Traditional Chinese Medicine (TCM)
Natural Standard Bottom Line Monograph, Copyright © 2006 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
Acupressure, acupuncture, acustimulation, acutherapy, Asian bodywork, auricular acupuncture, chi kung, Chinese herbal medicine, Chinese herbs, Chinese nutrition therapy, Chinese patent remedies, classical acupuncture, coining, cupping, eclectic Chinese medicine, electroacupuncture, ethnic Chinese traditional medicine, feng shui, five element acupuncture, I Ching, Japanese acupuncture, medical acupuncture, moxibustion (moxa), qigong, Reiki, scraping, shiatsu, tai chi, taoism, tiji, ting sha, TCM, traditional acupuncture, tui na.
Chinese medicine is a broad term encompassing many different modalities and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) and dating back over 5,000 years. The term traditional Chinese medicine (TCM) is actually a recent development with a specific meaning in the long history of Chinese medicine. In the 1940s and 1950s the Chinese government undertook an effort to coalesce many diverse forms of Chinese medicine into a unified system to be officially defined as traditional Chinese medicine. The intent was to integrate the country’s large workforce of traditional practitioners into an organized health service delivery system. This would aid in providing care for a large population by using familiar and inexpensive methods.
Because TCM and Western medicine are used side by side in modern China, that country is relatively advanced compared to Western countries in using the concept of “integrative medicine.” TCM figures are prominently in treatment and planning of services — including for major illnesses such as cancer and heart disease. According to the World Health Organization (WHO), TCM is fully integrated into the Chinese health system with 95% of Chinese hospitals practicing it. As an example of such integration, it is common in treatment of children with intravenous antibiotics to be simultaneously treated with Chinese herbs in order to counteract the side effects of the antibiotic and boost the child’s immune system.
TCM places strong emphasis on herbal medicine since herbs can be taken every day. TCM regards acupuncture as more of a supportive treatment, although the two are used together when feasible for the patient. Herbs are usually given in the form of manufactured or processed pills, extracts, capsules, tinctures, or powders. This contrasts with the raw and dried form used in the more informal and older forms of practice. There are more than 2,000 different kinds of herbs of which about 400 are commonly used.
TCM has herbal regimens for use with major illnesses, such as cancer and heart disease. Herbal combinations are commonly used to reduce the side effects of chemotherapy and improve immune functioning in cancer, and to improve cardiovascular health in heart and circulatory diseases. Other herbal combinations are used in diabetes, infections, and other conditions.
Cupping is a therapeutic method in TCM that refers to the application of a heated cup over an area of the body. As the air inside cools its volume decreases, thus creating a slight suction on the area that stimulates blood circulation.
Moxibustion is a therapeutic method in TCM in which an herb, usually mugwort (Artemisia vulgaris), is burned above the skin or on the acupuncture points to introduce heat into an acupuncture point and alleviate symptoms. The herb may be applied in the form of a cone, stick, or loose herb; or it may be placed on the head of an acupuncture needle, to manipulate the temperature gradient of the needle.
TCM also uses dietary recommendations that are based on the energetic qualities of foods in terms of the theory of the eight principles. This is in contrast to Western concepts of specific nutrients and biochemistry.
TCM practitioners may call upon a wide range of other modalities as well, from meditation and martial arts to feng shui.
In the West, TCM offers a popular alternative to conventional medicine. Despite this growing popularity, there is debate as to its evidence of effectiveness. The modality within TCM with the largest body of evidence is acupuncture. Few well-designed trials of TCM herbal formulas have been conducted. Establishing and applying stronger clinical trial methodologies in TCM is imperative for integrating it with modern medicine and achieving the end goal of creating evidence-based options for patient care.
Note: To supplement the evidence described in this TCM monograph, the evidence table below gives additional examples of research that have taken place using TCM herbs for various conditions. This is not a complete list of evidence on traditional Chinese medicine. It should be noted that there has been very little standardization of Chinese herbal medicine. This makes the available evidence weak for establishing reliable evidence-based expectations for treatment of any condition with Chinese herbs.
