Monday, October 6, 2008

Traditional Chinese medicine

Traditional Chinese medicine includes a range of practices originating in China.
It is considered a system in much of the western world while remaining as a form of primary care throughout most of Asia.

TCM practices include treatments such as , acupuncture, dietary therapy, Tui na and Shiatsu massage; often Qigong and Taiji are also strongly affiliated with TCM.

TCM theory is extremely complex and originated thousands of years ago through meticulous observation of nature, the cosmos, and the human body. Major theories include those of Yin-yang, the , the human body system, Zang Fu organ theory, six confirmations, four layers, etc.

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History


Much of the philosophy of traditional Chinese medicine derived from the same philosophical bases that Taoist and Buddhist philosophies are based on, and reflects the classical belief that the life and activity of individual human beings have an intimate relationship with the environment at all scales. It has also been noted that early traditional Chinese medicine stemmed from Taoist masters who had an extraordinary sense of the body and its workings through their many hours of meditation. This may be why TCM also inherited many of the principles inherent to Daoism .

During the golden age of his reign from 2698 to 2596 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'', also known as the ''Huangdi Neijing''. Modern scholarly opinion holds that the extant text of this title was compiled by an anonymous scholar no earlier than the Han dynasty just over two-thousand years ago.

During the Han Dynasty , Zhang Zhongjing , the Hippocrates of China, who was mayor of Chang-sha toward the end of the 2nd century AD, wrote a ''Treatise on Cold Damage'', which contains the earliest known reference to ''Neijing Suwen''. Another prominent Eastern Han physician was Hua Tuo , who patients during surgery with a formula of wine and powdered hemp. Hua's physical, surgical, and herbal treatments were also used to cure headaches, dizziness, internal worms, fevers, coughing, blocked throat, and even a diagnosis for one lady that she had a dead fetus within her that needed to be taken out. The practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi , also quoted the Yellow Emperor in his ''Jia Yi Jing'' , ca. 265 AD. 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 11th century AD.

There were noted advances in Chinese medicine during the Middle Ages. of the Tang Dynasty commissioned the scholarly compilation of a ''materia medica'' in 657 that documented 833 medicinal substances taken from stones, minerals, metals, plants, herbs, animals, vegetables, fruits, and cereal crops. In his ''Bencao Tujing'' , the scholar-official Su Song not only systematically categorized and according to their pharmaceutical uses, but he also took an interest in zoology. For example, Su made systematic descriptions of animal species and the environmental regions they could be found, such as the freshwater crab ''Eriocher sinensis'' found in the Huai River running through Anhui, in waterways near , as well as reservoirs and marshes of Hebei.

Contact with Western culture and medicine has not displaced TCM. While there may be traditional factors involved in the persistent practice, two reasons are most obvious in the westward spread of TCM in recent decades. Firstly, TCM practices are believed by many to be very effective, sometimes offering palliative efficacy where the practices of Western medicine fail or unable to provide treatment, especially for routine ailments such as flu and , or when Western medicine fails to relieve patients suffering from chronic ailments. CCM has been shown to be effective in the treatment of chronic, functional disorders, such as migraines and osteoarthritis, and is traditionally used for a wide range of functional disorders. Secondly, TCM provides an alternative to otherwise costly procedures whom many can not afford, or which is not covered by insurance. There are also many who turn to TCM to avoid the toxic side effects of pharmaceuticals.

TCM of the last few centuries is seen by at least some sinologists as part of the evolution of a culture, from shamans blaming illnesses on evil spirits to "proto-scientific" systems of correspondence; any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Taoist-inspired classics of acupuncture such as the Huang Di Nei Jing. The system's development has, over its history, been analysed both skeptically and extensively, and the practice and development of it has waxed and waned over the centuries and cultures through which it has travelled - yet the system has still survived thus far. It is true that the focus from the beginning has been on pragmatism, not necessarily understanding of the mechanisms of the actions - and that this has hindered its modern acceptance in the West. This, despite that there were times such as the early 18th century when "acupuncture and moxa were a matter of course in polite European society"

Medicine Overview



Acupuncture: is a technique in which the practitioner gently inserts fine needles into specific points on the patient's body.

