صفحه 1:
صفحه 2:
Essentials of
Chinese Medicine
Robert Hayden, M.S.O.M.
صفحه 3:
Class 1
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Introduction
Chinese Medicine - What is it?
Chinese Medicine history overview
Chinese Medicine in the West
Chinese Medicine & Biomedicine
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صفحه 4:
Chinese Medicine
* Therapeutic system founded in
China
* Continuous history from circa 300
BCE to present
* Often abbreviated TCM - “Traditional
Chinese Medicine”, though
widespread throughout East Asia
صفحه 5:
Therapeutic Methods
* Acupuncture and Moxibustion -
Stimulation of superficial body
tissues with needles and heat;
includes accessory techniques such
as cupping and scraping
صفحه 6:
* Chinese Herbal Medicine - Internal
and external application of complex
formulations of botanical, zoological
and mineral origin
* Dietary therapy - Medicated and
non-medicated diet
صفحه 7:
+ Manual therapy (Tui Na) - Massage
and manipulation of soft tissues and
bones
* Qi Gong - Encompasses meditation,
breathing, exercise, as well as
emission of healing energy
صفحه 8:
Historical.
Development
+ Literary and non-literary (oral)
transmission
+ Literary transmission dates back to
circa 300 BCE -- Mawangdui
manuscripts
* Early stone needles (Bian) date to
prehistory
صفحه 9:
Huang Di Nel Jing
* a.k.a Yellow Emperor's Classic of
Internal Medicine
* compiled circa 100 BCE
* Foundation classic of TCM and most
other forms of AOM.
صفحه 10:
Huang Di Nel Jing
* Two books exist:
* 1) Huang Di Nei Jing Su Wen
(Basic Questions, Simple
Questions)
* 2) Huang Di Nei Jing Ling Shu
(Divine Pivot, Spiritual Axis)
صفحه 11:
* Su Wen is primarily concerned with
theory where Ling Shu is specifically
concerned with acupuncture.
* The language in both is archaic,
cryptic and often difficult to
understand.
٠ All OM based on Yin-Yang & Five-
phase theory may be considered to
stem from differing interpretations
of the Nei Jing .
صفحه 12:
Historical Background:
Chinese Dynasties
۱ * commentary from Birch and Felt,
1996
صفحه 13:
* -1523 to -1027: Shang
* Chinese bronze age.
+ “Demonological beliefs and
ancestral propitiation indicate that
a medicine distinct from religion
has yet to develop”
صفحه 14:
* -1027 to -772: early Zhou
+ Agriculture and feudalism.
+ “Wu shamen lead a ritual-based
religious system in which medicine
is rooted in magical and
demonological beliefs”
صفحه 15:
* - 772 to -480: middle Zhou
* Recorded history begins,
Confucianism arises
* “Medicine, although dominated by
magical correspondences and
demonology, begins to develop as a
distinct activity”
صفحه 16:
* - 480 to -221: late Zhou
* a.k.a. Warring States period.
* “Chinese culture descends into a
chaos of warring principalities.
Daoism arises and the five phases
emerge as medicine begins to
develop as an institution”
صفحه 17:
-221 to -206: Qin
China unified
“Book burning”
Autocratic rule creates an empire
that establishes and consolidates
social and cultural institutions by
creating a governmental
bureaucracy
صفحه 18:
-206 to 220: Han
Period of systematization.
“Medicine of systematic
correspondence dominates
acupuncture through seminal texts
such as the Nei Jing and Nan Jing.
Shang Han Lun is also written in
this era, its incorporation of
naturally occurring drugs into the
medicine of systematic
correspondence fails to find
followers”
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صفحه 19:
220 to 589: 6 Dynasties, time of
disunity
Buddhism rises; “medicine of
systematic correspondence becomes
more formal and a technical literature
develops”
Systematic Classic is written
590 to 617: Sui, a period of
reunification.
Chinese culture, including
acupuncture, spreads throughout Asia
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صفحه 20:
* 618 to 906: Tang
٠ Chinese medical ideas are diffused
and absorbed throughout Asia
* “Chinese developments are
dominated by the search for
alchemical immortality during a
period of immense wealth and
cultural fecundity”
صفحه 21:
907 to 960: Five Dynasties, a period
of disunity.
960 to 1264: Song
Period of neo-Confucianism.
“Medicine of systematic
correspondence predominates.
Traditional medicine as drug
therapy is incorporated into the qi
paradigm”
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صفحه 22:
1264 to 1368: Yuan
Mongols control China.
European influences begin to take
hold.
First independent medical college
established
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صفحه 23:
* 1368 to 1643: Ming
* Period of restoration.
