POINTS EAST AND WEST
Acupuncture and Teaching the Cultural Contexts of Science
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
INTRODUCTION
Conveying an appreciation of the cultural context of science
can be challenging given prevailing conceptions of the nature
of science. To convey context clearly, one wants vivid illustrations.
Ideally, one also wants to show how the same topic can be approached
scientifically in contrasting ways by different cultures. The
history of acupuncture is ideal in both these respects. Here
I discuss how to engage students in thinking about the cultural
roots of scientific knowledge and scientific methodology by
comparing traditional Chinese and Western approaches to acupuncture
in the early 1970s (see Hagen, Allchin and Singer, 1996, for
a more complete teaching unit aimed at the introductory college
level).
Imagine yourself, for example, as an American physician
visiting a Beijing hospital in 1971. A traditional Chinese
doctor there tells you that they can alleviate pain by inserting
needles at specific points in the skin and then twirling
them slowly. The points are sometimes quite remote from the
source of pain. Should you believe them?
Next, you witness a surgery where the main source of pain
control is from a needle inserted in the patient's forearm.
During the operation, the surgeon makes a 14-inch incision
around the left side of the thorax, cuts two ribs, and removes
a lobe of a tuberculosis-infected lung. Meanwhile, the patient--still
conscious--chats with the surgeon. At the end of the 2-hour
procedure, the patient sits up and leaves the operating table
under his own power, brandishing a copy of Mao's "little
red book." Is seeing believing? What did you see?
Finally, the doctor, who knows some Western medicine, explains
that it is all quite reasonable if you understand traditional
Chinese medicine. The needling, the doctor explains, redirects
the flow of the life force through the body, balancing the
potentially painful influence of the incision. Does the explanation
affect the status of your belief? How? Why?
The use of needling as a form of medicine--a practice known
as acupuncture--extends back for over 2000 years in China
(Lu and Needham 1980). Acupuncture only received widespread
exposure in the U.S., however, in the early 1970s when President
Nixon began to reestablish U.S. diplomatic ties with the
People's Republic of China. American physicians were at first
largely baffled by how acupuncture could suppress pain. It
followed no known physiological mechanisms. Indeed, it seemed
contrary to scientific and common-sense notions about pain
and the body in general. The Chinese explanation was incredible
by their standards, but there was no satisfactory Western
alternative. What would have been an appropriate `scientific'
repsonse in 1971? This case poses penetrating questions for
students, introducing them to the problems of science in
two cultures.
CHINESE TRADITION AND WESTERN SKEPTICISM
In 1971, the U.S. was still basking in having landed the first
man on the moon--perhaps the greatest technological feat of
human history. An electronic microprocessor--a computer "chip"--had
just been introduced. Texas Instruments had begun marketing
the first pocket calculator. By contrast, China was the most
populous nation on the globe, with one-quarter of the Earth's
people crowded within its borders. China had a rich tradition
of culture and basic technological discovery dating back thousands
of years, but it was also largely a nation of peasants. This
certainly provided a background for how Americans assessed
reports from China.
The spectacle of surgery done under acupuncture startled
many Western physicians. But Chinese doctors reported further
that they used acupuncture to alleviate other sorts of pain
as well, such as headaches, toothaches, lumbago, and chronic
pain in joints and muscles. They inserted needles at different
points specific for each treatment, as prescribed by their
many centuries of experience. The Chinese even used needling
to treat general ailments: hiccups, insomnia, asthma, muteness
and blindness, ulcers, vitamin E deficiency and, more recently,
drug addiction and smoking habits. That was quite an extraordinary
list for such a modest procedure.
It is hardly surprising that some American doctors doubted
the Chinese claims. For them, acupuncture was unscientific.
They alleged fraud, suggesting that the "demonstrations" for
Western physicians had been staged merely to promote China's
communist regime. They warned of possible abuse by "quackupuncturists".
In fact, many acupuncture clinics that opened in the U.S.--and
some that had existed previously in various Chinatowns in
major U.S. cities--were soon closed by government authorities.
Only when U.S. doctors began to replicate the effects of
acupuncture in American hospitals did such criticism abate.
The historical case allows the teacher to introduce fundamental
questions about how scientists judge the crediblity of claims,
especially indirectly through the credibility of other researchers.
Western physicians were clearly accorded more authority than
Chinese physicians. Why? In what ways were their judgments
justified or unjustified? Students may best appreciate the
problem by considering the Chinese perspective: how would
a Chinese physician--credible among Chinese peers--have established
credibility in a community of Western scientists?
Many people acknowledged the positive effects for persons
treated with acupuncture, but they were nonetheless unimpressed.
Two reasons were given. First, in about one-third of all
cases, a patient recovers from his or her condition even
without treatment. For these cases, they argued, it would
be inappropriate to credit acupuncture. The historical context
of skepticism, here, provides an opportunity to underscore
(in a constructivist sylte) the role of controlled experiments.
