ISO/TS 17948:2014 health information traditional chinese medicine literature metedata

Courtesy: ISO/TS 17948:2014 health information traditional chinese medicine literature metedata

The term “herbal medicine” is somewhat misleading in that, while plant elements are by far the most commonly used substances in TCM, other, non-botanic substances are used as well: animal, human, and mineral products are also used. Thus, the term “medicinal” (instead of herb) may be used, although there is no scientific evidence that any of these compounds have medicinal effects.

Raw materials

There are roughly 13,000 compounds used in China and over 100,000 TCM recipes recorded in the ancient literature. Plant elements and extracts are by far the most common elements used. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed – out of these, 45 were animal parts, and 30 were minerals.

Animal substances

Some animal parts used can be considered rather strange such as cow gallstones, hornet nests, leeches, and scorpion. Other examples of animal parts include horn of the antelope or buffalo, deer antlers, testicles and penis bone of the dog, and snake bile. Some TCM textbooks still recommend preparations containing animal tissues, but there has been little research to justify the claimed clinical efficacy of many TCM animal products.

Some compounds can include the parts of endangered species, including tiger bones and rhinoceros horn which is used for many ailments (though not as an aphrodisiac as is commonly misunderstood in the West). The black market in rhinoceros horns (driven not just by TCM but also unrelated status-seeking) has reduced the world’s rhino population by more than 90 percent over the past 40 years. Concerns have also arisen over the use of pangolin scales, turtle plastron, seahorses, and the gill plates of mobula and manta ray

Poachers hunt restricted or endangered species to supply the black market with TCM products. There is no scientific evidence of efficacy for tiger medicines. Concern over China considering to legalize the trade in tiger parts prompted the 171-nation Convention on International Trade in Endangered Species (CITES) to endorse a decision opposing the resurgence of trade in tigers. Fewer than 30,000 saiga antelopes remain, which are exported to China for use in traditional fever therapies. Organized gangs illegally export the horn of the antelopes to China. The pressures on seahorses (Hippocampus spp.) used in traditional medicine is enormous; tens of millions of animals are unsustainably caught annually. Many species of syngnathid are currently part of the IUCN Red List of Threatened Species or national equivalents.

Since TCM recognizes bear bile as a treatment compound, more than 12,000 asiatic black bears are held in bear farms. The bile is extracted through a permanent hole in the abdomen leading to the gall bladder, which can cause severe pain. This can lead to bears trying to kill themselves. As of 2012, approximately 10,000 bears are farmed in China for their bile. This practice has spurred public outcry across the country. The bile is collected from live bears via a surgical procedure. As of March 2020 bear bile as ingredient of Tan Re Qing injection remains on the list of remedies recommended for treatment of “severe cases” of COVID-19 by National Health Commission of China and the National Administration of Traditional Chinese Medicine.

The deer penis is believed to have therapeutic benefits according to traditional Chinese medicine. Tiger parts from poached animals include tiger penis, believed to improve virility, and tiger eyes. The illegal trade for tiger parts in China has driven the species to near-extinction because of its popularity in traditional medicine. Laws protecting even critically endangered species such as the Sumatran tiger fail to stop the display and sale of these items in open markets. Shark fin soup is traditionally regarded in Chinese medicine as beneficial for health in East Asia, and its status as an elite dish has led to huge demand with the increase of affluence in China, devastating shark populations. The shark fins have been a part of traditional Chinese medicine for centuries. Shark finning is banned in many countries, but the trade is thriving in Hong Kong and China, where the fins are part of shark fin soup, a dish considered a delicacy, and used in some types of traditional Chinese medicine.

The tortoise (freshwater turtle, guiban) and turtle (Chinese softshell turtle, biejia) species used in traditional Chinese medicine are raised on farms, while restrictions are made on the accumulation and export of other endangered species. However, issues concerning the overexploitation of Asian turtles in China have not been completely solved. Australian scientists have developed methods to identify medicines containing DNA traces of endangered species. Finally, although not an endangered species, sharp rises in exports of donkeys and donkey hide from Africa to China to make the traditional remedy ejiao have prompted export restrictions by some African countries.

Traditional Chinese medicine also includes some human parts: the classic Materia medica (Bencao Gangmu) describes (also criticizes) the use of 35 human body parts and excreta in medicines, including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, organs, but most are no longer in use.

Human placenta has been used an ingredient in certain traditional Chinese medicines, including using dried human placenta, known as “Ziheche”, to treat infertility, impotence and other conditions. The consumption of the human placenta is a potential source of infection.

