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Traditional Chinese Medicine

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History | Timeline | Uses | Theory | Model of the body |
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Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong.   Sample of Herbal  Tea 

Traditional Chinese medicine (also known as TCM, Simplified Chinese: 中医学; Traditional Chinese: 中醫學; Pinyin: zhōngyī xu) is a range of traditional medical practices originating in China that developed over several thousand years. The English phrase "TCM" was created in the 1950s by the PRC in order to export Chinese medicine; there is no equivalent phrase in Chinese (zhōngyī xu translates literally as simply "Chinese medicine studies"). In fact, TCM is a modern compilation of traditional Chinese medicine. TCM practices include theories, diagnosis and treatments such as herbal medicine, acupuncture and massage; often Qigong is also strongly affiliated with TCM. TCM is a form of so-called Oriental medicine, which includes other traditional East Asian medical systems such as traditional Japanese, and Korean medicine.

TCM theory asserts that processes of the human body are interrelated and in constant interaction with the environment. Signs of disharmony help the TCM practitioner to understand, treat and prevent illness and disease.

TCM theory is based on a number of philosophical frameworks including the theory of Yin-yang, the Five Elements, the human body Meridian system, Zang Fu organ theory, and others. Diagnosis and treatment are conducted with reference to these concepts. TCM does not operate within a scientific paradigm but some practitioners make efforts to bring practices into a biomedical and evidence-based medicine framework.

History

Much of the philosophy of traditional Chinese medicine derived from the same philosophical bases that contributed to the development of Taoist philosophy, and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales.

 

An old Chinese medical chart

 

 

During the golden age of his reign from 2698 to 2596 B.C, as a result of a dialogue with his minister Ch'i Pai (岐伯), the Yellow Emperor is supposed by Chinese tradition to have composed his Neijing Suwen (內經 素問) or Basic Questions of Internal Medicine, also known as the Huangdi Neijing. 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, Zhang Zhong Jing (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. 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 (甲乙經), ca. 265 AD. During the Tang dynasty, Wang Ping 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.

Classical Chinese Medicine (CCM) is notably different from Traditional Chinese Medicine (TCM). The Nationalist government elected to abandon and outlaw the practice of CCM as it did not want China to be left behind by scientific progress. For 30 years, CCM was forbidden in China and several people were prosecuted by the government for engaging in CCM. In the 1960's, Mao Zedong finally decided that the government could not continue to outlaw the use of CCM. He commissioned the top 10 doctors (M.D.'s) to take a survey of CCM and create a standardized format for its application. This standardized form is now known as TCM.

Today, TCM is what is taught in nearly all those medical schools in China , most of Asia and Northern America, that teach traditional medical practices at all. To learn CCM typically one must be part of a family lineage of medicine. Recently, there has been a resurgence in interest in CCM in China , Europe and United States , as a specialty. For example, see the program of Classical Chinese Medicine at National College of Natural Medicine. See also [http://www.classicalchinesemedicine.org Heiner Fruehauf's website covering topics related to Classical Chinese Medicine.

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 best practices of Western medicine fail, especially for routine ailments such as flu and allergies, and managing to avoid the toxicity of some chemically composed medicines. Secondly, TCM provides the only care available to ill people, when they cannot afford to try the western option. On the other hand, there is, for example, no longer a distinct branch of Chinese physics or Chinese biology.

TCM formed part of the barefoot doctor program in the People's Republic of China, which extended public health into rural areas. It is also cheaper to the PRC government, because the cost of training a TCM practitioner and staffing a TCM hospital is considerably less than that of a practitioner of Western medicine; hence TCM has been seen as an integral part of extending health services in China .

There is some notion that TCM requires supernatural forces or even cosmology to explain itself. However most historical accounts of the system will acknowledge it was invented by a culture of people that were already fed up of listening to Shamans trying to explain illnesses on evil spirits[1]; 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 Ni Jīng or Zhēnjiǔ Dchng. The system's development has over its history been skeptically analysed extensively, and practice and development of it has waxed and waned over the centuries and cultures which it has travelled - yet the system has still survived this 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"

Timeline

The history of TCM can be summarized by a list of important doctors and books.

