SARS: Bian Zheng Lun Zhi

[Guest guest]

May 22, 2003

 

Dear Listmembers,

 

The following is an article written by Wu Jia Wen and published in the

newspaper Takung Pao (May 20,2003). I have translated the article because

it has elucidated and expanded on the use of the clinical practice of bian

zheng lun zhi in looking at the SARS .In addition, the article addresses

issues relating of the use of Chinese medicine in dealing with

life-threatening conditions .

 

Regards,

 

Rey Tiquia

Phd Candidate

Dept of History and Philosophy of Science

University of Melbourne

Victoria

Australia

 

Looking At the Development of Traditional in Hongkong From

the Unfolding of the SARS Epidemic

 

Mr. Wu Jia Wen Hongkong Model TCM Practitioner, Hongkong Registered

Laboratory Technician

 

In the past months, SARS has been running wild in Hongkong which is

putting unprecedented pressure upon the medical and health system . Front

line medical personnel unmindful of their own health , care for SARS

patients. Researchers work day and night to unravel the mystery of the

epidemic. In the face of the danger facing thousands of SARS patients,

Hongkong¹s TCM practitioners could not participate in front line medical

support and salvation work. This makes many of the TCM practitioners

depressed Qi Jie (got their Qi all knotted up).

 

Hindered by the present system, the public hospital system does not

include TCM medical services. However, in this unusual circumstances, every

person has a responsibility in dealing with the epidemic.. Every one¹s

talent and skills must be put into utmost use. Many TCM organizations and

educational institutions have appealed to the government to participate in

the fight against the epidemic. However, the Hongkong authorities have not

responded positively.

 

Mainland Chinese TCM Experts Cannot Treat Large number of SARS Patients

 

Currently, Guangzhou City has sent two TCM experts to Hongkong to to

diagnose and treat SARS patients. We can consider this as the first step

taken by TCM to participate in the war against SARS. However, these two TCM

experts are facing thousands of SARS patients. They cannot stay here for a

long period of time. I am afraid that this is like Œusing a cup of water to

put out a carload of blazing bundle of sticks and twigs¹ bei shui che xin ;

and Œdistant water won¹t put out a fire close at hand Œ yuan shui nan jiu

jin huo . Under the current health system in Hongkong , it seems that TCM

cannot cannot put into full play it¹s positive role. And several sections of

the community who seem to have a deficient knowledge and awareness of the

discipline of TCM. The elucidations below are my opinions vis-a-vis the two

above questions posed by various segments of the Hongkong community.

 

 

I Can TCM treat Acute Life-threatening Conditions

 

In the community, there are people who doubt the efficacy of TCM and

Materia medica zhong yi zhong yao in the treatment of acute diseases and

life-threatening conditions ji bing zhong zheng . More seriously, some think

that TCM can only be effective in treating chronic diseases and conditions.

However, this thinking perhaps does not accord with facts. Because in

clinical practice lin chuang zhi liao shang , so long as the diagnosis is

correct zhen duan zheng que , and one grasp the principle of " choosing

individual remedies yao for a formula on the basis of the established

therapeutic method and principle " li fa fang yao (Tiquia R. Traditional

A Guide to Its Practice .Sydney, Choice Books p.25) ,cups

and cups of herbal decoction are administered, and from the point of the

modern medicine, it's active ingredients can maintain the therapeutic level

in the body of the patient , 'until the illness is driven away by the

remedy' yao dao bing chu .

 

On the otherhand, in Mainland China's emergency medicine ji zheng yi

xue, more often it is a type of integrated Chinese and Western medicines

zhong xi yi jie he. It seems, TCM's 'Four Examination methods' si zhen of

'observing, listening, questioning, palpating ' wang, wen, wen qie which

allows the medical practitioner to observe the minutest hao wei of changes

in the patient's symptoms; the convenience of using the concept of the

acupuncture meridians jing luo xue shuo in making a prognosis yu ce

changes in the illness's symptomatic manifestations, in order to achieve the

purpose of 'treating the illness before it occurs' zhi wei bing and

prevent the worsening of the condition. Of course, advance laboratory

medicine jian yan yi xue , X-ray technology diagnosis, are useful

technologies no matter whether it is Chinese or Western medicines. If the

diagnostic methodologies, symptoms differentiation thinking and therapy of

both Chinese and western medicines can be' coordinated ' pei he , then we

can get twice the result with half the effort shi ban gong bei .

