East Meets West

Contents

Traditional Chinese Medicine (TCM) History

The same kind of world philosophy was also prevailing in Western cultures such as the Greek's. The departure occurred around the Renaissance in 14-16 centuries, when European started to adopt to the more liberal view and examine the surroundings with the method of reductionism. Meanwhile, China was content with its old way of doing things resulting in a long period of stagnation including the advance of medicine.

Figure 38 Chinese History [view large image]

There are four classical text books every student has to learn in the TCM school (samples for three of them are shown in Figure 39a, b, c). The contents have not been modified intentionally over the years. Nevertheless, it is doubtful that the originals have been kept intact with all the wars, natural disasters, and copying mistakes. It is believed that the gaps have been filled by un-named individuals. Modifications did occurred in the form of treatises or supplements promoting improvement or new theory as shown in some examples below.



Huangdi's Internal Canon (¶À«Ò¤º¸g) - This is believed to be a collective work over thousands of years by many individuals. It was compiled into one piece at the period of East Han Dynasty around 100 AD. The book has two parts, the first one Suwen (¯À°Ý) is in the form of dialogue between the pseudo-emperor (¶À«Ò) and one of his ministers or physicians by the name of Qibo (§Á§B). The text lays down the doctrines of "Five Phases (¤­¦æ)" and "Organs (ŦµÆ)". The other part is called Lingshu (ÆF¼Ï), it is about acupuncture therapy. While Suwen is mostly related to concepts, Lingshu is more practical locating 160 acupunctural points (ß}¥Þ) for healing - about 1/2 the total today. Figure 39a shows the first page of the table of contents. Shennong's Classic of Materia Medica (¯«¹A¥»¯ó¸g) - This is the first book to cover medicinal herbs, minerals and animal parts. It was complied in the same period around 100 AD. The discovery of some 365 kinds of drug is attributed to the legendary Shennong, who has a transparent body showing the reaction of every oddity that he swallowed to discover its property. He eventually died from too much poisoning. Actually, it should be another collective work as people fall ill all the time; remedies were sought after long before recorded history. Figure 39c is a cartoon of Shennong sporting a pair of horns to indicate his herbivorous origin.

Figure 39 TCM Classic [view large image]



• Treatise on Cold Pathogenic and Miscellaneous Diseases (¶Ë´HÂø¯f½×) - This book is written by Zhang Zhongjing around 200 AD near the end of the East Han Dynasty when pathogenic diseases were running rampant. His work was ignored until the North Song Dynasty at around 1000 AD. The re-assembled text includes more than 40 types of internal medical cases, and 250 herbal formulas to treat these diseases. Its clinical value even surpasses the Huangdi's Internal Canon.

A-B Classic of Acupuncture (°w¨b¥Ò¤A¸g) - This book was written in ~ 250 AD, it supplements the acupunctural part of the Huangdi's Internal Canon . It is divided into theoretical and clinical sections. A bronze statue with all the meridians and acupunctural points was commissioned by the North Song government as shown in Figure 40a. Compendium of Materia Medica (¥»¯óºõ¥Ø) - It is compiled by Li Shizhen (§õ®É¬Ã) in 1578 AD (during the Ming Dynasty). This is the most comprehensive documentation of the use of medicinal herbs, minerals and animal parts including 1892 drugs, 1109 illustrations, and 11096 herbal formulas. An one page sample is shown in Figure 39d.

Figure 40 TCM Classic 2 [view large image]

• Warm Disease Theory (½E/·Å¬Ì½×) - This is the most modern of the four classics. It was written in 1642 AD during another period of wide-spread diseases near the end of the Ming Dynasty. The author argued that not all the diseases can be cured by the cold pathogenic treatments. This theory represents an advancement against the authoritative establishment. Figure 40b shows a page of the preface.

TCM Concepts

The TCM philosophy was laid down mostly by Huangdi's Internal Canon. It can be categorized into Ying-Yang, the Five-Phases, the Zang-Fu(organs), and acupuncture. Each of these is described below not exactly according to the ancient text.


• Ying-Yang - This is a very simple concept of opposition, e.g., yes/no, is/isn't, have/haven't, in/out, hot/cold, ... All these examples can be represented mathematically by the binary number 0, 1 (0/1) or worldly as female/male, water/fire, loose-stool/constipation, ... (see a list in Figure Figure 41). A single Ying/Yang (or 0/1) does not yield much information, but lot of information can be obtained with a lengthy interrogation such as : are you female/male? do you have pain/no-pain? is it in upper/lower body? acute/chronic? ... At the end it reveals, for example, the person is male having chronic pain in upper body ..., and concludes that he may have problem with coronary blood vessels. It shows that more knowledge would be obtained with longer questioning. This is the essence of "Information Theory" proposed

  		by Claude Shannon in 1948. The TCM practitioners use the same kind of logical deduction in determining the nature of the illness although they may not exactly run such binary interrogation. The process is performed visually and mentally. it is called "Syndromes Differentiation" (¿ëÃÒ) in TCM parlance. Since this is not done by a machine, subjective judgment may involve in the process.
  Figure 41 TCM Concepts [view large image]	Figure 42 Five Phases [view large image]	NB : "Symptom" is the sign accompanies a disease, while "Syndrome" means a group of symptoms characterizing a disease.

