Traditional Chinese medicine

'' is a pharmaceutical text written by Li Shizhen (1518–1593) during the Ming dynasty of China. This edition was published in 1593. 1340s, Yuan dynasty). This image from Shisi jingfahui (Expression of the Fourteen Meridians). (Tokyo: Suharaya Heisuke kanko, Kyoho gan 1716). Scholars in the history of medicine in China distinguish its doctrines and practice from those of present-day TCM. J. A. Jewell and S. M. Hillier state that the term "Traditional Chinese Medicine" became an established term due to the work of Dr. Kan-Wen Ma, a Western-trained medical doctor who was persecuted during the Cultural Revolution and immigrated to Britain, joining the University of London's Wellcome Institute for the History of Medicine. The doctrines of Chinese medicine are rooted in books such as the ''Yellow Emperor's Inner Canon and the Treatise on Cold Damage, as well as in cosmological notions such as yin–yang and the five phases. The Compendium of Materia Medica'' dates back to around 1,100 BCE when only a few dozen drugs were described. By the end of the 16th century, the number of drugs documented had reached close to 1,900. And by the end of the last century, published records of CMM had reached 12,800 drugs." Starting in the 1950s, these precepts were standardized in the People's Republic of China, including attempts to integrate them with modern notions of anatomy and pathology. In the 1950s, the Chinese government promoted a systematized form of TCM. Though the Shang did not have a concept of "medicine" as distinct from other health practices, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, and such. Shang elites usually attributed them to curses sent by their ancestors. There is currently no evidence that the Shang nobility used herbal remedies. This being said, most historians now make a distinction between medical lancing (or bloodletting) and acupuncture in the narrower sense of using metal needles to attempt to treat illnesses by stimulating points along circulation channels ("meridians") in accordance with beliefs related to the circulation of "Qi". The earliest evidence for acupuncture in this sense dates to the second or first century BCE. Han dynasty The ''Yellow Emperor's Inner Canon (Huangdi Neijing)'', the oldest received work of Chinese medical theory, was compiled during the Han dynasty around the first century BCE on the basis of shorter texts from different medical lineages. Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on the relation between humans, their environment, and the cosmos, on the contents of the body, on human vitality and pathology, on the symptoms of illness, and on how to make diagnostic and therapeutic decisions in light of all these factors. it was the first medical work to combine Yinyang and the Five Phases with drug therapy. Nanjing or "Classic of Difficult Issues", originally called "The Yellow Emperor Eighty-one Nan Jing", ascribed to Bian Que in the eastern Han dynasty. This book was compiled in the form of question-and-answer explanations. A total of 81 questions have been discussed. Therefore, it is also called "Eighty-One Nan". The book is based on basic theory and has also analyzed some disease certificates. Questions one to twenty-two is about pulse study, questions twenty-three to twenty-nine is about meridian study, questions thirty to forty-seven is related to urgent illnesses, questions forty-eight to sixty-one is related to serious diseases, questions sixty-two to sixty-eight is related to acupuncture points, and questions sixty-nine to eighty-one is related to the needlepoint methods. Most of the pharmacological theories and compatibility rules and the proposed "seven emotions and harmony" principle have played a role in the practice of medicine for thousands of years. Post-Han dynasty In the centuries that followed, several shorter books tried to summarize or systematize the contents of the ''Yellow Emperor's Inner Canon. The Canon of Problems (probably second century CE) tried to reconcile divergent doctrines from the Inner Canon'' and developed a complete medical system centered on needling therapy. Prominent medical scholars of the post-Han period included Tao Hongjing (456–536), Sun Simiao of the Sui and Tang dynasties, Zhang Jiegu (–1234), and Li Shizhen (1518–1593). ==Modern history==

Chinese communities under colonial rule Chinese communities living in colonial port cities were influenced by the diverse cultures they encountered, which also led to evolving understandings of medical practices where Chinese forms of medicine were combined with Western medical knowledge. For example, the Tung Wah Hospital was established in Hong Kong in 1869 based on the widespread rejection of Western medicine for pre-existing medical practices, although Western medicine would still be practiced in the hospital alongside Chinese medicinal practices. The Tung Wah Hospital was likely connected to another Chinese medical institution, the Kwong Wai Shiu Hospital of Singapore, which had previous community links to Tung Wah, was established for similar reasons, and also provided both Western and Chinese medical care. By 1935, English-language newspapers in Colonial Singapore already used the term "Traditional Chinese Medicine" to label Chinese ethnic medical practices. In the Chinese Communist Party-controlled areas prior to the founding of the People's Republic of China, there was a lack of access to Western-style medical resources. To improve health care, the Chinese Communist Party (CCP) promoted the integration of traditional Chinese medicine with Western medical science. During the Cultural Revolution (1966–1976), the CCP and the government emphasized modernity, cultural identity, and China's social and economic reconstruction and contrasted them to the colonial and feudal past. The government established a grassroots health care system as a step in the search for a new national identity, tried to revitalize traditional medicine, and made large investments in traditional medicine to try to develop affordable medical care and public health facilities. The Ministry of Health directed health care throughout China and established primary care units. Chinese physicians trained in Western medicine were required to learn traditional medicine, while traditional healers received training in modern methods. This strategy aimed to integrate modern medical concepts and methods and revitalize appropriate aspects of traditional medicine. Therefore, traditional Chinese medicine was re-created in response to Western medicine. Nathan Sivin's 1987 translation of Revised Outline of Chinese Medicine: For Western-medicine practitioners to learn Chinese medicine (; 1972) serves as a good, though outdated, example of this principle in practice. The State Intellectual