Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is an ancient medical system that has been
practiced for thousands of years and remains part of mainstream healthcare delivery
in many Asian countries today. TCM promotes a holistic approach to health and
aims to maintain physical, emotional, and spiritual balance in order to prevent
and treat disease (Parker 2000; Ergil 1996). TCM modalities include acupuncture,
moxibustion, herbal medicine, Chinese massage (known as tui na), movement combined
with breathing exercises (such as tai chi and qi gong), nutrition, and lifestyle
modification (Parker 2000). Cupping and bleeding are also employed (Ergil 1996).
The first written documentation of TCM is recorded in the Pharmacopoeia
of the Heavenly Husbandman, a text dating back to 200 B.C. (Parker 2000). Herbal
medicine and acupuncture, including theory, practice, diagnosis, and treatment,
were recorded in classical Chinese texts and refined over many centuries (Ergil
Although TCM has been practiced in the United States since the mid-19th
century, it remained largely the province of immigrant Chinese communities until
the general public became exposed to the practice following former President Nixon's
trip to China in 1971. While covering Nixon's trip, New York Times reporter James
Reston received acupuncture for post-operative pain following an emergency appendectomy.
He published accounts of his experience with TCM that fascinated the public and
contributed to its mainstream emergence as an alternative modality (Ergil 1996).
TCM is practiced all over the world. A new term, Oriental medicine, has been coined
to encompass both traditional and contemporary interpretations of TCM that are
practiced throughout Asia (Ergil 1996).
to an expert in the field, Dr. Kevin Ergil, TCM is based on three fundamental
principles not easily understood from a Western cultural perspective. The first
is the idea that qi (pronounced "chee"), described often in Western
terminology as life energy, exists throughout the body and is responsible for
maintaining normal physiological, psychological, and spiritual functions. There
are five different types of qi with distinct associations: support and nourishment
(construction qi); protection and warmth (defensive qi); flow of energy through
channels, called meridians (channel qi); physiological activity of organs (organ
qi); and ancestral qi, which controls circulation and respiration. Disease is
caused by a disruption of qi and manifests as a unique collection of signs and
symptoms depending on the origin of the disturbance. In an interesting analogy
often used to explain its nature, qi is described as the wind in a sail; we do
not see the wind directly but we are aware of its presence as it fills the sail
Qi also maintains the balance of yin and yang, the principle
of complementary opposites that determines the world around us and is reflected
within each of us; together, yin and yang represent a state of dynamic equilibrium
that exists among all things in the universe. Thus, an individual cannot be understood
outside the context of his or her environment. As Ergil writes, "The external
landscape, or human environment, is understood to be in profound and dynamic relationship
with the internal landscape, or human organism" (Ergil 1996).
principle influencing health and illness in Oriental medicine is known as the
five phases-earth, metal, water, wood, and fire-which may be thought of as metaphoric
representations of the five patterns that characterize the dynamic interactions
of natural phenomena (Ergil 1996); the concept again reflects the inability to
separate the individual from the environment that is fundamental to the TCM philosophy
and belief system.
Two additional concepts are essential to the practice of
TCM: mind and body are not distinct from one another, and moderation is required
to achieve balance and health (Ergil 1996).
Finally, TCM reflects an understanding
of human anatomy that is different from that of conventional medicine. TCM views
the internal organs not as individual structures, but as complex networks (Ergil
1996). In parallel with the five phases or elements mentioned above, there are
five internal organs regulating the human body. These five organs-liver, heart,
spleen, lung, and kidney-correspond to more than a specific bodily part. The kidney,
for example, represents not only the kidney itself, but the entire urinary system
and the adrenal glands as well. The heart represents both the heart and the brain
(Cheng 2000). According to TCM, there are three major causes of disease: the external
factors or environmental influences known as wind, cold, fire, dampness, heat,
and dryness; the internal emotions of joy, anger, worry, sorrow, and fear (Ergil
1996; Cheng 2000); and the constitutional factors relating to diet, sexual activity,
lifestyle, work, and exercise (Parker 2000).
Mechanism of Action
the use of its therapeutic modalities, TCM stimulates the body's own healing mechanisms
to regulate the flow of qi and the function of the organ systems, bringing the
body back into a state of balance (Parker 2000). The main focus in TCM is to treat
the underlying cause of disease as opposed to simply managing symptoms (Ergil
The mechanistic action of acupuncture, in TCM terminology, is to access
qi with the needle. The practitioner knows that qi has been accessed when a gentle
grabbing of the needle is sensed in his or her hand and/or when the patient reports
a feeling of itching, numbness, soreness, or change in temperature at the site
of the needle (Ergil 1996).