  
  The traditional interpretation of Ying/Yang is different from the description above. While it attributes material as ying and function as Yang such as stomach/digestion; the rule also accepts the definition of solid organs as Ying and the hollow ones as Yang such as heart/stomach creating some confusion. The principle is "balance" - even though the Ying or Yang may prevail at some moment but eventually the balance has to be restored for a healthy person. This concept of Ying/Yang leads directly to the "Five Phases".


• Five Phases (¤­¦æ) - The original geometric shape for the five pentagon representation of the five phases is a 3X3 matrix as shown in Figure 43. This matrix has the curious property that the sum is 15 whether it is over the row, the column, or diagonal. The most primitive labeling is applied to the 4 directions plus the center. Additional labeling with various 5-things were attached including the 5-phases of

  Earth, Metal, Water, Wood, and Fire (Figure 42). It is then replaced by a pentagon (Figure 41). TCM attaches either the various organs or physiological functions to the corners of the pentagon and asserts that there is a promotional effect toward the clockwise neighourhood. On the other hand, the interaction is restrictive for elements two steps away also in clockwise direction (see Figure 41). Illness is caused by excessive promotion, too much restraint or not enough (with the arrow pointing to the reverse direction). This scheme of interaction is similar to the modern notion of positive nor negative feedback such as the use of logistic equations to similate the "World Model" in the 1990's. As for the assignment of the various organs to the respective corners, it must have been the results of statistical observations. The healing process would work only when the items are placed in the correct corners.

  Figure 43 3X3 Matrix [view large image]

Anatomy According to TCM

		Organs (Zang-Fu) - TCM defines the organs in terms of five Zang (Ŧ, the solid storage organs) and six Fu (µÆ, the hollow circulating organs) as shown in Figure 44. This arrangement is very close to the modern anatomy (Figure 45), if the spleen and kidney-bladder are replaced by the pancreas and rectum respectively (in TCM). Modern Embryology reveals that there are three major tubings developed in the fetus - the neural, gut and heart tubes. The hollow organs in TCM are those parts of the gut tube from mouth to rectum, while the solid ones belong to three branches out of the gut tube, the pump in the heart tube, and the kidney is related to one more tubing developed from mesoderm. Many organs such as the brain, uterus, the nervous and immune systems ... etc. are missed out in the
Figure 44 TCM Anatomy [view large image]	Figure 45 Modern Anatomy [view large image]	Znag-Fu definition, some of them are collected into the "exotic" catalogue. Table 08 lists some properties of the Zang-Fu accordibg to TCM.

Table 08 List of TCM Organs

Comments on Table 08 :


• The suggestion to replace the TCM spleen with pancreas is based on : (a) The shape for TCM spleen in Figure 44 looks more like the pancreas instead of the spleen which shaped like a deflated football. (b) The pancreas is closely related to the digestive function (see Table 08) as it belongs to the "Earth" element (phase), while spleen is a blood filter and also synthesizes antibodies for the immune system. (c) The close proximity of the two organs might lead to the mis-identification or it is just the case of two different names for the same thing.


• The suggestion for replacing the kidney-bladder with the rectum is based on : (a) The rectum is a part of the gut tube similar to the other Fu ograns, while kidney-bladder belongs to another tubing system arised from the mesoderm. (b) The close proximity of the two organs might lead to the mis-identification although its shape as shown in Figure 44 for the TCM anatomy seems to be too large for the rectum.


• The openings are referred to Zang organs only as the connection to the outside world. The Fu organs are within a tube with the mouth and anus as the entry and exit point respectively (as suggested by the new assignment).


• Manifestations as well as openings reflect the condition of the internal organs, which are unobservable in ancient time. A standard healthy look would be vibrant and shine, not too dark, not too pale. The manifestations of muscle and bone are among the list of 12 human organs (Figure 45) in modern time.


• It is the link between the Zang-Fu and Function that is most problematic. Except for the links between stomach-digestive and lung-respiration, it does not make much sense according to modern anatomy, by which the rest of the relationships should be liver-digestive, heart-circulatory, and kidney-excretory (see Figure 45). BTW the modern endocrine system is related to various glands which release hormones to govern many body process such as growth and energy production.


