1Today’s global health challenges reveal that the established Global North biomedical models often fall short in meeting diverse healthcare needs (Holst 2020). Yet discussions about medical pluralism still tend to favour biomedical knowledge and sideline other healing traditions (Cohen-Founier et al. 2021). In this paper, I examine how Traditional Chinese Medicine (TCM) is understood and portrayed, focusing on the Eurocentric influences that shape the broader Global North views of medical practices that originate in Global South contexts. By reflecting on how TCM is received and adapted in the Global North settings, I question the idea of ‘medical pluralism’ – a term used to describe the coexistence of different medical systems, such as biomedicine, traditional healers, and complementary and alternative medicine (CAM) (Nordstrom 1988; Leslie 1998; Khalikova 2021). While this idea aims to be inclusive, it can unintentionally reinforce the dominance of biomedicine by treating other traditions as ‘complementary’ or ‘alternative’.
2Drawing on ethnographic scholarship that examines TCM as a dynamic and evolving practice (Farquhar 1994) and recognising its ongoing ‘interactive generation’ and hybridisation with biomedicine in its sites of origin (Zhan 2001), this paper challenges the persistent reliance on Global North social theories to analyse medical knowledge systems. Rather than treating these systems as bounded entities arising from isolated sociocultural contexts, I ground my critique in the reality of their complex, hybridised contemporary formations. The selective integration of TCM in Europe, where acupuncture has achieved widespread acceptance whilst herbal medicine remains marginalised, exemplifies how the global north epistemic norms of evidence, legitimacy, and scientific validity shape not only institutional policies but also the everyday practices of practitioners and patients (see Huang et al. 2012). This differential reception reveals deeper tensions: whilst acupuncture, as a concrete means of treatment, has been readily translated into biomedical frameworks through randomised controlled trials and neurophysiological explanations, the holistic epistemology underlying TCM’s diagnostic methods and herbal prescriptions resists such reductionist appropriation.
3This paper goes beyond describing these differences and argues for a more careful and grounded approach to the decolonisation of medical anthropology. Decolonisation means more than just recognizing different medical traditions; it requires rethinking the theories and methods we use to understand health, illness, and healing. By looking at how ideas like ‘efficacy’, ‘evidence’, and ‘medicine’ are shaped by culture and society, I suggest we should see medical knowledge as dynamic and shaped by history. It is important to note that TCM does not exist in a “pure” or isolated form. Its current ideas and institutions have developed through years of interaction, blending, and negotiation with biomedicine.
4Through this critical examination of TCM in European contexts, this paper calls for medical anthropologists to foster epistemologically equitable frameworks that account for medical syncretism and hybridity. Only by moving beyond current paradigms of medical pluralism – which often conceptualise medical traditions as bounded, static entities and inadvertently domesticate difference – can we develop theoretical approaches that adequately capture the fluid, interconnected, and complex realities of contemporary global healthcare knowledge production.
5Medical pluralism emerged in the 1970s-1980s to describe the simultaneous presence of multiple medical systems within a single society (Leslie 1998; Kleinman 1978, 1980; Janzen 1978). The concept evolved from early anthropological studies that sought to understand Global South medical traditions in their diversity, co-existence, and competition with biomedicine (Khalikova 2021). As Leslie and Young (1992) argue, this transformation in the Global North intellectual sensibilities opened space for cultural studies of Asian medicine systems, challenging earlier modernisation paradigms.
6However, the very notion of distinct ‘medical systems’ is fundamentally problematic, as it treats medical knowledge as independent, closed entities, thereby downplaying their profound mutual development. Moving beyond a mere presentation of pluralism, a genuinely critical framework must engage with complex systems and hybridization. While early critiques offered alternative conceptualisations – such as ‘medical syncretism’ (Nichter 1980; Baer 2011), ‘therapeutic itineraries’ (Orr 2012), and ‘medical diversity’ (Krause et al. 2012) – to capture the fluidity of healthcare, these concepts must be pushed further. Pluralism operates fundamentally within these systems, blurring boundaries from laboratories to patient perceptions. Therefore, medical traditions do not merely coexist or syncretize as discrete, authentic entities; rather, they are continuously hybridizing, constantly reshaping each other’s epistemological boundaries.
7The way TCM has become part of institutions shows that medical pluralism depends on specific historical and political situations. Shim (2018) describes ‘interpenetrative’, ‘exclusionary’, and ‘subjugatory’ models in East Asia. In China, the mixing of biomedicine and TCM matches what Zhang (2007) calls ‘switching’ between their different ethical systems. Practitioners and patients do not move between ‘pure’ or closed traditions. Instead, they work within a complex and mixed environment where these traditions keep influencing and changing each other.
