Chinese medicine

Related Terms

• Acupressure, acupuncture, acustimulation, acutherapy, Asian bodywork, auricular acupuncture, chi kung, Chinese herbal medicine, Chinese nutrition therapy, classical acupuncture, coining, cupping, eclectic Chinese medicine, electroacupuncture, ethnic Chinese traditional medicine, feng shui, five element acupuncture, I Ching, Japanese acupuncture, medical acupuncture, moxibustion (moxa), Qi gong, qigong, Reiki, scraping ("coining"), shiatsu, tai chi, taoism, tiji, ting sha, TCM, traditional acupuncture, traditional Chinese medicine, tui na.

Background

• Chinese medicine is a broad term encompassing many different modalities and traditions of healing that share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism). Given the distribution of the world population, it is likely that more people have been treated by Chinese medicine in its various forms than any other approach in history. There are many possible ways to categorize the modalities and traditions of Chinese medicine. The following categorization will be used in this monograph to describe the major approaches available:
• Chinese herbal medicine: This is perhaps the oldest form of medicine based on Chinese medical principles. It is based on the energetic qualities of the herbs rather than the chemical properties as understood by Western pharmacology. There are over 2,000 different kinds of herbs (of which about 400 are commonly used). Chinese herbal medicine may be employed as a complete system of healing in itself, or may be combined with many of the other practices outlined below.
• Traditional acupuncture: Also known as "five element" or "classical acupuncture," traditional acupuncture evolved as a distinct practice (separate from herbs). It is the longest-established form of acupuncture practice in the United States. Its philosophy is that acupuncture without herbs is a complete medical system in itself.
• Medical acupuncture: This is acupuncture delivered by a Western-trained medical practitioner within the practice of Western medicine. Medical acupuncture developed in Europe as a result of the introduction of Chinese medical texts and practices by traders and missionaries in the17th and 18th Centuries.
• Ethnic Chinese traditional medicine: This is a loosely defined, generic form of Chinese medicine usually practiced by the ethnic Chinese practitioners in large urban centers in the United States and other countries. There is no single organized body of theory or training. This is in contrast to the more formal, organized system referred to as traditional Chinese medicine (TCM, described later). Both acupuncture and herbs may be used, and some practitioners use electrical stimulation of the needles. Practitioners commonly prepare raw herb formulas and send them home in paper wrappings or jars for the client to brew into a medicinal tea at home.
• Japanese acupuncture: Japanese acupuncture is practiced by a small, but growing number of Western acupuncturists. Japanese needles are considerably thinner than others and as a result are now used by many practitioners of other forms of Chinese medicine because they are thought to be more gentle and subtle for the patient. Japanese acupuncture theory does not include herbs, although some practitioners do employ them based on other principles.
• Auricular acupuncture: Auricular acupuncture is acupuncture performed at points exclusively on the ear. Many of its practitioners consider this approach to be a complete medical system for treating functional and allergic disorders, and they often use it exclusive of any other type of practice. It is also used for pain control and to assist in drug and alcohol withdrawal.
• Traditional Chinese medicine (TCM): In the 1940s and 50s, the government of China undertook an effort to combine the myriad forms of Chinese medicine into a unified system officially labeled traditional Chinese medicine (TCM). The intent was to integrate the country's large work force of traditional practitioners into a Western-style health service delivery system to help provide care for a large population, using familiar and inexpensive methods. TCM uses a well-defined theory and places a heavy emphasis on herbal medicine supplemented by acupuncture. Herbs are usually given in the form of manufactured or processed pills, extracts, capsules, tinctures, or powders, in contrast to the raw and dried form favored in ethnic Chinese traditional medicine.
• Cupping and moxibustion: Cupping is the application of a heated cup over an area of the body. As the air inside cools its volume decreases and it creates a slight suction on the area that stimulates blood circulation. Moxibustion is the burning of an herb, usually mugwort (Artemisia vulgaris), above the skin or on the acupuncture points in order to introduce heat into an acupuncture point to alleviate symptoms. It may be applied in the form of a cone, stick, or loose herb or it may be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle.
• Acupressure and shiatsu: These are both names for a technique of massage involving the use of finger pressure on acupuncture points (rather than using needles). Based on Chinese medical theory of the human energy system, acupressure and shiatsu seek to stimulate the flow and circulation of chi (vital energy, life force) through the person's meridian system (system of pathways of circulation of chi through the body).
• Eclectic Chinese medicine: The greatest number of Western practitioners of Chinese medicine may be described as eclectic, although their original training was in one of the specific forms above. Many practitioners draw from several different sources to create their own synthesis that works best for them in their own style of practice.
• Other modalities: There are other related modalities of healing that have their origins in Chinese medicine concepts or theory. Many of these have been examined in scientific studies. Please read individual Natural Standard monographs for details.
• Practitioners: Because of the diversity of forms in which Chinese medicine is practiced, there is no one single credential for all practitioners.

Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. Taoist principles as described below are present throughout the literature and teachings of the many forms of Chinese medicine.
• Nature and the laws that govern the on-going, harmonious flow of life energy through the natural world are used to understand the body and health. The person is viewed as an ecosystem that is embedded in, and related to, the larger ecosystem of nature and subject to the same laws.
• The life force, chi (qi), circulates through the body and enlivens it. Health is a function of a balanced, harmonious flow of chi and illness results when there is a blockage or an imbalance in the flow of chi. Yin and yang are opposite and complementary qualities of life energy (chi). Yin is regarded as the feminine principle and yang the masculine principle.
• The human being has a system of pathways called meridians (also sometimes called channels) through which the chi flows. The body has been mapped with these meridians, which pass through all its organs, and specific meridians correspond with specific organs or organ systems (organ networks, described below). Health is an ongoing process of maintaining balance and harmony of the circulation of chi through all the organs and systems of the body.
• Symptoms are regarded as signals of impaired flow or circulation of chi through the body. Symptoms are considered as part of a larger picture or pattern affecting the whole person. The practitioner seeks to connect seemingly unrelated symptoms and come up with a unifying explanation, in terms of what is going on with the person's chi on a global basis.
• Most modern diseases are considered "chi deficiency" diseases, caused by not maintaining or supporting a harmonious internal ecology.
• Harmony and disharmony are understood in two main conceptual frameworks: the eight principles, and the five elements, described below.
• The eight principles are actually four pairs of complementary opposites describing patterns of disharmony within the person. Briefly the principles are interior/exterior, referring to the location of the disharmony in the body (internal organs vs. skin or bones); hot/cold, referring to qualities of the disease pattern, such as fever or thirst vs. chilliness or desire to drink warm liquids; full/empty, referring to whether the condition is acute or chronic, and whether the body's responses are strong or weak; and the balance of yin/yang, which adds further to the description of the other six principles. The eight principles are the theoretical basis of the TCM approach described above.
• The five elements are fire, earth, metal, water, and wood. These terms do not refer to basic constituents of matter, but are dynamic qualities of nature. They are used to describe the changing qualities of chi energy as it circulates through the person. Five element theory is the basis of the approach called traditional acupuncture (also referred to as classical or five element acupuncture).
• The body has five organ networks, each corresponding with a particular element: heart/small intestine with fire, spleen/stomach with earth, lungs/large intestine with metal, kidneys/bladder with water, and liver/gall bladder with wood. The organ networks are named for the common meridian that circulates through and connects the organs, as it circulates chi throughout the larger, body-wide, meridian system. The practitioner's efforts to harmonize the five elements promote greater harmony in the functioning of all the organ networks.
• Chinese medicine comprises many related but individual modalities, each with its own body of research, with varying degrees of scientific support. Natural Standard monographs are available for reviews of evidence for the following modalities employing principles of Chinese medicine: acupressure, acupuncture, acustimulation, Asian body work, chi kung, cupping, electroacupuncture, energy-based bodywork, macrobiotic diet, moxibustion, Qi gong, shiatsu, tai chi, taiji, traditional Chinese medicine (TCM), tuina, and others.

