Wendy

Oct

2015

Chinese Medicine: Science In Its Own Right

By Dr. Manfred Porkert

Scientific discoveries and inventions should eventually benefit all mankind. However, even in our age, historical conditions may for a long time inhibit or delay the diffusion of even the most mature and incontrovertible findings of an exact science. Chinese medicine or, to use the more precise term, “traditional Chinese medicine”, is perhaps the most outstanding example in point. To understand this paradoxical situation, a few historical facts should be reviewed briefly.

Chinese medicine, as all sciences of nature in China, had been fostered and brought to maturity by what, for want of a better term, we may call Taoist consciousness—implying a vivid yet serene awareness of all cosmic phenomena including the diverse functions of a human personality (we intentionally say ‘personality’ since the Taoists never divorce mental and physical processes). Before this background, Chinese medicine as early as the third century BC, by the diffusion of the Huang Di Nei Jing (the Inner Classic of the Yellow Sovereign) accomplished the transmission from an empirical formative stage to a true healing science, logically stringent in method, highly effective in practice. This healing science, apparently since the beginning of the Christian era until the 11th century AD, was superior in nearly every respect to anything available elsewhere in this world. Unfortunately, this development did not persist.

For during the 11th century, the Confucian administration had definitely taken over the training, examination and to a large extent even the employment of doctors and pharmacists. At the outset, the result of this change appeared to be quite beneficial. Concentration of the most competent physicians and of all the organized training facilities in the provincial centers and at the capital fostered a more intense exchange of ideas as well as wholesome competition among different medical traditions. This in turn led to an extraordinary expansion of medical research and theorizing. The 12th and 13th centuries witnessed a dramatic increase in medical publications. Then, the deleterious influence of Confucian values upon medical thought became evident, an influence that had been latently effective for quite some time. It should here be recorded that the salient trait of Confucian thought through more than two millennia consisted in an unswerving concentration upon the social phenomena, i.e. upon the perception and systematic control of human relations. In comparison to the social issues, in the eyes of the Confucianists, all other problems dwindled to mere trifles, unfit to occupy the minds of any serious scholar. Upon such premises, the integration of medical education and research into the Confucian administrative system gradually yet ineluctably caused humanistic and sociological methods to be applied to the solution of biological and medical problems, a tendency which, in the long run, lead to a perversion of theoretical speculation and to an erosion of clinical and empirical research.

This degenerative process of medical empirical science in China reached rock-bottom during the l9th century. In practice Chinese medicine then consisted only of an odd assortment of proven and fairly crude techniques between which most practitioners could hardly grasp, let alone reconstruct, the guiding ideas. Worse still, the widening gaps in what formerly had been a highly consistent scientific system had been filled with a host of paramedical, i.e. magical or exorcist, procedures. When, at this critical juncture, to top it all, Western medicine appeared upon the scene in the wake of Western civilization and political influence, the total demise of indigenous Chinese medicine seemed to be imminent.

At the turn of the century, what many outside observers believed to be the agony of Chinese medicine was apparently protracted only by the utter destitution of the country and by political chaos. Consequently, it was a matter of general surprise when, after the founding of the People’s Republic since the early fifties, the better part of China’s traditional medical literature was again made available in excellent editions, and when gradually an increasing number of spoken language translations of the medical classics as well as of modern studies and textbooks appeared.

The policy of the new government regarding traditional Chinese medicine culminated in the November 1958 decision of the Central Committee which explicitly stipulated that traditional Chinese medicine should be employed side by side with Western medicine. As a consequence, in the People’s Republic doctors of Western medicine also received what is considered a grounding in Chinese medicine and doctors of Chinese medicine are urged to familiarize themselves with the fundamentals of Western medicine. The implementation of this at first sight most judicious directive led to numerous improvements in health care within China and to some new discoveries such as acupuncture anaesthesia. Yet viewed from a distance of almost two decades since its issuance, there is ample evidence that since the mid-sixties it is jeopardizing and might even destroy the very tradition which it intended to preserve.

The two principal factors bringing about this most regrettable shift are easy to define:

1) In China, already during the years after 1911, and even more so since 1949, constant preference has been given to practice-oriented research, leaving little room for basic investigations into the premises of China’s scientific heritage and none at all for the advanced philological and epistemological research that is indispensable to accomplish the amalgamation of traditional Chinese science with modern Western science.

2) The—at first bonafide, now quite often dogmatic—advocacy of the premise that Chinese medicine at best represents an empirical discipline whereas, by contradistinction, Western medicine constitutes scientific medicine. This latter premise, if left unrefuted, would eventually wreak the extinction of Chinese medicine as a distinctive science.

THE PITFALL OF CONFUSING “SCIENTIFIC METHOD” AND “SCIENTIFIC CRITERIA”

In order to be used today and in the future, traditional Chinese medicine, as any other discipline, must be assessed, evaluated and redefined in accordance with the ‘criteria’ of modern science. But, of course, these criteria must not be confused or identified with the ‘methods’ used in different fields of modern science. Since even scientists sometimes are liable to confuse ‘methods’ and the ‘criteria’ at the basis of these methods, let us simply recall that the essential criteria of exact science in the modern sense (e.g. physics, chemistry or astronomy) are:

1 Positive experience,
2 Univocality of statements,
3 Stringent rational integration (systematization) of empirical data.

It should also be noted that different from these essential criteria are a number of other criteria such as notably the causality nexus, controlled experiment and quantification of data. These constitute accidental criteria whose application is limited to some specific disciplines or fields of research only. The question of paramount interest is to what extent does Chinese medicine comply with the essential criteria of exact science as enumerated.

There is practically no controversy about the fact that Chinese medicine is based upon positive empirical data, upon close and skillful observation of natural and social phenomena. Admission of this is implicit even in the most dilettante accounts of Chinese medicine appearing today in the Far East and in the West, which label Chinese medicine an ‘empirical medicine’. Most students with only moderate familiarity with the original sources of Chinese medical literature agree that these show stringent systematization of collected data. The only issue that baffles modern advocates and critics of Chinese medicine alike is the application of the second essential criterion of science, namely the achievement of univocality of statements. Univocality of statements denotes that in a given context every single statement must only be employed and accepted with one single, precisely defined meaning, to the exclusion of all others, with even slightly similar meanings. (This criterion distinguishes ‘scientific’ from ‘common’ and even from ‘philosophical’ statements which, as a rule, can be understood or interpreted in more than one way.)

