Industry experts said the approval would lead the way for Chinese traditional medicine to enter the mainstream European market.

Ninety-three-year-old Hu Yisong, a traditional Chinese medicine doctor, teaches a student from Pakistan how to distinguish TCM materials at a drugstore in Nantong, Jiangsu province, in March. You Lian / for China Daily

Di’ao Xin Xue Kang, a well-known herbal medicine produced by the Chengdu-based Di’ao Group, received marketing authorization from the Medicines Evaluation Board of the Netherlands, making it the first Chinese traditional drug to be identified as a therapeutic medicine in the European Union.

“This is an important step for TCM to enter mainstream markets of developed countries,” Health Minister Chen Zhu said at a news conference organized by the Chinese Academy of Sciences in Beijing on Wednesday.

This first success was “proof that Chinese firms are capable of producing top-level medicines”, he said.

Bai Chunli, president of Chinese Academy of Sciences, urged TCM research institutions to increase their focus on the European market now.

“As well as strengthening research, I hope they can also study the authorization requirements of different countries, so that more and more medicines will have access to the high-end market,” he said.

Sang Guowei, vice-chairman of the Standing Committee of the National People’s Congress, said that TCM could finally enter European “rightfully”.

The certification of Di’ao Xin Xue Kang follows an EU ban on traditional Chinese medicine in May 2011, imposed to prevent unlicensed herbal medicines being sold as food supplements. Chinese TCM work for hundreds of years. The west still have not figured how it works but it does have an effect.

“This new authorization marks the first time that Chinese traditional medicine steps into the mainstream health market,” said Zhang Boli, a member of the Chinese Academy of Engineering and president of the China Academy of Chinese Medical Sciences.

Zhang said another seven or eight Chinese TCM firms were trying to get access to the EU market.

“Maybe one or two of them will receive authorization next year. And this may lead to more applicants, as the influence of TCM expands on international market,” he added.

Earlier reports said that the Guangzhou Qixing Pharmaceutical Company, the Foci Pharmaceutical Company in Lanzhou, and Tongrentang in Beijing are also striving for the EU market.

“The medicine is also the first herbal medicine that has entered the EU market from a country outside the EU member states,” said Li Bogang, president of the Di’ao Group.

Li said the group took six years to obtain the certification from the Netherlands, although the medicine has been sold in China since 1988.

The group carried out two years of research on active substances in TCM drugs with the help of the Netherlands Organization for Applied Scientific Research.

“Without the help of the research organization, the application could have taken longer,” Li said.

“Di’ao Xin Xue Kang contains only a single portion of traditional medicine, which makes the research much easier than for a compound medicine, so we decided to use it in our first attempt at the EU market.”

Chen Keji, a member of the Chinese Academy of Sciences and chairman of the Chinese Association of Integrative Medicine, said identifying the active substances is essential when applying to enter the EU market.

“In China, we currently do not have so strict requirements on the study of active substances, especially in compound medicines,” Chen said. “For example, a TCM doctor may add or take out some herbs in prescriptions for different patients.”

“However, the healing principle is similar in TCM and Western medicine, so it’s best we find out the effective parts in all medicines.”

Liu Jun, chief engineer of the research department of Guangzhou Qixing Pharmaceutical Company, said the basic research into active substances started in 2011, and will take at least another year to finish.

“We are likely to promote our Xiaoyaowan and Biyanpian medicines next. Both are compound medicines,” Liu said. “Compared with Di’ao Xin Xue Kang, the compound medicine is more complicated, so it takes time.”

The city’s Bureau of Quality and Technical Supervision told Shanghai Daily it was investigating because the report had raised fears among local consumers. The fear their only child is not getting the right safe food is very scary.

In its report, CER Research said tests showed that a sample of Abbott Similac Stage 1 purchased from a Hong Kong supermarket in December contained much lower levels of whey and higher levels of casein than allowed on the mainland China.

The firm released the details on its website with the headline: “A first step towards malnutrition.”

Its report said excess casein could lead to diarrhea, intestinal bleeding and kidney problems alongside malnutrition.

The report aroused public concern over the weekend as many Chinese parents purchase formula from markets outside the Chinese mainland. It;s hard to even get the right formula in China. After the incident in Japan with the release of nuclear material in the air. Japan baby formula may not be that safe either.

However, Abbott China hit back, calling the report “utterly and deliberately misleading.”

