Traditional Chinese Medicine (TCM)

Traditional Chinese medicine (TCM) is one of the oldest healing systems, it includes herbal medicine, acupuncture, moxibustion, massage, food therapy, and physical exercise. TCM is a fully institutionalised part of Chinese health care and widely used with western medicine.

The body is an organic whole, all the component parts are interconnected, they depend and restrict each other physiologically, influence each other pathologically. The five organs act as the core functional units, and through the linking of the meridian system, a complex set of inter-relationships are formed within the body. Every part of the body has special relationships with the five organs, and the five organs themselves are inter-related too. 

Furthermore, qi (vital energy or life force), blood and body fluids are the material basis for various body functions; they flow through the body to facilitate all parts of the body working together and to ensure the unity and harmony inside the body. 

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Physiological aspect: Each organ not only performs its own individual functions; it also complements other organs and even the entire internal system to perform life activities. For example, although nutrient essence is transformed in the spleen, but the transforming process also involves nourishment of the heart blood, regulation of the liver and promotion of the kidney. A harmonious and coordinated relationship between the organs is essential for normal life activities.

Diagnostic aspect: The four diagnostic skills and correlations made between internal and external body are concrete samples of TCM holistic concept. Since the organs and tissues of the body are interdependent physiologically and mutually affected pathologically, physicians are able to assess the status of internal organs and construct a detailed picture of the patient's disease based on the symptoms, pulse and tongue of the patient. For example, the tongue has special relationships with the internal organs. The tongue body and its coating create the tongue signs, which are an important factor in diagnosis. Changes in the tongue signs reflect changes of organ functioning, blood and qi activities, body fluid metabolism, and progressing direction of diseases. In addition, it is a routine practice of TCM to associate a patient's condition with external influences and personal details. Factors like weather, season, lifestyles, eating habit, mental state, body constitution, age, gender and career are usually taken into account in TCM diagnosis, they help provide a full evaluation and design the most appropriate treatment plan to the patient.

Therapeutic aspect: TCM treatment focuses on the overall disharmony of the body rather than specific organ or body region. Treatment based on syndrome differentiation (identifying disharmony pattern) implies the holistic concept of TCM, which has made use of the organic wholeness and interrelationships of the body.

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The body should be in tune with the external environment: The body communicates with the external environment constantly, factors such as weather, geographic location, working and family environments can all affect our health. External changes cause the body to respond physiologically or pathologically, which reflects the united relationship between human and the outside world. We should live in harmony with nature, other people, and the immediate environment. When changes occur in external environment, and the body fails to adapt to the changes, diseases are likely to occur.

Climatic Influences: Under normal circumstances, climatic factors do not cause disease, only in extreme changes or when the body is too weak to adapt to climatic changes, they become pathogens that could cause disease. The six climatic influences, which are wind, cold, summer-heat, dampness, dryness, and fire or heat, are considered as the important external pathogens for disease development, also known as the "six evils" in TCM. The correlations made between the climate and disease development is a particular way for TCM to explore the imbalance of the body. It facilitates physicians to identify the exogenous pathogens based on particular symptoms, regardless of identifying bacteria, viruses, toxins or parasites, and allows for a different approach in disease treatment that has been met with success over the centuries in China.

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Seasonal Influences: The body makes appropriate physiological responses in accordance with seasonal changes. For example, it opens the skin pores and sweat more in summer, while closes the skin pores and sweats less in winter, thus the body temperatures can be maintained within a normal range. TCM physicians always consider the seasonal physiological changes when distinguishing the abnormal body signs from the normal ones.

Social and life influences: Technology and social progress has created many new health problems, stress is a part of modern life. We are constantly overwhelmed by demands at work and home, and challenged by social turmoil, life changes, financial and interpersonal issues. A combination of these factors puts extra strain on our mind and spirit, and also drains the body's reserves. Health is achieved only when the body is in balance which includes the physical, emotional and mental aspects. Overreacting psychological activities can easily disturb the organ functioning, as time passes some real physical damage will occur.

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TCM has a unique concept about mind and body connection, stress and mental distress are considered to be the usual factors that affect disease development. Excess psychological factors are known as the "seven emotions" which include joy, anger, sadness, anxiety, worry, fear and fright. Each of the emotions interacts with particular internal organs and affects qi activities differently, leading to different disharmony patterns.

From the above, we can see that TCM holistic approaches are based on the views of whole-body, whole-person, whole-world. Under the guidance of holistic concept, all aspects must be considered when treating a problem, only a comprehensive analysis on the patients' physical condition, age, lifestyles, medical history, career and mental state can a correct diagnosis be made and then treated properly. 