• San(3)jiao (¤TµJ) is the 6th Fu but not included in Table 08. It is not well defined - subjected to at least 7 different interpretations.

  The ancient definition is rather abstract, it divides the body cavity into three parts (Figure 46) - upper jiao (including heart and lung, for dispensing goodies to the body), middle jiao (upper abdomen containing the stomach etc. for digestion), and lower jiao (for excretion or expulsion through the intestines and kidneys). It is likened to a wrapping for protecting the various organs. A relatively modern version is to identify the jiao with the membranes - the upper jiao to the pleura enclosing the lung, middle jiao to the diaphragm separating the body near the middle, and the lower jiao to the omentum covering the abdominal organs (Figure 46).

  Figure 46 Sanjiao [view large image]

  The corresponding Ying pair in the Sanjiao meridian is the pericardium which is another membrane enclosing the heart (Figure 46).

  
  
• The six exotic organs include the brain (nervous system ?), marrow, bone, blood vessel, gall-bladder, and uterus. Their physical appearances are similar to Zang (solid) but the functions run like the Fu, that's why they are excluded from the Zang-Fu category. Notice that the gall-bladder has a double identity.


• Meridians and Collaterals (¸gµ¸) - They are supposed to be the linkages between various organs and body parts. It is a very important component of TCM both theorectically and clinically.
  
  

  History - The functions of meridians (¸g), collaterals (µ¸) and its clinical applications had been established in Lingshu (ÆF¼Ï) more than 2000 years ago. It is believed that the use of needles to heal started as a way to drain pus and other pathogens under the skin. Gradually, it was discovered that stimulation of certain points in the body could produce healing effect for specific diseases. Then it was found that some of those points (now called acupoints) are aligned along a path and have clinical effect on certain organ, such observations leaded to the invention of meridian - a line formed by connecting those points. The theory was further developed to include the collaterals, which serve to link the meridians to the internal organs. Nobody has ever found the physical counter parts of these imaginary meridians although some qigong practitioners claim that they can feel some sort of sensation running along the

  Figure 47 Meridian Samples [view large image]

  meridians while in deep mediation. Figure 47 shows two samples of such paths from illustrations in ancient text.

  
  
  • Distribution - As shown in Figure 48 the meridian locates deep inside the skin. It is the acupuncture point (acupoint) that is right on the skin. The collateral (luo) provides the bridge to link the acupoint and the meridian. Figure 49 shows a few

    			meridians run along the length of the body and the complementary acupoints with the luo distribution patterns. Figure 50 illustrates the complicated network with the meridians, luos, divergents (the major meridian branching), and organs all linking together. There are 12 meridians (Figure 51a) relating to each of the organs (Zang and Fu) as listed in Table 08. The naming convention is Ying for Zang, Yang for Fu; there are six meridians run along the hand-body routes, another six run along the foot-body paths; then it is called fore, mid, and aft according to its position on the fingers or toes (see Figure 51a). This complicated naming scheme is shown in Table 08 (also see two examples in Figure 47).
    Figure 48 Meridian Structure	Figure 49 Meridian Distribution	Figure 50 Meridian Links

    
    In addition, the governing vessel (·þ¯ß) runs from the bottom up along the back mid-line, around the head terminating at the

    		upper lip; it moderates the Yang substance and reflects the condition in the brain, marrow, and kidney. The conception vessel (¥ô¯ß) also starts from the bottom but runs up along the front mid-line meeting the governing at the upper lip; it moderates the Ying substance and promote the female reproductive function together with the penetrating vessel (¨R¯ß, see Figure 50). Actually there are five more main vessels and numerous minor ones not mentioned here. The distribution of meridians etc. is mostly theoretical, it is the acupoint that has the immediate effect on healing various kinds of ailments just by applying pressure to the specific acupoint. A detailed description can be found in, for exmaple, "Healing Therapist" or the more Westernized version "All about Acupressure".
    Figure 51a Meridians [view large image]	Figure 51b Meridians, Anterior View [view large image]

  Figure 51b shows the meridians in Anterior View together with the names of the acupoints in Chineses and standard nomenclature assigned by Western practitioners, e.g., ST for Stomach, Kl for.Kidney, SP for Spleen, CV for Conception Vessel, etc.
  
  

  Essence, Energy, Spirit (ºë¡B®ð¡B¯«) - This is TCM's view on the functioning of the body nicknamed three treasures (¤TÄ_, Figure 52). It asserts that energy (®ð) is converted from the material base (essence, ºë) to maintain all kinds of activities in life (spirit, ¯«). It emphasizes the difference before and after the formation of the fetus. The distinction is on the source, while the very early life of the fetus requires the content in the egg to sustain, it relies on nutrition from the outside world including the mother's later during the rest of its life.

