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August 06, 2007

Toward an Understanding of Traditional Chinese Medicine, Part I

First, an apologia: what follows is something of a propaedeutic, defined as “a subject or course of study forming an introduction to an art or science or to more advanced study.” In our case, I hope to provide some epistemically sound reasons for a cross-cultural appreciation, understanding, and evaluation of Traditional Chinese Medicine (TCM), and in particular, for the practice of acupuncture. I share with most readers a lack of expertise on this subject, approaching it as a curious and inspired amateur, an educated layperson utterly dependent, in the end, on those in possession of the requisite professional and practitioner’s knowledge (and skill), a knowledge often assiduously nurtured over the better part of a lifetime.

My primary exposure to acupuncture comes under the heading of anecdotal or testimonial reports (in this instance, favorable), the sort of evidence routinely dismissed or derided in philosophical and scientific circles, and frequently for good reason. A serendipitous illustration from a deservedly popular book used in courses on critical thinking and informal logic will suffice: “if you are deciding whether or not acupuncture is an adequate alternative to conventional medicine, someone might tell you that their friend tried acupuncture and that it seemed to work wonders. On its own this is merely anecdotal evidence. First, there is a risk that details of the story may get changed in the retelling. More importantly, to argue from this simple case that acupuncture is an adequate alternative to conventional medicine would be irresponsible [notice the assumption as to what counts as ‘conventional’ here]: anecdotal evidence is different from a controlled scientific investigation into the effectiveness of acupuncture” (Warburton: 2000 ed.).  Of course evidence-based medicine (EBM) enthusiasts are reflexively nodding in agreement, and understandably so.

But let’s complicate matters a bit. Warburton goes on to remind us that “not all anecdotal evidence is unreliable: if you have reason to be confident in the source of the evidence, then anecdotal evidence can help to support or undermine a conclusion.” In my case, the source was a good friend of many years, a retired professor and former colleague. And I suspect very few people in fact argue in the “irresponsible” manner of our hypothetical example. Indeed, further vindication for some kinds of anecdotal evidence follows the realization that “many sorts of scientific enquiry begin by examining anecdotal evidence about the phenomenon to be examined.” What is more, we might appreciate the societal distribution and frequency of anecdotal reports in public fora outside disciplinary domains or intellectual fields of expertise: “Communication is an efficient mode of increasing knowledge because information transmission is typically easier, quicker, and less costly than fresh discovery. [….] Since not every member of a community observes each fact other members observe, there is room for veritistic improvement through communication” (Goldman: 1999).

False anecdotal or testimonial reports can occur for any number of reasons, but the default presumption, however much recognized in the breach, holds reporters’ observations to be accurate. This was well articulated in the Scottish philosopher Thomas Reid’s (1710-1796) hypothesis that we “have a natural default disposition to speak the truth, to express our beliefs honestly and sincerely,” what Goldman terms the motivation-innateness hypothesis. So while it is obvious that an “innate disposition toward truthful revelation can be overridden by conflicting incentives,” social mechanisms as crude as reward and punishment, including the entrenchment of social norms, can motivate “potential” speakers or reporters to increase their capacity for veritistic (truth-linked) improvement of knowledge communication. Goldman proceeds to outline a handful of non-reductionist epistemic theories of testimonial justification, noting how “Philosophers have been struck by how many of our beliefs are based on testimony, where it is doubtful that that there is any testimony-free basis for trusting that testimony.”

All of this by way of exorcising a general attitude of skepticism toward the practice of alternative medicine, a practice we often become first acquainted with through anecdotal or testimonial reports. In his thorough and welcome critique of the “hyper-rationalist” premises of “autonomism” in bioethics, Carl Schneider speaks of his resort to anecdotal research to confirm or at least supplement substantive empirical studies: “…anecdotal, but concrete, textual, personal, vivid, and illuminating” (The Practice of Autonomy: Patients, Doctors, and Medical Decisions, 1998).

Yet another (perhaps related) way to meet initial skepticism or epistemically motivated doubts in the efficacy of therapeutic practices from TCM is to see the latter as taking the form of presumptive knowledge, as possessing tentative plausibility (largely pre-evidential in bearing from the perspective of EBM; I’m well aware there exists some scientific evidence for the efficacy of acupuncture as summarized, for example, in the NIH Consensus Statement on Acupuncture): “The key idea of presumption thus roots in analogy with the legal principle: innocent until proven guilty. A presumption is a thesis that is provisionally appropriate—one which can be maintained pro tem, viewed as applicable until or unless sufficiently weighty counter-considerations arise to displace it. On this basis, a presumption is a contention that remains in place until something better comes along” (Rescher: 2003).

