Traditional Chinese medicine
Traditional Chinese Medicine
Traditional Chinese medicine (TCM) is based on a set of interventions designed to restore balance to human beings. The therapies usually considered under the heading of classic Chinese medicine include:
- acupunture and moxibustion
- dietary regulation
- herbal remedies
- therapeutic exercise
These forms of treatments are based upon beliefs that differ from the disease concept favored by Western medicine. What is referred to as illness by Western medicine is considered in traditional Chinese medicine to be a matter of disharmony or imbalance.
The philosophy behind Chinese medicine is a melding of tenets from Buddhism, Confucianism, and the combined religious and philosophical ideas of Taoism. Although there are various schools of thought among practitioners of traditional Chinese medicine, five Taoist axioms form its basis:
- There are natural laws which govern the universe, including human beings.
- The natural order of the universe is innately harmonious and well-organized. When people live according to the laws of the universe, they live in harmony with that universe and the natural environment.
- The universe is dynamic, with change as its only constant. Stagnation is in opposition to the law of the universe and causes what Western medicine calls illness.
- All living things are connected and interdependent.
- Humans are intimately connected to and affected by all facets of their environment.
Traditional Chinese medicine is over 2,000 years old. It originated in the region of eastern Asia that today includes China, Tibet, Vietnam, Korea, and Japan. The first written Chinese medical treatises (as the West understands the term) date from the Han dynasty (206 b.c.–a.d. 220). Tribal shamans and holy men who lived as hermits in the mountains of China as early as 3500 b.c. practiced what was called the "Way of Long Life." This regimen included a diet based on herbs and other plants; kung-fu exercises; and special breathing techniques that were thought to improve vitality and life expectancy.
After the Han dynasty, the next great age of Chinese medicine was under the Tang emperors, who ruled from a.d. 608-a.d. 906. The first Tang emperor established China's first medical school in a.d. 629. Under the Song (a.d. 960–1279) and Ming (a.d. 1368–1644) dynasties, new medical schools were established, their curricula and qualifying examinations were standardized, and the traditional herbal prescriptions were written down and collected into encyclopedias. One important difference between the development of medicine in China and in the West is the greater interest in the West in surgical procedures and techniques. In the nineteenth and early twentieth centuries, the opening of China to the West led to the establishment of Western-style medical schools in Shanghai and other large cities, and a growing rivalry between the two traditions of medicine. In 1929 a group of Chinese physicians who had studied Western medicine petitioned the government to ban traditional Chinese medicine. This move was opposed, and by 1933 the Nationalist government appointed a chief justice of the Chinese Supreme Court to systematize and promote the traditional system of medicine. In contemporary China, both traditional and Western forms of medicine are practiced alongside each other.
Philosophical background: the cosmic and natural order
In Taoist thought, the Tao, or universal first principle, generated a duality of opposing principles that underlie all the patterns of nature. These principles, yin and yang, are mutually dependent as well as polar opposites. They are basic concepts in traditional Chinese medicine. Yin represents everything that is cold, moist, dim, passive, slow, heavy, and moving downward or inward; while yang represents heat, dryness, brightness, activity, rapidity, lightness, and upward or outward motion. Both forces are equally necessary in nature and in human well-being, and neither force can exist without the other. The dynamic interaction of these two principles is reflected in the cycles of the seasons, the human life cycle, and other natural phenomena. One objective of traditional Chinese medicine is to keep yin and yang in harmonious balance within a person.
In addition to yin and yang, Taoist teachers also believed that the Tao produced a third force, primordial energy or qi (also spelled chi or ki). The interplay between yin, yang, and qi gave rise to the Five Elements of water, metal, earth, wood, and fire. These entities are all reflected in the structure and functioning of the human body.
The human being
Traditional Chinese physicians did not learn about the structures of the human body from dissection because they thought that cutting open a body insulted the person's ancestors. Instead they built up an understanding of the location and functions of the major organs over centuries of observation, and then correlated them with the principles of yin, yang, qi, and the Five Elements. Thus wood is related to the liver (yin) and the gall bladder (yang); fire to the heart (yin) and the small intestine (yang); earth to the spleen (yin) and the stomach (yang); metal to the lungs (yin) and the large intestine (yang); and water to the kidneys (yin) and the bladder (yang). The Chinese also believed that the body contains Five Essential Substances, which include blood, spirit, vital essence (a principle of growth and development produced by the body from qi and blood); fluids (all body fluids other than blood, such as saliva, spinal fluid, sweat, etc.); and qi.
