SEPTEMBER 28, 2013, 3:00 PM
The Enigma of Chinese MedicineBy STEPHEN T. ASMA
A few years ago, while visiting Beijing, I caught a cold. My wife, who is Chinese, and wanted me to feel better, took me to a local restaurant. After we sat down, she ordered a live turtle. The proprietors sent it over. I startled as the waiters unceremoniously cut the turtle’s throat, then poured its blood into a glass. To this frightening prospect, they added a shot of baijiu, very strong grain alcohol. The proprietor and waiters, now tableside, gestured with obvious pride for me to drink the potent medicine. I winced, found the courage, and drank up.
I felt better later that night and in the days that followed, but I wasn’t sure why. Was it the placebo effect? Perhaps my body was already on the mend that night, rendering the medicine superfluous. Or did the turtle blood-baijiu potion speed my recovery? Maybe in years to come we will discover some subtle chemical properties in turtle blood that ameliorate certain illnesses.
Many Westerners will scoff at the very idea that turtle blood could have medicinal effects. But at least some of those same people will quaff a tree-bark tincture or put on an eggplant compress recommended by Dr. Oz to treat skin cancer. We are all living in the vast gray area between leech-bleeding and antibiotics. Alternative medicine has exploded in recent years, reawakening a philosophical problem that epistemologists call the “demarcation problem.”
The demarcation problem is primarily the challenge of distinguishing real science from pseudoscience. It often gets trotted out in the fight between evolutionists and creation scientists. In that tired debate, creationism is usually dismissed on the grounds that its claims cannot be falsified (evidence cannot prove or disprove its natural theology beliefs). This criterion of “falsifiability” was originally formulated by Karl Popper, perhaps the most influential philosopher of science of the 20th century, and, at first blush, it seems like a good one — it nicely rules out the spooky claims of pseudoscientists and snake oil salesmen. Or does it?
The contemporary philosopher of science Larry Laudan claims that philosophers have failed to give credible criteria for demarcating science from pseudoscience. Even falsifiability, the benchmark for positivist science, rules out many of the legitimate theoretical claims of cutting-edge physics, and rules in many wacky claims, like astrology — if the proponents are clever about which observations corroborate their predictions. Moreover, historians of science since Thomas Kuhn have pointed out that legitimate science rarely abandons a theory the moment falsifying observations come in, preferring instead (sometimes for decades) to chalk up counter evidence to experimental error. The Austrian philosopher Paul Feyerabend even gave up altogether on a so-called scientific method, arguing that science is not a special technique for producing truth but a flawed species of regular human reasoning (loaded with error, bias and rhetorical persuasion). And finally, increased rationality doesn’t always decrease credulity.
We like to think that a rigorous application of logic will eliminate kooky ideas. But it doesn’t. Even a person as well versed in induction and deduction as Arthur Conan Doyle believed that the death of Lord Carnarvon, the patron of the Tutankhamen expedition, may have been caused by a pharaoh’s curse.
The issue of alternative medicine, especially Traditional Chinese Medicine (T.C.M.), brings fresh passion to the demarcation problem. Americans are gravitating to acupuncture and herbal medicines (less so the zoological pharmacology, like my turtle blood), but we crave some scientific validation for these ancient practices. And the Chinese are themselves looking for ways to legitimize T.C.M. to the Western world, and distinguish it from the more superstitious aspects of traditional culture.
A couple years after the Beijing visit, while I was looking for a place to live in Shanghai, a realtor assured me that the apartment we were viewing was in a very auspicious location. Looking out the window 10 floors up, I could see the bend of Suzhou Creek as it passed the building. He explained that this curve and flow was very good feng shui. It was a prosperous channel of “positive qi energy.”
I took the apartment.
The general facts of feng shui (literally “wind and water”) strike many of us as relatively indisputable. Simply put, if you arrange your furniture in certain patterns and directions, it feels to most people psychologically better than certain other patterns. But the metaphysical “causal theory” behind these facts is more controversial. Chinese medicine holds that energy meridians mark the flow of a force called “qi” and this force is streaming throughout nature and our bodies — causing harmony and health or disharmony and illness (depending on the degree to which it is blocked or unblocked).
I certainly don’t need this theory to be true to explain why I feel less agitated when my office desk faces the doorway than I do when my back is to the door. And I don’t think I need it to explain the sense of peace I get from looking out my window at Suzhou Creek. Perhaps the metaphysical qi theory of feng shui will eventually give way to one that aligns with our understanding of sensory perception or psychology. Growing clinical evidence showing the palliative effects of placebos has led many tough-minded doctors to conclude that beneficial physiological responses (like endorphin and dopamine release) can be triggered by subtle suggestions, sugar pills, prayer, music and other seemingly gratuitous mechanisms. So, why not furniture placement?
