These doctrines and teachings are recorded in books such as the
These are ancient healing methods, and what happened was what beginning late 1940s to early 1950s, these precepts started to be standardized in China (People's Republic of China).
There were a nation-wide scale to consolidate and integrate them with modern teachings and notions of anatomy and pathology. However, much of these precepts, including the model of the body, the concept of disease, was not supported by science of evidence based medicine then. TCM was just not termed to be based upon current knowledge with regards to scientific community and health care.
Of course, since then, over continued time, research, communication and combined medical care, TCM is slowly gaining traction. In eastern Asia, such as China, Japan, Malaysia, Singapore, Indonesia - TCM is a trusted source of treatment and medicine, with its own rights of practice, regulations and management.
Traditional Chinese medicine views the body not primarily on anatomical structures (this bone, that bone), but moreso from a function-system standpoint (digestion, energy, breathing, aging etc).
TCM diagnosis includes in tracing symptoms to patterns of an underlying disharmony such as
that "makes up" the entire individual.
traditional Chinese herbal medicine, plant elements are by far the most
commonly, but not solely used substances; animal, human, and mineral products
are also utilized.
There are traces of therapeutic activities in China date from the Shang dynasty (14th–11th centuries BCE).
Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family:
which Shang elites usually attributed to curses sent by their ancestors. There was no evidence that the Shang nobility used herbal remedies.
The Yellow Emperor's Inner Canon, the oldest received work of Chinese medical theory, was compiled around the first century BCE on the basis of shorter texts from different medical lineages.
Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on
Unlike earlier texts like Recipes for Fifty-Two Ailments, which was excavated in the 1970s from a tomb that had been sealed in 168 BCE, the Inner Canon rejected the influence of spirits and the use of magic. It was also one of the first books in which the cosmological doctrines of Yinyang and the Five Phases were brought to a mature synthesis.
The Treatise on Cold Damage Disorders and Miscellaneous Illnesses was collated by Zhang Zhongjing sometime between 196 and 220 CE, at the end of the Han dynasty. Focusing on drug prescriptions rather than acupuncture, it was the first medical work to combine Yin-yang and the Five Phases with drug therapy.
This formulary was also the earliest public Chinese medical text to group symptoms into clinically useful "patterns" (zheng 證) that could serve as targets for therapy although the private scrolls held by families were jealously guarded and although it is not known for sure what is in them, the traditional school today say that they have had this information for much longer.
Having gone through numerous changes over time, the formulary now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty.
In the centuries that followed the completion of the Yellow Emperor's Inner Canon, several shorter books tried to summarize or systematize its contents.
Traditional Chinese medicine (TCM) is based on Yinyangism (i.e., the combination of Five Phases theory with Yin-yang theory), which was later absorbed by Daoism.
Yin and yang symbol for balance. In Traditional Chinese Medicine, good health is believed to be achieved by a balance between yin and yang.
Yin and yang are ancient Chinese concepts which can be traced back to the Shang dynasty (1600–1100 BC).
They represent two abstract and complementary aspects that every phenomenon in the universe can be divided into.
In the yin-yang theory, detailed attributions are made regarding the yin or yang character of things:
Thus, yin and yang of the body are seen as phenomena whose lack (or overabundance) comes with characteristic symptom combinations:
TCM also identifies drugs believed to treat these specific symptom combinations, i.e., to reinforce yin and yang.
Five Phases (五行, pinyin: wǔ xíng), sometimes also translated as the "Five Elements" theory, presumes that all phenomena of the universe and nature can be broken down into five elemental qualities – represented by
In this way, lines of correspondence can be drawn:
Strict rules are identified to apply to the relationships between the Five Phases in terms of sequence, of acting on each other, of counteraction etc. All these aspects of Five Phases theory constitute the basis of the zàng-fǔ concept, and thus have great influence regarding the TCM model of the body. Five Phase theory is also applied in diagnosis and therapy.
Correspondences between the body and the universe have historically not only been seen in terms of the Five Elements, but also of the "Great Numbers" (大數, pinyin: dà shū) For example, the number of acu-points has at times been seen to be 365, in correspondence with the number of days in a year; and the number of main meridians – 12 – has been seen in correspondence with the number of rivers flowing through the ancient Chinese empire.
