From TCM Enthusiast to TCM Detractor: All It Takes Is One Kidney Failure

Around the end of June or the beginning of July this year, a reader messaged me about an experience of his former teacher. His teacher had once been a diehard fan of Traditional Chinese Medicine (TCM); whenever he fell ill he would seek TCM treatment, and he firmly believed that folk TCM practitioners were more skilled than hospital physicians, because he subscribed to the idea that "the real masters are among the people."

Then this teacher suddenly developed kidney failure and had to go on dialysis. The nephrologist diagnosed that the kidney failure had been caused by poisoning from Chinese herbal medicine, and nearly all of his fellow dialysis patients had a history of long-term herbal use, having fallen ill from either acute or chronic cumulative poisoning by Chinese herbs.

One can imagine how dramatically the outlook of this teacher and his fellow dialysis patients must have shifted. They all went from being TCM fans to TCM detractors, adopting a deeply hostile attitude toward Chinese medicine.

As an onlooker, this reader felt that his teacher's anti-TCM stance was itself somewhat off-balance, yet he too had been thrown into confusion by what had happened. So he asked me: as an ordinary person, when illness strikes, how should one actually choose between TCM and Western medicine?

He said he consulted me because I have always held a neutral and objective attitude toward both TCM and Western medicine, and because I have studied both, so he believed I could resolve his doubts. It happened to be university exam season, and we had over a dozen exams that semester; I had no time to reply, so I put the question off until summer break.

Not only have I seen many people like his teacher, I have such a case among my own acquaintances. An acquaintance of mine was also a staunch TCM fan; in the past, anyone who criticized TCM in his presence would face fierce attacks from him. Then one day his kidneys failed, and he could only survive on lifelong dialysis, at which point he had no choice but to accept Western medical treatment.

Besides his blind faith in TCM, this friend had long lived on convenient foods loaded with additives as his staple diet. Many people must have warned him about this, but he refused to listen and insisted on his own way. He even wrote a TCM book of his own, hoping to publish it, and asked me to write a preface; I refused.

Most people can accept the common sense that "every medicine carries some toxicity." Yet many remain deluded by advertising into believing that Chinese herbs are non-toxic natural remedies. No matter how many popular-science articles we write about herbal toxicity, we cannot change these people's minds.

The kind of people I have encountered in real life are usually very hard to reason with. On the surface they may seem open to others' opinions, but deep down they are extremely stubborn. They over-trust their own judgment and never question their own beliefs, even when those beliefs look extreme to outside observers.

My WeChat public account also attracts such readers. After I publish articles that run counter to their views, they often hurl abuse at me through the backend. In my early days online, whenever I met such people I would always argue with them. But after the age of thirty I rarely do so anymore, and simply ignore them.

Nowadays I just block them outright—that is one advantage of the WeChat official account: once blocked, I no longer receive their messages. They themselves still think I receive everything they send. They vent their anger, and I am left undisturbed; it is a win-win. I have to say, this feature is quite wonderful.

People with single, extreme beliefs are hard to communicate with; more or less all of them show paranoid personality traits. The defining feature of such personalities is distrust of others—they trust only themselves or those who share their views. No matter how well-intentioned the attitude of others during communication, they interpret it as an attack on themselves.

Paranoid personality disorder falls under Cluster A personality disorders. It is among the hardest personalities to change and the most prone to extremism. Even professional counselors and psychiatrists are often powerless against it, and ordinary people basically lack the ability to engage them in meaningful dialogue. In fact, the so-called "folk TCM masters" they venerate are essentially the same kind of people; if you live in the real world with those who preach TCM supremacism, you will find the same paranoid traits in them.

People who end up with kidney failure from taking Chinese herbs are not many; their proportion in the population is tiny. The overwhelming majority of people have a basically clear-headed view: they accept that both TCM and Western medicine have strengths and weaknesses. They know that some Chinese herbs, like some Western drugs, are toxic and cannot be eaten daily as food, let alone used for health preservation and longevity. But the beliefs of paranoid personalities distort into something beyond normal reason.

Sane TCM physicians also hold a sense of reverence and know that medicine must firmly hold the bottom line of "safety and efficacy." When prescribing, they are cautious, and they instruct patients and families to watch for adverse reactions, even reminding patients to have their liver and kidney function and basic bloodwork rechecked regularly. But among over-zealous TCM fans, such physicians are usually dismissed as having no real skill; many pure TCM fans reject everything connected to modern medicine.

Let a TCM physician touch anything from Western medicine, and they label him "Westernized" and no longer trust him. That is why some TCM fans trust only so-called "folk masters." Because only such "folk masters" dare speak without restraint, saying the most extreme things.

Some Chinese herbs are indeed toxic, but when toxic medicines are used skillfully, they can cure disease without causing major iatrogenic harm. Take arsenic—a highly lethal, extremely toxic Chinese herb—it is now used to treat acute promyelocytic leukemia with excellent results, and the WHO recommends this regimen. But modern hospitals control the dosage carefully when using arsenic to ensure patient safety, and they have a full set of backup measures to handle side effects.

Anyone trained in proper medicine (whether through legitimate TCM apprenticeship or medical school) pays attention to iatrogenic harm, because every supervising teacher emphasizes this. Iatrogenic injury is at the root of most doctor–patient disputes; a doctor who fails to guard against it will have a short career.

Medical risk is objective, and iatrogenic harm is not unique to TCM—Western medicine causes it too. For instance, the recently deceased economist Gao Shanwen can be said to have died from an immune storm caused by immunotherapy—a classic iatrogenic injury. To reject an entire branch of medicine merely because iatrogenic harm exists would leave one with no doctor to trust and no drug to take when ill.

Returning to the reader's question: when ordinary people fall ill, how should they choose between TCM and Western medicine? My answer is that the key is not which one to pick. The key is that patients and their families must do some homework themselves—learn about the disease, learn about the doctor, learn about the proposed treatments and drugs, including their effects and side effects, and judge comprehensively.

Ordinary people need not panic at the sight of one or two cases of iatrogenic harm. Usually, rigorous, neutral, rational doctors do not act recklessly; they are responsible for patient safety and also mindful of their own professional safety. A treatment plan chosen after careful consideration by patients and families is generally safe and reliable. The most dangerous thing is wholesale superstition—a one-person decision made by a personality-prone individual.

This is also a wake-up call for physicians: there is much we can learn from such events.

First, we must keep learning, understand more drug side effects, become more familiar with medical risks, and prevent such iatrogenic harm.

Second, when we encounter patients with over-zealous beliefs, we must handle them even more carefully. It is best to reach their families and communicate more with them to avoid such tragedies.

From my actual experience, such patients or families often take additional medicines or health supplements on top of the prescription—things they think work but that are actually harmful. If these risk factors are not eliminated, the chance of serious harm rises further.

Iatrogenic injury harms not only patients' health but can also devastate a physician's career. Both sides must take it seriously.