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Traditional Chinese Medicine
1 Traditional Chinese Medicine Chapter Objectives: 1. Investigate the history of traditional Chinese medicine from antiquity to the modern era. 2. Describe body constitution according to traditional Chinese medicine through body characteristics, pathological characteristics, and recovery suggestions. 3. Describe herbal preparation and delivery types according to traditional Chinese medicine.
A brief history of medicine, pharmacology, and formula preparation in traditional Chinese medicine The history of medicine, identifying pathology of the human body, and treatment methods in Chinese medicine date far into antiquity. The Yellow Emperor was considered by many scholars to be a mythological deity and actual ruler between 2698e2598 BC. Through discussions with advisors, known as ministers, about life and health, the emperor is considered to be the founder of traditional Chinese medicine. Artifacts from the Yin (Shang) Dynasty (1700e1100 BC), which was also during the bronze age, give evidence of folk medicine practices. Taoism, a religious practice of alchemy, involved beliefs of evil supernatural causes and magical treatment of human diseases by shamans. Animal bones, known as oracle bones of Taoists, included scribed records of treatment methods, magical practices, and prescriptions of herbs, food, hot water, and moxibustion. Bronze knives and metal and bone needles were used on and within the body. The Huangdi Nei Jing (Inner Cannon of the Yellow Emperor Classic) may be the oldest medical text still in regular circulation today. The text is estimated to have been compiled by elite scholars who followed the practices of the Yellow Emperor similar to a religion sometime during the Warring States Period (475e221 Herbal, Bio-nutrient and Drug Titration According to Disease Stages in Integrative Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817580-4.00001-9 Copyright © 2020 Elsevier Inc. All rights reserved.
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BC) of the Western and Eastern Zhou Dynasty (1100e221 BC) and perhaps modified with contemporary influences during the Qin Dynasty (221e207 BC) and Western- Eastern Han Dynasty (206 BCeAD 9 and AD 25e220). Today, the Huangdi Nei Jing is the oldest record in China, which identifies yin and yang, five elements, anatomy and physiology, gender and age directing factors of body constitution and emotions, diet, lifestyle, and environment influencing the development of diseases. The text is based on a compilation of recorded conversations between the Yellow Emperor and his ministers about life and health and is divided into two sections, the Su Wen and the Ling Shu. The Su Wen, known as the Basic Questions, discusses the foundation of diagnosis and the Ling Shu also known as the Miraculous Pivot, discusses acupuncture therapy. Shen Nong lived during the time of Yellow Emperor and developed agricultural practices adopted by local farmers. His knowledge of planting and harvesting food and herbs for medicine was used to treat diseases.
During the Qin and Han dynasties (221 BCeAD 220) Writing, systems of weights and measurements, technology, astronomy, the arts, philosophy, advanced medicine, education, and Confucian laws were developing and the separation of religion (Taoism) and state (Confucianism) brought burning of books considered witchcraft and executions of important scholars. 1. Creation of Shen Nong Ben Cao Jing (Divine Husbandman’s Classic of Materia Medica). This textbook describes 365 herbs and principles of combinations. It is the basis for the development of later additions and creations of other herbal texts. 2. Creation of Shanghan Za Bing Lun (Treatise on Cold-Induced and Miscellaneous Diseases). This textbook is divided into two books: Treatise on Cold-Induced Diseases and Synopsis of the Golden Chamber. It includes prescriptions for general use in clinical practice. 3. Zhang Zhong Jing: Physician who was famous for developing the principles of creating prescriptions, and wrote textbooks for treating infectious and internal medicine diseases. 4. Hua Tuo: One of many famous physicians who studied under Zhang Zhong Jing, famous for the surgical, wu qing xi (five animals) martial arts techniques, acupuncture (hua tuo jia ji points), moxibustion, herbal prescription expertise including use of cannabis in decoctions for anesthesia, and adapting
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Taoist and Ayurvedic medicine practices in general clinical use. He was executed, and his secrets mostly lost.
Period of middle ages in China Three kingdoms period Western and eastern Jin dynasty Southern dynasty Northern dynasty
AD AD AD AD AD
220e580 220e280 265e420 420e589 386e581
During this period the military was spreading throughout China as well as a heavy influence of Indian culture with the introduction of Buddhism and Ayurvedic medicine. Medical education developed with academies teaching mathematics, astronomy, human sciences, and departments of Chinese medicine. Acupuncture, moxibustion, meridian and pulse, materia medica, and herbal prescriptions books were written and developed by scientists, and famous physicians were practicing and teaching clinical pearls. 1. Creation of Mai Jing (Pulse Classic). This book standardized pulse diagnosis. 2. Zhenjiu Jia Ying (Systemic Classic of Acupuncture and Moxibustion). This book standardized meridian system, acupoints, acupuncture, and moxibustion clinical practices used today. 3. Zhou Hou Jiu Zu Fang (Prescriptions for Emergencies). This book described treatment of diseases in emergency medicine. 4. Ben Cao Jing Ji Zhu (Annotations to the Classic of Materia Medica Significance). This book included farming and harvesting practices of medicinal herbs.
Sui dynasty (AD 581e618) and Tang dynasty (AD 618e907) During this period government-run medical academies opened with two specialties: medicine and pharmacy. The result was the development of a standard pharmacopeia, medical ethics, doctor qualifying examinations, and the importance of holism in medicine. Chinese medicine continued to develop the system of syndrome differentiation and disease classification in internal medicine and surgery, and preserved Taoist, Buddhist and Ayurvedic traditions of grouping acupuncture with massage, cupping, charms, and incantations and to emphasize the importance of spiritualism in medicine.
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1. Creation of Yao Xing Ben Cao (Materia Medica of Medicinal Properties). This book described the four qi as yang ability to penetrate turbidity and awaken digestion and consciousness, and five tastes of herbs that should be used to treat diseases. 2. Tao Hon Jing (AD 452e536) was a famous physician who revised the Shen Nong Ben Cao to classify the herbs according to botanical, mineral and zoological categories, and included additional herbs and described the clinical benefits. 3. Su Jing (AD 657e759) was a famous physician who wrote the Xin Xiu Ben Cao (Newly Revised Materia Medica). The book was illustrated with 844 different herbs and became the pharmacopeia mandated by the government of the Tang Dynasty. 4. Sun Si Miao (AD 581e682) was an imperial physician who mastered medicine, Ayurveda, Buddhism, Confucianism, and Taoism. He was also a famous physician who advocated therapy through diet. He identified treatment for cholera, diarrhea, tuberculosis deficiency disorders, treatment of hypothyroidism with iodine from animal thyroid, treatment of vitamin A deficiencies using animal livers, and B-vitamin deficiencies using herbs. He also developed the a-shi points used today in medical acupuncture and qi gong exercises.
Song dynasty (AD 960e1108) During this period, international silk road and Arab marine trade and exchange involved the export and import of herbs, books, and medical practices. The printing press was invented, resulting in vast publishing and printing of medical books and wide distribution of Chinese medicine texts abroad and medical books about Ayurveda from India. During these periods foreign exchange brought the spread of medical practices between India, Korea, Japan, and Vietnam. Government-run academies dividing medicine and pharmacy developed, resulting in the development of a standard pharmacopeia, medical ethics and doctor qualifying examinations. 1. Tongren Su Xue Zhen Jiu Tu Jing (Illustrated Manual of Bronze Statue Acupuncture). This book provided all meridians and their acupoints. 2. Zhenglei Ben Cao (Classified Materia Medica). This book listed 1558 different prescriptions and illustrations. 3. Xiao Er Yao Zheng Zhi Jue (Key to Differentiation and Treatment of Children’s Diseases). This book was based on pediatrics and congenital (genetic) diseases. 4. You You Xin Shu (New Book of Pediatric Influence). This book described inspection andw examination of children for genetic and acquired illnesses. 5. Cun Zhen Tu (Anatomical Atlas of Truth). This book described anatomy based on performing autopsies.
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Ming dynasty (AD 1368e644) During this period, agriculture, art, and culture flourished with international exchange and trade in business, including western influences. The Jesuits had arrived and developed a relationship with the Chinese scholars sharing scientific and medical knowledge, philosophy, and religion. Plagues and pestilential epidemics were sweeping the planet. Famous physicians were reinterpreting and revising the ancient Nei Jing and Ben Cao, creating new texts on developments and trends in medicine, and debating important medical philosophies of the day. Texts on gynecology and pediatrics, including congenital conditions, were being written. Three different schools of medicine emerged: School of Nourishing Yin (and quenching the minister fire), School of Warming and Invigoration (by invigorating spleen and stomach to preserve vital energy (qi), the intention of internal medicine), and School of Epidemic Diseases (considered infectious and noninfectious due to exogenous invasion and formerly just as febrile and cold-induced). There were new cases of the outbreak of venereal diseases, especially syphilis, and advancements in surgical techniques involving cancer treatment, methods of analgesia, asepsis, hemostasis, and instruments used in the processes. The development of more advanced and illustrated acupuncture texts and pharmacy and prescription books were promoted and distributed than at any time in history. 1. Pu Ji Fang (Universal Aid Formulary). This book organized prescriptions according to disease and health condition. 2. Nei Ke Zhai Yao (Synopsis of Internal Medicine). This book is considered the first in history dedicated entirely to the study and treatment of internal medicine diseases. 3. Yi Fang Kao (Study on Prescriptions). This book discussed prescriptions according to efficacy, actions of the herbal components, indications and contraindications, and modification suggestions. 4. Zu Sheng Bai Jian (Eight Essays on Life Nourishment). This book discusses disease prevention by nourishing lifestyle and maintaining health.
