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                    Traditional Chinese Medicine


Traditional Chinese Medicine (TCM) refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage (Tui na), exercise (qigong), and dietary therapy. Although these practices are considered alternative medicine in the Western world, they are a common part of medical care throughout East Asia, accounting for estimated 40% of all health care delivered in China.

The doctrines of Chinese medicine are rooted in books such as the Yellow Emperor's Inner Canon and the Treatise on Cold Damage, as well as in cosmological notions like yin-yang and the Five Phases. Starting in the 1950s, these precepts were modernized in the People's Republic of China so as to integrate many anatomical and pathological notions from scientific medicine. Nonetheless, many of its assumptions, including the model of the body, or concept of disease, are not supported by modern evidence-based medicine.

TCM's view of the body places little emphasis on anatomical structures, but is mainly concerned with the identification of functional entities (which regulate digestion, breathing, aging etc.). While health is perceived as harmonious interaction of these entities and the outside world, disease is interpreted as a disharmony in interaction. TCM diagnosis consists in tracing symptoms to an underlying disharmony pattern, mainly by palpating the pulse and inspecting the tongue.

History

The Compendium of Materia Medica is a pharmaceutical text written by Li Shizhen (1518-1593 AD) during the Ming Dynasty of China. This edition was published in 1593.
Acupuncture chart from Hua Shou (fl. 1340s, Ming Dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo: Suharaya Heisuke kanko, Kyoho gan 1716).

The first traces of therapeutic activities in China date from the Shang dynasty (14th-11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, etc., which Shang elites usually attributed to curses sent by their ancestors.

There is no evidence that the Shang nobility used herbal remedies.

Stone and bone needles found in ancient tombs have made Joseph Needham speculate that acupuncture might have originated in the Shang dynasty.

But most historians now make a distinction between medical lancing (or bloodletting) and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels ("meridians") in accordance with theories related to the circulation of Qi.

The earliest evidence for acupuncture in this sense dates to the second or first century BCE.

 

The Yellow Emperor's Inner Canon, the oldest received work of Chinese medical theory, was compiled around the first century BCE on the basis of shorter texts from different medical lineages.

Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on the relation between humans, their environment, and the cosmos, on the contents of the body, on human vitality and pathology, on the symptoms of illness, and on how to make diagnostic and therapeutic decisions in light of all these factors. Unlike earlier texts like Recipes for Fifty-Two Ailments, which was excavated in the 1970s from tomb that had been sealed in 168 BCE, the Inner Canon rejected the influence of spirits and the use of magic. It was also one of the first books in which the cosmological doctrines of Yinyang and the Five Phases were brought to a mature synthesis.

The Treatise on Cold Damage Disorders and Miscellaneous Illnesses was collated by Zhang Zhongjing sometime between 196 and 220 CE, at the end of the Han dynasty. Focusing on drug prescriptions rather than acupuncture,it was the first medical work to combine Yinyang and the Five Phases with drug therapy. This formulary was also the earliest Chinese medical text to group symptoms into clinically useful "patterns" (zheng 證) that could serve as targets for therapy. Having gone through numerous changes over time, it now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty.

In the centuries that followed the completion of the Yellow Emperor's Inner Canon, several shorter books tried to summarize or systematize its contents. The Canon of Problems (probably second century CE) tried to reconcile divergent doctrines from the Inner Canon and developed a complete medical system centered on needling therapy. The AB Canon of Acupuncture and Moxibustion (Zhenjiu jiayi jing 針灸甲乙經, compiled by Huangfu Mi sometime between 256 and 282 CE) assembled a consistent body of doctrines concerning acupuncture; whereas the Canon of the Pulse (Maijing 脈經; ca. 280) presented itself as a "comprehensive handbook of diagnostics and therapy."

Historical physicians

These include Zhang Zhongjing, Hua Tuo, Sun Simiao, Tao Hongjing, Zhang Jiegu, and Li Shizhen.


Traditional Chinese medicine (TCM) is based on Yinyangism (i.e., the combination of Five Phases theory with Yin-yang theory), which was later absorbed by Daoism.

Yin and yang symbol for balance. In Traditional Chinese Medicine, good health is believed to be achieved by a balance between yin and yang.

Yin and yang

Yin and yang are ancient Chinese concepts which can be traced back to the Shang dynasty(1600-1100 BC). They represent two abstract and complementary aspects that every phenomenon in the universe can be divided into. Primordial analogies for these aspects are the sun-facing (yang) and the shady (yin) side of a hill. Two other commonly used representational allegories of yin and yang are water and fire.

