JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
G UA SH S H A AS CO UN TERAC TERACTION TION
Th e Cri C risi siss is i s th t h e Cu C u re Arya Nielsen I wish I could make a petechial fever; that is, I wish I could produce upon the skin that state of counteraction existing when petechial petechial spots are formed. (Boerhave, (Boerhave, Du tch phy sician sician 1668-1738)
What is Gua Sha ? Gua means to scrape or scratch. scratch. Sha is a ‘redd ‘redd ish, 14 elevated , millet-like millet-like skin rash ’. Gua Sha is a technique th at intentionally raises sha rash or p etechiae. etechiae. Sha is the term u sed to d escribe escribe stuck surface blood before or after it is raised as petechiae. See figures 1 and 2.
Fig. Fig.22
When is Gua Sha used? Gua Sha is applied for p ain wh en external factors factors such as wind or cold hav e obstructed the blood in the sur face face tissues. When When n ormal finger pressure on a pa tient’s tient’s skin causes blanching th at is slow to fade, Fig. 2: Gua Sha at neck and shoulder for pain subsequent to whiplash injury.
Fig. 1 Fig. 1
sha is present. See figures figures 3 and 4. Gua Sha is applied as treatment an d prevention for common cold, cold, 'flu, 'flu, bronchitis and asth ma, as well as chronic disorders involving congestion congestion of qi and blood.
Where is Gua Sha applied? Sha is raised raised p rimarily at the yan g surface of the body: the back, neck, shou lders, butt ocks, and limbs. On occasion, occasion, Gua Sha is applied at the chest chest and abd omen. How is Gua Sha applied? The area where Gua Sha is to be app lied is lubr lubr icated icated w ith oil. I use Vick’s Vick’s Vapo-rub because my patients are familiar with its smell and a re comforted by it, although a thick oil such such as peanu t oil was trad itionally itionally used. The skin is pressured in down ward strokes by a round -edged -edged instrumen t such a s a coin, spoon, m etal jar jar lid etc. (see figure figure 5). Strokes are continued along one area u ntil the petechiae that surface are completely raised. If If there is no sha, petechiae petechiae will not form form and the skin will only only turn pink.
Fig. 1: Gua Sha at left left shoulder and upp er back for for p ain du e to trauma.
What does the type of sha indicate? The colour colour of the sha is both diagnostic and p rognostic. Very light coloured sha can ind icate deficiency deficiency of blood. 5
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
Fig. 3 Fig. 3
Fig. 3: Palpating p ainful areas for sha; the p ractitioner presses her fingers onto th e flesh.
Fig. 4 Fig. 4
Fig. 4: Sha is ind icated w hen finger pressure causes blanching that is distinct and d isappears slowly.
Fig. 5 Fig. 5
Fig. 5: Gua Sha is app lied w ith a round -edged tool. In China this may be a sou p sp oon, or slice of water buffalo horn specifically mad e for this pu rpose. The slice in the foreground has an ind entation for finger joints. A simp le metal lid w ith a roun ded lip is the most comfortable tool I have found .
If the sha is fresh r ed, it is of recent p enetration. If the sha is pu rple or black, the blood stasis is long-stand ing. If brown, the blood may be dry. Dark red sha can indicate heat. The sha petechiae sh ould fade in 2-3 da ys. If it is slower to fade, the patient h as poor blood circulation. What are the benefits of Gua Sha ? Gua Sha moves stu ck qi and blood, releases the exterior mimicking sweating, moves fluids and metabolic waste 6
congesting sur face tissues and m uscles and prom otes normal circulation and metabolic processes. It is a valuable treatment for both external and internal pain, and facilitates the resolution of both acute and chronic disorders. I have practised Chinese med icine for nearly twenty years. Next to needles, Gua Sha has been the most valuable technique th at I know. The results of Gua Sha are visible and the relief it p rovides for p atients immediate. For som e disorders it is all that is needed; for others, it opens the w ay to a d eeper p rocess of healing. Why then has Gua Sha been slighted by practitioners in the West? Why do ou r schools venerate acupu ncture and herbal therapy w hile de-emp hasising techniqu es integral to the tra dition of Chinese med icine like Gua Sha, cup ping, bloodletting, moxibustion, plum blossom n eedling and so on ? I believe the answer lies in our ow n history, and m odern Western cultural values that cast shadow status on some therapeu tic method s and light on others. The truth is that techniques like Gua Sha, a n d t h e h u m o u r a l t h e or y t h a t drives them , are not new to the West. When the Western hum oural perception of the body gave way to micro-analysis advanced by techn ology, therapies like Gua Sha were rejected. It is my h ope th at they can be r evived, to be u sed when clinically app ropriate. In this article I will examine the counteractive techniques of early Western med icine, the humou ral theory that informed t hem, an d th eir decline in the West. Lastly, I will consider in m ore d etail the clinical relevance of Gua Sha to modern practice.
