Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. A large share of its claims are pseudoscientific, with the majority of treatments having no robust evidence of effectiveness or logical mechanism of action. Some TCM ingredients are known to be toxic and cause disease, including cancer. Medicine in traditional China encompassed a range of sometimes competing health and healing practices, folk beliefs, literati theory, Taoist and Confucian philosophy, herbal remedies, food, diet, exercise, medical specializations, and schools of thought. TCM as it exists today has been described as a largely 20th century invention. In the early twentieth century, Chinese cultural and political modernizers worked to eliminate traditional practices as backward and unscientific. Traditional practitioners then selected elements of philosophy and practice and organized them into what they called "Chinese medicine". In the 1950s, the Chinese government sought to revive traditional medicine (including legalizing previously banned practices) and sponsored the integration of Chinese and Western medicine. In the Cultural Revolution of the 1960s, the government promoted TCM as inexpensive and popular. This was largely spearheaded by Mao Zedong, despite the fact that, according to The Private Life of Chairman Mao, he did not believe in its effectiveness. After the opening of relations between the United States and China after 1972, there was great interest in the West for what is now called traditional Chinese medicine (TCM). TCM is said to be based on such texts as Huangdi Neijing (The Inner Canon of the Yellow Emperor), and Compendium of Materia Medica, a sixteenth-century encyclopedic work, and includes various forms of herbal medicine, acupuncture, cupping therapy, gua sha, massage (tui na), bonesetter (die-da), exercise (qigong), and dietary therapy. TCM is widely used in the Sinosphere. One of the basic tenets is that the body's qi is circulating through channels called meridians having branches connected to bodily organs and functions. There is no evidence that meridians or vital energy exist. Concepts of the body and of disease used in TCM reflect its ancient origins and its emphasis on dynamic processes over material structure, similar to the humoral theory of ancient Greece and ancient Rome. The demand for traditional medicines in China is a major generator of illegal wildlife smuggling, linked to the killing and smuggling of endangered animals. The Chinese authorities have engaged in attempts to crack down on illegal TCM-related wildlife smuggling.
Ancient history
Scholars in the history of medicine in China distinguish its doctrines and practice from those of present-day TCM. J. A. Jewell and S. M. Hillier state that the term "Traditional Chinese Medicine" became an established term due to the work of Dr. Kan-Wen Ma, a Western-trained medical doctor who was persecuted during the Cultural Revolution and immigrated to Britain, joining the University of London's Wellcome Institute for the History of Medicine. Ian Johnson says, on the other hand, that the English-language term "traditional Chinese medicine" was coined by "party propagandists" in 1955. Nathan Sivin criticizes attempts to treat medicine and medical practices in traditional China as if they were a single system. Instead, he says, there were 2,000 years of "medical system in turmoil" and speaks of a "myth of an unchanging medical tradition". He urges that "Traditional medicine translated purely into terms of modern medicine becomes partly nonsensical, partly irrelevant, and partly mistaken; that is also true the other way around, a point easily overlooked." TJ Hinrichs observes that people in modern Western societies divide healing practices into biomedicine for the body, psychology for the mind, and religion for the spirit, but these distinctions are inadequate to describe medical concepts among Chinese historically and to a considerable degree today. The medical anthropologist Charles Leslie writes that Chinese, Greco-Arabic, and Indian traditional medicines were all grounded in systems of correspondence that aligned the organization of society, the universe, and the human body and other forms of life into an "all-embracing order of things". Each of these traditional systems was organized with such qualities as heat and cold, wet and dry, light and darkness, qualities that also align the seasons, compass directions, and the human cycle of birth, growth, and death. They provided, Leslie continued, a "comprehensive way of conceiving patterns that ran through all of nature," and they "served as a classificatory and mnemonic device to observe health problems and to reflect upon, store, and recover empirical knowledge," but they were also "subject to stultifying theoretical elaboration, self-deception, and dogmatism." The doctrines of Chinese medicine are rooted in books such as the Yellow Emperor's Inner Canon and the Treatise on Cold Damage, as well as in cosmological notions such as yin–yang and the five phases. The Compendium of Materia Medica dates back to around 1,100 BCE when only a few dozen drugs were described. By the end of the 16th century, the number of drugs documented had reached close to 1,900. And by the end of the last century, published records of CMM had reached 12,800 drugs." Starting in the 1950s, these precepts were standardized in the People's Republic of China, including attempts to integrate them with modern notions of anatomy and pathology. In the 1950s, the Chinese government promoted a systematized form of TCM.
