The Research Methodology of Traditional Chinese Medicine

By Samuel Wang, PhD, L.Ac.

Introduction to the Theory of Microcosmic and Macrocosmic Views

 Professor Emeritus, Doctoral Program in Acupuncture & Oriental Medicine, University of East-West Medicine

August 2011

  1. The New Challenge in Research Methodology of TCM

It is commonly recognized that the renaissance of traditional Chinese medicine of 21st century has made great contributions to the human health. Particularly since 1980s, the general acceptance of acupuncture in the developed countries has opened a new avenue for the western medical societies to explore the treasures of traditional Chinese medicine. In the western countries, since the recognition of the unique therapeutic results of acupuncture, it has also been quickly convinced that traditional Chinese medicine maintains its own superiority. So far, traditional Chinese medicine has merged into the main stream of medical sciences of the world, and many scholars in various countries, particularly those at the National Institute of Health in the U.S. have done numerous researches on traditional Chinese medicine by the means of modern sciences. Since traditional Chinese medicine is considered a branch of medical sciences of the world, it is no doubt that the general principles of modern scientific research are applied to traditional Chinese medicine as well.

It is also universally believed that modern sciences including western medicine is under the deep influence of the English philosopher Francis Bacon, who established the basic ideas of mechanical materialism and scientific experimentation between the 16th and 17th century. Since his era, the methodology of modern scientific research has been following his footstep without substantial changes. However, the ways of thinking in traditional Chinese medicine stem from classical Chinese philosophy, i.e. mostly from Yijing, in which the naïve universal dialectics is the main concept. Due to the difference of philosophical backgrounds, traditional Chinese medicine has its unique ways of thinking different from those of conventional western medical sciences and other modern sciences. Therefore, the general principles of research for conventional medicine and other sciences are not sufficient to deal with the issues encountered in the research on traditional Chinese medicine. The research methodology of traditional Chinese medicine is a new challenge.

In the past, because most researchers only applied the general principles of western medical research to the study of traditional Chinese medicine, the results were not quite successful. In the research on TCM, few of our forbears have ever really solved the issues of methodology. Therefore, the author believes those special principles of research on traditional Chinese medicine have to be explored in addition to those principles as mentioned above.

In this article, after reviewing both eastern and western literatures regarding the research methodology, and summing up his experience in the past forty years of research and clinical practice in both modern western medicine and traditional Chinese medicine, the author will discuss this new challenge in the methodology of research on traditional Chinese medicine involving its general principles and special principles. And based on these principles from the two different aspects, the author will also propose a preliminary draft of methodology for the TCM research, especially for its clinical studies. The new approach of research of TCM is called the microcosmic theory or microcosmic method of Chinese medicine

Medical researches, either eastern or western, also share some common methods as any other research works. If the general principles of all researches are the operating software in a computer, the special principles of research on TCM are the Microsoft Words, or the Microsoft Excel and Power Points. By the help of all these pieces of software, one can accomplish a perfect presentation with beautiful charts and tables in slides. If any piece of the above software is missing, the presentation will never be perfect. For example, if the operating software is lost, nothing can be even done in the computer; if the Excel and power point are malfunctioning, one can only do word processing without charts, tables and slides, which will never be a real or ideal presentation. For the same reasons, a perfect or ideal research on traditional Chinese medicine can only be accomplished through the organic combination of all the research principles from the above two aspects, which will be discussed in the following chapters respectively.

  1. The General Principles of Research on TCM

The so-called general principles of research on traditional Chinese medicine are defined as the same as those applied to modern western medical sciences. Therefore, in this aspect, the procedures and methods of doing a research are the same in both traditional Chinese medicine and modern western medicine. Medical researches, either eastern or western, share some common methods.

