Traditional Chinese medicine: Compare China with the U.S.


I've written quite a few times, both here and elsewhere, about the sham that is known as "traditional Chinese medicine" (TCM). Basically, there is no such thing as TCM per se. There were in the distant past many "traditional Chinese medicines," various folk medicine traditions that, contrary to what is taught now, did not form a cohesive system of medicine that worked. Then, in the 1940s and 1950s, Chairman Mao Zedong, unable to provide "Western" science-based medicine to all of his people, popularized Chinese folk medicine as "traditional Chinese medicine" and exported it to the world using language eerily reminiscent of the very same language used today to promote "integrative medicine" not as integrating quackery with medicine but as integrating the "best of both worlds." Thus was born the myth of TCM, helped along by convenient stories of "acupuncture anesthesia" and other stories of the seeming wonders of TCM.

Oddly enough, as the popularity of TCM has increased in the "West," even in places that should know better, such as academic medical centers like the Cleveland Clinic, with scientists casting the proverbial pearls before swine by using advanced scientific techniques such as systems biology techniques.

Odd, then, that back in China the Chinese themselves do not seem nearly as enamored of TCM as us "Western" types. So sayeth an English language version of a story in the South China Morning Post the other day, which starts out with an account of a seeming role reversal:

It's a proud tradition dating back thousands of years, that's in danger of being supplanted by an arrogant young upstart that muscled its way in just a couple of hundred years ago.

Traditional Chinese medicine (TCM) has suffered many affronts at the hands of the proponents of Western medicine, yet the latest attack has really got people's blood pumping.

Celebrity blogger Ning Fanggang, a Beijing-based doctor practising Western medicine, is the latest public figure to criticise TCM as a pseudo-science that borders on the fraudulent.

His offer of 50,000 yuan (HK$63,200) to any TCM doctor who can correctly tell if a woman is pregnant, in at least 80 per cent of cases, merely by holding her pulse appears to have hit a nerve with clinical precision.

Pulse-touching is one of the basic diagnostic steps in traditional medicine.

Not surprisingly, not a single TCM practitioner has tried to claim the prize. They are, however, full of the usual excuses, none of which would surprise a regular reader of this blog: It's not just pulse diagnosis. It's seeing, smelling, asking, and touching. To that, I'd answer: OK, use whatever TCM means at your disposal that you'd like. I still bet you couldn't correctly tell if a woman is pregnant 80% of the time. From where I stand, these TCM practitioners are just making excuses.

The rest of their defenses of TCM are full of the same misinformation, equivocations, and, above all, attempts to make it sound as though TCM is ahead of the curve and that "Western" medicine is only now starting to see things the same way as TCM practitioners. Above all, if TCM practitioners are to be believed, the only reason why "Western" doctors are suspicious of TCM is because they don't understand it. Of course, in reality, the reason that physicians who practice science-based medicine don't like TCM is because they understand it all to well. They understand that it is a system of medicine invented by cobbling together elements of various strands of Chinese folk medicine. Even if they don't know about the true history of TCM, they recognize that acupuncture, tongue diagnosis (think reflexology, only substituting the tongue for the soles of the feet and palms of the hand), pulse diagnosis, and the vast majority of TCM treatments are not based in science, but rather a prescientific understanding of the world. Sure, the occasional herb might have real medicinal properties, but, overall, just because something is ancient doesn't mean it works.

Not that that stops Dr Zhong Nanshan from leaping to the defense of TCM:

Zhong, a respiratory specialist trained in Western medicine, said it was wrong to claim that TCM was unscientific. "I think the TCM doctrines that illness should be treated in a holistic manner and that doctors should try to prevent illnesses can indeed be scientific," he said.

"In TCM theory, organs of our body are connected with each other and doctors should treat diseases by regarding the person as a whole [rather than checking only a specific part of the body]. "These are the TCM ideas that I think highly of."

Except that there's nothing in these ideas that are inconsistent with science-based medicine or that require TCM. All good doctors are holistic doctors, no woo or quackery needed. It's the same false dichotomy here, the implication that in order to practice truly holistic medicine you must embrace quackery like TCM.

