TCM Common Sense

TCM, or Traditional Chinese Medicine, is an ancient system of health and wellness. Many people around the world use TCM practices such as acupuncture, cupping, herbs, to fight disease, and more importantly, to prevent it. 

When should you seek help from TCM? As described in the WebMD article What Is Traditional Chinese Medicine, TCM may be a good choice if you:

  • Have a lot of different symptoms with no clear cause
  • Need to treat side effects from drugs
  • Have tried Western medicine but didn’t get results
  • Want to prevent illness

Nowadays, elite hospitals like the Mayo Clinic, Cleveland clinic, University of California San Francisco, Duke University Medical Center are offering acupuncture and massage among other services. However, many scientists still look skeptically at TCM. Scientific American published an article 5 Scientists Weigh in on Acupuncture on July 1, 2014. In this article, both sides of the divided opinions of scientists about TCM are discussed. However, most of the information about TCM is still from one side of opinions. For example, in the term of Acupuncture at Wikipedia, acupuncture is described as a pseudoscience and has been characterized as quackery. This causes a lot misunderstanding about TCM.

In this article, we will discuss some basic TCM concepts.

1. What is TCM?

2. How many people use TCM?

3. Why should I care about TCM?

4. What is TCM syndrome?

5. What is TCM Constitution?

1. What is TCM?

There is a definition of TCM in the book Genomics and Society:

“Traditional Chinese medicine (TCM) is a range of medicine practices sharing common concepts which have been originated and developed in China, including various forms of acupuncture, dietary therapy, herbal medicine, moxibustion, and physical exercise, which collectively predate to the birth of Chinese civilization.”

This TCM definition is widely accepted in the science community. It is also reused by ScienceDirect, the leading platform of peer-reviewed literature.

On the World Health Organization (WHO) website, traditional medicine, which includes TCM from China, Kampo from Japan, Hanyak from Korea, Ayurveda from India and Tuoc from Vietnam, and traditional medicine from other countries as well, is defined as “the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”

Based on the above two definitions, it is clear that TCM contains two components. The first component is the practices such as acupuncture, dietary therapy, herbal medicine, etc. The second one is a common concept, which includes TCM Theory, beliefs, and experiences.

2. How many people use TCM?

Among all the traditional and complementary medicine in the world, TCM is one of the most accepted options and is getting more and more popular. There are 170 WHO member states acknowledging their use of Traditional and Complementary medicine since 2018. On December 21, 2011, Nature published an article TCM: Made in China. The article reported some statistical data about TCM Prevalence.

"Millions of patients around the world use TCM or related practice. In Hong Kong and mainland China, approximately 60% of the population has consulted traditional medicine practitioners at least once. According to the latest national survey data, anywhere from 60% to 75% of the populations of Taiwan, Japan, South Korea, and Singapore use traditional medicine at least once a year."

"According to the Centers for Disease Control and Prevention in Atlanta, Georgia, four out of ten US adults use complementary and alternative medicine (CAM) in a given year. The CAM category includes TCM and other herbal medicines, as well as non-traditional medicines such as homeopathy — so using CAM as a proxy for TCM might overestimate its use, but it does indicate a general willingness to seek alternative forms of therapy."

Europe, too, is experiencing a growth in the use of TCM. In 2010, exports of TCM products from China to European countries amounted to nearly US$2 billion, and that figure is rising at 10% per year. National surveys have found that, in the United Kingdom, approximately one in ten people had used CAM in the past year, whereas in Switzerland and the Scandinavian countries, the equivalent figures were between three and five out of ten.

Australia has even higher figures: a national survey found that two-thirds of the population had used CAM in the past year and, at 69 million, the number of visits by Australian adults to CAM practitioners was almost identical to the number of visits made to medical doctors.

In 2019, WHO formally approved the 11th version of the "International Statistical Classification of Diseases and Related Health Problems" (ICD), which will include TCM remedies for the first time. According to the article Why Chinese medicine is heading for clinics around the world published on Nature in 2018, “Chapter 26 is meant to be a standard reference that all practitioners can use to help diagnose disease and assess possible causes. For example, ‘wasting thirst syndrome’ is characterized by excessive hunger and increased urination and explained by “factors which deplete yin fluids in the lung, spleen or kidney systems and generate fire and heat in the body”. On the basis of those observations, physicians can work out how to treat them. The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics, and moxibustion — in which practitioners burn herbs near the skin of the patient. Spinach tea, celery, soya beans, and other ‘cooling’ foods would also be recommended.”

3. Why should I care about TCM?

Even though TCM is widely known to the world, TCM theory is very complicated. Some people may think that it is TCM practitioners who should know TCM. This is not true.

On Oct 6, 2010, New York Times published an article Rampant Fraud Threat to China’s Brisk Ascent. In this article, a famous TCM-related fraud was reported.

“No one disputes Zhang Wuben’s talents as a salesman. Through television shows, DVDs, and a best-selling book, he convinced millions of people that raw eggplant and immense quantities of mung beans could cure lupus, diabetes, depression, and cancer."

“For $450, seriously ill patients could buy a 10-minute consultation and a prescription — except Mr. Zhang, one of the most popular practitioners of traditional Chinese medicine, was booked through 2012."

“But when the price of mung beans skyrocketed this spring, Chinese journalists began digging deeper. They learned that contrary to his claims, Mr. Zhang, 47, was not from a long line of doctors (his father was a weaver). Nor did he earn a degree from Beijing Medical University (his only formal education, it turned out, was the brief correspondence course he took after losing his job at a textile mill)"

Zhang Wuben was not telling something absolutely from the air, even though he significantly exaggerated the function of Mung beans and raw eggplants. The fact that millions of people were convinced by his theory indicated that most people do not have any TCM common sense at all.

