Traditional Chinese Medicine: an in-depth look at a thousand-year-old practice

Chinese herbal medicine is the central branch of Traditional Chinese Medicine, and the predominant practice in this field. It is based on the use of natural elements, mainly plants and minerals. The Chinese pharmacopoeia lists over 8,000 ingredients, of which 800 are commonly used and 400 are used on a daily basis. The fundamental work on Chinese phytotherapy is the Materia Medica, which lists thousands of medicinal substances. Plants are the main component of the pharmacopoeia, although some preparations also include animal or mineral extracts.

History of Chinese Medicine

Chinese medicine has its roots in the legend of three emblematic figures. Fuxi, author of the Yi Jing (Book of Changes), the oldest Chinese text. Shennong, the “divine ploughman”, was the pioneer of agriculture and herbal medicine. Huang Di, the Yellow Emperor, is the founder of rites and medicine. He is credited with writing the Nei Jing (Classic of the Yellow Emperor’s Esoteric Tradition), a historic work that has endured down the ages.

The first dynasties

During the Shang dynasty (around 1700-1500 BC), the first written medical terms appeared on turtle shells or animal shoulder blades, used for divinatory purposes in scapulomancy. Among these terms, the character “chi” (disease) stands out, made up of the elements “man” and “bed”, surrounded by one to four lines interpreted as drops of blood or arrowheads.

Some inscriptions refer to illness as being caused by a “bad wind” or “snow”. These references mark the beginning of the attribution of illnesses to influences of “natural” origin. Gradually, divinatory methods focusing on the world of the dead were replaced by more pragmatic approaches concerning the world of the living.

Under the Zhou dynasty (11th to 3rd century BC), medicine evolved. Initially, medicine was seen as a battle against hostile forces such as demons or spirits. These entities attacked the body’s soul, day and night. This magical approach used exorcisms, incantations, talismans, breathing techniques and drugs.

However, towards the end of the Zhou dynasty, a change took place, similar to that in the Greek world in the 5th century BC. A new vision emerged, based on philosophy and medicine. It abandoned the gods and demons in favour of natural forces. The Yi doctors distinguished themselves from the priests and magicians, forming an independent corporation. The medical hierarchy diversified, including master doctors yishi, internal medicine doctors jiyi, wound doctors yangyi, dieticians shiyi and veterinarians.

Ancient medicine

After the period of the Warring Kingdoms (5th-8th centuries BC), China was unified under the Han Empire (221 BC-220 AD). This era marked the beginning of the great period of Taoism, which stretched from the 2nd century BC to the 7th century AD. Within this philosophy, alchemy, pharmacopoeia and medicine played a significant role, influenced by many Taoist masters.

The Han Empire, a contemporary of the Roman Empire and the Sassanid Empire, marked the first emergence of Chinese civilisation on a global scale. This period was marked by the opening of the “Silk Road” in 122 BC and the “Burma Road” in 115 BC, encouraging maritime, commercial and cultural exchanges between China, Persia, India, South-East Asia and the Mediterranean.

The first writings

Medical texts from this period were often made up of chapters of varying ages and origins, which meant that for the Chinese, ancient writings were just as valuable as modern books. The “Nei Jing Su Wen” is an example of a medical text from this period. The archaic language of these early treatises made them difficult to understand, even for sinologists. As a result, official publishing agencies undertook to republish these classics in a simplified form to make them more accessible.

The earliest attested medical writings, dating from between 580 and 320 BC, can be found in the “Zuo Zhuan”, composed at the beginning of the fifth century BC. The oldest fragments of the “Nei Jing Su Wen” date from the fifth to eighth centuries BC. This text was divided into two parts at the end of this period, under the Qin dynasty. These parts are the “Su Wen” (Simple Questions) and the ” Ling Shu” (Spiritual Pivot), focusing on medical theory and practice. The “Nan Jing” (Classic of Difficulties), a treatise from the first or second century, comments on 81 passages of the “Nei Jing” and deals with the theory of the pulse.

Commentaries were added to ancient medical texts, often under the name of the Ancients. Over time, the “Nei Jing” was modified and parts were replaced, creating confusion and contradictions. Despite these changes, the Nei Jing has survived and has been translated into French by sinologists such as Chamfrault and Husson.

The first great scholars

As far asthe great physicians of this period are concerned, several notable figures stand out. Bian Que, also known as Qin Yueren, is cited as one of the first historical figures in the medical field in China. He is renowned for his knowledge of pulse-taking and is associated with the “Nan Jing”. Zou Yan introduced the theory of the Five Elements to China, which has influenced many fields of knowledge, including medicine and alchemy.

During this period, several famous doctors left their mark on history. Among them, Chunyu Yi is known for his writings detailing the illnesses he treated. Zhang Zhongjing, often compared to Hippocrates, and Huatuo, a renowned surgeon, also made major contributions to Chinese medicine, particularly in symptomatology and therapeutics.

After the Han era, China went through periods of division and political instability, such as during the Three Kingdoms (220-280). Despite this, Chinese medicine continued to progress. Personalities such as Ge Hong and Tao Hongjing enriched Chinese pharmacopoeia and medicine. The legacy of the Han period in medicine has persisted, influencing its evolution through the centuries in China.