Shang dynasty Traces of therapeutic activities in China date from the Shang dynasty (14th–11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other health practices, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, and such. Shang elites usually attributed them to curses sent by their ancestors. There is currently no evidence that the Shang nobility used herbal remedies. Stone and bone needles found in ancient tombs led Joseph Needham to speculate that acupuncture might have been carried out in the Shang dynasty. This being said, most historians now make a distinction between medical lancing (or bloodletting) and acupuncture in the narrower sense of using metal needles to attempt to treat illnesses by stimulating points along circulation channels ("meridians") in accordance with beliefs related to the circulation of "Qi". The earliest evidence for acupuncture in this sense dates to the second or first century BCE.
Han dynasty The Yellow Emperor's Inner Canon (Huangdi Neijing), the oldest received work of Chinese medical theory, was compiled during the Han dynasty around the first century BCE on the basis of shorter texts from different medical lineages. Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on the relation between humans, their environment, and the cosmos, on the contents of the body, on human vitality and pathology, on the symptoms of illness, and on how to make diagnostic and therapeutic decisions in light of all these factors. Unlike earlier texts like Recipes for Fifty-Two Ailments, which was excavated in the 1970s from the Mawangdui tomb that had been sealed in 168 BCE, the Inner Canon rejected the influence of spirits and the use of magic. It was also one of the first books in which the cosmological doctrines of Yinyang and the Five Phases were brought to a mature synthesis. The Treatise on Cold Damage Disorders and Miscellaneous Illnesses (Shang Han Lun) was collated by Zhang Zhongjing sometime between 196 and 220 CE; at the end of the Han dynasty. Focusing on drug prescriptions rather than acupuncture, it was the first medical work to combine Yinyang and the Five Phases with drug therapy. This formulary was also the earliest public Chinese medical text to group symptoms into clinically useful "patterns" (zheng 證) that could serve as targets for therapy. Having gone through numerous changes over time, the formulary now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty. Nanjing or "Classic of Difficult Issues", originally called "The Yellow Emperor Eighty-one Nan Jing", ascribed to Bian Que in the eastern Han dynasty. This book was compiled in the form of question-and-answer explanations. A total of 81 questions have been discussed. Therefore, it is also called "Eighty-One Nan". The book is based on basic theory and has also analyzed some disease certificates. Questions one to twenty-two is about pulse study, questions twenty-three to twenty-nine is about meridian study, questions thirty to forty-seven is related to urgent illnesses, questions forty-eight to sixty-one is related to serious diseases, questions sixty-two to sixty-eight is related to acupuncture points, and questions sixty-nine to eighty-one is related to the needlepoint methods. The book is credited as developing its own path, while also inheriting the theories from Huangdi Neijing. The content includes physiology, pathology, diagnosis, treatment contents, and a more essential and specific discussion of pulse diagnosis. It has become one of the four classics for Chinese medicine practitioners to learn from and has impacted the medical development in China. Shennong Ben Cao Jing is one of the earliest written medical books in China. Written during the Eastern Han dynasty between 200 and 250 CE, it was the combined effort of practitioners in the Qin and Han dynasties who summarized, collected and compiled the results of pharmacological experience during their time periods. It was the first systematic summary of Chinese herbal medicine. Most of the pharmacological theories and compatibility rules and the proposed "seven emotions and harmony" principle have played a role in the practice of medicine for thousands of years. Therefore, it has been a textbook for medical workers in modern China. The full text of Shennong Ben Cao Jing in English can be found online.
