Chinese Medicine Demystified (Part I): A Case of Mistaken Identity

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Note: This is the first article in an ongoing series. Make sure to check out the next articles when you’re finished with this one:

I’m sure you’re at least somewhat familiar with Chinese medicine and acupuncture by now.  It’s received a lot of media coverage over the last decade, and insurance companies are now covering it in many states. But even though an increasing number of people are using acupuncture to address their health problems, most still don’t understand how Chinese medicine works.

We’ve been told that Chinese medicine involves mysterious energy called “qi” circulating through invisible “meridians” in the body.  When the flow of qi through our meridians becomes blocked, illness results.  The purpose of acupuncture and other Chinese medical therapies (like herbal medicine and qi gong) is to promote the proper flow of qi through the meridians, thus restoring health.  Sound familiar?

If you’ve ever been to an acupuncturist in the west, I’m sure you’ve received some version of this explanation. After all, this is what they teach in acupuncture school. I know this because I’m in my final semester of studying Chinese medicine, and this is the explanation in our textbooks.

Understandably, these fundamental concepts of Chinese medicine have been difficult for western patients and doctors to accept.  If you sit a doctor down who has had ten years of post-graduate medical training and tell him that an unidentified energy called qi flowing through imaginary meridians is the key to health and disease, he’s going to look at you like you’re crazy.  And I don’t blame him.

What if I told you that nearly everything we’ve been taught in the West about how Chinese medicine works isn’t accurate?  What if I told you that Chinese medicine isn’t a woo-woo, esoteric “energy medicine” at all, but instead a functional, “flesh and bones” medicine based on the same basic physiology as western medicine?  And what if I told you I could explain the mechanisms of Chinese medicine in simple, familiar terms that any eight year-old could understand and even the most skeptical, conservative doctor couldn’t argue with?

Here’s the thing. The “energy meridian” model that has become the default explanation of Chinese medicine US is not only out of sync with our modern, scientific understanding of the body – it’s also completely inconsistent with classical Chinese medical theory.  In other words, we’ve made up our own western version of Chinese medicine that has little to do with how it was understood and practiced since it began more than 3,000 years ago in China.

This gross mischaracterization has kept Chinese medicine on the fringes of conventional medical care since the 1930s and 1940s.  Most doctors and patients have simply been unable to accept the explanation they’ve been offered for how acupuncture works. The result is that acupuncture has come to be seen as either a mystical, psychic medicine or a foofy, relaxing spa-type treatment.

And that’s a big shame. Because Chinese medicine is in fact a complete system of medicine that has successfully treated many common health conditions for more than 2,500 years. Chinese medicine was passed through the ages in an unbroken lineage of some of the best minds of China. It was used by emperors and the royal courts to help them live into their 90s and stay fertile into their 80s at a time when the average life expectancy in the west was 30 years.

The Chinese were performing detailed human dissections where they carefully measured the blood vessels and weighed the internal organs at a time when western physicians thought the body was made up of “humors”. These dissections helped Chinese physicians to discover the phenomenon of continuous blood circulation 2,000 years before it was discovered in the west. The discovery of blood circulation is still considered the single most important event in the history of medicine.

Chinese medicine has been around for a very, very long time. The first evidence of the type of medicine that led to the Chinese Medicine in use today dates back to about 6,000 BC, which was during the neolithic (new stone age) period. Stone tools from this period have been found that were specially shaped for making small incisions in the skin, which was the early form of acupuncture. That’s 8,000 years of uninterrupted use. To put this in perspective, western medicine as we’ve come to recognize it today wasn’t even invented until the 1350s (the middle ages), which makes it less than 700 years old. Ah hem.

Let me ask you this. Do you think Chinese medicine would have survived for more than 3,000 years and spread to every corner of the globe if it wasn’t a powerful, complete system of medicine?

The reason Chinese medicine isn’t more popular in the west is that it’s completely misunderstood even by the people who practice it. And as long as acupuncturists continue to promote the “energy meridian” model as the explanation for how Chinese works, it’s destined to remain a fringe alternative modality.

In the next article I’m going to give you an explanation for how Chinese medicine works that is not only historically accurate, but also consistent with the principles of anatomy and physiology as we understand them today. I’m also going to tell you how this blatant mischaracterization of Chinese medicine in the west came about.

Read the next post in the series: Chinese Medicine Demystified (Part II): Origins of the “Energy Meridian” Myth

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  1. says

    Interesting! I look forward to reading what you have to say on this topic, as all I’ve heard is the Western version, which is easily dismissed.
    Though to address your final question, people are easily fooled by placebos and such when they lack the objectivity of the scientific method to help determine what works. Consider how what you call the Western version of Chinese medicine persists. So it might be possible for the real version to persist too.

  2. admin says

    Hi Jesse,

    The placebo is indeed an interesting subject, and I’ll be writing an entire series of posts on it in the future.  It’s something I have a strong personal interest in and I’ve done a significant amount of research and writing about it in school.

    Here’s the thing.  Researchers today estimate that placebo accounts for between 30-50% of the therapeutic effects of any treatment.

    But not all treatments get the same placebo effect.  There are two requirements for the placebo effect to kick in.  The first is the belief that a treatment will work, and the second is a strong desire to get better.

    In this country, we’re raised in the religion of western medicine.  We’re bombarded with advertisements that tell us to “see your doctor” when we get ill.  We’re one of only two countries that allows direct-to-consumer drug advertising.  Our belief in western medicine is deeply ingrained, whether we know it or not.

