Traditional Chinese medicine

'''Traditional Chinese medicine''' (TCM) also known simply as Chinese medicine (Chinese: 中醫學 or 中药学, zhōngyào xŭe) or traditional Oriental medicine, is the name commonly given to a range of traditional medical practices originating in China thousands of years ago. Primary medical theoretical foundation of TCM includes that of Five Elements, human body Meridian system and Yin-yang. Treatments are done with reference to this philosophical framework.

Uses

In the West, TCM is often considered alternative medicine, while in both Mainland China and on Taiwan, TCM is widely considered to be an integral part of the health care system. (The term TCM is sometimes used specifically within the field of Chinese Medicine to refer to the standardized set of theories and practices introduced in the mid-20th century under the government of Mao, as distinguished from other theories and practices such as Worsley's Five Element Acupuncture or the kyo/jitsu theory of Shizuto Masunaga's Zen shiatsu. However we use the more general sense here.) TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine) or traditional medicine, rooted in ancient religious belief systems. Chinese medical practitioners before the 19th century relied essentially on observation, trial and error. Like their counterparts in the West, they had a very different understanding of infection which predated the discovery of bacteria, viruses (germ theory of disease) or cellular structures and little knowledge of organic chemistry, relying mainly on distinctly personal medical theory describing the nature of infections and remedies. Tradition guided their courses of treatment and instruction of diagnostic principles. Unlike these other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. There are thousands of years of empirical knowledge about TCM on its own terms, and in recent decades there has been an effort to place traditional Chinese medicine on a firmer Western scientific empirical and methodological basis as well as efforts to integrate Chinese and Western medical traditions. That this effort has occurred is surprising to many for a number of reasons. In most of the world, indigenous medical practices have been supplanted by practices brought from the West, while in Chinese societies, this has not occurred and shows no sign of occurring. Furthermore, many have found it peculiar that Chinese medicine remains a distinct branch of medicine separate from Western medicine, while the same has not happened with other intellectual fields. There is, for example, no longer a distinct branch of Chinese physics or Chinese biology. In the West, TCM is usually regarded as a form of alternative medicine (CAM). TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions that conventional medicine is claimed to be sometimes ineffective in treating. TCM has also been used to treat antibiotic-resistant infections. In China, practitioners of Chinese medicine tend to perform functions which in the West would be performed by allied health professionals such as nutritionists, pharmacists, nurses, chiropractors physical therapists and other rehabilition specialists. Chinese medicine hospitals also perform some emergency medicine such as prevention and treatment of shock and seizure. The general distinction made by Chinese in China is that Western medicine involves cutting while Chinese medicine involves manipulation. Hence medical procedures such as bone setting or chiropractic spinal manipulation tends to be seen as Chinese, while surgery tends to be seen as Western.

TCM theory

Foundation Principles

There are many schools of thought on which TCM is based. Because of this, the foundation principles of Oriental Medicine are not necessarily uniform but their continual evolution began approximately between 2000 B.C. and 4000 B.C. The roots of TCM are considered by most to be Buddhism, Taoism, and Confucianism, however, mostly it is based on Taoism which is both a philosophy and a religion. For over 2500 years (5000 B.C. - 500 B.C.), the Taoists mainly focused on the observable and natural laws of the universe and the implications for human beings' relationship to the universe. Afterwards, they came up with five fundamental principles and their applications to health and healing:

There are natural laws that govern the Universe.
*Man is part of the universe and is therefore subject to and exist according to those laws.
The natural order of the Universe is harmonious and organized.
*Harmony results in living according to those laws.
The Universe is dynamic; Change is constant.
*Change is inevitable. If there is no change, illnesses occur.
All Life is interconnected.
*Always use a systems approach.
Humans are part of the Universe, not outside of it. We are intimately connected to the environment and thus, the Universe.
*Man's health is affected by his environment.

