How do we know TCM works?

kelinsheng
March 05, 2010, 08:17 AM posted in General Discussion

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pretzellogic had some questions: 1. Do you study when to use certain medicines, and when not to? 2. Does each Chinese medicine have a list of side effects, and contraindications? 3. do Chinese medicines get studied in large systematic trials for medicine effectiveness? 4. Oh, and "hundreds of years of experience" means "doesn't need clinical trials".

Okay, I will try to answer these questions to the best of my ability here, but to answer completely would require a thesis paper (especially for 4.), and I'm going to try my best not to take any sides.

1. Yes, our treatment plans are based on a TCM diagnosis. Diagnosis is necessary in any form of medicine before coming up with any kind of treatment plan.

2. Yes there are lists of contraindications. You can take a look at Huang Qi on sacredlotus.com as an example.

3. I think your asking if TCM has standard scientific research validating it. It depends. A lot of research has been going into TCM and lately people have even been trying to extract a chemical from Frankincense to help with cancer. However, almost all the research completely neglects the methodology of TCM and instead uses an allopathic medical model. In TCM Ru Xiang (frankincense resin) can be used to help reduce swelling, but usually only if it is due to qi and blood stasis (often from trauma) or wind-damp bi syndrome. So rather than trying to scientifically prove if Ru Xiang helps with wind-damp bi syndrome, they're testing to see how a particular ingredient in Frankincense reacts with DNA to reduce swelling (tumours). I have a sneaky suspicion that it has something to do with patentability.

4. Basically your last two questions come down to epistemology. Epistemology is the study of knowledge, or how we know that we know. The scientific method is one way to obtain knowledge, but that doesn't mean there are not other ways of obtaining knowledge. TCM predates the scientific method and the ancient Chinese explained the world through concepts like Yin, Yang, and Qi among others.

It would be fascinating to know how they developed their knowledge back then, but I really don't know. I'm pretty sure they used both deductive and inductive reasoning. Here's example of deductive reasoning: Heat usually helps to keep a person from feeling cold. This person is feeling cold. Therefore, heat usually helps to keep this person from feeling cold. (This is Yin (cold) and Yang (warm) and and is the foundation of Daoism and by extension the foundation of TCM.) This could also be extended to Chinese herbal medicine: These herbs usually help with yang deficiency (warm). This person is yang deficient (cold). Therefore, these herbs (warm) will usually help this person with yang deficiency (cold).

And here's an example of inductive reasoning: Since heat helped to keep that person warm yesterday, and heat helped to keep that person warm today, then chances are heat will help keep that person warm tomorrow. Obviously in this case, the conclusion may not be true. Let's look at the sun though. The sun rose yesterday, it rose today, so chances are it will rise tomorrow. Does the conclusion for the sun example seem more true than the conclusion about using heat? Does it seem more plausible because the sun has risen daily for quite sometime? Does it change the probability that sun will rise tomorrow? How about billions of people over 4 500 years being helped everyday with a particular form of medicine?

Of course inductive reasoning doesn't actually prove anything. It only gives speculation as to what is most probable, but that could be why someone may have told you “'hundreds of years of experience' means 'doesn't need clinical trials'”.

Here's an article on the philosophy of science if your interested.

I hope that answered your questions and I hope I stayed as neutral as possible. I don't want to debate about the validity of any these things. I think each has their place.

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kelinsheng
March 05, 2010, 08:27 AM

(not sure how to edit that top bit out of the post)

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pretzellogic
March 05, 2010, 09:58 AM

Kelingsheng, thanks for taking the time to respond.  I guess on that last point, about the clinical trials vs. experience, Maybe it would be helpful to ask this way: Does TCM treat all conditions/illnesses as ying/yang imbalances?

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bodawei
March 05, 2010, 11:54 AM

Thanks kelinsheng - plenty there to ponder.  I have not looked into TCM at all seriously, but I like to observe Chinese culture, so I have collected interesting (but fairly superficial) evidence of what I think is TCM.  

Case 1.  I was ill a couple of months ago and the mother of a friend visited me at home.  She is trained in Western medicine, used to work as a gynacologist as far as I could establish, and now works in the more relaxed (?) world of public health in central China. I was surprised that her response to my illness was along the lines of 'drink hot water' and 'take these herbs that I have brought from my home province'.  A range of very strange looking herbs, processed to various degrees, were proffered.  After she left I just stuck to the hot water. And sleep.       

