TRADITIONAL CHINESE MEDICINE

What is Traditional Chinese Medicine (TCM)?

Initially it is useful to look at the meaning of the term Traditional Chinese Medicine. Through a long history, both written and practical, Chinese Medicine has developed as a system dependent upon many traditions. These traditions have emanated from a synthesis of not only philosophical, religious, intellectual and cultural ideas, but also as a result of the varying political influences that have affected the evolution of Chinese society. Chinese Medicine has in the past been subject to many micro interpretations. These varying interpretations have been dependant on one's heritage and subjective training, both from a regional and personal perspective. Even within these micro variations of thought there has always been a broader consensual body of knowledge based on interpretations of seminal classical texts. It is within this historical framework that the term Chinese Medicine (Zhong yi ) was adapted by the Chinese Communist Party (CCP) in the 1950s to encapsulate a coherent and standardised body of knowledge (Birch and Felt:52). During this time, medical schools with standardised curricula were established to teach basic medical sciences, traditional pharmacotherapy, acupuncture and Chinese remedial massage. To accomplish this the theoretical basis of Chinese medicine had to be standardised and adapted to classroom teaching, as Birch and Felt suggest, " for the first time in history a united medicine was abstracted from the materials of tradition" (1999:52).

This standardised version of Chinese medicine has come to be known by those Chinese interested in exporting this system to the West, and by most western consumers, as Traditional Chinese Medicine (TCM)

What should be kept in mind is the political censorship exercised in all eras, and by all persuasions through the development of China's inherent "traditional" medical system, the present Chinese Communist Party (CCP) notwithstanding. Although the curricula developed by the institutionalisation of Chinese Medicine is used as a firm basis for contemporary western instruction, many of the philosophical concepts concerning the mental and emotional aspects of disharmony have been systematically converted to a purely somatic realm by the contemporary political culture inherent in China (Wilmot :195). In order to create a more holistic educational framework these philosophical concepts have been reintroduced into this particular course and it is within this context that the term Traditional Chinese Medicine (TCM) is used in this school.

OVERVIEW

Conceptually TCM is based on an understanding of health and illness which differs substantially from that in western medicine. Clinical phenomena are interpreted by reference to systems based theories of bodily function. These systems are interpreted within a more holistic observational diagnostic framework. This framework utilises a phenomenological (interpretive) paradigm, rather than a reductionist (normative) paradigm which is the predominant paradigm used in the contemporary western medical system (Benn, 6).

Modern trends currently suggest a movement toward a more integrated approach to the development of medical practice which can be interpreted as beneficial. Within this integrated approach the traditions of both systems are respected within a complementary, rather than alternative forum. There is a strong emphasis toward this complementary trend reiterated throughout the structure of this particular course.

Traditional Chinese Medicine (TCM) is as diverse in its practice as is Western medicine.

It is employed in both acute and chronic illnesses and it includes:

• Medicinal therapy
  
  Chinese herbal medicine including the use of plant, animal and mineral substances. These medicinal substances are applied in both internal and external pharmacological therapy.

• Acupuncture and ancillary techniques

Including:

Traditional manual needle stimulation.

Modern usage of laser and electrical stimulation.

Moxibustion.

Cupping.

Scraping.

• Chinese Massage

• Dietary. Exercise and Lifestyle advice

(Bensoussan,A and ,Myers, S.:1996)

*(Please note the acknowledgment to Bensoussan and Myers: 1996, upon whose framework the following report has been based.)

Chinese Medical Theory

Chinese medical theory and practice is based upon a sophisticated diagnostic and therapeutic body of knowledge providing a sound basis for clinical practice. The diagnostic categories of TCM describe recurring clinical patterns of both subjective symptoms and objective signs. They have been used with relative consistency over the twenty centuries of recorded clinical practice. In this way TCM may be viewed as an empirical science.

For example, in TCM, health and disease is defined by specific characteristics. These characteristics include not only the absence or presence of discomfort and pain, regularity of sleep, digestive, respiratory, sexual and other behaviours, but also characteristic observable qualities in the patient's mental function and demeanour as well as tongue, skin, hair etc. Another important aspect of TCM diagnostics pertains to palpation skills associated with specific TCM anatomical functions of the radial pulse and energy meridians.