Univocality of statements is achieved by, the expression of data with reference to conventional standards. The best-known and today most widely applied conventional standards of Western science are those of the so-called metric system (c.g.s. system) and its technical derivations. These standards are called conventional because their application rests solely upon the tacit or even express agreement of all contributors to a science to formulate all findings with reference to these standards. In other words the standards are not themselves the outcome of any discovery or invention; even less are they the expression of natural law or necessity. Instead they have to comply with the methodological and technical requirements of the science which they serve.

Why this lengthy description? Because in Chinese science the qualitative standards of Yin and Yang and the Five Phases play a role quite parallel to the c.g.s. standards of Western science; because in recent times the failure to correctly assess the role of Yin and Yang and the wuxing has led to endless fruitless debates about the very essence of medical science in China. I doubt, this failure is in turn only the result of a very imperfect perception of the complementary and polar roles of Chinese and Western science.

THE POLARITY OF CHINESE AND WESTERN SCIENCE

After what has just been stated, if we use the term “polarity”, we do not do so because the expression may be en vogue in certain contexts. Rather are we motivated by its strong and basic implications, namely, polar statements are mutually exclusive, at the same time mutually perfectly complementary. Polarizing filters perfectly shut off light of one plane of oscillation, letting pass that of all other planes with different intensities. Any scientific method and its concomitant terminology produces effects similar to that of a polarizing filter: it gives unimpeded passage to cognate data, more or less modifies most other information and hermetically precludes directly polar statements.

It is well to keep in mind these effects when we are faced with the fact that today throughout the world, and including China and Japan, practically everybody making a claim to a scientific opinion on Chinese medicine has, to start with, been thoroughly inculcated with the essentials of Western medicine. This fact by itself, would suffice to explain why modern medical authors either flatly are at a loss to conceive any scientific system different from, yet on a par with, Western medicine, or, if they suspect that there might be more to Chinese medicine than some drug and acupuncture recipes, why they experience extreme difficulties in substantiating such a hypothesis. — Why should this concern us? — Because to the extent that the exact sciences of the West implement their criteria for heuristic methods of unprecedented stringency and effectiveness, there is, in recent times, increasing evidence showing that precisely these criteria and truly scientific methods are really applicable and produce impressive results only within a few clearly defined sections of medical endeavour—leaving others on the level of proto-scientific empiricism.

Every physician has been taught that the specificity of diagnoses and therapy as well as the precision of prognoses is in direct proportion to the rational elaboration, hence to the scientific stringency of any statement. Consequently, in his daily practice, he is constantly reminded of the steep gradient existing in Western medicine between very precise and very vague statements. But he will lack the leisure as well as the intellectual tools to explain this gradient. This leads us to the question of the limitations of the specific method of Western medicine: causal analysis.

CAUSAL ANALYSIS AND ITS LIMITATIONS

Everybody is aware that not each and every object or effect may be completely perceived from a single vantage point or out of one single perspective. And surely this truth applies not only to particular professions such as astronomers, who are obliged to erect their observatories in the Northern and Southern hemisphere as well as in favorable climates – but to absolutely every scientific discipline.

It also applies to heuristic methods and to epistemological modes. Thus in order to perceive and control matter, substratum causal analysis is required. Causal analysis implies that all relations of an observed effect to other simultaneous effects are consciously severed or suppressed and the relation to its cause is explicitly established. Causes axiomatically precede their effects in time, hence, by definition, lie in the past. Past effects constitute materialized effects, hence matter.

Inversely, causal analysis confines positive perception and control to concrete, material, somatic objects. Not even the most judiciously chosen real vantage point will let our eye sight (or the perception of instruments invented to boost their power) take in all the things that may be seen; similarly, no single mode of cognizance—which also implies a finite cognizable horizon—will enable us to perfectly perceive all cognizable effects. The limiting factor of the significance (and applicability of causal analysis is what) from the vantage point of human perception is the decrease of the homogeneity of substrata (matter). This homogeneity of substrata appears to be the greatest in elementary particles whence we observe a steady decrease as we proceed from these in the direction of atoms, molecules, cells, tissues of primitive and higher organisms, animals, human beings, social, political, cultural communities, planetary and galactic systems……

The information that any textbook gives, for example, on the oxygen atom is not merely the result of the observation of one single and particular oxygen atom; rather is it based upon the observation of a statistical number of such atoms. This procedure will yield statements of a probability almost equal to 1 because of the high homogeneity of the atoms. In other words, as a consequence of the fact that the oxygen atoms involved show practically no significant individual differences. Similar consequences apply to other phenomena, with the evident restriction that a decrease in homogeneity (increasingly significant individual differences) will reduce the stringency, the probability, hence the positive quality of statements based upon causal analysis.

Due to the continuous decrease of the homogeneity of substrata (material objects), the limit of significance of statements based upon causal analysis is evidently situated in the center of the scale occupied by biological phenomena where human medicine exercises its functions. In other words, in the vicinity of this borderline, causal statements approach and finally attain the average probability of all aleatory procedures. Or, put still differently, the greater the differentiation and complication of biological organisms (decrease in homogeneity), the less probability attaches to inferences drawn from the observation of one single individual as regards the reactions of all others. Less stringency also attaches to statistical data obtained from the observation of large number of similar individuals if used to prognosticate in detail individual and specific changes. In brief, the stringency and significance of statements based upon causal analysis show a clear decline in the field of human physiology; and they fade away into utter indetermination when psychological or social phenomena are involved.

INDUCTIVE SYNTHESIS AND ITS LIMITATIONS

The fact just described that statements based upon causal analysis will completely lose all stringency and significance is by no means tantamount to a complete blurring of stringent rational statements bearing on the phenomena concerned; after all, causal analysis is not the only mode of cognizance, not the sole perspective permitting the rational expression of positive statements on reality. In order to perceive and control functions, movement, dynamic or psychic phenomena, inductive synthesis is required. Inductive synthesis implies that agents actually inducing effects in each other are consciously maintained or assembled. Induction implies the simultaneous presence of agent and effect (and perception). Present effects constitute dynamic effects functions, movement.

