Current Status of Traditional Chinese Medicine (TCM)

Traditional Chinese medicine is an unique medical system practiced in China and the Far East for thousands of years. Today Chinese medicine and Western medicine enjoy equal status in China. All medical doctors must be trained in both Chinese medicine and Western medicine although they may have either as their major area of training and practice. All hospitals provide both services and when a patient comes to see a doctor, he or she may have a choice with the help of the doctor. What is important, medical care picks up the cost the same way as Western medicine.

Status of Chinese medicine is very different in other parts of the world depending upon the social and political environment of their host countries. In some countries, they are commonly used in health care and people there have easy access to it and it contributes considerably to the general health of the local people. In some other countries, especially industrialized countries like the United States and Western Europe however, where stringent policies against traditional practices are in force favoring biomedicine, Chinese medicine is faced with severe restraint. The Dietary Supplement Health and Education Act of 1994 (DSHEA) and the issuing policy by the US Food and Drug Administration (FDA) created another category that is neither regular food nor drug: dietary supplements. Since Chinese medicine is not recognized as medicine, many Chinese medicinal patent formulas came to the US under this category. Since only "functional claims" such as "maintain normal blood pressure", "help to maintain a healthy cholesterol level", "may help strengthen the immune system", etc., are allowed, many Chinese have to go elsewhere to look for information which can not be legally shown in the labels of the products.

Four Thousand Years of Unbroken Tradition

Legend of Chinese attributes the origin of TCM to Shennong, "the Divine Peasant", one of the earliest emperors who was said to have tasted hundreds of herbs. Later Shennong Ben Cao Jing (Shennong's Herbal) was compiled in his name. It is perhaps the world first pharmacopoeia. Since then a great amount of information has been accumulated and methods of preparing herbal formulas have been continuously refined, and the number and variety of clinical applications have grown in proportion.

In the third century B.C., Huangdi Nei Jing (The Yellow Emperor's Classics of Internal Medicine) was compiled showing how advanced practical medical knowledge was at that time. Many of the formulas described in it are still being used today. Hua Tuo a historically famous medical specialist in the beginning of the third century, was able to perform major surgery on the stomach to repair the intestines under anesthesia.

The secular nature of TCM came from the Confucian attitude "to respect gods and ghosts but hold them in distance." Many Confucian scholars were also famous doctors, and their strong sense of history and responsibility to society made them instrumental in making TCM a strong and unbroken tradition.

Landmark medical writings including materia medica and treatment experiences are countless including such works as Zhang Zhongjing's Shang Han Lun (Discussion of Cold Diseases, about 200 B.C.), Sun Shimiao's Invaluable Prescriptions for Ready Reference (652 A. D.), Li Shizhen's A Compendium of Materia Medica of the Ming Dynasty (1368-1644), A Grand Dictionary of Chinese Medicine (1979) and the China Pharmacopoeia (2001).

Traditional Herbal Practitioners: Most TCM professionals people generally call "doctors" are full time herbalists while some, depending upon the circumstances in the community, may be part time practitioners and part time peasants.

TCM Doctors used to be trained mainly in actual practice in which a master-apprentice relationship was formed. An apprentice would follow the old master for years before he could practice, and every old master may have some special methods or formulas that had been passed down from generation to generation and were guarded as trade secrets. Very often this master-apprentice relationship was just between the father and son. Many Doctors of Chinese medicines even today are from well-known traditional herbalist families and equipped with such rich experience in some particular area of herbalist medicine that they are high respected and much more sought after.

Many Daoist (Taoist) priests and Buddhist monks had good knowledge of traditional medicine and used them in their congregations.

Since 1949 TCM is officially recognized and enjoys the same status to Western medicine, the training of doctors of Chinese medicine became formalized and institutionalized, and research institutions have been set up with the China Academy of Traditional Chinese Medicine as the nation's highest authority and with provincial academies responsible for local research. Universities and colleges have been set up to train traditional doctors and other specialists. They major in TCM, but at the same time they must have basic training in Western medicine as well. After graduation they would work in metropolitan hospitals or rural clinics. While mainly use herbs to treat and cure, they also can legally use Western medicine, integrating the two systems as they see fit. Patients would also have a choice to elect either Western drugs or herb formulas.