Post-Han dynasty In the centuries that followed, several shorter books tried to summarize or systematize the contents of the Yellow Emperor's Inner Canon. The Canon of Problems (probably second century CE) tried to reconcile divergent doctrines from the Inner Canon and developed a complete medical system centered on needling therapy. The AB Canon of Acupuncture and Moxibustion (Zhenjiu jiayi jing 針灸甲乙經, compiled by Huangfu Mi sometime between 256 and 282 CE) assembled a consistent body of doctrines concerning acupuncture; whereas the Canon of the Pulse (Maijing 脈經; c. 280) presented itself as a "comprehensive handbook of diagnostics and therapy." Around 900–1000 AD, Chinese were the first to develop a form of vaccination, known as variolation or inoculation, to prevent smallpox. Chinese physicians had realised that when healthy people were exposed to smallpox scab tissue, they had a smaller chance of being infected by the disease later on. The common methods of inoculation at the time was through crushing smallpox scabs into powder and breathing it through the nose. Prominent medical scholars of the post-Han period included Tao Hongjing (456–536), Sun Simiao of the Sui and Tang dynasties, Zhang Jiegu (c. 1151–1234), and Li Shizhen (1518–1593).
Modern history
Chinese communities under colonial rule Chinese communities living in colonial port cities were influenced by the diverse cultures they encountered, which also led to evolving understandings of medical practices where Chinese forms of medicine were combined with Western medical knowledge. For example, the Tung Wah Hospital was established in Hong Kong in 1869 based on the widespread rejection of Western medicine for pre-existing medical practices, although Western medicine would still be practiced in the hospital alongside Chinese medicinal practices. The Tung Wah Hospital was likely connected to another Chinese medical institution, the Kwong Wai Shiu Hospital of Singapore, which had previous community links to Tung Wah, was established for similar reasons, and also provided both Western and Chinese medical care. By 1935, English-language newspapers in Colonial Singapore already used the term "Traditional Chinese Medicine" to label Chinese ethnic medical practices. In the Chinese Communist Party-controlled areas prior to the founding of the People's Republic of China, there was a lack of access to Western-style medical resources. To improve health care, the Chinese Communist Party (CCP) promoted the integration of traditional Chinese medicine with Western medical science. In the Yan'an Soviet, mass campaigns sought to "scientize Chinese medicine" and "make Western medicine Chinese."
People's Republic In 1950, CCP chairman Mao Zedong announced support of traditional Chinese medicine; this was despite the fact that Mao did not personally believe in and did not use TCM, according to his personal physician Li Zhisui. In 1952, the president of the Chinese Medical Association said that, "This One Medicine, will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements – and will be China's New Medicine!" During the Cultural Revolution (1966–1976), the CCP and the government emphasized modernity, cultural identity, and China's social and economic reconstruction and contrasted them to the colonial and feudal past. The government established a grassroots health care system as a step in the search for a new national identity, tried to revitalize traditional medicine, and made large investments in traditional medicine to try to develop affordable medical care and public health facilities. The Ministry of Health directed health care throughout China and established primary care units. Chinese physicians trained in Western medicine were required to learn traditional medicine, while traditional healers received training in modern methods. This strategy aimed to integrate modern medical concepts and methods and revitalize appropriate aspects of traditional medicine. Therefore, traditional Chinese medicine was re-created in response to Western medicine.
