|NEWS & VIEWS
|Year : 2020 | Volume
| Issue : 1 | Page : 39-43
What can western medicine relearn from chinese medicine?
Peter Emanuel Petros
School of Mechanical and Chemical Engineering, University of Western Australia, Perth, Australia
|Date of Submission||22-Jan-2020|
|Date of Acceptance||22-Jan-2020|
|Date of Web Publication||27-Mar-2020|
Prof. Peter Emanuel Petros
School of Mechanical and Chemical Engineering, University of Western Australia, Perth
Source of Support: None, Conflict of Interest: None
The article begins with a short review of similarities between traditional Chinese medicine (TCM) and original Hippocratic medicine. Both were holistic, and taking every aspect contributing to illness into account, both followed the dictum, “ first do no harm.” A key difference between the two, even 2400 years ago, was the Hippocratic emphasis on scientific medicine. The explosion of science and technology in the latter half of the 2nd century was applied to Western medicine, which became ever more complex, specialized, and reductionist, losing much of its original holism. The strength of TCM is its holistic approach and techniques such as acupuncture, so necessary for the management for patients who have chronic illnesses such as pain for which Western medicine has few answers.
Keywords: Chinese medicine, Hippocratic medicine, Western medicine
|How to cite this article:|
Petros PE. What can western medicine relearn from chinese medicine?. Chin Med Cult 2020;3:39-43
| Introduction|| |
One important question which keeps arising is, “Why is the health consumer increasingly turning to “alternative medicine?” Complementary and alternative medicine (CAM) has become an established part of health care for many Australians. CAM is estimated to be used by up to two out of three Australians and accounts for $3.5 billion in expenditure every year., It is noteworthy that the annual patient expenditure for CAM exceeds expenditure on Pharmaceutical Benefits Scheme medications by $1.8 billion.
Prominent among such other medical avenues is traditional Chinese medicine (TCM), which is becoming increasingly popular in Western countries. TCM can hardly be classed as an “alternative medicine!” It has a 5000-year-old tradition and is a recognized medical discipline in its own right. TCM, which includes the use of meditation, exercise, nutrition, acupuncture, Chinese herbs, and massage, has been developing for 1000s of years. As we all know, many aspects of TCM, in particular acupuncture, massage, and meditation, are increasingly being applied in Western medicine, very successfully, especially by general practitioners, physiotherapists, and others who have to deal with chronic pain and other conditions for which Western medicine has few answers. Speaking on acupuncture alone, David Mioduski, a Western-trained doctor and keen student of Chinese medicine and acupuncture, stated that Chinese medicine and acupuncture could treat almost everything except life-threatening conditions. He mentioned pain; stopping smoking; drug and alcohol addiction; obesity; cosmetic and beautification issues such as elimination of scar tissue, wrinkles, sagging skin, acne, and skin disorders; anxiety and depression; infertility and women's issues; stress management; fitness and sports enhancement; prevention of injuries; optimizing mental functioning and clarity; immune boosting; and chronic allergies. In his view, TCM can detoxify and strengthen the body. He says that it works by treating the root cause of all diseases and conditions without causing side effects. It balances out the body and unblocks that which is blocked: poor blood flow, poor nerve conduction, and poor energy flow. He describes acupuncture points like electrical switches in the body, which can sometimes short circuit and cause chronic pain or destructive behaviors such as overeating or smoking. He attests that over a decade of experience in treating all sorts of conditions successfully, by utilizing his knowledge of Western medicine and TCM, he is able to fuse the benefits of both.
