Delivered at the 6th World Congress of Chinese Medicine 5th – 6th December 2009, Melbourne, Australia
Abstract
By examining the concept of “Change” in philosophical terms contrasting with the latest scientific discoveries in new physics on the dynamics of change in our universe, we can compare, the diagnostic concept of pathological changes and disease development in both Chinese and western medicine. Diagnostic thoughts in medicine guide our treatment principle. The development of disease and return to health with medical treatment is a process of change. In diagnosis, Chinese medicine differentiates patterns and syndromes holistically, whereas western medicine categorizes symptoms as diseases and classifies them by their bio-chemical structures. This comparative study is to explore their differences and similarities in order to find ways to organically integrate the two systems of medicine.
Western medicine develops from physical and symptomatic examination to modern laboratory analysis, MRI and other technological apparatus with the advances in medical physics as diagnostic tools. Chinese medicine relies on the clinical experience of a thinking physician according to the Four Diagnosis Methods and Eight Principles of Differentiation ( 四诊八纲 ). The two systems need to develop towards each others to create an integrative system of medicine that embraces both modern science and philosophical holism. This research studies the modernisation of Chinese diagnosis and analyses how western disease differentiations can be transformed into a more holistic approach of syndrome differentiations. The dialectical logic of distinguishing objectivity and subjectivity in medical diagnosis is also discussed here.
Keywords: Chinese medicine, western medicine, integrative medicine, Evidence-Based-Medicine, new physics, Daoism (Taoism), yin and yang, change, syndrome differentiation, disease classification, dialectical differentiation.
Background to the study
Discourse on the differences between Chinese medicine (CM) and western medicine (WM) is rapidly becoming the central issue in the integration process of medicine. Modern science has reached a platform on which a holistic understanding of nature in a universe of many dimensions is enabling us to look beyond our physical reality. It is therefore necessary for us to draw on the wisdom of Chinese medicine in its 5000 years of systematic clinical experience and compare it with western evidence based medicine in order to evolve a new medical system in line with the new frontiers of human intellect. Western science and eastern philosophy have both reached a state ready for synthesis that may produce a direction for medicine.
It is the author’s belief that medicine will lead the way in east-west intellectual integration. Diagnostic thoughts in medicine are one of the important areas in integrating the theoretical system and clinical practice of both Chinese medicine and western medicine towards a new medicine. A body of knowledge should be built up by research in the comparative study of both systems of medicine.
Comparative Study of Diagnostic Methods
In the process of this study, the following tables illustrate the comparative features of Chinese and western diagnosis that led to this discussion on the philosophical and scientific approach to medicine. By comparing the logics of both Chinese medicine and western medicine methodology together with the latest scientific advances in theoretical physics, we can begin to explore an integrative model in medicine and the innovative direction of the future.
1.Diagnostic Methodology 诊断方法
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| Holistic patterns evolved from clinical experience | Evidence produced by laboratory analysis (GLP) and RCT |
| Syndrome differentiation according to the theoretical basis of Chinese medicine | Judgement made by specialist(s) on disease basis |
| Whole body approach by considering the root causes of diseases. | Focus on symptoms and cure of a particular disease |
2.Symptomatic Diagnosis 症状诊断
| Chinese Medicine 中医 | Western Medicine 西医 | ||
|---|---|---|---|
| Patient’s subjective information:
Same as western medicine in questioning, but diagnosis according to Chinese medical theories – yin and yang, meridians, zangfu, Qi, blood and body fluid. |
Patient’s subjective information: | ||
| Temperature (hot/cold) Breathing (difficulty) Heartbeats (fast/slow/irregular) Pain (chest, stomach, head etc.) Spasm Vomit Dizziness Jaundice Mental alertness Stress, depression Emotion |
┐ │ │ │ │ │=> │ │ │ │ │ ┘ |
To Identify the location of problems and classify diseases | |
3.Physical Examination 检体诊断