As mentioned previously, Francis Bacon (1561-1626) was the pioneer of modern scientific thought, which has been the guideline in the research methodology of modern sciences including modern medical sciences during the past several hundred years. Bacon emphasized the belief that people are the servants and interpreters of nature, that truth is not derived from authority, and that knowledge is the fruit of experience. Bacon also contributed to the logic method known as ampliative inference, a technique of inductive reasoning. Previous logicians had practiced induction by simple enumeration that is, drawing general conclusions from particular data. Bacon’s method was to infer by use of analogy, from the characteristics or properties of the larger group, to which that datum belonged, leaving to later experience the correction of evident errors. Because it added significantly to the improvement of scientific hypotheses, this method was a fundamental advancement of the scientific method. Since his era, many of scientific fundamental theories have been born by his ampliative induction, such as Newton’s laws, later the theory of relativity, modern quantum theory, and Darwin’s evolution, etc. Bacon successfully influenced the acceptance of accurate observation and experimentation in science. He maintained that all prejudices and preconceived attitudes, which he called idols, must be abandoned, whether they be the common property of the race due to common modes of thought (“idols of the tribe”), or the peculiar possession of the individual (“idols of the cave”); whether they arise from too great a dependence on language (“idols of the marketplace”), or from tradition (“idols of the theater”). The above principles had an important influence on the subsequent development of empiricist thought, particularly the development of experimental sciences.

Modern western medical sciences like other modern sciences have inherited Bacon’s basic ideas in the ways of thinking. The research methodology of modern western medicine is the derivative of Bacon’s philosophy, involving the following:

  1. Truth is from large quantities of all facts resulting from clinical practice, clinical experiments, and laboratory experiments including animal experiments. In modern western medicine, each step of advancement is associated with scientific experiments either from clinical practice, or from laboratory and animals.
  2. These facts are the only standard in the judgement of truth. All the authorities, idols, concepts and theories, either previous or current, must go though the judgement of the above facts, and if they are in contradiction with the facts, they have to be abandoned or modified. Therefore, modern western medicine does not have absolute authorities except practice. It is an ever-changing science because its theories have been continuously modified according to the new discoveries of facts which it has no burden to accept, including those from other sciences, such as physics, chemistry, mathematics and biology, etc.
  3. Large quantities of the above facts are summarized into hypotheses through ampliative inference or analog induction. Then, the hypotheses receive examinations by the above facts. If they are agreeable with the facts for a period of time, they will become theories, if not; they will be abandoned, or be modified until they are completely agreeable with the above facts. In modern medical sciences, both clinical experiments and laboratory experiments, particularly animal experiments, are not only the most important sources to provide facts for research, but also the most important means to examine hypothesis, theories, concepts and ideas from research. Animal and laboratory experiments are also a very important method for analog induction of hypotheses for clinical use. For example, today’s human physiology is actually animal physiology, because most the concepts and conclusions in human physiology were originally from animal experiments. Through Bacon’s ampliative inference or analog induction, results from animal experiments were raised to hypotheses for the human body. Then, through the strict examinations and modification of clinical practice, these hypotheses turned into theories in todays textbook of human physiology.
  4. Of course, hypotheses in modern medicine can also be directly generated from the facts of clinical practice by means of analog induction. Clinical observations and clinical experiments are the other main method of generating hypotheses through analog induction, and these hypotheses may follow the same way as mentioned above to become theories.
  5. In order to eliminate any possible prejudice and preconceived attitudes called idols by Bacon, in its researches, modern western medicine widely uses mathematical tools, particularly statistics, which has been the most powerful weapon in ensuring objective accuracy and reliability. In addition, mathematical tools provide western medical research with most precise quantitative analysis. Any persuasive conclusion in western medical research must go through the treatment of statistics including control group establishment, random principle and double blind or single blind method, etc.

