Introduction

Evidence based medicine re-emphasises applied clinical research in human subjects.12 However, research in traditional Chinese medicine has had a mechanism centred approach and has been dominated by studies of basic and intermediate mechanisms. Though tremendous efforts have been made, and despite occasional successes, such as in acupuncture,3 most questions—for example, the nature of disease in traditional Chinese medicine—have not been satisfactorily answered.4

According to Liang, “Since the early 1990s, the search for the nature of disease has descended into a downward spiral. All the breakthroughs once cheerily anticipated seemed to have become an illusion. The entire traditional Chinese medicine research is currently in a state of disarray. Basic research had come to a standstill. What has gone wrong? Where should we go from here?”4 In this article, I argue that research priorities in traditional Chinese medicine need to be reviewed, and I propose an efficacy driven strategy.

Two possible approaches to research

The mechanism centred approach is primarily concerned with the search for the molecular, cellular, and pharmacological bases of traditional medicines. It seeks to identify the active substances of herbal treatments and investigate the mechanism of action. This strategy is shaped by a belief that traditional Chinese medicine need not be evaluated,5 by the general prosperity of basic biomedical sciences, and by drug development models in conventional medicine. As many research activities in traditional Chinese medicine aim to develop new drugs, the model used by conventional medicine to design and develop new drugs, such as drugs for cancer,6 seems directly relevant.7 It has three important conventions (fig 1, left). Firstly, the potential drug must be a single chemical entity, or a combination of known …