方舟子的Blog

    
《洛杉矶时报》在2007年1月8日头版头条刊登记者Mark
Magnierd的报道《中国发生的解剖刀对草药之战》（Scalpel vs. herb in
China，网络版的标题为China’s medicine
wars），报道新近发生在中国的中医之争，文中大量报道支持中医一方的辩护，但对反对中医一方的观点主要只引用了我的一句话：“许多被认为无毒的草药实际上毒性很大，”生化学者、专栏作家和一个揭露学术造假网站的创始人方舟子说。“但是从业者和支持者用各种借口加以掩盖。”（”Many
herbal medicines considered innocuous are actually very toxic,”
said Fang Zhouzi, a biochemist, columnist and founder of a website
that targets academic fraud. “But practitioners and proponents
cover this up using various excuses.”）

   
我当初接受该记者的电子邮件采访时，回答了14个问题，现把问答翻译成中文如下。英文原文附后。

1. 你认为中医现在的问题是什么？

答：最大的问题是安全性问题。生物医学研究已表明许多种被中医认为无毒的草药实际上有很强的毒性，能够导致严重疾病，例如肾病、癌症、肝炎等等。但是公众还未充分注意到这个问题，而中医从业者和支持者正用种种借口加以掩盖。中药至今还普遍被吹嘘为“没有任何毒性和副作用的天然药物”，而且通常不列出其可能的副作用。

   
另一个问题是中医从业者惯于夸大、捏造其有效性并愚弄了太多的人。虽然几乎没有一种中医疗法通过了双盲、随机分组、有安慰剂对照的临床试验，但是许多中国人仍然相信中医是一直就是最好的医学、能够治疗几乎任何疾病。民族自豪感使这个问题变得复杂，对许多中国人来说批评中医是不可想像的，几乎就像是在叛国。

   
因为中医药并非真正有效，所以有一个很普遍的现象是，把化学药物添加到中药中然后做为纯中药销售。这种欺诈行为对病人来说也是非常危险的。

2. 有很多假医生和滥用吗？

答：是的。

3. 是否有许多没有受过训练的人试图骗人并获益？

答：是的。

4. 你认为中医是不科学的吗？请解释。

答：中医不是建立在科学基础上的，而是建立在玄学、巫术和传闻基础上的，加上一些民间医术。它的理论体系基本上不具有可检验性和测量性，而且完全与现代科学不兼容。它更像是一种宗教，仍然在崇拜数百年前写的古代医学著作。中医从业者通常引用古代医学著作做为他们进行诊断和治疗的依据。有没有一门科学只在一个国家获得承认和实践，完全与其他科学不相干，并且崇拜古代著作？那将会是一门非常特殊的科学。

5. 你认为中国依赖中医还有哪些问题？

答：即使在经过恰当的医学治疗之后，中国的病人通常还被要求花费额外的钱去购买不必要的、昂贵的中药，这是一种浪费。

   
而且，已经浪费了大量的公共资金试图用“科学”证明中医理论，例如试图证明经络的存在。

6. 西医中有哪些是中医不能提供的？

答：虽然现代医学起源于西方，但是它不属于西方，因此我更喜欢用“现代医学”、“医学科学”的说法，而把“西医”一词留给传统的西方医术，例如顺势疗法。现代医学能够做手术，防治多种疾病（特别是传染病），这些是中医做不到的。甚至就慢性病而言，也没有科学证据证明中医比现代医学更安全可靠。现代医学之所以更安全可靠，是因为它是建立在来自实验和随机临床试验的科学证据基础上的。

7. 某些成分是否有什么问题？它们是否有时候是不安全的？

答：许多中药含有有毒成分。例如，20多种中草药含有马兜铃酸，这是已知的一种肾毒性毒素和可能的致癌物。有许多医学报道表明病人由于使用了含马兜铃酸的草药而导致肾衰竭。许多中药含有高含量的朱砂和雄黄，能够导致汞和砷中毒。