The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. Taoist principles as described below are present throughout the literature and teachings of the many forms of Chinese medicine.
Nature and the laws that govern the on-going, harmonious flow of life energy through the natural world are used to understand the body and health. The person is viewed as an ecosystem that is embedded in, and related to, the larger ecosystem of nature and subject to the same laws.
The life force, chi (qi), circulates through the body and enlivens it. Health is a function of a balanced, harmonious flow of chi and illness results when there is a blockage or an imbalance in the flow of chi. Yin and yang are opposite and complementary qualities of life energy (chi). Yin is regarded as the feminine principle and yang the masculine principle.
The human being has a system of pathways called “meridians” (also sometimes called “channels”) through which the chi flows. The body has been mapped with these meridians that pass through all its organs, and specific meridians correspond with specific organs or organ systems (“organ networks,” below). Health is an ongoing process of maintaining balance and harmony of the circulation of chi through all the organs and systems of the body.
Symptoms are regarded as signals of impaired flow or circulation of chi through the body. Symptoms are considered as part of a larger picture or pattern affecting the whole person. The practitioner seeks to connect seemingly unrelated symptoms and develop a unifying explanation of what is going on with the person’s chi overall.
Most modern diseases are considered “chi deficiency” diseases, caused by not maintaining or supporting a harmonious internal ecology. Harmony and disharmony are understood in two main conceptual frameworks: the eight principles, and the five elements, described below.
The eight principles are actually four pairs of complementary opposites describing patterns of disharmony within the person. Briefly the principles are interior/exterior, referring to the location of the disharmony in the body (internal organs vs. skin or bones); hot/cold, referring to qualities of the disease pattern, such as fever or thirst vs. chilliness or desire to drink warm liquids; full/empty, referring to whether the condition is acute or chronic, and whether the body’s responses are strong or weak; and the balance of yin/yang, which adds further to the description of the other six principles. The eight principles are the theoretical basis of the TCM approach.
The five elements are fire, earth, metal, water, and wood. These terms do not refer to basic constituents of matter, but are dynamic qualities of nature. They are used to describe the changing qualities of chi energy as it circulates through the person. Five element theory is the basis of traditional acupuncture (also referred to as classical or five element acupuncture), which does not use herbs. However, some TCM practitioners also use the concept of the five elements.
The body has five organ networks, each corresponding with a particular element: heart/small intestine with fire, spleen/stomach with earth, lungs/large intestine with metal, kidneys/bladder with water, and liver/gall bladder with wood. The organ networks are named for the common meridian that circulates through and connects the organs, as it circulates chi throughout the larger, body-wide, meridian system. The practitioner’s efforts to harmonize the five elements promote greater harmony in the functioning of all the organ networks.
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acne, aging, allergic rhinitis (seasonal), allergies, anemia (infantile chronic aplastic), antiviral, asthma, back pain, bleeding (subarachnoid hemorrhage), blood circulation, blood flow enhancement, blood stagnation, brain damage, cerebral palsy, cerebrovascular accident (stroke), cirrhosis (hepatic fibrosis), cognitive function, common cold, cutaneous disorders, cystitis, dental procedures, dermatitis, detoxification, diabetes, diarrhea, dry mouth, encephalopathy (pulmonary), epilepsy, fatigue, fever, gallstones, gastritis, Graves’ disease, growth disorders, headache, heart failure, hepatitis B, hypertension, immunomodulation, immunostimulant, infant development / neonatal care, infertility, inflammation, influenza, insomnia, irregular menstrual cycles, kidney disorders, liver cirrhosis, liver disorders (fibrosis), liver health, migraine, motion sickness, nasopharyngeal carcinoma, nausea/vomiting, nausea and vomiting of pregnancy (hyperemesis gravidarum), neck pain, ovulation disorders, pain, pancreatitis, Parkinson’s disease, pelvic inflammatory disease, peptic ulcer, post-traumatic stress disorder, pre-eclampsia, prostatitis/chronic pelvic pain syndrome (CP/CPPS), quality of life, renal failure, renal impairment, respiratory infections, rheumatoid arthritis, senile dementia, sleep disorders, spleen disoders (liver stagnation and spleen deficiency syndrome), stroke, tendonitis (rotator cuff), thrombocytopenia, ulcerative colitis, urinary stimulant, vasodilation, venous disorders, viral myocarditis, wound healing.