Qing dynasty (AD 1644e911) During this period the School of Epidemic Diseases developed even further with inoculation studies, especially with small pox to cure the disease, and more advanced textbooks were written. Western medicine began to emerge, bringing U.S. and British political treatises to set up medical offices and hospitals in certain provinces around China. Integrated traditional Chinese medicine emerged, and the abolishment of Chinese medicine was threatened.
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1. Yi Gaun (Key Link of Medicine). This book discussed warming methods of the body and protecting the vital gate or ming men fire. 2. Ben Cao Bei Yao (Essential of Materia Medica). This book discussed health problems associated with smoking tobacco and other drugs. 3. Shi Bing Lun (Treatise on Seasonal Diseases). This book discussed seasonal diseases, causes, pathology, symptoms, diagnosis, and methods of treatment. 4. Zhonxi Hui Tong Yi Shu Wu Zhong (Five Medical Works on Linking up Traditional Chinese with Western Medicine). This book was the first text on integrating the systems of medicine. 5. Xue Zheng Lun (Treatise on Blood Syndromes). This book discusses diseases involving the blood. 6. Hua Yang Zang Xiang Yue Zuan (A Combination of Chinese and Western Illustration). This book provided images of body organs with Chinese and Western discussion of anatomy and physiology. 7. Zhong Xi Hui Tong Yi Jing Jing Yi (Essential Meaning of the Medical Classics from the Perspective of the Convergence of Chinese and Western Medicine). This book discussed the advantages and disadvantages of the exchange of Chinese and western medicine.
Twentieth century China (AD 1912e99) During the first half of the 20th century, previous treaties and trade deals between China and the consulates of United States and Britain concerning the advancement of medicine were being used to modernize China. At this point escalating tensions and World Wars I and II threatened those international relationships, with speculation over whether it was a good or bad thing. Traditional Chinese medicine and western medicine established a coexistence in China, though the rising difficult and complicated political climate threatened the abolishment of Chinese medicine as well. Epidemic plagues and famines led to further abandonment of Chinese medicine for western medicine answers. Professional and medical associations emerged in China and despite government pressure to continue to abolish traditional Chinese medicine, on March 12, 1929 doctors from 132 Chinese medicine associations came together in Shanghai and formed the National Union of Associations for Chinese Medicine. During the second half of the 20th century around the end of World War II, government influences under Mao Ze Dong redirected the anti-Chinese medicine campaign. In efforts to free the nation from dependence on the Soviet Union for medical equipment and pharmaceutical drugs and to become more patriotic and self-reliant, borders were closed to outside western
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influence. This sparked a nationalistic resurgence of pride in traditional Chinese medicine. In 1954 the Ministry of Health opened the Department of Chinese Medicine and Beijing College of TCM, Shanghai College of TCM, Nanjing College of TCM, Guangzhou College of TCM, and Chengdu College of TCM. During the Great Leap Forward campaign in 1958, around 200 western medicineetrained physicians graduated from a two-year program of traditional Chinese medicine who went on to become administrators during the 1980s and 1990s. It is noted that agricultural hardships led to widespread starvation and diminishing of available herbs leading to 20 million deaths from 1958 to 1962. In 1960, the Great Leap Forward was repealed resulting in private land being returned to peasants. The cultural revolution between 1966e76 was most devastating to the preservation, study, and advancement of medicine in general and traditional Chinese medicine specifically. Medical schools were shut down, medical curriculums and thousands of original and edited textbooks from many dynasties destroyed, students sent to countryside to be reeducated, and physicians and professors killed or imprisoned. The minimally educated barefoot doctor was promoted, and comprised around 1.3 million. The death of Mao Ze Dong in 1976 slowly brought surviving Chinese medicine and western medicine physicians and academics back into society. In 1980 the World Health Organization published around 43 pathologies that can be effectively treated with acupuncture. Between 1980 and 1990 Colleges of Traditional Chinese Medicine and Western Medicine reopened with record enrollment in both. In 1978 The Chinese Society of Cardiology was founded. The Ministry of Health established guidelines for development and coexistence of Chinese Medicine and Western Medicine, publishing houses were established, and in 1987 the Joint Society of World Acupuncture and Moxibustion was founded in Beijing.
Twenty-first century China Acceptance of integration of Chinese and Western medicine is part of everyday healthcare. Clinical trials on herbs with cardiovascular benefits are conducted at universities and pharmaceutical firms across China. Many Chinese medical journals discuss case studies and diagnostic and treatment methods. Students, physicians, and researchers from all over the world study medicine in China. Many medical universities around the world have educational exchange relationships with cardiology departments of traditional Chinese and western medicine universities in China. China Heart Association was established in 2017.
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Constitutional theories
1a 9 Body constitutions in Chinese medicine
Constitution Symptoms
Diet
Neutral
Strong body build, a stable psychoemotional state, energetic adaptable to the environment
Moderate and balanced and free of oily and spicy food
Qi deficient
Easily tired, breathlessness, spontaneous sweating, easily catches the cold or flu, weak immune functioning, tooth marks on tongue sides, sensitive to the environment Cold limbs especially hands and feet, puffy face and pale puffy tongue, diarrhea, throat mucous problems, sensitive to cold and dampness, sensitive to temperature and noise changes in the environment
More qi food and nutrition that invigorates the spleen Avoid garlic, radishes, and cilantro
Thin body build, hot flushes, hot palms and soles, dry mouth, dry stool, irritability, sore throat and fever, preference for cold drinks, sensitive to hot weather environments Skin is painful, dry, course, and easily bruised. Dark circles under eyes, unknown bruises, abnormal growths. Sensitive to windy and cold environments. Overweight body type, profuse sweating, limb heaviness, oily face, a preference for oily and sweet foods, thick tongue coating, sensitivity to rainy and damp environments
More foods that cool such as salads and fresh fruits No foods that heat such as lamb
Yang deficient
Yin deficient
Blood stasis
Phlegm dampness
More food that benefits qi such as red meat Cook food and eat it hot Less raw cold food such as salads and fresh fruits
Lifestyle • Exercises according to age • Optimistic life outlook and positive attitude • Avoid strenuous exercises • Avoid windy areas • Keep warm • Get enough sleep • • • •
Do mild exercise Do saunas Keep warm Avoid living in cold weather towns and prolonged air conditioning • Moderate exercises • Avoid late nights • Avoid wasteful sexual activity that depletes body fluids
More food that promotes blood circulation No fatty meat or dairy products
• Exercises and activities that promotes blood circulation
Eat a bland diet Reduce or avoid sweet food and drinks Include more seaweed in the diet
• Avoid risk factors for diabetes • Avoid risk factors for metabolic syndrome • Avoid risk factors for cardiovascular diseases • Avoid a sedentary lifestyle
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Damp heat
Normal or thin body type, oily skin that is acne prone, bitter taste in the mouth and bad breath, fatigue or body heaviness, heavy urination or unexplained scant urination both with site pain or lower abdominal pain, excessive vaginal discharge, damp scrotum, sensitive to damp and hot environments
Eat less greasy sweet foods Include more seaweed in the diet
Qi stagnation
Thin body build, depressed mood, easily stressed and anxious. Prone to insomnia and diagnosed psycho-emotional disorders, frequent sighing, and chest palpitations. Sensitive to seasonal depression and overcast rainy days
Eat more hawthorn and seaweed
Congenital deficiency
Body is born with weaknesses, allergies and sensitivities to different foods, medicines, smells, pollen and plants. They develop upper respiratory and nasal problems, itchy skin rashes and patches. Extreme sensitivity to outdoor environments and seasonal changes.
Bland diet Avoid spicy food and allergens
• Avoid living in environments that are hot and damp • Incorporate dry and ventilated home environment • Intense exercises recommended • Find relaxing activities to help alleviate emotional irritability • Find relaxing activities to help alleviate emotional irritability • Live in a quiet, clean and bright environment • Engage in organized social activities that bring fulfillment • Intense exercises recommended • Exercises to invigorate immune system • Keep warm when in the cold environments • Living space should be clean and well ventilated
1b Basic seasonal habits for cardiovascular disease prevention Spring
Summer
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Diet: cultivate the yang and regulate the smooth flow of liver qi. Prevent adverse influence on the blood pressure by blending more sour flavors into daily meals. Include sour herbs, which activate yang and immune mechanisms of wei qi, to prepare for the autumn. Exercise: include vigorous activities, jogging, and tai qi, which stretch the muscles and tendons and increase energy; can be done outdoors or indoors due to the weather. Diet: cultivate the yang and regulate the rising of heart yang. Balance bitter, salty, acrid, and sour foods in moderation in daily meals. Eat vegetable soups with various seasonal fruits and vegetables and herbs which maintain body temperature and blood circulation. Drink water and other fluids in moderation to avoid edema.
