TRADITIONAL CHINESE MEDICINE AND MODERN MEDICINE --- WHEN EAST MEETS WEST QIONG DI WU, MSc, BSc, LICACU, TCMCI TUNG-CHI TRADITIONAL CHINESE HEALTH CENTRE

TRADITIONAL CHINESE MEDICINE (TCM) Simplified Chinese: 中医学 Traditional Chinese: 中醫學 Pin Yin: zhōng yī xué

TRADITIONAL CHINESE MEDICINE HISTORY OF TRADITIONAL CHINESE MEDICINE

Several Thousand Years TCM Several Thousand Years MODERN MEDICINE Several Hundred Years

Huang-di Nei-jing (Canon of Medicine): Suwen and Lingshu The earlist medical classic in China Compiled between 500 – 300 B.C. Summary of the medical experience and theoretical knowledge including yin-yang, the five elements, zang-fu, meridians (channels and collaterals), qi (vital energy) and blood, etiology, pathology, dignostic methods, differentiation of syndromes, As well as basic knowledge of acupuncture points and needling methods

TRADITIONAL CHINESE MEDICINE PRACTICES OF TRADITIONAL CHINESE MEDICINE

MODERN MEDICINE Internal Medicine Surgery Immunotherapy Radiotherapy Chemotherapy

1. Chinese Herbal Medicine 中药 2. Acupuncture and Moxibustion 針灸 Cupping Gua Sha 刮痧 3. Chinese Massage – Tui Na 推拿 Die-da or Tieh Ta – 跌打

TRADITIONAL CHINESE MEDICINE THE BASIC THEORIES OF TRADITIONAL CHINESE MEDICINE

MODERN MEDICINE Anatomy Biology Physiology Biochemistry Immunology Microbiology Genetics Pathology Radiology

Yin-Yang Theory The Five Elements Zang-Fu Therory Meridians (Channels and Collaterals) Qi, Blood, and Body Fluid

THE THEORIES OF YIN-YANG AND FIVE ELEMENTS The theories of yin-yang and the five elements were two kinds of outlook on nature in ancient China Chinese ancient physicians applied these two theories in traditional Chinese medicine, which have guided clinical practice up to the present

YIN-YANG THEORY The theory yin-yang holds that the every subject or phenomenon in the universe consists of two opposite sepects, namely, yin and yang Yin Female Foot Abdomen Internal Zang organs Substances Xu (deficiency) Yang Male Head Back External Fu organs Functions Shi (excess)

THE FIVE ELEMENTS Wood Liver Fire Heart Water Kidney Metal Lung Earth Inter-promoting Metal Lung Earth Spleen Inter-acting

(CHANNELS AND COLLATERALS) MERIDIANS (CHANNELS AND COLLATERALS) The body's vital energy, qi, circulates through the body along specific interconnected channels called Meridians (Jing-luo 经络) There are 12 regular channels and 8 extra channels, which connect 400 acupuncture points

The twelve regular channels Hand or foot Yin or yang A zang or a fu organ The spleen channel of foot-taiyin The small intestine channel of hand-taiyang

ZANG FU THEORY Six zang organs: heart, liver, spleen, lung, kidney, and pericardium To manufacture and store essential substances including vital essence, qi (vital energy), blood, and body fluid Six fu organs: small intestine, gall bladder, stomach, large intestine, urinary bladder, and sanjiao To receive and digest food, absorb nutrient substances, transmit and excrete wastes

ZANG FU THEORY Each zang organ is linked with a fu organ by a channel, a situation known as external-internal relation Heart - Small intestine Liver - Gall bladder Spleen - Stomach Lung - Large intestine Kidney – Urinary bladder Pericardium - Sanjiao

ZANG FU THEORY Each zang organ opens into a sense organ, indicating a close structural or physiological and pathological relationship between the internal organs and the sense organs Heart – Tongue Liver – Eye Spleen – Mouth Lung – Nose Kidney - Ear