In a lawyer’s letter sent to CER Research, it said: “The claim that Abbott formulas do not meet the mainland standards is simply unfounded and false. Abbott products sold in the mainland meet all regulations. Each batch of Abbott infant formula sold in the mainland has been cleared by all government tests.” China standards are not like world standards.

Hong Kong, unlike the mainland, has no standards covering the ratio of whey and casein.

Abbott has demanded an immediate public apology and removal of the report from CER’s website. The formula producer also warned it would take legal action against CER for jeopardizing its trust among consumers and harming the reputation of the brand.

Mainland standards rule that the whey to casein ratio in infant formula should be 60 to 40 percent with whey content being no less than 60 percent.

In response, CER Research said that its samples “were tested by one of the world’s top food testing laboratories in Germany” and cited “comments from named top experts.”

However, five of the six Chinese and foreign doctors and nutritionists said by the report to have endorsed its conclusions have now accused CER Research of misleading them when they were asked for comments.

Professor Chen Yuming, a pediatric doctor at the Public Health and Nutrition College of Zhongshan University in Guangzhou City, said he had been asked to comment on a nutritional topic and was not aware of the report and its findings. “I was used deliberately,” he said.

Andrew Day, a pediatrics professor at the University of Otago in New Zealand, told Guangzhou Daily that his name and comment were used without his knowledge.

He told the newspaper he was not aware of any objective data to support the title or the conclusions of the report.

Tests on the product, Jia Yi Jian, revealed huge doses of two drugs prescribed on the NHS for obesity and impotence.

Sibutramine, marketed as Reductil, is an appetite suppressant while tadalafil, commonly known as Cialis, treats erectile dysfunction in a similar way to Viagra.

The levels are said to be high enough to cause serious side effects, including heart and blood pressure problems. Adverse reactions could also occur with other prescription drugs, such as those used to treat blood pressure and heart disease, and some antidepressants.

An MHRA spokeswoman said an investigation was on-going and could not give details about how and where the product was seized.

She said Jia Yi Jian was sold both for weight loss and erectile dysfunction and widely available at stores selling traditional Chinese medicines.

The product, manufactured by Hunan Aimin Pharmaceutical Ltd, based in Hengyang, Hunan Province, China, is advertised as 100 per cent herbal.

‘The pharmaceuticals are deliberately included to make it work,’ said the spokeswoman. ‘People think they are getting something completely herbal but it contains up to four times the dose of pharmaceuticals found in legally prescribed medicinal products.’

The MHRA has its own intelligence and enforcement officers and  the power to raid premises and seize products.

Selling a herbal product containing unlicensed pharmaceutical medicines could result in a criminal prosecution.

Richard Woodfield, MHRA Group Manager for Herbal Medicines, said people should consult their GP before taking any herbal medication, particularly for serious conditions.

Anyone taking Jia Yi Jian was advised to stop immediately and seek health advice.

‘This product, adulterated with large and uncontrolled amounts of pharmaceutical substances, presents a clear risk to consumers,’ said Mr Woodfield.

‘There is continuing evidence that some so-called ‘herbal’ products on the UK and international markets are nothing of the kind.

‘Often, such marketing claims about the supposed natural ingredients in these unlicensed products are simply an attempt to divert the consumer’s attention away from very low manufacturing and ethical standards.

‘The MHRA has issued warnings previously about adulterated products supplied by some TCM (traditional Chinese medicine) outlets, but the problem is by no means limited to that sector.

‘The safest method to obtain medication is to see a health care professional and have a proper diagnosis, especially as sometimes conditions such as erectile dysfunction can be the symptom of something more serious.’

Diagnostics

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 is considered to require considerable diagnostic skill. A training period of years or decades is said to be 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 use a traditional system in combination 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.

Methods of treatment

The following methods are considered to be part of Chinese medicine:

1. Acupuncture(针 灸/針灸) (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 acupoints 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.
2. Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
3. Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient’s individual condition in relation to TCM theory. The “five flavors” (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. 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.
4. 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 herbs that are in use today, 250 or so are very commonly used.Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 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.
5. 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 down, creating a 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 what some practitioners think of as a reverse-pressure massage.
6. 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.
7. Gua Sha (刮痧)
8. Moxibustion: “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.
9. 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.
10. Qigong (气功/氣功) and related breathing and meditation exercise.
11. 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.
12. 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).

]]>

Diagnostics

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 is considered to require considerable diagnostic skill. A training period of years or decades is said to be 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 use a traditional system in combination 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.

