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Taking the pulse of modern TCM
By Tan Weiyun

While Western medicine armed with its sophisticated diagnostic tools and high-tech equipment is developing rapidly, traditional Chinese medicine is still, well, traditional and very much hands-on.

To assess a person's condition, practitioners typically make a diagnosis by looking at the tongue, taking the pulse, listening to the breath, looking at the face and complexion, and, of course, asking questions.

These approaches have been used for more than a thousand years. Prescriptions mostly use herbs, sometimes animal parts and minerals. Acupuncture, acupressure and massage are also prescribed.

There is often no clear explanation for why a certain amount of a certain herb is prescribed and how it is supposed to work.

Therapies prescribed by different practitioners for the same ailment or for the same patient can vary considerably.

TCM practitioners - schooled in an entirely different medical approach rooted in Chinese philosophy - rely on extensive clinical experience as well as intuition to make their diagnosis and prescribe a course of treatment.

Here, we are not talking about infectious disease and serious conditions for which Western medicine is clearly indicated. TCM practitioners know when a patient needs to be hospitalized and needs antibiotics, for example.

Calls to modernize, quantify and standardize ancient TCM treatments have been heard for many years. And some efforts are underway, but the idea is still very controversial.

The idea of trying to modernize TCM was first raised in the mid-1990s.

One modernization approach in Shanghai involves the use of medical equipment. These include massage beds that simulate the massage by human hands, providing standard massage for relaxing neck, shoulders and back.

Computer-controlled acupuncture instruments accurately identify acupuncture points, insert needles to a prescribed depth and control the duration of treatment and strength of electric current.

Electromagnetic physiotherapy equipment is used to "dredge" energy meridians and collaterals, activate blood circulation, treat the kidneys and ovaries.

During the World Expo 2010 in Shanghai, a TCM diagnostic robot, developed by Shanghai University of Traditional Chinese Medicine and IT scientists, was demonstrated on volunteers. People simple sat in front of the machine, which recorded their breathing and pulse and took pictures of their tongues and faces.

Within seconds the robot captured basic physical information and compared it with its database of different pulse types, breathing, tongue conditions and complexions. The machine swiftly delivered a preliminary diagnosis. The system could potentially help patients far away, if the right photo, recording and communications equipment were available.

"Frankly, to modernize TCM or not is always a controversial issue, even today," says Dr Shang Li, director of the Shanghai Association of TCM International Exchange Center, a government-backed organization that promotes the TCM industry to the West.

"Western medicine and TCM are two entirely different systems. TCM was formed by millions of cases and the prescriptions were invented through doctors' rich clinical experiences," he says.

But Dr Shang is still positive about scientific development in TCM, which, he says, might be a great aid in promoting its understanding and acceptance in the West.

"I have to say, TCM doctors and the Western medicine practitioners are like people living in two different worlds; quarrels never end," Shang says with honor. "Western medicine is built upon accurate statistics, rigorous logic and scientific proof, while TCM is kind of abstract and random, even mysterious."

For many years, lack of unified standards, accurate dosage and scientific studies were cited by Chinese and Western critics of TCM.

"That's because traditional Chinese medicine holds that each patient is unique, thus, they should be treated in different ways with 'customized' approaches," Shang says.

Ancient TCM texts describe dozens of pulse types, tongue colors and complexions, facial aspects, which are important in making a correct diagnosis.

The old descriptions can be difficult to grasp, however, and only practice with an experienced doctor enabled practitioners to understand in the old days, and even today.

Descriptions of pulse in one text are an example cited by Dr Zhang. "A string pulse is just like a tight, tense string, which might indicate something wrong with liver and gallbladder; a smooth pulse is like pearls falling to the ground, which might be a signal of anemia and rheumatism."

"Can you figure out exactly what kind of pulse is like a tight string or falling pearls It's too abstract and vague. You'll never know until you feel the different pulses for hundreds and even thousands of times," Shang says. "It's the same facial complexion. What's a pale face? What's a yellow or red face? The correct diagnosis is based on a doctor's rich clinical experience."

As an intern, Shang followed his own teacher in a TCM hospital and found that each master doctor had his own unique treatments and prescriptions.

"With just a quick glance at a patience, they would tell me to add or reduce 15g of some herbal medicine," he recalls. "It was not something learned from textbooks, it came from extensive clinical experience and experiments. That's why many people find TCM unsystematic and lacking unified standards."

The TCM diagnostic equipment was tested around a year and a half ago and got mixed, lukewarm reviews.

"The machine's pulse reading was not very accurate because the results were quite different from what we doctors did, but the tongue diagnosis the robot made was not bad," says Professor Zhou Duan from Shanghai TCM University and former deputy director of Longhua TCM Hospital.

Zhou has practiced TCM for more than three decades and says that TCM modernization and standardization should be more focused on pharmacology, herbal treatment, quality control, extraction techniques and storage.

"Medical herbs will have different effects in different regions and climates. Meanwhile, the way we extract, process and store them can also have a direct impact on the medical effect," Zhou says.

At the TCM university, students concentrate on traditional medicine but basic theories of Western medicine account for more than 30 percent of the curriculum.

"A doctor, TCM or Western, is at least able to read lab test results. I believe knowing something of Western medicine can build a comprehensive system of knowledge," Zhou says. "I am for TCM modernization but don't expect too much. You can try, of course, but don't be too adamant. I think the best way is to absorb the essence of both TCM and Western medicine. After all, curing illness is what we all hope to do."

Today it is hard to find a "100-percent pure" TCM doctor who uses only traditional diagnostics and treatment.

"There might be one or two in the rural areas and ethnic minority groups," says Wu Qing, a TCM doctor at Shuguang Hospital. He studied for seven years to obtain a master's degree at a TCM university, and another two as an intern at a TCM hospital.

"We should see that everything has its good sides and shortcomings. Nothing is omnipotent," Wu says. When he was in medical school, Wu used to talk with his traditionally trained professor, Jiang Xingjun, and both agreed that Eastern and Western medicine can complement each other.

Wu cites blood pressure as an example. "Western medicine can effectively control them immediately, while TCM takes a long time," he says. "Western medicine is more targeted to a certain disease within a short time, but TCM can have a better effect in nurturing the health in an all-around way, which takes months and even years."

Professor Qian Hai dislikes the way the two medical systems are described as contradictory, as opposites.

"Medicine is always a developing science. It's not necessary to fight over which is better. If they benefit health, they are both winners," he says.

Drug trials

TCM-based drugs are also being introduced overseas for assessment. Shanghai Shuguang Hospital, affiliated with the Shanghai University of Traditional Chinese Medicine, has submitted a hepatitis drug called Fu Zheng Hua Yu (扶正化瘀) for assessment to the United States Food and Drug Administration. It treats chronic hepatitis C.

Fu Zheng Hua Yu has been found through numerous studies in China to have "a satisfactory effect on chronic liver injury and formed liver fibrosis." Preliminary studies also indicate that it has a "good safety and tolerability profile with promising efficacy," according to the website.

Delivered in capsule form, the main ingredients include salvia miltiorrhiza (dan shen 丹参), pollen pini (song hua fen 松花粉) and fiveleaf gynostemma herb (jiao gu lan 绞股蓝).

The drug is in Phase II clinical trials in the United States. On July 30, 2011, 86 patients were enrolled in the trial to be completed this December, according to Shuguang Hospital. Trials are expected to be complete in 2014.

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