    The same can’t be said for Chinese medicine.  Most people don’t understand it at all.  It’s not part of our cultural paradigm.  Many who go to get acupuncture not only don’t believe it will work, they are downright skeptical.  This means acupuncturists are not getting the same placebo effect for their treatments that western doctors get for theirs.

    Sure, there are a few alternative types that really believe in the energy model explanation of acupuncture.  They’ll get the placebo effect.  But the rest of the skeptical majority are missing a key element (the belief that the treatment will work), so the placebo won’t be as big a part of their therapeutic response.

    The fact that acupuncture is as effective as it is without getting that extra 30-50% boost from placebo is remarkable.  Contrast that with certain classes of drugs like antidepressants, which have recently been shown to be no more effective than placebo.   These drugs are almost universally believed in by patients and doctors alike.  And yet they don’t work any better than sugar pills.

    There’s a lot more to say on this subject, but I’ll save it for the future series.  I’ll end by suggesting the possibility that the placebo effect is not something to be derided and avoided.  It’s something to be respected and cultivated.

    If you could choose between a completely non-invasive treatment with no side effects that works by supporting your body’s own sophisticated, innate healing ability, or between taking a dangerous drug for the rest of your life with severe side effects and complications, what would you choose?

    A physician who can support the body’s natural healing ability, which is one way of describing the placebo effect, is a far superior physician in my book to the one who relies on comparatively crude methods like drugs and surgery. I’m not arguing that the effect of acupuncture is all placebo. Quite the contrary, as you’ll see in the next few articles in this series. I am saying that we should be learning how to get more of the placebo effect, not less.

  3. says

    I look forward to that series!
     
    That’s a good point about people being skeptical of acupuncture. I would hypothesize that if acupuncture were solely placebo, then most of the people who went in with skepticism would not continue very long, and that most of those that did continue treatment would have started out expecting it to work. It would be interesting to see a survey address that question.

    You said, “I’ll end by suggesting the possibility that the placebo effect is not something to be derided and avoided.  It’s something to be respected and cultivated.”

    Depending on what you mean, I agree. It’s a good idea to encourage healing by making the treatment environment and experience as positive and hopeful as possible. On the other hand, if you’re suggesting dishonesty, telling patients that a treatment works when you know it doesn’t except in their heads, I don’t think that would turn out well in the end. I’m sure you agree.

    Also, it’s sometimes possible to distinguish between perceived improvement and actual improvement, objectively measured. For example, if a person’s arm is injured and he receives treatment, it is possible to test the efficacy of the treatment in two ways: by asking him if he is getting better, and by testing the function of the arm, say with strength tests or something, to see if it is improving. A perception of improvement is valuable, of course, but if the person perceives he is getting better but isn’t actually getting better, the treatment may not be truly effective. When possible, it seems like a good idea to distinguish between the two possibilities. I’m just talking generally here, about what should be done when evaluating treatments.

    Like I said, I am eager to read your future posts.

  4. John says

    “Let me ask you this. Do you think Chinese medicine would have survived for more than 3,000 years and spread to every corner of the globe if it wasn’t a powerful, complete system of medicine?”
    Er, yes, actually, I do. I guess the biggest example of an idea which has survived despited there being zero evidence in its favour is religion. Seems pretty popular still, doesn’t it?
    I’ll certainly return to see what you have to say, but it’s fair to put me on the sceptical side of the fence at the moment!

    • admin says

      I appreciate your point of view, John, but I think the two are somewhat different. For any idea, philosophy or practice to survive it must offer some benefit. Religion offered benefits to those who practiced it, so it survived. Chinese medicine would have never survived if it didn’t offer any benefit. Now, we can argue about whether that benefit was due to placebo, or whether it was due to clear physiological mechanisms not dependent upon belief in the treatment. This is another question I’ll address in future posts.

  5. says

    It is indeed a big mistake to think that only “energy” flows through the meridians.  Chinese books say Qi and Blood flow through them, and my understanding of Qi and Blood indicate form and function.
    Now how were these meridians mapped?  I’ve performed acupuncture on patients (obviously, since I am an acupuncturist and MD) and they will testify that they can feel a propagation of “qi sensation” (proven by studies by Pomeranz et al to be stimulation of a-delta fibers) along the pathways of the meridians.  Hence, it is erroneous to assume that meridians are anatomic structures – they’re physiologic.

    • admin says

      Thanks for your comments, Phillip. Stay tuned for the next few articles. I’ll be going into greater detail about the mechanisms.

    • Jim Lee says

      ***Now how were these meridians mapped? I’ve performed acupuncture on patients (obviously, since I am an acupuncturist and MD) and they will testify that they can feel a propagation of “qi sensation”***

      The qi sensation” is the nerves feeling the insertion of the needles in the muscles. The meridians fall right on our nerves in the nervous system. If you compare the meridians with the nervous system diagrams in an anatomy book. You will see what I mean.

      FYI In the Modern Chinese acupuncture books are indicating each acu-point corresponding to the location of the nerves. It shows where and how deep a needle should go into the muscles which is where a particular nerve is located. How acupuncture works is just like an electrical switch. The human body has a sympathetic and a parasympathetic system. Each system does the opposite of the other. Even though the ancient Chinese didn’t know this, but they knew what are the causing effects by poking needles to find those points. Due to the lack of scientific knowledge at the time, we must give credits to the ancients for coming up with such myths that we have today. Hence, we had something to work with and confirm today.

