Traditional Chinese medicine

Traditional Chinese medicine (or TCM) refers to the theories and practices of diagnosis and healing developed historically in China. Beginning in ancient times, its influence spread to neighbouring countries such as Korea and Japan, and largely shaped their traditional medicine. More recently, TCM has become popular as an alternative medicine in Europe and North America.

“”…But that didn't matter to me, eventually went to Nanjing to attend school K. In this school, I knew natural sciences, math, geography, history, art, and physical health for the first time. Biology was not included, but we saw books like On the Whole Body and On Chemical Hygiene. I remembered arguments and prescriptions of the old doctors, compared them with that of today's, and slowly realized TCM is deceit, willful or not, but also felt great pity for the patients and their families scammed. From translated history I also knew Japanese Reformation has much roots in Western medicine. …
—Lu XunFile:Wikipedia's W.svg, in the preface of NahanFile:Wikipedia's W.svg(1922)(emphasis added)[1]
Against allopathy
Alternative medicine
Clinically unproven
v - t - e

Like much Chinese lore, such as feng shui and the martial arts, Chinese medicine is based on the qi (or chi, 氣) principle of energy. Qi is said to be channelled through a complex system of meridians in the body, and illnesses are believed to be related to blocked or unbalanced flow of qi.[2] Common treatments include acupressure, acupuncture, acupuncture bloodletting, reflexology, and herbal medicine, though treatments can also be of inorganic, animal or even mythologic origin (clawed human, one-footed monster, sprite/elf/naiad, and dryad).[3] In one study, 260 TCM products sold in California were analyzed for adulterants: 32% contained drugs and/or heavy metals.[4]

History

Alleged mythical origins

Fuxi (or Paoxi, 伏羲) was a legendary ruler to whom many fundamental aspects of domestic life (animal domestication, cooking, etc.) have been ascribed, including medical philosophy and the I Ching.[5]:6 One of the Three Sovereigns,File:Wikipedia's W.svg who is variously considered as deity or a god-emperors is considered by the the Chinese to be the founder of Chinese medicine: Shennong (神農 or 神农) is claimed to have discovered herbalism and to have written the first treatise on herbs, the Shennong Pen-tsao ChingFile:Wikipedia's W.svg (神農本草經).[5]:6-7 In addition, he was said to have discovered, or invented, tea, the hoe, the plow, the axe, wells, irrigation, preserving seeds in boiled horse urine, the 24 hours of the day, the calendar, the weekly farmers' market, the harvest festival, pulse measuring, moxibustion and acupuncture.[6]:190-199 Additionally, he was said to have known the secret to immortality and the transmutation of substances into gold.

Religion was deeply intertwined with Chinese medicine, particularly in the earliest years, and it included sorcery, divination (I Ching), astrology[5]:12-14 In ancient times, doctors were referred to as priest-doctors (Wu I).[5]:13 Spirituality remains an important part of Chinese medicine[7]

The Chinese have a reverence for authority,[5]:86 in large part due to the "Five Relationships" of Confucianism. This likely is a source of resistance to change and acceptance of evidence-based medicine.

Pre-modern history

Chinese medicine is based upon four ancient, mutually-contradictory classics:[8]:142

  1. Huangdi NeijingFile:Wikipedia's W.svg (黃帝內經) or Inner Canon of the Yellow Emperor or Inner Canon (c. 100 CE)
  2. Shanghan LunFile:Wikipedia's W.svg (傷寒論) or Treatise on Cold Damage Diseases or Book of Cold Damage (c. 200 CE)
  3. Jingui YaolüeFile:Wikipedia's W.svg (金匱要略) or Essential Prescriptions from the Golden Cabinet or Golden Casket[note 1] (c. 200 CE)
  4. Various texts of 'warmth-factor diseases' (known as wenbing, 温病) (17th-19th centuries CE)

Proto- and Pseudo-Science

While today, what has worked in the 'fields' of herbalism has been added to pharmacology and what hasn't worked has been discarded, it should be noted that prior to the scientific method, there really wasn't a good way to gather reliable information. Various medicine men and priests and the like would have made an observation and passed it on to other healers, but not have the resources or education to actually test these observations. Some of the herbs and such would work (for example, willow bark tea), others did not. But without the resources of a modern university research department, better forms of acquiring knowledge weren't really practical. Various herbal and folk remedies that relied on limited observation and lacked rigorous testing were protosciences rather than pseudo-sciences. That is, "not yet sciences", rather than "never sciences".

