Paradigm Evolution of the Traditional Chinese Medicine and its Application in International Community
- 1. Department of Health Services, Beijing University of Chinese Medicine, China
- 2. Department of Primary Health care, Monash University, Australia
- 3. The University of Adelaide, Australia
- 4. Royal District Nursing Service Australia, Australia
- 5. University College London, UK
CONCLUSION
TCM is an important traditional culture in China
TCM exited for thousands of years in China. In ancient times, there were quite lot of magic stories on efficiency of TCM and four famous works (‘Huang Di Nei Jing’, ‘Nan Jing’, ‘Shen Nong Bai Cao Jing’ and ‘Shang Han Lun’) which built up the ideology of medicine. From the story and history development, we could find out medicine in China was not named as Traditional Chinese Medicine until the People’s Republic of China built up, but TCM always played an important role in health promotion and health maintenance. Furthermore, the theory in four works, such as ‘Yin-Yang and Wuxing’, ‘Jin,Qi, Shen’, comes from the culture in China and became the fundamental of the theory. By far, TCM is still an important traditional culture in China because of its history and ideology.
TCM is an umbrella term for many therapies
Broadly speaking, TCM can be considered as a package of all kinds of traditional medicine in China, such as ‘Han Medicine’, ‘Tibetan Medicine’, ‘Mongolian Medicine’, ‘Miao Medicine’ and more. But a restricted view of TCM is base on the four famous works. TCM in this research refers to the latter one.
Even in a narrow sense of TCM, it covers acupuncture and moxibustion, Chinese herbal medicine, massage, cupping, qigong, Guasha, Taiji, health cultivation and others. All the therapies above are based on the theory from four famous works.
Classification of narrow TCM
Classification will help the health policy department and health providers better understand TCM. Unfortunately, no classification of TCM in China exits in the literatures by now, so this paper aims to do it.
If at the angle of different theory, TCM is divided into three types: ?Acupuncture and Moxibustion, Cupping, Massage and Guash which are based on the clinical TCM; ?Chinese Herbal which is based on Shennong Bencao Jing; ?Health cultivation, Qi Gong and Taiji which are based on the theory of health cultivation. If at the angle of life cycle, TCM could be divided into: ?Health cultivation, Taiji, Qigong and Massage, Cupping and Guasha which are used in prevention stage; ?Chinese herbal, Acupuncture and Moxibustion, Massage which are used in treatment stage; ?Acupuncture and Moxibustion (including Acupoint Incision and Blood-pricking), Cupping and Massage which are used in recovery stage.
Increasing demand of TCM
With the immigration of Chinese people, the aging progress and the increasing medical expenditure, more and more countries are paying attention to complementary medicine including TCM. In the application of TCM, lots of therapies like acupuncture, massage, Taiji are widely accepted in the world. And some Chinese herbal medicines were testified to be effect on treatment or prevention of the global infectious diseases.
SUGGESTION OF FURTHER STUDIES
Systematic review on TCM
The research is mainly based on WHO reports, the literatures from Chinese journals and related textbooks. That is to say, the literature searching maybe is not enough to support the paper, and there is no quality assessment of the literature. A systematic review of TCM will be on progress in the next step.
Application of TCM
The paper describes the application of TCM in the world, but just lists some typical therapies without covering all the therapies. Further studies could be taken like the systematic review of application of TCM in the world or the utilization of TCM investigation.
ACKNOWLEDGEMENT
Thank for the funding from China Scholarship Council, and thank Professor Xianggen Zhong from Beijing University of Chinese Medicine, who provided me the perfect suggestion of the content of TCM.
REFERENCES
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7. J Li. History of Traditional Chinese Medicine. Hainan press.
13. H. Zhu. Accupotomy. People’s Medical Publishing House Co. LTD. Beijing. 2002.
14. X Gao .Science of Chinese Pharmacology. Chinese Medicine Press. Beijing. 2007.
16. L Gao. Practical Chinese cupping, Xueyuan Press. Beijing. 2004.
17. T Liu. Chinese Medical Qigong. Chinese Medicine Press. Beijing. 2005.
18. Q Zhao, Guasha. Science Press Ltd. Beijing. 2013.
21. S Ni. Phagoiatreusiology. Chinese Medicine Press. Beijing. 2009.
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23. WHO, WHO traditional medicine strategy. 2014-2023, 2013.
