At the Institute for Traditional Medicine, several hundred requests are received annually for information about whether or not particular diseases are responsive to Chinese medicine or other traditional healing methods. The question is most frequently asked by a practitioner prior to seeing a patient for the first time, in an effort to focus attention on certain therapeutic issues and also to advise the patient about the potential outcome. Prognosis has been a difficult area for Chinese doctors. In the Jin Gui Yao Lue (c. 200 A.D.), detailed remedies were described for reviving those who had died by hanging or drowning. Today, few would accept such remedies as potentially, or even plausibly, effective; a Japanese commentator wrote, however, that these remedies are "quite uniquely significant and beyond ordinary understanding ...and are truly great life-saving arts," no doubt unable to disparage the writings of the revered author. In fact, today it is quite difficult to suggest that something is impossible or unlikely in the field of "alternative medicine," a field well-known for successfully treating many individuals deemed incurable by modem medicine. The suggestion of limitations as given below might find exceptions. As stated more than 200 years ago by Hsu Ta-chun "it is by no means difficult to acquire an ability to cure illnesses, but it is difficult to know whether illness will end in a cure or not."
It must be recognized that ailments unlikely to be resolved by Chinese medicine might best be left untreated by the Oriental techniques to save the individual and his family financial hardship and any other inconvenience involved. Still, despite any limitations on treating a particular disease, it is certainly possible that secondary effects of the disease (e.g. reduced circulation associated with reduced mobility) might be greatly improved with Chinese medical treatment. Further, in a culture where herb use and physical therapies are underutilized, the application of these methods may improve overall health in almost everyone, regardless of the nature of any disease that might be present. Therefore, treatments applied with the knowledge that a cure is unlikely can yet be justified.
GENETIC DISEASES
Genetic material provides biological information for the structure of an individual and function of organs and tissues which is expressed through the developmental process. Defects in genetic coding occur both naturally and also under the influence of modem contaminants (radiation, drugs, environmental chemicals). Modern medicine is attempting a cure of genetic diseases by first identifying the defective genes or the product of these genes (e.g. certain proteins), and then turning to genetic engineering, transplants, or fetal tissue implants as a means of correcting the problem. These high-tech solutions may be the only way of correcting a genetic defect. There is no evidence that Chinese medical treatments can have any impact on the genes or their products. While secondary effects of the genetic defect or more severe expression of the problem due to a concurrent non-genetic problem may respond to Chinese medicine, a cure or resolution of the basic genetic disease ought not to be suggested to patients or potential patients.
DESTRUCTION OR REMOVAL OF ORGANS OR OTHER PARTS
The body has remarkable regenerative capacities, but once an organ, a cell line, or a substantial part of the body is removed or destroyed, it usually can not be regenerated. Modem medicine approaches this problem by replacing the damaged or removed portion (e.g. organ transplant or hip joint replacement), or by replacing the product or function of the affected part (giving insulin or thyroid hormone, using dialysis equipment or breathing apparatus).
Chinese medicine can not be applied to restore such missing tissues or functions. Furthermore, there is very limited experience of applying Chinese medicine in such cases. Thus, even where it may help with secondary effects (e.g. skin rashes with dialysis), the knowledge of what specific therapies might be effective is lacking and the chances of beneficial results can not be predicted at present. The method of treating a condition based on its manifestations (i.e. using the same remedy as one would use for the same symptom pattern arising from a different cause) may or may not apply when organs are removed or severely affected. Secondary effects of damage or removal of body parts may be moderated by use of Chinese medicine.
ADVANCED DEGENERATIVE DISEASE
Many degenerative diseases progress by building up scar tissue or other lesions that are beyond repair. It has been learned recently that some damage, such as build-up of atherosclerotic plaques, can be partially reversed by a combination of dietary adjustment and drug therapy. However, the ability to reverse any degenerative condition depends on the degree to which the physiologic changes have 'ossified' and also on the age of the individual, since the healing potential declines with aging. There is no evidence at present that Chinese medical techniques can reverse old scars, large accumulations (e.g. massive fibroids, large gallstones, extreme obesity), or progressively deteriorated cartilage and bone. It is likely that Chinese medicine can halt further deterioration, and it may be able to reverse some of the more recent damage.
