POINTS EAST AND WEST
Acupuncture and Teaching the Cultural Contexts of Science
Part II
Douglas Allchin, Biology Dept., University of
Texas, El Paso TX
Acupuncture has been practiced in China for
centuries, but American scientists were largely skeptical
of its efficacy when they were widely exposed to it in
the early 1970s. Chinese doctors explain the phenomenon
using a conception of the body unfamiliar to Westerners.
Western physiologists, at first largely baffled, have in
the past few decades been able to explain the startling
analgesic effects of acupuncture in their own terms. I
show how a teacher may effectively use the contrasting
explanations and research practice, east and west, to teach
the cultural contexts of science.
Table of Contents
GETTING TO THE POINT
The notion that an apparently painful stimulus might reduce
pain was paradoxical enough for Americans. But even more puzzling
for Westerners were the patterns of needling. Chinese doctors
do not insert acupuncture needles haphazardly. There are specific
points. Sometimes, the points are quite remote from the site
of their intended effect. Thus, you might insert a needle between
the thumb and forefinger (a well-known point called ho-ku)
to treat either a headache or abdominal cramps(!). For coughing
or a fever, you would use a point above the third toe. For
Westerners, at least, the correlations made no anatomical sense.
The Chinese explanation for acupuncture, however, accounted
for why the points and their effects could sometimes be so
distant from each other. Because qi flows along meridians,
needles inserted along one meridian may be effective anywhere
along that meridan, even though they may be far from the
place of the effect. Thus a needle at ho-ku can affect a
headache or abdominal cramps because all lie on the `large
intestine' meridian.
Acupuncturists also use the notion of qi in inserting the
needle. When needles are placed in the correct location,
the patient usually feels a slight distension or numbness.
The sensation is called de qi, or "striking the qi," relfecting
the view that the patient perceives how the flow of qi changes.
Patients can sometimes also feel the numbness of de qi spread
along the line of the meridian. Thus, even if the meridians
and points have no Western anatomical "reality," they
do have a basis in sense perception. And these perceptions
guide treatment. For the practicing acupuncturist and the
patient, at least, the traditional theory explains key observations.
Historically, acupuncturists learned exactly where the
points were and how they were connected along meridians by
experience. No one could predict, apparently, the sometimes
zig- zagging pathways of the meridians--and there is no reason
in the Chinese view why they follow the paths as now described.
Instead, the meridian maps represent the collected wisdom
of generations of acupuncturists.
Westerners could not explain the relationship of points
in acupuncture. Not that they hadn't noticed similar phenomena.
They were familiar, for example, with `referred pain'. In
these cases, pain from an injured internal organ was felt
on the surface of the body, but not always near the organ.
Perceptions generally occurred within segments of the body,
however. They did not always match the sometimes distant
separation of acupuncture points and their effects.
Westerners were also familiar with another set of points,
discovered at the end of last century, that evoke pain when
pressure is applied. These are now known as `trigger points'.
One physician claimed that sometimes pressure on these points
can also alleviate pain. Researchers found in the 1970s that
there is a strong correlation between the location of the
trigger points of the West and the acupuncture points of
traditional Chinese medicine (Melzack et al 1977; Baldry
1993). But again, no one understands fully why trigger points
produce pain, sometimes at specific locations remote from
the point. In neither case--for trigger points or referred
pain--is there an explanation in Western terms why these
points might be related to pain relief.
The cross-cultural dimensions of acupuncture can be highlighted
once again by new discoveries. In recent years, many points
have been found that do not lie on traditional meridians.
How would a Western skeptic likely interpret this fact? How
might a Chinese doctor interpret the same fact? What can
the pair of interpretations reveal about the cultural context
of science?
