Comparing TCM textbook descriptions of menopausal syndrome with the lived experience of London women at midlife and the implications for Chinese medicine research.

Almost without exception clinical research seeking to evaluate the effectiveness of Chinese medicine relies on TCM textbook knowledge - accessed directly or via practitioners' clinical usage - in order to frame its hypotheses. Recent historical research shows that these textbooks, products of a politically directed process of modernisation, constitute complex hybrids of western and Chinese knowledge that are designed to facilitate the integration of Chinese medicine into biomedically dominated contexts of practice. As such they produce a number of unresolved and generally unacknowledged tensions, such as between the emphasis on local illness experience in the Chinese medical tradition and the universality aspired to by biomedical knowledge. To examine the effect of these tensions we have carried out a study that compares local symptom patterns experienced by post-menopausal women in London with the universal patterns described in TCM textbooks. The results of this study confirm our proposition, namely that the TCM textbook descriptions of disease are not always grounded in clinical experience even if that is what textbooks claim. This raises questions about the relation of textbooks to clinical practice, and about the validity of clinical research based on textbooks and textbook derived normative practice. We argue that only a multidisciplinary approach that includes an understanding of the historical construction of contemporary Chinese medical knowledge and its relation to clinical practice can overcome these problems and enable a meaningful evaluation and utilisation of Chinese medicine in the context of 21st century evidence-based healthcare.