Traditional Chinese Medicine

Still Valid after 2,500 Years

Enter the waiting room of a Traditional Chinese Medicine practitioner and you've left the world of the medically familiar behind. The air may be strangely scented with unfamiliar herbs. Jars may be stuffed with gnarled roots, shells, dried plants and blackened wormlike creatures, even sea horses, and placed right next to modern, colorfully wrapped patent medicines with labels printed in Chinese. The walls may be hung with delicately inked rice-paper panels in oriental motifs. Here, even the Muzak sounds exotic.

Clearly, this is like no doctor's waiting room that you've ever been in. You have taken a great leap of faith, suspending for the moment your lifelong reliance on modern Western medicine.

Take a deep breath. Relax. You're about to participate in a healing art that's been around for more than 2,500 years, one that is used today by an estimated one-quarter of the world's population.

What prompts women to give Traditional Chinese Medicine a try? Usually, some kind of chronic pain, says Barbara Bernie, licensed acupuncturist and president of the American Foundation of Traditional Chinese Medicine (TCM) in San Francisco. "Although we don't have statistics on how many people visit TCM practitioners, experience tells me that many people first try acupuncture, one of TCM's therapeutic treatments, for chronic pain that hasn't responded to traditional Western medicine.

Tsung O. Cheng, M.D., professor of medicine and a cardiologist at George Washington University School of Medicine in Washington, D.C., agrees. "TCM offers excellent pain relief." Dr. Cheng several years ago saw an acupuncturist for lower-back pain with satisfactory results.

A TOTAL HEALING SYSTEM

But Traditional Chinese Medicine is much more than the practice of acupuncture. It is a medical system, combining acupuncture with the use of medicinal herbs, massage and dietary therapy. Practitioners also often recommend exercise, breathing disciplines and meditation in the form of qi gong (chi gung) and tai ji (more commonly known as tai chi) as part of an ongoing, holistic wellness program.

And when it comes to women's health concerns, practitioners say that TCM can't be beat.

"I think that women's reproductive and endocrinological problems are well-addressed by Traditional Chinese Medicine," says Martha Howard, M.D., co-director of Wellness Associates, a Chicago-based family medical practice. "I treat menstrual irregularities, premenstrual syndrome, ovarian cysts and symptoms of menopause very successfully with TCM." Dr. Howard says that TCM is just one of a variety of complementary therapies that she prescribes, including good nutrition, exercise, proper rest, vitamin supplements, stress reduction, herbs, acupuncture and others.

"Premenstrual syndrome is easily treated with acupuncture and Chinese herbs," says Christina Stemmler, M.D., a Houston physician who integrates TCM and acupuncture with Western medicine and previously headed the American Academy of Medical Acupuncture. "I believe that a TCM approach can ease hot flashes in the majority of women who are so treated."

Traditional Chinese Medicine can also provide effective pain relief during labor and childbirth, according to Dr. Howard.

WISDOM FROM THE WORLD'S
OLDEST MEDICAL BOOK

Traditional Chinese Medicine emanates from a culture that is vastly different from our own. So if you decide to consult a TCM practitioner, be prepared to hear some very strange terminology. You'll learn about yin and yang, about the five elements of nature, about your body's meridians and about the status of your qi, or vital energy. These are health attributes that don't show up on Western diagnostic tools such as x-rays and CAT scans.

Not to worry, says Andrew Weil, M.D., professor of herbalism and director of the Program of Integrative Medicine at the University of Arizona College of Medicine, near Tucson, and best-selling author of Spontaneous Healing and Health and Healing. "Just because we cannot detect, perceive or measure forces and factors that Chinese doctors say are important in


managing illness does not automatically mean they do not exist," Dr. Weil explains in his book Health and Healing.

Though some of the TCM concepts seem decidedly exotic to Westerners, the fact is that they have withstood the test of time, says David Molony, Ph.D., licensed acupuncturist and executive director of the American Association of Acupuncture and Oriental Medicine, who practices in the northern suburbs of Philadelphia. And, he notes, "according to the Chinese, who've had nearly 3,000 years of experience to back up their science, conventional medicine, which is only a couple of hundred years old at best, has yet to be proven."

