Talk:Traditional Chinese medicine

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question about TCM research

I'm interested in this article for a couple of reasons. One, I want to know more about TCM. Second, I'm interested in the research. I'd like to understand more about the efficacy of TCM. In ref #1 (Status of TCM Research) the NIH states that "scientific evidence of the effectiveness of TCM is limited" (I like the way that is phrased). In ref #191 the WHO lists "Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials-to be an effective treatment." Is acupuncture more thoroughly researched than other modalities used in TCM? Octopet (talk) 01:04, 1 July 2011 (UTC)

WHO, being a governmental organization, is not really a good source, per WP:MEDRS. I would guess that acupuncture has been more thoroughly researched than just about any other junk medicine claim. And almost all of the real studies show that it is nothing more than a placebo. These fake medical "treatments" fail on two levels. First, no one has been able to show how they might work physiologically. All real medicine can show how it works either through pharmacology, physiology, or some real science. Second, fake medicine fails to provide real clinical studies, double-blinded, and published in real peer-reviewed journals. Real science, and by extension, real medicine, always allows itself to be exposed to the bright light of criticism, and either passes or fails. Fake medicine, like TCM, whines about that criticism. TCM is a pseudoscience. It is junk medicine. OrangeMarlin ^{Talk• Contributions} 01:26, 1 July 2011 (UTC)

Your argument defeats itself; you fail to understand the goal of real medicine. Sure, real science is about such claims - but real medicine is about curing patients... and wouldn't you know it, just as you yourself point out, the placebo effect is quite real, quite repeatable, and studies have to be designed in strict ways to rule out this very strong placebo effect. But, since the goal of real medicine is curing the patient, and not making scientific discoveries per se, its idiotic in the extreme to disqualify all medical techniques that rely upon the placebo effect as "junk" if they continue to provide provable, repeatable results even if they do so via the placebo effect. Zaphraud (talk) 05:56, 15 January 2012 (UTC)

I do find it interesting that while TCM has not been proven by western science (about 100-200 years old) and is considered "junk medicine", western science has proven that cough syrups are ineffective, yet they are still recommended and sold as "medicine". Additionally, TCM (acupuncture, herbology, and a variety of other practices), have been around for 5000 years (reference any google search for 5000 year old ice man) and only in the past 10-20 years have scientists started to realize that the points acupuncture uses, and the herbs that are used do have measurable effects (by the active ingredients in a given herb). — Preceding unsigned comment added by 173.165.40.25 (talk) 13:49, 15 September 2011 (UTC)

If someone managed to demonstrate the existence of TCM circulation channels ("meridians") and to devise effective therapy on the basis of that knowledge, he or she would undoubtedly deserve a Nobel Prize in Medicine. This hasn't happened, of course, and nobody expects this to happen.

There are two logical flaws here. 1. Not verified by scientific method does not equal to ineffective (or junk) 2. Having a non-scientific theory basis does not mean it's ineffective. If someone can provide studies that show TCM is ineffective I would be more than happy to take that. But I think the consensus (according to #1) is it's just not studied well yet. So I would refrain from calling it junk or fake. — Preceding unsigned comment added by Hiei81 (talk • contribs) 04:29, 8 September 2011 (UTC)

You are right on both counts. However, since science is nothing more than the building of models that give reliable predictions (at least in some conditions), it is surprising that practitioners of TCM have not endeavored to meet this very simple requirement. It is not surprising that people treat it with suspicion. This also answers objection #2. If a model works, it works. If in experiment after experiment its predictions are better than guessing, then it would be accepted by the scientific community (if not immediately, it will eventually). So for the time being, TCM is junk science. --Wynand.winterbach (talk) 21:02, 9 January 2012 (UTC)

Note that acupuncture might be the best-known TCM treatment in Western countries, but it's not very widespread in China. In most "TCM hospitals," what you get is herbal prescriptions. But the TCM doctors who work there have all received training in "Western medicine" as well, so they will also prescribe things like hormones and painkillers when necessary, or some pre-made pills based on Chinese pharmacology that might contain acetaminophen or other substances that have nothing to do with TCM.

This is to say that TCM as it is practiced in China today has already integrated large chunks of "Western medicine." There's been a big struggle in China since the 1950s to preserve Chinese medicine by integrating more scientific knowledge into it: anatomical knowledge, knowledge about the causes of illness, use of "Western" medicinal substances, toning down of cosmological concepts like the Five Phases, etc. Respected historians of science like Nathan Sivin have predicted that TCM doctrines will not be able to survive the tensions between the two systems, but this demise of TCM hasn't happened yet.

In China and elsewhere, "Chinese medicine" is often contrasted with "Western medicine." For example it is said to work better for chronic conditions (whereas "Western medicine" is the treatment of choice for acute infections); it supposedly has fewer side effects; and it is said to treat the entire person instead of localized illness causes. Many of these statements first emerged in the Republican period (1911-1949), when Chinese medical practitioners were being attacked by proponents of "scientific medicine" and had to find a distinct niche for Chinese medicine.

