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Traditional Chinese medicine (中医, pinyin: zhōng yī), also known as TCM, includes a range of traditional medicine practices originating in Asia, primarily in regions that are now part of China. TCM is a common part of medical care throughout East Asia, but is considered a complementary and alternative medical system (CAM) in much of the Western world. TCM therapy largely consists of Chinese herbal medicine (use of plants, human and animal parts, and minerals to make medicines), acupuncture (insertion of needles in the body), tuī-nǎ massage, and dietary therapy. Traditional Chinese medicine is not based on the scientific method or sciences like biology as is evidence based medicine, but rather on tradition and mystical considerations. Sometimes scientific analysis of TCM medicines points to possibly effective uses of the medicines in their TCM use, or in ways other than as used by TCM, which is referred to as "Chinese integrative medicine". TCM is sometimes called classical "Chinese Medicine" or "Oriental medicine".
Traditional Chinese medicines play a major role in Chinese lifestyle that is substantially different than the role of medicines in the west. Use of these medicines are part of everyday and social life in Chinese society. They account for 75% of TCM practice. Those that have been scientifically analyzed have sometimes been found to be ineffective or contain toxins, and have sometimes been used to make discoveries in science-based pharmacology, possibly for although not necessarily for what it was believed to treat under TCM. According to TCM theory, one method of attacking "toxins" in the body is to take toxic substances. Although described as “natural” and herbal, TCM medicines also include human and animal parts, minerals, and processed substances. TCM medicines are processed using Chinese alchemy, not chemistry.
Traditional Chinese medicine theory is based on ancient Daoist philosophical and religious conceptions of balance and opposites (yin and yang), and other metaphysical belief systems, such as Chinese astrology. In evidence based medicine, disproved theories are "continually being replaced with new ones", but in traditional Chinese medicine little has changed since antiquity and “the most current medical knowledge always had roots centuries old”. Chinese knowledge of the human body was based not on anatomical studies using dissection, but on an “alternative anatomy” based on astrological calculations and complex associations with religion, spirituality, and the stars of astrology. Ill health is believed to result from an imbalance between what are believed to be interconnected organ systems, with one organ system believed to weaken or overexcite others. TCM practitioners believe that plant and animal products, and minerals can be used to stimulate or calm particular systems and bring them into balance. It is believed that ingestion of medicines, insertion of needles in points of the body (acupuncture points), or burning mugwort on the skin at these points (moxibustion), stimulates the systems directly along what TCM believes are metaphysical flow lines (meridians) of a supernatural "energy" called qi, and that these can also be stimulated by practices such a special kind of massage and exercise. Astrological considerations are made in considering a medicine's efficacy or toxicity and are believed to influences health, e.g., the alignment of homes with the planets and stars, and the year, month, day, and hour of birth, or planting a plant on the right date such as the winter solstice for determining the plant's effectiveness or toxicity., TCM is steeped in mystical concepts and was more broadly introduced to America via its New age fascination with magical thinking. "steeped in the mystical concepts of TCM, was introduced to an America infatuated with New Age magical thinking,ref name=TEBA>", Traditional and Evidence-Based Acupuncture: History, Mechanisms, and Present Status, GA Ulett, J Han, Southern Medical Journal, December 1998 - Volume 91 - Issue 12</ref>
TCM uses a biologically incorrect "alternative anatomy", metaphysical principles that have no correlates in evidence based medicine, and is fundamentally based on a conclusion from these principles that is inconsistent with scientific facts; that the blood is propelled by a supernatural force called qi, whereas in science based medicine blood is not influenced by supernatural forces but is propelled by the mechanical pumping of the heart and always obeys the laws of physics. According to the metaphysical principles, bad health is caused not by germs or genetics, but by metaphysical imbalances in what medical historian Rachael Matuk calls “imaginary organ systems”, causing blood to be blocked, to flow in the wrong vessels or to pool up or stagnate. When bad health is caused by toxins, it is believed that this is corrected by methods such as this stimulation or by ingesting still more toxins. TCM has been subject to criticism regarding a number of issues: its lack of scientific basis, its questionable effectiveness, its medicines containing toxins, its use in place of proven science based medicines, possible side effects of its treatment methods, the ecological impact on endangered species by creating a black market demand for ineffective medicines made from animal parts, and the superstitious beliefs it promotes.
- 1 Basic beliefs about the body and disease
- 2 Medicines
- 2.1 Medicines made from human parts, exreta, and souls of hanged criminals
- 2.2 Medicines made from mammals
- 2.3 Medicines made from reptiles and amphibians
- 2.4 Medicines made from marine life
- 2.5 Medicines made from insects
- 2.6 Medicines made from fungus
- 2.7 Medicines made from plants
- 2.7.1 Aconite root
- 2.7.2 Camellia
- 2.7.3 Cayenne
- 2.7.4 Chinese cucumber
- 2.7.5 Chrysanthemum flowers
- 2.7.6 Cocklebur fruit
- 2.7.7 Cow dipper
- 2.7.8 Croton seed
- 2.7.9 Ginger
- 2.7.10 Ginkgo
- 2.7.11 Ginseng
- 2.7.12 Goji berry
- 2.7.13 Horny goat weed
- 2.7.14 Rhubarb
- 2.7.15 Seven steps to death
- 2.7.16 Strychnine tree seeds
- 2.7.17 Willow bark
- 2.8 Medicines made from minerals
- 2.9 Pills and powders
- 2.10 Chinese alchemy (Pao zhi)
- 2.11 Ecological impacts of use of medicines
- 3 Techniques
- 4 Diagnostics
- 5 Theoretical superstructure
- 6 History
- 7 See also
- 8 Notes
- 9 References
- 10 Further reading
Basic beliefs about the body and disease
Traditional Chinese medicine uses an “alternative anatomy” that is not based on dissection and biology as in evidence based medicine. It is determined by making complex associations with religion, spirituality, using Chinese astrology's “inauspicious dates” to determine relationships between astrology and medical procedures, deducing anatomy through "speculation and hazy recollections of past experiences" and metaphor, and making "mystical numerical associations". These include that the number of arms and legs matched the number of seasons and directions, that the “five” organs correspond to the “five” planets, that the "twelve" blood and air vessels thought to exist correspond to the "twelve" rivers flowing toward and ancient Chinese kingdom, and that the original 365 acupuncture "points" located on the body correspond to one for "each" day of the year (there are approximately 365 1⁄4 days per year).
