Guest guest Posted September 16, 2003 Report Share Posted September 16, 2003 Dear Colleagues, Paul Unschuld is an important scholar of CM. He is a voice to be listened to, but at the same time as providing valuable information and stimulating hypotheses, I think we should be careful to remain critical. Unschuld's essay 'Nature versus Chemistry and Technology' is simplistic and in many ways reductionist, betraying biomedical prejudice. Considered alongside his interview in the European Journal of Oriental Medicine Vol1 No.4, where he makes many of the same points, and some additional ones, I would challenge some of his assertions as stimulating yet potentially misleading: 1) 'Neither in Europe not in China has man been able to interpret disease of his personal organism in a way different from that which he interprets crises in the social organism.' That's a very interesting observation, and I'm sure that it has a lot of merit. Unschuld develops this point in considering the early introduction of acupuncture in the west, which was short lived because, he believes, the social crises of that time didn't favour the somewhat 'ecological' worldviews. etc. of CM, which resonate with us much more in the (post-Rachel Carson) world of environmental destruction. What is potentially misleading about this insight is that clinical results are also very significant. If I treat a person with low back pain, and that person knows that acupuncture has helped because it's self-evident that it did, that is going to lead to that patient informing friends, etc. who will take note. Similarly, much of the discontent with WM is not simply due to to a fear of chemistry and technology, but the direct recognition that it is failing to get results. A number of my patients are, and have been, medical doctors, and I also know a number of medical doctors who have given up conventional medicine in favour of CM, not simply due to a generalised distrust in chemistry and technology, but because of disenchantment with the results they have had with conventional medicine, and discovering that CM works in a way biomedicine does not. 2) Unschuld asserts that the Western interest in CM is primarily in acupuncture because CM pharmacology is in many ways similar to WM pharmacology, and thus not a contrast to it, as is acupuncture, so that it will not fulfil the social need as an ideological alternative to conventional medicine. This 'observation' follows from and is integrated with other points he makes about the reasons why acupuncture is popular in the West, that have little do do with the actual merits of CM. Unschuld may have written this before the increase in popularity in Chinese herbal medicine in the West, but even so, it shows how wrong he is. In the UK, around 1990, CHM became very well known as a treatment for eczema. It has led to Chinese herb shops opening all around the UK. The issue to note is the both the immediate popular interest in CHM once the public and a few open minded doctors became aware of the efficacy of CHM, but also the response from vested interests to surpress this development, through scare stories of 'back street herbalists' in the press, articles about aconite poisoning in Hong Kong (that were irrelevant in the UK because aconite was already illegal to use), scares about herb toxicity that were greatly exaggerated, particularly when the degree of iatrogenesis from conventional pharmaceuticals are taken into account, etc. 3) Unschuld has rather casually dismissed the possibilities for rigorous clinical research into CM therapies, or its being taught in medical schools. Although important issues about the nature of suitable research into CM exist, essentially the reason why more research doesn't get done is not that CM isn't amenable to meaningful and useful research, but because of prejudice in favour of biomedicine and against its alternatives. In other words, it has to do not so much with epistemology as with power-political considerations, which in general Unschuld glosses over. Unschuld incorrectly acts as if though the nature of CM is such that if you're interested in it, by all means study it or practice it, but let's continue to give official state and other establishment support to 'scientific' biomedicine, because in our culture, only science possesses 'truth value' (which, by the way, many philosophers would dispute). My feeling is that Unschuld's arguments will appeal to people who are attracted to Chinese medicine, but don't want it given too much establishment-supported recognition, or else hope to gain something by biomedicalising it - for example, by 'building bridges' between oriental theory and biomedical theory. I'm not suggesting that Unschuld himself would fall into this last category. I get the impression that he is quite content to be a pluralist, and to let CM get on with doing its own thing, and maybe in the end this is a very enlightened attitude. Best wishes, Wainwright - " " <attiliodalberto <Chinese Medicine > Monday, September 15, 2003 9:48 PM Re: Miscellanous Replies Hi Bob. Atti: I picked up the thread from your previous well constructed message. Firstly, I would like to know are you completely speaking for him? Or are you relaying these messages to him and gaining a response. I merely ask because what you say in your messages seem to be spoken on his behalf in his tongue. I in-fact and simply quoting his words from his speech. Bob: No pre-modern lay Chinese, any more than a modern Westerner, had a working knowledge of how effective the