+ “Democratization of the Confucian
bureaucracy leads to an information
explosion, greater heterogeneity,
individualism. The extremely
influential Zhen Jiu Da Cheng and
Ben Cao Gang Mu are written”
صفحه 24:
* 1644 to 1911: Qing
* The end of the empire.
* “The decline of traditional medicine
becomes severe as the Chinese
people lose faith in their traditions.
Acupuncture largely lost.”
صفحه 25:
1950s: Revolutionary China
Chinese traditional medicines
received support from Mao.
“TCM”: Political committees
scientize/standardize traditional
medicine to serve China's vast
primary-care needs.
The major traditional medical
schools were established.
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صفحه 26:
* 1950s: Acupuncture and
moxibustion developed in France,
Germany, Austria, and other
European countries; France limited
the practice of acupuncture to
physicians
٠ Acupuncture exported to the USSR
and other Eastern bloc countries.
صفحه 27:
+ 1958-1959 The 'Great Leap
Forward' in China; traditional and
modern medicine began to be
integrated
1960 Acupuncture integrated
into the health-care system in
Vietnam
1960s Acupuncture started to be
promulgated in the UK through the
works of Mann, Worsley, and others
1
صفحه 28:
* 1969: Barefoot Doctor program in
China
* 1971: James Reston wrote about his
postsurgical acupuncture
experiences; acupuncture made
headlines in the West
* 1972: American President Richard
Nixon visited China. Interest in
acupuncture begins to develop in
the USA and worldwide.
صفحه 29:
* 1978: WHO begins advocating the
use of traditional medicines,
including the promotion of
acupuncture.
* 1980: Chinese Government strongly
promoting integration of TCM and
Western medicine
صفحه 30:
* Early 1980s: Texts on acupuncture
by Western practitioners who
studied in China are published in
English. TCM introduced into the
USA and UK.
* Late 1980s - 1990s: TCM continues
to expand in the USA; other
systems such as Japanese and
Korean acupuncture become better
known in the West
صفحه 31:
Chinese Medicine and
Western Medicine
صفحه 32:
Chinese medicine is now
international.
Kaptchuk: "Many Westerners have
strange notions about Chinese
medicine":
Voodoo
Placebo effect
More " true " than Western medicine
صفحه 33:
* Chinese medicine is a coherent and
independent system of thought and
practice that has been developed
over two millennia.
* Result of a continuous process of
critical thinking, as well as
extensive clinical observation and
testing.
صفحه 34:
* Developed its own perception of
health and illness.
* Chinese medicine considers
important certain aspects of the
human body and personality that
are not significant to Western
medicine.
صفحه 35:
Western medicine observes and can
describe aspects of the human body
that are not perceptible to Chinese
medicine, for example:
nervous system
endocrine system
microbial causes of disease
صفحه 36:
* Chinese medicine uses terminology
that is strange to the Western ear:
+ “Dampness”, “Heat”, or “Wind” are
causes of disease.
* Terms (such as organ names) may
have distinct meanings from
anatomical correlates: Liver,
Spleen, Blood
صفحه 37:
* Logical structure underlying the
methodology differs radically.
* Biomedicine (Western medicine) is
primarily concerned with isolable
disease categories or agents of
disease , which it tries to change,
control, or destroy.
صفحه 38:
« The Western physician starts with a
symptom , then searches for the
underlying mechanism - a precise
cause for a specific disease.
* The Chinese doctor looks for
patterns of disharmony rather than
specific disease agent.
صفحه 39:
+ Patterns of disharmony (Zheng) are
basis for treatment in TCM.
+ Different from diseases because
they cannot be isolated from the
patient in whom they occur.
+ “Many diseases, one pattern; Many
patterns, one disease”
صفحه 40:
“To Western medicine,
understanding an illness means
uncovering a distinct entity that is
separate from the patient 's being ;
to Chinese medicine ,
understanding means perceiving
the relationships among all the
patient 's signs and symptoms in
the context of his or her life.”
صفحه 41:
* The Chinese method is based on
the idea that no single part can be
understood except in its relation to
the whole.
* A discrete symptom is not traced
back to a cause, but is looked at as
a part of a totality.
صفحه 42:
٠ “Ifa person has a complaint or
symptom, Chinese medicine wants
to know how the symptom fits into
the patient's entire being and
behavior. Illness is situated in the
context of a person's life and
biography... The Chinese system is
not less logical than the Western ,
just less analytical .”
صفحه 43:
* Idea of causation, central to
Western thinking, is almost entirely
absent in Chinese thought.
