The Role of Yì Fâ [Intention & Method] in Healing
Introduction by Richard Freiberg | Introduction by Phil Rogers | Article by Scheid & Bensky
Introduction by Richard Freiberg <acudoc11@aol.com>, Fri, 15 Sep 2000
Below (#1) is an introduction into the work of Volker Schied, a research Scientist who has specialised in cancer. Volker Schied & Dan Bensky wrote on the subject of "Yì Fâ". The article has much to do with the area of discussion. With this in mind I confirm from my own experience that the interaction between healthcare provider & patient is much more than a list of points or a formula of points.
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#1 "My own [Richard's] work may not fit easily into categories. I feel for example that the treatment method - even when successful, does not describe the disease process it treats. Treatment is a pragmatic & partial set of data - even though when successful it is the most urgent set of data. We are looking at time varying electro-chemical reactions of the larger biological molecules. These energy spectra are underlying interactive processes in the living state. They have received no attention historically because they require training in physical chemistry, physics, & electronics. Also the instrumentation is very specialised, requires special course-work, and is expensive. It is important to do this because otherwise biochemical energetics is limited to isolate concepts of metabolism & ATP levels. Metabolism is not an adequate approach to the diffuse nature of energy in the living state, where it dances & rapidly signals & shifts energies & action potentials. My group is preparing a summational manuscript for a major Journal on these concepts. I also have a report coming out on pseudo-inductance in the gene polymers. These are magnetic fields (expressed by Ampere's law) from cations being pumped through DNA & RNA. These fields have precise ultra-low frequencies, & extend over distance through heterogeneous media, to signal other polymers with synchronous capacitative frequencies. I believe these are the living state resonance patterns. I believe they are important & fragile".
Phil's categorisation of points [http://homepage.eircom.net/~progers/ff.htm] is a statistical "world experiential" listing or dictionary of AP point usage over centuries of time, not just an isolated snapshot in time. From there it is up to the energetic interplay of the practitioner & patient, the time of day, the conditions of the year, the geography, the malady, how deep the imbalance is in the body, the overall condition of health & disease of the individual patient at the specific point in time, etc. There are too many variables to set out a specific point formula that makes any kind of sense for EVERY patient & EVERY condition. [Salutation: On Wings of Light, Richard Freiberg]
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What follows is an edited version of the text by Scheid & Bensky. I have taken the liberty of making very slight changes, including highlighting some of the most important statements.
In my opinion, this is a text of immense importance - one to be read over & over until it sinks into the subconscious, & can be brought to the conscious at will.
Great Yi & Qi to all who read this. Phil Rogers
Keywords: bian, bianzheng, bianzheng lunzhi, cheng, cheng yi, de, fa, fang, ge, ge wu, jing, jingfang, jingyan, lun, lunzhi, nei, neijing, shen, shi, shifang, wu, yan, yi, yi de, yi fa, zheng, zhi
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#2 "Medicine is Signification" - Moving Towards Healing Power in TCM
Volker Scheid Ph.D. and Dan Bensky D.O.
As this years BAcC Conference demonstrates, defining with more precision what it means to be an acupuncturist, herbalist or practitioner of Oriental medicine is becoming an urgent question in the rapidly transforming world of medicine in the West. It is a question that contains within itself a number of important sub-questions such as:
Each of these questions deserves detailed analysis. They also demand of us first to answer an even more important question, one to which we pretend to know the answer (for it is crucial to everything we do). The question is: what is CM actually? To the best of our knowledge, the question has never been addressed in a satisfactory manner by any proponent of CM in the West. In this article we shall provide an idiosyncratic response. While neither complete nor based on the kind of comprehensive investigation which would indeed be necessary, it reflects our current thinking. We believe that this response can act as a stimulus for future research, reflection and debate.
From Descriptive to Normative Accounts: Healing Power in CM:
One way of looking at CM is to examine how CM is practised at a given place at a given time. Such studies are known as descriptive accounts. All available descriptive evidence informs us that throughout its history CM has been characterised by two important characteristics, heterogeneity & plurality.
