Traditional Chinese medicine (TCM)

Alternate Title

Chinese herbal medicine,Chinese herbs,Chinese patent remedies

Synonyms

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

Background

Chinese medicine is a broad term encompassing many different modalities and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) dating back over 5,000 years. The phrase traditional Chinese medicine (TCM) is actually a recent development with a specific meaning in the long history of Chinese medicine. In the 1940s and 1950s, the Chinese government undertook an effort to combine many diverse forms of Chinese medicine into a unified system to be officially defined as traditional Chinese medicine. The intent was to integrate the country's large workforce of traditional practitioners into an organized health service delivery system. This would aid in providing care for a large population by using familiar and inexpensive methods.

Because TCM and Western medicine are used side by side in modern China, China is relatively advanced compared to Western countries in using the concept of "integrative medicine." TCM figures are prominently in treatment and planning of services -- including for major illnesses such as cancer and heart disease. According to the World Health Organization (WHO), TCM is fully integrated into the Chinese health system with 95% of Chinese hospitals practicing it. As an example of such integration, it is common that children being treated with intravenous antibiotics are simultaneously treated with Chinese herbs in order to counteract the side effects of the antibiotic and boost the child's immune system.

TCM places strong emphasis on herbal medicine since herbs can be taken every day. TCM regards acupuncture as more of a supportive treatment, although the two are used together when feasible for the patient. Herbs are usually given in the form of manufactured or processed pills, extracts, capsules, tinctures, or powders. This contrasts with the raw and dried form used in the more informal and older forms of practice. There are more than 2,000 different kinds of herbs of which about 400 are commonly used.

TCM has herbal regimens for use with major illnesses, such as cancer and heart disease. Herbal combinations are commonly used to reduce the side effects of chemotherapy and improve immune functioning in cancer and to improve cardiovascular health in heart and circulatory diseases. Other herbal combinations are used in diabetes, infections, and other conditions.

Cupping is a therapeutic method in TCM that refers to the application of a heated cup over an area of the body. As the air inside cools, its volume decreases thus creating a slight suction on the area that stimulates blood circulation.

Moxibustion is a therapeutic method in TCM in which an herb, usually mugwort (Artemisia vulgaris), is burned above the skin or on the acupuncture points to introduce heat into an acupuncture point and alleviate symptoms. The herb may be applied in the form of a cone, stick, or loose herb or it may be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle.

TCM practitioners may call upon a wide range of other modalities as well, from meditation and martial arts to feng shui.

In the West, TCM offers a popular alternative to conventional medicine. Despite this growing popularity, there is debate as to the evidence of its effectiveness. The modality within TCM with the largest body of evidence is acupuncture. Few well-designed trials of TCM herbal formulas are available. Establishing and applying stronger clinical trial methodologies in TCM is imperative for integrating it with modern medicine and achieving the end goal of creating evidence-based options for patient care.

Note: To supplement the evidence described in this TCM monograph, the evidence table below gives additional examples of research that have taken place using TCM herbs for various conditions. This is not a complete list of evidence on traditional Chinese medicine. It should be noted that there has been very little standardization of Chinese herbal medicine. This makes the available evidence weak for establishing reliable evidence-based expectations for treatment of any condition with Chinese herbs.

Chinese medicine is a broad term encompassing many different modalities and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) dating back over 5,000 years. The phrase traditional Chinese medicine (TCM) is actually a recent development with a specific meaning in the long history of Chinese medicine. In the 1940s and 1950s, the Chinese government undertook an effort to combine many diverse forms of Chinese medicine into a unified system to be officially defined as traditional Chinese medicine. The intent was to integrate the country's large workforce of traditional practitioners into an organized health service delivery system. This would aid in providing care for a large population by using familiar and inexpensive methods.

Because TCM and Western medicine are used side by side in modern China, China is relatively advanced compared to Western countries in using the concept of "integrative medicine." TCM figures are prominently in treatment and planning of services -- including for major illnesses such as cancer and heart disease. According to the World Health Organization (WHO), TCM is fully integrated into the Chinese health system with 95% of Chinese hospitals practicing it. As an example of such integration, it is common that children being treated with intravenous antibiotics are simultaneously treated with Chinese herbs in order to counteract the side effects of the antibiotic and boost the child's immune system.

