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Common TCM Questions

Q¡GDoes TCM need a longer time to work?

A: While TCM has an advantage in relieving symptoms associated with chronic diseases like diabetes and cancer, it is also good at treating acute conditions. For example, coma from an acute stroke can be treated with acupuncture or a drug made with the gallstone of an ox. Just like western medicine, the period is subject to individual conditions. Chronic diseases need a longer treatment time; for acute diseases or infections, patients can recover in a short period.

Q¡GDoes Chinese medicine always have to have a bitter taste?

A: No. To put it simply, the flavors of Chinese medicine are classified into five types or "five tastes": pungent or hot (ephedra, peppermint and tangerine peel); sweet (liquorice, kudzu root, astragalus root); sour (raspberry fruit, spine date and smoked plum); bitter (dandelion, wild chrysanthemum and motherwort herb); and salty (clam shell, seaweed and cuttlebone). There is a close relationship between the flavor of the herb and its effectiveness.

Pungent medicines have the effect of dispersing and enhancing the flow of qi (energy) and blood, such as in the case of digestive or emotional problems.
2 Sweet medicines have a tonification effect and can be used to alleviate acute conditions.
3 Sour medicines possess astringent, consolidating and cessation effects that can be used to arrest conditions like profuse sweating, incontinence and spermatorrhea.
4 Bitter medicines possess cooling and purgative properties. Therefore, most herbal teas prescribed for fever are bitter.
5 Salty medicines have the effect of softening the hard and dispersing knots. It can release congestion downwards. Herbs in this category are used for conditions like tumors, abdominal masses or fluid retention.

Q¡GSome people after taking tonics experience symptoms such as nasal bleeding; if this occurs, is it the so-called "being deficient, one cannot benefit from tonification"?

A: "When deficient, tonify it" and "when excessive, release/reduce it" are the basic principles of treating diseases in TCM. No matter whether you are treating a disease or keeping your body in balance, it should be noted that tonification methods can only be used in a deficient state. In excess states, e.g. the acute stage of an infection, tonification should be applied with caution.

TCM tonifying methods are mainly used to treat a particular deficiency in the body. Symptoms vary according to the cause, degree of deficiency, and organs involved. Tonifying medicines can be categorized into 4 types: (1) benefiting qi (vital energy); (2) supplementing blood; (3) nourishing the yin; and (4) replenishing yang. If tonification is not done in the appropriate way, the particular deficiency will not be tonified. Individuals should take sweet, cold, yin-nourishing herbs so as to nourish the yin and clear the heat. Yet if this patient by mistake takes spicy, warm and yang-assisting herbs that flare up the fire, further exhausting the yin, it will aggravate the situation, leading the fire evils to irritate the blood and cause nasal bleeding.

Q¡GWhat is a "sub-health state"?

A: A "sub-health state" means that the body is unhealthy but does not fulfill the criteria of illness. For example, people are always complaining about headache, dizziness or fatigue; however on medical examination, nothing appears abnormal. From a TCM perspective, however, the body is already manifesting an imbalance of yin and yang, qi, blood, and the viscera.

In comparison with healthy people, people in a "sub-health state " have a higher rate of developing a psychological or physiological disease. Therefore, prevention and elimination of the "sub-health state" have become one of the most important tasks in TCM. To prevent and treat a state of "sub-health", in addition to paying attention to the healthy state of one's body and mind, having a proper diet, regular sleep and an appropriate amount of exercise, one should also try to detect the early appearance of problems and deal with them early. The "sub-health state" in TCM is classified according to the following categories:
stagnation of liver-qi;
phlegm and dampness generate internally;
deficiencies in the heart and spleen;
deficiency in the lung's protective qi;
deficiencies in the liver and kidney;
deficiencies in the spleen and kidney.
If you want to understand whether you are in any of the "sub-health states" please consult your TCM practitioner. Then they will prescribe a treatment according to your particular type.

Q¡GWhat is acupuncture and moxibustion?

A: Acupuncture and moxibustion are two different methods of treatment. Acupuncture inserts metallic needles into certain designated points on the skin and exerts a healing effect by different manipulation techniques. Moxibustion uses burning moxa or moxa cones (moxa refers to the Chinese mugwort herb) above the skin to warm or heat certain designated points. These designated points are called acu-points in both acupuncture and moxibustion. The chosen points and locations will vary according to the disease. The methods activate the flow of qi (vital energy) and removes blockages in the meridians, so that the body can reach a new balance through its self-healing processes.

Acupuncture can either be used to fortify a weakness or release/reduce an excessive condition. Moxibustion is only suitable for fortifying or removing blockages through its warming effect. Acupuncture works quicker than moxibustion; however, the effect of moxibution lasts longer. Clinically, they are often used together. Sometimes, moxibustion is used to replace acupuncture method, e.g. in cases like umbilical regions that are contraindicated for acupuncture.

Q¡GCan you explain about the toxicity and adverse effects of Chinese medicine?

A: Most people think that Chinese medicine only has a mild action so that no harm will come to you if you take it for a long time. This is absolutely wrong! Improper use of any medicine can lead to adverse effects. For example, when ginseng is used in individuals with fever, skin sores or constipation, the symptoms will become worse. Therefore, it is better to seek professional advice before you take any medicine.

Some recent reports have shown that a Chinese herb, Caulis Aristolochiae Manshuriensis (Guan mu tong), contains a toxic ingredient called Arisolochic Acid, which can cause kidney failure. It should be noted that a common herb used by TCM is Caulis Clematidis Armandii (Chuan mu tong), the two are different species. Furthermore, TCM will use some toxic herbs in complicated cases, for example, Radix Aconiti Lateralis Preparata (fu zi) and Radix Aconiti (chuan wu) are used to treat rheumatoid arthritis; special attention should be paid to the dosage and preparation procedures for these herbs in order to avoid side effects. Therefore it is important to monitor the quality of Chinese herbs.