In 1968, the CCP supported a new system of health care delivery for rural areas. Villages were assigned a barefoot doctor (a medical staff with basic medical skills and knowledge to deal with minor illnesses) responsible for basic medical care. The medical staff combined the values of traditional China with modern methods to provide health and medical care to poor farmers in remote rural areas. The barefoot doctors became a symbol of the Cultural Revolution, for the introduction of modern medicine into villages where traditional Chinese medicine services were used. The barefoot doctor system represents a hybrid of modern and traditional Chinese medicine (Chinese: 中西医结合; lit. 'Chinese western medicine combination', usually translated "Integrative Chinese Medicine"), a guiding principle that has far outlived the barefoot doctor system. Nathan Sivin's 1987 translation of Revised Outline of Chinese Medicine: For Western-medicine practitioners to learn Chinese medicine (新编中医学概要：供西医学习中医用; 1972) serves as a good, though outdated, example of this principle in practice. The State Intellectual Property Office (now known as CNIPA) established a database of patents granted for traditional Chinese medicine. In the second decade of the twenty-first century, Chinese Communist Party general secretary Xi Jinping strongly supported TCM, calling it a "gem". As of May 2011, in order to promote TCM worldwide, China had signed TCM partnership agreements with over 70 countries. His government pushed to increase its use and the number of TCM-trained doctors and announced that students of TCM would no longer be required to pass examinations in Western medicine. Chinese scientists and researchers, however, expressed concern that TCM training and therapies would receive equal support with Western medicine. They also criticized a reduction in government testing and regulation of the production of TCMs, some of which were toxic. Government censors have removed Internet posts that question TCM. In 2020 Beijing drafted a local regulation outlawing criticism of TCM. According to Caixin, the regulation was later passed with the provision outlawing criticism of TCM removed. Traditional Chinese Medicine does not reflect ancient medical practice, instead being a modern selection from very diverse traditions, with "a minimal vestige of ideas and practices" having been retained from them.
Hong Kong
At the beginning of Hong Kong's opening up, Western medicine was not yet popular, and Western medicine doctors were mostly foreigners; local residents mostly relied on Chinese medicine practitioners. In 1841, the British government of Hong Kong issued an announcement pledging to govern Hong Kong residents in accordance with all the original rituals, customs and private legal property rights. As traditional Chinese medicine had always been used in China, the use of traditional Chinese medicine was not regulated. The establishment in 1870 of the Tung Wah Hospital was the first use of Chinese medicine for the treatment in Chinese hospitals providing free medical services. As the promotion of Western medicine by the British government started from 1940, Western medicine started being popular among Hong Kong population. In 1959, Hong Kong had researched the use of traditional Chinese medicine to replace Western medicine.
Historiography of Chinese medicine The study of traditional medicine in China is an academic field within the history of science, with its own scholarly associations, journals, graduate programs, and debates with each other. These scholars distinguish traditional medicine in historical China from the more recent traditional Chinese medicine (TCM), which took elements from traditional texts and practices to construct a systematic body. Paul Unschuld, for instance, sees a "departure of TCM from its historical origins." What is called "Traditional Chinese Medicine" and practiced today in China and the West is not thousands of years old, but recently constructed using selected traditional terms, some of which have been taken out of context, some badly misunderstood. He has criticized Chinese and Western popular books for selective use of evidence, choosing only those works or parts of historical works that seem to lead to modern medicine, ignoring those elements that do not now seem to be effective. Historians have noted two key aspects of Chinese medical history: understanding conceptual differences when translating the term 身, and observing the history from the perspective of cosmology rather than biology. In Chinese classical texts, the term 身 is the closest historical translation to the English word "body" because it sometimes refers to the physical human body in terms of being weighed or measured, but the term is to be understood as an "ensemble of functions" encompassing both the human psyche and emotions. This concept of the human body is opposed to the European duality of a separate mind and body. It is critical for scholars to understand the fundamental differences in concepts of the body in order to connect the medical theory of the classics to the "human organism" it is explaining. Chinese scholars established a correlation between the cosmos and the "human organism". The basic components of cosmology, qi, yin yang and the Five Phase theory, were used to explain health and disease in texts such as Huangdi neijing. Yin and yang are the changing factors in cosmology, with qi as the vital force or energy of life. The Five Phase theory (Wuxing) of the Han dynasty contains the elements wood, fire, earth, metal, and water. By understanding medicine from a cosmology perspective, historians better understand Chinese medical and social classifications, such as gender, which was defined by a domination or remission of yang in terms of yin. These two distinctions are imperative when analyzing the history of traditional Chinese medical science. A majority of Chinese medical history written after the classical canons comes in the form of primary source case studies where academic physicians record the illness of a particular person and the healing techniques used, as well as their effectiveness. Historians have noted that Chinese scholars wrote these studies instead of "books of prescriptions or advice manuals." In their historical and environmental understanding, no two illnesses were alike, so the healing strategies of the practitioner were unique every time to the specific diagnosis of the patient. Medical case studies existed throughout Chinese history, but "individually authored and published case history" was a prominent creation of the Ming dynasty. An example of such case studies would be the literati physician, Cheng Congzhou, collection of 93 cases published in 1644.
