In EAM patients are diagnosed within the context of EAM theory, which then leads to the determination of a treatment principle and the selection of approaches, which can include acupuncture, CHM, moxibustion, cupping, and various other modalities. Patient treatment is individualized, and there is an emphasis on basing treatment upon the patient’s presenting objective and subjective signs and symptoms. This is often referred to as “treat what you see.” Tongue and pulse analysis are important objective diagnostic techniques. CHM prescriptions (called formulas) are specific to individual patients and typically consist of 10–15 different constituents selected from the CHM pharmacopeia that contains over 500 different constituents. Practitioners usually start with a commonly used formula and then modify for individual patients by adding and/or removing specific constituents. This is termed formula modification.
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Despite a growing evidence base to support the use of acupuncture35,36 and efforts by the National Institutes of Health who funded research programs within complementary and integrative health institutions aimed at increasing research literacy, there are still significant cultural barriers to embracing the use of evidence to inform clinical practice.33,34,37 Some of this relates to the barriers and limitations in applying evidence-based medicine to EAM38–42 due to the significantly different paradigms of biomedicine and EAM.40,41 EAM uses a whole person health43–45 approach in which illness is assessed in relation to an assessment of the whole physical, mental, and spiritual health of an individual. This contrasts with the more reductionist approach of biomedicine and science. Applying scientific models used for clinical research to assess the efficacy and effectiveness of EAM is problematic41 because these studies usually don’t use EAM diagnostic approaches or tailor treatments to individual participants. Such issues weaken the external validity of the research and its ability to inform real world clinical practice.
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In studies assessing the efficacy and effectiveness of CHM for COVID-19 these issues are especially problematic.45 CHM formulas are individualized to address specific patient symptoms and presentation.46,47 COVID-19 infection presents with a broad range of associated symptoms.48 The CHM formulas used in the COVID-19 trials were designed to treat common COVID-19 symptoms and were not individualized or modified over time. COVID-19 pathology is associated with a rapidly changing symptom picture. In real world clinical practice EAM practitioners would modify CHM formulas as the symptoms changed. In our study many participants talked about this and the importance of delivering modified formulas to patients in a timely manner—“I’d fill the formulas and hop in my car and drive it to their doorstep, which was great, ‘cause I could do it—I could change it every couple of days as their symptoms evolved” (PC 9).
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Given the mounting evidence of effectiveness of CHM for COVID-1910–12 perhaps a reevaluation of the value of traditional medicines and their theories and paradigms is warranted.
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The information sources informing their treatment strategies included anecdotal information from China disseminated through professional networks and EAM websites and journals, and to a lesser extent scientific studies evaluating the effectiveness of CHM for COVID-19. The latter were generally not deemed useful for informing patient care because treatment had been initiated before they were published and because of limitations associated with the research and the ability to apply it to real world practice.