I am not a medical doctor and I don’t even play one on TV! So how am I qualified to write about Chinese medicine? Well because I grew up with it! Is that really good enough? Yes, and every Chinese who grew up in a Chinese household in a Chinese community are inculcated with knowledge about Chinese medicine and how it works. Like any other Chinese kid growing up, when I was sick my mother could quickly diagnose my illness and if she couldn’t, she could turn to her mother or aunts or other higher authority figures. In more severe cases, there’s always the guy selling herbs. No formal training is required. By osmosis, we were all supposed to have absorbed medical knowledge and know what foods – plant/animal parts would be good medication for whatever ailed us. I now live in a region of the U.S. very much enamored with eschewing Western evidence-base medicine for herbal treatments, acupuncture, and other Traditional Chinese Medicine (TCM) cures. I can usually provoke shock and jaw-dropping silence when my response to questions about TCM is that I want nothing to do with it when it comes to the health and well-being of my family. The two primary arguments in favor of TCM involve the classic logical fallacy of argument from antiquity and conspiracy theory about the evil intents of “Big Pharma. I will confine the rest of this blog to discussing the totally unscientific and perhaps even anti-scientific origins of TCM and leave debunking the Big Pharma Conspiracy to my fellow skeptics.
The argument from antiquity in favor of TCM usually goes like this: it’s been around N-thousand years (replace N with your favorite integer between 1 and 5) and so it must have worked well! The truth of the matter is that TCM has no scientific basis and has been developed over the years on a foundation of very flawed understanding of the human anatomy and physiology. Historically, the pathetically low cure-rate of diseases plaguing the Chinese population with access only to TCM resulted in the evolution of a hyper-superstitious culture bent on seeing ghosts and goblins around every corner and behind every bush, too ready to take another life away. The inefficacy of their medical treatments throughout history, in my opinion, is responsible for the Chinese culture’s obsession with superstitions associated with maintaining good health and longevity. The list of superstitious do’s and don’ts are especially long when it came to childbirth, prenatal and postnatal care. Please note that I am not talking about ancient history or even 100 years ago – I am talking about the persistence of these superstitions today in very modern Chinese communities in Hong Kong, Singapore, Taiwan and big modern cities in China.
To understand TCM, you do not need to understand chemistry, biology, anatomy or physiology because the foundation of TCM has nothing to do with them. You need instead to understand Taoism and Confucianism, as these philosophies are the founding principles of TCM. I will expend some ink here to explain these two very powerful underlying influences on Chinese society which gave rise to their understanding of the human body and the attendant medical fallacies.
Taoism is a philosophical movement founded by Lao-Zhi . In his canon, the “Tao I-Ching,” Lao-Zhi laid out what Chinese are taught as the “Tao” of life – translated properly as “the righteous way” of life. Taoism asserts that because we humans are a part of nature, goodness and well-being comes from being in harmony with nature. Nature was thought to be made up of five elements – water, fire, wood, metal (gold) and earth. This led to the conclusion that we must have five organs and five orifices, each one associated with one of the five elements. The difference between living and non-living things in nature was thought to be in the presence of “vital energy flow” in living organisms and absent in non-living things. This is “Chi” (or “Qi”) — which has been adopted by the New Age Movement as their ubiquitous pseudoscience jargon de jour. Along with Chi, is the concept of maleness (strength, virility, bravery, intelligence and every sexist stereotype you can ascribe to men) and femaleness (gentility, compassion, intuition, nurturing and every sexist stereotype you can ascribe to women) which are enshrined in the principle of Ying and Yang. Every food, animal, plant, word, color, taste, and feel have varying degrees of Ying and Yang.
Taoism is the quest for harmony with the universe. Life is good when you are in harmony with each other and with nature. You are healthy when your Chi flows smoothly through your body and you consume food, do stuff, use words and think thoughts that will keep your Ying and Yang in balance. Since everything ultimately comes from nature, we must all somehow be one with nature, animate and inanimate objects included. From this cosmogony – and unencumbered by verification or falsification by any experimentation – other fantastic ideas about nature and how nature works spawned. Taoism proposed many of the proto-scientific ideas found among early Greek philosophers like Aristotle, Epicurus, Pythagoras, and others. But while the West has long moved away from the five elements/five senses approach to understanding nature and pathology of illness, every classically trained TCM “doctor” still start out with the proposition that the kidney is water, liver is fire, stomach is wood, lungs are metal and heart is earth when diagnosing illness and dispensing herbal medication. I will leave you to your imagination to associate our five orifices with the five elements! While there may be nothing wrong with adopting Taoism as a philosophy or religion, it was unmitigated disaster to use it to gain an understanding of the physical human body for medical purpose.
