Traditional Chinese medicine

Traditional Chinese medicine (TCM) is an alternative medical practice from old healing ways in China. It includes methods like herbal medicine, acupuncture, and special exercises. However, many of its ideas lack strong scientific support, and some ingredients can be unsafe.

People in China have used many health practices for thousands of years. These included folk beliefs, Taoist and Confucian philosophy, and natural remedies. In the 1900s, some Chinese leaders thought these old ways were outdated. But later, the government helped bring them back, especially during the Cultural Revolution.

Today, TCM is used by many people in China and other parts of Asia. It is based on the idea that a special energy called qi flows through the body. Scientists have not found proof that these paths or this energy really exist. Sadly, the need for some traditional medicines has led to problems for wildlife protection.

Ancient history

People who study medicine in China say that the ideas of what we now call Traditional Chinese Medicine are different from older ways of healing. Some say the name started because of a doctor named Dr. Kan-Wen Ma who moved to Britain, while others say it began in 1955.

One scholar, Nathan Sivin, says that for 2,000 years, medicine in China changed a lot and was not one simple system. He says it can be confusing to understand old Chinese medicine using today’s ideas.

Traditional Chinese medicine is based on old books like the Yellow Emperor's Inner Canon and ideas such as yin–yang and the five phases. The Compendium of Materia Medica started around 1,100 BCE with just a few drugs, but later it listed almost 1,900 drugs.

Traces of healing in China go back to the Shang dynasty (14th–11th centuries BCE). We know they had health problems like eye disorders and toothaches, which they thought were caused by spirits. There is no proof they used herbs.

The Yellow Emperor's Inner Canon, written around the first century BCE, is the oldest known book on Chinese medicine. It talks about how humans relate to the world, what’s inside the body, and how to decide on treatments. Unlike older books, it did not believe in magic or spirits.

Later books such as the Treatise on Cold Damage Disorders and Miscellaneous Illnesses focused more on using medicines instead of methods like acupuncture. These books helped organize symptoms to make treatment easier.

Chinese doctors were also the first to use a kind of early vaccination called variolation around 900–1000 AD to protect against smallpox. They found that if healthy people were exposed to small pieces of smallpox skin, they were less likely to get sick from the disease later.

Modern history

Chinese communities under colonial rule

Chinese communities in colonial port cities were influenced by many cultures. This led to changes in medical practices, where Chinese medicine mixed with Western medical knowledge. For example, the Tung Wah Hospital was opened in Hong Kong in 1869 because many people preferred Chinese medicine. Later, Western medicine was also used there. A similar hospital, the Kwong Wai Shiu Hospital in Singapore, opened for the same reasons and also used both types of medicine. By 1935, newspapers in Singapore used the term “Traditional Chinese Medicine” to describe these Chinese medical practices.

In areas controlled by the Chinese Communist Party before 1949, Western medical resources were scarce. To improve healthcare, the Party encouraged combining traditional Chinese medicine with Western science.

People's Republic

In 1950, Mao Zedong, the leader of the Chinese Communist Party, announced support for traditional Chinese medicine. During the Cultural Revolution from 1966 to 1976, the government focused on modernizing the country. They created a basic healthcare system and invested in traditional medicine. They wanted to make healthcare more affordable and available. Doctors trained in Western medicine learned traditional methods, and traditional healers learned modern techniques. This helped mix the two styles of medicine.

In 1968, the government started a program for rural areas. Each village got a barefoot doctor, someone with basic medical skills to help with common health problems. These doctors used both traditional and modern methods to help people in remote areas.

More recently, leaders have supported traditional Chinese medicine strongly.

Hong Kong

When Hong Kong opened up, most people still used Chinese medicine because Western doctors were rare. In 1841, the British government promised to respect local customs, so Chinese medicine was allowed. The Tung Wah Hospital opened in 1870 and used Chinese medicine. Later, Western medicine became more popular, especially after 1940.

Historiography of Chinese medicine

Studying traditional Chinese medicine is a special field in the history of science. Some experts say that today’s version of traditional Chinese medicine is newer and not exactly the same as ancient practices. They point out that ideas about the body in Chinese medicine are different from Western ideas. In Chinese medicine, the body includes both physical and emotional parts, connected to the whole universe. Concepts like balance (yin and yang) and energy (qi) are important in understanding health.

Critiques

Some people think that traditional Chinese medicine does not fit with what we know from science today. They say that why some treatments work is not always clear.

There have been worries that some ingredients in traditional Chinese medicine can be bad for health. There are also concerns that some animals used in these practices are not treated well, and that some plants come from animals that are in danger.

