1
CONSTRUCTING A NON-HEGEMONIC, INTERACTIVE SPACE FOR
TRADITIONAL ASIAN MEDICINE1
Dr. Rey Tiquia PhD
Department of History and Philosophy of Science,
University of Melbourne
rtiquia@ bigpond.net.au
The Hidden Agenda of Modernity: Western Science
And Asian Indigenous Traditions of Healing
Modernity is a historical epoch characterised by the emergence of capitalism, industrialism,
ratio-legal bureaucracies, and state control of military power and surveillance. Its cultural
dimensions include discourses of rationality, scientism, and progress through economic
development1, objectivity, and in the field of medicine the culture of the randomised
controlled trial (RCT). In his book Cosmopolis the Hidden Agenda of Modernity (1990),
Stephen Toulmin aptly describes the cosmology of ‘High Modernity’ as one “which saw
nature and humanity as distinct and separate.” 2. This cosmology in turn gave rise to the
Cartesian credo of “ I think, therefore I am” 3 which opened the way to the mechanical
metaphysics of dichotomising the mind from the body as well as theory from practice.
1
This paper was presented to the 17th Biennial Conference of the Asian Studies
Association of Australia in Melbourne 1-3 July 2008. It has been peer reviewed via a
double blind referee process and appears on the Conference Proceedings Website by the
permission of the author who retains copyright. This paper may be downloaded for fair
use under the Copyright Act (1954), its later amendments and other relevant legislation.
2
Asian societies were confronted by the realities of modernity, science and biomedicine as
European Western colonialism and imperialism crashed onto their shores at the turn of
the 18th century. Their collective experience of anti-colonialist and anti-imperialist
struggles in turn led to transformations in their respective pre-colonial state formations,
political ecology and patterns of migration. Consequently, various indigenous and
traditional healing systems in various Asian nations such as the tradition of Chinese
medicine, Japanese Kanpo medicine, Ayurvedic medicine, the herbolaryo and ‘Hilot’
healing systems in the Philippines, Tibetan medicine, Shamanic healing systems in Korea
and Taiwan, etc all were gradually displaced by ‘modern scientific medicine’. As Linda
H. Connor observed in her introduction to the the book Healing Powers and Modernity
Traditional Medicine, Shamanism, and Science in Asian Societies:
One of the ways in which modernity has laid a claim on people’s lives
Is through biomedicine’s expansion around the globe. In virtually every
social situation considered in this volume, biomedicine has become a
metonym for modernity in the domain of healing. It has been placed
there by by national governments intent on their own modernists projects
of “development,” implying notions of social progress and economic
improvement for the nation’s citizens. While agencies like the World
Health Organizatiion (WHO) and United Nations International Children
Emergency Funds (UNICEF) have exerted a unifying influence on
international health policy and planning, their agendas have always
had to come to terms with varying national visions of modernity, many
of which have explicitly anti-Western elements. National visions of
modernity, in turn, articulate in various ways communities whose
aspirations may point to quite different possibilities, particularly
where minorities in authoritarian states perceive themselves as
marginalized.4
3
The Hegemony of Scientific Translation- ‘Save TCM and Other Asian Traditional
Medicine’
How Should We Communicate With Mr. Science?
At the threshold of this post-modern epoch of ‘humanized modernity’ where we
experience and witness a growing “disbelief in the metanarratives of science, rationality
and objectivity where “lived lives, the diverse, the complex, the unique,” are favoured
and more importantly the local, which ‘acknowledges individuality, complexity and
subjectivity of personal experience’ [Chan, Jonathan J. & Chan, Julienne E, 2000], as
well as the organic unity of man (humanity) and heaven (nature) tian ren he yi 天人合一
i.e. the natureworld and the humanworld being organically of one Qi” tian ren tong Qi
天人同氣 5, how should we practitioners of traditional Asian medicine(s) communicate
with Mr. Science? Should we abandon science? Should we repudiate it? Should we use
its language? Or, should we become Mr. Science?
While TCM (traditional Chinese medicine) a non-European and non-scientific Asian
medical tradition finds its own place in this continuously changing globalise world, for
more than half a millennium it has suffered the fate of being translated (displaced) by the
hegemony of science and its kissing cousin, Western biomedical science. I call this type
of translation ‘hegemonic scientific translation’ which places TCM, the ‘guest’ language
within the universal frames of modernity, objectivity, rationality and scientificity. This
means, paraphrasing Bruno Latour’s definition of a geometric sense of translation, at
once offering a universal interpretation of all the interests of all knowledge systems
including TCM, and channelling them in one universal direction.
