In this essay I will be examining Western medicine and alternative medicine. As I am more familiar with Chinese, TCM and acupuncture the examples that I will be using mainly come from this field, however homeopathy and naturopathic medicine have similar views of what constitutes health and the holistic principles that constitute treatment. Trattler (1985), Castro (1990).
I hope to demonstrate that the underlying philosophies, understanding of the meaning of symptoms, treatment principles and definition of cure are radically different in these two types of medicine. They truly are alternatives to each other and not complementary. I will point out that there are concerns that Western/biomedicine will try and measure alternative medicine in ways that it is not possible to do, owing to its ‘energetic’ principles, different approach to health and healing, and the central place of the practitioner/healer.
Definition of Health
From a Western conventional medicine point of view health is difficult to define positively and it seems that the only real way to define it is to say that health is the absence of symptoms. However it is not only the absence of symptoms, but the absence of measurable symptoms. I have heard many tales of people going to the doctor not feeling right, only to be sent away by the doctor telling them that they are perfectly well as s/he can’t find anything wrong with them. Even blood and urine samples may be taken and come back, after testing, within normal limits and this proves that you are healthy even if you don’t feel it! Western medicine seems to pride itself on its scientific credentials almost to the point of saying if it isn’t measurable then it doesn’t exist.
Western medicine also separates the body from the mind. Gascoigne(1994) p13 ‘Conventional medicine, in common with the prevailing scientific view in the West , believes that there is only a physical body which can be measured, weighed and analysed by physical methods’. While I believe this position to be a little extreme, it is true that the mind and certainly the spirit (if it acknowledged to exist at all) are often problematic to Western medicine and so the easiest thing is to ignore them and just treat the body, as after all we can test it and so can prove that it’s getting better. Alternative medicine believes that we are more like an energy system. As Gascoinge(1994) p14 says, ‘ The essence of alternative medical thought is that there is a vitalistic principle behind and encompassing any physical object. For the human body this means that the physical body is merely the outer manifestation of an inner energetic state. Any changes in that inner state are reflected in the physical body and changes in the physical body can affect the inner energetic state.’ So we are seeing the whole person as an energy system where there is no split or separation of body/mind and Cartesian dualism has never happened – our physical, mental and spiritual health are interrelated and inseparable and so the organs within our body are interconnected and inter-related and we are looking at the person as a complete whole and therefore having an holistic viewpoint.
Chinese medicine has its own philosophy, terms and ideas that have no equivalent in the west and so are often difficult for westerners to comprehend. Concepts like Qi, Yin and Yang are not widely understood by western doctors and may never be measurable in biomedicine, but are fundamental to TCM. Van Straten (1990) p67 in his entry on acupuncture says ’Health is regarded as a measure of the freedom of flow of Chi and the balance of Yin and Yang. Ill health is seen as a reflection of the fact that Chi is prevented from circulating freely and is therefore unable to nourish and protect the body.’ Jackson and Scrambler (2007) however point out that in spite of clinical showing effectiveness, most biomedical practitioners don’t believe in Qi or the existence of meridians and only when neurophysiological effect of acupuncture can be measured is there any belief that acupuncture works.
Western medicine has also split the body into different sections and functions and created specialists in particular areas. These specialists look at their own areas as though they are entities in their own right as though there is no relationship with the rest of the body. A TCM practitioner by contrast knows that the organs of the body are intimately connected and interrelated and that intervening in one area will affect another for example Kidney energy assists the Lungs to receive Qi.
Of course to say that Western Medicine is reductionist and alternative medicine is holistic is too simplistic. Some Western doctors and even my local osteopath use acupuncture without any regard to the notion of ‘Qi’. Many Chinese TCM practitioners use acupuncture to cure the illness presented without looking at the whole system and equally some western doctors approach is more holistic than others, however the broad tendency for these two systems is on the one hand separatist, reductionist and specialising in discrete systems and on the other hand an encompassing, inter-related and holistic approach.
Lastly I want to look at the role of patients. It seems to me also that the attitude of the patient may be different in Western and TCM. Often in the West we are passive about our health. When we are ill we go and see the doctor, the expert, who will give us medicine and make us better, but in the holistic model, the patient is more knowledgeable and is encouraged by the practitioner to be so. We rightly become responsible for our own health; whereas in the West up till quite recently doctors didn’t want the patients to be knowledgeable and they discouraged people from asking too many questions almost in a paternalistic and patronising way. In the alternative medical system it is seen by the practitioners and more and more by the patients that the key to health is prevention rather than cure.
The concept of disease differs in TCM and Western Medicine and sometimes what Chinese medicine would categorise as a disease, Western medicine would categorise as a symptom. Maciocia (2006) p418 gives the example of painful periods. ‘Painful periods’ is a disease category, whereas in Western medicine it is a symptom (and Western medicine would attempt to find a ‘disease’, e.g. endometriosis, causing the symptoms of painful periods).’