Abstract
Objective: This paper aims to explore the definition, historical development, category and international application of TCM to help the world understand the TCM better.
Method: The research searched the database of CNKI (China National Knowledge Infrastructure), web of WHO and the textbook related with TCM by the keywords such as ‘Traditional Chinese Medicine’, ‘Traditional Medicine’, ‘history’, ‘utilization’, ‘classification’, and analyzed the material and made a conclusion.
Result: The term of Traditional Chinese Medicine (TCM) was named after the People’s Republic of China was set up; The four famous works built up the fundamental of theory and ideology of medicine in China, which are ‘Huang Di Nei Jing’, ‘Nan Jing’, ‘Shen Nong Bai Cao Jing’ and ‘Shang Han Zai Bing Lun’; The paper classified TCM into two different ways, one is based on the theory difference, the other is based on the life cycle of disease; TCM is well accepted by the world with its effectiveness.
Conclusion: TCM is an important tradition in China with the increasing demand in the world, it is an umbrella covering kinds of therapies. But the term of TCM is still not clear enough, which requires more research on it to make the world have a better understand.
Citation
He M, Yang H, Thomas S, Browning C, Searle K, et al. (2015) Paradigm Evolution of the Traditional Chinese Medicine and its Application in International Community. Ann Community Med Pract 1(2): 1007.
Keywords
• Traditional chinese medicine
• Paradigm evolution
• Classification
• Application
INTRODUCTION
The term of Traditional Chinese Medicine (TCM) is widely used across the World by the academics and layperson alike. It is recommended as the most popular and important complementary and/or alternative medicine by the World Health Organization [1]. With the ageing population, growing medical expenditure and limitation of western medicine, the demand for TCM is growing. This increased demand has generated interest in the philosophy and practice of TCMs in many countries of the World.
However, the concept of TCM does not be clearly understood. Definitions of TCM are varied and contested. The TCM has been defined in a number of different ways, across countries and regions, cultures and languages, as well as eras of historic periods.
This paper is a review based on the literatures from database of CNKI (China National Knowledge Infrastructure), web of WHO and the TCM text book with ‘Traditional Chinese Medicine’, ‘Traditional Medicine’, ‘history’, ‘utilization’, and ‘classification’ as the searching keywords. It explores the evolution of the TCM paradigm by tracking the theories and practices of TCM both in previous and modern times to make the world have a better understanding of TCM and its application. The approach to this exploration is two folds: 1) In previous times: this paper tries to sort out the history development of the term ‘TCM’ and its theoretical framework basis; 2) In modern times: this paper tries to induce the contents of TCM in the medicine field and classify it, and to review its application across the world.
HISTORICALLY CONCEPTUAL DEVELOPMENT OF TCM
Ancient times: early terms for medicine
Traditional Chinese Medicine (TCM) has made great contribution to the well-being and the prosperity of China for thousands of years. However, the term ‘Traditional Chinese Medicine’ (chuan tong zhongyi, ??????) in China was formally used after 1949 when the People’s Republic of China was set up. Prior to that time, these approaches were known by a variety of names including‘?’yi, medicine)’, ‘?? (guoyi,national medicine)’, ‘???hanfang (Kampo in Japanese)’ [2], ‘??, (xinglin (apricot woods)’, ‘Qi-Huang (Huang Di and Qi Bo)’, ‘?? (xuanhu (a gourd hanging on)’, ‘Qing Nang (a kind of black bag for books)’ and more.
The original use of Yi (the same character as Yi in Chuan Tong ZhongYi from TCM) pre-dates to1400-1100 BC of oracle bone inscriptions. was originally found in the oracles which is a combination of a basket and an arrow, and then changed into with a rest person on top right and an alcohol container on bottom and with a wizard on the bottom after the Stone Age and in the Bronze Age (1300-220 BC), but simplified as at present time. The symbolic character illustrated medicine is the way of a wizard using alcohol to comfort a solider with arrow wound [Fu, 1997 #59].
