Traditional Chinese medicine

Traditional Chinese medicine

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Encyclopedia
Traditional Chinese Medicine(: "Chinese medicine") refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

 and are based on a tradition of more than 2,000 years, including various forms of herbal medicine
Chinese herbology
Chinese Herbology is the theory of Traditional Chinese herbal therapy, which accounts for the majority of treatments in Traditional Chinese medicine ....

, acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

, massage (Tui na)
Tui na
Tui na , is a form of Chinese manipulative therapy often used in conjunction with acupuncture, moxibustion, fire cupping, Chinese herbalism, t'ai chi, and qigong....

, exercise (qigong)
Qigong
Qigong or chi kung is a practice of aligning breath, movement, and awareness for exercise, healing, and meditation...

, and dietary therapy. These practices are a common part of medical care throughout East Asia, but are considered alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 in the Western world.

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
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...

 so as to integrate many anatomical
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

 and pathological
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 notions from scientific medicine
Scientific medicine
Scientific medicine, as a descriptive term, applies to "the form of medicine derived from the Flexnerian reformation of medical education and the germ theory in the early 1900s"....

. Nonetheless, many of its assumptions, including the model of the body, or concept of disease, are not supported by modern evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...

.

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
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

 is perceived as harmonious interaction of these entities and the outside world, disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 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 first traces of therapeutic activities in the territories that are now considered China date from the Shang dynasty
Shang Dynasty
The Shang Dynasty or Yin Dynasty was, according to traditional sources, the second Chinese dynasty, after the Xia. They ruled in the northeastern regions of the area known as "China proper" in the Yellow River valley...

 (14th-11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular
Oracle
In Classical Antiquity, an oracle was a person or agency considered to be a source of wise counsel or prophetic predictions or precognition of the future, inspired by the gods. As such it is a form of divination....

 inscriptions on bones
Oracle bone
Oracle bones are pieces of bone normally from ox scapula or turtle plastron which were used for divination chiefly during the late Shang Dynasty. The bones were first inscribed with divination in oracle bone script by using a bronze pin, and then heated until crack lines appeared in which the...

 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
Joseph Needham
Noel Joseph Terence Montgomery Needham, CH, FRS, FBA , also known as Li Yuese , was a British scientist, historian and sinologist known for his scientific research and writing on the history of Chinese science. He was elected a fellow of the Royal Society in 1941, and as a fellow of the British...

 speculate that acupuncture might have originated in the Shang dynasty. But most historians now make a distinction between medical lancing
Lancing
Lancing may refer to:*Lancing *Lancing , a manufacturing procedure*Lancing, West Sussex*Lancing College*Lancing railway station*Lancing Carriage Works...

 (or bloodletting
Bloodletting
Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...

) and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

 ("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
Yellow Emperor
The Yellow Emperor or Huangdi1 is a legendary Chinese sovereign and culture hero, included among the Three Sovereigns and Five Emperors. Tradition holds that he reigned from 2697–2597 or 2696–2598 BC...

 and his ministers, it offers explanations on the relation between humans, their environment
Natural environment
The natural environment encompasses all living and non-living things occurring naturally on Earth or some region thereof. It is an environment that encompasses the interaction of all living species....

, and the cosmos
Cosmos
In the general sense, a cosmos is an orderly or harmonious system. It originates from the Greek term κόσμος , meaning "order" or "ornament" and is antithetical to the concept of chaos. Today, the word is generally used as a synonym of the word Universe . The word cosmos originates from the same root...

, on the contents of the body, on human vitality and pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

, on the symptoms of illness, and on how to make diagnostic
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...

 and therapeutic decisions in light of all these factors. Unlike earlier texts like Recipes for Fifty-Two Ailments
Wushi'er Bingfang
The Wushi'er Bingfang , or Recipes for Fifty-Two Ailments, is an ancient Chinese medical text that was discovered in 1973 in Mawangdui in a tomb that was sealed in 168 BCE under the Han Dynasty. The text was copied in seal script on sheets of silk around 215 BCE, under the Qin Dynasty, but might...

