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Submitted by admin on September 19, 2006 - 3:52pm.
Acupuncture Case Histories The Treatment of Mental Diseases
This collection of acupuncture case histories that are focused on treating mental diseases is a direct development of my work on Soothing the Troubled Mind; Acupuncture and Moxibustion in the Treatment and Prevention of Schizophrenia. To my mind, one of the great strengths and weaknesses of Soothing is that the original authors intended their work for a Chinese audience. In the course of translating their book, it became apparent to me that much could be done to enhance what they were trying to convey, but my duty was to stay in the role of translator and not usurp the role of author. One of the things that we did was include an explanatory foreword from an internationally respected schizophrenia specialist, Dr. Richard Warner. The translator’s preface to Soothing also is aimed at putting the authors’ ideas into perspective. In addition, this collection of case histories is intended to display a broader array of treatments for mental diseases and further expose the cultural backdrop behind TCM treatments in the PRC.
The Beauty of Case Histories
If Chinese medicine is as much an art as it is a science, then case histories are the masterpieces of Chinese medicine. When we read classical texts or modern textbooks on Chinese medicine, we can perhaps get a sense that the authors had great knowledge and literary skill. But other than by studying case histories, where can we observe individual practitioners at work? There is a great tradition of writing case histories in Chinese medicine and great value in making this tradition available to non-Chinese readers.
Sometimes case histories can remind us how powerful TCM can be. In modern society we have to work with “institutional views” of medical practices. For example, the National Institute of Health, the World Health Organization and others have to run clinical studies that determine, from a certain perspective, which illnesses acupuncture and other modalities can and cannot treat. But dyed-in-the-wool acupuncturists know that the only limit to what a practitioner can treat is his/her own understanding of yin and yang. Practically speaking, even if the fairest of fair studies shows that acupuncture is not beneficial for a given disease, if the right acupuncturist tries to treat that disease, the patient can still be cured or benefited. Especially in the treatment of mental diseases, extraordinary treatment skills can be required. (See pages 72-83 of Soothing the Troubled Mind for the authors’ exhortations and advice on refining general acupuncture skills and improving therapeutic effectiveness.) Thus, what is possible for individuals can be made clear in case histories, which is what gives case histories their inspiring nature.
Case histories are also instructive to a broad range of readers. Many of the cases were perhaps deemed worthy of publication because they have story lines that appeal to laymen. Whereas the point selections and herbal prescriptions may make no sense at all to non-specialists reading the case histories, the initial symptoms, the course of treatment, and the final results can be appreciated by almost everyone. In some circumstances students and practitioners can benefit by pushing themselves to predict what comes next in each case. For example, after reading all of the relevant symptoms, one can internally decide on a diagnosis before reading on to see what the practitioner in the case decided or determine one’s own points for such a patient, and so forth. In this way the cases can be especially instructive.
Case Histories on the Internet
We feel that the world wide web is especially suited for publishing a collection of case histories.
Characteristics of Case Histories
With so many case histories around, there are certain parts of the cases that readers of the genre expect to see. These can include:
(1) Basic Biodata—including the patient’s age, sex, date of initial consultation, and a name of sorts (frequently the surname is provided but the given name is simply XX).
(2) Patient’s Remarks—the patient’s report of what is wrong; frequently in cases of withdrawal/mania it is pointedly reported that a family member or some accompanying friend provided this information.
(3) Investigation—what the doctor finds when examining the patient, including tongue description and pulse diagnosis; one can surmise that at the time of investigation they may have noted many other things, but what makes it into the case history is only the symptoms that are most relevant.
(4) Diagnosis and Treatment Principle—very textbook steps from the TCM custom of identifying patterns and determining treatment.
(5) Point Selection—the points selected, as well as any manipulation, moxibustion, or other techniques to be simultaneously performed; there may also be an herbal prescription.
(6) Treatment Results—after the treatment is explained, the effectiveness is discussed; until the patient is fully cured steps 4 to 6 of this list are repeated. Some cases are cured in one treatment, while others require a course of treatments with many adjustments to the original prescription.
(7) Conclusion—a review of the important aspects of the case. In many cases this includes a discussion of why the points or other treatment selected was appropriate. In other cases the conclusion will deal with an unexpected turn of events or some other special feature of the case at hand.
