East vs. West: Battle on the Medical Field
by, Abigail Levine
If you walk into any pharmacy, grocery store, or natural foods store, you
cannot avoid the shelves and displays of "alternative" remedies
and treatments. Promises of fewer aches and pains, clearer skin, slower
aging, better digestion, and more "harmonious" body functions
are plastered on store walls and across bottle labels with many, often
green, pills and liquids. Ginseng, Echinacea, acupuncture, reflexology,
antioxidants, Vitamin A, B, C, E... have all become a familiar part of
our culture's vocabulary, and for many, a part of their health regime.
The allure of treatments that are as simple as a collection of plants or
are based on a well-loved substance like garlic are obvious, particularly
in an cultural environment where not only medical labels but most food
labels seem to be written in a different language, and where people are
taught that "science [and medicine] know more about them than they
could ever know or understand about themselves"(Beinfield, 24). A
full-page advertisement in the New York Times for the Oxford HMO is an
insightful illustration of both public demand of alternative treatments
and its current misgivings about Western medical care. In the first paragraph,
Oxford says it has redesigned its program to take on a more "physician-responsive,
patient-centered approach." Another section begins with the heading,
"Alternative Medicine. The Choice is Yours." It goes on to state,
"A third of the people we serve already use alternative therapies.
Now they have access to the first credentialed network of alternative care
practitioners. It includes acupuncturists, chiropractors, massage therapists
and nutritionists, to name a few... In traditional health care, specialty
care has been focused more on isolated treatments versus overall healing...
We're building a system that rewards healing, not just treatment."
The ad has a picture of an inserted acupuncture needle and a caption reads,
"Why doesn't every health plan realize that no two people should be
treated the same"(New Yrok Times 4/1/97). All of the above is the
language of Eastern medical philosophy. Whether or not this is reflected
in the actual care is debatable, but its prominent place in a large-scale
advertisement demonstrates that this is what the public is seeking and
moving towards.
Yet despite the strengthening public call for unconventional therapies
and medicines, much of the Western medical and scientific establishment
rejects alternative treatments across the board as "quackery"
or invalid because in has not, and possibly cannot, be proven by Western
scientific research methods. Some non-Western medical systems have been
in place and effective for thousands of years. For example, "[t]he
theoretical framework of [traditional] Chinese medicine was established
more than two millennia ago" and has been treating the majority of
the vast population of China and other parts of Asia since (hanwei.com).
Traditional Eastern medical systems provide one of the best opponents in
the debate between Western medicine and alternative schools because, different
than many alternative treatments, they are highly developed and sophisticated
practical and philosophical systems that stand independent of Western medicine.
Western Experience with and Views of Non-Traditional Medicines
In the last two decades, there has been a public movement towards exploration
of alternative treatments. The National Institute of Health (NIH), a government
research agency, established an Office of Alternative Medicine (OAM) to
research "the potential benefits of unorthodox remedies such as bee
pollen for allergies and antineoplaston (peptides originally derived from
urine) for cancer" (Scientific American 10/96). Vancouver hospital
has recently established the Tzu Chi Institute for Complementary and Alternative
Medicine, which will be a pioneering institution in that is provides "a
variety of traditional healers work space at a major Western-style hospital
and subject[s] their work to rigorous, Western-style research to verify
or disprove its value" (chinaplus.com). Large scale clinical studies
are being performed to try to understand the effects of acupuncture, shark
cartilage enemas for cancer, herbal remedies, and many other types of treatment.
However, all of this research is proposed within the framework of Western
science and research methodology (Science 9/30/94). Through these narrow
lenses only a fraction of the potential benefits of non-traditional treatments
can be realized because the treatments themselves were created and do not
necessarily operate within the Western scientific paradigm.
Western medicine has also lumped all forms of non-traditional medicine
together, often giving equal validity to home grown, New Age therapies
and medical systems that have thousands of years of successful treatment.