Q¡GCan TCM practitioners diagnose every illness just by taking the pulse?

A: Pulse-taking has a vital role in disease diagnosis. However, just relying on this will only tell you part of the story. For example, the "rolling pulse" is a usual sign in pregnant women; however it can also be seen in patients who have dampness in their intestines and stomach.

In order to make an accurate diagnosis, it is necessary to combine the four methods of diagnosis: (1) inspection ¡V observe anything unusual about the patient's appearance; (2) listening and smelling ¡V listen to the patient's voice and notice how they smell; (3) questioning ¡V asking the patient about their medical history and symptoms; and (4) palpitation ¡V finding out the pulse rate and its nature as well as by pressing the skin, hands, feet, chest and abdominal areas to check for pathological changes. A comprehensive view of all the body's symptoms and signs has to be undertaken before any diagnosis can be made.

Q¡GA TCM practitioner can use various and even totally different prescriptions to treat the same disease. How do you explain that?

A: First of all, TCM stresses the uniqueness of each patient in the treatment of disease, so the amount and contents of formulas used could either increase or decrease according to the individual.

Secondly, TCM views what we called a disease representing the entire course of pathological changes whereas a syndrome reflects the pathology of a disease at a certain stage. A TCM syndrome is a complex disharmony pattern of signs and symptoms that manifest at a given stage of the disease. The TCM practitioner treats a syndrome instead of a disease. For example, the common cold or flu has different syndromes according to TCM understanding, such as wind-cold syndrome, wind-heat type syndrome or low-resistance syndrome. As a result, various therapeutic strategies are employed and different prescriptions will be used among patients; this is called treatment based on syndrome differentiation.

Q¡GChinese herbs are said to have 4 energies: cold, cool, warm, and hot. So is the food in our daily diet classified in the same way?

A: Medicines and foods share the same origins and they both can be used as medicine. Therefore, foods can also be classified into cold, cool, warm and hot energies. Actually, most foods have a neutral nature; however certain foods have extreme energies, for example, cold foods include bamboo shoot, banana, bitter gourd, clam, crab, grapefruit, kelp, lettuce, muskmelon, persimmon, salt, seaweed, star fruit, sugarcane, water chestnut, watermelon and lotus root; hot foods include peppers, chili, cinnamon, cottonseed, ginger and chives. It is important to know about the energies of food because different energies act upon the human body in different ways and affect the state of health. If a person suffers from cold rheumatism and the pain is particularly severe on a cold winter's day, eating foods with warm or hot energy shall relieve the pain considerably. Or if a person suffers from skin eruptions that worsen when exposed to heat, it is beneficial to eat food with a cold or cool energy to relieve symptoms.

Q¡GTCM uses herbs to treat disease but not on the basis of their chemical components. So on what is the principle of disease treatment in Chinese medicine?

A: This is the major difference between Western and Chinese medicine. Generally, TCM treatments focus on the overall state of the body, rather than pinpoint a specific pathogen that may cause the condition. This focus on the overall state of the body is done according to set principles.

Firstly, practitioners definite the nature a disease into yin, yang, exterior, interior, cold, heat, deficiency (xu) and excess (shi) which summarize the location and pathological changes as well as the course of the disease. Then they use certain properties of a particular Chinese medicine, what they call energy, flavor, movement, and therapeutic action on a certain meridian to draft the appropriate formulae. Every type of Chinese medicine has a particular energy: cold, hot, warm, and cool; it also has a particular taste: spicy, sweet, sour, bitter, salty; they also have ascending, descending, floating and sinking properties and their corresponding targeted meridians. Practitioners use these properties of herbs to stimulate the body's self-healing power, and make the body resume its balance. The medicinal nature of substances has been determined through years of accumulated experience.

Chinese herbs rely on their unique properties to counteract the opposite nature of the disease, and make the body shift to a new balance. For example, herbs that can treat or eliminate heat or hot syndromes mostly have a cold or cool nature, such as baical skullcap and isatis root. Herbs that can treat or eliminate cold syndromes mostly have a warm or hot nature, such as monkshood and ginger. As the Shennong Bencaojing (Classic of Herbal Medicine) says, "Treat cold disease with hot medicines and treat hot diseases with cold medicines." The Su Wen (Book of Plain Questions) also states: "Treat cold with heat and heat with cold." These are the basic principles in prescribing medicines.

Q¡GIt is said that traditional Chinese medicines have no side effects and that using them for a long time will not harm our health. Therefore, even if the medicine doesn't match the symptoms, they don't do much harm. Is this true?

A: In treating diseases, Chinese medicines restore the yin-yang balance of the human body through their different natures. All medicines have their own particular nature and some degree of toxicity. Improper use will lead to extreme energy excess inside the body and disturb the yin-yang balance.

Q¡GIsn't Chinese medicine mainly just bitter decoctions?

A: Chinese medicine has always taken many different forms. These forms developed because of their different processing methods. The most common forms are: decoction, soft extracts, pastes, granules, boluses, powders, syrups, lotions and tablets. In clinical application, the appropriate forms will be prescribed according to the nature of the disease.

TCM Principles
TCM Diagnosis
Internal Medicine of TCM
Chinese Meteria Medica
Formulae of TCM
Published by Shanghai Science and Technology Publishing House, 6th edition.

Written by:
Shirley Yau, Enid Cheung, Ivy Poon, Janie Wong & Ray Chan.
CM Promotion Group - School of Chinese Medicine, CUHK.

Translated and Edited by:
Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd.
Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.
Rose Tse, Integrated Chinese Medicine Holdings Ltd.