The first remedies

The Han era was also marked by major exchanges between China, India and Persia. At the same time, Chinese medicine evolved. It studied poisons, herbal and mineral remedies, dietetics, the quest for immortality, breathing techniques, physical culture and sexology. Under the Han, peace stimulated the writing of numerous medical works. These books are grouped into several categories: Classics of Medicine, Collections of Recipes, Treatises of the Bedroom, and Method and Recipes for Becoming Immortal. Of these, the Nei Jing is the best known. It is classified as one of the Classics of Medicine.

The quest for immortality also played a major role in Chinese medicine and Taoism at the time. Immortality remedies were based on the ‘five canonical substances’, namely realgar, sulphur, ovre, turquoise and amethyst. As some of these substances were toxic, they required progressive immunisation training. The emperor Qin Shihuang even undertook expeditions in search of these mythical remedies.

Classical” medicine

Under the Sui (581 or 589 – 618) and Tang (618-907) dynasties, China experienced a period of reunification and flowering of Chinese medicine.

Under the Sui and Tang, Chinese medicine reached its apogee. In 624, the Great Medical Service was created to supervise medical studies and organise medical research. During this period, many diseases were accurately described. These included leprosy, smallpox, measles, scabies, dysentery (acute and chronic), cholera, dropsy and deficiency diseases such as beriberi, night blindness, rickets and goitre. Venereal diseases, tuberculosis (pulmonary and bone), cervical adenopathy, diabetes and tumours were also studied.

After the Tang era, the Song dynasty (960-1279) marked major progress in China, both technically and scientifically. This period saw the birth of eminent scholars such as Chen Kua. He was an architect, agronomist, physician, historian and ambassador. A renowned paediatrician, Qian Yi, identified diseases such as chickenpox, measles, scarlet fever and smallpox.

Forensic medicine made its appearance with Song Ci’s “Xi Yuan Ji Lu” (Collection for Cleansing Injustice) (1188-1249), marking the beginning of anatomy in China. Dissections of people condemned to death were carried out and documented in the eleventh and early twelfth centuries. The medical field developed considerably, incorporating many exotic medicines such as opium.

Some important names in the field of medicine from this period include Hu Zheng Qi Huei, an imperial dietician who described deficiency diseases and their treatment by rational dietetics, and Hua Shou, famous for his commentaries on the medical classics, notably the Nan Jing.

Medicine under the Ming

The Ming Dynasty (1368-1644) came to power through a popular peasant revolution, marking an intermediate period between the conquering Mongol and Manchu dynasties. During this period, Beijing was liberated and established as the capital.

Under the Ming Dynasty, China enjoyed a new golden age. Zheng He undertook several voyages by ship to West Africa between 1405 and 1433, establishing trade and cultural links with other parts of the world. In 1601, Father Matteo Ricci arrived in Beijing with the Jesuits, bringing with him Western medicine. However, this medicine was mainly reserved for the emperor. Texts on anatomy and blood circulation were translated into Chinese, arousing the interest of the Kangxi emperor, although he considered them potentially dangerous for the people.

Li Shizhen (1518-1593) created the “Grand Traité de Matière Médicale”, a medical masterpiece. It took him almost 30 years to complete. This treatise was much more than a simple guide to pathology and therapeutics. It also served as a natural history reference, classifying mineral, plant and animal products. It included chapters on chemical and industrial technology, as well as geographical, historical, dietetic, culinary, cosmological, philosophical and philological information. This encyclopaedia was translated into many languages, both Eastern and Western. It also documented the appearance of syphilis in China around 1505-1506, corroborating the reports of Western, Arab and Indian physicians.

Li Shizhen also produced two “minor” works, the “Binhu mai xue” (Study of the pulses of the lakeshore), which was a benchmark in pulse diagnosis, and the “Qi jing ba mai kao” (Research on the eight extraordinary vessels), the first systematic study on the Marvellous Vessels, incorporating knowledge of internal alchemy at the time.

Today, the

In the 20th century, European medicine strongly influenced China. This influence reduced morbidity and mortality, triggering a demographic explosion during the Communist era. This period saw the emergence of a new Chinese medicine, combining clinical approaches with traditional techniques. This led to greater efficiency and more sophisticated medicine.

Maoism had a complex relationship with traditional medicine. Initially, the government wanted to suppress ancient medical traditions, considering them ineffective and superstitious, in favour of modern medicine. This had a significant impact on morbidity. But then, because of the shortage of doctors, the high cost of modern medicine and nationalist sentiment, Mao encouraged the use of traditional medicine. It has become a worldwide symbol. In 2017, traditional Chinese medicine was recognised by theWorld Health Assembly in its International Statistical Classification of Diseases. This recognition has paved the way for the proliferation of hospitals, registered therapists and pharmacies around the world.

Many Chinese pharmacies still sell plant- or animal-based remedies, despite evidence that they are ineffective or harmful. Every year, the Chinese government acknowledges more than 230,000 cases of harmful side effects.

It should be stressed that the definition of “traditional Chinese medicine” remains vague. Many potions sold under this name lack any traditional basis. This is particularly true of those made from animals that do not exist in China. Deceptive commercial practices and the marketing of animal organs without medical or traditional justification are worrying problems.

What is Traditional Chinese Medicine (TCM)?

Chinese medicine, also known as “medicine in the Chinese space”, takes two distinct forms. The first is folk medicine, based on recipes handed down in rural communities, as well as ancient magical and religious practices such as shamanism, Buddhism and Taoism.

The second form is traditional Chinese medicine proper, often referred to as “classical Chinese medicine”. This approach is based on a vast body of literature and is practised by medical officers of the Chinese administration, also known as “mandarins”. It has evolved significantly, while preserving certain fundamental principles inherited from Antiquity.