  Figure 52 The Three Treasures

  Starting from Huangdi's Internal Canon, there are various interpretations for these three treasures over the years. A brief summary in the following is based on those ideas that make sense to modern science.

  
  
  • Essence - This is the material base to maintain all life not only human. Nutrition is swallowed into the digestive system which breaks down the food into macro-molecules such as glucose, Fatty Acids, etc. Although the ancients did not understand modern science, somehow they knew that the essence has to be microscopic and in the form of fluid or solid.
  
  
  • Energy - This would be the energy to drive the circulation of blood, the respiration of oxygen, and the movement of other fluids within the body. It runs all kinds of activity, but is invisible, that's why it is sometimes called qi (®ð). The converting agent from the essence has to be the ATP synthase in mitochondria (½u²ÉÅé) within each cell. The too-little/too-much or under/over performance would be manifest as Ying/Yang (³±/¶§) or cold/hot (´H/¼ö) in term of TCM jarons as energy is required to keep the body healthy and warm.
  
  

  N.B. Energy can be in the forms of heat, chemical, electrical, mechanical, etc. Qi could be yet another form unknown so far. Ultimately, the source of all the energy on Earth is from the Sun. The principle of balance in TCM is actually referred to an non-equilibrium state maintained by energy infusion from the Sun. All animals convert food (the essence in TCM) to energy to keep alive (see Figure 53, and more information on life at molecular level).

  Figure 53 Process in Life [view large image]

  The most convincing evidence for the all-important energy in supporting life is revealed by a dead body, which is cold and motionless.

  
  
  • Spirit - This is more than mental activities such as the act of cognition, it also means the bodily movement, disposition and facial expressions. It is through the appearance, i.e., the "spirit" that the condition of the body is determined.

TCM Healing Process

	rigorous training in medical school; until very recently, the TCM counterparts inherited the know-how mostly from family or through apprenticeship. Thus the quality of TCM service varies, it makes the treatment even less reliable. Anyway, the principles of the TCM healing process is outlined below :
Figure 54 TCM Healing Process [view large image]

Figure 55 TCM 4 Diagnosis [view large image]	Figure 56 Tongue Symptoms [view large image]	Figure 57 TCM 8 Principles [view large image]	Figure 58 TCM Syndromes [view large image]

• TCM 4 Diagnosis (¥|¶E, Figure 55) :
  
  
  • Inspection (±æ) - This is the visual scan of the patient's general appearance. Some of the signs are listed in Figure 55. The quality of stool is also an important clinical data in the West, but it is done cleanly in the laboratory. The analysis is actually done on the bio-molecular substances rather than just a casual look. Tongue examination is very important in TCM diagonsis. As shown in Figure 56, the color and texture of the tongue is the main indicator of symptom.
  
  
  • Auscultation and Olfaction (»D) - Auscultation (listening) is to find the abnormal sound of the patient by hearing. Olfaction (smelling) uses the nose - a rather unpleasant way to detect bio-molecules.
  
  
  • Inquire (°Ý) - This is another way to obtain information about the patient through verbal interrogation or dialogue.
  
  
  • Palpation (¤Á) - This involves touching the patient's body for swelling or tumour. The most important part is taking the pulse on the wrist according to a set of rules to determine the symptom. The pulse is generated by heartbeat, for which Western doctors use the stethoscope to detect the sound - another example of using machine or instrument to replace personal touch.
  
  
  N.B. TCM fee may be lower, but it is not covered by "Health Insurance" in countries such as Canada, and the US.
  
  
• Differentiation of Syndromes according to the 8 Principles (¤Kºõ) - The eight principles are Ying/Yang, Exterior/Interior, Deficiency/Excess, Cold/Heat. Figure 57 depicts some general properties of these. In addition, a list of symptoms are assigned to each one. The Ying/Yang consists the root (the condition of energy supply in the body) under each one are the Exterior/Interior each of which further combines to one of the Deficiency/Excess, and Cold/Heat types to form a syndrome (Figure 58). For example, when a patient shows sign of hyper-activity, and develops aversion of wind blowing, body aching, and fever; then the syndrome can be categorized as Yang/Exterior/Excess/Heat. The following is a very brief description on each one of the 8 principles.
  
  
  • Ying (³±) - It is characterized by inhibition, quietude, decline, and gloominess. This kind of symptoms reveals insufficient energy supply leading to imbalance of Ying and Yang - the cause of disease.
  
  
  • Yang (¶§) - The symptoms is the opposite of Ying including excitation, restlessness, hyper-activity and optimism. It is an indication of over production of energy. Ying and Yang are the leading principles among the 8 Principles.
  
  
  • Interior (ùØ) - This indicates a more serious illness resulting from the penetration of pathogens deep into the organs or from dysfunction of the organ itself. The problem would be related to the organs as defined in the 5 phases concept. The disease has to be treated according to the interaction between those 5 elements. The many symptoms for further differentiation on Deficiency/Excess and Cold/Heat are listed in Figure 58.
  
