What Is It?
Traditional Chinese medicine (TCM) is a system of health care based on the late-twentieth-century standardization of medical practices that originated in China some 2500 years ago. Two classic medical texts, the Nei Jing (compiled from 100 B.C. to 100 A.D.) and the Nan Jing (written circa 100 to 200 A.D.) were important early documents that presented the core concepts of TCM, and they have informed generations of scholars and practitioners ever since. These core concepts suggest that disease is the result of imbalances in the flow of the body's vital energy, or qi (pronounced "chee"), and that the human body is a microcosm of the basic natural forces at work in the universe.

As TCM evolved over the centuries, it came to include treatment of disease using acupuncture, herbal medicine, dietary principles, physical manipulation of the body tissues, therapeutic exercise and movement (tai chi), and the mind-body practice of qigong. TCM reached its apex during the Ming dynasty (1368-1644) then gradually declined to the status of a folk practice until 1949. It was then that the government of the People’s Republic of China began to exploit the remaining TCM practitioners as a means of making health care accessible to a suffering and underserved population.

While TCM was fading in China it was nevertheless migrating to the rest of the globe as traders, missionaries, and diplomats visited East Asia in the 17th and 18th centuries and returned home with reports and texts of the classical practices. Chinese immigrating to the United States in the 19th century brought other components of traditional practice with them.

It wasn't until 1971, however, that U.S. citizens really became aware of TCM--and of acupuncture in particular. This came about because James Reston, a New York Times reporter became stricken with appendicitis while doing a story on a ping-pong tournament in Beijing, and was treated for post-surgical pain with acupuncture. In a front-page Timesstory he wrote, "I've seen the past, and it works!" This exposure came at a time when many Americans were looking for a more holistic, naturalistic approach to health care, and caused quite a stir among the Western medical community. Since then, acupuncture has become a widely accepted form of treatment in the U.S., and other aspects of TCM are gaining supporters as well.

How Does It Work?
Practitioners of TCM seek to promote or restore health by diagnosing and treating "disharmonies" or imbalances in the qi, or natural vital energy of the body. A typical TCM evaluation will include three components:

The first assesses the balance between yin and yang--complementary but opposing qualities that represent the natural dualities of the world, such as male/female, day/night, and hot/cold.

The second considers the correspondence of the ailment to the five Chinese elements--wood, fire, earth, metal, and water. It is believed that each internal organ and body system is related to an elemental quality and that the body reflects the natural world in this way.

The third determines which organ or metabolic system requires the most support from therapy. Because of this ancient symbolic method of describing the body in natural terms, a TCM diagnosis can sound like a weather report. Colds and flus may be described as "wind-heat invading the lungs," or "wind-cold affecting the stomach." Some kinds of endometriosis could be described as "damp-heat " in the "lower burner." An asthma patient might have "a failure of the kidneys to moisten the lungs." These descriptive diagnoses can lead some conventional physicians to conclude that TCM is "unscientific," whereas the actual practice of TCM is a sophisticated system based on the practical science of observing and altering the natural functions of the body.

Practitioners of TCM use tools such as acupuncture, massage, qigong, and herbal medicine to restore balance and health to the body. A change in diet may also be recommended. For example, if someone's condition is showing too much dampness and cold, the practitioner may suggest cutting out cold foods such as salads, and recommend drying and warming herbs for dietary support. If the condition is more a physical problem, such as an injury, the treatment may focus on the muscles, nerves, tendons, and circulation at the site of the injury, with acupuncture, massage, and anti-inflammatory herbs all being prescribed.

In fact, Chinese herbs are prescribed in most TCM practices. These remedies are often sophisticated and complex mixtures that were developed for organ imbalances and disease support--and standardized--centuries ago. Those most often used today have been carefully formulated to have minimal side effects.

Chinese herbs are available in the U.S. in liquid, tablet, or powder form and can be prescribed by practitioners familiar with the proper diagnosis of a particular condition. In China, some TCM practitioners specialize in herbal medicines and are expert at modifying and individualizing the classical herbal formulas. These practitioners can artfully construct a mixture from raw herbs or powders to treat disharmonies of the organs as well as any current symptoms.

If you plan to take Chinese herbs, make sure any mixtures you use have standardized content and are processed under the direction of a licensed health professional familiar with their medicinal effects. Individualized herbal mixtures should be prescribed only under the advice of a TCM practitioner who has training in herbal drug compounding. A TCM herbal mixture could be as safe as an over-the-counter cold and flu drug mixture, or as powerful as a strong prescription drug.

What You Can Expect
A TCM examination is thorough, but noninvasive. The practitioner will take a careful medical history, noting your body's reaction to stress and your tendencies toward illness symptoms. He will observe the color and form of your face and body, note the condition of your skin and nails, check how your breath and body odor smells, and look at your posture and demeanor. The condition of your tongue--its shape, color, and coating--also provides important data on the way your circulation and metabolism is affecting your internal organs. Your pulse will be felt at three different points on each wrist, each location corresponding to a different part of the body. Considered together, this information gives the practitioner a sense of your body's current functioning.