Tui Na Massage: a form of massage akin to acupressure.

Dietetics: dietary recommendations are usually made based upon the patient's individual condition in relation to TCM theory.

Herbal Medicine: a significant branch of Chinese Medicine. Each remedy is a mixture of herbs tailored to the patient and their malady.

These are the main types of Chinese medicine and practice; although there are others, it is rare to find them.

Timeline



The history of TCM can be summarized by a list of important doctors and books.
*Unknown, - Sù Wèn & Líng Shū . The earliest classic of TCM passed on to the present.

* Warring States Period : Silk scrolls recording channels and collaterals, Zu Bi Shi Yi Mai Jiu Jing , and Yin Yang Shi Yi Mai Jiu Jing

* Eastern Han Dynasty to Three Kingdoms Period :
** Zhen Jiu Zhen Zhong Jing by
** Shang Han Za Bing Lun, also known as Shāng Hán Lùn by

*Jìn Dynasty : Zhēn Jiǔ Jiǎ Yǐ Jīng by .

* Tang Dynasty
**Bei Ji Qian Jin Yao Fang and Qian Jin Yi Fang by
** Wai Tai Mi Yao by Wang Tao

* Song Dynasty :
** Tóngrén Shūxué Zhēn Jiǔ Tú Jīng by .
**Emergence of Wenbing School

* Yuan Dynasty : Shísì Jīng Fā Huī by .

* Ming Dynasty : Climax of acupuncture and Moxibustion. Many famous doctors and books. Only name a few:
** Zhēnjiǔ Da Quan by Xu Feng
** Zhēnjiǔ Jù Yīng Fa Hui by
** Zhēnjiǔ Dàchéng by Yang Jizhou, a milestone book. 1601CE, Yáng Jì Zhōu .
** Běncǎo Gāng Mù by , the most complete and comprehensive pre-modern herb book
**Wen Yi Lun by Wu YouShing

* Qing Dynasty:
**Yi Zong Jin Jian by Wu Quan, sponsored by the imperial.
**Zhen Jiu Feng Yuan by Li Xuechuan
**Wen Zhen Lun Dz by Ye TianShi
**Wen Bing Tiao Bian written by Wu Jutong, a Qing dynasty physician, in 1798 C.E.

Theory



The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM can be shown to be influenced by Taoism, Buddhism, and Neo-Confucianism.

Since 1200 BC, 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, Chinese writers described general principles and their applications to health and healing.

Porkert, a Western medical doctor, placed Chinese medical theory in context as:

Chinese medicine, like many other Chinese sciences, defines data on the basis of the inductive and synthetic mode of cognition. Inductivity corresponds to a logical link between two effective positions existing at the same time in different places in space. In other words, effects based on positions that are separate in space yet simultaneous in time are mutually inductive and thus are called ''inductive effects''. In Western science prior to the development of electrodynamics and nuclear physics , the inductive nexus was limited to subordinate uses in protosciences such as astrology. Now Western man, as a consequence of two thousand years of intellectual tradition, persists in the habit of making causal connections first and inductive links, if at all, only as an afterthought. This habit must still be considered the biggest obstacle to an adequate appreciation of Chinese science in general and Chinese medicine in particular. Given such different cognitive bases, many of the apparent similarities between traditional Chinese and European science which attract the attention of positivists turn out to be spurious.

Model of the body





Traditional Chinese medicine is largely based on the concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi , blood, , other bodily fluids, the , emotions, and the soul or spirit . TCM has a unique , notably concerned with the . 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.

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

Theories invoked to describe the human body in TCM include:

*Yin or Yang
*
*Zang Fu theory
*Meridian
*Three jiaos also known as the Triple Burner or the Triple Warmer

The Yin/Yang and five element theories may be applied to a variety of systems other than the human body, whereas Zang Fu theory, meridian theory and three-jiao theories are more specific.

There are also separate models that apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and the Eight principles system of disease classification.

