HCS338: Integrative Health
Instructor: Jennifer Brown
25 April 2016
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Increasing numbers of people are beginning to look at alternative modalities to complement their existing health care. There are numerous modalities available, but in this paper we will discuss Traditional Chinese Medicine (TCM) and Therapeutic massage and bodywork therapies. These Alternative modalities are useful complements to Western Medicine (WM); working together to heal the whole patient. Remember an ounce of prevention is worth a pound of cure.
Describe Traditional Chinese medicine
TCM has been around for thousands of years and like other ancient cultural medicines it was originally passed down from practitioner to apprentice. “TCM is a professional medical system that combines the use of medicinal herbs, acupuncture, dietary therapy, massage and therapeutic mind/body practices” (Rochelle, & Yim, 2014, P. 454, pp. 1). These modalities are used for the purpose of improving health by improving the flow of energy (Qi) through the body.
One concept of TCM is qi (pronounced chee); the life force energy that flows through the human body, as well as all other forms of life. “As early as the second century BC, the Chinese developed the concept of qi, the life energy that circulates and flows through 12 organs and 12 meridians (Endres, Diener, & Molsberger, 2007, P. 1121, pp. 3). “When the body is balanced and flow of qi is unobstructed, the body is perceived in TCM terms to be in good health, while conversely, if the flow of qi is obstructed or there is evidence of imbalance within the body, this can lead to ill health (Rochelle, & Yim, 2014, P. 454, pp. 1). A great example is a stereo speaker: if the energy flow to the speaker is too low the sound quality will be weak and eventually wear out the speaker, or if the energy flow is to high the speaker will blow out. The same principle applies to living tissue, when the energy is flowing properly all parts of the whole work at the optimal level.
5 Element Theory
The five element theory is used to diagnose and treat dis-ease of the body; each element corresponds to a yin organ and a yang organ, a season, direction, taste, body tissues, color, and sense organ. Each element increases another element and the correlating body parts: Wood feeds Fire, Fire creates Earth, Earth bears Metal, Metal enriches Water, Water nourishes Wood. Each element also diminishes another element: Wood parts Earth, Earth dams (or muddles or absorbs) Water, Water extinguishes Fire, Fire melts Metal, Metal chops Wood. Example: Metal organ lung is weak, use Earth to strengthen the Metal; this can be done through Earth element herbs and/or food, Earth acupuncture/acupressure points, Moxibustion on Earth acupuncture points.
Medicinal herbs are traditionally boiled and drank as a tea. More recently these herbs have been packaged as supplements to make them more appealing to younger generations (Rochelle, & Yim, 2014, P. 461, pp. 2). Many of the traditional Chinese herbs are very unpleasant tasting and smelling.
Acupuncture is the process of pushing needles (about as thick as a hair) into particular points along the energy meridians of the body. This releases stagnant energy, allowing for proper energy flow and function. There are 359 classic acupuncture points along the meridian lines where the flow qi can be restored from (Endres, Diener, & Molsberger, 2007, P. 1121, pp. 3). Moxibustion is burning moxa, a dried mixture of mugwart on acupuncture points, and is sometimes used along with acupuncture.
Dietary therapy, is eating according to the five element theory; the elements balance one another as described above.
Cupping is a modality where traditionally glass cups were used and fire produced suction, now there are plastic cups with a suction gun attaching to the top of the cup. Cupping can be used to either loosen the fascial layer or placed with magnets along the meridian lines for acupressure. The latter use works similar to acupuncture without the invasion of the needle.
TCM was founded in a culture that as Westerners we are just beginning to study and understand; TCM practices started to spread in the West around the 1960s, with acupuncture being the first modality to catch on around the 1970s. In the West we have just scratched the surface of ancient Chinese knowledge. “It is estimated that there are more than 100,000 TCM books that were published before 1900 which may hold great medical value waiting to be discovered” (Yifan, 2016, pp. 6). Maybe one day we will be as knowledgeable about the human mystery as some of our ancestors were, it is all about perception.
