Traditional Chinese medicine

Traditional Chinese medicine (中医, pinyin: zhōng yī), also known as TCM, includes a range of traditional medicine practices originating in China. Although a common part of medical care throughout East Asia, it is considered an alternative medical system in much of the Western world.

TCM therapy largely consists of Chinese herbal medicine, acupuncture, dietary therapy, and tui na massage. The health promoting aspects of qigong and taijiquan are also closely associated with it. Main aspects of TCM's concept of the human body, health, and disease, are yin and yang, the Five

Elements (五形, pinyin: wǔx?ng), the z?ng-f? (脏腑) organs, q?, xuě (血, ‘’blood‘’), meridians and the li?

y?n (六淫, lit. ‘’six excesses‘’, usually translated with Six Exogenous Pathogenic Factors).

Modern TCM was systematized in the 1950s under the People's Republic of China and Mao Zedong. Prior to this, Chinese medicine was mainly practiced within family lineage systems. The term "Classical Chinese medicine" (CCM) usually refers these medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911).

Contents

1. History

2 .Theoretical superstructure

2.1 Model of the body

2.1.1 Qi

2.1.2 Xue (Blood)

2.1.2.1 Jinye

2.2 Concept of disease

3. Diagnostics

3.1 Techniques

4. Treatment methods

5. Branches

6. Scientific view

6.1 Efficacy

6.1.1 Acupuncture

6.1.2 Herbal

6.2 Safety

6.2.1 In practice

6.2.2 Allergy

6.2.3 Toxins and contaminants

6.2.4 Standardization

6.2.5 Naming

7. Relationship with Western medicine

7.1 Opposition

8 .Animal products

9. Form factor

10 .See also

11. Notes

12. References

13. Further reading

History

Taijitu

The practice of acupuncture probably dates back to the stone age, as suggested by findings of ancient stone needles [1]. Also, hieroglyphs and pictographs documenting acupunture and moxibustion have been found which are dating back to the Shang Dynasty (1600-1100 BC)[2].

When acupuncture (and herbal medicine) became integrated into an embracing medical theory system is difficult to judge. TCM theory is, however, inextricably intertwined with the principles of Yinyangism[3], which was represented for the first time by Zōu Yǎn (305 - 240 BC).

The earliest and most fundamental composition identified in TCM is the Huăngd? Ne?jīng (黄帝内经, Yellow Emperor's Inner Canon), probably dating back to 300 - 100 BC[citation needed]. According to legend, it was composed by the mythical Yellow Emperor (said to have lived 2698 - 2596 BC) as a result

of a dialogue with his minister Qibo (岐伯).

Mythical origin was also claimed regarding the Shénnóng Běn Cǎo Jīng (神农本草经, Shennong's Materia Medica), which traditionally was attributed to the legendary emperor Sh?nn?ng, said to have lived around 2800 BC. The original text has been lost, however, based on extant translations[4] and references in other texts, modern researchers assume a date of origin somewhere between 300 BC and 200 AD[citation needed].

Two other very early (although less famous) medical texts are the 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 the 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). Not considered to be as old as the Hu?ngd? Ne?jīng they nevertheless are attributed to the Warring States Period (5th century BC to 221 BC)[citation needed]. The Yinyang shiyi mai jiu jing actually was part of a cache of the Mawangdui Silk Texts rediscovered in 1973[citation needed].

TCM's second central classical composition, the Shāng H?n Z?b?ng L?n (伤寒杂病论, later divided into Shāng H?n L?n and Jīngu? Y?ol??), was written by Zhang Zhongjing (张仲景) during the Han Dynasty, approximately around 200 AD.

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

Subsequent centuries saw a large number of prominent doctors developing medical theories on the basis of the classical works, or contributing original material which would later be brought in tune with the TCM system:

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 Hu? Tu? (华佗/華佗, approx. 140-208 AD), who anesthetized patients during surgery with a formula of wine and powdered cannabis. Hua's physical, surgical, and herbal treatments were also used to cure diseases like headaches, dizziness, worms, fever, cough, etc.

Jin Dynasty (265 - 420)

Zhēnjiǔ jiǎyǐ jīng (针灸甲乙经/鍼灸甲乙經) (Systematic Classic of Acupuncture and Moxibustion) by

Hu?ngfǔ M? (皇甫谧/皇甫謐), ca. 265 AD.