Impact on TCM

TCM is based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated closely-related sub-systems. Those systems usually work balancely and harmoniously to maintain the normal function of the human body. There are also systems (much like the immune system in modern concept) in human body to heal illness automatically. In case of any imbalance between those sub systems in human body, the healing system may lose power and the illness occurs. On the other hand, if balance is restored, the person heals. TCM seeks to balance yin and yang, Qi, Blood, Jing, Body fluids, the Five Elements, the emotions, and the spirit (Shen). There are different schools of thought within TCM theory, including Five Element theory and Zang Fu theory. TCM has a unique model of the body, ( human body Meridian ) which is different from the models in other traditions. Obviously, TCM theory pay more attention to assisting the balance of human body and let its healing system to heal illness while western medicine is more good at fighting the cause of illness directly. That is why pople in mainland China seek treatment from western medicine for acute illness and prefer to TCM for long-term problem. Sometimes, there is not enough time for the body to fight those acute illness and we need direct actions.

TCM diagnostics

Because traditional Chinese medicine predates the more invasive medical testing used in conventional Western medicine, TCM requires skill in a range of diagnostic systems not commonly used outside of TCM. Much of this diagnostic skill involves developing the abilities to observe subtle appearances; to observe that which is right in front of us, but escapes the observation of most people.

Diagnostic techniques

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

TCM treatment techniques

TCM utilizes numerous techniques or healing modalities to achieve the desired balance of Yin and Yang as well as Qi, Blood, Jing (Body Fluids), and Shen (Mind/Spirit). It also aims to maintain the normal function of the Meridian system in the human body. The traditional treatment in Chinese medicine consists of four major methods: #Gua Sha or coin-rubbing or other physical treatments #Acupuncture #Moxibustion #Herbology It may surprise modern people that the Traditional Chinese Medicine uses medicine as the last resort to fight health problems. However, this kind of practice conforms to its basic belief: a human body has a sophistcated system to find illness, allocate resources and energy and finally fix the problems by itself. The goal of external efforts should carefully focus on assisting the normal self-healing function of human body, not interfering with it. There is also a very famous Chinese saying which reflects the same idea: "Any medicine has 30% poison ingredients." However, with modern practice of the Traditional Chinese Medicine relies more and more on medicine and eventually abandons the physical treatments (like Gua Sha) largely. Some people believe it is because medicine can bring more profits to doctors than simpler physical treatments. Supplemental treatments include:

Nutrition or food therapy
Qigong exercises and Medical qigong
Plum blossom or seven-star
Acupressure, and various styles of massage such as tui na
Sonopuncture or phonophorese--the use of sound vibration on acupoints
Auriculotherapy
T'ai Chi Ch'uan and other Chinese martial arts. Die-da, Dit Da or Tieh Ta (跌打): practitioners who specialize in healing trauma injury such as bone fractures, sprains, bruises etc. 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.

TCM and science

There are two questions about TCM which can be investigated scientifically:

Does it work?
How does it work?

Does it work?

Most scientific research in the West about TCM has focused on acupuncture. The National Institutes of Health Consensus Statement on Acupuncture summarizes research on the efficacy of acupuncture as follows:

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

Much less work in the West has been done on Chinese herbal medicines, which comprises much of TCM in China. It is clear, however, that many if not most of these medicines do have powerful biochemical effects. An example is the herb ephedra which was introduced into the West as a stimulant, and later banned in the United States after deaths were attributed to its use. In the West, many Chinese medicines have been marketed as herbal supplements and there has been considerable controversy over the regulatory status of these substances. TCM practitioners have no philosophical objections to scientific studies on the effectiveness of treatments. The main barrier to the adoption of Chinese herbal medicines into Western practice is economic. It requires a large amount of expertise and money to conduct, for example, a double-blind drug trial, making it a large venture to test even one of the thousands of compounds used by TCM. Because these compounds cannot be patented, there is a distinct lack of a self-interested party to sponsor such expensive protocols. There are also great a priori doubts about the effifacy of many TCM treatments that appear to have their basis in magical thinking, e.g. plants with heart-shaped leaves will help the heart, ground bones of tiger give a person energy because tigers are energetic animals and so on. To researchers, this is a very small base to start serious research on.

