MD, PhD, FMedSci, FSB, FRCP, FRCPEd

For those who know about the subject, this is an old hat, of course. But for many readers of this blog, it might be news: ‘Traditional’ Chinese Medicine (TCM) is not nearly as traditional as it pretends to be. In fact, it is an artefact of recent creation. The man who has been saying that for years is Professor Paul Unschuld, one of the leading sinologist worldwide and an expert who has written many books and journal articles on the subject.

During an interview given in 2004, he defined TCM as “an artificial system of health care ideas and practices generated between 1950 and 1973 by committees in the People’s Republic of China, with the aim of restructuring the vast and heterogenous heritage of Chinese traditional medicine in such a way that it fitted the principles–Marxist Maoist type democracy and modern science and technology on which the future of the PRC was to be built…[the Daoist underpinning for TCM] is incorrect for two reasons.  First . . . TCM is a product of Communist China.  Second, even if we were to apply the term TCM to pre-revolutionary Chinese medicine, the Daoist impact should be considered minimal.”

In a much more recent interview entitled INVENTION FROM THE FAR EAST which he gave to DER SPIEGEL (in German), he explained this in a little more detail (I have tried to translate his words as literally as possible):

What is being offered in our country to patients as TCM is a construct that was created in China on an office desk which has been altered further on its way to the West.

Already at the beginning of the 20th century, reformers and revolutionaries urged that the traditional medicine in China should be abolished and that the western form of medicine should be introduced instead. Traditional thinking was seen as backwards and it was held responsible for the oppressing superiority of the West. The introduction of Western natural sciences, medicine and technology was also thought later, after the foundation of the People’s Republic, to be essential for rendering the country competitive again. Since the traditional Chinese medicine could not be totally abolished then because it offered a living to many citizens, it was reduced to a kernel, which could be brought just about in line with the scientific orientation  of the future communist society. In the 1950s and 60s, an especially appointed commission had been working on this task. The filtrate which they created from the original medical tradition was hence forward to be called TCM vis a vis foreigners.

There is little more to add, I think – perhaps just two brief after-thoughts. TCM is a most lucrative export article for China. So don’t expect Chinese officials to rid TCM of the highly marketable ‘TRADITIONAL’ label. And remember: the appeal to tradition’ argument is a fallacy anyway.

18 Responses to The myth about ‘Traditional’ Chinese Medicine

  • The matter of the true origins of TCM was discussed following a post by Mr. Ernst: Alternative practitioners treat the whole person, not the disease !?!?.

    I hope I am excused for referring to my own successive comments in that discussion here and here. In the later comment I gave a reference to a free downloadable ebook containing a contemporary, extremely graphic account by the Scottish missionary physician Dugald Christie, of what constituted the real tradition of chinese healing a little more than a hundred years ago. I recommend anyone interested in knowing what “traditional chinese medicine” was, to read Dr. Christies book, which is, as I said, readily downloadable.

  • Indeed. I curdle when I hear people (particularly acupuncturists) say that the tradition is “thousands of years old.” I blogged in detail about the claim of famous acupuncturist J.R. Worsley (founding head of the modern Five Element Acupuncture schools) that *real* acupuncture hasn’t changed for 5000 years. Here’s an excerpt from my post:

    Worsley, in _Talking about Acupuncture in New York_ (page 3) states:

    “The one thing I want to impress upon you first of all is that there are many different types of acupuncture. And one that is predominantly practised in the Western world is what we call ‘barefoot doctor’, or ‘local doctor’.
    This is where we can put a needle in various parts of the body and we can take away pain. This is true. There is hardly any pain that we cannot take away by inserting a needle. But, of course, what happens is that after a period of time the pain returns. So what we are really doing is giving symptomatic relief…
    To learn how to become a local doctor is just child’s play…
    The vast difference between traditional Chinese medicine and the methods I have just described is that traditional Chinese medicine does not treat the symptoms…
    It is a very in-depth, personal system of medicine. And to become a doctor of traditional Chinese medicine takes ten years of training. There is a vast difference between someone who does traditional Chinese medicine and someone who does local doctor, which you can probably learn in a few weeks… This system has not changed in five thousand years; and it will not change in the next five thousand years.”