The author's interest in Chinese medicine began in 2015 at a visit to the Colorectal Department of the Nanjing Municipal Hospital of Chinese Medicine with Dr. Ding Shuqing, a 10th generation TCM specialist and specialist colorectal surgeon in Western medicine. The hospital is an Affiliated Teaching Hospital of Nanjing University of Chinese Medicine. Ding Shuqing is the granddaughter of Ding Zemin (丁泽民), one of the founders of the hospital. In 1956, Ding Zemin generously donated eight generations of family secrets including herb prescriptions and instruments to the hospital. He set up the colorectal department with his wife and his elder brother. Ding Zemin [Figure 1] was the founder of the Chinese medicine Colorectal Disciplinary and Society in China. He had a high reputation in the colorectal field in the Asian Pacific area and has been honored as such by the Chinese government [Figure 2].
|Figure 1: Photograph in Zemin Ding Colorectal Museum, Nanjing. From left, Yijiang Ding Professor of colorectal surgery Nanjing University of Chinese medicine and 9th generation Ding Chinese medicine specialist, Dr. Shuqing Ding, colorectal surgeon and 10th generation Ding Chinese medicine specialist, Professor Peter Petros|
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|Figure 2: Plaque describing tenth generation family-owned Chinese medicine technology is the National Intangible Cultural Heritage published by the State Council of the People's Republic of China, issued by the ministry of culture of the People's Republic of China in 2014|
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A visit to the Ding Zemin Museum dispelled any ideas that TCM was simply going to a herbal specialist and getting some Chinese herbs! Many of Zemin Ding's colorectal disease treatments are still in use today, all minimally invasive. I recommend interested readers view the fascinating story of these treatments as practiced by the 10th generation Ding family on https://www.youtube.com/watch?v=AP2NRzeIM5c &t=61s.
My visit to Nanjing to give lectures on my integral theory of pelvic floor function and dysfunction was a rich and busy experience for me. I found some time to work with Dr. Ding Shuqing on some original research “Interventional anorectal manometry based on the integral theory system” which ultimately led to a fine paper Dr. Ding Shuqing. We spent a half day at the Nanjing Municipal Hospital of Chinese Medicine. I was impressed by the holistic approach of the medical treatment at the Nanjing Hospital, even for something as specific as colorectal disease. This holistic approach resonated with my own research work into the etiopathology and treatment of bladder/bowel incontinence and chronic pelvic pain. The cause of these conditions goes well outside the organs to muscles, ligaments, and fascia situated in the front, middle, and back parts of the pelvis. These structures form three natural divisions which are always in balance [Figure 3]. These interact holistically to form the peripheral neurological control mechanisms for the bladder and bowel. In turn, all are subject to central cortical control, a seamless interaction of body and mind. Important aspects of such etiopathology are the differing contributions of each of these structures to the nonlinear feedback control mechanisms and how damage to these structures can influence the end results. According to the integral theory,, it is the biomechanical imbalance between these divisions, front, middle, and back, which causes the main bladder and bowel symptoms [Figure 3]. We have found that strengthening these ligaments and muscles, either with specialized squatting-based exercises or ligament surgery, cures or improves the symptoms indicated in [Figure 3]. Unfortunately, even today, many of the symptoms in [Figure 3] are regarded as incurable. The problem is that a Western medicine brain fixed in reductionist mode treats the organ only, bladder or bowel, usually with poor results. A reductionist mindset will never understand the interactive role of ligaments muscles and feedback systems as set out by the integral theory system. Such an understanding will be required so medicine can progress, and cures can be provided for these afflictions which affect up to 50% of older citizens.
|Figure 3: The muscles and ligaments structures for three natural divisions within the pelvis, front, middle and back. If specific ligaments are weak, the system is thrown out of balance and prolapse and symptoms appear as indicated|
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I see the “humours” of Hippocratic medicine and the “essential elements” of TCM as an intuitive holistic understanding of the body's natural nonlinear control mechanisms by our forebears. It remains a fact that when these are out of balance, disease processes occur, much as TCM and Hippocratic medicine state, even if the exact pathways themselves were then not known. One modern example of imbalance causing disease is in my own specialty. When the bladder's neurological feedback control system is disturbed and unbalanced, the patient cannot control her bladder and wets on the way to the toilet [Figure 3].
