Here are the last few paragraphs of my thesis in Chinese medicine for my MSOM degree at National College of Natural Medicine. As you can probably tell, I did not go as far with any of my research topics as I would have liked. I saw it mainly as a way to learn what resources existed, and sketch a general outline of where I would like to go with my investigations. I have to be frank, I haven’t yet taken the time to explore these topics much more deeply – I’ve been trying to rejuvenate myself from the rigors of school while also opening the clinic and writing more on this blog. However, I have all of the resources amassed and lots of brainstorms and outlines ready to be further explored. I’ll definitely share my ongoing investigations with Deepest Health readers.

—

Read Part I of the final chapter of my thesis

Read Part II of the final chapter of my thesis

—

First, the system must demonstrate a basic level of effectiveness. This could include evidence in the contemporary Western sense of controlled laboratory or clinical research, but could also include a mature history of effectiveness, such as Chinese medicine has in its extensive written record. Obviously, it could also include currently undeveloped research methodologies such as I discussed in Whole Systems Research. It will almost certainly also include so far undiscovered methods of obtaining knowledge.

Second, it must demonstrate its inclusion of a mature system of practitioner education and basic regulation of ongoing practitioner behavior. This simply means that an included system of medicine should show that it is making active attempts to behave ethically and to ensure that its practitioners obtain the highest level of education that is possible. External governmental controls could also be developed that both respect the integrity of the community of practitioners while providing the public with a sense of safety.

Third, a system of medicine should be open to discussion and evaluation by other systems. These interactions should be governed by an understanding that such interaction is for the benefit of all involved, not intended to discredit or eliminate one system in favor of another. Practitioners of each system should seek to become steeped in the foundational material of the other system before they seek to criticize it, as this will make for a more productive and scholarly interaction. My thoughts on this point resonate with the early philosophical work of Alasdair MacIntyre as developed in his book, After Virtue, published in 1981.

Finally, a system of medicine should not be integrated into the larger health care system until it demonstrates its safety for general use. As I’ve already mentioned, one of the biggest concerns about alternative medicine is whether it is safe. This is to be understood, since the primary guiding principle of all medical practice is to “first, do no harm.” Whether by laboratory testing, historical record or some other acceptable method, the system should indicate that its diagnostics and therapies meet a minimum standard of safety. Further, as stated before, the profession should be internally or externally regulated in an adequate way to ensure that practitioners are making safety a primary focus of daily practice.

Of course, there is a viable system of medicine that meets all of these criteria – Chinese medicine.

Chinese medicine not only meets the criteria above, but is also an ideal vehicle for avoiding the kind of objectification of patients that I am arguing against. In Chinese medicine, one always considers the more physical, measurable characteristics of a person as well as the less measurable, subtler features of his mental and social situation. In fact, such a separation of features of the person’s experience is simply not done. Every single identified sign or symptom is taken into the diagnostic framework and interpreted. This includes the more precise information as might be included on a laboratory report. But it also, and more commonly, includes the patient’s vague and self-defined complaints (“fuzzy headed,” “stuck,” and so on). Further, it relies on the complex and embodied senses of the practitioner to accurately observe and interpret the symbolic information inherent in face color and quality, pulse rate and quality, nail bed color and quality and so on. While this may seem a hopeless mess of factors that cannot possibly result in effective diagnosis, much less treatment, such is not the case. Diagnosis does happen, and so does healing. Chinese medicine, through its use of symbol, of metaphor, and its integration of the various subtle meanings and meetings within a human life both in diagnosis and in treatment – has a unique and time tested way to bring the interpretive meeting back into medicine.

In sum, I believe that medicine is not the kind of activity that can, or should, be governed by single-minded adherence to the analytical sciences as they are currently practiced in most places in First world nations. Such devotion to technological medicine encourages a compartmentalized way of viewing the body and the human being’s place in the universe while also producing a distance between doctor and patient that is not conducive to healing. We need not abandon the analytical tradition or the fine tools brought to us by contemporary Western medical practice. But nor should we attempt to eradicate all systems of medicine that fail to meet our ideological standards concerning evidence. Condemning disciplines based on ideological notions of “pseudoscience” cannot be helpful for patients. A more inclusive approach respects the integrity of safe, integral and mature disciplines while acknowledging the need for the public to feel reasonably assured concerning their safety and effectiveness.

Related posts:

1. Phenomenology and Classical Chinese Medicine
2. Phenomenology and Chinese Medicine : the lifeworld, holism and integrative medicine
3. Phenomenology and Chinese Medicine : Our body is the greatest medical technology

Chinese medicine and phenomenology thesis Part I

Chinese medicine and phenomenology thesis Part II

EDIT 8/5/09: I just realized that the portions linked above were mistakenly taken from an earlier draft of the thesis. I should be more careful! Please forgive me if there are any inconsistencies between the versions.

