Traditional Chinese medicine

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Definition

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.

Description

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 healthcare.

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 15–20 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 dong quai 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 t'ai chi, and the breathing techniques of Qi Dong exercise is considered essential to relieving stress and promoting the smooth flow of chi.

As a system of total healthcare, 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.

— Leonard C. Bruno, PhD

Definition

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
• massage
• 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.

Origins

Historical Background

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).

Benefits

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.

Description

Acupuncture/Moxibustion

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.

Dietary Regulation

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.

Herbal Remedies

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

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

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

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.

Precautions

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

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.

Resources

Books

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.

Periodicals

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.

Organizations

American Association of Oriental Medicine. 909 22nd St. Sacramento, CA 95816. .

American Foundation of Traditional Chinese Medicine (AFTCM). 505 Beach Street. San Francisco, CA 94133. (415) 776-0502. Fax: (415) 392-7003. aftcm@earthlink.net.

Florida Institute of Traditional Chinese Medicine. (800) 565-1246. fitcm@gte.net.

[Article by: Joan Schonbeck; Teresa G. Odle]

Chinese traditional medicine comprises four interrelated therapies: Zhong Yao (herbal medicine), Zhen Jiu (acupuncture and moxibustion), Qi Gong (vital energy exercises), and Tui Na (therapeutic massage), although some purists prefer not to include the latter two theories. There is no distinct demarcation between clinical medicine and public health practice. Chinese traditional medicine considers a person's well-being physically and mentally. It approaches health with due consideration to nature in all its complexity and multidimensionality. Enhancing natural healing is central to Chinese medical practice. The basic concepts underlying all Chinese medical therapies are the Taoist doctrine of yin and yang (the theory of opposites); the five elements (metal, wood, water, fire, and earth); and "Qi" (pronounced chee), the vital energy of life that circulates in the human body via a system of pathways.

Traditional Chinese medicine has a different paradigm from that of Western biomedicine, and the world depicted in the former is not easily translated to the latter. Chinese medicine treats the body as a microcosm that follows macrocosmic laws and is continually influenced by macrocosmic factors, such as the seasonal patterns created by conjunctions of sun, moon, and stars. It defines health as the process of refining body essences, cultivating vital and spiritual forces, and maximizing physiological functions. Generally, biomedicine treats the body as a sovereign entity and sees health as the absence of pathology.

In China today, there is an effort to integrate Chinese traditional medicine and biomedicine in clinical practice and research. Doctors trained in biomedicine regularly prescribe herb-based antibiotics, and traditional doctors often depend on X-rays and scientific instruments for their diagnoses and treatment of injuries.

Herbal Medicine (Zhong Yao)

The earliest known work on Chinese herbs appeared as early as 100 B.C.E. Li Shih-chen's (1386–1644) chronicle of herbal medicines (1578), which has been used for the last four centuries, consists of 52 volumes, cataloging 1,898 herbs or substances and a total of 11,096 separate prescriptions. The Encyclopedia of Traditional Chinese Medicinal Substances, published by the Jiangsu College of New Medicine in 1997, identifies 5,767 substances. The majority of Chinese traditional medicines are of herbal origin, but minerals and animal parts are also included in Zhong Yao pharmacopoeia. Prescriptions usually comprise four or more herbs, with interaction among them for complementary and synergistic pharmacology. They are boiled as medicinal tea or processed into pills for oral ingestion. Some of these substances are also formulated as paste or plaster for external application.

In herbal medicine, there are four main diagnostic methods: visual inspection, inquiry, auscultation and smelling, and pulse diagnosis. The pulse reveals specific aspects of a person's health. Taking a pulse is, therefore, one of the diagnostic acts of a Chinese herbalist doctor. The doctor tries to identify the psychosocial, environmental, and dietetic causes of symptoms, and prescribes remedies, including advice on psychosocial issues.

Another belief is that the use of medicines must be assisted by nourishment of the body. Herbal therapies often provide nutrients for the body to overcome illness and to build up the body's defense against disease. Good medicines and nutrients replenish and strengthen the essence of "Qi." When Qi, which flows through channels and collaterals (jing and luo) in the body, is blocked or out of balance, illness or pain ensues.

Acupuncture/Moxibustion (Zhen Jui)

Zhen Jiu consists of acupuncture and moxibution, both of which have been practiced as therapeutic techniques in China for more than 2,000 years. They are used to induce stimulation in various locations of the body to treat ailments and relieve pain. The practice requires a thorough knowledge of anatomy and physiology as well as the system of Qi flow. There are fourteen channels and numerous collaterals under the body surface, which connect the body surface to various internal organs. Along the channels and collaterals are more than 360 acupoints and a number of extraordinary acupoints.

Acupuncture (the use of needles), and moxibustion (the use of heated herbs), aimed at specific acupoints along the pathways (channels and collaterals) in the body, can correct the flow of Qi and blood to restore optimal health and to block pain. Such stimulation can prompt a cascade of chemicals in the muscles, spinal cord, and brain to release the body's natural painkilling endorphins (a morphine-like substance generated by the body) and can impact on Qi, blood circulation, and various body functions. Magnets, mild electric current, manual pressure, or even low frequency lasers can also stimulate these acupoints to the same effect. These trigger points are rich with nerve endings that are linked to various parts of the human body. Some of the sensitive points that affect various body functions are located in the ear and on the sole of the foot. Acupuncture's painkilling effect has been used successfully for anesthesia in surgery, including thyroid surgery and some thoracic procedures.