Principles of TCM

Chinese Thought

Traditional Chinese texts differ markedly from Greek logos. They present challenges for distinguishing between what is considered “scientific”, “philosophical”, “religious” or “literary”. These texts are written in sinograms, a so-called “surface script”, rather than using a linear alphabetical script.

Chinese thought does not follow Greek logic based on independent concepts linked by logical reasoning and syllogisms. Chinese discourse does not seek to reveal immutable, abstract and absolute truths. On the contrary, it explores the appropriate ‘dosages’ for concrete situations. Unlike the Greeks’ principle of non-contradiction, which excludes falsehoods, Chinese thought is based on the principle of non-contradiction. Chinese thought is based on the principle of alternatives or complementary oppositions that manifest themselves in concrete reality, through temporal order and spatial position.

Anne Cheng explains that Chinese thought does not progress in a linear or dialectical way, but rather in a spiral. It does not try to define its object definitively through a set of definitions, but rather by drawing ever-narrower circles around it. Jacques Gernet adds that Chinese theory seeks to explain change, not immutability.

Chinese medicine is influenced by many philosophical traditions. Among these, Taoism plays a key role in the understanding of nature. Confucianism serves as a moral and political system. Mohism brings its perspective in terms of logic and naming. Legism was important for norms and standardisation. From the 11th century onwards, neo-Confucianism emerged, merging with or reacting to Taoism and Buddhism. These philosophical currents shaped Chinese medicine, making it unique and complex. The understanding of health and disease in Chinese medicine is deeply rooted in the Chinese cultural and philosophical context.

Philosophy of nature

Chinese medicine is rooted in a natural philosophy intrinsic to Chinese culture, characterised by key concepts: Tao, Qi, Yin and Yang and Wuxing.

From this perspective, natural phenomena are rarely the result of mechanical causal mechanisms. Rather, they are understood as flows, echoes or resonances resulting from the influence at a distance between the world (represented by Heaven and Earth) and human society. The concept of zhi embodies the idea of a natural order, as opposed to disorder (luan). It also involves the governance of a country and the treatment of disease. The approach consists of harmonising human actions with cosmic cycles, thereby encouraging the emergence of spontaneous harmony.

Chinese medicine considers the notion of imbalance between deficiencies and excesses to be fundamental. It is perceived as a preventive medicine. This perception is due to its adaptation to cyclical changes in the world. These changes are characterised by fluctuations between deficiency and surplus. The holistic approach is at the heart of this medicine. It recognises the importance of balance and harmony. This balance must be maintained in the human body and in the universe. This approach fosters a unique understanding of health and disease in Chinese medicine.

Tao

The term “Tao” in Chinese philosophy, represented by the character 道 (dào), means “supreme way” or “path”. It embodies the primordial source of all that exists, a fundamental force present in the universe and beyond all description. The Tao is symbolised by the taïjítú, representing unity beyond the duality of yin and yang. It is at the heart of the Tao Te King, attributed to Lao Tzu, where it was elaborated and systematised.

The Tao is considered to be the initial matrix from which the ‘qi’ or original breath emerges, preceding the yin-yang duality. It plays a central role in Chinese ethical concepts, often associated with the search for the right balance. Individuality enters into communion with the Tao through ‘wuwei’, or ‘non-action’.

The Tao is the key concept of Taoism, a Chinese philosophy and spiritual path, but it is also referred to in Confucianism, although generally with a more moral connotation. Sometimes translated as ‘the principle’, it is also present in many Eastern arts and practices, with the suffix ‘dao’, meaning ‘the art of’. For example, “cha dao” means “the art of tea” and “kongshoudao” or “karate-do” means “the art of the empty hand”.

Lao Tzu emphasised the ineffability of the Tao when he said “The Tao that can be named is not the Tao”. Taoism, like Confucianism, played an essential role in the development of the Chinese sciences.

The word ” Tao” has a complex history. Its meanings vary: “road”, “doctrine”, ” explain“. These terms come from the Book of Odes, an ancient Chinese text. This diversity of meanings illustrates the richness and complexity of Chinese philosophy. In this philosophy, the concept of Tao is central. It helps us to understand the world and nature.

Qi

Ch’i” (simplified Chinese: 气; traditional Chinese: 氣), also called “ki” in Japanese, is a concept from Chinese and Japanese cultures. It can be translated as “natural energy flow”. According to followers of Taoism and traditional Chinese medicine, ch’i is the fundamental principle that shapes and animates the universe and life. It is considered to be at the origin of the universe and links all beings and things together.

Ch’i is described as a subtle substance that circulates within the body via meridians, all of which intersect in the ‘energy centre’ known as the ‘cinnabar field’. It is present in all manifestations of nature.

The meaning of ch’i is difficult to translate because it encompasses different aspects of life and the universe in Chinese cosmogony. It has also evolved over time under the influence of different schools of thought.

It predates the emergence of yin and yang, the two aspects of breath, which combine to form all the beings and objects in the universe. Ch’i is also associated with polarity and the five elements, representing five modes of breath activity.

In Confucian philosophy, ch’i is associated with the structuring principle of beings and things called “lǐ”, which governs morality and ideal social rules. Ch’i plays a central role because morality is directly linked to the body, which is where ch’i circulates.

Traditional Chinese medicine identifies three areas of qi concentration called “dāntián”:

• The lower, located below the navel, where ch’i is produced.
• The middle one, at the level of the sternum, transforms ch’i into spiritual breath.
• The upper one, between the eyebrows, transforms the spirit into a free spiritual breath, leading to harmony with the cosmos.

