Traditional Chinese medicine

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Traditional Hong Kong drug store

The Chinese medicine includes the naturopathic theory and practice of the pre-med medicine of the 1st millennium BC. Chr. To today's medicine in China and in the tradition of Chinese medicine of healing methods practiced worldwide.

As a traditional Chinese medicine , TCM ( Chinese  中醫  /  中医 , Pinyin Zhongyi  - "Chinese Medicine") is referred to those medicine, which in China has developed for more than 2,000 years. Their original range includes the East Asian region, in particular Vietnam , Korea and Japan . On this basis, special variants developed in these countries, such as the Japanese Kampo medicine.

The term zhōngyī ( 中醫  /  中医 ) can be translated with both Chinese medicine and TCM doctor . The term traditional Chinese medicine commonly used in the West , i.e. TCM , is unusual in China.

The therapeutic methods of Chinese medicine include above all Chinese drug therapy and acupuncture, as well as moxibustion (heating of acupuncture points). Together with massage techniques such as Tuina Anmo and Shiatsu , with movement exercises such as Qigong and Taijiquan, and with a diet based on the effects of the medicinal products , the procedures are now often referred to as the five pillars of Chinese therapy. TCM is the traditional medicine with the largest area of ​​use, especially acupuncture is practiced worldwide today. The largest relevant research center is the Chinese Academy of Traditional Chinese Medicine .

From a scientific point of view, the therapeutic effectiveness of many TCM treatment methods is contested and a number of treatment methods are viewed as pseudo-scientific . In 2010 Die Zeit reported that the number of institutes, university projects and pharmaceutical companies was growing that were using new methods to search for active ingredients in the old means of traditional Chinese medicine.

history

The historical source material spans more than three millennia. This time span can be roughly divided into three social epochs:

  1. the pre-Confucian of the Shang (around 1500 to 1050) and Zhou (1050 to 256 BC) dynasties,
  2. the Confucian era until the beginning of the 20th century and
  3. the post-Confucian era of the Republic of China and the People's Republic of China .

On the conceptual level there is a multitude of different healing systems that, with a few exceptions, have been handed down and practiced to the present day. Side by side, partly in one and the same medical work, there are theories that attributed illness to the fall of man, the influence of demons, deviations from norm-conforming lifestyles or the ill will of deceased ancestors or fellow human beings. But they can also be assigned to different epochs and different social groups.

Ancestral medicine

The earliest sources are oracle bones and turtle shells, which were inscribed around the 13th century BC. It can be seen from the texts that the cause of illnesses in almost all cases was traced back to a possible influence of deceased ancestors or third parties as well as to malicious magic, i.e. the influence of people who were still alive. Conjurations, gifts, and gifts of reconciliation are considered appropriate preventive and healing measures. The Shang ruler was a king who was solely responsible for questioning and interpreting the oracles and thus the practice of ancestral medicine. His clientele included the small circle of the ruling elite, and in the case of epidemics, the whole of society.

Demon medicine

A further development of the ancestral medicine documented for the Shang culture led to demon medicine, which can be proven centuries before our era. From it in turn came the corresponding systematic medicine. The starting point of the healing system of demon medicine is the assumption that diseases are caused by the action of malicious demons . On the one hand, the so-called wu magicians knew how to communicate with the spirits of the deceased and sought their advice, especially in the case of health problems; on the other hand on influencing and driving away demons, who populated the universe independently of certain deceased. The medical practice of these wu wizards gradually turned into pure demonic medicine.

“The demons are constantly present, visible and invisible and use every weakness of the people to attack. Only if the guardian spirits and demons emanating from oneself are strong enough or if one is able to win such beings for one's own assistance, whose position in the metaphysical hierarchy is higher than that of the attacker, one is protected from the corresponding threats or armed for counterattack in case of illness. "

Paul Ulrich Innocence sees demon medicine as a true reflection of social conditions in the period from the 8th to the 3rd century BC: almost uninterrupted power struggles and the temporary break-up of China into hundreds of small states that fought “everyone against everyone”. Needle treatment (acupuncture), burning (moxibustion) and massage are likely to be regarded as the original healing methods of demon medicine. The aim of their use was to force the intruders to leave the body. These procedures were later integrated into corresponding systematic medicine. The fight against the demonic attackers was now carried out on the basis of “prohibitions” or highly effective medicinal drugs. The former were pronounced or written down by exorcists or the person concerned himself; The latter could be taken or carried as an amulet . The preventive and healing methods based on the basic concept of demon medicine were recommended for use by authors of various educational levels in the period that followed and have maintained an outstanding position in the medical care of the Chinese population up to the present day.

Religious Medicine

During the second Han dynasty (25 to 220), various religious healing systems emerged as part of efforts to implement socio-political forms of organization on a theocratic basis. General Zhang Xiu (Chang Hsiu) had established himself as a successful warlord in an area of Sichuan and began to build a new social hierarchy based on both a religious and a military basis. The movement that initially appeared as a healing cult (cf. Five Bushels of Rice ) advocated the idea that illness was the justified punishment for past misconduct. The spirits of the dead of deceased ancestors are not responsible for the retribution, but certain deities. Above all, repentance is appropriate for them. So Chang Hsiu imprisoned the sick. They should spend their time in jail realizing their past sins. The healing is only possible when the sick person wrote his sins on three pieces of paper, which were deposited on a mountain top for the three rulers heaven, earth and water or buried in the earth and thrown into a river. After Chang Hsiu fell victim to the assassination attempt by General Zhang Lu , the latter also built up a theocratic system of rule. Zhang Lu also followed the concept that human misconduct would be punished by illness by the gods. Therefore, he left criminals unpunished until they relapsed for the third time. Another cult arose in the 2nd century AD as the Great Peace Movement with Zhang Jiao at its head. His healings consisted of dramatic public mass rituals during which sufferers had to confess their wrongdoings. Hundreds of thousands flocked to these rituals. In decades of military conflict, the central government finally smashed the theocratic states. The defense of the followers of Zhang Jiao went down in history as the Yellow Turban Revolt .

