I received this video through a WhatsApp Chat on the speed of medical treatment. China, the way forward.
The
video claimed the Chinese health care system is by far one of the best in the
world and has the combination of Traditional Chinese Medicine (TCM) and other
platforms as well.
To me,
it is not just the speed a patient gets to get an appointment to see a doctor
in China, but more importantly they are able to integrate TCM with western
conventional medicine. Let me explain.
It is true that China has the world's best health care system where they
integrate conventional allopathic medicine with their Traditional Chinese
Medicine (TCM).
This was told to us by one of the senior directors from the Ministry of Health
(MOH) Malaysia who went on an official visit to China, as well as by one of the
officials from WHO in the mid1980's when I sat as a member of the Joint World
Health Organization – Ministry of Health -Institute for Medical Research
(WHO-MOH-IMR) Technical Expert Committee.
As far back as in the early 1980 the Malaysian government on advice of
WHO wanted to integrate and officially recognise the traditional medical
practices such as TCM, Indian Ayurveda, Siddha, and Unani systems of medicine,
and other western alternatives systems of medicine, like homeopathic,
naturopathic, osteopathic and chiropractic medicine in this country
I was selected to sit in this very high powered policy making committee for
nearly 6 years till I retired
The Committee told us that medical schools in China combine at least 30 %
of TCM and 30 % of western medicine taken from either system during their
students' medical training.
For
instance, if a student chose to study conventional allopathic medicine, he also
has to study 30 % of TCM. Likewise, if a student opted to study TCM, the
student has to study 30 % of drug based conventional medicine
In their preclinical year, all medical students study the same subjects plus 30
% of the other medical systems.
Only in the clinical years they separated but they exchanged clinical notes and
understand each other’s technical languages, and they worked together in the
same hospital referring cases to each other using the best therapeutic
modalities from either system. They don’t insist it should be modern drug based
or using ancient TCM.
In the 5th year for their final examinations in both systems, all students must
answer 30 % of the questions from both medical systems
Both WHO and the directors from MOH described China as having the best medical
training in the world where they integrate the best therapeutic modality taken
from each system. WHO praised the way they integrate ancient and modern systems
of medicine for the best care of their patients.
But here we study them separately. That was why WHO wanted the government
to integrate and officially recognise all the relevant medical systems
practiced here in Malaysia since traditional and other systems of medicine are
used by over 80 % of the world population till this day according to WHO.
See
some examples here:
1.
WHO summit aims to unlock power of traditional medicine through science
2.
WHO Global Summit on Traditional Medicine highlights scientific evidence and
integration into health systems
3.
Use of traditional medicine in middle-income countries: a WHO-SAGE study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013777/
4.
Traditional Medicines in the World: Where to Go Next?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295149/
But it
took us a very, very long time to do and accept this because our Committee
needed to study other systems of medical training, their syllabus, length of
training, the legal, logistics, administrative, safety, aspects, their clinical
efficacy as well as the social, cultural and religious acceptance by the
people among other issues
All these issues took us many, many years to study with constant meetings once
every two weeks for more than 10 years even after I retired
The only system of medicine yet to be officially recognised till now is bomoh
and Malay medicine because they have no written records, or was
documented nor do they undergo structured training in a university or
college, unlike a formal 5 year training course for TCM, homeopathy,
naturopathic, osteopathic and chiropractic medicine similar in intensity and
duration to those undergoing an MBBS or an MD degree course in
conventional medicine.
When I
was a senior medical research officer at the Institute for Medical Research in
Kuala Lumpur, Malaysia from 1968 till 1994, I was asked to sit in a Joint World
Health Organization – Ministry of Health -Institute for Medical Research
(WHO-MOH-IMR) Technical Expert Committee.
I was
assigned to observe and study TCM in one of their clinics for 4 hours each
evening after work for 6 months. I spoke to the practitioners of TCM to have an
idea of the principles behind their traditional system as well as to interview
patients undergoing TCM treatment to understand better why they chose TCM over
conventional.
I
went to a major TCM Clinic in Kuala Lumpur, and I was very surprised that the
clinic was very crowded every evening I was there. There were all kinds of
patients from all races, mainly Chinese with about 40 % of them Indians and
Malays. The air there was very fragrant, filled with an aroma of herbal
medicines so unlike in the pharmacy of a hospital where the drugs kept and
prescribed were synthetic as a pure isolate without any smell.
