Despite the pseudoscientific basis of Chinese Medicine, ‎its popularity, and the fact that health systems embrace it ‎according to popular demand – It does not meet the basic ‎standards of modern science and medicine

"Even though I believe we should promote Chinese medicine, I personally do not believe it" - Mao Zedong

In recent decades, traditional Chinese medicine therapies have played a larger role alongside Western medicine, and are even encouraged by some medical institutions. Chinese medicine is based on a tradition over 3,000 years old, using concepts and unconventional therapy techniques that are totally foreign to the scientific world – from inserting needles at strategic points on the body to using medications that have not passed proper controlled processes.

The popularity of Chinese medicine is now so vast, so much so that one-quarter (!) of the American public use Chinese herbal medicines. Although the scientific community doubt their effectiveness, many Western medical institutions offer Chinese medicine as complementary therapies to patients, such as those suffering from cancer.

Public debate on the effectiveness of Chinese medicine flared anew in recent years following the publication of the controversial book "Trick or Treatment?" by Simon Singh and Edzrd Ernst (who is actually a "Professor of Complementary Medicine"). The authors claimed that Chinese medicine does not meet most scientific criteria. This confusion infiltrates into the general public who cannot decipher whether Chinese medicine "works" or not.

What methods are used in Chinese medicine? Do they meet scientific criteria? Are the therapies effective, ineffective or even harmful?

Alternative anatomy

First we need to understand, if only briefly, the logic that Chinese medicine is based on. The theoretical basis of Chinese medicine is very complicated, so in order to be concise we will only touch on the most basic concepts.

Chinese medicine, influenced by Chinese philosophy, is based on the five elements that make up everything in the universe, including the human body: water, fire, earth, wood and metal. These elements interact with each other in many complex ways. Each one of them is connected to specific tastes, colors, emotions, seasons, humidity and even organs and tissues in the body, albeit the definition does not translate to Western anatomical-functional definitions. For example the heart relates to fire, and the kidney to water.

The most important concept in Chinese medicine is qi: a form of energy that flows through the body enabling all activities of the mind and body. Qi flows through channels termed the meridian system, and interference with this flow is what causes disease. During acupuncture, the therapist diagnoses the problematic meridians, and prods  helps diagnose the problems, while inserting thin pins through the skin at strategic points, acupoints, affects the qi that influences the balance of the body. The therapist usually combines acupuncture treatment with traditional medicines (called "herbs" but also includes minerals, animal products and even human products), as well as treatments more closely associated to the principles of Western medicine, such as massage, dietary changes and exercise.

Becoming a qualified Chinese medicine therapist is not easy. One is required to rigorously understand the extensive documentation on Chinese medications, the number of which in ancient literature reaches tens of thousands. One must also recognize all the different herbs and medications and how to use them. Also, theories on meridians have actually developed over time, almost empirically i.e. based on observations – interpretations were given to symptoms and to what treated them, so a therapist is required to know around 400 acupuncture points listed in the atlas of traditional medicine.

However, these theories are generally not based on the anatomy or actual function of the organ in the body. Throughout history, evidence of the existence of qi and meridians has never been found using Western scientific tools – they are entirely abstract concepts that have no physical existence. Similarly, there is no medical meaning to the principle of the five elements and the link between body organs to certain colors or flavors. So the basic starting point of Chinese medicine is not consistent with the knowledge we base modern science and medicine on.

Between results and illusion

Although the pseudoscientific principles of Chinese medicine are no more "scientific" than those of homeopathy, it is uniquely perceived as reliable and efficient compared to other types of alternative medicine. Well-established organizations like the British health care system and health service organizations in Israel subsidize such treatments.

Due to its popularity, Chinese medicine has attracted interest from the scientific community, ranging from academic researchers to pharmaceutical companies who are trying to develop new drugs and treatments based on traditional Chinese medicine, but of course only after undergoing rigorous testing according to the standards of modern medicine. For example, a drug used to cure malaria, artemisinin, which earned developer Tu Youyou a Nobel Prize for Medicine in 2015, was produced from a plant widely used in Chinese medicine.

Indeed, the question is whether Chinese medicine is beneficial according to scientific standards? Is it possible to reproduce results in a controlled trial? Is it an effective medical treatment compared to control, or rather an illusion created following the expectation of treatment? Due to the special nature of Chinese medicine it is very difficult to investigate certain aspects of it using standard scientific tools, and therefore the conclusions are controversial.

Acupuncture under examination

One of the cornerstones of Chinese medicine is the practice of acupuncture. Is it really effective? Before turning to the scientific evaluation of Chinese medicine, we need to understand how research aimed at determining the effectiveness of a particular treatment is carried out. A sample of subjects is divided into a group that receives the treatment itself and a control group that receives similar treatment but without the active substance (placebo). High-quality research insists on the double-blind method; where both participants and researchers do not know if the subject is getting the treatment itself or the placebo, in order to minimize any biases.

