Unit 13 · Traditional Medicine and the Evidence

Picture a clinic in Shanghai. A practitioner takes a patient’s pulse at both wrists for a long time. She looks at his tongue. She asks how he sleeps, what he eats and whether he feels hot or cold. These steps come from Traditional Chinese Medicine, or TCM, a system of healing developed in China over more than 2,000 years.

TCM teaches that the body is filled with qi (said "chee"), often translated as vital energy. In this tradition, qi moves along pathways called meridians. Health means qi flows smoothly and stays in balance. Illness means qi is blocked, too weak or out of balance. Treatments such as acupuncture, herbs and exercise aim to restore that flow.

Qi and meridians are ideas inside the TCM framework. Scientists have not found meridians as physical structures, and qi has not been measured as a form of energy. That does not mean a treatment is useless. It means we test each treatment by its results in people, not by whether its explanation matches modern biology.

Think of a day. Morning light grows, noon is bright and hot, and evening cools into a dark night. Chinese thinkers used this kind of pattern to describe yin and yang. Yin stands for cool, dark, still and inward qualities. Yang stands for warm, bright, active and outward qualities. Each needs the other, and each slowly turns into the other.

TCM applies this idea to the body. A person with a high fever, a red face and a fast pulse may be described as having too much yang. A person who feels cold, tired and pale may be described as having too much yin. The practitioner then chooses herbs or foods that are said to cool or warm, bringing the two back into balance.

TCM also uses the five phases: wood, fire, earth, metal and water. Each phase is linked to organs, seasons, colors and emotions. In the tradition, the phases support and control one another in cycles. These are ways of organizing observations, like a map. Modern medicine uses a different map, based on cells, chemistry and experiments.

Walk into a large hospital in Beijing and you may find two pharmacies. One hands out pills made in factories. The other has rows of drawers filled with dried roots, bark and flowers. In China, many hospitals offer both Western medicine and TCM, and many doctors are trained in both.

After 1949, the government of the People’s Republic of China supported TCM and built colleges to train its practitioners. It also encouraged integration, meaning TCM and Western medicine working together. A patient might have surgery for a broken hip and also receive acupuncture or herbal tea during recovery.

TCM is also used far beyond China. Acupuncture clinics exist in cities across the United States, including Chicago. In the U.S., each state decides who may practice acupuncture and what training is required. Researchers in China and around the world now run clinical trials to test which TCM treatments help, and for what.

Maria, a nurse, has had low back pain for more than a year. Her doctor suggests physical therapy, and she also tries acupuncture. In acupuncture, a trained practitioner places very thin needles into the skin at chosen points. Many patients say it feels like a small tap or a dull ache, not like a shot.

Researchers have studied acupuncture in thousands of patients with chronic pain, which is pain that lasts three months or longer. Large reviews of these trials suggest that acupuncture may help some people with back pain, neck pain, knee arthritis and headaches. The benefit is usually modest, not dramatic. Some people improve a lot, and some not at all.

Acupuncture has also been tested for nausea. Studies of pressing or needling a point on the inner wrist suggest it may reduce nausea after surgery for some patients. Acupuncture is usually safe when done by a licensed practitioner with clean, single-use needles. Anyone thinking about it should talk with a doctor first.

How do you test a needle treatment fairly? In a sham trial, one group gets real acupuncture. Another group gets a fake version. The fake might use needles placed at the wrong points, or blunt needles that touch the skin but do not go in. Patients do not know which group they are in.

Many sham-controlled trials find that real and sham acupuncture give similar results. Both groups often feel better than people who get no acupuncture at all. When real acupuncture does beat sham, the difference is usually small. This tells researchers that much of the benefit may come from the whole experience, not the exact needle points.

Part of that experience is the placebo effect: real improvement that comes from expecting to get better and from caring attention. Placebo effects are real for symptoms such as pain. Scientists still debate what these results mean. Some say acupuncture works mainly through placebo. Others say needling any spot may have real effects on nerves.

Early in the morning in a park in Chicago’s Chinatown, a group of older adults move together in slow, flowing steps. They shift weight from one foot to the other and turn their arms in wide circles. This is tai chi, a mind-body exercise that began in China as a martial art.

