If you are new to Traditional Chinese Medicine I suggest reading my other posts on the topic first (1, 2, 3, 4)
For many Westerners “Traditional Chinese Medicine” brings to mind an image something like this
However this is not what TCM looks like in most of China. At the hospital where I work there is a TCM department, their patients are mostly elderly and have been referred for pain management, not yin and yang disharmony. TCM is shifting from local practitioners who collected their own herbs to massive TCM pharmaceutical companies, the entire system is changing. I thought today we should wrap up our look at TCM by discussing its possible future.
Medications
It may surprise many of my western readers to learn that Chinese herbal medicines usually look nothing like that picture above. Now most cures come in the form of a pill, a powder, or a pre-mixed tonic; gone are the days of an individualized prescription.
As TCM pharmaceutical companies strive to package the herbs in a more palatable form, they are slowly moving away from whole herbs to isolated active ingredients. This is exactly what happened in Western Medicine almost 200 years ago.
The major difference that remains is the approach the two systems take to dosage, as western medicine is typically a once daily pill. TCM prescriptions however still require multiple doses (highest I’ve seen is 6/day), but this is changing as Chinese society becomes more focused on convenience.
TCM herbal cures today
Diagnostics
For decades TCM has insisted that modern scientific methods could not be used to evaluate the efficacy of TCM cures, because their diagnostic approaches were completely different. For example it is not uncommon for similar symptoms, which may be diagnosed as one disease in modern medicine, while it could be seen as distinctly different problems in TCM.
However recent labeling requirements by the drug regulators in the US and the EU require scientific studies that show these are effective in treating the ailments described. In the interest of profits many TCM pharm. companies have dropped their previous reservations about these tests in an effort to reach new markets.
Being able to claim that herbal cures are effective by western standards implies that the TCM diagnostic system is not necessary. If you show that a certain herb is effective in combating bacterial infections, means that the root cause was never an excess of “heat”.
I think in the next few decades, TCM’s role will shift away from diagnostic work, but will continue to produce medications that are based on traditional ideals.
Acupuncture
This is one aspect of TCM that will remain in-use and keep its distinct identity (partially because of its popularity abroad at the moment). However as the TCM diagnostic system declines, acupuncture will shift from being used to re-calibrate the system, and become used largely for subjective treatments (pain management, nausea reduction…).
Currently my hospital is experimenting with the clinical use of herbs and acupuncture for similar purposes, and are having some good results.
Interesting note for scientific minded people, acupuncture methods are tested against sham acupuncture (needles in non-meridian points) to help control the placebo effect.
I am hopeful for the future inclusion of traditional knowledge in modern medicine. TCM is a treasure trove of cures that were discovered over thousands of years of experimentation, and soon the useful bits will be absorbed into modern medicine to benefit all people, without the false promises and scams that currently affect TCM.
Note: I am basing these conclusions on discussions I’ve had with employees of my hospital’s TCM department, as well as discussions I’ve had with students and co-workers about their views on these products, which were largely negative.
First i must state that my wife is a Dr of TCM here in Shenyang so i am not entirely neutral on the matter, and that i have not yet had the chance to read the other parts of the story, so my comment refers to only the above.
Regarding acupuncture testing. It has also been tested against sham acupuncture and conventional western treatments in order to test it’s effectiveness. The test was for back pain Group A given western meds/pain killers Group B given sham acupuncture and Group C given the real acupuncture. The results were in the region (i forget the exact %s) Group A 30% improvement Group B 40% improvement and Group C 45% improvement. There are two things about this that should be noted first although there is a clear difference between Western pain killers and the other two group there isn’t too much of a difference between B and C. Furthermore the placebo effect is thought to be effective for about 40% of cases and so again there isn’t too much of a difference between real acupuncture and the placebo. (I am not saying it is without value as even if only as a placebo effect is has some merit).
The other point is that in order for a test to be carried out properly it should be a ‘double blind’ test ie) one where the patient and the person giving the treatment don’t know if it is the genuine treatment or not. Thereby not unduly influencing the out come of the test. It may be possible for the patient to pick up on something the treatment giver does that may influence the outcome. This is the way most western meds are tested. Unfortunately with acupuncture it is impossible to do this as the treatment giver will need to know if the acupuncture point is a genuine one of not.
In regard to herbal “teas” if you go to a TCM hospital, such as my wife’s, they still make up prescriptions of various herbs as shown in the photo above.
On a personal note after a trip to Changbai Shan in Jilin province my shoulder became unbearably painful, to the point i couldn’t move it at all without the feeling that someone had stabbed me with a knife. We tried all manner of TCM, from herbs, acupuncture, massage to hot cups and nothing worked. That night i went out for a meal with the in-law and my father-in-law gave me some baijiu…after that i had no problems at all, no pain, no stiffness and my mobility was normal. They really should look into putting baijiu in the health care service!
I almost linked to the placebo effect wiki page, just because it has been observed in the treatment of so many diseases, like you said it effects about 35% of people. My hospital is a very large one, so the TCM department has become a bit more….commercial/efficient. Many of the “teas” are pre-packaged, but there are still smaller shops that offer the more traditional type you mentioned.
For pain management, placebo effect is just as good as interfering with pain signals. For some of the more fantastical claims I’ve heard, it’s dangerous for the patient’s health to ignore the very real medical problems.
Thanks for this more exact comment.
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