Traditional Chinese Medicine

    Traditional Chinese Medicine (TCM) is a well of medical knowledge gained from over 4,000 years of observation, investigation and clinical experience. TCM has evolved as an empirical science and its theories and treatments have been repeatedly in use and refined over this long period of time.

History

    The development of TCM can be traced back to the New Stone Age over 10,000 years ago. TCM practices developed in an empirical manner through the observation of the effects they produced on certain parts of the body and on specific ailments. Early acupuncture was carried out using sharpened bone fragments prior to the development of other tools. The first and most important classic text of TCM had been completed in about 200 BC. This book, known as the Yellow Emperor's Classic of Internal Medicine , discussed the theory and philosophy of TCM as well as the therapeutic benefits of acupuncture, herbs, diet and exercise. By the Han dynasty (206 B.C. - 220 A.D.), another valuable classic, the Treatise on Diseases Caused by Cold Factors (Shang Han Lun) had been written by Chang Chung-ching. This classic is an authoritative practical guide to the treatment of illness even to the present day. Another well-known Chinese medical works is the Materia Medica (Pen Tshao Kang Mu), compiled in the Ming dynasty (1368- 1644 A.D.) by Li Shih-chen. This encyclopedic work includes descriptions of almost 2,000 different kinds of medicines and forms an important framework for TCM herbology.

Present Day

    Oriental Medicine is a term with many variations of a general meaning. Among the majority of american practitioners it refers to a system of medicine which originated approximately 4000 years ago in in far east Asia. This area included what are now China, Korea, Japan, Tibet, and Vietnam.

    In the 20th century Oriental Medicine serves almost two billion people in far east Asia, the former Soviet Union and Europe. In the U.S. thirty-eight states have scope of practice for NCCAOM National Commission for the Certification of Acupuncture and Oriental Medicine or equivalent level practitioners. There are approximately 10,000 NCCA national board certified acupuncturists in the country. Since several states have licensure requirements and processes that are independent of the NCCA exhaustive totals have not been compiled.

    Research on Oriental Medicine has been continual in China since the early 1950's. After the civil war was settled in 1948, the Communist Government of China realized it could not afford to train, let alone equip, a sufficient number of allopathic doctors to meet the needs of the country's population. The government evaluation of the traditional medicine showed that it had enough effectiveness to warrant not only active use and perpetuation but development. Today Traditional Chinese Medicine (TCM) is practiced in allopathic hospitals, in traditional hospitals, in conjunction with allopathic medicine, and hybrids of both forms of medicine have been developed.

Foundation Principles

    Although Oriental Medicine has a set of foundation principles it is not uniform. There have been and are many schools of thought. Oriental Medicine is a complete health care system capable of delivering both primary and specialized care. It's based on principles which began evolving approximately between 2000BC and 4000BC and which continue to evolve. The roots of Oriental Medicine are considered by most to be Buddhism, Taoism, and Confucianism. Buddhism is a religion, Confucianism is social and political philosophy, and Taoism is both a religion and a philosophy. These are gross simplifications. Literally thousands of volumes have been written on these subjects. But we are concerned here with giving you enough information for useful understanding of your diagnosis.

    Taoism is the most influential root of Oriental Medicine. The Taoists main focus was on the observable and natural laws of the universe and the implications for human beings' relationship to the universe. 2500 years (5000BC - 500BC) allowed much time for observation, study and speculation by many people. This activity yielded myriad principles. Below are five of the fundamental principles and applications of them to health and healing.

1. THERE ARE NATURAL LAWS THAT GOVERN THE UNIVERSE.
You are part of the universe and therefore exist according to and subject to those laws.
2. THE NATURAL ORDER OF THE UNIVERSE IS HARMONIUS AND ORGANIZED. If you live according to it's laws you will be harmonius.
3. THE UNIVERSE IS DYNAMIC; CHANGE IS A CONSTANT.
Lack of change is contrary to the universe and therefore causes illness.
4. ALL LIFE IS INTERCONNECTED
Always use a systems approach.
5. HUMANS ARE A PART OF THE UNIVERSE, NOT OUTSIDE OF IT. WE ARE INTIMATELY CONNECTED TO THE ENVIRONMENT AND THUS THE UNIVERSE.
Your health is affected by your environment.

    These principles are the axioms about existence that form the foundation for Yin & Yang, The Five Elements, and Qi (pronounced chee). And those concepts are the primary engines of Oriental Medicine.

