INTRODUCTION
A BRIEF HISTORY OF CHINESE TRADITIONAL MEDICINE
The roots of Chinese Traditional Medicine (also referred to as TCM) date back more than 2000 years. Its rich history tells of the many influences on its development, including the Japanese, Europeans, and the Communist revolution. The changes that followed these influences explains why both terms--Traditional Chinese Medicine and Traditional Oriental Medicine (TOM)--are seen in the literature. Although these two terms are sometimes used interchangeably, TOM generally refers to the system of Chinese medicine practiced until the early 1900s. Up until this period, Chinese medicine had witnessed great growth, but also decline, as Western influence expanded and the training of traditional medicine grew poorer and more limited.
The Communist party of China was formed under the leadership of Chairman Mao in 1928 and took over power in 1949. The Communities realized that there were little or no medical services and actively encouraged the use of traditional Chinese remedies because they were cheap, acceptable to the Chinese, and used the skills already available in the countryside. In 1940, Yang Shao proposed to "scientificise" and "popularise" Traditional Chinese Medicine. Since then, this resurgence has opened facilities in China to provide, teach, and investigate Chinese Traditional Medicine. While both Western and Chinese medicine have been practiced in China since the late 1800s, the traditional Chinese approach to medicine began to grow in popularity in the West in the 1970s, when ties to China opened.
BASIC PRINCIPLES
Acupuncture is the practice that most often comes to mind when thinking of Chinese medicine, but TCM represents a much broader system of medicine that includes herbs, massage, diet and exercise therapy.
The underlying basis of TCM is that all of creation is born from the interdependence of two opposite principles, yin and yang (see the Eight Guiding Principles below). These two opposites are in constant motion, creating a fluctuating balance in the healthy body. Disease results when either yin or yang is in a state of prolonged excess or deficiency.
One of the body constituents is Qi (pronounced "chee"), which is the energy that gives us the ability to move, think, feel, and work. Qi circulates along a system of conduits, the principle ones being channels or meridians. There are twelve principle bilateral channels of Qi, each intimately connected with one of the viscera of the body, and each manifesting its own characteristic Qi (e.g. Liver Qi, Gallbladder Qi, etc.). When the flow of Qi becomes unbalanced through physical, emotional, or environmental insults, illness may result.
TCM practitioners are trained to view the body, mind, and spirit as one system, as opposed to Western medicine practitioners, who are taught to regard each of these elements as separate. Despite TCM's dramatically different approach, Westerners have been drawn to its practice because of its emphasis on healing the whole person and seeking the root cause of illness. However, Westerners do often find it difficult to translate a TCM diagnosis or remedy into the western practice of medicine with which they are familiar. For example, there is no direct translation for how a TCM practitioner might explain a patient’s condition as "cool with dampness," or an "imbalance in water," with a need to "tonify the kidneys" or "replenish Qi".
Traditional Chinese Medicine is a complex system that requires many years of training to master. This guide serves as an introduction to the practice of TCM, providing additional resources for your research.
ACUPUNCTURE
The practice of acupuncture and moxibustion is based on the theory of meridians. According to this theory, qi (vital energy) and blood circulate in the body through a system of channels called meridians, connecting internal organs with external organs or tissues. By stimulating certain points of the body surface reached by meridians through needling or moxibustion, the flow of qi and blood can be regulated and diseases are thus treated. These stimulation points are called acupuncture points, or acupoints. Acupoints reside along more than a dozen of major meridians. There are 12 pairs of regular meridians that are systematically distributed over both sides of the body, and two major extra meridians running along the midlines of the abdomen and back. Along these meridians more than three hundred acupoints are identified, each having its own therapeutic action. For example, the point Hegu (LI 4), located between the first and second metacarpal bones, can reduce pain in the head and mouth. The point Shenmen (HT 7), located on the medial end of the transverse crease of the wrist, can induce tranquilization.
In acupuncture clinics, the practitioner first selects appropriate acupoints along different meridians based on identified health problems. Then very fine and thin needles are inserted into these acupoints. The needles are made of stainless steel and vary in length from half an inch to 3 inches. The choice of needle is usually determined by the location of the acupoint and the effects being sought. If the point is correctly located and the required depth reached, the patient will usually experience a feeling of soreness, heaviness, numbness and distension. The manipulator will simultaneously feel that the needle is tightened. The needles are usually left in situ for 15-30 minutes. During this time the needles may be manipulated to achieve the effect of tonifying the qi.
