Journal of Chinese Medicine Number 104 February 2014 Traditional Chinese Medicine - Science or Pseudoscience? A Response to Paul Unschuld 41

Traditional Chinese Medicine -

Science or Pseudoscience?

A Response to Paul Unschuld

Abstract

This article was motivated by the interview in Issue 103 of The Journal of Chinese Medicine (October 2013) with

Professor Paul Unschuld. Although Professor Unschuld is a prolific translator of Chinese medicine texts, and thus

a gatekeeper to vital information for practitioners who do not read classical Chinese, this interview (together with

other communications from Professor Unschuld) raises questions about his perspective on Chinese medicine. It

appears that Unschuld characterises Chinese medical theories as magical’ i.e. pseudoscientific thinking. This

article examines the tacit beliefs which appear to underlie the work of Professor Unschuld (and that seem to be

shared by other prominent authors such as Joseph Needham and Ted Kaptchuk) that deny Chinese medicine equal

status with modern biomedicine - as being based on scientific fact. In addition, the question is asked: Should

Chinese medicine be subject to verification by the methods of Western biomedicine, and if so, which part(s) of

Chinese medicine meet that standard?

Advocates and practitioners of traditional Chinese

medicine face a number of perplexing issues in the

21st century: What is traditional Chinese medicine?

Is it the same as classical Chinese medicine? Does it

differ from the traditional medicines of other Asian

countries? Is it an effective system of health care,

and is it based on scientific principles or on faith and

unsubstantiated dogma? These are just some of the

questions that are frequently asked about Chinese

medicine by practitioners, advocates, researchers

and the consuming public. They are not always easy

to answer in light of the fact that the government of

the People’s Republic of China has given its stamp

of approval to a particular version of the medicine

called Traditional Chinese Medicine’ (TCM), the

identity and boundaries of which are fluid, evolving

and subject to dispute by historians and partisan

groups alike.1 Perhaps a more provocative question is:

Should Chinese medicine be subject to verification by

the methods of Western biomedicine, and if so, which

part(s) of Chinese medicine meet that standard?

The specific motivation for this article was the

interview of Professor Paul Unschuld by Z’ev

Rosenberg in issue 103 (October 2013) of The Journal

of Chinese Medicine. For me, this interview raised

a number of red flags. Unschuld is an eminent

philologist and translator of numerous Chinese

medical works, including some of the classics, and his

work is generally accepted by the Chinese medicine

community in the West as authoritative. It might

come as a surprise to these readers, therefore, to

discover that Unschuld does not accord the premises

of Chinese medicine (i.e. qi, yinyang, wuxing, etc.) the

status of scientific laws or axioms, but rather regards

them as hypotheses that must be proven by Western

biomedical science before he will acknowledge their

validity as the basis for a rational medical system.2,3

Unschuld appears to view these concepts of what

he refers to as systematic correspondence theory’ as

pseudoscience in comparison to Western medicine,

which for him is based on real’ science.4 While the

interview does not state this opinion explicitly, one

only has to read Unschuld’s literary works carefully

to see this underlying thread. It was for this reason

that when I had a chance to chat with Unschuld in

2008, following a speech he gave at the Acupuncture

& Integrative Medicine College (AIMC) campus

in Berkeley (California), I asked him the following

question: If you happened to develop a case of low

back pain or sciatica, would you consider acupuncture

treatment?’ His unequivocal answer was, Certainly

not!’ When pressed for his reasons, he explained that

he was only interested in using treatments that had

proven themselves according to Western biomedical

standards.5

Let me be as clear as possible here: I happen to hold

Unschuld in high regard for the breadth and depth

of his work in translating Chinese medical texts, and

for his anthropological, sociological and political

analyses of these materials. Among the latter aspects

By: Peter Eckman

Keywords:

Chinese

medicine,

acupuncture,

TCM, science,

systematic

correspondence,

pseudoscience,

history, Neijing,

Sasang.

Unschuld appears to view these concepts of what he refers

to as systematic correspondence theory’ as pseudoscience.

42 Traditional Chinese Medicine - Science or Pseudoscience? A Response to Paul Unschuld Journal of Chinese Medicine Number 104 February 2014

of Unschuld’s work, as revealed in Rosenberg’s interview,

is his report that the Chinese government’s attitude toward

TCM is that it is part of modern biomedicine and that the

basis of TCM is molecular biology (positions codified in

the Beijing Declaration of 2007 and presented to health

representatives and scientists from 50 nations).6 Although

Unschuld’s works are meticulous and consistently

interesting they come with a hidden premise (as stated

above), which crucially affects the conclusions he comes to,

and which should be made explicit. Unschuld is not alone

in this regard, and in fact acknowledges his indebtedness

to the work of his predecessor, Joseph Needham, whose

Science and Civilisation in China series showed a similar

scepticism regarding systematic correspondence’ as a

scientific approach to medical knowledge and practice.7

Perhaps protoscience’ more accurately conveys these

authors’ opinions of Chinese medicine than the more

derogatory term pseudoscience’, but this distinction does

not change the danger of such thinking.8 Whilst practitioners

of Chinese medicine as a community are beholden to these

pioneering authors, they should read their works with a

clear understanding of the underlying belief systems and

biases.9 Therefore, when it comes to searching for a deeper

understanding of these foundational concepts of Chinese

medicine, the serious student or practitioner must look

elsewhere.