PART ON E: CHIN ESE M ED ICINE AN D EARLY WESTERN M EDICIN E As I was d oing research for my book on Gua Sha , I wa s surp rised to find m any of the techniqu es used in Chinese medicine were a p art of early Western m edicine. Known as Hipp ocratic or coun teractive, early Western med icine has a language an d inten t strikingly similar to the theories of Chinese medicine. Hipp ocratic med icine held that sickness resulted when a body hu mour became impu re, out of place or out of balance. Dietary or beh avioura l indiscretions as well as exposure to th e elements led to illness1. Restorative treatm ent aimed at r emoving or d iminishing the excess offend ing hum our by manipu lation, purging, bleeding or blistering, or by ind ucing vomiting, urination, salivation, or sweating. A deficient hum our w as restored by man ipulation, diet, and herbs or drugs2. Drugs, herbs, food an d behaviour were classified according to their warm, cold, moist, or dry qualities. For example, pepp er was a heating herb th at countered cold. Cucum ber was a cooling herb th at countered heat. Speaking in term s of excess and deficiency, and app lying principles of hot and cold, counteractive medicine
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
used d iscutient3 ‘touch’ to scatter and disperse pathologic accumulation and revive a balanced circulation of humours.
Theory of Count eraction It was a maxim of early Western med icine dating to th e Hipp ocratic corpus th at "no two d iseased actions, affecting the general constitution, can go on at the same time, for any considerable period in the same system4". A patient’s asthm a subsided with an attack of gout or was relieved by a discharge of blood from piles. A child’s seizures stopp ed wh en an accidenta l poker burn caused a sma ll infection on his lower leg. It was thou ght the new d isease action created a crisis that ‘counteracted’ the original disease5. H ipp ocratic meth od recorded these crises, surm ising that ar tificial crises could be created as intervention, hastening resolution. In fact, the definition of allopathy springs from this approach: "Allopathy is a therap eutic system in which a d isease is treated by prod ucing a second condition that is incompatible with or antagonistic to the first6". For examp le, observing tha t fever resolves in sweating, indu cing sw eat might cure a fever7. Natural critical haemorrhages preceding the crisis stage in acute disease were thou ght to h ave fostered bloodletting as counteraction. Bloodletting w as p ractised by every ancient culture to p revent or red uce path ologic accum ulation described as ‘heat’, ‘residu e’, ‘malevolen t sp irit’ or just ‘bad blood’. In the West, bloodletting became venesection; patients were bled un til they fainted8. In th e East, blood w as let by dr ops u ntil its colour chang ed from d ark to light. Sites were bled according to channel theory, time of day, month, and year. Tracing the chron ology and langu age of the Su Wen, Epler argu es convincingly that acup uncture d escends from bloodletting9. Hipp ocratic medicine never d eveloped a procedu re like acupu ncture but u tilised cupp ing, cautery, setons and issues10, poultices, and so on. The Western counteractive analogue to Gua Sha was called frictioning. The indications for frictioning sh are a similar history to Gua Sha.
A seton is the early Western m edicine counteractive techniqu e closest to acup unctu re. Here the skin was pinched at the back of the head an d a fibre or hair was thread ed into the flesh. The subsequen t surface infection, though m ild, coun teracted a deeper infection, in this case of the eye.
cases of cholera. In the West cholera was described as congestion of blood and internal heat at the p it of th e stoma ch w ith excessive coldness a t the su rface: " ... excite countera ction at the surface. We relieve the internal congestion. Warmth is the counteragent13". Classical Chinese medicine d escribes cholera as d isease from ‘evil water’ with exterior cold and interior damp . The character for sha is sometimes translated as cholera14, or loosely ‘sickness from discharge of water’15.