8. 你是否有案例表明人们因为使用中药而死亡或使病情加重？

答：自1993年以来，西方研究人员已发现含有马兜铃酸的草药是强烈的肾毒素，但是中国政府和中医从业者拒绝这一发现，直到2003年才承认这个问题。因为有这10年的耽误，估计有十几万中国患者因为服用了由著名的中药厂家北京同仁堂生产的含马兜铃酸的非处方著名药物龙胆泻肝丸而得了肾衰竭，需要做肾移植或做血液透析。一些受害者已起诉北京同仁堂。

   
两年前，我的一位近亲因胃癌病故。多年来他为了治胃疼和消化不良，只看中医、吃中药。等到他最终被送往医院时，已是胃癌晚期，已无法进行恰当的治疗。

9. 是否有些成分对全球环境有害，例如使用濒危动物成分？

答：是，中医根据取象比类的巫术原则，至今还把犀角、虎骨、虎鞭、熊胆和其他濒危动物的器官当成宝贝。

10. 对改革中医你有什么建议？

答：中国可能是世界主要国家中唯一一个有两套独立的医学“科学”，并对中医采用一套非常不同的、非常低的标准。我们不应该把中医当成另一种合理的“医学科学”，而是应该当成另类医术。它的理论体系应该被完全抛弃，而它的有效性和安全性应该用科学方法进行充分的检验。我们对中医和现代医学都应该采用相同的严格标准。

11. 你是否认为中国医疗保险系统应该包括中医药？

答：既然大多数中国人相信并使用中医药，满足他们的要求我想是合理的。

12. 毛泽东说过需要中西医相结合。对这个观念你怎么认为？

答：你能够把占星术和天文学、炼金术和化学相结合吗？把两个不兼容的系统相结合是不可能的。它从未有效。它只是给医生们一个借口，开不必要的中药去赚病人更多的钱。但是当然了，在经过充分的科学研究之后，某些有价值的草药和民间医术可以被现代医学所吸收。

13.
中国政府正在寻求为中医申请世界遗产，并似乎把它做为中国文化输出和海外形象的一部分。对这种观点你有什么看法？

答：我支持让中医成为文化遗产，并把它放进博物馆。中医是一种文化遗产，虽然不是科学。

14.
在中国有越来越多的人怀疑中医的价值的同时，西方国家中似乎有越来越多的富人在拥抱中医。对此你有什么看法？

答：我把这当成西方国家中反科学、反文化运动的一部分。既然现代医学不能治愈所有的疾病，那么另类医术和任何伪科学和迷信一样，总是能够利用人们的无知和弱点，将会有生存和生长的土壤。

RE: interview request from L.A.Times

1.     
What problems do you see with TCM these days?

The biggest problem is the safety. Biomedical research has shown
that many herbal medicines considered as innocuous by TCM are
actually very toxic and can cause serious diseases, such as renal
disease, cancers, hepatitis, etc. But the public haven’t been fully
aware of this problem, and TCM practitioners and proponents are
covering it up using various excuses. TCM is still generally
advertised as a “natural medicine without any toxic and side
effects”, and usually doesn’t list its possible side effects.
Another problem is that TCM practitioners are used to make
exaggerative and dubious claims about its efficacy and fool too
many people. Although almost none of TCM treatments has passed
double-blind, random-assignment, placebo-controlled test, most
Chinese believe that TCM has always been the best medicine and can
cure almost any diseases. The national pride complicates the issue,
and criticizing TCM is unthinkable to many Chinese people and
almost like committing a traitorous act.
Because TCM is not really effective, it’s very common that chemical
medicine is added into TCM medicine and sold as pure TCM medicine.
This cheating practice is also very dangerous to patients.

2.     
Are there a lot of fake doctors and abuses?

Yes.

3.     
Do some people try and get rich or take advantage of people without
having the training?

Yes.

4.     
Do you think it is not scientific? Please explain.

TCM is not based on science, but based on mysticism, magic and
anecdote, plus some folk remedies. Its theoretical system is
generally untestable and unmeasurable, and is totally incompatible
with modern science. It’s more like a religion, which still
worships ancient medical works written hundreds of years ago. TCM
practitioners often cite ancient medical works as their basis to
make diagnosis and treatment. Is there any science that is
recognized and practiced in only one nation, completely independent
from other sciences, and worships ancient works? That will be a
very special science.

