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Traditional Chinese Medicine: What You Need To Know

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How much do we know about traditional chinese medicine.

The approaches that make up traditional Chinese medicine (such as acupuncture, tai chi, and herbal products) have been the subjects of many clinical studies and scientific reviews.

What Do We Know About the Effectiveness of Traditional Chinese Medicine?

Some psychological and/or physical approaches used in traditional Chinese medicine practices, such as acupuncture and tai chi, may help improve quality of life and certain pain conditions. Studies of Chinese herbal products used in traditional Chinese medicine for a range of medical conditions have had mixed results.

What Do We Know About the Safety of Traditional Chinese Medicine?

Some Chinese herbal products have been contaminated with toxic compounds, heavy metals, pesticides, and microorganisms and may have serious side effects. Manufacturing errors, in which one herb is mistakenly replaced with another, also have resulted in serious complications.

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Traditional Chinese medicine (TCM) has evolved over thousands of years. TCM practitioners use various psychological and/or physical approaches (such as acupuncture and tai chi) as well as herbal products to address health problems.

What the Science Says About the Effectiveness of Traditional Chinese Medicine

Acupuncture.

Acupuncture is a technique in which practitioners stimulate specific points on the body, usually by inserting thin needles through the skin. Studies suggest that acupuncture stimulates the release of the body’s natural painkillers and affects areas in the brain involved in processing pain; however, some trials suggest that real acupuncture and sham acupuncture are equally effective, indicating a placebo effect . Results from a number of studies, however, suggest real acupuncture may help ease types of pain that are often chronic, such as low-back pain, neck pain, osteoarthritis/knee pain, and carpal tunnel syndrome. It also may help reduce the frequency of tension headaches and prevent migraine headaches. For more information, see NCCIH’s acupuncture fact sheet .

Tai chi combines certain postures, gentle movements, mental focus, breathing, and relaxation. Research findings suggest that practicing tai chi may improve balance and stability in older people and those with Parkinson’s disease, reduce pain from knee osteoarthritis, help people cope with fibromyalgia and back pain, and promote quality of life and improve mood in people with heart failure. For more information, see NCCIH’s tai chi fact sheet .

Chinese Herbal Products

Chinese herbal products have been studied for many medical problems, including stroke, heart disease, mental disorders, and respiratory diseases (such as bronchitis and the common cold). Because many studies have been of poor quality, no firm conclusions can be made about their effectiveness. For more information about specific herbs, see NCCIH’s Herbs at a Glance webpage . You can find additional information on botanical (plant) dietary supplements on the Office of Dietary Supplements website.

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Reports and studies of herbal products used in TCM have found a variety of safety issues.

• Some Chinese herbal products have been found to be contaminated with undeclared plant or animal material; drugs (such as the blood-thinner warfarin and the nonsteroidal anti-inflammatory agent diclofenac); heavy metals (such as arsenic, lead, and cadmium); pesticides or compounds called sulfites, which could cause asthma or severe allergic reactions; or incorrect herbs, some of which have caused organ damage.
• Relatively few complications from using acupuncture have been reported. Still, complications have resulted from the use of nonsterile needles and improper delivery of treatments. When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.
• Tai chi and a similar technique called qigong appear to be safe practices. While it’s unlikely that tai chi will result in serious injury, it may be associated with minor aches and pains. Women who are pregnant should talk with their health care providers before beginning tai chi, qigong, or any other exercise program.

NCCIH-Funded Research

NCCIH is supporting studies to determine if:

• TCM can treat fibromyalgia.
• Acupuncture can ease joint pain caused by medical treatments for breast cancer.
• A tai chi program can be a feasible alternative to traditional cardiac rehabilitation programs in selected people.

More To Consider

• If you’re considering TCM, be sure to discuss this with your health care providers. Don’t use TCM to replace or delay seeking conventional care.
• If you have a health condition, talk with your health care provider before using TCM herbal products.
• Ask about the training and experience of the TCM practitioner you are considering. Most states and the District of Columbia have laws regulating acupuncture practice, and most states require certification from the National Certification Commission for Acupuncture and Oriental Medicine. For more information, see NCCIH’s webpage on credentials and licensing of complementary health practitioners .
• If you are pregnant or nursing, or are thinking of using TCM to treat a child, be especially sure to consult your (or the child’s) health care provider.
• Tell all your health care providers about any complementary or integrative 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.

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• Coghlan ML, Maker G, Crighton E, et al. Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM) . Scientific Reports . 2015;5:17475.
• Fung FY, Linn YC. Developing traditional Chinese medicine in the era of evidence-based medicine: current evidences and challenges . Evidence-Based Complementary and Alternative Medicine: eCAM . 2015;2015:425037.
• Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community . Cochrane Database of Systemic Reviews . 2012;(9):CD007146 [edited 2015]. Accessed at https://www.cochranelibrary.com on February 19, 2016.
• Hall AM, Maher CG, Lam P, et al. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial . Arthritis Care & Research . 2011;63(11):1576-1583.
• Hu J, Zhang J, Zhao W, et al. Cochrane systematic reviews of Chinese herbal medicines: an overview . PLoS One . 2011;6(12):e28696.
• Jones KD, Sherman CA, Mist SD, et al. A randomized controlled trial of 8-form tai chi improves symptoms and functional mobility in fibromyalgia patients . Clinical Rheumatology . 2012;31(8):1205-1214.
• Kendrick D, Kumar A, Carpenter H, et al. Exercise for reducing fear of falling in older people living in the community . Cochrane Database of Systemic Reviews . 2014;(11):CD009848. Accessed at https://www.cochranelibrary.com on February 19, 2016.
• Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease . New England Journal of Medicine . 2012;366(6):511-519.
• Liu S-H, Chuang W-C, Lam W, et al. Safety surveillance of traditional Chinese medicine: current and future . Drug Safety . 2015;38(2):117-128.
• Linde K, Allais G, Brinkhaus B, et al. Acupuncture for migraine prophylaxis . Cochrane Database of Systematic Reviews . 2009;(1):CD001218. Accessed at https://www.cochranelibrary.com on March 18, 2016.
• Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache . Cochrane Database of Systematic Reviews . 2009;(1):CD007587. Accessed at https://www.cochranelibrary.com on March 18, 2016.
• Maeda Y, Kim H, Kettner N, et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture . Brain . 2017;140(4):914-927.
• Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis . Cochrane Database of Systematic Reviews. 2010;(1):CD001977. Accessed at https://www.cochranelibrary.com on February 24, 2016.
• Nery RM, Zanini M, de Lima JB, et al. Tai chi chuan improves functional capacity after myocardial infarction: a randomized clinical trial . American Heart Journal . 2015;169(6):854-860.
• Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis . Archives of Internal Medicine . 2012;172(19):1444-1453.
• Vickers AJ, Linde K. Acupuncture for chronic pain . JAMA . 2014;311(9):955-956.
• Wang C, Schmid CH, Hibberd PL, et al. Tai chi is effective in treating knee osteoarthritis: a randomized controlled trial . Arthritis & Rheumatism (Arthritis Care & Research) . 2009;61(11):1545-1553.
• Wayne PM, Berkowitz DL, Litrownik DE, et al. What do we really know about the safety of tai chi? A systematic review of adverse event reports in randomized trials . Archives of Physical Medicine and Rehabilitation . 2014;95(12):2470-2483.
• Xue CC, Zhang AL, Greenwood KM, et al. Traditional Chinese medicine: an update on clinical evidence . Journal of Alternative and Complementary Medicine . 2010;16(3):301-312.
• Yan J-H, Gu W-J, Sun J, et al. Efficacy of tai chi on pain, stiffness and function in patients with osteoarthritis: a meta-analysis . PLoS One . 2013;8(4):e61672.
• Yeh GY, McCarthy EP, Wayne PM, et al. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial . Archives of Internal Medicine . 2011;171(8):750-757.

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• Birdee GS, Wayne PM, Davis RB, et al. T’ai chi and qigong for health: patterns of use in the United States. J ournal of Alternative and Complementary Medicine . 2009;15(9):969-973.
• Ernst E. Acupuncture—a critical analysis. Journal of Internal Medicine . 2006;259(2):125-137.
• Furlan AD, Yazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment No. 194. Rockville, MD: Agency for Healthcare Research and Quality. 2010. AHRQ publication no. 10(11)-E007.
• Jahnke R, Larkey L, Rogers C, et al. A comprehensive review of health benefits of qigong and tai chi. American Journal of Health Promotion. 2010;24(6):e1-e25.
• Manheimer E, Wieland S, Kimbrough E, et al. Evidence from the Cochrane Collaboration for traditional Chinese medicine therapies. Journal of Alternative and Complementary Medicine. 2009;15(9):1001-1014.
• Rogers C, Larkey LK, Keller C. A review of clinical trials of tai chi and qigong in older adults. Western Journal of Nursing Research . 2009;31(2):245-279.
• Witt CM, Jena S, Brinkhaus B, et al. Acupuncture for patients with chronic neck pain. Pain. 2006;125(1-2):98-106.
• Zhang G, Xiong N, Zhang Z, et al. Effectiveness of traditional Chinese medicine as an adjunct therapy for Parkinson’s disease: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0118498.

Acknowledgments

NCCIH thanks D. Craig Hopp, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their contributions to the 2019 update of this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

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Acupuncture: What You Need To Know

Tai Chi: What You Need To Know

Qigong: What You Need To Know

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traditional Chinese medicine

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• Verywell Health - A Beginner’s Guide to Traditional Chinese Medicine
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traditional Chinese medicine (TCM) , system of medicine at least 23 centuries old that aims to prevent or heal disease by maintaining or restoring yinyang balance. China has one of the world’s oldest medical systems. Acupuncture and Chinese herbal remedies date back at least 2,200 years, although the earliest known written record of Chinese medicine is the Huangdi neijing ( The Yellow Emperor’s Inner Classic ) from the 3rd century bce . That opus provided the theoretical concepts for TCM that remain the basis of its practice today. In essence, traditional Chinese healers seek to restore a dynamic balance between two complementary forces, yin (passive) and yang (active), which pervade the human body as they do the universe as a whole. According to TCM, a person is healthy when harmony exists between these two forces; illness, on the other hand, results from a breakdown in the equilibrium of yin and yang.