, which was excavated in the 1970s from a 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
Zhang Zhongjing
Zhang Zhongjing , formal name Zhang Ji, was a Han Dynasty physician and one of the most eminent Chinese physicians during the later years of the Han Dynasty...

 sometime between 196 and 220 CE, at the end of the Han dynasty
Han Dynasty
The Han Dynasty was the second imperial dynasty of China, preceded by the Qin Dynasty and succeeded by the Three Kingdoms . It was founded by the rebel leader Liu Bang, known posthumously as Emperor Gaozu of Han. It was briefly interrupted by the Xin Dynasty of the former regent Wang Mang...

. 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
Formulary (pharmacy)
At its most basic level, a formulary is a list of medicines. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication . The main function of formularies today is to specify which medicines are approved to be prescribed under a particular contract...

 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
Shang Han Lun
The Shang Han Lun or Shang Han Za Bing Lun , known in English as the Treatise on Cold Damage Disorders or the Treatise on Cold Injury, is a Chinese medical treatise that was compiled by Zhang Zhongjing sometime before the year 220, at the end of the Han dynasty...

and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty
Song Dynasty
The Song Dynasty was a ruling dynasty in China between 960 and 1279; it succeeded the Five Dynasties and Ten Kingdoms Period, and was followed by the Yuan Dynasty. It was the first government in world history to issue banknotes or paper money, and the first Chinese government to establish a...

.

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
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

. 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."

Famous historical physicians


These include Zhang Zhongjing
Zhang Zhongjing
Zhang Zhongjing , formal name Zhang Ji, was a Han Dynasty physician and one of the most eminent Chinese physicians during the later years of the Han Dynasty...

, Hua Tuo
Hua Tuo
Hua Tuo was an ancient Chinese physician who lived during the late Han Dynasty and Three Kingdoms era of Chinese history. The Records of Three Kingdoms and Book of Later Han record Hua as the first person in China to use anesthesia during surgery. He used a general anesthetic combining wine with a...

, Sun Simiao
Sun Simiao
Sun Simiao was a famous traditional Chinese medicine doctor of the Sui and Tang dynasty. He was titled as China's King of Medicine for his significant contributions to Chinese medicine and tremendous care to his patients....

, Tao Hongjing, Zhang Jiegu, and Li Shizhen
Li Shizhen
Li Shizhen , courtesy name Dongbi , was one of the greatest Chinese herbologists and acupuncturists in Chinese history. His major contribution to medicine was his 27-year work, which is found in his epic book the Bencao Gangmu...

.

Philosophical background


Traditional Chinese medicine (TCM) is based on Yinyangism (i.e., the combination of Five Phases theory with Yin-yang
Yin and yang
In Asian philosophy, the concept of yin yang , which is often referred to in the West as "yin and yang", is used to describe how polar opposites or seemingly contrary forces are interconnected and interdependent in the natural world, and how they give rise to each other in turn. Opposites thus only...

 theory), which was later absorbed by Daoism.


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.

Five Phases theory


Five Phases (五行, , 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), fire (火), earth (土), metal (金), and water (水). 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) 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
Meridian (Chinese medicine)
The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

 - 12 - has been seen in correspondence with the number of rivers flowing through the ancient Chinese empire
History of China
Chinese civilization originated in various regional centers along both the Yellow River and the Yangtze River valleys in the Neolithic era, but the Yellow River is said to be the Cradle of Chinese Civilization. With thousands of years of continuous history, China is one of the world's oldest...

.


TCM model of the body


TCM's view of the human body is only marginally concerned with anatomical
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

 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.

Qi


TCM distinguishes not only one but several different kinds of qi (氣). 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
    Meridian (Chinese medicine)
    The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

    .
  2. Warming (溫煦) - the body, especially the limbs.
  3. Defense (防御) - against Exogenous Pathogenic Factors
  4. Containment (固攝) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
  5. Transformation (氣化) - 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 (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 (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) of the body (also called 真氣 , ‘’true‘’ qi, or 原氣 , ‘’original‘’ qi).

