Posts Tagged ‘TCM’

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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ACUPUNCTURE: CHINESE OR WESTERN, TRADITIONAL OR MODERN?

Wednesday, March 16th, 2011

Acupuncture is a form of medical treatment which has been practised in China for over two thousand years and which is becoming increasingly popular in the West. Because of its evident effectiveness, it is now utilised by some western medical practitioners such as GPs, physiotherapists and chiropractors; however, most of these practitioners, whilst utilising acupuncture as a technique, discard the traditional Chinese context in which acupuncture has been practised. This article elaborates on the difference between acupuncture as practised within this context and without it. It is important to understand this difference: for example, it would be wrong for someone to conclude that ‘acupuncture doesn’t work’ after a session of acupuncture with a physiotherapist had not produced any improvement in their condition – what the physiotherapist is doing with the needles they use may well be significantly different from what a traditional acupuncturist does with them.

WESTERNISED FORMS OF ACUPUNCTURE

Acupuncture shorn of its traditional context is sometimes known as ‘dry needling’, to distinguish it from the usual way in which needles are used in western medicine – injections! ‘Dry needling’ is usually used as a method of pain relief by chiropractors, physiotherapists, GPs and others; an acupuncture needle is inserted into a tight band of muscle fibre known as a ‘trigger point’, with the aim of releasing the tightness and relaxing the muscle. Usually dry needling is used in conjunction with other techniques such as chiropractic manipulation or massage therapy.

A small number of GPs and other western medical practitioners also practice acupuncture; whilst a very small fraction of these are trained in and utilise classical Chinese medical ideas, the majority of them practise what they call ‘medical acupuncture’. ‘Medical acupuncture’ involves an attempt to understand the mechanisms of how acupuncture works using the framework of western medicine, rather than the classical Chinese framework. ‘Medical acupuncturists’ mainly use acupuncture in the treatment of pain, but also use it for a few other conditions such as nausea and menopausal problems.

TRADITIONAL CHINESE ACUPUNCTURE

There are two kinds of acupuncture practised in the West which continue to utilise the traditional Chinese ideas which gave rise to acupuncture. These are Traditional Chinese Medicine (TCM), and Five Element Constitutional Acupuncture (FECA), which are based on a system of medicine whose roots date back at least 2500 years, and which is still evolving today. Within these forms, acupuncture is used to treat a very wide range of ailments. In this article we shall refer to these two forms as ‘traditional acupuncture.’

WHAT’S THE DIFFERENCE?

The main difference between traditional acupuncturists on the one hand and GPs, physios and chiropractors who use acupuncture on the other, is that the former practice acupuncture broadly within the context in which acupuncture was developed in China, whilst the latter abandon this context and attempt to relocate acupuncture within a western medical context.

Thus when you go for treatment to a traditional acupuncturist, you are going to someone who will understand your health and any health problems you have from a very different point of view from that of a western medical practitioner. A traditional acupuncturist will probably have completed a degree or postgraduate level course in traditional acupuncture, and thus will have spent at least three years studying and training in acupuncture and its application within its classical Chinese medical context. Western medical professionals who use acupuncture may have only done as little as a few days training in acupuncture.

To begin with, the traditional acupuncturist thinks in terms of ‘Qi’ (pronounced ‘chee’.) Qi is a key concept in understanding how acupuncture has been used over the millennia in China and other parts of Asia, but it is quite difficult to translate into English. Broadly speaking we can say that a healthy being has abundant Qi which flows freely – a living being is characterised by constant movement on all levels of their being. Qi is an important concept not only in classical Chinese medicine, but in things like martial arts and philosophy. What a traditional acupuncturist is doing when they insert a needle into the skin, is seeking to influence the Qi; the needle is usually inserted at an ‘acupuncture point’, a specific site on the body at which the Qi can be influenced in various ways. Most traditional acupuncturists will insert the needle until the patient actually feels their Qi responding, when a dull achy feeling, or perhaps a numb or tingling sensation, is felt in the vicinity of the point. Sometimes, especially if the acupuncturist is experienced and skilful, the Qi will be felt to move along a local pathway, called a meridian. The attention of the acupuncturist is focused on the tip of the needle, which provides a point of communication between the Qi of the acupuncturist and the Qi of the patient.