Philosophical background

Traditional Chinese medicine has many practices used in China for over 2,000 years. These include herbal medicine, acupuncture, massage, special exercises, and special ways of eating. People use these methods to help with health issues. These ideas come from old Chinese thoughts about balance and nature. They include ideas about energy called qi, and balance between two forces called yin and yang.

Yin and yang

Main article: Yin and yang

Yin and yang are old Chinese ideas that help explain how things work. They represent two sides of everything in the world. For example, the sunny side of a hill is yang, and the shady side is yin. These ideas are used to understand health and sickness in the body. For example, feelings like being hot or cold are linked to yin or yang. Traditional Chinese medicine uses these ideas to help treat health problems.

Model of the body

Main article: TCM model of the body

Traditional Chinese medicine (TCM) talks about the body in a special way. It says the body has something called "chi" or "qi" (vital energy) that moves through channels named "jingluo" (meridians). These channels connect to different parts of the body and help with things like digestion and breathing.

TCM focuses on how the body works instead of looking at its physical structure. It uses ideas like "qi", "xuĕ" (blood), and organ systems to explain health. Some scientists say these ideas are not based on real science.

Qi

Main article: Qi

"Qi" is an important idea in TCM. It is thought to help with many body functions, like moving blood and keeping the body warm. If someone has too little "qi", they might feel tired or weak.

Xie

"Xuĕ" or "xiĕ" (blood) in TCM is linked to the red liquid in our veins. It is said to give nutrition to the body and help with sleep.

Jinye

"Jinye" are body fluids like tears, sweat, and saliva. They help keep the body moist and support other body functions.

Zangfu

Main article: Zangfu

The "zangfu" are groups of body functions in TCM, not exactly the same as real organs. They are split into five "zang" (yin) and six "fu" (yang) parts, each linked to different body processes.

Jing-luo

Main article: Meridian (Chinese medicine)

Meridians are believed to be paths in the body that carry "qi" and "xuĕ". TCM talks about 12 main meridians and 8 extra ones that connect different parts of the body.

Gender in traditional medicine

In traditional Chinese medicine, there was a special area called fuke that focused on women's health. This was similar to what we now call gynecology and obstetrics.

Back then, people knew less about women's health. Women often found it hard to talk openly about their health, especially with male doctors. This made it difficult to understand and diagnose problems.

Doctors used different methods to check a woman’s health. The ideas of yin and yang—two forces that balance each other—were important. These ideas helped doctors think about how energy moved through the body.

Traditional Chinese medicine saw pregnancy as hard to recognize early. After childbirth, mothers were given special care to help them get better. Infertility was a serious issue and was hard to diagnose.

Concept of disease

In Traditional Chinese medicine (TCM), disease is an imbalance in the body. This imbalance can involve energy (called qi), blood (called xuĕ), or other body parts.

TCM doctors check things like tongue color, pulse, and breathing to find these imbalances. For example, they might see signs that suggest a specific imbalance and then choose a treatment to help balance the body again.

TCM talks about diseases in two ways: one is the general name of the problem (like a cold), and the other is the specific pattern of imbalance. Two people with the same problem might have different patterns, so they would get different treatments. This helps TCM doctors choose the best way to help each person based on their unique signs and symptoms.

Diagnostics

In Traditional Chinese medicine (TCM), there are five main ways to check someone's health: looking, listening, smelling, asking questions, and feeling. These are called the "Four pillars" of diagnosis.

• Looking means checking the face and especially the tongue. This includes looking at the tongue's size, shape, color, and any marks on it.
• Listening means paying attention to sounds like wheezing.
• Smelling means noticing any body odors.
• Asking questions means talking to the person about things like feeling cold or hot, sweating, eating, drinking, and other body functions.
• Feeling means touching the body to find tender spots and feeling the pulses at the wrist.

Checking the tongue and feeling the pulse are very important in TCM. The tongue's look can give clues about health, and feeling the pulse at different spots on the wrist can show different health patterns. Learning these methods can take many years.

Main article: tongue diagnosis

Herbal medicine

Main article: Chinese herbology

See also: List of traditional Chinese medicines

Herbal medicine in traditional Chinese medicine includes plants, animal parts, human products, fungi, and minerals. A review in 2019 found that while many people use these treatments, there is not enough scientific proof to show they work well.

Raw materials

There are about 13,000 different substances used in China, with over 100,000 recorded recipes. Plants are the most common ingredient. An old book from 1941 listed 517 drugs, of which 45 came from animals and 30 from minerals.

