Traditional Chinese Medicine

Early texts and materia medica

The Huangdi Neijing (Yellow Emperor's Inner Classic) is a foundational text of Chinese medicine. The publisher's description of Unschuld and Tessenow's annotated translation of its Su wen part states that the text came into being over a long period, from the 2nd century BCE to the 8th century CE, and that it defines health and disease through yin/yang and Five Agents doctrines. It is therefore a layered compilation, not a single work with one date, and the sources reviewed do not fix a more exact date.

The sinologist Ute Engelhardt describes a recipe manuscript from Mawangdui tomb 3, sealed in 168 BCE, as one of the earliest surviving recipe works of Chinese medicine, and the Shennong bencao jing, dated to the 2nd century CE, as the earliest surviving materia medica. She places the first separate term for food therapy (shiliao) in the Tang dynasty (618 to 907), in a work by Sun Simiao (581 to 682) that she dates to 650.

A state-standardised TCM in the twentieth century

Scholarship separates earlier Chinese medical practice from the standardised system now commonly labelled TCM. Kim Taylor's history of 1945 to 1963 is described by its publisher as tracing Chinese medicine from a marginal practice in the early twentieth century to an important part of the national health-care system under the Chinese Communist Party. Its chapter titles date the creation of a 'Traditional' Chinese Medicine to 1953 to 1956 and its standardisation to 1957 to 1963. These details come from the publisher's description and contents list, not from the book itself.

According to its publisher, Volker Scheid's ethnography of contemporary Chinese medicine treats plurality as an intrinsic and irreducible feature of practice. It observes that a patient visiting ten practitioners may receive ten different prescriptions, and it traces how state standardisation coexisted with persistent pluralistic practice across the Republican, Maoist and contemporary periods.

Transmission and teaching

Elisabeth Hsu's fieldwork in Kunming, Yunnan, distinguishes three routes by which Chinese medical knowledge was passed on: apprenticeship to a qigong healer who taught largely by imitation, seminars led by a senior doctor who studied classical texts, and standardised courses at the Yunnan College of Traditional Chinese Medicine. She reports that the same technical terms can take different meanings depending on the context of instruction, so one TCM label can cover different bodies of knowledge.

What the label covers

The label covers more than one method. The US National Center for Complementary and Integrative Health (NCCIH) describes TCM as a medical system that evolved over thousands of years and lists acupuncture, tai chi and herbal products among its components. Scheid and Hsu write of 'Chinese medicine', and Taylor's chapter titles place 'Traditional' in quotation marks when dating the 1953 to 1956 creation of the category. This page uses Traditional Chinese Medicine for the family and names a member wherever a statement applies to one method only.

Concepts as the tradition states them

The concepts below are the tradition's own explanatory vocabulary and are not biomedical findings. The Su wen is described as defining health and disease through yin/yang and Five Agents doctrines. Engelhardt quotes Sun Simiao as holding that food can support qi and blood and expel pathogenic influences (xie), and she notes that everyday dietary knowledge in China often distinguishes only cold from heat and deficiency from excess.

In the WHO classification, diagnosis is organised by patterns, which Reddy and Fan describe as diagnostic categories that gather signs and symptoms into a conceptual frame, with Kidney Yang Deficiency Pattern as one example. A pattern is a category within the tradition and is not equivalent to a biomedical diagnosis.

The WHO ICD-11 traditional medicine chapter

The WHO International Classification of Diseases, 11th revision (ICD-11), includes a supplementary Chapter 26 on traditional medicine conditions. Its Module 1 covers traditional medicine that originated in ancient China and is used in China, Japan, Korea and elsewhere, and it harmonises Chinese, Japanese and Korean terminology; Reddy and Fan count 150 disorders and 196 patterns. It is for optional dual coding alongside a conventional diagnosis in morbidity data and not for mortality reporting.

