The Science of Chinese Medicine
In the February 2014 issue of Journal of Chinese medicine (number 204), Peter Eckman M.D., physician and acupuncturist, presented a short article titled “Traditional Chinese Medicine – Science or Pseudoscience? A Response to Paul Unschuld” in which he questions Paul Unschuld’s supposed belief that Chinese medicine and acupuncture are pseudoscientific pursuits that need validation by biomedical science. Other Chinese medicine scholars have argued that Unschuld is equally skeptical of both biomedicine and Chinese medicine. Whatever Unschuld believes personally is not as concerning as the general tendency in the west to see biomedicine as the only legitimate medical science and thus the only legitimate path to medical knowlwedge.
Eckman raises good questions, and calls for acupuncturists to determine what methods of research are most appropriate to Chinese medicine. He touches upon the distinction between Western science and Eastern science by stating, “Many authors before me have pointed out that Western science is analytical, quantitative and deductive, whereas Eastern science is synthetic, qualitative and inductive.” In my experience, many acupuncturists do not consider Chinese medicine a science because they have not read or been introduced to the authors who have paved the way of apprehending why it should be considered as such. Additionally, many leaders in the field of Chinese medicine feel pressured to reduce Chinese medical thoughts and concepts to western ideas to make them acceptable. An example is reducing the idea of qi to the oxygen molecule. By comprehensively understanding why a modern rational person would consider Chinese medicine a science and not a pseudoscience or an example of pre-scientific thought, we are more able to guide the future of our medicine and propose intelligent ways to make it grow through considered research. Eckman cites Manfred Porkert as a source for understanding the differences between Western and Eastern science, as no other author has done more to clarify the differences in the two modes of thought than Porkert. In this short piece I wish to redact and explain one of Porkert’s central arguments, a deep understanding of which, could lend to a clear understanding of why Chinese medicine is indeed a science. Hopefully the argument will be useful to practitioners and students in their continued debate over the validity and practice of acupuncture and Chinese medicine, and its place within the dominant paradigm of biomedicine. As Dr. Nguyen Van Nghi used to say, “Chinese medicine does not compete with western medicine, it completes it.”
Introduction to the argument
In 1977, Dr. Manfred Porkert, the eminent sinologist and scholar-practitioner of Chinese medicine, wrote an article published in the journal Eastern Horizon titled: “Chinese medicine: A Science in its own Right.” The core argument of this piece, when fully understood gives practitioners an incredibly solid footing from which to understand their profession in terms of a mature science. In light of the fact that science is considered the hallmark of knowledge in many cultures, it makes sense to understand if Chinese medicine is truly a science in its own right, or if the biomedical trials of western medicine are needed to validate its practice. After reflecting on Porkert’s work for many years, I am convinced that with a deep understanding of the issues presented, practitioners can make a strong case to any intelligent and rational person anywhere, that Chinese medicine deserves deep respect and is more than empirically interesting or a grab bag of archaic techniques. Chinese medicine is a mature science and demonstrates all the criteria necessary to qualify it as such.
How Do We Define Science?
Disagreements about how we define science and distinguish it from other pursuits, such as philosophy, gets us right to the crux of the issue at hand.
The Oxford etymological dictionary gives this origin of the word science:
“mid-14c., “what is known, knowledge (of something) acquired by study; information;” also “assurance of knowledge, certitude, certainty,” from Old French science “knowledge, learning, application; corpus of human knowledge” (12c.), from Latin scientia “knowledge, a knowing; expertness,” from sciens (genitive scientis) “intelligent, skilled,” present participle of scire “to know,” probably originally “to separate one thing from another, to distinguish,” related to scindere “to cut, divide,” from PIE root *skei- “to cut, to split” (cf. Greek skhizein “to split, rend, cleave,” Gothic skaidan, Old English sceadan “to divide, separate”
For most people, the common understanding of science is something that is universally true, and the word truth often gets confused with the word science. Science should be understood as a human activity and attempt to arrive at warranted knowledge, or approximations of truth. What was considered true to one generation, changes as human beings discover more about the universe, or as anomalous facts collect and require new theories. (The Structure of Scientific Revolutions: Kuhn)
As the history of science and the philosophy of science shows, science is often riddled with cultural assumptions, agreements and methods, so much so that Goldstein and Goldstein point out in their book, How We Know, that “facts are theory laden.” The Goldsteins give the example of mass. In order for us to weigh a rock, we must agree on certain definitions and measurements, and our facts proceed from these. Without the agreement about the definition of mass, without agreeing to a shared set of terms, we would have no science.
