| |
|
|
Chinese
Medicine And Psychiatry: A Textbook And Clinical Manual
By Bob Flaws
and James Lake, MD
©2001 Blue Poppy Press
Reviewed by Michael Greenwood, MB (MD)
For physicians interested in the combination of psychiatry and Oriental
Medicine (OM), Bob Flaws and James Lake, MD have joined forces to produce
a remarkable blend of Oriental and Western thought. Chinese Medicine
and Psychiatry is detailed and encompasses enough different diagnostic
categories to satisfy the most ardent practitioner of either discipline.
The book is divided into 3 parts: Book 1 covers the history and theory
of Chinese Medicine from the Shang dynasty (1523-1027 BCE) to the present;
Book 2 discusses Western and Traditional Chinese Medicine (TCM) perspectives
for 21 OM disorders; Book 3 presents a similar discussion of 12 Western
psychiatric disorders.
The authors believe that both Oriental and Western systems tend to somewhat
miss the mark, but for different reasons. Because of the stigma attached
to mental illness, the Chinese tend to somatize their illnesses into
a condition called "neurasthenia," whereas Western medicine
generally interprets mental pathologies as biochemical processes that
are then treated with drugs. Neurasthenia literally means "weak
nerves," but refers to a combination of fatigue, anxiety, and depression
along with various somatic complaints such as headache, sexual dysfunction,
back pain, and insomnia. Western physicians will be familiar with such
presentations, but the diagnosis of neurasthenia has been curtailed
in the West; in China, it remains a common diagnosis.
TCM has none of the mind-body split that characterizes Western thought.
The English word psyche roughly corresponds to the Chinese phrase Jing
Shen, or "Essence-Spirit." Mental-emotional patterns arise
for much the same reasons as any other OM disorders: particularly, the
6 environmental excesses (such as faulty diet), and the 7 affects (or
imbalanced emotions). The energetic imbalances seem fairly consistent
throughout the text and often reflect Yin deficiency Fire, which arises
from a combination of Liver Qi stagnation, Spleen vacuity, Blood/Yin
vacuity, stirring of Ministerial Fire, and Damp Heat or Phlegm. One
common scenario in Western patients involves Liver Qi Stagnation; when
combined with Spleen vacuity, this tends to produce rising Heat that,
in turn, blocks or "mists" the Heart. Because Oriental thought
considers the Heart to be the abode of Essence-Spirit, such misting
leads to mental-emotional instability. In Western terms, this rising
fire might present as anxiety syndromes, insomnia, manic behavior, or
even menopausal flushing.
As for acupuncture, since the Yin tends to raise the Tai Yang to the
head and neck area, treatment strategies focus on ways to bring it down.
In this regard, Flaws shares his personal approach. He uses a 7-star
hammer on the upper back to draw the heat, and uses peripheral points
to draw down heat such as LV 3, KI 3, BL 62, SI 3, and MH 6. He favors
the use of points around the head and neck on the Governing Vessel (GV)
and Bladder (BL) meridians, particularly Ah Shi points, and draws similarities
between these points and the 13 mythical ghost points that historically
have been indicated for Essence-Spirit disorders.
The bulk of the book presents various Oriental and conventional Western
syndromes, and then cross-references the Western and Eastern perspectives.
With each syndrome, the text covers Western nosology, epidemiology,
differential diagnosis, etiology and pathophysiology, conventional treatment,
advantages and disadvantages of such treatment (which generally amount
to short-term control versus long-term adverse effects), prognosis,
and indications for conventional medical intervention. This is followed
by a discussion of TCM patterns, herbal prescriptions, acupuncture protocols,
rele-
vant studies in the literature, and case studies. With particular regard
to herbs, the information is extensive and readers will likely use these
sections as a reference manual for designing herbal remedies, rather
than looking specifically for acupuncture pearls.
In the Oriental medicine section of the book, the diagnostic patterns
begin with the basic Five-Element imbalances: irritability, joy/sadness,
anxiety/thinking, sorrow, and fear. It then moves on to more exotic-sounding
syndromes such as Running Piglet, Plum Pit Qi, and Lily disease. In
the Western diagnoses area of the book, there are the familiar categories
ranging from depression to attention-deficit/hyperactivity disorder
toschizophrenia, and an interesting chapter on psychological disturbances
due to erroneous Qi Gong practice.
Throughout, the authors' emphasis is on herbal medicine, with less discussion
of acupuncture protocols. The authors are unapologetic about this. They
point out that herbal medicine is the mainstay of TCM, and that acupuncture
is considered of secondary importance in China. There is a wealth of
information on herbs, presented in a readily accessible format for practitioners.
A key point the authors make is the need to consider using larger doses
of herbs. Apparently, Western doses used in prepared herbal pills are
often less than optimal, a practice initiated to avoid potential lawsuits.
That being the case, we may well be significantly underestimating the
true value of herbal therapy in psychiatric conditions.
The overriding and exciting theme of this text is "integration,"
the idea that 2 such diverse systems of medicine might be synergistic.
Similar to Yin and Yang, Western and Eastern medical paradigms reflect
complementary world-views that have the capacity to assist and support
each other if viewed without the habitual antagonism. For example, the
unique perspective of TCM gives practitioners a chance to reframe a
patient's experience and provide a sense of hope and personal empowerment.
TCM is often less expensive and can treat the adverse effects of Western
drugs. Conversely, Western medicine can provide betterprognosis, recognition
of complications and danger signs, more powerful treatments, and emergency
care. While it obviously will take time before such an integration of
Eastern and Western approaches is widely practiced, this text offers
an immensely positive step toward that realization.
REVIEWER
INFORMATION
Dr Michael Greenwood is the Medical Director of the Victoria Pain Clinic
in Victoria, British Columbia, Canada. His specialty is working with
chronic pain and illness patients, and in developing techniques integrating
the body, mind, and spirit.
Michael Greenwood, MB (MD), BChir, CCFP, CAFCI
Medical Director, Victoria Pain Clinic
365 Hector Road, RR#3
Victoria, British Columbia V8X 3X1 Canada
Phone/Fax: 250-595-1486 o E-mail: michaeltgreenwood@home.com
|
|
|
|