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Acupuncture: a new paradigm?
I've been reading Donald Kendall's The Dao of Chinese Medicine. I wrote this summary of the ideas presented in the book for my own learning process and as a means of stimulating discussion. I'd be curious to hear what you think of this perspective.
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Acupuncture: A New Paradigm?
Here in the West the idea of mysterious energy (qi) flowing through invisible meridians in the body has become the de facto explanation of how acupuncture works. This concept has been - understandably - incomprehensible to patients and doctors alike because it is completely at odds with modern, scientific knowledge of human physiology.
Recent scholarship suggests that the “energy meridian” explanation of acupuncture is also at odds with classical Chinese theory, and is based on gross mistranslations and misinterpretations of key Chinese medical terms. According to Donald Kendall in his book, The Dao of Chinese Medicine, these errors can be traced back to a young French bank clerk, Soulie de Morant, who lived in China from 1910 to 1917. Morant became very interested in Chinese medicine during his stay, and when he returned to France he began teaching acupuncture to physicians and lay people.
Morant promoted the mistaken idea that Chinese medicine didn’t require an understanding of anatomy and physiology. After all, he was a bank clerk - not a physician - and had no medical training at all. Nor was he a linguist or expert in the Chinese language, especially the ancient Chinese found in the classical medical texts. He translated the Chinese character qi as energy “for lack of a better word” (Zmiewski 1994) and translated the character jing in jingluo as “meridian”, even though both jing and luo can refer to blood vessels and the Chinese term for meridian is actually jingxian (Kendall 2000).
These and other major translation errors by Morant created a new Western concept that Chinese medicine was based on undefined energy circulating through imaginary meridians. Once the physiology underlying Chinese medicine was characterized in this way, it’s easy to understand why doctors and patients thought of it as a metaphysical - and not medical - system.
A more careful reading of classical Chinese medical texts, however, indicates that Chinese medical theories are based on the same understanding of anatomy and physiology that we have in the West. This knowledge was derived through systematic post-mortem dissection studies. The Chinese described the internal organs, brain, spinal cord, the vascular system (including superficial and internal routes), and the muscles of the body.
What’s more, the Chinese made two truly unique physiological discoveries thousands of years before they were made in the West. First, they recognized that neurovascular nodes (acupuncture points) on the surface of the body could reflect disease conditions in the internal organs, and that these same nodes could be stimulated to relieve pain and treat internal organ problems. It was not until the early 1890s that William Head discovered the phenomenon organ-referred pain in the West.
Second, the Chinese understood that impaired blood flow can result in pain and dysfunction, and that external environmental factors, emotions and stress can adversely effect blood flow. In fact, continuous blood circulation was discovered in China at least 2,000 years before William Harvey explained it in the West (in 1628). The discovery of blood circulation is still considered to be the single most important event in this history of medicine.
Recent translations of qi, jingluo and other characters by trained scholars and physicians have provided us with a a more authentic understanding of the key concepts of Chinese medicine. The character qi was known to mean “breath” or “air”, but the Chinese understood that air was a vital component needed to support metabolic processes (Kendall 2000). Therefore, qi is best translated as “vital air”, and may be analogous to oxygen in the context of medicine.
The Chinese used the term jingluo, meaning longitudinal distribution and collateral blood vessels, to describe the vascular system formation of superficial nodes where a dense supply of fine vessels, including arterioles, capillaries and venules supply the skin regions. The superficial nodes (acupoints) were recognized to have afferent and efferent neural properties. Hence, nodes (acupoints) were understood to be concentrations of fine vascular structures and related nerves.
Meridians, as they are erroneously referred to in the West, are the pathways formed by connecting the superficial nodes together, following the main arteries, veins and nerve distributions of the vascular system. They are not invisible lines that transport indefinable energy through the body.
The Chinese were aware that blood and vital air (qi) are circulated only in the vascular system. It is not physically possible to distribute blood and vital air (qi) via imaginary pathways in the body. To rationalize how blood circulates through invisible pathways, the “energy meridian” theory makes the contention that Chinese blood is a dense material form of qi, and hence not real blood. But the blood of the ancient Chinese is the same as all blood in the 21st century!