  6. says

    I forgot to add that it is my belief, which I’m sure you’ll concur with, that the cultural use of language is important here.  I tend to tell my residents that I believe that Chinese medicine will be easier to understand if we look at it from a “what were the ancients trying to say when they chose to use a particular word or term?”  instead of using our own understanding of a word or term in our attempt to comprehend their ideas.  I am quite sure that you know what I mean and will definitely expound on that more.  I can’t wait to see if your ideas on “fire”, “cold”, “wind”, etc concur with mine.  Looking forward to your next posts.
     

    • Jim Lee says

      “I tend to tell my residents that I believe that Chinese medicine will be easier to understand if we look at it from a “what were the ancients trying to say when they chose to use a particular word or term?” instead of using our own understanding of a word or term in our attempt to comprehend their ideas. I am quite sure that you know what I mean and will definitely expound on that more.”
      Philip…
      I do am quite sure I know what you mean. I can agree with you more.
      Even though I am a Chinese and can speak and read the Chinese language fluently. However, I do have problem interpreting the medical classics. Nowadays, we have knowledgeable modern Chinese scholars are explaining what are the terms meant in modern Chinese. As you have mentioned the terms about “qi and blood” in the above”.

      ” Chinese books say Qi and Blood flow through them, and my understanding of Qi and Blood indicate form and function.”

      The former is skeptical and the latter is the modern interpretation. The term “qi” used in TCM means the function of internal organs. When one said “qi stagnation” is simply means it’s the dysfunction of an internal organ. In the west, it was interpreted as “energy flow”. Despite to the fact, there is only one definition of “qi” in the west which is “energy.” This falls exactly what you have said about “instead of using our own understanding of a word or term in our attempt to comprehend their ideas.”

      FYI I am a practitioner of Tai Ji Quan and Chi Kung. The “Chi” in Chi Kung means “breathing.” Based on the definition of breathing, then Chi Kung is the ultimate method of breathing to a Chinese. Again, the people in the west would like to say it is the “energy work”. By using this term, they will practice Chi Kung without the paying much attention to their breathing which lose the original effect of the practice. Unfortunately, it was very sad; I even to hear them say that breathing has nothing to do with Chi Kung. Sometimes, I wonder do they ever think why that they had practiced for so long and have not gained any of the Chi Kung effect.

  7. admin says

    Yes, I agree that context is important.  But as my next article will explain, de Morant grossly mistranslated several key terms because 1) he had no training in medicine or anatomy, and 2) he wasn’t trained in the ancient Chinese language.  I have more to say but it’s coming in the next article.

  8. FriendofMatt says

    The world is a complicated place.   There is more than one version of Chinese medicine, and beyond duration, for validation, try head-count: 1.3 billion Chinese thrive in conditions that might challenge the average American.   The good doctor (M.D.) Ted Kapchuck wrote a delightful tome: The Web that Has No Weaver,  in which he introduces west to east.   It turns out that the Chinese have no descriptive principle that corresponds to the endocrine system, an entire specialty here in the west, and the west has nothing close to the triple warmer, that explanatory principle that discusses how the digestive fires are cooking (middle burner) or the sexual fires (lower burner)burn or blow out.
    There are various forms of proof.   Geometry has proofs.   Science can confirm an hypothesis and generate a Theory… which is not a proof.     But have your life saved, (so you feel, determine, experience) by some modality, be it western or eastern, and that is proof enough for most human beings.
    My opinion is that the school, spreadsheet, cookie cutter method of teaching acupuncture here is not very good.  Apprenticeship is so much better.  I believe that many folks in the US of a may experienced poor examples of the art.
    I imported acupuncture needles to the  US from China during the previous millennium and I had to do so under an “experimental” license, for this 3 – 8,000 year old modality, Chinese Medicine.   The medical guild does not appreciate friendly competition.    Good luck in De-mystifing this subject.  I have studied it with interest, in English,  for twenty-five years and I am still mystified.
    Old Chinese Proverb:   A doing is worth a thousand showings, a showing is worth a thousand tellings.
    Good acupuncture is a blessing.
    Poor acupuncture is…. the hokey pokey.
    The best acupuncturist uses no needles.     Best medicine is least medicine.

  9. says

    @Friend of Matt:
    Agreed, The best acupuncturist uses no needles.  I think I have a brief explanation to the seeming lack of an “endocrine” system in Chinese medicine.  What is the endocrine system but the relationship between organs, between different parts of the body, as signified by hormones?  In that sense, the entirety of Chinese medicine, with it’s emphasis on harmonization of the different aspects of anatomy and physiology, can be seen as a correspondence to the endocrine system, can it not?  Also, isn’t Ted Kapchuk an oriental medicine doctor? I know he teaches at Harvard medical school.

  10. gordie w says

    1. Anecdotes are the only evidence that acupuncture has been curing “common conditions” for thousands of years. If that’s all you need then fair enough
    2. the Chinese were way behind western doctors in dissecting human bodies (that’s why they invented 12 meridians based on China’s 12 great rivers as a proxy explanation)
    3.  comparing the lifespan of Chinese emperors to western hoi polloi is hardly fair now is it?
     
    PS I much preferred your article on the myth of chemical imbalances.

    • admin says

      The Chinese were performing detailed dissections as far back as the 6th Century BC. Similar procedures weren’t performed in the West by Greek physicians until the 3rd Century BC. Historical evidence suggests that the practice of bloodletting preceded acupuncture in China. As I’ve argued in this series of posts (this is only the first – read the next two if you haven’t already), the concept of a “meridian” that had no basis in human physiology was created by a French bank clerk in the early 1900s, not by the Chinese. If the Chinese were bloodletting, and they had performed dissections, they clearly understood that what they were bleeding were blood vessels – not meridians.

