Following the first day lecture on Philosophy of Chinese Medicine 1 for the Global University for Sustainability, Keekok Lee continued on a second day on some topics:
- Anatomy as structure; physiology as function (and process);
- Process ontology, and thing ontology;
- Qi ju as qi-in-concentrating mode, and qi san as qi-in-dissipsating mode; and
- the 4 P’s of Chinese medicine.
20210617 SSFS8 LEE Kee Kok – Philosophy of Chinese Medicine 2
Again, this online web video lecture is a complement (and update) to two prior books:
- Lee, Keekok. 2017. The Philosophical Foundations of Classical Chinese Medicine: Philosophy, Methodology, Science. London: Lexington Books. https://rowman.com/ISBN/9781498538886/The-Philosophical-Foundations-of-Classical-Chinese-Medicine-Philosophy-Methodology-Science.
- Lee, Keekok. 2018. Classical Chinese Medicine: Theory, Methodology and Therapy in Its Philosophical Framework. Newcastle upon Tyne, UK: Cambridge Scholars Publishing. https://www.cambridgescholars.com/product/978-1-5275-0397-7.
Highlights from the transcript from the Youtube recording are provided below, in the interest of scholarship.
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[0:24] Now then, where we stopped yesterday, as far as i can recall, is that I was stressing on thing ontology in biomedicine. The emphasis is on the notion of the body as machine, if you remember. Now because you are talking about the body particularly as machine, you are therefore talking about structure. And structure is a subject which is very dear to the heart of engineering. So take a watch when you from the engineering part of your watch is: what is a watch? You could take a watch to pieces, you know, the spring, and the handle at the hands of the clock, the frame, the metal frame, or whatever, and so you can split it up, deconstruct it, into its component parts. But in engineering, what you have decomposed you can also reassemble. So engineering implies also the concept of reverse engineering. You can both construct and deconstruct.
[1:58] Now because you’re talking about structure, where this kind of thinking is then applied in the context of medicine to understanding the body, because the emphasis is of the body, the thing, there, then you are emphasizing anatomy.
[2:21] Because anatomy is what occupies space, right? Now so that is why it might be sound a bit of a caricature to say that modern, that BioMedicine, is actually based on autopsy.
[2:44] In other words you learn the medicine initially by doing the section on the cadaver, on the corpse. So all medical students as far as i know, even today i believe, have to do the initial training in the path [pathology] lab. You’ve got to do a certain amount of dissection, because without dissection you cannot know about the body, how the body as a machine is structured, and held together the component parts.
[3:24] Now, another emphasis because of this ontology of body …. It also means that surgery plays a very important part in BioMedicine. So if you have structure you also have surgery.
[3:52] A medical scientist and philosopher in the 16th century called Ambroise Paré, he laid down five functions of surgery. And to this day, those five functions remain correct. So he was very perceptive and insightful.
[4:21] So what are these five functions of surgery?
[4:28] He said first, to remove what is superfluous. Now, that is quite true. Biomedicine for a long time today it might have shifted its position a little bit./ But for a long time it says your appendix is superfluous. So, when it gets inflamed, you’ve got to get rid of it. So some people jump the gun and say, why wait for it to get inflamed before we remove it? It’s superfluous anyway let us choose a time and place of our own convenience have a surgical operation and remove it.
[5:08] The same thing with tonsils for a long time, at least Americans, middle class … Americans thought that the tonsils were superfluous. So they got their children, have the operation, remove the tonsils. Appendix, tonsils, all superfluous. So that’s rule that is one function to remove what is superfluous.
[5:30] Then, the second function is to restore what has been dislocated.
[5:39] Now that can be quite helpful, I do admit. For instance, if you twisted your waist, or what we call the hips, or whatever, and it’s painful, right? So sometimes you do need an operation to readjust the dislocated hip. So i grant that that’s very useful.
[6:00] And then, the third is you remove what has been, you divide or separate what has been conjoined Now this, for a long time, was very difficult and didn’t come to pass. But I believe, in December 2020, that surgical operation was performed, a spectacular surgical operation, which involves separating two conjoined twins. So the surgeon, marvelous people, needed to divide the children, and the children survived. So that is another function.
[6:45] And then, a function is …. Suppose you sever your finger in an unfortunate, when you’re chopping on the chopping board — the Chinese use a cleaver especially not a simple small cleaver, chop chop chop chop and you chop up your finger — then you carry the finger quickly to the hospital and the surgeon can reattach the finger, right? Or a severed limb in an accident at a factory. So that is also very useful, so you see.
[7:17] And then the final function is that you also do what I call cosmetic surgery, not in the vain sense, in the sense of vanity to look good, but because it becomes a disability itself. For instance people who are born with a hair cleft. you know where the ren zhong, the philtrum had not occurred. So you know, so that’s not mere vanity, to have it stuck together, stitched together in a surgical operation. And so that is very, very important, as well.
[8:02] So there you are, you see. Paré puts forth these five functions of surgery. they remain true today.