Correspondence Medicine

The healing systems that can be described as equivalent medicine are based on the paradigm that the phenomena of the visible and the invisible environment are interdependent. Older magical concepts ( "correspondence magic " ) can be distinguished from later systematic ones. The latter were developed into an increasingly detailed system with the help of the yin-yang theory and the theory of the five-element change phases . Their foundations in turn correspond to the socio-political ideas of the Confucian state ideology conceived in the same epoch .

Two examples to illustrate the magic of correspondence (from: Shan-hai ching, “Classics of Mountains and Seas” , written down in the 8th to 1st century BC): “There is an herb there that does not produce any fruit. His name is ku-jung. If you eat from it, you won't have children. ”-“ Bow and crossbow tendons help with difficult births when there is no afterbirth. ”

While the influence of demons seemed omnipresent before, in the developing corresponding systematic medicine influences and radiations of all conceivable natural phenomena had to be taken into account: cardinal points, stars, food, heaven and earth, rain and wind, heat and cold. Less an exact anatomy was developed in this healing system, but rather a highly complicated speculative system of physiological processes, which combines the effects and changes of the various influences and radiations with the ideological concepts of the Yin-Yang doctrine and the doctrine of the five-element Sought to combine phases of change.

“The body's own internal influences absorbed from the outside are conducted through the organism in a complicated channel system. These channels can be affected by congestion and blockages, which may need to be pierced. (...) In metaphorical reference to state-economic forms of organization, the organism u. a. so-called "granaries" ( tsang ) and "palaces" ( fu ), between which a regulated exchange of influences must take place. "

Preventive and therapeutic measures were developed according to this system. Basically, it was about “deriving” symptoms of excess and “filling in” deficiency symptoms. The aim was to harmonize the currents and changes in the organism. This corresponded to the ideas of the Confucians about the social order. As long as Confucianism was dominant in China, the ruling class protected the corresponding medicine as the only officially permissible medicine. This saved an archaic healing system into modern times. The classic written evidence of Huang-ti nei-ching or Huangdi Neijing dates from around the 3rd century BC. In terms of healing techniques, the methods of needling and burning, which are probably borrowed from demonic medicine, are presented here. Some passages contain references to massage, ablutions and hot presses. Some medicinal drugs are also mentioned. However, their application was obviously not yet intended in accordance with the theoretical principles of corresponding systematic medicine. The experimental systematic integration of certain medicinal drugs into this healing system did not take place until one and a half millennia later.

The "Four Outstanding Physicians" of the Jin and Yuan Dynasties in the 12th century include Liu Wansu and his student Zhang Yuansu and his student Li Gao (1180–1251) and in the 15th and 16th centuries. Century Zhu Zhenheng (1563-1640).

Natural medicine

Representation of a meridian and its associated points

The oldest basic medical works that are still in use today are attributed to emperors who are believed to have lived several millennia before our era. However, these are legends. Well-known are the Shennong ben cao jing , a herbal medicine , and the Huangdi Neijing, a detailed description of both diagnostic and therapeutic methods and acupuncture. After the beginning of our era, the Shang Han Lun, a treatise on cold illnesses, was created. It is considered to be the oldest clinical treatise in medical history. A number of famous writings date from the Ming Dynasty (1368 to 1644), including the Ben Cao Gang Mu, a compendium of the Materia Medica.

With the beginning of the Jesuit mission in the Far East, medical exchanges between Europe and East Asia also took off. In Japan, Jesuits had already observed native medicine in the second half of the 16th century, as demonstrated by a wealth of comments in their letters, the inclusion of Sino-Japanese terms in their dictionaries, and a comparison of Western and Japanese medicine by Luís Fróis . In the 17th century in China the Jesuit Johannes Schreck brought about a further exchange of Chinese and Western knowledge in the field of technology and anatomy. From the beginning of the Qing dynasty (1644–1912), whose most famous doctors and medical writers included Ye Gui (1667–1746), also known as Ye Tianshi, Jesuits also worked in China at the imperial court as astronomers, geographers, painters, Architects or mathematicians. In addition to brief explanations in some of her letters, there are extensive translations of Chinese texts that were published by the German doctor and VOC merchant Andreas Cleyer as Specimen Medicinae Sinicae, sive, Opuscula medica ad mentem sinensium (Frankfurt, 1682) . Equally important was the printing of Clavis medica ad Chinarum doctrinam de pulsibus from the pen of Michael Boym . The first lengthy treatise on moxa was written by the Dutch pastor Hermann Buschoff, who lives in Batavia . Through his writing Het Podagra, Nader als oyt nagevorst en uytgevonden, Midsgaders Des selfs sekere Genesingh of ontlastend Hulp-Mittel (1674) , which was also translated into German and English , the Japanese word mogusa (Chinese ai) was established as moxa in Europe. The Dutch doctor Willem ten Rhijne (1647–1700), who was stimulated by Buschoff, continued to pursue burning therapy in the Dejima branch (Nagasaki, Japan) of the East India Company. His compilation, printed in London in 1683, contains the first detailed treatise on needling, which he named acupunctura . Stimulated by ten Rhijne, the German doctor Engelbert Kaempfer (1651–1716) also collected further information and materials in Japan, which he published in 1712. His long essays on acupuncture and moxa were widely distributed in the appendix to his Japanese book, which has been translated into many languages. While moxa therapy met with great interest, authorities such as Georg Ernst Stahl or Lorenz Heister reacted negatively to ten Rhijnes and Kaempfer's descriptions of acupuncture - not least because both of them couldn't get along with the term Qi, so that one could get the impression that the doctors in East Asia would stab the stomach to drain intestinal gases.

China found itself in a new situation in the second half of the 19th century. Western powers had forced access to the Chinese markets by force of arms and waged the first (1839–1842) and second opium wars (1856–1860). Western technology and science subsequently penetrated the everyday life of the urban population unhindered. In the cities the number of those who wanted their diseases to be treated according to the imported Western methods no longer increased according to the traditional methods. Those who promised to heal according to ancient craft were cornered. There were considerations to ban these, as they were seen as an obstacle to a smooth transformation into the Western style of effectiveness through rationality. The traditional diagnostic and therapeutic methods of East Asia were increasingly under pressure.