Property Office (now known as CNIPA) established a database of patents granted for traditional Chinese medicine. In the second decade of the twenty-first century, Chinese Communist Party general secretary Xi Jinping strongly supported TCM, calling it a "gem". As of May 2011, in order to promote TCM worldwide, China had signed TCM partnership agreements with over 70 countries. His government pushed to increase its use and the number of TCM-trained doctors and announced that students of TCM would no longer be required to pass examinations in Western medicine. Chinese scientists and researchers, however, expressed concern that TCM training and therapies would receive equal support with Western medicine. They also criticized a reduction in government testing and regulation of the production of TCMs, some of which were toxic. Government censors have removed Internet posts that question TCM. In 2020 Beijing drafted a local regulation outlawing criticism of TCM. According to Caixin, the regulation was later passed with the provision outlawing criticism of TCM removed. Hong Kong At the beginning of Hong Kong's opening up, Western medicine was not yet popular, and Western medicine doctors were mostly foreigners; local residents mostly relied on Chinese medicine practitioners. In 1841, the British government of Hong Kong issued an announcement pledging to govern Hong Kong residents in accordance with all the original rituals, customs and private legal property rights. As traditional Chinese medicine had always been used in China, the use of traditional Chinese medicine was not regulated. The establishment in 1870 of the Tung Wah Hospital was the first use of Chinese medicine for the treatment in Chinese hospitals providing free medical services. As the promotion of Western medicine by the British government started from 1940, Western medicine started being popular among Hong Kong population. In 1959, Hong Kong had researched the use of traditional Chinese medicine to replace Western medicine. Historiography of Chinese medicine The study of traditional medicine in China is an academic field within the history of science, with its own scholarly associations, journals, graduate programs, and debates with each other. These scholars distinguish traditional medicine in historical China from the more recent traditional Chinese medicine (TCM), which took elements from traditional texts and practices to construct a systematic body. Paul Unschuld, for instance, sees a "departure of TCM from its historical origins." What is called "Traditional Chinese Medicine" and practiced today in China and the West is not thousands of years old, but recently constructed using selected traditional terms, some of which have been taken out of context, some badly misunderstood. He has criticized Chinese and Western popular books for selective use of evidence, choosing only those works or parts of historical works that seem to lead to modern medicine, ignoring those elements that do not now seem to be effective. Historians have noted two key aspects of Chinese medical history: understanding conceptual differences when translating the term , and observing the history from the perspective of cosmology rather than biology. In Chinese classical texts, the term is the closest historical translation to the English word "body" because it sometimes refers to the physical human body in terms of being weighed or measured, but the term is to be understood as an "ensemble of functions" encompassing both the human psyche and emotions. This concept of the human body is opposed to the European duality of a separate mind and body. It is critical for scholars to understand the fundamental differences in concepts of the body in order to connect the medical theory of the classics to the "human organism" it is explaining. Chinese scholars established a correlation between the cosmos and the "human organism". The basic components of cosmology, qi, yin yang and the Five Phase theory, were used to explain health and disease in texts such as Huangdi neijing. Yin and yang are the changing factors in cosmology, with qi as the vital force or energy of life. The Five Phase theory (Wuxing) of the Han dynasty contains the elements wood, fire, earth, metal, and water. By understanding medicine from a cosmology perspective, historians better understand Chinese medical and social classifications, such as gender, which was defined by a domination or remission of yang in terms of yin. These two distinctions are imperative when analyzing the history of traditional Chinese medical science. A majority of Chinese medical history written after the classical canons comes in the form of primary source case studies where academic physicians record the illness of a particular person and the healing techniques used, as well as their effectiveness. Historians have noted that Chinese scholars wrote these studies instead of "books of prescriptions or advice manuals." In their historical and environmental understanding, no two illnesses were alike, so the healing strategies of the practitioner were unique every time to the specific diagnosis of the patient. Medical case studies existed throughout Chinese history, but "individually authored and published case history" was a prominent creation of the Ming dynasty. An example of such case studies would be the literati physician, Cheng Congzhou, collection of 93 cases published in 1644. ==Critiques==

Critics say that TCM theory and practice have no basis in modern science, and that TCM practitioners do not agree on what diagnosis and treatments should be used for any given person. and that the traditional principles of acupuncture are deeply flawed. "Acupuncture points and meridians are not a reality", the review continued, but "merely the product of an ancient Chinese philosophy". In June 2019, the World Health Organization included traditional Chinese medicine in a global diagnostic compendium, but a spokesman said this was "not an endorsement of the scientific validity of any Traditional Medicine practice or the efficacy of any Traditional Medicine intervention." A 2012 review of cost-effectiveness research for TCM found that studies had low levels of evidence, with no beneficial outcomes. There are concerns about a number of potentially toxic plants, animal parts, and mineral compounds from China, There are additional concerns over the illegal trade and transport of endangered species including rhinoceroses and tigers, and the welfare of specially farmed animals, including bears. Many "natural" TCM remedies are effective because they contain hidden allopathic drugs. ==Philosophical background==

