Traditional Chinese medicine

Alternative medical systems
NCCAM classifications [1]

1. Alternative Medical Systems

2. Mind-Body Intervention

3. Biologically Based Therapy

4. Manipulative and body-based methods

5. Energy Therapy

See also
Alternative medicine

Traditional Chinese medicine (also known as TCM, Simplified Chinese: 中医学; Traditional Chinese: 中醫學; pinyin: zhōngyī xué) is a range of traditional medical practices originating in China that developed over several thousand years. The English phrase "TCM" was created in the 1950s by the PRC in order to export Chinese medicine; there is no equivalent phrase in Chinese (zhōngyī xué translates literally as simply "Chinese medicine studies"). In fact, TCM is a modern compilation of traditional Chinese medicine. TCM practices include theories, diagnosis and treatments such as herbal medicine, acupuncture and massage; often Qigong is also strongly affiliated with TCM. TCM is a form of so-called Oriental medicine, which includes other traditional East Asian medical systems such as traditional Japanese, and Korean medicine.

TCM theory asserts that processes of the human body are interrelated and in constant interaction with the environment. Signs of disharmony help the TCM practitioner to understand, treat and prevent illness and disease.

Contents

TCM theory is based on a number of philosophical frameworks including the theory of Yin-yang, the Five Elements, the human body Meridian system, Zang Fu organ theory, and others. Diagnosis and treatment are conducted with reference to these concepts. TCM does not operate within a scientific paradigm but some practitioners make efforts to bring practices into a biomedical and evidence-based medicine framework.

Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong.

History

An old Chinese medical chart

Much of the philosophy of traditional Chinese medicine derived from the same philosophical bases that contributed to the development of Daoist philosophy, and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales.

During the golden age of his reign from 2698 to 2596 B.C.E., as a result of a dialogue with his minister Ch'i Pai (岐伯), the Yellow Emperor is supposed by Chinese tradition to have composed his Neijing Suwen (內經 素問) or Basic Questions of Internal Medicine, also known as the Huangdi Neijing. Modern scholarly opinion holds that the extant text of this title was compiled by an anonymous scholar no earlier than the Han Dynasty just over two-thousand years ago.

During the Han dynasty, Zhang Zhong Jing (張仲景), the Hippocrates of China, who was mayor of Chang-sha toward the end of the second century C.E., wrote a Treatise on Cold Damage, which contains the earliest known reference to Neijing Suwen. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 - 282 C.E.), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙經), ca. 265 C.E. During the Tang dynasty, Wang Ping claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the eleventh century.

Classical Chinese Medicine (CCM) is notably different from Traditional Chinese Medicine (TCM). The Nationalist government elected to abandon and outlaw the practice of CCM as it did not want China to be left behind by scientific progress. For 30 years, CCM was forbidden in China and several people were prosecuted by the government for engaging in CCM. In the 1960s, Mao Zedong finally decided that the government could not continue to outlaw the use of CCM. He commissioned the top ten doctors (M.D.s) to make a survey of CCM and create a standardized format for its application. This standardized form is now known as TCM.

Today, TCM is what is taught in nearly all those medical schools in China, most of Asia and North America, that teach traditional medical practices at all. To learn CCM typically one must be part of a family lineage of medicine. Recently, there has been a resurgence in interest in CCM in China, Europe and United States, as a specialty.[1]

Contact with Western culture and medicine has not displaced TCM. While there may be traditional factors involved in the persistent practice, two reasons are most obvious in the westward spread of TCM in recent decades. Firstly, TCM practices are believed by many to be very effective, sometimes offering palliative efficacy where the best practices of Western medicine fail, especially for routine ailments such as flu and allergies, and managing to avoid the toxicity of some chemically composed medicines. Secondly, TCM provides the only care available to ill people, when they cannot afford to try the western option. On the other hand, there is, for example, no longer a distinct branch of Chinese physics or Chinese biology.

TCM formed part of the barefoot doctor program in the People's Republic of China, which extended public health into rural areas. It is also cheaper to the PRC government, because the cost of training a TCM practitioner and staffing a TCM hospital is considerably less than that of a practitioner of Western medicine; hence TCM has been seen as an integral part of extending health services in China.

