Chinese Traditional Medicine and Western Scientific Medicine

We came upon this little sign in a public park in Guangzhou.
It does not read "Keep off the grass". It reads "Rejoice with the Grass and Enjoy the sun".
The shape of the sign is of a stylised pearl, as will be found on some Chinese carpets.
Even at the most mundane level, the Chinese view of life can differ from our own and
have a holistic sensitivity which we do not generally have.
This is much more evident in China now that people's rights are so vastly greater than was the case a couple of decades ago.
In the 1970's and into the early 1980s, in the Beijing winter, the only fruit and vegetables were bruised apples and cabbages.
It seemed to me then that we could not expect unbruised apples until the people themselves were unbruised.
The quality of fruit available to the general public, albeit in the south and late summer, is now very good, and unbruised.
We had the luxury of private accommodation in Guangzhou.
Margaret asked Xiao Zeng, the Cantonese cook, for turtle soup, knowing it was nutritious.
When the soup was made, the next day, it contained, as a matter of normal judgment by a good Chinese cook,
an array of other items, many of which will also be found in a Chinese herbal medicine supply shop - all delicious.
A good Chinese cook may make a soup year round which may be called chicken soup,
but which will at different times contain different herbs and other ingredients
available in season and beneficial to health as well as especially tasty in that season.
Our own perspectives on diet and nutrition and taste and the seasons are by contrast primitive,
too often based on media and marketing driven fantastications of healthiness,
focused on packaging and often far from fresh.

There are a number of sources of information on Chinese traditional medicine on the world wide web. for example:
http://www.libraries.wayne.edu/shiffman/altmed/china/china.html
http://www.medicinechinese.com/index.shtml
http://www.gio.gov.tw/info/culture/culture1.html
http://www.ultranet.com/~wdlu/zctcm1.htm
http://www.science.uts.edu.au/depts/hs/tcm/

My own perspective is not as someone trained in medicine of one school or another, but as someone trained in anthropology, studying other societies and cultural systems as far as possible without the baggage of judgment derived from our own. This paper is not intended to be definitive, but to point to some issues to bear in mind in comparing different approaches to medicine and health.

Be conscious that there is a lot of modern, new-agey practice out there taking in some aspects of Chinese traditional medicine. Education and training standards vary. Grabbing an aspect of any system and making a trade or craft out of it has problems. In referring to Chinese traditional medicine here I am referring to a whole institutional system of cultural depth and knowledge. Not all practitioners in western countries will be equally qualified.

When I first went to see Chinese traditional doctors at the traditional hospital in Beijing in 1985, I was surprised by the process and left with some sense of dissatisfaction by the pronouncements. The senior doctors and junior doctors sat at a table in a room, the room was open. I took a seat with them, my pulse was read (a long reading, at two points on each wrist, taking some time); the pulse-taking chief then gave an account to his colleagues which I did not follow, they discussed me, and then, with nods of accord from all, and indulgent smiles, the chief said: "You are sick because you have not been looking after your health."

Perhaps many Western doctors would like just to say that to their customers, but many prefer to have an authority status, and the great body of patients have an expectation of Western doctors which demands that the doctor take control, identify and name a disorder, describe a villain of pestilence or disorder with adequately portentous name, and prescribe an assassin to kill the villain-disease-cause, operate to remove it, or to replace defect with technology, or, regardless of secondary, iatrogenic impact, prescribe something to mask the symptoms. It is especially evident in internet discussions among disease sufferers that most often the first concern is to name the disease, even to squabble about precise classification, secure its social and legal acceptance, then to deal with symptoms. This is not a description of science, but of a pattern of social behaviour and expectation. Medicare in Australia will not rebate costs for preventative medicine, only for repairs. Imagine a government subsidised transport system in which costs were met after the vehicle was neglected and broken down.

Our 'scientific' medicine is derived from particular cultural background. From Socrates, the New Testament and Descartes, not to mention Freud, we get a habit of mind-body separation which is entirely a cultural construct (not to mention a basis for clinical buck-passing of difficult patients). Look at your hand or imagine a cell in any part of your body subjected to a stress of any kind: bacterial, viral, trauma, psychological or whatever. I cannot see the individual cell having a think (click here for some interesting thoughts on cell intelligence) about whether it is a mind problem or a body problem - it is a stressor. My preferred model, fundamental to understanding of biology, is (1) of a vast array of stressors impacting on organisms, (2) with basic effects on their immune, reproductive and nervous systems; (3) from this arises, because of timing or individual differences, the whole diverse array of named diseases, the difference between which ought to be less the focus than should be the basic mechanism of disregulation. Our western medicine is however focused on 3, on the taxonomy of diseases, and specialisation in their treatment. More and more we seem to ignore the critical links between 1 and 2, which should form the core of a preventative medicine.

From the evolution of the microscope 200 years ago came the discovery of bacteria and a focus on bacterial and later viral causes of disease. But this framework of thinking pollutes our whole perspective on health, not to mention our prejudices against microorganisms. We think too often that health management is a 'them and us' issue, that there has to be a gun to kill every health problem, that medical antagonism, allopathic medicine, is the key to health. We buy antibacterial everything, we seek to remove bacteria from our environment, which is not only impossible but dangerous for organisms, like us, which are perhaps 10% dry weight microorganisms. A very large number of important body functions, especially digestion and manufacture and absorption of nutrients, is the responsibility. In each of our cells, except red blood cells, we have 10 to 1000 mitochondria who have their own DNA, distinct from our nuclear DNA, and it is the mitochondria which take sugar and oxygen and make energy and which take cholesterol and make steroidal hormones. And perhaps we should regard viruses as the internet of life on the planet, the communter trains of innovation, choose your own metaphor. In all the notional understanding of the human genome, there is a brushing aside of the fact that most of the material is retroviral, of unknown function. The popular perception of virus, as in "I've got a virus" is of an enemy. How far from reality this is.

