Traditional Chinese medicine (TCM) is one of the oldest healthcare systems in the world. During its thousands years of practice, physicians use a unique set of rules to interpret disease development, make diagnosis and provide treatment. The following questions provide a glimpse on how it works.

• Does TCM take a longer time to work?
• What are the five flavors in Chinese medicine?
• After taking tonic herbs, some people may not feeling well such as having nasal bleeding, that means what?
• What is a sub-health state?
• What are acupuncture and moxibustion
• How TCM physicians decide the primary and the secondary treatment for patients?
• How to understand the toxicity and adverse effects of Chinese herbs?
• Can physicians identify a condition by taking pulse alone?
• Physician may use various and even totally different prescriptions to treat the same disease, how to explain that?
• Chinese herbs have four energies, what about the foods we eat everyday?
• TCM uses herbs to treat diseases but not on the basis of their chemical components, so what are the principles to apply them?
• It is said that Chinese medicines have fewer side effects, and even safe for a long time or unfit condition.
• Chinese medicines are mainly just bitter decoctions?

Q：Does TCM take a longer time to work?

A:  While TCM has an advantage in relieving symptoms associated with chronic diseases like diabetes and cancer, it is also good at treating acute conditions. For example, coma from a sudden stroke may be relieved by acupuncture or a drug made with bezoar (gallstone of ox). Just like western medicine, the time is subject to individual conditions. Chronic diseases need a longer treatment time; for acute diseases or infections, patients can recover in a short time.

Q：What are the five flavors in Chinese medicine?

A: TCM claims that Chinese herbs have "five flavors", which are pungent (ephedra, peppermint and tangerine peel); sweet (liquorice, kudzu root, astragalus root); sour (hawthorn fruit, white peony root and smoked plum); bitter (dandelion, wild chrysanthemum and motherwort herb); and salty (clam shell, seaweed and cuttlefish bone). There is a close relationship between the flavor of a herb and its effectiveness.

• Pungent herbs have the effects of dispersing and enhancing the flow of qi (vital energy) and blood, so they are usually used in digestive or emotional problems.
• Sweet herbs have a tonic effect and can be used to alleviate acute conditions.
• Sour herbs possess astringent, and consolidating effects that can be used to arrest conditions such as profuse sweating, incontinence and secretions.
• Bitter herbs possess cooling and purgative properties, therefore many herbal teas prescribed for fever are bitter.
• Salty herbs have the effects of softening hard tissues, dispersing knots and purgative, so herbs in this category are used for conditions like tumors, abdominal distention or fluid retention.

Q：After taking tonic herbs, some people may not feeling well such as having nasal bleeding, that means what?

 A: "Tonify the deficiency, reduce the excess" are the basic therapeutic principles in TCM. No matter whether you are treating a disease or keeping your body in balance, it should be noted that tonification methods can only be used in a deficient state. In excess states, e.g. the acute stage of an infection, tonification should be applied with caution.

TCM tonifying methods are mainly used to treat a particular deficiency in the body. Symptoms vary according to the cause, degree of deficiency, and organs involved. Tonifying herbs can be categorized into four types: (1) benefiting qi (vital energy); (2) supplementing blood; (3) nourishing the yin; and (4) replenishing yang. If tonification is not done in the appropriate way, not only the particular deficiency cannot be resumed, the individual may further aggravate or experience new symptoms. For example, individuals should take sweet, cold, yin-nourishing herbs if they occur yin deficiency with internal fire. Yet if they by mistake take spicy, warm and yang-assisting herbs that flare up the fire, further exhausting the yin, it will aggravate the situation, leading the fire evils to irritate the blood and cause nasal bleeding.

Q：What is a sub-health state?

 A: Sub-optimal health status (SHS) or sub-health state is characterized by some disturbances in psychological behaviors or physical functioning, or in some indices of medical examination, but without typical pathological features. It is considered as a therapeutic working concept, that defines an intermediate stage between health and illness. Individuals who are sub-healthy can experience a wide range of discomforts but without any obvious and diagnostic illnesses identified through standard medical checkup. TCM takes seriously about a sub-health state, which claims the body has manifested a imbalance of yin and yang, qi, blood, or organs.

In comparison with healthy individuals, those in a sub-health state have a much higher risk of developing illnesses. Therefore, prevention and elimination of the "sub-health state" have become one of the most important tasks in TCM. Individuals should pay attention and take care their common ailments in the earliest possible so as prevent suffering from sub-healthy, they should also keep a balanced body and mind, have a proper diet, regular sleep and appropriate amount of exercise. From a TCM viewpoint, sub-health states often fall into the following disharmony patterns:

•  stagnation of liver-qi;
•  phlegm and dampness generate internally;
•  deficiency of heart and spleen;
•  deficiency of protective qi in lungs;
•  yin deficiency of liver and kidneys;
•  yang deficiency of spleen and kidneys.