There is some notion that TCM requires supernatural forces or even cosmology to explain itself. However most historical accounts of the system will acknowledge it was invented by a culture of people that were already tired of listening to shamans trying to explain illnesses on evil spirits;[2] any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Daoist-inspired classics of acupuncture such as the Nèi Jīng or Zhēnjiǔ Dàchéng. The system's development has over its history been skeptically analyzed extensively, and practice and development of it has waxed and waned over the centuries and cultures which it has traveled[3] - yet the system has still survived this far. It is true that the focus from the beginning has been on pragmatism, not necessarily understanding of the mechanisms of the actions - and that this has hindered its modern acceptance in the West. This, despite that there were times such as the early eighteenth century when "acupuncture and moxa were a matter of course in polite European society."[4]

Timeline

The history of TCM can be summarized by a list of important doctors and books.

  • Time unknown, author unknown, Huáng Dì Nèi Jīng (黃帝內經)(Classic of Internal Medicine by Emperor Huang) - Sù Wèn (素問) & Líng Shū (靈樞). The earliest classic of TCM passed on to the present.
  • According to archaelogical findings like in Mawangdui's tombs in 1973 writings on medicine first appeared between the eleventh and thid centuries B.C.E.
  • Warring States Period (fifth century B.C.E. to 221 B.C.E.): Silk scrolls recording channels and collaterals, Zu Bi Shi Yi Mai Jiu Jing (Moxibustion Classic of the Eleven Channels of Legs and Arms), and Yin Yang Shi Yi Mai Jiu Jing (Moxibustion Classic on the Eleven Yin and Yang Channels)
  • Eastern Han Dynasty (206 B.C.E. – 220 C.E.) to Three Kingdoms Period (220 - 280 C.E.):
    • Zhen Jiu Zhen Zhong Jing (Classic of Moxibustion and Acupuncture Preserved in a Pillow) by Huà Tuó (華佗)
    • Shang Han Za Bing Lun aka Shāng Hán Lùn (Treatise on Febrile and Miscellaneous Diseases) by Zhāng Zhòng Jǐng (張仲景)
  • Jìn Dynasty (265-420): Zhēn Jiǔ Jiǎ Yǐ Jīng (Systematic Classic of Acupuncture and Moxibustion) by Huángfǔ Mì (皇甫謐).
  • Tang Dynasty (June 18, 618 – June 4, 907)
    • Bei Ji Qian Jin Yao Fang (Emergency Formulas of a thousand gold worth) and Qian Jin Yi Fang (Supplement to the Formulas of a thousand gold worth) by Sūn Sīmiǎo (孫思邈)
    • Wai Tai Mi Yao (Arcane Essentials from the Imperial Library) by Wang Tao
  • Song Dynasty.)
    • Tóngrén Shūxué Zhēn Jiǔ Tú Jīng (Illustrated Manual of the Practice of Acupuncture and Moxibustion at (the Transmission) (and other) Acu-points, for use with the Bronze Figure) by Wáng Wéi Yī (王惟一).
    • Emergence of (Warm Disease Theory (Wen Bing Xue).
  • Yuan Dynasty(1271 to 1368): Shísì Jīng Fā Huī (Exposition of the Fourteen Channels) by Huá Shòu (滑壽).
  • Ming Dynasty (1368 to 1644): Climax of acupuncture and Moxibustion. Many famous doctors and books. Only name a few:
    • Zhēnjiǔ Da Quan (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng
    • Zhēnjiǔ Jù Yīng Fa Hui (鍼灸聚英??) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武)
    • Zhēnjiǔ Dàchéng (針灸大成) (Compendium of Acupuncture and Moxibustion) by Yang Jizhou, 1601 C.E., Yáng Jì Zhōu (楊繼洲).
    • Běncǎo Gāng Mù (本草綱目) (Compendium of Materia Medica) by Lǐ Shízhēn (李時珍), the most complete and comprehensive pre-modern herb book
    • Wen Yi Lun (Theory of Warm-Induced Disorders) by Wu YouShing
  • Qing Dynasty(1644-1912):
    • Yi Zong Jin Jian (Golden Reference of the Medical Tradition) by Wu Quan, sponsored by the imperial.
    • Zhen Jiu Feng Yuan (The Source of Acupuncture and Moxibustion) by Li Xuechuan
    • Wen Zhen Lun Dz by Ye TianShi.
    • Wen Bing Tiao Bian (Systematized Identification of Warm Disease) written by Wu Jutong, a Qing dynasty physician, in 1798 C.E.[5]

Uses

In the West, traditional Chinese medicine is considered alternative medicine. In mainland China and Taiwan, TCM is considered an integral part of the health care system. The term "TCM" is sometimes used specifically in modern Chinese medicine to refer to the standardized set of theories and practices introduced in the mid-twentieth century under Mao Zedong, as distinguished from related traditional theories and practices preserved by people in Taiwan, Hong Kong and the overseas Chinese. The more general sense is meant in this article.

