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Science, Scientism, Healing and Medicine

Friday, January 27th, 2012

Today I had a mooch around Waterstone’s. I meandered past the section on religion, where the first book I noticed looked something like an anti-religious polemic; part of the blurb was an endorsement by Richard Dawkins, warning any religious apologist not to risk getting into a debate with the author, who would presumably run rings around their pathetic and irrational arguments. I wandered on to the science section, replete with several titles by the aforesaid Professor Dawkins, but nothing I noticed along the lines of an anti-scientific polemic. Science gets all the good PR these days.

Now I’ve got a physics degree and a healthy respect for the scientific method. But working as I do now in healthcare, I’m not altogether sold on the ability of modern science to make life better and people healthier. In their book ‘Why Do People Get Ill?’ Darian Leader and David Corfield suggest that doctors would be better prepared for their profession if they did an arts degree, rather than a science degree. What leads them to this radical suggestion is their belief, which their book aims to substantiate, that key factors in what make people get ill lie in their emotional life, and thus a good doctor is one who can meet the patient on this emotional level, with understanding, empathy, humanity. (Of course, one might want to question whether people graduating from arts courses have any more humanity than their scientific colleagues!)

 In other words, healing is as much art as science. People cannot be understood if they are just understood as a set of numbers, a set of data. Can illness really be fully understood by science? (It is a sad fact that the word ‘clinical’ connotes a kind of cold rationality.) Of course you want a doctor, a healer, to be able to think clearly: this is no apology for the worst kind of woolly minded alternative therapists. But you also want them to have humanity, even compassion. Not just because it makes the treatment experience more bearable, more civilised, but because it is an essential part of that treatment.

 Good medical treatment isn’t entirely reducible to numbers. In traditional acupuncture, for instance, a lot of emphasis is placed on the Qi of the acupuncturist. The Chinese word Qi is impossible to translate accurately into English – it is something like the vital energy of the individual, which in a healthy person is free-flowing and abundant. (For a more detailed explanation, click here.) The Qi of the acupuncturist includes such things as the quality of the attention of that acupuncturist, their freedom from distraction and sense of presence. Included here is the rapport between the acupuncturist and the patient. Included here is the ability to find the exact right spot to insert the needle, the exact right depth for it, and the ability to sense what lies at the end of the needle, how the needle interacts with the patient’s own Qi. (Of course there are guidelines about where to put the needle and so on, but the fine tuning relies on the Qi of the acupuncturist.) These things are not measured in most scientific trials of acupuncture, probably because they are not so easy to measure, but there is a world of difference between having an acupuncture needle inserted by someone who has been on a few courses and is thinking about what they are going to have for their dinner, and by, say, a serious traditional acupuncturist who practises Chi Kung (a traditional Chinese form of meditative exercise and health preservation) for two hours every morning, and is able to focus his entire attention on what he is doing. Medical treatments of this kind are very complex interactions between two very complex entities: human beings.

 One can distinguish between science and scientism. Scientism is the belief that science is the only valid form of knowledge, the reduction of all forms of knowledge to that which is measurable. My fear is that scientism is invading the world of medicine and healing, so that any form or aspect of treatment which is not measurable (or perhaps not easily or cheaply measurable) is disregarded or downplayed, when in fact it is an essential part of that treatment. 

 I remember reading an article by a surgeon who described how he had postponed an operation by a day for no other reason than he had an intuitive sense that it would be better to wait 24 hours. Personally, if a good surgeon told me he had a gut instinct that we should wait an extra day before my operation, I would be glad to go with that. Some of the most important things that happen in a healing context are not measurable by scientific means. Science, therefore, should know its place! In its place it is fantastic, but it is not the be all and end all of medical treatment.

 

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The Myth of Getting ‘Old’

Monday, January 16th, 2012

Having spent the last 15 years observing what makes one 80 year old ‘old’ and another ‘young’ and indeed witnessing the transformation of some ‘old’ ones into ‘young’ ones, I’ve been pretty humbled.  I never cease to be amazed by human potential. Through a gradual process of mental reflection, dietary and lifestyle changes and therapy, some have been able to turn their circumstances around by realising they had more control over how they felt than they realised and that they had succumbed to the popular myth about age.

Many of our patients are content merely with the removal of pain from their arthritic joints. Some, however, realise that they have become what they have through their choices and actions. They then make different choices and experience different outcomes as a result.

Of course, this doesn’t just apply to old people. These same processes occur in younger age. At the time of writing, I’m 43 and setting myself physical and mental goals that my contemporaries have clearly convinced themselves they can’t achieve. Of course, they can achieve them!They just need to engage in the lifestyle that supports their achievement. They’ve succumbed, like the majority, to societal norms and assumptions that say “you’re getting old now and so you’re going to be weaker, have poorer health and generally start going downhill”

Of course, age does play a significant role in our wellbeing. The older we get, the more time we have had to practice the habits that have determined our health in the first place. In turning things round, it might be a slower process because of this. You’ve been letting yourself go over a longer period of time. However, change you certainly can!

