Ruminations: TCM and Western Medicine are similar but also not the same thing

Sep 5, 2026

Ruminations: TCM and Western Medicine are similar but also not the same thing

Chinese Medicine, or TCM, is not one medicine contrary to popular belief. There are numerous variations of it, within China and across different countries. While different styles operate differently, the most important thing any clinician really thinks about is probably whether it is actually different from Western Medicine or actually more similar than we believe. There is actually no real answer. At least, I don’t think I have come to my own answer so far after 15 years of practice. Talking to some of the older practitioners it seems they haven’t come to their own conclusions either.

There are a few reasons why thinking about this is important other than just being an interesting philosophical exercise. Firstly, it’s hard to explain to patients the ‘operating theory’ of TCM in a strictly faithful manner. The official terminology is highly metaphysical, eg. liver fire, heart fire, spleen dampness, external ‘evil’, etc. They genuinely sound like something out of a Western interpretation of Eastern esotericism or some internal language used in fantasy novels. It is typical fashion for practitioners to rephrase them in more ‘modern’ language usually along biomedical terminology so people can understand them better. It is sort of an attempt to ‘scientificate’ the medicine. Perhaps it gives it more credence, but really, it’s at the very least about ‘effective’ communication. People may have a hard time deciding whether a treatment modality is right for them if they fundamentally have no clue what it is even remotely is. This is understandable. As such, liver fire and heart fire, or whatever fire, can be loosely translated as ‘inflammation’ because ‘liver and heart inflammation’ certainly are not the same as ‘liver and heart fire’, so strictly speaking just simply ‘inflammation’, while more vague, is actually more accurate and ‘safe’, at least in my opinion. ‘Spleen dampness’ may be viewed as ‘moisture’, which patients often relate to ‘yeast infections’. To this day however, most patients still do not have clear ideas of how TCM actually operates because these translations do not fully impart the real picture of not actually what TCM is, but what it was.

Secondly, there could be an issue of convenience on the part of the practitioner, not simply for the sake of explaining to patients but also to give oneself a more ‘clear’ framework to work with. This is largely how foundation theory in TCM is taught today. Certain elements from Western Medicine have been incorporated into TCM actually, so it can be taught more like modules. While there is an emphasis on ‘holism’, it is often still studied as parts, which you put together to construct a ‘system’. This is very similar to how Western Medicine operates, or really how Western thought operates. Study the parts, and put them together. The ‘system’ is just a sum of the parts. It provides an easy way to think about things, lets schools teach and evaluate it more measurably and in a way, ensures at least an ‘entry-level’ competency among the graduates. More than really about the medicine itself, it’s more about a ‘factory’ producing ‘satisfactory’ ‘workers’ in my somewhat more critical opinion. But other than that, I would assume at least on the part of the practitioners, that if they are clear-headed, treatment will also be clear, and the patients know exactly where the direction is heading. But this is really an epistemological issue actually, and does not necessarily mean things are more ‘clear’.

Thirdly, thinking about epistemological problems like this is actually a practical take on clinical outcomes, whether things are actually ‘clear’ or not, or whether patients ‘get it’ or not. For one thing, it is hard for me to entirely conclude that modern Traditional Chinese Medicine, TCM, is actually ‘traditional’, because of how it is practiced or studied. Certainly, looking back at ancient texts, there is a stark contrast to what it is now, and what it was before in the past. The thinking is not the same when it comes to looking at medical problems (as much as how TCM likes to harp that it is ‘holistic’). A medicine that could have so many variants says either that there is really no ‘unifying’ theory in TCM, or that somehow, the body operates on multiple levels, so that any variant model would actually work. Or perhaps, both can be true simultaneously. You can observe this when looking at scientific reviews of TCM and acupuncture. There is actually no consensus to this day. There are reports that it is all placebo, and there are reports that it is measurably effective. From a scientific point of view, this is technically impossible, because either it works or it doesn’t; you cannot have both at the same time. We want to think this is a logical problem or experiment design problem but it is really a conceptual problem of how we even view medicine, treatments and patients because this is what is actually observed in the data. The conflicting results point to something altogether.

