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Traditional Chinese Medicine
138
Complementary
3. French
Therapies
S ed. Physiotherapy:
in Medicine:
Clinical
a psychological
Butterworth Heinemann, 1992. pp33 i-332. 4. Cartwright-Adams N. A study of the osteopathic matics. BSO Project 1989/12.
TRADITIONAL
forum
approach.
Oxford:
treatment for asth-
5. Coleshill A. Osteopathic II: 15-16. 6. Sutherland osteopathy.
treatment for asthmatics.
Br Osteo J 1988;
WC. In: Wales AL. ed. Teachings in the science of Cambridge, Mass: Rudra Press, 199 I.
CHINESE MEDICINE
BACKGROUND
In Traditional Chinese Medicine (TCM) asthma is not a disease but a symptom of imbalance in all organ systems. At the heart of TCM are the life force Chi, which sustains all things, and Yin and Yang, manifestations of the complementary antagonistic opposites which characterise all things. In health Chi is of a certain quality, quantity and direction of movement, if not, disease occurs. In TCM asthma may be due to environmental ‘wind-heat’ or ‘wind-cold’ (air pollution, viral or bacterial infections, inclement weather, poor diet etc.). Such ‘evils’ invade and weaken the lungs disrupting the movement of Chi. Weak lungs can also be caused by dysfunction in the digestive (spleen/stomach) and hereditary/immune (kidney) energy systems. This may lead to excessive heat in the lungs and/or water retention which, if it concentrates to form phlegm, may obstruct air-flow and so cause asthma.
THE PATIENT Janie is the second of two children, is nearly 10 years old, has a family history of atopy (dermatitis, eczema, asthma and hayfever), a classical chesty picture beginning as a toddler of 4 with night coughs, being inhalerdependent by the age of 7 and on inhaled steroids by the age of 8, on which she is currently maintained. Her GP is well informed and sensitive, aware of both actual and potential family tensions. Janie’s mother has given up work, her father has a new stressful job, communication is difficult, and Janie has just had an acute respiratory crisis necessitating hospitalisation. This involves and reflects complex psycho-physical dynamics. From the available information Janie is an ideal candidate for TCM. We expect her to respond well after a few treatments.
THE ASSESSMENT Whilst in allopathic terms Janie has a clear diagnosis of asthma, additional information is required for a proper TCM diagnosis:
l At exactly what age did her symptoms first appear and what precipitated them? l Was there initial evidence of a viral infection or a more sudden ‘allergic’ onset? l At what time (am/pm) do symptoms appear? l What factors are associated with symptoms, e.g. sport, pets, weather, infections, house dust mite, or emotional/stressful situations? l Do food and time of eating matter? What mucogenic foods such as milk, cheese, other dairy products, red meat, chocolate, alcohol, yeast or gluten containing foods is she eating?
For a TCM diagnosis the balance of Janie’s yin and i.e. hot and cold, wet and dry, wind and heat, as internal and external conditions at organ, blood and energy levels are assessed. The arterial pulses, tongue, skin colour, texture and smell, facial and other signs are noted. In TCM disturbed lung function in childhood asthma is most often due to ‘lung heat and phlegm’. The hereditary component indicates kidney energy dysfunction, the eczema indicates both disturbed lung and colon energies (the lung, colon and skin are intimately linked in TCM), but foods and infections are also important causes of skin problems, particularly in Janie’s case. yang,
THE TREATMENT TCM treatment involves physical and systemic psychological approaches for both Janie and her parents. Children are more sensitive than adults so acupressure, gentle acupoint massage, or surface electro- or laser point stimulation are often preferable to needle insertion. Minimal needle insertion may suffice. Always respect the child’s fears and wishes and explain to the child what is going to be done and why, as often as possible. This will help her cope with the changes which treatment will entail and bring about. The first aim is to promote sleep and calm the child. When selecting herbs for children try to select fruit plants which are well tolerated, extensively researched and have known chemical profiles. The ongoing medication should not be stopped precipitously
