Traditional Chinese medicine
Traditional Chinese medicine (TCM) also known simply as Chinese medicine (Chinese: 中药, zhōngyÃÂÃÂ o) or traditional Oriental medicine, is the name commonly given to a range of traditional medical practices originating in China. The basic mechanism of TCM is akin to treating the body as a blackbox, recording and classifying changes and observations of the patient using a traditional philosophy of Five Elements and Yin-yang. Treatments are done with reference to this philosophical framework.
In the West,
TCM is often considered alternative medicine, while in both Mainland China and on Taiwan, TCM is widely considered to be an integral part of the health care system. (The term TCM is sometimes used specifically within the field of Chinese
Medicine to refer to the standardized set of theories and practices
introduced in the mid-20th century under the government of Mao, as
distinguished from other theories and practices such as Worsley's
Five Element Acupuncture or the kyo/jitsu theory of Shizuto
Masunaga's Zen shiatsu. However we use the more general sense here.)
TCM developed as a form of pre-modern medical practice (also described as
folk medicine) or traditional medicine, rooted in ancient religious belief systems. Chinese medical practitioners before the 19th century relied essentially on 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 cellularular structures and little knowledge of organic chemistry, relying mainly on a medical theory describing the nature of infections and remedies as well as tradition to guide their courses of treatment.
Unlike these other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. There are thousands of years of empirical knowledge about TCM on its own terms, and in recent decades there has been an effort to place traditional Chinese medicine on a firmer Western scientific empirical and methodological basis as well as efforts to integrate Chinese and Western medical traditions.
That this effort has occurred is surprising to many for a number of reasons. In most of the world, indigenous medical practices have been supplanted by practices brought from the West, while in Chinese societies, this has not occurred and shows no sign of occurring. Furthermore, many have found it peculiar that Chinese medicine remains a distinct branch of medicine separate from Western medicine, while the same has not happened with other intellectual fields. There is, for example, no distinct branch of Chinese physics or Chinese biology.
In the West, TCM is usually regarded as a form of alternative medicine (CAM). TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions that conventional medicine is claimed to be ineffective against. TCM has also been used to treat antibiotic-resistant infections.
In China, practitioners of Chinese medicine tend to perform functions which in the West would be performed by allied health professionals such as
nutritionists, pharmacists, nurses, chiropractors physical therapists and other rehabilition specialists. Chinese medicine hospitals also perform some emergency medicine such as prevention and treatment of shock and seizure. The general distinction made by Chinese in China is that Western medicine
involves cutting while Chinese medicine involves manipulation. Hence
medical procedures such as bone setting or chiropractic spinal manipulation
tends to be seen as Chinese, while surgery tends to be seen as Western.
TCM is based on the philosophical concept that if balance is restored, the person heals. TCM seeks to balance yin and yang, Qi, Blood, Jing, Bodily fluids, the Five Elements, the emotions, and the spirit (Shen).
The most fundamental concept in TCM is the philosophical construct of Yin Yang, complementary qualities seen in all natural phenomena. Yin and yang are not forces, energies, or material substances; neither are they irrational mystical concepts (though they do not work well with Aristotelian logic). Yin Yang is a way of thinking about phenomena, and a way to describe how things function and interact with each other in the Universe.
The Chinese characters for Yin and yang are derived from pictographs for, respectively, the shady and sunny sides of a hill. This relationship is an example of several elements of the Yin Yang dynamic; there can be no
shady side without the sunny side, and one transforms into the other as the day
progresses. On the sunny side there are shady spots (under a tree, for
example), while on the shady side there are bright spots (in a clearing). These exemplify
yin within yang and yang within yin, respectively. By extension, the artificiality of discriminations between yin and yang is posited, informing the traditional Chinese medical practitioner that in some cases yin and yang are plastic metaphors based on relative points of view rather than an absolute identity, a non-dualistic dynamic represented by the Taoist and Neo-Confucian icon known as the Taijitu.
Yin is used to describe phenomena which are dark, cool, at rest,
down, inward, female, still, and/or decreasing. Yang corresponds to bright, warm,
active, up, outward, male, and/or increasing. Within the human body,
certain elements are considered more yin and some more yang: the front is
considered more yin, the back more yang; the upper part yang, the lower
part yin; the interior yin, and the exterior yang.
Simplisticly speaking, fever, irritability, and redness from blood rushing to the skin are signs of too much yang, or not enough yin to balance the yang. Coldness,
lethargy, and paleness are signs of excess yin or deficient yang. Medicines
and treatments are classified as to their ability to strengthen or disperse
yin and yang. Because of the continuous movement of change and the interactions between yin and yang, actual situations are usually far more complex than this example.
