4/17/2014 East and West history: Eastern and Western medicine overview:
Traditional Chinese medicine (TCM) is an ancient medical system that takes a deep understanding of the laws and patterns of nature and applies them to the human body.
TCM is a holistic medical system which combines the use of acupuncture, herbs, nutrition, massage, and physical movement like Qigong and Tai Chi, to bring body into balance.
Western medicine looks closely at a symptom and tried to find an underlying cause, TCM looks at the body as a whole. Each Symptom is looked at in the relationship to all other presenting symptoms. The goal of the TCM practitioner is to assess the entire constitution of the patient—considering both physiological and psychological aspects.
The practitioner first observes the general characteristics of the patient, then tries to discern a relationship between symptoms in order to establish what is called a “pattern of disharmony”.
Treatment is aimed at restoring harmony and brining the body into balance.
Basic concepts:
I. Qi and Blood:
-the circulating life energy that in Chinese Philosophy is thought to be inherent in all things.
-Blood: meaning jing, hormones, lymph, yin, and blood.
-Qi: meaning: yuan, kong, gu, zhen, zong, ying, and wei varieties.
Nutrition Qi is ying qi. Helped with herbs and acupuncture.
Defensive Qi or Wei qi is helped with Tu-Na, Dao-yin, Qigong, Tai chi, etc.
II. Yin and Yang theory:
The shape of the yin sections of the symbol, actually gives you a sense of continual movement of these two energies, yin to yang, and yang to yin,
causing everything to happen: just as things expand and contract and temperature changes from cold to hot.
-Inside vs outside
-lower vs higher part.
-softer part vs. harder part.
-Blood vs. Qi.
- Lu,Sp,Ht,Kd,Pc,Lv vs. Li,St,Si,Bd,Sj,Gb.
-Yin is important part and essential part (holds things in).
-Yang is less important in terms of life threating (it passes through).
Yin/yang- balance, understand one is stronger and weaker. Restore the balance, know the proportions of yin and yang.
Upper Body- Yang, Face is hottest part.
Lower Body- Yin, feet is coldest part.
When you are Sick- face gets extra hot, feel temperature at forehead, this is a way to measure if it is a blood circulation problem due to excessive heat. Use cold towel to help balance.
When sick- warm-up the feet in the Yin part.
Men- are more Yang body is warm and hot temperature.
Women are colder more Yin, because of blood loss monthly. Tend to cold limbs. This changes at menopause when menstruation stops. Body will begin to get warm, thus ‘hot flashes’.
Healthy women- adjust to menopause in weeks’ time and get used to new internal system.
Unhealthy women- takes several years to adjust, have a hard time adjusting to new internal system.
Use common sense, listen to your body.
One thing is that in some western practices they may have mother who just gave birth take a cold bath. Taking a cold bath is not good after giving birth.
It is best to use warm. In Asian culture many new mothers are expected to stay away from cold 100 days after giving birth. Warm heals faster than cold.
Ice and cold are for pain, but if you do not feel a lot of pain and are just sore, use heat. Some women have a heat linament rubbed on legs after giving birth.
Yin and yang are relative:
-water is yin, but water is yang because ice is yin.
-fire is yang, but fire is yin, and laser is yang.
Age: boy is yang, but old man is yin.
Yin and yang standout in people, for example: Old woman has a very yang personality, but is old and female: yin.
Front of body is yin (soft organs) while back of body ins yang (hard bones of spine). However this is for upper body, lower part of body, front is yang (hard bones of knee) and back of legs are Yin (soft muscles).
Change:
Change happens in months, conditions of patient change with the seasons. A herb prescribed 6 months ago may not be needed to be taken. A new diagnosis may be needed to determine if you still need same herb or new formula.
Acupuncture and herbs combination:
Acupuncture is like teaching someone how to study, and herbs is like extra material a teacher will give to improve the studying: books, charts, handouts. Herbs add more help to the acupuncture. This is a good combination.
Diagnosis:
The patient is sick, you have to find out how they got sick, not just fix the symptoms of the sickness. Interview the patient, find where/how they got sick.
A patient says is feeling better and ask if they can stop taking the medicine: If you stop taking a shower will you stop getting dirty? You will get dirty, thus you will get sick.
Example: a patient with high blood pressure stops taking medicine, high blood pressure will come back.
3 types of patients that cannot be healed/cured:
1. Shamanic/faith healer: have irrational ways and lack logic. Example: snake handler religion, think snake/god will take care of sickness.
2. Money greedy: people who sacrifice money over health. Will not spend money on things they will help them and improve life. No exercise, just work to make money.
