Traditional Chinese medicine

Traditional Chinese medicine (中医, pinyin: zhōng yī, often abbreviated TCM), includes a range of beliefs and traditional medicine practices originating in East Asia. It typically excludes science based medicine, and is based on beliefs about the body that are not consistent with established science. Although a common part of medical care throughout East Asia, it is considered an alternative medical system in much of the Western world. TCM therapy largely consists of Chinese herbal medicine, acupuncture, dietary therapy, and tui na massage.

TCM uses a different medical model than modern western medicine: while it recognizes the same organs and structures as modern medicine does, it conceives of them in terms of functional interconnected systems, and organizes them with respect to metaphysical principles that have no correlates in scientific medicine and would generally be rejected by modern medical science. In TCM, ill-health is usually construed as an imbalance between organ systems (脏腑, zàng-fú), based on Daoist conceptions of yin and yang and other belief systems such as Wu Xing's Five Elements or the six excesses (六淫, liù yín, often translated as Six Exogenous Pathogenic Factors). Because organ systems are interrelated, one system can weaken or overexcite other organ systems, and the resulting imbalance is the origin point of illness. TCM practitioners try to rebalance the organ systems through the use of herbs intended to stimulate or calm particular systems, through stimulation of the systems directly along particular meridians, or through practices such as Qigong, taijiquan, or massage which attempt to balance the body as a whole.

Modern TCM was systematized in the 1950s under the People's Republic of China and Mao Zedong. Prior to this, Chinese medicine was mainly practiced within family lineage systems. The term "Classical Chinese medicine" (CCM) usually refers to these medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911).

TCM has been criticized for causing the endangerment of species, for example the use of Sumatran Tiger's penis to treat impotence.

Snake oil and other “cures”

Snake oil is a traditional Chinese medicine used to treat joint pain by rubbing it on joints. 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. 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.

Theory

Traditional Chinese Medicine is based on numerological claims about the anatomy of the body, and claims about kinds of "energy" believed to flow in the body called "qi". The notion of qi energy is unsupported by the science of physics. The anatomical structures claimed to exist are inconsistent with the sciences of human anatomy and human physiology. The location of accupuncture points is based on the number of rivers considered to be major that flowed through a particular ancient Chinese empire, and is based on what was believed to be the number of days in the year, and the numbers are believed to be related to the flow of qi energy in the body.

Model of the body

Main article: TCM model of the body

TCM's view of the human body is only marginally morphologic, i.e., concerned with anatomy, but primarily focuses on the body functions (e.g., digesting food, breathing, keeping a certain temperature etc.).

As a first step of systematization, certain body functions are identified as being connected and ascribed 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 terms used for those functional entities are usually very illustrative (blood, essence, liver, heart etc.), but don't claim to be anatomically correct.

The most important functional entities stipulated are

• qì
• xuě (‘’blood‘’)
• the five zàng organs
• the six fǔ organs
• the meridians

Qi

Main article: Qi § Traditional Chinese medicine

Qì (气) is probably the single most prominent term in TCM, however, also one of the most difficult ones since TCM distinguishes several different kinds of qi. In a general sense, qi is defined by five cardinal functions:

1. Actuation (推动, tuīdòng) - of all physical processes in the body, especially the circulation of all body fluids in their vessels. This includes actuation of the functions of the zàng-fú organs and meridians.
2. Warming (温煦, wēnxù) - the body, especially the limbs.
3. Defence (防御, fángyù) - against Exogenous Pathogenic Factors
4. Containment (固摄, gùshè) - of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
5. 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 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).

Xue (Blood)

In contrast to most of the other functional entities, xuě (血, blood) has a pronounced tangible and morphological dimension in the sense that it basically is identified as the red liquid running in the blood vessels; however, there also is an intangible dimension to its concept as it extends into mental functions as well.
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. Contrariwise, clinical symptoms of a dysfunction (e.g., lack) of xuě are believed to be pale complexion, dry skin and hair, dry stools, numbness of hands and feet, forgetfulness, insomnia, excessive dreaming, anxiety etc.

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.