After the founding of the People's Republic of China, Mao Zedong led to a state-driven countermovement. The task now was to provide medical care for the rural population of a huge empire with limited resources. The solution was seen in the maintenance and control of the traditional healing art, which was widespread in the rural population. New universities for Chinese medicine were founded, old classics were rediscovered and prepared for the modern age. With the “ barefoot doctors ” - TCM doctors trained in short courses - medical care was organized across the board.

Only now did the term “Chinese medicine / Chinese medicine” ( 中 醫學  /  中 医学 ) spread, in the English translation with the addition “traditional” and the abbreviation “TCM”. In China, the term often referred less to traditional medicine in the broadest sense than to the newly created health care system .

TCM is a fully institutionalized part of the Chinese health system. In 2006, the TCM sector served over 200 million outpatients and approximately 7 million inpatients, accounting for 10% to 20% of health care in China.

Outside central China

In Korea, Japan and Vietnam the term “Chinese medicine” was not adopted. There, the name Oriental Medicine ( Japanese 東洋 医学 - German: East Asian medicine) has established itself for the Chinese medical tradition . Kampō ( jap. 漢 方 ) originally means the recipe ( 方 jap. Pō ; chin. Fāng ) of the Chinese ( 漢 , jap. Kan ; chin. Hàn ), since it was mainly adopted from there in the 6th century.

In Europe, the oldest occupation with Chinese medicine - with acupuncture and moxibustion - dates back to the late 17th century. New interest arose in the West in the first half of the 20th century and with the opening of the People's Republic of China in the 1970s, the transfer of the methods to North America and Europe under the name of TCM began.

Taiwan

In Taiwan , traditional medicine was able to hold up despite modernization and is now practiced in addition. Taiwan has its own TCM tradition, which is more strongly influenced by old families of doctors, more traditional and therefore less standardized, with more spiritual elements. Taiwan hardly trains foreigners in TCM. It should be noted, however, that the average Taiwanese tend to rely on treatment methods of modern medicine when in doubt. TCM is mainly used for chronic diseases, as an additional treatment, or to care for patients in the context of palliative care . Restaurants in Taiwan that offer medicinal dishes based on the dietary teachings of the CM are very popular. The food is classified according to the five "elements" earth, wood, water, fire and metal.

Japan

The import of Chinese medicine to Japan began at the beginning of the 7th century. An early testimony to the occupation with this healing art is the medical writing Ishimpō from 982, which is also appreciated today because it contains parts of Chinese texts that have been lost in China.

Since the formation of government structures in Japan, the medicine of the archipelago has always been stimulated by Chinese sources, but it did not stop at mere adoption. Since around the 16th century, Japanese doctors have shown an increasingly clear independence, rejected or changed Chinese concepts and developed their own therapies such as the "hammer needling" ( uchibari ) according to Mubun or instruments such as the "tubular needle " ( kudabari ) according to Sugiyama Wa'ichi.

Japanese hammer needle ( uchibari ) after Mubun, 17th century
Tubular needle ( kudabari ) according to Sugiyama Wa'ichi

Conflicts among doctors with serious consequences occurred in the 17th century. A group of doctors turned against the import of more recent Chinese concepts, which were viewed as too schematic and rigid, and resorted to the then 1500-year-old work Shang Han Lun (Japanese Shōkan ron ), a treatise that was feverish due to the cold Had placed diseases under clinical observation. This renewal through recourse to the old led to the development of an independent "old school" (ko-ihō-ha, 古 医 方 派 ).

With the penetration of Western medicine from the second half of the 16th century and especially after the founding of the Dutch trading post Dejima , a group emerged among the Japanese doctors who, within the framework of the Holland Studies ( Rangaku ), laid the foundations for the rapid modernization after the opening of the country . But the traditionalists of the “old school” of medicine also reacted surprisingly flexibly to European influences. The court doctor of the Tenno in Kyoto, Ogino Gengai (1737–1806), tried to combine western bloodletting with Chinese and Japanese concepts. Ishizaka Sōtetsu (1770–1841), an acupuncturist at the court of the Shogun in Edo, sought to integrate Western anatomy . Ogino contacted the VOC doctor Carl Peter Thunberg , Ishizaka handed over to Dr. Philipp Franz von Siebold , from whom he hoped for a cooperation, even long written statements on this.

The name Kampo medicine (漢 方 医学) came up in the 19th century to differentiate between Chinese and Western medicine. Kampō means something like "Chinese method", "Chinese direction". The conceptual field is not precisely delimited. Sometimes it includes the full arsenal of procedures that are used, including massage, acupuncture, and dietetics. Often, however, it is limited to drug therapy.

With the opening of Japan in the middle of the 19th century, state authorities intervened more and more in the previously free world of medical training and practice. With the beginning of the Meiji period, doctors had to prove that they knew their way around the craft of Western medicine. In 1870, German medicine was implemented as the basic model in the newly founded universities and clinics in the country by decree. Those who only had experience with traditional methods were no longer entitled to cure and were excluded from the association of state-recognized doctors. However, this did not lead to the death of Kampo medicine. Since the second half of the twentieth century, the number of doctors who have completed additional training in Kampo medicine after their license to practice medicine has increased. In 1976 Kampo products were eligible for cash register. In 1979 the first department of kampo medicine was established in the medical faculty of a state university. There are now similar departments in a number of government and private institutions. In many pharmaceutical faculties in the country, traditional remedies are researched in terms of their active ingredients. Kampo pharmacies can be found in larger cities, but “Western” pharmacies also sometimes offer Kampo preparations.

Acupuncture is a world of its own. In terms of personnel and institutions, it is separate from Kampo medicine. Treatment with medicinal drugs is in the hands of licensed doctors, whereas treatment with needles is in the hands of therapists who also understand the techniques of massaging and other manual procedures. Corresponding practices - often equipped in the style of a small clinic with one or two dozen employees - are available nationwide and integrated into the healthcare system. Even as a patient with a compulsory health insurance fund, you can go directly to the therapist without first having to get a letter of referral from a doctor to take advantage of acupuncture or massage services.

Current TCM boom in the west

From the 1950s onwards, TCM found increasing interest in western cultures . In Germany naturopathic oriented medical practitioners as Gerhard Bachmann, August Brodde, Heribert Schmidt, Erich Stiefvater parts of it had rezipiert . The naturopaths Hörner and Korn were active as trainers in the first courses, which took place in the early 1950s under the direction of stepfather. They obtained their knowledge from Vietnam and Japan and incorporated new knowledge from sinologists . The works of Manfred Porkert contributed to the spread of TCM . His 1978 Clinical Chinese Pharmacology, for example, provided a comprehensive description of Chinese medicines in a Western language for the first time.