Now follows the attempt to shoehorn TCM concepts (poorly) into science-based medicine:

Zhong gave the example of a cancerous tumour. Western medicine tended to focus on killing or removing the tumour tissue, he said, but in many cases this still would not prevent the patient from dying. But a TCM specialist might advise the patient try to live with the tumour, and focus their efforts on improving their quality of life instead. In some cases, Western doctors were now coming round to a similar approach, he said.

"TCM proposes supporting the growth of positive energy inside our body in order to conquer evil energy," he said. "Tumour doctors around the world are changing their goals [and advocating that patients learn to live with tumours]."

Yes, there is an understanding in oncology that's been developing over the last couple of decades that it might not be necessary to kill some tumors completely, that it might be possible to turn some forms of cancer into chronic diseases, much like diabetes or hypertension, diseases that can be managed and with which a patient can live a long time, even to a full life span. This idea first gained wide currency back in the 1990s, at least as far as I can remember, when Judah Folkman first demonstrated that antiangiogenic therapy (targeting the blood vessels that sustain a tumor) could be an effective anticancer treatment. Dr. Folkman used to speak openly of turning cancer into a chronic disease, and it seemed an appealing concept for tumors that can't be completely eradicated. Of course, what Zhong forgets to mention is that, as yet, this sort of strategy doesn't work for the vast majority of cancers.

Of course, that next bit about "positive energy" conquering "evil energy" is utter vitalistic nonsense. What Zhong is trying to do, whether he knows it or not, is to argue that, just because "Western medicine" has, through science, come to the conclusion that in some cases it might be feasible and desirable to maintain stable disease (cancer that no longer grows or progresses), somehow TCM is validated.

Ironically, if Zhong is to be believed, there is now open hostility towards TCM in Chinese universities where it is taught. No longer is it taught exclusively, but rather always with "Western" medicine, and those who study it are apparently becoming discouraged:

While it may be wrong to interpret Western medicine and TCM as mutually exclusive approaches, TCM proponents say the constant negativity is starting to affect students.

Fu said that given the hostile atmosphere, students majoring in TCM often questioned what they were learning. He said their minds were easily "captured" by Western medicine.

This is good. It's also hard not to contrast it to the US, where medical student's minds seem to be relatively easily "captured" by the mystical gobbledygook of TCM. Certainly our academics are, to the point that TCM, particularly acupuncture, is finding its way into large numbers of American medical schools and academic medical centers, something I've documented here time and time again. It's rather amusing to see what is happening in China:

"This is the inevitable outcome of a teaching over the past few decades that includes a hefty amount of Western medicine knowledge," said Dr Liu Lihong, from Guangxi Traditional Chinese Medical University.

"Among the graduates from TCM universities, there are very few who can truly adopt the thought, spirit and method of TCM to solve problems."

Qi said that when he attended TCM college three decades ago, 30 per cent of classes were on Western medicine, such as anatomy and pharmacology. The proportion had risen to 50 per cent in recent years, he said.

On the one hand, you could look at this as contaminating anatomy and pharmacology with mystical woo. On the other hand, the proportion of science is, if Zhong it to be believed, rising, and the proportion of TCM woo declining. This is a good thing.

I must admit, however, that there is one thing in this article that's hard not to agree with. Apparently Vice-Premier Liu Yandong gave a speech in which he stated that there "should be 'top-level designs' for the development" of TCM. He also said:

"We should reflect and our education should be adjusted," Liu said. "After all, traditional medicine is not a part of modern science. It has its own character and we should adhere to it in teaching and developing it."

That's hard to disagree with. It's a system of medicine based on prescientific vitalism and an understanding of how the human body works that is based in mysticism, not science. Actually, on second thought, I disagree with Liu. Such a system should not be developed at all. Perhaps in a generation or two, as Chinese youth comes to accept science-based medicine more and more and matures into physicians and other medical professionals and then into leaders of the medical profession training the next generation, superstitious nonsense like TCM will fade from China.

A guy can hope, can't he?


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Embrace the chai.......tea.

Good on Dr. Ning for his put-up-or-shut-up prize offer.

It's poetically appropriate that the TCM pusher has the surname Zhong. The most common character with that transliteration is the one Chinese use to refer to their country (Zhongguo, literally "center country", or "Middle Kingdom" as some translate it). If I were writing fiction, I would avoid that surname--especially in a TCM practitioner--for exactly that reason. It would be like a SBM practitioner having the surname Xi (west).

