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An ICD Code for the Running Piglets!

… animals are divided into (a) those that belong to the emperor; (b) embalmed ones; (c) those that are trained; (d) suckling pigs; (e) mermaids; (f) fabulous ones; (g) stray dogs; (h) those that are included in this classification; (i) those that tremble as if they were mad; (j) innumerable ones; (k) those drawn with a very fine camel’s-hair brush; (l) etcetera; (m) those that have just broken the flower vase; (n) those that at a distance resemble flies.

— Jorge Luis Borges (1899–1986)1

Not too long ago, I came across a disease taxonomy proposed by a certain East-West Medical Research Institute (EWMRI), that includes the kind of fantastic afflictions — such as “running piglet” disorder — fit for the best Borgesian list.

This obscure institute, located at Kyung Hee University in Seoul, Korea, is one of the 800 WHO Collaborating Centres designated to carry out various activities in support of the Organization’s programs. With the collaboration of China, Japan, Vietnam, Australia, and the US, this center is working to incorporate medieval Asian disease nomenclature to the 11th version of the International Classification of Disease (ICD-11).

The proposed taxonomy that has resulted from the collaboration is called the International Classification of Traditional Medicine (ICTM). It resembles a shopping list made by randomly mixing a medical dictionary with Harry Potter, and reads like a Surrealist poem penned in a marathon Automatic Writing session. Right after influenza, dysentery, and cholera, one can find miasmatic malaria (瘴瘧)… pestilence (瘟疫)… plum-pit qi (梅核氣)… running piglet (奔豚)… wasting-thirst (消渴)… T-shaped malnutrition (丁奚疳)… umbilical wind (臍風)… syndrome of liver fire blazing the ear (肝火燔耳證) (ouch!)… and many other astonishing entries, which I invite you to browse for your own amusement — or dismay.

The 2007 version of the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region lists the proposed disease categories on pages 162 to 203.

The proposal suggests that “a future ICTM could comprise not only East Asian Traditional Medicine but traditional medicine practices from other WHO regions… such as India, Sri Lanka and Africa.” This leaves us to wonder whether “pacing zombie swagger” may figure as a possible entry if the ICTM decides to include the Caribbean one day?!

I recognize that the Korean research institute, the Kyung Hee University, and the health care community in Asian countries are free to believe in the existence of pestilence or miasmatic malaria, and can treat their populations with incantations, amulets, talismans, lancing, or even bloodletting, if they so choose. But what really concerns me is the possibility that these medieval views on disease might someday become legitimized in the US, not only because they fit New Age ideas and ideals, but also because they bear WHO’s seal of approval.

Traditional acupuncturists in many US states already practice medicine based on medieval views similar to those expressed by Avicenna (c. 980–1037) in the 1025 Canon of Medicine, which — although ingenious for its time — was already obsolete in the 17th century. This “medical primitivism” (the rejection of science-based and industrialized medicine) is the result of the counterculture of the 1960s, postmodern ideology, and the New Age movement. Trough political pressure, primitivism has increasingly become an acceptable form of healthcare in the US under the guise of “alternative” or “Oriental” medicine. An ICD that includes the “running piglet” might reinforce this political momentum, and might further the resurrection and re-legitimation of notions that are closer to fantasy than reality.

Indeed, as Jeannie Kang, an acupuncturist in Los Angeles, CA, and the head of the American Association of Acupuncture and Oriental Medicine (AAAOM) Korean Advisory Council, writes in Qi-Unity Report:

Incorporating traditional medicine into the ICD coding system for medical records and billing is an essential prerequisite for advancement of traditional medicine into the mainstream medical system. The WHO has agreed to work with a standardized terminology on the basic terms it has identified.

The last WHO meeting to discuss the ICTM was held in the Philippines, February 7–11, 2011.

I find that this “standardized terminology” bears a significant — and instructive — resemblance to the outlandish bestiary that Borges recounts in The Analytical Language of John Wilkins. Borges, whose Magical Realism blends facts and fiction liberally, attributes the passage he cites to an elusive Chinese encyclopedia called The Celestial Emporium of Benevolent Knowledge.

The naive oddity of the underlying logic of association that yields the Celestial Emporium‘s taxonomy has inspired considerable commentary, notably by the philosopher Michel Foucault, who writes in The Order of Things that it shatters “all the familiar landmarks of thought — our thought, the thought that bears the stamp of our age and our geography.”2 But more pertinently, the clinical psychologist, Louis A Sass, writes in Madness and Modernism that such oddity of thinking shows the signs of a typical schizophrenic thought pattern.3

Different cultures at different stages of their development have used different logics of association to categorize illnesses. Prior the advent of modern science, disease taxonomies (nosologies) were predominantly based on symptoms, and identified by means of vernacular naming systems. “Running piglet” is, for instance, a Chinese agrarian metaphor that indicates a panic attack. However, scientific nosology is predominantly based on etiology (causative agent) or pathogenesis (causative mechanism), except for idiopathic conditions. As a result, most ancient categories have disappeared: they are obsolete. “Melancholia” (meaning “excess of black bile”) is an example. Other categories are archaic: that is, when the name is used in modern nosology, it refers to a significantly different category. Malaria (originally meaning “bad air”) is a good example. The proposed addition to the ICD11 ignores this important paradigm shift.

Therefore, tossing modern and obsolete categories together into a single system of categorization, like the proposed ICTM, departs from common-sense, loses coherence, fragments into contradictory points of view, and ultimately turns into a “word salad”: a mixture of words and expressions that, while seemingly meaningful, actually carries no significance.

Lastly, I think the illogical nosology for which the AAAOM is “very excited” is the product of a style of thought that is, at best, idiosyncratic and odd. At worst, it is the hallmark of the cognitive slippage and technophobic delusions that characterize the modern apologists of unscientific medicine(s). In all, it is a significant leap away from reason, in the direction of the Dark Ages.

With special thanks to Kristin Koster, PhD, for her valuable contribution.

REFERENCES

  1. Borges, Jorge Luis (Author), Weinberger, Eliot (Editor). ‘The Analytical Language of John Wilkins’ in Selected Nonfictions. Penguin Books. 1999. Return to text
  2. Foucault, Michel. The Order of Things: An Archaeology of Human Sciences. Tavistock. 1985. Return to text
  3. Sass, Louis A. Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought. Harvard University Press. 1998. Return to text

Posted in: Acupuncture, Basic Science, Science and Medicine

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