[8:07]Now, I’m talking about the ren zhong on this point. I might as well make a point which is relevant to our understanding of Chinese medicine to BioMedicine.
[8:23] The ren zhong is simply that bit of the anatomy where unfortunately in the case of some people something happened to your prenatal development and the two bits never met.
[8:36] So now we have the technology to stitch them together so that’s wonderful. That’s fine, and one is grateful for people being restored in this way to wholeness.
[8:50] But to the Chinese, the philtrum or the ren zhong is not simply an anatomical bit. It is a cosmological site because it is the place where tian, heaven, meets earth, di.
[9:06] Tian, as we know stands for yang, and di stands for yin. So this is the place where yin yang meets. And according to qian ren xiang ying — the mouthful, macro micro cosmic wholism — unless you have zhang and jing in yourself in a microcosm, you wouldn’t be a proper person. You wouldn’t be functioning properly. You won’t be whole.
[9:34] So that is why, to the Chinese, it’s a cosmological site.
[9:41] And so, it’s not simply a piece of anatomy, it’s a very, very important site.
[9:48] So okay … Now then so, Chinese …. Western medicine and BioMedicine emphasizes structure that, therefore, surgery.
[10:00] Now, if you look at Chinese medicine, surgery I wouldn’t say plays no role, but it plays a very minor role, historically.
[10:11] So I wouldn’t want to say that Chinese medicine never took any interest in anatomy and therefore in surgery. But the anatomy was downplayed and the surgery was minor. There was a very minor surgery. And I believe in the Huangdi Neijing, there are several passages especially in the lingshu. which is the spiritual pivot, or the luminous pivot. References to anatomy — so there you are, so just make the picture correct — it’s not that Chinese medicine is not interested in it, but the role played by anatomy is somewhat minor let us say.
[10:59] So what is the polar contrast to structure and anatomy? It will be function. So Chinese medicine stresses on function. How parts of you, from the component parts which form a whole function. How your organ systems — what yesterday i called organ systems — such as your piwei [spleen-stomach system], your zangfu [the yin and the yang visceral organ-systems] — how they function. How one zangfu functions as a whole. How several zangfu in us, as a living individual, functions with other zangfu. And this is how the function works.
[11:43] So, when you’re talking about function, you’re therefore talking about physiology not anatomy.
[11:50] So to me, then, Chinese medicine following this line of exploration talks therefore about physiology, or at least the Chinese understanding of physiology.
[12:07] Now, if this is so, then i think various consequences follow.
[12:21] Now I would like to draw your attention to some of these differences very, very radical differences between BioMedicine on the one hand, and Chinese medicine on the other.
[12:42] Now, one of these differences is that — which i have just alluded to in fact — is between structure anatomy on the one hand, and function physiology on the other. I’ll come back to this point, later but let’s just call this is a fundamental difference.
[13:06] So any system of medicine which does not emphasize structure and anatomy, to BioMedicine, they would consider as an absurdity.
[13:19] So you can say, absurdity 1, according to the understanding of BioMedicine with regard to Chinese medicine is that it fails to talk to emphasize fully of structure and anatomy. So how can we take seriously a system of medicine which ignores such two important concepts structure and anatomy? So it’s not a serious thing, right? Okay, absurdity number 1.
[13:49] Absurdity number 2 is that BioMedicine takes a very very very drastic distinction between what may be called today’s medical texts, which medical students at a medical school study, as opposed to historical medical texts.
[14:14] Now, it is not part of the training of a medical student, in a modern medical school, to go and look at historical medical texts. You’ll be laughing stock if you make your students look at historical medical texts.
[14:36] So you’re not a medical student, I’m not expected to go about by Hippocrates writing, you know, we would go back to the ancient Greek because the western civilization claims to have its roots and ancient Greek stuff. But he wouldn’t ask you to read Hippocrates, Galen or any of these nonsense. And never mind that it wouldn’t even ask you to, in spite of his heavy emphasis on anatomy and structure, it wouldn’t ask medical students to look at Berzelius, who in the 16th century wrote the definitive, put modern, put study of, anatomy on the modern basis as it were. Oh, no, no, no. They are for fuddy duck people like myself, philosophers and historians of science and medicine, who may be interested in these ancient tones
[15:37] So, these are museum pieces for them. So today in fact, as far as I know, you have to have the latest medical knowledge. And where do you find your latest medical knowledge? Not even in a textbook, because today, textbooks, hard copy, take a long time to be produced. the latest is to be found online. Online publications.
[16:07] So if I want to be really at the cutting edge of modern western medicine, I would have to be constantly on, and find out who has said what. What are the latest experiments, etc etc.
[16:21] And every day, the revision goes: what was extant knowledge at time t1 is no longer extent knowledge at time t2. And the difference the the difference between time t1 and time t2 maybe indeed yesterday and today. So there’s a tremendous pressure to keep up with the latest development, it does. So no museum pieces anything which reaches beyond the present. The present moment is really ancient knowledge. We don’t want to know. It might be knowledge in the past, and we may deign to call it ancient knowledge, but it’s not present knowledge, and not extant relevant knowledge. So we move on.
