Traditional Chinese Medicine

Introduction
Traditional Chinese medicine (TCM) originated in ancient China and has
evolved over thousands of years. TCM practitioners use herbal medicines and
various mind and body practices, such as acupuncture and tai chi, to treat or
prevent health problems. In the United States, people use TCM primarily as
a complementary health approach. This fact sheet provides a general
overview of TCM and suggests sources for additional information.

Key Points
Is It Safe?

Acupuncture is generally considered safe when performed by an

experienced practitioner using sterile needles. Improperly performed
acupuncture can cause potentially serious side effects.

Tai chi and qi gong, two mind and body practices used in TCM, are
generally safe.

There have been reports of Chinese herbal products being

contaminated with drugs, toxins, or heavy metals or not containing the listed
ingredients. Some of the herbs used in Chinese medicine can interact with
drugs, have serious side effects, or be unsafe for people with certain
medical conditions.

Is It Effective?

For most conditions, there is not enough rigorous scientific evidence to

know whether TCM methods work for the conditions for which they are used.

Keep in Mind

Tell all your health care providers about any complementary health
approaches you use. Give them a full picture of what you do to manage your
health. This will help ensure coordinated and safe care.

Background
TCM encompasses many different practices, including acupuncture,
moxibustion (burning an herb above the skin to apply heat to acupuncture
points), Chinese herbal medicine, tui na (Chinese therapeutic massage),
dietary therapy, and tai chi and qi gong (practices that combine specific
movements or postures, coordinated breathing, and mental focus). TCM is
rooted in the ancient philosophy of Taoism and dates back more than 2,500
years. Traditional systems of medicine also exist in other East and South
Asian countries, including Japan (where the traditional herbal medicine is
called Kampo) and Korea. Some of these systems have been influenced by
TCM and are similar to it in some ways, but each has developed distinctive
features of its own.
Although the exact number of people who use TCM in the United States is
unknown, it was estimated in 1997 that some 10,000 practitioners served
more than 1 million patients each year. According to the 2007 National
Health Interview Survey (NHIS), which included a comprehensive survey on
the use of complementary health approaches by Americans, an estimated
3.1 million U.S. adults had used acupuncture in the previous year. The
number of visits to acupuncturists tripled between 1997 and 2007. According
to the 2007 NHIS, about 2.3 million Americans practiced tai chi and 600,000
practiced qi gong in the previous year.
This fact sheet focuses on TCM as a whole. For information about some of the
individual practices included in TCM, see the pages on acupuncture, tai chi,
and qi gong on the National Center for Complementary and Integrative
Health (NCCIH) Web site. Some of the individual herbs used in TCM are
discussed in NCCIHs Herbs at a Glance eBook and fact sheets.

Side Effects and Risks

Herbal medicines used in TCM are sometimes marketed in the United

States as dietary supplements. The U.S. Food and Drug Administration (FDA)

regulations for dietary supplements are not the same as those for prescription
or over-the-counter drugs; in general, the regulations for dietary supplements
are less stringent. For example, manufacturers dont have to prove to the FDA
that most claims made for dietary supplements are valid; if the product were
a drug, they would have to provide proof.

Some Chinese herbal products may be safe, but others may not be.
There have been reports of products being contaminated with drugs, toxins,
or heavy metals or not containing the listed ingredients. Some of the herbs
used in Chinese medicine can interact with drugs, can have serious side
effects, or may be unsafe for people with certain medical conditions. For
example, the Chinese herb ephedra (ma huang) has been linked to serious
health complications, including heart attack and stroke. In 2004, the FDA
banned the sale of ephedra-containing dietary supplements, but the ban does
not apply to TCM remedies.

The FDA regulates acupuncture needles as medical devices and

requires that the needles be sterile, nontoxic, and labeled for single use by
qualified practitioners only. Relatively few complications from the use of
acupuncture have been reported. However, adverse effectssome of them
serioushave resulted from the use of nonsterile needles or improper
delivery of acupuncture treatments.

Tai chi and qi gong are considered to be generally safe practices.

