders sounds like “oriental astrology” (Buck, 2010, p. 28).

However,hestressesthatwhenCMphysicianstalkabout‘qi’oryinandyang,these

terms are used specifically in the context of medicine and are not necessarily

congruentwiththeiruseineitherphilosophy,astrologyormetaphysics(Buck,2010,

p.28).InBuck’sview,“CMisatsomeleveluntranslatable;tofullyunderstandityou

have tounderstandChinese language” (Buck,2010,p.29). Forexample, regarding

theconceptof‘qi’–likemanyotherTCMpractitionersDanielKeownthinksthatthis

is the most misunderstood and mistranslated term of TCM (Keown, 2014). He

describes‘qi’asan“intelligentmetabolism”andtriestoexplainthemeaningofthis

word that is a good dealmore thanmetabolism or energy (Keown, 2014, p. 26).

Chinesewordsarewrittenincharactersthatcanalsobebrokendownintoradicals

andeachofthemhasameaning.Thecharacter‘qi’(氣）consistsoftheradicals‘air’

and ‘rice’ which combined could mean “food+air=energy”. However, Keown

concludes that ‘qi’ is too broad to be a substance and that it is rather a concept

(Keown, 2014). And that is only one concept. Looking from an anthropological

20

perspective, Buck’s opinion sounds like the great ideas of the so-called ‘father of

anthropology’. In his famous book “Argonauts of the Western Pacific” (1984),

Bronislaw Malinowski suggests that in order to learn about foreign culture, the

researcherhastolearnthenativelanguage(Malinowski,1984).Sincethepracticeof

TCM is a tradition that has been shaped through the centuries and has great

importanceinpeople’slives,itisdefinitelyapartofChineseculture.Soifweapply

Malinowski’s rule of studying the local language in order to learn the culture, the

personthatwantstounderstandTCMhastolearntheChineselanguage.Onlythen

canhe/shefullyunderstandit.

AnotherpointofviewregardingtheefficacyofTCMwasexpressedbyTCM

practitionerPeterEckman. Inhisarticle“TraditionalChineseMedicine–Scienceor

Pseudoscience? Response to Paul Unschuld” (2014), Eckman questions whether

Chinese medicine should be subject to verification by the methods of Western

biomedicine.Hebelievesthatthereisacommonbeliefthat“scienceislimitedtoits

Westerntraditionandthattherecanbenootherkindsofscience”(Eckman,2014,p.

40).EckmanarguesthatbecauseofthedifferencesinEasternandWesternscience,

theinvestigationnecessarytovalidatepropositionsineachwillalsobedifferent.He

explainsthatwhileWesternscienceisanalytical,quantitativeanddeductive,Eastern

science issynthetic,qualitativeand inductive.EckmannotesthatUnschuldaccepts

thelawsofWesternthoughtasscientificbuttheonesoftheEasthecharacterisesas

‘magical thinking’ and thus implies that they are not scientific in nature. Eckman

disagreeswith thisnotionandargues that “thedifference is thatWestern science

laws may be tested quantitatively, while Eastern scientific ‘laws’ tend to be

qualitative in nature, and thus cannot be proven by the same methods used by

Westernscience” (Eckman,2014,Endnotes,2).Heconcludes thatwhile traditional

Orientalmedicine (including TCM) is a branchof Eastern science, biomedicine is a

branchofWesternscience:“Bothrevealtruths,bothareusefulguidesforhealthcare

providers,butneither isreducibletotheother.Likesomanyotherchallengesthat

facehumanity,thesolutiontothisquandaryispeacefulcoexistence”(Eckman,2014,

p.42).Barnesalsosuggeststhateffortsindefiningwhetheracupunctureiseffective

ornotarebasedonmethodologiesofbiomedicineandareself-limiting.Thiskindof

approach is asking a question of whether acupuncture is “effective biomedical

21

treatment” (Barnes,2005,p.250).AndrewandKaptchukdescribe theseeffortsas

theprocesswhich“canbeequatedtoaskingasculptortosculptwithapaintbrushto

proveheisan‘artist’”(Andrew&Kaptchuk,2005,p.41).