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kelinsheng
March 05, 2010, 07:07 PM

@pretzellogic: fundamentally yes, but over time other theories developed like five phases theory and Zang Fu theory, and external evils (or external pathogenic influences).  If you want to know more, check out http://www.sacredlotus.com

@bodawei: lol I like your story.  Patient compliance is an issue everywhere.  I hope she at least told you how to brew the medicine. . . 哈哈.

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dedsall78
June 07, 2010, 10:45 PM

I'll add a bit to kelinsheng's response here.  I hope you don't mind, kelinsheng :)

In regards to #3, there actually are more and more western studies done with Chinese Medicine.  I have come across some showing the effectiveness of using Chinese Herbs in conjuction with Western Drugs and comparing that to usage with Western Drugs alone.

Here is an overview of one in regards to Acupunture Treatment of Dysmenorrhea.  However, it does not seem to have a control group:

http://ecam.oxfordjournals.org/cgi/content/abstract/5/2/227?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT

If you search around, you can actually find all sorts of medical research around Chinese Acupuncture and Herbs.

One really interesting one which I heard of, but have not read, deals with the stimulating of Acupuncture Points and the reaction in the Human Brain.  Here is an overview of it (although you'd have to be a member to read the whole article):

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYR-4XY4GNJ-3&_user=10&_coverDate=02%2F22%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0d38b8a6e6d4a3599e86c756e869e44f

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pretzellogic
June 08, 2010, 04:41 AM

Hi Dedsall78, not quite sure if you were addressing my questions, but if you were, thanks. I guess I thought of acupuncture and Chinese Medicine as two separate disciplines.

I guess one thing i'm taking from this thread and from other TCM websites that i've looked at is that it appears to my casual eye that TCM is really focused on"Wellness" instead of "Medicine". Ifthat were the case, I would understand what's trying to be accomplished.

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dedsall78
June 09, 2010, 09:17 PM

@pretzellogic Yes, I was addressing your question that kelinsheng had answered.  Acupuncture and Moxibustion are one area of Chinese Medicine, there are also fields such as Herbal Medicine and 推拿 (Tuina).

Actually, Chinese Medicine is very much a form of medicine.  If you wanted to compare it to something in the West, the closest would be to Osteopathic Medicine, where doctors take a more holistic approach rather than treating diseases sympomatically.  However, Western and Eastern Medical Theory still differ greatly.

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pretzellogic

Hey dedsall, is there a peer-reviewed journal for Chinese medicine? and actually, is there a peer-reviewed journal for Osteopathic medicine? I hear you about Chinese (and Osteopathic Medicine) being a form of medicine. I guess now I'm starting to feel that "western" medicine is more inclusive of effective treatment cases than either Chinese or Osteopathic medicine. One example is a cancer treatment.

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dedsall78

I am not sure if there are peer-reviewed journals for either Eastern / Chinese or Osteopathic Medicine. But, as Osteopathic Medicine is Western Medicine (just not the mainstream one), I would assume there is.

I have seen many journals for Eastern / Chinese Medicine with case studies in them. However, I am not sure if they are peer-reviewed or not.

I am not sure exactly what you mean by "more inclusive of effective treatment cases" but I am guessing you mean more inclusive of case studies? In that case, I would say that, yes, there are definitely more case studies in Western Medicine than in Chinese Medicine. The idea of doing case studies to prove the effectiveness of techniques / medicinals was formulated in the West. It has only been recently that they started performing them in China.

In terms of the mainstream Western Medicine compared to Osteopathic Medicine, I would not know. :)

However, since we are on the topic of case studies, I will add that, although I am glad to see more case studies done with Chinese Medicine, case studies are not without flaws. Case studies are designed to isolate factors so that one can see how a certain factor, A, affects a certain result, B. This is beneficial but works better with the mechanical outlook of Western Medicine rather than a holistic outlook, like Chinese Medicine.

When one is dealing with a Chinese Medicine, one is not as concerned with isolating a certain factor and seeing how that factor affects the results. After all, the body is far too complicated and far too connected to be able to isolate a certain factor(s) and say they are the one and only cause of a certain disease.

Case studies are beneficial and have there place in the medical community. But they should never be the sole thing that is looked at.