Inversely put, inductive synthesis confines positive perception and control to dynamic, functional effects or phenomena. Needless to insist, just as causal analysis, inductive synthesis has its natural and axiomatic limitations. The significance of statements based upon inductive synthesis out of the human cognitive perspective appears to be limited by the stability of functions, in other words, by the relative duration within which a given function is maintained in the same quality or direction. This stability of function appears as being great in galaxies and shows a continuous decline in planetary systems, cultural, political, social communities, human individuals, higher and lower animals… In other words, the stability of function varies in inverse proportion to the homogeneity of corresponding substrata.

[Our use of the terms inductive, induction, inductivity derives from and extends the meaning these terms have in Electrodynamics.] In practice, this theorem establishes the complementary validity, significance and applicability of causal analysis and inductive synthesis: to the extent that the positive quality of statements based upon causal analysis decreases, that of statements based upon in inductive synthesis increases—and vice versa. At this juncture we should have little difficulty in realizing that the thematic over lapping of the positive results of causal analytic science and inductive and synthetic science may occur only in a small central area, that, consequently, aside from this, both will furnish equally positive and significant data on utterly different aspects of reality.

THE MESSAGE OF CHINESE MEDICINE OBSCURED BY THE FASHIONABLE USE OF WESTERN TERMINOLOGY

Resuming the preceding comparisons we should bear in mind:

la. the adequate perception of movement is dependent upon its duration;
lb. the adequate perception of matter is dependent upon its homogeneity.

2a. Similar movements (functions) show qualitative differences;
2b. similar material bodies show quantitative differences.

3a. The choice either of a causal and analytic or of an inductive and synthetic approach is neither an indifferent nor a personal and arbitrary one; instead it will determine which part of reality will be defined positively;
3b. similarly — conventional standards being intellectual tools for achieving univocality of statements — the choice of either quantitative conventional standards (the metric system) or qualitative conventional standards ( Yin, Yang and the wuxing, the five Evolutive phases) is determined solely by the aspect of reality that is to be dealt with.

4a. The refusal to use these tools will thwart any attempt at achieving any degree of scientific stringency.
4b. The use of the inappropriate tools (e.g. of quantitative standards applied to the functional statements of Chinese medicine, or qualitative standards used on the material data of Western science) will obliterate or destroy existing scientific data.

What applies in a strict and narrow way to the conventional standards applies in a wider sense to scientific terminology in general. It is a well-known fact that the massive influx and acceptance of Western science and technology into China and Japan since the 19th century in these countries gradually lead to contempt for, if not outright ostracism of, all traditional learning, including medicine. And, to be sure, this disdain was only to a small extent justified by the real shortcomings of indigenous science; it was (and in fact still is) preponderantly motivated by the trauma and inferiority complexes in the wake of the political and cultural collapse following Western expansion into East Asia.

In Japan the government flatly ruled that Western medicine constitutes the only scientifically acceptable and proven kind of medicine and is consequently prerequisite to the training and to the licensing of every physician. In China, the struggle between both systems is still on. The sympathies of the Chinese medical establishment are clearly going to Western medicine with its cosmopolitan and modern flavor. In this situation the practitioners and advocates of traditional medicine fell to what they thought was the best expediency for convincing everybody of the value of the traditional craft: they tried to explain it in terms of Western medicine. From what precedes it should be clear that those well-intentioned native defenders of their medical heritage are in reality jettisoning and destroying what they set out to preserve. As a highly instructive example let us consider the case of anatomy versus Zangxiang, orbisiconography.

ANATOMY VERSUS ORBISICONOGRAPHY

Anatomy is rightly considered one of the mainstays of modern medical science. Any graduated MD today treating a patient in any corner of this world will have a neat array of anatomical knowledge operative at the back of his mind. So what should there be wrong with the statement that anatomy is prerequisite to curing sick people’? Chinese doctors, so we are told, at times have been very successful in curing disease; And their recent accomplishments in the People’s Republic of China certainly offer ample evidence of the effectiveness of their techniques. So why not grant that they must have at least some basic notions about anatomy? This is precisely what we find rehashed today in all the popular and not so popular accounts of the theories of Chinese medicine not only in the West but also in modern China. A simple experience should put us on guard. Any Chinese doctor who, speaking English, may blithely perorate on ‘Chinese Anatomy ‘(with an apologetic shrug sometimes: ‘It: is very primitive’), will unfailingly avoid the equivalent of the Western term (Jie pou xue, Anatomy; literally “The Study of Dissection”) as soon as he talks in Chinese on Chinese medicine. Why? Because his language has a different term for what he and his Western colleagues, out of habit or convenience, have persistently called “Chinese anatomy.”

This term is Zangxiang, and its English normative equivalent is ‘orbisiconography’. It is under this term — Zangxiang — that the body of knowledge in question is dealt with in all except the most recent Chinese textbooks of Chinese medicine. Consulting the usual dictionaries for the usual meanings of the terms Zang and xiang will advance us but slightly. Xiang is given as ‘picture’, ‘image’, ‘outward appearance’. Hence, since we deal with a descriptive discipline, the notion ‘imagery’ and, from the Greek eikon equal to ‘picture’, iconography may appear justified. The term Zang, however, is only given as ‘intestine’, an equivalent perfectly acceptable if it occurs in the speech of a butcher or an ancient Chinese executioner. It makes next to no sense in the texts of traditional Chinese medicine. With the sole exception of the Nan-jing, a slim book, probably compiled during the second or third century AD, positively no influential medical treatise produced during the more than two millennia of the indigenous Chinese tradition gives anything that could be generously admitted as ‘anatomical data’ beyond the statement that certain Zang are situated above, others below the diaphragm.

But what then do the compendious chapters on the Zang, found in almost every treatise, contain? They are filled with wild speculation and insipid theories, we are told by the self-appointed ‘experts’. These ‘experts’ point to the pictures with which some of the Chinese authors had rashly chosen to illustrate their Zangxiang theories.