  
  • Exterior (ªí) - It is generally appeared as acute occurrences, superficially located, and with a short duration. The problem would be related to the openings or manifestations as shown in Table 08. The disease has to be treated according to the interaction between those 5 elements. The many symptoms for further differentiation on Deficiency/Excess and Cold/Heat are listed in Figure 58.
  
  
  • Deficiency (µê) - This signifies the weakness of body resistance to pathogens. It is further classified into qi, blood, Ying/Yang deficiency with various clinical manifestations (Figure 58).
  
  
  • Excess (¹ê) - The immunity seems to be normal in this case, but it is the pathogen that is too strong to resist resulting in qi stagnation, blood stasis, phlegm obstruction, stagnancy of water etc (Figure 58).
  
  
  • Cold (´H) - Different parts of the body have different temperatures, oral temperature (under the tongue) should be 36.8 0.4 ^oC. The normal range is 36.5 - 37.5 ^oC. Low temperature within or below the normal range would cause cold. It also reflects the deterioration of the body function. Death occurs below 24 ^oC. (See Figure 58 for the list of symptoms.)
  
  
  • Heat (¼ö) - High temperature within or beyond the normal range would cause heat. It also reflects the excessive functioning of the body. Body temperature over 44 ^oC means certain death. (See Figure 58 for the list of symptoms.)
  
  
  In general, Ying is associated with Interior/Deficiency/Cold, and Yang with Exterior/Excess/Heat, however there are cross-over cases making the differentiation more complicated and the syndromes more diversified.
  
  
• Herbal Formula Prescription - Unlike Western medication using one drug to treat one disease, TCM's herbal formula contains many herbs targeting each symptom in a syndrome, while some of them assist the delivery (to certain organ) or minimize the side effects. The combination and dosage are tailored to each individual. However, there are some general guidelines for the prescription as described briefly in the followings.
  
  

  Four Properties (¥|®ð) - As shown in the temperature scale in Figure 59, the 4 properties Heat/Warm/Cool/Cold are just a discrete description on a continuous scale. The herbal medicines with the property of Heat/Warm are prescribed for cold-syndrome, and the opposite for Cool/Cold herbs. Five Flavors (¤­¨ý) - The 5 flavours are spicy (¨¯), sweet (¥Ì), sour (»Ä), bitter (­W), and salty (ÄÐ). In general, spicy serves to expel, activate; sweet to invigorate, regulate, moderate; sour to astringe, preserve; bitter to lower, release, dry; salty to soften, purge. In addition, the bland flavor (²H) manages the delivery (see examples in Figure 59). Seven Functions (¤C±¡) - This is the interaction between various herbs in a formula : 1. Work-alone (³æ¦æ); 2. Work-together (¬Û¶·) to strengthen the effect; 3. Assisting (¬Û¨Ï) each other to achieve the different goals; 4. Suppressing (¬Û¬È) the other herb's effect; 5. Minimizing (¬Û´c) the effect of another herb; 6. Producing side effect (¬Û¤Ï) from the mixture; 7. Suppression of the toxic effect (¬Û±þ) of a potent herb.

  Figure 59 TCM Herbal Formula, Example [view large image]

  Figure 59 shows a very simple herbal formula for relieving the dampness (dosage not given). See "Sacred Lotus Chinese Medicine" for 257 herbal formulas treating variuos symptoms.

  
  
• Herbal Therapy - The herbs in a formula are usually mixed and boiled in water. The timing is measured by the amount evaporated, e.g.,

  from three bowls down to one (Figure 60). Modern convenience produces ready made herbal remedy in powder or pill form. There are strict rules for taking the herbal medicine, for examples, tonic drug should be taken before meal, laxative with empty stomach, sedative before sleeping, all the other kinds could be taken after meal. In general, it should be taken 2 - 3 times per day and in lukewarm temperature. This healing process should be repeated many times until the patient has recovered. Then other kind of herbal formula may be prescribed to replenished whatever had been lost during the illness.

  Figure 60 Herbal Remedy [view large image]

Modern Interpretations of Acupoints and Meridians

• Conduction via Myelin Sheath - Research in the 1970s indicates that current is carried in the myelin sheath laid down by specialized cells

  		called Schwann cells (see Figure 61). The cells that biologists had considered merely as insulation turned out to be the real wires to conduct DC current. It is thought that the acupuncture points along the meridians may act as amplifiers to maintain the strength of the current, similar to the booster amplifiers along a transmission line used to keep the signal from getting weaker with distance. Unfortunately, further study ceased abruptly when NIH canceled the research grant (see research in 21st century on glial cells' electric property).
  Figure 61 Myelin Sheath	Figure 62 Electrical Resistance at Acupoint [view large image]	Low Electrical Resistance at Acupoint - Measurements of the electrical resistance over the human body have revealed that there are low resistance (high conductivity) spots corresponding closely to the acupoints (Figure 62). The connecting lines between these

  points are also closely matched with the meridians. It is suggested that qi is just the electrical current running along these pathways (see more information about this subject).