8The integration of such hybridized systems into Global North contexts reveals significant epistemological tensions. Foundational works by Leslie (1976) and Kleinman (1980) initially conceptualized medical systems as distinct cultural frameworks with coherent internal logics; however, contemporary ethnography requires that these systems be understood as complex and evolving entities. Farquhar (1994) demonstrates that TCM is not static but continually transforms through encounters with modernization. This evolution is notably asymmetrical, shaped by ‘hegemonic scientism’. Zhang’s (2007) analysis illustrates this dynamic, as TCM doctors are compelled to reconcile traditional Yang Qi with biomedical diagnostics of erectile dysfunction. Such hybridization unfolds within unequal power relations; Lock and Nguyen (2010) and Young (1981) emphasize that biomedicine’s global dominance is sustained by colonial legacies, state alignment, and political-economic structures, rather than by inherent therapeutic superiority.
9Because of the demand for legitimate knowledge, non-biomedical traditions face a difficult situation. Adams (2002), with support from Langford (2002), shows that Tibetan medicine practitioners must prove their legitimacy using scientific standards, even though their basic ways of knowing are not recognized. This situation shows that ‘efficacy’ is a contested and powerful idea. Craig (2012) argues that instead of just asking “Does a medicine work?”, we should look at how and by whom these claims are made. Since clinical methods within the scope of contemporary medicine often do not fit with holistic approaches (Waldram 2000), judging mixed medical systems by strict biomedical standards controls and limits difference, rather than treating medical diversity fairly.
10Recent scholarship calls for a thorough decolonisation of medical anthropology, necessitating critical reflection on the processes of knowledge production. Khalikova (2021) argues that this process extends beyond recognising diverse medical traditions; it requires dismantling the hierarchies that shape conceptualisations of health and healing. Rabinow’s (1996) concept of ‘cosmopolitanism’, which seeks to balance historical context with global connections, should be applied critically rather than idealised. As Zhang (2007) observes, movement between medical systems is rarely a straightforward or equitable choice. Instead, individuals often navigate unequal systems in which traditional practices must continually adapt to dominant biomedical norms. Such reflection must also interrogate how the marginalisation of knowledge intersects with other forms of power, including gender. The exclusion of Global South approaches frequently mirrors patriarchal structures. Cameron (2010) shows in her study of Ayurveda in Nepal that as more women entered the profession, its value declined. When the Nepali state modernised healthcare using an established biomedical model, Ayurveda was increasingly seen as lower-status 'women's work.' This shift marginalised both female practitioners and local knowledge. Flesch’s (2010) research on complementary and alternative medicine (CAM) education finds a similar pattern. As women lead more in these fields, they are often limited by gender stereotypes. CAM practices are labelled as ‘intuitive’, ‘nurturing’, or ‘innate’ healing linked to nature, which makes the biomedical field question their legitimacy. This view pushes alternative medicine into the emotional or domestic sphere and keeps it from challenging the authority of mainstream biomedicine.
11Consequently, anthropological methodologies must shift from treating medical traditions as bounded entities to mapping complex, hybridized ‘therapeutic itineraries’. This involves tracing transnational therapy networks (Krause 2008) and the digital circulation of knowledge (Hampshire, Owusu 2012). Yet, this global circulation introduces new colonising mechanisms via neoliberal commodification. As Kloos (2017) argues regarding the Tibetan medicine industry, the transformation of traditional medicines into transnational industries enforces market-driven standardisation. This commercialisation imposes external criteria for “authenticity” that often strip these practices of their foundational epistemologies.
12At the macro-institutional level, the illusion of pluralistic equality is particularly evident in global health governance. Although the World Health Organisation advocates for the “appropriate integration, regulation and supervision” of traditional medicines (WHO 2002, 2013, 2025), these policies frequently operationalise a paradigm of conditional assimilation rather than genuine equity. Integration efforts remain tightly constrained by biomedical epistemologies; traditional practices such as TCM are validated and included only when translated into reductionist biomedical terms, leaving their underlying knowledge systems unrecognised and epistemologically subordinated.