Chinese and Hippocratic medicine as originally conceived had a common holistic origin and purpose. The essence of individualized treatment of a patient in both was minimal unharmful treatment. This was summarized in the famous Hippocratic statement from the Greek “to abstain from doing harm” or the oft-quoted Latin “ first do no harm.”
Hippocrates was the first physician to introduce science into medicine. He systematically classified diseases and originated the disciplines of etiology and pathology. Not only the subjective symptoms but also the objective signs of the disease must be considered to arrive at an accurate assessment of what was going on. For Hippocrates, the human body functioned as one unified organism, or physis, and must be treated, in health and disease, as one coherent and integrated whole. The concept of balance was important. Hippocratic medical treatment aimed at improving the natural resistance of the organism to overcome the disease. It placed great emphasis on strengthening and building up the body's inherent resistance to disease. For this, he prescribed diet, gymnastics, exercise, massage, hydrotherapy, and sea bathing. Hippocratic medicine was holistic. Fundamental in Hippocratic medicine was the imperative to first treat the patient and then treat the disease.
Hippocratic medicine described disease as an imbalance of four humors. Hippocrates stated, “The body of man has in itself blood, phlegm, yellow bile, and black bile; these make up the nature of the body, and through these he feels pain or enjoys health. Now, he enjoys the most perfect health when these elements are duly proportioned to one another in respect to compounding, power and bulk, and when they are perfectly mingled. Pain is felt when one of these elements is in defect or excess, or is isolated in the body without being compounded with all the others.” But not entirely. Hippocrates' surgical techniques for dislocations of the hip and jaw were unsurpassed until the nineteenth century.
For Chinese people, cherishing Chinese medicine also has a cultural aspect. It is the very manifestation of traditional Chinese culture in areas related to human health. Western medicine advocates a science-based approach; everything has to be tested according to science-based rules. Yet, many diseases cannot be tested with science-based rules, perhaps up to 70% of problems which lead to general practice (GP) visits. Chinese medicine follows the principle of yin and yang, balance and imbalance. Chinese medicine believes in the existence of energy channels and acupuncture points even though they cannot be seen with human eyes.
Furthermore, Chinese tradition holds that any matter in this universe has its physical side and its spiritual side. Both sides work together to form a complete entity. The TCM doctor is inextricably part of the treatment.
Practitioners of Chinese medicine understand the world and the human body in terms of five essential elements:
In my view, we should not take such classifications literally. The classification provides a framework which allows TCM diagnosis and treatments to be categorized in a consistent, understandable holistic way. We still have our classifications today. Not all of these modern classifications make good sense, but they do provide a framework, like TCM and classic Hippocratic medicine. Whatever the criticisms, much fewer these days, TCM treatments such as acupuncture have been scientifically proven to work and increasing number of Western trained GPs are learning them.
| Evolution of Chinese Medicine|| |
Like the 10th generation Ding family, much of the knowledge contained in TCM was handed down secretly from generation to generation, unlike Western medicine which was taught openly in universities. Only after the founding of the People's Republic of China, did TCM become more open. The closed attitude around Chinese medicine no doubt has contributed to the slow adoption of much Western medicine in China. Slow uptake of much “new Western medicine technology” has not been all bad. Sometimes such “new technology” may turn out to have problems, may not be particularly effective, or may have significant side effects or complications. It is invariably expensive. All these factors are consistent with the conservative nature of TCM philosophy. Then, there is the broader Chinese philosophy of what constitutes “time.” In Western countries, “time” is the 3–4 years till the next election. The Chinese think in 100-year segments, perhaps engendering a “wait and see” attitude to new often not well proven technology. In my specialty, pelvic floor surgery, TCM treatment has concentrated on nonsurgical aspects, with surgery reserved for very serious cases. For example, there are only 10,000 operations for urinary stress incontinence (leakage on coughing) and even fewer operations for organ prolapse in the whole China. In contrast, France alone has between 20 and 30,000 operations p.a. for each. In consequence, China has avoided the mesh controversies associated with such operations.