Ying and Yang

In Chinese philosophy, the concepts of Yin and Yang are essential. They help us to understand life and the universe. Yin (陰) and Yang (陽) are two complementary and opposing forces. They represent duality in the world. Yin and Yang are not substances or energies. They are concepts to define all duality. The symbol of Yin and Yang is the “tàijí tú”. It is known throughout the world. Yin is in black. It represents the feminine principle, the moon, darkness, freshness and receptivity. In contrast, the Yang, represented in white, embodies the masculine principle, the sun, luminosity, warmth, impetus and action.

In Chinese medicine, the concept of Yin and Yang is essential. They are associated with dualities such as cold and hot, slow and fast, calm and restless. These dualities are considered to be Yin/Yang pairs because they are on the same scale of temperature, speed, etc. The dynamic balance between Yin and Yang results from the alternating phases of growth and decline of each of these terms.

After the Cultural Revolution, new teaching manuals on Chinese medicine were published. They described the interrelationship of Yin and Yang as different types of manifestation of change, including oppositional control, mutual dependence, growth-decay balance and mutual transformation. However, some researchers have questioned the clarity of these concepts.

Yin and Yang can only exist in relation to each other. Finally, mutual transformation refers to the idea that extreme cold can be transformed into extreme heat, and vice versa.

Wuxing

The‘Wuxing‘, also known as the Five Phases in Chinese, represent a key element in traditional Chinese cosmology. These phases are fire, water, wood, metal and earth. They came into being during the era of the Warring Kingdoms. They formed the basis of a complex system of classification and correspondences. Integrated with the concepts of Yin and Yang and Qi, they have greatly influenced the evolution of Chinese thought.

The five elements are generally listed in the following order in Chinese:

1. 木, mù, meaning “wood”
2. 火, huǒ, meaning “fire”
3. 土, tǔ, meaning “earth
4. 金, jīn, meaning “metal”
5. 水, shuǐ, meaning “water

According to the integrated system developed under the Han dynasty, all the elements of the universe are classified in one of these five categories. These elements interact with each other in two cycles: the cycle of generation (or begetting) and the cycle of domination (or destruction).

Cycle of generation :

1. Metal generates water.
2. Water promotes the growth of wood.
3. Wood feeds the fire.
4. Fire produces earth (ash).
5. Earth contains minerals, the source of metal.

Cycle of domination (or destruction):

1. Metal can cut wood.
2. Wood can pierce earth.
3. Earth can absorb water.
4. Water can extinguish fire.
5. Fire can melt metal.

The relationship of creation or destruction between elements A and B is based on the possibility of an action by A on B. This action promotes or prevents the emergence of B or one of its distinctive properties. However, if the dominant element is weak and the dominated element is strong, this can lead to a “contempt relationship”. In this case, the element that is supposed to be dominant is in fact dominated by the other. In traditional Chinese medicine, this outrageous relationship is an indicator of imbalances affecting health.

The body

According to the Chinese view, the human body is a microcosm between Heaven and Earth, reflecting the architecture of the world. This belief underlines the importance of harmony between the social structure and the conformation of the universe, with an analogy between various forms of knowledge. The Chinese perceive the Earth as square and Heaven as round, symbolising man with his square feet (Earth) and round head (Heaven). Social, moral and cosmic order depend on this harmony.

In Chinese medicine, anatomy and physiology are intrinsically linked, mirroring the elements of the universe. Human organs are comparable to cosmic elements. Blood vessels are like rivers and bones like mountains. Certain organs have links with cosmic movements and vital breaths.

Health depends on the circulation of Qi (vital energy). There are three types of Qi: nourishing energy, defensive energy and ancestral energy. The acupuncture meridians form a network of channels in the body. They are the ancestors of our knowledge of blood circulation and the nervous system.

At the same time, the body is seen through various numerical systems, reflecting cosmic arithmetic. Man is an analogy of the universe: four limbs for the seasons, twelve major joints for the months, and 360 minor joints for the days of the year.

This Chinese perspective, compared to the medieval West, is seen by some as a forerunner of chronobiology and medical climatology. Authors such as René Berthelot have described this thinking asastrobiology. Modern interpretations attempt to link these beliefs to current scientific knowledge, with parallels in neuro-endocrinology, sexology and environmental medicine.

The disease

Inancient China, the understanding of disease was based on a pluralism of principles, rather than exclusion. Practitioners of traditional Chinese medicine often interpreted disorders as imbalances in the Qi (vital breath), manifesting as states of fullness, emptiness or stagnation. External factors, such as climatic conditions, or internal factors, such as emotions, could cause these imbalances. They also saw illness as a Yin-Yang imbalance or disharmony of the five movements.

Diagnosis in Chinese medicine involved a holistic approach, focusing on observation, listening, questioning and palpation. The practitioner sought to identify spontaneous symptoms of change, examining the complexion, mind, breathing and orifices of the body. Auscultation was replaced by careful listening to the sounds made by the patient, and a complementary olfactory examination. Questioning clarified the symptoms, and palpation of the abdomen, meridians and pulses provided additional clues. Chinese medicine recognised a wide variety of pulses, each indicating different health conditions.

Chinese medicine paid particular attention tochildren and women, with examination methods adapted to ethical and cultural standards. In the case of women, the examination was sometimes carried out indirectly using a medical doll.