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pretzellogic

I was pretty unclear about what I meant with cases. I was trying for something more like examples where some patient, or test group of patients were ill with some disease that wouldn't have shown itself under TCM, but would have shown up under Western medicine. As an example, sometime ago, I dislocated my knee skiing. A doctor X-rayed my knee to see if there was any ligament or bone damage, and then told me that he discovered I had this major league bone growth on my lower leg, just under the knee joint. I didn't know the bone growth was there. He casually mentioned that this bone growth was nothing, but it if had been cancerous, I would have been admitted into the hospital right then.

I wonder if TCM treatments can illuminate problems that do not otherwise have any external symptoms? An X-ray exists in western medicine, is there such a tool in TCM? If a TCM doctor sees a patient that has a lump on his arm, what tools does a TCM doctor use to determine if the lump is a benign or malignant cancer? At what point does the TCM doctor say, "you need to see a western medicine doctor"? Or does a TCM doctor ever say that for fear of losing face?

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dedsall78

Ah, ok. I see a bit of what you are getting at.

Well, first off, I will note that you are basically taking Western Medicine and assuming that, in Chinese Medicine, they have something similar. You must keep in mind that Chinese Medicine is an old medicine that has existed far before we had X-Rays or even knew exactly what cancer was. So, there are no tests for cancer in Chinese Medicine. Nor any reason to have them; they already exist in Western Medicine. They may have existed in the past but I did not learn them myself.

This is the reason why all schools also teach Western Medicine. That way, we know when someone needs to go see an MD to get a further diagnosis or to get some more detailed tests. If someone is showing up with signs of just having a stroke, they need to go to the emergency room. A former classmate of mine had this happen to him since, as you may or may not know, people can have strokes without realizing they have had one.

Now, as for problems with no external symptons, Chinese Medicine is quite good at that. This is especially true for a skilled practitioner. A few months ago, I went to a Chinese Doctor to help me with my stomach issues. Simply by taking my pulse, he told me that my stomach acid was too high (he was an MD as well, so tended to think in Western terms at times) and that I had sleep problems, both of which were true. This was before I even told him anything. I have heard of doctors, that my former teachers had met, who could even tell you your entire health history simply by your pulse.

Interestingly enough, before we developed, and came to over-rely on, all of this high-tech equipment, MDs were also skilled in pulse taking and tongue diagnosis. I saw an old book, I think from the late 1800s or early 1900s, on tongue diagnosis at an old bookstore not too long ago. But I doubt, these days, that many MDs would know tongue diagnosis as it's been forgotten and not taught anymore.

Anyways, I hope this sheds a little more light on things. Western and Eastern Medicine should be complementary as they each have strengths and weaknesses. For dealing with more common problems, such as allergies or sleep issues, Chinese Medicine is much better. However, for the much more serious ones, such as where a surgery is required, Western Medicine is.

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pretzellogic

Thanks for the reply. The pitch black that surrounded TCM for me is lightening up. Its interesting that there were things like Tongue diagnosis. Not sure how to refer to this analysis through the pulse that you mentioned, but that's interesting as well. I would be interested to hear your take on why the fell out of favor in western medicine; was tongue diagnosis inaccurate in some cases? Were you missing key problems with pulse analysis?

I must admit, I'm a bit amazed that you would say that Chinese medicine (being an old medicine), doesn't have tests for things like cancer. To me, that sounds much like TCM advances the TCM art in a relatively narrow set of illnesses and treatments. May I ask what TCM thinks of mental illnesses like schizophrenia or bipolar disorder as well? Not that western medicine, despite decades of treatments, is anywhere near good at treating these things. In that vein, what does TCM practitioners do with Down's syndrome, Alzheimer's Disease and other ailments that have been around for awhile?

I guess though that the benefit of having TCM teaching hospitals teach western medicine is that the students can make their own determination when the things you mentioned like allergies, sleep issues or excess stomach acid are symptoms of something more serious.

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dedsall78

Well, first off, let me clarify a bit on the whole cancer issue. The day after posting that, I realized that my explanation wasn't so good :)

When I mean by no tests is, there are no advanced tests to determine if a cancer is benign or malignant. That is not to say that Chinese Doctors do not have a way of diagnosing cancer. I was just reading this morning about how cancer is diagnosed in Chinese Medicine and how to treat it (but please don't ask me if it works as I am not sure; I have heard claims that it both does and others that it does not). It is also possible that there are doctors out there who can determine if a cancer is benign or malignant. However, I have never met one nor do I know how one diagnose if a cancer is benign or malignant without going through advanced western tests. It's possible that this knowledge was around prior to the Cultural Revolution but, now, has been largely lost; I am not sure.

