A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE
Eastern Approaches
Part 3: Qi gong, tai chi, Chinese and Japanese herbal medicine, other miscellaneous Chinese therapies, Anma massage
Thomas J. Wheeler, Ph.D.
Associate Professor (retired), Department of Biochemistry and Molecular Biology,
University of Louisville School of Medicine, Louisville KY
thomas.wheeler@louisville.edu
Revised 2019
This original version of this material was a handout for an elective course given to medical students at the University of Louisville.
Copyright 2019. Permission to copy for non-profit uses is granted as long as proper citation of the source is given.
DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.
A pdf file containing all parts and references can be downloaded from ARTICLES or EASTERN.
CONTENTS OF PART 3
Qi gong
Background
Practice and scope
Reviews
Scientific critique
Characteristics of pseudoscience
Tai chi
Selected trials
Reviews
Chinese and Japanese herbal medicine
Introduction
Practice and scope
Reviews
Scientific critique
Toxicity
Other miscellaneous Chinese therapies
Anma massage
QI GONG
Background
"Qigong is a general term or concept for a variety of traditional Chinese energy exercises and therapies that facilitate the flow of qi (vital energy). In general, qigong refers to the self-training method or technique that integrates the adjustments of body posture, breathing, and mind status into one to achieve optimal status of both mind and body...Traditionally, qigong was passed from generation to generation in a secret manner. Only recently has qigong become a public health practice in China. Currently, it is reported that more than 100 million people practice qigong in China and more practice around the world to treat diseases ranging from hypertension and arthritis to cancer and human immunodeficiency virus. In the tradition of medical qigong, there have been two major types of therapies: internal qigong training (self-practice) and external qigong therapy (EQT). Self-practice of qigong forms is the key or major part of qigong therapy, whereas EQT refers to the process by which qigong practitioners direct or emit their own qi energy to help break the qi blockage and remove the sick qi from the bodies of others so as to balance the qi system, which in turn is thought to relieve pain and eliminate disease. As part of TCM practice, EQT is widely practiced in many hospitals in China" (Chen et al. 2006. J Altern Complement Med 12(9):851-6).
Practice and scope
Internal qi gong - includes deep breathing exercises, posture exercises, stylized body movements, visualization, and meditation. It is less strenuous and methodical than tai chi (see below).
"Each exercise involves several postures that, according to tradition, focus qi on a particular organ or region of the body" (Stone 1997 Jul 28. Newsweek). "When a person practices qigong, she or he can experience the vital energy or life force alive as a sense of resistance between their hands, electrical current flow or warm water flow in their internal body... There are thousands of types of internal qigong, and they can vary in focus from martial arts, sports, health, spiritual growth and more" (Putiri et al. 2017. Medicines (Basel). 4(3). pii: E59).
"Baduanjin is one of the most widely practiced forms of the Chinese traditional qigong and dates back nearly 2500 years. Baduanjin is also called Eight-Section Brocades because its exercise routine consists of eight individual movements; characterized by symmetrical body postures and movements, breathing control, a meditative state of mind, and mental focus" (Zou et al. 2018. J Altern Complement Med 24(4):324-35).
"Basically, qigong exercise can be divided into different types including meditative qigong or quiescent qigong (known as jing gong in Chinese), dynamic qigong or active qigong (dong gong in Chinese), and a combination of the two (jing dong gong in Chinese. The intensity of exercise is often different for these types of qigong" (Chan et al. 2012. J Altern Complement Med 18(7):641-6).
External qi gong - a "qi master" is said to be able to qi energies from an acupoint; this can be transmitted to the subject (without touching directly). It is claimed to be able to cure numerous diseases, including cancer and AIDS. It has even been said that one can receive benefits by watching a videotape of qi gong.
"In external medical qigong, the practitioner works with his or her client by cleansing and clearing unhealthy qi, removing blockages or qi stagnation from the client’s energy field to promote healthy internal qi circulation, or by projecting specific healing qi into the energy field of the client and directing it to specific areas and systems of the body for restoring internal balance and harmony. The medical qigong practitioner may also transmit universal healing energy and energetic intelligence to their client for improving health conditions and restoring well-being" (Putiri et al. 2017. Op. cit.).