Our minds are far stronger than most of us are willing to admit. One just needs to watch a few episodes of Derren Brown to get an idea of this. Countless studies on the placebo affect also provide fascinating food for thought. Even ignoring the obvious dietary, exercise and lifestyle choices that are proven to affect our health, our minds can convince us into high or low levels of physical and mental performance or health states. So, its not enough to just regulate our diet, and lifestyle. We have to train our minds too. Good health is not a matter of luck, its crafted! I’m  reminded of what Gary Player is noted for having said: “It’s funny, the more I practice the luckier I seem to get”.

And that’s not even considering the amazing folk with significant, life-limiting circumstances who still remain positive.  Like Chris Moon, 49 at the time of writing, the ultra runner who had one leg and one arm blown off by a land mine, then ran the London marathon within a year of the incident!!! Check him out at:

http://www.ultralegends.com/chris-moon-bathurst-to-sydney-1997/

Geneticists estimate that our genes are responsible for about 15% of our health outcomes. The other 85% is down to our lifestyle. In other words, the choices we make in life have the largest effect on our health, by far.

So, check out your self-limiting beliefs, engage in some positive thinking training, and start releasing your latent potential now. Commit to a programme of regular exercise, whether it includes Tai Chi, running, squash or whatever. And guess what, once you’ve got over that initial inertia that inevitably exists when you’ve been inactive for so long, its really enjoyable and feels great! Go get some…you’re more than you think you are!

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Personality Types, Chinese Style

Thursday, December 15th, 2011

What we do as human beings is to try to make sense of the world we inhabit. Perhaps the hardest bit of that world to make sense of is that part of it occupied by other people (although some of us also have a hard time trying to make sense of ourselves too!). People, after all, are complex things. One way in which we try to make sense of the people we come in into contact with is by comparing – for example, one person we meet may remind us of someone else we know, and this may help us to understand the new person. Taking this further, we start to categorise the personalities of the people we know. Over the years there have been many ways of doing this. For example, relatively recently the great Swiss psychologist Carl Jung developed a way of categorising people according to the relative strength of their faculties of thinking, intuiting, feeling and sensing; and furthermore according to whether they were predominantly introverted or extroverted. Thus I might be an introverted feeling type, whereas you might be an extroverted thinking type. An older system of categorisation was based on the four humours of classical medicine: phlegm, black bile, yellow bile and blood; according to which of the humours predominated, a person might be phlegmatic, choleric, melancholic or sanguine (words we still, on occasion, use today to describe people).

One of the advantages of such categorisation is that it begins to help make things like medical or spiritual advice more specific – a melancholic person may need a different kind of medical treatment to a choleric one, even if they have similar symptoms; an introverted thinking type may need to do a different kind of meditation practice to an extroverted sensation type.

In the classical Chinese tradition, one way of classifying people is in terms of the ‘Wu Xing’, the five Elements of Chinese thought: wood, fire, earth, metal and water. As in the western ‘humoural’ system, each person may be thought of as dominated or governed by a particular element; but each element is present in each person to some extent, in a one-off blend that makes that person the unique individual they are. This way of making sense of people is particularly useful for Traditional Chinese Medicine in helping us to decide what kind of treatment a person needs, even what kind of life they need to live to maximise their health and well being.

The Wood element represents solidity and pliability, as symbolised by a tree which bends a little in the wind so as to maintain its form. Furthermore, just as a tree grows upwards and outwards, Wood connotes expansion, and is particularly associated with the springtime and new growth. Fire, of course, stands for heat and combustion, and upward movement. Summer is the time of Fire. The Earth (as in mother Earth) represents nutrition and stability, and is sometimes represented as lying at the centre, with the other elements around it at the points of the compass; Earth is the centre. Metal is something that can be worked and moulded; it is dense and represents contraction as opposed to expansion. Autumn is the time of Metal, when nature begins to turn back inwards to prepare for winter. Finally, Water means fluidity and flow, and downward movement – water always flows down. Water is associated with winter.

Applying the Wu Xing to human personalities gives us five different types of people. Because Wood is associated with expansion, the Wood type likes action, movement and adventure, seeks challenges and enjoying pushing his or her limits. Wood types can easily be intolerant and impatient, and can become inflexible, not knowing when to yield a bit. This can be associated with physiological problems such as migraine, irritable bowel syndrome and hypertension – inflexibility on a mental level leading to tightness and tension on a more physical one. Of course, just because you are this type of person does not mean that you are bound to have these problems; it means that, if you don’t look after yourself, these are the likely consequences.

Someone whose governing element is Fire looks for excitement and intimacy; they are intuitive and passionate, and desire is often strong within them. If things go badly, they can become anxious, neurotic and agitated. Insomnia and palpitations can also follow, and Fire types may get into trouble with addictive substances which give them the excitement they crave, but at a heavy cost.

People ruled by Earth, the central element, want to be involved and needed. The link between Earth and the digestive system shows itself in Earth types’ desire to nourish and nurture. However, sometimes they forget that they too have needs and become the person who looks after everyone else (whether they want looking after or not!), but fails to look after themselves. Typically they suffer from digestive complaints, failing to nourish themselves properly, and may develop eating disorders or become overweight.

Those under the influence of Metal like things like definition, structure and discipline. They are often rational and self-controlled, but can lack spontaneity and become isolated. This isolation often shows in respiratory problems, as the breathing process is the most basic way in which we interact with our environment.

Water and metal are often confused, but Water types are typically articulate and clever, their minds running smoothly like water flowing over pebbles. They can develop problems in the genitourinary system, and suffer from chilliness, loss of libido, infertility – too much water putting out their fire.

