Traditional Chinese medicine

Traditional Chinese medicine (TCM) is an alternative medical practice that comes from old healing ways in China. It includes many different methods like herbal medicine, acupuncture, and special exercises. However, many of its ideas are not supported by strong science, and some ingredients can be harmful.

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 In the 1900s, some Chinese leaders thought these old ways were outdated.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 in certain paths. But scientists have not found proof that these paths or this energy really exist. Sadly, the need for some traditional medicines has led to the killing and smuggling of endangered animals, which is a big problem for wildlife protection.

Ancient history

People who study the history of medicine in China say that the ideas and practices of what we now call Traditional Chinese Medicine are different from the older ways of healing used in the past. Some say the name "Traditional Chinese Medicine" started because of a doctor named Dr. Kan-Wen Ma who moved to Britain, while others say it was created by people spreading ideas 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 warns that trying to understand old Chinese medicine using today’s medical ideas can be confusing or wrong.

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 by the end of the 16th century, 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 into groups 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 around them. 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 over Western styles. 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. However, some scientists worry that traditional methods aren’t always tested as carefully as Western medicine.

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. Historians learn about old Chinese medicine by reading case studies written by doctors about their patients, which show how treatments were personalized for each person.

Critiques

Critics say that traditional Chinese medicine does not match what we know from modern science. They say its treatments often lack a clear reason why they work. Some believe it is based on old ideas that are not scientifically proven.

There have been concerns about some ingredients in traditional Chinese medicine being harmful or even causing illness. Some animals used in these practices are treated poorly, and there are worries about the use of endangered species.

Philosophical background

Traditional Chinese medicine includes many practices that have been used in China for over 2,000 years. These practices include herbal medicine, acupuncture, massage, special exercises, and special ways of eating. People often use these methods to help with health issues. These ideas come from old Chinese thoughts about balance and nature, including 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, different feelings like being hot or cold are linked to yin or yang. Traditional Chinese medicine uses these ideas to help treat different 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, breathing, and keeping the body warm.

TCM focuses on how the body works rather than its physical structure. It uses ideas like "qi", "xuě" (blood), and different organ systems to explain health. However, many scientists say these ideas are not based on real science. They say there is no proof for things like "qi" or meridians, and some treatments can be harmful.

Qi

Main article: Qi

"Qi" is a key 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, weak, or have trouble breathing.

Xie

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

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 like digestion and breathing.

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 compared to men's, partly because of cultural norms. Women often found it hard to talk openly about their health, especially with male doctors present, which made proper diagnosis difficult.

Doctors used different methods to understand a woman’s health, sometimes using a special medical doll to help women point out where they felt unwell. The ideas of yin and yang—two forces that balance each other—were important in understanding both men’s and women’s bodies. These ideas helped doctors think about how energy moved through the body. Traditional Chinese medicine saw pregnancy as a condition that was hard to recognize early, often only noticed when problems arose. After childbirth, mothers were given special care to help them recover their strength. Infertility was a serious issue, often linked to problems with the body’s energy systems, and diagnosing it was challenging due to the difficulties women had in discussing certain symptoms openly.

Concept of disease

In Traditional Chinese medicine (TCM), disease is seen as an imbalance in the body's functions. This imbalance can involve energy (called qi), blood (called xuĕ), or other body parts. To treat a disease, TCM looks for patterns of imbalance.

Doctors in TCM check things like tongue color, pulse, and breathing to find these patterns. 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 find out about 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 often includes more than just plants. Animal parts, human products, fungi, and minerals are also used. A review in 2019 found that while these treatments are popular, 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. Fewer than 30,000 saiga antelopes remain, and their horns are smuggled to China. Seahorses are also heavily hunted, and many are at risk of disappearing.

The deer penis is thought to have health benefits in traditional medicine. Tiger parts from poached animals, like tiger penis, are also used despite driving tigers almost to extinction. 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 that can cause them terrible pain. 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. Traditional medicines have caused severe liver problems in China.

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 involves placing thin needles into certain spots on the body to help with pain and other health issues. It is often used together with moxibustion, which means burning a plant called mugwort near the skin. Some people believe this can help with many health problems, but scientific studies have not always shown that it works.

Research on acupuncture has given mixed results. Some studies show small benefits for certain types of pain, while others find no real difference compared to other treatments. Experts say it is generally 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 type of massage that comes from old ideas about health in China. It is believed to be the basis for a Japanese method called shiatsu. Tui na uses different moves like pressing with thumbs, rubbing, tapping, and helping 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 where small glass cups are placed on the skin. A match lights the air inside the cup, which makes the air expand. When the cup is placed on the skin and the air cools, it creates a gentle pull, making the cup stick. With massage oil, the cups can be moved around the back, giving a special kind of massage.

Gua sha

Main article: Gua sha

Gua sha is a treatment where smooth tools like jade or stone are used to gently scrape the skin. This can cause red spots or small bruises, which are believed to help with many health problems. The skin usually heals in about three to ten days, and there might be some soreness where it was done.

Die-da

Main article: Die-da

Diē-dǎ, or Dit Da, is a Chinese method for fixing broken or injured bones. It is often done by people who know about Chinese medicine and martial arts. They help set bones and may also suggest other treatments if the injury is serious. 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.

Shanghai pedicure

Regulations

Many governments have created laws 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 and changed over time. 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.