Western Dominance

The idea that TCM cannot be measured by Western science quantitative

measuresraisesthequestionastowhytherearenotdifferentkindsofmethodsto

evaluatetheefficacyofTCM.SinceTCMisstillbeingpractisedinChinaandaround

theglobe,thisimpliesthatitmustworkforatleastsomepeople.Manypeoplethat

sufferfromchronic illnessesturntotraditionalorso-calledcomplementaryhealing

practices,sincethepillsprescribedbyWesterndoctorscanonlyeliminatethepain

but not the illness itself. According to Barnes, some people keep coming back to

acupuncturetreatmentseventhoughtheirsymptomshavenotdisappeared–thisis

because their whole quality of life improves (Barnes, 2005). Since these kinds of

practices do help for some people, therefore, why are they often disregarded as

non-scientificorevenassomethingmagical?WhyistheefficacyofTCMbeingtested

endlesslybybiomedicinebutnottheotherwayround?

ThestatusofbiomedicinecomparedtoTCMisclearlysuperior,eventhefact

thatoneiscalled“conventionalmedicine”andtheother“complementarymedicine”

indicate this.Talkingabout theWestandEast, it isnotonlymedicine that reflects

this superior versus inferior relationship. Inhis book “Orientalism” (2003), Edward

W.SaidtalksabouthowthroughhistorytheWestviewedtheEastinasuperiorway.

Europe continuously maintained the “position of strength” and dominance in

relationtotheOrient(Said,1985,p.40).Forinstance,atthetimeofcolonisationthe

superiority of Britain over Egypt was taken for granted and the British even saw

occupyingEgyptasanactofdoingafavourforEgypt(Said,2003).Saidtalksabout

works of such British intellectuals as Cromer and Balfour, who talked about the

differencesbetweenEuropeansandthepeople fromtheEast.TheOrientalpeople

wereportrayedasirrational,childlike,deprived,“different”andunintelligentpeople

whose “disordered minds fail to understand what the clever Europeans grasps

immediately”(Said,2003,pp.38,40).TheEuropeansincontrastwereshowntobe

22

“rational,virtuous,mature,and ‘normal’” (Said,2003,p.40).FromSaid’spointof

view, such Europeans as British and French shared not only the land (that they

occupiedtogether),profit,or rule,butalsothe“intellectualpower” (Said,2003,p.

41)thatSaidcallsOrientalism.FromtheWesterner’spointofview(suchasBalfour),

BritainwashelpingtheOrientbyoccupyingitsterritoriesandestablishingaWestern

stylegovernment.ThiskindofsuperiorthinkingmayhaveledtheWesternscholars

toassumethatWesternscienceistheonlytruescienceandeverythingelsethat is

not testable by its methods must be some kind of quackery or magic. Chunjuan

NancyWei notes that “with the advent of theOpiumWar (1839 - 1941) and the

subsequent Century of Humiliation, Chinese confidence in its own culturewaned.

Chinesemedicinewasbranded‘feudalsuperstition’andWesterneducatedChinese

wanted toexpunge suchevidenceof ’beingbackward’.”(Wei, 2013,p. 262).Many

MayFourth(politicalmovementinChinain1919)intellectualscriticisedTCM–they

werepro-modernistsandanti-traditionalists.In1929therewasevenabanonTCM,

although it was unsuccessful – people could not give up the ancient practices so

suddenly. Eventually, the Government turned back to preserving its culture and

traditions,aswasmentionedinChapter3.

The important point that Sutherland (2000) notes is that although Chinese

medical practice developed alongside Daoism, Confucianism, and Buddhism, and

although it adopted the Eastern religious belief that both physical and mental

exercisecouldbeusedtoachievehealth,ithasalsobeenpractisedaccordingtothe

resultsofpreviouslyusedtherapies(Sutherland,2000).Inotherwords,theefficacy

ofTCMhasbeen tested formore than2000yearsbypeople themselvesbeing,as

WongLai-Yiputit,“guineapigs”(Wong,2005,p.13).OvertheyearsChinesepeople

testedplantsonthemselvesfortheirpropertiesofinducingwarmth,heat,coolness

andcold.Theyclassifiedthemedicinaleffectsoftheplantsonthedifferentpartsof

the body and determined their therapeutic and toxicity dose (Wong, 2005).

