Basic Theory of Traditional Chinese Medicine and Treatment for Urinary Incontinence
● Tao Kong, Limin Liao
IN RECENT YEARS, there has been a surge of interest in Traditional Chinese Medicine in the Western world. What is it and how did it evolve? We take a brief look here at the basic principles.
Origins of traditional Chinese Medicine
Traditional Chinese Medicine (TCM) has a recorded history dating back over 4,000 years. The “Huang Di Nei Jing” or “Yellow Emperor’s Classic of Medicine” is one of the earliest books on TCM, going back to 1000 BC. TCM is fundamentally different from Western medicine and is derived from Taoist philosophy. It reflects the classical Chinese philosophy that man should maintain the harmony of his body and at the same time coordinate with the laws of nature. Confucianism, as an orthodox doctrine, provided a favourable social environment for the development of medicine.
Modern Chinese Medicine
Modern Chinese Medicine (MCM) is a holistic medical approach that integrates Traditional Chinese Medicine (TCM) with modern western medicine. In 1955, the People’s Republic of China established formal medical schools to teach three kinds of medicine: TCM (Zhong Yi), Western medicine (Xi Yi) and Modern Chinese Medicine (Zhong Xi Yi Jiehe). The most highly trained and respected doctors in China are those with MCM education and experience. MCM includes acupunc- ture, Tui Na, Chinese Herbs and Qi Gong. While in the past Chinese medicine was taught through apprenticeship, today China has some 25 colleges teaching TCM. Some Chinese universities provide English language programmes in TCM.
What are the basic principles of TCM?
TCM identified the vital energy called Qi as the life force driving all living things. Qi flows through meridians (also called lines or channels) in the body, similar to water flowing in a river. There are twelve primary meridians, each associated with an organ system. Disease is believed to occur as a result of imbalance, causing excessive or deficient amounts of Qi in the meridians. TCM works to alleviate this imbalance and restore harmony using acupuncture and herbs. The theory of holism plays a central role in TCM. Treatment is based on eight strategies (Ba Fa): Sweating (Han Fa), Vomiting (Tu Fa), Draining Downward (Xia Fa), Harmonizing (He Fa), Warming (Wen Fa), Clearing (Qing Fa), Reducing (Xiao Fa) and Tonifying (Bu Fa).
Chinese herbs
Herbs are an important component of TCM used in the prevention and treatment of disease. Ancient Chinese herbal formulas are as ef- fective as they were more than 4,000 years ago when they were first introduced. The formulas contain two to eighteen different types of herbs and are used to treat a wide variety of symptoms while stimu- lating the body’s natural healing process. Most countries in Asia use the TCM methods of acupuncture and moxibustion. Moxibustion is a traditional Chinese therapy using moxa or mugwort herb. It plays an important role in the traditional medicine of China, Japan, Korea, Vietnam, Tibet and Mongolia. It is dried and ground to a fluff which is either burned or processed into a stick form. Practitioners can either use it indirectly, with acupuncture needles, or burn it on the patient’s skin.
Acupuncture
Acupuncture has a clearly recorded history of some 2,000 years, but archaeology has indicated that it may possibly date back to Neolithic or Stone Age eras. Originally needles of stone or bone were used and have been found in ancient tombs, but were replaced by metal in the 2nd century BC. There are indications that acupuncture may indeed have spread from China to Eurasia by the early Bronze Age. Examination of the well-known 5,000 year old mummified body of Ötzi the Iceman has revealed signs of tattooing that may possibly indicate use of acupuncture. The principle behind traditional acupuncture is that acupuncture points are located throughout the body and act as gateways to influence, redirect, increase or decrease the vital “substance” of Qi, thereby modifying imbalances that cause disease. Thin, sterile, stainless steel acupuncture needles are inserted into acupuncture points to mobilise energy (Qi) flow and invigorate the proper function of muscles, nerves, vessels, glands and organs.
Tui Na
Tui Na is a hands-on body treatment that uses Chinese Taoist and martial art principles in an attempt to bring into balance the eight principles of TCM. Tui Na incorporates three techniques: Massage: to treat the soft tissue. Acupressure: to affect the flow of the Qi. Adjustments: to realign the musculoskeletal and ligamentous relationships and spine subluxations to restore the body’s normal functions. The practitioner may brush, knead, roll/press and rub the areas between each of the joints (known as the eight gates) to open the body’s defensive (Wei) Qi and get the energy moving in the meridians as well as the muscles. Traditionally Tui Na seeks to establish a more harmonious flow of Qi throughout the system of channels and collaterals, allowing the body to naturally heal itself. Tui Na is an integral part of TCM and is taught in TCM schools as part of formal training in Oriental medicine. Many East Asian martial arts schools also teach Tui Na to their advanced students for the treatment and management of injury and pain due to training.