Traditional Chinese medicine includes a broad range of practices sharing common concepts that developed in China for more than 2,000 years, including various forms of herbal medicine, acupuncture, massage (), exercise (), and dietary therapy. It is primarily used as a complementary alternative medicine approach. and elements of which were absorbed by Daoism. Philosophical texts influenced medical thought and practice, mostly by being grounded in the same theories of qi, yin-yang and wuxing and microcosm-macrocosm analogies. Yin and yang Yin and yang are ancient Chinese deductive reasoning concepts used within Chinese medical diagnosis which can be traced back to the Shang dynasty (1600–1100 BCE). They represent two abstract and complementary aspects that every phenomenon in the universe can be divided into. Thus, yin and yang of the body are seen as phenomena whose lack (or over-abundance) comes with characteristic symptom combinations: • Yin vacuity (also termed "vacuity-heat"): heat sensations, possible sweating at night, insomnia, dry pharynx, dry mouth, dark urine, and a "fine" and rapid pulse. • Yang vacuity ("vacuity-cold"): aversion to cold, cold limbs, bright white complexion, long voidings of clear urine, diarrhea, pale and enlarged tongue, and a slightly weak, slow and fine pulse. All these aspects of Five Phases theory constitute the basis of the zàng-fǔ concept, and thus have great influence regarding the TCM model of the body. ==Model of the body==

TCM "holds that the body's vital energy (chi or qi) circulates through channels, called jingluo ("meridians and collaterals"), that have branches connected to bodily organs and functions." The primary functional entities used by traditional Chinese medicine are qì, xuě, the five zàng organs, the six fǔ organs, and the meridians which extend through the organ systems. These are all theoretically interconnected: each zàng organ is paired with a fǔ organ, which are nourished by the blood and concentrate qi for a particular function, with meridians being extensions of those functional systems throughout the body. Concepts of the body and of disease used in TCM are pseudoscientific, similar to Mediterranean humoral theory. TCM's model of the body is characterized as full of pseudoscience. Some practitioners no longer consider yin and yang and the idea of an energy flow to apply. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points. It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians. The scientific evidence for the anatomical existence of either meridians or acupuncture points is not compelling. Stephen Barrett of Quackwatch writes that, "TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care." Qi Qi is a polysemous word that traditional Chinese medicine distinguishes as being able to transform into many different qualities of qi (). • Actuation () – of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians. • Warming () – the body, especially the limbs. • Defense () – against Exogenous Pathogenic Factors • Containment () – of body fluids, i.e., keeping blood, sweat, urine, semen, etc. from leakage or excessive emission. • Inter-transformationel () – of food, drink, and breath into qi, xue (blood), and jinye ("fluids"), and/or transformation of all of the latter into each other. A lack of qi will be characterized especially by pale complexion, lassitude of spirit, lack of strength, spontaneous sweating, laziness to speak, non-digestion of food, shortness of breath (especially on exertion), and a pale and enlarged tongue. The latter is called weiqi (); its main function is defence and it has pronounced yang nature. Its concept is, nevertheless, defined by its functions: nourishing all parts and tissues of the body, safeguarding an adequate degree of moisture, and sustaining and soothing both consciousness and sleep. Jinye Closely related to xuě are the jinye (, usually translated as "body fluids"), and just like xuě they are considered to be yin in nature, and defined first and foremost by the functions of nurturing and moisturizing the different structures of the body. Their other functions are to harmonize yin and yang, and to help with the secretion of waste products. Jinye are ultimately extracted from food and drink, and constitute the raw material for the production of xuě; conversely, xuě can also be transformed into jinye. Zangfu The zangfu () are the collective name of eleven entities (similar to organs) that constitute the centre piece of TCM's systematization of bodily functions. The term zang refers to the five considered to be yin in nature – Heart, Liver, Spleen, Lung, Kidney – while fu refers to the six associated with yang – Small Intestine, Large Intestine, Gallbladder, Urinary Bladder, Stomach and San Jiao. Despite having the names of organs, they are only loosely tied to (rudimentary) anatomical assumptions. Instead, they are primarily understood to be certain "functions" of the body. substances such as waste and food. Since their concept was developed on the basis of Wǔ Xíng philosophy, each zàng is paired with a fǔ, and each zàng-fǔ pair is assigned to one of five elemental qualities (i.e., the Five Elements or Five Phases). These correspondences are stipulated as: • Fire () = Heart () and Small Intestine () (and, secondarily, Sānjiaō [, "Triple Burner"] and Pericardium []) • Earth () = Spleen () and Stomach () • Metal () = Lung () and Large Intestine () • Water () = Kidney () and Bladder () • Wood () = Liver () and Gallbladder () The zàng-fǔ are also connected to the twelve standard meridians – each yang meridian is attached to a fǔ organ, and five of the yin meridians are attached to a zàng. Jing-luo (c. 1368–1644)|200px The meridians (, ) are believed to be channels running from the zàng-fǔ in the interior (, ) of the body to the limbs and joints ("the surface" [, ]), transporting qi and xuĕ. TCM identifies 12 "regular" and 8 "extraordinary" meridians; There's also a number of less customary channels branching from the "regular" meridians. == Gender in traditional medicine ==