Zang-fu

Main article: Zang-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 loosely tied to (rudimental) anatomical assumptions (the fǔ a little more, the zàng much less). As they are entities defined by function first and foremost, however, 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:

• 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)

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.

Meridians

Main article: Meridian (Chinese medicine)

The meridians (经络, pinyin: jīng-luò) are stipulated 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).

Concept of disease

TCM posits that illness is caused by external and/or internal factors which disrupt the body's natural processes.

• 
  Old Chinese medical chart on acupuncture meridians
• 
  Interactions of Wu Xing
• 
  Ancient Tibetan Medicine Poster

There are significant regional and philosophical differences between practitioners and schools which in turn have led to differences in practice and theory.

Diagnostics

Diagnosis in TCM consists of various forms of observation including visual, auditory, olfactory, touch, and questioning. These observations take the form of descriptions of color, moisture and heat, among many others to ultimately identify a pattern that can be subsequently treated.

Methods for diagnostic pattern recognition include the following:

The Yin/Yang and five element theories may be applied to a variety of systems other than the body, whereasZang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific. Separate models apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and theEight principles system of disease classification.

Following a "macro" philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than "micro" level laboratory tests. 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). 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."

Traditional Chinese medicine requires considerable diagnostic skill. A training period of years or decades is necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, A good (TCM) doctor is also qualified to be a good prime minister in a country. Modern practitioners in China often combine a traditional system with Western methods.

Techniques

• Palpation of the patient's radial artery pulse (pulse diagnosis) in six positions
• Observations of patient's tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children
• Palpation of the patient's body (especially the abdomen, chest, back, and lumbar areas) for tenderness or comparison of relative warmth or coolness of different parts of the body
• Observation of the patient's various odors
• Asking the patient about the effects of their problem.
• Anything else that can be observed without instruments and without harming the patient
• Asking detailed questions about their family, living environment, personal habits, food diet, emotions, menstrual cycle for women, child bearing history, sleep, exercise, and anything that may give insight into the balance or imbalance of an individual.

Treatment methods

The methods are part of Chinese medicine:

• Acupuncture(针疗/針療) (from the Latin word acus, "needle", and pungere, meaning "prick") is a technique in which the practitioner inserts fine needles into specific points on the patient's body. Usually about a dozen points are needled in one session, although the number of needles used may range anywhere from just one or two to 20 or more. The intended effect is to increase circulation and balance energy (Qi) within the body.
• Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
• Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient's individual condition. The "five flavors" (an important aspect of Chinese herbalism as well) indicate the function of various types of food. A balanced diet, which leads to health, is when the five functional flavors are in balance. When one is diseased (and therefore unbalanced), certain foods and herbs are prescribed to restore balance to the body.
• Chinese herbal medicine (中草药/中药/中藥): In China, herbal medicine is considered as the primary therapeutic modality of internal medicine. Of the approximately 500 Chinese medicinal herbs, 250 or so are commonly used. Rather than being prescribed individually, herbs are formulated to adapt to the specific needs of individual patients. A herbal formula can contain 3 to 25 herbs. As with diet therapy, each herb has one or more of the five flavors/functions and one of five "temperatures" ("Qi") (hot, warm, neutral, cool, cold). After the herbalist determines the energetic temperature and functional state of the patient's body, he or she prescribes a mixture of herbs tailored to balance disharmony. One classic example of Chinese herbal medicine is the use of various mushrooms such as reishi and shiitake, which are currently under intense study by ethnobotanists and medical researchers for immune system enhancement. Unlike Western herbalism, Chinese herbal medicine uses many animal, mineral and mineraloid remedies, and also uses more products from marine sources.
• Cupping (拔罐): 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 (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 (刮痧) is a form of mechanical dermabrasion using a hand-held scraper to irritate and inflame various regions of the JingLuo's dermal areas. It is frequently used to treat invasion by seasonal external pathogens.
• Moxibustion(灸疗/灸療): "Moxa," often used in conjunction with acupuncture, consists in burning of dried Chinese mugwort (Artemisia vulgaris) on acupoints. "Direct Moxa" involves the pinching of clumps of the herb into cones that are placed on acupoints and lit until warm. Typically the burning cone is removed before burning the skin and is thought, after repeated use, to warm the body and increase circulation. Moxa can also be rolled into a cigar-shaped tube, lit, and held over an acupuncture point, or rolled into a ball and stuck onto the back end of an inserted needle for warming effect.
• Physical Qigong exercises such as Tai chi chuan (Taijiquan 太极拳/太極拳), Standing Meditation (站樁功), Yoga, Brocade BaDuanJin exercises (八段锦/八段錦) and other Chinese martial arts.
• 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.
• Some TCM doctors may also utilize esoteric methods that incorporate or reflect personal beliefs or specializations such as Fengshui (风水/風水) or Bazi (八字).