Describe Various Therapeutic Massage and Bodywork Therapies
Therapeutic massage is a part of TCM, but it is also a stand-alone study that incorporates many additional schools of thought; but was also originally passed down from practitioner to apprentice. “Early reports of its use as a therapeutic medium are recorded in writings from more than 2,000 years ago and in the Chinese, Japanese, Egyptian, Roman, Greek, and Hindu cultures” (Barnett, Shale, Elkins, & Fisher, 2014, P. 210, pp. 2). “Hippocrates defined medicine as “the art of rubbing”” (Agarwal, 2011, P. 48, pp. 2). Every culture has had a version of touch therapy, touch and energy exchange are very important to the survival of the human being.
Today massage is taught in a more scientific way, because we now understand more about anatomy and physiology. “The AMTA (American Massage Therapy Association) (2010c) defined massage therapy as “a profession in which the practitioner applies manual techniques, and may apply adjunctive therapies, with the intention of positively affecting the health and well-being of the patient”” (Barnett, Shale, Elkins, & Fisher, 2014, P. 210, pp. 1). Over time the definition and training of massage have changed but massage is still a very beneficial healing modality.
There are more modalities of therapeutic massage and bodywork than we have room in this paper to cover, so we will just cover a few. The main purpose of massage is to relieve pain, reduce stress, anxiety, and depression as well as rehabilitating physical injuries (Agarwal, 2011, P. 48, pp. 3).
Swedish massage is the basic relaxation massage where scented or unscented lotion/oil (lubricant) is relaxingly massaged into the skin. This massage promotes circulation, good hormone release, relaxes tension, using soft strokes focused towards the heart. Reduces stress, anxiety, and depression.
Myofascial Release (MFR) is a modality that uses slow deep stretching to unwind the fascial layer allowing muscles to relax. This modality is focused more on relieving pain while realigning the structure of the body; rehabilitates physical injury in a semi-relaxing manner.
Neuromuscular modalities use static pressure to release tension and trigger points. This modality is a little more uncomfortable, it is very important to stay within the clients’ pain tolerance or the muscle will tighten and not let the therapist back in to release it. This modality releases tension and rehabilitates physical injuries.
Essential oils are usually diffused into the air, adding to the relaxing atmosphere; and used topically to reduce inflammation and tenderness. No matter what modality is being used it is important that the client is relaxed; when the client is tense the muscles do not respond as well, especially to the deeper work. Some deep work can cause slight tenderness and applying oils such as Deep Blue can ease the discomfort.
Now that we have described our modalities let us look at our case study on TCM & Therapeutic Massage and Bodywork Therapies for Migraines:
Mike is male, 28 years old, has chronic migraines that interrupt his ability to focus in college. The migraines started two years ago when he was under extreme stress studying for the Medical College Admissions Test (M.C.A.T.), which is an exam required for admission into conventional medical school. The migraines start with an aura (slightly flashing images; scintillating) that then progresses to a pounding headache on the side of his head. The migraines last at least two days and cause Mike to have nausea and an inability to carry out daily tasks.
Let us start this study with the scientific explanation of the cause of migraines:
Migraine attacks begin with a central activation (or noninhibition) of the fibers of the trigeminal ganglion (trigeminovascular system). The mechanisms by which this activation occurs are not yet known. The brainstem regions (particularly periaqueductal gray and locus coeruleus) probably play a key role, since PET images have shown increased blood flow in these regions during migraine attacks. (Endres, Diener, & Molsberger, 2007, P. 1122, pp. 4)
The periaqueductal gray (brainstem): the gray matter surrounding the cerebral aqueduct, which, among its many functions, is responsible for inhibiting pain transmission (central control over the spinal pain pathway). (Endres, Diener, & Molsberger, 2007, P. 1123, pp. 4)
Among these peptides are calcitonin gene-related peptide, a potent dilatator at arterioles, and substance P, which also dilates the venous side and induces plasma protein extravasation. Finally, these and other peptides originating from nerve cells within the trigeminal ganglion produce an aseptic ‘neurogenic inflammation’ with mast cell degranulation and the release of inflammation mediators such as histamine, serotonin or prostaglandins, a process that has so far been demonstrated only in animal experiments. (Endres, Diener, & Molsberger, 2007, P. 1122, pp. 5).
