Australian Journal of

Acupuncture and
Chinese Medicine
CONTENTS
01 Editorial
02 Guest Editoral
V Lin
06 Letters to the Editor
07 Does Acupuncture Improve the Endometrium for Women Undergoing an Embryo
Transfer: A Pilot Randomised Controlled Trial
CA Smith, M Coyle and RJ Norman
14 On the Psychological Significance of Heart Governing Shen Ming
LF Qu and M Garvey
23 Farewell to Chinese Medicine?
The Future of Traditional Chinese Medicine
SF Zhou
Some Thoughts on Medicine as a Science – A Layperson’s Contribution to the
Controversy Over TCM
B Butcher
Farewell to Professor Zhang Gongyao’s Ideals
B Xu and CH Ju
30 Interview with Professor Zhou Zhongying of NJUTCM, Nanjing, China
MW Zhu and Z Zheng
34
Current Research and Clinical Applications
Response to: Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture Treatment
for Pain: Systematic Review of Randomised Clinical Trials with Acupuncture,
Placebo Acupuncture, and No Acupuncture. BMJ 338:a3115, doi:10.1136/bmj.a3115 (Published 27 January 2009)
Z Zheng
37 Book Reviews
39 Upcoming International Conferences
40 AJACM Instructions for Authors

2009 VOLUME 4 ISSUE 1
 Australian Journal of
Acupuncture and Chinese Medicine
A PEER-REVIEWED JOURNAL

EDITOR-IN-CHIEF
Zhen Zheng, PhD, BMed
RMIT University, Australia

The Australian Journal of Acupuncture and

Chinese Medicine (AJACM) is the official journal DEPUTY EDITOR
of the Australian Acupuncture and Chinese
Medicine Association Ltd (AACMA). It is Christopher Zaslawski, PhD, DipAcu, PGDipCHM, BAppSc(Physio), MHlthScEd
Australia’s only peer-reviewed journal for the University of Technology, Sydney, Australia
acupuncture and Chinese medicine profession.
All articles, other than Current Research and
Clinical Applications, Research Snapshots, Book
Reviews, Conference Reports, Standards and EDITORIAL BOARD
Guidelines, and National and International
John Deare, MAppSc(Acu), BHSc(CompMed) Damien Ryan, PhD, BA(Theol), BA(Phil),
News, have undergone the peer-review process.
Australian Acupuncture and Chinese Medicine DipAcu, DipHerbMed(Nat), MEd(Res)
AJACM is indexed in the Australasian Medical
Index.
Association Ltd Riverina Institute of TAFE, Australia

AJACM Management Committee Peter Ferrigno, PhD, BA, DipEd, BSW, DipAcu, Caroline Smith, PhD, BSc(Hons), MSc, LicAc
James Flowers, Chair, AACMA Past-President GradDipHerbMed, MA(Res) University of Western Sydney, Australia
John Deare, AACMA President In private practice, Melbourne, Australia
Judy James, AACMA CEO
Ke Li, AACMA Director

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Judy James, BAcu, BA, LLB(Hons) I N T E R N AT I O N A L A D V I S O RY B O A R D
Managing Editor
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AdvCertAc(Nanjing), DipAc, DipEd, BSc Kyung Hee University, Republic of Korea
AACMA Manager of Marketing, Events
National Institute of Complementary Medicine,
and Professional Development Charlotte Paterson, PhD, MSc, MBChB
Australia
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Publication, design and printing Traditional East Asian Medicine, The Netherlands University of Technology, Sydney, Australia
Published by the Australian Acupuncture and
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AUSTRALIA Prof. Liangyue Deng State Administration of Traditional Chinese
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E-mail: [email protected]
Web: www.acupuncture.org.au/ajacm.cfm Richard Hammerschlag, PhD Medicine, China
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advertising, please see end pages.
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Disclaimer RMIT University, Australia
The ideas and opinions expressed in the Australian Prof. Lixing Lao, PhD, CMD, LicAc
Journal of Acupuncture and Chinese Medicine do not University of Maryland Baltimore, USA Jerry Zhang, PhD, BMed
necessarily reflect the views, ideas or opinions of the A/Prof. Chun Guang Li, PhD, BMed, MMed RMIT University, Australia
AJACM or AACMA. All articles and advertisements
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Editorial

I am very pleased to see this issue arriving as the news breaks Continuing from our previous issue, we have a paper about
that the Chinese medicine profession will be included in Shen. The authors, Qu and Garvey, review the classic literature
the National Registration and Accreditation Scheme for the and discuss the relationship between disturbed shen and
Health Professions from 1 July 2012. Until now, Victoria has modern diseases such as Attention Deficit Hyperactivity
been the only state in Australia which has had registration for Disorder (ADHD).
the Chinese medicine profession. In the next three years, much
work needs to be done to prepare for national registration. In response to your wishes, we publish our first interview of a
prominent 80-year-old Chinese medicine doctor in Nanjing,
The opening ceremony of the Australasian Acupuncture China, Professor Zhongying Zhou. In this interview, we
and Chinese Medicine Annual Conference (AACMAC) in ask him how to understand modern diseases with Chinese
Melbourne on 23 May 2009 was specifically dedicated to medicine theories, how to improve our clinical practice, and
celebrate this breaking news. In her keynote presentation if we need to understand western medical science and modern
following the Conference Opening Ceremony Dr Louise research methods. Professor Zhou gives detailed accounts of
Morauta, Project Director of the National Registration how he used Wei-Qi-Yin-Xue theory to understand epidemic
and Accreditation Implementation Project, outlined the haemorrhagic fever and develop treatment approaches. He
process leading up to that time and how registration would shares with us his personal experience of studying Chinese
be implemented. She also pointed out three main issues that medicine. We hope you will find this article helpful for your
would be mandatory for all nationally registered professions: personal development.
professional indemnity, continuing professional development
and identity checking. Professor Vivian Lin, President of the As usual, there are reviews of recently published Chinese
Chinese Medicine Registration Board of Victoria, shared medicine books and a current research report. Some of you
with us the Victorian experience, the challenges that national might recall a systematic review published in the British
registration would face and the balance between the registration Medical Journal early this year. It found that real acupuncture
board, the association and the universities. You will find more was as good as sham acupuncture in relieving acute and chronic
in her guest editorial in this issue. pain. This review has received wide publicity on the radio, in
newspapers and on the web. In Current Research and Clinical
Not everyone recognises the contribution of Chinese medicine Applications you will find an analysis of the deficiencies of the
to human health or understands its philosophy. In 2006, an review and the flaws in some of the recommendations.
article entitled ‘Farewell to Chinese Medicine’ evoked a nation-
wide debate about its future in China. In this issue, there are Again, we bring you a plateful of ideas and discussion. We hope
three short papers about this ‘farewell’ debate. Although the you will enjoy the reading. Please do not forget, we want to
debate happened in China, it is relevant to us in Australia. know your thoughts on the debate and the views presented.
Chinese medicine is under much questioning from various
groups of society; some are political, some are academic and Zhen Zheng
some are economic. I hope these three papers will stimulate Editor-in-Chief
thought in this area. We look forward to hearing your views.

Acupuncture assisted in-vitro fertilisation is a research topic that

attracts much attention from medical specialists, acupuncturists
and the public. In this issue, our Australian researcher, Associate
Professor Caroline Smith, and her colleagues look further into
the mechanism underlying this use of acupuncture.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 
 Guest Editorial
Vivian Lin* DrPH, MPH, BA
Professor of Public Health, La Trobe University
President, Chinese Medicine Registration Board of Victoria

Looking Back to Look Forward: Lessons from

Chinese Medicine Registration in Victoria

Introduction 16 formal hearings and 4 referrals to the Victorian Civil and

Australian health ministers agreed on 9 May 2009 to Administrative Tribunal (VCAT), plus 16 informal hearings
incorporate Chinese medicine (CM) practitioners into the and professional standards panel hearings.
national registration scheme from July 2012. As Victoria
has been the only jurisdiction to register CM, it is useful to The Board has taken its duty of protection of public health and
reflect on the issues faced by the Victorian Chinese Medicine safety seriously, including where individuals are holding out
Registration Board (CMRB, ‘the Board’) since its inception 9 as qualified practitioners. There have thus been 24 successful
years ago, in order to consider what lessons might be offered prosecutions.
as the profession begins to plan for national registration.
Equally, consideration of the past and present developments Ideally, however, the Board should be supporting good
in the Australian health system may offer some pointers to professional practice, as well as setting basic standards. To this
the upcoming challenges and opportunities for the Chinese end, the Board has issued 20 guidelines for professional practice
medicine profession. and 19 related to legislation processes.

What has the CMRB done? Of course, there can never be too much communication – with
the practitioners, the government, other registration boards,
The most basic part of the Board’s ‘core business’ is to assess and other stakeholders. CMRB maintains a highly informative
and register practitioners, through ‘grandparenting’, approving website, produces annual reports that try to document the
courses, and conducting exams. To this end, the CMRB work fully, and issues regular newsletters whose bilingual
processed and assessed more than 1600 registration applicants content has grown significantly over time. In addition to
(and refused 170 of them) since its commencement, approved specific consultations on guidelines, the Board established a
20 courses (in 5 institutions), and conducted around 50 reference group with practitioners and consumers, an initiative
examinations. that became a model for the new Victorian Health Practitioner
Registration Act 2007. Regular meetings with presidents,
The regulatory role of the Board requires that all complaints registrars, and legal members of other Boards were most helpful
(now called notifications) be investigated. Since the Board’s in learning from their experiences, establishing cooperative
establishment, 139 investigations have been undertaken, working relations, and ultimately having trust placed with
representing a higher number than such boards as CMRB to endorse other registered practitioners who wished to
chiropractic and osteopathy, but lower than medicine, use the acupuncture title.
nursing and psychology. Many complaints arise because of
miscommunication between practitioner and patient, or Some board presidents have remarked that the CMRB within
because practitioners have not fully understood the expected a very short time has had to work on all the issues, that other
standard of professional ethics. The Board has endeavoured boards have had some of these issues, and they have had them
to resolve problems through a variety of means, such as spread over a longer time span.
warning letters and mentoring. Nonetheless, there have been

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):2–5.

Australian Journal
 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Guest Editorial V Lin

It can be expected that these tasks and obligations will be professional associations, not the registration authority.
mirrored at the national level. It must be remembered, too, Conversely, health funds often failed to comprehend that
that the establishment of underlying policies and systems the CMRB was not a professional association, and that its
(including governance arrangements) are pre-requisites to role was comparable to any other registration board.
smooth implementation of the statutory responsibilities. A
national system will be even more complex. (3) When one more practitioner refers to him or herself
as a member of the board, thus illustrating continued
The biggest challenges for the confusion between what is a professional association vs

Board what is the registration board.

A continuing challenge for the Board is developing effective

Over the past nine years, the Board has faced any number communication with the profession. Despite various
of difficult decisions, about individual cases as well as about communication channels, and increasing effort at translations,
policy. Many of these will resurface for the national registration there remain underlying difficulties for overseas trained
board when it comes into existence. practitioners coming to terms with the Board as a regulatory
authority and the Australian regulatory regime.
The first big challenge was in setting the grandparenting
standards. In particular, how to strike the right balance Some of these challenges may surface with national registration,
between people’s right to livelihoods, the need to have an but at least there are some experiences in Victoria to draw
extended regulatory net to capture those whose skills might from.
be questionable, and the ideal standards that the profession
wished to achieve. What contributes to Board
Equally difficult were the questions about how to set effectiveness?
examinations, and whether overseas courses should be
approved. In the ideal world, there would have been mutual Within Victoria, the CMRB has a good reputation amongst
recognition with registration boards in other Australian states, boards for its approach to decision-making and its operational
if not international mutual recognition. The reality was that systems.
CMRB was on its own.
A good administrative system is the bottom line for delivering
The two longest standing policy development projects related the core business. Having good governance policies (ranging
to infection control guidelines and preparing the Board’s from managing conflict of interest to media representation) is
submission for scheduling of herbs. The former was held up by essential to instilling a culture of deliberative decision-making.
delays within the Victorian Department of Human Services,
whose cooperation was important to ensure the guidelines were Some of the notable moments that capture the ethos of the
seen to be relevant to all acupuncturists, whether registered by CMRB include:
CMRB or endorsed by other boards. The latter was a much
more complex exercise in pulling together the scientific • At the first strategic planning day, practitioner members
material, and in a form that would satisfy both federal and recalled the first term of the Board being the first time
state governments. in their professional involvement where they could agree
to disagree while respecting differences, and then finding
The three issues that the Board found most troublesome were: ways forward.

(1) What to do about yet one more advertising complaint. • Vigilant and reflective decision-making was seen
Despite guidelines, newsletter articles, hearings, and multiple times when Board members sought to consider
prosecutions, the message just doesn’t seem to get through systematically whether decision-making criteria had been
that use of testimonials is not an acceptable practice in the consistently and fairly applied, whether for grandparenting
Australian health care system. or consideration of financial hardship.

(2) Yet one more explanation needed about the Board’s role • Focus on the legislative objectives and the role of the
regarding health funds. This applies both to practitioners Board has been unwavering, with Board members, from
and to health funds, where practitioners had difficulty time to time, reminding each other that the principle task
understanding that access to health funds was a matter for for the Board is to protect public health and safety.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 
 Guest Editorial V Lin

• Whenever a new issue arises and no policy has been and these are cultural issues as much as they are linguistic
established, the Board consistently strives for clarity about problems.
the policy issue first. Only when the policy framework has
been agreed, and tested against hypothetical scenarios, At the same time, there remain misunderstandings within the
does the Board return to the issue at hand and then apply Australian community and the Australian health system in
the policy framework to the individual instance. relation to the role and value of Chinese medicine practice. Some
have doubts about the evidence base for Chinese medicine, while
• The Board aims for team work and complementarities others are concerned about the over-promotion of the efficacy
of skills in constituting committees, working groups and of Chinese medicine treatments. The frequency of acupuncture
hearing panels, so as to draw on each others’ strengths and treatment regimes and the dispensing of herbal medicines
perspectives. by Chinese medicine practitioners can be misinterpreted as
over-servicing or a commercial practice. So there is a need to
• When a complaint arrives about the Board’s own work, it both promote a greater community understanding of Chinese
is taken as a matter for reflection and learning. While there medicine practice as well as to ensure ethical practice amongst
are often two sides to every story, a defensive attitude in practitioners.
the first instance seldom contributes to problem solving.
To address these broader challenges will require a collaborative
Beyond internal operations of the Board, maintaining good and cohesive approach across professional associations,
relations with other boards and the government has also been educational institutions, and the registration board. With the
most helpful in the Board’s ability to discharge its statutory requirement in the national registration system for compulsory
obligations well. That the Board is seen in a good light by continuing professional development (CPD), an ongoing
others also reflects well on the professionalism of Chinese partnership will need to be institutionalised quickly as well.
medicine practitioners. Fundamentally, the registration board should be interested in
quality improvement and minimisation of disciplinary action.
Issues still requiring attention at
the national level Additional interfaces that need
to be worked on at national level
There will be many tasks confronting a new national board.
At the organisational level, consideration will have to be Registration is, of course, not just an activity of and for the
given to whether separate state structures will be necessary profession. It is a regulatory responsibility delegated by
and affordable; and if not, then how best to put into place government to a range of health professions. As such, there are a
consultative mechanisms. The most important policy myriad of interfaces with the health system and with other areas
issues will relate to national standards for registration – for of health policy that will require attention by a national board.
grandparenting, course approvals, examinations and post-
graduate specialties. With practitioners currently registered The most critical areas of interface will relate to:
(which includes Victorian practitioners as well as some
interstate practitioners at present) moving automatically across • endorsement to practise acupuncture by other health
to national registration, the alignment between Victorian practitioner registration boards to ensure comparability
standards and any new or different national approaches will in the standards of practice within the Australian health
require careful deliberation. In the longer run, the question of system
international mutual recognition will also need to be placed on
the policy agenda. • practitioner registration and product regulation by the
Therapeutic Goods Administration (TGA) in relation
Beyond the administrative and policy developments, there to scheduling of herbs, but also with other authorities
are broader issues that will require attention. The CMRB in terms of use of endangered species, quality of herbal
has been keenly aware that overseas-trained members of the supplies, monitoring of adverse events, etc
Chinese medicine profession have to make adjustments not
only to the language of clinical consultation and practising • the different state systems for complaints management
in a different healthcare system context, but also to develop and disciplinary procedures to ensure appropriate legal
a deep understanding of Australian community expectations processes are in place as well as equitable processes for
in relation to complementary healthcare. Miscommunication complainants and practitioners alike.
and misunderstanding are often at the heart of complaints,

Australian Journal
 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Guest Editorial V Lin

The CMRB experiences at the state level will have relevance Given Chinese medicine practitioners are used by many for
for how to manage these interfaces at the national level. primary care, either as a first point of contact, or in conjunction
with a general practitioner (GP), the National Primary Health
Opportunities for engagement Care Strategy might be of particular importance, to see how

with the broader health system the Chinese medicine profession should take its rightful place
in the Australian healthcare system.

Since the advent of the Rudd government, the pace of health Conclusion: Some lessons
reforms has quickened. These represent opportunities and
challenges for the profession as a whole, with the need to follow from Victoria
a range of policy developments and to monitor the timing for
engagement and input. Planning for national registration is expected to begin formally
a year in advance from the date of the national system’s
National registration has been one aspect of the national commencement (1 July 2012). The key lessons from the
health workforce reforms. There are other dimensions that CMRB since its establishment, that could be offered early on
will have implications for the profession. Issues to watch to a national board are:
include the proposal to develop generic competencies for
health professionals, multidisciplinary teams, and workforce • Stay focused. Stick to the knitting. Registration is about
substitution (including prescribing rights). protecting public health and safety.

