"TCM relies on the vast amount of trial-and-error medical knowledge over a 4,000-year timeframe"
Normally, traditional Chinese medicines are prescribed while patients come for their diagnoses and treatment as part of entire healing process.
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The History of Traditional Chinese Medicine
For those of Chinese descent, traditional Chinese medicine (TCM) is an important part of their cultural heritage. Many have some degree of familiarity with TCM practices, which are aimed at maintaining health and preventing disease by combining lifestyle practices (e.g., diet, exercise, meditation), physical manipulations (e.g., massage and acupuncture), and herbal formulations. Although “TCM” normally refers to the whole spectrum of traditional Chinese medicine, the acronym is used here to refer to that part of TCM relating to traditional Chinese herbal formulations.
Chinese medical practices date back thousands of years. The world’s first known medical document was Nei Jing, the Yellow Emperor’s Classic of Internal Medicine. Compiled in the 3rd century BC, the volume recounts a series of conversations about medicine between the Emperor Huang Di and his court physician. A century later, during the Han Dynasty, Shen Nong wrote the first known guide to herbal medicine, summarizing the pharmacological effects of some 365 substances.
In the modern era, in which new drug treatments and enhanced diagnostic and treatment technologies bring whirlwind changes to the field of medicine, there is new interest in TCM. Seen through the lens of biology and biochemistry, TCM seems to lack a scientific basis and falls more into the realm of myth. Yet, in an early exposure to traditional Chinese medical practices in 1976, in an operating theater at a major Beijing medical center as brain surgery to remove a large tumor was carried out using acupuncture as the sole anesthetic procedure. Whatever a visiting team of US Army surgeons from Walter Reed Hospital thought of the theoretical foundations for acupuncture, thereafter the world starts to accept that the traditional Chinese medicine was medically effective.
Global interests in TCM has increased significantly in recent years, driven by global trends in health care. Mainstream medicine in North America, however, tends to view TCM and its potential applications with some degree of skepticism. While acupuncture and massage may be accepted as a potential treatment for body aches and pains, the holistic approach of TCM is not understood widely. The reluctance to accept TCM herbal preparations is based not only on a lack of scientific and clinical validation, but also on fundamental philosophical differences. Westerners and Chinese tend to look at health and disease in fundamentally different ways. In seeking a chemical drug treatment, for example, a Western patient is looking to treat his or her disease or symptoms, with quick results. A Chinese patient, in contrast, would see the prescribed TCM treatment as part of a longer-term process to restore the body’s overall equilibrium.
In spite of these basic differences, both forms of medical practice share a common view that health is associated with homeostasis, or the process by which an organism maintains a state of balance. Western medicine makes use of modern technology and powerful drugs that consist of single chemical entities to deal with anomalies in target cells, tissues, or organs. Such forceful interventions often succeed, but at the cost of further loss of homeostasis, which is expressed as severe side effects. The Chinese emphasis on maintaining and restoring balance may be less effective with acute diseases, but may be more appropriate for disease prevention and treatment of chronic diseases without an unacceptably high level of collateral damage. If the ultimate goal of health care is to maintain health, fight diseases, and meet medical needs, an integrated approach may provide the optimal solution.
The processes by which both bodies of medical knowledge have evolved also are dramatically different. Western medicine follows a strictly defined and rational process, combining chemical analysis and synthesis, biological assays using enzymatic reactions or cellular systems, and animal tests. The final stages involve closely controlled clinical trials to determine the safety and efficacy of any new drug treatment. In contrast, traditional Chinese medicine is based on a philosophical and theoretical framework that does not reflect current views of modern science, but relies on the vast amount of trial-and-error medical knowledge accumulated within large populations over a 4,000-year timeframe. It can be argued, therefore, that TCM started empirically with the clinical experience, and is moving only now in the direction of scientific validation.
The Science of Traditional Chinese Medicine
Western medicine makes extensive use of drugs that consist of single chemical entities, this follows the principle of seeking the “silver bullet” that will act on a single organism or organ. The Chinese alternative is the use of medicinal herbs, usually in formulations that contain anywhere from various herbs. The rationale is that disease is caused by a loss of homeostasis that involves more than a single function of the body or a particular organ. Thus, the treatment needs to be multi-factorial.
TCM herbal formulations are designed to stimulate and enhance functionality, to suppress and counteract toxicity, and to avoid antagonism and incompatibility. The prescription is most often specific to the individual patient. The proper combination of herbs is based on a functional classification. For example, if two herbs are being combined, they can be classified in terms of:
For the most part, the western medical establishment does not take TCM formulations seriously, considering TCM unscientific in its understanding of the human body and the nature of disease and effective treatments. Over the past few years, however, a number of laboratories have worked on establishing a scientific framework for the study of TCM. The goal of these efforts is to try to reconcile traditional knowledge and modern scientific methodologies. This process can be organized into a number of different steps:
Identification of raw materials
Plant species need to be identified properly. Within each species, there is considerable variability in the content of specific active compounds, depending on such variables as soil conditions, temperature, precipitation, and time of harvest. There also is limited understanding of the differences between medicinal plants grown in the wild, and those cultivated commercially. To be safe, plants used in TCM also should be free of both chemical and microbial contaminants.
35,000 samples of roots, fruits, and bark were screened from 12,000 plant species during the 1980s, which resulted in the discovery of only three new drugs. Such data contradicts the ancient pharmacopoeias of China, which contain thousands of therapeutic formulations. This contradiction can be resolved if Western scientists look at biological activities as resulting from a mixture of active compounds, rather than a single chemical entity. This means that efforts to understand the science behind TCM can be useful only if the preparation follows closely the conditions prescribed in the pharmacopoeia.
Each of the principal herbs should be standardized as to the content of the major active compounds (many of which might be unknown). The objective is to establish a chemical “fingerprint” that meets certain standards for each lot of a particular herb. The actual formulation always will be based on a mixture of such standardized herbs.
These laboratory tests should reflect the biological activity in vivo. The biological activity of standardized TCM herbal preparations should correlate with a particular chemical fingerprint. The objective is not necessarily to characterize and isolate the active compounds, but to ensure that each lot will always have the same biological activity.
The procedures used in the laboratory must be able to be scaled up in order to produce enough material for testing, and to assure that proper standards for drug manufacturing can be met. The finished product also must be formulated in such a manner that they can be used easily on the patients.
When the disease can be induced in an appropriate animal, the standardized TCM can be tested for its therapeutic effect.