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).

W?ng B?ng (王冰) 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[citation needed].

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.[5]

In his Bencao Tujing (Illustrated Materia Medica), the scholar-official Su Song (1020–1101) systematically categorized herbs and minerals according to their pharmaceutical uses.[6]

Song Dynasty (960 – 1279):

Tóngrén shūxué zhēnjiǔ t?jīng (铜人腧穴针灸图经/銅人腧穴鍼灸圖經) (Illustrated Manual for the Practice of Acupuncture and Moxibustion with the Help of a Bronze Figure bearing Acupuncture Points)

by W?ng W?iyī (王惟一).

Yuan Dynasty (1271–1368): Sh?s? jīng fāhuī (十四经发挥/十四經發揮) (Exposition of the Fourteen

Channels) by Hu? Sh?u (滑寿/滑壽).

Ming Dynasty (1368–1644, considered the golden age of acupuncture and moxibustion, spawning many famous doctors and books)

Zhēnjiǔ d?quan (针灸大全/鍼灸大全) (A Complete Collection of Acupuncture and Moxibustion) by Xu

Feng (徐凤/徐鳳).

Zhēnjiǔ j?yīng 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 d?ch?ng (针灸大成/鍼灸大成) (Compendium of Acupuncture and Moxibustion) by Y?ng J?zhōu

(杨继洲/楊繼洲), completed in 1601.

Běncǎo gāngm? (本草纲目/本草綱目) (Outlined Materia Medica) by Lǐ Sh?zhēn (李时珍/李時珍), the most complete and comprehensive pre-modern herbal book (completed in 1578)[citation needed].

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 Qian (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 Differentiation of Febrile Disorders) compiled by

Wu Jutong (吴鞠通) in 1798.[7]This article cites its sources but does not provide page references. You can help to improve it by introducing citations that are more precise.

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.

Theoretical superstructure

Model of the body

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TCM's view of the human body is only marginally morphologic, i.e., concerned with anatomy, but primarily focuses on the body functions (e.g., digesting food, breathing, keeping a certain temperature etc.).

As a first step of systematization, certain body functions are identified as being connected and ascribed to a common functional entity (e.g., nourishing the tissues and maintaining their moisture is seen as connected and the functional entity identified to be in charge is: xuě/blood). The terms used for those functional entities are usually very illustrative (blood, essence, liver, heart etc.), but don't claim to be anatomically correct.

Q? (气) is probably the single most prominent term in TCM, however, also one of the most difficult ones since TCM distinguishes several different kinds of qi. In a general sense, qi is defined by five cardinal functions[8][9]:

Actuation (推动, tuīd?ng) - of all physical processes in the body, especially the circulation of all body fluids in their vessels. This includes actuation of the functions of the z?ng-f? organs and meridians.

Warming (温煦, wēnx?) - the body, especially the limbs.

Defence (防御, f?ngy?) - against Exogenous Pathogenic Factors

Containment (固摄, g?sh?) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.

Transformation (气化, q?hu?) - of food, drink, and breath into qi, xuě, and jīnyė (‘’fluids‘’, see below), and/or transformation of all of the latter into each other.

Qi is partially generated from food and drink, and partially from air (by breathing). Another considerable part of it is inherited from the parents and will be consumed in the course of life[10]

In terms of location, TCM uses special terms for qi running inside of the blood vessels and for qi which is distributed in the skin, muscles, and tissues between those. The former is called y?ng-q? (营气), its function is to complement xuě and its nature has a strong yin aspect (although qi in general is considered to be yang). The latter is called we?-q? (卫气), its main function is defence and it has pronounced yang nature[11].

Qi also circulates in the meridians. Just as the qi held by each of the z?ng-f? organs, this is considered to

be part of the ‘’principal‘’ qi (元气, pinyin: yu?n q?) of the body (also called 真气 pinyin: zhēn q?, ‘’true‘’

qi, or 原气 pinyin: yu?n q?, ‘’original‘’ qi)[12].

Xue (Blood)

In contrast to most of the other functional entities, xuě (血, blood) has a pronounced tangible and morphological dimension in the sense that it basically is identified as the red liquid running in the blood vessels; however, there also is an intangible dimension to its concept as it extends into mental functions as well[13].

