IT seems to be a cliche plot in almost every TV series about Chinese royal families: An old imperial physician congratulates an imperial concubine for getting pregnant after a simple pulse-taking test, thus stirring wars within the harem.

Now a bet on whether TCM doctors can diagnose pregnancy accurately by pulse-taking is arousing nationwide attention. A blogger threw down a challenge to TCM doctors on diagnosing pregnancy simply by pulse feeling and promised never to name TCM as pseudoscience if any TCM doctor succeeds in the challenge.

Only two TCM doctors accepted it so far, and neither has yet completed it.

However, Shanghai TCM doctors say the challenge itself is unreasonable, as TCM diagnosis is based on four methods — wang wen wen qie (literally “observe, smell/listen, inquire and pulse feeling”) rather than any single one of them. Besides, TCM diagnoses, in general, aim to describe the energy within the body and thus give a prescription accordingly, rather than just identify a specific disease.

The challenger, whose weibo moniker is “Burn Superman Ah Bao,” is a burn department doctor in Beijing. He offered 50,000 yuan to any TCM doctor who accepts the challenge and manages an accuracy rate of over 80 percent. He also promised to stop criticizing TCM if his challenge is successfully met.

Yang Zhen, associate professor of Beijing University of TCM, accepted the challenge but his requirements were rejected by Ah Bao. Yang’s proposal was to consider 104 women ranging from 18 to 35 years old, eliminating those with high blood pressure or heart disease, and to work in a quiet environment without live broadcasting, which was one of Ah Bao’s conditions.

Yang says he remains ready to accept the challenge if Ah Bao can make out a better scientific test system.

Lu Jilai, a TCM physician from Chengdu, capital city of Sichuan Province, is the only TCM doctor so far to start the challenge. He also upped the ante, saying he would pay 200,000 yuan to a doctor who was successful.

Chengdu media selected one pregnant woman, three young women who are not pregnant and a man. Dr Li eliminated the man by blind pulse-feeling in the first round, but it was not until the second round of pulse-feeling that he identified the pregnant woman. It can be difficult because women who just finished their periods or are about to start have pulses similar to those who are pregnant.

Slippery pulse

Challenger Ah Bao said on weibo that he did not agree that Li had succeeded, as there were only five samples and he did not manage to identify the pregnant woman in the first round.

Li had planned a second test with 20 people in two groups — one for simply pulse feeling, the other for two TCM diagnostic methods including qie (pulse feeling) and wen (inquiring). However, the test was stopped for lack of enough volunteers. Like Dr Yang, Dr Li says he is ready to take another test when conditions are ripe.

Pulse feeling remains an important method to diagnose pregnancy in TCM, but it is not an isolated test that can draw any conclusions, says Zhao Li, associate chief physician of the gynecology department at Yueyang Hospital attached to Shanghai University of TCM.

Hua mai (slippery pulse 滑脉), which is like the feel of a small ball slipping through your fingers, is a general pulse condition of a pregnant woman. Increased general blood volume is a major reason for hua mai in pregnant women, but other conditions can also contribute to this condition. They include dyspeptic retention (food stagnation), gathered pathogenic phlegm-dampness within the body, or if the woman is narrowly pre- or post-menstrual.

Therefore, taking the pulse while asking about the patient’s health and menstrual cycle is an essential way to diagnose pregnancy, Dr Zhao says.

Though many TCM doctors today also use urinalysis as a more common way to diagnose pregnancy, they still take a patient’s pulse to see whether the woman and embryo are in good condition and thus prescribe therapies when necessary.

Wang wen wen qie help doctors give a comprehensive conclusion of the patient’s health, and thus help the doctor to prescribe therapy accordingly.

“Having TCM doctors identify pregnant women by simple pulse-taking is an unreasonable request, and it will be even more ridiculous to judge whether TCM is scientific or not based on the challenge result,” says Dr Zhao, from Shanghai.

This episode is not the first time TCM has been challenged in recent years. A report questioning the TCM patent drug “Longdan Xiegan Wan” in 2003 sparked a heated discussion on the safety of TCM medicine.

Challenges

In another challenge, Fang Zhouzi, a self-described “anti-fake campaigner,” wrote an article doubting the existence of an energy channel in TCM by anatomical theory in 2007. Also, a news feature on 40 medical workers in Gansu Province unblocking the circulation between the den and du meridians in 2012 triggered mockery of TCM.