Vital Energy (Qi Gong)

Qi Gong, as an art of healing and health preservation, dates back to the Tang Yao period, some twenty centuries B.C.E. Dancing and body movements, and various ways of breathing, exhalation, and exclamation were recognized as ways to read-just some functions of the human body and treat diseases.

Medical scholars throughout Chinese history, beginning with the Qin dynasty (200 B.C.E.), have written about Qi and body movements. In the Song and Yuan dynasties (900–1300 C.E.), Taoist and Buddhist priests introduced the importance of cultivating the Tantian (inner elixir). Since 1978, Qi Gong masters have popularized such practice for health preservation and disease prevention.

One of the characteristics of Qi Gong is to allow practitioners to cultivate their demeanor and stamina to enable them to engage in strenuous activities. Another is to cultivate the ability of practitioners to transmit Qi to patients through needles or their hands. Patients are also taught to undertake Qi exercises to maintain health. There are dynamic exercises involving multiple movements of limbs and the body and static exercises that call for simple postures with mind concentration and breathing exercise. After symptoms and signs are analyzed, Qi doctors prescribe specific therapies for problems. Inappropriate Qi therapies can be harmful and Qi exercises need to be adapted and individualized to each person's needs and situation.

Massage (Tui Na)

Tui Na, literally meaning pushing and pulling, refers to a system of massage, manual stimulation and manipulation of muscles, tendons, ligaments, joints, and trigger points. Different schools—each with its own theory, training, style, and practice— have been established in various regions of China. Those in northern China tend to be more vigorous, while those in southern China are more subtle. Some use rolling movements, while others focus on bone setting and digital point pressure. Some aim at health preservation, while others are designed to treat specific ailments.

A distinct aspect of Tui Na is the extensive training of the hands to reach a state of "conditioned reflex," which is necessary to accomplish focused and forceful movements on various areas of the body. Generally speaking, all massage methods promote blood circulation, remove blood stasis, restore and treat injured soft tissues, and correct deformities and abnormal positions of bones and muscles. Dynamic wave signals can influence the physiological function, the pathological state of the body fluid, the balance of yin and yang, Qi blood circulation, and mind and emotion interaction.

The relationship among Qi Gong, acupuncture, and Tui Na are quite close, as they are all based on the same theoretical basis of Chinese traditional medicine.

Chinese Traditional Medicine in the West

For some time, the scientific community in the West looked upon traditional remedies in the East with suspicion. The former could not accept the claim of the latter without objective scientific evaluation. In recent decades, however, there has been a healthy crossover from Western biomedicine to Chinese traditional medicine. Pharmacologically, the cross-fertilization came earlier. Aspirin, one of the West's popular pain-relieving compounds, for instance, has its origin in a tree bark.

Biomedicine is increasingly looking toward traditional medicines for possible solutions to some of the intractable chronic illnesses. As life expectancies lengthen, chronic illnesses will increase. As environment-related diseases increase and lifestyle-related illnesses become more prevalent, Chinese traditional medicine, which takes a more holistic view of health and has had thousands of years of empirical successes, should offer different approaches to the treatment of diseases and advice for health preservation and promotion.

At the end of the twentieth century there was an explosion of interest in herbs as food supplements for better health. The trend of self-help for better health fueled this interest. Ginseng is an example of an herb that is widely accepted as an agent to help fight cancer as well as to add vitality to life. While many Chinese herbal medicines have proven to be effective, however, quality and dosage control remains a serious concern.

Pharmaceutical companies have to comply with governmental regulations on the production of drugs, but food supplements are not subject to similar review and control for quality and proper dosage. The perception that all herbs, because they are natural, have no side effects is erroneous and some herbal substances are toxic. It is important therefore to be educated about herbs before consuming them.

(SEE ALSO: Acculturation; Barefoot Doctors; Bioculturalism; Cultural Factors; Ethnicity and Health; Holistic Medicine; Immigrants, Immigration; Traditional Health Beliefs, Practices)

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— JACK CHIEH-SHENG LING

For more information on traditional Chinese medicine, visit Britannica.com.

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Traditional Chinese medicine/dried goods shop in Tsim Sha Tsui, Hong Kong

Traditional Chinese medicine, also known as TCM (simplified Chinese: 中医; traditional Chinese: 中醫; pinyin: zhōngyī), includes a range of traditional medical practices originating in China. Although well accepted in the mainstream of medical care throughout East Asia, it is considered an alternative medical system in much of the western world.

TCM practices include such treatments as herbal medicine (中药), acupuncture, dietary therapy, and both Tui na and Shiatsu massage. Qigong and Taijiquan are also closely associated with TCM.

TCM theory originated thousands of years ago through meticulous observation of nature, the cosmos, and the human body. Major theories include those of Yin-yang, the Five Phases, the human body Channel system, Zang Fu organ theory, six confirmations, four layers, etc.

