traditional Chinese medicine - The Skeptic's Dictionary (original) (raw)
Traditional Chinese medicine is a hodgepodge of diagnostic and healing practices developed over many centuries across a vast expanse of land that roughly corresponds to what today we call China. Most of the history of these practices occurred without much communication between the many different areas where they originated. There was no central healing school and what medical practices evolved often involve contradictions. Most important, though, is that these practices evolved long before the development of science and science-based medicine. What is called Traditional Chinese Medicine (TCM) is a label that mischaracterizes two millennia of various healing traditions as if they comprised a monolithic brand. The expression 'traditional Chinese medicine,' without the capitalization of 'traditional' and 'medicine' is also a misnomer if meant to convey that there is a single tradition of medicine that has endured and evolved in an area of land that covers approximately 3.7 million square miles (9.6 million square kilometers) and over 1 billion people. The expression 'traditional Chinese medicine' originated in 1954 when used by Chinese communist officials for political reasons (Taylor 1995).
Nevertheless, there are several practices usually identified as part of TCM: acupuncture and acupressure, "herbalism" (in quotes because the term refers to the use of animal as well as plant parts and minerals), meditation, and subtle-energy fitness programs (chi kung [qigong] and tai chi [taiji]). There are other practices associated with TCM as well: moxibustion or cupping, gua sha massage, tongue examination, and pulse palpation. Underlying every aspect of TCM is a metaphysical system that has little, if any, correlation to science-based medicine. This is not surprising since the many practices of TCM developed before science as we know it began evolving in the 16th and 17th centuries.
It is also not surprising that the many attempts to confirm the scientific validity of TCM practices have largely failed since there is no plausible "mechanism of action for most of its therapies."* What may seem surprising to many is that a form of medicine that is based on superstitions and metaphysical beliefs that have no scientific validity has lasted as long as it has and continues to draw in more advocates, many of whom seem to have become attracted to Eastern medicine because of their disaffection with Western medicine. (A blurb for The Complete Illustrated Guide to Chinese Medicine on Amazon claims that the book "is a fine prescription for those tired of the bureaucracy or the ineffectiveness of Western medicine." This sentiment seems common among Western proponents of TCM.)
I believe a similar seeming surprise was addressed by Dante Alighieri about Christianity. Dante thought that the spread of Christianity was the greatest miracle of all, greater than all the miracles ever performed in the history of the world, and stood as evidence of its truth. I would say the spread of Christianity is no more baffling than the continued belief in the superstitions and pseudoscience of TCM. Our species may have evolved to be what we are thanks to our large brains, but that doesn't mean we've always used our brains in the most logical and rational ways. We've also evolved to make many erroneous judgments due to natural cognitive, affective, and perceptual biases that helped our species survive and prosper in more primitive times. Several of these biases have been at work for millennia, allowing shamans of various shades to satisfy many customers with a medicine bag of time (allowing nature to takes it course), the power of suggestion, expectation, confidence-boosting theatricals, and conditioning. Historical conditions also played a large role in the spread of Christianity and the perseverance of TCM, but this is not the place to review either delusional system's history.
metaphysical basis of TCM
The primary metaphysical belief running through all aspects of TCM is the notion of qi ("chee"), a life-force or vital energy that flows through everything. In the West, the related concept of vitalism was once popular, but was abandoned by Western medicine as it became more science-based. There are still a few holdovers in the West from the vitalistic era, e.g., homeopathy and chiropractic. Science-based medicine does not recognize qi or any other form of subtle energy because there is no convincing empirical evidence that such energy exists. Nor is there any evidence for the alleged meridians or channels in the body where qi flows and can become blocked or 
unblocked or unbalanced in yin or yang, imaginary primal cosmic principles of the universe. Blockage and imbalance allegedly cause ill health, while various herbs and animal parts allegedly keep qi flowing healthily. Acupuncture and acupressure (placing physical pressure on acupuncture points) supposedly unblocks passages in meridians, allowing qi to flow freely and restore health. The tongue supposedly is connected to the body's organs via meridians, allowing diagnosis of internal organ problems by examining various parts of the tongue.* There is no scientific basis for any of these notions, all of which were introduced during pre-scientific times. The continued rise of popularity of TCM in Western medicine attests not only to the general public's ignorance of disease and biology and to the role of the so-called placebo effect on healing, but to the power of cognitive biases embedded in our brains over tens of thousands of years of evolution. It is a combination of these biases and our ignorance that allows modern day shamans to be invited to join integrative health care teams and medical faculty at dozens of first-tier medical centers and universities around the world. A significant portion of the general public want non-science-based medical interventions and as long as this thirst for pseudomedicine is left unquenched our NIH will continue to promote TCM and so-called integrative medicine.
