Hong Hai 黄海

Nanyang Technological University 南洋理工大学

BIT 3rd Global Health Conference – 2015

Kaohsiung, Taiwan

27th November, 2015

Traditional Chinese Medicine in Preventative

Healthcare

Objections to TCM

Entities like qi and meridians are ill-defined. Response: They are conceptual constructs to

facilitate diagnostic and therapy models

“Organs” like spleen and kidney are different from those in modern physiology.

These are clusters of functions

Models like Yin-Yang and the Five Elements have no basis in laws of nature, unlike physics.

True. They are heuristic

It is not “evidence-based”. Most interventions not subjected to randomized

controlled trials (RCTs). Fair comment.

Should a therapeutic method be used when evidence is still lacking by EBM

standards? (Personal choice)

“Last great problem” in biomedicine

“Medicine’s post-war success, built on discovery of drugs and technological

innovation, concealed the fact that its impressive achievements had been

without the necessity to understand the nature of causation of disease.”

“ The future prospect of medical advance is predicated on confronting the

central, unanswered but most potent of all questions, the biological cause of

diseases… indeed the vast majority of the conditions in the medical

textbooks.”

James Le Fanu. The Rise and Fall of Modern Medicine (2012)

(Le Fanu lists rheumatoid arthritis, multiple sclerosis, shcizophrenia and most

forms of cancer as among those with unknown causes.)

“Diseases of civilization” Stephen Ilardi, MD

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1. “Radical environmental mutation” Depression, atherosclerosis, asthma,

diabetes and cancers are results of modern lifestyles following the industrial revolution

2. Evolution Interrupted: Man changed from hunter-gatherers to desk-workers

for which he is genetically unadapted. Brain’s “runaway stress response” (minutes)

replaced by prolonged stress, processed foods and lack of exercise/social interaction.

3. Proliferation of anti-depressants, statins, hormonal therapies and antibiotics

replaces the body’s self-healing with interventions whose impact on human physiology

are not fully understood. Clinical trial: Walking half an hour 3 times a day beats Zoloft.

4. Solution : Return to old lifestyles. TCM Yangsheng 养生 (Life cultivation) points in the same direction:

Regularity , moderation, balance, qigong exercises, tranquility of mind

Role of TCM in modern society

Yangsheng for cultivating good health and preventing illness esp. aged

Complementarity to Western interventions in selective areas, e.g, stroke patients using

acupuncture and mild tonics; cancer patients with weakened immune systems

Common complaints like gastritis, irritable bowel syndrome, chronic cough, menstrual

problems (after more serious underlying conditions have been excluded.)

Diet: Follow modern guidelines on healthy diet but within that diet it is possible to

choose foods and herb supplements that fits one’s constitution

More research needed on safety and efficacy of TCM practices, and better understanding

of TCM by Western physicians whose patients also use TCM

New Dietary Guidelines

1. Lifted caps on dietary cholesterol: “no appreciable relationship” between dietary cholesterol and blood cholesterol. No need to avoid egg yolks, liver and shellfish.

2. Cutting fat and cholesterol may have even worsened our health. More grains, pasta and starchy vegetables for 50 years, cutting fat intake by 25 percent and increased carbohydrates by more than 30 percent.

3. A high-carbohydrate diet rich in sugar and refined grains increases the risk of obesity, diabetes and heart disease — much more so than a diet high in fat and cholesterol.

Nutritionist Dr Mercola recommends 50% or more of the diet to consist of “healthy fats” argues that “A high-fat low-carb diet can be effective for weight loss. A certain amount of saturated fats are essential for cellular and hormonal function, but also provide a concentrated source of energy.” http://articles.mercola.com/sites/articles/archive/2015/06/15/2015-dietary-

guidelines.aspx

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Combining Chinese and Western diets

West: Limit carbohydrate intake, avoid high glycemic-index carbohydrates and trans

fats, and use moderate the amounts of saturated and unsaturated fats. Eat more

vegetables especially those rich in fibre.

Chinese: Tailor diet (including tonic foods and herbs) to constitution, environmental

conditions and daily activities.