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Tui Na

Like acupuncture and moxibustion, Chinese massage is based on theories dealing with the organs, meridians, qi and blood. The massage techniques work on particular meridians or acupoints and regulate the flows of the body network, creating either a local or general effect for the body.
In China, massage is not simply regarded as a mean of relaxation but as an important component of traditional Chinese medicine. Its origins date back much earlier than many other therapeutic techniques and because of its simplicity and safety in application, as well as its effective results, it has evolved into its present popular form.

Chinese massage involves applying various manipulations to stimulate the soft tissues, stretch the muscles and mobilize the joints. When massage is used on specific body regions, the stress acting locally can promote blood circulation and remove stagnations, restore impaired soft tissues and correct bone and joint deformities. In addition, despite being applied to the surface of the body, massage creates signals that affect the transmission of fluids, qi and blood, which helps to regulate the functional state of the internal organs.

Regulate nervous system: Massage helps balance the nervous system by soothing or stimulating the nerve endings, resulting in different physiological responses that lead to healing. 

Improve blood and lymph circulation: The rhythmical manual pressure and movement used in massage not only creates a pumping effect on the blood and lymph flows, but also enhances the biological activities of the components. For example, studies show that after massage, changes in the blood include a raised white blood count, higher endocytosis action, and increased blood volume.

Promote bio-active ingredient release: Massage enhances the secretions of bio-active ingredients like endorphins and serotonin (5-HT), which relieve painful conditions. Massage also lowers the body's catecholamine level, which means certain actions of neurotransmitters and hormones in the sympathetic nerves are inhibited, resulting in some important physiological activities slowing down, and the body becomes relaxed. 

Speed up tissue healing: Massage helps to ease pain, promote local circulation, relieve swelling and adhesions, which all facilitate the healing process of damage tissues. 

Increase metabolism: Massage increases the body's secretions and excretions; for example, it promotes the production of gastric juices, saliva and urine. It also promotes gas exchange in the lungs, and other physiological activities inside the body. These reflect an overall increase in the metabolic rate. 

Enhance mobility and flexibility: The stretching of the muscles and connective tissues in massage helps keep the tissues elastic and firm. 

Basic Techniques of Chinese Massage
One of the characteristics of Chinese massage is that it can often be quite brisk, as it is not just for relaxing or calming but to create a healing effect. Proficient therapists should make their manipulations persistent, forceful and rhythmic yet soft, so as to achieve pressure effects that are deep and penetrating. For instance, massage therapists may repeatedly apply a single technique hundreds of times on a frozen shoulder, time that Western therapists would spend on an entire treatment. The basic techniques of TCM massage are categorized as below: 

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Compression
This includes motions like pressing, nipping, stepping and twisting that direct apply pressure by the fingers, palms or other part of the limbs. For example, fingernail nipping on the groove between the nose and lip is used to regain consciousness from syncope or coma, while pressing back and forth with finger tips along the tendons is used to alleviate muscle spasm. The techniques are usually used for relieving muscular stiffness, removing blockages and promoting circulation.

Swing
This includes finger-pushing, rolling and kneading that stresses a coordinated action of the elbow, which makes the applied pressure act on the selected region for some time. "Pushing with One-finger Meditation" is a common technique in TCM massage; the therapist uses the thumb to push and rotate forward along a meridian, the swing frequency is usually up to 120-160 times per minute. Rolling refers to rotating the back of the hand rapidly back and forth over the body surface.

Friction
This includes rubbing, gilding, pushing and wiping, all of which creates heat on the body surface and enhances the circulation underneath. Gentle and rhythmic small circular movements made with the palm or fingers over the skin, which is usually used for abdominal problems; gross scrubbing motions are usually applied to the chest, back and limbs and helps to stimulate or activate a larger area.

Vibration
This includes rapidly vibrating, shaking or rocking a selected region to create a constant force, so as to remove stagnation, resume qi movement, release tensions and promote gastro-intestinal functioning. Massage therapists usually apply digital-shaking on the head and chest regions to relax athletes, or relieve problems like insomnia, amnesia or bowel disorders. Limb-shaking is usually applied after twisting the muscles at the end of manipulation.

Percussion
To clap, strike, tap or knock the body surface with hands or tools. These techniques are usually used to ease muscular pain, numbness, spasm and headache. Fist striking is used on the back; palm patting is used on the crown of the head, waist, hip and limbs, while finger tapping is used on the head, chest and abdominal regions.

