Traditional Chinese Medicine Research: What Are We Investigating? The Case Of Menopause

Author

Volker Scheid, School of Integrated Health, University of Westminster 115 New Cavendish Street London, W1W 6UW, United Kingdom

Proceeding

1st International Conference & Exhibition on Women's Health & Asian Traditional (WHAT) Medicine

Date

23/8/2005

Keyword

menopouse, menopausal syndrome, complementary and alternative medicines, Traditional chinese medicine

Abstract

Eighty per cent of women in the UK experience menopausal symptoms and 45% find the symptoms distressing. An increasing awareness of problems associated with hormone replacement therapy, the fact that women’s use of complementary and alternative medicines (CAM) in addition to any use of conventional medicine is directly related to the severity of their symptoms, and the dearth of evidence based clinical studies in this field make this an urgent priority for research. At present, our ability to do so is disabled by two constraints: (i) A narrow definition of menopause as a disorder of biology that fails to pay attention to its social and cultural dimensions. This limits communication between patients and physicians and, by excluding major aspects of its manifestation from the clinical gaze, is likely to impinge on the clinical effectiveness of treatments offered. (ii) A failure to understand issues of knowledge transfer between medical systems. My presentation will discuss these issues from the perspective of Chinese medicine and its utilization for the treatment of disorders associated with menopause. I argue that Chinese medicine does not make available ready-made solutions for the treatment of menopause that can be tested by means of clinical studies. Rather, Chinese medicine offers a number of diverse and competing perspectives that allows us “to think about” menopause and to develop potentially fruitful treatment strategies for different use contexts. My argument starts from the observation that the term menopausal syndrome (gengnianqi zonghezheng) appears in the Chinese medicine literature not before 1964. It is thus not an aspect of “traditional medicine” but rather an effect of politically driven efforts to make Chinese medicine textbooks fit more closely to dominant biomedical models of disease. Textbook Chinese medicine treatment protocols for menopausal syndrome have simply translated notions of hormone deficiency into the Chinese medicine idiom of “kidney depletion” (shen xu). They therefore do not provide us with “alternative” treatment strategies but, on the contrary, biomedicalize Chinese medicine. Western understandings of Chinese medicine, which is derived from these textbooks, further simplifies these interpretations arriving at a match between menopause and kidney yin deficiency (shen yin xu). Treatment strategies used by Chinese physicians “on the ground”, on the other hand, remain influenced by older theories and methods of clinical decision making that are sometimes diametrically opposed to that of modern textbooks. However, the clinically driven agenda of these practices generally does not penetrate into the politically driven editing of Chinese medicine textbooks and therefore remain inaccessible to Westerners. Clinical research that merely evaluates CM textbook treatments thus is of limited value. Yet, even the “local” and context bound character or individualized treatment strategies found in the case-history literature cannot be simply translated into a Western context, which differs from Asia both in terms of institutional set-up and the experience – and therefore clinical presentation - of menopause. For as anthropological research demonstrates, women’s experience of menopause is an effect of culturally inflected “local biologies.” At least two conclusions that invalidate much of contemporary research on Chinese medicine and menopause can be drawn from these observations: (i) Because there exists no single approach to menopause in Chinese medicine, we cannot evaluate “the Chinese medical treatment” of menopause. (ii) CAM research must urgently develop processes of translation that facilitate the integration of promising Chinese medicine treatment strategies into modern evidence based practice. I will present some ideas about how this might be achieved.