3. People who keep secrets. Not telling the doctor everything, truth. Not telling about lifestyle or bad habits.
3 ways of getting sickness:
1. Outside/External influence (Evil Qi): virus, bacteria, germs, cold energy, damp, heat, winds, ect.
2. Inside imbalance: food, emotion/stress: excessive joy, anger, fear, worry, sad, over-thinking.
3. Qi/blood Blockage: maybe from outside influence, inside influence or both.
Body signals: Use common sense, listen to your body.
Sometimes the craving you have are from the body and other times from the mind. You need to really sense what your body and mind are saying: for example you are craving seafood, this is salty, your body is telling you need some salt, but wanting something fatty and unhealthy is a mind craving. Eating the food that is not right for you will cause an internal imbalance and blockage.
External/Outside/”Evil Qi” for example it is very cold outside: the cold can get under layers: the skin, under muscles, under the blood vessles and meridians, penetrate to the bones, and finally the Zhang/Fu organs.
(Cold weather sample) into layers:
|
———–skin
|
———–muscles
|
————blood vessel/meridian
|
———–Bone
|
Zhang/Fu organ.
When the outside influence penetrates deep to the bone and organ, it is very hard to fix.
Different methods treat the different layers:
Massage can help with skin, muscle, and blood levels.
Acupuncture helps the deeper layers of meridian, bone, and organ.
5 Element theory:
5 Element theory- heart fire, water kidney. “raise water-drain fire”. Metal- decrease, Wood- expand/rise, Earth- absorb.
5 images used to describe forces, and specific relationship to one another.
5 Elements: personality, body shape, organs, climate, taste, tissue, sense, direction, season, color, yin/yang organ, etc.
Talk on Calcium
- Milk is best for baby (baby cows that is), not adults. Digestion in humans change with age and harder to adjust to dairy when older.
- Milk is not always the best source of calcium.
Yin and yang theory is best for acupuncture, while 5 Element theory is best for Chinese herbs. This is saying that 5 element theory in acupuncture has been researched in the history of chinese medicine and found to be not as useful, using yin-yang theory in acupuncture history found this practice yields better results.
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Trends in Eastern History in Chinese Medicine:
Pre-history, Antiquity:
Early inhabitants found foods that could relieve illnesses, others were poisonous.
Discovery of fire allowed for food to be cooked.
3 shaman leaders:
1. Fu xi- I-ching, yin-yang, and bagua theory.
2. Shennong- father of agriculture and herbs.
3. Huang di- Yellow emperor. Su wen book on lifestyle and Ling Shu- book on acupuncture clinical practice.
Shang dynasty (1700-1100BC)-
-use of wine and hot water a medicine.
-needles and bronze knives as surgical instruments.
-yin and yang theory and 5 element theory are basically common knowledge at this point.
Concepts of Qi, moxibustion, herbal decoctions, needles.
Zhou dynasty (1100-221BC)-
Taoism and Confucius time.
-organized medical systems developed: court appointed physicians.
Spring and Autumn period of Zhou dynasty:
Bian Que: Book: Nan Jing. patient diagnostics improved, questions, observer eyes, throat, etc.
Warring states period: book- Wushier Bingfang: 52 prescriptions early pharmacology.
Qin Dynasty (221-207 BC):
-Emperor Shi Huangdi burned books and killed scholars in 213 BC.
Han dynasty (206 BC-220 AD):
Most TCM theory and practice.
Qi and Blood fully entrenched in practice of TCM.
Examinations to recruit qualified physicians were introduced.
Silk road- communication and trade route.
Bencaogang (Classic of herbal medicine)- 365 medicines, 252 plant origin, 67 from animals, 46 from minerals.
Physicians:
Zhang Zhongjing- Shanghan Zabinglun.
Huang Fu Mi- Zhenjiu Jiayijing. ABC book of acupuncture and Moxibustion.
Wang Shuhe- The Maijing (Pulse classic, manual of the pulses.)
Hua To- surgeon and battlefield doctor, developed anesthesia, and exercise for body based on animal movement.
Tao hanjing- commentaries on the Shennong Bencaojing (Classic of herbal medicine).
-Emperor Wen of Song Kingdom: appoint physicians to teach medical students, government assigned teachers to educate higher standard of TCM.
Jin Dynasty- (265 AD to 960 ad)
Classic of pulse
First pharmacopeia
Imperial medical school
Systematic acupuncture and moxibustion
Disease and symptioms by Chao Yuanfeng
1000 golden prescriptions Sun simiao
Sui dynasty (581-618 AD)
Physician Chao Yuangfang- Zhubing Yuanhoulun (Treatise on Cause and symptoms of disease) book.
Tang dynasty (618-907 AD)
Imperial academy: Medical school system and Pharmacy system.
Pysicians:
Sun Simiao- Hippocrates of TCM (body over disease)
His book: The Qianjian Yaofang- (Prescriptions worth a 1000 gold for emergencies, or Precious prescriptions for emergencies).
