difficult because, particularly with traditional Chinese or Indian ayurvedic
medicine, where the aim may be to correct imbalances in health, there is no
outcome to measure in the same way that western medicine allows. For the
same reason animal models are unlikely to provide applicable results. Practi-
tioners frequently use mixtures of ingredients and testing standardised indi-
vidual elements may not be appropriate. Another significant factor with
ethnic medicine is the charisma and seniority of the practitioner, which
introduces a significant element of placebo response that cannot be quantified.
The number of RCTs of TCM has increased in recent years. However,
there have been few systematic assessments of the quality of reporting of
these trials. Wang et al. concluded from an assessment of 7422 RCTs,
published in mainland China from 1999 to 2004, that, although the quality
of reporting of RCTs of TCM was improving, it still remained poor.^19
Modern Chinese medicine
Since the 1950s, the Chinese government and the government of the
Republic of Chinese Taiwan have put great efforts into promoting the
modernisation of Chinese medicine. This has been in response to national
planning needs to provide comprehensive healthcare services. Previously,
TCM had been viewed as part of an imperial legacy, to be replaced by a
secular healthcare system. Integration was guided by health officials trained
in modern medicine; harmonisation with modern medicine was the goal.
This was accomplished by a science-based approach to the education of
TCM and an emphasis on research. There are now Chinese professionals
trained in both TCM and modern western medicine, who conduct research
on the development of Chinese medicine. Western science methodologies
have been employed to analyse the effectiveness of herbs and treatment on
various individuals. Many of the differences between TCM and western
scientific practices are now being studied for their synergistic potential.
Tang has asked whether the current western model of research – trying
out unknown treatments in animals – is suitable for studying treatments
that have long been used in humans.^20 Evidence-based medicine focuses on
clinical research in humans. However, research in TCM has had a mecha-
nism-centred approach. Despite occasional successes, such as in acupunc-
ture,^21 most questions, e.g. the nature of disease in TCM, have not been
satisfactorily answered.
TCM research has been accused of being in disarray.^22 A long history of
use, traditions, faith, popularity and anecdotes is widely taken as evidence
for the efficacy of traditional Chinese medicines. Some traditional therapies
are undoubtedly effective but this does not mean that all are. These medi-
cines have been used for thousands of years. Whether tested or not, they will
continue to be used in places where TCM is officially recognised. Tang
132 | Traditional medicine