In other words, while Westerners think of TCM and other nonmainstream medical practices as new, experimental alternatives, to practitioners and their satisfied patients, modern Western medicine is the real "alternative" medical system.

Nearly 2,500 years ago, The Yellow Emperor's Classic of Internal Medicine was written as discussions between Huang Ti, the legendary first emperor of China and the pioneer of Chinese medical science, and six Chinese scholars. A summary of ancient medical practices, the world's oldest medical book reveals the principles of Traditional Chinese Medicine. These principles, which were originally based on observations of nature, still guide modern TCM practitioners today.

"Traditional Chinese Medicine is all about nature's balancing act," says Martin L. Rossman, M.D., physician, certified acupuncturist and clinical associate in the Department of Medicine at the University of California at San Francisco. "The ancients suggested that we take a cue from nature's seasonal activity, and that still makes sense today."

Winter is the season when nature rests, for example, says Dr. Rossman. Animals hibernate to conserve their energy. Plants go dormant. Trees lose their leaves. And what do humans do (at least, in Western cultures)?

"They party!" says Dr. Rossman. "Starting around the holidays, at a time of year when nature dictates that we slow down, we shop till we drop, work way past the natural sunset and run ourselves ragged with holiday activities. It's no wonder that by January and February, many people, especially women, are exhausted, and inevitably more vulnerable to colds and flu bugs."

USER-FRIENDLY TCM

To prepare you for what to expect if you consult a Traditional Chinese Medicine practitioner, here's a brief run-down of the basic concepts behind this ancient healing art.

About Yin and Yang

"Yin and yang signify two opposite yet complementary forces, which create movement in all aspects of our lives," explains Dr. Rossman. "Yang is the desire to become something and yin is the desire to return to nothing," says Dr. Rossman. TCM holds that balance and harmony between these, with shifting balances to suit the season and situation, are essential to good health.

These are some of the traditional yin and yang associations, cited by Dr. Rossman.

The Five Natural Elements

In Traditional Chinese Medicine, the interaction of five natural elements plays a role in determining your health. When there is an imbalance in the natural harmony of these elements, health problems can ensue.

An ancient Chinese medical text, the Shang Shu, describes the interaction of the five elements as follows: "The five elements are water, fire, wood, metal and earth. Water moistens downward; fire flares upward; wood can be bent and straightened; metal can be molded and can harden; and earth permits sowing, growing and reaping. That which soaks and descends (water) is salty, that which blazes upward (fire) is bitter, that which can be bent and straightened (wood) is sour, that which can be molded and become hard (metal) is pungent and that which permits sowing and reaping (earth) is sweet."

Five Natural Elements

The five elements are an essential principal of Traditional Chinese Medicine. The elements--water, fire, wood, metal and earth--symbolize and link five different qualities and states of natural phenomena. In addition, the elements correspond to different colors, seasons and internal organs.

The theory behind this system may sound esoteric, almost beyond our Western understanding. But from an Eastern perspective, it's all quite logical. According to Dr. Stemmler, "The five elements arose from the ancients' observations of nature, and today we know that these observations translate into many of our current concepts of physics. Each element is associated with certain energies that affect specific organs, emotions and spiritual states."

"Chinese medicine has effective and valid ways of treating a variety of health problems," says Elaine Stern, licensed acupuncturist and TCM practitioner in private practice and at the Pacific Institute in New York City.

Qi, the Essential Life Force

To the Chinese, qi (also written as chi and pronounced "chee") is the river of energy that courses through our bodies and gives us life.

"Think of qi as the force that organizes a bunch of chemicals into a living, breathing human being," says Dr. Rossman. "Qi doesn't just sit around in a puddle; it flows through the body through special channels that we call meridians, much like the blood flows through arteries and veins."

Dr. Rossman says that it's especially easy to explain the concept of qi to women that he treats. "I tell them that qi is whatever took a microscopic cell and caused it to grow into your beautiful baby."