Needle manipulations are generally involved with lifting, thrusting, twisting and rotating, according to treatment specifications for the health problem. Needling may also be activated by electrical stimulation, a procedure usually called electro-acupuncture, in which manipulations are attained through varying frequencies and voltages.
Treatment protocols, frequency and duration are a matter of professional judgment of the practitioner, in consultation with the patient. A common course of treatment may initially involve between ten and fifteen treatments spaced at approximately weekly intervals, and spread out to monthly later in a program.
A professional practitioner will always warn the patient of the possibility of exacerbation at the start of a course of treatment. The patients may find that in the short term after treatment, the symptoms may in fact get worse before an improvement sets in. This is a quite common feature of acupuncture treatment.
Patients should inquire about types of needles used prior to treatment. Most practitioners now use pre-packed and sterilized disposable needles that are only once. If re-useable needles are being used patients should ask to see the sterilization procedures that the practitioner adopts. The effectiveness of an acupuncture treatment is strongly dependent upon an accurate Chinese medical diagnosis. The needling skills and techniques of the practitioner will also influence greatly the effectiveness of the outcome. Acupuncture can be remarkably effective in many conditions, but in the West, patients often use acupuncture as the last option for their long-term chronic problems. Therefore we sometimes see the treatment as slow and in some cases of marginal benefit. With the gradual establishment of acupuncture as the treatment of choice for many people, the effectiveness of the approach with acute as well as with more chronic conditions is being recognized.
Acupuncture is often conducted in combination with Moxibustion. Moxibustion is the process where moxa sticks, made of dry moxa leaves (Artemisia vulgaris) is ignited and held about an inch above the patient’s skin over specific acupuncture points. Moxa is available in a loose form that can be used for making moxa cones. Alternatively, moxa is packed and rolled in a long stick like a large cigar, about 15-20 cm long and about 1-2 cm in diameter. The purpose of this process is to warm the qi and blood in the channels. Moxibustion is most commonly used when there is the requirement to expel cold and damp or to tonify the qi and blood. A single treatment of moxibustion usually lasts 10-15 minutes. Needle-warming moxibustion combines needling and moxibustion by attaching a moxa stub (about 2 cm long) to an inserted needle. This method enhances the effects of needling and is often used to treat chronic rheumatism and rheumatoid arthritis.
THE FIVE ELEMENT THEORY
The five element theory, also called the five-phase theory, holds that everything in the universe, including our health, is governed by five natural elements: wood, fire, earth, metal and water. This theory underscores the Chinese belief that human beings, both physically and mentally, are intertwined with nature. Although it is difficult for Westerners to relate this philosophy to the Western approach to medicine, it is fundamental to the understanding of Traditional Chinese Medicine.
In the five element theory, each of the five elements has a season and particular organs and senses associated with it, such as taste, color, sound.
The wood element, for example, is associated with spring, the liver, and the gall bladder.
Similarly, the fire element is associated with early summer, the heart, and small intestines;
the earth element corresponds to late summer, the stomach and spleen;
metal is associated with autumn, the lungs and large intestine;
and water is associated with winter, the kidneys and bladder.
In contrast to Western medicine's teaching of a separation between the mind and body, TCM views each organ as having particular body and mind functions, as illustrated in the belief that the liver is involved in planning, and in the storage of anger, while the gall bladder is the organ of decision-making.
To determine a patient’s composition of the five elements, a TCM practitioner asks many detailed questions that will provide clues as to the nature of their imbalances. They will ask about the person’s occupation, stress associated with it, what they like to eat, what physical problems they are experiencing, etc. Although a person may be oriented towards a particular element - a person who is aggressive might be described as having a "wood" personality - the Chinese believe that aspects of each of the five elements are present in every person at different times.
THE EIGHT GUIDING PRINCIPLES
In addition to the theory of the five elements, TCM practitioners employ the Eight Guiding Principles to analyze and differentiate the energetic imbalances in the body or the nature of a patient’s condition.
The eight guiding principles actually consist of four polar opposites: yin/yang, cold/heat, deficiency (xu)/excess (shi), and interior/exterior.
Cold/Heat: This principle is used to determine the overall energy of the patient. A cold condition would be one marked by a slow metabolism, chills, pale skin, and a low-grade fever, while a hot condition would be characterized by a heightened metabolism, sensations of heat in the body, high fevers, and a flushed complexion.