Best of both worlds

A diet that integrates the best of Chinese and Western diets may consist of something akin

to a Mediterranean diet within which the choice of grains, meats, fruits and vegetables are

appropriate to the individual’s constitution and physical environment, supplemented with

tonic herbs

Chronic illnesses in the middle-aged

and elderly

Common Conditions

Cardiovascular diseases

Gastro-intestinal disorders

Arthritis and joint pains

Metabolic syndrome and diabetes

Insomnia

Dementia and Depression

Cancers

TCM

The conditions expressed in Western terms usually have no exact equivalents in TCM

Role of TCM – alternative/complementary

Acute and emergency situations often not suited to TCM treatment

Yangsheng and treating diseases that have

not yet occurred 治未病

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Sub-clinical illness (yajiankang 亚健康) No clinical indications of disease, but the

person does not feel totally well. 80% of people are in this category (WHO). TCM

regards the person as being unwell, having one or more syndromes

Yangsheng addresses this issue at two levels:

Avoid developing syndromes (e.g. avoid developing deficiency of yin in hot sweaty

weather)

If already at sub-clinical illness level, prevent the syndrome from developing into a

clinical disease (e.g. prevent endogenous wind, arising from stress, from developing

into hypertension)

The physiology of ageing

Biomedical view TCM view

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Cardiac output declines; elasticity of lung

decreases

Metabolic syndrome develops ; fluid and

electrolyte homeostasis affected

Vision and hearing neurological decline

Inflammation, the body’s defense against

invaders such as bad bacteria, viruses, and

toxins, involves oxidative stress (a biological

“rusting” of our tissues and organs)

Inflammation can disrupt the immune system,

cause accelerated ageing and lead to chronic

illnesses

Decline of the five zang organs 五脏日虚

Difficulty in transforming food into

nutrients 易生积滞 (spleen-stomach weakness)

Vulnerable to attack by external pathogens

易感外邪 (defensive qi declines)

Tendency to have emotional upsets 易伤七情, and developing depression

TCM Health preservation

At middle age For the elderly

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1. Cultivate mind and spirit for

tranquility. Meditation.

2. Work moderately and avoid

overstrain.

3. Regularity in living habits helps

avoid overstrain.

4. Prudent use of tonics is needed to

slow down the ageing process and

delay decline into infirmity.

1. Come to terms with limit of life: seek peace, have positive outlook.

2. Diet: With weak spleen and stomach, eat warm cooked food that is easy to digest. Choose medicated diet over medicine.

3. Exercise to boost qi. Avoid competitive sports and exercising in bad weather

4. Lifestyle: Regularity in habits, avoid late nights, wear clothes appropriate to the climate.

5. Tonics should be taken in smaller quantities over longer periods.

TCM understanding of coronary heart

disease 胸痹

Two main common underlying “syndromes” of CHDs:

Blood stasis

Manifested as impediments to the flow of blood and qi

Qi deficiency (weakness of ‘heart-qi’)

“Qi is the marshal of blood, blood is the mother of qi”

(Weak qi will result in poor circulation of blood, hence one can regard weak qi as

the basic underlying syndrome and blood stasis as the resultant syndrome)

Prevention of Coronary Heart Disease (combining biomedicine and TCM)

• Regular exercise and a diet rich in fibre with fresh fruit and vegetable to promote endothelial

health. Moderation in amounts of fats and carbohydrates (nutritionist opinions differ); TCM

recommends diverse diet (five flavours) chosen to suit one’s constitution and environment

• Studies show some foods, e.g. pomegranate (石榴) juice improve arterial health; TCM:

hawthorne, bitter gourd, yellow ginger and black fungus for reducing blood stasis

• Incidences of re-stenosis for patients who have undergone angioplasty and stenting have been

found to respond well to a formulation containing herbs that improve qi and resolve blood

stasis: renshen 人参, huangqi 黄芪, danshen 丹参 (red sage), honghua 红花, taoren 桃仁,

fuling 茯苓and gancao 甘草。

TCM management of hypertension & Stroke

Stress leads to the hyperactivity of liver yang 肝阳上亢, manifested as hypertension.

Liver wind (肝风) is the main internal pathogen for stroke, generated by hyperactivity of the liver, wind from pathogenic heat, weakness of yin and blood, emotional stress etc.

Treatments

• Mild cases treated with diet, lifestyle changes and medications like tianmagouteng yin 天麻钩藤饮 to calm liver and reduce hypertension

• Patients in the recovery phase usually have qi deficiency and poor blood flow.

Buyanghuanwu tang 补阳还五汤 is used for patients at later stages to tonify qi and reduce blood stasis

• Acupuncture/acupressure, qigong and taiji improve qi level and flow and motor skills;

counselling to cultivate positive emotions

Herbs and foods for blood pressure

The herbs tianma 天麻 and gouteng 钩藤 are believed to help control blood

pressure. They have the action of calming liver yang and expel liver wind. Hence,

they are also often used to treat headaches and dizziness resulted from hyperactivity

of liver yang.

They are used in the prescription tianma gouteng yin 天麻钩藤饮for treating

hypertension and managing the initial period after a stroke.

Foods thought to help control blood pressure are beet juice, spinach, lettuce,

cabbage, carrots, bananas, raisins, potatoes, and melons.