Xue (blood)


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, }) are described as: Pale-white or withered-yellow complexion, dizziness, flowery vision, palpitations, insomnia, numbness of the extremities; pale tongue; "fine" pulse.

Jinye (bodily fluids)


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.

Zàng-fǔ



The zàng-fǔ constitute the centre piece of TCM's systematization of bodily functions. Bearing the names of organs, they are, however, only secondarily tied to (rudimentary) anatomical
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

 assumptions (the fǔ a little more, the zàng much less). As they are primarily defined by their functions, they are not equivalent to the anatomical organs - to highlight this fact, their names are usually capitalized.

The term zàng (臟) refers to the five entities considered to be yin in nature - Heart, Liver, Spleen, Lung, Kidney -, while fǔ (腑) refers to the six yang organs - Small Intestine, Large Intestine, Gallbladder
Gallbladder (Chinese medicine)
Distinct from the Western medical concept of gallbladder, the concept of the Gallbladder in Traditional Chinese Medicine is more a way of describing a set of interrelated parts than an anatomical organ....

, Urinary Bladder, Stomach
Stomach (Chinese medicine)
Stomach, a concept from traditional Chinese medicine as distinct from the Western medical concept of stomach, is more a way of describing a set of interrelated parts than an anatomical organ....

 and Sānjiaō
San Jiao
San Jiao is a term found in traditional Chinese medicine , as part of modelling the workings of the human body attempted by early Chinese medical writers...

.

The zàng's essential functions consist in production and storage of qì and blood; in a wider sense they are stipulated to regulate digestion, breathing, water metabolism, the musculoskeletal system, the skin, the sense organs, aging, emotional processes, mental activity etc. The fǔ organs' main purpose is merely to transmit and digest (傳化) substances like waste, food, etc.

Since their concept was developed on the basis of Wǔ Xíng philosophy, each zàng is paired with a fǔ, and each zàng-fǔ pair is assigned to one of five elemental qualities (i.e., the Five Elements or Five Phases). These correspondences are stipulated as:
  • Fire (火) = Heart (心) and Small Intestine (小腸) (and, secondarily, Sānjiaō [三焦, "Triple Burner"] and Pericardium [心包, ])
  • Earth (土) = Spleen (脾) and Stomach (胃)
  • Metal (金) = Lung (肺) and Large Intestine (大腸)
  • Water (水) = Kidney (腎) and Bladder (膀胱)
  • Wood (木) = Liver (肝) and Gallbladder (膽)


The zàng-fǔ are also connected to the twelve standard meridians - each yang meridian is attached to a fǔ organ and five of the yin meridians are attached to a zàng. As there are only five zàng but six yin meridians, the sixth is assigned to the Pericardium, a peculiar entity almost similar to the Heart zàng.

Jīng-luò (meridians)


The meridians (经络) are believed to be channels running from the
zàng-fǔ in the interior (里) of the body to the limbs and joints ("the surface" [表, ]), transporting qi and xuĕ (blood). TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being 十二经脉 and 奇经八脉 respectively. There's also a number of less customary channels branching off from the "regular" meridians.

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.

Disease entities


In TCM, a disease has two aspects: "bìng" and "zhèng". The former is often translated as "disease entity", "disease category", "illness", or simply "diagnosis". The latter, and more important one, is usually translated as "pattern" (or sometimes also as "syndrome"). For example, the disease entity of a common cold might present with a pattern of wind-cold in one patient, and with the pattern of wind-heat in another.

From a scientific point of view, most of the disease entitites (病) listed by TCM constitute mere symptoms. Examples include headache, cough, abdominal pain, constipation etc.