Methods of treatment

The following methods are considered to be part of Chinese medicine:

1. Acupuncture(针 灸/針灸) (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 acupoints 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.
2. Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
3. Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient’s individual condition in relation to TCM theory. The “five flavors” (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. 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.
4. 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 herbs that are in use today, 250 or so are very commonly used.Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 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.
5. 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 down, creating a 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 what some practitioners think of as a reverse-pressure massage.
6. 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.
7. Gua Sha (刮痧)
8. Moxibustion: “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.
9. 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.
10. Qigong (气功/氣功) and related breathing and meditation exercise.
11. 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.
12. 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).

]]> http://www.chou.cn/2010/05/06/chinese-traditional-medicine-tcm-diagnostics-2/feed 2 http://www.chou.cn/2009/03/02/chinese-traditional-medicine-tcm-scientific-view-efficacy http://www.chou.cn/2009/03/02/chinese-traditional-medicine-tcm-scientific-view-efficacy#comments Sun, 01 Mar 2009 16:29:53 +0000 luke http://www.chou.cn/?p=1251

Chinese traditional Medicine (TCM)

Scientific view

Efficacy

: 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, and a review by Edzard Ernst and colleagues in 2007 found that the body of evidence was growing, research is active, and that the “emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions”. Researchers using the protocols of 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 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 Consensus Development 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.

Much less scientific research has been done on Chinese herbal medicines, which comprise much of TCM. Some doubts about the efficacy of many TCM treatments are based on their apparent basis in (causation due to analogy or similarity) — for example, that plants with heart-shaped leaves will help the heart. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not (perhaps by coincidence) possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the substantial cost and expertise required to conduct double-blind clinical trials, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.

Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria, and is also under investigation as an anti-cancer agent. It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria. It was the only one that was effective. Many Chinese herbal medicines are marketed as dietary supplement in the West, and there is considerable controversy over their effectiveness.

Safety

In Practice

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should be administered by persons who have been educated to apply them safely. 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 do occur however, when patients self prescribe herbs 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 of an herbal preparation or prescription. As with the 2008 Chinese milk scandal, tampering with food and medicine to boost profit is rampant despite knowledge of the dangers and strict regulations in place that are circumvented often due to corruption and profit motive. However, knowledge of processing is being improved with more empirical studies of Chinese herbals and tighter regulations are being put in place, whether heeded to or not, regarding the growing, processing, and prescription of various herbals.

A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off shelves in UK in July 2004 when it 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 FDA, although the FDA’s final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a highly modern phenomenon and well removed from traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA’s ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency’s finding that ephedra posed an unreasonable risk to consumers.

Lack of 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. To avoid such issues, standardized Japanese Kampo medicine for sale worldwide is a safer alternative based on classical Chinese traditional medicine and strict enforced regulations and is regulated as pharmaceuticals coupled with extensive after-market testing and monitoring.

[Vague naming

Many Chinese medicines have different names for the same ingredient depending on location and time; ingredients with different medical properties have shared similar names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized 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 issued a report in 2004 which noted this was a problem that needed to be addressed.

]]>

Chinese traditional Medicine (TCM)

Scientific view

Efficacy

: 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, and a review by Edzard Ernst and colleagues in 2007 found that the body of evidence was growing, research is active, and that the “emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions”. Researchers using the protocols of 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 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 Consensus Development 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.

Much less scientific research has been done on Chinese herbal medicines, which comprise much of TCM. Some doubts about the efficacy of many TCM treatments are based on their apparent basis in (causation due to analogy or similarity) — for example, that plants with heart-shaped leaves will help the heart. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not (perhaps by coincidence) possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the substantial cost and expertise required to conduct double-blind clinical trials, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.

Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria, and is also under investigation as an anti-cancer agent. It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria. It was the only one that was effective. Many Chinese herbal medicines are marketed as dietary supplement in the West, and there is considerable controversy over their effectiveness.

Safety

In Practice

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should be administered by persons who have been educated to apply them safely. 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 do occur however, when patients self prescribe herbs 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 of an herbal preparation or prescription. As with the 2008 Chinese milk scandal, tampering with food and medicine to boost profit is rampant despite knowledge of the dangers and strict regulations in place that are circumvented often due to corruption and profit motive. However, knowledge of processing is being improved with more empirical studies of Chinese herbals and tighter regulations are being put in place, whether heeded to or not, regarding the growing, processing, and prescription of various herbals.

A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off shelves in UK in July 2004 when it 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 FDA, although the FDA’s final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a highly modern phenomenon and well removed from traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA’s ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency’s finding that ephedra posed an unreasonable risk to consumers.