      The Chinese were obviously not conducting randomized clinical trials on the effectiveness of their medicine 2,000 years ago. They had a practical system. Doctors in China only got paid if the patient got better. You might argue that the improvement could have been placebo, and that is possible. We’ll discuss placebo more in a future post. But once you understand the mechanisms of acupuncture as described by recent research, you won’t have any trouble understanding how it cured common health conditions. Acupuncture relieves pain, reduces inflammation and restores homeostasis. This is well understood in the scientific literature. Pain, inflammation and disturbance of homeostasis are characteristics of nearly every common condition. If acupuncture can address those features, which research indicates it can, then it can treat those conditions.

  11. says

    @ gordie w
    1) it’s not just anecdotes.  Even in the old days, people didn’t just treat one patient then wrote down the results – they’d make sure what they wrote was relatively consistent before having the guts to put their reputation on the line via a book.  One anecdote isn’t good enough for me.  Several thousand patients’ worth of clinical experience is
    2) Not that far behind, based on the descriptions of the anatomical organs (average size and weight, general shape) described in the Huangdi Neijing.  Also, Chinese didn’t just “invent” 12 meridians.  The earliest texts actually combined the Heart and Pericardium, making a total of 11 source points.

  12. says

    Chris, I’ve blogged several times on how Big Pharma manipulates data so that the results of such randomized clinical trials can be made to say what Big Pharma wants.  About the placebo thing, a colleague of mine who is a chiropractor and acupuncturist once taught me how to respond to accusations that what I do (acupuncture and other TCM modalities) is just placebo.  He told me to reply, “My placebo works better than your placebo.”

  13. admin says

    I’ll be writing more about placebo in future posts.  My response to those accusations is to point out that placebo is better understood as “self-healing”.  I ask them this question: if you had to choose between a treatment that stimulated your body’s innate healing mechanisms to address the root cause of your problem, and did this with little cost and no side effects, or a treatment that merely suppresses the symptoms and has significant costs, side effects and risks (i.e. drugs and surgery), which would you choose?

    The answer is obvious.  I believe that in the future we’ll come to respect – instead of scorn – the power of placebo and those who are able to successfully invoke it.

    I’m not saying that the effects of acupuncture are limited to placebo.  In fact there is strong evidence that acupuncture consistently outperforms placebo, with an average of a 70% response rate in trials.  I’m just saying that placebo is nothing to scoff at – it’s quite simply the power of the body to heal itself.

  14. Peter Deadman says

    Mmmmm … before we dismiss qi flow etc. Science – medicine, physics, mechanics – flourished in China for many centuries from around the 3rd or 4th century BCE. Just look in Needham’s Science & Civilisation in China, or indeed – more briefly – any book on inventions. We find that Chinese inventions often predate their discovery/adoption in the West by up to 1500 years.
    It is not unreasonable, both scientifically and philosophically, to accept that the microcosm of the human body might reflect the macrocosm of the universe … that there are parallels between the structure, energies and laws governing both. So how does the universe work? Basically – as far as I can tell – no-one knows. I watched a TV programme the other day which proposes the existence of ‘dark flow’, dark matter of course, and multiple universes (incidentally early Daoism in the 5th century BCE posited a universe that came into existence through no divine intervention from a pre-existing condition of nothingness – damn right as far as we know!). In the light of this its’s not – in my opinion – wise to dismiss either the ideas of early Chinese science (qi flow), nor the seemingly fuzzy science that is so easily dismissed by hard-edged know-it-alls.

    • admin says

      Hi Peter,

      Thanks for your comment. I have the greatest respect for the early discoveries of Chinese medicine, and make reference to them in this series. The fact that they discovered continuous blood circulation, referred organ pain, the immune system (wei), the internal mesentery system (san jiao), and more thousands of years before these things were described in the west is impressive to say the least.

      I also recognize that there is much we still don’t understand about the body and the universe, as you point out. Perhaps de Morant’s “meridians” will be discovered in the future, and perhaps we’ll learn of a process/substance that could be referred to “energy” (that is different from what we currently understand as energy) that flows through these meridians. My intention here was to stand on the shoulders of people much more learned about Chinese medicine than myself (Unschuld, Schnorrenberger, Kendall, etc.) and present the historical facts about the Neijing and what it suggests about Chinese medicine.

      Their interpretation is what makes the most sense to me, especially as it is consistent with the modern scientific understanding of the body. I personally find a theory much more compelling when it can be justified by several different lines of reasoning.

      In any event, I’m happy to see you here and welcome your comments. And assuming you’re the Peter Deadman that wrote the books sitting on my shelf, I’m very grateful for your contribution to this medicine. Your acupuncture book saved me countless painful hours that I would have had to spend with the CAM text!

  15. says

    *fanboy reaction* PETER DEADMAN.  *kowtows*  You’re one of my heroes!  I refer to your Manual of Acupuncture all the time!  I don’t think Chris is trying to debunk qi flow but rather look at it from a western point of view.  I basically agree with what Chris says except for the idea that the meridians as we know it were a result of De Morant’s childhood connect-the-dots.
    @Chris, of course acupuncture works better than placebo.  Otherwise it would not work on animals or young children.  While it is obvious that acupuncture has better effects on people with a positive outlook, it also works on those who come in skeptics and just want to “see what it can do.”  It’s like Lourdes (I’m catholic) – people come in skeptics and leave as believers.

  16. says

    *speaking er, writing as a former member of my high school debating team* and how exactly is it a fallacy, sir? (just so that I don’t use that logic again in the future)…
    thanks.