Since therapy will not be chosen according to the disease entity but according to the pattern, two patients with the same disease entity but different patterns will receive different therapy. Vice versa, patients with similar patterns might receive similar therapy even if their disease entities are different. This is called 异病同治,同病异治 .

Patterns


In TCM, "pattern" (证) refers to a "pattern of disharmony" or "functional disturbance" within the functional entities the TCM model of the body is composed of. There are disharmony patterns of qi, xuě, the body fluids, the zàng-fǔ, and the meridians. They are ultimately defined by their symptoms and "signs" (i.e., for example, pulse and tongue findings).

In clinical practise, the identified pattern usually involves a combination of affected entities (compare with typical examples of patterns). The concrete pattern identified should account for all the symptoms a patient has.

Six Excesses


The Six Excesses (六淫, , sometimes also translated as "Pathogenic Factors", or "Six Pernicious Influences"; with the alternative term of 六邪, , - "Six Evils" or "Six Devils") are allegorical terms used to describe disharmony patterns displaying certain typical symptoms. These symptoms resemble the effects of six climatic factors. In the allegory, these symptoms can occur because one or more of those climatic factors (called 六气, , "the six qi") were able to invade the body surface and to proceed to the interior. This is sometimes used to draw causal relationships (i.e., prior exposure to wind/cold/etc. is identified as the cause of a disease), while other authors explicitly deny a direct cause-effect relationship between weather conditions and disease, pointing out that the Six Excesses are primarily descriptions of a certain combination of symptoms translated into a pattern of disharmony.

It is undisputed, though, that the Six Excesses can manifest inside the body without an external cause. In this case, they might be denoted "internal", e.g., "internal wind" or "internal fire (or heat)".

The Six Excesses and their characteristic clinical signs are:
  1. Wind (风): rapid onset of symptoms, wandering location of symptoms, itching, nasal congestion, "floating" pulse; tremor, paralysis, convulsion.
  2. Cold (寒): cold sensations, aversion to cold, relief of symptoms by warmth, watery/clear excreta, severe pain, abdominal pain, contracture/hypertonicity of muscles, (slimy) white tongue fur, "deep"/"hidden" or "string-like" pulse, or slow pulse.
  3. Fire/Heat (火): aversion to heat, high fever, thirst, concentrated urine, red face, red tongue, yellow tongue fur, rapid pulse. (Fire and heat are basically seen to be the same)
  4. Dampness (湿): sensation of heaviness, sensation of fullness, symptoms of Spleen dysfunction, greasy tongue fur, "slippery" pulse.
  5. Dryness (燥): dry cough, dry mouth, dry throat, dry lips, nosebleeds, dry skin, dry stools.
  6. Summerheat (暑): either heat or mixed damp-heat symptoms.

Six-Excesses-patterns can consist of only one or a combination of Excesses (e.g., wind-cold, wind-damp-heat). They can also transform from one into another.

Typical examples of patterns


For each of the functional entities (qi, xuĕ, zàng-fǔ, meridians etc.), typical disharmony patterns are recognized; for example: qi vacuity and qi stagnation in the case of qi; blood vacuity, blood stasis, and blood heat in the case of xuĕ; Spleen qi vacuity, Spleen yang vacuity, Spleen qi vacuity with down-bearing qi, Spleen qi vacuity with lack of blood containment, cold-damp invasion of the Spleen, damp-heat invasion of Spleen and Stomach in case of the Spleen zàng; wind/cold/damp invasion in the case of the meridians.

TCM gives detailed prescriptions of these patterns regarding their typical symptoms, mostly including characteristic tongue and/or pulse findings. For example:
  • "Upflaming Liver fire" (肝火上炎): Headache, red face, reddened eyes, dry mouth, nosebleeds, constipation, dry or hard stools, profuse menstruation, sudden tinnitus or deafness, vomiting of sour or bitter fluids, expectoration of blood, irascibility, impatience; red tongue with dry yellow fur; slippery and string-like pulse.