    Other than being historically wrong, Worsley is also showing himself to be another deluded egotist. Because, of course, his system is “the real traditional acupuncture” and all of the other systems are just “ignorant barefoot locals.”

    How has acupuncture changed in 5000 years?

    For one, before about 200 BCE, acupuncture needles were stone, bone, or bamboo (ouch!). The earliest metal needles were found in a tomb from 113 BCE and were gold. They were thick. The best of them were silver or gold, steel wasn’t developed until later. They got reused time and time again. Additionally, the earliest works on Chinese medicine mentioned just the channels, and not the points.

    The whole post may be found here: http://ancientway.com/blog/?p=538

    Research has repeatedly shown that all styles of acupuncture work about the same, including non-penetrating sham acupuncture. That is why I’m taking a sabbatical and re-evaluating my career path. Reading around the internet shows me I’m not the only acupuncturist who has been following the trend of good research and real history…

    • Have you got citations for your assertion that all acupuncture works about the same?

      • The abstract for the study I blogged about is here: http://www.ncbi.nlm.nih.gov/pubmed/22231691

        For your convenience, here is the full abstract text: CMAJ. 2012 Mar 6;184(4):401-10. doi: 10.1503/cmaj.110551. Epub 2012 Jan 9.
        Acupuncture for migraine prophylaxis: a randomized controlled trial.
        Li Y, Zheng H, Witt CM, Roll S, Yu SG, Yan J, Sun GJ, Zhao L, Huang WJ, Chang XR, Zhang HX, Wang DJ, Lan L, Zou R, Liang FR.
        Source
        Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
        Abstract
        BACKGROUND:
        Acupuncture is commonly used to treat migraine. We assessed the efficacy of acupuncture at migraine-specific acupuncture points compared with other acupuncture points and sham acupuncture.
        METHODS:
        We performed a multicentre, single-blind randomized controlled trial. In total, 480 patients with migraine were randomly assigned to one of four groups (Shaoyang-specific acupuncture, Shaoyang-nonspecific acupuncture, Yangming-specific acupuncture or sham acupuncture [control]). All groups received 20 treatments, which included electrical stimulation, over a period of four weeks. The primary outcome was the number of days with a migraine experienced during weeks 5-8 after randomization. Our secondary outcomes included the frequency of migraine attack, migraine intensity and migraine-specific quality of life.
        RESULTS:
        Compared with patients in the control group, patients in the acupuncture groups reported fewer days with a migraine during weeks 5-8, however the differences between treatments were not significant (p > 0.05). There was a significant reduction in the number of days with a migraine during weeks 13-16 in all acupuncture groups compared with control (Shaoyang-specific acupuncture v. control: difference -1.06 [95% confidence interval (CI) -1.77 to -0.5], p = 0.003; Shaoyang-nonspecific acupuncture v. control: difference -1.22 [95% CI -1.92 to -0.52], p < 0.001; Yangming-specific acupuncture v. control: difference -0.91 [95% CI -1.61 to -0.21], p = 0.011). We found that there was a significant, but not clinically relevant, benefit for almost all secondary outcomes in the three acupuncture groups compared with the control group. We found no relevant differences between the three acupuncture groups.
        INTERPRETATION:
        Acupuncture tested appeared to have a clinically minor effect on migraine prophylaxis compared with sham acupuncture.
        TRIAL REGISTRATION:
        Clinicaltrials.gov NCT00599586.

