Traditional Chinese Medicine (TCM) is not just some pseudo-scientific quackery one can easily laugh at and dismiss. It keeps finding its way in serious research literature, and even WHO guidelines. In China, TCM is being imposed from the very top, by the Communist Party, as this White Paper from Chinese Government pronounced in 2016:
“Boasting the establishment of a TCM medical care system covering both urban and rural areas in China, the white paper said there were 3,966 TCM hospitals, 42,528 TCM clinics and 452,000 practitioners and assistant practitioners of TCM across the country by 2015.
In addition to making contribution to the prevention and treatment of common, endemic and difficult diseases, TCM has played an important role in the prevention and treatment of major epidemics, such as SARS, HIV/AIDS, and Hand, Foot and Mouth Disease”
All Chinese universities belong to the state and every scientist is a state employee, many are Communist Party members, some even sport military ranks. No new government will be reversing the TCM endorsements, because China is a one-party state and the all-knowing control-obsessed communist party is not likely to admit to its own silly mistakes. Patriotism or rather Han-nationalism is big in China and counts more than science and rationality. All this means that every Chinese scientist is expected to churn out scientific evidence in support of TCM, which as my site contributor Smut Clyde pointed out, is a state-imposed expectation to commit research fraud. Some Chinese researchers follow a two-pronged approach: they publish “normal” science in international journals in English, and TCM bunk in national scientific outlets. The team of Hui Cai and Junyi Shen operates like this, pledging TCM efficiency against stroke in Chinese journals, while using more conventional medicines in international ones; the figures remain the same though. Because the money to promote TCM is also being sent abroad, we get cases like Wen Jiang at Cardiff University in UK, who keeps his English-language papers TCM-free, but in Chinese, anything goes. Incidentally, also Jiang is a prolific data forger, but because of the actual TCM money he brings to Cardiff, the Welsh university didn’t mind the fraud.
This is exactly the kind of dishonest parodies of scientists the Communist Party of China is nurturing, via its TCM-imbibed wisdom. What else can you expect when academic science is controlled by an undemocratic nationalistic regime? For reasons of fairness, it should be mentioned that similar things happen in the democratic India. There, nobody is forced by governmental decree to peddle Ayurveda-infused fraud (occasionally featuring cow dung or urine) in Indian universities, but fact remains: too many Indian politicians are scientifically-illiterate religious zealots and Hindu nationalists, and this is the kind of research they reward with money and favours. It goes from Ayurvedic “green” nanotechnology to ancient Vedic aeronautics, at least that conference proceedings paper (flagged by John Chen) has been retracted despite Elsevier’s instructions to “deal with it”:
The Ayurveda and TCM concoctions gunk started spilling over into allegedly serious international journals, meanwhile the pretence to any actual science has been dropped . Which brings us to the main focus of this article, a paper published by the highly respected Royal Society of Chemistry (RSC). A reader alerted me to this masterpiece, published in a RSC journal sporting an Impact Factor of 4.8:
Xiang Fei, Qiaofeng Yao, Jianping Xiea and Jim Yang Lee
Probing the Qi of traditional Chinese herbal medicines by the biological synthesis of nano-Au
Journal of Materials Chemistry B (2018) DOI: 10.1039/C8TB00068A
The Chinese-nationals authors working abroad at the National University of Singapore provided this illustrated abstract:
Herbal medicines with different Qi properties (the primary proxy of their therapeutic effects) are used in traditional Chinese medicine to maintain the harmony of vital forces in a human body. In the Western medicinal practice, the classification of Qi into four major families (“Si Qi” in Chinese Pinyin) is a challenging endeavor, especially by a simple non-reductionist approach. The method presented here is however able to distinguish the Qi of herbal medicines based on the measurements of several Qi-related features in a biological synthesis of nano-Au in herbal extracts: solution color, surface plasmon resonance properties, reaction time and nano-Au morphology. These Qi-related features on their own do not form sufficiently distinct clusters that are useful for the classification of the Qi-properties. The power of differentiation, however, is significantly improved when all the Qi-related features are considered together. The statistics of differentiation is encouraging, enabling us to develop a scheme which can classify all of the tested TCHMs into their respective Qi families. While this classification method was developed using a limited number of herbal medicines with known Qi properties, it has the potential to be applied as a scientific quick test to determine the Qi of new herbal medicines or herbal concoctions. It is our aspiration that this study can generate more interest in the development of non-reductionist approaches to modernize the understanding of TCHMs.
