Traditional Chinese Medicine

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Traditional Chinese Medicine

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There are many traditional medical practices. Of particular note are the Chinese, Ayurvedic, and Greek systems of healing. Owing to the limitations of space in this chapter, one traditional system of healing, Chinese medicine, which has influenced so many other systems, is considered.

With more than 10 million people, the Asian and Pacific Islander group represents the third largest minority group in the United States. The Chinese approach to healing is a rich and complex tradition. It emphasizes the importance of promoting balance and harmony in body, mind, and spirit and has become the foundation for many other traditional medical systems. Chinese medicine had its origins more than 2500 years ago and is still in use to treat millions of people in China and throughout the world. As a result, to the traditional Chinese healers, allopathic medicine is new and experimental.

Chinese medicine is based on the idea that the human system is a microcosmic mirror of the macrocosmic universe. This means that no one thing can exist without the existence of the others. Each person is subject to the same laws that govern the stars, the planets, the trees, and the land. Tao, sometimes translated as ''the infinite origin," is the single unified source from which all life and the entire universe originated;it is the way to ultimate reality. To follow the laws of nature is to be blessed with good health, long life, and good fortune. Because nature is the most enduring manifestation of tao, much of the traditional terminology of Chinese medicine is derived from natural phenomena, such as fire and water, wind and heat, and dryness and dampness. When the elements in the human body remain in balance, ''fair weather'' is said to prevail in the body, and the human is well both physically and mentally.

Tao created two opposing forces, yin and yang, which are the opposites that combine to create everything in the world. Yin is a force of darkness and is associated with such qualities as femininity, cold, rest, passivity, emptiness, introverted, and negative energy. Yang is a force of brightness and is associated with masculinity, heat, stimulation, activity, excitement, vigor, fullness, extroverted, and positive energy. Table 4-1 lists the aspects of yin and yang polarity.

There are two main concepts in traditional Chinese medicine. The first is that the occurrence of disease represents a failure in preventive health care. The second is that health is a responsibility shared equally by the patient and clinician. According to a Chinese proverb, ''The superior physician teaches his patients how to stay healthy.'' In traditional Chinese medicine, the clinician treats the patient as a whole system rather than dealing with separate parts, as is common in Western medicine. An important belief is that the mind is engaged to

Table 4-

-1 Aspects of Yin and Yang Polarity

Aspect

Yin

Yang

Cosmic bodies

Earth Moon

Sun

Mentality active

Asleep

Weak

Empty

Deficient

Physically active

Awake

Strong

Full

Excessive Hot

Time of day

Night

Day

Winter

Spring Summer

Magnetic pole

Negative

Hot

Speed

Slow

Fast

Body location

Interior Lower torso Lower extremities Feet

Right side

Back

Exterior

Upper torso Upper extremities Head Left side Front

Gender

Female

Male

Numbers

Even

Odd

Distance

Near

Far

Relative moisture

Very moist, saturated

Dry

Quality of light

Dark

Light

Acid/base

Alkaline

Acid

Speed

Slow

Fast

Metabolism

Anabolism

Catabolism

Introverted

Extroverted

Robust

control and guide energy to heal and repair the body. Chinese medicine is a system of preserving health and curing disease that treats the mind, body, and spirit as a whole.

Whereas the Western clinician starts with a symptom and tries to search for the cause of a specific disease, the traditional Chinese clinician directs his or her attention to the whole patient and forms a ''pattern of disharmony.'' This pattern describes the situation of ''imbalance'' in the patient's body. The traditional Chinese clinician asks not ''Which A is causing B?'' but ''What is the relationship between A and B?'' The patterns of disharmony provide the framework for therapy. In Chinese medicine, a person does not catch the flu; a person develops a disharmony. If a patient requires an antibiotic, herbs or acupuncture may be used to dispel the disharmony. Regardless of the ailment, the mind, body, and spirit must be treated as a whole. Healing is achieved by rebalancing yin and yang and restoring harmony in the whole person.

