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    95 views705 pages

    Google Books Download - The Accupuncturist's Guide To Conventional Medicine

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    carte buna

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    © All Rights Reserved
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    Foreword by Angela Hicks + John Hicks SINGING DRAGON | This second edition frst published in 2017 by Singing Drago an imprint of Jessica Kingsley Publishers 7 Collier Steet London NI 9BE, UK ond 400 Market Steet, Site 400 Philadephia, PA 19106, USA sow cemgtaqncom Fist editon published in 2011 by Chul Livingstone, Ekevir, Lona, UK and in 2015 iby Singing Dragon, an imprint of esa Kingsley Publishers London, UK Copyright © Clae Stephenson 2015, 2017 Foreword copyright © Angela Hicks and John Hicks 2017 All ighss eserved, No pat ofthis publication may be reproduce in any mada frm (cluding photocopying, storing in any medium by electronic means or transmitting) \withou the writen permission ofthe copyright osiner excep in accordance with the provisions ofthe law or under terms ofa licence issued inthe UK by the Copyright Licensing Agency Ltd. wwswelacouk or in overseas tetitoies bythe relevant reproduction rights organisation, for details see wowttraorg. Appliations for the copyright owner \wetten permission to reproduce any pat ofthis publication shouldbe ates 0 the publishes ‘Warning The doing of an unauthorised act in elation 1o 3 copyright work may tes in both a civil lim for damages and criminal prosecution, Library of Congress Cataloging in Publication Data “ite The acupunceiis’s guide to coaventional medicine / late Stephenson. ther tiles: Complementary therapis'spuie to conventional medicine Description: Second edition. | London; Philadelphia: Jessica Kingsley Publishers, 2017. | Preceded by Complementary therapist's guide to conventional medicine / Clare Stephenson, 2011. | Includes bibliographical referenes and inde dentiiers: LCCN 2016056980 | ISBN 9781848193024 (alk. paper) Subjects: | MESH: Medicine | Acupuncture Therapy | Medicine, Chinese Tradtional~methods CClasifiation: LEC R129 | NLM WB 100 | DDC 610.1/4~de23 LC record available at bsp: lee oe go/ 2016056980 British Library Cataloguing in Publication Daca [ACCP catalogue recor for this boos i avilable fom the British Library ISBN 978 | 84819 3024 eISBN 978 0 85701 2555, The accompanying online material can be downloaded at wurskp.com/oucher using the code STEPHENSONACU for personal use with this program, bur may noe be reproduced for any other purposes without the permission ofthe publish. Foreword by Angela Hicks a John Hicks Adknledgmonte, Inerduction [Nott the Redo Urdertending Western Moss Termivolegy in Chie Madine Terms Stage 1: Introduction to Medical Sciences 1.4 Introduction to Medical Sciences... - 1.1 Induction o physiology: tems ofthe body 1.1b The cl: composition, respitation and division 1. Cell anspor and homeostasis Ad The dssve types... * 1. Le Ieroduction to pathology and phasmacology 1.2 Conventional Clinical Practice 1.28 The conventional medicine approach 1.26 Conventional medics peseibing 1.2¢ Insodustion to conventional drugs 1.3 Comparisons with Aleersative Medical Viewpoints... . 1.34 Contrasting philosophies of heath 1b Deugs from a complementary medical viewpoint Nor. Stage 2: Introduction to Processes of Disease 2.1 Barriers to Disease and Susceptibility. 2.18 Health and suscep: wit makes us volnerable to disease? 2b Bares to disease: wound healing 2.Le Bates to disease: Hood clotting 2.1d Barriers to disease: the immune system " 6 1» 19 24 Fa 31 ar 50 50 53 37 58 2.2 Processes of Disease os ss 2.28 Inroduton to process of disease 2.26 Inlarmation 2.2 Disorders ofthe imma system 2.24 Thrombosis, embolism and infarction DUICHEERE sa cs ve necimetow noe He 24 Infectious Disease oe 2da Principles of infectious disease 2d The diferent types of infections dives 24 The red lags of serious infictous disease 24d Diagnosis, prevention and treatment of fnfectis disease Nowe. Stage 3: The Gastrointestinal, Cardiovascular and Respiratory System 3.1 The Gastrointestinal System <6 ee 3.ta The physiology ofthe gastrointestinal system 5.18 The iasetigtion ofthe gatontinal system. 5.1 Diseases of the mouth, esophagus, stomach and duodenum 5.1d Diseases ofthe pancreas, liver and gallbladder 3.1e Diseases of che smal intestine and large 3.2 The Cardiovascular System. vv 6. es 3.2 The physiology ofthe cardiovascular system 3.26 The investigation ofthe cardiovascular eystem 4.2c Diseases of the blood vessels 3.2d Hypertension 3.26 Coronary heart disease 3.26 Heart failre and archythaias 5.2 Diseases ofthe hears masle, peeiardim snd ear valves, and congenital hear disease 66 0 m4 8 86 96 96 100 no na nes 126 126 139 1a 155 64 176 176 187 192 202 210 219 229 43.3 The Respiratory System... 3.32 The physiology ofthe respistry system 5.30 The investigation ofthe respiratory sytem 5.3e Diseases ofthe upper respiratory tract. 5.3d Diseaes ofthe bronchi and bronchioles, 3.3e Diseaes ofthe alveoli an pleura 3.4 The Blood . . 3.4 The physiology ofthe Blood 5.40 The investigation ofthe blood te Anemia 3.4d Acute Blood las. transfusion and disorders of| the spleen 4.4e Cancer of te blond cols Stage 4: The Nervous, Musculoskeletal and Urinary Systems 4.1. The Nervous System 6 oe eo 4.12 The physiology ofthe nervous system 4:18 The tvetgation of the nervous system 4.1e Disorders of the central nervous sytem: ‘impaiment of consciousness 4.14 Disorders ofthe central nervous system: Ihemochg, stroke and brain tumors 4.1e Disorders ofthe central nervous sytem headache and itestions 4.1F Disorders ofthe central nervous system: dementia, epilepsy and other disorders 4.3g Disorders ofthe spinal cord and peripheral 4.2 The Musculoskeletal System 4.24 The physiology of the musculoskeletal sytem 4.2b The investigation ofthe musculoskeletal syste 4.20 The teat 4.2d Diseases of the bones ment of masculoskleal pain 4.2¢ Localized diseases ofthe joins, ligaments sand muscles 4.2F Generalized diseases ofthe joints, ligaments and muscles 4.3 The Urinary System 6 43a The physiology of the urinary system 4.3b The instigation ofthe urinary system 4.3e Diseases ofthe kidneys 4.3d Diseases of the ureters, bladder and the urate Notes 236 236 243 2s 253 262 23 273 26 278 286 2 207 300 300 318 i 326 sat 353 365 365 370 an 376 382 393 403 403 408 410 425 a1 Stage 5: The Endocrine and Reproductive Systems and Child Health 5.1 The Endocrine System . . 5: The physiology ofthe endocrine system. 5.1b The investigation ofthe endocrine system, 5:Le Diseases ofthe thysod gland 5d Diabetes mellitus Ie Diseates of the adrenal gland and the gland i 5.2 The Reproductive System. . 5.28 The physiology ofthe reproductive sytem 5.2 The investigation ofthe reproductive sysem 5.2c Disoiders of menstruation and the menopause 5.24 Sexual health and sexually transmitted disease 5.2e Comieaception 5.26 tnferty 2g Seructral disorders of| ‘system female eproduetive 5.3 Pregnancy and Childbieth . 5.38 The physiology of pregnancy and childbirth 5.3 Routine care and investigation i pregnancy snd chibi 5.3 Abortion and bleeding in pregnancy. 5.3 Other complications of pregnancy 5.3 Complications of childbirth and the puerperium 5.3 Lactation and disorders of the brent 5.4 Childsen's Health 54a Itrodeton to children's health 5.Ab Assessment of child health and development 5 de Congenital disorders 5.4d Infetious disease in childhood 5 de Other common disorders of childhood Nove Stage 6: The Skin, Eye and Ear, Mental Health and Conclusions 6.1 The Skin, the Eye and the Ear 6.18 The physiology ofthe skin, the eye and the 6.1 The investigation of the skin, the eye and the 6.te Diseases ofthe skin 6.14 Diseases of the eye G6.te Diseases ofthe ei. a4 a4 aa 456 461 461 469 ana 430 489 494 sit on 521 526 532 548 356 564 sot 369 om soz 612 2 64 658 686 or 6.2 Mental Health ae 6.2 Intodtion to mental est 6. Clasfcation of mental heath disorders f6.2e Assessment and treatment of mental health disorders 6.24 Anxiety, depression, somatoform disorders and cating disorders 6.2 Psyeheses, personality disorders and Teaming disability 6.5 Conclusions 6.34 "The ed flags of diseane review 6.36 Withdrawing fom conventional medication 66.3¢ Communicating with conventional medical practitioners 6.3 Ethical sss 705 705 m3 n6 28 29 733 733 155 762 766 Append 1 The Fersins ofthe Organs Conespondence Tables Append 1 Worked Examples of the Sx Sop Maho for cpg th Energi ton of Drage Append 1 ed Flag Conditions: A Gide for ‘Acspuactaris Append IV Table Showing Cage of Drag fir Withdrawal from Mediation Nowe Indes. a7 wes sor Notices Disclaimer Knowledge and best practice in this field are constantly