In TCM physiology, internal organs were not thought to have distinct physiological functions as in evidence based medicine, but functions associated with mystical and religious concepts of Daoism such as balancing the metaphysical forces of yin and yang. TCM uses “imaginary organ systems” and disregards organ shape and location to determine what under TCM is belived to be a balance of mystical forces of yin and yang between the organ systems.
TCM medical theory is not based on the scientific method, or on sciences such as biology, chemistry, and physics. It is based in part on the religion of Daoism, with a belief that all parts of the universe are interconnected. The imbalance of metaphysical forces of yin and yang is believed to be caused by a blockage or stagnation of a supernatural energy called "qi", or by external events such as the day and time of birth, weather, or alignment of the house with the heavens, whereas in evidence based medicine illness is typically caused by germs, such as bacteria and viruses, environmental factors, or genetics. According to TCM theory, one way to correct an imbalance of yin and yang caused by toxins in the body is to take more toxins. An eminent practitioner writes about the cause of bleeding from the mouth and nose in the Journal of Chinese Medicine:
- "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."
Regions of the tongue are believed to correspond to body organs as in a map, with areas on the tongue believed to react to the condition of the corresponding organ in such a way that is visible to a medical practitioner who examines the tongue. An imbalance of mystical yin and yang in the organs is believed to be possibly caused by blood flow being "blocked", blood "stagnating" or "pooling", or blood flowing in the "wrong" blood vessels. Blood flow is believed under TCM to be caused by self propulsion via supernatural qi energy. By feeling the pulse, looking at the tongue or complexion, smelling the breath, examining other external body indicators, checking the year, month, day, and hour of birth, and checking how a person's house and doors are aligned with the sun, TCM practitioners believe they can detect these imbalances and blood flow problems. For example, teeth marks on one part of the tongue might indicate a problem with the heart, while teeth marks on another part of the tongue might indicate a problem with the liver. The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as "Going to have my pulse felt." Acupuncture practitioners believe it can be used to treat infertility, and “both pregnancy and the sex of a child can be diagnosed from the pulses by a skilled practitioner”, as part of an overall reproductive technology.
The diagnosis is used to make treatments under a believed that by using the right mixture of medicines, by stimulating acupuncture points along what is believed to be the paths of the flow (meridians) of qi in the pody, and/or by changing the orientation of furniture or doors in a home, the balance and correct blood flow can be restored.
"Material objects" used in medicines may include things such as human breath and the “soul of criminals that were hanged”, which is considered under TCM to be a a material object resembling pine charcoal dug out of the ground beneath the body shortly after a hanged person died.
Blood flows by mechanical pumping of the heart according to the laws of physics, and is not propelled by supernural forces. The vessels in which blood is believed to flow under TCM are anatomically incorrect, as are the shape and location of the organ. The meridians in which qi is believed to flow do not correspond to any anatomical structures. No force corresponding to qi (or yin and yang) has been found in the sciences of physics or human physiology.
- “All the medicinal are toxic.” - Zhang Jiegu
- "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
Traditional Chinese medicines are made from plant parts, human parts, animal parts, and minerals. These are typically crushed and combined with multiple ingredients into a medicine, which then is often made into a tea.
There are about 13,000 TCM medicines and over 100,000 mixtures of them recorded in the ancient literature. Under TCM it is believed that toxicity is needed to fight pathogens in the body; that the therapeutic dose of a poisonous drug is generally close to what is believed to be its toxic dose. According to Y.L. Yang in the “Textbook for TCM Higher Education: Traditional Chinese Materia Medica”, “To treat diseases with extremely toxic medicinal, discontinue the administration when the disease is eighty percent improved and with the non-toxic ones, discontinue the administration when the disease is ninety percent improved.” TCM medicines are associated with unproven claims of efficacy. Some TCM medicines have been found to have adverse effects. Potentially toxic and carcinogenic compounds such as arsenic trioxide and cinnabar are sometimes prescribed as part of a medicinal mixture. A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off UK shelves in July 2004 when found to contain 11-13% mercury. Many Chinese herbal medicines are marketed as dietary supplements in the West, whereby they are exempted from some testing requirements.
Chinese herbal medicine plays a special role in everyday and social life in China, so plays a different role than medicines in western science based medicine. In China, herbal medicine plays a large role in the everyday health care system, along side Western medicine, accounting for 75% TCM practice. Chinese medicinals are now used world-wide under a belief by TCM practitioners that they treat many internal medicine complaints and diseases.
Snake oil is likely the most widely known outside of Asia, but ginseng is the most broadly used substance for the most broad set of alleged cures. Powdered pre-calcified antler, horns, teeth, and bones are second in importance to ginseng, with claims ranging from curing cancer to improving immune system function to curing impotence.
Herbalists have used different names for the same ingredient depending on location and time, while ingredients with different medical properties have shared similar names. For example, mirabilite/sodium sulphate decahydrate (芒硝) was mislabeled as sodium nitrite (牙硝), resulting in a poisoned victim. In some Chinese medical texts, both names are interchangeable.
Plants are more commonly used than animals and minerals in the medicines. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed - 442 were plant parts, 45 were animal parts, and 30 were minerals.
Medicines made from human parts, exreta, and souls of hanged criminals
Human parts and excreta are currently used in TCM medicines and are included in its new textbooks and handbooks, such as licorice in human feces, dried human placenta, finger nails, child's urine, hair, and urinary sediments(Hominis Urinae Sedimentum, Ren Zhong Bai). The current consumption of human parts is considered cannibalism by some. Other parts include pubic hair, flesh, blood, bone, semen, and menstrual blood. The classic Meteria medica (Bencao Gangmu) describes the use of 35 human body parts and extreta in medicines, such as bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, organs, but most are no longer in use.
