Nov 25, 2015

Bian Que: A Legendary Doctor

29 Oct 2015, 22:18

I would like to share with you a famous ancient medical case report.
It was recorded in the ancient history book "Records of the Grand Historian" (
史記 Shǐjì) written by Sima Qian (145 or 135 – 86 BC)
https://en.wikipedia.org/wiki/Records_of_the_Grand_Historian

The doctor's name is "Bian Que" (扁鵲; ca. 500 B.C)

The article below came from here: http://english.eastday.com/e/zx/userobj ... 59567.html
Bian Que's real name was Qi Yueren (秦越人). He was reputed to be an excellent diagnostician, excelling in pulse taking and acupuncture therapy. He is ascribed the authorship of Bian Que Neijing (Internal Classic of Bian Que). Han Dynasty physicians claimed to have studied his works, which have since been lost. Credited with incredible healing knowledge, stories of his life and treatments are used in teaching and known to all Chinese medicine practitioners today.

In Sima Qian's book Shi Ji, in Bian Que Chronicles, An Ancient Miracle Doctor: Bian Que (I), Sima Qian described that Bian Que obtained his medical skills from personal teachings by Chang Sangjun. Sima Qian also recorded three specific medical cases that Bian Que handled. In the first case, he diagnosed Zhao Jianzi's illness by feeling his pulses. In the second case, he kept track of the state of the illness of the Crown Prince Guo through consulting, examining and feeling the pulse and finally brought Crown Prince Guo back from death. In the third case, Bian was able to describe the developing illness of Marquis Qi Huan by simply looking at him.

Once Bian Que, along with an apprentice, went to the Kingdom of Guo (what is now part of Henan province) as a traveling physician. There they saw that the people of the city were busily running around and discovered that a funeral was being prepared for the king's son. Bian Que went up to the door of the palace, asked someone what had happened. He learned that the king's son passed away from a sudden illness and had already been dead for a half day. Bian Que asked in detail about the circumstances of the prince's illness and death and came to believe that it was not certain that the prince was dead.

He requested to be let into the palace to examine the prince. After he entered the palace, Bian Que palpated the thick part of the prince's thighs, and discovered that they were warm. He also detected a very slight sound in the prince's ears, and diagnosed the prince as "body collapsed" (quite similar to shock), not dead. He then instructed his apprentice to set a single acupuncture needle, in the Baihui point (Du 20) on the head, and the prince regained consciousness. They then boiled some herbal medicine and used it for compresses applied to the prince's armpits, after which he was able to slowly sit up. The prince was then prescribed boiled herbal compounds to be taken for twenty days, and fully recovered his health. Word of this spread, everyone was saying that Bian Que could bring the dead back to life. Bian Que said "No, I can't bring the dead back to life, the prince wasn't dead. I only treated his illness, and that's what brought him around."

Since the English translation do not include the detailed thinking process of Bian Que, I found the original record written in classical Chinese. 
For those who might be interested in this case: 
其後扁鵲過虢。虢太子死,扁鵲至虢宮門下,問中庶子喜方者曰:「太子何病,國中治穰過於眾事?」中庶子曰:「太子病血氣不時,交錯而不得泄,暴發於外,則為中害。精神不能止邪氣,邪氣畜積而不得泄,是以陽緩而陰急,故暴蹶而死。」扁鵲曰:「其死何如時?」曰:「雞鳴至今。」曰:「收乎?」曰:「未也,其死未能半日也。」「言臣齊勃海秦越人也,家在於鄭,未嘗得望精光侍謁於前也。聞太子不幸而死,臣能生之。」中庶子曰:「先生得無誕之乎?何以言太子可生也!臣聞上古之時,醫有俞跗,治病不以湯液醴灑,鑱石撟引,案扤毒熨,一撥見病之應,因五藏之輸,乃割皮解肌,訣脈結筋,搦髓腦,揲荒爪幕,湔浣腸胃,漱滌五藏,練精易形。先生之方能若是,則太子可生也;不能若是而欲生之,曾不可以告咳嬰之兒。」終日,扁鵲仰天歎曰:「夫子之為方也,若以管窺天,以郤視文。越人之為方也,不待切脈望色聽聲寫形,言病之所在。聞病之陽,論得其陰;聞病之陰,論得其陽。病應見於大表,不出千里,決者至眾,不可曲止也。子以吾言為不誠,試入診太子,當聞其耳鳴而鼻張,循其兩股以至於陰,當尚溫也。」