DISCOVERY AND PURSUIT OF RESEARCH
What is especially striking is that while Westerners tend to
dismiss Chinese explanations, they nevertheless acknowledge
that the Chinese discovered acupuncture. Chinese physicians,
beginning centuries ago, developed a thorough knowledge of
a complex phenomenon that escaped the notice of Western inquiry
in the three centuries since the Scientific Revolution. Growth
of knowledge is another feature sometimes used to characterize
science. In this view, discovery is as central to science as
forms of justification. Novel findings, however, do not always
emerge from laboratory studies or controlled experiments, another
archetypal image of science. To the extent that discovery of
new phenomena is a part of science, science in the Chinese
culture on this occasion was somehow effective where science
in the Western tradition was not.
Science is a process and the pursuit of research can be
as significant as its results. Scientists cannot pursue every
question, and so they make choices. In addition, their research
involves equipment, human effort and time. They must decide
where they will invest their limited resources. As noted
above, for example, research on acupuncture and its clinical
efficacy reflected a degree of commitment, even if based
on skepticism. Ultimately, the factors that can influence
what research is done help shape science itself. But which
research is pursued, and why?
Chinese and American cultures offer very different contexts
for the pursuit of research on acupuncture. Acupuncture is
valued in China partly in an economic context. It is a relatively "low-
tech" form of medicine. It requires little equipment,
though it does require expertise and substantial training
for the acupuncturist. It is a labor-intensive rather than
capital-intensive form of medicine. It was through a deliberate
program of research in the late 1950s, in fact, that the
Chinese first applied and then developed acupuncture as a
form of analgesia for dental work and, subsequently, surgery.
The circumstances for acupuncture research in highly industrialized,
capitalist nations are quite different. Because acupuncture
involves no product to sell, drug companies and other investors
have had little incentive to fund acupuncture research. There
is no opportunity for profit. By contrast, research on endorphin-like
molecules that may relieve pain has been well funded. Funds
exist for research on pain relief, but only for certain types
of pain relief. The prospect for knowing more about acupuncture
thus depends on certain sources of funding to support research--in
this case, support for `basic' research.
In addition, acupuncture in the U.S. is still widely viewed
as an "alternative" or "folk" medicine.
It has peripheral status. Many insurance companies or health
plans, for example, do not pay for acupuncture treatments.
Even Western doctors sympathetic to acupuncture often recommend
it only when Western medicine fails or is first shown to
be ineffective. Many practitioners and health administrators
say that scientific assessments leave the efficacy and explanations
of acupuncture still uncertain. They also continue to cite
the potential for fraud (see, e.g., Consumer Reports, 1994).
With the current commitments to Western medicine, the potential
of acupuncture--and hence research on it--will be limited.
What we know about acupuncture will be shaped, as it has
in the past, by the research that is done.
CROSS-CULTURAL PERSPECTIVES AND CULTURAL SYMMETRY
The case of acupuncture effectively illustrates how to appreciate
the cultural context of science, I think, because one can compare--and
perhaps feel the tension between--two different cultural perspectives.
First, it is possible to understand and to appreciate independently
the perspective of each culture. In this case--as perhaps in
most cases of cultural divergence in science-- the contrast
is especially dramatic because one must undergo a gestalt-like
conceptual shift when moving from one way of thinking to the
other.
Second, neither account conveniently reduces to the other.
The Western accounts of nerve pathways and the effects of
endorphin offer powerful ways to relate acupuncture to other
aspects of pain and physiology in general where traditional
Chinese explanations remain silent. At the same time, the
Chinese lay claim to the original discovery and to explanations
on the sensations of de qi and clinical practice. Neither
culture has "cornered the market" on explanations
for acupuncture. The standards for scientific practice in
each culture relate to what each knows. I suggest that such
tensions offer the cognitive dissonance or discrepant episodes
that effectively prompt students to reflect on the cultural
contexts of science.
A basic test for a cultural case study, then, is whether
it works symmetrically. That is, the example should
be equally effective from each cultural perspective, or
if the cultural perspective is reversed.
BEYOND ACUPUNCTURE
Cross-cultural perspectives in medical science have become
increasingly important recently. Many researchers are interested
in medical treatments among cultures in non-industrialized
nations. Native practitioners (including the Chinese) often
use plants that are not familiar to Westerners. Many drug companies
are investing heavily to research whether indigenous herbal
treatments can cure various diseases. Where effective, they
want to look for their "active" chemical ingredients.
