Skepticblog

Rewind the tape 50 years – I awoke one morning with a bit of extra sleep on my eyes and complained to my mom about canker sore in my mouth. That afternoon when I came home from school, a tall glass of cooling barley water awaits me to offset the extra heat due to too much activity in my liver. In the folklore of Traditional Chinese Medicine (TCM), our bodies can be too heaty, or too cool, or damp or dry. Our bodies can also, according to that tradition have a combination of these undesirable conditions such as dry heat or damp heat which must be treated accordingly.  By Western (and modern) standard of behavior, as an eight-year old kid with a ten-year old brother, it would not be considered the least bit unhealthy to engage in some sibling rivalry scuffles and quarrels. But whenever we bickered or had some spat in front of older relatives we could count on them to admonish my mother to brew us some chrysanthemum tea (and make it extra sweet!) Childish verbal or physical jousting between us brothers must be due to overly vinegary or acidic disposition and can be neutralized by sweet chrysanthemum tea. Arthritis is damp wind in the joints so the cure is to take herbs that will remove the wind and dry up the joints. For every condition, physical or mental where external manifestations can be observed, there are corresponding herbs, animal parts/by-products or even toxic minerals to help neutralize and restore harmony to the body. This is TCM in its most rudimentary form and is still practiced today.

Unchecked by the scientific method, the Taoist origin of TCM, which depends on intuition and common sense, spawned some ridiculous concepts, which can only be described as naive imagination. It is believed that eating frogs which live in cool ponds must have a cooling effect on the body, while eating a lung shaped plant could be good for people suffering with tuberculosis. The latter is taken seriously for the shapes of natural objects are not mere cosmic accidents and must therefore have some intrinsic medicinal value associated with the shape of the organs of our body. Walnuts look like our brain – so it must be good brain food. Lima beans and cashew nuts look like kidneys so they are good for guess what? The longan berry (Dimocarpus longana aka “dragon eye”),  which really looks like an eyeball when peeled, must be good for vision. The panacea elixir extraordinaire of TCM is the ginseng root which can allegedly strengthen the heart and nervous system and shore up mental and physical vitality, build up resistance to diseases and even cure cancer. How? Because it looks like a complete human! Look at any advertisement or packaging for ginseng root, it is always posed to look like a stick figure human drawn by every aspiring kindergarten Picasso.  Ginseng in Chinese is “ren xing” meaning “human heart.” With such a name and such a shape, how can you go wrong?

Many a Chinese schoolboy in Hong Kong, Singapore and Malaysia can attest to how many stew pig brains he had been fed in preparation to take the SAT or the infamous Cambridge Overseas School Certificate “O” and “A”-level exams required for admissions to some of the most prestigious universities in the US, UK, Canada and Australia. (How did you think a kid from Borneo got into MIT?) Every herbalist will have a good stock of deer sinews for their arthritic customers and ground up tiger bones for aspiring kung-fu masters. Go to any butcher shop in any Chinatown in the U.S. and you can buy, off the shelf, chicken and pig vagina which are made into soup to be consumed by women (presumably of reproductive age!) In every major city in China and Taiwan, you can find restaurants specializing in serving penises of every animal known to the Chinese. You can probably guess that they cater exclusive to male patrons. Who needs Viagra when you had tiger penis for dinner!