The above methods of research have brought modern western medicine abundant harvests. Standard medical textbooks have to be revised every three to five years as soon as new theories, new techniques and new data have come out. However, in research methods, what modern western medicine has, is exactly what traditional Chinese medicine has been missing. Despite large quantities of facts have surfaced from its clinical practice, traditional Chinese medicine has not made any progress in its theories. It has been isolated from other modern sciences as well, having never absorbed any new development in other sciences. Despite the fact that the method of analog induction has been commonly used in traditional Chinese medicine for over thousands of years, according to Bacon’s philosophy, the conclusions and ideas still stay at the stage of hypotheses, which haven’t been proved by strict scientific experiments, in which statistical treatment is always required. Therefore, traditional Chinese medicine needs all the above research methods used in modern western medicine. Obviously, many modern researchers have employed all those most advanced methods including the most sophisticated statistical analysis to explore TCM , however, as mentioned in the first chapter of this article, why have few of them been really successful in the research on traditional Chinese medicine? The answer is that they have neglected the philosophical difference between the two medical systems; that they have westernized traditional Chinese medicine; that they have omitted the quintessence of traditional Chinese medicine.

What is the quintessence of traditional Chinese medicine? It is its dialectical concept or dialectics that modern western medicine lacks. With this quintessence, traditional Chinese medicine has been maintaining its superiority over the past two thousand years. This is why western medicine cannot substitute for traditional Chinese medicine and why traditional Chinese medicine can treat some conditions that western medicine cannot treat. Without this quintessence, traditional Chinese medicine will not survive. Without the involvement of this quintessence, its research will turn into a pure western medical research or never been successful in reaching a conclusion of traditional Chinese medical concept. Obviously, traditional Chinese medicine needs to be modernized, but not to be westernized. Its dialectical concept should be maintained, and for this purpose, its special methods of research need to be set up. Therefore, the author emphasizes the special principles of research on traditional Chinese medicine according to its quintessence-the dialectical concept, which will be discussed in the next chapter.

  1. 3. The Special Principles of Research on Traditional Chinese Medicine

Dialectical concept in philosophy originally means the method of investigating the nature of truth by critical analysis of concepts and hypotheses. One of the earliest examples of the dialectical method in western countries was proposed by the Greek philosopher Plato, in which he sought to study truth through discussion in the form of questions and answers. Another noted Greek philosopher, Aristotle, thought of dialectics as the search for the philosophic basis of science.

Dialectics was not a complete and clear concept in western countries until the 19th century, when the German philosopher G. W. F. Hegel (1770-1831) applied the term dialectic to his philosophic system. Hegel believed that the evolution of ideas occurs through a dialectical process—that is, a concept gives rise to its opposite, and as a result of this conflict, a third view, the synthesis, arises. The synthesis is at a higher level of truth than the first two views. Hegel’s work is based on the idealistic concept of a universal mind that, through evolution, seeks to arrive at the highest level of self-awareness and freedom. Hegel, the German idealist philosopher became one of the most influential thinkers of the 19th century in the western countries.

Soon after Hegel, German political philosopher Karl Marx applied the concept of dialectic to social and economic processes. Marx’s so-called dialectical materialism, frequently considered to be a revision of the Hegelian system, asserts that ideas can arise only as a result of a material condition.

However, the complete concept of dialectics in Chinese classical philosophy can be traced back to the West Zhou dynasty (1171-1122 BC), when the first Chinese philosophy book Yijing appeared. In Yijing, dialectics is the central idea, with which the universe is explained. The Yellow Emperor’s Classic of Internal Medicine that appeared over two thousand years ago, totally integrated the dialectical idea from Yijing into medicine. This classical Chinese medical textbook well describes the concept of Ying and Yang, which is not only opposed, but also contained and dependent upon each other in unity. This dialectic concept, in certain aspects, is similar to that of Hegel and that of Marx’s theory, but the Chinese concept came out at least two thousand years earlier. However, the dialectical concept in traditional Chinese medicine, in other aspects, is still different from either Hegel’s philosophy or Marx’s dialectical materialism. Hegel’s idea is based on idealistic concept, while dialectical idea in traditional Chinese medicine the material reality. Marx’s dialectical materialism emphasizes conflicts between the two opposite sides, believing that the conflict is absolute, while the dialectical idea in traditional Chinese medicine the unity of the two opposite sides, insisting that the harmony of the Ying and Yang is the goal. Generally, the dialectical concept in traditional Chinese medicine, in certain degrees, involves part of Hegel’s philosophy and part of Bacon’s.