13Moving forward, medical anthropology must turn this critique inward, interrogating how our own epistemological frameworks determine which healing practices gain legitimacy within so-called pluralistic systems. Decolonising medical knowledge production requires far more than merely documenting diversity; it demands creating analytical spaces where different ways of knowing health, illness, and healing exist on genuinely equal terms, rather than being continuously filtered through biomedical validation criteria. Developing inclusive global health frameworks requires simultaneous, radical action at multiple levels. At the macro level, international health policies must accommodate diverse medical epistemologies without imposing biomedical standards as universal benchmarks. At the micro level, our research must capture the realities of hybridization: how patients navigate structurally unequal therapeutic landscapes, how practitioners actively negotiate between competing knowledge systems, and how healing emerges through the dynamic interplay of medical traditions. Only through such comprehensive, reflexive engagement – one that respects the integrity of complex, hybridized knowledge systems rather than subordinating them to singular hegemonic frameworks – can we genuinely address humanity’s diverse healing needs.
14The globalisation of TCM has seen it transition from a regional practice with millennia of history into a significant player in the international healthcare landscape. The inclusion of TCM in the International Classification of Diseases (ICD) marks a notable milestone, reflecting its acknowledged contribution to healthcare and the growing demand for its services (see Chang, Zhao 2021). Acupuncture, the most globally practised TCM discipline, particularly in the Global North, has a history in Europe dating back to the 17th century (Lo, Lu, Needham 1980). After facing periods of criticism and neglect, it was reintroduced in the early 20th century, leading to the establishment of various schools and its integration into mainstream healthcare. Acupuncture’s modern resurgence was significantly boosted by innovations such as acupuncture analgesia during the mid-20th century, attracting worldwide attention, particularly during the period of Nixon’s visit to China in 1972. Since the 1970s, acupuncture has gained popularity as an alternative therapy, with biomedical professionals increasingly recognising its complementary role (Zhan 2001). Today, acupuncture is widely offered through private colleges and university departments, often within primary care settings.
15This analysis builds on the topic of medical pluralism by looking at how acupuncture is received in Global North countries and whether current ideas about localising Chinese medicine need to change. Using ethnographic research from France and Italy, the study highlights real tensions in daily clinical work. Lucia Candelise’s (2011) research shows that Europe-trained doctors who turn to acupuncture often do so because they are dissatisfied with the established Global North medical norms and models. Her interviews reveal that these doctors are often critical of ‘orthodox medicine’, which they see as too rigid. They adopt Chinese medicine to try to reform the compartmentalised biomedical systems they were trained in, using TCM’s holistic approach to question biomedicine’s certainty.
16Chinese medical theory indeed offers these acupuncture-trained physicians a conceptualisation of illness as a dynamic process or ‘imbalance’, a notable departure from the contemporary biomedicine’s paradigmatic models. However, my reflection focuses on examining the underlying motivations and clinical mechanisms producing such perspectives. An important question emerges: how do Orientalism and exoticism function as practical tools for Global-North-Based physicians when using these modalities? Within medical anthropology, the broader sensemaking of clinical Orientalism functions not only as a form of subjugation of the 'Other' (Said 1978), but also as a romanticizing gaze. Practitioners attribute mystical, inherently 'holistic', and ancient qualities to Global South medical traditions to offset the perceived alienation and reductionism of their own biomedical training (Barnes 1998). This Orientalist appropriation is not simply an abstract ideology; it is actively integrated into clinical practice as a strategic mechanism for establishing boundaries. By selectively incorporating the “exotic” imagery, philosophy, and vocabulary of Eastern traditions, these physicians create a distinct therapeutic niche. This approach enables them to differentiate their services within the healthcare market and critique conventional biomedicine, while simultaneously preserving the authoritative legal and social status of medical doctors (Karchmer 2005).
17This selective appropriation of TCM affirms that the localisation of Chinese medicine within European medical systems constitutes concrete medical pluralism in practice. European adaptations present theoretical and practical tools that enrich highly systematised biomedical approaches (Rushforth et al. 2019). However, rather than fundamentally challenging the dominant epistemological order, TCM is frequently employed as an instrumental tool to address biomedicine’s internal clinical crises. A careful review of clinical Orientalism necessitates deeper reflection on Eurocentric epistemologies: while TCM exists as an ‘outsider’ knowledge system, its incorporation into Global North contexts remains highly conditional. For stakeholders, including physicians and policymakers, to institutionalise this ‘outsider’ knowledge, they require TCM to continuously translate itself to conform to contemporary biomedical standards, thereby neutralising its power to disrupt existing biomedical epistemological frameworks.