In Han dynasty (206 BC-220 AD) [3], Yi was formally recorded in a classic Chinese Medicine book-’Han Shu Yi Wen Zhi• Fangji Lue’. During the early phase of the history, the seven founding books of traditional medicine, known as the ‘Yi Jing’ were already in circulation as were special notebooks for medical reports (called ‘Yi An’ or ‘Zhen Ji’). Doctor roles had already differentiated too into those who lived and worked within a community (called ‘Yi Gong’), traveling doctors (called ‘Zou Fang Yi), and the most highly regarded of all, doctors who provided service for kings and officials (‘Tai Yi’ or ‘Yu Yi’). By the time of Tang Dynasty, a doctor might have and established place of work, known as ‘Tai Yi Shu’, which then involved into ‘Tai Yi Ju’ and ‘Tai Yi Yuan’ in the time for the Song and Qing Dynasty respectively.
TCM embodies other meaningful names, such as ‘Qi-Huang’, ‘Qing Nang’, ‘Xing Lin’, and ‘Xuan Hu’[4]. ‘Qi-Huang’ comes from the famous book-‘Huangdi Neijing (sometimes named as ‘Yellow emperor’s Canon of Internal Medicine’)’, which is all about a conversation (Q and A) between Qi Bo (a famous doctor in the Remote Ages) and Huang Di (the ancestor of the Chinese nation) concerning medical problems. So ‘Qi-Huang’ is named after Huang Di and Qi Bo as the alternative name of TCM.
‘Qing Nang’ is closely related with ‘Hua tuo’, a famous doctor in the Three Kingdoms. It was said that Hua sent his own medical writings fully filled in a ‘Qing Nang’ as a gift to a prison guard, who served him well with sufficient food in prison before his execution. This guard then became a doctor and handed down the medical skills of Hua after his death, that’s why TCM was so called as ‘Qing Nang’.
Interestingly, the ‘Xing Lin’ originated from the period of three Kingdoms as well. According to the records, there was a famous doctor named Dong Feng, who lived in the Mountain Lushan, China as a hermit. Dong never charged patients money but asked them to plant the apricot trees in front of his house if cured. Many years later, an endless apricot forest showed up in the front door. Hence the TCM was being honored as ‘Xing Lin’.
In addition, ‘Xuan Hu’ came from legends. A man named Zhangfang Fei met an older man selling medicine with a gourd on a rod. It was strange to discover that each evening, the old man would jump and disappear into that gourd. To find out the truth, Fei served the older man with a nice dinner, and then accepted the old man’s invite of thanks to visit the gourd. Surprisingly, the inner gourd was a gorgeous place with excellent wine and decent food. Fei immediately knelt down and begged the elderly man to be his supervisor and teach him how to cultivate immortality. Years later, he began to practice as a doctor saving the lives of the patients just like the old man with the gourd on the rod given by him.
The fantastical stories above show that traditional medicine played an important role and was well accepted by Chinese people because of its effectiveness in ancient China. But there was no universal term for traditional medicines at ancient times.
Ancient times: early theory and ideology of medicine in China
Although there was no single term used for medicine in ancient China, the following scholars built up the framework, the theory and the ideology for medicine in China.
The milestone of TCM is four classic medical papers laid out during the period from Three Kingdoms to Qin and Han Dynasty and know as ‘Huangdi Neijing ( Neijing in short)’ ,‘Huangdi Eighty-one Nan Jing (Nanjing in short)’, ‘Shennong Bencao Jing (Bencao Jing in short)’, and ‘Shanghan ZabingLun’ [5].
The Oriental philosophy of medicine-Huang Di Nei Jing and Nan Jing
The ‘Huangdi Neijing’ and the ‘Nanjing’ laid the fundamental theory of medicine in China. Huangdi Neijing’ is one of the earliest literary works found in oriental world. Based on historical study, the first draft was written in the Spring and Autumn and the Warring States Periods (770-221BC). The work was developed and modified aby successive generations and then separated into two volumes: the Lingshu (??) and Suwen (Suwen).