Qi masters perform demonstrations in which they supposedly project energy that causes subjects to fall down or move in other ways. It has also been claimed that they can emit infrared radiation from their hands and produce biochemical effects in cultured cells.
Reviews
* = review by Edzard Ernst and colleagues. (Note: reviews covering both qigong and tai chi are included in the tai chi section.)
Cardiovascular disease - *Hartley et al. 2015. Cochrane Database Syst Rev. CD010390. "Currently, very limited evidence is available on the effectiveness of qigong for the primary prevention of CVD. Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results."
Diabetes - Putiri et al. 2017. Op. cit. Promising results, but "Due to the inconsistencies in study design and methods and the lack of large-scale studies, further well-designed randomized control trials (RCT) are needed."
Fibromyalgia - Chan et al. 2012. J Altern Complement Med. 18(7):641-6. "Given methodological flaws in the included studies, it is still too early to draw a conclusion about the effectiveness..."
Hypertension - Guo et al. 2008. J Altern Complement Med. 14(1):27-37. Qigong was better than no treatment controls, but not superior to active controls.
Scientific critique
There is a lack of well-documented studies for what are (in the case of external qi gong) extraordinary claims.
Mayer (J Altern Complement. Med. 5:371-82 (1999)) noted that “many of the studies of qigong practice and hypertension are flawed,” but concluded that “The weight of the evidence suggests that practicing qigong may have a positive effect on hypertension.”
Representatives of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP) tested several qi gong masters during a visit to China in 1988. The masters were unable to demonstrate their alleged powers under controlled conditions. Similarly, qi gong masters in North America cannot perform for skeptics.
If qi masters can emit infrared radiation from their hands, this should be detectable with imaging technology.
Characteristics of pseudoscience
It is based on undefined, non-measurable "energy" or "life force."
Claims for external qi gong violate laws of physics.
It is said that skeptics cannot acquire the ability to perform it.
TAI CHI
Tai chi is a system of exercises involving slow, gentle movements. “It combines deep diaphragmatic breathing and relaxation with many fundamental postures that flow imperceptibly and smoothly from one to the other through slow, gentle, graceful movements” (Wang et al. 2004. Arch Intern Med 164:493-501). This supposedly opens blocked channels to stimulate the flow of qi.
From "Tai Chi for Health Purposes" (National Center for Complementary and Alternative Medicine 2006 Jun):
Tai chi developed in China in about the 12th century A.D. It started as a martial art, or a practice for fighting or self-defense, usually without weapons. Over time, people began to use tai chi for health purposes as well...While accounts of tai chi's history often differ, the most consistently important figure is a Taoist monk (and semilegendary figure) in 12th-century China named Chang San-Feng (or Zan Sanfeng). Chang is said to have observed five animals - tiger, dragon, leopard, snake, and crane - and to have concluded that the snake and the crane, through their movements, were the ones most able to overcome strong, unyielding opponents. Chang developed an initial set of exercises that imitated the movements of animals. He also brought flexibility and suppleness in place of strength to the martial arts, as well as some key philosophical concepts.
A person practicing tai chi moves her body in a slow, relaxed, and graceful series of movements. One can practice on one's own or in a group. The movements make up what are called forms (or routines). Some movements are named for animals or birds, such as "White Crane Spreads Its Wings." The simplest style of tai chi uses 13 movements; more complex styles can have dozens.
In tai chi, each movement flows into the next. The entire body is always in motion, with the movements performed gently and at uniform speed. It is considered important to keep the body upright, especially the upper body - many tai chi practitioners use the image of a string that goes from the top of the head into the heavens - and to let the body's weight sink to the soles of the feet.
In addition to movement, two other important elements in tai chi are breathing and meditation. In tai chi practice, it is considered important to concentrate; put aside distracting thoughts; and breathe in a deep, relaxed, and focused manner.