These pictures are revealing indeed. To bring them in to full relief, let us recall that, in the course of history, Chinese butchers have slaughtered millions of pigs and Chinese executioners have slashed open or cut to pieces tens of thousands of criminals. How then did the Chinese medicos envisage and depict the Zang? A Zang called ‘heart’ connected through the ‘lung pipe’ (trachea) with a Zang called lungs’; the same Zang connected by three (or four) separate ducts with other Zang called respectively ‘liver’, ‘spleen’, ‘kidneys’ and again ‘lungs’; a Zang called ‘urinary bladder’ connecting by its upper orifice to a Zang called ‘large intestine’, etc.

May we conclude that Chinese doctors did only take a most perfunctory look at the intestines when they had a chance to inspect them? — It is probably more correct to state that they did not look at them at all! This persistent refusal of Chinese doctors to perceive the macroscopic configurations of the vitals before their eyes will amaze us only if we very much underrate the decisive influence of the perceptive modes (i.e. inductive versus causal) which produces a complete polarization of reality already on the level of empirical description.

To make the picture complete, Western doctors to this day manage to ignore almost completely a host of quite significant functional changes that they might clearly discern without the aid of an instrument every hour of the day, upon their own and their patients’ organisms. It is these functions and their changes which form the meat and marrow of Chinese medicine. It is the description of these functions which constitutes the fundamental data coming under the heading of Zang-xiang, orbisiconography.

If we examine the information laid down in the chapters on orbisiconography, we rapidly become aware that nearly all the statements made bear on the imbricated and interdependent vital functions, on cyclical functional patterns, in other words on ‘orbs of functions’. The felicity of this choice of an equivalent is confirmed in whichever direction we may decide to advance into the complexities of Chinese medical theory.

Take for instance the problem of the sensible interpretation of the orbisiconographic illustrations already alluded to. If Zang is understood as an orb of functions then the pictures of orbis-iconography can only represent graphic models similar to those used, for example, in nuclear physics. No physicist, building a model of some specific atom, will believe that he is simply enlarging a photographic picture of such a structure; and if he represents the electron by smooth metal balls, and their tracks by metal rings and the nucleus by a raspberry, he will never pretend that, on a much smaller scale, the real electrons are smooth balls running on metal rails, and the nucleus looks like a raspberry. If his model of the atom incorporates elements more or less resembling known objects, this is merely because he intends to appeal to the imagination and to help the memory of those whom he wants to instruct. Similarly, the medical authors who formerly illustrated the orbisiconographic treatises did not (and never pretended they meant to) depict what they had observed in an anatomical theatre. Their unique aim was to facilitate the mnemonic assimilation by their reading audience of systematized results of positive observations.

This point leads us directly to another point that must be made with regard to the normative translation of Zang by orb(i)s: Having constantly stressed the fundamental difference of outlook at the base of Chinese and Western sciences, we should have no difficulty comprehending that, not in spite of, but precisely because of, the high degree of empirical sophistication and logic consistency achieved in each system, their respective statements can never be completely congruent.

A Chinese “Zang-manifestation” (orbisiconogram) is the logical integration of the positive observations on a coherent chain of manifest functional changes of the human being (we do not say ‘body’ since, let us repeat, the Chinese did not divorce physis and psyche). And, in spite of the name it may bear (e.g.-cardial orb) ‘heart’ or ‘spleen (orb)’..etc., it is only faintly associated with the somatic organs so designated. No traditional Chinese doctor will pay greater attention to pulses when dealing with disorders of the cardial orb than in dealing with those of the ‘spleen’.

By contradistinction, the functions Western physicians attribute to the elaborately described organs are accessory to the anatomical definitions of these organs. The Western medical scientist feels awkward if he has no organ to account for a given vital function; the Chinese medical scientist would have been worried if he failed to tie in properly a newly observed function with a stock of functional observations accumulated by his predecessors. The latter is, it may be recalled, the attitude of the astronomer from antiquity to this day.

CONCLUSIONS

There is a worldwide consensus within the medical profession that, in spite of the significant advances of medicine during the past 100 years, for a large proportion of ordinary health disorders still no safe and certain treatments exist. Hence the continued search for new treatments and remedies, hence the interest in medical traditions beyond the methodological limits of Western medicine.

Traditional Chinese medicine constitutes by far the most comprehensive, coherent and effective body of medical science beyond these limits. Yet to this date, and despite the most intense efforts in China as well as in the West, only a small fraction of its therapeutic potential has really been tapped. Worse still, by the very efforts made to exploit Chinese medicine, its scientific core and essence is in danger of obliteration. This danger as well as the meager results of pertinent research — as our considerations were intended to demonstrate — are quite patently the consequence of a confusion between scientific criteria and scientific methods.

Thus instead of applying to Chinese medicine the universal criteria of exact science, the absurd and of necessity, abortive attempt is constantly repeated to reassess it by means of methods evolved by and only applicable to Western medical science. This attempt is tantamount to observing the stars during the day or watching clouds during a moonless night: no amount of persistence will then produce the information which could otherwise be obtained quite easily.

Consequently respecting and applying the methods of Chinese medicine in order to verify and apply the mature and rational data of this very medicine is not a matter of historical style but an ineluctable necessity of elementary logic. The sooner this is realized, the sooner hitherto seemingly insuperable obstacles may be overcome.

Dr. Manfred Porkert is professor at the Institut für Ostasienkunde der Universität München, West Germany.

Sep

2015

Moxa Boxes

Cloth lines the bottoms of these boxes but trays are also commonly made of grated metal, both providing the benefits of moxibustion to spread throughout and penetrate an area of the body.

Ginger lines the cloth bottom of these moxa boxes then moxa is layered over it.

Photos Courtesy of Zhang-Zhong-Jizaaang

Aug

2015

The Web That Has No Weaver

In the world as seen through human eyes, all phenomena have multiple affinities, adding to the complexity and often the element of common error in human interpretations. Cosmological patterns recognized by the ancient Chinese, allow us a way to view the world, not least of which, diagnostics and treatments in medicine, with remarkable accuracy. Ted Kaptchuck’s Web That Has No Weaver is an excellent book for the serious layperson who is interested in straightforward but not predigested, watered down or romanticized information. For anyone interested in the utility and rich associations of Eastern medicine, ‘The Web That Has No Weaver’ covers this terrain authentically, with remarkably rational analysis. The first book that I read on the subject of Acupuncture and Chinese Medicine was in 1987, and it was “The Web” as the book is reverentially referred to.