4
The TCM Body being colonized by Modernity, Rationality, RCT and Zhong xi Yi Jie He
(the system of Integrating the ‘theory’ of Western biomedicine with the ‘theory’ of
TCM)
5
We can actually compare this type of hegemonic translation to what the British Chinese
medicine practitioner and medical anthropologist Volker Scheid refers to as the Trojan
horse that “ smuggle(s) the power of the biomedical-industrial complex into the very
hearts”6 of our respective medical traditions. The Trojan horse in classical western history
refers to a hollow wooden statue of a horse in which the Greeks surreptitiously place a
load of soldiers inside as a strategy to capture the city of Troy ”.7
Historically, there has not been any meaningful two-way communication between science
and traditional medicine(s), not to mention between science and traditional Asian
medicine(s). The cultures and language of Western science and biomedicine are
displacing the traditional language and culture of various Asian traditional medicine(s)
including traditional Chinese Medicine (TCM). The traditional epistemology of these
ancient bodies of medical knowledge is being ‘displaced’ by the Trojan horse of science
i.e. by the universal theories of objectivity, rationality, replicability, RCT (randomised
controlled trials) etc. Hence, the call by a practitioner of TCM in Mainland China, Prof.
Lu Jia Ge two years ago to “save the tradition of Chinese medicine” 换救中医！Huan jiu
zhong yi8, and the American anthropologists Hans Baer who sees ‘revolution’ as the only
viable way out of this impasse.9
And the above situation is equally true here in contemporary Australia vis-à-vis the
relationship between biomedicine and Complementary and Alternative Medical (CAM)
traditions which encompass Asian traditional medicine(s) such as TCM, Ayurvedic
medicine, Australian aboriginal healing traditions and the Japanese healing traditions of
Shiatsu and Kanpo etc. Please refer to the book Medical Dominance by Evan Willis. 10
6
Separating Theory From Practice: Modernizing, Scientising, Objectifying and
Rationalizing TCM
With the modernist Cartesian credo of “ I think, therefore I am”, the mind dichotomizes
from the body while theory separates from practice. With the advent of the modern era,
the American theologian Prof. David Tracy observed that
…most modern philosophers and even theologians with important
exceptions like Kant or Schopenhauer or Kierkegaard or Wittgenstein or
Foucault later in life or Levinas or Lonergan and many others has
somehow gone into the modern way of separating their theories on
life and the universe from their own way of living. 11
David Tracy
In China, following the Marxist epistemological dogma of dichotomizing theory from
practice, Mao Ze Dong, the founder of the Chinese People’s Republic, developed the
concept (which later evolved into a party and state policy) of ‘integrating’ jie he of the
theory of biomedicine with the theory of TCM i.e. Zhong Xi Yi Jie He. In contemporary
Mainland Chinese jargon, the term jie he means to combine, integrate or unite entities,
concepts or people (as in integrating with the workers, peasants and soldiers) in a
decontextualized manner. The talk is of ‘integrating theory with practice’ li lun yu shijian
xiang jiehe.
7
Referring to the integration of TCM and biomedicine, Mao used the term jie he in 1956 in a
formal meeting with a team of Chinese musicians. However, the content of this meeting
was made public only in 1977 in the Guang Ming Daily. Mainland China historian Si Yuan
Yi in his review of the work on the ‘integration of TCM and Western medicine’ (in which
he referred to as duchuang 独创 or ‘original creation’) quoted Mao as saying:
We have to learn contemporary foreign things. After studying them, then
we study Chinese things. We have to accept the strong points that foreign
things have. This will create a leap yue jin 跃进 in our own things. Chinese
and foreign things must be organically integrated you ji de jie he 有机地结
合. We must not mechanically apply foreign things tao yong 套用 foreign
things to the Chinese situation.12
‘Chinese and foreign things must be organically integrated.’
http://en.wikiquote.org/wiki/Mao_Zedong
But the ultimate aim of ‘reforming TCM’ through the ‘integration of biomedicine and
TCM’ was to elevate it to a ‘scientific level’. As the Chinese historian Si Yuan Yi pointed
8
out in a commentary on Mao’s instructions: ‘ As for the study of medicine, we have to use
contemporary science to research (‘study’ yan jiu 研究) the pattern of development gui lu
of China’s traditional medicine, and thus develop China’s own ‘new medicine’. As a matter
of fact, Si Yuan Yi pointed out that the ‘integration of Western biomedicine and TCM is an
important content of the modernization of TCM, Zhong Xi Yi Jie He shiji shang shi zhongyi
xiandaihua de zhongyao nei rong [Si Yuan Yi, 1984, p. 126].