Model of the body
TCM's view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body's functions (such as digestion, breathing, temperature maintenance, etc.):
These functions are aggregated and then associated with a primary functional entity – for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xuě (blood).
These functional entities thus constitute concepts rather than something with biochemical or anatomical properties.
The primary functional entities used by traditional Chinese medicine are qì, xuě, the five zàng organs, the six fǔ organs, and the meridians which extend through the organ systems.These are all theoretically interconnected: each zàng organ is paired with a fǔ organ, which are nourished by the blood and concentrate qi for a particular function, with meridians being extensions of those functional systems throughout the body.
Attempts to reconcile these concepts with modern science – in terms of identifying a physical correlate of them – have so far failed.
TCM distinguishes not only one but several different kinds of qi (simplified Chinese: 气; traditional Chinese: 氣; pinyin: qì).
In a general sense, qi is something that is defined by five "cardinal functions":
Vacuity of qi will especially be characterized by pale complexion, lassitude of spirit, lack of strength, spontaneous sweating, laziness to speak, non-digestion of food, shortness of breath (especially on exertion), and a pale and enlarged tongue.
Qi is believed to be 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.
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 yíng-qì (simplified Chinese: 营气; traditional Chinese: 營氣), its function is to complement xuè and its nature has a strong yin aspect (although qi in general is considered to be yang). The latter is called weì-qì (Chinese: 衛氣), its main function is defence and it has pronounced yang nature.
Qi also circulates in the meridians. Just as the qi held by each of the zang-fu organs, this is considered to be part of the ‘’principal‘’ qi (元氣, pinyin: yuánqì) of the body (also called 真氣 pinyin: zhēn qì, ‘’true‘’ qi, or 原氣 pinyin: yuán qì, ‘’original‘’ qi).
In contrast to the majority of other functional entities, xuě (血, "blood") is correlated with a physical form – the red liquid running in the blood vessels. Its concept is, nevertheless, defined by its functions:
Typical symptoms of a lack of xuě (usually termed "blood vacuity" [血虚, pinyin: xuě xū]) are described as:
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.
Their other functions are to harmonize yin and yang, and to help with the secretion of waste products.
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.
Their palpable manifestations are all bodily fluids:
The zàng-fǔ (simplified Chinese: 脏腑; traditional Chinese: 臟腑) constitute the centre piece of TCM's systematization of bodily functions. Bearing the names of organs, they are, however, only secondarily tied to (rudimentary) anatomical assumptions (the fǔ a little more, the zàng much less).
As they are primarily defined by their functions, they are not equivalent to the anatomical organs – to highlight this fact, their names are usually capitalized.
The term zàng (臟) refers to the five entities considered to be yin in nature –
while fǔ (腑) refers to the six yang organs –
Since their concept was developed on the basis of Wǔ Xíng philosophy, each zàng is paired with a fǔ, and each zàng-fǔ pair is assigned to one of five elemental qualities (i.e., the Five Elements or Five Phases).
These correspondences are stipulated as:
The zàng-fǔ are also connected to the twelve standard meridians – each yang meridian is attached to a fǔ organ and five of the yin meridians are attached to a zàng. As there are only five zàng but six yin meridians, the sixth is assigned to the Pericardium, a peculiar entity almost similar to the Heart zàng.
Acupuncture chart from the Ming Dynasty (c. 1368–1644)
In general, disease is perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment.
TCM therapies and healing is based on which "pattern of disharmony" can be identified. Thus, "pattern discrimination" is the most important step in TCM diagnosis. It is also known to be the most difficult aspect of practicing TCM.
In order to determine which pattern is at hand, practitioners will examine things like the
For example, depending on tongue and pulse conditions, a TCM practitioner might diagnose bleeding from the mouth and nose as: "Liver fire rushes upwards and scorches the Lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose". He might then go on to prescribe treatments designed to clear heat or supplement the Lung.