With respect to the use of herbs, TCM practitioners
formulate herbal combinations to act synergistically in the body, and therefore
typically prescribe combinations of herbs rather than a single herbal remedy (Ergil
Moxibustion refers to burning the leaves of the herb Artemesia vulgaris
on or near the skin; although used separately as well, it is often applied in
conjunction with acupuncture to move qi appropriately. A safe and common way to
apply this technique is with a cigar-shaped stick known as pole moxa held just
above the skin to gently warm the acupuncture point (Ergil 1996).
Tui na literally
means "pushing and pulling" and refers to a process of massage that
stimulates acupuncture points. Tui na can be used either as an adjunct to or instead
of acupuncture, particularly for people such as children who may have a difficult
time with needle insertion. The massage technique is used for many neurological
and orthopedic conditions to increase the range of motion of joints; it can also
be used for medical conditions not usually thought of as treatable via massage,
such as asthma, gastritis, and dysmenorrhea (Ergil 1996).
Cupping refers to
a practice in which a cup with a vacuum seal is placed on the surface of the skin;
the theory is that the local application of a vacuum to the skin increases lymph
and blood circulation in the area under treatment. In TCM terminology, the intention
is to draw out cold or damp elements from the patient that may be contributing
to disease (Ergil 1996).
A clinical evaluation includes,
in the following order: visual assessment of the patient's skin, hair, posture,
affect, tongue, complexion, and eyes (Parker 2000; Ergil 1996); listening to the
quality of the patient's breathing and speech; being aware of the patient's body
odors; taking a medical history; diagnosing the pulse; and palpating the body
along acupuncture points or meridian lines (Ergil 1996). Visualizing the overall
appearance, complexion, and eyes, as well as assessing the quality of the patient's
voice, enables the practitioner to observe the patient's shen (or spirit), which
is critical for determining prognosis. Shen is the radiant aspect of human existence
that encompasses consciousness and healthy mental and physical functioning (Ergil
Following this assessment, the TCM practitioner makes recommendations
for the modalities to be used (as described in the section on Mechanism of Action)
and the course of treatment; these decisions are based on "pattern identification"
as determined by the TCM practitioner. Pattern identification is, again, a difficult
concept to define in Western terminology; it is based on eight principles of yin
and yang and, unlike the situation in Western medicine, the definition and particular
diagnostic pattern does not depend solely on the disease. Rather, it depends on
a complex interaction of the illness or set of signs and symptoms, the particular
patient affected, and the environment at large. Therefore, one disease can have
many different appropriate treatment approaches. Similarly, one treatment pattern
can be appropriate for a wide variety of illnesses (Ergil 1996). These facts illustrate
some of the difficulty in trying to understand TCM from the Western, biomedical
Despite the difficulty of applying contemporary
research methodologies to evaluate outcomes of TCM, there have been some attempts
with worthwhile results; the following paragraphs provide a few examples of traditional
herbal remedies examined from the Western perspective. These examples are not
meant to be an exhaustive reflection of the breadth of appropriate applications
of TCM, a health system and approach that has been used for many diverse conditions
for thousands of years. The intent of the following examples is to give some sense
of the clinical benefits and limitations learned from studying aspects of TCM
from a biomedical point of view. (Please see the Acupuncture monograph for more
information on clinical applications of that modality specifically.)
In a report
published in JAMA, a randomized, double-blind, placebo-controlled trial of a Chinese
herbal formulation was found to offer significant improvements for some patients
with Irritable Bowel Syndrome (Bensoussan et al. 1998).
Qian ceng ta, a Chinese
herb used to treat age-related memory dysfunction and dementia, may show promise
for possible adjunctive treatment of Alzheimer's disease. Of 103 Alzheimer's patients
from seven different hospitals in Mainland China, 58% treated with huperzine A
(the active ingredient of Qian ceng ta) chemically linked to tacrine (a medication
commonly used for Alzheimer's) showed improvement in memory, cognition, and behavior
(Carlier et al. 1999). Another small study in the elderly suggests that Cs-4,
a fermentation product of Cordyceps sinesis (a popular supplement in China), increases
maximum oxygen uptake and anaerobic threshold compared to placebo, thus improving
exercise capacity and resistance to fatigue in this population (Xiao et al. 1999).
The study, presented at the 46th annual meeting of the American College of Sports
Medicine, included only 30 subjects, making it difficult to draw conclusions;
however, the information is intriguing since Cordyceps sinesis has been used for
similar purposes in TCM for many years.
A combination of Chinese herbs known
as "Slimax" reduced weight, waist and hip circumference, and body mass
index significantly in an experimental group of 140 subjects participating in
a randomized, placebo-controlled clinical trial (Ignjatovic et al. 2000).