Semi-conductor Model - This model also suggests that the DC current are carried via the glial cells mentioned earlier. This kind of current is produced by the glial system, and is associated with growth and repair. Acupoints are considered to be analogous to booster stations along the meridians, which are lines connecting these points, and these meridian lines are likened to transmission lines for these DC signals. The model for acupuncture healing proposes that

Figure 63 Semi-conductor Model [view large image]

normally miniature current (the qi ?) goes through the tissue unimpeded. The semi-conducting effect (of the diode) kick in when an abnormality occurs. This action has the effect of blocking the current flow, and the acupoint becomes electrically active (charged). Insertion of a special

acupuncture needle into the acupoint sends a biphasic signal over, and restart the current flow to heal (see Figure 63, and more information about this subject).



Collagen and Liquid Crystal - Collagen makes up bone, skin, tendons. The macro-molecules are aligned and twisted around into long fibres (Figure 64a). It can conduct electrical current when water molecules arrange themselves in the form of liquid crystal three or four molecules thick along its length. It is suggested that the chains of collagen proteins may just be the channels of the qi, i.e., the meridians. A needle in contact with an acupoint at the collagen will induce a local electrical stimulation which then enables the positive electricity there to be conducted to some distant sites (see more information about this subject).

Figure 64a Liquid Crystal [view large image]



• Mechano-transduction - Attempts to identify the meridians with tangible substance always associate something electrical in nature. Recently in the 21st Century, the effect of mechanical transmission becomes part of the searches for its identity. Specifically, it is the hydraulic transmission that draws a lot of attentions. The physics is rather simple for transmitting the force from one point to another. In an ideal condition the pressure = force/area is the same at both ends, that is,
  
  P_A = F_A/A = P_B = F_B/B, where A and B are the cross-section of the pistons (Figure 64b).
  
  The above equation can be rewritten as F_B = (BxF_A)/A, which suggests that the "load force" F_B can be amplified to arbitrarily large value by increasing the area B. However, there are 2 limitations :
  
  

  (1) Since the volume of the fluid is the same, AxLA = BxLB = V = constant, where the L's are the displacements at the corresponding ends and V is the volume. Thus, a larger area B would reduce LB, meaning a smaller movement at the loading end. (2) In the real world, the conservation of energy dictates that FALA = FBLB + Heat, indicating that it is not possible to deliver all the work from one end to the other. For free loading end (no load) FBLB = MU2/2, the fluid speed per unit mass U = [2FBLA x(A/B)]1/2 = (2PBV)1/2.

  Figure 64b Hydraulic Action [view large image]

  Anyway, its application to the mechano-transduction hypothesis is mainly on the pressure transmission of the fluid, any gain in "load force" would just be a side benefit (see "Hydraulic Press").

  
  The Interstitial Fluid (IF) is a component within the system of Loose Connective Tissue (CT) hence the abbreviation (CTIF). The CT also has fibers to pad the space between cells, and there are many types of cells for immunity. The whole system is sometimes referred to as Extra-cellular Matrix (ECM, blood and mineral deposits are the ECM for other types of connective tissues, see Figure 64c).
  
  All multicellular organisms require a circulation system within to deliver nutrients and eliminate wastes. Humans have arteries, veins, capillaries, lymphatic vessels and other tubular systems for such purposes; but it is the IF which performs the ultimate

  		function of exchange (between nutrients and wastes, see Figure 64c), the rest just serve as conduits. Thus, any blockage along the "capillary-interstitial fluid-lymphatiic vessels" pathway would create serious survival problem for the surrounding cells. The action of the needle in acupuncture is to generate fluid pressure or pushing/shearing force to clear up the blockage (Figure 64d).
  Figure 64c Connective Tissue Interstitial Fluid (CTIF) [view large image]	Figure 64d Acupuncture

  
  Many experiments have confirmed the influence of mechanical force on tissue morphogenesis during embryological development. In particular, it is found in vitro experiment that the CTIF networks can be connected together by mechano-transduction, of which the action of acupuncture is one example. It is suggested that the embryo relies on such pathway to maintain its multicellular existence before the development of other circulation systems. This pathway is identified with the meridians in grown-up. The acupoints are hypothesized as the most efficient sites in transmitting the mechanical signals.
  