In TCM, a disease has two aspects: "bìng" and "zhèng". The former is often translated as "disease entity", "disease category", "illness", or simply "diagnosis". The latter, and more important one, is usually translated as "pattern" (or sometimes also as "syndrome"). For example, the disease entity of a common cold might present with a pattern of wind-cold in one patient, and with the pattern of wind-heat in another.
From a scientific point of view, most of the disease entitites (病, pinyin: bìng) listed by TCM constitute mere symptoms. Examples include headache, cough, abdominal pain, constipation etc.
Since therapy will not be chosen according to the disease entity but according to the pattern, two patients with the same disease entity but different patterns will receive different therapy. Vice versa, patients with similar patterns might receive similar therapy even if their disease entities are different.
This is called 异病同治，同病异治 (pinyin: yì bìng tóng zhì, tóng bìng yì zhì, "different diseases, same treatment; same disease, different treatments").
In TCM, "pattern" (证, pinyin: zhèng) refers to a "pattern of disharmony" or "functional disturbance" within the functional entities the TCM model of the body is composed of.
There are disharmony patterns of
They are ultimately defined by their symptoms and "signs" (i.e., for example, pulse and tongue findings).
In clinical practice, the identified pattern usually involves a combination of affected entities (compare with typical examples of patterns). The concrete pattern identified should account for all the symptoms a patient has.
The Six Excesses (六淫, pinyin: liù yín, sometimes also translated as "Pathogenic Factors", or "Six Pernicious Influences"; with the alternative term of 六邪, pinyin: liù xié, – "Six Evils" or "Six Devils") are allegorical terms used to describe disharmony patterns displaying certain typical symptoms.
These symptoms resemble the effects of six climatic factors.
In the allegory, these symptoms can occur because one or more of those climatic factors (called 六气, pinyin: liù qì, "the six qi") were able to invade the body surface and to proceed to the interior. This is sometimes used to draw causal relationships (i.e., prior exposure to wind/cold/etc. is identified as the cause of a disease), while other authors explicitly deny a direct cause-effect relationship between weather conditions and disease, pointing out that the Six Excesses are primarily descriptions of a certain combination of symptoms translated into a pattern of disharmony.
It is undisputed, though, that the Six Excesses can manifest inside the body without an external cause. In this case, they might be denoted "internal", e.g., "internal wind" or "internal fire (or heat)".
The Six Excesses and their characteristic clinical signs are:
Six-Excesses-patterns can consist of only one or a combination of Excesses (e.g., wind-cold, wind-damp-heat). They can also transform from one into another.
For each of the functional entities (qi, xuĕ, zàng-fǔ, meridians etc.), typical disharmony patterns are recognized; for example: qi vacuity and qi stagnation in the case of qi;blood vacuity, blood stasis, and blood heat in the case of xuĕ; Spleen qi vacuity, Spleen yang vacuity, Spleen qi vacuity with down-bearing qi, Spleen qi vacuity with lack of blood containment, cold-damp invasion of the Spleen, damp-heat invasion of Spleen and Stomach in case of the Spleen zàng; wind/cold/damp invasion in the case of the meridians.
TCM gives detailed prescriptions of these patterns regarding their typical symptoms, mostly including characteristic tongue and/or pulse findings.
The process of determining which actual pattern is on hand is called 辩证 (pinyin: biàn zhèng, usually translated as "pattern diagnosis", "pattern identification" or "pattern discrimination").
Generally, the first and most important step in pattern diagnosis is an evaluation of the present signs and symptoms on the basis of the "Eight Principles" (八纲, pinyin: bā gāng).
These eight principles refer to four pairs of fundamental qualities of a disease:
Out of these, heat/cold and vacuity/repletion have the biggest clinical importance. The yin/yang quality, on the other side, has the smallest importance and is somewhat seen aside from the other three pairs, since it merely presents a general and vague conclusion regarding what other qualities are found.
After the fundamental nature of a disease in terms of the Eight Principles is determined, the investigation focuses on more specific aspects.