From this examination, the practitioner will consider the patterns of imbalance in your body and will choose the proper type of treatment for you. Depending on the training of the practitioner, treatment may consist of acupuncture, massage, change in diet, herbal remedies, qigong, or any combination of these.

Duration and frequency of treatment depends on the ailment and the person being treated. Acute problems may require one to three visits over two weeks, whereas a course of acupuncture for a chronic problem may require 12 treatments in three months to see positive results. Herbal tonics for restoring healthy internal organ function may require weeks of use, whereas herbs for colds and flu can show good results in hours. Practitioners with other skills in addition to their TCM training, such as chiropractic, homeopathy, Western physical medicine, and drug therapy, may integrate these treatments with the TCM program.

Health Benefits
The various techniques used in TCM can address a wide range of illnesses. Acupuncture has been shown to be particularly effective in relieving chronic pain--caused by such ailments as arthritis, sinusitis, headache, PMS, and back pain--and has aided postoperative pain as well. It can also ease nausea and other discomforts associated with cancer treatment. In addition, acupuncture has been beneficial in rehabilitation for certain neurologic problems such as stroke. It is also used in treating addiction to cigarettes, alcohol, and other drugs.

Chinese herbal remedies are often used to treat acute ailments such as the flu and the common cold, and are also recommended for chronic conditions such as fibromyalgia, migraine headaches, and irritable bowel syndrome.

Chinese massage techniques, such as anmo and tuina, utilize the same points as acupuncture to unblock qi and ease the stress and tension that often accompanies illness. Anmo involves pressing and rubbing motions; tuina is a thrusting and rolling type of massage.

Many research studies of the various types of TCM are currently ongoing. A 1999 study published in Clinical and Experimental Obstetrics and Gynecology showed that acupuncture eased pain following breast cancer surgery. Another recent study in Alternative Therapies in Health and Medicine found that practicing tai chi helped improve mobility for people with multiple sclerosis.

A 1998 study published in the Journal of the American Medical Association showed that Chinese herbal medicine helped improve the symptoms of irritable bowel syndrome. A group of 116 patients were divided into groups: One group was given an individualized Chinese herbal treatment, one group was given a standard Chinese herbal formulation, and the third group was given a placebo, or dummy pill. The two groups who received the herbs experienced significant improvement in their symptoms (the individualized group maintained the improvement longer), as compared to the placebo group.

Preliminary studies have also been conducted on Chinese herbal treatments and skin conditions. A study published in Lancet found that 31 patients with atopic dermatitis appeared to be helped by Chinese herbal therapy. A review of clinical trials in the British Journal of Clinical Pharmacology found two trials that showed Chinese herbs as a more effective treatment than a placebo for treating eczema. More study is needed in this area, however, because some adverse reactions have been reported to the treatment.

How To Choose a Practitioner
In the United States, practitioners typically specialize in a particular component of TCM, such as acupuncture, herbs, or massage, rather than the entire discipline. The regulation of TCM varies from state to state. Acupuncturists are licensed in many states and Doctors of Oriental Medicine (O.M.D.) are licensed in some states to prescribe herbal remedies as well as acupuncture treatments. Many biomedically trained doctors, naturopaths, osteopaths, and chiropractors have studied acupuncture and other branches of TCM and incorporated them into their practices.

Mastering the full range of Chinese medicine is a complex process that requires many years of study and practice. However, medical personnel with less training may still be able to perform acupuncture and herbal medicine safely, by working according to protocols designed by TCM practitioners. As you would with any health provider, check into your TCM practitioner's training and background.

Cautions
If you have a chronic condition or a new acute problem that is seriously disabling you, get a diagnostic evaluation from a conventional primary-care physician before consulting an acupuncturist.

Plan on coordinating your care between your biomedical doctor and your acupuncturist. If they won’t work together, find ones that will.

Be sure your acupuncturist uses sterile, disposable needles.

As with any health practitioner, if the condition is not improving in a reasonable time, get a second opinion. There are increasing numbers of practitioners familiar with both Western and traditional Chinese medicine, should you need a re-evaluation.

Acupuncturists in California and Nevada must take an exam in order to dispense Chinese herbs. In other states, herbal certification is voluntary. Ask if your acupuncturist has passed the National Certification Commission for Acupuncture and Oriental Medicine herbal exam.

Herbal remedies are regulated as "foodstuffs" under current Federal laws. This means that the Food and Drug Administration (FDA) has not evaluated their effectiveness and safety as therapies. Be sure to work only with a licensed and certified practitioner to ensure that you get the best care.