Synchronicity, Paradox and Cultural Epistemology in the Creation of Integrative Medicine

 

 

 

 

 

 

 

 

 

 

 

 

            The treatment and management of chronic disease is best served by pattern diagnosis.  This piece will explain why. Chronic disease is – by nature and definition - 1) complicated disease for which 2) there is no standard or reliable ‘cure.’ The simple explanation as to why pattern diagnosis is better suited to chronic disease is because pattern – as the very word implies – involves the inclusion and consideration of a multiplicity of factors. Because chronic disease is so intimately tied to life-style and habit patterns of thought and emotion (which conventional medical treatment cannot easily weigh and measure and would therefore prefer to dismiss) pattern diagnosis more accurately assesses and reveals to patients and practitioners alike just what is occurring and how one may best reconcile the presenting imbalance. That conventional medical treatment (as it is currently practiced in a conventional clinical setting) prefers to dismiss such factors as mental emotional habit patterns and the whims of the gods (Astin, 1998) is not necessarily a bad or incorrect approach; it is merely a defining characteristic of one culturally bound epistemology - one that allows for tremendous insight and leverage of action in treating patients when observation at a distance is preferable; but which has certain disadvantages when chronic disease is the case. 

However, there is a shift in the health of the world’s population and that shift will require an approach that emphasizes different aspects of reality. (2) Therefore, the medical approach which is applied to patients who are experiencing the reality of chronic illness must be one that includes the multiplicity of factors that constitute any chronic disease. The ability to consider multiple factors is one that resides outside the conventional approach - for reasons that will be explained - and yet is present in the holistic epistemology which so neatly forms its complement. Furthermore, rather than merely submitting this piece as another long-winded criticism of a medical system in trouble. This paper proposes a sound and coherent explanation as to why epistemology matters in treating patients who face chronic disease. Therefore, and above all, this piece will examine the topic of synchronicity – a dangerous phenomenon that threatens to turn passive patients into empowered, self-healing and autonomous individuals. 

            There is an inherent complementarity between eastern and western approaches to medicine, health and healing. Clarifying the pivotal cognitive differences which underpin complementary approaches to medicine and medical systems aids one in understanding the reasons for this inherent complementarity and is an essential stage in learning about integration. Integration is a process and not a standard set of beliefs. It is a process that is applied to a given situation, one patient at a time, with sound logic based on an understanding of cultural epistemology and the subsequent strengths and weaknesses born out in clinical applications. In fact, understanding the epistemological differences between east and west may be the bedrock of integration.  The two dominant medical systems in the world, (Traditional Chinese Medicine and conventional allopathic western medicine) so faithfully portray the axiomatic qualities of their respective epistemological assumptions, that one may see revealed in each system an archetypal human way of ordering reality. I will refer to these two archetypes as the holistic and the reductionist respectively. At a level of pure pragmatism, what knowledge of these fundamental archetypes allows is an introspective lens through which one may enhance their awareness of choice – “the core gift of the human experience.” (Myss, 2001) This paper is an attempt to frame the issues which constitute high-quality, competent integrative medicine, which stems from 1) the axiomatic archetypal assumptions of holism and reductionism; and 2) different versions of cause and effect. 

            Section one will cover the essential preliminaries of eastern and western epistemology as they relate to medicine, health and healing. The purpose of this first section is to highlight the obvious strengths and weaknesses of each culturally bound approach and to trace each approach – in the simplest terms possible – to their respective cultural and philosophical roots. 

            A synthesis of the two dominant medical systems in the world reveals their aforementioned inherent complementarity in which one sees how and why western allopathy is best suited to trauma, acute infectious disorders and histological aspects of disease; and Traditional Chinese Medicine (TCM) is best suited to treat chronic, recalcitrant and functional disorders. 

            Section two briefly examines the state of human health and the vicissitudes of integration, highlighting the specific challenges to providing healthcare and healing in the 21^st century. 

            Section three clarifies the single greatest obstacle to integrating holistic and reductionist approaches: the issue of evidence based studies and the ‘burden of proof.’ Having dissected the cultural creation and parameters of epistemology – TCM vis a vis western medicine – this issue of proof is actually revealed to be a question of methodology. In point of fact, once one understands the cultural, philosophical and epistemological lens appropriate to each approach, the methodology of research required to substantiate efficacy in a given therapeutic intervention is axiomatic. 

 

In the preface to Steven Pressfield’s War of Art, Robert McKee writes, “. . . .talent, (is) the innate power to discover the hidden connection between two things – images, ideas, words – that no one else has ever seen before, link them and create for the world a third, utterly unique work.”  (Pressfield, 2002)

            The talent of the artist is to meld seemingly disconnected entities and synthesize their integration in the creation of a third, new and unprecedented work. Defined in this way, creative talent bears a striking resemblance to synchronicity. It is an ability to see connections – even in the absence of linear causality and material proof. It is the sensibility of the artist that makes the audience revere his talent, not explanations; or rather, the work, the fruit of the artist’s talent is the explanation to his audience of the proof and validity of his worldview. He bears for his audience a glimpse into his reality – with no better proof than the shared experience he creates through his art – and, finding favor with the audience through this empathetic resonance, is dubbed talented. A forward- looking quest for connection between things that no one else has thought to notice before is the obverse and complement of linear causality and the backward looking approach that underpins conventional medicine. Like the artist in his attempt to create, the search for connection results in meaning. 

How does a synchronous principle of causality permit and promote creativity in medicine? What are the implications of including a synchronous principle of causality? What are the implications of creativity in medical care? In what specific scenario of illness might such a preference for connection and the creation of meaning be preferable to the conventional attempt to fix what has become broken? Furthermore, what might be the epistemological considerations that would allow for a notion of creativity in healthcare? Could it be that the inclusion of a synchronous principle of causality is the missing piece to the epistemology of conventional medicine that allows for the emergence of integrative medicine via the infusion of creativity? A notion of non-linear, synchronous causality births an approach to medicine in which patients are empowered to create health (or illness) and are not reduced to passive roles or mere disease entities to be lorded over by doctor-mechanics. 

 

The assumption of separation between phenomena is the legacy of an epistemology that departed from holism in an effort to differentiate, specify and analyze factors of linear-causality and their results.

“Science, assisted by mathematics, was able to describe the universe in quantitative terms that had impressive predictive power. Using the scientific approach, any phenomenon could be isolated and analyzed under repeatable conditions until even the most complex of processes were reduced to a collection of known elementary units acting predictably as a result of the forces between them.” (Peat, 1987)

 The methodology based on linear causality - which separates and reduces material phenomena in search of a discrete causative factor - is a recent development in the epistemology of human inquiry into the natural world. It is also, arguably, the single greatest overthrow of all that came before. This approach - which we call science, but which is actually a culturally determined set of axiomatic assumptions – has changed utterly how humans consider their place in the natural world.

“Darwin’s alienation of the outside from the inside was an absolutely essential step in the development of modern biology. Without it, we would still be wallowing in the mire of an obscurantist holism that merged the organic and the inorganic into an un-analyzable whole. But the conditions that are necessary for progress at one stage in history become bars to further progress at another. (Lewontin: 2000)

 

Has conventional medical science descried the limits of reductionism in any practical sense? 

“Crisis . . . ‘a crucial or decisive point or situation: a turning point . . . an unstable condition . . . involving an impending abrupt or decisive change . . . which aptly describes the transition taking place in science today. In physics, biology, chemistry . . . experts concur on the fact that the traditionally western dependence upon reductionism, linear thinking . . . has reached its limits.” (Pritzker, 2002)

 

Without a reconsideration – a re-cognition – of the relationships that exist between seemingly disparate phenomena, the reductionist approach applied to medicine is revealed to have passed the zenith of its greatness. If this statement cannot be substantiated on a philosophical level, it most assuredly can be defended on an economic one, since the progress of reductionism in medicine simply cannot be sustained or paid for. (DeHaven, 2005; Sturrock, 2006)

 

“The time has come when further progress in our understanding of nature requires that we reconsider the relationship between the outside and the inside, between organism and environment.” (Lewontin: 2000) 

 

The primary tenet of holism and the holistic cognitive archetype is an axiomatic assumption that the inner and outer aspects of any given phenomena relate - to wit, they are not separate, but one, seamless and paradoxically indivisible whole. Reductionism divides these inner and outer realities for convenience and ease of therapeutic manipulation. But in the end, the micro and macro-cosms influence one another in a bi-directional relationship. The significance of this one single assumption is enough to make a logical case for why the holistic approach is the clear champion for the management of chronic disease. The implications of the inner/outer connection and the holistic archetype are that passive patients become empowered ones and the notion of linear cause and effect gives way to a second and equally valid understanding of cause and effect in which a non-linear or synchronous principle obtains. Although a synchronous principle of causality presents with its own biases and limiting parameters as well, nonetheless, contained within the inclusion of this single principle is a large portion of the remedy that will aid conventional medicine and science in obtaining a more complete approach to healthcare and healing.  