"Qigong focuses more on 'inside' energy flow than Tai Chi. Qigong can be practiced as a 'static' (sitting, lying or standing) or 'dynamic' (moving) style, and is generally easier to master than Tai Chi" (Liu et al. 2015. Complement Ther Med. 23(4):516-34). "There is one difference between qigong and tai chi that 'traditional tai chi is typically performed as a highly choreographed, lengthy, and complex series of movements, while health enhancement qigong is typically a simpler, easy to learn, more repetitive practice.' However, tai chi incorporate many movements that are similar to qigong exercise, and the longer forms of tai chi include qigong exercises as a warm up. Due to sharing the same basic principles of the regulation of body focus, breath focus and mind focus by practicing qigong or tai chi, the research literatures for these two forms of mind-body interventions could be considered as one body of evidence in the health promotion and wellness context" (Zeng et al. 2014. Complement Ther Med 22(1):173-86).
"Tai Chi and Qigong have been shown to promote relaxation and decrease sympathetic output. Relaxation interventions are known to reduce clinical somatic symptoms and to benefit anxiety, depression, blood pressure, and recovery from immune-mediated diseases. Tai Chi and Qigong have been shown to improve immune function and vaccine-response, to increase blood levels of endorphins and baroreflex sensitivity, as well as to reduce levels of inflammatory markers (C-reactive protein [CRP]), adrenocorticotropic hormone, and cortisol. Electroencephalography (EEG) studies of participants undergoing Tai Chi and Qigong exercise have found increased frontal EEG α, β, and θ wave activity, suggesting increased relaxation and attentiveness. These changes have not been present in exercise controls" (Abbott and Lavretsky 2013. Psychiatr Clin North Am. 36(1):109-19).
Some scientific investigations suggest that it may provide various benefits, such as decreased blood pressure, improved strength and coordination in the elderly, reduced chance of sports injuries, decreased arthritis pain, and increased immunity. It is also a way to deal with stress, having aspects similar to meditation. The review by Wang et al. (op. cit.) concluded that it “appears to have physiological and psychosocial benefits and also appears to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions. However, limitations or biases exist in most studies, and it is difficult to draw firm conclusions about the benefits reported.” A scientific view holds that any benefits of tai chi arise from the benefits of exercise, and have nothing to do with qi.
Selected trials
Balance - Li et al. 2012. N Engl J Med. 366(6):511-9. "Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson's disease, with additional benefits of improved functional capacity and reduced falls.
Chronic heart failure - Yeh et al. 2011. Arch Intern Med. 171(8):750-7. Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF." However, in an accompanying commentary (pp. 758-9), Teerlink noted that "Despite borderline improvements in MLHFQ [Minnesota Living with Heart Failure Questionnaire] responses...there was no improvement in 6-minute walk test, peak oxygen uptake, or exercise duration, and there was a trend toward worsening norepinephrine levels..."
Fibromyalgia - Wang et al. 2010. N Engl J Med. 363(8):743-54. May be useful.
Shingles - Irwin et al. 2007.J Am Geriatr Soc. 55(4):511-7. Tai chi enhances the immune response to varicella zoster virus, the agent that causes shingles.
Reviews. * = review by Edzard Ernst and colleagues. + = review of qigong and tai chi
Anxiety - Sharma et al. 2015. J Evid Based Complementary Altern Med. 20(2):143-53. "Despite the limitations of not all studies using randomized controlled designs, having smaller sample sizes, having different outcomes, having nonstandardized tai chi interventions, and having varying lengths, tai chi appears to be a promising modality for anxiety management."
Cancer - +Zeng et al. 2014. Complement Ther Med. 22(1):173-86. "This study found that qigong/tai chi had positive effects on the cancer-specific QOL [quality of life], fatigue, immune function and cortisol level of cancer patients. However, these findings need to be interpreted cautiously due to the limited number of studies identified and high risk of bias in included trials."
Cardiovascular disease prevention - *Hartley et al. 2014. Cochrane Database Syst Rev. CD010366. "Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors."
