by Bob Flaws

Thinking about some of the blogs I've written lately, it seems to me that one of my recurrent themes has been authenticity. In fact, I think authenticity has been in the forefront of my mind for a couple of years now. In a number of my blogs, pod-casts, and webinars, not to mention f2f classes and conversations, I've talked about the importance of authenticity, but I don't think I've actually said why I think authenticity is important in terms of Chinese medicine. I have simply used the word "authentic," somehow assuming that everyone shares my belief that authenticity is valuable and important. However, I now realize that many of my readers may ask, "Why is authencity important? Why should we care about this?"

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When I talk about authenticity, it is usually in relationship to someone's teaching, writing, or saying something about Chinese medicine which I believe is not supported by Chinese medical history. For instance, I've written on this blog about the triad of "body, mind, spirit" not being an authentic historical part of Chinese medicine in China. I've also called into question the historical authenticity of Worsleyan/Leamington "Five Phase" acupuncture as well as others' attempt to recast Chinese medicine as a spiritual or religious path. In all these cases, I find little evidence for these points of view in the history of Chinese medicine (as far as we know that history) in China. And of course, for years I have been harping on the issue of correct translational terminology and its role in the correct, "authentic" understanding and application of Chinese medical theory.

So first of all, what do I mean when I say something is authentic in Chinese medicine? I mean that something, be it an idea or a practice, is a verifiable part of Chinese medicine as thought, spoken about and practiced in China. In other words, one can definitely find references to the idea or practice in the Chinese medical literature in essentially the same way some particular person has said. When we talk about history, there are two basic kinds: oral history and written history. Because oral history is based on human memory, it has its limitations. It also is hard to verify and can easily be manipulated or falsified. Therefore, written history is much more reliable. (It too can be manipulated and falsified, and that's where scholarship comes in. Scholarship attempts to winnow the wheat from the chaff within the written record.) When we say that something is historically verifiable, we mean that we can find that something in the written historical record. Similarly, when we talk about pre-history, we mean before the advent of surviving written records. So when I use the word "authentic" in terms of Chinese medicine, I mostly mean that one can read about and trace the theory, concept, or practice in question within the Chinese medical literature in Chinese.

If that's what I mean when I talk about some aspect of Chinese medicine being authentic, why is such authenticity valuable? In other words, so what? The answer to that question comes back to another issue I have been speaking and writing about since last year's (2009) Pacific Symposium, and that is evidence. These two issues, authenticity and evidence, are intimately related. In fact, ultimately, authenticity is a species of evidence. When I value some aspect of Chinese medicine because it is "authentic," it's because I can trace that something back to China, the birthplace of Chinese medicine, the place where there has been the deepest and broadest study and application of this system of medicine over its recorded 2,500 history. Chinese are the progenitors of this medicine. They created it, and, by and large, this system of medicine has evolved due to their thought about it and clinical experience with it over two and half millenia of their practice. (Even up until only 150 or so years ago, Chinese medicine was written about in Chinese in Vietnam, Korea, and Japan.) Further, and not inconsequentially, Chinese thinkers and practitioners in China have and are thinking and writing about this medicine in essentially their native language (or at least in a second, literary language that they were/are fluent in).

By comparison, Chinese medicine in North America is not even 50 years old. So we have yet to have accumulated even a fraction of a fraction of the combined clinical experience in China. Further, because we, as a group, persist in refusing to learn the source language of this medicine, i.e., Chinese, much of the information we have about it is poorly or even erroneously translated, thus fundamentally skewing and warping our understanding and practice of it. In addition, because the vacuum of historically and linguistically accurate primary (meaning Chinese) source materials, many Western practitioner have taken the liberty of spinning their intellectual wheels and creating a mythology about Chinese medicine unsupported by the primary source literature. Therefore, our peers are relatively free to write and say anything they want about Chinese medicine and "it's all good." For instance, that such and such a point balances/opens/affects this or that chakra, or this or that essential oil placed on an acupoint treats this or that disease.

When I hear or read that kind of statement, my first response is to ask for evidence, and one of the kinds of evidence that I would accept, at least provisionally, is written evidence within the Chinese medical literature, whether that be premodern or contemporary.

So now, you might ask, why am I so hyped up about evidence? What difference does it make if there's no evidence for some Westerner's assertions or understanding of Chinese medicine? If it sounds good, if it's something we want to hear, want to believe, then why not just go with it? What's the harm? The harm is that this is medicine. We are doing things to people who have come to us asking us to help cure a disease or alleviate a discomfort. That seems to me to be a different order of importance than many things we do in life. You can sell someone else a "bill of goods" about the qualities of some motor oil, either purposively or unknowingly, and the repercussions are just not going to be all that severe if the claims are bogus. But if we take someone's money to treat their disease or help decrease their pain, that something of a whole other moral order. In other words, I believe we owe it to that person to do something that evidence suggests does have a good chance of helping them.

When we say to the public at large and our patients in particular that Chinese medicine has a 2,000+ year history, we are using that as a type of evidence. We are saying that the combined clinical experience of all those Chinese generations over all those years has shown that what we are doing or offering tends to work for the case at hand. We are using that history as our imprimatur, our stamp of approval. However, in order to use that evidence honestly, what we are saying, thinking, and doing needs to be historically authentic to that tradition -- not made up on the spot. For instance, Xiao Chai Hu Tang has been in constant use for close to 1800 years. Therefore, there's a huge amount of clinical experience recorded in the Chinese medical literature backing up its safety and efficacy. On the other hand, putting essential oils on acupoints may seem attractive and we may even think that potentially it may work, but, until or unless there's some kind of compelling evidence, we cannot say for sure it will work.

Unfortunately, many of the kinds of evidence used in medicine to test or validate safety and efficacy are expensive, difficult-to-implement, and/or time-consuming to do, such as large double-blind, placebo-controlled, randomized clinical trials. While Chinese practitioners in China are doing at least randomized clinical trials (if not double-blind, placebo-controlled) and cohort studies, few practitioners of Chinese medicine in North America are doing any kind of controlled research. In addition, because of the "language barrier," few North American practitioners have access to and make routine use of this Chinese research literature. Thus we, as a profession in the West, trade heavily on our claims of tradition and history. Yet, as a profession, I find we are cavalier in demanding, providing, and appreciating authenticity in that tradition and history.

In any case, it is because authenticity is a kind of evidence that I value authenticity in Chinese medicine. Two, three, or four generations down the line, we will have created our own evidence for what we are saying, thinking, and doing in English (or Spanish!). But for now, when many of us are still first-generation North American practitioners, the overwhelming majority of evidence for this medicine is Chinese. Hence the value of being authentic to that tradition, that history.

Copyright Blue Poppy Press, 2009. All rights reserved.