Contact Information: Dr. Rey Tiquia Honorary Fellow School of Historical and Philosophical Studies (SHAPS) The University of Melbourne Email: rtiquia@unimelb.edu.au Mobile: 0419616630Bio: Dr. Rey Tiquia is an Honorary Fellow of the School of Historical and Philosophical Studies, University of Melbourne. He is a qualified practitioner of Traditional Chinesé Medicine. He took his BA from Manuel Luis Quezon University, Manila, Philippines. and his MSc and Ph.D. degrees in History and Philosophy of Science, University of Melbourne, Australia. He is an Honorary Professor of the Shanxi College of TCM, Taiyuan City, China. He is author of numerous peer-reviewed journal articles and book chapters including “ The Qi That Got Lost in Translation: Traditional Chinese Medicine, Humour and Healing,” which is part of a two volume book Humour in Chinese Life and Letters Classical and Traditional Approaches ( 2011) and Humour Chinese Life and Culture Resistance and Control in Modern Times (2013) which were both edited by Prof. Jocelyn Chey who is a visiting professor in the School of Languages and Cultures, University of Sydney, and a consultant on Australia-Chin: relations and Jessica Milner Davis who is an honorary research associate in the School of Letters, Art and Media, University of Sydney.Revisiting the Chinese Medical Case Statement and its Publics Abstract Traditional Chinese medicine is a dynamic body of knowledge. It incorporates systematic forms of evaluation which supports innovation. Critical here are clinical records. The text-based Chinese medical case statement is an interactive space of discourse ‘that enables a reflexivity in the circulation of texts among strangers who become by virtue of their reflexively circulating discourse, a social entity’ or public entity. Through the evaluative agency of the medical case statement and a ‘diary of outcome measures,’ the efficacy of Chinese medical therapies is clinically evaluated. In this way, the medical case statement and the ‘diary of outcome measures’ in unison re-enact the tradition of proof that gives testimony about and witness to the efficacy of Chinese medicines.Revisiting the Chinese Medical Case Statement and its Publics Introduction The text-based Chinese medical case statement (case study) is an interactive space of discourse ‘that enables a reflexivity in the circulation of texts among strangers who become by virtue of their reflexively circulating discourse, a social entity.’ Being a public entity that encompasses the concems of both the patient and the Chinese medicine practitioner, the medical case statement embodies the doctor's diagnosis, the treatment protocol administered, the patient’s body and the yao (the remedies administered). The medical case statement re-enacts the tradition of proof or clinical evidence that gives testimony about and witness to the efficacy of Chinese medicines. In the colonial Australia of 1874, however, the standard of scientific objectivity in the form of a ‘clinical trial’ was enacted to test the efficacy of a non-pharmaceutical Chinese anti-diphtheria powder. This ‘clinical trial’ was performed not by Chinese medicine practitioners but by a biomedical practitioner: Dr. John Blair. The laboratory facilities at the Technology Museum, Melbourne were used to qualitatively examine the contents of the Chinese medicine preparations. Speaking before a meeting of the Medical Society of Victoria, Dr. Blair reported that the “Chinaman powder contains nothing new.’? It was composed of pharmaceutical compounds such as ‘alum, carbonate of lime, nitrate of potash, sulphate of sodium, sulphate of copper, nitrate, and chlorate of potash with camphor and mush added to give them odor’ [Blair 1874, 294—295].” ? Blair only looked into the components of the medicine without examining other factors like the dosage of the medicines administered, how often they were dispensed to the patients, for what clinical condition they were administered, and (most importantly) their efficacy. It appeared that the Chinese medications were looked at in isolation and no reference was made to the context in which they are used. No efforts were made to understand what they meant in their host culture (what we call TCM). Given the times and cultures involved, these were understandable flaws under the prevailing circumstances. The ‘trial’ as a matter of course ignored the concerns and interests of the public ie a public entity that is endowed with social agency.’ The ‘Blair Trial,’ as it became known in Australian history, highlights andKnowl ae, Chine = of the above historical event and recent national regulation of Traditional ee ledicine (hereafter referred to as T (CM) practitioners in Australia® have combined to make the development of a clinical evaluation system for traditional Chinese medicine (TCM) practice a pressing contemporary issue. Up to now there has been no widespread recognition that systematic evaluation is already embedded in TCM practice. It incorporates systematic forms of evaluation which support innovation. Critical here are clinical records and Possibilities for developing new schools of practice. I propose that—as opposed to the modern science-based randomized controlled trial (RCT) model—the practice of bian zheng ping yao, “clinically evaluating the administered yao in accordance with the diagnosed clinical pattern,”® be adopted as a suitable evaluation model for TCM. A set of clinical trial protocols evaluating yao that is based on standardizing clinical records should be established. Working through clinical records is consistent with the values, practical logic, and practice paradigms of TCM, as the clinical records of TCM provide testimony about and witness the life of qi or ‘air’” da gi *. yin and yang and the five elements* in Chinese medicine. TCM Values are All Embedded in the Medical Case Statement (¥i Am) In 2007, as a Victorian registered practitioner of TCM, I received from the Chinese Medicine Registration Board of the State of Victoria a consultation document titled ‘Guidelines on Patient Records,” which solicited the views of registered practitioners of TCM on the ‘Guidelines.’ The document was in English and partly in Chinese. I wrote a fifty-one-page submission titled ‘An Epistemological and Linguistic Translation of a Contemporary Set of Guidelines on Writing a Chinese Medical Case Statement from China into the Australian Locale.” I proposed a change of nomenclature. Instead of using the phrase ‘patient record’ to refer to a documentation of TCM clinical encounters, I suggested that the “Guidelines’ recommend use of the traditional nomenclature yi an, i.e. “Chinese medical case histories,” or “Chinese medical case statement.’ This proposal was in keeping with the work of the British| 6 eliwalunl ¢ Ninew lanuinge wmpert ¢ tho Nesdhary asia hilstopher Cullen, who wns at that time director of nistitute wt the University of ¢ “ambridge,” Using thewe inigivish linguistically, epistemologivally, 4 Chinese medical case statement from the Western record, or bing li, ppellations, would, 1 arwived, disti ontolouionlly and Motaphysieally ‘biomedical notion of the ease ‘The medical cave statement is a clinical record of a TCM physician's practice of examining, investigating, analyzing, and managing the illness condition through the deployment of the following ‘four examination techniques’ (st zhen): observation (wang); inquiry (wen), listening/omelling (wen), and palpation (gle). It is a record of TCM clinical practice, ‘The medical case statement reflects not only the entire course of the development of the illness, but alvo the thinking and actions of the practitioner as he or she carries out the work of investigating and treating the ailment, The medical case statement is a very important basis upon which the process of ‘differentiating clinical patterns and associating the appropriate yaowu (bian zheng lun yao)’ is correctly carried out. Further, it is on the medical case statement that a calculation of the prognosis, as well as the twists and turns in the development of the illness, is grounded. The medical cave statement is also a resource available to the practitioner at the next consultation, ‘or as a basis upon which referrals to another health practitioner may be made. At times, the medical case statement may be used to assess the practitioner’ s medical or technical proficiency; it may be used by the courts as a basis for handing down a legal opinion. In TCM clinical practice, an accurate, and systematic writing of the medical case record is one of the preconditions that can guarantee successful healing. It also provides valuable clinical educational materials. Such a record comprehensively reflects shifts in the patho-mechanism of the entire therapeutic process, as well as the success and failures in ‘differentiating clinical patterns and associating yao.’ For thestudent, it serves as a guide towards correctly executing a differentiation of clinical Patterns and associating yao, and grasping the method of ‘choosing individual remedies for a formula on the basis of the established therapeutic method and Principle.” or fifa fang yao. The case history is moreover an important form of Primary data from which lessons are drawn from ‘doing the theory-as-practice of ‘TCM,’ and assessing its clinical efficacy. In all, it can be said that the medical case statement is vitally important in the conduct of clinical scientific research. Hence, conscientiousness in the writing of the medical case statement plays a significant role in raising the standards of Chinese medical education, medical treatment, and scientific research." Separating Theory From Practice: Modernising, Scientising, Objectifying, and Rationalising TCM With the modernist Cartesian credo of ‘I think, therefore I am,’ the mind is separated into a dichotomous relationship with the body, while theory separates from practice. ‘And with the advent of the modem era, the theologian David Tracy observed the following: Many great contemporary scholars—Pierre Bourdieu and Mic in France, Amold Davidson, Martha Nussbaum} and many others—have come to deplore =the curious separation of theory from practice, including specific practices which Bourdieu ... called spiritual exercises. This separation was clearly not present in pre-moder, ancient, or medieval Western culture. Nor is it present in other cultures, including highly modemized ones like East and South East Asia influenced by Buddhism or Taoism or Hinduism Confucianism." In China, following the Marxist epistemological dogma of dichotomizing theory from practice, Mao Ze Dong (1893-1976), the founder of the modern People’s Republic of China, developed the concept of ‘integrating’ (jie he) the theory of Western biomedicine with the theory of TCM—zhong xi yi jie he. The concept later evolved into a political party and a state policy. In the jargon of contemporary Mainland China,the term jie he me i leans S to combine, integrate, or Unite entities, concepts, or people (for instance, integrating with the workers, peasants, and soldiers), in a de-contextualized manner ~~ “integrating theory with practice.” Referring to the integration of TCM and biomedicine, Mao used the term jie he in 1956, ina formal meeting with a team of Chinese musicians, However, the content of this meeting was made public only in 1977, in the Guang Ming Daily. Historian of Mainland China Si Yuanyi reviewed the work on the ‘integration of TCM and Western medicine’ (which he referred to as an ‘original creation,”) and he quoted Mao as saying: We have to lea contemporary foreign things. After studying them, then we study Chinese things. We have to accept the strong points that foreign things have. This will create a leap in our own things. Chinese and foreign things must be organically integrated. * But the ultimate aim of ‘reforming TCM’ through the ‘integration of biomedicine with TCM?’ was to ‘elevate’ it to a ‘scientific level.” As Si Yuanyi observed, ina commentary on Mao’s instructions: ‘As for the study of medicine, we have to use contemporary science to research the pattern of development of China’s traditional medicine, and thus develop China’s own ‘new medicine.’ (i Yuanyi pointed out that the ‘integration of Western biomedicine and TCM is an important content of the modernization of TCM.’'