Is Traditional Chinese medicine scientific? According to modern scientific standards, TCM as a medical system has its own inadequacies. Its use of folk categories, unique concepts, wholistic view of both the world and the human body, etc, makes it difficult to understand to those from different cultures. Due to cultural and historical reasons, it failed to develop into a medical system based on molecular biological, anatomic and genetic science, and the lack of quantification and qualification parameters often make it sound bizarre and unreliable to those who have no knowledge of it.

However, a medical system that has been an unbroken tradition for thousands of years and has served the Chinese nation well must not be dismissed wholesale as unscientific and quackery. The continuous popularity it is enjoying in the Far East, especially in China and surrounding countries is an unmistakable testimony of its high value and validity including safety, and the increasing acceptance in the rest of the world points to the potential contribution it stands to make to the good health of mankind.

Traditional Chinese medical communities have been aware of the dire need to make up for the weaknesses of TCM and trying hard to learn from Western medicine. For the last half a century they have gone a long way in improving TCM with modern science and technology.

Since doctors are trained in both Western medicine and TCM, Chinese herbal doctors are using more and more modern medical concepts to explain TCM. For instance, they are using diabetes and hypertension instead of "consumptive thirst" and "disharmony among the liver, kidney, yin and yang", etc as they are originally named in TCM. On the other hand they still tend to use the traditional sub-classification and break the two diseases into several types in order to tailor the prescription to their diagnostic conclusions and are very resourceful in treating their patients.

In terms of pharmacology, there have been many progresses made using modern science and technology. Many "mysteries" have been explained clearly by modern medical science. The famous herb astragalus, for instance, has been extensively used in herbal formulas and we now know that is because of its rich content of polysaccharides, monosaccharides, flavonoid, alkaloid, including choline and betaine, folic acid, various amino acids, mucoitin, gum, cellulose, picrorhiza, and fourteen mineral trace elements, including selenium, zinc, iron, etc, which are imperative for man and animals. Selenium that is specially rich in astragalus, is a strong antioxidant and is a great immunity enhancer. Chrysanthemum flower has been considered as longevity elixir mainly because its choline and other contents which tend to improve blood circulation to the capillaries (especially the brain and limbs).

TCM is a systematic summary of a few thousand years of clinical trials and practices in the orient and is a great treasure house of natural remedies and nutrition.

Many Chinese feel that Western medicine is particularistic and analytic, and focuses on the ailing part of the body, "seeing only trees, but not the forest." On the other hand, Chinese medicine though slow in efficacy, tackles the root cause of the diseases. So they tend to take advantage from both and would go to a western medical doctor when the illness is acute, and go to a doctor of Chinese medicine when it is not.

Since the 50s, a process of integration took place in China and it has become accepted way of treatment. Today, Western medicine is playing a key role in modernizing traditional Chinese medicine. The combination of the two systems has shown promising results giving full play to the strength of both and make them supplement each other. A popular statement in this connection is that 1 + 1 > 2, and the experience has enriched both Western medicine and Chinese medicine. < h2>Chinese Concept of the Universe and of the Human Body</ h2>

The Universe and Nature

Chinese consider the world, man and history in terms of comprehensive harmony that permeates anything and everything. Everything in the Universe including the Universe itself, is changing all the time, and each has two opposite aspects: Yin and Yang, which are in conflict and at the same time interdependent; any change is the result of the Yin-Yang change within it. Everything is related to everything else in the Universe in the Way they should be: the Dao or Tao.

The Human Body and Five Elements Man is part of the Universe, or nature, and the ideal relationship between man and nature is harmony. Adaptation to nature and be one with it is the way (Dao). The human body, like the larger Universe, is an organic whole.

Due to Confucian norms of filial piety which forbid hurting the human body since everything is given by one's parents and it is a disrespect and a crime to hurt it, anatomy is not very developed in Chinese medicine. That is why it is quite different from Western medicine with regard to the structure and functions of the human body. What are called the visceral organs are referred to rather as comprehensive systems of physiological functions than as anatomical entities. Among them the most important ones are the heart, liver, spleen, lung and kidney. But they are not the organs as understood in the English language. They should be read when used in the Chinese medical context, as the heart and/or higher nervous system (heart), the system that controls emotional activities, muscle action, bile secretion and blood storage (liver), the system responsible for digestion, absorption, assimilation and energy metabolism (spleen), respiratory system (lung) and the system including the adrenal gland, which works to secrete urine and provide vital essence for heredity, reproduction, development as well as replenishing the brain, nourishing the bone and producing marrow (kidney).

