Traditional Chinese Medicine in Preventative Healthcare Hong Hai - - PowerPoint PPT Presentation

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

Obje jecti tions

• ns 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

Rol

• le

e of

• f TCM

M in mo modern ern so socie iety ty

 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

• f TCM by Western physicians whose patients also use TCM

New w Di Dietar tary y Gu Guidelines delines

• 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

• f 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

• f 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

Combini mbining ng Chine inese se an and West stern ern diets ets

 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

Chr hronic

• nic illnesses

lnesses in th the mi e middle ddle-aged aged and nd el elderly erly

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

Yang ngshen sheng an and tr trea eating ting diseases seases th that at ha have e not t yet et occur ccurred red 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 he physiology ysiology of ag ageing ing

Biomed

• medica

ical l 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 M Healt ealth h pr pres eser ervation ation

At midd ddle le age For the elderly erly

11

1.

Cultivate mind and spirit for

• tranquility. Meditation.

2.

Work moderately and avoid

• verstrain.

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 M un under erstand standing ing of

• f cor
• ronar
• nary

y he heart t disease sease 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)

Prevent ntion ion of Corona

• nary

y Heart t Disease ease

(combi

• mbinin

ing bio iomedi edici cine and d 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 CM ma manag agement ement of hyper pertension ension & Str trok

• ke

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

Her erbs bs and nd foods ds for r blood d pr pres essure sure

 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

• f 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 M ma manag nagement ement of

• f meta

metabolic bolic sy syndr ndrome

• me

and nd Type pe 2 diabet iabetes es

 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

Chines nese e her erbs s th that t su sugg gges est t can n contr ntrol

• l

blood

• d gl

gluc ucose

• se level

el

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 M un under erstanding standing of rh rheu eumat matism ism (bi bi bi bing ng 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)

Syndr ndrom

• mes

es co comm mmonl

• nly

y associat

• ciated

ed wi with h rh rheum eumatism tism

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

• rgans

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

Combini mbining ng West estern ern an and Chinese hinese exer ercise cises

 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 nut utsh shell ell

 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)