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How does traditional chinese medicine compare with western treatments? Fred Pearce asked the foremost historian on TCM, Cai Jing-Feng, who trained in the Western tradition.

Is traditional Chinese medicine scientific?

Western doctors have often accused TCM of being unscientific and even metaphysical. Early in the 20th century, the Chinese government tried to eliminate TCM on those grounds. But it is not unscientific. After all, a lot of practical medicine of all disciplines is empirical-it is scientifically shown to work even if the details of how it works are unclear. If TCM was unscientific in that sense, if it did nothing for the patient, then it would have faded away naturally.

Can you test it scientifically? What results do you get?

In TCM hospitals in China, we try to integrate our work with Western medical methods. We do research using strict biomedical methods of investigation, for instance. We do double-blind trials and apply the standard tests of statistical significance and so on to establish whether the claims made for TCM treatment are real. One of the things we see is that in biomedical examinations of patients after TCM treatment, there are changes to the patient’s basic physiological processes, such as the endocrine, nervous or immune systems. Acupuncture stimulates the immune system and causes endorphin and opiate releases. So we can see we are having real effects.

How do you characterise the difference between TCM and Western medicine?

In Western medicine, the treatment is targeted specifically at the disease and the diseased organ. In TCM it is not. The target instead is the patient’s physiological function, which we believe has been put off balance. We target the whole patient. Once the physiological balance is restored, we reason that the body’s resistance will be able to overcome the disease. There is a growing interest in Western medicine in the importance of physiological systems, such as the immune and endocrine systems. We see that as a recognition of the validity of our approach. In many cases, disease occurs because of, say, a dysfunction of the immune system. And you could say that the primary aim of TCM is to bolster the immune system. That would be a Western interpretation of the Chinese concept of the yin-yang balance. There are other differences that arise from this, for instance in diagnosis. Western medicine looks for objective abnormalities, while TCM depends more on the patient’s subjective complaints.

How does this difference show up in practical medicine?

Take pneumonia. Western science knows this is caused by a bacterium, Pneumococcus. Western doctors use antibiotics like penicillin to fight it. In TCM, different practitioners may use different herbal recipes to improve the body’s ability to fight the bacterium. Or take asthma. The Western response is to administer drugs to relieve the spasms of the bronchus, but TCM looks first at the patient. We ask what imbalances they show. Each patient will manifest slightly different symptoms, and we look for that. We treat people individually. But patients might land up with the same drug. Ephedrine, which is prescribed by Western doctors for asthma, comes from a plant that Chinese doctors have used for hundreds of years.

But what evidence is there that the rather mystical terms TCM uses, such as yin-yang or qi, relate to what Western scientists see as real bodily functions?

We have done a lot of research and we do see such evidence. For instance, the ancient Chinese idea of the opposites, yin and yang, does explain real functions in the body and can be used for diagnosis and treatment. Perhaps the best example is the hormone system. In the past few years, Western scientists have discovered chemical messengers, cAMP and cGMP, that allow cells to communicate and they seem to be opposites. When Chinese doctors describe yin and yang being out of balance, Western doctors see a change in the ratio of the two chemical messengers in the body. In the yang condition, we find that cAMP is low and cGMP is high. In the yin condition, it is the reverse.

Is that all there is to it?

We can see that hormones that increase cAMP and decrease cGMP belong to what Chinese doctors call yang nature, and the opposite yin nature. So when the body produces adrenalin, this signals the heart muscle cells to produce cAMP, which makes the heart beat faster. TCM has always called a fast-beating heart a yang state. When Chinese doctors say their patients have a yang deficiency, Western doctors diagnose that cAMP levels are lower than normal. And if a patient gets night sweats, we would talk about a yin deficiency because the patient cannot control the sweating function.

What about qi?

