Traditional Chinese medicine



Traditional Chinese medicine (also known as TCM, ) is a range of traditional medical practices originating in China that developed over several thousand years. The English phrase "TCM" was created in the 1950s by the PRC in order to export Chinese medicine; there is no equivalent phrase in Chinese (zhōngyī xué translates literally as simply "Chinese medicine studies"). In fact, TCM is a modern compilation of traditional Chinese medicine. TCM practices include theories, diagnosis and treatments such as herbal medicine, acupuncture and massage; often Qigong is also strongly affiliated with TCM. TCM is a form of so-called Oriental medicine, which includes other traditional East Asian medical systems such as traditional Japanese, and Korean medicine.

TCM theory asserts that processes of the human body are interrelated and in constant interaction with the environment. Signs of disharmony help the TCM practitioner to understand, treat and prevent illness and disease.

In the West, traditional Chinese medicine is considered alternative medicine. In mainland China and Taiwan, TCM is considered an integral part of the health care system. For example, TCM treatments may be prescribed to counter the side effects of chemotherapy, cravings and withdrawal symptoms of drug addicts, and a variety of chronic conditions.

TCM theory is based on a number of philosophical frameworks including the theory of Yin-yang, the Five Elements, the human body Meridian system, Zang Fu organ theory, and others. Diagnosis and treatment are conducted with reference to these concepts. TCM does not operate within a scientific paradigm but some practitioners make efforts to bring practices into a biomedical and evidence-based medicine framework.

History
Much of the philosophy of traditional Chinese medicine derived from the same philosophical bases that contributed to the development of Taoist philosophy, and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales.

During the golden age of his reign from 2698 to 2596 B.C, as a result of a dialogue with his minister Ch'i Pai (岐伯), the Yellow Emperor is supposed by Chinese tradition to have composed his Neijing Suwen (內經 素問) or Basic Questions of Internal Medicine, also known as the Huangdi Neijing. Modern scholarly opinion holds that the extant text of this title was compiled by an anonymous scholar no earlier than the Han dynasty just over two-thousand years ago.

During the Han Dynasty, Zhang Zhong Jing (張仲景), the Hippocrates of China, who was mayor of Chang-sha toward the end of the 2nd century AD, wrote a Treatise on Cold Damage, which contains the earliest known reference to Neijing Suwen. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 - 282 AD), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙經), ca. 265 AD. During the Tang dynasty, Wang Ping claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the 11th century AD.

Classical Chinese Medicine (CCM) is notably different from Traditional Chinese Medicine (TCM). The Nationalist government elected to abandon and outlaw the practice of CCM as it did not want China to be left behind by scientific progress. For 30 years, CCM was forbidden in China and several people were prosecuted by the government for engaging in CCM. In the 1960's, Mao Zedong finally decided that the government could not continue to outlaw the use of CCM. He commissioned the top 10 doctors (M.D.'s) to take a survey of CCM and create a standardized format for its application. This standardized form is now known as TCM.

Today, TCM is what is taught in nearly all those medical schools in China, most of Asia and Northern America, that teach traditional medical practices at all. To learn CCM typically one must be part of a family lineage of medicine. Recently, there has been a resurgence in interest in CCM in China, Europe and United States, as a specialty.

Contact with Western culture and medicine has not displaced TCM. While there may be traditional factors involved in the persistent practice, two reasons are most obvious in the westward spread of TCM in recent decades. Firstly, TCM practices are believed by many to be very effective, sometimes offering palliative efficacy where the best practices of Western medicine fail, especially for routine ailments such as flu and allergies, and managing to avoid the toxicity of some chemically composed medicines. Secondly, TCM provides the only care available to ill people, when they cannot afford to try the western option. On the other hand, there is, for example, no longer a distinct branch of Chinese physics or Chinese biology.

TCM formed part of the barefoot doctor program in the People's Republic of China, which extended public health into rural areas. It is also cheaper to the PRC government, because the cost of training a TCM practitioner and staffing a TCM hospital is considerably less than that of a practitioner of Western medicine; hence TCM has been seen as an integral part of extending health services in China.

