In 2006, Cochrane Reviews put out a systematic analysis of herbal treatment for Irritable Bowel Syndrome (IBS). I was finishing chinese Medicine school and had entered into an apprenticeship at the time, and that Cochrane review made my future seem so bright. 

“Now” there is proof that some herbs work for IBS, I thought, published by a highly respected, charity organization. If regular doctors and their patients want Evidence Based Medicine, here is the evidence. I recall bringing that study to my mentor, who was less enthusiastic than I expected. Already in his 60’s, he was not open to the idea that things would change, vis-à-vis TCM. Of course, things haven’t changed since that time – not really – and I am left to think about why. 

Little did either of us know that we were entering into a period – starting around 2007 – when top-down perspectives – cultural, economic, medical, etc. – would increase in dominance. Since that time and until recently, for example, many companies have demonstrated that they can increase prices – Apple, Starbucks, Coca-Cola, Louis Vuitton, McDonald’s – without reducing customer loyalty to their brand. This collective loyalty also appeared in relation to celebrities, musicians, political movements, and even renowned doctors and medical institutions, like the Mayo Clinic. 

In hindsight, I was naive to think that a low-profit practice like herbal medicine, with no scalability and limited mass production, could penetrate the business of corporate healthcare. But, I was imbued with hope by that Cochrane review. Their statements were grand. When it came to comparison with placebos, the research on various TCM herbal formulas “showed significant improvement of global symptoms [of IBS].” When it came to comparison with prescription drugs, they showed that across 65 research trials, a variety of herbal formulas did well. 22 herbal medicines beat the pharmaceuticals, and 29 did as well as the pharmaceuticals. Most of these trials used TCM. 

Of course, IBS research didn’t stop in 2006. There have been several large-scale systematic reviews since. Recently, a Korean research group did a systematic review, which they published in Frontiers in Pharmacology, for example. They concluded that [TCM] “can be considered as an effective and safe treatment for IBS.” Eighteen of the research studies they included were rated to be of high or moderate quality. So, continued work like this has broadly confirmed that herbal therapies – at the very least, and I’m being very conservative here – show promise for IBS, in all its forms. However, who knows about this? I believe the tragedy is that almost no one in the West who has IBS knows about this. Again, I wonder why. 

Actually, this post was prompted because I recently received a comment from someone, as I have before, that there is no research supporting the use of TCM. That person has IBS, and they were so certain about their perspective – that there is no research. We could chalk this up to that person being outside of the scientific and medical communities, of course. However, I’ve heard this sort of thing from the mouths of researchers, too. I was once at a party, when a very loud-mouthed researcher, who was trying to impress the group, began spouting out that there is no research support for the use of TCM. I couldn’t hold back at this and opened my mouth loudly too. For the sake of the party, the host intervened. 

To be fair, critics would point out that the research on TCM is often smaller in scale and of lower quality. The number of participants in a study may fall in the low hundreds, whereas studies for an IBS drug like Linaclotide (Linzess) had over 1,600 participants. This much money and focused attention on one drug leads to government approval, usually in numerous countries. The healthcare machine starts to turn. Never mind that the total number of participants across TCM studies for IBS number in the thousands (the Cochrane Review from 2006 covered 7,957 participants). Faced with great financial, governmental, and academic barriers, TCM researchers are more-or-less required to enter a very precious sentence of modesty and equipoise in their research, and it always goes something like this: “More rigorous trials are needed.” 

Every single scientific paper about TCM ends with that little sentence. We can all appreciate researchers who call for better research, but it loses a little authenticity when the same thing is repeated, robotically. What outside factors could contribute? Maybe researchers are just angling for more funding, but it begins to sound like lip-service after a while, like speaking to one’s boss – the dominant perspective – not to the reality of the situation. After all, it is a bland, politically safe, and statistically neutral thing to say, because it does not rock the boat. 

Researchers have difficulty speaking their mind because the clinical use of TCM already far exceeds the threshold of practical testing. The result is hypocrisy. Modern medicine (or science), which has much less actual clinical validation, is calling the shots, and it is fascinating – and a real lesson in how the world sometimes works – that doctors in the Far East (and outside of it) are using TCM with millions of patients on a daily basis, yet they cannot assert their own pride and professional standard as doctors. Instead their nations’ research basically says – with its face turned towards the Western expectation – “We don’t have enough evidence yet!” 

Can you see the split in consciousness and what is lost in translation? Have you personally ever felt forced to say one thing, while you are thinking another? The situation brings images to my mind – a water jug with no bottom, for example – one that can never be filled. There can never be enough research to prove to a Western audience that TCM is effective medicine. It has nothing to do with the evidence base. To suggest that TCM is efficacious simply provokes disbelief and leads to a loss of authority, which then becomes the grounds for dismissing anything else that is said. By expressing clarity, or suggesting something different to expectation, you’ve already lost the argument. Why should it be this way, if our concern is with finding the best treatments?