Chronic conditions - Li et al. 2014. Complement Ther Med. 22(4):743-55. Has "positive effects on health related quality of life in patients with chronic conditions, especially for patients with disorders in Cardio-cerebrovascular and respiratory systems, and musculoskeletal system."
Chronic obstructive pulmonary disease
+Ding et al. 2014. J Altern Complement Med. 20(2)79-86. "TCQ [tai chi and qigong] might be beneficial with respect to physical performance, lung function, remission of dyspnea, and quality of life in patients with COPD; however, caution is needed to draw a firm conclusion because of the low methodological quality of the included trials."
Ngai et al. 2016. Cochrane Database Syst Rev. CD009953. "Evidence of very low to moderate quality suggests better functional capacity and pulmonary function in post-programme data for Tai Chi versus usual care. When Tai Chi in addition to other interventions was compared with other interventions alone, Tai Chi did not show superiority and showed no additional effects on symptoms nor on physical and psychosocial function improvement."
Depression - +Liu et al. 2015. Complement Ther Med. 23(4):516-34. "Qigong appears to be beneficial for reducing depressive symptom severity. However, given the low quality of the included studies and the documented evidence of publication bias, these results should be viewed cautiously." Tai chi had no effect.
Diabetes - Lee et al. 2015. Maturitas. 80(1):14-23. "... the existing trial evidence is not convincing enough to suggest that tai chi is effective for managing patients with T2DM."
Lipid profiles - Alenazi et al. 2018. J Altern Complement Med. 24(3):220-30. "Although there were conflicting results regarding the effect of t'ai chi on lipid profiles, the majority of studies had at least a small positive effect..."
Mental disorders - +Abbott and Lavretsky 2013. Op. cit. "There is not strong evidence that Tai Chi and Qigong are effective as either primary or complementary treatments for mental disorders...promising results from multiple RCTs suggest that these are potentially effective treatments for reducing stress, anxiety, depression, and low mood, as well as for improving self-esteem and general psychosocial well-being. Results from the RCTs evaluating Tai Chi and Qigong for specific mental diseases suggest that they may be effective for improving symptoms of Parkinson disease, TBI, sleep disturbance, substance abuse, and cognitive impairment."
Multiple sclerosis - Taylor and Taylor-Piliae 2017. Complement Ther Med. 31:100-8. "...may provide physical and psychosocial benefits..."
Osteoarthritis of the knee - Lauche et al. 2013. Complement Ther Med. 21(4):396-406. Moderate evidence for short-term improvement.
CHINESE AND JAPANESE HERBAL MEDICINE
Introduction
"There are 8980 herbs compiled into Zhong Hua Ben Cao (Chinese Materia Medica 1999) and 1444 Chinese herbal formulae collected in 2010 edition of the Chinese Pharmacopoeia...When two or more Chinese herbal medicines (CHMs) are combined, they become a named formula. Over 2,0000 years of practice, CHM has accumulated over 100,000 formulae that are constructed according to specific TCM principles" (Su et al. 2016. Evid Based Complement Alternat Med. 2016:7279361).
Chinese “herbs” include not just plant material but also animal parts and minerals. “Animal substances include: antelope and deer horn, donkey skin gelatin, earthworms, human placenta, bat feces, cicada exoskeleton, wingless cockroach, bear gallbladder, charred human hair, and seal penis” (B. Burley, Healthfraud e-mail discussion list). For example, "In Traditional Chinese Medicine (TCM), the deer antler, the young, non-ossifying, and pilose antler on the head of deer, is known as Lu Rong...It is used for curing all deficiency syndromes, especially deficiency of the kidney, weak constitution, premature aging, deficiency of qi, blood, and semen. Reportedly, deer antlers contain 25 kinds of amino acids and a variety of vitamins that can improve the body’s immune system and promote hematopoietic function" (Ernst 2018 Dec 24. Edzard Ernst blog).