[17:08] So I look at the Chinese. What do they do? If you want to learn Chinese medicine, what do your master, your shifu, tells you to do? Go and study the Huangdi Neijing. The Shanghan Lun. If you don’t know .… First of all, you have to know this by heart, best of all. Otherwise you know you don’t really know your text. Having learnt it by heart, you must always carry it in your mind. Never mind carrying your mind, you consult it if you come across problems in your clinical experience. so if you’re puzzled by a patient and you diagnose, right, you say, ooh, this sounds a bit odd.
[17:54] And you could make sense of, you know, the results of the four methods of diagnosis in chinese medicine. So the moment you have the time, you go and turn over the pages of your Neijing to find the relevant pages and to hope to get inspiration and wisdom for it. You’ll meet up with a fellow, a group of fellow physicians, and you discuss this. And you go through the pages of the Neijing and the Shanghan problem.
[18:29]. And so now, if you have the mentality of BioMedicine you would consider this as a ludicrous, absurd, activity. Why do you want to look at ancient texts? They’re museum pieces. “They’re not relevant to your present preoccupation.
[18:46] An, no, the Chinese say this: you don’t understand what we are doing. So, talking a conversation between the deaf and the dumb, as it were. So you get nowhere.
[19:05] Another absurdity, which follows from the second absurdity, would be that, naturally, you use the prescriptions which physicians used more than 2 000 years ago, to try to apply it in your clinical, in your clinical case, the case before you, it you know, in your consultation room now.
[19:44] To BioMedicine, this again is simply absurd. Simply absurd. Now to see how absurd it is, let me give you a small history of modern of biomedicine from the point of view of treatment. And then you could begin to see how absurd it is.
[20:12] Now, the treatment modern western medicine began, let us say, roughly from the time of the Ascanius, and slowly, slowly, it built up to today. So the theoretical understanding to, up to a point, was well in advance of its ability to offer treatments to patients who are, who were, ill.
[20:41] Now what did … It was not until in a sense, as late as 1945, the second, post-second World War, that biomedicine had efficacious treatment for a lot of disease. Now you may be surprised to hear this. Now this is not a fantasy of mine. I’m going to back it up with with evidence now.
[21:10] Now before that moment, what did people do? What did the biomedical — so we didn’t call them biomedical physician, then, we just called them the doctor, right — the medical doctor. The doctor, the doctor had two ways of coping, probably three.
[21:30] But two important ways. One is what is called venisection, I’ll explain what that means. And the second is leeching.
[21:47] Now, what is venisection? That is, I do know that there is a very important distinguished journal in BioMedicine which is called a Lancet. Now why is it called a lancet? Now it’s called The Lancet, because people before the end of World War II, they use a little knife, I suppose a scalpel called a lancet in order to cut away, then a section, cutting a vein, in order to draw blood from it. Because they believed that the blood is no good. I mean, this is putting it simplistically. We have no time to go into the detail. So you drain the blood, as it were. And after draining the blood, you’ll be fine, they think, right?
[22:42] So the other instead of cutting your vein, and draining the blood with the lancet, the other thing is by leeches. Leeches. You know little little creatures called leeches. Now, medicine, modern medicine, used up so many leeches, that the leeches of the uk were used up. So they imported from France. And france also used leeches at that time as well, right? So leeches became almost extinct in Western Europe.
[23:21] So they had got to go to Turkey to import leeches. So there you are, you say, these were two modes.
[23:27] Now back to venisection first. Now venisection, in the end, killed a lot of people.
[24:20] So that were the two main techniques. And the third one, which they also used, and which Chinese medicine also — I mean not that chinese medicine didn’t use venisection and leeching, they did, but on a very very small scale, right? And also the third method, which were used by western medicine, was also used, occurred in Chinese medicine, but again on the small, not on the large scale, but on a small scale. So it was cupping, right?
[24:54] Ba guan. So it was cupping. So, in fact it’s some chart in some French novels, in the early 20th century the late 19th century, stories of rural France you can still read, you know, the doctors doing cupping and things like that. So today, I think it has probably fallen out of use in western medicine but it remains one of the methods in Chinese medicine.
[25:28] But chinese medicine includes a whole suite of treatments, of which the two main ones, as we know, like acupuncture and decoction. Using medicinals to decoct and make up a brew, and then to drink the very unpleasant liquid from such a decocted material.
[27:54] Modern practitioners in Chinese medicine, admittedly use the prescriptions in what they call a linghua manner. Linghua, I suppose can be translated in a sensitive nuanced manner. You make modifications, but in a nuanced sensitive manner, in the light of your actual clinical assessment of the patient in your consultation role. So you adjust the ancient prescription formula, in order to address the peculiar characteristics of the individual in front of you in a consulted role. But that is how China medicine is so obviously is a piece of nonsense according to BioMedicine.