Did you know?
Traditional Chinese medicine is a broad range of medicine practices developed in China, including various forms of herbal medicine, acupuncture, massage (Tui na), exercise (qigong), and dietary therapy

TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine or traditional medicine) rooted in ancient belief systems, including traditional religious concepts. Chinese medical practitioners before the nineteenth century relied on observation, trial and error, which incorporated certain mystical concepts. Like their Western counterparts, doctors of TCM had a limited understanding of infection, which predated the discovery of bacteria, viruses (germ theory of disease) and an understanding of cellular structures and organic chemistry. Instead they relied mainly on observation and description on the nature of infections for creating remedies. Based on theories formulated through three millennia of observation and practical experience, a system of procedure was formed as to guide a TCM practitioner in courses of treatment and diagnosis.

Unlike other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. In recent decades there has been an effort to integrate Traditional Chinese Medicine with scientific medicine. One important component of this work is to use the instrumentation and the methodological tools available via Western medicine to investigate observations and hypotheses made by the Chinese tradition.

However, in Hong Kong, the city dominated by Western medicine for more than a hundred years, traditional medicine has struggled for a long time to be recognized by the society. Albeit Former Chief Executive Tung Chee-hwa introduced a bill in his first Policy Address, aiming at recognizing the professional status of Chinese medicine practitioners and developing Hong Kong into an international center for the manufacture and trading of Chinese medicine, and for the promotion of this approach to medical care.[6]

TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions, such as pains, that conventional medicine has not been able to treat. A report issued by the Victorian state government in Australia describes TCM education in China:

Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practice TCM as a specialty within the broader organization of Chinese health care.[7]

In other countries it is not necessarily the case that traditional Chinese and Western medicine are practiced concurrently by the same practitioner. TCM education in Australia, for example, does not qualify a practitioner to provide diagnosis in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures. [2] While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.[8]

Theory

The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM can be shown to be most influenced by Daoism, Buddhism, and Neo-Confucianism.

Since 1200 B.C.E., Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterization of humanity's place in the universe. In the I Ching (Book of Changes) and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:

  • There are observable principles of constant change by which the Universe is maintained. Humans are part of the universe and cannot be separated from the universal process of change.
  • As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself. Optimum health results from living harmoniously, allowing the spontaneous process of change to bring one closer to balance. If there is no change (stagnation), or too much change (catastrophism), balance is lost and illnesses can result.
  • Everything is ultimately interconnected. Always use a holistic ("systemic" or "system-wide") approach when addressing imbalances.

Pharmacology

The legendary emperor Shennong, who invented agriculture, is supposed to have tested herbs. "A number of herbs, Asiatic plantain, frtillary, motherwort, etc., are mentioned in the Book of Odes, Shi Jing. The Classic of Mountains and Rivers, Shan Hai Jing written 2000 years ago named a total of 120 drugs of vegetable, animal and mineral origin and described their effects in treating and preventing diseases as well as their processing and administration."[9] In the second century B.C.E. was published the Shennong's Materia Medica, the earliest pharmacological work presenting 365 drugs divided in three categories and explaining the properties and therapeutic value of each medicinal herb. The ancient Chinese found specific medicines for certain diseases. Pharmacology was later developed particularly during the Tang dynasty. The greatest achievement took place in the sixteenth century with Li Shizen (1518-1593) who published in 1578 his 52 volumes encyclopedia called Compendium of Materia Medica.

According to the theory of pharmacology, medicines are classified according to their temperature, tastes and nature of "ascending" (inducing perspiration, relieving the feeling of pressure) or "descending". There is a specific way to prepare them according to fluid-treatment, heat treatment and fluid-heat treatment. Doctors in traditional Chinese medicine prescribe several or dozens of different items for a dose, all of which are in balance for co-ordinated action. Different ratios of ingredients in a prescription and different dosages yield different effects.