TCM ANATOMY & PHYSIOLOGY

    Qi or Chi (pronounced chee) is a difficult concept to translate. It's usually left untranslated because there is no single English word that conveys all parts of the Chinese concept. The word that comes closest is energy. Like energy Qi is the fundamental stuff of the universe. The origins of energy and Qi are both unknown. The origins of both are tied to their cultures' creation theories. The Taoist creation theory isn't actually a theory. It's more a statement of fact than speculation. "From nothing came something." The Void versus Qi. Yin versus Yang. From Yin & Yang came the Five Elements. From the Five Elements came the Ten Thousand Things (all things in creation).

    Neither Qi nor energy can be destroyed, only changed in their forms. Everything is composed of Qi; our bodies, the earth, water, sound, light. The Nei Jing - The Yellow Emperor's Classic of Internal Medicine (c.500BC) says "There is no place that Qi is not."

    The Taoist philosopher Wang Chong wrote in 50 A.D. that "Qi produces the human body just as water becomes ice. As water freezes into ice so Qi coagulates to form the human body. When ice melts it returns to water. When people die they return to spirit". Zhang Zai, a contemporary of Wang Chong, expressed a an almost identical version of this concept. "Every birth is a condensation of Qi, every death is a dispersal."

    Qi flows throughout the body in currents or conduits called channels or meridians or in Chinese; jing luo. There are fourteen main channels and these possess the most commonly used acupuncture points. Twelve of these channels connect to a yin or yang organ from which they derive their name.

    For example, the Wood Element yin organ is the liver. The liver channel runs from the foot up the inside of the leg, along the center of one-half of the abdomen and goes inside below the sixth rib. Inside it connects to the liver and the gallbladder, goes up through the diapragm, up to the throat, then the eyes and terminates at the vertex of the skull. There are two branches from the liver channel. One which connects to the inside of the lips and one which connects with the lung.

Yin and Yang

    The theory of yin and yang is a kind of world outlook. It holds that all things have two opposite aspects, yin and yang, which are both opposite and at the same time interdependent. This is a universal law of the material world. These two aspects are in opposition to each other but because one end of the spectrum cannot exist without the other they are interdependent.

    The ancient Chinese used water and fire to symbolize yin and yang; anything moving, hot, bright and hyperactive is yang, and anything quiescent, cold, dim and hypoactive is yin.

    The yin and yang properties of things are not absolute but relative. As an object or person changes so the yin and yang components change at a gradual rate. Each of the yin and yang properties of the object is a condition for the existence of the other; neither can exist in isolation.

    These two opposites are not stationary but in constant motion. If we imagine the circadian rhythm, night is yin and day is yang; as night (yin) fades it becomes day (yang), and as yang fades it becomes yin. Yin and yang are therefore changing into each other as well as balancing each other.

The Application of Yin and Yang to Chinese Medicine

    Each organ has an element of yin and yang within it. The histological structures and nutrients are yin, and the functional activities are yang. Some organs are predominantly yang in their functions, such as the gan-liver, while others are predominantly yin, such as the shen-kidney. Even though one organ may be predominantly yin (or yang) in nature, the balance of yin and yang is maintained in the whole healthy body because the sum total of the yin and yang will be in a fluctuating balance.

    If a condition of prolonged excess or deficiency of either yin or yang occurs then disease results. In an excess of yin the yang qi would be damaged, and a disease of cold of shi nature would develop. Excess of yang will consume yin and a disease of heat of shi nature would develop. In a deficiency of yin, diseases of heat of xu nature develop, while a deficiency of yang causes diseases of cold of xu nature.

The Channels and Collaterals

    The channels and collaterals are the representation of the organs of the body. They are also a functional system in their own right and they are responsible for conducting the flow of qi and blood through the body. The flow of qi can be disrupted by direct damage to the channels, such as trauma, or by an internal imbalance of yin and yang within the body.

    The central principle of traditional Chinese medicine is to diagnose the cause of the internal disease, or yin yang imbalance within the body, and, by using the relevant acupuncture points, to correct the flow of qi in the channels and thus correct the internal disease. The acupuncture points that are on the channels have a direct influence on the flow of qi through the channels, and also on the internal organs. The zang channels are yin in nature and the fu channels are yang in nature.

    Qi circulates through the channels of the body in a well defined circadian rhythm.

