Chinese herbal medicine, a major component of Traditional Chinese medicine (TCM), one of the oldest self-contained health systems, is criticised for lacking scientific evidence due to difficulties running randomised clinical trials (RCTs), but it does not mean that we cannot employ other forms of quality research to provide evidence.
TCM is an ancient, pre-scientific medical system and popular in Australia. Typically, it covers a range of modalities such as acupuncture, Chinese herbal medicine, Tui Na massage, diet therapy and Qi Gong meditation. You might be familiar with the practice of acupuncture (the insertion of tiny needles into so-called acupuncture points located across the body) particularly for pain. If you come across a group of people in the park making slow movements with their arms in a standing position, then you are watching Qi Gong. Or perhaps you might have been given Chinese herbs, which you will probably remember by their unusual taste. And if you are a fan of remedial massage, then Tui Na (pinch and pull) techniques could have been used on you by a trained massage therapist.
TCM requires to improve standards but it’s not pseudoscientific
For the past 60 years, TCM has been completely integrated into the Western medical system in China with hospitals offering access to both types of medical care. Chinese herbs were trading worldwide at an estimated US$ 1 billion in 2016 with an upward moving trend, suggesting that it’s a popular remedy.
TCM is a holistic health system and in many ways different to Western medicine. If you consider the jobs of the gardener and the mechanic, they are both important, but have different orientations. Let’s say the mechanic works similarly to a Western doctor, they look after the car, they service it and replace parts when needed or broken. The gardener ensures that plants in their garden flourish, always considering factors like seasons, weather, water supply, shelter, and weeds (more like a Chinese medicine practitioner).
TCM is also part of complementary and alternative medicines (CAM), and those methods have complex interventions. What does this mean? It means that the treatment covers several components, and each has its own mechanism. For example, if a Chinese medicine practitioner examines headaches, an extended conversation to establish timelines and history on how and when it started will be held. The practitioner will put their fingers on your pulse, examine your tongue and consider seemingly unrelated symptoms and factors such as how we feel, what we eat and how we live our life. Based on their findings, a TCM treatment strategy is set. A Chinese medicine practitioner will spend between 60-90 minutes in an initial consultation to establish all those elements and considerably longer than a doctor for follow up sessions. Over time you will form a therapeutic alliance with your practitioner. It has been found that all those factors may contribute to the outcome of the treatment and must be considered. Now you may understand that research design that caters for all these aspects is challenging and requires a careful approach with multiple segments.
Randomized clinical trials (RCTs) occupy the top of the research pyramid and are considered the gold standard in western medical studies. They are helpful in isolating single agents or one-dimensional effects. But to investigate complex interventions such as acupuncture or Chinese herbal medicine, they are not suitable. Consequently, scientists being unfamiliar with TCM concepts, condemn it as pseudoscience.
A unique approach to diagnosis and treatment: pattern differentiation
Instead of using individual herbs (such as St John’s Wort or Echinacea) to treat symptoms with certain pharmaceutical properties, Chinese herbal formulas focus on treating the imbalance causing the symptoms in the first place. In this way, the body receives assistance from the herbs to correct the discrepancy and return it to equilibrium. Chinese herbal formulas aim at treating a variety of ‘patterns’ rather than a disease. TCM uses a unique framework of physiology, pathology, diagnosis, and treatment principles. For example, diabetes has been known in TCM for a long time, but is regarded as a range of imbalance patterns that are distinctive for each person and consequently are treated differently in each individual. ‘Many diseases, one treatment. One disease, many treatments’, this means that even though the name of the disease is different, the imbalance patterns causing it, may be similar across a range of conditions. Chinese medicine takes a macroscopic approach and is excellent for chronic disease management.
Biomedical treatments focus on the very aspect or fault, like the mechanics of your car. They fix what’s broken and replace what is no longer working. Western medicine does this remarkably well. But the emphasis and attention are on that specific part of the body, disregarding the connection with other sections or the interaction with the environment, food, or emotional wellbeing. Problems are addressed isolated from each other and mirror a microscopic strategy.
Western medicine being the primary health care system in Australia does not recognise the TCM framework nor the fact that each herbal formulation is tailored to the individual based on all those extra factors causing the pattern of disease.
Case series or studies are considered observational studies on the research pyramid
TCM has earned its place in today’s health systems. It might be based on empirical (based on observation and experience) evidence that has been collected for thousands of years. This is not a reason for its unworthiness and the body of knowledge considerable. Case series or studies have always been part of clinical practice and TCM practitioners learn best from those reports because they can easily relate to the information and apply it to the experience with their own patients. Case studies offer the recognition of a pattern to help identify similar cases across the entire field. Ways to systematically gather and analyse information already exist and meet evidence-based practice and scientific rigour guidelines. A centrally organised coordination for case series does not only meet the practical and pragmatic aspects of research but likely honour the core system of tailoring herbs, patient-centred care and the dynamics of complex interventions. The customisation of Chinese herbs is an advantage and essential to TCM. TCM has been around for a lot longer than conventional medicine and it wants to be honoured for its prolonged existence as much as any other traditional medicine system.
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