Prognosis and nosology were based on the pa-kang system, which classified symptoms into eight categories based on pairs of opposites such as yin/yang and hot/cold. This classification helped to determine the severity, location and reactivity of the disease. Chinese medicine used metaphors such as the tree to illustrate that visible symptoms were only the emerging part of a deeper problem.

The elements used in TCM

Chinese medicine is based on key therapeutic pillars. The Chinese pharmacopoeia, including phytotherapy, minerals and animal substances, is fundamental, with the Shennong bencao jing as the reference text.Acupuncture and moxibustion are used to manipulate vital energy, or Qi. Diet plays a crucial role in maintaining health. Traditional Chinese massage (An Mo / Tui Na) and Qi gong help to balance Qi. Finally, emotional management is essential to the overall balance of body and mind. This holistic approach integrates the body, mind and environment to promote health and treat illness.

An Mo / Tui Na

Tui Na massage, a speciality of Traditional Chinese Medicine (TCM), focuses on the body’s meridians and acupuncture points. The term Tui Na, meaning “to push” (tui) and “to grasp” (na), describes the techniques used to disperse energy blockages or stimulate energy. This massage acts on reflex zones to tone and revitalise the body and mind, aiming to rebalance energies.

Created around 1300 BC in Luoyang, China, Tui Na is based on the body’s yin (matter) and yang (energy) balance. Health depends on this balance, which is disturbed by energy blockages along the meridians. These meridians, like rivers of energy, feed the body with qi and blood.

Tui Na uses a variety of movements such as pushing, grasping, pressing and rubbing, adapted to the patient’s specific needs. Tui Na is one of the five key branches of Traditional Chinese Medicine (TCM). It is often used in conjunction with other techniques such asacupuncture, phytotherapy, dietetics and Qi Gong.

Tui Na massage is not limited to manual manipulations. It sometimes incorporates additional TCM techniques, such as cupping or moxibustion, to correct energy imbalances. This method is renowned for its holistic approach, targeting the whole person’s well-being (body, mind and energy) based on the fundamental principles of TCM, such as Yin/Yang and the 5 elements. With its 50 main techniques and over 300 sub-techniques, Tui Na offers a sophisticated manual treatment tailored to each individual.

Qi gong

Qi Gong, a traditional Chinese form of gymnastics, combines slow movements, breathing exercises and concentration to control the breath, or Qi. The term literally means “realisation or accomplishment relative to Qi”. Derived from the Taoist tradition and influenced by traditional Chinese medicine, Qi Gong incorporates practices of meditation, visualisation and charismatic healing.

The origins of Qi Gong date back to ancient China, evolving over the millennia. Popularised in the 20th century, Qi Gong was promoted by Liu Guizhen. The Communist regime adopted it as a popular therapy, unlike Western medicine. Although it was repressed during the Cultural Revolution, it regained popularity in the 1970s. It is seen as a means ofimproving public health.

Qi Gong comes in many forms. These include Shaolin Wu shu Kung-fu, the Eight Pieces of Brocade and Yi jin jing. They are adapted to the specific needs of each individual. The claimed effects range from preventing and curing disease toincreasing longevity and personal development. This practice aims to harmonise the body, breathing and consciousness. It helps to improve vital functions, manage stress and emotions, and maintain flexibility and balance.

Qi Gong is considered a gentle method that is accessible to all, and is recommended for a variety of health purposes, from strengthening muscles to improving sleep and chronic illnesses. However, people with specific health problems are advised to consult a doctor before taking up Qi Gong.

Acupuncture, an age-old practice

Acupuncture, which stems from the Chinese medical tradition, is often classed as a pseudo-science. This method, based on the stimulation of specific areas of the epidermis called ” acupuncture points “, mainly uses needles and sometimes other physical or physico-chemical means. Alternative techniques such asapipuncture present more risks. Despite its long history in Asia, the effectiveness of acupuncture has only been scientifically proven as a placebo effect.

The theoretical foundations of acupuncture include the five wu xing elements (wood, fire, earth, metal, water) and the six climatic energies. It aims to balance yin and yang, focusing on the body’s meridians and points. However, the clinical effectiveness of these methods remains controversial.

Historically, although rooted in Asia, acupuncture spread to Europe in the 17th century, and in 2010 was listed byUNESCO as part of humanity’s intangible cultural heritage. However, most scientific studies do not confirm its effectiveness beyond the placebo effect. The neuro-hormonal theories put forward to explain its action remain in the minority and unconfirmed.

Acupuncture carries risks associated with inappropriate practices or a lack of asepsis. To reduce these risks, the West favours the use ofsterile, single-use needles. In China, it is part of a university curriculum parallel to modern medicine. In France, it is legally reserved for certain health professionals.

Although acupuncture is used as a complement to conventional treatments, its place in modern medicine is open to debate. Derivative methods such asacupressure, shiatsu and Tui-Na share similar principles.Laser acupuncture, which is more modern, is also the subject of debate as to its effectiveness. Overall, acupuncture remains a subject of debate in the context of contemporary medicine.

Moxibustion

Moxibustion is a technique of heat stimulation of acupuncture points using moxa, a heating object traditionally made from mugwort (Artemisia argyi). The term moxa derives from the Japanese mogusa, meaning ‘burning herbs’.