Now, not all of Chinese medicine depends on its cosmological doctrines. Herbs that are commonly used in Chinese medicine need to be evaluated on a case-by-case basis instead of being lumped together into one big "junk medicine" trash can. Both ephedrine and artemisinin, for example, were first isolated from Chinese pharmacological substances. There might be other such drugs out there.

Finally, I haven't read the WHO report on the efficacy of some Chinese medical treatments, so I can't say anything about its content. But WP:MEDRS (cited above by OrangeMarlin) says this:

"Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the Institute of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization. The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature." [Source: Wikipedia:MEDRS#Medical_and_scientific_organizations.]

Some editors might not agree with the WHO's conclusions, which may indeed be "less authoritative than the underlying medical literature," but the WHO report definitely seems to be a reliable source.

Cheers,

Madalibi (talk) 01:40, 4 July 2011 (UTC)

Thanks Madalibi, your explanation is helpful, and balanced.Octopet (talk) 19:09, 6 July 2011 (UTC)

In light of reference #191 which states "Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment" (a list of specific conditions, followed by lists of other conditions for which acupuncture has NOT been found to be effective), is this sentence from the lead accurate: "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." There appears to be a contradiction. What do you and other editors think about changing the word "little" to "limited" in this sentence? It would more closely match the statement by the NIH reference.Octopet (talk) 19:23, 6 July 2011 (UTC)

You're welcome, Octopet! I'm not qualified to review the medical evidence for and against acupuncture, but considering that "the threshold for inclusion in Wikipedia is verifiability, not truth," and because the WHO report qualifies as a reliable source (as per WP:MEDRS cited above), I think we should indeed change the lead to reflect the report's conclusions. Madalibi (talk) 07:19, 7 July 2011 (UTC)

One citation in support, with dozens not so much in support, is an undue weight concern. In fact #191 would probably fail MEDRS, so that statement is the one that's the contradiction. It's hard to find every single MEDRS problem in every single article around these places. The fact is there is NO evidence that acupuncture or TCM does anything beyond a placebo. I'm just going to delete whatever 191 refers to. That'll fix the issue. OrangeMarlin ^{Talk• Contributions} 07:27, 7 July 2011 (UTC)

Hi OrangeMarlin. Just asking: what is this "reference 191" that you and Octopet are referring to? Couldn't find it in the article. And undue weight is certainly an important issue. That's why I modified the wording so that it doesn't imply that Chinese medicine or acupuncture are widely considered efficient. I even removed the two words "so far," which semed to suggest that scientists were going to find evidence soon. Comments? Madalibi (talk) 07:33, 7 July 2011 (UTC)

Hi again! "Limited" is vague, so I agree it might not be the best word. But "no evidence" might not be better than "little evidence" either. I've never used (and I don't plan to use) TCM therapies, and I have no emotional involvement in this topic. Here I'm just concerned about editing Wikipedia. In that spirit, my point is that unless we can show that the WHO report represents a WP:fringe view despite citing 293 studies on acupuncture, we will probably have to mention it somewhere.

Some of these 293 studies will inevitably be unscientific (studies made in China are infamous for always finding Chinese medical treatments effective!), but at least some of these 293 sources should qualify as reliable by the standards of WP:MEDRS. If in the lead we say "no evidence beyond the placebo effect," we fail to reflect the minority point of view that these studies represent. As WP:WEIGHT puts it, "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint." I agree that the viewpoint that acupuncture is sometimes efficient is a minority view. As such it should only deserve a proportionally small space, but it sounds significant enough to deserve mention somewhere. Would you agree with that?

It's not my style as an editor to revert edits quickly, especially when we disagree over wording, so can we just discuss this here before we go back and forth? Can we try to find an acceptable wording that would say neither "no evidence" nor "limited evidence"? Cheers, Madalibi (talk) 08:02, 7 July 2011 (UTC)

I think reference number 191 is not that number any more. I think the reference that Octopet referred to is the WHO one (at least it contains this list of "diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment"). However, this (peculiarly bold) WHO statement is less authoritative than the underlying medical literature (per WP:MEDRS), so I don't understand all this ruckus. "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." still sounds very accurate to me. --Mallexikon (talk) 09:40, 7 July 2011 (UTC)

Sure, no problem with that. Should we just revert to that version? Madalibi (talk) 12:16, 7 July 2011 (UTC)

Yes, I'd recommend that. --Mallexikon (talk) 03:37, 8 July 2011 (UTC)

All right, done! Madalibi (talk) 04:15, 8 July 2011 (UTC)

WHO is one of the most respected medical organizations in the world, why dismiss it so readily? Could you point me to the source of your phrase "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." - it may be out of date and not taking more recent German trials into account.Herbxue (talk) 16:41, 26 August 2011 (UTC)

neutrality

Does this article still warrant the neutrality tag? Octopet (talk) 20:53, 18 August 2011 (UTC)

Not in my book :)--Mallexikon (talk) 02:35, 19 August 2011 (UTC)

The article might still feel controversial to some readers, especially concerning the issue of efficacy, but I don't think it suffers from lack of neutrality. In this sense, the tag doesn't look warranted. Madalibi (talk) 02:48, 19 August 2011 (UTC)

The two of you (Mallexikon and Madalibi) who appear to be the most educated about this topic, don't give the impression of being biased. In fact, I can't tell what your opinions are regarding the efficacy of TCM. (I've looked back through March history). It's easier to be a critic than a neutral and knowledgeable contributor.

