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Eighteenth Session of the International Bioethics Committee
31 May - 2 June 2011
Baku, Azerbaijan _______________
Tuesday 31 May 2011
Ethical implications of traditional medicine: Hearings of traditional health practitioners
1. Dr (Mr) Emilio La Rosa Chairperson of the IBC Working Group on traditional medicine and its ethical implications. Title of presentation : « La médecine traditionnelle et ses implications éthiques. Rapport d’étape »
2. Dr (Mr) Manikandan Kanjoor Parithapurathkalathil
CNS Ayurveda Chikitsalayam & Research Center Mezhathur, Kerala, India Title of presentation: « Ethical Implications of traditional medicine »
3. Dr (Mr) Jack Githae
Director, School of Alternative Medicine and Technology (SAMTECH) Nyeri, Kenya Title of presentation: «The Ethical Implications of Traditional Medicine: The Experiences of a Kenyan Practitioner »
4. Dr (Mr) Guan Xin
Director, International Cooperation Exchange Department Member of the Ethics Committee, Shanghai Shuguang Hospital, Shanghai Traditional Chinese Medical University, China Title of presentation: « Traditional Chinese Medicine »
La médecine traditionnelle et ses implications éthiques
Rapport d’étape
Emilio LA ROSA
Création du groupe de travail
Motivations
:
La médecine traditionnelle est très répandue dans le mondeBon nombre de pays n’ont pas de normes éthiques relatives à la pratique de la médecine traditionnelle L’OMS considère que la médecine traditionnelle doit être intégrée au système de santé des pays
Composition du groupe de travail• Dr. Emilio La Rosa, Président du groupe• Prof. Fouad Boustany• Dr. Aïssatou Touré• Prof. Ibrahima Boiro • Prof. Achille Massougbodji
Le groupe compte sur l’appui de: • Prof. Donald Evans, Président du CIB• Mme Dafna Feinholz• Mme Sabina Colombo
Objectifs du groupe de travail
• Analyser les implications éthiques de la médecine traditionnelle
• Proposer des lignes de base pour la mise en place d’un cadre éthique des pratiques traditionnelles .
• Fournir une base de réflexion pour l’élaboration de normes concernant la pratique, la recherche, la formation et le contrôle dans le domaine de la médecine traditionnelle.
Les suites de notre travailPremière réunion de travail, juin 2010
Préparation d’un projet préliminaire
17è session du CIB et session conjointe du CIB et du Comité Intergouvernemental de bioéthique (CIGB) de l’UNESCO, octobre 2010
consultations avec des experts invités, des spécialistes du Secteur des sciences exactes et naturelles et du secteur de la culture de l’UNESCO, échanges avec les Etats membres du CIGB
Conclusions majeures de ces sessions
Confirmation du choix de l’étude des implications éthiques de la médecine traditionnelle par le CIB ;
Problème de définition de la médecine traditionnelle et des pratiques qui la composent ;
La grande variété des pratiques traditionnelles et la pluralité des points de vue exprimés lors de cette session par les membres du CIB nous sommes amenés à prendre les décisions suivantes:
DécisionsQuestionnaire destiné à des instituts de recherche spécialisés en médecine traditionnelle
collecter des informations spécifiques sur les pratiques de médecine qui sont traditionnellement exercées et depuis des générations transmises dans divers pays.