In the yin-yang theory, detailed attributions are made regarding the yin or yang character of things:

Phenomenon Yin Yang
Celestial bodies moon sun
Gender female male
Location inside outside
Temperature cold hot
Direction downward upward
Degree of humidity damp/moist dry

The concept of yin and yang is also applicable to the human body; for example, the upper part of the body and the back are assigned to yang, while the lower part of the body are believed to have the yin character. Yin and yang characterization also extends to the various body functions, and - more importantly - to disease symptoms (e.g., cold and heat sensations are assumed to be yin and yang symptoms, respectively). Thus, yin and yang of the body are seen as phenomena whose lack (or overabundance) comes with characteristic symptom combinations:

  • Yin vacuity (also termed "vacuity-heat"): heat sensations, possible night sweats, insomnia, dry pharynx, dry mouth, dark urine, a red tongue with scant fur, and a "fine" and rapid pulse.
  • Yang vacuity ("vacuity-cold"): aversion to cold, cold limbs, bright white complexion, long voidings of clear urine, diarrhea, pale and enlarged tongue, and a slightly weak, slow and fine pulse.

TCM also identifies drugs believed to treat these specific symptom combinations, i.e., to reinforce yin and yang.

Interactions of Wu Xing

Five Phases theory

Five Phases, sometimes also translated as the "Five Elements" theory, presumes that all phenomena of the universe and nature can be broken down into five elemental qualities - represented by wood (木, pinyin: ), fire (火pinyin: huǒ), earth (土, pinyin: ), metal (金, pinyin: jīn), and water (水, pinyin: shuǐ). In this way, lines of correspondence can be drawn:

Phenomenon Wood Fire Earth Metal Water
Direction east south center west north
Color green/blue red yellow white black
Climate wind heat damp dryness cold
Taste sour bitter sweet acrid salty
Zang Organ Liver Heart Spleen Lung Kidney
Fu Organ Gallbladder Small Intestine Stomach Large Intestine Bladder
Sense organ eye tongue mouth nose ears
Facial part above bridge of nose between eyes, lower part bridge of nose between eyes, middle part cheeks (below cheekbone)
Eye part iris inner/outer corner of the eye upper and lower lid sclera pupil

Strict rules are identified to apply to the relationships between the Five Phases in terms of sequence, of acting on each other, of counteraction etc. All these aspects of Five Phases theory constitute the basis of the zàng-fǔ concept, and thus have great influence regarding the TCM model of the body. Five Phase theory is also applied in diagnosis and therapy.

Correspondences between the body and the universe have historically not only been seen in terms of the Five Elements, but also of the "Great Numbers" (大數, pinyin: dà shū) For example, the number of acu-points has at times been seen to be 365, in correspondence with the number of days in a year; and the number of main meridians - 12 - has been seen in correspondence with the number of rivers flowing through the ancient Chinese empire.

Old Chinese medical chart on acupuncture meridians

Model of the body

TCM's view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body's functions (such as digestion, breathing, temperature maintenance, etc.):

"The tendency of Chinese thought is to seek out dynamic functional activity rather than to look for the fixed somatic structures that perform the activities. Because of this, the Chinese have no system of anatomy comparable to that of the West."
—Ted Kaptchuk, The Web That Has No Weaver

These functions are aggregated and then associated with a primary functional entity - for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xuě (blood) - but this is mainly a matter of stipulation, not anatomical insight.

The primary functional entities used by traditional Chinese medicine are qì, xuě, the five zàng organs, the six fǔ organs, and the meridians which extend through the organ systems. These are all theoretically interconnected: each zàng organ is paired with a fǔ organ, which are nourished by the blood and concentrate qi for a particular function, with meridians being extensions of those functional systems throughout the body.

Attempts to reconcile these concepts with modern science - in terms of identifying a physical correlate of them - have so far failed.

Qi

TCM distinguishes not only one but several different kinds of qi (simplified Chinese: ; traditional Chinese: ; pinyin: ).In a general sense, qi is something that is defined by five "cardinal functions":

  1. Actuation (推動, tuīdòng) - of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians.
  2. Warming (溫煦, pinyin: wēnxù) - the body, especially the limbs.
  3. Defense (防御, pinyin: fángyù) - against Exogenous Pathogenic Factors
  4. Containment (固攝, pinyin: gùshè) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
  5. Transformation (氣化, pinyin: qìhuà) - of food, drink, and breath into qi, xue (blood), and jinye (“fluids”), and/or transformation of all of the latter into each other.

Vacuity of qi will especially be characterized by pale complexion, lassitude of spirit, lack of strength, spontaneous sweating, laziness to speak, non-digestion of food, shortness of breath (especially on exertion), and a pale and enlarged tongue.

Qi is believed to be partially generated from food and drink, and partially from air (by breathing). Another considerable part of it is inherited from the parents and will be consumed in the course of life.