Traditional categorization

The traditional categorizations and classifications that can still be found today are:

• The classification according to the Four Natures (四气; sì qì): hot, warm, cool, or cold (or, neutral in terms of temperature) and hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat heat diseases.
• The classification according to the Five Flavors, (五味; wǔ wèi, sometimes also translated as Five Tastes): acrid, sweet, bitter, sour, and salty. Substances may also have more than one flavor, or none (i.e., a “bland” flavor). Each of the Five Flavors corresponds to one of zàng organs, which in turn corresponds to one of the Five Phases. A flavor implies certain properties and therapeutic actions of a substance; e.g., saltiness drains downward and softens hard masses, while sweetness is supplementing, harmonizing, and moistening.
• The classification according to the meridian – more precisely, the zàng-fu organ including its associated meridian – which can be expected to be primarily affected by a given compound.
• The categorization according to the specific function mainly include: exterior-releasing or exterior-resolving, heat-clearing, downward-draining, or precipitating wind-damp-dispelling, dampness-transforming, promoting the movement of water and percolating dampness or dampness-percolating, interior-warming, qi-regulating or qi-rectifying, dispersing food accumulation or food-dispersing, worm-expelling, stopping bleeding or blood-stanching, quickening the Blood and dispelling stasis or blood-quickening, transforming phlegm, stopping coughing and calming wheezing or phlegm-transforming and cough- and panting-suppressing, Spirit-quieting, calming the liver and expelling wind or liver-calming and wind-extinguishing orifice-opening supplementing which includes qi-supplementing, blood-nourishing, yin-enriching, and yang-fortifying, astriction-promoting or securing and astringing, vomiting-inducing, and substances for external application.

Efficacy

As of 2007 there were not enough good-quality trials of herbal therapies to allow their effectiveness to be determined. A high percentage of relevant studies on traditional Chinese medicine are in Chinese databases. Fifty percent of systematic reviews on TCM did not search Chinese databases, which could lead to a bias in the results. Many systematic reviews of TCM interventions published in Chinese journals are incomplete, some contained errors or were misleading. The herbs recommended by traditional Chinese practitioners in the US are unregulated.

• A 2013 review found the data too weak to support use of Chinese herbal medicine (CHM) for benign prostatic hyperplasia.
• A 2013 review found the research on the benefit and safety of CHM for idiopathic sudden sensorineural hearing loss is of poor quality and cannot be relied upon to support their use.
• A 2013 Cochrane review found inconclusive evidence that CHM reduces the severity of eczema.
• The traditional medicine ginger, which has shown anti-inflammatory properties in laboratory experiments, has been used to treat rheumatism, headache and digestive and respiratory issues, though there is no firm evidence supporting these uses.
• A 2012 Cochrane review found no difference in mortality rate among 640 SARS patients when Chinese herbs were used alongside Western medicine versus Western medicine exclusively, although they concluded some herbs may have improved symptoms and decreased corticosteroid doses.
• A 2012 Cochrane review found insufficient evidence to support the use of TCM for people with adhesive small bowel obstruction.
• A 2011 review found low quality evidence that suggests CHM improves the symptoms of Sjogren’s syndrome.
• A 2011 Cochrane review found inconclusive evidence to support the use of TCM herbal medicines for treatment of hypercholesterolemia.
• A 2011 Cochrane review did not find improvement in fasting C-peptide when compared to insulin treatment for latent autoimmune diabetes in adults after 3 months. It is important to highlight that the studies available to be included in this review presented considerable flaws in quality and design.
• A 2010 review found TCM seems to be effective for the treatment of fibromyalgia but the findings were of insufficient methodological rigor.
• A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving painful menstruation, but the trials assessed were of such low methodological quality that no conclusion could be drawn about the remedies’ suitability as a recommendable treatment option.
• Turmeric has been used in traditional Chinese medicine for centuries to treat various conditions. This includes jaundice and hepatic disorders, rheumatism, anorexia, diabetic wounds, and menstrual complications. Most of its effects have been attributed to curcumin. Research that curcumin shows strong anti-inflammatory and antioxidant activities have instigated mechanism of action studies on the possibility for cancer and inflammatory diseases prevention and treatment. It also exhibits immunomodulatory effects.
• A 2005 Cochrane review found insufficient evidence for the use of CHM in HIV-infected people and people with AIDS.
• A 2010 Cochrane review found insufficient evidence to support the use of Traditional Chinese Herbal Products (THCP) in the treatment of angina.
• A 2010 Cochrane review found no evidence supporting the use of TCHM for stopping bleeding from haemorrhoids. There was some weak evidence of pain relief.