There is a Rhyme and a Reason

December 8, 2008 at 12:54 am | In Chinese Medicine, Herbal Medicine, Modern Research, Science | Leave a Comment
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While I don’t like to go on about reductionism and its assumed evils and so forth, there are grains of truth in these criticisms.
There is a difference between a complex, open (interconnected) system and a small, (relatively) closed system – the former is like the weather, and the latter is like a motor vehicle. I believe we are all familiar with the viscissitudes of weather forecasting, and yet, on the other hand, how generally reliable and unperplexing our vehicles are.
In essence, the first system cannot be reduced without losing its essential complexity and interrelatedness, while the second one can (for a deeper discussion on the relative aspects of this idea, click here). This means that in order to understand a complex, open system, it must be met in its arena of effect. Reducing the arena changes the game and damages the data irretrievably.
In a previous post (Herb Comparable to Prednisone), I wrote about how the oversimplification of Chinese Medical principles tended to damage the effectiveness of the intervention, sometimes completely, and how it was important to understand that in Chinese Medicine we do things for a reason.
More careful research can illuminate some of these reasons, and I would like to provide you with a brief glimpse into one of these investigations:

Chinese Medicine almost always uses herbal combinations rather than single herbs, not only because a single herb has a weak effect, but because herbs can act in synergistic or antagonistic ways to each other (amongst other effects). Thus a properly constructed formula with the individual patient in mind provides a superior effect than the administration of a single herb, or of a non-individualised formula.
The following graph from the Biological and Pharmaceutical Bulletin (2003;26(7):911-919) dramatically illustrates this phenomenon:

The blood concentration of wagonoside from HuangQinTang was twice as high as that of HuangQin alone.

The blood concentration of wagonoside from HuangQinTang was twice as high as that of HuangQin alone.

HuangQin Tang is a Chinese Herbal Combination, Huang Qin is merely the lead herb.
HuangQin Tang contains: huáng qín, huáng lián, gé gēn, and zhì gān cǎo.
This type of investigation makes two points:
1. There is a reason that herbal combinations are the standard of care in CM.
2. Deconstructing an open, complex system is fraught with dangers if the aim is to illuminate the true mechanisms or energetic dynamics of said system.
In the western world, and even the eastern world, too much effort has been spent on “identifying” the one herb in a formula which provides the effect, and then further “isolating” “active ingredients” in order to provide the end-user with a “real” medicinal in a “more potent” form for, ostensibly, superior clinical effect.
It’s as if a scientist wanted to provide us with a better vehicle, and decided the active ingredient was the piston, made us a big giant piston to use and acted all proud.
It is my hope that our understanding of the ancient and wise medical systems of this world becomes much more mature in the next short little while.
Incidentally, HuangQin Tang is primarily used for something called “Damp-Heat in the Lower Burner”, one manifestation of which is dysentery. Years ago, a chemical called “berberine” was isolated from another herb in this formula, huáng lián, and used in cases of dysentery. And yes, you guessed it, it doesn’t work as well as HuangQin Tang for the indicated condition.
Oh well.

Scientific Authority

October 7, 2008 at 9:08 am | In BioMedicine, Social Medicine | Leave a Comment
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Scientific authority, like any type of authority, is easily abused, and often unwittingly abused.
M. Scott Peck takes a stab at illuminating the subject in the paragraphs below.

The Danger of Cloaking Moral Judgment in Scientific Authority

This is a major pitfall. It is a pitfall because we ascribe to science much more authority than it deserves. We do so for two reasons. One is that very few of us understand the limitations of science. The other is that we are too dependent upon authority in general.
When our children were infants we were blessed by the very best of pediatricians, a kind and dedicated man of great erudition. When we visited him a month after the birth of our oldest child, he instructed to start feeding her solid foods almost immediately, because such supplementation was needed for babies being breast fed. A year later, when we visited him a month after the birth of our second daughter, he directed us to delay feeding this one solid food as long as possible so as to not deprive her of the extraordinary nutrition in breast milk. The state of “science” had changed! When I was in medical school we were taught that the essential treatment for diverticulitis was a low-roughage diet. Now medical students are taught that the essential treatment is a high-roughage diet.
Such experiences have taught me that what is paraded as scientific fact is simply the current opinion of some scientists. We are accustomed to regard science as Truth with a capital T. What scientific knowledge is, in fact, is the best available approximation of truth in the judgment of the majority of scientists who work in the particular specialty involved. Truth is not something we possess; it is a goal toward which we, hopefully, strive.
[...]
The problem is aggravated by the fact that the public is actually eager to be guided by the pronouncements of scientists. [...] We are content, even anxious, to let our authorities do our thinking for us. There is a profound tendency to make of our scientists “philosopher kings,” whom we allow to guide us through intellectual labyrinths, when they are often just as lost as the rest of us.
M.S. Peck, MD, 1985, pp 257-258.

As I mentioned in yesterday’s post regarding skepticism, it is very important to turn both science and skepticism in on themselves and each other. If this is not done, neither deserves their own title.

Skeptical to the End

October 2, 2008 at 12:46 pm | In BioMedicine, Chinese Medicine, Social Medicine | Leave a Comment
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I found an interesting post and comment thread at scienceblog.com (http://tinyurl.com/3zgatd). It seems that a study involving drugs and acupuncture for hot flashes due to cancer therapy found that acupuncture was as effective at relieving hot flashes as the commonly-used drugs, had other beneficial effects such as increased libido and energy, had no side-effects, and produced a longer-lasting effect than the drugs, and is more cost-effective.

The data from this study are clear. What is interesting are the varied “skeptical” responses, which ranged from denouncing acupuncture as religious and superstitious, to saying it was all a placebo effect. Without needing to dispute any of these charges, I feel a need to ask a question: How can it be that a placebo is so superior to a tested drug? (1)

Skepticism is not the automatic gain-saying of certain classes of claims. It is the ability to retain critical thought, in particular of one’s own self. Simply calling one’s attitude “skeptical” does not make it so. Many other behaviours masquerade as skepticism: cynicism, egoism, narcissism – it’s tricky. For this reason the power of skepticism must be turned in on itself a good portion of the time. The word comes from the Greek skeptomai, which means to look about, or to consider; to not be rigid or fixed in one’s point of view.

Paraphrased from Wikipedia:
A Philosophical Skeptic makes certain propositions about (a) an inquiry, (b) a method of obtaining knowledge through systematic doubt and continual testing, (c) the arbitrariness, relativity, or subjectivity of moral values, (d) the limitations of knowledge, (e) a method of intellectual caution and suspended judgment.

Also from Wikipedia:

The “Skeptikoi” were a school of philosophers of whom it was said that they “asserted nothing but only opined.” In this sense, philosophical skepticism, or Pyrrhonism, is the philosophical position that one should avoid the postulation of final truths. Turned on itself, skepticism would question that skepticism is a valid perspective at all.

1. Alleviation of Hot Flashes With Increase in Venlafaxine Dose
Prasad R. Padala, Srinivas B. Rapuri, and Kalpana P. Padala
Prim Care Companion J Clin Psychiatry. 2007; 9(1): 70–71.
PMCID: PMC1894834

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