  

  Here's a flow chart to show the possible consequences with acupuncture. The process starts at box 3.3, marked by "acupuncture at acupoint". Solid arrow signifies the process is supported by either in vitro or in vivo experiment. Dotted arrow is speculation. Arrow with question mark indicates uncertainty. The number inside each box refers to the section number for which the process is discussed in Chapter 5 "Plausible Biomedical Consequences of Acupuncture Applied at Sites Characteristic of Acupoints in the Connective-Tissue-Interstitial-Fluid System" by Peter Chin Wan Fung. [view enlarged flow chart here]

  
  

  Other researches come up with similar idea with the ECM re-labeled as fascia (Figure 64e). The superficial one near the skin is identified as the meridian's exterior pathways, while the deep variety corresponds to the internal pathways leading all the way to the fascia in the visceral regions. It is proposed that acupuncture needle manipulation (particularly at the acupoints) produces cellular changes that propagate along the connective tissue planes.

  Figure 64e Fascia [view large image]

  
  

  While the effect of mechanical force on embryonic development has been demonstrated conclusively by many experiments. The most common example of mechano-transduction is the various kinds of massage, which facilitate the circulation of interstitial fluid by mechanical force. Meditation helps to promote recycling of the fluid by relaxing the muscles as well as the mind. Qi-gang directs the fluid to move along a direction (the meridians? need supervision to prevent blockage or bleeding through wrong pathway). Then some forms of martial art use internal fluid pressure against external force (Figure 64f).

  Figure 64f [view large image] Mechano-transduction, Examples




Acupuncture as Anaesthesia - The most successful application of acupuncture is in the area of anaesthesia in surgical operations. Its pain killing effect is often explained by simulating the brain to release opiate, a pain killing, in the body (Figure 65a). Opiate is known to be an inhibitory neurotransmitter to reduce transmission of signal at the synaptic end of the neuron. This kind of interpretation implies that the meridians are somewhat related to the neurons and nerves.

Figure 65 (a) Opiate and (b) Meditation

(see more information about this subject).



• Mind Focusing to Produce Qi - It is asserted that focusing the mind is a process of affecting physiological activity through mental activity (see more detail in "meditation" and "additional information" about this subject). Figure 65b shows that focusing is not easy, the mind keeps wandering off to other worldly things.


• Electroceuticals vs Qigong - In 2013, GlaxoSmithKline (a multinational pharmaceutical at Brentford, UK) initiated a research

  project on using electrical impulses to modulate the body's neural circuits in treating ailments such as diabetes, obesity, hypertension, ... They envision a day when clinician will administer electroceuticals that target individual nerve fibers or specific brain circuits to treat an array of conditions. These treatments will modulate the neural impulses - action potential - to repair lost function and restore health (Figure 66a). Such approach requires the mapping of neural circuits associated with disease and identifying the points of intervention for the electrical delivery. This methodology is strikingly similar to Qigong's use of meridians (~ GSK's neural circuit map)

  Figure 66a Electroceuticals vs Qigong [view large image]

  and acupuncture points (~ GSK's intervention points) except that it will acquire a physical base while the substance associated with Qigong had evaded detection for two thousand years.

Primo Vascular System (PVS) - This is the controversial discovery in the 1962s by Kim Bong-Han (ª÷®p¿«), who was a physiologist in South Korea, but crossed over to the North during the Korean War and finally disappeared without a trace in 1966 leaving behind detailed description of the PVS as the meridians and acupuncture points that nobody could duplicate until its re-discovery in 2011 by researchers in South Korea. Figure 66b shows the tiny thread reputed to be the PVS which shows up only via a special dye. However, such system have not been accepted by mainstream anatomists (see a skeptic's view in "The Primo Vascular System, the N-Ray of Acupuncture").

Figure 66b Primo Vascular System [view large image]

Circadian Cycle, East and West

The modern version of circadian cycle in the West goes by the title of "Biological Clock". It has been found that the sleep-wake states are determined by a cluster of nerve cells in the suprachiasmatic nuclei (SCN), which secrete the melatonin hormone to induce drowsiness at night. Other organs operate under their own clock, which are set by mealtimes, and working hours (Figure 66a). Recent investigations show that symptoms of some diseases (such as Alzheimer's and Parkinson's) seem to tie with the circadian rhythms as described by Meridian Flow (¤l¤È¬yª`) in Huangdi's Internal Canon (¶À«Ò¤º¸g) more than 2000 years ago (Figure 66.

Figure 66c Circadian Cycle, East and West [view large image]

It should be emphasized that the clocks can be reset according to the daily routines. The peripheral body clocks can be adjusted quicker than the brain's master clock.

