Traditional Chinese Medicine (TCM)

A way of understanding integrated medicine

Lecture Outline

• The main theories of TCM
• The main characteristics of clinical practice
• The main characteristics of elderly people from a view of TCM and  WM.

How we treat and prevent the hypertension of the elderly patients by IM in our clinical practice

Abbreviations used in this lecture:

• TCM: Traditional Chinese Medicine;
• WM: Western Medicine;
• IM: Integrated Medicine;
• EH: Essential Hypertension;

Part One:

The way we believe, the main theories of TCM which are mainly based on the Traditional Chinese Philosophy of Taoism

I: Qi theory: About the original substance of the nature and body

According to the Qi theory of TCM, we consider that the Qi of human body comes from the nature, which means that human body is one part of the nature; This is the most fundamental evidence of the holistic theory of TCM.

What is Qi ?

• Qi is a gas-likeenergy which has both substance and function. It is  necessary for transformations and energy exchange between nature and the human body and is our main life force.
• if the energy exchange stops or the function separate from the substance, it means the life circle of the systems stops;

We can not feel the existence of Qi, like…the fish in the aquarium that they might not feel the existence of water;

Qi the so subtile and invisible, therefore, most people might ignore its function and importance to us; Actually, Qi the most important substance we need at every moment, which not only maintains our basic life activities, such as: breathing, heart beating, but also the energy exchange between the nature and the human body;

Because, even our mother earth need to breath also, just human body could not feel it;

The types of Qi inside of our bodies:

• Qing Qi – the fresh Qi from the air;
• Yin Qi – the nutrition Qi from the food and drink;
• Jing Qi – the prenatal essential Qi inherited from our parents;
• Zhuo Qi – the waste Qi after the metabolism of the 3 different kinds of Qi above;

The types of Qi outside of our bodies:

Six normal climate Qi of the nature, such as: Wind, Summer / Heat, Humidity, Dryness, Cold

These six normal climate Qi might become the pathogen that cause the sickness of human bodies, due to the different condition of the human bodies;

Li Qi : epidemic Qi from nature;

Ancient TCM specialists also noticed that there was a very strong and different kind of Qi from the nature could cause many people become sick with same symptoms almost at the same time, and sometimes it was very fatal to the health of human bodies, or sometimes it would disappear very quickly;

Where the Qi circulate inside of our bodies ?

• Blood vessels;
• Channels or meridians;

The Function of Qi:

• circulating inside of the blood vessels, to form the blood, to calm and nourish the body;
• circulating inside of the channels, to warm and protect of the body from the attack of pathogen;
• to push and lead the circulation of the energy flow, blood current, body liquid, excretion of the waste, which maintain the life activities of the body;

The meaning of Qi in TCM:

• every life activity, such as: we not only take in the nutrients from the food, beverage we take everyday, but also the Qi;
• every disease;
• the mechanism of the medical therapies of TCM, such as: using the Qi of herbal medicine to regulate the Qi of the human body; there is also Qi exchange between the Patients and practitioners

Other Approaches to Balance the body

• “Still” Qi-gong (Qi Exercises): breathing, meditation
• “Active” Qi-gong: Tai-ji (Tai-Chi), breathing exercise with movement

Pathological condition of the Qi of human bodies:

• being deficient, such as: a state of malnutrition; chronic overwork or overloading the stress; a fatigue condition (primary or secondary); later period of chronic condition of diseases; rehabilitating state after a serious disease;

• being excessive, such as: Diabetes, high cholesterol, gout condition; acute inflammation/ infections condition;

• slow Qi circulation, such as: the high density of blood current condition for the patients before or after the heart attack, or stroke;

• blocked Qi circulation inside one part of the body, such as: chronic or acute pain of the body; chronic or acute depression of the body;

Type of herbal Qi:

• Warm Qi; to warm/ boost / stimulate the body;
• Cool Qi; to cool down the over-heated / functioning or hypersensitive condition of the body;

Function of herbal Qi:

• Bu Qi : to tonify / promote the Qi of the body;
• Xie Qi: to reduce / inhibit the pathological / abnormal Qi of the body;

II: Yin-yang theory

What is Yin-yang?

The original concept of Yin-yang: Because our earth spins around the sun all the time, and there is always one side of earth is facing to the sun, which forms the day, while the opposite side to the sun forms the night; that is the original concept of Yin-yang, and gradually, people classify the two different properties of the things on the world into two main categories, according their two different characteristics of property;

Yang: Warmth / Heat; Active; Daytime; Bright; Positive; Rapid; Loud

Yin: Cool; Inactive; Night; Dark; Negativ; Slow; Quiet

The meaning of Yin-yang theory:

Yin-yang are two different properties of one same things, while usually the Yang property is equal to the condition of function, while the Yin is similar to the material side of one living organs. Therefore, we can see, we can separate the function from the material, the reversed one does not work either; there is balanced situation

According to Yin-yang theory, the property of the body can be classified into Yin-yang categories, for instance:

1. Physiology: excitement/ rest; contraction/ relaxation (for all muscle tissue) ; inhale/ exhale; in-take/ excretion;
2. Nervous system: sympathetic nerve/ parasympathetic nerve;
3. Immunology: excessive immune reaction/ immunodeficiency;
4. Pathology: injury, inflammation/ rehabilitation;
5. Traditional Pharmacology: based on the above discovery develop and invent the drugs;