18As medical anthropologists, we must identify not simply why social actors – specifically practitioners and their patients in the Global North context – experiment with Chinese medicine, but what structural epistemological limitations these integrations reflect. Regardless of how compelling an “alternative option” TCM appears to patients pursuing holistic care, it is essentially positioned as the ‘Other’ within health systems. This dynamic represents an asymmetrical engagement: such applications and adoptions frequently extract specific therapeutic techniques (like acupuncture needles) while discarding their underlying philosophical and diagnostic frameworks (see Zhan 2016). Beyond acupuncture, ethnographic studies of TCM’s localisation across Europe demonstrate recurring patterns of exactly how this epistemological subordination operates in daily practice. The empirical cases below show that current medical pluralism frameworks, instead of encouraging equitable dialogue between diverse healing traditions, consistently force Global South modalities to adapt to the structural and legal confines dictated by biomedicine (see Lambert 2012).
19Stöckelová and Trnka’s (2020) concept of ‘collective particularisation’ reveals how Czech TCM practitioners adapt therapies to purported local ‘biosocial conditions’ – alleging Europeans require lower herb dosages and different acupuncture depths. Whilst presented as evidence of TCM’s cultural responsiveness, this adaptation practically executes the subjugation of TCM’s epistemology to biological reductionism. By altering dosages to correspond to European physiological expectations, these practitioners maintain biomedical body concepts as the ultimate standard against which herbal efficacy and safety are measured. When these local practitioners assert that Czech bodies are uniquely sensitive to Chinese herbs due to a lack of historical exposure, they are not engaging in TCM diagnostic logic; rather, they are reproducing Eurocentric narratives of essential biological difference under the guise of honouring local specificity.
20Koppel’s (2018) analysis of the Estonian healthcare system explicitly addresses the tension between holistic practice and scientific legitimacy. The study observes that, to gain acceptance among Estonian biomedical doctors and state regulators, TCM must be presented exclusively as ‘secular and scientific’. Conventional healthcare professionals employ TCM primarily to fill gaps in ‘preventative treatment’, deploying it to reinforce rather than challenge their established diagnostic authority. Koppel documents that local practitioners must actively self-censor to avoid the stigma associated with ‘witch doctoring’. This dynamic demonstrates that the categorisation of TCM as ‘complementary and alternative medicine’ (CAM) functions as a regulatory mechanism, granting TCM clinical survival only by requiring it to concede its epistemological independence and remain subordinate to biomedical oversight.
21In analysing Stöckelová and Trnka’s (2020) argument, the authors celebrate how Czech TCM represents a medical diversity encompassing the individualisation of therapeutics. However, their ethnographic evidence reveals that this variation operates within strict, biomedically defined boundaries: acupuncture gains acceptance primarily when explained through neurophysiological mechanisms, whilst herbal medicine is marginalised because it resists direct biomedical translation. The authors’ finding that Czech practitioners successfully ‘copy’ only a portion of TCM herbal treatments from China reveals a more profound structural issue. Rather than a neutral process of clinical ‘adaptation’, the selective integration systematically dismantles TCM’s holistic diagnostic rationale, reducing a complex clinical system into isolated, biomedically palatable components. This demonstrates how pluralism in practice frequently serves to regulate and domesticate alternative practices rather than equitably engaging with them.
22Furthermore, when researchers note that TCM’s «ostensible “exoticness” is considered part of its allure», we must specify how this exoticism functions among specific social actors, namely, European patients and local practitioners. The study documents practitioners importing Chinese herbs over local equivalents due to beliefs in ‘bioauthenticity’ and ‘geoauthenticity’—the notion held by both practitioners and consumers that efficacy is intrinsically tied to the Chinese soil. Rather than merely satisfying patient fantasies, this commodification of authenticity actively constrains epistemological engagement; it forces TCM to perform as a static, ancient artefact in the European market, thereby preventing its recognition as a dynamic, evolving clinical science.
23Koppel’s (2018) research similarly demonstrates how pluralistic frameworks are operationalised by state institutions, particularly Estonian healthcare regulatory bodies, as mechanisms of control. By reclassifying acupuncture to avoid its strict categorisation as alternative medicine, the Estonian state legitimised it only by severing it from TCM’s broader conceptual framework. Even practitioners who actively support TCM claim that authoritative diagnoses must be made by biomedical specialists, relegating TCM to the status of lifestyle intervention. This is not necessarily due to epistemological disbelief, but rather because institutional authority and legal liability are monopolised by biomedicine. As a result, TCM attains market acceptance through its romanticised association with ‘ancient’ and ‘natural’ practices, illustrating that the integration of medical or biomedical approaches contextualised by Global North often requires the adoption of existing Global South medicine to alternate between strict biomedical scientism and exotic romanticisation, leaving no institutional space for hybridised clinical realities.