The basic philosophy of medicine in China is to describe the structure and function of human body, physiology and pathology, then to diagnose and provide the treatments or prevention therapies, based on the theories-‘Yin-Yang and Wuxing’, ‘Jingqi’, ‘Zangfu’, ‘Qi and Blood’, ‘Jingluo’ and ‘Jingshen’. The work systematically describes the basic principle and rule of TCM by employing theories of ‘Jingqi’, ‘Yin-Yang’ and the ‘Five Elements’, which regard the human body as a whole. It also details its physiology and function of the ‘Zangfu’, ‘Qi and Blood’, ‘Jingluo’, ’Jingshen’. As to ‘Nanjing’, written in Eastern Han Dynasty, it is seen as an extension and complementary to the ‘Neijing’ and seeks to explain 81 hypochondriasises.
Theory of herbal medicine- Shen Nong Bai Cao Jing
The ‘Shennong Bencao Jing’ proposed the basic theory framework of Chinese herbal medicine, such as the ‘Four Properties & Five Tastes’ , ‘Monarch- Minister- Assistant- Guide’, ‘seven conditions in making up prescription’. It is also recorded the origin, collection, identification, processing, storage and using of 365 herbs, which become the basis of the further development of traditional Chinese pharmacology.
CLINICAL PRACTICE
The ‘Shanghan Zabing Lun’ (literally Treatise on Cold Pathogenic and Miscellaneous Diseases) is the basis of TCM clinical practice. It analyzed the pathogenesis, clinical manifestation, diagnosis and therapy of different diseases, categorized the symptoms into different syndromes, and creatively established the treatment principle of ‘Liujing Bianzheng’ to typhoid fever, which is also the theoretical basis of ‘Li (mechanism of diseases), Fa (approach to diagnosis), Fang (prescription), Yao (drug or medicine)’ of the TCM.
In conclusion, these four works above built up the basic theory framework of TCM, paving a way for promoting TCM in the next years [6].
Modern period: the formation of the universal term of TCM
The Opium War (1840-1842) is a prelude to the modern history of China, which resulted in the semi-colonization of China from autarchy feudal society. Since then, the western medicine was introduced to China and many more terms for TCM came into use to differentiate these approaches from the western medicine [7].
According to the historical records, Benjamin Hobson, a doctor from the Church of England published the book ‘Xiyi Luelun (the introduction of western medicine)’ in China in 1851 (?? Xianfeng Period in Qing Dynasty), which compared the different terms of TCM with west medicine, such as ‘Zhongtu (Eastern) Medicine’, ‘Chinese (Eastern) Doctor’, ‘Medicine of Zhongtu (Chinese)’. Hobson was the first person who categorised the medical science with geographical location- ‘Western’ and ‘Chinese’.
Unfortunately, in a trend for the Chinese learning from the western countries after the Sino Japanese War (1894-1895), there was eventually a collision between the Chinese and Western medicine, which resulted in TCM losing its dominance as the common medical practice to gradual and finally becoming the marginalized medical practice [5].
In 1929, the ‘Old Medicine Abolition Act’ was passed through in the National Health Commission Conference held by the Chinese Nationalist Party. This bill irritated key stakeholders such as the Chinese Medicine Industry, the business and the press, who petitioned and pretested against it. Finally, the term of ‘Traditional Chinese Medicine’ was officially used in ‘Traditional Chinese Medicine Regulation’ conducted by the Chinese National Government.
After the foundation of People’s Republic of China in 1949, Traditional Chinese Medicine was widely spread and used, which included all kinds of traditional medicine in China [3]. Moreover, in the early stage after the establishment of the People’s Republic of China, the government proposed three strategies in health care services, ‘Combining TCM and Western Medicine, Servicing the workers, peasants and soldiers, Prevention as the priority job’. ‘The Health Care Act’ in 1985 pointed out that the TCM and Western Medicine should play the same important role in health care, which became one of the five strategies in health care policy (??????) in 1991.
If only considering the term usage, we will find ‘Chinese medicine’ (??) is the most popular used term among Chinese both of in the country and in overseas; while the ‘Traditional Chinese Medicine’ (????) is the term widely used by ‘westerners’ and non-Chinese texts which is distinguished with ‘western’ and/or ‘modern’ medicine that developed in north America and European countries.