The National Healthcare and Hospital Reform Commission • Adopt good governance principles and practices. Good
(NHHRC), the Preventative Health Taskforce (PHT), and the decision-making processes engender trust, which is a
National Primary Health Care Strategy will all report in mid- critical foundation for any group.
2009. The NHHRC has proposed four foci for reform: taking
responsibility, connecting care, facing inequities and driving • Be meticulous about administrative decision-making.
quality performance. These principles all have relevance for the The Board is accountable for carrying out its statutory
Chinese medicine profession. For instance, the profession has responsibilities.
a great deal to contribute in relation to supporting consumers
taking greater responsibility for their health and well-being • Appreciate diversity. Within the framework of protecting
and for improved care coordination for chronic conditions. public health and safety, there is scope for different styles
The profession within Victoria has also demonstrated its and emphases in professional education and practice.
commitment to supporting disadvantaged communities,
offering services to victims of the 2009 bushfires, to clients in • Reach out and communicate broadly with all stakeholders.
alcohol and drug services, and in low-income communities. The array of stakeholders is broad, and it is important to
The question about quality performance might put a focus keep in mind the interests and needs of each group.
within the profession about what mechanisms exist to assure
and improve quality and outcomes in professional practice. • Remember it should be win-win for both the community
and the profession. It is in the interest of everyone to
The profession can equally consider how it might contribute to ensure inappropriate conduct and unethical practices are
prevention in relation to the PHT’s focus on obesity, tobacco, weeded out.
and alcohol. It is expected that National Men’s Health and
Women’s Health Strategies will also be released in 2009, • Take a rightful place in the mainstream. Chinese medicine
and no doubt there will be specific areas of clinical practice is appreciated by the Australian community, and it can
where the Chinese medicine profession can make a significant engage successfully with the health system and health
contribution. policy at large.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 
 Letters to the Editor
Dear Sir/Madam arise in an individual, at a fundamental Since the Large Intestine is responsible
level these expressions of disharmony are for excreting all turbid wastes from the
Please explain the association between regarded as manifestations of a single body, it can be understood that any
constipation and neck pain, lower back underlying pathology. obstruction of this function will cause
pain and headache. Perhaps, it is just the entire system to suffer through
poor think [sic] and lack of clinical For six months prior to the documented increased toxicity and a reduction of
skills. treatments, the patient had been taking free flow. Thus a person with long-term
a powerful laxative that would normally constipation may experience a worsening
Edwin Y Miao only be prescribed for 1 to 2 weeks. The of pre-existing conditions including –
18 December 2009 long-term purgative action of this agent low back pain, neck pain and headache.
had depleted the patient’s body fluids,
Reference: AJACM 2008;3(2):22–27 dried her stools and injured the Kidney Your comment suggests that while the
Acupuncture for the Treatment of Normal Yin. Kidney Yin deficiency had given holistic philosophy that underpins
Transit Constipation: A Case Report rise to lower back pain and Empty Heat Chinese medicine has been established
JZ Kremer & JC Deare had further dehydrated the patient’s in texts both ancient and new, those
intestinal fluids, so compounding the who have fully grasped the implications

Authors’ response existing constipation. of these subtle formulations remain

relatively few.
This connectivity of symptoms was also
In the seventy-fifth chapter of the Suwen,
Huang Di states, ‘Do not forget that the
evident in the patient’s neck pain, which
resulted from a fractured cervical vertebra
Reference
myriad things of the universe have an suffered in childhood. The neck pain 1. The yellow emperor’s classic of medicine:
a new translation of the neijing suwen
intimate relationship with one another. centered on the point LI 18 Futu, was
with commentary. Ni MS, translator
They present as varied as yin and regarded as an obstruction of the Large and commentator. Boston and London:
yang, internal and external, male and Intestine channel from which subsequent Shambhala Publications; 1995. p. 287.
female, upper and lower, but they are all headaches had developed. This channel
interconnected’.1 As an holistic medical obstruction was also disrupting the Jason Kremer
system, Chinese medicine regards the function of Large Intestine organ (as Correspondent Author
body, mind and spirit as an integrated, above, so below) thereby contributing
energetic whole. Thus while seemingly further to constipation.
independent signs and symptoms may

Australian Journal
 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Does Acupuncture Improve
the Endometrium for Women
Undergoing an Embryo Transfer:
A Pilot Randomised Controlled
Trial
Dr Caroline Smith*1,2 PhD
Dr Meaghan Coyle3 PhD
Prof Robert J Norman1,4 MD
1. Centre for Reproductive Health, School of Paediatrics and Reproductive Health, The University of Adelaide, Australia
2. CompleMED, The University of Western Sydney, Australia
3. Private practice, Sale, Victoria, Australia
4. Repromed, Adelaide, Australia

ABSTRACT
Background: There is a growing body of research suggesting acupuncture may increase pregnancy
and live births, when administered on the day of embryo transfer. The physiological effects of
acupuncture that may influence the outcome from embryo transfer remain unclear. Aims: To
examine the effects of acupuncture on uterine endometrium thickness and pattern, and the level
of hormonal medication during an IVF cycle. Design: Randomised controlled trial. Subjects:
Women undergoing an IVF cycle with a planned embryo transfer at day 3 or day 5. Setting: A
reproductive medicine unit in South Australia. Intervention: Women were randomly allocated to
acupuncture or standard care. Women in the acupuncture group received three treatments, the first
undertaken on day 9 of stimulating injections, and two on the day of embryo transfer. Outcome
measures: The primary outcomes were change in endometrial thickness and pattern, and levels of
plasma progesterone, and oestradiol during the IVF cycle, through to seven days post-egg retrieval.
Secondary outcomes included number of oocytes retrieved, number of oocytes fertilised, and
biochemical pregnancy rate. Results: Endometrial thickness and pattern and levels of hormonal
medication did not differ between groups on the day of embryo transfer or in the luteal phase
(p > 0.05). There were no differences in any secondary outcomes. Discussion and Conclusion:
The results of this pilot study suggest acupuncture did not influence the endometrium or levels
of hormonal medication during the IVF cycle. The small number of subjects and incomplete
data make conclusions difficult, and consideration must be given to whether the measurement
parameters were sensitive to changes from acupuncture, or whether the study sample was too
small to detect a change. Interestingly, for the women who received acupuncture, there was a non-
significant trend towards a higher fertilisation rate and numbers of women proceeding to embryo
transfer.

K ey W ords acupuncture, infertility, randomised controlled trial.

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):7–13.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 
 Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

Introduction The physiological effects of acupuncture that may influence

the outcome from embryo transfer remain unclear. There
There is a small but growing body of research examining is currently no data available on whether acupuncture
the effectiveness of acupuncture as an adjunct to in-vitro treatment administered earlier in the cycle effects the growth
fertilization (IVF). There are two systematic reviews reporting of the endometrium over the subsequent days following
on a benefit from acupuncture when it is used as an adjunct embryo transfer. The aim of this research was to examine
on the day of embryo transfer (ET) for women undergoing a potential mechanism arising from acupuncture that may
assisted reproductive technology (ART) (OR 1.65, 95% CI affect endometrial receptivity and subsequently increase the
1.27 to 2.14).1 A recent Cochrane review reported evidence of success of pregnancy rates. The research examined the effects
benefit when acupuncture is performed on the day of ET on of acupuncture on endometrium thickness and pattern from
the live birth rate (OR 1.89, 95% CI 1.29 to 2.77).2 However, baseline, at embryo transfer and in the luteal phase, and the
further research is required. level of hormonal medication (plasma progesterone, and
plasma oestradiol) during the IVF cycle through to seven days
The endometrium in IVF cycles is subject to an altered post-egg retrieval. The study also aimed to pilot the processes
endocrine environment, and factors influencing endometrium and procedures for undertaking further research in this area.
receptivity are poorly understood.3 The thickness of the
endometrium, morphology and uterine artery blood flow
however have been identified as potential, important variables Methods
influencing the success of the implantation by the embryo.4
Endometrium thickness is required to optimize the pregnancy PARTICIPANTS AND METHODS
rate and is partly a reflection of uterine artery blood flow. We recruited women to this trial from Repromed, a reproductive
Pregnancies generally occur where the endometrium achieves a medicine unit in Adelaide, South Australia between
thickness of greater than 8 mm. October and December 2007. The research was approved
by the Women’s and Children’s Hospital research and ethics
Conventional science has hypothesised that acupuncture committee, Adelaide. Women undergoing an IVF cycle with a
works by neurological, neuro-hormonal and psychological planned embryo transfer at day 3 or day 5 were eligible to join
mechanisms. Needle insertion into the skin and deeper tissues the study. Women who were planning a frozen embryo transfer,
results in a particular pattern of afferent activity in peripheral or who were planning to have acupuncture were excluded from
nerves. The mechanisms through which acupuncture might the study. Eligible women were identified by a research nurse
influence female fertility could involve central effects on the at Repromed. All women received hormonal stimulation as per
release of neurotransmitters including ß-endorphin, which Repromed treatment protocols.
in turn influence gonadotropin releasing hormone (GnRH)
release and impact on pituitary gonadotropin secretion, ovarian INTERVENTION
follicular growth, ovulation and fertility.5–7 Acupuncture may Women were recruited to the trial on day 9 of their IVF cycle.
also exert a sympatho-inhibitory effect which may reduce After obtaining their written consent, subjects underwent a
uterine artery impedance and thereby increase uterine and traditional Chinese medicine (TCM) differential diagnosis to
ovarian blood flow. Stener-Victorin (1996) demonstrated that identify the predominant TCM syndrome, and baseline data
when acupuncture was administered to 10 infertile women, was collected. Women were randomised to acupuncture or
blood flow impedance was reduced in women receiving standard care groups. Randomisation was undertaken by the
acupuncture (P < 0.05).8 study acupuncturist, by taking the next sequentially numbered
sealed opaque envelope. An independent researcher developed
It has been suggested that this improved uterine blood flow the computer generated randomisation schedule. The number
could improve the growth and thickness of the endometrium. of cases in each randomisation block was 2 and 4 and this was
Acupuncture might also impact on local humoral factors that not revealed to the acupuncturist.
are involved with the regulation of implantation. A study by
Paulus however found no difference between groups on the The two acupuncturists who administered the acupuncture
endometrium thickness and plasma oestradiol on the day of over the study period were accredited members of the Australian
transfer.9 The pulsatility index of uterine arteries before and Acupuncture and Chinese Medicine Association Ltd. Both
after transfer was also not found to differ between groups (p acupuncturists have previous experience in this area, and with
> 0.05). In another trial, Quintero evaluated the effectiveness administering acupuncture clinical trials and private practice,
of acupuncture as an adjunct to IVF and found acupuncture (CS four years training and fifteen years clinical experience,
significantly reduced the amount of gonadotropin used (p < MC four years training and nine years clinical experience).
0.05), however no effect on the pregnancy rate was found.10 The majority of women saw the same acupuncturist for all

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 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

treatments. The trial was administered in private acupuncture reflectivity as the surrounding myometrium and a poorly
clinic rooms, a 10 minute drive from the fertility centre. For defined central echogenic line; or type C, a multilayered ‘triple-
women receiving acupuncture, an individualised acupuncture line’ endometrium, consisting of a prominent outer and central
treatment was administered on day nine of the IVF cycle, as hyperechogenic line and inner hypoechogenic region. Routine
per our previous trial.11 Treatment was administered according blood collection was undertaken on day nine of the IVF
to TCM pattern differential diagnosis, and in consideration cycle for plasma oestradiol and progesterone, and additional
of the ‘stimulation’ stage of the IVF cycle, for example, blood was taken on day seven following egg retrieval. Nurses
supporting Kidney yin and building blood. The second and taking the blood were blind to the woman’s group allocation.
third acupuncture treatments were administered on the day Secondary outcomes included number of oocytes retrieved,
of embryo transfer, and administered before and after the number of oocytes fertilized, and biochemical pregnancy rate,
embryo transfer. The acupuncture treatment administered and were collected from clinical case records.
prior to embryo transfer included points PC 6 Neiguan, SP 8
Diji, LR 3 Taichong, ST 29 Guilai, and CV 4 Guanyuan, and This was a pilot study, there was no data reported on the
auricular acupuncture points Shenmen, Zhigong, Neifenmi and thickness or pattern of the endometrium in the literature to
Naodian. The treatment administered after embryo transfer guide a sample size power calculation. The aim of the study
included acupuncture points ST 36 Zusanli, SP 6 Sanyinjiao, was therefore to have 20 subjects available for analysis. The
and SP 10 Xuehai, and auricular acupuncture points Shenmen, initial analysis examined the baseline characteristics of women
Zhigong, Neifenmi and Naodian. Modifications were made to randomised to the trial. The main analyses used an ‘intention
the Paulus treatment protocol9; we substituted CV 4 Guanyuan to treat’ approach and compared differences in the primary
for CV 6 Qihai, to provide greater support to the Kidney qi. study outcome measures between the two groups over time
We excluded LI 4 Hegu, due to its use contra-indicated in early using repeated-measures analysis of variance. Comparisons
pregnancy, and to promote menstruation12 and GV 20 Baihui were also made between groups in binary variables using the
was excluded due to the multiple use of acupuncture points to chi-square test. Data on serum was analysed using the Mann
calm the patient.9 Acupuncture was applied bilaterally, with Whitney test. The analysis was undertaken by the investigator
the exception of the four auricular acupuncture points used on blind to study group. Levels of significance were reported at p
the day of transfer. Before the transfer, two points were needled < 0.05. Data were analysed using SPSS version 11.5.
in the right ear, and the other two points were needled in the
left ear. After embryo transfer the side of auricular acupuncture
was reversed. Seirin brand 0.22 x 30 mm acupuncture needles Results
were inserted to tissue level and stimulated manually to elicit
the deqi response. Needles were retained for 25 minutes in each Forty six women were approached to participate in the trial
treatment. (Figure 1). Eighteen women declined to participate in the
trial, the reasons given included not wishing to be randomised
Women randomised to the standard care group received the to the study, the woman was already having acupuncture,
standard Repromed treatment protocols only. Women allocated or they were unable to attend for all proposed acupuncture
to this group were also offered acupuncture at no cost if they sessions. Twenty eight women agreed to be randomised to the
were to undergo a future embryo transfer. trial, and fourteen women were allocated to each group. One
woman was withdrawn from the trial when she was unable to
Primary outcome data was assessed from ultrasound and attend for measurements of the primary endpoints following
blood tests. An assessment of the endometrium was made randomisation. Six women were unable to complete their
recording the pattern and thickness of endometrium by vaginal participation in the trial due to their treatment not progressing
ultrasound. The ultrasound was performed by a nurse at the to embryo transfer; five of these women were in the control
clinic who was blind to the subject’s study group. A routine group, and one woman was in the acupuncture group.
ultrasound scan was undertaken at day nine to assess timing
for egg retrieval. Further ultrasound measurements were The mean age of women participating in the trial was 35 years
undertaken at the time of embryo transfer, and an additional (Table 1). The majority of women had completed at least one
non-routine ultrasound was undertaken one week following egg IVF cycle, had a body mass index just above the normal range,
retrieval. The endometrial pattern was categorised by the study and 64% were childless. Over 64% of women had experienced
nurse blind to group allocation. Classification of endometrium infertility for greater than two years, and the main reasons
pattern was made based on three criteria proposed by Gonen for infertility were unexplained (25%), or male factor (28%).
and Casper12 as follows: type A, an entirely homogenous, Almost all women had finished high school (96%), 92% had
hyperechogenic pattern without a central echogenic line; completed vocational training award or university degree, and
type B, an intermediate isoechogenic pattern, with the same 86% were employed outside the home. Fifty percent had used

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of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 
 Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

Women approached to
participate in the study

Women who agreed to Women who declined to

take part in the trial take part
n = 28 n = 18

Randomly assigned
n = 28

Randomised to Randomised to
acupuncture n = 14 control n = 14

Complete outcome data

n = 12 Complete outcome data
Cycle cancelled n = 1 n=9
Unable to complete study Cycle cancelled n = 5
due to logistics n = 1

FIGURE 1 Trial flow chart

acupuncture previously. No differences existed between groups, Discussion

suggesting randomisation produced comparable groups at
baseline. We also present details of women’s TCM diagnosis The findings from this pilot study provide no preliminary
by group (Table 2). A Kidney deficiency was diagnosed in results that acupuncture administered prior to and on the day
over 50% of women. The most frequent diagnosis was Kidney of embryo transfer has an influence on endometrial thickness or
yang, and Qi stagnation. There were no differences in TCM pattern, or plasma levels of progesterone and oestradiol levels.
diagnosis between groups (p = ns). However, the small numbers of subjects, and incomplete data
make conclusions difficult, and consideration must be given
The primary and secondary outcomes are presented in Table 3. to whether the current measurement parameters were sensitive
Endometrial thickness did not differ between groups at baseline, to changes from acupuncture, and that the pilot sample size
the day of embryo transfer or in the luteal phase (p > 0.05). was too small to demonstrate any small changes in the primary
Data on outcomes at three time-points were available from endpoints. We can conclude that the effect of acupuncture
nine women; however, there was no difference in endometrial on these outcomes is not large. We were unable to measure
thickness or pattern between groups over time. There were no blood flow in this study and the degree of endometrium
differences found between groups for other study outcomes: vascularisation remains unknown. Interestingly, for the women
plasma progesterone and oestradiol levels at baseline and 7 who received acupuncture, there was a non-significant trend
days post-egg retrieval, number of oocytes retrieved, number towards a higher fertilisation rate and the number of women
of oocytes fertilized, and biochemical pregnancy rate. proceeding to embryo transfer. Although not an outcome of the
study the pregnancy rate was also not found to differ between
groups, and may be explained by the small sample.

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Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

Resources for the trial were to allow data analysis from 20

TABLE 1 Characteristics of the women at trial entry women. Although resources were allocated to 28 women
randomised to the study, seven women withdrew due
to their IVF cycle being cancelled. We also encountered
Acupuncture Control
n = 14 n = 14 some logistical difficulties with obtaining measurements
of the endometrium. For embryo transfers occurring at
Age (years) 36.0 (5.1) 35.7 (5.0)
the weekend we did not have access to staff who would
No. of previous IVF cycles undertake measurements for the study. We also found
0 2 (14.3) 3 (21.4) for those women proceeding to embryo transfer, some
1–3 10 (71.4) 6 (42.9) were reluctant to return for their blood and ultrasound
4+ 2 (14.3) 5 (35.7) measurements. These are important factors identified
from the pilot relating to feasibility and study design,
Duration of infertility (years)
which will guide researchers with planning future
<2 y 5 (35.7) 5 (35.7)
research in this area.
2–4 9 (64.3) 7 (50.0)
5+ 0 (0.0) 2 (14.3)
One potential limitation of the study was the times
Parity
scheduled for measurement of the endometrium and
0 7 (53.8) 11 (78.6) hormonal measurements. We scheduled measurements
1+ 6 (46.2) 2 (21.4)
following embryo transfer (day 3 or day 5), and day seven,
Reason for infertility post-egg retrieval. This was based on an assumption
Male factor 4 (28.6) 4 (28.6) that any acupuncture effect would be detectable at
Maternal age 4 (28.6) 3 (21.4) these time points. Although the day of embryo transfer
Tubal 1 (7.1) 1 (7.1) varied between day 3 or day 5, both groups of women
Unexplained 4 (28.6) 3 (21.4) would have received hormonal stimulation to ensure
Endometriosis 0 (0) 1 (7.1) the endometrium thickness met the IVF centre criteria.
BMI 26.1 (4.3) 23.9 (4.8) The current literature provides no evidence for when,
and for how long, biophysical changes may occur after
Finished high school 13 (100) 13 (92.9) acupuncture; it is possible that any changes that may
Completed tertiary education 12 (92.3) 13 (92.9)
have occurred between and during the test interval
Employed outside the home 14 (100) 13 (92.9) have escaped detection. A study design with frequent
measurements after initial exposure and longer intervals
Previous use of acupuncture 7 (50.0) 7 (50.0) between measurements as time passes, may allow for
Values are number (%) of women or mean (SD)
detection of any acupuncture effects; however, the
intensive requirements of this type of design may not
be acceptable and practical for women receiving IVF
treatment.

