TCM Should Openly and Confidently Embrace Evidence-Based Medicine

Evidence-based medicine (EBM) is an emerging interdisciplinary field that arose in the early 1990s. Its formation and development have had enormous impacts on medical research, clinical practice, medical education, and health policy decision-making, and it has been widely applied in healthcare, scientific decision-making, and scientific management. As a new social consensus, the influence of EBM concepts among the general public is growing day by day. TCM is part of medicine; if it is to continue to play a role in future society, it should openly and confidently embrace the concepts of evidence-based medicine and introduce the advanced methods of EBM into TCM research to promote its development.

Some TCM enthusiasts may be deeply unhappy that modern people criticize TCM from the perspective of evidence-based medicine, but we must see the trend of future social development and follow that trend to innovate TCM; only then can TCM continue to develop in future society. We need only look at the textbooks of modern elementary and middle school students to know what kind of education our next generation is receiving; they are no longer ancient people, and are even completely different from ourselves. Their concepts will change with the development of the times. TCM skills will have a future only if they are still accepted and applied by these people. The changing times force us to progress; anyone who tries to stem the tide of the times with individual strength will be futile. We can only survive by adapting to the changes of the times; going against the tide will only result in elimination.

Evidence-based medicine is an interdisciplinary field that integrates epidemiology, modern science, and statistics into medicine. Modern children have been exposed to many EBM concepts from the start of their schooling, so for them, EBM is more trustworthy. Evidence-based medicine means that clinicians' diagnosis and treatment decisions should be based on the best available current research evidence, combined with their own clinical experience and professional knowledge and skills, and respecting patients' choices and wishes. EBM is a medical practice process that follows the best scientific evidence; it is the organic integration of the best research evidence, clinicians' practical experience, and patients' wishes. EBM values evidence and data; in the EBM framework, a treatment applied clinically should be supported by clinical trial data, and such clinical trials should be unbiased double-blind experiments; only such double-blind trials (randomized controlled trials) can yield objective judgments. It uses objective statistical methods to evaluate the effects of medical protocols, so it is very easily accepted.

Unlike traditional empirical medicine, EBM re-evaluates the reliability of medical experience; after rigorous efficacy evaluation, the conclusions reached are more rigorous and more able to withstand scrutiny. EBM represents the direction of medical progress, and the public has high expectations for the evidence-based transformation of TCM. The TCM community should respond positively. If we are confident that TCM is an effective medical method, we should not fear the test of evidence-based medicine.

In fact, many progressive members of the TCM community have already embraced EBM concepts and done a great deal of practical work. For example, the late Professors Yin Huiang and Jiang Chunhua conducted relevant randomized controlled trials according to EBM principles throughout their lives, and these clinical controlled trials achieved certain results. As for double-blind trials of Chinese herbal medicines, someone has been doing them all along — for example, arsenic trioxide treating cancer and artemisinin treating malaria; these clinical trials have all yielded fruitful results.

But some people are very unwilling to acknowledge that these are also TCM achievements; they prefer to classify them as modern medical research and deny everything about TCM. This is a very paranoid and narrow-minded perception. From ancient times to the present, TCM physicians and pharmacists engaged in TCM research have never given up efforts to advance the cause of Chinese medicine. It can be said that every era has had large numbers of clinical TCM physicians and pharmacists combining the advanced technologies and methods of their time to study Chinese medicine. Even Professor Tu Youyou, who discovered artemisinin, herself refuses to deny that her achievements came from research on Chinese medicine. We cannot dress up someone else's child, then claim the child is not theirs but our own — how does this behavior differ from that of a robber? Some anti-TCM people today, when stripping TCM of its intellectual property, really do so without batting an eye.

TCM has a tradition of keeping pace with the times; TCM physicians through the ages have included many innovators. It is true that some TCM practitioners hold to revivalism, but they do not represent the entire community of TCM physicians. We should see that the majority of TCM practitioners keep pace with the times; we cannot deny the whole TCM community just because we disapprove of some who refuse to do so.

The TCM community has never had a unified opinion; TCM writings through the dynasties are full of mutual criticism. For example, Zhang Jingyue criticized Zhu Danxi, arguing that his yin-nourishing theory was wrong. Wu Youke rejected the practice of treating epidemic diseases as cold damage across the dynasties, proposing that epidemics were caused by a transmissible "pestilential qi" existing between heaven and earth. Wang Qingren even believed that Huangdi Neijing and Nan Jing were full of errors, and used facts to correct the mistakes of TCM classics. Not to mention the large amount of work done by many innovative TCM physicians in modern and contemporary times using modern scientific methods to study TCM. These self-criticisms within the TCM community have driven TCM progress, and therefore I am not worried that TCM will have no foothold in future society. After all, TCM is a vast whole, not an individual. No matter how arrogant and closed-minded any individual or small group may be, they cannot change the overall trend of progress of the large TCM community.

Science progresses through continuous self-correction. Setting aside the debate over whether science as a whole has done more harm or good to humanity (this debate has always existed), in terms of the changes science has brought, we must admit that at least at the technical level, science is progressing; with the help of science, we can achieve many dreams previously unimaginable. Tracing the entire development of TCM, we can see that TCM also progresses through continuous self-correction.

TCM has much valuable clinical experience that can withstand the test of evidence-based medicine. I have personally treated many patients; many of these patients were simultaneously trying modern medical treatment, and some wealthy patients even went to top hospitals in developed countries such as the United States, Germany, and Japan for treatment. But in the end they would come back to me, for no other reason than that the actual effect of advanced medicine in solving their problems was not necessarily better than the effect of my traditional medical methods. Patients evaluate the value of doctors and medicine based on actual efficacy; this is the fundamental reason why traditional medicine still has vigorous vitality today.

Many of my treatment methods were learned from the writings of predecessors; I can personally affirm that these methods have real effects. I hope that we can also openly conduct evidence-based medicine research on these treatment protocols and produce convincing data, so that the efficacy of TCM can be objectively evaluated rather than subjectively assessed by TCM physicians themselves. Such work is already underway, and I believe that in the near future, TCM will produce more and more clinical data obtained through evidence-based medicine methods. These data are important not only to all sectors of society but also to TCM physicians themselves; with more accurate data, we will reduce misdiagnosis and mistreatment in clinical decision-making and improve treatment success rates.