With the political opening up of China and the accompanying easing of travel, acupuncture in particular has experienced a real boom since the 1970s. The trigger is the report by an American journalist about the successful acupuncture pain treatment after his own appendix operation during a visit to China in 1971. One of the great protagonists of TCM among those who traveled to China at the time was the North American Ted J. Kaptchuk, whose 1983 appeared The book "The Web That Has No Weaver" (German: The Great Book of Chinese Medicine 1988) has contributed significantly to the popularity of TCM.

TCM is listed as the most frequently used alternative form of therapy in 100 WHO member states. In 13 member states of the WHO, TCM is paid for by the state health insurance.

Basics - the concept of Qi

The term " Qi " plays a key role in the medical discourse of the Chinese tradition . The organism appears as an extraordinarily complex structure of dynamic Qi structures. It's a dynamic built on balance. If the equilibrium is severely disturbed, a doctor is needed, who tries to determine the cause of the disturbance with his experienced eye and in conversation with the patient. We are talking about “Liver Qi”, “Heart Qi”, “Ascending Qi”, “Qi weakness” etc.

The Qi in the tension of Yin and Yang

The balance of the Qi dynamic consists in a balance of opposites, which are formed according to patterns such as: illuminated and shady, male and female, above and below, outside and inside, active and suffering, etc. According to the form of their opposites they become under the The pair of terms Yin and Yang brought. One does not - as for example in the opposition of good and bad - carry victory over the other, but finds its purpose only in the recognition and promotion of the other. The idea that everything that happens in nature and in society is subject to tension between yin and yang is not only found in Chinese medicine. It can be found in the “ Yijing ”, one of the “classics” written long before Confucianism and Daoism appeared , and is deeply anchored in Chinese culture. The sinologist Wolfgang Bauer pointed out that the dynamic of the conflict between Confucianism and Daoism, which has shaped Chinese history, was also borne by thinking about Yin and Yang opposites.

The Qi in the five phases of change

The five phases of change

In the second place, the Qi dynamic is integrated into a cycle that follows the pattern of five seasons. Each circle ( functional circle ( TCM) or orb) emerges from a previous one and merges into the next. Opposites and couples emerge based on the pattern of the relationship between grandmother and grandchildren. There are five elements associated with the seasons: wood, fire, earth, metal and water. Finally, the human organism is understood as an interaction of five “organs” (functional circles), each of which has its special relationship to one of the five elements and one of the five seasons. The five organs / functional circles are connected to one another in the mode of growing apart: liver, heart, spleen, lungs and kidneys. These organs / functional groups only partially coincide with the term we are familiar with. In the “heart”, for example, in addition to the organ as a pump, the ability to create the right form is included. Physical and psychological often merge indistinguishably. The most important difference to the scientific understanding is: The five organs / functional circles are a self-fulfilling whole, a microcosm as an image of a macrocosm, which is linked with its seasons and elements with the individual organism. The organs / functional circles relate to the organism like the five seasons relate to the cycle of arising and passing away and the five elements (five phases of change) relate to the whole of material being.

Qi

Qi is often translated as "power" or "energy". In classical Chinese and Japanese sources one can also find descriptions that suggest a material concept. Similar to the Pneuma of Greek medicine, this Qi pervades both the body and the outside world in a variety of forms. That is why there are countless terms in modern everyday language that contain the word component Qi. Qi is also used in a medical context. "Wei-Qi" describes the ability to withstand harmful weather conditions and to cope with injuries and infections. It should be present differently in the waking organism than in the sleeping organism and withdraw from the surface of the body into the interior of the body when falling asleep. “ Qigong ”, on the other hand, means “working on Qi”.

The concept is often used in connection with the “ meridians ” on which 365 therapy points are located. By stimulating the points with needles, the “De-Qi” (feeling) is evoked - “Arrival of Qi”. For the therapist, it is noticeable through an increase in tissue resistance, for the sensitive patient through a radiant sensation along the affected meridian.

Meridians and therapy points

The term meridian , which is borrowed from geography , does not actually match the original meaning of the Chinese name jingluo ( 經絡  /  经络 , jīngluò ), more aptly the term interconnect , more precisely: interconnect network or interconnect network . It was not a question of projected lines on the surface of the body, but rather a system of paths ( jīng , 經  /  经 ) and meshwork ( luò , 絡  /  络 ) through which the Qi pulsates. In ancient texts in particular, the term Qi is often associated with the term blood ( xuè , 血 ) ( xuèqì , 血氣  /  血气 ), which led to 17th century Europeans like Willem ten Rhijne or Engelbert Kaempfer misunderstanding the meridians as blood vessels. The number of therapy points increased with the development of Chinese medicine. The location of the points was not always stable. Some are only used for needles ( acupuncture ), others only for burning ( moxibustion ). A large part serves both therapy methods, depending on the indication.

Diagnosis and therapy

According to Chinese disease theory, the internal disturbances in the external come to light in a differentiated way. Correspondingly, there are diagnostic procedures that focus on the perceptible nature of the outside of the body and excretions. Examples of this are pulse and tongue diagnosis , which have no correspondence with scientific diagnostic techniques.

Various methods are used in combination for treatment. The five main methods are:

Acupuncture and moxibustion
Certain points, which are arranged along meridians, are stimulated with needles in acupuncture and with burning mugwort (moxa) in moxibustion .
Drug therapy
It consists in the prescription of formulations made from raw drugs and is the most important of the methods in terms of therapeutic range.
Movement exercises
like Qigong or the internal martial arts (for example Taijiquan ): Using the power of imagination, which focuses on the body and its surroundings and often aims to imitate images, such as images of animals, the organism is calmed and invigorated in slow and flowing movements.
Dietetics
Food has a specific profile of action based on the example of drugs. According to this, the common foods can be used to accompany therapy and preventive.
massage
Tuina , Shiatsu in Japan: It is based on the meridians / channels .

drug

In an extensive study, Manfred Porkert describes a total of 515 individual substances . which are used in traditional Chinese medicine. According to this, less than five percent of these are preparations or parts of vertebrate animals, including, for example, the bones of the tiger, but also fossil bones of prehistoric animals. A good five percent each are mineral or made up of excrement, secretions, worms, insects and parts of molluscs and 85 percent are of vegetable origin . The only medicinal substances of animal origin officially used in Europe are various mussel shells (e.g. the Chinese oyster or arca mussel shells).