By Eric Lund (not verified) on 17 Dec 2014 #permalink

I've always wondered, if TCM is so bloody good, why was the average lifespan of rural China in the early 1900s, which should have been the time when TCM was prominent, 25 for men and 24 for women?

(women lived shorter lives because they died in childbirth)

By Marry Me, Mindy (not verified) on 17 Dec 2014 #permalink

Erick Lund @2

And Nick Fang Gang is a totally bad ass name for an SBM advocate.

By Militant Agnostic (not verified) on 17 Dec 2014 #permalink

Regarding acupuncture anesthesia:

An anesthetist colleague witnessed one of these procedures - abdominal approach to remove uterine fibroids.

He reported the acupuncture was assisted by intravenous pethidine, a prilocaine rectus sheath nerve block and peritoneal irrigation with prilocaine.

He commented that, with some oral sedation as a premed, there was no need to add the magic touch of acupuncture.

The desire to see science and medicine as being every bit as culturally specific as food and music is strong. People want their tribe to have their own 'ways.' Couple this with the tendency to lob religion and spirituality into the mix and view these systems as primary explanations for a "holistic" system and you've got a recipe for disaster.

Science says some things are wrong. How intolerant of it.

Traditional Western Medicine also had a problem with that science-based stuff infiltrating in. In fact, there are practically no true TWM practitioners today. This cultural tragedy is no doubt compensated for by the much longer and less disease-ridden lives people in western countries tend to live today, especially since few people seem to have been emotionally too attached to the TWM ways.

By justthestats (not verified) on 17 Dec 2014 #permalink

I still bet you couldn’t correctly tell if a woman is pregnant 80% of the time

Because sometimes, a lady is too busy doing dishes to do sbm or tcm-- as God intended.

From a reader comment on some blog somewhere:

Shows a woman with a huge family washing dishes with her teen daughter, baby falls out on the floor and she says to her daughter “Get it will you, Deirdre?”. . . completely the opposite of the techno machine that goes ping one.

Funny, I can't seem to find a clip of that -- It is in MP, Meaning of Life.

justthestats wins the thread. We need to run with this TWM. Only problem is so many woos call SBM "Convential or even Traditional Medicine" just the way organic famers us the term "conventional or even traditional" farming to refer to using industrially produced pesticides, herbicides and fertilizers.

By Militant Agnostic (not verified) on 17 Dec 2014 #permalink

"The desire to see (x) as culturally specific is strong."

But that's only visible where cultures come into friction, otherwise cultural specificity is just the water in which the fish swim. When a smorgasbord of cultural difference appears, the desire to hold onto one's traditional ways is balanced (if not exceeded) by grass-is-always-greener desire for some Other in search of the better-than-routine thing that MUST be out there somewhere.

Reggae sold more records in the US and UK than in Jamaica. Mid-level American rock bands sell out stadiums in Japan. Etc. Etc. 'TCM' isn't just a promise of magic to Americans, It's an exotic magic that signifies the user is more discriminating and cosmopolitan and enlightened than the sheeplie mob. Otherness is the universal currency of Hip, 'tradition' the domain of the squares. If Chinese consumers queue up at the medical steakhouse, and U.S. consumers queue up for medical Jade Rabbit Sea Cucumber, it's hardly a surprise. (Yes, I know the JRSC is probably healthier than the fare at Ponderosa, and the rising popularity of Western medicine in China is probably aided by the fact it actually works. Still...)

Those who hold to 'tradition' in the 21st Century are likely grasping historical chimera. Industrialization and especially mass media severed cultures and sub-cultures from the chain of practices actually handed down over centuries. 'Tradition' is a socio-cultural function in the now, and what fills that function best under the circumstances is likely to be crafted via artifice, turning a variety of diverse historical influences into a new thing.

As Orac notes, 'TCM' was an invention of the Chinese CP as a response to the pragmatics of maintaining some sort of civil order amidst post-WWII / Cold War resource scarcity. It's no more an authentic historical Chinese tradition than The Little Red Book is. But if the past is what the media says it is, a fake tradition doesn't just do the same job as a 'real' one, it works even better.

