Currently viewing the tag: "diagnosis"

Smoking is a significant risk factor for many diseases including cancer, cardiovascular, chronic lung diseases and gastric ulcers. According to The WHO  smoking kills nearly 6 million people each year i.e. approximately one death every six seconds. 5 million of these results directly from smoking, while more than 600,000 are due to passive smoking. Due to the lag of many years, smoking is a slow gradual killer and people don’t realise its impact on their health until much later.  By then they have already developed an addiction.  A survey in China revealed that only 38% were aware it caused coronary heart disease.  Amongst smokers who are aware of its dangers, most want to quit however worldwide national smoking cessation services are only available in 21 countries. Smokers wanting to give up have tried, but most attempts are unsuccessful. E-cigarettes have become the new alternative to smoking but its safety is yet to be evidenced, and in my opinion there is a need to be cautious before giving it the green light. Getting help through cessation advice services using nicotine replacement therapy and counselling may be helpful but don’t always work for everyone. Complementary therapy studies have been done on acupuncture, hypnotherapy, yoga, mindfulness meditation herbal remedies and dietary supplements with some encouraging preliminary results.

Acupuncture is an ancient traditional Chinese therapy involving the insertion of fine needles at specific points in the body. It aims to affect symptoms of withdrawal, and studies show that it reduces the taste of tobacco and the intensity of the desire to smoke. A review of of 38 acupuncture and related randomised studies found inconsistent evidence of benefit, however there is enough to support the possibility of a positive effect that is greater than placebo. When used in combination with education it is found to have greater benefit. Studies on  smoking longer term effects show that it helps to keep smokers motivated to reduce or even quit smoking, with the effects lasting up to 5 yrs.

Hypnotherapy is a therapeutic tool used to affect patterns of behaviour. A Cochrane review found the evidence to be unclear, and not more successful than other therapist contact interventions. Any encouraging results were attributed to the individual’s strong motivation.

Yoga, breathing exercises and meditation-based therapies demonstrate some positive results to stop smoking in a small number of studies. Yoga compared to a psychologist led wellness group showed greater rates of abstinence in the longer term, but also improvements in anxiety levels and perceived health and well-being.

Dietary supplements and herbal remedies, S-adenosyl-L-methionine (SaMe), silver acetate, lobeline (Lobelia inflate) and St. John’s Wort have not shown to be effective, and should only be tried with the advice and guidance of an appropriately qualified health professional.

There has been an ongoing interest in the use of complementary therapies to stop smoking. Regularly, I get smokers who express a need (for all the right health and economic reasons) to give up smoking and inquire about the effectiveness of complementary therapies.  My answer has always been the importance of a <b>strong inner desire (rather than just need) to give up, without which nothing works completely. Therapies like acupuncture can help to alleviate stress, aid relaxation, reduce withdrawal symptoms and the urge to smoke thus easing the journey to becoming smoke free somewhat soother, but in my experience the reason for smoking is the key influencing factor which needs to be addressed. Issues of life style choices, work, family, relationships and childhood can all form part of the picture. Finally, what determines which way it swings is a willingness to make real life changes, which is the ultimate ‘Crunch Factor’.

 

It’s not uncommon for the proponents of conventional and of holistic systems of medicine to feel that they inhabit competing camps in the war to alleviate human suffering. In fact, Western and Eastern medicine are essential branches on the great tree of scientific knowledge.  Many of us are working towards the ideal of a continuum of care that provides the very best treatment to all patients. Western medicine has achieved remarkable triumphs.  Vaccination against many infectious diseases has greatly reduced their incidence; science has eradicated smallpox and come close to doing the same for polio.  It has saved millions of children from the scourges that once prevented so many from reaching their fifth birthday.

The specialties of surgery and emergency medicine save countless lives every day.

After decades of clinical practice I still wonder; Where does Western medicine fall short?  In the promotion of lifelong wellness; in the diagnosis and treatment of complex disorders; in the unnecessary or excessive use of pharmaceutical drugs; in safe, effective, ongoing pain management.

We’re certainly making progress in bringing these two branches of medicine closer, for example;  acupuncture has been proven to offer effective pain relief and increasingly accepted in medical pain clinics, and it doesn’t carry the risks associated with drug-based analgesia. Integration of auricular acupuncture in addiction clinics is another measure of its success. There is worldwide recognition of acupuncture for anxiety and stress particularly in cancer treatment, post traumatic stress disorder amongst veterans, and its potential value as anesthesia during surgical procedures.

