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SARS Update:
The Development of TCM in Hong Kong and the SARS Disease
Epidemic
Written by Mr. Wu Jia Wen,
Translated by Rey Tiquia
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Related Articles:
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 Chinese
Medicine in Hong Kong From the Unfolding of the SARS Disease Epidemic
by Mr. Wu Jia Wen, Hong Kong TCM
Practitioner,
Hong Kong Registered Laboratory Technician
In the past months, SARS has been running wild in Hong Kong,
putting unprecedented pressure upon the medical and health system.
Front line medical personnel, at the risk 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, Hong Kong's Traditional Chinese Medicine
(TCM) practitioners have not been allowed to participate in front
line medical support and life-saving work. This has caused qi
constraint in many of the TCM practitioners.
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 one's 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 Hong Kong 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 Hong Kong
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 using a cup of water to put out a carload of blazing
bundle of sticks and twigs - as the saying goes, "distant
water won¹t put out a fire close at hand." Under the
current health system in Hong Kong, it seems that TCM cannot put
into full play it's positive role. And some of the community seem
to have a deficient knowledge and awareness of what the discipline
of TCM is. The elucidations below are my opinions vis-à-vis
the two above questions posed by various segments of the Hong
Kong community.
Can TCM Treat Acute Life-threatening Conditions?
In the community, there are people who doubt the efficacy of
TCM and Chinese herbs in the treatment of acute diseases and life-threatening
conditions. More seriously, some think
that TCM can only be effective in treating chronic diseases and
conditions. However, this thinking does not accord with facts.
In clinical practice, so long as the diagnosis is correct , and
one grasp the principle of "choosing individual remedies
for a formula on the basis of the established therapeutic method
and principle " (Tiquia R. Traditional Chinese Medicine 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, its active ingredients can maintain a therapeutic
level in the body of the patient "until the illness is driven
away by the remedy."
Integration of Western and Chinese Medicine in
the ER
On the other hand, Mainland China's emergency medicine, is more
often a type of integrated Chinese and Western medicines. By including
TCM's 'Four Examination methods' of 'observing, listening, questioning,
palpating,' the medical practitioner can observe the minutest
of changes in the patient's symptoms. The concept of the acupuncture
meridians helps making a prognosis, and they can stay on top of
care by observing changes in the illness's symptomatic manifestations.
Overall, this helps doctors achieve the goal of 'treating the
illness before it occurs' and prevent a worsening of the condition.
Of course, advance laboratory medicine and X-rays are useful
technologies. If these diagnostic methodologies, can be coordinated
with symptom-differentiation thinking and the use of both Chinese
and western medicines therapies, we can get twice the result with
half the effort.
Some people say, "Boiling an herbal decoction requires at
least half an hour. Can an emergency situation accommodate decoction
times of this duration?"
TCM has historically faced life-threatening emergency clinical
situations. Concentrated preparations, pellets, pills, and powders
have been studied and pre-formulated for quicker use. Acupuncture
and traditional massage on acupuncture points have been used in
life-threatening clinical situations with consistently immediate
results.
Can TCM Treat the SARS Disease?
Although one cannot find records of pathology and treatment of
'Atypical pneumonia' in classical TCM books (this is a new , 'atypical'
fei dian xing disease and clinical pattern) this does not mean
that the theoretical framework of TCM cannot deal with SARS. As
a matter of fact, TCM has a different philosophy and nosology
from that of Western medicine (biomedicine) . In treating diseases,
TCM does not necessarily have to first find a pathogen and then
subsequently study to find a specifically efficacious drug.
Traditional Chinese medicine 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' symptoms are differentiated. Then the
disease condition is 'summed-up' through the 'methodology' of
the:
- Eight Principal Patterns (exterior, interior, yin, yang, cold,
heat, vacuity, excess)
- Six Divisions Liu Jing (Taiyang, Yangming, Shaoyang, Taiyin,
Shaoyin, Jueyin )
- Patterns of the Five Zang and Six Fu
- Patterns of Four Stages (Wei, Qi, Ying, Xue)
- Pattern of the San Jiao (Upper, middle and Lower Energizers)
[Translator's note: In my masters thesis,
I refer to these methodologies which sum-up the data collected
through the Four Examination Techniques as conceptual templates
- Tiquia R. 1996, 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 multi-focal understanding of the disease
condition. Afterwards, Chinese herbs and the formula are 'tailored'
into a well-focused therapy that is 'custom-made to the patient's
body.'
SARS Symptoms and Treatment: TCM is 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
- diarrhoeia
- chest X-ray reveals symptoms of pneumonia, the disease in
the lungs that 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 wheezing and dyspnea. 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 several acupuncture channels affected?
Subsequently, the formula and herbs are selected based on all
this information.
More distinctions:
- When there is high fever, then select some materia
medica and formula that can beat back the heat. However, in
making the choice, pay attention to the vacuity/excess condition
of the patient. Do not 'drain down the heat' blindly. If the
condition is a chronic one, and the illness is 'deep' shen,
and or the patient has a vacuous constitution and often gets
sick, when adopting a 'downward draining heat' approach, it
must be combined with a tonifying approach.
- When there is much phlegm, expel the phlegm. However,
distinguish between a cold and hot phlegm.
- When the patient is suffering from headache and dizziness,
differentiate the location or site of the pain i.e. top of the
head, frontal forehead, both sides of the head, back skull,
back of the neck. This is due to the fact that different pain
site reflects the location of the heteropathy in a different
acupuncture meridian (all the Yang meridians as well as the
Ren and Du meridians all flow along different sites in the head).
Consequently, one uses different herbs.
- 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.
- If the patient has diarrhea and skin rash, because
of the exterior/interior relationship between the Lungs and
the Large Intestines as well as the Lung's 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 or other complicating symptoms. 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 diarrhea, this all depends upon the patient's condition
and the time factor.
Until there is a SARS Cure that focuses
on the SARS Virus…
At this point in time, since nothing much is known about the
pathogen, and there are no known specific drug focused against
the pathogen, the Hong Kong Health Authorities must consider the
use of therapies that are specifically focused upon the patient.
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 and the patient can both have more
than one choice. At the same time, clinically, both Chinese medicine
and Western medicine must coordinate Respirators, food tubes,
laboratory tests, and X-ray machines.
Chinese and Western Medicine Cooperation
"When the sleeping dragon and the Phoenix becomes one there
will be tranquility under Heaven." The cooperation of Chinese
and Western medicines can certainly defeat serious illness. At
this time, due to the problem with the social system as well as
mutual non-understanding between the two, there are no mechanism
for cooperation. However, the emergence of SARS should serve as
a turning point, and a beginning. In the short term, the Hong
Kong authorities should assemble the TCM practitioners in the
special administrative region (SAR) on the front lines to help
in the 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
- Deal with the epidemic
- Raise their survival rate, and
- Reduce the sufferings of the patients
In the long term, the Hong Kong 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. Practicing doctor most fear the 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 Hong Kong, none of its 7,000 Chinese medicine practitioners
are standing on 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 Hong Kong authorities should resonate with the wishes
of the TCM medical circles and allow the TCM practitioners in
Hong Kong to contribute a bit of their humble efforts in the fight
against SARS.
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