Heterogeneity implies that neither medical traditions nor medical practitioners constitute entities with clearly definable boundaries. Biomedical knowledge, technology & research practices, for instance, are infiltrating contemporary CM around the world, even as traditional poetry, painting & calligraphy continue to constitute powerful influences on Chinese physicians. In Europe & the United States CM is reshaped by its association with peculiarly Western understandings of concepts such as holism & energy, while in China it is redefined through particularly Chinese perceptions of science & processes of modernisation. New practices like auricular AP (which soon become "traditional") continually emerge in the ongoing commerce of ideas and technologies between East & West. Even apparently immutable core concepts of CM such as Qi & practices such as pattern diagnosis are continually up for discussion as social, cultural, technological & economic factors penetrate into the medical domain.
Plurality is a consequence of heterogeneity. It indicates that at any one place & time we usually find a variety of different ways of thinking about the body, of diagnosing & treating it & of ideas about what constitutes good medical practice. We also can observe various types of practitioners, ways of transmitting knowledge and usually of competition between individuals & groups. Importantly, this plurality exists at any level of description, within as well as between medical traditions, & even with respect to individual physicians whose practices change over time or in different contexts.
Immutable or bounded medical systems thus only exist in our imagination. Actually existing medicine emerges in & through an ongoing processes of borrowing, exchange & assimilation over which physicians have only very limited control. This is an important observation. It undercuts a tendency, deeply ingrained in Western thought, to think of objects of description as bounded phenomena whose attributes can easily be compared & contrasted to each other. It contrasts Western medicine versus CM, CM in the Imperial era versus modern TCM, the Shanghanlun tradition versus the Wenbing tradition, scholar physicians versus shamans, science versus traditional knowledge, medicine versus art & so on.
Reflecting on descriptive accounts of CM thus brings us face to face with a widely discussed issue of post-modern life, the problem of relativism. If we allow for the co-existence of a potentially unlimited number of different practices of CM, how do we relate ourselves to them? This calls for a second type of inquiry: a discussion of the proper ways in which CM should be practised. This is known as a normative account. Normative accounts are always political in nature and are always produced within the contexts of ongoing debates and struggles: inter-professional struggles between various medical systems, intraprofessional struggles between various schools of thought & intrapersonal struggles about how to develop one's own practice. Descriptive & normative accounts unfortunately often get mixed up with each other. As a result we mistake our value-laden (normative) judgements of what we believe we should be doing for a (descriptive) account of what we think we actually are doing. When we are then confronted with the reality of CM in all its complexity & all of its complications, we end up fighting each other about who represents true CM. Or we reshape history, theory & practice so as to create the systems and traditions we imagine ourselves to represent rather than follow where our patients lead us. This process not only causes us to lose respect for truth but also limits our potential for understanding & efficacy in the clinic.
We therefore suggest that any attempt to construct a normative account of CM must be attentive to the following. First, that it is in fact a normative account. That it is an attempt to define for ourselves what CM is and, by implication, also an attempt to define ourselves. That it is accordingly always a personal statement & never a statement of truth.
Second, that it should by guided by what we know from description to be true: that CM is heterogeneous & plural. Many (but not all) physicians in the history of CM have experienced this richness of tradition as empowering rather than as a hindrance. If, for us as Westerners, plurality & difference is more difficult to tolerate than this says something about ourselves, not about CM. In that sense, our normative account should be therapeutic & encourage the development of an open-minded, tolerant & inquiring profession.
Third, that it should allow for heterogeneity & plurality not only on the level of tradition but also on that of personal development. That it should guide individual practitioners in attaining mastery of the craft they have chosen without surrendering their individuality in the process.