—-

According to Svenaeus, important information that penetrates the clinical encounter is, in a way of speaking, pre-scientific. It is prescientific insofar that is minimally mediated by theory and not readily systematized by the analytical processes recognizable as the basis of contemporary science. In the terminology of philosopher Edmund Husserl (and later, Martin Heidegger and Maurice Merleau-Ponty), this information is all part of the lifeworld. The lifeworld is the sum total of lived experience, not as a static object, but as it is lived. It is those things and experiences that, woven together, make up what we refer to as our life. Things only have meaning insofar that they are situated within the lifeworld. Abstracted outside of that, they cease to have what most of us think of as “meaning” or “importance.” This is obviously a very deep philosophical concept, and I cannot elucidate its full meaning here.

However, it seems, when applied to medicine, as a clinical encounter between two human beings, this theory can inform practitioners that we should seek to engage the wholeness of each person during each encounter. If we incorporate information taken from laboratory tests, or other processes that isolate particular characteristics of our patient, we should situate that information in a field of everything else we know and can perceive about the patient. This would include demographic information filled in on a form, the subjective reports of the patients, our understanding of the world and regional situation the patient is confronting (war, weather, and so on) as well as all the information available to the senses of the physician. Physical palpation (including of the pulse), the visual presentation on all levels, the sound of the patient’s voice, any odors that can be perceived may all provide us with information of use in diagnosis. Before the advent of modern medical technology, of course, this was the primary source of information that physicians worked with.

We can utilize this “lifeworld field” in the service of restoring the patient to a greater state of health. In this view, far from being extraneous information, the particular life characteristics of the patient are a key component in her disease process, physicians’ diagnosis of it the ongoing healing process.

Later, Svenaeus indicates that there are efforts in the mainstream medical community to take seriously the implications in the type of argument I am advancing. These enterprising physicians are attempting to construct a system of medicine that situates the lifeworld centrally in the clinical gaze. You can see evidence of this in the formation of medical centers that incorporate spa services, family and individual counseling and other such services. While the chapel has always been a feature of hospitals, increasing numbers of medical centers are also offering meditation, Taiji, yoga and other benefits that seek to address the spiritual side of its patient population.

The inclusion of these services within the medical center itself shows an understanding that the healing of the physical body is not separate from the health of the rest of the human experience. Some of these medical centers have also begun to offer complementary and alternative medicine alongside Western medicine. It is obviously important to point out that complementary and alternative systems of medicine (CAM) take the wholeness of the patient very seriously. In fact, the primary focus of most CAM therapies is to restore the person to harmony within that wholeness of their being.

“One central goal of CAM is to improve the “wellness” of the patient. Rather than just removing a disease-producing agent, “quality of life” is emphasized by treating functional or somatic problems with ancillary and important psychological, social, emotional, and spiritual aspects” (Complementary and Alternative Medicine: An Evidence-Based Approach, John W. Spencer, Joseph J. Jacobs) 17.

The continuing integration of CAM into hospitals and other large medical facilities indicates that many Western medicine practitioners are seeing the value of these services.All of these changes, and the important conversations they generate within the profession of Western medicine, are quite important. As CAM becomes increasingly integrated into mainstream medicine, it will begin to inform the practice of Western medicine even as it is informed by Western medicine. Perhaps, then, the holistic nature of the human being and the importance of considering the lifeworld of the patient when diagnosing and treating will become a more central principle in all of medicine.
There are a number of concerns that mainstream medical practitioners and Western scientists have about this integrative process – many of them discussed in my paper already. Much of the worry centers on two basic desires. First, people want to know that medicine, meant to heal, is not harmful for patients. Second, people are concerned that even if a therapy is not harmful, it may simply be an elaborate placebo-based swindle duping hapless patients. While there is much I have said and could say about this, I would like to suggest a few basic principles that can guide us when deciding what therapies and systems of medicine we would like to integrate into our unified health care system.

These principles encompass elements of all the criteria of demarcation I have already discussed, while creating a system of holistic care that takes seriously the lifeworld and personhood of the patient. If a system of medicine or particular therapy does not meet these criteria, I contend that it must work to rectify any deficiencies before being embraced by the mainstream.

Related posts:

1. Phenomenology and Chinese Medicine : Our body is the greatest medical technology
2. Phenomenology and Classical Chinese Medicine

If you missed the first installment, please go read about Phenomenology and Chinese Medicine (Part 1).

—-

The doctor possesses all the same complexities [as the patient]. When the two come together, they are also under the influence of the particular place and time where they meet. The multiple variables inhering on the situation boggle the mind. The weather, the paint, the particular complement of the room, what’s going on in the news and whether either is aware of it. This is all perceived, on some level, by everyone involved – though perhaps not consciously. I do not want to imply that each of these variables has some lasting, measurable effect on either one of the participants in the encounter. I simply want the reader to keep in mind that every single medical encounter is simply two human beings, with their messy lived experience, coming together for the purposes of rectifying or maintaining some particular state that each agrees is worth attaining – health or the cessation of disease – depending on one’s outlook.