Fuke () is the traditional Chinese term for women's medicine (it means gynecology and obstetrics in modern medicine). However, there are few or no ancient works on it except for Fu Qingzhu's Fu Qingzhu Nu Ke (Fu Qingzhu's Gynecology ), with "Nu Ke" literally meaning "Women studies", much like the etymology of gynecology. In traditional China, as in many other cultures, the health and medicine of female bodies was less understood than that of male bodies. Women's bodies were often secondary to male bodies, since women were thought of as the weaker, sicklier sex. In clinical encounters, women and men were treated differently. Diagnosing women was not as simple as diagnosing men. First, when a woman fell ill, an appropriate adult man was to call the doctor and remain present during the examination, for the woman could not be left alone with the male doctor. The physician would discuss the female's problems and diagnosis only through the male. However, in certain cases, when a woman dealt with complications of pregnancy or birth, older women assumed the role of the formal authority. Men in these situations would not have much power to interfere. being the most challenging. Doctors used a medical doll known as a Doctor's lady, on which female patients could indicate the location of their symptoms. Cheng Maoxian (b. 1581), who practiced medicine in Yangzhou, described the difficulties doctors had with the norm of female modesty. One of his case studies was that of Fan Jisuo's teenage daughter, who could not be diagnosed because she was unwilling to speak about her symptoms, since the illness involved discharge from her intimate areas. As Cheng describes, there were four standard methods of diagnosis – looking, asking, listening and smelling and touching (for pulse-taking). To maintain some form of modesty, women would often stay hidden behind curtains and screens. The doctor was allowed to touch enough of her body to complete his examination, often just the pulse taking. This would lead to situations where the symptoms and the doctor's diagnosis did not agree and the doctor would have to ask to view more of the patient. These social and cultural beliefs were often barriers to learning more about female health, with women themselves often being the most formidable barrier. Women were often uncomfortable talking about their illnesses, especially in front of the male chaperones that attended medical examinations. Yin and yang ruled the body, the body being a microcosm of the universe and the earth. In addition, gender in the body was understood as homologous, the two genders operating in synchronization. Yin and yang concepts were applied to the feminine and masculine aspects of all bodies, implying that the differences between men and women begin at the level of this energy flow. According to Bequeathed Writings of Master Chu the male's yang pulse movement follows an ascending path in "compliance [with cosmic direction] so that the cycle of circulation in the body and the Vital Gate are felt...The female's yin pulse movement follows a defending path against the direction of cosmic influences, so that the nadir and the Gate of Life are felt at the inch position of the left hand". In sum, classical medicine marked yin and yang as high and low on bodies which in turn would be labeled normal or abnormal and gendered either male or female. As in other cultures, fertility and menstruation dominate female health concerns. Women were often silent about suspected pregnancy, which led to many men not knowing that their wife or daughter was pregnant until complications arrived. Complications through the misdiagnosis and the woman's reluctance to speak often led to medically induced abortions. Cheng Maoxian, Furth wrote, "was unapologetic about endangering a fetus when pregnancy risked a mother's well being". With these tools, the baby was born, cleaned, and swaddled; however, the mother was then immediately the focus of the doctor to replenish her qi. This process was followed up by a month check-in with the physician, a practice known as zuo yuezi. Infertility Infertility, not very well understood, posed serious social and cultural repercussions. The seventh-century scholar Sun Simiao is often quoted: "those who have prescriptions for women's distinctiveness take their differences of pregnancy, childbirth and [internal] bursting injuries as their basis." Even in contemporary fuke placing emphasis on reproductive functions, rather than the entire health of the woman, suggests that the main function of fuke is to produce children. Once again, the kidney visceral system governs the "source Qi", which governs the reproductive systems in both sexes. This source Qi was thought to "be slowly depleted through sexual activity, menstruation and childbirth." It was also understood that the depletion of source Qi could result from the movement of an external pathology that moved through the outer visceral systems before causing more permanent damage to the home of source Qi, the kidney system. In addition, the view that only very serious ailments ended in the damage of this system means that those who had trouble with their reproductive systems or fertility were seriously ill. According to traditional Chinese medical texts, infertility can be summarized into different syndrome types. These were spleen and kidney depletion (yang depletion), liver and kidney depletion (yin depletion), blood depletion, phlegm damp, liver oppression, and damp heat. This is important because, while most other issues were complex in Chinese medical physiology, women's fertility issues were simple. Most syndrome types revolved around menstruation, or lack thereof. The patient was entrusted with recording not only the frequency, but also the "volume, color, consistency, and odor of menstrual flow." This placed responsibility of symptom recording on the patient, and was compounded by the earlier discussed issue of female chastity and honor. This meant that diagnosing female infertility was difficult, because the only symptoms that were recorded and monitored by the physician were the pulse and color of the tongue. == Concept of disease ==

In general, disease is perceived as a disharmony (or imbalance) in the functions or interactions of yin, yang, qi, xuĕ, zàng-fǔ, meridians etc. and/or of the interaction between the human body and the environment. For example, depending on tongue and pulse conditions, a TCM practitioner might diagnose bleeding from the mouth and nose as: "Liver fire rushes upwards and scorches the Lung, injuring the blood vessels and giving rise to reckless pouring of blood from the mouth and nose." He might then go on to prescribe treatments designed to clear heat or supplement the Lung. Disease entities In TCM, a disease has two aspects: "bìng" and "zhèng". The former is often translated as "disease entity", Since therapy will not be chosen according to the disease entity but according to the pattern, two people with the same disease entity but different patterns will receive different therapy. (compare with typical examples of patterns). The concrete pattern identified should account for all the symptoms a person has. Six Excesses The Six Excesses (, or "Six Pernicious Influences"; or slow pulse. In a concurrent exterior pattern, excess is characterized by the absence of sweating. pattern discrimination can include considerations regarding the disease cause; this is called (, "disease-cause pattern discrimination"). There are three fundamental categories of disease causes () recognized: • external causes: these include the Six Excesses and "Pestilential Qi". • internal causes: the "Seven Affects" (, sometimes also translated as "Seven Emotions") – joy, anger, brooding, sorrow, fear, fright and grief. These are believed to be able to cause damage to the functions of the zàng-fú, especially of the Liver. • non-external-non-internal causes: dietary irregularities (especially: too much raw, cold, spicy, fatty or sweet food; voracious eating; too much alcohol), fatigue, sexual intemperance, trauma, and parasites (). ==Diagnostics==