Critiques Critics say that TCM theory and practice have no basis in modern science, and that TCM practitioners do not agree on what diagnosis and treatments should be used for any given person. A 2007 editorial in the journal Nature wrote that TCM "remains poorly researched and supported, and most of its treatments have no logical mechanism of action." It also described TCM as "fraught with pseudoscience". A review of the literature in 2008 found that scientists are "still unable to find a shred of evidence" according to standards of science-based medicine for traditional Chinese concepts such as qi, meridians, and acupuncture points, and that the traditional principles of acupuncture are deeply flawed. "Acupuncture points and meridians are not a reality", the review continued, but "merely the product of an ancient Chinese philosophy". In June 2019, the World Health Organization included traditional Chinese medicine in a global diagnostic compendium, but a spokesman said this was "not an endorsement of the scientific validity of any Traditional Medicine practice or the efficacy of any Traditional Medicine intervention." A 2012 review of cost-effectiveness research for TCM found that studies had low levels of evidence, with no beneficial outcomes. Pharmaceutical research on the potential for creating new drugs from traditional remedies has had few successful results. Proponents suggest that research has so far missed key features of the art of TCM, such as unknown interactions between various ingredients and complex interactive biological systems. One of the basic tenets of TCM is that the body's qi (sometimes translated as vital energy) is circulating through channels called meridians having branches connected to bodily organs and functions. The concept of vital energy is pseudoscientific. Concepts of the body and of disease used in TCM reflect its ancient origins and its emphasis on dynamic processes over material structure, similar to Classical humoral theory. TCM has also been controversial within China. In 2006, the Chinese philosopher Zhang Gongyao triggered a national debate with an article entitled "Farewell to Traditional Chinese Medicine", arguing that TCM was a pseudoscience that should be abolished in public healthcare and academia. The Chinese government took the stance that TCM is a science and continued to encourage its development. There are concerns about a number of potentially toxic plants, animal parts, and mineral compounds from China, as well as the facilitation of disease. Trafficked and farm-raised animals used in TCM are a source of several fatal zoonotic diseases. There are additional concerns over the illegal trade and transport of endangered species including rhinoceroses and tigers, and the welfare of specially farmed animals, including bears. Many TCM remedies are effective because they are combined with modern Western medicine. An example is the popular over-the-counter cold medication Ganmaoling Keli (Chinese: 感冒灵颗粒; pinyin: Gǎnmàolíng Kēlì; lit. 'Cold Relief Granules'), which contains 200 mg of paracetamol, 4 mg of caffeine and 4 mg of chlorpheniramine maleate, which are standard ingredients in many Western over-the-counter cold medications.
Philosophical background Traditional Chinese medicine includes a broad range of practices sharing common concepts that developed in China for more than 2,000 years, including various forms of herbal medicine, acupuncture, massage (tui na), exercise (qigong), and dietary therapy. It is primarily used as a complementary alternative medicine approach. Traditional practices are widely used in China and, in an adapted form, also in the West. Its philosophy is based on School of Yin Yang, which incorporates Five Phases theory and Yin–Yang theory, and elements of which were absorbed by Daoism. Philosophical texts influenced medical thought and practice, mostly by being grounded in the same theories of qi, yin-yang and wuxing and microcosm-macrocosm analogies.