The latest discoveries in modern sciences support the ancient dialectics of traditional Chinese medicine. In molecular biology, the DNA and RNA double helix chain is a good example of opposite unity. In modern physics, the most important discovery during the past 20 years is believed to be quarks, which are the most hypothetical particles so far to form the basic constituents of the elementary particles, or the smallest subunits to constitute universal materials. Quarks are divided by bottom and top, and up and down quarks, hypothesized for theoretical reasons of symmetry. Each kind of quark has its antiparticle, showing the opposite unity as well. In modern cosmology, the possible existence of anti-matter and anti-gravity is another example. Obviously, the dialectics in traditional Chinese medicine is universal truth having been tested for over two thousand years

The philosophical difference between the two medical systems and the universal truth of the traditional Chinese medical philosophy can well explain why modern western medical research methodology alone cannot solve all the issues encountered in the research on traditional Chinese medicine. Therefore, new research methods need to be developed for this ancient medical system.

Since the time of Yellow Emperor, Ying and Yang theory and its derivative theories, in the other words the dialectical concept in various fields of TCM, has been the central idea in all the classical Chinese medical literatures. It will not be traditional Chinese medicine without dialectics. Bacon’s philosophy, however, does not involve this concept; neither does modern western medicine. Modern western medicine is mechanical, but not dialectical. By taking this concept into consideration, the author intends to integrate both traditional Chinese medicine and modern western medicine particularly on the clinical aspect. For this purpose, he has the following proposals as the special principles of research on traditional Chinese medicine:

  1. Traditional Chinese medicine has its own scientific structures, ways of thinking, theories and clinical methods. Therefore, when research principles of the modern western medicine are employed to traditional Chinese medicine, the characteristics of traditional Chinese medicine should not be neglected, particularly its essence-the dialectical concept including dialectical diagnosis and treatment. Since traditional Chinese medicine contains abundant clinical data from the practice for over two thousand years, its basic theoretical research should be combined with clinical research.
  2. As discussed previously, traditional Chinese medicine needs to be modernized, but not westernized. There is no absolute authority in this medical system either. Any theories, ideas, methods and concepts in traditional Chinese medicine can be changed or modified according to the new discoveries of facts, except its dialectical concept including its dialectical diagnosis and treatment. Some old theories, e.g. the controversial five elements and some therapeutic methods should go through the examination of modern scientific methods, but those methods must involve the dialectical concept. The dialectical concept and its derivatives like pattern differentiations in 8 Entities, Zangfu, Meridians, Qi, Blood, Fluid, and External Pathogenic Factors, as the quintessence of TCM has been considered to be the axiom so far, and should not be changed.
  3. Traditional Chinese medicine should also continuously absorb new nutrition from modern western medicine and other modern sciences, taking advantage of the discoveries from these sciences by means of its essential dialectical methods. Some conservative scholars of TCM may concern that, if it is open to modern western medicine, traditional Chinese medicine will be swallowed. In fact, this concern is unnecessary. As long as its essential character-the dialectical concept is not changed, traditional Chinese medicine will be developed and modernized, but never be disappeared. During the past decade, traditional Chinese orthopedics has been the pioneer in opening its door to western medical sciences. Now, Not only hasn’t traditional Chinese orthopedics been swallowed, but it has also been more independent than before as it has maintained its own unique characters, such as tuina, manipulation and acupuncture, internal and external use of herbs, and its unique dialectical diagnosis and treatment according to the patterns.
  4. The dialectical methods in traditional Chinese medicine can be employed to analyze the macrocosmic fields as well as to explore the microcosmic details of modern western medicine. In ancient TCM, the scope of research is restricted to macrocosmic aspect only, due to the lack of advanced scientific instruments. When traditional Chinese medicine accepts all the facts, particularly the microcosmic details of modern western medicine, its essential methods and ideas can be used to investigate the microcosmic world by the help of the advanced technologies of western medicine. Several years ago, some acupuncturists and physicians from SF general hospital jointly completed a research project for studying the effectiveness of Chinese herbs in AIDS patients. This was a strict modern scientific research in conjunction with traditional Chinese medical concept, using both statistical analysis and traditional Chinese diagnosis and treatment of patterns, but the results were not satisfactory, showing no substantial effectiveness of Chinese herbs in treating AIDS patients. The researchers in this project only limited their design to the old traditional way-the macrocosmic aspect, completely ignoring all the microcosmic discoveries of AIDS from western medical research. Currently, the research on AIDS in modern western medicine has reached to the molecular level. If traditional Chinese medicine can use its eight-entity method and dialectical treatment principle to analyze the phenomena at the molecular level, the research results will possibly be different.
  5. Traditional Chinese medicine uses pattern differentiation or diagnosis to classified symptoms, while modern western medicine emphasizes disease diagnosis to differentiate symptoms. In the past, most the research projects for traditional Chinese medicine were limited to disease diagnosis, totally neglecting the pattern diagnosis. These kinds of totally westernized projects rarely ended up with satisfactory results. Disease diagnosis has its superiority as well as inferiority; vise versa, pattern diagnosis also has its superiority as well as inferiority. The integration of both diagnostic systems can neutralize the inferiorities of both medical systems. For example, clinically, hepatitis B virus infects some apparently healthy people without any symptoms. The diagnosis in modern western medicine is hepatitis B virus carrier, but to this group of people, traditional Chinese medicine is unable to give the pattern diagnosis in its macrocosmic view, because they have no symptoms to be classified. Of course, traditional Chinese medicine can go further, using its eight-entity diagnosis and organ-diagnosis to investigate microcosmic view of hepatitis B infection, as discussed previously, to create new concept of eight-entity diagnosis and Zangfu-diagnosis at the microcosmic level. On the other hand, to some conditions, modern western medicine cannot give the diagnosis, but traditional Chinese medicine can. It is not uncommon that some infertile couples have gone through all the most advanced examinations available in modern western medicine, but everything was within the “normal” range in the view of modern western medicine and no diagnosis can be made. This is called unexplained infertility by western medicine, accounting for 12-22% of all the infertile couples. To this type of couples, traditional Chinese medicine is almost always able to give the pattern diagnosis. The most common idea of integrating both diagnostic systems is that disease diagnosis is subdivided by pattern diagnosis.
  6. The research advancement of TCM diagnosis will probably experience two stages. The first stage is to integrate both diagnostic systems in the macrocosmic view. The second stage is to use the TCM dialectical diagnostic principles to investigate the microcosmic details discovered by modern western medicine. Through the second stage, traditional Chinese medicine will progress to a higher lever, and new concepts in TCM diagnosis at the microcosmic level will be created. The research advancement of TCM therapeutics will also go through the same process. For example, hypertension is a pure western medical terminology, and ancient traditional Chinese medicine did not have such a concept about blood pressure. At the first stage of research, hypertension will be subdivided into various patterns according to TCM diagnosis. This subdivision will be based on the patient’s medical history, symptoms and physical examinations including tongue and pulse characteristics, all of which are in the range of macrocosmic view. TCM therapeutics will be introduced according to the macrocosmic TCM diagnosis. At this stage, traditional Chinese medicine will still maintains its ancient macrocosmic view, and both medical systems will still be independent to each other, but dialectics of TCM will be imposed on the research in addition to Bacon’s method. At the second stage, the dialectics of TCM will be infiltrated into the most advanced discoveries in modern western medicine. Disturbance of renin-angiotensin or ischemia of cervical vertebral artery may cause hypertension. These are the latest microcosmic discoveries in modern western medicine. So TCM pathological concepts and diagnostic methods can be used to analyze the disturbance of rein-angiotensin and the ischemia of the cervical vertebral artery, in order to set up microcosmic eight-entity diagnosis and Zangfu diagnosis as well as microcosmic TCM pathogenesis. Therefore, new TCM hypotheses will be proposed. Then, through the clinical practice or/and laboratory studies including animal experiments to confirm or modify these hypotheses. Finally, the new TCM theories will be born at the higher level involving both macrocosmic and microcosmic views. The TCM therapeutics will also go through the similar process. When the TCM theories are set up at the higher level, the TCM diagnosis of hypertension will no longer be based on the appearance of tongue and pulse alone, because they only represent the macrocosmic changes. At this level, TCM diagnosis will be based on both macrocosmic and microcosmic eight-entities.
  1. 4. Introduction to Microcosmic Theory of Chinese Medicine