I want to caution the reader against assuming that this “messiness” as I’ve called it is a detriment to medicine, as some might imply. It is attractive to some to believe that if we simply make diagnosis and treatment maximally objective, by using the mediator of advanced technology and standard diagnostic and treatment protocols based on sound science, we will come to a purer, more useful medicine. But if this results in the removal of the human being from the doctor, if this results in the replacement of the patient by a list of variables gleaned by diagnostic tests, it can do nothing but take us farther down the road of an impersonal medicine that makes mistakes because it does not know enough about the person of its patients. I do not want to imply that any particular medical system, in its totality, does this on purpose or by design. But it is a danger for any medical system, particularly one that seeks to become increasingly rooted in objectivity.

Several philosophers, particularly those who are categorized as “Continental” philosophers, such as Foucault, Heidegger and American Philosopher Richard Rorty can help us to understand why this subjective, messy and quintessentially human nature of medicine is so actually an important feature of its integrity and usefulness. To analyze all of these philosophers and develop a rigorous theory concerning this point is a dissertation-level project. Fortunately, philosopher Fredrik Svenaeus, in his book The Hermeneutics of Medicine and the Phenomenology of Health, does an admirable job of pulling together diverse thinkers in Continental philosophy and other traditions to develop a rigorous philosophy of medical practice. I will offer and annotate some of his argument here as I believe his work points a way forward in any discussion of whether and how

The central focus of Svenaeus’ argument is the examination of the clinical encounter – the functional unit of medicine. Svenaeus explains that technological medicine and an increasing reliance on laboratory research has created a separation between the patient and the doctor. This separation is produced when the patient is not seen as an integral human being with mind, body and cultural context but is instead seen as a kind of space in which particular biochemical reactions and microorganisms are present in specific concentrations and configurations. In essence, the patient has become an object to be carefully studied by the doctor. He explains,

“Negligence of the human side of medicine has been fostered and fed by a focus upon medical scientific research and its biological objects, as existing in a relation of opposition to, instead of connecting with, the encounter between doctor and patient with its specific ‘lived’ characteristics”(Svenaeus, 2001, p. 7).

Much of the patient’s lived experience is disregarded as irrelevant in the situation at hand, unless a study has vindicated that some feature of that experience affects something that can be measured in a laboratory. This, he believes, takes medicine away from its purpose and power as a clinical practice. In sum, the ongoing pursuit of solely objective information as provided by the “causal” studies I discussed above is creating an undesirable side-effect: the removal of the human from the practice of medicine.

There are obvious ethical implications here. When we approach human subjects as objects, our ability to relate to them and, ultimately, to treat them as persons suffers. In the most extreme cases, this leads to sociopathic behavior such as is found in scenes of torture and police brutality. Obviously, in the medical context, the situation is not so extreme. The vast majority of physicians, regardless of their ideological stance, seek to help their patients. But, this is not only a philosophical or ethical issue. I contend that medicine that takes the intersubjectivity and embeddedness of its patients seriously, even makes that the very center of clinical thinking, is actually more effective.

In his discussion, Svenaeus recommends a variety of introspective turns that medical professionals can take. In essence, they all point to the same holistic conclusion. While technological advances and laboratory testing can provide valuable information, physicians must see these variables as only a couple among many. The amazing advances brought about by technological science allow us to, in a way, extend our senses. However, this happy development should not cause us to abandon those bodily tools that physicians have been using since medicine began.

Related posts:

1. Phenomenology and Classical Chinese Medicine

“In modernizing TCM, efforts will be made to improve standards, study new applications and standardize planting, production and processing of medicinal herbs, according to the report of the center, which is under the Ministry of Science and Technology.”

This doesn’t sound too bad, actually.

I can understand the wisdom in standardizing planting, production and processing of herbs. Unfortunately, standardization too often means bringing everything down to the standard of the least excellent instead of bringing everything up to the standard of the most excellent! If they are going to standardize the herb industry they need to take care to:

• Make sure the integrity of biological systems is maintained, or where already damaged, improved. The energetic quality of the herb is certainly impacted by its environment. In ancient times, these herbs grew wild – in harmony with their surroundings. The best quality of many herbs is still found in their wild counterparts! In standardized cultivation, one should do the best they can to replicate that environment – even if it harms yields.
• Follow traditional guidelines in harvest and processing of herbs.  Some, like Heiner Fruehauf, are devoted to making sure this takes place.  If in the Materia Medica an herbs is meant to be mix-fried until yellow, don’t char it. If it is meant to be processed in salt water, process it in salt water. Perhaps contemporary research methods don’t pick up the difference between one processing method and another – but don’t kid yourself into thinking that the sages that developed this medicine were stupid. Their guidelines were precise and developed over centuries of testing. Respect that.
• Use the implementation of standards to ensure the elimination of heavy metals, pesticides and non-edible products from the herbs.

Unfortunately, this isn’t likely to be all “modernization” has in store for Chinese medicine in China.

If history is any measure, it will almost certainly entail the purging of important information from the official canon and redoubled efforts to justify Chinese medicine from a Western scientific standpoint. Further, practitioners with diverse (yet vital and functional) theoretical standpoints, diagnostic methods and treatment principles may be forced to embrace the standard despite the fact that it is not clinically more effective. This, so the line goes, is the only way that Chinese medicine will be accepted into the mainstream.

If that’s what it takes to be accepted into the mainstream – I’ll take the tributaries.