TCM terms, diabetes and its complications are considered "wasting and thirsting"
disorders; a common treatment for diabetes nourishes yin and tonifies qi (Luwen
2000). Patients with complications of diabetes, including elevated cholesterol
and triglycerides, poorly controlled blood sugar, and metabolic disturbances,
are frequently diagnosed by a TCM practitioner as having "stagnant phlegm."
According to researchers in China, Chinese herbs used to treat phlegm stagnation,
such as Wen dan tang, also tend to lower lipid levels; there have been case reports
of Wen dan tang improving additional diabetic complications such as retinopathy
Although a popular application in the lay community, the use
of Chinese herbal remedies for eczema remains controversial. There is a paucity
of data in the literature supporting the efficacy of oral Chinese herbs for this
application (Armstrong and Ernst 1999); in addition, one study addressing the
constituents of topical TCM remedies frequently used for eczema found that many
of them actually contained illegal, unlabeled steroids. One concern here is that
many patients taking such herbal preparations as an alternative to prescription
medications are under the impression that they do not contain steroids, which
may lead to excessive use, application to inappropriate sites, and unanticipated
risks (Keane et al. 1999).
All TCM modalities have traditionally been used
for both male and female infertility. TCM treatment of male infertility from sperm
anomalies, for example, generally involves replenishing kidney yin and/or kidney
yang, fortifying the spleen, and nourishing the liver (Becker 2000). TCM treatment
for infertility offers a viable opportunity for TCM to interface with Western
medicine, since sperm count and quality can be followed easily, as can other contributing
factors to male infertility such as chronic prostatitis and hyperprolactinemia
Risks, Side Effects, Adverse Events
Side effects from Chinese
herbs are more likely to occur when a single agent or active ingredient is used,
rather than the customary combination of herbs that are formulated to work harmoniously
together and counterbalance side effects (Parker 2000). As is the case with Western
pharmaceuticals, there are interactions among herbal medicines too numerous to
mention here; trained and certified TCM practitioners know which herbs can be
safely and effectively administered together (Parker 2000).
Chinese herbs containing
aristolochic acid, a compound present in plants of the family Aristolochiaceae,
should be avoided, particularly in patients with underlying kidney disorders;
the active ingredient has been identified as a carcinogen and nephrotoxin causing,
by some reports, nearly 100 cases of kidney failure (Lewis and Alpert 2000) and
even urothelial dysplasia and carcinoma in patients with end-stage nephropathy
(Nortier et al. 2000). In addition, as mentioned above, some Chinese herbal creams
used to treat skin conditions such as eczema contain unlabeled steroids (Keane
et al. 1999). Although generally considered safe for autoimmune and rheumatological
disorders, patients prescribed a remedy prepared from Tripterygium wilfordii Hook
F (TwHF) occasionally report side effects of dry mouth, changes in skin pigmentation,
rash, and loss of appetite; nausea, vomiting, diarrhea, abdominal pain, and secondary
amenorrhea are even less common; leukopenia and thrombocytopenia may occur with
this herbal anti-inflammatory. The use of properly prepared formulations of TwHF
needs to be monitored, particularly for patients with impaired renal function.
Long-term treatment may also result in reproductive tract damage (Tao and Lipsky
2000). These examples point to the fact that all herbs need to be regulated for
toxicity and monitored for side effects (Keane et al. 1999).
Great caution and, at times, avoidance of some of the herbs mentioned in the
section entitled Risks, Side Effects, Adverse Events should be exercised; otherwise,
there are no specific conditions for which TCM is contraindicated in its totality.
There may be, however, specific conditions for which certain Chinese herbs should
not be used, such as during pregnancy and/or lactation (Parker 2000). A trained
and certified TCM practitioner knows under which clinical circumstances particular
herbal remedies are contraindicated.
Additional Clinical Outcomes
also be a useful adjunctive or alternative treatment for addictions, allergies,
sinusitis, asthma, respiratory infections, strep throat, amenorrhea, premenstrual
syndrome, childbirth, postpartum care, arthritis (including rheumatoid arthritis),
chronic or acute pain, bladder infection, candidal or other vaginal infections,
benign prostatic hypertrophy, prostatic cancer, prostatitis, restless leg syndrome,
sleep disorders, abdominal pain, stress, and tinnitus (Parker 2000).
further research is needed, the Chinese herbal remedy Tripterygium wilfordii Hook
F shows considerable promise for treating autoimmune and inflammatory diseases,
including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis,
psoriasis, Behcet's disease, Henoch-Schnlein purpura, IgA nephropathy, chronic
nephrotic syndrome, nephritis, chronic lymphocytic thyroiditis, dermatitis, scleroderma,
polymyositis, and kidney transplant rejection (Tao and Lipsky 2000).
