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Traditional Chinese medicine

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Traditional Chinese medicine (TCM) also known simply as Chinese medicine (Chinese: 中药, zhōngyào) or traditional Oriental medicine, is the name commonly to a range of traditional medical practices originating in China. 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, based on observation, meditation, and experiment over a long period of time. Like their counterparts in the West, Chinese medical practitioners before the 19th century had a very different understanding of infection which predated the discovery of bacteria, viruses (germ theory) or cellular 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 medical practice, and within China, it is an important part of the public health care system. There has been an effort to place traditional Chinese medicine on a firmer empirical and methodological basis and 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.

Uses

In the West, TCM is usually regarded as a complementary and alternative medicine. For example, modern applications of TCM include treatment of the side effects of chemotherapy when treating cancer patients, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions that conventional medicine is ineffective against.

In China, practitioners of Chinese medicine tend to perform functions which would in the West be performed by allied health professionals such as nutritionists, pharmacists, nurses, chiropractors and rehabilition specialists. Chinese medicine hospitals also perform some emergency medicine such as prevention and treatment of shock.

The general distinction that Chinese in China make is that Western medicine involves cutting while Chinese medicine involves manipulation. Hence medical procedures such as bone setting or chiropratic spinal operations tends to be seen as Chinese, while surgery tends to be seen as Western.

In sharp contrast to Western practitioners of Chinese medicine, Chinese medicine practitioners generally are not hostile to Western medicine, and there has been much interest among Chinese medicine practitioners in introducing some Western techniques such as double-blind trials of medicines and publication in peer reviewed journals. There is also intense interest in China in recent Western advances in biochemistry which holds the promise of helping to understand how Chinese medicine works. In addition, there is also relatively little hostility toward TCM among Chinese practitioners of Western medicine, and surveys of Chinese practitioners show that most Western doctors in China also incorporate some elements of TCM into their practice, while the reverse is also true.

TCM techniques

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:

TCM theory

Chinese medicine is based on the belief that a person will recover from illness when their natual balance is restored, and seeks to support this process. In contrast, Western medical doctors in China tend to be much more interventionist than doctors in the West. In comparing the effectiveness of Western medicine and TCM in China, it is also worth noting that some practices common among practitioners of Western medicine in China (such as the indiscriminate use of antibiotics and steroids) are widely regarded in the West as having little use and can be harmful to the patient.

Yin and Yang

The most fundamental concept in TCM is the philosophical construct of Yin-Yang, complimentary 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 and Yang are sometimes associated with sexual terms, which leads to some major misconceptions about Chinese medicine. One such misconception is that Chinese herbal medicines 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

Qi is perhaps the most contentious entity in Western discussions of TCM. The translation of "Qi" as "energy" has caused much consternation among skeptics and Western practitioners, 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; they focus rather on what it does.

Whatever Qi is, one basic notion of Chinese medicine is that living organisms must possess it. Without it, one is dead. To maintain life, Qi must circulate, and when this circulation stops, disease results. Many of the rudimentary treatments of Chinese medicine are to get Qi to flow, and to prevent Qi from being blocked.

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.)

Still others say that Qi should be though of not as energy at all, but as a strictly subjective experience of vitality. While clearly our perception of vitality is related to chemical and electrical energy in the body, the relationship is not a simple mapping.

Another idea is that Qi is best translated as "potential": where Qi is present, there are many different possibile actions that an organism or system may take, while where it is absent there are few. (This idea of Qi is more applicable to Qi as a cosmological rather than medical concept; it 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 highly esoteric language that would make no sense to lay people, especially when worded in English.

Five element theory

The Five Element theory (wu xing, sometimes translated "Five Movements" or "Five Transformations") is also a fundamental concept in TCM theory.

The Five elements of TCM are:

  • Wood
  • Fire
  • Earth
  • Water
  • Metal

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 priority of Five Element theory; it is primary to one particular school of thought within TCM appropriately called the Five Element School, while others make little direct reference to it.

Zang-Fu Theory

The five elements are associated energetically with the following Zang-Fu organs in the same order as above:

There is also a school of thought within TCM called 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. 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 grmatest therapeutic benefit, and requires true mastery of the art of traditional Chinese Medicine.

The TCM model of the body

Applying the ideas of Yin-Yang and Five Elements to the human being, Chinese medicine has a rather simple and limited theory of the human organism. It sees the details of biochemistry, cellular physiology, et cetera, to be largely irrelevant to taking the signs and symptoms displayed by a patient and organizing them into a pattern that determines the treatment. 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 Organs; the Zang-Fu Organs (see below); 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 Heater has no anatomical correspondent at all, and is completely a functional entity.

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 [http://odp.od.nih.gov/consensus/cons/107/107_statement.htm Consensus Statement on Acupuncture] 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 causing some deaths. In the West, many Chinese medicines have been marketed as herbal supplements and there has been great concern at the lack of regulation of these supplements.

Most TCM practitioners have no philosophical objections to scientific studies on the effectiveness of treatments, and the main barrier is logistical. 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 the thousands of compounds used by TCM.

How does it work?