Information on the safety of other TCM methods is limited. Reported

complications of moxibustion include allergic reactions, burns, and infections,
but how often these events occur is not known. Both moxibustion and
cupping (applying a heated cup to the skin to create a slight suction) may
mark the skin, usually temporarily. The origin of these marks should be
explained to health care providers so that they will not be mistaken for signs
of disease or physical abuse.

Underlying Concepts
When thinking about ancient medical systems such as TCM, it is important to
separate questions about traditional theories and concepts of health and
wellness from questions about whether specific interventions might be
helpful in the context of modern science-based medicine and health
promotion practices.
The ancient beliefs on which TCM is based include the following:

The human body is a miniature version of the larger,

surrounding universe.

Harmony between two opposing yet complementary forces,

called yin and yang, supports health, and disease results from an imbalance
between these forces.

Five elementsfire, earth, wood, metal, and watersymbolically

represent all phenomena, including the stages of human life, and explain the
functioning of the body and how it changes during disease.

Qi, a vital energy that flows through the body, performs multiple
functions in maintaining health.
Concepts such as these are of interest in understanding the history of TCM.
However, NCCIH-supported research on TCM does not focus on these ideas.
Instead, it examines specific TCM practices from a scientific perspective,
looking at their effects in the body and whether the practices are helpful in
symptom management.
TCM practitioners use a variety of techniques in an effort to promote health
and treat disease. In the United States, the most commonly used approaches
include Chinese herbal medicine, acupuncture, and tai chi.

Chinese herbal medicine. The Chinese Materia Medica (a

pharmacological reference book used by TCM practitioners) describes
thousands of medicinal substancesprimarily plants, but also some minerals
and animal products. Different parts of plants, such as the leaves, roots,
stems, flowers, and seeds, are used. In TCM, herbs are often combined in
formulas and given as teas, capsules, liquid extracts, granules, or powders.

Acupuncture. Acupuncture is a family of procedures involving the

stimulation of specific points on the body using a variety of techniques. The
acupuncture technique that has been most often studied scientifically
involves penetrating the skin with thin, solid, metal needles that are
manipulated by the hands or by electrical stimulation.

Tai chi. Tai chi is a centuries-old mind and body practice. It involves
gentle, dance-like body movements with mental focus, breathing,
and relaxation.

The Status of TCM Research

In spite of the widespread use of TCM in China and its use in the West,
rigorous scientific evidence of its effectiveness is limited. TCM can be difficult
for researchers to study because its treatments are often complex and are
based on ideas very different from those of modern Western medicine.
Most research studies on TCM have focused on specific techniques, primarily
acupuncture and Chinese herbal remedies, and there have been many
systematic reviews of studies of TCM approaches for various conditions.

An assessment of the research found that 41 of 70 systematic reviews

of the scientific evidence (including 19 of 26 reviews on acupuncture for a
variety of conditions and 22 of 42 reviews on Chinese herbal medicine) were
unable to reach conclusions about whether the technique worked for the
condition under investigation because there was not enough good-quality
evidence. The other 29 systematic reviews (including 7 of 26 reviews on
acupuncture and 20 of 42 reviews on Chinese herbal medicine) suggested
possible benefits but could not reach definite conclusions because of the
small quantity or poor quality of the studies.

In a 2012 analysis that combined data on individual participants in 29

studies of acupuncture for pain, patients who received acupuncture for back
or neck pain, osteoarthritis, or chronic headache had better pain relief than
those who did not receive acupuncture. However, in the same analysis, when
actual acupuncture was compared with simulated acupuncture (a sham
procedure that resembles acupuncture but in which the needles do not
penetrate the skin or penetrate it only slightly), the difference in pain relief
between the two treatments was much smallerso small that it may not
have been meaningful to patients.

Tai chi has not been investigated as extensively as acupuncture or

Chinese herbal medicine, but recent studies, including some supported by
NCCIH, suggest that practicing tai chi may help to improve balance and
stability in people with Parkinsons disease; reduce pain from knee
osteoarthritis and fibromyalgia; and promote quality of life and mood in
people with heart failure.

If You Are Thinking About Using TCM

Do not use TCM to replace effective conventional care or as a reason to

postpone seeing a health care provider about a medical problem.

Look for published research studies on TCM for the health condition
that interests you.

It is better to use TCM herbal remedies under the supervision of your

health care provider or a professional trained in herbal medicine than to try to
treat yourself.