changing, As new research and experience broaden out understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rly on their cown experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein, In using such information or methods they should be mindful of their own safety and the safery of others including parties for whom they have a professional responsibility. ‘with respect to any drugs or pharmaceutical products identified, readers are advised 10 check the most current information provided (i) on procedures feaured or (i) by the manufacturer of each product to be administered, (0 verily the recommended dose or formula, the method and duration of administration, and. contraindieations Ie is the responsibilty of practitioners, relying on their cown experience and knowledge of thet patients, ro make diagnoses, to determine dosages and the best treatment for cach individual patient, and to take all appropriate safery precautions. “ote flest extent of the law, neither the Publisher nor the authors, contributors, or editors. assume any ibility for any injury and/or damage to persons or property as 4 matter of products liability, negligence or otherwise, fr from any use or operation of any methods, products, instructions, or ideas contained in the material here Online material ‘The online material supporting this text canbe downloaded at worwjkpcom/voucher using the code STEPHENSONACU. Ie includes + Full-color illustrations from the book. ‘+ Self assessment questions and answers. These sol assessment questions are designed to support home study of the text, The student is advised co write down answers to each question as they progress through the study of a section. The wri ‘ean then be compared with the model answers ‘which are also co be Found online. + End of section self-assessment tests, These are designed to help the student review their learning after completion of each of the sections that make ‘up each chapter. Foreword The College of Integrated Chinese Medicine brings together t#0 styles of Chinese medicine, We had not thought, however, of bringing together Chinese and Western medicine. Until, that is, Clare Stephenson joined the teaching staff; She saw che potential for something different {As both a Westem doctor and a practitioner of Chinese medicine, Clare immediately recognized the huge areas of similarity, as well as differences, beween these «wo systems of medicine. She graduated from the College, and subsequently became the program leader for conventional medicine. This stated her on the path of writing what was Iater to become this textbook, From the moment we saw the first texts for the study couse, it became clear that she was writing something very special, unique even. ‘The students agreed. ‘Their evaluations sang the praises of the course. Staff who hhad not done the course elamored for the text. They had recognized its potential for deepening their earning and asa reference tool, Jt soon became obvious to us that this should and would become a textbook at some stage. It rook over five years for Clare to fully complete what was then an in-depth study course for our students. We are now delighted that, from its ist conception as a course at the College, through fts extensive development, it was born as a book in 2011 and nov, in 2017, iin its second edition Before this book the only in-depth texts available were those written for Western medicine practitioners such as doctors, murses and physiotherapists. Clare's innovative vision for Chinese medicine practitioners was to enable them to learn Western medicine but from their own perspective: Chinese medicine and Western medicine are wo substantial yet very different medical models, Chinese medicine practitioners can offen search for connections and rclationships between the two models but find more differences than similarities. This book bridges that gap and brings the two closer. This enables practitioners of both medical models to understand how the other thinks In this textbook Clare takes complementary practitioners through the basics of Western physiology and pathology, and compares and comtasts ie with the underlying theory of Chinese medicine, I helps Chinese medicine practitioners to understand the workings of the mind of a conventional doctor: how they question patients, ‘what tests they might carry ous, how the results might be inerpreted, a8 well as possible Western treatments and their offers ‘Throughout the text each subject is discussed not only from the Western but also from the Chinese medical perspective, For instance, Clare examines holistic versus reductionist theories, she summarizes the underlying philosophy of both medical models and also exphins medications both in Western terms and in terms of their Chinese energetic effets. On top of this, and perhaps most striking, is how she thoughtfully considers each Western disease and compares it to a possible Chinese medicine diagnosis For a holistic practitioner, comparing diseases from ‘these two perspectives might be seen as slightly risky. We might worry chat it could encourage practitioners 10 treat ‘only what in Chinese medicine terms is called the Bizo, or ‘outward manifestation, rather than the Bex, oF root cause (of the problem. Clare's rich understanding prevents this from happening. Whilst remembering that this is primarily 4 conventional medicine textbook, she comments on ‘Chinese medicine diferemtiations of disease, without being too prescriptive. Ths gives practitioners useful insighes but doesn’t narrow their holistic point of view. Each part ofthis cleartext is complemented by online learning-poines, selftests and case histories as well as numerous additional comments andl comparisons between Western and complementary medicine. ‘This book will bof use nar only co students of Chinese medicine but also to practitioners of all complementary therapies as an in-depth step-by-step study course with timed and specified sections of study. Equally itis ‘extremely useful to qualified practitioners as a reference book. Although this book was not written for Western practitioners, those who read it with an open mind might also find it arouses their interest, The discussion about the Chinese medicine approach might resonate with theit ‘experience of patients, ‘This book is immensely dense and at the same time ‘exceedingly readable. Ie will be hard for another textbook The Acupunctuis’s Guide to Conventional Medicine fo match it in its breadth and depth. We have no doubt as well as much mote informed about, Wester medicine, ‘hat i¢ will soon be a standard text for Chinese and other whilst remaining proud of our own Chinese medicine, complementary medicine students as well as a standart reference for practitioners It has so much embedded in the Angela Hicks a Job Hiks text that the reader might find, as we did, valuable gems Principals, Collegeof Inet Chinese Medicine, Reading, popping out at every visit. It has lft us more interested in, Berkshire, UK, September 2010, Update in 2077, Acknowledgements This book is primarily dedicated to all students and practitioners who, through the practice of acupuncture, ate committed to enriching the lives of others. Their Focus fon restoring health through enabling patients 0 find a place of more balanced living is a profound contribution to human well-being, but is nat necessarily rocagnized as such in this current age of speed and technology. ‘The creation ofthis book was inspired by my contact with suecessive generations of students of acupuncture at the College of Integrated Chinese Medicine in Reading, UK. Over the years of teaching these studems, this textbook evolved in response to their expressed need both {© understand conventional medicine and also to make sense of how it sat alongside their studies of Chinese medicine. Moreover, this book was very much shaped by the feedback these students gave to the emerging text, and for this tam very thank 1 also have great gratitude to Angela and John Hicks and Peter Mole, the founders of the College of Integrated Chinese Medicine, who continue t@ teach and inspire ssudents, From the outset they supported my enthusiasm to develop teaching materials about conventional medicine for their students. They then very generously encouraged sme to submit these materials, written for the College, as material to be considered for publication. Without their support this book could not have been published, In the writing of the first edition of the book 1 had great help from my colleagues at the time, Di Eckersley and Pam Batten, I am very grateful for their wisdom and encouragement. Tam also indebted to John Wheeler who read through the whole of the First Edition and deftly pruned my Jong sentences. ‘Thanks also have to go to Claire Wilson, Jane Evans and all the ceam at Singing Dragon who have taken on the "unenviable task of the production and distribution of this book, It has been a pleasure to work with you al In the research for the Second Edition I have cured time and time again to a small number of source texts. | have always been impressed by the breadth and depth of the writings of Giovanni Maciocia and Bob Flaws in particular, I have enormous respect for the dedication of these two masters of Chinese medicine who have enabled ‘so many in the West t0 have aecess to the wisdom of both the ancient and current day healers from China, In terms of sources of up-to-date information on ‘conventional medical practice, I have relied heavily on the internet-based resource, Patient (htp:/ patient. info). This website is regularly updated, thoroughly researched and very accessible, Lam also very grateful to the small team ‘of doctors who write the hundreds of articles to be found ‘on this website st trained in conventional medicine, and this ning will always form the foundation of my practice in acupuncture and also in teaching. 