Some major Eastern medical systems (Aruevetic, Chinese, and Tibetan) have
been in place for thousands of years, treating people successfully. They
have been dismissed in the past simply because they do not operate by the
same logic as Western medicine and cannot be proven by Western scientific
research methods, but today some in the US and other Western countries
are demanding they be given attention because of their long history and
success.
The "It Can't Hurt"/ "As a Last Resort" View of
Eastern Medicine
In the 1970s, Eastern medicinal practices began to be noticed in the US.
In 1976, the first 210 licensed acupuncture practitioners graduated in
California. By 1991, there were 6-10,000 practitioners of Chinese medicine,
24 states with license programs for Chinese medicine, and more than 20
colleges for study (Beinfield 12). Practitioners of Chinese medicine are
today in demand. Today's increasing popularity can be attributed to the
high success rates of Chinese and other Eastern medicines, but many also
practice it simply as a harmless last resort. The gentleness and general
lack of side-effects of Eastern medicine has been fairly well-accepted,
so many are willing to try it "if all else fails." I have heard
countless stories that end: "Nothing had cured my problem, so I tried
some of those Chinese herbs. I got better in no time. I mean, who knows
if it was the herbs or if I just got better..."
My family has had such experiences with Chinese herbs and is slowly being
convinced of their validity, although all still express a desire for some
"proof" in Western scientific terms. One relative of mine had
had a history of troubled pregnancies. She had an abortion and since then
had been unable to become pregnant. She and her husband had decided to
adopt a child, although she still wanted to try to become pregnant. My
uncle, a practitioner of Chinese medicine, examined her and suggested a
traditional Chinese treatment. It required a diet change, including significantly
increased iron, a combination of herbs, and the use of Moxibustion. The
process required igniting of a cone of Moxa (a collection of plants that
looked like a bundle of twigs and smelled distinctly like marijuana) and
circling it over the skin at specific points on the lower abdomen and legs.
This treatment was repeated one to two times a day for a number of weeks.
Within three months, my relative was pregnant. Who knows, but apparently
there are now dozens of babies waddling around South Florida who are named
for my uncle, who is credited (indirectly) with their conception. While
even this skeptical approach to Eastern medicine has resulted in many successful
treatments, there is much more room for improved health, if these systems
are trusted fully and implemented in their proper context.
Potential Uses for Eastern Medicine Within a Western Framework and Its
Limitations
There is now mounting scientific evidence to "prove" the validity
of Eastern medicines. For example, "recent studies indicate that Chinese
Herbal Medicine (CHM) has worked effectively in some instances in which
conventional Western therapies failed or proved to be insufficient... They
represent a significant source of new pharmaceuticals" (the-scientist.library.upenn.edu).
Traditional herbs provide a basis for the search for new drugs. Instead
of "random screening" which can be tedious and fruitless, "rational
drug design" can be implemented, a process in which scientists begin
looking for potential drug treatments in herbal remedies that have been
used successfully in Eastern medical systems. Acupuncture has been touted
as an analgesic (pain reliever), and treatments such as giving doses of
bee pollen to prevent allergies are being seriously researched and implemented.
Additionally, Eastern systems are based much more on preventive care than
curative treatments, and preventive care is proving to be significantly
cheaper. One article states, "[E]very dollar invested in preventive
care saves $10 later..." (The Nation 3/3/97).
Problems arise though because all of these successes are of treatments
implemented and understood outside of the framework of the systems in which
they were created. Therefore, validity is not being granted to the systems
of Eastern medicine but only to isolated treatments. Dr. David Eisenberg
asserts that "because traditional Chinese medical diagnoses frequently
appear to have nothing in common with Western medical diagnoses, a comparison
of the efficacy of Chinese and Western therapeutic techniques is extremely
problematical" (Eisenberg 57). Similarly, study of Eastern systems
will always be incomplete and unsatisfactory when conducted with Western
methodologies because while Western medicine views a problem as standardized,
that the same ailment affects different people in the same way, traditional
Chinese medicine asserts that "each patient with symptoms is unique
and each may have a different underlying imbalance" causing a specific
symptom, therefore it is resistant to Western-style statistical research
(Eisenberg 58).
