by Melissa Carr, B.Sc., Dr.TCM

One of the bragging points that we Traditional Chinese Medicine (TCM) practitioners sometimes use is that it has been a practice for thousands of years. TCM boasts the oldest medical text in the world, with the book Huang Di Nei Jing—TCM’s most important written work, a treatise on health and disease—dating back to 800 to 200 B.C., and the practice itself is believed to be even older than that. But, as brilliant as the ancient texts are, TCM does not stop maturing and continues to evolve in our modern world.

The obvious ways TCM has grown with the times include no longer using sharpened bone shards, bamboo slivers, or thorns for acupuncture needles. We use surgical stainless steel, highly refined, and very thin needles that are classified as medical devices. Had we not changed our tools, I think we’d be hard-pressed to find willing patients today.

The subtle ways are the improving of our interpretation of ancient terminology, refining what works, and working collaboratively with health professionals in other fields.

Everything Old is New Again

Our current medical model places a strong emphasis on technology and finding the specific target cells or body chemicals that result in related symptoms and diseases. This has saved many lives. But rising medical costs and complicated chronic illnesses unresolved by conventional healthcare mean that both policy makers and the public are looking for alternative options that don’t require expensive technology.

Huang Di Nei Jing, the old book mentioned above, promoted wellness through three steps:

  • Disease prevention
  • Early diagnosis and prevention of disease
  • Prevention of the disease returning and treatment of conditions that may have resulted from the illness

These principles are reemphasized in many of today’s growing medical practices, from naturopathy to integrative medicine to functional medicine. I’ve even heard functional medicine physicians draw from TCM’s description of treating the root (cause) and branch (symptom) of illness.

Clinical Take-Home

TCM’s foundation principles are the same as many of today’s modern medical and health practices, so though it can seem quite foreign to many in the western world, we’re on the same page when it comes to patient care.

The Language Challenge

One of TCM’s biggest challenges in collaborating with other health professionals is that we use a different language. Though I can’t converse in Mandarin or Cantonese, TCM uses terminology that is far outside of the western medical realm.

A common diagnosis for a TCM practitioner is Liver qi stagnation with Spleen qi deficiency, and other terms frequently used include yin, yang, jing, meridian, wind-cold-damp obstruction, superficial wind-heat, Blood heat, and so forth.

TCM can be hard to explain to those outside of the field. I had a science degree and no experience with TCM when I started studying it. I had never been poked by an acupuncture needle, taken a Chinese herb, or even seen anyone doing qi gong. I remember having to tell myself to temporarily forget the human biology I had learned so that I could grasp this new—and very foreign—approach.

However, partway through my first year of TCM studies, it all started to make sense. At that stage, I could mentally start to combine the western and the eastern approaches to health. But it took time.

TCM is deeply rooted in its cultural history, and some of the terminology is difficult to understand because of translation issues or re-use of anatomical (physical organs like spleen or blood) or natural element words (wind, damp, dry, cold, and hot) with a different meaning.

The TCM Spleen, for example, is more closely linked to the functions of the physical pancreas. A diagnosis of issues with the Spleen are likely going to show up if there are issues with blood sugar balance and digestion. The TCM Spleen does hold some roles close to that of the physical spleen as well. Easy bruising or bleeding, fatigue, foggy-headedness, and weak muscles are all symptoms that can occur with both Spleen qi deficiency and spleen organ weakness. However, the TCM Spleen issues will also encompass areas outside of either the spleen or the pancreas, with symptoms like organ prolapse, drooling, worry, and a propensity to overthinking.

Clinical Take-Home

Don’t be surprised to hear some strange terminology when speaking to a TCM practitioner. After all, most health professions have their own lingo. Much of modern conventional medicine is filled with Latin and Greek words.

When I was 12, I was diagnosed with bilateral chondromalacia patellae. While it may sound scary, it simply means both sides have softening of the cartilage under the kneecap. The language doesn’t make the diagnosis or the therapy more or less relevant or effective. It can make it hard to explain, but when working with a TCM practitioner, ask them to describe their assessment in language that is more easily comprehensible.

For fun, ask a TCM practitioner why TCM discuses two hearts, but no brain. Or, email me and I’ll answer.

One convention TCM practitioners employ is to capitalize the names of organs and other anatomical parts in order to distinguish the TCM version from the physical version. E.g. the definition of TCM Heart may be distinct from the actual physical heart, so someone who is told they have Heart fire is likely suffering from insomnia, tongue ulcers, anxiety, or even urinary tract infections, not a heart on fire (ouch!) or heartburn.

Using New Tools

TCM’s strength is not necessarily in its treatment tools, but in its foundations—the way an illness is assessed by asking questions, observing, listening, palpating, and smelling. That means that once the diagnostic groundwork is understood, new treatment tools can be added.

Supplements, modern foods, and other treatment modalities are assessed through TCM’s lens and applied in a therapeutic fashion to patients. I can even now choose a remedy (homeopathic, vitamin, or mineral) to inject into acupuncture points based on the patient’s TCM diagnosis.