In many cases there is a placebo has a positive effect, because of the mere provision of care, real or imagined, activating psychological mechanisms such as anticipation, relief, reduced anxiety, etc.; a real physiological effect known as the "placebo effect". In other words, a scientist does not ask "Is Chinese medicine effective?" But "Is Chinese medicine more effective than placebo?" This is a difficult question in which to find a satisfactory answer.

A non-blind study

How do we conduct placebo studies for acupuncture? Some researchers define "placebo acupuncture" in different ways such as inserting needles in random places (i.e. not traditional acupuncture points, the acupoints), only superficial insertion of needles into acupuncture points or by external contact on acupuncture points without actual needle insertion.

All these placebo treatments are somewhat problematic, since it is unclear whether they activate the mechanisms acupuncture is claimed to activate. In addition, it is unclear whether it is possible to maintain the blind principle here, so patients are unaware if they are receiving actual acupuncture or not. It is also understood that such studies cannot maintain double-blind standards, because the therapist knows if they are performing acupuncture or placebo treatment. Therefore, the study of acupuncture is very limited and often leads to contradictory conclusions.

Needle in a haystack

Studies of traditional acupuncture began in the early 1970s and there have been thousands of papers published on the subject. Some studies report a positive effect of acupuncture in treating symptoms such as pain, depression, post-traumatic stress disorder, arthritis and even improving thinking skills. Other studies, however, report that they found no effect of acupuncture beyond the placebo.

From the great body of research it is also expected to have some exceptions, so therefore some meta-analyses were done by incorporating a large number of controlled studies into a thorough analysis. Such studies, one of which used data from eighteen thousand patients, statistically showed that real acupuncture is only slightly more beneficial than placebo that mimicked acupuncture without the use of the traditional knowledge involved in it, so it is doubtful if it has any real clinical benefit.

Edzard Ernst, a German-British doctor who also deals with alternative medicine and was co-author of the book "Trick or Treatment?", published an important comprehensive review summarizing fifty seven studies on acupuncture in the scientific journal "Pain". He concluded that in the majority of studies it was not found to have an effective treatment. However, in some cases, patients did show infections resulting from using unclean needles...

In light of the findings from most studies in the field, along with their limitations, the consensus in the scientific community is that acupuncture is sort of an effective "placebo". That is, the very fact that the patient trusts the therapist and expects great improvements, and the very physical contact with the skin, induces a placebo effect that slightly improves the patient's condition. In other words, the scientific establishment agrees that there are some very beneficial effects of treatment but not necessarily because qi and meridians are playing a real role in improving the condition of the patient, and that we can have a similar therapeutic effect even if we stuck the needles randomly in our skin. Nevertheless, some researchers still believe that acupuncture is an effective treatment method, and hold the limitations of research in the field responsible for the lack of results.

Chinese electricity

Still, it seems the debate about acupuncture is still far from conclusive. In 2014, a very successful study was published in the journal Nature Medicine. Researchers from the New Jersey Medical School showed combining acupuncture and electrical stimulation (electro-acupuncture) had an effect on treatment of inflammation.

Electro-acupuncture was performed in mice treated with inflammatory substances the induce sepsis. The needles were inserted at a certain location representing a certain acupoint, which was located by chance (or not by chance...) near the sciatic nerve in the pelvis and hip. The researchers also sent an electric current through the needle that also roused this nerve, while the placebo needles were inserted according to an identical procedure, but without electrical stimulation. A statistically significant difference was found with the electric current leading to the release of anti-inflammatory substances called catecholamines, which reduced the risk of sepsis and hence saved the mice.

Needless to say the Chinese therapists who laid the foundations for acupuncture knew nothing about the biology of infections, and definitely did not use electricity. Studies of this type excite advocates of Chinese medicine who believe in the effectiveness of the traditional practice of acupuncture. Indeed, it may be possible that under certain conditions acupuncture is appropriate, but this needs to be tested in a properly controlled clinical trial.

Traditional medicines

The ancient literature of Chinese medicine records tens of thousands of medicinal materials, of which thousands of them are used today in traditional practice. As mentioned above, the basis for their use in Chinese medicine is according to the theory of five elements, which are linked to all parts of the body and involve flavor, color, season and more. When a Chinese therapist finds, for example, an imbalance between the heart and kidney resulting from overactivity of the heart, which is associated with the fire element, the treatment will be to reduce fire and increase water, which is connected to the kidney. In this case the therapist will prepare for the patient a salty-tasting black medicine, associated with the water element and kidney.

Chinese medicine may contain a mixture of several different materials, popularly called "herbs", but which often includes materials of animal origin such as tiger genitalia or products from a dried human placenta.

Good materials

With the sheer abundance of medicinal plants used in Chinese medicine there are some examples of herbs that science has translated into modern drugs with commercial potential. The 2015 Nobel Prize Laureate Tu Youyou developed artemisinin as part of a government project to find a cure for malaria in the 1970s. The researchers screened hundreds of traditional Chinese herbs while trying to isolate anti-malaria materials and found that the herb Artemisia inhibits the growth of malaria parasites. However, researchers have not been able to replicate its extraction in a chemically stable form. Tu said she found a hint in classical Chinese literature for the effective production of through a low-temperature extraction process than had been used previously by researchers.

