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Introduction

Traditional Chinese medicine (TCM) originated in ancient China and has evolved over thousands
of years. TCM practitioners use herbal medicines and various mind and body practices, such as
acupuncture and tai chi, to treat or prevent health problems. In the United States, people use
TCM primarily as a complementary health approach. This fact sheet provides a general
overview of TCM and suggests sources for additional information.

Key Points
Is It Safe?

Acupuncture is generally considered safe when performed by an experienced practitioner


using sterile needles. Improperly performed acupuncture can cause potentially serious
side effects.
Tai chi and qi gong, two mind and body practices used in TCM, are generally safe.
There have been reports of Chinese herbal products being contaminated with drugs,
toxins, or heavy metals or not containing the listed ingredients. Some of the herbs used in
Chinese medicine can interact with drugs, have serious side effects, or be unsafe for
people with certain medical conditions.

Is It Effective?

For most conditions, there is not enough rigorous scientific evidence to know whether
TCM methods work for the conditions for which they are used.

Keep in Mind
Tell all your health care providers about any complementary health approaches you use.
Give them a full picture of what you do to manage your health. This will help ensure
coordinated and safe care.

Background
TCM encompasses many different practices, including acupuncture, moxibustion (burning an
herb above the skin to apply heat to acupuncture points), Chinese herbal medicine, tui na
(Chinese therapeutic massage), dietary therapy, and tai chi and qi gong (practices that combine
specific movements or postures, coordinated breathing, and mental focus). TCM is rooted in the
ancient philosophy of Taoism and dates back more than 2,500 years. Traditional systems of
medicine also exist in other East and South Asian countries, including Japan (where the
traditional herbal medicine is called Kampo) and Korea. Some of these systems have been
influenced by TCM and are similar to it in some ways, but each has developed distinctive
features of its own.

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 (NHIS), which included a
comprehensive survey on the use of complementary health approaches by Americans, an
estimated 3.1 million U.S. adults had used acupuncture in the previous year. The number of
visits to acupuncturists tripled between 1997 and 2007. According to the 2007 NHIS, about
2.3 million Americans practiced tai chi and 600,000 practiced qi gong in the previous year.

This fact sheet focuses on TCM as a whole. For information about some of the individual
practices included in TCM, see the pages on acupuncture, tai chi, and qi gong on the National
Center for Complementary and Integrative Health (NCCIH) Web site. Some of the individual
herbs used in TCM are discussed in NCCIHs Herbs at a Glance fact sheets.

Side Effects and Risks


Herbal medicines used in TCM are sometimes marketed in the United States as dietary
supplements. The U.S. Food and Drug Administration (FDA) regulations for dietary
supplements are not the same as those for prescription or over-the-counter drugs; in
general, the regulations for dietary supplements are less stringent. For example,
manufacturers dont have to prove to the FDA that most claims made for dietary
supplements are valid; if the product were a drug, they would have to provide proof.
Some Chinese herbal products may be safe, but others may not be. There have been
reports of products being contaminated with drugs, toxins, or heavy metals or not
containing the listed ingredients. Some of the herbs used in Chinese medicine can interact
with drugs, can have serious side effects, or may be unsafe for people with certain
medical conditions. 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, but the ban does not apply to
TCM remedies.
The FDA regulates acupuncture needles as medical devices and requires that the needles
be sterile, nontoxic, and labeled for single use by qualified practitioners only. Relatively
few complications from the use of acupuncture have been reported. However, adverse
effectssome of them serioushave resulted from the use of nonsterile needles or
improper delivery of acupuncture treatments.
Tai chi and qi gong are considered to be generally safe practices.
Information on the safety of other TCM methods is limited. Reported complications of
moxibustion include allergic reactions, burns, and infections, but how often these events
occur is not known. Both moxibustion and cupping (applying a heated cup to the skin to
create a slight suction) may mark the skin, usually temporarily. The origin of these marks
should be explained to health care providers so that they will not be mistaken for signs of
disease or physical abuse.