Evidence

*Key to grades:

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

General

• Since Chinese medicine covers so many different therapies and modalities, the below information includes only examples of safety concerns with selected herbs, supplements, and modalities. For more detailed information, please see the Natural Standard monographs on individual therapies.

Chinese herbs

• Studies of the Chinese herb ma huang, which is the main active ingredient in the weight-loss drug ephedra, indicate that use of the substance is associated with serious health complications, including acute hepatitis and deaths. Pregnant or lactating women should not use ma huang or other herbs such as ginseng where safety has not been clearly established.
• Chinese herbs, when taken by mouth or applied on the skin, may cause an allergic reaction. For example, shi-un-ko, a Chinese medicine that is applied to the skin, may cause an allergic skin rash.
• There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metals or not containing the listed ingredients. A qualified healthcare professional, including a pharmacist, should be consulted for recommendations of safe herbal products.
• Chinese herbs can be powerful. There have been reports of adverse effects. A qualified healthcare practitioner, including a pharmacist, should be consulted on dosage.
• Chinese herbs can interact with drugs, interfering with or exaggerating their effects. In particular, ma huang should not be taken with caffeine. Consumers should consult with a medical professional including a pharmacist before mixing herbs with any prescription drugs.
• Traditional Chinese medicine should be used with extreme caution in infants and children as harmful effects including blood disorder have been reported.

Acupuncture

• Acupuncture is generally reported as a safe procedure when performed by an experienced practitioner using standard sterile techniques. Needles must be sterile in order to avoid disease transmission (most practitioners now use disposable needles).
• Rare serious and potentially lethal complications have been noted including infection and organ, nerve, or vascular injury, such as cardiac tamponade. There are several reports of fatalities in the available medical literature. Acupuncture may be particularly unsafe when performed on patients with emphysema or other pulmonary diseases, due to multiple case reports of pneumothorax, elderly or medically compromised patients, diabetics (due to poor circulation), or patients with history of seizures.
• Electrostimulation acupuncture should be avoided in pregnant women (theoretical) and in patients with a cardiac history, including those persons with an arrhythmia or a pacemaker, due to risk of arrhythmia or interference with pacemaker functioning.
• Acupuncture should be avoided in the following conditions: valvular heart disease, known bleeding disorders, use of anticoagulant (blood thinning) drugs, unstable medical conditions or infections, pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, and neurologic disorders. It should also be avoided on areas that have received radiation therapy.

Cupping and moxibustion

• Adverse events reported in the scientific literature from cupping and moxibustion are rare. Cupping commonly leaves a temporary bruising of the skin, which disappears on its own. For both cupping and moxibustion, precautions and contraindications are offered based on tradition, clinical experience, and theory rather than controlled research, as follows.
• Cupping: Avoid the abdomen/sacral area during pregnancy, contraindicated acupuncture points, during high fever, during convulsions or cramps, over allergic skin conditions or ulcerated sores, over an inflamed organ, over inflamed areas in general, in patients with cardiac disease and/or aneurysms, in patients with extreme fatigue and/or anemia, and in patients who have just finished exercising or taking a hot bath or shower. Avoid sliding cups over the spine, moles, or other skin abnormalities.
• Moxibustion: Use caution with patients with neuropathy. Avoid face, head, nipples, and genitals, skin adhesions, points where needling is contraindicated for the individual patient, in patients with any kind of "heat syndrome" according to acupuncture theory, in patients with strong heat signs, high fever, etc., on or near inflamed and/or red areas of the body, and in patients with diabetic neuropathy or in any situation where the patient may not respond to the sensations of heat. Patients are advised not to bathe or shower for up to 24 hours after a moxibustion treatment.
• Pregnancy and breastfeeding: The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus although there is a lack of published reports of related adverse effects.