Discovery for surgery: It is said that in the third century the great surgeon Hua Tuo applied for an operation an effervescing powder called mafeisan as an anaesthetic which may be the origin of surgical anesthesia.

Model of the body

Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi ("breath," "life force," or "spiritual energy"), blood, jing ("kidney essence" or "semen"), other bodily fluids, the Five elements, emotions, and the soul or spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. Unlike the Western anatomical model which divides the physical body into parts, the Chinese model is more concerned with function. Thus, the TCM Spleen is not a specific piece of flesh, but an aspect of function related to transformation and transportation within the body, and of the mental functions of thinking and studying.

There are significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice and theory.

Models of the body include:

  • Yin or Yang
  • Five elements
  • Zang Fu theory
  • Meridian (Chinese medicine)
  • Three jiaos

The Yin/Yang and five element theories may be applied to a variety of systems other than the human body, whereas Zang Fu theory, meridian theory and three-jiao theories are more specific.

There are also separate models that apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and the Eight principles system of disease classification.

Macro approach to disease

Traditional Chinese medicine has a "macro" or holistic view of disease. For example, one modern interpretation is that well-balanced human bodies can resist most everyday bacteria and viruses, which are ubiquitous and quickly changing. Infection, while having a proximal cause of a microorganism, would have an underlying cause of an imbalance of some kind. The traditional treatment would target the imbalance, not the infectious organism. There is a popular saying in China as follows:

Chinese medicine treats humans while western medicine treats diseases.

A practitioner might give very different herbal prescriptions to patients affected by the same type of infection, because the different symptoms reported by the patients would indicate a different type of imbalance, in a traditional diagnostic system.

Western medicine treats infections by targeting the microorganisms directly, whether preventively (through sterilization of instruments, hand washing, and covering bandages), with antibiotics, or making use of the immune system through vaccines. While conventional medicine recognizes the importance of nutrition, exercise and reducing stress in maintaining a healthy immune system (and thus preventing infection), it also faces problems with antibiotic resistance caused by overuse of chemical agents and the high mutation rate of microorganisms. Pharmaceutical treatments also sometimes have side effects, the most severe of which are seen in regimens used to treat otherwise fatal illnesses, such as chemotherapy and radiotherapy for cancer, and antiretroviral drugs for HIV/AIDS.

The holistic approach of traditional Chinese medicine makes all practitioners generalists. Western medicine has general practitioners who dispense primary care, but increasing reliance is placed on specialists who have expertise in treating only certain types of diseases. Primary care physicians often refer patients to specialists. Emergency departments are located in large hospitals where many specialists are available.

Traditional Chinese as preventive

Early medical texts such as Su Wen show the importance of preventing a disease, which reflects the early trend of Chinese Philosophy according to which "man must concentrate silently before acting". The Su Wen states that to treat a disease after its onset is like to dig a well only after one is thirsty.

"An experienced doctor, it says, should effectively treat a disease at its first stage. The best remedy is one applied before the sickness grows." (Chinese Academy of Sciences, 1983)

Diagnostics

Following the macro philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than "micro" level laboratory tests. There are four types of TCM diagnostic methods: observe (望 wàng), hear and smell (聞 wén), ask about background (問 wèn) and touching (切 qiè).[10] The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as "Going to have my pulse felt."[11]

The study of the pulse was made famous by the great physician Bian Que in the 5th century B.C.E. but it existed already in much earlier periods according to recent discoveries. It developed with Chunyu Yi (205-? BC), Zhang Zhongjing (150-219) and Wang Shuhe (180-270) who wrote the Classic on Pulse, Mai jing which described 24 patterns of pulse beat and the diagnostic significance.

The pulse study was related to an an understanding of the whole body, the vital relation between the heart, the blood and the blood vessels and also the inhalation and exhalation of the breath. Through the pulse the doctor is able to find out the condition of the heart and the problems caused by the ill functioning of certain internal organs. The doctor takes the pulse at more that one site, head, legs… to obtain a more extensive and reliable diagnosis.