Branches

The most prominent branches of Chinese medicine are the Jingfang (经方学派) and Wenbing (温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shennong Bencaojing. The more recent Wenbing school's practise is largely based on more recent books including Compendium of Materia Medica from the Ming and Qing Dynastys, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in mainland China, when Wenbing used political power to suppress the opposing school.

Scientific view

Efficacy

Acupuncture

See also: Acupuncture: Scientific research into efficacy

Much of the scientific research on TCM has focused on acupuncture. The effectiveness of acupuncture remains controversial in the scientific community. A review by Edzard Ernst and colleagues in 2007 found that research is active and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions". Researchers using evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.

A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions. 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 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 World Health Organization (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted. The 1997 NIH Conference Statement on acupuncture concluded:

...promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Herbal

In isolated cases, useful pharmacological compounds have been found in some Chinese herbal medicines, but there is no scientific basis for most Chinese herbal remedies. Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used to treat multi-drug resistant strains of falciparum malaria. Other compounds, such as those seen in Dichroa febrifuga Lour and Bidens pilosa, including febrifugine, exhibit high toxicity Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.

Safety

TCM herbs may be toxic. If the TCM treatment only has a placebo effect, patients may fail to receive effective scientific medical treatement when it is available, such as in the treatmet of easily cured bacteriological infection.

In practice

Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. Dizziness and bruising sometimes result from acupuncture.

Some governments have decided to certify practitioners. One Australian report said in 2006, "A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended traditional Chinese medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs."

Allergy

Certain Chinese herbal medicines involve a risk of allergic reaction and in rare cases involve a risk of poisoning. Cases of acute and chronic poisoning due to treatment through ingested Chinese medicines are found in China, Hong Kong, and Taiwan, with a few deaths occurring each year. Many of these deaths occur when patients self–medicate or take unprocessed versions of toxic herbs. The raw and unprocessed form of aconite, or fuzi is the most common cause of poisoning. The use of aconite in Chinese herbal medicine is usually limited to processed aconite, in which the toxicity is denatured by heat treatment.

Toxins and contaminants

Potentially toxic and carcinogenic compounds such as arsenic trioxide (三氧化二砷) and cinnabar (called zhūshā, 朱砂) are sometimes prescribed as part of a medicinal mixture, in a sense "using poison to cure poison". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect. Empirical studies are improving processing of Chinese herbals, and supporting better regulations regarding the growing, processing, and prescription of various herbals.

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.

In the United States, the Chinese herb má huáng (麻黄; lit. "hemp yellow") — known commonly in the West by its Latin name Ephedra—was banned in 2004 by the Food and Drug Administration (FDA), although the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The ban was meant to combat the use of this herb in Western weight loss products, a phenomenon well removed from traditional Asian uses. There were no cases of Ephedra based fatalities with patients using traditional preparations for traditional uses. Following court battles, the Appeals Court upheld the FDA's ban in 2006, finding that the 133,000-page administrative record supported the finding of unreasonable risk to consumers.

Standardization

Chinese herbals are often not standardized from one pill to the next, or from one brand to the next, and can be reformulated, remixed, or otherwise altered by any company.

Naming

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. The Chinese Medicine Registration Board of the Australian state of Victoria in 2004 noted this problem.

Relationship with Western medicine

A person might see a Chinese medicine practitioner for a broken bone.

A report by the Victorian state government in Australia on TCM education in China noted:

Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practise TCM as a specialty within the broader organisation of Chinese health care.