Auditions de praticiens lors de la 18e session du CIB
enrichir le débat d’une perspective interne des questions éthiques qui entourent les pratiques
Le questionnairePoints abordés par le questionnaire
:
1. Détails des pratiques de médecine traditionnellement développées de génération en génération dans des pays
2. Mode de transmission de leurs savoirs
3. Leur place et reconnaissance par rapport à
la médecine conventionnelle
4. Leur mode de réglementation
5. Leur encadrement par des principes d’ordre éthiques
Points ignorées par le questionnaire
:
– médecines dites parallèles ou alternatives – médecines traditionnelles récemment importées d’un autre pays
Le questionnaire• Récipiendaires du questionnaire
: 100 instituts de
recherche• Mode de sélection
:
– Recommandations de l’OMS, de l’Institut d’Etudes Supérieures de l’Université
des Nations Unies
(IAS/UNU) – Contribution du Secteur des sciences exactes et
naturelles de l’UNESCO, – Informations collectées auprès de chercheurs et – Informations collectées dans la littérature spécialisée
• Réponses
: 20
Les résultats de l’enquête20 réponses représentant 13 pays
:
– 3 pays de la région Asie et Pacifique (Inde, Japon, République de Corée)
– 4 de la région Afrique (Guinée, Libéria, Rwanda, Sénégal)
– 2 de la région Amérique latine et Caraïbes (Bolivie, Pérou)
– 4 de la région Europe et Amérique (Arménie, Canada, Portugal, Roumanie)
• Les pratiques de médecines traditionnelles combinent quasiment toutes des thérapies médicamenteuses et non-médicamenteuses
• Cette variété
de pratiques utilisent communément:• Thérapies manuelles, • Phytothérapie, • Thérapies mentales et spirituelles• Thérapies physiques
• Cette variété
d’approche nosologique et thérapeutique rendre plus complexe l’élaboration de normes éthiques.
Résultats –
1 Multiplicité
de pratiques
• Les pratiques de médecine traditionnelle sont en quelques sortes régulées et organisées de manière interne par l’intermédiaire des nombreux groupements et réseaux (locaux, communautaires, régionaux, nationaux) de praticiens de médecine traditionnelle dans la quasi-totalité
des pays
représentés.• Il est quasiment certains que les charlatans ne font pas partie de ces réseaux.
Résultats –
2Réseaux et regroupements de
praticiens
Recours à la médecine traditionnelle par la population locale dans le monde
très important moyenmarginal
En moyenne, le recours aux pratiques de médecine traditionnel est important dans les pays qui ont répondu au
questionnaire
Résultats – 3Recours à
la médecine traditionnelle
Recours à la médecine traditionnelle par la population en Asie & Pacifique
très important moyen
Recours à la médecine traditionnelle par la population en Afrique
très important
Recours à la médecine traditionnelle par la population en Amérique latine & Caraïbes
très important
Recours à la médecine traditionnelle par population en Europe & Amérique
très important moyenmarginal
Recours à
la médecine traditionnelle par région
Aujourd’hui, l’évolution de la transmission du savoir en matière de médecine traditionnelle est
majoritairement positive
Résultats –
4État de la transmission du savoir
Etat de la transmission du savoir en médecine traditionnelle
en progressionmaintenueen perte de vitesse
Note: l’importance du recours de la population à
ces pratiques n’est pas partout en accord avec l’évolution de
la transmission de ses savoirs.
Tendance de la transmission du savoir en medicine traditionelle en Afrique
en progressionmaintenueen perte de vitesse
Recours à la médecine traditionnelle par la population en Afrique
très important
Mode de transmission du savoir
Aujourd’hui, dans la majorité
des pays, la transmission du savoir se fait de manière privilégiée au sein d’écoles, d’instituts et de facultés dédiées qui garantissent le niveau de savoir et la qualité
de la
formation des praticiens formés.
Résultats -
5
Résultats –
6Place de la médecine traditionnelle
Place de la médecine traditionelle dans le système de santé
Reconnaissance etintégrationReconnaissance, maispas d'intégrationPartielle reconnaissanceet intégrationPas d'intégration maistolérance Pas de reconnaissance,pas de tolérance
Sur les 13 pays représentés
7 n’ont pas une réglementation de la médecine traditionnelle ni de l’usage des médicaments à
base de
plantes ou de matières minérales.
A l’inverse, les pays de la zone Asie représentés disposent d’une réglementation suivie et contrôlée par divers instances nationales officielles.
2 pays ont cependant des règlementations en cours de préparation, ce qui témoigne d’une reconnaissance de la nécessité
de mieux y encadrer la médecine
traditionnelle.