To get more of a sense of these, consider the following classroom scenario. Wood probably sits towards the back of the class, and at his worse can be a bit of a bully. He likes to push boundaries a bit and needs fairly firm control by the teacher. If he gets frustrated, he can explode into anger, and he can be obstinate too. But he has plenty of outgoing energy which, if it is channelled well, can make him a high achiever. Fire is also a bit explosive at times, but if her enthusiasm is engaged she can be very creative. She has a circle of close friends who vie a bit for her attention, and some people think she is a bit full of herself. She needs good communication, including from the teacher. Earth is the person who looks after everyone else in the class; if someone is in trouble she will be there to offer her help. Part of this is because she wants to be liked, but also she is naturally caring. Sometimes she is put upon, especially by Wood, but often she is the peacemaker. Metal sits at the front of the class and does not get involved with all the goings on further back. He is conscientious in his school work, and always gets good marks (but not brilliant ones). The teacher may be in danger of not giving Metal enough attention, because whilst in some ways he is a model pupil, he needs some gentle encouragement to explore beyond his boundaries and engage with the other kids more. Water is one of the brightest of the kids; she can turn in really good work at times, and is thoughtful and questioning, in a way that makes her quietly popular with her class-mates. Sometimes she is the one who can articulate what is going on for the whole group. The teacher needs to meet Water’s intelligence and help nurture it, even when she is asking difficult questions.

　

The way that, in nature, the different elements interact with each other in a dynamic and harmonious balance, can provide a model for human harmony. Just as in the classroom above, in a work situation each element needs to find its own place and play its own role. For example, a Fire type may provide the inspiration, and a Water type will be good at articulating and clarifying that inspiration, whilst a Metal type will provide the structure and discipline to harness that inspiration. A Wood type may bring ambition and drive to the party, whilst an Earth type will make sure everyone is involved and looked after. Knowing what type you are, and what type your colleagues are, helps you understand each other and work together more effectively, and more enjoyably.

This same kind of synergy takes place within the individual between the main organ systems; indeed the organs can be viewed as a team working together. When they work well together, there is health, when that harmony is lost, there is illness. For example, there is an important relationship between Wood and Earth, which correspond within the individual to the Liver and the Spleen/Stomach. If the Liver starts to lose the pliability and flexibility that is essential for the Wood element, it starts to ‘invade’ the Earth element, causing disruption in the digestive system such as nausea, abdominal pain and loose stools or constipation (or both). This is also more likely to happen if the Earth element has been weakened, perhaps by poor digestive habits or a general lack of self-care. Similar important relationships exist between other organs; for example there needs to be a dynamic balance between Fire (the Heart) and Water (the Kidneys); too much Water douses the Fire. These ideas form part of the complex web that practitioners of Traditional Chinese Medicine use to understand why someone is not as well as they could be, and to get at the root of the problem, restoring the dynamic balance between the elements that is health

　

If you are, by now, wondering which of the elements is your element, you can try following this link to a click questionnaire which might throw some light on the question.

 

http://www.longevity-center.com/five_element.html

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Illness and Responsibility

Saturday, November 5th, 2011

Why do we get ill? No doubt the answer is often complex, and it is a mistake to think there is just one single cause when very often it is a combination of factors. In Traditional Chinese Medicine these factors include inherited imbalances, poor dietary choices, climatic factors, lifestyle issues and, not least, emotional difficulties. Most of these things we can influence, for better or for worse. This then raises what may be a controversial question. If we are ill, is it our fault? On the one hand, if we tend to answer yes to this question – maybe we eat badly, or avoid exercise, or keep ourselves trapped in a long-standing state of anger or anxiety – this can lead to guilt and even self-loathing, which will only make matters worse. On the other hand, if we bristle with resentment at the very suggestion that our suffering may, in part, be our own doing, we can settle down into the role of the helpless victim.

Thus, especially if we have a serious and chronic illness such as ME or cancer, we need to work out our emotional response to the question, “Why me?” This response needs to avoid the extremes of, on the one hand, beating ourselves up about it all and, on the other, of taking up the role of helpless and resentful victim. In fact this is an issue which every human being has to face, as every one of us reaps the consequences of how we have lived, and few of us have lived like an angel or a sage. Most of us have made mistakes, and have to live with the consequences of those mistakes, whether those consequences manifest as illness or in some other way.

So what should our attitude be to the past? Perhaps we need to acknowledge it, and, in the context of illness, acknowledge the ways in which we may have contributed to our getting ill. However, we may instead say that we have not the faintest idea why we are ill. This is especially so when our health system is so technical and specialised. How can we, a mere layman, understand why we have the illness we have? Something is going wrong, and we do not understand it, and do not understand why it is happening. This may tend to put is in the victim camp.

On the other hand, perhaps we can free ourselves from the shackles of technical medicine, and use our intuition. The more self-awareness we have, the more likely our intuition, or even our common sense, will tell us why we are the way we are. If I go around all the time in a constant state of fear, with my shoulders hunched up, is it not possible that I may end up with a headache or an arthritic neck? If I am always angry and frustrated, is it not possible that my blood pressure gets too high? If I always gobble down my food whilst doing something else, not chewing it properly, is it not possible that I will get some kind of digestive problem, like a stomach ulcer or acid reflux? In some ways the illness we get may be giving us some kind of feedback as to how we have lived our life to date, and if we endeavour to be receptive to that feedback, we may learn something crucial about ourselves.