Contents 1 History 1.1 Ancient (classical) TCM history 1.2 Timeline 2 Theory 2.1 Basic theory and model of the body 3 Diagnostics 3.1 Techniques 4 Methods of treatment 5 Branches 6 Scientific view 6.1 Efficacy 6.2 Safety 6.2.1 In practice 6.2.2 Allergy 6.2.3 Toxins and contaminants 6.2.4 Lack of standardization 6.2.5 Vague naming 7 Relationship with Western medicine 8 Animal products 9 Opposition 10 Modernization 11 See also 12 Footnotes 13 References 14 Further reading 15 External links 15.1 Online databases

History

Ancient (classical) TCM history

Taijitu

Much of the philosophy of traditional Chinese medicine derives from the same philosophy that inform Taoist and Buddhist thought, and reflects the classical Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment on all levels.^[1]

In legend, as a result of a dialogue with his minister Qibo (岐伯), the Yellow Emperor (2698 - 2596 BCE) is supposed by Chinese tradition to have composed his Neijing Suwen (《内经·素问》) or Inner Canon: Basic Questions, also known as the Huangdi Neijing (Yellow Emperor's Inner Canon). The book's title is often mistranslated as Yellow Emperor's Classic of Internal Medicine. 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. Also another chinese index book of herbs is "Ben Cao Gang Mu" written by Li Shi Zhen.

During the Han Dynasty (202 BC –220 AD), Zhang Zhongjing (张仲景/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. Another prominent Eastern Han physician was Hua Tuo (c. 140 – c. 208 AD), who anesthetized patients during surgery with a formula of wine and powdered marijuana. Hua's physical, surgical, and herbal treatments were also used to cure headaches, dizziness, internal worms, fevers, coughing, blocked throat, and even a diagnosis for one lady that she had a dead fetus within her that needed to be taken out. 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 (甲乙经/甲乙經), ca. 265 AD. During the Tang dynasty, Wang Bing 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.

There were noted advances in Chinese medicine during the Middle Ages. Emperor Gaozong (r. 649–683) of the Tang Dynasty (618–907) commissioned the scholarly compilation of a materia medica in 657 that documented 833 medicinal substances taken from stones, minerals, metals, plants, herbs, animals, vegetables, fruits, and cereal crops.^[2] In his Bencao Tujing ('Illustrated Pharmacopoeia'), the scholar-official Su Song (1020–1101) not only systematically categorized herbs and minerals according to their pharmaceutical uses, but he also took an interest in zoology.^[3][4][5][6] For example, Su made systematic descriptions of animal species and the environmental regions they could be found, such as the freshwater crab Eriocher sinensis found in the Huai River running through Anhui, in waterways near the capital city, as well as reservoirs and marshes of Hebei.^[7]

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 practices of Western medicine fail or unable to provide treatment, especially for routine ailments such as flu and allergies, or when Western medicine fails to relieve patients suffering from chronic ailments. TCM has been shown to be effective^{[citation needed]} in the treatment of chronic, functional disorders, such as migraines and osteoarthritis, and is traditionally used for a wide range of functional disorders. Secondly, TCM provides an alternative to otherwise costly procedures whom many can not afford, or which is not covered by insurance. There are also many who turn to TCM to avoid the side effects of pharmaceuticals.

TCM of the last few centuries is seen by at least some sinologists as part of the evolution of a culture, from shamans blaming illnesses on evil spirits to "proto-scientific" systems of correspondence;^[8] any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Taoist-inspired classics of acupuncture such as the Huang Di Nei Jing. The system's development has, over its history, been analysed both skeptically and extensively, and the practice and development of it has waxed and waned over the centuries and cultures through which it has travelled^[9] - yet the system has still survived thus 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 18th century when "acupuncture and moxa were a matter of course in polite European society"^[10]

The term "TCM" describes the modern practice of Chinese medicine as a result of sweeping reforms that took place after 1950 in the People's Republic of China. The term "Classical Chinese medicine" (CCM) often refers to medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911). Advocates of CCM portray it as less influenced by Western and political agendas than TCM.

Timeline

Macerated medicinal liquor with wolfberry, tokay gecko, and ginseng, for sale at a traditional medicine market in Xi'an.

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

• Unknown, Huángdì nèijīng (黃帝內經/黄帝内经) (Yellow Emperor's Inner Canon) - Sùwèn (素问/素問) and Língshū (灵枢/靈樞). The earliest classic of TCM passed on to the present.

• Warring States Period (5th century BC to 221 BC): Silk manuscripts recording channels and collaterals, Zubi shiyi mai jiu jing (足臂十一脉灸经/足臂十一脈灸經) (Moxibustion Classic of the Eleven Channels of Legs and Arms), and Yinyang shiyi mai jiu jing (阴阳十一脉灸经/陰陽十一脈灸經) (Moxibustion Classic on the Eleven Yin and Yang Channels). The latter was part of a cache of texts found in Mawangdui in the 1970s.

• Han Dynasty (206 BC–AD 220) to Three Kingdoms Period (220 - 280 AD):
  • Zhenjiu zhenzhong jing (针灸枕中经/鍼灸枕中經) (Classic of Moxibustion and Acupuncture Preserved in a Pillow) by Huà Tuó (华佗/華佗).
  • Shanghan zabing lun (伤寒杂病论/傷寒雜病論), which has since been split into two texts: the Shānghán lùn (伤寒论/傷寒論) ("Treatise on Cold Damage [Disorders]" - focusing on febrile conditions attributed to "Cold") and the Jingui yaolue (金匱要略) ("Essentials of the Golden Cabinet" - focusing on "miscellaneous illnesses") by Zhāng Zhòngjǐng (张仲景/張仲景).

• Jìn Dynasty (265-420): Zhēnjiǔ jiǎyǐ jīng (针灸甲乙经/鍼灸甲乙經) (Systematic Classic of Acupuncture and Moxibustion) by Huángfǔ Mì (皇甫谧/皇甫謐).

