Traditional Chinese Veterinary Medicine (TCVM) is etching its way into the curricula of AVMA-accredited institutions and the veterinary internship matching program.1 If this trend continues and tuition dollars support an ever-higher percentage of myth and folklore within college curricula, what it means to practice veterinary medicine may change in the foreseeable future. Diagnoses will devolve from scientific, specific descriptions of anatomic and physiologic abnormalities into vague constellations of pseudoscientific disruptions of abstract bodily processes. While this approach may have qualified as medicine millennia ago, it does not now. Having more faculty hop on the bandwagon of TCVM may mean that valuable course time better spent on evidence-based instruction will be replaced by outdated ideas from long ago and far away. Mainly over the past decade, Asian medical practitioners introduced TCVM to the U.S. By first gaining a foothold and a following within institutions of higher learning, they used those connections as business opportunities that lent legitimacy to unapproved and untested herbal products. Students may become de facto distributors for their teachers’ proprietary mixtures when they perpetuate product promotion in their practices. That some Americans fall for self-proclaimed masters in Asian arts is nothing new; their attraction to gurus from the East bespeaks emotional yearning for spiritual salvation. But veterinary students are enrolled in school to learn medicine and science, not faith-healing and folklore. Personifying the Organs Course notes from one institution suggest how curricula may transmute the focus from the hard-won advances of modern medicine to the elementary ideas of prescientific society.2 As an example, neurology students are hearing that some seizures stem from accumulated wind, phlegm and heat that turn patients’ tongues pale and pulses slippery. Treatment entails expelling evil influences and opening orifices. Students are informed about a scorpion-silkworm TCVM “herbal” combination that supposedly stops seizures. It doubles as a remedy for dogs, cats and horses that are “screaming and foaming at the mouth.” For hydrocephalus, why spend time talking about brain malformations? TCVM holds that hydrocephalus happens on account of kidneys having dysfunctional family relationships with other organs: “The kidney does not nourish the child (liver) leading to stagnation of blood and qi. The grandparent (kidney) does not control the grandchild (heart) leading to mania. The grandchild (kidney) becomes rebellious and insults the grandparent (spleen) leading to accumulation of damp. As such, hydrocephalus can be thought of as the result of a spleen deficient damp pattern, where the accumulation of damp affects the mind and heart.” Under the new paradigm of TCVM neurology, the differential diagnosis for dogs suffering from acute intervertebral disk disease includes yang deficiency, yin deficiency or a combined yin-yang deficiency. One neurosurgeon recommends a TCVM cure containing strychnine and aconite, both considered highly toxic.3,4 Are students prompted to ask just how much strychnine and aconite a dog or cat can safely consume over weeks, months or a lifetime? Are they told that the exact amounts of these potentially lethal compounds cannot be known, as recipes are closely guarded “family secrets” and thus proprietary? Are they being encouraged to prescribe untested, unregulated remedies with unknown mechanisms and dubious or toxic ingredients in undisclosed amounts mainly because their teacher sells or promotes them? Is this the education that veterinarians selecting careers safeguarding our public health or defending our country in the military need to have to fulfill their obligations? Attaining accreditation by the American Veterinary Medical Association’s Council on Education means that an institution has achieved the “highest standard for veterinary medical education in the United States.”5 Colleges that earn the accreditation “confirm their commitment to quality and continuous improvement through a rigorous and comprehensive peer review.” They ensure that graduates attain three main goals: preparedness as professionals, knowledge of public health and safety, and acquisition of a body of knowledge based on contemporary curricula. Unless standards have changed recently, AVMA accreditation does not evaluate how well an institution teaches students to prescribe mystery mixtures of herbs, earthworms and strychnine. A Reawakening in China Even medical school faculty and drug regulatory agencies in China recognize