Traditional Chinese Medicine is often very helpful in helping us to understand why we are ill in the way we are. For instance, it makes useful connections between different emotional states and the way they affect the individual. For example, it says that anger makes Qi rise. (Qi cannot be easily translated, but means something like ‘vital energy’) This means that anger often causes symptoms in the upper body, especially the head and neck – think migraines, headaches, tinnitus etc. Of course everyone gets angry from time to time, but problems arise when we become habitually angry, or when we repress or deny our anger. Prolonged sadness, on the other hand, depletes the Qi, and may especially affect the lungs, leading to shortness of breath, fatigue, a weak voice, even asthma.

Of course these kind of ideas need not to be applied too literally, but they give us a clue, give us a framework to ponder on the connections between our emotional lives and our illnesses. Perhaps they can stimulate us to become more sensitive to the way that emotions manifest in our body – if we are really aware, we can begin to feel how, for instance, excessive worrying is tying our Qi in knots.

If this kind of process leads us to acknowledge that our illness may in part be due to how we have lived, then , knowing that we cannot change the past, we can come back to the present, where we do have a choice. That choice may not include the option of freeing ourselves totally from the consequences of our past actions, but it does include the choice to live in such a way as can at least mitigate the effects of the illness, at least to some extent.

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Labels, medical and otherwise.

Tuesday, August 30th, 2011

Last week a patient of mine told me that her GP had diagnosed her with mild depression. (Evidently mindful of the advice of Sir William Osler, the so-called father of modern medicine, who said that one of the first duties of a physician is to educate the masses not to take medicine, this GP told her he was not going to prescribe anti-depressants because he thought she could sort it out herself without their help.) Now you might think that being told you are depressed would in itself be a bit depressing, but not a bit of it. The lady in question sounded really rather pleased. Pleased that she now knew what was the matter. Mild depression.

This is a common experience. We don’t like uncertainty. We don’t like to be in the no-man’s land of an undiagnosed condition. After all, if doctors can’t find a handy label for us, we might start to wonder if there is really anything wrong with us at all; or we might start to wonder if other people are thinking that we are malingering. Furthermore, we might start to fear that perhaps we have got some really dreadful illness, that we are really only months away from death. So I can see why this lady was pleased and relieved. Bumping into an acquaintance in Tesco’s, she can tell them unequivocally “I’ve got mild depression”. And whatever you think about mild depression, it beats the hell out of cancer, multiple sclerosis or heart disease.

I’m reminded of another patient who came for treatment for an occasional achy numbness in her limbs. She’d had various investigations which had ruled out things like multiple sclerosis. Acupuncture, as one might expect, proved pretty effective at relieving this mysterious pain, but she still had the occasional relapse. However, she remained worried that she did not have a clear diagnosis.

Or rather, she was worried that she didn’t have a western medical diagnosis. It wasn’t too difficult for me to give her a Traditional Chinese Medical diagnosis, but, somehow, that didn’t reassure her. I guess if she bumped into someone in Tesco, telling them she had ‘Damp Painful Obstruction Syndrome’ wasn’t going to cut much ice. Like many people, her assumption was that conventional medicine is the real medicine, and any other form of diagnosis does not really count.

I’m slightly suspicious of this craving for certainty, for a label to attach to ourselves. Labels, after all, are our creations; they are not part of the fabric of the world. And as the second example mentioned may make clear, they are relative. If you live in a different culture, with a different medical tradition, you get a different label. And labels also change with time. Bear in mind that, apparently, the label ‘heart attack’ (or, rather, ‘crise cardiaque’) was not used in French medicine before 1968. Presumably if you collapsed in Paris in the early 60’s, complaining of pain in your chest, you would have been given a different label. And of course there are plenty of people for whom there just is not a suitable label. People are it seems far more complex, and pathology is far more complex, than any system, any language even, can quite cope with.

In Traditional Chinese Medicine we have a saying: “Same disease, different treatment” which means that just because ten people have the same label, it does not follow that they will need the same treatment. One person’s migraine (or, in Chinese medical context, one person’s Pian Tou Feng, which might translate as ‘unilateral head wind’) is not the same as another’s. One person’s mild depression is certainly not the same as anothers’. Medical practice needs not to be too foxed by convenient labels. If we think, this treatment worked for that person who had migraine, so we will use it on this one, we might be making a mistake. We need to look beyond the labels (although what we will find, perhaps, is more labels!).

Anyway, I would suggest that we should maybe loosen our desire for a nice convenient label. In the Zen Buddhist tradition, there is a saying (they are full of wise sayings, these orientals!), “Small doubt, small awakening; big doubt, big awakening; great doubt, great awakening!”) Which perhaps means, in effect, that a refusal to categorise and label everything in a nice tidy way allows for openness to a broader, more satisfying experience; an awakened experience. In pressing for a label to fix on ourselves, whether a medical label or any other, we may deprive ourselves of the full richness of what being human is. Humans can’t be tied down and packaged up in a label. They are too complex for that. Sure, labels are useful, but only up to a point. If there isn’t a suitable label for us, maybe that is no bad thing. If your medical practitioner, after doing all their diagnostic stuff, can’t tell you what you have got, and assuming they are not just incompetent, it might not be such a disaster. Welcome the uncertainty. Welcome your uniqueness. Maybe it is telling you something important about life.