The relationship among the five systems is represented with the relationship among the five elements: fire, earth, metal, water and wood in a complete circle as follows:

Figure 1: Relationship among the Five Elements (Translated from Li, 1989)

Here one can see the attempt of the ancient Chinese trying to illustrate the most important human organs or systems with things they considered basic in nature. Properties and nature of the five elements are being used to explain the relationships of the five visceral organs. In the scheme, things go clockwise in a circle with one promoting the one next to it, but constraining the one next but one to it as is shown in the five point star. This must be considered in case of diagnosis and treatment as everything must be taken into consideration in both processes.

In order to carry out their normal functions, these visceral organs and other organs and tissues need Qi, blood, vital essence, body fluid and nutrients. Here Qi is the basic particles which constitute the cosmos and produce everything in the world through their movement and changes. In Chinese medicine, in physiological sense it refers to the force or energy required for various functional processes. It consists of two sources, the inborn and the acquired.

Theories of Illness

In Chinese medicine, disease is defined in terms of breaking up of the relative balance in the human body. According to this theory, there is an endless process of adaptation among all parts of the human body and between the human body and the environment. This process maintains a relative dynamic balance that in turn supports normal biological activities. When the human body is in harmony with the environment, pathogens will not harm it.

Diseases happen under two circumstances, one is when functional disorders occur in the human body and the right Qi is relatively weak, and the other is when strong evil Qi has affected the body. Right Qi means normal functional activities and the body¡¯s ability to resist diseases, and the evil Qi means pathogenic factors. Inset and changes of the disease reflect the course of the struggle between the right Qi and the evil Qi.

Chinese people attach primary importance to maintaining the right Qi which largely means ¡°immunity¡± in terms of modern science. Diseases strike only when the right Qi is relatively weak. Outcome of the struggle between the right Qi and the evil Qi depends on the constitution, mental state, environments, habits, nutrition and exercise.

Pathogenic factors include atmospheric factors, epidemic pestilence, personal emotions, improper foods and physical fatigue, traumatic injuries, parasites, phlegm-rheum, and blood stagnancy.

There are 6 excessive atmospheric factors (liu Yin) that are wind, cold, heat, damp, dryness and fire. Normally these natural changes will not cause diseases. They do only when the body's resistance is low and adapts poorly to natural changes, or abnormal natural changes become too much for the body. Sometimes in-coordination among different organs may also produce the same symptoms. These are called "internal wind", "internal cold", "internal heat", "internal damp", "internal dryness", and "internal fire".

There are 7 emotions that are the normal reactions to the outside world, but when subjected to repeated long term stimuli, especially drastic ones, each may cause imbalance between the Yin and Yang, between the Qi and blood, and malfunction of the internal organs, thus leading to diseases.

Classification of Illness

TCM classifies diseases according to their major patterns in terms of Yin and Yang, internal and external, heat and cold, vacuity and excess. In connection to the state of Qi, blood, body fluids, and different body functions, it identifies the nature of the major problems as external cold, external heat, internal cold, internal heat, excess, vacuity, Yin problems, Yang problems, Qi inadequacy, blood inadequacy, etc.

Methods of Diagnosis

TCM Doctors diagnose in four major ways including inquiry (asking questions concerning body temperature and how the patient feels, perspiration, general body feeling, urination and stool, diet, feelings of the lung and stomach, monthly discharges in case of woman, etc.), visual observation (patient's mood, face color, shape of body, and color, shape of the tongue, etc.), smelling and listening (patient's body odor and voice), and pulsation. Generally the information thus collected and the observed symptoms are enough to help the doctor determine the nature of the disease. Today doctors of Chinese medicines are also using modern equipment and methods such as stereoscope, X-ray, CT, etc., to verify the diagnosis.

Treatment Principles

Prevention as Priority Determine the root cause is the overall guiding rule in treatment of diseases in Chinese medicine. It includes two aspects, one is to take precautions before disease strikes,emphasizing that internal factors lead to diseases. There are many formulas and methods to help enhance the immune system, and most TCM formulas have the power of prevention. As early as sixteen century, Chinese invented inoculation for smallpox. There is also the need for prevention even after a disease strikes. This is to intercept possible pathological changes. For instance, liver problems may lead to problems of the spleen, when the liver is out of order, it is important to protect and strengthen the spleen.