WHO states that the chapter is neither judging nor endorsing the scientific validity of traditional medicine practices or the effectiveness of interventions, and describes its purpose as standardised counting, comparison and research data. Reddy and Fan note that critics questioned whether including it sits comfortably with evidence-based medicine, so the chapter is best read as a classification tool and not as evidence of benefit.

Settings and practitioners

The sources reviewed do not describe one standard session, and practice varies by method, setting and training. NCCIH names acupuncture, tai chi and herbal products as components. In Hsu's Kunming fieldwork, practice ranged from college teaching to apprenticeship under a qigong healer. In the United Kingdom, the Register of Chinese Herbal Medicine says its members hold degree-level qualifications and that accredited courses include a significant supervised clinical component.

Needle, heat and ear-based methods

NCCIH describes acupuncture as stimulating specific body points with thin needles. Moxibustion burns herbal preparations containing Artemisia vulgaris to stimulate acupuncture points; in one review of five Chinese trials, all used indirect moxibustion with insulating material between the moxa and the skin. Auricular acupuncture stimulates points on the ear; its modern form dates to the 1950s, when the French physician Paul Nogier published an ear map in 1957, after which it spread rapidly to Russia, Japan and China.

Manual, scraping and suction methods

Acupressure uses manual finger pressure along the meridians described in Chinese medicine, and one systematic review located 71 acupressure studies alongside nine of the related method shiatsu. Tui na is described by a UK practitioner as an external treatment that manipulates body parts and acupuncture points by pressing, rubbing, kneading and similar manoeuvres, and as a major subject in Chinese medical education since 1959. Gua sha scrapes the usually lubricated skin with a smooth-edged object until petechiae appear. Cupping takes several forms, and wet cupping dominated the Chinese clinical studies in one review, whose earliest record is a silk text from a Han-dynasty tomb found in 1973.

Herbal and dietary methods

Engelhardt describes a long bencao (materia medica) literature in which drugs and foods are characterised by the same criteria: flavour, thermal nature and relation to organ systems or channels. She describes Chinese dietary therapy at three levels: everyday household knowledge, restaurant cuisine called yaoshan that combines medicinal substances with food, and clinical shiliao based on materia medica descriptions of foods. Yaoshan restaurants began in the early 1980s and numbered about 900 by 1990 to 1993.

Traditional and practitioner claims

Within the tradition, practice is directed at patterns rather than at named biomedical diseases, as the design of the ICD-11 chapter reflects. Engelhardt quotes Sun Simiao as holding that food can support qi and blood and calm emotions. A UK practitioner paper states that tui na has traditionally centred on bone and soft-tissue (orthopaedic and traumatology) conditions and has since extended to internal medicine, gynaecology, paediatrics and general health maintenance; this is a practitioner's description and not a tested claim.

In restaurants offering medicinal cuisine, Engelhardt reports that expectations moved from making diners strong in the early 1980s towards slimness, longevity, male potency and, more recently for women, beauty and weight reduction. These are consumer expectations recorded in one setting in China by one author.

Conditions that have been studied

Research has concentrated on pain-related conditions. A review of Chinese clinical studies of cupping found pain disorders, herpes zoster and respiratory symptoms among the conditions most commonly treated, and NCCIH lists chronic low back and neck pain, osteoarthritis, carpal tunnel syndrome and migraine among the pain conditions studied with acupuncture. Cochrane reviews of TCM interventions span 70 diseases across 16 disease systems. The sources reviewed do not show why people in general choose these practices, so this section lists research targets and attributed claims only.

Cochrane reviews across the family

A 2022 analysis in Phytomedicine identified 104 Cochrane systematic reviews of TCM interventions, searched to May 2021. They covered 70 diseases across 16 disease systems, 1,642 primary studies and 157,943 participants. The interventions were Chinese herbal medicine (70 reviews), acupuncture (28), TCM exercises (4) and moxibustion (2). On the AMSTAR 2 appraisal tool, 8 reviews (7.7%) were rated high quality, 17 moderate, 51 low and 28 critically low.