Aug

2015

Late Summer, The Fifth Season

The 5th elemental season in oriental cosmology is known as “Late Summer” and known as the elemental season of Earth. This is a season of abundance and flourishing life. Balanced Earth energy always provides a solid foundation upon which further endeavors can be based.

The golden season of late summer as regarded in Chinese 5 element cosmology, is the point in the progression of the seasons when nature itself is abundantly imbued in thickness, weight, and is in the culminating stage of growth and fruition that makes way for harvest. Late summer is considered to be the fifth season and has its elemental correspondence within the Earth element, axis of the five elements. Earth secures the human microcosm with the virtues of integrity, trust, loyalty, empathy, reciprocity and is also the seat of intellect. When one is in thought, vital blood of the Heart ascends to the brain. The capacity for thought and contemplation supports our life’s momentum by integrating, enriching, and providing the ripeness to nourish our destiny.

May All Welcome the Prosperity that comes of Kindness and Sharing

Aug

2015

Depression

PLEASE TAKE THE 30 MINUTES TO LISTEN TO THIS WITHOUT DISTRACTION AND THEN SHARE WITH SOMEONE ELSE.

Subtitles and Transcript

0:14 “I felt a Funeral, in my Brain, and Mourners to and fro kept treading — treading — till [it seemed] that Sense was breaking through — And when they all were seated, a Service, like a Drum — kept beating — beating — till I [thought] my Mind was going numb — And then I heard them lift a Box and creak across my Soul with those same Boots of Lead, again, then Space — began to toll, As [all] the Heavens were a Bell, and Being, [but] an Ear, and I, and Silence, some strange Race, wrecked, solitary, here — [And] then a Plank in Reason, broke, and I fell down and down — and hit a World, at every plunge, and Finished knowing — then –“

1:11 We know depression through metaphors. Emily Dickinson was able to convey it in language, Goya in an image. Half the purpose of art is to describe such iconic states.

1:26 As for me, I had always thought myself tough, one of the people who could survive if I’d been sent to a concentration camp.

1:35 In 1991, I had a series of losses. My mother died, a relationship I’d been in ended, I moved back to the United States from some years abroad, and I got through all of those experiences intact.

1:49 But in 1994, three years later, I found myself losing interest in almost everything. I didn’t want to do any of the things I had previously wanted to do, and I didn’t know why. The opposite of depression is not happiness, but vitality. And it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, “What a lot of people that is to have to call back.” Or I would decide I should have lunch, and then I would think, but I’d have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.

2:44 And one of the things that often gets lost in discussions of depression is that you know it’s ridiculous. You know it’s ridiculous while you’re experiencing it. You know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower and go out the front door and that it’s not a big deal, and yet you are nonetheless in its grip and you are unable to figure out any way around it. And so I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity.

3:21 And then the anxiety set in. If you told me that I’d have to be depressed for the next month, I would say, “As long I know it’ll be over in November, I can do it.” But if you said to me, “You have to have acute anxiety for the next month,” I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you’re walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months. It’s a sensation of being afraid all the time but not even knowing what it is that you’re afraid of. And it was at that point that I began to think that it was just too painful to be alive, and that the only reason not to kill oneself was so as not to hurt other people.

4:08 And finally one day, I woke up and I thought perhaps I’d had a stroke, because I lay in bed completely frozen, looking at the telephone, thinking, “Something is wrong and I should call for help,” and I couldn’t reach out my arm and pick up the phone and dial. And finally, after four full hours of my lying and staring at it, the phone rang, and somehow I managed to pick it up, and it was my father, and I said, “I’m in serious trouble. We need to do something.”

4:40 The next day I started with the medications and the therapy. And I also started reckoning with this terrible question: If I’m not the tough person who could have made it through a concentration camp, then who am I? And if I have to take medication, is that medication making me more fully myself, or is it making me someone else? And how do I feel about it if it’s making me someone else?

5:09 I had two advantages as I went into the fight. The first is that I knew that, objectively speaking, I had a nice life, and that if I could only get well, there was something at the other end that was worth living for. And the other was that I had access to good treatment.

5:25 But I nonetheless emerged and relapsed, and emerged and relapsed, and emerged and relapsed, and finally understood I would have to be on medication and in therapy forever. And I thought, “But is it a chemical problem or a psychological problem? And does it need a chemical cure or a philosophical cure?” And I couldn’t figure out which it was. And then I understood that actually, we aren’t advanced enough in either area for it to explain things fully. The chemical cure and the psychological cure both have a role to play, and I also figured out that depression was something that was braided so deep into us that there was no separating it from our character and personality.

6:12 I want to say that the treatments we have for depression are appalling. They’re not very effective. They’re extremely costly. They come with innumerable side effects. They’re a disaster. But I am so grateful that I live now and not 50 years ago, when there would have been almost nothing to be done. I hope that 50 years hence, people will hear about my treatments and be appalled that anyone endured such primitive science.

6:41 Depression is the flaw in love. If you were married to someone and thought, “Well, if my wife dies, I’ll find another one,” it wouldn’t be love as we know it. There’s no such thing as love without the anticipation of loss, and that specter of despair can be the engine of intimacy.

7:07 There are three things people tend to confuse: depression, grief and sadness. Grief is explicitly reactive. If you have a loss and you feel incredibly unhappy, and then, six months later, you are still deeply sad, but you’re functioning a little better, it’s probably grief, and it will probably ultimately resolve itself in some measure. If you experience a catastrophic loss, and you feel terrible, and six months later you can barely function at all, then it’s probably a depression that was triggered by the catastrophic circumstances. The trajectory tells us a great deal. People think of depression as being just sadness. It’s much, much too much sadness, much too much grief at far too slight a cause.