By evaluating the present signs and symptoms against the background of typical disharmony patterns of the various entities, evidence is collected whether or how specific entities are affected. This evaluation can be done
There are also three special pattern diagnosis systems used in case of febrile and infectious diseases only ("Six Channel system" or "six division pattern" [六经辩证, pinyin: liù jīng biàn zhèng]; "Wei Qi Ying Xue system" or "four division pattern" [卫气营血辩证, pinyin: weì qì yíng xuě biàn zhèng]; "San Jiao system" or "three burners pattern" [三角辩证, pinyin: sānjiaō biàn zhèng]).
Although TCM and its concept of disease do not strongly differentiate between cause and effect, pattern discrimination can include considerations regarding the disease cause; this is called 病因辩证 (pinyin: bìngyīn biàn zhèng, "disease-cause pattern discrimination").
There are three fundamental categories of disease causes (三因, pinyin: sān yīn) recognized:
In TCM, there are five diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation.
Examination of the tongue and the pulse are among the principal diagnostic methods in TCM.
Certain sectors of the tongue's surface are believed to correspond to the zàng-fŭ.
Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each arm, for a total of twelve pulses, all of which are thought to correspond with certain zàng-fŭ.
The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick"; each of these qualities indicate certain disease patterns.
Learning TCM pulse diagnosis can take several years.
The term "herbal medicine" is somewhat misleading in that, while plant elements are by far the most commonly used substances in TCM, other, non-botanic substances are used as well: animal, human, and mineral products are also used. Thus, the term "medicinal" (instead of herb) may be used, although there is no scientific evidence that any of these compounds have medicinal effects.
There are roughly 13,000 compounds used in China and over 100,000 TCM recipes recorded in the ancient literature. Plant elements and extracts are by far the most common elements used. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed – out of these, 45 were animal parts, and 30 were minerals.
Some animal parts used can be considered rather strange such as cow gallstones, hornet nests, leeches, and scorpion. Other examples of animal parts include horn of the antelope or buffalo, deer antlers, testicles and penis bone of the dog, and snake bile. Some TCM textbooks still recommend preparations containing animal tissues, but there has been little research to justify the claimed clinical efficacy of many TCM animal products.
Some compounds can include the parts of endangered species, including tiger bones and rhinoceros horn which is used for many ailments (though not as an aphrodisiac as is commonly misunderstood in the West).
The traditional categorizations and classifications that can still be found today are:
The classification according to the Four Natures (四气; sì qì): hot, warm, cool, or cold (or, neutral in terms of temperature) and hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat heat diseases.
The classification according to the Five Flavors, (五味; wǔ wèi, sometimes also translated as Five Tastes): acrid, sweet, bitter, sour, and salty. Substances may also have more than one flavor, or none (i.e., a "bland" flavor). Each of the Five Flavors corresponds to one of zàng organs, which in turn corresponds to one of the Five Phases.
A flavor implies certain properties and therapeutic actions of a substance; e.g., saltiness drains downward and softens hard masses, while sweetness is supplementing, harmonizing, and moistening
The classification according to the meridian – more precisely, the zàng-fu organ including its associated meridian – which can be expected to be primarily affected by a given compound.
The categorization according to the specific function mainly include:
From the earliest records regarding the use of medicinals to today, the toxicity of certain substances has been described in all Chinese materiae medicae. Since TCM has become more popular in the Western world, there are increasing concerns about the potential toxicity of many traditional Chinese medicinals including plants, animal parts and minerals.
For most medicinals, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis. The toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it couldn't (i.e., in Curculigo).
Substances known to be potentially dangerous include Aconitum, secretions from the Asiatic toad, powdered centipede, the Chinese beetle (Mylabris phalerata, ban mao), certain fungi, Aristolochia, and Aconitum. To avoid its toxic adverse effects Xanthium sibiricum must be processed. Hepatotoxicity has been reported with products containing Polygonum multiflorum, glycyrrhizin, Senecio and Symphytum.
The evidence suggests that hepatotoxic herbs also include Dictamnus dasycarpus, Astragalus membranaceous, and Paeonia lactiflora; although there is no evidence that they cause liver damage. Contrary to popular belief, Ganoderma lucidum mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity.
A 2013 review suggested that although the antimalarial herb Artemisia annua may not cause hepatotoxicity, haematotoxicity, or hyperlipidemia, it should be used cautiously during pregnancy due to a potential risk of embryotoxicity at a high dose.