 

Some people also ask: " to boil a herbal decoction requires at least

more than half a hour. Can a clinical emergency situation accommodate a

decoction boiling time of this duration ? First of all, for a very long

historical period, TCM zhong yi always faced life-threatening or emergency

clinical situations . Correspondingly, gao (concentrated preparations ) ,

dan (pellets) , wan (pills ), and san (powders) have been studied and

pre-prepared. At the same time,

acupuncture as well as traditional massage on acupuncture points have been

used in life-threatening clinical situations and the results can be seen

immediately li jian .

 

II Can TCM Treat SARS ?

 

Although one cannot find records of pathology and treatment of fei

dian xing fei yan 'Atypical pneumonia' in classical TCM books, (much less

of clinical data, because this is a new , 'atypical' fei dian xing disease

and clinical pattern bing zheng ) this does not mean that the theoretical

framework of TCM cannot deal chu li with SARS. As a matter of fact, TCM

has a different philosophy zhe xue and nosology ji bing fen lei from that

of Western medicine (biomedicine) . In treating diseases, TCM does not

necessarily have to first find a pathogen bing yuan ti and then

subsequently study to find a specifically efficacious drug. Traditional

Chinese medicine chuan tong zhong yi stresses the practice of bian zheng

lun zhi (tailoring treatment in accordance with the diagnosed clinical

pattern). Through the practice of the 'Four Examination Techniques' Si zhen

symptoms zheng zhuang are differentiated fen bie . Then through the

'methodology' fang fa of the 'Eight Principal Patterns' ba gang

(exterior, interior, Yin and Yang, Cold, Heat and vacuity and excess); Six

Divisions Liu Jing (Tai yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin, Jue

Yin ); 'Patterns of the Five Visceral and Six Hollow Organs Zang Fu ,

Patterns of Four Stages wei Qi Ying Xue ; and Pattern of the Three

Energizers San Jiao (Upper, middle and Lower Energizers) etc. the disease

condition bing qing is 'summed-up' gui na . { in my masters thesis, I

refer to these Œmethodologies Œ which Œsumms-up the data collected through

the ŒFour Examination Techniques¹ as Œconceptual templates Œ Tiquia R.

l996, Connecting Traditional Chinese medicine and Western Scientific

Medicine .Masters Thesis, Dept of History and Philosophy of Science,

University of Melbourne, Victoria, Australia p. 16-18}In this way, one has a

multifocal understanding of the disease condition. Afterwards, materia

medica and and the formula are 'tailored' cai hua into a ' well-focused

therapy that is' custom-made to the patient's body' du shen ding zao

 

TCM Well-focused therapy that is 'Custom-made to the Patient's body'

 

Speaking of SARs, the main symptoms are fever (the body temperature

goes beyond 38 degrees Celsius); cough; hurried breathing or difficulty in

breathing; soreness all over the body , tiredness, the feeling of coldness,

headache, skin rash and diarrhoeia, chest X-ray reveals symptoms of

pneumonia). The disease is in the lungs which accounts for the symptoms of

cough, hurried breathing or difficulty in breathing.

 

Speaking about TCM diagnosis of the disease, one must differentiate the

disease symptoms like the sound of the cough, the time of coughing, the

degree of Xiao (wheezing) nd Chuan. (dypsnoeia or catching ones breathe)

These (data) should be coordinated with the phenomena of the pulse to work

out in which acupuncture meridian or channel the disease is situated; are

there several acupuncture channels affected; subsequently, the formula and

materia medica are selected. When there is high fever zhuang re, then

select some materia medica and formula that can beat back the heat tui re .