As mentioned previously, classical Chinese medicine perceives the human body only in the macrocosmic view, so it assumes that the microcosmic conditions in the human body are always compatible with the macrocosmic ones. However, it cannot explain the fact that under certain circumstances, the differences do exist between microcosmic and macrocosmic conditions.

Since modern Western medicine usually emphasizes the pathological changes in microcosmic view, while classical Chinese medicine is dissociated with the achievements in modern Western medical sciences. The issue is still related to the research methodology of Chinese medicine. The author has developed a new research methodology of Chinese medicine: applying the unique dialectical philosophy of Chinese medicine in microcosmic view to the achievements in modern Western medicine. In light of this new research methodology, the author is capable of establishing his innovative microcosmic theory of Chinese medicine, which enables Chinese medicine to be naturally integrated with modern Western medical sciences.

Chinese medicine is essentially characterized by its dialectical concept, without which it is not Chinese medicine. However, microcosmic theory or microcosmic method of Chinese medicine is different from the classical Chinese medicine in some aspects. Microcosmic method of Chinese medicine not only inherits the quintessence of the methodology of classical Chinese medicine, but also absorbs the great achievements in modern Western medicine. Since its quintessence is not changed, microcosmic method of Chinese medicine is still in the category of Chinese medicine, except for its acceptance of modern medical sciences as well as its application of dialectical philosophy of Chinese medicine to both macrocosmic and microcosmic views.

Generally, microcosmic theory of Chinese medicine involves both micro and macro sides. It is quite similar to classical Chinese medicine in its macrocosmic aspect, emphasizing the coordination of the whole body. However, its microcosmic patterns are focused on the local pathological changes or on the function of a specific system of the body. Pulse, tongue and facial complexion diagnoses are routinely used in classical Chinese medicine, but they commonly reflect the macrocosmic patterns of Chinese medicine. The microcosmic patterns of Chinese medicine mostly correlate with the individual Western diseases or western pathological changes. Therefore, in the same patient, the microcosmic patterns may not always be compatible with the macrocosmic ones. It is possible that pulse and tongue may show Yang deficiency, but the microcosmic TCM diagnosis may still be Excess Heat. This contradicted diagnosis between macroscopic and microscopic aspects just reflexes the complexity of the human body. The TCM treatment principle for the above case may end up with using cold purging herbs to treat the microcosmic Excess Heat, while using hot strengthening remedies for macrocosmic Yang deficiency in order to have better results.

  1. 5. Summary

In this article, the author has discussed the research methodology of traditional Chinese medicine from two different aspects. The general principles of research on traditional Chinese medicine stem from those for modern western medical research. However, they are not enough to deal with the issues encountered in traditional Chinese medical research. The author has also discussed the difference of philosophical background between traditional Chinese and modern western medical systems. Modern western medicine is based on Bacon’s mechanical materialism and scientific experimentation, while traditional Chinese medicine is characterized by its unique dialectics. The dialectics in traditional Chinese medicine, in some aspects, is similar to Hegel’s philosophy or Marx’s dialectic materialism, but in other aspects, different from both of them. Therefore, the research methodology of TCM is a new challenge, for which the author has proposed the special principles. Finally, the author introduces the new approach-the microcosmic theory or method of Chinese medicine. With all the principles from two different aspects, particularly the microcosmic theory of Chinese medicine, the author believes that the research on traditional Chinese medicine will be successful, reaching to a higher level.


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