1bdcontinued Basic seasonal habits for cardiovascular disease prevention
Autumn
Winter
Exercise: moderate activities such as tai qi or sports that stretch the muscles and tendons and maintain energy; can be done outdoors. Diet: nourish the yin and regulate the lung qi and spleen qi. Mix and alternate choices of seasonal vegetables and fruits with sour, bitter, and pungent flavors with sweet and reducing the acrid flavors. Exercise: the accumulated energy of the summer should be stored for the coming winter. Exercise should be moderate to slow. Some activity can be done outside and indoors due to the weather. Diet: nourish the yin and maintain heart and kidney yang balance. Eat less salty and more bitter and acrid food. Exercise: moderate to slow indoor exercises to avoid opening the pores too much and losing yin fluids.
1c Constitution
General body characteristics
Basic male constitutional
Yang type: Excessive amounts of yang and blood, sexual desires, or activities that rapidly deplete essence, yin, and blood. The balance of yin and yang through the nourishment of essence and blood is the life challenge of the male. Yin type: Excessive amounts of qi, insufficient amounts of yang and blood. Pathological evidences are noticed between the menstruation, childbirth and menopausal stages. Balancing yin and yang through building and nourishment of blood is the life challenge of the female. Yang characteristics of rapid development and growth. Potential for excessive heat and fire syndromes in the liver and heart, deficient immunity wei qi, deficient spleen and kidney syndromes. The personality stage is between agreeable and obstinate. Continuous rapid growth and development in adolescence that leads to a plateau in adulthood. Yin and yang are balanced, essence generates, qi moves freely, and blood flows smoothly. Characteristics include the development of mental and emotional individuality, maturity, selfperception, sexuality, morality, virtues, and choices. The personality is changeable. The developmental plateau leads to decline of vitality. Essence is depleted and there is instability of balance between yin, yang, qi, and blood. The personality is stable yet mental and emotional status begins to decline. The viscera, other organs begin to show signs of dysfunction. The menopausal and climacteric stages in both males and females begin. The rapid decline of vitality leads to eventual mortality. Essence has long been depleted with near depletion of immunity wei qi, yin, yang, qi and blood. Stagnation of body fluids accumulates along with poor circulation and elimination. Dampness and phlegm is more abundant. The personality is changeable with mental and physical deterioration.
Basic female constitutional
General stages of infant and childhood constitution
General stages of teenage and young adult constitution
General stages of the middle-aged constitution
General geriatric constitutions
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1d Constitution Basic male constitutional
General prevention suggestions
Diet: foods, drinks, herbs, and supplements that maintain yin and yang balance. Specifics include tonifying yang and building and nourishing blood and kidney essence. Exercise: include activities that move and nourish blood, build and strengthen muscles and tendons, and generate masculine vitality. Basic female constitutional Diet: foods, drinks, herbs and supplements that maintain yin and yang balance. Specifics include nourishing yin and blood before and after monthly discharge, maintaining mood by smoothing and freeing the flow of liver qi, assisting digestion and water metabolism by tonifying spleen qi and kidney qi. Exercise: include activities that move and nourish blood for muscles and tendons, skin and hair, circulation of feminine vitality. General stages of infant and Diet: foods, drinks, herbs and supplements that establish the balance of yin childhood constitution and yang. Specifics include tonifying kidney essence for intelligence, soothing liver qi and reducing heart fire for colic and uncontrollable behavior problems, and tonifying deficiency spleen qi incontinence and drooling. Exercise: activities that promote intelligence, fitness, self-awareness, and responsibility. General stages of teenage and Diet: foods, drinks, herbs, and supplements that maintain the balance of yin young adult constitution and yang. Specifics include tonifying and regulating kidney essence, soothing and smoothing the liver qi, reducing heart fire, tonifying the kidney essence, lung qi, and spleen qi. The focus is to meet the stressors and demands of puberty, emotional stabilization development of selfexpression, irregular dietary habits, career, and physical and sexual activities. Exercise: activities that regulate energy, build and strengthen muscles and tissues, and regulate fat. General stages of the middle-age Diet: foods, drinks, herbs, and supplements that repair the imbalance of yin constitution and yang. Specifics include tonifying and regulating qi, nourishing and moving blood, smoothing the flow liver qi, balancing kidney yin and yang, and promoting activity, relaxation, and sleep. Exercise: activities that promote energy and relieve stress. General geriatric constitutions Diet: foods, drinks, herbs, and supplements that continually work to rebalance yin, yang, qi, blood, and body fluids. Specifics include building and protecting immunity and wei qi, circulation of blood, proper movement of body fluids and wastes, draining dampness, and phlegm accumulation. Exercises: activities that stretch the tendons and muscles and assist with blood and fluid circulation.
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1e Constitution
General pathological characteristics
Yin deficiency constitution
Characteristic: flushed complexion, dry throat, dry skin and hair, emaciated and weak body structure, interior heat sensation at the center of the chest, feverish palms of hands and foot soles, intolerance for summer weather or tropical regions. Behavior: extroverted personality, manic psychoses, hyper sexual desire or activity. Causes: deficiency of yang, innate essence insufficiency, premature delivery, excessive sexual activity, illicit recreational and designer drug use, certain prescription drugs, decline in old age. Characteristic: Pale complexion and lips, obese body structure, muscle atrophy and weakness, cold sensation from the interior and circulating throughout the body. Aversion to cold environments and climates, fluid accumulation especially in limbs and midline, diminished or lack of sexual desire, spontaneous sweating, clear profuse urination and poor or weak defecation, intolerance for winter weather regions. Behavior: introverted personality, depression. Causes: deficiency of yin, premature delivery, insufficient postnatal care; severe emotional trauma, multiple close duration pregnancies/deliveries; weakness and nutritional and emotional imbalance during pregnancy; prolonged illness; perimenopause; certain bacterial, viral, or fungal infections; decline in age. Characteristic: Round chest and/or waistline with cold limbs, edema, shortness of breath and abdominal fullness, fatigue, dull complexion, spontaneous sweating, low voice, no desire to speak much, intolerance for hot summer weather and tropical climates. Behavior: introversion and emotional instability. Causes: deficient innate and acquired essence, anorexia, prolonged or undertreated illness, and advancing age. Characteristic: emaciated appearance, dizziness, muscle atrophy, numbness and tingling of the limbs; pale complexion, eyes, lips, and nails; limp and dull brittle hair and easy hair loss. Behavior: introverted or extroverted personality, depression. Causes: deficient innate essence inheritance; postnatal malnutrition; prolonged untreated illness; severe bacterial, viral, parasitic, or fungal infections; nutritional deficiencies; tumors; irregular menstruation; hemorrhage; illicit and designer drug use; aggressive prescription drug therapies.
Yang deficiency constitution
Yang deficiency constitution
Blood deficiency constitution
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1f Constitution
General pathological characteristics
Qi stagnation
Characteristic: thin body or fluctuating weight gain or a round waistline, intolerance for prolonged heat environments. Behavior: introverted personality, mental instability, emotional sensitivity. Causes: prolonged emotional and psychological trauma due to fright, grief, disappointment, depression, physical and mental overstrain. Characteristic: thin body; abnormally patterned pigmented complexion; dark orbital cavity; purple lips or tongue; hair loss; dry skin calluses or squamation; susceptibility for cold, flu, and infections; intolerance for windy weather and cold climates. Behavior: depressed personality, amnesia, irritability. Causes: inhibited blood circulation, retention of blood in the body, fluid deficiency in the vessels, kidney deficiencies or failure, infections. Characteristic: obese body, protruding soggy waistline, heavy body sensation, oily and sallow skin complexion especially the forehead and nose, acne, puffy face, limb edema, irritable personality, intolerance for damp tropical climates. Causes: heredity, irregular daily routines, unbalanced diet of sweet and fatty food, insufficient water intake, lack of exercise, and irregular sleep schedule. Characteristic: obese body appearance, inability to adapt to a wet tropical environment, oily and dirty or dark yellow complexion and eyes, vexed personality. Causes: exposure to rain, diet of sweet and fatty food, abnormal alcoholic beverage consumption habit, prolonged edema, tropical environments, digestive disturbance, summer heat climate that transforms into the autumn, insufficient fluid circulation, bacterial or viral infection, bladder or kidney infections, liver or kidney failure, gallbladder disorders.
Blood stasis constitution
Damp phlegm constitution
Damp heat constitution
1g Constitution
Recovery suggestions for stagnation, stasis and excess constitutions
Yin deficiency constitution
Diet: foods, drinks, herbs, and supplements that nourish yin and blood and subdue yang hyperenergy. Avoid spicy, hot, astringent, greasy, alcoholic food and beverages. Life: organize and maintain regular daily schedules of waking and sleeping, meals, work, and recreation; avoid overstraining efforts in work, sex; avoid hot weather and rooms, tobacco, marijuana products, OTC remedies, prescription and illicit recreational drugs, which tend to dry yin fluids. Exercise: avoid activities that create a lot of sweating. Diet: foods, drinks, herbs, and supplements that tonify yang and reduce yin by warming the spleen and kidney yang. Avoid cold, raw, bitter, greasy. Life: organize and maintain regular daily schedules of waking and sleeping, meals,
Yang deficiency constitution
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1gdcontinued Constitution
Qi deficiency constitution
Blood deficiency constitution
Recovery suggestions for stagnation, stasis and excess constitutions work, and recreation; avoid cold weather and rooms, tobacco, marijuana products, OTC remedies, prescription and illicit recreational drugs, which tend to deplete the proper accumulation of yang while reducing yin fluids. Exercise: avoid activities in cold or damp environments. Diet: foods, drinks, herbs, and supplements that invigorate the spleen, tonify and nourish the blood, and builds immunity and wei qi. Avoid greasy, cold, bitter, sweet, and spicy Life: organize and maintain regular daily schedules of waking and sleeping, meals, work and recreation avoid tobacco, marijuana products, OTC remedies, prescription, and illicit recreational drugs, which tend to dissipate qi. Exercise: avoid continuous repetitious activity. Diet: foods, drinks, herbs and supplements that tonify and nourish blood flow. Avoid spicy and astringent flavors that vent, dry, or deplete yin fluids. Life: organize and maintain regular daily schedules and limit study times and other periods of concentrated focus. Avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to deplete or make the blood dry and apt to stagnation or stasis. Exercise: avoid activities that require a lot brute effort and overstrain.