Five Elements

    The five elements emerged from the observation of the various groups of dynamic processes, functions and characteristics in the natural world. They are:

1. Water: wet, cool, descending, flowing, yielding
2. Fire: dry, hot, ascending, moving
3. Wood: growing, flexible, rooted, strong
4. Metal: cutting, hard, conducting
5. Earth: productive, fertile, potential for growth

    Each Element is seen as having a series of correspondences relating both to the natural world and also the human body. Each is linked with a season, a climate, a taste, a colour, a sound, an emotion, an odour, an movement, a sense organ, a body part, a Yang organ and a Yin organ.

    TCM uses a system of inter-relationships between the Five Elements in order to understand how the various processes of the body support and control each other. Because of these inter-relationships, when one of the organs and its associated Element is out of balance, the other elements are also affected. This imbalance will manifest in the individual with many different signs and symptoms. It may show in the facial colour, the sound of the voice, a change in the emotional state as well as disharmony in the functioning of the connected organs.

The Vital Substances

    TCM views the human body as an energy system in which various substances interact with each other to create the physical organism. These basic substances are Qi, Jing, Blood and Body Fluids.

Qi

usually translated as 'energy' or 'vital energy', is the energy that underlies everything in the universe. The Qi inside our bodies is created from the combination of the food we eat and digest via our Stomach and Spleen and the air we breathe into our Lungs. It is the source of body activity and movement, protects us from illness and keeps our bodies warm. If the Qi becomes deficient or blocked, this will result in an inability to transform and transport our food and drink, an inability to keep warm, and a lack of resistance to diseases and depleted energy.

Jing

usually translated as 'essence', is crucial to the development of the individual through life. It is inherited at birth and is stored in the kidneys and allows us to develop from childhood to adulthood and then into old age. It governs growth, reproduction and development, promotes kidney Qi and works with Qi to help protect the body from external factors. Any developmental disorder such as learning difficulties and physical disabilities in children may be due to a deficiency of Jing. Other disorders such as infertility, poor memory and chronic tendency to external disease and allergies may also be due to deficient Jing.

Blood

in TCM is not the same substance that is recognised in Western medicine. In TCM, Blood means the fluid that nourishes and moisturizes the body. It also houses the Shen (or spirit) and aids in the development of clear and stable thought processes. Disharmonies of Blood include deficient Blood, which typically lead to pale complexion, dry skin and dizziness; stagnant Blood causing sharp and intense pain or even the development of tumour; and heat in the Blood causing bleeding symptoms such as uterine haemorrhage or nosebleeds.

Body Fluids

called Jin Ye in Chinese, are considered to be the organic liquids that moisten and lubricate the body in addition to Blood. These fluids moisten and nourish the skin, muscles, hair, joints, brain, spine and bone marrow. Deficiency in body fluids can lead to various forms of dehydration such as dry skin and constipation. If fluids accumulate and get stuck, this can lead to problems of dampness and phlegm in TCM and may manifest as symptoms like lethargy and a feeling of heaviness in the body.

Meridians

    Meridians or channels form a distribution system that carries Qi, Jing, Blood and Body Fluids around the body.

    There are 12 main meridians. Branching from them is a network of other smaller channels. Each main meridian is connected to one of the twelve organs and travels along its own route within the body. For example, the Heart meridian travels in a pathway from the heart itself to the armpit and down the inside of the arm to the little finger. This explains why someone with a heart problem often has a tingling feeling running down the arm to the little finger.

The Zangfu System

    The term Zangfu is a collective name for the various Yin and Yang organs identified in TCM. A Yin organ is called a Zang and a Yang organ is called a Fu. Each organ is considered to have its own functions, but these functions have a far wider scope than the purely physiological function described in Western medicine.

    The Zang consists of the five solid (Yin) organs. They are:
Spleen
Heart
Lungs
Liver
Kidneys

    A sixth organ called the Pericardium, unknown in Western physiology, is also considered as a Yin Zang. In general, TCM considers the Zang to be deeper in the body and to be concerned with the manufacture, storage and regulation of the fundamental substances. For example, the Heart makes blood, the Lung governs Qi and the Kidney stores Jing or Essence. Each Zang also connects to a sense organ and have an associated spiritual aspect. For example, the liver connects to the eye and is associated with anger.
The Fu consists of the six hollow (Yang) organs. They are:
Small Intestine
Large Intestine
Gall Bladder
Bladder
Stomach
San Jiao or Triple Burner (also unknown to Western physiology)

    In general, Fu organs are closer to the surface of the body and have the functions of receiving, separating, distributing and excreting body substances.

