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Medicine At The Crossroads:
Acupuncture As A Case In Point
Jia Gottlieb, MD
ABSTRACT
The rapidly growing intellectual and philosophical interest in alternative, holistic medicine among both patients and physicians challenges the underlying assumptions of conventional medicine. This article uses Chinese acupuncture as representation of a well-established system of medicine to elucidate an intellectual framework that effectively bridges the philosophical gap between conventional and holistic approaches to medicine.
KEY WORDS
Integrative Medicine, Alternative Medicine, CAM, Acupuncture, Chinese Medicine, Holistic Medicine, TCM
INTRODUCTION
The current crisis in medicine extends beyond the moral and economic shortcomings of managed care to an even deeper level that challenges the exclusivity of the scientific paradigm. The rise of what is variously termed holistic, alternative, complementary, mind/body, and integrative medicine indicates a growing need to explore new and, at times, ancient forms of medicine. I use Chinese acupuncture as a case in point to discuss an intellectual framework that can guide us into an emerging paradigm as conventional medicine expands to incorporate novel therapeutic systems.
In 1983, during a 12-month intensive study of acupuncture in Beijing, China, I was exposed to Traditional Chinese Medicine (TCM), an ancient and self-consistent system. TCM has had the longest continuous history and has affected more lives than any other system of medicine in the world. Although TCM is based on systematic observations, it was developed within a Chinese cultural context quite distinct from the Western scientific tradition.
Every idea springs forth from and rests upon the assumptions of a particular cultural context. Yet it is human nature to adapt to circumstances. Much like a fish that is unaware of the water in which it swims, it is difficult for us to appreciate the underlying assumptions of our own Western medicine paradigm. Although Western and Chinese medicine developed from different philosophical methodologies, they share a common appreciation of the two basic physiological principles of all medicines: homeodynamics and flow.
THE CULTURAL CONTEXT
The Chinese approach to the theory and practice of medicine never used anatomical dissections or experimental inquiry. Chairman Mao Zedong accurately referred to Chinese medicine as "a vast treasure house of medical wisdom." As in any warehouse, one must be willing to rummage through a number of worthless relics to discover the truly exquisite works of art.
About 2500 years ago, ancient Chinese sages began recording their keen observations of the patterns they saw in the natural world. They studied how water flows through streams, the changes of season, the alternation of day and night, and from these observations, formulated powerful cosmological principles. These general principles were then applied to specific fields ranging from government and social organization to military warfare, aesthetics, and medicine. The ancient sages considered the microcosm to be nothing other than the macrocosm manifest in miniature.
Consequently, within TCM, one can move interdimensionally from the small to the large and back again with ease. For example, it is not surprising that a person with a type A, aggressive personality, a macrocharacteristic, would be predisposed to having an overly aggressive immune system, a micro-characteristic, leading to inflammatory diseases like atherosclerosis and autoimmune disorders. Conversely, a type C, cancer-prone individual who feels helpless and hopeless at a behavioral dimension, would be expected to have an under-functioning immune system at a cellular level. Thinking in terms of interdimensional patterned relationships is a powerful insight that becomes second nature within the holistic paradigm of Chinese medicine.
Generally, conventional medicine excels in discerning the micropicture, honed down all the way to a biochemical level, while TCM has its greatest strength in elucidating the macropicture at the level of ordinary reality. These two systems of medicine are simply focused on two different scales of reality. In this way, they can be said to be complementary and together provide a more complete description of the whole.
Another source of confusion for the Western mindset when it first encounters Chinese thinking is the vast differences between the two cultures. One of the great strengths of Chinese culture is its emphasis on practicality, i.e., getting the job done. TCM physicians may discuss their medical theories with great interest, but the theories are only valued insofar as they lead to intended outcomes. It is understood that any theory is at best a rough approximation of reality used as a guide to actual clinical experience. The theory of TCM, being broad-based
and poetic, has tremendous flexibility, which lends itself to the illumination of complex patterns of human dysfunction that are seemingly opaque to the conventional medical paradigm.
In contrast, within the Western scientific tradition, theory plays a much more central role. The scientific method relies on theory to direct the gathering of data through experimental investigations, which then are used to further refine the theory. This is principally a deductive approach. As Thomas Kuhn points out, the theoretical paradigm is so important that data that do not conform to the theory are simply disregarded as anomalous.1
The Chinese mind, conversely, is much more inductively oriented, holding the data to be of central importance. The data points in Chinese medicine are each unique patient encounter, the symptoms, course of action, and the final outcome. Each unique patient encounter is truth, and therefore takes precedence over any theoretical concern.
