La doble dimensión de la adaptación: producto y proceso

Zeng explained that ‘Sizhen’ comprised the clinical features of examining their client; questioning, inspection, palpation and pulse assessment are conducted and this systematic assessment governs the construction of a diagnosis. Thus a complex framework of interconnected information is assembled from the client-practitioner interaction known as Kanbing, through which the interconnections are made between factors to explain an illness. Kaptchuk (2000) puts it like this:

‘… that instead of a biomedicine perspective of explaining why x is causing y, in Chinese medicine the focus is explaining the relationship between x and y’ (p. 4).

The notion of explaining X number of signs that are observable are turned into symptoms as a causation factor in an illness, which then becomes a progressive process of Sizhen, from which the organisation of symptoms are assembled into what is known as ‘syndrome’. Thus TCM looks at the root cause of the illness (Scheid, 2001). Farquar (1994) reinforces this notion by suggesting that biomedicine treated the surface manifestations of illness while, “Chinese medicine excels at ‘treating the root of a problem’ even though it may take some time, zhongyi zhi ben, xiyi shi biao” (p. 137). It is the complete integration of these methods that forms the basis of the TCM diagnostic process which will be analysed in the case study analysis (6.5). Zeng explained that Chinese theory is an essential to guide the diagnosis and the intervention that follows specific to the nature of the problem.

After [we examine the patient] to make diagnosis we still follow Chinese medicine theory, choose related formulas (herbs) or acupuncture points.

When questioned how a decision was made to use either the herbs or acupuncture Zeng informed me that the depended on the kind of disease that was present whether it was simple or complex and replied:

For patients when we need acupuncture or herbs or both, usually this first depends on whether – we use acupuncture all the time usually for some simple diseases. Sometimes doctors use herbs –

most times only use herbs – some complex diseases use only acupuncture or herbs.

I asked Zeng to explain how the treatment was strengthened by using acupuncture and herbs together. He replied:

Not stronger, but more effective. This also depends on what the Chinese doctor what they use most of the time. The second time depends on the patient’s condition.

Zeng gave me this example of what he referred to as the principle consideration in treatment and drawing on the example of ‘wind heat’ he explained this is how he would choose a prescription:

Using the formula called Qiao San to drive out the heat and to remove wind. This formula has been used for several hundred years. Yin flower Qiao another herb – these are the main ingredient and choose the formula but different patients get different constitutions so the basic formula we choose also needs modification – either take out some herbs. For acupuncture points we choose the same.

Herbs or acupuncture treatments were based on the premise that a balance must be achieved between the notion of promoting and acting upon to strengthen the Qi or to diminish hyperactivity. With the combines use of acupuncture points the treatment can be strengthened according to the individual constitution of the patient. I now explain therapeutic care and make reference to examples that the practitioner discussed to illustrate the basis on which a decision to initiate care is made.

To explain how therapeutic care is prescribed based on the assessment, Zeng provided an example of a client who in this example experienced a ‘headache’. Even a headache has a complex consideration that necessitates that the correct identification is made to determine what kind of headache the person has. The practitioner explained the classification of the headache was determined by the time the headache commenced, which is linked to the five element and yin/yang theory to identify differences according to the interactive elements of different body organs. Zeng expressed it this way:

A headache commencing at 7pm at night would be treated differently from that of a headache commencing at say 2am in the morning. According to reason we use different formula herbs to treat the root not just the symptom, so the reason for the disease is

also different, that’s why we need to use different formula for some disease for different patient.

Zeng further explained that, the hours between 5pm-7pm correspond with the organ the kidney and of the element water whereas the time between 1am-3am corresponds to the liver and the element wood.

The information that he identified implies the headache requires different formulas related to several factors. If say the headache is caused by an exogenous or external factor, then pathogenic wind disturb the meridian flow of Qi. Another reason may be if there is an internal disturbance of Qi (endogenous) and is due to abnormal flow of liver yang and a deficiency of Qi and blood. Herbs that are used to treat a headache will differ according to the diagnosis of whether the headache is caused by wind pathogens in the meridians which conduct the Qi, whether it is a headache due to the surge of liver yang rising or if the headache is caused by deficient Qi and blood flow. This is elaborated on by Rosli the Chinese herbalist;

The treatment of a liver problem where there may be too much heat is treated by herbs that can cleanse, whereas the headache that occurs in the early morning is probably related to a lack of energy and therefore a low Qi. Herbs are given that will to promote energy or the flow of Qi.

Therefore it can be stressed that the individualised nature of the treatment is implemented on the premise of the exact nature of the problem of the imbalance of Qi, found to be either deficient or in excess in the energy system of the body. Alleviation of the headache comes through the identification of the underlying cause caused by an imbalance, in Qi and or blood flow. Treatment then is based on what is identified a correction of the imbalance of yin and yang energy within the Zang Fu organ system that has contributed to the headache.