I have always found that it is necessary to treat the whole person, and not just deal with an immediate crisis or what presents as their most significant symptom. I wanted to share this story (to ensure anonymity names and certain details have been changed).

Ria’s Story-  “Please… I Just Want the Pain to Stop”.

In the hospital waiting room Ria’s stomach churns and twists once again sending shooting pains throughout her body, followed by a cold sweat.  Over the past six months, she’s seen six different doctors; has endured repeated blood tests and other procedures.  No one has been able to offer her a definitive diagnosis. After each visit, she’s sent home with different prescriptions but no effective treatment for the repeated, alternating bouts of diarrhoea and constipation, sometimes nausea too.  Pain medication doesn’t bring any relief.  Her husband Pete feels equally anxious and frustrated.

Visits to six different doctors, blood tests and investigations all have proven to be unhelpful – there is no definitive diagnosis. Each time she is sent home with new meds, pain medication doesn’t work, one tells her that she is stressed and emotionally disturbed and prescribes her antidepressants another says there is some inflammation in her spleen, but nothing else. Ria is desperate, her symptoms are worsening.

Ria is beginning to doubt herself; wondering if it really is “all in her mind.”  She’s afraid to eat because everything just makes her feel worse, and she’s now two sizes smaller.

After yet another round of tests, Ria’s new consultant is also perplexed by her symptoms.  His examination of her shows nothing significant.  He’s ruled out cancer or other serious disease; all her other results are relatively normal. But fortunately for her, this doctor takes the time to listed to her and has a positive view of complementary therapies; he understands that functional disorders often underlie a patient’s stress and anxiety.  He knows that food intolerance is increasingly common and is often very hard to properly pinpoint. He asks her if she would be willing to accept a referral to a holistic physician.  Ria has always had an interest in complementary therapies and gladly agrees. He also gives her advice on juicing and enrolls her on to a mindfulness course.

As a holistic practitioner, I see Ria’s physical and emotional distress to be strongly interrelated, but requiring individual attention, with this in mind I begin acupuncture treatments. Almost immediately, they help to ease her distressed state and bring some relief for her stomach pain.

Over a period of months I guide Ria to make changes to her diet.  Together we develop a plan to identify problem foods. She learns about carbohydrate intolerance and how the FODMAP diet can help.  Ria finds the mindfulness course very effective in relieving her anxiety.  She began to realize her physical and emotional distress began years before the manifestation of painful bowel dysfunction.

Six months after starting treatment, Ria has made great progress.  She knows it will take time to regain the good health she thought was out of her reach, but she is no longer frightened and discouraged.  She is starting to take pleasure in eating again.  She and her husband are now enjoying what they thought might never be possible again–everyday pleasures.

 

Part 9: Mechanical signaling as a mechanism for Acupuncture

To date much of the acupuncture mechanism of action has been related to the nervous system, linking it to the medical physiological concept of ‘‘Gate control theory of pain’. Based on this theory acupuncture needling or electrical stimulation is said to activate relevant neural pathways. However this theory does not explain other non-pain related effects, nor does it correlate with the Traditional Chinese Medicine (TCM) acupuncture concepts.

Acupuncture involves the process of needle insertion. In TCM acupuncture, depending on the result intended the needle is inserted to a particular depth at a chosen acupoint site. This is followed by its manipulation to attain the ‘Arrival of Qi’ (De Qi). De Qi is experienced by the patient as soreness, numbness or a feeling of fullness around the needle point. Alternatively, in ancient texts for practitioners it is described as “seems a fish bites on fishing pulling the line downward” and may be felt as a needle grasp. This is an essential step in the therapeutic process. However, practitioners may not readily attain ‘De Qi’, and will therefore need to resort to needle manipulation. Basic needle manipulation techniques include; lifting and thrusting, and twirling or rotating movements. If Qi still fails to arrive then further manipulations techniques may be used. These can be;

  • Pressing, the skin along the meridian line to promote the circulation of Qi and blood.
  • Plucking (lightly), the handle of the needle to stimulate the Qi.
  • Scraping, the needle with the finger to spread needing sensation.
  • Shaking, to strengthen the needling sensation.
  • Flying, is to twirl the needle quickly three times to promote needle sensation.
  • Trembling, is a quick and small lift-thrust movements to cause vibration and promote Qi.

