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Traditional Chinese Medicine—–What Are We Investigating? the Case of Menopauseଝ

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Traditional Chinese Medicine—–What Are We Investigating? the Case of Menopauseଝ Complementary Therapies in Medicine (2007) 15, 54—68 Traditional Chinese medicine—–What are we investigating? The case of menopauseଝ Volker Scheid ∗ School of Integrated Health, University of Westminster, 115 New Cavendish Street, Westminster, London W1W 6UW, United Kingdom Available online 9 February 2006 KEYWORDS Summary CAM researchers commonly treat traditional medicines as unchang- Traditional Chinese ing systems. This article questions the validity of this approach by examining the medicine; treatment of menopausal syndrome by traditional Chinese medicine (TCM). Such Kampo; treatment strategies were invented in 1964 and betray a strong influence of biomed- Traditional medicine; ical thinking. While they determine TCM treatment of menopausal syndrome in the Menopause; West, physicians in China and Japan use many other treatment strategies from within the wider Chinese medical tradition in clinical practice. Cultural variability in the Research design; manifestation of menopausal syndrome furthermore questions the usefulness of sim- Medical anthropology; ply importing treatment strategies from China to the West. This leads me to conclude History of medicine that Chinese medicine as such can never be evaluated by means of clinical research. What we can do is use Chinese medicine as a resource for thinking about illness, and for formulating clinical interventions that may then be assessed using methods of evidence based research. © 2006 Published by Elsevier Ltd. Introduction ous efforts to find alternatives. This specifically includes the integration of complementary and Eighty percent of women in the UK experience alternative medicines (CAM) into treatment proto- menopausal symptoms and 45% find the symp- cols tailored to women’s individual needs.1—3 toms distressing.1 An increasing awareness among Traditional Chinese medicine (TCM) appears to both health care providers and patients regarding be a fruitful area to which such efforts might be potential adverse effects associated with hormone directed. It offers a clear and systematic approach replacement therapy (HRT) is leading to strenu- to the treatment of menopausal syndrome that might readily be evaluated with the help of inno- vative research protocols being developed in the ଝ The research on which this article is based was supported wider field of CAM research.4,5 These protocols by the DH-National Co-ordinating Centre for Research Capacity are committed to establishing an evidence base Development (NCC RCD). ∗ Tel.: +44 20 7689 4764; fax: +44 20 7689 4764. for CAM. They frequently group research sub- E-mail address: [email protected]. jects according to TCM diagnoses, or use TCM 0965-2299/$ — see front matter © 2006 Published by Elsevier Ltd. doi:10.1016/j.ctim.2005.12.002 Traditional Chinese medicine—–What are we investigating? 55 diagnoses in their analysis. This still leaves open ment strategies for menopausal syndrome as con- a host of unresolved methodological difficulties, tingent upon specific political factors in the Maoist i.e. whether or not clinical interventions should China of the early 1960s. It also provides us with an be standardized. But they do provide a platform understanding of the plurality of approaches to the from which such difficulties can be approached as treatment of menopausal syndrome within the Chi- ‘‘technical’’ problems by experts who share com- nese medical tradition. Steps three and four con- mon standards rather than as ‘‘conceptual’’ issues textualize TCM treatments further by exploring the that divide groups of researchers on the basis of cultural variability of menopausal experience and ideological commitments. by presenting some Japanese Kampo approaches to From a sociological perspective, the develop- menopausal syndrome. East Asian women experi- ment of such research protocols is indicative of a ence menopause differently to women in the West, maturing discipline. Some commentators, in fact, and Kampo physicians respond to these differences interpret them as signs that traditional medicines by utilizing traditional Chinese herbal medicine for- everywhere are ready to be integrated into a sin- mulas in ways that is entirely different from the gle, global, and progressive medical system.6 This TCM approach. In the final section I analyze what article seeks to challenge this analysis and the hid- the consequences of these observations are for CAM den ideologies and value judgments that sustain it. research on Chinese medicine and beyond. Using the Chinese medical treatment of menopause as an example, I argue that a collective unwilling- ness among practitioners and researchers to criti- cally examine the myth of tradition that underpins Traditional Chinese medicine (TCM) the discourse on TCM and CAM — even though this approaches to menopause critique is readily available in the anthropologi- cal and historical literature — invalidates much of For the purposes of this discussion I define TCM the research that is currently carried out and that as that