Also listed are human breath and the “soul of criminals that were hanged”, which is considered under TCM to be a a material object resembling pine charcoal dug out of the ground beneath the body shortly after a hanged criminal died, but many are no longer in use.
Dried human placenta
Human placenta is believed to be sweet, salty, and warm, so it is dried and believed to treat impotence, infertility due to cold sperm or deficiency, and female infertility because of uterine coldness, chronic cough, asthma, and insomnia, and marketed as such.
Human feces and urine
The contemporary use of licorice in prepared human feces is known as "Radix glycyrrhizae Cum Excremento Hominis Praeparatum" (Ren Zhong Huang). Human urine sediment is called Hominis Urinae Sedimentum (ren zhong bai ). Both Ren Zhong Huang and Ren Zhong Bai are used in a belief that they can treat acute inflammatory conditions in oral cavity sores in children due to mycotic or fungal infection, and that their observations have confirmed this.
In Traditional Chinese medicine, human feces is used in a decoction of licorice. These feces-licorice decoctions have been found to have a profound difference in pharmacokinetics regarding glycyrrhizin as compared to not so decocted. Initial studies investigating traditional Chinese Medicine indicate that taking fecal bacterial products orally may improve on protective effects over taking it by injection to the body cavity, and that associated bacteria may produce an antitumor effect and an autoimmune boosting effect. Depending on preparation, human feces may protect against cell damage caused by hydrogen peroxide due a byproduct of fecal bacteria.
"“the human penis is not a drug” - Li Shizhen
Human penis is believed under TCM to stop bleeding, and as with other TCM medicines, the basis for belief in its therapeutic effects is anecdotal and not based on the scientific method; Li Shizhen, author of the greatest pharmacological work in pre-modern China, the Bencao Gangmu materia medica, objected to use of human penis, but cited the anecdotal evidence and included it in the Bencao Gangmu, which is still a standard reference today.
Human pubic hair
Human pubic hair (“shady hair”) was claimed to cure snakebite, difficult birth, abnormal urination, and “yin and yang disorder”, which is a disease unique to TCM based on its views of sexual behavior.
Medicines made from mammals
Ass-hide glue pellets
Glue made from the hide of donkeys is made into pellets for use in making teas.
Deer penis is commonly sold in Chinese pharmacies. The deer penis is typically very large and, under TCM it must be extracted from the deer whilst still alive. Often it is then sliced into small pieces, typically by women and then roasted and dried in the sun and then preserved while the deer looks on.[not in citation given]
China banned deer penis during the 2008 Summer Olympics. Under TCM it is believed that deer penis wine is an effective remedy for athletic injuries, to enhance male virility, and to be an aphrodisiac.
Flying squirrel feces
The text Chinese Medical Herbology and Pharmacology notes that flying squirrel feces has a "distinct odor" that "may decrease patient compliance" with ingesting it.
It is believed to have uses for amenorrhea, menses pain, postpartum abdominal pain, epigastric pain, and chest pain. It is boiled in a decoction with other herbs prior to ingestion. If it is to be used in a formula to stop bleeding (dark purple uterine bleeding with clots, retained lochia due to stasis), it is dry fried prior to making the decoction. Flying squirrel feces has been associated with typhus fever.
Endangered rhinoceros horn is used as an antifever agent, because it is believed to "cool the blood". The black market in rhinoceros horn decimated the world's rhino population by more than 90 percent over the past 40 years.
Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility, and tiger eyes. Laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets.
Medicines made from reptiles and amphibians
Snake oil 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. Snake oil is a traditional Chinese medicine used to treat joint pain by rubbing it on joints as a liniment.
It is claimed that this is “plausible” because oils from snakes are higher in eicosapentaenoic acid than some other sources. But there are no replicated studies showing that rubbing it on joints has any positive effect, or that drinking it in sufficient quantity to get an effect from the acid is not dangerous because of the many other compounds in the oil.
Medicines made from marine life
Seahorse fish is a fundamental ingredient in therapies for a variety of disorders, including asthma, arteriosclerosis, incontinence, impotence, thyroid disorders, skin ailments, broken bones, heart disease, as well as to facilitate childbirth and even as an aphrodisiac.
Shark fin soup
Shark fin soup is traditionally regarded as beneficial for health in East Asia, and its status as an "elite" dish has led to huge demand with the increase of affluence in China, devastating shark populations.
Medicines made from insects
Medicines made from fungus
The supernatural mushroom (lingzhi mushroom, Chinese “linh chi” = “supernatural mushroom”, "reishi mushroom" in Japan) encompasses several fungal species of the genus Ganoderma, and most commonly refers to the closely related species, Ganoderma lucidum and Ganoderma tsugae. G. lucidum enjoys special veneration in East Asia, where it has been used as a medicinal mushroom in traditional Chinese medicine for more than 2,000 years, making it one of the oldest mushrooms known to have been used medicinally.
Medicines made from plants
There are thousands of herbs that are used as medicines. The following list of herbs represents a very small portion of the pharmacopoeia.
Aconite root contains what is called "the Queen of Poisons", the highly toxic neurotoxin aconitine. There is no antidote. It is quickly absorbed via mucous membranes, but also via skin. Respiratory paralysis, in very high doses also cardiac arrest, leads to death. A few minutes after ingestion paresthesia starts, which includes tingling in the oral region. This extends to the whole body, starting from the extremities. Anesthesia, sweating and cooling of the body, nausea and vomiting and other similar symptoms follow. Sometimes there is strong pain, accompanied by cramps, or diarrhea.
When a person has a negative reaction to the highly toxic aconite root, some proponents of classical Chinese medicine think that this is because it was either processed incorrectly or planted on the wrong place or on the wrong day of the year, i.e., for supernatural or astrological reasons, not because of the toxins.
