Simultaneous Use of TCM and Biomedicine

The philosophical systems of Confucianism, Taoism, Buddhism and Folk Religion reinforce the mind-body-spirit connection and for many East Asian clients, approaches to health that include all these aspects is elemental. Consequently, pluralistic health practices are common as the expected holistic focus is not traditional in New Zealand healthcare.

Simultaneous use is widespread and growing

Research indicates that many East and Southeast Asian clients (from China and Taiwan in particular) use traditional approaches alongside Western biomedicine, both in countries of origin and in countries of resettlement (Chen & Rankin, 2002). In spite of the prejudice against complimentary and alternative practices amongst biomedical professionals, Chang & Wang (2008) report on how the prevalence of simultaneous use is nevertheless increasing in medical settings, as well as outside of hospital settings. Consultations with local practitioners (TCM and Western medicine practitioners), Internet searches and many research papers (Chan et al, 2010) all indicate that this prevalence is widespread.

In their study Chang and Wang (which was conducted in Taiwan) found that clients and caregivers used creative and covert ways of integrating the alternative medicines into daily routines, so as to avoid challenging the primacy of the biomedical treatment plans, and to avoid receiving disparaging responses from clinicians. Because herbal remedies produced the most controversy in their study, the use of these became a clandestine activity.

Research on health seeking behaviour of East Asian clients indicates that many utilise alternative and complementary remedies before turning to western medicine. Because of constitutional differences, and the emphasis on the principle of balance, the effects of western medicine are often considered to be disruptive to the body or 'too strong' and so biomedical drugs and procedures are avoided until absolutely necessary. Routines and remedies that restore balance and increase chi will often be used in conjunction to counterbalance effects of some treatments, or during the recovery phase of illness. Other clients who prioritise biomedical treatment may also use alternatives to counterbalance the effects of drugs and procedures.

The subscription to the theory of harmony and balance determines to some degree how much western treatment is supplemented by other practices (Chen & Rankin, 2002).

Potential problems with simultaneous use of herbs and western drugs

Herbs used for therapeutic effects are common throughout the world and the World Health Organization (WHO) estimates that approximately 80% of the global populations rely on traditional herbal medicines as standard healthcare. However, the use of herbs or combinations of herbs has significant pharmacological effects, with the result that there is concern amongst biomedical practitioners about their potential interactions.

The concept of integrated medicine (the combination of traditional and integrated medicine) originated in China and is growing internationally. CAIM (Chinese Association of Integrated Medicine) has led research in this area for the last few decades, however much of its focus has been on new approaches to the treatment of disease. More evidence-based research on the efficacy and safety of phytochemical constituents in herbs and TCM formulations is needed in order to assess the synergistic and antagonistic interactions with western medicines. Research with reproducible results however is fraught with challenges due to variations in different country's regulations, sources of products, variations in quality and content of phytochemical constituents, differences in preparation, variations in concentrations of tinctures, and other problems. The result is that there is not yet a reliable or comprehensive enough database to establish effects of interactions. Some practitioners prefer to avoid simultaneous use, whilst others manage these with the use of the information that is available. To date there is a proliferation of information online and a growing number of articles in medical journals for practitioner's use.

Whilst some herb and drug interactions can be critical, others are less so but can reduce the efficacy of either intervention. However, there is also evidence that some Chinese herbs can potentiate certain western drugs and enhance interventions. Below is a table provided by Chan et al (2010) on interactions with some prescribed drugs:

• Table of interactions from research paper (requires Adobe Reader)

Implications for practice

It is highly desirable that clients are encouraged to disclose simultaneous use and for practitioners to be willing to work through some of the concomitant issues. Whether the client or family raise the issue can be influenced by their level of acculturation, English language proficiency, and understanding of the New Zealand health system, but it will largely depend on the attitude of the practitioner. Clients may not be aware of problems that can arise over interactions between herbal and western medications, and respectful and supportive dialogue is imperative if the way through this quandary is to be forged.

(An interviewee for this resource who is a New Zealand GP and is a trained TCM practitioner has worked for decades in both fields. She noted that many clients do not raise the issue with their health providers because they believe that their traditional practices will be dismissed, and for fear of reproach. Chan et al (2010) report that less than 40% of alternative or complimentary therapies are disclosed to health practitioners).