1h Constitution
Recovery suggestions for stagnation, stasis, and excess constitutions
Qi stagnation
Diet: foods, drinks, herbs, and supplements that promote the regulations of qi of the heart, spleen, lungs, and liver. Avoid cold and astringent products. Life: organize and maintain a regular daily schedule; avoid tobacco and marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to stagnate liver qi. Exercise: avoid activities that require a lot brute effort and mental overstrain. Diet: foods, drinks, herbs, and supplements that invigorate the spleen, promote movement of qi, and move and circulate blood. Avoid spicy and astringent products that vent, dry, or deplete yin fluids, cold and astringent. Life: organize and maintain a regular daily schedule, avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to deplete or make the blood dry and apt to stagnation or stasis. Exercise: avoid activities that require a lot of brute effort and overstrain. Diet: foods, drinks, herbs, and supplements that invigorate the spleen qi and yang, drain dampness, and activate the san jiao. This patient is in danger of developing hyperlipidemia and coronary artery disease. Avoid greasy, sweet, cold, and astringent
Blood stasis constitution
Damp phlegm constitution
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Damp heat constitution
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flavors, which nourish yin fluids or generate phlegm. Life: organize and maintain regular daily life of sleep, rest, work, and activity. Avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to contribute to factors of phlegm stagnation and dampness. Make sure the living environment is dry and free of fungus. Exercise: avoid activities that require a lot brute effort and overstraining, do exercises that allow normal movement sequences such as walking, jogging, taiqi, swimming, etc. Diet: foods, drinks, herbs, and supplements that invigorate the spleen qi, drain dampness, clear heat, and activate the san jiao. This patient may have concurrent kidney, bladder, or vaginal infections. Avoid greasy, sweet, hot, spicy, and astringent flavors, which generate heat. Life: organize and maintain a regular daily schedule, avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to be more astringent, compromise the immune system wei qi, and generate heat in the body. Exercise: incorporate activities that require brute effort and vigorous movement to remove the dampness and vent the heat.
Using traditional Chinese medicines: herbal preparation and delivery types There are many herbal preparation methods in Chinese medicine. Tea pills are the most popular because of convenience, followed by granules, powders, tinctures, and finally raw herbal decoctions. Raw herbal decoctions are the least preferred by patients because of direct contact of the herbal brew with the taste buds. If the flavor is unpleasing, it will discourage the patient from continuing medicinal doses during the treatment course. However, the herbal decoction is the most preferred during a treatment course for moderate to severe cardiovascular symptoms. • The suggested hot temperature of the brew has a better chance of assimilating with gastrointestinal processes • The concentration and quick delivery of the herbal constituents dispersed in a decoction can be digested and quickly sent to assist the target meridian and/or organ. • The decoction formula can easily be modified by adding or eliminating herbs for optimal effect. In addition, difficult herbs can be processed separately and either poured into the mouth and chased by the decoction or dissolved into a decoction with the other herbs.
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• Custom decoctions can be made into granules and powders and packaged for portability and convenience of mixing into a cup of hot water. Herbal decoctions for cardiovascular benefit are cooked two to three times to extract all the constituents. • Decoctions that include plant parts such as blossoms and leaves as well as aromatic herbs are processed in small doses. • Decoctions that include the fruit, root, and heavy substances such as bones and shells are processed in large doses. • One or few herb decoctions are processed in large quantities. • Weaker strength decoctions can be taken regularly for prevention and should be given patients in the weaker constitution categories (children, elderly, those with chronic symptoms with debility). • Stronger strength decoctions should be given to patients with acute and chronic conditions in the stronger constitution categories. Doses are subjective as to age, gender, health condition, and severity of disease. They are also indicated and titrated as follows: Prevention: Take once per day around bed time or breakfast. Acute symptoms: Take at any time and in some cases liberally until symptoms abate. Chronic symptoms: Take every 6e8 hours, 2 hours before or after eating a meal. Recovery: Take every 4e6 hours until well-being is restored.
1i Decoction dosage Suggestions According to Constitution Constitution
Prevention/Recovery
Acute
Chronic
Teenage to young adult Age 13e30 Middle age 40e60 Geriatric age 70þ Weak and ill patients
Medium 30e50 g/dose Medium 30e50 g/dose Small 30e50 g/dose
Large 50e100 g/dose Medium 30e50 g/dose Medium 30e50 g/dose
Medium 30e50 g/dose Medium 30e50 g/dose Small 30e50 g/dose
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Most common herbs used in Chinese medicine cardiology
1j Most commonly Used Herbs in Traditional Chinese Medicine Cardiology Herb
Main active constituents
Significance
Kun bu
Iodine, iron, potassium, laminine
Hai zao
Iodine, potassium, mannitol, laminine
Huo xiang
d-limonene, a-patchouline, linalool
Shan zha
Crategolic acid, citric acid, vitamin C
Dang gui
b-sitosterol, vitamin B₁₂,
Shou di huang
b-sitosterol, mannitol, arginine, rehmannin, campesterol Amino acids: arginine, cystadine, glycine, lysine histadine, Nicotinic acid, corynanthine, corynoxeine b-sitosterol, campesterol, baicalin, wogonoside
Lipid, excess fluid and blood pressure reduction Lipid, excess fluid and blood pressure reduction Lipids, digestion, antimicrobial, antiinflammatory Lipids, vasodilation, digestion, antiinflammatory Build blood, blood pressure reduction, reduce LDL Build blood, blood pressure reduction, reduce LDL Build and nourish blood
E jiao Gou teng Huang qin
Gan cao
Mai men dong Hong hua
Chuan xiong Ru xiang
Glycyrrhizin (saponin), coumarins, inositol, folic acid, PABA, arginine, vitamins B₁, B₂, B₃, B₆, flavonoids, b-sitosterol, iron, selenium, zinc, potassium, magnesium b-sitosterol, stigmasterol Carthamin, Omega-6 (linoleic acid) ALA (a-linolenic acid), palmitic acid, oleic acid, arachic acid Ferulic acid, perolyrine, chuanxingol a- and b- boswellic acid, a- and bphellandrine, olibanoresene, pinene
Blood pressure reduction Antimicrobial, immune builder, basal temperature regulation, lipid, excess fluid and blood pressure reduction Lipid reduction, antiinflammatory, antidiabetic, antiallergen, blood pressure reduction Blood pressure reduction, antiinflammatory Lipid reduction, blood pressure reduction, invigorates blood Invigorates blood circulation, reduces blood pressure Invigorates blood circulation, reduces chest pain
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1jdcontinued Most commonly Used Herbs in Traditional Chinese Medicine Cardiology Herb
Main active constituents
Significance
Huang lian Mu dan pi
Berberine, coptisine, ferulic acid, palmatine, jatrorrhizine Paeonol, camperterol
Ban lan gen Dan shen
b-sitosterol, isatin, glutamine, tyrosine, proline Tanishnone, protocatechuic acid
Suan zao ren
Betulinm jujuboside, saponins, betulic acid, ebelin lactone
He shou wu Yu jin Huang qi
Chrysophanic acid, lecithin d- campene, a- and b- curcumene, tumerone D- b-asparagine, b-sitosterol choline, betaine
Du zhong
Alkaloids, potassium, aucubin, glycosides, vitamin C Panaxadiol, ginsenin, panaenic acid, nicotinic acid
Broad-spectrum antimicrobial, antidiabetic, antiinflammatory Reduces edema and blood pressure, antimicrobial, basal temperature regulation Broad-spectrum antimicrobial Invigorates blood circulation, dilates coronary arteries, reduces blood pressure Sedative and analgesic, basal temperature regulation, reduces blood pressure Tonifies the blood, reduces lipids Reduces lipids Reduces blood pressure, reduces blood lipids Reduces blood pressure
Ren shen
Rou cong rong
alkaloids
Reduces or stops arrhythmia, reduces lipids, increases the immune system, reduces stress Blood pressure reduction
References Al-Shura AN. Integrative Cardiovascular Chinese Medicine: A Personalized Medicine Perspective. Elsevier Academic Press; 2014. Dominique H, Marie-Joseph H. A History of Chinese Medicine [Bailey P, Trans]. Edinburgh University Press Ltd.; 1993. State Administration of TCM. Advanced Textbook on Traditional Chinese Medicine and Pharmacology. New World Press; 1995.