However, many adverse reactions are due misuse or abuse of Chinese medicine. For example, the misuse of the dietary supplement Ephedra (containing ephedrine) can lead to adverse events including gastrointestinal problems as well as sudden death from cardiomyopathy.
Products adulterated with pharmaceuticals for weight loss or erectile dysfunction are one of the main concerns. Chinese herbal medicine has been a major cause of acute liver failure in China.
Regarding traditional Chinese herbal therapy, only a few trials of adequate methodology exist and its effectiveness therefore remains poorly documented. A high percentage of relevant studies on traditional Chinese medicine are in Chinese databases.
A 2012 meta-analysis concluded that acupuncture was effective for the treatment of chronic pain. Commenting on the meta-analysis, Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo.
A 2011 overview of Cochrane reviews found high quality evidence that suggests acupuncture is effective for some but not all kinds of pain. A 2010 systematic review found that there is evidence "that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention" in the treatment of chronic low back pain.
Two review articles discussing the effectiveness of acupuncture, from 2008 and 2009, have concluded that there is not enough evidence to conclude that it is effective beyond the placebo effect.
Acupuncture is generally safe when administered using Clean Needle Technique (CNT). Although serious adverse effects are rare, acupuncture is not without risk.
Tui na (推拿) is 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.
Qìgōng (气功 or 氣功) is a TCM system of exercise and meditation that combines regulated breathing, slow movement, and focused awareness, purportedly to cultivate and balance qi. One branch of qigong is qigong massage, in which the practitioner combines massage techniques with awareness of the acupuncture channels and points.
Main article: Cupping therapy
Cupping (拔罐) is a type of Chinese massage, consisting 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".
It has not been found to be effective for the treatment of any disease.
Gua Sha is abrading the skin with pieces of smooth jade, bone, animal tusks or horns or smooth stones; until red spots then bruising cover the area to which it is done.
It is believed that this treatment is for almost any ailment including cholera. The red spots and bruising take 3 to 10 days to heal, there is often some soreness in the area that has been treated.
Diē-dá (跌打) or bone-setting 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 or 正骨) is not common in the West.
Many governments have enacted laws to regulate TCM practice.
Traditional Chinese Medicine TCM History Australia
From 1 July 2012 Chinese medicine practitioners must be registered under the national registration and accreditation scheme with the Chinese Medicine Board of Australia and meet the Board's Registration Standards, in order to practise in Australia.
Traditional Chinese Medicine TCM History Hong Kong
The Chinese Medicine Council of Hong Kong was established in 1999. It regulates the medicinals and professional standards for TCM practitioners.
All TCM practitioners in Hong Kong are required to register with the Council. The eligibility for registration includes a recognised 5-year university degree of TCM, a 30-week minimum supervised clinical internship, and passing the licensing exam.
Traditional Chinese Medicine TCM History Malaysia
The Traditional and Complementary Medicine Bill was passed by Parliament in 2012 establishing the Traditional and Complementary Medicine Council to register and regulate traditional and complementary medicine practitioners, including traditional Chinese medicine practitioners as well as other traditional and complementary medicine practitioners such as those in traditional Malay medicine and traditional Indian medicine.
Traditional Chinese Medicine TCM History Singapore
The TCM Practitioners Act was passed by Parliament in 2000 and the TCM Practitioners Board was established in 2001 as a statutory board under the Ministry of Health, to register and regulate TCM practitioners.
The requirements for registration include possession of a diploma or degree from a TCM educational institution/university on a gazetted list, either structured TCM clinical training at an approved local TCM educational institution or foreign TCM registration together with supervised TCM clinical attachment/practice at an approved local TCM clinic, and upon meeting these requirements, passing the Singapore TCM Physicians Registration Examination (STRE) conducted by the TCM Practitioners Board.
Traditional Chinese Medicine TCM History United States
As of July 2012, only six states do not have existing legislation to regulate the professional practice of TCM. These six states are Alabama, Kansas, North Dakota, South Dakota, Oklahoma, and Wyoming. In 1976, California established an Acupuncture Board and became the first state licensing professional acupuncturists.