Historically, moxibustion, mentioned in the Huangdi Nei Jing, an ancient Chinese medical text, dates back to the era of stone punches, before the use of metal needles. It was also used in Buddhism for initiation rituals. During the Ming dynasty, moxibustion was commonly used in conjunction with acupuncture. In the 17th century, moxibustion became popular in Europe, where it was appreciated for its benefits against gout. In the 19th century, moxibustion was widely used in France to stimulate the nervous system, particularly for chronic illnesses. Today, moxibustion is mainly associated with Chinese medicine, and has been declared a UNESCO World Heritage Site.

The traditional method uses mugwort in different forms: moxibustion cigars, small cones or pellets. The technique aims to activate and circulate the Qi (energy) and blood in the meridians. Moxibustion is reputed to relieve a variety of ailments, including muscular pain, digestive and respiratory disorders, and certain skin problems.

A moxibustion session, often performed in winter to boost the immune system, can be done alone or in conjunction with acupuncture. It is painless, with the heat penetrating deeply but remaining lukewarm. The practitioner assesses the patient’s sensitivity and may even advise the use of moxas at home.

As a preventive measure, regular stimulation of the lumbar region with a moxa belt and point 36 E (Zu San Li) is recommended to restore energy. However, for specific pathologies, it is advisable to consult a qualified professional.

Chinese Pharmacopoeia

The Chinese Pharmacopoeia, considered a national treasure in China, is the first approach chosen in traditional Chinese medicine (TCM). Drawing on over 3,000 years of experience, it includes around 300 commonly used products among the thousands available.

The West discovered TCM mainly throughacupuncture and TuiNa massage, but the Chinese Pharmacopoeia is much more than that. It embodies the intimate relationship between the Chinese Wise Men and Nature, through which they explored the benefits offered by the Earth.

This pharmacopoeia is based on the energetic principle that everything in the Universe is Energy. Each raw material is seen as a unique energetic entity, and their combination aims to balance Man’s energy levels and harmonise his integration into the Universe.

The Masters classified each product according to specific criteria such as Flavour, Nature or Tropism. Their analyses were also based on the structure, place of growth, assimilation and sometimes even the shape or colour of the products.

In Chinese Pharmacopoeia, products are treated specifically. They can be used raw or after treatment to optimise or reduce their effects, make them more digestible, and facilitate their use and conservation. These products are combined to create specific therapeutic effects, in different forms such as decoctions, powders, pastes, liqueurs and infusions.

The classification of plants in TCM is based on key elements. Among these, the Four Natures (Si Qi), the Flavours and the Meridians are essential. This method also includes the Six Excesses (Li Yin) and the Seven Feelings (Qi Qing). The approach is holistic: it considers various factors. These factors include climatic and emotional conditions, as well as epidemic diseases.Diet, work,inactivity and trauma also play a role. In this way, Chinese pharmacopoeia is a complex and integrated medical practice.

Prescription rules

Chinese Pharmacopoeia preparation procedures go beyond simply preserving and facilitating use, as is often the case in the West. In China, these methods are specifically aimed at revealing and modulating the properties of ingredients, by selecting and adjusting their effects, amplifying or reducing them, while eliminating undesirable effects. For example, Rhizoma Cyperi (Xiang Fu) demonstrates the importance of these methods. When cooked in vinegar, Xiang Fu helps to drain the Liver and reduce pain. When cooked with ginger juice, it acts on dampness stagnation. If cooked with wine, it penetrates the Meridians, while cooked with salt, it moistens the Dry Blood. Finally, cooked with charcoal, it is used to stop uterine bleeding.

Objectives

The Chinese Pharmacopoeia aims to achieve various objectives through the meticulous preparation of its remedies. These include

• Cleaning and Conditioning: Removing impurities and unnecessary parts from plants. This includes washing, soaking to remove soil, dividing into large pieces, and cutting hard parts into small pieces. Damaged or useless parts are also removed, such as the bark of certain plants.
• Activation and Assimilation: Grind and reduce to a fine powder for better assimilation, especially for minerals, shells, animal carapaces and scales.
• Preservation: Drying can be done in the shade, in the sun, or by the heat of a gentle fire, suitable in particular for flowers and insects. Store in a cool, dark, dry place.
• Odour Elimination: Methods such as cooking with wheat bran can be used to eliminate unpleasant odours.
• Toxicity Reduction: Reduce toxic effects and side effects. For example, preparing Rhizoma Pinelliae with ginger juice to reduce throat irritation, or using washing processes to reduce the toxicity of Radix Aconiti.
• Modification of properties: Change the characteristics of medicines to adjust their therapeutic action. For example, Radix Rehmanniae can be transformed from cold to hot, changing its use from heat clarifier to nourishing tonic.
• Therapeutic Optimisation: Choosing the method of preparation to maximise therapeutic efficacy. This allows the active ingredients to be released more effectively or the action of the product to be reinforced. For example, vinegar can increase the efficacy of the alkaloids in Rhizoma Corydalis. Similarly, preparing Rhizoma Pinelliae with ginger increases its anti-vomiting action.

Preparing the remedies

Chinese Pharmacopoeia uses a variety of preparation processes adapted to each product, which may involve water, heat or a combination of the two. Here are some key examples:

1. High Temperature Roasting (Wei): Wrap the product in wet paper, paste or clay and heat until the wrapping is charred. Used to remove the oils from drugs and moderate their action on intestinal transit, as with Radix Saussureae.
2. Braising (Zhi): Long cooking of the product with adjuvants to modify its characteristics, reinforce the desired actions and reduce side effects.
3. Common adjuvants:
4. Honey: Used to enhance the tonic power of Radix Astragali and Radix Glycyrrhizae, as well as the antitussive action of Radix Stemonae and Flos Farfarae.