Lagecin et al (2001) has refuted suggestions that muscle contraction is the cause of the needle grasp (De Qi), as the same effect is also seen in areas where skeletal muscle is absent. Instead, they suggest that the cause is mechanical coupling between the needle and winding of the local tissue around it. They established this through histological examination of rat tissue explants with acupuncture needle manipulation which showed marked thickening of the connective tissue layer around the needle, while changes in the dermis or muscle were not observed. Acupuncture needle insertion and manipulation is thought to have both local and distal therapeutic effects. These effects are based on;

  • Mechanical coupling of the needle to the connective tissue due to surface tension and electrical attraction between the two.
  • Winding of the tissue around the needle during insertion and manipulation
  • Generation of a mechanical signal through pulling of the collagen fibers during the manipulation process
  • Mechanotransduction of the signals into the cells

Mechanotransduction activates changes in the fibroblasts and/or other cells, which in turn starts a variety of downstream effect including; cell secretion, modification of extracellular matrix, amplification and transmission of nerve signals travelling along the planes of the connective tissue into the spinal cord and brain. At the same time there is modulation of the sensory input due to changes in the connective tissue environment.

Finally, within the phenomenon of mechanotransduction TCM acupuncture and its effects can have some scientific validity. It can be attributed as the common mechanism through which the effects of acupuncture needling are realised. De Qi is an essential contributory process which determines the overall effectiveness of the treatment, whilst downstreaming effects resulting in cellular changes explain the longer term effects of acupuncture. This is an important clinical understanding which could have considerable implications in changing our knowledge base of biological mechanisms and the future applications within medicine.

In Part 9, our Final in this series we will look at the phenomenon of  Mechanotransduction as a mechanism for acupuncture.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory
Part 4:  Chinese Diagnosis
Part 5: Integrating Western Physiology with TCM Philosophies
Part 6: TCM Meridians
Part 7: Meridians & Fascia
Part 8: Arrival of Qi (De Qi)

References: 
  1. Stux G, Berman B, Pomeranz (2003). Basics of acupuncture, 5th  edition.  Springer Berlin Heidelberg, New York.
  2. Xinnong C (2000). Chinese acupuncture and moxibustion, 5th edition. China Books & Periodicals Inc, San Francisco.
  3. Dong J (2013). Evidence-Based Complementary and Alternative Medicine. 2013:153148.
  4. Eachou Chen (2008). Does qi travel on meridian like thin membrane energy transmission through the fascia? 4(2): 84-86.
  5. Teppone M, Avakian R, Karneev. “Arrival of qi” phenomenon during ehf – puncture.
    1st International Symposium on Quantum Medicine. November 17-22, 2001, Bled, Slovenia, p. 116-118.
  6. Chen CW, Tai CJ, Choy CS et al. Wave-Induced Flow in Meridians Demonstrated Using Photoluminescent Bioceramic Material on Acupuncture Points. Evi Based Complement Alternat Med (2013). 2013:739293.
  7. Langevin HM, Churchill DL, Cipolla M J (2001). Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 15:2275–2282

Part 8: Arrival of Qi (De Qi)

The phenomenon of “Arrival of Qi” (De Qi) has been described as a vital part of the effectiveness of an acupuncture treatment. It is described as a sensation of soreness, numbness or a feeling of distension around the point after the needle is inserted to a certain depth. At the same time the practitioner may feel tenseness (or ‘grasp’) around the needle. One hypothesis states that the grasp is due to a mechanical coupling between the needle and connective tissue winding during insertion. De Qi is determined by accurate needing of acupoint, depth of needle insertion and needle manipulation to promote the arrival of qi. In ancient Chinese books its importance is described as, “acupuncture therapy does not take effect until arrival of Qi”. This understanding was later revised to explain that the quick arrival of Qi suggested good effects, while slow arrival was a sign of retarded effects.

At the 1st International Symposium of Quantum Medicine the ‘De Qi’ was accepted as a broader phenomenon. Acupuncture needle manipulation giving rise to different sensations of moving along the legs, arms or trunk was described as the phenomenon of ‘propagated sensations along the channels’ (PSC). PSC can be manifest or latent, both of which can be detected by changes in the low electrical resistance, cutaneous potential, sound signals, temperature, spontaneous visible light and others.  Research shows that the arrival of PSC results in observed functional changes in certaiorgans and thus ‘De Qi’ was described as a change in Qi conditions at the acupoints, channel or organ, which can be accompanied by sensory responses, including changes in symptoms. The characteristic intensity of Qi arrival relates to the speed of changing Qi conditions and therefore effects of the treatment. The intensity of this phenomenon is subject to the;