The Chinese also used Aconitum poisons both for hunting and for warfare. Aconitine is well known in the west for its use in poisoning historic figures or in literature. Aconitine was also made famous by its use in Oscar Wilde's 1891 story Lord Arthur Savile's Crime. Aconite also plays a prominent role in James Joyce's Ulysses, in which the protagonist Leopold Bloom's father used pastilles of the chemical to commit suicide. It was the poison used by George Henry Lamson in 1881 to murder his brother-in-law in order to secure an inheritance. Lamson had learnt about aconitine as a medical student from Professor Robert Christison, who had taught that it was undetectable—but forensic science had improved since Lamson's student days. In 1953 aconitine was used by a Soviet biochemist and poison developer Grigory Mairanovsky in experiments with prisoners in the secret NKVD laboratory in Moscow. He admitted killing around 10 people using the poison.
Chinese cucumber (Trichosanthes kirilowi) is believed to treat tumors, reduce fevers, swelling and coughing, abscesses, amenorrhea, jaundice, and polyuria.
Extracts are extremely toxic. Side effects include hormone changes, allergic reaction, fluid in the lungs or brain, bleeding in the brain, heart damage, seizures, and fever.
Chrysanthemum flowers (Ju Hua ) are used in TCM under a belief that it treats headaches, fever, dizziness and dry eyes. It is also popular for use in teas as a beverage.
Cocklebur fruit (Xanthium, cang er zi) is one of the most important herbs in TCM, which believes it can be used to treat sinus congestion, chronic nasal obstructions and discharges, and respiratory allergies.
Xanthium is toxic and causes vomiting, diarrhea and abdominal pain.
Cow dipper (sheng ban xia, Pinellia ternata) is believed under TCM to be the strongest of all TCM herbs for removing phlegm. Cow dipper is highly toxic to humans. Traditional Chinese medicine advocates believe toxicity can be reduced in their method of preparation.
Croton seed (Croton tiglium)is believed under TCM to treat gastrointestinal disorders, convulsions, and skin lesions. It is often used with rhubarb, dried ginger and apricot seed. Croton contains cancer causing chemicals.
Ginger root Zingiber officinale) has been used in China for over 2,000 years under a belief that it aids digestion and treats uspet stomach, diarrhea, and nausea. TCM also teaches that it helps treat arthritis, colic, diarrhea, and heart conditions. Traditional Chinese medicine believes that it treats the common cold, flu-like symptoms, headaches, and menstrual cramps. Today, health care professionals commonly recommend to help prevent or treat nausea and vomiting associated with motion sickness, pregnancy, and cancer chemotherapy. It is also used as a digestive aid for mild stomach upset, as support in inflammatory conditions such as arthritis, and may even be used in heart disease or cancer.
Ginkgo biloba seeds are crushed and believed under TCM to treat asthma. Ginkgo has been used in TCM for nearly 5,000 years. Further studies to establish the efficacy both as used under TCM beliefs and for proposed uses as an evidence based medicne are required.
Ginseng root is the most widely sold traditional Chinese medicine. The name "ginseng" is used to refer to both American (Panax quinquefolius) and Asian or Korean ginseng (Panax ginseng), which belong to the species Panax and have a similar chemical makeup. Siberian ginseng or Eleuthero (Eleutherococcus senticosus) is another type of plant. Asian ginseng has a light tan, gnarled root that often looks like a human body with stringy shoots for arms and legs. In ancient times, herbalists thought that because of the way ginseng looks it could treat many different kinds of syndromes, from fatigue and stress to asthma and cancer. In traditional Chinese medicine, ginseng was often combined with other herbs and used often to bring longevity, strength, and mental alacrity to its users. Asian ginseng is believed to enhance the immune system in preventing and treating infection and disease. Several clinical studies report that Asian ginseng can improve immune function. Studies have found that ginseng seems to increase the number of immune cells in the blood, and improve the immune system's response to a flu vaccine. In one study, 227 participants received either ginseng or placebo for 12 weeks, with a flu shot administered after 4 weeks. The number of colds and flu were two-thirds lower in the group that took ginseng.
Ginseng contains stimulants, but may produce side effect including high blood pressure, low blood pressure, and mastalgia. Ginseng may also lead to induction of mania in depressed patients who mix it with antidepressants. One of the most common and characteristic symptoms of acute overdose of ginseng from the genus Panax is bleeding. Symptoms of mild overdose with Panax ginseng may include dry mouth and lips, excitation, fidgeting, irritability, tremor, palpitations, blurred vision, headache, insomnia, increased body temperature, increased blood pressure, edema, decreased appetite, increased sexual desire, dizziness, itching, eczema, early morning diarrhea, bleeding, and fatigue. Symptoms of gross overdose with Panax ginseng may include nausea, vomiting, irritability, restlessness, urinary and bowel incontinence, fever, increased blood pressure, increased respiration, decreased sensitivity and reaction to light, decreased heart rate, cyanotic facial complexion, red face, seizures, convulsions, and delirium.
Marketing literature for goji berry (wolfberry) products including several "goji juices" suggest that wolfberry polysaccharides have extensive biological effects and health benefits, although none of these claims have been supported by peer-reviewed research.
A May 2008 clinical study published by the peer-reviewed Journal of Alternative and Complementary Medicine indicated that parametric data, including body weight, did not show significant differences between subjects receiving Lycium barbarum berry juice and subjects receiving the placebo; the study concluded that subjective measures of health were improved and suggested further research in humans was necessary. This study, however, was subject to a variety of criticisms concerning its experimental design and interpretations.
Published studies have also reported possible medicinal benefits of Lycium barbarum, especially due to its antioxidant properties, including potential benefits against cardiovascular and inflammatory diseases, vision-related diseases (such as age-related macular degeneration and glaucoma), having neuroprotective properties or as an anticancer and immunomodulatory agent.
Wolfberry leaves may be used to make tea, together with Lycium root bark (called dìgǔpí; 地 骨 皮 in Chinese), for traditional Chinese medicine (TCM). A glucopyranoside isolated from wolfberry root bark have inhibitory activity in vitro against human pathogenic bacteria and fungi.
Horny goat weed
Horny goat weed (Epimedium spp., Yin Yang Huo, 淫羊藿) is believed to be an aphrodisiac. Exploitation of wild populations is having potentially serious consequences for the long-term survival of several species.