Song dynasty (960-1270 AD)
Wood Block printing, many books on TCM were printed under government supervision.
-Yellow Emperor’s classic, Classic of herbal medicine, Pulse classic, ABC of Acupuncture and moxibustion in publication.
Acupuncture statue.
New theory: The 3 causes.
Yuan dynasty (1270-1370)
Discussion on new methods: pathology, gynecology, pediatrics.
Physicians-
Liu Wansu: 5 movement, 6 influence. School of cooling: nourishing yin.
Zhang Congzheng- 6 doors , 3 methods.
Zhang Yuansu- illness was result of imbalance in zhang and fu organs.
Li Gao- how lifestyle affects body, spleen and stomach were vitality, emotions affect Qi.
Zhu Zhenheng- Minister of fire- fire and heat school.
Bone setting and tramatic surgery.
Eating for health.
(era of different schools)
Anatomy
Ming Dynasty- (1368-1644)
Debates, 3 schools:
1. Nourishing yin school,
2. Warming and invigorating school,
3.epidemic disease school.
Advancement in surgery
Physicians:
Waike zhengzong- early surgery records in TCM.
Li shizhen- Bencao Gangmu (Compendium of material medica.)
Qing dynasty (1644-1912 AD)
Western influence
Publishing of many encyclopedias.
Medical standards.
Integrated TCM.
Modern times (1912- today)
TCM to the world.
Combine western and eastern medicine.
National and international standards.
Parts of China and what they influenced based on climate to TCM:
North: moxibutions (cold)
South- herbs (warm) grasses.
Eastern region- (sea) acupuncture.
Western- (dry) qigong.
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Anatomy I- Respiratory system
II. Lungs:
1. Trachea- is about 2.5 cm in diameter and 12.5 cm in length.
2. It splits into right and left bronchi.
3. Supported by hyaline cartilage.
4. Ciliated mucous membrane, smooth muscle and connective tissue.
Lower respiratory tract:
1. Primary, secondary, and tertiary bronchi.
2. Bronchial tree connect trachea and alveoli.
3. Interlobular bronchioles-> terminal bronchioles-> respiratory bronchioles-> alveolar duct-> alveolar sacs-> alveoli.
4. Alveoli- dense network of capillaries.
Functions of the respiratory tubes and aveoli
-the branches of the bronchial tree are air passages which continue to filter incoming air.
-alveoli- provide a large surface area of epithelial cells through which gas exchange occurs.
-300 million alveoli in lung.
Lung surface anaotomy:
1. Apex- top of lung
2. Right lung – larger, separated in 3 parts: superior, middle and inferior lobes.
3. Left lung has two parts- superior and inferior lobe.
Plerura Cavity- lung has a fluid lubrication layer.
Visceral pleura- covers surface of lung.
Parietal pleura- lines the thoracic cavity.
Thin film provides reducing friction between the layers.
Breathing Ventilation-
Brachial tree to alveoli, in/out.
Gas exchange in alveoli (inspiration/expiration, or inhalation/exhalation).
External- lungs and blood exchange.
Internal- blood and tissue exchange.
Cellular- 02 and co2 inside the cell.
Lungs at rest- pressure is equal inside and outside at 760 mm Hg.
Inspriation- pressure is 758 mm Hg.
Expiration- pressure is 762 mm hg.
Boyles law- pressure and volume are related in opposite way. Syringe example- suck in air (big), push out air (small).
4 Respiration Air Volumes capacities
1. Tidal volume: normal respiratory cycle inhale/exhale is 500cc.
2. Inspiratory reserve volume- maximal inspiration. 3000 ml.
3. Expiratory Reserve volume- force maxed expiration 1100ml.
4. Residual volume- still have air, after max expiration- 1200 ml.
COPD- cannot breathe well, emphysema. Residual air in lung, fresh air and residual air cause disease.
Alveolar Gas exchange
-pulmonary vein- low oxygen from heart.
-pulmonary artery- high oxygen to heart.
The respiratory membrane is where gas exchange occurs (squamous epithelial cells.
Partial pressure: higher partial pressure to area of lower pressure in two regions equal.
PCO2- in blood pulmonary capillary, is 45mm Hg in alveolar air is 40 mm Hg.
PO2- in blood is 40 mm Hg, in alveolar is 104 mm hg.
Heart pushed the high O2 concentrate blood to tissue.
O2 transport
Hemoglobin molecules: red blood cell carry O2 called oxyhemoglobin.
Blood -> PO2= 95 mm Hg.
Tissue-> PO2= 40 mm Hg.
Diffusion- high to low blood (95 mm Hg) Tissue (40 mm Hg).