TCM thinks that mung beans can be used to clear heat, relieving toxicity, alleviate thirst. For diabetes patients with the symptom of thirst, mung beans can help improve the health condition. However, not all diabetes have this symptom. Only diabetes patients with specific TCM syndrome, in Chinese terms Zheng(证), such as yin deficiency syndrome, will feel extremely thirsty and can use mung beans to alleviate thirst.

4. What is TCM syndrome?

TCM syndrome is one of the most important TCM concepts. So what is TCM syndrome?

According to the article What is “zheng” in traditional Chinese medicine? “In English, zheng is translated as “pattern” or “TCM syndrome.” Zheng is defined as a comprehensive summary of the cause, location, nature, and development tendency of an illness at a certain stage during its course. It specifies the state of interaction between the pathogenic factors and the body's corresponding reactions."

“Zheng may change at different stages of the same illness as a result of changing body conditions during the course of an illness. Different illnesses may present the same zheng because of similar pathogenesis during their progressions.

Different illnesses may present the same Zheng or syndrome, and the same illness can have different Zheng or syndrome. There are around 240 common TCM syndromes in total. In TCM, treatment is determined based on Zheng, or syndrome. Therefore, the same treatment can be used for various illnesses if the illnesses present the same Zheng. On the other hand, different treatments might be used for the same illness if the Zheng is different.

As a quick example, a boy who only sleeps 3 hours every day for a whole year may develop a blood deficiency syndrome. Similarly, a girl who only eats two cucumbers every day for a few months may also develop a blood deficiency syndrome. The boy may suffer from headaches, while the girl may have serious cold hands and feet. Since they both have blood deficiency syndrome, the same treatment to tonify blood can be prescribed for them. As a good TCM doctor, it is also necessary to find out the cause of the Zheng, and provide advice accordingly - eat more and sleep more. (source: On Blood Deficiency)

In the article Traditional Chinese Medicine Zheng in the Era of Evidence-Based Medicine: A Literature Analysis, the top 20 most frequent Disease-Zheng are reported based on all research articles published between 1990 to 2010.

There are 7 different TCM Zhengs related to diabetes mellitus. Both diabetes mellitus and hepatocirrhosis may have the same TCM Zheng of Kidney yin deficiency.

5. What is TCM Constitution?

For each TCM Zheng, there is a recommended treatment. However, there are more than 240 TCM Zheng and it needs intensive training to know each of them. Therefore, Prof. Qi Wang and his research team proposed the most representative means of classification known as “the constitution rule of nine”, which classifies people's constitution into 9 types as follows:

Type 1. Balanced Constitution (23% of the population in a research falls into this type)
  • Ruddy complexion
  • Good sleep
  • Energetic
  • Regular pulse
  • Light red tongue with thin coating

Type 2. Qi-deficiency (19%)
  • Easy to catch cold and get tired
  • Shortness of breath
  • Low voice
  • Lassitude
  • Easy to sweat
  • Muscle grows flabby
  • Reddish tongue with tooth print
  • Weak pulse

Type 3. Phlegm-dampness (11%)
  • Overweight with fat abdomen fatness
  • Light yellow complexion
  • More oil on the face
  • More phlegm and sticky sensation in mouth
  • Greasy and fat tongue with white thick coating
  • Laziness prone to lie down
  • Slippery pulse

Type 4. Dampness-heat (9%)
  • Proneness to acne
  • Foul breath
  • Sticky stool
  • Dirty and greasy complexion
  • Sleepiness
  • Bitter taste in mouth
  • Feel somatic heavy
  • Thirst
  • Short and yellow urine
  • Red tongue with yellow and greasy coating
  • Slippery and rapid pulse
Type 5. Yang-deficiency (9%)
  • Cold hands and feet
  • Fear of cold
  • Pale face
  • Prefer hot food and drink
  • Fat and tender tongue with tooth print and white coating
  • Deep and weak pulse

Type 6. Yin-deficiency (8%)
  • Feverish sensation in the palms and soles
  • Dry eyes, mouth, throat, skin and stool
  • Flush face
  • Constipation
  • Easily suffering from insomnia
  • Prefer cool drink
  • Reddish tongue with thin or no coating
  • Thready and weak pulse

Type 7. Blood Stasis (8%)
  • Hyperpigmentation
  • Dim lip and tongue
  • All kinds of pain
  • Easy to have bruises
  • Dark and dim skin
  • Lips and eye sockets
  • Roughness of skin
  • Uneven pulse

Type 8. Qi Stagnation (7%)
  • Like to sigh
  • Depression
  • Emotional fragility
  • Anxiety
  • Doldrums
  • Easy to insomnia
  • Light red tongue with thin coating
  • Stringy pulse

Type 9. Inherited Special Constitution (5%)
  • Hives (urticaria)
  • Pharyngeal itching
  • Nasal obstruction
  • Sneeze
  • Asthma
  • Various hereditary physical defects and allergic constitution

Reference 1: Association between Nine Types of TCM Constitution and Five Chronic Diseases: A Correspondence Analysis Based on a Sample of 2,660 Participants
Reference 2: The theory development of traditional Chinese medicine constitution: a review
Reference 3: Effects of TCMC on Transformation of Good Health Status to Suboptimal Health Status: A Nested Case-Control Study

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