The paper is paywalled, and because it is such an important and educative work of science, I strongly advise you not to use the pirate site Sci-Hub, but to pay RSC the requested fee of £42.50 to read it. In case some journal editors and reviewers were initially confused what that Qi might be (an obscure chemical element? a novel measurement unit in nanotechnology? a Chinese word for “bribe”?) the authors explain, with references:
“TCM believes that the imbalance of Yin and Yang is the cause for disease. Consequently, disease prevention and treatment is all about restoring a body’s Yin and Yang to the balanced state. TCM relies more on the use of Traditional Chinese Herbal Medicines (TCHMs) than surgical procedures to deliver treatments.1,2,4,5
TCHMs are categorized, according to their therapeutic effect on the Yin/Yang balance, into two broad categories of Yang and Yin, which can be further divided into four large Qi families (hot, warm, cool and cold (Table 1); collectively known as “Si Qi” in Chinese Pinyin). The clinical application of TCHMs is governed by their Qi properties. As a basic principle, the Yang TCHMs are the cure for Yin diseases (e.g., typhoid and diarrhea), while the Yin TCHMs are the cure for Yang diseases (e.g., pyrexia and anorexia).4,5
It is also believed that the Yang medicines enhance the metabolism of organisms, while the Yin medicines do exactly the opposite by suppressing metabolism. Time-tested practices in medication are the basis of these principles.”
The references lead to some obscure Chinese and other alternative medicine journals, but reference number 2 leads to Science magazine: Wang and Xu, Zheng: A systems biology approach to diagnosis and treatments, 2014. The famous top-rank journal published by The American Association for the Advancement of Science (AAAS) namely had an entire issue in December 2014 celebrating TCM, first of the three-part series under the headline “The Art and Science of Traditional Medicine”, initiated by Science/AAAS and “making a case for the integration of traditional Chinese medicine (TCM) into modern medical practice”. The Wang and Xu paper from the Beijing University of Chinese Medicine (which is listed as sponsor of that special issue!) opens with:
“As a key concept in TCM, Zheng (meaning syndrome or pattern) is the overall physiological and/or pathological pattern of the human body in response to a given internal and external condition, which usually is an abstraction of internal disharmony defined by a comprehensive analysis of the clinical symptoms and signs gathered by a practitioner using inspection, auscultation, olfaction, interrogation, and palpation of the pulses (1). Correctly identifying the Zhengis fundamental for the diagnosis and treatment of diseases”
If it’s in Science, it must be science, right? Even if it bears a label “Materials that appear in this section were not reviewed or assessed by Science Editorial staff, but have been evaluated by an international editorial team consisting of experts in traditional medicine research“. Which basically means: we at Science and AAAS are well aware that we are peddling utter deranged pseudoscience quackery, but China is too important to be messed with, and we also get paid, so bear with us.
After what Science did in 2014, I feel bad about pointing fingers at RSC. But still. This Yin-Yang folklore is openly and unashamedly served as the scientific foundation of the peer reviewed Fei et al 2018 paper already in the abstract, the study then proceeds to combine the eastern quackery with the gold obsession of western alchemy. The authors used TCM herbal extracts to produce gold nanoparticles (a standard method in “green” nanotechnology, described here) to measure that magical Qi for 16 TCM herbal ingredients: 4 hot, 4 warm (Yang) vs 4 cool and 4 cold (Yin). These were rather over-concisely presented in the Table 1:
There was however a detailed listing of the 16 tested TCM ingredients in supplementary material. It makes from gustatory point of view perfect sense why chilli peppers, cinnamon and ginger are deemed to be hot as Yang, while green tea, mint and dandelion are seen to be on the cool side of Yin. We were also ensured that
“The selection was based on the consultation of two authoritative classical texts
of TCM (i.e. Shennong’s Classic of Materia Medica and Compendium of Materia Medica) and the confirmation of the representativeness of the “Si Qi” properties by TCM practitioners”
Peer-reviewed references of highest quality, surely. Here I must warn that the actual TCM herbal medicine concoctions are not necessarily fully vegan: in many cases they also contain dried powdered animals, in bits or in whole. It can be a cockroach & chicken gizzard mix to cure cancer (Wen Jiang) or ground leech to treat stroke (Hui Cai). The main ingredients are indeed herbal, and these were assessed for their Qi by the solution colour, surface plasmon resonance intensity, reaction time and “the presence or absence of mutually exclusive discrete and self-assembled supra-nanostructures”. The final result was this very useful and self-explanatory “classification scheme”:
It seems the authors were unable to detect any yin or yang relevant pattern in their nanoparticle synthesis data. Hence their decision to combine the different aspects until a result which might fit can be imagined. It still didn’t work out too well. They conclude that more research is needed:
“The contribution of this work is to demonstrate a non-reductionist scientific approach for the categorization of the TCHM Qi properties; which has the potential to be developed further for the determination of the Qi of new herbal medicines or herbal concoctions. As such it is expected to help accelerate TCM modernization and the development of TCHM standardization”.
At least, a clear commercial and translation potential outlined, both the Communist Party of China and the Singapore regime will be happy. These were the Acknowledgements:
“This work was financially supported by the Academic Research Fund from Singapore Ministry of Education (R-279-000-470-112). We also gratefully acknowledge Dr. Bo Peng (Shanghai Lixin University of Accounting & Finance) for her suggestions and assistance in the statistical analysis of the results.”