Not all Western translators of Chinese medical texts have

disavowed the basic tenets of Chinese medicine. Manfred

Porkert, Claude Larre and Elisabeth Rochat de la Vallee

have all taken the view that the axiomatic theses of Chinese

medicine are accurate descriptions of nature, and thus

qualify as scientific’.10 Interestingly, Porkert and Rochat de

la Vallee are themselves practitioners of Chinese medicine,

while Larre was a founder of the European School of

Acupuncture in France. Neither Unschuld nor Needham

have any experience as medical practitioners, a fact which

Unschuld acknowledges and discusses in his interview.

He cites his experience collaborating with Professor Zheng

Jinsheng, former director of the Research Institute for the

History of Chinese Medicine and Medical Literature of

the China Academy of Chinese Medical Sciences on the

translation of the Neijing. What is not revealed is Zheng’s

belief regarding the premises of Chinese medicine, and

whether it is similar to Unschuld’s (and thus represents

the official Chinese governmental position that is so

well described by Unschuld), or whether he acted as a

counterfoil to Unschuld’s scepticism. Unschuld reports

having observed a traditional practitioner in Taipei for

several months, but inevitably his belief system would

have affected his perception of the treatments, and how

he interpreted both the positive and negative clinical

outcomes. I myself have been in the position of observing

respected acupuncture practitioners at work, and what I

learned was immeasurably enhanced by my acceptance of

the truth of the theoretical premises upon which their work

was based.11

Unschuld’s is not the only voice from within the Chinese

medicine community in the West to have questioned its

fundamental tenets. As early as 1983, Ted Kaptchuk, in

his groundbreaking book The Web That Has No Weaver,

was generally dismissive of five phase (wuxing) theory as

a clinical guideline,12 although at the time he was a clear

proponent of yinyang theory and the rest of the seminal

beliefs and practices which form the basis of TCM, a style

of medical care he had learned in Macau.13 In a subsequent

edition of his book, Kaptchuk modified his negative

comments about the five phases,14 and he has generally been

accepted by the Chinese medicine community in the West

as one of its leading teachers and spokesmen.15 Since I knew

Kaptchuk personally,16 and was impressed by reports of his

post-Web’ research (especially with regards to the psychospiritual

aspects of Chinese medicine17), I was dumbstruck

when I read an article in the New Yorker magazine in 2011, in

which Kaptchuk was quoted as believing that acupuncture

was nothing more than a powerful placebo, and that he had

given up its practice more than twenty years ago.18 It would

appear that Kaptchuk has adopted the same stance as

Unschuld - that Western biomedicine is the only scientific

medical system. Where he differs from most practitioners

of Western medicine is in his belief that a dynamically

presented placebo is one of the most effective treatments

in a physician’s armamentarium, and that the relationship

between physician and patient is the most powerful

component of placebo treatment.19

I believe there is a common belief - shared by Unschuld,

Kaptchuk and the Chinese government (among many

others) - that science is limited to its Western tradition,

and that there can be no other kinds of science. This is a

proposition which I find untenable, and which undermines

all versions of traditional Oriental medicine. The essence

of science, to me at least, is the careful observation of the

natural world, with a view to learning useful, and hopefully

reliable methods of influencing future phenomena.

Chinese medicine is notable for the emphasis it puts on

the careful observation of nature. The empirical evidence

for the usefulness of Chinese medicine is hard to dispute,

since it has been successfully preserved by the peoples of

both China and Japan, despite governmental attempts to

outlaw its practice during various historical epochs. It has

additionally gained a strong foothold in the West, where

people have voted with their wallets to support a growing

Kaptchuk was quoted as believing that acupuncture was

nothing more than a powerful placebo ...

Journal of Chinese Medicine Number 104 February 2014 Traditional Chinese Medicine - Science or Pseudoscience? A Response to Paul Unschuld 43

Oriental medical profession. People obviously find it useful.

The most difficult criterion to evaluate is reliability, that is,

how well can theory predict the outcome of interventions

(experiments, treatments). This criterion is where Western

science has traditionally been most heavily invested

with its emphasis on the gold standard of the randomised,

controlled, double blind trial - and where Oriental medicine

has most often been criticised.

A careful analysis shows that things are not as simple as

the critics of Oriental medicine suggest. Take the Western

medical treatment of rheumatoid arthritis as an example.