There has been a continuous debate on the status of Chinese medicine in the country, although it is being widely used in the country and in the world. In New Cultural Movement, Chinese pioneers and westerners introduced Mr De (???, Democracy) and Mr Sai (???, Science) into China. Significantly, Mr Sai does not teach Chinese medicine as it was referenced as non-scientific practice in medicine.
THERAPIES OF TCM AND ITS CATEGORIES
Broadly speaking, TCM can be considered as a package which includes all kinds of traditional medicine from different ethnicities and ideologies of China, such as ‘Han Medicine’, ‘Tibetan Medicine’, ‘Mongolian Medicine’, ‘Miao Medicine’, ‘Sutra of Medicine’, ‘Taoist Medicine’ and more. A more restricted view of the TCM definition is based on the four famous works. TCM in this research refers to the latter one.
In a narrow sense, TCM regards the human body as a balancing unity of ‘Jing (Essence), Qi, Shen (Vitality Blood Thin and Thick Fluid)’, Jingluo and so on. Based on the Yin-Yang and Five Elements theory, TCM explores the pathogenesis, etiology, location and nature of diseases as well as the changes of Zang and Fu (vital organs), Meridians, Qi, Blood and Shen (Thin & Thick Fluid) by five specific diagnosis methods-’inspection’, ‘auscultation’, ‘olfaction’, ‘inquiry’ and ‘palpation’ to tell the increase or decrease of the Zhengqi (vital energy) and Xieqi (pathogenic energy), and then judges the disease and its pattern of syndrome [8]. These observations determine which principal therapy should be initiated, such as ‘Han (Perspiration)’, ‘Tu (Vomit)’, ‘Xia (Purgation)’, ‘He(Regulation)’, ‘Wen (Warm)’, ‘Qing (Refreshment)’, ‘Bu (Supplement)’ and ‘Xiao (Digestion)’ and different measures, which includes Chinese herbal, Acupuncture and Moxibustion, Massage, Tuina (Manipulation), Cupping, Qigong, Tai-chi, Dietotherapy, to achieve the harmonious status of balance of Yin and Yang[8] .
Introduction of Therapies of TCM
Traditional Chinese Medicine is an umbrella term, which brings together several traditional approaches to medicine as follows:
Acupuncture and Moxibustion
Acupuncture and Moxibustion are the most important components of TCM and are widely used in the world. However, there appears to be a difference of the usage and meaning of the word ‘Acupuncture’ between Chinese and International physicians and consequently a divergence in practice too. In Chinese, acupuncture and moxibustion are usually called Zhenjiu. Zhenjiu promotes the use of both acupuncture and moxibustion. These two approaches combined from the needle and moxibustion on the acupoint. In contrast, ‘Acupuncture’ is more widely used internationally and tends to be associated with the practice of acupuncture without moxibustion.
Zhenjiu works by acting on Zang-Fu and Meridians for the regulation of Yin and Yang, strengthening the body resistance to eliminate pathogenic factors, dredging meridians as well as promoting flow of qi and blood circulation, preventing and treating diseases in a quick, simple and safe way [9]. Moxibustion involves burning mugwort on or near the skin at an acupuncture point. It is claimed that moxibustion militates against cold and dampness in the body, and can serve to turn breech babies.
Acupoint incision, blood-pricking and Accupotomy are also included in Zhenjiu. Acupoint incision is an external therapy that is applied by cutting the skin on the specific acupoints, procuring a bit of fat and manipulating stimuli in part, which has been demonstrated with a positive effect on the prevention and treatment of migraine [10]. And blood pricking is a therapy that makes use of the three-edged, hand sewing, plum-blossom needles, scalpel knifes and more to stab the acupoint, nidus, pathological point or superficial veins, releasing a bit of blood for the regulation of Zang and Fu, Qi and Blood as well as Meridians [11]. The Blood-pricking therapy plays an active role in treating the Shingles, Acne, Hordeolum, Spondylosis and dental ulcer [12]. As to Accupotomy, it can cut and detach the adhesive, cicatricial and contractured abnormal tissues, remove clog and restore dynamic balance with almost no trauma [13].
