Increasingly, advocates of Chinese acupuncture are seeking validation by conducting and studying clinical trials. But has anyone stopped to consider if this is truly the best way forwards for this complex tradition, which exists within its own scientific paradigm, and stands apart from modern scientific practice?
At the moment there is a very real danger of traditional Chinese medicine, with all its depth and scope, its richness and wisdom, being usurped by the relatively narrow field of western dry needling. The distinction between the two is lost on most of the general public, so a cheap, tack-on course for physiotherapists and osteopaths becomes indistinguishable from a degree-level, and in some cases a lifetime’s, study of TCM. Furthermore, the push to “prove” Chinese Medicine through clinical trials risks the profession losing its way and becoming mired with Western methods.
(As a note, I use the term Western medicine throughout this discussion, to distinguish it from traditional Chinese medicine. Of course “Western” medicine is prevalent throughout the whole world, and could equally be termed “modern” medicine, or even “reductive”, as opposed to “holistic”, medicine; but historically its roots are in the West, and I think most people would instinctively understand the distinction.)
I’d like to make it clear that I think the regulation of Chinese medicine practitioners is certainly a good thing, for obvious reasons of public trust and safety; but there is a world of difference between being regulated, and being controlled and dictated to by governing bodies with no real comprehension of its beauty and profundity, and probably amongst some even a perception of it as being dry needling plus some new age woo-woo as an added ingredient.
While I can see good arguments in favour of clinical trials, I have to admit this need to “prove” acupuncture has always struck me as kind of paranoid. But I’d never really thought through the consequences of its gaining full acceptance by the medical community. Its whole dynamic and character would change as it got synthesised and inevitably diluted by western institutions, which tend to be led by a drive for conformity, more often termed as standardisation. I suspect and fear it would be reduced to a collection of “clinically proved” protocols, as a kind of one-treatment-fits-all approach, which in reality might not be the best solution for the individual complexities of each patient. In Chinese medicine a headache isn’t just a headache; it is a symptom of any number of possible patterns of the human body, mind and spirit.
I guess there’s good and bad in it, as with anything, but on the whole I’m skeptical of forcing Chinese Medicine into the straitjacket of a Western model. There’s a Daoist tale by Zhuangzi about the useless tree that’s too gnarled and twisted to be any good for firewood, so it never gets cut down. At least that way it has room to grow on its own terms. But as soon as it is seen as something useful, it will get chopped up into pieces and lose its essential wholeness and naturalness.
What would be the advantages of a more rigorous testing of Chinese Medicine practice through clinical trials? Scientific inquiry means confirmation of efficacy and would undoubtedly lead to all round growth in the profession. More research would mean more acceptance by the public, and more respectability amongst the medical community. It would also help to weed out unqualified practitioners and charlatans, unfortunately an all too prevalent scourge of so-called alternative therapies.
I’d also add that properly conducted clinical trials and literature reviews help to eradicate some of the erroneous conclusions and decidedly woolly thinking that are lurking out there around the subject of energy work. There are many individuals in the field, or at least on its murky peripheries, who see nothing wrong in conflating different systems of thought, often from completely different cultures. To give an example, just because there are some similarities between the chakras of the yogic traditions, and the lower, middle and upper fields of the Chinese energy body, this doesn’t mean to say that they are exactly the same thing. They are not interchangeable, and to dilute systems in this way is to do them a great disservice. Yet it happens all the time, and this only serves to muddy the waters and lend ammunition to those who would seek to denigrate sophisticated and complete systems such as those of Daoist alchemy and Chinese medicine.
These are all really strong arguments in favour of clinical trials and application of Western methods, however my gut instinct is still one of hesitancy. Already standardised TCM practice is quite far removed from the traditional master-apprentice style of classical Chinese Medicine. In becoming assimilated by Western Medicine I feel TCM is only going to become more diluted, and will eventually be eroded and washed away by a tide of reductive “improvements”. It will become more rigid. More closed. More objective and material in its approach. More standardised. More prescriptive. Less of an inquiry. Less of a direct communication between patient and practitioner. Less of a dialogue. Less of an art. It is the difference between doctor as fixer and doctor as listener and healer.
There’s a huge qualitative difference between fixing somebody’s problems (which often means disguising them with drugs) and truly healing them in both mind and body. I can imagine a rapid degeneration into a “this point is for this symptom” way of causative, Western logical thinking, rather than the “big picture”, pattern-led and subjective insights of the Eastern approach. I fear that by becoming more “respectable” and “scientific”, Chinese Medicine is in serious danger of losing its heart. Objectivity is a poor exchange for insight and intuition, in my opinion. We have this idea in the West that the new thing is better, that progress is always good, that ideas change and develop and get superseded by better ideas.