Underlying Concepts

When thinking about ancient medical systems such as TCM, it is important to separate questions
about traditional theories and concepts of health and wellness from questions about whether
specific interventions might be helpful in the context of modern science-based medicine and
health promotion practices.

The ancient beliefs on which TCM is based include the following:

The human body is a miniature version of the larger, surrounding universe.


Harmony between two opposing yet complementary forces, called yin and yang,
supports health, and disease results from an imbalance between these forces.
Five elementsfire, earth, wood, metal, and watersymbolically represent all
phenomena, including the stages of human life, and explain the functioning of
the body and how it changes during disease.
Qi, a vital energy that flows through the body, performs multiple functions in
maintaining health.

Concepts such as these are of interest in understanding the history of TCM. However, NCCIH-
supported research on TCM does not focus on these ideas. Instead, it examines specific TCM
practices from a scientific perspective, looking at their effects in the body and whether the
practices are helpful in symptom management.

TCM practitioners use a variety of techniques in an effort to promote health and treat disease. In
the United States, the most commonly used approaches include Chinese herbal medicine,
acupuncture, and tai chi.

Chinese herbal medicine. The Chinese Materia Medica (a pharmacological reference


book used by TCM practitioners) describes thousands of medicinal substances
primarily plants, but also some minerals and animal products. Different parts of plants,
such as the leaves, roots, stems, flowers, and seeds, are used. In TCM, herbs are often
combined in formulas and given as teas, capsules, liquid extracts, granules, or powders.
Acupuncture. Acupuncture is a family of procedures involving the stimulation of
specific points on the body using a variety of techniques. The acupuncture technique that
has been most often studied scientifically involves penetrating the skin with thin, solid,
metal needles that are manipulated by the hands or by electrical stimulation.
Tai chi. Tai chi is a centuries-old mind and body practice. It involves gentle, dance-like
body movements with mental focus, breathing, and relaxation.
The Status of TCM Research
In spite of the widespread use of TCM in China and its use in the West, rigorous scientific
evidence of its effectiveness is limited. TCM can be difficult for researchers to study because its
treatments are often complex and are based on ideas very different from those of modern
Western medicine.

Most research studies on TCM have focused on specific techniques, primarily acupuncture and
Chinese herbal remedies, and there have been many systematic reviews of studies of TCM
approaches for various conditions.

An assessment of the research found that 41 of 70 systematic reviews of the scientific


evidence (including 19 of 26 reviews on acupuncture for a variety of conditions and 22 of
42 reviews on Chinese herbal medicine) were unable to reach conclusions about whether
the technique worked for the condition under investigation because there was not enough
good-quality evidence. The other 29 systematic reviews (including 7 of 26 reviews on
acupuncture and 20 of 42 reviews on Chinese herbal medicine) suggested possible
benefits but could not reach definite conclusions because of the small quantity or poor
quality of the studies.
In a 2012 analysis that combined data on individual participants in 29 studies of
acupuncture for pain, patients who received acupuncture for back or neck pain,
osteoarthritis, or chronic headache had better pain relief than those who did not receive
acupuncture. However, in the same analysis, when actual acupuncture was compared
with simulated acupuncture (a sham procedure that resembles acupuncture but in which
the needles do not penetrate the skin or penetrate it only slightly), the difference in pain
relief between the two treatments was much smallerso small that it may not have been
meaningful to patients.
Tai chi has not been investigated as extensively as acupuncture or Chinese herbal
medicine, but recent studies, including some supported by NCCIH, suggest that
practicing tai chi may help to improve balance and stability in people with Parkinsons
disease; reduce pain from knee osteoarthritis and fibromyalgia; and promote quality of
life and mood in people with heart failure.