As for why Western Medicine stopped using tongue diagnosis and pulse analysis, it's because it was stopped being taught. Why they stopped teaching it is, in my opinion, due to the fact that they developed advanced testing. Advanced testing is, as with most things, both good and bad. Over-reliance on the tests has been the outcome.

Chinese Medicine does diagnose all of these diseases you mentioned and, without having a knowledge of Chinese Medicine, I wouldn't really be able to explain to you how they are diagnosed.

And, actually, as Chinese Medicine was the only form of medicine here in China before Western Medicine was introduced, it has always diagnosed all types of diseases. It has also gone through many changes throughout the years and is always changing as new theories and information comes out.

To give you an idea, you may notice that I never say TCM, do I? That's because TCM is, basically, Communist Chinese Medicine. It is a modernization of Chinese Medicine that has taken out a lot of the traditional aspects in order to make it "modern." There are many other schools of thoughts that have differing viewpoints on how to treat diseases.

Finally, I should add that, although I am a licensed practitioner and did practice in the clinic previously, I have not been doing much since moving to Asia after I graduated. So, my clinical experience is rather limited. I figured I'd point that out so that you realize why I can't say exactly what I would do if faced with a patient with Alzheimer's or another disease I haven't worked with (although, as with many, many diseases, Alzheimer's is one of those you want to avoid by being healthy long before it shows up). I can only say how I would treat things that I have treated previously or that I have read about.

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dedsall78

Ah, and I just realized something else I may not be explaining clearly.

When I say that Chinese Medicine doesn't have advanced tests, my meaning is it was not developed in Chinese Medicine. X-Rays, Blood tests, etc. were all developed by Western Medicine. Now that doesn't mean that a Chinese Doctor won't use those Western Medical tests. These sorts of tests can also be very useful to a Chinese Doctor in determining the best method of treatment.

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pretzellogic

so Dedsall78, I didn't notice that you weren't using the term "Traditional Chinese Medicine". I'm glad that you pointed that out, although in the end, it confuses what I think I am referring to as Traditional Chinese Medicine.

I'm also glad to hear that you're a practitioner of Chinese Medicine. Good to know i'm hearing from an authoritative source.

I also was thinking that it seemed interesting that earlier, you said that for things like allergies, Chinese Medicine was better than western medicine. I'm not clear why you would say that, when western medicine merely alerts allergy sufferers to the cause of the allergy, but may or may not eliminate the allergy. Can Chinese Medicine eliminate allergies?

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simonpettersson
July 27, 2010, 02:42 PM

Cool! I just decided to pop back to Chinesepod and I discover a discussion on a topic that interests me profoundly. I'd love to share my thoughts on this, but I'll be cautious and ask first. This is not my thread and I don't want to barge in and threadcrap.

Basically, I'm very skeptical towards all kinds of 'alternative medicine', TCM (or whatever I should call it) included. I'd love to shine some light on what a person "on this side of the fence" thinks about the subject. However, as I said, I'll first ask if my thoughts are wanted. I can start a separate thread about it, if that's preferable.

Oh, and as a side note, just like dedsall78 doesn't like the name "TCM", there are many people, myself included, who don't like the name "Western medicine", but prefer the name "evidence-based medicine", which is more descriptive, although possibly provocative (?). We don't, after all, talk about "Western physics" or "Western mathematics", even though those sciences were largely developed in the West.

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pretzellogic

Welcome back Simon! I know you were asked about your whereabouts and status on your "yes i'm in China now" thread. You should check that out if you haven't already done so.

I welcome your question. After looking around on the web, I found more going on than I thought regarding the research behind some Chinese Medicine practices. More peer reviewed studies and the like. I guess I am seeing that while the peer reviewed studies are ok, those particular studies didn't seem to have a connection to the actual treatment of patients. I didn't come across a Chinese Medicine treatment peer-reviewed study that looked at patient outcomes, but maybe it was because I didn't look around enough.

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xiao_liang
July 29, 2010, 08:23 AM

I kind of consider it a bit like homeopathy...

http://www.howdoeshomeopathywork.com/

 

;-)

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kelinsheng

please explain why.

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kelinsheng

Definitely add your own thread to this group. The more we have open and respectful discussions the more we can learn.

I've also tended to use "allopathic medicine" as a preferred term over "evidence-based medicine" because "evidence based medicine" is largely researched through biased mediums. Also, I don't know exactly why allopathic medicine completely disregards inductive reasoning.

If you have any ideas why. I'd love to hear them.