Traditional Chinese Medicine in Preventative Healthcare Hong Hai 黄海 Nanyang Technological University 南洋理工大学 BIT 3 rd Global Health Conference – 2015 Kaohsiung, Taiwan 27 th November, 2015
Obje jecti tions ons 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 “Radical environmental mutation” Depression, atherosclerosis, asthma, 1. diabetes and cancers are results of modern lifestyles following the industrial revolution Evolution Interrupted: Man changed from hunter-gatherers to desk-workers 2. for which he is genetically unadapted. Brain’s “runaway stress response” (minutes) replaced by prolonged stress, processed foods and lack of exercise/social interaction. Proliferation of anti-depressants, statins, hormonal therapies and antibiotics 3. 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. Yangsheng 养生 (Life cultivation) points Solution : Return to old lifestyles . TCM 4. in the same direction: Regularity , moderation, balance, qigong exercises, tranquility of mind 4
Rol ole e of of TCM M in mo modern ern so socie iety ty Y angsheng 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 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. A high-carbohydrate diet rich in sugar and refined grains increases the risk 3. 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
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 onic illnesses lnesses in th the mi e middle ddle-aged aged and nd el elderly erly Common Conditions TCM Cardiovascular diseases The conditions expressed in Western terms usually have Gastro-intestinal disorders no exact equivalents in TCM Arthritis and joint pains Metabolic syndrome and diabetes Role of TCM – Insomnia alternative/complementary Dementia and Depression Cancers 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 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) 9
The he physiology ysiology of ag ageing ing Biomed omedica ical l view TCM view Cardiac output declines; elasticity of lung Decline of the five zang organs 五脏日虚 decreases Difficulty in transforming food into Metabolic syndrome develops ; fluid and nutrients 易生积滞 (spleen-stomach electrolyte homeostasis affected weakness) Vision and hearing neurological decline Vulnerable to attack by external pathogens Inflammation , the body’s defense against 易感外邪 (defensive qi declines) invaders such as bad bacteria, viruses, and toxins, involves oxidative stress (a biological Tendency to have emotional upsets 易伤七 “rusting” of our tissues and organs) 情 , and developing depression Inflammation can disrupt the immune system, cause accelerated ageing and lead to chronic illnesses 10
TCM M Healt ealth h pr pres eser ervation ation For the elderly erly At midd ddle le age Come to terms with limit of life: 1. seek peace, have positive outlook. Cultivate mind and spirit for 1. Diet: With weak spleen and stomach, 2. tranquility. Meditation. eat warm cooked food that is easy to digest. Choose medicated diet over Work moderately and avoid 2. medicine. overstrain. Exercise to boost qi . Avoid 3. competitive sports and exercising in bad Regularity in living habits helps 3. weather avoid overstrain. Lifestyle : Regularity in habits, avoid 4. late nights, wear clothes appropriate to Prudent use of tonics is needed to 4. the climate. slow down the ageing process and Tonics should be taken in smaller 5. delay decline into infirmity. quantities over longer periods. 11
TCM M un under erstand standing ing of of cor oronar onary 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 onary y Heart t Disease ease (combi ombinin 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。
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