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‘but health is whatever works/and for as long…’
John Stone ‘He Makes a House Call’
Although Western medical acupuncture (WMA) is based on a more ‘mainstream’ biomedical approach to diagnosis and management of a problem, there are still some obvious overlaps with traditional Chinese medicine (TCM). Take for example, the nomenclature of specific points and meridians, used in both WMA and TCM, which allows us to record treatment plans identifying previously needled points for future reference, which would be understood by either practitioner. The concept of qi is also used in both WMA and TCM. However, digging deeper there appear to be few further similarities between the two, with many of the TCM concepts of diagnosis and management of a problem being somewhat of an enigma, without the appropriate training and experience. Is it possible to merge the two, to obtain the best of both worlds? Are they really so different? What are the potential benefits and pitfalls? Is it just about integrating TCM into Western medicine, or evolving TCM into a more modern version of itself by and for its own practitioners?
With a book titled Integrating East Asian Medicine into Contemporary Healthcare these are a few of the questions one may expect to be answered.
The foreword and first two chapters set out to provide an overview of some of the history of East Asian medicine, and the possible differences between Eastern and Western medicine. There are interesting points raised throughout, such as the availability of acupuncture as a treatment modality in Cuban accident and emergency departments; one may only dream of this as an acceptable possibility in the West! There are enlightening discussions of Eastern medicine having similar issues as the West in that there may be heavy political or social agendas influencing its status at any one time. However, the chapters are quite complex in some of the ideas and writing, making it sometimes difficult to follow the arguments
The author suggests that practitioners of TCM take a very individualised approach to a patient, and no two problems will be treated the same, whereas in the West, there is a very standard ‘best practice’ approach to a diagnosis and its management based on robust clinical trials and evidence, which gives the impression of Western, or biomedicine being quite rigid and not tailored to each patient. This is explored further in the following chapters using descriptions of pulse diagnosis to highlight these differences, and emphasizing the perspective of a TCM practitioner treating patients alongside medical doctors in a clinic for HIV positive patients.
Further information about the integration of traditional medicine into contemporary healthcare deals with problems of language standardisation, which is clearly a long running area of tension between different groups and organisations, none of which appear to fully agree with each other. Other areas of standardisation relating to needle type appear to be more easily resolved.
Debate follows about the possibility of reproducing tongue diagnosis with imaging to enable a more consistent, or standardised, method of tongue diagnosis. Again, the conclusion seems to be that this is difficult and does not reproduce the experience of a TCM practitioner. Chapters discussing the difficulties of producing a sturdy evidence base for TCM discuss the limitations of RCTs and other trials in their application to TCM. The nature of these takes away what is fundamentally an individualised treatment programme for each patient, which is at the core of TCM. It is acknowledged that for TCM to become more ‘mainstream and accepted in a broader sense’, evidence needs to be produced somehow. Suggestions are included as to which type of study may be most appropriate in TCM to produce this evidence, albeit not the ‘gold standard’ RCT.
In the final chapter it is good to read the acknowledgement that Western doctors also practise their ‘art’ and treat each patient as unique, with their own set of complexities which may not fit neatly into a category tested rigorously by a trial. Even biomedically trained doctors will stretch the rules according to their experience and assessment of the individual. Maybe there are not so many differences after all.
This book, in essence, seems to be a collection of eloquently written essays by a variety of authors who have all been involved in the effort to integrate East Asian medicine into mainstream practice. The chapters are frequently well written and fascinating in their content, but often make a challenging read, with a lot of historical detail complicating the arguments. The vignettes throughout, designed to support the information in the main text, do not always seem relevant to the topic at hand, and are sometimes difficult to appreciate without the background of TCM training and experience. Some chapters seem to have more relevance than others for the purpose of this book. To a Western trained practitioner, the detail presented relating to actual practice of TCM, such as tongue and pulse diagnosis, may be beyond their understanding, as this is a whole different sphere of medicine. Nonetheless, the details are enlightening and interesting, and start to unravel some of the mystique of TCM. We are presented with the problems facing integration of the two medical domains, but little in the way of solutions. Perhaps the authors' aim was merely to raise the awareness of the difficulties of integrating the two systems and stimulate debate, or perhaps the solutions remain elusive?
Those looking for a straight forward read providing clear answers, or merely assistance with clinical conundrums, may wish to peruse other texts and clinical based textbooks. For others looking for a more challenging read that is a little more ‘off the beaten track’ with philosophical notions and historical detail a-plenty, this would be a good choice. Be warned though, it is not bed-time reading!
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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