If You Are Thinking About Using TCM


Do not use TCM to replace effective conventional care or as a reason to postpone seeing
a health care provider about a medical problem.
Look for published research studies on TCM for the health condition that interests you.
It is better to use TCM herbal remedies under the supervision of your health care provider
or a professional trained in herbal medicine than to try to treat yourself.
Ask about the training and experience of the TCM practitioner you are considering. You
can find information about the credentials and licensing of complementary health
practitioners on the NCCIH Web site.
If you are pregnant or nursing, or are thinking of using TCM to treat a child, you should
be especially sure to consult your (or the childs) health care provider.
Tell all your health care providers about any complementary health approaches you use.
Give them a full picture of what you do to manage your health. This will help ensure
coordinated and safe care.
Traditional Chinese medicine

Definition
Traditional Chinese medicine (TCM) is based on a set of interventions designed to restore
balance to human beings. The therapies usually considered under the heading of classic Chinese
medicine include:

acupunture and moxibustion


dietary regulation
herbal remedies
massage
therapeutic exercise

These forms of treatments are based upon beliefs that differ from the disease concept favored by
Western medicine. What is referred to as illness by Western medicine is considered in traditional
Chinese medicine to be a matter of disharmony or imbalance.

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The philosophy behind Chinese medicine is a melding of tenets from Buddhism, Confucianism,
and the combined religious and philosophical ideas of Taoism. Although there are various
schools of thought among practitioners of traditional Chinese medicine, five Taoist axioms form
its basis:

There are natural laws which govern the universe, including human beings.

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The natural order of the universe is innately harmonious and well-organized. When people live
according to the laws of the universe, they live in harmony with that universe and the natural
environment.
The universe is dynamic, with change as its only constant. Stagnation is in opposition to the law
of the universe and causes what Western medicine calls illness.

All living things are connected and interdependent.


Humans are intimately connected to and affected by all facets of their environment.

Origins
Historical background

Traditional Chinese medicine is over 2,000 years old. It originated in the region of eastern Asia
that today includes China, Tibet, Vietnam, Korea, and Japan. The first written Chinese medical
treatises (as the West understands the term) date from the Han dynasty (206 b.c.a.d. 220). Tribal
shamans and holy men who lived as hermits in the mountains of China as early as 3500 b.c.
practiced what was called the "Way of Long Life." This regimen included a diet based on herbs
and other plants; kung-fu exercises; and special breathing techniques that were thought to
improve vitality and life expectancy.

After the Han dynasty, the next great age of Chinese medicine was under the Tang emperors,
who ruled from a.d. 608-a.d. 906. The first Tang emperor established China's first medical
school in a.d. 629. Under the Song (a.d. 9601279) and Ming (a.d. 13681644) dynasties, new
medical schools were established, their curricula and qualifying examinations were standardized,
and the traditional herbal prescriptions were written down and collected into encyclopedias. One
important difference between the development of medicine in China and in the West is the
greater interest in the West in surgical procedures and techniques. In the nineteenth and early
twentieth centuries, the opening of China to the West led to the establishment of Western-style
medical schools in Shanghai and other large cities, and a growing rivalry between the two
traditions of medicine. In 1929 a group of Chinese physicians who had studied Western medicine
petitioned the government to ban traditional Chinese medicine. This move was opposed, and by
1933 the Nationalist government appointed a chief justice of the Chinese Supreme Court to
systematize and promote the traditional system of medicine. In contemporary China, both
traditional and Western forms of medicine are practiced alongside each other.

Philosophical background: the cosmic and natural order

In Taoist thought, the Tao, or universal first principle, generated a duality of opposing principles
that underlie all the patterns of nature. These principles, yin and yang, are mutually dependent as
well as polar opposites. They are basic concepts in traditional Chinese medicine. Yin represents
everything that is cold, moist, dim, passive, slow, heavy, and moving downward or inward; while
yang represents heat, dryness, brightness, activity, rapidity, lightness, and upward or outward
motion. Both forces are equally necessary in nature and in human well-being, and neither force
can exist without the other. The dynamic interaction of these two principles is reflected in the
cycles of the seasons, the human life cycle, and other natural phenomena. One objective of
traditional Chinese medicine is to keep yin and yang in harmonious balance within a person.

In addition to yin and yang, Taoist teachers also believed that the Tao produced a third force,
primordial energy or qi (also spelled chi or ki). The interplay between yin, yang, and qi gave rise
to the Five Elements of water, metal, earth, wood, and fire. These entities are all reflected in the
structure and functioning of the human body.