"Ancient Chinese medical practitioners were enabled by pulse feeling to know whether a disease was "cold" or "warm" in nature and whether the patient's vital energy was growing or declining. They were able also to determine the cause of a disease, the part of the body affected, and prognostic signs…/…. The pulse pattern indicates not only the visceral origin of a disease but also its basic cause. This formula stems from the concept that the human body should be viewed as a whole, based on a theory that channels and collaterals in the body are routes along which vital energy circulates and which connect the visceral organs with the extremities, muscles, skin and joints into an organic whole." [12] Modern practitioners in China often use a traditional system in combination with Western methods.

Traditional Chinese medicine is considered to require considerable diagnostic skill. This often depends on the ability to observe what are described as subtle differences. This may be contrasted with a straightforward laboratory test which indicates an unambiguous cause. A training period of years or decades is said to be necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, A good (TCM) doctor is also qualified to be a good prime minister in a country.

Techniques

  • Palpation of the patient's radial artery pulse (Pulse diagnosis) in six positions
  • Observation of the appearance of the patient's tongue
  • Observation of the patient's face
  • Palpation of the patient's body (especially the abdomen) for tenderness
  • Observation of the sound of the patient's voice
  • Observation of the surface of the ear
  • Observation of the vein on the index finger on small children
  • Comparisons of the relative warmth or coolness of different parts of the body
  • Observation of the patient's various odors
  • Asking the patient about the effects of his problem
  • Anything else that can be observed without instruments and without harming the patient

Treatment

The below methods are considered as part of the Chinese medicine treatment:

  1. Chinese herbal medicine(中藥)
  2. Acupuncture and Moxibustion (針灸)
  3. Die-da or Tieh Ta (跌打)
  4. Chinese food therapy (食療)
  5. Tui na (推拿) - massage therapy
  6. Qigong (氣功) and related breathing and meditation exercise
  7. Physical exercise such as T'ai Chi Ch'uan (太極拳) and other Chinese martial arts
  8. Mental health therapy such as Feng shui (風水) and Chinese astrology

Modern TCM treatments consist of herbal medicine or acupuncture as the primary method, with other methods such as massage, qi gong, or food therapy playing a secondary role. Illness in TCM is seen as a lack of harmony, and the goal of all traditional treatment is to assist the body to regain balance and achieve proper homeostasis. The modern practice of traditional Chinese medicine is increasingly incorporating techniques and theories of Western medicine.

Specific treatment methods are grouped into these branches. Cupping and Gua Sha (刮痧) are part of Tui Na. Auriculotherapy (耳燭療法) comes under the heading of Acupuncture and Moxibustion. Die-da or Tieh Ta (跌打) are practitioners who specialize in healing trauma injury such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. Such practice of bone-setting is not common in the West.

Branches

Traditional Chinese medicine has many branches, the most prominent of which are the Jingfang (经方学派) and Wenbing (温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shenlong Bencaojing. The more recent Wenbing school's practice is largely based on more recent books including Compendium of Materia Medica from Ming and Qing Dynasty, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in mainland China, when Wenbing school used political power to suppress the opposing school.

Scientific view

The question of efficacy

Much scientific research about TCM has focused on acupuncture. There is no scientific consensus as to whether acupuncture is effective or only has value as a placebo. Reviews of existing clinical trials have been conducted by the Cochrane Collaboration and Bandolier according to the protocols of evidence-based medicine; some reviews have found efficacy for headache,[13] but for most conditions have concluded a lack of effectiveness or lack of well-conducted clinical trials.[14] The World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture. [15] These groups disagree on what is acceptable evidence and on how to interpret it, but generally agree that acupuncture is relatively safe (even if not effective) and that further investigation is warranted. The 1997 NIH [16] summarized research and made a prediction as follows:

…promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Much less work in the West has been done on Chinese herbal medicines, which comprise much of TCM. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.

Some herbs have known active ingredients which are also used in Western pharmaceuticals. For example, ma huang, or ephedra, contains ephedrine and pseudoephedrine. (Due to the risk of adverse impact on the cardiovascular system and some deaths due to consumption of extracts in high doses, the use of ephedra is restricted by law in the United States.) Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria. It is also under investigation as an anti-cancer agent.

In the West, many Chinese herbal medicines have been marketed as dietary supplements and there has been considerable controversy over the effectiveness, safety, and regulatory status of these substances. One barrier to scientific research on traditional remedies is the large amount of money and expertise required to conduct a double-blind clinical trial, and the lack of financial incentive from the ability to obtain patents.

