How Real is Traditional Chinese Medicine (TCM)?

The question of "what exists?" (or "what is real?") is a recurring hot topic in philosophy. Admittedly, at first glance this question may sound like one of those impractical brain-teasers that philosophy is often accused for producing (consider: how is necessary knowledge knowable only a posteriori possible? I've yet to be convinced of the usefulness of this inquiry). While I do find some philosophical questions to be almost ridiculously detached from practice and common sense, I am generally persuaded that questions concerning existence or reality have important implications for how general research should proceed. 

Here are a short list of questions of this type, which reveal their links with other disciplines: 

• Do moral values exist?
• Do numbers exist?
• Does the four-dimensional space-time (sub. for any other theoretical entities in well-confirmed scientific theories) exist? 
• Does the mind (or the soul) exist? ...

And of course, there is the familiar and perennial "Does God exist?" debate.

In these questions, I'm generally treating "Does x exist?" and "Is x real?" to be asking the same questions, which I don't think is particularly problematic for now. My query this time is about the realism of Traditional Chinese Medicine (TCM): does chi (氣) exist? Is "internal heat" (熱氣) real? Are there really meridians and collaterals (經脈, 絡脈) running through our body? 

Are meridians real? Why can't we find corresponding physical structures then?
(Photo courtesy from www.healing-with-eft.com)

I was first introduced to this general problem when I came across Richard Dawkins' The Enemies of Reason (2007) documentary series, which challenged superstitious practices that lacked good scientific evidence (Youtube link here). Although the documentary did not look specifically into acupuncture or other practices in TCM, its attack on suspicious "alternative medicine" practices really struck me, since in Hong Kong (where I was raised) I was taught and grown accustomed to the belief that TCM had genuine therapeutic effects and is as legitimate a medical enterprise as orthodox western medicine. I was told that one should only have moderate amount of fries (or generally any deep-fried food) and lychee because it contributes to "internal heat" (熱氣), a phenomenon which manifests itself in acne, bad breath and smellier gas.

Lychee: the fruit that TCM suggests as causally responsible for the phenomenon of "internal heat".
(Photo courtesy: vpwallpapers.com) 

Interestingly, I was brought up with the belief that the globally inferior status of TCM to orthodox western medicine was due to political reasons or poor marketing, rather than skepticism over its ineffectiveness. After watching the documentary and looking at a few papers and articles raising doubts or citing the lack of statistical significance for TCM (Novella, S,,2012; Yeh, L. et al., 2007; Shang, A. I., et al., 2007, Quackwatch, 2011), I felt (at least slightly) swayed to the side of the skeptic. 

Here are some general problems that arise for the realism of TCM: 

(1) If the entities and the structures (e.g. chi, meridians, etc.) postulated by the general theory that is TCM are real, why is it still so difficult to express these structures in the terms available in biology and physiology? Defenders of TCM may argue that this is a problem that isn't specific to TCM, since many branches of science are to some extent incommensurable (Cf. neuroscience and cognitive science face their own challenges in linking neurons and concepts). But what can we say about incommensurability then? 

• (A) Both TCM and the natural sciences are right. Reality, in this case, is perspectival or relative (?)
• (B) TCM is wrong - assuming that there is a single objective reality. 
• (C) TCM is right - and assuming that there is a single objective reality, the natural sciences have gotten something awfully wrong. 
• (D) There is nothing importantly wrong with TCM or the natural sciences. More research work has to be conducted to find out about how the theories translate into each other. 

(2) Although TCM has a long history of development, researchers have found it difficult to come up with enough statistical significance to show that TCM is really effective. While this may be explained away with the holistic nature of TCM and the difficulty in excluding the placebo effect (Yeung), the lack of statistically significant results raises doubts as to whether the entities postulated are really there.   

(3) If TCM is a true theory, should it not be able to pass empirical tests just like any other successful theory? (The "test of time" is often cited as an argument for TCM, but this should not matter; if it is true, then it should pass empirical tests anyhow)

The names may look familiar, but the same names refer to very different things in TCM than in the natural sciences or western medicine. It is also difficult to parse the individual causal relations between organs and energies. (Photo courtesy: drdonfa.ca)

Admittedly, all of this is a gross simplification of the controversy, but the point is that TCM does come with features which attract genuine skepticism about its reality. I acknowledge that a short blog piece can go nowhere to covering a topic of such breadth and controversy, but I think it's still worth highlighting that there is a live debate here. It is humbling to know how things that I thought I was reasonably familiar with can be so easily doubted into non-existence (it hasn't yet, by the way - the jury is still out). 

While we can wait for more empirical studies to come out to confirm (or disconfirm) the effectiveness of TCM, here are a few questions that we can think about: 

• IF TCM is effective but only effective in virtue of the psychological (placebo) effect, is it then established that the entities and structures in TCM do not exist? (... what is the criteria for determining reality?)
• IF TCM is effective in virtue of real causal interactions with its postulated entities (e.g. chi), then is biology and medicine as we know it seriously inadequate? OR... can we just step back and say that there is no single objective description of reality as presented by the natural sciences? (this of course depends on whether principles in TCM are fundamentally contradictory with the natural sciences)
• Should we care about existence at all? Does it only matter whether theories are useful, and not whether they are true? 

Caveats

• The dichotomy between TCM and the natural sciences is grossly simplified here. It would be interesting and illuminating to look at more details between their respective claims. 
• There are different interpretations of TCM principles and structures, even within TCM itself. This may change the debate if particular interpretations are fully compatible with natural science. 
• The references are terrible here, since they aren't supposed to be proper academic references. But they do provide interesting further reading if you follow the links.