What is TCM?

Traditional Chinese medicine (TCM) is an aggregate of healing modalities, which includes acupuncture, Chinese herbal therapy, Tuina massage, dietary therapy, Tai Chi and Qi Gong. It is ultimately based in Taoist philosophy and rests on several thousand years of observation, clinical experience, and scholarly research. The treatment methods and herbal formulas are empirically proven and have been refined over the centuries by many schools and many healing masters. It is a very stable and comprehensive system, yet it is also open-ended, able to incorporate any successful new methods. Chinese researchers have been applying scientific methodology to aspects of Chinese medicine for decades; Western scientists have jumped on the bandwagon more recently as interest in Oriental medicine has grown. The National Institutes of Health have classified traditional Chinese medicine as a “complete medical system.” Scientific studies, both in China and in the West, have tended to substantiate the efficacy of Chinese medicine techniques and herbal therapies.

Traditional Chinese medicine is highly respected worldwide for effectively treating both common ailments and difficult health conditions. Millions of people throughout China’s long history have maintained their wellness with Chinese medicine, used either as primary or complementary care.

Traditional Chinese medicine is more preventive in nature than conventional medicine. It believes that waiting to treat a patient until symptoms are full-blown is similar to digging a well after one has become thirsty. In ancient China, physicians were paid if they kept their clients well, not once their patients became ill. The relationship between physicians and patients was very close. Traditional Chinese medicine is holistic. The modalities of treatment (acupuncture, Chinese herbal therapy, Tuina massage), diet (nutrition and dietary therapy), and exercise (Tai Chi and Qi Gong) are aimed at resolving the underlying causes of illness. Body, mind and spirit are considered to have a reciprocal relationship and are given equal weight when a Chinese medicine practitioner analyzes the causes of an imbalance.

From the very beginning, traditional Chinese medicine paid close attention to the emotional roots of illness, focusing especially on fear, anger, sadness, grief and worry. China’s first book of medicine, Yellow Emperor’s Classic of Internal Medicine, which was written more than 2,000 years ago, explains how these emotional factors attack different organ systems in the human body, causing a variety of health problems. In addition to the emotions, climatic and environmental factors such as cold, heat, or dampness may cause specific illnesses. We are all familiar with people whose joint pains can predict weather changes. These profound, yet common-sense interconnections between the external and internal environments are at the core of traditional Chinese medicine’s diagnosis and treatment principles.

Traditional Chinese medicine has a more comprehensive way of treating diseases than Western medicine. For instance, when a patient gets frequent infections, traditional Chinese medicine believes that just killing the bacteria is insufficient. It is more important to strive to enhance the patient’s immune system, thereby preventing future infections as well. Treatment for this kind of condition could include acupuncture, Chinese herbal therapy and Tuina massage. Because of its emphasis on preventive treatment, traditional Chinese medicine has an advantage in treating chronic health conditions such as asthma, headaches, depression, fatigue, allergies, immune deficiency disorders, joint and muscle pain, and gynecological disorders.

Every type of health problem has been treated successfully for thousands of years in China. Yet people always wonder: “Is there any scientific evidence?” Modern scientific research has found that:

• Acupuncture points contain dramatically decreased electrical resistance, as compared with the surrounding skin.
• Acupuncture releases neurotransmitters such as endorphins, serotonin and norepinephrine.
• Acupuncture stimulates the nervous system to release adrenocorticotropic hormones.
• Acupuncture promotes vasodilatation and increases blood flow.
• Acupuncture connects acupoints with corresponding brain structures, observed by functional magnetic resonance imaging (fMRI).

This may explain why acupuncture relieves pain, fights inflammation, helps wounds heal faster, and treats stroke and many other conditions. Scientific evidence has already convinced the FDA to upgrade acupuncture needles from “for investigational use only” to “safe and effective.”

Many Chinese herbs, such as ginseng and ginkgo, have received extensive study. There are thousands of scientific papers available in English about these and other herbs’ ability to treat health conditions and maintain wellness.

Chinese dietary therapy has gained respectful attention in the United States. Many of the phytochemicals that are prevalent in Chinese cuisine have been scientifically proven to be beneficial for numerous health conditions, such as the photestrogen in soy products being therapeutic for menopause and cancer.

Studies done at the Medical School of Washington University and the Health Center of Emory University show that practicing Tai Chi is an excellent way to improve endurance, balance and flexibility at any age.

