Traditional Chinese medicine
|
|
Traditional Chinese medicine (TCM) also known simply as Chinese medicine (Chinese: 中醫學, zhōngyī xué, or 中药学, zhōngyaò xué) or traditional Oriental medicine, is the name commonly given to a range of traditional medical practices used in China that have developed over the course of several thousand years of history. Chinese medicine principally employs a method of analysis and synthesis, inquiring on a macro-level into the internal systems of the human body and their mutual relationships with the internal and external environment in an attempt to gain an understanding of the fundamental laws which govern the functioning of the human organism, and to apply this understanding to the treatment and prevention of disease, and health maintenance. TCM is rooted in a unique, comprehensive and systematic theoretical structure which includes the Theory of the Five Elements, the human body Meridian system and Yin-yang. Treatment is conducted with reference to this philosophical framework.
| Contents |
Uses
In the West, TCM is often considered alternative medicine, however in mainland China and Taiwan, TCM is widely considered to be an integral part of the health care system. The term TCM is sometimes used specifically within the field of Chinese medicine to refer to the standardized set of theories and practices introduced in the mid-20th century under the government of Mao, as distinguished from related traditional theories and practices preserved by people in Taiwan, Hong Kong and by the overseas Chinese. The more general sense is meant in this article.
TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine) or traditional medicine, rooted in ancient belief systems, including traditional religious concepts. Chinese medical practitioners before the 19th century relied essentially on observation, trial and error. Like their counterparts in the West, they had a very different understanding of infection which predated the discovery of bacteria, viruses (germ theory of disease) or cellular structures and little knowledge of organic chemistry, relying mainly on distinctly personal medical theory describing the nature of infections and remedies. Traditions associated with three millenia of practical experience guided their courses of treatment and instruction in diagnostic principles.
Unlike other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. There are thousands of years of empirical knowledge about TCM 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 longer a 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 sometimes ineffective in treating. 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 others. 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 or acute care while Chinese medicine involves manipulation or chronic care. Hence medical procedures such as bone setting or chiropractic spinal manipulation would be seen as Chinese, while surgery tends to be seen as Western.
TCM theory
There are many schools of thought on which TCM is based. Because of this, the foundation principles of Chinese medicine are not necessarily uniform. Received TCM can be shown to be most influenced by Taoism, Buddhism, and Neo-Confucianism.
For over 3000 years (1200 BC - present), Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:
- There are observable principles of constant phenomenal change by which the Universe is maintained.
- Man is part of the universe and cannot be separated from the universal process of change.
- As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself.
- Optimum health should result from living as harmoniously as possible with the spontaneous process of change tending towards balance. If there is no change (stagnation), or too much change (catastrophism), balance is increasingly lost and illnesses can occur.
- Everything is ultimately interconnected.
- Always use a systemic approach when addressing inbalances.
TCM is therefore largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems. Those systems usually work in balance to maintain the healthy function of the human body. The balance is described as necessarily including qi, blood, jing, bodily fluids, the wu xing, emotions, and spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. TCM isn't monolithic, however, and there are from minor to significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice.
TCM diagnostics
The basics of TCM diagnostics are: observe (望 wàng), hear and smell (聞 wén), ask about background (問 wèn) and read the pulse (切 qiè). Then classify the symptoms into different types:
- Yin or Yang (yin-yang 陰陽)
- Superficial or internal (li-biao 表裡)
- Cold or hot (han-re 寒熱)
- Psychological or physical (xu-shi 虛實 "fake or real")
Because traditional Chinese medicine predates the more invasive medical testing used in conventional Western medicine, TCM requires skill in a range of diagnostic systems not commonly used outside of TCM. Much of this diagnostic skill involves developing the abilities to observe subtle appearances; to observe that which is right in front of us, but escapes the observation of most people.