There are a priori doubts about the efficacy of many TCM treatments that appear to have their basis in magical thinking—for example that plants with heart-shaped leaves will help the heart, or that ground bones of the tiger can function as a stimulant because tigers are energetic animals. Such doubts, however, do not invalidate the efficacy of the medicines themselves. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not mean the substances do not (perhaps by coincidence) possess the attributed properties. Given the thousand-year evolution of Chinese materia medica, it is possible that while herbs were originally selected on erroneous grounds, only those that actually proved effective have remained in use. In any case, clinical trials of Chinese herbal medicines will need to be conducted before the question can be considered resolved.

Mechanism of action

The basic mechanism of TCM is akin to treating the body as a black box, recording and classifying changes and observations of the patient using a traditional philosophy. In contrast to many alternative and complementary medicines such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, the largest barriers to describing the mechanisms of TCM in scientific terms are the difference of language and lack of research. TCM concepts such as qi and yin and yang are used to describe specific biological processes but are difficult to translate into scientific terms. Some research is now beginning to emerge explaining possible scientific mechanisms behind these TCM concepts.

Safety

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should only be administered by persons who have been educated to apply them safely. "A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended Traditional Chinese Medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs."[17]

Certain Chinese herbal medicines involve a risk of allergic reaction and in rare cases involve a risk of poisoning. Cases of acute and chronic poisoning due to treatment through ingested Chinese medicines are found in China, Hong Kong, and Taiwan, with a few deaths occurring each year. Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs. The raw and unprocessed form of aconite, or fuzi is the most common cause of poisoning. The use of aconite in Chinese herbal medicine is usually limited to processed aconite, in which the toxicity is denatured by heat treatment.

Furthermore, potentially toxic and carcinogenic compounds such as arsenic and cinnabar are sometimes prescribed as part of a medicinal mixture or used on the basis of "using poison to cure poison." Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. Much of these are being prevented with more empirical studies of Chinese herbals and tighter regulation regarding the growing, processing, and prescription of various herbals.

In the United States, the Chinese herb má huáng (麻黄; lit. "hemp yellow")—known commonly in the West by its Latin name Ephedra—was banned in 2004 by the FDA, although, the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a usage that directly conflicts with traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA's ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency's finding that ephedra posed an unreasonable risk to consumers.

Many Chinese medicines have different names for the same ingredient depending on location and time, but worse yet, ingredients with vastly different medical properties have shared similar or even same names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized as sodium nitrite (牙硝), [18] resulting in a poisoned victim. [19]

Relationship with Western medicine

Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine.

Outside of China, the relationship between TCM and Western medicine is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well-meaning but improperly-trained "TCM practitioners" who have done people more harm than good in many instances.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner or visit a martial arts school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.

This is not to say that TCM techniques are considered worthless in the West. In fact, Western pharmaceutical companies have recognized the value of traditional medicines and are employing teams of scientists in many parts of the world to gather knowledge from traditional mouth healers and medical practitioners. After all, the active ingredients of most modern medicines were discovered in plants or animals. The particular contribution of Western medicine is that it strictly applies the scientific method to promising traditional treatments, separating those that work from those that do not. As another example, most Western hospitals and increasing numbers of other clinics now offer T'ai Chi Ch'uan or qigong classes as part of their inpatient and community health programs.

Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. As a simple example, you see a Western doctor if you have acute appendicitis, but you do exercises or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.

A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula.

It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.

In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for over-prescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional Chinese herbal remedies.

Traditional Chinese diagnostics and treatments are often much cheaper than Western methods which require high-tech equipment or extensive chemical manipulation.

TCM doctors often criticize Western doctors for paying too much attention to laboratory tests and showing insufficient concern for the overall feelings of patients.

Modern TCM practitioners will refer patients to Western medical facilities if a medical condition is deemed to have put the body too far out of "balance" for traditional methods to remedy.

Animal products

Animal products are used in certain Chinese formulae, which may present a problem for vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances.

The use of endangered species is controversial within TCM. In particular, is the belief that tiger penis and rhinoceros horn are aphrodisiacs (although the traditional use of rhinoceros horn is to reduce fever).[20] This depletes these species in the wild. Medicinal use is also having a major impact on the populations of seahorses.[21]

Shark fin soup is traditionally regarded as beneficial for health in East Asia. According to Compendium of Materia Medica, it's good at strengthening the waist, supplementing vital energy, nourishing blood, invigorating kidney and lung and improving digestion. However, such claims are not supported by scientific evidence.[22] Furthermore, they have been found to contain high levels of mercury, which is known for its ill effects.

