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What is Chinese medicine, what is it good for, and what will it do for you: a reflection after two years in practice.

What is Chinese medicine, what is it good for, and what will it do for you: a reflection after two years in practice.

by Chad Ryan

Chinese medicine is中醫 zhōng yī. The second of these two characters, 醫 , can be interpreted through its radical components. 矢 shĭ, means arrow, dart, straight, to vow, to swear, and is an old variant of 屎, meaning stool, faeces, ear wax or nasal mucous. Surrounding this is the open rectangle ⊏ means cover or conceal. To the right, 殳 shū means a bamboo or wooden spear. Beneath, 酉yǒu, as a radical, means wine. This character 醫 can thus be seen as depicting a wooden spear with its arrowhead imbedded, presumably within flesh, and a bottle of alcohol ready to sterilise the wound which has been created by this injury, once the spear has been removed. Its literal meaning is medicine. The first character 中 zhōng is a straight line intercepting the centre of a rectangle, and while this is the character which the Chinese now use to refer to their own country, its basic meaning is ‘middle’. My own impression is that it is befitting that 中醫 zhōng yī may be said, not only to mean ‘medicine of the China’, but also to mean ‘medicine of the middle’, for Chinese medicine is a medical system which perceives life entities at the centre of their own universe.

Consider, the human body, dotted with hundreds of pressure points, which when stimulated by touch, can adjust the balance of the energetics of the entire organism; or that much of the entire natural world, with all its flora, fauna and minerals, can be ingested to therapeutic effect; or that even the blood, coursing through arterial vessels, can be felt from the surface, and by its pulsating manner, reveal the nature of the disharmony in health of its bearer in their entirety. If this is all coming across as a bit egocentric, well Chinese medicine like most health therapies is indeed designed to serve an individual self. Though while Western biomedicine could be considered comparatively objective in nature, traditional Chinese medicine might generally be considered a relatively subjective theoretical entity, and this observation becomes apparent when considering the some of the symptoms which Chinese medicine inquires into, such as dreams during sleep and tastes in the mouth. From the side of the consultation desk where sits the practitioner or student of Chinese medicine, there are no doubt many self-serving perks which make entering this particular field of study particularly attractive. The Chinese medical student, who is typically a passionate proponent of his or her own profession, receives a sound knowledge of anatomy and physiology, an introduction to botany, a foundation in remedial massage, and familiarity with the functional properties of food, all of which comes as profitable knowledge for everyday life.

Dietary acumen is an area of Chinese medicine where a patient too can learn from their physician and thus play a more active role in the regulation of their own health. Such common Chinese sayings as 病從口入 bìngcóngkŏurù, which means ‘disease enters through the mouth’, and 藥食同源 yàoshítóngyuán, which means ‘there is no clear-cut distinction between food and medicine’, underline the importance diet therapy. A patient should nonetheless be admonished from assuming that they can always treat themselves effectively by plucking out a few facts according to symptomology. Diagnosis is perhaps the most complex, and surely the most important skill in Chinese medicine, and it is done according to a number of what are called "patterns" that have no fixed presentation, but rather are only progressively reaffirmed by increased incidence of combinations of markers, or symptoms, that are considered to be in correlation, and which happen to outweigh rivaling combinations of markers.  對症下藥 dìuzhèngxiàyào ‘to prescribe medicine according to the underlying syndrome’ pays heed to this necessity of looking at the whole picture. As food is not as therapeutically potent as most herbs which can only be prescribed by physicians, it is naturally okay to try out certain diets, and the good news is, the more you eat something which you don’t ideally need to be eating a lot of, the more you are likely to notice that something feels not quite right when you eat that thing, and so you probably feel less like eating it. Health is a bit intuitive, and it is said that 久病成醫 jiŭbìngchéngyī ‘a long illness makes the patient into a doctor’. Along with lifestyle practices, the patient has a huge bearing on their own health, and looking at that from a positive angle, the patient would do well to 因勢利導 yīnshìlìdăo ‘take advantage of the unique nature of one’s own inherent situation’.