Pinching and grasping
This includes the rhythmic picking up and squeezing of the soft tissues while holding, twisting, kneading or pinching with the operator's fingers. The techniques are mainly applied to regions that anchor ligaments and tendons. For example, grasping the shoulder helps to resume the flow of qi in the chest.

Joint manipulation
This includes rotating, pulling, abducing and adducting actions with the body part along its axis, which helps to increase range of joint motion, and promote flexibility of the limbs and spine.

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Based on syndrome differentiation, massage therapists apply gentle, heavy, slow, rapid, vigorous or soft stimulations for specific conditions.

For example: Light, soft and slow kneading and rubbing on particular body points are to overcome organ weakness; Strong or forceful rubbing, scrubbing, squeezing or pressing techniques are to expel pathogens and inhibit over-functioning; For conditions like coldness or under-functioning, relatively slow and soft rhythmical manipulations are performed for a considerable length of time, so as to promote the circulation and create warmth.

In a typical session, the massage is given on a table or stool with the patient wearing loose clothing. The length of a massage will be determined by the selected region(s) as well as individual responses and the therapist's technique. The number of massage sessions needed depends on the severity and type of condition, with generally acute mild muscular sprains, for example neck stiffness, being alleviated in one to three sessions, while acute lumbar sprains need three to five sessions. For chronic cases like a particular organ dysfunction, the course of treatment can last for up to three months, while the more stubborn joint problems may take longer. 

Indications and Contraindications for Chinese Massage: Chinese massage therapies are widely applied to a variety of conditions, especially for traumatic injuries as well as painful diseases. If you are in doubt or under medical supervision, discuss with your doctor before embarking on massage therapy. 

Indications for massage therapies: Physical injuries that are caused by direct violence or chronic strain; Middle and late stage soft tissue injuries caused by direct violence; Certain bone or joint diseases that lead to pain and limited movement; Some internal functional disorders.

Contraindications for massage therapies: Suspected fractures, strains, injuries that are accompanied with neural signs; Tumors, tuberculosis & bone infections; Early acute joint sprains with severe swelling; Acute soft tissue contusions with severe swelling; Severe heart and lung disease; Bleeding or blood vessel disorders; Presence of infected skin and wounds in the selected region; Pregnancy and during menstrual period are not appropriate to stimulate the pelvic region; Elderly people with weak constitutions or osteoporosis; After meals, when drunk or extremely tired.

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Acupuncture
In China, acupuncture and moxibustion have been used as routine clinical procedures for thousands of years. Acupuncture involves using fine needles to pierce specific body areas, while moxibustion is the burning of moxa (the leaf of the Chinese wormwood tree) to provide a warming effect. Acupuncture and moxibustion are considered complimentary forms of treatment and are commonly used together. They have been widely adopted by the general public for its wide range of applications, good results and convenience of use.

The Meridian System and Acupuncture
According to traditional Chinese medicine theory, our body consists of a giant web called the meridian system linking different parts together; its channels making up a comprehensive yet complex body map that supplies qi (vital energy) to every part of the body, assists the distribution of blood and body fluids, maintains the balance between yin and yang elements, and protects the body against disease. Along these channels, acupoints are the sites through which the qi of the organs and meridians is transported to the body surface. It is generally believed that diseases can be treated when the affected meridians or the affected organs are cleared. Acupuncturists work on these points to regulate corresponding organs or meridians so that the body can return to a state of balance and health. 

The meridian system is made up by a series of channels, which are sequential to each other in the circulation of qi. In the system, the twelve regular meridians form the major structure; they branch out twelve large collaterals to enter the chest, abdomen and head for connecting the internal organs; fifteen external collaterals to run along the limbs and on the trunk. There are also twelve small collaterals for controlling the muscles and tendons, and smaller collaterals disturbed on the skin surface, and the eight extra meridians to enhance the communications and functions within the system. They work closely with each other, with a dysfunction in one usually affecting another. In Chinese medicine, to be knowledgeable about the meridian system is as important as anatomy and physiology in Western medicine.

Twelve Regular Meridians
The twelve regular meridians make up the main part of the meridian system. They are distributed symmetrically on both sides of the body and are paired with their corresponding internal organs. TCM groups the meridians under arm, leg, yin and yang.