The animal rights movement notes that a few traditional Chinese medicinal solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China, gallbladders from butchered cattle are recommended as a substitute for this ingredient.[20]

Opposition

Starting from late nineteenth century, politicians and Chinese scholars with background in Western medicine have being trying to phase out TCM totally in China. Some of the prominent advocates of the elimination of TCM include:

  • Lu Xun, who argues that TCM doctors are intentionally or unintentionally deceiving their patients
  • Wang Jingwei, who asserts that TCM has no basis in human anatomy nor any scientific foundation
  • Li Ao, who argues that TCM is a kind of superstition.
  • Fang Shimin, who argues that TCM is pseudo-science and may be unsafe due to a lack of Double blind tests.

The attempts to curtail TCM in China always provoke large scale debates but have never completely succeeded. Still, many researchers and practitioners of TCM in China and the United States argue the need to document TCM's efficacy with controlled, double blind experiments. These efforts remain hampered by the difficulty of creating effective placebos for acupuncture studies.

The attempt to phase out TCM in Japan partially succeeded after Meiji Restoration. However, in the 1920s a movement emerged that attempted to restore traditional medical practice, especially acupuncture. This movement, known as the Meridian Therapy movement (Keiraku Chiryo in Japanese) persists to this day. Furthermore, many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine.

Schools of Traditional Chinese Medicine

  • Midwest College of Oriental Medicine - offers a combined Bachelor of Science in Nutrition and Master's in traditional Chinese medicine (TCM), acupuncture certification, and a new doctoral program.
  • New England School of Acupuncture - acupuncture school, traditional Chinese medicine (TCM), Chinese herbal medicine, Chinese medical qigong, integrative medicine, and Japanese acupuncture (Newton, MA)
  • Oregon College of Oriental Medicine - acupuncture school, traditional Chinese medicine, Chinese herbal medicine, Qigong, Shiatsu, Tui Na, taiji quan, clinical doctor of acupuncture & Oriental medicine degree program (Portland, OR)
  • Southwest Acupuncture College, Boulder, CO - an accredited post-graduate college that offers a Master's of Science in Oriental Medicine, which includes Chinese herbal medicine, acupuncture, qi gong, shiatsu, tui na, tai ji, and clinical experience. The Master's degree is an extensive, four-year, 3000-plus-hour program (Boulder, CO)

See also

Notes

  1. For example, see the program of Heiner Fruehauf et al., Classical Chinese Medicine at National College of Natural Medicine. See also Heiner Fruehauf's website covering topics related to Classical Chinese Medicine. Retrieved February 13, 2009.
  2. "It could be said that the theory of the 5 Elements, and its application to medicine, marks the beginning of what one might call 'scientific' medicine and a departure from Shamanism. No longer do healers look for a supernatural cause of disease: they now observe Nature and, with a combination of the inductive and deductive method, the set out to find patterns within it and, by extension, apply these in the interpretation of disease" - from an introductory textbook used by many acupuncture courses - Giovanni Maciocia, The Foundations of Chinese Medicine. (Churchill Livingstone, 1989, ISBN 0443039801), 16.
  3. Joseph Needham, Lu Gwei-Djen, Celestial Lancets (Cambridge University Press, 1980, ISBN 0521215137), 69-170, 262-302.
  4. Needham et al., 296.
  5. Treating Damp-Warmth Disease with San ren tang. pacificcollege.edu. Retrieved February 13, 2009.
  6. Chief Executive's Policy Address 1997 Retrieved May 23, 2013.
  7. Education in Traditional Chinese Medicine Retrieved May 23, 2013.
  8. Safe Access to Chinese Herbs Chinese Medicine Review Board, Victoria, AU. Retrieved February 14, 2009.
  9. Zhongguo ke xue yuan, Ancient China's technology and science (Beijing: Foreign Languages Press, 1983, ISBN 9780835110013).
  10. Giovanni Maciocia, The Foundations of Chinese Medicine (Churchill Livingstone, 1989).
  11. Ted J. Kaptchuk, The Web That Has No Weaver: Understanding Chinese Medicine (McGraw Hill, 2000, ISBN 0809228408).
  12. Ancient China's Technology and Science (Chinese Academy of Science, 1983).
  13. Acupuncture for migraine prophylaxis and Nausea Cochrane Reviews. Retrieved May 23, 2013.
  14. Acupuncture for Recurrent Headache Bandolier. Retrieved February 14, 2009.
  15. Acupuncture and Oriental Medicine AMA.org. Retrieved February 14, 2009.
  16. Consensus Statement on Acupuncture Retrieved May 23, 2013.
  17. Summary of Findings Victoria, AU.gov. Retrieved February 14, 2009.
  18. Hong Kong Commonly confused Chinese Medicine (in Chinese) Retrieved February 14, 2009.
  19. Chinese medicine Natrii Sulfas not to be confused with chemical Sodium Nitrite. Press release, Hong Kong govt. Retrieved February 14, 2009.
  20. 20.0 20.1 Volker Scheid, Dan Bensky, Andrew Ellis, and Randall Barolet, Chinese Herbal Medicine: Formulas & Strategies (Seattle, WA: Eastland Press, 2009, ISBN 978-0939616671).
  21. Kingdom of the Seahorses. Nova PBS.org. Retrieved February 13, 2009.
  22. Shark Fin Soup: An Eco-Catastrophe?. SFGate. Retrieved February 14, 2009.