In TCM, each of these individual substances is assigned a specific profile, which results from the "temperature behavior" (seven-point scale) and the "taste direction" (sour, bitter, sweet, hot, salty and neutral). These are directly related to certain working tendencies. As a result, indications and contraindications are given for each remedy. Further determinations include the compatibility and incompatibility with other drugs, the toxicity and the dosage according to the form of administration. The drug administered to the patient usually consists of a composition of various individual remedies. The classic form of administration is usually decoction , more rarely an extract obtained by means of infusion . In addition to other forms of administration, standardized combinations of active ingredients in the form of pills and granules are used for common indications. A further form of administration is the syrup, such as Pei Pa Koa ( Loquat syrup) which in TCM against pharyngitis , cough and hoarseness is used.

TCM in German-speaking countries

Traditional Chinese medicine is now also widespread in German-speaking countries. It has spawned a number of medical societies.

  • The "German Medical Association for Acupuncture" (DÄGfA eV, founded in 1951) is one of the largest specialist societies in the field of naturopathy and the oldest German acupuncture society.
  • The "German Society for Acupuncture and Neural Therapy" (DGfAN eV, founded in 1971), which emerged from the reflex medicine working group of the GDR, integrates Chinese medicine into its overall reflex therapy concept.
  • The entire field of Chinese therapies, especially phytotherapy, is covered by the Societas medicinae Sinensis (SMS - International Society for Chinese Medicine eV).
  • The focus of the scientific society "Research Group Acupuncture" is the further and advanced training in the field of acupuncture and the development and implementation of large clinical studies. The research group was significantly involved in the conception and implementation of the GERAC studies.

TCM is only recognized to a limited extent in terms of health policy in Germany. Following the model tests to check the effectiveness of acupuncture , acupuncture has been recognized as a health insurance benefit since January 1, 2007 for chronic pain in the lumbar spine or the knee joint. The accounting doctor must adhere to the requirements of the acupuncture quality assurance agreement. Other TCM services are not reimbursed.

In Switzerland , the treatment costs of EMR- approved, non-medical TCM therapists are largely covered by the supplementary insurance. The approval for TCM therapists is federally regulated, mainly the requirements of the Swiss Professional Association for TCM (SBO-TCM) apply, which in turn is based on the standards of the NCCAOM and ETCMA. Various schools are recommended by the SBO-TCM and offer extensive full-time training over several years. Of the medical treatment methods from TCM, since 2006 only acupuncture can be billed via the basic insurance, all other therapy methods of TCM can be reimbursed through any additional insurance taken out. The standards for medical certificates of proficiency for TCM are mainly set by the umbrella organization of the Swiss medical TCM associations (ASA). From 2012, traditional Chinese therapy as well as homeopathy , anthroposophic medicine , phytotherapy and neural therapy will again be paid for by the mandatory health insurance under certain conditions . This regulation applies provisionally until the end of 2017. During this time, the effectiveness, appropriateness and cost-effectiveness of the five complementary medical methods are considered to be partly controversial and will be evaluated with regard to these criteria.

In Austria , doctors can obtain a diploma for "Chinese diagnostics and medicinal therapy" from the Austrian Medical Association . This training lasts at least two years and comprises at least 500 hours of training. In Vienna there was a private university that had dedicated itself to research and teaching in the field of traditional Chinese medicine, the TCM Private University Li Shi Zhen . The university's accreditation expired in 2009.

Scientific assessment and criticism

From the scientific side of evidence-based medicine, the effectiveness of many TCM treatment methods is negated. The basic concepts of TCM therefore contradict scientific principles, and empirical evidence is also lacking.

The criticism of the TCM concerns different aspects. One is that of the "meridians", on which a multitude of procedures such as acupuncture, massage, movement exercises, etc. are based. The assumed meridians cannot be scientifically proven. There is no scientifically sound evidence or plausible mechanism of action for the assertion that internal states and organs can be influenced via specific points on the body surface. The representatives of TCM stated that there is not a multitude of meridian teachings , but rather one teaching as a whole . However, this contradicts the fact that this has changed and modified several times over the course of time. In addition, the uniformity or dissemination of a theory do not allow any conclusions to be drawn about its truth content.

Systematic reviews of studies on the effectiveness of acupuncture show inconsistent results. A small number of reviews conclude that acupuncture is helpful for a very limited number of indications .

With regard to acupuncture, it could be shown that it does not play a role in the effect where it was stung. The effect of observing “classic” acupuncture points and the deliberate disregard of these points and meridians made no difference in studies.

Chinese phytotherapy has also been examined in scientific studies. A group of scientists from the University of Bern compared studies on Chinese phytotherapy with those of conventional medicine. 136 double-blind studies were compared . The authors of the comparison draw the conclusion that the bias in the Chinese studies is more pronounced and, due to the small number of high-quality publications, it is not possible to make a binding judgment about the effectiveness of Chinese phytotherapy.

A tradition that is thousands of years old is often used as an argument for the effectiveness of TCM. However, the age of a healing process does not allow any conclusions to be drawn about its effectiveness. The Chinese government supports the spread of TCM in Europe, as a large market is opening up there for Chinese manufacturers.

Side effects and quality control

There have been reports of cases of poisoning from the use of Chinese medicines (e.g. aristolochic acids ). An interdisciplinary project to research cultivation of 16 selected Chinese medicinal plant species has been running at the Bavarian State Institute for Agriculture since 1999. According to the state institute, controlled cultivation could make a significant contribution to the safety of pharmaceuticals and also to security of supply in this area.

