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Skepticism on the Road: A Glimpse of Traditional Medicine in China PDF Print E-mail
Swift
Written by Kyle Hill   
About a decade and a half ago, I spent roughly 16 percent of my childhood in Shanghai, China, while my father worked in the leather industry. I would easily recommend that anyone go and see China; for a young foreigner like myself it was quite literally another world and very conceptually broadening. Now in my early 20’s and embarking on what I assume will be a skeptical/scientific journey that will occupy the rest of my life, I had the idea to use my frequent trips to China (to visit my father) to gain insight into what many skeptics surely think is the origin of a multitude of pseudoscientific beliefs, specifically doubtful medical beliefs.
My goal here is then to chronicle my recent holiday quest in the Huiyang District, China (Guangdong Province) to see just how easy it would be to find pseudoscience, to discover the character of medicine in China, and to hopefully bring some insight from considering the prevalence and nature of uncritical thought in another country.

 

The Huiyang district is what the locals describe as a “2nd level city” (a fairly undeveloped and rural one) that is host to some 558,000 people.

                                                                 hui_yang

                                                                                ---An aerial view of the Huiyang District

Although I have called this a rural city, you can still find many modern amenities that any sufficiently large city would hold. However, even in this large city, it is difficult to find modernized, western medical care. Many former ex-patriots like myself have to travel to a place like Hong Kong, a massive westernized city, to get suitable medical attention. When I lived in Shanghai, I had a friend who had to be flown by helicopter to Hong Kong after a bite from a feral dog, as no acceptable hospitals could be found in my city. This is what we are dealing with. In Huiyang, by far the most prevalent and used medicine is that of the traditional Chinese and herbal kind practiced in family run clinics. The closest comparison to these many clinics would be to a Walgreens or CVS pharmacy, however with many notable exceptions which we will get to later on.

Before I begin, I have to make my intentions clear. My goal here is not to characterize the whole of China by what I found in my short stay. However, by seeing just how easy it is to find pseudoscience, we might be able to compare China and the US. For example, if you are looking for it like I was, it is immediately apparent that pseudoscientific shops, practitioners, and advertisements are much more visible on the streets of China than they are in the US. Turn a corner and you will see another reflexology-based foot massage parlor or powdered herb purveyor.

                                                                    reflex_sign     

                                                                               ---Sign for reflexology-based massage

Again, though it would be hard to disagree with an argument stemming from this observation, being true to the scientific method, we can’t say anything definitively without more data points. More data is hopefully what we will have by the end of this journal.

My other goal is to get up close and personal with the pseudosciences that we as skeptics so routinely rally against. I will, to the best of my ability via a translator, ask questions of those who sell the products and services that I find, not only discovering the rationales behind their function but also connecting with the believers themselves. Through interviews and pictures, some conclusions will hopefully present themselves, and the whole exercise will prove interesting.

 

Dirty Needles, Snake Ribs, and Cigarettes

Much of the information that I gained on this trip was from a traditional Chinese herb practitioner who I visited and interviewed. His clinic was located in a small village outside of Huiyang. The first thing that I noticed about the clinic was its surroundings and exterior.

                                                                      office_area

                                                                                ---Area of the city surrounding the medicine clinic

 

                                                                     exterior

                                                                                ---The exterior of the medicine shop

Far from being located in a city center, the clinic was nestled among dilapidated apartment buildings and dirt alleyways. When I walked in with my translator, the “doctor” and his son who ran the “pharmacy” warmly greeted us.

As a white westerner, I am quite used to these kinds of encounters in China, and the word “warmly” more describes looks of confused excitement from seeing a young white kid than it does a tight embrace. And as the operator of a small village clinic in rural China, he was very exited to get his picture taken with me.

                                                                      me_and_doc

                                                                                ---The “doctor” and myself

Like the exterior, the interior of the clinic was about as unhygienic for a clinic as you could imagine. Patients were smoking, layers of dust clung to the windows and fans, and dead insects were gathered in convenient piles in the corners of the room.

                                                                      doc_office

                                                                                ---The interior of the clinic

After surveying the small front room, I then asked the “doctor” (these scare quotes will be explained below) to show me to the room where all of the herbs were held, which is pictured below.