The traditional Chinese clinician inspects a patient in four stages: looking, listening or smelling, asking, and touching. Inspection of the tongue and palpation of the pulse are the two most important examinations. The tongue is believed to be the clearest indicator of the nature of the disharmony. The Chinese recognize more than 100 different conditions of internal energy imbalance, based on the color and texture of the tongue ''fur.'' The condition of the five major organ-energy systems is evaluated according to their corresponding areas on the tongue. These systems are the kidneys, liver, spleen, lungs, and heart.

In traditional Chinese medicine, pulse diagnosis is evaluated at the radial artery. It is believed that disharmonies of the body leave a specific impression on the pulse. Figure 4-9 depicts an early description, from a scroll, of pulse diagnosis. There are at least 28 specific types of pulse abnormalities. The pulse is evaluated by placing subtle pressure by the three middle fingers on three points on the radial pulse. When the pulse is strong and regular, the person is considered to be in good health. The traditional Chinese clinician can evaluate six organs on each wrist.

The Chinese have used iron balls for health since the Ming Dynasty (1368—1644). The balls, originally solid, today are hollow with a sounding plate inside them. Each pair consists of one that produces a high tone and the other a low tone. The iron balls are believed to enhance the user's health and well-being. By moving the iron balls with the fingers, various acupuncture points on the hand are stimulated, resulting in increased circulation of vital energy and blood to the internal organs. Those who use these balls believe that, with daily use, the brain can be kept in good health with improved memory, fatigue will be relieved, and life will be prolonged.

Another major concept in traditional Chinese medicine is the five element theory, also known as the five phases (wu xing). This theory is an attempt to classify phenomena in terms of five quintessential processes represented by wood, fire, earth, metal, and water. Each phase has

Table 4-2 Somatic Associations of the Five Phases

Wood

Fire

Earth

Metal

Water

Taste

Sour

Bitter

Sweet

Pungent

Salty

Yin organ

Liver

Heart

Spleen

Lungs

Kidney

Yang organ

Gallbladder

Small intestine

Stomach

Colon

Urinary bladder

Orifice

Eyes

Tongue

Mouth

Nose

Ears

Tissue

Tendons

Blood vessels

Flesh

Skin

Bones

qualities and functions that describe the various processes in the body and their interactions with the environment. The phases are as follows:

• Wood: proper and straight;characterizes the liver, gallbladder, anger, sour taste, and windy weather

• Fire: ascending and blooming;characterizes the heart, small intestine, joy, bitter taste, and hot weather

• Earth: solid and quiet;characterizes the spleen, stomach, melancholy, sweet taste, and damp weather

Metal: firm and strong; characterizes the lung, colon, grief, pungent taste, and dry weather

• Water: inward and clear;characterizes the kidney, urinary bladder, fear, salty taste, and cold weather

Traditional Chinese healers use this theory to diagnose and treat illness. Often plotted on a circle, the five phases show a unity in the world and in the body. Many conditions correspond to the five phases. Table 4-2 lists some of the medically relevant associations.

In addition to acupuncture, acupressure and massage are also important aspects of the traditional Chinese healing arts. Acupressure, or dian hsueh, is the forerunner of the Japanese technique called shiatsu. Acupressure is the technique of transferring energy from the therapist's body directly into the patient's system by pressing thumb and hands into the patient's vital areas. Acupressure involves the application of deep pressure to the same points along the channels used in acupuncture. Once a point is located, rotating pressure is applied for 10 to 15 seconds, released, and then repeated as often as the therapist believes necessary. Massage (tui na), in contrast, focuses primarily on the muscle masses, ear, abdomen, foot, and spine. Massage offers the energy of acupuncture, the serenity of meditation, and spiritual refreshment. Tui na stimulates circulation and energy within the body, activates and drains the lymph, tones the muscles, and enhances nerve function.