TABLE 2 TCM diagnosis by group While there is a growing body of evidence for
acupuncture improving the pregnancy rate with IVF
Acupuncture Control treatment, the mechanism of action remains elusive.
n = 14 n = 14 Research examining the potential mechanism of
Kidney yang 8 (57.1) 6 (42.9) acupuncture following embryo transfer has focused on
measuring uterine blood flow and changes within the
Kidney yin 5 (35.7) 5 (35.7) endometrium. These preliminary studies suggest no effect
Blood deficiency 1 (7.1) 3 (21.4) from acupuncture. The aims of acupuncture treatment
when administered on the day of embryo transfer are to
Heat 2 (14.3) 0 (0.0) increase blood and energy flow to the uterus, to sedate
Qi stagnation 8 (57.6) 6 (42.9) the patient and to stabilize the endocrine system.9 Other
potential mechanisms should be given consideration.
Blood stagnation 3 (21.4) 3 (21.4) Several papers have suggested that psychological state
Sp Qi deficiency 5 (35.7) 3 (21.4) can impact on the chance of success with an IVF
cycle.12 There is little research examining the effect of
Values are number (%) of women
acupuncture on the psychological state (either through

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of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 11
 Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

TABLE 3 Primary and secondary outcomes by study group

N Acupuncture Control Significance

p value
Endometrial thickness
Baseline 12/9 9.9 (1.8) 9.7 (1.4) 0.89
Embryo transfer 9/3 11.5 (2.0) 11.1 (2.0) 0.79
7 days post-egg retrieval 11/5 11.9 (3.0) 14.6 (3.7) 0.14

Endometrium pattern
Baseline 10/8 0.63
B 4 (40.0) 5 (62.5)
C 2 (20.0) 1 (12.5)
B-C 4 (40.0) 2 (25.0)
7 days post-egg retrieval 11/5 0.48
B 10 (90.9) 5 (100.0)
C 1 (9.1)
Oestradiol nmol/L
Baseline 12/10 2.5 (1.9) (11.71) 2.2 (1.1) (11.25) 0.87
7 days post-egg retrieval 12/5 2.4 (1.7) (9.29) 2.2 (1.4) (8.30) 0.72

Progesterone nmol/L
Baseline 11/11 3.2 (0.7) (12.36) 3.5 (2.2) (10.64) 0.56
7 days post-egg retrieval 12/5 389.6 (6.2) (9.17) 313.4 (221.4) (8.6) 0.87

Number of oocytes retrieved per subject 13/11 8.9 (6.2) 8.4 (5.6) 0.85

Number of ooyctes fertilised per subject 12/11 4.5 (4.4) 2.4 (2.4) 0.19

Biochemical pregnancy 12/9 2 (16.7) 2 (22.2) 0.74

Values are number (%) of women or mean (SD) with mean rank

biophysical measures or self-report questionnaires) of women Acknowledgements

undergoing IVF. Research in these areas, for example, cortisol
levels as an indicator of relative levels of stress, may provide We wish to thank the women participating in the trial, our
more information about possible mechanisms of acupuncture. thanks also to the Repromed staff for their assistance with
recruitment and implementation, and in particular Paula
There is a need for further research in this area to clarify Scanlon for undertaking the ultrasounds, and Helen Alvino,
possible mechanisms of acupuncture. It is recommended that research manager, for her assistance with trial implementation.
clinical trials incorporate collection of other biophysical and
psychological measures to further the knowledge base. Funding for this study was provided from a grant made by the
Australian Acupuncture and Chinese Medicine Association
Ltd.
Conflict of interest statement
Clinical Clinical trial registration
The authors have no conflict of interest. <www.anzctr.org.au> registration number 12607000015448.

Australian Journal
12 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Influence of Acupuncture CA Smith, M Coyle and RJ Norman
on the Endometrium

Clinical Commentary
IVF is a common and accepted form of treatment for many couples seeking assistance with achieving a pregnancy.
Acupuncture may increase clinical pregnancy and live birth rates when administered on the day of embryo transfer,
and interest is turning to exploring potential mechanisms. Our small pilot feasibility study found insufficient evidence
to suggest acupuncture had an effect on the endometrium and serum levels of oestradiol and progesterone. The
clinical implications of this study provide practitioners with no insight to a possible mechanism. The study does
assist clinical researchers working in this discipline with the design and planning of future research.

References
1. Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman 8. Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland
BM, et al. Effects of acupuncture on rates of pregnancy and live M. Reduction of blood flow impedance in the uterine arteries
birth among women undergoing in vitro fertilization: a systematic of infertile women with electro-acupuncture. Hum Reprod
review and meta-analysis. BMJ 2008;336(7643):545–9. 1996;11(6):1314–17.
2. Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted 9. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K.
conception. Cochrane Database Syst Rev. 2008 8;(4):CD006920. Influence of acupuncture on the pregnancy rate in patients
3. Borgain C, Devroey P. The endometrium in stimulated cycles for who undergo assisted reproduction therapy. Fertil Steril
IVF. Hum Reprod Update 2003;9(6):515–22. 2002;77(4):721–4.
4. Schild RL, Knobloch C, Dorn C, Fimmers R, van der Ven H, 10. Quintero R. A randomized, controlled, double-blind cross-over
Hansmann M. Endometrial receptivity in an in vitro fertilization study evaluating acupuncture as an adjunct to IVF. Fertil Steril
program as assessed by spiral artery blood flow, endometrial 2004;81(S3):S11–12.
thickness, endometrial volume, and uterine artery blood flow. 11. Smith C, Coyle M, Norman RJ. Influence of acupuncture
Fertil Steril 2001;75(2):361–6. stimulation on pregnancy rates for women undergoing embryo
5. Ferin M, Vande Wiele R. Endogenous opioid peptides and the transfer. Fertil Steril 2006;85(5):1352–8.
control of the menstrual cycle. Eur J Obstet Gynecol Reprod Biol 12. Betts D. Essential guide to acupuncture in pregnancy and
1984;18(5–6):365–73. childbirth. Hove, UK: The Journal of Chinese Medicine; 2006.
6. Petraglia F, Di Meo G, Storchi R, Segre A, Facchinetti F, Szalay 13. Gonen Y, Casper RF. Prediction of implantation by the sonographic
S, et al. Proopiomelanocortin-related peptides and methionine appearance of the endometrium during controlled ovarian
enkephalin in human follicular fluid: changes during the menstrual stimulation for in vitro fertilization (IVF). J In Vitro Fert Embryo
cycle. Am J Obstet Gynecol 1987;157(1):142–6. Transf 1990;7(3):146–52.
7. Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the 14. Eugster A, Vingerhoets AJJM. Psychological aspects of in vitro
treatment of female infertility. Fertil Steril 2002;78(6):1149–53. fertilization: a review. Soc Sci Med 1999;48(5):575–89.

Australian Journal
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 Acupuncture for Migraine:
On the Psychological
A Systematic Review
Significance of Heart Governing
Shen Ming Sean W Scott* MBBS(Hons), MMed
Department of Emergency Medicine, Gold Coast Hospital, Southport, Australia
John C Deare BHSc(CompMed), MAppSc(Acu)
Compmed Health Institute, Southport, Australia

Lifang Qu MMed
Shanghai University of Traditional Chinese Medicine, Shanghai, China

Mary Garvey* MHSc

College of Traditional Chinese Medicine, University of Technology, Sydney, Australia

ABSTRACT
According to the Huangdi Neijing, Suwen Chapter 8, the heart is the ruler of the body and the
host for spirit brightness (shen ming). The paper examines the meaning and contribution of the
heart with spirit brightness (xin zhu shen ming) to Chinese medical thinking. From earliest times,
Chinese medicine’s analysis of health and illness included the physical, sensory, emotional, social
and cognitive aspects of the person’s lived experience. The shen-mind with ming-brightness was
said to radiate peace, virtue, clarity and intelligence, and the cultivation of shenming was thought
to enhance one’s physical health and longevity. In Part One, we discuss the conditions that
influence the development of shenming and the maturation of mental-emotional intelligence. In
Part Two we discuss its opposite, the heart without spirit brightness (xin zhu bu ming) to identify
its mechanisms and the consequences for health. Xin zhu bu ming leads to the distortion of sensory
perceptions and emotional responses, and refers to a person with mental-emotional instability
and poor adaptive ability. Daoism, Confucianism and Buddhism identify the influences affecting
shenming-spirit brightness and explain the connections between ethical conduct, correct qi, and
mind-body health. Mental-emotional development and the cultivation of shenming is discussed
and contrasted with the social consequences and clinical manifestations of human mentality
without spirit brightness.

K ey W ords Chinese medicine, intelligence, mental health, mental illness, mind and
body, personality, psychology, self-cultivation.

Introduction and managed emotional responses; and while the heart lodged
the shen, the shen for its part governed the body form and its
Although the Chinese medical tradition did not develop external appearance.
a distinct branch of medicine for psychological disorders, it
analyses all manifestations of human life without separating One of the earliest explanations of the relationship between
physical, mental and emotional features. This means Chinese the xin-shen (心神) and the body form (xing 形), between the
medicine is uniquely equipped to identify and treat body-mind inner spirit-mind and the external appearance, can be found
illnesses because from ancient times it ‘perceived the interior of in a Huang-Lao (Daoist) text of the early Warring States
the living body as a cosmos, combining cognitive ingredients, period (475–221 BCE). ‘If the heart [in this context xin 心
social ideals, physical data, and sensual self-awareness’.1 The is the heart-mind] is complete within, the [body] form will be
heart (xin 心) was seen as a physical organ as well as the complete without ... When a man is capable of being correct
abode of the spirit-mind (shen 神). The xin-shen received and and quiescent, His flesh is full, His ears and eyes sharp and
coordinated sensory perceptions, generated cognitive processes, clear, His muscles taut, and His bones sturdy’.2

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):14–22

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Heart Governing Shen Ming LF Qu and M Garvey

Porkert explains shen as ‘configurative force’, meaning the bu ming 明不明). Xin zhu shen ming and xin zhu bu ming
‘directing influence’ which shapes the body form and guides form the basis of Chinese medicine’s perspective on human
the materialization of qi.3 Hay agrees with this reading of consciousness and its ideas of psychological health and illness.
‘shen as the force which shapes the materialization of [qi], in
a process from active states (yang) through structured states Our paper will discuss the significance of this short section
(yin)’; he adds that the shen’s influence also ‘conditions the of the Suwen Chapter 8 for human life and mentality, and
character and the cohesion of the personality’.4 the implications for medical practice. Our examination of
this topic shows that the expression xin zhu shen ming not
While the Huangdi Neijing (HDNJ) does not comment on only encapsulates the notion of a healthy mind but refers
contemporary notions of psychology as such it does contain to a state that facilitates our ability to cultivate heart-mind
many references to the xin-shen (heart-mind). This paper will brightness. In Part One, we concentrate on xin zhu shen ming
examine a small section of the HDNJ Suwen Chapter 8 that and its cultivation. In Part Two the discussion will shift to the
describes the xin-heart as the sovereign ruler (jun zhu 君主) problems of psychological obstruction and disorder resulting
and host of the shen, and affirms the role of the heart with from xin zhu bu ming.
respect to spirit brightness (shenming 神明). Shenming-spirit
brightness refers to a person with intelligence, perspicacity Part 1: Xin zhu shen ming
and clear insight,3,5 and the heart’s relationship with shenming
invokes some of the core features of the Chinese perspective on In the HDNJ, the body is analogous to a nation with a
human mentality. governing bureaucracy of offices that coordinate and manage its
qi functions, movements and resources. In the Suwen Chapter
According to the Suwen Chapter 8: ‘the heart fills the role of 8, the HDNJ uses the importance of shenming for the ruler
sovereign ruler from whom emanate directing influence [shen governing the nation to explain shenming’s directing influence
神] and clear insight [ming 明]’.3 From this we may condense on the human form, its life and health. Within the body/
Chinese medical psychology to two basic ideas: nation, the internal viscera and their associations are systems
1. the heart-host with spirit-mind brightness (xin zhu shen and configurations of orderly process, power and influence,
ming 心主神明); and its opposite, and the HDNJ repeatedly emphasises the idea of health and
2. the heart-host without brightness (xin zhu bu ming 心主 illness as states of order and disorder respectively. The zang-
不明). viscera govern (zhu 主) the sense organs, body tissues, and
the transformations and distribution of substances. The idea
The first statement uses the Suwen’s analogy – the heart is the of zhu-governance bound together the body form (xing 形)
ruler and host of spirit-mind brightness – to indicate a healthy and its functional processes, including its mental-emotional
mind and personality. The second statement, the negative of processes, and the HDNJ endowed the heart with clarity and
the first, indicates a state of mental disarray and personality intelligence (shenming).
problems. The Suwen Chapter 8 is a key chapter describing the
duties and relationships of the body’s visceral systems, and here The heart’s governance of the five zang and six fu is a well
is some of the context for the heart and shenming statements understood tenet of traditional Chinese medicine (TCM),
above: and all the zangfu have their own responsibilities that follow
the associations of systematic correspondence. Zhu (主)
The heart holds the office of eminent ruler, spirit brilliance also means to host, as in to receive or entertain. So just as a
emanates from it. country’s head of state, the jun (君) gentleman, lord and
… Therefore, the ruler with ming-brightness radiates virtue, peace sovereign, receives its important guests, xin zhu ming means
and mental clarity, if one cultivates life one keeps the shen bright that the heart-host provides lodging for the shen and cultivates
and has health and longevity. If the ruler governs with shenming, ming-brightness. If the heart-host receives ming-brightness, the
the country is great and glorious. people communicate harmoniously through all the nation’s
If the ruler-host does not radiate brightness the twelve offices [the agencies and officials. And if the heart-ruler exerts his authority
senses and their orifices] are in danger, the spirit path is closed and in a ‘goodly manner’ the effects of virtuous leadership spread
obstructed, the body form is severely damaged, if one cultivates life throughout the empire.8
without shenming it is disastrous, if governing without shenming
then the country will be ruined.3,6-8 Xin zhu – the heart ruler and
host
The Suwen here condenses the complexity of psychological So to help its readers understand xin zhu shen ming, the HDNJ
phenomena to emphasise two characteristics: the heart-host describes the living body as a nation with the heart as its
with and without the clear insight of ming-brightness (ming eminent ruler – ultimate authority and control resides with

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 Heart Governing Shen Ming LF Qu and M Garvey

the head of state, who receives and takes care of the nation’s At birth the shi shen is in an uncultured, unenlightened state,
guests. In the microcosm of the human form this is the role having little intelligence (meng mei, veiled and dark 蒙昧),
of the heart-mind (xin-shen 心神). To perform these functions and as the person develops and matures it gradually evolves
the heart-mind and the ruler of a country must be bright and towards a state of clarity (ming xi, never in a dark state, having
clear rather than marred, dull or confused. If the heart-host is good judgement 明晰). The psychological processes involved
without brightness, then intelligence, cultured life and general are lengthy and complex and in Chinese medicine, they are
health are in danger. regarded as the development of the shi shen from meng mei to
ming xi. Our progress towards ming xi from birth refers to the
In fact all the zang contribute to psychological health and development and maturation of mental-emotional intelligence
intelligence (shenming). In reference to the Suwen Chapter 2 and cognitive powers such as analysis, discernment and
and Lingshu Chapter 8, Rochat de la Vallee says, ‘When the judgement.
clear and pure essences are nourished through the work of the
five zang, then life is brilliant and the radiance of the spirits, The development of shi shen psychological resources and
shen ming (神明) is able to appear’.9 In its management of the character are strongly influenced by family environment,
body’s administrative offices (zangfu systems and guan-offices), cultural, social and economic background and the level and
the heart-mind receives and co-ordinates all their materials style of education received; and intelligence (li zhi 理智) relies
and influences, and to effectively govern the human form on the correct course of development. So what is correct for the
and its life functions, the xin-shen must have ming-brightness development of intelligence and healthy psychology?
rather than dullness or confusion. A nation’s ruler in fact needs
exceptional qualities (ming jun 明君) to govern the country Sivin’s examination of the HDNJ texts notes their use of
well and bring prosperity to its people, and just as the ruler with political terms for early medical ideas. Health and illness are
ming-brightness brings great glory to the country, the heart- described as ‘order’ and ‘disorder’ respectively; zhi-treatment
host with brightness brings a cultured life with intelligence and (治) is another political term meaning ‘to overcome disorder’.12
longevity. ‘Sivin’s explanation … enables one to perceive bodily health and
healing in continuity with the self-cultivation of the superior
Xin zhu shen ming – healthy man and the management of family, local, and state affairs’.13
psychology and personality The notion of ‘correct’ (zheng 正) also links the cultivation
Many inherited and lifetime factors contribute towards xin of social and personal ethical conduct with familiar Chinese
zhu shen ming. At conception the new life begins with the medicine concepts concerning correct qi (zheng qi 正气), and
inherited essence and spirit (yuan jing 元精 and yuan shen 元 its opposite, evil qi (xie qi 邪气). Xie-evil is often translated
神) that provide the foetus with basic developmental resources, as pathogenic in contemporary texts, replacing xie-evil with
information, and instinctual functions. After birth, pre-natal a more biomedical interpretation and avoiding the moralistic
resources are stored in the life gate (ming men 命门) and connotations of ‘evil’ for Westerners. Yet zheng-correct and xie-
kidneys, and according to Li Shizhen (1518–1593) yuan shen, evil are purposely borrowed from the socio-political sphere of
the pre-natal spirit-mind, is stored in the brain – ‘the house of administrative ethics and invoke the moral dimensions of social
the original spirit’.7 The pre-natal yuan shen governs instinctual relations.
functions, such as breathing, heart beat and digestion. These
abilities are unlearnt and inherited from our biological Ethical conduct and the cultivation of virtue have been major
evolution. topics of Chinese philosophy since very early times. Many
Daoist and Confucian classics and other pre-Qin texts contain
Post-natal consciousness (shi shen 识神) consists of the sensory discussions on how to train and cultivate oneself. The Book
information, feelings, thoughts and perceptions we experience of Changes (Yi Jing 易经) ‘provides guidance for choosing
during our lifetime,10,11 and the heart is the host of the post- appropriate action if action is called for and an inspiration for
natal spirit-mind. So, the brain (nao 脑) houses the yuan shen self-disciplining and self-cultivation of oneself toward better
(元神) and the heart is the ruler-host of the shi shen (识神). moral development’.14 To cultivate the goodness of human
After birth, post-natal shi shen activities combine with those nature, Mengzi (372–289 BCE) emphasised four virtues
of the five spirits (wushen 五神), five yin viscera (wuzang 五 – benevolence (ren 仁), dutifulness (yi 义), propriety (li 礼),
藏 [五脏]), five senses (wuguan 五官) and five tissues (wuti and moral intelligence (zhi 智). He stressed that one’s qi (气)
五体) functions, responses and processes. Their harmonious – in this context, xin is the heart-mind and qi is one’s ‘moral
interactions accomplish human life so that one is able to act and physical energy – should not be forced’, but gently lead by
in the world. the will (zhi 志).15 For the Confucians in particular, practices
assisting the processes of ethical enhancement included rituals
that helped bind their participants to upright behaviours.16