I'm leaving a request on your talk pages for feedback on some other articles. Octopet (talk) 18:02, 19 August 2011 (UTC)

I think there still is an issue with neutrality. Mallexikon rightly reverted a couple edits I made because I did not source them. However, I have objected to the Matuk article as a valid source several times before because it looks at TCM from an anatomists POV. This would be like asking a pharmacologist whether TCM is concerned with the pharmacological actions of herbs or not. TCM is very concerned with anatomy - both structure and function play important roles in assessment and treatment.

Also, there should be more context and specificity to the statement that clinical trials have shown little efficacy. For one thing, very little research has been conducted in the west, and the statement in the article makes it sound like TCM has been thoroughly tested, which it has not. It is not even possible to "test TCM" - the studies that claim to are usually testing the effect of a TCM herbal formula or single herb. It is true that several acupuncture trials have failed to show efficacy, but there is a lot of controversy surrounding the methodology. There are also many clinical trials in Chinese journals showing positive results. Also, perhaps most importantly, the statement made should really refer specifically just to acupuncture. In China, acupuncture is considered one modality of TCM. So attributing the poor results of acupuncture trials to a failure of TCM is a bit like saying the failure of a certain surgical procedure shows that western biomedicine is ineffective.Herbxue (talk) 15:08, 25 August 2011 (UTC)

I don't quite understand the problem with the Matuk article - it's by all means a reliable source. Why not read it once? It's not written by an anatomist, but by a M.Sc. in Biomedical Communications. Anyway, besides the Matuk source we also have Kaptchuk and Ross (please refer to the beginning of the "TCM model of the body" section), all stating the same thing about TCM and anatomic structures.

Regarding the efficacy - well, we have to go with what can be verified. All statements in the TCM article as they are now are absolutely true to their sources and the sources are all very reliable. If you'd like to contribute new reliable sources - very welcome, please go ahead.

BTW in my opinion what this article very urgently needs is a section about TCM diagnostics. Any interest, Herbxue? --Mallexikon (talk) 05:15, 26 August 2011 (UTC)

I feel that proper context is important and the article approaches the subject from distinct points of view (treating it as if it were a branch of biomedical science) and makes a judgement about how much TCM is "concerned" with anatomical structures that is only true relative to biomedicine. I would be fine if the article said "relative to modern biomedicine, TCM places less emphasis on anatomical structures and more on functional relationships" - this would be a more accurate picture. The current sentence sounds like TCM practitioners dismiss the importance of anatomy which is not accurate. When Kaptchuck says it, he is trying to introduce the unfamiliar reader to a very new way of looking at the body. When Matuk does it, she is doing it from the position of "who depicted anatomy more correctly?" Matuk is also an illustrator - someone whose job it is to make money by drawing anatomically accurate pictures and getting them published, not an authority on TCM.

Also, I do insist that the cochrane reviews are not capable of evaluating "TCM" - which involves looking at health and adapting in the moment to changing signs and symptoms - Show me some RCT's that don't eliminate the possibility of practicing TCM correctly. The sentence can accurately state that systematic reviews of acupuncture RCT's have shown little effect, but the article should also articulate the issues acupuncturists have with research methodology (not that this in any way cancels out the results of the systematic reviews) because that is a very important issue in the acupuncture community. There are many RCT's showing positive effects of TCM herbs and herbal formulas, but similar methodology problems and pluralistic clinical application raise similar issues. Can we just make the sentence more specific?Herbxue (talk) 14:19, 26 August 2011 (UTC)

Interesting discussion here, which resurrects some of my questions about the earlier discussion on TCM research.... Octopet (talk) 14:49, 26 August 2011 (UTC)

Ok, how would changing the lede sentence to "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." work for you?

Regarding the efficacy discussion I can only once more emphasize that wikipedia is all about verifiability. If you can contribute reliable sources documenting TCM's efficacy - great. Similarly, your argument about cochrane reviews not being capable of evaluating TCM is OR unless you have a RS to back it up. Cheers, --Mallexikon (talk) 02:54, 27 August 2011 (UTC)

One Cochrane review (http://www2.cochrane.org/reviews/en/ab003444.html) concludes Chinese Herbal Medicine to be effective when added to conventional care for schizophrenia. Even I will point out this does not really validate "TCM" it only really validates the specific herbal approaches used in the studies under review. Can you point me to the reviews that show that "TCM" has little effect? If not, the sentence should specify what modality (acupuncture) was concluded to have "little" efficacy, and for what conditions, in which reviews.

I appreciate your qualification of "compared with scientific medicine" - but it is does not clarify if the rest of the sentence reads the same as it did. I would be ok if it said "less concerned with anatomy than function" or something like that. I will look for a more reliable source. Because this is stating what TCM is "concerned with" the source should be from a standard TCM textbook or perhaps works by Unschuld or Sheid - people who have actually bothered to understand TCM before making generalizations like Matuk did.