        • I’m really bad at reading these so I’m not clear whether there was any attempt to differentiate migraine into possible TCM syndromes or not. I’ll have to assume there was otherwise that would be to abandon the nuances of TCM differential diagnosis, such as they are and would tell us very little. Within my own understanding migraine is often either a blood flow to the head issue with a dietary/emotional underpinning and possibly to do with issues of the du mai/spine. It’s often very hard to treat.
          Are the non specific Shao yang/yang ming points designed to activate the sinew meridians? Again I’m not clear.
          The study seems to implicitly reiterate the fallacy that needling a point is a defined quantity like a chemical compound rather than contingent on the ability of the therapist involved. Both this and the failure to differentiate the migraines would make this study yet another instance of refusing to engage acupuncture on its own terms rather than the framework proposed by western medicine.
          That said I can see your thinking and I’ve had to question the validity of acupuncture as a therapeutic intervention. My current conclusion is that practicing it at any level of competence requires a lot more input than three years in front of a bad text book. The difference between a run of the mill acupuncturist and say, someone who has been trained in a Taoist sect for fifteen years is really quite large and this is the kind of thing you have to do to be any good. TCM is complete crap. Acupuncture is basically very, very refined body work, a high skill based on nei gung and in terms of what is reasonably accessible in the western world, usually no better than placebo. But it could be, and when practicing it you sometimes you get a taste of what that might be like and that keeps me there.
          Most acupuncturists are kidding themselves about research and studies and if you ask them they just come up with drug company conspiracies, it’s impossible to really assess it etc. The Chinese have an industry around a politically sanitised national cultural product that when you look closely melts away to being nothing at all. We have silly hippy platitudes and wishful thinking. Between those we have developed a lie and the big acupuncture colleges and publishing companies perpetuate that lie. This lie is actually hobbling and stifling its potential it rather than protecting it.
          However if you can with whatever you are doing get someone off some scorched earth medication like methotrexate or steroids with that lie or whatever then that’s something, and just sometimes it’s possible.
          Worsley though, what an inconsistent fantasist he was.

          • “The difference between a run of the mill acupuncturist and say, someone who has been trained in a Taoist sect for fifteen years is really quite large “. Any evidence to support this statement [see also my latest blog post on this subject].

  • Apparently Traditional Chinese Medicine isn’t as popular in its mother country as it’s painted. In an article from 2006, Professor Zhang Gongyao of Central South University, Hunan province, China, warned that Traditional Chinese Medicine was often unscientific, unreliable, dangerous, a threat to endangered species, and even fatal to humans in some cases:
    http://www.saukvalley.com/articles/2006/11/14/features/health_and_medical/292809835983434.txt?__xsl=/print.xsl

    His comments triggered serious debate in Chinese society, and revealed that many Chinese felt distrustful of traditional medicine, especially as their country was moving into the global mainstream. According to the article, Chinese newspapers had been pointing out that China had about 270,000 traditional medicine practitioners, far fewer than its 800,000 during the early 20th century. Indeed, the number of physicians trained in Western medicine had soared from 87,000 in the early 20th century to about 1.75 million at the time the article was written.

    In addition to the above, and with acupuncture forming part of Traditional Chinese Medicine, it’s worth noting that the popularity of surgery under acupuncture anaesthesia in China is due to most of the patients being highly selected on the basis that they are prone to suggestion. Most of them are also likely to be quite poor. Indeed, at the end of the following video clip, it mentions that the bill for a patient who was filmed undergoing heart surgery – apparently using acupuncture – was a third of the cost of an operation under general anaesthesia. See 4 mins 10 secs in:
    http://www.youtube.com/watch?v=t-dWMpuYnwQ

    But perhaps what’s really interesting about that clip is what the writer and scientist, Simon Singh, had to say about it:

    Quote
    “…the scene showing a patient punctured with needles and undergoing heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the chest.
    With such a cocktail of chemicals, the needles were merely cosmetic. In short, this memorable bit of television was emotionally powerful, but scientifically meaningless in building a case for acupuncture. I have spoken to several experts who say that the procedure was neither shocking nor impressive, but it was unconventional because the Chinese surgeons seemed to have used a higher level of local anaesthetic to compensate for the lack of general anaesthetic.
    When I put this to Professor Sykes, she replied: “The suggestion that the operation could have taken place without the acupuncture and it would have been fine is an interesting idea and might possibly be the case.”
    Even though the television commentary was technically accurate, by omission and emphasis, viewers were left with a false impression. Everyone I have spoken to, including Ian Bell, believed they had witnessed acupuncture providing major pain relief, so they felt misled when I explained what was really going on.
    Of course, recent scientific studies have hinted at tentative evidence that acupuncture might provide limited pain relief, but this is still far from proved and many other studies have shown that acupuncture is nothing more than a placebo. However, the programme makers seemed to have focused on whatever positive evidence was available and then added a dollop of impressively irrelevant heart surgery to cast acupuncture in the best light.”

    http://www.telegraph.co.uk/science/science-news/3344833/Did-we-really-witness-the-amazing-power-of-acupuncture.html

  • TCM is indeed a construct from the 50s-60s, but please don’t forget it is based on ideas and practices that pre-date it, and therefore a re-working rather than something completely new. I am not defending TCM – I personally see it as a starting point from which an acupuncturist can begin their journey. There is in fact a discernible movement under way at the moment to re-introduce Classical acupuncture techniques and theories, and I believe this will gradually lead to improved efficacy (it has in my own practice).

    • It is commonly assumed that contemporary Chinese Medicine has an ancient lineage and its practice can be related in a straightforward way to medicine practiced in China for thousands of years. In this article, I argue that this impression is mistaken. What we currently call traditional Chinese Medicine is only sixty years old and it does not share the same theoretical principles to the ancient medicine of China (referred to as yi). Both yi and contemporary Chinese medicine practices use herbs and acupuncture methods, but yi is based on the principles of yinyang, wuxing whereas contemporary Chinese medicine is fundamentally based on western anatomical understandings of the body and disease, and notably, the two practices create different healing outcomes.
      THIS IS THE ABSTRACT OF A NEW ARTICLE ON THE SUBJECT [http://www.ncbi.nlm.nih.gov/pubmed/25095485]

  • Very true Edzard. Although, is it also just the way you/we interpret the word ‘Traditional’? Monty

  • Thank you for this informative post and it helps us to more about TCM which is an alternative medicine approach.

    [Alisa: Since you posted from an IP address in India, not Wokingham, I have deleted the link to the business you are advertising – Admin]

  • A better link to the interview with Paul Unschuld: http://www.spiegel.de/spiegel/spiegelwissen/d-119150788.html

  • Concerning the question if today’s acupuncture really is more than 2000 years old, some answers can be found in my essay “Acupuncture in ancient China – How important was it really?”, published in
    http://www.jcimjournal.com/articles/publisharticles/pdf/jintegrmed2013008.pdf
    H. Lehmann, Berlin

    • @Hanjo Lehmann

      Thank you for a most interesting essay, which begs the question:
      Seeing that you have with historical factuality confirmed that pre-modern acupuncture was nothing better than archaic sorcery-torture and the modern reinvention of acupuncture was based on nothing resembling proven experience, research or medical know-how.
      Also seeing that “modern” acupuncture has despite enormous anticipation and decades of arduous clinical testing by competent physicians, namely anesthesiologists and pain specialists, acupuncture has almost totally failed to gain foothold in clinical practice, being today in effect relegated to non-medical high-street practitioners.
      Further seeing that recent well-controlled studies have repeatedly and reproducibly failed to detect neither specific nor selective effects beyond expectations and wishful thinking (i.e. placebo).

      What hidden evidence has led a scholar of your caliber to continue to be so cheerfully supportive of acupuncture’s future utility?

Leave a Reply

Your email address will not be published. Required fields are marked *

Please answer the following: *

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories