Most, if not virtually all, of what is now referred to as "traditional Chinese medicine" is quackery. I realize that it's considered "intolerant" and not politically correct to say that in these days of "integrative medicine" departments infiltrating academic medical centers like so much kudzu enveloping a telephone pole, but I don't care. I'm supposed to be impressed that the M.D. Anderson and Memorial-Sloan Kettering Cancer Centers, among others, have lost their collective mind and now "integrate" prescientific nonsense along with their state-of-the-art cancer therapy? I don't think so. I can be puzzled by it. I can be dismayed by it. I can even be enraged by the infiltration of woo into prestigious medical centers. I am not, however, impressed by it, at least not in the sense that I'm about to jump on the bandwagon and embrace pseudoscience, too. I will admit, however, to being impressed—but not in a good way—with the ability of clinical leaders at such institutions who really should know better to embrace pure pseudoscience, including acupuncture, tongue diagnosis, the balancing of hot, cold, damp, and the other things that TCM claims to balance, and the vitalism that is at the heart of TCM in the form of qi, the undetectably imaginary life "energy" whose flow is supposedly redirected to healing effect by acupuncture.

Particularly galling about the ascendency of TCM in the US is the myth that is swallowed whole by its advocates. That myth is the very history of TCM, whose true origins are unknown by all but a very few. Contrary to popular belief (particularly about acupuncture), those beliefs do not go back thousands of years into antiquity, when the ancient healing wisdom of the Chinese was supposedly first discovered. In actuality, very few people are aware that the single person most responsible for the current popularity of TCM was not some ancient Chinese healer but rather Chairman Mao Zedong. That's why an article published by Alan Levinovitz in Slate.com entitled Chairman Mao Invented Traditional Chinese Medicine is so important.

Before I get to the good stuff, I do have to point out one thing that irritated the hell out of me about the article. Never let it be said that there is anyone more dismissive of naturopathy. My favorite description of naturopathy is that it is a veritable cornucopia of quackery, selected in a manner not unlike that of the proverbial menu in a Chinese restaurant: One quackery from column A, two from column B. Naturopathy mixes homeopathy, TCM, herbalism, diet woo, and just about every other form of quackery you can think of, mixing it into one homogenous pseudoscientific slurry of quacky badness. I was also the one who noticed that Senator Barbara Mikulski (D-MD), a woo-friendly legislator almost on par with the Dark Lord of Legislative Quackery and Creator of the National Center for Complementary and Alternative Medicine (NCCAM) himself, Senator Tom Harkin (D-IA), had gotten a resolution through the Senate declaring the week of October 7-13 as Naturopathic Medicine Week. I declared it Quackery Week, and a few bloggers agreed. Oh, well, it wasn't one of my more successful ideas.

Be that as it may, Levinovitz uses Naturopathic Medicine Week to introduce his article, and it's a mistake:

Mikulski and the rest of the Senate may be surprised to learn that they were repeating 60-year-old justifications of Chinese medicine put forward by Chairman Mao. Unlike Mikulski, however, Mao was under no illusion that Chinese medicine—a key component of naturopathic education—actually worked. In The Private Life of Chairman Mao, Li Zhisui, one of Mao’s personal physicians, recounts a conversation they had on the subject. Trained as an M.D. in Western medicine, Li admitted to being baffled by ancient Chinese medical books, especially their theories relating to the five elements. It turns out his employer also found them implausible. “Even though I believe we should promote Chinese medicine,” Mao told him, “I personally do not believe in it. I don’t take Chinese medicine.”

TCM is not naturopathy. It is part of naturopathy, but it is not naturopathy, any more than homeopathy is, even though, as I have pointed out, you can't have naturopathy without homeopathy. The introduction is a stretch that gives the mistaken impression that naturopathy is mostly TCM. It's not. For instance, take a look at this statement by a naturopath named Erika Horowitz:

Detoxification is a big part of naturopathic theory and practice. Helping the body eliminate toxins safely and effectively can play an important role in improving health and preventing disease. One of the most useful detoxification therapies I use in my practice is the use of UNDA numbers, which are unique combinations of liquid homeopathic formulas founded on the theories of Chinese medicine, homeopathy, and anthroposophy.

This brief paragraph to me sums up the essence of naturopathy, which is to mix and match quackeries from a variety of sources like an insane game of Mad Libs for quacks. One coud as well insert Ayurvedic medicine, Native American medicine, shamanism, iridology, reflexology (popular among naturopaths), detox foot baths, biotherapeutic drainage, and, of course, chelation therapy.

My little fit of pique over an aspect of the article thus disposed with, I'll say that the rest of the article is quite good, and it is quite true that much of the reason for the popularity of TCM in China and its spread to the US and beyond was because of Chairman Mao's promotion. The reason, as has been explained on one of my favorite bloggers, Kimball Atwood, and others, is because there simply weren't enough doctors in China trained in scientific medicine, as admitted by Mao (quoted by Levinovitz):

Our nation’s health work teams are large. They have to concern themselves with over 500 million people [including the] young, old, and ill. … At present, doctors of Western medicine are few, and thus the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. (Translations from Kim Taylor’s Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution.)

Who knew? (Well, I did.) I also knew, as Levinovitz relates, that this was the very first "integrative" medicine, "integrating quackery with science-based medicine more than four decades before the term "integrative medicine" caught on in the US. A particularly pertinent quote sums this idea up:

“This One Medicine,” exulted the president of the Chinese Medical Association in 1952, “will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements—and will be China’s New Medicine!”

Indeed, what's interesting about Levinovitz's article is his description of how the exportation of TCM to the world was quite deliberate, as part of a strategy to popularize it among the Chinese. There was a problem, however. As Levinovitz noted, there was no such thing as "traditional Chinese medicine." Rather, there were traditional Chinese medicines. For many centuries, healing practices in China had been highly variable, and attempts at institutionalizing medical education were mostly unsuccessful and "most practitioners drew at will on a mixture of demonology, astrology, yin-yang five phases theory, classic texts, folk wisdom, and personal experience." While it's irresistible (to me, at least) to make an analogy to how naturopaths draw from a wide variety of quackeries, TCM is not naturopathy. Mao realized that TCM would be unappealing to foreigners, as even many Chinese, particularly those with an education, realized that TCM was mostly quackery. For instance, in 1923, Lu Xun realized that "Chinese doctors are no more than a type of swindler, either intentional or unintentional, and I sympathize with deceived sick people and their families." Such sentiments were common among the upper classes and the educated. Indeed, as we have seen, Mao himself didn't use TCM practitioners. He wanted scientific "Western" medicine.

Mao's strategy to deal with these criticisms was quite deliberate—and clever. It consisted of two strategies, both designed to mythologize TCM as being a scientifically sound and harmonious "whole medical system" and to provide "evidence" in the form of testimonials that it worked, as Levinovitz relates:

His solution was a two-pronged approach. First, inconsistent texts and idiosyncratic practices had to be standardized. Textbooks were written that portrayed Chinese medicine as a theoretical and practical whole, and they were taught in newly founded academies of so-called “traditional Chinese medicine,” a term that first appeared in English, not Chinese. Needless to say, the academies were anything but traditional, striving valiantly to “scientify” the teachings of classics that often contradicted one another and themselves. Terms such as “holism” (zhengtiguan) and “preventative care” (yufangxing) were used to provide the new system with appealing foundational principles, principles that are now standard fare in arguments about the benefits of alternative medicine.

The second part of the strategy was the dissemination of spectacular anecdotes to "prove" the efficacy of TCM. The most famous of these was the case of James Reston, a New York Times editor who underwent an emergency appendectomy while visiting China in 1971. Even though the surgeons there used a fairly standard anesthesia technique, described by my good bud anesthesiologist Dr. Kimball Atwood as sounding like a "standard regional technique, most likely an epidural," acupuncture was used to treat cramping on second evening after the surgery, which I interpreted as being the evening of postoperative day one. The story is familiar to any surgeon; about a day and a half after surgery Reston had some cramping, likely due to postoperative ileus that kept the gas from moving through his bowels the way it normally does. It passed after an hour or so. Around that time, the staff at the hospital used acupuncture to treat his discomfort, and the logical fallacy known as post hoc ergo propter hoc fallacy (and a bunch of credulous Westerners, eager to believe that some magical mystical "Eastern" wisdom" could do what "Western medicine" could not, did the rest. Most likely what happened is that Reston finally farted, letting the built up gas move through and relieving the cramps and bloating. About a day or two after an uncomplicated appendectomy is about right for that.

Over time, reports of "acupuncture anesthesia" trickled out of China to a welcoming, credulous "Western" press. When examined closely by doctors who know about anesthesia (such as an anesthesiologist), these stories universally have big holes in them. Just a few examples were catalogued by an anesthesiologist, again my good bud Kimball Atwood. In fact, you can view Levinovitz's article as the CliffsNotes version of the campaign by Mao to convince the West that acupuncture (and, by extension, TCM) worked as well or better than any "Western medicine." Read Kimball Atwood's epic “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part I, Part II, Part III, Part IV, and Part V) for the detailed version. Of particular interest to students of "integrative medicine" is Part III, in which Dr. Atwood has an entire section entitled "From ‘Co-operation’ to ‘Integration,'" in which he lists the five main party slogans about TCM:

1945-50 ‘The Co-operation of Chinese and Western Medicines’

1950-8 ‘The Unification of Chinese and Western Medicines’

1950-53 ‘Chinese Medicine studies Western Medicine’

1954-8 ‘Western Medicine studies Chinese Medicine’

1958- ‘The Integration of Chinese and Western Medicines’

Mao's idea was nothing less than the complete unification of TCM and "Western" medicine, as quoted by Kimball Atwood further from The Private Life of Chairman Mao:

Mao laughed. ‘The theory of yin and yang and the five elements really is very difficult,’ he said. ‘The theory is used by doctors of Chinese medicine to explain the physiological and pathological conditions of the human body. What I believe is that Chinese and Western medicine should be integrated. Well-trained doctors of Western medicine should learn Chinese medicine; senior doctors of Chinese medicine should learn anatomy, physiology, bacteriology, pathology, and so on. They should learn how to use modern science to explain the principles of Chinese medicine. They should translate some classical Chinese medicine books into modern language, with proper annotations and explanations. Then a new medical science, based on the integration of Chinese and Western medicine, can emerge. That would be a great contribution to the world.’

It's certainly a "contribution," but it's certainly not "great." Unfortunately, it is a contribution that keeps on giving. "Integrative medicine" today echoes the very same arguments pioneered by Chairman Mao, the Chinese medical establishment 60 years ago, and one of the greatest mass propaganda machines that ever existed. Of all the TCM modalities, acupuncture benefited the most from Chinese propaganda. Most people are unaware of TCM tongue diagnosis (which is basically reflexology, with organs mapped to areas of the tongue rather than to areas of the soles of the feet or palms of the hand) or its ideas of balancing five elements. Almost everyone, however, knows what acupuncture is, and many of them believe that there might be something to it, the more so given that so many academic medical centers are embracing quackery like acupuncture wholesale.

Moreover, acupuncture is probably not nearly as ancient as its advocates portray it. Common portrayals of acupuncture paint it as being 3,000 years old, as implausible as that is. Why implausible? For one thing, the technology to make such incredibly thin needles didn't exist 3,000 years ago. For another thing, as Harriet Hall points out, the earliest Chinese medical texts from the 3rd century BC don't mention acupuncture, and the earliest reference to "needling" is from 90 BC referring to bloodletting and lancing abscesses. Indeed, even by the 13th century the earliest accounts of Chinese medicine reaching the West didn't mention acupuncture, and the first account of acupuncture by a Westerner in the 1600s described large golden needles inserted into the skull and left in place for 30 respirations. It has also been argued that acupuncture evolved from bloodletting based on astrology.

While it is true that there was such a thing as Chinese folk medicine that's existed for hundreds of years, the phenomenon of TCM as we know it today was invented—or perhaps I should say "re-invented"— nearly out of whole cloth by Chairman Mao, whose powerful propaganda machine used a combination of "harmonizing" inconveniently unharmonious sources and manufacturing a dog and pony show of testimonials and demonstrations of "acupuncture anesthesia" to sell it first to the Chinese people and then to the rest of the world. The entire undergirding of TCM is little more than vitalism, magical thinking, and five elements instead of four. It is very depressing to think there are more than a few Very Serious Academic Doctors out there who have bought into this myth and have even widened Mao's vision of "integration" beyond "integrating" SBM with TCM to include virtually every form of magical quackery in existence.