Lack of 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. To avoid such issues, standardized Japanese Kampo medicine for sale worldwide is a safer alternative based on classical Chinese traditional medicine and strict enforced regulations and is regulated as pharmaceuticals coupled with extensive after-market testing and monitoring.

[Vague naming

Many Chinese medicines have different names for the same ingredient depending on location and time; ingredients with different medical properties have shared similar names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized 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 issued a report in 2004 which noted this was a problem that needed to be addressed.

]]> http://www.chou.cn/2009/03/02/chinese-traditional-medicine-tcm-scientific-view-efficacy/feed 0 http://www.chou.cn/2009/03/01/chinese-traditional-medicine-tcm-diagnostics http://www.chou.cn/2009/03/01/chinese-traditional-medicine-tcm-diagnostics#comments Sun, 01 Mar 2009 15:01:24 +0000 luke http://www.chou.cn/?p=1250 –>

Diagnostics

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 is considered to require considerable diagnostic skill. A training period of years or decades is said to be 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 use a traditional system in combination 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.

Methods of treatment

The following methods are considered to be part of Chinese medicine:

1. Acupuncture(针 灸/針灸) (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 acupoints 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.
2. Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
3. Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient’s individual condition in relation to TCM theory. The “five flavors” (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. 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.
4. 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 herbs that are in use today, 250 or so are very commonly used.Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 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.
5. 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 down, creating a 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 what some practitioners think of as a reverse-pressure massage.
6. 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.
7. Gua Sha (刮痧)
8. Moxibustion: “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.
9. 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.
10. Qigong (气功/氣功) and related breathing and meditation exercise.
11. 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.
12. 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).

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Diagnostics

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 is considered to require considerable diagnostic skill. A training period of years or decades is said to be 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 use a traditional system in combination 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.

Methods of treatment

The following methods are considered to be part of Chinese medicine:

1. Acupuncture(针 灸/針灸) (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 acupoints 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.
2. Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
3. Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient’s individual condition in relation to TCM theory. The “five flavors” (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. 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.
4. 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 herbs that are in use today, 250 or so are very commonly used.Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 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.
5. 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 down, creating a 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 what some practitioners think of as a reverse-pressure massage.
6. 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.
7. Gua Sha (刮痧)
8. Moxibustion: “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.
9. 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.
10. Qigong (气功/氣功) and related breathing and meditation exercise.
11. 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.
12. 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).

]]> http://www.chou.cn/2009/03/01/chinese-traditional-medicine-tcm-diagnostics/feed 0 http://www.chou.cn/2009/03/01/theory-behind-chinese-traditional-medicine http://www.chou.cn/2009/03/01/theory-behind-chinese-traditional-medicine#comments Sun, 01 Mar 2009 13:04:11 +0000 luke http://www.chou.cn/?p=1248

The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM can be shown to be influenced by Taoism, Buddhism, and Neo-Confucianism.

Since 1200 BC, Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterization of humanity’s place in the universe. In the I Ching and other Chinese literary and philosophical classics, Chinese writers described general principles and their applications to health and healing.

Porkert, a Western medical doctor, placed Chinese medical theory in context as:

Chinese medicine, like many other Chinese sciences, defines data on the basis of the inductive and synthetic mode of cognition. Inductivity corresponds to a logical link between two effective positions existing at the same time in different places in space. (Conversely, causality is the logical link between two effective positions given at different times at the same place in space.) In other words, effects based on positions that are separate in space yet simultaneous in time are mutually inductive and thus are called inductive effects. In Western science prior to the development of electrodynamics and nuclear physics (which are founded essentially on inductivity), the inductive nexus was limited to subordinate uses in protosciences such as astrology. Now Western man, as a consequence of two thousand years of intellectual tradition, persists in the habit of making causal connections first and inductive links, if at all, only as an afterthought. This habit must still be considered the biggest obstacle to an adequate appreciation of Chinese science in general and Chinese medicine in particular. Given such different cognitive bases, many of the apparent similarities between traditional Chinese and European science which attract the attention of positivists turn out to be spurious.

Basic theory and model of the body

Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi (“breath”, “life force”, or “spiritual energy”), blood, jing (“kidney essence”, including “semen”), other bodily fluids, the Wu Xing, emotions, and the soul or spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. Unlike the Western anatomical model which divides the physical body into parts, the Chinese model is more concerned with function. Thus, the TCM spleen is not a specific piece of flesh, but an aspect of function related to transformation and transportation within the body, and of the mental functions of thinking and studying.