In TCM, there are five major diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation. These are grouped into what is known as the "Four pillars" of diagnosis, which are Inspection, Auscultation/ Olfaction, Inquiry, and Palpation (). • Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge. • Auscultation refers to listening for particular sounds (such as wheezing). • Olfaction refers to attending to body odor. • Inquiry focuses on the "seven inquiries", which involve asking the person about the regularity, severity, or other characteristics of: chills, fever, perspiration, appetite, thirst, taste, defecation, urination, pain, sleep, menses, leukorrhea. • Palpation which includes feeling the body for tender A-shi points, and the palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen. Tongue and pulse Examination of the tongue and the pulse are among the principal diagnostic methods in TCM. Details of the tongue, including shape, size, color, texture, cracks, teeth marks, as well as tongue coating are all considered as part of tongue diagnosis. Various regions of the tongue's surface are believed to correspond to the zàng-fŭ organs. For example, redness on the tip of the tongue might indicate heat in the Heart, while redness on the sides of the tongue might indicate heat in the Liver. Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each arm, for a total of twelve pulses, all of which are thought to correspond with certain zàng-fŭ. The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick"; each of these qualities indicates certain disease patterns. Learning TCM pulse diagnosis can take several years. ==Herbal medicine==

(), ginseng, Luo Han Guo, turtle shell underbelly (plastron), and dried curled snakes. in a "crush cage" on Huizhou Farm, China s are extensively used in traditional medicine in China and elsewhere. Thus, the term "medicinal" (instead of herb) may be used. A 2019 review of traditional herbal treatments found they are widely used but lacking in scientific evidence, and urged a more rigorous approach by which genuinely useful medicinals might be identified. Plant elements and extracts are by far the most common elements used. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed – out of these, 45 were animal parts, and 30 were minerals. hornet nests, leeches, and scorpion. Other examples of animal parts include horn of the antelope or buffalo, deer antlers, testicles and penis bone of the dog, and snake bile. Some compounds can include the parts of endangered species, including tiger bones and rhinoceros horn which is used for many ailments (though not as an aphrodisiac as is commonly misunderstood in the West). The black market in rhinoceros horns (driven not just by TCM but also unrelated status-seeking) has reduced the world's rhino population by more than 90 percent over the past 40 years. Concerns have also arisen over the use of pangolin scales, turtle plastron, seahorses, and the gill plates of mobula and manta rays. Poachers hunt restricted or endangered species to supply the black market with TCM products. There is no scientific evidence of efficacy for tiger medicines. Since TCM recognizes bear bile as a treatment compound, more than 12,000 asiatic black bears are held in bear farms. The bile is extracted through a permanent hole in the abdomen leading to the gall bladder, which can cause severe pain. This can lead to bears trying to kill themselves. As of 2012, approximately 10,000 bears are farmed in China for their bile. As of March 2020 bear bile as ingredient of Tan Re Qing injection remains on the list of remedies recommended for treatment of "severe cases" of COVID-19 by National Health Commission of China and the National Administration of Traditional Chinese Medicine. The deer penis is believed to have therapeutic benefits according to traditional Chinese medicine. Tiger parts from poached animals include tiger penis, believed to improve virility, and tiger eyes. The illegal trade for tiger parts in China has driven the species to near-extinction because of its popularity in traditional medicine. Shark fin soup is traditionally regarded in Chinese medicine as beneficial for health in East Asia, and its status as an elite dish has led to huge demand with the increase of affluence in China, devastating shark populations. The shark fins have been a part of traditional Chinese medicine for centuries. Shark finning is banned in many countries, but the trade is thriving in Hong Kong and China, where the fins are part of shark fin soup, a dish considered a delicacy, and used in some types of traditional Chinese medicine. The tortoise (freshwater turtle, guiban) and turtle (Chinese softshell turtle, biejia) species used in traditional Chinese medicine are raised on farms, while restrictions are made on the accumulation and export of other endangered species. However, issues concerning the overexploitation of Asian turtles in China have not been completely solved. Finally, although not an endangered species, sharp rises in exports of donkeys and donkey hide from Africa to China to make the traditional remedy ejiao have prompted export restrictions by some African countries. Human body parts (Ziheche () is used in traditional Chinese medicine. Human placenta has been used an ingredient in certain traditional Chinese medicines, including using dried human placenta, known as "Ziheche", to treat infertility, impotence and other conditions. The consumption of the human placenta is a potential source of infection. Efficacy there were not enough good-quality trials of herbal therapies to allow their effectiveness to be determined. A high percentage of relevant studies on traditional Chinese medicine are in Chinese databases. Fifty percent of systematic reviews on TCM did not search Chinese databases, which could lead to a bias in the results. Many systematic reviews of TCM interventions published in Chinese journals are incomplete, some contained errors or were misleading. The herbs recommended by traditional Chinese practitioners in the US are unregulated. • A 2013 review found the data too weak to support use of Chinese herbal medicine (CHM) for benign prostatic hyperplasia. • A 2013 review found the research on the benefit and safety of CHM for idiopathic sudden sensorineural hearing loss is of poor quality and cannot be relied upon to support their use. • A 2013 Cochrane review found inconclusive evidence