Traditional Chinese Medicine: An Introduction

Introduction

Traditional Chinese medicine (TCM) originated in ancient China and has evolved over thousands of years. TCM practitioners use herbs, acupuncture, and other methods to treat a wide range of conditions. In the United States, TCM is considered part of complementary and alternative medicine (CAM). This fact sheet provides a general overview of TCM and suggests sources for additional information.

Key Points

• Herbal remedies and acupuncture are the treatments most commonly used by TCM practitioners. Other TCM practices include moxibustion, cupping, massage, mind-body therapy, and dietary therapy.
• The TCM view of how the human body works, what causes illness, and how to treat illness is different from Western medicine concepts. Although TCM is used by the American public, scientific evidence of its effectiveness is, for the most part, limited. Acupuncture has the largest body of evidence and is considered safe if practiced correctly. Some Chinese herbal remedies may be safe, but others may not be.
• TCM is typically delivered by a practitioner. Before using TCM, ask about the practitioner's qualifications, including training and licensure.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Background

Traditional Chinese medicine, which encompasses many different practices, is rooted in the ancient philosophy of Taoism and dates back more than 5,000 years. Today, TCM is practiced side by side with Western medicine in many of China's hospitals and clinics.
TCM is widely used in the United States. Although the exact number of people who use TCM in the United States is unknown, it was estimated in 1997 that some 10,000 practitioners served more than 1 million patients each year. According to the 2007 National Health Interview Survey, which included questions on the use of various CAM therapies, an estimated 3.1 million U.S. adults had used acupuncture in the previous year. In addition, according to this same survey, approximately 17 percent of adults use natural products, including herbs, making it the most commonly used therapy. In another survey, more than one-third of the patients at six large acupuncture clinics said they also received Chinese herbal treatments at the clinics.

Underlying Concepts

Underlying the practice of TCM is a unique view of the world and the human body that is different from Western medicine concepts. This view is based on the ancient Chinese perception of humans as microcosms of the larger, surrounding universe—interconnected with nature and subject to its forces. The human body is regarded as an organic entity in which the various organs, tissues, and other parts have distinct functions but are all interdependent. In this view, health and disease relate to balance of the functions.

The theoretical framework of TCM has a number of key components:

• Yin-yang theory—the concept of two opposing, yet complementary, forces that shape the world and all life—is central to TCM.
• In the TCM view, a vital energy or life force called qi circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi.
• The TCM approach uses eight principles to analyze symptoms and categorize conditions: cold/heat, interior/exterior, excess/deficiency, and yin/yang (the chief principles). TCM also uses the theory of five elements—fire, earth, metal, water, and wood—to explain how the body works; these elements correspond to particular organs and tissues in the body.

These concepts are documented in the Huang Di Nei Jing (Inner Canon of the Yellow Emperor), the classic Chinese medicine text.

Treatment

TCM emphasizes individualized treatment. Practitioners traditionally used four methods to evaluate a patient's condition: observing (especially the tongue), hearing/smelling, asking/interviewing, and touching/palpating (especially the pulse).

TCM practitioners use a variety of therapies in an effort to promote health and treat disease. The most commonly used are Chinese herbal medicine and acupuncture.

• Chinese herbal medicine. The Chinese materia medica (a pharmacological reference book used by TCM practitioners) contains hundreds of medicinal substances—primarily plants, but also some minerals and animal products—classified by their perceived action in the body. Different parts of plants such as the leaves, roots, stems, flowers, and seeds are used. Usually, herbs are combined in formulas and given as teas, capsules, tinctures, or powders.
• Acupuncture. By stimulating specific points on the body, most often by inserting thin metal needles through the skin, practitioners seek to remove blockages in the flow of qi.
  Other TCM therapies include moxibustion (burning moxa—a cone or stick of dried herb, usually mugwort—on or near the skin, sometimes in conjunction with acupuncture); cupping (applying a heated cup to the skin to create a slight suction); Chinese massage; mind-body therapies such as qi gong and tai chi; and dietary therapy.

Status of TCM Research

In spite of the widespread use of TCM in China and its use in the West, scientific evidence of its effectiveness is, for the most part, limited. TCM's complexity and underlying conceptual foundations present challenges for researchers seeking evidence on whether and how it works. Most research has focused on specific modalities, primarily acupuncture and Chinese herbal remedies.

Acupuncture research has produced a large body of scientific evidence. Studies suggest that it may be useful for a number of different conditions, but additional research is still needed.