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Inner Rioting

Tuesday, August 16th, 2011

Today the headlines in the English newspapers are all about chaos and anarchy, this because of the rioting over the last few days in London and other cities. Perhaps most of us fear few things more than we fear chaos and anarchy and the loss of order in society.

As with society at large, so with the human individual – most of us value some kind of order in our lives. Interestingly, classical Chinese medicine evolved in part by thinking of the human individual on an analogy with the wider society. The heart, for instance, is spoken of as the emperor, and the other organs compared to government officials, the liver being the general of the army for instance. The meridians which traverse the body are like the waterways of ancient China, which made possible communication and trade between the regions of that vast country. Just as unhindered waterways facilitated such exchange, so do clear meridians make possible the body’s harmonious functioning.

Some kinds of illness, in fact, are like riots, like chaos breaking out within. Internal disharmony affecting the liver, for instance, can lead to an eruption of stagnant energy, or Qi, which courses violently upwards to the head causing, for instance, migraine or even stroke. The natural functioning of the stomach if interrupted can lead to “rebellious stomach Qi”, manifesting as heartburn, acid reflux or vomiting. Notice the political metaphor. Perhaps one of the most common kinds of inner chaos is the panic attack, which in some cases is also seen as rebellious Qi, this time in a meridian called the Chong Mai.

However, whilst mob rule and anarchy may be bad, the other extreme is also to be avoided. As the German philosopher Nietzsche puts it, “one must have chaos within one to give birth to a dancing star.” Too much control and order stifles creativity. Think of totalitarian regimes. Within the individual, if afraid of inner chaos we seek to impose too much order, illness may also follow. Indeed the first example above, the migraine attack or stroke, might be due to a long-term habit of excessive control, particularly of anger. Eventually the pressure becomes too much, and too much order becomes too much chaos.

On a more subtle level, there may be an excessive controlling of what the ancient Chinese referred to as the ‘hun’, sometimes translated as ‘ethereal soul.” This ‘hun’, which is associated with the liver organ, is responsible for a sense of direction and purpose in life, inspiration, dreaming, moving towards our life’s goals. Whilst an uncontrolled ‘hun’ manifests in wild and vivid dreams (so that we wake exhausted rather than refreshed), or more seriously in manic behaviour, an over-controlled ‘hun’ leaves us depressed and apathetic, with no direction or creative spark. The hun’s relation with the liver means that liver pathologies may cause these kind of problems, one way or the other.

So just as in society there needs to be harmony and order, but not excessive control, so too in the life of the individual. Whilst achieving exactly the right balance may be nigh-on impossible, we need to avoid swinging from extremes and tread a middle path so that we have enough freedom to express ourselves and envision our future, but also a well regulated life (regular sleep and meals for instance!), so that anarchic chaos does not overwhelm us.

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TREATING PEOPLE, NOT DISEASES

Wednesday, July 20th, 2011

Diseases are not isolated discrete entities. There is not something called asthma, or sinusitis, or migraine, distinct from the person suffering from it. A disease isn’t a thing inside you in a little box, separated from the rest of you. It might work that way with something as relatively unsophisticated as a car; maybe if there is something wrong with the gearbox, it does not affect all the other systems (although maybe a mechanic might think otherwise.) But a human being is much, much more complex. Another difference of course is that a human being is alive.

What this means is that medical treatment and health care needs to take cognisance of the person as a whole, and not just focus on the disease. This also has repercussions for medical research: suppose you read that research shows that statin anti-cholesterol medication reduces the risk of death from cardiovascular disease in women who take these drugs: if you are a woman, you might then conclude that you should take statins. However, it seems that such women do not in fact live any longer; they just die of something else. (See Dr. Malcolm Kendrick’s provocative book, “The Great Cholesterol Con”). The question we need to ask of any treatment is not, “does it cure the condition?”, but, “will I be healthier?”.

A simplified model of how a human being works involves thinking of them in terms of a number of systems; the respiratory system, the digestive system, the nervous system, and so on. This is no doubt an over-simplification, but even so it does not take much thought to realise that all these systems are dynamic and inter-related, so that a small change in one of these systems has knock on effects in all the others. For instance, if your digestive system gets upset, maybe through eating some dodgy take-away, this has a knock on effect on all the others because they all rely for essential nourishment on the digestive system processing what you eat. For medical treatment to be really effective, therefore, it needs to take stock of the whole person and not just focus down on one system, or even on one sub-system, as if that system existed in isolation from all the others. It doesn’t.

To understand this, consider the case of Fred. Fred grows up as a fairly healthy child, albeit with a tendency, inherited from his dad, to be a bit on the chubby side. He does well at school and goes to university to study computer science. He enjoys his subject and happily spends long hours studying away; to unwind he goes for a few (or sometimes more than a few) beers with his mates. Already he is developing something of a beer belly, which is perhaps not helped by his reliance on fast food and take-aways. Still, he does not have any major health problems and rarely if ever sees his GP, although he notices that his stools are tending to get loose and, I’m afraid to say, rather smelly.