We suggest to draw for this purpose on Brodwin's concept of healing power. This is an attempt to collapse into a single analytic framework how actual medical practice emerges as a synthesis of the plural & heterogeneous actions of physicians & patients. Healing power is a deliberately inclusive term with a variety of interlocking meanings, connoting clinical effectiveness as much as the manner in which medical practice functions as a tool in people's search for personal identity. By its very definition, it is a concept that admits to the fragility of all knowledge & to the limited role played by physicians in the process of healing. Constructing a normative account of CM thus becomes the task of formulating how we, as practitioners of CM, might best move in the direction of healing power given the tools bestowed by the tradition to which we claim to belong.
CM & the Notion of Yì
Normative discussions about what medicine is took place in China even before the compilation of the great medical classics. Throughout subsequent centuries many famous scholar-physicians made personal contributions to these debates, creating a large corpus of works referred to in contemporary China as yï dé writings. The term yï dé is usually translated as "medical ethics", though the varied contributions to the genre relate themselves to the "character of medicine" as a whole, that is to practical as well as moral dimensions of medical practice without distinguishing categorically between the two.
We shall examine one much discussed statement from this canon of yï dé writings. It is a play on words which in Chinese reads yï zhê yì yê, which for the time being we translate as "medicine is intention". The reasons for the choice of this phrase are straightforward. First, it is a statement about medicine. Second, it has served as the focus of yï dé debates for 2000 years. Many famous scholar physicians such as Sun Simiao & Zhu Danxi have written about it. Modern textbooks & commentaries continue to deliberate on this phrase & contemporary schools of CM discussed it. Third, while in these discussions (a number of which we shall translate below) the precise meaning of yì is contested, its importance for medical practice is never questioned. The concept of yì, simultaneously characteristic of CM yet also plural and heterogeneous, fulfils all the conditions from where we might develop the kind of normative theory that we desire.
The literature of the Han Dynasty acupuncturist Guo Yu was the first to elaborate on the importance of yì in the realm of medicine. King He asked Guo Yu, who was renowned for his needling skills, to explain the essence of his craft. Guo Yu replied: "As for doctors talking about intention, the interstices & pores have extremely subtle divisions, so to follow the Qi requires skill. When inserting the needles & the stone [probes] between them, being a hair off means failure. The knack exists in the connection between the heart-mind & hand. It can be understood, but it cannot be spoken of".
Here, Yì (intention) seems to refer to that which the physician desires & consciously conceives of, that which he wills, but also to that which comes about through a kind of focusing of consciousness. The present best guess as to the original meaning of this word is that it referred to what goes on in one's mind before speaking. According to Graham, it is the image rather than the concept of a thing, & the movement to action with which one responds to it. In that sense, it is a practical activity that goes beyond conceptual knowledge or the application of a technical skill. Nevertheless, it is something the doer can identify and execute & which allows him to bring about desired effects. This becomes even clearer in a subsequent passage where Guo Yu explains how anxiety hampers intention. "Now when it comes to treating nobles, they look down on me from the heights of their distinguished places, & I am filled with anxiety that I might not please them … Though the AP needles demand precise measure, with them I am often in error. I am burdened with a heart full of trepidation, compounded by a will reduced in strength. Thus intention is not fully there. Consider what influence this has on treating the disorder. This is the reason I cannot bring about a cure".
Intention, however, is a noun whereas Guo Yu is talking about a practice. Hence, translating yì verbally as "intending" to denote that which the physician does or, indeed, has to do in order to achieve a cure might be more appropriate. But what precisely is "intention" or "intending"? & why is it of such crucial importance for physicians?
To answer the first question we can explore some of the contexts of the use of the term "yì" in early Chinese philosophy. In pre-Han China, yì (intention) was considered a pre-requisite of the knowledge & understanding required for & derived from the divination practices based on the Yijing. "Intention is what the sages used to search profundity & study the all encompassing. As it is profound, it can penetrate throughout the purpose of the subcelestial realm. As it is all encompassing, it can penetrate throughout the affairs of the subcelestial realm. As it is divine, it is fast but never hurries & arrives but never travels".