CO2 Transport
-blood flowing through capallaries gain CO2 because tissues have high PCO2, this CO2 is transported in the blood in 3 forms:
1. CO2 dissolves in plasma 7%.
2. CO2 bonding to hemoglobin 23%.
3. Bicarbonate ions- HCO3 mechanism- 70%
Chemistry change- (release and combine CO2) CO2 CO2+H2O H2CO3 H+HCO3.
CO2 transport from blood and air
1. Hemoglobin to to air-
2. Chemistry to air
3. Plasma to air.
Factors affecting breathing
1. Nervous system
2. Hormone- chemical receptors- aorta of heart, carotid artieris.
3. Nerves: glossopharyngeal sensory nerve attaches to carotid arteries.
4. Nerve: Vagus sensory nerve- attaches to aorta of the heart.
Fever, emotion, temperature, exercise, age all have an affect on breathing from the brain stem (medulla oblongata) region of brain.
Factors affecting breathing rate and depth
PO2 and PCO2 in body fluids. Receptors involved in the central and peripheral chemo receptors, which located in the brain
Respiratory center and in the walls of carotid and aortic arch.
-low PO2 and High PCO2 can stimulate the rate and depth resulting in increased alveolar ventilation.
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Anatomy II
Alimentary Canal- digestive system
Amalyse- saliva that digest carbs and starches.
Liver- left and right lobes, inferior Vena cava.
Porta hepatic- hepatic portal vein, hepatic artery, common hepatic duct, gall bladder.
Bile- emulse fat substances in duodenum.
Pancreases- endocrine and exocrine hormone. Pancreases is located in back of stomach, behind doudeum.
Agina- enzyme.
Fluids, enzymes, etc.
Saliva- 1000 cc
Stomach- 1500 cc
Brunners gland (duodenum)- 200 cc
Pancreas- 1000-1500 cc
Bile- 1000 cc
Small intestines- 1800 cc
Large Intestines- 200 cc.
Tongue- 10,000 taste buds.
Sweet- front of tongue
Bitter- back of tongue
Salty- front sides of tongue
Sour back sides of tongue.
Digestive system:
Mechanical- teeth.
-incisors: cut
-canine- chisel and carve
-Molars- grind
Tooth structure:
Crown, neck, root.
Enamel, dentin, pulp cavity, gingival sulcus, gingiva, root canal, nerve/blood vessels.
Digestive Chemicals- break down food.
4 basic layers of digestive system:
1. Mucose
2. Sub mucose
3. Muscularis
4. Serosa
Sigmoid colon- waiting area of colon
Gastro colic reflex- baby often drink milk and poop at same time.
Pepsinogen (pepsin)- breaks down proteins.
Skeletal muscles- we can control.
Smooth muscles- cannot control.
Stomach nerve fibers-
1. Maintain muscle tone.
2. Regulate strength
3. Rate and velocity of muscular contractions.
Parasympathetic- increase activity of digestive system.
Sympathetic- inhibit digestive actions.
Pharynx- inner circular and longitudinal muscle groups.
-muscles that pull wall inward during swallowing.
1. superior constrictor- skull and mandible muscles.
2. Middle constrictor- hyoid and fan/middle of pharynx.
3. Inferior constrictor- lower portion of pharyngeal cavity.
Swallow mechanism-
1. Voluntary
2. Trigger to Reflex
3. Swallow reflex- momentarily inhibits breathing. Transports food in esophagus to stomach.
Stomach-
1. Cardia- esophageal opening.
2. Fundus- Balloon top portion.
3. Body- main part between fundus and pylorus.
4. Pylorus- funnel shape that becomes narrow, sphincter controls gastric emptying.
Gastric secretion-
Mucous membrane from mouth to anus.
Stomach is thick with gastric pits.
3 types of secretion cells in stomach-
1. Mucous cells- opening of gastric pits.
2. Chief/peptic cells- digestive enzymes.
3. Parietal cells- hydrochloric acid.
Gastric enzymes in gastric juice:
1. Pepsin- digests proteins.
2. Gastric lipase- fat splitting enzyme.
3. 3. Intrinsic factor- B-12 absorption.
Regulation of Gastric secretions- Gastric juice is produced continuously, controlled neutrally and hormonally.
1. Hormone Somotostatin- parietal secrete, inhibits acid secretion.
2. Acetylcholine- suppress secretion of somotostatin.
3. Gastric- pyloric region histamine, stimulate gastric secretion.
Gastric secretion phases:
1. Cephalic phase- sight, smell, thought of food triggers parasympathetic reflexes, 30-50% secretions.
2. Gastric- 40-50% secretary activity. Food chemically and mechanically stimulates release of gastric juices.
3. Intestinal phase- when food reaches intestines, intestine release hormone 5%. (CCK) Cholecystokinin.