24To fully grasp the dynamics of global medical pluralism, we must first recognise that biomedical dominance and the reshaping of TCM are not solely a Global North phenomenon. Research situated within China, known as the original context of TCM, demonstrates that 'traditional' medicine has already been profoundly reconstructed by modernising paradigms. As Elizabeth Hsu (2008) illustrates, TCM’s contemporary framework illustrates a centralised construction deeply entangled with state politics, national cultural discourse, and scientific modernism. Rather than searching for a 'genuine' or untainted epistemology at the individual practitioner level, a pursuit that risks romanticising an imagined, pre-modern past, we must acknowledge that contemporary TCM enters the global stage already operating as a state-sponsored, modernised hybrid. The critical analytical task is therefore not to mourn the loss of a mythical 'pure' tradition, but to thoroughly examine how this already-hybridised system navigates further structural subordination when it encounters Euro-American medical hegemony.
25To dismantle such Eurocentric frameworks, we must profoundly engage with Mei Zhan’s (2001) ethnographic fieldwork across China and the United States, which delivers a crucial corrective to essentialist narratives. Zhan acutely identifies that so-called ‘traditional Chinese medicine’ is not a closed, static system, but rather a complex hybrid continuously reshaped through an ‘interactive generation’ with biomedicine. In contrast to mainstream science, TCM’s efficacy is frequently narrated as ‘miraculous’. Yet, rather than viewing this as a triumph, Zhan shows that this positioning traps TCM, categorising it as permanently ‘exceptional’ or ‘alternative’ to exclude it from the realm of normative medical science. This reveals that TCM’s contemporary knowledge and authority are not remnants of an untouched past, but are active products of socio-historical interactions and ongoing negotiations between diverse actors.
26Zhan’s work brilliantly reveals how this marginality and these ‘miracle narratives’ are strategically reproduced by specific actors navigating transnational networks of power. For example, Chinese physicians in America utilise these accounts to construct professional communities and seek legitimacy, while medical doctors co-opt acupuncture by transforming it into a mere ‘appendage’ of their own knowledge systems. By exploring the construction of boundaries between ‘science’ and ‘other’ knowledge, Zhan demonstrates that the marginalisation of TCM relies heavily on reinforcing ‘rational-irrational’ and ‘universal-local’ binary structures, which ultimately serve to stabilise the central hegemony of the Global North framework of science. Crucially, Zhan’s analysis of TCM’s ‘localisation’ in the United States forces us to reconsider how we critique this process. TCM is not being “weakened in the integrity of its original knowledge system”, a phrasing that erroneously implies a fall from an essentialist purity. Instead, acknowledging its inherent hybridisation reveals a more insidious mechanism: TCM is undergoing a coercive, asymmetrical hybridisation. It is simultaneously subjected to ‘cultural consumption’ as an exotic commodity and aggressively re-disciplined under the logic of contemporary biomedicine as a subordinate ‘alternative therapy’.
27This grounded understanding of asymmetrical hybridisation enables a decisive critique of the systemic limitations of ‘medical pluralism’ as a theoretical and policy framework. Pluralism does not merely “mask” biomedical hegemony by relegating the ‘Other’ to a complementary position; it actively operates as a regulatory apparatus that prescribes the terms under which knowledge systems may hybridise. By constructing boundaries based on 'rational-irrational' and ‘universal-local’ binaries, biomedicine consolidates its central authority. The ultimate consequence of this critique is significant: even when TCM modalities such as acupuncture achieve mainstream recognition, they are structurally confined as ‘exceptional’ cases, adjunct therapies, or isolated neurophysiological mechanisms. Therefore, a genuine decolonial project in medical anthropology cannot be satisfied with championing the generalisation and mere "inclusion" of any Global South frameworks of medicine within existing pluralistic systems. True decolonisation requires dismantling the unequal power structures that compel these complex, hybridised medical systems to perpetually translate, fragment, and validate themselves according to the reductionist standards of the dominant biomedical centre.
28The conceptual understandings we must derive from such research go far beyond the elementary observation that Global South medical epistemologies simply “differ” from modern biomedicine. Instead, the critical revelation consists in understanding exactly how these alternative knowledge structures are structurally managed, consumed, and subordinated when they intersect with the existing medical epistemology hegemony. We cannot simply advocate for appraising these knowledge systems “comprehensively within their original contexts”, because those contexts, whether in contemporary China or the diaspora, are already profoundly hybridised. The analytical imperative is therefore not to salvage an imagined, pre-modern purity, but to critically dissect how these hybridised systems negotiate their survival in deeply unequal fields of power, actively resisting their continued subjugation to a singular, dominant biomedical epistemology under the deceptive guise of “pluralism”.