And while I’m sure it would be incorrect to claim that Chinese Medicine hasn’t had its pioneers or benefited from new ideas and approaches over the centuries, at its fundamental core it has remained static because that core is perfectly in line with the way things are in nature. A practitioner might always be able to improve their skill, but the art itself is already complete and universal. So why then this seemingly rather paranoid urgency to prove Chinese Medicine a worthy endeavour? It’s very difficult to make any experiment watertight, and doubly so with something like acupuncture. I’d even say it feels precariously close to a disrespect to the masters of its 2,000 year (and almost certainly far longer) history.
By reducing Chinese Medicine to graphs, charts and tables of experimental results, severed from the individual patient and their place in the environment, you’re forcing a holistic and largely inductive system into a reductive and deductive paradigm. You depersonalise it. You throw out subjective factors entirely in favour of the objective and measurable. And by taking out the subjectivity you remove its most characteristic and effective factor.
One of the biggest differences between modern “Western” medicine and TCM is that the Chinese approach engages with the individual in each case, and treatment is inextricably interwoven with that individual, whereas modern medical methods largely stand independently of the patient. By which I mean, if you have a headache, you and everybody else should take this particular pill; as opposed to the TCM method of looking more deeply into causes – lifestyle, diet, sleep, stress, etc. – and not just plastering over the underlying problem by making the pain go away.
The objective approach might make sense for chemistry or physics experiments, but our minds are intrinsically involved in our health; I’d say it’s a mistake to leave subjective factors out when it comes to medical efficacy. And of course, often the very act of measuring can greatly influence results. Scientists looking at the subatomic world have already found this to be true. The very act of looking, of paying attention to something, alters its behaviour fundamentally.
Evidence-based medicine is an excellent model for the reductive and specific approach of Western science. But it leaves out some crucial elements that are essential to the effectiveness of a treatment…
The expertise and experience of the practitioner.
Their diagnostic insight.
Their skilful technique.
Their clear-minded intention and close attention to the patient.
The clarity and honesty of communication between practitioner and patient.
Trust and expectations, including the well-documented and often underestimated placebo effect.
The environment in which a treatment is carried out.
And other peripheral but no less important circumstances, such as variations in patients’ lifestyle, outlook, diet, emotional disposition, mental acuity, air quality, environmental climate, sleep patterns, relationships, work, life history…
A human being is all of this, and when we try to narrow the parameters to test things in isolation, we leave out so much of value.
In Chinese Medicine there is great importance placed upon the Yi of the practitioner, which comprises skill, insight, knowledge, focus and intent; and their quality of Ting, which is a measure of their ability to listen to and observe the patient. All of this is largely disregarded by the homogenised nature of clinical trials. Generally, experiments of this type endeavour to leave out human factors as far as possible. What’s more, control groups are often arrived at through highly unsatisfactory methods such as sham acupuncture. And often, studies are simply neither large enough nor rigorous enough to be of any real use.
On balance I do welcome clinical trials, but we should be very wary of promoting their importance too much. I think they bring an interesting dimension to Chinese Medicine. But that’s as far as I’d go. I don’t think they’re imperative or even particularly useful at all. And I wonder with some trepidation where they will lead us. That’s just my take on the subject. I appreciate there are lots of differing and totally valid viewpoints.
The trouble is that as an Eastern art gets drawn into modern Western science, and Western science becomes increasingly prevalent in the East, there are fewer and fewer people who really have a feel for the particular mental approach that guides the skilful and subtle art of Chinese Medicine, so their voices don’t get listened to. Practices become steered more and more by Western ways of thinking and working, and in the end we are left with a medicine that is a shadow of its former self, impersonal and stale.
That would be a real shame, a tragedy in fact, so I think we have to be careful about how much weight we lend to the double-blind trials and (no doubt well-intentioned) scientific journals that publish them. No experiment is perfect. Especially in a field of research like Chinese Medicine, faults can always be found in terms of the comprehensiveness of trials, the effectiveness of sham acupuncture, timescales, control groups, etc.
I think both Chinese and Western medicines can happily coexist, and they definitely have their respective strengths. If you’re depressed and suffering from IBS, anxiety, migraines or insomnia, go get some herbs or needles. But if you’re having a heart attack or an arterial bleed, do go to A&E and not your local acupuncturist! But just because the two medicines can coexist doesn’t mean that they can’t stand apart. They don’t have to speak the same language. Something always gets lost in translation.
The Azure Dragon 