A brief history of medicine, pharmacology, and formula preparation in traditional Chinese medicine The history of medicine, identifying pathology of the human body, and treatment methods in Chinese medicine date far into antiquity. The Yellow Emperor was considered by many scholars to be a mythological deity and actual ruler between 2698e2598 BC. Through discussions with advisors, known as ministers, about life and health, the emperor is considered to be the founder of traditional Chinese medicine. Artifacts from the Yin (Shang) Dynasty (1700e1100 BC), which was also during the bronze age, give evidence of folk medicine practices. Taoism, a religious practice of alchemy, involved beliefs of evil supernatural causes and magical treatment of human diseases by shamans. Animal bones, known as oracle bones of Taoists, included scribed records of treatment methods, magical practices, and prescriptions of herbs, food, hot water, and moxibustion. Bronze knives and metal and bone needles were used on and within the body. The Huangdi Nei Jing (Inner Cannon of the Yellow Emperor Classic) may be the oldest medical text still in regular circulation today. The text is estimated to have been compiled by elite scholars who followed the practices of the Yellow Emperor similar to a religion sometime during the Warring States Period (475e221 Herbal, Bio-nutrient and Drug Titration According to Disease Stages in Integrative Cardiovascular Chinese Medicine. https://doi.org/10.1016/B978-0-12-817580-4.00001-9 Copyright © 2020 Elsevier Inc. All rights reserved.
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BC) of the Western and Eastern Zhou Dynasty (1100e221 BC) and perhaps modified with contemporary influences during the Qin Dynasty (221e207 BC) and Western- Eastern Han Dynasty (206 BCeAD 9 and AD 25e220). Today, the Huangdi Nei Jing is the oldest record in China, which identifies yin and yang, five elements, anatomy and physiology, gender and age directing factors of body constitution and emotions, diet, lifestyle, and environment influencing the development of diseases. The text is based on a compilation of recorded conversations between the Yellow Emperor and his ministers about life and health and is divided into two sections, the Su Wen and the Ling Shu. The Su Wen, known as the Basic Questions, discusses the foundation of diagnosis and the Ling Shu also known as the Miraculous Pivot, discusses acupuncture therapy. Shen Nong lived during the time of Yellow Emperor and developed agricultural practices adopted by local farmers. His knowledge of planting and harvesting food and herbs for medicine was used to treat diseases.
During the Qin and Han dynasties (221 BCeAD 220) Writing, systems of weights and measurements, technology, astronomy, the arts, philosophy, advanced medicine, education, and Confucian laws were developing and the separation of religion (Taoism) and state (Confucianism) brought burning of books considered witchcraft and executions of important scholars. 1. Creation of Shen Nong Ben Cao Jing (Divine Husbandman’s Classic of Materia Medica). This textbook describes 365 herbs and principles of combinations. It is the basis for the development of later additions and creations of other herbal texts. 2. Creation of Shanghan Za Bing Lun (Treatise on Cold-Induced and Miscellaneous Diseases). This textbook is divided into two books: Treatise on Cold-Induced Diseases and Synopsis of the Golden Chamber. It includes prescriptions for general use in clinical practice. 3. Zhang Zhong Jing: Physician who was famous for developing the principles of creating prescriptions, and wrote textbooks for treating infectious and internal medicine diseases. 4. Hua Tuo: One of many famous physicians who studied under Zhang Zhong Jing, famous for the surgical, wu qing xi (five animals) martial arts techniques, acupuncture (hua tuo jia ji points), moxibustion, herbal prescription expertise including use of cannabis in decoctions for anesthesia, and adapting
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Taoist and Ayurvedic medicine practices in general clinical use. He was executed, and his secrets mostly lost.
Period of middle ages in China Three kingdoms period Western and eastern Jin dynasty Southern dynasty Northern dynasty
AD AD AD AD AD
220e580 220e280 265e420 420e589 386e581
During this period the military was spreading throughout China as well as a heavy influence of Indian culture with the introduction of Buddhism and Ayurvedic medicine. Medical education developed with academies teaching mathematics, astronomy, human sciences, and departments of Chinese medicine. Acupuncture, moxibustion, meridian and pulse, materia medica, and herbal prescriptions books were written and developed by scientists, and famous physicians were practicing and teaching clinical pearls. 1. Creation of Mai Jing (Pulse Classic). This book standardized pulse diagnosis. 2. Zhenjiu Jia Ying (Systemic Classic of Acupuncture and Moxibustion). This book standardized meridian system, acupoints, acupuncture, and moxibustion clinical practices used today. 3. Zhou Hou Jiu Zu Fang (Prescriptions for Emergencies). This book described treatment of diseases in emergency medicine. 4. Ben Cao Jing Ji Zhu (Annotations to the Classic of Materia Medica Significance). This book included farming and harvesting practices of medicinal herbs.
Sui dynasty (AD 581e618) and Tang dynasty (AD 618e907) During this period government-run medical academies opened with two specialties: medicine and pharmacy. The result was the development of a standard pharmacopeia, medical ethics, doctor qualifying examinations, and the importance of holism in medicine. Chinese medicine continued to develop the system of syndrome differentiation and disease classification in internal medicine and surgery, and preserved Taoist, Buddhist and Ayurvedic traditions of grouping acupuncture with massage, cupping, charms, and incantations and to emphasize the importance of spiritualism in medicine.
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1. Creation of Yao Xing Ben Cao (Materia Medica of Medicinal Properties). This book described the four qi as yang ability to penetrate turbidity and awaken digestion and consciousness, and five tastes of herbs that should be used to treat diseases. 2. Tao Hon Jing (AD 452e536) was a famous physician who revised the Shen Nong Ben Cao to classify the herbs according to botanical, mineral and zoological categories, and included additional herbs and described the clinical benefits. 3. Su Jing (AD 657e759) was a famous physician who wrote the Xin Xiu Ben Cao (Newly Revised Materia Medica). The book was illustrated with 844 different herbs and became the pharmacopeia mandated by the government of the Tang Dynasty. 4. Sun Si Miao (AD 581e682) was an imperial physician who mastered medicine, Ayurveda, Buddhism, Confucianism, and Taoism. He was also a famous physician who advocated therapy through diet. He identified treatment for cholera, diarrhea, tuberculosis deficiency disorders, treatment of hypothyroidism with iodine from animal thyroid, treatment of vitamin A deficiencies using animal livers, and B-vitamin deficiencies using herbs. He also developed the a-shi points used today in medical acupuncture and qi gong exercises.
Song dynasty (AD 960e1108) During this period, international silk road and Arab marine trade and exchange involved the export and import of herbs, books, and medical practices. The printing press was invented, resulting in vast publishing and printing of medical books and wide distribution of Chinese medicine texts abroad and medical books about Ayurveda from India. During these periods foreign exchange brought the spread of medical practices between India, Korea, Japan, and Vietnam. Government-run academies dividing medicine and pharmacy developed, resulting in the development of a standard pharmacopeia, medical ethics and doctor qualifying examinations. 1. Tongren Su Xue Zhen Jiu Tu Jing (Illustrated Manual of Bronze Statue Acupuncture). This book provided all meridians and their acupoints. 2. Zhenglei Ben Cao (Classified Materia Medica). This book listed 1558 different prescriptions and illustrations. 3. Xiao Er Yao Zheng Zhi Jue (Key to Differentiation and Treatment of Children’s Diseases). This book was based on pediatrics and congenital (genetic) diseases. 4. You You Xin Shu (New Book of Pediatric Influence). This book described inspection andw examination of children for genetic and acquired illnesses. 5. Cun Zhen Tu (Anatomical Atlas of Truth). This book described anatomy based on performing autopsies.
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Ming dynasty (AD 1368e644) During this period, agriculture, art, and culture flourished with international exchange and trade in business, including western influences. The Jesuits had arrived and developed a relationship with the Chinese scholars sharing scientific and medical knowledge, philosophy, and religion. Plagues and pestilential epidemics were sweeping the planet. Famous physicians were reinterpreting and revising the ancient Nei Jing and Ben Cao, creating new texts on developments and trends in medicine, and debating important medical philosophies of the day. Texts on gynecology and pediatrics, including congenital conditions, were being written. Three different schools of medicine emerged: School of Nourishing Yin (and quenching the minister fire), School of Warming and Invigoration (by invigorating spleen and stomach to preserve vital energy (qi), the intention of internal medicine), and School of Epidemic Diseases (considered infectious and noninfectious due to exogenous invasion and formerly just as febrile and cold-induced). There were new cases of the outbreak of venereal diseases, especially syphilis, and advancements in surgical techniques involving cancer treatment, methods of analgesia, asepsis, hemostasis, and instruments used in the processes. The development of more advanced and illustrated acupuncture texts and pharmacy and prescription books were promoted and distributed than at any time in history. 1. Pu Ji Fang (Universal Aid Formulary). This book organized prescriptions according to disease and health condition. 2. Nei Ke Zhai Yao (Synopsis of Internal Medicine). This book is considered the first in history dedicated entirely to the study and treatment of internal medicine diseases. 3. Yi Fang Kao (Study on Prescriptions). This book discussed prescriptions according to efficacy, actions of the herbal components, indications and contraindications, and modification suggestions. 4. Zu Sheng Bai Jian (Eight Essays on Life Nourishment). This book discusses disease prevention by nourishing lifestyle and maintaining health.