that CHM reduces the severity of eczema. • The traditional medicine ginger, which has shown anti-inflammatory properties in laboratory experiments, has been used to treat rheumatism, headache and digestive and respiratory issues, though there is no firm evidence supporting these uses. • A 2012 Cochrane review found no difference in mortality rate among 640 SARS patients when Chinese herbs were used alongside Western medicine versus Western medicine exclusively, although they concluded some herbs may have improved symptoms and decreased corticosteroid doses. • A 2012 Cochrane review found insufficient evidence to support the use of TCM for people with adhesive small bowel obstruction. • A 2011 review found low quality evidence that suggests CHM improves the symptoms of Sjögren's syndrome. • A 2011 Cochrane review found inconclusive evidence to support the use of TCM herbal medicines for treatment of hypercholesterolemia. • A 2011 Cochrane review did not find improvement in fasting C-peptide when compared to insulin treatment for latent autoimmune diabetes in adults after 3 months. It is important to highlight that the studies available to be included in this review presented considerable flaws in quality and design. • A 2010 review found TCM seems to be effective for the treatment of fibromyalgia but the findings were of insufficient methodological rigor. • A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving painful menstruation, but the trials assessed were of such low methodological quality that no conclusion could be drawn about the remedies' suitability as a recommendable treatment option. • Turmeric has been used in traditional Chinese medicine for centuries to treat various conditions. This includes jaundice and hepatic disorders, rheumatism, anorexia, diabetic wounds, and menstrual complications. • A 2005 Cochrane review found insufficient evidence for the use of CHM in HIV-infected people and people with AIDS. • A 2010 Cochrane review found insufficient evidence to support the use of Traditional Chinese Herbal Products (THCP) in the treatment of angina. • A 2010 Cochrane review found no evidence supporting the use of TCHM for stopping bleeding from haemorrhoids. There was some weak evidence of pain relief. Drug research '', traditionally used to treat fever, has been found to have antimalarial properties. There was success in the 1970s, however, with the development of the antimalarial drug artemisinin, which is a chemical compound isolated the herb Artemisia annua that has been used traditionally as a treatment for fever. Artemisia annua has been used by Chinese herbalists in traditional Chinese medicines for 2,000 years. In 1596, Li Shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his Compendium of Materia Medica. Researcher Tu Youyou discovered that a low-temperature extraction process could isolate an effective antimalarial substance from the plant. The extracted substance, once subject to detoxification and purification processes, is a usable antimalarial drug For her work on malaria, Tu received the 2015 Nobel Prize in Physiology or Medicine. Despite global efforts in combating malaria, it remains a large burden for the population. Also in the 1970s Chinese researcher Zhang TingDong and colleagues investigated the potential use of the traditionally used substance arsenic trioxide to treat acute promyelocytic leukemia (APL). Building on his work, research both in China and the West eventually led to the development of the drug Trisenox, which was approved for leukemia treatment by the FDA in 2000. Huperzine A, an extract from the herb, Huperzia serrata, is under preliminary research as a possible therapeutic for Alzheimer's disease, but poor methodological quality of the research restricts conclusions about its effectiveness. Ephedrine in its natural form, known as má huáng () in TCM, has been documented in China since the Han dynasty (206 BCE – 220 CE) as an antiasthmatic and stimulant. In 1885, the chemical synthesis of ephedrine was first accomplished by Japanese organic chemist Nagai Nagayoshi based on his research on Japanese and Chinese traditional herbal medicines Pien tze huang was first documented in the Ming dynasty. Cost-effectiveness A 2012 systematic review found there is a lack of available cost-effectiveness evidence in TCM. Safety From the earliest records regarding the use of compounds to today, the toxicity of certain substances has been described in all Chinese materiae medicae. For most compounds, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis. The toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it could not (i.e., in Curculigo). Botanical misidentification of plants can cause toxic reactions in humans. Traditional herbal medicines are sometimes contaminated with toxic heavy metals, including lead, arsenic, mercury and cadmium, which inflict serious health risks to consumers. Also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as corticosteroids, phenylbutazone, phenytoin, and glibenclamide, has been reported. Substances known to be potentially dangerous include Aconitum, the Chinese beetle (Mylabris phalerata), certain fungi, Aristolochia (which is known to cause cancer). and cinnabar. Asbestos ore (Actinolite, Yang Qi Shi, 阳起石) is used to treat impotence in TCM. Due to galena's (litharge, lead(II) oxide) high lead content, it is known to be toxic. Lead, mercury, arsenic, copper, cadmium, and thallium have been detected in TCM products sold in the U.S. and China. To avoid its toxic adverse effects Xanthium sibiricum must be processed. A 2013 review suggested that although the antimalarial herb Artemisia annua may not cause hepatotoxicity, haematotoxicity, or hyperlipidemia, it should be used cautiously during pregnancy due to a potential risk of embryotoxicity at a high dose. However, many adverse reactions are due to misuse or abuse of Chinese medicine. The harvesting of guano from bat caves (yemingsha) brings workers into close contact with these animals, increasing the risk of zoonosis. The Chinese virologist Shi Zhengli has identified dozens of SARS-like coronaviruses in samples of bat droppings. ==Acupuncture and moxibustion==