A visit to a traditional Chinese pharmacy is like a visit to a small natural history museum. The hundreds of cabinet drawers, glass cases, and jars in a typical pharmacy hold an enormous variety of desiccated plant and animal material. In 1578 Li Shizhen published his famous Bencao gangmu ( Compendium of Materia Medica ), which lists 1,892 drugs and some 11,000 formal prescriptions for specific ailments.

The practice of traditional medicine

To restore harmony, the Chinese healer may use any of a staggeringly large array of traditional remedies. The patient may be treated with acupuncture or acupressure , moxibustion (moxa treatment), or cupping (in which hot glass cups are placed on the patient to draw blood to the skin ). The Chinese healer may prescribe a brew prepared with one (or some combination) of thousands of medicinal plants or dried animal parts (e.g., snakes, scorpions, insects, deer antlers) in the Chinese pharmaceutical armamentarium.

An essential aspect of TCM is an understanding of the body’s qi (life force; literally, “vital breath”), which flows through invisible meridians (channels) of the body. This energy network connects organs , tissues , veins , nerves , cells , atoms , and consciousness itself. Generally speaking, there are 12 major meridians, each of which connects to one of the 12 major organs in TCM theory. Meridians are also related to a variety of phenomena, including circadian rhythms , seasons, and planetary movements, to create additional invisible networks.

In acupuncture thin needles are inserted into specific points along the meridians. The needles stimulate the meridians and readjust the flow of qi to balance the body’s yin and yang. In place of needles, massage (acupressure) can also be used to stimulate the acupuncture points. Acupuncture is sometimes accompanied by moxibustion, the burning of small cones of an herb (typically Artemisia moxa ) at acupuncture points. Not only can the meridian network be used to alleviate symptoms; it can also endow TCM with the ability to change consciousness in those who receive treatment .

A TCM practitioner uses smell, hearing, voice vibration, touch, and pulse diagnosis to discover the source of an unbalanced health condition, which organ it is related to, and which meridians are affected. In addition, the practitioner typically makes use of what is known as the five agents, or five phases ( wuxing ). By observing natural law in action, ancient healers recognized five basic elements in the world—wood ( mu ), fire ( huo ), earth ( tu ), metal ( jin ), and water ( shui )—and found that these elements have myriad correspondences, both visible and invisible. This framework helps skilled TCM practitioners to identify unbalanced relationships. For instance, one key correspondence relates to time of day. If an individual always gets a headache at 4 pm , this signals that Bladder qi is unbalanced, since the Bladder (of the TCM Kidney/Bladder organ pair) is in charge of maintaining the body’s functions at that time. Using the five-element theory, the practitioner can create a healing plan that might contain such components as acupuncture, herbs, lifestyle changes, and foods for healing. It might also include Chinese psychology, which shows how the energy of unbalanced emotions can affect proper organ function.

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The American Journal of Chinese Medicine

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AJCM is a Quartile 1 journal in JCR ranking (Integrative & Complementary Medicine/ General & Internal Medicine)

AJCM Best Papers Award:

Traditional Chinese Herbal Medicine for Allergic Diseases: A Review Chenyang Ai, Yi Zou, Hao Liu, Zheqiong Yang, Jinlei Xi Am J Chin Med, 2023;51(4):779-806

Berberine Attenuates Hyperuricemia by Regulating Urate Transporters and Gut Microbiota Baixi Shan, Mingyu Wu, Ting Chen, Weiwei Tang, Ping Li, Jun Chen Am J Chin Med, 2022;50(8):2199

Editor’s Pick for AJCM

Traditional Uses, Phytochemistry, Pharmacology, Quality Control, Industrial Application, Pharmacokinetics and Network Pharmacology of Pogostemon cablin: A Comprehensive Review. 50(3): 691-721, 2022. Xu, FF; Cai, WN; (...); Liu, B.

Polyphenols from Chinese Herbal Medicine: Molecular Mechanisms and Therapeutic Targets in Pulmonary Fibrosis. 50(4): 1063-1094, 2022. Wang, L; Zhu, T; (...); Zhang, CF.

Neuroprotective Effects of Alpinia oxyphylla Miq against Mitochondria-Related Apoptosis by the Interactions between Upregulated p38 MAPK Signaling and Downregulated JNK Signaling in the Subacute Phase of Cerebral Ischemia-Reperfusion in Rats. 50(8), 2022. Tsai, YT; Huang, HC; (...); Cheng, CY

Protective Effects and Therapeutics of Ginsenosides for Improving Endothelial Dysfunction: From Therapeutic Potentials, Pharmaceutical Developments to Clinical Trials. 50(3): 749-772, 2022. Yang, F; Yang, MY; (...); Shao, JW.

Ginsenoside Rh2 Regulates the CFAP20DC-AS1/MicroRNA-3614-3p/BBX and TNFAIP3 Axis to Induce Apoptosis in Breast Cancer Cells. 50(6): 1703-1717, 2022. Park, JE; Ji, HW; (...); Kim, SJ

Fisetin Ameliorates Alcohol-Induced Liver Injury through Regulating SIRT1 and SphK1 Pathway. 50(8): 2022. Zhou, ZS; Kong, CF; (...); Sun, AT.

Featured Articles 2022

Acupuncture Medical Therapy and its Underlying Mechanisms: A Systematic Review. Wen et al., 2021 Jingyi Wen, Xi Chen, Yong Yang, Jianxin Liu, Enyin Li, Jiayou Liu, Ziwei Zhou, Weihua Wu and Kai He

The Impact of Artificial Intelligence on Traditional Chinese Medicine. Wang et al. 2021 Yulin Wang, Xiuming Shi, Li Li, Thomas Efferth and Dong Shang

Intestinal Flora: A Pivotal Role in Investigation of Traditional Chinese Medicine. Li et al., 2021 Xiao Li, Dan Wu, Jingjie Niu, Yanping Sun, Qiuhong Wang, Bingyou Yang and Haixue Kuang

Epigallocatechin Gallate Reduces Homocysteine-Caused Oxidative Damages through Modulation SIRT1/AMPK Pathway in Endothelial Cells. Pai et al., 2021 Pei-Ying Pai, Wan-Ching Chou, Shih-Hung Chan, Shu-Yih Wu, Hsiu-I Chen, Chi-Wen Li, Pei-Ling Hsieh, Pei-Ming Chu, Yu-An Chen, Hsiu-Chung Ou and Kun-Ling Tsai

Panax notoginseng Saponins Modulate the Inflammatory Response and Improve IBD-Like Symptoms via TLR/NF-B and MAPK Signaling Pathways. Luo et al., 2021 Hua Luo, Chi Teng Vong, Dechao Tan, Jinming Zhang, Hua Yu, Lin Yang, Chen Zhang, Chun Luo, Zhangfeng Zhong and Yitao Wang

Efficacy and Safety of Chinese Medicine for COVID-19: A Systematic Review and Meta-Analysis. Wu et al., 2022 Hanting Wu, Rongchen Dai, Xiaqiu Wu, Qiushuang Li, Hanti Lu, Junchao Yang, Wei Mao, Peijie Hei, Juan Liang and Conghua Ji

Herbal Medicines for Constipation and Phytochemical Comparison of Active Components. Ma et al., 2022 Qinge Ma, Chong-Zhi Wang, Wamtinga R. Sawadogo, Zhao-Xiang Bian and Chun-Su Yuan

A Clinical Study on the Relationship Among Insomnia, Tongue Diagnosis, and Oral Microbiome. Park et al, 2022 Seo-Hyun Park, Na Rae Shin, Meng Yang, Shambhunath Bose, Ojin Kwon, Dong-Hyun Nam, Jun-Hwan Lee, Eun-Ji Song, Young-Do Nam and Hojun Kim

Efficacy and Safety of Chinese Herbal Medicine for Endometriosis Associated Pain. Lin et al., 2022 Yuezhen Lin, Ruijie Hou, Tao Zhang, Jacqueline Pui Wah Chung, Chi Chiu Wang and Ruihua Zhao

Sinomenium acutum: A Comprehensive Review of its Botany, Phytochemistry, Pharmacology and Clinical Application. Ding et al., 2022 Chao Ding, Yuze Li, Yu Sun, Ying Wu, Fengrui Wang, Chenwang Liu, Huawei Zhang, Yi Jiang, Dongdong Zhang and Xiaomei Song

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Review of transcutaneous electrical acupoint stimulation and related devices

Science of Traditional Chinese Medicine. 2(2):71-81, June 2024.

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Research progress of Chinese herbal medicines and classic prescriptions in the treatment of COPD based on the TCM theory and medicinal characteristics

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Anti-acute gastric ulcer resistance of Aurantii Fructus Immaturus juice processing Atractylodis Macrocephalae Rhizoma by regulating PTGS2, MAPK1, and KDR targets based on metabolomics and integrated network pharmacology analysis

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Spectrum-effect relationship between components and antitumor activity of Lonicerae Japonicae Flos based on orthogonal partial least squares regression

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Alterations of tau and Camk2 in acute stroke and effects of a multicomponent drug

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Comprehensive analysis of Perilla frutescens (L.) Britt. along the value chain in northeast Inner Mongolia

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Chinese Medicine

What is chinese medicine.

Traditional Chinese medicine (TCM) is thousands of years old and has changed little over the centuries. Its basic concept is that a vital force of life, called Qi, surges through the body.  Any imbalance to Qi can cause disease and illness. This imbalance is most commonly thought to be caused by an alteration in the opposite and complementary forces that make up the Qi. These are called yin and yang.

Ancient Chinese believed that humans are microcosms of the larger surrounding universe, and are interconnected with nature and subject to its forces. Balance between health and disease is a key concept. TCM treatment seeks to restore this balance through treatment specific to the individual. 

It is believed that to regain balance, you must achieve the balance between the internal body organs and the external elements of earth, fire, water, wood, and metal.