If you want to understand whether you are in any of the "sub-health states," please consult a TCM physician. Then they will prescribe a remedy according to your particular pattern to keep you in more healthy state.

Q：What are acupuncture and moxibustion?

A: Acupuncture and moxibustion are two different methods of treatment. Acupuncture involves inserting metallic needles into certain points on the body surface and exerts a healing effect by different manipulation techniques. Moxibustion uses burning moxa or moxa sticks  (moxa refers to the Chinese mugwort herb) above the skin to warm or heat certain points. These designated points are called acupoints. The chosen body points and locations will vary according to individual conditions. The therapies activate the flow of qi (vital energy) and removes blockages in the meridians, so that the body can reach a new balance through its self-healing processes.

Acupuncture can either be used to fortify a weakness or release/reduce an excess disharmony pattern. Moxibustion is only suitable for fortifying or removing blockages through its warming effect. Acupuncture works quicker than moxibustion, however the effect of moxibution lasts longer, they are often used together clinically. Sometimes, moxibustion is used to replace acupuncture method, e.g. remedies applied at the belly button that is contraindicated for acupuncture.

Q: How TCM physicians decide the primary and the secondary treatment for patients?

A: Primary treatment and secondary treatment are therapeutic concepts that considered relatively according to the forces between healthy energy and pathogenic factors in the body, this treatment strategy is often decided based on causes vs symptoms, or acute vs remission stage. For example, in patients with liver cirrhosis, severe ascites (fluid retention in abdomen) will make them shortness of breath, difficulty in lying down, and urinary problem, therefore the primary treatment is to get rid of the excessive fluid and resolve the swollen condition directly, while the secondary treatment is aimed at invigorating internal organs to facilitate the body's fluid excretion process. However, once the symptoms of ascites alleviated, the primary treatment will change to replenish healthy energy, regulate liver functioning, and invigorate spleen and kidneys, so as to prevent further accumulation of body fluid in the abdomen; fluid expelling will then become secondary. As you can see, primary treatment and secondary treatment are not absolute, physicians will adjust treatment strategy during the course of disease, and it is important to closely monitor the disease changes in patients.

 Q：How to understand the toxicity and adverse effects of Chinese herbs?

A: Most people think that Chinese herbs are mild, so that no harm will come to you if you take it for a long time. This is absolutely wrong! Improper use of any medicine can lead to adverse effects. For example, when ginseng is used in individuals with fever, skin sores or constipation, the symptoms will become worse. Therefore, it is better to seek professional advice before you take any medicine.

Some recent reports have shown that a Chinese herb, Caulis Aristolochiae Manshuriensis (guan mu tong), contains a toxic ingredient called Arisolochic Acid, which can cause kidney failure. It should be noted that a common herb used by TCM is Caulis Clematidis Armandii (chuan mu tong), the two are different species. Furthermore, TCM will use some potent herbs in complicated cases, for example, aconite daughter root (fu zi) and aconite mother root (chuan wu) are common herbs for the treatment of joint problems, physicians will always remind their patients to pay special attention in their dosages and preparation procedures in order to avoid side effects. It is very important to know the proper way of consuming Chinese herbs, and also select the quality Chinese herbs.

Q：Can physicians identify a condition by taking pulse alone?

A: Pulse taking plays a vital role in disease diagnosis of TCM, however just relying on this will only tell part of the story. For example, the "rolling pulse" is a usual sign in pregnant women; however it can also be seen in those who have dampness in their intestines and stomach. In order to make an accurate diagnosis, it is necessary to combine the four examination skills of diagnosis: (1) inspection – observe anything unusual about the patient's appearance; (2) listening and smelling – listen to the patient's noises and notice how they smell; (3) questioning – asking the patient about their medical history and symptoms; and (4) palpitation – finding out the pulse pattern as well as by pressing the skin, hands, feet, chest and abdominal areas to check for pathological changes. Physicians will undertake a comprehensive analysis of all clinical features of the patient before making a diagnosis.

Q：Physician may use various and even totally different prescriptions to treat the same disease, how to explain that?

A: First of all, TCM treatment for diseases is based on the condition of each patient, the amount and ingredients in a prescription vary according to the individual condition only.

Secondly, TCM views what we called a disease representing the entire course of pathological changes, whereas a syndrome reflects the pathology of a disease at a certain stage. A TCM syndrome, also called disharmony pattern, is confirmed by grouping the signs and symptoms that manifest at a given stage of the disease. Physicians often treat a syndrome rather than a disease. For example, common cold and flu has different syndromes according to TCM understanding, such as wind-cold syndrome, wind-heat type syndrome or low-resistance syndrome. As a result, various therapeutic strategies are employed and different prescriptions will be used among patients; this is called treatment based on syndrome differentiation.

