How We Think—Does It Matter?

In my first year of TCM studies, long ago in 1995, I was bitterly disappointed when I quickly realized all was not as it was purported to be. Teachers were talking and writing about a different way of thinking, a more circular, less linear-reductionistic way, but what I observed was that this was for the most part lip service. In reality they were using the same old reductionistic ways of thinking that I was well familiar with. I felt betrayed and disappointed. I want to be crystal clear at this point about what I am NOT saying: I am not claiming this reductionistic way of thought so dominant in the modern era does not have it merits and its uses. It does indeed have a good side to it, and a lot has been accomplished through this way of perceiving the world. But I did not attend TCM college to get more of the same. I had been a math teacher and had also studied logic in college and was quite good at that sort of thought, but in changing my career to Chinese medicine I was looking for a different way, a different approach to sorting through information. It wasn’t until I graduated that I was able to find some teachers who could offer some help in this desired direction.

I was recently in a conversation with Heiner Fruehauf, Ph.D., L.Ac., a noted sinologist-herbalist-classical scholar, about this topic that occupies my thought a good deal of the time, and that is: How we think in Chinese medicine, how we make meaning clinically. This topic gets insufficient attention in Chinese medicine education, and yet it is so important. It is as if we imagine there is only one way of organizing our clinical thinking—the TCM way of analyzing signs and symptoms that we learned in school. Heiner and I will publish the interview in a few months. I think it will be helpful to many people—at least that is my hope.

NUNM, where Heiner and I teach, is likely the only Chinese medicine college where courses in Chinese Cosmology and Symbolism are required parts of the program. Heiner’s own early background was in comparative literature and the European classics, and he moved on from there to Chinese literature and later Chinese medicine. These cosmology classes are his brainchild, and he is a compelling speaker in making his point that Chinese medicine is an ancient symbol science. My own studies in college focused on German literature and mathematics, so I received ample exposure to two radically different ways of thinking. In literature we need to think symbolically, but in math it is a linear-logical thinking that rules the day. Perhaps because of this I am acutely aware always that there is more than one way to formulate our clinical thinking in Chinese medicine.

I have written previous blogs about my interest in dream work in Chinese medicine (two chapters in the Neijing cover the diagnostic significance of dreams). In dreams obviously, at least if one accepts Carl Jung’s brilliant work (and that of others), we are dealing with symbols, not logic. This has made me particularly receptive to Heiner’s core message about Chinese medicine being a symbol science. Again and again in dream interpretation with patients I see Chinese medicine’s symbol system validated. Patients really do often dream in images that help us to understand their cases on a different level—I should say, if we are familiar with this type of symbolic thinking and our Chinese medicine symbols in particular.

If we come into the modern era in the West we see Gregory Bateson, a world-class scientist who worked in many fields, making the point that nature communicates in metaphor—literally in metaphor (not logic). Goethe, who was one of Bateson’s noted influences, claimed that nature is language. He meant it literally. I think the ancient Chinese saw things this way as well.

Bateson gave the interesting example of watching wolf behavior at a zoo. An adolescent male tried to mount a female in the pack. The alpha male grabbed the adolescent by the scruff of the neck and pushed his head to the ground where he held it for a bit. Bateson understood what was going on. Newly born pups are disciplined in exactly the same manner. The older alpha male was using a metaphor to communicate.

We treat poorly behaving little pups by pushing their heads down to the ground.

I am treating you the same way.

You are (therefore) nothing but a pup (still).

This is a variation of the famous “syllogism in grass:”

Grass dies.

Humans die.

Humans are grass.

Of course logicians jump up and point out the problems (logically) with this construction. What they want to see is the “syllogism in Barbara:”

Socrates was a man.

Men die.

Socrates will (therefore) die.

This type of logic though, although helpful to have in our kit as one tool to pull out when needed, will only get us so far in coming to understand our patients at a deeper level, especially the complicated cases. Metaphor, myth, images, these are the way in to a deeper understanding of our patients. It is as if we should require our prospective Chinese medicine students to take a term each of classical Chinese poetry and Zen poetry before beginning their studies. Personally I think this more valuable than college biology 101. Too often we are training our students to simply follow protocols without ever gaining any real insights into their patients. The protocol approach of course is helpful to a certain point, and I don’t want to be too critical of these efforts, but Heiner Fruehauf’s point has always been that Chinese medicine has the potential to be helpful even in very serious diseases—if we get this deeper level of meaning and allow it instead of rote protocols to drive our clinical thinking. The protocols will not get us there.

Our students at NUNM love this cosmology-symbolism perspective, and yet it has been my observation that they do not often bring this approach into the clinic treatment rooms. The only exception would be when patients share dreams as part of their intake interview (we often ask about recent dreams). Then some students occasionally can manage to bring in the material they have learned in the cosmology classes. It is surprising to patients and interns alike how these dream images are helpful in understanding their conditions. But in general, students have not yet managed to transition from our culture’s near exclusive focus on the logical method to a more symbol-oriented way. This should come as no surprise and does not in any way reflect a failure on their part—or on the part of our program at NUNM. Every waking hour of their lives they have been subjected to the implicit and explicit message that there is only one valid way to make meaning of things. It is now automatic for them to think this way. It takes real sustained effort to achieve “escape velocity” and to cut free from the gravitational pull of this cultural myopia.

A few years ago Heiner and I had a conversation in which I suggested that our accreditation standards ought to include a class in epistemology. He agreed. Epistemology is the branch of philosophy that studies the nature of knowledge, especially in terms of its limits and validity. We do after all practice a 2000-year old medicine; how one thought in the Han Dynasty is not how people in our modern culture commonly think. The ancient Han way and the modern positivistic way could in fact not be more different. It is nothing more than a modern conceit that our current way of thinking and coming to meaning is the only legitimate way. This wholehearted and exclusive embrace of the modern is quite common in our Chinese medicine community in the US. I am always saddened when practitioners feel proud to have abandoned all traditional ideas and strategies in the embrace of an exclusively modern approach to acupuncture. I have no argument with innovations—in fact I support moving our medicine forward in all kinds of ways—but there is no need to entirely abandon the old in sculpting something new.

I went to Japan in 2007 to study for ten days at the Meridian Therapy Summer Institute. While there Ikeda Masakazu came by to see our group for two hours. In talking he mentioned one thing that struck me. He said: “I can’t think and treat a patient at the same time.” Fascinating. I believe I understood him properly to be saying that he entered a state of flow with a patient and at that point discursive thought was not needed. His hands already knew how to understand what was to be done and knew how to assess how the treatment was progressing without being analytical. His treatments are a doing, not a thinking

The great German literary figure Johann Wolfgang von Goethe was also an amateur scientist. In fact he was much more proud of his work in science than of his significant literary accomplishments. He said something similar: “My thinking is a perception and my perception a thinking.” In other words, thought and perception were in him married. What we are taught is not this Goethean way; we are taught to perceive and then think about what we have perceived. That is quite different. It lacks the immediacy of the Goethean approach. It’s the difference between asking the meaning of a given finding and seeing that finding as an instance of meaning. I think this is where we need to go as practitioners, and we would be wise to include it in our education.