Treatment to regain balance may involve:

Acupuncture

Moxibustion (the burning of herbal leaves on or near the body)

Cupping (the use of warmed glass jars to create suction on certain points of the body)

Herbal remedies

Movement and concentration exercises (such as tai chi)

Acupuncture is a component of TCM commonly found in Western medicine and has received the most study of all the alternative therapies. Some herbal treatments used in TCM can act as medicines and be very effective but may also have serious side effects. In 2004, for example, the FDA banned the sale of dietary supplements containing ephedra and plants containing ephedra group alkaloids due to complications, such as heart attack and stroke. Ephedra is a Chinese herb used in dietary supplements for weight loss and performance enhancement. However, the ban does not apply to certain herbal products prepared under TCM guidelines intended only for short-term use rather than long-term dosing. It also does not apply to OTC and prescription drugs or to herbal teas.

If you are thinking of using TCM, a certified practitioner is your safest choice. The federally recognized Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits schools that teach acupuncture and TCM. Many of the states that license acupuncture require graduation from an ACAOM-accredited school. The National Certification Commission for Acupuncture and Oriental Medicine offers separate certification programs in acupuncture, Chinese herbology, and Oriental bodywork.

TCM should not be used as a replacement for conventional or allopathic treatment, especially for serious conditions, but it may be beneficial when used as complementary therapy. Since some TCM herbal medicines can interfere or be toxic when combined with Western medicines, you should inform your doctor if you are using TCM. 

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Does traditional Chinese medicine work? Network science can help evaluate effectiveness, Northeastern researchers say

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Does traditional Chinese medicine work? Network science can help evaluate effectiveness, Northeastern researchers say 

How new science can unlock the secrets of thousand-year-old natural therapies

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In a striking example of old meets new, Northeastern University researchers say network science promises to be a powerful tool in evaluating the effectiveness of traditional Chinese medicine herbal remedies used for more than 2,000 years. 

Traditional Chinese medicine, or TCM, has proved a challenge for researchers seeking to pinpoint the specific mechanisms by which it operates.

But now a paper in Science Advances says researchers established a network science framework that reveals the general principle for TCM treatment and a relationship between disease symptoms and herb targets.

The method establishes a scientific foundation for a therapy sometimes considered a myth, according to the report whose co-authors include Albert-Laszlo Barabasi , the Robert Gray Dodge professor of network science and a distinguished university professor of physics at Northeastern, and his former postdoctoral assistant Xiao Gan.

They say it could lead to world-changing drug discoveries based on a new understanding of natural and traditional medicine.

“There are hundreds, often over a thousand years’ experience in natural medicine,” Barabasi says. “Some of the collected wisdom has been confirmed by modern medicine, but most has not been tested or confirmed.”

“Traditional therapies such as TCM typically involve a complex system that conventional bio-medical scientific studies don’t know how to tackle,” says Gan, the paper’s lead author.

“For example in conventional medicine, one may be able to experimentally measure the treatment effect of a single chemical against a specified disease process,” he says.

“But this conventional paradigm is less effective in studying TCM, as no one knows which chemical in so many herbs may be relevant to an herb’s therapeutic effect. This makes pinpointing the effective target difficult.” 

“This is where network science may help,” Gan says.

With complexity in mind, the researchers came up with a different strategy: to collect  herb-chemical-target data systematically and search for generic patterns.

“The idea is that if there is a generic principle of how herbs are effective, this principle may be uncovered as statistically significant trends in a large dataset,” Gan says.

In the future, revealing the pattern may help researchers better focus on key therapeutic properties, he says.

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In particular, researchers developed a network medicine framework based on the human protein interactome, Gan says.

The idea is that drugs and diseases affect health by perturbing proteins, and protein interaction may mediate how drugs and disease affect each other in terms of treatment efficacy, he says. 

“Studying the network topology of the human protein interactome might show patterns of how drugs treat diseases,” Gan says, noting that the network medicine framework is generic and not restricted to TCM.

“The therapeutic potential of each herb comes from the molecules it carries,” Barabasi says.

“A typical plant has about 5,000 to 10,000 distinct chemical compounds,” he says. 

“A few of these are known as nutritional components that provide energy and vitamins,” the vast majority of which are small molecules that can bind to human proteins and modulate their activity, Barabasi says. 

He says information about target molecules to which individual food compounds bind is known through experiments or can be predicted using computational tools like the AI-Bind tool developed in his lab.

“What we observed in the clinical dataset is that the effective herb-symptom pairs indeed have significantly more proximal network metrics,” which supports the theoretical model, Gan says.

The researchers used clinical data from 1,936 patients at the Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan, China. The clinical dataset included 218 herbs, Gan says.

“We’re hoping to validate the results with more experimental and clinical data,” Gan says. “We’re also exploring if our theoretical framework could help identify key chemicals or key mechanisms of action in herbal treatments.”

Researchers say in their report that “understanding the therapeutic effects of traditional and natural medicine can lead to drug discoveries that reshape world welfare.”

As an example, they cited aspirin, whose active ingredient, acetylsalicylic acid, is extracted from willow bark and has been used therapeutically for thousands of years.

Gan says what he and his fellow researchers found suggests “the possibility of a generic network pattern in disease-treating substances, be they drugs, herbs or natural chemicals.”

“Patients need all the help they can get — whether it comes in the form of drugs or through natural treatments like diet and herbs, when available,” Barabasi says.

“Network science offers the tools to unveil the potential molecular mechanism behind some herbs,” Barabasi says, adding that if it can lead to effective cures, “we must take advantage of it.”

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Early History

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Where to Find a TCM Practitioner

Consult your healthcare provider, frequently asked questions.

Traditional Chinese Medicine (TCM) is a holistic approach to treating a person’s mental and physical health problems. It developed thousands of years ago, and its core practices have changed little since then.

Traditional Chinese medicine is based on the theory that sickness stems from an imbalance in a person’s life force energy (known as qi ). The goal of TCM is to restore harmony within an individual and balance the forces of yin and yang, which are components of qi.

YinYang / Getty Images

Eastern Medicine vs. Western Medicine 

The differences between Eastern and Western medicine are defined by:

• How diagnosis works : Eastern medicine looks at the physical and energetic health of the whole person and their environment, not just isolated symptoms from structural or organ-related issues.
• How treatment is applied : TCM treatment is applied to balance qi, whereas Western medicine focuses on reducing or curing specific symptoms of diseases.
• Methods of discovery : Eastern medicine uses a range of methods, including observation, trial-and-error, and clinical research. Western medicine is focused on the scientific method for testing specific ideas to see if they work.

The earliest writings attributed to traditional Chinese medicine are attributed to the Shang dynasty and date back 3,000 years. Etched into tortoiseshell and bone, the writings describe the concept of qi, defined as circular movement in the body. It also describes xue , or blood. These texts describe how excess, deficiency, or stagnation in the movement of qi and/or xue can lead to imbalance and poor health.

Chi is the English word for qi. It represents the concept of the “vital life force” existing both inside and outside of the body. Qi is described as a force that composes and binds all things in the universe together.

Chi is made of two branches that can impact health. One branch is all about what we take into our body (breath) and the other is about what flows through our body (blood). TCM practitioners also think of blood as an energetic concept.

These two branches can be considered complementary opposites or yin and yang. According to traditional Chinese medicine, an imbalance between our internal state and the external world creates illness.

Balancing Yin and Yang

Balancing yin and yang is the goal of any TCM treatment. TCM works from the understanding that balance is achieved by creating harmony between internal organs and external elements of earth, fire, water, wood, and metal.

List of Healing Techniques

The following techniques are all meant to help a person regain balance and promote harmony between yin and yang:

Acupuncture

Acupuncture is when a practitioner stimulates specific points on the body by inserting thin needles through the skin. It is one of the most well-evidenced methods used in traditional Chinese medicine, although study results do vary.

Clinical research reviews suggest acupuncture helps the body release natural painkillers and may be effective in helping reduce symptoms in patients with chronic (ongoing) pain.

Tai chi is a type of gentle and slow exercise that includes body movement and focused breath work. It has been described as “meditation in motion” and “medication in motion.”

While it was originally a form of martial arts, it has been adapted into the TCM umbrella of techniques as means of encouraging proper flow of qi and promoting balance between yin and yang.

In cupping, also called cupping therapy , a practitioner uses warm glass jars that create suction on the skin on certain body areas (usually the back, stomach, arms, and legs).

Cupping pulls your skin into the jar, breaks open tiny blood vessels beneath the skin, and works by creating this setting for blood to flow to the area and stimulate the injury-healing process. More research is needed to confirm exactly how it works and how effective it is in helping with chronic pain, high blood pressure, and other ailments.

Herbs are used in traditional Chinese medicine to treat the whole person and their symptoms. Herbs are prepared in capsule form, teas or extracts, and powders, in traditional or custom formulas. Herbal remedies are unlike pharmaceuticals used in Western medicine, which target specific disease symptoms. Many herbs may help with hard-to-diagnose or -treat syndromes, including allergies, infertility, and menopause.

Before starting any herbal supplement, check with your healthcare provider to make sure it's right for you and it doesn't interfere with any medications you may already be taking.

Ensuring Safety

Traditional Chinese medicine may have a longstanding history, but that doesn’t mean all methods are safe and without risk or that all people offering traditional Chinese medicine are qualified to do so.

For example, while herbs may be used effectively to treat certain ailments, these remedies may also cause serious side effects and contraindications with medications and other health conditions. Knowing what you’re taking when it comes to herbs is difficult due to a lack of standardized regulations and labeling practices.

Ensuring safety comes down to working directly with a qualified TCM practitioner.

To find a TCM practitioner, consider going to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) website directory. Choosing someone from this directory ensures you will be working with someone who holds a recognized certification.

During Your First Visit

During your first visit, the practitioner will gather information. They will ask direct questions and check on "nonverbal elements" including your demeanor, voice, bodily sounds, complexion, and how your body moves.

They will also examine your tongue, take your pulse and temperature, and check areas for muscle tone and pain or discomfort near or around internal organs, as appropriate.

For safety purposes, you'll want to ensure your healthcare provider is up-to-date on which traditional Chinese medicine techniques you're considering using and which ones you've decided to try. This is particularly true in cases of chronic illness, pregnancy, and where prescription medications are involved.

Traditional Chinese medicine techniques such as acupuncture, Tai Chi, cupping, and herbs have been used for thousands of years. Their goal is to help a person balance their vital life force known as qi. Qi is made up of yin and yang elements. While some methods may be helpful, TCM is not risk-free and should be applied only with the support of a qualified practitioner.

