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The History
of
Traditional Chinese Medicine
For those of Chinese
descent,
traditional Chinese
medicine (TCM) is an important part of their cultural heritage. Many have some degree of familiarity with TCM
practices, which are aimed at maintaining
health and preventing disease by combining
lifestyle practices (e.g., diet, exercise, meditation), physical manipulations
(e.g., massage and acupuncture), and herbal formulations. Although “TCM”
normally refers to the whole spectrum of traditional Chinese medicine, the
acronym is used here to refer to that part of TCM relating to traditional
Chinese herbal formulations.
Chinese
medical practices date back thousands of years. The world’s first known medical
document was Nei Jing, the Yellow Emperor’s Classic of Internal Medicine.
Compiled in the 3rd century BC, the volume recounts a series of conversations
about medicine between the Emperor Huang Di and his court physician. A century
later, during the Han Dynasty, Shen Nong wrote the first known guide to herbal
medicine, summarizing the pharmacological effects of some 365 substances.
In the modern era, in which new
drug treatments and enhanced diagnostic and treatment technologies bring
whirlwind changes to the field of medicine, there is new interest in TCM. Seen through the lens of biology and biochemistry, TCM seems to lack a
scientific basis and falls more into the realm of myth. Yet, in an early
exposure to traditional Chinese medical practices in 1976, in an
operating theater at a major Beijing medical center as brain surgery to remove a
large tumor was carried out using acupuncture as the sole anesthetic procedure.
Whatever a visiting team of US Army surgeons from Walter Reed Hospital
thought of the theoretical foundations for acupuncture, thereafter the world
starts to accept that
the traditional Chinese medicine was medically effective.
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Global interests in TCM has
increased significantly in recent years, driven by global trends in health care.
Mainstream medicine in North America,
however, tends to view TCM and its potential applications with some degree of
skepticism. While acupuncture and massage may be accepted as a
potential treatment for body aches and pains, the holistic approach of TCM is
not understood widely. The reluctance to accept TCM herbal
preparations is based not only on a lack of scientific and clinical validation,
but also on fundamental philosophical differences. Westerners and Chinese tend
to look at health and disease in fundamentally different ways. In seeking a
chemical drug treatment, for example, a Western patient is looking to treat his
or her disease or symptoms, with quick results. A Chinese patient, in contrast,
would see the prescribed TCM treatment as part of a longer-term process to
restore the body’s overall equilibrium.
In spite of these basic
differences, both forms of medical practice share a common view that health is
associated with homeostasis, or the process by which an organism maintains a
state of balance. Western medicine makes use of modern technology and powerful
drugs that consist of single chemical entities to deal with anomalies in target
cells, tissues, or organs. Such forceful interventions often succeed, but at the
cost of further loss of homeostasis, which is expressed as severe side effects.
The Chinese emphasis on maintaining and restoring balance may be less effective
with acute diseases, but may be more appropriate for disease prevention and
treatment of chronic diseases without an unacceptably high level of collateral
damage. If the ultimate goal of health care is to maintain health, fight
diseases, and meet medical needs, an integrated approach may provide the optimal
solution.
The processes by which both bodies
of medical knowledge have evolved also are dramatically different. Western
medicine follows a strictly defined and rational process, combining chemical
analysis and synthesis, biological assays using enzymatic reactions or cellular
systems, and animal tests. The final stages involve closely controlled clinical
trials to determine the safety and efficacy of any new drug treatment. In
contrast, traditional Chinese medicine is based on a philosophical and theoretical framework that does not
reflect current views of modern science, but relies on the vast amount of
trial-and-error medical knowledge accumulated within large populations over a
4,000-year timeframe. It can be argued, therefore, that TCM started empirically
with the clinical experience, and is moving only now in the direction of
scientific validation.
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The Science of Traditional Chinese
Medicine
Western medicine makes extensive
use of drugs that consist of single chemical entities, this follows the
principle of seeking the “silver bullet” that will act on a single organism or
organ. The Chinese alternative is the use of medicinal herbs, usually in
formulations that contain anywhere from various herbs. The rationale
is that disease is caused by a loss of homeostasis that involves more than a
single function of the body or a particular organ. Thus, the treatment needs to
be multi-factorial.
TCM herbal formulations are
designed to stimulate and enhance functionality, to suppress and counteract
toxicity, and to avoid antagonism and incompatibility. The prescription is most
often specific to the individual patient. The proper combination of herbs is
based on a functional classification. For example, if two herbs are being
combined, they can be classified in terms of:
Mutual Accentuation
Mutual Enhancement
Mutual Counteraction
Mutual Suppression
Mutual Antagonism
Mutual Incompatibility
For the most part, the western
medical establishment does not take TCM formulations seriously, considering
TCM unscientific in its understanding of the human body and the nature of
disease and effective treatments. Over the past few years, however,
a number of laboratories have worked on establishing a scientific framework for
the study of TCM. The goal of these efforts is to try to reconcile traditional
knowledge and modern scientific methodologies. This process can be organized
into a number of different steps:
Plant species need to be identified properly. Within each species,
there is considerable variability in the content of specific active compounds,
depending on such variables as soil conditions, temperature, precipitation, and
time of harvest. There also is limited understanding of the differences between
medicinal plants grown in the wild, and those cultivated commercially. To be
safe, plants used in TCM also should be free of both chemical and microbial
contaminants.