Therefore,TCMdidnotsolelyevolveaccordingtoreligiousphilosophy,eventhough

thatplaysasignificantpartinit.Lookingagainfromananthropologicalperspective,

onecouldquestion,whoisinchargeofdefiningscience,orasMeiZhanputsit,“in

everydaydiscourseandpracticeof traditionalChinesemedicine,and, inparticular,

throughtheproductionof ‘clinicalmiracles’,therecurringquestionofwhatcounts

23

asscienceprovesinextricablefromthequestionofwhoisauthorizedtodefineand

craft science and rationality” (Zhan, 2001, p. 475). Zhan suggests that we should

explore“morefluidandparticipatorywaysofenvisioning,producing,andanalyzing

science”, as well as seeing science as “translocal, open-ended processes and

networks forknowledge,andcommunity formation” (Zhan,2001,pp.475). In that

waywecouldmovebeyond theGreatDivide– “between scienceandnonscience,

knowledgeandbelief,rationalandirrational,universalandlocal,natureandculture,

andUsandThem”(Zhan,2001,pp.474).

Comparing Biomedicine and TCM

ItwouldappearthatcuringdiseaseintheWest(inbiomedicine)isallabout

drugs.Oncethereisnoactivepharmaceuticalsubstanceinthepillthatthepatient

takes and after taking it the patient feels better,Western science would call it a

placeboeffect. Butwhat does thatmean?Does thatmean that the condition can

improve by just believing it will? What about other factors, such as diet, mental

healthand lifestyle?There isaChineseproverbthatsays,“Hewhotakesmedicine

andneglectsdietwastes theskillof thephysician” (Wang,Keh,&Bolton,2010,p.

80). Campbell and Campbell question the relationship of diet and health in their

book“TheChinaStudy” (2006).They talkaboutnutrition in theUSAand inChina.

Theyareconcernedaboutpeople’shealth in theUSandaretryingtodiscoverthe

causesof various diseases, such as cancer. Itwas a hugediscovery to themwhen

ChineseauthoritiespublishedanAtlasinwhichyoucouldseetheratesofcancerin

Chinaindifferentregions.ThisAtlasimplicatedthattherearehigherratesofcancer

incertainregions inChina,whichwouldmeanthattheremaybeadditionalcauses

forthisdiseaseapartfromgenetic.Thissuggestedthatitcouldbetheenvironment

or nutritional habits that may cause this disease (Campbell & Campbell, 2006).

Campbell andCampbell conducted research in rural China,where they found that

Chinesepeople’sdietdiffersgreatlyfromtheWesterndiet.Theresearchhasshown

thatAmericansareseventeentimesmorelikelytodiefromcoronaryheartdisease

thanaruralChineseman;andthatthedeathratefrombreastcancerinAmericais

fivetimeshigherthanthatofChina(Campbell&Campbell,2006).Theseresearchers

learntthatpeopleinruralChinaconsumesignificantlymorefibrethanAmericansdo

24

andtheirdietismainlyplantbased.WhyistheChinesedietmorehealthythanthat

ofWesterners?DotheChinesefocusonsomeaspectsofthefoodthatWesterners

donotpayanyattentionto?Intheirarticle“LayTheoriesofMedicineandaHealthy

Lifestyle” (2010), Wang, Keh, and Bolton suggest that “lay theories of medicine”

guidepeople’sbehavioursandpreferences in thedomainofhealth (Wang,Keh,&

Bolton, 2010, p. 80). Such complementary medicines as TCM or AM (Ayurvedic

medicine) often require not only consumption of a medication but also specific

health-promoting habits like diet and exercise. For example, when takingmedical

herbs,oneshouldavoidconsuminggreasy,raw,orcoldfoods(Wang,Keh&Bolton,

2010, p. 83). Health-protective behaviour is even listed as “one of the necessary

conditionstopromotehealing”inthefamousYellowEmperormanual(Wang,Keh&

Bolton,2010,p.83).Wang,KehandBolton’sresearchhasshownthatunlikeTCM,

WM treatment causes a boomerang effect – the remedies have “unintended

consequences that undermine risk avoiding among consumers” (Wang, Keh &

Bolton, 2010, p. 81). Inotherwords, consumersofWMmedicationdonotpay as

muchattentiontohealth-promotinghabitsastheconsumersofTCMmedicationdo:

WM (vs. TCM) undermines perceived importance of, and motivation to

engagein,healthprotectivebehaviors,therebyreducinghealthylifestylebehaviors.

An intervention enhanced perceived importance and motivation to engage in

complementary behaviors, thereby mitigating the boomerang effect of WM (vs.

