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The Future of TCM is Western Medicine

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.

Eating Everything – TCM and Chinese Cuisine

“In Guangxi we eat everything with 4 legs but tables and chairs, everything in the ocean but submarines, and anything in the sky but airplanes,” a giddy student told me when I asked about local dishes. It turned out that this was much closer to the truth than I had imagined at the time.

In my four years here in China, I have been introduced to a variety of foods: roast dog, snake soup, chicken ovaries, duck stomach, goose intestines, a variety of fowl flippers, and pig arteries, brain, and even urethra (my previous post on dog meat). I’ve seen so many animals served up that I doubt that there is even a Chinese word for kosher.

Behind many of these strange dishes are concepts from TCM. It’s actually hard to get through a trip to a Chinese barbecue without being told that X is good for your health.

Many local cuisines feature flavors and spices that attempt to ward off illnesses caused by the climate. According to TCM theories, Sichuan is very damp, so the overload of chilies is to prevent “damp” related illnesses.

Another example is dog meat, which is considered to be very “yang” or “hot” (this usually implies it is good for male virility). So dog meat tends to be a winter food to protect your body from “cold” illnesses. As a result I have been told by countless students, that if I have a cold (actually a “hot” illness) eating dog could aggravate the symptoms, and possibly kill me.

As I mentioned yesterday, many other TCM beliefs are based on sympathetic magic. The powers of many rare or powerful animals are absorbed through their organs, or by drinking special alcoholic tonics that have been improved with real bits of animal.

In Jonathan Watts’ book “When A Billion Chinese Jump” (which I will be reviewing soon), he points out the wider ecological impact of China’s culinary pursuits. Perhaps the most disturbing is his account of a tiger farm, where the park’s restaurant serves up “secret” dishes prepared with tiger meat for 500RMB. Watts also reported last year that the Beijing zoo had been selling various wild animal dishes too. For now he said the most common Chinese reaction to seeing a new animal is “how does it taste?”

He also notes that pangolins, which used to be common in my former home of Guangxi, are now exceptionally rare due to poaching. Because of the high prices that often come with TCM treatments, their populations have also declined in Malaysia and Indonesia. TCM claims that their flesh improves blood circulation (so does aspirin).

Watts says that the Chinese gov’t is willing to protect TCM at the cost of China’s biodiversity. Considering the governments condemnation of religion as anti-science, this seems a bit hypocritical.

In many cases though this is a false choice, TCM and China’s animals do not have to be at odds. The best case for this is bear bile.

In China TCM pharmaceutical companies currently run bear farms. These practices have not only been exposed as being disgustingly barbaric, but threaten the popularity of TCM as Chinese people are slowly becoming more opposed to animal abuse.

The problem is that bear bile actually does contain a chemical that has some health benefits (ursodeoxycholic acid). TCM treatments insist on whole bear bile. To collect this, thousands of Asiatic black bears are kept in cages so small they cannot move, and in some cases have permanent catheters inserted directly into their gall bladders to allow easier collection. Current estimates place total production at over 7,000kg/year even though there is only demand for 500kg. This has led to it being added to an increasing number of TCM based products that are completely inconsistent with tradition.

This savagery however is entirely unnecessary because this active ingredient can be synthesized. If TCM practitioners would accept this as the valid substitute that it is, we could stop the suffering of these animals.

The problem is that the gov’t media portrays this option as an assault on culture, instead of acknowledging that modern medicine has actually endorsed an active ingredient from TCM.

If you are interested in learning more about bear farming, and the efforts being made to stop this practice, please visit Animals Asia 

An example that I was surprised not to see in Watts’ book was shark fin soup. Widely believed to be an excellent booster of Qi, but actually contains no additional nutrition beyond vegetable stew. You can learn more about this destructive practice here

Tomorrow we’ll be looking at the future of TCM

An Introduction to Traditional Chinese Medicine – 2000 years of practice in ~600 words

When I tell other foreigners that I am working in a Chinese hospital, the conversation often takes a quick detour to Traditional Chinese Medicine (TCM). Often they tell me that TCM is a much healthier choice, the evil of big pharmaceutical companies, and how thousands of years of practice have made TCM more effective. There is a lot here to unpack.

Today though we’ll just be building a basic understanding of some of the concepts central to TCM. Bear with me, understanding TCM is essential for understanding how Chinese culture views intricate systems, not just the physical body.

Modern TCM generally traces itself back to a book from the 1st century BC called “The Yellow Emperor’s Inner Cannon.” This led Chinese medicine from focusing on supernatural/mystical forces  to natural/environmental forces. It is through this writing that we see concepts like Yin and Yang, Qi and the five-elements that become incredibly influential in the ancient Chinese understanding of the cosmos.

Illness

In these first two basic concepts the most important aspect is always balance between these forces. Too much of any of these is just as problematic as too little, and this disunity leads to illnesses.