+ “Men do not think they know a
thing till they have grasped the
‘why’ of it (which is to grasp its
primary cause).” -Aristotle
صفحه 44:
* For the Chinese, phenomena occur
independently of an external act of
creation; no need to search for a
cause .
صفحه 45:
* “Tao produced the One. The One
produced the two. The two
produced the three. And the three
produced the ten thousand things.
The ten thousand things carry the
Yin and embrace the Yang and
through the blending of the Qi they
achieve harmony.” - Dao De Jing 42
صفحه 46:
٠ “The way to Heaven is to take no
action . Therefore in the spring it
does not act to start life , in
summer it does not act to help grow
, in autumn it does not act to bring
maturity , and in winter it does not
act to store up .
صفحه 47:
* When the ... Yang comes forth
itself , things naturally come to life
and grow . When the ... Yin arises of
itself , things naturally mature and
are stored up .... Originally no result
is sought , and yet results are
achieved ... Since Heaven takes no
action , it does not speak .
صفحه 48:
* Since Heaven takes no action , it
does not speak . When the time
comes for calamities and strange
transformations , the [ Qi ] produces
them spontaneously .... When there
is [ Cold ] in the Stomach , it aches .
It is not that man causes it .
Rather , the [ Qi ] does it
spontaneously ....” - Wang Cong
صفحه 49:
* “Conceptions are not subsumed
under one another but placed side
by side in a pattern , and things
influence one another not by acts of
mechanical causation, but by a kind
of 'inductance.'... The key-word in
Chinese thought is Order and above
all Pattern...
صفحه 50:
* Things behave in particular ways
not necessarily because of prior
actions or impulsions of other
things, but because their position in
the ever-moving cyclical universe
was such that they were endowed
with intrinsic natures which made
that behavior inevitable for them.” -
Joseph Needham, Science and
Civilization in China
صفحه 51:
* What does Chinese medicine have
to offer the West?
٠ Does a medicine based on an
alternate description of the
universe really work?
+ Advantages and Disadvantages to
Both Systems
صفحه 52:
* Because TCM is based on Patterns
rather than diseases, it is by nature
better suited to treating holistically:
* "..all too often biomedicine is... not
concerned with general well-being
because it can only assess very
small, discrete bits of information."
صفحه 53:
* "Much that is human and medically
effective may have been lost or
remains to be discovered because
modern health care too often avoids
seeing... self conscious human
beings with feelings, intentions, and
self-created meaning."
صفحه 54:
* Biomed at its best when disease
agent can be isolated and
destroyed: tumors, microbes
* Complex syndromes still poorly
understood and no suitable therapy
exists
صفحه 55:
* Biomed has very little concept of
mind-body integration
* Psycho-neuro-immunology (PNI) still
in its infancy and not widely
accepted
٠ TCM posits emotions as primary
cause of illness
صفحه 56:
* Biomed has no developed concept
of Yang Sheng (Nourishing Life)
+ Nutrition only recently gained wide
acceptance among MDs
+ Little notion of "Terrain" -- where
TCM can anticipate diseases before
they arise
صفحه 57:
* Risk/benefit ratio often very poor:
* "Our medicine parallels our society.
New cures often produce side
effects of unexpected virulence"
* TCM intervention usually safer
though weaker
صفحه 58:
* TCM Patterns have patient-specific
dose-adjustment built in
* Chinese Herbal medicine based on
polypharmacy; side effects are
anticipated and controlled by
composition of formula
صفحه 59:
* TCM has clear *disadvantages* as
well
+ Holistic emphasis makes TCM less
precise
* TCM weak on specific prognosis;
because disease is de-emphasized
in favor of patterns, natural history
of diseases poorly understood
صفحه 60:
* TCM at a disadvantage in acute or
life-threatening situations
* Often there is a window of
opportunity outside of which TCM is
ineffective and Biomed MUST be
used
* Recovery from illness: TCM once
again advantageous where Biomed
has no strategy for restoration of
health
1
صفحه 61:
* Biomed increasingly based on
expensive technology
+ TCM relatively inexpensive, “Low
Tech
+ Problems arise from
internationalizing TCM , particularly
in Herbal Medicine
صفحه 62:
* Scientific method has no respect for
tradition; methods quickly become
outdated and their merits may not
be preserved
* Leeches are back!
صفحه 63:
Increasing integration of the two
systems
Evidence-Based Medicine (EBM) is
ever-increasing influence in TCM
RCT has changed the game:
"Biomedicine reconceptualized
legitimate healing as 'a cause and
effect relationship between a specific
agent between a specific agent or
treatment and a specific biological
result'."
۰
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صفحه 64:
* Current debate in Western TCM
community over increasing science
curriculum and professional
standing