At this point Fred is beginning to suffer from what in Traditional Chinese Medicine we call ‘Pi Qi Xu’, which basically means a weakness of the main digestive organ, the ‘Pi’. This is weakened by a poor diet, but also by excessive intellectual work (think about the way we link intellectual activity with digestion, as in phrases such as ‘food for thought’, ‘chewing it over’, and ‘digesting information’). Intellectual indigestion causes actual indigestion. A likely consequence of this disharmony is what we call ‘damp accumulation’, an over-retention of moisture in the body, manifesting, for instance, as weight gain around the abdomen, and loose smelly stools, possibly with mucus in them (charming, I know.).

Ten years down the line, Fred has a good job in IT, which unfortunately is fairly desk-bound. He is more over-weight, still fond of a few beers, and the less said about his toileting the better. But he is also struggling a bit now. Never a morning person, he now wakes with difficulty from heavy sleep and is reliant on strong coffee to get him going. Even then he is prone to lethargy and when he gets home from work he tends to slump in front of the telly a lot. He knows he should get some exercise, but the trouble is that his knees ache and are a bit swollen, and any way he hasn’t got the motivation. In Traditional Chinese Medicine this is all more dampness, which typically produces feelings of heaviness, muzziness, dullness and apathy, like being bogged down. Fred’s long-suffering girlfriend knows that something is not right (and if truth be told is not overjoyed by the lack of bedroom action these days, and the snoring), and eventually prevails on him to see the GP. The GP thinks Fred is depressed and prescribes a low-dose antidepressant.

Ten years later Fred is still taking the anti-depressant, which did at least seem to lift his mood for a while, although the effect has worn off and his GP is reluctant to increase the dose. He is snoring badly now and may have sleep apnoea. He also seems to catch colds a lot, and his sinuses are almost constantly blocked with thick mucus which is often yellow. He is also a bit wheezy if he has to walk up a flight of stairs. The dampness has led to phlegm in the lungs and sinuses. This leads to Fred having a lot of dull headaches. Although, as you may have gathered, Fred is quite good at just putting up with less than optimal health, these headaches combined with the sinus problem have really started to get to him. He tries over-the-counter decongestant medication, he goes to his GP to get some better decongestant medication, he tries using olbas oil, but nothing seems to work for very long.

However, for as long as Fred, or the people treating him, just focus on his sinus problem, nothing much is going to happen. Whether you call this disease sinusitis or not, it has not come into existence on its own, but is simply what is, for Fred, the most obvious manifestation of something which has been going on throughout his entire being for at least 20 years. Even if he finds some slick new decongestant pill that does unblock his nose, this is just suppressing a symptom rather than healing a person, and there will no doubt be some side effects from the pill which might even mean he needs another pill. (Possible side effects of one of the most common decongestants include insomnia – which will at least put a stop to the snoring – anxiety, restlessness and a fast pulse). Fred does not need treatment for sinusitis, he needs treatment for his whole being, body and soul.

Hopefully this makes clear why we say treat the person, not the disease. We sometimes talk about treatment principles, which are the goals of treatment. If we think of treating the disease, there is only one treatment principle:

• Clear the sinuses

If, however, we think of treating Fred, the person, there are many treatment principles, some of which might be:

• Clear the sinuses
• Strengthen the digestive system (the ‘Pi Qi’)
• Drain excess moisture from the body (‘drain dampness’)
• Strengthen the respiratory system
• Work with Fred to help him develop the motivation to do more exercise
• Treat the joint pain
• Help Fred develop the motivation, and the understanding, to modify his diet to avoid clogging up his system
• Help Fred to start to consider that he might benefit from cutting down on the beer

The point is that, to really clear the sinuses and keep them clear, we need to apply all of these treatment principles. This is, of course, not the work of a day, and it is undoubtedly easier in the short term to just pop a decongestant pill. It is easier for Fred, who does not have to consider changing his life much. The trouble is that, at best, this approach frees up Fred’s sinuses for a bit, without doing anything to help with his other problems. In the long run it may see him taking several pharmaceuticals – pain-killers for his knees for instance – none of which are addressing the fundamental problems.

But, if Fred gets some kind of treatment which addresses all the principles listed above, by which is meant he gets some form of holistic treatment, and if he is able to work with whoever provides this treatment, he could end up having a life which is a whole lot better than the one he is having. So that is why it is important to treat the person and not the disease.

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THE PERILS OF ‘NORMAL’ LIFE

Thursday, July 7th, 2011

What makes us get ill? A big factor in a lot of cases is the kind of life we are living; a lot of the patients we see are suffering from symptoms which have been brought on directly or indirectly, by what is regarded in our society as a ‘normal’ life. This ‘normality’ involves a lot of activity. It involves working hard, perhaps for long hours, sometimes in a job which we do not really like. And then, when work finishes, we either keep on pushing our self, making sure we and our family don’t miss out on all the goodies which society has to offer – making sure we see the latest film, buy the best hi-fi, book the best holiday. The advertising industry, of course, ensures that we know that we mustn’t miss out on all these things.

A ‘normal’ life, then, involves pushing ourselves. When our energy has run out and what we really need is to relax and recuperate, what we do is to keep pushing, keep doing, keep achieving, keep getting (or trying to get). In this way we gradually draw on and expend our natural reserves of energy. Periodically we collapse in front of the telly, which unfortunately is not so effective as a means of revitalising ourselves.