According to TCM, everything you consume, animal, vegetable or mineral have some medicine value attached to it and every Chinese growing up is supposed to know about it. The difference between mother/aunt/grandmother and a trained TCM herbalist is that the latter has a more encyclopedic knowledge about these properties and knows more exotic consumables; all of which will have the power to restore balance to your yin and yang and to make sure your Chi flow is unobstructed. Next time you are in any Chinatown, stop by an herbal store and marvel at the wall of small index-card size drawers, each containing a different medicine. Most of the contents are dehydrated plant parts (leaves, stems, flowers, fruits, seeds, roots) and fungi but there are also tiger bones, toad skin, sea-horse and seal penis just to name a few. Unfortunately this list of ingredients also includes many body parts of endangered species including rhinoceros horns, bear gall bladders, bear claws and tiger paws. Some ingredients are known to be toxic if the dosage is not dispensed without some precision like foxglove (digitalis) and ma-huang (ephedra). When the herbalist diagnoses your condition (and I use the word “diagnose” loosely) he will pick out a combination of herbs, nuts and dried organ parts to make up a potion. Sometimes he just picks a pinch or a handful from the drawers. Sometime, he may even have to weigh the ingredient – usually only the more expensive ingredients get weighed, not the ones that may have the most potency or side-effects if over-dosed! Then he wraps everything in white newsprint paper. (Cultural hint for barbarians doing business in China: white paper is only for wrapping medicine – never use white paper as gift warp – never!)  Then he will explain to you how to prepare the concoction when you get home – sometimes you have to boil them in water (for anywhere from just boiling for a few minutes to simmering for up to 4 or 5 hours.) Sometimes, a gold or copper coin is dropped into the boiling concoction if some metallic essence is called for to compliment the brew. Sometimes all the ingredients are put into the pot at the same time, sometimes different ingredients are added at different times.

Individual herbalists may give you different ingredients for the same condition or they may give you different preparation instructions for the same ingredients. I remembered very distinctly an incident when my father was quite ill with stomachache, high fever, and diarrhea. He could not hold down any food for a couple of days. His cousin heard about his problem and on the way to visit us, stopped by his favorite herbalist to bring my father some medication – yes, the patient need not be present as long as the symptoms can be described. Unbeknown to my mom that his cousin was coming over with medication, she too went to her own favorite herbalist, presumably described the same symptoms and came home with another version of a cure. While the herbs themselves were a little different, the instructions on how to prepare them were; how much water to use and when to take the extracted bitter tea was completely different. I remembered my mom and cousin comparing the open packages on the kitchen table and discussing the significance of the differences especially the preparation.  Rational thinking may have befallen the Chan household that day.  By the fourth day my father gave in to Western medicine and was immediately checked into the Queen Elizabeth Hospital of North Borneo to have his very inflamed appendix removed.

But what is a kid suppose to think about East verse West? A visit to a Western medicine doctor often ends with a painful shot in the arm or buttock. A painless visit to the Chinese herbalist is always followed by having to drink up a few cups of black vomit-inducing bitter brew when mom is done boiling it. Of course, it’s never fun to be sick. What I remember of my childhood visits to the Western doctors is the hypodermic needle (thicker and bigger in my memory that they probably really were) and my main memory of visits to the Chinese herbalists is the pulse reading. A visit to the herbal doctor always started with the obligatory pulse reading. The herbalist feels your pulse at your wrist with his index and middle fingers. Supposedly a well trained pulse reader will be able to tell a lot about your general state of health by knowing how well your blood is flowing just by feeling your pulse.  They claim that they can feel for any irregularity from which to make a diagnosis about the patient’s liver and kidney in addition to the heart. It’s as good as dowsing!

That the foundation of TCM is unscientific, irrational and not supported by any empirical evidence is obvious, but that does not, unfortunately, means that TCM will go the way of flat-earth geography or alchemy. It is a cherished belief and a source of pride for Chinese all over the over the world today. For the People’s Republic of China (PRC), TCM is a patriotic symbol, enshrined in their constitution, taught in universities and protected and promoted by government agencies at all levels, from the village governing council to the most inner sanctum of the Chinese Communists Party. Since the founding of the PRC, TCM is sacrosanct and next to criticizing party or politburo officials in public, dissing TCM is the sure way to provoke and incite the wrath of the State.

In October 2006 someone did dare to skewer the scared cow of TCM in China.  A professor at an obscure provincial university launched an online petition to seek removal of the special status of TCM from the Chinese Constitution and as the only officially recognized medical system in China. Professor Zhang Gongyao from Central South University in Hunan province quickly found himself the center of controversy for voicing quite mild and reasonable criticism of TCM. He basically appealed for some serious research to be done on TCM and to update some of TCM’s outdated concepts and views about the human body using scientific principles. For daring to question the ancient wisdom of his ancestors and the political expediency of the Communist Party, vitriolic condemnation from his countrymen and government was quick. He was cursed on websites and Chinese culture discussion forums on the Internet by Chinese all over the world and denounced as a traitor by the Chinese government. He was right on target in his criticism that: “TCM has no clear understanding of the human body, of the functions of medicines and their links to disease. It’s like a boat without a compass: it may reach the shore but it’s all up to luck.”

