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Traditional Chinese medicineFrom Wikipedia, the free encyclopedia
Traditional Chinese medicine, also known as TCM, includes a range of traditional medicine practices originating in China. Although well accepted in the mainstream of medical care throughout East Asia, it is considered an alternative medical system in much of the Western world. TCM practices include such treatments as Chinese herbal medicine, acupuncture, dietary therapy, and both Tui na and Shiatsu massage. Qigong and Taijiquan are also closely associated with TCM. Major theories include: Yin-yang, the Five Phases, the human body Meridian/Channel system, Zang Fu organ theory, six confirmations, four levels, etc. Modern TCM was systematized in the 1950s under the People's Republic of China and Mao Zedong. Prior to this, Chinese medicine was mainly practiced within family lineage systems.
HistoryAncient (classical) historyMuch of the philosophy of traditional Chinese medicine derives from the same philosophy that informs Taoist and Buddhist thought, and reflects the classical Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment on all levels.[1] In legend, as a result of a dialogue with his minister Qibo (岐伯), the Yellow Emperor (2698 - 2596 BCE) is supposed by Chinese tradition to have composed his Neijing: Suwen or Inner Canon: Basic Questions (内经·素问). The book Huangdi Neijing (黄帝内经), Yellow Emperor's Inner Canon's title is often mistranslated as Yellow Emperor's Classic of Internal Medicine. 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 (202 BC –220 AD), Zhang Zhongjing (张仲景/張仲景), 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 (c. 140 – c. 208 AD), who anesthetized patients during surgery with a formula of wine and powdered cannabis. 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 Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 - 282 AD), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙经/甲乙經), ca. 265 AD. During the Tang dynasty, Wang Bing 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. Emperor Gaozong (r. 649–683) of the Tang Dynasty (618–907) 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.[2] In his Bencao Tujing ('Illustrated Pharmacopoeia'), the scholar-official Su Song (1020–1101) not only systematically categorized herbs and minerals according to their pharmaceutical uses, but he also took an interest in zoology.[3][4][5][6] 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 the capital city, as well as reservoirs and marshes of Hebei.[7] 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.[8] 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 analyzed 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[9] - 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"[10] The term "TCM" describes the modern practice of Chinese medicine as a result of sweeping reforms that took place after 1950 in the People's Republic of China. The term "Classical Chinese medicine" (CCM) often refers to medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911). Timeline.JPG)
The history of TCM can be summarized by a list of important doctors and books.
Theory.JPG)
The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM are shown to have been influenced by Taoism, Buddhism, and Neo-Confucianism.[12] Since 1200 BC, Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterization 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:
The Shen Nong's Herbal Classic, a 2000-year old medicinal Chinese book considered today as the oldest book on oriental herbal medicine, classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:
Lingzhi ranked number one of the superior medicines, and was therefore the most exalted medicine in ancient times.[14] The ancient Chinese use of mushrooms for medicine, has inspired modern day research into medicinal mushrooms like shiitake, Agaricus blazei, Trametes versicolor, the table mushroom and of course lingzhi.[15] Highly purified compounds isolated from medicinal mushrooms like lentinan (isolated from Shiitake), and Polysaccharide-K, (isolated from Trametes versicolor), have become incorporated into the health care system of countries such as Japan.[16] The compounds are used to stimulate the immune system and promote health. Basic theory and model of the bodyMain article: TCM model of the body
Traditional Chinese Medicine (TCM) is largely based on the philosophical concept that the universe is made of an energy called chi. This energy can be any state of matter or energy in existence. TCM believes that the human body is a small universe unto itself that is a complex system of subsystems of energy and matter, and that these systems work together to maintain a healthy human mind and body. The characteristics of the operation of the system/subsystems of the human mind/body are described in terms of the five elements (metal, water, wood, fire, and earth), Ying/Yang organs, deficiency/excess, emptiness/fullness, hot, cold, wind, dampness, pathogenic factors, internal/external, meridian channels, chi (several different types), essences, body fluids, vessels and more. TCM posits that illness is caused by external and/or internal factors which affect the human body's natural processes negatively. The body concept in TCM is based on a functional description of human mind/body processes, as opposed to discrete tissues, or specific organic compounds. Thus, there are differences in anatomy in TCM, the spleen is not as specific a piece of flesh, but an aspect of function related to a body process (transformation and transportation). An additional difference (among many) from Science is a functional description of the mind and emotions as a result of TCM internal organs as opposed to the brain. As a result of using this functional approach to describing the processes of the human mind/body it is possible to treat the entire human mind and body not just the mind or just the body through the therapies available in this system.