  • Functional condition of the patient
  • Structures involved into the reaction
  • Type of Qi stimulated into the reaction

Other studies using extremely high frequency (EHF) puncture through low intensity millimetre (MM) electromagnetic radiation on an acupoint have shown to give rise to sensory reactions in the patient. These include temperature sensations (warm or cool), waves or creeps at certain areas or moving along the limbs or trunk, similar to the ‘De Qi’. Changes in emotional states and changes in functional activity of different organs were recorded via electrocardiograph, electroencephalograph, electro-gastrography, heat monitor, etc.  These sensory reactions have also been associated with temperature changes (0.2o– 0.5oC) at acupoints.  e.g. ‘fullness and heaviness in the abdomen’ was associated with a rise in temperature at Ren-12 and St-25 acupoints, and similarly ‘vertigo’ was associated with temperature changes at Liver channel points, and feeling of ‘changes of the weight’ when needling spleen channel points.  There is a collective conclusion that the key point in treatment efficacy was not the frequency of MM EMR but more importantly its application on the acupoint zone. Instead the frequency determined the range of MM EMR radiation absorbed by the water-containing structures of the skin.

EHF-Puncture research has been investigated in the Traditional Chinese Medicine conditions TCM) of Qi ‘excess’ or ‘deficiency’. Parallelling a ‘place of deficiency’, a deficient condition exhibits the quick ‘De Qi’, while in the case of excess initially there may be a short period of aggravation of the presenting symptoms (similar to the widely accepted acupuncture healing reaction). This temporary worsening of symptoms is explained as reinforcing effects during the start of the EHF treatment which later disappears.

De Qi has shown to initiate changes at acupoints locally, however it does not explain how the effects occur distally. One explanation could be the facial reach into deeper tissues and internal organs (Chen 2008), while another theory is based on the phenomenon of mechanical signally resulting from the interaction of the needle and the surrounding connective tissue.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory
Part 4:  Chinese Diagnosis
Part 5: Integrating Western Physiology with TCM Philosophies
Part 6: TCM Meridians
Part 7: Meridians & Fascia

Part 7:  Do Meridians lines lie in fascia?

Fung (2009) hypothesized that TCM meridian system upper boundaries are the skin with dense sensory receptors of various types, while the lower boundaries are another layer of connective tissue with intersititial fluid flowing through. Numerous other studies suggest the most probable location is the fascia just beneath the subcutaneous tissue.  Fascia is found throughout our body creating continuity between tissues enhancing body function and support. Classical historical text of the Yellow Emperor of Internal Medicine (Unknown Author, 1931) explanation of where meridians lie states;

“Following the course of each of the meridians there are vital points (365) for acupuncture. Meridians are deeply embedded in the muscles beneath the skin; at point 365, however, they emerge to the surface and thus present the points for needling”.

Another description says that the;

“Twelve meridians travel between white and red meats. It is deep not being

able to be visible”.

Fascia is found throughout our body. It is an active structure which is virtually inseparable from our body structures providing functional stability to organs and mobility.  In 2007 the First International Fascia Research Congress recognised its key characteristic being a continual uninterrupted, three-dimensional web-like structure. Under the umbrella of fascia was included, joints, organ capsules, muscular septa, ligaments, retinacula, aponeurosis, tendons, neurofascia and other fibrous collagenous tissue.

  • Traditionally fascia has been grouped in relation to the region it is found, while more recent literature suggests grouping it according to function; connecting and
  • Fascia is optimally designed to take up tension forces through antagonist and synergistic muscle groups in the musculoskeletal system.
  • Fascia has sensory nerve fibres which contribute to nerve function and potentially to manual, temperature and vibration stimuli. One scientific model also proposes an alternative explanation for referred pain distribution based on facial connections with various nerve units.

Microscopic examination shows that fascia is a form of connective tissue. The functional properties of fascia are reliant on the type and combination of collagen protein which determines its resistance to stretch and tension and facial integrity. Fibroblast cells within the fascia are highly adaptable and able to remodel according to mechanical stimuli, while myofibroblasts demonstrate a contractile property. In response to biomechanical tension or compression, cellular changes occur including the release of biochemicals. Similarly local tissue injury via mechano transduction stimulates the formation of fibroblasts, a mechanism that has been linked with embryonic development. There is evidence to suggest that the insertion and manipulation of acupuncture needles into the fascia (causing strain on the tissue) stimulates fibroblastic activity.