Western medical acupuncturists and dry needlers do not, on the whole, think in terms of Qi. They may be thinking rather in terms of needling into a trigger point to loosen a tight muscle, or possibly in terms of influencing the peripheral and/or central nervous system. Whilst to a casual observer what the western acupuncturist is doing and what the traditional acupuncturist is doing may look similar, there is a considerable difference in what each thinks of themselves as doing. At least from the point of view of traditional acupuncture, this is important; traditional acupuncture stresses the necessity of the acupuncturist having a focused intention on the needle and the effect he or she is trying to have on the patient’s Qi; it also stresses the importance of the acupuncturist’s Qi being free flowing, as the treatment is seen very much as an interaction between the Qi of the clinician and the patient. Many traditional acupuncturists practice disciplines such as T’ai Chi, Chi Kung and meditation which they see as virtually indispensible support for the healing work they do with acupuncture. Of course a good western medical acupuncturist may indeed have this kind of focused intention without thinking of it in these terms; however, the framework of modern western medical science, still not free of the Cartesian separation of mind and body1, might be considered to undervalue the effect of the mental and emotional state of the healer, so that acupuncture can come to be seen as a mere technique not significantly affected by the mental state of the person administering it.

Another one of the hallmarks of the traditional Chinese medical context is that it is holistic. So, for example, suppose you have an ache in your low back. (This is one of the main complaints which acupuncture is used to treat in the UK today – in fact the National Institute for Health and Clinical Excellence recommends that a course of acupuncture is one of the ways in which persistent non-specific back pain is treated within the NHS.) A traditional acupuncturist will, of course, examine your back and ask you about the pain – how long have you had it, what it feels like, what makes it worse, whether there is anything that relieves it, and so on. But they will also be interested in most other aspects of your health – including your digestion, any breathing problems you have, how well you sleep, even what kind of temperament you have and what your emotional life is like. This is because they want to see your back pain in the context of you as a whole person. Let’s say they discover that your digestive system is not working quite as well as it could – maybe you don’t have much of an appetite, but you do have a sweet tooth, you bloat easily and your stools can be a bit loose. Now this has nothing to do with your back ache – or does it? The traditional acupuncturist would consider it likely that there is a knock on effect from this digestive weakness which is affecting your back. After all, the nourishment which the muscles, ligaments and bones of the back need if they are to function properly largely comes from the food we eat – and if we are not digesting that food as well as we could, this will impact negatively on the degree of nourishment. In fact in Chinese medicine there is a well known connection between an impaired digestive system and muscular weakness.

Perhaps also you are under a fair bit of stress – and of course low back pain may add to this. The traditional acupuncturist will probably take your pulse during his or her examination of you, and if they find that the pulse feels ‘wiry’ – a bit like a taut guitar string – and if you report being short-tempered or moody, and get frequent headaches, they will probably conclude that the stress you are under is inhibiting the free flow of your Qi; in plain English, you are uptight and tense. It is again no great surprise that this kind of thing can exacerbate any kind of pain, including back pain. In fact it may even be that the main reason you have got low back pain is because of this up-tightness combined with the digestive weakness.

So what the traditional acupuncturist will probably do is to treat your back with acupuncture, aiming to smooth the flow of Qi through your back, but also will use acupuncture to strengthen the digestive system and promote the smooth flow of Qi throughout your system. That is to say, they will treat the back pain locally, but also address systemic underlying issues which may also be contributing to the back pain and undermining your body’s natural ability to heal itself. They can do this utilising acupuncture points on the lower leg, abdomen and back which in classical Chinese medicine are known to be able to effect the digestive Qi; similarly there are points on the hands and feet which can be used to smooth the flow of Qi throughout the system.

In addition to this they may also suggest dietary changes you may be able to make to help support your digestive system and things you can do, such as Chi Kung exercises or meditation practices, which will help you relax more fully and be able to deal with the stress in your life more effectively. They may also use other classical Chinese medical treatments to help your back, such as moxibustion – the use of mugwort, a warming herb, to improve local circulation and warm and relax the muscles, Chinese massage and cupping therapy.

So when you go to see a traditional acupuncturist for your back problem, you will receive a treatment which addresses the pain directly, but which also seeks to restore balance and harmony to your system as a whole, so that the back pain is less likely to return – and, incidentally, other aspects of your health improve too; in this example, perhaps your bloating disappears, your stools firm up a bit, and you feel more relaxed in general and better able to cope with the strains which life is bringing you.