In the West, Yin Yang are sometimes associated with sexual terms, which leads to some major misconceptions about Chinese medicine. One such misconception is that a Chinese herbal medicine such as rhinoceros horn is used primarily as an aphrodisiac. This is not true, as rhinoceros horn is intended mainly as a fever reducer, and has a number of substitutes.
Qi is typically translated as "vital energy" or "life force." At the simplest level, it is the common Chinese word for "breath" or "to breathe." Therefore, Qi is said to permeate all of life. In the body, Qi pools in certain places called acupuncture points which are generally along interior pathways or channels called meridians which are similar to rivers of Qi. Qi is not considered to be a physical substance, meaning it is not visible or tangible. However, it is somehow necessary for life.
Whatever Qi is, one basic notion of Chinese medicine is that living
organisms must possess it. To maintain life, Qi must circulate, and when this circulation is impeded, disease results. Many of the rudimentary treatments of Chinese medicine are to get Qi to flow, and to prevent Qi from being "blocked".
The translation of "Qi" as "energy" has caused much consternation among
skeptics and Western scientists, who hold that any form of energy
flowing though the body must be amenable to reductionist analysis, and that
no such energy has been observed. However, neither ancient nor modern
Chinese texts discuss what Qi is, but emphasize the function of Qi.
Some practitioners treat Qi as a form of electromagnetic or biological energy. Others hold that if Qi is to be understood as energy, it is in the sense of that which is present when we say "I feel full of energy today!", not in the sense of the chemical energy of a chemical battery, or the kinetic energy of a falling rock. (When a person in Japan asks the common greeting question "O-genki desu ka?" ("How is your Qi?") the expected answer is not given in joules.)
Another idea is that Qi is best translated as "potential": where Qi is present, there are many different possible actions that an organism or system may take, while where it is absent there are few. This idea has interesting parallels with the concept of information entropy.)
None of these explanations fully describe what Qi is or what it does. Such concepts are almost impossible to disseminate in anything less than esoteric language that would make little sense to lay people, especially when worded in English.
The Five Elements theory (五行 wǔ xÃÂÃÂng), sometimes translated
"Five Movements" or "Five Transformations," is also a fundamental
concept in TCM theory.
The Five Elements of TCM are:
The five elements are associated energetically with the following
Zang-Fu organs in the same order as above:
The elements of the TCM model of the body are the Fundamental
Substances (Qi, Blood, Jing (Essence), Shen (Mind), and Fluids)
that nourish and protect the Zang-Fu organs; and
the meridians (jing-luo) which connect and unify the body. Every
diagnosis is a "Pattern of disharmony" that affects one or more organs
(such as "Spleen Qi Deficiency" or "Liver Fire Blazing" or "Invasion of the Stomach by Cold"), and every treatment is centered on correcting the disharmony.
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. Indeed, the
San Jiao or Triple Burner has no anatomical correspondent at all, and is
completely a functional entity.
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.
TCM utilizes numerous techniques or healing modalities to achieve the
desired balance of Yin and Yang as well as Qi, Blood, Bodily Fluids,
and Shen (Mind/Spirit). These include:
Much of the philosophy of Chinese medicine derived from Taoist philosophy,
and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales.
These causative principles, whether material, essential, or spiritual,
correlate as the expression of the fates decreed by heaven.
During the golden age of his reign from 2696 to 2598 B.C,
as a result of a dialogue with his minister Ch'i Pai, the Yellow Emperor
is supposed by Chinese tradition to have composed his Neijing Suwen
or Basic Questions of Internal Medicine. Modern scholarly opinion holds
that the extant text of this title was compiled by an eponymous scholar
between the Chou and Han dynasties more than two thousand years later
than tradition reports, although some parts of the extant work may have
originated as early as 1000 B.C.
During the Han dynasty, Chang Chung-Ching, who was mayor of Chang-sha near
the end of the second century A.D., wrote a Treatise on Typhoid Fever,
which contains the earliest known reference to Neijing Suwen.
The Chin dynasty practitioner and advocate of acupuncture and moxibustion,
Huang-fu Mi (215-282 A.D), also quotes the Yellow Emperor in his
Chia I Ching, ca. 265 A.D. During the Tang dynasty, Wang Ping
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 eleventh century A.D., and the result
is our best extant representation of the foundational tradition of TCM.
Contact with Western culture and medicine did not displace TCM. While
there may be many sociological and anthropological factors involved in
the persistent practice and, in recent decades, the westward spread of TCM, two reasons are most
obvious. Firstly, TCM practices are often very effective, sometimes offering
palliative efficacy where the best practices of Western medicine fail, especially for routine ailments such as flu and allergies,
and manage to avoid the toxicity of chemically composed medicines.
Secondly, TCM provides the only available care when resources are
inadequate to import Western medical technologies.
