Traditional Chinese Medicine (TCM) has only come in tangentially during my research, but it is still an interesting topic to me.  TCM is undeniably a force in China.  TCM has it’s own government bureau, the State Administration for Traditional Chinese Medicine (中华人民共和国国家中医药管理局, note: their website was down at the time of writing this post), which is under the auspices of the Ministry of Health.  TCM and Western medicine exist side-by-side in China as facets of the public healthcare system, albeit sometimes antagonistically.  Even in China, doctors trained in Western methods are highly skeptical of TCM; but its cultural stature and pull means it continues to be a mainstay in Chinese society.

One of the current goals in China is the “modernization” of TCM, essentially a systematic rechecking of TCM medicines and methods through standard clinical and research trials.  And this is laudable, but what I did not appreciate were the inherent difficulties involved in assessing TCM based on “Western” methods (i.e. randomized controlled trials).  I was reading a report about research ethics in China, published by the UK’s Medical Research Council, and they had a section on TCM and precisely this problem.  To summarize, standardized TCM research in China can be difficult for five reasons:

1. Many TCM treatments, ideally, are individualized and holistic; it would be exceedingly difficult to set up truly randomized, controlled trials because it would be impossible to find similarly-afflicted individuals who require the same exact treatment.
2. Because much of TCM relies on herbal medicine, there are difficulties in purifying the proper extract in trials, because the unadultered plants or mixtures may have ingredients that interact with each other.
3. Standardization may be difficult because the proportions of different compounds may be different in each treatment using the same medicine.
4. Using a placebo in place of actual TCM may be ethically dubious in China, where practitioners and patients might believe that the efficacy of a certain treatment is already proven.  Ethically withholding that treatment is then problematic.
5. While assessing TCM treatment of some disease, you may be neglecting to provide a patient with Western medicine already proven to treat the patient’s disease.

I do not think that any of these are truly insurmountable difficulties; I suppose I am just once again struck by the observation that “holisticity” is such an easy gateway to unfalsifiability.  The idea that something is so complicated and dependent on other factors that it is unprovable.  Anything that toes that line inevitably risks association with disingenuousness and blind faith.

“Because such methods work, there is no reason to seek the causes of their effectiveness…In a tradition like that, you do not have to know why something works.  Rather, you just have to follow the example of others.  From knowing the past, one obtains those methods for ensuring one’s own existence.  Moreover, these methods are not isolated techniques; they are embedded in, and naturally carry with them a set of values.  When we say that some technique is effective (灵验), we mean that there is some unknown magic behind it.  If you use that technique, you will have luck; if you don’t, you will have problems.  Therefore, people grow up in awe of tradition.”