® The scientising'’ or biomedicalization of TCM formally began in China when laboratory experimental techniques were introduced into TCM research in 1959. In 1960, with the use of the Western pharmaceutical drug cortisone, a Chinese researcher Kuang An Kun developed a laboratory animal model replicating the TCM clinical pattern of ‘yang deficiency’ (yang xu).'* The efficacy of a traditional herbal formula which is commonly used to address this clinical pattern was supposedly successfully ‘tested’ using this animal model. In the People’s Republic of China this development signalled the birth of the so-called school of ‘integrated Chinese and Western medicines.”GOO ES ee Universal yardstick generated in the laboratory became lad to be measured and accepted as ‘scientific.’ Without due regard for the different Contextual requirements of TCM as a body of medical knowledge—one with an ancient history predating Western science—a whole set of reset j i , arch projects were undertaken to rework the parameters of TCM in keeping with ascendant notions of ‘scientific objectivity,” Such a separation of theory and practice has resulted in a distorted picture of TCM Practice, and an unhealthy and unbalanced development of the TCM body of knowledge. ‘Theories’ which assume life in one locale of practice are ostensibly ‘integrated’ with TCM practice. Theories of Western medical disciplines of anatomy, pathology, physiology, and biochemistry (which assume life in the biomedical body of knowledge) are integrated with bian zheng lun zhi, The Wester disciplines supposedly raise the latter to a ‘modern,’ ‘scientific’ level. In the process, theoretical configurations were correlated with biomedical technology, such as magnetic resonance imaging: x- ray, CT scan. These technologies are standardizing the practice of bian zheng lun zhi. Translating Bian Zheng Lun zhi into Bian Zheng Lun Yao Ihave reconstituted the practice of TCM known as bian zheng lun zhi for the Australian locale.'® Bian zheng lun zhi is a premodern body of medical knowledge which is anchored in local conditions. To quote feminist philosopher of science Susan Leigh Star, it consists of medical practices that ‘adapt to different local circumstances, to meet the heterogeneity of the local requirements of the system (plasticity) and the capacity... to incorporate many local circumstances and still retain a recognizable identity (coherence)."'” According to Star, plasticity and coherence are the two factors which make a system of knowledge ‘robust.’ Bian zheng lun zhi is a medical practice that emerged from and became systematized amidst the local health contingencies in ancient China, and then extended in time and space to other locales in China, Japan, Asia, Europe, America, and Australia. This pre-modern local body of medical knowledge eventually connected with other locales around the globe.'* Through the processes of translation—of ‘moving from one place to another’—the local is mobilized so that it has global reach, while the global is articulated locally.!?ae This new scientific understanding of local and situated knowledge critiques notions of the mimetic universality of ‘theory.’ The practice of TCM known as bian zheng lun 2hi is guided by the premise of such a critique; itis a practice of ‘proposing treatment principles in accordance with the differentiation of patterns of clinical phenomena,” and has been reconstituted and reconceptualized in the Australian locale as “differentiating clinical patterns to associate the appropriate yaowu,’”” ot bian zheng Jun yao" in Chinese. Yaowu are ‘matter or things that put qi into order; the natural body—which is alive and full of gi, or life force—is enacted in practices that are a natural part of the whole body.” The medical treatments and materials include acupuncture and chronoacupuncture;”* traditional Chinese massage; food therapy; and the use of materia medica, emotional counter-therapy and qi exercises, such as qi ‘gong and taijiquan. The varied qi motions of individual yaowu, or of a group of them collected in a standardized formula known as fang, are chosen to fit the clinical pattern of disequilibrium in the patient's uneasy body. Qi exercises, Chinese herbal medicine, chronoacupuncture, and emotional counter-therapy all act in the same way to rebalance the gi.”* From more than two millennia of historical development and practice, the TCM theoretical framework (the TCM standardized body of knowledge) emerged, developed, and was systematized from various spatial and temporal locales in and out of China. In the process it was influenced by heterogeneous premodern and contemporary cultures, traditions, religions, and philosophies—such as The Book of Changes (Bagua Yijing), Taoism, Confucianism, Buddhism, History and Philosophy of Science - as well as by Science and Technology Studies. As a result, in and out of China, TCM has evolved, and continues to evolve, a unique way of dealing with diseases and their prevention, health and wellbeing, longevity and nutrition. Chinese Medical Case Statements and Western Medical Case Histories Undoubtedly, while the presence of the three agential figures of the patient, the practitioner, and the practitioner's medical and diagnostic tools mark a similarity between TCM and Western biomedical systems of medical practices, there are, at the same time, metaphysical and ontological differences between the two.