Traditional Chinese medicine

Traditional Chinese medicine (also known as TCM or T.C.M., simplified Chinese: 中医学; traditional Chinese: 中醫學; pinyin: Zhōngyī xué) is a range of traditional medical practices used in China that developed during several thousand years. These practices include herbal medicine, acupuncture, and massage. TCM is a form of Oriental medicine, which includes other traditional East Asian medical systems such as Japanese and Korean medicine. TCM says processes of the human body are interrelated and constantly interact with the environment. Therefore the theory looks for the signs of disharmony in the external and internal environment of a person in order to understand, treat and prevent illness and disease. 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 theory, and others. Diagnosis and treatment are conducted with reference to these concepts. TCM does not usually operate within a scientific paradigm but some practitioners make efforts to bring practices into an evidence-based medicine framework.

History

Uses

In the West, traditional Chinese medicine is often considered alternative medicine; however, in mainland China and Taiwan, TCM is widely considered to be an integral part of the health care system. The term "TCM" is sometimes used specifically within the field of modern Chinese medicine to refer to the standardized set of theories and practices introduced in the mid-20th century under the government of Mao, as distinguished from related traditional theories and practices preserved by people in Taiwan, Hong Kong and by the overseas Chinese. The more general sense is meant in this article.

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 19th 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 the discoveries made by traditional Chinese medicine with the discoveries made by workers in the Western medical traditions. One important component of this work is to use the instrumentation and the methodological tools available via Western medicine to investigate observations made and hypotheses raised by the Chinese tradition.

That this effort has occurred is surprising to many for a number of reasons. In most of the world, indigenous medical practices have been supplanted by practices brought from the West, while in Chinese societies, this has not occurred and shows no sign of occurring. Furthermore, many have found it peculiar that Chinese medicine remains a distinct branch of medicine separate from Western medicine, while the same has not happened with other intellectual fields. There is, for example, no longer a distinct branch of Chinese physics or Chinese biology.

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 that conventional medicine is claimed to be sometimes ineffective in treating. It has also been used to treat antibiotic-resistant infection.^{[citation needed]}

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 practise TCM as a specialty within the broader organisation of Chinese health care. [1]

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 prescribe scheduled pharmaceuticals, nor to undertake surgical procedures or diagnose in Western medical terms.[2]

TCM 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 Taoism, Buddhism, and Neo-Confucianism.^{[citation needed]}

For over 3000 years (1200 BC - present), Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other^{[citation needed]} 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.

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.

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.^{[citation needed]}

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, handwashing, and covering bandages), with antibiotics, or making use of the immune system through vaccines. Conventional medicine does recognize the importance of nutrition and 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.

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 read the pulse (切 qiè).^{[citation needed]}

Systems of diagnosis include:

Modern practitioners in China often use a traditional system in combination with Western methods.^{[citation needed]}

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.

Diagnostic techniques

Palpation of the patient's radial artery pulse 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
Anything else that can be observed without instruments and without harming the patient

Treatment techniques

Historically, eight branches comprised Chinese medicine treatment:

Tui na (推拿) - massage therapy
Acupuncture and Moxibustion (針灸)
Chinese herbal medicine(中药)
Chinese food therapy (食疗)
Qigong (氣功) and related breathing and meditation exercise
T'ai Chi Ch'uan (太極拳) and other Chinese martial arts
Feng shui (风水)
Chinese astrology^{[dubious – discuss]}

Today, all of the above except Feng shui and Chinese astrology are routinely used as part of TCM treatments.^{[citation needed]}

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.

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 homeostasis.

The modern practice of traditional Chinese medicine is increasingly incorporating techniques and theories of Western medicine in its praxis.

TCM and science

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 [3][4] and nausea [5][6], but for most conditions have concluded a lack of effectiveness or lack of well-conducted clinical trials. The World Health Organisation (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture[7][8]. 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 Consensus Statement on Acupuncture 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.^{[citation needed]}

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 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 requied 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 of Chinese medicines

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.

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. "flax 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.

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)[9], resulting a poisoned victim[10][11]. In some Chinese medical texts, both names are interchangeable[12]. Unless the Chinese herbal medicine authorities start to adopt unique names for different medicines, this situation is unlikely to improve.

TCM and 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.

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 healers and medical practitioners. After all, the active ingredients of most modern medicines were discovered in plants or animals.^{[citation needed]} 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. To put it simply, 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 to far out of "balance" for traditional methods to remedy.

