Our last posting told of how Chinese pharmacologist Tu Youyou was awarded a share of the 2015 Nobel Prize for Physiology or Medicine for discovering an anti-malaria medicine called artemisinin (1). A key feature of Tu’s story is that her discovery happened only because she could read 1,500-year-old Chinese medical texts.
Tu’s discovery caused some individuals to comment that Western medicine needs to pay more attention to traditional Asian therapies. In contrast, others noted that while traditional medicine has provided some potentially useful leads, it also has been the source of many useless and even harmful treatments. In any case, the current version of traditional Chinese medicine circulating in the West is not nearly as ancient as many might presume. The story is as follows.
Western medicine was brought to China in the 1880s by missionaries whose activities were protected by the trade deals forced on China by the Western powers. Initially, Western medicine spread only slowly through the country. But, during the first half of the twentieth century the Chinese people were suffering from epidemics of plague, smallpox, diphtheria, malaria, tuberculosis, and other illnesses, which traditional Chinese medicine was ineffective against. Consequently, by the late 1920s the Nationalist government, headed by Chiang Kai-shek, adapted the view that important principles of Chinese medicine, such as Yin Yang theory and the five elements (see below) were not based on any empirical reality, and, in fact, were fraudulent (See Aside 1). Thus, the government began assuming a preference for Western medicine. Moreover, implementing Western medicine was seen as an important step towards modernizing China.
[Aside 1: The Nationalist Kuomintang party was founded by Sun Yat-sen in 1912, and was led by Chiang Kai-shek after 1925. It came into power in China in 1927 and, for a time, unified the country. The Chinese Communist Party, established in 1921, was the major political force opposing the Nationalists. Following a long civil war, in 1949 the Communists, led by Mao Zedong, established control over all of China.]
Interestingly, the person most responsible for the resurgence of interest in traditional Chinese medicine, both in China and in the West, was Chairman Mao Zedong. Mao promoted traditional Chinese medicine in the 1950s, ostensibly to alleviate the shortage of health care providers among his under-served populations. However, his advocacy may also have been motivated by a political agenda. He may have hoped that exporting traditional Chinese medicine might improve relations with the West. And, he may have hoped that an indigenous Chinese medicine might diminish China’s reliance on its Communist rival, Russia, for medical equipment and drugs. Moreover, Mao considered traditional Chinese medicine to be a symbol of China and, in fact, a national treasure. Apropos that, in 1954 he wrote: “Chinese medicine [itself] should be well-protected and developed. Our country’s Chinese medicine has a history of several thousand years, and it is an extremely valued asset of our homeland (2).”
Mao continued, “[Traditional] Chinese medicine has made great contributions to the people of our country. With a population of six hundred-million, China is the most populace country in the world. Of course, there are many factors contributing to the ability of our country’s people to propagate and prosper day by day, but of these, the part played by health care must be one of the most important. In this respect, we must give credit first to [traditional] Chinese medicine.”
“If we compare Chinese and Western medicine, [traditional] Chinese medicine has a history of several thousand years, whereas Western medicine was introduced into China only a few decades ago. To this day, there are still more than 500 million people in the entire country who rely on [traditional] Chinese medicine for the diagnosis and treatment of their illnesses, while those who depend on Western medicine number only in several tens of millions (and most are located in big cities). Therefore, if we speak of China’s health care since the beginning of history, the contributions and accomplishments of [traditional] Chinese medicine are very great.”
Notwithstanding Mao’s enthusiasm for traditional Chinese as expressed in the above writings, he was well aware that much of what he wrote was propaganda and that the then existent traditional Chinese medicine, with its implausible theories and untested doctrines, would not be accepted by empirically-minded people abroad, or indeed at home. Thus, Mao took several steps to facilitate the acceptance of traditional Chinese medicine. Among these steps, he ordered the clinical testing of traditional Chinese herbal remedies. And, he advocated the unification of traditional Chinese medicine with Western medicine. Interestingly, he stated, “the most important thing is to first ask practitioners of Western medicine to study [traditional] Chinese medicine, and not for practitioners of [traditional] Chinese medicine to study Western medicine (2).”