TCM & Migraine
It has not at this point been scientifically proven how acupuncture relieves this process, but it has been recorded to do so just as well if not better than pharmaceuticals. One theory suggests: “Serotonergic projections from the raphe nucleus to higher centers of the CNS and descending projections to the spinal cord, in this case in conjunction with noradrenaline, could play a role in acupuncture analgesia” (Endres, Diener, & Molsberger, 2007, P. 1123, pp. 5). Acupuncture causes nerve fibers in the muscles to transmit impulses to the spinal cord to activate the spinal cord, midbrain, and pituitary/hypothalamus causing analgesia (loss of pain).
There have been clinical studies, so far the medical community has not been satisfied because the studies have been short term and few in number; but the current study results have been positive. “For all parameters, acupuncture has been found to be at least as effective as a well-proven 6-month pharmacological migraine prevention treatment, and point selection, needling depth and needle stimulation all do not appear to be important for the success of acupuncture” (Endres, Diener, & Molsberger, 2007, P. 1132, pp. 6). This shows that acupuncture is at least equal to the pharmaceutical therapy counterpart. “Migraine patients show a clinically relevant reduction in migraine symptoms (number of migraine days or headache score) compared with baseline, even 6 months after the start of a 6-week acupuncture treatment, or 1 year after the start of a 3-month combination of acupuncture and standard care” (Endres, Diener, & Molsberger, 2007, P. 1131, pp. 8). This result proves that combining the schools of thought can produce a more positive outcome in less time.
Therapeutic Massage and Bodywork & Migraines
The bodywork treatments I have personally found most helpful for migraines is a combination of MFR with Neuromuscular, gentle cupping, and Essential oils, preferably followed by a manual chiropractic adjustment. The MFR uses slow deep stretching to unwind the fascia around the head, face, and base of skull, while the neuromuscular uses a direct static pressure to release the trigger points that have been softened by the MFR. Focusing on the superior nuchal line along the base of the skull, as well as the sternocleidomastoid muscle (SCM) from the mastoid process of the temporal bone to the sternal manubrium, medial clavicle, and through the trapezius to the rhomboid major & minor from the vertebral column to the scapula. This combination helps encourage proper blood and nerve flow and reduces muscle tension; when the muscles are hyper-tense proper blood and nerve flow are interrupted. Then use the smallest cup and very light suction around the sinus areas of the face with a very light layer of coconut oil. This helps the fascia and muscles around the sinus, temple, and jaw areas to unwind, releasing more pressure. Then end using an anti-inflammatory topical Essential oil such as Deep Blue around the superior nuchal line along the base of the skull, temples, and at the SCM attachment helps with later discomfort. If at all possible I recommend the client then see a manual chiropractor for an adjustment; this ensures the vertebra are in correct alignment releasing strain on muscles, while also improving blood and nerve flow. Another type of pain, headache, also responds well to massage, reducing migraines and promoting better sleep” (Agarwal, 2011, P. 49, pp. 3). I have personally seen this work on approximately 90% of the migraine sufferers I have seen; but there are a few that massage and chiropractic do not seem to do much for, I refer them to acupuncture and/or a general physician.
TCM & Bodywork integrated into a health care setting
The ideal method to integrating these particular holistic modalities with WM is to have a TCMP, Massage Therapist, and Chiropractor setup an office together (or as a Co-op) near or inside a health care facility such as a hospital or medical office building. This would make integration more convenient for patients as well as allow for the health care professionals to network and become familiar with one another and each other’s scope of practice.