1 have had an cever-deepening education in medicine, spread as itis over many years from medical student to experienced doctor. ‘The opportunity co learn from others never ceases in medicine. Many teachers and dactors [ worked alongside ‘with over the years have been sources of inspiration; they include, to name but a few, Alan Weeds, Chris Bunch, Bent Juel-fensen, Basil Shepstone, Crispin Fisher, Geoff Summerfield, Judith Shakespeare, Angie Anderson and Sally Hope Finally | ave to express my great admiration for my most recent medical colleagues Matthew Easdale, Robin Cart and Chloe Borton, who are sill working extremely long and relentless hours in UK general practice. The ‘commitment and dedication of conventional doctors in the UK National Health Service (NHS) has to be worked alongside co be believe. trust that this book will be a source of support for acupuncturist in practice, It is also my hope that it will help to cnable constructive dialogue between healers from ‘the conventional and Chinese medical traditions Introduction This textbook fis been developed co enable studems and practioner of complementary health disciplines, and acupunctriss in particular, to understand more about the Wester medical model of healthcare. Iti intended 0 enable a recognition of how the Wester medical approach to interpreting. and managing disease can be. stod alongside, and to some degre ransltd, ito the tems of 4 more holistic mode, namely. that of Chinese medicine. “The alkmate aim is tha interactions with patients inthe clinic will be enriched by helping both acupunctrit, and patent make sense of how the patent's experiences, Of Western medicine might relate to the eestments they are being offered in the acupunctre cnc Tis will have the added benef of enabling patients 19 make safe and postive healthcare choices based on this understanding ly sndertanding of consenionsl medicine comes from having tained as a medical doctor and having practiced fora amber of years in Brith hospital medicine and general practice, However my perspectiveon healthcare bas been fundamentally shaped by stepping aide from Conventional practice, and spending over 13 yeas in the practice of traditional acupuncture. My interest in Chinese tmedicne was sparked by a bre inal training in linia acupunctae in Nanjing, China. fllowed tis by studying, the practice of acupunctare at the Collegeof Integrated Chinese Medicine in Reading, UK. I then spent ten years both practicing acupuetie in Oxford and alo teaching conventional medicine to students tthe College where I bad jus xed As began to elect on these vo contrasting practices oF medicine and brought these elections into my clinica practic, I leamed how my consultations with patients sere positively inuenced by the drawing together of information fom more than one medical philosophical framework I found hat my increasing fvency in these contrasting languages of medicine, and also the ability 0 “aanslae” benvecn them, enabled my patents 19 bene fromthe insights and wisdom inherent nthe Bost aspects of both conventional and “alrerative” medical disciplines | found that also helped them to make more informed choices about what treatments might be best for them. 1 now no longer regularly practice conventional medicine. I found the eversicreasing pressures placed on conventional dlnicians who work in modern healthcare systems t0 deliver guideline-based medical treatments {irrespective ofthe individual needs and preferences of the patients) incompadible with my desire to understand and manage the patient holistically. ‘This decision was not taken cally. Fes, I recognize that modern conventional medicine offrs so much that crucial 10 the well-being of countess individuals. This includes: the management of day-to-day mundane health queries in general practice; the safe management of pregnancy and childbirth and children’s developmental problems; s© many health promotion programs in the developing and developed worlds; the provision of a robust and safe setting and framework for meeting the needs of the many people who will need nursing care; and also access to high quality emergency care. The very young, the vulnerable, those with serious chronic disease and those at che end of their lives are more than likely to rely on conventional healtheare when they need support. My experience is that the people who work in conventional medicine, the doctors, nurses, paramedics, healthcare assistants, and even administrative staf and cleaners, are more often than not healers in their own right, In a public healthcare system they are often paid low wages, and even then tend to work Tonger hours than for wisich they are paid. In che seting ‘of conventional healtheare provision, ii so often the kind ‘words and gentle rouch that is remembered by patients in spite of the pressure and speed and underfunding of the system within which the care is offered, 1 will always have the utmost respect forthe dedication and care of so many ‘wonderful colleagues in conventional medicine in the UK. Second, and regrettably alternative medical approaches in the West are very offen only accessible to those who can alford them, Cersain population groups (arguably those most in need of gentle approaches to healing) will never come elose to being able t benefit from them, In ‘my practice as a GP 1 would routinely come into contact ‘with people of all ages and fiom all walks of life. AS an acupuncturist in the UK, however, I do not expect ever to have the privilege of being able co care for such a diverse client group, Tlive in hope, though, and I trusc chat by enabling the patients with whom I do have clinical contact 0 live a more natural life in cune with their environment, respectful of + their own bodies and attentive to the needs of the people around them, this will indeed have an indirect beneficial effect on many more individuals than I could hope to mect a5 a practitioner. Asa holistic practitioner I hope that my patients will be able to manage their own health and, in the most part, have no need for conventional medicine, OF coutse, in the event of serious disease or atthe time of the important transitions of childbirth and death, itis of great comfort to know that conventional medicine is the safety retin place for when people really need to rely on its care and powerful interventions. With this brief personal history as background, 1 shall now go on to clarify the rationale and structure of this textbook, ‘As [have explained, the overarching aim of the book {s that acupuncturists might develop an understanding of conventional medicine chat will frst enable them to make Jinks beoween conventional and more holistic medical concepts, and asa result chis will ensich their consultations with their patients, Further aims are to encourage a clear understanding of why doctors work in the way they do, and ta instill greater confidence in the management of "red flag” conditions, those situations when a patent is likely 0 bbenefc from, or even urgently need, access co conventional medical creatment. ‘Many institutions involved in taining complementary healthcare practitioners in the conventional medical sciences currently rely on source texts designed for doctors and nurses in taining, These texts are, of course, appropriate for detailing the knowledge base of conventional medical practice, but were not intended to answer questions about how medical facts and approaches may relate to a complementary health discipline. For this reason, many students find the conventional medical aspects of thie training dry and irrelevant, and the material dificult ro retain ‘What this text