Rosli based on her expertise of herbal medicine informed me the treatment selection for a headache was like this;

Some herbs can settle down yang – subdue the yin, so in that case we have some herbs for yang and some for yin. There was a difference in taking into consideration that the constitution of the body type of the individual. For certain disease in different patients the reason for the disease is the same but the constitution is different. That’s why we need to use different formula for some diseases for different patients.

Then an allusion was made to how the constitution of the individual which Chinese medicine takes into consideration when initiating treatment and Rosli referred to Western medicine to support her statement which in one respect is true, but also is a bias in how she considered the stance assumed of Western medicine.

Somebody who is thin has got a different body type to somebody who is fat. So you have to take that into consideration whereas in Western medicine, if you’re fat or thin it doesn’t make any difference, [the Western doctor] doesn’t [usually] look at body type. In Western medicine if you have a problem – he just gives you a prescription for Panadol but doesn’t look at the body type. So somebody who is thin has got a different body type to somebody who is fat.

Interestingly the point reinforced by this practitioner that the Chinese factored into the assessment of the individual the difference in body type to treat the condition and to provide a different herbal formula individually tailored for each person. The treatment that might be effective for one person will not be for another based on their constitution. To illustrate how this application is based, Zeng gave a different example of how the treatment works with reference to the example of hypertension:

How do we use the theory of yin and yang in directing the patient’s assessment? Five elements same – we still say – some examples are easier to understand and one form of hypertension is the hyperactivity of yang and deficiency of yin. The liver belongs to wood. Kidney belongs to water. So there is ‘Yuan Qi’ deficiency of kidney yin and hyperactivity of kidney yang.

Zeng elaborated on how the five element theory formed the basis for the TCM assessment to show it is important how each organ inter-promotes the function of other organs in reference to the five element theory.

The water couldn’t nourish the wood so cause yin/yang couldn’t balance. To nourish the yin settle down the yang control the wood. They say some herbs nourish the yin – the water gets enough. Some herbs subdue the yang and liver yang to control the wood. This is the five elements how to use them in TCM theory.

When asked why there was such a focus on the importance of how each organ inter- promoted the function of the other, he explained that this was based on the holistic focus of TCM that the body was treated as a whole. What did he mean by whole and how could this be understood? Zeng stated:

The mind and body are treated as a separate entity [in Western medicine] but they need to work together. The Chinese medicine have some holistic – let me give you some example, the ear gets disorder or some problem. The Chinese medicine thinks the problem must be caused from kidney – because in Chinese medicine they say kidney has orifice opening into ear, liver – nails, spleen –mouth, heart, and the tongue.

The illustration that he gave when he referred to these organs of the body did not provide a very clear picture of what is meant by his notion of ‘whole’ and the idea that TCM viewed the organs of the body as a composite whole needed further exploration. So Zeng turned to the explanation in the following way. He discusses what he considers the relationship between an emotional disturbance and the interactions of the organs with each other.

The organs - Also they restrict each other as well like the water and earth belong to kidney and spleen. They are easy to understand when we get angry. Emotional upset that means damage the wood, damage the liver in that case we feel distension in the stomach area, we have burping and no appetite, poor appetite usually belongs to the spleen and stomach function and is not straight away from the liver. It is known as ‘Wu Ko Pei Tu’.

In this example he provides a clearer perspective of how TCM approaches a somatic connection between the illness, the organ and the emotional factor that has caused the problem. He explained that the assessment of the client is made on how the inter- relationship of the Zang organs and Qi are understood like this:

The examination for the client assessment begins with a diagnosis based on the Law of the Five Elements and identifying the flow of Qi. According to the reason we use different formula in herbs to treat the root not just the symptoms. It’s also a very complex form of medicine – a total way of looking at why you have a particular problem so that is only why I brought [sic] the term ‘holistic’.

To clarify what is meant by holistic Zeng drew from the example of insomnia which from a Western perspective might be thought to be associated with worry that cause a person to be unsettled and hence to experience disturbed patterns of sleep.

There are these examples why person might not sleep at night: anxiety and overwork [damages heart and spleen], congenital

deficiency of yin [kidney] emotional depression causing stagnant Qi [liver]. Irregular consumption of food and alcohol [spleen and stomach] you look at the interaction of all the organs in the body, the whole picture [sic] not just one organ.

With reference made to these associated factors, a more complex picture evolved of what might cause this problem. Zeng made the connections of the body organs to a specific problem, insomnia, but argued that other environmental factors can contribute to this condition like overwork, strain that affects the flow of the kidney yin Qi. He considered other factors as well that might cause harm within the body such as the consumption of food and alcohol. Zeng argued that as a practitioner he perceived that TCM was based on a complex approach that viewed the assessment of a client holistically.