Résultats –
7Réglementation
Existence de réglementations et d’encadrements institutionnels de la médecine traditionnelle en
Asie & Pacifique
oui
Existence de réglementations et d’encadrements institutionnels de la médecine traditionnelle en
Afrique
oui non
Existence de réglementations et d’encadrements institutionnels de la médecine traditionnelle en
Amérique latine & Caraïbes
oui non
Existence de réglementations et d’encadrements institutionnels de la médecine traditionnelle en
Europe & Amérique
oui non
Existence de réglementations et d’encadrements institutionnels de la médecine traditionnelle
par régions
Sur les 13 pays représentés:• 9 ont une unité
ou un département de médecine
traditionnelle au sein du Ministère de la santé. • Cependant, 4 pays disposant de tels unités
ministérielles n’ont pas de réglementation de la médecine traditionnelle ni de médicaments à
base de plantes ou minéraux.• A l’inverse,
3 pays qui disposent de
réglementations n’ont pas de telle unité ministérielle.
•
Résultats –
8 Unité
ou département dédié
au sein du gouvernement
Résultats –
9Code et principes d’ordre éthique
• Dans une bonne partie des pays les praticiens suivent un code éthique ou des principes d’ordre éthiques
• Pour la grande majorité, ce code et ces principes ne sont cependant pas dédiés à
la médecine
traditionnelle, mais sont partagé
avec la médecine conventionnelle.
A remarquer: les réponses au questionnaire montrent que les praticiens dans la zone Afrique ne suivent pas de code éthique déterminé. Cette zone concentre cependant l’une des plus grandes utilisations de la médecine traditionnelle par la population locale au monde.
Auditions de praticiensINDE: Dr K.P. Manikandan, spécialiste de la médecine traditionnelle indienne appelée AyurvedaKENYA: Dr Jack Githae, practicien de médecine traditionnelle CHINE: Dr Xin Guan, practicien de médecine traditionnelle chinoise et membre du comité d’éthique de l’hôpital de l’Université de médecine traditionnelle chinoise de ShanghaiPEROU: Dr Sasha Barrio, practicien de médecine traditionnel, spécialiste en phytothérapie
Auditions de praticiens (suite)Thèmes abordés de la perspective du praticien :
Mode et domaines de la transmission des savoirs Forces et faiblesses de leur pratique (maux ou d’affections non traités, domaines d’efficacité de leur traitement)Critères établissant l’efficacité des soins prodigués Relation avec les patients Perception et gestion du risque de nuire les patients Principes d’ordre éthiquesSystèmes locaux qui garantissent la qualité et l’expertise des praticiensRéseaux locaux de praticiens Différences et relation médicine traditionnelle /médecine conventionnelle.
Ethical Implications of traditional medicine
Presentation by
Dr.K.P.ManikandanCNS Ayurveda Chikitsalayam & Research Center
Mezhathur, Kerala, India.
Ethical Implications of traditional medicine
Knowledge TransmissionAyurveda pediatrics (Baala chikitsa)
Late. Vaidya Chatharu Nair(Great Grand Father 1874 – 1967)
Vaidya Gangadharan Nair(Father)
Dr.K.P.Manikandan B.A.M.S Degree Holder
Ethical Implications of traditional medicine
The 8 branches of Ayurveda1.Kaya (General Medicine)
2. Baala (Pediatrics)3. Graha (Psychiatry)4.Urdwanga (ENT) 5. Shalya (Surgery)
6. Damshtra (Toxicology)7. Jaraa (Geriatrics) &
8. Vrishya (Aphrodisiacs)
Ethical Implications of traditional medicine
Scope of treatment
Enhance Patient Satisfaction through the effective application
of Traditional Ayurveda System & build a healthy new
generation through Ayurveda Pediatrics (Bala Chikitsa)
Ethical Implications of traditional medicine
Definition of AyurvedaThe discriminative knowledge for longevity of both
psyche and soma is known as Ayurveda.
W.H.O Definition of traditional medicine“ The sum total of knowledge, skills and practices based on
the theories, beliefs and experiences indigenous to different cultures that are used maintain health, as well as to prevent, diagnose, improve or treat physical and
mental illness”
Ethical Implications of traditional medicine
Strengths
Wide recognition among rural and urban areas as Primary Health care Providers.