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Heart Governing Shen Ming LF Qu and M Garvey

can conquer oneself. Content, one is rich; with strong will, one
While Confucian texts argued for the cultivation of strength,
can persevere.21
respect and wisdom, the Daoists preferred non-assertiveness,
quietude and simplicity. They replaced Confucianism’s
‘conformist methodologies for one that was non-imposing Confucian, Daoist and Buddhist philosophical currents
(wuwei) and did not seek to control the spontaneous proposed injunctions that created a system of rites and dutiful
expressions of the people (Daodejing 49)’.17 Chinese Buddhist actions, admonitions that encouraged the development of
texts meanwhile identified wholesome and unwholesome kindness and humanity, and simple moral rules that helped
mental factors, their resultant mental states, and appropriate one abstain from harmful acts and guard against unwholesome
corrective strategies. For example, ignorance and mental influences. Daoist texts in particular linked the five precepts
cloudiness lead to misperceptions and confusion and could (against killing, stealing, sexual misconduct, lying, intoxication)
be corrected by cultivating mental clarity. Aversion and ill will and the five virtues (benevolence, wisdom, righteousness,
could be countered by loving kindness, selfish attachment by propriety, faithfulness) with the wuxing (five transformative
equanimity, laziness by effort and enthusiasm, and so on. In phases 五行) and the wuzang (the five yin organ systems).
this way they developed a simple ‘operational definition’ of They explained that ‘bad behaviour comes from a lack of
mental health and its cultivation.18 control over the senses’, that indulgence in the senses disturbs
the wushen and causes ‘confusion and darkness’ and that in
Overall, in terms of personal intentions and behaviours, the that state the wuzang can no longer function properly. Thus,
meaning of ‘correct’ in Chinese culture and medicine seems ‘Morality becomes an aspect of psycho-physical health and the
to have taken more account of one’s social responsibilities proper qi-flow in the individual’.22
and effectiveness than does the Western preoccupation with
internal struggles and individual agency. The HDNJ’s political According to Buddhism shenming brightness is like a mirror
state/embodied self analogy becomes less metaphoric and more which cannot become darkened by negative factors and
directly connected when we keep the two (social and personal) misperceptions: if shi shen is correct (zheng 正), this means
levels of lived experience in mind. there is ming-brightness, and if shenming is bright, then the
heart is correct and negative ideas cannot form. Furthermore,
Heart-host is cultivated by the the inter-promoting qualities of host brightness, bodily health
ethical person and a cultured life are said to give longevity. The wise and ethical
Confucianism urges everyone to become a true gentleman person therefore practises virtue, temperance and restraint,
(junzi 君子), a wise, ethical, exemplary person. Such a person and ethical behaviour shapes one’s mental-emotional life and
always works to improve and strengthen him– or herself and to personality. Determination applied to continued, focussed,
move forwards, so for example in the Yi Jing’s Great Appendix ethical practices helps to develop healthy psychological
the Heaven (qian 乾) and Earth (kun 坤) hexagrams state resources and to cultivate the body and mind.
that:
So to correct the heart and brighten the shen, one must conquer
The [true gentleman] due to [‘Heaven moves in strength’] is oneself, know oneself, be content, and be strong. Thence: xin
himself ceaseless in activity, shi jian feng, xin zhu jian ming, ren ge jian quan (心识渐丰, 心
and: 主渐明, 人格渐全). Heart recognition is gradually plentiful,
the heart host is gradually bright, and the person is gradually
The [true gentleman] uses this rich virtue [‘Earth power’] to perfected.
support all creatures.19

To summarise the discussion so far we can say that the meaning

The exemplary person with the power of heaven is untiring and of xin zhu shen ming in the HDNJ has three interlocking parts.
consistently strong in character. With the power and devotion Firstly, the heart is the host of the shen: the term heart-mind
of earth s/he is able to bear all things, good and evil, without (xin-shen) refers to this meaning. Secondly, the xin-shen is to
exception.20 the body form as the ruler is to a nation: this part includes
the heart as ruler of the zangfu. Thirdly, the shen must be
In the Daodejing, Chapters 8 and 33, Laozi says: ming and the heart governs/hosts shenming. Here in Part 1 we
have examined the importance of xin zhu shen ming for the
The highest good is like water. Water benefits everything by giving cultivation of positive mental and physical resources. In Part
without taking or contending. 2 we will continue the discussion to focus on xin zhu bu ming
– the mechanisms and consequences of bu ming dullness and
It needs observation to know others, but reflection to know oneself. confusion.
Physically strong, one can conquer others; mentally strong, one

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 Heart Governing Shen Ming LF Qu and M Garvey

Part 2: Xin zhu bu ming shi 舌识), and tactile perception (shen shi 身识). The heart-
mind (xin-shen 心神) receives, coordinates and manages this
In Part One – Xin Zhu Shen Ming – we discussed the Suwen’s complex stream of information and influences, so the orderly
analogy of political governance and how it draws attention to functioning of the five sense organs (wu guan 五官) belongs
the role of a country’s head of state. With regard to human to the function of ordinary human consciousness, the shi shen
life systems, the heart is the head of state. As befits its role, the (识神).
heart governs and coordinates the zangfu, their functions and
associations, and as host the ruler brings shenming to the nation The shi shen is also called shen shi (神识) – the recognition,
and its people. In Part One we saw that the Suwen Chapter 8 understanding and acquisition of knowledge and skills. Shen shi
affirms the correct and eminent fulfilment of the heart’s role is heart shi, which means that everything we do depends on the
– xin zhu shen ming – and that for contemporary readers, this heart. The heart-shen without ming-brightness is dull, confused
refers to a healthy mental-emotional state. and muddled; its reception, analysis and interpretations of
sensory information are disordered and distorted. But shen shi
Where there is xin zhu shen ming the person’s mental-emotional recognition and understanding is not a singular function – it is
stamina and stability are strong; their adaptive abilities and performed by the unified activities of the five spirits (wu shen
responsiveness to change are positive and appropriate. Their 五神) and their associated senses.23 The role of the senses, our
emotions are not easily disturbed or only briefly disturbed, and reception and interpretation of the external world, is crucial to
they are not easily roused to extreme emotional responses. Such how we experience life.
a person does not easily suffer from psychological disturbance.
Their clarity and brightness (shenming) can be observed in Even before the compilation of the HDNJ, Mencius (c. 371–289
their appearance, eyes, temperament and conversation. BCE) and Xunzi (330–227 BCE) emphasized that the senses
are ruled by the heart-mind and can interfere with ordering
Suwen Chapter 8 says that if the head of state (the heart) is the person. Even earlier, in the Spring and Autumn Annals
dull and confused (bu ming 不明) the country (the body) is (770–404 BCE), the ears, eyes, nose and mouth were the four
in chaos and its citizens are in danger. Thus, xin zhu bu ming officials that guarded against excess pleasures that could enter
is the basis of psychological obstructions (zhang ai 障碍), and corrupt the body, and if the shen ‘fixed on an external desire
personality flaws (que xian 缺陷) and abnormalities (bian yi it could find itself permanently exiled from its dwelling place’.2
变异). Generally speaking, the person whose heart is without In an essay called Jie bi (Dispelling obsessions), Xunzi explained
ming-brightness has very little mental stamina; their emotional that the ‘sense appetites react mechanically to attractive objects,
stability and adaptive ability are poor, and their psychological which cover (bi 蔽), that is, blind or obsess them’, and similarly,
responsiveness and regulative ability are reduced. They cannot the heart-mind can be ‘obsessed, so that it blindly pursues a
face, adapt to, or manage social or environmental changes. wrong course thinking it to be right’.15 Disordered sensory
They cannot deal appropriately with social interactions, or perceptions distort our lived experiences and cause negative
with success, defeat, setbacks or frustrations. When faced with emotional responses, which then influence zangfu functions
failure, their emotions and mental state are easily disturbed and lead to the situation described in the Suwen Chapter 8
and their reactions are disproportionate because it is very where, ‘if the host does not have shen ming then the twelve sense
difficult for them to regulate their heart state. In this situation orifices are in danger, the spirit path is closed and obstructed,
extreme behaviours such as suicide and murder can occur, and the body form is severely damaged’ (see Part One).
they are more likely to suffer from psychological disorders and
psychosis. Negative influences on a person’s emotions and mentality
can easily lead to a variety of somato-psychic illness (shenxin
The post-natal shi shen (ordinary consciousness 识神) ji bing 身心疾病) such as hypertension, asthma or diabetes,
resides in the heart. The heart-shen’s management of sensory or to psychological disorders, psychosis, self-harm or suicide.
information, feelings, thoughts and perceptions is determined The cultivation of shenming was discussed in Part One. Here
by the development of its shenming clarity and intelligence. The we will discuss other influences, negative influences, and their
cultivation of shenming is influenced by inherited and acquired ramifications for medical practice.
tendencies and involves all the zangfu, their associated tissues,
substances and senses. In particular, orderly shi shen activities Xin zhu bu ming – disordered
include the reception, co-ordination and analysis of information psychology and cultured life in
from the external world and received by normal sensory and danger
perceptive functions. Specifically, those sensory functions are: Buddhism holds that a person’s psychology is determined by two
visual perception (yan shi 眼识), auditory perception (er shi 耳 main kinds of influences – inherited and acquired. Inherited
识), olfactory perception (bi shi 鼻识), taste perception (she tendencies are sometimes called instinctual or acquired at birth,

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Heart Governing Shen Ming LF Qu and M Garvey

and refer to a person’s innate psychological disposition (such and West, a person’s character and morality is shaped by social
as extroverted/introverted, gentle/rough, sanguine/insecure). systems, personal actions, and the ‘habitus’ of injunctions,
‘Acquired influences’ mean that one can gradually form and admonitions, precepts and laws that forms the reality and
develop some characteristics by study and cultivation (such as identity of a community and its members.22
prudence, patience, stability, experience). Cultivated tendencies
are acquired with practice and habit (xin xun 新熏). Family, friends and educational environment have a deep
and lasting impact on the complex factors and processes of
From birth, the five senses begin to take in the outside world psychological development and maturation. Schooling and
and the heart-mind begins to be ‘smoked’ or habituated family life generally provide positive xunran influences and
(xun xi 熏习). Environmental influences are sometimes environment, but not in every case and not all of the time.
called ‘smoking and dyed’ (xun ran 熏染) – xun-smoking Today for example, there are many external influences that
means subtle, on-going influences, and ran-dyed refers to encourage the desire for material possessions, fame, wealth
more sudden or specific influences. ‘Acquired at birth’ is and success. If those influences are persistent and persuasive
determined by inherited factors, while ‘acquired with practice’ they can perpetuate habits and heighten desires that result
is determined by life circumstances and personality factors. in negative psychological states. Over time this can cause the
Together, inherited and acquired influences decide the degree heart-mind to change from ming to bu ming, and a person
and nature of xin zhu shen ming. who cultivates such desires may risk more seriously damaging
behaviour such as corruption and embezzlement.
Whether an adult’s heart-host (xin zhu) is bright or dim is
decided in part by childhood experiences, and environmental Medically, shenming clarity and brightness are qualities we
factors will influence the person throughout their life in associate with the senses (guan 官) and their orifices (qiao
different ways and degrees. Generally, a wholesome and positive 窍), the eyes, ears, nose and so on. A sense orifice is a body
environment enriches the person, because the more positive aperture, a window to the external world, and by the time the
the environment the more one can cultivate correct (zheng 正) HDNJ was compiled, the Chinese had noted many of their
recognition and understanding (shen shi 神识), and then the physiological features, processes and interactions. Sensory
potential for the development of heart-shenming is very high. information and activities enable human consciousness; but
The cultivation of heart-shen brightness ideally should start sensory desires can ‘distract the heartmind from its ability to
from birth and early childhood. But at any stage of life positive think and accomplish its aims [and lead] toward inauspicious
influences can repair and correct (xiu xi 修习) unwholesome and immoral extremes’.16
ideas and habits, they can replace harmful perceptions and
habits with benevolence and kindness, and change the heart- Because sense orifices belong to the shen orifice (shen qiao 神
host-shen from bu ming to ming. 窍), the correct reception and analysis of sensory information
relies on xin zhu shen ming. When there is xin zhu bu ming, the
As we know, a normal healthy mental-emotional life in shi shen’s senses and perceptions are distorted and misguided.
childhood does not guarantee a healthy mind in later life, As in the Suwen Chapter 8, this is shi dao bu tong (使道不通)
and nor does an unstable early environment lead inevitably to – the road where the shen is coming and going is obstructed.
psychological illness. But a person growing up in an unstable, A person in this state for example, can hear but cannot listen
unsafe or unhealthy environment can form dysfunctional or understand. Shi dao bu tong means in effect ‘psychological
mental-emotional patterns and social disposition more easily obstruction’ because misguided sensory information negatively
than one growing up in a stable, safe and positive environment. affects psychological activities, mental clarity and all aspects
They see more social darkness and are more sensitive to it; they of human life. In these cases the person’s five sense organs still
grow up with higher levels of anxiety and suspicion and can receive information from the external world but their inner
more easily form delusions, paranoia, dysfunctional personality experiences are deviated and abnormal.
traits, or anxious/depressive responses.
Chinese medicine attempts to ascertain the clarity and brightness
Xin zhu bu ming – heart-host of the senses and their apertures, as well as that of the heart-
without brightness shen. The orifice of the heart (xinqiao 心窍) encompasses all
According to Chinese medicine, normal human development the sense orifices because it coordinates, analyses and interprets
includes the development of the heart-shen, and heart-shen the information they receive: the heart-shen orifice signifies the
maturation is influenced by complex social and environmental alertness, receptivity, strength, clarity and flexibility of human
factors, mechanisms and xunran (smoking/dyeing) influences. consciousness. Medically, the heart orifice must be clear and
Historically, Chinese societies embraced the ethical principles open; if it is blocked, the heart-shen is confused and lost.
of Daoism, Confucianism and Buddhism. In every age, East

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 Heart Governing Shen Ming LF Qu and M Garvey

From the point of view of Chinese medicine psychology, be accidentally induced by physical trauma. For example, in
the analysis of mental, emotional and spirit diseases helps to older patients with senile dementia or children with ADHD, a
demonstrate this relationship to the heart-shen ming bu ming. variety of patterns can be found including phlegm and/or blood
The expression cai mi xin qiao (财迷心窍) means ‘wealth stasis obstructing the orifices. In Hou24 phlegm-clearing and
confounds the heart orifice’, and describes a person who is stasis removing medicinals are given in cases of ‘undernourished
obsessed by the desire for wealth. They want only affluence and orifices due to obstruction of channels caused by blood stasis’,
possessions and will attain them by any means. Similarly for and modifications of Wang Qingren’s (1768–1831) Tong
money – qian mi xin qiao (钱迷心窍) – when ‘money confounds Qiao Huo Xue Tang (Opening Orifices and Activating Blood
the heart orifice’ it means the person’s mind is dimmed or filled Decoction) are recommended for ADHD and senile dementia
up with money, so much so that they will go to extremes (such patients. Blood stasis obstructing the orifices patterns in
as fraud, theft, robbery) to acquire it. Mi (迷) means to be children may have its origins in a history of birth injury, and in
confused and lost, and to be fascinated by – ‘fascination’ here older patients, a history of TIAs or simple lack of mobility will
meaning an obsessive or fixated attention. Where there is xin impair the circulation of blood.
mi (心迷) the heart is confused and lost. The expression is used
medically and in common language to indicate that the heart- Conclusion
mind is obstructed, blocked or dimmed, and that the person
has lost their bearings. Many mental-emotional factors can Just as greed and arrogance corrupt good governance, anger
overcome, confuse and bewilder the mind. and discontent pollute the heart-mind. In the HDNJ, the xin-
shen as eminent ruler means that, just as the country cannot
In cases where qing mi xin qiao (情迷心窍), feelings and do without its head of state for one day, the body cannot do
emotions overfill and obstruct the heart orifice. Lovers’ suicide without the shen; and just as the ruler with ming-brightness
is an example – when emotions are high, intelligence (clear brings peace, safety and glory to the whole country, xin-shen
insight) and actions are misguided. Quan mi xin qiao (权迷心 ming brings mental clarity and accomplishment to human life.
窍) applies to someone who is obsessed with power – they crave
leadership and control, and become ruthless in their pursuit Xin zhu shen ming is both a description encapsulating the
of an ever more powerful position. Even beauty can dim the healthy mind, and the causal influence for its ongoing process
heart orifice (se mi xin qiao 色迷心窍). An example could and development. Xin zhu shen ming gives us the ability to
be the person who becomes sexually inappropriate, addicted, regulate our psycho-emotional receptivity, responsiveness and
or aggressive because they continually lust after younger and adaptability so we can respond to life’s successes, failures and
more beautiful sexual partners. If their heart is mi-fixated they infractions reasonably and constructively. Xin zhu shen ming
will experience this kind of sexual dysfunction, if ming their also guides the formation of positive life values and personal
sexual behaviour is appropriate. qualities – to cultivate cognitive and emotional intelligence,
and acquire psychological resilience the shen must have ming-
Medically, the terminology for this kind of shen disorder is tan brightness. Without ming, the xin-shen is dim and obscured.
mi xin qiao (痰迷心窍) – phlegm misting the heart orifice;
sometimes this is given as tan meng xin qiao (痰蒙心窍) – Xin zhu shen ming guides the gradual maturing of a person’s
phlegm clouding the heart orifice. The other common TCM character and humanity, the development of their xin-shen
pattern is yu zu xin qiao (瘀阻心窍) – blood stasis confounds and wushen activities from simple to complex, from veiled to
heart orifice. Phlegm and blood stasis are pathological products unveiled, from dull to clear and bright. Furthermore, shenming’s
that obstruct the orifices leading to clinical manifestations such clear insight is the light of virtue. When it shines, ‘the person
as blurred vision, diminished hearing and smell, or slurred has presence, their eyes are bright, they radiate liveliness’,8 and
speech or aphasia. In the context of mental-emotional disorders, its brilliance and radiance manifests everywhere throughout the
they often result from liver qi stagnation: qi stagnation leads to empire/body.
blood stasis, or to the stagnation of untransformed body fluids,
which in turn leads to obstruction of the heart orifice. All three The level or degree of zhu ming/shen ming is different for
patterns (liver qi, blood stasis, phlegm stagnation) are common every person, and human psychology has great potential and
in cases of depression, mania, severe insomnia and psychosis. malleability. Although at the beginning of life everyone’s shi shen
(ordinary consciousness) is veiled and dim, correct educational
The post-natal cultivation of xin zhu shen ming can prevent the and developmental conditions cultivate the shi shen towards
formation of negative mental-emotional habits and tendencies a healthy, bright, unveiled intelligence. Over time, if one
and the obstruction of the heart orifice. But it is worth keeping continually accumulates positive influences, habits, knowledge
in mind that while orifice obstructions can be inherited and/or and experience, one’s shen shi (understanding and recognition)
gradually cultivated over time as described above, they can also gradually improves and the heart-host becomes brighter.