Please tell me which review states that TCM has little efficacy. Herbxue (talk) 04:00, 27 August 2011 (UTC)

Actually, after browsing through more of the Cochrane reviews like this one (http://www2.cochrane.org/reviews/en/ab001218.html) I would like to go back to my change from "little evidence" to "mixed evidence" with the additional caveat that the inconclusive reviews are generally inconclusive due to methodological problems rather than failure of the intervention. The verbiage in the lead is not clearly supported by the RS. Please browse through at least 5-10 of the reviews searching "Chinese medicine" and "acupuncture", you will see what I mean. When they cannot support Acu or herbs, they often also cannot refute. That should be indicated in the lead.Herbxue (talk) 04:31, 27 August 2011 (UTC)

As far as I can see, the verbiage is clearly supported by the source. "The effectiveness of acupuncture beyond the placebo effect is not well established.". (And there're more sources given in the acupuncture article.) "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented."

We only state that there is little evidence. Why there is little evidence of efficacy doesn't matter. Maybe it's because of methological problems; maybe it's because TCM just doesn't work. But this is not the place to speculate. Cheers, --Mallexikon (talk) 04:59, 27 August 2011 (UTC)

Thanks for that. My problem is that to the novice reader the sentence in the lead sounds like TCM has been thoroughly studied and found to have little effect. That is not what your source says. The source says there have been few quality studies done. In the 4 years since, there have been other review papers, such as the ones I mentioned. Some point towards efficacy comparable or superior to conventional care, some continue to say positive results may be due to bias or poor methodology, some show that sham acu is as or almost as effective as real acu. Sounds like there is "mixed" evidence out there, and there is definitely more evidence now than there was in 2007 when the source said there was little.

I do not mean to be difficult and I certainly do not wish to cherry-pick evidence to suit my likes, but I do think a narrow retelling of part of the 2007 source's conclusion gives an incomplete and potentially misleading representation of the current state of the research. I think that is supported by the later, mixed evidence.Herbxue (talk) 05:28, 27 August 2011 (UTC)

I guess this discussion lead nowhere unless you actually contribute RS producing evidence for efficacy of TCM treatments. What our sources say so far is that effectiveness is "not well established" beyond placebo, or "poorly documented". Should we change the sentence in the lede accordingly? --Mallexikon (talk) 06:03, 27 August 2011 (UTC)

We should change the sentence to reflect the reality, as demonstrated in numerous Cochrane reviews, that the current state of the research is not the simplified statement you just made but rather a mixed bag of some promising (http://www2.cochrane.org/reviews/en/ab005288.html), (http://www2.cochrane.org/reviews/en/ab006568.html), (http://www2.cochrane.org/reviews/en/ab005052.html), (http://www.ncbi.nlm.nih.gov/pubmed/17893311?dopt=Abstract), (http://www2.cochrane.org/reviews/en/ab003444.html), some that demonstrate lack of significant effect (http://www2.cochrane.org/reviews/en/ab006791.html), (http://www2.cochrane.org/reviews/en/ab004882.html), (http://www2.cochrane.org/reviews/es/ab006454.html), and many that conclude there have not been sufficient RCT's to make any conclusions whatsoever (http://www2.cochrane.org/reviews/en/ab006224.html), (http://www2.cochrane.org/reviews/en/ab006414.html). I did not see any claims of irrefutable efficacy, but some that conclude that "Acupuncture should be considered a treatment option" (http://www2.cochrane.org/reviews/en/ab001218.html) due to increasing trend towards stronger evidence of efficacy, or that "the available evidence suggests that acupuncture could be a valuable option" (http://www2.cochrane.org/reviews/en/ab007587.html). Nowhere in these reviews did I see language such as "there is no difference between TCM and placebo" though there are those in which acupuncture and placebo are the same. Most just say "inconclusive" due to lack of studies. This is a reflection of where the research is at - mixed and inconclusive - so the lede should not give the impression that there is consensus about a lack of efficacy or lack of differentiation from placebo. Herbxue (talk) 07:16, 27 August 2011 (UTC)

To me, a neophyte reader of this topic, the lead implies there have been no studies showing promise. Perhaps expanding the section on efficacy by elaborating on the present state of research (without getting too arcane) would be valuable. Octopet (talk) 22:00, 27 August 2011 (UTC)

I think Herbxue has a point, here. We have to make an effort to take as many reliable clinical trials into account as possible (including the newest ones), and this will mean going beyond what one summarizing source says. The problem is I don't see how we can give a fair account of "TCM"'s efficacy (or lack thereof) in a single sentence. In the lead, we should probably mention which kinds of acupuncture or herbal therapies have been tested so far, and then explain what kinds of conclusions the testers have drawn. This will mean more than choosing between "little" and "mixed," since we will have to agree on a corpus of reliable sources, and then find a wording that all editors will agree represent the sources in a neutral and proportional way. I'm too tight on time to review the relevant literature to suggest a formulation, but I would be glad to discuss other editors' suggestions.

The issue of anatomy might be even more complex to tackle. Both TCM popularizers and historians of Chinese medicine have tended to say that function trumps anatomy, but historians are also starting to dig out evidence that anatomy and structure were far more important than we thought. Sure, Chinese interest in dissection was far less intense than the European obsession for it, but Chinese doctors knew the approximate location, shape, and size of internal organs, and they gave at least some importance to the physicality of these organs when they made a diagnosis or proposed a treatment. The problem is that this POV has not clearly emerged in many reliable sources, so we can't present it too strongly without falling into original research.

