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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.

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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

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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.

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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)

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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

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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.

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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

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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’.

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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

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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

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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].

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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

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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.

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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.

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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 single-

masking 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

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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

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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.

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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

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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 de-

colonized 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 two-

way 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

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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 4 Linda H. Connor &Geoffrey Samuel op. cit., pp. 7-8. 5 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. 8 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. 9 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’.

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10 Evan Willis, Medical Dominance: The division of labour in Australian health care, Sydney, George Allen and Unwin, l983. 11 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. 13 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. 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> 14 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. 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). 19 Liu Hong Tao, Zhongguo Gudai Keji Shi [History of China’s Ancient Science and Technology] Nankai daxue chubanshe, Tianjin, l991, p. 8. 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]. 21 Benson K.A., “ A Comparison of Observational Studies and Randomized Control Tests”, New England Journal of Medicine, 2000, 342:1878-86. 22 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].

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23 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]