Chinese Herbal Medicine
Chinese Herbal Medicine is also an important part of TCM. The principle of Chinese Herbal is to collect, process and prepare the Chinese herbal based on the Traditional Chinese Medicine theory. The herbal preparation is specific to the individual. The patients, after drinking their Herbal remedy are restored to a harmonious and healthy state by increasing the Zhengqi, decreasing the Xieqi and eliminating the pathogenic energy to make the Zangfu back to the normal healthy status [14].
Massage(Tuina)
Massage (Tuina) is widely used in China, but it has different name in different parts of China. It is also known as ‘Massage’ in the north part of China, whilst ‘Tuina’ is commonly used in the southern China. Massage is a kind of manipulation with special skills and operations under the TCM theory by using hands and other part of limbs on specific body location or acupoints of patients, which could be the benefit for relaxing the muscles and tendons, dredging blocked meridians, lubricating joints, enhancing the flexibility and range of motion of muscle and ligaments, promoting blood circulation and removing fatigue as well [15].
Ointment massage is one special kind of massage with ointments on specific parts of body, and the ointments are usually made of herbals to promote the blood circulation, remove the blood stasis, warm meridians to dissipate cold, strengthen tendons and bones.
Cupping
Cupping is a therapy putting cups, tanks or barrels on acupoint and meridian by air suction, resulting in the pores puff and skin congestion by which the toxins and the pathogen will be sucked out of the body to promote blood circulation, regulate function of Zang and Fu, and finally cure diseases. The methods for cupping are specific and various, which include Liu Guan, Shan Guan, Zou Guan, Zixuan Guan, Ti Guan, Xiang Guan, Ti’an Guan, Yao Guan, Zhendang Guan and Zhenchan Guan [16].
Qigong
Qigong is an exercise technique based on theories of YinYang, Five Elements, Jing Qi Shen, Meridians as well as Visceral Manifestations to regulate the body, heart and breath into a harmonious and healthy unit. Generally speaking, Qigong include Neilian Fa ( internal exercises focusing on adjusting the Qi) and Waizhi Fa (external exercises focusing on action) composing of ‘Waiqi Liaofa’, ‘Qigong Tuina’, ‘Qigong Zhenjiu’, and ‘Qigong Dianxue’ [17].
Tuna is a breathing exercise under Qigong. In the term of Tuna, Tu means expiration and Na means inspiration. Daoyin is more complicated, which is a kind of Qigong combined with breathing exercise, body movement and mental activity. Huatuo, a famous doctor in Three Kingdom, summarized the characters of Daoyin and created an activity named ‘Wuqin Xi’ (five animal show), including tiger, deer, bear, monkey and bird show. It helps to promote and maintain the health by keeping meridians, blood and Qi in smooth cycling and the function of Zangfu in perfect balance. By the end of Song Dynasty (960-1279), ‘Ba Duanjin’ showed up, which is also a kind of Qigong activity from Daoyin. It is still widely used in China.
Guasha
Guasha, commonly called ‘scraping, spooning or coining’, involves remedial therapist creating friction over an area of skin with a blunt object such as the rounded edge of Chinese ceramic soup spoon. It draws toxins out from deep within the muscles and body, allowing them to be cleansed and renourished with fresh blood, it has an anti-inflammatory and immunity stimulation effect on the body and is an alternative treatment commonly used to help release muscular tension, as well as ward off the initial onset of the common cold [18].
Taiji
Taiji, also named Tai Chi, Taiji embodies in Taichi Chaun and Taichi instruments like sword or fan. It is an ancient Chinese tradition that is practiced as a graceful form of exercise. Taiji aims to enhance the body immunity, promote health and prevent disease by adjusting the breathing, making the Zangfu and meridians run smoothly [19].
Health Cultivation of Traditional Chinese Medicine [20]
Health cultivation of TCM, also named ‘nourishing of life’, ‘health maintenance of TCM’, ‘Regimen’, is a Chinese tradition to maintain the health for the public, which is also based on the TCM theory and follow the ‘Yin-Yang’ and ‘Wuxing’ to balance the body and keep body in vital station. Health cultivation covers physique health cultivation, living health cultivation, dietotherapy, environmental health cultivation and spiritual health cultivation, which means physique, environmental, food, living status, spirit are the factors of health cultivation.