• Tang Dynasty (618–907)
  • Beiji qianjin yaofang (备急千金要方/備急千金要方) (Emergency Formulas Worth a Thousand in Gold) and Qianjin yifang (千金翼方) (Supplement to the Formulas Worth a Thousand in Gold) by Sūn Sīmiǎo (孙思邈/孫思邈).
  • Waitai miyao (外台秘要/外臺秘要) (Arcane Essentials from the Imperial Library) by Wang Tao (王焘/王燾).

• Song Dynasty (960 – 1279):
  • Tóngrén shūxué zhēnjiǔ tújīng (铜人腧穴针灸图经/銅人腧穴鍼灸圖經) (Illustrated Manual of the Practice of Acupuncture and Moxibustion at (the Transmission) (and other) Acu-points, for use with the Bronze Figure) by Wáng Wéiyī (王惟一).

• Yuan Dynasty (1271 to 1368): Shísì jīng fāhuī (十四经发挥/十四經發揮) (Exposition of the Fourteen Channels) by Huá Shòu (滑寿/滑壽).

• Ming Dynasty (1368 to 1644): golden age of acupuncture and moxibustion. Many famous doctors and books. To name only a few:
  • Zhēnjiǔ dàquan (针灸大全/鍼灸大全) (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng (徐凤/徐鳳).
  • Zhēnjiǔ jùyīng fāhuī (针灸聚英发挥/鍼灸聚英發揮) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武).
  • Zhēnjiǔ dàchéng (针灸大成/鍼灸大成) (Compendium of Acupuncture and Moxibustion) by Yáng Jìzhōu (杨继洲/楊繼洲), completed in 1601.
  • Běncǎo gāngmù (本草冈目/本草綱目) (Compendium of Materia Medica) by Lǐ Shízhēn (李时珍/李時珍), the most complete and comprehensive pre-modern herbal book (completed in 1578).
  • Wenyi lun (温疫论/溫疫論), by Wu Youxing 吴有性 (1642).

• Qing Dynasty (1644-1912):
  • Yizong jinjian (医宗金鉴/醫宗金鑒) (Golden Mirror of the Medical Tradition) compiled by Wu Quan (吴谦/吴謙) under imperial commission.
  • Zhenjiu fengyuan (针灸逢源/鍼灸逢源) (The Source of Acupuncture and Moxibustion) by Li Xuechuan (李学川/李學川).
  • Wenre lun (温热论/溫熱論), by Ye Tianshi (叶天士/業天士).
  • Wenbing tiaobian (温病条辨/溫病條辨) (Systematized Identification of Warm-factor disorders) compiled by Wu Jutong (吴鞠通) in 1798.^[11]

Theory

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Dried plants and animals parts are used in traditional Chinese medicines. In the image are dried lingzhi, snake, turtle plastron, Luo Han Guo, and species of ginseng.

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 influenced by Taoism, Buddhism, and Neo-Confucianism.^[12]

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, Chinese writers described general principles and their applications to health and healing.

Porkert, a Western medical doctor, placed Chinese medical theory in context as:

Chinese medicine, like many other Chinese sciences, defines data on the basis of the inductive and synthetic mode of cognition. Inductivity corresponds to a logical link between two effective positions existing at the same time in different places in space. (Conversely, causality is the logical link between two effective positions given at different times at the same place in space.) In other words, effects based on positions that are separate in space yet simultaneous in time are mutually inductive and thus are called inductive effects. In Western science prior to the development of electrodynamics and nuclear physics (which are founded essentially on inductivity), the inductive nexus was limited to subordinate uses in protosciences such as astrology. Now Western man, as a consequence of two thousand years of intellectual tradition, persists in the habit of making causal connections first and inductive links, if at all, only as an afterthought. This habit must still be considered the biggest obstacle to an adequate appreciation of Chinese science in general and Chinese medicine in particular. Given such different cognitive bases, many of the apparent similarities between traditional Chinese and European science which attract the attention of positivists turn out to be spurious.^[13]

The Shen Nong's Herbal Classic, a 2000-year old medicinal Chinese book considered today as the oldest book on oriental herbal medicine, classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:

• The first category, called "superior", includes herbs effective for multiple diseases and are mostly responsible for maintaining and restoring the body balance. They have almost no unfavorable side-effects.
• The second category comprises tonics and boosters, for which their consumption must not be prolonged.
• The third category must be taken, usually in small doses, and for the treatment of specific ailments only.

Lingzhi ranked number one of the superior medicines, and was therefore the most exalted medicine in ancient times.^[14] The ancient Chinese use of mushrooms for medicine, has inspired modern day research into medicinal mushrooms like shiitake, Agaricus blazei, Trametes versicolor, the table mushroom and of course lingzhi.^[15] Although a 2008 Review, by UC Davis, concluded that there is not enough evidence yet to promote the use of mushrooms or mushroom extracts in the treatment of disease, it stressed the urgency of further research and future clinical trials due to large numbers of promising in vivo and in vitro experiments.^[16]

Basic theory and model of the body

An old Chinese medical chart on acupuncture meridians

Interactions of Wu Xing.

Main article: TCM model of the body

The following text needs to be harmonized with text in TCM 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", including "semen"), other bodily fluids, the Wu Xing, 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.

Theories invoked to describe the human body in TCM include:

• Channels, also known as "meridians"
• Wu Xing
• Qi
• Three jiaos also known as the Triple Burner, the Triple Warmer or the Triple Energiser
• Yin and Yang
• Zang and Fu

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 (Triple warmer) 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.