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| Doctor’s objective observations: Same observations, however, according to Chinese medicine theories: Complexion Vitality Tongue colours/coating/shape & texture Pulse – quality/speed etc. |
Doctor’s objective observations: Skin conditions/wounds Body structure, swelling, lumps ENT observations Blood pressure Stethoscope for heartbeats |
4.Laboratory Examination 实验诊断
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| According to physicians sense of smell and observations | Blood Urine Stools Liver/kidney etc function Bacteriology, virology Other Bio-chemical analysis |
5.Apparatus Diagnosis 器械检查诊断
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| None 无 | Electrocardiogram (ECG) 心电图 Lung measurement apparatus (lung volume, capacity & compliance) 肺功能仪（肺容积、容量和顺应性） Electroencephalogram 脑电图 Endoscope 内视镜 |
6.Medical Physics Diagnosis 医学物理诊断
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| None 无 | Computed Tomography (CT-X Ray) X线（光）计算机体层成像仪 Emission Computerised Tomography (ECT) 介入放射发射体层成像仪 Ultrasound 超声波 Magnetic Resonance Imaging (MRI) 磁共振成像仪 Myocardial Perfusion Imaging 心肌灌注显像 Liver (Hepatic) Imaging 肝显像 Lung Imaging 肺显像 Renal Imaging 肾脏显像 Bone Imaging 骨显像 Chemo luminescence Analysis Method 体外放射分析 －化学发光法 |
7.Medical Physics – Nuclear Medicine 医学物理 － 核医学
| Chinese Medicine 中医 | Western Medicine 西医 |
|---|---|
| None 无 | Radionuclide Diagnosis 放射性核素诊断 Radioimmunoassay (RIA) 放射免疫分析 Single Photon Emission Computed Tomography (SPECT) 单光子发射计算机断层 Positron Emission Tomography (PET) 正电子发射体层成像 |
8.Modern Research in Diagnosis 现代研究诊断
| Chinese Medicine 中医 | Western Medicine 西医 | ||
|---|---|---|---|
| Four diagnosis Analytical Quantification System 四诊检测分析系统 Tongue diagnosis research 舌诊研究 Questioning diagnosis research 问诊研究 Pulse diagnosis research 脉诊 |
Medical physics (further research) Biochemical sciences Systems Biology Post-genomic Research |
||
| Listening diagnosis research 闻诊研究 Pulsography中医脉象仪 Observation diagnostic system 望诊（中医人脸识别系统） Tongue computed Tomography 中医计算机体层舌象仪 |
┐ │ │=> │ │ ┘ |
Advanced apparatus and R&D for the verification of four diagnostic methods | |
9.Diagnosis according to Clinical Features (Experiences) 临床诊断象征（经验）
| Chinese Medicine 中医 | Western Medicine 西医 | ||
|---|---|---|---|
| Heat/Cold Deficiency/Excess Yin/Yang Exterior/Interior |
┐ │ │=> │ ┘ |
Wealth of recorded clinical features (over 5000 years) | None 无 |
| Tongue Face Sound/Smell Pulse |
┐ │ │=> │ ┘ |
Clinical features according to Syndromes systematically recorded | |
| Syndromes & Patterns according to stages, change & complex factors in diseases | ┐ │=> ┘ |
Systematically recorded as clinical experience over 5000 years | |
| Meridians Qi, blood, body fluid |
┐ │=> ┘ |
Observations in special features and theories | |
| Acupuncture Points Energetic Measurement (EAV, VEGA, RYODORAKU Auriculo-medicine Diagnosis (ACR & VAS) NOGIER |
|||
A Modern Prospective to Chinese Diagnostic Methodology
The vastness and depth of Chinese clinical experience systematically recorded in several thousand years of practice will be an important contribution to the formation of a new medicine. From a modern perspective, contrasting to western evidence based medicine, Chinese medicine represents a new trend towards regulation of the natural process of health and disease as a holistic system rather than intervention with drugs or surgery as practiced by western medicine. Chinese diagnostic thought focuses on the “thinking physician” with the wisdom of knowing a special body of patterns of diseases with different clinical signs and features verified by physicians of the past, to differentiate the patient’s health problems in an individualized way.
These patterns reflect wisdom of subtle observation and logical analysis according to the theoretical foundation of Chinese medicine. Syndrome differentiation （辨证Bian Zheng）as a special methodology of Chinese medicine in recognizing patterns of diseases is therefore the essence by which it will contribute to a modern medicine that is in need of traditional wisdom. However, there is also a need to modernise Chinese medicine diagnosis to improve judgment in the methodology of tongue diagnosis, palpation, and other clinical data collection through modern technology, modern medical physics and computerised technology to provide us with quantifiable, more defined and objective data for the Chinese physicians to differentiate syndromes. Chinese medicine provides us with the “thinking physician” model which western medicine model lacks. Critical thinking in conventional medical education has not been filtered through and applied in clinical settings at a level demanded from a Chinese physician.