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Heart Governing Shen Ming LF Qu and M Garvey

The HDNJ’s Suwen Chapter 8 states two essential features for

Chinese medicine psychology: the heart-host with brightness Clinical Commentary
enables normal, healthy human life and mentality; the heart-
host without brightness causes abnormal, unhealthy human Xin zhu shen ming 心主神明 (heart governing spirit-
life and mentality. Xin zhu shen ming and xin zhu bu ming mind brightness) is a fundamental topic in Chinese
therefore are the basis of a fundamental topic (ming ti 命题) in medicine because it is essential to its analysis
Chinese medicine, but healthy psychology is not only a matter of health and illness. The paper identifies the
for medical research and practice. consequences, mechanisms and manifestations for
our patients of the shen (spirit-mind) with and without
A person’s psychology is related to inherited factors, cultivated ming-brightness. Medically, we associate the clarity
by personal effort and shaped by early influences and events, of shenming with the sense orifices, including the
family, personal relationships and the wider socio-cultural heart orifice. If the sensory and heart orifices are
environment. The xin-shen can be influenced and trained obstructed the person experiences mental dullness
throughout one’s life; it can change from dim to bright but also and confusion, and their sensory perceptions and
from bright to dim. The accomplishment and maintenance emotional responses are distorted and inappropriate.
of healthy psychology (xin zhu shen ming) and the effective The xin-heart without ming-brightness negatively
prevention of abnormal psychology (xin zhu bu ming) is both affects not just our mental-emotional life, but also
a personal and social responsibility. our physical state and our ability to cultivate life and
good health.

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 Heart governing shen ming LF Qu and M Garvey

GLOSSARY OF TERMS GLOSSARY OF TERMS (continued)

bi 蔽 cover, conceal; obsess, blind ordinary (acquired, post-natal)

shi shen 识神
consciousness
bi shi 鼻识 olfactory perception
phlegm obscures, dims or blindfolds
abnormal changes, abnormal personality/ tan meng xin qiao 痰蒙心窍
bian yi 变异 the heart orifice (see meng mei)
character traits
tan mi xin qiao 痰迷心窍 phlegm blocks the heart orifice
bu ming 不明 without brightness, dull and confused
five offices (meaning, the five sense
wu guan 五官
er shi 耳识 auditory perception organs)
the ideal of a true gentleman or exemplary wu shen 五神 five spirits
junzi 君子
person
wu xing 五行 five transformative phases
jun zhu 君主 eminent ruler
wu ti 五体 five tissues
li is logical and reasonable, zhi is wisdom and
li zhi 理智
intelligence five yin organs [In the HDNJ all
references to the 脏/臟 zang are
li 礼 propriety, courtesy written藏, without the flesh radical.
wu zang 五脏(五藏)
Because our topic is about shen, we
meng means covered, or blindfolded; veiled and feel the original character is more
meng mei 蒙昧 dark/dim; here the expression means there is suitable.]
little intelligence (ming) when one is born
xie 邪 evil
confused, lost, fascinated, fixated attention, heart – the zang-organ system; in
mi 迷
obsessed xin 心 early Chinese texts xin also means
the mind
clear, clean, bright, radiant, brilliant [On the
left side of the character is the sun and on the xin qiao 心窍 heart-mind orifice
ming 明
right side is the moon. Together they give light
night and day so we never lose our way.] xing 形 (body) form

ming jun 明君 exceptional qualities literally, smoking and dyeing; an

expression for gradual/immediate
ming men 命门 life gate, gate of destiny influences on and changes in human
xun ran 熏染 psychology and personality – xun
ming ti 命题 named topic, proposition ran meaning gradual and sudden
changes respectively; the binome also
ming means bright, and xi is an accomplished meaning to contaminate or corrupt
ability for analysis, discernment and
ming xi 明晰 judgement; with ming xi, the person is never in xun – gradual (‘smoking’) practices;
a dark state – ming xi is the opposite of meng xun xi 熏习
xi – practice, habit or ‘habitus’
mei
yan shi 眼识 visual perception
nao 脑 brain
yi 义 dutifulness, righteousness
deficient, lessened, sunken, defect, drawback,
que xian 缺陷
flaw; in this context, a personality defect yu zu xin qiao 瘀阻心窍 blood stasis blocks heart orifice
ren 仁 benevolence original (inherited, pre-natal,
yuan jing 元精
ancestral) essence
she shi 舌识 taste perception
original (inherited) spirit-mind
shen 神 spirit-mind yuan shen 元神
(consciousness)
intelligence, spirit-mind brightness, radiance, blocked sight/eye, or obstruction on
shenming 神明
brilliance zhang ai 障碍 the road; in this context meaning
psychological obstruction
shen shi 身识 tactile perception
zheng 正 correct
shen shi 神识 recognition and understanding
zhi 智 moral intelligence, wisdom
shen qiao 神窍 spirit-mind (mind, heart) orifice
zhi 志 will, mind
body-mind (somato-psychic) illness
– physical illness that develops or worsens zhi 治 treatment
shen xin ji bing 身心疾病
due to psychological stresses or emotional
disturbances zhu 主 ruler-host

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Farewell to Chinese Medicine?
EDITOR’S NOTE: In 2006, Professor Gongyao Zhang, a professor of Philosophy from the Central South University
in Changsha, China, published an article in Medicine and Philosophy. In the article entitled ‘Farewell to Chinese
Medicine’, Professor Zhang said that Chinese medicine was neither scientific nor empirical. He used a number of
examples to illustrate that some Chinese herbs were poisonous and to argue that some were used without any backing
from evidence. In a later article published in 2009, he stated that Chinese medicine was fake science, subjective and
lacking evidence. He argued that the health care systems of China should not include Chinese medicine.
Since 2006, there has been much debate on this topic in China.
AJACM received a letter from Associate Professor Zhou about Zhang’s article and its impact in China. We invited
two scholars, Dr Barry Butcher, an historian of Science and Professor Bin Xu, an academic of acupuncture, to respond
to the article by Zhang. Each of them chose a particular angle for their response. We hope you will find these three
articles stimulating.

The Future of Traditional Chinese Medicine

Shu-Feng Zhou* MBBS, PhD
Division of Chinese Medicine, School of Health Sciences, RMIT University
Melbourne, Australia

ABSTRACT
China is the only country in the world where conventional Western medicine and traditional
Chinese medicine (TCM) are practised alongside each other at every level of its healthcare
system. TCM has a unique theoretical and practical approach to the treatment of disease, which
includes herbal remedies, acupuncture, acupressure and massage, and moxibustion. As with most
modalities of ethnic traditional medicines such as Ayurveda (traditional Indian medicine) and
naturopathy, the theoretical and diagnostic basis of TCM cannot be fully explained in terms of
Western medicine. In recent years, the Chinese government has significantly increased financial
support for TCM in the hope that it is modernised and even integrated with Western medicine.
However, there is argument that TCM should be abolished from the health care system in China.
The future of TCM may be evidence-dependent, relying on more evidence of the effectiveness and
safety of TCM treatments. Detailed pharmacology and toxicology research of all Chinese herbal
medicine should also be conducted.

Traditional Chinese medicine (TCM), a pride and prize of the ‘TCM has no clear understanding of the human body, of the
nation, is now faced with a tough challenge. A recent on-line functions of medicines and their links to disease. It is more like
petition letter written by Professor Gongyao Zhang from the a boat without a compass: it may reach the shore finally but
Central South China University (Chansha, China) has caused a it’s all up to luck.’ Thereafter, about 200 people signed their
furore in China. In this letter, Professor Zhang strongly advised names in support of this petition. Dr Zhou-Zi Fang, a famous
the central government of China to abolish TCM. Zhang person who has revealed a number of academic misconducts
strongly believes that the Chinese government needs to adopt of Chinese scientists at his popular website <www.xys.org>,
a more practical medical system with all healthcare resources claimed to completely agree with Zhang’s idea.
focused on evidence-based Western medicine. He criticised,

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):23–24.

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 Farewell to Chinese Medicine? SF Zhou
The Future of TCM

However, the Ministry of Health and the State Administration (SATCM). The lack of widely accepted standards has long
of TCM of China have refused this petition, ‘The idea of been a hurdle for TCM in being recognised and used in other
abolishing TCM is a denial of science, an ignorance of Chinese countries. The new standards will help improve the quality of
history and dumping of traditional cultural heritage.’ An official traditional medicines and make them more acceptable to other
from the Ministry of Health of China, Mr Mao, has recently people. China currently has approximately 3000 traditional
emphasised, ‘Traditional Chinese medicine is an essential medical hospitals that dispensed medical treatment to nearly
component of China’s medical care system.’ Many professional 300 million people in 2006.
TCM practitioners in China also opposed the petition. Dr
Yonghua Yang, a medical professor with the Human Academy Chinese herbal medicines may provide important and unique
of TCM, said ‘50% percent of his patients suffering from therapies for some diseases that result from a disrupted network
terminal cancer disease opt for traditional Chinese medicine in the body (eg. cancer and diabetes).3 For these diseases,
treatments.’ Some doctors of TCM said, ‘While it is increasingly a single drug that targets a single protein molecule may not
popular in the West, TCM is being criticised and ignored in provide satisfactory clinical efficacy.3 Most TCM practitioners
China.’ The traditional Chinese medical industry, with a total now agree that TCM must be evidence-based, thus randomised
production value of nearly 81.026 billion yuan (about 10.125 controlled trials of common treatments are needed to
billion US dollars), accounted for a quarter of China’s overall establish the effectiveness and safety of treatments. Detailed
medical industry in 2005. Mao said the Chinese government pharmacology and toxicology research of all Chinese herbal
has helped develop traditional Chinese medicine and Western medicine should also be conducted. As for experts engaged in
medicine equally in China. the research and development of traditional Chinese medicine,
they are unanimously optimistic about the future of TCM. They
China is the only country in the world where conventional consider the recent challenge to traditional Chinese medicine is
Western medicine and TCM are practised alongside each a result of a lack of confidence as well as misinterpretation. Dr
other at every level of its healthcare system. TCM has a unique Yuansheng Tan, a young TCM doctor said that since traditional
theoretical and practical approach to the treatment of disease, Chinese medicine has survived challenges even more severe
which includes herbal remedies, acupuncture, acupressure than this, he was sure that it will be able to cope with the
and massage, and moxibustion.1 As with most modalities of latest one. At a time like this, voices like his help to make the
ethnic traditional medicines such as homeopathy, Ayurveda public hopeful again about the future of traditional Chinese
and naturopathy, the theoretical and diagnostic basis of TCM medicine.
cannot be explained in terms of Western medicine.

In recent years, the Chinese government has significantly

References
increased financial support for TCM in the hope that it is 1. Qiu J. Traditional medicine: a culture in the balance. Nature
2007;448(7150):126–8.
modernised and even integrated with Western medicine.2
China will make an effort to standardise 500 traditional 2. Qiu J. China plans to modernize traditional medicine. Nature
2007;446(7136):590–1.
Chinese medicine remedies and procedures over the next
3. Schmidt BM, Ribnicky DM, Lipsky PE, Raskin I. Revisiting
five years. The standardisation work will cover remedies,
the ancient concept of botanical therapeutics. Nat Chem Biol
procedures, traditional medical terms and acupuncture 2007;3(7):360–6.
standards, according to the State Administration of TCM

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Farewell to Chinese Medicine? B Butcher
Medicine as Science

Some Thoughts on Medicine as a Science

– A Layperson’s Contribution to the Controversy
Over TCM
Barry W Butcher* PhD
Senior Lecturer, School of History, Heritage and Society
Deakin University, Geelong Campus at Waurn Ponds, Victoria, Australia

Almost fifteen years ago the late and much lamented historian consumer of TCM (though I did once have a large malamute
of medicine Roy Porter published a typically provocative dog whose spinal paralysis was much helped by acupuncture…
article in the Times Literary Supplement entitled A professional but that’s another story). I am instead a trained professionally
malaise: how medicine became the prisoner of its success.1 Porter’s employed historian of science who has at various times
claim was that as Western medicine had become more scientific studied the philosophy of science and has taught courses with
and increasingly able to improve health and control disease and grandiose titles such as ‘Medicine, Healing and Society’ where
life threatening processes such as childbirth, so it had become I have sought to introduce students to the idea that there are
a site of social concern, scepticism and academic attack. New other ways of seeing the worlds of sickness and health than
medical discoveries in the second half of the twentieth century, that presented to us as part of the scientific culture in which we
ranging from antibiotics to immunosuppressant drugs had in the West supposedly live, breathe and have our being. It is,
built on nineteenth century discoveries such as the germ then, from the perspective of an historian that I approach this
theory and the role of parasite vectors. To these could be added current debate over TCM, and it is with the history of Western
genetic engineering and stem cell technologies promising to medicine that I will begin in order to pose questions about the
overcome previously incurable diseases such as Parkinson’s scientific nature of the various disciplines that constitute its
disease and various forms of cancer. As Porter made clear, we in modern form. My approach will be selective and (hopefully)
the West now live in a world remarkably free of life threatening provocative but nonetheless will, I think, be illuminating.
illnesses, and despite the threat posed by new diseases such as
HIV/AIDS we could confidently expect that the application of The history of Western medicine has been traditionally
science would continue to guard the health of the people. So presented as part of the post-enlightenment agenda of progress
why then the attacks and criticism mentioned above? Porter from superstition and darkness to science and light. While the
himself pointed the way to what is almost certainly the correct crudest of such histories are now recognised as being simplistic,
explanation: and indeed often historically inaccurate, there remains in the
literature a tendency to a Whiggish interpretation of medicine’s
Today, with mission accomplished, medicine’s triumphs are history, at least in the Western world. This is particularly true
dissolving in disorientation. Medicine has led to vastly inflated of its story in the nineteenth century, where it is generally
expectations, which the public has swallowed. Yet as these seen as taking off as a scientific endeavour as part of the
expectations grow unlimited, they become unfulfillable. The task professionalisation of science generally. The success of William
facing medicine in the twenty-first century will be to redefine its Budd and John Snow in tracing the epidemiology of diseases
limits even as it extends its capacities.2 such as typhoid and cholera,3 coupled with Edward Jenner’s
earlier demonstration of the value of vaccination for small pox4
Fifteen years on and the crisis in Western scientific medicine is were practical steps to improved public health but had limited
as prominent as ever in both the popular press and academic scientific underpinning – they were the result of practical actions
discourse; stem cell research, the overuse of drugs, high hospital in the main – most notably Jenner’s successful inoculation
mortality rates, the rise of antibiotically immune ‘superbugs’ and of the eight-year-old James Phipps and Snow’s removal of
a plethora of public complaints about medical malpractice and the Broad Street pump as a means of convincing authorities
bureaucratic stuff-ups are just the start. Porter was right – for all that the ‘cause’ of cholera could be sourced to a specific water
its triumphs, Western medicine is suffering from a malaise. supply.5 Gradual acceptance of the germ theory after 1860 led
to antiseptics of course – though it was not known at the time
I was brought back to Porter’s article recently when asked if how these worked to kill the germs themselves. Improvements
I would contribute something to the current debate over the in technology allowed for better surgical procedures, the
scientific basis of traditional Chinese medicine (TCM).3 Now outcomes of which were much improved with the arrival of
let me make it clear right away that I am not a practitioner or anaesthetics in the 1840s. Again, the actions of anaesthetics

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):25–27.

