Stand like a mountain

Flow like a mighty river.

 

"If the spirit is at peace, the heart is in harmony;

when the heart is in harmony, the body is whole;

if the spirit becomes aggravated, the heart wavers,

and when the heart wavers the spirit becomes injured;

if one seeks to heal the physical body,

therefore, one needs to regulate the spirit first"

 

                                    6th Century philosopher

                                    Before Pharmacuticals, Fudeman, 2012

 

Traditional Chinese Medicine (TCM) has been practiced for thousands of years, but has only recently become known in the west, particularly since 1971 when a well known journalist who fell ill while accompanying President Nixon to China was treated with acupuncture. TCM views the physical, emotional and spiritual as thoroughly interrelated, and, thus, is used to treat physical conditions such as lower back pain, fibromyalgia, and osteoarthritis, as well as emotional and psychological problems, including schizophrenia.

 

To give you more a sense of how TCM works in the treatment of schizophrenia,, a very brief overview of some fundamental TCM concepts and some examples follow. TCM takes a holistic view of people and their environment. In the TCM view, everything is qi, or energy, in various forms or manifestations, a view consistent with modern quantum physics. 

 

Man is a part of community, nature, the universe, and, at the same time, is a microcosm of the universe. Body, mind and spirit are viewed and treated as interacting, and, ultimately, as unified. As a part of nature, man is affected by the forces of nature, including the temperature, winds, foods, the community. To the extent that man is in harmony and in balance with nature, his community and himself, he or she is healthy. Where there is lack of balance, illness can occur. TCM treatment seeks to bring back harmony. The emphasis is less on treating an illness than on restoring health.

 

In the view of TCM, everything has 2 opposite but relative and inseparable aspcects: yin and yang. Yin characteristics includes dark, interior, below, front, female, negative. Yang includes light, experior, above, back, male, positive. Neither yin nor yang can exist without the other, and over time each becomes the other. Everything is relative and in constant change.

 

Everything, according to TCM, also has 5 properties or processes which describe the dynamics of relationships. These processes are the Five Elements or Five Phases, Wood, Fire, Earth, Metal and Water. Wood represents the process of birth, Fire, growth, Earth, transformation, Metal, harvest or ripening, and Water, storage, death or resting. Other aspects of each of these Phases are bodily organs, seasons, weather conditions, directions, colors, smells, tastes, emotions, and sounds. Organs and emotions, for instance, related to the Phases are: Wood, liver and gall bladder, and anger and patience;  Fire, heart and the small intestine, and hate and love; Earth, stomach and spleen, worry and empathy; Metal, lungs and large intestine, sadness and courage; Water, kidneys and gall bladder, fear and calmness. Westerners can feel some familiarity in TCM’s associations of Fire, the heart, love and hate, the color red.

 

Qi, or energy, flows in meridians, or channels, throughout the body, interconnecting parts of the body, including organs, with one another. The qi can be accessed at hundreds of points in the meridians. The organs have specific relationships with each other, and a person’s health depends on the proper flow of energy in the body, including to and from the various organs. Qi is and can be affected by all the various conditions within a person and outside the person in his environment. Internally, emotions, will, nutrients, temperature all affect a person’s qi. External things, such as weather, wind, heat, harsh life experiences, bad food, and difficult physical environment, also affect a person’s qi.

 

Illness can be caused by numerous factors, both external and internal to the body, including emotions, weak or stagnant qi. For example, “poor development of the Lung and little vital capacity may directly cause sadness, depression, and a tendency to develop pessimistic attitude and ideas. When Heart-qi is not strong or if flow in the Heart meridian is obstructed, the person’s capacity for self-knowledge and for understanding the world may be limited, and consequently he or she may often lose orientation in life. All of these limitations may lead to mental disorders, such as anxiety, schizophrenia, and autism.” External factors may cause physical disturbance and excessive emotion such as sadness, anger, or fear, either very intense or extended, which may disturb the normal flow of qi or blood, and cause disturbances such as post traumatic stress syndrome (during war or natural disaster), or depression (death of loved one) (Bosch & den Noort, 2008).

 

Diagnosis is done by history taking, and reading the pulse and tongue. All symptoms are reviewed, along with the individual’s constitution, physical condition, emotional features, and duration of problem. Pulse is read, which can involve 3 different positions on each wrist, and at each position, 3 different levels, considering 28 separate qualities, including rate and rhythm. Tongue reading includes examining the color and texture of different parts of the tongue which correspond to different parts of the body. From these, the practitioner determines the type of disturbance, the organs and mieridians involved, the circumstances in which the disturbance occurred, and how it developed, and the kind of influence and consequence it has on the body and mind.