A Word From Verywell

Traditional Chinese medicine should not be used in replacement of Western medicine or to delay the possibility of treatment for serious disorders, infections, or the like. If you're curious about what traditional Chinese medicine may offer, consider talking to your healthcare provider and a traditional Chinese medicine practitioner before trying any options at home.

Traditional Chinese Medicine is thousands of years old. Early writings date back 3,000 years to the Shang dynasty. It has changed little since.

Before buying Chinese herbs online, speak with a qualified Chinese herbalist who can help guide your exact needs. Seek herbs that are third-party tested for quality and accuracy, rather than buying bulk herbs online.

In TCM, it's believed that a person's internal health is impacted by the external elements of earth, fire, water, wood, and metal. Balancing these elements with your internal life force is the goal of TCM treatment.

You can ask a local practitioner or healthcare provider (medical or naturopathic doctor) about the best place to find Chinese herbal medicines. You can also search online for "local Chinese herb stores" or your closest herbal remedy and herbal supplement store.

Johns Hopkins Medicine. Chinese medicine .

Johns Hopkins Medicine. When East meets West .

Acupuncture and Massage College. What is qi? Definition of qi in traditional Chinese medicine .

American College of Traditional Chinese Medicine. What is Chinese medicine?

National Center for Complementary and Integrative Health. Acupuncture: What you need to know .

Harvard Health Publishing. The health benefits of tai chi .

Vaccaro M, Coppola M, Ceccarelli M, Montopoli M, Guarneri C.  The good and the bad of cupping therapy: Case report and review of the literature .  European Review for Medical and Pharmacological Sciences . 2021;25(5):2327-2330. doi:10.26355/eurrev_202103_25266

Cleveland Clinic. What you should know about Chinese herbs .

University of Minnesota. What happens when you visit a TCM practitioner ?

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10 Traditional Chinese Medicine Methods to Boost Your Mental Health

You're probably already practicing some of them in your daily wellness routine

Alicia Bigelow, ND is a functional and integrative medicine physician with over 20 years of experience in patient care. Formerly, she served as a clinical and academic faculty member at NUNM. Currently, she offers consultations through the non-profit organization, Right to Heal. She also provides IV ketamine treatment to patients with depression, anxiety, and PTSD at Cascade Psychedelic Medicine in Portland, OR.

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• What Is Traditional Chinese Medicine (TCM)?
• Traditional Chinese Medicine Approaches to Mental Health
• Integrating Chinese Medicine with Western Approaches to Mental Health

Taking care of your mental health is equally important as caring for your physical health. From the East to the West, there are many different forms of medication but none is more ancient than Traditional Chinese Medicine (TCM). Its techniques have existed since the age of time and are known to optimize your mental well-being. But what exactly is traditional Chinese medicine and should you practice it?

At a Glance

Like Western medicine, TCM offers different methods to treat mood issues and improve mental well-being. You probably have heard of popular TCM methods like meditation or feng shui and may have incorporated them into your daily wellness routine. But there are other methods, from herbal medicine to acupuncture, that can treat anxiety and stress-related disorders.

What Is Traditional Chinese Medicine (TCM)?

Traditional Chinese Medicine (TCM) is a holistic system of healthcare that has been practiced for thousands of years in China and other parts of Asia. It views the body and mind as interconnected and influenced by the flow of vital energy (Qi) along pathways known as 'meridians'. TCM uses a combination of methods to identify and treat deficiencies and imbalances in the body.

Dr. Tedi Fisher, RAc , a kinesiologist and owner of The Nest Clinic , a wellness clinic that practices TCM, says that Western medicine believes in regulating hormones and neurotransmitters such as dopamine, serotonin, and cortisol to help balance the nervous system and bring a person out of " fight or flight " and into "rest and digest."

A TCM perspective, in comparison, looks at each organ system—the Qi and blood and the yin and the yang—to help bring the body back into balance, so a person can feel their optimal self. 

For example, anger often comes up when there is a TCM diagnosis of liver Qi stagnation or liver yang hyperactivity. Acupuncture and herbal medicine can move the liver Qi, clear the hyperactive yang Qi, and calm the anger. 

Dr. Danielle Baert, BSc, RAc , adds that in TCM, the patient’s health history and symptoms need to be known before the practitioner can determine the TCM diagnosis. A person’s TCM treatment is unique and customized to their needs.

Traditional Chinese Medicine Approaches to Mental Health

TCM does more than “boost mental health," explains Dr. Baert. It helps treat specific mood issues including frustration, being quick to anger, moodiness, grief, depression, fearfulness, and anxiety. 

She adds that TCM can treat mood issues, no matter how they came to be. For example, say you're experiencing moodiness from pre-menstrual syndrome or depression from the death of a friend. TCM can treat these symptoms equally, despite their different causes.

Herbal Medicine

TCM utilizes a wide range of herbal formulas tailored to individual needs that can help improve mood, reduce stress, and enhance overall mental well-being.

Michelle Oravitz, AP, LAc , the owner and founder of the Wholesome Lotus, a fertility acupuncture wellness clinic, says the herbal formula prescribed to an individual is based on patterns. Different patterns dictate which herbal medicine can improve their mental and emotional well-being. For example, most liver and heart patterns are connected to one's emotions. To improve issues like depression or moodiness, one would take herbal medicine designed to improve liver and heart function.

“We often use herbal formulas to support the heart Qi and heart blood, which impact the mind, according to TCM," explains Oravitz. "This can not only impact the way a person feels by lowering anxiety, but it can also impact a person’s sleep because it can calm the mind."

Tatiana Rivera Cruz, MSW, LCSW, says some common herbs used in TCM include Red Ginseng root, Codonopsis root, Astragalus root, and more. These herbs help restore energy balance and help with opposing forces of energy.

Acupuncture 

Acupuncture involves the insertion of thin needles into specific points on the body to stimulate energy flow (Qi) and promote balance within the body.

Oravitz explains that acupuncture can support overall well-being through the release of stagnation. Acupuncture can help regulate the nervous system by stimulating deep relaxation during treatments. Some auricular points—the external anatomy of an ear—can stimulate the vagus nerve, which calms the body and supports the digestive system.

“Acupuncture by itself is often powerful enough to greatly influence mood, but some patients may need Chinese herbal medicine as well depending upon their TCM diagnosis,” says Dr. Baert.

Acupressure

Acupressure involves applying pressure to specific points on the body. These points correspond to the same meridians, the channels through which our Qi flows, used in acupuncture. By stimulating these points, acupressure aims to promote balance and improve the flow of energy within the body.

During an acupressure session, pressure is typically applied using fingers, thumbs, palms, or specialized tools. The pressure may be gentle or firm, depending on the individual’s tolerance and the specific condition being treated.

Moxibustion

Moxibustion involves burning dried mugwort leaves over specific acupuncture points to stimulate circulation and promote healing, says Dr. Baert. It can help alleviate symptoms of stress, anxiety, and depression by promoting relaxation and reducing tension. Some practitioners perform moxibustion in the clinic, while others teach patients how to do it at home.

Qi Gong consists of gentle movements, breathing exercises, and meditation techniques aimed at cultivating and balancing Qi in the body. Regular practice of Qi Gong can help calm the mind, reduce stress, and promote emotional stability.

Similar to Qi Gong, Tai Chi is a mind-body practice that combines slow, flowing movements with deep breathing and mental focus. Practicing Tai Chi can help promote relaxation, reduce anxiety, improve mood, and enhance cognitive function.

Dietary Therapy

According to TCM principles, certain foods can have a significant impact on mental health . Eating a balanced diet that includes nourishing foods like fruits, vegetables, whole grains, and lean proteins can support emotional well-being.

Tuina Massage 

Tuina is a form of Chinese therapeutic massage that focuses on stimulating acupressure points and manipulating the body’s energy channels. Tuina massage can help release tension, reduce anxiety and depression, and improve insomnia and sleep quality.

Feng Shui is the practice of arranging your environment to promote harmony and balance. Creating a supportive and harmonious living or working space can positively influence mental health and emotional well-being, according to TCM principles.

Mindfulness and Meditation

TCM emphasizes the importance of mindfulness and meditation practices to create inner peace and mental clarity. Engaging in mindfulness meditation regularly can help reduce stress, enhance self-awareness, and improve emotional resilience.

Integrating Chinese Medicine with Western Approaches to Mental Health

Dr. Baert says that many TCM patients use Chinese medicine in combination with Western medication to manage their mood issues. She adds that some patients stay on their medication while getting TCM treatment and then gradually taper off (under the guidance of their physician) once their mood is more stable. Other patients prefer to stay on Western medication but use TCM to treat any side effects or help them reduce the dosage so that the side effects are less bothersome. Either approach is fine.

Oravtiz recommends using Western and Chinese medicines in tandem, as she believes "all medicines have their strengths" and that both approaches can "help improve certain conditions."

If you’re looking to explore TCM therapies, Dr. Fisher suggests finding a practitioner you connect with. Practitioners have different ways of looking at health, philosophy, medicine, and the world. Be sure to go with one that is professionally licensed and registered in the specific modality they are providing.

Marshall AC. Traditional chinese medicine and clinical pharmacology .  Drug Discovery and Evaluation: Methods in Clinical Pharmacology .

Liu, X., Li, R., Cui, J., Liu, F., Smith, L., Chen, X., & Zhang, D. (2021). The effects of tai chi and qigong exercise on psychological status in adolescents: A systematic review and meta-analysis.  Frontiers in Psychology ,  12 , 746975. https://doi.org/10.3389/fpsyg.2021.746975

Zhao X, Tan X, Shi H, Xia D. Nutrition and traditional Chinese medicine (Tcm): a system’s theoretical perspective .  Eur J Clin Nutr . 2021;75(2):267-273.

Wang, Z., Xu, H., Zhou, H., Lei, Y., Yang, L., Guo, J., Wang, Y., & Zhou, Y. (2023). A systematic review with meta-analysis: Traditional Chinese tuina therapy for insomnia.  Frontiers in Neuroscience ,  16 , 1096003. https://doi.org/10.3389/fnins.2022.1096003

By Katharine Chan, MSc, BSc, PMP Katharine is the author of three books (How To Deal With Asian Parents, A Brutally Honest Dating Guide and A Straight Up Guide to a Happy and Healthy Marriage) and the creator of 60 Feelings To Feel: A Journal To Identify Your Emotions. She has over 15 years of experience working in British Columbia's healthcare system.