There were indeed some important discoveries made by Chinese medicine. The most important of which was "variolation" (vaccination); exposing someone to a weak form of smallpox (or cowpox) to prevent that person succumbing later on to a deadlier form of smallpox. This folk remedy happened to work, and spread to India, then to the Ottoman Empire and then to Europe. This makes vaccine denialists that adhere to other forms of TCM a rather strange breed.

In China

Access to Western medicine in China was especially difficult in China up through the first half of the 20th century due to poverty and wars (particularly the Second Sino-Japanese War and the Chinese civil war). During the Chinese Civil War, the People's Liberation Army used Chinese medicine by necessity for lack of reliable access to anything else. Following the victory of the People's Liberation Army, Mao Zedong saw the importance of maintaining the employment of the hundreds of thousands of people involved in various aspects of Chinese medicine, so as to assure social stability.[8]:35,43 Mao laid out abstract goals (or slogans) for the integration of Chinese and Western medicine, the details of which were left to Chinese Communist Party officials:[8]:11-13

  • 1945-50: The Co-operation of Chinese and Western Medicines
  • 1950-58: The Unification of Chinese and Western Medicines
  • 1950-53: Chinese Medicine Studies Western Medicine
  • 1954-58: Western Medicine Studies Chinese Medicine
  • 1958-: The Integration of Chinese and Western Medicine

Evidence suggests that as early as 1954, Mao had doubts about the effectiveness of Chinese medicine.[8]:43 Both Mao and Li Zhisui, Mao's personal physician, were very skeptical of the usefulness of Chinese medicine.[9]:84,548,551 Mao was also ignorant of modern medicine.[9]:99[note 2][note 3] Because Mao was privately skeptical of Chinese medicine and ignorant of modern medicine, his promotion of integrative medicine was entirely a political maneuver. Because Mao was skeptical of Chinese medicine, his strong and continuous promotion of Chinese medicine was intentionally promoting nationalism while sacrificing the physical health of the nation. The nationalist aspect Chinese medicine was made explicit by:

  1. Mao's use of the slogan, "China's medicine and pharmacology is a great treasure-house!!" (中国药学是一个伟大的宝库!! zhongguo yiyaoxue shi yige weida de baoku)[8]:120-121
  2. He Cheng,File:Wikipedia's W.svg a Western medicine trained physician in the revolutionary army who eventually became director of the People's Government Ministry of Health,[8]:32 endorsed the idea of nationalist-based sciences. He Cheng was particularly interested in Soviet science.[8]:53

The problem with relying on nationalist science is that there is no such thing. Science is based on a universal, the scientific method. Soviet science, while excellent in some regards, was deficient in others due to reliance on ideology and dialectical materialism.[12]

It was during this period (roughly mid-1950s to mid-1960s) that Chinese medicine became standardized, resolving or glossing over the contradictory elements of the four ancient texts.[8]:79,127,142 In 1955, the term 'Traditional Chinese Medicine' (in capital letters)[note 4] began to be used to refer to this standardized version to the English-speaking world; notably, it was first used as a political term.[8]:79,84-86 The term in Chinese however remained the same as it was in pre-revolutionary China, 中医 (zhongyi) as it always had, which just translates to 'Chinese medicine', a term that was used starting in the 19th century to contrast it with Western medicine (西医, xiyi).[8]:79 It was also during this period that the idea of integrated medicine developed, based on Mao's sloganeering, the mixing Chinese and Western medicine.[8]:11-13,68,135-136 Other non-standardized forms of Chinese medicine are still practiced both within the People's Republic of China (PRC) and in Singapore, Hong Kong and Taiwan.[8]:86-87

Despite the death of Mao, the rise of capitalism, the general lack of evidence supporting TCM, and the preference of Chinese citizens for TCM only for minor ailments,[8]:152-153 the Chinese government continues to actively promote TCM within China and abroad,[13][14] likely based on a sense of nationalism.