Some critics have raised concerns that Chinese medicines, even if handled skillfully, could lead to liver damage. However, a “long-term study on possible side effects of Chinese herbs” by the Friends of Chinese Medicine in Germany came to the conclusion that it was able to refute the “often raised allegation of liver toxicity of Chinese herbs”. This is countered by a study by a group led by Rolf Teschke from the Hanau Clinic, which, when evaluating the scientific literature from 2011 to 2014, came to the conclusion that 18 of the classified herbal mixtures used in TCM, some unclassifiable mixtures and 39 individual TCM Herbs can cause liver damage. In most of the cases, those affected were able to recover, but some cases were also recorded in which the liver was permanently damaged and required an organ transplant. In rare cases, the patient even died.

In 2013, a study of Chinese medicinal herbs found pesticide residues in 17 of 36 samples, which the World Health Organization classified as extremely dangerous or dangerous. 26 of the 36 samples showed residues above the maximum levels permitted in the EU.

The Center for Therapy Safety in Chinese Medicinal Therapy (CTCA), an amalgamation of the major specialist societies for Chinese medicinal therapy in Germany and individuals, endeavors to ensure safe therapy with Chinese medicinal products.

Various qualifications and training courses are offered for further training in TCM, which cannot be compared with one another due to the lack of standards. Acupuncture is an additional designation recognized by the respective regional medical associations. At the German Medical Congress in 2003, the additional designation acupuncture was newly introduced into the training regulations. The aim of the additional training is to acquire the technical competence and practical skills in acupuncture after completing the prescribed training time and training content as well as the training courses.

Protection of species and animal welfare

Selling traditional medicines at a street market in Xi'an.
Selling traditional medicines at a street market in Xi'an.

Protected and rare plants are also used in TCM. In Germany, for example, cowslips and arnica are endangered.

The same applies to animals. The TCM drug list also includes extracts from endangered animal species, such as tiger , snow leopard , Asiatic black bear , rhinoceros , saiga antelope ( recommended by WWF as a substitute for the rhinoceros in the 1990s), certain pangolin species , saw rays , some seahorse species as well as different species of turtles .

These products are often traded on the black market. Medicinal herbs and other medicines in Asia have been offered in street markets and in shops from time immemorial without any control. Sales of pangolins on a Wet market of Wuhan is a possible cause of the outbreak of SARS-CoV-2 under discussion. The apt term for this sector is that of "folk medicine", which is only partly based on the knowledge of TCM and partly on superstition. The South African lion farms are also a potential source of zoonoses due to the sometimes catastrophic hygienic conditions there . Combating them is difficult because side effects can reverse a well-intentioned intention.

The industry serving this sector has been pushing into the markets of the West since TCM was fashionable there.

The TCM societies in Germany speak out against the use of protected animal and plant species without exception. The Working Group for Classical Acupuncture and Traditional Chinese Medicine (AGTCM) is involved in the “AG Medicine and Species Protection” of the WWF. The International Society for Chinese Medicine cooperates with Pro Wildlife. German pharmacies do not offer TCM drugs that contain components of protected species.

See also

literature

  • Dan Bensky, Andrew Gamble: Chinese Herbal Medicine. Materia Medica. Eastland Press, Seattle 1993, ISBN 0-939616-15-7 (standard work).
  • Claudia Focks (Ed.), Norman Hillenbrand: Guide to Chinese Medicine. 4th edition. Urban & Fischer, Munich / Jena 2003, ISBN 3-437-56481-1 .
  • Fritz Friedl: Introduction to Chinese Medicine. In: EA Stöger, F. Friedl (Ed.): Pharmacopoeia of Chinese Medicine. 2nd Edition. Deutscher Apotheker-Verlag, Stuttgart 2005, ISBN 3-7692-1965-1 .
  • Jochen Gleditsch : Traditional Chinese Medicine II. In: Center for Documentation for Natural Healing Methods : Documentation of the special therapy directions and natural healing methods in Europe. Volume 1.2, Essen 1991, ISBN 3-88699-025-7 , pp. 905ff.
  • Johannes Greten: Course book traditional Chinese medicine: Understanding TCM and applying it correctly. Thieme, Stuttgart / New York 2003, ISBN 3-13-121661-1 .
  • Carl-Hermann Hempen : The medicine of the Chinese. Bertelsmann, Munich 1988, ISBN 3-570-03877-7 . (Paperback edition: Goldmann, Munich 1991, ISBN 3-442-12309-7 )
  • Ted J. Kaptchuk: The Great Book of Chinese Medicine. Fischer, Frankfurt am Main 2006, ISBN 3-596-17123-7 .
  • Giovanni Maciocia: The Basics of Chinese Medicine. A textbook for acupuncturists and drug therapists. Traditional Chinese Medicine Publisher Dr. Erich Wühr, Kötzting 1994, ISBN 3-927344-07-9 .
  • Thomas Ots: Traditional Chinese Medicine I. In: Center for Documentation for Naturopathic Methods : Documentation of the special therapy directions and natural healing methods in Europe. Volume 1.2. Essen 1991, ISBN 3-88699-025-7 , pp. 891ff.
  • Manfred Porkert : The theoretical foundations of Chinese medicine. 2nd Edition. Hirzel, Stuttgart 1982, ISBN 3-7776-0369-4 .
  • Manfred Porkert (with the assistance of Christian Ullmann): The Chinese medicine . Econ, Düsseldorf / Vienna 1982, ISBN 3-430-17603-4 .
  • Christian Schmincke: Chinese Medicine for the Western World. Springer, Heidelberg 2004, ISBN 3-540-00058-5 .
  • Claus C. Schnorrenberger: Textbook of Chinese medicine for western doctors. The theoretical foundations of Chinese acupuncture and medication prescription. 3. Edition. Hippokrates, Stuttgart 1985, ISBN 3-7773-0730-0 .
  • Paul U. Innocence : Medicine in China. A story of ideas. Beck, Munich 1980, ISBN 3-406-07599-1 .
  • Paul U. Innocence: Chinese Medicine. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 243-250.
  • Paul U. Innocence: Traditional Chinese Medicine . Beck, Munich 2013, ISBN 978-3-406-65602-6 .
  • John Zhou: Chinese Medicine, Compendium: with 3 registers; [Healing methods, history, philosophy]. 1st edition. OZV, Bad Pyrmont / Beijing 2004, ISBN 3-9809443-0-1 .
  • Zuo Yanfu: Surgery of Traditional Chinese Medicine. Shanghai 2002, ISBN 7-81010-656-2 .