Acupuncture is the insertion of needles into superficial structures of the body (skin, subcutaneous tissue, muscles) – usually at acupuncture points (acupoints) – and their subsequent manipulation; this aims at influencing the flow of qi. According to TCM it relieves pain and treats (and prevents) various diseases. The US FDA classifies single-use acupuncture needles as Class II medical devices, under CFR 21. Acupuncture is often accompanied by moxibustion – the Chinese characters for acupuncture () literally meaning "acupuncture-moxibustion" – which involves burning mugwort on or near the skin at an acupuncture point. According to the American Cancer Society, "available scientific evidence does not support claims that moxibustion is effective in preventing or treating cancer or any other disease". In electroacupuncture, an electric current is applied to the needles once they are inserted, to further stimulate the respective acupuncture points. A recent historian of Chinese medicine remarked that it is "nicely ironic that the specialty of acupuncture – arguably the most questionable part of their medical heritage for most Chinese at the start of the twentieth century – has become the most marketable aspect of Chinese medicine." She found that acupuncture as we know it today has hardly been in existence for sixty years. Moreover, the fine, filiform needle we think of as the acupuncture needle today was not widely used a century ago. Present day acupuncture was developed in the 1930s and put into wide practice only as late as the 1960s. Efficacy A 2013 editorial in the American journal Anesthesia and Analgesia stated that acupuncture studies produced inconsistent results, (i.e. acupuncture relieved pain in some conditions but had no effect in other very similar conditions) which suggests the presence of false positive results. These may be caused by factors like biased study design, poor blinding, and the classification of electrified needles (a type of TENS) as a form of acupuncture. The inability to find consistent results despite more than 3,000 studies, the editorial continued, suggests that the treatment seems to be a placebo effect and the existing equivocal positive results are the type of noise one expects to see after a large number of studies are performed on an inert therapy. The editorial concluded that the best controlled studies showed a clear pattern, in which the outcome does not rely upon needle location or even needle insertion, and since "these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work." A 2012 meta-analysis of 17,922 patients found modest increases in chronic pain relief from real acupuncture compared with sham acupuncture controls, suggesting an effect greater than a placebo. The meta-analysis also noted that the mechanisms of acupuncture "are clinically relevant, but that an important part of these total effects is not due to issues considered to be crucial by most acupuncturists, such as the correct location of points and depth of needling" and that acupuncture may be "associated with more potent placebo or context effects" than other treatments. Commenting on these findings, both Edzard Ernst and David Colquhoun said the results were of negligible clinical significance. A 2011 overview of Cochrane reviews found evidence that suggests acupuncture is effective for some but not all kinds of pain. A 2010 systematic review found that there is evidence "that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention" in the treatment of chronic low back pain. Two review articles discussing the effectiveness of acupuncture, from 2008 and 2009, have concluded that there is not enough evidence to conclude that it is effective beyond the placebo effect. Acupuncture is generally safe when administered using Clean Needle Technique (CNT). Severe adverse effects, including very rarely death (five case reports), have been reported. ==Tui na==

Tui na () is a form of massage, based on the assumptions of TCM, from which shiatsu is thought to have evolved. Techniques employed may include thumb presses, rubbing, percussion, and assisted stretching. == Qigong ==

Qìgōng () is a TCM system of exercise and meditation that combines regulated breathing, slow movement, and focused awareness, purportedly to cultivate and balance qi. One branch of qigong is Qigong massage, in which the practitioner combines massage techniques with awareness of the acupuncture channels and points. Qi is air, breath, energy, or primordial life source that is neither matter or spirit. While Gong is a skillful movement, work, or exercise of the qi. Forms • Neigong: introspective and meditative • Waigong: external energy and motion • Donggong: dynamic or active • Jinggong: tranquil or passive ==Other therapies==

Cupping Cupping () is a type of Chinese massage, consisting of placing several glass "cups" (open spheres) on the body. A match is lit and placed inside the cup and then removed before placing the cup against the skin. As the air in the cup is heated, it expands, and after placing in the skin, cools, creating lower pressure inside the cup that allows the cup to stick to the skin via suction. When combined with massage oil, the cups can be slid around the back, offering "reverse-pressure massage". Gua sha Gua sha () is abrading the skin with pieces of smooth jade, bone, animal tusks or horns or smooth stones; until red spots then bruising cover the area to which it is done. It is believed that this treatment is for almost any ailment. The red spots and bruising take three to ten days to heal, there is often some soreness in the area that has been treated. Die-da Diē-dǎ () or Dit Da, is a traditional Chinese bone-setting technique, usually practiced by martial artists who know aspects of Chinese medicine that apply to the treatment of trauma and injuries such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies if serious injury is involved. Such practice of bone-setting () is not common in the West. Chinese food therapy The concepts yin and yang are associated with different classes of foods, and tradition considers it important to consume them in a balanced fashion. However, there is no scientific evidence supporting such claims, nor their implied notions. Shanghai pedicure ==Regulations==

Many governments have enacted laws to regulate TCM practice. Australia From 1 July 2012 Chinese medicine practitioners must be registered under the national registration and accreditation scheme with the Chinese Medicine Board of Australia and meet the Board's Registration Standards, to practice in Australia. Canada TCM is regulated in five provinces in Canada: Alberta, British Columbia, Ontario, Quebec, and Newfoundland & Labrador. China (mainland) The National Administration of Traditional Chinese Medicine was created in 1949, which then absorbed existing TCM management in 1986 with major changes in 1998. China's National People's Congress Standing Committee passed the country's first law on TCM in 2016, which came into effect on 1 July 2017. The new law standardized TCM certifications by requiring TCM practitioners to (i) pass exams administered by provincial-level TCM authorities, and (ii) obtain recommendations from two certified practitioners. TCM products and services can be advertised only with approval from the local TCM authority. Ready-to-use TCM preparations, also known as Chinese patent medicines, are regulated by the National Medical Products