THE ZANG ORGANS Heart Controlling blood and vessels (blood circulation and nourishment of the whole body) Housing mind (governing mental activities, i.e. spirit, consciousness, thinking, and sleep) Opening into the tongue: the tongue is the mirror of the heart (colour, form, motility, and sense of taste of the tongue)

Liver Storing blood (regulating the volume of circulating blood) Maintaining patency for the flow of qi (promoting functional activities of the human body including all other zang-fu organs, and regulating emotional activities, especially depression and anger) Controlling the tendons (the yin and blood of the liver nourish the tendons) Opening into the eye

Spleen Governing transportation and transformation (digestion, absorption, and transmission of essential substances, and normal functioning of the spleen is required for good appetite) Controlling blood (keeping blood circulating inside the vessels and preventing it from extravasation) Dominating the muscles (maintaining muscle thickness and strength) Opening into the mouth

Lung Dminating qi (air) and controlling respiration (inhaling clean qi to supply the body’s functions and exhaling waste qi) Regulating water passages (promoting water metabolism by turning one part of the body fluid into sweat to be excreted, also sending other part of the body fluid down to the kidney to be excreted as urine) Dominating the skin and hair (regulating the opening and closing of the pores on the entire body surface) Opening into the nose

Kidney Storing essence and dominating reproduction, growth and development (essence in the kidney - the yin of the kidney, either inherited from the parents or acquired from the essential substances of food) Producing marrow, dominating the bones, and manufacturing blood Dominating water metablism (one part of the bod fluid sent down by lung is divided by the yang function of the kidney into clear and turbid parts) Opening into the ear

QI, BLOOD AND BODY FLUID Qi, blood, and body fluid are fundamental substances in the human body to sustain normal vital activities Qi, blood, and body fluid, together with the zang-fu organs and the meridians (channels and collaterals), constitute the theoretical basis of human physiology in traditional Chinese medicine

Qi Qi is involved in physiology, pathology, and clinical treatment Qi implies both substances and function: clean qi, waste qi, and qi from essence of food are material qi the qi of the zang organs, and the qi of meridians are functional qi Source qi (yuang-qi) – the qi of the kidney Essential qi (zong-qi) – nourishing the heart and lung Defensive qi (wei-qi) – defending the body against exogenous etiological factors

Blood Blood is constituted of nutrient qi, body fluid, and essence of the kidney, and its formation requires the co-ordination of the zang organs including spleen, kidney, heart, and lung Blood and qi are closely related. Clinically, xu (deficiency) of qi often leads to xu (deficiency) of blood, and xu (deficiency) of blood, in turn, often results in xu (deficiency) of qi

TRADITIONAL CHINESE MEDICINE THE ETIOLOGY OF TRADITIONAL CHINESE MEDICINE

ETIOLOGY Six Exogenous Factors Seven Emotional Factors Wind, Cold, Summer heat, Damp, Dryness, and Heat (fire, mild heat) Seven Emotional Factors Joy, Anger, Melancholy, Meditation, Grief, Fear, and Fright

TRADITIONAL CHINESE MEDICINE THE DIAGNOSIS OF TRADITIONAL CHINESE MEDICINE

Standard Laboratory Tests MODERN MEDICINE Physical Examination Standard Laboratory Tests Special Examinations

METHODS OF DIAGNOSIS Inspection (wàng 望) Smelling (wén 聞) Inquiring (wèn 問) Palpation (qiè 切)

Observation of the tongue Tongue proper Pale - xu in qi and blood, or cold syndrome due to weaknee of yang qi Red - heat syndrome of either shi (excess) or xu due to consumption of yin Deep red - xu due to exhausted yin Purplish – stagnation of qi and blood Flabby – larger than normal and whitish, xu in bth qi and yang Crached – xu of yin and loss of the essnce of the kidney