Of course some chiropractors, physiotherapists and GPs may also be thinking holistically, and they too are unlikely to use acupuncture as a stand-alone treatment. But hopefully the above example makes it clear that there is a considerable difference between western medical acupuncture or dry needling on the one hand, and traditional acupuncture on the other. The point is that it is incorrect to see acupuncture as a technique divorced from the system of medicine in which it is embedded. Traditional acupuncture is acupuncture embedded within the classical Chinese medical context, a holistic form of therapy which seeks to rebalance and strengthen the Qi of the patient through the use of acupuncture and related techniques as well as dietary and other advice; dry needling and ‘medical acupuncture’ use acupuncture as a technique to release trigger points in tight muscles and modify the central and peripheral nervous systems, whilst attempting to understand acupuncture within the framework of western medicine.

1. The Seventeenth century French philosopher Rene Descartes is considered to be at least partly responsible for the way in which western science has tended to view the mind on the one hand, and the body on the other, as separate entities. One consequence of this for medical practice is that people trained in western medicine, which is of course rooted in the western scientific tradition, are not often inclined to consider that their state of mind will have much effect on the treatment they administer. The western doctor, like the western scientist, may tend to think of themselves more as a detached observer who interacts only in a more or less mechanical way with their patient. Although modern scientific advances, such as those in quantum physics, have shown that this tendency to view the scientist/doctor as detached is illusory, the Cartesian legacy remains.

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‘Fighting’ cancer or other life-thereatening diseases

Sunday, July 11th, 2010

I was just reading a Telegraph article today entitled “Socialising with others ‘can help fight cancer’”. The headline led me to ‘put pen to paper’.

From my clinical experience, one of the most prevalent causes of disease, whether it be a bad back or whether it be heart disease, is the unconscious refusal or inability to freely and honestly express ourselves as we truly are. The most common example of this is in the work we choose to engage in to earn a living.

The whole idea of recovering from a life-threatening disease, like cancer, being a ‘fight’, I find difficult to get my mind round. My appreciation of disease processes is clearly influenced by my style of medicine, Traditional Chinese Medicine (TCM) with its range of therapeutic techniques, such as acupuncture. TCM is holistic in its approach to healthcare. Holism states that body and mind are inextricably linked so what happens to one will have an inevitable knock-on effect on the function of the other. Holism understands that disease is not some random, chance occurrence that we have little or no control over. Even geneticists attribute only 25% of our state of health to our inheritance. My own personal experience of scrutinising my state of health, and intermittent fall from good health over the years, has yielded a clear connection between this and my thought processes. Scrutinising the health of thousands of others in my professional capacity, and studying research and the clinical experience of others far more experienced and talented than me, has corroborated my conclusions.

Gradually, modern medicine is starting to fully appreciate the huge influence our state of mind has on our health. This is really well summarised in Adrian Leader and    book “Why do People get Ill?” ), available from our online shop. Literally, we are what we think. It is becoming increasingly evident that our thought processes create our diseases, whether they involve physical or mental symptoms, or both. We can say that our heart condition has been brought on by working intensely under stressful circumstances for a prolonged period of time, but what thought processes have led us to work like this in the first place. For example, if during our upbringing, we have thought, for whatever reason, that we needed to ‘achieve’ in order to gain ‘acceptance’ or ‘love’ from our parents, then this might have trained the habit of ‘flogging’ ourselves in our work life.

Holistic healthcare is about helping each individual bring their unconscious motivations into conscious awareness whilst using tried and tested techniques to facilitate recovery from the current disease-state. We do this by stimulating the body’s own, already amazingly well-equipped self-preservation systems. When an individual understands their disease process as part of who they are, they see that there can be no ‘fight’ against cancer because the cancer is a part of them. There is no external ‘enemy’ to fight. They have literally created their circumstances by their thoughts words and deeds in their life to date. Therefore, the only long-term, sustainable solution is through new thoughts, words and deeds. So, in my mind, self-understanding is the key. As far as I can see, achieving self-understanding is a process, often long and arduous, which is why we are often well-advised to seek external help when experiencing a life-threatening disease state.

The word ‘fight’ often implies a struggle. Because of the negative connotations this idea holds, this is just likely to make the process of recovery that much more difficult. So, I believe that our best chance of survival is to embrace the symptoms we are suffering as messages sent from deep inside us as an aid to reaching fullness. This way we can utilise the healing power of love, love of our self and the people around us and of life. Being diagnosed with a life-threatening illness is probably one of the best wake-up calls we will ever get in helping us to express ourselves as we truly are. So let’s embrace it. Or, as the motif on one of the Tai Chi students in my class says: “make tea, not war!”