TCM shares some common ideas with other forms of complementary medicine, including belief in a strong interrelationship between the environment and bodily function, and an understanding of illness as starting with an imbalance 'energy' or vital force (a concept central to many complementary medical practices). The TCM understanding of this concept of energy is defined as QI, a fundamental substance which has the potential to activate all bodily functions and therefore is an essential force to manipulate in the restoration of health to the ailing patient.

'Pattern identification' is the irreducible basis for treatment using TCM techniques. While TCM will, like western allopathic medicine, employ tactics aimed at eradicating pathogens, the emphasis, particularly in chronic conditions, is on the restoration of normal physiological functioning through the manipulation of essential bodily substances with various combinations of medicinal herbs, acupuncture, dietary and lifestyle advice.

Kaptchuk (1983:15) highlights the differences between western and eastern clinical approaches, in a typical study a western physician may diagnose, by endoscopy, six patients with stomach pain as having peptic ulcers and then prescribe similar medication for each patient. However when each patient is examined by a physician trained in TCM, the possibility of up to six differing syndromes may present. Each syndrome comprises a specific set of signs and symptoms in association with the western diagnosis of "peptic ulcer". Because of this the aetiology and pathology of each case is significantly different according to the TCM diagnostic paradigm. Therefore the treatment for each patient will differ, based on the unique clinical picture. Even though these six patients all have peptic ulcers, no two are likely to receive the same TCM medication.

TCM is considered as complementary to conventional western practice. It is rooted in its cultural tradition and is capable of generating therapeutic options for a range of illnesses. TCM has traditionally been used by large numbers of Australians of East Asian origin. However, recently TCM has increasingly assumed an international flavour and is now an established modality used increasingly by those Australians of non-Asian origin. In this sense, TCM is an important component of Australia's multicultural mix.

CONTEMPORARY FOCUS

(Please note the following is an edited version of Bensoussan and Myers, as it is acknowledged that this information is authoritariative (Dept. of Human Services, 1997).

China

In China, Chinese herbal medicine (CHM) and acupuncture play a significant role in the treatment and prevention of a wide range of common and chronic diseases. Chinese statistics in the mid-eighties revealed that 80% of the one billion population used a variety of herbal preparations not only for the treatment of a wide range of diseases but also as a prophylactic. (Hu, S.L, 1986: 9-12)

Similarly, acupuncture is used widely in most Chinese hospitals and in a large number of public health clinics. In China, all TCM techniques are employed in in-patient and outpatient settings in public hospitals and in private practices. A number of large public hospitals are dedicated principally to the provision of TCM.

Australia

The recent growth in the practice of TCM in Australia is significant:

• Australian distributors of Chinese medicines estimate that importation of raw and proprietary Chinese medicines has grown four-fold since 1992 (Bensoussan and Myers.1996)

• In 1986 it was estimated that at least 20% of the Victorian public used some form of unconventional therapy (Dixon. 1984-6)

• A 1992-93 survey reported in the Lancet concluded that half the South Australian population has used alternative medicines and one fifth visit alternative medical practitioners each year (MacLennan.: 569-573) This study also estimated that $621 million was spent by Australians on alternative medicines in 1992-93, compared with the $360 million of patient contributions for all pharmaceutical drugs purchased in the same year.

• Similar findings were noted in the United Kingdom, the United States, Germany and Europe in general, where at least as much appears to be spent out of pocket on alternative medicines as on pharmaceuticals or hospitalisations (Eisenberg, et.al: 246-252).

The most recent development in an evolution towards the more significant acceptance of TCM, at least as to the prevalence of TCM practice in Australia, has culminated in the Chinese Medicine Registration Act being passed by the Victorian Parliament on 9th May 2000, and receiving Royal Assent on 16th May 2000. This regulatory procedure is incumbent on both practitioners and course providers.

References

Benn, D.L 'Compare and contrast The Experimental (Normative) and Phenomenological (Interpretive) approaches to Educational research' Unpublished paper, M.Ed.. (UNE), 2001.

Bensoussan,A and ,Myers,S Towards A Safer Choice, the Practice of Traditional Chinese Medicine in Australia, Faculty of Health University of Western Sydney and Dept. of Human Services (Vic.),1996.

Birch,S,J. & Felt, R.L. Understanding Acupuncture. Churchill Livingstone,Edinburgh,1999.

Dixon J (Chairperson). Parliament of Victoria, Social Development Committee. Inquiry into alternative medicine and the health food industry. 1984-86, report Vol 2.