In TCM, tai chi is said to help qi flow. Scientists have studied it in a different way, by counting falls. Falls are a leading cause of injury in older adults. Many trials show that regular tai chi improves balance and leg strength. Reviews of these trials find that exercise programs that include tai chi lower the number of falls in older people.

Because of this evidence, the U.S. Centers for Disease Control and Prevention lists tai chi among programs that can help prevent falls. Tai chi is gentle, and people can adjust it for their own bodies. It shows how a traditional practice can earn a place in modern care by passing careful tests.

In the 1960s, malaria was killing soldiers and civilians in Southeast Asia. The malaria parasite had become resistant to chloroquine, the main drug of the time. Resistance means the germ is no longer killed by a medicine that used to work. China started a secret program, Project 523, to find new drugs.

Tu Youyou’s team gathered more than 2,000 old recipes and tested extracts from about 200 herbs. Sweet wormwood looked promising but gave uneven results. Tu reread a fourth-century handbook by Ge Hong, which described soaking the herb in water, with no boiling. She guessed that heat was breaking down the active chemical, so she used a low-temperature extraction with a solvent called ether.

The new extract worked in animals in 1971. The team then tested it in people, including themselves, to check safety. Chemists found the structure of the active molecule, artemisinin. The old book gave the clue. Careful lab work, animal tests and clinical trials turned the clue into a proven medicine.

Today a child with malaria in Nigeria or Uganda is often treated with an artemisinin-based combination therapy, or ACT. An ACT pairs a drug made from artemisinin with a second malaria drug. The World Health Organization recommends ACTs as a first-line treatment for the most common dangerous type of malaria.

Why combine two drugs? Artemisinin clears parasites very fast, but it leaves the body quickly. The partner drug lasts longer and kills parasites that remain. Using two drugs together also makes it harder for the parasite to develop resistance, because it would need to resist both at once.

In 2015, Tu Youyou shared the Nobel Prize in Physiology or Medicine with William Campbell and Satoshi Omura, who discovered a drug against parasitic worms. Tu was the first Chinese woman to win a Nobel Prize in science. Her story shows that a traditional remedy can hold a real clue, but the clue must be tested.

Mr. Chen takes a blood thinner after a heart problem. His cousin mails him a box of herbal tea said to help circulation. Some herbs can change how a medicine works in the body. This is called a herb-drug interaction. A few herbs may add to a blood thinner’s effect and raise the risk of bleeding.

Another risk is contamination. In some tests of herbal products, including some sold as TCM, researchers have found lead, mercury or arsenic. Others have found hidden prescription drugs or the wrong plant. In the 1990s, patients in Belgium had serious kidney damage after taking a slimming product that contained a plant with aristolochic acid.

"Natural" does not always mean safe. The U.S. Food and Drug Administration does not approve herbal supplements for safety and effectiveness before they are sold, as it does for medicines. That is why the best step is simple: tell your doctor or pharmacist about every herb, tea and supplement you use.

A ranger in Africa guards a rhinoceros through the night. Poachers kill rhinos for their horns, which are sold in some markets as traditional medicine. Tiger bone and pangolin scales have also been sold this way. These animals are now endangered, which means they are at risk of dying out.

An international treaty called CITES controls trade in endangered wildlife, and most countries have signed it. Rhino horn is made of keratin, the same protein as fingernails. There is no good scientific evidence that it treats disease. Many TCM practitioners and organizations support using plant or farmed substitutes instead of wild animals.

Talking about TCM fairly means holding two ideas at once. The tradition has deep roots and has given the world real gifts, such as artemisinin and tai chi. Some of its products also have risks or lack evidence. Evidence-based discussion respects the people who use TCM by asking the same careful questions of every treatment, Eastern or Western.

In a clinic in Kerala, in southern India, a practitioner asks a new patient about her sleep, her digestion and her moods. She notes that the patient is thin, moves quickly and often feels cold. These questions come from Ayurveda, a healing tradition from India whose classic texts are about 2,000 years old. Its name means "knowledge of life."

Ayurveda holds that each body is shaped by three doshas, or forces. Vata is linked to air and movement. Pitta is linked to fire and digestion. Kapha is linked to earth, water and structure. In the tradition, each person is born with their own mix, called their prakriti, or constitution.