Practitioners of TCM face a dilemma today essentially. Using biomedical lens to practice TCM makes it ‘easy’ so to speak, but it is hard to quantify whether ‘easy’ is actually more effective and better for patients. When I treat patients, I use different treatments for everyone because that is how we were taught it should be practiced. But there are times when you see recurring patterns across people, and that if we statistically analyze our treatments, we realize the treatments are actually quite similar to one another as well. And yet, sometimes you run into another dilemma. A treatment that works for the same patient today may not actually work the next week they come even though you ‘believe’ they are the same from the week prior. And yet, different treatments that are supposed to dynamically map on to their changing state from week 1 to week 2 can also not work as anticipated. So it is almost like how is it possible that if a coin is not face down how can it not be face up? The famous logical problem also explains this well, if A->B, then B->A. Well, not true, because given A->B, B doesn’t necessarily have to be from A. A could be just a bunch of other things that lead to B, because B could be a large system wherein A is only one of the many paths. Another example: if it rains, then the floor must be wet, but a wet floor doesn’t necessarily mean it is raining. Likewise, a practitioner doing A treatment to get B results does not mean B results can only be achieved by doing A treatment. In fact A treatment does not necessarily always produce B results all the time either. It explains why there are multiple variants of TCM, or you can even say, there are multiple variants of medical practice in general; TCM, Western Medicine are really just specific expressions of medicine which work on the body. There are other methods and theories that work as well.

Clinicians are therefore confused. I’v talked to some older practitioners and it seems even they, are muddled. At the end of the day, it doesn’t seem like there are even ‘frameworks’ anymore; there are only ‘treatments’ that ‘work’ and who ‘cares what is actually is’. This seems to be the underlying philosophy, if it even is at all. So this really goes back to what TCM actually is and how it should be practiced. Do you adhere to traditional methods or do you just take whatever works and add to your repertoire because at the end of the day, if it helps patients then it’s ‘good’? And therefore TCM is just for ‘branding’ purposes? It is a tough question because both aims are actually not even entirely achievable—’traditional’ TCM may be largely lost due to passage of time and loss of lineage while a pure results driven purpose is theoretically biased to failure because of physic’s quantum mechanic observer effect which was famously demonstrated in the double slit electron experiment. The observer effect basically says the patient can change depending on the practitioner’s angle so to speak, in a sense, reality is actually shifting in real time, so the same method does not work on everybody, and it does not even work all the time on the same person either. Adhering to tradition has, as some say, its limitations, but sticking to results driven outcomes may run into the problem of neglecting the infinite ways a patient presents themselves—sort of doing something not knowing why it is done that way, and therefore not thinking why it sometimes does not work—a Western mindset of ‘oh, 60%+ effective rate is good enough for this drug, the rest 40% is not worthy of research or understanding’ is in my opinion not very ‘scientific’. It’s certainly a problematic place to be. A lack of theory is perhaps just as dangerous as a theory that purports to be self-contained when reality itself is not even fully understood or explained by such ‘theory’. Essentially, a bunch of ‘theories’ that are not related to each other that somehow all work at the same time to some extent makes this even more messy.

The middle ground is probably not the answer, or at least, not the ultimate answer. The middle ground, the ‘hybrid’ model, or the ‘integrative model’ is sort of the ‘best of both worlds’ kind of idea that is often thrown around in more ‘progressive’ and ‘inclusive’ medical circles. But really, it probably is only a compromise, a temporary compromise that only exists in the absence of something clearer. This model is often not truly even ‘integrative’ either. It is often dictated by Western Medicine thinking, and TCM and other modalities are usually relegated to very minimal involvement based on my observations. A truly ‘integrative’ model would technically require another theoretical framework that to the fullest extent possible homogenize both realms into another new theory. This approach is usually what the more top-tier clinicians do from what I’ve learned. Sadly this comes by extremely rarely. I can count with my fingers the numbers of such things I’ve come across over the years and had the fortune to study. However even then, it is theoretically handicapped in itself because neither theory, TCM or Western Medicine, is fully complete in themselves, and which versions of each one uses to construct the new theory adds even more variables. At the very least, putting two incomplete things together does not mean getting a complete whole; there could be n number of missing parts so to speak mathetimatically that we do not actually know, because reality itself is not even fully mapped. And we could theoretically be aiming for something that does not actually exist. Mathematically it seems plausible that you could derive infinite new equations form existing ones to produce new ones, but it does not mean these new equations actually manifest at all. They could simply be on paper and have no basis in reality. It’s like a 3D immersive environment wherein you look out into the distance and you see another side of the world, but that ‘other side’ could be real or it could be a texture wallpaper. You don’t actually know, let alone if you can even reach that point, which sometimes you cannot. The off chance you become like Truman in Truman’s World where he manages to reach the ‘horizon’ only to find that it is just painted wall with ladder to go outside is hard to quantify.

For now, this is purely a realm of philosophical reflection. But it is important to think about these abstract issues because that is sort of how TCM has evolved over time. I cannot say whether it has evolved in the right way or not but I should say that is how human civilization has ‘evolved’ over time regardless. Progress is usually predisposed by thinking changes and view angle shifts. But philosophy is ultimately a very unwelcome subject of study today unfortunately. There are things we know. There are things we don’t know. And there are things we don’t know that we don’t know.