Diagnostics



Following a macro philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than "micro" level laboratory tests. There are four types of TCM diagnostic methods: observe , hear and smell , ask about background and touching . The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as "Going to have my pulse felt"

Traditional Chinese medicine is considered to require considerable diagnostic skill. A training period of years or decades is said to be necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, ''A good doctor is also qualified to be a good prime minister in a country''. Modern practitioners in China often use a traditional system in combination with Western methods.

Techniques


* Palpation of the patient's radial artery pulse in six positions
* Observations of patient's tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children
* Palpation of the patient's body for tenderness or comparison of relative warmth or coolness of different parts of the body
* Observation of the patient's various odors
* Asking the patient about the effects of their problem.
* Anything else that can be observed without instruments and without harming the patient
* Asking detailed questions about their family, living environment, personal habits, food diet, emotions, menstrual cycle for women, child bearing history, sleep, exercise, and anything that may give insight into the balance or imbalance of an individual.

Treatment


The below methods are considered as part of the Chinese medicine treatment:
#
# Acupuncture- Moxibustion, Cupping,Gua Sha
# Tui na - TuiNa healing massage therapy
# Qigong and related breathing and meditation exercise
# Chinese food therapy
# Physical Qigong exercises such as TaiJiChuan , Standing Meditation (站樁功), Yoga, Brocade BaDuanJin exercises and even perhaps other Chinese martial arts
# ''Die-da'' or ''Tieh Ta'' as practiced usually by martial artists who usually know just parts of Chinese medicine as it applies to the therapy of wounds and trauma.
# Some TCM doctors may also utilize esoteric methods that incorporate/reflect personal beliefs or specializations such as Fengshui or astrology

Auriculotherapy comes under the heading of Acupuncture and Moxibustion. ''Tieh Ta'' are practitioners who specialize in healing injury such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies if serious injury is involved. Such practice of bone-setting is not common in the West.

Branches


Traditional Chinese medicine has many branches, the most prominent of which are the Jingfang and Wenbing schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the and Tang dynasty, such as Huangdi Neijing and Shennong Bencaojing. The more recent Wenbing school's practise is largely based on more recent books including Compendium of Materia Medica from and Qing Dynasty, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in mainland China, when Wenbing school used political power to suppress the opposing school.

Scientific view


Efficacy



:See also:

Much of the scientific research on TCM has focused on acupuncture. The effectiveness of acupuncture remains controversial in the scientific community, and a review by Edzard Ernst and colleagues in 2007 found that the body of evidence was growing, research is active, and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions". Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea. A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions. There is conflicting evidence that it can treat chronic low back pain, and moderate evidence of efficacy for neck pain and headache. For most other conditions reviewers have found either a lack of efficacy or have concluded that there is insufficient evidence to determine if acupuncture is effective . While little is known about the mechanisms by which acupuncture may act, a review of neuroimaging research suggests that specific acupuncture points have distinct effects on cerebral activity in specific areas that are not otherwise predictable anatomically.

The World Health Organisation , the National Institutes of Health , and the American Medical Association have also commented on acupuncture. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted. The 1997 NIH on acupuncture concluded:


...promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.


Much less scientific research has been done on Chinese herbal medicines, which comprise much of TCM.
Some doubts about the efficacy of many TCM treatments are based on their apparent basis in sympathetic magic — for example, that plants with heart-shaped leaves will help the heart, or that ground bones of the tiger can function as a stimulant because tigers are energetic animals. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the substantial cost and expertise required to conduct double-blind clinical trials, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.

Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria, and is also under investigation as an anti-cancer agent. It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria. It was the only one that was effective. Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.

Safety


Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should be administered by persons who have been educated to apply them safely. One Australian report said in 2006, "A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended traditional Chinese medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs."

Certain Chinese herbal medicines involve a risk of reaction and in rare cases involve a risk of poisoning. Cases of acute and chronic poisoning due to treatment through ingested Chinese medicines are found in China, Hong Kong, and Taiwan, with a few deaths occurring each year. Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs. The raw and unprocessed form of aconite, or fuzi is the most common cause of poisoning. The use of aconite in Chinese herbal medicine is usually limited to processed aconite, in which the toxicity is denatured by heat treatment.