And we face another challenge: this wiki discusses a lot of classical concepts like the Five Phases or Yinyang cosmology, but other sections are clearly about modern TCM only. Where do we draw the line? I know that modern modern practice is inextricably tied to classical doctrines, but we will get a different picture of Chinese medicine if we discuss modernized TCM diagnostics than if we explain how Chinese physicians diagnosed patients in, say, the sixteenth century. If we focus on pre-modern times, we might want to point out that Chinese medical books did not mention the pancreas, and that the "Gate of Life" (命门) and the "triple burner" (三焦) correspond to no anatomical reality. But modern TCM doctors know that the pancreas exists, and do not falsely believe that the Gate of Life is a physical structure. So again, where do we draw the line? By the same token, are we discussing TCM as it is practiced in the Western world, or are we also including China? If the latter, TCM theory will look quite different, since Chinese TCM colleges routinely teach anatomy and biomedical precepts to their students.

For anatomy, I think the simplest way to start would be to reword our sentence on the relative importance of function vis-a-vis structure. Do you all find that the Kaptchuk citation at the beginning of the "TCM model of the body" section gives a fair picture? If so, we should summarize it. If not, we could also cite reliable info from Nathan Sivin's survey of Chinese medical doctrines at the beginning of his Traditional Medicine in Contemporary China (1987), which is about modern TCM, but is aware of Chinese medical history (since Sivin is a historian of Chinese science).

In any case, we can further improve this article without forgetting about "verifiability" and "reliable sources," so let's give it a try! Madalibi (talk) 03:38, 28 August 2011 (UTC)

There is very much to think about in your post, Madalibi, so I will start a new section for the Anatomy issue and lets keep the issue about how to re-word the statements about research in this section. About the issues of classical (or "canonical" - based on classic texts) vs. modern practice: that could be another section as well, but I believe the term "TCM" generally is considered a 20th century development that distinguishes it from modern biomedicine. As such, in my mind, we would default towards contemporary practices in general and specify when we are talking about a distinct theory prevalent in a particular era.Herbxue (talk) 02:31, 30 August 2011 (UTC)

Yes, I agree that we should focus on modern practices, though we shouldn't forget to explain how "TCM" emerged in the 1950s and 60s. And I'm looking forward to reading your new section on anatomy! Cheers, Madalibi (talk) 02:45, 30 August 2011 (UTC)

Lead/Lede

The phrase 'tongue findings' is vague. Does anyone object to rewording it: 'TCM diagnosis involves identification of patterns of disharmony, usually by taking into account the pulse and the condition of the tongue'?Octopet (talk) 22:11, 27 August 2011 (UTC)

Sure, let's try to eliminate vague words. Another one is "involves," followed by a noun (identification). How about "TCM diagnosis consists in identifying..."? Madalibi (talk) 08:18, 28 August 2011 (UTC)

Sounds good - its difficult to not go into too much detail while trying to clear these up. For example, TCM Diagnosis requires 4 diagnostic methods: Inspection (including but not limited to the tongue), Auscultation and Olfaction (Listening and Smelling grouped together), Palpation (including but not limited to the pulse), and Interrogation (taking their medical history and detailed questions about symptoms). For now, how about we put our ideas together for something like "TCM diagnosis consists of identifying patterns of disharmony by taking into account the patient's medical history, current symptoms, and various diagnostic methods including palpation of the pulse and inspection of the tongue" ? Is that sentence too unwieldy? — Preceding unsigned comment added by Herbxue (talk • contribs) 15:07, 28 August 2011 (UTC)

Yes, these are the "four methods of diagnosis" (si zhen 四診), an old construct that is still presented as central in TCM manuals. Listening and smelling are put together because the Chinese word for them is the same: wen 聞. I like the flow of the sentence you propose, Herbxue, but I think it makes pulse diagnosis appear less central than it is, and that there is probably a better way to explain the role of "current symptoms." How about "TCM diagnosis consists in tracing visible symptoms to an underlying disharmony, mainly by palpating the pulse and inspecting the tongue." Short and sweet, and "mainly" makes it clear that there are other methods, which we can explain in more detail in an eventual section on diagnosis. Any comments? (Note that tongue inspection was only systematized in the late 19th century. Does anybody know when it became such a mainstream diagnostic method?) Madalibi (talk) 09:57, 29 August 2011 (UTC)

Your sentence sounds great (although "visible" might be replaced with apparent or just no qualifier of "symptoms" at all as symptoms are generally subjective and not visible). The diagnosis section can give the fuller picture. Ye Tian Shi, whose lectures on Warm Diseases (Wen Bing) and copious case studies are generally credited with expanding the use of tongue diagnosis in the early 18th century. Because of his many volumes of case studies and great reputation, his methods became more and more popular. The great syncretists of the early modern era (such as Qin Bowei) incorporated tongue diagnosis and Wen Bing methods into a more universal overview of Chinese medicine that eventually got boiled down even more with the systemization of "TCM" in the 20th century. Today, tongue diagnosis is generally considered easier to learn and relatively more objective than pulse diagnosis (there is greater likelihood that different practitioners will arrive at the same diagnosis by inspecting the tongue), but that does not need to be in the article, just an example of why tongue diagnosis is on equal footing in modern textbooks despite its relatively short (300+ years) period of development.Herbxue (talk) 15:10, 29 August 2011 (UTC)