There
in the pharmacy of TCM clinic, the air was filled with very nice fragrance and
aroma emitting from all kinds of natural herbs which made me want to stay there
as long as possible each evening. The smell was very fragrance in the evening
air with the TCM pharmacists dispensing the prescription.
The TCM
practitioners were very professional and careful especially during their
acupuncture procedures. They all wore face masks, and hand gloves to ensure the
acupunctures were aseptically done using sterile needles that were used only
once, and even that, after passing the needles through a flame from a spirit
lamp. They also sterilized the skin before insertion of the acupuncture needles
I spoke
to the TCM practitioners who were all qualified about the principles behind
their practice, and they told me about balancing the body using the yin and
yang principles. This when translated in the western eyes of science and
physiology means the maintenance of health and the management of diseases and
illnesses that rely on a complex interplay of various factors and mechanisms in
the body. Some of the most important factors and mechanisms include from the
western perspective are:
The
immune system. First, there is the innate immunity they told me. This is the
body's first line of defence against pathogens, including physical barriers
(skin, mucous membranes) and cellular defences (phagocytes, natural killer
cells).
Second,
we also have adaptive immunity. This is a more specific and adaptive response
involving lymphocytes (T-cells and B-cells), which target and remember specific
pathogens for faster response upon re-exposure.
Third,
there is this homeostasis. We take the endocrine system for example. This
regulates various functions through hormones, including metabolism, growth, and
stress responses. Key glands include the thyroid, adrenal, and pancreas.
Then
the nervous system that maintains homeostasis through neural regulation,
including autonomic responses that control heart rate, blood pressure, and
digestion. Disease is also associated with inflammation. There is inflammatory
response: A critical response to injury or infection that involves the
activation of immune cells, release of cytokines, and increased blood flow to
affected areas.
This is
followed by tissue repair and regeneration. These processes restore tissue
integrity, involving fibroblasts, collagen deposition, and, in some tissues,
stem cells for regeneration.
Consider
also microbiomes. The gut microbiota plays a crucial role in digestion,
synthesis of certain vitamins, immune function, and protection against
pathogens. The skin and mucosal microbiota protect against colonization by
harmful microbes and maintain skin and mucosal health.
Consider
also genetic and epigenetic regulation. Genetic factors influence
susceptibility to diseases, response to treatments, and overall health.
Epigenetics is the modification in gene expression without changing the DNA
sequence, influenced by environmental factors, diet, and lifestyle, impacting
disease risk and health.
TCM
offers the same view on homeostasis as in western medicine.
TCM,
like conventional medicine, also gives importance to diet and nutritional
status. Both systems advocate a balanced diet that can provide essential
nutrients that support immune function, cell repair, and overall metabolic
processes. Micronutrients like vitamins and minerals such as vitamin D, vitamin
C, zinc, and iron are crucial for immune function and overall health.
TCM
gives great importance to the detoxification systems. For example, the liver
function is to detoxify harmful substances, metabolizes drugs, and processes
waste products. The kidney function is to filter blood, remove waste, and
maintain electrolyte and fluid balance.
Cardiovascular
and respiratory health is to ensure efficient delivery of oxygen and nutrients
to tissues and removal of waste products. The respiratory system is to maintain
oxygen and carbon dioxide balance, essential for cellular respiration and
energy production through deep and slow breathing exercises in open-air parks
in the early morning. This is also TCM principle to draw in life-giving and the
healing Qi energy from the trees and greeneries around.
TCM
insists that each of these factors and mechanisms plays a vital role in
maintaining health and managing diseases. The immune system, for example, is
paramount in protecting against infections and malignancies. Homeostatic
mechanisms ensure that the body's internal environment remains stable despite
external changes. The microbiome significantly influences not only digestion
but also immune responses and overall health. TCM uses diet and food as
part of the healing process. Nutritional status and detoxification
systems are critical in supporting the body's natural defences and recovery
processes. Cardiovascular and respiratory health are foundational for overall
well-being, as they ensure that all body systems receive the oxygen and
nutrients they need to function effectively.