Here also is a medical system that is quite entirely non-reliant on modern technological advances, and heaven forbid an apocalypse which would see an end to the global electrical energy supply, traditional Chinese medicine could quite possibly continue on its merry way, hardly breaking stride. With regard to the notion of first principles, the notion of simplicity, and the notion of the worship of nature; traditional therapy, to which traditional Chinese medicine may be considered a vanguard, may furthermore be something to be valued, nurtured and invested in.

The question could on the other hand be begged, as to whether a practice which has inspired the poaching of several animals such as the pangolin, the rhinoceros and the tiger, and which has subsequently brought these species to a threatened status, is truly "worshipping nature". The high price paid for animal products by consumers would suggest that these animals are valued, though that demand being in excess of natural supply as it is, would reveal that such a value has driven exploitation. Chinese medical knowledge is widespread in Asia, and while the practitioner can do their part in helping to make ethical decisions with regard to animal cruelty, by not prescribing medicines made from animals for conditions where there are alternatives at hand, the more widespread cultural challenge in thwarting the process of poaching, may suggest that it is better regulated through a governing body, than allowed to function illegally, where every hunter is just working for themselves. In China, farming practices are in place in many instances, in order to match demands for such medicines, however keeping animals ought raise further misgivings on the subject of righteousness. For instance, in the case of the extortion of the age-old medicine in China of bear bile, though scientific procedures have been adopted to reduce the pain experienced, it is a method performed on live bears over ongoing periods, which sees them kept in permanent captivity.

The notion of pain infliction within Chinese medicine is not refined to poacher toward animal either. As a Chinese saying goes 良藥苦口 liáng​yào​kǔ​kǒu, ‘good medicine tastes bitter’. In China today, needles the width of a toothpick may be thrusted back and forth into the trapezius muscle, before a generous amount of medicinal fluid is injected through a syringe into the same tissue, as a long term pain relieving remedy. A young boy with rickets meanwhile fronts up to clinic on a daily basis in accord with his parents' resolution, where he is constrained and stretched on the table by the weight of two fully grown men; and despite his best attempts to remain brave, he will in due course scream, tears pouring from his eyes. As such does another saying in Chinese, of 諱疾忌醫 huì​jí​jì​yī 'hiding a sickness for fear of treatment', apparently come to stand to some reason. The difference in attitude towards pain in China, where the farming of bears for bile is regulated but still legal, may go some way to explaining how such practices, which have a long history of use, but which involve what could easily be considered animal cruelty in Australia today, continue to be practiced. The sale of bear galls and bile is illegal in Australia, and the practitioners you are likely to meet will not have any involvement in the prescription of this product.

In line with informed consent, a patient of a standard traditional Chinese medicine consultation, as it exists in its current form, might expect a needle no greater than 0.25mm in width to be inserted, and for such a needle to be retained for approximately 25 minutes. A prick would be felt as the needle punctures the skin, and then as the needle is inserted deeper, the idea of eliciting a dull ache would be the intention. Once that sensation had been elicited, the release of the needle would normally allow the feeling to calm down, without necessarily disappearing completely. Then, as the patient lies still in a meditative or relaxed state, they may become aware of their energy at, or in line, or remotely, to the locations of the needle. Other commonly employed implements, such as cups which suck the skin upwards into an airspace of reduced pressure, may form a bruise if left for a period of time not unlike a large ‘hickey’; or a blunt-edged blade which is rubbed on the skin to cause reddening in the practice known as ‘scraping’, may be cause for more intense experiences than standard acupuncture. Heat therapy, known as ‘moxibustion’, may also in certain variations of use be allowed to inflict mild burns, although it is usually used just to provide warmth and is met with approval of the recipient as a nice feeling.

