Mythic Chinese heroes were simultaneously the progenitors of Chinese civilization and medicine. For the last centuries in China, traditional medicine has evolved yet remained rooted in the contending, sometimes conflicting theories of the preceding millennia. Safety, effectiveness, and low cost appear to drive the utilization of Chinese medicine in the West. It is one of the fastest growing forms of health care in the United States.
Fu Xi invented picture symbols, the rules of marriage, the arts of cooking, music, and the ba gua or eight trigrams, upon which the Yi Jing or Book of Changes is based. The originator of herbal medicine is Shen Nong, the Divine Husbandman and legendary founder of agriculture. Believed to have lived 4600 years ago, he taught the Chinese people how to cultivate plants and identify their healing virtues as well as how to raise livestock. The Shen Nong Ben Cao Jing or Divine Husbandman’s Classic of the Materia Medica is attributed to Shen Nong but was written during the latter Han Dynasty, between 200 and 500 ACE. This text, still in current use, describes the medicinal properties of 252 botanical herbs, 45 minerals, and 67 animal substances. Although there are more than 13,000 substances currently catalogued in the Chinese Materia Medica, physicians routinely use about 500 to 700 of them.
About two thousand years ago, the mythic Yellow Emperor, Huang Di, is said to have produced the Huang-di Nei-jing or Inner Classic of the Yellow Emperor, written over the course of 200 years as a dialogue between himself and his minister Qi Bo, setting forth the systematic theories of Chinese medicine (Understanding Acupuncture, 1999, Stephen Birch and Bob Felt). The Nei Jing describes human harmony with the seasons, advising doctors how to guide patients toward an accord with the natural world. It is divided into two texts: the Su Wen or Fundamental Questions elaborates basic medical concepts, including Yin-Yang, five phases, anatomy, physiology, pathology, and treatment; and the Ling Shu or Spiritual Axis explains the principles of acupuncture. In addition to medicine, Huang Di is said to have taught humankind how to build with wood, weave with silk, and craft boats, wheeled carts, bows and arrows. Disease from this time forth was not simply regarded as a natural cataclysm about which to seek supernatural aid – medicine became a human endeavor, and environmental and behavioral vectors were seen as causes of disease.
According to the preeminent historical scholar of Chinese medicine, Paul Unschuld, although science and medicine arose simultaneously in both Greece and China, European medical ideas differed dramatically from those in China. In both places people were clever and thoughtful, shared the same biology, and complained about similar maladies – the differences lay in the realm of cultural interpretation. Unique social, economic, and political conditions within each culture generated unique explanatory models.
Unschuld notes that the Ancient Greeks originated the notion of democracy, the pillar of which was one person, one vote. New rules were needed to make self-governance work. Because even natural laws are human constructs, the ideas underlying the organization of the state were transposed onto the body, and the image of the human body was modeled on the political body (polis). Just as the state was comprised of individual citizens, the body was reduced to an aggregate of discrete structural components forming larger entities. To understand the whole, it was necessary to dissect it into smaller parts.
In China, chaos reigned during the Warring States Period, when approximately 1,500 small kingdoms remained in constant combat for generations. This situation shifted during the third century BCE when smaller states were consolidated and unified as the Chinese Empire. Lo and behold, the image of the body was similarly consolidated and integrated. Only after the birth of the Empire did the idea of the human body as a coherent organism emerge. The visceral organs were assigned roles that corresponded to the political structure of the state: the Heart was the Emperor, the Spleen the Minister of Agriculture, the Stomach the Granary, the Liver the General, the Gall Bladder the Judge. The body became a mutually interacting set of organized bureaucracies. Just as canals, rivers, and irrigation agriculture enabled the production and transport of goods and resources throughout the Empire, a matrix of channels were presumed to transport Qi and Blood throughout the body.
