On the Integration of Chinese and Western Medicine

by Z'ev Rosenberg, L. Ac.

Integrated medicine has become the latest buzzword in the acupuncture/Chinese medicine community. This concept is also mainstream in mainland China, where the integration or combination of Chinese and Western medicine, (zhong xi yi jie he) is considered to be essential to the continued development of Chinese medicine.

However, there is little agreement among its proponents as to what this means (1). While the Chinese government supports this integration, it is not actually working so well in practice. Journals that support this integrated approach have appeared in recent years, and several articles using this approach have been published in such journals as the American College of Traditional Chinese Medicine Journal (no longer in print). There seems to be, at least in the translated material, an emphasis on biomedical disease descriptions, and reliance on blood tests, X-rays and other biomedical testing procedures.

If Chinese bian zheng/pattern diagnosis is used at all, it is after the fact, sloppy, and perfunctory. The pulse diagnosis is especially oversimplified to be almost useless. This integrated medicine, fortunately seems to take place solely in hospital settings, and not in the increasingly more common private practices of more traditional Chinese medical doctors. Despite the integrative trend, a great deal of mutual suspicion still remains between Western and Chinese-trained physicians. On one issue, there seems to be no argument; biomedicine clearly is predominant in defining health care in China, determining the diagnosis, and influencing treatment in the hospital setting and public health care system.

Here in the West, the situation is one where outright suppression of alternative and Chinese medicine is giving way to a more 'complementary medicine' approach. Slowly, the total disdain for non-traditional techniques is giving way to respect from Western physicians, and especially the general public, who are demanding our services more and more. HMOs and major insurance companies are beginning to cover these treatments, and a Medicare bill to cover acupuncture is being introduced in the U.S. Congress. The FDA has removed the experimental status of acupuncture needles, and 34 states license the practice of acupuncture and Chinese medicine. It would seem that we have 'arrived' on the Western medical scene.

Where do we go from here? The future holds great promise and opportunity, but with potential dangers. This would seem to be an ideal time to examine our present situation, and especially our knowledge base, before we move ahead.

Medicine is a complex undertaking, requiring knowledge that spans philosophy, history, economics and sociology. Clearly, the introduction of Chinese medicine, a 'foreign' system, into our society has parallels in world history, such as the transmission of Greek medicine to the Arab world during the Islamic Golden Age. Conversely, Chinese medicine has never been so challenged by another medical system in its long history until the 20th century. Change is happening so quickly in medicine world-wide, that we can clearly predict the emergence of global medicine that draws on a multitude of cultures, as they cross-pollinate. How this will present itself will have to be observed over the next several decades.

In order for us to participate in the development of a global medicine, we who practice Chinese medicine, along with anyone who wishes to understand it, integrate or critique it, must study it in its original form. This is essential for any true integration to occur. In our profession, the knowledge base of reliable textbooks and materials has only begun in the last decade or so. Only now is a Chinese/English clinical dictionary (by Nigel Wiseman, published by Paradigm Press) being published! Without a clinical dictionary, we have not had acceptable translation standards to work with, which means a lack of clear terminology. Reliable translation, courses of study in medical Chinese, and coherent historical references are at their very beginning in the West. Courses of study at our major colleges of Chinese medicine are undergoing constant revision and growth. It will take perhaps another ten to twenty years for this process to mature. Our colleagues in Western medicine, chiropractic, naturopathic and related fields have even more homework to do in gaining a necessary working understanding the vast data-base of Chinese medicine. At the level of information, it would be facile to suggest that any true theoretical integration could possibly occur at this time. It would be like asking a physicist to critique a course in psychology without previous training.

Before looking for common points of reference between Chinese and biomedicine, we must also understand the differences. Clearly, the paradigms are vastly different. The general feeling in the biomedical community, and much of the lay public, is that medicine as a phenomenon is adequately explained by biomedical terminology, research and practice, and that any other methodologies, systems or techniques need to be explained according to these standards. Not only is this approach narrow-minded and exclusive, but it does not permit any development of understanding. Rather, it reduces Chinese medicine to a technique practiced by a technician with minimal training. Chinese medicine developed historically without the benefits of modern technology, or a sophisticated anatomy and physiology. It did, however, develop a very sophisticated and detailed medicine (see Wiseman's Clinical Dictionary for details) based on sense, observation, and resonance between human life and universal laws and principles. Chinese medicine clearly has much to offer Western culture, if we approach the subject with due respect and professional standards of translation and review.