Ask about the training and experience of the TCM practitioner you are
considering. You can find information about the credentials and licensing of
complementary health practitioners on the NCCIH Web site.

If you are pregnant or nursing, or are thinking of using TCM to treat a

child, you should be especially sure to consult your (or the childs) health
care provider.

Tell all your health care providers about any complementary health
approaches you use. Give them a full picture of what you do to manage your
health. This will help ensure coordinated and safe care.

(NCCIH, 2013)

Definition of Naturopathic Medicine

Naturopathic medicine is a distinct primary health care profession, emphasizing
prevention, treatment, and optimal
health through the use of therapeutic methods and substances that encourage
individuals inherent self-healing
process. The practice of naturopathic medicine includes modern and traditional,
scientific, and empirical methods.

The following principles are the foundation of naturopathic medical practice:

The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic

medicine recognizes an inherent self-healing process in people that is ordered
and intelligent. Naturopathic physicians act to identify and remove obstacles
to healing and recovery, and to facilitate and augment this inherent selfhealing process.

Identify and Treat the Causes (Tolle Causam): The naturopathic

physician seeks to identify and remove the underlying causes of illness rather
than to merely eliminate or suppress symptoms.

First Do No Harm (Primum Non Nocere): Naturopathic physicians follow

three guidelines to avoid harming the patient:
o

Utilize methods and medicinal substances which minimize the risk of

harmful side effects, using the least force necessary to diagnose and treat;

Avoid when possible the harmful suppression of symptoms; and

Acknowledge, respect, and work with individuals self-healing process.

Doctor as Teacher (Docere): Naturopathic physicians educate their

patients and encourage self-responsibility for health. They also recognize and
employ the therapeutic potential of the doctor-patient relationship.

Treat the Whole Person: Naturopathic physicians treat each patient by

taking into account individual physical, mental, emotional, genetic,

environmental, social, and other factors. Since total health also includes
spiritual health, naturopathic physicians encourage individuals to pursue their
personal spiritual development.

Prevention: Naturopathic physicians emphasize the prevention of disease

by assessing risk factors, heredity and susceptibility to disease, and by making
appropriate interventions in partnership with their patients to prevent illness.

NATUROPATHIC PRACTICE
Naturopathic practice includes the following diagnostic and therapeutic modalities:
clinical and laboratory diagnostic testing, nutritional medicine, botanical medicine,
naturopathic physical medicine (including naturopathic manipulative therapy),
public health measures, hygiene, counseling, minor surgery, homeopathy,
acupuncture, prescription medication, intravenous and injection therapy, and
naturopathic obstetrics (natural childbirth).

(AANP, 2016)

What Naturopathic Practitioners Do

Naturopathic practitioners use many different treatment approaches.
Examples include:

Dietary and lifestyle changes

Stress reduction

Herbs and other dietary supplements

Homeopathy

Manipulative therapies

Exercise therapy

Practitioner-guided detoxification

Psychotherapy and counseling.

Some practitioners use other methods as well or, if appropriate, may refer
patients to conventional health care providers.

Education and Licensure of Practitioners

Education and licensing differ for the three types of
naturopathic practitioners:

Naturopathic physicians generally complete a 4-year, graduatelevel program at one of the North American naturopathic medical schools
accredited by the Council on Naturopathic Medical Education, an
organization recognized for accreditation purposes by the U.S. Department
of Education. Some U.S. states and territories have licensing requirements
for naturopathic physicians; others dont. In those jurisdictions that have
licensing requirements, naturopathic physicians must graduate from a 4year naturopathic medical college and pass an examination to receive a
license. They must also fulfill annual continuing education requirements.

Traditional naturopaths, also known simply as naturopaths, may

receive training in a variety of ways. Training programs vary in length and
content and are not accredited by organizations recognized for
accreditation purposes by the U.S. Department of Education. Traditional
naturopaths are often not eligible for licensing.

Other health care providers (such as physicians, osteopathic

physicians, chiropractors, dentists, and nurses) sometimes offer
naturopathic treatments, functional medicine, and other holistic therapies,
having pursued additional training in these areas. Training programs vary.

(NCCIH, 2016)

What is Homeopathy?