  17. admin says

    Gordie,

    There’s abundant evidence that acupuncture outperforms placebo.  In the recent Moffet paper published in the Journal of Clinical Epidemiology, he states:

    “Clinical trials demonstrate that acupuncture can affect outcomes and is distinguishable from a placebo.”

    I wonder if your skepticism extends to western pharmaceuticals.  Did you know that antidepressants are no more effective than placebo in most cases?  And did you know that researchers believe that placebo accounts for between 30 – 80% of the treatment effect of most drugs?  Many drugs are only 4-7% better than a sugar pill (not to mention often carrying considerable side effects and risks).

    As you know, I’m a skeptic myself, so I’m not discouraging a skeptical approach. On the contrary! But most people who claim they are “skeptics” are only skeptical of the non-dominant paradigm. That’s not skepticism, it’s narrow-mindedness.

  18. says

    Hm, that Moffet paper is interesting. There were many things I hadn’t heard of before. Do lasers, capsicum bandaids, and electro-stimulation really count as acupuncture?
     
    The paper also concluded: “In short, acupuncture can affect outcomes but might not depend on specific points, locations, or techniques.” Weren’t you saying that the traditional acupuncture points were supposed to work because they had the largest concentrations of nerves or something?
     
    That’s a good point about drugs though. I hadn’t considered that I could investigate the efficacy of drugs I might be prescribed.

  19. admin says

    Jesse,

    What the study showed was that there may not be a statistically significant difference between one style of choosing points and another.  This is also supported by the fact that there are many different methods of acupuncture (80 in China alone), and they all seem to be effective.

    Elsewhere in the paper Moffet does point out that traditional acupuncture points do have a higher concentration of neurovascular structures than non-points, so the treatment effect could be expected to be higher when points rather than non-points are selected.

    However, the research done so far doesn’t support the idea that one method of acupuncture point selection is better than another.  Keep in mind that this doesn’t mean that there isn’t a better method.  It just means the research doesn’t currently support this idea.

  20. says

    @jesse and Chris
    Yes, I believe that different traditions also depend on the practitioner.  I know someone who just loves scalp acupuncture for some reason.  I prefer five transporting points and combining Yuan Source and Luo Connecting Points as needed.  Our choice of “style” reflects practitioner preference.

  21. says

    It’s true that lack of evidence for one method over another doesn’t mean there isn’t a better method.
     
    Are you aware of this more recent paper by Moffet? It concludes, from my reading of the abstract, that acupuncture points that were specifically selected as either the wrong points or not points at all (as opposed to just points selected with a different method) give as much effect as true acupuncture points. What do you think?

  22. admin says

    Jesse,

    I’m aware of that study, and others like it.  Here’s what I think (and I’m not alone – several very well-respected luminaries of Chinese medicine in China have said the same thing): acupuncture by nature is mostly non-specific and doesn’t target any particular pathology, but instead restores homeostasis by stimulating the body’s innate healing mechanisms.  From this perspective it makes sense that inserting a needle just about anywhere would create a treatment response.

    Acupuncture is a far more elegant approach than using drugs or surgery to suppress symptoms, which is what western medicine does.  The immune system is the most complex and sophisticated ecology we’re aware of.  We have the ability to spontaneously heal injuries, fight infection and regenerate tissue without any conscious awareness or participation on our part.  Drugs and surgery are like children’s toys when compared to the regulatory mechanisms of the immune system.  And although we’ve made great strides in understanding how it works, we have only barely scratched the surface.

    So I don’t see the nonspecificity of acupuncture as a problem.  I see it as an advantage.  Acupuncture stimulates the body’s self-healing ability. When you go in to get an acupuncture treatment for elbow pain, not only will your elbow pain go away, you’re digestive problem will improve, you’ll start sleeping better, and your chronic sinus issue will clear up.  Nothing in western medicine can do this.  Drugs can’t do this.  Surgery can’t do this.  And acupuncture does it at a minimal cost, with virtually no side effects and risks.

  23. gordie w says

    philip: because the placebo effect encompasses more than just “feeling a bit better because the doctor was nice to us”. It also includes regression to the mean (i.e. getting better naturally) and observer bias (i.e. having faith in some treatment and as a result imagining that your baby’s condition has improved when it hasn’t). Presumably if your baby is sick you wouldn’t rely solely on acupuncture etc. You would feed him differently, you would keep him warm or make sure he slept more. Who’s to say this isn’t what helped him? It is even possible that, because you have so much faith in a treatment, your child feels better as a result of recognising your own confidence. All of these are well established problems with relying on anecdote, not just in alt med but in mainstream medicine too.

  24. admin says

    Gordie,

    I agree with your points about placebo and how it can confound research. However, as I mentioned above acupuncture has consistently outperformed placebo in clinical trials.

    The question that is harder to answer is whether point selection has any bearing on the outcome of a treatment.  The research suggests not, but my personal experience and that of many other practitioners and patients suggests otherwise.  I wouldn’t make an argument here because my observations are just anecdote, but mention it for whatever it’s worth.

  25. says

    Chris,
    Non-specificity does seem like it could be an advantage. It strikes me though, that if the positioning of the needles doesn’t seem to make a significant difference, couldn’t I get some sterile needles and stick myself in random places, rather than paying someone to do it for me?

  26. admin says

    One would think.  But as any acupuncturist can tell you, giving yourself a treatment doesn’t seem to have quite the same effect.  I’m not sure how to explain this, but it’s true in my experience as well.

