Traditional chinese medicine

Traditional Chinese medicine (TCM) also known simply as Chinese medicine (Chinese: 中醫學, zhōngyī xué, or 中药学, zhōngyaò xué) is the name commonly given to a range of traditional medical practices used in China that have developed over the course of several thousand years of history. It is also regarded as an instance of oriental medicine, a term which may include other traditional Asian medical systems such as Japanese, Korean, Tibetan, and Mongolian medicine. Chinese medicine principally employs a method of analysis and synthesis, inquiring on a macro-level into the internal systems of the human body and their mutual relationships with the internal and external environment in an attempt to gain an understanding of the fundamental laws which govern the functioning of the human organism, and to apply this understanding to the treatment and prevention of disease, and health maintenance. TCM is rooted in a unique, comprehensive and systematic theoretical structure which includes the Theory of the Five Elements, the human body Meridian system, Yin-yang and other systems. Treatment is conducted with reference to this philosophical framework.

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

TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine or traditional medicine) rooted in ancient belief systems, including traditional religious concepts. Chinese medical practitioners before the 19th century relied 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 observational medical theory describing the nature of infections and remedies actions. Traditions, and observations based on their theory, along with three millennia of practical experience guided their courses of treatment and instruction in diagnostic principles.

Unlike other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. There are thousands of years of empirical knowledge about TCM conceptualized and recorded in terms appropriate to that system, and in recent decades there has been an effort to integrate the discoveries made by traditional Chinese medicine with the discoveries made by workers in the Western medical traditions. One important component of this work is to use the instrumentation and the methodological tools available via Western medicine to investigate observations made and hypotheses raised by the Chinese tradition.

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

TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions that conventional medicine is claimed to be sometimes ineffective in treating. TCM has also been used to treat antibiotic-resistant infection

A report issued by the Victorian state government in Australia states that:
 * 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. []

TCM theory
There are many schools of thought on which TCM is based. Because of this, the foundation principles of Chinese medicine are not necessarily uniform. Received TCM can be shown to be most influenced by Taoism, Buddhism, and Neo-Confucianism.

For over 3000 years (1200 BC - present), Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:


 * There are observable principles of constant phenomenal change by which the Universe is maintained.
 * Man is part of the universe and cannot be separated from the universal process of change.
 * As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself.
 * Optimum health should result from living as harmoniously as possible with the spontaneous process of change tending towards balance. If there is no change (stagnation), or too much change (catastrophism), balance is increasingly lost and illnesses can occur.
 * Everything is ultimately interconnected.
 * Always use a systemic approach when addressing imbalances.

TCM is therefore largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems. Those systems usually work in balance to maintain the healthy function of the human body. The balance is described as necessarily including qi, blood, jing, bodily fluids, the wu xing, emotions, and spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. TCM isn't monolithic, however, and there are from minor to significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice and theory.

TCM diagnostics
The basics of TCM diagnostics are: observe (望 wàng), hear and smell (聞 wén), ask about background (問 wèn) and read the pulse (切 qiè). Then a diagnosis is made using a system to classify the symptoms.

Systems of diagnosis include:


 * Yin or Yang
 * Five elements
 * eight principles
 * Zang Fu theory
 * Meridian (Chinese medicine)
 * Six levels
 * four stages
 * Three jiaos

And a modern cross that is not formal but in China TCM diagnosis is being very heavily influenced by and integrated with western diagnostic thought moving towards total integration of the two systems. Modern practitioners often use the systems in combination to understand what is happening with the patient.

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
The traditional treatment in Chinese medicine consists of six major methods:
 * 1) Tui na(推拿)
 * 2) Acupuncture(針疚)
 * 3) Moxibustion(艾炙)
 * 4) Cupping(拔罐)
 * 5) Herbology(中药)
 * 6) Physical culture related to breathing and circulation exercises like qigong (氣功) or T'ai Chi Ch'uan (太極拳) and other Chinese martial arts. Die-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. These practices are also seen as health maintenance regimes as well as interventions.

Traditional Chinese medicine uses herbs and other drugs as the last resort to fight health problems. This conforms to its basic belief: a human body has a sophisticated system to find illness, allocate resources and energy and heal 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 a Chinese saying which reflects the same idea: "Any medicine has 30% poison ingredients."

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

Other specialties include:
 * Nutrition or food therapy
 * Gua Sha or coin-rubbing (刮痧)
 * Auriculotherapy(耳燭療法)

TCM and science
There are some questions about TCM which can be investigated scientifically:


 * Does it work?
 * How does it work?
 * Is it safe?

The question of efficacy
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. A less controversial example is artemisinin, derived from a herb long-used used in TCM, and now used worldwide to treat multi-drug resistant strains of falciparum malaria. 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 and owned exclusively, there is a distinct disincentive to sponsor such expensive protocols. Some important western medical drugs have come from Chinese herbs like Ephedrine.

There are also great a priori doubts about the efficacy 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.

Purported mechanism of action
The basic mechanism of TCM is akin to treating the body as a black box, recording and classifying changes and observations of the patient using a traditional philosophy. In contrast to many alternative and complementary medicines such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, the causative mechanisms of healing often traditionally claimed to be at work in TCM techniques such as "manipulation of qi" as in the case of qigong and accupuncture, are often not recognized as scientifically valid or even possible.

Safety of Chinese medicines
Accupressure and accupuncture are largely accepted to be safe from results gain through medical studies. However, there is always the possiblity of nerve damage or infection in the latter treatment if the practitioner are not experienced or do not follow sanitation guidelines.

Chinese herbal medicines, in certain cases are more risky due to the risk of poisoning. Cases of acute and chronic poisoning of due to treatment through injested Chinese medicines are relatively common in China, Hong kong, and Taiwan, with numerous deaths occurring each year. In the west, herbs such as ephedra (má huáng） have been known to alter the heart rates and blood pressure of individuals as to cause death. Although some of these cases can be attributed to practitioners who participate in quackery or people who self-medicate, many of the poisonings are caused by certified herbalists and doctors of Chinese medicine.

Furthermore, potentially toxic and carcinogenic compounds such as arsenic and cinnabar are sometimes prescribed as part of a medicinal mixture or used on the basis of "using poison to cure poison". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. Much of these can prevented with more empirical studies of Chinese herbals and tighter regulation regarding the growing, processing, and prescription of various herbals.

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 "TCM practitioners" who have done people more harm than good in many instances.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner or visit a martial arts school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.

This is not to say that TCM techniques are considered worthless in the West. In fact, Western pharmaceutical companies have recognized the value of traditional medicines and are employing teams of scientists in many parts of the world to gather knowledge from traditional healers and medical practitioners. After all, the active ingredients of most modern medicines were discovered in plants or animals. The particular contribution of Western medicine is that it strictly applies the scientific method to promising traditional treatments, separating those that work from those that do not. As another example, most Western hospitals and increasing numbers of other clinics now offer T'ai Chi Ch'uan or qigong classes as part of their inpatient and community health programs.

Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. To put it simply, you see a Western doctor if you have acute appendicitis, but you do exercises or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.

A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula.

It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.

In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for 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
As animal products are used in Chinese formulas, vegans and vegetarians should inform their practitioner, if their beliefs forbid the ingestion of animals. Often alternative substances can be used.

The use of endangered species is controversial within TCM. In particular, the belief that tiger penis and rhinoceros horn are aphrodisiacs has been blamed for depleting these species in the wild.

The animal rights movement notes that a few traditional Chinese medicinal solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often even kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China.