 

“The respective strengths and weaknesses of Chinese and Western medicine overlap in a way that makes Western medicine seem best suited to coping with (acute) infectious diseases and Chinese medicine with those functional disorders and chronic illness in which discrete or long-term physical symptoms have not yet become apparent. (Porkert, 1988)

 

In a comparative study of Chinese medicine with its basic assumption of interconnectivity between inner states and outer manifestation, and modern western, conventional medicine with its tenet of linear causality and the preference to reduce and isolate, what one discovers is two versions of the same reality, one based on a principle of linear causality, the other maintaining a synchronous version of causality. Dr. Manfred Porkert writes,

“As a result of their fundamentally different perspectives on reality . . . emphasis on functional and organic factors in the one case, and retrospective analysis of past events (with) emphasis on somatic and material factors on the other – Chinese and Western medicine can make their observations and then present us with two different ‘versions’ of the same phenomenon.” (ibid)

                                               

What Dr. Porkert is referring to when he writes about ‘their fundamentally different perspectives on reality’ is the reductionist and holistic archetypal mind-set that accompanies each system of medicine and to which each system is thus bound. Predicting things like strengths and weaknesses within a given system is no great leap once one understands the way in which each system organizes reality. Understanding this point is essential for integrative specialists as it allows for 1) practical application of treatment strategy in a clinical setting; and 2) informed discussions and administrative decisions. 

 

“a singular premise guiding Western (conventional) science and clinical medicine (and one, we hasten to add, that is responsible for its awesome efficacy) is commitment to a fundamental opposition between spirit and matter, mind and body, and (underlying this) real and unreal.” (Scheper-Hughes and Locke, 1987) 

 

In the treatment of many of the acute infectious diseases that were the bane of humankind until about a century ago, as well as situations of traumatic injury at which it still excels, the success of conventional medicine stands undeniable; is there, however, an inherent weakness in the epistemology of conventional medicine that makes it less well suited for the situations in which modern humans must seek and achieve healing? In conventional medicine, success is a matter of cure. But what about disease for which no cure yet exists? Might not such a situation require an approach that sought to create - insofar as possible - a sound and healthy reality, learning and adjusting form the dictates of the illness and building on the best of what still exists? (3)

            Consider also that, conventional medicine accepts and dismisses collateral damage in the form of iatrogenesis.   Surprising statistics given by the U.S. National Center for Health Statistics and the Institute of Medicine estimates that death from iatrogenesis actually surpasses deaths from malpractice. The numbers for 2002 of the leading causes of death place deaths related to medical malpractice at 98,000. (4) These are unintentional mistakes and the unfortunate results from risky procedures that comprise the cutting edge of technological intervention. Yet, a far more arresting figure is the sum attributed to ‘correctly’ prescribed medicines. There were 106, 000 (4) deaths from medicines for which a certain number of ‘casualties’ is apparently factored into the equation. The conventional approach accepts this. It seems iatrogenesis is an inherent characteristic of the epistemology that underpins the conventional approach. 

            Conventional medicine is somatic by nature. In conventional medicine, as Manfred Porkert M.D. tells us, “sickness can be identified only when it brings about a detectable physical change in one of these various substances” (i.e. bones, muscles, tendons, organs, skin, nerves, veins arteries, blood, hormones and the other material, corporeal, substantial tissues of the body). (Porkert, 1988). The reductionist epistemology favors a bias toward physics and physical proof. This is the natural expression and preference of reductionism simply because the reducing of matter to smaller and smaller sub-units creates a focus on material aspects of reality.

The possibility that qualitatively different aspects of reality may be equal in ontological terms is not a feature of the reductionist model. As Good and Good explain,

“A critical experience for most medical students (is) where they see physiological responses to various chemicals introduced into a living animal . . . (which) serves as the architecture for developing medical knowledge . . . (this) quickly becomes the only reasonable way to think . . . physiology elaborates this world in the language of mechanism and function.” (Good and Good, 1993)

 

It is possible and even easy to measure and weigh and count matter; not so thought and emotion. Because of its unique epistemology, conventional medical diagnosis and treatment still hinges on the assumption of linear cause and effect. This linear, causal-analytic assumption has certain ramifications that limit and define the parameters and efficacy of any system of healthcare upon which it operates. Carl Jung pointed out the shortcoming of a controlled laboratory environment and the way it excludes chance (read: synchronous causality). “We have not sufficiently taken into account as yet that we need the laboratory with its incisive restrictions in order to demonstrate the invariable validity of natural law.” (Jung, 1973)  Reinforcement of this point comes at every turn. Food expert Marion Nestle, speaking to a packed audience at Stanford’s Annenberg Auditorium, explained that the tremendous focus on nutrients has allowed the food production industry to obfuscate the issue of what is actually contained in food. In other words, the segmentation and emphasis on the particular components of a food from a biochemical point of view has utterly overshadowed the importance that food is more than just a few nutrients, vitamins or essential minerals; that it is in fact a whole thing, an experience; that it is sustenance whose sum is greater far than its individual parts. (Nestle, 2008)

            This seminal difference – the treating of disease by conventional medicine and the treatment of patterns by holistic TCM – is the pivotal point at which reductionist and holistic epistemologies diverge. It is from this pivotal distinction that all subsequent implications may be traced. (6)  Furthermore, this pivotal distinction – treating a disease or balancing a pattern - arises from a single axiomatic, epistemological assumption about the nature of reality. The holistic and reductionist archetypal modes of cognition each carry and rely upon specific assumptions of cause and effect. The attacking of disease by conventional medicine is not an arbitrary decision or a haphazard clinical application. It is the natural therapeutic intervention arising from the singular axiomatic assumption that reality can be reduced to smaller and smaller sub-units of physical matter. The conventional approach has to attack disease. That’s all it knows; it can do no other. (7, 8) Fortunately, when called for and in the grave situations where no other option obtains, it performs this task with great aplomb. But since this piece seeks to expose the shift toward a patient population now suffering primarily from chronic disease (Weilawski, ) in which patients frequently require supplementation of function, one must also declare the limitations of the conventional medical approach as Dr. Manfred Porkert does, saying, “we also know that people are less susceptible to infection when their vital functions are in good working order, and this is something that (conventional) medicine knows next to nothing about.” (Porkert, 1988) 

 

The attempt to render objectivity in science has led to largely meaningless - if copious - quantitative information that has the inherent ability to leave patients and scientists alike stumped and wondering, ‘so what?’ It seems that ‘so what’ can only be addressed when meaning prevails. Carl Jung’s insight was to realize that meaning was created in the realm of the subjective; or - put another way - meaning arises out of the individual’s personal experience. 

The inclusion of a patient’s lived, subjective experience is a conspicuously absent and essential piece to the mosaic of healthcare reform. The inclusion of the patient’s subjective experience necessitates not just a shift in research methods but also a shift in the assumptions which underlie phenomena of healing in the natural world away from linear causality - the bedrock of all conventional inquiry and research - toward the inclusion of a synchronous principle of causality. Furthermore, the inclusion of a synchronous principle permits patients the opportunity to achieve what is perhaps the single greatest tenet of any shift in healthcare: self-empowerment through choice.

            James Gordon M.D. of the Center for Mind-Body Medicine places self-care at the center of any shift in treatment strategy.  The demands of modern diseases and the state of human health in this epoch suggest that the patient with an empowered ability to ‘read’ the signs and symptoms, who is able to determine for themselves what action to take in alleviating their own suffering stands a much better chance of achieving and maintaining a good quality of life in the face of chronic disease.

A good example is pain. While there may be situations in which a patient is exceedingly uncomfortable and in which it is advisable to relieve their pain by masking it; nonetheless, the prevalence of NSAID’s (Non-Steroidal Anti Inflammatory Drugs) attests to the fact that most people suffering from pain dismiss the message it is conveying about some functional aspect of the body – and along with it, the meaning this symptom brings. 

 

“If and when we think reductionistically about the mind-body, it is because it is ‘good for us to think’ in this way. To do otherwise, using a radically different metaphysics would imply the ‘unmaking’ of our own assumptive reality. To admit the ‘as-ifness’ of our ethnoepistemology is to court the Cartesian anxiety – the fear that in the absence of a sure objective foundation for knowledge we would fall into the void, into the chaos of absolute relativism and subjectivity.” (Scheper-Hughes and Locke, 1987)

 

            Consider the way in which pattern-based diagnosis and its axiomatic assumption of inner/outer, holistic connection views the phenomenon of pain. Pain is never an isolated symptom to be covered up. There is meaning in pain. Its significance may be discerned, with or without professional help. NSAID’s are a great example of the culture of separation that is manifest in conventional medicine, where pain is masked in an attempt to dismiss it. Jason Theodosakis M.D. reports on the use of NSAID’s, the main treatment of arthritis by conventional medicine.