In addition, ancient TCM practitioners never used a far-infrared TDP heat lamp, electrostimulation, microcurrent stimulation, laser acupuncture, press needles, silicone cups, or even guide-tubes for their acupuncture needles. These are modern inventions that have enhanced current TCM practice.

Some of these newer tools are so successful that non-TCM practitioners take them on as part of their therapy. Examples of this include cupping and scraping.

Cupping is now relatively well-known due to mainstream popularity. Patients specifically request the therapy, and now musculoskeletal therapists of varied backgrounds use cups for myofascial release.

Used initially to draw out blood and pus from boils, and later used to pull out the venom from snake bites, cupping now used predominantly in TCM to treat asthma, common cold, cough, indigestion, some skin conditions, and musculoskeletal pain.

The first cups were made of cattle horns or cross-sections of bamboo. Today, cups are made from more conventional materials, like silicone, which I personally use for musculoskeletal issues. Glass cups are also fairly common, and I still do fire cupping with these. The diversity of cups allows for easier use.

Another technique borrowed from TCM therapy is “gua sha,” also known as scraping, spooning, or coining. “Gua” means “rub” or “scrape” while “sha” refers to the red dots and discoloration that occur on the skin after treatment. Bone or animal (like water buffalo) horn may have been used, but also spoons (especially Chinese porcelain), coins, pieces of jade, or stone. Gua sha is chosen to treat heat stroke, muscle tightness and pain, fever, colds and flu, dizziness, migraines, mastitis, and more. Strongly scraping the gua sha tool along the chosen tissue causes micro-traumas, resulting in an increase in blood circulation, and ultimately a stimulation of the immune response followed by a decrease in inflammation.

This therapy is fairly similar to manual therapy’s Graston technique, which uses specific metal tools to friction along tissue to treat fascial adhesions, injuries, scar tissue, and musculoskeletal pain. It may not be a direct lineage, but the idea for treatment is much the same. TCM practitioners have also improved our tools with varied shapes for specific needs—some for larger surfaces, some for smaller, some for softer, some for firmer. Plus, there are ones that are shaped better for practitioner hands, easier to hold.

Clinical Take-Home

The key to applying acupuncture, Chinese herbs, cupping, or any other TCM traditional modality most effectively is to understand the TCM diagnosis. After the TCM diagnosis is made, it’s possible to use a variety of therapeutic treatment forms.

For example, for patients that are nervous or sensitive, instead of using regular acupuncture needles, a practitioner could instead use superficial press needles that are painless, laser acupuncture, or microcurrent point stimulation.

Furthermore, the improvement of tools has allowed for TCM’s therapies to be more widely utilized.

Under the Microscope

There are several hurdles to overcome when researching TCM. One is that it’s hard to do large-sized studies of identical treatments for one particular disease. TCM treatment is based on the individual’s condition, symptoms, constitution, and even personality, so herbal formulas to treat specific conditions can vary widely from person to person.

Though there are some techniques, there are also many flaws that arise when trying to create a double-blind study on acupuncture, as neither practitioner nor patient can know if the acupuncture employed is “sham” acupuncture or true acupuncture. “Sham” acupuncture is the use of either non-penetrating needles, needling into non-acupuncture points, or needling to a non-therapeutic depth. The challenge is that it generally needs to be performed on patients who don’t know the proper technique. There is also debate about some acupuncture point locations, meaning a person might be inadvertently acupuncturing a valid point when trying to needle a non-point. Additionally, some types of acupuncture use quite shallow depths and still have therapeutic value, so choosing a non-therapeutic depth may be beneficial.

Having said that, many folks are working hard to put TCM and its treatments to the test, and there is a growing field of research in this regard, including studies of how acupuncture works and what biomedical health issues it can effectively address. Acupuncture was recently ranked highly by the American College of Physicians as a first-line therapy for low back pain.

The Journal of the American Medical Association (JAMA) published a meta-analysis study in 2012, finding acupuncture more effective than no acupuncture or sham acupuncture at treating four chronic pain conditions: back and neck pain, osteoarthritis, headache, and shoulder pain.

And, as long ago as 1996, the World Health Organization (WHO) published a report on controlled clinical trials, finding acupuncture proved to be effective at treating 28 diseases, symptoms, or conditions; have therapeutic effect on a further 63 diseases, symptoms, or conditions; and be worth trying for another nine diseases, symptoms, or conditions.

It’s not just the “what” acupuncture treats that has been studied. The “how” it works is also a valuable area of research, and luckily some clever scientists have compiled a document to summarize some of the mechanisms of action.

When it comes to the herbal studies, researchers are trying to determine what compounds are most active in some of the herbs. For example, some of TCM’s herbs that can address certain gastrointestinal issues contain a compound called berberine, finding it to restore intestinal wall barrier function to improve intestinal disease states.

Clinical Take-Home

Don’t believe the lie that TCM and its treatments have no research to back them. Though limited in some areas, the body of evidence is present and growing.

A Final “Point”

Though the major health concerns have changed dramatically over the years, today’s major illnesses, like heart disease, cancer, chronic fatigue, irritable bowel syndrome, and environmental sensitivities, can be assessed and treated using the same foundation. Don’t think of TCM as an old medicine mired in the past. It is a modern medicine that is continuing to develop and change.