Homeopathy is a safe, gentle, and natural system of

healing that works with your body to relieve symptoms, restore itself, and
improve your overall health. It is extremely safe to use, even with very
small children and pets, has none of the side effects of many traditional
medications, is very affordable, is made from natural substances, and is
FDA regulated.
It is used to treat acute illnesses, like colds, ear infections, migraines, and sore throats, as well
as chronic conditions, like asthma, depression, autism, and arthritis.
Homeopathic medicines known as remedies are made from natural sources (e.g., plants,
minerals), and are environmentally friendly and cruelty free. Most are available over the counter
in grocery stores, drug stores, health food stores, homeopathic pharmacies, and online. They
are also extremely affordable. Homeopathic remedies when used as directed, are completely
safe for everyone including pregnant and nursing women, infants, children, and adults. They
are given in such small doses that they dont cause side effects.
One thing to note is that the word homeopathy is not a general or umbrella term that describes
a variety of different natural therapies. Although homeopathic remedies are derived from natural
substances, homeopathy should not be confused with herbal medicine, Chinese medicine, or
other types of natural medicines. It is its own, unique therapeutic system.

How does homeopathy differ from conventional

medicine?
Homeopathy is based on a rule of nature called the Law of Similars. This law states that "like
cures like," or that a medicine can cure a sick person if it can cause a similar sickness in a
healthy person. For instance, if you peel an onion, your eyes burn, itch and water. You might
also have a runny nose and begin to sneeze. If you had similar symptoms during a cold or
allergy attack, such as a runny nose, watery eyes and sneezing, a homeopathic micro-dose of
the remedy Allium cepa (red onion) would help your body heal itself.

The homeopath regards symptoms as the bodys healthy attempt to restore itself to balance.
That is why a homeopath will choose a remedy that supports the symptomsrather than
opposing them or suppressing them as in conventional medicine. In conventional medicine, a
cold or hayfever sufferer is given an antihistamine to dry up the runny nose and watery eyes
artificially. But this medication often comes with unpleasant side effects like sleepiness and
constipation. With the correct homeopathic remedy, however, there are no side effects and a
person is restored to health naturally.
Homeopathy also recognizes that each person exhibits his or her disease in a unique and
slightly different way. That is why two people with the same disease will not necessarily receive
the same homeopathic remedy. A cold sufferer with a stopped up nose and dry eyes would
receive a different remedy than one with a runny nose and watering eyes. Unlike the one size
fits all approach to prescribing often used in conventional medicine, a homeopath chooses a
remedy that matches the unique symptom profile of the individual. Conventional medicine seeks
to control illness through the regular use of medications; if the medicine is withdrawn, the
persons symptoms return. For example, the daily use of drugs for asthma (or any chronic
disease for that matter) alleviates the symptoms but does not cure the underlying problem. In
homeopathy the ideal is that a person needs just enough of the homeopathic remedy to
stimulate their healing response. In other words, homeopathy seeks to cure a person so that
they do not need any medicationshomeopathic or otherwise.

Are homeopathic medicines regulated?

Homeopathic medicines are considered to be drugs under U.S. federal law, and the Food and Drug Administration
regulates the manufacture, marketing, and sales of all homeopathic medicines. Homeopathic medicines are made
according to a book of standards called the Homoeopathic Pharmacopoeia of the United States (HPUS). The HPUS
contains all of the information necessary for the proper identification of the raw materials used to make homeopathic
medicines, as well as techniques for their manufacture and quality control. Homeopathic medicines are derived from
botanical (plant), mineral, and some animal sources.

Are homeopathic medicines safe?

Because of the minute doses used in homeopathy, the medicines labeled for internal use are non-toxic. When
properly administered, the medicines are completely safe for everyone including pregnant women, newborns,
children, and adults through the senior years. Many veterinarians use homeopathy in the treatment of animals. There
are no known or suspected contraindications or drug interactions between homeopathic and conventional
medications.