The Causes of Disharmony

    TCM divides the causes of disharmony into three main areas:

Internal Causes

    which are illnesses caused by emotions. This include anger, sadness, worry, fear, joy, grief, pensiveness and shock and are usually termed as the seven emotions. While these emotions are normal and healthy responses to the many situations we encounter in daily life, they can cause disease when they are intense or prolonged, or are not expressed or acknowledged over a long period of time.

External Causes

    which are causes of disharmony that relate to climatic conditions. There are six of these conditions, usually known as the six pathogenic factors or the six outside evils. They are: wind, cold, damp, fire and heat, dryness and summer heat. Different climatic conditions are appropriate during each season and we usually adapt to them as they come and go. However, extremes of weather such as a very cold winter or unseasonal weather such as a warm spell in winter make us more vulnerable to the effects of that climatic condition and consequently to becoming ill. Also, people whose underlying energy is weak are more vulnerable to the effects of climatic conditions than those who have a strong constitution.

Miscellaneous Causes

    include work, exercise, diet, sexual activity and physical trauma. TCM thinks that these factors can have a profound influence on our bodies. For example, too much physical work can impair Qi, too much mental activity can damage the Spleen, someone who works outdoors is more liable to be at risk from the six outside evils, excessive sexual activity is considered to be damaging to the Kidney and injuries would make the injured body part more vulnerable to the outside evils.

Diagnosis

    In TCM, the diagnostic process is considered in four areas - known as the Four Examinations. These are:

Looking

complexion, eyes, tongue, nails, hair, gait, stature and affect

Hearing and Smelling

sound of voice and breath, odor of breath, skin

Questioning

current complaints, health history, family health history, patterns of sleep, appetite, digestion, bowel movement, bladder, sweat, pain, emotional features, lifestyle features and gynecological features

Touching

palpation of the body to discover body temperature, body moisture, pain; and taking of the pulse

Treatment

Acupuncture

    Acupuncture is a form of treatment in TCM. The Chinese words for Acupuncture is ZhenJiu. Zhen means acupuncture and Jiu means moxibustion. Acupuncture is the insertion of various needles into points on the body. These points are located and join together in 'channels' or 'meridians', along which Qi flows. The points used in treatment are carefully chosen by the TCM practitioner to disperse any blockages and to bring the patient's Qi into balance.

    Moxibustion is the process whereby a dried herb is burnt, either directly on the skin or indirectly above the skin over specific acupuncture points to warm the Qi and Blood in the channels. Moxibustion is most commonly used when there is a requirement to expel Cold and Dampness from the body.

Herbology

    Herbal Medicine in TCM describes formulae which are made from the roots, stems, bark, leaves, seeds or flowers of many plants, as well as some mineral and animal parts.

    The herbs are usually decocted into a soup. Some come in ready-prepared pill or powder, called 'patent' herbal remedies. The herbal medicine are usually taken in the form of a 'recipe' called a prescription. To make up a prescription, the TCM practitioner carefully blends together a number of herbs which have specific functions.

Tuina

    Tuina is Chinese therapeutic massage. The word 'tuina' actually means 'push grab'. Some of the common techniques include rolling, pushing, grasping, kneading, rubbing, nipping, vibrating, chopping, revolving, pinching and pressing. These techniques are used individually or combined together, and apply on specific acupuncture points, along a channel or meridian, or a whole area of the body.

    Although best known for its capacity to heal joint problems and create relaxation, Tuina can help many other disorders.

Qigong

    The word Qigong is made up of two words, 'Qi' and 'Gong'. 'Qi' usually translated as 'energy' or 'vital energy', is the energy that underlies everything in the universe. The word 'Gong' can be translated as 'practice'. The word QiGong conveys the meaning of 'practice concerned with exercising of Qi'. The use of Qigong to improve and maintain health was first mentioned in the Yellow Emperor's Classic of Internal Medicine, written in about 200 BC.

Acupuncture

    Acupuncturists diagnose human illness in terms of Traditional Chinese Medicine (TCM) which perceives the human organism and it's processes as flows of Qi or energy; somewhat like the currents, eddies and swirls in a stream or lake. The major currents are called channels or meridians or in Chinese: jing luo.

    Twelve of the channels connect with organs in the trunk. Each of the twelve is named for the organ with which it connects. The organ channels and two other channels which follow the front (Ren channel) and rear (Du channel) midline of the body contain the acupuncture points. The names, locations and usages of the points vary with the specific school or nationality of acupuncture. Proper rate of flow and amount of Qi in the channels is the OM definition of health. The acupuncture points are needled to restore or maintain the flow.