Treating almost all chronic medical conditions successfully. (e.g. Rheumatism, Skin disorders, Metabolic disorders, Musculo-skeletal disorders, Neurological anomalies, Life style disordersetc.).
We help people avoid drug overuse or abuse and reduce dependency on unsafe, unreliable synthetic drugs in short and long term use (Eg. Usage of Sodium Valporate in Epilepsy)
Ethical Implications of traditional medicine
Weakness
Closely held information as secret or sacred remedies within families of Traditional Practitioners.
Absence of network or team work amongst traditional Practitioners. They prefer to work as individual and not as a team.
Inability to manage acute medical conditions effectively. (e.g. Severe Accidental Injuries, Burns, etc)
Ethical Implications of traditional medicine
Major Strength
Ayurveda believes almost all disorders are due to poor/weak digestive system and this is the
most significant factor in Ayurveda.
Ethical Implications of traditional medicine
Efficiency of treatment
The efficacy of Ayurveda Treatment depends on the satisfaction of the patient .Quality of medicine is also an important factor in the efficacy of treatment. Ayurveda treatment is highly individualistic, one can not arrive at a common criterion. Ayurveda defines health not only as the state of equilibrium of the three bio-energies of the body - Vata. Pita & Kapha but also the healthy state of mind. Hence only through a physical observation we can not establish the efficacy of the treatment.
Ethical Implications of traditional medicine
Relationship Patient/Practitioner
“Obedience to Physician is the virtue of Patient & Practical Skill is the Quality of a Physician”
I am proud of being a Physician in the service of Ayurveda for peoples see the reflection of God in Physician.
Ethical Implications of traditional medicine
Risk assessment
There are two types of Ayurveda treatment Sodana (Purificatory) and
Samana (Pacification). There is some risk involved in Purificatory
treatment, mainly in some surgical conditions like Sira Veda (a blood
letting therapy), induced vomiting, and Enema using decoctions.
There is no risk involved in the Pacificatory treatment. Further it is a
well known factor that Ayurveda medicine has no side effects.
Ethical Implications of traditional medicine
Ethical Values
There are three factors that governs the ethical value of Ayurveda, that the Physician shall not overuse, misuse or disuse Ayurveda System.
Physician shall able to enhance the value of Ayurveda through social commitment and self-less service to alleviate the ailing humanity at a reasonable cost.
Ethical Implications of traditional medicine
Quality and Expertise of Traditional medical knowledge
The Govt. of India established a department of Ayurveda, Yoga & Naturopathy, Unani, Sidha & Homeopathy (AYUSH) in 2003 with a view to providing focused attention to development of Education, Research, Quality control and Standardization of drugs and awareness generation about the efficacy of the system domestically and internationally.
As such there is no unofficial system prevails for sanctioning /guaranteeing the quality and expertise of practitioners’ medical knowledge.
Ethical Implications of traditional medicine
Network of Practitioners
There are various Private Ayurveda Practitioners Associations,
located in Kerala which represent the Practitioners before
Government Authorities and Conducting Continual Medical
Education (CME) Classes/training etc.
Ethical Implications of traditional medicineDifferences between traditional and Conventional Medicine
Not individualistic. Highly Individualistic
Relationship is not based in person but based on various tests.
Good Patient – Physician relationship
Cost of treatment is often unaffordable Cost of consultations / therapy are affordable
Limited since Doctors are concentrated in Cities.
Accessibility to all sections of the community
Developed in 19th Century only. Since time immemorial (more than 5000 years)
Based on Scientific evidence hence frequent updating is needed.
Based on Established knowledge
Treatments are symptom based Equilibrium of the three bio-energies is the base of treatment.
Conventional medicineTraditional medicine
Ethical Implications of traditional medicine
Conclusion
In my practice, different conventional clinical tests are restricted to adjudge various conditions of ailments.Helps to develop products which is palatable in taste and easy to consume with the present trend.