(NCH, 2015)

What Is Ayurveda?
The term Ayurveda combines the Sanskrit words ayur (life)
and veda (science or knowledge). Ayurvedic medicine, as practiced in India,
is one of the oldest systems of medicine in the world. Many Ayurvedic
practices predate written records and were handed down by word of mouth.
Three ancient books known as the Great Trilogy were written in Sanskrit
more than 2,000 years ago and are considered the main texts on Ayurvedic
medicineCaraka Samhita, Sushruta Samhita, and Astanga Hridaya.
Key concepts of Ayurvedic medicine include universal interconnectedness
(among people, their health, and the universe), the bodys
constitution (prakriti), and life forces(dosha), which are often compared to
the biologic humors of the ancient Greek system. Using these concepts,
Ayurvedic physicians prescribe individualized treatments, including
compounds of herbs or proprietary ingredients, and diet, exercise, and
lifestyle recommendations.
The majority of Indias population uses Ayurvedic medicine exclusively or
combined with conventional Western medicine, and its practiced in varying
forms in Southeast Asia.
Ayurvedic medicine (also called Ayurveda) is one of the worlds oldest
medical systems. It originated in India more than 3,000 years ago and
remains one of the countrys traditional health care systems. Its concepts
about health and disease promote the use of herbal compounds, special
diets, and other unique health practices. Indias government and other
institutes throughout the world support clinical and laboratory research on
Ayurvedic medicine, within the context of the Eastern belief system. But
Ayurvedic medicine isnt widely studied as part of conventional (Western)
medicine. This fact sheet provides a general overview of Ayurvedic medicine
and suggests sources for additional information.

Key Points

Is Ayurvedic medicine safe?

Ayurvedic medicine uses a variety of products and practices. Some of these
productswhich may contain herbs, minerals, or metalsmay be harmful,
particularly if used improperly or without the direction of a trained
practitioner. For example, some herbs can cause side effects or interact

with conventional medicines. Also, ingesting some metals, such as

lead, can be poisonous.

Is Ayurvedic medicine effective?

Studies have examined Ayurvedic medicine, including herbal products, for
specific conditions. However, there arent enough well-controlled clinical
trials and systematic research reviewsthe gold standard for Western
medical researchto prove that the approaches are beneficial.

What the Science Says About the Safety and

Side Effects of Ayurvedic Medicine
Ayurvedic medicine uses a variety of products and practices. Ayurvedic
products are made either of herbs only or a combination of herbs, metals,
minerals, or other materials in an Ayurvedic practice called rasa shastra.
Some of these products may be harmful if used improperly or without
the direction of a trained practitioner.

Toxicity
Ayurvedic products have the potential to be toxic. Many materials used in
them havent been studied for safety in controlled clinical trials. In the United
States, Ayurvedic products are regulated as dietary supplements. As such,
they arent required to meet the same safety and effectiveness standards as
conventional medicines. For more information on dietary
supplement regulations, see the National Center for Complementary and
Integrative Healths (NCCIH) fact sheet Using Dietary Supplements Wisely.
In 2008, an NCCIH-funded study examined the content of 193 Ayurvedic
products purchased over the Internet and manufactured in either the United
States or India. The researchers found that 21 percent of the products
contained levels of lead, mercury, and/or arsenic that exceeded the
standards for acceptable daily intake.
Other approaches used in Ayurvedic medicine, such as massage, special
diets, and cleansing techniques may have side effects as well. To help ensure
coordinated and safe care, its important to tell all your health care providers
about any Ayurvedic products and practices or other complementary and
integrative health approaches you use.

(NCCIH, 2016)

References:
National Center for Complementary and Integrative Health
(NCCIH). (2013). Traditional Chinese Medicine: In Depth.
Retrieved from:
https://nccih.nih.gov/health/whatiscam/chinesemed.htm
National Center for Complementary and Integrative Health
(NCCIH). (2016). Ayurvedic Medicine: In Depth. Retrieved
from: https://nccih.nih.gov/health/ayurveda/introduction.htm
National Center for Complementary and Integrative Health
(NCCIH). (2016). Naturopathy. Retrieved from:
https://nccih.nih.gov/health/naturopathy
National Center for Homeopathy (NCH). (2015). What is
Homeopathy? Retrieved from:
http://www.homeopathycenter.org/learn-about-homeopathy
The American Association of Naturopathic Physicians (AANP).
(2016). Definition of Naturopathic Medicine. Retrieved from:
http://www.naturopathic.org/content.asp?contentid=59