Basic principles of pattern discrimination


The process of determining which actual pattern is on hand is called 辩证 . Generally, the first and most important step in pattern diagnosis is an evaluation of the present signs and symptoms on the basis of the "Eight Principles" (八纲).
These eight principles refer to four pairs of fundamental qualities of a disease: exterior/interior, heat/cold, vacuity/repletion, and yin/yang. Out of these, heat/cold and vacuity/repletion have the biggest clinical importance. The yin/yang quality, on the other side, has the smallest importance and is somewhat seen aside from the other three pairs, since it merely presents a general and vague conclusion regarding what other qualities are found. In detail, the Eight Principles refer to the following:
  • Exterior (表) refers to a disease manifesting in the superficial layers of the body - skin, hair, flesh, and meridians. It is characterized by aversion to cold and/or wind, headache, muscle ache, mild fever, a "floating" pulse, and a normal tongue appearance.
  • Interior (里)refers to disease manifestation in the zàng-fǔ, or (in a wider sense) to any disease that can not be counted as exterior. There are no generalized characteristic symptoms of interior patterns, since they'll be determined by the affected zàng or fǔ entity.
  • Cold (寒) is generally characterized by aversion to cold, absence of thirst, and a white tongue fur. More detailed characterization depends on whether cold is coupled with vacuity or repletion.
  • Heat (热) is characterized by absence of aversion to cold, a red and painful throat, a dry tongue fur and a rapid and floating pulse, if it falls together with an exterior pattern. In all other cases, symptoms depend on whether heat is coupled with vacuity or repletion.
  • Vacuity (虚) often referred to as "deficiency", can be further differentiated into vacuity of qi, xuě, yin and yang, with all their respective characteristic symptoms. Yin vacuity can also be termed "vacuity-heat", while yang vacuity is equivalent to "vacuity-cold".
  • Repletion (实) often called "excess", generally refers to any disease that can't be identified as a vacuity pattern, and usually indicates the presence of one of the Six Excesses, or a pattern of stagnation (of qi, xuě, etc.). In a concurrent exterior pattern, repletion is characterized by the absence of sweating. The signs and symptoms of repletion-cold patterns are equivalent to cold excess patterns, and repletion-heat is similar to heat excess patterns.
  • Yin and yang
    Yin and yang
    In Asian philosophy, the concept of yin yang , which is often referred to in the West as "yin and yang", is used to describe how polar opposites or seemingly contrary forces are interconnected and interdependent in the natural world, and how they give rise to each other in turn. Opposites thus only...

    are universal aspects all things can be classified under, this includes diseases in general as well as the Eight Principles' first three couples. For example, cold is identified to be a yin aspect, while heat is attributed to yang. Since descriptions of patterns in terms of yin and yang lack complexity and clinical practicality, though, patterns are usually not labelled this way anymore. Exceptions are vacuity-cold and repletion-heat patterns, who are sometimes referred to as "yin patterns" and "yang patterns" respectively.


After the fundamental nature of a disease in terms of the Eight Principles is determined, the investigation focuses on more specific aspects. By evaluating the present signs and symptoms against the background of typical disharmony patterns of the various entities, evidence is collected whether or how specific entities are affected. This evaluation can be done
  1. in respect of the meridians (经络辩证)
  2. in respect of qi (气血辩证)
  3. in respect of xuě (气血辩证)
  4. in respect of the body fluids (津液辩证)
  5. in respect of the zàng-fǔ (脏腑辩证) - very similar to this, though less specific, is disharmony pattern description in terms of the Five Elements [五行辩证, ])


There are also three special pattern diagnosis systems used in case of febrile and infectious diseases only ("Six Channel system" or "six division pattern" [六经辩证, ]; "Wei Qi Ying Xue system" or "four division pattern" [卫气营血辩证, ]; "San Jiao system" or "three burners pattern" [三角辩证, ]).

Considerations of disease causes


Although TCM and its concept of disease do not strongly differentiate between cause and effect, pattern discrimination can include considerations regarding the disease cause; this is called 病因辩证 .