offers in addition to the material found in standard. medical texts is a presentation of medical information in the same systematic way, but with continual reference to how this information might relate to the practice of holistic medicine, and Chinese medicine in particular. Whilst the comparisons ate largely confined to the language and concepts of Chinese medicine, they itlustrate a process of “translation” that itis easly possible to undertake in any ofthe complementary medical disciplines. er the introductory chapters in Stages | and 2 ofthe text, all the chapters that follow have a similar structure, In each chapter the following copics relating to a physiological subsystem of the body are explored: + The physiology of thar system. + The pathology relevant to the system (le, what happens when disease causes imbalance), Introduction ‘The conventional medicine approach to treatment of the diseases that have been described + Comparisons with the language of Chinese medicine wherever possible, These “translations” relate to physiology, pathology and the effects of medical treatments. Ta distinguish these paragraphs from the main part of the text, this information is presented in characteristic text boxes. The attempt t0 translate from one medical language to another in this text is based on the premise that there is ‘one reliable constant irrespective of the world view of the health practitioner. This reliable constant is the patient's ‘experience of disease (the symptoms), and how the patient demonstrates a respanse to the disease process in their body (the signs). All medical approaches respond co these Features of illness. Moreover, although conventional and complementary medical approaches may seem ¢o have different languages, they all respond co a patient's symptoms and signs in predictable ways. For this reason, in cheory, it is possible co cranslate from one medical language to another, even when the underlying theoretical framework of the two medical approaches appears to be startlingly different. The patien’s symptoms and signs become the point at which a medical description from one discipline, “inflammation,” for example, can be mapped ‘onto a medical description from another such as “Wind Heat.” This is nor to say that inflammation is the same as Wind Heat; it most definitely is not. Instead it means that when a doctor diagnoses inflammation ~ because of localized redness, pain and swelling ~ then the Chinese ‘energetic syndrome of Wind Heat is likely 0 be diagnosed in the same patient by a Chinese medicine practitioner, simply because this is the diagnosis to which these ‘symptoms point. Some principles that underlie this process of translation can be found in the "Note to the Reader” “which follows this Introduction. ‘This text is for the main part, however, a conventional medical textbook, It presents information about clinical medicine that is both up to date and relevant to clinical practice in any developed country and in the UK in particular, The most significant area in which the text may differ from texts written for a readership from other developed countries is in that of drug nomenclature. The names used in this text are based on the International Nonproprietary Name (INN) system recommended by the World Health Organization (WHO 2016) and as used in the British National Formulary of Medications (British Medical Association and Royal Pharmaceutical Society 2016). "The book has been designed for two modes of use. First, it will stand alone as a medical textbook, which ‘cin be referred t0 in the course of clinical practice by therapists in a wide range of complementary disciplines. ‘The language in which i is veriten has been chosen to The Acupunctuis’s Guide to Conventional Medicine bee accessible to complementary therapists, Mdeally it will act asa goide for a practitioner with litle or no scientific background in the navigation of what might be written about a patient’s medical diagnosis in standard medical texts of online medical resources. Initially designed as 2 seudy course for students of acupuncture in the UK, the text has been studied in detail by hundreds of students who have provided valuable feedback and confirmed the readability of the information it presents Second, the text has been written in such a way that it can be followed systematically as part ofa course in clinical medicine for students of acupuncture. To this end, online sendy aids such as a list of learning intentions for each chapter, “in-text questions” and end of chapter assessment rests have been designed to relate to the material in cach chapter, and these can be found in the online study ‘materials linked to this text. ‘The online material can be downloaded at www:ikp. com/voucher using the code STEPHENSONACU, It includes: + Full-color ilustrations ftom the book. ‘+ Selfassessment questions and answers, These self: assessment questions are designed to support home study of the text. The student is advised to write clown answers to each question as they progress through the study of a chapter The written answers can then be compared with the model answers, which are also to be found online. + End of chapter sel-assessmenc tests. These ate designed to help the student review their learning after completion of each chapter, “This book is structured in sx stages, each of which consists of three ro four chapters ordered into topic sections, There are four appendices. ‘Stages | and 2 relate co topics that form the foundation of the study of clinical medicine, and include basic principles of physiology, pathology and pharmacology. ‘These stages also introduce the theoretical basis used throughout the text for the translation of conventional medical language into Chinese medicine language, as described catlier. Stages 3-6 focus on the description of all the important medical conditions and their treatment a8 they relate to conventionally recognized body systems or patient groups. The conclusions in Chapter 6.3 focus on topics relevant to the practical management of clinical patients with Western medical diagnoses. This includes ‘guidance on the referral of patients with “red flag” conditions (Section 6.32), managing the withdrawal from conventional medication (Section 6.36), and some cthico-legal aspects of treating a patient who is also under the care of a medical practitioner (Section 6.34). In terms of using the book as study course, the online selF-assessment tests for each section have been designed 10 help the student ensure that the specified learning intentions have been met, If teaching institutions choose 10 adopt this text as a study course, then a pace of one stage per semester (i.e, six semesters in total) provides continual challenge without becoming too overwhelming, Ideally, if the course is taught in this way, home study can be supported by two to four teaching sessions per stage of the course, and by setting the students an end-of stage ‘written assignment as a form of summative assessment of their learning. ‘Thisbook is packed with information intended to enrich the clinical encounter with a patient in need of healing, It is always good, however, to retain a degree of perspective ‘when dealing with such information; there may be a danger that the weight ofthe information distacts the peactitioner tthe decriment of the potential of the healing cncounte, For this cason, tis Intreduccion concludes with the words ‘of a wise healer These encourage the practitioner engaged in developing a mastery of information to allow those theories to work quietly from only che background of their consciousness during the profound time when the patient has emtered the clinic room, Practical medicine is, and always has been an at, and the same is true of practical analysis True artis eration, and creation is beyond all theories That is why I say to any beginner: lesen your theories as well as you can, but put hem aside when you touch the miracle ofthe living soul No theories but your own creative individuality alone snust decide Jung etal 1928) Notes 1 WHO (Word Heath Organization) (2016) Nonpropisry Newell whined services! ‘mem accened om 9 May 2016, 2. Brtsh Medial Associaton and Royal Pharmaceutical Society (2016) Arsh Natal fornlry 74 Landon: BH} Group. and 3 Jong, CG. a (1928) Corba m Anata Pycoigy New Yerke Haroos, Brac & Company Note to the Reader: Understanding Western Medical Terminology in Chinese Medical Terms AAs explained in the Introduction, the primary focus of this book is to intwoduee practitioners of Chinese medicine to the basic principles, pathological interpretations and clinical approaches of Western medicine. In addition, throughout the text “translations” are offered for expressing some ofthe signs and symptoms of Western