Why have the Chinese after thousands of years of civilization not developed the scientific method to examine and put to test all the “common sense” knowledge about nature they have been taught or acquired by intuition? Blame it on the sage Kung-Zhi, anglicized as Confucius. The teachings of Confucius saturated every aspect of the Chinese society but it is not a religion and barely a philosophy. The teachings are basically a set of rules governing relationships and the “proper” conducts of every possible social intercourse. Confucianism is concerned with the hierarchical relationships of emperors over subjects, masters over serfs, husbands over wives, parents over children, teachers over students … and the list goes on. Then there is the preference for symmetry over non-symmetry, intellectual work over manual labor, and common sense over logic. He promoted common sense and reasonableness as the hallmark of a scholar. For Confucius, it is not enough that a proposition be “logically correct”; it must be in accord with “human nature.” Between Taoism and Confucianism, all the necessary ingredients to incubate and foster critical thinking was “taught” out of the Chinese society.
The complexity of the human body and all its attendant diseases and ailments can neither be explored nor understood by mere intuition and common sense. Advancement in medical science requires application of the scientific method and as we make discoveries we must have an avenue to replace past knowledge with more current ones even if we have to contradict our teachers. When students cannot challenge inaccurate or flawed knowledge of the teachers, errors are passed on generations after generations and the quest for knowledge and understanding of nature is stifled. When scholars can only contemplate and make common sense guesses and did not roll up their sleeves to dig into the dirt to study earthworms or cut open dead bodies to study inner organs, wild speculation of the unseen part of nature resulted. Common sense, intuition, reasonableness and the pursuit of harmony may be ideal for understanding humanity and settling human disputes but they are inadequate for determining the locations of our internal organs or understanding the life-cycle of earthworms. Canonical knowledge from antiquity located the heart in the middle of the body (“symmetry”). In the 1700’s, Jesuit missionaries first arrived in China bringing with them the latest anatomy books from Europe showing the heart to be on the left side of the chest cavity. Common sense led Chinese scholars to conclude that since Europeans look different (“inferior”) externally, they must also have defective placement of their internal organs, which they intuit gave rise to their different religion. It was thought then that if the Jesuits succeeded in converting any Chinese to their religion, it must be because these converts have hearts on the left side like the Europeans and thus defective as Chinese. The Chinese scholars of the day pitied the Jesuits for not knowing that they were only converting defective Chinese! One can conclude that it must have been beneath the dignity of a scholar to hold his hand to the left side of his chest to feel for palpitation – that would be manual labor.
“But.. but.. but.. TCM does work sometimes..” I hear my detractors protest. Well, yes it does – sometimes. And here I am going to invoke the “it’s-been-around-N-thousand-years” defense. TCM could possibly work sometimes (rarely) for the same reason that if you give a blind archer enough arrows and enough time (thousands of year?) it is not unreasonable to expect that he may hit a target or even a bulls-eye. Would you trust your health and well being of yourself and your family to dumb luck and random chance? Consider the fact that in its long history, and in spite of their professed love of children, the Chinese never developed a branch of medicine to take care of children. When the prevailing unscientific common sense wisdom was that babies were just smaller version of regular people and cannot be that different in their medical needs there is no need for a specialty of pediatrics. Thus terms for distinct periods of childhood development like “adolescent” and “puberty” are absent from traditional Chinese medical vocabulary.
Next week, I will continue in Part II to relate some personal experience I have with TCM while growing up and how TCM must be accompanied by a heavy dose of superstition to work properly. That the foundation of TCM is utterly unscientific is obvious to those of us who grew up with it and later discover science and the scientific method. In modern times some efforts have been made to subject many TCM herbs and modalities to vigorous testing for efficacy and side-effects. A lot of these efforts were undertaken by the People’s Republic of China (PRC) in their quest to promote TCM along side Western evidence-base medicine. I will also comment on some of these efforts and why they are so politically sensitive about the subject. Of the thousands of herbs commonly prescribed by “modern” TCM herbalists, a few have been found to actually do something. The blind archer may have grazed the target a few times! Modalities like acupuncture to treat various ailments from back pain to diabetes or “medical Qi-Gong” to treat cancer all turned out to be placebo at best. But yet TCM is making some headway in the U.S., for unfortunately in an increasingly scientifically ignorant society, the paucity of research-grade evidence is not a barrier for acceptance by the consumers as long as there are enough personal anecdotes in the form of “satisfied customer” testimonies.