The human being

Traditional Chinese physicians did not learn about the structures of the human body from
dissection because they thought that cutting open a body insulted the person's ancestors. Instead
they built up an understanding of the location and functions of the major organs over centuries of
observation, and then correlated them with the principles of yin, yang, qi, and the Five Elements.
Thus wood is related to the liver (yin) and the gall bladder (yang); fire to the heart (yin) and the
small intestine (yang); earth to the spleen (yin) and the stomach (yang); metal to the lungs (yin)
and the large intestine (yang); and water to the kidneys (yin) and the bladder (yang). The Chinese
also believed that the body contains Five Essential Substances, which include blood, spirit, vital
essence (a principle of growth and development produced by the body from qi and blood); fluids
(all body fluids other than blood, such as saliva, spinal fluid, sweat, etc.); and qi.

A unique feature of traditional Chinese medicine is the meridian system. Chinese doctors viewed
the body as regulated by a network of energy pathways called meridians that link and balance the
various organs. The meridians have four functions: to connect the internal organs with the
exterior of the body, and connect the person to the environment and the universe; to harmonize
the yin and yang principles within the body's organs and Five Substances; to distribute qi within
the body; and to protect the body against external imbalances related to weather (wind, summer
heat, dampness, dryness, cold, and fire).

Benefits
Traditional Chinese medicine offers the following benefits:

It is believed by some to treat certain chronic illnesses more effectively than Western medicine.
It is holistic; all aspects of the person's being are taken into account.
It treats the root cause of the disease as well as the manifest symptoms. Chinese practitioners
distinguish between the root (ben ) of an illness and its branches (biao ). The root is the basic
pattern of imbalance in the patient's qi; the branches are the evident symptoms.
Traditional Chinese medicine does not rely on pharmaceutical products that often cause side
effects.
It improves a person's general health as well as treating specific diseases or disorders.
It is often less expensive than standard allopathic treatment.
It is not a self-enclosed system but can be used in combination with Western medicine.
It can be used to treat the side effects of Western modalities of treatment.

Description
Acupuncture/moxibustion

Acupuncture is probably the form of treatment most familiar to Westerners. It is often used for
pain relief, but has wider applications in traditional Chinese practice. It is based on a view of the
meridians that regards them as conduits or pathways for the qi, or life energy. Disease is
attributed to a blockage of the meridians; thus acupuncture

can be used to treat disorders of the internal organs as well as muscular and skin problems. The
insertion of needles at specific points along the meridians is thought to unblock the qi. More than
800 acupuncture points have been identified, but only about 50 are commonly used. Acupuncture
is usually used as a treatment together with herbal medicines.

Moxibustion refers to the practice of burning a moxa wick over the patient's skin at vital points.
Moxa is a word derived from Japanese and means "burning herbs." The moxa wick is most
commonly made from Artemisia vulgaris, or Chinese wormwood , but other herbs can also be
used. Moxibustion is thought to send heat and nourishing qi into the body. It is used to treat a
number of different illnesses, including nosebleeds , pulled muscles, mumps , arthritis, and
vaginal bleeding.

Dietary regulation

Diet is regarded as the first line of treatment in Chinese medicine; acupuncture and herbal
treatments are used only after changes in diet fail to cure the problem. Chinese medicine uses
foods to keep the body in internal harmony and in a state of balance with the external
environment. In giving dietary advice, the Chinese physician takes into account the weather, the
season, the geography of the area, and the patient's specific imbalances (including emotional
upsets) in order to select foods that will counteract excesses or supply deficient elements. Basic
preventive dietary care, for example, would recommend eating yin foods in the summer, which is
a yang season. In the winter, by contrast, yang foods should be eaten to counteract the yin
temperatures. In the case of illness, yin symptom patterns (fatigue , pale complexion, weak
voice) would be treated with yang foods, while yang symptoms (flushed face, loud voice,
restlessness) would be treated by yin foods.