TCM and animals

Animal products are used in certain Chinese formulas, 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, the belief that tiger penis and rhinoceros horn are aphrodisiacs has been blamed for depleting these species in the wild. Medicinal use is also having a major impact on the populations of sea horses.[13]

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 even kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China.^{[citation needed]}

TCM and the Internet

With the popularity of the Internet, an increasing number of TCM doctors are seeking new [[approaches to diagnose and treat diseases using remote, non-contact methods, such as creating online symptom questionnaires and uploading photos. Some TCM advocates have even established web sites to provide free herb prescriptions to patients. These sites are putting in question the traditional importance placed on direct visual examination and palpation of the patient.

Quotes and Proverbs

A single untried popular remedy often throws the scientific doctor into hysterics. -Chinese proverb

A young doctor makes a full graveyard. -Chinese proverb

An ignorant doctor is no better than a murderer. -Chinese proverb

The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness. -Chinese proverb

References

Chang, Stephen T. The Great Tao; Tao Longevity; ISBN 0-942196-01-5 Stephen T. Chang
Kaptchuck, Ted J., The Web That Has No Weaver; Congdon & Weed; ISBN 0-8092-2933-1Z
Jin, Guanyuan, Xiang, Jia-Jia and Jin, Lei: Clinical Reflexology of Acupuncture and Moxibustion; Beijing Science and Technology Press, Beijing, 2004. ISBN 7-5304-2862-4
Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; ISBN 0-443-03980-1
Ni, Mao-Shing, The Yellow Emperor's Classic of Medicine : A New Translation of the Neijing Suwen with Commentary; Shambhala, 1995; ISBN 1-57062-080-6
Holland, Alex Voices of Qi: An Introductory Guide to Traditional Chinese Medicine; North Atlantic Books, 2000; ISBN 1-55643-326-3
Unschuld, Paul U., Medicine in China: A History of Ideas; University of California Press, 1985; ISBN 0-520-05023-1
Scheid, Volker, Chinese Medicine in Contemporary China: Plurality and Synthesis; Duke University Press, 2002; ISBN 0-8223-2972-0
Qu, Jiecheng, When Chinese Medicine Meets Western Medicine - History and Ideas (in Chinese); Joint Publishing (H.K.), 2004; ISBN 962-04-2336-4
Chan, T.Y. (2002). Incidence of herb-induced aconitine poisoning in Hong Kong: impact of publicity measures to promote awareness among the herbalists and the public. Drug Saf. 25:823–828.
Benowitz, Neal L. (2000) Review of adverse reaction reports involving ephedrine-containing herbal products. Submitted to U.S. Food and Drug Administration. Jan. 17.
Porkert, Manfred The Theoretical Foundations of Chinese Medicine MIT Press, 1974 ISBN 0-262-16058-7
Hongyi, L., Hua, T., Jiming, H., Lianxin, C., Nai, L., Weiya, X., Wentao, M. (2003) Perivascular Space: Possible anatomical substrate for the meridian. Journal of Complimentary and Alternative Medicine. 9:6 (2003) pp851-859

External links

State Administration of Traditional Chinese Medicine for the People's Republic of China, (English)
The Journal of Chinese Medicine
Classics of Traditional Chinese Medicine, by the National Library of Medicine (NLM)
Acupuncture. NIH Consensus Statement 1997 Nov 3-5; 15(5):1-34.
China, Chi, and Chicanery (a sceptical view)
Effects of acupuncture on gastroparesis study
Traditional Chinese Medicine--A Favored Adjunctive Therapy for American Cancer Patients
Merging Chinese Traditional Medicine into the American Health System
The Chinese Medicine Sampler- Historical Roots of Traditional Chinese Medicine
Folks TCM A famous Chinese TCM web site providing free herb prescription to patients.
A Visit to a Chinese Pharmacy, a virtual tour
Chinese medicine, Chinese Herbal Medicine and Acupuncture Medline Most recent research articles on Chinese medicine, Chinese Herbal Medicine and Acupuncture from Medline/Entrez PubMed
An essay on translation of Chinese concepts into English
Traditional Chinese Medicine news, information, education, research and discussion - A regularly updated TCM website based in Australia
ChineseMedicine.com.hk 香港中醫網-網上復方中成葯
National Certification Commission for Acupuncture and Oriental Medicine (USA)
American Association for Acupuncture and Oriental Medicine