Only 5 of the 104 reviews (4.8%) drew positive conclusions; 42 (40.4%) reported insufficient evidence, 54 (51.9%) could not draw firm conclusions and 3 (2.9%) found no supporting evidence. Of the graded outcomes, 6 were rated high certainty, 45 moderate, 172 low and 130 very low. These figures describe Cochrane reviews only and are not a verdict on any single therapy, and 'insufficient evidence' is not the same as evidence of no effect.

Findings by method

NCCIH summarises the evidence as mixed: acupuncture has shown promise for some chronic pain conditions, although in some studies real and sham acupuncture were equally effective; tai chi has shown benefits for balance, Parkinson's disease and knee osteoarthritis; and Chinese herbal research has given mixed results because of poor study quality. These findings belong to the named methods and do not apply to the whole family.

For gua sha, a systematic review located 32 articles and included 6 trials of musculoskeletal pain, mostly spinal, followed for 7 to 21 days with moderate quality on the PEDro scale and control groups that often used hot water bottles. For cupping, a review of 550 Chinese clinical studies from 1959 to 2008 included 73 randomised trials, 78.1% of which were at high risk of bias, and none met the low-risk criteria. For moxibustion in cancer care, five Chinese trials found no benefit on response rates and a lower relative risk of chemotherapy-induced nausea and vomiting (80 participants), all at high risk of bias.

A 2011 systematic review of 71 acupressure and 9 shiatsu studies found the strongest evidence for pain (dysmenorrhoea, lower back pain and labour) and for postoperative nausea and vomiting, with variable or poor evidence for several other outcomes. The sources reviewed for this page do not assess clinical outcomes for tui na or auricular acupuncture, and this page does not carry results from one member to another.

Herbal products and aristolochic acid

Aristolochic acid nephropathy is a rapidly progressive kidney scarring caused by exposure to aristolochic acid, which occurs in herbs of the Aristolochia genus. A 2023 review states that the Belgian outbreak, reported nearly 30 years earlier, drew attention to the safety of herbal remedies, that incidence is unknown and may be underestimated, and that no effective treatment reverses the damage. It adds that cases have fallen sharply where aristolochic-acid-containing herbs are strictly controlled.

A 2022 narrative review reports that a Taiwanese nationwide database showed 39% of the population had been exposed to aristolochic-acid-containing herbs between 1997 and 2003, with a higher hazard of renal failure and upper urinary tract urothelial cancer among those exposed. These findings concern specific Aristolochia-based products and should not be extended to every Chinese herbal product.

Contamination, adulteration and other cautions

NCCIH names contamination with heavy metals such as arsenic, lead and cadmium and accidental herb substitution as risks of herbal products. An overview of 26 systematic reviews found that herbal medicinal products were contaminated or adulterated with substances including toxic metals and prescription drugs, most often for traditional Indian and Chinese remedies respectively. A Canadian laboratory study of 121 natural health products, including traditional Chinese ones, found that levels above limits occurred in only a small percentage, but that products made in China generally had higher mercury and aluminium.

Method-specific cautions also appear in the sources. NCCIH reports complications from non-sterile acupuncture needles. A gua sha review lists sunburn, rash, haemophilia, immunodeficiency and anaemia as contraindications. A UK tui na paper lists open soft-tissue injuries, bleeding, fractures, skin infections and pregnancy among its counter-indications, and a moxibustion review notes that no included trial assessed safety and that one study raised concern about smoke inhalation.

Training, professional bodies and care boundaries

Training and registration differ by country and by method. In the United Kingdom, the Register of Chinese Herbal Medicine, founded in 1987, states that its regulation is voluntary, that membership requires a degree-level qualification in Chinese herbal medicine from an accredited course, and that members must carry professional insurance, keep up continuing professional development and follow a code that excludes endangered species. This review did not verify a worldwide training standard, and requirements elsewhere should be checked with the relevant professional body.

Herbal products, needling and manual therapies can interact with existing conditions and treatment, so a person with a serious or worsening condition should keep their usual medical care. These practices should not delay or replace assessment or prescribed treatment.