Seven steps to death
Seven steps to death (qi bu si, Radix tripterygii wilfordii, or lei gong teng) use is on the rise in TCM because of a belief under TCM that it treats arthritis, relieves pain and reduces joint swelling. It is an extremely toxic. Within two to three hours after ingestion, a patient may begin to have gastrointestinal problems, headache, dizziness, severe vomiting (sometimes with blood), chills, high fever, and irregular heart beat. Damage to the central nervous system follows, as well as internal bleeding of the (real) organs, then their necrosis.
Strychnine tree seeds
Strychnine tree seeds (Strychnos nux-vomica, Ma Quan Zi) are marketed and sold with a claim to treat diseases of the respiratory tract, anemia, and geriatric complaints. It contains toxic strychnine, so can also be used as a poison for rodents. Dan Besky writes in his Materia Medica that "due to the small difference between the therapeutic and toxic doses, use of strychni semen (ma quian zi) bears a high risk of inducing severe poisoning and for this reason should be regarded as an obsolete drug".
Salix genus plants were used since the time of Hippocrates (400 BC) when patients were advised to chew on the bark to reduce fever and inflammation. Willow bark has been used throughout the centuries in China and Europe to the present for the treatment of pain (particularly low back pain and osteoarthritis), headache, and inflammatory conditions such as bursitis and tendinitis. The bark of white willow contains salicin, which is a chemical similar to aspirin (acetylsalicylic acid). It is thought to be responsible for the pain-relieving and anti-inflammatory effects of the herb. In the 1829, salicin was used to develop aspirin. White willow appears to be slower than aspirin to bring pain relief, but its effects may last longer.
Medicines made from minerals
Despite its toxicity, sulfide of mercury (cinnabar) has historically been used in Chinese medicine, where it is called zhūshā (朱砂), and was highly valued in Chinese Alchemy. It was also referred to as dān (丹), meaning all of Chinese alchemy, cinnabar, and the "elixir of immortality". Cinnabar (HgS, sulfide of mercury) has been used in Traditional Chinese medicine as a sedative for more than 2000 years, and has been shown to have sedative and toxic effects in mice.
Pills and powders
The TCM industry traditionally supplied medicines as powders to be measured and/or compounded by individual practitioners. More recently, soluble granules and tablets have become available with specific dosage levels. Modern formulations in pills and sachets used 675 plant and fungi ingredients and about 25 from non-plant sources such as snakes, geckos, toads, frogs, bees, and earthworms.
Chinese alchemy (Pao zhi)
Ecological impacts of use of medicines
Animal products are used in certain Chinese preparations, which may disturb conservationists, vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances.
The practice of using endangered species is controversial within TCM. Modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text discuss substances derived from endangered species in an appendix, emphasizing alternatives.
The animal rights movement claims that traditional Chinese medicinal solutions still use bear bile (xíong dǎn). In 1988, the Chinese Ministry of Health started controlling bile production, which previously used bears killed before winter. Now bears are fitted with a sort of permanent catheter, which was more profitable than killing the bears. The treatment itself and especially the extraction of the bile is very painful, and damages their stomach and intestines, often resulting in their eventual death. Increased international attention has mostly stopped the use of bile outside of China; gallbladders from butchered cattle (niú dǎn / 牛膽 / 牛胆) are recommended as a substitute for this ingredient.
Medicinal use is impacting seahorse populations.
Ecological effects are greater than just on the species used in TCM. The worldwide shark population has been devastated to a small fraction of its original population by a growing demand for shark fin soup. Sharks fins are cut off and the live shark which is then dumped back in the ocean to sink and slowly die. Once considered only for rare occasions, with a growing Asian middle class, there is an accompanying demand for shark fin. Sharks take many years to mature to give birth. The problem does not only affect sharks. Since sharks are the top predator in the food chain, the impact on shark populations threatens to throw the entire marine ecosystem out of balance, with an unpredicatble outcome.
Acupuncture, moxibustion, and auriculotherapy
Acupuncture is an alternative medicine that treats patients by insertion and manipulation of needles in the body. Its proponents variously claim that it relieves pain, treats infertility, treats disease, prevents disease, promotes general health, or can be used for therapeutic purposes. Acupuncture typically incorporates traditional Chinese medicine (TCM) as an integral part of its practice and theory. The term “acupuncture” is sometimes used to refer to insertion of needles at points other than traditional ones, or to applying an electric current to needles in acupuncture points. Acupuncture dates back to prehistoric times, with written records from the second century BCE. Different variations of acupuncture are practiced and taught throughout the world.
Acupuncture is often accompanied by moxibustion, which involves burning mugwort on or near the skin at an acupuncture point. There are three methods of moxibustion: Direct scarring, direct non-scarring, and indirect moxibustion. Direct scarring moxibustion places a small cone of mugwort on the skin at an acupuncture point and burns it until the skin blisters, which then scars after it heals. Direct non-scarring moxibustion removes the burning mugwort before the skin burns enough to scar, unless the burning mugwort is left on the skin too long. Indirect moxibustion holds a cigar made of mugwort near the acupuncture point to heat the skin, or holds it on an acupuncture needle inserted in the skin to heat the needle. The Chinese character for acupuncture means "acupuncture-moxibustion".
The effectiveness of acupuncture beyond the placebo effect of a nonpenetrating sham treatment placebo effect is not well established. A systematic review found that acupuncture is no more effective than a nonpenetrating sham treatment for treating post operative nausea. A 2008 meta analysis pooled studies without placebos with those that had them concluded that combining acupuncture with conventional infertility treatments such as IVF improves the success rates of such medical interventions, but did not conclude that acupuncture was more effective than a sham treatment. There is conflicting evidence that it can treat chronic low back pain, and moderate evidence of efficacy for neck pain and headache. For most other conditions reviewers have found either a lack of efficacy (e.g., help in quitting smoking) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain). While little is known about the mechanisms by which acupuncture may act, a review publishe in an alternative medicine journal of neuroimaging research suggests that specific acupuncture points have distinct effects on cerebral activity in specific areas that are not otherwise predictable anatomically. The website Quackwatch mentions that TCM has been the subject of criticism as having unproven efficacy and an unsound scientific basis.