TCM)(Wang,Keh&Bolton,2010,p.91).

While “WM is closely linked to the scientific method and emphasizes

empiricallymeasurablebiochemicalprocessesthatdrivedisease,itstreatment,and

health”,TCM“isprimarilyconcernedwiththematerialaspectofthebodyandviews

all medical phenomena as cause-effect sequences, relying on rigorous scientific

studies and research that seek empirical proof to all phenomena” (Wang, Keh &

Bolton,2010,p.82).Inordertoremedydisease,WMreliesondrugs,radiationand

surgery.Meanwhile,TCMfavoursaholisticapproach,themindandthebodyisseen

as a whole system, and for treatment it relies on inductive tools and methods

(Wang, Keh & Bolton, 2010). In both Ayurvedic Medicine (AM) and TCM (both

25

complementary medicines) there is a great importance placed on balance and

harmony.Inthecaseofillness,TCMseesitastheimbalanceofthewholebody,asa

‘disharmony’ in thebody: “UnlikeModernmedicine,Chinesemedicine focusedon

the person, not just the illness. In Chinese medical thinking, illness was only one

manifestationofanimbalancethatexistsintheentireperson”(Wong,2005,p.13).

Onemore difference betweenMW and TCM is that “Unlike biomedicine, Eastern

therapies such as acupuncture value experience and even intuition over

reproducible and definitive facts” (Andrew & Kaptchuk, 2005, p. 41). The

practitionersareencouragedto“tobuildupontheseexperiencesandcreateastyle

that works best for them” (Andrew & Kaptchuk, 2005, p. 41). For that reason

practitioners have developed a variety of styles – in theUS alone there are eight

differentstylesofacupuncture.

TCMandWMhavecoexistedinChinaforover200years,andHongKongis

probably the most interesting place to study people’s views on TCM. This region

belongedtoChinaforhundredsofyears,andthenforthe lastcenturywasgreatly

influencedbytheEnglishoccupation.TodayHongKongislikeacombinationofAsia

andEuropeinmanysenses.DoctorLam(2001)interviewedtwenty-ninelocalpeople

inHongKongandfoundoutthattheyconsideredbothtypesofmedicinestohave

strengthsandweaknesses.Theyalsousedbothofthemconcurrentlydependingon

what disease they were suffering from. They felt TCMwas good for curing some

milder illnesses like coughs and colds and was better in curing the root of the

problem. It is also often used as a supplement toWesternmedication –Western

medicineissupposedtohaveaquickeffectandtraditionalmedicineisexpectedto

“cutthetailofthe illness”(Lam,2001,pp.762-763).Anotherquestionnairesurvey

thatwasconductedwith100healthypeopleand82breastcancerpatientsinHong

Kong showed thatbothgroupsconsideredTCM“moreholistic,humane, saferand

less invasive than Modern medicine” (Wong, 2005, abstract). Western medicine,

therefore, is seenas aquickway to recoverbecause it ismorepowerful than the

medicine of TCM.However, sometimes it is too powerful and it causes significant

side effects (Lam, 2001). In comparison, Lam suggests that Chinese medicine is

considered tobemilder thanWesternmedicine anddoesnothave as strong side

effects.TCM’sweakness isseenasbeing lessconvenientthanWesternmedicine–

26

while using it youmay have to boil the herbs and see the doctormultiple times,

meanwhiletheWesterndoctormight justprescribeyousomepills,whichareeasy

totake.Inaddition,theherbalteaisusuallyverybitter,slowtoactandthepatient

mayberequiredtoavoidsometypeoffoodaswell–notsoconvenient(Lam,2001).

Normile (2003) notes that the authorities in Hong Kong are making an effort to

restore both global and local faith in the traditional herbal approach. By the year

2003, it had started regulating every aspect of the herbal business. A licencewas

finallyrequiredtobeabletopractiseChinesemedicineandselltheherbs;thetoxic

herbswere no longer availablewithout prescription and the quality of herbs and

formulae began to be regulated (Normile, 2003, p. 190). The institute of Chinese

medicinehopedthatthiskindofscreening,trialsandregulationswouldbringsome

modern scientific rigour to traditional herbal medicine, and that the new, herb-

based formulations would meet “the same standards of safety and efficacy as

conventionalpharmaceuticals”(Normile,2003,p.190).