In his book, The Mismeasure of Man, Stephen Jay Gould, the eminent paleontologist, evolutionary biologist and historian of science remarked:
“Science, since people must do it, is a socially embedded activity. It progresses by hunch, vision, and intuition. Much of its change through time does not record a closer approach to absolute truth, but the alteration of cultural contexts that influence it so strongly. Facts are not pure and unsullied bits of information; culture also influences what we see and how we see it. Theories, moreover, are not inexorable inductions from facts. The most creative theories are often imaginative visions imposed upon facts; the source of imagination is also strongly cultural.”
Though the very word science can conjure many things to many people, in general we use it to imply a way of obtaining approximate truth, universally warranted knowledge that extends across cultures, ideologies and belief systems. But we are also aware that certain agreements and beliefs are embedded in any science.
So in a general way science means an activity and mode of thought that leads to knowing with certainty, but it often gets confused with a method of analysis, called by Porkert “causal analysis”, and a specific mode of cognizance that is reductive in method. When we use the word science we mean to separate it from a specific mode of cognizance, and use it in the more general sense of universal approximate knowledge, or more precisely “warranted knowledge.” (J. Linn Mackey)
If you look in any high school science textbook in America, it will tell you that science in practice is distinguished by the scientific method. Unfortunately, science often gets confused with “the scientific method.” The Oxford English Dictionary defines the scientific method as, “a method or procedure that has characterized natural science since the 17th century, consisting in systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses.”
But in real life some of the greatest discoveries in science have come from dreams or other unorthodox methods of reflection or intuition. For instance, Friedrich August Kekule discovered the Benzene ring structure after a dream of a snake swallowing its tail. Meaning that the scientific method as it applies to warranted knowledge is only another approximation and not the only way of apprehending knowledge. Dreams and revelations from meditations on them, have served as ways of receiving crucial insights that later are revealed as warranted.
Additionally, there is nothing in the scientific method that identifies the mode of thought of science as causally analytic, reductive or quantitative. The Eastern science of Chinese medicine follows the scientific method as defined by the Oxford dictionary, in that it applies systematic observation, measurement and experiment…thereby arriving at the classical hypotheses of Chinese medicine: yin-yang and five phase theories.
So Western science and Eastern science are completely different modes of cognizance, but they are equally valid as sciences because they meet the core criteria that establishes them as universal ways of knowing as we will see below.
Eastern V Western Science: Two Modes of Cognizance
Many people and most scientists, will tell you that science is universal, that it provides knowledge available to all, and that therefore we should not speak in terms of Western versus Eastern science. What they don’t understand is that when we use these terms, Western and Eastern, we are describing different ways of seeing, different methods of thought and modes of cognizance only.
When we assume that Western science is the only true science, we make a fundamental mistake in confusing the methods, procedures and thought processes of that science with the criteria which establishes what a true science consists of. A science is not merely the methods it uses to acquire knowledge, it is based on specific criteria that distinguish it from other ways of knowing.
One of my mentors, Dr. Nguyen Van Nghi used to say “Chinese medicine does not compete with Western medicine, it completes it.”
Porkert makes clear in his writings that Eastern science is qualitative and he characterizes the mode of thought of Chinese medicine as inductively synthetic. While Western science is by and large quantitative and causally analytic. Whereas Chinese medicine looks to the present moment to see qualities and patterns as they present in the now, Western medicine looks for causes in the past. And the causes that western medicine seeks to find are material causes of increasingly microscopic origin. For instance, the search for causes goes to the cell, or molecule, all the way to do the DNA, as in the search for the genetic origins of disease.