Qing dynasty (AD 1644e911) During this period the School of Epidemic Diseases developed even further with inoculation studies, especially with small pox to cure the disease, and more advanced textbooks were written. Western medicine began to emerge, bringing U.S. and British political treatises to set up medical offices and hospitals in certain provinces around China. Integrated traditional Chinese medicine emerged, and the abolishment of Chinese medicine was threatened.
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1. Yi Gaun (Key Link of Medicine). This book discussed warming methods of the body and protecting the vital gate or ming men fire. 2. Ben Cao Bei Yao (Essential of Materia Medica). This book discussed health problems associated with smoking tobacco and other drugs. 3. Shi Bing Lun (Treatise on Seasonal Diseases). This book discussed seasonal diseases, causes, pathology, symptoms, diagnosis, and methods of treatment. 4. Zhonxi Hui Tong Yi Shu Wu Zhong (Five Medical Works on Linking up Traditional Chinese with Western Medicine). This book was the first text on integrating the systems of medicine. 5. Xue Zheng Lun (Treatise on Blood Syndromes). This book discusses diseases involving the blood. 6. Hua Yang Zang Xiang Yue Zuan (A Combination of Chinese and Western Illustration). This book provided images of body organs with Chinese and Western discussion of anatomy and physiology. 7. Zhong Xi Hui Tong Yi Jing Jing Yi (Essential Meaning of the Medical Classics from the Perspective of the Convergence of Chinese and Western Medicine). This book discussed the advantages and disadvantages of the exchange of Chinese and western medicine.
Twentieth century China (AD 1912e99) During the first half of the 20th century, previous treaties and trade deals between China and the consulates of United States and Britain concerning the advancement of medicine were being used to modernize China. At this point escalating tensions and World Wars I and II threatened those international relationships, with speculation over whether it was a good or bad thing. Traditional Chinese medicine and western medicine established a coexistence in China, though the rising difficult and complicated political climate threatened the abolishment of Chinese medicine as well. Epidemic plagues and famines led to further abandonment of Chinese medicine for western medicine answers. Professional and medical associations emerged in China and despite government pressure to continue to abolish traditional Chinese medicine, on March 12, 1929 doctors from 132 Chinese medicine associations came together in Shanghai and formed the National Union of Associations for Chinese Medicine. During the second half of the 20th century around the end of World War II, government influences under Mao Ze Dong redirected the anti-Chinese medicine campaign. In efforts to free the nation from dependence on the Soviet Union for medical equipment and pharmaceutical drugs and to become more patriotic and self-reliant, borders were closed to outside western
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influence. This sparked a nationalistic resurgence of pride in traditional Chinese medicine. In 1954 the Ministry of Health opened the Department of Chinese Medicine and Beijing College of TCM, Shanghai College of TCM, Nanjing College of TCM, Guangzhou College of TCM, and Chengdu College of TCM. During the Great Leap Forward campaign in 1958, around 200 western medicineetrained physicians graduated from a two-year program of traditional Chinese medicine who went on to become administrators during the 1980s and 1990s. It is noted that agricultural hardships led to widespread starvation and diminishing of available herbs leading to 20 million deaths from 1958 to 1962. In 1960, the Great Leap Forward was repealed resulting in private land being returned to peasants. The cultural revolution between 1966e76 was most devastating to the preservation, study, and advancement of medicine in general and traditional Chinese medicine specifically. Medical schools were shut down, medical curriculums and thousands of original and edited textbooks from many dynasties destroyed, students sent to countryside to be reeducated, and physicians and professors killed or imprisoned. The minimally educated barefoot doctor was promoted, and comprised around 1.3 million. The death of Mao Ze Dong in 1976 slowly brought surviving Chinese medicine and western medicine physicians and academics back into society. In 1980 the World Health Organization published around 43 pathologies that can be effectively treated with acupuncture. Between 1980 and 1990 Colleges of Traditional Chinese Medicine and Western Medicine reopened with record enrollment in both. In 1978 The Chinese Society of Cardiology was founded. The Ministry of Health established guidelines for development and coexistence of Chinese Medicine and Western Medicine, publishing houses were established, and in 1987 the Joint Society of World Acupuncture and Moxibustion was founded in Beijing.
Twenty-first century China Acceptance of integration of Chinese and Western medicine is part of everyday healthcare. Clinical trials on herbs with cardiovascular benefits are conducted at universities and pharmaceutical firms across China. Many Chinese medical journals discuss case studies and diagnostic and treatment methods. Students, physicians, and researchers from all over the world study medicine in China. Many medical universities around the world have educational exchange relationships with cardiology departments of traditional Chinese and western medicine universities in China. China Heart Association was established in 2017.
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Constitutional theories
1a 9 Body constitutions in Chinese medicine
Constitution Symptoms
Diet
Neutral
Strong body build, a stable psychoemotional state, energetic adaptable to the environment
Moderate and balanced and free of oily and spicy food
Qi deficient
Easily tired, breathlessness, spontaneous sweating, easily catches the cold or flu, weak immune functioning, tooth marks on tongue sides, sensitive to the environment Cold limbs especially hands and feet, puffy face and pale puffy tongue, diarrhea, throat mucous problems, sensitive to cold and dampness, sensitive to temperature and noise changes in the environment
More qi food and nutrition that invigorates the spleen Avoid garlic, radishes, and cilantro
Thin body build, hot flushes, hot palms and soles, dry mouth, dry stool, irritability, sore throat and fever, preference for cold drinks, sensitive to hot weather environments Skin is painful, dry, course, and easily bruised. Dark circles under eyes, unknown bruises, abnormal growths. Sensitive to windy and cold environments. Overweight body type, profuse sweating, limb heaviness, oily face, a preference for oily and sweet foods, thick tongue coating, sensitivity to rainy and damp environments
More foods that cool such as salads and fresh fruits No foods that heat such as lamb
Yang deficient
Yin deficient
Blood stasis
Phlegm dampness
More food that benefits qi such as red meat Cook food and eat it hot Less raw cold food such as salads and fresh fruits
Lifestyle • Exercises according to age • Optimistic life outlook and positive attitude • Avoid strenuous exercises • Avoid windy areas • Keep warm • Get enough sleep • • • •
Do mild exercise Do saunas Keep warm Avoid living in cold weather towns and prolonged air conditioning • Moderate exercises • Avoid late nights • Avoid wasteful sexual activity that depletes body fluids
More food that promotes blood circulation No fatty meat or dairy products
• Exercises and activities that promotes blood circulation
Eat a bland diet Reduce or avoid sweet food and drinks Include more seaweed in the diet
• Avoid risk factors for diabetes • Avoid risk factors for metabolic syndrome • Avoid risk factors for cardiovascular diseases • Avoid a sedentary lifestyle
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Damp heat
Normal or thin body type, oily skin that is acne prone, bitter taste in the mouth and bad breath, fatigue or body heaviness, heavy urination or unexplained scant urination both with site pain or lower abdominal pain, excessive vaginal discharge, damp scrotum, sensitive to damp and hot environments
Eat less greasy sweet foods Include more seaweed in the diet
Qi stagnation
Thin body build, depressed mood, easily stressed and anxious. Prone to insomnia and diagnosed psycho-emotional disorders, frequent sighing, and chest palpitations. Sensitive to seasonal depression and overcast rainy days
Eat more hawthorn and seaweed
Congenital deficiency
Body is born with weaknesses, allergies and sensitivities to different foods, medicines, smells, pollen and plants. They develop upper respiratory and nasal problems, itchy skin rashes and patches. Extreme sensitivity to outdoor environments and seasonal changes.
Bland diet Avoid spicy food and allergens
• Avoid living in environments that are hot and damp • Incorporate dry and ventilated home environment • Intense exercises recommended • Find relaxing activities to help alleviate emotional irritability • Find relaxing activities to help alleviate emotional irritability • Live in a quiet, clean and bright environment • Engage in organized social activities that bring fulfillment • Intense exercises recommended • Exercises to invigorate immune system • Keep warm when in the cold environments • Living space should be clean and well ventilated
1b Basic seasonal habits for cardiovascular disease prevention Spring
Summer
9
Diet: cultivate the yang and regulate the smooth flow of liver qi. Prevent adverse influence on the blood pressure by blending more sour flavors into daily meals. Include sour herbs, which activate yang and immune mechanisms of wei qi, to prepare for the autumn. Exercise: include vigorous activities, jogging, and tai qi, which stretch the muscles and tendons and increase energy; can be done outdoors or indoors due to the weather. Diet: cultivate the yang and regulate the rising of heart yang. Balance bitter, salty, acrid, and sour foods in moderation in daily meals. Eat vegetable soups with various seasonal fruits and vegetables and herbs which maintain body temperature and blood circulation. Drink water and other fluids in moderation to avoid edema.
1bdcontinued Basic seasonal habits for cardiovascular disease prevention
Autumn
Winter
Exercise: moderate activities such as tai qi or sports that stretch the muscles and tendons and maintain energy; can be done outdoors. Diet: nourish the yin and regulate the lung qi and spleen qi. Mix and alternate choices of seasonal vegetables and fruits with sour, bitter, and pungent flavors with sweet and reducing the acrid flavors. Exercise: the accumulated energy of the summer should be stored for the coming winter. Exercise should be moderate to slow. Some activity can be done outside and indoors due to the weather. Diet: nourish the yin and maintain heart and kidney yang balance. Eat less salty and more bitter and acrid food. Exercise: moderate to slow indoor exercises to avoid opening the pores too much and losing yin fluids.