- 1 I would like to express my most sincere gratitude to the two anonymous reviewers for their rigorous (...)
29To achieve this decolonial critique, medical anthropology must rigorously avoid a pervasive methodological pitfall: detaching from grounded clinical realities to engage in purely philosophical or Sinological abstractions of ancient classical texts. When we rely on abstracted philosophical theories to explain contemporary clinical phenomena, we unintentionally replicate the very Orientalist and essentialist frameworks we seek to dismantle, ultimately forcing the discourse back into Eurocentric conceptual boundaries. Moving forward, a genuinely decolonial approach requires us to remain acutely attentive to the ethnographic present. We must relentlessly document how actual social actors, including patients seeking care, practitioners defending their legitimacy, and policymakers setting regulations, dynamically negotiate, hybridise, and exert power through these intersecting medical systems on the ground1.
30Whilst identifying the gaps in thought and knowledge production regarding Chinese medicine’s localisation in various Global North contexts, I believe researchers must simultaneously confront the predicaments and challenges that policy and compliance barriers, along with the dominant discourse of existing medical science, pose for recognising, understanding, and adopting Global South medical systems under globalisation’s attractive veneer. Using Chinese medicine as an example, I briefly argue that policy obstacles and intermittent politicised contexts present practical challenges to implementing medical pluralism, even reducing pluralism's discourse to superficiality to some extent. However, it is also worth acknowledging that policy-level shifts and improvements have been made at various levels, including WHO and national-level regulatory establishments, which apparently eased the difficulties of market access faced by TCM products and treatments (see Bilia et al. 2024).
31While acupuncture has seen widespread global uptake, the adoption of herbal TCM treatments has been more limited, often constrained by regulatory challenges. In Europe, Chinese TCM practitioners have imported materia medica for individualised patient treatments, but these practices remain niche compared to the mainstream acceptance of acupuncture (Chan 2016). The Chinese government’s promotion of TCM during the mid-20th century also had significant global ramifications. Notably, the so-called barefoot doctor scheme, which aimed to bring healthcare to underprivileged rural areas making use of traditional healers, later served as an inspiration for the WHO’s Alma-Ata declaration in 1978 (see WHO 1978). The Alma-Ata Declaration’s vision of “Health for All” embodied principles that ostensibly aligned with medical pluralism. By establishing health as a fundamental human right and calling for primary healthcare to use «scientifically sound and socially acceptable methods» the Declaration implicitly validated diverse cultural healing practices. Its emphasis on community participation and self-determination theoretically created space for local healing traditions within health systems, challenging the dominance of the contemporary biomedical norms and models (Navarro 2009).
32However, the subsequent trajectory of TCM’s global integration demands that we move beyond simply stating the existence of epistemological hierarchies, to explaining how and why they are institutionally enforced. The reason for this hierarchy lies in the bureaucratic and financial structures of global health, which demand quantifiable, standardised metrics of “evidence”. Comparatively, this structural demand produces divergent outcomes for different modalities: acupuncture achieved widespread integration in regions like North America and the UK precisely because its mechanics could be translated into the reductionist language of neurophysiology and pain management. Conversely, herbal medicine remains heavily marginalised because its complex, synergistic formulations fundamentally resist this single-molecule biomedical translation (see Exworthy 2008). Thus, Alma-Ata’s progressive vision of ‘socially acceptable’ methods was practically redefined by bureaucratic institutions to mean ‘biomedically translatable’.
33With years passing, grassroots, local TCM had to ultimately make room for neoliberal health policies that prioritise not only the health knowledge production dominated by contemporary biomedicine’s approaches, but also commercial healthcare models (Bloom, Gu 1997). The commodification of healthcare has seen TCM rebranded in China as Chinese Medicine Processing (中医药, or zhong yiyao in pinyin, in short CMP), positioning it to appeal to a global market increasingly focused on personal agency and self-care. This trend has also influenced the hybridisation of Chinese health practices, with practices such as meditation and martial arts becoming popular in wellness and preventive care sectors globally. The split between therapeutic and spiritual approaches to Chinese medicine reflects the dual pressures of adapting to a biomedical framework while retaining elements of traditional practice. This evolving landscape underscores the potential for more integrated and holistic approaches to healthcare, combining TCM’s rich heritage with modern medical advances.