[28:50] Now, the fourth absurdity I would like to draw your attention to about Chinese medicine, in the eyes of BioMedicine is, I think, even more nonsensical than the other three that i’ve mentioned. Why is it so nonsensical? Because it amounts to a boasts if you like. And what is this boast of chinese Medicine? It boasts that Chinese medicine can cure any illness, of course, in principle,
[29:37] In principle, I’m not saying every Chinese practitioner can cure it but in principle it has the intellectual resources to cure any illness which the patient presents him — I’ll use the plural — presents themselves, right, so that’s not to be gender biased.
[30:12] So, now that is obviously ludicrous. How can you, in principle, cure whatever illness is presented by the patient in your consulting room? Even in principle, this is absurd, without knowing “the cause” in biomedical understanding of what is “the cause” of the disease suffered by the patient.
[30:43] Now what is the biomedical understanding of “the cause” suffered by the individual patient in front of you as the practitioner as the medic.
[31:00] Take Covid-19. According to biomedicinem all diseases are caused by either a bacterium, a virus, poison, a prion — a prion is a piece of protein — or today, since the human genome project of genomics, a piece of the effective gene through you, right? So your illness is caused by one of these five things.
[31:43] So, some of these things, we can do something about as biotechnology improves. And other things in the past, you can’t do anything about.
[31:56] Today, we can do something about your faulty genetic sequence. Not all genetic sequences can be so easily cured by biotechnology unfortunately but a very limited amount one can do. For instance, in single gene defect you can do it. But not many diseases are caused by single genes defect. So having said that, you’ve got to hand it to BioMedicine, that in very limited cases, it can even fiddle with your genome, with your individual genome, to remove the offending bit of DNA sequence which you happen to have inherited from both your parents, right? So that is what, precisely what, it claims to to be able to do.
[32:52] Whereas, Chinese medicine is totally different.
[33:01] One doesn’t assess, analyze disease. We don’t call it disease in chinese medicine, anyway. We call it an illness because a disease presupposes that that variable, the relevant variable, is an entity. But as I say, Chinese medicine is not based on thing ontology.
[33:28] It is based on both process ontology and thing ontology. So it is a functioning of both right now.
[33:42] This now leads me to cover a gap which, something which I left out yesterday, because it was inconvenient and to reintroduce that matter. But now I think I will. Now yesterday I say that chinese medicine is Daojia medicine, Daoist philosophical medicine, medicine based on Daoist philosophy. And I said a YjJing is a daoist text, that the DaoDeJing of the Laozi is definitely a daoist text. That is a Daoist philosophical text.
[34:21] But there is also another text, which is the Zhuangzi. The Zhuangzi is also a Daoist philosophical text. Now yesterday, I said the DaoDeJing or the Laozi, although it did not never mention the word yinyang, nevertheless, you’ll never be able to understand yinyang, unless you have the concept of yingyang.
[34:50] Because it presupposes that everybody knows about the concept of yinyang, so he didn’t bother to set it out, all over again. And also the concept of what I called dyadism, and not dualism. So it also presupposes that but anyway.
[35:08] So the missing element comes then from the Zhuangzi. The Zhuangzi, of course, is later than the Laozi, but in the Zhuangzi, there is a very important distinction made and about qi. As you know that the fundamental category, in Daojia philosophy, in Chinese philosophy in general, is qi.
[35:38] Now qi, as i say, if you want me to explain what qi is, you probably have to have another 10 lectures on the subject, so I’m not going to attempt. All that I say is to rely on one’s intuitive understanding of what yang qi, as opposed to yin qi, right? That’s all I want to say because one has just about no time. But anyway if you think of yang qi or yin qi, or whatever it is that the qi, according to the Zhuangzi, occurs in two forms in the macrocosm, as well as in you, the microcosm. It is qi ju, and qi san.
[36:30] Now qi ju, I have personally myself translated as qi-in-concentrating mode, and qi san as qi-in-dissipating mode.
[36:50] Now in the macrocosm, of course, there is qi-in-concentrated mode, because qi-in-concentrating mode, in the abiotic world, in the world of the of nature which is non-organic, such as rocks, primarily — that’s the most obvious example of qi-in-concentrating mode in nature. Mountains made of rocks, et cetera, right? Now that is qi-in-concentrating mode, it exists as a thing. The Himalayas exist as a thing. But the Himalayas is very very tall.
[38:10] The Himalayas will become shorter and shorter and shorter, because erosion will have taken place, weathering would have taken place. And as a result, what was concentrated in the concentrating mode has become qi-in-dissipating mode.
[38:35] Now, in the laws of thermodynamics, in the modern laws of thermodynamics, we talk of the production of entropy. Now, of course, the Chinese have no equivalent direct equivalent concept of entropy, but I think if you read between the lines, the implications of qi-in-concentrating mode qi ju, as opposed to qi-in-dissipating mode, which is qi san, then you begin to grasp that the chinese do have some implicit understanding of what entropy could be.
[39:15] Because entropy is just simply, you know, an object like a table, no longer exists as the table. It exists as bits of wood, and from bits of wood, eventually become atoms and molecules of all bits, of standing for, bits of … I don’t know what they are.