Eisenberg DM, 'Unconventional medicine in the United States:

Kessler RC, prevalence costs and patterns of use'.

Foster C et al., New England Journal of Medicine 1993; 328(4):246-252.

Hu SL. 'Exploring the future of CHM'. Acta Medica Sinica 1986; 1(2):9-12.

Dept.Human Services Traditional Chinese Medicine Options for Regulation of Practitioners -Discussion Paper Publication no.96/0480, September 1997

Kaptchuk T. Chinese Medicine: the web that has no weaver. London: Rider; 1983.

Wilmot,D. 'Traditional Oriental Medicine: The Need for Historical Perspective' American Journal of Acupuncture, Vol.26 No. 2/3 1998

What is Traditional Chinese Medicine (TCM)?

Initially it is useful to look at the meaning of the term Traditional Chinese Medicine. Through a long history, both written and practical, Chinese Medicine has developed as a system dependent upon many traditions. These traditions have emanated from a synthesis of not only philosophical, religious, intellectual and cultural ideas, but also as a result of the varying political influences that have effected the evolution of Chinese society. Chinese Medicine has in the past been subject to many micro interpretations. These varying interpretations being dependant on one's heritage and subjective training, both from a regional and personal perspective. Even within these micro variations of thought there has always been a broader consensual body of knowledge based on interpretations of seminal classical texts. It is within this historical framework that the term Chinese Medicine (Zhong yi ) was adapted by the Chinese Communist Party (CCP) in the 1950s to encapsulate a coherent and standardised body of knowledge (Birch and Felt:52). During this time, medical schools with standardised curricula were established to teach basic medical sciences, traditional pharmacotherapy, acupuncture and Chinese remedial massage. To accomplish this the theoretical basis of Chinese medicine had to be standardised and adapted to classroom teaching, as Birch and Felt suggest, " for the first time in history a united medicine was abstracted from the materials of tradition" (1999:52).

This standardised version of Chinese medicine has come to be known by those Chinese interested in exporting this system to the West, and by most western consumers, as Traditional Chinese Medicine (TCM).

What should be kept in mind is the political censorship exercised in all eras, and by all persuasions through the development of China's inherent "traditional" medical system, the present Chinese Communist Party (CCP) notwithstanding. Although the curricula developed by the institutionalisation of Chinese Medicine instruction is used as a firm basis for contemporary western instruction, many of the philosophical concepts concerning the mental and emotional aspects of disharmony have been systematically converted to a purely somatic realm by the contemporary political culture inherent in China (Wilmot :195). In order to create a more holistic educational framework these philosophical concepts have been reintroduced into this particular course, and it is within this context that the term Traditional Chinese Medicine (TCM) is used in this document.

OVERVIEW

Conceptually TCM is based on an understanding of health and illness which differs substantially from that in western medicine. Clinical phenomena are interpreted by reference to systems based theories of bodily function. These systems are interpreted within a more holistically based observational diagnostic framework. This framework operates within a more phenomenological (interpretive) paradigm, rather than a reductionist (normative) paradigm which is used predominantly within the contemporary western medical system (Benn,6). Modern trends currently suggest a more integrated approach to the development of medical practice is beneficial. Within this approach the traditions of both systems are respected within a complementary, rather than alternative forum. There is a strong emphasis toward this complementary trend reiterated throughout the structure of this particular course.

Traditional Chinese Medicine (TCM) is as diverse in its practice as is Western medicine.

It is employed in both acute and chronic illnesses and it includes:

Medicinal therapy

• Chinese herbal medicine includes the use of plant, animal and mineral substances as an internal and external pharmacological therapy.

Acupuncture and ancilliary techniques
Including:

• Traditional manual needle stimulation.
• Modern usage of laser and electrical stimulation.
• Moxibustion.
• Cupping.
• Scraping.

Chinese Massage

• Dietary. Exercise and Lifestyle advice

(Bensoussan,A and ,Myers, S.:1996)

*( Please note the acknowledgment to Bensoussan and Myers:1996, upon whose framework the following report has been based.)

Chinese Medical Theory

Chinese medical theory and practice is based upon a sophisticated diagnostic and therapeutic body of knowledge providing a sound basis for clinical practice. The diagnostic categories of TCM describe recurring clinical patterns of both subjective symptoms and objective signs. They have been used with relative consistency over the twenty centuries of recorded clinical practice. In this way TCM may be viewed as an empirical science.