Traditional Chinese medicine formed part of the barefoot doctor program
in the People's Republic of China, which extended public health into
rural areas. A large motivation behind the interest in traditional
Chinese medicine by both individuals in China and the PRC government is
that the cost of training a traditional Chinese medicine practitioner and
staffing a TCM hospital is considerably less than that of a practitioner of Western medicine, hence TCM has been seen as an integral part of extending
health services in China.
Attitudes toward traditional Chinese medicine in China have been strongly
influenced by Marxism and the May Fourth Movement. The notion of
supernatural forces runs counter to the Marxist belief in [[dialectic
materialism]] and strikes many Chinese as feudalistic and superstitious. At
the same time, there is the notion of learning from the masses, and
traditional Chinese medicine is seen as the distillation of thousands of
years of experiences which should be respected and understood. Modern Chinese descriptions of traditional Chinese medicine tend to deemphasize the cosmological
aspects of TCM and emphasize its compatibility with modern science and
technology.
There are two questions about TCM which can be investigated scientifically:
Most scientific research in the West about TCM has focused on acupuncture. The National
Institutes of Health
[http://odp.od.nih.gov/consensus/cons/107/107_statement.htm Consensus
Statement on Acupuncture] summarizes research on the efficacy of
acupuncture as follows:
TCM practitioners have no philosophical objections to scientific studies on the effectiveness of treatments. The main barrier to the adoption of Chinese
herbal medicines into Western practice is economic. It requires a large amount of expertise and money to conduct, for example, a double-blind drug trial, making it a large venture to test even one of the thousands of compounds used by TCM. Because these compounds cannot be patented, there is
a distinct lack of a self-interested party to sponsor such expensive protocols.
In contrast to many alternative and complementary mediciness such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, these are great oversimplifications of TCM and how or why it works. The metaphors used in TCM theory often concern areas not readily measured or described by Western science.
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.
Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of
sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in
science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well meaning but improperly trained New Age "TCM practitioners" who have done people more harm than good in many instances.
As an example of the different roles of TCM in China and the West, a person
with a broken bone in the West would never see a Chinese medicine
practitioner to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.
This is not to say that Western medicine considers all practical outcomes of TCM techniques to be worthless. Many Western hospitals and clinics now offer Tai Chi Chuan or qigong classes as part of their community health programs. As well, TCM techniques have developed a range of medicines and
techniques which have been demonstrated to cure some illnesses. The same,
however, can be said of traditional European medicine, and of the medical practices of India, the Islamic world, pre-Columbian America and the
Australian Aboriginal people. In all these cases, therapies
have been discovered empirically rather than through the scientific method.
Most Chinese in China do not see traditional Chinese medicine and Western
medicine as being in conflict. In cases of emergency and crisis situations,
there is generally no reluctance in using conventional Western medicine. At the
same time, belief in Chinese medicine remains strong in the area of
maintaining health and wellness. To put it simply, you see a Western doctor
if you have acute appendicitis, but you take Chinese medicines to make your
body healthy enough to prevent appendicitis, or you recover quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own
practice. The converse also holds true.
It is worth noting that the practice of Western medicine in China is somewhat different than that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.
In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for overprescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional
Chinese herbal remedies.
Uses
TCM theory
Yin Yang
Qi
Five element theory
Like Yin and Yang, these are not energies or substances, but basic
qualities or phases of a cycle that can be found in natural phenomena,
including the human being. Different schools of thought within TCM have had differing opinions on the importance of Five Element theory; it is primary to one particular school of thought within TCM appropriately called Five Element Acupuncture, while others make little direct reference to it.Zang-Fu theory
Another school of thought within TCM is the Zang-Fu school.
This theory treats each of the Zang organs (the first in the pairs above,
the more yin of the organs) as an energy center that runs an entire
system, similar to the Hindu chakra concept. The Zang systems include organs, senses, emotions, and the
musculoskeletal system--essentially, the entire person divided into five
categorical systems. With a thorough understanding of either of these
schools of thought, therapeutic results are achieved accordingly. The
theory is always in service of practical, therapeutic application, with the
goal of an "elegant" treatment. An elegant treatment uses the least amount
of force for the greatest therapeutic benefit, and requires true mastery of
the art of traditional Chinese Medicine.The TCM model of the body
TCM diagnostics
Diagnostic techniques
TCM techniques
History of Traditional Chinese medicine
TCM and Science
Does it work?
Much less work in the West has been done on Chinese herbal
medicines, which comprises much of TCM in China. It is clear, however, that many if not most of these medicines do have powerful biochemical effects. An example is the herb ephedra which was introduced into the West as a stimulant, and later banned in the United States after deaths were attributed
to its use. In the West, many Chinese medicines have been marketed as herbal supplements and there has been considerable
controversy over the regulatory status of these substances.How does it work?
Western Medicine and Traditional Chinese Medicine
See also
References
External links