How does it work?

The basic mechanism of TCM is akin to treating the body as a black box, recording and classifying changes and observations of the patient using a traditional philosophy. In contrast to many alternative and complementary medicines such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, these are great oversimplifications of TCM and how or why it works. The metaphors used in TCM theory often concern areas not readily measured or described by Western science.

The relationship between TCM and Western medicine

Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine. The relationship between TCM and Western medicine in the West is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well meaning but improperly trained New Age "TCM practitioners" who have done people more harm than good in many instances. As an example of the different roles of TCM in China and the West, a person with a broken bone in the West would never see a Chinese medicine practitioner or visit a martial art school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one. This is not to say that Western medicine considers all practical outcomes of TCM techniques to be worthless. Many Western hospitals and clinics now offer Tai Chi Chuan or qigong classes as part of their community health programs. As well, TCM techniques have developed a range of medicines and techniques which have been demonstrated to cure some illnesses. The same, however, can be said of traditional European medicine, and of the medical practices of India, the Islamic world, pre-Columbian America and the Australian Aboriginal people. In all these cases, therapies have been discovered empirically rather than through the scientific method. Western pharmaceutical companies have recognised the value of emperically discovered medicine and are employing teams of scientists in many parts of the world to gather knowledge from traditional healers. After all, the active ingredients of most modern medicin have been discovered in plants or animals. The scientific method is then applied to the most promising traditional treatments, to separate those that work from those that don't. Ideally, this should lead to absorption of all traditional and folk medicine (including TCM) that actually works into Western medicine, leaving only medicine that works and medicine that doesn't.

Western medicine and traditional Chinese medicine

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 and wellness. To put it simply, you see a Western doctor if you have acute appendicitis, but you take Chinese medicines to make your body healthy enough to prevent appendicitis, or to recover 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 mutlidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula. It is worth noting that the practice of Western medicine in China is somewhat different than that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy. In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for overprescribing 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.

TCM and Animals

SARS

"While primarily a health concern, the suspicion that the SARS virus may have jumped to humans from exotic wild animal food products led to proposals from within the Chinese government during the 2003 outbreak to prohibit the consumption of wild animals. In response to SARS in 2003, Chinese officials confiscated more than 800,000 animals from markets and arrested over 4,000 people for selling protected species. ...the [Peoples Republic of China] began shutting wildlife markets in the province and exterminating thousands of masked palm civets and other animals on sale—a move that World Health Organization officials said may be in haste but, if not undertaken with extreme care, could cause further health risks and eliminate evidence of the origins of the disease." http://www.cepf.net/xp/cepf/news/newsletter/2004/january_topstory.xml

Ethics and Animal Rights

As animal products are used in Chinese formulas, vegans and vegetarians should inform their practioner, if their beliefs forbid the ingestion of animals. Often alternate substances can be used. The animal rights movement notes that a few traditional Chinese medicinary solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often even kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practioners outside of China.

References

Kaptchuck, Ted J., The Web That Has No Weaver; Congdon & Weed; Order: ISBN 0809229331Z
Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; Order: ISBN 0443-039801
Ni, Mao-Shing, The Yellow Emperor's Classic of Medicine : A New Translation of the Neijing Suwen with Commentary; Shambala, 1995; Order: ISBN 1570620806
Holland, Alex Voices of Qi: An Introductory Guide to Traditional Chinese Medicine; North Atlantic Books, 2000; Order: ISBN 1556433263
Unschuld, Paul U., Medicine in China: A History of Ideas; University of California Press, 1985; Order: ISBN 0520050231
The Chinese Medicine Sampler- Historical Roots of Traditional Chinese Medicine

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