For example, in TCM, health and disease is defined by specific characteristics. These characteristics include not only the absence or presence of discomfort and pain, regularity of sleep, digestive, respiratory, sexual and other behaviours, but also characteristic observable qualities in the patient's mental function and demeanour as well as tongue, skin, hair etc. Another important aspect of TCM diagnostics pertains to palpation skills associated with specific TCM anatomical functions of the radial pulse and energy meridians.

TCM shares some common ideas with other forms of complementary medicine, including belief in a strong interrelationship between the environment and bodily function, and an understanding of illness as starting with an imbalance 'energy' or vital force (a concept central to many complementary medical practices). The TCM understanding of this concept of energy is defined as QI, a fundamental substance which has the potential to activate all bodily functions and therefore is an essential force to manipulate in the restoration of health to the ailing patient.

'Pattern identification' is the irreducible basis for treatment using TCM techniques. While TCM will, like western allopathic medicine, employ tactics aimed at eradicating pathogens, the emphasis, particularly in chronic conditions, is on the restoration of normal physiological functioning through the manipulation of essential bodily substances with various combinations of medicinal herbs, acupuncture, dietary and lifestyle advice.

Kaptchuk (1983:15) highlights the differences between western and eastern clinical approaches, In a typical study a western physician may diagnose, by endoscopy, six patients with stomach pain as having peptic ulcers and then prescribe similar medication for each patient. However when each patient is examined by a physician trained in TCM, the possibility of up to six differing syndromes may present. Each syndrome comprises a specific set of signs and symptoms in association with the western diagnosis of "peptic ulcer". Because of this the aetiology and pathology of each case is significantly different according to the TCM diagnostic paradigm. Therefore the treatment for each patient will differ, based on the unique clinical picture. Even though these six patients all have peptic ulcers, no two are likely to receive the same TCM medication.

TCM is considered as complementary to conventional western practice. It is rooted in its cultural tradition and is capable of generating therapeutic options for a range of illnesses. TCM has traditionally been used by large numbers of Australians of East Asian origin. However, recently TCM has increasingly assumed an international flavour and is now an established modality used increasingly by those Australians of non-Asian origin. In this sense, TCM is an important component of Australia's multicultural mix.

CONTEMPORARY FOCUS

(Please note The following is an edited version of Bensoussan and Myers, as it is acknowledged that this information is authoritariative (Dept. of Human Services, 1997).

China
In China, Chinese herbal medicine (CHM) and acupuncture play a significant role in the treatment and prevention of a wide range of common and chronic diseases. Chinese statistics in the mid-eighties revealed that 80% of the one billion population used a variety of herbal preparations not only for the treatment of a wide range of diseases but also as a prophylactic. (Hu, S.L, 1986: 9-12)

Similarly, acupuncture is used widely in most Chinese hospitals and in a large number of public health clinics. In China, all TCM techniques are employed in in-patient and outpatient settings in public hospitals and in private practices. A number of large public hospitals are dedicated principally to the provision of TCM.

Australia
The recent growth in the practice of TCM in Australia is significant:

• Australian distributors of Chinese medicines estimate that importation of raw and proprietary Chinese medicines has grown four-fold since 1992 (Bensoussan and Myers.1996)
• In 1986 it was estimated that at least 20% of the Victorian public used some form of unconventional therapy (Dixon. 1984-6)
• A 1992-93 survey reported in the Lancet concluded that half the South Australian population has used alternative medicines and one fifth visit alternative medical practitioners each year (MacLennan.: 569-573) This study also estimated that $621 million was spent by Australians on alternative medicines in 1992-93, compared with the $360 million of patient contributions for all pharmaceutical drugs purchased in the same year.
• Similar findings were noted in the United Kingdom, the United States, Germany and Europe in general, where at least as much appears to be spent out of pocket on alternative medicines as on pharmaceuticals or hospitalisations (Eisenberg, et.al: 246-252).

The most recent development in an evolution towards the more significant acceptance of TCM, at least as to the prevalence of TCM practice in Australia, has culminated in the Chinese Medicine Registration Act being passed by the Victorian Parliament on 9th May 2000, and receiving Royal Assent on 16th May 2000. This regulatory procedure is incumbent on both practitioners and course providers.

References