The main difference between Chinese and Western views on physiology relates to how the body systems dynamically interact, and how external and internal factors cause disease. Perhaps most crucial to the Chinese view is the highly integrated nature of the body, involving the neurovascular systems, the internal organs, and the external body, which includes the musculoskeletal system. These major aspects of the body give rise to viscerosomatic (internal organ-to-body), somatovisceral (body-to-internal organ), and somatovisceral (body-to-body) relationships important in health, disease, and clinical practice. (Kendall 2000)
Modern research suggests that the mechanisms of acupuncture don’t involve mysterious “energy circulation” but involve extremely complex physiological pathways that can be described in Western terms. It is also apparent that the concepts of Chinese medicine operate under known physiological principles, involving the sophisticated organization of the neural, vascular, endocrine, visceral and somatic systems. Research in this area is ongoing, but to date the bioenergetics involved have been explained by highly credible Nobel Prize-winning scientists.
Therefore, Chinese medicine is best characterized as a physiological medicine, which depends on maintaining internal functional balance, known as homeostasis in Western scientific medicine. Maintaining this balance in turn relies on the proper circulation of blood, vital air (qi) and vital substances.
-------------------
Acupuncture: A New Paradigm?
Here in the West the idea of mysterious energy (qi) flowing through invisible meridians in the body has become the de facto explanation of how acupuncture works. This concept has been - understandably - incomprehensible to patients and doctors alike because it is completely at odds with modern, scientific knowledge of human physiology.
Recent scholarship suggests that the “energy meridian” explanation of acupuncture is also at odds with classical Chinese theory, and is based on gross mistranslations and misinterpretations of key Chinese medical terms. According to Donald Kendall in his book, The Dao of Chinese Medicine, these errors can be traced back to a young French bank clerk, Soulie de Morant, who lived in China from 1910 to 1917. Morant became very interested in Chinese medicine during his stay, and when he returned to France he began teaching acupuncture to physicians and lay people.
Morant promoted the mistaken idea that Chinese medicine didn’t require an understanding of anatomy and physiology. After all, he was a bank clerk - not a physician - and had no medical training at all. Nor was he a linguist or expert in the Chinese language, especially the ancient Chinese found in the classical medical texts. He translated the Chinese character qi as energy “for lack of a better word” (Zmiewski 1994) and translated the character jing in jingluo as “meridian”, even though both jing and luo can refer to blood vessels and the Chinese term for meridian is actually jingxian (Kendall 2000).
These and other major translation errors by Morant created a new Western concept that Chinese medicine was based on undefined energy circulating through imaginary meridians. Once the physiology underlying Chinese medicine was characterized in this way, it’s easy to understand why doctors and patients thought of it as a metaphysical - and not medical - system.
A more careful reading of classical Chinese medical texts, however, indicates that Chinese medical theories are based on the same understanding of anatomy and physiology that we have in the West. This knowledge was derived through systematic post-mortem dissection studies. The Chinese described the internal organs, brain, spinal cord, the vascular system (including superficial and internal routes), and the muscles of the body.
What’s more, the Chinese made two truly unique physiological discoveries thousands of years before they were made in the West. First, they recognized that neurovascular nodes (acupuncture points) on the surface of the body could reflect disease conditions in the internal organs, and that these same nodes could be stimulated to relieve pain and treat internal organ problems. It was not until the early 1890s that William Head discovered the phenomenon organ-referred pain in the West.
Second, the Chinese understood that impaired blood flow can result in pain and dysfunction, and that external environmental factors, emotions and stress can adversely effect blood flow. In fact, continuous blood circulation was discovered in China at least 2,000 years before William Harvey explained it in the West (in 1628). The discovery of blood circulation is still considered to be the single most important event in this history of medicine.
Recent translations of qi, jingluo and other characters by trained scholars and physicians have provided us with a a more authentic understanding of the key concepts of Chinese medicine. The character qi was known to mean “breath” or “air”, but the Chinese understood that air was a vital component needed to support metabolic processes (Kendall 2000). Therefore, qi is best translated as “vital air”, and may be analogous to oxygen in the context of medicine.