Yì, intention, is that whereby one "searches profundity" & "studies the all encompassing" to arrive at complete understanding. This process is a complex one that is "fast but never hurries", that "arrives but never travels". It implies the use of a logic that does not proceed from observation to conclusion in well-defined steps as along a line or algorithm. It is a process with its own trajectory or natural flow that follows a path or dào by the exploration of subtle resonances & the weighing up of imponderables that result in complete & penetrating insight into the totality of a situation
Although in later texts, yì takes on exclusively mental connotations, in pre-Han texts such as the Guanzi, it still involves the meditation-like bodily practice of "intending", whereby one opens oneself to the universal flow of Qi so as to acquire a luminous awareness of the world. "Hence this Qi, cannot be stayed by force, but can be established by potency (dé); cannot be called by the voice, but one may go to meet it by intending as it comes. By reverence hold it fast, do not let it go: this is called maturing of the potency. Potency being matured, knowledge issues, & to the last one the myriad things are grasped".
All major schools of Chinese philosophy discuss the nature of yì & its relation to knowledge. In the Great Learning, one of the five Confucian classics, the notion of chéng yì or "integrating the intentions" is an essential component of the process whereby the ideal Confucian person develops sincerity. Sincerity manifests outwardly in the authenticity of one's words, an authenticity that ultimately effects the best possible order of things. Inwardly, it depends on a perfection of knowledge that comes from arriving at the things (gé wù). Although the Great Learning does not elucidate what it means "to arrive at the things", Graham argues that already in classical Confucianism it implied a valuation of knowledge as the foundation of authentic action. "Knowledge is perfect only after the things have been arrived at, & only then is there integrity of intention, & only then are hearts correct, and only then are hearts cultivated, & only then are families regulated, & only then are states in order, & only then is the Empire at peace".
Cultivation of one's person is the cultivation of one's heart, the bodily function from which appropriate action issues forth. Such action can only originate from a heart in which all intentions have been brought to integrity. Integrity (chéng) here implies the wholeness or completeness of a person that manifests itself in speech. According to Hall & Ames it also refers to accurate, self-fulfilling forecasting. According to Graham, intention (yì) thus includes both the image or idea of a thing, our knowledge of it & the intention to act which is inseparable from it & which manifests itself in what the heart does.
This is the same association that the authors of the Neijing later translated into a medical context. In the Língshü we learn: "That which takes responsibility for things is called the heart. The heart has a place to focus its attention which is called intention (yì)".
In the Nèijïng the heart is also the residence of spirit (shén). & as we know from both reading and experience, spirit manifests itself simultaneously in the integrity of our actions & the clarity of our understanding. In both medical & philosophical contexts we can therefore speak of yì also as a kind of intelligence, an intelligence which comes from knowing & which manifests in doing, though an intelligence which goes beyond representational knowledge.
Zhuangzi provides us with a Daoist reading of yì to emphasise this latter point: "The bait is the means to get the fish where you want it, catch the fish and you forget the bait. The snare is the means to get the rabbit where you want it, catch the rabbit & you can forget the snare. Words are the means to get the idea (yì) where you want it, catch on to the idea & you forget about the words. Where shall we find a man who forgets about words, & have a word with him?"
For Zhuangzi words can never express reality as it is, even if a Confucian gentleman utters them. Words or concepts are intrinsically unreliable because of their tendency to fix the complexities of the world. Ideas (yì) come closer to how things really are because in our minds we can view different ideas & images all at the same time & thus grasp a thing from many perspectives at once. This is the reason why we can understand the world & act purposefully in it, even if that understanding is not always communicable. True knowledge & successful behaviour, thus are not rooted in accurate representations (as in Enlightenment positivism), nor do they presuppose counter-rational intuitions (as in Western Romanticism). For Zhuangzi they flow from a kind of unanalysable knack which manifests itself in all kinds of masterful craftsmanship.