Aristotle distinguished science from other kinds of knowledge on the grounds that it gave a causal explanation for observable experience, and its claims were systematic (logically coherent). By these Aristotelian criteria, T.C.M. at least looks fairly scientific — the system of qi provides the causal foundation for specific associations within acupuncture healing, kung fu skills, feng shui architecture, herbal remedies and so on.
Starting in the 17th century, however, the definition of science changed significantly. It wasn’t enough to have a systematic causal story, since many competing stories could fit the same observable phenomenon. Retrograde planetary motion could be explained by Ptolemaic epicycle causation, for example, but that causal picture was eventually unseated by a shift to heliocentric astronomy. What’s needed is the correct and verifiable causal explanation; and the scientific method (the “hypothetico-deductive model” in philosophy of science parlance) arose in order to put causal explanations through a gantlet of empirical tests.
Can qi theory be scientific in this more rigorous sense? Skepticism seems reasonable here because no one has seen qi directly. Even the meridians (or channels) of qi in the body remain undetectable to Western instruments, yet T.C.M. practitioners spend years mastering the meridian anatomical charts.
Are they chasing an illusion that takes authority from tradition alone, or are we still only at the commencement stage of discovery? Qi energy looks unfalsifiable, but maybe the promissory note will soon be paid. After all, scientists theorized, hypothesized and assumed the reality of the gene (a unit of heredity) long before anyone actually observed one. And the Higgs boson was posited in the 1960s, but only confirmed in 2013. Will qi energy be confirmed as the causal underpinning for the often-reported correspondence between acupuncture and healing?
In the 19th century, Darwin’s scientific revolution didn’t correspond to the experimental method of the falsifiability model. Galileo had been rolling balls down inclined planes and making direct observations to evaluate his gravitation theory, but Darwin’s theory of natural selection was less observable. Instead, Darwin’s natural selection attained increasing scientific acceptance because it explained so many diverse phenomena (like adaptive structures, anatomical homologies, the fossil record, and so on). The paradigm of qi is as explanatorily resourceful and deeply rooted in China as Darwinism is in Western science. But there’s a major difference, too, and it needs articulation.
Darwinism only posits three major ingredients for evolution; offspring vary from their parents and siblings, offspring resemble their parents more than non-kin, and more offspring are born than can survive in their environment. Each of these facts is easily observable and when you put them together you get adaptive evolution of populations. No additional metaphysical force, like qi, is being posited.
While lying on the acupuncturist’s table in China recently, I wondered if I was too skeptical or too gullible about qi. Dr. Shao Lei, at the Huashan Hospital, was nationally renowned as a skillful manager of this mysterious force. I explained to him that I had chronic lower back pain. Dr. Shao made a study of my tongue and informed me that my back pain was actually a qi problem with my kidney, but he could strengthen the weak qi area. He stuck me with 10 needles in my lumbar region, and a couple of pins behind my knees. He hooked these to an electrical voltage generator and zapped me gently for 20 minutes, while warming my back with a heat lamp that looked like it could be keeping french fries hot at a fast-food joint. I did not engage in this mild torture once, but several times — just to make a thorough, albeit anecdotal, study of the matter. And I can honestly say that my back improved in the few days that followed each session.
It seems entirely reasonable to believe in the effectiveness of T.C.M. and still have grave doubts about qi. In other words, it is possible for people to practice a kind of “accidental medicine” — in the sense that symptoms might be alleviated even when their causes are misdiagnosed (it happens all the time in Western medicine, too). Acupuncture, turtle blood, and many similar therapies are not superstitious, but may be morsels of practical folk wisdom. The causal theory that’s concocted to explain the practical successes of treatment is not terribly important or interesting to the poor schlub who’s thrown out his back or taken ill.
Ultimately, one can be skeptical of both qi and a sacrosanct scientific method, but still be a devotee of fallible pragmatic truth. In the end, most of us are gamblers about health treatments. We play as many options as we can; a little acupuncture, a little ibuprofen, a little turtle’s blood. Throw enough cards (or remedies), and eventually some odds will go your way. Is that superstition or wisdom?
Stephen T. Asma is a professor of philosophy at Columbia College Chicago, and the author, most recently, of “Against Fairness.” He will be in Beijing on a Fulbright grant in 2014.