  中庶子聞扁鵲言,目眩然而不瞚,舌撟然而不下,乃以扁鵲言入報虢君。虢君聞之大驚,出見扁鵲於中闕,曰:「竊聞高義之日久矣,然未嘗得拜謁於前也。先生過小國,幸而舉之,偏國寡臣幸甚。有先生則活,無先生則棄捐填溝壑,長終而不得反。」言末卒,因噓唏服臆,魂精泄橫,流涕長潸,忽忽承鑞,悲不能自止,容貌變更。扁鵲曰:「若太子病,所謂『屍蹶』者也。夫以陽入陰中,動胃繵緣,中經維絡,別下於三焦、膀胱,是以陽脈下遂,陰脈上爭,會氣閉而不通,陰上而陽內行,下內鼓而不起,上外絕而不為使,上有絕陽之絡,下有破陰之紐,破陰絕陽,色廢脈亂,故形靜如死狀。太子未死也。夫以陽入陰支蘭藏者生,以陰入陽支蘭藏者死。凡此數事,皆五藏蹙中之時暴作也。良工取之,拙者疑殆。」

  扁鵲乃使弟子子陽厲針砥石,以取外三陽五會。有間,太子蘇。乃使子豹為五分之熨,以八減之齊和煮之,以更熨兩脅下。太子起坐。更適陰陽,但服湯二旬而複故。故天下盡以扁鵲為能生死人。扁鵲曰:「越人非能生死人也,此自當生者,越人能使之起耳。」

Here's the same record in brief written in modern Chinese:  http://goo.gl/eEAmsd


This medical record makes us realize how good the doctors are in ancient China and we should not only take a detailed history but also exam our patient comprehensively. The most important thing is get to know the mechanism of how people get sick and treat accordingly.

The Hidden Meanings of Yin and Yang

Here's an interesting animation about yin and yang from TED-Ed. 
This is the first thing one should learn in order to study traditional Chinese medicine. 
Also take a look at this: http://en.wikipedia.org/wiki/Yin_and_yang






Female Infertility

A new friend on internet asked me something about treating female infertility with acupuncture. Here's my reply.

Lots of Taiwanese couples who suffer from infertility turn to TCM for help, especially those who have already done all the examination and find no organic problem or those who have difficulty keeping the fetus after IVF (In vitro fertilisation). BTW, It's a huge market because patients are willing to pay out of pocket. Ask any of your Taiwanese friends about infertilty "不孕", most of them would think of TCM "中醫". Usually, the problem in men is easy to identify, so here we mainly focus on the problem in women. 

Remember, there is no difference between TCM and modern medicine when it comes to gathering information from patient, because the patient is right there and there can be only one truth. However, the language TCM use to describe and explain the symptom and sign is different, as well as the tool we have to diagnosis and to treat. We need to focus on what really happen in women's body. The sonography, CT might tells you because there's a teratoma in ovary, endometriosis or adenomyosis, blood test might shows hormone imbalance, etc. If the cause of infertility is organic, it's not too hard to prescribe herbal medicine to treat. It might take some time to treat if it's not indicated for surgery. The main thing we could do with TCM is to make the qi and blood flow fluently in the dysfunction organ. If it's lack of qi and blood, we supply. If it's stagnated, we dredge. If the cause is not organic, we'll have to adjust the body constitution to make the environment comfortable for fetus, such as "warm" the uterus. Usually we will prescribe some herbal medicine (decoction is more effective), some doctors will use both herbal medicine and acupuncture. 

Ancient Chinese develop a meridian theory for the guide of using acupuncture. Imagine that the acupoints are like small lakes and the meridians are like rivers that connecting these lakes. Our body organs are way more bigger lakes. The main function of acupoints are to adjust the water (qi & blood) level of organs. There are 12 main streams that connecting the 12 important organs. The main function of acupuncture is "引此注彼", which means "guide the water here to pour over there." So what acupuncture really does is to guide the qi (& blood) from where qi is sufficient to the place where qi is insufficient. For example, we will do acupuncture on the acupoints that can bring more qi and blood to uterus, if the diagnosis is qi and blood deficiency in uterus. There's other function of other acupoints that can "dispell heat", "dissolve sputum and stagnation",etc. It really depends on the diagnosis to select acupoints. Usually, with a couple of months herbal medicine treatment, some patients will conceive naturally. However, it depends on the cause of infertility, it needs expertise to do proper treatment.

Nov 21, 2015

Orthopedics and Traumatology in TCM

28 Aug 2015, 19:42

I'd like to introduce you Orthopedics and Traumatology in TCM (
中醫骨傷科學) . 

The practice of Orthopedics and Traumatology in TCM is to prevent and treat osteoarticular and periarticular soft tissue injuries and diseases. It uses various treatment methods, based on TCM theory, such as manipulation, acupuncture and Chinese herbal medicine, to manage these disorders and to cure the traumata of sinews and bones, meridians and collaterals, Qi and blood. The diseases managed in this field are classified as traumatology and osteopathy, such as fractures, dislocations, injuries of muscle and tendons, internal traumatic syndromes, and osteoarticular bi-syndromes, osteoarticular degenerative diseases, etc.