Gua Sha and Frict ioning Frictioning applies rough pressure to chafe, stress or irritate the surface, counterirritating and counteracting a deep er condition. Kaim describes “The part vexed by friction begins to be red , to swell, to be warm 11” Broussais (1772-1838), surgeon to th e French arm y explains: The theory of disease took irritation to be at the bottom of every morbid condition, and held that this irritation always resulted in an increased flow of blood to the par t. This was inflamm ation, and th e seemingly reasonable way to act in such a case was, if possible, prevent th at flow of blood and that Inflammation. An External irritant wou ld serve this purp ose. It would d etermine the flow of blood outwards and away from the diseased direction in wh ich it might be going. It would stop the inflamm ation. This is called coun terirritant12. Frictioning in the West and Gua Sha in Asia were app lied in
= Sha or cholera
+ Chi to lie on a bed Sick/Sickness
Sh a Sediment, gravel or sand deposed by wa ter, or sandlik e rash from severe dehydration
Cholera is characterised by d iarrhoea, vomiting, cramps, supp ression of u rine, and collapse. It qu ickly dehyd rates its victims. A n end stage of choleric dehydration is rashlike petechiae and ecchym osis from ruptured blood vessels at the surface (italics mine)16. As seen in figures 1 and 2, application of Gua Sha results in the sur facing of sha petechiae that can ran ge in colour from red to dark purple. The petechial or ecchymotic stage of cholera is natur ally occurring sha. By raising the petechiae, Gua Sha counter acts the action of ch olera ; it artificially indu ces ‘the crisis tha t is th e cure’.
7
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
Into t he Shadow s
There are th ree significant p oints to th is definition. The first is the notion, shared by early Western med icine, that disease can be caused by exposur e to the elements or climatic factors.
Coun teractive therapies of early Western med icine were aband oned ov er time. As the West indu strialised, it developed a micro-analysis of disease. Hu mou ral theory was replaced with the view that inflammation w as caused by micro-organisms that could n ot be ‘rubb ed aw ay’ or flushed by letting blood 17. With some exception, the West focused on sma ller and smaller body u nits, refining an ‘attack the pat hogen ’ app roach to cure, and a ‘win lose’ military mod el of immunity. The East continued to view health and disease as a p lay of natural forces; yin an d yang, hot an d cold, excess and deficiency, operating within and without. Chinese medicine included the ‘attack the pathogen’ approach, but emp hasised ‘sup porting the bod y’s natu ral resistance’. The Eastern d isease mod el included metaph ors of war, but also of peace in abiding observable laws of nature. On th e positive side, mod ern science dashed the religious and sup erstitious bias that saw illness as a cause for reproach. On the dow nside, technology separated m ind from body , patient from context and d istanced the physician from the p atient. The pa tient became a passive recipient an d rarely an agent to his or her own condition. The humou ral approach, which tends to view the patient as a whole in a larger context, came to be viewed as un soph isticated an d u nscientific. The therap eutic techniqu es,
If a climat ic element is able to p enetra te the bod y’s resistance, it is the ‘character’ or ‘natu re’ of the elemen t tha t invades the bod y. The inner qi is disturbed in a mann er characteristic of that factor. Cold Penetration by cold causes the bod y to contract, slowing things d own just like a stream freezing ov er. ‘Just a s cold causes the wat er in rivers to freeze so it is said to cause th e blood in th e vessels to congeal20.’ Cold inhibits circulation causing stagnation and hence pain characterised by chilliness, contraction, cramps an d spasms. Damp Penetration by d ampn ess gives rise to wetness and sluggishness, which may collect as oedema or pou r d own as diarrh oea or discharge. Pain du e to damp ness is characterised by a stead y heavy a ching that is fixed in location. Dryness Dryness dep rives the body of moistur e, injuring all fun c-
even w hen u seful, were d iscoura ged as archaic. It is no coincidence that m any p hysical therapy departm ents are housed in hospital basements. There is a mod ern expectation, held even by acup un cturists that science, medicine, even acupuncture or herbs can
tions d ependent u pon fluid. Fluids conduct body nou rishment an d elimination, and even facilitate movement itself. Fever, fluid loss or inability to drink create internal dryness that can be life threaten ing. Externa l dryn ess injur es the skin and the Lungs first, causing dry skin, dr y cough , and
intervene and cure. And w hen a cure is obtainable, who wou ld not want it? How ever, "In man y cases, med ical science prevents the patient from dying, without restoring him to h ealth. It is thu s a pr imary cau se of chron ic illness18." Chinese medicine practised w ith its traditional perceptions, techniques and recommend ations, can restore many pat ients to health. It is up to acup un cturists to utilise all of Chinese medicine even in a cultural setting that h as abandoned much of its own hands-on interventions and humoural outlook.