That 2006 Cochrane review ends with the unprovocative, “It is premature to recommend herbal medicines for routine use in Irritable Bowel Syndrome,” even after reporting good evidence. A sentence like that will be taken as the most up-to-date, knowable information, case closed. However, I’d like to share with you what most researchers of TCM are actually thinking: Their research is better than the credit it is given. For example, if you were to track IBS treatment results in a busy hospital setting, with different patients receiving a variety of treatment options, plus dietary recommendations, maybe some exercise and lifestyle recommendations, and then looked at the total effect for that group, would you consider it good research? If you have IBS, would you like to know whether those hundreds or thousands of patients improved at that hospital or not? Would this tell you something about whether or not TCM works?    

The answer from modern science is that it does not tell us anything. The kind of research that I mentioned above is common in China, where their hospitals treat many people using TCM (including for IBS), but that sort of research gets categorized as being of “low” quality in the West. Instead, the research that is considered high quality must be an RCT (Randomized Controlled Trial). In RCT’s, there is a control group or placebo group. There is “blinding” about who is in which group. There is standardization of the participants, who cannot have more than one condition. No complex cases are allowed. No complex interventions are allowed. The specific outcomes – what constitutes a result – are predefined. 

RCT’s were developed mostly for drug research, and this limits what they can handle. The problem with leaning on them to research other medical systems is that their research questions are asked in a way that prefaces the acceptable answers. It is sort of like leading the witness or putting words in the mouth of your suspect. If you are a participant, they will decide whether you have been helped or not, you won’t be telling them. RCT’s are famous for assuming that treatment has a linear cause-and-effect mechanism, based on a single drug and set of measurable outcomes. In simpler language, what they assume – as their forefathers the Naturopaths did – is that there should be a best, single medication for every disease or condition. 

As I’ve sort-of mentioned already, this has nothing to do with how TCM is actually practiced. Besides the diet and lifestyle advice, patients are given complex formulas containing many thousands of chemicals (as herbs). The formulas are custom made and different from patient to patient, even if they have the same diagnosis. Then their medicine is changed or modified often – even daily or weekly – based on how they respond and change. It is called a “complex intervention,” and an RTC cannot handle it. When we force TCM into an RTC, we cut off most of its efficacy, and even then, it still somehow shows itself to be better than placebo or standard medication, in some instances.   

Yesterday, I saw a scientific paper from China, which started by saying, “Irritable Bowel Syndrome (IBS) is a common refractory disease.” Refractory is an interesting word. It is often used to describe cancers. It means the condition is stubborn, difficult to treat, and likely to reoccur. Notice that those sound like the words of someone who actually works with illness. They are grounded, pragmatic, and experienced. There is no fantasy in those words. They portray medicine as a practical discipline, challenged by the real-life impossibility of anyone staying well forever. However, the very next sentence in that research expresses the actual consensus – among both doctors and researchers in the Far East: “Chinese medicine has remarkable efficacy and advantage [in] the treatment of IBS.”

I think, as we consider the need for rigorous research and its limitations, it’s essential to reflect on real-world cases where TCM has helped patients with IBS. These days, we can glimpse people’s direct experience, just by using reddit:

“Chinese medicine is the only thing that has helped my IBS. I use Bu Zhong Yi Qi Wan. … cloudy and mucus like poops have went away for two-three months now.” reddit

“… Switched to raw herbs recently and while it has helped, the symptoms haven’t gone away … But there is less ‘upward agitation’ and overall ‘less rebellion.’ … I am much calmer and don’t overthink stuff.” reddit

“I was very skeptical of TCM … did acupuncture- and brought a 3 week supply of herbs home. It’s day 3 now and … for the first two days my poops were perfect solid first thing in the morning compared to the soft/diarrhea … I seem to release more gas instead of storing it up over the day so my tummy is flatter … feel quite light in general.” reddit

“My tcm doc checked my tongue, eyes, pulse … gave me a recipe for some very special herbs … for me a flare usually lasts way longer … I got out of a bad flare very quick and the red ginseng is very helpful … People, my new diet and that red ginseng is giving me my energy back.” reddit

If you would like to read about one of my IBS cases, I wrote about it here. Alex (the patient in that case) did not have abdominal pain, but I would still see his condition as IBS. 

It is now 21 years since the publication of that Cochran Review (I can’t believe it!), and I can better see my old mentor’s unspoken perspective. He knew that a change in people’s viewpoint was going to take more than research. However, I continue to wonder why this is true. I sometimes hear people refer to the necessity of a “tidal shift” – in which, what has come in, is now going out, governed by invisible forces much larger than ourselves (like gravity). The tension of that moment, when the water slows and slows and then stops proceeding, eventually reaching a balance point with no movement – I do ask whether we are at that precise moment in history today. 

It may be time to rediscover what has been lost. In our race to put the “best” ideas and people at the top, their shadows have eclipsed everything else of value. With its in-and-out service, high costs, mediocre product, and insistence that it is the best, modern Medicine now looks to me like the McDonald’s of healthcare. They have the process down pat, but is there not a better burger in town? What is the cost of one’s allegiance? If I can say it simply, looking up towards them has become a pain in the neck, for all of us. It’s time to look around. If that turns out not to be TCM for you, I say fine. If you tell me that there’s no evidence to support the use of TCM, well then, we really have something to talk about.