Yin and Yang – complimentary forces like (yin example first): dark and light, woman and man, yielding and forcing, cold and hot, internal and external.

Five-Elements – These forces are seen as generating and limiting each other. These elements relate to different organs, senses, colors, and tastes. Which can be used to determine which are out of balance.

  • Generating cycle: Wood->Fire->Earth->Metal->Water->Wood
  • Limiting cycle: Metal->Wood->Earth->Water->Fire->Metal

These five-elements also relate to different Yin and Yang “organs” of the body (I use “organs” because the concept is not the same as the Western understanding). These “organs” store and regulate Qi and are nourished by the blood. Restricted flow of Qi, or blockage of Qi along the meridians (like vessels for Qi) can also cause illnesses.

Note: Qi is a concept that doesn’t translate well into English. It is something like a life-force which comes from food and air, but also comes from your parents, and diminishes over time. Unlike blood, it is an invisible force.

These forces are all part of one unified system, and should be thought of as co-existing.

There are other types of forces that can cause illnesses, but I’m afraid this already fairly confusing.

Cures

When these forces become unbalanced, the treatments strive to restore the initial harmony. My TCM enthusiast friends like to say that Western medicine treats the symptoms (not actually true) while TCM treats the underlying cause.

Herbs – Over 13,000 ingredients are used to concoct over 100,000 medicinal recipes in TCM. These ingredients range from run of the mill (ginger, ginseng, rhubarb…) to the fantastical (dried seahorse, rhinoceros horn, any kind of animal penis…). Traditionally these are mixed together to create a kind of tea or soup that should be consumed several times a day, but recently many of these have been pressed into pills (still taken several times a day).

we will be looking at the effects of this in daily life more closely tomorrow

Acupuncture – While easily recognized in the West, I think its purpose is poorly understood. The basic idea is that Qi can become blocked along certain meridians, and acupuncture can help stimulate its flow. The points on these meridians connect with the different organs and systems, so acupuncture can be used to push the system back into balance. It has been proven effective for pain management and controlling nausea, but few clinical studies exist that compare it to placebo effects.

Talking about Traditional Chinese Medicine with Chinese Doctors

A few months ago my friend told me that she had a small tumor. The doctor said that it was benign and she could either have it removed with an operation, or try to reduce its size using Chinese medicine. She opted for the Chinese medicine. 3x’s a day for months she drank the thick brown bitter liquid which was distilled from bear bile, birds nests and shark fins.

Now I try to keep an open mind about alternative medicine, and I think there are many things in Chinese medicine that have promise for medical applications, this however doesn’t seem to be one of those times. For four months my co-worker wasted her money on this concoction with no results. The sad thing is I know the hospital is selling this “treatment” partially because of the money they receive in exchange for pushing this product. We just hide behind the name of TCM (Traditional Chinese Medicine) when there is no clinical proof that this is in any way an effective medical treatment.

These aren’t just my opinions either, many Chinese doctors who have been trained in “western” medicine worry about the effects of TCM too. One mentioned that often the patients are unaware of the side-effects of the traditional cures, and arrive in our hospital with liver or renal failure. Even the TCM doctor pointed to the fact that many people are graduating with only 3 months of study and calling themselves traditional healers, when really an apprenticeship and study takes almost as much time as becoming a doctor.

Of the 6 doctors I talked with, 3 of them said they would never take TCM treatments, 2 of them said they would take Chinese herbs for a cold or minor illness, and only one said she would take them for any serious disease (my friend who took the drugs for her tumor).

All of the doctors though agreed that they would like to see more regulations concerning TCM to protect the reputation of the practice. The TCM doctor said that he was very disappointed to see how commercialized it had become in the past decade, and how easily universities were handing out diplomas.

The TCM doctor was saying that he saw TCM’s role as accompanying Western medicine in a pain management role. For example, chemotherapy patients often struggle with side-effects which, according to patient reports, can be better controlled with acupuncture for pain and herbs for stomach problems.

Ultimately more clinical research will be useful in proving that there is value in TCM, protecting the integrity of the practice, and at the same time will help to protect Chinese patients from “cures” that delay them from getting proper treatment.

500 Million infected with TB – News Story of the Week

A few weeks ago I wrote “Can Culture Be a Problem?” in which I detailed some of the public health problems that are common in China, and how they are at least partially perpetuated by ideas in Traditional Chinese Medicine.

This weeks story highlights one of the problems, tuberculosis, and it’s prevalence in China, and that many of the sufferers are not aware that they are carriers of the disease. Not surprisingly, People’s Daily failed to mention that TB is easily spread by spitting.

According to one of the doctors at my hospital, China had actually largely eradicated TB just a few decades ago through a large medical campaign. This was done through the creation of large hospitals that specialized in treating this disease. That is why, she explained, that many of the doctors today think TB is not so common in China.

Unfortunately with little emphasis placed on improving ideas about public health, TB has once again flourished in China.