 

“Symptom differentiation” is applied, whereby, not just the symptoms, but the derivation of the symptoms is determined. “For instance, patients who are diagnosed with depression in conventional psychotherapy all have the same symptoms, such as a loss of interest in life, feeling tired, and a  poor appetite. Yet, in TCM, after tongue and pulse diagnosis, it may be found that in some patients the depression is caused by deficiency of qi of the Lung and Spleen, whereas in other patients the depression may be caused by Kidney-qi deficiency or by Liver-qi stagnation…the disturbance of qi and blood…may then play a role in generating new pathologies in the body. For instance, intense emotions may cause a disturbance in Liver-qi movement. When the qi is restrained, heat is generated. This directly influences the Heart and generates Heart-Fire. If this occurs in a person with a heat-domiated constitution, the heat may develop into strong Fire, which may be manifested in a quick temper, concentration problems, difficulty falling asleep, and dryness in the mouth and throat. Furthermore, when the yin and body fluids are consumed, they are too weak to control the yang and the Fire, so the Fire becomes more active and aggressive. The patient then feels more angry and restless without any reason, or is obviously hyperactive and cannot sleep at all, such as in manic disorder. Meanwhile, if the Fire consumes the blood and causes blood stagnation, the congealed blood may obstruct the Heart and Liver meridians. In this condition, the patient has obsessive, paranoid ideas, and suffers from delirium.” (Yang, p. 274-275.)

 

Various treatment techniques are used. With acupuncture, needles are inserted at specific meridian points to stimulate and regulate the flow of bodily energy. Moxibustion uses heat at specific meridian points. Massage is used to manually manipulate the qi flow. Qi gong exercises use movement to do the same. Meditation utilizes the mind to facilitate harmony and balance. Herbal remedies and diet are used to ensure proper nutrients for sufficient qi.  

 

Given the symptoms and the person’s specific constitution, personality, temperament and life experience, an individualized treatment is fashioned. Even though individualized treatment is required, some procedures are commonly used for various symptoms. For instance, sadness, common in mental disturbances, can arise from a Lung-qi disturbance, when, for instance a major disappointment or loss occurs in life. Sadness can also arise from Kidney-qi deficiency, which, because the Kidney supports the Lung, results in Lung-qi deficiency. Thus, in addition to psychotherapy, for a person who is sufficiently fit, physical exercise or breathing exercise, as well as acupuncture or moxibustion, is recommended to activate Lung-qi (Yang, p. 280-283)

 

Specific acupuncture points can be used for negative symptoms of schizophrenia, auditory and visual hallucinations, as well as to ameliorate the side effects of neuroleptics, such as headaches, dizziness, tinitis, lactation. Acupuncture can also be used for other symptoms such as insomnia, mania, depression,  obsessions, agitation, fear (Bosch & den Noort, 2008, p.287-288) frustration, anger, hyperactivity, and anxiety, (Yang, p. 281-285)

 

Six patterns have been found which “roughly correspond” to Western subtypes of schizophrenia, for which acupuncture treatment can be used:

 

1. Qi Stagnation with Blood Stasis/Paranoid Type of Schizophrenia as defined in China (CCMD-III, 20.1; Chinese Society of Psychiatry, 2001), the United States(DSM-IV,  295.3; American Psychiatric Association, 1994), and the World Health Organization (ICD-10, F20.0; World Health organization, 2007).

2. Phlegn-Fire Harassing Internally/Hebephrenic or Disorganized Type (CCMD-III, 20.2; DSM-IV, 295.1; ICD-10, F20.1).

3. Effulgent Yin-Vacuity Fire/Catatonic Type (CCMD-III, 20.3; DSM-IV, 295.2, IDC-10, F20.2).

4. Phlegm-Damp Obstructing Internally/Simple Type (CCMD-III, 20.4, ICD-10, F20.6 (not recognized by DSM-IV).

5. Yang Vacuity Damage/Chronic Type (CCMD-III 20.4; DSM-IV, 295.6, ICD-10, F20.5).

6. Other Patterns includes all cases that don’t fit in prior categories (CCMD-III 20.9; DSM-IV, 295.9, ICD-10, F20.3, F20.8, F20.9; Qinzhang Ding, et.al., p 289-293.).