and certainly not without consultation
Childhood asthma
with the GP. Dietary regulation is a cornerstone of TCM. It can profoundly affect sleep, hyperactivity and breathlessness. Intake of mucous-forming foods should be minimised, well-cooked white meat should be eaten instead of red, apple juice is the least heat-forming and fatty, spicy foods should be avoided. Light, early evening meals help prevent abdominal distension and nocturnal gastric acid regurgitation, all of which cause wakefulness, coughing, bronchospasm and therefore breathlessness. According to the Chinese energy clock the asthmatic child’s classic pattern of waking between 2 and 3 a.m. reflects liver energy dysfunction due to late eating, slowed night-time digestion, and consequent hyper-acidity and breathlessness. Gentle breathing exercises may be beneficial. Any eczema and sinusitis must be treated to prevent recurrent bronchospasm. To this end bowel function should be regular. Janie should be seen every week for the first 7 weeks, bi-weekly thereafter. Monitor lung function with a peak-flow meter before and after treatment, and mornings and evenings. This will help monitor progress and also capture her interest. Ideally, Janie should have a check-up at the change of each season. With the help of her GP, her other medication may then be gradually withdrawn. Janie’s parents, Helen and Bob, are crucial to Janie’s wellbeing. They need to be reassured, to have an opportunity to talk freely; together and separately. Janie’s GP may be the best person for this and may then involve the TCM physician. Guilt is probably important at many levels; they married only when Helen became pregnant. Janie will almost certainly be responding to their currently tense dynamic. Both Helen and Bob may also benefit from acupuncture, herbs, relaxation and Tai Chi exercises. It will be particularly important to help Helen; first to sleep and then with other aspects of her asthma. Optimal management will involve liaison with the GP at
139
all times. In this case he is supportive and interested and should be kept informed professionally so as to nurture the relationship he has with Helen and Bob.
SUGGESTIONS
FOR TREATMENT
TCM treatment should be individualised, hence our brief suggestions only. Nothing can substitute for experience and training. Acupuncture points: Lung: 5,7,9; Colon: 4, 10, 1I ; Conception vessel: 17; Stomach: 36; Spleen: 6; Kidney: 3; Back shu points: extra 19, 17; Bladder 13, 15. 17, 21. Herbal prescriptions: Qing Chi hua Tan Tang and Xiao Qing long Tang are both effective but should be carefully adjusted according to the patient’s condition.
Jing Hua Chen MD, Asthma Research Physician, Osler Chest Unit, Churchill Hospital, Headington, Oxford OX3 7LJ, UK Kim Jobst MA, MRCP, Clinical Director, Oxford Project to Investigate Memory and Ageing (OPTIMA), Radcliffe Infirmary Trust, Woodstock Road Oxford OX2 6HE, UK Recommended
reading
Scott J. Natural medicine for children. London: Unwin, 1990. Jobst KA, Chen JH, McPherson K et al. Controlled trial of acupuncture in chronic disabling breathlessness. Lancet 1986; ii: 14161418. Also Lancet 1987; i: 802.
Lane DJ, Lane TV. Alternative and complementary medicine for asthma (editorial).Thorax 1991;46(ii): 787-797.
HOMOEOPATHY
BACKGROUND This article is not a suitable forum to discuss or describe the rationale of homoeopathy. Let me just say that there are 2 basic homoeopathic approaches to desensitise patients to their major allergens. This can be done without any deep homoeopathic knowledge and will produce an amelioration of the patient’s asthma. On the other hand, it is possible to treat the whole patient using a deep-acting, individually selected, constitutional homoeopathic remedy. In practice I would normally try
to do both of these to achieve the best possible result. The treatment of the acute attack of asthma is also beyond the scope of this article. Asthma is a lifethreatening condition and modern allopathic medicine has developed good and safe ways of dealing with the acutely distressed asthmatic. There are some homoeopathic remedies that can be used acutely by a skilled prescriber, with good effect, such as Antimonium Tartaricum, Arsenicurn Album, fpecacuana and K&i Carbonicum. Indications for these different remedies are complex and should only be attempted by a trained person.
