Talk:Traditional Chinese medicine/Archive 5

This is a seriously POV article

There is absolutely no scientific evidence supporting just about anything written here. There is no qi. There is no xue. Nothing. It should be clearly stated everywhere, that there is no scientific evidence for almost everything here. Right now, this is merely an big giant advertisement for the bogus TCM. If this were TCM-pedia, we'd have no problem. The violation of just about every principle of NPOV is amazing, this article takes the gold medal for POV editing. Oh, and the one slightly neutral comment that TCM is considered alternative medicine is almost pejorative, written as if Western people are so "stupid" as to consider it AltMed. I know it doesn't say that, but it certainly implies it. OrangeMarlin ^{Talk• Contributions} 21:20, 22 March 2011 (UTC)

I'm not sure which article you are reading but there are not any medical claims being made here. An article about any subject needs to describe that subject, not judge it. (Totally beside the point, there actually is a good deal of science supporting the validity of many TCM treatments). Whether Qi exists or not - this is not the place to discuss that issue. It would be way more POV to assert that Qi does not exist, less POV to simply describe a phenomenon, even if it were just an idea, as it has been conceived and used over thousands of years. This is the place to describe the theories and practices of TCM. If the Beatles article says that they wrote Rock and Roll music - that is not an endorsement of Rock and Roll, it is simply a description.

It also begs the question of what you consider "scientific evidence" to mean. Even within conventional Biomedicine there is great debate about the value of many practices - consider that relatively few cases of prostatitis are actually due to bacterial infection but urologists routinely prescribe cipro without any testing. Is that scientific? No, it is based on the doc's clinical judgement. But wikipedia is not the place to debate who does or does not have good clinical judgement. What a mess that would be! This is a place to describe and explain things.Herbxue (talk) 01:04, 23 March 2011 (UTC)

We probably should review what NPOV means. It does not mean that we represent all views. No, we state what is supported and what is not. Qi does not exist, is not supported by ANY scientific evidence at all. NONE. To state otherwise is POV. And we're not talking about other medical technologies....whether you are right or wrong, that's a discussion in those articles. The fact is, this article is extremely POV. It is an advert for a pseudoscience. OrangeMarlin ^{Talk• Contributions} 01:31, 23 March 2011 (UTC)

By the way, scientific evidence is clear. Please see scientific method. OrangeMarlin ^{Talk• Contributions} 01:33, 23 March 2011 (UTC)

OM, no one is presenting Qi as a truth, we're simply reporting what TCM says about it. Please remember that Wikipedia is not trying to establish Truth, but simply trying to present the sum total of human knowledge (including knowledge about things which are wrong). If you've got other concerns about the material, please do tell, but if your only issue is that what this page says is not 'true' in some ontological sense... well, I'm not sure I see the relevance. --Ludwigs2 01:58, 23 March 2011 (UTC)

Ludwigs, I see you're still prone to personal attacks. See WP:NPA please. Of course, I know that science doesn't establish a truth. However, I think you should review WP:NPOV, since we're not here to present fringe viewpoints, just what is supported by evidence that qualifies as a reliable source. I can point you to the appropriate links if necessary. OrangeMarlin ^{Talk• Contributions} 03:38, 23 March 2011 (UTC)

Sorry, I'm not sure I understand what you're referring to. can you clarify? --Ludwigs2 03:43, 23 March 2011 (UTC)

I welcome this discussion but I don't want another toxic discussion here poisoning the atmosphere. So, OM, could you please explain to me where you felt personally attacked by Ludwigs2 (cause I can't see it)? --Mallexikon (talk) 13:04, 23 March 2011 (UTC)

Article is a little confusing - suggestions for improvement - POV

I am a little confused when I read this article, I have several texts on Traditional Chinese Medicine at home and the information presented in this article seems nothing like the information there. My suggestions for this article would be:

1. For the parts of the article which describe the theory and practice of TCM, to begin by briefly explaining the concepts of Qi, Yin/Yang, and the Five Elements, as the basis of Chinese Medical Theory, as well as Qi's relationship to blood and body fluids, and the relationship of the triple-heater to Qi production, and perhaps simply to list the 12 meridians, their associated organs, and their associated element and whether they are yin or yang. Then, to briefly mention or summarize theories of pathology and methods of diagnosis, and then to briefly list major methods of treatment, including chi gung, accupuncture, massage, and herbal medicine. Also, the vast majority of medicines used in TCM are plant-based herbal combinations that can be bought over-the-counter, and while I know that has been mentioned before it seems the list of herbs on the page still gives a very biased view of traditional preparations as being mineral or animal based and highly dangerous.

2. To indicate the significance of Qi, and Yin and Yang, in the Chinese culture in order to give context to their use in TCM

3. To briefly summarize the basic philosophical principles of Heaven, Earth, and Human, and how the system of TCM is related to the treatment of the human within this greater system.

4. To present TCM from the viewpoint of its own practice rather than through Western academic eyes, in order to give it the appreciation and fairness it deserves as a system unto itself. For example, not using terms like metaphorical or subjective to describe its methods. Also, I personally don't feel it is POV to include Qi in this article, it is, after all, an article on Traditional Chinese Medicine. Likewise, Traditional Chinese Medicine is a holistic system to which it is hard to apply Western Experimental Studies, for reasons already discussed. In my opinion this article should be focused primarily on the general principles and theory, methods of diagnosis, methods of treatment, history, and cultural background of TCM as a subject unto itself, as that is the subject of the article. Logically, an article on Western medicine wouldn't reference TCM, so why would an article on TCM reference Western medicine or it's methods of research, except as a basis for comparison in order for Western peoples to understand the differences between the two systems.

Lnkeener (talk) 09:08, 24 March 2011 (UTC)Lane

Hi Lnkeener. Your ideas and input are very welcomed here. I guess you could help the article a little better, though, by contributing some actual text/citations. Be bold! Mallexikon (talk) 01:39, 25 March 2011 (UTC)

Examples of patterns

I think it's a good idea to give about three examples of typical patterns. I already chose "upflaming Liver fire" because it has been mentioned in the article earlier. Any else suggestions? Mallexikon (talk) 07:10, 28 March 2011 (UTC)

Unsure what this means

I think the lead is pretty neutral and readable but have a problem with this.

Because of the differences between the TCM and modern scientific medical models, it is generally impossible to establish the efficacy of TCM practices from an analytical perspective.

It seems to be claiming it is not possible to determine the efficacy of TCM interventions using rigorous study. I know placebo can be a problem when studying certain practices but any intervention can be compared with another intervention, and any potion can be tested in placebo-controlled trials. --Anthonyhcole (talk) 13:51, 23 March 2011 (UTC)

Good point, it is definitely not impossible. Is is difficult to properly make this point without a long discussion, but in a nutshell, TCM practitioners change the intervention based on presenting signs and symptoms, so doing a RCT on an herbal formula, while evaluating that particular formula, is not a realistic evaluation of the way TCM is practiced as it would commonly be modified for each individual, or a completely different formula used for individuals with the same disorder. That's why TCM is difficult to evaluate with RCT's. I think this issue needs a whole section in the article.Herbxue (talk) 14:10, 23 March 2011 (UTC)

When it comes to a medical intervention, I want to know whether a symptom or pathology will respond to it. If I sent a thousand patients whose main complaint is high blood pressure to TCM practitioners, put a thousand comparable patients on a blood pressure medication, a thousand on placebo, and left another thousand on the waiting list, I'd know something about the effectiveness of TCM for that symptom. Saying efficacy cannot generally be tested sounds wrong. Can someone please rewrite the sentence in question. --Anthonyhcole (talk) 14:26, 23 March 2011 (UTC)

The problem with evaluating TCM analytically is that TCM (because it predates a lot of the understandings of modern science) relies heavily on subjective forms of diagnosis and on analogical reasoning. For instance, one of the more common forms of diagnosis is muscle testing - basically have the patient hold a medicinal herb in one hand, and then make a circle of the thumb and forefinger of the other hand. The practitioner tests the thumb and forefinger to see how strong it is (a necessarily qualitative assessment, not an objective one), with the presumption that the right medicine will make the circle firmer and the wrong one will make it weaker. On the one hand, this involves too many assumptions, too many subjective apperceptions, and too much doctor-patient interaction to be reduced to an easy empirical design, so it can't actually be validated or invalidated in its own terms; on the other hand, it's a (seemingly) effective tool in a millennial practice. Or for another example, ginger is a medicinal herb used in TCM because it 'adds heat to the body, and particularly to the digestive function'. Now I'm sure that there are particular chemical compounds in ginger that cause it to give that 'feeling of heat', but TCM theory isn't concerned with the chemistry of it, but rather with the way that 'feeling of heat' (as an analogy) spreads through the body and purportedly affects the body holistically.

What I'm trying to say is that you can certainly test to see whether or not individual bits of TCM have objective qualities meaningful to western scientific medicine, but it's almost impossible to test TCM treatments in their natural context. The best you might do (and I don't know of anyone who's done this) is try longitudinal studies of people who do and do not use TCM practices to see if there are significant 'quality of life' differences (since TCM is geared more towards supplementing and maintaining health than in treating overt disease). and even that would be problematic; there's no way to double-blind it (since the TCM practitioners would have to know that they are practicing) and, you'd basically have to make up some funky ritualized nonsense-practice and fool people with it to get a proper control group.

The real issue here is the philosophical tussle over the difference between 'untested/untestable' and 'senseless'. there are a lot of medical practices in the world that are just out-and-out senseless (modern-day Rife devices, orgone boxes, e-meters. magnetic healing bracelets - the list goes on...). However, there are literally hundreds of millions of people who use TCM practices regularly and seem to get satisfactory results. It may just call for better analytical tools, it may require an as yet unknown wrinkle on scientific testing practices, it may never be amenable to proper scientific testing - wikipedia in not a crystal ball. the best you can say at this point is that there's a decent amount of anecdotal evidence in TCMs favor and no scientific evidence that actively supports or refutes it.

That's all just context (and a bit of me waffling on about the issues). I'm open to better wording than whats there if you can suggest any, and if you give me a day I'll see if I can come up with something better myself. --Ludwigs2 15:08, 23 March 2011 (UTC)

Thanks very much. So, given the subjective nature of diagnosis and prescription, assessment of individual modalities would be pointless. It's probably possible to explain that concisely enough for the lead (but I'll leave that to the experts).

Have there been any RCTs (not, obviously, placebo controlled) comparing the efficacy of TCM (as a whole, not individual modalities) and Western medicine for any particular illnesses or symptoms? Forgive me if that's mentioned in the article. I read it a couple of weeks ago and don't remember seeing anything there. --Anthonyhcole (talk) 16:09, 23 March 2011 (UTC)

I don't agree with L2. It would definetely be possible to test TCM herbal medication against placebo. It would also be possible to test it against scientific medical therapy (problem is just that you'd have to match the TCM patterns with the scientific diagnosis, which is an effort). Don't know why no one in the West is doing this (the Chinese do it sometimes but I haven't seen a solid study so far) - maybe because there's little money to be earned by the big pharmaceutical players who usually pay for those large studies. I personally also think that TCM herbal medication is not really a match for scientific therapy (if there is one. Cause sometimes there isn't. Take flatulence).

One more thing about this muscle testing thing L2 mentioned ("...For instance, one of the more common forms of diagnosis is muscle testing - basically have the patient hold a medicinal herb in one hand, and then make a circle of the thumb and forefinger of the other hand. The practitioner tests the thumb and forefinger to see how strong it is (a necessarily qualitative assessment, not an objective one), with the presumption that the right medicine will make the circle firmer and the wrong one will make it weaker...") - this is definitely not common/orthodox TCM. Sounds more like Western alt.med. freestyle improvisation to me. Mallexikon (talk) 03:44, 24 March 2011 (UTC)

Mallexikon is contradicting Ludwigs2. Is there a secondary source that supports the quote that started this thread? I think Imperfectly Informed authored it. Can you provide a source II? --Anthonyhcole (talk) 10:41, 24 March 2011 (UTC)

Mallexikon is not contradicting me, we are simply having a discussion about the issue. I don't claim to be an expert on TCM, though Muscle testing does seem to be a fairly common practice in the (US) locales where I've encountered it. I welcome any clarification on the matter, but let's not fly off into an entirely irrelevant tangent.

With respect to the quote in question, I'm not sure exactly what you're objecting to, so I'm flying a little blind. Technically speaking, a 'placebo effect' really means "any effect which is not explainable in terms of the specific treatment being investigated"; this is not something used in TCM, and many of the things that TCM tries to achieve will inevitably get lumped under the 'placebo effect' rubric by scientific medicine because of the difference in the way the two systems work.

Because of the differences between the TCM and modern scientific medical models, it is generally difficult to test TCM practices properly in ways consistent with western medical research paradigms.

Basically I just tried to remove the jargon terms, and make a general statement to the effect that two systems are not entirely analytically compatible. does something like that work for you? --Ludwigs2 16:31, 24 March 2011 (UTC)

Yes, works with me. I think we could even be more specific:

Because of the different disease entities recognized by TCM and scientific medicine, it is difficult to scientifically test the efficacy of TCM drugs.

This is my own conclusion, however. I can't back it up with any sources. Mallexikon (talk) 01:39, 25 March 2011 (UTC)

OK. If TCM doesn't recognise or treat the same illnesses as Western medicine, their effectiveness in treating illnesses can't be compared. However, TCM treats symptoms such as fever, sore throat, runny nose, diarrhea, constipation, boils, rashes, fluid retention, swelling, fatigue, and pain. The scientific method is used to assess the efficacy of treatments addressing these symptoms all the time. Why can't the efficacy of TCM be tested for these symptoms? --Anthonyhcole (talk) 06:49, 25 March 2011 (UTC)

Well, no, I'm not saying it can't be compared. The problems is just that those disease entities (bing) like diarrhea, headache etc. don't determine the therapy. Therapy will be based on the pattern (zheng) that is found. So in headache, for example, you have patterns like uprising liver-yang, wind-cold, damp-heat etc. - each of those requiring a totally different selection of herbs. If you wanted to compare TCM therapy against scientific medicine, you could only admit patients with headache of a certain pattern (e.g., headache of damp-heat type) to the study. In order to do this, you'd have establish precise criteria for the damp-heat pattern (that's probably possible but not easy). What's worse is that those criteria would probably include a certain colour of the tongue (red), a certain tongue fur (yellow and greasy) and a certain pulse (slippery) - not very objective criteria. I think you could work yourself around that by double-blind pattern confirmation of two to three experienced TCM practitioners, but all of this definetely would take quite an effort. --Mallexikon (talk) 13:27, 25 March 2011 (UTC)

People usually seek treatment because of troubling symptoms. It is pretty clear to me from what's been said in this thread, that it would be perfectly possible to test the efficacy of TCM in the relief of symptoms, but expensive. So, the quote at the top of this thread is inaccurate. --Anthonyhcole (talk) 10:50, 26 March 2011 (UTC)

So could we all agree on

Because of the different disease entities recognized by TCM and scientific medicine, it is difficult to scientifically test the efficacy of TCM drugs.

then? Mallexikon (talk) 02:12, 28 March 2011 (UTC)

Ok, I'll just go and change the quote accordingly, then. Mallexikon (talk) 03:18, 31 March 2011 (UTC)

New take on "theoretical model" section

I'm about to try again and bring the first part of this section into a more streamlined form. First thing is that I'd like to delete this sentence:
"In the worldview of traditional Chinese medicine, all parts of the body necessarily undertake all functions to a limited extent, but on a holistic level functions are concentrated in particular systems."
This is an incorrect statement as far as I'm concerned. Any objections to deleting it? Mallexikon (talk) 10:57, 29 March 2011 (UTC)

I agree with deleting it.Herbxue (talk) 21:29, 30 March 2011 (UTC)

Is it okay that I deleted this?

"Much of the process of diagnosis in TCM is metaphorical rather than analytical, based in the abstract relationships between these conceptualized organ systems."
This is incorrect as far as I can see, as TCM diagnosis seems indeed analytical to me. Any objections to me having deleted this? Mallexikon (talk) 09:51, 31 March 2011 (UTC)

No objections from me. While there are aspects of TCM that can be said to be metaphorical and abstract, diagnosis is largely based on a combination of objective signs and subjective symptoms.Herbxue (talk) 15:42, 1 April 2011 (UTC)

Organ extension

"The extension of organ systems throughout the body is central to diagnosis in TCM." - I'm not sure what this means. The way I understand it, what is central to TCM diagnosis is pattern discrimination including pulse and tongue findings. I recommend deleting this sentence. Comments? --Mallexikon (talk) 13:11, 3 April 2011 (UTC)

Redundant summarizing sections

The sections "Overview" and "Symptoms, diagnosis and treatment" seem superfluous to me, since they only give summaries of material explained elsewhere. Ideally, I think their function should be performed by the lead section. I recommend deletion. Comments? Mallexikon (talk) 11:05, 31 March 2011 (UTC)

I'll hide these two sections, for now. --Mallexikon (talk) 09:17, 14 April 2011 (UTC)

"Nonpenetrating Sham Treatment"

I have little technical knowledge when it comes to either this subject or for using Wikipedia as a whole, but the use of the word "sham" several times in comparison to Acupuncture seems very much to use Contentious Labeling, so much so that I bothered to go and look-up what that is called on this site. I deleted the phrase in the first sentence of the paragraph in question because it wasn't necessary, but eliminating it in the other positions would require greater rewriting that I feel I have expertise to do.

In conjunction with this, it looks like some of the citations on the acupuncture section have some problems, as they imply that acupuncture's effectiveness is being shown to be primarily psychosomatic, while in actually examining the citations it appears that the usefulness of acupuncture is simply being narrowed through testing, finding that it is useful for some things but not useful for others.

Overall, the neutrality of this section seems to have some serious problems. Some attention from someone more familiar than I am with Wikipedia's standards of neutrality and accurate citation would be appreciated. —Preceding unsigned comment added by 173.20.42.76 (talk) 10:27, 4 April 2011 (UTC)

I don't have time to look at the article closely enough to comment on your other points, but "sham treatment" is a technical term for a (pseudo-)medical intervention other than taking medicine, which is done in order to study how much of the efficacy of an actual medical intervention is due to the placebo effect. See sham surgery for a closely related technical term. When talking about something like acupuncture it's not clear what is meant by the placebo effect. With your edit you removed the information that the placebo effect in question is the one that compares acupuncture done in the normal way with something that doesn't actually stick any needles anywhere. The alternative would be to stick the needles into more or less random points rather than those indicated according to acupuncturists.

But I see you left the second instance in, and so maybe you know all this? I agree that the repetition was bad and looked as if designed to impress readers who don't know the technical terms and can easily confuse sham with scam in this context. Hans Adler 11:25, 4 April 2011 (UTC)

This whole issue of TCM research is huge and messy. I would advise that we avoid general statements that appear to assess the meaning of the current state of acupuncture research. General statements in this article should acknowledge the inherent difficulties of evaluating TCM's system of choosing a treatment strategy. The relative value of individual studies or systematic reviews will no doubt push or pull the article towards POV. For example, there are studies that show that Acu at the median nerve on the wrist is effective against nausea and vomiting due to a variety of causes, but the mechanism is not fully understood. Then there is research that says many studies show Acu ineffective for back pain but meanwhile many mechanism-based studies verify Acu's ability to release endorphins and flood the substantia gelatinosa with signals that block pain reception, which backs up the wealth of anecdotal evidence that Acu is effective for back pain. Right now, there has not been a truly agreed-upon method for evaluating true TCM pattern-based practice. Its a mess. Not sure how to best describe that mess in this article.Herbxue (talk) 19:22, 4 April 2011 (UTC)

If we do go down this road of trying to give context to the state of TCM research, we may need to present many many examples of studies, both supportive and not supportive, and that could get unwieldy. But to make a judgement about what the current body of research means would constitute original research and would not be appropriate for WP.Herbxue (talk) 19:25, 4 April 2011 (UTC)

Some feedback

I've started reading the article thoroughly and would like to give some feedback as to how understandable it is. I haven't finished reading yet and - as most of what I know about TCM is from this article - didn't check for accuracy, so these are just some thoughts from a layperson's perspective and (as always) discussion is welcome (which is why I'll make subsections and sign them in order to avoid confusion). It's already quite late so I can't add more right now and also won't be able to discuss things in the next few hours, but it's a start and I hope I'll find time to add more during the week.--Six words (talk) 23:14, 3 April 2011 (UTC)

Lede

Looks OK, but there are two sentences I have problems with:

1. These practices are common part of medical care troughout East Asia, accounting for roughly 75% of worldwide use, but are considered alternative medicine in the western world. It is not clear which practices are meant (everything regarded TCM, i.e. herbal medicines, acupuncture, massage therapy and dietary therapy as noted in the first lede sentence?) and I'm also not sure about the “worldwide use” part. I vaguely remember that figure being cited as proportion of herbal medicines in TCM here or on some other talk page but I don't recall where exactly; what do the sources say? (I don't have them). (talk) 23:14, 3 April 2011 (UTC)

I also do not know where these figures come from and suspect them as false. Better to simply say that TCM and other styles of traditional east Asian medicine are very common healthcare options throughout Asia, while in the west it is considered to be a form of Complimentary and Alternative Medicine (CAM).Herbxue (talk) 16:16, 4 April 2011 (UTC)

I agree; if in the future we find out what the 75% figure is about we can still put it back into the article. --Six words (talk) 21:33, 7 April 2011 (UTC)

1. Because of the different disease entities recognized by TCM and scientific medicine, it is difficult to scientifically test the efficacy of TCM drugs. I've read the discussion above so I know what it's supposed to mean and it's definitely an improvement, but it still sounds fallacious, because effects of a drug are usually “easier” to study in blinded tests than the effects of manipulative/physical interventions (and the following sentence tells the reader that some other TCM treatments have been tested positively). Right now I don't have an idea how to fix this, but I'll keep thinking about it. --Six words (talk) 23:14, 3 April 2011 (UTC)

I recommend something like "Although individual TCM interventions such as herbs, formulas, or stimulation of specific points on the body have been scientifically studied, it is difficult to study the effectiveness of TCM's diagnostic techniques and individual-based treatment strategies" - not a great sentence but the idea is that, for example, TCM practitioners may use Curcuma Longa (turmeric) for treatment of liver cirrhosis or liver tumors, and it has been studied for that purpose with positive results, but that does not mean that TCM practitioners always see it as an appropriate herb for all patients with that condition. The mode of practice is based on totality of clinical data gathered, including subjective symptoms, objective diagnostic techniques, medical history, and response to previous treatment. As such, the RCT's only inform us about how effective a given herb is in a given situation, but do not ultimately determine when and how such an herb will be used. Herbxue (talk) 16:16, 4 April 2011 (UTC)

Sounds OK to me. --Six words (talk) 21:33, 7 April 2011 (UTC)

I'm not sure. As far as I understand, there's been mixed (contradictory?) findings regarding acupuncture, and the biggest problem in testing its efficacy seems to be control groups (in my opinion there can't be any real placebo control here due to the very nature of acupuncture, because there should ideally be a de-qi sensation involved. You also can't have placebo control in massage or surgery, can you?). With herbs, though, the situation looks much different. It'd be quite easy to test them against placebo as far as I understand - I just can't find any studies doing it (sincerely). --Mallexikon (talk) 03:06, 8 April 2011 (UTC)

How about Because of the different disease entities recognized by TCM and scientific medicine, it is difficult to scientifically test the efficacy of TCM drugs. Regarding acupuncture, placebo control is an ongoing issue in the discussion about how to interprete the results of efficacy studies.? --Mallexikon (talk) 09:17, 14 April 2011 (UTC)

Ok, I'll take the absence of objections as approval. --Mallexikon (talk) 02:55, 22 April 2011 (UTC)

Overview

1. Again, there's the 75% figure, and this time it sounds even stranger: It is estimated that 40% of healthcare in China (75% of worldwide practice) is based in such practices. Does this mean 40% of Chinese medical practice consists of TCM, and worldwide about 75% is TCM (even though it's considered AltMed in “western countries”)? That would be very strange.
2. The overlap between traditional Chinese medicine proper, folk remedies (such as shark fin soup), metaphysical belief systems (such as Chinese astrology), and exploitive products (usually sexual potency preparations, containing things like horny goat weed or rhinoceros horn) makes determining the efficacy of TCM as a theoretical construct problematic. Does the proper belong to traditional Chinese medicine or to folk remedies (or is it perhaps redundant)?
3. Further, the introduction of traditional practices into the western world has blended TCM in some cases with New Age ideation that has further obscured the traditional practice. I had to look up what ideation means (that of course may be because English is my second language) but even after that it doesn't make too much sense. Can someone tell me what the sources for this sentence say? --Six words (talk) 23:14, 3 April 2011 (UTC)

TCM model of the body

If the quote is needed, per WP:MOS#Attribution it should be attributed properly, i.e. both author and work should be named directly after the quotation - but is it really needed? It pretty much repeats what the previous sentence says. --Six words (talk) 23:20, 7 April 2011 (UTC)

Yes, it does. But given the latent dicussion about whether TCM is based on incorrect anatomical assumptions, I personally would rather say it twice. I'll fix the attribution for now. --Mallexikon (talk) 03:23, 8 April 2011 (UTC)

Qi

This section is pretty OK, but if you say something has “a strong yin aspect” or “pronounced yang nature”, you have to explain what that means. If it's not possible to explain it in a way that a layperson would understand, leave it out - saying qi that moves through one's blood vessels is called yíng-qì and qi in tissues is called weì-qì is graspable without more details, I think. --Six words (talk) 23:20, 7 April 2011 (UTC)

True. I've been planning to add a section about yin and yang to the "model of the body" chapter - I'll try to hurry that up a little. --Mallexikon (talk) 03:06, 8 April 2011 (UTC)

Symptoms, diagnosis and treatment

While the section is titled ‘symptoms, diagnosis and treatment’, it doesn't really say anything about diagnosis. Deleting the word diagnosis would be a ‘quick fix’, but I'd prefer to get to know a little about what techniques TCM practitioners use to diagnose diseases. The section also focusses exclusively on herbal remedies it seems. Is there a general rule as to when other forms of treatment such as acupuncture or dietary therapy are preferred?
The section is interesting, but it's very “packed” with information, resulting in some very long and sometimes confusing sentences. The first sentence is a good example: from what I understand it's just saying that there are different ways to classify a patient's symptoms and the following text explains one of them, but it says that in a very roundabout way. Would it be OK to split it or, even better, just say that there's no one materia medica that is generally accepted but different schools of TCM use different materia medicas (materias medica, materia medicae, materias medicae? - whatever the correct plural is)? It could then go on either explaining how the major schools classify symptoms or (as I understand the section is now) use one as an example. The sentence starting with “Downward draining” substances ... is very long, too, and this part is confusing: ... include “purgatives”, of which rhubarb root and aloe are believed to work, ... - who thinks these work? Are there a lot of traditional ones, but modern TCM practitioners have found only the two to work, or do TCM practitioners use more than those two but only they have (so far) been tested scientifically and found effective? Does it perhaps mean something else altogether? --Six words (talk) 23:20, 7 April 2011 (UTC)

I still recommend to delete this (and the "overview") section altogether. I'd prefer to have only one general summary (in the lede), not redundant ones. --Mallexikon (talk) 03:06, 8 April 2011 (UTC)

As long as that doesn't mean that there's material in the lede that isn't in the article body (in more detail) that's OK I guess. The way it is right now some of it is hard to read and/or understand. As an alterative (if you think about fixing it some time in the future, or someone else wants to but doesn't have the time right now), we could also hide the section(s) - that way you won't have to search through the page history when you want to improve it so it's good enough for the article. --Six words (talk) 03:24, 8 April 2011 (UTC)

Good idea. I'll hide these two sections then, for now. --Mallexikon (talk) 09:17, 14 April 2011 (UTC)

Famous doctors

It's interesting material, but the section about famous historical physicians is redundant. For each of them, there already exists a proper Wikipedia article. Therefore, I'll relocate the material to those articles. --Mallexikon (talk) 01:37, 29 April 2011 (UTC)

Lede

"Traditional Chinese medicine (中醫, pinyin: zhōng yī) (TCM), is a label that covers a broad range of traditional medicine practices spread throughout Asia,..."
I'm not sure what is meant with "broad range of traditional medicine practices" and I'd like to rephrase. I'd like to change the sentence to:
"... is a traditional medicine system whose fundamental composition dates back to the second century BC." Please comment if there are any objections. --Mallexikon (talk) 01:25, 29 April 2011 (UTC)

Well, when I read the full sentence ([TCM] is a label that covers a broad range of traditional medicine practices spread throughout Asia, including various forms of herbal medicine, acupuncture, massage therapy, and dietary therapy.), it seems that the broad range comment is just to indicate that there are other, less known (and probably also less commonly used) traditional practices that are TCM, too. The very next sentence says that it (TCM) is based on principles and beliefs that originated during the “Warring States Period” (475 - 221 BCE, if the Wikipedia article on that is correct), so if you were to change the first sentence like you suggested, those two sentences would be contradicting each other a little (I know, 200 years more or less aren't much if you look at the bigger picture, but still, it's not the same). Is there a source we could cite for either 2nd century or Warring States Period? --Six words (talk) 12:54, 30 April 2011 (UTC)

Yes. Please compare with the history section: "TCM theory is, however, inextricably intertwined with the principles of Yinyangism,[231] which was represented for the first time by Zōu Yǎn (340 - 260 BC).[4] The earliest and most fundamental composition identified in TCM is the Huăngdì Neìjīng[232] (黄帝内经, Yellow Emperor's Inner Canon), probably dating back to the second century BC.[233]" Yinangism was present at the end of the Warring States period, but it took some time until this was used as the base of a whole medicine system. --Mallexikon (talk) 13:50, 1 May 2011 (UTC)

Unfortunately the source cited ([Lu, Gwei-djen and Joseph Needham (1980). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. New York, NY: Routledge/Curzon. pp. 89-90.], or at least its 2002 edition) doesn't say anything about when the Huăngdì Neìjīng was written (a lot of it is available online via google books) - I used the search function and Huăngdì Neìjīng is only mentioned in the foreword (no preview available for that). It seems that the pages our article uses as citation talk about “The Yellow Emperor's Manual of Corporeal (Medicine)” (section starts at p. 88 of the book). We have to make sure the sources used in our article actually support our article's wording, so right now I don't think we can use this citation . --Six words (talk) 15:30, 1 May 2011 (UTC)

Hmm. I read the source as well and actually it talks about the "Huang Ti Nei Ching" at the beginning of the chapter (p. 88), then goes on about the two parts of it (Su Wen and Ling Shu), and finally comes up with the dates of both of these parts (Su Wen 2nd century, Ling Shu a little younger) at the end of p. 89. I changed the page numbers in the citation accordingly. You could argue that we should only use sources that stick to pinyin version (Huangdi Neijing instead of Huang Ti Nei Ching), but isn't that a little too strict? --Mallexikon (talk) 07:18, 2 May 2011 (UTC)

I don't know any of these books so I can only go by their title, or rather by the translation of their titles. If one is called “The Yellow Emperor's Inner Canon” and another one “The Yellow Emperor's Manual of Corporeal Medicine” I assume that they're not the same book. If this is just due to different transliteration/translation the source is OK to use, I guess. --Six words (talk) 08:05, 2 May 2011 (UTC)

On the other hand, wikipedia articles should be transparent for everybody. Could you maybe read p. 88-89 of the source [[1]] once more, and then tell me whether you think it's transparent? If you think it's not, I'm going to find a new one. I think Lu & Needham's source is very exact, but maybe I've just worked myself too deep into this bizarre material by now to notice if it's too detailed. —Preceding unsigned comment added by Mallexikon (talk • contribs) 14:33, 2 May 2011 (UTC) sorry --Mallexikon (talk) 14:37, 2 May 2011 (UTC)

No, it's not too detailed, I was just confused because of the different spelling and book titles. IOW: it's not your fault I don't speak Mandarin (?) and am unfamiliar with methods of transcribing Chinese characters into the Latin alphabet. --Six words (talk) 21:35, 2 May 2011 (UTC)

hidden overview?

Currently the overview section is hidden. I'm not sure why that is, can someone clarify? --Ludwigs2 19:10, 2 May 2011 (UTC)

I suggested that as an alternative to deletion, thinking that the section was confusing but not beyond repair. Right now it's pretty much only Mallexikon and me discussing things here and while I can help with copy editing and saying whether I think stuff is understandable, I'm too unfamiliar with the subject to help with content. --Six words (talk) 20:18, 2 May 2011 (UTC)

I raelly haven't looked it over in a while, so I don't know whether it's salvageable - I just noticed it and wondered what was up with it. I'll give it a once over and see what can be done. --Ludwigs2 15:57, 3 May 2011 (UTC)

structure

I'd like to make two changes here, for structure:

1. wrapping the 'TCM model of the body' and 'concepts of disease' sections in as subsections of the 'philosophy' section
2. wrapping the Medicines and Techniques sections into one general 'practices' section

I'm also thinking about moving the history section up (possibly merging it with the currently hidden 'overview' section).

Comments? --Ludwigs2 19:22, 2 May 2011 (UTC)

Good points.

1. I had "TCM model of the body" + "concepts of disease" as subsections of "theoretical superstructure" before. "Philosophy" clearly would have its place here, too. However, the headings of the different subsections tend to get awfully small this way, so I thought I'd leave the "theoretical superstructure" superstructure out in order to improve the visual style of the article
2. a general "practices" (or, even better) "therapy" section would definitively improve the logical structure of the article.
3. I earlier had the "history" section at the beginning of the article, until PPdd moved it to the end. Since the section includes a large table, though, I think PPdd probably was right. A large, boring table at the very beginning of the article doesn't improve its accessability.
4. I still think that "overview" should rather be merged with the lede. --Mallexikon (talk) 03:45, 3 May 2011 (UTC)

Medicines?

Couldn't we maybe agree on "drugs" instead of "medicines"? The latter sound somehow unwieldy. --Mallexikon (talk) 10:45, 14 April 2011 (UTC)

Within the profession in the US and Europe we increasingly use the term "medicinals" after Nigel Wiseman (a prolific and technically proficient translator and terminology expert). However, we most commonly still use the admittedly inaccurate term "herbs" to refer to Chinese medicinals in general.Herbxue (talk) 01:44, 18 April 2011 (UTC)

I would agree that medicine or medicinals is preferable to the term drug, since drug conveys connotations not relevent. For example, in America the FDA regulates drugs, and they are for the most part single compounds or molecules whereas herbal medicinals are whole substances, and may fall under dietary supplement categories in regards to the FDA. Calus (talk) 03:59, 6 May 2011 (UTC)

'Preparations' is also a useful term, if needed. --Ludwigs2 04:05, 6 May 2011 (UTC)

TCM\YIN & YANG

TCM Is based on the Yin And the Yang Theory. When one goes out of balance the acupuncture and herbal medicines and massage put you back on track. The Yin represents female, cold, moon, and the insides while the yang represents the opposite of all that. —Preceding unsigned comment added by 69.128.143.66 (talk) 13:37, 18 April 2011 (UTC)

I really don't understand what this is doing here. I propose it be deleted as irrelevant. JoGusto (talk) 09:16, 3 May 2011 (UTC)

I would agree that this is irrelevant and suggest to the author that should they want to contribute to the article they familiarize themselves with wikipedia and start by finding sources for what they would like to include, (sources other than lineage teaching) but continue to bring it up here on talk before making major changes to the actual article.Calus (talk) 04:12, 6 May 2011 (UTC)

Efficacy testing

"TCM is not based on modern anatomical and disease models, complicating research on the efficacy of TCM medicinals and practices."

This is wrong. In general, anatomy doesn't have anything to do with efficacy testing

"Interpretation of studies of the efficacy of acupuncture remains controversial due largely to questions of designing an effective placebo."

Also wrong. The question also centers around the question whether placebo control is at all possible in acupuncture (and in my opinion it isn't. The same goes for massage therapy and surgical therapy).
I recommend to re-instate the sentence as it was before. Apart from this, I strongly recommend to discuss any changes of the lede on the discussion page before making them. --Mallexikon (talk) 02:51, 25 April 2011 (UTC)

I will try to find the study which used random points for acupuncture as the placebo control. The study was peer reviewed and the placebo was accepted as a worthwhile approach. The study was mentioned recently by Dean Adell on his radio show. Surgical sham placebo controls are also part of modern surgical efficacy studies. By the way, the study on acupuncture definitely showed it to be nothing more than a placebo effect. JoGusto (talk) 09:32, 3 May 2011 (UTC)

See, that's part of the problem with efficacy testing on TCM and acupuncture. No one in their right mind would suggest that one should test the efficacy of a drug by comparing it to the effects of random chemicals - the placebo concept is a very specific activity in which one uses an inert substance to overcome the influence of psychological/sociological factors in the treatment of disease. testing the efficacy of acupuncture properly requires that one find something that is inert in the context of TCM, not just randomly chosen. That's poor study design. --Ludwigs2 15:55, 3 May 2011 (UTC)

I'd really like to take a look at the study. The I problem I see with placebo controlled acupuncture is that there is a category of often used acupoints they call "a-shi" points. These allegedly are points of tenderness that can pop up at random places (especially in the vicinity of painful joints or muscles) - more like those "trigger points" they work with in orthopedics and physiotherapy. So sticking needles at "random" points might actually result in hitting a-shi points - I'm not saying it does so all the time, but if the possibility is there, the placebo design is fundamentally flawed. --Mallexikon (talk) 03:35, 5 May 2011 (UTC)

General comment on the article

I feel that the author who wrote the article lacks a basic understanding of the Daoist philosophy and the TCM history. Many of what the author presents is from how he looks at the Chinese Medicine from a Westner's prospective, and from what he is being exposed to in western Chinese herbal shops. I come from a family where we practice Chinese Medicine from generation to generation, and I will also start studying this art of healing in September. One cannot interpret Chinese medicine without having a true understanding of Taoism. Chinese medicine is practiced based on the philosophy of Taoism, and the treatment methods and medicines used by TCM doctors today are derived from thousands of years of observing, experimenting, and modification. The method of improving techniques of this branch of medicine is no different from western science, and has been accurately recorded during the past thousands of years by physicians. It is not a medicine system that remains the still, it is constantly revolving through out the years with new discoveries of medicinal herbs, new accupuncture techniques, etc. —Preceding unsigned comment added by 174.6.228.42 (talk) 18:47, 2 May 2011 (UTC)

we're all volunteers, so feel free to chip in if you like. always welcoming new input... --Ludwigs2 18:56, 2 May 2011 (UTC)

The article is not an "interpretation" of Chinese medicine. It's an encyclopedic entry conveying information collected from other sources. This isn't the place for a general defense of the value, efficacy, or worthiness of Chinese medicine, especially given the very non NPOV of the commenter. I propose we remove this comment. JoGusto (talk) 09:22, 3 May 2011 (UTC)

Sorry, which comment in the article do you refer to (or do you want to remove 174.6.228.42's comment above)? --Mallexikon (talk) 03:41, 5 May 2011 (UTC)

MY two cents is that any person who practices acupuncture from a taoist lineage is practicing classical chinese medicine and not Traditional Chinese Medicine as came about during the communist revolution. All Taoist notions were suppressed during that time, although still historically relevant. The article as it stands, is a fair representation of the sources (which is saying a lot given what it has looked like in the recent past.) Calus (talk) 04:06, 6 May 2011 (UTC)

Deleting "Chinese alchemy" section

Hi everybody. First, thank you to all those who have been improving this wiki over the last few weeks! It looks better than ever. For the sake of improvement, I just deleted the section called "Chinese alchemy." First, pao zhi 炮炙 does not mean "alchemy" at all: it means preparing raw ingredients by roasting or frying. The wiki link to pao zhi is fine; the one to Chinese alchemy is very misleading. The section claims that TCM ingredients are still being roasted with "toxic metals" like mercury, lead, and arsenic. The two references given do not support this claim. The first one (a book on Pao Zhi by Philippe Sionneau) is a general work on the preparation of TCM ingredients. From everything I have read about it, it does not concentrate on the use of toxic substances. If it does, the references should at least cite a page number. The second reference is an article about medieval alchemical practices, not current TCM ones. Perhaps the preparation of alchemical ingredients was once called pao zhi, but we shouldn't assume that these old practices are still part of modern TCM pao zhi just because that term used to be more inclusive centuries ago.

To the best of my knowledge, lead is no longer used to prepare any medicine (TCM regulators know of lead's toxicity in all its forms). Arsenic (actually realgar and orpiment, neither of which is a metal) might still be in use, but it doesn't serve to prepare other ingredients: it is itself an ingredient, and it is roasted so that its toxicity is reduced. And as far as I know (I'm a historian of Chinese medicine with a Ph.D. in East Asian Studies), elemental mercury was never used in medical practice. It was manipulated in furnaces to produce elixirs of immortality that only a few people (including emperors) had access to. Cinnabar, however, was widely used in medicine, including in many remedies for children. Cinnabar is mercuric sulfide, a mercuric ore; it is a mineral, not a metal. It might certainly be toxic, but before we claim it is, we need serious pharmacological studies claiming that it is. I have found a scientific study claiming that cinnabar is chemically inert and has relatively low toxic potential:

"Cinnabar is insoluble, has very low bioavailability and thus is poorly absorbed from the gastrointestinal tract. Once absorbed into the blood, the mercury disposition from cinnabar follows the pattern for inorganic mercury salts and preferentially distributed to the kidneys, with a small portion to the brain. The heating, overdose and the long-term use of cinnabar are major causes of mercury intoxication, but at the therapeutic doses, the adverse effects cinnabar-containing traditional medicines seem to be tolerable and reversible. In safety evaluation of cinnabar-containing traditional medicines, total mercury content alone is insufficient, and chemical forms of mercurial compounds should be taken into consideration. Toxicologically, cinnabar or synthetic mercury sulfide should be distinguished from mercury vapor, mercuric chloride, and methyl mercury." (Source: Jie Liu et al., "Mercury in traditional medicines: is cinnabar toxicologically similar to common mercurials?" Experimental Biology and Medicine 233.7 [July 2008]: 810-17.)

Even regulated Chinese medicine still uses compounds that have the potential to be toxic. But to discuss this topic responsibly, we need prudent claims supported by strong citations, not blanket statements supported by misleading references. This is why I deleted the section "Chinese alchemy," which is misleading in name, factually wrong in claims, and not supported by the two references it cites.

Cheers, Madalibi (talk) 03:30, 18 May 2011 (UTC)

Alright! Sounds reasonable. --Mallexikon (talk) 03:27, 20 May 2011 (UTC)

Shortlist of medicinals

Since we deal with a pretty lengthy article already, I recommend to delete the table with the medicinals' shortlist. There already is a separate article about it. And what I dislike most about this list is that it lacks all the traditional categorizations (like temperatur, flavor, meridian, and function) of the substances. Comments? --Mallexikon (talk) 09:16, 7 June 2011 (UTC)

Sounds ok to me. It is impossible to give a sample that doesn't skew the relative importance of the included medicinals. Herbxue (talk) 19:48, 7 June 2011 (UTC)

I was about to make the same suggestion. The article is already more than 130-KB long, 30 KB more than the size at which a split is strongly recommended (see Wikipedia:SIZERULE). But the article is still incomplete and cannot really be split for now. What we can do, though, is to remove details that can already be found on other pages. Since List of medicines in traditional Chinese medicine already has its own wiki, the shortlist of medicinals would seem like an obvious place to cut.

And for the sake of comparison: the "History" section of the featured article Han Dynasty starts with a link to List of emperors of the Han Dynasty (a featured list). No list is included in the Han Dynasty itself. (The same practice can be found at Song Dynasty and Ming Dynasty, which are also featured articles.)

Because of size issues, best practice (featured articles), and per Mallexicon's and Herbxue's arguments, I support deleting the table.

Madalibi (talk) 01:09, 8 June 2011 (UTC)

Alright, then! Agreed upon. --Mallexikon (talk) 03:47, 9 June 2011 (UTC)

Translating 中医

Although it's correct that 中医 literally only means Chinese medicine, the usual translation (not just abroad, but also in China) is Traditional Chinese Medicine, so I'd rather stick to that. --Mallexikon (talk) 04:47, 13 June 2011 (UTC)

Yeah, I should have discussed this here before changing it in the text. Sorry about that. I still think the change is justified, simply because "Chinese medicine" is a very common translation for Zhongyi, both among historians of Chinese medicine and among the practitioners who write books about "TCM" today. Sample book titles from my library: The Theoretical Foundations of Chinese Medicine (by historian/practitioner Manfred Porkert; 1974); The Psyche in Chinese Medicine (by British practitioner Giovanni Maccioccia; 2009); Innovations in Chinese Medicine (edited by historian Elizabeth Hsu, 2001); Shen: Psycho-Emotional Aspects of Chinese Medicine (by Italian practitioner Elisa Rossi; 2007 for first English edition), Transforming Emotions with Chinese Medicine (by anthropologist Yanhua Zhang, who works on contemporary China; 2007); Currents of Tradition in Chinese Medicine, 1626-2006 (by historian/anthropologist/practitioner Volker Scheid; 2007), etc.

I think the combined weight of these reliable sources amply justifies adding "Chinese medicine" to the lead, not only as a literal translation of Zhongyi 中医, but as another common appellation for all the practices and doctrines that are often referred to as TCM.

Cheers, Madalibi (talk) 06:58, 13 June 2011 (UTC)

Well, both Porkert and Maccioccia studied in the PR China (I don't know the others). Here in the PR, "TCM" is the common translation (e.g., the 上海中医药大学 as well as the 南京中医药大学 call themselves "Shanghai/Nanjing University for TCM" - this should be easy to verify since they have webpages). I'm not saying you're wrong - there definetely are reasons to go with just "Chinese medicine" (problems, though, with differentiating against Chinese scientific medicine). Most of the community (and our article's references) go with TCM, however, and in my understanding wikipedia should reflect that. Cheers, --Mallexikon (talk) 12:05, 13 June 2011 (UTC)

Then again, the sentence as it is still does reflect it. How about just adding a "lit." before "Chinese medicine"? --Mallexikon (talk) 12:22, 13 June 2011 (UTC)

Hi again! Zhang Yanhua is from the PRC, Scheid and Hsu did most of their fieldwork and research there, and I'm not sure about Rossi. But I think where they studied is irrelevant to the issue at hand. What counts here is how they refer to 中医 in their books, which are some of the reliable sources we should rely on when deciding on the name of this article and alternative names for our topic. To quote from Wikipedia policy again:

• "The article title is subject to the same sourcing standards as the article content." [Source: Wikipedia:Manual_of_Style_(medicine-related_articles)#Naming_conventions.]

AND:

• "By the design of Wikipedia's software, an article can only have one title. When this title is a name, significant alternative names for the topic should be mentioned in the article, usually in the first sentence or paragraph." [Source: Wikipedia:Naming#Treatment_of_alternative_names.]

I'm not saying we should rename the article, of course. After all, "Traditional Chinese medicine" is still the dominant name in the literature and arguably the most recognizable name for the readers of English Wikipedia. And it is a quasi official translation of "Zhongyi" in the PRC, as the names of organizations like 上海中医药大学 illustrate. But as the book titles I cited also illustrate, "Chinese medicine" is more than just a literal translation of 中医 (as "teachings of the Dao" would be a literal translation of 道教/Taoism). It is a "significant alternative name" found in reliable sources, and I think it should therefore be included as such in the lead.

But this is not a very big issue anyway. There is already a redirect to this article at Chinese medicine, and we will not lose much whether we present Chinese medicine as a literal translation, put it within parentheses with quotation marks around it, or present it as a full-fledged alternative name. I trust your judgment, Mallexicon: you make the call! Now let's turn to editing!

Cheers, Madalibi (talk) 01:58, 14 June 2011 (UTC)

Actually, after going through all the references listed in the article I have to admit that "Chinese medicine" does appear quite frequently :) Let's keep the sentence as you wrote it. --Mallexikon (talk) 04:13, 14 June 2011 (UTC)

All right, great! Madalibi (talk) 04:45, 14 June 2011 (UTC)

Medicinals pictures

There are too many pictures in this section, and I'd like to transfer at least 2 to the Chinese herbology article. My suggestions would be the seahorse and the shark fins, as these are fringe phenomenons as far as I can tell. Comments? --Mallexikon (talk) 06:10, 9 June 2011 (UTC)

Hi Mallexicon. Thanks for putting so much effort into the article again! I agree that shark fins are a fringe phenomenon in Chinese medicine. They're quite common in Chinese gastronomy and their nutritive value might be discussed in terms that also make sense in Chinese medicine, but I've never heard of Chinese doctors who prescribed shark fins to their patients. Seahorses, however, are more common. I've seen them often in Chinese drugstores in Hong Kong, Beijing, and Southern China. They're certainly not the most common ingredient in TCM, but they're not marginal. Maybe you could remove the picture of "lingzhi" (ganoderma) instead? It already appears in the lingzhi wiki, and lingzhi already appear in the picture right below, so there is some redundancy. Madalibi (talk) 13:23, 11 June 2011 (UTC)

Very reasonable. I'll delete the shark fins and the lingzhi, then. --Mallexikon (talk) 07:11, 14 June 2011 (UTC)

Doesn't work. Still at least 3 pictures too many. I propose the following: keep the "dried plants and animal parts...", the ginger, the ginseng, and transfer the top picture of the Chinese herbology article here. Then transfer all the other pictures to the Chinese herbology article. Comments? --Mallexikon (talk) 07:30, 14 June 2011 (UTC)

Yes, there is still a huge white gap in the "History" section before the unreferenced table. So sure, let's delete some more! It would be nice to have one illustration among our three selections (instead of three photos). How about keeping the dried plants and animal parts, the ginseng, and the wormwood? Red ginseng and the rhubarb are already in Chinese herbology, where the rest of the photos can go. Madalibi (talk) 00:51, 15 June 2011 (UTC)

Alright. The ginger must go, then. Wormwood can stay. --Mallexikon (talk) 06:00, 16 June 2011 (UTC)

Sorry, sorry, I meant to say keep the ginger, not the red ginseng! If you've already made the change, then don't worry about it. Madalibi (talk) 06:40, 16 June 2011 (UTC)

Acupuncture efficacy

I'd like to delete the excessively long efficacy part in the acupuncture section. This seems to be a difficult topic which can't easily be shortened to a few sentences. Comments? --Mallexikon (talk) 09:32, 9 June 2011 (UTC)

Not sure what to say about this one. The problem of the efficacy of acupuncture is very important, but it's difficult to present in an NPOV fashion because it's quite controversial. This section might be a can of worms, but I don't think it should be deleted too quickly. I don't have any concrete suggestions to improve it, though! Cheers, Madalibi (talk) 13:29, 11 June 2011 (UTC)

Ok, how about keeping the first sentence ("The effectiveness of acupuncture beyond the placebo effect is not well established.[189]") and getting rid of the all the rest? There is, after all, a proper acupuncture article with all this information already. --Mallexikon (talk) 09:29, 14 June 2011 (UTC)

I read the Acupuncture wiki and you're right: most of the material presented here is already there. So in the spirit of summarizing other wikis instead of repeating them, we should cut some material. But some referenced statements found here are nowhere to be found at "Acupuncture." It would be too bad to delete them for good. I know it would take some time, but could you check which passages are unique to this wiki and which are duplicates of the Acupouncture wiki? Madalibi (talk) 01:11, 15 June 2011 (UTC)

Done. --Mallexikon (talk) 10:56, 16 June 2011 (UTC)

Just saw that. Very impressive. Thank you for taking the time! Madalibi (talk) 11:01, 16 June 2011 (UTC)

Lede, 2nd sentence

"These practices are a common part of medical care throughout East Asia, accounting for roughly 75% of worldwide use,[2][3] but are considered alternative medicine in the western world.[1]"
"...common part of medical care throughout East Asia" is ok with me, but "75% of worldwide use"? Of what? And it's not just considered alternative medicine in the West but also in China itself. Could we just delete everything except for the first part, maybe? --Mallexikon (talk) 09:23, 14 June 2011 (UTC)

I'm also puzzled by this 75% figure. The reference to Scheid 2002 (the book Chinese Medicine in Contemporary China: Plurality and Synthesis) has no page number, and I couldn't find the figure "75%" in a Google Books search.[2] I also doubt that an article titled "Facial Rejuvenation With Traditional Chinese Healing Herbs" would give us a reliable figure concerning the "worldwide use" of Chinese medicine. So I fully suport deleting this figure.

"Alternative medicine" is a more complex issue. TCM is is a central part of the Chinese healthcare system, and has been so since about the 1960s, when reforms guided by the Communist Party precisely attempted to place Chinese medicine at the center of the healthcare system. Even today, Chinese medicine is being promoted as a science. For example, the influential "China Academy of Traditional Chinese Medicine" (CATCM, 中国中医研究院), which led the effort to find TCM-based remedies for SARS, was recently renamed to "China Academy of Chinese Medical Sciences" (CACMS, 中国中医科学院). And there are state-sponsored "Chinese medicine hospitals" 中医院 throughout the country. So I don't think we can call TCM an alternative medicine in China.

Chinese medicine doesn't have this kind of institutional strength in Japan and, I suspect, in Korea and Vietnam. In these East Asian countries, Chinese medicine might be considered alternative, but we would need reliable sources to support this claim.

So here's a simple suggestion for rewording: "These practices are a central part of the healthcare system in China, but are considered alternative medicine in the western world."

Madalibi (talk) 02:49, 15 June 2011 (UTC)

My impression still is that it is considered alternative medicine in China as well. Yes, there are state owned TCM hospitals, but I don't see that as a contradiciton to being alternative medicine. TCM is definetely being regarded as special by the Chinese. And the ratio between scientific medicine clinics and TCM clinics is something around 5:1 as far as I remember. This also casts doubt on the "central" nature of the part TCM plays in China's health system. --Mallexikon (talk) 05:28, 16 June 2011 (UTC)

"Central" might not be the right word, but I also live in China and I feel that TCM is more than "alternative" here. And it is more than simply a source of national pride. Central might not be the right word, but I would still make a distinction between private TCM clinics as in the West, and state-sponsored TCM schools and hospitals, which have no equivalent in the West. Reforms from the 1950s onwards clearly aimed to place TCM at the center of the healthcare system, and as far as I know, patients in China can still get insurance refunds for all kinds of TCM treatments, much more than in Western countries or even Japan. So to refer back to the second sentence of the lead, I still think we should make a distinction between China and the rest of East Asia, where TCM doesn't is far from having the same institutional standing and general prestige.

But anyway, I don't think there should be much controversy here, since no matter which word we choose ("central," "alternative," "common," or anything else) will have to be supported by reliable sources! Cheers, Madalibi (talk) 06:36, 16 June 2011 (UTC)

The table in the "History" section

The section on History is full of mistakes, but that can be corrected. But I don't know what to do with the historical table that comes at the end. Here we face the same problem as with the table of medicinals we decided to delete: how do we decide what events are worth including? Writing a full chronological table of Chinese medical history would take a long wiki in and of itself, so this would not help us improve this particular page. And correcting mistakes and adding references to the table would not solve the problem of representativity. I propose we just delete the table! Madalibi (talk) 03:15, 15 June 2011 (UTC)

The entire information in the table is unsourced, so to delete it is fine with me. --Mallexikon (talk) 05:33, 16 June 2011 (UTC)

Ok, deleted for now! Madalibi (talk) 05:52, 16 June 2011 (UTC)

"Yinyangism"?

Can anyone give me a source for the term "Yinyangism"? It doesn't sound like a very common term to me. I'm a historian of China specializing in Chinese medical history and ancient Chinese thought. I've done fairly extensive research on the origins of Yin-yang and the Five Phases (in both primary and secondary sources), but I've never heard of "Yinyangism" anywhere. This term only gets one hit on Google Books, and it's from a conference paper dated 1977.[3] As I see it, we should probably delete this term, because it does not appear in reliable sources, at least those that I know of (i.e., the fields of ancient Chinese intellectual history and the history of Chinese medicine). Or am I missing something? Cheers, Madalibi (talk) 04:55, 14 June 2011 (UTC)

No, it's definetely not a common term. I read it years ago in some book about history of daoism, but I can't remember the author nor the exact title. I thought it was a good translation of 阴阳家, though. What do you propose instead? --Mallexikon (talk) 06:53, 14 June 2011 (UTC)

I would say just delete and rephrase! All we need is to mention Yinyang thought and the doctrine of the Five Phases, without trying to find a more encompassing term that refers to both. If we feel bold, we could speak of "correlative thinking," a term that historians of China use to discuss Yinyang and the Five Phases at the time when the Huangdi Neijing was compiled, or "systematic correspondence," which was popularized by Paul Unschuld in his well-known history of Chinese medical ideas. Madalibi (talk) 07:03, 14 June 2011 (UTC)

The result would be something like this: "Traditional Chinese Medicine is based on Yin-yang thought and the doctrine of the Five Phases." We could add a few references to RS (plenty of those) and a brief summary of what Yinyang and Wuxing mean before turning to the two more detailed sections below. Madalibi (talk) 07:09, 14 June 2011 (UTC)

Ok, that would work for the lede. But what should we do with:

"When acupuncture (and herbal medicine) became integrated into an embracing medical theory system is difficult to judge. TCM theory is, however, inextricably intertwined with the principles of Yinyangism, which was represented for the first time by Zōu Yǎn (340 - 260 BC)."

from the history section? Neither "systematic correspondence" nor "correlative thinking" seem to fit as a translation for 阴阳家 here.

I went back to one of the references (Liu 1999). He talks about the "Yin Yang School" (while obviously referring to 阴阳家). Would that work for you? --Mallexikon (talk) 08:19, 14 June 2011 (UTC)

Hi Mallexicon. A few points, here:

• "Yin-yang school" or "School of Yin-Yang" would be a problematic translation for a historian of ancient Chinese thought (because 家 in the Shiji, where the first mention of 阴阳家 appeared, did not really mean "school"), but it will do for a wiki on TCM. So let's go with Liu 1999 on this one.
• "Systematic correspondence" would not be a translation of "Yinyang jia": it's an encompassing term for the belief (central to Chinese medicine) that everything in the body and the cosmos is interrelated. Paul Unschuld is a noted historian of Chinese medicine, so maybe we could quote his term here (with proper attribution, of course).
• As for the two sentences you quoted, I see lots of problems with them. 1. The second one doesn't seem to follow from the first one. 2. What is an "embracing medical theory system"? 3. The formulation doesn't say clearly what is "difficult to judge": is it when acupuncture was integrated into an "embracing medical theory system" (still not sure what that would mean), or when acupuncture and herbal medicine were integrated together into an "embracing medical theory system"? 4. And we actually know when these developments took place. Acupuncture was integrated with a systematic understanding of the circulation of Qi and Blood within the "meridians" during the Han dynasty. And acupuncture and herbal medicine were made compatible doctrinally during the Song dynasty. I will find the proper references.

I'll see what I can do about this in the next few days.

Cheers, Madalibi (talk) 01:31, 15 June 2011 (UTC)

Ok, great! Thanks a lot for trying to find those references. And just out of curiosity, what did 阴阳家's 家 mean in the Shiji? ('cause simple minded as I am I assumed it was equivalent to the 家 in, for example, 道家) --Mallexikon (talk) 03:17, 16 June 2011 (UTC)

Nothing simple-minded about this! Generations of scholars assumed that these 家 referred to various "schools of thought" from pre-Han China, things like Taoism, Legalism, and the like. Joseph Needham himself translated Yin-yang jia 陰陽家 as the "School of Naturalists." But since about the 1990s, Western historians of ancient China have shown that these "schools" were retrospective constructs, a projection of Han-dynasty conceptions onto the Warring States period. It appears that Sima Qian's father Sima Tan (who wrote the influential Shiji passage on the 六家) just created these categories of 道家, 法家, 陰陽家, etc. for the purpose of his own argument on correct forms of government. Actually, there were no such "schools" in the Warring States period. (That's why it's meaningless to speak of Daoist and Legalist "influences" on a text like Hanfeizi when these two notions didn't even exist at the time.) These 家 also did not correspond to teaching traditions (except for Rujia 儒家) or to institutional formations, and they didn't have "founders" like Laozi or Zou Yan. They were just Sima Tan's own grouping of various techniques of government under new appellations that ended up becoming so influential that we're still using them today to discuss the intellectual history of the Warring States (as in Hundred Schools of Thought, for example). So to make a long story short, 家 in the Shiji means something like "experts." Madalibi (talk) 06:22, 16 June 2011 (UTC)

Ok, that makes sense. We're still short of a term here, though. If we translate 阴阳家's 家 with expert, the next question would be, expert of what? Yinyang doctrine? Yinyangism? Yinyang thinking? --Mallexikon (talk) 01:11, 17 June 2011 (UTC)

Historians of Chinese medicine (our reliable sources for the "History" section) would not say that early Chinese medical doctrines were designed or shaped by the "Yinyang School" or "Yinyang experts." So I suggest we don't mention these terms at all! Historians would say instead that early medical thinking integrated more widely available cosmological conceptions like Yinyang and the Five Phases. The Huangdi Neijing itself was one of the earliest instances of a merging of Yinyang thought with the Five Phases. These claims will of course be supported by "reliable sources." Let me post part of my history draft in a new section... Madalibi (talk) 02:55, 17 June 2011 (UTC)

What to include in the History section?

I'm thinking of improving the History section, but I'm not sure what we should include in it. Chinese medical history is long and complex, and there are plenty of reliable sources to document it. We probably need something on the origins of acupuncture and on the main books that still inform TCM doctrines. And because Traditional Chinese medicine is a modern construct selectively rooted in the past, I think we should include something on the modern reforms that shaped modern "TCM." But apart from that, what? Any suggestions? Comments? Madalibi (talk) 05:51, 15 June 2011 (UTC)

Also, once we have a more presentable history section, I think we should consider putting it at the beginning of the wiki, as in Acupuncture, for example. That would take a few pictures away from the end of the wiki, where pictures are already overflowing. Madalibi (talk) 05:54, 15 June 2011 (UTC)

I don't know much about TCM history so I'd focus on the origins and main books, just as you suggested. The reforms of the 50s also seem important to mention. If we could keep the section that short, I'd also recommend to move the section to the article's front. So, yes, yes, and yes. --Mallexikon (talk) 05:46, 16 June 2011 (UTC)

I'm working on a draft. I've also created a new page called Wushi'er bingfang that will help to write this section. Comments welcome! Madalibi (talk) 06:46, 16 June 2011 (UTC)

Hard to comment on that article. Seems perfect already! --Mallexikon (talk) 05:04, 17 June 2011 (UTC)

Hiding feng-shui section

This section now contains only this sentence:
"The four components (year, month, day, and hour of birth) may at times be used alongside fortune telling practices such as Zǐ wēi dòu shù as assistance in diagnosing patients or in considerations about medicines."
This material is challenged and there's considerable doubt whether the citation given is actually supporting the claim. I'll hide the section for now until the exact supporting quote is provided. --Mallexikon (talk) 02:38, 17 June 2011 (UTC)

Sure, let's hide it. If it proves to be supported by the cited source, we will have to clarify again what "the four components" mean, but that can wait. Good job! Madalibi (talk) 02:56, 17 June 2011 (UTC)

New take on lede

I rewrote the second part of the lede in order to specify the information a little. I didn't include citations since I merely repeated contents from the respective sections. Only exception is the mention of tongue and pulse findings, since those sections have not been created yet.
This is just another shot. Corrections/amendments are welcome. --Mallexikon (talk) 08:03, 17 June 2011 (UTC)

Lede

"Traditional Chinese Medicine (中醫, pinyin: zhōng yī) (Traditional Chinese Medicine), is a label that covers a broad range of traditional medicine practices spread throughout Asia, including various forms of herbal medicine, acupuncture, massage therapy, and dietary therapy.[1]"
I don't know anything about these broad range of practices - TCM actually looks quite homogeneous to me. How about:
"Traditional Chinese Medicine (中醫, pinyin: zhōng yī) (Traditional Chinese Medicine) is an alternative medicine system which has been developed in China and looks back on a tradition of more than 2000 years."? --Mallexikon (talk) 03:11, 11 June 2011 (UTC)

Hmmm, this is a tough one. I think the first version of the lead reflects the diversity of Chinese medicine better than the proposed new version. Modern textbooks often present Chinese medicine as doctrinally unified, but this is an illusion. What we call "Chinese medicine" is actually extremely diversified. Even in the People's Republic of China, where traditional practices have arguably been the most streamlined, there is still an enormous variety of practitioners and practices that claim to belong to "Chinese medicine." TCM is a coherent system only when it is presented as such in textbooks for beginners.

For a sustained scholarly argument about the plurality of TCM doctrines and various attempts at synthesizing them, I recommend Volker Scheid's Chinese Medicine in Contemporary China: Plurality and Synthesis (2002). Scheid, who has a Ph.D. in Medical Anthropology, teaches at the University of Westminster, but he also practices Chinese medicine clinically.[4][5]

The proposed version also claims that Chinese medicine is an "alternative medical system," but as is made clear lower in the lead paragraph, this is not true in China!

Actually, what might be missing from the lead section is a claim that "Chinese medicine" is now a global phenomenon (not only a Chinese or an East Asian one), and that it keeps changing to adapt to new circumstances, as it has in the past hundred years or so in response to various challenges. And it has changed a lot too during the more than two millennia that have gone by since the Huangdi Neijing. But I digress. My point is that the current version of the lead is not perfect, but still seems more balanced and more accurate.

Cheers, Madalibi (talk) 14:04, 11 June 2011 (UTC)

Ok, then how about:

"Traditional Chinese Medicine (中醫, pinyin: zhōng yī) (Traditional Chinese Medicine), is a label that covers a broad range of medicine practices sharing a unified theoretical system which has been developed in China and looks back on a tradition of more than 2000 years."? --Mallexikon (talk) 04:47, 13 June 2011 (UTC)

Hi Mallexicon. I guess my point is that TCM does not really share a unified theoretical system. Unless we can find a few reliable sources that make this very claim, I don't think we should include this kind of statement in the lead. For example, many practitioners of Chinese medicine in Taiwan, Japan, and the West reject the theoretical constructs and the curriculum that were designed in the PRC starting in the 1950s and that now constitute the core of what we call "TCM." These practitioners often claim they are practicing "Classical Chinese Medicine," which they consider as a more authentic form of Chinese medicine. Just to avoid this kind of debate, I think we should avoid claims of theoretical unity.

But I really like the idea of mentioning that TCM developed in China and goes back more than 2000 years. This is the kind of essential info that should appear in a good lead. Based on all this, here's another formulation to work with:

"Traditional Chinese Medicine (中醫, pinyin: zhōng yī) (Traditional Chinese Medicine) refers to a broad range of therapeutic and dietary practices and their underlying doctrines, some of which have a history of more than 2000 years. First developed in China, for centuries Chinese medicine formed the core of health care in most of East Asia; as an alternative medicine system, it is now practiced globally."

It's a little longer, but it sounds relatively tight and it makes some important points, with a nod toward history. Comments?

Cheers, Madalibi (talk) 06:32, 13 June 2011 (UTC)

Hi Madalibi, sorry, but I object. The unified theoretical system I referred to is the theoretical superstructure of the model of the body and the concept of disease. Regarding the Japanese practitioners of TCM - does this really still count as TCM (the Chinese probably would say no). Regarding the Taiwanese/Hongkongnese practitioners - they may reject certain aspects of the PR's curriculum, but they certainly don't reject the classical works. I guess no one can. Actually, if you follow a kind of medicine which is not based on yinyangism, zang-fu, qi, xue, Six Evils, pattern discrimination etc. - can you still call that Classical/Traditional Chinese medicine? --Mallexikon (talk) 12:35, 13 June 2011 (UTC)

Hi Mallexicon. We might be giving a different content to the same words. For me, saying they share a "unified theoretical basis" is a much stronger claim than saying they share some concepts and techniques. I agree that most doctors in the Chinese tradition believe in Qi, generally speak of internal organs in a similar fashion, and embrace some notion of Yin and Yang. But not all give the same importance to the Five Phases (many in the PRC argue it's outdated cosmological stuff that should be phased out of Chinese medicine), not all will agree on the meaning of Blood/xue (some see it simply as a red inner fluid as in biomedicine, while others see it more traditionally as the Yin aspect of human vitality), and some find meridians irrelevant to their practice. Not to mention that guasha specialists and massotherapists almost never use pattern discrimination (or actually any form of diagnosis) and will have little to say about the Six Evils.

To me, a "unified theoretical basis" would mean that almost all practitioners of traditional Chinese medicine throughout the world agree theoretically about which notions are important and what these notions mean. They would all agree about what Yin and Yang mean and about what functions Blood/Xue has, and they will all tell you roughly the same thing about "meridians." I really don't think this is the case. I think the practices and doctrines TCM consists of are linked by family resemblances, not unified theories. Saying they "share common concepts" would sound more measured and less controversial.

But I think there's a simple solution to our disagreement, or to any disagreement about content, for that matter. As the first line of the policy page called WP:Verifiability says: "The threshold for inclusion in Wikipedia is verifiability, not truth—whether readers can check that material in Wikipedia has already been published by a reliable source, not whether editors think it is true." So no matter what either of us thinks about whether TCM theory is unified, what we say on this wiki will have to come from reliable sources, not from our own impressions. If you can find a number of reliable sources explicitly claiming that TCM has a unified theoretical basis, and if these sources represent the majority point of view, then you will get no objection from me (as an editor) even if I disagree in fact (as a person)! What do you think?

Cheers, Madalibi (talk) 01:25, 14 June 2011 (UTC)

Hi Madalibi, good point about the verifiability. The thing is that our article here already has the sections of "Philosophical background", "TCM model of the body", and "Concept of disease". Now if you question a "unified theoretical basis" (emphasisis on basis) you actually question the validiy of the these sections. Their content is, however, extensively cited with reliable sources already. In other words, if you want to claim that there are schools or individuals not adhering (or even rejecting) the concepts laid out in the mentioned sections, it would actually be on you to find reliable sources that these schools or individuals can still be counted as TCM.

I don't want to make it harder as it is, though. "Common concepts" is actually fine with me. So how about:

"Traditional Chinese Medicine (中醫, pinyin: zhōng yī) (Traditional Chinese Medicine), is a label that covers a broad range of medicine practices sharing common theoretical concepts which have been developed in China and look back on a tradition of more than 2000 years."? --Mallexikon (talk) 04:10, 14 June 2011 (UTC)

Hi Mallexicon. Yes, the point about verifiability and reliable sources applies to me too! I think I could find many sources explaining why TCM doesn't have a unified theoretical basis (emphasis on unified ;) ), but I agree with your priority of not making things harder than they already are. In order words, we should present a relatively coherent version of Chinese medical doctrines before we introduce more complexity and discrepancies.

And your sentence sounds fine as it is, though I would still replace "is a label that covers" with the simpler "refers to."

By the way, what did you think of the sentence I proposed above? ("....refers to a broad range of therapeutic and dietary practices and their underlying doctrines, some of which have a history of more than 2000 years. First developed in China, for centuries Chinese medicine formed the core of health care in most of East Asia; as an alternative medicine system, it is now practiced globally.") Do you think we could merge parts of this into your sentence?

Madalibi (talk) 04:43, 14 June 2011 (UTC)

Well, I would agree that it is practiced globally, but this is a very vague term. How do you verify that? "...formed the core of health care in most of East Asia" poses the same problem. Not easy to back it up with RS. And unless we don't have any, I'd rather leave statements about the importance of TCM out. Cheers, --Mallexikon (talk) 06:28, 14 June 2011 (UTC)

I do have RS to support these claims, but such statements in the lead would need to be developed in the article itself, probably in a more substantial "History" section. Unfortunately I don't have time to do this kind of work. One day I might rewrite History of Chinese medicine, and then we'll talk! Thanks for your views, and don't hesitate to go ahead with your proposed modifications. Cheers, Madalibi (talk) 06:37, 14 June 2011 (UTC)

Ok! Changed accordingly. --Mallexikon (talk) 08:28, 14 June 2011 (UTC)

I'm new to this topic, but the article (and your discussion) interest me. I wonder about the use of the wording "inconsistent with natural sciences" in the second paragraph: "...these models are inconsistent with natural sciences and complicate scientific research on the efficacy of TCM medicinals and practices.' This implies that TCM is unscientific (unverifiable, not repeatable), but is that accurate?Octopet (talk) 17:49, 17 June 2011 (UTC)

Hi Octopet! The encyclopedia britannica's definition of science is:

"science: any system of knowledge that is concerned with the physical world and its phenomena and that entails unbiased observations and systematic experimentation. In general, a science involves a pursuit of knowledge covering general truths or the operations of fundamental laws."

TCM involves pursuit of knowledge, but its observations are not unbiased, but perceived through the lens of Five Phases and yin-yang theories. On top of that, traditionally there was no systematic experimentation at all. Cheers, --Mallexikon (talk) 01:50, 18 June 2011 (UTC)

Octopet raises a legitimate issue, here, and I'm not sure how to answer it. Is it true that TCM models are "inconsistent with natural science"? I'm not sure. Maybe the claim is too broad to be judged true or false. But to quote Wikipedia policy: "The threshold for inclusion in Wikipedia is verifiability, not truth—whether readers can check that material in Wikipedia has already been published by a reliable source, not whether editors think it is true." [Source: Wikipedia:Verifiability.] This means that any claim we make in the lead and elsewhere should be representative of what reliable sources say about this issue. Drawing our own conclusion from an encyclopedic definition of "science" might not be the best way to go. The older version of the lead said:

• "TCM practices use different physiological and disease models than modern medicine, and make a number of assumptions that are inconsistent with or untestable under the principles of scientific methods"

The newer one (proposed by Mallexicon) is:

• "TCM theory has the Five Phases and yin-yang doctrines as a background. It uses a different model of disease and of the body than modern medicine; these models are inconsistent with natural sciences."

I must say I prefer the older version because it is less strongly worded. 1. It speaks of "a number of assumptions" rather than all of TCM models concerning physiology and pathology. 2. It compares some of TCM's assumptions with scientific methods rather than with the natural sciences as a whole. 3. It says that some assumptions are either "inconsistent with or untestable under" rather than just "inconsistent with" science.

I think we to make balanced claims about, first, TCM's selective integration of "Western medicine" into its doctrines (very important to the formation of TCM doctrines as we know them), and, second, how TCM differs in dynamics from modern scientific medicine. I will try to come up with something in the next few days, but it would go something like this:

"The doctrines of Chinese medicine are rooted in books such as the Yellow Emperor's Inner Canon and the Treatise on Cold Damage. Starting in the 1950s, these precepts were modernized in the People's Republic of China so as to integrate many anatomical and pathological notions from scientific medicine. Nonetheless, many of its assumptions remain different from those of modern medicine. As a result, the efficacy of many TCM practices (like acupuncture) is difficult to test under the scientific method."

(I have reliable sources to support all these claims.) To be more specific, we could also say that treatment with both herbal medicine and acupuncture is designed to be unique to each patient, which makes double blind testings difficult, but that could go somewhere else. Anyway, just a basic attempt, but you see where I'm heading. Comments?

Cheers! Madalibi (talk) 04:53, 18 June 2011 (UTC)

No objections from me. I would, however, try to mention Five Phases and yin-yang doctrines in the lede, just as they are mentioned a lot throughout the article. --Mallexikon (talk) 01:21, 20 June 2011 (UTC)

Yes, good idea, and my omission. The first two sentences could then be: ""The doctrines of Chinese medicine are rooted in books such as the Yellow Emperor's Inner Canon and the Treatise on Cold Damage, as well as in Yinyang thought and the Five Phases. Starting in the 1950s, these precepts were modernized..." (I removed "however" and "systematically" from the original sentence.) Thanks! Madalibi (talk) 02:07, 20 June 2011 (UTC)

Alright. Changed accordingly. --Mallexikon (talk) 04:04, 21 June 2011 (UTC)

And I see that we're improving on it already. Great! Madalibi (talk) 04:08, 21 June 2011 (UTC)

Just returning after a few days away, and I find your suggested edits are an improvement. It gives a reader like me, who is unfamiliar with TCM, a better understanding of the context. Thanks for considering my input.Octopet (talk) 00:03, 22 June 2011 (UTC)

Three editors worked on this and it was a lot of fun. Glad it looks better! Madalibi (talk) 10:56, 22 June 2011 (UTC)

TCM model of the body wiki article

I deleted the templates in the "model of the body" section referring to the proper article. That article isn't much more than a stub. It is, however, also not worth to rewrite it, as it's quite useless in my opinion (and would best be deleted altogether). --Mallexikon (talk) 05:42, 23 June 2011 (UTC)

The "Fengshui and Chinese astrology" section

I just tagged two sentences and deleted five references in the section called Fengshui and Chinese astrology. Whoever wrote this section was very sloppy. The five references did not even mention the content of this section, and the two remaining references have nothing to do with the opening sentence of each paragraph, which is why I tagged these sentences. Four sentences remain:

1. QUOTE "TCM doctors may also incorporate beliefs about the alignment of buildings with fēng-shuǐ (风水/風水) or Chinese astrology."
2. QUOTE: "Some Chinese doctors believe that the season and location of planting and harvesting affects the degree of effectiveness and toxicity of drugs." The reference is to an interview with an old practitioner who laments that these cosmologically informed ways of cultivating aconite have been lost. This man would seem to represent a fringe point of view.
3. QUOTE: "The Four Pillars of Destiny (Bazi, 八字) are the four components believed under TCM to create a person's destiny or fate.
4. QUOTE: "The four components (year, month, day, and hour of birth) may at times be used alongside fortune telling practices such as Zǐ wēi dòu shù as assistance in diagnosing patients or in considerations about medicines." The reference is to a book by Simon Singh and Edzard Ernst called Trick or Treatment: The Undeniable Facts about Alternative Medicine (2008). I strongly doubt that Singh and Ernst would mention the Chinese name of some obscure fortune-telling practice, and the fact that I've already deleted four references to this paragraph, all of which didn't support the claim at hand, makes me suspicious about the last remaining reference. In any case, the assistance of diagnosis with astrology would be a fringe phenomenon in Chinese medicine.
   

So here's what I propose:

• We delete the sentence on fengshui altogether, because it is not supported by any reference.
• We move the sentence on planting and harvesting to the section on medicinals.
• We look for the specific quotation from pp. 70-73 in Singh and Ernest to see what that book says, so that we can delete the unsupported material from the sentence (if any).
• We delete the section on "Fengshui and Chinese astrology," because all we have left in it is a single claim about astrology as an aide for diagnosis. If that claim proves to be supported by the source (Singh and Ernest), we find a way to integrate it somewhere in the article.

Comments? Madalibi (talk) 09:07, 16 June 2011 (UTC)

I doubt that pp. 70-73 will actually yield a quote supporting that sentence. I think I know who wrote this section; he's a nice guy and his influence lifted the citation level of this article to a whole new level, but in some instance he bended the sources a little (in order to prove his point that TCM concepts are rooted in black magic). However, I've been unsuccessful in trying to review pp. 70 - 73 online and I don't intend to buy this book.

Since that claim about astrology being used in TCM sounds pretty dodgy, I recommend we hide it for now. I'll put up a section on the discussion page about it. Maybe someone can come up with a quote supporting it. Regarding your proposals no. 1,2 and 4, I totally agree. --Mallexikon (talk) 01:54, 17 June 2011 (UTC)

Sure, hiding that one-sentence section sounds like a good solution until someone can check Singh and Ernst. And it's true that Chinese medical doctrines were once permeated by cosmological meanings derived from Yin-yang thought, the Five Phases, and the Yijing, but these cosmological notions are not the same as fengshui, astrology, and black magic. Now a good wiki on Chinese medical history should definitely discuss things like demonology and "iatromancy" (medical divination), but these practices are no longer part of mainstream TCM. I think you agree with that already. Just saying. Cheers, Madalibi (talk) 02:47, 17 June 2011 (UTC)

I finally got to consult pages 70-73 of Singh and Ernst's book. They criticize Chinese anatomical claims about meridians and Qi for not being based on dissections. They go on to assess two possible theories for the validity of acupuncture: the "gate control theory of pain," and the hypothesis that puncturing the body with needles releases endorphins or other natural pain-killing opioids. They find both views lacking. They then suggest that the effects of acupuncture are probably based on the placebo effect. All nice and interesting, but not related to Chinese astrology. I therefore deleted the hidden section altogether. Madalibi (talk) 07:30, 4 July 2011 (UTC)

Very well. Thanks for going the extra mile, again! --Mallexikon (talk) 03:15, 30 July 2011 (UTC)

Influence on other cultures

When the Tibetans first learned about TCM doesn't belong in this article here, but in the Traditional Tibetan medicine article. Besides, this insignificant little sentence suffers from citation overkill. I'd delete it. Comments? --Mallexikon (talk) 01:50, 29 July 2011 (UTC)

Ok. Deleted. --Mallexikon (talk) 03:16, 4 August 2011 (UTC)

Draft of new "History" section: requesting comments

Here's the beginning of a new draft of the History section. For now, I've cleared up the confused claims about the origins of acupuncture. I will provide detailed references later. Notes 1 to 3 are from other sections above. You can just ignore them.

The first traces of therapeutic activities in the territories that are now considered China date from the Shang dynasty (14th-11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular inscriptions on bones and tortoise plastrons refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, etc., which Shang elites usually attributed to curses sent by their ancestors. There is no evidence that the Shang nobility used herbal remedies.

Stone and bone needles found in ancient tombs have made Joseph Needham speculate that acupuncture might have originated in the Shang dynasty. But most historians now make a distinction between medical lancing or bloodletting on the one hand, and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels ("meridians") in accordance with theories related to the circulation of Qi. The earliest evidence for acupuncture in this sense dates to the second or first century BCE.

Comments welcome! Madalibi (talk) 03:07, 17 June 2011 (UTC)

Excellent. If keeping it short should turn out to be too painful, we could also create an extra article about it :) --Mallexikon (talk) 04:58, 17 June 2011 (UTC)

I've been meaning to create a page on "History of Chinese medicine" for a long time. I wanted to write it all up before posting it, but maybe I should post something shorter to begin with. Thanks for the encouragement! Madalibi (talk) 02:12, 19 June 2011 (UTC)

Hi everybody. Instead of going through many rounds of comments, I just posted my new (and hopefully much improved) version of the History section and placed it at the beginning of the wiki. It is fully referenced to the work of Western (and a few Chinese) historians of Chinese medicine. Let me know what you think! Madalibi (talk) 12:43, 3 July 2011 (UTC)

It's much better than any history summary I've seen in TCM books so far. Good job! --Mallexikon (talk) 04:57, 30 July 2011 (UTC)

Just came back from a one-month vacation. Thanks for your generous assessment. I'll try to add to this section if I have time. After all, we still have almost two millennia of history to cover! Cheers, Madalibi (talk) 07:12, 13 August 2011 (UTC)

Lede: bear bile

Doseiai2 would like to add this to the lede:

There are aspects of TCM which are extremely cruel/hazardous to animals, such as bear bile harvesting.

I think it is sufficient to have the bear bile information in the appropriate section, and recommend to keep this out of the lede. Just my impression, though. Comments? --Mallexikon (talk) 02:52, 14 August 2011 (UTC)

I agree with you, Mallexicon. Bile harvesting is an appalling practice that deserves to be denounced, but not in the lede of a general Wikipedia article on TCM. Madalibi (talk) 03:16, 14 August 2011 (UTC)

I also agree. If you check classical and modern formulae and therapeutics texts, bear bile is rarely mentioned. Very rarely. It is one of many examples of expensive exotica that are not part of the everyday practice of TCM.Herbxue (talk) 22:36, 14 August 2011 (UTC)

question about TCM research

I'm interested in this article for a couple of reasons. One, I want to know more about TCM. Second, I'm interested in the research. I'd like to understand more about the efficacy of TCM. In ref #1 (Status of TCM Research) the NIH states that "scientific evidence of the effectiveness of TCM is limited" (I like the way that is phrased). In ref #191 the WHO lists "Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials-to be an effective treatment." Is acupuncture more thoroughly researched than other modalities used in TCM? Octopet (talk) 01:04, 1 July 2011 (UTC)

WHO, being a governmental organization, is not really a good source, per WP:MEDRS. I would guess that acupuncture has been more thoroughly researched than just about any other junk medicine claim. And almost all of the real studies show that it is nothing more than a placebo. These fake medical "treatments" fail on two levels. First, no one has been able to show how they might work physiologically. All real medicine can show how it works either through pharmacology, physiology, or some real science. Second, fake medicine fails to provide real clinical studies, double-blinded, and published in real peer-reviewed journals. Real science, and by extension, real medicine, always allows itself to be exposed to the bright light of criticism, and either passes or fails. Fake medicine, like TCM, whines about that criticism. TCM is a pseudoscience. It is junk medicine. OrangeMarlin ^{Talk• Contributions} 01:26, 1 July 2011 (UTC)

Your argument defeats itself; you fail to understand the goal of real medicine. Sure, real science is about such claims - but real medicine is about curing patients... and wouldn't you know it, just as you yourself point out, the placebo effect is quite real, quite repeatable, and studies have to be designed in strict ways to rule out this very strong placebo effect. But, since the goal of real medicine is curing the patient, and not making scientific discoveries per se, its idiotic in the extreme to disqualify all medical techniques that rely upon the placebo effect as "junk" if they continue to provide provable, repeatable results even if they do so via the placebo effect. Zaphraud (talk) 05:56, 15 January 2012 (UTC)

I do find it interesting that while TCM has not been proven by western science (about 100-200 years old) and is considered "junk medicine", western science has proven that cough syrups are ineffective, yet they are still recommended and sold as "medicine". Additionally, TCM (acupuncture, herbology, and a variety of other practices), have been around for 5000 years (reference any google search for 5000 year old ice man) and only in the past 10-20 years have scientists started to realize that the points acupuncture uses, and the herbs that are used do have measurable effects (by the active ingredients in a given herb). — Preceding unsigned comment added by 173.165.40.25 (talk) 13:49, 15 September 2011 (UTC)

If someone managed to demonstrate the existence of TCM circulation channels ("meridians") and to devise effective therapy on the basis of that knowledge, he or she would undoubtedly deserve a Nobel Prize in Medicine. This hasn't happened, of course, and nobody expects this to happen.

There are two logical flaws here. 1. Not verified by scientific method does not equal to ineffective (or junk) 2. Having a non-scientific theory basis does not mean it's ineffective. If someone can provide studies that show TCM is ineffective I would be more than happy to take that. But I think the consensus (according to #1) is it's just not studied well yet. So I would refrain from calling it junk or fake. — Preceding unsigned comment added by Hiei81 (talk • contribs) 04:29, 8 September 2011 (UTC)

You are right on both counts. However, since science is nothing more than the building of models that give reliable predictions (at least in some conditions), it is surprising that practitioners of TCM have not endeavored to meet this very simple requirement. It is not surprising that people treat it with suspicion. This also answers objection #2. If a model works, it works. If in experiment after experiment its predictions are better than guessing, then it would be accepted by the scientific community (if not immediately, it will eventually). So for the time being, TCM is junk science. --Wynand.winterbach (talk) 21:02, 9 January 2012 (UTC)

Note that acupuncture might be the best-known TCM treatment in Western countries, but it's not very widespread in China. In most "TCM hospitals," what you get is herbal prescriptions. But the TCM doctors who work there have all received training in "Western medicine" as well, so they will also prescribe things like hormones and painkillers when necessary, or some pre-made pills based on Chinese pharmacology that might contain acetaminophen or other substances that have nothing to do with TCM.

This is to say that TCM as it is practiced in China today has already integrated large chunks of "Western medicine." There's been a big struggle in China since the 1950s to preserve Chinese medicine by integrating more scientific knowledge into it: anatomical knowledge, knowledge about the causes of illness, use of "Western" medicinal substances, toning down of cosmological concepts like the Five Phases, etc. Respected historians of science like Nathan Sivin have predicted that TCM doctrines will not be able to survive the tensions between the two systems, but this demise of TCM hasn't happened yet.

In China and elsewhere, "Chinese medicine" is often contrasted with "Western medicine." For example it is said to work better for chronic conditions (whereas "Western medicine" is the treatment of choice for acute infections); it supposedly has fewer side effects; and it is said to treat the entire person instead of localized illness causes. Many of these statements first emerged in the Republican period (1911-1949), when Chinese medical practitioners were being attacked by proponents of "scientific medicine" and had to find a distinct niche for Chinese medicine.

Now, not all of Chinese medicine depends on its cosmological doctrines. Herbs that are commonly used in Chinese medicine need to be evaluated on a case-by-case basis instead of being lumped together into one big "junk medicine" trash can. Both ephedrine and artemisinin, for example, were first isolated from Chinese pharmacological substances. There might be other such drugs out there.

Finally, I haven't read the WHO report on the efficacy of some Chinese medical treatments, so I can't say anything about its content. But WP:MEDRS (cited above by OrangeMarlin) says this:

"Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the Institute of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization. The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature." [Source: Wikipedia:MEDRS#Medical_and_scientific_organizations.]

Some editors might not agree with the WHO's conclusions, which may indeed be "less authoritative than the underlying medical literature," but the WHO report definitely seems to be a reliable source.

Cheers,

Madalibi (talk) 01:40, 4 July 2011 (UTC)

Thanks Madalibi, your explanation is helpful, and balanced.Octopet (talk) 19:09, 6 July 2011 (UTC)

In light of reference #191 which states "Diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment" (a list of specific conditions, followed by lists of other conditions for which acupuncture has NOT been found to be effective), is this sentence from the lead accurate: "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." There appears to be a contradiction. What do you and other editors think about changing the word "little" to "limited" in this sentence? It would more closely match the statement by the NIH reference.Octopet (talk) 19:23, 6 July 2011 (UTC)

You're welcome, Octopet! I'm not qualified to review the medical evidence for and against acupuncture, but considering that "the threshold for inclusion in Wikipedia is verifiability, not truth," and because the WHO report qualifies as a reliable source (as per WP:MEDRS cited above), I think we should indeed change the lead to reflect the report's conclusions. Madalibi (talk) 07:19, 7 July 2011 (UTC)

One citation in support, with dozens not so much in support, is an undue weight concern. In fact #191 would probably fail MEDRS, so that statement is the one that's the contradiction. It's hard to find every single MEDRS problem in every single article around these places. The fact is there is NO evidence that acupuncture or TCM does anything beyond a placebo. I'm just going to delete whatever 191 refers to. That'll fix the issue. OrangeMarlin ^{Talk• Contributions} 07:27, 7 July 2011 (UTC)

Hi OrangeMarlin. Just asking: what is this "reference 191" that you and Octopet are referring to? Couldn't find it in the article. And undue weight is certainly an important issue. That's why I modified the wording so that it doesn't imply that Chinese medicine or acupuncture are widely considered efficient. I even removed the two words "so far," which semed to suggest that scientists were going to find evidence soon. Comments? Madalibi (talk) 07:33, 7 July 2011 (UTC)

Hi again! "Limited" is vague, so I agree it might not be the best word. But "no evidence" might not be better than "little evidence" either. I've never used (and I don't plan to use) TCM therapies, and I have no emotional involvement in this topic. Here I'm just concerned about editing Wikipedia. In that spirit, my point is that unless we can show that the WHO report represents a WP:fringe view despite citing 293 studies on acupuncture, we will probably have to mention it somewhere.

Some of these 293 studies will inevitably be unscientific (studies made in China are infamous for always finding Chinese medical treatments effective!), but at least some of these 293 sources should qualify as reliable by the standards of WP:MEDRS. If in the lead we say "no evidence beyond the placebo effect," we fail to reflect the minority point of view that these studies represent. As WP:WEIGHT puts it, "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint." I agree that the viewpoint that acupuncture is sometimes efficient is a minority view. As such it should only deserve a proportionally small space, but it sounds significant enough to deserve mention somewhere. Would you agree with that?

It's not my style as an editor to revert edits quickly, especially when we disagree over wording, so can we just discuss this here before we go back and forth? Can we try to find an acceptable wording that would say neither "no evidence" nor "limited evidence"? Cheers, Madalibi (talk) 08:02, 7 July 2011 (UTC)

I think reference number 191 is not that number any more. I think the reference that Octopet referred to is the WHO one (at least it contains this list of "diseases, symptoms or conditions for which acupuncture has been proved through controlled trials to be an effective treatment"). However, this (peculiarly bold) WHO statement is less authoritative than the underlying medical literature (per WP:MEDRS), so I don't understand all this ruckus. "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." still sounds very accurate to me. --Mallexikon (talk) 09:40, 7 July 2011 (UTC)

Sure, no problem with that. Should we just revert to that version? Madalibi (talk) 12:16, 7 July 2011 (UTC)

Yes, I'd recommend that. --Mallexikon (talk) 03:37, 8 July 2011 (UTC)

All right, done! Madalibi (talk) 04:15, 8 July 2011 (UTC)

WHO is one of the most respected medical organizations in the world, why dismiss it so readily? Could you point me to the source of your phrase "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture." - it may be out of date and not taking more recent German trials into account.Herbxue (talk) 16:41, 26 August 2011 (UTC)

neutrality

Does this article still warrant the neutrality tag? Octopet (talk) 20:53, 18 August 2011 (UTC)

Not in my book :)--Mallexikon (talk) 02:35, 19 August 2011 (UTC)

The article might still feel controversial to some readers, especially concerning the issue of efficacy, but I don't think it suffers from lack of neutrality. In this sense, the tag doesn't look warranted. Madalibi (talk) 02:48, 19 August 2011 (UTC)

The two of you (Mallexikon and Madalibi) who appear to be the most educated about this topic, don't give the impression of being biased. In fact, I can't tell what your opinions are regarding the efficacy of TCM. (I've looked back through March history). It's easier to be a critic than a neutral and knowledgeable contributor.

I'm leaving a request on your talk pages for feedback on some other articles. Octopet (talk) 18:02, 19 August 2011 (UTC)

I think there still is an issue with neutrality. Mallexikon rightly reverted a couple edits I made because I did not source them. However, I have objected to the Matuk article as a valid source several times before because it looks at TCM from an anatomists POV. This would be like asking a pharmacologist whether TCM is concerned with the pharmacological actions of herbs or not. TCM is very concerned with anatomy - both structure and function play important roles in assessment and treatment.

Also, there should be more context and specificity to the statement that clinical trials have shown little efficacy. For one thing, very little research has been conducted in the west, and the statement in the article makes it sound like TCM has been thoroughly tested, which it has not. It is not even possible to "test TCM" - the studies that claim to are usually testing the effect of a TCM herbal formula or single herb. It is true that several acupuncture trials have failed to show efficacy, but there is a lot of controversy surrounding the methodology. There are also many clinical trials in Chinese journals showing positive results. Also, perhaps most importantly, the statement made should really refer specifically just to acupuncture. In China, acupuncture is considered one modality of TCM. So attributing the poor results of acupuncture trials to a failure of TCM is a bit like saying the failure of a certain surgical procedure shows that western biomedicine is ineffective.Herbxue (talk) 15:08, 25 August 2011 (UTC)

I don't quite understand the problem with the Matuk article - it's by all means a reliable source. Why not read it once? It's not written by an anatomist, but by a M.Sc. in Biomedical Communications. Anyway, besides the Matuk source we also have Kaptchuk and Ross (please refer to the beginning of the "TCM model of the body" section), all stating the same thing about TCM and anatomic structures.

Regarding the efficacy - well, we have to go with what can be verified. All statements in the TCM article as they are now are absolutely true to their sources and the sources are all very reliable. If you'd like to contribute new reliable sources - very welcome, please go ahead.

BTW in my opinion what this article very urgently needs is a section about TCM diagnostics. Any interest, Herbxue? --Mallexikon (talk) 05:15, 26 August 2011 (UTC)

I feel that proper context is important and the article approaches the subject from distinct points of view (treating it as if it were a branch of biomedical science) and makes a judgement about how much TCM is "concerned" with anatomical structures that is only true relative to biomedicine. I would be fine if the article said "relative to modern biomedicine, TCM places less emphasis on anatomical structures and more on functional relationships" - this would be a more accurate picture. The current sentence sounds like TCM practitioners dismiss the importance of anatomy which is not accurate. When Kaptchuck says it, he is trying to introduce the unfamiliar reader to a very new way of looking at the body. When Matuk does it, she is doing it from the position of "who depicted anatomy more correctly?" Matuk is also an illustrator - someone whose job it is to make money by drawing anatomically accurate pictures and getting them published, not an authority on TCM.

Also, I do insist that the cochrane reviews are not capable of evaluating "TCM" - which involves looking at health and adapting in the moment to changing signs and symptoms - Show me some RCT's that don't eliminate the possibility of practicing TCM correctly. The sentence can accurately state that systematic reviews of acupuncture RCT's have shown little effect, but the article should also articulate the issues acupuncturists have with research methodology (not that this in any way cancels out the results of the systematic reviews) because that is a very important issue in the acupuncture community. There are many RCT's showing positive effects of TCM herbs and herbal formulas, but similar methodology problems and pluralistic clinical application raise similar issues. Can we just make the sentence more specific?Herbxue (talk) 14:19, 26 August 2011 (UTC)

Interesting discussion here, which resurrects some of my questions about the earlier discussion on TCM research.... Octopet (talk) 14:49, 26 August 2011 (UTC)

Ok, how would changing the lede sentence to "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." work for you?

Regarding the efficacy discussion I can only once more emphasize that wikipedia is all about verifiability. If you can contribute reliable sources documenting TCM's efficacy - great. Similarly, your argument about cochrane reviews not being capable of evaluating TCM is OR unless you have a RS to back it up. Cheers, --Mallexikon (talk) 02:54, 27 August 2011 (UTC)

One Cochrane review (http://www2.cochrane.org/reviews/en/ab003444.html) concludes Chinese Herbal Medicine to be effective when added to conventional care for schizophrenia. Even I will point out this does not really validate "TCM" it only really validates the specific herbal approaches used in the studies under review. Can you point me to the reviews that show that "TCM" has little effect? If not, the sentence should specify what modality (acupuncture) was concluded to have "little" efficacy, and for what conditions, in which reviews.

I appreciate your qualification of "compared with scientific medicine" - but it is does not clarify if the rest of the sentence reads the same as it did. I would be ok if it said "less concerned with anatomy than function" or something like that. I will look for a more reliable source. Because this is stating what TCM is "concerned with" the source should be from a standard TCM textbook or perhaps works by Unschuld or Sheid - people who have actually bothered to understand TCM before making generalizations like Matuk did.

Please tell me which review states that TCM has little efficacy. Herbxue (talk) 04:00, 27 August 2011 (UTC)

Actually, after browsing through more of the Cochrane reviews like this one (http://www2.cochrane.org/reviews/en/ab001218.html) I would like to go back to my change from "little evidence" to "mixed evidence" with the additional caveat that the inconclusive reviews are generally inconclusive due to methodological problems rather than failure of the intervention. The verbiage in the lead is not clearly supported by the RS. Please browse through at least 5-10 of the reviews searching "Chinese medicine" and "acupuncture", you will see what I mean. When they cannot support Acu or herbs, they often also cannot refute. That should be indicated in the lead.Herbxue (talk) 04:31, 27 August 2011 (UTC)

As far as I can see, the verbiage is clearly supported by the source. "The effectiveness of acupuncture beyond the placebo effect is not well established.". (And there're more sources given in the acupuncture article.) "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented."

We only state that there is little evidence. Why there is little evidence of efficacy doesn't matter. Maybe it's because of methological problems; maybe it's because TCM just doesn't work. But this is not the place to speculate. Cheers, --Mallexikon (talk) 04:59, 27 August 2011 (UTC)

Thanks for that. My problem is that to the novice reader the sentence in the lead sounds like TCM has been thoroughly studied and found to have little effect. That is not what your source says. The source says there have been few quality studies done. In the 4 years since, there have been other review papers, such as the ones I mentioned. Some point towards efficacy comparable or superior to conventional care, some continue to say positive results may be due to bias or poor methodology, some show that sham acu is as or almost as effective as real acu. Sounds like there is "mixed" evidence out there, and there is definitely more evidence now than there was in 2007 when the source said there was little.

I do not mean to be difficult and I certainly do not wish to cherry-pick evidence to suit my likes, but I do think a narrow retelling of part of the 2007 source's conclusion gives an incomplete and potentially misleading representation of the current state of the research. I think that is supported by the later, mixed evidence.Herbxue (talk) 05:28, 27 August 2011 (UTC)

I guess this discussion lead nowhere unless you actually contribute RS producing evidence for efficacy of TCM treatments. What our sources say so far is that effectiveness is "not well established" beyond placebo, or "poorly documented". Should we change the sentence in the lede accordingly? --Mallexikon (talk) 06:03, 27 August 2011 (UTC)

We should change the sentence to reflect the reality, as demonstrated in numerous Cochrane reviews, that the current state of the research is not the simplified statement you just made but rather a mixed bag of some promising (http://www2.cochrane.org/reviews/en/ab005288.html), (http://www2.cochrane.org/reviews/en/ab006568.html), (http://www2.cochrane.org/reviews/en/ab005052.html), (http://www.ncbi.nlm.nih.gov/pubmed/17893311?dopt=Abstract), (http://www2.cochrane.org/reviews/en/ab003444.html), some that demonstrate lack of significant effect (http://www2.cochrane.org/reviews/en/ab006791.html), (http://www2.cochrane.org/reviews/en/ab004882.html), (http://www2.cochrane.org/reviews/es/ab006454.html), and many that conclude there have not been sufficient RCT's to make any conclusions whatsoever (http://www2.cochrane.org/reviews/en/ab006224.html), (http://www2.cochrane.org/reviews/en/ab006414.html). I did not see any claims of irrefutable efficacy, but some that conclude that "Acupuncture should be considered a treatment option" (http://www2.cochrane.org/reviews/en/ab001218.html) due to increasing trend towards stronger evidence of efficacy, or that "the available evidence suggests that acupuncture could be a valuable option" (http://www2.cochrane.org/reviews/en/ab007587.html). Nowhere in these reviews did I see language such as "there is no difference between TCM and placebo" though there are those in which acupuncture and placebo are the same. Most just say "inconclusive" due to lack of studies. This is a reflection of where the research is at - mixed and inconclusive - so the lede should not give the impression that there is consensus about a lack of efficacy or lack of differentiation from placebo. Herbxue (talk) 07:16, 27 August 2011 (UTC)

To me, a neophyte reader of this topic, the lead implies there have been no studies showing promise. Perhaps expanding the section on efficacy by elaborating on the present state of research (without getting too arcane) would be valuable. Octopet (talk) 22:00, 27 August 2011 (UTC)

I think Herbxue has a point, here. We have to make an effort to take as many reliable clinical trials into account as possible (including the newest ones), and this will mean going beyond what one summarizing source says. The problem is I don't see how we can give a fair account of "TCM"'s efficacy (or lack thereof) in a single sentence. In the lead, we should probably mention which kinds of acupuncture or herbal therapies have been tested so far, and then explain what kinds of conclusions the testers have drawn. This will mean more than choosing between "little" and "mixed," since we will have to agree on a corpus of reliable sources, and then find a wording that all editors will agree represent the sources in a neutral and proportional way. I'm too tight on time to review the relevant literature to suggest a formulation, but I would be glad to discuss other editors' suggestions.

The issue of anatomy might be even more complex to tackle. Both TCM popularizers and historians of Chinese medicine have tended to say that function trumps anatomy, but historians are also starting to dig out evidence that anatomy and structure were far more important than we thought. Sure, Chinese interest in dissection was far less intense than the European obsession for it, but Chinese doctors knew the approximate location, shape, and size of internal organs, and they gave at least some importance to the physicality of these organs when they made a diagnosis or proposed a treatment. The problem is that this POV has not clearly emerged in many reliable sources, so we can't present it too strongly without falling into original research.

And we face another challenge: this wiki discusses a lot of classical concepts like the Five Phases or Yinyang cosmology, but other sections are clearly about modern TCM only. Where do we draw the line? I know that modern modern practice is inextricably tied to classical doctrines, but we will get a different picture of Chinese medicine if we discuss modernized TCM diagnostics than if we explain how Chinese physicians diagnosed patients in, say, the sixteenth century. If we focus on pre-modern times, we might want to point out that Chinese medical books did not mention the pancreas, and that the "Gate of Life" (命门) and the "triple burner" (三焦) correspond to no anatomical reality. But modern TCM doctors know that the pancreas exists, and do not falsely believe that the Gate of Life is a physical structure. So again, where do we draw the line? By the same token, are we discussing TCM as it is practiced in the Western world, or are we also including China? If the latter, TCM theory will look quite different, since Chinese TCM colleges routinely teach anatomy and biomedical precepts to their students.

For anatomy, I think the simplest way to start would be to reword our sentence on the relative importance of function vis-a-vis structure. Do you all find that the Kaptchuk citation at the beginning of the "TCM model of the body" section gives a fair picture? If so, we should summarize it. If not, we could also cite reliable info from Nathan Sivin's survey of Chinese medical doctrines at the beginning of his Traditional Medicine in Contemporary China (1987), which is about modern TCM, but is aware of Chinese medical history (since Sivin is a historian of Chinese science).

In any case, we can further improve this article without forgetting about "verifiability" and "reliable sources," so let's give it a try! Madalibi (talk) 03:38, 28 August 2011 (UTC)

There is very much to think about in your post, Madalibi, so I will start a new section for the Anatomy issue and lets keep the issue about how to re-word the statements about research in this section. About the issues of classical (or "canonical" - based on classic texts) vs. modern practice: that could be another section as well, but I believe the term "TCM" generally is considered a 20th century development that distinguishes it from modern biomedicine. As such, in my mind, we would default towards contemporary practices in general and specify when we are talking about a distinct theory prevalent in a particular era.Herbxue (talk) 02:31, 30 August 2011 (UTC)

Yes, I agree that we should focus on modern practices, though we shouldn't forget to explain how "TCM" emerged in the 1950s and 60s. And I'm looking forward to reading your new section on anatomy! Cheers, Madalibi (talk) 02:45, 30 August 2011 (UTC)

Lead/Lede

The phrase 'tongue findings' is vague. Does anyone object to rewording it: 'TCM diagnosis involves identification of patterns of disharmony, usually by taking into account the pulse and the condition of the tongue'?Octopet (talk) 22:11, 27 August 2011 (UTC)

Sure, let's try to eliminate vague words. Another one is "involves," followed by a noun (identification). How about "TCM diagnosis consists in identifying..."? Madalibi (talk) 08:18, 28 August 2011 (UTC)

Sounds good - its difficult to not go into too much detail while trying to clear these up. For example, TCM Diagnosis requires 4 diagnostic methods: Inspection (including but not limited to the tongue), Auscultation and Olfaction (Listening and Smelling grouped together), Palpation (including but not limited to the pulse), and Interrogation (taking their medical history and detailed questions about symptoms). For now, how about we put our ideas together for something like "TCM diagnosis consists of identifying patterns of disharmony by taking into account the patient's medical history, current symptoms, and various diagnostic methods including palpation of the pulse and inspection of the tongue" ? Is that sentence too unwieldy? — Preceding unsigned comment added by Herbxue (talk • contribs) 15:07, 28 August 2011 (UTC)

Yes, these are the "four methods of diagnosis" (si zhen 四診), an old construct that is still presented as central in TCM manuals. Listening and smelling are put together because the Chinese word for them is the same: wen 聞. I like the flow of the sentence you propose, Herbxue, but I think it makes pulse diagnosis appear less central than it is, and that there is probably a better way to explain the role of "current symptoms." How about "TCM diagnosis consists in tracing visible symptoms to an underlying disharmony, mainly by palpating the pulse and inspecting the tongue." Short and sweet, and "mainly" makes it clear that there are other methods, which we can explain in more detail in an eventual section on diagnosis. Any comments? (Note that tongue inspection was only systematized in the late 19th century. Does anybody know when it became such a mainstream diagnostic method?) Madalibi (talk) 09:57, 29 August 2011 (UTC)

Your sentence sounds great (although "visible" might be replaced with apparent or just no qualifier of "symptoms" at all as symptoms are generally subjective and not visible). The diagnosis section can give the fuller picture. Ye Tian Shi, whose lectures on Warm Diseases (Wen Bing) and copious case studies are generally credited with expanding the use of tongue diagnosis in the early 18th century. Because of his many volumes of case studies and great reputation, his methods became more and more popular. The great syncretists of the early modern era (such as Qin Bowei) incorporated tongue diagnosis and Wen Bing methods into a more universal overview of Chinese medicine that eventually got boiled down even more with the systemization of "TCM" in the 20th century. Today, tongue diagnosis is generally considered easier to learn and relatively more objective than pulse diagnosis (there is greater likelihood that different practitioners will arrive at the same diagnosis by inspecting the tongue), but that does not need to be in the article, just an example of why tongue diagnosis is on equal footing in modern textbooks despite its relatively short (300+ years) period of development.Herbxue (talk) 15:10, 29 August 2011 (UTC)

I think Zhou Xuehai also played a role in the late nineteenth century, but I would have to check my sources. Thanks for the information! Madalibi (talk) 03:41, 30 August 2011 (UTC)

I also like the sentence as Madalibi suggested it. I'd like to emphasize once more, though, that the diagnosis section still has to be created (and I'm too busy right now). Cheers, --Mallexikon (talk) 07:12, 30 August 2011 (UTC)

Efficacy

I went through the cochrane reviews that Herbxue found - at least through the ones with "promising" results. Altogether, there were 5.

1. Herbal medication for menstrual pain. Data for placebo control not obtainable (so it's not an RTC in the strict sense of the term). "... results are limited by the poor methodological quality of the included trials".
2. Herbal medication for endometriosis. Both trials without placebo control (= again, no real RCT). "...poor methodological quality".
3. Herbal medication for heart insufficiency. Only one of the 6 included trials had placebo control, and was very small (40 patients). "...the evidence for any benefit of Shengmai is weak, as the trials were all of low quality..."
4. The GERAC study (acupuncture for low back pain). Acupuncture was seen to be significantly effective, however, no more effective than placebo ("sham acupuncture").
5. Herbal medication for schizophrenia. No placebo controls (...). "...further trials are needed before the effects of TCM for people with schizophrenia can be evaluated with any real confidence".

I'm sorry but except for the GERAC study I don't even find these studies worth mentioning. Their results can't be termed "evidence" as their methological quality is too bad to be counted as proof (mainly because they lack placebo controls). Our articles statements "The effectiveness of acupuncture beyond the placebo effect is not well established" and "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented" are all still valid in light of those cochrane reviews, and thus I'd also not change the lede sentence ("Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture.) --Mallexikon (talk) 07:12, 30 August 2011 (UTC)

I think you may be missing my point, and I think you are selectively accepting one reliable source over several. Cochrane reviews are considered among the strongest sources by the WP community, and words like "promising" come from the authors' conclusions, not my interpretation. And critiques like your of the studies covered by the systematic reviews 1. Can be made about the individual studies if primary sources are "allowed", but not the systematic review and 2. Are not our jobs as a WP Editors - the Cochrane reviewers made their conclusions and we should report them as-is, blemishes and all. (I am not opposed to then discussing their relative merit - but I am told that would be considered Original Research here).

But that is neither here nor there - I am not nearly as insistent on showcasing effective herbal or acu studies as you are insistent on wording (corrected from "verbiage") that makes it sound conclusively ineffective to the average reader.

You seem to think I want to make the picture look prettier than it is. I don't mind that TCM gets beat up in the uneasy early attempts at integration into the Evidenced Based Model (which is not all its cracked up to be either), but I strongly object to wording that wraps the messy reality up into a neat little bundle. The real evidence is not neat. Its a mixed-up mess. The sources support what I say. Lets report it as it really is. There is not conclusive evidence that TCM therapies are ineffective (or effective), but the article continues to suggest that to the reader (as confirmed by Octopet), which leaves the reader with incomplete information (at best) or inaccurate assumptions (at worst). Herbxue (talk) 15:09, 30 August 2011 (UTC)

This issue is difficult to deal with because it's complex in real life, and because editing on "alternative medicine" is one of the most delicate things you can do on Wikipedia. Disagreements are normal, so let's all take it easy! Mallexicon, a good-faith editor who has contributed a lot to this article, has defended a formulation which, far from being verbiage, might actually be too short to accommodate the level of complexity that Herbxue wants to introduce into the article. One point of disagreement seems to be over how to use Cochrane reviews: should we only take these reviews' conclusions into account (Herbxue), or should we also evaluate the evidence they use to support their conclusions (Mallexicon)? I usually like to evaluate the content of individual sources to see if they're reliable (as I tried to do above with Matuk's article), but maybe this is not how Wikipedia editors commonly treat Cochrane reviews, which are obviously different from the historical articles I'm used to dealing with. For now, let me just suggest that both of you consult a section called Acupuncture#Scientific_basis_and_research_on_efficacy, which cites lots of evidence on acupuncture and contains lots of balanced formulations on its efficacy or lack thereof. Maybe that will help to adopt turns of phrase that we can all agree with. Madalibi (talk) 08:09, 31 August 2011 (UTC)

Thanks. I definitely recognize Malllexicon has been one of the greatest contributors to this article and has improved it immensely. I actually was misusing the term verbiage, attempting to just refer to the wording, which I thought sounded too conclusive.Herbxue (talk) 14:02, 31 August 2011 (UTC)

No offence taken, and thanks for the compliment :) Madalibi has once more found more suitable, diplomatic words than me here. I still think that our current statement "Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented" is summing the Cochrane reviews up astonishingly well even as it comes from a much earlier paper. However, I don't see any harm in elaborating a little more on those reviews in the efficacy section. In the lede, the situation is different, though, since it should give a short overview. But I'm sure we'll work it out. --Mallexikon (talk) 11:24, 1 September 2011 (UTC)

I thought about how to specify the information about efficacy in the lede a little. How does "Clinical trials have so far produced little evidence for the efficacy of TCM therapies, such as acupuncture, beyond placebo; for herbal therapy, few trials of adequate methodology exist" sound? --Mallexikon (talk) 02:21, 18 September 2011 (UTC)

After making queries at other medicine-related article talk pages, my current assessment is that any statement about efficacy is not appropriate for the lede. If you look at other medical articles, the lede paragraphs are mainly descriptive of the practice or specialty. See pages such as Urology, Gynecology, Dilation and curettage, Whipple procedure, Osteopathy. Given the mixed and incomplete picture in the literature, it is premature to include such a statement in the lede. Given the norms at other similar articles, it seems inappropriate.Herbxue (talk) 23:00, 18 September 2011 (UTC)

Hm, I just checked homeopathy - and efficacy is big in the lede. Then I checked a largely outdated Western treatment called bed rest - the lede includes this: "Some clinicians now regard bed rest as being at best neutral to outcome, and in some cases potentially harmful to patients." So, no, I don't think mentioning efficacy in the lede is inappropriate. Besides, the picture in the literature is not necessarily mixed - there's no study of adequate methodology proving the efficacy of acupuncture or herbal therapy beyond placebo. Why not say it as it is? --Mallexikon (talk) 04:56, 20 September 2011 (UTC)

Relative importance of Anatomy in TCM

I had proposed rewording the phrase "TCM's view of the body is little concerned with anatomical structures" because this phrase is misleading (sounds like TCM dismisses anatomy or does not utilize knowledge of anatomy). I recognize that the original wording is based on RS that is acceptable by WP guidelines, but I think it gives undue weight to a view of TCM from the outside that makes a judgement about what it is "concerned" with relative to how much western biomedicine is concerned with that same topic. (It is only relatively true, not absolutely true). If you read the source (Matuk) you see that the comparison is from the perspective of a medical illustrator. Of course she will conclude that TCM is not very concerned with anatomy - they never bothered to do good drawings and her conclusions are not based on contemporary TCM. In the case of the Kaptchuk quote, he rightly points out the relative "tendency" to emphasize function over structure, and that the classical depictions of anatomy are nowhere near as accurate and sophisticated as those of western scientists. This is not the same as suggesting that TCM doctors are not concerned, or only slightly concerned with anatomy. Mallexikon had proposed changing it to: "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." My issue really is with the word "little", though it may be useful to include the comparison to conventional biomedicine (why say "scientific medicine"? Have you met any MDs? Ask a dermatologist how evidence-based their practice is. Not very).

I recommend changing the sentence from: "TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities (which regulate digestion, breathing, aging etc)" to: "TCM's view of the body is less concerned with anatomical structures than with the identification of functional entities (which regulate digestion, breathing, aging etc)"

What do you think?Herbxue (talk) 03:12, 30 August 2011 (UTC)

I like your sentence. The key adjustment is that it speaks of relative interest rather than lack of concern. And I agree that we should find a better source than Matuk for anatomy. It's convenient because it's short and available online, but her analyses are either undigested (tension between a constructionist position and an outright rejection of pre-modern views; tension between "vision is cultural" and "the Chinese were not investigative so they just failed to see it") or drawn from much better sources, like Shigehisa Kuriyama's book The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (1999). I can also propose better sources on cosmologically driven correlations between the body, the universe, and the state. Madalibi (talk) 03:38, 30 August 2011 (UTC)

I still recommend "In comparison to scientific medicine, TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities ..." From an anatomical point of view, TCM contributed about zero discoveries to this subject. And I don't blame them - anatomy is a natural science "that seek(s) to elucidate the rules that govern the natural world by using empirical and scientific methods" - which TCM never did, and never attempted to. It's very obvious and we have sources (Matuk, Kaptchuk, Ross) stating the very same. --Mallexikon (talk) 07:42, 30 August 2011 (UTC)

As I see it, the issue is more about the place of anatomy in TCM's model of the body than about which tradition contributed the most to anatomical knowledge. In this sense I'm not sure such an explicit comparison with "scientific medicine" is helpful. After all, this is a wiki about TCM, not a comparative article between TCM and biomedicine! Also, the comparison with "scientific medicine" should be explicit in our reliable sources if we want to include it in here. I know that neither Katpchuk nor Ross use this kind of language, and Matuk doesn't use these words directly, though one could argue that this is what she means. But honestly, Matuk's article a huge mess, as you would expect from a text that speaks of "medieval Europe (322 B.C.)" or of "the rise of Holy Roman Empire over Egypt." Let me take a day or two to see what other reliable sources say about anatomy in Chinese medicine, and I'll get back to you on this.

Incidentally, "TCM's view of the body is little concerned with anatomical structures, but with the identification of functional entities" sounds grammatically awkward. We could say either: 1) "...is concerned not with..., but with..." (too absolute); or 2) "...is little concerned with..., but prefers to see organs as..." (potentially acceptable, but we will have to see if "little concerned" is verifiable). In the end I still think that Herbxue's "...is less concerned with... than with..." is the best formulation we've seen so far, because it's both neutral and reflective of RS, not to mention simple. Madalibi (talk) 09:32, 30 August 2011 (UTC)

Well, Kaptchuk says "... the Chinese have no system of anatomy comparable to that of the West", and Ross says "Chinese medicine ... emphasizes function. Little emphasis is placed on structure, especially internal structures." (I took these quotes directly from our article). You could of course argue that a debate about phrasing it "little concerned" or "less concerned" amounts to hair-splitting, but I think we should be careful here not to put lipstick on a pig, in order to keep our NPOV. Cheers, --Mallexikon (talk) 11:06, 30 August 2011 (UTC)

Both in the spirit of verifiability and substantially in the real world, I basically agree with what Kaptchuk and Ross say. Below, I also provided more references we can use. What I find neither NPOV nor verifiable, though, is an explicit comparison with "scientific medicine," because this is not the language our sources use. Many people will read this article with an implicit comparative mindset, so maybe we should make some kind of comparison explicit, but I don't think "scientific medicine" is the word we're looking for. Using it would be like placing a new mule next to that pig we're so lovingly trying to redecorate. Lol. All right, the last sentence confirms that it's time to log out for today! Madalibi (talk) 11:26, 30 August 2011 (UTC)

[Written before I saw Mallexicon's new post above.] Just for consultation, here are a few passages on TCM anatomy from sources I consider reliable.

Judith Farquhar (University of Chicago anthropologist who did her fieldwork in a TCM college in Guangzhou) says this:

Chinese medicine heals in a world of unceasing transformation. This condition of constant change, this fluidity of material forms, stands in sharp contrast to a (modern Western) commonsense world of discrete entities characterized by fixed essences, which seem to be exhaustively describable in structural terms.... One consequence of this dynamic bias in Chinese medicine is that the body and its organs (i.e., anatomical structures) appear as merely contingent effects or by-products of physiological processes. (SOURCE: Knowing Practice: The Clinical Encounter in Chinese Medicine [1994], pp. 24-25.)

Nathan Sivin (eminent historian of Chinese science, now retired from the University of Pennsylvania):

The authors [of a book Sivin translates into Chinese] emphasize that they "cannot simply impose Western medicine's conception of the internal organs". Indeed what we learn about the Chinese conceptions is not anatomical but physiological and pathological–as usual, not what the viscera are but what they do in health and sickness. In order to keep constantly before the reader the emphatic differences between these functions and those of the organs that bear the same names in modern medicine, I translate tsang-fu [i.e., zang-fu] 脏腑 in chapter 2 and elsewhere not as "viscera," but as "visceral systems of function" (abbreviated as "visceral systems"), and similarly for the individual tsang and fu. (SOURCE: Traditional Medicine in Contemporary China [1987], pp. 120-21.)

Shigehisa Kuriyama (Harvard Ph.D. and Harvard Professor, whose book is the direct source of almost all the good ideas in Matuk's article):

Discussions of the zang and fu in the Neijing typically have to do less with discrete structures seen in dissection thatn with configurations of sympathetic powers. "Gall bladder disease" thus could refer as easily to disorders like dizziness or ringing in the ears as to an affliction in the gall bladder itself. When scholars insist that Chinese viscera differ from Western organs, this is what they usually mean: the zang and fu weren't anatomically conceived. (SOURCE: The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine [1999], pp. 265-67.)

Volker Scheid (anthropologist, historian, and TCM practitioner) calls TCM conceptions of internal organs a "functional anatomy" (Chinese Medicine in Contemporary China: Plurality and Synthesis [2002], p. 196).

I'll let other editors judge what information we can draw from these passages. Note in any case that comparisons are to "Western medicine" (the textbook Sivin translated), "modern medicine" (Sivin), "(modern Western) commonsense world" (Farquhar), and Greek medicine (Kuriyama). Logging out for today! Cheers, Madalibi (talk) 11:19, 30 August 2011 (UTC)

Thank you for doing so much work! These are all great sources and really flesh out (pun intended) the topic in a more diligent way than the Matuk paper did. These do a wonderful job of getting at the distinction between the western medical goal of locating a physical cause of disease and the Chinese medical goal of understanding the physiological disharmony among the zang fu. I haven't thought about how to incorporate these into the article wording yet but will.Herbxue (talk) 21:23, 30 August 2011 (UTC)

Tone indication in pinyin headings

I know it's tempting to use the correct form of pinyin terms as much as possible, but in order to make the article consistent I'm afraid we'll have to consent about whether to use qi, zang-fu, xue etc. or qì, zāng-fú, xuě in the headings. Since article headings in wikipedia don't use the tone-indicating form (like qi, zang-fu etc.) I recommend to stick to that in the section headings as well (and harmonised accordingly). Comments? -Mallexikon (talk) 04:48, 27 December 2011 (UTC)

Yes, the tone marks can get too bulky, and confusing for readers unfamiliar with Chinese language. Also, the situations in which important terms are homophones (such as Jing 精 essence and Jing 经 channels ) only occasionally are clearly distinguished by different tones (Jing and Jing are both first tone) so the tone marks are not that helpful in this context. Herbxue (talk) 06:06, 29 December 2011 (UTC)

Removed Cite errors

Here, I removed the references because they were empty references and created citation errors. Look at the bottom of the page in "References" and you will see 2 consecutive reference (references 168 and 169) errors:

• Cite error: Invalid <ref> tag; no text was provided for refs named Ernst2006; see Help:Cite errors/Cite error references no text

and

• Cite error: Invalid <ref> tag; no text was provided for refs named Cochrane_back_2005; see Help:Cite errors/Cite error references no text

in big red font. Curb Chain 06:59, March 8, 2012‎ (UTC)

Thanks for the explanation. Next time you can explain in the edit summary. (This will also keep your statistics "clean", since edit summaries are tracked, and you'll want to keep it at 100%). I'll fix the problem. -- Brangifer (talk) 05:38, 9 March 2012 (UTC)

I did write "empty" in the edit summary. That may not have been very informative I admit.Curb Chain (talk)

Quote in herbs section

I can't see the significance of this quote here: "According to Zhang Jiegu: "The method of appropriately using herbs in accordance with the symptom and sign presentation of the patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the meridian it has entered." —Zhang Jiegu" Can someone point it out to me? Otherwise I'd delete the quote. --Mallexikon (talk) 09:22, 9 March 2012 (UTC) 05:38, 9 March 2012 (UTC)

Well, I am ambivalent. The quote neatly sums up some of the considerations of TCM herbalists, but without understanding TCM concepts it probably just sounds like nonsense. "Thick and thin" makes absolutely no sense if you don't know what herbs are considered "thick" and which are "thin" and why we think of them that way (has to do with strength of flavor and corresponding therapeutic effect). Also, PPdd was trying to make Zhang seem to be a much more important figure than he was so he (PPdd) could include some quotes from Zhang that lent undue weight to some fringe aspects of medicine from his era. So, I would say go ahead and delete.Herbxue (talk) 05:48, 9 March 2012 (UTC)

Cool. Done. --Mallexikon (talk) 07:15, 16 March 2012 (UTC)

Environmental Impact

There should be a section explaining the impact of TCM. It is well known for being a cause of rhino, tiger, etc. poaching. — Preceding unsigned comment added by 70.59.19.180 (talk) 20:28, 28 October 2012 (UTC)

On Manchu Medical Manuscripts and Blockprints

http://www.hopkinsmedicine.org/martahanson/Content/Hanson_Manchu_Medical_Sources_Bibliography_2003_Saksaha.pdf

Rajmaan (talk) 21:30, 30 December 2012 (UTC)