Xuě is defined by its functions of nourishing all parts and tissues of the body and safeguarding an adequate degree of moisture[14], and of sustaining and soothing both consciousness and sleep[15]. Contrariwise, clinical symptoms of a dysfunction (e.g., lack) of xuě are pale complexion, dry skin and hair, dry stools, numbness of hands and feet, forgetfulness, insomnia, excessive dreaming, anxiety etc.[16]

Jinye

Closely related to xuě are the jīnyė (津液, usually translated as ‘’body fluids‘’), and just like xuě they are considered to be yin in nature, and defined first and foremost by the functions of nurturing and moisturizing the different structures of the body[17]. Their other functions are to harmonize yin and yang, and to help with secretion of waste products[18].

Jīnyė are ultimately extracted from food and drink, and constitute the raw material for the production of xuě; conversely, xuě can also be transformed into jīnyė.[19]. Their palpable manifestations are all bodily fluids: tears, sputum, saliva, gastric juice, joint fluid, sweat, urine, etc.[20]

Concept of disease

TCM posits that illness is caused by external and/or internal factors which disrupt the body's natural processes.

Old Chinese medical chart on acupuncture meridians

Interactions of Wu Xing

Ancient Tibetan Medicine Poster

There are significant regional and philosophical differences between practitioners and schools which in turn have led to differences in practice and theory.

Diagnostics This article cites its sources but does not provide page references. You can help to improve it by introducing citations that are more precise.

Diagnosis in TCM consists of various forms of observation including visual, auditory, olfactory, touch, and questioning. These observations take the form of descriptions of color, moisture and heat, among many others to ultimately identify a pattern that can be subsequently treated.

Methods for diagnostic pattern recognition include the following:

The Yin/Yang and five element theories may be applied to a variety of systems other than the body, whereasZang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific. Separate models 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 theEight principles system of disease classification.

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 w?ng), hear and smell (闻/聞 w?n), ask about background (问/問 w?n)

and touching (切 qi?).[21] 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."[22]

Traditional Chinese medicine requires considerable diagnostic skill. A training period of years or decades is 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 combine a traditional system with Western methods.

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.

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The methods are part of Chinese medicine:

Acupuncture(针疗/針療) (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 points 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.

Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.

Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient's individual condition. The "five flavors" (an important aspect of Chinese herbalism as well) indicate the function of various types of food. 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.

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 medicinal herbs, 250 or so are commonly used.[citation needed] Rather than being prescribed individually, herbs are formulated to adapt to the specific needs of individual patients. A herbal formula can contain 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 such as reishi and shiitake, which are currently under intense study by ethnobotanists and medical researchers

for immune system enhancement. Unlike Western herbalism, Chinese herbal medicine uses many animal, mineral and mineraloid remedies, and also uses more products from marine sources.

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, creating 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 "reverse-pressure massage".

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.

Gua Sha (刮痧) is a form of mechanical dermabrasion using a hand-held scraper to irritate and inflame various regions of the JingLuo's dermal areas. It is frequently used to treat invasion by seasonal external pathogens.

Moxibustion(灸疗/灸療): "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.

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.

Qigong (气功/氣功) and related breathing and meditation exercise.

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.

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

The most prominent branches of Chinese medicine 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 the Ming and Qing Dynastys, 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 used political power to suppress the opposing school.[citation needed]

Scientific view

Efficacy

Acupuncture

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. A review by Edzard Ernst and colleagues in 2007 found that research is active and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".[23] Researchers using evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.[24][25]

A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.[26] There is conflicting evidence that it can treat chronic low back pain,[27][28] and moderate evidence of efficacy for neck pain[29][30] and headache.[31] For most other conditions[32] reviewers have found either a lack of efficacy (e.g., help in quitting smoking[33]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain[34]).

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.[35] The website Quackwatch mentions that TCM has been the subject of criticism as having unproven efficacy and an unsound scientific basis.[36]

The World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture.[37][38] 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 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.[39]

Herbal

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]. Other compounds, such as those seen in Dichroa febrifuga Lour and Bidens pilosa, including febrifugine, also have potential antimalarial properties currently being researched, but also exhibit high toxicity [40][41] Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.[42]

Safety

In practice

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies.[citation needed] Several cases of pneumothorax, nerve damage[citation needed] and infection[citation needed] have been reported as resulting from acupuncture treatments. However, 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 sometimes result from acupuncture.[citation needed]

Some governments have decided to certify practitioners. 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."[43]

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 occur when patients self–medicate 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. Empirical studies are improving processing of Chinese herbals, and supporting better regulations regarding the growing, processing, and prescription of various herbals.

