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Hong Hai 黄海
Nanyang Technological University 南洋理工大学
BIT 3rd Global Health Conference – 2015
Kaohsiung, Taiwan
27th November, 2015
Traditional Chinese Medicine in Preventative
Healthcare
Objections to TCM
Entities like qi and meridians are ill-defined. Response: They are conceptual constructs to
facilitate diagnostic and therapy models
“Organs” like spleen and kidney are different from those in modern physiology.
These are clusters of functions
Models like Yin-Yang and the Five Elements have no basis in laws of nature, unlike physics.
True. They are heuristic
It is not “evidence-based”. Most interventions not subjected to randomized
controlled trials (RCTs). Fair comment.
Should a therapeutic method be used when evidence is still lacking by EBM
standards? (Personal choice)
“Last great problem” in biomedicine
“Medicine’s post-war success, built on discovery of drugs and technological
innovation, concealed the fact that its impressive achievements had been
without the necessity to understand the nature of causation of disease.”
“ The future prospect of medical advance is predicated on confronting the
central, unanswered but most potent of all questions, the biological cause of
diseases… indeed the vast majority of the conditions in the medical
textbooks.”
James Le Fanu. The Rise and Fall of Modern Medicine (2012)
(Le Fanu lists rheumatoid arthritis, multiple sclerosis, shcizophrenia and most
forms of cancer as among those with unknown causes.)
“Diseases of civilization” Stephen Ilardi, MD
4
1. “Radical environmental mutation” Depression, atherosclerosis, asthma,
diabetes and cancers are results of modern lifestyles following the industrial revolution
2. Evolution Interrupted: Man changed from hunter-gatherers to desk-workers
for which he is genetically unadapted. Brain’s “runaway stress response” (minutes)
replaced by prolonged stress, processed foods and lack of exercise/social interaction.
3. Proliferation of anti-depressants, statins, hormonal therapies and antibiotics
replaces the body’s self-healing with interventions whose impact on human physiology
are not fully understood. Clinical trial: Walking half an hour 3 times a day beats Zoloft.
4. Solution : Return to old lifestyles. TCM Yangsheng 养生 (Life cultivation) points in the same direction:
Regularity , moderation, balance, qigong exercises, tranquility of mind
Role of TCM in modern society
Yangsheng for cultivating good health and preventing illness esp. aged
Complementarity to Western interventions in selective areas, e.g, stroke patients using
acupuncture and mild tonics; cancer patients with weakened immune systems
Common complaints like gastritis, irritable bowel syndrome, chronic cough, menstrual
problems (after more serious underlying conditions have been excluded.)
Diet: Follow modern guidelines on healthy diet but within that diet it is possible to
choose foods and herb supplements that fits one’s constitution
More research needed on safety and efficacy of TCM practices, and better understanding
of TCM by Western physicians whose patients also use TCM
New Dietary Guidelines
1. Lifted caps on dietary cholesterol: “no appreciable relationship” between dietary cholesterol and blood cholesterol. No need to avoid egg yolks, liver and shellfish.
2. Cutting fat and cholesterol may have even worsened our health. More grains, pasta and starchy vegetables for 50 years, cutting fat intake by 25 percent and increased carbohydrates by more than 30 percent.
3. A high-carbohydrate diet rich in sugar and refined grains increases the risk of obesity, diabetes and heart disease — much more so than a diet high in fat and cholesterol.
Nutritionist Dr Mercola recommends 50% or more of the diet to consist of “healthy fats” argues that “A high-fat low-carb diet can be effective for weight loss. A certain amount of saturated fats are essential for cellular and hormonal function, but also provide a concentrated source of energy.” http://articles.mercola.com/sites/articles/archive/2015/06/15/2015-dietary-
guidelines.aspx
6
Combining Chinese and Western diets
West: Limit carbohydrate intake, avoid high glycemic-index carbohydrates and trans
fats, and use moderate the amounts of saturated and unsaturated fats. Eat more
vegetables especially those rich in fibre.
Chinese: Tailor diet (including tonic foods and herbs) to constitution, environmental
conditions and daily activities.