                                                                      herb_shelf

                                                                                ---Shelves of herbs and medicines

 

                                                                                 herb_shelf_2

 

                                                                      herb_shelf_3

                                                                                ---You’d be surprised what you can find here

 

The son who handled the procurement of these herbs quickly began opening up all the most expensive jars (which treated the most exotic illnesses, apparently). What I found in them was about as far from a Walgreen’s pharmacy as you could expect. Jars of dried insects, reptiles, vegetables, and fruit lined the shelves. Looking at the pictures, remember that all of these are supposed to be ingested in some way, curing ailments from stroke (I am not sure what this means, the doctor was vague on this point) to indigestion.

 

                                                                      coiled_snake

                                                                                ---Mini coiled snakes

 

                                                                      scorpions

                                                                                ---Container of scorpions

 

                                                                      sawfish  

                                                                               ---Bag of sawfish?

 

                                                                      snake_ribs

                                                                                ---Assorted snake ribs

 

                                                                      lizard

                                                                                ---Gliding lizards on sticks

 

                                                                      centipede

                                                                                 ---Massive centipede on a stick (minus legs)

 

 

                                                                      earthworm

                                                                                 ---Dried earthworms

 

 

                                                                      leech

                                                                                 ---Dried leeches

 

                                                                      poppy

                                                                                 --- Dried opium poppy

I am not exaggerating when I say that a bit of cooked centipede and flying lizard regularly grace the patient’s prescriptions. The routine is as follows: a patient comes in complaining of some illness, the doctor examines the patient and recommends some assorted herbs, the son gets the herbs for the patient, and the patient takes the herbs home to cook and ingest them (typically in a tea type fashion). All of the herbs pictured above could, according to the doctor, be combined to treat a variety of symptoms. That is to say that many herbs are often taken at once as “they work better this way.” It falls upon the herbal practitioner to decide which combinations will be helpful or harmful.

 

                                                                                prescription

                                                                                            ---Herbal prescription

Still not done in the herbal closet, I then examined the hardware with which the medicines are prepared. No laboratories here, just simple implements. Sterile, this was not.

 

                                                                                 axe

                                                                                            ---The prescription axe

It must be said that while I am aware that all of these herbs are sealed within containers and seem harmless, the preparation, storage, and overall medical competency was appalling. No washing of hands was observed before or after herb handling (indeed, no concern for cleanliness was the name of the game), no expiration dates or regulatory information were visible on the containers, no sterile preparation tools were used, no cleaning of the containers or the shelves they occupied was done, nothing that would assure me that I would get a sound treatment from this clinic. The doctor was a very nice man and enthusiastic to talk to me, but it was clear that the whole clinic was a few centuries behind medical science.

After smelling my fair share of desiccated leeches, seahorses, and poppies, I returned to the main waiting area of the clinic to speak with the “doctor.” While I was waiting for him to finish up with a patient, my translator informed me that the doctor was busy performing acupuncture. Being the interested skeptic that I am, this was something that I had to see for myself. Here in the US, skeptics grumble about the incredible prevalence of “professional” acupuncture clinics springing up here and there, but it was another thing altogether to see real Chinese acupuncture, in China, first hand. The patient who was receiving the treatment had been complaining of a tight neck (likely from construction work), and consequently he had received both cupping, which is where round glass containers are placed on a patient’s back and the air inside the container is removed with a hand pump or open flame (raising the incredible welts that you can see below), and acupuncture along his upper spine.

 

                                                                                acup_patient_1

                                                                                           ---Notice the cigarette

 

                                                                      acup_patient_2

                              ---The doctor removes the acupuncture needles from the patient. The large welts that you can see are from the cupping procedure.

 

I stuck around until the doctor was finished with the procedure, with which the patient was not entirely satisfied. After removing the needles the doctor gave the patient a thorough neck massage. This slight detail seems innocuous enough, but it makes me wonder from which the patient is receiving benefit, the massage or the needles (the science would suggest the massage). This is something that was of course unrecognized by either the doctor or the patient. Another small point which I think can give you a better idea of the state of medicine in this clinic: the needles that were inserted into the patient were neither sterilized before or after insertion and were stored for later use in an empty cigarette tin.