TCM places strong emphasis on herbal medicine since herbs can be taken every day. TCM regards acupuncture as more of a supportive treatment, although the two are used together when feasible for the patient. Herbs are usually given in the form of manufactured or processed pills, extracts, capsules, tinctures, or powders. This contrasts with the raw and dried form used in the more informal and older forms of practice. There are more than 2,000 different kinds of herbs of which about 400 are commonly used.

TCM has herbal regimens for use with major illnesses, such as cancer and heart disease. Herbal combinations are commonly used to reduce the side effects of chemotherapy and improve immune functioning in cancer and to improve cardiovascular health in heart and circulatory diseases. Other herbal combinations are used in diabetes, infections, and other conditions.

Cupping is a therapeutic method in TCM that refers to the application of a heated cup over an area of the body. As the air inside cools, its volume decreases thus creating a slight suction on the area that stimulates blood circulation.

Moxibustion is a therapeutic method in TCM in which an herb, usually mugwort (Artemisia vulgaris), is burned above the skin or on the acupuncture points to introduce heat into an acupuncture point and alleviate symptoms. The herb may be applied in the form of a cone, stick, or loose herb or it may be placed on the head of an acupuncture needle to manipulate the temperature gradient of the needle.

TCM practitioners may call upon a wide range of other modalities as well, from meditation and martial arts to feng shui.

In the West, TCM offers a popular alternative to conventional medicine. Despite this growing popularity, there is debate as to the evidence of its effectiveness. The modality within TCM with the largest body of evidence is acupuncture. Few well-designed trials of TCM herbal formulas are available. Establishing and applying stronger clinical trial methodologies in TCM is imperative for integrating it with modern medicine and achieving the end goal of creating evidence-based options for patient care.

Note: To supplement the evidence described in this TCM monograph, the evidence table below gives additional examples of research that have taken place using TCM herbs for various conditions. This is not a complete list of evidence on traditional Chinese medicine. It should be noted that there has been very little standardization of Chinese herbal medicine. This makes the available evidence weak for establishing reliable evidence-based expectations for treatment of any condition with Chinese herbs.

Theory

The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. Taoist principles as described below are present throughout the literature and teachings of the many forms of Chinese medicine.

Nature and the laws that govern the on-going, harmonious flow of life energy through the natural world are used to understand the body and health. The person is viewed as an ecosystem that is embedded in, and related to, the larger ecosystem of nature and subject to the same laws.

The life force, chi (qi), circulates through the body and enlivens it. Health is a function of a balanced, harmonious flow of chi and illness results when there is a blockage or an imbalance in the flow of chi. Yin and yang are opposite and complementary qualities of life energy (chi). Yin is regarded as the feminine principle and yang the masculine principle.

The human being has a system of pathways called "meridians" (also sometimes called "channels") through which the chi flows. The body has been mapped with these meridians that pass through all its organs, and specific meridians correspond with specific organs or organ systems ("organ networks," below). Health is an ongoing process of maintaining balance and harmony of the circulation of chi through all of the organs and systems of the body.

Symptoms are regarded as signals of impaired flow or circulation of chi through the body. Symptoms are considered as part of a larger picture or pattern affecting the whole person. The practitioner seeks to connect seemingly unrelated symptoms and develop a unifying explanation of what is going on with the person's chi overall.

Most modern diseases are considered "chi deficiency" diseases, caused by not maintaining or supporting a harmonious internal ecology. Harmony and disharmony are understood in two main conceptual frameworks: the eight principles and the five elements, described below.

The eight principles are actually four pairs of complementary opposites describing patterns of disharmony within the person. Briefly the principles are interior/exterior, referring to the location of the disharmony in the body (internal organs vs. skin or bones); hot/cold, referring to qualities of the disease pattern, such as fever or thirst vs. chilliness or desire to drink warm liquids; full/empty, referring to whether the condition is acute or chronic and whether the body's responses are strong or weak; and the balance of yin/yang, which adds further to the description of the other six principles. The eight principles are the theoretical basis of the TCM approach.

The five elements are fire, earth, metal, water, and wood. These terms do not refer to basic constituents of matter, but are dynamic qualities of nature. They are used to describe the changing qualities of chi energy as it circulates through the person. Five element theory is the basis of traditional acupuncture (also referred to as classical or five element acupuncture), which does not use herbs. However, some TCM practitioners also use the concept of the five elements.