Q：Chinese herbs have four energies, what about the foods we eat everyday?

A: Herbs and foods share the same origins and they both can be used as medicine. Therefore, foods can also be classified into cold, cool, warm and hot energies. Actually, most foods are neutral in nature, however certain foods have extreme energies, for example, cold foods include bamboo shoot, banana, bitter gourd, clam, crab, grapefruit, kelp, lettuce, muskmelon, persimmon, salt, seaweed, star fruit, sugarcane, water chestnut, watermelon and lotus root; hot foods include peppers, chili, cinnamon, cottonseed, ginger and chives. It is important to know about the energies of foods, because different energies act upon the body in different ways and so can affect the state of health. If a person suffers from cold rheumatoid arthritis and the pain is particularly severe on cold winter days, eating foods with warm or hot energy shall relieve the pain considerably. Or if a person suffers from skin eruptions that worsen when exposed to high temperatures, it is beneficial to eat food with a cold or cool energy to relieve the symptoms.

Q：TCM uses herbs to treat diseases but not on the basis of their chemical components, so what are the principles to apply them?

A: There is a major difference between Western and Chinese medicines in treating diseases. Generally, TCM focuses on the overall condition of a patient, and the remedy is designed to work on the whole body rather than pinpoint a specific pathogen that may cause the condition. This focus on the overall state of the body is done according to set principles.

Firstly, physicians have to identify a syndrome or disharmony pattern of patients, for example the Eight Principles Differentiation using yin, yang, exterior, interior, cold, heat, deficiency (xu) and excess (shi) to summarize the location and pathological changes as well as the course of a disease. Then they select herbs to fit the disharmony pattern, that based on herbs' properties such as energy, flavor, movement, and therapeutic action on a certain meridian to draft the appropriate remedy. Every Chinese herb has a particular energy: cold, hot, warm, and cool; it also has a particular flavor: spicy, sweet, sour, bitter, salty; they also have ascending, descending, floating and sinking properties and their corresponding targeted meridians. Physicians use these properties of herbs to stimulate the body's self-healing power, making the body resume its balance. These knowledge about medicinal nature of substances has been determined through years of accumulated experience.

TCM claims that Chinese herbs rely on their unique properties to counteract the pathogenic factors inside the body, to make the body shift into a new balance. For example, herbs that can treat or eliminate heat or hot syndromes mostly have a cold or cool energy, such as baical skullcap and isatis root. Herbs that can treat or eliminate cold syndromes mostly have a warm or hot energy, such as monkshood and ginger. As the Shen Nong's Classic of Herbal Medicinesays, "Treat cold disease with hot medicines and treat hot diseases with cold medicines." The Plain Questions also states: "Treat cold with heat and heat with cold." These are the basic principles in prescribing medicines, that had established in the very early date of TCM.

Q：It is said that Chinese medicines have fewer side effects, and even safe for a long time or unfit condition.

A: Not true, the ultimate goal of TCM herbal treatment is to restore yin-yang balance of the body through different properties of herbs. Herbal remedies provided by physicians are based on individual condition of each patient, and the herbs are not simply added in a cumulative fashion but combined according to particular principles. Each ingredient in the prescription should be carefully balanced in quality and quantity, in order to accentuate its efficacy while reducing side effects. Improper use will lead to extreme energy excess inside the body and disturb the yin-yang balance. All medicines have their own particular properties and will definitely show certain adverse effects if used inappropriately. It is important to read the label carefully, before choice any herbal supplement too.

Q：Chinese medicines are mainly just bitter decoctions?

A: Traditionally, herbs are boiled with water and prepared in herbal solution for oral administration. It is called decoction and is the most common form of TCM treatment. However, Chinese medicines can be used in many different preparation forms. These forms developed because of their different processing methods. Other common forms are soft extracts, pastes, granules, boluses, powders, syrups, lotions and tablets. In clinical applications, the appropriate forms will be provides according to the types of diseases and individual request.  

Written by:

Shirley Yau, Enid Cheung, Ivy Poon, Janie Wong & Ray Chan.
CM Promotion Group - School of Chinese Medicine, CUHK.

References:

• TCM Principles
• TCM Diagnosis
• Internal Medicine of TCM
• Chinese Meteria Medica
• Formulae of TCM

Published by Shanghai Science and Technology Publishing House, 6th edition.

Translated and Edited by:

Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.
Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.
Rose Tse, Integrated Chinese Medicine Holdings Ltd.