Diagnostics

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Following a 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 (闻/聞 wén), ask about background (问/問 wèn) and touching (切 qiè).^[17] 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."^[18]

Traditional Chinese medicine is considered to require considerable diagnostic skill. 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.^{[citation needed][dubious – discuss]} Modern practitioners in China often use a traditional system in combination with Western methods.^{[citation needed]}

Techniques

• Palpation of the patient's radial artery pulse (pulse diagnosis) in six positions
• Observations of patient's tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children
• Palpation of the patient's body (especially the abdomen, chest, back, and lumbar areas) for tenderness or comparison of relative warmth or coolness of different parts of the body
• Observation of the patient's various odors
• Asking the patient about the effects of their problem.
• Anything else that can be observed without instruments and without harming the patient
• Asking detailed questions about their family, living environment, personal habits, food diet, emotions, menstrual cycle for women, child bearing history, sleep, exercise, and anything that may give insight into the balance or imbalance of an individual.

Methods of treatment

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The following methods are considered to be part of Chinese medicine:

1. Acupuncture(针灸/針灸) (from the Latin word acus, "needle", and pungere, meaning "prick") is a technique in which the practitioner inserts fine needles into specific points on the patient's body. Usually about a dozen acupoints are needled in one session, although the number of needles used may range anywhere from just one or two to 20 or more. The intended effect is to increase circulation and balance energy (Qi) within the body.
2. Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
3. Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient's individual condition in relation to TCM theory. The "five flavors" (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. A balanced diet, which leads to health, is when the five functional flavors are in balance. When one is diseased (and therefore unbalanced), certain foods and herbs are prescribed to restore balance to the body.
4. Chinese herbal medicine (中草药/中药/中藥): In China, herbal medicine is considered as the primary therapeutic modality of internal medicine. Of the approximately 500 Chinese herbs that are in use today, 250 or so are very commonly used.^{[citation needed]} Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 3 to 25 herbs. As with diet therapy, each herb has one or more of the five flavors/functions and one of five "temperatures" ("Qi") (hot, warm, neutral, cool, cold). After the herbalist determines the energetic temperature and functional state of the patient's body, he or she prescribes a mixture of herbs tailored to balance disharmony. One classic example of Chinese herbal medicine is the use of various mushrooms, like reishi and shiitake, which are currently under intense study by ethnobotanists and medical researchers for immune system enhancement.
5. Cupping (拔罐): A type of Chinese massage, cupping consists of placing several glass "cups" (open spheres) on the body. A match is lit and placed inside the cup and then removed before placing the cup against the skin. As the air in the cup is heated, it expands, and after placing in the skin, cools down, creating a lower pressure inside the cup that allows the cup to stick to the skin via suction. When combined with massage oil, the cups can be slid around the back, offering what some practitioners think of as a reverse-pressure massage.
6. Die-da or Tieh Ta (跌打) is usually practiced by martial artists who know aspects of Chinese medicine that apply to the treatment of trauma and injuries 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 (整骨) is not common in the West.
7. Gua Sha (刮痧)
8. Moxibustion: "Moxa," often used in conjunction with acupuncture, consists in burning of dried Chinese mugwort (Artemisia vulgaris) on acupoints. "Direct Moxa" involves the pinching of clumps of the herb into cones that are placed on acupoints and lit until warm. Typically the burning cone is removed before burning the skin and is thought, after repeated use, to warm the body and increase circulation. Moxa can also be rolled into a cigar-shaped tube, lit, and held over an acupuncture point, or rolled into a ball and stuck onto the back end of an inserted needle for warming effect.
9. Physical Qigong exercises such as Tai chi chuan (Taijiquan 太极拳/太極拳), Standing Meditation (站樁功), Yoga, Brocade BaDuanJin exercises (八段锦/八段錦) and other Chinese martial arts.
10. Qigong (气功/氣功) and related breathing and meditation exercise.
11. Tui na (推拿) massage: a form of massage akin to acupressure (from which shiatsu evolved). Oriental massage is typically administered with the patient fully clothed, without the application of grease or oils. Choreography often involves thumb presses, rubbing, percussion, and stretches.
12. Some TCM doctors may also utilize esoteric methods that incorporate or reflect personal beliefs or specializations such as Fengshui (风水/風水) or Bazi (八字).

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 Shennong 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 view

Efficacy

See also: Acupuncture: Scientific research into efficacy

Much of the scientific research on TCM has focused on acupuncture. The effectiveness of acupuncture remains controversial in the scientific community, and a review by Edzard Ernst and colleagues in 2007 found that the body of evidence was growing, research is active, and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".^[19] Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.^[20][21] A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.^[22] There is conflicting evidence that it can treat chronic low back pain,^[23][24] and moderate evidence of efficacy for neck pain^[25][26] and headache.^[27] For most other conditions^[28] reviewers have found either a lack of efficacy (e.g., help in quitting smoking^[29]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain^[30]). While little is known about the mechanisms by which acupuncture may act, a review of neuroimaging research suggests that specific acupuncture points have distinct effects on cerebral activity in specific areas that are not otherwise predictable anatomically.^[31]

The World Health Organisation (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture^[32][33]. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted. The 1997 NIH Consensus Development Conference Statement on acupuncture concluded:

...promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative 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, in 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 scientific research has been done on Chinese herbal medicines, which comprise much of TCM. Some doubts about the efficacy of many TCM treatments are based on their apparent basis in sympathetic magic (causation due to analogy or similarity) — for example, that plants with heart-shaped leaves will help the heart. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not (perhaps by coincidence) possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the substantial cost and expertise required to conduct double-blind clinical trials^{[citation needed]}, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.^{[citation needed]}

Pharmacological compounds have been isolated from some Chinese herbal medicines; 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, and is also under investigation as an anti-cancer agent.^{[citation needed]} It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria^{[citation needed]}. It was the only one that was effective^{[citation needed]}. Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.^[34]

Safety

In practice

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage^{[citation needed]} and infection^{[citation needed]} 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.^{[citation needed]} Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should be administered by persons who have been educated to apply them safely. One Australian report said in 2006, "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."^[35]

Allergy

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.^{[citation needed]} Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs.^{[citation needed]} 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.

Toxins and contaminants

Potentially toxic and carcinogenic compounds such as arsenic trioxide (三氧化二砷) and cinnabar (called zhūshā, 朱砂) are sometimes prescribed as part of a medicinal mixture, in a sense "using poison to cure poison". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. As with the 2008 Chinese milk scandal, tampering with food and medicine to boost profit is rampant despite knowledge of the dangers and strict regulations in place that are circumvented often due to corruption and profit motive. However, knowledge of processing is being improved with more empirical studies of Chinese herbals and tighter regulations are being put in place, whether heeded to or not, regarding the growing, processing, and prescription of various herbals.

A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off shelves in UK in July 2004 when it found to contain 11-13% mercury.^[36]

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 highly modern phenomenon and well removed from 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.

Lack of standardization

Chinese herbals are often not standardized from one pill to the next, or from one brand to the next, and can be reformulated, remixed, or otherwise altered by any company. To avoid such issues, standardized Japanese Kampo medicine for sale worldwide is a safer alternative based on classical Chinese traditional medicine and strict enforced regulations and is regulated as pharmaceuticals coupled with extensive after-market testing and monitoring.

Vague naming

Many Chinese medicines have different names for the same ingredient depending on location and time, ingredients with different medical properties have shared similar names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized as sodium nitrite (牙硝)^[37], resulting in a poisoned victim^[38][39]. In some Chinese medical texts, both names are interchangeable^[40]. The Chinese Medicine Registration Board of the Australian state of Victoria issued a report in 2004 which noted this was a problem that needed to be addressed.^[41]

Relationship with Western medicine

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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, whereas this is routine in China.

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 exercise 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. A report by the Victorian state government in Australia on TCM education in China noted:

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.^[42]

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.^[43] 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.^[41]

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 affected 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. A more popular and reliable explanation is the financial benefits doctors receive from pharmaceutical companies for prescribing medication that may not be necessary.^[44]

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

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

Dried seahorses like these are extensively used in traditional medicine in China and elsewhere

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 practice of using endangered species is controversial within TCM. Many substances fall into this category, with modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text dealing with substances derived from endangered species in an appendix, with an emphasis on recommending alternatives.^[45] Some claimed uses of certain animal derived ingredients, such as use of the tiger's penis for impotence, cannot be considered true, because the substances in question do not appear in the ingredients lists of the pharmacopoeia^{[citation needed]}. Use of rhinoceros horn (xī jiǎo / 犀角) for "cooling the blood" was replaced with buffalo horn (shuǐ niú jiǎo / 水牛角) starting from perhaps 5CE, and cow (bovine) bile (niú dǎn / 牛膽 / 牛胆) is a modern replacement for bear (ursine) bile (xíong dǎn / 熊膽 / 熊胆). An ingredient like "horny goat weed" (yín yáng hoù / 淫羊藿) is obviously a plant (Epimedium).

Medicinal use is having a major impact on the populations of seahorses, which are considered a fundamental ingredient, and used to treat a variety of disorders, including asthma, arteriosclerosis, incontinence, impotence, thyroid disorders, skin ailments, broken bones, heart disease, as well as to facilitate childbirth and even as an aphrodisiac.^[46]

Shark fin soup is traditionally regarded as beneficial for health in East Asia, and its status as an "elite" dish has led to huge demand with the increase of affluence in China, but it is surely having a devastating effect on shark populations^[47].

The animal rights movement notes that a few traditional Chinese medicinal solutions still use bear bile (xíong dǎn). Since 1988, the Chinese Ministry of Health started controlling production of this, which previously used bears killed before winter. The bears are often fitted with a sort of permanent catheter, which was more profitable than killing the bears^[48]. The treatment itself and especially the extraction of the bile is very painful for bears, and causes damage to their stomach and intestines, often resulting in their eventual death. 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 (cow bile / niú dǎn) are recommended as a substitute for this ingredient.

Opposition

Starting from the late 19th century, some politicians and Chinese scholars with background in Western medicine have been trying to phase out TCM totally in China.^{[citation needed]}

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 the 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.^{[citations needed]} However, there are many differences such as standardization and strong enforced regulations in Kampo that are absent in TCM. The most scientific derivative of TCM practiced in Japan is ryodoraku (良導絡), which was developed by Yosio Nakatani in 1950. It utilizes objective electricity test instruments and direct current stimulation of acuーpoints instead of subjective interpretation of symptoms and treatment. 　Ryodoraku research is centered at Osaka Medical College, Japan.

The use of parts of endangered species (such as seahorses, rhinoceros horns, and tiger bones and claws) has created controversy and resulted in a black market of poachers who hunt restricted animals. ^[49][50] Deep-seated cultural beliefs in the potency of tiger parts are so prevalent across Asia that laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets, according to a 2008 report from TRAFFIC Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility,^[51] and tiger eyes. In Black Market, photographer Patrick Brown took a deep look at the illegal wildlife trade in Asia.