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Mumbo Jumbo

Wednesday, June 2nd, 2010

Some people say that Chinese Medicine is mumbo jumbo – all this talk of Yin and Yang, Qi and so on. I think these people should be careful; it is not that these ideas were dreamt up by a couple of new age types who didn’t like their GP, they originated in a highly sophisticated culture where they were integral to disciplines as (apparently) diverse as martial arts, medicine, poetry, cooking and philosophy. Dismissing this whole culture, with its perceptive and subtle way of understanding the natural world, because it does not speak the language of Western science, might be a little presumptuous – especially perhaps when the pharmaceuticals Western medicine relies on so heavily start becoming too expensive as the world’s oil reserves run dry.

Two hundred years ago, people in the West believed Christianity was the one true faith, and that it was our responsibility to propagate it to the ignorant world – which was, of course, ridden with ‘mumbo jumbo’. Could it be that our faith in Western science and Western medicine, and the intolerance and even arrogance of those who dismiss any other form of understanding the natural world, is a harping back to this kind of evangelical intolerance?

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QI

Tuesday, August 4th, 2009

If you come for some treatment with a Chinese medical acupuncturist, he or she will probably talk to you, sooner or later, about your Qi. Qi, sometimes spelt ‘Chi’, is one of the key concepts of Traditional Chinese Medicine (TCM), a form of healthcare whose roots date back at least 2,500 years. To understand anything about TCM, you need to understand what Qi is, and also to begin to recognise it in your own experience. Whilst for any Chinese person (except perhaps one who has been so thoroughly westernized as to lose touch with their roots), Qi is an everyday reality, as it will be indeed for any westerner who has trained in disciplines such as T’ai Chi or Chi Kung, for many people in the west Qi is still a strange and foreign concept.

Qi is not only a key idea in Chinese Medicine, it is a key concept in traditional Chinese thought, and no understanding of Chinese philosophy, Chinese religion, or, indeed, what may be termed Chinese science, is possible without grasping something of the meaning of Qi. Chinese civilization is of course very ancient and very sophisticated, and the notion of Qi has been central to how the Chinese have understood the human condition for millennia. However, and this is perhaps illustrative of the traditional Chinese approach to life which is so different from the western approach, Qi is not easily defined or tied down.

Qi is sometimes translated as ‘energy’ or ‘vital energy’. Perhaps the key thing to understand about Qi is that, in a healthy person, it flows. It flows all around the body, on the surface and through the interior, in a network of channels or meridians. In fact all movement in the body, including the circulation of blood and other body fluids, is governed by Qi. Qi also warms and invigorates the body, and aspects of Qi are responsible for defending the body against external pathogens, in a way analogous, to some extent, to the western notion of the immune system. Qi includes both what we would call mind and matter; the subtlest thought is a movement of Qi, just as much as is the movement of food through the digestive system. Patients experience Qi as an unusual dull achy or tingling feeling around the needle, or propagating along the meridian from the needle; this feeling arises when the acupuncturist inserts the needle so as to contact the patient’s Qi.

When people started practicing acupuncture in the west, some people scoffed at the notion of Qi and the meridians, because, they thought, in western medicine there was nothing corresponding to them. The meridians do not correspond to blood vessels for example, or to nerves. However, more recently researchers have been investigating the matter further, partly because acupuncture is so obviously effective – no less a body that the World Health Organization1 lists a number of medical conditions for which it considers that research shows that acupuncture treatment is of proven effectiveness.

Some of the research into how acupuncture works from a western perspective2 shows that the meridians may correspond to lines of slightly decreased electrical resistance, which would suggest that Qi may, at least in part, be made up of micro currents of electricity. (Modern acupuncturists sometimes make use of this fact to locate acupuncture points using a simple device to measure variations in electrical resistance on the skin, although whether this is a more effective technique than the traditional palpatory skill of the acupuncturist is open to question.)