Professor Zhang should take heart that despite being given special status; TCM is losing its luster in the eyes of many Chinese at home and abroad. Even Chinese newspapers reported that today the number of TCM practitioners in China has decrease to a little more than a quarter of what it was from the beginning of the 20th century and the number of physicians in Western medicine practice has more than doubled in the same period. In the case of my immediate family, my father was sold on Western medicine after his bout with appendicitis and followed a year later when my then 12-year-old older brother was diagnosed with brain tumor by a British educated and London University trained Chinese neurologist. He endured a 4 hour open-skull operation followed by a 2-month stay in a severely ill children’s ward in a Hong Kong hospital run by the British government. That was 1962, before MRI, endoscope probes and modern electronic medical instrumentation. I guess the surgical scalpel makes a very convincing argument in favor of Western evident-based medicine.

Today in any Chinese communities throughout China and Asia, access to and acceptance of Western medicine is widespread. The attitude of most Chinese, even those who profess to believe in TCM, laud Western evidence-based medicine for its ability to make accurate diagnosis of the most complicated illness with even the most subtle symptoms.  Without access to blood chemistry and urine analysis, TCM diagnostic techniques for non-communicative patients like babies are confined to just looking at their skin tone and smelling their poop and urine. (Reader may recall the scene from the 1987 Academy Award-winning movie The Last Emperor with concerned court physicians smelling the emperor’s chamber pot.) They concede that TCM has nothing to offer for serious illness, infectious diseases, trauma victims, organ transplantation and cosmetic reconstructions. Many have delicately downgraded their support of TCM to the equivalent of taking daily vitamin supplements. They use TCM to tonify themselves by regular consumption of the right tonic herbal brew to keep themselves healthy and disease free. Many are like my parents after they have “seen the light” and would always take their kids to Western-medicine trained physicians whenever they were sick. However, they themselves took the occasional herbal tea when they felt the need to balance and regulate their bodies. But as much as they were sold on Western medicine, they found it very puzzling that a Western-medicine trained doctor could not do anything for cold or flu except to tell us to drink lots of fluid and go to bed whereas every TCM herbalist will swear up and down that they have the ultimate herbal brew to do the job!

My quarrel with TCM is that it is unscientific and the body of knowledge upon which it rests is outdated and flawed. We now have a very good understanding of the operation of our human body – not complete but fairly accurate – yet TCM still seeks to describe the anatomy and physiology of our body with unrevised knowledge from our scientifically ignorant past. It’s not just bad science, it’s not even science. TCM needs to be brought up to 21^st Century scientific standards – shed all the voodoo, put it to vigorous tests and evaluate the results. I too, subscribe to the truism not to throw the baby out with the bath water – but let’s find out if there is a baby in there!  When the ginseng root and the quintessential female herb dong-quai were studied scientifically for their alleged cancer-curing power, they were found not only to be ineffective but in fact encouraged the growth of some cancer cells. It is quite possible that TCM herbs may be effective for many illnesses and may have something to offer modern pharmacology, but the active ingredients present vary in concentration depending on the soil and climate conditions under which they are grown. This makes the dosage unreliable and even dangerous when prepared by primitive home brewing. Until a pharmacological process is applied to preparation of Chinese herbs in the form of extracting the active ingredients and calibrating dosage, herbal treatment cannot be admitted into the realm of 21st century medical “science.” Like Prof Zhang, I like to see a concerted effort made to study them scientifically and let the results speak for themselves. That’s how Western medicine has ascended to it position of respectability. Study, research and promote the chemistry and pharmacology of the herbs and relegate the magic and superstitions to folklore and religion.