A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off UK shelves in July 2004 when found to contain 11-13% mercury.[44]

In the United States, the Chinese herb m? hu?ng (麻黄; lit. "hemp yellow") — known commonly in the West by its Latin name Ephedra—was banned in 2004 by the Food and Drug Administration (FDA), although the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The ban was meant to combat the use of this herb in Western weight loss products, a phenomenon well removed from traditional Asian uses. There were no cases of Ephedra based fatalities with patients using traditional preparations for traditional uses. Following court battles, the Appeals Court upheld the FDA's ban in 2006, finding that the 133,000-page administrative record supported the finding of unreasonable risk to consumers.

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.[citation needed]

Naming

Herbalists have used different names for the same ingredient depending on location and time, while ingredients with different medical properties have shared similar names. For example, mirabilite/sodium

sulphate decahydrate (芒硝) was mislabeled as sodium nitrite (牙硝),[45] resulting in a poisoned victim.[46][47] In some Chinese medical texts, both names are interchangeable.[48] The Chinese Medicine Registration Board of the Australian state of Victoria in 2004 noted this problem.[49]

Relationship with Western medicine

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 condition) would almost never see a Chinese medicine practitioner, whereas this is routine in parts of rural China.

Most Chinese, in China as well as other countries, do not see traditional Chinese and modern Western medicine as conflicting. In emergency and crisis situations, there is generally no objection to Western medicine. At the same time, belief in Chinese medicine remains strong for maintaining health. As a simple example, they will see a Western doctor if they have acute appendicitis, but they exercise or take Chinese herbs to keep their bodies healthy enough to prevent appendicitis, or to recover more quickly from surgery. Very few doctors in China reject traditional Chinese medicine[citation needed], and most use some elements of Chinese medicine in their own practice.[citation needed]

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, chemotherapy, surgery, 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.[50]

In other countries traditional Chinese and Western medicine are rarely practiced by the same practitioner. TCM education in Australia, for example, does not attempt to qualify practitioners to diagnose in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures.[51] Australia is constructing a separate legislative framework to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.[49]

Traditional Chinese diagnostics and treatments are often much cheaper than Western methods which require expensive equipment or medicines still under patent.

Modern TCM practitioners refer severe cases to Western providers.[citation needed]

Investigation of the active ingredients in TCM has produced well-known drugs such as : Artemisinin, widely used in the treatment of malaria.

Opposition

Starting from the late 19th century, some politicians and Chinese scholars with backgrounds in Western medicine have been trying to phase out TCM totally in China.[citation needed] Critics argue that the efficacy of TCM has not been proven in a clinical setting. The attempts to curtail TCM in China provoke debates but have never succeeded.

Western medicine documents the efficacy of its pharmaceuticals through controlled, double blind experiments. Yet this is rarely applicable to TCM. It is impossible to create an effective placebo for acupuncture, for example. Chinese herbs are almost always given in combination with other herbs, but Western testing procedures are based on testing the validity of one herb at a time. Moreover, Chinese herbs are prescribed to treat the individual patient and the reason he/she developed a health problem; the problem itself does not have a standardized cure. To give a single herb to 100 patients for the same health problem, as is done in clinical testing, is not Chinese medicine: it is a Western program for incorporating Chinese herbs as Western pharmaceuticals.[52]

Modernizers partially phased out TCM in Japan after the Meiji Restoration. However, in the 1920s the Meridian Therapy movement (Keiraku Chiryo in Japanese) attempted to restore traditional medical practice, especially acupuncture. Many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine.[citation needed] However, Kampo practitioners adopted standardization and regulations that are absent in TCM. Yosio

Nakatani in 1950 derived ryodoraku (良導絡) from TCM. It utilizes electric test instruments and direct current stimulation of acupoints instead of subjective interpretation of symptoms and treatment. Ryodoraku research is centered at Osaka Medical College, Japan.[citation needed]

Animal products

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

Animal products are used in certain Chinese preparations, which may disturb vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances.