In the West

TCM became more widely noticed in the West beginning in the 1970s.[8]:137-138[15] The biggest publicity generator for China at this time was acupuncture analgesia for surgery, which was publicized by James Reston, a New York Times reporter who accompanied Secretary of State Henry Kissinger to China in 1971, in preparation for President Richard Nixon's visit in 1972. Reston had an emergency appendectomy while in China using conventioanal anesthesia,[8]:138 and received post-surgical acupuncture analgesia, which he described as causing diversionary pain.[16] Acupuncture analgesia has been portrayed elsewhere as occurring during surgery,[8]:138-140 but this has largely been debunked: when acupuncture has been used during surgery, it has been used in addition to chemical sedatives.[17][18][19][20]

Notably, the first three Western textbooks on TCM following Reston's article[21][22][23] were based on a 1958 PRC textbook, The Outline of TCM (中医学概论, Zhongyixue Gailun)[24] that was filtered through revolutionary communist fervor.[8]:144-147[18]

TCM has become popular in North America and Europe during recent decades, largely due to the growing popularity of CAM (Complementary and Alternative Medicine) and the New Age preoccupation with other Eastern woo such as feng shui, Chinese astrology, Reiki and Zen Buddhism. As with most of these fads, the most common variants of TCM popularised in the west tend to be simplified and bastardised versions of authentic TCM, and are often bundled with other forms of CAM. For example, Chinese medicine centers in the UK and USA often offer non-Chinese complementary therapies such as hypnotherapy and homeopathy, alongside Chinese herbalism and acupuncture.

However, just because one remedy works does not mean all the others work. Each remedy or herb gets tested; those that work become part of medicine, while those that don't get discarded. Keeping the remedies that are unproven or have been proven not to work is instead pseudoscience.

Materia medica

The Bencao GangmuFile:Wikipedia's W.svg (本草綱目) or Compendium of Materia Medica was first published in the 1578 by Li ShizhenFile:Wikipedia's W.svg (李時珍). An early book was written in 1505 by the physician Liu Wentai under orders from Emperor Xiaozong, titled Bencao Pinhui Jingyao (Collection of the Essential Medical Herbs of Materia Medica), but this book was not available to the general public and is not now well-known.[25][26]

The Bencao Gangmu has remained in use continuously since its publication, and was replaced in China by the 10-volume Zhong Hua Ben Cao (中华本草, Encyclopedia of Chinese Materia Medica) in 1999.[27] The now-official Pharmacopoeia of the People's Republic of China was published in 2005.[28]

Controversial and dangerous ingredients used in TCM

TCM ingredients can range from common plants, such as dandelion, persimmon, and mint, to weird or even dangerous stuff. Some of the more revolting (from a Western standpoint) things found in TCM include genitals of various animals (including dogs, tigers, seals, oxen, goats, and deer), bear bile (commonly obtained by means of slow, inhumane extraction methods), and (genuine) snake oil.[3][29][30] It is worth noting that the sale and use of all of these animal ingredients is illegal in many parts of Asia, Europe, North America and almost everywhere else. New methods of combating the use of these illegal animal parts have been discussed.[31] Urine, feces, placenta and other human-derived medicines were traditionally used[3] but some may no longer be in use.[32]

Some of the dangerous ingredients include lead,[33] calomel (mercurous chloride), cinnabar (red mercuric sulfide),[34] asbestos (including asbestiform actinolite,[35][36] sometimes erroneously called aconite[37][38]) realgar (arsenic),[39] and birthwort (Aristolochia spp.).[40] Bloodletting is also practiced. Bizarrely, lead oxide, cinnabar, and calomel are said to be good for detoxification.[41][42][43][44][45] Lead oxide is also supposed to help with ringworms, skin rashes, rosacea, eczema, sores, ulcers, and intestinal parasites, cinnabar allegedly helps you live longer,[43][44] and asbestos is used (including in powder form) for treating impotence, spermatorrhea, premature ejaculation, colic, muscle cramps, prostatitis, endometritis, as well as for kidney-warming and yang-fortifying. Admittedly, the amounts of cinnabar and calomel used in TCM are small enough that the damage they cause is usually reversible.[45]