Pathological  / unbalanced condition of Yin-yang:

1. Deficiency (one or both);
2. Excess (one or both);
3. the key is: we need to find out which is the primary and which is the secondary;

Herbal examples are good for Yin part of body: American Ginseng

Herbal examples are good for Yin part of body: Ginger; Cinnamon

III: Five Elements theory

It comes from Five geographical theory of Feng-shui, gradually, it develops a unique theory of the relationship of the nature and human body;

Five different geographical location à Five different condition of the Qi from the sun à Five different climates à Five different properties (elements) à Five different characteristics à Five different functions à Five different appearances

In general, this panel, listed below, is the example to show the classic classification of the elements, appearance of the nature and human body:

Five elements: with five different inherent qualities, characteristics, and states of nature and human bodies

• East Spring Wood ( with the characteristics of being able to bent and stretched);
• South Summer Fire ( with the characteristics of heat, flame and flare upward);
• West Autumn Metal (with the characteristics of being able to be melted, purified and harden)
• North Winter Water (with the characteristics of moistening, and moving downward like water)
• Middle  Late Summer Earth (with the characteristics of being able to be loaded, carry, grow and reap)

The relationship of our organic system:

• Generating relationship: Wood generates Fire; Fire generates Earth; Earth generates Metal; Metal generates Water; Water generates Wood;
• Controlling relationship: Wood controls Earth; Fire controls Metal; Earth controls Water; Metal controls Wood; Water controls Fire;
• The relationship of generating and controlling is still based on the theory of Yin-yang;

Part Two:

The way we train and practice of TCM

The main characteristics of clinical practice of TCM

Holistic view: a unique methodology -  Zang Xiang : the image of organ

TCM practitioners believe that the appearance of the body on the surface has a close connection with the internal condition of organ in the deep part of the body; for instance, from the appearance of the lotus, we can tell the quality of the earth of the pond; because, the whole systems of the body is connected by the meridians from the internal to the external;

What is the external appearance of a human body? The appearance of tongue, pulse, hair, nail, excretion, etc can tell the function /condition of the internal organs;

Differential diagnosing methodology: another unique concept of TCM diagnoses -- Zheng Hou (the syndromes of TCM)

The component of Zheng-hou (TCM syndromes):

• Patient’s complaint, symptoms &signs (external)
• Qi, blood and body fluid condition of the human body (internal)
• The pathogen that causes disease (externally or internally)

How IM specialists view the patients

• TCM Consultation;
• Physical examination: such as, feeling the pulse, meridians, reading the images of tongue etc;

Combining with the WM’s approaches, relying on the high technologies, to focusing on the diseases and analyze:

• the etiology
• the state of pathology change
• the laboratory tests
• the conclusion of the diseases ( Diagnosis)
• the management for the diseases;

Therefore, we can read and understand both of body and diseases;

Part Three:

The main characteristics of elderly people from an IM perspective

In general, elderly people’s organic function becomes slow down systematically, physically and mentally.

From a view of TCM, elderly people may have some characteristics such as:

• Reduced function of digestive system;
• Reduced storage of essential substances (Qi, blood etc) inside organic systems;
• Reduced function of self-healing systems;

Part Four:

How we treat hypertension in elderly patients using an IM approach in clinical practice

By WM classic and golden standard, there are:

• Diuretic;
• B-blocker;
• Ca-channel blocker;
• a-receptor blocker;
• Vasodilator;
• ACEI, Angiotensin converting enzyme inhibitor;
• ARB, Angiotensin Ⅱ receptor antagonist;
• The variety of drugs for treating EH indicates that the mechanism for causing the EH is also very broad;

By TCM analyze, EH in elderly people manifests as: Yin deficient condition of Liver and Kidney systems; elevated level of Yang in the liver system;

By the internal medicine of TCM

• For nourishing Yin;
• For depressing Yang;
• For promoting blood circulation;
• For boosting Qi;
• For promoting water circulation;
• For promoting the process of excretion of the body;

With the aim is…

• To balance the function and material;
• To balance the Yin-yang of the body;
• To balance the organic system;
• To help the body to regulate and treat by itself from multiple aspects;

And we can combine with other natural approaches, such as:

• Acupuncture;
• Moxibustion;
• Chinese massage;
• Cupping;

And, combined with a new healthy life of the patient

• Diet;
• Meditation;
• Tai-chi exercises;
• Music;

With the awareness of side effect from:

• Smoke;
• Coffee;
• Alcohol;
• Drugs;
• Overload stress & irregular sleeping pattern;

Therefore, by using these integrated medical care approaches from diagnosis to treatment, the result will be: management of the disease as well as balancing the body and stimulating the self healing process

Part Five:

The main Challenge of IM at the present and future

• Mutual-understanding;
• Different world views with respect to health (holistic vs reductionist);
• No sufficient data base to rely on;
• Lack of facilities / right platform to practice;
• Individual variability – practitioner and patients reaction / responses / acceptance;
• Quality control of herbal material, process technology, and its products (including the herbal medicine);
• Policy, regulation, financial, standardization, administration of IM;
• Equitable access by all patients

Part Six:

Summary

For the health of public, we need more people to join in…to think, to train, to practice, to share…

And, I believe that a Good Medical Care system is an art for helping people to be in the middle. (Being in the middle = being in the balanced situation)

. . .