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Introduction of Traditional Chinese

Medicine

Yam Mun Fei, PhD


School of Pharmaceutical Sciences,
Universiti Sains Malaysia
What is TCM?
• TCM is an academic system about human physiology and
pathology, as well as the diagnosis and treatment of
diseases. Its establishment is based on thousands of years of
experience of Chinese medicine, prescription, principle, and
reflection on the relationship between man and nature.

• It is generally believed that Chinese medicine started from


Shennong who tasted hundred of herbs, among which,
about seventy kinds are poisonous. Such a record vividly
reflects how the ancient Chinese learned about medicine
(including plants, animals, and minerals) and accumulated
pharmacological experiences.
Principle concept of TCM
1. Essence-qi-spirit theory
• Qi : all visible things in the universe originated from the
invisible qi, including a human being was formed from qi.
• “the condensation of qi forms human beings”

• Essence : essential substance constituting the human body


and maintaining life activities. Without essence there will be
no life. In a broad sense, it generally refers to qi, blood, body
fluid, and essential substances from foodstuff.
• “The essence is formed first, and then it develops into brain and
spinal cord, and finally the human body”

• Spirit: an internal and dynamic power for the development


and changes of everything. Human spirit is manifested in
the form of consciousness and thinking. It will disappear
when one dies.
2. Yin and Yang theory
Yin and yang are two aspects of the unity of opposite things.
Major concepts of yin-yang theory:
Opposition of yin-yang
Interdependence of yin-yang
Wax-wane of yin-yang
Transformation of yin-yang

Yang Yin
Fire Water
Heat Cold
Restless Quiet
Dry Wet
Hard Soft
Excitement Inhibition
Rapidity Slowness
Non-substantial Substantial
Transformation/change Conservation/storage/sustainment
Yang
Yin

Yin

Yang
Balance of Yin and Yang Consumption of Yang
Yin

Yang
Yang

Yin
Excess of Yin Consumption of Yin
Yang
Yin

Excess of Yang
3. Five elements theory

The generating sequence

The internal organ and the five elements


The organ-generating sequence
The generating sequence of the internal organs
The over-acting sequence of the internal organs
4. The eight principles
• The eight principles include exterior, interior, cold, heat,
deficiency, excess, yin and yang. Syndrome differentiation
(pattern identification) of the eight principles is an essential
paradigm in the Chinese medicine system.
• Pattern identification of the eight principles aims to tell
about the disease location, the pathogenic nature and the
strength between antipathogenic qi and pathogenic factors,
thus generalizing the condition into eight categories.
• The eight principles can be divided into four pairs:
interior/exterior for the depth of pathogens; cold/heat for
the disease nature; deficiency/excess for the strength
between antipathogenic qi and pathogenic factors; and
yin/yang for the preponderance of yin and yang. However,
yin and yang can also generalize the other six principles:
exterior, heat and excess are ascribed to yang, and interior,
cold and deficiency to yin.
The four diagnostic methods
1. Inspection
• Inspection aims to observe a patient’s body, specific
body parts, secretion and discharges to collect data for
diagnosis. It can be generalized into observation of the
spirit (vitality), color, shape and movement
• Inspecting the Spirit
• Inspecting the Facial Complexion
• Inspecting the Body Shape and Posture
• Inspecting the Five Sense Organs
• Inspecting the collaterals of the index fingers
• Inspecting the tongue (tongue diagnosis)
(KI) Yang deficiency

Swollen, pale, scalloped,


thin clear coat

Kidney Yin Deficiency


Excess Heat in Heart
Invasion of Wind
Heart Yin and Blood Severe Yin Deficiency
Long, thin, dry, red body with
Deficiency Long-standing heat lateral deviation
or fire (LR or ST) Dry yellow coat
Tongue body pale and
tip red and pointed Red tongue body with black,
No coat dry central coat
2. Auscultation and olfaction
• Auscultation and olfaction aims to understand patients’
conditions by listening to the sounds and smelling the
odors. The sounds include speaking voices, speech,
breathing, coughing, vomiting, hiccups, belching,
sighing, sneezing and bowel sounds. The odors include
a foul breath and offensive smells of the secretions and
excretions.
• Listening to the Sounds
• Smelling the Odor

3. Inquiry
• Inquiry aims to, by asking patients or the accompanying
persons, collect information regarding the disease
occurrence, development, treatment, present
symptoms and other relevant data including life habits,
hobbies and family histories, etc.
4. Palpation
• Palpation is a method of touching, palpating or
pressing the patient’s body to obtain medical
information. It includes two parts: feeling the pulse
and palpating or pressing the body areas, such as
the skin, hands, feet, chest and abdomen.
• Feeling the Pulse (Pulse Diagnosis)
How TCM treat patient?