A unique feature of traditional Chinese medicine is the meridian system. Chinese doctors viewed the body as regulated by a network of energy pathways called meridians that link and balance the various organs. The meridians have four functions: to connect the internal organs with the exterior of the body, and connect the person to the environment and the universe; to harmonize the yin and yang principles within the body's organs and Five Substances; to distribute qi within the body; and to protect the body against external imbalances related to weather (wind, summer heat, dampness, dryness, cold, and fire).
Traditional Chinese medicine offers the following benefits:
- It is believed by some to treat certain chronic illnesses more effectively than Western medicine.
- It is holistic; all aspects of the person's being are taken into account.
- It treats the root cause of the disease as well as the manifest symptoms. Chinese practitioners distinguish between the root (ben ) of an illness and its branches (biao ). The root is the basic pattern of imbalance in the patient's qi; the branches are the evident symptoms.
- Traditional Chinese medicine does not rely on pharmaceutical products that often cause side effects.
- It improves a person's general health as well as treating specific diseases or disorders.
- It is often less expensive than standard allopathic treatment.
- It is not a self-enclosed system but can be used in combination with Western medicine.
- It can be used to treat the side effects of Western modalities of treatment.
Acupuncture is probably the form of treatment most familiar to Westerners. It is often used for pain relief, but has wider applications in traditional Chinese practice. It is based on a view of the meridians that regards them as conduits or pathways for the qi, or life energy. Disease is attributed to a blockage of the meridians; thus acupuncture
can be used to treat disorders of the internal organs as well as muscular and skin problems. The insertion of needles at specific points along the meridians is thought to unblock the qi. More than 800 acupuncture points have been identified, but only about 50 are commonly used. Acupuncture is usually used as a treatment together with herbal medicines.
Moxibustion refers to the practice of burning a moxa wick over the patient's skin at vital points. Moxa is a word derived from Japanese and means "burning herbs." The moxa wick is most commonly made from Artemisia vulgaris, or Chinese wormwood , but other herbs can also be used. Moxibustion is thought to send heat and nourishing qi into the body. It is used to treat a number of different illnesses, including nosebleeds , pulled muscles, mumps , arthritis, and vaginal bleeding.
Diet is regarded as the first line of treatment in Chinese medicine; acupuncture and herbal treatments are used only after changes in diet fail to cure the problem. Chinese medicine uses foods to keep the body in internal harmony and in a state of balance with the external environment. In giving dietary advice, the Chinese physician takes into account the weather, the season, the geography of the area, and the patient's specific imbalances (including emotional upsets) in order to select foods that will counteract excesses or supply deficient elements. Basic preventive dietary care, for example, would recommend eating yin foods in the summer, which is a yang season. In the winter, by contrast, yang foods should be eaten to counteract the yin temperatures. In the case of illness, yin symptom patterns (fatigue , pale complexion, weak voice) would be treated with yang foods, while yang symptoms (flushed face, loud voice, restlessness) would be treated by yin foods.
Chinese medicine also uses food as therapy in combination with exercise and herbal preparations. One aspect of a balanced diet is maintaining a proper balance of rest and activity as well as selecting the right foods for the time of year and other circumstances. If a person does not get enough exercise, the body cannot transform food into qi and Vital Essence. If they are hyperactive, the body consumes too much of its own substance. With respect to herbal preparations, the Chinese used tonics taken as part of a meal before they began to use them as medicines. Herbs are used in Chinese cooking to give the food specific medicinal qualities as well as to flavor it. For example, ginger might be added to a fish dish to counteract fever . Food and medical treatment are closely interrelated in traditional Chinese medicine. A classical Chinese meal seeks to balance not only flavors, aromas, textures, and colors in the different courses that are served, but also the energies provided for the body by the various ingredients.
Chinese herbal treatment differs from Western herbalism in several respects. In Chinese practice, several different herbs may be used, according to each plant's effect on the individual's qi and the Five Elements. There are many formulas used within traditional Chinese medicine to treat certain common imbalance patterns. These formulas can be modified to fit specific individuals more closely.
In 2002, a study in Texas showed that a traditional Chinese antirheumatic herb extract helped patients with rheumatoid arthritis by improving symptoms such as morning stiffness and tender, swollen joints. Side effects of decreased appetite and nausea were tolerable for those the herb helped. The researchers planned to move on to a more scientifically controlled clinical trial phase to further test the herb's effectiveness. Another scientific study that year reported new benefits for applying soy proteins, an ancient Chinese practice, to the skin. Scientists worked on a new preparation that showed benefits in reducing age spots and ultraviolet ray damage, and smoothing and moisturizing the skin, among other benefits.