Because it implied a limited but real power over life & death, medicine was one such craft in Imperial China. The craft was at once exalted but also demanded very special skills. Many physicians argued that yì (intention, intending, ideas, intelligence) was the basis for efficacious action in medicine. Sun Simiao, for instance, stated emphatically that "medicine is yì. Those who are proficient at using yì are good doctors". In another passage, which deals with how to correctly select between different modes of administering medicinals he repeats that only "…those who can match [the correct type of medicine with the appropriate condition] … can be considered superior craftsmen. So it is said, "Medicine is yì"".
Several hundred years later, Ming dynasty physician Zhao Xuemin restates this view: "Medicine is yì. It is not as good to use medicinals as it is to use yì. Whether or not a treatment works is based on yì. If yì can enter the fundamental subtleties [of the illness], one can achieve a penetrating understanding. After this, when one uses medicinals, none will not work as expected".
Following Sun Simiao, Zhao Xuemin and many others, we thus note that physicians move towards healing power by way of their yì. They must be able to enter into the totality of a clinical situation, view it from different angles simultaneously, match it with ideas already present in the mind, compare & contrast them, weigh up different possibilities for action & then, & only then, do exactly what is appropriate. We therefore suggest to translate yì (at least in this medical context) as "signification". The Oxford English Dictionary defines signification as the "act of signifying". Signifying implies both that something is important because it has a special meaning (a meaning that is context-specific & not absolute), that this meaning can be communicated (though often only with a loss of meaning) & that it is this special meaning which manifests in action. Medicine thus is yì (signification), the process whereby the meaning of a set of symptoms & signs is understood & acted upon.
How well it has been understood becomes immediately clear through the results produced. And superior skills at signification mark out the superior craftsman. Suwen Chapter 26 says as much. "As for observing the obscure, this speaks of what is not manifested externally of the form, Qi, nutritive, & protective but which the craftsman alone knows. Knowing about the differences of warmth & cold of the days, the waxing & waning of the moon, the floating & sinking of seasonal Qi, & considering their various interactions so as to regulate them. The craftsman regularly is the first to see them. As these do not manifest externally, one speaks of observing the obscure. That which differentiates craftsmen is that which is not manifested to be observed externally & that all cannot observe. Therefore observing that which is obscure means seeing that which has no form & tasting that which has no flavour. This [capacity] seems to be divine".
The differences between a medicine based on signification & one based on representational knowledge (as in modern biomedicine) or intuition (as in Romanticist perceptions of medicine as an expressive art) are once more thrown into relief. The healing power that flows from signification, like in modern biomedicine but unlike in Romanticist art, is grounded in an understanding that involves thinking & deliberating. Unlike in modern biomedicine, however, and more like in Romanticist art, this knowledge is context specific, personal & not readily communicable. The following anecdote about the famous Tang physician Xu Yinzong makes this clear. Someone said, "Your medical skills are divine, why do you not write a book to bequeath to posterity?" Yinzong said, "Medicine is signification; it is in one's thoughts and deliberations. Moreover, the indicators of the pulse are murky and subtle & the difficulty in distinguishing them is distressing. That which is understood by intention cannot be disseminated by mouth. All of the famous practitioners of antiquity are so only [because of the abilities] to differentiate pulses. Once the pulse is differentiated clearly, one recognises the disease. As for the disease's relation to the medicine, it is one of appropriate matching. It only requires the use of a single [medicinal] to directly attack that disease. When the force of the medicine is pure, the disease is cured immediately. Nowadays people cannot differentiate pulses & none recognises the source of diseases. They use their feeling to speculate & set out a multiplicity of medicinals. This is like a hunter who does not know where the hares are & so sends out a multitude of men & horses to enclose an empty piece of land. Occasionally one hopes one guy will stumble onto something. If one treats illness in this manner won't the [results] also be haphazard? If one has one medicinal that happens to match the disease & other ingredients are added to "harmonise" it, the chiefs & the ministers will restrict each other's [effects] to that the force of the Qi does not proceed. By this means it is difficult to get better & here lies the excuse. The profundity of the pulse cannot be spoken of. If one vainly sets out classic formulas, how can this add to [the knowledge of] old? I have thought about this for a long time & am not able to write anything".
