East Asian Medical Theory and Diagnosis
East Asian Medicine (EAM) differs from modern biomedicine
in its basic medical orientation, physiological theories, etiology, diagnostics,
therapeutics and pharmacology. For instance, while modern biomedicine
views the essence of illness as anatomico-pathological, EAM views it as
a symptom-complex of the whole body. While biomedicine identifies the
sources of illness as disease entities, EAM identifies them as imbalances
of climate, lifestyle, diet, and/or emotional factors. While biomedicine
uses advanced lab and mechanical investigations as diagnostic means, EAM
uses ordinary patient contact, namely looking, smelling, asking, and palpation
(methods known as the "Four Pillars of Diagnosis"), to locate
problems. While biomedicine emphasizes pathological anatomy, EAM focuses
on the patientís complaint and actual experience of being sick. While
biomedicine focuses on curing diseases, EAM focuses on balancing functional
factors. While biomedicine employs chemical drugs or surgeries, EAM employs
natural herbs, massage, simple needles, diet, exercise and meditation.
In EAM, a diagnosis is made through the differentiation of signs
and symptoms and will reflect the nature and character of the
disease, its location in the body, and the strength of both the
patient and the pathogenesis of the disease. Diseases are organized
into patterns and it is these patterns that are treated. By contrast,
a disease will manifest, over time, as different patterns. The
fundamental methods of East Asian medical diagnosis were first
described as a method of organizing disease and its manifestations
in the classical Chinese text the Shan Hun Lun (Treatise on Colds
and Fevers) in AD 225.
In EAM, differential diagnosis arises from 5 major medical theories:
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Eight Principles: First described as a method of organizing disease and its manifestations in the Shan Hun Lun (Treatise on Colds and Fevers) in AD 225. Patterns and symptoms are organized into the following 4 diads: Hot/Cold, Interior/Exterior, Yin/Yang, Vacuity/Repletion.
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Organ (Zang-Fu): Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium, Triple Warmer, Gall Bladder, Liver.
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Channel (Jing-Luo): Vessels or meridians of the body that course through the body carrying Qi and Blood (Xue) and which enable connections between the organs, as well as the interior and exterior aspects of the body.
- Qi and Blood (Xue): substances ability to perform their functions.
- Pathogen Etiology: based on classical Chinese medical canon and their commentary.
EAM treats disease by seeking its primary cause; as
such, the urgency of the disease, season, and individual condition are
considered in the diagnosis and treatment. Throughout, there is an emphasis
on prevention and early intervention. The guiding principle of treatment
is to regulate Yin and Yang. Treatment is directed
at both the roots of the disorder, particularly with chronic conditions,
and the branch or manifestation of the illness. The fundamental objective
of treatment is to reinforce functional Qi and eliminate
pathological Qi.
It is worth noting that in EAM, there can be no diagnosis without treatment
as each diagnosis suggests treatment methods and strategies. In EAM, the
diagnosis and treatment process is as follows:
- Differentiate signs and symptoms, identify patterns and make a diagnosis.
- Set treatment strategy and develop prescription:
- Select treatment modalities and methods
- Modify treatment for the individual and their condition
- Adjust dosage and administration.
- Determine treatment frequency.
- Provide treatment.
- Evaluate disease and assess prognosis, e.g., when the condition is likely to resolve, acute/chronic in nature and severity. Prognosis should address what is expected to happen when the patient stops treatment.
- Provide preventative care and remove causes of the disease.
Health and Illness
Health in East Asian Medicine
(EAM) can be defined as the dynamic balance of yin
and yang within the individual and between the individual
and his or her environment. From this perspective, the individual
is subject to the same forces that operate on the environment:
seasonal changes, time, astronomic influences and climate. Similarly,
forces affecting an individual's "inner environment"
are also critical to health: diet, emotions, and life cycle. This
idea of a human ecology is further demonstrated in the traditional
East Asian medical understanding of mind-body-spirit. In East
Asian Medicine, mind-body-spirit are understood to be inextricably
linked, with each aspect reflecting the conditions of the others.
The concept of illness in East Asian Medicine
suggests a body's inability to respond and adapt to changes in
the environment, diet, aging/development, or an inability to rid
the body of an attacking pathogen. In East Asian Medicine, patterns
of disharmony are used to diagnose illness; these patterns are
described as complexes of patient signs and symptoms and are specific
to an individual. Patterns of illness do not describe diseases;
they describe the functioning of the patientís whole body at a
definite time or stage of a disease. Patterns are differentiated
according to the eight principles, the state of Qi
and Blood (Xue), the channel theory, the theory of the organs
(Zang-Fu), the etiology of the disease, and so on. See above
for further information on these theories.
Yin and Yang
The concepts of Yin and Yang are fundamental concepts
in East Asian Medicine (EAM) and key to its understanding. The essential
aim of EAM is to bring into balance Yin and Yang within the individual
and between the individual and the social and physical environment.
The Chinese character for Yin originally represented the shady
side of a mountain. Thus, Yin represents form and is associated
with concepts of darkness, stillness, coolness, descending, solidification
and moisture.
The character for Yang originally represented the sunny side of a mountain.
Thus, Yang suggests brightness, movement, heat, ascending, and metabolic
function.
The
Yin-Yang symbol, or the Tai Ji, represents the dynamic
inter-relation of yin and yang. Within yin is yang; note the small
white dot within the dark half of the symbol. Within yang is yin;
note the dark dot within the light half of the symbol. This symbol
suggests that aspects of yin and yang are constantly transmuting
into the other.
Yin and Yang are simultaneously independent and interdependent, that is,
one does not exist without the other and the state of one affects the
other. Thus, Yin-Yang theory is based on a dynamic and relative balance.
These concepts are used as metaphoric frameworks for East Asian medical
descriptions of anatomy and physiology and well as pathophysiology.
[References
- Sources 8-10]
Qi
Along with Yin-Yang theory, the concept of Qi is at the heart of traditional East Asian medical thought. In the traditional East Asian Medicine (EAM) paradigm, all things animate and inanimate are understood to be imbued with Qi.
The Chinese character for Qi itself depicts steam rising from a bundle
of rice suggesting change, movement and transformation; a subtle substance
deriving from a coarse substance. Qi, while an ineffable vitalic force,
is said to be both material and immaterial. It is potential and movement,
and by nature is in a state of constant flux and movement.
Basic Physiological Functions of Qi
In EAM, the fundamental functions of Qi are to:
- Transform materials, such as food into fuel in the body
- Transport substances, like blood throughout the bodyís vessels
- Hold substances in place, such as blood in vessels and viscera in the abdomen
- Protect against pathogens and trauma
- Warm living tissues
Qi within a person is the result of the interaction
and merging of essential Yin and Yang forces between parents at the time
of conception, between the individual and the larger universe.
Types of Qi
Qi exists in different forms depending on its location and undertaking.
Types include:
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Prenatal Qi is given to an individual at the time of conception by the parents
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Postnatal Qi is maintained by eating and breathing
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Organ Qi is associated with EAMís understanding of organs, such as Lung Qi, Liver Qi, Kidney Qi, etc.
Pathologies of Qi are based on it ceasing to function true to its physiological nature. It may become excess or replete, deficient or vacuous, or it may stagnate.
NCCAM