traditional Chinese medicines
Thousands of plant and animal parts, as well as a few minerals, make up the pharmacopoeia of traditional Chinese medicines. Magical thinking is clearly the basis for some of these concoctions, e.g., deer penis to enhance male virility. Many of the medicinals lead to the suffering and unnecessary maiming and killing of many animals. Throughout Asia, "tens of thousands of bears are kept in tiny cages their entire lives so that their gall bladders can be tapped for bile."* Bear bile is used to create medicinals "for trauma, sprains, fractures, hemorrhoids, conjunctivitis, severe hepatitis, high fever, convulsions, and delirium."* There is no scientific basis for bear-bile or deer-penis medicine, but even if there were, one would still be hard pressed to justify the practices by which these medicines are produced. Other animals are treated with equal disdain: sharks for their fins, rhinos for their horns, and tigers and tortoises for various body parts. (Western medicine also abuses animals in the name of human health, but not on a grand scale and not as part of everyday treatment for minor complaints. One rarely hears complaints, however, about such things as mice being infected with cancer cells to test out various cytotoxins for individual cancer patients.)
I hope nobody harms any animals or wastes their time doing randomized control group studies of bear bile, tiger eye, deer penis, etc. The barbaric practices behind these pseudoscientific concoctions should stop immediately and should give any rational person pause regarding traditional Chinese medicine. On the other hand, many herbs, spices, and plant parts can be and have been scientifically tested for their health benefits. Information on these studies is easily found on the Internet. I have posted some information on herbs elsewhere and will not go into detail on any of them here. Herbal supplements are not subject to the same government regulations that drugs are. The user of herbs is forewarned: Many herbal products do not contain the ingredients they list on their labels. "The F.D.A. requires that companies verify that every supplement they manufacture is safe and accurately labeled. But the system essentially operates on the honor code."*
acupuncture and acupressure
When and where acupuncture as a method of sticking needles through the skin to unblock energy and harmonize forces began is unknown. The technology for needles made of spun steel, which today's needles are usually made of, didn't exist until the early 17th century (Imrie et al.). In any case, the word 'acupuncture' is clearly not Chinese, but Latin. Acus means "needle" and pungere means "to prick." The first use of the term in the West was in the late 17th century, but the first use that also connected needling with chi, meridians, yin and yang, was by the 20th century Frenchman George Soulié de Morant.
While acupuncture was being promoted in the West as an ancient healing art that could cure just about anything, it was being banned in China and Japan. After the introduction of scientific medicine in those countries, efforts were made to stifle ancient medical superstitions and myths. By 1911 in China, acupuncture was no longer a subject for examination by the Chinese Imperial Medical Academy (Imrie et al.). Mao Zedong promoted Chinese medicine for political and practical reasons, but he did not use it or believe in it himself. Acupuncture came to the attention of the Western world in dramatic fashion when it was widely reported in 1971 that James Reston, the New York Times journalist, had undergone an appendectomy in Beijing with the only anesthesia being provided by acupuncture. In fact, he had chemical anesthesia for the operation, but acupuncture was administered afterward to relieve pain. Reston allegedly reported that about an hour after the acupuncture he felt pain relief. Was the relief due to the acupuncture? Perhaps. It may also have been due to his having a bowel movement. Did the acupuncture cause his bowel movement? I don't know, but I do know that after this story was reported in the Western press, acupuncture began its current run as the darling of alternative medicine in the West. Simultaneously, acupuncture has grown less popular in China (Beyerstein and Sampson 1996). It might be of interest to some readers that The National Council Against Health Fraud (NCAHF) found that of the 46 medical journals published by the Chinese Medical Association, not one is devoted to acupuncture or other so-called traditional Chinese medical practices.