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Since traditional Chinese medicine covers so many different therapies and modalities, the below information are only examples of safety concerns with selected herbs, supplements, and modalities. For more detailed information, please see Natural Standard monographs on individual therapies.
Studies of the Chinese herb ma huang, which is the main active ingredient in the weight-loss drug, ephedra, indicate that use of the substance is associated with serious health complications, including acute hepatitis and deaths.
Pregnant or lactating women should not use ma huang or other herbs such as ginseng where safety has not been clearly established. For more details on individual therapies please see Natural Standard monographs.
There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metals or not containing the listed ingredients. A qualified healthcare professional, including a pharmacist, should be consulted for recommendations of safe herbal products.
Chinese herbs can be powerful. Based on one study, Sang Ju Yin or Yu Ping Feng San formulas may cause headache or dizziness. There have been reports of adverse effects; a qualified healthcare practitioner, including a pharmacist, should be consulted on dosage.
Chinese herbs can interact with drugs, interfering with or exaggerating their effects. In particular, ma huang should not be taken with caffeine. Consumers should consult with a medical professional, including a pharmacist, before mixing herbs with any prescription drugs.
Acupuncture is generally reported as a safe procedure when performed by an experienced practitioner using standard sterile techniques. Needles must be sterile in order to avoid disease transmission (most practitioners now use disposable needles).
Rare serious and potentially lethal complications have been noted, including infection, and organ, nerve, or vascular injury, such as cardiac tamponade. There are several reports of fatalities in the available medical literature. Acupuncture may be unsafe in particular when performed on patients with emphysema or other pulmonary disease, due to multiple case reports of pneumothorax, elderly or medically compromised patients, diabetics (due to poor circulation), or patients with history of seizures.
Electrostimulation acupuncture should be avoided in pregnant women (theoretical), in patients with a cardiac history, including those persons with an arrhythmia or a pacemaker, due to risk of arrhythmia or interference with pacemaker functioning.
Acupuncture should be avoided in the following conditions: valvular heart disease, known bleeding disorders, use of anticoagulant drugs, unstable medical condition or infection, pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, neurologic patients. Acupuncture should also be avoided on areas that have received radiation therapy.
CUPPING AND MOXIBUSTION
Adverse events reported in the scientific literature from cupping and moxibustion are extremely rare.Cupping commonly leaves a temporary bruising of the skin, which disappears on its own.
For both cupping and moxibustion, the following precautions and contraindications are based on tradition, clinical experience, and theory rather than controlled research.
Cupping: Avoid the abdomen/sacral area during pregnancy, contraindicated acupuncture points, during high fever, during convulsions or cramps, over allergic skin conditions or ulcerated sores, over an inflamed organ, over inflamed areas in general, in patients with cardiac disease and/or aneurysms, in patients with extreme fatigue and/or anemia, in patients who have just finished exercising or taking a hot bath or shower. Avoid sliding cups over the spine, moles, or other skin abnormalities.
Moxibustion: Use caution with patients with neuropathy. Avoid face, head, nipples and genitals, skin adhesions, points where needling is contraindicated for the individual patient, in patients with any kind of “heat syndrome” according to acupuncture theory, in patients with strong heat signs–high fever, etc.–on or near inflamed and/or red areas of the body, or in patients with diabetic neuropathy or in any situation where the patient may not respond to the sensations of heat.Patients are advised not to bathe or shower for up to 24 hours after a moxibustion treatment.
Pregnancy & lactation: The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus, although there are no published reports of related adverse effects.
More safety information can be found in the specific monographs on this site for related modalities that are sometimes used with TCM.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).