The chemical structure of facial proteins is very similar to that of organic polymer which has good semiconductor properties. It also has an ideal organic liquid crystal chemical property which exhibits double refractive light properties. A study using digital anatomical dissection methods analysing three-dimensional fascia of the human body found a pearl-like chain similar to the meridians. They concluded that beyond the supportive function the fascia is also a storage, self-monitoring and self-adjustment system.  On the basis of anatomical, biophysical evidence of low electrical resistance, high acoustic, illumination and thermal lines only found in tissue with semi-conductor properties Chen (2008) concluded that fascia was the most likely structure where meridians may lie. He also uses its continuation from superficial to deeper tissue and internal organs to explain why there is an enhanced feeling of Qi flow during qigong practice when in a state of complete relaxation, and the reverse when there is anxiety, tension or other high emotional states.

In the ancient Chinese book of Miraculous Pivot it is stated, “acupuncture does not take effect until the arrival of qi’. The effectiveness of an acupuncture treatment is determined not just by the meridian but also the selection of acupoints and the phenomenon of ‘Arrival of Qi’. Arrival of Qi is described as a sensation of soreness, numbness or distension at the needle site.  Factors influencing arrival include accuracy of acupoint location, needle insertion depth and needle manipulation. In the next part of our series we try to break down the science behind the ‘arrival of qi’ and its importance.  

In Part 8 we will discuss, Arrival of Qi (De Qi)

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory
Part 4:  Chinese Diagnosis
Part 5: Integrating Western Physiology with TCM Philosophies
Part 6: TCM Meridians

Part 6:  What are TCM meridians ?

According to Traditional Chinese Medicine (TCM) text Qi flow in a network of meridian channels found all over the body, but despite scientific efforts we have yet to find the modern biomedical equivalent. There are 12 major meridians, supported by 8 extra meridians, 15 collaterals and others. Each of the 12 major meridians is linked internally to an organ and externally with joints, limbs and other superficial tissue.

Unlike the circulatory system meridians are not visible and therefore from a western scientific perspective harder to justify. Western science focuses on anatomical and physiological science to explain the functions of the body.  Meridians are not blood vessels, nerves, muscles, lymphatics or connective tissue, but anatomical studies have concluded that acupoints are sites near dense nerve structures, dense vasculature, near lymphatic vessels and have interstitial fluid flow.

Interstitial fluid (or tissue fluid) is a solution that is found in interstitial spaces (or tissue spaces). It is pushed out of capillaries into interstitial spaces due to hydrostatic pressures. It bathes and surrounds cells and tissue. To prevent a build up of interstitial fluid it enters the lymphatic vessels to be transported back into the blood. Overall, the whole interstitium is considered to be four times the volume of blood in the body.

Modern biophysical research on meridians and acupoints show the following;

  • Meridians as lines of low electrical resistance and electromagnetic transmission. This has been demonstrated by acupoint finders using the principle of Ohm’s law. Tests show a ten-fold increase in electrical resistance when compared to non-acupoints. Similarly, interstitial fluid has high electro conductively whilst flowing under the skin and when compared to surrounding tissue there is also high sound conductivity.
  • Some researchers describe meridians to characteristically have low liquid-pressure resistance, which indicates that the tissue on the meridians is looser.
  • Radioactive tracer studies at acupuncture points have helped to show interstitial fluid flow along the meridian lines whilst other similar studies have excluded its flow proximity to be alongside blood vessels.
  • The interstitial fluid system is in a state of dynamic equilibrium and depending on a number of factors the fluid pressures (Pi) are not equal at all sites. This suggests that the interstitial fluid is in a constant state of flow due to the varying levels of Pi, and there is a constant need to maintain fluidic equilibrium. Using biorheology techniques the measured speed of flow is found to be much slower than that of blood circulation.
  • Another study using magnetic resonance studies demonstrated six specific migration channels of interstitial fluid which again did not correspond to the circulatory or lymphatic vessels instead it followed the pathways of the six Yin TCM meridians, further supporting the flow of interstitial fluid along these meridians.
  • Other research has also found that light propagation is more efficient with infrared thermal imaging showing radiant tracks along meridian pathways. There is also significant correlated metabolic activity.

Reasonably conclusions can therefore be made that meridian lines are related to routes of interstitial flow. Further, to this investigators have proposed the most logical location of meridians be the fascia, just below the subcutaneous tissue. Fascia is characteristically a continuous structure found throughout our body similar to meridian pathways, but also typically exhibits the ability of facial transmission of forces  which could resolve the question of how the insertion of an acupuncture needle is able to initiate a therapeutic effect.