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Chinese herbal medicine for female infertility: an updated meta-analysis

Affiliation.

• 1 National Institute of Integrative Medicine, Hawthorn, Melbourne, VIC, Australia. Electronic address: [email protected].
• PMID: 25637159
• DOI: 10.1016/j.ctim.2014.12.004

Objectives: To assess the effect of Traditional Chinese herbal medicine (CHM) in the management of female infertility and on pregnancy rates compared with Western medical (WM) treatment and update previous meta-analyses.

Methods: We searched the Medline and Cochrane databases until December 2013 for randomized controlled trials and meta-analyses investigating Chinese herbal medicine therapy for female infertility and compared clinical pregnancy rates achieved with CHM versus WM drug treatment.

Results: Forty RCTs involving 4247 women with infertility were included in our systematic review. Meta-analysis suggested a 1.74 higher probability of achieving a pregnancy with CHM therapy than with WM therapy alone (risk ratio 1.74, 95%CI: 1.56-1.94; p<0.0001; odds ratio 3.14; 95%CI: 2.72-3.62; p<0.0001) in women with infertility. Trials included women with PCOS, endometriosis, anovulation, fallopian tube blockage, or unexplained infertility. Mean pregnancy rates in the CHM group were 60% compared with 33% in the WM group.

Conclusions: Our review suggests that management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy.

Keywords: Infertility; Meta-analysis; Pregnancy rate; Traditional Chinese herbal medicine.

Copyright © 2015 Elsevier Ltd. All rights reserved.

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Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

Foon yin fung.

1 Traditional Medicine Information Service, Department of Pharmacy, Singapore General Hospital, Singapore

Yeh Ching Linn

2 Department of Haematology, Singapore General Hospital, Academia, 20 College Road, Singapore 169856

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM.

1. Introduction

Evidence-based medicine (EBM) is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research [ 1 ]. In just over two decades since its first introduction, the EBM movement has created a paradigm shift to become the standard of modern medical practice, elevating it to a higher level and with greater accuracy, efficacy, and safety.

Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago. In contrast to the disease-targeted approach adopted by Western medicine where there is a standard treatment protocol defined for each disease entity, TCM takes a holistic approach in treating the individual with customized treatment based on the concept of “Syndrome Differentiation.” The basic theories of TCM were derived from the Chinese philosophy of Yin-Yang and Five Elements, and its fundamental concepts such as the Zang-fu (viscera) concept, Qi (vital energy), and meridians have yet to be mapped by scientific equivalents or clearly elucidated in scientific terms.

While TCM is widely practiced in Asian populations such as China, Hong Kong, Taiwan, and Singapore, many non-Asian countries have, in recent decades, also recognized the huge therapeutic potential of this traditional practice and have been actively tapping into the benefits of TCM so as to provide patients with an additional option in their health management. In 1991, a TCM hospital was opened in KoÈtzting, Germany, whereby trained TCM physicians from China administered treatment according to the traditional practice [ 2 ]. In the United States, UCLA Center for East-West Medicine was founded in 1993 to provide integrative medicine treatment [ 3 ]. In 1998, the National Institutes of Health within the US Department of Health and Human Services set up the National Center for Complementary and Alternative Medicine with the mission to “define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions (including TCM) and their roles in improving health and health care” [ 4 ]. In 2007, the National Institute of Complementary Medicine at the University of Western Sydney was established by the Australian and New South Wales Governments with a research focus on Chinese medicine via laboratory analysis, clinical trials, and translation into practice [ 5 ]. In 2014, Cleveland Clinic opened a hospital-based Chinese herbal therapy clinic in their Center for Integrative Medicine to provide supplementary options for patients seeking a holistic, natural approach to their care [ 6 ]. According to interim data from 2nd WHO TRM global survey as of 11 June 2012, 80% of the 129 member states now accept the use of acupuncture as a treatment modality [ 7 ].

Despite the growing prevalence of TCM usage and the worldwide interest in its therapeutic benefits, the fundamental issue hindering its acceptance by the Western medicine community and integration into mainstream healthcare is still the lack of robust evidence from the EBM perspectives. In order for TCM to be rationally used for patients who may benefit from it, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence using methods which are accepted in the evaluation of mainstream medicine, that is, in accordance with evidence-based medicine. In the EBM system, different types of evidences are prioritized into a set of hierarchical levels. Randomized controlled trials (RCTs) or systematic reviews of RCTs are the golden standard for the highest level of evidence, followed by other types of evidences such as cohort studies, case-control studies, case series, case reports, animal/ in vitro studies, and expert opinion. Whether the EBM model can be applied to TCM has long been a subject of debate and an area where much effort has been focused on.

This review aims at (1) discussing the current status of research in TCM, (2) exploring the evidences available on the efficacy and safety of Chinese herbal medicine and acupuncture, and (3) highlighting the issues and challenges faced in applying EBM to TCM.

2. Current Status of Research on TCM Intervention

Vast amount of basic research has been conducted on TCM herbs, mostly in characterizing the multiple-herb constituents, isolating active components from the herbs, and testing their pharmacological activities in the pursuit of new drug discovery. The US Pharmacopeial Convention published the Herbal Medicines Compendium, which is an online database that provides such standards for herbs. Each herbal monograph contains specifications including tests for critical quality attributes of the herbal ingredient, as well as analytical test procedures and acceptance criteria for specified tests [ 8 ]. In China, the TCM systems of pharmacology database and analysis platform were developed as a comprehensive source of herb pharmacochemistry, pharmacokinetic properties, and so forth to help drive drug discovery from herbal sources [ 9 ]. Two famous examples of active ingredients effectively extracted from TCM and since proven to be clinically successful are artesunate derived from Artemisia annua used for severe malaria [ 10 , 11 ] and arsenic trioxide used for treatment of acute promyelocytic leukaemia [ 12 , 13 ]. Taking up the challenge of fulfilling the stringent requirements of good clinical practice, a few TCM formulations are currently undergoing FDA clinical trials. These include Danshen dripping pill ( Salvia miltiorrhiza , Radix notoginseng , and Borneol) for stable angina in phase III trial, Kanglaite injection (coix seed oil and excipients) for cancer, Xuezhikang capsule (red yeast) for hyperlipidemia, and Fuzheng Huayu capsule ( Salvia miltiorrhiza , peach seed, pine pollen, Gynostemma pentaphylla , and Schisandra chinensis ) for liver fibrosis in phase II trials [ 14 ].

Quantitatively, there is no shortage of clinical studies in TCM conducted worldwide. A search on the Clinicaltrials.gov found 436 trials on TCM and 607 acupuncture trials globally (as of November 2014), while a search on online scientific journal portals, for example, Pubmed, Chinese National Knowledge Infrastructure (CNKI), yielded more than ten thousand research papers covering a wide spectrum of research topics studying TCM from various approaches. The critical problem, however, lies in the dearth of good quality evidence and lack of strong research rigor in the plethora of studies published, which undermine the credibility of the evidences.

A screening of all the TCM-related systematic reviews published by the Cochrane database to date found that almost all of the reviews commented on the lack of high quality clinical trials done with good methodology, thereby negating any definitive conclusion on the efficacy of herbal or acupuncture interventions. Some of the specific criticisms cited in these reviews included lack of trials that tested the same herbal medicine, lack of details on cointerventions, unclear methods of randomisation, poor reporting, high risks of bias, and the need for well-designed and conducted trials with sufficient numbers of participants to perform subgroup analyses [ 15 ]. The lament on the suboptimal quality of clinical studies on TCM was also echoed by two systematic reviews of reports on RCTs of TCM published in China from 1999 to 2004 and those indexed in the CNKI database from 2005 to 2012, respectively. The former found that the mean Jadad score (a scoring system for the methodology quality of a clinical trial on a scale of 0 to 5) of the 7422 RCTs identified was 1.03 overall, with a mean score of only 0.85 in 1999 (746 RCTs) and 1.20 in 2004 (1634 RCTs) [ 16 ]. The latter concluded that although the quality of reporting RCTs of TCM has improved in 2011-2012 (2861 trials) compared to 2005–2009 (4133 trials), the percentages of high quality reports remained low-mean Jadad scores of 1.22 versus 1.25, with only 15.15% and 19.71% of the reports having a score of 2 [ 17 ]. These results highlighted the present state of huge disparity between the quantity and quality of TCM RCTs and demonstrated that much more work needs to be done to improve on the latter aspect.

3. Some Challenges of Applying EBM to TCM Clinical Trials

One fundamental challenge in conducting valid RCTs in TCM is the batch-to-batch variation of the active constituents contained in the herbal formulation used. Product-to-product variation arising from different manufacturers, brands, or formulation further hinders the fair comparison of the findings among similar studies. Such inconsistencies may result in lack of reproducibility between clinical trials and even challenge the validity of generalizing the findings of clinical trials to routine use. However this is something that can potentially be overcome by technological advancement. Newly developed analytical tools and techniques have made it possible to profile the constituents of herbs, for example, by using high-pressure liquid chromatography to establish a chemical fingerprint of the herb, where the profiles of different batches can be compared to ensure no significant variability [ 18 ]. Precise reporting of such information by clinical trials has to be implemented to assure validity of TCM trials. In parallel, legislation to define the required standard of proprietary products will eventually be required for acceptance of the clinical trial findings and efficacy of TCM products by the Western medicine practitioners.

Another challenge is the difficulty in creating an appropriate placebo for multiple-herb herbal decoctions, which compromises the effectiveness of blinding. While it is feasible to create placebos for capsules, pills, and tablets, it is technically challenging to create an indistinguishable placebo for a multiple-herb formulation in the form of decoction. However, with multiple-herb formulations in the form of granules being more favored over decoction due to its convenience of use, it is not impossible to overcome the aforementioned challenge. In addressing this need for good quality placebo in TCM clinical research, one recent research in China has described a novel technique which claims feasibility in creating a good quality placebo in granule form that has similar appearance, smell, and taste as the original preparation but with no pharmacological activity [ 19 ]. Besides herbal medicine, designing appropriate placebo for acupuncture trials is yet another challenge, though researchers have come up with various control measures such as nonacupuncture inert controls, placebo acupuncture, sham acupuncture, real acupuncture with a decoy treatment, waiting list controls, standard care controls, and adjunctive care comparisons [ 20 ].