In other words, students might well recognize on their own
that to assess the effect of the needling alone, you would
need to compare patients treated with acupuncture with those
who received no treatment.
From a traditional Chinese perspective, however, the mere
idea of such an experiment posed an ethical problem: why
would you refrain from a treatment that your expreience showed
was effective? Chinese medicine stresses the result for the
patient. Research is secondary. Therefore, you would not
withhold a treatment just for the sake of a test. For the
traditional Chinese, if you already knew how to help a patient
recover, you did not also need to know why the procedure
worked, especially if your research would likely cost patients
their well-being. While a Chinese scientist might not disagree
with the reasoning behind the design of the controlled experiment,
it would be outside proper science. What is the boundary
of science and can it vary culturally?
A second reason for disregarding acupuncture, according
to some critics, was that pain might be suppressed merely
through psychological suggestion--not a method worthy of
serious medical attention. In other words, pain control might
have resulted from some "unscientific" influence,
such as hypnosis, not by the needling itself. In 1972 one
doctor asserted, `the "needlism" merely acts as
a reinforcing stimulus as well as a diversionary maneuver
to disguise the presence of a subtle placebo effect'. There
was, he claimed, `a misdirection of attention' (Kroger 1972).
Many Westerners were especially suspicious when they discovered
that the Chinese tended to screen patients: not all were
deemed eligible for acupuncture. Indeed, the Chinese had
considered the attitude of the patient towards acupuncture
as early as the Han period (2nd century B.C.). At the same
time, Chinese doctors did not distinguish so sharply between
psychological and physiological mechanisms. The treatment
itself was effective. A Chinese doctor might have replied:
is psychosomatic healing not healing? Chinese and Western
standards for "good" medicine and science emphasized
different values in this instance.
Of course, one could test for the effect of suggestion--and
a teacher can invite students to design such a test. They
might imagine, for example, that you could check acupuncture
on a person or organism that can feel pain but that is not
susceptible to suggestion. Both infants and animals, in fact,
respond to acupuncture. Illustrations of acupuncture charts
for horses, pigs, water buffalo, camels and other animals
dating back to the Yuan period (14th century--before the
European Renaissance) offer striking images of the Chinese
tradition. Students might be able to interview local veterinarians
who now use acupuncture (see Schoen 1994).
Another approach to testing suggestibility, commonly used
in drug trials, is to prevent the patient from knowing whether
he or she is receiving treatment. Some researchers have used "sham
acupuncture," needling at non-acupuncture points. Others
have used "treatments" of needles taped to the
skin. Students may interpret the results themselves (reviewed
in Pomeranz 1987). In various lab studies in the past few
decades, acute pain stimuli (such as intense heat or sharp
objects) were given to humans, mice, cats, horses, rats and
rabbits. Needling of true points clearly suppressed pain,
while needling of sham points produced very weak effects.
In the case of chronic (long-lasting) pain, such as backaches
or arthritis (studied clinically), results were more complex
(the differences between groups are statistically significant):
Effectiveness in Relieving Pain
| sham acupuncture |
33%-50% |
| placebos of needles taped to the skin |
30%-35% |
| "true" acupuncture |
55%-85% |
*Morphine, accepted in the West as the most widely effective
pain-killer, is effective in 70% of the cases.
Philosophers and sociologists have viewed `organized skepicism'
as a hallmark of (Western) science for some time). This case
allows one to assess the role of such skepticism. What may
have motivated such strong criticism and concerns about fraud
in this case? Given the 2000-year tradition of practice in
China, were additional tests warranted? In what ways, if any,
did the early criticisms contribute to developing scientific
knowledge? Students may consider how incentives or institutionalized
checks and balances can either encourage or suppress such motivations.
Teachers may invite them to devise a system that might positively
regulate their effect.
PHYSIOLOGICAL EXPLANATIONS
While some American medical researchers regarded acupuncture
as so much hocus-pocus, others were curious to know how acupuncture
might work. But the Chinese explanations were based on a fundamentally
different, even incompatible "geography" of the body
(Moyers 1993). For the Chinese, the body is maintained by a life
force, qi (pronounced as a short, breathy `chee'). The qi flows
through the body along several intersecting meridians or channels.
There are twelve primary meridians, each corresponding to a major
organ (liver, stomach, spleen, gall bladder, etc.). They also
corresponded to the twelve yearly cycles of the moon. The flow
of qi along the meridians maintains a balance between yin and
yang, the two complementary forces of the universe according
to Chinese philosophy. Thus, some meridians or channels are yin,
others yang.
The flow of qi along the meridians is how the Chinese traditionally
explain health and illness. When the flow is impeded or imbalanced,
disease, malfunction or pain results. To restore the balance,
needles are inserted at points along the appropriate meridian.
The needles either promote or impede the flow of qi, reestablishing
the balance of yin and yang.