The order and arrangement of the twelve regular meridians result in particular ways of communication inside the body, TCM uses Yin/Yang characteristics to distinguish and understand the pattern of meridian flow. All the twelve meridians run through the limbs, with certain meridians and their corresponding organs creating an interior and exterior relationship. For example, the lung meridian (greater yin of arm) and the large intestine meridian (brightness yang of arm) are paired based on their pathways, and clinically they are closely related; problems in the lung or its meridian can also be treated by using various points on the larger intestine meridian. Furthermore, the arm and leg meridians of the same yin/yang names are also related. For example, problems in the lung or its meridian (greater yin of arm) can be treated by using various points on its communication partner the spleen meridian (greater yin of leg), besides the ones on the lung meridian.

The Eight Extra Meridians
In the meridian systme, there are eight extra meridians which are the Governor Vessel, Conception Vessel, Thoroughfare Vessel, Girdling Vessel, Yin Link Vessel, Yang Link Vessel, Yin Heel Vessel and Yang Heel Vessel. Unlike the twelve regular meridians, these eight channels do not correspond with the organs directly, and only the Governor Vessel and Conception Vessel have acupoints on them. Their main function is to strengthen the links between the twelve regular meridians and also act as reservoirs of the fundamental substances, buffering the blood and qi circulation. They have special relationships with the liver, kidney, uterus, brain and marrow and thus influence these structures physiologically and pathologically.

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Basic Insertion Techniques
Due to the anatomical features of the acupoint, needle insertion technique varies. Traditionally, the needle is inserted using both hands. In one hand, physicians hold the needle between 15 degrees to 90 degrees to the skin surface. They also use their fingers to press, hold-up, or stretch the local skin surface and then guide the needle to be inserted in appropriate speed, force, depth and direction. Alternatively, a needling guide tube can be used. The needle is inserted into the tube and placed firmly on the point; physicians then tap firmly on the handle of needle so that it penetrates the skin. The guide is then removed and the needle is further adjusted as required.

After the needle is inserted, physicians will look for the appearance of needling sensation. TCM calls this deqi literally, the "arrival of qi". The patient may feel a dull ache, heaviness, distention, tingling, or electrical sensation either around the needle or traveling up or down the affected meridian. Meanwhile, the practitioner may experience tightness and dragging around the needle similar to a fish taking the bait. This needling sensation varies greatly from person to person. Pain is not an expected response to most acupuncture stimulation, though certain acupoints may involve some occasional pain.

TCM focuses on this needling sensation, which is influenced by many factors, such as the constitution of a patient, severity of the illness, location of the acupoints and the needling techniques. In general, if the needling sensation occurs easily and the qi can travel to stimulate the lesion, the therapeutic effect will be better; if qi is difficult to secure, then the effect is not so good. For individuals who get this sensation slowly or faintly, the physician will further manipulate to adjust the position, direction and depth of the needle; this includes techniques like lifting and thrusting the needle into place, twirling the needle in a specific manner, plucking or scraping the handle of the needle, and also pressing the skin up and down along the course of the meridian with the fingers.

Precautions in Chinese Acupuncture Treatment
When patients are hungry, have overeaten, are drunk or temporary exhausted, acupuncture procedures should only be commenced after they have rested properly. For very weak patients, the manipulation of needles should not be too strong, there should be a limited number of acupoints and it is preferable for the procedure be undertaken in a supine posture.It is contraindicated to puncture points on the abdominal and lower back regions for pregnant women. The points that may cause contraction of the uterus, such as he gu (Li 4), san yin jiao (Sp 6), kun lun (Bl 60) and zhi yin (Bl 67) should not be used. During menstruation, acupuncture treatment is not recommended unless it is for regulating the menses. Points on the vertex of infants should not be needled when the fontanel is not closed. In addition, retention of needles is not recommended since infants are unable to cooperate with the practitioner. Avoid puncturing the blood vessels so as to prevent bleeding; patients with clotting problems are not candidates for acupuncture treatment.Do not puncture where there are skin infections, ulcers and sores. In order to avoid accidents, practitioners should pay attention to the angle, direction and depth of needling, especially for points near the eyes, on the neck, chest and back.

The Regulating Effects of Chinese Acupuncture
Unlike herbal therapy which uses external substances to supplement the body, acupuncture is concerned with stimulating and enhancing the body's self-healing power. Acupuncture is physical stimulation, which creates a cascade of positive changes inside the body to promote physiological functions, self regulation and encourage the body's self-healing abilities. In other words, acupuncture largely relies on the body's own regulatory state to accomplish its therapeutic proposes; if the health condition cannot resolve through body's own natural healing abilities, then other alternatives should be used in a timely manner. Understanding the concrete action of acupuncture gives insight to its clinical validity.