The Chinese used the term jingluo, meaning longitudinal distribution and collateral blood vessels, to describe the vascular system formation of superficial nodes where a dense supply of fine vessels, including arterioles, capillaries and venules supply the skin regions. The superficial nodes (acupoints) were recognized to have afferent and efferent neural properties. Hence, nodes (acupoints) were understood to be concentrations of fine vascular structures and related nerves.
Meridians, as they are erroneously referred to in the West, are the pathways formed by connecting the superficial nodes together, following the main arteries, veins and nerve distributions of the vascular system. They are not invisible lines that transport indefinable energy through the body.
The Chinese were aware that blood and vital air (qi) are circulated only in the vascular system. It is not physically possible to distribute blood and vital air (qi) via imaginary pathways in the body. To rationalize how blood circulates through invisible pathways, the “energy meridian” theory makes the contention that Chinese blood is a dense material form of qi, and hence not real blood. But the blood of the ancient Chinese is the same as all blood in the 21st century!
The main difference between Chinese and Western views on physiology relates to how the body systems dynamically interact, and how external and internal factors cause disease. Perhaps most crucial to the Chinese view is the highly integrated nature of the body, involving the neurovascular systems, the internal organs, and the external body, which includes the musculoskeletal system. These major aspects of the body give rise to viscerosomatic (internal organ-to-body), somatovisceral (body-to-internal organ), and somatovisceral (body-to-body) relationships important in health, disease, and clinical practice. (Kendall 2000)
Modern research suggests that the mechanisms of acupuncture don’t involve mysterious “energy circulation” but involve extremely complex physiological pathways that can be described in Western terms. It is also apparent that the concepts of Chinese medicine operate under known physiological principles, involving the sophisticated organization of the neural, vascular, endocrine, visceral and somatic systems. Research in this area is ongoing, but to date the bioenergetics involved have been explained by highly credible Nobel Prize-winning scientists.
Therefore, Chinese medicine is best characterized as a physiological medicine, which depends on maintaining internal functional balance, known as homeostasis in Western scientific medicine. Maintaining this balance in turn relies on the proper circulation of blood, vital air (qi) and vital substances.
Tags: acupuncture, chinese, dao, kendall, medicine, new, paradigm
Replies to This Discussion
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Permalink Reply by Nathan on -
This is an interesting piece of sophistry, to be sure. It meshes quite well with the grand designs of the current Communist Party line that "the future of TCM is biomedicine," and I'm sure it'll make the folks at NIH and WHO happy as well, but I don't quite think it holds water.
For example, because of the deeply ingrained practices of ancestor worship, which was compounded by Confucianism, cadaver dissection was a far bigger taboo than in Christian Europe. Thus, precise anatomical knowledge came centuries after the regular practice of Chinese Medicine.
Also, looking at the notion that Qi equals oxygen, some irregularities come up. It is possible, perhaps, that Qi could be read as "vital air," or some such, but it seems suspicious that a broad cross-section of ancient languages, such as Greek, Hebrew, and Sanskrit, also have a word that is precisely that same agglomeration of "Breath / Air / Life-force / Energy / Spirit." (i.e. Pneuma, Neshima, Prana, etc)
I don't argue that much of the current body of Chinese medical literature has been translated questionably, but I think Kendall is trying to apply a paradigm based on Cartesian dualism to a paradigm arising from a culture which has no such dualism. Take the word Xīn [心] for example. By the logic Kendall is espousing, this would translate as Heart, period, end of sentence. Whereas, both in traditional usage, TCM terminology, and in modern usage, it is translated simultaneously as Heart (the organ), Heart (the emotional center) and Mind. Psychology is XinLiXue, the study of what is inside the heart.
There is more to both arguments, certainly, and I thank you for posting an interesting and controversial article. I would like to hear your thoughts, should you have the time and inclination to share them.
“SOPHISTRY, n. The controversial method of an opponent, distinguished from one's own by superior insincerity and fooling. This method is that of the later Sophists, a Grecian sect of philosophers who began by teaching wisdom, prudence, science, art and, in brief, whatever men ought to know, but lost themselves in a maze of quibbles and a fog of words."
-Ambrose Bierce, "The Devil's Dictionary"
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Permalink Reply by Chris Kresser on -
For example, because of the deeply ingrained practices of ancestor worship, which was compounded by Confucianism, cadaver dissection was a far bigger taboo than in Christian Europe. Thus, precise anatomical knowledge came centuries after the regular practice of Chinese Medicine.