Presumptions have significant probative weight but are in principle defeasible, that is, ”subject to defeat in being overthrown by sufficiently weighty countervailing considerations” or by “something more evidentially substantial.” (This is in keeping with the modern conception of knowledge in general which is ‘fallibilist,’ meaning the possibility of error can never be logically eliminated.) Moreover, “not everything qualifies as a presumption: the concept is to have some probative bite. A presumption is not merely something that is ‘possibly true,’ or that is ‘true for all I know about the matter.’ To class a proposition as a presumption is to take a definite and committed position with respect to it, so as to say, ‘I propose to accept it as true insofar as no difficulties arise from doing so.’”

Rescher explains that there is “a presumption in favor of such cognitive sources as the senses and memory—or for that matter trustworthy personal or documentary resources such as experts and encyclopedias.” Or, in Michael Williams’ words, “In claiming knowledge, I commit myself to my belief’s being adequately grounded—formed by a reliable method—but not to my having already established its well-groundedness.” Our cognitive affairs are such that we commonly and routinely incorporate a host of fundamental presumptions of reliability, for example, and again, accepting at face value the declarations of other people and the declarations of recognized experts and authorities within their respective domains of expertise. For our purposes, the latter entail the (sometimes ‘sacred’) texts of TCM transmitted from one generation to the next through the various kinds of practitioners of TCM who transmit their knowledge and expertise in “secret,” “personal” and “standardised” modes of transmission: “TCM, like the professionalised Ayurvedic medicine in India or Kanpo in Japan, can be regarded as…professionalised Chinese medicine” (Hsu: 1999). (In another post we will touch upon the extent to which TCM is ‘traditional.’

That we are dealing with Chinese medicinal texts and Chinese experts hardly seems sufficient reason to deny them the presumptive deference we accord to the opinions and judgments of other, more familiar, expert authorities. At the very least, we can concede the Chinese (and anyone socialized into its traditions) have presumptive reasons for deference to TCM, reasons others might likewise see fit to entertain in an identical manner. Insofar as plausibility is, for Rescher, one of the criteria for evaluating presumptions, “the standing of an authoritative source is an important criterion of plausibility” (Godden and Walton, 326).

At this juncture I think we all can be sufficiently receptive to the following from Nathan Sivin, one of the pioneers in the study of TCM: “The data collected over the centuries about the body, health and disorders were structured by the concepts of Nature…[of proto-Taoist and ancient provenance], forming a coherent body of theory used to diagnose and treat illness. Classical [Chinese] medicine deserves the adjective ‘scientific’ no less (but no more) than its counterparts in Western culture until recent times. [….] What we call medicine incorporated and imposed order on experience related to every aspect of health, disease, and injury. One Chinese scheme of its major divisions include theoretical studies of health and disorder; therapeutics; the theory and practice of longevity techniques, including sexual hygiene; pharmacognosy, and veterinary medicine. [….] Prescriptions made up of both crude drugs and extracts were commonly used in combination with a great variety of other therapeutic means, including acupuncture and moxibustion.”

The fact that we can make sense of this description, that we find it intelligible, speaks to the question of incommensurability between TCM and Western scientific medicine, which is clearly a matter of degrees or aspectual in nature. That there is some measure of incommensurability follows from remaining linguistic, conceptual, ontological and explanatory differences we have not discussed and warrant systematic exploration. It seems safe to conclude, if only provisionally, that such differences are not insuperable obstacles to the rational evaluation of acupuncture as a therapeutic regimen in TCM. But more on this and related topics in future posts.

References and Further Reading

Godden, David M. and Douglas Walton, “A Theory of Presumption for Everyday Argumentation,” Pragmatics and Cognition 15: 2 (2007), 313-346.

Goldman, Alvin I. Knowledge in a Social World. New York: Oxford University Press, 1999.

Hsu, Elisabeth. The Transmission of Chinese Medicine. Cambridge, UK: Cambridge University Press, 1999.

Rescher, Nicholas. Epistemology: An Introduction to the Theory of Knowledge. Albany, NY: State University of New York Press, 2003.

Sivin, Nathan. “Science and Medicine in Chinese History,” 1990, accessed at http://ccat.sas.upenn.edu/~nsivin/writ.html

Veith, Ilza, trans. The Yellow Emperor’s Classic of Internal Medicine (Huang Ti Nei Ching Su Wên). Berkeley, CA: University of California Press, 2002.

Warburton, Nigel. Thinking from A-Z. London: Routledge, 2nd ed., 2000.

Williams, Michael. Problems of Knowledge: A Critical Introduction to Epistemology. New York: Oxford University Press, 2001.


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