Animal substances

Some treatments use parts from animals like cow gallstones, hornet nests, leeches, and scorpions. Others include antelope or buffalo horns, deer antlers, dog testicles, and snake bile. While some books still suggest using animal tissues, there is not much research to prove these work well.

Endangered species and other wild animals

Some treatments use parts from endangered animals, like tiger bones and rhinoceros horn. The demand for rhino horn has greatly reduced rhino populations. There are also concerns about using pangolin scales, turtle shells, seahorses, and parts from mobula and manta rays.

Poachers hunt endangered animals to sell their parts for traditional medicine. There is no proof that tiger parts work as medicine. Laws protect endangered species, but tiger parts are still sold illegally. Seahorses are also heavily hunted, and many are at risk of disappearing.

The deer penis is thought to have health benefits in traditional medicine. Shark fin soup is considered beneficial in Chinese medicine and is popular, but it has greatly harmed shark populations. Shark finning is banned in many places, but trading still happens in Hong Kong and China.

Rules limit the use and trade of endangered species not raised on farms. Scientists can find DNA from endangered species in some medicines. Donkey hide, used to make a remedy called ejiao, has led some African countries to restrict exports.

Animals raised in captivity

Because traditional medicine values bear bile, over 12,000 Asiatic black bears are kept on bear farms. Bile is taken from them through a surgical procedure. This practice has caused much concern. Bear bile was listed as a treatment for severe COVID-19 cases in China in 2020.

Tortoises and turtles used in traditional medicine are often farmed, but wild turtles in China are still at risk.

Replacement

Some ingredients from endangered animals have alternatives. For example, rhinoceros horn is often replaced with buffalo horn powder. Tiger bone is replaced with a mix of bones from livestock in some approved medicines.

Human body parts

Traditional Chinese medicine sometimes used parts from humans, like bones, nails, hair, and even organs. Human placenta, called "Ziheche," was used to treat infertility and other conditions, but it can cause infections.

Traditional categorization

Traditional ways to group these medicines include:

• Four Natures: hot, warm, cool, or cold. Hot and warm treat cold illnesses, while cool and cold treat heat illnesses.
• Five Flavors: acrid, sweet, bitter, sour, and salty. Each flavor is linked to body organs and has specific effects.
• Meridian classification: which body system the medicine affects.
• Specific functions: such as reducing fever, easing pain, or helping digestion.

Efficacy

As of 2007, there were not enough good studies to prove herbal therapies work. Many studies are written in Chinese and not always included in reviews. Some reviews have mistakes or are hard to trust. Herbs recommended in the US are not regulated.

• A 2013 review found not enough proof that Chinese herbs help with prostate issues.
• Another 2013 review could not support using these herbs for hearing loss.
• A 2013 review found unsure results for treating eczema.
• Ginger, used for rheumatism and headaches, does not have strong proof it works.
• A 2012 review found no difference in death rates among SARS patients using Chinese herbs or only Western medicine, though some herbs may have helped symptoms.
• Other reviews found weak or no proof for treating Sjögren's syndrome, high cholesterol, diabetes, fibromyalgia, painful periods, turmeric for various illnesses, HIV/AIDS, angina, and stopping bleeding from haemorrhoids.

Drug research

Further information: Arsenic trioxide, Artemisinin, Huperzine A, and Ephedrine

Scientists have tried to make new drugs from traditional medicines. In the 1970s, they found artemisinin from the herb Artemisia annua, which is very good for treating malaria. Tu Youyou won a Nobel Prize for this work in 2015. Another drug, Trisenox, was developed from arsenic trioxide to treat leukemia.

Huperzine A from the herb Huperzia serrata is being studied for Alzheimer's disease, but more research is needed. Ephedrine, found in the herb má huáng, has been used since ancient times to help with breathing problems.

Pien tze huang was first used in the Ming dynasty.

Cost-effectiveness

A 2012 review found not enough information about the cost-effectiveness of traditional Chinese medicine.

Safety

Some traditional medicines can be very harmful. They may contain toxic chemicals, heavy metals, or wrong plants. Some herbs can cause liver damage or other health problems. For example, Xanthium sibiricum must be processed to be safe. Some herbs like Reynoutria multiflora can harm the liver.

Misuse of some medicines, like Ephedra, can cause serious health issues. Some herbal products are mixed with strong drugs, which can be dangerous. Working close to bat caves for gathering guano can put people at risk of diseases carried by bats.