We have also done biomedical research into what lies behind the ancient Chinese idea of qi, or vital energy. TCM says that every organ of the body-heart, liver, kidneys and so on-has qi. We have found, for instance, that when TCM says a patient’s heart and circulation system lack qi, they are often anaemic. I think this is all strong evidence that, even if it is expressed in ancient philosophical terms, TCM has real ability to diagnose and cure.

Why do you think some Westerners are so attracted to TCM? Don’t you find it a bit ironic that TCM is all the rage in the West, while most Chinese use Western medicine?

I have recently spent some months in California, where TCM is very popular. People there see the shortcomings of Western biomedicine, which depends on pure chemical drugs that may have harmful side effects. Many people would like to return to more natural methods that do less harm. Traditional medicine can offer this. They also like the idea of traditional medicine treating the patient as a whole, rather than just attacking the disease. But, yes, when I saw all the TCM clinics in Los Angeles, I did find it amusing.

Is TCM still mainstream in China?

There are still rural areas where only TCM is used, in folk practices. But in the cities, most of our mainstream hospitals use the Western method, and TCM hospitals try to integrate the two systems. We have more than 30 TCM universities and colleges producing graduates. They learn about both Western biomedicine and TCM. In fact, Western medicine takes up about two years of a typical five-year course. In theory, government policy is for equality between the two systems. But in practice there are maybe twice as many biomedical practitioners. Unfortunately, mainstream medical schools in China do not teach TCM.

Which tradition did you start in?

I graduated from a Western medical college in China and became a resident physician in a hospital. But in the late 1950s, during the upheavals of the Great Leap Forward when the government decided to revive TCM, they asked for some doctors trained in Western medicine to study TCM. I was assigned. After I finished TCM training, by 1970, I worked on an encyclopedia of China’s medical history.

During the Cultural Revolution in the sixties and seventies, professionals like you were made to work in the countryside. Intellectuals went into hiding. After it ended, you took a new direction. . .

Yes. There was great interest in traditional medicines of all sorts, and there are many different sorts in China. So, as a follow-up to my work on TCM, I started studying the history of Tibetan medicine and have worked on the history of minority medicine in China ever since.

So do Chinese folk treatments differ across the country?

Yes. The main TCM is that of the Han people, who are the main people in China. But many Chinese minorities in the west and south of the country have their own traditional medicines that have sometimes survived and are still used, particularly in the villages.

Does TCM evolve or is it totally handed down?

TCM is certainly not just old therapies. Treatments do develop-they are always progressing. Take acupuncture. Archaeologists have found stone needles up to a thousand years old. Today, the acupuncture points are the same but the needles have changed radically. We even use electro-acupuncture and laser acupuncture.

TCM is under attack from conservationists for endangering species such as rhinos, tigers and even certain herbs. What is to be done?

This is a big problem. In the old traditions we used a lot of species that are now endangered, such as musk from deer and rhino horn. But for the past two decades we have been working on substitutes for some of these rare medicines. Research groups looking for substitutes for tiger bones, for instance, have found that the leg bones of mole rats give good results. So tiger bones can now be abandoned. Another way is to cultivate certain species. So we now keep bears on farms where we can harvest the bile, rather than hunting them in the wild. We are still accused of mistreating the animals, and I agree it’s not kind. But it is sustainable and we are not endangering the species any more. Even some herbs are becoming rare. We have an institute studying substitutes and trying to synthesise active ingredients.

But wouldn’t synthesising the ingredients of herbs destroy much of the point of TCM? Surely the idea of using entirely natural ingredients is one of the key things that makes it different from Western biomedicine?

This is controversial. Many indigenous practitioners say that TCM requires working with whole plants and a compound recipe, not a single ingredient. Finding the active ingredient is very like Western medicine. And in practice, it is very difficult to work out all the active ingredients and what they do. One of the reasons diseases don’t gain resistance to traditional remedies is because they are really a cocktail of active biochemicals rather than a single compound. Synthesising the bioactive ingredients would inevitably reduce or eliminate that benefit. So both philosophically and practically, there are difficulties here. And ironically, the very success of TCM could make its continuance increasingly difficult.