Food thought to help achieve healthy cholesterol levels include black fungus, celery,

walnuts, fishes (salmons), cereals with high fibre content (e.g. rye bread, whole grain

wheat).

TCM management of metabolic syndrome

and Type 2 diabetes

Recorded as 消渴 xiaoke in Huangdi Neijing 黄帝内经 . Main

underlying problem: Yin deficiency with asthenic fire and dryness 阴虚燥热

TCM approach: To treat the imbalances which are determined by the

syndrome

To replenish the yin and dryness and remove the heat (yin tonics)

Some herbs can be used to control blood glucose level eg. purslane 马齿苋which is made into capsules to better manage blood glucose level

Chinese herbs that suggest can control

blood glucose level

Huangqi 黄芪 (Astragalus)

Huaishan 山药 (Chinese yam)

Gegeng 葛根 (Kudzuvine Root)

Cangshu 苍术 Xuanshen 玄参 （Figwort Root）

Rougui 肉桂 (Cinnamon bark)

TCM understanding of rheumatism (bi

bing 痹病)

• TCM interprets rheumatism to arise from impeded flows of

blood and qi (气血不通) and blockages in the meridians

(经络痹阻)

• Primary pathogens involved are wind, dampness, cold and heat.

They attack a body that has weakened healthy qi (zheng qi), in

particular defensive qi (wei qi)

Syndromes commonly associated with

rheumatism

Wind and dampness 风湿痹阻

Pain in the joints and muscles, move to different locations; joints feel heavy and numb

Prescription: Juan bi tang 蠲痹汤

Deficiency of kidney and liver 肝肾亏虚

Chronic joint pain accompanied by stiff joints, soreness in the knee and lower back, aversion to cold.

Prescription: Du huo ji sheng tang 独活寄生汤

Heat dampness 湿热痹阻

Red swollen joints, joints feel heavy and restrict movements, yellow urine, yellow greasy fur.

Prescription: Dang gui nian tong tang当归拈痛汤 + Xuan bi tang 宣痹汤

•“Qi” in qigong refers to the qi of TCM, “gong” refers to skill or

technique

•Hence qigong is a method or technique of building and moving qi.

•Qigong involves meditation and breathing to promote the

production and flow of blood and qi and strengthen the internal

organs

Qigong 气功 and Meditation

Evolved as a school in its own right from

various forms of qigong. It comprises

theory, manipulating skills, and clinical

practice.

Guided by traditional Chinese philosophy

Emphasizes integration of dynamic and

static exercise

Attention to the integration of three

adjustments 三调合一(movement, breathing and mind)

Aims at preventing and treating diseases

以传统哲学思想为指导

对各家修炼方法兼收并蓄

强调动静结合

重视三调合一 (以自身形体活动、呼吸吐纳、心理调节相结合为主要运动形式)

以防治疾病为目的

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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

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Combining Western and Chinese exercises

Jogging, racquet sports good for cardiovascular

systems

Muscle strengthening and stretching exercises

for posture and muscular-skeletal fitness

Qigong and Taiji promote qi and blood

circulation, mind and body balance

Car Analogy -- keep engine in tune

Can combine both kinds of exercise; but in later

years Chinese exercises may be more feasible

for the elderly

Conjectures

1. Inflammation that underlies cancer, cardiovascular disease, arthritis, etc may have

something in common with yin-yang imbalance and impeded qi flows in TCM.

2. For example, the TCM concept of improving qi flow and“reducing blood stasis”

(huoxue huayu 活血化瘀) may be related to improving endothelial health for management of coronary heart disease. (Clinicians at the China Academy of TCM

use cocktail of qi and blood stasis reduction herbs to slow down plaque formation

and prevent re-stenosis after angioplasty. Clinical trials in progress).

3. System biology focusing on interactions within biological systems has much in

common with TCM holism. Research in this direction could lead to a measure of

convergence between biomedicine and ancient medicine in promoting better health

and disease prevention.

In a nutshell

TCM treats each person as different (patient-centric) and does not prescribe diets or exercises that suit everyone

TCM diets must fit the person’s constitution, environment and activities

Western nutrition guidelines should be followed, but within those guidelines we can use TCM principles to choose foods and supplements suitable for the individual

Aerobic exercises for cardiovascular and muscular fitness should be moderated at intensity levels to fit the individual.

Chinese exercises like qigong and taiji aim more at better qi and blood flow, and better mobility and balance, and may be practised to a late old age.

Modern perspective of principles

underlying Chinese therapies and

health cultivation

Empirical scientific basis for TCM

Chinese and Western explanations of

common chronic illnesses

Table of herbs and herbal formulations

in the appendix

(Available from Amazon/Kindle)