Some authors do not include all seven of these steps but simply put enough to explain the crux of the case. In part because everyone knows this is the general outline of case histories, and in part because TCM Chinese has a well developed vocabulary, case history authors tend to be extremely terse. For example, when explaining the patient’s symptoms, they often simply list what is to be said. Usually in English it feels more natural to put such lists into sentence form. Yet a single list may cover, say, eight or more symptoms and change from past tense to present tense such that 10 or 20 Chinese characters will translate into, perhaps, three English sentences. While it is the translator’s job to make each case as readable as possible, readers who are challenged to follow a translation are once again encouraged to learn Chinese and have a look at the original text for themselves.
Observations of This Collection of Case Histories
While reading through this collection of case histories, readers may wish to contemplate that there could be a collection like this for each disease under the sun. There are certainly other cases about withdrawal and mania that have been published that are not included here. Yet the fact that this collection takes cases from 5 different practitioners means that it has relatively good breadth, while the fact that there will ultimately be 30 cases from one doctor alone means that it has a special depth. [The initial posting of this collection does not include all of the cases from Dr. Jin Shu Bai.] Although each case can stand alone as a valuable learning tool, one can also look at the cases in relation to each other and gain a broader perspective on various social themes and medical issues in China, as well as a comparative understanding of specific cases.
For example, in these case histories one can see certain attitudes expressed by the authors about Western medicine. Whereas in the West there are strong cultural currents that are pushing more and more people to seek “alternative” treatments, the cultural currents in China push its citizens to seek Western medicine. Many of the cases include references to failed treatments with Western medicine before the master acupuncturist was called in to help out, or in some cases powerful pharmaceutical drugs are being used and the reductions in their dosages are fully documented. For example, see:
|JinSB-1 (Withdrawal)||Jin4-2 (Depression)|
|Jin3-2 (Mania + Withdrawal)||HuangX-Y1(Hysteria)|
If it only happened once or twice, it would be overanalyzing to make anything of it. But it happens so frequently that we can see a pattern of Chinese doctors defending the importance of their profession vis-à-vis Western medicine.
A medical issue that is brought to light in this collection is the misdiagnosis of schizophrenia in China. Readers should all know that the exact diagnosis of schizophrenia is a subject of much debate. The definition changes from country to country and from time to time. (This is discussed at greater length in Dr. Warner’s Foreword to Soothing the Troubled Mind, pp. x-xi.) When discussed in China, however, there is a layer of eclectic complexity that results in all sorts of mental illnesses being diagnosed as schizophrenia. Here is the origination of this complexity: In TCM, all mental diseases are considered to be within the realm of withdrawal and mania, with withdrawal representing the yin aspects of mental diseases and mania representing the yang aspects of mental diseases. Schizophrenia can have predominantly yin symptoms or predominantly yang symptoms, so schizophrenia can be either withdrawal or mania. Of course, only a small percentage of patients with withdrawal and/or mania are technically schizophrenics, yet in China patients that are obviously suffering from withdrawal and/or mania quite frequently are diagnosed as schizophrenic.
Depending on which country you are in and who you are listening to, a basic definition of schizophrenia usually includes a cognitive split with reality that lasts for a prolonged period—three months is average, some definitions require six months, others can be shorter than three months. In this collection of cases there are numerous examples of patients who have been diagnosed as schizophrenic; while they are definitely suffering deeply, the duration of their malady is usually nowhere near three months. For examples, see
Jin-A-5 (Pseudo Mania Withdrawal)—the commentary to this case has a very curious claim about the duration of mania withdrawal; it is as if they should have been talking about schizophrenia rather than mania withdrawal in terms of having a prolonged duration and severe symptoms.
Please let me reemphasize that textbooks in China which explain schizophrenia from a Western point of view all clearly state that the prolonged term of illness is one aspect of schizophrenia. Yet in actual practice the diagnosis of schizophrenia is arrived at and accepted for patients with relatively short periods of mental abnormalities.
Introductions of the Authors and the Sources
By far the largest number of cases in this collection are from Dr. Jin Shu Bai, a doctor from Shanghai who is alluded to on page 101 of Soothing the Troubled Mind. Her cases are from a book entitled Zhen Jiu Zhi Liao Jing Shen Bing (Acumoxa Treatments for Mental Diseases) (ISBN 7-81010-030-5). It was published in 1987 by the Shanghai College of TCM Publishing House. The book is over 100 pages long, and is primarily comprised of Dr. Jin’s case histories. There are also some introductory essays that review her work and the theories that she emphasized in her practice. [Depending on reader interest, perhaps all of the introductory essays will be added to this website at a later date; the first priority is to provide all of the cases.] It makes me especially happy to have such a large collection of cases from one physician, because one can see how her basic formulas are modified for different patients and for different stages of treating specific patients. Also, whereas the vast majority of case histories in the generally available literature deal with a single treatment, or perhaps three or four treatments at most, Dr. Jin has provided cases where she did dozens of treatments or over 100 treatments on a single patient. (I have made some effort to contact Dr. Jin, but have not been successful; if any readers know of a way to communicate with her, it would be greatly appreciated.)
