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by Martin Retherford, BASc, MBA, MSOM, Dipl OM, DOM
How Systems Language is Injuring Patients
In my practice, healthy communication between my patients and I enables my patients to better understand their treatment plan and therefore to stick to it. In the same way, communicating well with my nurse practitioner enables him or her to understand what work I have done with a patient as an East Asian Medicine Practitioner (EAMP).
In school, a professor labelled this communication, ‘Mouth Needles’. Why? Because of the therapeutic benefits for patients. As such, within any healing discipline, good communication is mandatory. But what about communication between disciplines? Within the U.S. East Asian Medicine (EAM) is not included under the blanket lexicon of Medicine.
EAM is undergoing substantial discipline-wide changes, including the establishment of practice acts throughout most of the country and the demand for EAM services is soaring. Despite these positive changes, only about 25%²,³ of the total U.S. population⁴ use Complementary and Alternative Medicine (CAM), including Traditional Chinese Medicine (TCM). EAMPs account for circa 4-10% of that figure. These numbers clearly demonstrate how few understand the true scope of EAM and what it could do for them. Through better communication, an increasing number of people could realize the value of EAM.
The purpose of this article is to discuss Systems Language and jargon associated with EAMPs and our biomedical counterparts. Historically, EAMPs are the Internal Medicine Specialists of the ancient world, the primary care providers of the day. This is not the case in the US today, despite the discipline being utilized in the country since the early 19th century⁵).
There are a number of contributing factors that result in poor communication but the most fundamental is language.
Some may assert philosophical or cultural differences, but these can be classified under ‘systems language’ or ‘jargon’. Both disciplines are focused on their objective of alleviating suffering and neither approach is incorrect. However, constructs such as ‘Running Piglet Qi’ or ‘Liver Qi Stagnation’ simply have no meaning for our biomedical colleagues.
EAM’s systems language speaks of the body as a functional unit using descriptors such as Qi, Blood, Yin, Yang, Five Phases, Six Pathogenic Factors, Seven Taxations, Eight Principles, Ten Stems, 12 Branches, 24 Cycles and other conceptual constructs to describe the functions, interrelationships and effects of the body. They are challenging to learn and in certain instances, beautifully artistic.
On the other hand, our bio-medical counterparts describe the body using systems language such as CD45 pathway, CIP pathways, anatomical organs, tissues, viruses, bacterium and other constructs.
The communications failure that Jing and Genetics codifies, that anti-inflammatory and clearing heat or Yang Ming and Colitis entail is a tough chasm to bridge. However, in 2017 Qi Y., et al⁶ published an article about Huang Qi (Astragalus Membranaceus) and a compound found in Huang Qi identified in Astragaloside (ASI). ASI and some of its functions were explained in biomedical terms, specifically that the drug stimulates the CD45 phosphatase pathway, which then down regulates an inflammatory pathway, NFB, whilst also activating and regulating T-cells, which may up regulate the expression of interferon.
From an EAM point of view, Huang Qi is used to tonify Lung and Spleen Qi, augment Wei Qi, facilitate urination, promote discharge of puss and generate flesh. As such, the biomedical description of the functions of ASI effectively describe the effects captured in EAM descriptions of herb actions. The reduction of inflammation may be the mechanism of improved fluid flow in the body, explaining the tonification of Lung and Spleen Qi (Tai Yin), facilitating urination and promoting the discharge of puss. The up regulation of T-cells and interferon may encompass augmentation of Wei Qi and generating flesh by means of a more active immune system’s suppression of microbial activity in sores and wounds.
Huang Qi is also used in immune-modulation and is therefore very effective as prophylactic for asthma patients. This could also be explained by the immune-regulating effects of T-cell expression. The implication is that Huang Qi may also be beneficial for HIV patients and even Type 1 diabetics⁷ for the same reason.
Articles such as the one published by Qi Y., et al may be the best way to create a bridge between systems languages. I have yet to find a better mechanism to effect a common narrative to enable communication between the two disciplines.
In summary, the obvious solution to the problem of chasm in systems languages is to communicate and to find every opportunity to have the conversation, respect the differences between disciplines and begin to work towards a collaborative alleviation of suffering for all patients. To not address this issue of communication between disciplines would be unethical and we would not be acting in the best interest of our patients. It would be the absence of words that could cause suffering in others. First do no harm, after all.
¹ Ha, J. F., Longnecker, N. (2010). Doctor-Patient Communication: A Review, Ochsner J. 2010 Spring; 10(1): 38–43. Retrieved July 7, 2018 from https://www.ncbi.nlm. nih.gov/pmc/articles/PMC3096184/
² NCCIH (2017). The Use of Complementary and Alternative Medicine in the United States. Retrieved July 7, 2018 from camsurvey_fs1.htm#use
³ NCCIH (2018). The Use of Complementary and Alternative Medicine in the United States: Cost Data. Retrieved July 7, 2018 from camstats/costs/costdatafs.htm
⁴ Vintage Population Estimates (2018). U.S. Census Bureau. Retrieved July 7, 2018 from https://www.census. gov/programs-surveys/popest.html
⁵ Harvis, R. J. (2018). TCM and the Black Panthers: Chinese medicine and its American history goes under the spotlight in New York exhibition. Retrieved July 7, 2018 from article/2148322/tcm-and-black-panthers-chinese-medicineand-its-american
⁶ Qi Y. et al (2017). Anti-Inflammatory and Immunostimulatory Activities of Astragalosides. Am J Chin Med. 2017;45(6):1157- 1167. doi: 10.1142/S0192415X1750063X. Epub 2017 Aug 22. Abstract retrieved July 7 2018 from https://www.ncbi.nlm.nih. gov/pubmed/2883021
Massachusetts General Hospital (2017). Mass. General study finds potential mechanism for BCG vaccine reversal of type 1 diabetes. Retrieved July 7, 2018 from https://www. massgeneral.org/News/pressrelease.aspx?id=2114