Here within the Chinese paradigm, we are standing in a radically different relationship to reality, one where subjective truth is actually superior to what we call objective scientific truth. It is a pivotal distinction between TCM and conventional medicine; many patients have turned away from the conventional physician's office to seek the care of medical acupuncturists or other alternative medicine practitioners who are often more willing to see the world through the patient's eyes.
In a clinical setting, patients present their unique subjective experience of truth, e.g., there is no heart disease apart from an individual with heart disease, and each individual experiences heart disease in his or her own way. Unfortunately, the conventional medical paradigm is to disregard patient subjectivity as clinicians try to understand their symptoms in terms of objectively based theory. We try to sift out the pertinent facts from a patient's history so that we may fit them into a diagnostic category. Because Western disease categories are so narrow, we end up disregarding much of what our patients communicate to us through words, facial expressions, and gestures. Not surprisingly, patients often feel unheard and disregarded; worst of all, if the patient's symptoms and concerns do not fit within our theoretical constructs, they are summarily dismissed with "it must be all in your head."
Although there is much more to be said about these contextual issues, the preceding provides a useful groundwork from which we can discuss the two most important principles of TCM, which are identical to the twin foundational physiological principles of Western medicine: homeodynamics and circulation.
Homeodynamics
The homeodynamic principle is eloquently depicted by the well-known ancient Yin/Yang emblem, which is a graphical representation of pendular motion. The Taiji, as this emblem is called, is actually in continual motion, the black and white crescents swelling, contracting, and swirling through time. In the simplest case, the white crescent, which represents the Yang expansive, positive activity swells until the whole circle is white except for the black dot, which represents a seed of the Yin contractive, negative activity. At this point, the process reverses itself and the black dot begins to swell, overtaking the white area until only the white seed remains, just as a pendulum swings back and forth after reaching its furthest extent. Yin and Yang are the two complementary fundamental activities of the universe that are always seeking balance, just as cold and hot seek thermal equilibrium in accord with the Second Law of Thermodynamics.
If plotted through time, the pendular motion takes the form of a wave, and hence, all wave phenomena - cycles, rhythms, and vibrations - are expressions of the balance principle, Yin and Yang. The concept of Yin and Yang, when applied to mathematics, becomes the symbols minus and plus. Moreover, the equal sign that appears in every mathematical equation represents a statement about equivalence that is inherent in the concept of balance. If quantum mechanics and the Schrödinger wave equation are taken seriously, then Yin/Yang theory represents an ancient intuitive insight into the fundamental nature of reality.
Allopathic medicine focuses on the physiological balance of electrolytes, pH, blood gases, fluid balance, and myriad other parameters. Consequently, it is not difficult to extrapolate the notion of homeodynamics up the interdimensional scale to consider the balance of one's life. Thus, it makes perfect sense that the imbalanced, high-stress lifestyle of the fast-paced US culture commonly results in real diseases. There are a growing number of studies that demonstrate the serious adverse health consequences of stress.
The Yin/Yang theory is a profound cosmological principle that has far-reaching implications for the practice of medicine. In medicine, it is nothing more and nothing less than applying the physiological concept of homeodynamics to the full range of the human experience – from the biochemical to the spiritual.
Circulation
The expansion and contraction of Yang and Yin, as in breathing in and breathing out, is the motive force that causes the breath and blood to circulate throughout the body. Circulation or flow is the second fundamental physiological principle of medicine. We understand the importance of the free flow of oxygen and blood in the maintenance of healthy physiological function, which is why the pulse, respiration, and blood pressure are called "vital signs." We also recognize the importance of the free flow of other fluids in the body such as urine in the bladder, or mucus in the sinuses. When flow is obstructed, stagnation occurs and results in tissue damage or infection. In TCM, the importance of circulation was acknowledged long ago. A Confucian author wrote in the 3rd century BC, "Flowing water and the pivot of a door do not rot because of their constant movement."2
Unique to the Asian experience and most extensively developed in China is the concept of Qi. In its simplest and most accurate terms, Qi may be defined in a direct experiential way as the flow of sensations and thoughts through the body and mind. One may empirically verify that at any given moment, the experience of one's own life is composed of only two components - the flow of sensations unfolding within the body and the flow of thoughts unfolding within the mind. All of human experience is woven from these two essential components: the flow of sensations and the flow of thoughts.