 

                                                                      needle_tin

                                                                                 ---Cigarette tin/needle receptacle

 

Now done with the patients that he was seeing, the doctor, my translator, and I sat down for some green tea and an interview.

 

A Cure for Everything, Unless It Is Really Bad

While some may have already made up their minds as to what Chinese herbs and other treatments are all about, I could not let an opportunity to learn from a traditional practitioner pass me by. The following conversation is an attempt to get to the root of Chinese medicine and to hopefully determine the state of medicine in China.

The following conversation must be considered appropriately, as my note taking was via paraphrasing and all responses from the doctor had to be first translated. I also apologize for the short responses, but the doctor was rather curt and the translator I suspect distilled many of his answers. Even so, the picture of medicine in China after this interview became much more clear to me, and it seems as though skeptics in the US have it easy.

Q (me): What are all these herbs (like the snake ribs and leeches) used for?

A (the doctor): Chinese herbs are used to release ‘heat’ from the body and restore balance. Everything is about balance, balance with the elements like fire, wood, earth, and gold.

What is treatable with Chinese (herbs, acupuncture, etc.) medicine?
Basically everything is curable by Chinese herbs. Even tumors are curable. They can also do things like help a woman get pregnant. For example, the snake ribs (pictured above) can cure a stroke and high blood pressure.

They can cure everything?
Chinese herbs and Chinese medicine can cure anything if it is caught early enough. For example, cancer that is caught early can be fully cured by herbs.

Is there any illness or medical problem that you would recommend western medicine over the eastern medicine you practice here?
For cases like bleeding or surgery (immediate treatments), I would recommend a patient to a western hospital because Chinese medicine cannot work for these problems.

Once you give the patient a prescription and they receive the herbs, how do they use them?
The herbs in the prescription are not to be taken individually; they should be all combined together for the health effect. The patient takes the herbs home and cooks them in a few cups of water for between 30 minutes and two hours. After they cook them, the mixture is strained and consumed.

Do your patients typically request eastern or western medicine?
I would say that about 80 percent of my patients either ask for or choose Chinese herbs and traditional treatments over western medication. I have both eastern and western medicine in my clinic. Patients who want to see quick results choose western medication because Chinese herbs can sometimes take months to work.

Where did you get your education in Chinese medicine?
Most of my knowledge about Chinese medicine was past down to me from my father. This knowledge has been in my family for hundreds of years. This is why this clinic is called “traditional,” because of the family knowledge. You cannot call me a doctor because I am traditional (instead, a Dao Shi—traditional medicine practitioner).

Do you have a license to practice this medicine?
Because I am a traditional practitioner, I had to take only a few courses (not a full education) to get my license from the government. Most of my knowledge was passed down to me. The license from the government covers both eastern and western medicine.

Is there any regulation of your clinic by the government or other agency?
One government department that handles medical standards comes in and checks all the medicines that I sell and even goes through my computer files.

Are there many clinics like yours in China?
Yes, there are very many just in this village. Many are traditional clinics that sell herbs and are run by families. The new herbal practitioners get full educations and are considered doctors.

[As I spoke to him, I could not help but notice that he was lighting up a cigarette. Naturally curious why a man who was supposed to manage people’s health would be so clearly and voluntarily harming his own, I pressed him on his habit.]

As a medical practitioner, are you worried about your smoking affecting your health?

Smoking is no problem. For example, a few years ago when there was a SARS outbreak, people who were smokers got SARS less than people who did not smoke. Tobacco is a kind of herb too. This herb protects the body from the harmful smoke. Many old women in this village have smoked for their whole lives and they have lived past 100 years old, so the percentage is good that smoking is not harmful.

[The Dao Shi then was then kind enough to produce the source of much of his medical knowledge, 150-year-old books from the Ching Dynasty. The books were exquisite pieces of history that were completely hand-written.]

                                                                      book1

 

                                                                      book3

 

                                                                      book2

 

Do you get a lot of your knowledge from these books?

Yes, I routinely perform the same practices that are in these books.