[39:34] But anyway you can imagine what the physics of that may be.
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The ideas of qi-in-concentrating mode and qi-in-dissipating mode are more fully explained in Keekok Lee’s 2018 book. Here’s a table.
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[39:40] So, this is what it is about now. Then, in Chinese medicine, of course, you use we use the decocted, we use medicinals, which are qi ju, qi-in-concentrating mode.
[40:02] We use bits of plants, bits of animals and you’ll be putting them together put some water in it — water is also qi-in-concentrating mode — put them together, put the fire underneath, and you decoct and and you drink, right?
[40:18] But surprise, surprise, of the two medicines and there are various domains of Chinese medicine but primarily you can say — Efrem may may correct me in this if i’m wrong — two forms:
[40:37] One is decocted material that you drink, qi-in-concentrating mode. And the other you don’t use medicinals which consists of things, of things.
[40:5t] What you do is acupuncture.
[41:02] Now, ironically, ironically, acupuncture seems to go down better in the west today, than decoction.
[41:16] Now,l this to me is a puzzle. It’s very very strange. Because acupuncture is primarily about qi-in-dissipating mode.
[41:31] Medicinal decocted medicines treat the ill patient, the patient, via qi-in-concentrating mode, via things. But in acupuncture you are treating the patient not via things, but via qi-in-dissipating mode.
[41:54] That I find it very, very strange, that the most difficult concept from the BioMedical point of view, for some odd reason, the West buys much more, and much happier with it, than the other version. It fits in better with its metaphysics.
[42:18] Now, I see why the west buys acupuncture, which is the difficult notion as opposed to a decocted medicine which is metaphysically the easiest thing to cope. I express it in terms of geopolitics, and economics.
[42:38] First the geopolitics. Why is it that it goes down so well and that has something to do with Nixon. If you remember Nixon and Kissinger were the ones who broke the ice with China, with communist China in the 1970s.
[44:06] And the other is, this is also economics. Because, imagine you are an American. In america where there’s no national insurance, no free medicine, you’ve got to buy your own insurance, right? Now, for people who have no insurance then you cannot go to a consultant– a grand consultant, a BioMedical consultant — if you have an illness because you haven’t got the insurance to cover you, and you are suffering. So you realize maybe I could consult a bumble jumble man he costs less. So you go to your Chinese practitioner who probably charges you one-twentieth of what, or one-thirtieth of, what the grand consultant, you know, at the John Hopkins hospital, or wherever, whatever, or the Mayo Clinic would charge you.
[45:00] So, it’s both a geopolitical reason, and for economic reason, that acupuncture has become better acceptable, accepted in the west, than decoction.
[45:24] But in terms of metaphysics, it’s a very, very, difficult concept, it seems to me. Because you’re now talking about qi when the acupuncturist sticks the needle in you, in the jingluo, in the network of the jingmai, you are fiddling with qi-in-dissipating mode, in order ultimately to affect qi-in-concentrating mode.
[45:58] Now how is this done? This is done via a fundamental postulate methodological postulate which I will now introduce.
[46:28] And in Chinese it reads bu tong zhi teng, tong zhi bu teng. Now that sounds like a mouthful, because they all sound alike, you know, in Chinese, right?
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Here’s a helpful translation from Don Tai, on appreciating the Chinese language.
These are opposites and say the same thing:
- bu4 tong4 zhi2 teng4 不通只疼 If there is a blockage then there is pain;
- tong1 zhi3 bu4 teng2 通只不疼 if there is a clear path then there is no pain.
This is some word play she is doing.
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[46:33] So let me explain a bit. The first bu tong zhi teng, the bu tong here means a blockage. No passage. No right through passage. A blockage.
[46:48] So, if there is other words … At the second bu tong zhi tong, the second tone — although it sounds the same to a person who doesn’t know Chinese — the character is the << ? >> because the second tone means pain.
[47:09] So, bu tong zhi teng, means if there’s a blockage — blockage of what? — of qi, if there’s a blockage you’ll feel pain.
[47:18] Now the second bit tong zhi bu teng, the first tone in the second part is, if there’s no blockage, there is no pain.
[47:33] So the whole thing, bu tong zhi teng, tong zhi bu teng, translated it means, if there’s << spot? >> blockage, there’s pain.
[47:52] If there’s no << pop with? >> blockage there’s no pain.
[47:57] So in other words, then what does acupuncture actually tell us, when the patient comes to your consulting room, if you were a Chinese practitioner, medical practitioner? Ah, you will say, where’s the pain, right?
[48:12] Oh, of course, the patient is usually voluble, and can tell you without prompting, even, and so says, oh it hurts here, or it hurts there, or it hurts somewhere, pointing to a bit of the anatomy.
[48:25] And, of course, the Chinese medical practitioner would then take the pulse, ask questions, look at your complexion, and with these four diagnostic methods, pseudo, he would come to an assess, or she will come to an assessment, of what is wrong with you.