There are three fundamental categories of disease causes (三因) recognized:
  1. external causes: these include the Six Excesses and "Pestilential Qi".
  2. internal causes: the "Seven Affects" (七情, , sometimes also translated as "Seven Emotions") - joy, anger, brooding, sorrow, fear, fright and grief. These are believed to be able to cause damage to the functions of the zàng-fú, especially of the Liver.
  3. non-external-non-internal causes: dietary irregularities (especially: too much raw, cold, spicy, fatty or sweet food; voracious eating; too much alcohol), fatigue, sexual intemperance, trauma, and parasites (虫).

Herbal medicine



"The method of appropriately using herbs in accordance with the symptom and sign presentation of the patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the meridian it has entered." - Zhang Jiegu




Raw materials


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
Tiger penis
In traditional Chinese medicine, a tiger penis is said to have important therapeutic properties. However, modern science does not support the belief that the tiger penis possesses any special potency. Furthermore, the demand for tiger parts exacerbates the endangered status of the tiger by...

 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
Turtle
Turtles are reptiles of the order Testudines , characterised by a special bony or cartilaginous shell developed from their ribs that acts as a shield...

 plastron and seahorse
Seahorse
Seahorses compose the fish genus Hippocampus within the family Syngnathidae, in order Syngnathiformes. Syngnathidae also includes the pipefishes. "Hippocampus" comes from the Ancient Greek hippos meaning "horse" and kampos meaning “sea monster”.There are nearly 50 species of seahorse...

s. In general, Chinese traditional medicine emphasizes the penis of animals as therapeutic. Snake oil
Snake oil
Snake oil is a topical preparation made from the Chinese Water Snake , which is used to treat joint pain. However, the most common usage of the phrase is as a derogatory term for quack medicine...

, which is used traditionally for joint pain as a liniment
Liniment
Liniment , from the Latin linere, to anoint, is a medicated topical preparation for application to the skin. Preparations of this type are also called balm...

, is the most widely known Chinese medicine in the west, due to extensive marketing in the west in the late 1800s and early 1900s, and wild claims of its efficacy to treat many maladies; 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.

Human body parts


Traditional Chinese Medicine also includes some human parts: the classic Materia medica
Materia medica
Materia medica is a Latin medical term for the body of collected knowledge about the therapeutic properties of any substance used for healing . The term 'materia medica' derived from the title of a work by the Ancient Greek physician Pedanius Dioscorides in the 1st century AD, De materia medica libre...

 (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.

Traditional categorization


The traditional categorizations and classifications that can still be found today are:
  • classification according to the Four Natures (四气): hot, warm, cool, or cold (or, neutral in terms of temperature). Hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat heat diseases.
  • classification according to the Five Flavors, (五味, , sometimes also translated as Five Tastes): acrid, sweet, bitter, sour, and salty. Substances may also have more than one flavor, or none (i.e., a "bland" flavor). Each of the Five Flavors corresponds to one of zàng organs, which in turn corresponds to one of the Five Phases. A flavor implies certain properties and therapeutic actions of a substance; e.g., saltiness drains downward and softens hard masses, while sweetness is supplementing, harmonizing, and moistening.
  • classification according to the meridian
    Meridian (Chinese medicine)
    The meridian is a path through which the life-energy known as "qi" is believed to flow, in traditional Chinese medicine. There is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians.- Main concepts :...