Science and Philosophy in Diagnostic Thoughts
Diagnostic thoughts are central to the philosophy of biology and medicine. The structured thinking behind our medical diagnostic methodology separates different systems of medicine. Chinese medicine has evolved with a philosophical concept of holism within which the Yin and Yang dynamics create patterns of change in our physiology that manifests different signs that Chinese physicians observe and palpate according to the fundamental theories of Zangfu, Qi, Blood and body fluid developed in 5000 years of clinical practice. This methodology is essentially a logical differentiation of syndromes that are manifested by the changes occurred in the human body. The guiding principle of treatment is to regulate these syndromes to regain health.
Western medicine diagnosis on the other hand is based on empirical evidence collected from factual, quantifiable data in the change of physiology relating to a particular disease. These data from clinical symptoms to laboratory analysis and technological scan results are analyzed in a methodology called “Evidence-Based-Medicine, EBM”. The result of this analysis is to decide on the treatment intervention to cure a particular disease. This methodology is a scientific procedure of repeatable evidence experimentally concluded in randomized control trials (RCT). This golden standard is based on the objectivity of evidence according to Newtonian empiricism.
In integrating the two systems of medicine, we will have to reconcile the differences in our understanding of health and disease. Chinese medicine links health and disease together in holistic pattern of change that the human body cannot be separated from the influences of nature beside its own psycho-emotional make-up. This approach necessitates a philosophical methodology in diagnosis. With western medicine, the requirement of repeatable evidence can only be experimentally produced by sciences. Current thoughts on an integrated medicine reflect the necessity for the synthesis of both philosophy and science in order to arrive at a new understanding in medicine.
Ultimately for the patients, medicine is to cure their diseases. Their concern is not an intellectual one. However, as physicians we must adopt a correct approach to medicine. Does science provide the answer or we need to explore beyond physical evidence with philosophy?
Both Chinese medicine and western medicine contain the elements of science and philosophy within its system methodology. We are seeking to modernize Chinese diagnosis using technology to quantify its observations. Western medicine is also looking into complex syndromes in diseases to arrive at a more holistic understanding of illness. To integrate the two systems organically, we will have to merge the concept of “change” and “disease development” within Chinese philosophy with the latest discoveries in theoretical science.
Concept of Change in Chinese Medicine and the New Theories in Physics since Einstein
The book of change which was compiled during a course of several hundred years of early Chinese history summarized “change” as the interactions of yin and yang. Within the material (physical) world there is function, and within the functional (conscious) world there are materials. As interpreted by Lao Tse in his Dao De Jing (Tao Te Ching) written 2500 years ago. “First there is Dao, Dao gives rise to one (entity), one (entity) gives rise to two (yin & yang), Two gives rise to three (yin, yang & balance), from three all matters are created (dynamics of change). All matters carry yin and embraced with yang, synthesized as Qi in the process of becoming harmonized (Chapter 42 Lao Tse, Dao De Jing) “道生一，一生二（阴阳），二生三（阴阳和），三生万物（变化运动），万物负阴而抱阳，冲气而为和”(老子道德经42章)
Lao Tse regards the fundamental laws of yin and yang give rise to the dynamics of change in nature, thus the concept of harmony being the result of balance and counterbalance between the forces of yin and yang that defines existence. All things in nature are created by the dynamics of yin and yang that interlink the material world and Dao. Dao is the Way – a pre-material world of consciousness. In Chinese medicine, change is also manifested by the interaction of yin and yang. Such changes induce pathological factors that cause the imbalance of yin and yang, and in turn cause the Zangfu organs disharmony as well as Qi-blood disorders within the body. Chinese diagnosis observes and differentiates these changes. Particular time and location (space) in relation to matters (physical, material existence) and energy (dynamics of change, functionality of Qi) are important factors in Chinese diagnosis.
Let’s look at the latest discoveries in particle physics and the quantum theory. In the structure of molecules, atoms and subatomic particles, quantum physicists know that all matters are held in motion at a subatomic level with the positive charge of attractions and the negative charge of repulsion. Matters are constantly changing in a perpetual motion of energy in wave like vibrations accord to the “String” theorists in physics. Matters in the form as we see them are stable waves in motion. The motion of matters goes forward in time, where as anti-matters go backward in time. An electron with a reverse charge (positive instead of negative) becomes an anti-electron that goes backward in time. According to quantum theory, Higg’s boson, a particle that created mass (matters as we know it) originally belongs to an un-observable energy calls Tachyons which have an infinite velocity beyond the speed of light. Tachyons set off the big bang that created our universe which is expanding as a bubble in the fabric of space-time.