"China’s State Council is now replacing its 1993 ban on the trade of tiger bones and rhino horn. Horns of rhinos or bones of tigers that were bred in captivity can hence force be used 'for medical research or clinical treatment of critical illnesses' under the new rules. The fact that no critical illness responds to either of these remedies seems to matter little" (Ernst 2018 Oct 30. Edzard Ernst blog). Even if the intent is to use animals bred in captivity, the effect would have been to encourage illegal trade in these endangered animals. "The move was postponed in November, following a global outcry" (The Editors 2019 Apr 1. Scientific American).
In 2008 Chinese scientists began the Herbalome project, seeking to use modern methods to determine the components of the remedies.
According to draft regulations proposed in 2018, traditional medicines in China would not be required to pass clinical trials.
Japan has its own traditional herbal medical system, kampo. "Of the thousands of Kampo formulae available, 236 are officially registered by the Japanese ministry of health and produced in pill or powder form. More than 80% of medical doctors in Japan currently prescribe Kampo, and two-thirds of the officially registered formulations are covered by national health insurance" (Fuyuno 2011. Nature. 480(7378):S96). However, Kampo has diminished in importance, being largely replaced by Western and traditional Chinese medicine.
Practice and scope
"Herbs are classified in 2 major categories: the first refers to temperaturelike characteristics of the herb, viz. hot, warm, cold, neutral, and aromatic. The second refers to the taste property of the herb, viz. sour, bitter, sweet, spicy, and salty. Practitioners of TCM prepare combinations of herbs whose properties are matched to the complementary properties of specific conditions that can influence the yin-yang properties of the body in specific ways that lead to the restoration of balance" (Melnick 2006. J Pediatr Hematol Oncol 28(4):221-30).
"In TCM herbs are often prescribed in 'Fu-Fang' combinations. This means that the preparation combines processed toxic medicinal plants and non-toxic plants that are later supposed to neutralize the poison of the toxic plants" (Ekar and Kreft 2019. Food Chem Toxicol. 123:288-297).
"TCM practitioners formulate their herbal remedies according to a set of principles (peiwu), which organize ingredients in any fufang into four functional roles: sovereign, minister, assistant and envoy. The sovereign is the ingredient with major pharmacological activity. The ministers provide additive or synergistic activities. Assistants can either augment the pharmacological effect, detoxify or even counteract an excessively strong action. Envoys harmonize the whole recipe to ensure that all the substances in the fufang are compatible" (Tian 2011. Nature 480(7378):S84-6).
"Chinese herbalism considers the tastes, temperatures, and meridians that the herbs are said to enter, in creating formulas that balance these features to fit particular therapeutic strategies." For example, "Natural sweet-tasting herbs, typically containing amino acids and saccharides are said to moisten, harmonize, tonify, and strengthen in moderation, although excessive amounts of sweet-tasting herbs (or foods) can lead to edema and phlegm physically and to anxiety and confusion psychologically. Spicy and pungent herbs, typically featuring volatile oils, either disperse pathogenic factors on or to the exterior, or descend and activate peristaltic activity. Bitter-tasting herbs, usually containing alkaloids and glycosides, promote exocrine secretions and contribute, with spicy herbs, to the stimulation of tubular muscles to induce peristalsis" (White 2009. Exp Clin Psychopharmacol. 17(6):384-95).
Types of herbal preparations include extraction with solvent, decoction (from brewing in water), infusion (from steeping in hot water), tincture (from soaking in alcohol and water), dry forms prepared by grinding, and pills prepared from powders or extracts.
"According to traditional Chinese medicine (TCM) theory, paozhi processing transforms raw herbal drugs into 'decoction pieces,' thus instilling them with the desired properties for their medical application, including improved flavor and detoxification or alteration of their therapeutic efficacy. Paozhi encompasses techniques such as cutting, crushing, calcining, or frying with or without liquid adjuvants such as vinegar or honey...different kinds of decoction pieces can be derived from the same raw material by processing in different ways. For example, the Chinese pharmacopeia describes four different decoction pieces that may be derived from raw rhizomes of the species Coptis. These pieces, from the same source, have distinct activity and different sites of action within the human body" (Sheridan et al. 2015. Science. 350(6262):S64-6).