Interior/Exterior: This principle describes symptoms in terms of the location of the patient’s problem. Exterior conditions are those caused by the invasion of the body by pathogens, and are usually acute and superficially located with a short duration. Exterior symptoms are those that affect the hair, skin, muscles, joints, peripheral nerves and blood vessels. Interior conditions result from pathogens that enter the interior of the body. Interior symptoms affect the organs, deep vessels and nerves, brain, spinal cord, and bones.
Deficiency/Excess: This principle describes the strength of an illness. In TCM, a deficient condition would be viewed as a lack of blood (such as in anemia), energy (Qi), heat, or fluids. Chronic illness would fall in this category. An excess condition, by contrast, means that the body has too much of something, such as Qi or blood. In TCM, an acute condition would be seen as an excess condition.
Yin/Yang: These principles are the generalization of the above principles, and a condition can be categorized in terms of the relative dominance of either yin and yang. In Chinese medicine, all organisms have both yin and yang qualities and a balance of the two is necessary for good health. In general, yin energy is associated with cold, female energy, and represents the solid organs. Yang is associated with hot, male energy, and represents the hollow organs. Chronic illness is seen as yin, while acute illness is seen as yang.
According to TCM, the combination of these principles determine the nature or quality of the three constituents of the body, which are energy (Qi), moisture, and blood. As described above, Qi is vital life energy. Moisture is the liquid medium which protects, nurtures, and lubricates tissue, and blood is the material foundation out of which we create bones, nerves, skin, muscles, and organs.
TCM practitioners diagnose health problems using various combinations of the eight guiding principles. For example, a patient might be diagnosed as having an "internal cold" or "external heat" condition. Used in conjunction with the five element theory, the eight guiding principles give the TCM practitioner a more complete picture of a patient’s energy imbalances and determine the treatment to be pursued through acupuncture, herbs, diet, and exercise.
DIAGNOSIS
The diagnosis of a patient’s condition in TCM consists of three activities: an extensive interview, pulse diagnosis, and a tongue examination.
Interview: The first step in diagnosing a patient’s condition is an extensive interview by the TCM practitioner. In addition to seeking information about the patient’s complaints, the practitioner will ask detailed questions about such issues as quality of sleep, dreams, appetite, preferred foods, and stress. The practitioner is also trained to use the senses of observation, listening, and smelling. Although smell is often camouflaged in the West by perfumes, deodorants, and breath mints, the Chinese believe it provides further knowledge about a person's health. In the Five Element Theory, each element has a corresponding smell associated with it.
Pulse Diagnosis: Whereas Western doctors locate one pulse on the radial artery in the wrist, a practitioner of TCM feels for six pulses in each wrist: three superficial and three deep at specific points along the radial artery. The twelve pulses correspond to the internal organs. For example, a deep pulse reading on the left wrist corresponds, top to bottom, to the heart, liver and kidney. Practitioners note the quality of the pulse in terms of frequency, rhythm, and volume and the Chinese have developed an elaborate vocabulary to describe a pulse, such as floating, thready, and slippery. Pulse taking requires years of training to master and is considered one of the most important diagnostic tools in Chinese medicine.
Tongue Examination: In addition to the pulse, the Chinese believe that the tongue is a strong barometer of human health. They developed an elaborate system to describe the condition of the tongue, including the color, texture, shape, size, and coating. A very red tongue indicates a fever or inflammation and is described in TCM as an excessive internal heat or dampness condition. A white tongue indicates some kind of deficiency of energy (Qi), blood, or moisture. In this system, each part of the tongue corresponds to the condition of an organ. The tip of the tongue, for example, represents the heart and lung organs. All three diagnostic techniques -- interview, pulse, and tongue -- provide useful information to the TCM practitioner regarding the nature of a patient’s condition.
CHINESE HERBS
In China, herbal remedies are used as much as acupuncture to treat energy imbalances and illness. When considering the appropriate herbal remedy for a patient, practitioners of TCM apply medical theory - the Five Elements and Eight Guiding Principles - along with tongue and pulse diagnosis. Herbs used in Chinese medicine are derived from plant, animal, and mineral substances. Although plant-derived herbs, such as ginseng and ginger, are the most common, minerals and animal parts such as oyster shells, deer antlers, and bear gall bladder are also prescribed.
In China, herbs in powder form are boiled and made into a tea. In the West, TCM practitioners often premix the herbal remedy or supply the herb in pill form, especially for those patients who find the bitter taste intolerable. Herbs have four basic qualities and properties: nature, taste, affinity, and primary action.