However a TCM physician would investigate further as we shall see in the diagnostic section of this essay and find out what syndrome or pattern the disease of painful periods was manifesting with as the same disease may manifest with different patterns, but not only that, the same pattern may give rise to many diseases. Maciocia (2006) again p419: ‘One disease, many patterns; one pattern, many diseases.’ This naturally causes problems when Western trained doctors look at Chinese Medicine – why are they treating the same disease with different remedies? But from a TCM point of view each person is different (and will present with different symptoms and history) and all the accompanying signs and symptoms have to be taken into account before arriving at a treatment principle.
The Medical Anthropology Wiki (Medanth) explains from a Western medical point of view ‘disease has a unique physical cause within the body, whether it is a microorganism causing infection, the growth of malignant cells or the failure of an organ due to repeated insults (such as alcohol consumption). It has a well developed and widely applicable set of diagnostic criteria used to describe a large number of disease states.’
However for TCM, Calvin Dale Smith(Calvindale) explains: ‘”Disease” represents a failure of the organism to adapt to a challenge, a disruption of the overall equilibrium The goal of TCM is to maintain this balance, or to assist the individual to return to a state of dynamic balance, enabling him or her to achieve their optimal level of well-being.’
Although Western medicine does recognise that the emotions affect the body, it’s almost in a peripheral sense when you are for example stressed, angry, upset or depressed. Emotions are not considered as a main cause of disease by Western medicine. The view of Chinese medicine is totally different. Maciola (2006) p242 ‘Chinese medicine views the emotions as an integral and inseparable part of the sphere of action of the Internal Organs and also as direct causes of disease.’ So Chinese medicine gives emotions a central role, but to Western medicine they are very much bit players.
Youngson (1995) p213 ‘Doctors distinguish between symptoms, which are what the patient experiences and complains of, and signs, which are bodily changes observable by the doctor, characteristic of, or sometimes, positively indicative of (diagnostic of ) certain diseases. Symptoms are subjective; signs are objective.’
For Western Medicine signs and symptoms are the manifestation of a disease. The doctor has to use his skill to identify the disease and once the disease is eradicated, the battle has been won and the signs and symptoms will disappear.
In alternative medicine by contrast signs and symptoms are the result of an internal imbalance and may manifest themselves as a result of the body’s attempt to heal itself. As such they are eliminative and should not be suppressed. Acute disease is then seen as an attempt by the body to re-establish equilibrium and positive health.
The initial method of coming to a diagnosis in both system of medicine is quite similar – you first look at the patient and then you talk with the patient! Naturally you want to know what it is that has brought the patient to see you – the main complaint and then you elicit more details through history taking, lifestyle and family background. It is a skilful process – Youngson (1995) p212, ‘A doctor may often be judged by the care, persistence and skill with which the history is taken, and by the simultaneous keenness of his or her observation. Good history-taking requires experience and wide knowledge, and the direction the questioning takes will be determined by the doctor’s awareness of the significance of certain responses.’ The questions may be slightly different between the two systems as the natural emphasis and significance of details differs, but the overall questioning process is very similar. However, it is crucial for a TCM practitioner to feel the pulses and inspect the patient’s tongue in order to get an overall view of the patient’s internal state of health and a Five Elements practitioner would be interested in colour, sound , emotion and odour. In both systems also after history taking there will generally be a physical examination which will be fairly similar.
A Western doctor might, depending on the nature of the illness, arrange further medical tests such as lab test on blood/urine or other detailed tests carried out at hospital. These test results can also be useful for alternative practitioners. It is very useful to have blood, urine and to take patient’s blood pressure as well as other tests that may be required, but as we’ve shown above, the emphasis is completely different.
Approach to Treatment
The Western approach to illness and disease and therefore treatment is more akin to the metaphor of the battlefield, with the disease or illness being the invading force and the drugs and technology of the doctors and surgeons being their weapons to fight off the disease. Beat, destroy or if something’s causing too much trouble then cut it out (gall bladder, appendix, tonsils and any other part that can be dispensed with without too much trouble). This is far from the days of Voltaire (FamousQuotes): “The art of medicine consists of amusing the patient while nature cures the disease.” For Western medicine it seems that the symptoms are the manifestation of the disease and so if you get rid of the symptoms then you get rid of the disease and the patient is cured. So if someone has gall stones then, by removing the gall bladder, they no longer get gall stones and so they are cured, but we are left wondering what imbalance was causing the gall stones and now that the gall bladder is no longer there where and in what form will the imbalance manifest itself? In general I think it is fair to say that Western medicine believes that if the symptoms have disappeared the patient is cured and therefore removal of the symptoms is the guiding treatment principle.