Prior to treatment, a Chinese medicine practitioner will also inspect a patient’s tongue, as this is thought to be reflective of the tissue with the corpus. By its many differential features from person to person, including shape, size, markings, colour and texture, the tongue is regarded a foremost diagnostic marker. More broadly, the many identifying aspects of a person’s makeup, those both physical and relating to personality, may all be suggestive of strength against or vulnerability toward certain ailments through the scope of Chinese medicine. Rarely does any single marker however prove to be conclusive by itself; but rather, sets of correlated markers in conjunction with a substantive complaint that is impeding a person’s wellbeing, will lay the foundations for the formulation of a diagnosis. Usually, disease as Chinese medicine interprets it, is not irreversible. Given an appropriate course of treatment and level of patient compliance, Chinese medicine can offer hope when there may otherwise not be. On the other hand, a person does not need to be aware that there is anything wrong with them at all, to benefit from a session with a Chinese medicine practitioner. Real small adjustments to one’s lifestyle may in time prevent the occurrence a formidable pathology from developing, according to an idea which the Chinese may refer to as 防微杜漸 fáng​wēi​dù​jiàn ‘nipping the bud’. Chinese medicine has not however, to record, succeeded in preventing one single case of mortality, and so should be engaged with alongside a hint of realism. This being said, the application of Chinese medicine should not refrain from addressing morbid and terminal conditions, because when a complete cure is not on the cards, an improved quality of life and abatement of disease progression may very well be.

The nature of Chinese medicine treatment is particularly elementary, being constructed by a number of facets that are combined to produce a sum effect, and these facets, or elements, of the treatment, are also strategically combined to enhance and complement each other, just like notes are combined to create chords and melodies in music. As such, herbs are usually used together in recipes, often copying proven successful combinations, that many be tweaked slightly to suit the individual; and pressure points are stimulated in acupuncture an several locations simultaneously. Acupuncture and herbal medicine seem most analogous to me to the art of selection and delegation, not unlike fielding a soccer team from a selection of several hundred players that will be especially chosen to best exploit, if you will, the opponent’s weaknesses, or the nature of the disease as it may be; except that in this contest, a variable number of choices may be utilised. Although somewhat less fitting with the sport analogy, at least on a level where the motive of the team is strongly geared towards victory, and where precedence of selection may generally be simply given to the most valuable individual players, in good faith that they are all professional enough to integrate themselves appropriately with those around them regardless of who that may be; the great importance of interaction between the selections in Chinese herbal medicine might otherwise be mulled over in manner similar to arranging a dinner party for a particular occasion, whereby guests could be chosen in accordance with the supposed benefit they might both provide and enjoy in the company of the other invitees. You may by now be getting a sense of what is 辯證論治 biànzhènglùnzhì ‘holistic diagnosis and treatment’.

The real question though is whether Chinese medicine really works or not? If I said it didn’t, that could just be a reflection of poor practice on my own behalf, and I wouldn’t want to concede to that. In my first two years of treating, I have seen 94 patients, and 64 of these have provided some sort of feedback on the effectiveness of their treatments. Of these 64, 9 patients were not entirely satisfied by the improvement in their condition, while two others did not seem unsatisfied, but also demonstrated relatively negligible results. Meanwhile 2 of these 64 cases were in fact receiving treatment as a preventative measure for upcoming sporting contests, and so the success these treatments has been defined by maintenance of a stable condition during the event period. Of the 51 others who cited noteworthy improvement in at least one capacity, 4 of these cited that they were just feeling better or less tense generally, 1 vaguely felt that there may have been some nondescript improvement, while another 2 found that their complaint returned prior to the completion of their treatment course. Of the 44 patients who found that a more specific area of their health improved overall during their interaction with me, up to our last time of contact, 17 had improvements in symptoms relating to pain: 5 of the back, 3 of the shoulder, 3 of the feet, 2 of the abdomen, 2 of the hamstring, 1 of the neck, 1 of the wrist, 1 of the hand, 1 of the ankle and 1 of the thumb. Another patient experienced an improvement in range of motion of the neck, while two others recovered from sore throats.  2 patients experiences improvements in their headaches, and 1 for migraines also, while 1 person overcame a condition of painful urination. 2 people experienced improvement in the numbness that they had been experiencing, and another 1 experienced reduced neuropathic tingling. Indeed, the most common reason for clients coming to consult me in these two years, has for the application of acupuncture for pain, which appears to have become quite an accepted and recognised intervention here in Victoria of Australia, where the practice of Chinese medicine has only become more widespread in the last couple of decades, and to many is still foreign or unknown.