This might be fine for a while, but sooner or later – depending on how strong our constitution is – it starts to affect us. Maybe we don’t sleep so well any more, or we start getting headaches, develop digestive problems such as IBS, or start suffering from anxiety or panic attacks. Different people are affected in different ways. Often we are mystified as to why these things are happening to us. This isn’t, after all, what it is like in the adverts. In the adverts, people do all the things we do, and seem perfectly healthy and happy. There must be something wrong with us.

The adverts are misleading. All the time we are being told about what is a ‘normal’ life, about how to be happy and fulfilled, but what we are being told is skewed. And then there is the ‘keep up with the Joneses’ factor. If everyone else has bought their kids the latest high-tech gadget, we are under pressure to do the same. If everyone else is working overtime to make more money, we don’t want to miss out ourselves. We don’t want to be abnormal.

In Chinese Medicine and in traditional Chinese thought in general, a key concept is the balance between Yin and Yang. In this context we can think of Yang as the active, outgoing, achieving aspect of human beings, and Yin as the receptive, reflective aspect. Health involves keeping these two in balance. In our civilization, they are out of balance; there is an over-emphasis on Yang. We don’t spend time quietly, we don’t ever get in touch with the stillness at the centre of our beings (in fact we maybe have no idea that it is even there), we don’t have time to meditate, go for a walk in the woods, or even to just drink a cup of tea for ten minutes whilst doing nothing other than gazing out of the window. (Slobbing out is not the same thing as this at all!)

What this means is that the Yin, which is not nourished in the ways it needs, gets depleted. This happens gradually. Yin deficiency results in such things as insomnia (night is the time of Yin), a low-level anxiety, and muscles that are under-nourished and tight. It can lead to things like migraine and tinnitus. And the more it is depleted, the harder it is to restore it – we can’t nip out to the supermarket and buy Yin, and we can’t just get a pill from the doctor, or a herbal pill from people like us for that matter, which will magically restore it.

This is not to say that acupuncture and Chinese herbal medicine cannot help to restore Yin over a period of time, but if meanwhile we are continuing to live a life which prioritises Yang over Yin, we will probably be just delaying the inevitable. A Chinese medical practitioner worth his or her salt, of course, will be looking to find ways of helping us to realise this as part of the treatment they provide.

We may protest that we have no choice in the matter. We have to push ourselves at work, maybe working long hours at a job we don’t even like, because we need the money. Maybe we’ve got kids who need a lot of attention, not to mention a lot of money. But there is always something we can do to change things; if we understand that our life is out of balance, if we understand what that is doing to us, we will take steps to restore some sort of harmony. The hard part is the understanding, because we are constantly being told, by the advertising industry, by the media in general – or at least some of it – what ‘normal’ is. If we don’t develop the ability to see through this, to be critical of it, we will suffer the consequences. Just accepting what we are told is ‘normal’ without thinking for ourselves is like being one of a pack of lemmings running for the cliff edge.

Fortunately there are places to turn to for support. Rather than just passively sitting in front of the TV when we have run out of steam on an evening, and passively imbibing the same old story, we can look around for alternatives. After all, over the centuries, some quite clever people have taken the trouble to sit down and think about human life and write about it. What is the best way for a human being to live? What is the best way to live a healthy life, healthy on all levels? People have asked these questions, and some of the answers they have come up with are at least worthy of our consideration. (Of course there are some TV programs which are worth watching for the same reasons – the point is not to knock TV, but to knock the passive acquiescence in a way of life which is unbalanced and unhealthy.) And there are groups of people around who are doing this, who are developing wiser ways to live, and we can hook up with some of them, perhaps. There are people around whom, whether they put it in these terms or not, live a life in which the Yin is nourished and the Yang expressed, in equal and balanced measure. Surprisingly enough, they tend to be healthier.

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The Healing Power of Touch

Wednesday, June 29th, 2011

At another clinic where I work in Sherwood, Nottingham, there is a cartoon on one of the notice boards which has been there for as long as I have. It shows an old man in a cloth cap sat in front of a doctor. The old man is complaining of back pain. The doctor says, “Well, at your age you have to expect a few aches and pains. Take two of these four times a day”, and hands the old man a prescription. Then you see the old man getting up to go. There is an arrow embedded in his back.

Admittedly this is a relatively rare cause of back pain, even in Nottingham (Robin Hood and all that.) It is perhaps unfair on doctors (or at least on some doctors) who must see lots of people with back pain and do not have time to examine them all. But I see it as a criticism of a form of health care in which the practitioner does not or even cannot interact fully with the patient – does not look properly at them, does not examine them, does not even touch them. It is probably only recently in the history of humanity that any kind of professed healer could treat someone in pain without even touching them.

I get the impression in my clinical practice that patients only fully feel that I have started to understand their painful condition when I start to examine them. If I put my hand on their back and they say, ‘yes that is where the pain is’, that seems to me important, possibly even the beginning of the healing process. Perhaps they feel that I have somehow validated their experience; maybe with some people if they are just given pills, they may unconsciously believe that they are being told the problem is all in their mind. They need to be interacted with on a physical level to feel they are being taken seriously. If I then say something like ‘yes, this muscle feels very tight’, or ‘it feels unusually warm to the touch here’, (or, ‘you appear to have been shot by outlaws or Native Americans’) this further validates their experience.