• • Chinese wine: Increases the action of Rhizoma Ligustici wallichii on blood circulation and reduces the emetic effect of Radix Dichroae.
  • Vinegar: Improves the effectiveness of Rhizoma Cyperi in draining the Liver and reducing pain.
  • Salt Water: Helps Cortex Eucommiae and Rhizoma Anemarrhenae to better tone the Kidney.
  • Ginger juice: Reinforces the action of Rhizoma Cyperi on dampness stagnation.

These sophisticated preparation methods demonstrate the holistic and detailed approach of Chinese pharmacopoeia in the handling and use of natural remedies.

The main properties sought

The Chinese Pharmacopoeia classifies its elements according to their unique properties. These properties fall into four main groups.

• Firstly, the Four Temperaments (Si Xing), which are aligned with the Eight Rules (Ba Gang) of diagnosis. These temperaments are Cold (Han), Cool (Liang), Hot/Heat (Re), and Lukewarm/Cold (Wen). For example, Radix Coptidis (Huang Lian) is categorised as cold. It clarifies Heat and releases poison (Qing Re Jie Du).
• The Five Flavours (Wu Wei): Comprising pungent, sweet, bitter, sour, salty, and neutral, each flavour has specific effects. For example, the pungent flavour disperses Qi and blood, while the sweet flavour tones and harmonises the Middle Heater.
• Directional Tendencies: Classifying symptoms according to their natural direction in the body, such as rising (vomiting) or falling (diarrhoea). Four main trends are identified: Ascending, Descending, Towards the Surface, and Towards the Internal. Preparation of the ingredients can modify these tendencies, as cooking with wine favours elevation.
• Preferred Places of Action: Linking symptoms to specific viscera and their corresponding meridians. For example, diarrhoea is linked to the Spleen. The components act according to their temperament, flavour, directional tendency and target meridian.

These categorisations reflect the complexity and richness of Chinese medicine, providing a detailed, holistic understanding of the properties and therapeutic effects of medicinal ingredients.

The components

Neutralisation reduces toxicity, such as Rhizoma Zingiberis recens (Sheng Jiang) which reduces the toxicity of Rhizoma Pinelliae recens (Sheng Ban Xia). In contrast, incompatibility between two components can create a toxic mixture. For example, Semen Raphani (Lai Fu Zi) reduces the action of Radix Ginseng (Ren Shen).

The Chinese Pharmacopoeia, with its complex preparation processes and detailed medicinal combinations, reflects a sophisticated, holistic approach to medicine, emphasising a deep understanding of the properties and interactions of natural components in the treatment of disease.

Remedies and phytotherapy

The Chinese Pharmacopoeia uses plants, minerals and animal parts in complex formulas, where each ingredient plays a specific role in treating the patient’s syndrome. Traditional formulas are designed to precisely match the patient’s overall condition, minimising side effects. The toxicity of the ingredients is monitored during the preparation of the remedies, ensuring safe use. This approach underlines the importance of a well-established prescription to avoid incompatibilities between plants and guarantee effective treatment with no adverse effects.

Establishing a formula

In the Chinese Pharmacopoeia, the composition of a formula is a precise science, where each ingredient has a specific role and follows an established hierarchy. Ingredients are classified as Emperor (Jun), Minister (Chen), Assistant (Zuo) and Ambassador (Shi). TheEmperor is the main component, treating the fundamental aspect of the pathology with the highest dosage. The Minister complements the Emperor, targeting a specific aspect of the disease. TheAssistant reinforces or specialises the effects of the Emperor and the Minister, or moderates their toxicity and side-effects. Finally, theAmbassador directs the therapeutic effects to a targeted area and harmonises the formula. The composition varies according to need, with formulas containing several Emperors or Ministers and various Assistants.

The classification of formulas in Traditional Chinese Medicine is diverse. It includes formulas for releasing biao, clarifying Heat, warming the interior, transforming Mucus, treating coughs and asthma, and more. Specific formulas are designed to mobilise Blood, stop bleeding and harmonise. Dedicated formulas are used in gynaecology. They are also used to calm the spirit, treat dryness, tonify qi, blood, yang and yin, and eliminate parasites.

Among the historical formulas, the Gui Zhi Tang stands out. Taken from the “Shanghan Lun” (Treatise on Cold Attacks), this text was written at the beginning of the 3rd century by Zhang Zhongjing. Recognised as one of the four fundamental classics of Chinese medicine, it demonstrates the complexity and nuance of this traditional pharmacopoeia.

Shang Han Lun

The Shang Han Lun, a key text in Chinese medicine, was written by Zhang Ji. The work focuses on diseases of external origin. It covers their aetiology, diagnosis, course and treatment. It is famous for having introduced 287 medicinal formulas that are still in use, marking a significant advance in combining theory and clinical practice. This work is a cornerstone of medical training in China, and is essential for all students of Chinese medicine.

Zhang Ji developed the theory that external diseases progress through six distinct stages: Tai Yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin, and Jue Yin. Each stage is characterised by specific syndromes, identifiable by unique signs and symptoms, enabling a precise diagnosis to be made.

The first three stages, called San Yang, concern the six Yang Organs. They relate to more superficial illnesses. In contrast, the last three stages – Tai Yin, Shao Yin, and Jue Yin (the Three Yins) – affect the five Yin Organs. These stages suggest a deeper illness. Zhang Ji noted that symptoms vary. This variation depends on the strength of the external pathogenic factor in relation to Zheng Qi (the correct vital energy). It also depends on how deeply the disease has penetrated the body.