° In TCMWw clinical encounters, qi is studied through differentiating clinical patterns to associate the appropriate yao % or yaowu %%—routine therapeutic practices.” Like the Chinese ideograph—which moves horizontally, vertically, slopes up, down, and crosses in accordance with a standardized ordering to convey the right meaning—it is the nature of the yao to embed a qi which assumes a yin and yang life, a motion ascending, descending, sinking, floating, moving in, moving out, hot and cold, in dispersion and condensation. These varied gi motions of the yao, a group of yao, represent a standardized formula (fang) which fits the clinical patter of imbalance to the uneasy body of the patient. However, in the received view in Western biomedicine, there is a hierarchy of agency. ‘The clinician has the most agency, the patient somewhat less, and the materialities deployed by the clinician are merely tools to be wielded by him or her. Practitioners of this tradition of healthcare map the presence or absence of certain entities in the patient's body. In its mode of representation the tradition seeks to mimic the presence certain enzymes in the body; as such, the mimicked or mapped body is “here,” and the practice of medicine is ‘over there.” Like the process of ‘matching’ speech sounds with the correct ordering of letters of the alphabet, this mapping ‘matches’ what is on the ground with what is on the map—the virus, bacteria or enzymes. As with the letters of the alphabet, pharmaceuticals, diagnostic tests, and so forth must be prescribed in the right order and sequence in accordance with stringent laboratory standards so as to return the ‘machine’ of the body to good working order. In sum, in Western biomedicine, the case history relates what is on the ground (the doing of biomedicine) to what is on the map (the theory of biomedicine). The diagnostic tools, injections, and pharmaceuticals ‘perform’ the body in its representation. On the other hand, the Chinese medical case statement embodies the doctor's diagnosis and treatment protocols, the patient body, and the yao. They ‘perform’ the patient body and the body of the yao (the acutracts; acupuncture needles; materia medica, and other routine therapeutic practices) in their re- presentation.”* TCM's clinical records witness the life of gi in TCM. They constitute a te-presentation or re-enactment of bian zheng lun yao. But in Western. biomedicine,42 medical case records or bing Ii are, in the words of Judith Farquhar, merely ‘ generalized textbook descriptions of the disease.’ The focus of TCM and all its Yao therapies is the patient at their ‘specific unease in the here-and-now.” Western 30 nd this clinical textually recorded biomedicine, in contrast, has a focus on a generalized condition. condition of the patient's ‘specific unease in the here-and-now” is on the spot dang chang" into the medical case statement. ‘The Medical Case Statement as a Text-Based Public and as part and parcel of the usual repertory of Being textually recorded on the spot ‘public®? that modem culture, the medical case statement in many ways constitutes a ‘ ie 7 comes into being only in relation to texts and their circulation. It is somewhat like the public of this paper. Differentiating a text-based public from ‘the notion of an ‘audience’ ‘crowd, ‘group,’ or the public of polity, * Michael Wamer pointed out that the idea of a public is text-based. He said: A public might be real and efficacious, but its reality lies in just this reflexivity by which an addressable object is conjured into being in order to enable the very discourse that gives it existence ... This sense of the term is completely modern; it is the only kind of public for which there is no other term. Neither ‘crowd’ nor ‘audience’ nor ‘people’ nor ‘group’ will capture the same sense. The difference shows us that the idea of a public, unlike a concrete audience or public ofa polity, is text-based ..% Warner further elaborated that ‘the idea of a public is motivating, not simply instrumental’ and ‘is constitutive of a social imaginary.’ As such, this ‘public organizes itself independently of state institutions, laws, formal frameworks of citizenship, or preexisting institutions such as the church.’ In societal contexts, the medical case statement is an important written record that mirrors the thinking and actions of the practitioner as he or she carries out the work of investigating and treating the patient. It can also be used as a basis upon which referrals to another health practitioner may be made. Court judges may use them as a basis for handing down a legal opinion. For the student, it can also serve as a guide towards correctly13 exec ing a differentiation of clinical patterns and associating yao, and grasping the method of ‘choosing individual remedies for a formula on the basis of the established therapeutic method and principle,’ or Ha fang yao. In shor, being autotelic and having its self-organizing discourse of raising the standards of Chinese medical education and ethics, medical treatment, and scientific research, the Chineve medical ase statement constitute a ‘social space’. i.e, a public. The medical case statement exists in similar ways that ‘books are published, shows broadcast, Web sites posted, speeches delivered, and opinions produced.’”” As such, it ‘enables a reflexivity in the circulation of texts among strangers who become by virtue of their reflexively circulating discourse, a social entity.’ And this public entity has a history of over two millennia ” and is expanding in Australia and all over the world. Robert Houston, an advocate-scholar of complementary and alternative therapies in the United States, considers case studies a valid alternative to the RCT. He argues: I consider what is being dismissed as anecdotal evidence to be, in cancer, actually an impressive area of evidence, because you can have much more detail in case studies than you can in a clinical trial.’ Measuring the Efficacy of Chinese Medicines Through the Evaluative Agency of Text-based Publics Hence, in the clinical trial protocol" that I am proposing, I envision a ‘reassessment of the Chinese medicine diagnosis, with all analysis done on an intention to treat basis.’ “? Here the ‘Chinese medicine diagnosis’ refers to the diagnostic process bian zheng lun yao outlined above—clinically evaluating the administered yao in accordance with the diagnosed clinical pattern.” Clinical data gathered by the four techniques, after the administration of the yao, become ‘outcome measures’ that point to the efficacy of the remedy rendered to the patient. All this data connects with the medical case statement that is stored by the Chinese doctor, and a ‘diary of outcome measures’ “ that the patient may keep. The patient’s ‘diary of outcome measures’ could take the form of a ‘Global Rating of Change Scale’ to indicate whether the patient has improved or deteriorated in his or her clinical condition.