In 1934, a Chinese physician, Zhang Xi-chun, published Yi xue zhong zhong can xi lu/Records of Heart-felt Experiences in Medicine with Reference to the West. This text, still available only in Chinese, provides a guide for us in dealing with the overwhelming informational data-base of biomedicine. Written at a time when biomedicine was beginning to greatly influence mainland China, this text encouraged an approach based on a strong grounding in the classical Chinese medical texts, such as the Nei Jing Su Wen, Nan Jing, and Shang Han Lun. However, Dr. Zhang also recommended using the empirical data of biomedicine as a resource when necessary. For me, this is a pragmatic approach that allows a practitioner of Chinese medicine to avoid compromising the theories and principles of the classics, but also to access information gathered by biomedicine in the libraries, on-line computer databases and other sources. It is necessary to have this information to communicate with Western physicians and our patients, and to understand biomedical treatments and medications in context. However, without a firm grounding in the teachings of Chinese medicine, we will be lost in a sea of data.

Communication and interaction with the biomedical community must be at an equal footing and stature, otherwise we will be reduced to just being therapists in the gargantuan biomedical system. There must be mutual respect, debate and informed critique as well. Western physicians recognize that there is a great deal of iatrogenesis in modern medical practice from excessive use of drug therapies and surgery, just as Chinese medical practitioners realize that we lack depth and experience at such an early stage of practice in our field. Both systems have strengths and shortcomings. Biomedicine has greatly advanced technologies for trauma and life-threatening conditions, but Chinese medicine has a gold-mine of strategies and treatments for chronic disorders, which are 80% of reported modern health problems, including allergies, chronic fatigue, auto-immune disorders, asthma and depression.

At the same time, we also cannot ignore the smear campaign carried out against all alternative forms of healing by certain political/economic factions in the media. We must answer them firmly and with a clear base of knowledge and experience. As Harris Coulter, the famous medical historian points out:

"One may ask why the parties in question cannot just recognize their profound differences of approach, and agree to go their separate ways. Why is this incessant desire to fuse the two systems, to take the best from each and synthesize them, etc., etc., ad nauseam? The answer is, of course, as in most things medical, that these are political and economic issues, questions of sovereignty. Allopathic physicians will never willingly relinquish their sovereignty over medical practice in all of its aspects. Hence, they call for fusion and convergence, for bringing (homeopathy) into the mainstream. But when one percent of the profession fuses with the remainder, we know who will be doing the fusing and who will be fused. The result will be the restructuring of (homeopathy) and its restructuring along allopathic lines."

From our perspective, is it really wise to want to be a totally integrated part of the existing medical system? How will we be able to maintain the unique qualities that so many people seek, such as individual care, increased time with patients, hospitable environments, and the human aspects of a wholistic system of medicine?

Perhaps we should re-examine the present structure of Western medical care, and realize that a good portion of the population is looking for alternatives to the present model of health care, vastly regulated, very expensive, and clogged with red tape. A pared-down, more personal system geared to individual patients may be a welcome outgrowth of our profession. Many Western physicians such as Andrew Weil are also interested in this type of health-care, and are developing alternative health plans for this purpose.

Finally, in terms of the science and philosophy of medicine, there are many advances waiting to come from both East and West. As books such as Second Medical Revolution (Foss and Rothenberg, Shambhala Books, Boston, Ma.) point out, modern medicine is ready to progress to a new paradigm, one embracing the 'new physics' of the late twentieth century. A vast mountain of data on the mechanisms of the body has been collected, but at the expense of neglecting essential relationships of mind and body, environmental, social and seasonal factors in health. The revolution in quantum physics and chaos theory in this century will soon influence biomedicine. Chinese medicine, which is based on a sophisticated informational structure, has much in common with these fields, theoretically. (2) This subject is theoretically vast and exciting, and will await another article for discussing these implications. In the meantime, let East and West meet on equal ground, enrich each other and share in the great global exchange.

Notes:

(1) This is discussed in detail in an article by Volker Scheid, Home and Away: In Search of Chinese Medicine, published in the European Journal of Oriental Medicine, Autumn 1994 issue.

(2) There are excellent discussions on the relationships of physics and Chinese medicine in Dr. Yoshio Manaka's master work, Chasing the Dragon's Tail (Paradigm Press, Brookline, Ma. 1995), and Johnson F. Yan's DNA and the I Ching, (North Atlantic Books, Berkeley, Ca. 1991)