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 Farewell to Chinese Medicine? B Butcher
Medicine as Science

were not explainable by contemporary science – they worked very well to intone that science is based on observation, theory,
and in medicine that was all that mattered. experiment and repeatability and that if we take heed of all these
we will end up with ‘objective’ knowledge of the world. Well,
So where is the science in Western scientific medicine? perhaps we might – for now. Tomorrow’s ‘objective knowledge’
Experiment, observation and theorising are certainly accepted might be very different. Even in the hardest of hard sciences,
as part of the process, but unlike the hard sciences, the biological physics, there have been occasions when the great men have got
basis of medicine means that there is what sociologists of it spectacularly wrong, the best example being Lord Kelvin, the
science would define as a degree of ‘slop’ to be accounted for. doyen of British nineteenth century physicists telling students
Genes may be the basis of all biological organisms but, unlike in Baltimore in 1904 that all the major discoveries in physics
the laws of physics, the laws of life are remarkably wobbly; had been made and that their job would simply be mopping
medicine deals with complex individuals and while certain up around the edges. In 1905 a post office clerk in Switzerland
processes can be applied to populations with every confidence published something about relativity and the rest – including
of a successful outcome – immunisation perhaps being the much of Kelvin’s life work – is, as they say, history.
most obvious example – at other times either individual
morphological, physiological and even anatomical factors must Few philosophers of science would now claim that there is a
be considered, or dependence on fairly crude statistical analysis scientific method suitable for application to all branches of the
be relied on. Examples of the first case would be individual sciences; and the ‘softer’ the science, be it psychology, biology
response to drugs, the role of allergies and so on. The second or medicine (let alone any of the social sciences) the less likely
case might include the need for large epidemiological studies are we to find a ‘one size fits all’ methodology. From Francis
(which often show minute differences in outcomes). Thus, Bacon in the seventeenth century to Karl Popper and Thomas
while general laws of life can be drawn up, and students taught Kuhn in the twentieth, there have been heroic attempts to
how the body functions, for instance, in the final analysis the somehow fence off science from all other knowledge systems in
medical practitioner in the West as much as in the East must order to protect its supposedly peculiar epistemological status.4
take account of the individual patient’s situation. None have convinced all, though all have their adherents. In
the end we have to take our own counsel as to what we see
Without question the greatest improvement in the health of as comprising science as opposed to non- or pseudo-science;
the populace came through improvements in hygiene; the a scary thought perhaps but we can console ourselves with the
non-medico bureaucrat Edwin Chadwick’s obsessive pursuit point made by the radical sociologist of science Harry Collins;
of means to provide clean water and remove excreta from the insofar as any knowledge system can be said to be rational then
burgeoning industrialised cities led to the creation of legislative science is probably the best of the lot.6
control over water quality and the construction of hundreds
of miles of underground sewerage systems.4 The application So where does this leave the current debate over the scientific
of science? Yes, the scientific theory of miasmas, the then status of TCM? Frankly, I’m not sure it really matters but
dominant idea that disease was caused in some way through because the question has raised so much heat (if not much
the filth and odour all too evident on the streets of London, light) it might be worth addressing, if only briefly here; and
Paris, New York and so on. Miasmas – not germs, as Chadwick as an outsider to TCM perhaps I can do so, shall we say,
and almost all his supporters were very keen to stress. On the more objectively than some of those working from within the
basis of this ‘failed’ theory, more lives have been saved and discipline. So here goes.
more lives improved than almost all other advances attributed
to medicine. And it should be noted here that one could apply Medicine both East and West has traditionally been seen as an
the same ‘failed’ theory today in those places around the globe art; diagnosis, prognosis and treatment, have until very recently
where water supply and the removal of human waste would been as much a matter of subjective experience on the part of
reduce mortality from the ‘diseases of filth’ that are still among the practitioner and patient in the West as they remain today
the biggest killers of young children. in TCM. I would suggest that one might interpret the move
away from the subjective to the objective mode in Western
Note that I am not here engaging in a process of bashing medicine as a prime cause of the malaise identified by Roy
Western medicine; on the contrary I accept its spectacular Porter. The sufferer is now a site of disease rather than a being
successes and its scientific claims – even those it proposed in with an individual personality and a social role to play. The
the nineteenth century which we now know to be incorrect. word holistic gets thrown around with careless abandon too
What I am suggesting – and this will not be news to anyone often these days and can become a catchcry for every oddball
with even a passing knowledge of recent developments in the system of medicine, but TCM can rightfully claim to be holistic
philosophy and sociology of science – is that science itself is in the proper sense of the word – it takes the whole person
a dynamic system of changing theories and practices. It is all seriously and does not reduce him or her to a diagnostic entity.

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Farewell to Chinese Medicine? B Butcher
Medicine as Science

The high costs associated with modern Western medicine and by my GP on the subject of what I could and could not now
the pressure for cost saving via improved throughput at the do; what I should eat, what exercise I should undertake and so
level of the general practitioner mean that any real interaction on. In the intervening period I have read widely on the subject
between the doctor and the patient is likely to be facile at best. of diabetes and so far as possible I have kept up with the most
Something here to be learned from the East perhaps? recent research and, falteringly, tried to follow some sort of
lifestyle that improves my chances of living a reasonable life.
Critics of TCM rightfully draw attention to its failures; wrong What have I learned? That I should look for low glycaemic
diagnosis, incorrect treatment, overdosing and poisoning and index (GI) foods – and there are many to choose from on
so on. Critics of Western medicine rightfully draw attention to the supermarket shelves so I have been assiduous in seeking
its failures; wrong diagnosis, incorrect treatment, overdosing them out – but wait, there’s more, for it turns out according
and poisoning and so on. Mud-slinging is easy, whoever is to current research that low GI foods are no good without
doing it and in the area of medicine it’s not hard to make it accompanying fibre…so my assiduity in that area has been
stick. Where would the commercial television stations be misplaced. I have learned not to eat potatoes – well, actually,
without their current affairs programs being able to run stories recent research suggests I can, and the same goes for bananas.
of appalling medical mess-ups? I learnt originally that I should eat six small meals a day rather
than the traditional three; now it seems I should go back to
Critics of TCM also seem to have a strong case in the area three because the six meals a day formula applies only to type
of accountability, by which I don’t mean at an individual 1 diabetics. Fructose was OK five years ago; now it’s as deadly
practitioner level only, but as an entire system of medical as any other form of sugar, but then sugar is not so deadly
knowledge. I have already hinted above that I don’t really apparently as it was five years ago, fats seem to be the villain
think it matters whether the underlying theory is objectively just as much now. What I am trying to say here is that scientific
provable, but I do think it matters that the potential patients medicine can be problematic in certain circumstances; new
in TCM can have some way of knowing that the treatment knowledge overturns old knowledge, to the dismay of the
they are going to receive is likely to be efficacious. Given the sufferer, and presumably to the medical researcher and GP. I
long history of TCM and its development of herbal, drug and doubt TCM would fare any worse or better in this respect.
other treatment regimes, this should not pose a problem for
researchers keen to test its efficacy. This may or may not be References
done through the application of Western scientific techniques,
1 Porter R. A professional malaise: how medicine became the prisoner
depending on what it is that is actually being assessed, but if of its success. Times Literary Supplement. 1994;4737:3–4.
we take the overall thrust to be something akin to the evidence 2 ibid. p. 4.
based approach of Western medicine, then it ought to be
3 Porter R. The greatest benefit to mankind: a medical history of
possible to construct a methodology suitable to analyse TCM humanity from antiquity to the present. London: Harper Collins;
(and bear in mind here that evidence based medicine is the 1997. p. 405–415.
product of Archie Cochrane’s fertile mind in post-war Britain; 4 Fisher RB. Edward Jenner (1749–1823).London: Andre Deutsch;
it is not something intrinsic to the long history of Western 1991.
medicine per se). 5 Lewis RA. Edwin Chadwick and the public health movement.
London: Longmans Green and Co; 1952.
Let me finish on a personal note. Five years ago I was diagnosed 6 Collins HM. Changing order: replication and induction in
with type 2 diabetes and subjected to some solemn lecturing scientific practice. London: Sage Publications; 1985.

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 Farewell to Chinese Medicine? B Xu and CH Ju
Farewell to Prof Zhang’s Ideals

Farewell to Professor Zhang Gongyao’s Ideals

Bin Xu* BMed, MMed, PhD
Chuanhui Ju BMed
Nanjing University of Traditional Chinese Medicine, Nanjing, China

A National debate as a way of engendering support for his assertions, arguing that
Confucius did not believe in shamans,7 the implication being
In China, arguments between proponents of traditional that TCM is not far from being a form of witchcraft. The article
Chinese medicine and critics who wish it would give way has been viewed more than 16 000 times and commented on
to biomedicine are not new. However, the publication of by about 2600 visitors during 2006–2009. More than 90%
Professor Zhang Gongyao’s article,1 essentially repeating the percent of the visitors were opposed to Zhang’s views.
same argument, has caused a flurry of debate. The author
even launched an online petition to do away with Chinese During a speech entitled ‘Why do I Claim to Remove Traditional
medicine. Chinese Medicine from Chinese Health Care System’8 at the
second International Conference of Oriental Medicine Present
In the two years since the article was published in 2006, more and Future in Seoul in January 2009, Professor Zhang cited
than two hundred and twenty papers and reports published in a study by Changchun University of TCM, saying that by
China offered a response to Zhang’s assertions. A quick search 2008 the population that blindly believed in the effectiveness
of the internet resulted in more than two hundred and forty of TCM had declined from 88% to 58%. We were unable to
thousand hits and more than ten books have been published access Zhang’s cited source for these statistics. On the contrary,
in this area of discussion. It is indeed rare to have so much we found that a survey conducted in January 2007 reported that
literature with regard to the retention or abolition of TCM in Jilin province in the northeast of China, 58% of the people
within such a short time in history. Zhang’s paper has led to a surveyed believed that TCM was very effective and could treat
new wave of discussion. the root syndrome; 25% thought that TCM was effective for
chronic diseases but not for acute diseases.9 These data display a
Among all the discussion papers, four articles by Zhang Boli, completely different picture from Zhang’s assertions.
a member of the Chinese Academy of Engineering2–5 and
other scholars essentially refute Zhang’s arguments from a As an acupuncture educator and researcher, I haven’t felt the
range of perspectives. They put the view that TCM has made significant impact of these discussions, whether it is positive or
a great contribution to the proliferation and prosperity of negative, on my clinical practice in China. TCM hasn’t suffered
Chinese nation and the development of world civilization. much on account of the ‘farewell’ incident. The general feeling
They also suggested that it is narrow-minded, irrational and of TCM doctors in China is that the public need for TCM
even self-belittling to suggest that TCM be abolished. Many treatment has increased rather than decreased.
other scholars also joined the discussions offering views from
differing perspectives, including history of science, scientific TCM Research in China (2006
methods, local knowledge, and intrinsic problems of TCM.
None of the scholars agreed with Professor Zhang’s argument. – 2020)
Of the ten books published, all but one defended TCM. The
one exception is the Fang Zhouzi which essentially outlines a Furthermore, research in TCM is valued highly by the central
litany of criticisms of TCM. government and the Chinese government is devoting substantial
amounts of money to further the promotion of TCM in China
Not long after the quick responses to Zhang’s critique of till 2020. For instance, the ‘TCM Theory Special Program’
TCM, he was quoted in the Xiaoxiang Morning News saying, established in 2005 has invested RMB 70 million each year.
‘I have never talked about the abolishment of Traditional Currently there are four acupuncture projects underway:
Chinese Medicine’….‘My so-called goodbye means that it’s ‘Acupuncture Specific Feature Research’ with an investment
advisable for Traditional Chinese Medicine to return to civil of RMB 14 million; ‘Acupuncture Anaesthesia Research’ with
society; we should make it as our emergency, or last choice, RMB 23 million; ‘Research of Moxibustion Basic Principles
instead of removing it completely’.6 However in another of and Application’ with RMB 11 million; and ‘Meridians and
Zhang’s polemics published in his blog he invokes Confucius Points Therapeutic Effects Research’.

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):28–29.

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Farewell to Chinese Medicine? B Xu and CH Ju
Farewell to Prof Zhang’s Ideals

The Eleventh Five-Year Plan has also funded many TCM developing rapidly in China. The overwhelming response
research programs. One of these projects is ‘Discovery of New to Zhang’s assertions suggest that his opinions fail to accord
Drugs’. It includes transformation of Chinese herbal medicine with educators, researchers, practitioners, government funding
species, research into Chinese herbal medicine standards, and authorities and critically, the consumers of TCM – the general
discovery and evaluation techniques of new Chinese herbal public. One positive consequence of Zhang’s opinion could
medicine and a total of RMB 500 million has already been be that the TCM community extend itself and continue to
invested. In addition to these nationally funded programs demonstrate the value of TCM in China and in the rest of
there are also many programs funded at the provincial level. the world.
Some are also privately funded.
References
The State Administration of TCM has commenced feasibility
1. Zhang GY. Farewell to traditional Chinese and medicine. Medicine
studies on the application of TCM key laboratories and the and Philosophy (Humanistic & Social Medicine Edition)
construction of research-based TCM hospitals. In 2008, the 2006;27(4):14–17.
central government published ten items of ‘Standardized 2.. Zhang BL. Do not admit to defame the scientific characteristics
Manipulations of Acupuncture and Moxibustion’. In the same of TCM. Journal of Central-South University (Social-Science)
year, the Chinese Association of Acupuncture-Moxibustion 2007;13(1):10.
completed four programs including ‘Research Plan of the 3. Li JS, Qiao WJ. TCM in the practical perspective of science and
Advantages of Acupuncture-Moxibustion’ and ‘Clinical philosophy. Journal of Central-South University (Social-Science)
2007;13(1):11–14.
Practice Guidelines for Acupuncture and Moxibustion’. The
4. Luo GH. Judgment of TCM needs scientific basis and rational
latter involved clinical practice guidelines for the following
spirit. Journal of Central-South University (Social-Science)
five diseases: depression, herpes zoster, dysphagia of apoplexy, 2007;13(1):14–15.
migraine and Bell’s palsy.
5. Xiao ZC. Discussion on the certainty of TCM medical mechanism
and pharmacology. Journal of Central-South University (Social-
The growth of TCM also impacts on education. In recent years, Science) 2007;13(1):15–16.
the People’s Medical Publishing House has published forty 6. Peng YH, Yue J. Famous TCM doctors refute ‘Farewell to Traditional
‘Teaching Materials for National Higher TCM University’s Chinese Medicine’ by Gongyao Zhang. <http://xinggongchang.
Post-Graduate Education’. These texts include basic, classical blog.hexun.com/6059720_d.html>.
and clinical aspects of TCM and Chinese herbal medicine. 7. Zhang GY. Confucius did not believe in shaman <http://blog.sina.
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2009.
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and private enterprise is substantial. TCM is healthy and 2008;29(5):75–76.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 29
 Interview with
Professor Zhou Zhongying of
NJUTCM, Nanjing, China
Minwei Zhu* MMed
Nanjing University of Traditional Chinese Medicine, China
Zheng Zheng PhD
Discipline of Chinese Medicine, School of Health Sciences, RMIT University, Melbourne, Australia

This article reports an interview that the AJACM had with he treated patients and taught me to read medical and cultural
Prof Zhou Zhongying in China in Dec 2008. literature whenever he had time. For masterpieces of TCM, he
not only made me understand the meaning but also asked me
Professor Zhou is 80 years old, and has been practicing and to learn and recite them fluently. I learnt this way for 6 years
teaching TCM for 60 years. He is one of the most prestigious until I was 19 years old. Actually this was the fundamental
traditional Chinese medicine (TCM) experts in China. period of my medical life. Even now I can still recall some of
Recently he has been authorized as a representative of TCM’s the masterpieces I learned at that time. I believe that period was
inheritances, a project under the International Non-Material a valuable initiation to Chinese medicine and it has formed a
Culture Heritage Program of China. solid foundation upon which my achievements have built.

Prof Zhou was a representative at the 7th National People’s In 1947 I left my hometown to study the advanced course
Congress of the People’s Republic of China, a member of the for TCM physicians in Shanghai Medical College of Chinese
State Natural Science Fund Assessment Committee, a senior Medicine. In 1955, I went to Nanjing to continue my study
editor of the ‘Journal of Traditional Chinese Medicine’ and the in the Advanced TCM School of Jiangsu Province for another
editor for over 30 (TCM) textbooks and books on internal two years. During that time I also practised TCM when I had
medicine. He was the president of Nanjing University of no classes.
Traditional Chinese Medicine (the former Nanjing College of
TCM). He practises more than 20 hours a week at the Jiangsu At the age of 28, I was transferred to the Affiliated Hospital of
Provincial Hospital of TCM and other hospitals. Nanjing College of TCM. I have been working there as resident
doctor, chief medical doctor and specialist since then. I also
One of the authors (ZMW) has observed at Professor Zhou’s taught at the college, now the Nanjing University of TCM. I
practice for more than twelve months. Professor Zhou sees am still a professor and supervisor of PhD students.
a large number of patients who have not been successfully
treated by other therapies or TCM doctors. Successful as he is, Zheng: Given the long history of Chinese medicine, many
he always patiently listens to every case and carefully examines young TCM doctors think we have little chance to develop new
the treatments that patients had. To him, the best way to assess theories and we can only follow the classics. Is it possible to
TCM and to ensure its development in modern society is its develop TCM theories?
clinical effectiveness.
Zhou: I am a clinical doctor and at the same time a TCM
In the following interview, we intended to find out his thoughts lecturer. I want to help patients effectively and to pass TCM
on some common questions that bother young doctors and down to the next generations. I try to develop and innovate
TCM students. TCM theories. I give you an example. After some time of
clinical observation and theoretical studies, I found out that
Zhu: Please tell us your experience when learning TCM? haemorrhage in some diseases, such as epidemic haemorrhagic
fever, pulmonary tuberculosis, bronchiectasis and peptic ulcer,
Zhou: I was born in 1928 in Rudong County of Jiangsu Province is caused by both heat and blood stasis. If you apply blood heat-
of China. By my generation, my family has practised Chinese clearing or stasis-removing drugs separately, you will not get
medicine for five generations. At the age of 13, I started to satisfactory results. So I put forward a new point of view of the
follow my father in his clinic and sometimes at patient’s home, pathogenesis of the mixture of stasis and heat to describe the
learning Chinese medicine. My father explained to me while progress of many diseases.

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):30–33.

