Demystifying the holographic foundations of Classical Chinese Medicine: "Tian ren he yi" and all that.

David Schleich, PhD (from an address presented in Rothenberg, Germany)

In The Book of the Duchess, the fourteenth-century English poet Geoffrey Chaucer considers the continuity and contrasts between two different sources of knowledge: “olde bokes” and “newe science.” The late European Middle Ages witnessed seismic upheavals in the academic community as the reappearance of Aristotelian modes of inquiry by way of the Middle East threatened to replace older methods of knowledge transmission via authoritative texts with direct encounters with the natural world via experimentation and experiential learning. Chaucer, himself a learned individual, examined this epistemological anxiety in much of his work—though, as a poet and writer of fiction, he cast this dilemma in the form of entertaining fables, as with the lusty Wife of Bath, who summarizes her expertise on intimate relationships after being married three times: “Experience is myn auctorite.” 

           Instructors and administrators in programs of natural medicine, including Chinese medicine, are faced with a similar challenge today. On the one hand, Chinese medicine programs strive to incorporate classical ways of knowing from the Neijing, Nanjing, Shanghan lun, Jin gui yao lue, and other foundational texts into the curriculum so that students understand the relationship between such root concepts as Yin and Yang, the Five Evolutive Phases, the Six Conformations, and others with the practicalities of point location and the actions of Chinese herbs. The ways of knowing conveyed by the classical texts are holistic: they arise directly from the human relationship with the natural world, with heaven and earth. On the other hand, though requirements differ depending upon the jurisdiction, students of Chinese medicine programs are expected to become conversant in the vocabulary and methods of contemporary biomedicine, both as a basis for their own understanding of the human body in health and disease and in order to communicate with other types of health care providers. In contrast with the epistemological style of classical Chinese texts, conventional bioscience is reductionistic. The body is presented as a series of parts and compartmentalized systems, and the human relationship with the natural world, other beings, and one’s cosmic destiny is minimized—for example, the environment may be discussed in the narrow sense of disease organisms to which one can be exposed. 

           The often uneasy combination of holistic and reductionistic ways of knowing in a single curriculum produces (to paraphrase the nineteenth-century writer and activist Frederick Douglass) a double consciousness in both students and faculty. Students of Chinese medicine use the “holistic side” of their brains when engaged with classical texts, Qigong, botanical medicine, acupuncture, moxibustion, and the other sources and methods of Chinese medical practice. However, when they turn to their bioscience courses, they must activate the “reductionistic side” of their brains. Both sides appear mutually exclusive and fundamentally opposed.            

Moreover, a third element can be added to this situation. Since at least the 1960s, a holistic tide has been rising in the scientific community with the work of physicists like David Bohm, biochemists like Candace Pert, medical practitioners like Deepak Chopra, and others. Their work has caused a resurgence of interest in the vitalistic approach that scientists formerly assumed the 18th-century Enlightenment and its heirs had discredited. Contemporary holistic science offers students and their instructors the opportunity to create a bridge between methods of inquiry promulgated by classical Chinese medicine (and other traditional methods of healing) and by biomedicine. 

While the discoveries of contemporary holistic science can be a refreshing source of validation for Chinese medical practitioners after decades of being excluded to the fringes of healing practice, it must be remembered that classical ways of knowing carry their own legitimizing force, which held sway long before the emergence of cutting-edge science. The existence and nature of Qi, for example, is not valid simply because particle physicists may be on the verge of discovering a scientific rationale for it. As the eminent Egyptologist R. A. Schwaller de Lubicz discussed in his 1957 work Le temple de l’homme, the rich symbolism with which ancient people described and engaged with the world was not the product of unsophisticated societies before the advent of modern science. Rather, symbolism is the chief tool of the science of the ancients. When endeavoring to bring together the accumulated wisdom and methods of inquiry from classical texts, biomedicine, and contemporary holistic science, designers of Chinese medicine curricula must keep this principle in mind so that the classical case study and the current research project are presented as equally valid ways of both preserving and advancing Chinese medicine. 