Yet, where new technology is important or life-saving, it is taken up quickly, indicating the wisdom and judgment required for long-term planning.
| Evolution of Western Medicine|| |
The very nature of its scientific traditions has led to an increasingly reductionist practice of Western medicine. This reductionism gathered rapid pace in the latter half of the 20th century following major scientific and technological advances such as computer engineering which were applied in almost every aspect of medicine, from imaging, to robotic surgery, to genetic science. To accommodate all this, Western medicine has been sliced and diced into subspecialty after subspecialty. In the specialties, there are now strict areas of demarcation. The worst example of reductionist medicine is the 5 min GP consultation. No connection with the patient psyche, no holistic medicine is possible in 5 min! Yet, it is well accepted that 70% of GP visits may not have an organic origin. It is no wonder that patients are increasingly seeking alternative avenues for their health.
| Where to Now for Western Medicine?|| |
In 2001, I wrote in Lancet that the quantitative research paradigm (Western medicine) was necessarily reductionist, because it must tightly confine all possible variables.
Yet, medicine is anything but reductionist. The body is governed by complex nonlinear systems that interact. This concept was expressed succinctly some 2000 years ago by Marcus Aurelius, the Roman Emperor and Stoic Philosopher:
“Always think of the Universe as one
living organism, with a single substance,
and a single soul; and observe how all
things are submitted to the single
perceptivity of this one whole; all are
moved by its single impulse, and all play
their part in the causation of every event
that happens. Remark the intricacy of
the skein, and the complexity of the
Whereas we can justify as essential the reductionist concepts inherent in the Cochrane collaboration, reductionism can cause confusion elsewhere, for example, definitions made by expert committees might place clinical investigation into an impossible straightjacket. The creation of long lists of rules can be counterproductive, as they can restrict not only clinical practice but also further research. Popper described such rules and artificial definitions as “linguistics” and believed that they only served to impoverish science.
Even symptoms, the very core of medical diagnosis, are judged unreliable, requiring costly imaging and other investigations. Unreliable they may be, but it is the nonlinearity of biological systems that makes them unreliable, not some inherent fault in the patient's recall. Small alterations in initial conditions may cause major variations in the end result. An adequate grasp of nonlinearity is essential for the understanding of qualitative and quantitative approaches to medicine.
Skillful practitioners of the art of medicine intuitively tune into all the system's elements, and might be able to harness them to treat the patient (holistic medicine). They absorb all afferent stimuli, e.g. history, examination, special tests, the patient's body language, what the patient says (and does not say), knowledge of family, and environment. These stimuli are referenced against the accumulated knowledge of quantitative medicine to intuitively weigh up each factor. The created perspective is continuously modified until a diagnosis and its relevance to the person is reached. Such physicians first treat patients and then treat the disease.
A person skilled in the art of medicine, who intuitively understands complexity, feedback control, and the importance of small alterations in initial disorders, would not treat an individual patient with the quantitative system alone. Medicine is 50% science and is subject to proper statistics and objective criteria. It has to be. However, it is also 50% art and tuning chaotically into the disordered biological systems of a sick individual. We should not forget our art.
| Conclusions|| |
TCM in its purest form has remained a holistic art. Its strength is its holistic approach and techniques such as acupuncture, so necessary for the management for patients who have chronic illnesses such as pain for which Western medicine has few answers. Although brilliantly successful scientifically, Western medicine has become reductionist, linear, and in areas such as imaging, soulless, the patient reduced to a mere object. Yet, the scientific basis of medicine is anything but reductionist. All biological science is nonlinear, irregularly holistic. Intuitive understanding of how all the elements contributing to the nonlinear mechanisms causing medical problems, whether organic or not, used to be known as “The Art of Medicine.” Perhaps it is time for Western medicine rediscover its “Art”, something TCM has never lost.
Financial support and sponsorship
Conflicts of interest
Peter Petros is the codiscoverer of the midurethral sling (“TVT”) and the Integral Theory on which it is based. He admits a major bias toward holistic medicine.
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[Figure 1], [Figure 2], [Figure 3]