Complementary
3. French
Therapies
S ed. Physiotherapy:
in Medicine:
Clinical
a psychological
Butterworth Heinemann, 1992. pp33 i-332. 4. Cartwright-Adams N. A study of the osteopathic matics. BSO Project 1989/12.
TRADITIONAL
forum
approach.
Oxford:
treatment for asth-
5. Coleshill A. Osteopathic II: 15-16. 6. Sutherland osteopathy.
treatment for asthmatics.
Br Osteo J 1988;
WC. In: Wales AL. ed. Teachings in the science of Cambridge, Mass: Rudra Press, 199 I.
CHINESE MEDICINE
BACKGROUND
In Traditional Chinese Medicine (TCM) asthma is not a disease but a symptom of imbalance in all organ systems. At the heart of TCM are the life force Chi, which sustains all things, and Yin and Yang, manifestations of the complementary antagonistic opposites which characterise all things. In health Chi is of a certain quality, quantity and direction of movement, if not, disease occurs. In TCM asthma may be due to environmental ‘wind-heat’ or ‘wind-cold’ (air pollution, viral or bacterial infections, inclement weather, poor diet etc.). Such ‘evils’ invade and weaken the lungs disrupting the movement of Chi. Weak lungs can also be caused by dysfunction in the digestive (spleen/stomach) and hereditary/immune (kidney) energy systems. This may lead to excessive heat in the lungs and/or water retention which, if it concentrates to form phlegm, may obstruct air-flow and so cause asthma.
THE PATIENT Janie is the second of two children, is nearly 10 years old, has a family history of atopy (dermatitis, eczema, asthma and hayfever), a classical chesty picture beginning as a toddler of 4 with night coughs, being inhalerdependent by the age of 7 and on inhaled steroids by the age of 8, on which she is currently maintained. Her GP is well informed and sensitive, aware of both actual and potential family tensions. Janie’s mother has given up work, her father has a new stressful job, communication is difficult, and Janie has just had an acute respiratory crisis necessitating hospitalisation. This involves and reflects complex psycho-physical dynamics. From the available information Janie is an ideal candidate for TCM. We expect her to respond well after a few treatments.
THE ASSESSMENT Whilst in allopathic terms Janie has a clear diagnosis of asthma, additional information is required for a proper TCM diagnosis:
l At exactly what age did her symptoms first appear and what precipitated them? l Was there initial evidence of a viral infection or a more sudden ‘allergic’ onset? l At what time (am/pm) do symptoms appear? l What factors are associated with symptoms, e.g. sport, pets, weather, infections, house dust mite, or emotional/stressful situations? l Do food and time of eating matter? What mucogenic foods such as milk, cheese, other dairy products, red meat, chocolate, alcohol, yeast or gluten containing foods is she eating?
For a TCM diagnosis the balance of Janie’s yin and i.e. hot and cold, wet and dry, wind and heat, as internal and external conditions at organ, blood and energy levels are assessed. The arterial pulses, tongue, skin colour, texture and smell, facial and other signs are noted. In TCM disturbed lung function in childhood asthma is most often due to ‘lung heat and phlegm’. The hereditary component indicates kidney energy dysfunction, the eczema indicates both disturbed lung and colon energies (the lung, colon and skin are intimately linked in TCM), but foods and infections are also important causes of skin problems, particularly in Janie’s case. yang,
THE TREATMENT TCM treatment involves physical and systemic psychological approaches for both Janie and her parents. Children are more sensitive than adults so acupressure, gentle acupoint massage, or surface electro- or laser point stimulation are often preferable to needle insertion. Minimal needle insertion may suffice. Always respect the child’s fears and wishes and explain to the child what is going to be done and why, as often as possible. This will help her cope with the changes which treatment will entail and bring about. The first aim is to promote sleep and calm the child. When selecting herbs for children try to select fruit plants which are well tolerated, extensively researched and have known chemical profiles. The ongoing medication should not be stopped precipitously
and certainly not without consultation