Acupuncture and moxibustion

Main articles: Acupuncture and Moxibustion

Acupuncture puts tiny needles into certain spots on the body to help with pain and other health issues. It is often used with moxibustion, which burns a plant called mugwort near the skin. Some people think this helps with many health problems, but studies have not always shown that it works.

Research on acupuncture has had mixed results. Some studies show small benefits for certain pains, while others find no real difference compared to other treatments. Experts say it is usually safe when done properly, but like any medical treatment, it can sometimes cause problems.

Tui na

Main article: Tui na

Tui na (推拿) is a kind of massage from old Chinese ideas about health. It is thought to be the basis for a Japanese method called shiatsu. Tui na uses moves such as pressing with thumbs, rubbing, tapping, and helping to stretch muscles.

Qigong

Main article: Qigong

Qìgōng (气功; 氣功) is a type of exercise and meditation from Traditional Chinese medicine. It uses slow movements, special breathing, and focus to help balance a person's energy, called qi. One kind of qigong is called Qigong massage, where the person doing the therapy uses massage along with knowledge of special energy points on the body.

Qi means the life energy inside us, and Gong means working with that energy through movement and practice.

Other therapies

Cupping

Main article: Cupping therapy

Cupping is a kind of Chinese massage. Small glass cups are placed on the skin. A match lights the air inside the cup, making the air expand. When the cup is placed on the skin and the air cools, it creates a gentle pull. The cups can be moved around the back with massage oil.

Gua sha

Main article: Gua sha

Gua sha is a treatment using smooth tools like jade or stone. These tools gently scrape the skin. This can cause red spots or small bruises. These marks are thought to help with health problems. The skin usually heals in about three to ten days. There might be some soreness where it was done.

Die-da

Main article: Die-da

Diē-dǎ, or Dit Da, is a Chinese way to help fix broken or injured bones. It is often done by people who know about Chinese medicine and martial arts. They help set bones and may suggest other treatments for serious injuries. This bone-setting practice is not common in many other places.

Chinese food therapy

Main article: Chinese food therapy

In Chinese food therapy, different foods are linked to ideas of yin and yang. The tradition says it is important to eat these foods in balance. However, there is no scientific proof to support these ideas.

Regulations

Many governments have made rules to control how Traditional Chinese medicine is practiced.

Australia

Since July 1, 2012, people who practice Chinese medicine in Australia must be registered with the Chinese Medicine Board of Australia and meet certain standards.

Canada

In five Canadian provinces—Alberta, British Columbia, Ontario, Quebec, and Newfoundland & Labrador—there are rules for TCM.

China (mainland)

The National Administration of Traditional Chinese Medicine began in 1949. In 2016, China made its first law about TCM, which started on July 1, 2017. This law sets rules for who can practice TCM and how products can be advertised.

Hong Kong

During British rule, TCM practitioners were not seen as medical doctors. Now, they must register with the Chinese Medicine Council of Hong Kong and meet certain education and exam requirements.

Macau

Macau started regulating TCM in 1994. In 2022, new laws were put in place to control how TCM is practiced there.

Indonesia

All traditional medicines, including TCM, follow rules set by the Indonesian Minister of Health. Only certain TCM methods, like acupuncture, are accepted and can be used by licensed practitioners.

Japan

Main articles: Kampo and Kampo list

Kampo is Japan’s version of Chinese medicine. It has its own ways of diagnosing and treating that are different from TCM. In Japan, doctors can use some TCM treatments, but often these are done by special therapists.

Korea

Main article: Traditional Korean medicine

In Korea, doctors who practice oriental medicine are treated the same as other medical doctors.

Malaysia

In 2012, Malaysia created a law to register and control practitioners of traditional and complementary medicine, including TCM.

Netherlands

There are no special rules for TCM in the Netherlands. Chinese herbs used in TCM are sold as food or supplements. Some health insurance companies may pay for acupuncture, depending on the policy.

New Zealand

New Zealand does not have specific rules for TCM, but acupuncture has been covered by the government’s Accident Compensation Corporation since 1990 for certain injuries.

Singapore

Since 2000, Singapore has had laws to register and control TCM practitioners. They must meet education and exam requirements. In 2024, Nanyang Technological University will start offering a degree in Chinese Medicine.

Taiwan

In Taiwan, TCM practitioners are doctors who can diagnose, prescribe medicine, and order tests like X-rays and blood tests. They must have a 7-year university degree in TCM.

United States

By July 2012, most U.S. states had laws to control TCM practice. California was the first state in 1976 to license professional acupuncturists.