There is some notion that TCM requires supernatural forces or even cosmology to explain itself. However most historical accounts of the system will acknowledge it was invented by a culture of people that were already tired of listening to shamans trying to explain illnesses on evil spirits ; any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Taoist-inspired classics of acupuncture such as the Nèi Jīng or Zhēnjiǔ Dàchéng. The system's development has over its history been skeptically analysed extensively, and practice and development of it has waxed and waned over the centuries and cultures which it has travelled - yet the system has still survived this far. It is true that the focus from the beginning has been on pragmatism, not necessarily understanding of the mechanisms of the actions - and that this has hindered its modern acceptance in the West. This, despite that there were times such as the early 18th Century when "acupuncture and moxa were a matter of course in polite European society"

Timeline
The history of TCM can be summarized by a list of important doctors and books. nknown, Huáng Dì Nèi Jīng (黃帝內經)(Classic of Internal Medicine by Emperor Huang) - Sù Wèn (素問) & Líng Shū (靈樞). The earliest classic of TCM passed on to the present.


 * Warring States Period (5th century BC to 221 BC): Silk scrolls recording channels and collaterals, Zu Bi Shi Yi Mai Jiu Jing (Moxibustion Classic of the Eleven Channels of Legs and Arms), and Yin Yang Shi Yi Mai Jiu Jing (Moxibustion Classic on the Eleven Yin and Yang Channels)


 * Eastern Han Dynasty (206 BC–AD 220) to Three Kingdoms Period (220 - 280 AD):
 * Zhen Jiu Zhen Zhong Jing (Classic of Moxibustion and Acupuncture Preserved in a Pillow) by Huà Tuó (華佗)
 * Shang Han Za Bing Lun, also known as Shāng Hán Lùn (Treatise on Febrile and Miscellaneous Diseases) by Zhāng Zhòng Jǐng (張仲景)


 * Jìn Dynasty (265-420): Zhēn Jiǔ Jiǎ Yǐ Jīng (Systematic Classic of Acupuncture and Moxibustion) by Huángfǔ Mì (皇甫謐).


 * Tang Dynasty (June 18, 618–June 4, 907)
 * Bei Ji Qian Jin Yao Fang (Emergency Formulas of a thousand gold worth) and Qian Jin Yi Fang (Supplement to the Formulas of a thousand gold worth) by Sūn Sīmiǎo (孫思邈)
 * Wai Tai Mi Yao (Arcane Essentials from the Imperial Library) by Wang Tao


 * Song Dynasty (960 – 1279):
 * Tóngrén Shūxué Zhēn Jiǔ Tú Jīng (Illustrated Manual of the Practice of Acupuncture and Moxibustion at (the Transmission) (and other) Acu-points, for use with the Bronze Figure) by Wáng Wéi Yī (王惟一).
 * Emergence of Wenbing School


 * Yuan Dynasty (1271 to 1368): Shísì Jīng Fā Huī (Exposition of the Fourteen Channels) by Huá Shòu (滑壽).


 * Ming Dynasty (1368 to 1644): Climax of acupuncture and Moxibustion. Many famous doctors and books. Only name a few:
 * Zhēnjiǔ Da Quan (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng
 * Zhēnjiǔ Jù Yīng Fa Hui (鍼灸聚英??) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武)
 * Zhēnjiǔ Dàchéng (針灸大成)(Compendium of Acupuncture and Moxibustion) by Yang Jizhou, a milestone book. 1601CE, Yáng Jì Zhōu (楊繼洲).
 * Běncǎo Gāng Mù (本草綱目)(Compendium of Materia Medica) by Lǐ Shízhēn (李時珍), the most complete and comprehensive pre-modern herb book
 * Wen Yi Lun by Wu YouShing


 * Qing Dynasty(1644-1912):
 * Yi Zong Jin Jian (Golden Reference of the Medical Tradition) by Wu Quan, sponsored by the imperial.
 * Zhen Jiu Feng Yuan (The Source of Acupuncture and Moxibustion) by Li Xuechuan
 * Wen Zhen Lun Dz by Ye TianShi
 * Wen Bing Tiao Bian(Systematized Identification of Warm Disease) written by Wu Jutong, a Qing dynasty physician, in 1798 C.E.

Theory
The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM can be shown to be most influenced by Taoism, Buddhism, and Neo-Confucianism.

Since 1200 BC, Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, they have described some general principles and their applications to health and healing:


 * There are observable principles of constant change by which the Universe is maintained. Humans are part of the universe and cannot be separated from the universal process of change.
 * As a result of these apparently inescapable primordial principles, the Universe (and every process therein) tends to eventually balance itself. Optimum health results from living harmoniously, allowing the spontaneous process of change to bring one closer to balance. If there is no change (stagnation), or too much change (catastrophism), balance is lost and illnesses can result.
 * Everything is ultimately interconnected. Always use a holistic ("systemic" or "system-wide") approach when addressing imbalances.