Ethical Implications of traditional medicine
GM Gary Kasparov
The Ethical Implications of
Traditional Medicine: The
Experiences of a Kenyan
Practitioner
Paper presented at the 18th Annual Session of UNESCO’s
International Bioethics Committee
On 31st May 2011 at Baku, Azerbaijan
By Dr Jack K Githae
The Practice of
Traditional Medicine in
the World
• Traditional Medicine occupies a central role in the world’s development
• The World Health Organization (WHO) estimates that 80% of people in the developing countries depend on traditional medicine for their healthcare needs
Acquisition and
Transmission of
Knowledge in Traditional
Medicine
•
Knowledge on traditional medicine has
been handed down over generations by
word of mouth.
•
By the way of voluntary participation,
traditional healers acquire knowledge
•
I developed interest in traditional
medicine as a young boy in the 1940s
through my paternal grandmother who
was a respected healer
Knowledge Acquisition and
Transmission contd.
•
I furthered this knowledge through
interaction with healers from diverse
ethnic groups
•
In my years of formal schooling, I
furthered this knowledge through
literature review in libraries, including
New Mexico (USA) and Southern
Australia where I was in university
•
as a full‐time practitioner, I interacted
with knowledgeable people who
contributed to my experience
Knowledge Acquisition and
Transmission contd.
•
I have served in senior capacities in the
field of traditional medicine – World
Council of Churches Pharmaceutical
Advisory Group; and currently a
member of the WHO Expert Committee
on Traditional Medicine – Africa
Regional Office
•
The field of traditional medicine is so
intensive, wide and embracing. I
initiated The School of Alternative
Medicine and Technology to articulate
ATM on participatory education
approaches
Scope of Treatment in
African Traditional
Medicine (ATM)
•
My practice evolved out of the
community’s desperate health needs.
•
I therefore evolved capacity and
resources to deal with all ailments
common in Kenya
•
I covered the entire country through a
network of 15 service outreach clinics
Disease prevalence rates in
some clinics
Disease prevalence rates in
some clinics
DONHOLMNAIROBI
ELDORET MALAB A
KISUM U
KISII NAKUR U
NYAHURURU NYER I
MERU MOMBASSA AVERAGE (MEAN)
DISTANCE FROM NAIROBI (KM)
0 350 470 340 354 154 190 157 267 480 276.2
ASTHMA 15.5 15 6.6 7.9 5.9 19 36 29.7 10.3 10.3 15.62
ULCERS 11.6 18 4.4 5.3 2.9 9.6 7.3 9.9 5.1 5.1 7.92
HYPERTENSION 15.5 12 13.3 18.2 8.7 9.6 7.3 9.9 5.1 17.9 11.75
DIABETES 3.9 3 11 7.9 20.3 9.6 7.3 4.9 7.2 15.4 9.05
MALARIA 1.6 1.8 4.4 7.9 20.3 3.8 1.5 0.9 5.1 10.3 5.76
TYPHOID 3.9 9 8.9 15.8 14.5 14.4 7.3 4.9 10.3 7.7 9.67
AMOEBIASIS 3.9 6 6.6 7.9 11.6 9.6 3 4.9 30.9 7.7 9.21
SICKLE CELL 1.6 0.6 15.6 2.6 0 0 0 0 0 0 2.04
CHEST INFECTION
23.4 15 13.3 10.5 8.7 9.6 14.6 19.8 10.3 10.3 13.55
VENEREALS 19.5 12 15.6 15.8 5.9 14.4 14.6 14.8 15.5 15.4 14.35
Table 2: Human diseases and their responses to h
Stomach ulcers 95%
Asthma / general chest infections 95%
Venereal diseases 85%
Skin diseases 70%
Malaria 70%
Kidney / Kidney infections 65%
Rheumatism / Arthritis 65%
Hypertension 65%
Goitre 65%
Sickle cell anaemia 60%
Diabetes 60%
Fibroids 60%
Tuberculosis 50%
HIV / Aids 50%
Breast cancer 50%
Prostate problems 50
Human diseases and their
estimated response to ATM
Success of Treatment by
ATM• In my practice of ATM, I have been able
to formulate effective cure of asthma,
stomach ulcers, sexually transmitted
infections and arthritis.