PARALYSIS AND OTHER NEUROMUSCULAR PROBLEMS
Chinese medicine is effective in treating some cases of paralysis, such as that occurring after a stroke. It can not repair severed spinal cord. Modern medicine is working on techniques for accomplishing such repair, including use of fetal tissue and electrical stimulation. Chinese medicine is also effective in treating some cases of shaking, spasm, convulsion, and other neuromuscular disorders, but most of the experience in this field is related to treatment of conditions which arise temporarily in relation to a feverish disease; it is not yet established whether Chinese medicine can cure ailments such as Parkinsonism or defects which occur in the brain and then affect muscular coordination, such as Alzheimer's; one can not claim, based on available information, that it is likely to be effective in these areas. If the cause of a neuromuscular disorder is not known, Chinese medical treatment (including acupuncture and Qigong) may be a reasonable thing to attempt; improvements in some patients with progressive loss of muscular control has been demonstrated with acupuncture treatment.
PERMANENT VIRUSES
Some viruses, such as that associated with influenza, affect the body for a limited period of time; others, such as hepatitis, herpes, and HIV, take up more permanent residence in certain cell lines. There is currently no evidence that Chinese medical techniques can remove these viruses from the body. However, it does appear that Chinese medicine can be employed to help maintain the viruses in a quiescent state--still present but causing no expression. It has been reported in China that seroconversion from hepatitis B positive to negative occurred in several patients treated by Chinese herbs. ITM has received two reports of individuals who tested HIV positive with repeated standard test methods and then tested HIV negative, also with repeated testing; both individuals had used herb remedies, as well as other methods. If these reports are correct and clinically significant, it may be that a relatively small number of individuals can either eliminate the virus or experience such long periods of quiescence of viral activity that detection of the virus becomes impossible by current means.
AUTOIMMUNE DISEASES AND ALLERGIES
There is no doubt that Chinese medicine has had a strong impact on autoimmune diseases. There is only suggestive evidence, however, that the underlying autoimmunity may be removed. Like the permanent viruses, it appears possible to maintain an autoimmune disease in a quiescent state where symptoms are not manifest; the potential remains for certain stress factors to initiate another bout of the disease process. In most cases, autoimmune disorders are managed by applying Chinese medicine over an extended period of time, perhaps years; in Chinese clinical trials, patients with diseases that are currently thought to be based on autoimmunity are sometimes rated as cured--including lack of symptoms for several months or years after completion of the therapeutic regimen. This finding needs to be confirmed in Western clinics using the most current measures for the diseases under consideration. True allergies, like autoimmune disorders, may be controlled in some individuals, but are unlikely to be cured in the sense of removing the basic immune system coding that initiates allergy responses. Sometimes, a condition which is called an allergy is actually a hypersensitivity that can be resolved. Environmental allergies, that is, very severe and persistent responses to numerous substances in the environment, may represent a derangement of the immune system that is beyond restoration by Chinese medical means.
HAIR AND OTHER COSMETIC CONCERNS
Chinese medical treatments for baldness are mentioned frequently in the literature; there is no doubt that some of these treatments can reverse hair loss due to a number of causes. However, well-established male pattern baldness usually does not respond to Oriental therapies, except for limited and temporary hair growth which is usually deemed unsatisfactory in the long run. According to Chinese clinical studies, patients who respond to the drug minoxidil--the only Western drug currently deemed helpful in some cases of male balding--may obtain somewhat better results using Chinese herbs along with this drug. Other cosmetic improvements--removing wrinkles, restoring gray hair to original color, influencing varicose veins, removing fatty lumps, adjusting size or appearance of breasts, reducing excessive body hair in women, and affecting skin discoloration's (dark or light spots) may only rarely respond to Chinese medical therapies. The desired effects, when attainable, may require inconvenient, expensive, and long-term treatment. There are clinical reports from China that indicate successful treatment of alopecia and skin discoloration, but most practitioners in the West find few satisfactory responses (see below).
DISEASE CURABLE, BUT NOT THIS CASE
A medical therapy, whether modem Western or ancient Chinese, which is deemed highly effective for cure or management of a certain disease will not prove successful for everyone. In fact, if 70% of individuals affected by the disease and treated by the accepted method show a satisfactory response, then the therapeutic method can be categorized as very effective. For the other 30%, however, the results will be unsatisfactory, and it is a matter of speculation whether or not these individuals will find relief by an alternative therapy. The cause of any such failures is usually unknown.
Aside from the limitations of any method to satisfy all members of a population group, there are other potential problems in treating individual cases. For example, a practitioner who is not adequately versed in the diagnostics and therapeutics appropriate to a particular case may prescribe an incorrect procedure, thus getting no positive benefits. This is especially problematic with the practice of Chinese medicine in the West, where the majority of the practitioners are not as well trained as those who are working in China. Furthermore, in the Orient, nearly all practitioners of traditional Chinese medicine also practice Western medicine and therefore can integrate the two approaches; in the West, those who have the best training in Chinese medicine usually lack training in Western medicine and vice versa. Even when the correct therapy is decided upon, its method of administration may be inadequate to the task. Thus, the dosage of herbs prescribed may be too low or the stimulation with acupuncture needles may be too little or too infrequent. In the case of herbal remedies, it is also possible that the materials being prescribed were improperly prepared (preprocessing of crude herbs, extraction methods, etc.) so that the resulting material turns out ineffective. Insufficient instructions to the patient, such as failure to recommend necessary dietary modifications, can also lessen the effect of a therapeutic program.
