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Image:ChineseMedicine-HK.JPG Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong. 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. These 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 Oriental medicine, which includes other traditional East Asian medical systems such as traditional Japanese, and Korean medicine.
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. Traditional TCM does not operate within a western scientific paradigm but some practitioners make efforts to bring practices into an evidence-based medicine framework.
HistoryMuch of the philosophy of traditional Chinese medicine derived from Taoist philosophy, and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or spiritual, correlate as the expression of the fates decreed by heaven. During the golden age of his reign from 2698 to 2596 B.C, 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 between the Chou and Han dynasties more than two thousand years later than tradition reports, although some parts of the extant work may have originated as early as 1000 B.C. 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 2nd century AD, 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 AD), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙經), ca. 265 AD. 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 11th century AD. However, Classical Chinese Medicine (CCM) is notably different from Traditional Chinese Medicine (TCM). The Nationalist government at that time 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 1960's, Mao Zedong finally decided that the government could not continue to outlaw the use of CCM. He commissioned the top 10 doctors (M.D.'s) to take 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 Northern 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.[citation needed] Jeffrey Yuen, allegedly of the 88th generation of a sect of CCM has lead this renewed interest in CCM.[citation needed] 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. Attitudes toward TCM in China have been strongly influenced by Marxism and the May Fourth Movement. The notion of supernatural forces runs counter to the Marxist consept of dialectical materialism and strikes many Chinese as feudalistic and superstitious. Modern Chinese descriptions of traditional Chinese medicine tend to deemphasize the cosmological aspects of TCM and emphasize its compatibility with modern science and technology. TimelineThe history of TCM can be summarized by a list of important doctors and books.
UsesIn 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-20th 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. 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 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.
A report issued by the Victorian state government in Australia describes TCM education in China:
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.[5] While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow prescribing Chinese herbs that would otherwise be classified as poisons[6] by registered practitioners. TheoryThe 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. Since 1200 BC, 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 Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:
Model of the bodyTraditional 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: 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 diseaseTraditional 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] 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, handwashing, 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. DiagnosticsFollowing 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).[2] 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"[3] 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. Techniques
TreatmentThe below methods are considered as part of the Chinese medicine treatment:
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. 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. BranchesTraditional 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 practise 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.[citations needed] Scientific viewThe question of efficacyMuch 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[7][8] and nausea[9][10], 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[11][12]. 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 proven 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 actionThe 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. SafetyAcupressure 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." [13] 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)[14], resulting in a poisoned victim[15][16]. In some Chinese medical texts, both names are interchangeable[17]. Chinese herbal medicine authorities are working towards improved standards in this area [18]. Relationship with Western medicineWithin 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 mouth 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 too far out of "balance" for traditional methods to remedy. Animal productsAnimal 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, is the belief that tiger penis and rhinoceros horn are aphrodisiacs. (Actually the traditional use of rhinoceros horn is to reduce fever.)[4] This depletes these species in the wild. Medicinal use is also having a major impact on the populations of sea horses.[19] 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.[20]. Furthermore, they have been found to contain high levels of mercury, which are 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[4] Bensky, Clavey and Stoger's comprehensive Chinese herbal text deals with substances derived from endangered species in an appendix, with an emphasis on recommending alternatives. OppositionStarting from late 19th 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:
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.[citations needed] The attempt to phase out TCM in Japan partially succeeded after Meiji Restoration. However, in the 1920's 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.[citations needed] See also
Footnotes
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