treatments they received may have been at scale. Atti: I'm not talking about the past which is of course Unschuld's chosen speciality. I'm talking about the present, the now. As Emmanuel rightly points out, we now fall in the realm of clinical efficacy, RCT's, methodology, cookbook approach and so forth. Acupuncture (and herbs) in certain episodes have been proven to be effective (Vincent 2001, p485, MacPherson et al 2001, p487, Ceccherelli et al 2002, p149, Carlsson et al 2001, p296, Margolin et al 2002, p55, Wen et al 1973a, 1973b, 1973c). We may of course then go onto the fact that these were small studies, the methodology was poor, the practitioner was a weekend warrior, the basis of tcm's syndrome differentiation does not fit the empirical model of testing and so on. Nevertheless, in these rare instances acupuncture has been shown to be effective and therefore is more effective in these areas tested than compared to WM. Also as the clinical safety of acupuncture is not rebutted but the side effects of pain killers for example are well known then it is clear that CM can be, but not always, more effective than WM. Therefore the statement that Unschuld makes " Chinese medicine is not preferred by a segment of the population because it is more effective than Western medicine (that is definitely not the case) " , is simply wrong, no if or no buts. This is the point I'm focusing on. Bob: I think the most dangerous are the ideas that Chinese medicine exists as a congruent intellectual monolith, or that there is a " true " Chinese medicine that is THE sine qua non . This includes the idea that systematic correspondences describe universal " truths, " rather than heuristic methods of problem solving, as well as the idea that there is someone, or some tradition that has access to an ultimate CM (and thus that others are technically or morally inferior). Ironically, these notions assume that the Chinese logic is identical to our own and thus disguise Chinese thinking. To the contrary, Chinese thinking (about medicine or anything else) never developed methods for removing from the corpus of knowledge that which had been in some manner labeled as false. Atti: This is a very valid point, but again I'm making reference to present research and present comments made against it. Bob: You are irritated by Dr. Unschuld because he has claimed that CM is not more effective than CM. Correct? Well, make you case? Don't tell us what you believe, tell us where on the planet you find evidence that any population has found CM more effective, or has chosen it over WM given equal access? If not in East Asian, where? And, East Asia, perhaps even particularly China, has had no difficulty embracing WM, in part, as Unschuld points-out, because the two forms share essential principles. Atti: Come on, I'm not that niave, stupid and narrow minded to demand that anyone who has tried, heard or been blessed by CM should stand up on a stage and proclaim that CM is man's salvation! As you well know, and as I've stated above, regrettably, with the limited number of RCTs, something in the empirical model needs to change or we won't be seeing much more research into CM at all. I've posted a wonderful article on efficacy driven research which highlights these points I've just made (should be straight after this email). As far as China embrassing WM, I think that if they had the WM infrastructure with WM docs straight after the revolution, then CM would have been banned altogether in a blinded effort to make everything `western'. Bob: Consider, for example, surgery and public health -- two medical arts that CM never fully developed despite very early intimations. While you may complain of overuse, too quick use, or other over- valuation for surgery, or you can complain that you do not hold to the germ theory on which public health measures from city sewers to water purification are based, you cannot dismiss that life expectancy, and the incidence of crippling and debilitating illness, have been greatly ameliorated by the biosciences. The fact that surgery and chemotherapy do not cure cancer handily does not eliminate the fact that people do not die in vast numbers from cholera and typhoid in any population where WM services can be afforded. Atti: The biggest medical revolution that occurred in WM was the idea of hygiene. From this, the big epidemics were understood and managed but not cured. You then jump a few hundred years later when WM really started to find its feet and all of this has moved along and been driven by technology. WM moved away from its origins and developed its own philosophy on illness and disease it has created a personalisation of the physician. Chinese medicine however, is a collective weight of its tradition as a whole. Individual Chinese doctors skills lie in their ability in translating and interpreting traditional texts. This is better accomplished with a collective amount of practical experience. This is why so much importance is given to practical application rather than theory. Bob: There is no more possibility that everything in CM is useful than there is possibility that nothing in CM is useful. Once that is admitted, the idea that CM is valid because it is rooted in a set of universal, always-true principles, must be abandoned along with the other easy justifications for its efficacy. For example, the more we know about the intellectual history of CM, the less we are able to say that CM has proven its efficacy by longevity. It has proven the ability to adapt to changing