Incorporating TCM principles in an RCT poses another challenge as it appears that the standardized treatment approach required by RCTs is in discordance with the individualized treatment approach inherent in TCM practice. This difference in approach, however, is not entirely irreconcilable. In order to accommodate TCM principle, that is, replicating the diagnosis using “Syndrome Differentiation” and giving the corresponding individualized treatment within the rigorous framework of EBM, a systematic process for assessing symptoms and signs, the identification, and the quantification of TCM syndrome for a sample group of study subjects with the same Western medical diagnosis can be applied before and after treatment [ 21 ]. To quantify a syndrome for diagnosis, the signs and symptoms of each subject could be tabulated and matched against the typical signs and symptoms which characterize a particular TCM syndrome. The percentage match between the two could then serve as the score for a certain syndrome and a corresponding treatment protocol would be administered, allowing an “individualized” treatment in a standardized and reproducible way [ 21 ]. One way of assessing the intervention effects could be done by comparing the change in scores.

4. Efforts to Improve the Quality of TCM Research

It is encouraging that the need to modernize the methodology of clinical trials in TCM is being recognized and actively addressed. A group of Chinese medicine researchers, practitioners, journal editors, and epidemiologists have established the Chinese CONSORT Group for TCM and proposed the Consolidated Standards for Reporting Trials (CONSORT) of Traditional Chinese Medicine [ 22 ]. To improve the quality of TCM research, some of the recommendations made by the group include the precise reporting of TCM interventions and outcome measures detailed as follows [ 22 , 23 ].

Precise Reporting of TCM Interventions in RCTs

• name, dosage format, and registration;
• composition and quality of intervention;
• pharmaceutical processing and quality control;
• stability of final product and quality control;
• function and safety description;
• dosage and treatment course;
• control group.
• name of active compound(s);
• original source of active compounds(s);
• the brief process obtaining active compound(s);
• percentage of active compound in final product;
• added materials and their quality and quantity control.

Precise Reporting of Outcome Measures of RCTs of TCM

• Identifying the primary and secondary outcomes based on the purpose and hypothesis of the trial;
• defining the primary and secondary outcomes clearly;
• presenting the rationale of selection;
• presenting the method with aims to standardize the assessment process;
• presenting the method to improve the reliability of assessment;
• stating the termination criteria in the trial.

More recently in 2009, the Good Practice in Traditional Chinese Medicine Research Association was launched. This was the European Union's first coordination action dedicated to TCM research, funded by the European Commission under its 7th Framework Programme to coordinate EU-China dialogues and collaborations in TCM research. This project has since engaged more than 200 scientists and clinicians in discussions on good practice issues related to various aspects of Chinese herbal medicine and acupuncture research [ 24 ].

5. Examples of Level 1 Evidences Supporting TCM Intervention

Despite the paucity of high quality evidences available, there are nevertheless a few examples of well-conducted RCTs with precise reporting, which attested to the feasibility of producing high quality evidence for TCM and provided valuable insight into this challenging undertaking.

5.1. Efficacy of TCM Formulation in Irritable Bowel Syndrome, 1998

In a study on patients with irritable bowel syndrome (IBS) [ 25 ], patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations ( n = 38), a standard 20-herb Chinese herbal formulation ( n = 43), or placebo ( n = 35), all in capsule form. Patients were treated for 16 weeks and evaluated regularly by a traditional Chinese herbalist and a gastroenterologist. In this randomized, double-blinded, placebo-controlled trial, TCM formulation was shown to be effective in the management of IBS. Patients who received the standard formulation fared best during the course of treatment, while patients who received the individualized formulations maintained their improvement up to 14 weeks beyond the treatment period. This study is a good illustration of the potential efficacy of TCM for common conditions such as IBS which to date has no good solution by Western medicine other than symptomatic treatment. One unique feature of this study is that it compared the effect of standardized TCM formulation with individualized formulation. TCM practice has always emphasized on individualized treatment and syndrome-directed modification of TCM formulation regularly throughout the course of treatment, which may not be cost-effective or convenient from the patients' perspective. Further trials incorporating such comparisons would help to shed light on the relative superiority of customized treatment over standard formulation.

5.2. Efficacy of Maxingshigan-Yinqiaosan as Compared to Oseltamivir in Treating H1N1 Influenza, 2011

A prospective, nonblinded, randomized, controlled, multicenter trial was conducted in young patients in eleven hospitals from 4 provinces in China to compare the efficacy and safety of Oseltamivir and a TCM decoction “Maxingshigan-Yinqiaosan” in treating uncomplicated H1N1 influenza [ 26 ]. “Maxingshigan-Yinqiaosan” is a 12-herb formulation combining two classical TCM formulae for their “diaphoretic and heat-clearing” activities to treat respiratory tract infection. Subjects were randomized into four groups: Oseltamivir group ( n = 102), Maxingshigan-Yinqiaosan group ( n = 103), Oseltamivir plus Maxingshigan-Yinqiaosan group ( n = 102), and control group with no intervention ( n = 103). The study found that Oseltamivir and “Maxingshigan-Yinqiaosan,” whether used alone or in combination over a course of 5 days, resulted in a comparable time to fever resolution in patients with H1N1 influenza virus infection, superior to control group. This data therefore suggests that “Maxingshigan-Yinqiaosan” may be used as an alternative treatment to Oseltamivir for H1N1 influenza virus infection. This trial also illustrates two important facts: that the TCM formulation is as effective as Oseltamivir and that it is safe to be used in combination with Oseltamivir. The former is of relevance in terms of cost consideration, and the latter is relevant in terms of safety for the common layman practice of consuming both Western and traditional medicines with the hope of attaining enhanced therapeutic effect.

5.3. CHInese Medicine Neuroaid Efficacy on Stroke Recovery (CHIMES) Study, 2013

MLC601 (Trade name: Neuroaid) is a TCM formulation “Danqipiantan jiaonang” containing 9 herbs and 5 animal components [ 27 ]. A systematic review of six RCTs provided evidence that MLC601 could be effective in improving functional independence and motor recovery as an add-on to standard treatment and is safe for patients with primarily nonacute stable stroke [ 28 ]. The CHInese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES) study, a multicentre, randomized, double-blinded, placebo-controlled trial ( n = 1099) comparing MLC601 with placebo in patients with acute ischemic stroke of intermediate severity in the preceding 72 hours, is one of the largest-scale TCM trials in the recent years with subject recruitment from various countries in South East Asia [ 29 ]. Although MLC601 is statistically no better than placebo in improving outcomes at 3 months when used among patients with acute ischemic stroke of intermediate severity, a post hoc analysis found that the MLC601 group had significantly less early vascular events compared to the placebo group [ 30 ]. The safety profile of MLC601 was also validated by the lack of significant difference in adverse events between treatment and placebo group. This study illustrated a few important lessons: while dispelling unrealistic hope on expedited recovery, it revealed the unexpected findings of reduced vascular events of a magnitude much larger than what aspirin has been shown to produce [ 31 ]. It also exemplified a well-conducted cum precisely reported TCM trial done in compliance with good clinical practices. Results from the ongoing extension study [ 32 ] investigating the longer-term efficacy over a 2-year follow-up from the initial course of intervention are eagerly awaited. A positive finding will be indicative of the value in conducting long-term assessments after initial short-course therapy, a method which may be relevant in evaluating TCM efficacy since TCM interventions aim at restoring balance and may thus have the potential to achieve long-term and sustained benefit rather than temporary symptomatic relief.

5.4. Efficacy of Tianqi Capsule in Patients with Impaired Glucose Tolerance, 2014

In a double-blind, randomized, placebo-controlled, multicenter trial, Tianqi capsule containing 10 TCM herbs was found to significantly decrease the incidence of progression to type 2 diabetes mellitus in subjects with impaired glucose tolerance, after a course of 12-month treatment ( n = 210) as compared with the placebo group ( n = 210) [ 33 ]. This particular study is laudable in that it reported in detail the subject inclusion and exclusion criteria and the randomization and blinding method as well as adverse events, which are often omitted or not elaborated on in most TCM clinical studies. It also conducted and described the chemical analysis of the composition of Tianqi capsule, quantifying the constituents of the formulation, which is in line with the precise reporting recommendations to improve the quality of TCM studies [ 22 ].

5.5. Efficacy of Acupuncture for Pain Management Based on Systematic Reviews

A Cochrane review of 33 trials ( n = 2293) found consistent evidence that acupuncture provides additional benefit in the treatment of acute migraine attacks compared to routine care and that acupuncture is at least as effective as or possibly more effective than prophylactic drug treatment and has fewer adverse effects. The review recommended acupuncture as a possible treatment option for patients who are willing to undergo this treatment [ 34 ]. Another review of 11 trials ( n = 2317) also concluded that acupuncture could be a valuable nonpharmacological tool in patients with frequent episodic or chronic tension-type headaches [ 35 ]. A review on efficacy of acupuncture on neck pain concluded that there is also moderate evidence that acupuncture is better at relieving neck pain compared with some sham treatments. It found that at short-term follow-up, patients who received acupuncture reported less pain than those on a waiting list and that acupuncture is more effective than inactive treatments for relieving pain after treatment and this effect is maintained at short-term follow-up [ 36 ]. A systematic review (12 trials, n = 1763) reported that acupuncture use is associated with significant reductions in pain intensity and improvement in functional mobility as well as quality of life in patients with osteoarthritis [ 37 ].

While these level 1 evidences on the whole prove the efficacy of certain TCM treatments, one shortcoming among these studies is the lack of incorporation of TCM principles in the study design. For example, with the exception of the IBS study, the principal concept of “Syndrome Differentiation” which guides TCM diagnosis and treatment was not applied. Subjects were recruited based on their diagnosis by Western medicine without further subcategorization into different TCM syndromes for which different formulations would be required correspondingly. Under such circumstances, the assessment of the efficacy of TCM treatment may be flawed because the methodology does not replicate the real-life practice of TCM, and any lack of efficacy demonstrated could arguably be a result of the deviation from the well-tested TCM principles. As advocated by some, study designs guided by TCM theory are necessary to validate and improve future RCTs in TCM [ 38 ].