The practice of using endangered species is controversial within TCM. Modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text discuss substances derived from endangered species in an appendix, emphasizing alternatives.[53] Alternatives to rhinoceros horn (xī

jiǎo / 犀角) for "cooling the blood" include buffalo horn (shuǐ ni? jiǎo / 水牛角) starting from perhaps

5CE. "Horny goat weed" (y?n y?ng ho? / 淫羊藿) is a plant (Epimedium), although it has been mistransalated as an animal.[citation needed]

Poachers hunt restricted animals to supply the black market for such products.[54][55]

The use of tiger's penis to treat impotence does not appear in the ingredients lists of any pharmacopoeia.[citation needed] However, their use continues. Laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets.[56] Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility, and tiger eyes.[57][58]

The animal rights movement claims that traditional Chinese medicinal solutions still use bear bile (x?ong dǎn). In 1988, the Chinese Ministry of Health started controlling bile production, which previously used bears killed before winter. Now bears are fitted with a sort of permanent catheter, which was more

profitable than killing the bears.[59] The treatment itself and especially the extraction of the bile is very painful, and damages their stomach and intestines, often resulting in their eventual death. Increased international attention has mostly stopped the use of bile outside of China; gallbladders from butchered

cattle (ni? dǎn / 牛膽 / 牛胆) are recommended as a substitute for this ingredient.

Medicinal use is impacting seahorse populations. The fish is a fundamental ingredient in therapies for 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.[60]

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, devastating shark populations.[61]

Widespread medicinal use of turtle plastron is of concern to conservationists.[62]

Customs authority in many countries monitor medicinal products to ensure that no items made from CITES-proscribed species are imported. Biochemical techniques are being developed to identify from what species a particular processed product has been made.[62][63]

Form factor

Medications on the shelves of a Chinese pharmacy in Seattle

The TCM industry traditionally supplied medicines as powders to be measured and/or compounded by individual practitioners. More recently, soluble granules and tablets have become available with specific dosage levels. 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.

Notes

^ Chiu, M (1993). Chinese acupuncture and moxibustion. Elsevier Health Sciences. pp. 2. ISBN 0443042233

^ Robson, T (2004). An Introduction to Complementary Medicine. Allen & Unwin. pp. 90. ISBN 1741140544

^ see Huang neijing Suwen, chapter 3.

^ Du Halde J-B (1736): Description g?ographique, historique etc. de la Chine, Paris

^ Charles Benn, China's Golden Age: Everyday Life in the Tang Dynasty. Oxford University Press, 2002, ISBN 0-19-517665-0), pp. 235.

^ Wu Jing-nuan. (2005). An Illustrated Chinese Materia Medica, p. 5.

^ An excerpt of this book is translated in http://www.pacificcollege.edu/alumni/newsletters/winter2004/damp_warmth.html.

^ 郭卜乐 (24t October 2009). "气 [Qi]" (in Chinese). Retrieved 2 December 2010.

^ Steven K. H. Aung & William Pai-Dei Chen: Clinical introduction to medical acupuncture. Thieme Mecial Publishers, 2007, pp 11-12

^ "What is Qi? Qi in TCM Acupuncture Theory". 20 June 2006. Retrieved 3 December 2010.

^ Elizabeth Reninger. "Qi (Chi): Various Forms Used In Qigong & Chinese Medicine - How Are The Major Forms Of Qi Created Within The Body?". Retrieved 6 December 2010.

^ 郭卜乐 (24t October 2009). "气 [Qi]" (in Chinese). Retrieved 6 December 2010.

^ "Blood from a TCM Perspective". Shen-Nong Limitied. Retrieved 7 December 2010.

^ "The Concept of Blood (Xue) in TCM Acupuncture Theory". 24 June 2006. Retrieved 3 December 2010.

^ 李霜花 (7 May 2010). "中医基础：血液的作用。四、血的生理功能. [Basics of TCM: The effects of blood. IV. Blood functions]" (in Chinese). Retrieved 3 December 2010.

^ 南方(editor) (19 July 2010). "中医说生命的基础是血、津液 [According to TCM, blood and jīnyė are the foundations of life]" (in Chinese). Retrieved 7 December 2010.

^ "Body Fluids (Yin Ye)". copyright 2001-2010 by Sacred Lotus Arts. Retrieved 9 December 2010.

^ "《中医基础理论》第四章 精、气、血、津液. 第四节 津液 [Basics of TCM theory. Chapter 4: Essence, qi, blood, jinye. Section 4: jinye]" (in Chinese). Retrieved 9 December 2010.