     - more precise, the zàng-organ including its associated meridian - which can be expected to be primarily affected by a given medicinal.
  • categorization according to the specific function. These categories mainly include:
    • exterior-releasing or exterior-resolving
    • heat-clearing
    • downward-draining or precipitating
    • wind-damp-dispelling
    • dampness-transforming
    • promoting the movement of water and percolating dampness or dampness-percolating
    • interior-warming
    • qi-regulating or qi-rectifying
    • dispersing food accumulation or food-dispersing
    • worm-expelling
    • stopping bleeding or blood-stanching
    • quickening the Blood and dispelling stasis or blood-quickening
    • transforming phlegm, stopping coughing and calming wheezing or phlegm-transforming and cough- and panting-suppressing
    • Spirit-quieting
    • calming the Liver and expelling wind or Liver-calming and wind-extinguishing
    • orifice-opening
    • supplementing: this includes qi-supplementing, blood-nourishing, yin-enriching, and yang-fortifying.
    • astriction-promoting or securing and astringing
    • vomiting-inducing
    • substances for external application

Efficacy


Regarding Traditional Chinese herbal therapy, only few trials of adequate methodology exist and its effectiveness therefore remains poorly documented. For example, a 2007 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving painful menstruation
Dysmenorrhea
Dysmenorrhea is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG and others. Still, dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive...

, compared to conventional medicine such as NSAIDs and the oral contraceptive pill, but the findings have to be interpreted with caution due to the generally low methodological quality of the included studies (as, amongst others, data for
placebo control could not be obtained).

Acupuncture and moxibustion




Acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

 means insertion of needles into superficial structures of the body (skin, subcutaneous tissue, muscles) - usually at acupuncture points (acupoints) - and their subsequent manipulation; this aims at influencing the flow of qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

. According to TCM it relieves pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

 and treats (and prevents) various diseases.

Acupuncture is often accompanied by moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

 - the Chinese characters for acupuncture literally meaning "acupuncture-moxibustion" - which involves burning mugwort on or near the skin at an acupuncture point.

In electroacupuncture
Electroacupuncture
Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles. Another term is Percutaneous Electrical Nerve Stimulation ....

, an electrical current is applied to the needles once they are inserted, in order to further stimulate the respective acupuncture points.

Efficacy


The effectiveness of acupuncture beyond the placebo effect is not well established.
There is, however, general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 (WHO) has compiled a list of disorders for which acupuncture might have an effect; adverse reactions to chemotherapy and radiation, induction of labor, sciatica, dysmenorrhea, depression, hypertension, rheumatoid arthritis, and low back pain.

Tui na



Tui na
Tui na
Tui na , is a form of Chinese manipulative therapy often used in conjunction with acupuncture, moxibustion, fire cupping, Chinese herbalism, t'ai chi, and qigong....

 (推拿) is a form of massage akin to acupressure (from which shiatsu
Shiatsu
Shiatsu is Japanese for "finger pressure;" it is a type of alternative medicine consisting of finger and palm pressure, stretches, and other massage techniques. There is no scientific evidence proving that shiatsu can treat any disease, but shiatsu practitioners promote it as a way to help people...

 evolved). Oriental massage is typically administered with the patient fully clothed, without the application of grease or oils. Choreography often involves thumb presses, rubbing, percussion, and stretches.

Qigong



Qigong (气功 or 氣功) is coordinated breathing, movement, and awareness used for exercise, healing, and mediation. Traditional Chinese medicine practioners believe that qìgōng
Qigong
Qigong or chi kung is a practice of aligning breath, movement, and awareness for exercise, healing, and meditation...

 (气功/氣功) and related practices prevent, heal, and treat diseases.

Cupping



Cupping
Fire cupping
Cupping therapy is an ancient form of alternative medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing. Suction is created using heat or mechanical devices...

 (拔罐) is a type of Chinese massage, consisting of placing several glass "cups" (open spheres) on the body. A match is lit and placed inside the cup and then removed before placing the cup against the skin. As the air in the cup is heated, it expands, and after placing in the skin, cools, creating lower pressure inside the cup that allows the cup to stick to the skin via suction
Suction
Suction is the flow of a fluid into a partial vacuum, or region of low pressure. The pressure gradient between this region and the ambient pressure will propel matter toward the low pressure area. Suction is popularly thought of as an attractive effect, which is incorrect since vacuums do not...

. When combined with massage oil, the cups can be slid around the back, offering "reverse-pressure massage".