“Only occasionally do you find inflammation in the later stages of the disease. Furthermore, there is preliminary evidence that when you put anti-inflammatory pills in a culture with cartilage cells, it impairs the healing process. So, you’re covering up the pain but probably impairing the healing process and stopping the signals that you have joint pain . . . they (NSAID’s) do not address the cause of disease and may in fact worsen it. . . . NSAID’s and aspirin usage has been linked to increased cartilage destruction. . . . ironic since most users of NSAID’s and aspirin are people with osteoarthritis caused by cartilage damage in the first place.” 

 

Additional side-effects appear substantial. Brent Bauer M.D. and Milt Hammerly M.D. report that approximately 16,000 deaths a year are attributed to gastrointestinal bleeding from the use of NSAID’s and aspirin. (4) Everybody prefers not to be in pain, so the taking of medication may not be the important point. What is at issue is they way in which pain is either imbued with meaning or seen as a mere nuisance to be dismissed and covered. 

            The way in which Chinese medicine cognizes the reality of pain is based on a different axiomatic assumption. The statement of dogmatic fact and the assumption upon which pain is based in TCM reads, “Where there is pain there is no free flow, where there is free flow there is no pain.” The concept that something is obstructed lies at the heart of the meaning of any symptom of pain. According to TCM theory, qi and blood must remain free-flowing. Furthermore, since holistic cognition assumes that inner and outer realities are inherently reflexive, the cause of the painful obstruction could be internally engendered, as an emotion; or externally contracted, as from an environmental excess. No matter what the cause, there is inherent and immediately attainable meaning rendered by the subjective experience of pain. 

Carl Jung – who first coined the term synchronicity – saw the usefulness of a world-view that accepted as implicit the need to infuse meaning. In Psyche and Cosmos Rick Tarnas, tells of the significance Jung read in synchronicity, “Jung’s concept possessed a special relevance for the schism in the modern world view between the meaning-seeking human subject and the meaning-voided objective world.” (Tarnas, 2006) In other words, inherent in the reductionist archetype is an assumption that subject and object are separate, disconnected, discrete and unaffected by one another. Thus, to the reductionist cognitive archetype, an inner realization has no corresponding outer manifestation and an outwardly presenting sign or symptom holds no inner significance for the individual suffering its consequence. To label this ‘reality’ or ‘science’ is limiting and, as time and the growing prevalence of chronic disease may reveal dangerously arrogant assumption to defend. This notion of a subject/object separation is a choice and axiom of epistemology. Its consequences naturally lead to a medical system not unlike the one which currently constitutes conventional medicine. Furthermore, reductionism is neither better nor worse than the holistic approach - which must abide its own standards, consequences and limits. The important take-away point are: 1) the needs among the patient population are increasingly away from the heroic intervention so well served by conventional medicine and toward the inclusive and empowering approach afforded by holism; and 2) it greatly behooves integrative specialists to get clear in their own minds about the limits and strengths of these axiomatic assumptions. 

            F. David Peat reports that Jung recognized the inherent bias of the East. “Synchronism is the prejudice of the East, (linear) causality is the modern prejudice of the West.” (Peat, 1987) Considering the state of the world’s health and of the enormous prevalence of chronic disease, it seems that inclusion of the synchronous principle of causality is inherently suited to manage and empower patients – or in other words - to meet the needs of the shift toward integrative medicine.

Dr. Manfred Porkert further explains the inherent biases of Chinese medicine, illuminating why it is suited to the treatment of chronic disease. 

The specificity of the diagnosis and the selectivity of the treatment not only make this approach more efficient but also manage to avoid all the side effects that cause so many problems when a symptomatic, prolonged   . . . . program of drug therapy is prescribed by Western medicine.” (Porkert, 1988)

 

The ‘specificity of diagnosis’ referred to by Dr. Porkert is pattern discrimination, which allows for the exact treatment of a pattern of imbalance within which iatrogenesis simply finds no purchase. 

Dr. Porkert is not alone in recognizing the potential and inherent complementarity of eastern and western approaches to medicine. But why? Is it simply because Chinese medicine uses herbal medicinals? Or because it is ancient? Or is it because Chinese medicine is infused with a mystical, quasi-spiritual haze that allows physicians to avoid the necessity of scientific explanations and viable, empirical proof? It is none of these. 

The best summary explanation of this point comes from a lecture by the prolific Bob Flaws, professor emeritus of Chinese medicine to the entire English speaking world:

“The most effective way of doing Chinese medicine is based on pattern. . . . . The best way that anyone has figured out to do Chinese herbal medicine . . . is by pattern discrimination. That’s (the) safest . . . (you’re) least likely to have a side effect. When you prescribe something according to the pattern, you’re actually prescribing it for that individual patient’s personal needs. That’s why Chinese medicine is safe. That’s why it’s holistic. That’s why it has no side-effects. The reason (conventional) medicine has side-effects is because it’s prescribed according to disease, one size fits all. Everybody gets Viagra, everybody gets Prozac . . . . There’s nothing wrong with Prozac, Viagra, prednisone . . . all those things are wonderful medicinals. It’s just that the way of prescribing those medicinals is not very discriminating. The whole benefit of Chinese medicine is that we have this fantastically, brilliant prescriptive methodology. . . . The important thing about Chinese medicine is the prescriptive methodology.”

 

It’s not the medicine, it’s the theory . . . what’s important about Chinese medicine . . . is how we prescribe things. There’s nothing really wrong with Celdane, if you understand that . . . probably it is an exterior-resolver. It’s dry. It eliminates dampness and transforms phlegm. And therefore short-term it might be a really good medicine. But in people who have a yin vacuity, fluid dryness (constitution) . . . Celdane is more likely to create a side-effect. . . . It’s not that Chinese herbs come from China. It’s that they’re prescribed according to a certain way of thinking. And that way of thinking could be applied to Celdane,. . . prednisone . . . cytotoxin . . . Viagra . . . Ayurvedic herbs . . . western herbs . . . it could be applied to anything.” (Flaws, 1999)

 

 

            Consideration of a multiplicity of interconnected relationships seems to be the primary factor in determining whether a given approach will render collateral damage in the form of iatrogenesis. A diagnostic methodology that includes qualitative aspects seen in relationship to each other seems less likely to prescribe treatment for a patient that does not suit them.

            Just as the synchronous version of causality has an inherent requirement to consider things in relational patterns, diagnosis and the prescription of treatment based on patterns of relationship makes for creativity in medicine. Just as synchronicity is the recognition of a pattern of relationships between inner realization and outer manifestation, thus prompting the observer to consider their part in the creation and meaning of their reality; so too it is a medical system that diagnoses patterns of imbalance which thus promotes meaning and the empowerment of choice within the individual observer. Just as the reductionist epistemology has inherent in it a tendency to isolate and reduce to smaller and smaller units, thus obviating meaningful connections in the attempt to render a single proximal cause for each effect; so too the synchronous epistemology bears witness to a consistent logic in the form of an approach to medicine that considers as primary the connections between things, between inner and outer phenomena which renders meaning for the patient and empowers the individual to self-determination.

“Chinese medicine holds out the possibility that the functional disorders associated with chronic illness can be exactly understood and selectively counteracted.” (Porkert, 1988)

 

What makes a medical approach functional medicine? Why is it useful in the treatment of chronic disease? There are several aspects to the answers which must be subsequently related to a scenario of chronic disease in order to fully appreciate the substantive difference. The short response is that functional medicine treats patient’s functions, their functional ability. But this is a mere tautology and will not suffice for any real insight. Instead one must examine an actual case in order to understand how functional medicine meets the needs of patients with chronic disease. 

            Diabetes Mellitus (DM) is a quintessential chronic disease. Its onset is almost always tied to lifestyle as the single greatest risk factor is obesity. This makes DM an excellent example because chronic disease is the single area of treatment that most benefits from functional medicine – i.e. the treatment and management of disease with no ‘cure.’ The TCM holistic patterns related to the western conventional medical disease diagnosis of DM are:

1.      spleen vacuity – liver depression

2.      spleen vacuity with damp encumbrance

3.      spleen vacuity with stasis and stagnation

4.      damp heat brewing and stagnating

5.      yin fluid vacuity and depletion

6.      yin vacuity with heat exuberance

7.      lung heat and fluid damage

8.      liver yin insufficiency

9.      heart yin insufficiency

10. qi and yin dual vacuity

11. qi and yin dual vacuity with blood stasis

12. yin and yang dual vacuity

 

 

Consider the difference between a lab test of blood glucose concentration and the treatment of signs and symptoms – of patterns – related to functional aspects of DM. (12) There is a certain advantage to pattern discrimination as it also manages to treat at a sub-clinical level, thus preventing the onset of serious chronic disease. One need not have a fasting blood glucose level of > 125ml/dl in order to be treated at the functional level for patterns relating to and eventually resulting in full-blown DM. 