Balance as the Ideal State of Health In Chinese concept, everything is connected to every else in a relationship of cooperation and coordination. For the human body, when all are maintained in a relative equilibrium and balance, ideal health prevails. If there is anything wrong in a man, it is the relationship, either between him and his environment, or between one part of him with other parts and equilibrium is broken. It is the mission of Chinese medicine to address this balance. What is more, in reestablishing this balance, efforts must be taken to avoid creating any new imbalance the other way round which might be worse. That is why treatment with Chinese medicine is expected to be slow and noninvasive.

Holistic considerations and Individualized Treatment Occurrence, development and changes of diseases are subjected to all kinds of factors. In prevention, diagnosis and treatment, everything, including the season and local conditions, physical and psychological environment, the patient's age, gender and general physical conditions, family history, etc, all have to be considered. A patient from Western cultures may feel uncomfortable with a TCM doctor when the doctor asks questions that are too personal.

The holistic approach of TCM has also contributed to the classification of the human body into functional systems rather then particular organs in anatomical sense as mentioned earlier.

Another result of this holisticism is the predominant use of compound formulas rather then single herbs. This becomes very obvious when one steps into a health food store in the U.S and compare Chinese made dietary supplements with local products.

This holisticism, together with the abundance of available means in terms of method and medicinal materials makes a doctor of Chinese medicine a resourceful practitioner. What he can do is virtually limitless. It is no exaggeration that Chinese medicine is an art of healing, and a good doctor of Chinese medicine treats the patient rather than the disease.

Since everyone is a complete organism subject to different physical and psychological environments and every organism is changing all the time, every patient is necessarily different in Chinese medical concept, and therefore everyone must necessarily be treated differently. Actually no two patients are alike. Every patient needs to be examined individually and individualized diagnosis must be made, and the treatment is certainly unique. In high plateau that is cold and dry, exterior pathological factors are mainly related to cold and dryness and treatment should use herbs that have the property of dissipating acridity, enriching and moistening; and in an environment of heat and damp lowland area, herbs that can dispel heat and transform damp should be given the priority.

Even in the same location, patients may be different. For an instance, two persons are both diagnosed by Western medical doctors as having essential hypertension. But patient one is robust with a red face, red eyes, constipation, irritability, thick yellow coat on a red tongue, and a wiry full pulse. A doctor of Chinese medicine would provide a treatment to calm down his liver fire (to cleanse the liver). Since patient two has pale and frail appearance, loose stools, low energy, pale flabby tongue and a weak pulse, the same doctor would formulate a treatment plan to invigorate the patient's kidney Yang (to tonify the kidney).

Strengthen the Immune System and Eliminate Pathogenic Factors As is stated above, the body's ability to defend itself is most important. But in actual treatment, the strategy has to vary according to the actual circumstances. In case of weak defense, the emphasis has to be on enhancing the immune system in order to eliminate pathogens. On the other hand, when pathogenic factors are too strong, the focus has to be the elimination of pathogenic factors in order to strengthen the body's defense. Sometimes, it is also necessary to do both at the same time.

Differentiation of Root Cause from Symptoms and Determination of Acuteness of the Disease To treat the root cause instead of the symptoms is always the principal aim of Chinese medicine, but in treatment considerations are given to the actual circumstances. For instance when it is a mild disease and not acute, it is right to treat the root cause. In case of acute diseases however, it may be necessary to treat the symptoms first. When the patient is running a high fever, bleeding or suffering from severe pain, the symptoms themselves may lead to death if no drastic measure is taken to treat the symptoms. Eliminate the high fever, stop bleeding and pain are imperative before going for the root cause. In some cases it may be better to treat both the root cause and the symptoms.

Straight Treatment and Paradoxical Treatment Straight treatment is to meet cold with heat and heat with cold, supplement in case of inadequacy (vacuity), and discharge in case of excess. These are the normal ways of treatment. However, when symptoms do not reflect the root cause, the opposite is called for. For instance cold symptoms may be the result of extreme heat, and in such case the right way is to use cold method. This paradoxical treatment is a hallmark of a good doctor.

Methods of Treatment

Since Chinese medicine is nutrition oriented, it treats various health problems in terms of excess syndromes, deficiency syndromes, and deficiency with excess syndromes. Deficiency includes deficiency in Qi, in blood, in Yin and Yang; excess includes excess in wind, cold, heat, damp, dryness, fire, phlegm and Qi.