That makes sense. The Singapore government are self-declared fans of TCM. There are special governmental Traditional Chinese Medicine Development Grants, as “as to better meet the evolving needs of the Singapore population”. What also makes sense is that the authors needed professional p-hacking help from China to bring some Qi harmony into their stochastically all over the place TCM-nanoparticle data which failed to indicate any Yin-Yang pattern whatsoever. But hey, it passed peer review at Royal Society of Chemistry.
RSC to the rescue
I therefore alerted the editors of Journal of Materials Chemistry B and the publisher RSC. Incidentally, 5 out of 9 associate editors are Chinese, one of them works abroad though. I don’t know where they stand on the party-imposed TCM wisdom, and was not sure they would have liked to discuss that. The Editor-in-Chief of the journal is Jeroen Cornelissen, professor in biomolecular nanotechnology at the University of Twente in the Netherlands. An expert for measuring Qi with gold nanoparticles, obviously, yet Cornelissen was too shy to reply to my emails. Or maybe he felt personally insulted by my scepticism towards TCM-flavoured nanotechnology and decided to sulk with his Qi out of balance. Also Jessica Winter, professor of biomedical engineering at Ohio State University in USA, member of executive editorial board and Associate Editor of Journal of Materials Chemistry B, never replied. Maybe she had to brush up her knowledge of Yin and Yang. The Editor-in-Chief for Journal of Materials Chemistry A, B & C Nazario Martin, professor of organic chemistry at the University Complutense of Madrid, did reply, eventually:
“This is certainly a difficult issue in which it is difficult to give an opinion without a scientific base. It is critical in our society to distinguish science from pseudo-sciences and, in this regard, the only and important difference is the use of the scientific method to prove the properties. In this regard, I imagine that only experts in this matter should provide opinion. I mean that an editor and some referees accepted this manuscript and it is important to know about the comments they provided.
Unfortunately, I am not an expert since I never heard about the Qi of traditional Chinese herbal medicines. So, please, contact the aforementioned persons to know more about it…”
Martin accepts surprisingly little responsibility for the contents of the journal he is being paid to act as Editor-in-Chief of. He instead invited me to contact the editors and reviewers of this paper, well aware I have absolutely no way of finding out who they might be. I then asked Martin and his editor colleagues whether their salaried positions with RSC mean they are required to discretely look away while Chinese TCM pseudoscience propaganda is being funnelled into their RSC journal, and included the RSC publisher executive Jamie Humphrey in this communication. Martin never replied again, but Humphrey forwarded my email to the RSC executive editor Sam Keltie, who then reiterated to me that the paper passed peer review:
“I’ve had a look at the review process that the article went through and it was handled following our standard processes by an associate editor. Two independent reviewers provided reports on the article, it was revised by the authors and then accepted by the associate editor. I do not have any concerns about the process that the article has gone through. If you have specific scientific concerns, I would be happy to look into these.”
I then explained to Keltie that I was not questioning the if of the peer review, but the how, or rather, the why. Of course that paper passed peer review at RSC, an incompetent TCM-friendly editor can sure find some incompetent TCM-friendly reviewers, but why was the manuscript ever admitted, instead of getting desk rejected right away? Humphrey apologised for Keltie’s patronisingly formulated email and promised that his colleague will be in touch again. Next day, on 9 April 2019, Keltie replied:
“Thank you for clarifying your concerns. I’m discussing the article with the associate editor that handled it and will get back you. For your information, the coverage of our journals is somewhat steered by the community, via what passes through peer review. The views and opinions advanced by contributors to our journals does not necessarily reflect those of the RSC.”
I haven’t heard from RSC since then. What impresses me most, is that both Keltie and Humphrey chose to ignore my repeated request for a RSC position statement on alchemy, animal magnetism, homeopathy, Ayurveda, Qi and Traditional Chinese Medicine. Maybe at Royal Society of Chemistry those are seen as controversial subjects where the science jury is still out. Or maybe science has to take the back seat these days when dealing with important customers from China, as Science indeed already demonstrated.
Sam Keltie of RSC replied today:
“I have discussed the paper with the associate editor that handled it. Having done this, it is my opinion that the experimental results concerning the biosynthesis of nano-Au products in the paper are scientifically sound. The authors’ presentation of these results in the paper were thought to be an interesting angle, which was not highlighted by the reviewers as being a barrier to publication.
As I have mentioned in a previous email, the coverage of our journals is somewhat steered by the community, via what is submitted and what passes through peer review. The views and opinions advanced by contributors to our journals do not necessarily reflect those of the RSC.
I hope you will see from my email that I have taken your concerns seriously. My response is reasoned based on the content of the paper and the comments the paper received during peer review by appropriately qualified scientists in the area of nanoparticle biosynthesis.”
Royal Society of Chemistry herewith issues a verdict that measurement of Qi and Yin-Yang properties of TCM is “scientifically sound”.
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