Dietotherapy and spirital health cultivation are the most important type of application in health cultivation. The rationales of both of them are the same that based on the ‘Yin-Yang’, ‘Wuxing’ and meridian. Dietotherapy aims to maintain the health of the body, reduce disease, improve health and longevity by food, such as herbal cuisine, gruel and drink, and medicinal liquor[21], whilst spirit health cultivation is by emotion and mental health adjustment, which includes mental health cultivation and emotional health cultivation.
Categories of Therapies of TCM
There are many kinds of therapies for TCM, but currently no standard classification exits. In this research, TCM is divided into three types because of the difference of treatment theory, ?Acupuncture and Moxibustion, Cupping, Massage and Guash which are based on the clinical TCM; ?Chinese Herbal which is based on Shennong Bencao Jing; ?Health cultivation, Qi Gong and Taiji which are based on the theory of health cultivation. Meanwhile, TCM could be divided into another three types according to the function during the life circle of the disease: ?Health cultivation, Taiji, Qigong and Massage, Cupping and Guasha which are used in prevention stage; ?Chinese herbal, Acupuncture and Moxibustion, Massage which are used in treatment stage; ?Acupuncture and Moxibustion (including Acupoint Incision and Blood-pricking), Cupping and Massage which are used in recovery or rehabilitation stage.
By now, TCM is a complementary way to improve or maintain health in clinical practice. Whilst in the angle of health service or health policy, the classification of TCM will contribute to the better understanding of TCM as a product and will help the stakeholder to identify the role of TCM in health care system.
FRAMEWORK OF TCM IN MEDICINE AND ITS APPLICATION IN INTERNATIONAL COMMUNITY
TCM and Traditional Medicine
According to World Health Organization, TCM belongs to Traditional Medicine (TM). Other related concepts are Complementary Medicine (CM), Alternative Medicine (AM), Un-conventional Medicine, and Traditional & Complementary Medicine (T&CM) as well. T&CM merges the terms TM and CM, encompassing products, practices and practitioners.
Traditional medicine [23], is the sum total of the knowledge, skill and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness, which includes Traditional Chinese Medicine, Indian Ayurveda and Arabic Unani Medicine, and other various forms of indigenous medicine. TM therapies include medication therapies (herbal medicines, animal parts and/ or minerals) and non-medication therapies (if they are carried out primarily without the use of medication, as in the case of acupuncture, manual therapies and spiritual therapies).
The terms ‘complementary medicine’ or ‘alternative medicine’ (sometimes non- conventional medicine or parallel medicine) refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries. Anthroposophic medicine, chiropractic, homeopathy, naturopathy and osteopathy are extensively used in forms of CM.
Complementary or Alternative Medicine refers to special healthcare, which is out of the range of conventional medicine or traditions in one country, and has not been in the dominant healthcare system. In some countries, the appellation CM or AM is alternatively used together with TM. Several items of CM, like Anthroposophic Medicine, Chiropractic medicine, homeopathy, naturopathy and osteopathy??
In conclusion, the terms of T&CM contain herbal medicines, acupuncture, manual therapies, spiritual therapies as well as exercises. The Commonly used TM/CAM and therapeutic techniques are shown in the following (Table 2) [1].
TCM and Framework of Medicine
As above, we could find out the framework of medicine in the world as shown in (Figure 1). Even the traditional medicine plays more and more important role because of ageing and the increasing medical expenditure, western medicine is still the main stream in clinical practice.
Under the umbrella of traditional medicine, it covers Indian Ayurveda, traditional Chinese medicine, Arabic Unani medicine and other traditional medicine as well. Traditional Chinese medicine plays an important role in China, and is always supported by the Chinese government, which includes acupuncture & moxibustion, Chinese herbal medicine, massage, cupping, Qigong, Guasha, Taiji, health cultivation and others.
UTILIZATION OF TCM IN THE WORLD
Chinese Acupuncture Therapy
Whilst many people are increasingly aware of TCM, it is the Zhenjiu component of TCM which has been the most readily embraced across the world as is demonstrated by the number of practicing acupuncuturists in Asia and Overseas. According to the World Federation of Acupuncture-Moxibustion Societies, there are at least 50 000 acupuncturists in Asia and 15000 acupuncturists in Europe. Based on the reports supplied by 129 countries, 80% of them now recognize the use of acupuncture (as shown in Figure 2).