Modernization

Traditional Chinese medicine has been to some degree modernized by transforming the plants and ingredients to soluble granules and tablets. Modern formulations in pills and sachets used 675 plant and fungi ingredients and about 25 from non-plant sources such as snakes, geckos, toads, frogs, bees, and earthworms.

Investigation of the active ingredients in TCM has produced western style drugs, for example Artemisinin now widely used in the treatment of malaria.

See also

• Alternative medicine
• Chinese classic herbal formula
• Chinese patent medicine
• List of branches of alternative medicine
• List of topics characterized as pseudoscience
• Medicinal mushrooms
• Pharmacognosy
• Public health in the People's Republic of China
• TCM Materia Medica (Plant)
• Traditional Korean medicine
• Traditional Mongolian medicine

Footnotes

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (February 2007)

1. ^ See Huang neijing Suwen, chapter 3.
2. ^ Charles Benn, China's Golden Age: Everyday Life in the Tang Dynasty. Oxford University Press, 2002, ISBN 0-19-517665-0), pp. 235.
3. ^ Wu Jing-nuan. (2005). An Illustrated Chinese Materia Medica, p. 5.
4. ^ Needham, Joseph. (1959). Mathematics and the Sciences of the Heavens and the Earth (Science and Civilization in China, Vol. III), pp. 645, 648-649.
5. ^ Joseph Needham, Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 1, Botany. (Taipei: Caves Books Ltd., 1986), pp. 174–175.
6. ^ Schafer, Edward H. "Orpiment and Realgar in Chinese Technology and Tradition," Journal of the American Oriental Society (Volume 75, Number 2, 1955): 73–89.
7. ^ West, Stephen H. "Cilia, Scale and Bristle: The Consumption of Fish and Shellfish in The Eastern Capital of The Northern Song," Harvard Journal of Asiatic Studies (Volume 47, Number 2, 1987): 595–634.
8. ^ "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 - Maciocia, Giovanni (1989). The Foundations of Chinese Medicine. Churchill Livingstone. pp. p.16. ISBN 0-443-03980-1. 
9. ^ Needham, Joseph et al. (2002) Celestial Lancets, pp.69-170, 262-302.
10. ^ Needham, Celestial Lancets, p. 296.
11. ^ An excerpt of this book is translated in http://www.pacificcollege.edu/alumni/newsletters/winter2004/damp_warmth.html.
12. ^ Unschuld, Paul Ulrich (1985). Medicine in China: A History of Ideas. University of California Press. ISBN 0520062167. 
13. ^ Porkert, Manfred (1974). The Theoretical Foundations of Chinese Medicine: Systems of Correspondence. MIT Press. ISBN 0262160587. 
14. ^ Halpern, Georges, MD, PhD. Medicinal Mushrooms Ancient Remedies for Modern Ailments. 
15. ^ , 2009, http://www.cityofhope.org/about/publications/eHope/2008-vol-7-num-7-july-29/Pages/a-salad-fixin-with-medical-benefits.aspx 
16. ^ Borchers AT, Krishnamurthy A, Keen CL, Meyers FJ, Gershwin ME (2008). "The immunobiology of mushrooms". Exp Biol Med 233 (3): 259–76. doi:10.3181/0708-MR-227. PMID 18296732. 
17. ^ Maciocia, Giovanni (1989). The Foundations of Chinese Medicine. Churchill Livingstone. 
18. ^ Kaptchuk, Ted (2000). Chinese Medicine: The Web That Has No Weaver (2nd ed.). Random House. 
19. ^ Ernst E, Pittler MH, Wider B, Boddy K (2007). "Acupuncture: its evidence-base is changing". Am. J. Chin. Med. 35 (1): 21–5. doi:10.1142/S0192415X07004588. PMID 17265547. 
20. ^ Lee A, Done ML (2004). "Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting". Cochrane database of systematic reviews (Online) (3): CD003281. doi:10.1002/14651858.CD003281.pub2. PMID 15266478. http://www.cochrane.org/reviews/en/ab003281.html. 
21. ^ Dibble SL, Luce J, Cooper BA, Israel J, Cohen M, Nussey B, Rugo H (2007). "Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial". Oncol Nurs Forum 34 (4): 813–20. doi:10.1188/07.ONF.xxx-xxx. PMID 17723973. 
22. ^ Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM (2008). "Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis". BMJ 336 (7643): 545–9. doi:10.1136/bmj.39471.430451.BE. PMID 18258932. 
23. ^ Furlan AD, van Tulder MW, Cherkin DC, et al. (2005). "Acupuncture and dry-needling for low back pain". Cochrane database of systematic reviews (Online) (1): CD001351. doi:10.1002/14651858.CD001351.pub2. PMID 15674876. http://www.cochrane.org/reviews/en/ab001351.html. 
24. ^ Manheimer E, White A, Berman B, Forys K, Ernst E (2005). "Meta-analysis: acupuncture for low back pain" (PDF). Ann. Intern. Med. 142 (8): 651–63. PMID 15838072. http://www.annals.org/cgi/reprint/142/8/651.pdf. 
25. ^ Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T (2007). "Acupuncture for neck disorders". Spine 32 (2): 236–43. doi:10.1097/01.brs.0000252100.61002.d4. PMID 17224820. 
26. ^ Trinh KV, Graham N, Gross AR et al. (2006). "Acupuncture for neck disorders". Cochrane Database of Systematic Reviews (3). doi:10.1002/14651858.CD004870.pub3. http://www.cochrane.org/reviews/en/ab004870.html. 
27. ^ The Cochrane Collaboration - Acupuncture for idiopathic headache. Melchart D, Linde K, Berman B, White A, Vickers A, Allais G, Brinkhaus B
28. ^ Cochrane Collaboration. [Search all Cochrane reviews for "acupuncture", retrieved 30 January 2008.
29. ^ Acupuncture and related interventions for smoking cessation
30. ^ Acupuncture for shoulder pain
31. ^ Lewith GT, White PJ, Pariente J (September 2005). "Investigating acupuncture using brain imaging techniques: the current state of play". Evidence-based complementary and alternative medicine: eCAM 2 (3): 315–9. doi:10.1093/ecam/neh110. PMID 16136210. http://ecam.oxfordjournals.org/cgi/content/full/2/3/315. Retrieved on 2007-03-06. 
32. ^ http://www.aaom.org/default.asp?pagenumber=47494
33. ^ AMA (CSAPH) Report 12 of the Council on Scientific Affairs (A-97) Full Text
34. ^ American Cancer Society. Chinese Herbal Medicine. http://www.cancer.org/docroot/ETO/content/ETO_5_3x_Chinese_Herbal_Medicine.asp
35. ^ Towards a Safer Choice - The Practice of Traditional Chinese medicine In Australia - Summary of Findings
36. ^ MHRA finds contaminated Chinese, Ayurvedic medicines
37. ^ 香港容易混淆中藥
38. ^ ¡u¨~µv¡v»P¡u¤úµv¡v¤Å²V²c¨Ï¥Î
39. ^ Chinese medicine Natrii Sulfas not to be confused with chemical Sodium Nitrite
40. ^ âÏõͼÆ×-¿óÎïÀà(¿óÎïÀà)
41. ^ ^{a b} http://www.cmrb.vic.gov.au/current-news/draft/CMRBDisPaperInternet.pdf
42. ^ Towards a Safer Choice - The Practice of Traditional Chinese medicine In Australia - Education in Traditional Chinese Medicine 8.1 - 8.3.3
43. ^ Towards a Safer Choice - The Practice of Traditional Chinese medicine In Australia - Risks Associated with the Practice of TCM - 4.1 - 4.6
44. ^ http://news.sina.com.cn/china/2000-07-18/108885.html
45. ^ Bensky, Clavey and Stoger (2004). Chinese Herbal Medicine Material Medica (3rd Edition). Eastland Press. 
46. ^ NOVA Online | Kingdom of the Seahorse | Amanda Vincent
47. ^ Shark Fin Soup: An Eco-Catastrophe?
48. ^ "治人病还是救熊命——对养熊“引流熊胆”的思考"南风窗. November 12, 2002
49. ^ Will traditional Chinese medicine mean the end of the wild tiger?
50. ^ Rhino rescue plan decimates Asian antelopes
51. ^ BBC NEWS | Beijing's penis emporium