  • Time unknown, author unknown, Hung D Ni Jīng (黃帝內經)(Classic of Internal Medicine by Emperor Huang) - S Wn (素問) & Lng Shū (靈樞). The earliest classic of TCM passed on to the present.
  • Warring States Period (5th century BC to 221 BC): Silk scrolls recording channels and collaterals, Zu Bi Shi Yi Mai Jiu Jing (Moxibustion Classic of the Eleven Channels of Legs and Arms), and Yin Yang Shi Yi Mai Jiu Jing (Moxibustion Classic on the Eleven Yin and Yang Channels)
  • Song Dynasty.)
    • Tngrn Shūxu Zhēn Jiǔ T Jīng (Illustrated Manual of the Practice of Acupuncture and Moxibustion at (the Transmission) (and other) Acu-points, for use with the Bronze Figure) by Wng Wi Yī (王惟一).
    • Emergence of Wenbing School  
  • Ming Dynasty (1368 to 1644): Climax of acupuncture and Moxibustion. Many famous doctors and books. Only name a few:
    • Zhēnjiǔ Da Quan (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng
    • Zhēnjiǔ J Yīng Fa Hui (鍼灸聚英??) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武)
    • Zhēnjiǔ Dchng (針灸大成)(Compendium of Acupuncture and Moxibustion) by Yang Jizhou, a milestone book. 1601CE, Yng J Zhōu (楊繼洲).
    • Běncǎo Gāng M (本草綱目)(Compendium of Materia Medica) by Lǐ Shzhēn (李時珍), the most complete and comprehensive pre-modern herb book
    • Wen Yi Lun by Wu YouShing
  • Qing Dynasty(1644-1912):
    • Yi Zong Jin Jian (Golden Reference of the Medical Tradition) by Wu Quan, sponsored by the imperial.
    • Zhen Jiu Feng Yuan (The Source of Acupuncture and Moxibustion) by Li Xuechuan
    • Wen Zhen Lun Dz by Ye TianShi[citation needed]
    • Wen Bing Tiao Bian(Systematized Identification of Warm Disease) written by Wu Jutong, a Qing dynasty physician, in 1798 C.E.

 Uses

In the West, traditional Chinese medicine is considered alternative medicine. In mainland China and Taiwan, TCM is considered an integral part of the health care system. The term "TCM" is sometimes used specifically in modern Chinese medicine to refer to the standardized set of theories and practices introduced in the mid-20th century under Mao Zedong, as distinguished from related traditional theories and practices preserved by people in Taiwan, Hong Kong and the overseas Chinese. The more general sense is meant in this article.

TCM developed as a form of noninvasive therapeutic intervention (also described as folk medicine or traditional medicine) rooted in ancient belief systems, including traditional religious concepts. Chinese medical practitioners before the 19th century relied on observation, trial and error, which incorporated certain mystical concepts. Like their Western counterparts, doctors of TCM had a limited understanding of infection, which predated the discovery of bacteria, viruses (germ theory of disease) and an understanding of cellular structures and organic chemistry. Instead they relied mainly on observation and description on the nature of infections for creating remedies. Based on theories formulated through three millennia of observation and practical experience, a system of procedure was formed as to guide a TCM practitioner in courses of treatment and diagnosis.

Unlike other forms of traditional medicine which have largely become extinct, traditional Chinese medicine continues as a distinct branch of modern medical practice, and within China, it is an important part of the public health care system. In recent decades there has been an effort to integrate Traditional Chinese Medicine with scientific medicine. One important component of this work is to use the instrumentation and the methodological tools available via Western medicine to investigate observations and hypotheses made by the Chinese tradition.

However, in Hong Kong , the city dominated by Western medicine for more than a hundred years,traditional medicine has struggled for a long time to be recognized by the society. Albeit Former Chief Executive Tung Chee-hwa introduced a bill in his first Policy Address, aiming at recognizing the professional status of Chinese medicine practitioners and developing Hong Kong into an international centre for the manufacture and trading of Chinese medicine, and for the promotion of this approach to medical care,until December 1, 2006,according to Labour Department of HKSAR,Hong Kong people, for the first time,can use a certification issued by a registered Chinese medicine practitioner as a sick leave,representing that traditional medicine has established its social status in Hong Kong.


TCM is used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions, such as pains, that conventional medicine has not been able to treat.

A report issued by the Victorian state government in Australia describes TCM education in China :

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

In other countries it is not necessarily the case that traditional Chinese and Western medicine are practiced concurrently by the same practitioner. TCM education in Australia , for example, does not qualify a practitioner to provide diagnosis in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures.  While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.

Theory

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 most 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 characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:

  • There are observable principles of constant change by which the Universe is maintained. Humans are part of the universe and cannot be separated from the universal process of change.
  • As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself. Optimum health results from living harmoniously, allowing the spontaneous process of change to bring one closer to balance. If there is no change (stagnation), or too much change (catastrophism), balance is lost and illnesses can result.
  • Everything is ultimately interconnected. Always use a holistic ("systemic" or "system-wide") approach when addressing imbalances.