“ In this sense, socially-contrived standardizing clinical case records consisting of the medical case statement and the ‘diary of outcome measures’ could be used together to measure the4 efficacy of TCM medicines or yao, Through the evaluative agency of text-based publics i.e. the medical case statement (the concer of the practitioner of TCM), and ‘diary of outcome measures’ (the concern of the patient), the efficacy of Chinese medical therapies are thus clinically evaluated, In this way, the medical cave statement and the ‘diary of outcome measure’ in unison re-enact the tradition of proof or clinical evidence that gives testimony about and bear witness 10 the efficacy of Chinese medicines. Undoubtedly, implementing the clinical trial protocols that will establish this new clinical evaluative regime would rectify the pemicious effects of “the Blair trial’ of 1874, And from a much broader perspective, it has the capacity 10 free the TCM body from the limiting influences of the Trojan horve of modernity. rationality, RCT, and zhong xi yi jie he. \n this way, standards from another tradition could be incorporated into TCM in ways that satisfy all publics who are in crose- translation’ ie. in cross-cultural communication.” TCM, Western biomedicine and their patients ean engage in mutual translation wherein clinical practice space can be viewed as a “social network’ through which the facticity (the social construction of “facts’ “) of both TCM and Westem biomedicine and their patients may be constructed in tandem. Using this framework, a typical translational case study is here presented. ‘A Translational ” Case Study” 1. Differentiating Clinical Patterns Name: Edgar Gender: Male Age: 6 years old Place of Origin: Australia Occupation: Primary School Student Season: 4 June 2009, Winter (A day before the beginning of the Solar Term of ‘Heavy Snow’ in the Southem Hemisphere). Main Complaint: For the past four days, the patient has been suffering from high fever, vorniting, nausea, coughing and difficulty in the passing of urine (he felt hot according to the parent). ‘Observation: The father carried the patient into the clinic. Edgar looked very tired. He complained of soreness on both sides of his neck. His tongue was reddish in colour and its coating was thick and white. Using an ear thermometer, | ascertained Edgar's temperature reached thirty-eight degrees centigrade. Inquiry: The patient had high fever for the past four days. The mother previously had15 2 similar condition. The parents took him to the local Wester medical practitioner who prescribed Amoxicillin. The parents later took the axilla temperature which cane to thirty-eight degrees centigrade. Elgar had no appetite and later Geveloped namics and vomiting. According to Edgar he lost lot of weight. Listening: Using the stethoscope, | heard no moist rales coming from the patient's Jungs. I heard the patient cough several times during the consultation. Palpation: Both radial pulses were rapid and agitated. Diagnosis: Winter warm factor disorder (epidemic) dong wen which is seen 25 seasonal influenza in Wester biomedicine. No sntibody test was undertaken by Se Westem physician who looked afier this boy to confirm whether the patient was 2 carrier of the A HINI virus (swine fi). “Therapentic Approach Used: Cool down the heat fever, put 2 stop 10 the cough P promoting the ventilating fanctions of the mgs and bolstering the patient's spleen 4. 2. Associating Yao (Formula, Remedy and) Operational Technique ‘4 June 2009. Chinese infant massage” was administered on acu-tracts/acupouts. ‘After administering the infant massage, | punctured the Lung acupoint 11 (located 0-1 cum superior to and side of the inner comer of the thumbnail“) using 2 disposable acupuncture needle 13mm long and 0.22 mm in gauge. After the acupuncture needle was pulled out, 2 small quantity of blood was squeezed ost of the punctured acupomnt. I prescribed and provided to the patient's parents a bottle of Minor Bupleurum Formula of which four pills should be taken three times a day”. 3. Clinically Evaluating the Efficacy of Yao 6 Sune 2009. A day after the Solar Term of “Great Snow’ in the southern hemisphere. The patient kept another appointment. To verify the efficacy of the treatment modalities administered. | used the Four Examination Techniques of wang wen wen gie 282 clinical evaluation template. observing wang. listening/smelling wen, inquiring wen and palpating gie. The Four Examination Techniques (Si zhen) undergoes transformation into the Four Evaluation Techniques (Si ping) ie. to observe, palpate, listen/smell and interrogate clinical symptoms to evaluate the efficacy of the administered therapy. The data is then verified and compared with data recorded in the clinical case record during the previous visit. Using the Four Examination Techniques, the clinical pattem is ‘revisited’ to evaluate whether the16 therapy achieved the aim of bringing about balance or harmony in the patient's physiological condition, First of all, I observed that the patient walked into my clinic without being carried by his Dad. He also seemed to be in better spirits. Upon inquiry (from the parents), the patient’s high fever went down on the night of the last treatment. I took his temperature using the ear thermometer and the patient's temperature registered normal. But the parents said that he was coughing a fair bit. Using a tongue depressor and a torch I inspected his throat. The throat and both tonsils were red and swollen. Edgar said that he was also suffering from frontal headache pointing to the area between the inner ends of his eyebrows. The vomiting also stopped on the day of the last treatment. Upon palpating his radial pulses, I found that they were still rapid but not as tense. Using the stethoscope, I also checked if there were any rales coming from his lungs. I did not hear any.17 * Michael Wat Te net Public and Counterpubics (New York: One Boks, 2002), 11-12. Rey Tiquia,* Trialling’ Chinese Me “A tiny medicine bot nthe Museum of Chinese- Australian history tell an interesting story aboot the practice of traditional Chinese medicine (TCM) in Melbourne and Ballarat tthe time of Australian Federation. Asan ‘inscription’ t relates how Chinese Australian herbalists ike FS. Goom situated the Practice of TCM within the