The Decline of Traditional Chinese Medicine (TCM) Efficacy: Challenges and Paradigm Shifts in Clinical Practice

The Vision for Modernizing Traditional Chinese Medicine: From Empirical Medicine to Technical Medicine

Ka Kui Wong — A Practitioner’s Reflection and Practice

I. Introduction: The Dilemma and Opportunity of TCM

Traditional Chinese Medicine (TCM), as the accumulated wisdom of generations, represents a unique medical system rooted in China’s cultural heritage and clinical experience. However, in today’s rapidly evolving medical landscape, TCM faces unprecedented challenges:

• Its theoretical framework is often vague and lacks unified terminology;
• Clinical efficacy lacks reproducibility and standardization;
• Education and inheritance still rely heavily on personal experience rather than systematic training;
• Much of its historical knowledge contains inaccuracies, inconsistencies, or even errors.

These issues have led to frequent misunderstandings, marginalization, and even skepticism about the scientific validity and practical value of TCM within modern medicine.

Yet, at the same time, TCM stands at a historic crossroads—an opportunity not to abandon tradition, but to reconstruct its clinical value system using modern language, methodology, and technology.

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II. The Core Philosophy of TCM Modernization: Technicization

I firmly believe that:

TCM is neither mysticism, nor literature, nor philosophy—it is a “clinical technical medicine.”

Its essence lies in a technical system of diagnosis and treatment , not in reciting classics, debating terminology, or engaging in abstract philosophical interpretations of concepts like yin-yang and the five elements.

The modernization of TCM must be:

• Clinically oriented ,
• Technically grounded , and
• Standardized in practice .

1. Clinical Orientation: Pursuing High Reliability and Reproducibility

The ultimate goal of medicine is to serve patients. Clinical effectiveness is the only criterion by which to judge medical value. Therefore, the modernization of TCM must focus on reproducible clinical outcomes :

• Different doctors should reach similar conclusions when diagnosing the same patient.
• Similar conditions should follow standardized diagnostic and therapeutic pathways.
• Treatment effects should be observable, recordable, and verifiable.

2. Technicization: Transforming TCM into a Teachable, Executable, and Transferable System

TCM should not remain an esoteric or intuitive discipline. It must become a structured, logically rigorous, and technically teachable system :

• Diagnostic techniques : such as the "Four-Dimensional Symptom Collection Method";
• Pattern recognition techniques : such as "Pathogenesis-Oriented Inquiry";
• Therapeutic techniques : such as "Disease Mechanism Analysis → Therapeutic Principle → Formula Construction";
• Teaching techniques : such as "Graded Training in Diagnostic Skills".

These are not invented from scratch, but distilled from classical texts, summarized from clinical practice, and borrowed from modern science, forming a replicable, teachable, and evaluable technical system .

3. Standardization: Establishing Unified Terminology, Pathways, and Evaluation Criteria

For too long, TCM has lacked unified standards, leading to communication difficulties among practitioners, teaching inconsistencies, and research verification challenges. The modernization of TCM must promote:

• Standardized terminology : e.g., clarifying terms like "zheng" (pattern), "bingji" (disease mechanism), and "maixiang" (pulse image);
• Standardized procedures : e.g., standardized operational steps for inspection, listening/smelling, inquiry, and palpation/pulse-taking;
• Standardized outcome evaluation : establishing observation indicators and assessment criteria for TCM treatments.

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III. The Technical Pathway of TCM Modernization: From Vagueness to Clarity

1. Reconstructing the Terminological System of TCM

The terminological system of TCM contains many ambiguous, repetitive, or even contradictory concepts. Terms like "zheng", "zhengzhuang" (symptom), "hou" (manifestation), and "ji" (mechanism) are often used interchangeably, leading to confusion among practitioners.

We propose to de-mystify, de-vaguenize, and de-labelize this system, redefining key terms with modern language:

• "Bianzheng Lunzhi" (Differentiating Patterns and Formulating Treatment) → "Shenji Dingzhi" (Analyzing Disease Mechanisms and Determining Therapy)
• "Zheng" → "Bingji Pattern"
• "Zhengzhuang" → "Clinical Symptoms"
• "Maixiang" → "Tactile Pulse Classification"

2. Building a Technical Process for TCM Diagnosis

Diagnosis in TCM should not revolve around debates over which method—inspection, listening/smelling, inquiry, or palpation—is superior. Instead, it should be a complete process involving:

• Sensory input
• Information collection
• Disease mechanism identification
• Therapeutic decision-making

We propose:

• Four-Dimensional Symptom Collection Method : collecting symptom information across four dimensions—existence, nature, timing, and causality;
• Pathogenesis-Oriented Inquiry : asking targeted questions based on suspected disease mechanisms;
• Standardized Information Collection Table : designing a structured form to improve the accuracy and efficiency of data gathering.