In Part 7 we will discuss, TCM Meridians & and its link to Fascia.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory
Part 4:  Chinese Diagnosis
Part 5: Integrating Western Physiology with TCM Philosophies

Part 5:  Integrating Western Physiology with Traditional Chinese Medicine Philosophies

With its 5,000 year old history Traditional Chinese Medicine (TCM) has been widely recognised for its knowledge and therapeutic approach. Although, still not fully understood there is every reason to be able to impact on the future and development of modern medicine. Admittedly researchers have yet to be able to successfully integrate TCM to western medicine. One research exploring this concluded by suggesting three elements to understanding TCM;

  • First part that is consistent with modern medicine, e.g. similarities in clinical examination methods (inspection, auscultation-olfaction, palpation), use of TCM treatments and prescription (including herbs) in modern medicine.
  • Second part is described as involuntarily beyond modern medicine, encompassing unique TCM theories, concepts and other advanced TCM treatments.
  • Third part requires further evaluation, consists of the knowledge of pulse diagnosis, prescriptions, herbs and other aspects.

The popularity and effectiveness of acupuncture has in the last decade prompted a wide integration of the use of acupuncture within most NHS pain clinics. Similarly, there are also an increasing number of physicians, physiotherapists, chiropractors and osteopaths offering it as part of an integrated practice. Based on the physiology and clinical approach there are now two schools of acupuncture;

  • Traditional Chinese Acupuncture
  • Western Acupuncture.

Western acupuncture is explained through the ‘Gate control theory of pain’ and largely restricted to the treatment of chronic pain. This theory was originally put forward by Ron Melzack and Patrick Wall in 1962, where they proposed that physical pain is not a direct result of the activation of pain receptors. Instead the perception of pain is modulated and changed through the interaction of different neurons.  Using this theory we can explain that the stimulation of nerve fibres through acupuncture needles can cause chemicals (enkephalin and dynorphon) in the spinal cord to block the transmission of the pain messages to the brain, thus creating an analgesic effect.

Alternatively, Traditional Chinese Medicine (TCM) takes on an entirely different perspective using more than one philosophical theories including; Yin-Yang theory; Five Element theory; and Qi, blood and body fluid.  Qi is defined as vital energy, which flows through a system of channels (also called meridians). The meridians are central to understanding TCM acupuncture and how it works. Following are its characteristics;

  • Meridians are understood to be a network of channels through which Qi is circulated.
  • They link up with the organs and tissue.
  • The main trunks run longitudinally and in the interior of the body, while the collaterals run transversely and superficially from the meridians.
  • There are a total of 12 major meridians, added to them are 8 extra meridians, additional collaterals and others.
  • Each of the 12 major meridians is linked internally to an organ and externally with joints, limbs and other superficial tissue forming a whole organ system, for example the lung system encompasses the nose, respiratory tubes and the lungs.

In comparison western physiology is based on a number of systems, e.g. circulatory, respiratory, nervous, lymphatic, musculo-skeletal, urinary and digestive system. Effective functioning of each of these systems is essential to maintaining good health.  Similarly TCM meridians also have functions including transporting qi, balance of yin and yang, resist pathogens, exhibit signs and symptoms of disease and disorder, and transmit acupuncture needing sensations to regulate any deficiency or excess conditions.

Meridian channels need to have free flowing and balanced Qi in order to maintain good body function.  They have a special quality of being sensitive and able to carry the healing effects of acupuncture to distal parts of the body. Researchers have attempted to verify its exact anatomical location in the body but also what meridians constitute. Is it nerves, lymphatics, blood or tissue?

In Part 6 we will discuss,  TCM Meridians.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory
Part 4:  Chinese Diagnosis

Part 4:  Chinese Medicine Diagnosis: A Balancing Act

Traditional Chinese Medicine (TCM) diagnosis constitutes the four basic methods of; inspection (of the physical body or coating on the tongue), auscultation (listening to speech, breathing or coughing) and olfaction (of mouth or body odour), inquiry (of symptoms) and palpation (of pulse or abdomen), very much similar to modern medical clinical methods. Along with the history each symptoms and sign is analysed singularly, but also generally to recognise the cause, nature and relationships to identify the syndrome. In addition, the patient’s personal and environmental factors are also taken into consideration.