The scientific and modern way of knowing began displacing the premodern traditional
epistemology of bian zheng lun zhi 辨證論治 i.e. differentiating clinical patterns and
associating yao. TCM ‘theory’ lost its subjectivity and became an ‘objective reality’. Doing
TCM theory separated from doing bian zheng lun zhi. With this dichotomised
understanding of TCM practice, some people claimed that TCM has theory, a ‘systems
theory’, and that it is normal science!
The scientising or biomedicalization of TCM formally began in China when laboratory
experimental technique was introduced into TCM research in 1959. In 1960, with the use
of the Western pharmaceutical drug cortisone pi zhi su 皮质素, a Chinese researcher by
the name of Kuang An Kun 鄺安坤13 developed a laboratory animal model replicating
the TCM clinical pattern zheng hou 證候of ‘yang deficiency’ yang xu. The efficacy of a
traditional herbal formula, which is commonly used to address this clinical pattern, was
supposedly successfully ‘tested’ using this animal model. This development signalled the
birth in the People’s Republic of China (PRC) of the so-called school of ‘integrated
Chinese and Western medicines’ zhong Xi yi jie he 中西醫結合. The standard universal
yardstick (theory) generated in the laboratory became the criteria by which traditional
Chinese medicine had to be measured and accepted as ‘scientific’. Without due regard for
the different contextual requirements of TCM as a body of medical knowledge with an
ancient history, predating Western science, a whole set of research projects were
undertaken to make the parameters of TCM more ‘scientifically objective’.
9
This separation of theory and practice has resulted in a distorted picture of TCM practice
and an unhealthy and unbalanced development of the TCM body of knowledge. ‘Theories’
which assume life in one locale of practice are ‘integrated’ with TCM practice. Theories of
WSM anatomy, pathology, and physiology, biochemistry that assume life in the biomedical
body of knowledge are integrated with bian zheng lun zhi. The former supposedly raises
the latter to a ‘modern’, ‘scientific’ level, and theoretical configurations of such biomedical
technology such as the magnetic resonance imaging, S-ray, CT scan, randomised controlled
trial (RCT) etc. are standardizing the practice of bian zheng lung zhi.
‘Harmonizing Traditional and Modern Medicine’ – A Reworked Trojan horse
It is interesting to note how this Trojan horse that smuggled the hegemonic power of the
biomedical industrial complex into China at the turn of the twentieth century is now
being reworked to us here in the West at the dawn of the new millennium, under a new
label, ‘ harmonization of traditional and modern medicine’.
In December 2005, an international conference on the ‘Harmonization of Traditional and
Modern Medicine’, Melbourne, was attended by 150 participants from 11 countries. The
conference, was organized by the Chinese Medicine Unit of the Royal Melbourne
Institute of Technology. The keynote speaker, the Vice Minister of Health and Director
General of the State Administration of Traditional Chinese Medicine, PRC, She Jing
spoke of the ‘Modernization of Chinese Medicine which promotes harmonious
Development of Traditional and Modern Medicine’. Vice Minister She Jing announced
before the conference that the PRC had developed its ‘ Guidelines for Modernization of
Chinese Medicines’ outlining its strategic goal of modernizing Chinese medicine by
2010” According to the Vice Minister:
The modernization of Chinese medicine requires effective and productive
collaboration between China and international organizations. It is
anticipated that through such collaboration and cooperation between
China and Australia as well as other countries in traditional and modern
10
medicine throughout the world, the two healthcare systems will be
developed and enhanced in parallel and harmoniously so as to enrich the
healthcare delivery and provide high quality Chinese herbal medicines
and to contribute to the global health.14
Ms. Theresia Hofer a medical anthropologist from the Wellcome Trust Centre for the
History of Medicine at the University College, London, who presented a paper at the
conference, wrote a very comprehensive report on various issues tackled during the
conference. Ms. Hofer then circulated her report via the discussion list (of which I was a
member) of the IASTAM (International Association for the Study of Traditional Asian
Medicine). In her overview of the theme of the conference, Ms. Hofer observed that “
harmonization” at this conference was often used synonymously with the term
integration, “modernization” and “Westernization”. 15
I agree with Ms. Hofer’s observation that ‘harmonization’ in the context of its use during
the conference was synonymous to ‘integration jie he, modernization, xiandaihua 现代化
and Westernisation xi hua 西化, and if I may add, scientisation ke xue hua 科学化 and
biomedicalisation xi yi hua 西医化. This conference launched in the international sphere,
the hegemonic translation policy of integrating TCM with Western biomedicine zhong xi
yi jiehe 中西医结合 creating an illusion of a ‘harmonized traditional and modern
medicine system underpinned by the hegemony of science and biomedicine.