Administration (and its predecessor CFDA) similar to preparations used in modern medicine since 1984. The barrier for entry, however, is much lower than medications based on modern/non-TCM principles; the rules allow for omitting clinical testing in a variety of circumstances. As of 2025, the latest (2020) rules allow a simplified procedure for preparations derived from an approved list of "classic prescriptions". The government-run healthcare system covers a number of TCM procedures and preparations. In 2021, a total of 7114.5 billion yuan went into healthcare, amounting for 6.59% of the year's national GDP. Of these, 1111.5 billion yuan went into covering costs associated with TCM preparations (0.97% of national GDP), with 592.4 billion yuan covering the actual medications. Hong Kong During British rule, Chinese medicine practitioners in Hong Kong were not recognized as "medical doctors", which meant they could not issue prescription drugs, give injections, and such. However, TCM practitioners could register and operate TCM as "herbalists". The Chinese Medicine Council of Hong Kong, established in 1999, regulates compounds and professional standards for TCM practitioners. All TCM practitioners in Hong Kong are required to register with the council. The eligibility for registration includes a recognised 5-year university degree of TCM, a 30-week minimum supervised clinical internship, and passing the licensing exam. The approved Chinese medicine institutions are Hong Kong University, Chinese University of Hong Kong and Hong Kong Baptist University. Macau The Portuguese Macau government seldom interfered in the affairs of Chinese society, including with regard to regulations on the practice of TCM. There were a few TCM pharmacies in Macau during the colonial period. In 1994, the Portuguese Macau government published Decree-Law no. 53/94/M that officially started to regulate the TCM market. After the sovereign handover, the Macau S.A.R. government also published regulations on the practice of TCM. In 2000, Macau University of Science and Technology and Nanjing University of Traditional Chinese Medicine established the Macau College of Traditional Chinese Medicine to offer a degree course in Chinese medicine. In 2022, a new law regulating TCM, Law no. 11/2021, came into effect. The same law also repealed Decree-Law no. 53/94/M. Indonesia All traditional medicines, including TCM, are regulated by Indonesian Minister of Health Regulation of 2013 on traditional medicine. Traditional medicine license (Surat Izin Pengobatan Tradisional – SIPT) is granted to the practitioners whose methods are recognized as safe and may benefit health. The TCM clinics are registered but there is no explicit regulation for it. The only TCM method which is accepted by medical logic and is empirically proofed is acupuncture. The acupuncturists can get SIPT and participate in health care facilities. Under modern Japanese medical law, it is possible for doctors to perform acupuncture and massage, but because there is a separate law regarding acupuncture and massage, these treatments are mainly performed by massage therapists, acupuncturists, and moxibustion practitioners. Korea Under the Medical Service Act (), an oriental medical doctor, whose obligation is to administer oriental medical treatment and provide guidance for health based on oriental medicine, shall be treated in the same manner as a medical doctor or dentist. The Korea Institute of Oriental Medicine is the top research center of TCM in Korea. Malaysia The Traditional and Complementary Medicine Bill was passed by parliament in 2012 establishing the Traditional and Complementary Medicine Council to register and regulate traditional and complementary medicine practitioners, including TCM practitioners as well as other traditional and complementary medicine practitioners such as those in traditional Malay medicine and traditional Indian medicine. Netherlands companies in the Netherlands. There are no specific regulations in the Netherlands on TCM; TCM is neither prohibited nor recognised by the government of the Netherlands. Chinese herbs as well as Chinese herbal products that are used in TCM are classified as foods and food supplements, and these Chinese herbs can be imported into the Netherlands as well as marketed as such without any type registration or notification to the government. New Zealand Although there are no regulatory standards for the practice of TCM in New Zealand, in the year 1990, acupuncture was included in the Governmental Accident Compensation Corporation (ACC) Act. This inclusion granted qualified and professionally registered acupuncturists to provide subsidised care and treatment to citizens, residents, and temporary visitors for work or sports related injuries that occurred within and upon the land of New Zealand. The two bodies for the regulation of acupuncture and attainment of ACC treatment provider status in New Zealand are Acupuncture NZ and The New Zealand Acupuncture Standards Authority. Singapore The TCM Practitioners Act was passed by Parliament in 2000 and the TCM Practitioners Board was established in 2001 as a statutory board under the Ministry of Health, to register and regulate TCM practitioners. The requirements for registration include possession of a diploma or degree from a TCM educational institution/university on a gazetted list, either structured TCM clinical training at an approved local TCM educational institution or foreign TCM registration together with supervised TCM clinical attachment/practice at an approved local TCM clinic, and upon meeting these requirements, passing the Singapore TCM Physicians Registration Examination (STRE) conducted by the TCM Practitioners Board. In 2024, Nanyang Technological University will offer the four-year Bachelor of Chinese Medicine programme, which is the first local programme accredited by the Ministry of Health. Taiwan In Taiwan, TCM practitioners are physicians and are regulated by the Physicians Act. They possess the authority to independently diagnose medical conditions, issue prescriptions, dispense Traditional Chinese Medicine, and prescribe a variety of diagnostic tests including X-rays, ECG, and blood and urine test. Under current law, those who wish to qualify for the Chinese medicine exam must have obtained a 7-year university degree in TCM. The National Research Institute of Chinese Medicine, established in 1963, is the largest Chinese herbal medicine research center in Taiwan. United States As of July 2012, only six states lack legislation to regulate the professional practice of TCM: Alabama, Kansas, North Dakota, South Dakota, Oklahoma, and Wyoming. In 1976, California established an Acupuncture Board and became the first state licensing professional acupuncturists. == See also ==