TCM practitioners use Chinese herbs, acupuncture, moxibustion and massage--treatments designed to restore the balance and healthful flow of qi throughout the body. They also emphasize prevention first and encourage their patients to follow an appropriate diet, sleep well and live life in alignment. TCM is a second line of defense after living a balanced life.

A VISIT TO A TCM PRACTITIONER

Your first Traditional Chinese Medicine visit is likely to be quite different from the doctor visits that you're used to.

You know the drill. You don a too-small gown and perch on a paper-covered table in a drafty room that smells of industrial-strength antiseptic. There you wait, far longer than you'd like, surrounded by fearfully modern medical equipment. The waiting, however, is not without purpose: It gives you plenty of time to consider just how that equipment may be used--on you.

"A Western medicine exam is typically a hurried process," says Dr. Howard. Think back to your last physical, when, very likely, you were rushed through as if on an assembly line.

In contrast, you're likely to feel a good deal less hurried and a whole lot more nurtured during a visit to a TCM practitioner. First of all, TCM uses completely different methods of diagnosis than does Western medicine. The practitioner will do nothing more invasive than examine your tongue and take your pulse. In TCM, diagnosis can be summed up in five words:

A Medical History Like No Other

Before she does anything else, the TCM practitioner will interview you (unlike a Western doctor, who may question you while you're up on the examining table). But be prepared to answer a lot more questions than you're used to being asked--some more personal and graphic than those that your family doctor usually asks.

You may feel like your Western doctor seems rushed--"just the facts, ma'am"--prompting you to pass over problems that you think are important.

In contrast, a TCM practitioner will want to know everything about you in infinite detail--details that she will take very seriously. You'll be asked about your lifestyle, your eating and sleeping patterns and about your monthly cycle, even about the color and content of your menstrual flow and how it changes during your period. You'll be asked if temperature affects you and whether you generally feel hotter rather than colder or vice versa.

Your diet and habits will be carefully questioned; so will your food preferences. Do you eat foods hot, cold, spicy or bland? Crave sweets? Salty foods? Do you drink coffee? How often? Do you smoke? Drink? And do you chew your food thoroughly? For how long? How do you deal with your emotions? What is the quality of your relationships? What is your stress level?

Finally, your output is at least as interesting as your input: Your TCM practitioner will also want to discuss the color, consistency and frequency of your bowel movements and urine flow.

Looking and Learning

If you think that your TCM practitioner seems to be looking very closely at you during the course of your exam, you're absolutely right.

Though a good practitioner of Traditional Chinese Medicine is far too subtle to stare obviously, she will be carefully observing many things during the course of her examination of you.

In The Yellow Emperor's Classic of Internal Medicine, it is said that "one should observe minute and trifling things as if they were normal size . . . " and that "those who are experts in examining patients judge their appearances. . . ." Your practitioner will carefully examine your face, studying your eyes, nose, ears, teeth and gums, throat, arms, legs and skin.

After she's checked you out physically, your practitioner will consider your spirit and emotions and your demeanor, because not just your body but also your mind and spirit will speak about your overall vitality and health patterns.

Revealing Sounds and Scents

How you sound has a lot to do with how you feel. So as you answer her questions, your practitioner will listen to the sound of your voice, your breathing and any coughs--even to the way your stomach gurgles.

To a classically trained TCM practitioner, a woman's body scent (if unperfumed) may provide valuable clinical information. Body odors, which an experienced TCM nose differentiates as rancid, burned, sweet, rank and putrid, indicate various imbalances within the body's system. Similarly, bad breath or foul-smelling excreta signal specific imbalances.

Stick Out Your Tongue and Say Nothing

A thorough examination of your tongue is another essential diagnostic tool used by practitioners of Traditonal Chinese Medicine.

Practitioners say that tongue diagnosis is remarkably reliable, especially in complicated conditions, since the tongue nearly always reflects your body's basic pattern of balance.