3. Establishing a Technical Roadmap for TCM Treatment: Analyzing Mechanism → Defining Therapy → Constructing Formulas

Treatment in TCM should not be a mechanical application of pre-existing formulas. It must be a precise intervention based on disease mechanisms .

We propose:

✅ Analyzing Mechanism and Defining Therapy

• Not simply applying formulas like Chuanxiong Cha Tiao San for headache or Suanzaoren Tang for insomnia;
• Instead, analyzing the underlying disease mechanism combination (e.g., liver qi stagnation + heart spirit deficiency + phlegm-damp disturbance);
• Then determining the appropriate therapeutic principle (e.g., soothing liver qi, nourishing the heart spirit, resolving phlegm).

✅ Defining Therapy and Constructing Formulas

• Therapeutic principles must translate into actionable herbal combinations;
• Each herb must target a specific disease mechanism;
• Principal herbs address the primary mechanism; secondary herbs address secondary ones;
• The formula structure reflects the principles of holistic regulation, synergy, and dynamic balance.

✅ Prioritizing Self-Formulation Over Formula Selection

• Classical formulas are learning tools, not templates to be blindly applied;
• True mastery involves constructing custom formulas based on disease mechanism combinations;
• Studying classical formulas should focus on understanding their composition logic, not rote copying;
• We oppose the current trend of stacking formulas without logical consistency, which undermines both structure and repeatability.

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IV. Critique of Contemporary TCM Formula Teaching

❌ Problems in Current Formula Instruction

Modern TCM education, particularly in university settings, suffers from several critical flaws:

1. Detachment of Formulas from Disease Mechanisms

• Many courses teach formulas through memorization of formula names, ingredients, and functions, without explaining the underlying disease mechanisms;
• Students may know “Ma Huang Tang treats wind-cold exterior syndrome,” but lack understanding of why Ma Huang is used instead of Gui Zhi;
• There is little emphasis on causal factors, lesion locations, pathogenic natures, and progression patterns.

2. Emphasis on Formula Selection Over Composition

• Courses emphasize “remembering which formula fits which condition” rather than teaching how to construct formulas based on mechanism;
• This results in students who can “look up formulas” but cannot “formulate independently”;
• This approach severs the internal logic chain of “diagnosis → therapeutic principle → formula construction”.

3. Misuse of “Addition/Subtraction” Concepts Without Logical Consistency

• Many textbooks encourage adding or subtracting herbs arbitrarily, without clear rules or rationale;
• For example, adding Chai Hu, Xiang Fu, and Dan Shen to Liu Wei Di Huang Wan creates a so-called “modified version,” but ignores that the original formula’s core mechanism has been fundamentally altered.

4. Lack of Real-World Clinical Application

• Courses often focus on idealized applications, not complex, real-world cases;
• For example, how to treat a patient presenting with liver qi stagnation, spleen deficiency with dampness, and heart spirit disturbance simultaneously?
• Without such integrated training, students are unprepared for actual clinical practice.

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V. Modernizing TCM Education: From Memorization to Skill Development

Traditional TCM education has long relied on memorizing classics and formula rhymes, neglecting hands-on clinical skills.

We advocate transforming TCM education by:

• Curriculum design : incorporating modules on diagnostic techniques, pattern recognition, and clinical interviewing;
• Teaching methods : using case-based instruction, simulated consultations, and pulse-taking practice;
• Assessment methods : developing a "TCM Diagnostic Competency Certification System" to evaluate practical skills.

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VI. Modernizing TCM Research: From Mysticism to Verification

TCM research should move beyond philosophical interpretations of classical texts and toward:

• Reinterpreting traditional theories in modern language ;
• Integrating physiological, pathological, and pharmacological knowledge to explain TCM mechanisms ;
• Promoting verifiability of TCM theories ;
• Discarding outdated or unverifiable concepts .

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VII. Conclusion: The Future of TCM Lies in Technicization, Standardization, and Systematization

As my mentor has advocated and the renowned scientist Qian Xuesen once said:

“TCM is not mysterious. It is a systematic, holistic, and dynamic medical system. It needs to be rediscovered, redefined, and revitalized through modern science.”

The modernization of TCM does not mean abandoning tradition, but reconstructing its clinical value system through modern means—to make it a truly “perceivable, communicable, transferable, and verifiable” clinical medicine.

This path requires the joint efforts of our generation of TCM practitioners—and the participation of more informed individuals.

The future of TCM does not lie in the past, but in our hands.