7:56 As I set out to understand depression, and to interview people who had experienced it, I found that there were people who seemed, on the surface, to have what sounded like relatively mild depression who were nonetheless utterly disabled by it. And there were other people who had what sounded as they described it like terribly severe depression who nonetheless had good lives in the interstices between their depressive episodes. And I set out to find out what it is that causes some people to be more resilient than other people. What are the mechanisms that allow people to survive? And I went out and I interviewed person after person who was suffering with depression.

8:37 One of the first people I interviewed described depression as a slower way of being dead, and that was a good thing for me to hear early on because it reminded me that that slow way of being dead can lead to actual deadness, that this is a serious business. It’s the leading disability worldwide, and people die of it every day.

9:00 One of the people I talked to when I was trying to understand this was a beloved friend who I had known for many years, and who had had a psychotic episode in her freshman year of college, and then plummeted into a horrific depression. She had bipolar illness, or manic depression, as it was then known. And then she did very well for many years on lithium, and then eventually, she was taken off her lithium to see how she would do without it, and she had another psychosis, and then plunged into the worst depression that I had ever seen in which she sat in her parents’ apartment, more or less catatonic, essentially without moving, day after day after day. And when I interviewed her about that experience some years later — she’s a poet and psychotherapist named Maggie Robbins — when I interviewed her, she said, “I was singing ‘Where Have All The Flowers Gone,’ over and over, to occupy my mind. I was singing to blot out the things my mind was saying, which were, ‘You are nothing. You are nobody. You don’t even deserve to live.’ And that was when I really started thinking about killing myself.”

10:14 You don’t think in depression that you’ve put on a gray veil and are seeing the world through the haze of a bad mood. You think that the veil has been taken away, the veil of happiness, and that now you’re seeing truly. It’s easier to help schizophrenics who perceive that there’s something foreign inside of them that needs to be exorcised, but it’s difficult with depressives, because we believe we are seeing the truth.

10:42 But the truth lies. I became obsessed with that sentence: “But the truth lies.” And I discovered, as I talked to depressive people, that they have many delusional perceptions. People will say, “No one loves me.” And you say, “I love you, your wife loves you, your mother loves you.” You can answer that one pretty readily, at least for most people. But people who are depressed will also say, “No matter what we do, we’re all just going to die in the end.” Or they’ll say, “There can be no true communion between two human beings. Each of us is trapped in his own body.” To which you have to say, “That’s true, but I think we should focus right now on what to have for breakfast.” (Laughter) A lot of the time, what they are expressing is not illness, but insight, and one comes to think what’s really extraordinary is that most of us know about those existential questions and they don’t distract us very much. There was a study I particularly liked in which a group of depressed and a group of non-depressed people were asked to play a video game for an hour, and at the end of the hour, they were asked how many little monsters they thought they had killed. The depressive group was usually accurate to within about 10 percent, and the non-depressed people guessed between 15 and 20 times as many little monsters — (Laughter) as they had actually killed.

12:06 A lot of people said, when I chose to write about my depression, that it must be very difficult to be out of that closet, to have people know. They said, “Do people talk to you differently?” I said, “Yes, people talk to me differently. They talk to me differently insofar as they start telling me about their experience, or their sister’s experience, or their friend’s experience. Things are different because now I know that depression is the family secret that everyone has.

12:34 I went a few years ago to a conference, and on Friday of the three-day conference, one of the participants took me aside, and she said, “I suffer from depression and I’m a little embarrassed about it, but I’ve been taking this medication, and I just wanted to ask you what you think?” And so I did my best to give her such advice as I could. And then she said, “You know, my husband would never understand this. He’s really the kind of guy to whom this wouldn’t make any sense, so, you know, it’s just between us.” And I said, “Yes, that’s fine.” On Sunday of the same conference, her husband took me aside, (Laughter) and he said, “My wife wouldn’t think that I was really much of a guy if she knew this, but I’ve been dealing with this depression and I’m taking some medication, and I wondered what you think?” They were hiding the same medication in two different places in the same bedroom. (Laughter) And I said that I thought communication within the marriage might be triggering some of their problems. (Laughter) But I was also struck by the burdensome nature of such mutual secrecy. Depression is so exhausting. It takes up so much of your time and energy, and silence about it, it really does make the depression worse.

13:56 And then I began thinking

13:57 about all the ways people make themselves better. I’d started off as a medical conservative. I thought there were a few kinds of therapy that worked, it was clear what they were — there was medication, there were certain psychotherapies, there was possibly electroconvulsive treatment, and that everything else was nonsense. But then I discovered something. If you have brain cancer, and you say that standing on your head for 20 minutes every morning makes you feel better, it may make you feel better, but you still have brain cancer, and you’ll still probably die from it. But if you say that you have depression, and standing on your head for 20 minutes every day makes you feel better, then it’s worked, because depression is an illness of how you feel, and if you feel better, then you are effectively not depressed anymore. So I became much more tolerant of the vast world of alternative treatments.

14:46 And I get letters, I get hundreds of letters from people writing to tell me about what’s worked for them. Someone was asking me backstage today about meditation. My favorite of the letters that I got was the one that came from a woman who wrote and said that she had tried therapy, medication, she had tried pretty much everything, and she had found a solution and hoped I would tell the world, and that was making little things from yarn. (Laughter) She sent me some of them. (Laughter) And I’m not wearing them right now. (Laughter) I suggested to her that she also should look up obsessive compulsive disorder in the DSM.