A TCM pattern - like those listed above - is a descriptive of imbalance. Thus ‘1) spleen vacuity with liver depression’ is a specific set of objective signs (meaning that both patient and practitioner can verify and agree upon their existence) and subjective symptoms (meaning that the patient reports their feeling or the existence of some aspect of their condition that the practitioner is unlikely to witness, but which may nonetheless be deduced by the high-quality, circumspect and experienced TCM physician). This reconciliation between the objective (signs) and the subjective (symptoms) is a major reversal of the subject/object dichotomy that reigns in conventional medicine. Taken to its logical conclusion, one may state and substantiate that it is this reconciliation of subject and object that allows for the inclusion of that which the conventional, reductionist epistemology cannot achieve –consideration of the quantum reality, in which the observer and the observed are not separate. (Peat, 1987) Put another way, it is axiomatic in this model that the patient is a participator in the reality of their health or illness. The patient and physician both witness the subject/object, inner/outer connection and work in tandem to alleviate the pattern of imbalance. 

            The qualitative signs and symptoms corresponding to spleen vacuity with liver depression are: fatigue, general lethargy (especially after meals), bloating after meals, lack of strength in the four limbs, heavy head, general lassitude, easy bruising, possible loose stools or alternating constipation and diarrhea, possible fever and chills, a swollen tongue with teeth-marks on the edges or cracks in the center, emotional outbursts, irritability, PMS, breast distension and pain, possible pain in the costal region, and a bowstring pulse. Each and every one of these can be verified and corroborated by another party and all save pulse diagnosis can be witnessed and understood by the patient himself. Consider the empowerment that arises from such corroboration. Conventional medicine relies on a system of pathologizing patients, the dynamics of which the medical profession seeks to obfuscate through technical language. But, “Health care depends for its outcome on a two-way relationship between the sick and the healer. In so far as health care is provided, both patient and healer are providing it, and indeed, the concern with so-called noncompliance is testimony to that.” (Taussig, 2003) Here Michael Taussig acknowledges the bi-directional relationship that is required in all but the most dire of traumatic circumstances. The quote confirms the importance of the axiomatic assumption of relationship and connection between observer and observed that is automatically present in and inseparable from the holistic archetype

In TCM, there is a sequential methodology. After substantiating a pattern diagnosis of spleen vacuity with liver depression, the physician would then state the treatment principles. The treatment principles are a statement in theory of what is required to balance the patient’s presenting pattern of disharmony. The treatment principles which logically follow a diagnosis of spleen vacuity with liver depression are thus to 1) fortify the spleen and boost the qi; and 2) course the liver and rectify the qi. This is the application of heteropathic therapeutic intervention required to rebalance a pattern of imbalance. There are certain points and formulas – agreed upon after many generations of use – which reliably fortify the spleen and boost the qi, and course the liver and rectify the qi. In a real-life patient with DM, there will likely be multiple patterns of imbalance presenting simultaneously. Thus for example, if there is spleen vacuity, there will be dampness (a pathological accumulation of fluids in the body). If there is liver depression there is likely to be heat. If there is heat there will likely be dryness. Witness the incredible complexity of a chronic disease like DM and the marvelous specificity of treatment afforded by pattern diagnosis. Dryness and dampness are diametrically opposed, irreconcilable opposites. Yet the system of pattern discrimination not only allows for the discernment of opposing phenomena, but also the logical and time-tested heteropathic treatment of patterns permits these opposing conditions to be treated simultaneously. The additional advantage afforded by TCM pattern discrimination in the management of chronic disease is that therapeutic interventions have been worked out over a period of not less than 2500 years of recorded, literate practice. In other words, to affect the necessary therapeutic intervention of ameliorating spleen vacuity with liver depression, one may reliably follow a time-tested, standard operating procedure. (9)  Certain acupuncture points and internally administered Chinese medicinals can be prescribed in poly-pharmacy formulas which may be counted on to affect exactly the necessary functional change toward recovery while simultaneously avoiding the unwanted changes dubbed ‘side-effects.’ Theoretically, every TCM professional in the world could look at the treatment of a given patient with spleen vacuity / liver depression and either agree or disagree with the acting physician’s use of medicinals and selection of points based on this logical, time-tested and consistent approach to treatment. If the diagnosis is in fact accurate, the outcome of treatment is axiomatic. 

            In TCM diabetes is referred to as wasting thirst or thirsting and wasting. The disease mechanisms that lead to patterns related to DM are dryness and heat leading to qi and yin vacuity. The mere concept of DM in TCM yields a certain insight that is consistently logical with the methodology and epistemology of a functional approach to clinical intervention. In TCM, DM is conceived of as a ‘melting down of muscles and flesh in to urine.’ The very concept is one that corresponds to the patient’s actual subjective experience of their illness. Such correspondence between the conceptual and linguistic creation of reality cannot fail to inform the patient – on some basic level – as to their condition and what must be done to affect is amelioration. (9)

Diagnosis and treatment based on pattern discrimination is done at the functional level. It is an approach which seeks leverage in healing by emphasizing the functions/dysfunctions present in a given patient. Long-term – i.e. chronic disease – is functional disease. It begins as a dysfunction of normal, healthy body systems and proceeds – often over many, many years – to worsen in severity until a structural, histological imbalance results. In DM, the end stage complications are all histological conditions in which the structure of tissues has been altered resulting usually in cardio-vascular failure, renal failure and or neoplastic malignancy. Therefore, functional medicine is medicine suited to treat chronic disease. Pattern discrimination lends to functional medicine. Chronic disease is disease of longstanding functional imbalance which is best managed by a medical approach that seeks to balance aspects of (dys)function. 

A patient with chronic, serious heart disease does not simply wake up one morning needing a quadruple by-pass. There are nearly always some functional signs and symptoms that are prelude to such a crisis which then requires heroic intervention. One exception to the above assertion might be a congenital defect of the heart in which blood supply was insufficient. In this case, heroic intervention, observation and analysis at a distance and conventional medicine would be the most appropriate and timely therapeutic intervention. But the patient with chronic disease is not only the focus of this piece, but also the new focus of human health and healthcare. 

Consider the following passage and the tremendous effect language has on human perception and cognition. 

 

Language permeates all aspects of existence and determines the manner in which phenomena may be organized by a given society of people. As F. David Peat notes,

 

The implications of a medical reality that is constructed through language places a premium on knowing the limitations and inherent biases of one’s given language. Humans create a portion of their reality through language. In medical science, no end of debate and consternation arises from this imperative. Yet even with this fact in plain view, the implications are largely over-looked or dismissed.   What are the implications of language in medical science? 

            Linguist and science historian Benjamin Lee Whorf noted the effects of western languages when he wrote

“Segmentation of nature is an aspect of grammar . . . We cut up and organize the spread and flow of events as we do, largely because, through our mother tongue, we are parties to an agreement to do so, not because nature itself is segmented in exactly that way for all to see.” (Whorf, 1956)

 

This segmentation is the ‘grammar of reductionism.’ Could it be that the natural preference for western medical science to separate and isolate physical phenomena is actually a feature of the western register? It seems that at the least it is a limiting and defining characteristic of the way in which conventional medicine is able to order and organize aspects of mind-body interaction. “We lack a precise vocabulary with which to deal with mind-body-society interactions and so we are left suspended in hyphens, testifying to the disconnectedness of our thoughts.” (Scheper-Hughes and Locke, 1987) As Whorf adds with ultimate succinctness, “philosophy is grammar writ large.” (Whorf, 1956) The preference for reductionism in conventional science is indissoluble from the way in which western people speak about reality. If language creates reality and the western register is one with a preference to speak in terms which connote separation and segmentation, then it follows logically that the conventional medical reality would defend a doctrine of separation. 

In contrast, the very language upon which Chinese medicine is based is a factor which favors the patient in his attempt to heal. Why? It is the result of a world-view which stems from pictographic language, a language of relational inclusion. 

‘The both/and world of complementary thinking (as opposed to Newtonian either/or) is foundational to ancient native science and twenty-first-century quantum physics and ecology. . . In their strong preference for process over product, Native American grammars differ significantly from the European grammars with which we are most familiar.’ (Bronson, 2002) 

 

Like the Native American peoples who never dichotomized the outer and inner worlds of human awareness, Chinese is the language of a world-view that stems from the holistic principle of inter-relatedness in which the patient’s inner psychological realm and their outer physical manifestations of health or illness are not considered separate, but rather related and connected. This is an empowering world-view for the patient with chronic disease who must be enlisted by the physician in aiding and supporting their own process of healing and managing their disease. Bob Flaws sums it up this way,

“Chinese medicine has a much more down to earth and immediately understandable vision of what causes joint pain and what you can do for it. Most of us on hearing that the most probable initial event in OA (osteoarthritis) is the mitosis of the chondrocyte with increased synthesis of proteoglycans and type II collagen, won’t have the foggiest notion of what this means on an everyday level and what we ourselves can do about this. Traditional Chinese Medicine . . . is based on a vision of the human body as a microcosmic miniature of the natural world. Therefore, the language of Chinese medicine is the language we use everyday to describe events in the world around us. More importantly, using this language, we are empowered to take charge of our own lives and well-being so that whether we experience pain and discomfort becomes a function of how we live our life.” (Flaws and Frank, 2006)

 

Because these metaphors are so easily explained and understood and furthermore, because the heteropathic rectification of a pattern of imbalance is so effectively managed by lifestyle and empowered choices, once grasped by the patient with chronic disease, the good TCM physician often enough becomes obsolete save for occasional maintenance. (Bean, 1999) Once the striking and consistent contrast between the holistic and reductionist approaches is glimpsed, then their subsequent resulting strengths and weaknesses finds yet more ground for substantiation.  Not surprisingly, there is an added advantage to pattern diagnosis in the way it creates space for patient’s subjective experiences.  