All the challenges try to prove TCM is unscientific or a pseudoscience. However, the grounds for such criticism miss the point, as TCM does not have to be science, according to Jiang Xiaoyuan, a professor at Shanghai Jiao Tong University’s science history department.

People today tend to judge whether something is scientific or not by measuring it with scientific theories and standards.

If it fits, it is science; otherwise, it must be pseudoscience. But, there are also things that are neither science nor pseudoscience, such as art and religion, and probably TCM as well, says Jiang.

“Medicine is an independent subject, just as science and mathematics in the West, but it’s only portrayed as part of science when entering China. Why should TCM fit the requirements of science in the first place?” says Jiang, adding that TCM has a unique way to observe and explain the world, different from science or Western medicine.

“We cannot explain by Western medical theory how a needle can impact another part of the body by simply piercing into one spot, but it does work,” says Jiang. “And the medicine helped protect Chinese people for thousands of years.”

Chen Xianchuan, chief physician of the geriatrics department of Yueyang Hospital, agrees and says it’s unreasonable to measure TCM by Western medical standards.

TCM and Western medicine embrace very different systems, from diagnosis to treatment. For example, Western medicine aims to identify bing (disease) in diagnosis while TCM focuses on zheng (energy condition).

Coughing can be identified as a symptom of a cold, lung inflammation or lung cancer in Western medicine, while in TCM it can be a symptom for invaded pathogenic wind and coldness, invaded pathogenic wind and heat, or gathered pathogenic liver fire.

Measuring TCM by Western medical standards would be like criticizing a square to be not round enough, Dr Chen says.

He also agrees that TCM and Western medicine can complement each other well. Many TCM doctors today also use Western medical checks to make their diagnosis more comprehensive and detailed.

“The treatment result is the only way to judge a medicine,” says Dr Zhao. “It is not necessary to deny any kinds of medicine, when they can make up for each other’s deficiencies. As doctors, we have the same goal to help the individual patients benefit most.”

Four diagnostic methods

Without X-ray photography or stethoscope, traditional Chinese medicine developed four diagnostics through ages-old practice, namely wang wen wen qie (observe, smell/listen, inquire and pulse feeling 寡壙狂학). 

TCM believes in a close relationship between the outside of the body and the organs inside. The changes of vital energy, blood, yin and yang of the organs usually reflect on the surface.

• Wang (寡), or observe, involves observing the changes on the relevant regions of the sufferer’s body and the changes of excretion to understand the state of pathological changes. Vitality and mental state, skin color, physical condition and the tongue are the most frequently inspected regions. 

• Wen (壙), or smell/listen, usually include two aspects — auscultation of voice and olfaction of odor which includes hearing the changes in sounds of speech and breath of the patient and smelling the odor of both the mouth and the excretions.

• Wen (狂), or inquire, is asking the patient about symptoms he/she feels, past and present medical history and other related matters. Perspiration, defecation, urination, taste for food and condition of sleep are all frequently asked by a TCM doctor in diagnosis.

• Qie (학), or pulse feeling, is also
essential. Palpating the chest, abdomen, hands, feet, skin and other regions can help the doctor learn the condition of an organ by touching it across the skin, while feeling the patient’s pulse can
help the doctor determine the condition of vital energy and blood, organism,
and organs.

Online comments 

“I think it will be a good opportunity for TCM to prove itself by participating in the challenge. Whether TCM can cure people cannot be proved by words but by effect. Let the truth prove itself.”

— Weihefeihu

“Chinese survived for thousands of years without Western medicine. TCM cured so many Chinese with herbs and needles. It was not until the recent hundreds of years for Western medicine to catch up.”

— Sanmiliu

“TCM is definitely reliable, but there are not so many good TCM physicians today. It is not easy to be a good TCM doctor, as experience is required. It may take a few years for a medical student to be a qualified Western doctor while it takes much more time for a TCM apprentice to master what his/er tutor taught him.”

— Yglwg

“Some people say that the debate and challenge were all raised because the Western medicine tries to make an issue on it. But in my opinion, it is also because TCM was overly deified in some way.”

— Shenshanlaoguai

“Few such debates will come up with a conclusion. Nobody will benefit from the debate but the ones who seized the opportunity to hype themselves.”

— Shijieguan

“It is ridiculous to judge TCM by Western medical standards. It is unscientific to have a TCM doctor diagnose simply by pulse feeling, let alone labeling TCM as unscientific by the result.”

— Jiang Wenlai