A 1998 study of 260 imported Asian patent medicines collected in California found that 14 had labels with declared pharmaceutical ingredients.[46] Of 243 products that were chemically analyzed, 17 had undeclared pharmaceuticals (including ephedrine, chlorpheniramine, methyltestosterone, and phenacetin).[46] Of the 251 products that were chemically analyzed, 24 contained lead in the range of 10 to 319 ppm, 35 contained arsenic in the range of 20.4 to 114,000 ppm, and 35 contained mercury in the range of 22.4 to 5070 ppm.[46] By way of comparison, the United States Pharmacopoeia limits heavy metals in pharmaceuticals to 30 ppm in most cases.[46]

Sites selling or promoting TCM remedies often lump all their products or recommended treatments under the generic term "herbs". However, many of these herbal products are really of mineral or otherwise non-herbal origin. These "herbs" are sometimes listed by their Chinese or mineral names (which people don't really recognize). Instead of listing "lead", they list a "herb" called mi tuo seng or "galena"; instead of listing asbestos, they list yang qi shi, and so on.

Lethal substitution

TCM allows for the substitution of ingredients that have the same or similar names in Chinese.[47] In Belgium, a weight-loss spa using TCM herbs gave its clients herbal supplements containing birthwort, and as a result, more than 100 out of 1800 of its patients developed kidney failure, and several also developed urothelial and kidney cancers. In this case, the relatively safe Stephania tetrandra (漢防己, Han Fang Ji) was intended for the clients, but the lethal Aristolochia fangchi (廣防己, Guang Fang Ji) was given to them instead.[48]

Environmental impact

In TCM, endangered species such as rhinos, pangolins, sharks, seahorses, manta rays, lions, leopards and tigers are highly prized;[3] rhino horns are considered panaceas which can cure everything from arthritis to cancer, even though studies have shown they do nothing.[49][50][51] Because of this demand, poachers hunt these animals for their body parts in order to sell them to TCM users. Since the 1970s, rhino populations have dropped 90%;[49] while this number may not be entirely due to TCM, it can plausibly be said that TCM is significantly contributing to the extinction of endangered species by encouraging the use of these clearly ineffective as well as illegally and unsustainably sourced substances.

Here be dragons

Some also grind up dinosaur fossils (mistakenly thought by some to be "dragon bones") to be used as medicines.[52][53][54] Given that dinosaur fossils have undergone complete mineralization, these "dragon bones" could not be any more effective than eating rocks.[citation NOT needed]

Bernard Read analyzed several dragon medicines used in TCM:[55]

Chinese nameEnglish translationActual substance
龍骨 (long gu)Dragon bonesPrehistoric animal bones, fossilized
龍齒 (long chi)Dragon teethPrehistoric animal teeth, fossilized
龍腦 (long nao)Dragon brainsType of limestone
龍涎 (long yen)Dragon salivaAmbergrisFile:Wikipedia's W.svg
gollark: oh apiariats.
gollark: Oh, they said "the password was potato".
gollark: This predates potatOS by 6 years.
gollark: Why did it assume potatOS was a virus?!
gollark: ~play orbital kinetic bombardment

See also

Notes
  1. Caveat emptor!
  2. Although Mao falsely claimed that Chinese medicine was responsible for China's large population,[9]:83-84 Mao is also quoted as saying, "Even though I believe we should promote Chinese medicine, I personally do not believe in it. I don't take Chinese medicine. Don't you think that is strange?"[9]:84
  3. There has been some dispute about the veracity of the source of this information, Li Zhisui's biography of Mao,[9] but the disputed information seems to be more focused on dates and political aspects.[10][11]
  4. The term "traditional Chinese medicine" (lower case 't' and 'm') in contrast can refer to Chinese medicine more broadly, to one that is not based on the Chinese Communist Party's standardization, though this capitalization is not strictly followed.