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Interview with Prof Zhou MW Zhu and Z Zheng

Let’s see the causes. Fire-heat is a very important pathogenic Rhizoma Rhei), Bai Mao Gen (Rhizoma Imperatae Cylindricae),
factor and it might originate from many sources: six exogenous Niu Xi (Radix Achyranthis Bidentatae), Huai Hua (Flos
pathogens turning to fire after further invasion into the interior Sophorae), Zi Zhu (Folium Callicarpae Pedunculatae), Han Lian
of the body; extreme emotional disturbance generating fire; Cao (Herba Ecliptae Prostratae), and Xue Yu Tan (carbonised
mental exhaustion stirring up empty fire; long-term depressed Crinis Carbonisatus). Seven days later the patient came back
mood transforming into fire; indulgence in fatty, sweet and with no more bleeding. Hot rushing sensation in the nose,
greasy food generating fire; obstruction of phlegm and stasis thirst and dry stools were also improved. His tongue margins
producing fire; and overuse of warm and dry drugs consuming and tip were dark purplish and the coating was yellow and
body fluids and inducing fire. Once fire-heat is produced, it sticky. The pulse was thready and slippery. I prescribed another
becomes a pathogenic factor. Blood stasis is often a result from seven packages of the same prescription but adding Sha Shen
a disorder of Qi or blood circulation. If a person has a chronic (Radix Glehniae) and Mai Men Dong (Radix Ophiopogonis).
disease, his or her qi and blood will be consumed. Qi deficiency This was to consolidate the previous effect.
fails to propel blood flow and blood deficiency results in a
slow blood circulation, leading to blood stasis. Blood stasis It is a general rule that epistaxis is caused by excessive heat
itself may generate fire heat if it is not resolved within a short in the lung and stomach and hyperactivity of liver fire, which
time. When heat and stasis are combined, they form a new jointly forces blood to overflow. The nose is the orifice of the
pathological basis for a variety of exogenous and endogenous lung, the stomach meridians travel along the sides of the nose
diseases. Fire and stasis tend to stick to each other and usually and the collaterals of the liver meridian go into the throat and
make the treatment very difficult. enter the nasal pharynx. When the fire heat becomes exuberant
in the lung, stomach and the liver, it may flame upwards
To me, cooling the blood to resolve stasis and clearing heat along the meridians, forcing blood to overflow and injure the
to dissolve heat stasis is the essential strategy for treating collaterals to cause nasal bleeding. Persistent blood heat tends
many diseases of stasis heat syndrome. But this pathogenesis to stagnate blood and cause stasis. So in order to stop bleeding,
wasn’t mentioned in the previous TCM classics except the treatment strategies should be to clear heat from the lung,
for scattered records, probably owing to incomplete and stomach and liver, cool blood and at the same time to resolve
superficial understanding at that time. Consequently there blood stasis.
is no comprehensive discussion or systematic treatment, nor
strategies and drugs for this syndrome in TCM classics. Zheng: One of the difficulties that young TCM doctors face
is how to understand new diseases and conditions with TCM
In 2001, I treated a 60 year-old male patient. He had two theories. Could you please tell us how you apply TCM theories
attacks of epistaxis each year for four successive years. During to the diagnosis and treatment of modern diseases?
the last year the symptoms became worse. Each time before
the bleeding, he felt hot rushes in the nose and throbbing Zhou: Chinese medicine is a complete therapeutic system.
of the blood vessels. The blood usually poured out with a Under the guidance of this system, we are able to treat
bright red color, sometimes it filled a basin. He felt dry of the common diseases, modern diseases or stubborn diseases if we
mouth in the morning and evening and liked to drink a lot of apply the method of differentiation of syndromes, ascertain the
water. He had dry stools, a red face and red tongue body with pathogenesis and treat patients and diseases accordingly. One
yellow sticky coating. The pulse was thready and slippery. He typical example I have is the TCM understanding of epidemic
didn’t have hypertension but hyperlipidermia and a history of haemorrhagic fever.
pulmonary TB and emphysema. He was hospitalised twice in
the Provincial People’s Hospital but with an unclear diagnosis In the 1970s, epidemic haemorrhagic fever spread over many
before coming to my clinic. I analysed his symptoms and signs European and Asian countries. Our country was among the
and believed they were caused by blood heat and stasis. This most severely affected. I had no idea how to treat this disease
patient had underlying excessive heat in the lung and stomach. when asked to take a medical team to the infected area. We
The fire heat tended to rush upwards and stagnate blood to went into the patients’ houses in spite of infection and tried
form stasis. Then heat and stasis combine to force blood to to help them with my TCM knowledge. At the same time
overflow. So the treatment strategies should be to clear heat I collected the clinical materials and studied them with
and cool blood so as to resolve stasis and check bleeding. I TCM theories. After some time of observation I found the
prescribed seven packages of Shui Niu Jiao (Cornu Bubali), common clinical features of this disease were fever, bleeding,
Sheng Di Huang (Radix Rehmanniae Glutinosae), Chi Shao hypotensive shock and renal damage. In Western medicine, the
(Radix Paeoniae Rubra), Mu Dan Pi (Cortex Moutan Radicis), pathological process includes fever, hypotensive shock, oliguria,
Zhi Zi (Fructus Gardeniae Jasminoidis), Xuan Shen (Radix polyuria and recovery phases. In TCM, we can describe the
Scrophulariae Ningpoensis), Da Huang Tan (carbonised Radix et pathological changes as the Defensive, Qi, Nutrient and Blood

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 Interview with Prof Zhou MW Zhu and Z Zheng

syndromes or stages (Wei Qi Yin Xue). The transitions between in Jiangsu province was of warm-heat type and that in Jiangxi
these syndromes or stages is often so fast that during the Qi province was of damp-heat type. Different persons also show
stage, sometimes even at the Defensive stage, the pathogenic different symptoms from the same pathogens.
heat has already involved the Nutrient and Blood systems,
manifesting simultaneous Defensive or Qi with Nutrient Secondly, we need to pay attention to the treatment sequence,
or Blood syndromes. Exuberant fire in the Qi and Nutrient particularly to these diseases with complicated pathogenic
stages is the most commonly seen syndrome and it may appear factors. We must be able to catch the main problem and
together with fever, hypotensive shock and oliguria phases. I distinguish the primary from the secondary. The general
also tried to explain the diseases from the theories of Sanjiao principle is to treat the symptoms for acute conditions and the
– Six Meridians. In light of the theories of warm diseases (Wen root cause for chronic circumstances. But in the clinic we also
Bin) and cold-induced diseases (Shang Han), I analysed the need to be flexible.
pathological features of each phase and came up with a TCM
understanding: the pathological center of this disease was at The third aspect is to apply compound prescriptions. In
the Qi and Nutrient stages and fever was due to exuberant fire the clinic, difficult and intractable cases are often seen
torturing the Qi and Nutrient systems; thereby even at the Qi involving several zangfu organs and presenting contradictory
stage, we could use nutrient-clearing drugs if there were some manifestations, for example, exterior and interior, cold and
signs showing heat invading the Nutrient system, for example: heat, deficiency and excess. The prescription should be made of
hotness in the body, red face and eyes, haemorrhagic spots in drugs with both cold and heat properties, possessing potential
the skin and mucous membrane. This strategy was effective in ascent and descent and purgative and tonifying effects. The
preventing further invasion of pathogenic heat. Furthermore concrete method is to determine the essential strategy according
we added qi-clearing drugs to nutrient-clearing drugs so as to to the principal syndrome, then to add the secondary strategies
drive pathogenic heat out through the Qi system even when and corresponding drugs to solve the mixed pathogenesis.
the heat has already moved into the Nutrient system. This
idea came from Ye Tianshi, a famous TCM physician in the The fourth is trial and error and ‘reversal thinking’. These two
Qing Dynasty. This method can control high fever and stop methods can be used when we have tried the conventional
further transmission; it is the key approach in shortening methods and failed. If the pathological conditions are too
the pathological process, reducing aggravated syndromes, complicated to find out the pathogenesis, try some gentle
enhancing the therapeutic result and lowering the fatality rate. formulas to ascertain the pathogenesis. Dosages can be increased
We used Chinese herbs to induce purgation, remove stasis, or more drugs can be added if there are some improvements. If
moisten yin and induce diuresis in patients with epidemic there is no result, try to think of other prescriptions.
haemorrhagic fever. Altogether we treated 1127 patients. The
fatality rate was 1.11%, which was much lower than that of the Reversal thinking is reanalysing the condition and trying to
control western medicine group (5.08%).1 treat it from the opposite aspect to your original strategy.

This research has obtained the First Class Prize of the National Zhu: Would you please give some advice to students on how to
Public Health Ministry of China and the result was sent to the study Chinese medicine?
former Soviet Union for international exchange as the highest
achievement of TCM treatment for haemorrhagic fever. Based Zhou: In addition to the required courses, I think there are two
on this experience, I started to do more research on difficult very important methods. The first is to read and recite TCM
and intractable diseases and initiated 20 projects, including classics and the second is to start clinical practice as early as
acute renal failure, viral infectious fever, tumor, hepatic possible. I read a lot of classic works of Chinese literature and
diseases, cerebral diseases, hypertension and shock. learnt by heart many masterpieces of the TCM classics. Even
now I can still recite some chapters in Shang Han Lun (Treatise
Zhu: What are your main secrets of successful TCM on Cold-Induced Diseases) and Qian Jin Fang (Prescriptions
treatments? Worth a Thousand Gold). Sun Simiao and Zhang Zhongjing
are my favorite physicians. TCM classics, originating from
Zhou: I am happy to share my treatment strategies. Firstly, Chinese culture, are the essential guides to previous physicians’
TCM emphasises individualised treatment. This is a basic rule experience. The later generations also enrich and supplement
and also one of the most important guides in treating difficult them to make a complete therapeutic system. These are the
and intractable diseases. The same disease with the same source and basis of Chinese medicine.
pathogenic agents may present different pathological changes
depending on the age, climate, seasons, geographic regions TCM classics can be learnt in two ways. One is to start reading
and individual constitutions. For example, haemorrhagic fever the most elementary ones, namely the four classics, Nei Jing (The

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32 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Interview with Prof Zhou MW Zhu and Z Zheng

Internal Classic of Yellow Emperor), Shang Han Lun (Treatise students today start practice as early and as soon as possible. It
on Cold-Induced Diseases), Jin Kui Yao Lue (Synopsis of the can help them comprehend and improve their understanding
Golden Chamber) and Wen Bing Lun (Treatise on Epidemic of TCM theories and it is the only way to become a superior
Febrile Diseases), then gradually to read other medical works. TCM doctor.
This way can lay a solid foundation for later study or even
the whole of life if one can memorize more masterpieces even Zheng: Some students do not see the necessity of studying
though it may seem boring, dull and confusing at the time of Western medicine or understanding modern research. What
studying. do you think the place of Western medicine is in our practice?

The other way is to study and remember some practical To improve TCM academic level, we must learn some western
writings written by the later generations, such as Tang Tou medical knowledge, which may help us understand the human
Ge Jue (The Rhymes of Chinese Herbal Formulas), Yao Xing body and supplement TCM theory. But the purpose is to
Fu, (The Odes of Herbal Potency), Pin Hu Mai Xue (Pin make TCM better. It is just like a Chinese saying ‘A stone may
Hu Pulsology), and Yi Xue San Zi Jing (Medical Classics of be as beautiful as a piece of jade in some circumstances’. For
Three Characters). At the same time read Wen Re Jing Wei example, modern pharmacological research finds out some
(The Essence of Epidemic Febrile Diseases), Wen Bing Tiao medicinal herbs possess blood pressure-lowering effect. We may
Bian (The Detailed Analysis of Epidemic Febrile Diseases), Yi use them to treat hypertension, but the usage must be under
Zong Jin Jian (The Golden Mirror of Medicine), Yi Xue Xin the guidance of TCM theories. Tian Ma (Rhizoma Gastrodiae
Wu (Medicine Comprehended)and Yi Fang Ji Jie (Collection Elatae) and Ju Hua (Flos Chrysanthemi Morifolii) have the
of Prescriptions with Notes). One should also read books of function to calm the liver and extinguish wind, so they should
case analysis by a couple of famous physicians. Books of case be used for hypertension due to hyperactivity of liver yang and
analysis are very useful and I still read them. Case studies are internal wind. Xia Ku Cao (Spica Prunellae Vulgaris) and Huang
close to clinical practice. Advanced study of the elementary Qin (Radix Scutellariae Baicalensis) have the function to clear
TCM classics is still necessary for laying a solid foundation. fire and resolve phlegm, so they are used in hypertension due
The classical learning will be better understood and perceived to exuberant phlegm fire. Anti-hypertension is the common
after some time of clinical practice. function of many herbs, but as a TCM doctor we should use
them according to syndrome differentiation.
Zhu: Why do you think that the TCM students should start
clinical practice as early as possible? Zheng: What do you think of today’s TCM education?

Zhou: TCM is a practical science that has originated and Zhou: In my opinion, high education of TCM should aim at
developed in people’s everyday life, work and clinical practice. training tip-top TCM doctors for the needs of society. TCM
So it is quite reasonable to say without clinical practice, there is a special profession and possesses its own features, just
will be no TCM. And there will be no brilliant TCM if there is like training Beijing Opera actors. We should know TCM is
no clinical practice with its excellent effects. a traditional medical science. It is a very important strategy
to balance the inheritance and its evolution since it will not
Nowadays TCM students spend too much time studying books continue to develop if there is no heritage. Apprenticeship is a
and in their classrooms, but with only a little time in the clinic. good model, which should be taken as a part of   TCM education.
Without clinical practice or observation, many students lose This is the traditional way of teaching TCM. The apprentice
their confidence in TCM and prefer to use western medicine students will learn basic theories, features, clinical effects as
instead of TCM. If they could start to practice TCM as early well as the master doctors’ way of thinking and treatment
and as soon as possible, and observe and experience the unique approaches when they follow the doctors in the clinic. As I said
results by themselves, I am sure they will have strong belief and before, clinical practice will not only build up their confidence
apply TCM in their practice confidently. in TCM practice but also enhance their understanding of
TCM. In this way they can inherit and develop it in future.
My confidence in TCM is very firm, which I think is related
to my TCM family. In that environment, I was able to observe Zhu and Zheng: Thank you very much for your time and
TCM even when I was very young. Now I am over 80 and I advice.
have practised TCM for over 60 years. Even when I was very
busy in the leading position as the president of the hospital Reference
or university, I still held onto clinical practice. Long-term
1 Jin MW, Zhou ZY, Fu WM. TCM routine treatment to epidemic
practice offered me opportunities and inspirations for my hemorrhagic fever. Journal of Nanjing College of Traditional
clinical experience and academic achievements. I hope that the Chinese Medicine 1980;04:10–13

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 33
 Current Research and
Clinical Applications
Response to: Madsen MV, Gøtzsche PC,
Hróbjartsson A. Acupuncture Treatment for Pain:
Systematic Review of Randomised Clinical Trials
with Acupuncture, Placebo acupuncture, and No
Acupuncture Groups.
BMJ 338:a3115, doi:10.1136/bmj.a3115 (Published 27 January 2009)

Zhen Zheng* PhD

This January, BMJ published a systematic later, a potential patient told me that although there was a statistically
review of acupuncture clinical trials for from his reading there was little evidence significant difference between real
pain conditions. The authors were from supporting the use of acupuncture and sham acupuncture in pain relief
Nordic Cochrane Centre in Denmark. for pain relief, and asked me what my [Standard Mean Difference (SMD)
They have been researching the placebo opinions about acupuncture for pain –0.17], the effect was small, about 4
effect in medical interventions for a management were. These incidents mm on a 100 mm VAS, and clinically
number of years. highlight the wide and strong impact of insignificant. The difference between
research on, not only further studies in real and no acupuncture groups was
The results of this paper were publicised the area, but also clinical practice. moderate (SMD –0.42). Furthermore,
in many newspapers, radio and online and contrary to the common view, the
media, and caused a world wide ABOUT THE REVIEW authors did not find any difference in
discussion on whether acupuncture was pain relief between sham acupuncture
effective. I believe most of you would So what is the review about and what using invasive methods and non-invasive
have read the news or heard of the are the recommendations? Madsen methods. The authors concluded that
review. At the time of publication, I was and colleagues wanted to know if real the analgesic effect of acupuncture was
busy working on three Human Research acupuncture was better than fake/sham clinically irrelevant and the psychological
Ethics applications for a clinical trial we acupuncture or no acupuncture for pain effect of acupuncture needs to be
planned to conduct in Melbourne and relief. To answer the questions, they studied.
paid little attention to the review. I said conducted a comprehensive literature
to myself it was just another such paper, search and utilized a set of selection The authors went further to
failing to recognise its wide impact. criteria. Briefly, they selected randomised recommend:
Then two Human Research Ethics controlled studies; (1) using invasive
Committees questioned me about the acupuncture as the real procedure; and (1) ‘…having the needling done by
implication of the review on our clinical (2) reporting pain intensity measured acupuncture naïve clinicians blinded
trial. The committees wanted to know, on a Visual Analogues Scale (VAS) or to the hypothesis of the trial’; and
given there was little difference between ranking scale. Thirteen studies with a
real and sham acupuncture as shown total of 3025 patients were selected. The (2) ‘…try to separate the effects
by the Madsen review, how we could study conditions included post-operative involved: the physiological effect of
justify the clinical trial we proposed and pain, scar pain, tension-type headache, needling at acupuncture sites or at
if we should consider adopting Madsen’s migraine, fibromyalgia, osteoarthritis other sites and psychological effect
recommendations? A couple of weeks and low back pain. They found that of the treatment…’

* Correspondent author; e-mail: [email protected] Aust J Acupunct Chin Med 2009;4(1):34–36.