^ 南方(editor) (19 July 2010). "中医说生命的基础是血、津液 [According to TCM, blood and jīnyė are the foundations of life]" (in Chinese). Retrieved 9 December 2010.

^ "《中医基础理论》第四章 精、气、血、津液. 第四节 津液 [Basics of TCM theory. Chapter 4: Essence, qi, blood, jinye. Section 4: jinye]" (in Chinese). Retrieved 9 December 2010.

^ Maciocia, Giovanni (1989). The Foundations of Chinese Medicine. Churchill Livingstone.

^ Kaptchuk 2000

^ 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.

^ Lee A, Done ML, Lee, Anna (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.

^ 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.

^ 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.

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^ 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.

^ 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.

^ Trinh KV, Graham N, Gross AR et al. (2006). "Acupuncture for neck disorders". Cochrane Database of Systematic Reviews 3 (3): CD004870. doi:10.1002/14651858.CD004870.pub3. PMID 16856065.

^ "The Cochrane Collaboration - Acupuncture for idiopathic headache. Melchart D, Linde K, Berman B, White A, Vickers A, Allais G, Brinkhaus B". Cochrane.org. Retrieved 2009-12-07.

^ Cochrane Collaboration. [Search all Cochrane reviews for "acupuncture". Retrieved 30 January 2008.

^ "Acupuncture and related interventions for smoking cessation". Cochrane.org. Retrieved 2009-12-07.

^ "Acupuncture for shoulder pain". Cochrane.org. 2005-04-20. Retrieved 2009-12-07.

^ 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. Retrieved 2007-03-06.

^ Stephen Barrett, M.D.. "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Retrieved 2010-05-31.

^ "American Association of Acupuncture and Oriental Medicine: Home". Aaom.org. 2009-11-12. Retrieved 2009-12-07.

^ "AMA (CSAPH) Report 12 of the Council on Scientific Affairs (A-97) Full Text". Ama-assn.org. Retrieved 2009-12-07.

^ Development Conference Statement

^ A Promising Anticancer and Antimalarial Component from the Leaves of Bidens pilosa. Planta Med. 2009;75:59-61

^ Synthesis and biological evaluation of febrifugine analogues as potential antimalarial agents. BIOORGANIC & MEDICINAL CHEMISTRY. 2009;17 13: 4496-502

^ American Cancer Society. Chinese Herbal Medicine. http://www.cancer.org/docroot/ETO/content/ETO_5_3x_Chinese_Herbal_Medicine.asp

^ "Towards a Safer Choice - The Practice of Traditional Chinese medicine In Australia - Summary of Findings". Health.vic.gov.au. Retrieved 2009-12-07.

^ "MHRA finds contaminated Chinese, Ayurvedic medicines". Nutraingredients.com. Retrieved 2009-12-07.

^ "香港容易混淆中藥". Hkcccm.com. Retrieved 2009-12-07.

^ "?u?~µv?v»P?u¤?µv?v¤??V?c????". .news.gov.hk. 2004-05-03. Retrieved 2009-12-07.

^ "Chinese medicine Natrii Sulfas not to be confused with chemical Sodium Nitrite". Info.gov.hk. 2004-05-03. Retrieved 2009-12-07.

^ "????????-??????(??????)". 100md.com. Retrieved 2009-12-07.

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^ David Hollenburg (2010), 'Epistemological Challenges to Integrative Medicine, an anti-colonial perspective on the combination of complementary/alternative medicine with biomedicine', in Health Sociology Review, Vol. 19(1), pp. 34 - 56, p. 46

^ Bensky, Clavey and Stoger (2004). Chinese Herbal Medicine Material Medica (3rd Edition). Eastland Press.

^ Brian K. Weirum, Special to the Chronicle (2007-11-11). "Will traditional Chinese medicine mean the end of the wild tiger?". Sfgate.com. Retrieved 2009-12-07.

^ "Rhino rescue plan decimates Asian antelopes". Newscientist.com. Retrieved 2009-12-07.

^ 2008 report from TRAFFIC

^ Harding, Andrew (2006-09-23). "Beijing's penis emporium". BBC News. Retrieved 2009-12-07.

^ Brown, P. Black Market. MediaStorm, LLC online

^ "治人病还是救熊命——对养熊“引流熊胆”的思考"南风窗. November 12, 2002

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[edit]

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