[48:44] And then, ah, then the practitioner would say, right, if I’m an acupuncturist — you need acupuncture. He might prefer to use medicinals but imagine, like Ephraim, who prefers presumably to choose acupuncture. I don’t know, I’m attributing it to him.
[49:03] He will then work out which is the right place to poke, you know, to stick the needle in, which is the correct xuewei of the jingmai, on which jingmai, you know, which will then unblock the blockage of qi. And once he unblocks the blockage of qi, there’ll be no more pain, right.
[49:26] So that is why, to me, this methodological postulate is very important. Because it directs the clinician’s attention to how to treat the patient.
[49:38] So your attempt is simply to unblock the blockage of qi, and when you have unblocked the blockage of qi, that lo and behold, the patient will tell you, ah daifu, there’s no more pain, right? No, if not immediately, at least a few days, or after a few sessions. It doesn’t mean that after one session you might be cured.
[50:13] Sometimes it requires a few sessions before you can tackle the business. So anyway, that is that.
[50:20] So, that’s a fundamental distinction very radical distinction between these two sets of medicines. And nothing presents the difference quite so drastically as in the notion of acupuncture. Because in acupuncture — as i keep repeating, and it may bear laboring the point — you are dealing with qi-in-dissipative mode.
[50:52] That’s why one owes it to the Zhuangzi, the Zhuangzi, for drawing attention to the distinction between qi ju and qi san.
[51:03] I don’t normally see this distinction much talked about, even in medical texts today in Chinese, written in Chinese. I’ve come across it before, but it’s not as often emphasized as you might think. So I think to pay a due respect and acknowledgement, we should put it Zhuangzi for having drawn our attention to these two modes of existence of qi.
[51:36] So that is why Chinese philosophy and Chinese medicine is not simply about the body, the physical body here. Never mind understanding the body as a machine. But just this body is not simply understanding around this body but understanding the qi circulating in this body as well.
[51:58] And so that is why in Chinese philosophy and medicine, nobody would be interested very much, in what a corpse is. Because a corpse has no live qi.
[52:17] So admittedly, and Ephraim will remind me of this, I’m sure, when a person dies, for a first few hours, the relatives people around the dead person wouldn’t notice much change. Quite often, the dead look as if they’re asleep, right? But if you don’t bury the dead straight awa,y after a few hours, and leave it lying about for seven days ah then it’s a different matter.
[52:49] It is no longer a qi-in-concentrating mode, a thing in the body, but the body, you know, becomes qi-in-dissipating mode, and you wouldn’t like that.
[53:03] And so, as a result, Chinese medicine doesn’t pay any attention to the corpse, because a corpse exquisite, has no qi-in-dissipating mode flowing through it, running through it.
[53:22] Whereas BioMedicine say, you cannot kill people, we cannot give you certificate to certify you as a proper doctor if you didn’t know your anatomy, if you didn’t know your bits of your skeleton, bits of your tissue, and now bits of your DNA, as well.
[53:41] So they are concentrating on single ontology and qi-in-concentrating mode at the expense of qi-in-dissipating mode.
[53:57] But in Chinese medicine you are concerned with both, because if something is wrong with your qi-in-dissipating mode, it will express itself as felt pain in a part of your body. And your body is qi-in-concentrating mode.
[54:18] So it marries, as I say before, thing ontology and process ontology, because qi-in-dissipating mode is about physiology. it is about function, and function is a process not a thing.
[54:43] So it marries the two: thing ontology with process ontology.
[54:53] So, in this sense I think, if you go back to acupuncture, you will see how this works … you can work out for yourself, those of you who know more about acupuncture than I. How qi-in-dissipating mode, in which you emphasize on, but not necessarily to the expense of qi-in-concentrating mode, you try to to combine both modes in your practice, in your theory and your practice.
[55:52] I’ll move on to a slightly different, though related, topic right now.
[55:59] I want to show that how Chinese medicine operates in practice, because i’ve been talking about high theory quite often. Too much so, according to some people. Now let me descend to the ground a bit more.
[56:19] And that is to talk about what sometimes is now called the four P’s in medicine.
[56:28] I don’t want for the moment to talk about the analogous four P’s is in BioMedicine which has developed,just eight or nine years ago, but I talked about the four P’s of chinese medicine.
[56:47] That chinese medicine is predictive, << modern? >> P; preventive, second p; personalized, third P; fourth P, participatory medicine. So four P’s, right? So what do I mean by the four Ps?
[57:14] Prediction. I’ll just do prediction and prevention together, because according to Chinese medicine, which is again absurd to modern BioMedical ears, if you know how to diagnose, your diagnosis will immediately lead you to an understanding on how to treat the patient. So I’m going to treat the two P’s prediction and prevention.
[57:51] Now I will choose an example which I have already used yesterday, because I think it’s good. It refreshes people’s mind. And I don’t have to cope with more examples. So I’ll use an old example which I used.
