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Alternative medical systems

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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, 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

[edit] History

[edit] Ancient (classical) TCM history

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.

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 hemp. 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 toxic 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.

[edit] Timeline

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]

[edit] Theory

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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]

[edit] Basic theory and 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.

[edit] 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).^[14] 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."^[15]

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]}

[edit] 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.

[edit] 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.
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).

[edit] 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]}

[edit] Scientific view

[edit] 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".^[16] Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.^[17][18] A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.^[19] There is conflicting evidence that it can treat chronic low back pain,^[20][21] and moderate evidence of efficacy for neck pain^[22][23] and headache.^[24] For most other conditions^[25] reviewers have found either a lack of efficacy (e.g., help in quitting smoking^[26]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain^[27]). 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.^[28]

The World Health Organisation (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture^[29][30]. 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 (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.^[31]

[edit] Safety

[edit] 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."^[32]

[edit] 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.

[edit] 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.^[33]

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.

[edit] 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.

[edit] 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)^[34], resulting in a poisoned victim^[35][36]. In some Chinese medical texts, both names are interchangeable^[37]. 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.^[38]

[edit] Relationship with 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.^{[citation needed]}

Outside of China, the relationship between TCM and Western medicine is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are 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^{[citation needed]}which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations.

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.^[39]

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.^[40] 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.^[38]

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.^[41]

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

TCM doctors often criticize Western doctors for paying too much attention to laboratory tests and showing insufficient concern for the overall feelings of patients.^{[citation needed]}

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.

[edit] Animal products

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.^[42] 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.^[43]

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^[44].

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^[45]. 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.

[edit] 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 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. ^[46][47] 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,^[48] and tiger eyes. In Black Market, photographer Patrick Brown took a deep look at the illegal wildlife trade in Asia.

[edit] 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.

[edit] See also

• Chinese classic herbal formula
• Chinese patent medicine
• List of topics characterized as pseudoscience
• Pharmacognosy
• Public health in the People's Republic of China
• Herb usage
• Traditional Korean medicine
• Traditional Mongolian medicine

[edit] Footnotes

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

[edit] 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

[edit] 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

[edit] External links

This article's external links may not follow Wikipedia's content policies or guidelines. Please improve this article by removing excessive or inappropriate external links.

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

[edit] Online databases

• [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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