It should interest the impartial reader that large multicenter clinical trials conducted in Germany (Linde et al., 2005; Melchart et, 2005; Haake et al, 2007, Witt et al, 2005) and in the United States {Cherkin et al, 2009) have found that acupuncture with real needles and sham acupuncture treatments have the same effect on pain levels across multiple chronic pain disorders: migraine, tension headache, low back pain, and osteoarthritis of the knee. The bottom line is: acupuncture is placebo medicine.*
I have examined elsewhere the claim that there is scientific evidence supporting the efficacy of acupuncture as a medical treatment, especially for the relief of pain. My conclusion is that the effects of acupuncture reported both in medical journals and anecdotally are due to the natural resolution of the pain or complaint, classical conditioning, expectation effects, calming effects of relaxation, the confidence-boosting theatricals accompanying treatment, and the power of suggestion. Acupuncture is, in brief, placebo medicine on par with the practices of ancient and modern shamans. Studies employing sham acupuncture clearly show that the effects are not due to needles piercing the skin. True believers maintain that acupressure is just acupuncture without piercing the skin and it works just as well. I agree. Acupressure and acupuncture work equally well and both are forms of placebo medicine, which does not mean, by the way, that the effects are "all in the head."
The World Health Organization, on the other hand, convened a council of experts in Cervia, Italy, in 1996 to review acupuncture studies. The WHO report used a very broad definition of 'acupuncture':
Acupuncture literally means to puncture with a needle. However, the application of needles is often used in combination with moxibustion—the burning on or over the skin of selected herbs—and may also involve the application of other kinds of stimulation to certain points. In this publication the term “acupuncture” is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture (electro-acupuncture), laser acupuncture (photoacupuncture), microsystem acupuncture such as ear (auricular), face, hand and scalp acupuncture, and acupressure (the application of pressure at selected sites).
The WHO report lists dozens of studies, most of them small (under 50 participants) and none, as far as I could tell, negative. The report claims:
Some of these studies have provided incontrovertible scientific evidence that acupuncture is more successful than placebo treatments in certain conditions. For example, the proportion of chronic pain relieved by acupuncture is generally in the range 55– 85%, which compares favourably with that of potent drugs (morphine helps in 70% of cases) and far outweighs the placebo effect (30–35%) (1–3). In addition, the mechanisms of acupuncture analgesia have been studied extensively since the late 1970s, revealing the role of neural and humoral factors.
The WHO continues to promote traditional medicine of all kinds, not just TCM. The WHO under the leadership of Margaret Chan, M.D., continues to ignore critics and contrary evidence in its promotion of TCM. An article detailing the WHO's strategy in this arena was recently published in Skeptical Inquirer. The authors--Thomas Dorlo, Willem Betz, and Cees Renckens--see the WHO as appearing to be "on a quest to promote the integration of consistently unproven and irrational therapies (quackery) into medicine worldwide." Contrary to the WHO report on acupuncture, Dorlo et al. claim that "in well-designed randomized clinical trials, the efficacy of CM therapies could not be established." Never mind that these therapies are based on magical thinking, superstition, and various metaphysical beliefs about subtle energies. True believers say that the Western "model" or "paradigm" for science is "reductionist" and "mechanistic," whereas what is needed to understand TCM and other medical pseudosciences like homeopathy and naturopathy is a "systems paradigm" that is "holistic." Alternatively, what is needed is to quit kowtowing to nonsense and gibberish. We need to admit that just because a practice is old, popular, and cheap doesn't mean it should be promoted when there are much better alternatives available in the form of science-based medicine.