According to Kendall this is a misconception. It's an incorrect assumption based on the impression that Confucian beliefs did not permit postmortem autopsy (Veith: 1949, Huard and Wong: 1968).
Postmortem dissection was described in 2697 BCE (Wang: 1926) and procedures for conducting such a study are referenced in the Nei Jing Ling Shu 12 (The Distribution Rivers). The passage is too long to reproduce here, but if you're interested I'd recommend looking it up.
The extremely detailed measurements and anatomical details provided throughout the Neijing, including tracings of all the major blood vessels in the body, could not have been accomplished by any intellectual construct or imaginative speculation. Descriptions of the internal organs, including their weight, size, and capacity, along with their functions, likewise cannot be ascertained by observing the external body. Describing the arteries separately from the veins, and indicating which vessels contain more blood than air, or vice versa, is only feasible if the body is dissected.
Kendall wouldn't argue that qi is equivalent to oxygen in an absolute sense. He translates it as vital air, and he draw the parallel to oxygen to suggest that the ancient Chinese knew that vital air was circulated along with the blood through anatomical - not imaginary - vessels in the body. They also appreciated that vital air inhaled from the atmosphere was necessary to sustain life and for the utilization of nutrients, as noted in NJSW 9 (The Six Junctures and Manifestations of the Viscera). A person's countenance or outward expression of vitality is also referred to as a reflection of one's qi, while functional activity, including organ function, can be referred to as qi as well. This is probably where the meaning of qi comes closest to terms like prana, neshima, pneuma and the others you pointed out.
I should also mention that the translation errors introduced by Soulie de Morant, the French bank clerk, were directly related to his confusion of Chinese medicine with Ayurvedic concepts, which he was familiar with at the time. He assumed that "qi" must be equivalent to "prana", which was in fact a mistake. Because he was neither a philologist, nor a physician, he was ill-equipped to deduce the meaning of "qi".
Kendall also would not simply translate Xin as Heart. I think you're making assumptions and leaps that aren't accurate here. He has an entire chapter called "Spirit, Vitality and Emotions" which explores the relationships between organs, emotions and spirit. He makes no attempt to reduce these concepts into biomedical terms.
I'd recommend picking up a copy of his book and exploring it further. At the very least, it would give you grounds for a more accurate critique. At best, it may influence the way you think about Chinese medicine.
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Permalink Reply by Nathan on
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Huh. Ok, fair enough. Maybe I should listen more and talk less :)
I'll check it out. Thanks.
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Permalink Reply by Austin Strickland on -
I would totally agree with you. I've been studying about chinese medicine and its relation with Ayurvedic concepts. Here's I have an excerpt of Subhuti Dharmananda, Ph.D., Institute for Traditional Medicine, Portland, OR writings. It'll help those understand more about chinese medicine.
Ayurvedic medicine is one of the major traditional medicine systems of the world, second only to Chinese medicine in terms of the extent to which it is used today. It has influenced Chinese medicine by virtue of the transfer of several herbs native to India to China for incorporation into the Chinese system. Much of that transfer was accomplished over a thousand years ago. Chinese medicine and India's medicine have been combined into Tibetan medicine to help produce yet another major traditional medical system. India's tradition has also combined with that of the Greeks to help form the modern Unani medicine as practiced in Pakistan and surrounding areas.
There is no licensing for the practice of Ayurvedic medicine in the United States (or most other countries outside those where it has been a central part of the healing tradition for centuries). It is provided by health professionals who have studied the subject independently (a few medical doctors, naturopathic physicians, acupuncturists, etc.), or interested persons may obtain herbs and formulas on their own by self-selection of remedies sold in stores or via the internet.
Ayurvedic medicine is of some interest to these practitioners and the general public for several reasons, aside from its long history of use, such as:
Ayurvedic suppliers are becoming a strong force in the nutriceutical industry, providing concentrated extracts or isolated components from major Ayurvedic herbs. These are coming to the attention of the public at large as well as many practitioners.
While all traditional medical systems emphasize the importance of diet in health and use of certain foods as medicines, the Ayurvedic system is especially known for this and offers some practical advice.