            The fruitful collaboration between Wolfgang Pauli and Carl Jung in the first half of the 20^th century left a legacy, the implications of which still linger outside the circles of conventional medicine and our current approach to healthcare. Pauli’s most noteworthy contribution – his Exclusion Principle – bears significance for those who seek to aid integration in the 21^st century. 

“Pauli’s most famous contribution to physics involved the discovery of an abstract pattern that lies hidden beneath the surface of atomic matter and determines behavior in a non-causal way. Pauli argued that at the quantum level, all nature engages in an abstract dance . . . Hence the underlying pattern of the whole dance has profound effect on the behavior of each individual particle.”   (Peat, 1987)

 

 

What the Exclusion Principle argues is that even matter is not as discretely separate as it appears to be. Or, to put it another way, the reality of a discreet, individual unit is reflected in and affected by the shared reality of the totality of all the discreet units together, and vice versa. Another way still to communicate this is to say that the macrocosm and the microcosm are ineluctably linked. 

            Quantum theory and its corollary complexity theory are not new; and yet the simple law of quantum physical reality – that observer and observed are not separate entities but rather interconnected and inextricable – has no real purchase in conventional medicine. Ordinary science (science which operates to the exclusion of quantum and complexity theories) has yet to reconcile this omission. In Synchronicity: bridge between matter and mind, F. David Peat writes,

“Implicit in such a . . . vision (i.e. the vision of conventional medicine) . . . is the image of a scientist who stands outside the system as impartial observer, able to predict events according to deterministic laws, without disturbing events in any way . . . the term “spectator must be struck from the record and the new word “participator” must replace it. By virtue of the quantum theory . . . physics and physicist are no longer separable but are one indivisible whole.” (Peat, 1987)

 

The quantum dictate that the observer is actually a participator can be likened to synchronicity. The patient who notices a connection between an inner state of realization and an outer manifestation that gives form and expression to that realization (or vice versa) has just experienced a moment of quantum clarity in which the seemingly separate entities of mind and body, physical and immaterial have revealed themselves to be one seamless indivisible whole. The patient who observes the reality of their illness is participating in that reality. 

            What might be the hindrance to such an inclusive approach? In The Structure of Scientific Revolutions, Thomas Kuhn points out the axiomatic quality of theoretical assumptions, noting that it is the nature of theory - rather than reality itself - that determines what a scientist ‘notices’ and what she remains unaware of. “No part of the aim of normal science is to call forth new sorts of phenomena; indeed, those that will not fit the box are often not seen at all.” (Kuhn, 1962) N. R. Hanson advanced a thesis that all scientific observations are ‘theory-laden’ and thus every scientist’s ‘empirical’ observations are, to some extent, predetermined by whatever existing body of theory he/she happens to subscribe. 

"The idea of a theoretically neutral, universally valid conclusion that would be independently verified by every scientist, everywhere is simply that – an idea, a philosophical abstraction that would be sought for in vain in the real world of science." (Hanson, 1958)

 

            In a model in which the qualitative connection and subjective experience of the individual is negated or minimalized in favor of ‘objective,’ quantitative and physical proof, the quantum connection that the patient is participating in the reality of their illness is ignored. In the last analysis, as Arthur Kleinman and Michael Foucault testify, a good case can be made that even ‘objectivity’ in science is nothing more than a culturally agreed upon aspect of subjective reality. (11) The exclusion of a quantum view of reality that maintains the split which defines conventional medicine may be the same split that is reconciled by synchronicity and a synchronous principle of causality. Could it be that the exclusion of synchronicity and complexity theory are the very things that limit ordinary science to conventional medicine? 

            Complexity theory holds that – like Pauli’s ExclusionPrinciple – there is an abstract pattern which underlies and gives rise to spontaneously emerging and self-organizing realities. So, what of it? To the patient with chronic disease, the management of and recovery from their illness would greatly benefit from a version of reality that includes and acknowledges connections between things and allows for the emergence of the spontaneously arising reality . . . of recovery! Connection between psychological states and physical manifestations may be the new manifesto for patients battling chronic disease. It is through the making of such connections that a patient finds the empowerment to care for themselves.   To the patient with chronic illness, connecting the effects of their dietary habits, their lifestyle choices and their exercise regimen and how each of these factors affects the course of their disease – either slowing its progress or speeding its exacerbation – is of ultimate and primary importance. Successful management of disease for which there is no cure may have everything to do with this ability to draw connection between inner realization and outer behavior. The talent to recognize synchronicity may be the requisite skill that leads patients with chronic disease to successfully allow for the emergence of the self-organizing reality of healing. 

Jung and Pauli both recognized the implications of a synchronous principle of causality and how it might “begin a dialogue between physics and psychology in such a way that the subjective would be introduced into physics and the objective into psychology.” (Peat, 1987)

 

            The Yijing or Book of Changes is – practically speaking – an interactive work of poetry. The user induces the phenomenon of synchronicity and then assigns meaning to the text that corresponds to a given outcome of divination. As a tool for cultivating awareness of synchronicity, the Yijing is without equal. Practically speaking, the Yijing is a matchless tutor in the art of learning to think in patterns; of seeing things in relationship, holistically, synchronistically. Is it any wonder then that,

“ . . . in studying the materials on the history of Chinese philosophy we constantly found it necessary to preface the analysis of each philosophical school with preliminary analysis of the Book of Changes – a fundamental starting point of discussion of almost all philosophers of ancient China.” (Shchutskii, 1980)

 

The foundation of all things Chinese is tied to an experiential philosophy that has, at its core, a fundament of synchronous cause and effect, of inner and outer relationship and of the paramount choice of meaning. 

The microcosmic – macrocosmic interconnectivity upon which Chinese medicine is based is the bedrock of the synchronous principle of causality. Within this relational assumption arises an inherent meaning, the result of which is that patient’s may aid their own treatment. Yet perhaps the most significant perquisite of the synchronous principle of causality is an inherent ability to avoid collateral damage in the form of iatrogenesis. In this forward-looking, ‘creative’ style of medicine, one does not treat disease, but patterns. The physician and patient join forces to create dynamic balance from the current state of a pattern of imbalance. Consider how qualitatively different this is from an approach that seeks to attack and be rid of disease.

            How does synchronicity relate to the current situation in medicine? It allows for connections in the absence of linear, material proof. Who makes these connections? The patient does through his/her subjective experience. What is required of physicians and patients that they may ‘see’ these connections? A version of reality that allows for the existence of non-linear connection – i.e. synchronous reality. 

The result of a worldview that has a bedrock and fundamental bias of patterns of interconnected and qualitative relationships renders an approach to healing that is inherently imbued with meaning. This meaning empowers patients to take charge in their own quest for healing. In addition, the rendering of qualitative patterns of imbalance inherently allows the physician to avoid unnecessary treatment that will result in iatrogenesis. It is patterns of relationship that are important. It is pattern diagnosis that is the result of an inclusive view of reality based on synchronicity. It is pattern discrimination and the requisite recognition of qualitative relationships between seemingly separate things (in contrast to reducing, isolating and presuming separation) that inherently promotes meaning and a specificity of treatment that is non-iatrogenic; and it is pattern diagnosis that is the gift of the Chinese to the world of medicine. 

“. . . I believe (this is) the single greatest gift of Chinese medicine to humanity – treatment based on pattern discrimination, i.e. safe and effective, truly holistic treatment – what could be the foundation of a New World Medicine.”                                      

            Why the need for integrative medicine? What demands have arisen that necessitate a shift in the philosophy and application of healthcare in the 21^st century? In October 2005, the World Health Organization published their report on chronic disease. The results are sobering. In all countries all around the world, rich and poor alike, eight out of ten people die prematurely of chronic disease. 