Theory-as-Practice – The Epistemology of Tradition in Chinese Medicine
Coming out of this imbalance in the practice of TCM, I suggest what I see as a balanced
method of looking at the relationship between the theory and practice in TCM. Instead of
separating theory and practice, I see TCM theory as embedded in its practice. TCM theory
emerges, develops and standardizes with its developing practice. It is generated from the
TCM clinical microworld. TCM theory is a standardization of its practice and in turn
theory standardizes practice. Theory is embedded in practice. Hence, in TCM, instead of a
separated theory and practice, I see a connectedness, an oneness between theory and
11
practice i.e. theory-as-practice. Theory is a logical extension, development and
standardization of practice. It is a standardized form of knowledge which connects locales,
achieves systemacity in the course of its development and then becomes a clotted
assemblage i.e. an obligatory passing node of various enterprises.
Instead of being a universalising entity, i.e. a Trojan horse of science that is instantiated
everywhere, ‘theory’ should be seen as ‘tools’ applied to situations, which are perceived as
similar or equivalent. 16
Theory-as-practice which sees knowledge as local and embedded in practice is a critique of
the standard representationalist view in science which upholds the universalising role of
theory in knowledge production. From this received view in science, all knowledge is a
mere abstraction of the world out there. The American philosopher of science Joseph Rouse,
in his critique of the representational view in science said, “action has its own kind of
understanding which cannot be reduced to theoretical representation.” Furthermore, he said,
“ theoretical representation is indifferent to local situations.” 17
Theory-as-practice also critiques the Marxist/Maoist epistemology, which sees TCM
knowledge generation as following the cycle of practice-theory-and then-higher theory
formation. This epistemology too, separates theory from practice.
Instead of representations of the outside world, theory-as-practice sees knowledge as
springing from “particular practical context” and is an embodiment rather than a
representation; local instead of universal. Knowledge is not just a theoretical abstraction of
the world outside but rather it includes the craft, skill, social, cultural, political, traditional,
emotional, psychological aspects which constitute the “whole-person-activity-in-setting”
(Verran-Turnbull, 1994, p. 33].
12
Wang Xi Chan (1628-1682)
The notion of theory-as-practice very aptly fits the nature of the premodern ancient Chinese
knowledge system. A Qing dynasty traditional astronomer Wang Xi Chan 王錫闡
describes the traditional Chinese natural studies, technology and medicine 18 in the
following terms:
When ancient people establish models for doing things, there is
always a principle li 理 that goes with it. While details are said about how
things are done, not much is said about the principle behind
it. The principle is within the method itself.
古人立一法，詳于法而不著其理，理具法中.19
The Theory-as-Practice of Differentiating Clinical Patterns and Associating yao20
As a practitioner of TCM in Australia for the past two decades and a half, I have been
observing, participating and reflecting. Necessarily, I translate/interpret events which
continue to shape the ‘life’ of TCM in Australia. With regards to these ‘life happenings’,
I am a familiar stranger. As a practitioner of TCM, I am particularly familiar with these
events. It is a sense of familiarity which belongs to someone who is an ‘insider’ i.e. a nei
13
heng in Chinese. This is my openly declared professional bias. On the other hand, as a
‘stranger’ vis-à-vis these events, I am an ‘outsider’ i.e. a wai heng I stand outside and
witness these events, striving to maintain a balanced stance and temper my personal and
hence partial inclinations. In this way, I hope to tell a holistic and unbiased story.
I am an alumnus of the Beijing TCM College class 1975, the first batch of foreign
students to embark on a TCM Bachelors degree course after the Cultural Revolution. Our
batch was also the first that came from the West. Looking back therefore, the curriculum,
course materials and pedagogical approach and even the place where we live had an
element of an experiment. It was in reality an attempt to implement the Communist
Party’s line on TCM education i.e. ‘integrating TCM with biomedicine as it related to
TCM education for foreign students from the West. This attempted integration of the two
has eventually led as we have seen to the ‘displacement’ (hegemonic translation) or
‘erasure’ of the Traditional practice of bian zheng lun zhi.
Deploying a syncretic ‘double insider’ methodology of standing outside both the analytic
tradition of contemporary science studies and inside contemporary TCM practice and
analysis, I connect with the theory of local knowledge developed by contemporary
philosophers of science such as Susan Leigh Star, Joseph Rouse, Bruno Latour, Helen
Verran and David Turnbull, who have been at the forefront of de-colonizing traditional
and indigenous knowledge systems from the Trojan horse of scientific theories.
