A Soldier's Song
[Traditional Chinese Medicine. Source: Flickr.com]
The Chinese people have relied on their own medicine for ages, until recently when some scientists raised a signature campaign to call for abandonment of the Tradition Chinese Medicine – both theoretically and practically – all around China. However this event triggered my consideration of some features of TCM that may be of the science of complexity.
The Trouble of TCM
Based on the the Yin Yang and Five Elements theories, TCM has been the only salvation of the ill since the Yellow Emperor period, in which the Huangdi Neijing (Yellow Emperor’s Inner Classic) is believed to appear and become the earliest classic of TCM. Later classics includes Shang Han Lun (On Typhoid), Compendium of Materia Medica, Jing Kui Yao Lue, and several other books from different dynasties (A short yet complete introduction to TCM is available here). After the commencement of modernization from 1840, China started to adopt modern science as a foreign culture, which solidified into the mainstream late in the 1980s under the policies of Deng Xiaoping. Nevertheless, TCM still survived throughout this history and remains the alternative to modern medicine (or western medicine as we call it). TCM is the first choice of almost half the population taken ill, especially normal diseases. The status of TCM in Chinese hygienic system is still a ruling one.
However, taken the anti-TCM signature campaign taking place in China as a sign, compatibility with modern science is an inevitable obstacle TCM today has to face. TCM, theoretically speaking, is a direct application of the Chinese philosophy. It bases its clinical practice on the ancient Yin Yang theory, although the detailed development and enrichment later is systematically rigid. So the language of TCM is unique compared with that of western medicine. For example, there is little convention of anatomy in TCM. All the names of organism in TCM refer to vague concepts rather than the specific anatomic structures that physically exist in human body. And there are only complex and abstract guidelines that instruct what herbals to use or which sites to undergo acupuncture for difference disease in these conceptual organisms, and in clinical practice it largely depends on the doctor’s wisdom and experience to write the right prescription for a specific patients. Therefore TCM is accused for its randomness and irreproducibility, let alone the dubious and superstitious parts alongside, and denied to be a real science.
The Trouble of Life Science
On the other hand, has the western medicine totally escaped from randomness or irreproducibility? As an outsider I should not draw any conclusion but since not long ago there has been the discussion of the Evidence-Based Medicine, which actually calls for less randomness and more reproducibility both in clinical and theoretical medicine (I post some of my humble opinions on this in my old blog). However, as our knowledge of life accumulates, basing medicine on evidence becomes increasingly difficult, because what we have discover about life belongs to the so-called complex system, which the traditional reductionistic approach cannot deal with.
The Science for Trouble
Complexity is not only found in life. Weather, ecologic system, business, and society are other example of complex system, all of which we earlier found it difficult to clarify based on reductionism, the general convention of science since its modernization. A viewpoint article by M. Regenmortel on EMBO Rep. 2004, 5, 1016-1020 (DOI: 10.1038/sj.embor.7400284“) discussed this issue in terms of molecular biology, in which the author proposed treating complex systems such as life phenomena with an emergent approach – phenomenologically realizing a property instead of finding its causes reductionistically.
Although this approach contradicts in a great measure with the tradition and may not seem safe to apply, TCM has already given many positive evidences of the effectiveness of emergent treatment of human body. TCM theory is totally emergent: In the context of TCM, entities are vague in structure and morphology, while relationships and functions are emphasized, be they vertical or horizontal.
For example, according to the Zang-Fu theory, there are five zang (heart, lung, spleen, liver and kidney) and six fu (gall bladder, stomach, large intestine, small intestine, urinary bladder and the sanjiao – three areas of the body cavity) organs in human body. These conceptual organs are classified according to their different features, so in fact there are no anatomic analogues to these names (as I have mentioned above). But according the functions of the Zang-Fu, they all seem to correspond to a collection of anatomic organs or tissues, and the TCM classification successfully overcomes the complexity one otherwise must face if he/she has to derived the pattern of functions from the pattern of anatomic structures.
Another example lies in the diagnose. In the diagnostic principles of TCM, the balance of Qi and treatment based on time (seasonal and climatic conditions), place (geographical location and environment), and person (such personal characteristics as age, sex, living customs, and body constitution) are emphasized. Human body is treated as an open system that exchanges matter and energy with the environment. Western medicine also emphasizes this principle, in a reductionistic context, though, full consideration of these factors is impractical, if not impossible. In contrast, TCM has provided practical theories on which Chinese doctors has relied for thousands of years.