35,000
samples of roots, fruits, and bark were screened from 12,000 plant species during the
1980s, which resulted in the discovery of only three new drugs. Such
data contradicts the ancient pharmacopoeias of China, which contain thousands of
therapeutic formulations. This contradiction can be resolved if Western
scientists look at biological activities as resulting from a mixture of active
compounds, rather than a single chemical entity. This means that efforts to
understand the science behind TCM can be useful only if the preparation follows
closely the conditions prescribed in the pharmacopoeia.
Each of the principal herbs should be standardized as to the
content of the major active compounds (many of which might be unknown). The
objective is to establish a chemical “fingerprint” that meets certain standards
for each lot of a particular herb. The actual formulation always will be based
on a mixture of such standardized herbs.
These
laboratory tests should reflect the biological activity in vivo. The biological
activity of standardized TCM herbal preparations should correlate with a
particular chemical fingerprint. The objective is not necessarily to
characterize and isolate the active compounds, but to ensure that each lot will
always have the same biological activity.
The
procedures used in the laboratory must be able to be scaled up in order to
produce enough material for testing, and to assure that proper standards for
drug manufacturing can be met. The finished product also must be formulated in
such a manner that they can be used easily on the patients.
When
the disease can be induced in an appropriate animal, the standardized TCM can be
tested for its therapeutic effect.
From
the perspective of Western medicine, studies of a medication on patients is
essential before it can be approved for human use. It is generally accepted by
the US Food and Drug Administration (FDA) that TCM herbs that have been in
long-term use are safe. Nevertheless, they need to undergo extensive tests to
demonstrate efficacy against the particular disease. Such tests are time
consuming and expensive.
A number of scientists are now
realizing that, both in principle and in practice, such an approach can be
carried out successfully in a manner consistent with modern scientific and
medical practice. It is much more difficult, however, to convince American
scientists and physicians since the mechanism of action of TCM formulations
remains unknown. If understanding the multiple reactions that take place with a
single chemical in the human body is difficult, the interaction between a
complex mixture of chemicals and the human body is singularly intractable, even
with today’s technology. Studies have shown that certain active compounds in TCM
formulations can act synergistically to boost or lower its biological
activities. It may very well be that the activity of TCM formulations at lower
concentrations and with relatively fewer side effects may reflect the properties
of such “medical cocktails.”
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Integrating the Best of Eastern and
Western Medicine
Western medicine is premised on a
science-based methodology that starts with the characterization and synthesis of
active compounds and culminates in clinical trials. The “silver bullet” paradigm
and an understanding of specific mechanisms are the foundations of this medical
system. Its greatest successes have been in the treatment of acute conditions. TCM, in contrast, is based on a large body of empirical evidence for which, by
and large, there is not a comparable scientific base. This should not, however,
prevent TCM preparations from being used if proven to be safe and effective.
This is particularly true since TCM is likely to be most useful in maintenance
of health and treatment of chronic conditions.
Now, an integrated approach is being practiced out of economic necessity and, more
importantly, to improve the quality of life. In this blended approach, cancer
patients are treated first with chemotherapy, radiation, and surgery. The side
effects (nausea, pain, and weight loss) are treated with Chinese herbs. These
herbs eventually build up the patient’s immune system to fight off infections
and rid the body of any remaining cancer cells. Stroke patients are treated
first with Western drugs to stabilize the condition, while acupuncture and TCM
preparations are used to regain functionality and prevent recurrence. Patients
with Parkinson’s disease are treated with Western drugs, followed by
acupuncture, massage, and herbs. These types of combined therapies result in
various degrees of symptom relief, as well as a reduction in the dosages of
Western medicine.
This approach may be of great
benefit that patients no longer would have to choose
between Western medicine and TCM, but would be encouraged to integrate elements
of both systems to maximize the treatment of their specific illness. Chinese
cosmology is symbolized by the circle of Tao where yin and yang
are opposites but indivisible, each transforming the other. This may prove to be
an apt description of how Chinese and Western medicine will evolve in the years
to come.
Traditional Chinese Herbal
Chinese herbal medicine is one
of the important pillars for the practice of traditional Chinese medicine.
Herbs have been used by many cultures around the world for thousands of years,
no other health system uses herbs as extensively and exclusively as the Chinese
medicine culture. There are more than 400 commonly used products, some of them
have been recognized by FDA . Many different products are used from stems,
roots, barks, flowers, twigs, fruits, sap of plants, animal parts, shells,
insects and minerals. The herbs have been formulated into pills or capsules for
easy taking, so you may find the herbs just like Aspirin pills.
There are no endangered, banned
or extinct products are used in this clinic.
Chinese herbs are very safe when prescribed correctly by a properly trained
practitioner. The easiest way to make sure you are taking the right Chinese
herbs for the right reasons is to consult with a qualified Chinese medicine
doctor. Often these experts will be licensed acupuncturists, who within their
licensure have extensive training in Chinese medicine and herbs. These
practitioners will take into account your condition, your current medications
and supplements, and they will have a good knowledge of the quality of the
products they are dispensing.
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