Understanding traditional Chinese medicine
Traditional Chinese Medicine (TCM), a collection of ancient Chinese knowledge and cultural wisdom, is a life science that has been passed down for thousands of years. Supporters of TCM stress its clinical efficacy, and while the particular characteristics and reliability of TCM have received widespread attention, they have also invited considerable criticism. This article aims to discuss some of these controversial topics.
Decipher the spirit—Shen
Shen is the basis for all human activities and the source from which all human spirit emerges. Shen can be divided into soul and wisdom. The soul is inborn, and it is contained in the heart—the “monarch”—of all human organs. Thus, practitioners of TCM believe that the heart can govern all life activities via other organs and perceive external feedback. For example, a patient who has received a heart transplant may fall in love with the heart donor’s lover—because the soul is governed by the heart. Wisdom is acquired, and it is contained in the brain. With the development of modern science and technology, people can learn new subjects much faster and deepen their wisdom, but their souls—the innate ability to perceive the universe—have gradually deteriorated. The balance between the soul and wisdom has been tilted so askew that it has become harder for people to perceive Yin and Yang, Qi (energy) and blood in TCM. Physicians in TCM must not only accrue clinical experience and accumulate wisdom, but also increase their awareness to perceive life and nature (the soul).
Understand substances
Our understanding of substances is mainly based on their appearances. Some substances are tangible, and some are intangible. The intangible can be further divided into verifiable substances (such as oxygen) and unverifiable substances, such as meridians in TCM. Meridians are intangible, but their existence can be sensed through clinical practice. There are still many unknown substances in the universe that have yet to be discovered and verified. A good approach to these unknown substances is to learn through theology. An example of this is can be found in the life of Sir Isaac Newton. His research interest spanned both the subjects of physics and theology, as theology is another way to acquire insights into the workings of the universe. In short, people should be aware that simply because the existence of an object has yet to be proven, it does not mean the object does not exist.
It is generally believed that TCM is holistic, macroscopic, and dialectical, while Western medicine is specific, microscopic, and scientific. However, in my opinion, the main difference between Chinese and Western medicine is that Chinese medicine attempts to unify the material and the spiritual, and it considers the influence of social and environmental factors, such as time and location, on the human body and diseases; meanwhile, Western medicine mainly considers the human body on the anatomical level (material level).
Verification of meridians
TCM theory is composed of two principal parts: the solid viscera system and the meridian system, which are explained in detail in the Inner Canon of the Yellow Emperor (also known as Huangdi Neijing). The practice of acupuncture, in which the therapist inserts needles into acupoints under the skin, is widely accepted across the globe, as it can improve the quality of life of the patient. Acupoints are located on meridians, which are the 12 pathways in the body that connect vital organs, allowing energy to flow through. However, current research on meridians mainly focuses on the visual, tangible, and material aspects of meridians, which is problematic for 2 reasons: first, it neglects the holistic nature of the TCM by isolating meridians from other influence factors and thereby violates the principles of TCM research; second, many researchers have little experience in practicing the essence of the meridian, and so a large number of meridian and acupoint studies fail to make substantial progress.
Standards of diagnosis and treatment
The formation of the TCM theoretical system is consonant with ancient Chinese philosophy. It pursues the balance between the Yin and Yang, between the Five Elements of the human body, and the harmonious coexistence of humanity with the universe. Regardless of one’s age or gender, the balance of the Yin and Yang in one’s viscera, Qi (energy) and blood is vital. For exogenous disease causes, TCM physicians remove disease-causing factors and treat the condition accordingly (which may include detoxification, heatstroke cooling, promoting blood circulation and diuresis, etc.); for internal injuries, TCM strengthens the organs’ vitality (nourishing the heart, protecting the liver, invigorating the spleen and kidney, etc.). Therefore, when treating a patient, TCM not only treats the underlying causes of diseases, but also coordinates the organs and tissues of the human body to facilitate its maximum capacity for recovery (holistic therapy). TCM attaches great importance to the use of comprehensive treatment to activate, improve, and exert the body’s self-regulation function (self-healing ability). This integration of the whole body’s function is often neglected in the clinical practice of Western medicine because of its current fragmentation into various subspecialties and its conceptual division of the human body into specific organs and corresponding diseases. Western medicine has recently discovered that immunotherapy is an effective treatment for some patients, but this theory has been widely accepted in TCM therapy for quite some time. The concept of immunotherapy can also explain the peculiar cases of curative recovery in TCM, the occurrence of which is one of the main factors contributing to the veneration of TCM. It is precisely the coordination of treatment concepts and methods that creates the miraculous effects sometimes seen in TCM. However, because different doctors have different levels of understanding and experience with diseases, and because each patient is unique, a TCM practitioner may often fail to achieve the so called “repeatability” of a clinical curative effect even for identical symptoms and diseases. This is a critical issue for TCM to solve going forward because the use of guidelines or standardized treatment can only be applied to determine the outcome of patients in general and not specific individuals. Interestingly, however, Western medicine has recently shifted focus to individualized treatment plans, which is more in line with tenets of Chinese medicine.
The standardization of the TCM consists of the four diagnostic methods, meridians, viscera, and the eight-principal syndrome differentiation. The efficacy of TCM should not be denied based on its lack of repeatability, nor should it be measured under the standard of modern medical science and dismissed thereby. TCM observes syndromes to guide clinical treatment, and part of the theoretical basis of the TCM is that a given prescription can be used to treat different diseases. Western medicine tends to build guidelines centering around a single specific disease, which is followed by standardized medicine and treatment plans. During the development of Western medicine, the accidental use of a medicine beyond the intended scope of the guidelines occasionally produced surprising results. For example, sildenafil was originally used for the research and treatment of cardiovascular diseases but was later found to be applicable to male sexual dysfunction. In another example, it was found that berberine, an antidiarrheal drug, could also be used to lower blood sugar. Within the frame of TCM, these findings are not surprising, as they merely realize the concept of treating different diseases with the same methods. Indeed, this is the foundation of TCM—comprehensive, individualized, and systematic.
The development of the TCM has indeed encountered many difficulties, but we should maintain confidence in TCM based on its clinical efficacy. When conducting research into Chinese medicine, researchers should follow the principles and the naturalistic development pattern of TCM. Furthermore, real-world experience with acupuncture and meridians is needed to understand authentic TCM and to draw accurate conclusions regarding its efficacy. These conclusions should be comprehensive, precise, enduring, and unbiased.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Hepatobiliary Surgery and Nutrition. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.org/article/view/10.21037/hbsn-2021-25/coif). The author has no conflicts of interest to declare.
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