In the ongoing process of refining our curriculum at the National College of Classical Chinese Medicine (one of National University of Natural Medicine's two medical colleges, the other being National College of Naturopathic Medicine), students, faculty members, and administrators have all provided valuable insights into how we might bring together these superficially contrasting but deeply connected human endeavors. The ways in which we have answered the question of integrating classical and contemporary, vitalistic and reductionistic knowledge and methods are here presented as a model for anyone who is concerned about the future of holistic medical education. However, ours is but one model and is offered as a source of inspiration rather than a prescription. Each institution will need to create its own integrative health curriculum based on the school’s unique vision and community. 

How can designers of holistic health curricula provide students with a necessary immersion in the vocabulary, thought processes, and methodology of bioscience (both conventional and neo-vitalistic) while at the same time grounding them in the very different modes of perception and interpretation that are essential for understanding and practicing Chinese medicine? To borrow a term from cultural studies, in order to become conversant in these multiple approaches, students must become proficient at deconstructing systems of thought. The study of epistemology is therefore a crucial part of our students’ first-year integrative biomedicine courses. 

Learning how we know what we know—which involves not simply perception but the inevitable interpretive filters that the human mind places upon the raw ingredients of the world around us—enables us to move freely between apparently disparate systems of thought. It also does not privilege any one way of thinking, such as the millennia-old privileging of reason over intuition and emotion in the Western world. Studying epistemology by way of phenomenology enables students to appreciate the benefits of both holistic and reductionistic ways of interpreting natural phenomena (including human physiology and pathology) and can help to bridge the two. 

Phenomenology, as first presented by G.W.F. Hegel and Edmund Husserl and then refined by Maurice Merleau-Ponty and Martin Heidegger, addresses the question of how we know what we know by examining the filters of perception, intuition, imagination, past experience, and belief through which we receive and interpret the phenomena of the world around us. Phenomenology is therefore the study of consciousness, which is important both because consciousness (cultural as well as individual) is what has created both the biomedical and the holistic medical worldviews and because biomedicine, with its tendency toward mechanistic explanations for living phenomena, is limited in its capacity to account for consciousness. Studying phenomenology is useful for Chinese medicine students because the modes of thinking and perceiving that gave rise to classical Chinese medical ideas were fundamentally different from those modes that generated biomedical approaches. Without being able to replicate the consciousness of the sages, we are in danger of misunderstanding, oversimplifying, or dismissing Chinese medicine and the Daoist shamanism that produced it. 

Husserl was intrigued by what we know and how we know it, which is the core of scientific inquiry. (After all, the word “science” is derived from the Latin “scientia,” and in the Middle Ages, the term referred to any branch of knowledge, the sum total of what can be known. This was the science of which Chaucer spoke.) However, while conventional science focuses on what can be known, which is assumed to be an objective reality from which the biases and interpretations of the perceiver can be strained out, Husserl attended to the subjective experience of the observer. His concern with subjectivity sprang from Hegel’s insight that the phenomena of the world we perceive through our senses (and our interpretations of what we sense, arising from our consciousness) are the gateway into a spiritual realm that emanates from somewhere beyond and behind “objective” reality. This approach is congruent with the far older philosophy of Daoism, which gave birth to Chinese medical philosophy. Like Hegel’s spiritual world-behind-the-world, Dao is the fundamental unity that generates the ten thousand things that represent the diversity of living forms, and yet we can only dimly perceive it with our limited consciousness. In the words of the holistic physicist David Bohm, both the Daoist sages and Hegel were concerned with the implicate order that shines forth from a realm beyond our own to create all living, sensible phenomena. 

Phenomenology received further refinement through the work of Maurice Merleau-Ponty, a student of Husserl’s who examined the relationship between the knower and the known. He suggested that this relationship was not a monologue where the knower creates ideas about the known, but a dialogue where the known has its own say in the matter. For Merleau-Ponty, that which is known is not an inert, quantifiable object but a living force that “thinks itself” and “senses itself” within the perceiver. His work has been widely used by anthropologists and cultural historians who study shamanic societies, with their different ways of processing information. 