Tongue coating (thin or thick, sticky or dry) White – thick white coating indicates retention of food (xu in spleen), white sticky coating invasion of cold damp Yellow – yellow sticky coating indicates accumulation of damp-heat in the interior; dry yellow coating indicates accumulation of heat (damage to the yin) Peeled (geographic tongue) – long illness and gross xu (deficiency) in the yin

Observation of the tongue proper is to differentiate xu (deficiency) or shi (excess) state of the zang-fu organs, qi, blood, and body fluid Whereas observation of the tongue coating is to judge the condition of pathogenic factors

PALPATION - RADIAL ARTERY PULSE

Abnormal pulse Superficial pulse Deep pulse Slow pulse Rapid pulse Pulse of the xu (deficiency) type Pulse of the shi (excess) type Wiry pulse Rolling pulse Thready pulse Short pulse Knotted pulse Intermittent pulse Long clinical experience is required to correctly identify the different types of pulse

DIFFERENTIATION OF SYNDROMES BY TRADITIONAL CHINESE MEDICINE

MODERN MEDICINE According to the causes According to the systems or organs involved According to the degrees or the properties of the diseases

DIFFERENTIATION OF SYNDROMES Traditional Chinese Medicine differentiates syndromes systematically in three ways According to the eight principles According to the theory of zang-fu According to the theory of meridians (channels and collaterals) Each of these three lays stress on a particular aspect, at the same time connecting with and supplementing one another

EIGHT PRINCIPLES Exterior vs Interior – the depth of the disease Cold vs Heat – nature of the disease Xu (deficiency) vs Shi (Excess) – the opposing force in the struggle between the anti-pathogenic and the pathogenic factors Yin vs Yang – the categories of the disease

Exterior vs Interior – the depth of the disease Exterior syndromes are mild and superficial Interior syndromes are mostly severe and deep, with damage of the zang-fu organs

Cold vs Heat – nature of the disease Diseases caused by pathogenic cold and damp are mostly cold syndromes Diseases caused by heat, summer heat and dryness are mostly heat syndromes

Xu (deficiency) vs Shi (excess) – the opposing force in the struggle between the anti-pathogenic and the pathogenic factors Syndromes of xu type indicate function of the body is weak, the anti-pathogenic factor is insufficient and the co-ordination of yin and yang is impaired Treatment – reinforcing (bu) Syndromes of shi type indicate body function is not to the point of impairment and the anti-pathogenic factor is still sufficient Treatment – reducing (xie)

Yin vs Yang – the categories of the disease Yin and Yang are the chief principles among eight Yin category – interior syndromes, cold syndromes and syndromes of the xu (deficiency) type Yang category – exterior syndromes, heat syndromes and syndromes of the shi (excess) type

THE THEORY OF ZANG FU To identify visceral diseases: Syndromes of the heart, liver, spleen, lung, kidney, and pericardium Syndromes of the small intestine, gall bladder, stomach, large intestine, and urinary bladder

THE THEORY OF MERIDIANS (CHANNELS AND COLLATERLS) Differentiation of diseases on the basis of the physiology of meridians gives direct guidance to clinical therapy by acupuncture and moxibustion

PRINCIPLES OF TREATMENT BY TRADITIONAL CHINESE MEDICINE

TCM Treats Humans MODERN MEDICINE Treats Diseases

The human body is endowed with the ability to resist the invasion of different pathogenic factors. This ability is called anti-pathogenic qi (factor) Traditional Chinese medicine attaches the great importance to the anti-pathogenic factor For example, well-balanced human bodies can resist most everyday bacteria and viruses, which are ubiquitous and quickly changing. Infection, while having a proximal cause of a microorganism, would have an underlying cause of an imbalance of some kind. The traditional Chinese medicine would target the imbalance, not the infectious microorganism

Equilibrium of yin and yang - Healthy Preponderance of yin consumes yang (Cold syndrome of the shi type) Preponderance of yang consumes yin (Heat syndrome of the shi type) Weakness of yang causes preponderance of yin (Cold syndrome of the xu type) Weakness of yin causes preponderance of yang (Heat syndrome of the xu type)