medicine into the descriptive language of Chinese medicine, Before any tanslaion can be attempted, however, some clarity is required about the use of language and terminology in Chinese medicine. It is unfortunate that Chinese medical terms for organs and substances ~ which have unique energetic meanings ~ have been conventionally ascribed Western medical names. Terms such as Hear, Small Intestine, Liver, Blood and Plegm ll have particular meanings in Chinese medicine that bear lie relationship to their biological namesakes, Throughout this text Chinese medical terms are ascribed & capital leter to difereniate them from biological terms. Appendix I clarifies in more systematic detail how the Chinese organs and biological organs of the same oame are very different entities. The reader is thus counseled to be alert when studying Chinese medicine in the English language not to conflate the (Chinese and biological organs and substances, and always to recognize each as constructs as defined within the terms of | their originating medical philosophy. To return to the topic of translation of disease descriptions all physicians observe and describe symptoms and signs in their patients, whatever cheit theoretical background. According to this background, they may place differem degrees of emphasis on different symptoms and ‘signs. The pulse qualities that are described and considered significant in Chinese medicine, for example, are very different from those considered clinically significant in Western medicine. Nevertheless, physicians ffom each discipline are unlikely to disagree that a patient as nausea, fever, a rash and swollen joints if indced these are the symptoms and signs present in that particular case. ‘The links suggested between Wester and Chinese medicine in this text are forged on the basis that Western and Chinese practisioners share this common ground, that they both recognize the consistency and value of symptoms and signs as indicators of disease. In this text, when a translation is attempted from Western medical terminology to that of Chinese medicine, the symptoms and signs form the bridge that enables this leap berwen the Western and Chinese medical incerpretations of disease. ‘Western medical diagnoses are, in keeping with their reductionist roots, based on detailed analyses of sympeoms and signs, as well as pathological changes and test results For example, an early diagnosis of rheumatoid arthritis is hinted at by hot symmetccally swollen joints, characteristic deformity and fever, This may then be confirmed by blood tests that demonstrate the measurable presence of specific auto-antibodies and inflammatory markers. These features distinguish this inflammatory polyarthritis from a number of conditions presenting with similar symptoms and signs. Western diagnoses describe physical conditions, the features ‘of which can be measured objectively, akin to the way in ‘which a geographer might describe mountains, rivers and Forests in a landscape, Chinese medicine diagnoses, however, may be based fon broad sweeps of clinical information, which are qualitatively rather than quantitatively assessed, Chinese diagnosis describes a state that is reflected in the whole person. The person é the diagnosis rather than Ade the diagnosis, and cannot be separated from it. In geographical terms, a Chinese medicine diagnosis is more comparable to an ever shifting climate or to an environment, rather than to a fixed feature such as a mountain or a forest. The diagnosis is based on the answers to questions such as “is the patient hot,” “is there dryness,” “is there swelling?” and "is the pain fixed and boring, oF dull and improved by movement?” The answers 0 these questions are supported by characteristic changes in che pulse and tongue that can only be subjectively assessed. The fine distinctions made "within Western diagnoses may not be so apparent in Chinese diagnoses. A case of early thoumatoid arthritis is likely o be described on the basis of hot swollen painful joints and fever asa form of "Heat Bi” syndrome (pattern) in which itis understood that pathogenic factors have transformed to Heat with resulting Blood and Qi Stagnation in the ‘Channels and Collaterals" These descriptions may also The Acupunctuis’s Guide to Conventional Medicine bee applied to any number of forms of polyarthritis that involve har, swollen and painful joints, In Chinese medicine the very subtle distinctions in diagnosis will emerge as a consequence of the uniqueness of the patient who is displaying the symptoms. While all patients with a symmetrical hot polyarthritis may readily bee described as manifesting che imbalances of Heat with Blood and Qi Stagnation in the Channels and Collaterals, this tells us nothing about the cause of the Heat and the Stagnation, or indeed if these need to be treated ditcetly It may be more important in such a case o assess the degree of underlying deficiency (eg, of Heart Qi or Kidney Yin), which could be a more appropriate focus of treatment. In this text, attempts to make linguistic links berwcen Western and Chinese medicine have been made using the consistent constellation of symptoms and signs as an enabling bridge between the ewo. There is nothing either remarkable or controversial about this. Once symptoms and signs are clearly described by Western medicine (eg. fever, constipation, depression, rash, etc), then Chinese theory very readily allows for a range of possible energetic diagnoses to be suggested. Ic is important to emphasize, however, that these “translations” are intended to enrich understanding of how Westem and Chinese medicine diagnoses may co-exist, They are not intended as guides to treatment. ‘A pethaps more controversial aspect of this mapping process is the attempt co make statements about Chinese energetic interpretations on the basis of intemal or microscopic changes in the body that would not have been directly observed in the patient by the ancient practitioners of Chinese medicine. For example, a pathological process that involves blood clotting might in this text be equated to Qi and Blood Stagnation, or inflammation to Heat and Stagnation, even if the process is going on deep within the body rather than on the surfiee, A process involving withering and loss of vitality of tissues, such as the degenerative changes seen in the lung in emphysema, might suggest that Yin Deficiency is an underlying imbalance, and a process in which the dynamic function of a body structure is compromised, such as inefficient pumping of the filing heart could be a manifestation of Qior Yang Deficiency. The compelling factor about assumptions that Western pathology can be equated to Chinese descriptions i that — very often — what ean be assumed about what is happening ata microscopic level in a disease from a Chinese medicine perspective is made manifest in the symptoms and signs commonly associated with that disease. For example, on the basis of there being a blood clot in coronary artery, & coronary thrombosis might suggest the syndrome of Heatt Blood Stagnation, This conjecture is then cortoborated by the fact that the common symptoms and signs of coronary thrombosis of intense fixed central chest pain and ieegular pulse rate chat are indeed consistent with those described in the Chinese medicine syndrome of Heart Blood Stagnation, This of course fts with the understanding that Chinese syndromes are holistic in nature; always in Chinese medicine the energetics ofthe part will reflect that of the ‘whole, This should apply at the microscopic and even subatomic level as well asst a humanly observable level ‘Again it must be emphasized that statements linking Western pathology with Chinese descriptions of disease process (such as "a blood clot suggests the presence of Blood Stagnation,” “an accumulation of fluid suggests the Accumulation of Damp’) are not intended to be guides for treatment, and are certainly not intended to represent exact ‘equivalences However, knowledge abouthow thesymproms and signs of known diseases relate to the syndromes will inform us about what sort of patients are likely to develop these conditions, and what sort of treatment principles might be considered for them, However, it should be repeated that creatmene always needs to be planned in the light of the unique constellation of sympcoms and signs ‘with which an individual patient presems. {A similar process has boen undertaken in this book with regard c the Chinese medicine interpretation of the actions of medical treatments. The Chinese medicine descriptions of drug actions are drawn from what is known in conventional medicine about how those drugs relieve symptoms and signs together with their side effecis Ic ‘must also be taken into consideration