Essentially, diagnosis is based on the two philosophical systems of Yin-Yang polarity and the Five Element theory. Based on the Eight diagnostic criteria (Ba Gang), signs and symptoms are classified according to their opposing characteristics represented by four polar extremes;

  • Ying -Yang
  • Internal and external
  • Deficiency and excess
  • Cold and heat

Any imbalances in the body are described according to the Eight diagnositic criteria and a ‘pattern of disharmony’ is established which is then referred to as a ‘syndrome’.  The flow of Qi (vital energy) through a system of channels (also called meridians) and a concentration of Qi in the organs is an important part of the regulation of the body functions. Assessment of the overall Yin-Yang balance is one of the primary aims of a Chinese medicine assessment and any diagnosis based on the interior-exterior, deficiency-excess, and cold-heat is under the general umbrella of Yin and Yang criteria.

  • Internal and External: Internal disturbances (known as Li in Chinese) are usually related to imbalances in the Zang or Fu organs and usually associated with chronic conditions, often caused by poor nutrition or emotional excesses of anxiety, fear, sadness or excitement. Examples of internal disturbances are diarrheoa, nausea and abdominal pain. External illnesses (known as Biao in Chinese) are disturbances in the channels or meridians particularly in the peripheral or superficial areas. There is sensitivity to environmental and climactic changes. Examples include peripheral neuralgia or arthritis of a few joints.
  • Deficiency and Excess: Deficiency diseases are usually chronic, typical symptoms are tiredness, exhaustion, dizziness, pallor and low blood pressure. This usually originates from a deficiency of Qi, blood or Jing (elementary essence). When these are in excess symptoms include acute pain, cramps, hypertension, insomnia and hyperactivity.
  • Cold and Heat: Cold disturbances (Han in Chinese) relate to a weakened body Qi resulting from effects of environmental cold influences. Examples are cold extremities and pallor. Heat disturbances (Re in Chinese) is due to increased Yang activity of the body Qi, which eventually overcomes the body Yin resulting in an imbalance between the two forces. Heat symptoms include; fever, redness, constipation, pain and agitation.

The above diagnostic criteria can be described in various combinations depending on the type of symptom and the functional or organ disturbances. Characteristically, symptoms of excess and heat will usually occur together, termed as ‘Yang in Yang’ e.g. acute pain and fever. Other combinations can be excess and cold (cramps and pallor), or deficiency and heat (exhaustion and agitation). Using this syndrome method Chinese medicine treats either the acute or chronic nature of the disease, or in some cases both. Whilst maintaining a balance the primary aim is to strengthen the body Qi but at the same time also dispel any excessive pathogenic Qi.

An acute infection resulting in fever is an example of an external cause of excessive heat (Yang). In western medicine it is very successfully treated with antibiotics therefore ‘clearing the heat’. Once the infection has been rid of, it is assumed that the body will fully recover of its own accord. In TCM no such assumptions are made. Instead, at this stage an inherent part of every TCM treatment plan is focused on strengthening the body systems to optimum health. A strong Qi includes a healthy immune system. Consequences of a weakened Qi are an increased susceptibility to frequent low-level health problems e.g. colds, flu, runny nose, low moods, easy fatigability and general tiredness. Such an approach encompassing greater recovery outcomes may be an extremely helpful addition to the more linear and absolute western treatment methodology.

In Part 5 we will discuss, Integrating Western Physiology and Traditional Chinese Medicine Philosophies.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force
Part 3: Five Elements Theory

 

Part 3: Five Element Theory

Following the Yin and Yang theory, in the 3rd century the Five Element theory was introduced which helped to understand the body as an interlinking system, where body functions are controlled through the actions of stimulation and inhibition.  As with other Chinese philosophies this system is also based on observations made of the natural world.  The Five Element theory is an abstract symbolization of empirical observations which reflect in medicine the various functions of the body’s organs and tissue. The theory constitutes the five phases of, wood, fire, earth, metal and water, considered to be the five indispensible materials that help to sustain life, as well as five important elemental states. Five-Element

In the book, A Collection of Ancient Works the interdependencies of the five elements is described as; “Food relies on water and fire. Production relies on metal and wood. Earth gives birth to everything. They are used by the people”.  Each of  the five elements are further related to categories such as the season, a direction, climate, stage of growth and development, organ, body tissue, emotion, taste, colour, sound and many other.