[58:05] If you remember yesterday, I said from the writings of Liu Lihong, I have got this particular narrative, this particular story, and that is that a particular, very distinguished, therefore excellent Chinese practitioner physician, who is therefore a shang gong and not a xia gong. A xia gong is not a very competent practitioner. A zhong gong, which most practhitioners are, they are competent but not really distinguished. But this is a genuine shang gong, really very distinguished, I’m told anyway.
[58:51] So this particular very distinguished practitioner took the assessed, the mai profile of a particular patient. And he said that, look there’s something wrong with you, because it is now winter and you are not presenting a mai profile which is consonant with the season of the year, because it is not a winter mai that you are showing, it is a summer mai.
[59:25] So qian ren xiang yin, macro micro cosmic wholism, means that you are out of synch with. Your microcosm is out of synch with the macrocosm. The macrocosm out there is winter, but your microcosm is overpowering already. Whereas in winter, yang qi is very subdued.
[59:48] So he diagnoses, and therefore he predicts, that if you don’t do something about it, come this summer, bring the yang qi in summer is at its maximum, and added to your own disorder already, you add to the yang qi from the outside world, oh you’ll be a goner he said.
[1:00:14] This man was very stubborn. He says no, there’s nothing wrong with me, he said. I don’t believe in your bumble jumble anyhow. You’re not scientific. I believe in Western medicine. Western medicine isn’t wrong but we haven’t been through all the tests. So if I’m fine, fine, fine. Nobody can force another person to have treatment, anyway.
[1:00:32] And so, okay come this summer, the following summer, indeed the daughter of this chap then rang up the physician who had diagnosed her father, and said, I’m afraid father had gone because the yang qi was overwhelming. I think he had a heart attack of some kind. So he was gone. Right, you say.
[1:00:55] So you say prediction, diagnosis, … prediction and prevention go together. So he knew that his prognosis would be correct and and so on.
[1:01:10] Now that personalized medicine …. I’ll give you a story, this time not from Liu Lihong, but from another very very distinguished writer, a practitioner, a scholar, scholar practitioner, called Hao Wanshan. Now I think Hao Wanshan is today acknowledged in China as an authority on the Shanghanlung. So I’m only borrowing from him. I take it he is the authority, to which I bow lower deeply, and so this is what he tells me.
[1:01:54] Personalized medicine he said during a particular flu epidemic in Beijing, some time ago — not this epidemic but another earlier epidemic — a couple came along to see him. And this couple then said to him – the woman was obviously the person who wore the pants in the household, right, in this couple — so she says, daifu, we have been to see the medical, the BioMedical doctors. And they say that we have the same virus, it’s flu. So you just give one prescription that will do duty for both of us. Because they suffer from the same thing.
[1:02:48] So Hao Wanshan was quite shocked by this, and patiently explained to the couple, the patients. He said look, this is you’re giving me an account of the illness from the BioMedical point of view, but I’m not a BioMedical doctor, I am a Chinese physician, and so I diagnose differently. I have to diagnose each of you separately, because it is personalized medicine that I do. I don’t do, you know …. Of course, this is not to say there is no mass produced formula in Chinese medicine but it’s always a faute-de-mieux, faute-de-mieux, because you have no time in an epidemic, you suddenly have no time to see individual patients, so you do have, you know, mass produced stuff.
[1:03:36] But ideally it’s personalized medicine. So, in the end, what it turns out is, the woman wore the pants. She was the extrovert. She was a person who dictated terms to the husband. The husband was a mouthy fellow. An introvert. And so the physician, Hao Wanshan, diagnosed accordingly. One was an extrovert. The other was an introvert. But therefore the personal condition was totally different according to Chinese medicine. But to cut a long story short, he had to give them two separate different types of medicinals, in order to cope with that, with their situation. And it turned out why the woman was so keen that they share one prescription [was] because her workplace had covered her with work insurance. So she said, whereas if the hospital knows i had a separate prescription he won’t be covered, then we’ll have to pay out of our own pocket. So why not save costs, so by asking for one prescription. So that was her thinking. So that was very funny. So that is you know what is meant by personalized or individualized medicine.
[1:04:56] Each person, technically, from the BioMedical point of view, you may have the same virus in you.
[1:05:03] So today a SARS-COV-2 might come along. Yeah, indeed, one has SARS-COV-2 but it doesn’t mean that your COVID-19 is the same as somebody else’s COVID-19.
[1:05:15] According to the Chinese practitioner, you’re one, you need a different types of treatment, all together, right? That’s it.
[1:05:22] Now participatory medicine. What could that mean? Hao Wanshan also gives, what I think is, a very a lovely example of what the Chinese practitioner means, medical practitioner means, by participatory medicine.
[1:05:41] He describes a client, a patient. This woman came in one day, looking very, very, cross very very angry. And then she also said she had a stabbing pain in the throat. Pain in the stomach.
[1:06:08] Well, anyway, she was all worked up. She couldn’t sleep. Insomnia was what she suffered from, as well. So she couldn’t sleep at all, right? Et cetera, et cetera.