This is
what yin and yang is all about as the most important factor or mechanism for
the maintenance of health and management of disease is not singular; it is the
integrated and balanced functioning of all these systems that ensures optimal
health
I too
concur with TCM medical principles the ability for the body to maintain
homeostasis against external and internal challenges would be far more
important than other requirements. This principle used in Traditional Chinese
Medicine is the same as the term "homeostasis" used in
conventional western medicine. The concept of homeostasis, or the body's
ability to maintain a stable internal environment in response to external and
internal changes, is indeed a fundamental aspect of health. This principle is central
to both traditional and modern medical paradigms, including Traditional Chinese
Medicine and Western medicine.
In TCM,
the idea of "yin and yang" reflects the balance between opposing
forces within the body. According to TCM, health is achieved when there is
harmony between yin (the passive, cooling, and nourishing aspects) and yang
(the active, warming, and transformative aspects). This balance ensures that
the body's physiological processes function smoothly.
In
Western medicine, homeostasis refers to the complex set of regulatory
mechanisms that the body employs to maintain stable conditions necessary for
survival. These include:
Temperature
Regulation: The body maintains a consistent internal temperature through
mechanisms like sweating, shivering, and blood flow regulation.
pH
Balance: The body regulates pH levels in the blood and tissues to ensure
optimal conditions for enzymatic and cellular functions.
Electrolyte
and Fluid Balance: The kidneys and other organs manage the balance of
electrolytes and fluids to support cellular function and overall physiological
stability.
Blood
Glucose Levels: Hormonal regulation, particularly through insulin and glucagon,
ensures that blood glucose levels remain within a narrow range.
Blood
Pressure: The cardiovascular system, through mechanisms involving the heart,
blood vessels, and kidneys, maintains blood pressure within an optimal range.
Both
TCM and Western medicine recognize that disturbances in these balances can lead
to illness. In TCM, this might manifest as an imbalance between yin and yang,
while in Western medicine, it would be seen as a failure to maintain
homeostasis.
The
importance of homeostasis is the main core beliefs in TCM. The body's ability
to maintain homeostasis is crucial for several reasons:
Adaptation
to stress. Homeostasis allows the body to adapt to both physical and
psychological stress, ensuring survival and functionality under various
conditions.
Disease
prevention. Many diseases are linked to the failure of homeostatic mechanisms.
For example, diabetes results from an inability to regulate blood glucose
levels, while hypertension involves disrupted blood pressure control.
Optimal
functioning. Homeostasis ensures that enzymes and biochemical processes
operate efficiently, which is necessary for overall health and vitality.
Recovery
and healing. The body's repair processes depend on a stable internal
environment. Effective wound healing and recovery from illness are facilitated
by homeostatic mechanisms.
I think
integrative approaches are crucial in any system of medicine. Recognizing the
importance of homeostasis or balance, integrative medicine combines principles
from both TCM and Western medicine to enhance health outcomes. For instance:
Both
TCM and Western medicine emphasize the role of a balanced diet in maintaining
health. TCM focuses on balancing "hot" and "cold" foods,
while Western medicine emphasizes macro- and micronutrient balance.
Techniques
such as acupuncture, meditation, and tai chi from TCM can complement Western
approaches like psychotherapy and pharmacotherapy in managing stress and
promoting homeostasis.
Both systems
of medicines recognize the importance of individualized treatment plans. TCM
tailors treatments to the individual's unique balance of yin and yang, while
Western medicine uses genetic and biochemical markers to personalize therapies.
I think
the concept of maintaining balance or homeostasis is indeed a cornerstone of
health and is central to both Traditional Chinese Medicine and Western
medicine. By appreciating and integrating these perspectives, we can gain a
more holistic understanding of health and develop more effective strategies for
disease prevention and management.
I don't
believe in using only western drugs to "cure" a disease. What is more
important is to find some natural therapeutic modalities to restore this
natural balance called homeostasis which is naturally in place all the time. In
some ways the principles of TCM used for thousands of years by the Chinese
works far better and more permanently than using drugs especially for chronic
diseases. Drugs can only alter, inhibit, substitute or replace a pathological
chemistry for a short while if the drug is still in the body called
"retention time" in pharmacokinetics but once it is metabolized and
excreted it can no longer act, let alone establish yin and yang or homeostasis.
The
distinction between symptomatic relief through pharmaceuticals and holistic
approaches used by TCM doctors aim to restore balance and promote overall
well-being. This is a central tenet of Traditional Chinese Medicine (TCM),
which focuses on achieving and maintaining balance within the body to prevent
and treat disease.