interpretation of Chinese medical practice might be used to evaluate the TCM treatment of that is presented to us in contemporary Chinese menopausal syndrome. medical textbooks.8(pp6—8),9(pp107—150) Emerging in In particular, I wish to challenge the notion that the late 1950s, these textbooks have been a corner- CAM research is examining ‘‘Chinese medicine’’ or stone of state-directed efforts at modernizing Chi- that it will ever be able to do so. As we shall nese medicine and integrating it into a larger health see, Chinese medicine is a living tradition. Like care system. In China, TCM exerts a significant influ- biomedicine it offers multiple competing (if inter- ence on the practice of medicine through its dom- related) models for thinking about illness and suf- inance of educational curricula. Its influence on fering. Physicians and patients use these models to medical practice, however, is tempered by the con- develop treatment options that fit specific clinical tinued existence of alternative resources on which contexts and, in turn, shape the understanding Chi- clinicians can draw. These include direct access to nese medicine has of itself as a tradition.7 Gaining the classical medical literature, the transmission familiarity with the complex histories that generate of medical knowledge through personal master- specific treatment protocols, assessing the validity disciple networks and lineages, and the historical of these protocols in relation to local contexts of plurality of the Chinese medical tradition.8,10 In the clinical practice, and the ability to define new pro- West, where such alternative resources are lack- tocols through processes of creative development ing, TCM is thus widely perceived to constitute and translation thus emerge as urgent priorities in mainland Chinese medicine as such, even if on the the field of Chinese medical research. level of both teaching and practice TCM coexists I will develop my critique in four steps. I with a large number of hybrid practices created in first examine the TCM diagnosis and treatment of the course of the last 200 years by the complex menopausal syndrome in the west. This demon- diffusion of Chinese medicine to Europe and the strates significant consensus among TCM practition- West.56—59 This view is further enabled by a widely ers regarding patho-physiology, diagnosis and treat- shared cultural discourse that perceives of tradi- ment. It also shows that the further a practitioner tions as homogenous, stable and unchanging. CAM in either China or the west moves away from access research into Chinese medicine follows this trend, to primary sources, the more simplistic and system- as TCM practices become the object of research atic these theories and models become. In a second claiming to evaluate not singular interventions for step I compare TCM to Chinese medicine as prac- a given disorder, but ‘‘the TCM treatment’’ of this ticed in contemporary and late imperial China. This disorder. TCM theories about menopause, its diag- allows us to understand the development of treat- nosis and treatment of menopausal syndrome, and 56 V. Scheid CAM research into these practices constitute a case us on its webpage, ‘‘a woman is not generally study that confirms these general observations. referred to as ‘menopausal.’ Rather, a practitioner Most Western TCM textbooks and TCM of TCM might say that she exhibits ‘[K]idney yin teachers11,12 state that Chinese medicine deficiency.’”14 Reversely, because hot flushes are attributes problems of menopause to Kidney such an emblematic and widely recognized symp- deficiency (shen xu ). In TCM the Kidneys tom, they can also be employed to communicate to (shen ) constitute a functional visceral system potential patients (i.e. menopausal women) how a (zang ) to which are ascribed the regulation and TCM practitioner may label their condition, namely sustenance of growth, maturation, and ageing. ‘‘yin deficiency’’ (Fig. 1). This system is sub-divided into two complementary Research investigating how TCM practitioners aspects. The actualizing dynamic of Kidney yang diagnose menopausal women with vasomotor symp- (shen yang ) is imagined as the driving forces toms shows that such understanding is not lim- of all metabolic process. The endpoint of this ited to discourse but that it consistently informs process, in turn, is the production of Kidney yin clinical practice. Zell et al.15 had a cohort of 23 (shen yin ), which constitutes the structive postmenopausal women suffering from hot flushes potential for the production of Kidney yang. Ageing independently successively examined by nine TCM in TCM is modelled as a diminishing vitality of this practitioners on the same day. Practitioners diag- transformative cycle caused by a decline of the nosed Kidney yin deficiency after 168 of 207 visits essence (jing ), which is stored in the Kidneys (81%). In 12 women (52%) the diagnosis Kidney yin and underpins the functions of both Kidney yin deficiency was made by eight of nine practitioners; and yang. The actual manifestations of ageing in 16 women (70%) by seven of nine; while in all are dependent upon the relative balance between 23 women (100%), at least five of nine practition- yin and yang.
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