[1:06:21] Now, Hao Wanshan then probed her, through the technique of asking the patient, wen,
[1:06:28] So through asking, the asking technique, he got her to put in the story of why she’s so angry. It turned out that a woman, her neighbor, wanted to build a kitchen against her external wall, by the side. And in digging up, to make the extension, the woman discovered that it was a huge boulder which came out from the ground. So the woman tried, the neighbor tried, to remove it. And she and others in the neighborhood, in the community, only managed to move the stone so much, and no further because, you know in Beijing, as those of you who have been to beijing know, these passages the huatong, are very narrow.
[1:07:29] So the neighbor only managed to move the large boulder, to a certain extent, of the huatong, of the narrow passage, but couldn’t get it out any further. And it just happened that the boulder stopped in front of this woman’s house. So this woman was irate. And she was even, because she said every day when she comes with her bicycle, she had to carry the bicycle inside into her house, carry a bicycle out of her house, over the boulder.
[1:08:02] That was, of course, inconvenient. And furthermore, she said when she got very angry with the neighbour, the husband tried to calm her down and said you cannot blame the woman, you know, our neighbor. She did ask for permission. She did ask me, and I said there was no problem about her building an extension leaning against my external wall.
[1:08:26] And it’s not our intention to block the passage. [It] just happens that the boulders too large to be to be carried, to be carried out. And this irate woman then said, of course, this is your story, but I know that you fancy her anyway, because she’s prettier than I, and she should play the role of the jealous housewife, she says. You can see all these going through, all these emotions. And in the end she had a terrible complexion. She suffered from insomnia and all other ills.
[1:09:00] And so finally Hao Wanshan diagnosed that there was hua, that there was this heat in her liver, because liver is the seat of of heat you say. And Hao Wanshan, however resorted to the means or technique in Chinese philosophy, and which is in certain circumstances you do not describe medicinals nor do you do acupuncture. You use other means. What other means did Hao Wanshan, non-medical means, altogether, to cure, to treat this patient?
[1:09:44] He asked questions about where she lived. And bells began to ring in his mind. He said, ah, you probably lived in a place which was, once upon a time, occupied by a very high Manchu official who had a vast garden. And, of course, Chinese rich people, including, you know, scholar officials and so on officials, they import into the gardens boulders, rocks, which, from the aesthetic point of view, they think it improves the garden. Whether modern people think so, it’s another matter. But they did, right?
[1:10:30] So Hao Wanshan deduced that it must be that this important official, whose ancient residents these characters are now living nearby, introduced this great big boulder. So he deduced it must be a very beautiful piece of boulder, too. So he said, may I come along to your house to see what the boat is like? So he went along to the woman’s house. The woman showed him. Ah, he said, that’s right, it’s a beautiful boulder. You can’t get it out. It’s obstructing the way. The woman is angry. No amount of medicine, in form of acupuncture or decoction, would help such a person. Let me transform the landscape for her.
[1:11:19] So, this is participation. That’s a huge answer. He said, now look, he said, let’s get the young men in the neighborhood with strong arms. We will shift the stone in a way, as far as we can, and in a position from which you can appreciate it best of all, from your window, or from your door when you open the door each morning when you get out to work. And he’s got the young men to do that. Then he got the young man to scrub clean because it was covered with soil, and filth for many many decades, like a century, a century, if not more.
[1:12:00] Scrubbed it lovely and clean, a beautiful boulder. The grain of this rock becomes clear. And so then he suggested, now then, why don’t we buy some plants, lovely plants, and plant them with soil, around the border of the stone. And he says now, in a few months time, I’ll come again and see what the new landscape would be. Oh, he said, even before he could go and see the patient’s house himself, the patient’s burst in one day looking a totally changed person. This time, no more anger on her face, smiling, looking, complexion looking good, and the moment he walked into his consulting room he said, she said to him, they said, oh it’s looking beautiful now! He said, you have transformed the whole landscape. It’s beautiful! They said, you know, daifu, today at night, I don’t even close the door. I sit, you know, with the open door to admire the landscape as long as I can, before I go to bed. And it’s so soothing, and so lovely so nice.
[1:13:25] And so Hao Wanshan went along to see it. Indeed it looks very beautiful because the << palms? >> had gone. The plants were flowering. So, he had to produce a different landscape for her to enjoy, a pleasurable landscape. So he used no medicine. He cured the woman.
[1:13:40] So this kind of participation, such as it is, peculiar to Chinese medicine, I cannot see, you know, my doctor, my brother BioMedical doctor, coming around and prescribing things like that to me.
[1:13:58] The most they might say, oh well, your job is very stressful. Change your job. Well telling people to change that job is easier said than done. I mean, where would you get your a new livelihood just changing your job?
[1:14:10] So this neither here nor there. But that’s a limit to the extent they will ask, they will use non-medical intervention, to solve your problem. But this one, actually, designed a landscape for the patient, and participation.
[1:14:29] So that’s why, I think, it’s very a lovely story to tell. “And it’s a very nice story to tell./
[1:14:34] So, these are the four P’s of Dhinese medicine.
0210617 SSFS8 LEE Kee Kok – Philosophy of Chinese Medicine 2
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