Traditional Chinese medicine: what is known
Traditional Chinese medicine combines herbs, acupuncture and movement for pain and wellbeing. Some parts have support; the herbal side lacks good studies.
What the evidence says
Limited evidence
A few small or low-quality studies suggest a possible effect for some uses. The legend
The US National Center for Complementary and Integrative Health (NCCIH) says acupuncture and tai chi may help quality of life and certain pain conditions, but studies of Chinese herbal products are mixed and often poor quality, so no firm conclusions can be made. A 2020 critical review found that none of 51 Cochrane reviews of Chinese herbal medicine provided high-quality evidence.
What practitioners say it does
- Described as resting on the balance of yin and yang and the smooth flow of qi through pathways called meridians
- Said to reveal patterns of imbalance through pulse and tongue diagnosis that guide individual treatment
- Believed by practitioners to restore balance with herbal formulas tailored to each person
- Used by many people to ease pain and improve wellbeing through acupuncture, tai chi and qigong
Origin
Evolved over thousands of years in China; its first written compilation is The Yellow Emperor's Inner Classic (Huangdi Neijing)
Traditional Chinese medicine (TCM) is a system of care from China that combines herbal formulas, acupuncture and movement practices such as tai chi. People usually try it for pain, long-running health complaints and general wellbeing. We rate the evidence for the system as a whole as limited: a few parts have some support, but much of it, especially Chinese herbal medicine, rests on weak or poor-quality research.
What it is
Traditional Chinese medicine has evolved over thousands of years in China. Its first written compilation is The Yellow Emperor’s Inner Classic (Huangdi Neijing). A major herbal reference, the Bencao gang mu, was written by the herbalist Li Shizhen during the Ming dynasty. After World War II, China founded TCM universities, hospitals and research institutes, and the system has drawn international attention since then.
In TCM, health is described through yin and yang, the five elements, and environmental factors such as wind, damp, heat and cold. Practitioners describe qi as the breath or force of life, flowing through pathways called meridians. The aim is to bring mind, body, health and prevention together, with care fitted to the individual. A 2020 critical review found no scientific basis for qi or meridians.
The main approaches are herbal products, which are mostly mixtures of herbs and sometimes include animal or mineral products. Movement practices such as tai chi and qigong are another, and acupuncture, covered on its own page, is a third. TCM diagnosis combines looking, listening, smelling, asking and touching to reach a “pattern” diagnosis. Reading the pulse at the wrist and inspecting the tongue are central to it.
What a session is like
A first visit usually starts with questions about your symptoms, lifestyle and history. The practitioner may look at the color, coating and shape of your tongue, look at your face and feel your pulse before suggesting a treatment. That treatment might be an herbal formula, acupuncture, or advice on tai chi or qigong. An acupuncture session can last up to about an hour.
Before booking, it is worth asking:
- What training and certification they hold, especially in herbal medicine
- Where their herbal products come from and whether they are tested
- How the suggested treatment fits with your medicines and medical care
What research says
The US National Center for Complementary and Integrative Health (NCCIH) says some TCM approaches may help improve quality of life and certain pain conditions. Research on tai chi suggests it may improve balance and stability in older people and in people with Parkinson’s disease. It may also reduce knee osteoarthritis pain, help people cope with fibromyalgia and back pain, and improve mood and quality of life in heart failure. Acupuncture has moderate evidence for some chronic pain and headache, often with only a small advantage over sham (fake) acupuncture. Its own page rates it separately.
The herbal side is weaker. NCCIH reports mixed results from studies of Chinese herbal products, and because many studies have been poor quality, no firm conclusions can be made. A 2020 critical review in the journal Wiener Klinische Wochenschrift found that none of 51 Cochrane reviews of Chinese herbal medicine provided high-quality evidence. The same review found low agreement between practitioners on pattern diagnoses. One notable exception exists: artemisinin, a malaria drug developed from a plant used in TCM, went through full modern drug development.
Who should be careful
The biggest risks come from herbal products. Some have been contaminated with undeclared drugs, heavy metals, pesticides or the wrong herb, and these mix-ups have caused organ damage. Herbs can also interact with medicines. Check with a provider first if you take medicines, have a health condition, are pregnant or nursing, or are considering TCM for a child. Acupuncture done improperly can cause infections or a collapsed lung. Tai chi and qigong appear safe but may cause minor aches. If you have symptoms that are new, severe or not improving, see a doctor or other licensed clinician rather than relying on TCM alone.
How it fits with the pillars
For the body, TCM uses physical methods, such as needles, herbs and movement, aimed at bodily symptoms. For the mind, the tradition describes mind and body as one system. Its movement practices pair posture with mental focus, breathing and relaxation.
If you are curious, tai chi is the most accessible starting point and one of the parts of TCM with research support.
Safety
- Talk to your health care provider before using Chinese herbal products, especially if you have a health condition or take medicines such as warfarin.
- Some Chinese herbal products have been contaminated with drugs, heavy metals such as lead or arsenic, pesticides or the wrong herb, causing serious harm.
- Check with a provider first if you are pregnant or nursing, or before using any TCM approach for a child.
- Choose a trained practitioner who uses sterile needles. Acupuncture done improperly can cause infections, nerve injury or a collapsed lung.
- Do not use TCM to replace or delay conventional care, and tell all your providers what you use.
What a session involves
A practitioner asks about your symptoms, lifestyle and history, may look at your tongue and face, and feels the pulse at your wrist. Treatment may include herbal formulas, advice on tai chi or qigong, or acupuncture. For acupuncture you lie on a padded table with thin needles in place for about 10 to 15 minutes, and a session lasts up to about an hour.
Training and regulation
In the US, most states and the District of Columbia regulate acupuncture, and some, such as Illinois and Ohio, require separate certification to practice Chinese herbal medicine. Rules vary in other countries.
Questions people ask
Is Chinese herbal medicine safe to take with my medications?
Not always. Herbs can interact with medicines. For example, ginseng may reduce the effect of the blood thinner warfarin. Some products have also been contaminated with undeclared drugs or heavy metals. Talk to your health care provider before using any TCM herbal product, especially if you have a health condition, take medicines, are pregnant or nursing, or are thinking of giving it to a child.
How do I find a qualified TCM practitioner in the US?
Ask about the practitioner's training, experience and certification. Most US states and the District of Columbia regulate acupuncture, and most require national certification. Some states, such as Illinois, Massachusetts, New Jersey and Ohio, require separate certification in Chinese herbal medicine. If herbs are part of the plan, ask about herbal training in particular and where the products come from.
Can traditional Chinese medicine replace my regular doctor?
No. NCCIH advises against using TCM to replace or delay conventional care. Some parts, such as tai chi and acupuncture, may help with quality of life and certain pain conditions. The research on herbal products is too weak to support firm conclusions. If you use TCM, tell all your providers what you are doing so they can look after you safely.
Sources
Read next
- Tai chi for beginners: slow movement, steady breath15 min
A gentle 15- to 30-minute practice of slow movements and controlled breathing from a Chinese martial art, used by many people for balance and calm.
- Qigong basics: a gentle morning routine15 min
A 15- to 20-minute standing qigong routine based on the Eight Brocades, used by many people for gentle morning movement, calm focus and energy.
- Holistic health: what it means and how to start
What holistic health means, how it differs from integrative and alternative care, what the evidence supports, and simple ways to start.