Yin and yang
Yin and yang are ancient Chinese deductive reasoning concepts used within Chinese medical diagnosis which can be traced back to the Shang dynasty (1600–1100 BCE). They represent two abstract and complementary aspects that every phenomenon in the universe can be divided into. Primordial analogies for these aspects are the sun-facing (yang) and the shady (yin) side of a hill. Two other commonly used representational allegories of yin and yang are water and fire. In the yin–yang theory, detailed attributions are made regarding the yin or yang character of things:
The concept of yin and yang is also applicable to the human body; for example, the upper part of the body and the back are assigned to yang, while the lower part of the body is believed to have the yin character. Yin and yang characterization also extends to the various body functions, and – more importantly – to disease symptoms (e.g., cold and heat sensations are assumed to be yin and yang symptoms, respectively). Thus, yin and yang of the body are seen as phenomena whose lack (or over-abundance) comes with characteristic symptom combinations:
Yin vacuity (also termed "vacuity-heat"): heat sensations, possible sweating at night, insomnia, dry pharynx, dry mouth, dark urine, and a "fine" and rapid pulse. Yang vacuity ("vacuity-cold"): aversion to cold, cold limbs, bright white complexion, long voidings of clear urine, diarrhea, pale and enlarged tongue, and a slightly weak, slow and fine pulse. TCM also identifies drugs believed to treat these specific symptom combinations, i.e., to reinforce yin and yang.
Strict rules are identified to apply to the relationships between the Five Phases in terms of sequence, of acting on each other, of counteraction, etc. All these aspects of Five Phases theory constitute the basis of the zàng-fǔ concept, and thus have great influence regarding the TCM model of the body. Five Phase theory is also applied in diagnosis and therapy. Correspondences between the body and the universe have historically not only been seen in terms of the Five Elements, but also of the "Great Numbers" (大數; dà shū) For example, the number of acu-points has at times been seen to be 365, corresponding with the number of days in a year; and the number of main meridians–12–has been seen as corresponding with the number of rivers flowing through the ancient Chinese empire.
Model of the body
TCM "holds that the body's vital energy (chi or qi) circulates through channels, called jingluo ("meridians and collaterals"), that have branches connected to bodily organs and functions." Its view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body's functions (such as digestion, breathing, temperature maintenance, etc.): These functions are aggregated and then associated with a primary functional entity – for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xiě (blood). These functional entities thus constitute concepts rather than something with biochemical or anatomical properties. The primary functional entities used by traditional Chinese medicine are qì, xuě, the five zàng organs, the six fǔ organs, and the meridians which extend through the organ systems. These are all theoretically interconnected: each zàng organ is paired with a fǔ organ, which are nourished by the blood and concentrate qi for a particular function, with meridians being extensions of those functional systems throughout the body. Concepts of the body and of disease used in TCM are pseudoscientific, similar to Mediterranean humoral theory. TCM's model of the body is characterized as full of pseudoscience. Some practitioners no longer consider yin and yang and the idea of an energy flow to apply. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points. It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians. The scientific evidence for the anatomical existence of either meridians or acupuncture points is not compelling. Stephen Barrett of Quackwatch writes that, "TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care."