The evidence for acupuncture's effectiveness for anything but the relief of some types of pain and nausea has not been established. Systematic reviews have concluded that acupuncture is no more effective than nonpenetrating stimulation of one point to reduce some types of nausea. Evidence for the treatment of other conditions is equivocal. Although evidence exists for a very small and short-lived effect on some types of pain, several review articles discussing the effectiveness of acupuncture have concluded it is possible to explain as a placebo effect. Publication bias is a significant concern when evaluating the literature. Reports from the US National Center for Complementary and Alternative Medicine In America (NCCAM), the American Medical Association (AMA) and various US government reports have studied and commented on the efficacy of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles. The World Health Organization (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.
Cupping (拔罐) is a type of Chinese massage, cupping consists 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. When combined with massage oil, the cups can be slid around the back, offering "reverse-pressure massage".===
Die-da or Tieh Ta
Die-da or Tieh Ta (跌打) is usually practiced by martial artists who know aspects of Chinese medicine that apply to the treatment of trauma 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.
Gua Sha (“to lift up for cholera”, or “to scrape for cholera”) is abrading the skin 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. Gua Sha: A Clinical Overview, Arya Nielson, Chinese Medicine Times, </ref>
Physical Qigong exercises
Breathing and meditation exercise
Qigong (气功/氣功) and related breathing and meditation exercise.
Tui na (推拿) massage: a form of massage akin to acupressure (from which shiatsu 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.
Fengshui aesthetics and Chinese astrology
TCM doctors may also incorporate beliefs about the astrological alignment of buildings with astronomical bodies such as the sun (Fengshui aesthetics, 风水/風水), or astrological beliefs about the year, month, date, and hour of birth. Astrological considerations such planting a poant on the solstice or in the correct location (Di Dao Yao Cai) are believed to be important as to a medicine's effectiveness or toxicity.
The Four Pillars of Destiny (Bazi, 八字) are the four components believed under TCM to create a person's destiny or fate. The four components within the moment of birth are the year, the month, the day, and the hour, and are used alongside fortune telling practices such as Zǐ wēi dòu shù within the realm of Chinese Astrology as part of diagnosing patients or considerations about medicines.
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Tongue and pulse diagnosis and acupuncture treatment
There are four types of TCM diagnostic methods: observe (望 wàng), hear and smell (闻/聞 wén), ask about background (问/問 wèn) and touching (切 qiè).
Traditional Chinese Medicine (TCM) is based on Yinyangism (which was later absorbed by Daoism). From this follows the belief that all parts of the universe (including the human body) are interconnected by correspondence. For example, the number of meridians has at times been seen in correspondence with the number of rivers flowing through the ancient Chinese empire, and the number of acupuncture points has been seen in correspondence with the number of days in a year.
Model of the body
||The following text needs to be harmonized with text in TCM model of the body.
TCM's view of the human body is only marginally morphologic, i.e., concerned with structures or anatomy, but primarily focuses on the body functions (e.g., digesting food, breathing, keeping a certain temperature etc.). In order to explain and systematize the body, TCM identified certain functions as being connected, and then ascribed them to a common functional entity (e.g., nourishing the tissues and maintaining their moisture is seen as connected and the functional entity identified to be in charge is: xuě/blood).
The most important functional entities stipulated are qì, xuě (‘’blood‘’), the five zàng organs, the six fǔ organs, and the meridians.
- Actuation (推动, 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 zàng-fú organs and meridians.
- Warming (温煦, wēnxù) - the body, especially the limbs.
- Defense (防御, fángyù) - against Exogenous Pathogenic Factors
- Containment (固摄, gùshè) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
- Transformation (气化, qìhuà) - of food, drink, and breath into qi, xuě, and jīnyė (‘’fluids‘’, see below), and/or transformation of all of the latter into each other.
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 (营气), its function is to complement xuě and its nature has a strong yin aspect (although qi in general is considered to be yang). The latter is called weì-qì (卫气), 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 zàng-fú organs, this is considered to be part of the ‘’principal‘’ qi (元气, pinyin: yuán qì) of the body (also called 真气 pinyin: zhēn qì, ‘’true‘’ qi, or 原气 pinyin: yuán qì, ‘’original‘’ qi).
Theoretical basis of meridians
The meridians (经络, pinyin: jīng-luò) are believed to be channels running from the zàng-fǔ in the interior (里, pinyin: lǐ) of the body to the limbs and joints ("the surface" [表, pinyin: biaǒ]), transporting qi and xuĕ (blood). TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being 十二经脉 (pinyin: shí-èr jīngmài, lit. "the Twelve Vessels") and 奇经八脉 (pinyin: qí jīng bā mài) respectively. There's also a number of less customary channels branching off from the "regular" meridians.
In contrast to most of the other functional entities, xuě (血, "blood") is visible/tangible.
Xuě is defined by its functions of nourishing all parts and tissues of the body and safeguarding an adequate degree of moisture, and of sustaining and soothing both consciousness and sleep. TCM practitioners believe that pale complexion, dry skin and hair, dry stools, numbness of hands and feet, forgetfulness, insomnia, excessive dreaming, and anxiety are symptoms of a dysfunction of xuě, such as a lack of it.
Bodily fluids (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 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.
Five elements or five phases (Fu, Wu xing philosophy)
- Fire (火) = Heart (心) and Small Intestine (小肠) (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 (大肠)
- Water (水) = Kidney (肾) and Bladder (膀胱)
- Wood (木) = Liver (肝) and Gallbladder (胆)
Organ systems (Zang, Zag-fu)
The zàng-fǔ (simplified Chinese: 脏腑; traditional Chinese: 臟腑) constitute the centre piece of TCM's systematization of bodily functions. Bearing the names of organs, they are, however, only secondarily tied to (rudimental) anatomical 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 (脏) 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, Urinary Bladder, Stomach and Sānjiaō.