But where does one's significatory capacity come from? & how is it developed? In other words, how does one become a good physician? Chinese writers are clear about this. It is learned from teachers & the ceaseless study of books, both of which embody the medical tradition. However, that process in itself already also involves significatory ability. Zhu Danxi, for instance, writes that "when reading the texts of our predecessors, one should know the signification of the words they set out".
Zhang Shoukong is even more specific: "The method for reading books [is as follows]. One should [first] read by following the characters one by one, then the sentences, then the sections. Then take up again the entire piece & in reading it achieve mastery of the subject. By thus also grasping the signification that [lies beyond the written] words one becomes a proficient reader".
Becoming a physician thus is not the learning of facts or techniques produced by others in the laboratory & their replication in the clinic, nor is it a totally personal expression of intrinsic healing power. Rather, as both the Confucian & Daoist readings of yì imply, it is a process of self-cultivation. Teachers & books guide this process, but what is learned from teachers & books provides only the basis for a more comprehensive & subtle self-determined agency that flows from signification.
The Dialectic Between Signification (yì) & Methods (fâ)
The force which drives this process of self-cultivation, which by implication also manifests in each clinical encounter, is perceived in the yï dé literature as a dialectic between personal signification (yì) and the standards, principles & methods laid down by and embodied in the tradition to which one belongs. Such methods include prescriptions, treatment principles, diagnostic techniques, needling methods & so on. They, as much as written texts, are what a student has to master to become a competent practitioner. "Medicine is signification, prescriptions are methods. The divine makes clear their signification within the methods [transmitted by tradition]. How can these be grasped by [ordinary] human beings if not via transmission from father to son or via the imparting of skills from master to disciple?"
As long as one is an inferior craftsman, one must be guided by the methods of one's teachers. However, as these methods are themselves derived from the significatory ability of previous masters, they are not immutable. Once one has become a superior craftsman, one is no longer bound by tradition but can add to it through one's own significatory capacity - a capacity which always remains grounded, however, in the knowledge of methods & principles one has previously acquired, that is in tradition. The following anecdote about the famous Ming dynasty physician Hua Shou is a nice example. Hua Shou'sa zi name was Boren & his hao name was Yingning. He crafted ci poetry using classical forms & was proficient in medicine. … When treating people's ailments, he was not stuck in the formulary manuals but used his significatory [ability] to make prescriptions. When given out, each [of these] was effective. One autumn, the worthies of Gusu went on an outing to Tiger Mound Mountain. There a rich family had a case of difficult labour & asked for aid. The worthies could do nothing. Mr. [Hua] went up the steps & saw some newly fallen wutong leaves. He gathered some up & said, "Hurry back & drink these after decocting them". Before he had finished his dinner the new baby had arrived. They all asked where this formula came from. Yingning said, "Medicine is signification. What formula could it be? If a pregnancy has gone on for ten [lunar] months & there is no delivery, the Qi is insufficient. Wutong leaves fall when they get exposed to the autumnal Qi, so I used them to help it along. Once the Qi was sufficient, how could delivery not occur?"
This special dialectic between yì and fâ, signification & method, bestows on medicine the character of a traditional craft without the constraints on development usually associated with traditional practices in the West. Signification is efficacious action based on penetrating insight in accordance with what is necessary & possible. To remain efficacious medicine must adapt & develop its methods according to circumstance. This occurs at any given time- synchronically & on a personal level from case to case, diachronically & on the level of living tradition by developing and adding to those methods that are transmitted from past to present. Zhu Danxi explains: "Medicine is signification. Although [the medicine] one uses has been acquired through transmission & though its achievements may be profound, [changing] disease mechanisms in the clinic demand the transformation [of that medicine] just as if one was opposing an enemy general. If the craft of the boatsman is the subtlety of going against accepted methods as the situation demands even if he himself is not quite a gentleman, then why should physicians be ashamed to do so".