Ayurveda teaches that illness comes when the doshas fall out of balance. The practitioner in Kerala might say her patient has a lot of vata and suggest warm food and a regular routine. Like qi in Chinese medicine, the doshas are ideas within the tradition. They have not been measured as physical substances.

Before sunrise, an Ayurvedic daily plan might begin with waking early, rinsing the mouth, drinking warm water and stretching. This routine is called dinacharya, or daily practice. Ayurveda teaches that doing the same healthy things at the same times each day helps keep the doshas in balance.

Food is central. Ayurveda sorts foods by six tastes: sweet, sour, salty, bitter, pungent and astringent. A practitioner may suggest more warm, cooked food for a person with strong vata, or cooling foods for strong pitta. Meals are meant to be eaten calmly, at regular times, with the largest meal near midday.

Some of this advice overlaps with modern lifestyle medicine, which studies how sleep, diet, activity and stress affect health. Regular sleep, plenty of vegetables and calm meals are supported by many studies. The dosha reasons behind the advice are the tradition’s own. The habits themselves can be tested and often hold up well.

In India, a young person can go to college for five years or more to become an Ayurvedic doctor. These colleges are regulated by the national government. In 2014, India created the Ministry of AYUSH, a government ministry for traditional systems of medicine.

AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. The ministry funds research, sets standards for training and supports hospitals and clinics. Millions of people in India use these systems, often together with modern medicine. Government recognition means these systems are part of public health care in India.

Recognition by a government is different from scientific proof. It shows that a society values a tradition and wants it to be taught and regulated. Whether a specific remedy works for a specific illness still has to be tested in fair trials. India’s own researchers run many such trials, and results vary from treatment to treatment.

James drives a delivery truck and has had low back pain for months. His doctor suggests a weekly yoga class designed for back pain. Yoga began in India as a spiritual practice. It joins body postures, breathing and focused attention. Many people today practice it mainly for health.

Researchers have tested yoga in many trials of adults with chronic low back pain. Reviews of these trials find that yoga can lower pain and improve daily function a small to moderate amount, about as much as other exercise programs. In 2017, the American College of Physicians advised doctors to try non-drug options such as exercise, yoga and tai chi first for chronic low back pain.

Yoga is not a cure-all. Some poses can strain the body, so beginners do best with a trained teacher who can adjust poses. People with health conditions should ask their doctor first. Yoga shows how a practice from one tradition can pass modern tests for a specific indication, which means a specific use.

Before a big exam, Aisha sits quietly for ten minutes. She breathes slowly and notices her thoughts without chasing them. This is a form of meditation, a practice of training attention. Meditation has roots in several Asian traditions, including those of India, and is part of Ayurvedic and yogic teaching.

Scientists have tested meditation programs, especially mindfulness, which means paying calm attention to the present moment. A large review published in 2014 in JAMA Internal Medicine found moderate evidence that mindfulness programs can ease anxiety, depression and pain for some adults. The effects were similar in size to some other helpful treatments.

Meditation is low-risk for most people and costs little. It is a tool, not a replacement for care. Someone who feels very anxious or sad for a long time should talk with a trusted adult, a school counselor or a doctor. Meditation can work alongside that support, and many people find it helps them feel steady.

Turmeric is the golden spice that colors many curries. Ayurveda has used it for centuries for digestion, skin and aches. Its best-known chemical is curcumin. In lab dishes and animal studies, curcumin has shown effects on inflammation, which is the body’s response to injury or infection.

Results in a lab dish do not always carry over to people. Curcumin is poorly absorbed by the gut and breaks down quickly in the body. That means very little may reach the tissues. Many human trials of curcumin have been small or short, and their results are mixed. A few suggest it may ease knee arthritis pain a little, but those studies are not strong. The U.S. National Center for Complementary and Integrative Health says there is little reliable evidence for most uses.

Some chemists have warned that curcumin can look active in many lab tests for reasons that do not mean it works as a drug. This is a lesson about preclinical research: early lab and animal studies are a starting point, not an answer. Turmeric in food is generally safe, but supplements can interact with some medicines, so tell your doctor.