Model of the body

The following text needs to be harmonized with text in the article TCM model of the body.

(See e.g. Wikipedia:Summary style.)

Main article: TCM 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" or "semen"), other bodily fluids, the Five elements, 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.

Models of the body include:

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 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.

Macro approach to disease

Traditional Chinese medicine has a "macro" or holistic view of disease. For example, one modern interpretation is that well-balanced human bodies can resist most everyday bacteria and viruses, which are ubiquitous and quickly changing. Infection, while having a proximal cause of a microorganism, would have an underlying cause of an imbalance of some kind. The traditional treatment would target the imbalance, not the infectious organism. There is a popular saying in China as follows: Chinese medicine treats humans while western medicine treats diseases.

A practitioner might give very different herbal prescriptions to patients affected by the same type of infection, because the different symptoms reported by the patients would indicate a different type of imbalance, in a traditional diagnostic system.

Western medicine treats infections by targeting the microorganisms directly, whether preventively (through sterilization of instruments, handwashing, and covering bandages), with antibiotics, or making use of the immune system through vaccines. While conventional medicine recognizes the importance of nutrition, exercise and reducing stress in maintaining a healthy immune system (and thus preventing infection), it also faces problems with antibiotic resistance caused by overuse of chemical agents and the high mutation rate of microorganisms. Pharmaceutical treatments also sometimes have side effects, the most severe of which are seen in regimens used to treat otherwise fatal illnesses, such as chemotherapy and radiotherapy for cancer, and antiretroviral drugs for HIV/AIDS.

The holistic approach of traditional Chinese medicine makes all practitioners generalists. Western medicine has general practitioners who dispense primary care, but increasing reliance is placed on specialists who have expertise in treating only certain types of diseases. Primary care physicians often refer patients to specialists. Emergency departments are located in large hospitals where many specialists are available.

Diagnostics

Following the 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 ( wng), hear and smell ( wn), ask about background ( wn) and touching ( qi). 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" 

Modern practitioners in China often use a traditional system in combination with Western methods.

Traditional Chinese medicine is considered to require considerable diagnostic skill. This often depends on the ability to observe what are described as subtle differences. This may be contrasted with a straightforward laboratory test which indicates an unambiguous cause. 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.

 Techniques

  • Palpation of the patient's radial artery pulse (Pulse diagnosis) in six positions
  • Observation of the appearance of the patient's tongue
  • Observation of the patient's face
  • Palpation of the patient's body (especially the abdomen) for tenderness
  • Observation of the sound of the patient's voice
  • Observation of the surface of the ear
  • Observation of the vein on the index finger on small children
  • Comparisons of the relative warmth or coolness of different parts of the body
  • Observation of the patient's various odors
  • Asking the patient about the effects of his problem
  • Anything else that can be observed without instruments and without harming the patient

Treatment

The below methods are considered as part of the Chinese medicine treatment:

  1. Chinese herbal medicine(中藥)
  2. Acupuncture and Moxibustion (針灸)
  3. Die-da or Tieh Ta (跌打)
  4. Chinese food therapy (食療)
  5. Tui na (推拿) - massage therapy
  6. Qigong (氣功) and related breathing and meditation exercise
  7. Physical exercise such as T'ai Chi Ch'uan (太極拳) and other Chinese martial arts
  8. Mental health therapy such as Feng shui (風水) and Chinese astrolog]

Modern TCM treatments consist of herbal medicine or acupuncture as the primary method, with other methods such as massage, qi gong, or food therapy playing a secondary role. Illness in TCM is seen as a lack of harmony, and the goal of all traditional treatment is to assist the body to regain balance and achieve homeostasis. The modern practice of traditional Chinese medicine is increasingly incorporating techniques and theories of Western medicine.

Specific treatment methods are grouped into these branches. Cupping and Gua Sha (刮痧) are part of Tui Na. Auriculotherapy (耳燭療法) comes under the heading of Acupuncture and Moxibustion. Die-da or Tieh Ta (跌打) are practitioners who specialize in healing trauma injury 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 is not common in the West.

 Branches

Traditional Chinese medicine has many branches, the most prominent of which are the Jingfang (经方学派) and Wenbing(温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shenlong Bencaojing. The more recent Wenbing school's practise is largely based on more recent books including Compendium of Materia Medica from Ming and Qing Dynasty, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools

  

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