In The Yellow Emperor's Classic of Internal Medicine, the oldest medico-theoretical text written in the 2nd century BC, the importance of Qi flow is indicated:
The Emperor asked: "I should like to hear which Qi causes man's depots [i.e., organs] to suffer from sudden pain." Ch'i Po replied: "The flow in the conduit vessels never stops; [it moves] in an annular circuit without a break. When influences of cold enter the conduits, [this flow] is retarded. [The contents of the conduits] congeal and do not move. If [the influences of cold] settle outside of the vessels, there will be only a little blood [moving; if they] settle within the vessels, the Qi cannot proceed. As a result there is sudden pain."2
Any problem experienced in life must exist within these two flows of thoughts and sensations and therefore, any treatment must ultimately be directed toward these two aspects. When coronary blood flow is impaired, angina and heart attacks result. When breathing is impaired, asthma or pulmonary disease develop. When the flow of Qi is impaired, all variety of musculoskeletal pains, spasms, irritable bowel symptoms, headaches, and neurological symptoms of numbness, weakness, and neuralgia can result. When the flow of Qi is impaired in the realm of thinking, there arises the full array of mental dysfunctions from depression and anxiety, to bipolar and obsessive-compulsive disorders. That is, if it doesn't flow, it hurts physically and emotionally.
Ultimately, the twin principles of homeodynamics and circulation represent fundamental activities of a vast web-like pattern that characterize the human body and its relationship to the cosmos. Just as all of physics is revealed in the burning of a candle, so are the vast interconnections of the universe revealed in the functioning of the human body. Because of TCM's cosmological perspective, the theory moves effortlessly between the biomechanical, energetic, emotional, and spiritual realms, weaving a holistic conception that is particularly well suited to identifying the broad patterns of health and disease.
Clinical Applications
TCM acupuncture in China is a comprehensive medical system with an internally consistent theory, diagnosis, and treatment for a wide range of human afflictions from the common cold to mania. It co-exists alongside conventional Western medicine as a parallel medical universe. In a 1979 report from the World Health Organization, 41 common illnesses are listed for which acupuncture is effective treatment.3
The textbook used as the national teaching text throughout China, Essentials of Chinese Acupuncture, has entries for the acupuncture treatment of 52 medical conditions.4 From an acupuncture perspective, there are 3 classes of conditions: those for which acupuncture will likely be effective, those for which acupuncture is likely to be ineffective, and a rather sizable category for which there is no accumulated experience. I have found acupuncture to be particularly efficacious in conditions that have clear elements of reversibility, such as many types of myofascial pain, and a wide range of conditions for which stress is a significant factor as in irritable bowel syndrome, insomnia, and autoimmune diseases. Headaches, for example, are episodic, implying reversibility; even the most severe types respond exceptionally well to acupuncture. Many individuals with anxiety and depression often benefit from acupuncture.
These conditions by their transient nature demonstrate that they are primarily disorders of Qi flow for which acupuncture is ideally suited, i.e., these conditions are a result of disordered processes rather than structural deficits. Once balance and flow are restored, the processes once again function normally.
Conditions for which acupuncture is inappropriate usually have symptoms that are fixed and continuous in time and are associated with structural abnormalities such as frankly herniated disks or tumors.
There are surely many gray areas, such as in stroke and arthritis, where there are fixed structural abnormalities in association with transient phenomena like swelling and muscle spasm. In these cases, acupuncture can improve the reversible component, which may offer considerable benefit.
Acupuncture works so well that for many patients, the relief of pain is readily achieved. What is more difficult is to keep the painful condition from recurring. Clearly, if the factors that led up to the pain are not addressed, they will continue to operate and the pain will recur. Consequently, acupuncture works best as one component of a much broader therapeutic approach that is complementary to conventional medicine.
CONCLUSION
I offer this metaphor: Western medicine is like the sun: its bright light illuminates objects with sharp-edged clarity, but casts a dark impenetrable shadow... Chinese Medicine is like the moonlight covering the landscape with soft light, yet provides distinct impressions and feelings, which allow one to traverse the shadows with deft skill.
REFERENCES
- Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago, IL: University of Chicago Press; 1970.
- Unschuld PU. Medicine in China: A History of Ideas. Berkeley: University of California Press; 1985.
- The World Health Organization Viewpoint on Acupuncture. URL: http://www.china-rmb.com/china-english/tcm/tcm-who.htm. Accessibility verified June 23, 2005.
- Beijing College of Traditional Chinese Medicine. Essentials of Chinese Acupuncture. Beijing, People's Republic of China: Foreign Language Press; 1980.
AUTHOR'S INFORMATION
Dr Jia Gottlieb is Board-certified in Family Practice and received postgraduate training at the Academy of Traditional Chinese Medicine in Beijing, China. In his practice, Dr Gottlieb integrates modern scientific concepts with ancient Eastern wisdom and traditions.
Jia Gottlieb, MD*
Still Mountain Clinic
331 Maxwell Ave
Boulder, CO 80304
Phone: 303-444-2425 • Fax: 303-444-7995 • E-mail: contact@jiamd.com • Website: www.jiamd.com
*Correspondence and reprint requests
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