            The health sections of major newspapers routinely publish articles on the necessity of promoting the same type of empowerment and self-care that is inherent in an approach that includes a synchronous version of causality. The following comes from an article that was recently posted in the San Francisco Chronicle:

 

“It is to all our benefits to maintain their (aging, elderly population) health at the highest level of functioning they can maintain for as long as possible without additional supports. We want to keep people functioning at the highest level so families don’t need to care for them and they don’t need to spend their resources to provide costly care. It’s a public resource issue.” (Sturrock, 2006)

 

 

If sentiment and the indignation of those who believe healthcare is a right is not sufficient to presage a change in our approach to healthcare, then simple economics might. Mark DeHaven M.D. PhD of Dallas Texas communicated his understanding of the situation thusly,

 

“Healthcare in the U.S. and the current practice of medicine must change. Currently we are spending about $1.5 trillion ($5440/capita) annually, 75% of which is devoted to treating and managing chronic (mostly preventable) disease using conventional (read: remedial) modalities. The projection is $3.4 trillion ($10,500/capita) by about 2011 or 18% of GDP . . . Our care delivery is about 95% treatment and 5% prevention. The U.S. cannot sustain the present system for much longer.” (DeHaven, 2005)

 

Chronic disease comes with its own vicissitudes and they are not the same ones addressed by conventional medicine. (Wielawski, )  Chronic disease is disease for which there currently is no standard or reliable cure. Chronic disease is functional disease in which the qualitative aspect of treatment and efficacy assume primary importance. Fortunately, this does not imply that there is no hope for the patient who suffers from chronic disease. 

            What are the tenets of healing when cure is not possible? Could it be that it is creativity that must be given a berth aboard the titanic ship of chronic disease? And what are the considerations which give space to creativity? It seems that one of the primary pillars that should be considered is a synchronous principle of causality. 

 

“Physics is messy . . . and it’s not that this mess is a mess created by the dirt that’s on the microscope glass. It’s that this mess is inherent in the systems themselves. You can’t capture any of them and confine them in a neat box of logic.”  (Waldrop, 1992)

 

The preference for empirical, quantifiable data that yet exists within conventional medical science is a hindrance to this more complete approach to healthcare and healing. 

The time has arrived to reconsider the limits of linear- reductionism as it maintains a doctrine of separation and specialization which hinders a more complete approach to healthcare in general and to integrative medicine in particular. “The narrow population-based RCT (randomized controlled trial) approach that has been widely acclaimed in evidence-based medicine fails to include qualitative measures, thereby missing important data regarding the meaning and impact of the therapy on patients.” (Johnston and Mills, 2004)

            The tendency in conventional medicine is to acknowledge quantitative evidence as the primary proof of validation. Matter being less ambiguous to measure than say, thought or feeling, there is a strong preference for that which can be quantified. Qualitative evidence is left the task of proving its worth. I might tell my reader that the U.S. soccer team lost 2-1 to Ghana, however, this quantitative data would do little to convey the quality of play, the run of the match and the performance of the players of both teams. This ‘just give me the bottom line” approach that is the signature preference of conventional medicine is of less use in medical situations where the quality of the patient’s life experience is the main goal of treatment. 

            The main casualty of conventional medicine is an inherent loss of meaning. The subjective experience of the patient’s illness is passed over in favor of an interpretation that focuses, not on what is inherently useful or empowering about the reality of illness and how it may require and even motivate useful growth, change and evolution within that patient; but rather on the disease, the evil that has disrupted the paradise of wellness. This loss of subjective meaning may be the essential piece that is recovered by an epistemology that attempts to view things, not in isolation, but in relationship and interconnected wholeness. 

 

“Nothing happens in this world of causality that does not originate in some cause. So the idea of an “acausal (synchronous) connection” seems to be ruled out right from the start – there is simply no room for it in a universe of (linear) causality.” (Peat, 1987)

 

            In the December 2004 issue of The Journal of Alternative and Complimentary Medicine, Bradley Johnston and Edward Mills make a compelling argument for a shift in research methodologies away from studies using large population ‘n’toward an ‘n-of-1’ approach in which the subjective experience of the individual is of primary importance to treatment efficacy. What is n-of-1 except the allowing of the inclusion of synchronicity and the synchronous principle of causality? Like synchronicity, n-of-1 not only permits for, but actually requires the inclusion of the patient’s subjective experience of illness and the meaning that it imbues. The authors do not suggest that n-of-1 utterly supplant all methodologies of research. Rather they advocate the elevation of an n-of-1 approach in the study of Complimentary and Alternative Medicine (CAM) or - to be consistent with the lexicon of this piece - modalities which are based upon a synchronous principle of causality, on holism, on the inclusive aspect of reality, not on the exclusive principle of reductionism. 

            What type of patients and medical situations might most benefit from such a shift in research methods? “n-of-1 trials are . . . applicable to chronic, recurrent conditions that require long-term, non-curative treatment.” (Johnson and Mills, 2004) Why does n-of-1 hold special appeal for such situations? Because “narrow population (i.e. large n) . . . fails to include qualitativemeasures, thereby missing important data regarding meaning . . . n-of-1 . . . may be able to identify more effectively the ways in which patients find meaning through CAM therapies.” (ibid) In the same way that synchronicity imbues reality with an interconnected and qualitative bias, so too n-of-1 emphasizes the qualitative and subjective aspect of the patient’s lived experience of illness. Inherent in such a view is that symptoms maintain meaning for the patient. Meaning, qualitative insight and the subjective experience are all supported by an n-of-1 approach and these seem also to be the primary tenets of diagnosing and treating disease for which no cure yet exists. 

In order to conduct research on such a supposition, quantitative research based on assumptions of linear cause and effect, reductionism and the doctrine of separation must necessarily give way to and/or include a qualitative approach in which the patient’s inner reality and felt-experience of illness or healing is paramount to the promotion of empowerment. Furthermore, synchronicity - by the very nature of the phenomena – lends not only to a qualitative method detailing one’s lived experience, but to an n-of-1 approach in which the uniqueness of each individual and their experience is held to be of importance equal to any quantitative set of data. Can a study of synchronicity reveal to an individual how choice is influencing their health or illness? Contained within this question lies some of the tenets and suppositions about what a useful shift in healthcare must consider. Ultimately, a mixed approach which employs both qualitative and quantitative methods may provide the most accurate way to collect data and to decipher its meaning.

 

            In a 1998 study into why people seek medical care that is alternative to conventional Western science, there was a trend among respondents that indicated a desire to discover a medical approach that allowed for the inclusion of spirit. In other words, the massive numbers of Americans who seek alternative modalities, do so because they feel these other modalities inherently include and acknowledge some aspect of the divine and they believe they are better served by treatment that sees a human being as more than a mechanistic sum of various disparate parts. (Astin, 1998)  This search for a link to spirit within medicine and healing is consistent with a cultural trend (awakening?) in which spirit may be conceived of as an impartial and functional entity that may be accessed for guidance and inspiration rather than an authority that must be punitively obeyed and feared. (Myss, 2001) The concept of spirit as a functional part of the human psyche opens the way for what is really at the heart of any grass-roots attempt to shift healthcare – i.e. self-empowerment and self-care. (Gordon, 2006)

The fundamental discourse about the efficacy of a given research methodology has to do with the issue of how a given methodology affects outcome. In other words, the way in which one inquires is of singular importance in determining what one eventually discovers. How one poses the question and the parameters one establishes as one’s methodology affects what one perceives as the answer to that inquiry. Because self-care necessarily implies the inclusion of a patient’s inner, subjective reality – a large portion of which may not be accessible to quantitative approaches – the challenge for researchers is to discover ways in which one may expose, include and validate the importance of the patient’s subjective experience. Furthermore, the core significance of how a given research method affects outcomes is that certain approaches hinder patient empowerment and other approaches inherently expose the patient’s own role in the creation of their reality of health or illness. 

 

“Medicine has been hampered by the incessant forces favoring specialization.” (Ewald, 2002) Not surprisingly then, Western medicine as a whole “can be described as hostile to connotative discourse.” (Garro and Mattingly, 2000).  It is narrative inquiry and interview that most lends to collaboration in expounding the subjective aspects of reality. “In narrative studies it makes little sense to band together in exclusionary disciplinary tribes. There is too much to be gained from cross-fertilizations that draw widely upon the social sciences, as well as literature, history and philosophy.”  (ibid) This stands in sharp contrast to the segmented and decidedly compartmentalized approach that conventional science has followed for the past several centuries in which all other sciences are presumed inferior to physics.

The notion of inclusion – the inclusion of the patient’s actual lived experience in understanding what is happening to them therapeutically – is echoed at a meta-level by the work of Linda TuhiwaiSmith. Her book Decolonizing Methodologies describes the fundamental pitfalls of conducting research on peoples of different cultures without casting an eye to the biases of the observer and concludes that research and analysis done ‘at a distance’ can never accurately portray the lived experience of the people it seeks to illuminate. Furthermore, the types of biases that are maintained when conducting research as an outsider only serve to highlight the self-referential blind-spot of the observer.  

“Most research methodologies assume that the researcher is an outsider able to observe without being implicated in the scene. This is related to positivism and notions of objectivity and neutrality. Feminist research and other more critical approaches have made the insider methodology much more acceptable in qualitative research . . . the critical issue with insider research is the constant need for reflexivity.” (Smith, 1999)

 

The parallel here is that the legacy of separation lends to predictable results whether one applies such an epistemology to methods of anthropologic study or whether one seeks to empower one’s patients. The obvious conclusion is that one must include the subject(s) being studied. “. . . Community concerns were always reframed around standard research problems. How can research ever address our needs as indigenous peoples if our questions are never taken seriously? It was as if the community’s questions were never heard, simply passed over, silenced.” (ibid)  Similarly, it is essential that individual patients have their subjective reality included as a part of their process of healing. Without this inclusion of their subjective view-point, any therapy or technique will only ever be partially successful. The input about how a people (person) will take part in their own redemption from illness to health is an essential and conspicuously absent piece to the methodology that sees phenomena and patients as essentially discrete and disconnected entities. 