Interest in the context of indigenous medicine, the explanations
for various cures or how they were discovered, by contrast,
is usually quite low. The practice of science here, as in the
acupuncture case, invites discussion about the assumptions
of Western science.
Other topics lend themselves equally well to teaching the
cultural contexts of science: for example, archeaoastronomy,
ethnobotany, metallurgy, agricultural systems, and counting
systems (see list below). In particular, each are amenable
to cultural symmetry and to viewing the effectiveness of
science from two or more cultural perspectives simultaneously:
Gerdes, Paulus: 1994, Explorations in Ethnomathematics
and Ethnoscience in Mozambique, Instituto Superior
Pedagogico (Mozambique).
Mshigeni, Keto: 1991, Traditional Medicinal Plants,
Dar Es Salaam University Press (Dar Es Salaam, Tanzania).
Selin, Helaine: 1992, Science Across Cultures: An Annotated
Bibliography of Books on Non- Western Science, Technology
and Medicine, Garland Publishing (New York).
Selin, Helaine: forthcoming, Encyclopedia of the History
of Science, Technology and Medicine in Non-Western Cultures,
Garland Publishing (New York).
Sofowora, Abayomi: 1985, Medicinal Plants and Traditional
Medicine in Africa, Spectrum/John Wiley (Ibadan).
Thomas-Emeagwali, Gloria: 1993, African Systems of
Science, Technology and Art, Karnak (London).
Vortloff, Charles: 1988, `Chi'mu Irrigation Systems', Scientific
American.
Williamson, Ray A. (ed.): , Archaeoastronomy in the
Americas, Center for Archaeoastronomy (College Park,
MD).
REFERENCES
`Acupuncture', Consumer Reports 59 (Jan., 1994): 54-59.
Baldry, P.E.: 1993, Acupuncture, Trigger Points and
Musculoskeletal Pain. Churchill Livingstone (Edinburgh).
Hagen, J., D. Allchin and F. Singer, 1996, Doing Biology,
Harper-Collins (Glenview, IL).
Kroger, William S.: 1972, `Hypnotism and Acupuncture', JAMA 220:1012-13.
Liao, Sung J., Matthew H.M. Lee and K.Y. Ng Lorenz: 1994, Principles
and Practice of Contemporary Acupuncture, Marcel Dekker
(New York).
Lu, G.-D. and J. Needham: 1980, Celestial Lancets:
A History and Rationale of Acupuncture, Cambridge
University Press (Cambridge).
Melzack, Ronald, Dorothy M. Stillwell and Elisabeth J.
Fox: 1977, `Trigger Points and Acupuncture Points for Pain:
Correlations and IMplications', Pain 3:3-23.
Pomeranz, Bruce: 1987, `Scientific Basis of Acupuncture',
in Acupuncture: Textbook and Atlas, G. Stux and
B. Pomeranz (eds.), Springer-Verlag (Berlin), pp. 1-34.
Research Group of Acupunture Anesthesia, Institute of Medicine
and Pharmacology of Fujian Province: 1986, `Studies of Phenomenon
of Blocking Activities of Channels and Collaterals', in Research
on Acupuncture, Moxibustion and Acupuncture Anesthesia, Science
Press (Beijing) and Springer-Verlag (Berlin), pp. 653-67.
Schoen, A.M. (ed.): 1994, Veterinary Acupuncture: Ancient
Art to Modern Medicine, American Veterinary Publications
(Goleta, CA).
Ulett, G.A.: 1982, Principles and Practice of Physiologic
Acupuncture, Warren H. Green, Inc. (St. Louis).
VIDEO:
`The Mystery of Chi', (Bill Moyers Healing and the Mind series).
Ambrose Video Publishing (New York, 1993).
LABS in Ethnoscience:
Multicullturalism in Mathematics, Science and technology:
Readings and Activitites. Addison Wesley (Menlo Park,
CA, 1993).
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