Chinese medicine also uses food as therapy in combination with exercise and herbal
preparations. One aspect of a balanced diet is maintaining a proper balance of rest and activity as
well as selecting the right foods for the time of year and other circumstances. If a person does not
get enough exercise, the body cannot transform food into qi and Vital Essence. If they are
hyperactive, the body consumes too much of its own substance. With respect to herbal
preparations, the Chinese used tonics taken as part of a meal before they began to use them as
medicines. Herbs are used in Chinese cooking to give the food specific medicinal qualities as
well as to flavor it. For example, ginger might be added to a fish dish to counteract fever . Food
and medical treatment are closely interrelated in traditional Chinese medicine. A classical
Chinese meal seeks to balance not only flavors, aromas, textures, and colors in the different
courses that are served, but also the energies provided for the body by the various ingredients.

Herbal remedies
Chinese herbal treatment differs from Western herbalism in several respects. In Chinese
practice, several different herbs may be used, according to each plant's effect on the individual's
qi and the Five Elements. There are many formulas used within traditional Chinese medicine to
treat certain common imbalance patterns. These formulas can be modified to fit specific
individuals more closely.

In 2002, a study in Texas showed that a traditional Chinese antirheumatic herb extract helped
patients with rheumatoid arthritis by improving symptoms such as morning stiffness and
tender, swollen joints. Side effects of decreased appetite and nausea were tolerable for those the
herb helped. The researchers planned to move on to a more scientifically controlled clinical trial
phase to further test the herb's effectiveness. Another scientific study that year reported new
benefits for applying soy proteins, an ancient Chinese practice, to the skin. Scientists worked on
a new preparation that showed benefits in reducing age spots and ultraviolet ray damage, and
smoothing and moisturizing the skin, among other benefits.

A traditional Chinese herbal formula typically contains four classes of ingredients, arranged in a
hierarchical order: a chief (the principal ingredient, chosen for the patient's specific illness); a
deputy (to reinforce the chief's action or treat a coexisting condition); an assistant (to counteract
side effects of the first two ingredients); and an envoy (to harmonize all the other ingredients and
convey them to the parts of the body that they are to treat).

Massage

Massage is recommended in traditional Chinese medicine to unblock the patient's meridians,


stimulate the circulation of blood and qi, loosen stiff joints and muscles, and strengthen the
immune system. It may be done to relieve symptoms without the need for complex diagnosis.
Chinese massage is commonly used to treat back strain, pulled muscles, tendinitis, sciatica ,
rheumatism, arthritis, sprains, and similar ailments. In Tui na massage, the practitioner presses
and kneads various qi points on the patient's body. The patient does not need to undress but
wears thin cotton clothes. He or she sits on a chair or lies on a massage couch while the
practitioner presses on or manipulates the soft tissues of the body. Tui na means "push and
grasp" in Chinese. It is not meant to be relaxing or pampering but is serious treatment for sports
injuries and chronic pain in the joints and muscles. Tui na is used to treat the members of
Chinese Olympic teams.

Therapeutic exercise

Therapeutic exercise, or qigong, is an ancient Chinese form of physical training that combines
preventive healthcare and therapy. Qigong relies on breathing techniques to direct the qi to
different parts of the body. The literal translation of qigong is "the cultivation and deliberate
control of a higher form of vital energy." Another form of therapeutic exercise is t'ai chi , in
which the person moves through a series of 3064 movements that require a relaxed body and
correct rhythmic breathing. Many Chinese practice t'ai chi as a form of preventive medicine.

Preparations
Preparations for treatment in traditional Chinese medicine are similar to preparing for a first-time
visit to a Western physician. The patient will be asked to give a complete and detailed medical
history. The practitioner may touch the patient's acupuncture meridians to evaluate them for
soreness or tightness. The major difference that the patient will notice is the much greater
attention given in Chinese medicine to the tongue and the pulse. The Chinese practitioner will
evaluate the patient's tongue for form, color, and the color and texture of the tongue fur. In taking
the pulse, the Chinese therapist feels three pressure points along each wrist, first with light
pressure and then with heavy pressure, for a total of 12 different pulses on both wrists. Each
pulse is thought to indicate the condition of one of the 12 vital organs.