So when we say western science, we mean a mode of thought that is focused on matter, is causally analytic and thereby reductive. In western science as applied to human beings, people are reduced to an effect, with a cause in the past, as in genetics.
Just because Chinese medicine uses a different mode of cognizance does not mean it is not a science in its’ own right. As established, modes of cognizance, are methods of thought, and Eastern science uses a different way of thought than Western science. In fact, Eastern thought does not disclude Western science, it includes it but also transcends it, while Western science necessarily discludes Eastern science, because it’s mode of cognizance is based on reduction and it must disclude any extraneous phenomenon not associated with the immediate concerned area of focus. As an example, to microscopically observe a part of the body, all other parts and functions of the body must be temporarily excluded from the observer’s focus, even though those other phenomena exist simultaneously. Chinese medicine takes the macro view, and synthesizes simultaneous phenomena to arrive at a gestalt or pattern. And these images, or patterns are universal.
The core of Porkert’s argument
Porkert makes clear that we must distinguish first between scientific criteria and scientific methods. Methods will differ depending on the branch of science. For instance, astronomers do not use the double-blinded placebo controlled study as a method, but astronomy is a science because it is based on the criteria that qualify it as a science. The criteria necessary to claim a way of knowing a science are:
1. Positive experience.
This would be the empirical part of the story. One of the most obvious facts about Chinese medicine is that it begins with very astute and precise observations of the human being. One could call this observation, but you have to be careful with that word. Porkert does not say objective here. When you do not separate mind and body, how can you separate subjective and objective? Still we experience things that are universal and understandable in terms of universality.
2. Univocality of statements.
For instance we all agree on what red means and signifies. When we say yin, yang or fire in Chinese medicine, we understand what each term means…and that heat is distinct from cold etc. Each word specifically points to specific phenomena and not other phenomena. Porkert says: “Univocality of statements denotes that in a given context every single statement must only be employed and accepted with one single, precisely defined meaning, to the exclusion of all others, with even slightly similar meanings. This criterion distinguishes ‘scientific’ from ‘common’ and even from ‘philosophical’ statements which, as a rule, can be understood or interpreted in more than one way.”
3. Stringent rational integration (systematization) of empirical data.
For hundreds if not thousands of years, this is exactly what Chinese physicians have done by observing patterns in human beings and delineating how those patterns change through time. Using the positive experience or their empirical observations, they used univocal statements, like “spleen qi deficiency” to recognize patterns and differentiate them. And thus an understanding of pattern differentiation is the rational systematization of empirical data at the core of Eastern science.
Porkert states: “It should also be noted that different from these essential criteria are a number of other criteria such as notably the causality nexus, controlled experiment and quantification of data. These constitute accidental criteria whose application is limited to some specific disciplines or fields of research only.”
In other words, depending on the branch of science there might be other criteria associated with it, but what establishes a science as legitimate are the core and principle criteria stated above, which Chinese medicine conforms to.
Putting reduction in its place
Porkert also makes clear that one of the methods of Western science, measurement and the metric system, implies a reductive mode of cognizance, because you cannot measure a human being without reducing that human being to the system of measurements. It is a mistake however to reduce humans to numbers solely, as it is clear that the human phenomenon is more than the sum of the parts that make humans up. The metric system is useful but only part of the mode of cognizance used by Western science to gain information about biological life.
To summarize: there are three pertinent criteria to meet if we are to consider Chinese medicine an exact science, which are stated and explained above. And when we look closely at Chinese medicine, we see that it indeed does meet all three criteria. The methods of Chinese science: yin yang and the five phases have been incorrectly assessed by western quantifiable methods, when they are qualitative empirical observations. For instance, you cannot apply quantification and measurement to the movements of emotions, but you can use words in a stringent fashion to observe their changes accurately. In the same way that the metric system is an agreed upon language to convey ideas, and that the metric system is not utilizable or of significance to someone who is not well versed in the language of the metric system, so too are the five phases and yin yang only of practical value when understood fully and used in a stringent fashion. Just as you cannot use the five phases and yin yang to assess Western science, you cannot use the invented methods of Western science and the metric system to evaluate Chinese medicine.