Alternative medicine takes a completely different view and recognises the body’s tendency to cure itself and so the treatment principle is to try and give it a helping hand. Symptoms are showing us that the body is out of balance and we are looking to cure at a deep level allowing the body to gain rebalance. Once the body has gained rebalance then the symptoms will naturally disappear of their own accord. The core belief is to treat the patient, not the disease!
An interesting point which must not be overlooked in considering treatment principles especially of TCM is raised by Hammer (1990) – One conceptual barrier ‘is the basic conflict between technology and art in the healing process. Technology insists that the healer must not be important to the healing process as a test of the validity of the healing process. However, in a healing system in which movement and balance of energy is the critical factor in sickness and health, the energy of the healer enters significantly into the system as a positive or negative force.’
Western medicine expects the same procedure carried out by different professionals to produce the same result – how else can it be measured? In acupuncture however it is well known that many practitioners have ‘good’ points that work well with their patients and ‘sore’ points that just don’t seem to do so well. However for another practitioner it might be the complete reverse.
Western medicine would find the concept of practitioners having an individual influence on treatment difficult to comprehend. Western medicine is believed to be culture-free and scientifically neutral and objective as well as being a universally valid system of classification – so it holds true for whatever place, race or disease – it will always be valid. At its most basic – same disease, same treatment. Jackson and Scrambler (2007) p213 ‘EBM (Evidence Based Medicine) is constructed as a ‘neutral ground’, a level playing field where different therapies, regardless of their social status, theoretical underpinning, mode of employment or context of use, can be conclusively shown to work or not work.’
From a Western medical point of view if the symptoms have gone away and can no longer be detected then the disease is defeated and the patient is cured. The equation is simple – no symptoms equals no disease. However from an alternative medicine point of view there might have been no cure, but only suppression of the symptoms. Furthermore, in suppressing the symptoms it is likely that in preventing the body from healing itself you have driven things deeper only for them to return in a worse form. As Gascoigne (1994) p17 states: ‘The only place now for a symptom to manifest is on a deeper, more internal level. This is potentially extremely dangerous and is one reason why conventional medical treatment is often followed by other, more severe disease. Conventionally, these are called side-effects but from an energetic viewpoint they are the results of suppressive treatment’. So in suppressing the symptoms the patient may initially appear recovered, but may in some case instead be developing a deeper and more serious illness which will manifest itself later more chronically or as another ‘disease’.
From an alternative medicine point of view, this is not a cure but simply suppression of symptoms; for a real cure to have taken place there must be a rebalancing of the inner energetic disharmony. Gascoigne (1994) p17 ‘If the symptoms disappear because the energetic imbalance has been rectified then true cure is the result.’
I think we can conclude by saying that Western medicine, because its paradigm is centred on symptoms and the battle to defeat them, has difficulty in distinguishing between suppression of symptoms and cure. Alternative medicine on the other hand finds that symptoms are a sign of the body being in distress and are a result of the natural tendency of the body to re-establish balance. I believe that therefore alternative practitioners see the symptoms in a different light and use the symptoms as a guide to what needs to be done to help the body re-establish homeostasis and therefore establish a real cure.
I hope I have elucidated the differences in definition of health and understanding of disease between the system of Western medicine and alternative medicine. Although signs and symptoms are recognised by the two systems the understanding of their significance is not identical and therefore the approach to treatment is completely different. The Western medical model almost disregards the patient who ‘has’ the disease and purely focuses on eradicating the symptoms and therefore ‘curing’ the disease.
From an alternative medical point of view the approach is more patient centred with the symptoms of the disease pointing to an imbalance that needs to be corrected. In order to do that the alternative practitioner will enlist the help of the body and try and restore balance to the patient and thereby cure the patient.
Each system has problems with the other’s approach. The alternative practitioner criticises orthodox medicine in that it often just suppresses the symptoms rather than cures the patient and in doing so can drive the imbalance deeper and so actually be making the patient worse off in the long run. Drugs also have side effects and so can imbalance systems that were not previously affected. From the biomedical point of view alternative medicine is often difficult to measure; its core beliefs of Qi and Yin/Yang have no measurable quantities and things such as meridians are invisible and otherwise undetectable. In Jackson and Scrambler (2007) few practitioners themselves could explain how acupuncture worked, however they had ample experience through clinical practice that it did. Also how do you quantify the impact of the practitioner? Western medicine prides itself that the practitioner should be irrelevant and not part of the equation.
In my opinion at the moment there is a generally a wide gulf between the approaches, understanding and treatment paradigms of Western and alternative medicine and although sometimes they get closer to understanding one another, there often is a backlash against alternative medicine by the diehard EBM supporters and pharmaceutical companies trying to restrict ‘unproven’ therapies. In some ways the hardliners approach to alternative medicine is the same as their approach to disease! – an infection that they wish to be rid of.
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