There are significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice and theory. Diagnosis of cause of illness in TCMMain article: Diagnosis of cause of illness in TCM
Diagnosis of causes of illness in TCM consists of the utilization of various forms of observation including visual, auditory, olfactory, touch, and questioning. These observations take the form of descriptions of color, moisture, heat, among many others to ultimately identify a pattern that can be subsequently treated. Some of the methods for pattern recognition include the following: 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 (Triple warmer) 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. DiagnosticsFollowing 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 (望 wàng), hear and smell (闻/聞 wén), ask about background (问/問 wèn) and touching (切 qiè).[17] 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."[18] 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 (TCM) doctor is also qualified to be a good prime minister in a country.[citation needed][dubious ] Modern practitioners in China often use a traditional system in combination with Western methods.[citation needed] Techniques
Methods of treatmentThe following methods are considered to be part of Chinese medicine:
BranchesTraditional Chinese medicine has many branches, the most prominent of which are the Jingfang (经方学派) and Wenbing (温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han 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 Ming 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.[citation needed] Scientific viewEfficacyMuch 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".[19] Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.[20][21] A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.[22] There is conflicting evidence that it can treat chronic low back pain,[23][24] and moderate evidence of efficacy for neck pain[25][26] and headache.[27] For most other conditions[28] reviewers have found either a lack of efficacy (e.g., help in quitting smoking[29]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain[30]). 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.[31] The website Quackwatch mentions that TCM as with many alternative medicines has been the subject of criticism as having unproven efficacy and an unsound scientific basis.[32] The World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture.[33][34] 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 Consensus Development Conference Statement on acupuncture concluded:
Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood (qinghao) 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.[citation needed] It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria[citation needed]. Other compounds, such as those seen in Dichroa febrifuga Lour and Bidens pilosa, including febrifugine, also have potential antimalarial properties currently being researched, but also exhibit high toxicity [35][36] Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.[37] SafetyIn practiceAcupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage[citation needed] and infection[citation needed] 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.[citation needed] 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."[38] AllergyCertain Chinese herbal medicines involve a risk of allergic 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.[citation needed] Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs.[citation needed] 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. Toxins and contaminantsPotentially toxic and carcinogenic compounds such as arsenic trioxide (三氧化二砷) and cinnabar (called zhūshā, 朱砂) 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. The knowledge of processing is being improved with more empirical studies of Chinese herbals and tighter regulations are being put in place, whether heeded to or not, regarding the growing, processing, and prescription of various herbals. A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off shelves in UK in July 2004 when it found to contain 11-13% mercury.[39] In the United States, the Chinese herb má huáng (麻黄; lit. "hemp yellow") — known commonly in the West by its Latin name Ephedra — was banned in 2004 by the FDA, 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. Lack of standardizationChinese herbals are often not standardized from one pill to the next, or from one brand to the next, and can be reformulated, remixed, or otherwise altered by any company.[citation needed] Vague namingMany Chinese medicines have different names for the same ingredient depending on location and time, ingredients with different medical properties have shared similar names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized as sodium nitrite (牙硝),[40] resulting in a poisoned victim.[41][42] In some Chinese medical texts, both names are interchangeable.[43] The Chinese Medicine Registration Board of the Australian state of Victoria issued a report in 2004 which noted this was a problem that needed to be addressed.[44] Relationship with Western medicineAs 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, whereas this may be routine in some parts of rural China. Most Chinese, in China as well as other countries, 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, they will see a Western doctor if they have acute appendicitis, but they exercise or take Chinese herbs to keep their bodies 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[citation needed], and most doctors in China will use some elements of Chinese medicine in their own practice[citation needed]. 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 Victorian state government in Australia on TCM education in China noted:
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.[46] 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.[44] Traditional Chinese diagnostics and treatments are often much cheaper than Western methods which require high-tech equipment or extensive chemical manipulation. Modern TCM practitioners will refer patients to Western medical facilities if a medical condition is deemed to have put the body too far out of balance for traditional methods to remedy. Animal products
Animal products are used in certain Chinese formulae, which may present a problem for vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances. The practice of using endangered species is controversial within TCM. Many substances fall into this category, with modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text dealing with substances derived from endangered species in an appendix, with an emphasis on recommending alternatives.[47] Some claimed uses of certain animal derived ingredients, such as use of the tiger's penis for impotence, cannot be considered true, because the substances in question do not appear in the ingredients lists of the pharmacopoeia[citation needed]. Use of rhinoceros horn (xī jiǎo / 犀角) for "cooling the blood" was replaced with buffalo horn (shuǐ niú jiǎo / 水牛角) starting from perhaps 5CE, and cow (bovine) bile (niú dǎn / 牛膽 / 牛胆) is a modern replacement for bear (ursine) bile (xíong dǎn / 熊膽 / 熊胆). An ingredient like "horny goat weed" (yín yáng hoù / 淫羊藿) is obviously a plant (Epimedium). 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.[48] 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.[49] Widespread medicinal use of turtle plastron is of concern to conservationists as well.[50] Customs authority in many countries monitor exports of medicinal products trying to ensure that no items made from CITES-proscribed species are imported. Since in some cases it is difficult to identify from what species a particular processed product has been made, sophisticated biochemical techniques are being developed to make such identification possible.[50][51] The animal rights movement notes that a few traditional Chinese medicinal solutions still use bear bile (xíong dǎn). 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 was more profitable than killing the bears.[52] The treatment itself and especially the extraction of the bile is very painful for bears, and causes damage to their stomach and intestines, often resulting in their eventual death. 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 (cow bile / niú dǎn) are recommended as a substitute for this ingredient. OppositionStarting from the late 19th century, some politicians and Chinese scholars with backgrounds in Western medicine have been trying to phase out TCM totally in China.[citation needed] 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.[citation needed] The attempt to phase out TCM in Japan partially succeeded after the 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 (Keiraku Chiryo in Japanese), 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.[citation needed] However, there are many differences such as standardization and strong enforced regulations in Kampo that are absent in TCM. The most scientific derivative of TCM practiced in Japan is ryodoraku (良導絡), which was developed by Yosio Nakatani in 1950. It utilizes objective electricity test instruments and direct current stimulation of acuーpoints instead of subjective interpretation of symptoms and treatment. Ryodoraku research is centered at Osaka Medical College, Japan. The use of parts of endangered species (such as seahorses, rhinoceros horns, and tiger bones and claws) has created controversy and resulted in a black market of poachers who hunt restricted animals.[53][54] Deep-seated cultural beliefs in the potency of tiger parts are so prevalent across Asia that laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets, according to a 2008 report from TRAFFIC Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility,[55] and tiger eyes. In Black Market, photographer Patrick Brown took a deep look at the illegal wildlife trade in Asia. 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, frogs, bees, and earthworms. Investigation of the active ingredients in TCM has produced well-known drugs such as : Artemisinin, widely used in the treatment of malaria. See also
Notes
References
Further reading
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