How East-West Cultural Differences Shaped Eastern and Western Medicine

In depression, the chief complaints of Eastern and Western patients differ. Patients with depression in Europe, America, and similar countries emphasize that they are worthless. The most famous depressive patient, British Prime Minister Churchill, said a classic line: "I have done many things in my life, but have accomplished nothing." Churchill fought this negative view of himself all his life, and so he also said: "All men are worms, but I believe I am a glowworm." He used this to dispel his depression. But depressed patients raised in Eastern culture emphasize fatigue and bodily pain; feelings of worthlessness are not their focus.

In reality, low self-evaluation (lack of worth), bodily pain and fatigue, and even constipation, hypersomnia, or insomnia are widespread among depressed patients, whether influenced by Eastern or Western culture. But the symptoms these patients perceive as most typical are completely different, which shows culture has a profound influence on disease.

One possible reason is that Eastern culture is immune to nihilism. The philosophies of Zhuangzi and Laozi and of the Buddha are immensely popular in the East; almost everyone raised in Eastern culture recognizes the ultimate vanity of life and is psychologically immune to it. So depressed patients raised in Eastern culture are also immune to feelings of worthlessness; since the whole society accepts that life has no ultimate meaning, they naturally do not emphasize this symptom, instead focusing on bodily pain and fatigue.

Scholars such as Daniel Schacter argue that cultural differences between East and West greatly influence the thinking of people raised in the two settings. People raised in Western culture tend to process information analytically, focusing on the object or person itself rather than its context; people raised in Eastern culture tend to process information holistically, focusing on the object or person and its relationship to its environment.

This difference is especially evident in Eastern and Western medicine. Western medicine focuses on fine-grained study of the human body, built on anatomy; Eastern medicine (including ancient Chinese and ancient Indian medicine) emphasizes the relationship between humans and environment. TCM stresses holism, holding that humans and nature, society, and family form a closely linked whole that prospers or suffers together, and that the external environment affects human health; ancient Indian Ayurveda agrees.

Today we know that each of these two grasps only one end and neither sees the whole elephant.

With the rise of epigenetics and precision medicine, people increasingly find that Eastern medicine has a certain rationality. Epigenetics studies the environment's effects on organisms, so biology students easily accept TCM's holistic view; likewise, TCM physicians feel at home learning epigenetics, because epigenetics' basic ideas align closely with TCM holism.

Epigenetics has found that environmental factors cause methylation of some genomes in organisms, an important cause of disease. Modern biologists are therefore seeking ways to demethylate, understanding disease through the principles of histone modification and searching for drugs to treat it.

TCM also holds that people fall ill under external environmental influences (such as the six exogenous pathogens TCM often names—wind, cold, dryness, dampness, summer-heat, and fire), and that TCM treatment aims to eliminate the harm these influences do to the body. TCM also holds that the seven emotions are important causes of disease, calling illness caused by them "emotional disorders." Findings from modern brain scientists, psychiatrists, and psychologists show that such diseases also result from environmental influences early in life (fetal and childhood), and are in effect an epigenetic phenomenon.

The future of medicine must lie in fusing the strengths of Eastern and Western medicine. Life is complex; we cannot ignore TCM holism, nor Western fine-grained research, nor the evolutionary viewpoint.

Evolutionary medicine is a medical perspective that has arisen only in recent decades; until twenty years ago most people had not heard of it. But today it is becoming a formidable force rising in the medical world. Evolutionary medicine looks at human diseases from an evolutionary standpoint, analyzing how human illness relates to human evolution in nature. Cancer, for example, relates to human reproduction and evolution. People carrying proto-oncogenes bear, on average, more children than those who do not, meaning proto-oncogene carriers have an evolutionary advantage.

Although we now see division between East and West in many respects, biologically the conflicts and integration driven by today's globalization will surely, in future, fuse Eastern and Western ways of thinking into a whole inherited by our descendants. Eastern and Western medicine will do the same: after collision and fusion, they too will blend into a whole, becoming a new kind of medicine.

Signs are already appearing. Edmund Bourne is a famous expert on anxiety disorders and phobias; his *The Anxiety and Phobia Workbook* is popular among physicians and patients worldwide and is now in its sixth edition. In his books we see abundant advice on diaphragmatic breathing, meditation, and sitting quietly—how does this differ from ancient Chinese qigong and sitting practice, or Buddhist dhyana? Seligman studied the benefits of virtuous conduct for the mentally ill and encouraged them to join public-welfare activities—how does this differ from Buddhism encouraging believers to give alms and release captive animals, holding that such activities bring health?

Disease is not a modern problem; humanity has fought physical and mental illness since ancient times. Ten thousand years ago the human brain had already evolved to the level of modern humans; that is, we are not smarter than our ancestors of ten thousand years ago, only richer in accumulated knowledge and technology. Whether Easterner or Westerner, the cultural and medical experience groped out over ten thousand years is practical. How to fuse ancient and modern, Eastern and Western medicine for patients' benefit is a question worth our thought.