The two most important things about integrating any type of service with another are convenience and personal relationships. Patients want it to be convenient to see multiple practitioners; this takes up less of their day. Practitioners want to know that the practitioner they are referring is not only the right person for the job, but they want to know the patient will be treated by a professional and caring person; a bad referral can cause bad feelings between the referring practitioner and the patient.
Integrated medicine and the medical delivery system
Acupuncture and bodywork both have a low risk of side effects and few contraindications. Acupuncture and bodywork also provide physicians with instruments to help, in particular, those patients who have contraindications against pharmacological therapies, are non-responsive to those therapies, or prefer not to use chemical therapies. It is also advantageous to try alternative methods before considering certain surgical or other invasive procedures. These alternatives also give patients an alternative place to turn for treatment.
Alternative modalities and WM can complement each other well. For example, in Hong Kong: “It is common for individuals to approach a pluralistic notion of health services, utilising both TCM and WM, sometimes simultaneously for the same illness or ailment (Rochelle, & Yim, 2014, P. 453, pp. 1). “Medical pluralism can help patients overcome barriers encountered by using one medical system and is also convenient if patients feel dissatisfied with explanations or treatments for illness by one medical system” (Rochelle, & Yim, 2014, P. 453, pp. 1). Where one modality leaves off another modality picks up; all medicine is meant to be used together to treat the whole patient in the best possible manner with respect for their being.
Mental attitude greatly affects the outcome of holistic sessions; those who are less tolerant and less open-minded experience less satisfaction with holistic sessions. I believe they create an energy block, resisting the work being done. I witnessed this when I tried to take my boyfriend in for acupuncture; he only did it to appease me, had a negative outlook, not to mention the TCMP was not ideal, and the results were poor. “Good doctor – patient communication has been shown to have a positive impact on a number of health outcomes, including improved emotional and physical health, medical adherence and improved patient compliance” (Cegala, Marinelli, & Post, 2000). The practitioner makes all the difference, holistic medicine is something you must love and love to do; your clients will feel it.
Agarwal, S. K. (2011). The credentialed art of massage therapy. Annals Of Psychotherapy And Integrative Health, (1), 48.
Barnett, J. E., Shale, A. J., Elkins, G., & Fisher, W. (2014). Massage therapy. In , Complementary and alternative medicine for psychologists: An essential resource (pp. 209-226). Washington, DC, US: American Psychological Association. doi:10.1037/14435-015
Chaibi, A., Tuchin, P. J., & Russell, M. B. (2011). Manual therapies for migraine: a systematic review. Journal Of Headache & Pain, 12(2), 127-133. doi:10.1007/s10194-011-0296-6
Endres, H. G., Diener, H., & Molsberger, A. (2007). Role of acupuncture in the treatment of migraine. Expert Review Of Neurotherapeutics, (9), 1121
Rochelle, T. L., & Yim, K. (2014). Factors associated with utilisation of traditional Chinese medicine among Hong Kong Chinese. Psychology, Health & Medicine, 19(4), 453-462 10p. doi:10.1080/13548506.2013.819439
Yifan, Y. (2016). A story of TCM Research. Journal Of The Australian Traditional-Medicine Society, 22(1), 55-55 2/3p.
* Just an interesting fact I have heard, but I have been unable to substantiate: in China it is said that individuals pay their TCMP monthly like we do our insurance companies, and do not pay for the months that they are ill because the TCMP is not doing their job. I think this is actually a very good idea!
** After speaking with a client of Asian descent, I do prefer the term TCMP. She informed me that the use of “Oriental” is very upsetting.
*** Interesting link, this popped up on my Facebook last night. I have yet to find an article from a scholastic source, but according to this science has proven that energy meridians exist! I do not want to use in body of paper because I cannot substantiate it, but thought you may find it as interesting as I did. http://upliftconnect.com/science-proves-meridians-exist/