6. Current Status of Available Evidence on Safety Issues of TCM Usage

Efficacy issues aside, one much neglected aspect of TCM is the safety issues of its usage, for which there is currently little available evidence but warrants great attention. We believe that the prerequisite for TCM to be accepted into mainstream healthcare lies in addressing the safety concerns including adverse herb reaction and herb-drug interactions. The following sections therefore elaborate on evidence available on the safety aspects of TCM.

As highlighted by the Chinese CONSORT for TCM, it is important for RCTs to transparently report not only efficacy but also all the related adverse effects [ 39 ]. In general, adverse effects (AE) of the TCM interventions can be classified into 5 types as summarized below [ 39 ]. We will discuss more toxicity inherent to the herbs and the important issue of herb-drug interaction.

Types of Adverse Effects of TCM Interventions

• AEs under proper TCM principles and guidelines, for example, acute/chronic toxicity and allergy;
• AEs due to improper usage without following TCM principles, involving without following the TCM therapeutic principles, over-dosage, improper processing and preparation methods, and improper formula strategy;
• AEs due to contamination, such as heavy metal and pesticides contaminations in TCM interventions and intentional or unintentional contamination with drugs;
• AEs due to replacement of TCM herbs;
• AEs due to drug-herb interaction.

6.1. Toxicity

Evidence of adverse effects can come from various levels, from careful monitoring in RCTs, to case series and case reports on observed toxicity. Evidence from animal or in vitro studies may be deemed as low level from the perspective of proving efficacy, but their role in providing safety information is much greater. Biomedical research on herb pharmacology and toxicity are crucial to ensure the safe and appropriate use of herbs. Conclusive evidences from modern studies should be continually updated into the Chinese herbal pharmacopoeia and taken into consideration in the current practice of TCM regardless of whether they were mentioned in ancient Chinese literature.

“Chinese Herb Nephropathy” is the unfortunate term coined after the misuse of Guang Fang Ji ( Aristolochia fangchi ) instead of Han Fang Ji ( Stephania tetrandra ) in slimming pills in a few European centers, which led to interstitial nephritis, renal failure, and urothelial carcinoma [ 40 ]. This is an example of evidence of toxicity learned the hard way. While ancient TCM literature did not caution against such toxicity, with modern technology we now know that Aristolochic acid is one of the most potent carcinogens known [ 41 ]. Such evidence of toxicity based on laboratory research is most clinically relevant and the physician's knowledge of such should prevent catastrophic adverse effects in clinical practice.

Another example of toxic alkaloids found in TCM herbs which are still widely used clinically is aconitine which is found in Aconitum species such as Fuzi/Chuanwu ( Aconitum carmichaelii ) and Caowu ( Aconitum kusnezoffii ). These herbs are often used for their analgesic and cardiotonic properties. Aconitine poisoning resulting from overdosing or inappropriate processing of herbs before consumption could lead to cardiovascular, gastrointestinal, and neurological toxicities such as palpitations, arrhythmias, hypotension, and perioral and limb paraesthesia [ 42 , 43 ]. Another known toxic herbal compound is ephedrine, the main active ingredient in Mahuang ( Ephedra sinica ) which is frequently used in respiratory condition for its antiasthmatic activity. Studies have found that misusing Mahuang at higher dosages could lead to hypertension and cardiac arrhythmia due to its sympathomimetic activity [ 44 ]. These are examples where the known pharmacological and toxicological properties of herbs, corroborated by even small case series which are low in the hierarchy in the pyramid of evidence levels, can constitute important evidence for developing guidelines on the safe dosage and contraindications in the use of herbs.

Apart from the above examples which are known to have toxicities, certain TCM herbs which are not known to be toxic may also pose health risks if consumed inappropriately. For example, Gancao ( Glycyrrhiza uralensis ) is a frequently used herb in TCM formulations for its Qi -tonifying effect. However, evidence provided from biochemical studies demonstrated that Gancao has corticosteroidal activity. Glycyrrhizin, the principal active ingredient in Gancao, and its hydrolysed metabolite Glycyrrhetinic acid are inhibitors of the oxidative function of the 11 β -hydroxysteroid dehydrogenase, thereby preventing the metabolism of cortisol. As such, cortisol could then bind to mineralocorticoid receptors, leading to pseudoaldosteronism, resulting in hypertension and hypokalemia [ 45 ]. The clinical significance of this experimental finding was ascertained by a few adverse case reports of pseudoaldosteronism caused by consumption of Gancao at high doses [ 46 ]. Further work to better define the safe dose of Gancao in prolonged usage will provide important evidence for physicians to utilize this herb safely in modern day practice.

The use of Huang Lian ( Rhizoma coptidis ) and Huang Bai ( Cortex phellodendri ) and products containing the alkaloid Berberine has been prohibited in Singapore since 1972 based on sporadic cases and circumstantial evidence that Berberine could cause kernicterus in glucose-6-phosphate dehydrogenase (G6PD) deficient neonates. This ban was lifted four decades later, after an extensive review process by the local authority. Evidence came from scientific publications and surveillance of adverse reactions reported in the Asian countries which practise TCM; all of which did not suggest major safety concerns when Berberine was used appropriately, with the provision that it should still be avoided in infants and G6PD deficient individuals of all ages as well as pregnant and breastfeeding women [ 47 , 48 ]. This illustrates that continuous research and review of herb toxicity against its therapeutic potential based on current evidence are important in guiding the rational use of herbs.

6.2. Herb-Drug Interactions

In communities where Western medicine is the primary mode of treatment and TCM is supplementary, there is a high prevalence for concomitant use of both drugs and herbs, raising the safety concern of potential herb-drug interactions. Interactions between drugs and herbs can generally occur at the pharmacodynamics level, whether the herbs may potentiate or antagonize the biological activities of the drugs by acting on the same target or at the pharmacokinetics level, where herbs may affect the absorption, distribution, metabolism, or excretion of the drugs [ 49 , 50 ]. Specifically, herbs can induce or inhibit cytochrome P450 family proteins which are the main metabolizing enzymes or interfere with the efflux activity of P-glycoprotein which can actively pump absorbed drugs back into the intestinal lumen, thus affecting the bioavailability of concomitant drugs. This is of particular concern in patients who are taking drugs with narrow therapeutic index, for example, warfarin, cyclosporine A, and phenytoin, where certain herbs may potentially result in undesirable consequences of toxic effects or therapeutic failure [ 49 , 50 ]. While such interactions are better studied in herbs used in Western folk medicine, for example, St John's Wort, Echinacea, and Milk thistle [ 49 , 51 ], clinical evidence for the interaction potential of TCM herbs with drugs is hugely lacking and needs to be established clearly.

An example of possible adverse interaction is that between Danshen ( Salviae miltiorrhizae ) and warfarin, as demonstrated by some published evidences. Danshen is a TCM herb with “Blood-invigorating” property commonly used in cardiovascular conditions. There are case reports of patients stable on warfarin experiencing elevated international normalized ratio and bleeding after consuming Danshen-containing formulations [ 52 , 53 ]. Preclinical studies investigating the interaction between Danshen and warfarin reported that the herb extract inhibited warfarin hydroxylation and increased its concentration in rats [ 54 ]. Furthermore, there were in vitro studies reporting that Danshen extract inhibited platelet aggregation [ 55 ]. Such evidences serve to provide preliminary but crucial information alerting on the potential problems with certain herb-drug pairs, which will mandate close monitoring in both clinical trials and real-life practice involving such combinations.

Contrary to the common assumption, not all herb-drug interactions are necessarily harmful. For instance, a study investigating the potential pharmacokinetic and pharmacodynamics interactions of a TCM formula CMF1 (Yinqiaosan and Sangjuyin) with Oseltamivir found that the antiviral activity of the Oseltamivir was enhanced by the herbal combination in healthy volunteers ( n = 14) [ 56 ]. This suggests that the combined use of CMF1 and Oseltamivir could achieve a better therapeutic effect against influenza without compromising on safety. That said, more studies need to be done in this area to establish the information needed to guide the appropriate use of herbs in patients on concomitant drugs so that the therapeutic effect of either is not compromised and undesired toxic side effects can be avoided.

7. Approaches of Some Asian Countries

There are plenty of in vitro and animal studies exploring herb-drug interactions. However, much variation exists among the studies in aspects such as the methodology used and dose of herb tested resulting in inconclusive interpretations of the results collectively. Interpretation of these findings is further complicated by the incongruence of results, where the same herb could be reported in different studies to have opposing effects. Moreover, it is difficult to assess the clinical significance of these preliminary research findings. Nonetheless, it is essential that we maximize the use of what is available such that this mass of evidence is systematically collected and transcribed into meaningful databases to provide clinicians with an objective assessment of the current evidences and assist them in making an informed decision. With this as the main objective, we in the Singapore General Hospital established a Traditional Medicine Information Service (TMIS) in 2011 as an extension to the Drug Information Service in the Department of Pharmacy, with the committee formed by a medical doctor, pharmacists, and licensed TCM practitioner. TMIS provides evidence-based information on traditional medicines (TCM, Jamu, Ayurveda herbal medicine, etc.) by conducting literature searches and critically reviewing the current evidences. It has embarked on the development of a warfarin-herb interaction database which serves as readily available information for reference by pharmacists within the hospital. At the National University of Singapore, an online oncology drug interaction database “OncoRx” [ 57 ] has been developed by an informatics team led by a pharmacist to allow quick searches on interactions between different combinations of anticancer agents and herbal medicines.

In addressing the safety issue of TCM herbs, in Hong Kong, a multidisciplinary team consisting of a pharmacist, a chemical pathologist, a scientific officer, and a physician was formed to provide an advisory service on herbal safety to healthcare professionals of all public hospitals since 2000 [ 42 ]. As part of the investigation of adverse events associated with herbal products, the products and biologic samples would be screened for the presence of synthetic drugs and natural toxins, for example, aconitine, ephedrine, and aristolochic acids using various analytical tools [ 42 ].