The concepts of qi and meridians are problematic from a Western
perspective because no anatomical structures define the meridians,
and no measurable force can be identified as qi. A Westerner
may thus be inclined to think that the notions of meridians
and qi are superfluous--perhaps relics of an ancient and discredited
cosmology. But the concepts are essential from the perspective
of actual practice. Acupuncturists use meridian maps to assess
where needles should be placed. Indeed, part of the acupuncturist's
skill is diagnosing which meridians have been affected and
where along those meridians needles should be placed.
If the notions of qi and meridians have been unsatisfactory
for Westerners, numerous studies over the past few decades
have given them a more complete understanding in their own
terms. Researchers found relatively quickly, for instance,
that acupuncture for acute pain stimulates one particular kind
of nerve. Most painful stimuli are carried along small fibers.
Acupuncture, though, apparently stimulates larger fibers (type
II and III muscle afferents). A theory proposed in 1965 suggested
how the two nerve impulses might interact. The interaction
was built on a mechanical analogy. According to the theory,
there was a figurative "gate" in the spinal cord
where the two types of fibers converged. Only one impulse could
be conveyed to the brain. As proposed, the large fiber would
synapse with the small fibers, inhibit them, and prevent further
impulses. This "gate- control" theory could thus
explain how gentle needling might "switch" off perceptions
of pain--at least where nerves entered the same segment of
the spinal cord.
Other researchers, however, noticed that the optimal effects
of acupuncture often occur after several minutes--too slowly
to be explained by nerve impulses. They wondered if there might
be some factor in the blood. Again, students have the opportunity
to propose or design possible experiments. In this case, researchers
cross-linked the circulation of two rabbits through the veins
in their legs. The acupuncture on one rabbit allowed the other
to withstand stronger painful stimuli. Cross-injections of
cerebral-spinal fluid also worked. They concluded that acupuncture
triggered the release of an unknown hormone or similar "messenger" substance.
In 1973, researchers discovered accidentally that the brain
releases a class of natural pain- relieving compounds similar
to well-known opiate drugs, such as morphine. Among them was
endorphin. Was endorophin involved in acupuncture, they wondered.
They could study endorphin's possible effects using naloxone,
a chemical that inhibited the action of opiates by blocking
their receptors on the cell surface. A 1976 study addressed
the effects of naloxone injected just prior to acupuncture
in rabbits (see Pomeranz 1987, p.9) to see if there WAS pain
relief:
| acupuncture |
|
|
Yes |
| acupuncture |
+ naloxone |
|
No |
| acupuncture |
+ saline* |
|
Yes |
|
naloxone |
(no acupuncture) |
No |
|
saline* |
(no acupuncture) |
No |
| acupuncture at non-points |
|
(sham acupuncture) |
No |
| handling & restraint |
|
(no acupuncture) |
No |
Again, students may interpret and discuss the results themselves,
noting the role of each treatment in reaching their conclusions.
How did the controlled experiment contribute to Western understanding
here?
Research on pain and acupuncture is far from complete, but
the picture is becoming clearer. The system of interactions
appears to be quite complex. The "gate-control" theory,
for example, now seems far too simple. Numerous nerves originating
in the brain and ending at more peripheral points appear to
inhibit the transmission of impulses towards the brain. Acupuncture
activates many of these inhibitory systems at several levels.
In quite different studies, acupuncture has also been linked
to increased levels of cortisone, a steroid hormone released
from the adrenal cortex. This suggests a link to immune responses.
If confirmed, these might help explain acupuncture's other
reported health effects in Western terms (Lu and Needham 1980;
Pomeranz 1987; Baldry 1993; Liao et al 1994).
Explanation has been another feature typically used to characterize
(Western) science. Again, the acupuncture case allows one to
assess the precise role of explanation. Both Chinese and Western
accounts present themselves as offering causal explanations.
Both ostensibly match observations, though there are limits
to what can be observed. Both have been revised through time.
Although the Western account is well articulated and has been
part of a deepening of knowledge about the perception of pain,
it has not contributed to the practice of acupuncture. Western
findings have yet to benefit or extend traditional treatment
methods. An open question is: what have Western explanations
achieved regarding acupuncture itself? In what ways are they
important? If they are part of what makes science `science',
what is the role or significance of science in this case? Are
there alternative ways to conceive `science'?
It is worth noting that considerable Western research has
been done by native scientists in China itself. Indeed, some
of the experiments noted above were done even before the U.S.
was introduced to acupuncture in 1971. At the same time, many
Chinese have pursued research on the traditional explanations
(e.g., Research Group... 1986). The Chinese, at least, do not
seem to find stifling contradictions in the two sets of explanations.
More generally, the Chinese have adopted Western medicine,
though not exclusively. Western and traditional Chinese systems
exist side by side. One American acupuncturist trained in China
noted, "in China the idea is: they do not only give you
Chinese traditional medicine, because if you only learn Chinese
traditional medicine, your mind will get stuck." The posture
of the Chinese towards the different explanations is itself
an interesting feature to provoke student discussion.
The curriculum module continues...
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