[I then turned to my translator, after she had additionally spoken to the Dao Shi for quite some time, to make sense of all of the information that I was getting and asked her the following:]

Would it be fair for me to say that much of the medicine in China is like what we found in this clinic?

There are many more of these clinics than there are hospitals in China. As a whole, clinics like these characterize Chinese medicine.

 

Thoughts on the Clinic

What did I take away from this experience? I hoped that not all the clinics were like this one (though I have reason to think that they are). The Dao Shi himself gave me a very clear idea as to how traditional practitioners operate. You could sum it up with the following:

1.     It is hard to accept the fact that people come to a place for disease treatment that lacks even basic concerns based on medical science. The lack of sterilization and cleanliness is particularly egregious.

2.     I am not surprised that people keep coming back to clinics like this one. Unless the disease is really bad (which will unfortunately lead to death for many patients, as they do not have the resources to travel to a hospital or pay for the care), herbs could subjectively relieve symptoms via the placebo effect. Acupuncture “works” in a similar way. Even though the patients are simply living with the disease or unknowingly letting it run its course, herbal remedies are assumed to work because of confirmation bias. For example, because the common cold will naturally ebb and flow in nastiness and eventually dissipate, it is obvious that sometime after taking an herb the cold will vanish. Though not the work of the herb, the patient will assume that the herb was their saving grace, and not a natural attenuation. This simple cognitive misstep keeps the entire herbal enterprise (of the kind I saw) afloat. Furthermore, given that “herbs can take months to work,” the herb will supposedly vanquish any ailment that naturally dies out or lessens in severity in that period. This only extends the goal posts wider.

3.     If there were one rule that we could make about good, science-based doctors who are legitimately concerned about health, it would be that they should not be smokers (or should at least discourage it). If medical science can agree upon one thing, it is that smoking is harmful to your health and those around you. Seeing a medical practitioner smoke in front of you cannot help but make you skeptical of their concerns and education, especially if they (and all their patients) are free to smoke in their medical establishment.

4.     The Dao Shi’s explanation of why smoking is OK for your health really hit the point home for me. His explanation was one that wrapped up confirmation bias, anecdotal evidence, confused ideas about correlation and causation, and objectively incorrect ideas about the dangers of smoking into an answer that informed me about the scientific reasoning that accompanies the herbal practice. Far from being based in science, it is rather based on word of mouth, subjectivity, and conjecture about the workings of the body.

5.     Every medical practitioner has referenced a medical textbook for help, I’m sure, but I doubt that the textbook was over a century old. Using this passed down knowledge is like playing the children’s game “Telephone” (where the first child is told a phrase and relates what is said to the next child, often distorting the phrase far beyond the original by the end) with medical knowledge. The fact that the Dao Shi told me that many of his practices come straight out of such ancient tomes should speak for itself.

6.     The Dao Shi, as a medical practitioner, showed little scientific knowledge or thinking. Many explanations I received were based on anecdote, confirmation bias, or flat out nonsense like herbs relieving “fire,” restoring “balance,” or curing cancer. If this characterizes most of the clinics in China, as my translator stated, then the situation for medical science is fairly dire.

7.     It should also be mentioned that the clinic had a small section that sold western medications like Tylenol. However, even though this is a good thing, the Dao Shi that I spoke to had little or no education in pharmacology (admittedly). I fear that this section of the clinic employs a “take some of this, whatever it is” mentality towards western medication.

 

The State of Medicine in China

So what can we say about medicine in China? Based on what I observed, I think that it would be safe to say that the skeptics have it right. Not only are pseudoscientific medical clinics everywhere (more than you can find in the US, surely), but also pre-scientific medical beliefs are mainstream. At least in the US we have given these same practices the designation of “alternative” to separate it from science-based medicine. For patients in China, getting acupuncture, ingesting herbs, or getting a foot massage based on reflexology is just as likely to be recommended (if not more likely from what I gathered, depending on the ailment), than surgery or drugs. Say what you will about the US’s reliance on medication, drinking “essence of snake rib” does not equate with taking an anti-depressant.