Traditional Chinese medicine is a complete, integrated, open-ended system of medicine. It is rooted in basic philosophical concepts, proven by centuries of observation and practice, and subject to continual re-evaluation by modern scientific analysis and methodology. Ancient, imperial China developed key concepts such as Yin, Yang, and Qi, applied them to human physiology and function, and refined them into practical, empirically-proven treatments. Over the centuries, many schools of Chinese medical theory were founded, based on the teachings of famous scholar-doctors like Hua Tuo, Zhang Zhongjing, and Li Shizheng. These schools contributed valuable research on disease pathology, diagnosis and treatment, and developed such “advanced technology” as the hair-thin acupuncture needles. Today, modern scholars research neurotransmitters, electro-magnetic energy, plant chemistry, and other phenomena in an ongoing effort to explain the mechanisms of Chinese medicine.

Traditional Chinese medicine is internally consistent, coherent, and practical. The most important philosophical concepts that form the “cosmological basis” of traditional Chinese medicine are Yin Yang theory and Five Element (or Five Phase) theory. These universal theories are then applied to the human experience, resulting in the working constructs of Qi and Blood, the fourteen major meridians, the twelve Zang Fu internal organs, the seven internal emotions and six external pathological factors. In the traditional Chinese medical model, health is perceived as the balance of Yin, Yang, and the Five Elements in the body, as expressed through the organs, meridians, and fundamental substances of the body. This model has been developed based on more than 5000 years of constant observation and continuous clinical practice.

The first medical textbook, Yellow Emperor’s Classic of Internal Medicine, was written 2300 years ago, and has been in continuous use as a textbook since it was written. It is still required reading for students of traditional Chinese medicine around the world. For two thousand years, students have studied and doctors have practiced the concepts set forth by the Yellow Emperor in his book: the concept of wholeness; the theory of Yin and Yang; Five Element interactions; meridian and collateral-channel theory; internal organ (Zang Fu) patterns, and other key ideas. This amounts to significant empirical evidence for the efficacy and usefulness of traditional Chinese medicine.

In addition to explaining basic principles and theories, Yellow Emperor’s Classic of Internal Medicine also lays down the foundation of clinical medicines. It contains discussions of:

• 225 internal diseases
• 36 gynecological diseases
• 32 ophthalmologic diseases
• 34 otorhinolaryngologic diseases
• 17 surgical diseases
• 12 pediatric diseases
• 13 medicinal herbal prescriptions

The first medical textbook was named after (and purportedly written by) the Yellow Emperor. China’s medical schools were imperial from the beginning. The Imperial Medical Bureau was established in 443 AD. By 624 AD, during the Tang Dynasty (618-907), it was fully complete and developed. It was both an educational institute and a medical service provider, and was the earliest medical school in the world. It had professors, medical doctors, lecturers, and pharmacists. The Imperial Medical Bureau had a Medicine Department, Acupuncture Department, Tuina Massage Department, and Prayer Department. Within the Medicine Department, internists required seven years of training; pediatricians required five years; dermatologists required five years; specialists on otology, ophthalmology and stomatology required four years, and surgeons required three years. During the Song Dynasty (960-1279), gynecology/obstetrics was established as an independent department of clinical medicine.

China adopted a double-track system of medical education from 1956 onwards. Each administrative area, such as a province or large city, has a conventional medical school and a traditional medical school. There are thirty traditional Chinese medical schools across the country. Conventional medical schools require a certain amount of training in traditional Chinese medicine, and traditional Chinese medical schools require a tremendous amount of training in conventional Western medicine. Each administrative area, such as a city or a county, has both Western medicine hospitals and traditional Chinese medicine hospitals. The two models get along very well in China, often combining modalities to treat health problems in the general population. The integration of these two medical traditions should not just benefit the Chinese, but should benefit human beings the world over.

Accordingly, traditional Chinese medicine has evolved into the following educational model:

• Basic Science: biology, biochemistry, anatomy, physiology, public health, philosophy of health
• TCM Foundation: history, theory, pathology, etiology, diagnosis
• TCM Treatment Modalities: acupuncture, moxibustion, herbal medicine, dietary therapy, Tuina massage, Tai Chi, Qi Gong
• TCM Clinical Medicine: internal medicine, surgery, gynecology/obstetrics, pediatrics ophthalmology, otorhinolaryngology, dermatology, orthopedics

It is a mistake to view traditional Chinese medicine as just an optional alternative to a few health problems. Like modern Western medicine, traditional Chinese medicine covers the whole range of health problems. While each system has its own advantages, the clinical practice of traditional Chinese medicine is 5000 years old, and the educational establishment of traditional Chinese medicine is 1500 years old. It is a model that is equal to, as well as complementary to, conventional Western medicine.

History doubles back on itself. Before modern Western medicine was developed, people relied on natural products and methods to heal themselves. Many of these natural remedies were very effective, but they cannot deal with all of the sufferings that both nature and industrialization bring to human beings. Because antibiotics, surgical intervention, and other wonders of modern medicine can be so dramatically effective, they have swept the world in the last hundred years, with the result that older forms of medicine have often been displaced or discredited. But it is true that, just as modern medicine demonstrated the limitations of natural medicine, so we are now beginning to recognize the limitations of Western medicine. The “magic bullets” of antibiotics or steroids, for example, have turned out to be a mixed blessing, with many side effects and unforeseen complications.