Some patients will fail to follow the instructions of the practitioner and thereby reduce or eliminate the effectiveness of the overall treatment. Patients who are experiencing high levels of stress may overwhelm the impact of natural therapies, especially in a disease which has stress-dependent manifestation. These types of factors can turn a disease which is fundamentally curable or manageable into one which is essentially unresponsive, not because the treatment method is fundamentally flawed, but because its influences are deflected from their goal.
CURABLE, BUT ONLY WITH ENOUGH TIME
Some disorders may be curable or manageable if adequate time is allowed for the therapeutic method to take effect. Necessary duration of treatment is often difficult to predict; in some cases average duration can be estimated but the actual duration necessary for an individual case remains unknown. As reported elsewhere, treatment times of three months are not uncommon for diseases or conditions considered difficult to cure. The three-month duration is not, however, necessarily the time to achieve a cure, but rather the time to obtain significant progress. Using vigorous methods of therapy, some ailments still require up to two years of regular treatment. Because our culture is accustomed to quick drug responses, failure of a therapeutic method to have an impact within a few days is often seen as reason to change the therapy. Yet frequent changes in a therapeutic methodology may result in further delays in obtaining the desired effects, with a negative outcome over time.
Ailments which have persisted for years prior to initiation of treatment may be expected to require several months of consistent therapy. Since Chinese medicine is often deemed a last resort in the West, it is quite common for ailments to be far progressed and perhaps worsened by the prior ineffective therapeutic attempts, leaving a substantial burden for the Chinese methods.
LIMITATIONS OF KNOWLEDGE
The range of diseases, and their nature, change with time. Just a century ago, the main diseases now encountered by American practitioners of Chinese medicine were rare or non-existent. Diseases also vary in their manifestation across cultural and racial groups. For example, multiple sclerosis is rare in the Orient due to genetic differences, and breast cancer is rare in the Orient due to dietary differences. Therefore, if the modem diseases or those common in the West are to be treated by the methods of traditional Chinese medicine, there may be very little precedent on which to base the treatment program. With limited experience comes a diminished likelihood of selecting the correct measures.
Limitations of knowledge also occur because many Western patients are taking drugs that were not used previously (especially by practitioners of traditional medicine in China); or they have undergone surgical or other procedures that were not employed until very recently. In such situations, it may be difficult or impossible to predict whether or not a disease will be curable under the new circumstances. An example is chronic asthma that has been treated for several years by corticosteroids and/or inhalants. Practitioners report that such patients do not respond to typical Chinese medical therapies for asthmatic breathing, and their conditions may be difficult to cure by other standard means as well.
Some diseases are of unknown origin (often called "ideopathic") and therefore are difficult to analyze for purpose of treatment. Although traditional Chinese medical therapies can be applied according to symptom/sign patterns, the outcome is impossible to predict because the factors inducing the disease may actually preclude effectiveness of those methods. Tinnitus and psoriasis are examples of ailments for which Chinese doctors claim a substantial degree of success, but Western practitioners most frequently find very difficult to treat effectively; the underlying cause of the conditions in the two populations may differ.
LIMITATIONS OF MATERIALS
Some Chinese herbs that are reported to be highly effective in Chinese clinical work are not available in the West. Sometimes this is because of inherent toxicity (Chinese herbs are imported to the U.S. as food products and therefore must be basically non-toxic), and other times it is because the material is simply not exported from China (due to inadequate supply or failure to prepare an exportable form). Chinese herbs are sometimes given in China by injection or intravenous administration, which is usually not an option in the West at the present time. As a result, claimed benefits from Chinese medical materials in treatment of difficult diseases may fail to be realized by Western practitioners.
IN SUM....
There are diseases which are unlikely to respond to Chinese medical treatment; the lack of response may be inherent to the disease itself, or to the particular circumstances of the practice of Chinese medicine that the patient encounters or exhibits. To maximize the treatment outcome, the practitioner must be fully familiar with the effects claimed by doctors working in the Orient and the methods employed to obtain those effects. Patients must be consistent in following the instructions of their practitioners and must allow the influence of the therapy to take full effect over time and in the proper environment.