Chinese herbal medicine has also been studied for a wide range of conditions. Most of the research has been done in China. Although there is evidence that herbs may be effective for some conditions, most studies have been methodologically flawed, and additional, better designed research is needed before any conclusions can be drawn.

Examples of TCM Uses and Studies

Both acupuncture and Chinese herbal medicine have been used and studied for a wide range of conditions. A few examples are

Acupuncture

• Back pain
• Chemotherapy-induced nausea
• Depression
• Osteoarthritis

Chinese herbal medicine

• Cancer
• Heart disease
• Diabetes
• HIV/AIDS

Safety

The U.S. Food and Drug Administration (FDA) regulations for dietary supplements (including manufactured herbal products) are not the same as those for prescription or over-the-counter drugs; in general, the regulations for dietary supplements are less strict. Some Chinese herbal treatments may be safe, but others may not. There have been reports of products being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients. Some of the herbs are very powerful, can interact with drugs, and may have serious side effects. For example, the Chinese herb ephedra (ma huang) has been linked to serious health complications, including heart attack and stroke. In 2004, the FDA banned the sale of ephedra-containing dietary supplements used for weight loss and performance enhancement, but the ban does not apply to TCM remedies or to herbal teas.

Acupuncture is considered safe when performed by an experienced practitioner using sterile needles.

Training, Licensing, and Certification

Most states license acupuncture, but states vary in their inclusion of other TCM components (e.g., herbal medicine) in the licenses they issue. The federally recognized Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits schools that teach acupuncture and TCM, and about one-third of the states that license acupuncture require graduation from an ACAOM-accredited school. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers separate certification programs in acupuncture, Chinese herbology, and Oriental bodywork. Almost all licensing states require completion of NCCAOM's national written exam; some states also require a practical exam.

If You Are Thinking About Using TCM

• Look for published research studies on TCM for the health condition that interests you.
• If you are thinking about trying TCM herbal remedies, it is better to use these products under the supervision of a medical professional trained in herbal medicine than to try to treat yourself.
• Ask about the training and experience of the TCM practitioner you are considering
• Do not use TCM as a replacement for effective conventional care or as a reason to postpone seeing a doctor about a medical problem.
• If you are pregnant or nursing, or are thinking of using TCM to treat a child, you should be especially sure to consult your health care provider.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.

NCCAM-Funded Research

Recent NCCAM-supported studies have been investigating:

• TCM for endometriosis-related pelvic pain, irritable bowel syndrome, and temporomandibular (jaw) disorders
• Chinese herbal medicines for food allergies and for osteoarthritis of the knee
• Consistency of TCM practitioners' diagnosis and herbal prescriptions for rheumatoid arthritis patients.

Selected References

Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008.

Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Rev. ed. Seattle, WA: Eastland Press; 1993.

Cassidy, C. Chinese medicine users in the United States. Part I: utilization, satisfaction, medical plurality. Journal of Alternative and Complementary Medicine. 1998;4(1):17–27.

Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.

National Center for Complementary and Alternative Medicine. Acupuncture: An Introduction. Bethesda, MD: National Center for Complementary and Alternative Medicine. NCCAM publication no. D404.

National Center for Complementary and Alternative Medicine. Using Dietary Supplements Wisely. Bethesda, MD: National Center for Complementary and Alternative Medicine. NCCAM publication no. D426.

National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement. National Institutes of Health Web site. Accessed at http://consensus.nih.gov/1997/1997acupuncture107html.htm  on July 15, 2008.

O'Brien KA, Xue CC. The theoretical framework of Chinese medicine. In: Leung PC, Xue CC, Cheng YC, eds. A Comprehensive Guide to Chinese Medicine. River Edge, NJ: World Scientific Publishing Co.; 2003.

Shang A, Huwiler K, Nartey L, et al. Placebo-controlled trials of Chinese herbal medicine and conventional medicine comparative study. International Journal of Epidemiology. 2007;36(5):1086–1092.

Shankar K, Liao, LP. Traditional systems of medicine. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):725–747.

Traditional Chinese medicine. Natural Medicines Comprehensive Database. Accessed on June 4, 2008.

Traditional Chinese medicine (TCM). Natural Standard Database Web site. Accessed on June 4, 2008.

Xue CC, O'Brien KA. Modalities of Chinese medicine. In: Leung PC, Xue CC, Cheng YC, eds. A Comprehensive Guide to Chinese Medicine. River Edge, NJ: World Scientific Publishing Co.; 2003.