The body has five organ networks, each corresponding with a particular element: heart/small intestine with fire, spleen/stomach with earth, lungs/large intestine with metal, kidneys/bladder with water, and liver/gall bladder with wood. The organ networks are named for the common meridian that circulates through and connects the organs, as it circulates chi throughout the larger, body-wide, meridian system. The practitioner's efforts to harmonize the five elements promote greater harmony in the functioning of all the organ networks.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Arrhythmia: TCM herb combinations have been used to stabilize arrhythmia after viral myocarditis (inflammation of the heart). Furthermore, patients with atrial fibrillation who underwent Qi gong training walked on average more at the end of treatment. More studies are needed before recommendations can be made.
Grade: C

Asthma: Laser acupuncture and probiotics provided a beneficial clinical effect in children with asthma. Further studies are needed to confirm these findings.
Grade: C

Cancer: TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects, and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment.
Grade: C

Cardiovascular disease / angina: TCM herb formulas as well as the traditional Chinese method of Liqi Kuanxiong Huoxue combined with conventional treatment have been reported to reduce symptoms of stable and unstable angina. However, more studies are needed before recommendations can be made.
Grade: C

Chronic obstructive pulmonary disease (COPD): TCM herbs have been reported to improve symptoms and improve immune function in COPD patients. However, research designs have been weak and more studies of better design are needed before recommendations can be made.
Grade: C

Congestive heart failure: Many studies of TCM herbs have focused on treatment of congestive heart failure. Further research of better design is needed before recommendations can be made.
Grade: C

Coronary heart disease: TCM herb combinations have been found to improve some markers of coronary heart disease. More studies of better design are needed before recommendations can be made.
Grade: C

Dementia: TCM herbal combinations have been used for the treatment of dementia and reportedly improve cognitive function and activities of daily living. More studies of better design are needed before recommendations can be made.
Grade: C

Diabetic nephropathy (kidney disease): TCM herbs may augment conventional Western medicine for better outcomes in diabetic nephropathy. More studies of better design are needed before recommendations can be made.
Grade: C

HIV/AIDS: TCM herbs are a popular complementary therapy in HIV/AIDS. However, study results conflict. More studies are needed before the potential benefits of TCM herbs in HIV/AIDS can be established.
Grade: C

Liver disease: TCM may provide liver protection. However, more studies are needed before recommendations can be made.
Grade: C

Lower back pain: TCM herbs may augment conventional Western medicine for better outcomes in lower back injury. Additional study is needed before a recommendation can be made.
Grade: C

Menopausal symptoms: TCM herbs are commonly used for menopausal symptoms such as hot flushes. Evidence is mixed. More studies are needed to explore the possible contributions of TCM herbs in menopausal symptoms.
Grade: C

Nephrotic syndrome: TCM herbs have been reported to improve the therapeutic effectiveness and counteract adverse reactions to hormone therapy in treating nephrotic syndrome as well as reduce the recurrence of symptoms. More studies of better design are needed before recommendations can be made.
Grade: C

Polycystic ovary syndrome: TCM herbs have been reported to not reduce symptoms, but to increase pregnancy rates in women with polycystic ovary syndrome. More studies are needed to explore the possible contributions of TCM herbs in this condition.
Grade: C

SARS (severe acute respiratory syndrome): Currently, study results conflict, but overall results show promise for TCM in immunomodulation effects and decreasing depression associated with SARS.
Grade: C

Schizophrenia: Based on early data, Chinese herbal medicines may be helpful when combined with prescription medications. Schizophrenia should be treated by a qualified healthcare practitioner including a psychiatrist and pharmacist.
Grade: C

Irritable bowel syndrome (IBS): TCM has been studied for diarrhea predominant irritable bowel syndrome but herbal formulations used in available studies have not led to global symptom improvement. Further studies may be necessary to characterize the role of TCM in the management of IBS.
Grade: D

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acne, aging, allergies, anemia (infantile chronic aplastic), antioxidant, antiviral, bleeding (subarachnoid hemorrhage), blood circulation, blood stagnation, brain damage, cerebral palsy, cerebrovascular accident (stroke), cirrhosis (hepatic fibrosis), cognitive function, common cold, cutaneous disorders, cystitis, dental procedures, dermatitis, detoxification, diabetes, diarrhea, dry mouth, encephalopathy (pulmonary), epilepsy, fatigue, fever, gallstones, gastritis, Graves' disease, growth disorders, headache, hepatitis B, hypertension (high blood pressure), immunomodulation, immunostimulant, infant development / neonatal care, infertility, inflammation, influenza, insomnia, irregular menstrual cycles, kidney disorders, migraine, motion sickness, nasopharyngeal carcinoma, nausea/vomiting, nausea and vomiting of pregnancy (hyperemesis gravidarum), neck pain, ovulation disorders, pain, pancreatitis, Parkinson's disease, pelvic inflammatory disease, peptic ulcer, post-traumatic stress disorder, pre-eclampsia, prostatitis/chronic pelvic pain syndrome (CP/CPPS), quality of life, respiratory infections, rheumatoid arthritis, senile dementia, sleep disorders, spleen disorders (liver stagnation and spleen deficiency syndrome), stroke, tendonitis (rotator cuff), thrombocytopenia, ulcerative colitis, urinary stimulant, vasodilation, venous disorders, viral myocarditis, wound healing.