Best of both worlds
A diet that integrates the best of Chinese and Western diets may consist of something akin
to a Mediterranean diet within which the choice of grains, meats, fruits and vegetables are
appropriate to the individual’s constitution and physical environment, supplemented with
tonic herbs
Chronic illnesses in the middle-aged
and elderly
Common Conditions
Cardiovascular diseases
Gastro-intestinal disorders
Arthritis and joint pains
Metabolic syndrome and diabetes
Insomnia
Dementia and Depression
Cancers
TCM
The conditions expressed in Western terms usually have no exact equivalents in TCM
Role of TCM – alternative/complementary
Acute and emergency situations often not suited to TCM treatment
Yangsheng and treating diseases that have
not yet occurred 治未病
9
Sub-clinical illness (yajiankang 亚健康) No clinical indications of disease, but the
person does not feel totally well. 80% of people are in this category (WHO). TCM
regards the person as being unwell, having one or more syndromes
Yangsheng addresses this issue at two levels:
Avoid developing syndromes (e.g. avoid developing deficiency of yin in hot sweaty
weather)
If already at sub-clinical illness level, prevent the syndrome from developing into a
clinical disease (e.g. prevent endogenous wind, arising from stress, from developing
into hypertension)
The physiology of ageing
Biomedical view TCM view
10
Cardiac output declines; elasticity of lung
decreases
Metabolic syndrome develops ; fluid and
electrolyte homeostasis affected
Vision and hearing neurological decline
Inflammation, the body’s defense against
invaders such as bad bacteria, viruses, and
toxins, involves oxidative stress (a biological
“rusting” of our tissues and organs)
Inflammation can disrupt the immune system,
cause accelerated ageing and lead to chronic
illnesses
Decline of the five zang organs 五脏日虚
Difficulty in transforming food into
nutrients 易生积滞 (spleen-stomach weakness)
Vulnerable to attack by external pathogens
易感外邪 (defensive qi declines)
Tendency to have emotional upsets 易伤七情, and developing depression
TCM Health preservation
At middle age For the elderly
11
1. Cultivate mind and spirit for
tranquility. Meditation.
2. Work moderately and avoid
overstrain.
3. Regularity in living habits helps
avoid overstrain.
4. Prudent use of tonics is needed to
slow down the ageing process and
delay decline into infirmity.
1. Come to terms with limit of life: seek peace, have positive outlook.
2. Diet: With weak spleen and stomach, eat warm cooked food that is easy to digest. Choose medicated diet over medicine.
3. Exercise to boost qi. Avoid competitive sports and exercising in bad weather
4. Lifestyle: Regularity in habits, avoid late nights, wear clothes appropriate to the climate.
5. Tonics should be taken in smaller quantities over longer periods.
TCM understanding of coronary heart
disease 胸痹
Two main common underlying “syndromes” of CHDs:
Blood stasis
Manifested as impediments to the flow of blood and qi
Qi deficiency (weakness of ‘heart-qi’)
“Qi is the marshal of blood, blood is the mother of qi”
(Weak qi will result in poor circulation of blood, hence one can regard weak qi as
the basic underlying syndrome and blood stasis as the resultant syndrome)
Prevention of Coronary Heart Disease (combining biomedicine and TCM)
• Regular exercise and a diet rich in fibre with fresh fruit and vegetable to promote endothelial
health. Moderation in amounts of fats and carbohydrates (nutritionist opinions differ); TCM
recommends diverse diet (five flavours) chosen to suit one’s constitution and environment
• Studies show some foods, e.g. pomegranate (石榴) juice improve arterial health; TCM:
hawthorne, bitter gourd, yellow ginger and black fungus for reducing blood stasis
• Incidences of re-stenosis for patients who have undergone angioplasty and stenting have been
found to respond well to a formulation containing herbs that improve qi and resolve blood
stasis: renshen 人参, huangqi 黄芪, danshen 丹参 (red sage), honghua 红花, taoren 桃仁,
fuling 茯苓and gancao 甘草。
TCM management of hypertension & Stroke
Stress leads to the hyperactivity of liver yang 肝阳上亢, manifested as hypertension.
Liver wind (肝风) is the main internal pathogen for stroke, generated by hyperactivity of the liver, wind from pathogenic heat, weakness of yin and blood, emotional stress etc.
Treatments
• Mild cases treated with diet, lifestyle changes and medications like tianmagouteng yin 天麻钩藤饮 to calm liver and reduce hypertension
• Patients in the recovery phase usually have qi deficiency and poor blood flow.
Buyanghuanwu tang 补阳还五汤 is used for patients at later stages to tonify qi and reduce blood stasis
• Acupuncture/acupressure, qigong and taiji improve qi level and flow and motor skills;
counselling to cultivate positive emotions
Herbs and foods for blood pressure
The herbs tianma 天麻 and gouteng 钩藤 are believed to help control blood
pressure. They have the action of calming liver yang and expel liver wind. Hence,
they are also often used to treat headaches and dizziness resulted from hyperactivity
of liver yang.
They are used in the prescription tianma gouteng yin 天麻钩藤饮for treating
hypertension and managing the initial period after a stroke.
Foods thought to help control blood pressure are beet juice, spinach, lettuce,
cabbage, carrots, bananas, raisins, potatoes, and melons.
Food thought to help achieve healthy cholesterol levels include black fungus, celery,
walnuts, fishes (salmons), cereals with high fibre content (e.g. rye bread, whole grain
wheat).