The key
principles of TCM are taking a holistic approach. TCM considers the body as an
interconnected whole. It emphasizes the importance of balancing the body's
internal environment (yin and yang) and its relationship with external factors.
Treatments
in TCM, such as acupuncture, herbal medicine, and dietary therapy, are designed
to support the body's natural healing processes and restore balance.
TCM
also uses personalized treatment. TCM practitioners tailor treatments to the
individual's unique condition, considering not just the symptoms but the
underlying imbalances that may be causing them.
This
personalized approach can be particularly effective for chronic conditions,
where long-term balance and harmony are crucial for sustained health.
TCM
places a strong emphasis on prevention. Regular practices such as tai chi,
qigong, and balanced nutrition are used to maintain health and prevent disease
by keeping the body's systems in balance.
There
are limitations of pharmaceuticals. Western medicine often relies on
pharmaceuticals to manage diseases, especially chronic conditions. While drugs
can be highly effective in certain situations, there are several limitations to
this approach.
Pharmaceuticals
typically provide temporary relief from symptoms rather than addressing the
root cause of the disease. Once the drug is metabolized and excreted, its
effects wear off. But for chronic diseases, this means continuous medication
may be required, leading to potential side effects and long-term dependency.
Then there are also side effects using chemical drugs. All drugs come with
potential side effects, which can sometimes be severe or outweigh the benefits,
especially with long-term use. The focus on symptom suppression can sometimes
lead to a neglect of underlying imbalances that continue to affect overall
health.
Western
medicine often takes a reductionist approach, targeting specific pathways or
symptoms rather than considering the whole-body system. This can be less
effective for complex, multifactorial diseases where a more holistic approach
is needed.
I think
TCM and conventional allopathic need to be integrated and complementary.
Integrative medicine combines the best of both worlds.
Many
practitioners and researchers advocate for an integrative approach, combining
the strengths of both TCM and Western medicine. There is a tremendous advantage
in complementary therapies. Using TCM therapies such as acupuncture and herbal
medicine alongside conventional treatments can enhance overall effectiveness
and reduce side effects. For example, acupuncture can help manage pain and
stress, which can improve the overall efficacy of other treatments.
In
chronic disease management TCM's focus on restoring balance and supporting the
body's natural healing processes can be particularly beneficial for chronic
conditions, where long-term health and balance are crucial. Integrating
lifestyle modifications, dietary adjustments, and stress management techniques
from TCM can complement pharmaceutical treatments.
Integrative
medicine emphasizes personalized, patient-centred care, considering the
individual's unique needs, preferences, and conditions.
This
holistic approach can lead to more comprehensive and sustainable health
outcomes.
While
pharmaceuticals play a critical role in managing acute conditions and providing
necessary relief for certain symptoms, they often fall short in establishing
the long-term balance necessary for overall health, particularly in chronic
diseases. TCM, with its holistic and individualized approach, offers valuable
insights and methods for maintaining health and preventing disease through
natural balance and homeostasis.
Adopting
an integrative approach that combines the strengths of both TCM and Western
medicine can lead to more effective, sustainable health care solutions,
emphasizing
I
managed to learn these from the TCM practitioners by observing, speaking and
learning from them 4 hours each evening over a period of 6 months. There was
much, much more to learn if it was a formal 4 -5-year course. I would prefer to
combine their theories on health and disease with my own view from a western
scientific perspective.
I
subsequently wrote up a 260 pages Technical Report that I observed, accompanied
by a 30-page Executive Summary for the busy policy makers in the Committee for
them to decide.
Halfway
through in the WHO-MOG-IMR series of meetings, the Ministry of Health and the
Institute for Medical Research organized a two-day National Conference on
Traditional Medicine where I managed to present a paper on behalf of Chinese
Traditional Medicine Practitioners, where doctors and paper presentations from
the Malaysian Medical Association, from Kuala Lumpur General Hospital and
practitioners in other systems of medicine and healthcare also took part.
I
remember there were 20 of us in the Committee. Six of them were from WHO, 12
were Directors from various sections of MOH and just 2 of us from IMR, my boss
and I were there.
My
report on TCM was accepted by them. There were also other reports on other
traditional medicines practised by other races in this country written by other
doctors from similar races after I have done my job
Finally an Act of Parliament legally enforced their acceptance and recognition.
Now MOH also has a huge section to oversee the registration and licences of
doctors from other medical systems.
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