However , in making the choice xuan cai , pay attention to the

vacuity/excess condition of the patient. Do not 'drain down the heat' xie re

blindly yi wei . If the condition is a chronic one huan bing shi jian chang

, and the illness is 'deep' shen, and or the patient has a vacuous

constitution ti xu and often gets sick duo bing when adopting a

'downward draining heat' approach, it must be combined with a tonifying

approach bu . When there is a lot of phlegm tan , then expel the phlegm.

However distinguish between a cold and hot phlegm tan zhi han re . When the

patient is suffering from headache and dizziness tou tong mu xuan ,

differentiate the location or site of the pain i.e. top of the head dian

ding, frontal forehead qian e , both sides of the head lian ce , back

skull zhen gu , back of the neck hou xiang . This is due to the fact that

different pain site reflects the location of the heteropathy in a different

acupuncture meridian jing luo ( all the Yang meridians as well as the Ren

and Du meridians all flow along different sites in the head) , consequently,

one uses different materia medica. When the patient suffers from soreness

all over the body and fatigue,then materia medica which can enliven the

collateral meridians and relax the tendons huo luo shu jin . If the patient

has diarrhoeia and skin rash, because of the exterior/interior relationship

between the lungs and the large intestines as well a as the lungs external

connection with the skin and hair skin, one should consider the complicated

nature of writing a prescription which addresses this complicated clinical

picture.As to whether to first deal with the main complaint zhu zheng or

other complicating symptoms jian zheng . Because in some cases, once the

main complaint or symptom has been cured the other complicating symptoms

gets relieved. Whether it is good first to stop the diarrhoeia, this all

depends upon the patient¹s condition and the time factor yin ren yin shi zhi

yi .

 

At this point in time, since nothing much is known about the pathogen,

and there are no known specific drug focused against the pathogen zhen dui

bing yuan de yao wu , the Hongkong Health Authorities wei sheng dang ju

must consider the use of therapies that are specifically focused upon the

patient zhen dui bing ren de zhi liao . This will save thousands of lives

and help us gain time in finding a drug against the pathogen and

implementing health and hygiene measures . Of course, this author is not

into one-sidedly praising TCM . What I hope is that the doctor yi zhe and

the patient bing zhe can both have more than one choice. At the same time,

clinically, both Chinese medicine and Western medicine must coordinate pei

he Respirators, food tubes shi wu dao guan , laboratory tests, X-ray

machines, casualty treatments are all necessary.

 

³When the sleeping dragon and the Phoenix becomes one there will be

tranquility under Heaven ³ wo long feng ji, de yi ke an tian xia .the

cooperation he zuo of Chinese and Western medicines can certainly win over

Œserious illness¹ bing mo (demons of diseases). Although at this time due to

the problem with the Œsocial system¹ zhi du de wen ti as well as mutual

non-understanding between the two , hence there are no mechanism for

cooperation. However, the emergence of SARS (Atypical should serve as a

Œturning point¹ qi ji , a beggining. In the short term , the Hongkong

authorities should assemble the TCM practitioners in the special

administrative region (SAR) in the front lines to help in t he efforts to

treat and save SARS patients. This will add a number of human hands,

relieve the stress on those currently in the front lines, and in a different

orientation deal with the epidemic yi zheng , raise their survival rate, and

reduce the sufferings of the patients. In the long term , the Hongkong

Government should promote the exchange between Chinese and Western

medicines.; make TCM learn from Biomedicine and biomedicine to learn from

TCM. As for the medical schools, they should exercise flexibility in

accepting future students. This is because of the fact that to profoundly

understand another medical system in another category , I am afraid that an

undergraduate medical course is the foundation.

 

It is painful for a medical practitioner to see the dying that he/she cannot

save

 

A practicing doctor xi yi fear most the sight of a dying person that

he/she cannot save.; a wounded patient he/she cannot help. At present, more

than 200 people have lost their life from SARS. In Hongkong, none of its

7,000 Chinese medicine practitioners are standing in the front line to

treat and save the SARS patients. . These people¹s sensibilities just

cannot stomach this . We hope that that the spread of the SARs epidemic can

be quickly checked . The Hongkong authorities also should resonate with the

wishes of the TCM medical circles and allow the TCM practitioners in

Hongkong to contribute a bit of their humble efforts mian li in the fight

against SARS.