In the Yang stages, where the Zheng Qi is strong but faced with a dominant external pathogenic factor, symptoms of excess and heat are observed. Conversely, in the Yin stages, the decline in Zheng Qi leads to symptoms of cold and deficiency. Treatment is then aimed at eliminating the pathogenic factor or strengthening the Zheng Qi, depending on the case.

During the Song Dynasty, the Shang Han Lun was called into question due to numerous fatal epidemics, attributed to migration and increased trade. This period saw the emergence of the Wen Bing theory, which proposed a different approach to illness.

Wen Yi Lun or Wen Bing

Wu Youxing developed the Wen Bing theory in his 1642 work, the “Wen Yi Lun”. This theory challenged the idea that diseases were caused by climatic changes. Instead, Wu Youxing focuses on invisible ‘pestilential Qi’ in the environment. These Qi, which are varied and virulent, are transmitted rapidly and regardless of an individual’s age or health.

Wu has identified four key stages in the progression of disease in the body. They go from the surface to the depths, encompassing the Protection/Defence Layer (Wei Qi Fen), the Qi Layer (Qi Fen), the Nourishing Qi Layer (Ying Fen), and finally the Blood Layer (Xue Fen). Each layer is characterised by specific syndromes, reflecting the degree of penetration of the disease.

The Wen Bing theory differs from the Shang Han Lun in that it focuses on the penetration of the disease into the body. Unlike Western medicine, which targets specific pathogens, Chinese medicine analyses the body’s general reaction. It groups symptoms together for diagnosis and appropriate treatment, and to predict the course of the disease. This approach makes it possible to control the progress of the disease, sometimes using cooling methods to prevent it worsening.

Chinese Pharmacopoeia plants used in Europe

Traditional Chinese medicine (TCM), with its two thousand years of history, has evolved through the contributions of Chinese pharmacopoeia and the influences of Arab-Persian, European and American cultures. Since 2000, a Franco-Chinese project has included fifty Chinese plants in the French pharmacopoeia. In addition, around sixty plants are included in the European Pharmacopoeia.

Various historical Chinese pharmacopoeias played a key role in the development of TCM. Works such as Shennong’s ” Book of Medical Matter ” were crucial. The latest English edition of the Official Pharmacopoeia of the People’s Republic of China (PPRC), published in 2015, is divided into four volumes. They cover Chinese Materia Medica, conventional pharmaceuticals, biologicals, and include various appendices.

The first volume of the PPRC includes 2,598 monographs on single-ingredient medicines. These medicines come from plant, fungal, animal or mineral sources. Since 2005, the European Pharmacopoeia Commission has been developing modern quality standards for these medicines, thus ensuring their safety and pharmaceutical quality.

Published in January 2020, Supplement 10.2 of the European Pharmacopoeia lists 73 Chinese herbal drugs, detailing their botanical and pinyin names. To facilitate quality control, the Commission has authorised semi-quantitative HPTLC evaluations as an alternative to LC assays for traditional Chinese medicines.

Certain plants used in TCM, which are also common in European phytotherapy, were already included in the Ph. Eur., such as ginseng, Chinese cinnamon, ginger, Chinese rhubarb, liquorice and star anise. These integrations illustrate the growing convergence and adoption of TCM practices in traditional and modern medicine.

The case of Aristoloches

Unintentional adulteration of Aristoloches is a serious public health problem.

In the 1990s, a serious public health incident broke out in Belgium and Europe. Many women suffered fromend-stage renal failure after taking weight-loss products. These products, which were supposed to contain Magnolia officinalis and Stephania tetrandra, actually contained Aristolochia fangchi by mistake, due to the similarity of the Chinese names.

Since 2005, the European Pharmacopoeia has been studying plants used in Traditional Chinese Medicine (TCM). In particular, it has produced a monograph on Stephania root, emphasising theabsence of aristolochic acid .Research has revealed a genetic mutation caused by aristolochic acid, a constituent of aristolochia, an extremely toxic Chinese medicinal plant.

This discovery highlights the danger of aristolochia. Used for a long time in Asia, and still on sale in China, it poses serious risks of kidney damage and bladder cancer. Aristolochic acid, known for its carcinogenic properties, has been linked to urinary tract cancers. These cancers are often wrongly attributed to other causes.

In France, the ANSM warns against the consumption of unregulated exotic plant-based preparations. Many countries, including France, have banned the Aristolochia plant because of its toxicity.

Aristolochia clematitis, historically known for its use in childbirth, contains nitrated phenanthrenic derivatives (aristolochic acids). These compounds are nephrotoxic, mutagenic and carcinogenic. Prolonged ingestion ofAristolochia fangchi, often confused with other plants, has caused severe poisoning, kidney failure and urothelial carcinoma. Since 2001, the preparation and sale of products containing Aristolochiaceae or similar substances have been banned.

Sources

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• https://fmtc.fr/home/mtc/
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• http://www.ethnopharmacologia.org/definition/les-pharmacopees-du-monde/les-plantes-de-la-mtc-inscrites-a-la-pharmacopee-europeenne/#:~:text=The main ones are root and star anise (Illicum verum).
• https://www.economie.gouv.fr/files/directions_services/dgccrf/securite/produits_alimentaires/Complement_alimentaire/colloque14oct2011/Expo_Alain_Nicolas.pdf
• CSHPSP Professional Licence Course “Notions of pharmacology in traditional Chinese medicine”