In other countries traditional Chinese and Western medicine are rarely practiced by the same practitioner. TCM education in Australia, for example, does not attempt to qualify practitioners to diagnose in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures. Australia is constructing a separate legislative framework to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.

Investigation of the active ingredients in TCM has produced drugs such as Artemisinin, used in the treatment of malaria.

Opposition

Starting from the late 19th century, some politicians and Chinese scholars with backgrounds in Western medicine have been trying to phase out TCM totally in China. Critics argue that the efficacy of TCM has not been proven in a clinical setting. The attempts to curtail TCM in China provoke debates but have never succeeded.

Western medicine documents the efficacy of its pharmaceuticals through controlled, double blind experiments. Yet this is rarely applicable to TCM. It is impossible to create an effective placebo for acupuncture, for example. Chinese herbs are almost always given in combination with other herbs, but Western testing procedures are based on testing the validity of one herb at a time. Moreover, Chinese herbs are prescribed to treat the individual patient and the reason he/she developed a health problem; the problem itself does not have a standardized cure. To give a single herb to 100 patients for the same health problem, as is done in clinical testing, is not Chinese medicine: it is a Western program for incorporating Chinese herbs as Western pharmaceuticals.

Modernizers partially phased out TCM in Japan after the Meiji Restoration. However, in the 1920s the Meridian Therapy movement (Keiraku Chiryo in Japanese) attempted to restore traditional medical practice, especially acupuncture. Many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine. However, Kampo practitioners adopted standardization and regulations that are absent in TCM. Yosio Nakatani in 1950 derived ryodoraku (良導絡) from TCM. It utilizes electric test instruments and direct current stimulation of acupoints instead of subjective interpretation of symptoms and treatment. Ryodoraku research is centered at Osaka Medical College, Japan.

Animal products

Dried seahorses like these are extensively used in traditional medicine in China and elsewhere

Animal products are used in certain Chinese preparations, which may disturb 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. Alternatives to rhinoceros horn (xī jiǎo / 犀角) for "cooling the blood" include buffalo horn (shuǐ niú jiǎo / 水牛角) starting from perhaps 5CE. "Horny goat weed" (yín yáng hoù / 淫羊藿) is a plant (Epimedium), although it has been mistransalated as an animal.

Poachers hunt restricted animals to supply the black market for such products.

The use of tiger's penis to treat impotence does not appear in the ingredients lists of any pharmacopoeia. However, their use continues. Laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets. Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility, and tiger eyes.

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. The 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 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.

Widespread medicinal use of turtle plastron is of concern to conservationists.

Customs authority in many countries monitor medicinal products to ensure that no items made from CITES-proscribed species are imported. Biochemical techniques are being developed to identify from what species a particular processed product has been made.

Form factor

Medications on the shelves of a Chinese pharmacy in Seattle

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.

History

Macerated medicinal liquor with wolfberry, tokay gecko, and ginseng, for sale at a traditional medicine market in Xi'an, China.

The practice of acupuncture may date back to the stone age, as suggested by findings of ancient stone needles. Hieroglyphs and pictographs dating back to the Shang Dynasty (1600-1100 BC) have been found which document acupunture and moxibustion, and while it is impossible to tell when acupuncture and herbal medicine might have become integrated into a formal medical system, they are clearly interrelated with the principles of Yinyangism, offered by Zōu Yǎn between 305 and 240 BC. The earliest composition identified in Chinese medicine is the Huăngdì Neìjīng (黄帝内经, Yellow Emperor's Inner Canon), probably dating back to between 300 - 100 BC . According to legend, it was composed by the mythical Yellow Emperor (said to have lived 2698 - 2596 BC) as a result of a dialogue with his minister Qibo (岐伯).

Shénnóng Běn Cǎo Jīng (神农本草经, Shennong's Materia Medica) is traditionally was attributed to the legendary emperor Shénnóng who is said to have lived around 2800 BC. The original text has been lost, but research on extant copies place its date of origin somewhere between 300 BC and 200 AD.