Chapter 5 - Conclusion

Chinesemedicinehassurvivedwith itsupsanddowns forover2000years.

The gathering and testing of herbs developed into complex herbal formulae that

could treat illnesses; the needles of acupuncture turned into thinner and more

comfortable touse tools,but thewholeessenceand theoryofTCMhas remained

verymuchthesameasitwashundredsofyearsago.WhileWesternsciencebased

medicine,orbiomedicine,hasbeengoingoneway,TCMhasbeengoingtheother.

Whileoneisbasedonscience,isquantitativeandfocusesondisease,separatebody

parts,organs,cellsandmolecules,theotherisratheraholisticapproachofhealing,

is qualitative, traditional, philosophical, and focuses on the whole person, the

harmony in his/her body, which may include physical, psychological and spiritual

wellness. And while orthodoxWesternmedicine is able to cure acute illness in a

short time, TCM ismore valued for healing chronic illnesses that require amuch

longertimetoheal.Conventionalmedicineisfastandstrong,butitalsoquiteoften

causessideeffectsandunderminestheimportanceofhealthprotectivebehaviours.

27

Incontrast,TCMmaytakeamuchlongertimeincuringtheillness,itsmedicationis

notasstrong,but thewholeprocessofhealingmay improvepatients’ life,since it

promotesahealthylifestyle–exerciseandahealthydiet.However,becauseTCMis

valuedforcuringchronicillnesses,itissuspectedtohaveaplaceboeffect,orthatits

patientshealbythemselveswithtime.WMandTCMhaveverydifferentapproaches

tothehumanbody,theoriesofhealthandeventheuniverseitself.Forthatreason,

it isnoteasy forpractitionersofbothWMandTCMtoagreewitheachother.We

growupintheenvironmentthatsurroundsus,withthepeoplearoundusthatare

familiartous;welearnthewaysoflifefromthemandthatwayseemstobetheonly

rational way possible. When we discover other cultures we may feel surprised

becausewe see people doing things thatwewould not expect anyone to do and

their behaviour does not correlate with our standards. So when an American or

European person hears that he has a “qi deficiency”, that may not tell him/her

anything, even if it is explained what it means. So in order to understand the

theories of TCM we have to learn about Chinese history, the ideas of ancient

philosophersandeventheChineselanguage.

Although the efficacy of TCM has been questioned and no conclusion has

beenmade, somepracticesofTCMspreadacross theworld.Acupuncturebecame

quiteapopularhealingtechniqueinbothEuropeandNorthAmerica,wherepeople

wereseekingnewwaysofhealingthataremorenaturalanddonotharmthebody

asmuchas thetechniquesandmedicationofbiomedicinedo.Somepeople find it

helpful, and some consider it a sham. While the efficacy of TCM is still being

questioned in theWest,modernorWesternmedicinehasbeenaccepted inChina

quiteeasilyduringtheperiodofmodernisation.AcceptingWMinChinawasseenas

a great step forward towards building a more modern and advanced China.

Meanwhile, TCM was respected for centuries, with some short periods of

Government opposition to traditionalism and Confucian ideas. Today China is the

onlycountry intheworldwhereTCMandWMarepractisedalongsideeachother,

complementingeachotherforanykindofillnessateverylevelofhealthcaresystem

(Hesketh&Zhu,1997).Suchtraditionaltreatmentsasherbalremedies,acupressure,

massage, acupuncture, andmoxibustion account for around 40% of all healthcare

deliveredinChina(Hesketh&Zhu,1997).Meanwhile, inWesterncountriesTCMis

28

just one more complementary or alternative medicine among many, very often

beingusedonlyinthosecaseswherebiomedicinefails.

And finally, although TCM is becomingmore andmore popular outside of

China,theunderstandingofitisnotexactlythesameasitisinChina.Itseemslike

the theories and techniques of all kinds of medicines – conventional, alternative,

traditionalandcomplementary–aremixingtogethertoday,justastheculturesare.

ThemixtureofTCMandWMisverycommoninChina,anditseemslikehereinthe

Westitisslowlyblendingtogetheraswell.AsBarneshasputit,complementaryand

conventionalmedicinesarelosingtheirborders(Barnes,2005).Andfinally,perhaps

just asEckmanargued,bothof themhave theirownbenefits andmerits, and the

peacefulcoexistenceofbothmaybenefitusall(Eckman,2014).

29

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