Here’s a more detailed content: http://tcmdiscovery.com/Orthopedics/

Here's a video I found on Youtube about "Relieving tendon and muscle" manipulation: https://www.youtube.com/watch?v=MJk2POWnNrk

Here's one on treating lumbar spinal transverse process: https://www.youtube.com/watch?v=zWnBNEc8NzY



Orthopedics and Traumatology in TCM has a lot to do with human anatomy and physical examination (all kinds of muscle, joint, nerve tests). Some patient underwent image studies and found nothing wrong or there's nothing else modern medicine could do and they turn to TCM Traumatology doctors for help. When injured, most Taiwanese just know when to see a TCM Traumatology doctor and when to see a western medicine doctor (Rehabilitation, orthopedics and neurology doctors).

 

 

Nov 20, 2015

Improving Sleep Disorder by Practicing Tao-yin for Menopausal Women

18 Jun 2015, 16:15

We're now conducting a clinical research on 
"Improving Sleep Disorder by Practicing Tao-yin for Menopausal Women"
We're looking for participants who live in Taipei, Hsinchu, Taichung and meets the following criteria:

歡迎45歲~60歲(實歲),有睡眠障礙之更年期婦女(無治療中之重大疾病)。
能自由行走,無肢體障礙或限制活動,
可以親自至收案地點。(約6次,每次半小時至1小時,填寫問卷。)
可以國語及台語溝通(speaks Chinese or Taiwanese),經解釋研究目的及過程,
能理解測量問卷之內容,同意受訪加入本研究,並簽署受試者同意書。
在家練習道家養生引術,共持續2個月。

If you know someone who might be interested in participating this research, please contact us.   http://bcq-health.blogspot.tw/


TCM use in patients with inflammatory bowel disease: a population study in Taiwan.

Hepatogastroenterology. 2008 Mar-Apr;55(82-83):467-70.
Patterns of traditional Chinese medicine use in patients with inflammatory bowel disease: a population study in Taiwan.

I see this citation in the morning meeting today about the topic: Ulcerative Colitis
You might also be interested in how Taiwanese use TCM
http://www.ncbi.nlm.nih.gov/pubmed/18613389

Abstract
BACKGROUND/AIMS:
Many researchers have reported on the utilization of complementary and alternative medicine by patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the use of traditional Chinese medicine (TCM) by all IBD patients within the National Health Insurance in Taiwan.

METHODOLOGY:
The complete ambulatory visits records of TCM in 2004 were obtained from the National Health Insurance Research Database. For all IBD patients identified from the registry for catastrophic illness patients, patterns of TCM visits were analyzed.

RESULTS:
The prevalence of IBD in Taiwan was 5.6 per 100,000 persons at the end of 2004. Of 1,206 IBD patients, 440 (37%) patients have in total 3,169 TCM visits in 2004. Women were more likely to use TCM than men (40.5% vs. 34.3%). Among the TCM users of the IBD patients, 200 (45.5%) patients had gastroenterological diagnoses at their TCM visits. Most of their TCM visits contained herbal remedies (90%), followed by manual therapy (11.7%) and acupuncture (9.8%).

CONCLUSIONS:
The high utilization rate of TCM among the IBD patients in Taiwan implied that their needs of medical care were not satisfied by the mainstream Western medicine. The TCM herbal regimens deserve further studies.

Tai Chi Chuan, Tao-yin, and Qi-gong

10 Apr 2015, 23:10

Is anyone interested in Tai Chi Chuan, Tao-yin or Qi-gong?
http://en.wikipedia.org/wiki/Tai_chi
http://en.wikipedia.org/wiki/Tao_yin
http://en.wikipedia.org/wiki/Qigong



↑Ju-Ming Art Museum in Jinshan, New Taipei City ↑ http://www.juming.org.tw/ I've been here twice.

The theory of Tai Chi has a lot to do with daoism, which is the core spirit of traditional Chinese medicine.
Tai chi chuan's theories and practice are believed to have been formulated by the Taoist monk Zhang Sanfeng (張三丰) in the 12th century. Although Tai Chi has been practiced for hundreds of years, not until recent years did we see some randomized control trials about the effectiveness of Tai Chi. In these RCTs, unlike most of the medicial research, not a single drop of blood was sampled, no lab tests or image studies required, just using questionnaires. And it was published in the best medical journal, NEJM. We hope there will be more and more studies like these to prove the effectiveness of the TCM theory, which came from the invaluable wisdom of ancient Chinese.

Lots of Taiwanese benefit from Tai Chi or Tao-yin and Qi-gong, they might not know the result of RCTs, they just feel more comfortable after doing it. Share with you.

A Randomized Trial of Tai Chi for Fibromyalgia 
N Engl J Med 2010; 363:743-754 August 19, 2010
http://www.nejm.org/doi/full/10.1056/NEJMoa0912611

Tai Chi and Postural Stability in Patients with Parkinson's Disease
N Engl J Med 2012; 366:511-519 February 9, 2012
http://www.nejm.org/doi/full/10.1056/NEJMoa1107911


Tao-yin pictures in ancient books.