Two other early (although less famous) medical texts are the Zubi shiyi mai jiu jing (足臂十一脉灸经/足臂十一脈灸經) (Moxibustion Classic of the Eleven Channels of Legs and Arms), and the Yinyang shiyi mai jiu jing (阴阳十一脉灸经/陰陽十一脈灸經) (Moxibustion Classic on the Eleven Yin and Yang Channels). These works are dated to the Warring States Period (5th century BC to 221 BC). The Yinyang shiyi mai jiu jing was discovered as part of the Mawangdui Silk Texts rediscovered in 1973 .

TCM's second central classical composition, the Shāng Hàn Zábìng Lùn (伤寒杂病论,which was later divided into Shāng Hàn Lùn and Jīnguì Yàolüè), was written by Zhang Zhongjing (张仲景) during the Han Dynasty, approximately around 200 AD.

Subsequent centuries saw a large number of prominent doctors developing medical theories on the basis of the classical works, or contributing original material which would later be brought in tune with the TCM system:

Han Dynasty (206 BC–AD 220) to Three Kingdoms Period (220 - 280 AD)	Zhenjiu zhenzhong jing (针灸枕中经/鍼灸枕中經) (Classic of Moxibustion and Acupuncture Preserved in a Pillow) by Huà Tuó (华佗/華佗, approx. 140-208 AD), who anesthetized patients during surgery with a formula of wine and powdered cannabis. Hua's physical, surgical, and herbal treatments were also used to cure diseases like headaches, dizziness, worms, fever, cough, etc.
Jin Dynasty (265 - 420)	Zhēnjiǔ jiǎyǐ jīng (针灸甲乙经/鍼灸甲乙經) (Systematic Classic of Acupuncture and Moxibustion) by Huángfǔ Mì (皇甫谧/皇甫謐), ca. 265 AD.
Tang Dynasty (618 - 907)	Beiji qianjin yaofang (备急千金要方/備急千金要方) (Emergency Formulas Worth a Thousand in Gold) and Qianjin yifang (千金翼方) (Supplement to the Formulas Worth a Thousand in Gold) by Sūn Sīmiǎo (孙思邈/孫思邈).| Waitai miyao (外台秘要/外臺秘要) (Arcane Essentials from the Imperial Library) by Wang Tao (王焘/王燾). Wáng Bìng (王冰) claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the 11th century AD . Emperor Gaozong (r. 649–683) of the Tang Dynasty (618–907) commissioned the scholarly compilation of a materia medica in 657 that documented 833 medicinal substances taken from stones, minerals, metals, plants, herbs, animals, vegetables, fruits, and cereal crops. In his Bencao Tujing (Illustrated Materia Medica), the scholar-official Su Song (1020–1101) systematically categorized herbs and minerals according to their pharmaceutical uses.
Song Dynasty (960 – 1279):	Tóngrén shūxué zhēnjiǔ tújīng (铜人腧穴针灸图经/銅人腧穴鍼灸圖經) (Illustrated Manual for the Practice of Acupuncture and Moxibustion with the Help of a Bronze Figure bearing Acupuncture Points) by Wáng Wéiyī (王惟一).
Yuan Dynasty (1271–1368)	Shísì jīng fāhuī (十四经发挥/十四經發揮) (Exposition of the Fourteen Channels) by Huá Shòu (滑寿/滑壽). There was also influence from Islamic medicine from Central Asia and from the sea. This school is known as Hui medicine.
Ming Dynasty (1368–1644, considered the golden age of acupuncture and moxibustion, spawning many famous doctors and books)	Zhēnjiǔ dàquan (针灸大全/鍼灸大全) (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng (徐凤/徐鳳). Zhēnjiǔ jùyīng fāhuī (针灸聚英发挥/鍼灸聚英發揮) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武). Zhēnjiǔ dàchéng (针灸大成/鍼灸大成) (Compendium of Acupuncture and Moxibustion) by Yáng Jìzhōu (杨继洲/楊繼洲), completed in 1601. Běncǎo gāngmù (本草纲目/本草綱目) (Outlined Materia Medica) by Lǐ Shízhēn (李时珍/李時珍), the most complete and comprehensive pre-modern herbal book (completed in 1578) . Wenyi lun (温疫论/溫疫論), by Wu Youxing (吴有性) (1642).
Qing Dynasty (1644–1912):	Yizong jinjian (医宗金鉴/醫宗金鑒) (Golden Mirror of the Medical Tradition) compiled by Wu Qian (吴谦/吴謙) under imperial commission. Zhenjiu fengyuan (针灸逢源/鍼灸逢源) (The Source of Acupuncture and Moxibustion) by Li Xuechuan (李学川/李學川). Wenre lun (温热论/溫熱論), by Ye Tianshi (叶天士/業天士). Wenbing tiaobian (温病条辨/溫病條辨) (Systematized Differentiation of Febrile Disorders) compiled by Wu Jutong (吴鞠通) in 1798.