References

  • Chang, Stephen T. The great Tao. San Francisco, CA: Tao Pub., 1985. ISBN 9780942196016.
  • Holland, Alex. Voices of Qi: an introductory guide to traditional Chinese medicine. Berkeley, CA: North Atlantic Books, 1999. ISBN 9781556433269.
  • Jin, Guanyuan, and Lei Jin. Lin chuang zhen jiu fan she xue = Clinical reflexology of acupuncture and moxibustion. Beijing: Beijing ke xue ji shu chu ban she, 2004. ISBN 9787530428627.
  • Kaptchuk, Ted J. The Web that has no weaver: understanding Chinese medicine,2nd ed. New York: Congdon & Weed, 2000. ISBN 9780865530218.
  • Maciocia, Giovanni. The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists. Edinburgh: Churchill Livingstone, 1989. ISBN 9780443039805.
  • Needham, Joseph. Lu Gwei-Djen. Celestial Lancets. Cambridge University Press, 1980. ISBN 0521215137.
  • Ni, Maoshing. The Yellow Emperor's Classic of medicine: a new translation of the Neijing Suwen with commentary. Boston: Shambhala, 1995. ISBN 9781570620805.
  • Ou, Jiecheng. Dang Zhong yi yu shang xi yi: li shi yu xing si. Xianggang: San lian shu dian (Xianggang) you xian gong si, 2004. ISBN 9789620423369.
  • Porkert, Manfred. The theoretical foundations of Chinese medicine: systems of correspondence. Cambridge: MIT Press, 1973. ISBN 9780262160582.
  • Scheid, Volker. Chinese medicine in contemporary China: plurality and synthesis. (Science and cultural theory.) Durham, NC: Duke University Press, 2002. ISBN 9780822328575.
  • Scheid, Volker, Dan Bensky, Andrew Ellis, and Randall Barolet. Chinese Herbal Medicine: Formulas & Strategies. Seattle, WA: Eastland Press, 2009. ISBN 978-0939616671
  • Unschuld, Paul U. Medicine in China: a history of ideas. (Comparative studies of health systems and medical care.) Berkeley, CA: University of California Press, 1985. ISBN 9780520050235.
  • Veith, Ilza. The Yellow Emperor's Classic of Internal Medicine. Berkeley, CA: University of California Press, 2002. ISBN 979-0520229364

External links

All links retrieved May 2, 2013.

Credits

New World Encyclopedia writers and editors rewrote and completed the Wikipedia article in accordance with New World Encyclopedia standards. This article abides by terms of the Creative Commons CC-by-sa 3.0 License (CC-by-sa), which may be used and disseminated with proper attribution. Credit is due under the terms of this license that can reference both the New World Encyclopedia contributors and the selfless volunteer contributors of the Wikimedia Foundation. To cite this article click here for a list of acceptable citing formats.The history of earlier contributions by wikipedians is accessible to researchers here:

Note: Some restrictions may apply to use of individual images which are separately licensed.