"The process of applying transdermal herbal medicine is not as simple as putting it directly on the skin. It should be applied specifically at the relevant acupuncture points (acupoints). According to Wu Shi-Ji, 'If a disease is due to an external factor, you should apply herbs to release it on location; however, when the disease has spread into the body, you should apply herbs on the relevant acupuncture points to treat it.' Thus, transdermal treatments exert their therapeutic actions not only by absorption of active ingredients from herbs, but also the stimulation of acupoints. This concept is one of the distinctive differences between Chinese transdermal herbal treatments and modern TDDS [transdermal drug delivery systems]...The curative effect of an herbal patch placed on an acupoint is commonly regarded as superior to that of a patch placed on a non-acupoint" (Wu et al. 2015. Science. 350(6262):S82-3).
In some cases herbal remedies are injected. "...The Chinese medicine sector has modernized along with the rest of the country, with local manufacturers turning age-old recipes into fast-acting injectable drugs. Chinese medicine injections generated sales of $13 billion last year...Over a hundred injections based on traditional recipes are sold in China these days, some without stringent human trials. Doctors often prescribe them in an array of untested combinations" (Anon. 2017 Nov 3. Patient deaths show darker side of modern Chinese medicine. Bloomberg News).
"Tanreqing injection (TRQ) was one of important Traditional Chinese Herbal Medicines. As a compound for injection, it includes extracts from Radix Scutellariae (Scutellaria baicalensis Georgi), Flos Lonicerae (Lonicera japanica Thunb), and Fructus Forsythiae (Forsythis suspensa Thunb)" (Xiong et al. 2018. J Altern Complement Med. 24(11):1051-62).
Reviews
There are numerous reviews of Chinese herbal medicine for a wide variety of conditions. The following list is restricted to those from the Cochrane Database of Systematic Reviews.
Angina - Zhuo et al. 2010. CD004468. Insufficient evidence of effectiveness, "should be used with caution."
Bleeding from hemorrhoids - Gan et al. 2010. CD006791. "Most of the included studies were of low quality...the evidence is not enough that clinical practice should be changed..."
Dementia - Chan et al. 2018. CD010284. "We found moderate- to very low-quality evidence of benefit and harm of TCHMs..."
Diabetic peripheral neuropathy - Zhang and Liu 2011. CD007796. No evidence in support.
Dysmenorrhea - Zhu et al. 2007. CD005288. Results promising but limited by poor methodological quality.
Endometriosis - Flower et al. 2012. CD006568. Two trials suggested use but of poor quality.
Gastric cancer - Yang et al. 2013. CD005096. "This review did not provide assured evidence concerning the effectiveness of TCMHs in improving quality of life or rate of remission."
Glucose tolerance - Grant et al. 2009. CD006690. Positive evidence is constrained by considerable risk of bias.
Heart failure - Chen et al. 2012. CD005052. Shengmai may be beneficial, but results "should be interpreted with caution" due to "the studies being of low quality" and other flaws.
Hypercholesterolemia - Liu et al. 2011. CD008305. "Some herbal medicines may have cholesterol-lowering effects. Our findings have to be interpreted with caution due to high or unclear risk of bias of the included trials."
Kidney disease
Cordyceps sinensis: Hong et al. 2015. CD009698. "Although there were some favourable aspects...longer-term studies are needed to clarify any benefit-harm tradeoffs." (Note: Cordyceps is a fungal parasite of caterpillars.)
Astragalus: Zhang et al. 2014. CD008369. Some promising effects, but "suboptimal methodological quality and poor reporting."
Rheum officinale: Wang et al. 2012. CD008000. Current evidence "is both scant and low quality."
Menopausal symptoms - Zhu et al. 2016. CD009023. Insufficient evidence that any more or less effective than placebo or hormone therapy.
Miscarriage - Li et al. 2012. CD008510. Insufficient evidence, quality of included studies was poor.
Osteoporosis - Liu et al. 2014. CD005467. Beneficial effect is still uncertain.