The dialectic between yì & fâ, signification & method, intrinsically sets up the space for plurality & heterogeneity in CM we have previously observed on the descriptive level. Regarding plurality, as the tradition develops its methods accumulate. Some methods may fall out of, though they can always be revived if demanded by circumstance. Physicians have different significatory capacities & vary in the comprehensiveness of their knowledge of the tradition. Hence, there are superior & inferior craftsmen. In contradistinction to Western positivist or realist accounts, this difference does not, however, derive from the difference between true & false knowledge but always remains grounded in the practice of signification. Debates in CM therefore are not concerned with the truth of a method but with its efficacy.
Heterogeneity derives from the fact that signification is, as we have seen, a process of self-cultivation rather than mere knowledge creation. As such many domains can feed it: poetry & calligraphy, biomedical knowledge and meditative contemplation. This makes it different from science. However, it is also not a personal, idiosyncratic or subjective process of self-realisation as in the Romanticist inspired psychotherapies that underpin much of contemporary alternative culture in the West. Rather, it is always a social process guided by & rooted in tradition. Unfortunately, this is not an easy process: "That which is referred to as reading the ancient [classics] but not getting bogged down by them, adopting their methods [or prescriptions] without being controlled by them, this marvel of transformative judgement, [unfortunately] is something of which people are capable only with difficulty".
Moving Towards Healing Power: Possibilities & Dangers
We are now in a position to define in broad outline a normative theory of CM that meets the previously established criteria. We can do this by stating that for many leading physicians in the history of CM, their ability to help their patients, their movement toward healing power, was located in & derived from yì or signification. We can further assert that the efficacious agency embodied in & flowing from signification is developed within a process of self-cultivation that is at once personal & social. & we can finally argue that this healing power develops out of & through the dialectic between yì & fâ, signification & method.
We pointed out at the beginning that we are interested, at this point, in nothing more than establishing a basis for discussion. Thus, rather than deepening our analysis by relating it to further writings from the yï dé literature, we want to conclude by shifting our focus first to comparative issues & then to the development of CM in the West.
The very term CM already presupposes comparison. Usually such comparisons imply binary oppositions between medical traditions, a view that blinds us to the pluralistic & heterogeneous character of all medical systems and, by implication, their very complex inter-relations. Our theory, instead, does not fix CM by attributing to it a set of stable theories or practices, yet it still allows us to compare it to other medical traditions.
With respect to CM itself we can note, for instance, that the inherent tension between yì & fâ, signification & method, is resolved differently at different times & by different schools & physicians. In other words, that this dialectic itself is contested & emergent. A pertinent historical example is the opposition between proponents of the jïngfäng "classical formula" school of thought, who favoured the use of classical prescriptions taken predominantly from the Han dynasty, & those of the shífäng "contemporary formulas" school, who favoured to treat contemporary problems with newly composed prescriptions. While in both cases the concrete choice of a formula was still determined by the yì fâ dialectic, the knack of the jïngfäng school was to determine which established method was best suited to a particular case. The knack of the shífäng school, instead, was to select medicinals in just the right manner to treat a particular pattern or illness.
A more recent example is the tension between modernisers & conservatives in the development of "pattern differentiation & treatment determination" (biànzhèng lùnzhï) in contemporary TCM. While the former attempt to fix the nature of patterns & corresponding treatments in a manner purposefully reminiscent of biomedical diseases (thus shifting the tension towards the importance of fâ, methods) the latter argue firmly to retain subtle analyses based on personal experience (jïngyàn) as the basis of healing power (thus retaining the importance of yì, signification).