Then a studies on "Daily Gene-oscillation in Mice" published in 2014 reveals the circadian rhythms of its 12 organs (Figure 66d). Actually, it is found that nearly half of all genes in the mouse genome oscillate on a 24-hour schedule somewhere in the body. It is suggested that drug could be dispensed more efficacious if it is delivered at the peak of the cycle. This is the same idea expounded 2000 years ago in the Huangdi's Internal Canon. However, comparing the mouse clock with the Meridian Flow chart shows that only the liver peaks at about the same time. The difference could be related to the peculiar lab setting in the experiments.

Figure 66d Mouse Clocks [view large image]

It is reported that the mice were entrained to a 12h:12h light:dark schedule for 1 week, then released into constant darkness.

Anyway, followings are the essence of the theory of Meridian Flow :


• During the period of 24 hours, the qi (energy) circulates through every part of the body via the meridians.


• Qi is never absent in a live body. It takes about 15 minutes for the qi to complete a cycle.


• Starting from the liver, the maximum tide moves across each of the 12 organs every two-hours as shown in the chart (Figure 66a).


• The organ is in its biggest strength during the peak hours. Problem with health also shows up most prominently during such period. Conversely, herbal remedy taken around the peak will maximize the efficiency, the same for acupuncture.


• The occurrence of certain symptoms, such as fatigue, pain, and the like at a particular time may be related to the corresponding organ in the Meridian Flow sequence.

Comparison

Table 09 Comparison between Traditional Chinese Medicine and Western Medicine

TCM Modernization

A causal observation in Table 09 would make it obvious that the two schools of medicine are very different in most aspects . TCM seems to be in a state of stagnation not keeping up with advanced knowledge. One advantage is the relatively low cost in TCM practice. The PRC has been trying to integrate both TCM and Western medicine into the medical schools with varying degree of success. For too many years in the past, TCM seems to be lingering on the verge of irrelevancy because there is no regulations to control the practice, and the patients lost confidence in the treatments. Harmonization is impossible because the two systems have different philosophy. Figure 67 is a group photo of Chinese medical students with their Western teachers in front of the "First Chinese Medical School" circa 1920.

Figure 67 East Meets West [view large image]

Then along comes the "White Knight" in the form of a Chinese government's plans to modernize traditional medicine. The purposes are to improve affordable public healthcare and to export traditional remedies to the West. It has allocated hundreds million US dollars for the initiative. The progress has been reported in a 2013 review article : "The quest for modernisation of traditional Chinese medicine".

Although it is not practical to merge (harmonize) the two different systems, they can benefit from each others in some areas as suggested in the 2011 Nature article "Convergence : Where West meets East" and summarized below (see a promising abstraction in Figure 68) :



Chronic Diseases - Western medical treatments are most successful with acute disease. It has problems with curing the chronic and degenerative ones like diabetes and Alzheimer's. TCM may show a way to heal the internal imbalance associated with those kinds. Herbal Remedies - China is eager to export herbal remedies as a cheap alternative to Western medications. They have to clean up their own house to win approval from Western regulatory agencies. Isolating a single active ingredient from the TCM formulas is easier to pass the regulations. There are only two successes so far - the antimalarial drug artemisinin and the leukaemia treatment arsenic trioxide (see Modernized Herbal Drug, and the 2015 Nobel Prize Award for Artemisinin). In particular, the herbs should be produced in a clean environment (not in toxic soil, or polluted water), and government agency should tighten up control to prevent counterfeits; while the Westerners should be introduced to the concept of multiple ingredients in TCM herbal remedies. System Biology - This is a new concept in the West to deal with the whole body instead of each part. It may show a way to understand TCM with the scientific methodology. A major challenge of the integration of TCM with modern midicine is the translation from TCM experience and concepts into biochemical and biological meanings that Western scientists can understand. System biology may pave a way to bridge the gap.

Figure 68 Convergence [view large image]

Acupuncture - Western medical professionals have to accept the anaesthetic effect of acupuncture even though its physical identity has not yet been discovered. This is one area which can demonstrate the latent value of TCM.



• Evidence-based Medicine (EBM) - This is the 21th Century paradigm promoted in Western medical circle. It emphasizes the importance of objective evidence in clinical practice. As shown in Figure 69, the part about looking for symptoms is not new, the thrust is on acquiring the best available information to heal. There are many levels of evidence (see Figure 70). The expert opinion is placed at the lowest trustworthy level, while the best quality is exemplified by RCT (Randomized Controlled Trials), and SR (Systematic Review).

  		According to this criterion, TCM is mostly operated at the lowest level depending on the classical texts for treatment information. Thus, inherently, the TCM practice cannot be upgraded to higher level of evidence.
  Figure 69 Evidence-based Practice (EBP) [view large image]	Figure 70 Evidence-based Medicine (EBM) [view large image]	The Chinese Herbal Control Agency is aware of the trend, and is in the process of evaluating the herbs using the EBM standard.

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