Furthermore, potentially toxic and carcinogenic compounds such as arsenic and cinnabar are sometimes prescribed as part of a medicinal mixture, in a sense "''using poison to cure poison''". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. Much of these are being prevented with more empirical studies of Chinese herbals and tighter regulation regarding the growing, processing, and prescription of various herbals.

In the United States, the Chinese herb ''má huáng'' — known commonly in the West by its Latin name Ephedra — was banned in 2004 by the , although the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a highly modern phenomenon and well removed from traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA's ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency's finding that ephedra posed an unreasonable risk to consumers.

Many Chinese medicines have different names for the same ingredient depending on location and time, but worse yet, ingredients with vastly different medical properties have shared similar or even the same names. For example, there was a report that mirabilite/sodium sulphate decahydrate was misrecognized as sodium nitrite , resulting in a poisoned victim. In some Chinese medical texts, both names are interchangeable. The Chinese Medicine Registration Board of the Australian state of issued a report in 2004 which noted this was a problem that needed to be addressed.

Relationship with 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.

Outside of China, the relationship between TCM and Western medicine is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are 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 some 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 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.

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. As a simple example, 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 multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula. A report by the state government in Australia on TCM education in China noted:
:Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practise TCM as a specialty within the broader organisation of Chinese health care.

In other countries it is not necessarily the case that traditional Chinese and Western medicine are practiced concurrently by the same practitioner. TCM education in Australia, for example, does not qualify a practitioner to provide diagnosis in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures. While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.. Some, such as the use of tiger's penis for impotence, cannot seriously be attributed to Chinese Medicine, nor any vague complaint about practitioners using these types of substances taken seriously, as the substances they talk about simply don't appear in the ingredients lists of the pharmacopoeia. Use of rhinoceros horn for "cooling the blood" was replaced with horn starting from perhaps 5CE, and cow bile is a modern replacement for bear bile . An ingredient like "horny goat weed" is obviously a plant .

Medicinal use is having a major impact on the populations of seahorses, which are considered a fundamental ingredient, and used to treat a variety of disorders, including asthma, arteriosclerosis, incontinence, impotence, thyroid disorders, skin ailments, broken bones, heart disease, as well as to facilitate childbirth and even as an aphrodisiac.

Shark fin soup is traditionally regarded as beneficial for health in East Asia, and its status as an "elite" dish has led to huge demand with the increase of affluence in China, but it is surely having a devastating effect on shark populations.

The animal rights movement notes that a few traditional Chinese medicinal solutions still use bear bile . Since 1988 the Chinese Ministry of Health started controlling production of this, which previously used bears killed before winter. The bears are often fitted with a sort of permanent catheter, which may have been thought to be more humane than killing the bears. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China; gallbladders from butchered cattle are recommended as a substitute for this ingredient.

Opposition


Starting from late 19th century, some politicians and Chinese scholars with background in Western medicine have been trying to phase out TCM totally in China.

The attempts to curtail TCM in China always provoke large scale debates but have never completely succeeded. Still, many researchers and practitioners of TCM in China and the United States argue the need to document TCM's efficacy with controlled, double blind experiments. These efforts remain hampered by the difficulty of creating effective placebos for acupuncture studies.

The attempt to phase out TCM in Japan partially succeeded after Meiji Restoration. However, in the 1920s a movement emerged that attempted to restore traditional medical practice, especially acupuncture. This movement, known as the Meridian Therapy movement persists to this day. Furthermore, many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine. The most scientific derivative of TCM practiced in Japan is ryodoraku. It was developed by Yosio Nakatani in 1950. It utilizes objective electricity test instruments and direct current stimulation of acupoints instead of subjective interpretation of symptoms and treatment. Ryodoraku research is centered at Osaka Medical College, Japan.

Modernization


Traditional Chinese medicine has been to some degree modernized by transforming the plants and ingredients to soluble granules and tablets. Modern formulations in pills and sachets used 675 plant and fungi ingredients and about 25 from non-plant sources such as snakes, geckos, toads, bees, and earthworms.

Investigation of the active ingredients in TCM has produced western style drugs, for example Artemisinin now widely used in the treatment of malaria.

Online databases


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* Classical texts in public domain.
* Classical texts for FTP

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