The Case of Acupuncture
Looking at acupuncture and its integration into Western society is a pertinent
way to illustrate the process through which Western science has evaluated
foreign medical practices and the limitations with the way it does so.
Acupuncture is a treatment that involves inserting fine needles into various
points on the body that are on the Meridians (or energy pathways). There
are over 2000 acupuncture points of possible use, although most acupuncturists
would only use about 150 (see diagram.) They stimulate the Qi and Blood,
helping to "rebalance bodily disharmonies." Their basic function
in Eastern terms is to unclog the Meridians, allowing Qi and Blood to flow
freely through the body. In Western terms, acupuncture is used for a variety
of dysfunctions and diseases, from acne to depression to cancer to gas.
When acupuncture was first introduced to the US in the 1970s, it "enjoyed
a brief surge of popularity," which was "quickly followed by
a backlash within the medical establishment, which, unable to obtain 'scientific
proof' of claims made by acupuncture proponents, was ready to abandon it
and to forbid its practice in the United States" (Caudill 79). It
was "listed for many years as an experimental procedure that should
only be performed under the supervision of a Western doctor. In other words,
although it worked, it was not widely accepted until it was shown scientifically
how it worked" (ccchome). This is understandable in our culture that
is based the maintenance of our scientific principles. However, it presents
a roadblock for the use of Eastern and other alternative medical systems
that defy proof by Western scientific research. Acupuncture is one of the
most technical, objective, and arguably "Western" components
of Eastern medicine, which is probably the reason it has been the most
easily studied and widely accepted form of Eastern medicine. Western science
has accepted acupuncture to a degree by proving it in its own terms: "[N]europhysiological
experiments have demonstrated that acupuncture modifies the transmission
of neural impulses between the spinal cord and the brain" (Beinfield
240). They believe that acupuncture inhibits the actions of pain fibers.
It has also been shown to cause the discharge of "endogenous morphine-like"
substances called endorphins, which are hormones secreted from the brain
as a response to stress. These neurological and hormonal studies do help
to validate the use of acupuncture in Western societies, but "they
do not adequately explain its diverse therapeutic effects" thereby
limiting our appreciation for and use of the vast therapeutic possibilities
of acupuncture. For example, there have been studies of acupuncture-assisted
surgery that show that the treatment not only stops pain, "but also
directly affects peripheral microcirculation, rhythm and stroke volume
of the heart, blood pressure, levels of circulating immunoglobulins, gastrointestinal
peristalsis, secretion of hydrochloric acid, and the production of red
and white blood cells" (Beinfield 241). None of these effects are
predicted by theories that came out of the Western nerve impulse or endorphin
hypotheses. Chinese medicine views and uses acupuncture very differently.
It sees
"[a]cupuncture as the process of stirring up the Qi (the invisible
force which animates life and beings) so that stasis is overcome, thereby
restoring circulation, reducing swelling, alleviating pain, and promoting
health... When Qi and Blood ( the material substance and the process of
generating, distributing, and storing nutrients) stagnate, the processes
of elimination and regeneration deteriorate, constituting the basic condition
underlying many forms of illness" (Beinfield 34 & 241).
Although acupuncture can be used effectively when viewed and applied through
either the Eastern or the Western lens, they clearly result in different
types of usage. Since acupuncture was developed within an Eastern framework,
it seems logical that it should be applied that way to achieve maximum
efficacy. This leads me to the conclusion that, although some Eastern treatments
such as acupuncture may be studiable with Western-style research, we should
attempt to approach it from outside of our culture's scientific and philosophical
framework and from within the one from which it originated.
The Differences Between East and West in Philosophy and Practice: An
Interview with Daniel Atchison-Nevel, L.Ac..