Chan is the author of the lead article in a promotional three-part advertisement for TCM recently published in Science much to the dismay of anyone trying to promote science-based medicine in the face of the growing popularity of so-called integrative or complementary medicine. Leading the voices in the scientific wilderness is, once again, David Gorski, M.D. In a companion piece to the Dorlo et al. article in Skeptical Inquirer, Dr. Gorski excoriates the editors of Science and its publisher, the American Association for the Advancement of Science. Chan argues for the integration and modernization of traditional medicine. Gorski argues that Science has sold out and published advertisements for the hodgepodge of superstition and pseudoscience that is TCM masquerading as scientific articles in a science magazine. The creation of the TCM supplements in Science did not originate with the magazine itself but was sponsored and paid for by the Beijing University of Chinese Medicine and Hong Kong Baptist University. Josephine Briggs, the current director of the National Center for Complementary and Integrative Health, an agency of the National Institutes of Health, was on the editorial staff of the supplement, which is misleadingly called The Art and Science of Traditional Medicine. Dr. Gorski writes:
It is a shameful thing when one of the most widely read general science journals in existence sells out by publishing, in essence, an advertisement for "integrating" a specific kind of pseudoscience into medicine. And this is not the first time: three years ago the other major general science journal, Nature, did the same thing ... bought and paid for by a Japanese supplement manufacturer as well as a TCM research center
According to Dorlo et al., China already gains more than $3 billion a year in exports of TCM products. The more we in the West are seduced by the sounds of the sirens promising natural cures that treat the cause not the symptom and the whole person not just the body, the more China stands to gain and the more the health of people around the world stands to suffer.
See also Defending Falsehoods, confirmation bias, gua sha, the illusion of control, the illusion of understanding, integrative oncology, magical thinking, placebo effect, post hoc reasoning, regressive fallacy, self-deception, testimonials (anecdotal evidence), and wishful thinking.
further reading
--- Nature editorial. 2007. 448, 105-106. Hard to swallow: Is it possible to gauge the true potential of traditional Chinese medicine? Published online 11 July. "...if traditional Chinese medicine is so great, why hasn't the qualitative study of its outcomes opened the door to a flood of cures? The most obvious answer is that it actually has little to offer: it is largely just pseudoscience, with no rational mechanism of action for most of its therapies."
--Wikipedia article on TCM "In general, disease is perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment. Therapy is based on which "pattern of disharmony" can be identified. Thus, "pattern discrimination" is the most important step in TCM diagnosis. It is also known to be the most difficult aspect of practicing TCM.
"In order to determine which pattern is at hand, practitioners will examine things like the color and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing or the sound of the voice. For example, depending on tongue and pulse conditions, a TCM practitioner might diagnose bleeding from the mouth and nose as: "Liver fire rushes upwards and scorches the Lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose." He might then go on to prescribe treatments designed to clear heat or supplement the Lung." Clearly, these ideas have nothing to do with what is really going on in the human body. These are prescientific notions on par with explaining why some valley has rocks because of some fight giants or gods had a long time ago.
Beyerstein, Barry L. Why Bogus Therapies Often Seem to Work
I'd like to offer an eighth reason to Barry's list: Ignorance of the many failures of the therapy. Alternative healers don't keep records of their failures. The patients who never return, either because they realized the treatment was worthless or they died, are not reported. Dead patients don't make good anecdotes.
Dorlo, Thomas, Willem Betz, and Cees Renckens. 2015. "WHO's Strategy on Traditional and Complementary Medicine: a Disgraceful Contempt for Evidence-Based Medicine." Skeptical Inquirer. vol 39. No. 3. May/June.
Gorski, David H. 2015. "Science Sells Out: Advertising Traditional Chinese Medicine in Three Supplements." Skeptical Inquirer. vol 39. No. 3. May/June.
Levinovit, Alan. 2013. Chairman Mao Invented Traditional Chinese Medicine. Slate. Oct. 22.
Websites & blogs
More Acupuncture Misrepresentation by Steven Novella "Stating that both the treatment and the control showed improvement is a non-sequitur in the context of a controlled clinical trial. The comparison of baseline symptoms to post treatment (real or sham) is unblinded, and therefore it is not possible to make any efficacy claims from that change alone, especially with subjective outcomes. Comparison to baseline or historical controls is only justified with objective outcomes (like death). Even then the data is suspect, unless there are blinded controls."