    And, as I mentioned, although studies don’t show that points selection matters many acupuncturists would disagree.  (Of course they would, you say.)  Many patients disagree as well.  It’s not uncommon for a patient to see one acupuncturist, not get a good result, and then see another and have their problem cured.  Now we can’t say that point selection made the difference, but we can’t rule it out either.

    Finally, many acupuncturists are also trained in Chinese herbalism, nutritional medicine, and other therapeutic and preventative modalities.  Acupuncture is just one aspect of Chinese medicine.  Kind of like the “physical therapy” of western medicine, only far more powerful.  But don’t ignore the other parts of Chinese medicine.  In some cases they can be even more helpful.

  27. gordie w says

    Chris, I believe you’re correct about acupuncture outperforming placebo for some conditions – even sceptics grudgingly admit that. I still wonder if that is to do with selection bias (i.e. only positive trials being published) but this is as much, or more, of a problem with mainstream medicine, as we all know. I wish acupuncture worked, I hope it does. I did end up here after searching for “chemical imbalance myth” and have had my own dreadful experiences with psychiatrists.

  28. says

    @ Gordie.  Good point: I will answer with a question: can it be considered placebo effect when an infant with spastic paralysis due to cerebral palsy can have his limbs relaxed, even temporarily, by an intervention such as putting acupuncture needles into select points?
    Also, you are right in mentioning multifactorials.  I myself am a father of a five year old and my main method for treating her would depend on the disease.  In one case of bronchitis I referred to her pediatrician for appropriate antibiotics.  In some cases of common cold I relied on massage.  I recall only two instances of using acupuncture needles on her and both were to quickly lyse a fever (both due to viral infections.)  Diet and massage are actually the most important tcm modalities for children.  Again this reinforces what Chris is saying about having many tools at one’s disposal.
    Chris: yes, for some reason sticking needles to yourself doesn’t quite have the same effect.
    General comment: one tragic error among many western MDs who study acupuncture (like myself) is that they end up only using acupuncture much to the detriment of patients who could benefit more from another modality like tui na or herbal medicine.  I myself learned that the hard way.

  29. says

    This is one hell of an article. I have a close friend who came from China to practice medicine in America. He has a western MD degree and a degree in Traditional Chinese Medicine from Shanghai, earned in 1963. I couldn’t agree more with the lack of understanding for this system. The arrogance of modern western medicine refuses to entertain that there could be knowledge that is unknown and misunderstood by them even as they look through their microscope hunting for answers to complex diseases. Arrogance ends in failure. Traditional Chinese Medicine employs herbs, massage, pulse and tongue diagnoses, stress reduction, Chi Gung, , cupping, laughter and needles.
    What impresses me most about my Chinese colleague is that he cares about his art and science and he actually works on your body for an hour or two when you come to see him. I know of no medical doctor who does the same thing. Instead, they see you for two minutes, write you a prescription and don’t care to listen to a word you have to say.

  30. says

    Loved your series, especially your explanation of Qi.  I usually describe the character for Qi as being made up of two radicals:  one is for things that are in the air, the other is grain.  Air and Grain make Qi….

  31. says

    I am on point with a lot of what you say in this series.  But let me clarify one thing are you saying that the nomenclature by which we define meridians is wrong, or that the whole concept of meridians is erroneous?  If it is the later, you are making a bold statment indeed!

    • Chris Kresser says

      That’s exactly what I’m saying. But it’s not just me saying it: it’s the classic texts. The notion of a meridian system outside of the vasculature was a creation of Soulie de Morant.

  32. Kumar says

    Chris,

    I was an engineer for 18 years prior to coming to school for TCM (in my 2nd year) and I really struggled with the TCM concepts for a while, constantly trying to translate them to a western paradigm.

    The article might be useful to give people to help them view TCM from a biomedical theory, especially if they are skeptical.

    Are you familiar with the Technitium-99 study done by French researchers (Nuclear Medicine Investigation of Trasmission of Acupuncture Information – by: J-C Darras, P Albarede, P de Vernejoul — published in: Acupuncture in Medicine May 1993 Vol 11, No 1)? They injected T-99 into known acupuncture points and compared them with non-acupuncture points, adjacent blood vessels, lymphatics). The tracer traveled along a pathway specific to the location of the primary channels. If it was injected in a point on a meridian, it would migrate along what appeared to be the meridian. If the dye was injected into a non-acupuncture point, it would diffuse in a circular pattern. If another tracer were injected into a blood-vessel (adjacent to the acupuncture-point), it would travel in a separate path (the blood-vessel) and disappear very quickly (assumed to be carried away by the relatively rapid blood flow.)

    I can forward you a copy of the article if you’re interested. How can one explain this result in terms of the blood-vessel paradigm? One theory I’ve heard is that the channels are myofascial tissue planes along the body. But there is more than one thing going on with regards to this study than simply myofascial planes — (eg: the relatively slow movement of the tracer along “meridians”, and the ultra fast response of the paired meridian on the opposite side of the body to contralateral stimulation).

  33. Joseph says

    There are some serious issues with your series.

    – Old doesn’t mean true or efficacious. Otherwise animal sacrifice to appease imagined deities and astrology could be counted superior to TCM.

    – Your comparisons with “western” medicine, whatever that is, doesn’t support or help your argument one bit. I could list dozens of examples from classic TCM texts which would make TCM appear ridiculous. (I withdrew from a TCM program due to nonsense propounded as truth)

    – Comparing western medicine (no such entity) with TCM is unhelpful, misleading, and fallacious, because there is no monolithic entity of either.

    – You wrote: “The reason Chinese medicine isn’t more popular in the west is that it’s completely misunderstood even by the people who practice it.” Nice that you know the truth while the professors who come from top universities in China don’t know (the real truth).