Other research projects suggest that the meridians may be related to connective tissue3, the fibrous support structure for body tissues and organs. The insertion of an acupuncture needle into a traditional acupuncture point may cause changes in local connective tissue which are both long lasting and capable of influencing distant parts of the body, since the connective tissue forms a continuous matrix throughout the body. Since nerve fibres are embedded in connective tissue, the needle may also have modulatory effects on nerve signals. The meridian system may also be explained in part by the notion of migratory tracks in interstitial fluid4, the fluid which surrounds the cells which make up the human body; cells such as mast cells (which have, amongst other functions, a key role in the immune system) and fibroblasts (which play a critical role in wound healing)

One can question, however, the necessity of explaining Qi in western scientific terms. Western science and western medicine are of course highly sophisticated bodies of knowledge, but it is perhaps a touch arrogant of us to consider that they are the be all and end all, the only way of looking at the world – after all, from the point of view of Chinese medicine, western medicine is a relatively new form of medicine. It looks at the person from a particular point of view, which gives it both strengths and weaknesses. Chinese medicine represents a different point of view, with different strengths and weaknesses. It will probably prove impossible to fully explain Chinese medicine in western terms, just as it would be impossible to fully explain western medicine in Chinese terms. The wisest course may well be to use whichever medicine is more helpful in the case in question. In modern China, in fact, this is what does happen: hospitals may be split between departments of TCM and of western medicine.

The scientific findings mentioned suggest that Qi is a relatively subtle and complex phenomenon, which is not to be explained by any one western idea but only by a combination of several (micro currents, connective tissue, interstitial fluid etc). Quite a few patients who come for acupuncture treatment are obviously ill, but western medical tests find nothing wrong with them – from a Chinese medical perspective, the problem lies at the level of Qi. At this level western medicine does not operate – western medicine is effective when the problem is more obvious. From this point of view TCM is effective at treating relatively subtle disharmonies which western medicine does not see, and also at preventing these disharmonies escalating and as it were condensing into more severe conditions.

1. WHO (2002): Acupuncture: Review and Analysis of Reports of Controlled Clinical Trials Available from URL http://apps.who.int/medicinedocs/en/d/Js4926e/5.html

2. Reichmanis M et al (1975) Electrical Correlates of Acupuncture Points IEEE Transactions on Biomedical Engineering

3. Langevin H et al (2002) Evidence of connective tissue involvement in acupuncture The FASEB Journal. 16:872-874

4. Fung P (2009) Probing the mystery of Chinese medicine meridian channels with special emphasis on the connective tissue interstitial fluid system, mechanotransduction, cells durotaxis and mast cell degranulation Chin Med 4:10

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TRADITIONAL CHINESE MEDICINE AND DYSTONIA

Saturday, July 25th, 2009

TCM is a system of medicine whose roots date back at least 2500 years, and is still evolving today. It is a holistic practice which evaluates the whole body, rather than just specific symptoms. Any side effects are rare and extremely minor when compared to conventional treatments, and its diagnostic techniques allow for great precision in treating each individual quite specifically, thus creating treatment plans which are equally precise. In effect, TCM encourages the body to regain its natural balance and therefore acts in a more subtle way than conventional medicine. It has a long and clinically verified history of effective treatment for most types of disease. Finally, it is an understandable and empowering system of treatment which helps patients to understand their disease process and thus gives them the opportunity to participate in their healing process.

Treatment in TCM may include acupuncture; the insertion of very fine needles at key points on the body, which helps to regulate the flow of energy known as Qi (pronounced ‘chee’). Other forms of TCM treatment include (but are not confined to) massage, herbal medicine, and a form of therapeutic exercise called Chi Kung. The patient can also take control of their overall health by following advice on diet, relaxation and exercise.