circumstances and that implies that a sufficient number of its clients percieve a benefit, which in turn implies efficacy. However, the pretense that we do not have a case to prove to our own populations has done us no good. Atti: I couldn't agree more and these are things that I'm not debating with you. I'm debating the things that have been said and not things that you think I'm saying. Although now that you've brought the subject up, I believe that CM is a mis-mash of quite contradictory believes or principles that have been carried through time and history to our present day. Although in a balanced view, the fact that WM offers a one medicine for all, cookbook approach is the very reason why so many thousands of people die each year from its attempts to cure the ill. WM hasn't changed like CM over its short history, apart from when technology allowed it to. There is a highly significant paradox to Western medicine: it is an unresolved dis-equilibrium between the powerful science-based medical establishment and the larger issue of unfulfilled health requirements of the people. Humanity today, lives in a wishful dream ideal of genetic molecular biology, when everywhere around us there is still disease, ignorance and unanswered questions, hundreds of years old, rotting in the corner where no one wants to look. Western medicine needs to change and update its philosophy if it ever wants to restore people's faith in it. This can only be led by an evolutionary step in Western philosophy as Unschuld points out, but is it gonna be patient driven or technology driven? Attilio Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2003 Report Share Posted September 16, 2003 Wainwright and Ken, Thank you so much. " To hell with coherence " , indeed! My running joke with my students for nine straight months of anatomy and physiology is that the " sense " that any of it makes it based on the size of the human mind. Are there Four Primary Tissues, two general forms of homeostasis, etc., etc.? The joke is that scientists debate, research and define things in a language coherent to the minds of other scientists .... hence, the written tradition. Life is working without a cognitive budget. A small detail that we often overlook. I like people who make an accommodation for this small detail. Emmanuel Segmen - Wainwright Churchill Chinese Medicine Tuesday, September 16, 2003 1:00 PM Re: Unschuld and CM in the West Dear Ken, I really look forward to your essay. 'To hell with coherence'. Yep, that sounds like the challenge we need to live up to. Best wishes, Wainwright - " kenrose2008 " <kenrose2008 <Chinese Medicine > Tuesday, September 16, 2003 7:48 PM Re: Unschuld and CM in the West Wainwright, Thanks for this post. I've just spent a week in the wilds of Siskiyou county with Paul Unschuld and a remarkable group of concerned individuals who all hunkered down in the woods to talk about... you guessed it! The hisotry of medicine in China. I am working on a little essay in which I hope to sum up what happened there, but I will share one little quip that emerged as we were trying to come to terms with what was happening as the days passed by: " to hell with coherence. " I will explain that further as soon as I catch up with a small mountain of other chores that seem to have had little to no respect for the fact that I was having a very good time without them. But your comments at the end of your post brought this phrase to mind. Ken I get the impression that he is quite content > to be a pluralist, and to let CM get on with doing its own thing, and maybe > in the end this is a very enlightened attitude. > > Best wishes, > Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2003 Report Share Posted September 16, 2003 Wainwright, Thanks for this post. I've just spent a week in the wilds of Siskiyou county with Paul Unschuld and a remarkable group of concerned individuals who all hunkered down in the woods to talk about... you guessed it! The hisotry of medicine in China. I am working on a little essay in which I hope to sum up what happened there, but I will share one little quip that emerged as we were trying to come to terms with what was happening as the days passed by: " to hell with coherence. " I will explain that further as soon as I catch up with a small mountain of other chores that seem to have had little to no respect for the fact that I was having a very good time without them. But your comments at the end of your post brought this phrase to mind. Ken I get the impression that he is quite content > to be a pluralist, and to let CM get on with doing its own thing, and maybe > in the end this is a very enlightened attitude. > > Best wishes, > Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2003 Report Share Posted September 16, 2003 Dear Ken, I really look forward to your essay. 