One modern interpretation of Traditional Chinese medicine's "macro" or holistic view of disease is that well-balanced human bodies can resist most everyday bacteria and viruses, which are ubiquitous and quickly changing. Infection, while having a proximal cause of a microorganism, would have an underlying cause of an imbalance of some kind. TCM would target the theorized imbalance, not the infectious organism. A TCM practitioner might give very different herbal prescriptions to patients affected by the same type of affliction, because the different symptoms reported by the patients would indicate a different type of imbalance. There is a popular saying in China: Chinese medicine treats humans while western medicine treats diseases.

Model of the body
Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi ("breath", "life force", or "spiritual energy"), blood, jing ("kidney essence" or "semen"), other bodily fluids, the Five elements, emotions, and the soul or spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. Unlike the Western anatomical model which divides the physical body into parts, the Chinese model is more concerned with function. Thus, the TCM Spleen is not a specific piece of flesh, but an aspect of function related to transformation and transportation within the body, and of the mental functions of thinking and studying.

There are significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice and theory.

Models of the body include:


 * Yin or Yang
 * Five elements
 * Zang Fu theory
 * Meridian (Chinese medicine)
 * Three jiaos also known as the Triple Burner or the Triple Warmer

The Yin/Yang and five element theories may be applied to a variety of systems other than the human body, whereas Zang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific.

There are also separate models that apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and the Eight principles system of disease classification.

Diagnostics
Following a macro philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than "micro" level laboratory tests. There are four types of TCM diagnostic methods: observe (望 wàng), hear and smell (聞 wén), ask about background (問 wèn) and touching (切 qiè). The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as "Going to have my pulse felt"

Traditional Chinese medicine is considered to require considerable diagnostic skill. A training period of years or decades is said to be necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, A good (TCM) doctor is also qualified to be a good prime minister in a country. Modern practitioners in China often use a traditional system in combination with Western methods.

Techniques

 * Palpation of the patient's radial artery pulse (Pulse diagnosis) in six positions
 * Observation of the appearance of the patient's tongue
 * Observation of the patient's face
 * Palpation of the patient's body (especially the abdomen) for tenderness
 * Observation of the sound of the patient's voice
 * Observation of the surface of the ear
 * Observation of the vein on the index finger on small children
 * Comparisons of the relative warmth or coolness of different parts of the body
 * Observation of the patient's various odors
 * Asking the patient about the effects of his problem
 * Anything else that can be observed without instruments and without harming the patient

Treatment
The below methods are considered as part of the Chinese medicine treatment:
 * 1) Chinese herbal medicine(中藥)
 * 2) Acupuncture and Moxibustion (針灸)
 * 3) Die-da or Tieh Ta (跌打)
 * 4) Chinese food therapy (食療)
 * 5) Tui na (推拿) - massage therapy
 * 6) Qigong (氣功) and related breathing and meditation exercise
 * 7) Physical exercise such as T'ai Chi Ch'uan (太極拳) and other Chinese martial arts
 * 8) Mental health therapy such as Feng shui (風水) and Chinese astrology

Specific treatment methods are grouped into these branches. Cupping and Gua Sha (刮痧) are part of Tui Na. Auriculotherapy (耳燭療法) comes under the heading of Acupuncture and Moxibustion. Die-da or Tieh Ta (跌打) are practitioners who specialize in healing trauma injury such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. Such practice of bone-setting is not common in the West.

Branches
Traditional Chinese medicine has many branches, the most prominent of which are the Jingfang (经方学派) and Wenbing(温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shenlong Bencaojing. The more recent Wenbing school's practise is largely based on more recent books including Compendium of Materia Medica from Ming and Qing Dynasty, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in mainland China, when Wenbing school used political power to suppress the opposing school.

The question of efficacy
Much of the scientific research on TCM has focused on acupuncture. Currently, there is no scientific consensus as to whether acupuncture is effective or only has value as a placebo. Evidence-based reviews of existing clinical trials, conducted by the Cochrane Collaboration and Bandolier, have suggested efficacy for idiopathic headache and post-operative nausea, but for most conditions have concluded a lack of effectiveness or an insufficiency of well-conducted clinical trials. The World Health Organisation (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted. The 1997 NIH Consensus Development Conference Statement on acupuncture concluded:

...promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Much less scientific research has been done on Chinese herbal medicines, which comprise much of TCM. Some doubts about the efficacy of many TCM treatments are based on their apparent basis in inductive reasoning &mdash; for example, that plants with heart-shaped leaves will help the heart, or that ground bones of the tiger can function as a stimulant because tigers are energetic animals. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not (perhaps by coincidence) possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the large amount of money and expertise required to conduct double-blind clinical trials, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.

Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria, and is also under investigation as an anti-cancer agent. Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness, safety, and regulatory status. For example, ma huang, or ephedra, which contains ephedrine and pseudoephedrine, is restricted in the United States, due to the risk of adverse impact on the cardiovascular system and some deaths due to consumption of extracts in high doses.

Safety
Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage and infection have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence. Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should only be administered by persons who have been educated to apply them safely. "A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended Traditional Chinese Medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs." 

Certain Chinese herbal medicines involve a risk of allergic reaction and in rare cases involve a risk of poisoning. Cases of acute and chronic poisoning due to treatment through ingested Chinese medicines are found in China, Hong Kong, and Taiwan, with a few deaths occurring each year. Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs. The raw and unprocessed form of aconite, or fuzi is the most common cause of poisoning. The use of aconite in Chinese herbal medicine is usually limited to processed aconite, in which the toxicity is denatured by heat treatment.

Furthermore, potentially toxic and carcinogenic compounds such as arsenic and cinnabar are sometimes prescribed as part of a medicinal mixture or used on the basis of "using poison to cure poison". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. Much of these are being prevented with more empirical studies of Chinese herbals and tighter regulation regarding the growing, processing, and prescription of various herbals.

In the United States, the Chinese herb má huáng (麻黄; lit. "hemp yellow") &mdash; known commonly in the West by its Latin name Ephedra &mdash; was banned in 2004 by the FDA, although, the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a usage that directly conflicts with traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA's ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency's finding that ephedra posed an unreasonable risk to consumers.

Many Chinese medicines have different names for the same ingredient depending on location and time, but worse yet, ingredients with vastly different medical properties have shared similar or even same names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized as sodium nitrite (牙硝), resulting in a poisoned victim. In some Chinese medical texts, both names are interchangeable. Chinese herbal medicine authorities are working towards improved standards in this area.

Relationship with Western medicine
Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine.

Outside of China, the relationship between TCM and Western medicine is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are far more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific, which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations. There have also been experiences in the West with unscrupulous or well-meaning but improperly-trained "TCM practitioners" who have done people more harm than good in many instances.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner or visit a martial arts school to get the bone set, whereas this is routine in China. As another example, most TCM hospitals in China have electron microscopes and many TCM practitioners know how to use one.

Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. As a simple example, you see a Western doctor if you have acute appendicitis, but you do exercises or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.

A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula. A report by the Victorian state government in Australia on TCM education in China noted:
 * Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practise TCM as a specialty within the broader organisation of Chinese health care.

In other countries it is not necessarily the case that traditional Chinese and Western medicine are practiced concurrently by the same practitioner. TCM education in Australia, for example, does not qualify a practitioner to provide diagnosis in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures. While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons. 

It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.

In addition, Chinese practitioners of Western medicine have been less impacted by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for over-prescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional Chinese herbal remedies.

Traditional Chinese diagnostics and treatments are often much cheaper than Western methods which require high-tech equipment or extensive chemical manipulation.

TCM doctors often criticize Western doctors for paying too much attention to laboratory tests and showing insufficient concern for the overall feelings of patients.

Modern TCM practitioners will refer patients to Western medical facilities if a medical condition is deemed to have put the body too far out of "balance" for traditional methods to remedy.

Animal products
Animal products are used in certain Chinese formulae, which may present a problem for vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances.

The use of endangered species is controversial within TCM. In particular, is the belief that tiger penis and rhinoceros horn are aphrodisiacs (although the traditional use of rhinoceros horn is to reduce fever.) This depletes these species in the wild. Medicinal use is also having a major impact on the populations of seahorses.

Shark fin soup is traditionally regarded as beneficial for health in East Asia. According to Compendium of Materia Medica, it's good at strengthening the waist, supplementing vital energy, nourishing blood, invigorating kidney and lung and improving digestion. However, such claims are not supported by scientific evidence.. Furthermore, they have been found to contain high levels of mercury, which is known for its ill effects.

The animal rights movement notes that a few traditional Chinese medicinal solutions use bear bile. To extract maximum amounts of the bile, the bears are often fitted with a sort of permanent catheter. The treatment itself and especially the extraction of the bile is very painful, causes damage to the intestines of the bear, and often kills the bears. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China, gallbladders from butchered cattle are recommended as a substitute for this ingredient Bensky, Clavey and Stoger's comprehensive Chinese herbal text deals with substances derived from endangered species in an appendix, with an emphasis on recommending alternatives.