Web links

Commons : Traditional Chinese Medicine  - Collection of Pictures, Videos and Audio Files

Individual evidence

  1. ^ Paul U. Innocence: Chinese Medicine. 2005, p. 243 f.
  2. ↑ a b Term "zhongyi (中醫 / 中医)" - Chinese: zdic.net - Retrieved on May 28, 2017 - zdic.net - Online
  3. ↑ a b Term "zhongyi (中醫 / 中医)" - Chinese / German: dict.leo.org - Accessed on May 28, 2017 - zdic.net - Online
  4. ^ World Health Organization: Legal Status of Traditional Medicine and Complementary / Alternative Medicine: A Worldwide Review. 2001, p. 2 ( document as PDF ).
  5. ^ Richard Stone: Lifting the Veil on Traditional Chinese Medicine. In: Science. Vol. 319, Issue 5864, February 8, 2008, pp. 709-710, accessed March 10, 2017.
  6. ↑ Hard to swallow . In: Nature . tape 448 , no. 7150 , 2007, p. 105-106 , doi : 10.1038 / 448106a : "But it seems problematic to apply a brand new technique, largely untested in the clinic, to test the veracity of traditional Chinese medicine, when the field is so fraught with pseudoscience."
  7. ↑ Richard Friebe: The realm of means. In: time online. April 6, 2010, accessed May 6, 2020
  8. ↑ Paul U. Innocence: China. In: Heinrich Schipperges, Eduard Seidler , Paul U. Unschuld (Ed.): Illness, healing art, healing. Alber, Freiburg (Breisgau) / Munich 1978, ISBN 3-495-47388-2 , pp. 193-227.
  9. ↑ PU Innocence: China. Munich 1978, p. 201.
  10. ↑ a b P. U. Innocence: China. Munich 1978.
  11. ↑ PU Innocence: China. Munich 1978.
  12. ↑ PU Innocence: China. Munich 1978, p. 207.
  13. ↑ PU Innocence: China. Munich 1978, p. 210 ff.
  14. ^ Paul U. Innocence : Medicine in China. A story of ideas. Munich 1980, pp. 134-144.
  15. ↑ Paul U. Innocence: Li Gao. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 849; see also Bencao Gangmu # The sources of Bencao Gangmu .
  16. ↑ Paul U. Innocence: Zhu Zhenheng. In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. 2005, p. 1529.
  17. ↑ See, for example, the online version of a US National Library of Medicine exhibit from October 2000: Classics of Traditional Chinese Medicine. ( Memento from October 1, 2009 in the Internet Archive )
  18. ^ W. Michel: Early western observations on acupuncture and moxibustion. In: Sudhoff's archive. Volume 77, No. 2, Stuttgart 1993, pp. 194–222 ( Document as PDF ( Memento from January 30, 2012 in the Internet Archive ))
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  20. ↑ Paul U. Innocence : Ye Gui. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1511 f.
  21. ^ W. Michel: Far Eastern Medicine in Seventeenth and Early Eighteenth Century Germany. In: Studies in Languages ​​and Cultures. (Faculty of Languages ​​and Cultures, Kyushu University), No. 20, 2004, pp. 67-82 ( document as PDF ( Memento from January 30, 2012 in the Internet Archive )).
  22. ↑ German edition from 1676: Hermann Buschof - The exactly examined and invented Podagra, mediating yourself safely = own recovery and relieving Huelff = means. (W. Michel ed.) Haug Verlag, Heidelberg 1993, p. 148 f.
  23. ↑ Wilhelmi th Rhyjne include: Transisalano-Daventriensis Dissertatio de arthritide: Mantissa Schematica: De acupunctura: Orationes et tres. London 1683. See website of the Groupe d'Etude et de Recherche en Acupuncture . There also excerpts from the script in English as PDF. German translation of the Mantissa Schematica in the Kyushu University Institutional Repository. (Wolfgang Michel: Willem ten Rhijne and Japanese Medicine (II). ( Memento from January 30, 2012 in the Internet Archive ))
  24. ↑ Traditional Chinese medicine. (PDF; 794 KB) In: who.int. October 20, 2008, accessed July 28, 2020 .
  25. ↑ Term "Oriental Medicine (東洋 医学)" - English / Japanese: edrdg.org - Retrieved May 28, 2017 - edrdg.org - online
  26. ^ Term "Oriental Medicine (東洋 医学)" - German / Japanese: wadoku.de - Accessed on May 28, 2017 - wadoku.de - online
  27. ↑ Term "kampo (漢 方)" - English / Japanese: edrdg.org - Accessed on May 28, 2017 - edrdg.org - online
  28. ↑ Term "kampo (漢 方)" - German / Japanese: wadoku.de - Retrieved on May 28, 2017 - wadoku.de - online
  29. ↑ See for example the language used at the 14th International Congress of Oriental Medicine. ( Memento from April 22, 2007 in the web archive archive.today ) in Taiwan, April 2–4. December 2007.
  30. ↑ The remarks on the tradition of Chinese medicine in Japan are based on the articles on the Japanese-language Wikipedia on the topics: "Traditional Chinese Medicine" - 伝 統 中国 医学 , "Chinese Medicine" - 中 医学 , "Korean Medicine" - 韓 医学 and "Kampo- Medicine “- 漢 方 医学 .
  31. ↑ A brief overview of the peculiarities of Japanese acupuncture can be found in the Kyushu University Institutional Repository (QIR) ( Japan's role in the early communication of acupuncture to Europe. ( Memento from January 30, 2012 in the Internet Archive ) Document as PDF).
  32. ^ Department of Oriental Japanese Medicine. In: med.u-toyama.ac.jp. Toyama University, accessed April 24, 2019 .
  33. ↑ Thomas E. Heise: China's medicine with us. On the reception of traditional Chinese medicine in the Federal Republic of Germany 1950–1982. Medical dissertation, Bochum 1984.
  34. ^ J. Reston: Now about my operation in Beijing. In: New York Times. 1, 1971, p. 6.
  35. ↑ WHO global report on traditional and complementary medicine 2019 . WHO, 2019, ISBN 978-92-4151543-6 , pp. 47 (English, apps.who.int [PDF; 5.9 MB ; accessed on June 12, 2020]).
  36. ↑ WHO global report on traditional and complementary medicine 2019 . WHO, 2019, ISBN 978-92-4151543-6 , pp. 54 (English, apps.who.int [PDF; 5.9 MB ; accessed on June 12, 2020]).