The legacy of separation and the holistic approach which seeks to provide balance through recognizing various interconnected relationships can amalgamate to form new methods of inquiry. The essential issue of how methodologies of research affect outcomes points toward a fundamentally different assumption about patients and toward different criteria for researchers to address. Is it not essential – in a model in which self-empowerment is primary – that the patient be permitted to discern for themselves not just the pattern of events that lead to illness, but also the meaning of their experience as it relates to wellness/recovery?   How can a patient learn to recognize the ways and the moments in which their mind is creating their matter? 

            Judith A. Sedgeman of the West Virginia University initiative for Innate Health says ‘yes’ to the former question above. In a paper on Innate Health and Healing Realization (IH/HR), Sedgeman makes an interesting observation that gives interdisciplinary evidence of the shift in research methodologies which attempt to include the lived experience of the individual. In her research on stress and its effects on a given individual, the question is shifted as to the where stress arises.

 “The persistent assumption that stress is a consequence of factors outside of the control of the individual, however, has kept research attention on the relationship between stressors and the individuals who are subject to them. As a result, studies focus on how best to protect people from stressors or equip them to respond to stressors as successfully as possible. A question for further study is how people access their internal resiliency. What allows some people to draw on their internal strengths when they most need them, while others are easily overwhelmed? What explains the power of the psychological immune system, and why is it not consistently engaged or functioning?” (Sedgeman, 2005)

 

 

The author highlights the disconnection between the source-origin of stress and the person suffering its effects. This is symptomatic of the self-referential blind-spot, analysis-at-a-distance and the reductionist archetypal methodology. The compelling twist that Innate Health researchers are introducing is that . . . the individual is empowered and not passive. So long as stress is seen as an outer force, no individual can hope to manage it. But this belief that stress arises from outside is a methodology based on the same beliefs that gave rise to the eminence of western science and that now limits that science. In other words, the essential difference to this empowering approach lies in the way the research question is posed and the method by which inquiry is conducted. By shifting assumptions about the origins of stress and no longer agreeing to assume that stress originates from without the individual who experiences its effects, the patient’s subjective reality and, more importantly, their personal role in the creation of that stress is acknowledged and included in the methodology.   If one were to put on the interdisciplinary goggles necessary in this line of study, one can discern that this is roughly analogous to the findings of Linda T. Smith who reminds us that it is not possible to approach another group of people as an outsider and ever hope to wholly understand their lived experience (so long as one were to remain an outsider). Furthermore, the suppositions of IH/HR are consistent with the tenets of CAM modalities in which the shift is toward an empowered individual. If the way in which one frames inquiry of their experience is central to how they will recognize and narrate that experience, to how that experience will color and shape their reality of health or illness, then any patient who seeks healing from chronic disease is better served by a method of inquiry that permits them to frame their search for pattern and understanding in a way that empowers them from the start and assumes that the source of their illness is not outside of their choosing but rather within it. (15)

            Michael Taussig writes about this same issue concerning a lack of alternative ontologies in American medicine, saying that they are “denied by an ideology or epistemology which regards its creations as really lying ‘out-there’ – solid, substantial things-in-themselves . . . this illusion is ubiquitous in our culture.” (Taussig, 2003) Thus it is not only that reductionism is itself a uniquely discernable ontology, it is also the case that a feature of reductionism is to deny comparable status to any alternative ontological world-view save one which reflects reductionism.

Whereas conventional medical diagnosis and treatment requires a disempowered, passive and compliant patient, similarly, conventional research methodologies maintain a focus on pathology, disease, and problems. In contrast to this, just as CAM modalities have an inherent focus on self-help as a central tenet of treatment of and recovery from illness, so too narrative interview has a primary preference for focusing on the actual lived experience of the individual and their illness/recovery with all the concomitant meaning and insights that accompany such a focus.

“N-of-1 trials have been used for diagnostic purposes and can help develop better diagnostic tests. Chinese and naturopathic medical practitioners often treat “syndrome” or “subclinical” conditions according to their particular evaluation and diagnostic procedures.” (Johnston and Mills, 2004)

 

Analysis at a distance and large n randomized control trials (RCT) is to linear-reductionism what n-of-1 RCT is to qualitative pattern discrimination with its assumption of synchronous causality (Table 1; Guyatt, et al, 2002).  Synchronicity is – by nature – an n-of-1 phenomenon. “the essence of a synchronicity is that the particular pattern has a meaning or value for the individual who experiences it . . . synchronicities act as mirrors to the inner processes of mind and take the form of outer manifestations of interior transformations.” (Peat, 1987) In addition, the ability to cognize health and illness at a ‘subclinical’ level is what lends to prevention. In a world where cause and effect do not have to be linear, one may notice the disharmony between mind and body that eventually gives rise to serious illness, long before a gross anomaly like a neoplastic growth becomes detectable (i.e. quantifiable). 

 

The inclusion of a patient’s lived experience mimics the very notion of quantum reality – the exclusion of which so defines and limits the conventional, mechanistic approach to healthcare. With the inclusion of a synchronistic principle of causality, the patient’s role in determining their own health and illness becomes impossible to ignore. Similarly, it is within quantum reality that the notion of the isolated observer collapses utterly and is no longer supportable.  The physicist Wolfgang Pauli was one of the first to report such a possibility and did so in correspondence to his countryman Carl Jung. “Pauli believed that synchronicity made it possible to begin a dialogue between physics and psychology in such a way that the subjective would be introduced into physics and the objective into psychology . . . in which subjective and objective aspects would reveal different features of the same underlying phenomena.” (Peat, 1987)

Not only do qualitative methods require a shift in assumptions about causality in nature, but an emphasis on meaning also requires that assumptions about healing must be expanded to include more than merely a notion of physical cure. A research methodology that includes a synchronous principle of causality will orient a patient-subject toward the discovery of meaning within their quest for healing and recovery – whether or not that quest ends in cure. 

It is subjective meaning that is missing from a heavily quantitative approach. It is synchronicity that imbues experience with meaning. It is CAM modalities and qualitative methodologies – of which n-of-1 is the epitome - that imbue healing and research with meaning. It is meaning that empowers patients to manage their chronic illness. It is meaning that is the common thread. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

·         [Bauer, Brent M.D. and Milt Hammerly M.D.] 2006. Presentation at the Fourth Annual Conference on Integrative Medicine for Healthcare organizations; quoting the Institute of Medicine. 1999. To Err is Human; Building a Safer Health System. Washington D.C. National Academies Press.

                  A presentation by two M.D.'s on the state of the art in integration. Concisely and poignantly revelatory of the shortcomings of conventional medicine. A rare and honest appraisal by individuals within the self-same model.

·         Bean, Jane.  Curing IBS Naturally with Chinese Medicine. Blue Poppy Press 1999. P. 90-91

Definitive source for TCM methodology of managing IBS. 

·         Bronson, Matthew PhD Rekindling the Flutes of Fire. Revision, Volume 25, number 2, 2002

A concise and well written explanation of the importance of language in the creation of reality by a world-class linguist and academic. 

·         Ewald, Paul. Plague Time: the new germ theory of disease. Free Press, New York, New York, 2002

A controversial - at the time it was written - work in which the author substantiates the view that infectious agents are driving far more of the chronic illnesses which now threaten human health than was previously believed. 

·         [Flaws, Bob]. From a seminar on Chinese internal medicine. Blue Poppy Distance Learning Programs, 1999

One of the first and best comprehensive distance learning programs for TCM professionals to learn the essential materia medica for high-quality practice. This presentation, like others from Bob Flaws, is replete with anecdotes and commentary on important points for young practitioners.

·         Flaws, Bob and Douglas Frank. Curing Arthritis Naturally with Chinese Medicine. Blue Poppy Press. Boulder Colorado, 2006

Part of a series intended to address and clarify for TCM practitioners the treatment of common ailments. 

·         Good, Byron J. and Mary-Jo DelVecchio Good. Learning Medicine: the constructing of medical knowledge at Harvard Medical school. From Knowledge, Power and Practice; the anthropology of medicine and everyday life. University of California Press, Berkeley, 1993.

A valuable article on the ways in which conventional medical students are inculcated with reductionist assumptions via technical language. 

·         Garro, Linda C. and Mattingly, Cheryl. Narrative and the Cultural Construction of Illness and Healing. University of California Press, Berkeley, California; 2000

An essential work on the way in which language creates the medical reality.

·         Gordon, James. From a lecture: Center for Mind-Body Medicine, Professional Training Program. Berkeley, California; January 2006

This organization is perhaps the forerunner of others to follow. The training program is a sound and organized prototype of one group's attempt to teach a new way of thinking to a wide and lay audience. 