Diagnostic techniques
- Palpation of the patient's radial artery pulse in six positions
- Observation of the appearance of the patient's tongue
- Observation of the patient's face
- Palpation of the patient's body (especially the abdomen) for tenderness
- Observation of the sound of the patient's voice
- Observation of the surface of the ear
- Observation of the vein on the index finger on small children
- Comparisons of the relative warmth or coolness of different parts of the body
- Anything else that can be observed without instruments and without harming the patient
TCM treatment techniques
The traditional treatment in Chinese medicine consists of five major methods:
- Tui na
- Acupuncture
- Moxibustion
- Herbology
- Qigong, T'ai Chi Ch'uan and Chinese martial arts in general. Die-da or Tieh Ta (跌打): practitioners who specialize in healing trauma injury such as bone fractures, sprains, bruises etc. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. These practices are also seen as health maintenance regimes as well as interventions.
Traditional Chinese medicine uses herbs and other drugs as the last resort to fight health problems. This conforms to its basic belief: a human body has a sophisticated system to find illness, allocate resources and energy and heal the problems by itself. The goal of external efforts should carefully focus on assisting the normal self-healing function of human body, not interfering with it. There is a Chinese saying which reflects the same idea: "Any medicine has 30% poison ingredients."
The modern practice of traditional Chinese medicine is increasingly incorporating techniques and theories of Western medicine in its praxis.
Other specialties include:
- Nutrition or food therapy
- Gua Sha or coin-rubbing
- Auriculotherapy
TCM and science
There are two questions about TCM which can be investigated scientifically:
- Does it work?
- How does it work?
Does it work?
Most scientific research in the West about TCM has focused on acupuncture. The National Institutes of Health Consensus Statement on Acupuncture (http://odp.od.nih.gov/consensus/cons/107/107_statement.htm) summarizes research on the efficacy of acupuncture as follows:
...promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.
Much less work in the West has been done on Chinese herbal medicines, which comprises much of TCM in China. It is clear, however, that many if not most of these medicines do have powerful biochemical effects. An example is the herb ephedra which was introduced into the West as a stimulant, and later banned in the United States after deaths were attributed to its use. A less controversial example is artemisinin, derived from an herb long-used used in TCM, and now used worldwide to treat multi-drug resistant strains of falciparum malaria. In the West, many Chinese medicines have been marketed as herbal supplements and there has been considerable controversy over the regulatory status of these substances.
TCM practitioners have no philosophical objections to scientific studies on the effectiveness of treatments. The main barrier to the adoption of Chinese herbal medicines into Western practice is economic. It requires a large amount of expertise and money to conduct, for example, a double-blind drug trial, making it a large venture to test even one of the thousands of compounds used by TCM. Because these compounds cannot be patented and owned exclusively, there is a distinct disincentive to sponsor such expensive protocols.
There are also great a priori doubts about the efficacy of many TCM treatments that appear to have their basis in magical thinking, e.g. plants with heart-shaped leaves will help the heart, ground bones of tiger give a person energy because tigers are energetic animals and so on. To researchers, this is a very small base to start serious research on.
How does it work?
The basic mechanism of TCM is akin to treating the body as a black box, recording and classifying changes and observations of the patient using a traditional philosophy. In contrast to many alternative and complementary medicines such as homeopathy, practically all techniques of TCM have explanations for why they may be more effective than a placebo, which Western medicine can find plausible. Most doctors of Western medicine would not find implausible claims that qigong preserves health by encouraging relaxation and movement, that acupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents. However, the metaphors used in TCM theory often concern areas not readily measured or described by Western science.
The relationship between TCM and Western medicine
Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine.
The relationship between TCM and Western medicine in the West is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well-meaning but improperly-trained "TCM practitioners" who have done people more harm than good in many instances.
As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner or visit a martial arts school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.
This is not to say that TCM techniques are considered worthless in the West. In fact, Western pharmaceutical companies have recognized the value of traditional medicines and are employing teams of scientists in many parts of the world to gather knowledge from traditional healers and medical practitioners. After all, the active ingredients of most modern medicines were discovered in plants or animals. The particular contribution of Western medicine is that it strictly applies the scientific method to promising traditional treatments, separating those that work from those that do not. As another example, most Western hospitals and increasing numbers of other clinics now offer T'ai Chi Ch'uan or qigong classes as part of their inpatient and community health programs.
Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. To put it simply, you see a Western doctor if you have acute appendicitis, but you do exercises or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.
A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a mutlidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula.
It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.
In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for overprescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional Chinese herbal remedies.
TCM and Animals
SARS
"While primarily a health concern, the suspicion that the SARS virus may have jumped to humans from exotic wild animal food products led to proposals from within the Chinese government during the 2003 outbreak to prohibit the consumption of wild animals.
In response to SARS in 2003, Chinese officials confiscated more than 800,000 animals from markets and arrested over 4,000 people for selling protected species.
...the [Peoples Republic of China] began shutting wildlife markets in the province and exterminating thousands of masked palm civets and other animals on sale—a move that World Health Organization officials said may be in haste but, if not undertaken with extreme care, could cause further health risks and eliminate evidence of the origins of the disease." [1] (http://www.cepf.net/xp/cepf/news/newsletter/2004/january_topstory.xml)
Ethics and Animal Rights
As animal products are used in Chinese formulas, vegans and vegetarians should inform their practioner, if their beliefs forbid the ingestion of animals. Often alternate substances can be used.
The animal rights movement notes that a few traditional Chinese medicinary solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often even kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practioners outside of China.
See also
References
- Chang, Stephen T. The Great Tao (http://www.bodhibooksellers.com/tao/store.book.great.tao.html); Tao Longevity; ISBN 0942196015 Stephen T. Chang
- Kaptchuck, Ted J., The Web That Has No Weaver; Congdon & Weed; ISBN 0809229331Z
- Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; ISBN 0443-039801
- Ni, Mao-Shing, The Yellow Emperor's Classic of Medicine : A New Translation of the Neijing Suwen with Commentary; Shambala, 1995; ISBN 1570620806
- Holland, Alex Voices of Qi: An Introductory Guide to Traditional Chinese Medicine; North Atlantic Books, 2000; ISBN 1556433263
- Unschuld, Paul U., Medicine in China: A History of Ideas; University of California Press, 1985; ISBN 0520050231
- Qu, Jiecheng, When Chinese Medicine Meets Western Medicine - History and Ideas (http://www.cp1897.com.hk/html/profess/chime/essays/profess0403s02.htm) (in Chinese); Joint Publishing (H.K.), 2004; ISBN 9620423364
External links
- State Administration of Traditional Chinese Medicine for the People's Republic of China (http://www.satcm.gov.cn/)
- State Administration of Traditional Chinese Medicine for the People's Republic of China (English) (http://www.satcm.gov.cn/english_satcm/eindex.htm)
- Journal of Chinese Medicine (http://www.jcm.co.uk/)
- General information about Chinese Medicine (http://chinese-school.netfirms.com/Chinese-medicine.html)
- Classics of Traditional Chinese Medicine (http://www.nlm.nih.gov/hmd/chinese/chinesehome.html), by the National Library of Medicine (NLM)
- Modern Medicine and Traditional Chinese Medicine - Diabetes (http://chinese-school.netfirms.com/Chinese-medicine-diabetes-background.html)
- Acupuncture. NIH Consensus Statement 1997 Nov 3-5; 15(5):1-34. (http://odp.od.nih.gov/consensus/cons/107/107_statement.htm)
- China, Chi, and Chicanery (http://www.csicop.org/si/9509/chi.html) (a sceptical view)
- Effects of acupuncture on gastroparesis study (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15510787)
- The Chinese Medicine Sampler (http://www.chinesemedicinesampler.com/theorybasic.html)- Historical Roots of Traditional Chinese Medicinede:Traditionelle Chinesische Medizin
es:Medicina china tradicional it:Medicina tradizionale cinese he:רפואה סינית ja:伝統中国医学 zh:中医学