Syndrome differentiation
therapy
Syndrome Differentiation Therapy

Diagnosis Interpretation Prescription


Four diagnostic Step 1: Differentiating Selection of Formula
etiology and pathogenesis • Main TCM formula and
methods
• Inspection core additional single
Step 2: Differentiating the
• Auscultation and herb
location of a disease
olfaction
• Inquiry
Step 3: Differentiating the
• Palpation
nature of a disease
Monitoring
The Eight Principles
• Concept Exterior Syndrome and
Interior Syndrome Monitoring the Effect of
• Cold Syndrome and Heat the Prescription
Syndrome Deficiency Syndrome
and Excess Syndrome • Maintain or change the
• Correlation Involving Cold, prescription of the TCM
Heat, Exterior, Interior, formula
Deficiency and Excess
• Yin Syndrome and Yang
Syndrome
Chinese
physician

Prescription not always similar


even same disease!
①Common Cold ②Common Cold ③Common Cold
Chinese physician Chinese physician Chinese physician Chinese physician

① ② ③ ④
The prescriptions from different
CP not always similar even same patient!
Liu Wei Di Huang Wan
Six-Ingredients Rehmannia Pill
Radix Rehmanniae Praeparata 24 g; Fructus Corni 12 g; Rhizoma Dioscoreae 12 g;
Rhizoma Alismatis 12 g; skinless Poria 9 g; Cortex Moutan 9 g.

Radix
Rehmanniae Fructus Rhizoma
preparata Corni Dioscoreae

Rhizoma Cortex
Alismatis Moutan Poria
Liu Wei Di Huang Wan
Six-Ingredients Rehmannia Pill

• Classical formula for nourishing kidney and liver yin

esophageal epithelial hyperplasia


hypertension diabetes insipidus

functional uterine
bleeding
central retinitis

sudden deafness chronic prostatitis

infantile malnutrition
aplastic anemia sores in the mouth and tongue

Liu Wei Di Huang Wan


Xue Fu Zhu Yu Tang Jia Jian
Tian Ma Gou Teng Yin Jia Jian

Banxia Tian Ma Bai Zu Tang

Liu Wei Di Huang Wan

Etiology and pathology of hypertension in Chinese medicine


Old method for boiling the herbal
tea- Clay pot
Latest method for the herbal tea
preparation
Granule TCM dispensing
Granule TCM products

Extractor/Concentrator Spray dryer/Fluidized bed dryer

Raw material Cleaning/grinding Extraction Concentration

Packing Drying
Evidence for efficacy:
convention or
randomized trials?
Tang J.L., Leung P.C. (2001). An efficacy-driven approach to the research and development of traditional
Chinese medicine. HKMJ 7(4); 375-380.
Banxia Baizhu Tianma Tang
• The second most frequently prescribed TCM formulae for hypertensive treatment
(Li, 2014)
• Glycyrrhiza uralensis, Pinellia ternate, Gastrodia elata, Atractylodes macrocephala,
Poria cocos, and Citri retriculatae
• Ancient TCM formula can be re-formulated in order to improve the clinical efficacy

BBT Separate extract of each Vasodilation effect each


component herb of BBT by extracts was tested using in
different solvent vitro aortic ring assay

Test on effect of various The most active extract of


SHR study, extraction method of each herb was selected
toxicity study optimum ratio on for orthogonal stimulus
vasodilation effect compatibility study

Li, X. L., 2014. Analysis on Syndrome and Clinical Treatment in Hypertension by Traditional Chinese Medicine
based on Literature Medicine Based on Literature (unpublished master thesis). Gansu University of Chinese
Medicine, China
Safety concern and
authentication of TCM herb
lead (10 ppm),
arsenic (5 ppm),
mercury (0.3 ppm),
cadmium (0.5 ppm)
Aristolochic acid nephropathy: a worldwide problem. (a) Counting cases of CHN/AAN around the world
reported in the literature. (b) CHNA/AAN is a rapidly progressive interstitial nephritis leading to end-stage renal
disease and urothelial malignancy, which was originally reported in Belgium in the context of the intake of
slimming pills containing powdered Chinese herbs (A. fangchi).
Mutong

Akebia quinata, Akebia trifoliate

Aristolochia manshuriensis

Clematis armandi, Clematis montana


Fingerprint of TCM herbs
HPTLC
HPLC
Fingerprint of TCM herbs
Triple steps FTIR