·         Guyatt G, Haynes B, Jaeschke R, Cook D, Greenhalgh T, Mead M, Green L, Naylor CD, Wilson M, McAlister F, Richardson WS. Introduction: The Philosophy of evidence-based medicine, Guyatt G, Rennie D, eds. Users’ Guides to the Medical Literature: A Manual for Evudence-based Clinical Practice. Chicago: American Medical Association Press, 2002:3-11

Source for Table 1. Good explanation of evidence hierarchy according to methodology.

·         Hanson, N.R. Patterns of Discovery. Cambridge, 1958

                  Excellent and essential piece on limits of epistemology.

·         Johnston, Bradley C and Mills, Edward. N-of-1 Randomized Controlled Trials: An opportunity for Complementary and Alternative Medicine Evaluation. Journal of Alternative and Complementary Medicine, volume 10, number 6, 2004, pp. 979-984

                  Essential study and articulate explanation of research methodology.

·         Jung, C.G. Synchronicity. Princeton, NJ. Bollingen, 1973

                  First monograph by Jung on synchronicity. In some ways, this                                work is the seminal piece for integration in medicine since -                          despite shortcomings that were later clarified by the author - it so                                 concisely articulates the phenomena which substantiates the                                     holistic world-view. 

·         Kuhn, Thomas S. The Structure of Scientific Revolutions. Chicago, 1962.

A classic text on the nature of science and the way in which new discoveries must struggle to find purchase amid the status quo. The author details the dynamics of breakthroughs and paradigm shifts and the resistance to such growth by establishment and institutional thinking before endorsement comes and outdated views are finally and utterly overturned.

·         Lewontin, Richard. The Triple Helix: gene organism and environment.  Harvard University Press, Cambridge Massachusetts, 2000   

                  This is a wonderful source and explanation from a biomedical                                  point of view as to why the study of DNA – as it is being                                                conducted in the conventional, reductionist             methodology – will                             not yield the kind of insight that science and the public hope and                           expect.

·         Morgan, Gareth PhD. see website: www.plexusinstitute.com/index

G. Morgan is the authority in complexity theory as it relates to healthcare organizations. His chief and principle point in this piece is to examine and give heed to discretionary emphasis – i.e. to place one’s efforts at the leverage point at which change may be affected with the greatest efficacy and least effort. 

·         McKenna, Terrance. Foods of the Gods. Bantam Book, 1992

McKenna was a visionary in the use and understanding of entheogenic plants and saw their usefulness to a society utterly at a loss for any solutions to the state of modern fragmentation so damning to medicine. His gift and message is that the psychedelic experience makes the phenomenon of synchronicity so absolutely undeniable that the debate over connections between the inner and outer realms became moot to those who had experienced the actual reality of synchronicity. McKenna understood the importance of experiencing synchronicity and not merely debating in the same disconnected western register about the existence of such a phenomenon. 

·         Myss, Carolyn. From and audio recording; Advanced Energy Anatomy, Sounds True recordings, 2001 

This work so concisely dissects the requirements of choice and its importance to the human condition that it should be required material for the integrative specialist. 

·         Nestle, Marion. Presentation at Stanford’s Annenberg Auditorium, March 6, 2008. "What to Eat: Personal Responsibility vs. Social Responsibility”

A definitive discussion of the food industry and how the American diet came to be so difficult to understand by the lay person and so intertwined with business interests.

·         Peat, F. David. Synchronicity: the bridge between mind and matter.  Bantam Book, New York, 1987

An essential work on synchronicity and therefore on integration in medicine. Peat explains so clearly what so many students seem to find illusory about the phenomenon of synchronicity – that it is neither mystical nor quasi spiritual, but rather, that it can be understood as science, if one considers ones assumptions about science and is willing to be transparent about the strengths and weaknesses of those assumptions. 

·         Porkert, Manfred. Chinese Medicine.  Henry Holt and Company, New York, NY. 1988

This was the first and may still be the best explanation to a western audience about the way in which the Chinese organize their medical reality.  

·         Pressfield, Steven. The War of Art. Rugged Land LLC. New York. 2002

Pressfield’s work holds special significance for the holistic and disenfranchised integrative specialist. Anyone who is operating outside the confines of normal, institutional channels would benefit from this treatise as it bravely sets forth the challenge to all who seek to create something new and unprecedented and the vicissitudes of such a path. 

·         Pritzker, Sonya. From the Simple to the Complex: what is complexity theory and how does it relate to Chinese medicine? Clinical Acupuncture and Oriental Medicine. Elsevier Science Ltd. Vol. 3. 2002. p. 99-104

This is a wonderfully lucid explanation of complexity theory and how this theory finds expression in Chinese medicine. The article is useful for TCM professionals (to clarify the strengths of TCM) as well as non-TCM professionals, as it explains why the omission of complexity theory from conventional science is such a limiting factor in clinical application.  

·         Scheper-Hughes, Nancy and Margaret Locke. The Mindful Body. Medical Anthropology Quarterly. Volume 1, number 1. March, 1987

                  Good explanation of language and the way it shapes medical                                   reality.

·         Shchutskii, Iulian. Researches on the I Ching. Routledge and Kegan Paul, London, England, 1980.

A work of great scope by a titan of sinology. Shchutskii was one of the first non-Chinese to recognize the Yijng’s worth to the west. 

·         Sedgeman, Judith A. Health Realization/Innate Health: can a quiet mind and a positive feeling state be accessible over the lifespan without stress relief techniques? Medical Science Monitor, 2005; 11 (12): HY 47-52

A rather useful and fresh approach that illustrates the short-comings of methodology inherent in conventional medicine and highlights why stress must be studied in a different way.

·         Seem, Mark. Blue Poppy Press, Boulder, CO. 2000 Acupuncture Physical Medicine: an Acupuncture Touchpoint Approach to the Treatment of Chronic Fatigue, Pain and Stress Disorders.

An early work in the cannon of TCM literature in the west. But still accurate, relevant and valuable for its insights as to how and why patients in the west are seduced by the exoticism of the east and what is required by TCM professionals to overcome such romantic and unscientific notions. 

·         Smith, Linda. Decolonizing Methodologies. University of Otago Press, Dunedin, New Zealand, 1999

A valuable look at the short-comings of methodology inherent in so-called post-colonial anthropology. 

·         Sturrock, Carrie.  Self-help for chronic ailments: Stanford model offers relief to sufferers when pills can’t. San Francisco Chronicle. Wednesday, April 26, 2006

An article confirming the trend toward self-sufficiency in the treatment of chronic illness.  

·         Tarnas, Rick. Cosmos and Psyche. Viking Press, 2006

A veritable tome on the relationships between the mind, thought, emotion and the heavens. This work is considered by many to be the new standard in its field. 

·         Taussig, Michael. The Nervous System. “Reification and the Consciousness of the Patient.” Routledge. New York, London. 2003.

The author does an admirable job in explaining the limitations imposed upon the patient and physician both by the way in which reality in constructed through language and the tenets of conventional science. 

·         Theodosakis, Jason M.D. The Amazing Cure for Arthritis: and Interview with Jason Theodosakis M.D., M.S. MHP. Nexus, Colorado's Holistic Journal. Boulder Colorado, May/June 1997

This interview and the book that it references are valuable for the simple reason that they display yet another conventionally trained M.D. who seeks transcendence of the confines of conventional thinking. Such professionals are invaluable as they pave the way for yet more such bold thinking in the future of integration. 

·         Verhoff MJ, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: Adding qualitative research methods to the “gold standard.” Journal of Alternative and Complementary Medicine 2002; 8: 275-278

                  Good source on methodology of research.

·         Waldrop, M. Complexity: the emerging science at the edge of order and chaos. New York. Simon and Schuster. 1992

Good source for understanding complexity and chaos theories.

·         Whorf, Benjamin Lee. Language, Thought and Reality. John B. Carroll, ed. Cambridge, Massachusetts, 1956.

                  A classic text on language and its implications.  

·         Wielawski, Irene M. Improving Chronic Illness Care. To Improve Health and Healthcare, Volume X. p. 55

Excellent source for understanding contemporary attempts and challenges to implementing a system of medicine that addresses chronic disease.

·         Wilhelm, Richard. The secret of the Golden Flower. Routledge and Keegan Paul, London, 1962

Perhaps the most esoteric of Wilhelm’s works. This piece was especially important to the Jung in the collegial relationship he had with Wilhelm. The theme of synchronicity and its prevalence in eastern thought runs throughout. 

·         World Health Organization. Preventing chronic diseases: a vital investment.  WHO press, Geneva Suisse. 2005

A telling study that chronic illness and its demands can no longer be confined to a select and unfortunate few. The demands of this new pandemic will drive the change in healthcare and medicine. 

 

 

Flaws, Bob. The Single Most Important Principle in Professional Chinese Medicine; Blue Poppy Herbal Product Guide