Chinese Herbal Medicine

Yesterday a practitioner of Chinese Medicine pleaded guilty to selling a banned substance to a woman who subsequently became very ill indeed. Ying "Susan" Wu who lives in Essex, worked as the "Chinese doctor" in the Chinese Herbal Medical Centre in Chelmsford.

Mrs Patricia Booth went to the centre to buy something that would help with patches of spots on her face, and was given something that contained a banned substance, aristolochic acid. She was given the pills and told to take around thirty of them, three times a day. Although Ms Wu didn't know about the dangerous nature of what she was selling, Mrs Booth developed chronic kidney failure and cancer of the urinary tract.

Chinese Traditional Medicine is based on very old, and completely unscientific, ideas about the human body. It sees health as a balance between Qi (life force), blood, jing (kidney essence), various other bodily fluids, along with emotions, and soul or spirit. All of these things are supposed to be in balance if we are to remain healthy.

But Qi and jing are completely unevidenced and undetectable, and therefore cannot form the basis of any form of diagnosis. The whole practice of TCM is based on the accumulated observations of non-scientific trial and error, often poorly recorded, and typically hopelessly confused. Not only is there no diagnostic basis for TCM, but each practitioner will produce their own interpretation and recommend different preparations.  Trials of their diagnostic skills have exposed frightening ignorance and inconsistency. There is no possible consistent diagnosis.

Medicine requires first an analysis of the symptoms so that likely causes can be identified, and this requires an understanding of how the human body works. For example, diabetes is not caused by an imbalance in imaginary entities such as Qi and jing, but a malfunction in the mechanism for controlling blood sugar levels. No amount of balancing, or TCM herbal remedies will replace those cells that produce insulin, or replace the enzymes needed to metabolise blood glucose.

Because there is no understanding of the medical causes of diseases, appeals to Qi and jing are pointless and misleading. At best, the patient will get some preparation that doesn't affect them but at worst, it could contain literally anything with largely unpredictable effects.

There is a long history of TCM preparations being found to have been adulterated with prescription pharmaceuticals (see for example Trick or Treatment by Simon Singh and Edzard Ernst) and even without that, there is no clear identification of the active ingredients, or the dosages. Herbal preparations often contain pharmacologically active ingredients, often several, along with contaminants, and they are not controlled so the dosages vary wildly.

The pharmacological effects themselves are often poorly described, sometimes only in ancient reference books produced before any kind of laboratory analysis was possible. Someone identifies a plant as being beneficial for a particular condition, and it is then taken on trust. But without clinical and pharmacological analysis, this is quite simply dangerous, as the recent case dramatically illustrates.

Should TCM be regulated?

There is a debate about whether or not alternative medicine practices should be legally regulated. On the one hand, insisting on high quality production standards, and identification of active ingredients and dosages might reduce some incidents of herbal poisoning, it won't address the irrational basis of the practice.

Where a therapy is based on the irrational belief that antiquity ensures efficacy, even if it was regulated, the danger still remains. For example, suppose there was a national or international authority on TCM set up to award and validate qualifications in Chinese Herbal Medicine. The qualifications would be worthless because the very basis of the practice is unsafe.

There is no consistent diagnosis because the practice cannot relate symptoms to likely causes. A doctor addresses the likely causes and tests the patient to narrow down the possibilities. Because treatments are directly related to the diagnosis, it is possible to provide specific medical help. If there is no connection between diagnosis and medication, there can be no consistency in the treatment. With TCM there is no rational basis for diagnosis at all so any qualification and regulation will at best be a fig leaf.

The need for evidence

Instead of regulation, any medical or health practice should be required to produce evidence of efficacy at a high scientific standard. It should be proved to be safe and to work before it could be made available to the public. That's a public health case rather than a business case.

TCM will of course be able to show that some herbal preparations have a pharmacological effect, but they should be required to demonstrate that they are safe and controlled with evidence of controlled clinical trials.  They should be shown to be free of contaminants, with a record of side effects and severity, and should be restricted to those that do not contain dosages of prescription pharmaceuticals which could be dangerous. At present anyone in the UK can set up shop and sell preparations from any source they feel like.

That doesn't require making TCM a profession, or regulating it as one, but simply classifying TCM preparations as pharmaceuticals. They will then come under the appropriate legislation and shops won't be able to sell them. It will of course, put many TCM shops out of business unless or until, the proprietors get themselves trained in the appropriate scientific disciplines to understand the nature of diagnostic techniques and pharmacological controls.

At the very least, that would be a positive health measure and socially would help reduce the dependence on irrational health beliefs. While ordinary people are tempted to try TCM on the grounds that "it might work", they are putting themselves at risk. The people diagnosing them don't have the clinical skills nor the pharmacological knowledge to be safe. The preparations themselves have appalling quality control standards and the customer has no way of knowing what they are really taking, nor the dosages.  They are gambling with their health.

Although the judge in the Wu case said she wasn't really to blame because of her ignorance, all those promoting uncontrolled herbal preparations, based on traditional unscientific theories, are partially culpable. She was after all designated the "Chinese doctor". 

It's not good enough to say that various preparations help with certain conditions unless that's been tested and demonstrated in controlled clinical trials with a clearly identified active ingredient and dosage. Pushing plant preparations may seem to be more "natural" but many plants contain dangerous alkaloids. Without the scientific knowledge of their contents and clinical effect, rather than just knowledge of ancient beliefs, recommending such plant extracts can be very dangerous indeed.

There are many branches of herbal medicine practitioners who revel in the antiquity of their beliefs but we should remember that at one time, illness was attributed to the "miasma", and bleeding patients by opening veins was the unchallenged medical orthodoxy. Very many ancient beliefs have been shown to be wrong, and almost all of the early medical claims. "Natural" doesn't necessarily mean "better". It might actually mean "seriously dangerous".