The core purpose of our integrative medicine curriculum in National College of Classical Chinese Medicine (within NUNM) is to train students in these ancient methods of perception and synthesis of knowledge, as well as in the very different style of perception and analysis characteristic of Western biomedicine. With these tools for navigating between these two mindsets—as well as within the potentially unifying modes of thought advocated by contemporary holistic science—it is our hope that students emerge from their basic science coursework not burdened by a double consciousness, but empowered to travel between these different mental worlds with confidence. 

What are the natures of the disparate systems of thought that students of complementary medicine, particularly Chinese medicine, must be able to navigate if they are to practice successfully in an increasingly integrated health care community? 

The philosophical underpinnings of Western biomedicine, with their origins in the eighteenth-century Enlightenment in Europe, produce several assumptions, all of which are so basic to Western science that they have become effectively transparent and therefore exempt from analysis or criticism. The first of these, reductionism, drives the relentless search for answers in the world of the minute: subatomic particles, genes, neurotransmitters, and the like. The smallest parts are responsible for the behavior of the whole, whether what is being measured is blood circulation or thought. The second assumption, mechanism, compares living entities with the technological marvels of the eighteenth century. Thus, the heart is a pump, the stomach is an internal combustion chamber, and the brain is a network of electrical wires. The third assumption, determinism, insists that the ultimate cause of any living phenomenon, no matter how complex, can be explained by fundamental mechano-physical laws. The awe people experience when hearing a sublime piece of music can thus be traced to a series of electrical impulses and neurochemicals in the brain. 

Bioscience and biomedicine approach the world in a relentlessly material fashion. Matter is the basis of reality and can be analyzed objectively. Its focus is quantitative: how much, how large, how heavy… Energetic phenomena can be reduced to matter, the quanta of subatomic particles (the contemporary version of the ancient Greek philosophy of atomism). Such analysis often involves sophisticated equipment, but the human mind designing a given study has its own mechanical habits, chief among them being objectivity. The observer does not intrude upon what he or she is measuring; the subjective, or qualitative, has no place in this worldview. The gold standard of medical research, the double-blind, placebo-controlled study, ensures that the subjective influence of the observer is purged from the results. 

The intellectual luminaries of this new scientific approach included Rene Descartes, who argued for the primal division between the soul and the body, Isaac Newton, who proposed that fundamental forces in nature operated according to mechanical principles, John Locke, who promulgated the difference between primary qualities (the objectively knowable world) and secondary qualities (our inner, subjective interpretation of the world), and Immanuel Kant, who posited that, while we cannot truly know the world in a completely objective fashion, our capacity for reasoned, logical thought is our best tool for approaching this ideal. While a mind-body split existed in Western philosophy long before the advent of the scientific method, the latter deepened the division between the favored categories of objectivity and reason over the subordinate categories of subjectivity and intuition. 

At the time of its inception in the Enlightenment, this worldview was liberating. For centuries, religious authority constrained any form of inquiry that did not arise from or concern sacred texts. The direct study of observable phenomena was discouraged in favor of transmitting received tradition unchanged through the generations. Thus, for medieval medical students, instead of learning about living processes from living beings (or even dead ones, in the case of cadaveric dissection, which church authorities proscribed), medical education was a purely theoretical experience gained through the equivalent of reading a textbook (mostly the writings of Galen from the classical era). The Enlightenment helped to remove the exclusive control that religious authorities exerted over scientific inquiry and celebrated the human capacity to reason and learn from the living world. However, the world from which the scientist was to learn did not long remain alive. The vitalistic approach, where all matter is imbued with spirit, fell into gradual disfavor, while the “clockwork universe” that Isaac Newton posited began to dominate the scientific community. 