The theory of yin and yang
The concept of Yin and Yang was originally a philosophical/metaphysical theory of ancient China and can be traced back to the Shang dynasty (1600-1100 BC). Later on, this theory was incorporated into medical practice and became an important component of the theory of TCM. According to this theory, everything in the universe contains the two aspects of Yin and Yang, which are in opposition and also in unison. Primaeval analogies for these aspects are the sun-facing (yang) and the shady (yin) side of a hill. Two other com- monly used representational allegories of yin and yang are water and fire. The yin and yang concept is also applicable to the human body, with the upper part of the body and the back assigned to yang, while the lower part of the body is assigned to yin. The same concept ex- tends to the different body functions and also to disease symptoms (e.g. cold and heat sensations are assumed to be yin and yang symptoms, respectively). TCM treatment is aimed at achieving the right balance between yin and yang and thereby curing the symptoms.
Many other principles and concepts
TCM has many other principles and concepts, including Bian Zheng Lun Zhi, a process of diagnosis aimed at determining the right therapy. Wu Xing – the Five Phases – is used to describe interactions and relationships between phenomena. In ancient times, it was thought that the five materials: metal, wood, water, fire, and earth were indispensable and fundamental elements constituting the Cosmos, enhancing, inhibiting and restraining relationships among each other. In Zang Fu (Viscera) emphasis is laid on the physiological functions of an organ rather than on its anatomical structure. Wu Zang (the five parenchymatous organs) represents the heart, liver, spleen, lung and kidney, while Liu Fu (the six hollow organs) represents the gallbladder, stomach, large intestine, small intestine, urinary bladder and triple heater.
Incontinence and TCM
As we all know, most bladder control problems occur due to weak or overactive bladder muscles. Muscle and nerve damage can cause urinary incontinence. Sneezing, laughing, jumping or lifting heavy objects can cause urine or stool to leak, or you may feel a strong urge to go to the bathroom frequently. Chinese medicine theory believes incontinence to be a deficiency of energy, or Qi. As “gates,” the bladder and anal sphincters need significant energy to function properly. Urinary incontinence is thought to stem from issues with kidney energy, so acupressure and acupuncture treatments may focus on increasing kidney Qi. Points along the bladder meridian may also be stimulated to help control urine flow. The spleen is thought to influence transportation and transformation fluids and foods, and is also responsible for developing the body’s muscles. Controlling urine elimination can relate to muscle function, so treatment for urinary incontinence may involve the spleen.
Herbal Medicine for Incontinence
Herbs can be especially effective for treating urinary incontinence. The group of plants called toning herbs can strengthen and restore the mucous membranes in the urinary tract and may prevent incontinence. The stems of horsetail, for example, can be taken in the form of juice, powder in capsules, or tincture. Other beneficial herbs include buchu, saw palmetto, corn silk, plantain and nettles. St. John’s wort is also often added to an herbal remedy for urinary incontinence. Herbs can also be effective for ailments related to or precipitating incontinence, such as recurrent urinary tract infection, constipation, and diarrhoea.
Acupuncture for Incontinence
An acupuncturist can correct imbalances in the flow of vital energy, or Qi. Urinary incontinence is thought to result from a deficiency of Qi in the kidney. Acupuncture can help ‘lift the Qi’ in the bladder. Scientific research is currently finding evidence demonstrating the value of acupuncture in treating a host of physical problems. From a bio- medical viewpoint, acupuncture is believed to stimulate the nervous system, which in turn influences the production of communication substances such as hormones and neurotransmitters. The ensuing biochemical adjustments activate the body’s self-regulating homeo- static systems, which stimulates natural healing abilities, promoting physical and emotional well-being. A study published in “Autonomic Neuroscience” in January 2009 found that participants who received acupuncture for faecal incontinence experienced significant im- provement in bowel control. The “Chinese Journal of Surgery” found acupuncture, in addition to pelvic floor muscle exercises, to be a beneficial strategy for decreasing urinary incontinence. The study, published in September 2010, tested participants recovering from prostate surgery. The experimental group saw more improvement than controls who only used pelvic floor muscle exercises. Animal studies have shown that acupuncture treatment may specifically be of benefit for urinary incontinence by: ● Decreasing the expression of c-Fos in the brain. Induction of stress urinary incontinence in rats has been shown to increase expression of c-Fos (Chung 2008). ● Controlling nitrergic neurotransmitters in order to increase nitric oxide levels in bladder tissue, thus relaxing smooth muscle and allowing increased bladder capacity (Chen 2006). Systematic reviews and trials suggest that acupuncture can help patients with urinary incontinence, especially those with urge urinary incontinence. Stress urinary incontinence is improved when it is used with pelvic floor muscle exercises. It may also help with incontinence caused by a stroke, and nocturnal enuresis in children. However, further study is necessary. ■