Is there a standard treatment for this condition? Not really.

There are multiple pharmaceutical interventions that can be

prescribed. Can a physician accurately predict if any given

patient will respond positively to one of these drugs, and if so,

for how long and with what side effects? Again, the answer

is no. All that Western medical science can tell us about

this intervention (experiment) is the statistical probability

of a positive outcome, the duration of said outcome,

and the likelihood of various side effects. Most Western

medical therapeutics are based on this kind of statistical

probability of success, which can vary from close to 100 per

cent in some cases (such as with smallpox vaccination20),

to a marginal likelihood in others, such as some varieties

of cancer chemotherapy. The efficacy of TCM therapeutics

may not be as well documented as for Western medical

therapies, but whether we look at acupuncture, herbal

medicine or other modalities, we will find the same pattern:

some patients respond well, the duration of response will

vary and some patients will not improve. In fact, I believe

the Oriental medical profession should be criticised for

often claiming that their treatments are free of side effects,

and that they can do no harm. Maybe such a statement

might be true for a perfect practitioner who never made

an error in diagnosis, treatment formulation or therapeutic

application, but I have never met such a practitioner in my

40 years of study and practise. In fact, I believe it is exactly

these negative responses to treatment that strengthen

the case for Oriental medicine being based on science. If

interventions like acupuncture have no inherent potential

to improve a person’s health and well-being (assuming an

accurate diagnosis, treatment formulation and application),

then there should also be no reason for occasional negative

outcomes. Actually the classic texts of Chinese medicine

repeatedly describe the potential for incorrect treatment

to worsen a patient’s health. This can only occur if there is

some real natural21 change evoked by such treatment, and

it is precisely the study, and application of therapies that

bring about this natural change that characterise Chinese

medicine, and mark it as scientifically based. Kaptchuk’s

placebo explanation for the efficacy of acupuncture appears

to me to be clearly inadequate, especially in view of its

successful use in babies and animals.

In his interview Unschuld presents several examples of

why the Chinese government has opted to favour Western

biomedical science over traditional Chinese medical science,

and how in the process it has attempted to eliminate the

latter’s classical underpinnings. His first example is a clear

case of attacking a straw man’. He states, To return to premodern

Chinese medicine would mean to use the same

needle on several persons and to neglect even the most

basic requirements of personal hygiene’. Do either of these

issues have the slightest connection to the theoretical or

practical principles of classical acupuncture? I should hope

not. His second example is: The Chinese administration

… is aware of the fact that those who believe in yinyang

and five phase theories rather than modern science will not

be able to design an electric lamp, make a cellular phone

speak …’ Aside from the sociopolitical implications of this

statement, there is an unexamined assumption in the use of

the word rather’, implying that these two belief systems

are incompatible. This assumption seems quite strange in

the context of Chinese culture, where it is quite common

for an individual to be a believer in Daoism, Confucianism

and Buddhism all at the same time. Different belief systems

- even those that contradict each other - capture different

aspects of reality. The explanation for such a proposition

lies in the frequently-stated observation that the map is

not the territory’. Nature, or reality, is never completely

as described by any theory or doctrine. These theories are

merely lenses we can use to look at different aspects of

reality. Biomedicine gives us one very useful lens to look

at health and illness. Oriental medicine provides us with a

different, but equally valid and useful lens.

Many authors before me have pointed out that Western

science is analytical, quantitative and deductive, whereas

Eastern science is synthetic, qualitative and inductive.22

Because of these differences, the types of investigation

(experiments) necessary to validate propositions in each

will also be different. In Eastern medicine (such as TCM), the

active role played by the therapist is an inherent part of any

treatment, thereby automatically excluding randomised

double blind trials as a valid means of evaluation.23 This

state of affairs does not disqualify Eastern medicine as being

scientifically-based. Even Western science has areas where

the influence of the observer (experimenter) cannot be

eliminated, such as in quantum mechanics, or in applying

the uncertainty principle. While agreed-upon standards

for research in Eastern medicine may not yet exist, our

professional response should be to examine and debate

this question to see if such an approach can be formulated,

Biomedicine gives us one very useful lens to look at health

and illness. Oriental medicine provides us with a different,

but equally valid and useful lens.

44 Traditional Chinese Medicine - Science or Pseudoscience? A Response to Paul Unschuld Journal of Chinese Medicine Number 104 February 2014

rather than to reduce ourselves to the position of being a

minor branch of biomedicine, or give up the pretense of

being a rational system of therapy altogether. If either of

these latter options is adopted, there will be no true Chinese

medicine left.

In summary, I believe that traditional Oriental medicine

(including TCM) is a branch of Eastern science, while

biomedicine is a branch of Western science. Both reveal

truths, both are useful guides for healthcare providers,

but neither is reducible to the other. Like so many other

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