    Each of the acupuncture points has specific effects on the different currents and/or organs of the body. In Traditional Chinese Medicine there are at least seven very commonly used groups of acu-points.

Transporting Points

    There are five transporting points on each channel. They begin at the fingers and toes and stop at the elbows and knees. Beginning at the finger or toe tip, they're named Well, Spring, Stream, River, Sea. At each point the flow of the Qi resembles that of the body of water it's named for. At the Well point the flow is slender and thin. The Spring point flow is larger and has direction. At the Stream point the current has depth and more width. The River is wider and deeper yet. And the Sea points are the widest and deepest. The Sea point is also where the Qi goes deep into the body and connects with the organs.

Five Element Points

    The Five Element points begin at the finger and toe tips. Each set of points begins with the names of Wood or Metal and continues up the arm or leg until all five elements are represented. The Five Element relationships are key to selection of the points in treatment.

Yuan-Source Points

    There is one Yuan-Source point on each organ channel. This point will release Source Qi in the system when needled.

Xi-Acumulating-Cleft Points

    The Xi-Cleft-Accumulating points are somewhat like wide shallow spots in a river where the Qi slows and collects. Needling Xi points therefore accesses more Qi and is more effective at clearing a channel than most points.

Mu-Front-Alarm Points

    A Mu-Front-Alarm point is on the front of the body and located close to the organ with which it has a diagnostic relationship. Visual examination, obtaining certain reactions when pressing the point or spontaneous sensation at the point are all significant diagnostic information. This is why Mu is also translated as Alarm.

Shu-Back Points

    The Shu-Back points are on the back on both branches of the Bladder channel. They are each named for an organ or body part and have the same diagnostic relationship with those parts as the Mu points have with the organs.

Window to the Sky Points

    Window to the Sky points are all in the upper third of the body. In one diagnostic model this third of the body is likened to Heaven. If there is poor Qi flow between the upper third and lower thirds then a window must be opened to restore communication between Heaven and Earth. In another model these points are held to facilitate connection to one's own spirit or to the spirit world thus reconnecting one to heaven.

THE EXPERIENCE OF NEEDLES

    Acupuncture needles range from 1/4 inch to several inches in length and a few thousandths to several thousandths of an inch in diameter. One inch and 1.5 inch are the most commonly used lengths of needle. The others are reserved for more specialized use. The vast majority of needles used in the US are stainless steel but copper, gold and silver are still in use. Gold is thought by some to tonify and silver to disperse Qi.

    When the needle is inserted the patient may feel nothing or a sensation akin to a mosquito bite, or perhaps a fly bite. Any pain should subside within a few seconds after insertion. Sensation after needles insertion varies widely.

    You may feel nothing. You may feel a heaviness either around the needle or your whole body. It may seem like there is electricity at the needle or coursing through the channel. Yet another sensation is the feel of water moving through a hose. All of these sensations are held to be the experience of Qi. If the sensation is burning or sharp and/or continuous the needle should be adjusted. According to the Nei Jing the practitioner feels "a fish taking a hook".

    The experience while the needles are in (usually 20 - 40 minutes) depends upon the nature of the imbalance of the flow of energy. Sometimes the patient relaxes profoundly, sometimes he/she feels energized. Many times patients will go to sleep. Other times the patient enters a meditative state. The kinds of experience can vary widely during the course of treatment.

RISKS OF ACUPUNCTURE

    Sterile needles designed for a single use are the most commonly available in the U.S. To assure safety many states require certification by the National Commission for the Certification of Acupuncture and Oriental Medicine. A requirement for board certification is CNT - Clean Needle Technique certification. CNT is a set procedure for handling and use of acupuncture needles and was adapted from the procedures for hypodermic injections. However, not all acupuncturists observe CNT. It isn't required in all parts of the world. So it's very important to make certain an acupuncturist uses safe needle procedures before taking treatment with him or her.

    Clean Needle Technique - CNT minimizes the possibility of infection but there are other risks. The most serious is the puncture of an organ. Though the research on the frequency of organ puncture is self-contradictory and inconclusive it is safe to say that organ punctures are not common occurrences.

    Other risks are more nuisance than danger. They include nausea, dizziness, bruising, and fainting - To minimize the danger of falling, be sure you are well supported and/or preferably in a lying position when receiving acupuncture.