If we can trust what I found to characterize much of the medicine that is practiced in China, which I believe we have a good reason to, then we can say that China has a lot of catching up to do. Given, China is about to outpace the US in terms of scientific papers published and obviously has very reputable medical research taking place within its borders, but even this research on the frontier of medicine has not wrestled control from pseudoscientific belief systems. In a country that is largely comprised of rural areas and lower class workers (China is absolutely huge and the major cities are but a small percentage of that area), the traditional medicines, and the beliefs that surround them like “chi” and acupuncture “meridians” remain more popular and more valued than western medicine. The scientific elite in China may be making great strides, but this has yet to find its way into a public that greatly values its tradition, medical beliefs included.

Many of the medical practices that I found, indeed the attitudes of the country toward traditional medicine, are based solely on arguments from tradition and antiquity. China has a wonderfully interesting history and strong traditional convictions, and I think that this has pervaded its practice of medicine. As eastern medical practices (the ones that are scientifically implausible or impossible) are continuously exported to the gullible west, we are then taking part in the largest logical fallacy in the developed world. It cannot be more clearly stated: just because something has traditionally been used or been used for a long time does not mean that it works. Chinese herbs have been utilized for medical purposes for centuries, but this fact is of no scientific value. Science may find a molecule in an herb that is useful, but this will result from increased study, not blind assertions of efficacy. For example, the medical literature on acupuncture is clear: it does not work beyond placebo. No amount of anecdotal evidence can prove otherwise. However, this clearly has not stopped acupuncture from being outrageously popular in China.

 

                                                            acupuncture_sign

Regrettably, the widespread acceptance of baseless medical practices in China has conferred acceptance from the government. I am not sure whether or not the government simply accepts the fact that the people want to use these medicines and just deals with it through regulation, is trying to phase is out, or outright supports it, but as it stands right now the government condones these practices (if we look at the large number of acupuncture and herbal medicine licensures, for example). By contrast, I would be surprised if the US government did not immediately shut down an herbal clinic that sold people products explicitly to treat disease, especially if it was in the kind of state the one I visited was in. Not only is a dirty, smoke-filled, herbal clinic in China able to sell products to treat disease, it receives licensure from the government. This, if anything, is a strong indicator of the attitude towards medicine in China.

 

                                                                                herb_store

                                                                                         ---Herbal shops on the streets of Huiyang

The beliefs that underlie the use of herbal remedies and traditional Chinese medicine seem so ingrained into Chinese culture that I cannot even begin to think how they could be successfully debunked. These medicines have the weight of thousands of years worth of acceptance, and additions from medical science less contradict this weight than they do merely add to number of treatment options. Governmental acceptance, ingrained traditional belief, and substantial presence of traditional clinics all paint a rather bleak picture for the skeptic. Again, I am not saying traditional treatments are the only ones available to the Chinese, far from it, I am saying that in China the portrayal of traditional medicine is much more akin to how science-based medicine is viewed (whereas in the US they are deemed “controversial” or “alternative”), which is the problem. You can find very good science-based doctors in China, no doubt about it, but you can find just as many if not more traditional and herbal practitioners vying for primacy over them.

 

                                                                      herb_store_1

                                                                                 ---Pharmacy shelves lined with herbal and traditional products

This was my own personal experience and is of course open to refutation. I did not have the time or the opportunity to see as many shops or speak to as many people as I would have liked to. It is true that I went looking for pseudoscience and avoided western clinics and hospitals, but from what I saw on my trip, most of the clinics are essentially similar to this one. From what I saw, the herbal clinics and traditional medical beliefs are mainstream enough to produce an almost alien medical landscape (to me, the American skeptic). If anything, these observations should galvanize all skeptics to work diligently and relentlessly for the cause of science-based medicine with hope that the time will come when treatments for cancer will not involve crushed scorpions.

 

Kyle Hill is the newly appointed JREF research fellow specializing in communication research and human information processing. He writes daily at the Science-Based Life blog and you can follow him on Twitter here .