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 (传化, pinyin: chuán-huà) 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:
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.
Concept of disease
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The TCM concept of disease is very different from scientific medicine's as TCM diagnosis includes two levels: "bìng" and "zhèng". The former is often translated as "illness", "disease category" or simply "diagnosis". The latter is usually translated as "pattern" (or sometimes also as "syndrome").
"Pattern differentiation" ("biàn zhèng") is the most important step in TCM diagnosis, since the therapy will be chosen on basis of the pattern that is found. It is also known to be the most difficult aspect of practicing TCM.
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The practice of acupuncture probably dates back to the stone age, as suggested by findings of ancient stone needles. Also, hieroglyphs and pictographs documenting acupuncture and moxibustion have been found which are dating back to the Shang Dynasty (1600-1100 BC).
When acupuncture (and herbal medicine) became integrated into an embracing medical theory system is difficult to judge. TCM theory is, however, inextricably intertwined with the principles of Yinyangism (i.e., the combination of Wǔ Xíng theory with Yin-yang theory), which was represented for the first time by Zōu Yǎn (340 - 260 BC)).
The earliest and most fundamental composition identified in TCM is the Huăngdì Neìjīng (黄帝内经, Yellow Emperor's Inner Canon), probably dating back to the second century BC. According to legend, it was composed by the mythical Yellow Emperor (said to have lived 2697 - 2597 BC) as a result of a dialogue with his ministers. It states that to be a master physician, one must master the use of metaphors as they apply to medicine and the body.
Mythical origin was also claimed regarding the Shénnóng Běn Cǎo Jīng (神农本草经, Shennong's Materia Medica) - it traditionally was attributed to the legendary emperor Shénnóng (神农, lit. "Divine Farmer"), said to have lived around 2800 BC. The original text has been lost, however, there are extant translations. The true date of origin is believed to fall into the late Western Han dynasty (i.e., the first century BC).
Zhang Zhongjing born in the later Eastern Han Dynasty, when a pestilence devastated the lives of two thirds of the people in just one decade, and febrile diseases caused by cold accounted for 70% of this. Zhang Zhongjing wrote the Treatise on Febrile Diseases Caused by Cold and Miscellaneous Diseases, which established the principle of treatment according to syndrome differentiation, had numerous new and old medicinal recipes, and established the six channels basis of treatment. He wrote, "in terms of the high level, medicine is for curing nobles of their diseases; in terms of the lower level, it is used to save the poor from disaster; in terms of the middle level, it is used to keep us in good health", which gained him the title of "Saint in Medicine".
Hua Tuo (the “Originator of Surgery”)
Hua Tuo (145 - 208A.D.), a physician of the Eastern Han Dynasty, lived in the same period as physician Zhang Zhongjing. The original of his book Zhongzang Classic is lost, but partially reconstructed by people in the Song Dynasty. It contains mouth-to-mouth respiration, a general anesthetic for surgery made with alcohol and mafeisan, and the “Five Mimic-Animal Exercise”, and original surgical procedures using a cutting bone. Mafeisan, is a powder most likely made of Stramonium flowers, which was believed to make patients numb after being washed down with alcohol, and then surgery could be carried out. He traveled to numerous places, collecting formulas, medicines, and knowledge from the local people.
"A Great Physician should not pay attention to status, wealth or age; neither should he question whether the particular person is attractive or unattractive, whether he is an enemy or friend,whether he is a Chinese or a foreigner, or finally, whether he is uneducated or educated. He should meet everyone on equal grounds. He should always act as if he were thinking of his close relatives."
Sun Simiao (581—682 A.D.) is called “King of Medicine” and “the father of Chinese medical theory”. He wrote the earliest Chinese encyclopedia of medicine, the highly influential Essential Recipes worth a Thousand Gold (Qianjin Yaofang) and A Supplement to Recipes worth a Thousand Gold (Qianjin Yifang). The two books summarized pre Tang Dynasty medicine. The former listed about 5300 recipes for medicines, and the latter 2000. He put forth the “Thirteen measures to keep health”, which claimed that actions like touching hair, rolling eyes, walking, and shaking heads improved health. He also claimed that medicine should be ethical, and wrote "On the Absolute Sincerity of Great Physicians" called "the Chinese Hippocratic Oath," and which is still required reading for Chinese physicians. It is said that Sun lived 141 years.
Tao Hongjing depicted five shen herbs (renshen, danshen, xuanshen, kushen, and shashen; ginseng, salvia, scrophularia, sophora, and adenophora, respectively).
Zhang Yuansu (Zhang Jiegu; ca. 1151-1234) integrated medicinal materials into the five element framework (wuxing) with both the five shen herbs framework and qi meridians. He helped to more clearly define the association of herb tastes and their effect on the different organs. Zhang asserted that herbs entered into and influenced the meridians. The culmination of Zhang's work was the Bag of Pearls (Zhenzhu Nang, zhenzhu = pearl; nan = bag).
Li Shi Zhen
Li Shizhen (1518-1593 AD) wrote the Compendium of Materia Medica ((Bencao Gangmu), one of the most frequently mentioned books in the Chinese herbal tradition, rivaled only by the Shanghan Lun. It was published in 1596 A.D., three years his death. It describes the use of human body parts and extreta in medicines, such as the penis, semen menstrual blood, pubic hair, urine, placenta, fingernails, bones, dandruff, earwax, impurities on the teeth, feces, urine, sweat, and organs.
|Han Dynasty (206 BC–AD 220) to Three Kingdoms Period (220 - 280 AD)||
|Jin Dynasty (265 - 420)||
|Tang Dynasty (618 - 907)||
|Song Dynasty (960 – 1279):||
|Yuan Dynasty (1271–1368)|
|Ming Dynasty (1368–1644, considered the golden age of acupuncture and moxibustion, spawning many famous doctors and books)
|Qing Dynasty (1644–1912):
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TCM was more broadly introduced to an America with recent the rise of the New age fascination with magical thinking regarding the mystical concepts of TCM, was introduced to an America infatuated with New Age magical thinking.