From this stance, I have reconstituted the practice of TCM known as bian zheng lun zhi
in the Australian locale. By linking the disembodied segments of the practice of bian
zheng lun zhi from its past and present locales, I have developed the notion of
‘ Differentiating clinical patterns and associating yao. I have linked the practice of the
‘Four Examination Techniques or Si zhen 四诊 with the practice of ‘differentiating
clinical patterns’ bian zheng 辩证, which is the first stage in the execution of the practice
of bian zheng lun zhi.
14
Subsequently, I have developed the second stage of ‘choosing treatment principles’ lun
zhi 论治. Between these two stages, I developed the practice of ‘differentiating clinical
patterns’ by linking it with notion of ‘conceptual templates.’ In this sense, we can say that
the theory of TCM is a product of connecting those disconnected ‘bits’ of TCM practice
which were disembodied, delocalised, and decotextualized by the Trojan horse of science
in the past and present locales.
From its more than two millennia of historical development and practice, the TCM
theoretical framework i.e. a standardized body of knowledge, emerged, developed and been
systematized from various spatial and temporal locales in and out of China, and has been
influenced by heterogenous premodern and contemporary cultures, traditions, religions and
philosophies such as Taoism, Confucianism, Yin and Yang, Mohism, Buddhism, History,
Science and Technology Studies (STS). As a result, it has and is evolving a unique way of
dealing with diseases, dis-eases, health, wellbeing, disease prevention, longevity, diet and
nutrition.
TCM and RCT
The theoria of TCM is a product of a ‘strategy, which connects’. Using this strategy,
TCM theory is reconnected with its practice. The TCM microworld which is constituted
by the three agential figures of the a) the yao 藥, an exemplary of those interventionary
tools that TCM practitioners have at their disposal; b) the figure of the ‘uneasy’ body of the
patient; c) the disciplined practitioner and corporate body of TCM practitioners, is
reconnected with the natureworld. Humanity becomes one with nature and One Qi connects
us all. This in turn provides the basis for generating a new clinical evaluation template: the
‘Four Evaluation Techniques si ping 四评 as an extension and development of the
epistemology of TCM. This is a template that is separate and independent of and distinct
from the randomised controlled trials (RCT) proposed by the received view in the Western
scientific biomedical model.
15
In many places in the world today, RCTs are already being used to evaluate the efficacy
of TCM treatment. RCTs have been adapted and are widely used to effect a form of
evaluation of TCM. The questions we need to ask are: first, what sorts of biases does this
introduce into the evaluation methods being employed? And, secondly, what sort of
distorting effects will it have on TCM to have RCTs as the standard form of evaluation?
In considering biases, some people note that RCTs involving TCM are invalidated
because RCTs are set up to test single agents of intervention. However, increasingly,
particularly with respect to cancer treatments ‘cocktails’ are tested. Multiple agent RCT
trials are now common. Another problem is the issue of ‘double-blindness’. It is correct
that double masking (that is hiding the nature of the treatment from both patient and
doctor) cannot be used in TCM. However, it is also true that double-blind trials are often
impossible in WSM treatments. This is certainly true of chemotherapy tests, where the
side effects make it impossible to ‘hide’ the nature of the treatment from doctors.
Increasingly, patients too, are aware of the side effects of particular drugs, so even singlemasking cannot be achieved. Others argue that RCTs can only be carried out with pills as
treatments and that makes RCTs unsuitable for TCM. However this fails to recognize that
many TCM herbal treatments are now available as pills. Similarly the argument that
focuses on the impossibility of placebo control in TCM does not really hold, since there
are in fact very few drug trials for chronic diseases that use placebo control due to
equipoise requirements.
The second issue with respect to the use of RCTs in TCM is more interesting. The forms
of standardization that RCTs introduce are incompatible with the knowledge practices of
TCM, and their use systematizes serious distortions in the clinical practice of TCM.
Unlike biomedical practice, the focus of traditional Chinese medicine and all its yao
therapies is the patient at their specific unease in the here-and-now. In contrast, Western
biomedicine has a focus on a generalized condition. It is true that there are now attempts
to individualize biomedical treatments (by weight, gender, ages, and sometimes even
genetic profile), however, biomedical treatments still treat generalized standardized
diseases, not uncomfortable, uneasy people. The capacity of WSM to ‘individualize’ is
16
severely limited. RCTs introduce this inadequacy into TCM. It is on that basis that their
application to TCM should be critiqued and rejected. It maybe that the only place that
RCTs have in TCM is to compare whole treatments. Patients with similar conditions
might be randomly allocated to treatment by a TCM practitioner or a WSM practitioner.