"The tongue is a place where the TCM practitioner can see what the inside of your body looks like," says Dr. Molony. "Interpreted correctly, the tongue accurately depicts the state of your health because it represents, in microcosm, your body and how it functions."

The practitioner will note your tongue's color, shape and how, or whether, it's coated. A thin white coating is said to be a normal sign that the stomach is digesting food properly. A thick coating may indicate imbalance. The moistness of your tongue is also a factor in your diagnosis.

What your practitioner learns from examining your tongue gives her additional information about a range of factors that are influencing your health.

Tongue Diagnosis

Different areas of the tongue are said to reflect the state of the internal organs. Traditional Chinese Medicine practitioners use the tongue's color--pale, pale red (normal), red, deep red, purple and blue--the shape of the tongue and its coating and moisture to diagnose the state of your well-being. The zones, shown here, cover many areas of the body in addition to the specific zone named. For example, the lung and heart zones cover the organs and body functions above the diaphragm, such as the esophagus or respiration.

A Different Take on Pulse-Taking

For a Western doctor, taking the pulse is simply a matter of noting the rate, rhythm and regularity of your heart rate at a peripheral artery, like your wrists. As such, taking a pulse doesn't take much time and can be learned with ease.

But when a well-trained TCM practitioner takes your pulse, years of training are on display. Pulse-taking is an essential TCM diagnostic tool, one that requires not only refined sensitivity but also a high degree of concentration on the part of the practitioner. Pulse-taking is considered a fine art and is said to be a difficult skill to acquire.

In Traditional Chinese Medicine, pulse-taking relies on fingertip palpations of 12 separate pulses, 6 on each wrist. When taking your pulse, the practitioner will regulate her breathing pattern to yours to enable her to tune in to your pulse sounds.

The first three fingers of the hand are used at three levels of the wrists' radial artery, the same one used for Western pulse-taking. The best TCM practitioners will be able to note 28 different pulse variations on frequency, rhythm and density.

Each pulse is believed to correlate with the activity of a different organ. Combined with your medical history and other parts of the exam, the subtle qualities of each pulse and how they fit into your pattern of health leads your practitioner to your diagnosis and the best method of treatment for you.

IS TRADITIONAL CHINESE MEDICINE RIGHT FOR YOU?

"The advantages of Traditional Chinese Medicine fit nicely with the disadvantages of Western medicine," says Glenn S. Rothfeld, M.D., clinical instructor in the Department of Community Health at Tufts University School of Medicine in Boston and a practitioner in Arlington, Massachusetts. "It's a classic yin/yang relationship."

TCM excels when you have diverse symptoms that don't form a coherent picture, says Dr. Rothfeld. "Western medicine will have you going to specialists who treat your symptoms independently. For example, you might see an ear, nose and throat specialist for your sinus problems and a gastroenterologist for your stomach problems. A TCM practitioner would see all those symptoms as part of an overall pattern and would treat you accordingly." In fact, he adds, stomach disorders are especially well-suited to TCM.

"When you see a gastroenterologist for your stomach problems, you may endure a lot of uncomfortable tests before the doctor diagnoses you with, say, irritable bowel syndrome and leaves it at that, because there isn't much that Western medicine has in its bag of tricks that works," says Dr. Rothfeld. "But TCM offers ways of treating the various symptoms that are called irritable bowel syndrome."

"Western medicine has some tremendous assets," says Dr. Stemmler. "It's far superior when it comes to surgical procedures. It excels at treating life-threatening diseases affecting the cardiovascular system as well as various serious illnesses affecting vital organs in the body." But, continues Dr. Stemmler, "such illnesses occur rarely or often later in someone's lifetime. Most daily ailments affecting the very young to the middle-aged are less serious and do not require a full trauma team at your bedside or the use of potentially dangerous drugs and expensive and uncomfortable procedures. TCM can serve this large sector of the general population well. There is definitely a well-defined place and time for each approach: Eastern or Western. Knowing when to use one, the other or both simultaneously is going to be the challenge of the new generation of dually trained physicians."