Artemisia is not alone: the active ingredient in the Huperzia weed has showed potential in impeding Alzheimer's disease; the drug Fingolimod, used for the treatment of multiple sclerosis, was developed from a fungus that according to Chinese medicine bestows eternal youth upon those who consume it; turmeric, also used in Chinese medicine, contains a proven anti-inflammatory molecule - curcumin; even the mineral arsenic, used in Chinese medicine, has been found to be beneficial in treating a certain type of leukemia, although if used in high doses is toxic and hazardous, and it is difficult to estimate the dose given in Chinese medicine. And the list of examples goes on.

In other words, some traditional Chinese medicines contain active ingredients that are indeed effective in treating diseases, and in some cases also lead to discoveries for commercial drug development. Is it possible from this to conclude that the drugs are "working"?

Without supervision

In terms of research it is much easier to check the effectiveness of Chinese medicinal herbs in the laboratory, as opposed to acupuncture. It is relatively easy to adjust placebo and control groups and uphold the double-blind principle. The main problem of research on traditional herbal medicines is the huge variety of medicinal plants rotating through the market without proper supervision. It is a huge task, perhaps impossible, to investigate them all.

As with regular drugs, two questions arise in connection with the use of herbs - whether they improve the condition of the patient and are they safe to use? The American Journal of Medicine, for example, argued in an opinion piece that the American market has twenty thousand types of “herbal” products, but their authenticity is questionable, and proof of their therapeutic efficacy was only shown in very few cases. However, there are many cases of poisoning or allergic reactions to these substances.

Other critics of herbal studies claim that the market is not supervised or standardized and therefore does not meet Western standards. Edzard Ernst, the co-author of Simon Singh's book "Trick or Treatment?", describes a similar picture of credible reports for some herbs improving health - for example, the plant Ginkgo is very popular in treating muscle pain. At the same time he notes that there are many reported cases of serious side effects for the use of herbal medicine.

It was also mentioned in the journal Planta Medica, which focuses on herbal medicine,  that some herbs have a toxic effect, mainly manifested in liver damage. Thus the efficacy and safety of medicinal plants remains in doubt because of the difficulty to collate them all, as well as the absence of regulated studies.

Ernst points out, for the sake of honesty, another reason for limited research – that is the lack of research grants from pharmaceutical companies due to the inability to patent herbal remedies. It should be noted that Western drugs can also be very toxic at high doses, but the medical establishment has developed an organized experimental system in order to regulate drugs and their registration.

In 2015, Australian researchers published in the journal "Scientific Reports" an innovative approach to review the safety of natural products. The researchers bought commercial products sold in health food stores and at Chinese medicine practices and put them through three tests.

Firstly, they conducted a DNA test to identify whether the products actually contained the plant and animal components listed by the manufacturer. Apparently it was not always the case, and some products actually had DNA prepared from plants that are considered hazardous. One specific preparation contained the DNA of the Snow Leopard, which is an endangered species - to distribute these ingredients is against international law.

The other test was a toxicological test, which found that several products included unreported materials such as ibuprofen (the active ingredient for analgesics like Adex or Nurofen), dexamethasone (a steroid used as an anti-inflammatory drug), antihistamines used for allergy treatment, antibiotics and other toxins like strychnine (a deadly pesticide). A third test examined the presence of heavy metals in the products and they discovered high levels of arsenic and lead, beyond what is permissible.

The study demonstrated the complete lack of regulation or supervision over herbal remedies. Hiding behind the belief that the products are "natural" and therefore not dangerous, there is a lack of transparency, and patients have no idea what they are getting in the products they purchased.

Ecological price

Finally, with respect to the question whether the Chinese medicines show efficacy and without toxicity, it is important to note that they have a dark side that the general public is not aware of: materials such as the bile of bears, are acquired through painful techniques. The demand for exotic animal substances, for example, leads to poaching of wild species such as the wild tiger, rhinoceros and sea turtle, and may cause their extinction. In the absence of scientific evidence of the efficacy of these drugs, we must ask whether the huge price paid by the animals and their ecosystems due to their uncontrolled hunting is indeed justified.

If so, certain herbs actually do contain active substances that were found effective in treating diseases, and traditional remedies have great potential for finding cures for diseases, which the scientific community is open to recognizing. However, this market is currently flooded with the manufacture of many products without supervision and it is very complicated to test their effectiveness. As we saw earlier, the effectiveness of acupuncture is minor - if it exists at all beyond the placebo effect.

Although Chinese medicine has a pseudoscientific basis, including textbooks and theories based on observation and accumulated knowledge, studies show that these theories do not hold true in reality. Science still cannot explanation all effects of Chinese medicine, including the psychological effects on patients. However, in order for Chinese medicine to win the trust of the medical and scientific community it must meet strict criteria developed over many years to test the efficacy and safety of treatments and medications. To this day, this still has not been done.

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