Medical specialties have such a tight focus on a particular organ or disease that the patient often feels that he is just a “heart” or a “cancer” to his doctor. His emotional and spiritual needs are not even recognized, much less addressed. More and more people are once again looking to older, more integrated forms of medicine to address the perceived body-mind-spirit connection that has been subordinated to modern technology. The most significant development in health care in the past few years has been the public’s increasing acceptance of complementary medicines. Chinese medicine, possibly because the acupuncture needles offer such striking visual images, has become almost the poster child of complementary medicines, featured in many cover-page magazine stories. Today, Traditional Chinese medicine – a medical system that has been in continuous use for the last 4,000 years – is steadily gaining popularity in the United States and worldwide.

Acupuncture and Chinese Medicine Utilization:

The extent to which people in the United States utilize acupuncture and Chinese medicine was revealed by two landmark reports published by Harvard Medical School professor Dr. David Eisenberg. The first report was published in the New England Journal of Medicine in 1993, based on a study conducted in 1990. Dr. Eisenberg reported that one-third of Americans had received complementary and alternative medicine interventions. Most of these people were in the 25-to-49 age group, were significantly more likely to be Caucasian than any other racial group, were significantly more likely to have a college education, and to have an income of $35,000 or more per annum. This national survey reported that Americans made more visits to complementary health care practitioners, including acupuncturists, than to MDs! A study conducted in 1994 showed that over 69% of physicians recommended complementary/alternative therapies to their patients at least once in the previous year, and 23% of the physicians had used complementary therapies themselves. A follow-up national survey by Dr. Eisenberg on trends in alternative medicine use was published in the Journal of the American Medical Association (JAMA) in 1998. This article reports a 47.3% increase in total visits to alternative medicine practitioners over seven years – from 427 million in 1990, to 629 million in 1997 – thereby exceeding total visits to all US primary care physicians.

The Food and Drug Administration (FDA) estimates that 15 million Americans visit acupuncturists annually. The National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) has certified 19,000 acupuncturists. The American Academy of Medical Acupuncture (AAMA) currently estimates more than 3,000 physicians practicing acupuncture in the United States. More and more MDs are beginning to recommend acupuncture to their patients. Recent gatherings of the Department of Continuing Education at Harvard Medical School included hundreds of MDs interested in learning more about complementary medicine. Every day’s program included lectures on acupuncture and traditional Chinese medicine. A 1998 study published in the Archives of Internal Medicine revealed that acupuncture is the first choice of US medical practitioners who refer patients to a complementary medicine provider. An article appearing in the March 5, 2002 issue of Annals of Internal Medicine (the official publication of the American College of Physicians and the third largest medical journal in the United States) stated that acupuncture holds the most credibility in the medical community amongst all the complementary medical systems.

In an article in Annals of Internal Medicine, July 1997, “Advising Patients Who Seek Alternative Medical Therapies,” Dr. David Eisenberg cited five principal reasons individuals seek complementary treatment, including acupuncture:

1. Health promotion and disease prevention.
2. Conventional therapies have been exhausted.
3. Conventional therapies are of indeterminate effectiveness or are commonly associated with side effects or significant risk.
4. No conventional therapy is known to relieve the patient’s condition.
5. The conventional approach is perceived to be emotionally or spiritually without benefit.

An article which appeared in the May 1998 issue of the Journal of the American Medical Association by John A. Astin, Ph.D. reported the results of a statistically representative survey of Americans about their use of acupuncture, homeopathy, herbal therapies, chiropractic, massage, exercise, vitamin therapy, spiritual healing, life-style, diet, relaxation, folk remedies, and others. This survey indicates that patients suffering from chronic pain, anxiety, chronic fatigue, sprains/strains, addictions, arthritis and headaches – which account for 75% of all visits to a physician – have a low success rate with conventional medical treatment. Traditional Chinese medicine, including acupuncture, has a well-documented history of success in treating medical conditions such as chronic pain, anxiety, chronic fatigue, sprains/strains, addictions, arthritis and headaches. Traditional Chinese medicine is a complete medical system with a comparative advantage in treating pain conditions, functional disorders, chronic diseases, gastroenterological problems, gynecological health issues, and neurological and muscular-skeletal diseases.

In 1973, Nevada became the first state to adopt a system of licensure for acupuncturists. In 1974, Oregon conducted the first formal examination of acupuncture candidates. New York adopted a standard for licensure in 1975. Today forty-four states, plus the District of Columbia, have an acupuncture statute and license the professional practice of acupuncture. Most states designate their practitioners as “Licensed Acupuncturist,” while “Doctor of Acupuncture” is the legal title in Rhode Island; “Acupuncture Physician” in Florida; “Doctor of Oriental Medicine” in New Mexico; “Doctor of Oriental Medicine” or “Acupuncture Assistant” in Nevada; “Acupuncture Assistant” in Louisiana. California uses both “Licensed Acupuncturist” and “Certified Acupuncturist” to designate its practitioners.