A traditional Chinese herbal formula typically contains four classes of ingredients, arranged in a hierarchical order: a chief (the principal ingredient, chosen for the patient's specific illness); a deputy (to reinforce the chief's action or treat a coexisting condition); an assistant (to counteract side effects of the first two ingredients); and an envoy (to harmonize all the other ingredients and convey them to the parts of the body that they are to treat).
Massage is recommended in traditional Chinese medicine to unblock the patient's meridians, stimulate the circulation of blood and qi, loosen stiff joints and muscles, and strengthen the immune system. It may be done to relieve symptoms without the need for complex diagnosis. Chinese massage is commonly used to treat back strain, pulled muscles, tendinitis, sciatica , rheumatism, arthritis, sprains, and similar ailments. In Tui na massage, the practitioner presses and kneads various qi points on the patient's body. The patient does not need to undress but wears thin cotton clothes. He or she sits on a chair or lies on a massage couch while the practitioner presses on or manipulates the soft tissues of the body. Tui na means "push and grasp" in Chinese. It is not meant to be relaxing or pampering but is serious treatment for sports injuries and chronic pain in the joints and muscles. Tui na is used to treat the members of Chinese Olympic teams.
Therapeutic exercise, or qigong, is an ancient Chinese form of physical training that combines preventive healthcare and therapy. Qigong relies on breathing techniques to direct the qi to different parts of the body. The literal translation of qigong is "the cultivation and deliberate control of a higher form of vital energy." Another form of therapeutic exercise is t'ai chi , in which the person moves through a series of 30–64 movements that require a relaxed body and correct rhythmic breathing. Many Chinese practice t'ai chi as a form of preventive medicine.
Preparations for treatment in traditional Chinese medicine are similar to preparing for a first-time visit to a Western physician. The patient will be asked to give a complete and detailed medical history. The practitioner may touch the patient's acupuncture meridians to evaluate them for soreness or tightness. The major difference that the patient will notice is the much greater attention given in Chinese medicine to the tongue and the pulse. The Chinese practitioner will evaluate the patient's tongue for form, color, and the color and texture of the tongue fur. In taking the pulse, the Chinese therapist feels three pressure points along each wrist, first with light pressure and then with heavy pressure, for a total of 12 different pulses on both wrists. Each pulse is thought to indicate the condition of one of the 12 vital organs.
There are no special precautions necessary for treatment with traditional Chinese medical techniques other than giving the practitioner necessary details about major or chronic health problems.
Side effects with traditional Chinese medicine are usually minor. With herbal treatments, there should be no side effects if the patient has been given the correct formula and is taking it in the prescribed manner. Some people feel a little sore or stiff the day after receiving Tui na massage, but the soreness does not last and usually clears up with repeated treatments. Side effects from acupuncture or from therapeutic exercise under the guidance of a competent teacher are unusual. However, care should be taken in using herbal preparations and possible side effects or toxins within any preparations, as well as interactions with other drugs. Patients should consult with qualified practitioners.
Research & general acceptance
At present, there is renewed interest in the West in traditional Chinese medicine. Of the 700 herbal remedies used by traditional Chinese practitioners, over 100 have been tested and found effective by the standards of Western science. Several United States agencies, including the National Institutes of Health, the Office of Alternative Medicine, and the Food and Drug Administration (FDA) are currently investigating Chinese herbal medicine as well as acupuncture and Tui na massage. In general, however, Western studies of Chinese medicine focus on the effects of traditional treatments and the reasons for those effects, thus attempting to fit traditional Chinese medicine within the Western framework of precise physical measurements and scientific hypotheses.
As use of traditional Chinese medicine has increased steadily in the West, many allopathic physicians have needed to understand the intricacies of the practice and to know how to deal with adverse reactions to herbal remedies. In 2002, a project was undertaken to develop a Chinese herbal medicine toxicology database to share information about English and Chinese studies on Chinese herbal medicines. The goal of the project was to help doctors in Western hospitals better manage poisonings or adverse reactions to Chinese medicines.
Training & certification
Traditional Chinese medicine practitioners can be either acupuncturists, herbalists, or both. At present, no schools accredited in the United States confer the degree of Doctor of Oriental Medicine because the standards for such a degree have not yet been established. More than half of the 50 states now have licensing boards for acupuncturists as of the early 2000s. There is no present independent licensing for herbalists. California has been the only state that has required (since 1982) acupuncture practitioners to take licensing examinations in both acupuncture and herbal medicine.
There is also a national organization called the National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) that offers certification in acupuncture. This certification provides the basis for licensure in a number of states. The NCCAOM also offers a certificate in herbal medicine that does not lead to licensure at present but is beginning to be used in some states as a basis for practice.