Australian social and cultural context and in the process bestowed a form of social agency tothe bottle similar to the sort we normally associate with laws. The medicine bottle ‘marks the development of Chinese medicine practice in Australia into a heterogeneous assemblage ‘which generates robust and standardized diagnostic and therapeutic ‘tools’ that perform the job of “tailoring treatment principles to the differentiated clinical pattern’ or bian zheng lun zhi. See Rey Tiquia, “ Traditional Chinese Medicine as an Australian Tradition of Health Care” (PhD thesis, The University of Melboume, 2005), 128-131. * Debra Gillick, “Impact of national registration on Chinese medicine practitioners,” Australian Journal of Acupuncture and Chinese Medicine, Vol. 6, No.2, 2011: 43-44 Rey Tiquia, “Developing an Alternative to the Randomized Controlled Trial in Clinically Evaluating ‘Ya0,” special issue, Journal of Shari College of Traditional Chinese Medicine 11 (2010): 55-60. 7” Theoretical physicist and cosmologist Stephen Hawking in his best-seller book 4 Brief History of Time stated that Aristotle believed that all matter in the universe was made up of four basic elements, earth, air, fire, and water. These elements were acted on by two forces: gravity, the tendency for earth and water to sink, and evity, the tendency for air and fire to rise. This division of the contents of the universe into matter and forces is still used today. [Stephen W. Hawking, A Brief History of Time, (London: Bantam Press, 1988) 63]. In 1988, Xu Ming Xian and Wu Zhong Chao, who are both science researchers from the China Science and Technology University, translated Hawking’s book into Chinese. In their ‘translation of the above ‘uote from Hawking, the element ar was translated into Chinese as gi. Below isa copy of their ‘raslation wherein pin yin transliteration of some Chinese script and their English translation are interpolated. WEBS [Aristotle] FF A OT AT On RAVE D te VERT be, Yin lgravity), RR SUA [levity], isa qi [Air] ALAA EFL Hear iY [Air), AUK ET RA, AAA RRA18 SSX AUK AGRE 4 [Shi Di Fen Huo Jin (Stephen Hawking), Shi Jian Jian Shi ( A brief history of time), Xu Ming Xian & Wu Zhong Chao (trans), [Hunan: Hunan kexue jishu shubanshe, 2007] 60. ‘This Western notion of the four elements is comparable to the wu xing Tiff (five elements) of TCM — sma FE (wood), haeo XK (Fire), mx (earth, in & (metal) and shui % (water) — in the sense that in both philosophical systems the elements constitute the ultimate roots of all natural things. See Rey ‘Tiquia, “The Qi That Got Lost in Translation: Traditional Chinese Medicine, Humour and Healing,” in Humour in Chinese Life and Letters: Classical and Traditional Approaches, edited by Jocelyn Chey and Jessica Milner Davis (Hong Kong: Hong Kong University Press, 2011), 37. * In his reconstructed book Ancient Chinese Medicine's Concept of Cyclical Motion, Peng Ziyi (1871- 1949), a late Qing and early Republican practitioner and teacher of Chinese medicine who is considered the ‘modern-day father ofthe renaissance of Chinese medicine,” saw qi as ‘air’ da qi He ‘saw ‘air’ or “atmosphere” as a circulating entity formed by the copulation of the Yin and Yang. Furthermore, he viewed the Five Elements wu xing, as encompassed by the two forces ofthe Yin and ‘Yang qi, and the five ascending, floating, descending, sinking and center on movements of matter. Peng stated that : It is in the nature of Yang to splash upwards 3 and Yin to press downwards Fis. Yang moves straight up while Yin moves stright down . Yin and Yang copulate 22 and a force of affection or attraction £73 occurs. Yin and Yang follow each other around. Thereupon, a circulating motion is formed !S\—* iE. As for he Five Elements wu xing, they are encompassed by the two Yin and Yang qi, and the five ascending, floating, descending, sinking ‘and center on movement of matter-in-motion. Xing 47 means yun dong ‘motion.’ A living creature has Yin and Yang attributes. As a result, there are both Yin and Yang in the atmosphere. This is the origin ofthe words Yin and Yang in traditional Chinese medicine. ‘As for the words =a0 hua,(‘spontaneous shaping of all things"} [Benjamin A. Elmam, OnTheir Own Terms: Science in China, 1550-1900, (Cambridge: Harvard University Press, 2005}] 3) they refer to the time when the atmosphere began its cyclical/circulating motion that gave birth tw all living creatures. We also refer to this entity as yu zhow iif . the Universe (spacetime) ‘see Rey Tiquia, “The 1911 Revolution in China, The Chinese Calendar, The Imaginary Qi and Healing: Translating Lifa into an Australian Chinese Calendar and into an English Edition of the Northern Hemispherical Chinese Calendar,” Chinese Studies | (2012): 23-36). ‘According to Peng, “Everything in the universe is generated by the circular/cyclical motion of the air/atmosphere da gi. Chinese culture originates from the circular/eyclical motion of the air/atmosphere. ‘And Chinese medicine is one of these [Peng Ziyi, Yuan yundong de gu shongyixue, p.269). ‘Anaxemenes, a presocratic Greek philosopher, expressed similar views about the ‘air’ as the arche of9 all things, See Silvia Benso, * The Breathing of Air: Presocratic echoes in Levinas,” Levinas and the Ancients, edited by Brian Schroeder and Silvia Benso (Indiana: Indiana University Press, 2008), 9. “Anaximenes declared that the original material of the universe is air. Air when rarefied becomes fire; when condensed it turns successively to wind, vapor, water, earth and stone.” See Edward McNall ‘Burns, Western Civilizations Their History and Their Culture, Vol |, (New York: W. W Norton & Company, 1973), 132, Hence even before the founding of the People’s Republic in China, Peng Ziyi was able to establish a shared space wherein the “forms of life,’ which emerge from clinical microworlds, are translated symmetrically in a Yin- Yang way. (Rey Tiquia, “ Constructing 2 Non-Hegemonic Space, Interactive ‘Space for Traditional Asian Medicine,” Proceedings of the 17* Biennial Conference of the Asian Studies Association of Australia in Melbourne 1-3 July 2008. Accessed October 4, 2014, ” Christopher Cullen, “Yi'an #83 (Case Statements): The Origins of a Genre