One of the most salient features of TCM is that it is a holistic form of medicine, which is to say that it always sees any health problem within the overall context of the human being as a whole, including the physical, emotional, mental and even spiritual aspects of the person; indeed it also sees the human being as part of the natural world in which we live, as our health is inextricably bound up with what is going on around us.
To do this TCM developed, over the centuries, a non-technical language and conceptual framework to understand illness; one of the most important concepts within TCM is that of ‘Qi’ (sometimes spelt Chi). Qi is the vital living energy of the human being, which circulates around the body in a number of channels, or meridians. Simplifying somewhat, illness arises when there is a problem with our Qi; either there is not enough of it, or it is not flowing freely, or both. Whilst Qi may still be a foreign concept to some westerners, any Chinese person will understand immediately what Qi is and be able to identify it within their own experience, and any westerner who practices the arts of Qigong (Chi Kung) or Taiji (T’ai Chi) learns this awareness from the start of their studies.
We might be tempted to ask what Qi is from a western point of view. There is a growing body of research, especially from China, which is addressing this task; one aspect of Qi would seem to be bio-electrical, the flow of tiny electrical currents around the body. However, countless generations of Chinese medical practitioners, as well as martial artists, meditators, and others, have worked with Qi without any need to understand it from a western point of view.
So how can TCM help dystonia? To begin with it is worth stressing that TCM treatment is always individualised to each patient. Whether the problem is dystonia, back-pain or the common cold, any course of CM treatment begins with a detailed consultation in which the therapist is interested in finding out not only about the problem itself, but also about every aspect of the patient’s health, from their digestion to their temperament, from how they sleep to the quality of their hearing. Pulse taking also has an important part to play in this process – practitioners of TCM are trained to glean a surprising amount of information from a patient’s pulse, paying attention not only to its rate but to numerous other aspects of the pulse such as its strength, width, smoothness and depth. Similarly examination of the patient’s tongue reveals other useful information.
This process enables the practitioner to get a clear picture of what is happening with the patient’s Qi and how the Qi of the different organ systems are interacting. The symptoms of dystonia are then viewed and understood within this context. To illustrate how this works in practice, consider the following case study:
Melissa came for treatment at the Sean Barkes Clinic for spasmodic torticollis which she had been suffering from for over three years. She suffered from neck and shoulder pain, shaking of the head, inability to move the head, and “sickly” headaches. She was having botox injections every three months, which were helping, but she was keen to discover other ways of moving forward. She also suffered from irregular and heavy periods preceded by pre-menstrual moodiness and cramping pain, and costochondritis (a swelling of a rib in the chest making breathing uncomfortable). She also reported hearing loss in her right ear.
Melissa had a demanding job which involved dealing with angry people and conflict on a daily basis, and having to remain calm and professional throughout. Such a situation is likely to lead to ‘Qi Stagnation’ – when our feelings are unable to find expression, the smooth flow of our Qi is impaired. In Melissa’s case it seemed likely that this tendency to Qi Stagnation was affecting her neck and shoulders in particular, but was also a major factor in her problems around period time – if a woman’s Qi is not flowing freely, the transition from one part of the menstrual cycle to the next is likely to be uncomfortable. The costochondritis also suggests Qi Stagnation affecting the chest. The diagnosis of Qi Stagnation was confirmed by taking Melissa’s pulse, which manifested the quality of what Chinese Medicine calls ‘wiriness’ – the pulse feels tense, a bit like a stretched elastic band. Wiriness in the pulse is more often than not caused by Qi Stagnation.
However, there was rather more to it than this. When asked about her sleep, Melissa reported that she suffered from ‘night terrors’ and woke a lot in the night. In Chinese Medicine the quality of our sleep is closely related to the quality of our blood (which is a somewhat different concept in Chinese Medicine than the western idea of blood.) The fact that Melissa also suffered from dry and gritty eyes, and had ‘floaters’ also suggested her blood was a little depleted. In Chinese Medicine one of the main functions of blood is to nourish the muscles and tendons, and if the blood is depleted these can become tense and inflexible. In Melissa’s case the blood deficiency seemed likely to be due to losing a lot of blood during her period, on top of a weakness in her digestive system that manifested in bloating and feeling tired after meals. Thus a picture was beginning to come together as to the main factors responsible for the torticollis.
Melissa was able to come in twice weekly for treatment, and acupuncture was used to smooth the flow of Qi and strengthen the digestive system. We also gave Melissa some tips on how she could modify her diet to nourish her blood and allow the digestive system to improve its functioning. Melissa reported that she felt a lot more energetic than usual, and her period was less problematic both in the run up to it and the actual bleed itself. After three treatments we began to treat the torticollis directly using one or two acupuncture points on the neck and other points lower down the body on the same meridians, to encourage the Qi to flow more smoothly through the neck and down the body. Occasionally we also used Chinese massage techniques to facilitate this process.
After five weeks of treatment Melissa reported that she felt “normal” for the first time in a long time. Her neck and shoulder pain was considerably reduced and her range of movement increased; her consultant told her that she did not need to continue with the botox injections. Melissa continues to attend for regular acupuncture treatment; whilst she was a little nervous at her first visit, being “terrified of injections”, she got over that very quickly and now enjoys coming for treatment. In her own words:
“As acupuncture treats the whole person, not only is my neck straighter and I now have more movement, I feel much better in myself. My husband keeps commenting on the improvement in my general well-being as well as my neck. I have overcome my fear of needles and as well as acupuncture I have had other Chinese therapies: cupping and gua sha, both specifically on my neck, and both appear to be effective.

I went not expecting a miracle cure. I still don’t have full movement but I have achieved a great improvement in my neck. It has also improved other medical conditions that I have suffered from, and I now enjoy it.”

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