Acupressure

• With proper training, self-administered acupressure and that performed by an experienced therapist appear to be generally safe. There is a lack of serious long-term complications that have been reported in the scientific literature. Forceful acupressure may cause bruising.

Other modalities

• More safety information can be found in the specific monographs on this site for the various modalities of Chinese medicine.

Authors

• This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Borud EK, Alraek T, White A, et al. The effect of TCM acupuncture on hot flushes among menopausal women (ACUFLASH) study: a study protocol of an ongoing multi-centre randomised controlled clinical trial. BMC Complement Altern Med 2007 Feb 26;7:6.
2. Chan B, Ui LQ, Ming TP. Methemoglobinemia after ingestion of Chinese herbal medicine in a 9-day-old infant. Clin Toxicol (Phila) 2007;45(3):281-3.
3. Kalish LA, Buczynski B, Connell P, et al. Stop Hypertension with the Acupuncture Research Program (SHARP): clinical trial design and screening results. Control Clin Trials 2004;25(1):76-103.
4. Kim SH, Lee SE, Oh H, et al. The radioprotective effects of bu-zhong-yi-qi-tang: a prescription of traditional Chinese medicine. Am J Chin Med 2002;30(1):127-137.
5. Kwee SH, Tan HH, Marsman A, et al. The effect of Chinese herbal medicines (CHM) on menopausal symptoms compared to hormone replacement therapy (HRT) and placebo. Maturitas 2007 Sep 20;58(1):83-90.
6. Mao JY, Ge YB, Wang HH, et al. Summary of 32 patients with cardiac syndrome X treated by TCM therapy of regulating qi relieving chest stuffiness and promoting blood circulation. Chin J Integr Med 2007;13(1):17-21.
7. Oiso N, Yamadori Y, Higashimori N, et al. Allergic contact dermatitis caused by sesame oil in a topical Chinese medicine, shi-un-ko. Contact Dermatitis 2008 Feb;58(2):109.
8. Piao BK, Wang YX, Xie GR, et al. Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial. Anticancer Res 2004;24(1):303-309.
9. Pippa L, Manzoli L, Corti I, et al. Functional capacity after traditional Chinese medicine (qi gong) training in patients with chronic atrial fibrillation: a randomized controlled trial. Prev Cardiol 2007 Winter;10(1):22-5.
10. Qin XY, Li XX, Suteanu S. [Comparative study on Chinese medicine and western medicine for treatment of prolapse of lumbar intervertebral disc]. Zhongguo Zhen Jiu 2007 May;27(5):365-8.
11. Stockert K, Schneider B, Porenta G, et al. Laser acupuncture and probiotics in school age children with asthma: a randomized, placebo-controlled pilot study of therapy guided by principles of Traditional Chinese Medicine. Pediatr Allergy Immunol. 2007 Mar;18(2):160-6.
12. Sung JJ, Leung WK, Ching JY, et al. Agreements among traditional Chinese medicine practitioners in the diagnosis and treatment of irritable bowel syndrome. Aliment PharmacolTher 11-15-2004;20(10):1205-1210.
13. Tseng, SH, Chien TY, Tzeng CF, et al. Prevention of hepatic oxidative injury by Xiao-Chen-Chi-Tang in mice. J Ethnopharmacol 2007 May 4;111(2):232-9.
14. Xia YW, Cai LX, Zhang SC. [Therapeutic effect of Chinese herbal medicines for nourishing blood and reinforcing shen in treating patients with anovulatory sterility of shen-deficiency type and its influence on the hemodynamics in ovarian and uterine arteries]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2004;24(4):299-302.
15. Yang HZ, Zhao JA, Dai M, et al. Traditional Chinese medicine syndromes of chronic hepatitis B with precore mutant. World J Gastroenterol 4-7-2005;11(13):2004-2008.

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