15:27 And yet, when I went to look at alternative treatments, I also gained perspective on other treatments. I went through a tribal exorcism in Senegal that involved a great deal of ram’s blood and that I’m not going to detail right now, but a few years afterwards I was in Rwanda, working on a different project, and I happened to describe my experience to someone, and he said, “Well, that’s West Africa, and we’re in East Africa, and our rituals are in some ways very different, but we do have some rituals that have something in common with what you’re describing.” And he said, “But we’ve had a lot of trouble with Western mental health workers, especially the ones who came right after the genocide.” I said, “What kind of trouble did you have?” And he said, “Well, they would do this bizarre thing. They didn’t take people out in the sunshine where you begin to feel better. They didn’t include drumming or music to get people’s blood going. They didn’t involve the whole community. They didn’t externalize the depression as an invasive spirit. Instead what they did was they took people one at a time into dingy little rooms and had them talk for an hour about bad things that had happened to them.” (Laughter) (Applause) He said, “We had to ask them to leave the country.” (Laughter)

16:41 Now at the other end of alternative treatments, let me tell you about Frank Russakoff. Frank Russakoff had the worst depression perhaps that I’ve ever seen in a man. He was constantly depressed. He was, when I met him, at a point at which every month, he would have electroshock treatment. Then he would feel sort of disoriented for a week. Then he would feel okay for a week. Then he would have a week of going downhill. And then he would have another electroshock treatment. And he said to me when I met him, “It’s unbearable to go through my weeks this way. I can’t go on this way, and I’ve figured out how I’m going to end it if I don’t get better.” “But,” he said to me, “I heard about a protocol at Mass General for a procedure called a cingulotomy, which is a brain surgery, and I think I’m going to give that a try.” And I remember being amazed at that point to think that someone who clearly had so many bad experiences with so many different treatments still had buried in him, somewhere, enough optimism to reach out for one more. And he had the cingulotomy, and it was incredibly successful. He’s now a friend of mine. He has a lovely wife and two beautiful children. He wrote me a letter the Christmas after the surgery, and he said, “My father sent me two presents this year, First, a motorized CD rack from The Sharper Image that I didn’t really need, but I knew he was giving it to me to celebrate the fact that I’m living on my own and have a job I seem to love. And the other present was a photo of my grandmother, who committed suicide. As I unwrapped it, I began to cry, and my mother came over and said, ‘Are you crying because of the relatives you never knew?’ And I said, ‘She had the same disease I have.’ I’m crying now as I write to you. It’s not that I’m so sad, but I get overwhelmed, I think, because I could have killed myself, but my parents kept me going, and so did the doctors, and I had the surgery. I’m alive and grateful. We live in the right time, even if it doesn’t always feel like it.”

18:46 I was struck by the fact that depression is broadly perceived to be a modern, Western, middle-class thing, and I went to look at how it operated in a variety of other contexts, and one of the things I was most interested in was depression among the indigent. And so I went out to try to look at what was being done for poor people with depression. And what I discovered is that poor people are mostly not being treated for depression. Depression is the result of a genetic vulnerability, which is presumably evenly distributed in the population, and triggering circumstances, which are likely to be more severe for people who are impoverished. And yet it turns out that if you have a really lovely life but feel miserable all the time, you think, “Why do I feel like this? I must have depression.” And you set out to find treatment for it. But if you have a perfectly awful life, and you feel miserable all the time, the way you feel is commensurate with your life, and it doesn’t occur to you to think, “Maybe this is treatable.” And so we have an epidemic in this country of depression among impoverished people that’s not being picked up and that’s not being treated and that’s not being addressed, and it’s a tragedy of a grand order. And so I found an academic who was doing a research project in slums outside of D.C., where she picked up women who had come in for other health problems and diagnosed them with depression, and then provided six months of the experimental protocol. One of them, Lolly, came in, and this is what she said the day she came in. She said, and she was a woman, by the way, who had seven children. She said, “I used to have a job but I had to give it up because I couldn’t go out of the house. I have nothing to say to my children. In the morning, I can’t wait for them to leave, and then I climb in bed and pull the covers over my head, and three o’clock when they come home, it just comes so fast.” She said, “I’ve been taking a lot of Tylenol, anything I can take so that I can sleep more. My husband has been telling me I’m stupid, I’m ugly. I wish I could stop the pain.”

20:47 Well, she was brought into this experimental protocol, and when I interviewed her six months later, she had taken a job working in childcare for the U.S. Navy, she had left the abusive husband, and she said to me, “My kids are so much happier now.” She said, “There’s one room in my new place for the boys and one room for the girls, but at night, they’re just all up on my bed, and we’re doing homework all together and everything. One of them wants to be a preacher, one of them wants to be a firefighter, and one of the girls says she’s going to be a lawyer. They don’t cry like they used to, and they don’t fight like they did. That’s all I need now, is my kids. Things keep on changing, the way I dress, the way I feel, the way I act. I can go outside not being afraid anymore, and I don’t think those bad feelings are coming back, and if it weren’t for Dr. Miranda and that, I would still be at home with the covers pulled over my head, if I were still alive at all. I asked the Lord to send me an angel, and He heard my prayers.”

22:01 I was really moved by these experiences, and I decided that I wanted to write about them not only in a book I was working on, but also in an article, and I got a commission from The New York Times Magazine to write about depression among the indigent.

22:14 And I turned in my story, and my editor called me and said, “We really can’t publish this.”

22:19 And I said, “Why not?”

22:20 And she said, “It just is too far-fetched. These people who are sort of at the very bottom rung of society and then they get a few months of treatment and they’re virtually ready to run Morgan Stanley? It’s just too implausible.” She said, “I’ve never even heard of anything like it.”

22:35 And I said, “The fact that you’ve never heard of it is an indication that it is news.” (Laughter) (Applause) “And you are a news magazine.”

22:50 So after a certain amount of negotiation, they agreed to it. But I think a lot of what they said was connected in some strange way to this distaste that people still have for the idea of treatment, the notion that somehow if we went out and treated a lot of people in indigent communities, that would be exploitative, because we would be changing them. There is this false moral imperative that seems to be all around us, that treatment of depression, the medications and so on, are an artifice, and that it’s not natural. And I think that’s very misguided. It would be natural for people’s teeth to fall out, but there is nobody militating against toothpaste, at least not in my circles.

23:32 People then say, “But isn’t depression part of what people are supposed to experience? Didn’t we evolve to have depression? Isn’t it part of your personality?” To which I would say, mood is adaptive. Being able to have sadness and fear and joy and pleasure and all of the other moods that we have, that’s incredibly valuable. And major depression is something that happens when that system gets broken. It’s maladaptive.

23:59 People will come to me and say, “I think, though, if I just stick it out for another year, I think I can just get through this.”

24:05 And I always say to them, “You may get through it, but you’ll never be 37 again. Life is short, and that’s a whole year you’re talking about giving up. Think it through.”

24:16 It’s a strange poverty of the English language, and indeed of many other languages, that we use this same word, depression, to describe how a kid feels when it rains on his birthday, and to describe how somebody feels the minute before they commit suicide.