There are numerous methods of treatment in Chinese medicine, but basically there are eight approaches that are used singularly or in combination as the situation calls for.

Diaphoretic approach is to induce sweet to expel pathogenic factors. It is used for external problems such as unripe pox, sores and boils. It may be due to external cold or external heat, and therefore there are two basic ways which are resolution of exterior with coolness and acridity, or resolution of exterior with warms and acridity;

Emetic approach is to induce vomiting to expel pathogenic factors or toxins. It is used in case of thick phlegm in the throat or stagnant or poisonous food in the stomach. For acute cases strong formulas may be used. It is also divided into cool method and warm method;

Purgation approach is used in case of serious constipation, bloating, stagnant phlegm and blood, or in case of parasite. It is comprised of cold purgation, warm purgation, expelling of water, dissolution of stagnation or expelling parasites;

Harmonization approach is used to resolve poor co-ordination between internal organs in their functions. Malaria and irregular menses are also treated this way;

Warming approach is taken mainly to dispel cold pathogens, etc, as in case of internal cold pattern of diseases;

Febrifugal approach is to remove internal heat to protect body fluids. It also is comprised of many different ways to accommodate the actual circumstances such as sweet-cool method, bitter-cold method, etc;

Tonification approach is employed in case of deficiency or vacuity including tonification of the Yin, tonification of the Yang, tonification of blood and tonification of the Qi, etc.;

Dispersion approach is used for stasis and accumulation in blood, Qi, phlegm, rheum and foods, etc.

It is obvious that the objective of all these is to achieve balance and harmony of the various organs and their functions while dynamic biological changes and processes are maintained.

Classification of Medicine

Sources of Chinese Medicine The vast territory, diverse terrain and climates provide an ideal natural environment to develop natural cures. This is the most important physical environment for the unbroken tradition of Chinese medicine. On the other hand Chinese extensive food habit leads to profound understanding of natural herbs and other medicinal sources.

Chinese medicine is characterized with natural and low cost and nutrition oriented sources. So far there are 12,807 medicinal materials out of which 11146 are herbals, 1581 are from animal sources and 80 minerals (Encyclopedia Sinica, Volume of Chinese Medicine, 2000 Edition.) Because of the predominance of herbal sources, people refer to Chinese materia Medica as herb medicine. Based upon principles of Chinese medicine in formulation, there are more than one million patent formulas that can be adjusted with addition or reduction of some ingredients to suit particular need of the patient. They represent a great rich treasure house for health care and fitness.

Properties of herbs Herbs are said to have four properties: cold, cool, warm and hot, and five flavors: sour, bitter, sweet, pungent and salty. The four properties have nothing to do with the temperature of the herbs. They are the resulting effects produced by the herbs. Coptis, phellodendron bark, gardenia fruit are classified as cold medicine because they eliminate heat, dryness and remove toxins and they are normally used to tackle heat patterns of diseases, while aconite and dry ginger are classified as hot medicine because they are normally employed to warm the center and dispel cold.

From the beginning Chinese medical practitioners found that herbs of certain taste tends to possess certain medical properties. With long historical development, the five flavors actually come to represent the properties rather than the actual flavor or taste. Herbs with sour flavor possess the ability of astriction and are used to treat seminal emission, night sweating, enuresis, enduring diarrhea, anal desertion, etc. Those with bitter flavor including such herbs as coptis, phellodendron bark, gardenia fruit, etc., have the properties of dispelling heat, dryness and toxins. Sweet herbs generally tonify and supplement, relax tension (acuteness) and harmonize the functions of different herbs. For instance, codynopsis, astragalus and cooked rehmannia tonify and supplement in case of vacuity, licorice and sugar relax tension, and harmonize different herbs. Pungent herbs disperse external pathogens, move the Qi and promote blood circulation. Mahuang treats wind cold and external problems, Cnidium (Chuangxiong) activates the blood, and carthamus disperses accumulation. Salty herbs soften hardness and drains precipitation and are used to treat scrofula, phlegm nodes, lump glomus and dry and hard stool. Oyster shell, for instance, may help disperse hard lumps, and mirabilitum can ease constipation.

Flavor and properties of an herb must be considered together. Herbs of same properties may be different in their flavor, and vice versa.