The conventional scientific philosophy also exhibits limitations, particularly for students of natural medicine, but also for the advocates of contemporary holistic science. Physicists from Albert Einstein to the present have disclosed how the subjectivity of the observer influences the location and direction of moving particles. The science of holography has provided important insights into the functioning of the human mind, along with other complex systems. Investigations into the theory of emergent properties have demonstrated how systems far from equilibrium—namely, living processes—exert the capacity for self-organization, which cannot be accounted for by the contemporary atomism of cellular genetics, for example. Whether the subject is Candace Pert’s biochemistry of emotion or James Lovelock’s Gaia hypothesis (where the earth is a self-organizing superorganism that makes use of its various life forms to regulate its homeodynamic processes), contemporary holistic science suggests a resurgence of the vitalistic principle and operates according to a series of assumptions that align it more closely with Chinese medicine than with biomedicine. 

In contrast with the philosophical foundations of biomedicine, the ways of knowing according to which the sages conceived of Chinese medicine privileged everything that the Enlightenment thinkers rejected. Rather than being reductionistic, Chinese medicine is holographic. The human being is a microcosm of the universe, as expressed by the classical principle “Tian ren he yi.” Though Chinese medical philosophy is as concerned with the causes of disease as is Western biomedicine, it does not make use of the same deterministic model. For a medical doctor with a Western biomedical training, depression might be reducible to a deficiency of serotonin and is thus reparable by means of administering a pharmaceutical that increases serotonin levels. For a Chinese medicine practitioner, however, a multitude of factors has likely contributed to the patient’s condition, some of which exist on the Shen and Qi levels rather than simply the material or Jing level of neurotransmitters. In addition, the principle of syndrome differentiation reminds the practitioner that every case of depression has its own unique pattern and thus should not be treated the same way. 

Finally, Chinese medicine is vitalistic rather than mechanistic. Instead of using metaphors derived from industrial processes and the machines that power them, Chinese medicine acknowledges how the larger forces of nature (the heavenly stems and earthly branches) have shaped human physiology and pathology. We contain within us organs, tissues, systems, and processes that reflect the qualities of Yin and Yang, the Five Evolutive Phases, and the Six Conformations. Because this vitalistic philosophy is more concerned with energy than matter and process rather than product, Chinese medical philosophy recognizes the fundamental dynamism of living beings. Just as the balance of forces in nature changes from season to season and hour to hour, so too does the energetic dance of human life change—both in health and in illness. If the practitioner is inflexible, he or she will not be able to respond to these changes and will not prescribe the most beneficial treatment.

While biomedicine assumes a detached observer, Chinese medicine assumes a participant whose subjective experience is to be embraced rather than censored. Although the primary mode of gaining information in biomedicine is the controlled experiment, in Chinese medicine, information is gained primarily through intuitive engagement with the world and its living, intelligent forces. The practitioner is equal parts scientist and shaman who enacts the linkage between heaven and earth that is humanity’s highest calling via cultivation of the self. Through spiritual and ritual practices, the shaman-scientist enters into a non-rational, dreamlike state in which he or she can perceive the patterns of the living world and the point at which the patient ceased operating in harmony with these ever-changing forces. 

           Holistic science provides a bridge between the disparate cognitive modes of biomedicine and Chinese medicine, yet another source of potential unity exists in the work of earlier vitalistic scientists such as Johann Wolfgang von Goethe and Rudolph Steiner, to which our students are also exposed. Goethe applied the insights of phenomenology to the life sciences. Although his contributions to science have often been neglected, his work is crucial to our understanding of living processes. He advocated increased attention to higher levels of organization, namely the organism rather than the cell. Although the study of the microcosm of individual cells is essential for our understanding of life processes, we cannot comprehend life in its full complexity without attending to these higher-order phenomena, such as consciousness. 