In a sense this type of RCT, black boxes the entire therapeutic system. Such holistic tests
have shown a high success rate for TCM treatments especially in the field of cancer. 21
Developing An Alternative to RCT
The development of an evaluation system for TCM practice is a pressing contemporary
issue. Up to this point in time there is no widespread recognition that systematic
evaluation is already embedded in TCM practice. TCM is not a static body of knowledge.
It incorporates systematic forms of evaluation, which support innovation. Critical here are
clinical records and possibilities for developing new schools of practice. I propose that
the practice of bian zheng ping zhi ‘ Clinically evaluating the administered yao in
accordance with the diagnosed clinical pattern, be adopted as suitable evaluation model
for TCM as opposed to the modern science-based RCT model. A set of clinical trial
protocols evaluating yao that is based on standardizing clinical records should be
established. Working through clinical records is consistent with the values, practical logic
and practice paradigms of TCM as TCM's clinical records give testimony about and
witness the life of the 'Qi' in TCM.
Evaluating the Administered yao in accordance with the diagnosed clinical Pattern Bian
zheng ping zhi 辩证评治
This clinical evaluation is undertaken by employing the Four Examination Techniques Si
Zhen as a clinical evaluation template or tool. Instead of using the Four Examination
Techniques Si Zhen of observing, listening/smelling, palpating and inquiring to gather
clinical data for eventual diagnosis of the patient’s clinical condition, the Four
Examination Techniques Si Zhen undergo a transformation into the ‘Four Evaluation
Techniques’ Si Ping to observe, palpate, listen/smell and interrogate clinical signs and
17
symptoms for data needed to evaluate the efficacy of the therapy administered. The data
gathered through the application of the Four Evaluation Techniques are then checked,
examined, verified, and compared with data on clinical signs and symptoms collected and
recorded on the medical case statement Yi An 醫案 during the previous visit. Using the
Four Evaluation Techniques, the clinical pattern of a contingent patient is revisited or
‘retraced’ lin zheng 臨證 to evaluate whether the therapy achieved the aim of bring about
balance or harmony in the patient’s condition. Hence, every subsequent visit or clinical
consultation is a process of evaluation of the therapy administered during the previous
visit. During those visits, presenting signs and symptoms are used as indicators of
efficacy of the therapy administered. As one veteran TCM practitioner Wei Zhang Chun
(1898-) from China summed up:
Wei Zhang Chun
Changes which occur in the patient’s condition after the administration of the
therapeutic remedy is the clear mirror which texts the efficacy of the practitioner’s
formula set on the basis of a therapeutic method. Hence, with regards the results of the
therapy, they should be timely evaluated and verified. Especially with regards typical
clinical cases, there should be follow-up visits, all-round investigation as
well as detailed records kept.
18
The Medical case statement or yi an re-presents the tradition of proof or clinical evidence
that gives testimony about and witness to the practice of differentiating clinical patterns
and associating yao 22. It embodies the doctor’s diagnosis, the treatment protocol
administered, the patients body and the yao Robert Houston, a science writer and an
advocate-scholar of complementary and alternative therapies in the United States
considers case studies as a valid alternative to the RCT. He stated that
what is being dismissed as anecdotal evidence in cancer [is]?
actually an impressive area of evidence, because you have much
more detail in case studies than you can in a clinical trial. 23
Given this state of affairs, the late Dr. Alvan R. Feinstein, a former Sterling Professor of
Medicine and Epidemiology and director emeritus of the Robert Wood Johnson Clinical
Scholars Program at Yale University suggests that clinicians should seek to improve the
value of their own clinical descriptions:
Dr. Alvan Feinstein
<< http://www.eng.yale.edu/images/Hall/Awfein615.PNG>>
Instead of zealously seeking dimensional measurement of symptoms,
signs and other human properties that cannot be dimensionally
measured with precision and convenience, clinicians must seek ways
of improving the value of their own clinical descriptions of these entities. 24
19
Once the clinical trial protocols evaluating yao that are based on standardizing clinical
records are established, then the traditional epistemology of Chinese medicine will be decolonized from the hegemonic 'theories' of science. TCM will have have it's own clinical
evaluative 'language'. Having its own traditional evaluative linguistic tool, it can now
communicate in symmetry with the biomedical linguistic tool of the RCT. A translating
knowledge space in true symmetry is thus constructed between the two medical
knowledge traditions.