Herbs are also classified according to their tendency to reach certain part of the body or channels. This selectivity of the herbs in their functions is called gui jing (channel entry). For instance, both phragmite and gentian root belong to cold herbs used to clear away heat. However, the former is particularly effective in clearing lung heat and the latter heat of the liver.

According to their functions herbs are classified into more than twenty categories, including diaphoretics or exterior resolution herbs, either for dispelling wind-cold or wind-heat; Antipyretis or Ferifuges; Antitussive, Expectorants and Anti-asthmatics; Digestives; Tonics including Qi replenishing herbs, blood replenishing herbs, Yin replenishing herbs and Yang replenishing herbs; Carminatives or Qi flow herbs; Blood circulators to remove blood stagnation; Hemostatics; Laxatives; Diuretics; Fragrant herbs for resolving damp; Anti-rheumatics including herbs for arthritic pain, for muscles and collaterals and for strengthening the bone and tendons; Warming herbs; Anticonvulsants; Sedatives; Aromatic stimulants; Astringents; Anti-malarial herbs; Anthelmintics; Analgesics, and Topical agents. These herbs are used as soldiers for specific missions whether singly or in groups to achieve prevention or curative effects.

Herb Preparation TCM Doctors are very sensitive to authenticity of the herbs depending upon the areas where they are produced. Through long time observation and composition they know that some herbs produced in certain areas are best in quality and therefore, the curative effects. Ginseng, deer antler and schisandra fruit in NE China, rehemannia root, Chinese Yam of Henan, coptis root and fritillary bulb in Sichuan, wolfberry in Ningxia and notoginseng in Yunnan are the most famous. They are much more sought after than others. Herbs are harvested when they have grown and reached the best quality and curative effects. Whole plants, flowers, fruits and seeds, root and barks are collected in different seasons.

Herbs must be carefully prepared and processed before they are used. Preparations include stir baking with or without auxiliary fluids (such as vinegar, wine, honey, salt water or ginger juice), calcination, roasting, steaming, boiling, water purification, fermentation, germination, frosting, etc., according to needs, to enhance the curative effects, reduce toxicity, to change the property so as to expand their use, remove undesired ingredients and taste, and make them easy to use and store.

Prescription Formulation Principles After diagnosis and determination of the treatment principles, the doctor of Chinese medicine would formulate the preparation accordingly. He decides the principle herb and the auxiliary herbs in the formulation to achieve the curative effects he wants. Sometimes a single herb is used, but most often it is a compound preparation that may consist of anywhere from four to twenty herbs.

A compound prescription normally includes four different component parts. They are called Monarch (principal), Minister (adjuvant), Assistant (auxiliary), and Guide (conductor) respectively.

Principal ingredient provides the main curative action. Adjuvant helps strengthen the principal action; auxiliary is a corrector ingredient to relieve secondary symptoms or to temper the action of the principal when it is too potent, and conductor is to direct the actions of the principal and adjuvant herbs to the affected area or site or acts as a minor ingredient.

In a compound prescription, drug interactions must be considered. According to Chinese medicine, herbs may be either mutually reinforcing (as between anemarrrhena and phallodendron), mutually assisting (Several work together to reinforce the principal. For instance, use poria to strengthen the diuretic action of astragalus), mutually restraining (to weaken or neutralize each other¡¯s actions (Scute weakens the warm temperament of fresh ginger), mutually counteracting (One ingredient to reduce the potency or toxicity of another (fresh ginger to eliminate toxicity of pinellia), mutually neutralizing (One counteracts the toxic reaction of another (Siler neutralizes toxicity of arsenic), or mutually incompatible. Modern research has found that some of these relationships are valid and some are not. However a good herbal doctor is one who knows really well of the properties of the herbs and uses them correctly and innovatively.

"Food Therapy" and Health through Proper Diet

A very important medical tradition is what is called shi liao, i.e., food therapy. The origin of this can be traced back in history for several thousand years. The Shennong Canon of Herbs (shen nong ben cao jing) carries 365 herbs classified into three categories including superior, medium and lower grades. Most of those listed as superior are food grains, vegetables, fruits, meats, and herbs with friendly nature. As herbal drugs are strong and taste awful, and long-term use may hurt the stomach, the best way is to use food to do the work. This is considered an ideal combination since it not only may cure in the long run, but also may be made into something really enjoyable. It follows the same principle as herbal treatment, i.e., to warm up when cold is present, cool off when heat is the problem, to supplement in case of deficiency (vacuity) and discharge in case of excess. For this, food items are classified into different categories according to their properties and diet is planned in such a way as to achieve therapeutic result in different situations. Food therapy is often employed to supplement medical treatments, especially for chronic diseases.