5.     
What other problems do you see with China’s reliance on TCM?

Even after proper medical treatments, Chinese patients are usually
asked to spend extra money to buy unnecessary expensive TCM
medicines, which it’s a waste.
It has also wasted a lot of public funds to “scientifically” prove
the theory of TCM, e.g., try to demonstrate the existence of
meridians.

6.     
What does Western medicine offer that TCM does not?

Although modern medicine first appeared in the West, it does not
belong to the West anymore. Therefore I prefer the term of “modern
medicine” or “medical science” to “Western medicine”, and reserve
the term “Western medicine” for traditional Western medicine, such
as homeotherapy. Modern medicine can perform surgical operations,
prevent and cure a lot of disease (particularly infectious
disease), which TCM can’t. Even to those chronic diseases, there is
not scientific evidence that TCM is more reliable and safer than
modern medicine. Modern medicine is more reliable and safer because
it’s based on scientific evidence from experiments and randomized
clinical trials.

7.     
What is the problem with some of the ingredients? Are they
sometimes unsafe?

Many TCMs contain toxic ingredients. For instance, more than 20
herbal medicines contain aristolochic acid, a well-known
nephrotoxin and potential carcinogen. There are a lot of reports
that patients developed end-stage renal disease in association with
the use of herbal medicines containing aristolochic acid. Many TCMs
contain high amounts of vermilion and realgar, and can cause
mercury and arsenic poisoning.
 
8.     
Do you have examples of cases where people have died or become
worse from using TCM?

Since 1993, Western researchers have shown that herbal medicines
containing aristolochic acid are potent nephrotoxin, but Chinese
government and TCM practitioners refused this finding until 2003.
Because this 10-year delay, it is estimated that more than 100
thousands of Chinese patients developed end-stage renal disease and
required renal transplant or dialysis because they took Long Dan
Xie Gan Wan, a popular OTC herbal medicine containing aristolochic
acid and produced by the famous TCM manufacturer Beijing
Tongrentang. Some victims have sued Beijing Tongrentang.
Two years ago, one of my close relatives died from stomach cancer.
For many years he only saw TCM practitioners and took TCM to treat
stomach pain and dyspepsia. When he was finally sent to the
hospital, he had developed terminal stomach cancer and was too late
to have proper treatments.

9.     
Are some of the ingredients bad for the global environment, i.e.
using endangered animal parts?

Yes, based on principles of sympathetic magic, TCM still treasures
rhinoceros horns, tiger bones and penises, bear gall bladders and
other endangered animal parts.

10.   What would you propose to
reform TCM?

China is probably the only major country in the world that has two
independent medical “sciences”, and applies a very different, very
low standard to TCM. We shouldn’t consider TCM as another
legitimate “medical science”, but an alternative medicine. Its
theoretical system should be completely abandoned, and the efficacy
and safety of TCM should be fully tested using scientific methods.
We should apply the same rigorous standard to both TCMs and modern
medicine.
 
11.   Do you think the Chinese
medical insurance system should cover TCM?

Since the majority of Chinese people believe and use TCM, I think
it’s reasonable to fulfill their requirement.

12.   Mao spoke of the need to
marry Eastern and Western medicine. What do you think of this
idea?

Can you marry astrology and astronomy, alchemy and chemistry? It’s
impossible to combine two incompatible systems. It never works. It
only gives doctors an excuse to charge patients more by prescribing
unnecessary TCM. But of course, some valuable herbal medicines and
folk remedies can be absorbed into modern medicine after sufficient
scientific investigation.  

13.   The government is seeking
heritage status for TCM and seems to view it as a part
of   China’s cultural export and
image overseas. What do you think of that idea?

I support to seek cultural heritage status for TCM and put it into
museum. TCM is a cultural, although unscientific, heritage.

14.   It seems like more rich
people in Western countries are embracing TCM while more people in
China question its value. Why do you think that is?

I consider it as part of anti-science and anti-culture movement in
Western countries. Since modern medicine can’t cure every disease,
the alternative medicines, like any pseudo-sciences and
superstitions, can always exploit people’s ignorance and weakness,
and will have soils to survive and grow.