References
  1. 呐喊 by Wikisource
  2. Chinese Traditional Medicine: An Alternative and Complementary Medicine Resource Guide Alternative Medicine Foundation
  3. Chinese Materia Medica: Animal Drugs by Bernard E. Read (1931). Peking Natural History Bulletin. Based upon the "Pen Ts'ao Kang Mu" [Bencao Gangmu] by Li Shih-Chen [Li Shizhen].
  4. A U.S. Perspective on the Adverse Reactions from Traditional Chinese Medicines by Richard J. Ko (2004) J. Chin. Med. Assoc. 67:109-116.
  5. History of Chinese Medicine: Being a Chronicle of Medical Happenings in China from Ancient Times to the Present Period by K. Chimin Wong & Wu Lien-Teh (1936) National Quarantine Service.
  6. Handbook of Chinese Mythology by Lihui Yang & Deming An (2008) Oxford University Press. ISBN 0195332636.
  7. Spirituality in Traditional Chinese Medicine by Lin Shi & Chenguang Zhang (2012) Pastoral Psychology 61(5–6):959–974. doi.org:10.1007/s11089-012-0480-x.
  8. Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution by Kim Taylor (2005). Routledge. ISBN 041534512X.
  9. The Private Life of Chairman Mao by Li Zhisui (1996) Random House. ISBN 0679764437.
  10. 歷史的真實: 毛澤東身邊工作人員的證言 (Li shi de zhen shi: Mao Zedong shen bian gong zuo ren yuan de zheng yan) by 林克 (Ke Lin) et al. (1995) 利文出版社 (Liwen Publishing House). ISBN 9627766534.
  11. Book Review: "Mao's Last Revolution by Roderick Macfarquhar, Michael Schoenhals" by Wai Kit Choi (2009) Science & Society 73(2):261-263.
  12. Soviet Science Guided History: History Research Guides by Boston University Students.
  13. China adopts law on traditional medicine Xinhua (December 26, 2016).
  14. In the tradition of Chairman Mao, traditional Chinese medicine gets a new boost by the Chinese government. Despite a lack of evidence for its efficacy and safety, traditional Chinese medicine (TCM) has made major inroads into US medical centers, both academic and community. I’ve told the story of how Chairman Mao Zedong created the myth of TCM and promoted it to credulous Westerners to facilitate the "integration" of TCM and "Western medicine." Over the holiday break, I learned that this process continues apace, even in today’s China. by David Gorski (January 2, 2017) Science-Based Medicine.
  15. Traditional Medicine in Modern China: Science, Nationalism, and the Tensions of Cultural Change' by Ralph C. Croizier (1968) Harvard University Press.
  16. Now, About My Operation in Peking by James Reston (July 26, 1971) The New York Times. Pages 1 and 6. The acupuncture "sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach."
  17. Acupuncture Is Theatrical Placebo by David Colquhoun & Steven Novella (2013) Anesthesia & Analgesia 116(6):1360-1363.
  18. Acupuncture Doesn't Work by Steven Novella (June 19, 2013) Science-Based Medicine.
  19. "Acupuncture Anesthesia": A Proclamation from Chairman Mao: Part I, Part II, Part III, and [Part IV by Kimball Atwood (May 15, 2009 - June 26, 2009) Science-Based Medicine.
  20. 'Acupuncture Anesthesia' Redux: another Skeptic and an Unfortunate Misportrayal at the NCCAM by Kimball Atwood (July 24, 2009) Science-Based Medicine.
  21. Theoretical Foundations of Chinese Medicine: Systems of Correspondence by Manfred Porkert (1978) The MIT Press. ISBN 0262660407.
  22. Web That Has No Weaver: Understanding Chinese Medicine by Ted Kaptchuk (1983) Congdon & Weed. ISBN 0865531099.