Shi Yang, health through proper diet, is to select certain diet to regulate various biological functions of the related organs of the body, to nurture the Qi, the blood, body fluids, to build up the body¡¯s resistance to diseases according to different needs in terms of constitution, age, gender, the season or local conditions. For this, people are classified into several types with different constitutions. For instance, those who tend to suffer Qi deficiency should include yam, lotus seeds, pork and eel in their diet, and those who have blood deficiency problem should include longan, wolf berry, mulberry leaf, chicken, carrots, etc. Those who have Yin deficiency should eat white fungus, honey, sesame, black bean, etc. And those who are identified to have Yang deficiency should add mutton, shrimp, chives, etc. Food are different in different seasons, and local conditions differ. People in different regions should have different needs in foods.

Another wider approach is called Yangsheng, i.e., life preservation. This includes a variety of ways to prolong life.

A very important part of this is Qigong. It is to achieve good health through breathing exercises, meditation, mental channeling, etc. As a component part of Chinese medicine it has a history of over 4,000 years originated from a kind of dance to maintain good health and to prevent diseases. Along the way it absorbed many elements from Daoism, Confucianism and Buddhism, and in a way it also acquired some religious characteristics to certain extent. The key concept is energy cultivation. It is said to be very effective to eliminate fatigue and achieve relaxation, to enhance the immune system for prevention of diseases and to treat and cure diseases connected with certain systems such as the nervous system, the circulatory system, the respiratory system, the digestive system, the endocrine system, and the immune system.

Most of the Chinese medical writings covered Qigong exercises. The best known is the Taiji exercise, a set of slow movements that spread far and wide outside of China. During the so-called "Great Proletarian Cultural Revolution" from mid 1960s to mid 1970s, Qigong was suppressed until the chaos was over. In 1986, the Degree Committee under the State Council made a decision to adopt Qigong in Chinese medicine as a new science discipline, and special funds were set up for further research and it became part of clinic treatment. Doing Qigong became part of daily life, especially in the morning in parks.

Currently the enthusiasm for Qigong seems to have a set back with the government suppressing the Falun Gong, a quasi-religious group officially named an evil cult. It started as a Qigong organization and attracted many people. The government was taken by a surprise when suddenly it organized a mammoth sit-in demonstration surrounding the government seat in Beijing.

Another aspect is to control desire and avoid indulgence, especially sexual indulgence. Self-emotional control is also a very important part of these exercises. All these are aimed at achieving balance between Yin and Yang, promoting normal flow of the Qi and blood, increasing the essence and preserving the semen.

Acupuncture, Moxibustion and Tuina

Originally a component part of Chinese medicine, acupuncture and moxibustion have developed into a medical system in itself. Two things are involved, one is to stimulate locals on the human body to achieve therapeutic effects with needles of different length and thickness, and the other is to use heat to achieve therapeutic results. They are used either in combination or separately. The origin can be traced to Neolithic age, eight thousand to four thousand years ago. Needles were made of stones, wood, bamboo and finally metal, especially silver or stainless steel. Moxibustion uses leaves of mugwort (artemesia vulgaris) made into a cone and burned on ointment or ginger slice. The basis of both acupuncture and moxibustion is the concept of channels (meridians and collaterals) in the human body through which Qi travels. Channels (meridians and collaterals) are distributed all over the body, coordination or various functional processes are realized through the Qi. Acupuncture and moxibustion rely on the relationship between the Qi and the meridians for successful therapy.

Now electricity, magnets, laser, infra-red, microwave are added to needle stimulation. Clinically it comprised of four aspects: a. treatment with acupuncture and moxibustion, maintenance of good health with acupuncture and moxibustion (mainly to enhance the immune system), anesthesia with acupuncture and diagnosis through channel-local manipulation. Acupuncture has been accepted as legal and valid method of treatment in many countries in the world.

Another treatment method in Chinese medicine is tuina, a special type of therapeutic massage. The origin can be traced back to pre-historical times. Its basic therapeutic orientation is the Chinese medical theory of the flow of Qithrough the meridians. Tuina has many unique techniques including one finger pushing, rolling, neigong (internal Qigong), pointing, bone setting, etc. It can be done alone or in combination with Qigong.

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