Evidence, Regulation, and the Global Standing of TCM

TCM's evidentiary record is uneven by design, since it comprises thousands of distinct herbal formulas and several distinct modalities rather than one treatment to test. Individual components have fared very differently under scrutiny. Artemisinin, isolated by Tu Youyou after she traced a lead to a cold-extraction method in Ge Hong's fourth century Zhouhou Beiji Fang, became one of the most important antimalarial drugs of the modern era and earned Tu a share of the 2015 Nobel Prize in Physiology or Medicine. Acupuncture, one of TCM's component practices, has amassed a large sham-controlled trial literature showing small benefits for some pain conditions. Many other herbal formulas remain untested, and some have caused clear, documented harm: Aristolochia species used in certain traditional preparations contain aristolochic acid, a potent nephrotoxin and carcinogen, and outbreaks including Belgian patients poisoned by a mislabeled weight-loss formula in the 1990s produced kidney failure and urothelial cancer, leading many countries to ban or restrict the plant.

TCM's institutional standing rose sharply after the Chinese state began systematizing and promoting it as a parallel system to biomedicine from the 1950s, and again when the World Health Organization added a chapter covering TCM diagnostic categories to the eleventh revision of its International Classification of Diseases in 2019. That decision drew criticism from scientists, some writing in Nature, who warned that folding an unfalsifiable diagnostic framework into the WHO's disease classification risked lending it unearned legitimacy.