'To hell with coherence'. Yep, that sounds like the challenge we need to live up to. Best wishes, Wainwright - " kenrose2008 " <kenrose2008 <Chinese Medicine > Tuesday, September 16, 2003 7:48 PM Re: Unschuld and CM in the West Wainwright, Thanks for this post. I've just spent a week in the wilds of Siskiyou county with Paul Unschuld and a remarkable group of concerned individuals who all hunkered down in the woods to talk about... you guessed it! The hisotry of medicine in China. I am working on a little essay in which I hope to sum up what happened there, but I will share one little quip that emerged as we were trying to come to terms with what was happening as the days passed by: " to hell with coherence. " I will explain that further as soon as I catch up with a small mountain of other chores that seem to have had little to no respect for the fact that I was having a very good time without them. But your comments at the end of your post brought this phrase to mind. Ken I get the impression that he is quite content > to be a pluralist, and to let CM get on with doing its own thing, and maybe > in the end this is a very enlightened attitude. > > Best wishes, > Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Wainwright and Ken, Thank you so much. " To hell with coherence " , indeed! My running joke with my students for nine straight months of anatomy and physiology is that the " sense " that any of it makes it based on the size of the human mind. Are there Four Primary Tissues, two general forms of homeostasis, etc., etc.? The joke is that scientists debate, research and define things in a language coherent to the minds of other scientists .... hence, the written tradition. Life is working without a cognitive budget. A small detail that we often overlook. I like people who make an accommodation for this small detail. Emmanuel Segmen - Wainwright Churchill Chinese Medicine Tuesday, September 16, 2003 1:00 PM Re: Unschuld and CM in the West Dear Ken, I really look forward to your essay. 'To hell with coherence'. Yep, that sounds like the challenge we need to live up to. Best wishes, Wainwright - " kenrose2008 " <kenrose2008 <Chinese Medicine > Tuesday, September 16, 2003 7:48 PM Re: Unschuld and CM in the West Wainwright, Thanks for this post. I've just spent a week in the wilds of Siskiyou county with Paul Unschuld and a remarkable group of concerned individuals who all hunkered down in the woods to talk about... you guessed it! The hisotry of medicine in China. I am working on a little essay in which I hope to sum up what happened there, but I will share one little quip that emerged as we were trying to come to terms with what was happening as the days passed by: " to hell with coherence. " I will explain that further as soon as I catch up with a small mountain of other chores that seem to have had little to no respect for the fact that I was having a very good time without them. But your comments at the end of your post brought this phrase to mind. Ken I get the impression that he is quite content > to be a pluralist, and to let CM get on with doing its own thing, and maybe > in the end this is a very enlightened attitude. > > Best wishes, > Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hello Emmanuel I totally agree with you in the " minds of other scientists .... hence, the written tradition. Life is working without a cognitive budget. " , but what we do when in this beautiful statement is added a large ilusion , based on the fact of the non-visibility in this process of not cognitive? Does this inborn matrix living inteligent healing process need to be called an ilusion based on our ability to not recognize it? Just curious, V >> Emmanuel Segmen <susegmen wrote: Wainwright and Ken, Thank you so much. " To hell with coherence " , indeed! My running joke with my students for nine straight months of anatomy and physiology is that the " sense " that any of it makes it based on the size of the human mind. Are there Four Primary Tissues, two general forms of homeostasis, etc., etc.? The joke is that scientists debate, research and define things in a language coherent to the minds of other scientists .... hence, the written tradition. Life is working without a cognitive budget. A small detail that we often overlook. I like people who make an accommodation for this small detail. Emmanuel Segmen - Wainwright Churchill Chinese Medicine Tuesday, September 16, 2003 1:00 PM Re: Unschuld and CM in the West Dear Ken, I really look forward to your essay. 'To hell with coherence'. Yep, that sounds like the challenge we need to live up to. Best wishes, Wainwright - " kenrose2008 " <kenrose2008 <Chinese Medicine > Tuesday, September 16, 2003 7:48 PM Re: Unschuld and CM in the West Wainwright, Thanks for this post. I've just spent a week in the wilds of Siskiyou county with Paul Unschuld and a remarkable group of concerned individuals who all hunkered down in the woods to talk about... you guessed it! The hisotry of medicine in China. I am working on a little essay in which I hope to sum up what happened there, but I will share one little quip that emerged as we were trying to come to terms with what was happening as the days passed by: " to hell with coherence. " I will explain that further as soon as I catch up with a small mountain of other chores that seem to have had little to no respect for the fact that I was having a very good time without them. But your comments at the end of your post brought this phrase to mind. Ken I get the impression that he is quite content > to be a pluralist, and to let CM get on with doing its own thing, and maybe > in the end this is a very enlightened attitude. > > Best wishes, > Wainwright Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hello Emmanuel I totally agree with you in the " minds of other scientists ..... hence, the written tradition. Life is working without a cognitive budget. " , but what we do when in this beautiful statement is added a large ilusion , based on the fact of the non-visibility in this process of not cognitive? Does this inborn matrix living inteligent healing process need to be called an ilusion based on our ability to not recognize it? Just curious, Vanessa >> You of course, were