I think Zhou Xuehai also played a role in the late nineteenth century, but I would have to check my sources. Thanks for the information! Madalibi (talk) 03:41, 30 August 2011 (UTC)

I also like the sentence as Madalibi suggested it. I'd like to emphasize once more, though, that the diagnosis section still has to be created (and I'm too busy right now). Cheers, --Mallexikon (talk) 07:12, 30 August 2011 (UTC)

Efficacy

I went through the cochrane reviews that Herbxue found - at least through the ones with "promising" results. Altogether, there were 5.

1. Herbal medication for menstrual pain. Data for placebo control not obtainable (so it's not an RTC in the strict sense of the term). "... results are limited by the poor methodological quality of the included trials".
2. Herbal medication for endometriosis. Both trials without placebo control (= again, no real RCT). "...poor methodological quality".
3. Herbal medication for heart insufficiency. Only one of the 6 included trials had placebo control, and was very small (40 patients). "...the evidence for any benefit of Shengmai is weak, as the trials were all of low quality..."
4. The GERAC study (acupuncture for low back pain). Acupuncture was seen to be significantly effective, however, no more effective than placebo ("sham acupuncture").
5. Herbal medication for schizophrenia. No placebo controls (...). "...further trials are needed before the effects of TCM for people with schizophrenia can be evaluated with any real confidence".

I'm sorry but except for the GERAC study I don't even find these studies worth mentioning. Their results can't be termed "evidence" as their methological quality is too bad to be counted as proof (mainly because they lack placebo controls). Our articles statements "The effectiveness of acupuncture beyond the placebo effect is not well established" and "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented" are all still valid in light of those cochrane reviews, and thus I'd also not change the lede sentence ("Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture.) --Mallexikon (talk) 07:12, 30 August 2011 (UTC)

I think you may be missing my point, and I think you are selectively accepting one reliable source over several. Cochrane reviews are considered among the strongest sources by the WP community, and words like "promising" come from the authors' conclusions, not my interpretation. And critiques like your of the studies covered by the systematic reviews 1. Can be made about the individual studies if primary sources are "allowed", but not the systematic review and 2. Are not our jobs as a WP Editors - the Cochrane reviewers made their conclusions and we should report them as-is, blemishes and all. (I am not opposed to then discussing their relative merit - but I am told that would be considered Original Research here).

But that is neither here nor there - I am not nearly as insistent on showcasing effective herbal or acu studies as you are insistent on wording (corrected from "verbiage") that makes it sound conclusively ineffective to the average reader.

You seem to think I want to make the picture look prettier than it is. I don't mind that TCM gets beat up in the uneasy early attempts at integration into the Evidenced Based Model (which is not all its cracked up to be either), but I strongly object to wording that wraps the messy reality up into a neat little bundle. The real evidence is not neat. Its a mixed-up mess. The sources support what I say. Lets report it as it really is. There is not conclusive evidence that TCM therapies are ineffective (or effective), but the article continues to suggest that to the reader (as confirmed by Octopet), which leaves the reader with incomplete information (at best) or inaccurate assumptions (at worst). Herbxue (talk) 15:09, 30 August 2011 (UTC)

This issue is difficult to deal with because it's complex in real life, and because editing on "alternative medicine" is one of the most delicate things you can do on Wikipedia. Disagreements are normal, so let's all take it easy! Mallexicon, a good-faith editor who has contributed a lot to this article, has defended a formulation which, far from being verbiage, might actually be too short to accommodate the level of complexity that Herbxue wants to introduce into the article. One point of disagreement seems to be over how to use Cochrane reviews: should we only take these reviews' conclusions into account (Herbxue), or should we also evaluate the evidence they use to support their conclusions (Mallexicon)? I usually like to evaluate the content of individual sources to see if they're reliable (as I tried to do above with Matuk's article), but maybe this is not how Wikipedia editors commonly treat Cochrane reviews, which are obviously different from the historical articles I'm used to dealing with. For now, let me just suggest that both of you consult a section called Acupuncture#Scientific_basis_and_research_on_efficacy, which cites lots of evidence on acupuncture and contains lots of balanced formulations on its efficacy or lack thereof. Maybe that will help to adopt turns of phrase that we can all agree with. Madalibi (talk) 08:09, 31 August 2011 (UTC)

Thanks. I definitely recognize Malllexicon has been one of the greatest contributors to this article and has improved it immensely. I actually was misusing the term verbiage, attempting to just refer to the wording, which I thought sounded too conclusive.Herbxue (talk) 14:02, 31 August 2011 (UTC)

No offence taken, and thanks for the compliment :) Madalibi has once more found more suitable, diplomatic words than me here. I still think that our current statement "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented" is summing the Cochrane reviews up astonishingly well even as it comes from a much earlier paper. However, I don't see any harm in elaborating a little more on those reviews in the efficacy section. In the lede, the situation is different, though, since it should give a short overview. But I'm sure we'll work it out. --Mallexikon (talk) 11:24, 1 September 2011 (UTC)