• At the same time, we are aggressively
engaged in improving our therapies for
cancer, TB and HIV‐Aids in humans.
• In livestock, we aspire to improve on
our formulations for CPP in goats, East
Coast Fever in cattle; parvo virus in
dogs and a few emerging diseases in
poultry and rabbits
Efficiency of Treatment
Our criteria of attaining and sustaining
high efficacy levels in our therapy is
basically centred on sustenance of
holistic organism approach as opposed
to symptom‐oriented Western
therapeutic approach.
Patient‐Practitioner
RelationshipCordial healer, patient and environmental
relationship is fundamental. This is
because wholistic healing –
body, mind
and spirit – is three‐pronged
constituting a triangle (The Triangle of
Wholistic Healing)
The HealerThe Sick
Ecosystem
GOD
The Assessment of Risk
•The diversity of ATM practices and
resources facilitates at all times selection
of both the safest practices and resources
in all therapeutic undertakings. •Consequently, good and authentic
practitioners start their practice by
outlining and avoiding all dangerous
practices and toxic therapeutic material
as a cardinal prerequisite to practice. •The four universal cardinal
considerations in therapeutic viability i.e.
safety, efficacy, affordability and
availability are always applied by ATM
practitioners in all their therapeutic
formulations and approaches.
Ethics and Values in ATM
•High moral fibre, •Very competent, passionate and
effective in practice •An all‐rounder and very industrious
person capable of prospecting, procuring,
processing, formulating, diagnosing and
dispensing simultaneously! •Selflessness, honesty, organizational and
managerial capacity and discipline of a
very high level. •Accessible, affordable and readily
available to serve patients whenever and
wherever required.
Quality Assurance and Safety
Systems
•Quality and safety assurance
mechanisms of ATM have been in
existence in most traditional societies. •Modern cosmopolitanism and
urbanization in most cases tend to
break the cultural norms and values
that regulate ATM and indigenous
knowledge •In many African countries, the WHO
member states are in the process of
adopting WHO Guidelines on
institutionalization, legislation and
regulation of ATM within which there
are professional provisions for quality
and safety assurance in ATM
ATM Practitioners Network
•Currently, the existing ATM associations and
networks are redundant and retrogressive.
•The scenario has given conventional medical
practitioners and the international drug
manufacturers a golden opportunity to cripple
and destroy ATM
•Without an appropriate national ATM legal and
regulatory framework, traditional health
practitioners are deemed irrelevant and un‐
impactful.
Differences between ATM
and Conventional Medicine
ATM is wholistic in nature where the patient’s
dietary and lifestyle habits; as well as relevant
socio‐cultural perspectives are addressed and
harmonized – making ATM much more culturally
acceptable and compatible than conventional
medicine.
ATM is more readily accessible, available and
affordable within the consumers natural and
cultural settings in which case its access and
utilization does not adversely disrupt the routine
and environmental setting of the patients.
Differences between ATM and
Conventional Medicine (Contd)
•
Because of its usage of local natural
resources, ATM is much safer and
effective than the conventional symptom‐
oriented chemical therapies with known
side effects.
•
The non‐commercial, voluntary/free
service and cultural nature of ethical ATM
practice makes it much more humane and
equitable than the commercial,
exploitative western medicine.
•
Conventional medical practice normally
handles the human being like a machine
whose broken or non‐functioning parts
are repaired or replaced, ignoring the
ATM’s cardinal appreciation of the fact
that a human being is a living organism
•
Conventional medicine is institutionalized
with inter‐dependent professional
associations and fraternities which are
fully economically and politically
supported and protected unlike ATM
which is not.
Differences between ATM and
Conventional Medicine (Contd)
Thank you.
Questions
Traditional Chinese Medicine
Dr. Guan XinMD, PhD
Shuguang HospitalAffiliated with Shanghai University of T.C.M.