Candidate licensure in most states requires passing the examinations provided by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), with the exception of California and Nevada, which have their own examinations. Most states have separate acupuncture boards to govern the practice of acupuncture, while some states choose other governance options such as the Board of Medical Practice (Minnesota), Department of Public Health (Connecticut), or Department of Regulation and Licensing (Wisconsin). The acupuncture boards in most states generally consist of acupuncturists who review applicants and regulate the practice of acupuncture. States which regulate acupuncture practice through their Medical Board or Department of Public Health will have an advisory board to assist the review of applicants and regulation of the field.

Thirty-two states allow medical doctors to practice acupuncture without specific training, while eleven states, plus Washington D.C., clearly indicate that acupuncture is not in the scope of practice of an MD without specific training. Seven states remain undetermined on this issue. Only seven states allow doctors of chiropractic to practice acupuncture without specific training, while thirty-seven states, plus Washington D.C., clearly stipulate that acupuncture is not in the scope of practice of a doctor of chiropractic without specific training, and five states are undetermined.

The practice of Chinese herbology is included in the definitions of acupuncture and Oriental medicine in states such as Florida, Minnesota, California, Texas, New Mexico, Oregon, while no clear definition is provided in many other states.

Acupuncture and Oriental medicine have been continuously practiced for thousands of years. Before Acupuncture and Oriental / Traditional Chinese medicine began to achieve higher visibility in the West in the 1970’s, very little scientific research had been done in the Unites States, although researchers in Asia had been applying scientific methodology to traditional Chinese medicine (TCM) for decades. After traditional Chinese medicine including acupuncture gained a foothold in the West, there was a demand for scientific studies that would either prove or conclusively disprove the success stories that acupuncture enthusiasts were claiming. Skeptics were sure that the bright light of scientific methodology would show that Chinese medicine, and especially acupuncture, was all “smoke and mirrors.” Significantly, the scientific studies have uniformly backed up the claims of Chinese medicine, lending support to those who wish to take the best of conventional and complementary medicine and integrate them.

Improved acupuncture research has steadily increased over the past ten years. A consensus conference on acupuncture convened by the National Institute of Health (NIH) concluded its panel report with the endorsement “…there is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.” This statement was published in the Journal of the American Medical Association in 1998. The Lancet concluded that “The West Gets the Point” in an End-of-Year review article in 1998. Scientific evidence has firmly established that acupuncture is effective for many conditions including post-operative pain from dental surgery, and nausea and vomiting from chemotherapy. The National Library of Medicine under the NIH has indexed 2302 research papers on acupuncture, compiled from January 1970 through October 1997 and available to English readers. The NIH has sponsored 155 acupuncture research projects to date.

Presently, there is a booming, ever-growing interest by researchers around the world in applying the scientific methodologies of clinical trials, pharmaceutical research, and doubleblind studies to acupuncture, Chinese herbal medicine, Tai Chi and Qi Gong.

Training programs for acupuncture, Chinese herbology, and other modalities of Oriental medicine are provided through accredited and candidacy colleges. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has established certification programs in acupuncture, Chinese herbology and Oriental bodywork therapy. The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is the accrediting agency for the master’s degree and master’s level certificate and diploma program in acupuncture. The Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) develops academic and clinical guidelines and core curriculum requirements for master’s level programs in acupuncture as well as acupuncture and Oriental medicine. More recently, CCAOM developed doctoral level programs in acupuncture and Oriental medicine.

Currently there are fifty accredited and candidacy colleges offering acupuncture and Oriental medicine programs in the United States. These organizations recognize the vast cultural and historical background of Oriental medicine, and the diversity involved in its teaching and practice. Because the United States has a strong tradition of respecting cultural diversity, Oriental medicine programs and colleges in this country have developed curricula and teaching protocols based in a variety of traditions including traditional Chinese medicine, Japanese acupuncture, Five Element acupuncture, and French acupuncture.

Textbooks are a significant part of acupuncture and Oriental medicine education. There are now a wide variety of textbooks dealing with acupuncture, Chinese herbology, Chinese dietary therapy, Chinese medicine theory, Chinese medicine diagnostics, Chinese internal medicine, Chinese medicine gynecology, Chinese medicine dermatology and Chinese medicine pediatrics. Leading publishers in this field include Eastland Press, Churchill Livingstone, Blue Poppy Press and Foreign Language Press. These publications significantly supplement the teaching and education of acupuncture and Oriental medicine in the United States.