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34 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Current Research and Clinical Applications

ANALYSIS OF THE REVIEW acupuncture had this effect.3 The results session, ‘Deqi … had to be elicited at all
indicated that both types of acupuncture points’, and needles were manipulated
The authors attempted to answer an could be similarly effective in FM 2 to 3 times during the treatment to
important question: the difference patients, possibly due to physiological, achieve consistent deqi. Independent
between real and sham acupuncture for rather than psychological factors. clinical monitors visited the trial centres
treating painful conditions. Overall the Experienced acupuncturists would know repeatedly to ensure the quality of the
review was executed with well-accepted that only shallow needling, similar to intervention. The differences between
methods and adequate statistical analysis. that used in sham acupuncture, should the two trials highlights that the effect
The two weaknesses of the review are the be used in FM patients at the early stages of acupuncture is beyond a simple
main threats to the validity of the study. of treatment because patients are often reporting of deqi and the acupuncture
Firstly, the review did not distinguish extremely sensitive to needling. points selected.
between chronic and acute pain in the
analysis. Secondly it failed to assess the Acupuncture is a complex intervention; It is not surprising that the recent
quality of acupuncture treatment. even in its technique, it is more than CONSORT statement on trials
just deqi and acupuncture points. Two assessing non-pharmacological treatments8
Chronic pain differs from acute pain in its questions students often ask about deqi expanded the ‘Intervention’ section from
pathology and management approaches. and yet we do not have the answer are one item in the previous statement9 to
Chronic pain is considered not just a how long deqi sensation should be three items. The recent statement also
symptom, but a disease in itself,1 whereas maintained and whether we need to emphasises the inclusion of experienced
acute pain is often self-limiting and produce deqi in all acupuncture points therapists. For instance, trial surgeons
disappears as tissue heals. Furthermore, used in the treatment. These questions must be experienced in and comfortable
chronic pain affects one’s physical imply the fine techniques involved in with the studied surgical procedure.
function, cognition and emotion. Due needling. Let me illustrate the importance
to the complexity of chronic pain, the of this question with an example. WHAT DO I THINK
International Association for the Study of In recent years, two clinical trials of ABOUT THE
Pain (IASP), the main organisation that acupuncture for tension-type headache RECOMMENDATIONS?
promotes pain research, education and were conducted in Germany.4,5 Both
practice, advocates multidisciplinary pain compared real with sham acupuncture, The authors of the Madsen review should
management. ‘The Initiative on Methods, selected similar acupuncture points, and have discussed the above-mentioned
Measurement, and Pain Assessment the treatment was delivered by physicians confounding factors before concluding
on Clinical Trials (IMMPACT)’2 states who had similar qualifications. The that acupuncture has only a small
that pain intensity is only one aspect of results were, however, different. For analgesic effect that is of little clinical
any pain condition. When assessing the headache days, Melchart’s study showed relevance. The suggestion of using ‘naïve
efficacy of an intervention, one has to no difference between real and sham clinicians’ so as to ensure the blinding of
consider not only reduction in pain, but acupuncture whereas Endres’s study therapists is not scientifically sound and
also improvement in physical function, found that real acupuncture reduced clearly against the CONSORT statement
quality of life and psychological status. headaches by 2.3 headache-days more as outlined above. Such a suggestion
Using pain intensity alone to judge the than sham acupuncture did. Fortunately will only introduce more variances.
clinical use of a therapy is not adequate. the authors of the two studies published The suggestion is also unethical, being
Thus, using limited data, a single type of their research methods and conduct against the International Conference
outcome assessment, or a single modality of the trials in great detail,6,7 which on Harmonization Guideline for Good
to judge the efficacy of acupuncture for allowed in-depth comparison of the Clinical Practice (ICH-GCP) E6 (1996).
pain, is also inadequate. two trials. It became apparent that the Item 4 states that in order to protect trial
administration of acupuncture and the subjects, the investigators should meet
Even within chronic pain, there are adherence to protocol differed in the two ‘all the qualifications specified by the
various types. For instance, fibromyalgia trials. In the Melchart study, one of the applicable regulatory requirement(s)’ and
(FM), a type of wide-spread pain, is quite eight main centres delivered 214 out of their qualifications should be up-to-date.
different from commonly seen localised 1507 sessions of treatment, and did not What would a subject in an acupuncture
musculoskeletal conditions, such as knee use two of the three mandatory points trial think when he or she is told that the
pain. One study showed that both real for 80% of their patients. ‘Deqi was trial therapist is a ‘naïve’ acupuncturist?
and sham acupuncture increased the achieved if possible’. In contrast, in the I think any Human Research Ethics
blood flow in the muscle of FM patients; Endres study, mandatory points had to Board or Committee that approves such
whereas in the healthy humans, only real be needled in every patient and in every practice in acupuncture trials would be

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of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 35
 Current Research and Clinical Applications

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al. Acupuncture in patients with tension- randomized trials. Ann Intern Med
more questions than it provides answers. type headache: randomised controlled 2001;134(8):657–62.
Future systematic reviews need to take trial. BMJ 2005;331(7513):376–82.
10. Kaptchuk TJ, Kelley JM, Conboy LA,
the quality of treatment administration 5. Endres HG, Böwing G, Diener HC, Davis RB, Kerr CE, Jacobson EE,
and adherence to protocol into account. Lange S, Maier C, Molsberger A, et al. et al. Components of placebo effect:
These factors of acupuncture treatment Acupuncture for tension-type headache: randomised controlled trial in patients
a multicentre, sham-controlled, patient- with irritable bowel syndrome. BMJ
need to be further studied in relation
and observer-blinded, randomised trial. J 2008;336(7651):999–1003.
to their impact on the outcomes. In Headache Pain, 2007;8(5):306–14.
addition, before we understand the
6. Melchart D, Streng A, Hoppe A,
underlying mechanisms of fibromyalgia, Brinkhaus B, Becker-Witt C, Hammes
systematic reviews of pain should not M, et al. The acupuncture randomised
confuse wide-spread musculoskeletal trial (ART) for tension-type headache
pain with other types of pain. – details of the treatment. Acupunct Med
2005;23(4):157–65.

Australian Journal
36 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
Book Reviews
Shang Han Lun Explained
Compiled and Translated by Greta Young Jie De and Robin Marchment
Churchill Livingstone, 2008
ISSN 9780 7295 3881 7

Diagnosis Study Guide

Qiao Yi and Al Stone
Eastland Press, 2008
ISBN 978 0 939616 64 0

Shang Han Lun The 543-page book is divided into nine the English translation often followed

Explained chapters and has sixteen appendices.

Chapter one introduces the main
by the formula, directions for its use
and a lengthy discussion on the clause.
The recent publication of Shang Han Lun concepts associated with the patterns of Interspersed are case studies which
Explained marks an important landmark the six channels. A brief introduction to demonstrate the clinical usage of a specific
for the development of Chinese herbal the historical development of the text formula and modern applications of the
medicine in Australia. Written by two and its methods of diagnosis and disease ancient formula. These six chapters are
Australian TCM practitioners, Greta transmission are introduced. Sections on extensive in detail and reflect a high level
Young Jie De, a strong advocate for the ebb and flow of qi in the six channels, of scholarship and clinical relevance.
classical Chinese medicine and Robin decoction and administration methods
Marchment, a specialist in Chinese complete this chapter and make it an Chapter 8 introduces the disease
language, the book offers an accurate excellent introduction to the next six concept of Huo Luan, often translated
translation and in-depth commentary chapters. as ‘sudden upheaval’ or ‘sudden turmoil’
on this important Chinese herbal canon. which refers to a range of acute digestive
The book has two aims as pointed out Chapters two to seven concentrate disorders such as food poisoning or
in the preface, firstly to explain the on each channel pattern individually, gastritis. Several clauses from the text
theory of Shang Han Lun and secondly commencing from Tai Yang and are used to identify the symptoms and
to explain how the ideas and principles finishing with Jue Yin. Every chapter has treatment of the condition. Again,
of the text can be used to treat disease in numerous sections, each focussing on a numerous case studies are used to
modern times. The text that it has been specific formula conformation or disease highlight the flexibility of several herbal
based on is the Ming Dynasty’s Zhao Kai pattern. For example, in the Tai Yang formulas such as Li Zhong Wan and Si Ni
Mei edition and while the 398 original chapter there are sections on the channel Tang used to treat the condition.
clauses have been included in the text patterns, the hollow organ patterns (fu),
they have been rearranged by the authors disease transmission and their treatment, The final chapter focuses on the
in terms of clinical relevance. This allows transmuted (deterioration of the disease) convalescent period after the disease and
the reader to have a continued focus on a patterns and their treatment, transmuted the potential for relapse called Yin Yang
concept or disease pattern without having patterns following inappropriate therapy Exchange and Taxation Relapse. Further
to refer to other pages and clauses. The and specific symptoms such as glomus relevant clauses are introduced with their
authors have also made extensive use of and chest bind associated with the appropriate treatment and the rationales
numerous summaries, tables and key Tai Yang pattern. Each concept area of why and how these patterns may have
points to assist understanding and clarify commences with the original clause arisen are explained.
difficult phrases and concepts. (in modern Chinese characters) and

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 37
 Book Reviews

The sixteen appendices take up over

100 pages and introduce supplementary
Diagnosis Study followed by the clinical significance of
the sign/symptom. Often a table is used
information that aids understanding of Guide to differentiate between different TCM
the text in general. The appendices are: patterns associated with the symptom/
App. 1. Additional Clauses not included Diagnosis is the bridge between theory sign. Both tongue inspection and pulse
in the Main Chapters; 2. The Sequence and clinical practice. Having taught this examination are given extensive coverage,
of Clauses in the Zhao edition of the subject for nearly twenty years, I am as are the ten traditional questions. The
Text; 3. Clause Index; 4. Summary of always on the look out for new texts. text also has a 200-question multiple-
Formulas and Indications; 5. Formula The recent book, Diagnosis Study Guide choice self-examination with answers,
Index; 6. Fu Zi Research; 7. Index to is a welcome addition to the growing which is a good way to check ones
Symptoms and Ailments; 8. Glossary; 9. number of specialised texts on Chinese level of understanding. An interesting
Weights and Measures – as used in the medical diagnosis. What is especially aspect is that the material has been peer
ancient text; 10. Han Dynasty Time – useful in this new book is the extensive reviewed prior to publication ensuring
the ebb and flow of the six channels; 11. use of flow charts and the numerous the accuracy and clarity of the content.
Heavenly Stems and Earthly Branches; tables that help the student or practitioner While this book has been written for the
12. Chinese Dynasties and their understand the pathomechanisms of student, it also has something to offer
Historical Periods; 13. Notable Figures many symptom/signs and diseases. Also the experienced practitioner, especially
in Chinese Medicine; 14. References; unique to the text is the Questions and some of the responses for the ‘Questions
15. Herb Names – Cross Reference of Answers for Deeper Insight sections and Answers for Deeper Insight’.
Chinese and Pharmaceutical Names and which explain and clarify the theory
16. Bibliography. behind difficult concepts. For example, The layout is clear and the text is
‘How does blood stagnation cause thirst organised in a systematic and logical
This text offers a detailed analysis of without a desire to drink’ or ’Why does manner. The material is ‘chunked’
one of the most important Chinese the body temperature increase between and has been written to distil the basic
herbal clinical manuals. It is the basis for 3 and 5 pm in the yang ming organ concepts and ideas associated with each
treatment for not only acute disease but pattern?’ diagnostic symptom/sign. This text is an
also many chronic diseases currently seen excellent primer before progressing to
in clinics across Australia. The authors The text is divided into four chapters each more complex diagnostic perspectives
have raised the benchmark and have concentrating on one of the four methods such as zangfu bian zheng and students
made the learning of classical Chinese of Chinese medicine (Inspection, should consider this text when first
medicine attainable by anyone who Listening and Smelling, Inquiry and beginning the study of Chinese medicine
studies this book. Palpation). Each sign/symptom is given diagnostics.
a definition, with the pathomechanism
Reviewed by Chris Zaslawski Reviewed by Chris Zaslawski

Australian Journal
38 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
 Upcoming International
Conferences
2009
19–21 June Wellington, New Zealand
New Zealand Register of Acupuncturists Annual Conference
Visit www.acupuncture.org.nz for more information
3–6 September Denmark
2nd Scandinavian TCM Congress
Visit www.tcm-kongres.dk for more information
12–13 September London, United Kingdom
British Conference of Acupuncture and Oriental Medicine
(British Acupuncture Council)
Visit www.acupuncture.org.uk/conference for more information
5–7 November Strasbourg, France
7th World Congress on Acupuncture
(World Federation of ACupuncture-Moxibustion Societies)
Visit www.wfas-2009.org for further information
5–8 November San Diego, USA
Pacific Symposium 2009
Visit www.pacificsymposium.org for more information
5–6 December Melbourne, Australia
6th World Congress of Traditional Medicine
(World Federation of Chinese Medicine Societies)
Visit www.2009wccm.com for further information

2010
26–28 February Chiba, Japan
15th International Congress of Oriental Medicine
(International Society of Oriental Medicine)
Visit http://icom15.umin.jp for more information
21–23 May Adelaide, Australia
Australasian Acupuncture & Chinese Medicine Annual Conference
(AACMA Annual Conference)
Contact AACMA on +61 7 3324 2599 or visit www.acupuncture.org.au
 AJACM
Instructions for Authors

The Australian Journal of Acupuncture and Chinese Medicine

(AJACM) is the official journal of the Australian Acupuncture
Organisation of manuscripts
and Chinese Medicine Association Ltd (AACMA). It is a peer-
reviewed journal published biannually and it has an Editorial GENERAL REQUIREMENTS
Board and an International Advisory Board. The Instructions AJACM endorses the Uniform Requirements for Manuscripts
for Authors are available online from: www.acupuncture.org. Submitted to Biomedical Journals, which is available from
au/ajacm.cfm. www.icmje.org/icmje.pdf.

Aims and scope LENGTH OF MANUSCRIPT

Original research, general articles and reviews should not exceed
AJACM acknowledges the diversity of Chinese medicine 3000 words, excluding abstract and reference list, without the
theories and practice, and encourages the integration of permission of the Editorial Board. Case reports and case series
research, practice and education. It promotes the use of rigorous should not exceed 1500 words. Letters to the Editor and Book
and appropriate research methodologies in the field of Chinese Reviews should not exceed 500 words.
medicine. AJACM publishes original research articles, general
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Authors of randomised, controlled trials (RCTs) are encouraged
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contain Background, Aims, Design, Subjects and Settings,
Authors of systematic reviews are encouraged to consult the Interventions, Outcome Measures, Results, Discussion and
QUORUM statement: Moher D et al. Improving the quality Conclusion. Up to six keywords may be used. Where possible,
of reports of meta-analysis of randomised controlled trials: keywords should use those recommended in the Index Medicus
the QUORUM statement. Lancet 1999;354:1896-1900 Medical Subject Headings (MeSH) list.
(Available from www.thelancet.com).
TEXT
Case reports and case series are to follow the guidelines in Manuscripts of original research or review articles should have
Writing Chinese Medicine Case Reports: Guidlines for the Introduction, Methods, Results, Discussion, Acknowledgments
Australian Journal of Acupuncture and Chinese Medicine and References. Authors of other articles should use appropriate
by P Ferrigno, JD Ryan and JC Deare, available from www. headings. All manuscripts should have a Clinical Commentary
acupuncture.org.au/ajacm.cfm. section, written in plain language for practitioners, describing
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The reporting of acupuncture treatment in clinical trials, case
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Council’s standards on research ethics, available from www.
nhmrc.gov.au/ethics/index.htm, or equivalent standard if
conducted outside Australia.

Australian Journal
40 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
AJACM Instructions for Authors

REFERENCES The Editorial Board will conduct an initial in-house review. The
AJACM adopts the Vancouver referencing system. A summary correspondent author will receive in one month of submission
of which is available from: library.curtin.edu.au/referencing/ an e-mail notifying whether the manuscript:
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managers such as EndNote. review; or
• has not been accepted through the in-house review.
In-text citations should use superscript Arabic numerals in the
appearing order. The use of footnotes is strongly discouraged. For articles sent for peer review, AJACM will notify the
Where there is supplementary comment in relation to a table correspondent author within three months of one of the
or a figure, this should be presented below the table using following four decisions:
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• acceptance with minor changes;
References should be listed according to the order of their • major changes required; or
appearance in the text. Please refer to the following referencing • rejection.
examples.
Authors will be given up to two months to amend the
1. WHO Standard acupuncture point locations in the manuscript. Once the amended manuscript has been accepted
Western Pacific region. Manila: WHO Regional Office for publication, a galley copy will be sent to the correspondent
for the Western Pacific; 2008. author for confirmation prior to publication. The Editorial
Board expects to receive the confirmation within seven days.
2. Cahn A, Carayon P, Hill C, Flamant R. Acupuncture in
gastroscopy. Lancet 1978;28(1):182–3. Twenty copies of reprints will be sent to the correspondent
author after publication.
Abbreviation of journal titles should follow those used in the
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COVER SHEET
Submission of manuscripts All submissions must include a completed cover sheet, which is
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about the manuscript. of all authors. An assignment of copyright form will be e-
mailed to the correspondent author after the final version of the
manuscript has been received and approved for publication.

Australian Journal
of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1 41
 AJACM Instructions for Authors

Terminology and English Pacific; 2007). It is recommended that each manuscript contain
a glossary of Chinese medicine terms used.
Acupuncture points should be named according to both
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Health Organization Western Pacific Regional Office (WHO be accepted as in-text characters. Downloads for using in-text
Standard Acupuncture Point Locations in the Western Pacific Chinese characters in MS Word can be obtained from the
Region. Manila: WHO Regional Office for the Western Microsoft website, www.microsoft.com.
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The language used in AJACM is standard Australian English
Chinese herbs should be named according to both the Pinyin as per the Macquarie Dictionary. Manuscripts will be amended
and the Latin name. AJACM reserves the right to correct accordingly.
Chinese herb names to conform with the Pharmacopoeia
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the People’s Republic of China 2000. English ed. Beijing:
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terminology and English translations should be in accordance Fax: +61 7 3394 2399
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Western Pacific Regional Office (WHO International Standard COORPAROO DC QLD 4151
Terminologies on Traditional Medicine in the Western Pacific AUSTRALIA
Region. Manila: WHO Regional Office for the Western

Australian Journal
42 of Acupuncture and Chinese Medicine 2009 VOLUME 4 ISSUE 1
AACMA Membership

The Australian Acupuncture and Chinese Medicine Association Ltd

(AACMA) is the peak national professional association representing

qualified practitioners of acupuncture and Chinese medicine.

Practitioner Membership
AACMA accredits practitioners in the following TCM modalities:

— acupuncture

— Chinese herbal medicine

— Chinese herbal dispensing

— TCM remedial massage (Tuina), and

— (Western) remedial masage (as adjunctive therapy only)

Student Membership
Membership is free for students enrolled in an accredited Australian

traditional Chinese medicine (TCM) program. Overseas students

may join for $75.00.

Further information
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website (www.acupuncture.org.au) or contact the AACMA national

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 AJACM Call for
Manuscripts

Australian Journal of Acupuncture

and Chinese Medicine

CALL FOR SUBMISSION OF MANUSCRIPTS

The Australian Journal of Acupuncture and Chinese Medicine is the official journal of the Australian
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The primary focus of the Journal is publishing peer-reviewed articles that will enhance quality
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 Publication and Subscription
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