Childhood asthma
with the GP. Dietary regulation is a cornerstone of TCM. It can profoundly affect sleep, hyperactivity and breathlessness. Intake of mucous-forming foods should be minimised, well-cooked white meat should be eaten instead of red, apple juice is the least heat-forming and fatty, spicy foods should be avoided. Light, early evening meals help prevent abdominal distension and nocturnal gastric acid regurgitation, all of which cause wakefulness, coughing, bronchospasm and therefore breathlessness. According to the Chinese energy clock the asthmatic child’s classic pattern of waking between 2 and 3 a.m. reflects liver energy dysfunction due to late eating, slowed night-time digestion, and consequent hyper-acidity and breathlessness. Gentle breathing exercises may be beneficial. Any eczema and sinusitis must be treated to prevent recurrent bronchospasm. To this end bowel function should be regular. Janie should be seen every week for the first 7 weeks, bi-weekly thereafter. Monitor lung function with a peak-flow meter before and after treatment, and mornings and evenings. This will help monitor progress and also capture her interest. Ideally, Janie should have a check-up at the change of each season. With the help of her GP, her other medication may then be gradually withdrawn. Janie’s parents, Helen and Bob, are crucial to Janie’s wellbeing. They need to be reassured, to have an opportunity to talk freely; together and separately. Janie’s GP may be the best person for this and may then involve the TCM physician. Guilt is probably important at many levels; they married only when Helen became pregnant. Janie will almost certainly be responding to their currently tense dynamic. Both Helen and Bob may also benefit from acupuncture, herbs, relaxation and Tai Chi exercises. It will be particularly important to help Helen; first to sleep and then with other aspects of her asthma. Optimal management will involve liaison with the GP at
139
all times. In this case he is supportive and interested and should be kept informed professionally so as to nurture the relationship he has with Helen and Bob.
SUGGESTIONS
FOR TREATMENT
TCM treatment should be individualised, hence our brief suggestions only. Nothing can substitute for experience and training. Acupuncture points: Lung: 5,7,9; Colon: 4, 10, 1I ; Conception vessel: 17; Stomach: 36; Spleen: 6; Kidney: 3; Back shu points: extra 19, 17; Bladder 13, 15. 17, 21. Herbal prescriptions: Qing Chi hua Tan Tang and Xiao Qing long Tang are both effective but should be carefully adjusted according to the patient’s condition.
Jing Hua Chen MD, Asthma Research Physician, Osler Chest Unit, Churchill Hospital, Headington, Oxford OX3 7LJ, UK Kim Jobst MA, MRCP, Clinical Director, Oxford Project to Investigate Memory and Ageing (OPTIMA), Radcliffe Infirmary Trust, Woodstock Road Oxford OX2 6HE, UK Recommended
reading
Scott J. Natural medicine for children. London: Unwin, 1990. Jobst KA, Chen JH, McPherson K et al. Controlled trial of acupuncture in chronic disabling breathlessness. Lancet 1986; ii: 14161418. Also Lancet 1987; i: 802.
Lane DJ, Lane TV. Alternative and complementary medicine for asthma (editorial).Thorax 1991;46(ii): 787-797.
HOMOEOPATHY
BACKGROUND This article is not a suitable forum to discuss or describe the rationale of homoeopathy. Let me just say that there are 2 basic homoeopathic approaches to desensitise patients to their major allergens. This can be done without any deep homoeopathic knowledge and will produce an amelioration of the patient’s asthma. On the other hand, it is possible to treat the whole patient using a deep-acting, individually selected, constitutional homoeopathic remedy. In practice I would normally try
to do both of these to achieve the best possible result. The treatment of the acute attack of asthma is also beyond the scope of this article. Asthma is a lifethreatening condition and modern allopathic medicine has developed good and safe ways of dealing with the acutely distressed asthmatic. There are some homoeopathic remedies that can be used acutely by a skilled prescriber, with good effect, such as Antimonium Tartaricum, Arsenicurn Album, fpecacuana and K&i Carbonicum. Indications for these different remedies are complex and should only be attempted by a trained person.