Another condition which I have had repetitive success with since during my early years of practice up until now is sleep disturbance and insomnia, with 8 patients having reported improvement in their sleep since coming to me. Other ailments which I have addressed and relieved on multiple occasions include 4 instances of poor energy, 4 instances of pathogenic flu, and 4 instances of sinus congestion. As well as treating the condition of an acute cold, I have 2 times reduced the manifestation of phlegm, and 1 time I have intervened productively against sneezing, while I have also freed the sensation of lung congestion in 1 instance.

Chinese medicine is thought to excel in treating conditions and symptoms thought to be partly or wholly psychological, as these conditions which are usually said to be affecting the spirit in Chinese medicine, the theories of Chinese medicine extending to encompass spiritual concepts as they do. 3 times in the last two years an improvement in mood or happiness has been mentioned under my care, and anxiety levels have reduced 2 times. There have been changes for the better for metal clarity for 1 case, palpitations or rapid heart rate for 2 cases, and mania in 1 case. 1 of my patients reported weight loss, and another 1 said that their practice of binge eating had reduced.

Some more miscellaneous sorts of improvements which I have come across while looking back over my notes are 2 improvements in rashes, 2 improvements in shaking, 2 improvements in spontaneous or excessive sweating, 2 improvements with regard to feeling cold, 1 improvement with regard to hot flushes, 1 improvement in digestion, 1 improvement in dizziness, 1 improvement in vertigo, 1 improvement in breathing, and 1 reduction of a trickling sensation that moved upward from the abdomen to the throat known to Chinese medicine as 奔豚氣 ‘bēn tún (running piglet) qì’. While the number of cases that I have tackled to this point are limited enough to overlook areas where Chinese medicine may also be beneficial, this does stand as a first-hand account from my point of view, of some of the possibilities using this modality of healthcare.

None the cited improvements above have not been tested against scientific norms, to deduce exactly whether they came about because of what I did, or whether they are the result of a concurrent intervention outside of my treatment. In many cases these results have indeed been achieved while concurrent interventions and treatments were taking place; and the results are furthermore dependent on the honesty of the client, being quite subjective as they are. If Chinese medicine though, is just the enactment of the powerful and universal “placebo effect” that induces positive outcomes for no reason other than that a positive outcome is expected, I might argue that in the context of healthcare, a positive result due to placebo should be regarded as a positive result nonetheless, 'wellbeing' being a higher priority to 'absolute control and understanding of the mechanism of the intervention'. Conducting mass trials to increase certainty of opinion about Chinese medicine is moreover likely to compromise optimal outcomes, as Chinese medical treatment is finicky with respect to being an individually tailored process, as does the adage avow 病萬變,藥亦萬變 bìngwànbiàn, yàoyìwànbiàn ‘for every change in circumstance, there is an appropriate change in treatment’.

Traditional Chinese medicine is ever-developing, and is currently an amalgamation of contributions from different eras over more than two thousands of years. At times certain schools of thought have developed, and while these may have been competitive and arguably contradictory with other schools of thoughts, there is too strength in diversity as well as accord. Without doubt, the practice of Chinese medicine must have been and must be flexible to 因地制宜 yīndìzhìyí ‘use methods in line with local circumstances’. It is about balance, being aware of yīn and yáng predominance, and of yīn and yáng intermingling, but it is also about strategy, such as 冬病夏治 dōngbìngxiàzhì ‘treating winter diseases in summer’, and 一舉兩得 yījŭliăngdé ‘killing two birds with one stone’. Chinese medicine seems to lure you in slowly, revealing itself gradually as you invest in it, while asking for some faith on your behalf along the way, not making promises, nor definitive conclusions, but letting you decide for yourself what is relevant and how to proceed. It is a thoroughly-organised and considerable attempt to solve many problems, and for this it may be esteemed.

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