Precautions
There are no special precautions necessary for treatment with traditional Chinese medical
techniques other than giving the practitioner necessary details about major or chronic health
problems.

Side effects
Side effects with traditional Chinese medicine are usually minor. With herbal treatments, there
should be no side effects if the patient has been given the correct formula and is taking it in the
prescribed manner. Some people feel a little sore or stiff the day after receiving Tui na massage,
but the soreness does not last and usually clears up with repeated treatments. Side effects from
acupuncture or from therapeutic exercise under the guidance of a competent teacher are unusual.
However, care should be taken in using herbal preparations and possible side effects or toxins
within any preparations, as well as interactions with other drugs. Patients should consult with
qualified practitioners.

Research & general acceptance


At present, there is renewed interest in the West in traditional Chinese medicine. Of the 700
herbal remedies used by traditional Chinese practitioners, over 100 have been tested and found
effective by the standards of Western science. Several United States agencies, including the
National Institutes of Health, the Office of Alternative Medicine, and the Food and Drug
Administration (FDA) are currently investigating Chinese herbal medicine as well as
acupuncture and Tui na massage. In general, however, Western studies of Chinese medicine
focus on the effects of traditional treatments and the reasons for those effects, thus attempting to
fit traditional Chinese medicine within the Western framework of precise physical measurements
and scientific hypotheses.

As use of traditional Chinese medicine has increased steadily in the West, many allopathic
physicians have needed to understand the intricacies of the practice and to know how to deal
with adverse reactions to herbal remedies. In 2002, a project was undertaken to develop a
Chinese herbal medicine toxicology database to share information about English and Chinese
studies on Chinese herbal medicines. The goal of the project was to help doctors in Western
hospitals better manage poisonings or adverse reactions to Chinese medicines.
Training & certification
Traditional Chinese medicine practitioners can be either acupuncturists, herbalists, or both. At
present, no schools accredited in the United States confer the degree of Doctor of Oriental
Medicine because the standards for such a degree have not yet been established. More than half
of the 50 states now have licensing boards for acupuncturists as of the early 2000s. There is no
present independent licensing for herbalists. California has been the only state that has required
(since 1982) acupuncture practitioners to take licensing examinations in both acupuncture and
herbal medicine.

There is also a national organization called the National Commission for the Certification of
Acupuncture and Oriental Medicine (NCCAOM) that offers certification in acupuncture. This
certification provides the basis for licensure in a number of states. The NCCAOM also offers a
certificate in herbal medicine that does not lead to licensure at present but is beginning to be used
in some states as a basis for practice.

Resources
BOOKS

Mills, Simon, M.A., and Steven Finando, PhD. Alternatives in Healing. New York: NAL
Penguin, Inc., 1989.

Reid, Daniel P. Chinese Herbal Medicine. Boston: Shambhala, 1993.

Stein, Diane. "All Women Are Healers: A Comprehensive Guide to Natural Healing." Chinese
Healing and Acupressure. Freedom, CA: The Crossing Press, 1996.

Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese Medicine and Ayurveda. Twin
Lakes, WI: Lotus Press, 1995.

PERIODICALS

Bensoussan, Alan, et al. "Development of a Chinese Herbal Medicine Toxicology Database."


Journal of Toxicology: Clinical Toxicology (March 2002): 159.

"Chinese Herbal Extract Safe and Effective for RA." The Journal of Musculoskeletal Medicine
(January 2002): 43.

Liu, Jue-Chen, et al. "Applications of Soy in Skin Care." The Journal of Nutrition (March 2002):
574S.

ORGANIZATIONS
American Association of Oriental Medicine. 909 22nd St. Sacramento, CA 95816.
<http://www.aaom.org>.

American Foundation of Traditional Chinese Medicine (AFTCM). 505 Beach Street. San
Francisco, CA 94133. (415) 776-0502. Fax: (415) 392-7003. aftcm@earthlink.net.

Florida Institute of Traditional Chinese Medicine. (800) 565-1246. fitcm@gte.net.

Joan Schonbeck

Teresa G. Odle