 

Elements

Internal organs Hollow organs Sensory organs Body layer Emotion

Taste

Wood

Liver Gall bladder Eye Muscle Anger Sour
Fire Heart Small intestine Tongue Blood vessels Joy Bitter
Earth Spleen Stomach Mouth Connective tissue “flesh” Anxiety Sweet
Metal Lung Large intestine Nose Skin Sadness Spicy
Water Kidney Urinary bladder Ear Bone, joints Fear

Salty

Based on the role and function particular body organs, the type of emotion and taste were generally representative of a particular element and thus helped to explain the nature of the organs and the relationship they had with other organs.

Primarily the Five Element Theory reminds us of how (in nature) things are connected and how our bodies relate to our environment but also defines the nature of each relationship. The two basic fundamental relationships which keep the balance of nature without which there would be instability and disturbance are;

  1. Generation: Generation pertains to creation, growth or production, while control is a limiting force to ensure that they do not occur too quickly or slowly, or too strongly or weakly. For example the generation of fire is dependent upon wood, or the growth of wood is dependent on water.
  2. Control: When in a dynamic state of equilibrium all the elements will exist in harmony but if we take our previous example when fire burns uncontrolled then it will consume all the wood, with no time left to replenish it. Similar relationships are reflected in the case of a mother and her child, where the mother gives birth and nurtures the child to grow, or in the body the relationship between the heart and spleen, where the heart generates the spleen.

All of these acts of balancing are in a state of constant flux, changing according to the need. They are necessary not just on a cosmic scale but also at the individual level.

Always remember that limitations in this theory have been acknowledged in the fact that not all of the inter-relationships between organs can be explained through this theory. However, combined with the Yin and Yang theory it served to guide Chinese medicine to develop a systematic process of clinical diagnosis and treatment.

In Part 4 we will discuss, Chinese Medicine Diagnosis: A Balancing Act.

Part 1: How Does Acupuncture Work?
Part 2:  Qi: Vital Energy, Life Force

Part 2:  Qi: Vital Energy, Life Force

In Chinese philosophy Yin and Yang are created by Tao (nature’s creative force). Within this also originates the flow of life force called ‘Qi’ (pronounced Chi). Qi is described as vital energy or life force that exists in nature and all life, in the form of movement and change. Every living process or organic function is an expression of the movement of Qi.  In the body Qi flows in channels (known as meridians) throughout the body, but gathers and becomes more focused in the organs.  The main functions of Qi are to;Qi

  • Enable physical activity of organs e.g. respiration, circulation, bowel movements.
  • Generation of heat for the purposes of keeping the body warm.
  • Psychic activity, consciousness and vitality (Shen, often translated as spirit).
  • Supporting organ functions, e.g. conversion of fluid and nutrients into blood and bone.
  • Protection of the body from negative environmental factors e.g. cold weather giving rise to illness (Protective Qi).

Depending on its intent or function there are three different types of Qi, which collectively make up ‘Jing Qi’.

  1. ‘Zong Qi’ or ‘Yang Qi’ is found in the lungs from the inhaled air interacting with the Nutrient Qi.
  2. ‘Nutrient Qi’ or ‘Yin Qi’ which originates from the digestion of food.
  3. ‘Yuan Qi’ is inherited from his/her parents and influences the person’s growth and development.

Together the three forms of Qi integrate and work as the ‘Jing Qi’, which is the Qi that flows through the channels. Jing is the body’s life essence and described as the ‘seed of life’ and ‘elemental reproductive force’. Thus the union of parental life essences gives birth to a baby’s primary or congenital Jing which determines their inherent growth and constitution.

Chinese medicine pathology links the development of an illness to the disturbance of the flow of Qi, usually an excess, a deficiency or stagnation of Qi in the relevant organ system and associated meridians.

  • Excess Yang conditions are represented by excessive organ functions e.g. acute pain, inflammation, fever, flushing, nervousness and hyperactivity.
  • Deficiency of Qi is characterised by Yin conditions e.g. dull pain, pallor, cold hands and feet, depression, hypoactivity and  general weakness and fatigue.  Stagnation of Qi flow is mainly found in the peripheral and superficial areas of the body.

Subsequent to the polar Yin and Yang theory, in the 3rd century the Five Element theory was introduced which helped to understand body as an interlinking system which controls body functions through stimulatory and inhibitory actions. This new theory introduced an abstract model that supported an understanding of the body organ systems and how they interacted with each other.

In Part 3 we will be examining the Five Element Theory.

Part 1: How Does Acupuncture Work?