of Chinese Medical Literature,” in Innovation in Chinese Medicine, eA. Elisabeth Hsu (Cambridge: Cambridge University Press, 2001), 297-336. «Submission to the Chinese Medicine Registration Board of Victoria, Australia, 2007,” Rey Tiquia, ‘An Epistemological and Linguistic Translation of A Contemporary Set of Guidelines on Writing a Chinese Medical Case Statement from China into the Australian Locale, Victoria, Australia. David Rutledge, presenter, “Tragic Vision: Abandoned Vision of the West,” Encounter, October 16, 2007, Australian Broadcasting Commission radio transcript; see ww abe.netau/radionational/programs/encounter/tragic-vision-the-abandoned-vision-of-the- -west/3361624htranscript (accessed October 31,2013). $i Yuanyi, Zhongguo yirue shi (History of Chinese medicine] (Beiji chubanshe, 1984), 124, my translation, $i Yuanyi, Zhongguo yixue shi, 126, my translation. '*°As of uly 28, 2014 the relevant article in Wikipedia stated that “scientism is belief in the universal applicability as ‘method and approach. Paul Feyerband in his essay Against Method pointed out [5] cence... non-scientific cultures, procedures and assumptions can also stand on their own feet and should be allowed to do so...’ Feyerabend, Against Method, p. vit.” ~hit://en.wikipedia.org/wiki/Scientism> Accessed July 28, 2014,” : Renmin weisheng rou gui (REE, dan cong omg ‘2333 can be used to treat this clinical condition.” See also Yang Wei Yi, “Zhongti xiyon, 1g yuy 2 eee eee neg Xo &: Wong Me re 2s in mega on the Occasiom of the 4th Anniversary of the Foundation ofthe Beijing TCM University, (Bejing: Xue yuan dpa, 196), 172-76. (Charlotte Furth refers to bian cheng lun zhi 2s “the standardizes diagnostic path of rmenticte-comtary Practitioners of Chinese medicine, documented in cases of contemporary ‘senior doctors’ (lao Znomzyi) in the People’s Republic.’ Charlotte Furth, * Producing Medical Knowledge Through Cases: History, Evidence, and Action,” in Thinking With Cases Specialist Knowledge in Chinese Cultural History, e2. Charlotte Furth, Judith T. Zeitlin and Ping-chen Hsiung (Honolulu: University of Hawai'i Press. 2007) 125-151, at 126. On the other hand, Chinese medicine historian Sia De Dao saw the Gizgnostic system of bian zheng lun zhi taking definite form during the Ming-Qing historical period (1368-1840) ‘outlined the content of bian zheng lun zhi and traced its evolution from the time of the Yellow Emperor's Cannon on Internal Medicine, Treatise on Injury from Cold Meteorological Qi and Oxher Miscellaneous Diseases Ut; the Easter Han dynasty, Song Dynasty up ent the Ming and ‘Qing dynasties: see Jia De Dao, Zhongguo yirue shilue [An outline history of medicine in Crina) (Taiyuan: Shanxi renmin chubanshe, 1979), 231-34. Regarding my reconstitution of bian zhemg fam. see Rey Tiquia, “Connecting Traditional Chinese Medicine and Western Scientific Medicine” (MSc coursework thesis, The University of Melbourne, 1996), 14-24. *7 Susan Leigh Star, Regions of the Mind: Brain Research and the Quest for Scientific Certainty (California: Stanford University Press), 1989). 21. “To borrow from the American philosopher of science Donna Haraway. like Western science or technoscience, bian zheng lun zhi * travels (or travelled] only as practice, 2s cultural apparatus, not as disembodied truth, but travel it does [or did]. Donna J. Haraway, Modest_Witness@Second_millennium. FemaleMan® Meets_OncoMouse™: Feminism and Technoscience (New Y¢ ‘outledge, 1997), 121. tn connection with ‘moving from one place to another,’ see Bruno Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge MA: Harvard University Press, 1987), 108-17. ® Tiquia, “The Qi That Got Lost in Translation,” 40-41. 7 See Tiquia, “Developing an Alternative to the Randomized Controlled Trial.” 55-60. * For the quoted definition of yaowu see Zhejiang Provincial TCM Research Office, Wen yi 44un pingzhu [On warm contagious diseases: Notes and commentary} (Beijing: Renmin ‘weisheng chubanshe, 1985; first published 1642), 164-65. . ® Tiquia, “The Qi That Got Lost in Translation,” 41.21 *-Chronoacupunctun iw Jal : 3 ziwuliuchu, is a specialist discipline in acupuncture that makes use of six acupuncture points which “open” in accord: aoe lance with the rules ofthe traditional a Ye ional Chi lifa): see Rey Tiquia, “The 1911 Revolution in China, The Chinese Calendar, The I mar Healing: Translating Lifa into an Australian Chinese Calendar and into an es h Se ae ‘Northern Hemispherical Chinese Calendar,” Chinese Studies 1 (2012): = at **Tiquia, “The Qi That Got Lost in Translation,” 41. ; 5 Nain ee a er in Ears Danis Dscoms (Akay: Ste University of . . ichael considers the three domains of cosmogony, cosmology, and ontology as the three central questions addressed by metaphysics. He believes thatthe domain of “metaphysics begins with the question of ontology. » See Tiquia, “Traditional Chinese Medicine,” 240. as embedded in TCM practice, language use exemplifies TCM’s central paradigm or imaginary of stheory-as-practce.” Here, clinical practice is an embodied, embedded expression ofa knowledge tradition in place: see Tiqua, “Chinese Language Books as Medium of Re-prsentation.” 81. Henes | refer to the medical case statement as “re-representing” the practice of bian zheng lum yao.” ® Judith Farquhar, “Time and Text: Approaching Contemporary Chinese Medicine through Analysis ofa Case: in Paths of Asian Medical Knowledge, ed. Charles Leslie and Allan Youns (Berkeley: University of California Press, 1992), 62-73. 3° See Tiquia, “Traditional Chinese Medicine,” 2958. > according to Huang Huang, authentically recorded medical case statements are tet materials written down on the spot dang chang by TCM doctors when performing home visits or outpatient consultations. See Huang Huang, Yan Zhu Du (An Aid in reading the Chinese medical case statement] (Beijing, Renmin weisheng, chubanshe, 2001). 