that drugs tend not to directly nourish or replenish the body (nutritional supplements and replacement hormones being possible exceptions), but instead often inhibit or stimulate bodily be they physiological or pathological. For the oral contraceptive pill inhibits the natural bodily process of ovulation and the ovulatory drug Clomiphene stimulates ovulation which would not have happened without medical assistance, Bera blockers (ch as Propranolol) inhibit che action of che heart and result in slowed heart rate and reduced blood pressure, Beta agonists (such as adrenaline and salbutamol) stimulate the action of the heart and lead to increased heart rate and blood pressure Manufactured drugs differ from herbal products in that, with the exception of some binding agents or liquid substrates, they essentially contain the active molecules the desieed changes, Herbal products, ‘when naturally processed, and particularly when prescribed in combination, contain a complex range of natural substances, and are understood in Chinese medicine ideally 1 have nourishing as well as moving or clearing qualities IF herbal combinations are prescribed appropriately, any potential depletion effected by moving Qi will be ideally supported by simultancously treating any root deficiency ‘What the text postulates is that such interruption of bodily processes by manufactured chemicals, even if they known 0 « ate pathological processes, caries an energetic cos, simply because a root imbalance has nat been treated. This could mean that the original imbalance that was manifesting, such as the Stagnation of Qi or Heat, might chen become expressed at another level in the body: This has some resonance with the classical homeopathic concept of suppression of symptoms where, as a result of the suppression, the imbalance becomes manifest at a deeper level in the body. Similarly, in Chinese medicine theory pathological bodily processes (eg. a tension headache) may be the result of a deeper energetic imbalance (eg. Ascent of Liver Yang resulting from sustained high levels of stress-related emotions such as anger) Simply inhibiting an fouter expression of the imbalance (by taking a painkiller) will not necessarily allow the deeper imbalance to be resolved Moreover, itis suggested chat while stimulating bodily functions by a medical treatment might be beneficial in the ‘short term, ulkimately it might be draining for che body. For example, the stimulation of heart rate and blood pressure by beta agonists may in the short erm profoundly benefit a bodily system in which these functions might be failing co rally round, and can literally be life-saving, From an energetic perspective, a system that was deficient in Yang has been stimulated. But this is nor the same as the Chinese medical concept of “nourishing” Yang, as mighh be che consequence of careful acention to diet, sleep and exercise, This sudden stimulation of heart rate may well be atthe cost of drawing ‘on deep bodily reserves, and so ultimately draining. At a deep level this stimulating of functions that might equate o healthy Yang possibly contributes tothe opposite situation, as the deep reserves of Yang are depleted, It makes sense that inthis situation the patient will also benefit from some additional treatment approaches 10 nourish the depleted reserves in the long term, ‘This theory fits with the common experience of using any of the stimulatory substances inthe diet, such as sugar, caffeine or chocolate, After a temporary high, overuse of these subsances may leave a person feeling even more rained and out of balance than before (and indeed, all these substances are recognized to exhaust Kidney Qi: Flaws and Wolfe 1983), These effects are all the more pronounced with some of the commonly abused drugs increasingly accessible to all in modern cult nicotine, alcohol, cannabis, cocaine, opiates, and mental stimulants such as methylphenidate. In this text, these ideas have been drawn into the interpretation of drug energetics. Because of inattention to the root cause of iliness, whar is happening on the surface as a result of drug treatment may be accompanied by paradoxical effect ata deeper level. A drug that clearly seems to be Cooling in nature aecording to Chinese medicine (eg. an antiinflammatory medication that pallates red angry joints) may also demonstrate a range of side effects such a Note to the Reader that are Hot in nature eg. rash, fever, inflammation of the stomach). Some of these may be a consequence ofthe toxic nature of the drug to body tissues, evidenced by the fact that che effects may be experienced by people taking these medications ierespective of the nature of the underlying disease. However, it is worthy of note that many drugs do seem to generate side effects that have an energetic ‘expression that is the opposite of that of their therapeutic action. This might be considered an indication that forcing the expression of the original symptoms to a different level of the organism might partly explain the energetic mechanism of their aetion. ‘Again the point needs to be made that these incerpretations of drug energetics are intended to enrich the diagnostic process. They are not intended as guides to Chinese medicine treatment, which always needs to be based on the outcome of the Chinese medicine diagnostic process. Drugs may cause dramatic symptoms and sigos in 4 patient, but offen its careful atention to the individuals root imbalance, and the one that probably preceded any drug teatment, which can lead to dhe most profound shifis in che patients heath In summary, the mecting of rwo independent systems ‘of medicine is'@ great opportunity to enrich and develop ‘each of them, It is haped that the interpretations offered in the Chinese medicine sections may deepen the Chinese medicine practitioner's understanding, of the patient with a Western diagnosis from a Chinese medicine perspective. Moreover, a Western medical doctor who has begun t0 ‘embrace the Chinese medicine understanding of the grouping and interrelationship of signs and symptoms may do well to add to their medical diagnostic framework the sophisticated understanding of the environmental, ‘emotional and spiritual correlates of physiological and pathological processes that are at the heart of all the systems of Chinese medicine, and in so doing enrich their conventional medical practice Notes. 1 Throughout the text the comention wil be used to capitalise all ters that resto Chinese medi diagoss. This ntnded to hop diiagubh dose Eoglsh wes commonly employed when Chinese medical deseipuons ate uansaed thar acwally have 1 unique meaning which ix diac ffm the cotton usge For ‘example the Chinese media tas Hea. Plog, Wind nd Tp eater all have unigue Chinese medial meanings hit beat 90 coreltion the common usage ofthe English words heat, phlegm, ‘vind, ple and ester Deng, Leal (1987) Chinoe Aponte sf Machin. Bling: Foreign Languages Press 3 Fw Bans Wate HL (1983) Pre He i Conk: Cac Diary "hp, Booklne, MA: Patadigm ablations ater cu dep de ator INTRODUCTION TO MEDICAL SCIENCES 1.1 1.1a Introduction to physiology: systems of the body ‘The term physiology,’ derived fiom the Greek meaning study of nature, is used to deseribe how all living organisms work or function, An understanding of physiology has to underpin the study of clinical medicine, a itis only through knowledge of how biological processes Function in health that the mechanisms and outcomes of disease may be understood. Throughout this text, physiological descriptions of the body systems will precede the descriptions of how disease: manifests in those systems. The introduction and explanation of the key concepts necessary to understand these descriptions isthe purpose of this frst section, ‘The study of physiology offers more to the Chinese medical practitioner than simply providing building blocks for the further study of medical sciences, Central to all healing modalities isthe development of an understanding and respect for the human body in health and disease This respect enriches the way in which the practitioner communicates with patients and handles theiebodies Te may wel, indeed, add co the healing potential of the encounter, as through this respect the patiene will fel recognized and understood, Respect comes with knoviledge, and although the perspective of Chinese medicine is that the body is 2 manifestation ofa tich interplay of energetic functions, i is nevertheless aso very helpful for practitioners to acquire « sound understanding ofthe strsetue and normal funetions of the physical parts as recognized by the patient and by theit medical doctors, which is, of course, the physical ‘manifestation of the energetic foundation, ‘And so, a physiological understanding of