One difficulty with TCM is that the theoretical framework used by TCM practitioners to decide which treatment to use, does not easily map to Western medical concepts, making it very difficult to judge the effectiveness of TCM theory with Western medical theory.

The theory of TCM itself is not very concerned with such analysis; and some TCM practitioners in the West tend to eschew science and argue that the elements of TCM are not amenable to scientific study. By contrast, most advanced TCM practitioners in China believe that Chinese views of medicine can be reconciled with Western views of medicine, and that the energies and elements in TCM theory can be linked to scientifically observed biochemical process.

In sharp 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 accupuncture relieves pain by stimulating the production of neurotransmitters, or that Chinese herbal medicines may contain powerful biochemical agents.

As a consequence, within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese medicine includes many compounds and techniques which are unused by Western medicine, and there is great interest in those compounds and the theories which TCM practitioners use to determine which compound to perscribe and which action to take. For their part, advanced TCM practitioners in China are extremely 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 far more contentionous. TCM practitioners in the West are far more likely than those in China to attribute non-physical characters to TCM concepts and reject scientific explanations for TCM. For their part, Western doctors and scientists are far more likely to reject TCM as pseudoscience and superstition. This hostility comes from a number of sources. For one, TCM in the West tends to be advocated by those that have completely lost faith in Western medicine, and TCM is often the last resort of those with conditions which Western medicine has deemed hopeless. Many people in the West have a stereotype of the East as mysterious, spiritual, and unscientific which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West would never see a Chinese medicine practitioner to get the bone set, while this is routine in China. As another example of the difference, most TCM hospitals in China have electron microscopes and learning how to use one is common among advance practitioners of TCM.

This is not to say that Western medicine considers all practical outcomes of TCM techniques to be worthless. TCM techniques have developed, through a process of trial and error over many centuries, a range of medicines and techniques which can in some circumstances cure some illnesses. The same, however, can be said of pre-modern European medicine, and of the medical practices of India, the Islamic world, pre-Columbian America and the Australian Aboriginal people. Nevertheless, in all these cases therapies have been discovered empirically, without any theoretical understanding of the principles of biomedical science.

Chinese medicine asserts that the body has some special energies and elements. The nature of these elements and forces is a subject of some disagreement. Although some claim to be able to sense these forces directly, most doctors, scientists, and practitioners of Chinese medicine in China do not think that this is possible.

Because traditional Chinese medicine in the West is seen as in opposition to Western medicine and because traditional Chinese medicine in the West is often adopted by people who have given up interest in Chinese medicine, practitioners of TCM in the West are far more likely than their Chinese counterparts to assert that that these energies have metaphysical existence, or properties that cannot be explained scientifically.

History of Traditional Chinese medicine

Many of the concepts of Chinese medicine derived from Taoist concepts and reflect the classical Chinese belief that the affairs of men had cosmological significance. Hence there was an impulse to place medical observations within a unifying cosmological context.

With contact with the West, many expected TCM to disappear completely and be replaced with Western medicine. That this has not happened and shows no sign of happening strikes many as surprising especially since indigenous medical traditions have been supplanted in other areas, and also because there is no separate Chinese branch in other fields of science.

There have been much speculation as to why this is so. One factor may be that for routine medical conditions, for example the flu and allergies, the treatments offered by Chinese medicine may has as much efficacy as those offered by Western medicine. Another factor is that doctors trained in Western medicine were less common, and therefore more expensive or in some cases non-existent.

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. Unlike descriptions of Chinese medicine in Western sources, Chinese descriptions of traditional Chinese medicine tend to deemphasize the cosmological aspects of TCM and emphasize its compatibility with modern science and technology.

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 very 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 Western medical practitioner, and hence TCM has been seen as an integral part of extending health services in China.

Western Medicine and Traditional Chinese Medicine

Although Westerners associate traditional Chinese medicine with herbs and medicines, TCM practitioners in Chinese societies will often perform medical activities such as setting broken bones or treating sprains and dislocations. Most Chinese generally see traditional Chinese medicine as a complement to Western rather than as an alternative. In Mainland China, there has been a very strong effort to merge Chinese and Western traditions of medicine, and this has resulted in things such as peer reviewed scientific journals and medical databases devoted to Chinese medicine.

In the West, Chinese medicine is largely regarded as antagonistic to Western medicine and as a alternative medicine to be used when Western medicine has proven unsatifactory. In most Western areas, Chinese practitioners are not licensed and are not permitted to perform certain basic medicial procedures such as setting broken bones or treating burns and sprains.

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 going using modern medicine. At the same time, belief in Chinese medicine among 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 strong enough so that you don't get appendicitis and so that you recover quickly from the surgery. Very few practitioners of Western medicine in China completely reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their 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 movement 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 doctors practitioners of Western medical have been widely criticized for overprescribing drugs such as cortisone or antibiotics for common viral infections, and 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.

See also

References

  • Kaptchuck, Ted J. The Web That Has No Weaver; Congdon & Weed; ISBN 0-8092-2933-1Z
  • Maciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; ISBN 0-443-03980-1
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