Qi
Qi is a polysemous word that traditional Chinese medicine distinguishes as being able to transform into many different qualities of qi (气; 氣; qì). In a general sense, qi is something that is defined by five "cardinal functions":
Actuation (推动; 推動; tuīdòng) – of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians. Warming (温煦; 溫煦; wēnxù) – the body, especially the limbs. Defense (防御; fángyù) – against Exogenous Pathogenic Factors Containment (固摄; 固攝; gùshè) – of body fluids, i.e., keeping blood, sweat, urine, semen, etc. from leakage or excessive emission. Inter-transformationel (气化; 氣化; qìhuà) – of food, drink, and breath into qi, xue (blood), and jinye ("fluids"), and/or transformation of all of the latter into each other. A lack of qi will be characterized especially by pale complexion, lassitude of spirit, lack of strength, spontaneous sweating, laziness to speak, non-digestion of food, shortness of breath (especially on exertion), and a pale and enlarged tongue. Qi is believed to be partially generated from food and drink, and partially from air (by breathing). Another considerable part of it is inherited from the parents and will be consumed in the course of life. TCM uses special terms for qi running inside of the blood vessels and for qi that is distributed in the skin, muscles, and tissues between them. The former is called yingqi (营气; 營氣; yíngqì); its function is to complement xuè and its nature has a strong yin aspect (although qi in general is considered to be yang). The latter is called weiqi (卫气; 衛氣; weìqì); its main function is defence and it has pronounced yang nature. Qi is said to circulate in the meridians. Just as the qi held by each of the zang-fu organs, this is considered to be part of the 'principal' qi of the body.
Xie In contrast to the majority of other functional entities, xuè or xiě (血, "blood") is correlated with a physical form – the red liquid running in the blood vessels. Its concept is, nevertheless, defined by its functions: nourishing all parts and tissues of the body, safeguarding an adequate degree of moisture, and sustaining and soothing both consciousness and sleep. Typical symptoms of a lack of xiě (usually termed "blood vacuity" [血虚; xiě xū]) are described as: Pale-white or withered-yellow complexion, dizziness, flowery vision, palpitations, insomnia, numbness of the extremities; pale tongue; "fine" pulse.
Jinye Closely related to xuě are the jinye (津液; jīnyè, usually translated as "body fluids"), and just like xuě they are considered to be yin in nature, and defined first and foremost by the functions of nurturing and moisturizing the different structures of the body. Their other functions are to harmonize yin and yang, and to help with the secretion of waste products. Jinye are ultimately extracted from food and drink, and constitute the raw material for the production of xuě; conversely, xuě can also be transformed into jinye. Their palpable manifestations are all bodily fluids: tears, sputum, saliva, gastric acid, joint fluid, sweat, urine, etc.
Zangfu
The zangfu (脏腑; 臟腑; zàngfǔ) are the collective name of eleven entities (similar to organs) that constitute the centre piece of TCM's systematization of bodily functions. The term zang refers to the five considered to be yin in nature – Heart, Liver, Spleen, Lung, Kidney – while fu refers to the six associated with yang – Small Intestine, Large Intestine, Gallbladder, Urinary Bladder, Stomach and San Jiao. Despite having the names of organs, they are only loosely tied to (rudimentary) anatomical assumptions. Instead, they are primarily understood to be certain "functions" of the body. To highlight the fact that they are not equivalent to anatomical organs, their names are usually capitalized. The zang's essential functions consist in production and storage of qi and xuě; they are said to regulate digestion, breathing, water metabolism, the musculoskeletal system, the skin, the sense organs, aging, emotional processes, and mental activity, among other structures and processes. The fǔ organs' main purpose is merely to transmit and digest (傳化; chuán-huà) substances such as waste and food. Since their concept was developed on the basis of Wǔ Xíng philosophy, each zàng is paired with a fǔ, and each zàng-fǔ pair is assigned to one of five elemental qualities (i.e., the Five Elements or Five Phases). These correspondences are stipulated as:
Fire (火) = Heart (心; xīn) and Small Intestine (小腸; xiaǒcháng) (and, secondarily, Sānjiaō [三焦, "Triple Burner"] and Pericardium [心包; xīnbaò]) Earth (土) = Spleen (脾; pí) and Stomach (胃; weì) Metal (金) = Lung (肺; feì) and Large Intestine (大腸; dàcháng) Water (水) = Kidney (腎; shèn) and Bladder (膀胱; pángguāng) Wood (木) = Liver (肝; gān) and Gallbladder (膽; dān) The zàng-fǔ are also connected to the twelve standard meridians – each yang meridian is attached to a fǔ organ, and five of the yin meridians are attached to a zàng. As there are only five zàng but six yin meridians, the sixth is assigned to the Pericardium, a peculiar entity almost similar to the Heart zàng.