  37. ↑ In addition, the books listed in the literature list by: Ted J. Kaptchuk: The great book of Chinese medicine ; Giovanni Maciocia: The Basics of Chinese Medicine ; Manfred Porkert: The theoretical foundations of Chinese medicine. A compact presentation of the term Qi is given by: Christian Schmincke: The concept of energy in Chinese medicine - How Qi moves the world. In: Naturarzt. Issue 08/2005, pp. 39–41. ( Manuscript as PDF ( Memento from January 1, 2007 in the Internet Archive )).
  38. ↑ Wolfgang Bauer: History of Chinese Philosophy. Beck, Munich 2001, ISBN 3-406-47157-9 , p. 95.
  39. ↑ For the historical background of the system of tracts and canals see Lu Gwei-Djen, Joseph Needham: Celestial Lancets. P. 13ff.
  40. ↑ Manfred Porkert: Clinical Chinese Pharmacology. Fischer, Heidelberg 1978, ISBN 3-85597-002-5 , pp. 52-59.
  41. ↑ AF Molsberger, J. Mau et al .: Does acupuncture improve the orthopedic management of chronic low back pain - a randomized, blinded, controlled trial with 3 months follow up. In: Pain. Volume 99, No. 3, Oct. 2002, pp. 579-587.
  42. ↑ HG Endres et al .: German Acupuncture Trials (gerac) address problems of methodology associated with acupuncture studies. In: pain. Volume 19, No. 3, June 2005, pp. 201-204, 206, 208-210.
  43. ↑ Quality assurance of acupuncture. In: kbv.de . 2006, accessed May 24, 2020 .
  44. ↑ Five methods of complementary medicine are provisionally remunerated for six years under certain conditions. In: admin.ch. January 12, 2011, accessed November 16, 2019 .
  45. ↑ ÖÄK diploma Directive: Complementary medicine - Chinese medicine diagnosis and therapy. (PDF; 47.1 KB) Came into force according to the decision of the board of the Austrian Medical Association on September 20, 2006. According to the decision of the board of the Austrian Medical Association, the transitional provisions came into force on November 24, 2004. In: arztakademie.at Austrian Academy of Doctors , accessed December 9, 2019 .
  46. ^ Edzard Ernst : Acupuncture: what does the most reliable evidence tell us? In: J Pain Symptom Manage. April 2009, Volume 37, No. 4, pp. 709-714. PMID 18789644 .
  47. ↑ Matias Vested Madsen, Peter C. Gøtzsche, Asbjørn Hrobjartsson: Acupuncture treatment for pain: systematic review of randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. In: BMJ. 2009, No. 338, Article: a3115.
  48. ↑ A. Shang, K. Huwiler, L. Nartey, P. Jüni, M. Egger: Placebo-controlled trials of Chinese herbal medicine and Conventional medicine comparative study. In: International Journal of Epidemiology. 2007, Volume 36, No. 5.
  49. ↑ A. Shang, K. Huwiler, L. Nartey, P. Jüni, M. Egger: Placebo-controlled trials of Chinese herbal medicine and Conventional medicine comparative study. In: International journal of epidemiology. Volume 36, Number 5, October 2007, pp. 1086-1092, doi: 10.1093 / ije / dym119 . PMID 17602184 (Review).
  50. ^ Richard Dawkins: The Enemies of Reason.
  51. ↑ Yunfang Liu Zhiping Yang, Jing Cheng, Daiming Fan: Barriers and countermeasures in developing traditional Chinese medicine in Europe. (PDF) Higher Education Press and Springer-Verlag, Berlin / Heidelberg, 2016, accessed on September 21, 2016 (English).
  52. ↑ China's medicinal plants enrich Bavaria's range of cultivation. In: lfl.bayern.de . August 2005, archived from the original on October 20, 2005 ; accessed on April 16, 2020 .
  53. ↑ Long-term study on possible side effects of Chinese herbs. In: tcm-forschung.de . Retrieved May 26, 2020.
  54. ↑ R. Teschke, A. Wolff, C. Frenzel, J. Schulze: Review article: herbal hepatotoxicity - an update on traditional Chinese medicine preparations. In: Alimentary Pharmacology & Therapeutics. Volume 40, 2014, pp. 32–50, doi: 10.1111 / apt.12798 .
  55. ↑ Examination of Chinese Medicinal Herbs for Pesticide Residues .
  56. ^ Website of the CTCA .
  57. ↑ Additional training in acupuncture. ( Memento of the original from March 24, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. on the website of the German Medical Association @1@ 2Template: Webachiv / IABot / www.bundesaerztekammer.de
  58. ↑ (Sample) course book acupuncture - methodical recommendations, teaching and learning content for the basic and advanced course of the additional training "Acupuncture" according to the (sample) training regulations 2003, as of June 25, 2010, and the (sample) guidelines, As of February 18, 2011, the German Medical Association. (PDF; 61.4 KB) In: bundesaerztekammer.de. July 1, 2011, accessed November 12, 2019 .
  59. ↑ Who protects the medicinal plants? SECURVITA cooperates with the WWF. In: Communications from the Securvita. March 13, 2003.
  60. ↑ The section Dedicated to Death - The (over) use of wild species for TCM in the article Traditional Chinese Medicine. ( Memento from October 19, 2013 in the Internet Archive ) on the NABU website.
  61. ↑ David Cyranoski: Did pangolins spread the China coronavirus to people? In: nature.com . February 7, 2020, accessed on May 15, 2020
  62. ↑ Roman Goergen: Only skins for trophies and bones for the market , on: Spektrum.de from July 26, 2020
  63. ↑ History and goals of the working group "Medicine and Species Protection" - A group of experts is formed .
  64. ↑ “No endangered animals on prescription!” - PRO WILDLIFE and the International Society for Chinese Medicine cooperate in the protection of species. (No longer available online.) In: prowildlife.de. January 8, 2002, archived from the original on June 17, 2007 ; accessed on May 18, 2019 .