TCM management of metabolic syndrome
and Type 2 diabetes
Recorded as 消渴 xiaoke in Huangdi Neijing 黄帝内经 . Main
underlying problem: Yin deficiency with asthenic fire and dryness 阴虚燥热
TCM approach: To treat the imbalances which are determined by the
syndrome
To replenish the yin and dryness and remove the heat (yin tonics)
Some herbs can be used to control blood glucose level eg. purslane 马齿苋which is made into capsules to better manage blood glucose level
Chinese herbs that suggest can control
blood glucose level
Huangqi 黄芪 (Astragalus)
Huaishan 山药 (Chinese yam)
Gegeng 葛根 (Kudzuvine Root)
Cangshu 苍术 Xuanshen 玄参 (Figwort Root)
Rougui 肉桂 (Cinnamon bark)
TCM understanding of rheumatism (bi
bing 痹病)
• TCM interprets rheumatism to arise from impeded flows of
blood and qi (气血不通) and blockages in the meridians
(经络痹阻)
• Primary pathogens involved are wind, dampness, cold and heat.
They attack a body that has weakened healthy qi (zheng qi), in
particular defensive qi (wei qi)
Syndromes commonly associated with
rheumatism
Wind and dampness 风湿痹阻
Pain in the joints and muscles, move to different locations; joints feel heavy and numb
Prescription: Juan bi tang 蠲痹汤
Deficiency of kidney and liver 肝肾亏虚
Chronic joint pain accompanied by stiff joints, soreness in the knee and lower back, aversion to cold.
Prescription: Du huo ji sheng tang 独活寄生汤
Heat dampness 湿热痹阻
Red swollen joints, joints feel heavy and restrict movements, yellow urine, yellow greasy fur.
Prescription: Dang gui nian tong tang当归拈痛汤 + Xuan bi tang 宣痹汤
•“Qi” in qigong refers to the qi of TCM, “gong” refers to skill or
technique
•Hence qigong is a method or technique of building and moving qi.
•Qigong involves meditation and breathing to promote the
production and flow of blood and qi and strengthen the internal
organs
Qigong 气功 and Meditation
Evolved as a school in its own right from
various forms of qigong. It comprises
theory, manipulating skills, and clinical
practice.
Guided by traditional Chinese philosophy
Emphasizes integration of dynamic and
static exercise
Attention to the integration of three
adjustments 三调合一(movement, breathing and mind)
Aims at preventing and treating diseases
以传统哲学思想为指导
对各家修炼方法兼收并蓄
强调动静结合
重视三调合一 (以自身形体活动、呼吸吐纳、心理调节相结合为主要运动形式)
以防治疾病为目的
21
Taijiquan as a form of martial arts qigong
Taijiquan 太极拳 Qigong 气功
Combines movement with
quiescence
Uses the breathing and
meditation techniques of qigong
Promotes physical balance –
may help to prevent falls
among the elderly
Qigong is a method of building and
moving qi.
Involves meditation and breathing
to promote the production and
flow of blood and qi and strengthen
the internal organs
May promote better circulation and
ameliorate the effects of ageing
22
Combining Western and Chinese exercises
Jogging, racquet sports good for cardiovascular
systems
Muscle strengthening and stretching exercises
for posture and muscular-skeletal fitness
Qigong and Taiji promote qi and blood
circulation, mind and body balance
Car Analogy -- keep engine in tune
Can combine both kinds of exercise; but in later
years Chinese exercises may be more feasible
for the elderly
Conjectures
1. Inflammation that underlies cancer, cardiovascular disease, arthritis, etc may have
something in common with yin-yang imbalance and impeded qi flows in TCM.
2. For example, the TCM concept of improving qi flow and“reducing blood stasis”
(huoxue huayu 活血化瘀) may be related to improving endothelial health for management of coronary heart disease. (Clinicians at the China Academy of TCM
use cocktail of qi and blood stasis reduction herbs to slow down plaque formation
and prevent re-stenosis after angioplasty. Clinical trials in progress).
3. System biology focusing on interactions within biological systems has much in
common with TCM holism. Research in this direction could lead to a measure of
convergence between biomedicine and ancient medicine in promoting better health
and disease prevention.
In a nutshell
TCM treats each person as different (patient-centric) and does not prescribe diets or exercises that suit everyone
TCM diets must fit the person’s constitution, environment and activities
Western nutrition guidelines should be followed, but within those guidelines we can use TCM principles to choose foods and supplements suitable for the individual
Aerobic exercises for cardiovascular and muscular fitness should be moderated at intensity levels to fit the individual.
Chinese exercises like qigong and taiji aim more at better qi and blood flow, and better mobility and balance, and may be practised to a late old age.
Modern perspective of principles
underlying Chinese therapies and
health cultivation
Empirical scientific basis for TCM
Chinese and Western explanations of
common chronic illnesses
Table of herbs and herbal formulations
in the appendix
(Available from Amazon/Kindle)