In some Ayurvedic practice, metals and minerals are processed into preparations called rasa shastra medicines. The tradition teaches that careful processing makes them safe. Testing tells a more worrying story. Some of these products, and some herbal ones too, have been found to contain heavy metals, such as lead, mercury and arsenic.

In 2008, researchers led by Robert Saper tested Ayurvedic products bought online. Published in JAMA, the study found that about one in five contained detectable lead, mercury or arsenic. Products made in India and products made in the U.S. both had problems. Doctors have reported cases of lead poisoning in people who took such products.

Lead can harm the brain, kidneys and blood, and children are most sensitive to it. This does not mean every Ayurvedic product is unsafe. It means quality control matters. Buy from trusted sources, show products to a pharmacist, and tell your doctor, who can order a simple blood test for lead if needed.

In Delhi, a patient visits a hakim, a practitioner of Unani medicine. The hakim asks about his temperament and diet and may suggest herbs, a change in food or rest. The word Unani comes from the Arabic word for Greek. The system began with Greek medicine, especially the ideas of Hippocrates and Galen.

Physicians in the Islamic world translated, tested and expanded these Greek ideas. The Persian physician Ibn Sina, known in Europe as Avicenna, wrote the Canon of Medicine around 1025. It was used as a medical textbook in Europe and the Middle East for centuries. Unani medicine kept the Greek idea of four humors, the body fluids once thought to control health.

Western medicine gave up the four humors in the 1800s, after experiments showed how germs and cells cause disease. Unani medicine still uses humors as its framework. Today it is practiced mainly in India, Pakistan and nearby countries, and it is part of India’s AYUSH ministry. As with any tradition, each remedy should be judged by fair tests.

In a Tokyo clinic, a doctor trained in Western medicine writes a prescription for a packet of powdered herbs. This is Kampo, Japanese herbal medicine. Kampo came to Japan from China more than 1,000 years ago. Over the centuries, Japanese doctors adapted it, simplified many formulas and developed their own ways of diagnosing.

Kampo is unusual because it is part of mainstream care. Since the 1970s, Japan’s national health insurance has covered many Kampo formulas, which are made in factories to set standards. In Japan, Kampo is usually prescribed by medical doctors, not by a separate group of practitioners. Many doctors use Kampo alongside modern drugs.

Researchers in Japan study Kampo formulas in clinical trials. Some show benefits for specific uses, while others have little evidence. Like any medicine, Kampo can cause side effects. For example, some formulas contain licorice, which in large amounts can raise blood pressure and lower potassium. That is why doctors track Kampo like any other prescription.

In the Pilsen neighborhood of Chicago, a small shop called a botanica sells dried herbs, candles and teas. Some families visit a curandero or curandera, a traditional healer in Mexican and other Latin American communities. Curanderismo mixes herbal knowledge, prayer and practices from Indigenous, Spanish and African roots.

Across North and South America, Indigenous nations have their own healing traditions. These differ from nation to nation, and many are private to each community. They often treat a person’s health as linked to family, community, land and spirit. Some U.S. health programs that serve Native American communities now include traditional healers in patient care when patients ask for them.

Respect matters here. Many of these traditions were once banned or mocked. Doctors now learn cultural humility, which means listening and learning from each patient instead of assuming. Some herbs used in these traditions have been studied and some have not. A good doctor asks about them openly, so patients feel safe telling the whole story.

At a large cancer center, a patient finishing chemotherapy meets with a team. One person teaches gentle yoga. Another offers acupuncture for nausea. A dietitian plans meals. Her cancer doctor leads the plan. This is integrative medicine, which combines standard care with complementary practices that have evidence for a specific use.

Integrative medicine is different from alternative medicine, which means using an unproven practice instead of standard care. Using an alternative remedy in place of proven cancer treatment can be dangerous. In the United States, a federal agency, the National Center for Complementary and Integrative Health, funds research on which practices help and which do not.

The simplest safety step is also the most important. Tell your doctor, nurse or pharmacist about every herb, tea, powder and supplement you use, including ones from family or from other countries. Bring the labels. A good clinician will listen with respect, check for interactions and help you keep what is safe.