All known physical phenomena in our visible universe began with the big bang. Before the big bang, there was a “true vacuum” which became a “false vacuum” when tachyons destabilized its balance making it to inflate into a bubble of space-time which becomes our universe. This quantum theory confirms the nothingness of Daoism (Taoism) as described by Lao Tse as beginning of everything. Lao Tse proposed that the consciousness of Dao would transcend the human observer to outside the dimension of this universe into nothingness – a perfectly balance void before existence. Quantum theorists call this a “true vacuum”. Einstein’s cosmological constant predicts the existence of antigravity force to balance gravity preventing the collapse of our universe suggest the presence of invisible energy that return us to the perfect harmony of the true vacuum from which our universe began. This illustrates the parallel between ancient Chinese philosophical thoughts and modern scientific thinking. The concept of universal Qi and the forces of balance between Yin and Yang are also parallel concepts in philosophical terms to the theorem of physicists in the form of a multi-dimensional universe with forces in a grand unification, to be proven by experimental science at the Large Hadron Collider (LHC).
On the basis of these parallels, we can begin to construct a new diagnostic methodology on the understanding of change from science and philosophy that envisage the visible and invisible factors in human health. With this methodology we can also begin to take into account the interactions of “mind” and “matter” in medicine.
The Modernization of Western Evidence Based Medicine
The modernization of western medicine from evidence based methodology of Newtonian world view in line with the new physics of “Standard Model relating Quantum and String Theories” is now necessary for medicine to progress further. Modern physics should induce an advancement towards nuclear and subatomic medicine. However, mainstream western clinical medicine is still essentially clinging to the out of date methodology of evidence based medicine insisting on RCT as the only gold standard for clinical evaluation. While credits are given to the improvement of safety, technical advances in surgery and diagnostic medical physics as well as modern drug R&D, we must admit that western medicine is primitive in methodology in view of the advancement in scientific theories from Newtonian physics. James Canton is calling for “the end of primitive medicine” as he consider “what we call modern medicine is quite primitive” 1
At present scientific research in medicine is lingering in cellular molecular level. Post-genome era systems biology and stem cell research are the frontiers of evidence based medicine, a level at which we can expect to yield objective evidence. As diseases occur at the atomic and subatomic levels, a level that evidence based medicine has not begun to explore. Research beyond cell molecules and DNA is a direction that western medicine can be modernized. Along with the recognition of the body’s interaction with the mind within a natural and social environment of a holistic universe, we can expect the demise of a methodology that mechanically look for evidence embodied in a randomized control regime such as RCT, and its equivalent gold standard in biological research. The modernization of western medicine therefore necessitates the demise of evidence based medicine which is outdated by the development of modern physics 2. The Quantum-Relativity physics of the “Standard Model” and “String Theory” is turning science upside down with a revolution in scientific world view overturning Newtonian empirical principles that scientific medicine has not yet caught up. The modernization of western evidence based medicine is therefore a necessary step towards a 21st Century medicine.
Theoretical Basis for a New Integrative Diagnostic Approach
To the greatest thinkers of our age, science and philosophy are now together giving human knowledge a cutting edge view of our existence. Medicine has not here-the-to enter this realm of advancement which makes medical methodology primitive in all different systems. Medical diagnosis as practiced now in mainstream and traditional medicine is inaccurate at best and misleading treatment in the worst circumstances.
We now return to the diagnostic thoughts of medicine in terms of dynamic of change within the human body. We cannot avoid the constructive relationships between physical being and conscious being between man and the cosmos. Chinese medicine calls this Tian Ren He Yi (天人合一), meaning that the “universe and man are one” in a pattern of holism within and without.
Conceptually, we can now integrate philosophy with science. Chinese medicine diagnosis can live happily with experimental science of western medicine. Chinese medicine diagnostic methodology has to adapt to quantification of clinical data, and western methodology must go beyond physical evidence into the realm of holistic philosophy with dialectical logic as the basis of differentiation. This is a direction that defines integration between the two systems of medicine to achieve an organic synthesis. The logic of dialectical differentiation can bring together the macro-view of holism and the micro-view of physiological evidence to form a truer diagnostic picture of the patient’s illness.
Dialectical Differentiation – A Logic for Integration
Dialectical logic is to look into the dynamics of interactions, e.g. the interaction of contradictory forces or factors. The unity and mutual dependents of the opposites, the balance of the forces of repulsion and attraction in the process of synergy. Dialectical progressivism as described by Hegel is a process of negation of the opposites.