Polycystic ovarian syndrome - Zhou et al. 2016. CD007535. Insufficient evidence to support use.
Schizophrenia, Wendan decoction: Deng and Xu 2017. CD012217. May be helpful, but not enough high quality evidence.
Urinary tract infections - Flower et al. 2015. CD010446. Studies were small and of poor quality.
Note that in no case was there convincing high-quality evidence of effectiveness. Studies generally were of poor quality.
Scientific critique
Herbs are often given in combination, so the effect, if any, of one component is difficult to establish. The descriptions of the components are often inadequate (e.g., Chinese names whose translation is ambiguous, or general words that could describe thousands of plant species). Thus, one does not know for sure what the remedy consists of. A single remedy may contain as many as 50 different herbs.
"Thousands of RCTs [randomized controlled trials] on CHMs have been performed, the overwhelming majority in China. A major problem in interpreting many of these trials was the unsystematic and often insufficient description of the study treatments received by the participants. An adequate description of an herbal combination includes, at a minimum, the name, source, processing method, and dose of each ingredient" (Linde and Brinkhaus 2017. Ann Intern Med 167(2):133-4). (To deal with this problem, "an extension of the CONSORT (Consolidated Standards of Reporting Trials) Statement presenting, explaining, and elaborating recommendations for the better description of CHM formulas" was developed in 2017 (ibid).)
"Chinese herbal medicines contain ingredients derived from endangered animals, toxic plants and livestock, a genetic audit has discovered. Few of these ingredients were listed on the packaging. 'There’s absolutely no honesty in the labelling of these products. What they declare is completely at odds with what’s in there,' says Mike Bunce, a geneticist at Murdoch University...Nearly half of the medicine samples tested for animal DNA contained genetic material from multiple animals, and more than three-quarters included DNA from animals not listed on the packaging, such as water buffalo, domestic cows and goats. 'Many of those traditional Chinese medicine supplements are such adventurous mixtures of multiple ingredients that, quite frankly, nothing surprises me about them,' says Edzard Ernst..." (Callaway 2012 Apr 12. Nature News). Of special concern is the use of rhinoceros horn in remedies that supposedly treat cancer and other conditions.
Chinese medicine includes the use of bear bile. "The harvesting of bear bile is truly a barbaric practice. Bears are confined in tiny cages, with catheters implanted in their gallbladders to harvest the bile" (Gorsky 2019 Jan 7. Respectful Insolence blog).
Recently the Chinese government has been removing Internet posts that criticize traditional medicine.
Toxicity
Mercury is used in some Chinese remedies.
Some Chinese herbal preparations have been found to be contaminated with heavy metals, or adulterated with conventional drugs. Numerous cases of liver injury have been reported.
Many remedies contain numerous ingredients. "There is clear evidence that polypharmacy (four or more medications) increases the risk of adverse drug reactions (ADRs)" (Hawkes and Benhamu 2014. Trends Pharmacol Sci. 35(3):111-2).
OTHER MISCELLANEOUS CHINESE THERAPIES
Gua sha - "Gua sha, sometimes referred to as 'scraping,' 'spooning' or 'coining,' is a traditional Chinese treatment that has spread to several other Asian countries. It has long been popular in Vietnam and is now also becoming well-known in the West. The treatment consists of scraping the skin with a smooth edge placed against the pre-oiled skin surface, pressed down firmly, and then moved downwards along muscles or meridians. According to its proponents, gua sha stimulates the flow of the vital energy ‘chi’ and releases unhealthy bodily matter from blood stasis within sore, tired, stiff or injured muscle areas. The technique is practised by TCM practitioners, acupuncturists, massage therapists, physical therapists, physicians and nurses. Practitioners claim that it stimulates blood flow to the treated areas, thus promoting cell metabolism, regeneration and healing. They also assume that it has anti-inflammatory effects and stimulates the immune system...There is little research of gua sha, and the few trials that exist tend to be published in Chinese" (Ernst 2018 Jun 16. Edzard Ernst blog).