    There are countless other reasons why it’s not popular: Not efficacious for many diseases, costs an arm and a leg, people are scared of the unknown.

    – You wrote: “I’m also going to tell you how this blatant mischaracterization of Chinese medicine in the west came about.” And it’s still perpetuated by my former Chinese professors who’ve been practicing for an average of 15 – 20 years and graduated from Chengdu University. Even the Chinese themselves don’t know this great truth!

  34. Joseph says

    I feel bad coming here and criticizing your blog without an invitation but there’s just so much misleading and wrong information here. You wrote:

    “And that’s a big shame. Because Chinese medicine is in fact a complete system of medicine that has successfully treated many common health conditions for more than 2,500 years. Chinese medicine was passed through the ages in an unbroken lineage of some of the best minds of China. It was used by emperors and the royal courts to help them live into their 90s and stay fertile into their 80s at a time when the average life expectancy in the west was 30 years.”

    You ought to know there was no “system” of Chinese medicine that long ago. There were umpteen various schools who held and taught dozens of conflicting theories. Most of what we can read from that time is pure superstition, unless you really believe that the corporeal soul is in the Liver, which stores the blood from our body in the evening, and the heart which “makes” blood. The brain is an empty organ which holds “essence” and plays no role at all in TCM. Amazingly, they discovered that needling the fingertips would cure all mental illnesses! Gosh, if we would just do that, our mental wards would be cleared out.

    You might want to research when the life expectancy of Chinese rose. I’ll give you a hint: it wasn’t way back then. It was after the introduction of the evil western medicine. The fact that some chinese lived a long time means nothing, as countless examples from European history show that many lived into old age, even Christian monks who ate much of nothing and had no doctors at all, which is probably why they lived longer, given the state of medicine at the time.

  35. Joseph says

    You mean “studies”. I couldn’t name them all. It sounds like you’re suggesting that TCM is efficacious for all diseases which even no accupuncturist would maintain. The Cochrane Review is a good place to start.

  36. Joseph says

    I want to apologize for coming in here with guns blazing. I’d remove my comments but I cannot or don’t know how. I’m a little bitter at wasting $20K on studying TCM. Feel free to remove my earlier comments. Thanks.

  37. Kumar says

    Replying regarding Chris C’s request for an online version of the study:
    I haven’t found it online. I have university access to journals and got a copy there.

    I sent him a pdf directly — if anyone wants it, please let me know.

    Here’s an editorial by the same researchers found online which summarizes the research:
    http://jnm.snmjournals.org/cgi/reprint/33/3/409.pdf

    They list a number of other citations (mostly in French) regarding similar research.

    Some interesting things to note:
    - it has also been reproduced by other researchers (Romania, France, China, Spain)
    - this has been reproduced in animals (specifically Beagles, in Spain)
    - if you block off one arm with a tourniquet you will stop the migration of the tracer along the channel, but if you stimulate the point, you can increase the speed of migration of the tracer in the OTHER arm. So there’s a physical migration, but the stimulation seems to cause an electrical (or chemo-electric if you prefer) signal to the other side, stimulating the corresponding contralateral channel.

  38. Natasha says

    Hi Chris,

    A very interesting set of articles. I just have one question in regards to the following information:

    ‘The Chinese were performing detailed human dissections where they carefully measured the blood vessels and weighed the internal organs at a time when western physicians thought the body was made up of “humors”

    This is the first time i have heard of Chinese Physicians performing dissections before western physicians. The general understanding is that Chinese Medicine forbade dissections. Could you cite some texts that discuss this. Much of the arguments against acupuncture rely on the ‘fact’ that Chinese Medicine was a medical system developed before dissection and that Chinese Medicine physicians had very little knowledge of internal anatomy and physiology. Interesting to hear another perspective.

    Thanks, Natasha.

  39. Peter Deadman says

    My understanding is that advanced surgery was undeveloped in China, largely because of unavailability of anaesthetics. Superficial surgery was clearly practised, indeed there is a clear overlap between early acupuncture and practices such as lancing of boils etc. And a famous illustration shows Hua Tuo performing surgery on the arm of a wounded general while he played chess. However dissection is another matter. Remember that the world’s first textbook of forensic medicine (The Washing Away of Wrongs) was written in 13th century China. And one of the Difficulties in the Nan Jing (from around 2nd or 3rd century) concerns the weight of the liver and the lung and the effects of drowning on them (I don’t have reference to hand). Chinese science is probably the least known and least respected in the West.

  40. Anonymous says

    Chris,
    While I am happy to see you willing to engage the subject of Chinese medicine, to base your conclusions on one book is bound to be highly biased. There are many more books with more engaging explanations. Western anatomy and physiology is important, but at this point in time has not succeeded in explaining the channel phenomenon. It will take several more decades of engagement with Chinese medicine before it can be understood in biomedical terms, and even then Chinese medicine will transcend that understanding.

    Z’ev Rosenberg, L. Ac.
    Chair, Department of Herbal Medicine
    Pacific College of Oriental Medicine,
    San Diego, Ca.

    • James Lee says

      There was no such thing as “channel phenomenon”. A phenomenon is observable but the “channel phenomenon” was not. Therefore, we must conclude that it was only the imaginary part of the Chinese Taoists, at the time, where there was no modern scientific knowledge available for explanation. Nowadays, we have the knowledge and technologies; why not link them together for a better understand of the unexplainable subject TCM…??? TCM is about healing the human body, why should we stay away from physiology to have a scientific back up for TCM rather than just left it hinging in thin air…???