not expecting a coherently non-cognitive response, right? Emmanuel Segmen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hello Emmanuel I totally agree with you in the " minds of other scientists ..... hence, the written tradition. Life is working without a cognitive budget. " , but what we do when in this beautiful statement is added a large ilusion , based on the fact of the non-visibility in this process of not cognitive? Does this inborn matrix living inteligent healing process need to be called an ilusion based on our ability to not recognize it? Just curious, Vanessa >> You of course, were not expecting a coherently non-cognitive response, right? Emmanuel Segmen Sorry Vanessa, I don't mean to be rude. I believe your question is a statement more than a question. A beautiful one. And, yes, I'm curious, too. Like you, I'm inclined to strive for clear vision with regard to artistic and meditative disciplines. Emmanuel Segmen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Hello Emmanueal thanks for the response. My point here is that many of this process in the healing physiology happens in a invisible way, with a self inteligence decision making and a tinge of an autocratic personality if you may. But many for not seeing or appreciating this invisible functions , call it ilusion or not possible, just an imagination. So thanks for your appreciation of this fact. Vanessa >> Emmanuel Segmen <susegmen wrote: Hello Emmanuel I totally agree with you in the " minds of other scientists ..... hence, the written tradition. Life is working without a cognitive budget. " , but what we do when in this beautiful statement is added a large ilusion , based on the fact of the non-visibility in this process of not cognitive? Does this inborn matrix living inteligent healing process need to be called an ilusion based on our ability to not recognize it? Just curious, Vanessa >> You of course, were not expecting a coherently non-cognitive response, right? Emmanuel Segmen Sorry Vanessa, I don't mean to be rude. I believe your question is a statement more than a question. A beautiful one. And, yes, I'm curious, too. Like you, I'm inclined to strive for clear vision with regard to artistic and meditative disciplines. Emmanuel Segmen For practitioners, students and those interested in TCM. Membership requires that you do not post any commerical, religious, spam messages or flame another member. If you want to change the way you receive email message, i.e. individually, daily digest or none, then visit the groups’ homepage: Chinese Medicine/ Click ‘edit my membership' on the right hand side and adjust accordingly. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 17, 2003 Report Share Posted September 17, 2003 Vanessa, So interesting that you point this out. Actually I held forth on this topic on both this list and much more so on another list (CHA). As a physiologist I pointed out the differences between " pharmacological " effects of externally applied medicines and the " physiological " effects of whatever can be externally applied as well as what evolves from internal processes. The latter is always more subtle and should be of the greatest interest to the scientist and practitioner. Yet this " internal dosaging " which is highly complex and essentially immeasurable due to thousands of changes per second (!!!) in billions of locations is wondrous vision that inspires me in my science. The " internal dosaging " that comes with sleep, a good meal, a belly-laugh, a beautiful morning run on the beach, etc. may be as powerful or more essential than any medicine from any tradition. The good practitioner has this also to teach the patient. In gratitude for your " clear vision " , Emmanuel Segmen - " " <vbirang <Chinese Medicine > Wednesday, September 17, 2003 11:37 AM Re: Unschuld and CM in the West Hello Emmanueal thanks for the response. My point here is that many of this process in the healing physiology happens in a invisible way, with a self inteligence decision making and a tinge of an autocratic personality if you may. But many for not seeing or appreciating this invisible functions , call it ilusion or not possible, just an imagination. So thanks for your appreciation of this fact. Vanessa >> Emmanuel Segmen <susegmen wrote: Hello Emmanuel I totally agree with you in the " minds of other scientists ..... hence, the written tradition. Life is working without a cognitive budget. " , but what we do when in this beautiful statement is added a large ilusion , based on the fact of the non-visibility in this process of not cognitive? Does this inborn matrix living inteligent healing process need to be called an ilusion based on our ability to not recognize it? Just curious, Vanessa >> You of course, were not expecting a coherently non-cognitive response, right? Emmanuel Segmen Sorry Vanessa, I don't mean to be rude. I believe your question is a statement more than a question. A beautiful one. And, yes, I'm curious, too. Like you, I'm inclined to strive for clear vision with regard to artistic and meditative disciplines. Emmanuel Segmen For practitioners, students and those interested in TCM. Membership requires that you do not post any commerical, religious, spam messages or flame another member. If you want to change the way you receive email message, i.e. individually, daily digest or none, then visit the groups' homepage: Chinese Medicine/ Click 'edit my membership' on the right hand side and adjust accordingly. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.