Special issue of Medical Acupuncture (March 26, 2013) deconstructed by Dr. David Gorski: "I’ve said it before, and I’ll say it again (at the risk of boring my readers): I actually used to think that maybe there was something to acupuncture, for the simple reason that it involves an actual physical act on the human body, namely sticking needles into it. On a strictly conceptual level, one can speculate that maybe sticking needles into the skin does something. However, the more I read about acupuncture, the more I delved into the actual scientific literature purporting to support acupuncture, the more I realized that there’s no “there” there, even from studies done by advocates, in which negative or equivocal results are almost uniformly spun to be supportive of acupuncture, and mechanisms that probably have little to do with any purported effects of acupuncture. The “adenosine” mechanism I wrote about three years ago comes to mind. The bottom line when it comes to acupuncture is that it’s almost certainly all placebo. It doesn’t matter where you stick the needles. In other words, acupuncture “meridians” are nonsense, which is not surprising, given that attempts to associate any real anatomical structures to meridians have uniformly failed. It doesn’t even matter if the needles are stuck in; twirling toothpicks against the skin does just as well, dubious systematic reviews of acupuncture notwithstanding."
An Acupuncture Meta-Analysis by Steven Novella, M.D. "The Vickers acupuncture meta-analysis, despite the authors’ claims, does not reveal anything new about the acupuncture literature, and does not provide support for use of acupuncture as a legitimate medical intervention. The data show that there is a large difference in outcome when an unblinded comparison is made between treatment and no treatment – an unsurprising result that is of no clinical relevance and says nothing about acupuncture itself."
Can we finally just say that acupuncture is nothing more than an elaborate placebo? by David Gorski, M.D. "I’m pretty much unimpressed at the whole study, although no doubt it will be touted by acupuncturists for years to come as “proof” that acupuncture really and truly works and isn’t just placebo medicine. It doesn’t, and it is. In fact, the study strongly suggests that any effect of acupuncture observed is almost certainly due to nonspecific and placebo effects and that the “positive” result is, as Ernst describes, likely due to small residual biases."
More “bait and switch” acupuncture studies by David Gorski "No wonder, of all the CAM modalities other than supplements, people tend to think that acupuncture “works” more than any others. It is, after all, sticking needles into the skin. That’s one reason why acupuncture also makes a most excellent Trojan horse. After all, doctors stick needles into people, don’t they? So it’s easy enough for a scientist curious about acupuncture and perhaps not so well-versed in placebo effects to allow his curiosity to lead him to stick some needles into some mice, measure some adenosine levels, and then rebrand a science-based mechanism of analgesia that could be turned into a new technique of anesthesia as somehow being based on acupuncture, and the message is that acupuncture works. As that message, as unjustified as it is, spreads, by extension the idea spreads that there might just be something to all this CAM stuff. That is how and why quackademic medicine is on the rise."
Does Chinese acupuncture affect the brain's ability to regulate pain? by Christina Stephens A recently published study by Richard E. Harris et al. suggests that true acupuncture appears to make the body more responsive than sham acupuncture to opioid painkillers. Stephens writes: "it seems fairly obvious to me that measuring neurobiological responses in a PET scan while some subjects have needles inserted during the scan and others do not is measuring a neurobiological response to needles being in the skin versus not in the skin. Sticking needles in subjects would likely provoke a different neurochemical response in subjects when compared to placebo acupuncture, which involved no needle insertion. So, if you do two different physical things to people, this provokes different neurochemical responses. Didn't we already know this?" See also "Needles in the skin cause changes in the brain, but acupuncture still doesn’t work [any better than placebo treatment]" by David Gorski. Gorski writes: all Harris has "shown is that opioid receptors light up more if there are needles in the skin than they do if there are not–hardly a finding that shows that acupuncture “works” and certainly not any sort of finding to validate the entire system of acupuncture, which relies upon the idea of qi flowing through meridians, flows that can be altered to therapeutic effect by sticking needles into those meridians."
Traditional Chinese Pseudo-Medicine Hodgepodge by Mark Crislip (scroll down to the bit on gua sha "massage" for some insight into how pseudoscience promotes itself in TCM)
Why Health Professionals Become Quacks by William T. Jarvis, Ph.D.
podcast