14 22 jp modern Mandarin, the English word ‘public's translated into Chinese as gon zhong ‘3%. Gong. ‘45 means ‘publi’ “public affairs" * make publics official duties,’ ete. While zhong %& refers to a serowa_ ‘multitude’ “numerous (of people’) [John DeFrancis, ed. ABC C inese-English Press, 1996), 197; 799]. However, in represented by the regular kai shu script zhong . And Comprehensive Dictionary, (Honolulu: University of Ha premodern China, the notion of “public this complex regular script has been implied int this 4X hong, that is written by putting together three standing human figures ren A. in profile’ [Gu fan Ping, Quwei zi cidian (A dietionary of interesting Chinese characters), Singapore: EPB Publishers, 1996) 114; 104, 33 Warner, Publics and Counterpublics, 66. * Ibid. 67. A soci imaginary is the ‘creative and symbolic dimension ofthe social world, the dimension through which human beings create their ways of living together and their ways of representing thelr collective life.” See John B. Thompson, Studies in the theory of Ideology (Cambridge: Polity Press, 1984), 6. * Ibid. 68.Ibid. 67. Ibid. 11-12. ” The first narratives on the medical case statements ; ; ‘Yi an were featured in the section on “grouped biographies or mem ” Lie Zhuan in the Records of the Historian Shi Ji which was “presented or between 104-87 (91) BC [Endymion Wilkinson, Chinese History a Manual, (Cambridge: Harvard-Yenching Institute, 2000), p. S01. *° See David J. Hess, printed” ed., Evaluating Alternative Cancer Therapies: A Guide to the Science and Politics of an Emerging Field (New Brunswick: Rutgers University Press, 1999), 135, *' The clinical trial Protocol is a“ document describing exactly what the trial will consist of, ie. design, subjects, statistical considerations, data elements to be recorded, study visits, inclusion/exclusion criteria, stopping rules, subject drawal, product handling, data gathering Procedures, adverse event reporting, record keeping, finance and insurance, trial extension, etc. Of paramount importance, patient consent and information documents, may form part of the protocol or be located separately”: Department of Health and Ageing, Therapeutic Goods Administration, The Australian Clinical Trial Handbook (Canberra: Australian Government Department of Health and Ageing, 2006), 16; emphasis in the original. 42 «In the studies of a system of traditional medicine to treat a specific disease the investigators consider the system as a whole, instead of a single core modality. These full spectrum studies can be done without identifying the underlying mechanism of action for each intervention, provided there is a clear, clinical endpoint.’ Richard, L. Nahin and Stephen E. Strauss, “Research into Complementary and ‘Alternative Medicine: Problems and Potential,” British Medical Journal 322 (2001): 161-64. © Tiquia, “Developing an Alternative to the Randomized Controlled Trial,” 55-60. 4 The use of the ‘patient outcome measure’ is still not a common practice among TCM practitioners. 45 steven J. Kamper, Christopher G. Maher, and Grant Mackay, “Global Rating of Change Scales: A Review of Strength and Weaknesses and Considerations for Design,” The Journal of Manual & ‘Manipulative Therapy 17, no. 3 (2009): 163~70. 46 Tiquia, “Trialling Chinese Medicine,” 345, * In this research, I used the sociological method of translation. I brought together in one platform (the clinic) the two paradigms of TCM and Western biomedicine. itis like bringing together two medical practices in a Yin and Yang way. In tis shared platform, TCM's culture of infection and epidemics as well as Western biomedicine’s art of dealing with epidemics are both presented. Specifically, TCM's Wenbing ot warm factor epidemics is simultaneously related to Western biomedicine viral epidemics Tike influenza. This is anovel type of medical research. Past ways of doing this type of study were dominated by the culture of ‘us’ and ‘them’ that exist the relationship between TCM and Western biomedicine. With this shared platform of the clinic, the medical practitioner, the patient and the medications used in both traditions of healthcare are all eaually ean........ >vuole, Laboratry Life Te Comurueton of Soleniie Fate @ 0 Latour and Bleve “See ru 919), VAAN Jersey Princeton University Pres 1979), leatinne prompment A + Mone! Catton an inlugnital author in Selene and Technology Siudles and a ne jiruno Latour, 990s the process of “iranstation ’ #6 etor-network theory (ANT) with 4 “alton, “1 jot wth Insoribed in intermediaries’ or ‘mediums,’ See Michel Calton, “Teeine-aconomie Newm Irroversibility,” in A Soelology of Monsters: Lanaya on Power, Technology and Innervation, elites oy John Law (London: Rutledge, 1991), 109-101, in 143), See also Viguia, Traditional Chinese Medicine,” #3), In this specific research J use the ‘clinic’ as a ‘medium’ oF platform to bring toyether in a yinyrang way the two paradigms of TCM and Western biomedicine, "This case study was originally published in the Argentinian online medical journal Mevieta de HMumanidades Medicas & Estudios Sociales de la Chencla y ta Teenologia. Vos. 2, Nosse §, 2080, 9p. b- 15 (Rey Tiquia, " A Cultural and Linguistic Translation of Warm Factor Epidemics Went as Seasonal Viral Influenza in Australia), ‘The evaluative system of the Global Rating Seale that concerns the Patient was non employed in this caine study, Also please refer to Chapter 3” Wenbing Ben Qi Pian {Writings on Warm Factor Epidernics and ‘Ones’ Innate qi] of Peng Ziyi's Ancient Chinese Medicine's Concept of CyeNeal Motion, 31-59), John DeFrancis translates the ancient Chinese term jhe qi $$, into English as “Solar Term’ ohn DeFrancis (ed), ABC Chinese-English Dictionary (Honolulu: University of Hawai'i Press, 1996, Pp 294), This is using the 2009 edition of the Southern Hemisphere Chinese Medical and Agricultural Lunisolar Calendar’ that | constructed for that year, ” Rey Viquia, Chinese Infant Massage (Melbourne: Greenhouse Publications, 1986), Jin Yi Cheng, Kao er tuina (Infant Massage) Shanghai: Shanghai kexue jishuwenxian chubanshe, 1961 “ "es Hans P, Ogal & Wolfram Stbr, Pictorial Atlas of Acupuncture An Mlustrated Manual of , ‘Acupuncture Points (Marburg: H.P, Ullmann, 2005), ” Reid, T, ). ' i. ferent ppc ag a i nt e é i se medicine, Melbourne: China Books, p.134, Refer as well to ‘u Hong Yuan and Xu Zhao Xin (1984), Changyong hanfan fa [Pictorial i 7 explanation of commonly used formulae in Chinese medici . 7 ia \edicine]. Taipei: Xin yiyao chubanshe, p.57-59.