Modern studies have revealed that acupuncture can stimulate the body's signaling systems, which speed up the healing process under certain circumstances. This means that acupuncture can either cure disease or alleviate symptoms through its multiple regulating effects. Specialists have found that the meridian system might actually correspond to a number of body tissues.

Preclinical studies have documented the effects of acupuncture; however, they are still not able to fully explain how acupuncture works using modern scientific theory. According to the National Institute of Health, acupuncture stimulates the central nervous system (the brain and spinal cord) to release chemicals such as hormones causing biochemical changes that help regulate the body's natural healing abilities and promote physical and emotional well-being.

Specialists have concluded that acupuncture works in three major ways: as analgesia, as a regulator of the physiological system, and as an enhancer of the immune defense system. Studies in China have showed some of the following phenomena:

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1. Analgesia
Acupuncture increases the threshold of pain perception; this action is mediated by stimulating the release of natural endorphins in the nervous system. According to clinical demonstrations, when the appropriate body points have been selected and the proper needling sensation is attained to stimulate the lesion, the analgesic effect can greatly be assured.

2. Respiratory system
Acupuncture can alter respiratory movements; it can modulate the capacity of gas exchange, the oxygen exhaustion rate as well as the contraction and secretion actions of the air ways.

3. Cardiovascular system
It has been found that acupuncture does little for the cardiovascular system in normal and healthy individuals; however, it has positive modulation effects in an abnormal cardiovascular system such as rapid heart rate, poor heart pumping, unstable blood pressure and poor peripheral circulation. The effects can vary according to the different physical states, point selections, and needling techniques. Acupuncture tends to slightly increase the blood pressure in normal healthy individuals; however, it is good for controlling the blood pressure in hypertensive individuals, and is especially beneficial to those with early-phase hypertension.

4. Digestive system
Acupuncture works on the digestive system by regulating gastrointestinal tract movements and digestive secretions. The treatment is ideal for problems like gastritis, stomachache, stomach prolapse and ulcers. Acupuncture tends to help under-functioning intestines to resume to their normal state; for example, it helps to arrest either constipation or diarrhea. In gallstone cases, it can significantly increase the secretion of bile and thus facilitates the elimination of gallstones.

5. Urinary system
Acupuncture modulates the excretion functions of the kidneys, and also modifies the bladder emptying. These might be because it induces different neural reflex actions to enhance their functional states.

6. Sex and the reproductive system
Studies have showed that when puncturing he gu (Li 4) and san yin jiao (Sp 6) in pregnant women, it can induce cervical relaxation in early pregnancy, uterine contractions at middle term and alternative mild irregular contractions and regular contractions at late term. Generally, acupuncture enhances the functioning of the sex organs by modulating the axis of the hypothalamus-pituitary-sex glands.

7. Endocrine system
Acupuncture induces neural activities and affects endocrine secretions. Sometimes, an exhausted state or adaptation phenomenon (poor response) during acupuncture treatment can also be explained by over-stimulation of the cortex in the adrenal gland. In hyperthyroidism, acupuncture helps to regulate the functional state of the thyroid gland, reduce the synthesis of T3 and T4 as well as their secretions. In diabetic patients, puncturing on san yin jiao (Sp 6) can lower insulin secretion, while points like qu chi(Li 11) and di ji (Sp 8) can stimulate insulin secretion.

8. Nervous system
Acupuncture mediates neuro-hormonal activities, which are accomplished by neural reflexes in different levels of the body system. In studies for the activation of the cerebral cortex in healthy individuals, heavy stimulation seems to have an inhibitory effect on the motor division of the cerebral cortex while light stimulation seems to have an excitatory effect on the division. For problems of the peripheral nervous system such as facial palsy, trigeminal neuralgia, sciatica and optical nerve atrophy, acupuncture helps to reduce inflammation, arrest pain, and promote regeneration of new nerve fibers. 

9. Immune system
There is plenty of evidence that acupuncture enhances immune functioning and helps to regulate various immune problems back to a normal state. Acupuncture not only increases the amount of white blood cells, but also improves their actions. Acupuncture helps cancer patients to endure surgery, e.g. puncturing points like zu san li (St 36), san yin jiao (Sp 6) and guan yuan (Cv 4) seem to improve the white cell count after three days of treatment. Chemotherapy usually leads to immune under-functioning while acupuncture treatment can markedly raise the immunoglobulin level.