A Non-Hegemonic and Interactive Space for Traditional Asian Medicine
After elucidating the process and strategy through which the epistemology of tradition in
Chinese medicine is freeing itself from the hegemony of Western science, let us now deal
with the ontological issue of communicating with Mr. Science. How should practitioners
of Asian medicine(s) communicate with Mr. Science? Undoubtedly, an effective twoway communication between traditional medicine(s) and Mr. Science can only occur
once this Trojan horse of scientism, modernism, biomedicalization, objectivity,
harmonization, integration, RCT, Zhong Xi yi jie he, is thoroughly critiqued and
deconstructed. Hopefully, an authentic pluralistic arrangement can come about where
biopsychosocial medical practice, complementary and alternative medical practice, and
various traditions of healing from Asia including TCM can co-exist independently as well
as collectively. Practitioners of Asian medicine(s) must take stock of this ‘reworked’
Trojan horse in the midst of our respective traditions. We have to make sense of our
being in this globalized world as practitioners of traditional Asian medicine(s). This
means establishing our independent identity as practitioners of a particular Asian tradition
of healing. Secondly, we call on practitioners of Western biomedicine to also reflect upon
their own being as Western biomedical practitioners in this globalized 25world and see
how this recycled Trojan horse is impacting upon their own healing tradition as well as
those of other healing traditions especially Asian healing traditions. Having established
our separate identities and being cognizant of this ‘recycled Trojan horse in midst of our
respective traditions of health care, we can then start constructing a shared space where
20
we can relate in mutuality with each other. A shared space wherein the ‘forms of life,
which emerge from clinical microworlds are translated symmetrically in a Yin- Yang way.
It will be a space where distinct traditions of health care can trans-relate, create
convergences and homologies as well as equivalences, analogues and connectivities. I
refer to this shared yin-yang space as a translating knowledge space i.e. a non-hegemonic
interactive space for traditional Asian medicine. To have healthy communities of men,
women and children, medical traditions have to learn to talk and listen to each other.
ENDNOTES/REFERENCES
1
Linda H. Connor and Geoffrey Samuel Eds. Healing powers and modernity: traditional medicine,
shamanism, and science in Asian societies, Westport, CT : Bergin & Garvey, 2000, p. 7.
2
Stephen Toulmin described ‘High Modernity’ as an age “which saw nature and humanity as distinct and
separate’ giving way to an epoch of ‘humanized Modernity’ or post modernity “which reintegrates nature
and humanity” [Stephen Toulmin, Cosmopolis: the hidden agenda of modernity, New York: Free Press,
c1990, pp. 182-183].
3
Chan, Jonathan J. & Chan, Julienne E., ‘Medicine For the Millennium,’ Medical Journal of Australia,
No.172, <http://www.mja.com.au/public/issues/172_07_030400/chan/chan.html>, 2000
Linda H. Connor &Geoffrey Samuel op. cit., pp. 7-8.
This is an English translation of the Chinese phrase Tian ren tong Qi ye, Chen Ding San, Jiang Er Sun
(ed.), Yixue Tanyuan [Exploring the Origins of Medicine], Sichuan kexue jishu chubanshe, Sichuan, l985,
p. 16
6
Voker Scheid, Chinese Medicine in Contemporary China Plurality and Synthesis, Durham & London,
Duke University Press, 2002, p. 26.
7
Brown, Lesley (ed.), The Shorter Oxford English Dictionary Vol II, Oxford, Clarendon Press, 1993, p.
3401.
4
5
Prof. Liu Jia Ge, the son of Lu Bing Kui, the former head of the Department of TCM in the Health
Ministry of the People’s Republic of China wrote a book entitled Save TCM! TCM Falls into the traps and
Pitfalls of the System and Scheme of Capital 换救中医中医遭遇的制度陷阱和资本阴谋(March 2006). In
this book, Lu Jia Ge calls for the rights of TCM practitioners to independently manage their own affairs to
be observed and a complete overhaul of the TCM Administrative Bureau under the Ministry of Health and
called for the establishment of a separate Ministry of TCM and Materia Medica 中医中药部.
8
Hans Baer gave a lecture on “Conventional Medicine and Alternative Healing Systems in the USA: Issues
of Class, Race, Ethnicity and Gender” at the Centre for Health and Society, University of Melbourne on
March 30, 2006. When queried on how the problem of the co-opting of CAM by conventional medicine in
the USA and the take over by Western biomedicine in China could be tackled and preempted, he said that
this is a very difficult issue, which probably can only be resolved by ‘revolution’.