The Ohio University College of Osteopathic Medicine and nine Chinese medical
institutions recently formed the Sino-American Consortium to study applications
for TCM in Western medicine (OU-COM. 2000). In 2001, the Ohio University College
of Osteopathic Medicine plans to incorporate basic TCM principles into its curriculum
(OU-COM. 2000). In addition, the University of Pittsburgh recently created the
International TCM Center to coordinate research efforts with several TCM institutes
in China. The result will be a large-scale, systematic, international effort to
develop clinical standards for TCM (UPMC 2000).
Future research studies and
clinical trials on TCM are required to establish the efficacy, safety, cost-effectiveness,
and mechanism of action of various TCM treatments and overcome the limitations
of existing research studies (Armstrong and Ernst 1999).
and Licensing Requirements
Currently, there are 35 Oriental medicine training
programs in the United States. Programs range in duration from two to four years
and include the study of herbs, acupuncture, and all other aspects of Oriental
medicine (Parker 2000). To be certified, students must graduate from accredited
institutions and pass the state board exam or the national certification commission
exam. Licensure requirements vary in each state (Parker 2000).
more information, contact the American Association of Oriental Medicine in Catasauqua,
Pennsylvania at 888-500-7999 or on the web at www.aaom.org; the National Acupuncture
and Oriental Medicine Alliance in Olalla, Washington at 253-851-6896 or on the
web at www.acuall.org; the Institute of Traditional Medicine in Portland, Oregon
at 503-233-4907 or on the web at www.itmonline.org; or the National Certification
Commission for Acupuncture and Oriental Medicine in Alexandria, Virginia at 703-548-9004
or on the web at www.nccaom.org.
Armstrong NC, Ernst E. The
treatment of eczema with Chinese herbs: a systematic review of randomized clinical
trials. Br J Clin Pharmacol. 1999;48(2):262-264.
Becker SA. Treatment by Chinese
medicine: semen anomalies. J Chin Med. 2000;62:46-51.
Bensoussan A, Talley
NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with
Chinese herbal medicine. JAMA. 1998;280(18):1585-1589.
Carlier PR, Du DM, Han
Y, Liu J, Pang YP. Potent, easily synthesized huperzine A-tacrine hybrid acetylcholinesterase
inhibitors. Bioorg Med Chem Lett. 1999;9(16):2335-2338.
Cheng JT. Review: drug
therapy in Chinese traditional medicine. J Clin Pharmacol. 2000;40(5):445-450.
KV. China's traditional medicine. In: Micozzi MS, ed. Fundamentals of Complementary
and Alternative Medicine. New York, NY: Churchill Livingstone Inc.; 1996:185-223.
V, Ogru E, Heffernan M, Libnaki R, Lim Y, Ng F. Studies on the use of "Slimax,"
a Chinese herbal mixture, in the treatment of human obesity. Pharm Biol. 2000;38(1):30-35.
FM, Munn SE, du Vivier AW, Higgins EM. Analysis of Chinese herbal creams prescribed
for dermatological conditions. BMJ. 1999;318(7183):563-564.
Lewis CJ, Alpert
S. Letter to Health Care Professionals on FDA Concerned about Botanical Products,
Including Dietary Supplements, Containing Aristolochic Acid. Washington, DC: U.S.
FDA Center for Food Safety and Applied Nutrition; May 31, 2000.
Luwen G. Wen
dan tang and diabetic retinal disease. J Chin Med. 2000;62:20-22.
Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use
of a Chinese herb. N Engl J Med. 2000;342(23):1686-1692.
OU-COM. OU medical
school teams with Chinese universities [press release]. Athens: Ohio University
College of Osteopathic Medicine; April 29, 2000.
Parker MJ. Traditional Chinese
herbal medicine. In: Novey DW, ed. Clinician's Complete Reference to Complementary
and Alternative Medicine. St. Louis, Mo: Mosby; 2000:203-218.
Tao X, Lipsky
PE. The Chinese anti-inflammatory and immunosuppressive herbal remedy Tripterygium
wilfordii Hook F. Rheum Dis Clin North Am. 2000;26(1):29-50.
government officials visit UPMC health system to establish ties with International
Traditional Chinese Medicine Center [press release]. Pittsburgh: University of
Pittsburgh Medical Center Health System; January 20, 2000.
Xiao Y, Huang XZ,
Chen G, Wang MB, Zhu JS, Cooper CB. Increased aerobic capacity in healthy elderly
humans given a fermentation product of Cordyceps Cs-4. Paper presented at: Annual
Meeting of the American College of Sports Medicine; June 2-5, 1999; Seattle, Wash.
Integrative Medicine Communications, Access 2.0; 2000.
obliterans of limbs
Bell's facial paralysis
Chronic lumbar muscle strain
Chronic suppurative otitis media
of mammary glands
Infection of biliary tract and gall stones
Prolapse of lumbar intervertebral disc