Daniel Atchison-Nevel is a licensed practitioner of Chinese Herbal Medicine
and Acupuncture in Florida. He has studied at institutes in California,
Florida, and China. He now runs a center for Chinese medicine in Florida
and teaches workshops around the world on Chinese medicine. We conducted
a phone interview in late March 1997 to discuss the differences between
Eastern adn Western medicine and the treatment of Eastern medicine in contemporary
Western society.
Abby Levine: Is "Eastern medicine" a proper term to use?
What are the different types and can they be talked about as a whole?
Daniel Atchison-Nevel: There are three main medical systems that
operate in Asia: Aruevetic, primarily in India, Chinese, operating in China,
Japan, and Vietnam, and Tibetan. These three think alike in the way they
organize and operate, but their practical applications are entirely different.
A.L.: How does Eastern medicine differ philosophically and in practice
from Western medicine?
D.A.N.:The core assumptions of the two are entirely different. The
Western assumption is that the universe is knowable. In the East, they
believe the universe is unknowable. Western medicine tries to know absolute
truths. The evolution of Western science is a linear progression of knowledge
from myths to scientific "truths." This progression occurs either
through "synthesis," [the merging of A and B into C, until A
and B no longer exist] or "revolution," [the rejection of idea
A for idea B.] In the East, they see the world as "observable."
You can observe ways of living in the world that make you more comfortable
but not discover the way the world works to conquer it.
In Eastern medicine, they don't replace or discard old ideas. They are
as important and valid as ideas conceived of in modern times because there
are no absolute truths [and so we are not moving any closer to a perfect
understanding of the universe.] An Eastern practitioner can look back 5000
years and understand medical ideas from that time. In Western medicine,
they discard concepts frequently. For example, during the Nineteenth century,
there was a prevailing model of the body as composed of "humors,"
and disease was seen as a malfunctioning of one of the humors. This is
a concept that is today not at all a part of our medical system. In Eastern
medicine, the ideas of humors would not have been rejected, but healers
would ask, "How is the concept of humors a part of our other conceptions
of the body? How does it enhance our understanding of the body and the
world?"
Another fundamental difference is the way information is understood and
processed. The West uses "reductionism," breaking things/ people
into their parts. The East operates from a point of "contextualism,"
putting a part or an individual problem in the context of its whole. A
metaphor that illustrates this well is that in Western science, to study
a tree, a scientist looks at the bark and the root system and the leaves,
takes the tree apart to study the functioning of each particular part.
The Eastern belief is that to understand the way a tree works, one should
not chop it down, but must observe it in the forest.
Western science is also based on the assumption of "objectivity"
or the belief that the scientist or doctor can act as an impartial observer.
This separates the doctor from the patient and makes the patient feel disconnected
from their own body and healing. Technology has increased this separation,
processing everything through a machine or instrument before it can be
understood, giving off the illusion of perfect objectivity. Eastern medicine
recognizes that true objectivity is impossible, and instead celebrates
subjectivity. The Eastern healer uses subjective skills far more than Western
doctors. They use visual observations of patients mannerisms, gaits, and
hues. They use their empathic skills, talking to their patients about their
general health, both physical and mental. They rely on palpation, [very
thorough and subtle pulse-taking] and observations of slight changes in
the appearance of the tongue to make diagnoses. Eastern medicine is less
technologically dependent. There are some objective skills required, but
more are subjective skills.
A.L.: The Western scientific community often objects to Eastern
medicine because it cannot e proven scientifically. Can Eastern medicine
be profitably fit into a Western scientific framework or studied with Western-style
research methods?
D.A.N.:Eastern medicine goes far beyond the Western scientific paradigm
of objective reduction. One would have to do bad Chinese medicine to study
it scientifically. One would have to use the same treatment for all patients
which is not something that is done in Chinese medicine. We use different
treatments for all patients each time they are treated because the context
[how the problem functions within the particular body system of each patient]
of the particular problem differs and changes.
