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CHINESE MEDICINE

Chinese medicine is a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage (Tui na), exercise (qigong), and dietary therapy. The doctrines of Chinese medicine are rooted in books such as the Yellow Emperor's Inner Canon and the Treatise on Cold Damage, as well as in cosmological notions like yin-yang and the five phases. Starting in the 1950s, these precepts were modernized in the People's Republic of China so as to integrate many anatomical and pathological notions from scientific medicine. Nonetheless, many of its assumptions, including the model of the body, or concept of disease, are not supported by modern evidence-based medicine. TCM's view of the body places little emphasis on anatomical structures, but is mainly concerned with the identification of functional entities (which regulate digestion, breathing, aging etc.). While health is perceived as harmonious interaction of these entities and the outside world, disease is interpreted as a disharmony in interaction. TCM diagnosis consists in tracing symptoms to patterns of an underlying disharmony, mainly by palpating the pulse and inspecting the tongue.

HISTORY


The first traces of therapeutic activities in China date from the Shang dynasty (14th–11th centuries BCE). Though the Shang did not have a concept of "medicine" as distinct from other fields, their oracular inscriptions on bones and tortoise shells refer to illnesses that affected the Shang royal family: eye disorders, toothaches, bloated abdomen, etc., which Shang elites usually attributed to curses sent by their ancestors. There is no evidence that the Shang nobility used herbal remedies. Stone and bone needles found in ancient tombs have made Joseph Needham speculate that acupuncture might have originated in the Shang dynasty. But most historians now make a distinction between medical lancing (or bloodletting) and acupuncture in the narrower sense of using metal needles to treat illnesses by stimulating specific points along circulation channels ("meridians") in accordance with theories related to the circulation of Qi. The earliest evidence for acupuncture in this sense dates to the second or first century BCE. The Yellow Emperor's Inner Canon, the oldest received work of Chinese medical theory, was compiled around the first century BCE on the basis of shorter texts from different medical lineages. Written in the form of dialogues between the legendary Yellow Emperor and his ministers, it offers explanations on the relation between humans, their environment, and the cosmos, on the contents of the body, on human vitality and pathology, on the symptoms of illness, and on how to make diagnostic and therapeutic decisions in light of all these factors. Unlike earlier texts like Recipes for Fifty-Two Ailments, which was excavated in the 1970s from a tomb that had been sealed in 168 BCE, the Inner Canon rejected the influence of spirits and the use of magic. It was also one of the first books in which the cosmological doctrines of Yinyang and the Five Phases were brought to a mature synthesis. The Treatise on Cold Damage Disorders and Miscellaneous Illnesses was collated by Zhang Zhongjing sometime between 196 and 220 CE, at the end of the Han dynasty. Focusing on drug prescriptions rather than acupuncture, it was the first medical work to combine Yinyang and the Five Phases with drug therapy. This formulary was also the earliest Chinese medical text to group symptoms into clinically useful "patterns" that could serve as targets for therapy. Having gone through numerous changes over time, it now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty. In the centuries that followed the completion of the Yellow Emperor's Inner Canon, several shorter books tried to summarize or systematize its contents. The Canon of Problems (probably second century CE) tried to reconcile divergent doctrines from the Inner Canon and developed a complete medical system centered on needling therapy. The AB Canon of Acupuncture and Moxibustion compiled by Huangfu Mi sometime between 256 and 282 CE) assembled a consistent body of doctrines concerning acupuncture; whereas the Canon of the Pulse presented itself as a "comprehensive handbook of diagnostics and therapy."

PHILOSOPHICAL BACKDROUND


Traditional Chinese medicine (TCM) is based on Yinyangism (i.e., the combination of Five Phases theory with Yin-yang theory), which was later absorbed by Daoism.

YIN AND YANG
Yin and yang are ancient Chinese concepts which can be traced back to the Shang dynasty (1600–1100 BC). They represent two abstract and complementary aspects that every phenomenon in the universe can be divided into. Primordial analogies for these aspects are the sun-facing (yang) and the shady (yin) side of a hill. Two other commonly used representational allegories of yin and yang are water and fire. The concept of yin and yang is also applicable to the human body; for example, the upper part of the body and the back are assigned to yang, while the lower part of the body are believed to have the yin character. Yin and yang characterization also extends to the various body functions, and – more importantly – to disease symptoms (e.g., cold and heat sensations are assumed to be yin and yang symptoms, respectively). Thus, yin and yang of the body are seen as phenomena whose lack (or overabundance) comes with characteristic symptom combinations: Yin vacuity (also termed "vacuity-heat"): heat sensations, possible night sweats, insomnia, dry pharynx, dry mouth, dark urine, a red tongue with scant fur, and a "fine" and rapid pulse. Yang vacuity ("vacuity-cold"): aversion to cold, cold limbs, bright white complexion, long voidings of clear urine, diarrhea, pale and enlarged tongue, and a slightly weak, slow and fine pulse. TCM also identifies drugs believed to treat these specific symptom combinations, i.e., to reinforce yin and yang.

FIVE PHASES THEORY
Five Phases ( pinyin: wu xing), sometimes also translated as the "Five Elements" theory, presumes that all phenomena of the universe and nature can be broken down into five elemental qualities – represented by wood ( pinyin: mu), fire (pinyin: huo), earth ( pinyin: tu), metal ( pinyin: jin), and water ( pinyin: shui).
Strict rules are identified to apply to the relationships between the Five Phases in terms of sequence, of acting on each other, of counteraction etc. All these aspects of Five Phases theory constitute the basis of the zang-fu concept, and thus have great influence regarding the TCM model of the body. Five Phase theory is also applied in diagnosis and therapy. Correspondences between the body and the universe have historically not only been seen in terms of the Five Elements, but also of the "Great Numbers" (pinyin: da shu) For example, the number of acu-points has at times been seen to be 365, in correspondence with the number of days in a year; and the number of main meridians – 12 – has been seen in correspondence with the number of rivers flowing through the ancient Chinese empire.

DIAGNOSIS


In TCM, there are four diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation. Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge. Auscultation refers to listening for particular sounds (such as wheezing). Olfaction refers to attending to body odor. Inquiry focuses on the "seven inquiries", which involve asking the patient about the regularity, severity, or other characteristics of:

chills
fever
perspiration
appetite
thirst
taste
defecation
urination
pain
sleep
menses
leukorrhea

Palpation includes feeling the body for tender A-shi points, palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen.

TONGUE AND PULSE
Examination of the tongue and the pulse are among the principal diagnostic methods in TCM. Certain sectors of the tongue's surface are believed to correspond to the zang-fu. For example, teeth marks on one part of the tongue might indicate a problem with the Heart, while teeth marks on another part of the tongue might indicate a problem with the Liver. Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each arm, for a total of twelve pulses, all of which are thought to correspond with certain zang-fu. The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick"; each of these qualities indicate certain disease patterns. Learning TCM pulse diagnosis can take several years.



 

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