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 0822328577
• 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. January 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 Complementary and Alternative Medicine. 9:6 (2003) pp851–859

Further reading

• Wellcome Historical Medical Museum and Library, Chinese Medicine (1966)
• Sivin, Nathan, ed. (2000). Medicine. (Science and civilisation in China, Vol. VI, Biology and Biological Technology, Part 6). Cambridge: Cambridge University Press. 10-ISBN 0-521-63262-5; 13-ISBN 978-0-521-63262-1; OCLC 163502797

External links

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Wikiquote has a collection of quotations related to: Traditional Chinese medicine

• Overview of TCM from the University of Minnesota's Center for Spirituality & Healing
• Traditional Chinese Medicine Material Mind Meridian QI,Informative Blog from an old TCM sinseh. Comparing modern medicine and traditional holistic medicine.
• Traditional Chinese Medicine World Foundation, not-for-profit organization dedicated to educating individuals and health-care practitioners about classical traditional Chinese medicine and natural healing.
• American Journal of Chinese Medicine, academic journal for TCM.
• Classics of Traditional Chinese Medicine, by the National Library of Medicine (NLM)
• Chinese Medical Institute and Register
• Traditional Chinese Medicine repository
• Acupuncture. NIH Consensus Statement November 3-5, 1997; 15(5):1-34.
• 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
• Traditional Chinese Medicine news, information, education, research and discussion - A regularly updated TCM website based in Australia
• Monthly newsletters on Chinese Medicine and Health (AUS)
• National Certification Commission for Acupuncture and Oriental Medicine (USA)
• American Association for Acupuncture and Oriental Medicine
• California State Oriental Medical Association (CSOMA)
• The Journal of Chinese Medicine: academic level journal for TCM
• Advanced Online Encyclopedia for Chinese Medicine and Acupuncture
• Chinese Medicine Notes- A Chinese Medicine Blog
• TCM Directory- Acupuncture and Chinese Medicine Resources
• The Theory of the Traditional Chinese Medical Science

Online databases

Wikimedia Commons has media related to: Chinese medicine

• [1] ("Traditional Chinese Medicine - Free Information Site in English, Chinese and German – 神农氏")
• Kamwo Herb Guide ("Traditional Functions of Chinese Herbs and Formulas - Free Online Database")
• 電子中醫藥古籍文獻("Electronic old Chinese Medicine books and texts") Classical texts for FTP

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