What would you consider the most "authentic" form of American pop culture, or the cultural form most understood in terms of 'tradition' by it's consumers? Would country music at least make your top three? Country music 'tradition' is a simulacrum, a fake, it's 'authenticity' an utterly manufactured fabrication. (See Richard A. Peterson, Creating Country Music, U. of Chicago, 1997.

Peterson doesn't argue there's anything wrong with that. He teaches in Nashville (Vandy) and he likes Country. Trained as a sociologist, he's mainly fascinated by how all the complex parts fit together to yield something that 'works.' But he's not stupid enough to tell a bar full of Good Ol' Boys singing along to 'Red Solo Cup' that none of the musical progenitors whose styles were cobbled together to create the music of Country ever wore cowboy hats.

So, what does any of this have to do with the spread of 'TCM' in quackademia? Good question, and I've only got some very tentative hypotheses. As much as I think 'wrong on science' is an inadequate counter-attack to woo, I'm thinking there isn't much purchase in noting a) the actual Chinese are moving away from TCM or b) the current version of TCM was made-up in the service of Mao-ism. As far as b) goes, I'm guessing the fans will just shut their ears and turn up whatever serves as their inner 'Red Solo Cup.' And with a) well of course those new-age Chinese are just dupes of American mediocrity, and blind to how extra-special their mystical ways are by comparison.

When science says something is wrong, folks may take that as an abstract intellectual proposition, and intolerant with its 'smarter-than-thou' posture. The most oft uttered maxim of screenwriting (and film directing) is "show don't tell." For non-scientists, being told something is wrong-on-the-facts pales next to seeing that something is Just Wrong.

A fat pile of cash compiled by a con-man? That's Just Wrong. A person visibly suffering from a severe illness because a quack led them away from effective treatment? That's Just Wrong. When someone advised by some Zhong to live with their tumor dies from their tumor (esophageal cancer could make an effective illustration?). That's. Just. Wrong. And if anyone's going to be seen as intolerant doing that "show", I'm betting it won't be the medical scientist.

I'd argue that TCM actually is traditional at this point. Tradition is what your grandparents did, not what their great-great-grandparents did. After all, traditional Italian cooking features tomatoes prominently, and tomatoes are only native to the Americas, so they can't have been traditional too long.

By justthestats (not verified) on 18 Dec 2014 #permalink

I'd say that jazz and blues music represent the most uniquely American genres.

Orac wrote

Yes, there is an understanding in oncology that’s been developing over the last couple of decades that it might not be necessary to kill some tumors completely, that it might be possible to turn some forms of cancer into chronic diseases, much like diabetes or hypertension, diseases that can be managed and with which a patient can live a long time, even to a full life span. This idea first gained wide currency back in the 1990s, at least as far as I can remember, when Judah Folkman first demonstrated that antiangiogenic therapy (targeting the blood vessels that sustain a tumor) could be an effective anticancer treatment.

I am someone getting that type of treatment. I have renal cell carcinoma. The diseased kidney was removed July 29th 2013
but not before it had metastasize to my lungs. Ironically it was a needle biopsy of one of the spots which told them what type of cancer I had. (A kidney biopsy was negative! Man that news caused a bit of depression.)

I am currently using Votrient (pazopanib) as a treatment. Since starting it in mid January of 2014, the spots on my lungs have not gotten any larger. A couple of spots have gotten smaller. As I like to say, "I can live with that"). Nor have I've had any significant side effects. All in all, I am quite upbeat about my condition. Thank you Science Based Medicine!


By George Martin (not verified) on 18 Dec 2014 #permalink

Good for you, George Martin.
My sister-in-law had a bad form of that same cancer and died of it. So, I especially hope you continue to keep it under control.

And stick with SBM, which at least has some evidence it works.

By squirrelelite (not verified) on 19 Dec 2014 #permalink

And Nick Fang Gang is a totally bad ass name for an SBM advocate.

Or a vampire.

As has been noted before, Mao himself always insisted on Western medicine for himself while inflicting TCM on the masses. He lived to 83, despite being a heavy smoker.

what does it means Mr. JSG:
blues music represent the most uniquely American genres.