I thought about how to specify the information about efficacy in the lede a little. How does "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture, beyond placebo; for herbal therapy, few trials of adequate methodology exist" sound? --Mallexikon (talk) 02:21, 18 September 2011 (UTC)

After making queries at other medicine-related article talk pages, my current assessment is that any statement about efficacy is not appropriate for the lede. If you look at other medical articles, the lede paragraphs are mainly descriptive of the practice or specialty. See pages such as Urology, Gynecology, Dilation and curettage, Whipple procedure, Osteopathy. Given the mixed and incomplete picture in the literature, it is premature to include such a statement in the lede. Given the norms at other similar articles, it seems inappropriate.Herbxue (talk) 23:00, 18 September 2011 (UTC)

Hm, I just checked homeopathy - and efficacy is big in the lede. Then I checked a largely outdated Western treatment called bed rest - the lede includes this: "Some clinicians now regard bed rest as being at best neutral to outcome, and in some cases potentially harmful to patients." So, no, I don't think mentioning efficacy in the lede is inappropriate. Besides, the picture in the literature is not necessarily mixed - there's no study of adequate methodology proving the efficacy of acupuncture or herbal therapy beyond placebo. Why not say it as it is? --Mallexikon (talk) 04:56, 20 September 2011 (UTC)

Relative importance of Anatomy in TCM

I had proposed rewording the phrase "TCM's view of the body is little concerned with anatomical structures" because this phrase is misleading (sounds like TCM dismisses anatomy or does not utilize knowledge of anatomy). I recognize that the original wording is based on RS that is acceptable by WP guidelines, but I think it gives undue weight to a view of TCM from the outside that makes a judgement about what it is "concerned" with relative to how much western biomedicine is concerned with that same topic. (It is only relatively true, not absolutely true). If you read the source (Matuk) you see that the comparison is from the perspective of a medical illustrator. Of course she will conclude that TCM is not very concerned with anatomy - they never bothered to do good drawings and her conclusions are not based on contemporary TCM. In the case of the Kaptchuk quote, he rightly points out the relative "tendency" to emphasize function over structure, and that the classical depictions of anatomy are nowhere near as accurate and sophisticated as those of western scientists. This is not the same as suggesting that TCM doctors are not concerned, or only slightly concerned with anatomy. Mallexikon had proposed changing it to: "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." My issue really is with the word "little", though it may be useful to include the comparison to conventional biomedicine (why say "scientific medicine"? Have you met any MDs? Ask a dermatologist how evidence-based their practice is. Not very).

I recommend changing the sentence from: "TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities (which regulate digestion, breathing, aging etc)" to: "TCM's view of the body is less concerned with anatomical structures than with the identification of functional entities (which regulate digestion, breathing, aging etc)"

What do you think?Herbxue (talk) 03:12, 30 August 2011 (UTC)

I like your sentence. The key adjustment is that it speaks of relative interest rather than lack of concern. And I agree that we should find a better source than Matuk for anatomy. It's convenient because it's short and available online, but her analyses are either undigested (tension between a constructionist position and an outright rejection of pre-modern views; tension between "vision is cultural" and "the Chinese were not investigative so they just failed to see it") or drawn from much better sources, like Shigehisa Kuriyama's book The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (1999). I can also propose better sources on cosmologically driven correlations between the body, the universe, and the state. Madalibi (talk) 03:38, 30 August 2011 (UTC)

I still recommend "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." From an anatomical point of view, TCM contributed about zero discoveries to this subject. And I don't blame them - anatomy is a natural science "that seek(s) to elucidate the rules that govern the natural world by using empirical and scientific methods" - which TCM never did, and never attempted to. It's very obvious and we have sources (Matuk, Kaptchuk, Ross) stating the very same. --Mallexikon (talk) 07:42, 30 August 2011 (UTC)

As I see it, the issue is more about the place of anatomy in TCM's model of the body than about which tradition contributed the most to anatomical knowledge. In this sense I'm not sure such an explicit comparison with "scientific medicine" is helpful. After all, this is a wiki about TCM, not a comparative article between TCM and biomedicine! Also, the comparison with "scientific medicine" should be explicit in our reliable sources if we want to include it in here. I know that neither Katpchuk nor Ross use this kind of language, and Matuk doesn't use these words directly, though one could argue that this is what she means. But honestly, Matuk's article a huge mess, as you would expect from a text that speaks of "medieval Europe (322 B.C.)" or of "the rise of Holy Roman Empire over Egypt." Let me take a day or two to see what other reliable sources say about anatomy in Chinese medicine, and I'll get back to you on this.