Mills, Simon, M.A., and Steven Finando, PhD. Alternatives in Healing. New York: NAL Penguin, Inc., 1989.
Reid, Daniel P. Chinese Herbal Medicine. Boston: Shambhala, 1993.
Stein, Diane. "All Women Are Healers: A Comprehensive Guide to Natural Healing." Chinese Healing and Acupressure. Freedom, CA: The Crossing Press, 1996.
Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin Lakes, WI: Lotus Press, 1995.
Bensoussan, Alan, et al. "Development of a Chinese Herbal Medicine Toxicology Database." Journal of Toxicology: Clinical Toxicology (March 2002): 159.
"Chinese Herbal Extract Safe and Effective for RA." The Journal of Musculoskeletal Medicine (January 2002): 43.
Liu, Jue-Chen, et al. "Applications of Soy in Skin Care." The Journal of Nutrition (March 2002): 574S.
American Association of Oriental Medicine. 909 22nd St. Sacramento, CA 95816. <http://www.aaom.org>.
Florida Institute of Traditional Chinese Medicine. (800) 565-1246. [email protected]
Teresa G. Odle
Traditional Chinese Medicine
Traditional Chinese Medicine
Traditional Chinese medicine (TCM) is an ancient and still very vital holistic system of health and healing, based on the notion of harmony and balance, and employing the ideas of moderation and prevention.
TCM is a complete system of health care with its own unique theories of anatomy, health, and treatment. It emphasizes diet and prevention and using acupuncture, herbal medicine, massage, and exercise; and focuses on stimulating the body's natural curative powers.
In situations of severe trauma, TCM should not be substituted for contemporary modern trauma practice; it is most useful as an adjunct to the healing regimen. TCM is not the first line of treatment for bacterial infection or cancer, but may usefully complement contemporary medical treatment for those conditions.
In theory and practice, traditional Chinese medicine is completely different from Western medicine, both in terms of considering how the human body works and how illness occurs and should be treated. As a part of a continuing system that has been in use for thousands of years, it is still employed to treat over one-quarter of the world's population. Since the earliest Chinese physicians were also philosophers, their ways of viewing the world and human beings role in it affected their medicine. In TCM, both philosophically and medically, moderation in all things is advocated, as is living in harmony with nature and striving for balance in all things. Prevention is also a key goal of Chinese medicine, and much emphasis is placed on educating the patient to live responsibly. The Chinese physician also is more of an advisor than an authority; he or she believes in treating every patient differently, based on the notion that one does not treat the disease or condition but rather the individual patient. Thus two people with the same complaint may be treated entirely differently, if their constitutions and life situations are dissimilar. Disease is also considered to be evidence of the failure of preventive health care and a falling out of balance or harmony.
There is some confusion in the West about the fundamental philosophical principles upon which traditional Chinese medicine is based—such as the concept of yin and yang, the notion of five elements (wood, fire, earth, metal and water), and the concept of chi —yet each can be explained in a way that is understandable to Westerners.
Yin and yang describe the interdependent relationship of opposing but complementary forces believed to be necessary for a healthy life. Basically, the goal is to maintain a balance of yin and yang in all things.
The five elements, or five phase theory, is also grounded in the notion of harmony and balance. The concept of chi, which means something like "life force" or "energy," is perhaps most different from Western ideas. TCM asserts that chi is an invisible energy force that flows freely in a healthy person, but is weakened or blocked when a person is ill. Specifically, the illness is a result of the blockage, rather than the blockage being the result of the illness.
Besides these philosophical concepts that differ considerably from infection-based principles of medicine and health, the methods employed by traditional Chinese medicine are also quite different. If allopathic Western practitioners could be described as interventionist and dependent on synthetic pharmaceuticals, TCM methods are mostly natural and noninvasive. For example, where Western physicians might employ surgery and chemotherapy or radiation for a cancer patient, a TCM physician might use acupuncture and dietary changes. TCM believes in "curing the root" of a disease and not merely in treating its symptoms.
Another major difference is how the patient is regarded. In Western medicine, patients with similar complaints or diseases, usually will receive virtually the same treatment. In TCM however, the physician treats the patient and not the condition, believing that identical diseases can have entirely different causes. In terms of the principles upon which it is based and the methods used, traditional Chinese medicine, therefore, is considered by many in the West to be a radically different system of health care.
To some in the Western world, this very strangeness is the reason why it might be attractive. To others, tired of what they perceive as their physician's perfunctory, analytical, and sometimes cold manner, TCM offers a more humane, patient-oriented approach that encourages a high degree of practitioner-patient interaction and is not overly dependent on technology.