In terms of location, TCM uses special terms for qi running inside of the blood vessels and for qi which is distributed in the skin, muscles, and tissues between those. The former is called yíng-qì (simplified Chinese: 营气; traditional Chinese: 營氣), its function is to complement xuè and its nature has a strong yin aspect (although qi in general is considered to be yang).The latter is called weì-qì (Chinese: 衛氣), its main function is defence and it has pronounced yang nature.

Qi also circulates in the meridians. Just as the qi held by each of the zang-fu organs, this is considered to be part of the ‘’principal‘’ qi (元氣, pinyin: yuánqì) of the body (also called 真氣 pinyin: zhēn qì, ‘’true‘’ qi, or 原氣 pinyin: yuán qì, ‘’original‘’ qi).

Xue

In contrast to the majority of other functional entities, xuě (血, "blood") is correlated with a physical form - the red liquid running in the blood vessels. Its concept is, nevertheless, defined by its functions: nourishing all parts and tissues of the body, safeguarding an adequate degree of moisture, and sustaining and soothing both consciousness and sleep.

Typical symptoms of a lack of xuě (usually termed "blood vacuity" [血虚, pinyin: xuě xū}) are described as: Pale-white or withered-yellow complexion, dizziness, flowery vision, palpitations, insomnia, numbness of the extremities; pale tongue; "fine" pulse.

Jinye

Closely related to xuě are the jīnyė (津液, usually translated as "body fluids"), and just like xuě they are considered to be yin in nature, and defined first and foremost by the functions of nurturing and moisturizing the different structures of the body.Their other functions are to harmonize yin and yang, and to help with the secretion of waste products.

Jīnyė are ultimately extracted from food and drink, and constitute the raw material for the production of xuě; conversely, xuě can also be transformed into jīnyė. Their palpable manifestations are all bodily fluids: tears, sputum, saliva, gastric juice, joint fluid, sweat, urine, etc.

Semen is another bodily fluid which is often included, especially in the context of shared philosophies between TCM & Qi Gong. Also the 3 energies of TCM are listed as JING (essence; 精), QI (vital energy; 氣), and SHEN (spirit; 神), and the common name for semen is jingye; 精液 (pinyin: jīng yè, literally: ‘essence’ fluid). However all the bodily fluids listed in the previous paragraph, as well as semen, are viewed as important in developing and nurturing JING (i.e. the 'essence' in TCM modalities).

Concept of disease

In general, disease is perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment. Therapy is based on which "pattern of disharmony" can be identified. Thus, "pattern discrimination" is the most important step in TCM diagnosis. It is also known to be the most difficult aspect of practicing TCM.

In order to determine which pattern is at hand, practitioners will examine things like the color and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing or the sound of the voice. For example, depending on tongue and pulse conditions, a TCM practitioner might diagnose bleeding from the mouth and nose as: "Liver fire rushes upwards and scorches the Lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose.".He might then go on to prescribe treatments designed to clear heat or supplement the Lung.


Herbal medicine

Dried plants and animals parts are used in traditional Chinese medicines. In the image are dried "Supernatural mushrooms" (Lingzhi), dried curled snakes, turtle shell underbelly (plastron), Luo Han Guo, and species of ginseng.
Chinese red ginseng roots
Artemisia annua, one kind of wormwood, is used to treat fevers. It has been found to have antimalarial properties.


Typically, one batch of medicinals is prepared as a decoction of about 9 to 18 substances. Some of these are considered as main herbs, some as ancillary herbs; within the ancillary herbs, up to three categories can be distinguished.

There are roughly 13,000 medicinals used in China and over 100,000 medicinal recipes recorded in the ancient literature. Plant elements and extracts are by far the most common elements used. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed - out of these, 45 were animal parts, and 30 were minerals.

Animal substances

Some animal parts used as medicinals can be considered rather strange such as cows' gallstones. Some can include the parts of endangered species, including tiger penis and rhinoceros horn. The black market in rhinoceros horn reduced the world's rhino population by more than 90 percent over the past 40 years. Concerns have also arisen over the use of turtle plastron and seahorses. In general, Chinese traditional medicine emphasizes the penis of animals as therapeutic. Snake oil has been used traditionally for joint pain as a liniment; however, there is no clinical evidence that it is effective. Since TCM recognizes bear bile as a medicinal, more than 12,000 asiatic black bears are held in "bear farms", where they suffer cruel conditions while being held in tiny cages. The bile is extracted through a permanent hole in the abdomen leading to the gall bladder, which can cause severe pain; the bears are known to regularly try to kill themselves. One of the most successful company Guizhentang Pharmaceutical company met many challenges trying to enter the stock market.

Australian scientists have developed methods to identify medicines containing DNA traces of endangered species.

Human body parts

Traditional Chinese Medicine also includes some human parts: the classic Materia medica (Bencao Gangmu) describes the use of 35 human body parts and excreta in medicines, including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, organs, but most are no longer in use.

































References

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