Incidentally, "TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities" sounds grammatically awkward. We could say either: 1) "...is concerned not with..., but with..." (too absolute); or 2) "...is little concerned with..., but prefers to see organs as..." (potentially acceptable, but we will have to see if "little concerned" is verifiable). In the end I still think that Herbxue's "...is less concerned with... than with..." is the best formulation we've seen so far, because it's both neutral and reflective of RS, not to mention simple. Madalibi (talk) 09:32, 30 August 2011 (UTC)

Well, Kaptchuk says "... the Chinese have no system of anatomy comparable to that of the West", and Ross says "Chinese medicine ... emphasizes function. Little emphasis is placed on structure, especially internal structures." (I took these quotes directly from our article). You could of course argue that a debate about phrasing it "little concerned" or "less concerned" amounts to hair-splitting, but I think we should be careful here not to put lipstick on a pig, in order to keep our NPOV. Cheers, --Mallexikon (talk) 11:06, 30 August 2011 (UTC)

Both in the spirit of verifiability and substantially in the real world, I basically agree with what Kaptchuk and Ross say. Below, I also provided more references we can use. What I find neither NPOV nor verifiable, though, is an explicit comparison with "scientific medicine," because this is not the language our sources use. Many people will read this article with an implicit comparative mindset, so maybe we should make some kind of comparison explicit, but I don't think "scientific medicine" is the word we're looking for. Using it would be like placing a new mule next to that pig we're so lovingly trying to redecorate. Lol. All right, the last sentence confirms that it's time to log out for today! Madalibi (talk) 11:26, 30 August 2011 (UTC)

[Written before I saw Mallexicon's new post above.] Just for consultation, here are a few passages on TCM anatomy from sources I consider reliable.

Judith Farquhar (University of Chicago anthropologist who did her fieldwork in a TCM college in Guangzhou) says this:

Chinese medicine heals in a world of unceasing transformation. This condition of constant change, this fluidity of material forms, stands in sharp contrast to a (modern Western) commonsense world of discrete entities characterized by fixed essences, which seem to be exhaustively describable in structural terms.... One consequence of this dynamic bias in Chinese medicine is that the body and its organs (i.e., anatomical structures) appear as merely contingent effects or by-products of physiological processes. (SOURCE: Knowing Practice: The Clinical Encounter in Chinese Medicine [1994], pp. 24-25.)

Nathan Sivin (eminent historian of Chinese science, now retired from the University of Pennsylvania):

The authors [of a book Sivin translates into Chinese] emphasize that they "cannot simply impose Western medicine's conception of the internal organs". Indeed what we learn about the Chinese conceptions is not anatomical but physiological and pathological–as usual, not what the viscera are but what they do in health and sickness. In order to keep constantly before the reader the emphatic differences between these functions and those of the organs that bear the same names in modern medicine, I translate tsang-fu [i.e., zang-fu] 脏腑 in chapter 2 and elsewhere not as "viscera," but as "visceral systems of function" (abbreviated as "visceral systems"), and similarly for the individual tsang and fu. (SOURCE: Traditional Medicine in Contemporary China [1987], pp. 120-21.)

Shigehisa Kuriyama (Harvard Ph.D. and Harvard Professor, whose book is the direct source of almost all the good ideas in Matuk's article):

Discussions of the zang and fu in the Neijing typically have to do less with discrete structures seen in dissection thatn with configurations of sympathetic powers. "Gall bladder disease" thus could refer as easily to disorders like dizziness or ringing in the ears as to an affliction in the gall bladder itself. When scholars insist that Chinese viscera differ from Western organs, this is what they usually mean: the zang and fu weren't anatomically conceived. (SOURCE: The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine [1999], pp. 265-67.)

Volker Scheid (anthropologist, historian, and TCM practitioner) calls TCM conceptions of internal organs a "functional anatomy" (Chinese Medicine in Contemporary China: Plurality and Synthesis [2002], p. 196).

I'll let other editors judge what information we can draw from these passages. Note in any case that comparisons are to "Western medicine" (the textbook Sivin translated), "modern medicine" (Sivin), "(modern Western) commonsense world" (Farquhar), and Greek medicine (Kuriyama). Logging out for today! Cheers, Madalibi (talk) 11:19, 30 August 2011 (UTC)

Thank you for doing so much work! These are all great sources and really flesh out (pun intended) the topic in a more diligent way than the Matuk paper did. These do a wonderful job of getting at the distinction between the western medical goal of locating a physical cause of disease and the Chinese medical goal of understanding the physiological disharmony among the zang fu. I haven't thought about how to incorporate these into the article wording yet but will.Herbxue (talk) 21:23, 30 August 2011 (UTC)

Tone indication in pinyin headings

I know it's tempting to use the correct form of pinyin terms as much as possible, but in order to make the article consistent I'm afraid we'll have to consent about whether to use qi, zang-fu, xue etc. or qì, zāng-fú, xuě in the headings. Since article headings in wikipedia don't use the tone-indicating form (like qi, zang-fu etc.) I recommend to stick to that in the section headings as well (and harmonised accordingly). Comments? -Mallexikon (talk) 04:48, 27 December 2011 (UTC)

Yes, the tone marks can get too bulky, and confusing for readers unfamiliar with Chinese language. Also, the situations in which important terms are homophones (such as Jing 精 essence and Jing 经 channels ) only occasionally are clearly distinguished by different tones (Jing and Jing are both first tone) so the tone marks are not that helpful in this context. Herbxue (talk) 06:06, 29 December 2011 (UTC)