  41. says

    Thank goodness…at last! I am an acupuncturist & what I really hate is hearing endless waffle about wellbeing & blocked energy. For me to know exactly what processes I am affecting with each point I use makes my treatment more beneficial. Nothing wrong with a bit of science ;) I’m reading with interest.

  42. Martin says

    If “The notion of a meridian system outside of the vasculature was a creation of Soulie de Morant.”… how come you find drawings of energetic channels and chakras for example on old Tibetan Medicine Thangkas…?
    Why is the “Western World” so eager to explain everything in scientifically measurable ways? Is that Descarte’s ghost still haunting us?

  43. James Lee says

    Hi, Chris
    Interesting reading.

    I am a Tai Chi Quan and Chi Kung practitioner. I have been finding answers to the unexplainable TCM from the modern science. What a coincidence! I had come up with the same conclusion as you did. I had written some articles since 2008. You may find them interesting in the site as indicated below.

    http://www.selfgrowth.com/articles/user/31611

  44. The Unteleported Man says

    I am concerned by the claims made in this piece Chris, especially because I find most of the other articles on this site highly informative. Thank you Joseph for attempting to inject some sense in the discussion. I live in China, and I have observed TCM first hand for 15 years.

    1) It is no exaggeration to say that TCM practitioners here still propagate belief in the equivalent of the four humours derided in the article. One of the pillars of TCM is the “elements” which you also find in Chinese Astrology, and which have zero basis in biology. Thankfully, “western” medicine overcame such beliefs hundreds of years ago. The concept of the elements (or humours) still thrives among the traditionalists in China (which is nearly everyone).

    2) Real doctors in China – the ones who work in real hospitals for example – are not taught TCM. They are taught Western medicine because it works, and TCM doesn’t. Doctors who practice TCM are distinguished by different “medical” degrees, licences, and insurance parameters and are subject to more restrictions than real medical professionals.

    3) TCM is a religion, just like its corollary Feng Shui (and if you believe in THAT, you have a serious problem). It is a VAST religion, and I admit it does contain some real medicine. For example, a percentage of Chinese herbal remedies are in fact valid – not that differently from traditional western medicine. But there is so much garbage that it fairly drowns out what good there is in TCM.

    4) Who cares what the Chinese have believed for 3,000 years? Have you ever been out here? Even after 3 millennia of “medicine” this is STILL the most superstitious country in the world. Astrology, Feng Shui, psychics, and snake-oil are literally everywhere you turn and are considered to be absolutely real. The biggest holiday of the year (lunar new year) is based on the idea that you can transfer luck to someone by giving them special envelopes containing money. This is not a cute tradition like the Western idea of Christmas and its associated exchange of presents; the Chinese ACTUALLY BELIEVE that “good fortune” is being generated in this and a myriad other ways.

    So please, please, by all means attempt to isolate the good that exists in TCM, but stop trying to present it as a legitimate system. Hippocrates performed better medicine 2500 years ago than the vast majority of Chinese medicine practitioners throughout all the ages up to and including today.

    • Diane says

      I am a scientist. In this country that means that I work with and meet a lot of Chinese, well-educated scientists. They do go to TCM doctors because it does work. As Chris has said many times, Western medicine is great for acute trauma (car accidents, severe burns etc.) and serious diseases. Although some diseases are serious because they are the result of years of poor healthcare and poor nutrition — TCM and other holistic modalities might have prevented them.

      • The Unteleported Man says

        Got any evidence of that? Not sure what country you are talking about, but if you mean China you are incorrect. High level doctors and real scientists in China tend to put their trust in Western medicine, which is what is taught/practiced at universities and hospitals. There is a high degree of chauvinism in China (the automatic belief that anything Chinese must be good) and it is one of the most superstitious mumbo-jumbo places in the world. In spite of this, modern medicine has made great inroads because it works.

        Of course, you can insist on putting your trust in charlatans if you want – the vast majority of the superstitious and uneducated Chinese population does so – but try, as a scientist, to explain the rationale for such “medicine” and you’ll quickly realize that it’s pure nonsense. Avoid eating duck to strengthen your bones? Eat snake meat to prevent feeling chilly? Have some tiger penis powder to rev up your sex drive?

        Complete nonsense. There is a clear test for Western medicine (it either works or it doesn’t) and no test at all for preventive TCM, only hand-waving, the placebo effect, superstitious belief, and post hoc rationalizations. Despite all this purportedly amazing and widespread TCM they have in China, and powerful dietary advantages (e.g., green tea and white rice consumption, no soy and corn oil everywhere) the Chinese do not enjoy especially good health and die earlier than countries that don’t waste time on TCM.

        I am not saying Western medicine is perfect at all. Look at the lipid hypothesis and coronary heart disease for a stunning example of anti-scientific idiocy in action, or the foolish dietary recommendations that might as well be framed as knock-knock jokes. But Western medicine at least has a logical framework for assessing efficacy of treatment, even if it is occasionally subverted by bad scientists.

  45. Tsu Dho Nimh says

    “It was used by emperors and the royal courts to help them live into their 90s and stay fertile into their 80s at a time when the average life expectancy in the west was 30 years.”

    You are using a poor example: What was the average life expentancy in China at that time? What was the distribution of age at death in the west? Not “average”, but how many of a thousand or ten thousand reached their 70s, 80s and 90s?

  46. says

    This article and followings are written with a rare virtue of semplicity and precision. Most of Italian people have to learn from this approach. The concept of Qi explained here is, for me, original and I must think about it. It sounds good and stimulate curiosity. Perfect, thank you Chris.

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