the body will enhance the understanding of the energetic nature Introduction to Medical Sciences of the body parts, as understood in Chinese medicine. Bodily functions are described in diverse ways, but some clements remain constant, All medical systems recognize major functional details ~ the lungs take in air, the heart ‘pumps blood, the blood clots and the skin produces sweat Although the processes of these various functions may be described very differently, awareness that all disciplines recognize the same summary descriptions can help when translating From the language of one medical discipline to another ‘As an ilhusttation of this, inthis text physiological concepts, from time to time, translated int the language fof Chinese medicine. In Chinese medicine the body is understood in terms of constantly interchanging and imerdependent forms of Qi, the underlying energetic principle on which that system of medicine is founded. ‘The comparisons with Chinese medical physiology described in this text clearly illustrate not only the internal consistency of thought in Chinese medicine, but also the possibility of translation. This process of translation has the potential to promote inereesed understanding and respect between conventionally trained practitioners and those Chinese medieal practitioners who use the language of energetics 10 describe the philosophical basis of their practice. It is important that, when translating in this way, we recognize we are not comparing “like for lke. ‘The Western descriptors are used to relate to measurable physical forms and funetions; the Chinese medical terms relate to energetic processes that eannot be bounded in the samme way (for more om this topic, see “Note to the Reader" at the beginning of this book). Whilst the translation process cat be deeply informative, the practitioner must avoid the temptation co consider Chinese medicine in a reductionist building block fashion, Concepts such as Liver ‘Qi Seagnant or Stomach Yin Deficient apply to the whole system and not to a precisely defined body part, Whilst a diseased body part might point to Kidney Qi Deficiency, the converse is not true; Kidney Qi Deficiency will manifest in the whole system and can become apparent physically {and emocionally) in a muiiplicity of ways, Systems of the body Physiologists consider the human body t0 be a collection of functionally integrated systems. Although these systems cannot work in isolation, each can be defined in terms of fits strucrare (anatomy) and function (physiology), ‘The physiological systems of the body are listed in Table 113-1. Most conventional general medical textbooks are subdivided according co these systems, This makes sense because conventional practitioners have learned to classify diseases as they affect each system. ‘The in-depth study of diseases according to a physiological system is known as a medical specialty. Usually, the term for the specialty is the name of the system together with the suffix “ology.” For example, the medical specialty devoted t0 diseases of the endocrine system is knawn as “endocrinology Table 1-1a+1 The 12 physiological ‘ystems of the body + Integumentary (kin) Muscular Skeletl (bone) Neurological (nervous Endocrine (hormone secreting} Cardiovascular/irculetary (heart and blood estes) Resprotory (breathing) Gastrointestinal (geste) Lymphatic immune) Hemotoiogicol (blood) Urologieai/renel/arinary (kidneys and bled) Reproductive Sometimes two or more systems are considered together because their functions are related. For example, the urinary and reproductive systems may be considered together as the ‘urogenital system, and the blood and cardiovascular system «an be considered together as the cireulatory system. Conversely, a system can be broken down into component subsystems for study in depth, This leads Introduction to Medical Sciences erase to terms such as ophthalmology {the study of the eye), ‘otorhinolaryngology (the study of the ear, nose and throat), hepatology (the study of the liver) and cardiology (che study of the heart. Each system in the body comprises organs that work together to enable the system to perform its role in the physiology of the whale body: Physiological levels The distinct systems of the body described earlier ‘an in turn be broken down into subsystems, each of which represents a collection of interrelated organs (se Figure I.1a-I). The concept of levels of organization can bee applied here. The most complex level of organization is the body itself. The next level consists of che 12 systems and their subsystems. The various organs that make up the systems form the next level of organization. ‘Ac the next level, organs can be considered in terms of the different tissues out of which they are made, Tissues, ‘of which there are four main types, comprise the range of basic living materials with which organs can be bulk Finally, the simplest level of organization that can be considered a living unit isthe cell. This isthe single living building block out of which all tissues, and therefore all ‘organs, systems and the body itself, are made, and itis, ‘of cours, the original frst component part of the human body formed at conception, Wesco) Fann ay J capes Popigea gis [Carentan] 1 T Open Tieteot Tames tae [teasing] [Cal (Cacacscal Figure 1.16-1 The levels of ‘organization of the body Aca @ Information box 1.1a-1 The Acupunctuis’s Guide to Conventional Medicine The organs: comments from a Chinese medicine perspective Chinese medicine describes 12 Organs, oll but one of which is given the same name a the solid orgons ‘hat are described in physiology. However, these (Organs, such as the Heart, Lung and Kidneys, do not correspond to the physiological structures afer which all but the San Jiao (Triple Heater) are named. The organs in physiology are defined primarily in terms of their structure and location, and also by their function In contrast, the Organs in Chinese medicine are not recognized to have @ physical structure. They ore defined in terms of the functions that they hove in the body and these include emotional or spiritual aspects 1a well as physical ones. They are recognized to have 2 dominant, but not exclusive, influence over the physical organ after which they ore named, but will ‘actually have an influence over every part of the body. The physiologist is talking about o physically tangible reality when discussing organs, but o Chinese medicine practitioner is describing energetics ‘when using the same term.” In Chinese medicine, this energetic body may be defined in terme of Yin ond Yong, the Five Elements and the Vilal Substances of Gi, Blood, Essence (Jing) and also the Pathogenic Factors (sich os Cold andl Damp) that may impact pen it. In this tex, to minimize possible confusion between terms used. diferently in Chinese and Western medicine, all Chinese medicine terms that have o meaning which is paricular to Chinese medicine theory are oscribed on upper-case initial letter. The cifferences may be briefly summarized at in the table on the right Whilstits tempting to do so, tis important never to presume that the physiological and Chinese medicine Use of a term might correspond. Its also important 40 explain this ta patients, who might otherwise make very incorrect assumptions obout what their Chinese medical diognoses might mean for them. Although there are some similares (e.g. the function of the slomach is to store food bath in physiological ond in Chinese medicine), there are mony more differences (e.g. the physiological spleen has nothing to do with the digestion of food, whereas this is 2 significant function of the Spleen in Chinese medicine) The organ correspondence tables in Appendix | demonstrate in more detail the nature of the differences between the functions of the physiological ‘ond Chinese medicine Organs. Each table relates to © particulor organ, ond illustrates how the various functions of the physiological ond Chinese medicine (Orgens can be mapped onto one another. Physiologicol organs Organs in Chinese medicine Terms to describe @ collection of functions The functions of the Chinese medicine Organs are assessed subjectively by checking the state of the Gi Using techniques such (08 pulse and tongue diagnosis The function of the Chinese medicine (Organs is not related to ony structure, lhiough the Chinese medicine Organ moy dominate the function of a physiological corgon (e.g, the Qi of the Heart Organ os interpreted in Chinese medicine supports the physiologicol heart organ) For any ane Chinese ‘medicine Organ there isnot necescarily © counterpart physiologicol organ [e.g Triple Burner) Solid physical structures The structure ond function ofthe organs can be assessed by scientific means: dissection, physical