1c Constitution
General body characteristics
Basic male constitutional
Yang type: Excessive amounts of yang and blood, sexual desires, or activities that rapidly deplete essence, yin, and blood. The balance of yin and yang through the nourishment of essence and blood is the life challenge of the male. Yin type: Excessive amounts of qi, insufficient amounts of yang and blood. Pathological evidences are noticed between the menstruation, childbirth and menopausal stages. Balancing yin and yang through building and nourishment of blood is the life challenge of the female. Yang characteristics of rapid development and growth. Potential for excessive heat and fire syndromes in the liver and heart, deficient immunity wei qi, deficient spleen and kidney syndromes. The personality stage is between agreeable and obstinate. Continuous rapid growth and development in adolescence that leads to a plateau in adulthood. Yin and yang are balanced, essence generates, qi moves freely, and blood flows smoothly. Characteristics include the development of mental and emotional individuality, maturity, selfperception, sexuality, morality, virtues, and choices. The personality is changeable. The developmental plateau leads to decline of vitality. Essence is depleted and there is instability of balance between yin, yang, qi, and blood. The personality is stable yet mental and emotional status begins to decline. The viscera, other organs begin to show signs of dysfunction. The menopausal and climacteric stages in both males and females begin. The rapid decline of vitality leads to eventual mortality. Essence has long been depleted with near depletion of immunity wei qi, yin, yang, qi and blood. Stagnation of body fluids accumulates along with poor circulation and elimination. Dampness and phlegm is more abundant. The personality is changeable with mental and physical deterioration.
Basic female constitutional
General stages of infant and childhood constitution
General stages of teenage and young adult constitution
General stages of the middle-aged constitution
General geriatric constitutions
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1d Constitution Basic male constitutional
General prevention suggestions
Diet: foods, drinks, herbs, and supplements that maintain yin and yang balance. Specifics include tonifying yang and building and nourishing blood and kidney essence. Exercise: include activities that move and nourish blood, build and strengthen muscles and tendons, and generate masculine vitality. Basic female constitutional Diet: foods, drinks, herbs and supplements that maintain yin and yang balance. Specifics include nourishing yin and blood before and after monthly discharge, maintaining mood by smoothing and freeing the flow of liver qi, assisting digestion and water metabolism by tonifying spleen qi and kidney qi. Exercise: include activities that move and nourish blood for muscles and tendons, skin and hair, circulation of feminine vitality. General stages of infant and Diet: foods, drinks, herbs and supplements that establish the balance of yin childhood constitution and yang. Specifics include tonifying kidney essence for intelligence, soothing liver qi and reducing heart fire for colic and uncontrollable behavior problems, and tonifying deficiency spleen qi incontinence and drooling. Exercise: activities that promote intelligence, fitness, self-awareness, and responsibility. General stages of teenage and Diet: foods, drinks, herbs, and supplements that maintain the balance of yin young adult constitution and yang. Specifics include tonifying and regulating kidney essence, soothing and smoothing the liver qi, reducing heart fire, tonifying the kidney essence, lung qi, and spleen qi. The focus is to meet the stressors and demands of puberty, emotional stabilization development of selfexpression, irregular dietary habits, career, and physical and sexual activities. Exercise: activities that regulate energy, build and strengthen muscles and tissues, and regulate fat. General stages of the middle-age Diet: foods, drinks, herbs, and supplements that repair the imbalance of yin constitution and yang. Specifics include tonifying and regulating qi, nourishing and moving blood, smoothing the flow liver qi, balancing kidney yin and yang, and promoting activity, relaxation, and sleep. Exercise: activities that promote energy and relieve stress. General geriatric constitutions Diet: foods, drinks, herbs, and supplements that continually work to rebalance yin, yang, qi, blood, and body fluids. Specifics include building and protecting immunity and wei qi, circulation of blood, proper movement of body fluids and wastes, draining dampness, and phlegm accumulation. Exercises: activities that stretch the tendons and muscles and assist with blood and fluid circulation.
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1e Constitution
General pathological characteristics
Yin deficiency constitution
Characteristic: flushed complexion, dry throat, dry skin and hair, emaciated and weak body structure, interior heat sensation at the center of the chest, feverish palms of hands and foot soles, intolerance for summer weather or tropical regions. Behavior: extroverted personality, manic psychoses, hyper sexual desire or activity. Causes: deficiency of yang, innate essence insufficiency, premature delivery, excessive sexual activity, illicit recreational and designer drug use, certain prescription drugs, decline in old age. Characteristic: Pale complexion and lips, obese body structure, muscle atrophy and weakness, cold sensation from the interior and circulating throughout the body. Aversion to cold environments and climates, fluid accumulation especially in limbs and midline, diminished or lack of sexual desire, spontaneous sweating, clear profuse urination and poor or weak defecation, intolerance for winter weather regions. Behavior: introverted personality, depression. Causes: deficiency of yin, premature delivery, insufficient postnatal care; severe emotional trauma, multiple close duration pregnancies/deliveries; weakness and nutritional and emotional imbalance during pregnancy; prolonged illness; perimenopause; certain bacterial, viral, or fungal infections; decline in age. Characteristic: Round chest and/or waistline with cold limbs, edema, shortness of breath and abdominal fullness, fatigue, dull complexion, spontaneous sweating, low voice, no desire to speak much, intolerance for hot summer weather and tropical climates. Behavior: introversion and emotional instability. Causes: deficient innate and acquired essence, anorexia, prolonged or undertreated illness, and advancing age. Characteristic: emaciated appearance, dizziness, muscle atrophy, numbness and tingling of the limbs; pale complexion, eyes, lips, and nails; limp and dull brittle hair and easy hair loss. Behavior: introverted or extroverted personality, depression. Causes: deficient innate essence inheritance; postnatal malnutrition; prolonged untreated illness; severe bacterial, viral, parasitic, or fungal infections; nutritional deficiencies; tumors; irregular menstruation; hemorrhage; illicit and designer drug use; aggressive prescription drug therapies.
Yang deficiency constitution
Yang deficiency constitution
Blood deficiency constitution
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1f Constitution
General pathological characteristics
Qi stagnation
Characteristic: thin body or fluctuating weight gain or a round waistline, intolerance for prolonged heat environments. Behavior: introverted personality, mental instability, emotional sensitivity. Causes: prolonged emotional and psychological trauma due to fright, grief, disappointment, depression, physical and mental overstrain. Characteristic: thin body; abnormally patterned pigmented complexion; dark orbital cavity; purple lips or tongue; hair loss; dry skin calluses or squamation; susceptibility for cold, flu, and infections; intolerance for windy weather and cold climates. Behavior: depressed personality, amnesia, irritability. Causes: inhibited blood circulation, retention of blood in the body, fluid deficiency in the vessels, kidney deficiencies or failure, infections. Characteristic: obese body, protruding soggy waistline, heavy body sensation, oily and sallow skin complexion especially the forehead and nose, acne, puffy face, limb edema, irritable personality, intolerance for damp tropical climates. Causes: heredity, irregular daily routines, unbalanced diet of sweet and fatty food, insufficient water intake, lack of exercise, and irregular sleep schedule. Characteristic: obese body appearance, inability to adapt to a wet tropical environment, oily and dirty or dark yellow complexion and eyes, vexed personality. Causes: exposure to rain, diet of sweet and fatty food, abnormal alcoholic beverage consumption habit, prolonged edema, tropical environments, digestive disturbance, summer heat climate that transforms into the autumn, insufficient fluid circulation, bacterial or viral infection, bladder or kidney infections, liver or kidney failure, gallbladder disorders.
Blood stasis constitution
Damp phlegm constitution
Damp heat constitution
1g Constitution
Recovery suggestions for stagnation, stasis and excess constitutions
Yin deficiency constitution
Diet: foods, drinks, herbs, and supplements that nourish yin and blood and subdue yang hyperenergy. Avoid spicy, hot, astringent, greasy, alcoholic food and beverages. Life: organize and maintain regular daily schedules of waking and sleeping, meals, work, and recreation; avoid overstraining efforts in work, sex; avoid hot weather and rooms, tobacco, marijuana products, OTC remedies, prescription and illicit recreational drugs, which tend to dry yin fluids. Exercise: avoid activities that create a lot of sweating. Diet: foods, drinks, herbs, and supplements that tonify yang and reduce yin by warming the spleen and kidney yang. Avoid cold, raw, bitter, greasy. Life: organize and maintain regular daily schedules of waking and sleeping, meals,
Yang deficiency constitution
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1gdcontinued Constitution
Qi deficiency constitution
Blood deficiency constitution
Recovery suggestions for stagnation, stasis and excess constitutions work, and recreation; avoid cold weather and rooms, tobacco, marijuana products, OTC remedies, prescription and illicit recreational drugs, which tend to deplete the proper accumulation of yang while reducing yin fluids. Exercise: avoid activities in cold or damp environments. Diet: foods, drinks, herbs, and supplements that invigorate the spleen, tonify and nourish the blood, and builds immunity and wei qi. Avoid greasy, cold, bitter, sweet, and spicy Life: organize and maintain regular daily schedules of waking and sleeping, meals, work and recreation avoid tobacco, marijuana products, OTC remedies, prescription, and illicit recreational drugs, which tend to dissipate qi. Exercise: avoid continuous repetitious activity. Diet: foods, drinks, herbs and supplements that tonify and nourish blood flow. Avoid spicy and astringent flavors that vent, dry, or deplete yin fluids. Life: organize and maintain regular daily schedules and limit study times and other periods of concentrated focus. Avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to deplete or make the blood dry and apt to stagnation or stasis. Exercise: avoid activities that require a lot brute effort and overstrain.