June 2011
Outline
1. Brief Introduction of TCM2. Education and Training3. Clinical Practice4. Ethical values5.
Integration Between TCM and Western Medicine
1, Brief introduction
•
More than 3000 years old•
Systematic theory support: Yin-Yang, Five-elements, Concepts of wholeness and syndrome differentiation, etc
•
Multiple methods to diagnose and cure illness: i.e.; Herbs, Acupuncture/Moxibustion, Tuina
massage,
Four diagnostic methods(����)
Four famous TCM doctors in the history
•
Bian
Que(2400 years ago)•
Hua
Tuo
(1870 years ago)•
Zhang Zhongjing
(1860 years ago)•
Li Shizhen
(500 years ago)
Four famous medical classic of TCM
•
Huangdi
Neijing
(Huangdi’s
Canon of Medicine)•
Shanghan
Lun
(Treatise on Exogenous Cold
Diseases)•
Jingui
Yaolue
(Synopsiss
of Golden Chamber)
•
Wenbing
Xue
(Seasonal Warm Diseases)
Basic theory of T.C.M.
Yin-yang and five elements
Zang xiang
Qi, blood and body fluid
The meridian and collaterals
etiology
Prevention and therapeutic principles
pathogenesis
The Theory of Yin-Yang
Yin-Yang theory holds that all phenomena consists of opposite aspects, yin and yang, which are defined as: up and down, left and right, light and dark, hot and cold, stillness and movement, substance and function, etc.
The concept of holism means that
• the human body is an organic wholeness
• and that human beings are interrelated with
nature.
Concept of holism/wholeness
Concept of Syndrome Differentiation (Bianzheng lunzhi)
Syndrome differentiation in treatment means to judge and summarize the clinical data of symptoms and signs collected through the four diagnostic methods into a specific pattern. Then the therapeutic methods are decided according to the result of this syndrome differentiation.
Four main diagnostic techniques
•
Observation•
Questioning
•
Smelling and listening•
Pulse taking
2. Education and TrainingIn the past knowledge was transferred from Master to apprentice. This type of learning was often done in familial lineages (ex: from father to son).
•Nowadays, there is an university/college in almost every province in China. •There are many different levels of study for students: bachelor, master, doctoral degree.•Generally speaking, TCM students get an education consisting of 60% TCM and 40% western medicine.•Very often, the bigger hospitals are also teaching hospitals affiliated with their respective universities. Senior doctors now hold the responsibilities to teach.
Take myself as example: •
I received a Master’s degree after 7 seven years of study. This was broken down as such:2 years in Fudan
University, a very
good General Science university3 years in Shanghai University of TCM, for TCM basic theory, Internal Medicine, Gynecology, Pediatrics, etc.2 years in Shuguang
Hospital to
intern in each department to gainclinical training.
•
I then became a residency doctor after completing a licensing exam
•
Became an attending doctor after 2 years rotation amongst different departments.
•
Became a vice chief doctor after 5 years when I completed the requirements
•
Currently, I am working on the title of chief doctor, this could perhaps take another 5 years
3. Clinical PracticeBackground information:
In 1986, state administration of TCM was established by the central government. TCM in China has very strong support in various aspects such as finance, human resource, policy, etc. For example:
•
TCM is covered by national medical insurance•
TCM doctors can prescribe western medicine as well
•
Good government budgets on modernization, standardization and internationalization of TCM
•
Many different tests/exams are established to guarantee the quality of practice, like licensing exam, continuing education/tests, inspections, etc.
•
The improvement of quality helps to reduce the risk/danger of harming a patient.
•
As an acupuncturist, I was told the potential danger of needling a patient and should know how to prevent it and the protocol for rescue measures in case of emergency.
Strength
of TCM•Individualized treatment•For many diseases, TCM treatment is very effective•Less side-effects and drug tolerance•Economic advantage and convenience to practice•Multiple therapeutic and preventive methods
• Individualized treatment. In accordance with the principle that different
people have different physiological and pathological reactions, tolerance of medicine and side-effects to drugs.