Other therapies
The Chinese herbal medicine was introduced to Japan, Korea and other countries and then developed into their own pathway of traditional medicine since Ancient times, such as Kampo in Japan, Korean Medicine in South Korean, Goryeo Medicine in North Korean, Eastern Medicine in Vietnam. In Japan, 84% of physicians use Kampo in general practices, and 147 prescriptions of Kampo and related 192 herbals were covered by the National Health Insurance by April, 2000. And in Switzerland, the Federal Department of Home Affairs (DHA) decided that five complementary therapies-anthroposophical medicine, homeopathy, neural therapy, phytotherapy and TCM would be covered by the compulsory health insurance program from 1999 to 2005. Other manual therapies like Tuina, Qigong, were widely used in several western countries as well.
Although, many countries are approved for Chinese acupuncture and Qigong, there are both ongoing safety and ethical concerns for the use of Chinese herbal medicine. For instance, U.S. Ministry of Health, Food and Drug Administration declared that it was risky to use some Chinese herbal medicine because of the side-effects and its likely contamination by heavy metals and toxins. It suggested that the guidelines should be developed to direct the international use of Chinese herbal medicines correctly. (U.S. department of health and human right). Therefore, it is necessary to have a further clinical, epidemiological and evidence-based research to assess the future use of Chinese herbal medicine.
Prevention and treatment of global infectious disease
TCM has made a great contribution to the infectious disease prevention and treatment worldwide. In 2003, TCM together with Western Medicine successfully combined to combat SARS(Severe Acute Respiratory Syndrome) [24]. Recently, many researchers proposed that TCM may have a role to play in the prevention and cure the Ebola hemorrhagic fever. According to theory of TCM, hemorrhagic fever of Ebola fits the symptom of ‘Fengre’ (‘Wind-Warm’) which results in the treatment of ‘Heat-clearing and Blood-cooling’ and ‘eliminating pathogens to support healthy qi’. The philosophy of ‘Differential Diagnosis’ provides a new strategy for the treatment of Ebola when in the bottleneck of curing the hemorrhagic fever [25].
Table 1: Classification of TCM [22].
| Classification for reason 1: theory | Classification for reason 2: life cycle of disease | |
| ? | on the clinical TCM theory: Acupuncture and Moxibustion, Massage, Cupping, Guasha | prevention stage: health cultivation, Taiji, Qigong and Massage, Qigong, Cupping,Guasha |
| ? | based on Shennong Bencao Jing Chinese herbal medicine | treatment stage: Chinese herbal, Acupuncture and Moxibustion, Massage |
| ? | based on the theory of health cultivation: health cultivation, Qi Gong, Tai Ji | recovery stage: Acupuncture and Moxibustion, Cupping and Massage |
Table 2: Commonly used TM/CAM and therapeutic techniques.
| TCM | Ayurveda | Unani | Naturopathy | Osteopathy | Homeopathy | Chiropractic | Others | |||
| Herbal medicines | • | • | • | • | ? | • | •a | |||
| Acupuncture/ Acupressure | • | ? | ?b | |||||||
| Manual therapies | Tuinac | • | • | ? | • | • | Shiatsud | |||
| Spiritual therapies | • | • | • | • | Hypnosis, healing, Meditation | |||||
| Exercises | Qigonge | Yoga | Relaxation | |||||||
| • commonly uses this therapy/therapeutic technique ?sometimes uses this therapy/ therapeutic technique ? uses therapeutic touch a. E.g. many informal TM systems in Africa and Latin America use herbal medicines. b. E.g. some commonly used TM therapies incorporate acupuncture and acupressure therapies in Thailand. c. E.g. types of manual therapy used in traditional Chinese medicine d. E.g. refers to manual therapy of Japanese origin in which pressure is applied with thumbs, palms, etc, to certain points of the body. e. E.g. component of traditional Chinese medicine that combines movement, meditation and regulation of breathing to enhance the flow of vital energy(qi) in the body to improve circulation and enhance immune function. |
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