The modern emphasis on scientific evaluation of traditional remedies means that there is increasing desire to use "proven" substances, regardless of which medical system they have been derived from. Thus, those who have studied Chinese medicine or Western herbs will still find any well-studied Ayurvedic herbs of value to know, understand, and possibly use.
In trying to grasp the meaning and application of traditional and modern medicine concepts, it is helpful to see the differences between medical approaches around the world so that one does not become confined to a single cultural model.
I hope it helps.
Thanks
Austin Strickland
Trophy Skin: Premier light therapy products for skin treatments.
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Permalink Reply by Donna Chang on -
Thanks for adding this discussion. It is quite possible that ancient chinese medical theories were based on some anatomical knowledge at least. I would be interested in learning how Chinese medicine intersects with western bio-medical model.
Some thoughts that I hope to add to this discussion:
1) Embracing paradoxes is something that's quite natural in asian thinking. While western thinking usually runs the logic in the line of if A equals B, B doesn't equal C, then A doesn't equal C. But in asian thinking, things don't have to be either/ or. It is very likely that even if e.g. blood is ancient Chinese medical theory does mean blood on one hand, it can also have other connotations.
2) The Chinese language imparts a very different worldview. Ancient chinese is very poetic, very metaphorical.
In traditional chinese culture/language, when we try to explain a concept, we use a lot of metaphors/stories instead of just to "define" it. I think it is because there are a lot of concepts that you can only "understand" yet not solidly defined. The more you try to define it, the more you lose the real meaning. There are many words/concepts that just doesn't have English equivalent.
And Chinese language is very contextual, meaning one word like Qi, depends on context, can mean a lot of different things.
For example,
Kong (empty) Qi means "air"
Tian (Heaven/Sky) Qi means "weather"
Yun (tranporting/movement) Qi means "Luck"
Sheng (life/generate/raw) Qi means "get angry"
Wok (that round-bottomed pan) Qi is something...I can't even translate. But when a dish that's just freshly stir fried with good level of heat, right amount of moisture, and vigorous stir-frying, it's said to have "Wok Qi".
...and so forth...
3)Here is a book I would like to recommend on how/and possibly why asian and western thoughts differ.
The Geography of Thought: How Asians and Westerners Think Different...
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Permalink Reply by Chris Kresser on
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You raise some great points about the difficulties inherent in translation. As you suggest, it's not just about language, it's about culture and ideas.
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Permalink Reply by Jill Morgyn on -
Do I dare to stick my neck out here and suggest that the roots of TCM are Daoist, and shamanistic in origin. These folks were in isolation in the mountains, far away from urban society, in order to freely and fully explore the nature of our reality. Using dietary restrictions (vegetarianism, wild plant food, and then eventually breatharianism), physical movement (postures used to channel earth energy through the body) and prolonged and specific meditations, they were able to develop skills that contemporary Western scientists and academics do not believe are possible. However, having been training in these methods myself for about 4 years now, I have seen the acupuncture meridians, can see auras and qi in the body, and have experiences beyond what Western academics and scientists are willing to discuss or consider. The anatomical information was viewed using extra-sensory perceptions. On the one hand, it's great that some aspects of this shamanic esoteric information have become widespread in practice through communist contemporary TCM; on the other hand, when we try to legitimize it using a 21st century Western surgical point of view, we place the healing system in a position where it is "below" Western popular thought in its level of sophistication and insight, when it is actually more advanced than modern science or academia.
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Permalink Reply by Chris Kresser on
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when we try to legitimize it using a 21st century Western surgical point of view, we place the healing system in a position where it is "below" Western popular thought in its level of sophistication and insight, when it is actually more advanced than modern science or academia.
I can't speak to your experience of seeing meridians or auras, but I firmly disagree with the statement above. The revelation that Chinese physicians/sages figured out 2,500 years ago physiological concepts that western doctors are just barely aware of hardly puts TOM "below" allopathic medicine. Quite the contrary.
The Chinese discovered blood circulation, referred organ pain, and the idea of preventative medicine thousands of years before these ideas emerged in the west. I'd say that elevates, not denigrates, the accomplishments of TOM.
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