the unreliability of the TCM diagnostic approach and the riskiness of Chinese herbs.6,7 Educators at Chinese veterinary colleges are seeking more science and less folklore in their curricula.8 Why is veterinary medicine in the U.S. going backward? If nothing else, the public health risk of Chinese herbs should cause veterinary professionals pause before placing their patients on TCM products. Researchers from a 2007 study published in the Journal of Toxicology and Environmental Health cited “severe” contamination of traditional Chinese medicinals with arsenic, lead and mercury. These toxicologists stated, “Given the high percentage of users who self-prescribe, this situation is not acceptable because it places consumers at risk of severe or even fatal heavy metal/metalloid poisoning from the consumption of ‘natural therapies.’ ”9 A more recent publication from the Journal of Environmental Science and Health identified concerns about genotoxic and tumorigenic ingredients found in raw herbs as well as the common issue of adulteration.10 A 1998 report from the California Department of Health indicated that 32 percent of traditional Asian medicines sold in that state contained either heavy metals such as lead, mercury and arsenic or undeclared pharmaceuticals.11 How can veterinarians who practice and preach TCVM consider themselves ethical and compassionate when they support the annihilation of endangered species in Asia? Concerns about the impact of the TCVM herb trade on chelonian fauna may make one wonder whether treating patients with turtle parts is worth not only jeopardizing these species’ survival but also risking the patient’s health with an unproven folk cure. Millions of turtles and tortoises are killed annually for the TCM market in Taiwan alone, indicating blatant disregard for the law.12 Collaborating with Chinese herbalists represents one approach to bridging the gap between modern medical treatments and traditional herbal approaches.13 However, adopting, promulgating and teaching TCVM in veterinary colleges has the potential to undermine the profession’s progress of the last two centuries. <HOME> Narda Robinson, DVM, DO, Dipl. ABMA, FAAMA, offers an evidential and scientific perspective on trends in complementary and alternative veterinary medicine. She oversees complementary veterinary education at Colorado State University. This article first appeared in the April 2010 issue of Veterinary Practice News FOOTNOTES 1. University of Florida Veterinary Medical Center Internship in Acupuncture. Obtained on February 23, 2010 here. 2. Clemmons RM. Acupuncture for the treatment of neurological conditions. University of Florida, Gainesville, FL. Obtained on February 21, 2010 here. 3. Chan TY. Aconite poisoning. Clin Toxicol. 2009;47(4):279-285. 4. Singhuber J, Zhu M, Prinz S, et al. Aconitum in traditional Chinese medicine: a valuable drug or an unpredictable risk? J Ethnopharmacol. 2009;126(1):18-30. 5. American Veterinary Medical Association. AVMA Center for Veterinary Education Accreditation. Obtained on February 21, 2010 here. 6. Wang H, Ye X, Gao Q, et al. Pharmacovigilance in Traditional Chinese Medicine safety surveillance. Pharmacoepidemiology and Drug Safety. 2009;18(5):357-361. 7. Hsiao C-F, Tsou H-H, Wu Y-J, et al. Translation in different diagnostic procedures – Traditional Chinese Medicine and western medicine. J Formos Med Assoc. 2008;107 (12 Suppl):S74-S85. 8. Yin J-C, Li G-X, and Ren X-F. An overview of veterinary medical education in China: current status, deficiencies, and strategy for improvement. JVME. 2006;33(2):238-243. 9. Cooper K, Noller B, Connell D, et al. Public health risks from heavy metals and metalloids present in Traditional Chinese Medicines. Journal of Toxicology and Environmental Health, Part A. 2007;70:1694-1699. 10. Fu PP, Chiang H-M, Xia Q, et al. Quality assurance and safety of herbal dietary supplements. Journal of Environmental Science and Health Part C. 2009;27:91-119. 11. Ko RJ. Adulterants in Asian patent medicines. New England Journal of Medicine. 1998;339(12):847. Cited in Amster E, Tiwary A, and Schenker MB. Case report: potential arsenic toxicosis secondary to herbal kelp supplement. Environmental Health Perspectives. 2007;115(4):606-608. 12. Chen T-H, Chang H-C, and Lue K-Y. Unregulated trade in turtle shells for Chinese Traditional Medicine in East and Southeast Asia: the case of Taiwan. Chelonian Conservation and Biology. 2009;8(1):11-18. 13. Kraut AM. Healers and strangers. Immigrant attitudes toward the physician in America – a relationship in historical perspective. JAMA. 1990;263(13):1807-1811.
