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

  1. *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.

  2. *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.

  3. 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.

    • 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!

  4. 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.

  5. 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.”

  6. @ 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.

  7. 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.

    • 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.

  8. @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.

  9. 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.

  10. 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.

  11. 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.
     

    • “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.

  12. 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.

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

    • ***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.

  13. “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!

    • 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.

  14. Oh, thank you for writing this.  I am looking forward to your next part of the piece.

  15. 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.

  16. 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.

  17. 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.