Jing-luo
The meridians (经络, jīng-luò) are believed to be channels running from the zàng-fǔ in the interior (里, lǐ) of the body to the limbs and joints ("the surface" [表, biaǒ]), transporting qi and xuĕ. TCM identifies 12 "regular" and 8 "extraordinary" meridians; the Chinese terms being 十二经脉 (shí-èr jīngmài, lit. "the Twelve Vessels") and 奇经八脉 (qí jīng bā mài) respectively. There's also a number of less customary channels branching from the "regular" meridians.
Gender in traditional medicine Fuke (妇科; 婦科; Fùkē) is the traditional Chinese term for women's medicine (it means gynecology and obstetrics in modern medicine). However, there are few or no ancient works on it except for Fu Qingzhu's Fu Qingzhu Nu Ke (Fu Qingzhu's Gynecology 傅青主女科), with "Nu Ke" literally meaning "Women studies", much like the etymology of gynecology. In traditional China, as in many other cultures, the health and medicine of female bodies was less understood than that of male bodies. Women's bodies were often secondary to male bodies, since women were thought of as the weaker, sicklier sex. In clinical encounters, women and men were treated differently. Diagnosing women was not as simple as diagnosing men. First, when a woman fell ill, an appropriate adult man was to call the doctor and remain present during the examination, for the woman could not be left alone with the male doctor. The physician would discuss the female's problems and diagnosis only through the male. However, in certain cases, when a woman dealt with complications of pregnancy or birth, older women assumed the role of the formal authority. Men in these situations would not have much power to interfere. Second, women were often silent about their issues with doctors due to the societal expectation of female modesty when a male figure was in the room. Third, patriarchal society also caused doctors to call women and children patients "the anonymous category of family members (Jia Ren) or household (Ju Jia)" in their journals. This anonymity and lack of conversation between the doctor and woman patient led to the inquiry diagnosis of the Four Diagnostic Methods being the most challenging. Doctors used a medical doll known as a Doctor's lady, on which female patients could indicate the location of their symptoms. Cheng Maoxian (b. 1581), who practiced medicine in Yangzhou, described the difficulties doctors had with the norm of female modesty. One of his case studies was that of Fan Jisuo's teenage daughter, who could not be diagnosed because she was unwilling to speak about her symptoms, since the illness involved discharge from her intimate areas. As Cheng describes, there were four standard methods of diagnosis – looking, asking, listening and smelling and touching (for pulse-taking). To maintain some form of modesty, women would often stay hidden behind curtains and screens. The doctor was allowed to touch enough of her body to complete his examination, often just the pulse taking. This would lead to situations where the symptoms and the doctor's diagnosis did not agree and the doctor would have to ask to view more of the patient. These social and cultural beliefs were often barriers to learning more about female health. Women were often uncomfortable talking about their illnesses, especially in front of the male chaperones that attended medical examinations. Women would choose to omit certain symptoms as a means of upholding their chastity and honor. One such example is the case in which a teenage girl was unable to be diagnosed because she failed to mention her symptom of vaginal discharge. Silence was their way of maintaining control in these situations, but it often came at the expense of their health and the advancement of female health and medicine. This silence and control were most obviously seen when the health problem was related to the core of Ming fuke, or the sexual body. It was often in these diagnostic settings that women would choose silence. In addition, there would be a conflict between patient and doctor on the probability of her diagnosis. For example, a woman who thought herself to be past the point of child-bearing age, might not believe a doctor who diagnoses her as pregnant. This only resulted in more conflict.
Yin yang and gender Yin and yang were critical to the understanding of women's bodies, but understood only in conjunction with male bodies. Yin and yang ruled the body, the body being a microcosm of the universe and the earth. In addition, gender in the body was understood as homologous, the two genders operating in syn