On the national level, various Asian countries have their own adverse reaction reporting and capturing systems for TCM, mostly based on voluntary reporting. The Chinese SFDA has its system established in 1989 [ 58 ] and Taiwan has a similar reporting system established in 1998 [ 59 ], relatively late considering the long history of use of TCM in both countries. In Hong Kong, this aspect is governed by the territory-wide Drug and Poisons Information Bureau [ 42 ], while in Singapore the Health Sciences Authority has an Adverse Event Monitoring unit for the reporting and investigation of dubious products suspected to be linked with the adverse events [ 60 ]. These pharmacovigilance efforts have the primary objectives of ensuring public safety, but their databases built up over time should also be an invaluable source of preliminary evidence and serve as the basis for further laboratory and clinical research to establish definitive evidence of adverse reaction and herb-drug interactions.

8. Future Directions

Many issues surrounding the efficacy and safety of TCM use in modern society remain unresolved and these hinder the potential benefits of TCM from being safely and effectively harnessed. Applying EBM to TCM is vital for the traditional practice to gain acceptance by Western medical practitioners and become an integral component of the healthcare system. This is a necessary step when exploring TCM as cost-effective treatment options to help tackle healthcare issues such as functional diseases, chronic illnesses in ageing populations, and rising healthcare costs. High quality evidences via RCTs assessing efficacy and safety are needed to substantiate the use of TCM in suitable conditions.

However, EBM should not be rigidly imposed onto TCM but rather adapted with flexibility taking into consideration the unique characteristics of TCM practice. As advocated in a review by Tang, a pragmatic approach towards TCM research by adopting an efficacy-driven approach instead of the conventional mechanism-based approach may be more applicable to TCM. This approach starts with evaluating safety and efficacy in humans by RCTs, from which efficacious interventions are identified before undertaking studies on mechanisms and active substances. This would avoid unnecessary basic research on inefficacious interventions and better channel resources to further study beneficial treatments. Most importantly, this strategy may provide high-level evidence for the expedited recognition of effective TCM interventions [ 61 ].

With the advancement of technology and research tools, continuous effort in conducting rigorous research into toxicities and drug-interacting potential of herbs as well as correlation of laboratory findings with clinical observations are essential. This provides new insights about the herbs to help us utilize the herbs in a more rational and safe way in the modern clinical setting. Stringent quality control in the manufacturing of herbal products, strict regulatory controls on TCM herbal products, and active safety surveillance to detect adverse events are crucial to safeguard the risks that TCM users are exposed to.

There are many challenges in applying EBM to TCM, but these can be overcome by various approaches. In the era of advanced technology and EBM, with the wise application of basic and clinical research methodology to provide the relevant evidence, TCM as an ancient science and art is poised to be brought to a greater height for its ultimate mission of benefiting human health.

Acknowledgment

The first author is employed under the Traditional Medicine Information Service which is a project funded by the Ministry of Health Healthcare Quality Improvement & Innovation Fund.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

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• NATURE INDEX
• 05 June 2024

Chinese science still has room to grow

Strong potential.

Chemistry and physical sciences are clear areas of focus for China, accounting for 85% of the country’s total Share in the Nature Index in 2023*. But output in other subjects is growing fast. China’s adjusted Share in biological sciences increased by 15.8% from 2022 to 2023* — the highest percentage among the four natural-sciences subjects shown below.

Source: Nature Index. Analysis by Bo Wu. Infographic by Simon Baker, Bec Crew and Tanner Maxwell

Topic trends

The top fields of research (FORs) in each of the five subjects tracked by Nature Index are shown. The most dominant FORs across the respective areas are biochemistry and cell biology, at 36% of biological-sciences output, and materials engineering, which represents 34.7% of physical-sciences output. FORs can relate to more than one subject: biochemistry and cell biology is also among the top five FORs for health sciences, for instance.

Looking outwards

China’s areas of relative weakness have the highest percentage of internationally collaborative papers. For most subject areas, China’s international-article percentage was lower than every other leading country in the Nature Index in 2023*. In biological sciences, however, it is 54.1%, a higher proportion than the United States (52.7%).

Strength in numbers

China might be more outward-looking in its approach to biological sciences research, but it still dominates its top three international partnerships in the subject. A different dynamic can be seen in its collaboration with Harvard University in Cambridge, Massachusetts, which has more than double the collaboration score (6.39) of the Chinese Academy of Sciences in Beijing (3.02), in the fourth-ranked international partnership in the subject (not shown).

Concentrated expertise

It’s perhaps no surprise that China’s largest research institute, the Chinese Academy of Sciences, forms five of the country’s ten leading international partnerships in biological sciences. What is striking is the strength of the University of Hong Kong — a much smaller institution — which forms the top three international health-sciences collaborations. Among China’s top international collaborations in health sciences and biology, the University of Sydney is the only institution from outside Europe and the United States.

Nature 630 , S17 (2024)

doi: https://doi.org/10.1038/d41586-024-01600-9

This article is part of Nature Index 2024 China , an editorially independent supplement. Advertisers have no influence over the content. For more information about Nature Index, see the homepage .

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New England School of Acupuncture (NESA) Students Study Chinese Herbal Medicine

Mcphs is the only accredited acupuncture and chinese herbal medicine institution in massachusetts..

New England School of Acupuncture (NESA) at MCPHS students can study both Eastern and Western medicine with the Master of Acupuncture and Chinese Herbal Medicine (MAc CHM) .

Dean and Professor of Acupuncture Dennis Moseman, DC, L.Ac., Dipl. Ac. (NCCAOM), explains that acupuncture programs appeared in the United States in the mid-70s, and their curricula were modeled similarly to those developed in China.

“In China, acupuncture and herbs are learned together,” he explains. “Herbs treat patients from the inside out while acupuncture treats a patient from the outside in. By incorporating both in clinical practice, you are able to treat a patient comprehensively."

Students in the Master of Acupuncture with a specialization in Chinese Herbal Medicine program complete the same coursework as the Master of Acupuncture program  with the addition of coursework related to the clinical practice of Chinese herbal medicine.

“Students learn clinical medicine from both an Eastern and Western medical perspective so that they are able to understand subject matter such as physiology, pathology, and pharmacology from an integrative perspective,” he says. “As a result, they are able to recommend Chinese herbs in a safe and effective manner to provide optimal patient care.”

He explains that in Traditional Chinese Medicine (TCM) there are five principal areas of study: acupuncture & moxibustion; Chinese herbal medicine; Eastern nutrition; tui na (a bodywork technique); and self-cultivation practices such as tai chi or qi gong.

In the first year, students learn essential foundational theories and principles of both Eastern and Western medicine. Students also participate in clinical assistantships in which they observe at NESA’s Acupuncture Treatment Center  as well as at offsite clinical affiliations.

“This allows students to see how acupuncture works in the real world,” he says.

In the second year, students integrate fundamental material from the first year with more advanced concepts of Eastern and Western medical clinical practice. Students continue to develop professional competencies and learn to formulate a diagnosis and treatment plan. Students continue their clinical training as clinical interns and are responsible for the management and delivery of patient care.

In the third year, students complete clinical training and are placed in a variety of clinical settings providing patient care under the direct supervision of senior faculty. Students continue their professional development by completing a series of practice management courses. Upon completion of the program, graduates are eligible to sit for the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) board examinations and to seek licensure.

“If I had to generalize, Western medicine is reductionist in its approach . . . a podiatrist treats only the foot, a cardiologist treats the heart, but acupuncture and Chinese herbal medicine is based on a holistic model that treats the whole body,” he says.

Hands-on clinical training

Dean Moseman emphasizes that the curriculum focuses on hands-on practice of clinical skills.

“There are many acupuncture programs where you do not really get into the hands-on portion until the second year of the program. But in our program, you are practicing and mastering all the skills that an acupuncturist needs to know for the entire three years that you are here,” he says.

Small Classroom Sizes

Students also benefit from the small classroom sizes and ratio of students to faculty.

“For example, in a class of 40 students, students work in pairs. You might have five acupuncturists in the class and one lead teacher who is lecturing but there are also five or so other teachers there to help you,” he says. “This is important when you are learning to perform a skill because acupuncture is a highly-skilled profession.”

State-of-the-Art Herbal Dispensary

Students assist in NESA’s herbal dispensary, which is stocked with an extensive selection of high-quality Chinese herbal products. Students learn to formulate concentrated granules and compound raw herbal formulas in a safe and accurate manner. They also gain experience in operating a successful herbal dispensary.

“One of the unique experiences that students have is that they can work in the state-of-the-art herbal dispensary where we dispense a variety of types of Chinese herbal formulations. A formula could consist of 10, 15, or 20 different raw herbs which could be made up of leaves, stems, minerals, or flowers. These are all put together and boiled in water in what is known as an herbal decoction,” he says.

Japanese Acupuncture Specialization

Students also have the option to specialize in Japanese Acupuncture Styles (JAS)  which teaches the use of very thin needles as well as other tools for non-needling techniques used for gentle treatments.

“There aren’t many programs in the United States that teach Japanese acupuncture so it is something that has been very important to NESA and we’ve taught it for several decades, so it’s something that we’ve always been committed to offering,” he says.

Teaching distinctive styles enables students to know powerful, patient-centered treatment options for a variety of health concerns.

“The acupuncture that you would administer to someone who works outdoors with their hands such as a construction worker is a very different kind of acupuncture that you would administer to someone who works in the city in an office and has more of a sedentary lifestyle,” he says. “The hardiness of the patient can affect how you would apply these treatments.”

Dean Moseman explains that alumni of the Master of Acupuncture and Chinese Herbal Medicine (MAc CHM) program have a diverse array of careers.

“We have graduates working in hospitals, some in multidisciplinary environments with other healthcare practitioners, and certainly in private practice,” he says.

He also cites Boston’s Longwood Medical Area  as a huge benefit for students. “We have had over 40 years to develop some great affiliations with some of the top hospitals in Massachusetts and the surrounding region. Our students complete rotations in hospitals in specialties such as oncology, pediatrics, or family medicine. Career opportunities are advancing and growing in the United States.”

“The field is really starting to expand more now than ever.”

MCPHS is the only institution in Massachusetts accredited by the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM). The following programs offered by MCPHS are accredited by ACAHM: Master of Acupuncture , Master of Acupuncture and Chinese Herbal Medicine (MAc CHM) , and Doctor of Acupuncture . ACAHM is recognized by the United States Department of Education as the specialized accreditation agency for institutions/programs preparing acupuncture practitioners.

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