Please do not feel that I am propagandizing the greatness of orient culture or something like that. TCM is far from being any prototype of the complexity science. I relate it to complexity only because it is now severely attacked by reductionists in China (as I have mentioned in the beginning) while it shows many features of complexity, and it may serve as a good reference for the development of the science of complexity.
Last updated: Sunday, 20 May 2007 - 16:22 GMT
© 2008 Nature Publishing Group
Traditional Chinese Medicine is alive and well in Woking (a small town near London). We have two groups of practioners called ‘Dr & Herbs’ and ‘everwell’. They offer acupuncture, acupressure, herbal medicines, Chinese reflexology and earcandle treatment. The list of problems that they treat is quite long, but most fall into the category of conditions that are, to my understanding, managed rather than cured by ‘conventional Western medicine’ (e.g. migraine, eczema, anxiety).
At the risk of stating the obvious, the reductionist approach has actually been remarkably effective. I am definitely open to the idea that the niche filled by TCM (in Woking!) is that of conditions where a different, more holistic? approach is necessary. I think that with the greater emphasis that is being placed on fields such as ‘Systems Biology’ in basic research, we can expect ‘Western Medicine’ to become increasingly better equipped to cope with (and more enthusiastic to embrace) this approach in the future?
You have pointed out the most central difference between TCM and western medicine. TCM does not cure any specific illness in human body. It just, as it claims, re-establishes the balance of the body. This sounds very pseudoscientific (and it may indeed be!) but it does represent the result of a different approach to understand human body. Reductionists always find the cause of a phenomenon; their doctors can always give their patients the sense of ‘cured’. Maybe Chinese patients are equally satisfied with that of ‘managed’?
However if you are implicitly stating that TCM is just effectiveness, I still agree with you, (partly, because even in China, TCM doctors that are able to bring out the full effectiveness of TCM are rare). In terms of effectiveness, obviously reductionistic medicine won the first round, almost without competitors. It not only cures people, but also shows the cause of the illness in a reductionistic way, which the generations grown under the influence of reductionism may be well satisfied. TCM will not become a science even in ‘the age of complexity’ but it may provide and example for how to understand the nature in an emergent way. If you see TCM as a trial of ‘emergent medicine’ rather than some ancient theory of China (full of ancient naiveness), you may find it quite a successful trial, with large cases of effectiveness in practice, although still not enough compared with its reductionistic counterpart and the current need of the patients. So we should not abandon TCM but re-investigate its theory with new eyes.
It is possible to demonstrate the effectiveness of a treatment without being able to reduce it to specific mechanisms of action.
The problem with many traditional or “alternative” medicines is that they cannot meet this minimal burden of proof.
An aunt of mine has studied chinese medicine (here in Brazil!), and I always find it quite interesting to hear all the concepts they tought her!... :)
Now, if you can excuse me to take the opportunity to advertise that big post of mine ... ;)
I believe we use the word “reductionism” in two different meanings, and this should be cleared up.
One thing is to study fundamental interactions that build up complex systems from basic particles. This is the reductionism that comes from the scientific analysis, and ends up in the Laplacean mechanicism. I don’t quite believe science can escape reductionism.
To make a simple test for TCM, picking up N people with any diseases, and treating only half of them, and letting the others without treatment, and seeing if it makes a difference would be a reductionistic experiment, even tough we don’t even talk about what were the medicines made from… We are considering TCM as a fundamental force, that is either on or off, and seeing what happens. It’s basic logic!...
Now, there is something else that people also call “reductionism”, and only this is in contraposition to holism: it’s the idea that you can study small perturbations in a system, and then predict that the effect of a larger and more complex perturbation will be a simple linear superposition of the predicted individual effects. This is making simplifications to a model, turning a non-linear one in a linear, for example.
There is nothing in the previous study of the fundamental forces that obliges us to use simplified models. On the contrary, the “bottom-up” reductionist-approved model should be very much complex!...
The holist would be someone aware that you can’t make those simplifications, while the reductionist would be someone that believe that things are all simple. This is wrong… We must undertand that, and pick up another name for those anti-holistic people. Reductionism is not to be simplistic or naïve…
And the fact that a very complex “reductionist” model “doesn´t tell us anything” is also something else.