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- Aung, S.K.H. & Chen, W.P.D. (2007): Clinical introduction to medical acupuncture. Thieme Mecial Publishers. ISBN 1-58890-221-8, p. 19
- Aung, S.K.H. & Chen, W.P.D. (2007): Clinical introduction to medical acupuncture. Thieme Mecial Publishers. ISBN 1-58890-221-8, pp 11-12
- "气的生理功能...(一)推动作用...(二)温煦作用...(三)防御作用...(四)固摄作用...(五)气化作用 [Physiological functions of qi ... 1.) Function of actuation ... 2.) Function of warming ... 3.) Function of defense ... 4.) Function of containment ... 5.) Function of transformation ...] as seen at 郭卜乐 (24t October 2009). "气" [Qi] (in Chinese). Retrieved 2 December 2010.
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- Elizabeth Reninger. "Qi (Chi): Various Forms Used In Qigong & Chinese Medicine - How Are The Major Forms Of Qi Created Within The Body?". Retrieved 6 December 2010.
- "...元气生成后，通过三焦而流行分布于全身，内至脏腑，外达腠理肌肤... [After yuan-qi is created, it disperses over the whole body, to the zang-fu in the interior, to the skin and the space beneath it on the exterior...] as seen in 郭卜乐 (24t October 2009). "气" [Qi] (in Chinese). Retrieved 6 December 2010.
- "1、元气 元气又称为"原气"、"真气"，为人体最基本、最重要的气，..." [1. Yuan-qi Yuan-qi is also known as "yuan-qi" and "zhen-qi", is the body's most fundamental and most important (kind of) qi ...] as seen at 郭卜乐 (24t October 2009). "气" [Qi] (in Chinese). Retrieved 6 December 2010.
- "经络是运行全身气血，联络脏腑肢节，沟通表里上下内外，..." [The jingluo transport qi and blood through the whole body, connecting the zang-fu with limbs and joints, connecting interior with surface, up with down, inside with outside ...] as seen at "中医基础理论辅导：经络概念及经络学说的形成: 经络学说的形成" [guide to basic TCM theory: the jing-luo concept and the emergence of jing-luo theory: the emergence of jing-luo theory] (in Chinese). Retrieved 13 January 2011.
- Aung, S.K.H. & Chen, W.P.D. (2007): Clinical introduction to medical acupuncture. Thieme Mecial Publishers. ISBN 1-58890-221-8, p. 20
- "（三）十二经脉 ...（四）奇经八脉 ..." [(3.) The Twelve Vessels ... (4.) The Extraordinary Eight Vessels ...] as seen at "经络学" [meridian theory] (in Chinese). Retrieved 22 February 2011.
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- "Body Fluids (Yin Ye)". copyright 2001-2010 by Sacred Lotus Arts. Retrieved 9 December 2010.
- "三、津液的功能 ...（三）调节阴阳 ...（四）排泄废物 ..." [3.) Functions of the Jinye: ... 3.3.)Harmonizing yin and yang ... 3.4.)Secretion of waste products ...] As seen at: "《中医基础理论》第四章 精、气、血、津液. 第四节 津液" [Basics of TCM theory. Chapter 4: Essence, qi, blood, jinye. Section 4: jinye] (in Chinese). Retrieved 9 December 2010.
- "Body Fluids (Yin Ye)". copyright 2001-2010 by Sacred Lotus Arts. Retrieved 3 March 2011.
- "津液包括各脏腑组织的正常体液和正常的分泌物，胃液、肠液、唾液、关节液等。习惯上也包括代谢产物中的尿、汗、泪等。" [The (term) jinye comprises all physiological bodily fluids of the zang-fu and tissues, and physiological secretions, gastric juice, intestinal juice, saliva, joint fluid etc. Costumarily this also includes metabolic products like urine, sweat, and tears, etc.] As seen at: "《中医基础理论》第四章 精、气、血、津液. 第四节 津液" [Basics of TCM theory. Chapter 4: Essence, qi, blood, jinye. Section 4: jinye] (in Chinese). Retrieved 9 December 2010.
- "Cultural China - Chinese Medicine - Basic Zang Fu Theory". Retrieved 8 January 2011.
- Ross 1984, p.6: "... the Zang Fu, the organ systems of TCM, do not refer so much to structures as to functions."
- Kaptchuk 2000, p. 76: "The Chinese Liver is defined first by the activites associated with it, the Western liver by its physical structure"
- by citation from the Huangdi Neijing's Suwen: ‘’言人身脏腑中阴阳，则脏者为阴，腑者为阳。‘’[Within the human body's zang-fu, there's yin and yang; the zang are yin, the fu are yang]. As seen at: "略论脏腑表里关系" [outline on the relationships between the zang-fu] (in Chinese). 22 January 2010. Retrieved 13 December 2010.
- "Cultural China - Chinese Medicine - Basic Zang Fu Theory". Retrieved 26 February 2011.
- "六腑：胆、胃、小肠、大肠、膀胱、三焦；“传化物质”。 [The Six Fu: gallbladder, stomach, small intestine, large intestine, bladder, sanjiao; "transmit and digest"] as seen at "中医基础理论-脏腑学说" [Basics of TCM theory - The zangfu concept] (in Chinese). 11 June 2010. Retrieved 14 December 2010.
- Aung, S.K.H. & Chen, W.P.D. (2007): Clinical introduction to medical acupuncture. Thieme Mecial Publishers. ISBN 1-58890-221-8, pp 15-16<
- Aung, S.K.H. & Chen, W.P.D. (2007): Clinical introduction to medical acupuncture. Thieme Mecial Publishers. ISBN 1-58890-221-8, p. 16
- Clavey 1995, p. XXX (30 of the introduction)
- Flaws 1990, p. 6
- Flaws 1990, p. 7
- Ergil et al. 2009, p. 146
- Ergil et al. 19, p. 148
- Flaws 1990, p. 5
- Ergil et al. 2009, p. 147
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- Robson, T (2004). An Introduction to Complementary Medicine. Allen & Unwin. pp. 90. ISBN 1741140544
- see Huang neijing Suwen, chapter 3.
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