  23. Traditional Medicine in Contemporary China: A Partial Translation of "Revised outline of Chinese medicine by Nathan Sivin (1987) IAnn Arbor Center for Chinese Studies. ISBN 0892640731.
  24. 中医学概论 (Zhongyixue Gailun) by Jingchun Meng (1958) 人民衛生出版社.
  25. Collection of the Essential Medical Herbs of Materia Medica
  26. A Brief History of Chinese Medicine and Its Influence by Peng Yoke Ho & F. P. Lisowski (1999). World Scientific, 2nd ed. ISBN 9810228031.
  27. Health Department and National Chinese Medicine Management Office (ed.). Zhong Hua Ben Cao, 3–460–509. Shanghai Science Technology Publication. 1999. ISBN 7532351068.
  28. Pharmacopoeia of the People's Republic of China (2005). Chemical Industry Press, 2 volumes: ISBN 7502520627 and ISBN 7502520635.
  29. Freeing China's caged bile bears / Animal activists aim to curtail trade in traditional remedy, SFgate.
  30. Media Releases for 2003, Medsafe.
  31. Combatting the illegal use of endangered animals in traditional medicine (November 6, 2013) Natural Reactions.
  32. "The Treatment of 75 Cases of Pediatric Oral Thrush with the Sweet, Cold, Protecting Yin Method" by Wang Le-ping, Shang Hai Zhong Yi Yao Za Zhi (The Shanghai Journal of Chinese Medicine & Medicinals), #5, 1994, p. 22
  33. Mi Tuo Seng — 密陀僧 — Lithargyrum American Dragon.
  34. Cinnabar Acupuncture Today.
  35. Actinolite, TCMwiki.com.
  36. See the Wikipedia article on Actinolite.
  37. Aconite Ask Dr. Mao
  38. See the Wikipedia article on Aconite.
  39. Realgar (xiong huang) Acupuncture Today.
  40. Guang Fang Zi (Aristolochia Root, Stephania) — Chinese Herbal Medicine Yin Yang House.
  41. Cinnabar (zhu sha), TCMtreatment.com.
  42. Qian Dan, TCMAssistant.
  43. Galena, Acupuncture Today.
  44. Mercury and Chinese herbal medicine by H.C. George Wong (2004) BCMJ 46(9):442.
  45. Mercury in Traditional Medicines: Is Cinnabar Toxicologically Similar to Common Mercurials? by Jie Liu et al. (2008) Experimental Biology and Medicine 233(7):810-817. doi:10.3181/0712-MR-336.
  46. Adulterants in Asian Patent Medicines by Richard J. Ko. (1998) N. Engl. J. Med. 339:847. doi:10.1056/NEJM199809173391214.
  47. Complexities of the herbal nomenclature system in traditional Chinese medicine (TCM): lessons learned from the misuse of Aristolochia-related species and the importance of the pharmaceutical name during botanical drug product development by K. M. Wu et al. Phytomedicine. 2007 Apr;14(4):273-9. Epub 2006 Jul 24.
  48. Aristolochic acid nephropathy: A worldwide problem by Debelle et al. Kidney International (2008) 74, 158–169; doi:10.1038/ki.2008.129.
  49. World Rhino Day — 22nd September 2012 by Michael Evans (22 Sep 2012 0:1:0 GMT) The Earth Times.
  50. How a myth is killing the rhino by Atul Sethi (Mar 4, 2013) The Times of India.
  51. Alternative Medicine Threatens Beasts with Extinction by Benjamin Radford (August 10, 2007) LiveScience.
  52. Chinese Medicine: "Dragon Bones" by Sharon Cornet (February 15, 2010) SunStar Solutions.
  53. Dinosaur Fossils Part of Longtime Chinese Tonic by Kevin Holden Platt (July 13, 2007) National Geographic News (archived from July 16, 2007).
  54. Dragon's Bones and Teeth by Subhuti Dharmananda. Institute for Traditional Medicine.
  55. Chinese Materia Medica. VII. Dragons and Snakes by Bernard E. Read (1934) Peking Natural History Bulletin. pp. 8-9.
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