Differentiation is a method in recognizing patterns and relationships within a holistic framework. Differentiating the micro details in order to discover the macro pictures from parts to the whole, and recognizing the patterns of change in the process of time, matters (mass) and space, are methods considered in the process of differentiation.
Dialectical differentiation is a logical methodology to arrive at the true nature of things (万物真相) by recognizing the macro patterns of holism in analyzing the micro details in a dynamic structure of opposite forces or motion of interaction and change in different dimensions as described by String theorists in quantum physics 3.
In the logic of dialectical differentiation, subjectivity and objectivity have a relationship of unity of the opposites, they depend on each other to form the more complete picture of the truth. Therefore, both subjectivities and objectivities are necessary for medical diagnosis of an organically integrated medicine. Dialectical differentiation is a logic that can comprehend the dynamic of change in the concept of logical synthesis in dialectical progressivism 4.
Clinical Applications of Dialectical Differentiation in Diagnosis
In Chinese medicine the relationships of Qi and blood is a unity of the opposites in dialectical logic, that is they are mutual dependent on each other and at the same time negates each other. The differentiation of Qi being the yang function and blood being the yin materials interacting to form patterns of syndromes when one abnormality affects the other. Blockage of Qi and blood resulting in pain, when Qi and blood moves then pain is alleviated. (（气血）不通则痛, 通则不痛). However, blood only moves when Qi moves, equally, blood is the mother (source) of Qi (气行血才行，血为气之母). Therefore when there is blood stasis (stagnation of blood, e.g. caused by injury), we need to invigorate Qi. The stagnation of Qi also causes blood stasis. The deficiency of yang Qi causes spleen deficiency resulting in a syndrome of blood deficiency. Qi and blood interact in a pattern of change that may result in illness. Dialectical logic of synthesis can explain the transformation of syndromes in the dynamic relationship of Qi and blood, as well as Zangfu relationship. The differentiation of these syndromes combining with the logic of Hegels dialectics can be applied to explain Chinese diagnostic methodology.
Integrating western nero-physiology in the change of MRI images of the brain chemical composition in relation with the release neurotransmitters caused by different stimuli such as electro-acupuncture, demonstrates the same dialectical relationship between different aspects of physiology that need a process of differentiation. Biochemical compositions in laboratory analysis as well as magnetic images and nuclear tomography are revealing a complexity that requires holistic differentiation to comprehend the fuller picture of the patient’s inter-related health problems. Such a process of dialectical differentiation in Chinese medicine and western medicine can be combined to transcend (升华) both medicine in a synthesis that demands a new diagnostic methodology.
The clinical examples described above are orientations that point to a new direction in diagnostic thought.
Concluding Remarks – On the Implication of a synergy in Diagnostic Thoughts and Future Research Orientation
Considering the fundamental change in theoretical physics and the implication to other sciences, medicines have to modernized its theoretical system and fundamentally change its methodology. It is now over a hundred years since Einstein published his “General Theory of Relativity” in 1905, the latest development of this discovery is now accepted in the form of the “Standard Model” in physics, and Max Planck’s Quantum mechanics has now advanced to “Super-String Theory” which studies a multi-dimensional universe. More is projected by physicists in their theories of unknown, undetectable phenomenon of an anti-universe and parallel multi-verse. If seeing is no longer believing, then we cannot insist on “evidence” as the only believable truth as argued by EBM conservationists. Many forces of energy such as “dark energy” and their interactions are unknown to scientific tests thus far. Modern physicists as scientific thinkers are shaking the foundation of conservative scientists of Newtonian empiricism. Medical theorists must now march forward with creditable research to lead the way towards integration. From this study, we can conclude that integration in diagnostic thoughts between Chinese medicine and western medicine is both necessary and inevitable. Indeed, this is a prerequisite for the emergence of any new modern medicine model. Chinese medicine and western medicine have a historical role to perform before the dawn of a “Bio-economic Era” which is upon us.
Man Fong Mei
Chinese Medical Institute and Register (CMIR)
London,
18th July 2009
——————–
1 James Canton, The Top Trends that Reshape the World in the Next 20 Years. Page 119
2 See “The implications of the Scientific Theories of New Physics to the Innovative Development of Dialectical Thoughts in Chinese Medicine”, Professor Man Fong Mei delivered at the World Congress of Chinese Medicine, Macau, 2008
3 Professor Lisa Randall: “Warped Passages”
4 See G.W.F. Hegel: “The Science of Logic” and “Integrative Medicine – Exploring a New System Methodology”, Professor Man Fong Mei delivered at the Integrative Medicine Conference, March 2007, Royal College of Physicians, London