Tui na therapy is accompanied by cupping, a technique called ba guan, in which glass or bamboo cups containing small amounts of alcohol are applied to the areas of disease and the alcohol is ignited, creating a vacuum inside. The underlying tissue swells up, and the vacuum pressure draws out heat, damp, or wind energies. This technique has been adapted by many other ethnic groups. Figure 4-10 shows the glass cups and a modern suction device for their application.

Chinese herbal therapy encompasses eight methods: sweating, vomiting, purging, harmonizing, warming, removing, supplementing, and reducing. There are 5767 herbal remedies known in traditional Chinese medicine, fewer than 10% of which are commonly used currently. Through clinical experience, Chinese medicine recognizes that each herbal remedy has an affinity for a particular meridian or organ. If an illness is caused by heat, cooling with herbal therapy is used; if caused by a deficiency, drugs that restore are used. In a manual of Chinese herbal remedies, each herb is listed as to the part of the plant used (P), the taste and nature (T&N), the meridian or organ affected (M), the actions (Act), the amount and form of use (A&F), and the cautions and contraindications (C&C). For example*:

• Acorus gramineus (Japanese sweet flag)

• Shichangpu P: Root stalk

*Adapted from Warner and Fan (1996).

Figure 4—10 Ba guan (cupping) devices.

• Act: To open ostia and conduits, to eliminate sputum, to regulate qi, to mobilize blood, to disperse wind, to excrete dampness

• A&F: 3 to 6 g (fresh 9 to 24 g) as decoction, pill, or powder

• C&C: Waning yin with waxing yang, restlessness with diaphoresis, cough, vomiting of blood, spontaneous semen emission

The photograph in Figure 4-11 was taken in a traditional Chinese herbal pharmacy in San Francisco's Chinatown. Note the prescription written in Chinese, which is necessary to purchase these herbal medications. Figure 4-12 shows the modern herbal pharmacy at the China Medical College in Taichung, Taiwan. Figure 4-13 shows an automated prescription for herbal medications.

The use of medicinal herbs is prevalent and growing. The health-care provider must be cognizant of the commonly used herbs and their benefits and limitations. Some herbs can interfere with prescribed medications and with surgery. Bleeding is a common problem. Certain antioxidants may interfere with chemotherapy. The use of medicinal herbs in the West goes back to the days of Paracelsus (1493—1541), who said, ''The dose determines the poison.'' More clinical trials of safety and efficacy of medicinal herbs are needed to help understand the active ingredients and herb actions.

Traditional Chinese Medicine Diagnosis

CAM therapies have long played a key role in health care. Most health-care providers have failed to recognize the magnitude of these forms of healing. Many of the therapies, however, are not based on any sound medical knowledge. Some have been derived from ethnic and folk traditions, semireligious cults, metaphysical movements, and health-care groups who rebel against technology and the perceived impersonality of 21st-century medical care. Unfortunately, marketing terms such as ''miracle cure,'' ''new discovery,'' and ''satisfaction guaranteed'' attract patients looking for cures for diseases for which there are no cures. ''Purify,'' ''detoxify,'' and ''energize'' sound impressive, but they are often used to cover up the lack of scientific proof of efficacy. Finally, clinicians must advise patients that the word natural does not always mean that the therapy is safe, and these products may have druglike effects that may be deleterious to their health and have dangerous interactions with prescribed medications. Therefore, clinicians should look for solid scientific studies. A lack of solid evidence does not always mean these treatments do not work, but it does mean they have not been proven effective.

This chapter has introduced the health-care provider to the richness of several of these CAM therapies. Ideally, the health-care provider is better prepared to deal with patients of diverse backgrounds who use CAM and with the challenges of caring for those patients in U.S. society. The provider must be open-minded with regard to these therapies and able to incorporate alternative and complementary therapies into Western medicine. All health-care providers must become familiar with CAM practices, the efficacies of the various practices, and the potential risks and benefits from their use.

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