Paida (slapping therapy) - "It involves slapping the body surface with a view of stimulating the flow of ‘chi.' Slapping therapists...believe that this ritual restores health and eliminates toxins" (Ernst 2016 Dec 2. Edzard Ernst blog).
Tui na (or tuina) - "a massage technique that is based on the Taoist principles of TCM. It involves a range of manipulations usually performed by an operator’s finger, hand, elbow, knee, or foot applied to muscle or soft tissue at specific parts of the body. According to one website of TCM-proponents 'Tui Na makes use of various hand techniques in combination with acupuncture and other manipulation techniques. To enhance the healing process, the practitioner may recommend the use of Chinese herbs. Many of the techniques used in this massage resemble that of a western massage like gliding, kneading, vibration, tapping, friction, pulling, rolling, pressing and shaking. In Tui Na massage, the muscles and tendons are massaged with the help of hands, and an acupressure technique is applied to directly affect the flow of Qi at different acupressure points of the body, thus facilitating the healing process. It removes the blockages and keeps the energy moving through the meridians as well as the muscles. A typical session of Tui Na massage may vary from thirty minutes to an hour'" (Ernst 2017 Apr 7. Edzard Ernst blog). It has been used for various types of pain, muscle spasms, and many other conditions. Reviews have been published for use with hypertension (Yang et al. 2014. Complement Ther Med. 22(3):541-8), cervical radiculopathy (Wei et al. 2017. Evid Based Complement Alternat Med. 2017: 9519285), and diarrhea in children (Lai et al. Complement Ther Med. 2018. 41:10-22), but for all three reviews the quality of included studies was low.
Yang Sheng "is said to be a health-promoting method in Traditional Chinese Medicine (TCM) that includes movement, mental exercise, and breathing technique. It is used mainly in China but has apparently it is currently enjoying an ever-widening acceptance in the Western world as well" (Ernst 2019 Feb 22. Edzard Ernst blog).
Some unscientific electronic devices claim to interact with acupuncture points or meridians in gaining information about health status or in transmitting healing energy or information. See the section on "Devices" in the article "Chelation Therapy; Allergy and Arthritis Treatments; Other Miscellaneous Topics" (CHELATION AND MISC).
ANMA MASSAGE (ANMA THERAPY)
"Anma therapy is a traditional Japanese massage brought from China as 'Do-in and Ankyo' in the 6th century at approximately the same time as acupuncture, moxibustion, and Chinese medicine were introduced. 'Do-in and Ankyo' were a kind of touch and manual therapy including movement and breathing exercises that were designed to stimulate the flow of ki, or life energy, throughout the body. This therapy is considered to be capable of rebalancing the flow of vital energy through the meridians. It originated as a way to prevent disease, maintain and promote good health. The art developed according to Japanese preferences, supported by public confidence, and at present, it is called Anma therapy ('an' is the Japanese term for applying pressure and kneading, and 'ma' the term for stroking), one of the most popular therapies in Complementary and Alternative Medicine (CAM) in Japan.
"Recently, Shiatsu (literally, in Japanese, 'pressing with the thumb') has become famous worldwide, although it is only one technique of many in Anma therapy...Anma therapy is composed of seven techniques, including stroking, kneading, and pressing, with kneading being used most frequently. These stimuli are applied to the deep muscle, usually through clothes, to achieve tactile and pressure sensation, whereas Western style massage is applied directly to the skin using stroking technique more frequently with softer superficial tactile stimulation and lubrication."
"Anma therapy has been empirically shown to maintain well-being, promote health, treat illness, and prevent disease. It has often been used to treat symptoms which are not treated by medical doctors, such as muscle stiffness in the neck and shoulder, lower back pain, musculoskeletal or arthritic pain, chronic pain, neuralgia, autonomic nerve disorders, fatigue and so on" (Donomoya et al. 2010. J Bodyw Mov Ther. 14(1):55-64).
"In general, the Anma massage is applied over the entire body, focusing not only on hypothesised meridians but also on anatomy, especially muscles" (Suoh et al. 2016. J Bodyw Mov Ther. 20(2):364-72).
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