Timing in Efficacy of Traditional Chinese Medicine and Acupuncture

Increasing scientific research on traditional Chinese medicine and acupuncture provides science-based explanations like deqi. However, most of the research focuses on diseases instead of following TCM and acupuncture theories about pattern identification. Timing is closely connected with therapeutic effects and surely plays a key role in the clinical efficacy that is often ignored. On the other hand, whether or not timing-related efficacy can be influenced with age, gender, and the processing of materia medica in Chinese herbs and acupuncture needs more attention and research.


Introduction
Both Traditional Chinese medicine (hereinafter TCM) and acupuncture originated in ancient China and has evolved for more than two thousand years. However, most of the people generally present themselves to the medical doctors first when they are in need of medical treatments. Part of this fact is because there is not sufficient scientific evidence to prove the efficacy and safety of TCM, acupuncture, moxibustion, acupressure, cupping, Tui na, and tai chi. TCM and acupuncture have undoubtedly established their status in the health system in the West, though they're totally different from the Western medicine with the philosophy, diagnosis approaches, and pattern identification for treatment. The literature shows TCM, which is developed on the base of observation of nature and is at present an essential part of the healthcare system in most Asian countries and areas like Taiwan, China, Hong Kong, and Korea, mostly relies on natural products and has been playing an important role with acupuncture in health protection and disease control for thousands of years. In addition to acupuncture, TCM therapeutic efficacy usually attributes to the synergistic property of multiple herbs and constituents with timing that has advocated combinatorial therapeutic strategies called formulas for the improvement of efficacy through targeting on syndromes and patient characteristics guided by the TCM theory.
Except Single Ginseng Decoction (Du Shen Tang) composed of only Ginseng, all the formulas are designed and developed to contain a combination of various kinds of herbs with the assumption that the maximum of therapeutic efficacy can be expected with a synergism of all ingredients. Integration of TCM and acupuncture and Western medicine draw more and more attention, but increasing attention has not been paid to the issue of timing, which is the key without doubt to successful treatment. In this study, discussions about the relation between efficacy and timing are provided.

Quick Look at Timing-Related Examples
The philosophical concepts like Yin-Yang, the Five Element, pattern identification, and Qi and Blood are, to some extents, unique and abstract to catch the whole picture with the functions broader than the anatomical knowledge in the Western medicine and are absolutely different from the theories of the Western medicine. In terms of relation of the human beings and the Heaven that interacts with each other in providing solutions to the health issues, it is totally different from the Western medicine that TCM views the human body as a whole and as a microcosm of the universe in diagnosis and treatment, bringing the body, mind and spirit into harmony with Yin-Yang balance [1]. Yin-Yang, the earliest concept presented in the I Ching (Book of Changes) in 700 BC, is one of the most fundamental concepts in TCM and acupuncture.

Timing in Efficacy of Traditional Chinese Medicine and Acupuncture
Tong Zheng Hong*

As-You-Wish Healthcare Institute, Taiwan
with the definitions that Zang organs are classified as Yin, and Fu organs, Yang [2]. In the meantime, this concept of Yin-Yang balance also serves as the foundation and the guidelines for the etiology of diseases, diagnosis, and treatments [3]. 24 hours a day from the aspect of TCM is divided philosophically into Yin (night) and Yang (day), as shown in Figure 1. On the base of this concept, a disease thus represents the loss of the balance of Yin-Yang. In general, all the physiological processes, signs, and symptoms can be reduced to Yin-Yang that can be treated with modality aimed at: shows that the blood uric acid level after acupuncture significantly decreased in patients with increased production (overproduction) of uric acid, decreased excretion (underexcretion) of uric acid, and mixed type [7]. In terms of efficacy, acupuncture stimulation with correct manipulations can elicit deqi, which is suggested to be the main mechanism to produce effects of acupuncture with the releasing spinal and supraspinal beta-endorphins, proinflammatory neuropeptides, and an increase in peripheral circulation [8].
Another point attracting attention is the time to retain the needles for 30 minutes. Classical Chinese philosophy has it that Qi is the groups [13]. The two studies presented above seem to suggest the longer needle retaining, the better result to patients with ischemic stroke and with post-stroke hemiplegia. Unfortunately, TCM pattern identification, which is the unique concept that distinguishes TCM and acupuncture from the Western medicine and seen as the guideline for diagnosis and treatment, was not discussed and whether or not the results can apply to hemorrhage stroke, other diseases, or even different patterns in TCM deserves more research.
With the cases about Chinese herbs discussed above, processing methods of herbs cannot apply to granules mostly used in the West.
In other words, this may be the key to unsuccessful treatments and suggest that the use of crude herbs needs more research and deserves much attention [14].