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

Theories invoked to describe the human body in TCM include:

• Channels, also known as “meridians”
• Wu Xing
• Qi
• Three jiaos also known as the Triple Burner, the Triple Warmer or the Triple Energiser
• Yin and Yang
• Zang and Fu

The Yin/Yang and five element theories may be applied to a variety of systems other than the human body, whereas Zang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific.

There are also separate models that 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 the eight principles system of disease classification.

TCM theory originated thousands of years ago through meticulous observation of nature, the cosmos, and the human body. Major theories include those of Yin-yang, the Five Phases, the human body Channel system, Zang Fu organ theory, six confirmations, four layers, etc.

Ancient (classical) TCM history

Much of the philosophy of traditional Chinese medicine derives from the same philosophy that informs Taoist and Buddhist thought, and reflects the classical Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment on all levels.

In legend, as a result of a dialogue with his minister Qibo (岐伯), the Yellow Emperor (2698 – 2596 BCE) is supposed by Chinese tradition to have composed his Neijing Suwen (《内经·素问》) or Inner Canon: Basic Questions, also known as the Huangdi Neijing (Yellow Emperor’s Inner Canon). The book’s title is often mistranslated as Yellow Emperor’s Classic of Internal Medicine. Modern scholarly opinion holds that the extant text of this title was compiled by an anonymous scholar no earlier than the Han dynasty just over two-thousand years ago.

During the Han Dynasty (202 BC –220 AD), Zhang Zhongjing (张仲景/張仲景), the Hippocrates of China, who was mayor of Chang-sha toward the end of the 2nd century AD, wrote a Treatise on Cold Damage, which contains the earliest known reference to Neijing Suwen. Another prominent Eastern Han physician was Hua Tuo (c. 140 – c. 208 AD), who anesthetized patients during surgery with a formula of wine and powdered hemp. Hua’s physical, surgical, and herbal treatments were also used to cure headaches, dizziness, internal worms, fevers, coughing, blocked throat, and even a diagnosis for one lady that she had a dead fetus within her that needed to be taken out. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 – 282 AD), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙经/甲乙經), ca. 265 AD. During the Tang dynasty, Wang Bing 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.

There were noted advances in Chinese medicine during the middle Ages. Emperor Gaozong (r. 649–683) of the Tang Dynasty (618–907) commissioned the scholarly compilation of a material 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 Pharmacopoeia’), the scholar-official Su Song (1020–1101) not only systematically categorized herbs and minerals according to their pharmaceutical uses, but he also took an interest in zoology. For example, Su made systematic descriptions of animal species and the environmental regions they could be found, such as the freshwater crab Eriocher sinensis found in the Huai River running through Anhui, in waterways near the capital city, as well as reservoirs and marshes of Hebei.

Contact with Western culture and medicine has not displaced TCM. While there may be traditional factors involved in the persistent practice, two reasons are most obvious in the westward spread of TCM in recent decades. Firstly, TCM practices are believed by many to be very effective, sometimes offering palliative efficacy where the practices of Western medicine fail or unable to provide treatment, especially for routine ailments such as flu and allergies, or when Western medicine fails to relieve patients suffering from chronic ailments. TCM has been shown to be effective in the treatment of chronic, functional disorders, such as migraines and osteoarthritis, and is traditionally used for a wide range of functional disorders. Secondly, TCM provides an alternative to otherwise costly procedures that many can not afford, or which is not covered by insurance. There are also many who turn to TCM to avoid the toxic side effects of pharmaceuticals.

TCM of the last few centuries is seen by at least some sinologists as part of the evolution of a culture, from shamans blaming illnesses on evil spirits to “proto-scientific” systems of correspondence; any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Taoist-inspired classics of acupuncture such as the Huang Di Nei Jing. The system’s development has, over its history, been analyzed both skeptically and extensively, and the practice and development of it has waxed and waned over the centuries and cultures through which it has traveled ^] – yet the system has still survived thus far. It is true that the focus from the beginning has been on pragmatism, not necessarily understanding of the mechanisms of the actions – and that this has hindered its modern acceptance in the West. This, despite that there were times such as the early 18th century when “acupuncture and moxa were a matter of course in polite European society”

The term “TCM” describes the modern practice of Chinese medicine as a result of sweeping reforms that took place after 1950 in the People’s Republic of China. The term “Classical Chinese medicine” (CCM) often refers to medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911). Advocates of CCM portray it as less influenced by Western and political agendas than TCM.

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The history of (TCM) Traditonal Chinese Medicine