Western medicine, too, has struggled with the dialectic between yì & fâ by conceiving of medicine as both an art & a science. While the historical development of that tension & its changing historical resolution is beyond the scope of this discussion, we can nevertheless note a fundamental difference between Chinese and modern biomedicine. While in CM yì & fâ are complementary (though it is clearly signification which drives development), the dominant view in biomedicine has been to separate art & science by reducing as much as possible all subjective elements from medical practice. Scientists produce medical power in the laboratory, while the clinic takes on more & more the character of an institution in which physician-technicians fit patients into appropriate boxes. Of course, the non-definable can never be entirely removed from medicine & placebo effects surface everywhere, from the use of antibiotics to open-heart surgery. Whatever residues of the medical art remain, however, are either made subservient to science (such as when physicians use their skill to increase patient compliance) or defined in such a way as to allow their future scientific explanation, such as when everything that cannot yet be measured & thereby regularised is labelled a "placebo".
The powerful influence of the biomedical model on CM over the course of the last century can be examined, therefore, in how physicians' movement towards healing power has been reconceptualised. There is a powerful faction at work in both China & the West which no longer grounds that movement in signification but in experiment, & which considers the separation of art & science, entirely absent within the yì fâ dialectic, an example to be followed. We believe that this attitude may help CM gain political acceptance, but that it will not help us to understand CM better nor to practice it more effectively.
We wish to conclude, therefore, by pointing out three sources of danger for CM which arise from not paying attention to the yì fâ dialectic as that which grounds the movement towards healing power in our tradition.
The first of these is the belief, at the basis of all scientific inquiry, that the only valuable knowledge is that which is quantifiable & that which can be expressed in numbers & words. The uncritical adoption of positivist research methodologies as the foundation from which CM should be developed should thus be resisted. Instead, we should focus on developing models of medical practice & strategies for research that resonate with the normative demands of medicine as signification.
The second danger is the uncritical import of fashionable Western philosophies (about holism, systems, personal self-realisation etc.) into CM. Many of these philosophies share with biomedicine a fundamental conceptual division between theory & practice, the personal and the social, parts & wholes. Romanticist locations of healing power solely or above all within the subjectivity of charismatic individuals go as much against CM as we have elaborated it, as do systems theories that remain wedded to the dream of an entirely explicit knowledge.
The third danger is insufficient access to the Chinese medical tradition. The movement towards healing power in CM is grounded in the relation between individual physicians & the tradition they represent (where living masters & the texts of the medical archive embody the latter). For reasons we all know, the connection of Western practitioners of CM to either of these is particularly tenuous, though it is becoming more & more problematic also in China.
Already in the 1970s, Yue Meizhong, one of the main architects of modern TCM, foresaw some of its contemporary pitfalls. As for him these were derived from paying insufficient attention to medicine as signification, his words eloquently summarise the purpose of this essay. He said: "Regarding symptoms one must analyse the [particular] synthesis between "disease" & "pattern" [that they represent]. One must seek out the intrinsic character of [each specific] illness. One cannot [in this endeavour] limit oneself to a superficial [analysis in terms of] hot & cold, repletion & depletion. If one encounters a severe illness or a complicated pattern one must be even more particular. With meticulous care & great artistry one must [penetrate] in each case to the precise disease mechanism".
Conclusions
The normative account we have presented emerges directly from the Chinese medical tradition. Given the relative strengths & weaknesses of that tradition, the utility of our account for study & self-cultivation will be readily apparent. Its implications for political & professional development are less obvious. However, we believe that our account provides not only a powerful vision statement but implies recommendations for action on all levels of CM's existence. It is up to us, individually & collectively, to see & realise them.
Acknowledgements:
Volker Scheid thanks Cinzia Scorzon & Thomas Quehl for comments & criticisms on earlier drafts of this paper & everyone at the Northern College of AP for providing the supportive space in which some of the ideas presented here could mature. Dan Bensky thanks Paul Karsten for his sage observations.