34The rise of CAM has further solidified acupuncture’s position as a professionally organised alternative therapy (Hsu 2009). Despite this, debates remain about its legitimacy, especially regarding the adaptation of Chinese medical practices to contemporary biomedical standards, such as the use of sham acupoints in clinical trials. In countries like the UK, acupuncture has gained a degree of official recognition within the National Health Service (NHS) for specific pain management, whereas broader TCM practices, particularly herbalism, have struggled to achieve similar statutory validation. This disparity is not simply due to an objective “lack of evidence”, but rather because the gold standards of evidence-based medicine (EBM), such as double-blind randomised controlled trials (RCTs), are methodologically misaligned with the individualised, holistic nature of traditional herbal prescriptions (Barry 2006; Knoess, Wiesner 2012).
35From a more general perspective of regulation and international recognition, the globalisation of TCM has seen significant progress over recent decades, with key milestones marking its increasing acceptance and integration into global healthcare systems. The first major regulatory advance in the West came in 2004, when the United States Food and Drug Administration (FDA) issued the “Guidance for Industry: Botanical Drug Products” (Wu et al. 2015). This guideline laid the foundation for botanical products to transition from being classified merely as dietary supplements to being considered potential pharmaceutical agents. The subsequent FDA approval of Veregen, a green tea-derived botanical drug for treating genital and perianal warts, represented a watershed moment, signalling greater recognition of herbal medicines as legitimate therapeutic options. The increasing recognition of TCM products continued with the approval of Fulyzaq in 2012, an oral botanical drug derived from the latex of Croton lechleri, intended to treat HIV-related diarrhoea. This progression underscores the gradual acceptance of botanical and herbal products into the Global North regulatory environment. As of the mid-2010s, there were over 600 herbal product applications with the FDA at different stages of review, although only a small fraction has successfully moved to Phase III clinical trials. The journey of TCM products within the FDA framework demonstrates the challenges of meeting the Global North context of regulatory standards while also highlighting the growing interest in botanical therapies (Wu et al. 2015).
36In Europe, the regulatory landscape for herbal medicines is primarily governed by the European Medicines Agency (EMA, with directives such as 2001/83/EC and 2004/24/EC providing pathways for traditional herbal medicine registration (Williamson et al. 2013). These regulations offer varying levels of registration complexity, with the 2004/24/EC directive providing a simplified registration process for traditional herbal products (MoC, PRC, 2008). This has allowed a number of TCM products, including the Diao Xin Xue Kang Capsule, to gain market approval under the traditional use category. Despite these advancements, the requirements for Class II and III registrations remain challenging for many TCM products, underscoring the ongoing difficulties of fully integrating TCM into Global North pharmaceutical markets.
37The inclusion of TCM in the World Health Organization’s International Classification of Diseases (ICD) represents another significant milestone in its global journey. This recognition by the WHO not only acknowledges the historical contributions of TCM to healthcare but also responds to the contemporary needs of member states where TCM has become an integral part of healthcare provision (Maizes, Rakel, Niemiec 2009). Currently, TCM is used in 183 countries and regions worldwide, with practices such as acupuncture and moxibustion formally approved in over 100 countries. The growing acceptance of TCM reflects its complementary role to the healthcare systems, particularly, pointed out by the Chinese government’s discourse, in managing chronic conditions and supporting holistic health (The State Council 2016). High-profile recognitions, such as Professor Tu Youyou’s Nobel Prize for the discovery of artemisinin, further underscore TCM’s potential in addressing global health challenges. The increasing number of TCM clinics and educational programmes across Europe and North America is a testament to the growing confidence in TCM, highlighting its evolving role as a significant player in the global healthcare landscape.
38Overall, the historical development and global spread of TCM have been characterised by significant milestones that reflect both progress and challenges. Regulatory acceptance in major markets like the United States and Europe has been gradual, and the evolving regulatory frameworks highlight the complex interplay between traditional knowledge and modern scientific standards. I argue that for anthropological research, these macro-level regulatory frameworks (such as FDA guidelines and EMA directives) cannot merely exist as background context; they are the very mechanisms through which epistemological subordination is operationalised. The regulatory barriers faced by “non-indigenous” medical products are not simply administrative hurdles or politicised rejections of foreign elements (Liu et al. 2016). Rather, they concretely execute the epistemological conflicts discussed earlier: by forcing holistic botanical networks to undergo reductionist Phase III clinical trials, regulatory bodies actively dismantle TCM’s internal cognitive structures, demanding that Global South medicines fundamentally transform themselves into a simplified framework of pharmaceuticals to earn legal existence.