1h Constitution
Recovery suggestions for stagnation, stasis, and excess constitutions
Qi stagnation
Diet: foods, drinks, herbs, and supplements that promote the regulations of qi of the heart, spleen, lungs, and liver. Avoid cold and astringent products. Life: organize and maintain a regular daily schedule; avoid tobacco and marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to stagnate liver qi. Exercise: avoid activities that require a lot brute effort and mental overstrain. Diet: foods, drinks, herbs, and supplements that invigorate the spleen, promote movement of qi, and move and circulate blood. Avoid spicy and astringent products that vent, dry, or deplete yin fluids, cold and astringent. Life: organize and maintain a regular daily schedule, avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to deplete or make the blood dry and apt to stagnation or stasis. Exercise: avoid activities that require a lot of brute effort and overstrain. Diet: foods, drinks, herbs, and supplements that invigorate the spleen qi and yang, drain dampness, and activate the san jiao. This patient is in danger of developing hyperlipidemia and coronary artery disease. Avoid greasy, sweet, cold, and astringent
Blood stasis constitution
Damp phlegm constitution
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Damp heat constitution
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flavors, which nourish yin fluids or generate phlegm. Life: organize and maintain regular daily life of sleep, rest, work, and activity. Avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to contribute to factors of phlegm stagnation and dampness. Make sure the living environment is dry and free of fungus. Exercise: avoid activities that require a lot brute effort and overstraining, do exercises that allow normal movement sequences such as walking, jogging, taiqi, swimming, etc. Diet: foods, drinks, herbs, and supplements that invigorate the spleen qi, drain dampness, clear heat, and activate the san jiao. This patient may have concurrent kidney, bladder, or vaginal infections. Avoid greasy, sweet, hot, spicy, and astringent flavors, which generate heat. Life: organize and maintain a regular daily schedule, avoid tobacco, marijuana, OTC remedies, prescription and illicit recreational drugs, which tend to be more astringent, compromise the immune system wei qi, and generate heat in the body. Exercise: incorporate activities that require brute effort and vigorous movement to remove the dampness and vent the heat.
Using traditional Chinese medicines: herbal preparation and delivery types There are many herbal preparation methods in Chinese medicine. Tea pills are the most popular because of convenience, followed by granules, powders, tinctures, and finally raw herbal decoctions. Raw herbal decoctions are the least preferred by patients because of direct contact of the herbal brew with the taste buds. If the flavor is unpleasing, it will discourage the patient from continuing medicinal doses during the treatment course. However, the herbal decoction is the most preferred during a treatment course for moderate to severe cardiovascular symptoms. • The suggested hot temperature of the brew has a better chance of assimilating with gastrointestinal processes • The concentration and quick delivery of the herbal constituents dispersed in a decoction can be digested and quickly sent to assist the target meridian and/or organ. • The decoction formula can easily be modified by adding or eliminating herbs for optimal effect. In addition, difficult herbs can be processed separately and either poured into the mouth and chased by the decoction or dissolved into a decoction with the other herbs.
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Chapter 1 Traditional Chinese Medicine
• Custom decoctions can be made into granules and powders and packaged for portability and convenience of mixing into a cup of hot water. Herbal decoctions for cardiovascular benefit are cooked two to three times to extract all the constituents. • Decoctions that include plant parts such as blossoms and leaves as well as aromatic herbs are processed in small doses. • Decoctions that include the fruit, root, and heavy substances such as bones and shells are processed in large doses. • One or few herb decoctions are processed in large quantities. • Weaker strength decoctions can be taken regularly for prevention and should be given patients in the weaker constitution categories (children, elderly, those with chronic symptoms with debility). • Stronger strength decoctions should be given to patients with acute and chronic conditions in the stronger constitution categories. Doses are subjective as to age, gender, health condition, and severity of disease. They are also indicated and titrated as follows: Prevention: Take once per day around bed time or breakfast. Acute symptoms: Take at any time and in some cases liberally until symptoms abate. Chronic symptoms: Take every 6e8 hours, 2 hours before or after eating a meal. Recovery: Take every 4e6 hours until well-being is restored.
1i Decoction dosage Suggestions According to Constitution Constitution
Prevention/Recovery
Acute
Chronic
Teenage to young adult Age 13e30 Middle age 40e60 Geriatric age 70þ Weak and ill patients
Medium 30e50 g/dose Medium 30e50 g/dose Small 30e50 g/dose
Large 50e100 g/dose Medium 30e50 g/dose Medium 30e50 g/dose
Medium 30e50 g/dose Medium 30e50 g/dose Small 30e50 g/dose
Chapter 1 Traditional Chinese Medicine
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Most common herbs used in Chinese medicine cardiology
1j Most commonly Used Herbs in Traditional Chinese Medicine Cardiology Herb
Main active constituents
Significance
Kun bu
Iodine, iron, potassium, laminine
Hai zao
Iodine, potassium, mannitol, laminine
Huo xiang
d-limonene, a-patchouline, linalool
Shan zha
Crategolic acid, citric acid, vitamin C
Dang gui
b-sitosterol, vitamin B₁₂,
Shou di huang
b-sitosterol, mannitol, arginine, rehmannin, campesterol Amino acids: arginine, cystadine, glycine, lysine histadine, Nicotinic acid, corynanthine, corynoxeine b-sitosterol, campesterol, baicalin, wogonoside
Lipid, excess fluid and blood pressure reduction Lipid, excess fluid and blood pressure reduction Lipids, digestion, antimicrobial, antiinflammatory Lipids, vasodilation, digestion, antiinflammatory Build blood, blood pressure reduction, reduce LDL Build blood, blood pressure reduction, reduce LDL Build and nourish blood
E jiao Gou teng Huang qin
Gan cao
Mai men dong Hong hua
Chuan xiong Ru xiang
Glycyrrhizin (saponin), coumarins, inositol, folic acid, PABA, arginine, vitamins B₁, B₂, B₃, B₆, flavonoids, b-sitosterol, iron, selenium, zinc, potassium, magnesium b-sitosterol, stigmasterol Carthamin, Omega-6 (linoleic acid) ALA (a-linolenic acid), palmitic acid, oleic acid, arachic acid Ferulic acid, perolyrine, chuanxingol a- and b- boswellic acid, a- and bphellandrine, olibanoresene, pinene
Blood pressure reduction Antimicrobial, immune builder, basal temperature regulation, lipid, excess fluid and blood pressure reduction Lipid reduction, antiinflammatory, antidiabetic, antiallergen, blood pressure reduction Blood pressure reduction, antiinflammatory Lipid reduction, blood pressure reduction, invigorates blood Invigorates blood circulation, reduces blood pressure Invigorates blood circulation, reduces chest pain
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Chapter 1 Traditional Chinese Medicine
1jdcontinued Most commonly Used Herbs in Traditional Chinese Medicine Cardiology Herb
Main active constituents
Significance
Huang lian Mu dan pi
Berberine, coptisine, ferulic acid, palmatine, jatrorrhizine Paeonol, camperterol
Ban lan gen Dan shen
b-sitosterol, isatin, glutamine, tyrosine, proline Tanishnone, protocatechuic acid
Suan zao ren
Betulinm jujuboside, saponins, betulic acid, ebelin lactone
He shou wu Yu jin Huang qi
Chrysophanic acid, lecithin d- campene, a- and b- curcumene, tumerone D- b-asparagine, b-sitosterol choline, betaine
Du zhong
Alkaloids, potassium, aucubin, glycosides, vitamin C Panaxadiol, ginsenin, panaenic acid, nicotinic acid
Broad-spectrum antimicrobial, antidiabetic, antiinflammatory Reduces edema and blood pressure, antimicrobial, basal temperature regulation Broad-spectrum antimicrobial Invigorates blood circulation, dilates coronary arteries, reduces blood pressure Sedative and analgesic, basal temperature regulation, reduces blood pressure Tonifies the blood, reduces lipids Reduces lipids Reduces blood pressure, reduces blood lipids Reduces blood pressure
Ren shen
Rou cong rong
alkaloids
Reduces or stops arrhythmia, reduces lipids, increases the immune system, reduces stress Blood pressure reduction
References Al-Shura AN. Integrative Cardiovascular Chinese Medicine: A Personalized Medicine Perspective. Elsevier Academic Press; 2014. Dominique H, Marie-Joseph H. A History of Chinese Medicine [Bailey P, Trans]. Edinburgh University Press Ltd.; 1993. State Administration of TCM. Advanced Textbook on Traditional Chinese Medicine and Pharmacology. New World Press; 1995.