Safety

DISCLAIMER: 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 traditional 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 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. For more details on individual therapies, please see Natural Standard monographs.

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. Based on one study, Sang Ju Yin or Yu Ping Feng San formulas may cause headache or dizziness. There have been reports of adverse effects; a qualified healthcare practitioner, including a pharmacist, should be consulted on dosage.

Chinese herbs can interact with drugs, interfering with or exaggerating their effects. In particular, ma huang should not be taken with caffeine. Consumers should consult with a medical professional, including a pharmacist, before mixing herbs with any prescription drugs.

Traditional Chinese medicine should be used with extreme caution in infants and children as harmful effects including blood disorders 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 unsafe in particular when performed on patients with emphysema or other pulmonary disease (due to multiple case reports of pneumothorax), elderly or medically compromised patients, diabetics (due to poor circulation), or patients with history of seizures.

Electrostimulation acupuncture should be avoided in pregnant women (theoretical) 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 drugs, unstable medical condition or infection, pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, neurologic disorders. Acupuncture should also be avoided on areas that have received radiation therapy.

Cupping and moxibustion

Adverse events reported in the scientific literature from cupping and moxibustion are extremely rare. Cupping commonly leaves a temporary bruising of the skin, which disappears on its own. For both cupping and moxibustion, the following precautions and contraindications are based on tradition, clinical experience, and theory rather than controlled research.

Cupping: Avoid the abdomen/sacral area during pregnancy, contraindicated acupuncture points, during high fever, during convulsions or cramps, over allergic skin conditions or ulcerated sores, over an inflamed organ, over inflamed areas in general, in patients with cardiac disease and/or aneurysms, in patients with extreme fatigue and/or anemia, in patients who have just finished exercising or taking a hot bath or shower. Avoid sliding cups over the spine, moles, or other skin abnormalities.

Moxibustion: Use caution with patients with neuropathy. Avoid face, head, nipples, and genitals, skin adhesions, points where needling is contraindicated for the individual patient, in patients with any kind of "heat syndrome" according to acupuncture theory, in patients with strong heat signs (high fever, etc.), on or near inflamed and/or red areas of the body, 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 lactation: The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus, although there are no published reports of related adverse effects.

Other modalities

More safety information can be found in the specific monographs on this site for related modalities that are sometimes used with TCM.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): William Collinge, PhD, MPH (Collinge & Associates); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Northeastern University).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough 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.

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.

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.

Hong ML, Yang GZ, Chen WX, et al. [Effect of Yufeining on induced sputum interleukin-8 in patients with chronic obstructive pulmonary disease at the stable phase.] Chin J Integr Med 2005 Sep;11(3):179-82.

Kwee SH, Tan HH, Marsman, A, Wauters C. 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.

Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol 2006 Jul;101(7):1574-80.

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.

Ng SM, Chan TH, Chan CL, et al. Group debriefing for people with chronic diseases during the SARS pandemic: Strength-Focused and Meaning-Oriented Approach for Resilience and Transformation (SMART). Community Ment Health J 2006 Feb;42(1):53-63.

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.

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.

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.

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.

Sucher NJ. Insights from molecular investigations of traditional Chinese herbal stroke medicines: implications for neuroprotective epilepsy therapy. Epilepsy Behav 2006 Mar;8(2):350-62.

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.

Wang G, Wang L, Xiong ZY, et al. Compound salvia pellet, a traditional Chinese medicine, for the treatment of chronic stable angina pectoris compared with nitrates: a meta-analysis. Med Sci Monit 2006 Jan;12(1):SR1-7.

Zhang J, Wu TX, Liu GJ. Chinese herbal medicine for the treatment of pre-eclampsia. Cochrane Database Syst Rev 2006 Apr 19;(2):CD005126.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.