Opposition
Starting from late 19th century, politicians and Chinese scholars with background in Western medicine have been trying to phase out TCM totally in China. Some of the prominent advocates of the elimination of TCM include:
 * Lu Xun, who argues that TCM doctors are intentionally or unintentionally deceiving their patients
 * Wang Jingwei, who asserts that TCM has no basis in human anatomy nor any scientific foundation
 * Li Ao, who argues that TCM is a kind of superstition.
 * Fang Shimin, who argues that TCM is pseudo-science and may be unsafe due to a lack of Double blind tests.

The attempts to curtail TCM in China always provoke large scale debates but have never completely succeeded. Still, many researchers and practitioners of TCM in China and the United States argue the need to document TCM's efficacy with controlled, double blind experiments. These efforts remain hampered by the difficulty of creating effective placebos for acupuncture studies.

The attempt to phase out TCM in Japan partially succeeded after Meiji Restoration. However, in the 1920s a movement emerged that attempted to restore traditional medical practice, especially acupuncture. This movement, known as the Meridian Therapy movement (Keiraku Chiryo in Japanese) persists to this day. Furthermore, many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine.

Dose of Modernity
On September 6, 2007, Abraham Chan, President of the Modernized Chinese Medicine International Association in Hong Kong announced that Traditional Chinese Medicine is getting a modern dose by transforming the plants and ingredients to soluble granules and tablets. He said that the pills and sachets used 675 plant and fungi ingredients and about 25 from non-plant sources such as snakes, geckos, toads, bees and earthworms.

Schools of Classical Chinese Medicine

 * Classical Chinese Medicine School at National College of Natural Medicine - Masters of Science in Oriental Medicine (MSOM) degree that offers a four-year program that educates students in the practice of Oriental medicine as illustrated by Chinese medical classics in the topics of acupuncture, Chinese herbal medicine, qi gong, tui na and more. (Portland, OR)

Schools of Traditional Chinese Medicine

 * Acupuncture & Integrative Medicine College, Berkeley | Acupuncture School - masters degree in Oriental medicine/traditional Chinese medicine (TCM), and other programs in medical qigong (certification), and Japanese acupuncture (certification) (Berkeley, CA)


 * American Academy of Acupuncture and Oriental Medicine - Masters Degree in Acupuncture and Oriental Medicine - specializing in Traditional Chinese Medicine including - acupuncture, herbology, dietary therapy, exercise therapy (Qi Gong, Tai Chi) and Tuina Massage. (Roseville, MN)


 * American College of Traditional Chinese Medicine - acupuncture school, traditional Chinese medicine (TCM), Chinese herbal medicine, tui na certification (San Francisco, CA)


 * Institute of Traditional Medicine - offers programs in Oriental Medicine, and Acupuncture, as well as Herbal Medicine, Asian Body Work Therapy, and Traditional Arts. Distinguished by a holistic vision and philosophy which offers its students the opportunity to explore and study Oriental Medicine and other forms of traditional healing (Toronto, Ontario, Canada)


 * Midwest College of Oriental Medicine - offers a combined Bachelor of Science in Nutrition and Master's in traditional Chinese medicine (TCM), acupuncture certification, and a new doctoral program.


 * New England School of Acupuncture - acupuncture school, traditional Chinese medicine (TCM), Chinese herbal medicine, Chinese medical qigong, integrative medicine, and Japanese acupuncture (Newton, MA)


 * Oregon College of Oriental Medicine - acupuncture school, traditional Chinese medicine, Chinese herbal medicine, Qigong, Shiatsu, Tui Na, taiji quan, clinical doctor of acupuncture & Oriental medicine degree program (Portland, OR)


 * Pacific Rim College - School of Acupuncture and Oriental Medicine - Diploma in Acupuncture, Diploma in Acupuncture and Oriental Medicine, Doctor of Traditional Chinese Medicine. (Victoria, British Columbia, Canada)


 * Southwest Acupuncture College, Boulder, CO - an accredited post-graduate college that offers a Master's of Science in Oriental Medicine, which includes Chinese herbal medicine, acupuncture, qi gong, shiatsu, tui na, tai ji, and clinical experience. The Master's degree is an extensive, four-year, 3000-plus-hour program (Boulder, CO)


 * Yo San University of Traditional Chinese Medicine - acupuncture, herbal medicine, chi development (Los Angeles, California)

Online databases

 * 中醫檔案區("Chinese medicine place") Classical texts in public domain.
 * 電子中醫藥古籍文獻("Electronic old Chinese Medicine books and texts") Classical texts for FTP
 * 蓮花海軟體工作坊("Lotus Sea software working place") Free Classical text database searchable software with downloadable compress files of the texts

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