In order to make traditional Chinese medicine accessible to both foreigners and native speakers, Mao ordered that the ancient texts be translated into modern Chinese. [Recall that Tu Youyou’s discovery of artemisinin happened only because of her rather unique ability to read 1,500-year-old Chinese medical texts (1).] But, that was not all. There was no canon per se of traditional Chinese medicine. Instead, Chinese medicine was a hodgepodge of inconsistent ancient texts, implausible theories (e.g., five element theory), undetectable phenomena (e.g., qi, acupuncture meridians, yin yang imbalance), folk wisdom, and anecdotal accounts. Thus, to facilitate the acceptance of Chinese medicine by empirically-minded critics, Mao ordered the writing of new texts; ones that would present a standardized, internally consistent Chinese medicine. Additionally, notions such as “holism” and “preventative care” were incorporated into the new writings, no doubt to increase Chinese medicine’s appeal to Western sensibilities. Thus, while traditional Chinese medicine is generally thought to be an ancient opus (which many value precisely because it is presumed to be ancient), to a real extent it is the modern result of Mao’s advocacy.
Despite Mao’s efforts to foster acceptance of traditional Chinese medicine in the West, there are more than a few skeptics who consider its entire oeuvre, including its so-called “holistic” approach, to be unsupported quackery. Many also contend that it is unfair to disparage Western medicine for being reductionist, since Western medicine most certainly knows that human diseases involve complex interactions between many factors. Others worry that hyping traditional Chinese medicine might undermine confidence in conventional Western medicine (the issue of vaccine non-compliance comes to mind). Then again, to dismiss all of Chinese medicine out of hand is not evidence-based either.
In any case, Mao was clearly successful in getting many in the West to embrace traditional Chinese medicine. Just this past October, a U.S. Senate resolution sponsored by Sen. Barbara Mikulski designated October 7-13 as Naturopathic Medicine Week. One reason cited in the Senate resolution is that naturopathic physicians (including those who practice traditional Chinese medicine) can help address the shortage of primary care providers in the United States.
It is interesting that the U.S. Senate’s justification for officially incorporating traditional Chinese medicine into our health care (i.e., the shortage of primary care providers) reiterates one of Mao’s seventy-year-old reasons for preserving traditional Chinese medicine. But, can traditional Chinese medicine, which many consider to be unsupported quackery, alleviate our situation?
Addendum: In traditional Chinese medicine…“the internal organs are divided into two groups: the five Yin or solid organs, and the six Yang or hollow organs. Each of the Yin and Yang organs are identified with one of the five elements; fire, earth, metal, water, and wood. The heart (Yin) and small intestine (Yang) are associated with fire, the spleen (Yin) and stomach (Yang) with earth, the lungs (Yin) and large intestine (Yang) with metal, the kidney (Yin) and bladder (Yang) with water, and the liver (Yin) and gallbladder (Yang) with wood…The five-element medical model stresses interrelationships among the internal organs rather than their individual functioning. Using principles of mutual creation and mutual destruction (as contained in five element theory), Chinese medicine explains that both an excess as well as deficiency in one organ may affect another organ. Consequently, problems with one organ may be cured by the treatment of one or more related organs (3).”
1. 2015 Nobel Laureate Tu Youyou and Ancient Chinese Medicine, posted on the blog October 12, 2015.
2. Directive on Work in Traditional Chinese Medicine (July 30, 1954), pp. 464-467 in The Writings of Mao Zedong, 1949-1976: Volume I September 1949 – December 1955. Michael Y. M. Kau, John K (eds), M. E. Sharpe Inc., 1986.
3. The Tao of Tai-Chi Chuan, by Jou, Tsung Hwa, Shoshana Shapiro (ed), Charles E. Tuttle Co, 1980.