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written by fishbait, January 12, 2012
Very interesting and well written piece. I will recommend this article to many others.
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Adding to my point
written by SciPhile, January 12, 2012
Somewhat supporting my point about governmental acceptance of TCM is the news that China is investing a billion dollars into the advancement of the TCM industry: http://www.chinadaily.com.cn/u...418180.htm
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written by denver, January 12, 2012
Thanks for one of the best articles I've seen published on Swift.

Also, as an aside, I've always assumed that the Chinese government actually supports this traditional medicine because the country simply could not support professional health care for their large population. By allowing such a widely citizen-run distributed system to fill that gap, it placates the population in its health care concerns. Can you imagine what would happen if the population suddenly demanded better?

Also, as another a side, "Gliding lizards on sticks" is a great name for a band.
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That was fascinating
written by Blizno, January 12, 2012
That was fascinating. Thank you for giving me a glimpse into typical Chinese medical practice.

The ancient books you photoed are beautiful. The skill and art put into every page is amazing.

You mentioned more than once that the lack of sterility bothered you. Since the treatments were prescribed to be cooked and strained, I would think that the final fluid would be sterile. The fluid is to be swallowed. If it was to be injected, I would fear the lax cleanliness much more.
The creatures appear to be well dried. If so, they could last a long time without rotting.

The lack of cleanliness and sterility suggests to me that the treatments aren't specific or potent. Cutting and grinding one medicine in the dust of the previous treatment would mix medications. If that doesn't matter, I have to wonder why to keep so many different supplies. Why not just keep a stock of ground ox bone and give that to all patients?

I share your concern about the unsterilized acupuncture needles.

Side rant: the trade in tiger bones and rhino horns must end!
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written by Caller X, January 12, 2012
Those books you showed are not written by hand, they are printed, and they are most certainly not 150 years old.
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In response to Caller X
written by SciPhile, January 12, 2012
Oh I apologize. I forgot that you spoke to the owner of the various books and examined them first hand.
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Baby And Bathwater?
written by Surferboy, January 13, 2012
Yes, good piece of travel writing. I share the author's scepticism about the efficacy of dried scorpions to cure anything other than a chronic desire to get rid of some cash. However, it would be unfair (and, dare I say, 'unscientific'?) to characterise herbalism - Chinese or other - in general and acupuncture in particular as hokum. I remember as a kid that my family's GP always had a cigarette in his mouth and whiskey on his breath. The doctors waiting room was invariably filled with smoke and in those days the only time you'd benefit from a clean needle was if you were first in the inoculation line! So, yes, Chinese medical establishments are probably well behind the curve when it comes to hygiene, not all TCM treatments are 'appropriate', but to paint the whole as little more than voodoo is pretty insulting to the Chinese. It would also come as quite a shock to the many patients in Chinese general hospitals where herbalism sits comfortably alongside more familiar 'western' procedures and where acupuncture is routinely used in place of anaesthetic. We shouldn't let our - recently acquired - obsession with germ and smoke free environments (which has, strangely, coincided with the emergence of hospital-born 'superbugs') to blind us to the possible merits of another way of doing things. Good Health!
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written by Caller X, January 13, 2012
written by SciPhile, January 12, 2012
Oh I apologize. I forgot that you spoke to the owner of the various books and examined them first hand.


No need to apologize. You're young yet. Take an herb and chill.

"Those books you showed are not written by hand, they are printed, and they are most certainly not 150 years old."


I can read Chinese, and just like with English I can distinguish between something written by hand and something printed. It is so far from difficult that the concept of easy or difficult doesn't even apply. It's either printed or written by hand, just like in English, and the books you showed in the photographs are printed.

[The Dao Shi then was then kind enough to produce the source of much of his medical knowledge, 150-year-old books from the Ching Dynasty. The books were exquisite pieces of history that were completely hand-written.]


"Those books you showed..." Perhaps there was one that was handwritten, that you didn't show.

Every medical practitioner has referenced a medical textbook for help, I’m sure, but I doubt that the textbook was over a century old.


I apologize. I forgot that you spoke to the author of the book (or looked at the publisher's information near the beginning).
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In response to Caller X
written by SciPhile, January 14, 2012
I'm just glad that we could focus on the important parts of the article.
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written by Caller X, January 14, 2012
Facts are stubborn things.
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