Gua Sha


Gua Sha
Gua Sha
Gua sha , literally "to scrape away fever" in Chinese , is an ancient medical treatment....

 is abrading the skin with pieces of smooth jade, bone, animal tusks or horns or smooth stones; until red spots then bruising cover the area to which it is done. It is believed that this treatment is for almost any ailment including cholera. The red spots and bruising take 3 to 10 days to heal. It is believed that most people can tolerate the pain of treatment, but there is often some soreness in the area that has been treated.

Die-da


Diē-dá (跌打) or bone-setting is usually practiced by martial artists who know aspects of Chinese medicine that apply to the treatment of trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 and injuries such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. Such practice of bone-setting (整骨) is not common in the West.

See also


  • Alternative medicine
    Alternative medicine
    Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

  • American Journal of Chinese Medicine
    American Journal of Chinese Medicine
    The American Journal of Chinese Medicine is published by World Scientific and covers topics relating to alternative medicine of all cultures, such as traditional Chinese medicine, including acupuncture. It was established in 1973 by Frederick F...

    (journal)
  • Ayurveda
    Ayurveda
    Ayurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,...

  • Chinese classic herbal formula
    Chinese classic herbal formula
    Chinese classic herbal formulas are a form of Chinese herbology, where herbs are combined for greater efficiency, compared to individual herbs. They are the basic herbal formulas that students of Traditional Chinese medicine learn...

  • Chinese food therapy
    Chinese food therapy
    Chinese food therapy is a practice in the belief of healing through the use of natural foods instead of medications.Chinese food or Nutrition therapy, is a modality of traditional Chinese medicine, as opposed to evidence-based medicine....

  • Chinese herbology
    Chinese herbology
    Chinese Herbology is the theory of Traditional Chinese herbal therapy, which accounts for the majority of treatments in Traditional Chinese medicine ....

  • Chinese patent medicine
    Chinese patent medicine
    Chinese patent medicine are herbal medicines in Traditional Chinese medicine. Many kinds of Chinese patent medicines are still sold today.-Description:...

  • List of branches of alternative medicine
  • List of topics characterized as pseudoscience
  • Medicinal mushrooms
    Medicinal mushrooms
    Medicinal mushrooms are mushrooms, or mushroom extracts, that are used or studied as possible treatments for diseases. Lentinula edodes , Grifola frondosa , Ganoderma lucidum , and Cordyceps, have a history of medicinal use spanning millennia in parts of Asia...

  • Pharmacognosy
    Pharmacognosy
    Pharmacognosy is the study of medicines derived from natural sources. The American Society of Pharmacognosy defines pharmacognosy as "the study of the physical, chemical, biochemical and biological properties of drugs, drug substances or potential drugs or drug substances of natural origin as well...

  • Public health in the People's Republic of China
  • Traditional Korean medicine
    Traditional Korean medicine
    Traditional Korean medicine developed with the influence of other traditional medicine. Its techniques in treatment and diagnosis are both similar and unique to other traditional medicine...

  • Traditional Mongolian medicine
    Traditional Mongolian medicine
    Traditional Mongolian medicine developed over many years among the Mongolian people. Many Mongolian doctors became so adept that they became well known in China and among Tibetan lamas.- History :...

  • Traditional Tibetan medicine
    Traditional Tibetan medicine
    Traditional Tibetan medicine is a centuries-old traditional medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis and urinalysis, and utilizes behavior and dietary modification, medicines composed of natural materials and physical therapies...


Further reading


  • Sivin
    Nathan Sivin
    Nathan Sivin , also known as Xiwen is an American author, scholar, sinologist, historian, essayist, and currently professor emeritus at the University of Pennsylvania...

    , Nathan, ed. (2000). Medicine. (Science and civilisation in China, Vol. VI, Biology and Biological Technology, Part 6). Cambridge: Cambridge University Press. 10-ISBN 978-0-521-63262-1; 13-ISBN 978-0-521-63262-1; OCLC 163502797