Nature: An herb's nature is often described as cooling or heating, but it can also be described as moistening, relaxing, and energizing. The peppermint herb, for example, has a cooling energy, and is used to lower the metabolism or reduce gas and bloating.
Taste: Herbs are categorized by five tastes -- sour, bitter, sweet or bland, spicy, and salty, and herbs representing different tastes are used to treat different conditions. Dandelion and goldenseal are two bitter herbs used for their drying properties in treating upper respiratory conditions.
Affinity: This property refers to the affinity that an herb has for a particular organ network.
Primary action: This property refers to the effect of a particular herb. An herb may be used to dispel (move), astringe (restrain), purge (expel), or tonify (strengthen).
In creating the herbal formula for a patient, the TCM practitioner considers the effect or outcome of the remedy, such as aiding digestion, clearing mucus, or strengthening the immune system. Applying the Eight Guiding Principles, they also consider the energy of the illness, such as hot/cold, damp/wind, or some mixture of the principles. Like the diagnostic tools of pulse and tongue reading, the prescription of herbal remedies takes a TCM practitioner years to master because it requires a deep understanding of medical theory and the complexity of herbs.
MASSAGE
All hospitals in China that are devoted to Traditional Chinese Medicine include a massage clinic along with acupuncture and herbal medicine. Chinese massage was developed over 2,000 years ago and was popular in the Tang, Ming, and Qing dynasties. The Chinese call this therapeutic bodywork tui na, which literally means "push" and "pull".
Tui na works with the energy system in the body (Qi), which flows through channels called meridians. By stimulating or subduing the energy in the body, practitioners help bring the patient’s body back into balance. To determine what meridians need work, tui na practitioners feel the patient’s wrist pulse.
Because it is based on the same meridian points as acupuncture, tui na is often called "acupuncture without needles."
Two popular styles of tui na practiced today are the rolling and one-finger methods.
Rolling Method: This style was developed in Shanghai and is used for joint and soft tissue problems, as well as insomnia, migraines, and high blood pressure.
One-Finger Method: This style is similar to shiatsu, practitioners push points along the meridians with the tip of the thumb or finger. This method is often used for chronic and internal problems, pediatrics and gynecological problems.
The Chinese believe that tui na regulates the nervous system so that Qi flows properly, boosts the immunological Qi of the body, and flushes metabolic waste out of the body. It is a popular part of the practice of TCM in China because it is both comfortable and effective.
DIET AND EXERCISE
In Traditional Chinese Medicine, diet and exercise play an important role in maintaining good health by contributing to an optimum balance of vital life energy (Qi). In fact, the Chinese believe that diet is one of the three origins (diet, heredity, and environment) or sources of qi.
Therefore, according to TCM, the foods we eat directly influence the excesses and deficiencies in our bodies. Unlike the American diet, which emphasizes a balance of protein, carbohydrates, and fats, the Chinese approach to diet is grounded in the five element and eight guiding principles theory. Foods are seen as having yin and yang, warming and cooling, drying and moistening properties. Certain foods are better for some people than others, depending on their type and condition. A person with a "cold damp" condition should not eat a diet of raw fruits and vegetables (which are yin), because they would further exaggerate the loss of body heat and fluid secretion.
Conversely, foods that are fried, broiled, high fat, or spicy are seen as warming (yang) because they generate heat and stimulate circulation. A person whose diagnosis is "hot dry" should avoid these foods, according to TCM. In general, the Chinese approach to diet is to optimize digestion and increase qi, moisture, and blood, and aid the organ function. In this sense, it can be seen as an extension of herbal medicine.
In addition to diet, TCM includes a form of exercise called Qi gong, which is believed to optimize the flow of Qi in the body. Qi gong incorporates posture, movement, breathing, meditation, visualization and conscious intent in order to cleanse or purify the qi.
There are two types of Qi gong practiced: internal and external.
Internal Qi gong: Used by individuals to maintain health by regulating Qi and harmonizing the internal energy of the body. Internal Qi gong uses certain movements and breath work or visualization to gather and circulate Qi in the body.
External Qi gong: The practice of transferring the practitioner’s Qi to another person for healing purposes. This form of Qi gong is similar to other body work modalities in the West, such as therapeutic touch. The movement postures of internal Qi gong have become the most common form of practice today and have been used as the basis for Tai Chi and other martial arts practices.