Modern medical research is for the most part reductionist in nature. Very small issues, at the level of single substances or single molecules or fragments of genetic material, are studied piece by piece. The pressure to work like this is multifold. It's easier, it's more 'certain', it fits hierarchies of knowledge, dogma and power in academic institutions, discouraging unorthodoxy, not least among the young. It suits the drug companies, allowing the patenting of single substances to perform single therapeutic functions. It suits governments, insurance companies, lawyers and doctors' guilds, allowing the regulation of professional behaviour and the control of substances and technological devices. It provides a manageable mechanism for control of government expenditure on health. But the great Nobel Prize winning physiologist, Albert Szent-Gyorgi made the point that

This principle of organisation seems lost sight of in much Western scientific medical research perspective. Research and popular ideas in medicine are also subject to fads, from virus, to the environment, to genes. We will at some point see a diminution of funding for gene research, which in the last decade or so has been in the rarefied company of defence and space as a major beneficiary of research funding (but yet competes for charitable contributions, as in 'Jeans for Genes Day'). In 1991 Richard Lewontin, of Harvard, asked:

When the money for the human genome research dwindles, as it will, where will biologists turn? To some other fad of particularity or back to broad issues? Meanwhile Margaret and I sit in the pathology waiting room, watching "Health TV", with a media-popular doctor, touting without hesitation the notional wonders of nasal corticosteroids, between ads for the product. And the National Heart Foundation carries on its letterhead the logo of a margarine product. It's easy to get annoyed, if you try to find your way between simplistic reductionism and marketing driven fallacies (to use a polite word for intellectual corruption or fraud).

Having grumbled, let's address one basic. There are some things Western medical science and technology does brilliantly. Without Western medical technological genius and particular skills and a system of support for that in hospitals and government subsidy, Margaret would probably not now be alive. The tumour, doubling in 10 or 11 days, would have snuffed out life. It was discovered by a modern diagnostic machine, the MRI scanner. It was reduced in bulk by skillful surgery; the remnants have been attacked by radiotherapy and we were pleased to find more advanced technology available in China.

But we have found the process of treatment rather like a walk in the dark to specialists with particular things to do and varying degrees of perspective in explaining them - and not much help with the overall perspective. No discussion of nutrition. (Maybe it's partly been the case for us because of professional despair at the aggressiveness of grade IV glioma - the notion that given the odds, eating cake makes as much sense as anything.)

It is said, with some accuracy, that no one knows what causes brain tumours. But we are aware from our own research that Otto Warburg won the Nobel Prize in the 1930s for establishing that tumour cells have defective respiration; they abandon mitochondrial respiration and run on glycolysis even in the presence of oxygen. It has seemed to me that if Margaret is to recover at all it should involve support for the restoration and maintenance of sound mitochondrial processes in her cells. But this notion of degenerative processes in the cell seem not currently not to be addressed. Lynn Margulis's work in evolutionary biology (see her very readable The Symbiotic Planet 1999) seems relevant, but that is in another compartment of scientific research.

Chinese traditional medicine has had a far longer history than our own. It has suffered from the atrophy of much of Chinese political and cultural life in the past and its practice was restricted in the last two centuries because of turbulence or political whim. Some codification occurred after the 1949 revolution and access has increased, but note my comment about bruised apples in the preamble above. I think the great days for Chinese medicine may be still ahead - unless the Chinese all were to succumb to the simplicities of western medicine.

At Chinese traditional medicine's core are, on my observation, four basic principles: of the responsibility of the individual for whole of life health and nutrition; the person (to avoid mind-body distinctions) as driven by whole systems energising and balancing of which is the key to health; 'medicine' as a whole synergistic package; and a greater awareness of and resort to epidemiology, understanding both the demographic incidence of illness and also the influence of nutritional and medicinal materials.

I am quite sure that the traditional Chinese medicines Margaret is taking can have effect. There is a lot of anecdotal evidence of their success. But it is going to be very difficult to advance Western understanding of them. While we recognise that many of our drugs are derived in the first instance from natural substances, our cultural bias in favour of 'single substance, single effect' would prevent any analysis of the total synergistic effect of a herbal medicine with ten to twenty complex ingredients. There are Western doctors who are beginning to argue that therapeutic substances may be more beneficial if provided in natural context rather than extracted and made stronger in isolation - but I would not want to expose their names to the conformity demands of their guild and its drug suppliers. Also, to the extent that Margaret's anti-tumour herbal contains creatures which do not get cancer, I have to presume that these millions-of-years-surviving creatures know something that Otto Warburg pointed at; that is, how to protect their mitochondrial respiratory systems from collapse. Some aspects of Chinese medicine get popularised and then laughed at, as in the possibility of shark fin being good against cancer. Sharks don't get cancer. A Western doctor smirked recently in mentioning this. I have no evidence for or against shark fin. He wants only empirical, reductionist evidence in favour of shark fin. But by and large I think that the clue, the anti-cancer factors, may be in the whole animal, and its a lot easier to boil up a few scorpions at home than a whole shark. I suspect thus that there is not just a tumour killing factor in the traditional medicine, but also a cellular respiration protective factor or two, or synergistic body of factors. The whole herbal treatment also contains substances to strengthen basic bodily processes, an aspect largely missing from the medication path of conventional western medicine.

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