fexomination, blood ‘ests, ulirasound, Xray imaging, ete ‘The function of the orgon can be related to the structure of the orgen (e.g. the pumping tection of the heart orgon con be related to its muscular shape, electrical activly ond valves) Fer eny ene organ there is not necessarily © counterpart Chinese medicine Organ (e.g pituitary) Introduction to Medical Sciences era ae 1.1b The cell: composition, respiration and division At the most basic of the levels of organization of all plants and animals lays the living building block known as the cell. An understanding af how the cell functions ‘will form a basis for the study of those more complex ‘organizational levels of the body, the tissues, the organs and the physiological systems. ‘Most cells are roo small to be seen with the naked eye, but a simple microscope can reveal certain details of their ‘structure, including the boundaties between cells. Figures 1.1b-I to 1.1b-IV are diagrammatic represen- tations of how cells in diferent tissues can appeat under the light microscope. These indicate the wide variety of cell shape seen in different tissues, and also that each cell contains a lage central structure known as the nucleus, eae illustrating immune cells (white blood cells and reticular cells) and supportive reticulin fibers Branching call Intercalated dise Figure 1.1b-IV Cardiac muscle tissue, Figure 1.1b-1 Fibrous tissue, illustrating fiber- _ illustrating the fiber-like cardiac muscle cells generating cells (fibrocytes) and collagen fibers _ linked by connecting “intercalating di ee ‘The: poweel ecton mlcoseope ib equied co bes reveal more dena in eal ects, Athongh the prec: 7 ohn structure of each cell is different, depending on the tissue L « in wich itis foved and the role iba op al cel thc barn sate bee eae Tet hep to comidr«eneralized cell” study how ll cele made up snd Faction. No ingle ll wil be exc ke ths diagram, but most cell wl have the fears porayed in the pneraized cella depicted in Figure Lib Figure 1.1b-II Adipose (fat) tissue, illustrating fat-filled adipose cells, and minimal connective fibers Figure 1.1b-V The structure of a generalized animal cell Structure of the cell Each cell contains a plasma membrane and a number of internal structures known as organelles, This cerminology reflects the fact that a single cell can be seen as a living Unie in isolation, with the organelles corresponding to the ‘organs of the body, The organelles ae fluid in nature, being bound by oily fluid membranes and suspended within fluid matrix known as the cytosol. Together, the cytosot and organelles ae called cytaplasm, and this is bounded by an oily fluid plasma membrane. “The plasma membrane aets asthe link berween the cell and the ouside world. Large molecules made of protein in this membrane make the cell unique and structurally respond to various chemicals in the cellular environment te bring about changes within the cytoplasm. In addition, the plasma membrane allows the passage of nuctients into the cell and waste ent ofthe cell, but able to retain essential substances within the cell. This important feature of cell membranes, known as semi-permeability, is described in Section Ite ‘The nucleus is the largest structure found within the cell. It contains genetic material in the form of chromosomes. These consist of strands of a very complex molecule called DNA (deoxyribonucleic acid), DNA is the template for the symthesis of proteins building materials in the cell, Another complex molecule with similar structure, RNA (fibonucleic acid), takes the role of the messenger. Messenger RNA transfers the information coded on DNA ‘out tothe cytosol and tothe ribosomes, where the proteins ae actually made, The Acupunctuis’s Guide to Conventional Medicine ‘The other large round structures in the cytosol are the mumerous cigar-shaped mitochondria, which utilize ‘oxygen to break down the basic nutrients obtained from carbohydrates and fits (and sometimes proteins) o form an «energized compound called ATP (adenosine triphosphate). ATP can be likened to a battery as it holds a readily available store of energy t© “power” all pracesses of the cell, This process of using oxygen and nutrients to form energy is called cellular respiration. The waste product of respiration is carbon dioxide. ‘A large part ofthe remaining cytosol consists of many layers of oily membrane called the endoplasmic reticulum (ER), on which the dense ribosomes are situated. Where the ribosomes are numerous the ER is described as rough (rough ER), and where they ar less numerous itis described as smooth (smooth ER). Ribosomes are the site at which the long molecule of RNA is used as a template to guide the production of proteins from simple chemicals called amino acids, out of which all proteins are made. Proteins made on the rough ER pass into the space between its _membranes in preparation for transport out of the cell. ‘The Golgi apparatus is an extension of the ER. I¢ takes the proteins made on the ribosomes and covers them ‘with 2 membrane coating, to make “vesieles” (also known as secretory granules). These can travel to the plasma membrane, so that proteins can be released into the outside environment when necessary Microfilaments and microtubules are fibers chat can contract and cause the movement of substances from one part of the cell to another. These fibers, also known as the cytoskeleton, maintain the structure of the cell and link the various organelles. ‘The features of the “generalized cell” are summarized. in Table 1. 1b. Table 1.1b-1 The important characteristics of the cell + The cell is @ self-contained living unit *+ Itis bounded by a “membrane,” which is studded with characteristic proteins + The membrane allows communication with the ‘ouside world + The cell tokes in nutrients and oxygen to produce ‘energy to “power” its activities + Hi contains genetic material in its nucleus, which cllows the manufacture of specif cellular building materiols, the proteins + These proteins can be “exported” out ofthe cell 10 the outside environment 08 Information box 1.1b-I The production of cellular energy: comments from a Chinese medicine perspective Just as the cel can be compared to a body with the organelles os small orgors, i is also reasonable fo cifempl to describe cellular function in terms of the Organ systems of Chinese medicine For example, one inferesting parallel between the Chinese’ description and the physiological insight is thot of the producion of cellular eneray. According to Chinese medicine os described by ‘Maciocia (1989)? the formation of True (Zhen) Gis derived from Gathering (Zong) Gi, which, in turn, is a product of Food Gi and Air. According 4 Chinese medicine theory, vitality from the food, Food Gi, is transported by the Spleen fo the Lungs, ‘where it is combined with vitality from the air to form Zong Gi. I is under the catelytic action of Original Qi that the Zong Gi is transformed into Zhen Gi, which then circulates in the Channels and rourishes the Organs inthe form of Nutritive (Ving) Gi ond Protective (Wei) Gi Physiologists recognize that cellulor energy is similarly derived from 0 catalytic process involving food {which is broken down into the essential ‘components of simple sugars and amino ocids) ‘ond owygen drawn ino the body from the oir breathed into the lungs. When explained in this ‘way, there is cleorly an interesting parallel with the production of cellslar energy, stored in the form of energized ATP as the source of eneray for all tissues, and the Chinese description of the production of True (Zhen) Gi, which olso outlines food ond air os basic substrates. Cell replication “The replication of cells sa Fundamental process within the body char begins with the first division of the fertilized egg (zygote). Ie is essential boch for growth and for the repair of aging and damaged tissues. There are (wo ways in which cells can divide, known as mitosis and meiosis. Mitosis is the process whereby a single cell divides into ‘wo sidentical cells following the replication and separation of the chromosomes in the nucleus. Meiosis isthe process whereby a single cell divides into daughter cells, ezeh of which cartes exactly half of the genetic material of the parent cel ‘The seages of mitosis ae illustrated in Figure 1.1b-VI In this diagram, for the sake of clarity, only a single pair of the human complement of 23 chromosomal pairs is illustrated, The diagram shows how mitosis results in two Introduction to Medical Sciences erase idemtical daughter cells, whereas meiosis results in the production of four generically unique daughter “half-cells” ‘or gametes. enone Ly conide Sonne Mitotic spine a aS. Prophase (ZARN; OA a ‘Metaphese |

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