Do TCM Users Live Longer? What a 12,000-Person Taiwan Study Can and Cannot Tell Us

A study published in PLOS ONE in December 2025 made a quietly bold claim: among older adults in Taiwan, people who used traditional Chinese medicine frequently lived longer — about 1.37 years longer — and faced a lower risk of dying during the study period than people who rarely used it.

It is the first study to ask this question with individual-level data in a general population. Not "does this herb treat that disease," but something broader: do people who make TCM a substantial part of their healthcare live longer? The study is large, careful, and — like all observational research — full of places where a careful reader should pause. As with our earlier look at 320 pharyngitis trials, the value is in reading the study, not the headline.

What the Researchers Did

The team, from Taipei Medical University and Academia Sinica, built a nationwide cohort by linking Taiwan's National Health Interview Survey (conducted in 2001, 2005, 2009, and 2013) with the country's near-universal health insurance claims database and its death registry. The final sample: 12,176 people aged 55 and older, followed for a median of 10.5 years, during which 4,023 deaths were recorded.

"Frequent TCM use" had a precise definition: in the 18 months before the study began, more than 20% of a person's outpatient visits were for TCM services — herbal formulas, acupuncture, or remedial massage (tuina). In Taiwan, TCM accounts for roughly 10% of all outpatient visits nationally, so the 20% threshold marks someone for whom TCM is a substantial part of their healthcare, not an occasional experiment. People with a history of cancer or autoimmune disease were excluded, keeping the comparison focused on the general older population.

Two methods do the heavy lifting:

Weighted comparison. Before any adjustment, frequent TCM users looked healthier in almost every way: younger on average (64 vs. 67), more likely to be women, more educated, less likely to smoke or drink, more physically active, eating more vegetables and fruit, and with less cardiovascular disease and diabetes. Obviously, healthier people live longer whether or not TCM is involved. The researchers used inverse probability weighting — a technique that rebalances the two groups so they look alike on all measured characteristics (age, sex, education, income, lifestyle, disease history), as if constructing two statistically "matched" populations. After weighting, the groups were well balanced on everything measured.

Lifetime estimation. A median follow-up of 10.5 years does not cover a whole lifetime, so the team used a "rolling extrapolation" method — extending each group's survival curve beyond the observed period through a statistically disciplined procedure — to estimate life expectancy: the area under the lifetime survival curve.

What They Found

After adjustment, frequent TCM users had a modestly lower risk of death from any cause: a hazard ratio of 0.89 (95% CI 0.80–0.99) — roughly an 11% lower mortality risk. Estimated life expectancy was 1.37 years longer (95% CI 0.22–3.32).

The result survived several stress tests: a dose-response analysis (the heaviest TCM users, whose visits were ≥30% TCM, had a hazard ratio of 0.81), and a time-updated analysis that re-measured TCM use every year instead of fixing it at baseline (each 10% increase in TCM share was associated with a hazard ratio of 0.95).

But the findings also have wobbles, and the authors report them honestly. Here are the four that matter most.

1. The healthy-user gap is real — and weighting only fixes what was measured

Look at that baseline table again. Before adjustment, frequent TCM users were younger, leaner, less likely to smoke, drink, or chew betel nut, more likely to exercise, and ate better. Weighting balanced these measured traits, but it cannot balance what was never measured. The authors say this directly: TCM users may differ in health awareness, social support, or health-seeking behavior in ways no survey captured.

This is the classic healthy-user problem. People who proactively seek out TCM also tend to be the kind of people who do other things that extend life. The study adjusts for a lot — but health consciousness is exactly the kind of trait that is hard to put in a spreadsheet.

2. The dose-response has a bump in the middle

If TCM use truly lowered mortality, you would expect a smooth staircase: more use, more benefit. The actual numbers, compared against the lowest-use group (under 10% of visits): 10–20% → hazard ratio 0.89; 20–30% → 1.01 (no benefit at all); ≥30% → 0.81. The middle category breaks the pattern entirely.

It could be noise — each category's confidence interval is wide — but a clean dose-response would have been stronger support for a causal reading. Notably, the authors' continuous analysis assumed a straight-line relationship, which glosses over this bump.

3. Life expectancy here is estimated, not observed

The headline "1.37 years longer" sounds like something that happened. It isn't — it is the output of extrapolating survival curves decades beyond the 10.5 years of actual observation. The method is established and carefully executed, but extrapolation is still projection, and the confidence interval (0.22 to 3.32 years) shows how wide the uncertainty is.

Note also that the benefit concentrated in men (+2.39 years) and in current or former smokers (+3.31 years), while among women the estimate was slightly negative and among never-smokers essentially zero. Subgroup patterns like these should make us humble rather than let us pick a favorite.

4. "TCM use" here means everything at once

The exposure bundles herbal formulas, acupuncture, and tuina into a single number: the share of visits that were TCM. So even if the association were fully causal, the study cannot say whether it was the herbs, the needles, the massage, or none of them. The authors also raise a subtler possibility: regular contact with a practitioner may bring non-specific benefits — health advice, stress reduction, simply being looked after — independent of any specific treatment. And in Taiwan, TCM is institutionalized and covered by national insurance, so "frequent user" may partly mark people well integrated into the healthcare system, not just people committed to TCM philosophy.

Why This Study Still Matters

None of this dismisses the work. Observational studies are how we learn things that randomized trials cannot ethically or practically test — nobody will randomize 12,000 people to use or avoid TCM for a decade. This study is, to the authors' knowledge, the first to measure the association between TCM use and life expectancy at the individual level in a general population. It provides a population-level signal, a careful methodology (pre-specified analyses, multiple sensitivity checks, honest limitations), and — most usefully — a map of exactly what the next study should investigate: which modalities, which doses, with repeated measurements over time.

The honest reading of the result is the authors' own: frequent TCM use was associated with modestly longer life expectancy and lower mortality, but causal inference cannot be established. That sentence is doing a lot of work, and it is the one worth remembering.

The Bottom Line

A large, careful Taiwanese cohort found that older adults who made TCM a substantial part of their healthcare lived slightly longer — about 1.37 years by extrapolation — and died at a slightly lower rate. The effect persisted across multiple analytical approaches, which is genuinely reassuring. But the users were healthier to begin with in ways no adjustment can fully erase, the dose-response wobbles in the middle, and "TCM use" here is an entire healthcare philosophy compressed into a single number.

If you want a headline: this is the strongest population-level evidence to date that TCM use is associated with longevity. If you want the truth: association is not prescription, and the most interesting question — what about TCM engagement connects to better outcomes — remains open.

If you are curious about how the classical tradition itself thinks about health — not as fighting disease but as maintaining balance, catching imbalance early, and living in rhythm with the seasons — our book Huangdi Neijing: A Modern Introduction is a beginner-friendly guide to the foundational text of Chinese medicine.

This article is for educational purposes only and is not medical advice. It reports on a published study and its limitations; it does not recommend any treatment.

References

• Wang J-Y, Wu H-C, Hwang J-S, Lo W-C. The impact of Traditional Chinese Medicine utilization on life expectancy and mortality. PLOS ONE, 2025;20(12):e0337593. https://doi.org/10.1371/journal.pone.0337593
• PubMed record: https://pubmed.ncbi.nlm.nih.gov/41343522/