39Indeed, this asynchrony in internal and external admission standards, along with its underlying currents of nativism and protectionism, exists not only in the West. Taking China as an example, the institutional promotion of Chinese patent medicines (CPMs) within China’s public health insurance system has led to policies that massively integrate these medicines into prescription guidelines at major public hospitals, sometimes displacing Western pharmaceuticals in national reimbursement budgets (see Pan et al. 2018; Xu,Yang 2009). This state-driven medical nationalism has yet to attract widespread critical anthropological attention, but it represents a concrete manifestation of defensive epistemological boundary-making in a context distinct from the Global North.
40Returning to this paper’s central argument, I would venture a radical question: does the macro-level, state-driven preservation of an ‘indigenous’ medical system’s subjectivity actually undermine the possibility of constructing an equitable, critically engaged medical pluralism? This compels us to examine whether protective policies, regardless of their regional contexts, ultimately serve to reify the very essentialist epistemological boundaries we seek to transcend. The challenge for medical anthropology lies not in romantically defending the “authenticity” of particular medical traditions, nor in striving for a friction-less inclusion. Rather, we must actively centre hybridity as the fundamental, inescapable reality of global healthcare. We must develop analytical frameworks that acknowledge how diverse healing systems are continuously co-produced, commodified, and asymmetrically hybridized. Only by engaging with this hybridity – without resorting to either defensive nationalism or uncritical biomedical assimilation – can we foster genuinely transformative dialogues in global health.
41Grounded analyses of clinical practices and institutional policies demonstrate that the conceptualisation of Traditional Chinese Medicine within European and global discourses exposes fundamental epistemological tensions that undermine the prevailing paradigm of medical pluralism. Rather than relying solely on abstract critiques of Eurocentrism, the ethnographic and regulatory evidence presented reveals the phenomenon that I describe as the unidirectional localisation: a systemic process in which TCM must continually translate itself into biomedical metrics to achieve institutional legitimacy. This concept highlights a more insidious form of epistemological violence within globalised knowledge production. While ethnocentrism often manifests as overt cultural superiority, unidirectional localisation operates through the ostensibly inclusive rhetoric of pluralistic translation and adaptation. These terms obscure significant asymmetries in knowledge legitimation, functioning not as bridges for genuine dialogue but as mechanisms that domesticate alternative epistemologies (Spivak 1988).
42The main feature of this process is its one-way direction. Unidirectional localisation makes the translation of Global South medical systems into Global North norms and epistemologies as a precondition of adoption, but there is no expectation that the Global North medical epistemology will transform itself accordingly. For TCM to be accepted globally, it has to explain its practices using the language of clinical trials and neurobiology. Meanwhile, biomedicine does not have to justify itself using ideas like qi or yin-yang balance. Biomedicine treats its own standards as neutral and universal, not as products of a specific culture. This forced, one-way translation leads to what Santos (2014) calls epistemicide – the loss of knowledge systems when they are made to fit dominant frameworks that cannot accept their core ideas. As Harding (2008) argues, demanding this kind of translation in the name of objectivity is a form of epistemological fundamentalism that hides its own cultural roots.
43Unidirectional localisation creates a cycle that reinforces itself. When Global South medical systems try to gain recognition by using biomedical standards, they end up strengthening biomedicine’s dominance. This influence is seen even in the early stages of these systems. In China, current discussions about TCM have taken two problematic paths in response to the Global North influence: one is strict scientific empiricism that rejects traditional theories as superstition, and the other is using TCM for national pride without considering its clinical knowledge. Both approaches show how knowledge about Chinese medicine, even in China, is shaped by the dominant ideas from the Global North epistemology that make it seem foreign. This pattern shows how global dominance in discourse limits the flexibility and growth of mixed Global South medical systems.
44This analysis highlights a central paradox of contemporary medical pluralism: protective policies intended to preserve the purported purity of indigenous medical systems may inadvertently reinforce the very epistemological boundaries they aim to transcend. Rather than organically creating spaces for diverse ways of knowing, such defensive strategies risk further domesticating difference within existing, asymmetrical power structures. The primary responsibility of medical anthropology may therefore lie less in defending the supposed integrity of isolated traditions and more in fundamentally reconceptualising theoretical frameworks to address the reality of asymmetrical hybridisation. Fostering genuinely equitable frameworks for global healthcare requires radical epistemological openness, which exposes the coercive mechanisms of unidirectional translation and recognises that all medical systems are intrinsically dynamic and co-produced. Ultimately, the critical task in debates on medical pluralism extends beyond managing diversity through static pluralism; it demands continuous, reflexive interrogation of the asymmetrical terms of translation that shape the conceptualisation and practice of global health.
Attualità