• For many diseases, TCM treatment is quite effective.
For example: chronic fatigue syndrome, menstruation disorder, infertility, colds & flu, chronic liver disease (hepatic fibrosis or hepatitis), tumors, aging diseases, pain management, inflammatory bowel syndrome (IBS), constipation, insomnia and weight problems to name just a few.
• Compared with chemical drugs, TCM has far fewer side-effects, drug tolerance and is also quite cost effective.
Acupuncture anesthesia
•
Very convenient to practice
A real case from my own practice: Single needle cured severe stomachache
• Plentiful therapeutic methods
Herbal medicine
TuiNa
massage
Cupping
Qigong: e.g. Taiji quan, Baduanjin
Prevention is KEY
TCM is given priority as prevention over treatment. It is important to take measures before the occurrence of a disease or at the primary stage of a disease in order to avoid suffering and/or aggravation.
Three aspects of this concept
• Preventing the occurrence of diseases
• Preventing progression and transmission through: early treatment and control
• Preventing the reoccurrence after cure
•
The fact is that the burden of medical expense is heavier and many new diseases appear at the time when we fight the hardest against diseases.
•
Currently, a huge project is being carried out in the entire country of China. The main purpose is to use TCM to prevent diseases and keep people healthy so that it could reduce the medical cost in the long term.
Weakness
•
All the classics were written in ancient Chinese characters which are quite difficult for people now to understand.
•
Theory system is very complicated and the experiences of one practitioner are not easy to duplicate.
•
Weakness on single point like reducing blood pressure, controlling blood sugar or bacteria infection.
•
Many techniques for acute illness, first-aid were lost
•
So flexible that it is very difficult to make standards for practice
•
Not many contributions in the area of surgery.
•
Herbal taste is often quite bitter
4, Ethical values•
In Tang dynasty, Dr. Sun Simiao
wrote the
following words which still guide our practice :Generally speaking, when the well-qualified doctors treat patients, they are usually calm and concentrated without any desire and avarice. They first have great sympathy for the patients and then are determined to save people from the suffering. If patients come to ask for help, they should not treat them differently by seeing whether they are rich or poor, old or young, beautiful or ugly, enemy or friend, Chinese or foreigners, and foolish or wise.
They should treat all the patients like their close relatives. In treating patients, they should not think over and over for themselves and pay too much attention to the protection of their own life. Being doctors, they should regard the patients suffering as their own and have deep sympathy for them. Confronted with danger, they should not try to avoid it. No matter in the daytime or night, in the winter or summer, and no matter they are hungry or thirsty, and tired or exhausted, they should work for the patients heart and soul, without any delay or regardless of personal thought for gain or loss. Only by doing so can one become a great doctor for the people. Otherwise he or she will surely become a scourge of the people.
In Ming dynasty, Dr. Chen Shigong
raised “Five Taboos and Ten Must”
which was
the first formal medical moral criteria in the history.
•
The core of TCM ethical value is “Ren” (Chinese character is “�”) which means
humanity, kindness, or philanthropy, etc.
•
The goal of TCM practice is “�“
which means harmony “between heaven and human”, “between Yin and Yang”, “between doctors and patients”
5. Integration Between TCM and Western Medicine
Although there are quite a few differences between themFor example:•
Different thinking methods. TCM focuses on the human and maintenance of a healthy balance rather than on diseases themselves.
•
TCM originated from the analysis of universe energy and human body. Western medicine relies on modern science techniques.
•
TCM accepts acupoints, meridians, and Qi which can not be touched or seen so far.
There are still many ways to combine these two medicines. As TCM doctors, we have the convenience to do that.
•
Almost all TCM doctors make two diagnosis then choose one or two treatment methods.
•
In order to get optimal results, we use these two medicines together very often, especially for diseases like diabetes, tumor, hypertension, etc.
Finally, I whole-heartedly believe that TCM has been a solution to human health problems for thousands of years and will continue to be for thousands more...
Thank you for your attention !