24:32 People say to me, “Well, is it continuous with normal sadness?” And I say, in a way it’s continuous with normal sadness. There is a certain amount of continuity, but it’s the same way there’s continuity between having an iron fence outside your house that gets a little rust spot that you have to sand off and do a little repainting, and what happens if you leave the house for 100 years and it rusts through until it’s only a pile of orange dust. And it’s that orange dust spot, that orange dust problem, that’s the one we’re setting out to address.

25:03 So now people say, “You take these happy pills, and do you feel happy?” And I don’t. But I don’t feel sad about having to eat lunch, and I don’t feel sad about my answering machine, and I don’t feel sad about taking a shower. I feel more, in fact, I think, because I can feel sadness without nullity. I feel sad about professional disappointments, about damaged relationships, about global warming. Those are the things that I feel sad about now. And I said to myself, well, what is the conclusion? How did those people who have better lives even with bigger depression manage to get through? What is the mechanism of resilience? And what I came up with over time was that the people who deny their experience, and say, “I was depressed a long time ago, I never want to think about it again, I’m not going to look at it and I’m just going to get on with my life,” ironically, those are the people who are most enslaved by what they have. Shutting out the depression strengthens it. While you hide from it, it grows. And the people who do better are the ones who are able to tolerate the fact that they have this condition. Those who can tolerate their depression are the ones who achieve resilience.

26:19 So Frank Russakoff said to me, “If I had a do-over, I suppose I wouldn’t do it this way, but in a strange way, I’m grateful for what I’ve experienced. I’m glad to have been in the hospital 40 times. It taught me so much about love, and my relationship with my parents and my doctors has been so precious to me, and will be always.”

26:41 And Maggie Robbins said, “I used to volunteer in an AIDS clinic, and I would just talk and talk and talk, and the people I was dealing with weren’t very responsive, and I thought, ‘That’s not very friendly or helpful of them.'” (Laughter) “And then I realized, I realized that they weren’t going to do more than make those first few minutes of small talk. It was simply going to be an occasion where I didn’t have AIDS and I wasn’t dying, but could tolerate the fact that they did and they were. Our needs are our greatest assets. It turns out I’ve learned to give all the things I need.”

27:23 Valuing one’s depression does not prevent a relapse, but it may make the prospect of relapse and even relapse itself easier to tolerate. The question is not so much of finding great meaning and deciding your depression has been very meaningful. It’s of seeking that meaning and thinking, when it comes again, “This will be hellish, but I will learn something from it.” I have learned in my own depression how big an emotion can be, how it can be more real than facts, and I have found that that experience has allowed me to experience positive emotion in a more intense and more focused way. The opposite of depression is not happiness, but vitality, and these days, my life is vital, even on the days when I’m sad. I felt that funeral in my brain, and I sat next to the colossus at the edge of the world, and I have discovered something inside of myself that I would have to call a soul that I had never formulated until that day 20 years ago when hell came to pay me a surprise visit. I think that while I hated being depressed and would hate to be depressed again, I’ve found a way to love my depression. I love it because it has forced me to find and cling to joy. I love it because each day I decide, sometimes gamely, and sometimes against the moment’s reason, to cleave to the reasons for living. And that, I think, is a highly privileged rapture.

29:06 Thank you. 29:07 (Applause) Thank you. (Applause)

Andrew Solomon, December 2013.

Jul

2015

Heart Relationship to Sense Organs

The five sensory orifices, referring to the nose, ears, eyes, lips, and tongue, are each paired with specific visceral organs. In particular, the Heart, regarded as ‘the emperor or sovereign ruler’, gives residence to Shen – a level of ‘Spirit’ which activates all mental activities, as well as perceives the emotional stimulus of all of the organs. The Heart has relationships with the other orifices beyond its own link with the tip of the tongue.

Heart 心 is the only organ with insight to do that.

For example, the eyes are related to Liver, but are also related to Heart. The Heart supplies blood, and blood vessels supply the eyes. According to the Su Wen 素問, the first medical text to address basic questions, theoretic foundations and diagnostics in Chinese medicine, excessive use of the eyes injures the Heart as well as the blood of the Liver. Diagnostically, the eyes are the most important window of Shen (or Spirit) that is inherently stored in the Heart, and although the eyes are particularly the orifice of the Liver, sight is a manifestation of the function of Heart.

Well-Wishes to All

Jul

2015

Attention Deficit Disorder

It appears that Attention Deficit Disorder, referred to as A.D.D., arises from a neurological defect, with abnormalities in brain tissue and/or biochemical functions. Nutritional deficiencies, exposure to harmful chemicals in-utero such as from smoking, alcohol, prescription and/or illicit drugs, and by further exposure to environmental pollutants – all of which have become wide-spread problems during the past four decades – seem to be the pathological factors that strongly contribute to A.D.D.

The imbalance of spiraling from Yang to Yin to Yang

From the perspective of Chinese medicine, essence and marrow are the foundation of the brain. Early problems with mental development indicate deficiency of an individual’s vital essence. As well, phlegm obstruction and settling agitated Yang energy that is manifesting as hyperactivity are significant pieces of the etiology of A.D.D. that can be improved with oriental medicine. Chinese literature suggests that treatment of this condition by acupuncture begins to show improvement ranging from two weeks to two months, with Chinese herbal preparations appropriate to the condition also crucial to the success of treatment.

Jul

2015

Flavinoids

Flavonoids, an aspect of the compound category of polyphenols, are present in practically all fruit and vegetable plants, and also in many herbs of the Chinese medicinal pharmacopeia. Flavonoids are starches that are soothing to the gastro-intestinal system, are anti-allergy, and elicit anti-viral activity. Flavonoids display their antioxidant and anti-inflammatory effects through compatible herbal interactions and by metabolizing a wholesome diet. Here is a short list of Chinese herbs and a chart highlighting some foods highest in flavonoids.

Among others:

Huang Qi, Huang Qin, Shan Dou Gen, Lian Qiao, San Qi, Shan Zha, Hong Hua, She Chuang Zi, Sang Bai Pi, Jiaogulan, Yuxingcao, Ge Gen