Western medicine is better at seeing pathological, structural problems,
while Eastern medicine is stronger at seeing functional problems. For example,
if a patient goes to a Western practitioner complaining of abdominal pain,
the doctor will run a series of tests and diagnose an ulcer. If she goes
to an Eastern practitioner, he may tell her that her liver and spleen channel
is in disarray. The two medical systems can work well together if they
stay philosophically intact and operate side by side. Continuing the example
above, the patient with abdominal pain could receive most relief by seeing
a Western doctor for diagnosis and treatment of an ulcer, and then seeing
an Eastern practitioner for treatment of the functional patterns that created
the problems.
Some have tried to fit aspects of Eastern medicine into Western contexts,
but it becomes mediocre in that framework. Most herbs and natural remedies
that we see in stores here are Western herbs. They are understood and marketed
in a Western way. They are not very effective because they are assigned
to a particular Western ailment which is not the way they are used in Easter
medicine. For personal use in the East, a person has a basic understanding
of herbs as we do of over-the-counter drugs. They do a rough contextual
diagnosis and mix herbs. This is like walking into a drug store for us.
A.L.:How does one become a practitioner of Chinese medicine?
D.A.N.:Traditionally, one became a healer through an apprenticeship.
Often, the role was passed through families. One of my teachers was a 33rd
generation practitioner. Today, in Florida, it is a three year graduate
program to become licensed. It is similar in most states.
A.L.: What are some concrete ways Eastern medicine can be useful
in the West today?
D.A.N.:Western medicine has made great strides in a very few areas;
Its progress is very narrow. It has made great progress in surgery, pharmacology,
and emergency treatment, but it has not been very successful at treating
many functional problems that have reached epidemic proportions in the
US, such as depression, PMS, Chronic digestive problems, Chronic Fatigue
Syndrome, etc.. Eastern medical systems are far better equipped to treat
such disorders.
Nevel sees a way in which Eastern and Western medical traditions can
work together and complement each other to provide more satisfactory care.
In China, there are hospitals where there are alternating floors of Western
and Eastern-style facilities and practitioners. A patient might go in and
see their primary doctor, a Western practitioner, who would then examine
her and either treat her or refer her to an Eastern medical practitioner,
and vice-versa. For this to be possible, however, the two systems must
be autonomous and equally trusted. This is a difficult, if not impossible,
step for the Western medical community to take. It would require doctors
and scientists to look beyond the Western scientific way of understanding
the world and trust another system of logic that contradicts their own
in many ways. This would affect not only the way our culture views and
operates in medicine and science, but in our economy, political and educational
systems, and also the very way we reason about the world and ourselves
within it. Eastern medicine practitioners are looking for ways to document
the success of their treatments to the satisfaction of Western science,
but in the mean time and in the interest of the lives that might be bettered
or saved with the use of alternative treatments, we should remember that
science is a belief system not an organization of objective reality, and
we should expand our beliefs to encompass challenging and unfamiliar ideas.
Works Cited
Beinfield, L.Ac., Harriet and Korngold, L.Ac., O.M.D., Efrem. Between
Heaven and Earth: A Guide to Chinese Medicine. 1991, New York. Ballatine
Books.
Advertisement for Oxford HMO. New York Times. Tuesday, April
1, 1997.
Website on Chinese Medicine: www.hanwei.com/culture/medic.htm
Stix, Gary. "Probing Medicine's Outer Reaches." Scientific
American. October 1996.
Website on Alternative Medicine: www.chinaplus.com
Marshall, Eliot. "The Politics of Alternative Medicine."
Science. Vol. 265. Sept. 30, 1994.
Website on Chinese Medicine: www.europa.com
Finkelstein, Katherine Eban. "Insuring Children: Health Care Reform
Writ Small." The Nation. March 3, 1997.
Eisenberg, M.D., David, with Thomas Lee Wright. Encounters with
Qi: Exploring Chinese Medicine. 1985, New York, W.W. Norton and Company.
Caudill, M.D., Ph.D., Margaret A.. Foreward, The Web that has No
Weaver: Understanding Chinese Medicine. Ted Kaptchuk, O.M.D.. 1983,
New York, Congdon and Weed.
Website on Chinese Medicine:www.ccchome.com