The cases by Dr. Xiao Shao Qing and by Dr. Fei Jiu Zhi appeared in Xian Dai Zhen Jiu Yi An Xuan (An Anthology of Modern Acumoxa Case Histories). This anthology was published by the People’s Health Publishing House in 1985 (ISBN 7-117-00756-7). 440 pages long, the editors tried to select cases that captured the full range of what acupuncture treats well. While it has 300 headings indicating treatment of a specific disease by a specific practitioner, some of the headings cover multiple cases. In showing a full range of uses for acupuncture, the editors simultaneously tried to find cases that demonstrated mastery of acupuncture and/or model treatments.
The editors allotted one heading for the treatment of withdrawal, and two headings for the treatment of mania. Two case examples from Dr. Xiao Shao Qing were chosen to illustrate the treatment of withdrawal; in both cases he uses the 13 ghost points, and in one case he explains how an unsuccessful first treatment lead him to discover a clinically useful reinterpretation of an ancient treatment poem. This is one example of something that should be written up as a case history—acupuncturists at all levels can learn something from that case. Dr. Xiao, by the way, was one of the instructors at the Nanjing College of TCM when I studied there in the mid-1980s; he even spent some time coaching me on an individual study project that I was working on. At the time he had just published a book on acupuncture point combinations. Perhaps his book could be described as a heavily referenced acupuncture version of an herbal formula book. Dr. Xiao said that whenever he was called on to lecture about acupuncture, he only needed to bring this one book with him and he was set. I will always remember him as a very energetic acupuncture practitioner, instructor, and scholar.
Dr. Xiao also wrote one of the Anthology’s two cases of mania. The other was provided by Dr. Fei Jiu Zhi, a practitioner who I know very little about.
The three cases by Dr. Huang Xing Yi all deal with treating hysterical disorders. His cases appeared in the periodical Zhong Guo Zhen Jiu (Chinese Acupuncture and Moxibustion), Vol 15, No. 2 April 1995, page 44, and my translation of them appeared in _______ in 199_. Dr. Huang corresponded with me about the translations of his cases. Because his three cases were presented as one article with one conclusion, they are all in one file. While all three cases individually have certain merits, by reading all three together with the five cases that were in the appendix of Dr. Jin Shu Bai’s book, one can get a much stronger impression of how acupuncture can be used on hysterical disorders.
The four cases by Dr. Zhou Zhi Jie appeared in a book entitled Shi Yong Zhen Jiu Yi An Xuan (An Anthology of Applicable Acumoxa Case Histories) (ISBN 7-5369-0413-4). The entire 217-page book is filled with cases by Dr. Zhou. He follows each case with a commentary on which points were selected and why. Each case is concluded with a brief poem that I have not tried to translate here. As far as my interpretive powers go, the poems do little more than repeat the points and a couple of the main symptoms; in short, they solely act as pneumonic devices. [Before long I will add the poems in Chinese to the website, and other readers can contribute their opinions as to whether there is more to be seen between the lines than my eyes can discern.] In this book Dr. Zhou has one section dedicated to withdrawal (2 cases), mania (2 cases), and epilepsy (4 cases). Obviously, he has selected these cases for their contrast in relation to each other.
Hopefully there is a good deal to be learned from these case histories in their current state of translation, but readers should know that in some of the cases I have left in question marks where it was not absolutely certain that my understanding of the text was correct. Perhaps I can guarantee 97% accuracy; in discussions with others it was agreed that the effort required to polish the last 3% was beyond what was necessary for a forum like this. Also, because my studies of TCM included very little on the use of medicinal agents, this case history selection primarily covers acupuncture. Some of the cases have medicinal agent treatments and I have dutifully translated the contents as best I could, but the collection as a whole is heavily slanted in favor of acupuncture because of my own limits in understanding the broader offerings of TCM. Finally, it may be that much of the writing does not reflect the clarity and eloquence of the original authors, but demonstrates my own cumbersome literary style. We hope that readers will be patient with shortcomings such as these and yet still appreciate the basic contents of the cases.