While the Greeks saw individuals, the Chinese saw interdependent networks. While Western science demands analysis of the composition of structures (organs, tissues, cells, molecules, atoms, subatomic particles), the Eastern tradition sees dynamic functional processes interacting within a complex whole. Western logic is reductive and quantitative, Eastern logic is contextual and qualitative. While authority in the West is derived from the latest research, in China it is derived from classical texts. In Chinese medicine it is often necessary to clothe a new idea in the language of ancient authors to gain acceptance. History matters.
Kim Taylor documents the origins of traditional Chinese medicine in post-revolutionary China in her book Chinese Medicine in Early Communist China 1945-1963. In the 1950s, Mao knew there were not enough Western-trained doctors to meet China’s needs, so he mandated that traditional medicine be “rehabilitated” to fill the gap. Committees were formed of Western-trained physicians, with a few traditional doctors as advisors, in order to carve a logical, internally consistent, standardized, homogeneous medical system out of the vast heterogeneous legacy of traditional knowledge. This neat, new system also had to conform to the ideologies of dialectical materialism and modern science. What we now know as Traditional Chinese Medicine, or TCM, was the work product of these committees that were hardly representative of the ancient pluralistic medical traditions of China.
We now recognize that TCM is a Westernized version, constructed over the last 50 years, and that it excises what was deemed antithetical to Maoist doctrines, either associated with elitist (Mandarin) schools of thought or, alternatively, backward folk traditions. For that reason, many have adopted the broader term Chinese traditional medicine (CTM), or the traditional medicine of China (TMC), or even China’s traditional medicine, rather than the politically charged TCM.
For the last centuries in China, traditional medicine has been evolving while remaining rooted in the contending, sometimes conflicting theories of the preceding millennia. After the 1949 revolution, a decision was made to revive China’s native medicine in addition to developing the Western medicine that had seeded itself there in the 1800s. Before this time, indigenous medical knowledge was transmitted less formally through apprenticeship and family lineage and was officially recorded in thousands of texts from a succession of imperial courts. In both cases, differences have abounded.
Traditional Chinese medicine was introduced into the United States when President Nixon lifted the Bamboo Curtain. New York Times journalist James Reston traveled to China in 1971 and was treated with acupuncture there for post-surgical pain following an appendectomy. He sent back front-page headlines claiming, “I’ve seen the past, and it works.” Since that time, the popularity of acupuncture and Chinese herbal medicine has mushroomed in the Western world.
Safety, effectiveness, and low cost appear to drive the utilization of Chinese medicine in the West. It is one of the fastest growing forms of health care in the United States. The National Institutes of Health (NIH) Consensus Conference in 1997 stated, “The data in support of acupuncture are as strong as those for many accepted Western medical therapies. One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs and other accepted medical procedures used for the same conditions.”
As of the year 2000, there are more than one million Chinese medicine practitioners world-wide, and more than 11,000 state-licensed or national, board-certified acupuncturists practicing in the United States, of whom approximately one quarter are medical doctors. Estimates project that there will be 40,000 acupuncture practitioners by the year 2015. Fifty states have recognized the practice of acupuncture, many issuing state licenses. There are more than 56 schools of acupuncture that are either accredited or in candidacy status. Altogether these schools graduate hundreds of students from 3 and 4-year programs. In 1993 the Food and Drug Administration estimated that Americans logged between 9 and 12 million yearly acupuncture visits. By 2002, it was estimated that 20 million Americans, or one in ten, had experienced an acupuncture treatment. It is estimated that $1 billion is spent annually by Americans on Chinese medicine.
Maintenance Organization that found 57.2% of primary care physicians in Northern California used or recommended acupuncture within a 12-month period in 1996. Controlled clinical trials evaluating acupuncture added to standard protocols in the treatment of stroke-induced paralysis found that 80% of the patients receiving acupuncture had beneficial results at an average cost saving of $26,000 per patient.
A study published in 1998 by Claire Cassidy reported that in six Chinese medicine clinics in five US states, data supported findings of cost savings and effectiveness of acupuncture for a variety of complaints and diseases: of patients treated, 92% reported disappearance or improvement of symptoms; 84% said they saw their physicians less, and 79% said they used fewer prescription drugs.