For example, during a consultation with a TCM practitioner, the patient will receive a considerable amount of time and attention. During the important first visit, the practitioner will conduct four types of examinations, all extremely observational and all quite different from what patients usually experience.
First, the practitioner will ask many questions, going beyond the typical patient history to inquire about such particulars as eating and bowel habits or sleep patterns. Next, the physician looks at the patient, observing his or her complexion and eyes, while also examining the tongue very closely, believing that it is a barometer of the body's health and that different areas of the tongue can reflect the functioning of different body organs. After observing, they listen to the patient's voice or cough and then smell his or her breath, body odor, urine, and even bowel movements. Finally, the practitioner touches the patient, palpating his or her abdomen and feeling the wrist to take up to six different pulses. It is through these different pulses that the well-trained practitioner can diagnose any problem with the flow of the all-important chi. Altogether, this essentially observational examination will lead the physician to diagnose or decide the patient's problem. This diagnosis is very different from one in contemporary Western medicine. No blood or urine samples are tested in a laboratory. The key to this technique lies in the experience and skill of the practitioner.
After making a diagnosis, the physician will suggest a course of treatment from one or all of the available TCM methods. These fall into four main categories: herbal medicine, acupuncture, dietary therapy, and massage and exercise. A typical TCM prescription consists of a complex variety of many different herbal and mineral ingredients. Chinese herbal remedies are intended to assist the body's own systems so that eventually the patient can stop taking them and never becomes dependent on them. Herbal formulas are usually given as teas, which differ according to the patient.
Other common techniques used in a TCM prescription are as follows:
- Acupuncture is based on the notion that the body's vital energy force, chi, travels through known channels or "meridians." The acupuncturist inserts tiny, thin sterile needles at particular, selected points on the body to unblock or correct the flow of energy. These needles are hardly felt as they are inserted and are left in place for 15 to 20 minutes. Some patients report immediate improvement, others feel exhilarated, while some feel like sleeping. In some cases, patients say their condition worsens before it improves. No contemporary scientific explanation exists as to how or why acupuncture works.
- Moxibustion is a variation sometimes employed. Moxibustion is the slow burning on or over the body of special herbal "cones." These are placed on specific acupoints and provide penetrating, relaxing heat.
- Massage is often recommended, and a deep finger pressure technique known as acupressure is often used to promote the proper flow of chi.
- Diet is considered essential to good health, and what might be called "kitchen medicine" is just another aspect of herbalism. One example is a delicious DQ black bean soup that is traditionally eaten by women in China after childbirth and each menstrual cycle.
- Therapeutic exercises are sometimes prescribed as well. In both the exact and flowing movements of tai chi, and the breathing techniques of Qi Dong exercise is considered essential to relieving stress and promoting the smooth flow of chi.
Allopathic— Pertaining to conventional medical treatment of disease symptoms that uses substances or techniques to oppose or suppress the symptoms.
Anatomy— The science of the body structure of an organism and its parts.
Holistic— That which pertains to the entire person, including the mind, body, and spirit.
Palpate— To examine the body by touching or pressing with the fingers or the palm of the hand.
Pharmaceutical— Pertaining to drugs.
Therapeutic— Curative or healing.
Trauma— Injury or damage to the body.
As a system of total health care, TCM is prepared to deal with any physical or mental problem, condition, or disease. However, unlike Western medicine at its best, TCM is not able to render the kind of emergency crisis intervention that saves lives during physical traumas. Nonetheless, it works best at achieving its goal of practicing preventive medicine. It has proven effective in treating many types of aches and pains and in helping people with depression and fatigue, as well as circulation and digestive problems. Overall, its emphasis on good diet and exercise, as well as on individual responsibility and moderation in all things, suggest that it is grounded in fundamentally sound principles.
In the hands of a qualified practitioner, TCM is very safe. However, there is a small chance of not only getting an infection from acupuncture, but also that an existing infection could be spread to other parts of the body by increased blood flow and circulation.
Traditional Chinese medicine seeks to harmonize and rebalance the entire human system rather than to treat just symptoms. Since proper internal balance is considered to be the key to human health, TCM strives to cure disease by restoring that balance and therefore allowing the body to repair itself. Its continuing medical goal is to detect and correct abnormalities before they cause permanent physical damage.
American Academy of Medical Acupuncture. 2520 Milvia St., Berkeley, CA 94704. (415) 841-3220.
American Association of Acupuncture & Oriental Medicine. 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607. (919) 787-5181.