Furthermore, how I do this matters. If I do it in a routine, mechanical way, this feels different to the patient than if I do it with sensitivity and awareness. People can tell the difference; we are very sensitive to the way we are touched. Examining a patient who is in pain with a heightened level of care, attention and sensitivity is often the beginning of their healing process.

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IT problems?

Tuesday, June 14th, 2011

Sometimes I see patients whose symptoms seem to be mainly due to IT. The technological revolution has proceeded much more rapidly than biological evolution does, so that human beings aren’t ‘designed’ to be sitting at a desk operating a PC (which is what I am doing right now!). Of course there are physical symptoms that result from such behaviour. You need to try to maintain a good posture, which is easier said than done if you are engrossed in whatever it is you are doing on your PC or laptop. Even then, a lot of such activity is probably going to take its toll on your neck and shoulders, and you really need to address this with the right kind of exercise, something that is going to loosen up the neck and shoulder muscles and stimulate the flow of Qi through the tissues in those areas – in Traditional Chinese Medicine the concept of Qi, which is impossible to translate accurately, includes the idea of physiological and psychological movement and flow; a stiff neck, for example, is one in and through which there is an impairment of this free flow.
　
And then there is the mouse. In my clinical experience using a mouse a lot can lead to something rather similar to tennis elbow, damage to the tendons of the flexor muscles of the forearm. Carpal tunnel syndrome is also a possibility, and holding the forearm in the pronated position (i.e. the position it is in when you are using a mouse!) for extended periods of time may cause tension spreading up the arm into the shoulder, shoulder blade and neck.  Again there are things you can be doing to offset all this; you can get ergonomic mice which claim to reduce the risk of such injury. I’ve trained myself to be ambidextrous as far as mice are concerned, so that the strain is shared between each arm. A problem shared is a problem halved, after all! And again, exercise which gently stimulates the circulation along the meridians of the arm is going to help – meridians are the main pathways of Qi through the body. If you are really clued up you might even invest in some appropriate treatment to prevent problems arising, maybe the occasional massage or acupuncture session to help the arm (and its owner) stay in good nick. Similarly if you use a mobile a lot, there are similar issues. I suspect we will soon start to see more patients with chronic injuries caused by keypad use.
I also see patients who have eye problems as the result of computer use. Dry eyes, lazy eyes, red eyes, and so on. Again, we are not designed to be staring at a screen for hours on end. The advice is to look away regularly, but that is all too easy to forget if you are absorbed in what you are doing, or are working to a deadline. In China, apparently, school kids are taught some eye exercises and massage techniques, so that they are less likely to need spectacles! Such exercises are a must for anyone working with computers a lot; a good Chi Kung teacher or a traditional acupuncturist can teach them.
In Traditional Chinese Medicine, the eyes have a special connection with the liver, which is said to ‘open into the eyes’. This means that someone with a liver disharmony may develop eye problems, but this is a two-way street; damage to the eyes may lead to liver disharmony. A common form of liver disharmony is called liver qi stagnation, where the liver’s important function of maintaining the smooth flow of qi is impaired, something which is exacerbated by not getting enough exercise, and by frustration (as when the computer crashes, goes slow, or just does not do what you want it to do!). Liver qi stagnation can lead to symptoms such as headache, migraine, heartburn, constipation, angry outbursts etc. So an over-sedentary lifestyle which involves a lot of staring at a screen is setting you up for a few problems!
Beyond that, there is the effect on the mind and the spirit. No doubt that depends a lot on what exactly you are doing on your computer, but my sense is that in general it is easy to become over focused and to lose touch with one’s body and, consequently, with one’s emotions. The extreme examples include a South Korean who died after playing a video game non-stop for almost 50 hours – apparently he had a heart attack. My guess is that his body had been protesting at what was happening to it for a long time, but he paid no attention. More moderate examples no doubt abound. I remember treating a young man for something which had been labelled as ‘depression’; he spent a lot of his working day on the computer, and then he came home and, guess what, more computer time. He seemed to have lost touch with himself. My personal experience is that there is something subtly addictive about using things like computers; I notice that when I finish doing something like writing this, I will look for some other things to do here, check my e-mail or look at the news, as if I am somehow reluctant to disengage from the technology. Maybe I’m just lazy, but it seems something more than that. Years ago I went to some lectures by an Oxford university academic who suggested there is something narcissistic about computer use – comparing someone staring into a screen to Narcissus. In Greek mythology Narcissus (who was rather good looking) became so enamoured of staring at his reflection in a forest pool that he could not tear himself away, and so eventually died. Possibly something similar to the South Korean mentioned above.
This all suggests that anyone using technology a lot needs to make sure they keep in touch with themselves on a number of levels. The most basic level is the level of the physical body. Exercise, and especially exercise which includes an emphasis on mindfulness and awareness, is essential. The injuries involved are usually chronic ones, so that the longer that you ignore them for, the more difficult they will be to heal. More subtly is the level of the emotions; too much use of IT may (perhaps depending on what we use it for), start to cut us off from what we really feel, and, in a sense, from who we really are.
　
　
　

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