Dried plants and animals parts are used in traditional Chinese medicines. In the image are dried Lingzhi, snake, turtle plastron, Luo Han Guo, and species of ginseng.

See also

• Alternative medicine
• American Journal of Chinese Medicine (journal)
• Ayurveda
• Chinese classic herbal formula
• Chinese food therapy
• Chinese herbology
• Chinese patent medicine
• List of branches of alternative medicine
• List of topics characterized as pseudoscience
• Medicinal mushrooms
• Pharmacognosy
• Public health in the People's Republic of China
• Traditional Korean medicine
• Traditional Mongolian medicine
• Traditional Tibetan medicine

References

• Benowitz, Neal L. (2000) Review of adverse reaction reports involving ephedrine-containing herbal products.Submitted to U.S. Food and Drug Administration. January 17.
• Chan, T.Y. (2002). Incidence of herb-induced aconitine poisoning in Hong Kong: impact of publicity measures to promote awareness among the herbalists and the public. Drug Saf. 25:823–828.
• Chang, Stephen T. The Great Tao; Tao Longevity; ISBN 0-942196-01-5 Stephen T. Chang
• Hongyi, L., Hua, T., Jiming, H., Lianxin, C., Nai, L., Weiya, X., Wentao, M. (2003) Perivascular Space: Possible anatomical substrate for the meridian. Journal of Complementary and Alternative Medicine. 9:6 (2003) pp851–859
• Jin, Guanyuan, Xiang, Jia-Jia and Jin, Lei: Clinical Reflexology of Acupuncture and Moxibustion; Beijing Science and Technology Press, Beijing, 2004. ISBN 7-5304-2862-4
• Kaptchuck, Ted J., The Web That Has No Weaver; Congdon & Weed; ISBN 0-8092-2933-1Z
• Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists; Churchill Livingstone; ISBN 0-443-03980-1
• Ni, Mao-Shing, The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary; Shambhala, 1995; ISBN 1-57062-080-6
• Holland, Alex Voices of Qi: An Introductory Guide to Traditional Chinese Medicine; North Atlantic Books, 2000; ISBN 1-55643-326-3
• Needham, Joseph (2002). Celestial Lancets. ISBN 9780700714582. {{cite book}}: Invalid |ref=harv (help)* Unschuld, Paul U., Medicine in China: A History of Ideas; University of California Press, 1985; ISBN 0-520-05023-1
• Porkert, Manfred (1974). The Theoretical Foundations of Chinese Medicine. MIT Press. ISBN 0-262-16058-7. {{cite book}}: Invalid |ref=harv (help)
• Qu, Jiecheng, When Chinese Medicine Meets Western Medicine - History and Ideas (in Chinese); Joint Publishing (H.K.), 2004; ISBN 962-04-2336-4
• Scheid, Volker, Chinese Medicine in Contemporary China: Plurality and Synthesis; Duke University Press, 2002; ISBN 0-8223-2857-7
• Unschuld, Paul U. (1985). Medicine in China: A History of Ideas. University of California Press. ISBN 0-520-05023-1. {{cite book}}: Invalid |ref=harv (help)

Further reading

• Sivin, Nathan, ed. (2000). Medicine. (Science and civilisation in China, Vol. VI, Biology and Biological Technology, Part 6). Cambridge: Cambridge University Press. 10-ISBN 0-521-63262-5; 13-ISBN 978-0-521-63262-1; OCLC 163502797