9
21
Evan Willis, Medical Dominance: The division of labour in Australian health care, Sydney, George
Allen and Unwin, l983.
10
Encounter: 16 October 2005-Tragic Vision: The Abandoned Vision of the West?”<
http://www.abc.net.au/rn/relig/enc/stories/s1479674.htm> (28/04/08).
12
Si YuanYi, Zhongguo Yixue Shi [History of Chinese Medicine], Renmin weisheng chubanshe, Beijing,
l984, p. 124.
11
Yang Wei Yi, ‘ With Traditional Chinese Medicine as ‘substance’ and Western learning as ‘utility’ , and
the notion of the Animal Model of TCM Clinical Patterns中体西用与证的动物模型, in Thesis Collection
on the Occasion of the 40th Anniversary of the Foundation of the Beijing TCM University, Beijing, Xue
Yuang Publication, 1996, pp. 172-176.
13
In 1960, it was reported that Kuang An Kun accidentally discovered that an overdose of the drug cortisone
administered to mice produced symptoms of ‘yang deficiency’ 陽虛 i.e. loss of weigth 體重下降,
decreased endurance to cold temperature 耐寒力低, and listlessness 委糜. In 1963, he found out that
Chinese materia medica like 附子，肉桂，淡苁蓉 can be used to treat this clinical condition.
<http://www.cintcm.com/lanmu/zhongyi_luntan/dongmo_zhongzhang.htm/4/17/2006>
She Jing, Modernization of Chinese Medicine Promotes Harmonious Development of Traditional and
Modern Medicine, paper preented to the International Symposium on the Harmonization of Traditional and
Modern Medicine, 12-14 December 2005, RMIT Storey Hall 344 Swanston St. Melbourne, Australia.
15
Theresia Hofer, “ Conference Report: Harmonisation of Traditional and Modern Medicine” paper
presented at the Harmonization of traditional and Modern Medicine Conference, 2005, Royal Melbourne
Institute of Technology (RMIT), Melbourne, Victoria, Australia, p. 27.
16
Helen Wastson-Verran & David Turnbull, ‘Science and Other Indigenous Knowledge Production
Systems, Science in Society Working Papers, Second Series No.5, Deakin University Science in Society
Centre, 1994, p. 26-27.
17
Joseph Rouse, Knowledge and Power, Towards a Political Philosophy of Science, New York, Cornell
University Press, 1987, p. 77.
14
18
The phrase ‘traditional Chinese natural studies, technology and medicine’ comes from Benjamin
Elman’s work “ Rethinking the 20th Century Denigration of Chinese Science and Medicine in the 21st
Century” <http://21century.himalaya.org.tw/Showbrief.asp?ThesisID=134> (20/9/08).
Liu Hong Tao, Zhongguo Gudai Keji Shi [History of China’s Ancient Science and Technology] Nankai
daxue chubanshe, Tianjin, l991, p. 8.
19
20
Yao 藥 are routine therapeutic practices theat move the patient’s Qi including acupuncture, traditional
Chinese massage, food therapy, prescribing materia medica, Qi exercises Qi gong, Tai Ji quan etc. [Rey
Calingo Tiquia, Traditional Chinese Medicine as an Australian tradition of health care, Thesis (Ph.D),
University of Melbourne, History and Philosophy of Science, Faculty of Arts, 2005, p .240].
Benson K.A., “ A Comparison of Observational Studies and Randomized Control Tests”, New England
Journal of Medicine, 2000, 342:1878-86.
21
Yao 藥 are routine therapeutic practices theat move the patient’s Qi including acupuncture, traditional
Chinese massage, food therapy, prescribing materia medica, Qi exercises Qi gong, Tai Ji quan etc. [Rey
Calingo Tiquia, Traditional Chinese Medicine as an Australian tradition of health care, Thesis (Ph.D),
University of Melbourne, History and Philosophy of Science, Faculty of Arts, 2005, p .240].
22
22
David J. Hess, Evaluating Alternative Cancer Therapies A Guide to the Science and Politics of an
Emerging Field, New Jersey, Rutgers University Press,1999, p.134.
24
Harris L Coulter, The Controlled Clinical Trial, Washington DC, Project Cure, 1991, p.66.
25
I agree with Linda H Connors view of globalization as “ the movements, connections, and processes that
link people, information and commodities around the globe.” [Linda H. Connor & Geoffrey Samuel (eds),
Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies,
Wesport, Bergin & Garvey, 2001, p. 14]
23