           Rudolph Steiner edited the scientific writings of Goethe and applied his philosophy to the spiritual realm. He devised what he called “spiritual science,” which he then applied to a broad variety of disciplines: education, agriculture, medicine, therapeutic dance and movement, among others. While the trend in bioscience from the eighteenth century was toward increasing specialization, Steiner embraced the notion that a learned individual is well versed in many areas of endeavor. This attitude echoes that of the Confucian scholars who became medical practitioners in ancient China. Far from encouraging specialization and professionalization, they argued that medicine was but one branch of the classical education that all scholars were expected to receive. 

           Steiner is the originator of anthroposophical medicine, which is still practiced today. This Western form of holistic medicine strives to understand humanity by examining how the spiritual aspects of the human being interact with the material aspects. Anthroposophical medicine is a helpful cognitive framework for approaching the study of Chinese medicine because it enshrines many of the same philosophical principles as Chinese medicine does (such as the relationship of humanity to nature as the basis for health), while it also makes use of ideas familiar to students trained in Western modes of analysis throughout their education. This is why, along with an examination of the most recent work in holistic science, our program introduces students to the work of Steiner, Goethe, and anthroposophical medicine. 

           Brief overviews of three of our courses will provide a more concrete understanding of how the foregoing ideas have guided the development of our integrative natural health science curriculum. In their first year, students are enrolled in the three-term Bridging Heaven and Earth: Ways of Knowing and the two-term Palpation and Perception. The first series covers evidence-based medicine in the context of Chinese medicine and provides students with approaches to evaluating both biomedical research (including on Chinese medicine) and classical texts. Palpation and Perception is (literally) a hands-on course that teaches students how to use their hands as tools for gathering information, both about tissue types and structures, as in the physical medicine component of our naturopathic medicine program, and about the energetic body as it manifests in the physical. 

           Students build upon the foundations they have gained in Palpation and Perception in the three-part Integrative Clinical Physical Diagnosis series. Divided into organ systems (both biomedical and classical Chinese), this series introduces students to diagnostic techniques from both conventional medicine and holistic traditions. Their exposure to Chinese medical assessment techniques (such as pulse diagnosis, observation of changes in the tongue and face, channel palpation, and hara diagnosis via abdominal palpation, among others) will continue in the Acu-Moxa series of clinical courses. Integrative CPD guides students in the process of gathering information in a medical interview (including via the traditional Ten Questions), performing physical examinations, and evaluating laboratory data and imaging from the perspective of Chinese medicine.

           Integrative Biomedicine, another three-term first-year course series, includes the disciplines of biochemistry, anatomy, and physiology, permeated throughout by classical Chinese and Goethian phenomenological perspectives on these disciplines. Students hone their capacity for receiving the world through the senses (macrocosm and microcosm, patient and universe) as well as the inner modes of perception that have traditionally received more credence in holistic than in reductionistic sciences and medical practices. They are encouraged to apply these various modes of perception to humanity and the natural world when studying subjects such as biochemical reactions, organs and tissues, and organ systems. Exercises assist students in comprehending the formative forces in the mineral, plant, animal, and human realms and classical Chinese discussions of the movements of these forces. In their second year, students concurrently take Integrative Anatomy and the first three courses in the series of point location and action courses. In the human cadaver laboratory, dissection reveals both the structures students need to identify for the biomedical part of their training and the structures that underlie each of the main acupuncture channels. 

           Producing a truly integrative course of natural health sciences study—one that permits students to feel equally comfortable reading the classics and contemporary research on Chinese medicine—will continue to pose a challenge for any school or program of Chinese medicine, or other holistic health professions for that matter. Our method is one approach, which continues to evolve. However one chooses to adapt these ideas to the individual needs of one’s academic program and student body, we hope that the core concern of our curriculum—to train students to enter into different ways of knowing as an authentic means of engaging with humanity in health and disease—will provide inspiration to anyone who wishes to instill in our next generation of practitioners a deep respect and insight into the foundations of Chinese medicine, literacy in the vocabulary and methodology of biomedicine, and appreciation for other strands of the holistic medicine tapestry, both historical and contemporary.