thirst. As dryn ess persists, it’s effects deepen in the bod y causing dr y stool, da rk infrequent u rine, fatigue, and stiffness. Dryness as yin d eficiency can also lead to internal wind th at appears as dizziness or spasms. Heat
PART TWO: OUT O F THE SHAD OWS The Clinical Use of Gua Sha in t he Cont ext of Chinese Medicine Gua Sha is effective for any cond ition that inv olves pain. It is practised throughout Asia as popular medicine, not
limited to th e p rofessional sector. Acupu ncturists generally u se Gua Sha after acupuncture needling, but it can be used outside of acupu ncture p ractice. Modern TCM describes Gua Sha as treatment for ‘sha syndrome’: A disease caused by the exposure of wind , cold, summerheat or wetness evil in summer or au tumn leading to blockage to merid ians; manifested as chilliness, fever, distension and pain of the body, or vomiting and diarrhoea, or rigidity and num bness of extremities19 . 8
1. Climat ic elements act in t he body li ke they act outside
Heat causes things to stir and ag itate. Heat raises body temperature systemically or locally, and dries fluids. Pain du e to heat is chara cterised by a su bjective sensation of heat and irritability. Hipp ocrates und erstood fever to arise from excessive internal m otion. He believed frictioning cou ld augm ent the vital force and excite a warm fever in even the most ‘frigid dropsical person21’ . Wind Wind moves. It can blow through openings carrying other factors into the bod y. External win d affects the skin, head , throa t, and Lu ngs first. Wind can a dv ance itself as well as other factors inw ard , to the body interior. Wind acts internally in the same w ay it acts externally. Pain d ue to w ind can be of sudden onset and tends to move around or shoot. Wind p ain can cause rigidity like a tree strained against a steady gale. The common effect of the penetratin g natu re of cold, dam p, wind, and sometimes heat is ‘blockage to the meridians’ or chann els. This is the second significant point of the sha syndrome definition. External factors obstruct the surface qi.
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
2. Pain means obstruction: consider Gua Sha The ‘ceaseless flow of qi’ is a bod y concept an alogous to the ceaseless flow of water in natu re. Obstruction causes problems reflected by the maxim: Bu tong ze tong, tong ze bu tong which means no free flow, pain; free flow, no pain. Pain m eans obstruction; intervention is aimed at freeing the flow. When th e pain is at th e surface, in th e mu scles, it can ind icate obstruction by extern al factors or climates, as described above. If only the qi is obstructed, m assage will disperse the pain. If the blood becomes obstructed, massage will not resolve it. Obstructed sur face blood, sha, can be verified by palpation. When finger pressur e causes blanching that is d istinct and d isappear s slowly, there is sha (see Figures 3 and 4). Interven tion is aimed at freeing th e flow by ‘releasing the exterior’, and by remov ing stagnan t blood. I palp ate every patien t I see for the presen ce of sha.
3. Gua Sh a releases t he Exterior Gua Sha not only treats pain but treats and p revents acute
illness by r eleasing th e exterior. Gua Sha extravasates stagnant fluid and blood, mimicking sweat. This stabilises the ‘pores’ and h alts furth er pen etration of wind, cold, and dam p. The pathogen ic factor is said to be w eakened, allowing the bod y’s wei, or anti-pathogen ic qi, to resolve the acute illness. If already sick the p atient may get sicker for a day and then recover rather quickly. Release of the exterior promotes a speedy resolution and rebound to health. Gua Sha prev ents pr otraction of illness to chron ic un resolved syndr omes like chronic fatigue, cough, sinu sitis, diarrhoea, and so on. ‘When you come in the house, close the door’. Aside from acute pain, acupu ncturists are most often asked to treat chronic disorders. The Jinkui yaolue fanglun warns that treatment d irected towa rd the interior can drive external factors deeper into the bod y, making a p atient sicker22. This is reflected in th e maxim Xian biao hou li: first treat the exterior, then t he interior. Treatment of a chron ic cond ition is postponed until any acute illness is resolved. Palpating for sha can help elucidate whether th ere are in fact external path ogens present and help the practitioner avoid deepening them w hen they have not yet expressed as an acute illness. The surface becomes stabilised, the door to the ou tside is closed, the p atient’s interior chron ic cond ition can be safely treated .
Gua Sha resolv es st agnation of blood at t he surface Sha petechiae verify stagnation of blood at the su rface. If there were no stagnation of blood, Gua Sha or any other
surface frictioning w ould only be ru bifacient, causing a pink blush. Practitioners can diagnose and prognose by the colour and nature of sha, and by how fast it disappears. The darker th e sha, the older th e blood stasis. If the sha surfaces quickly, it is a more recent p enetrat ion. If the sha is pale, the blood
may be d eficient. If the sha itself clears slow ly, the circulation is poor, reflecting a d eficiency in qi or ya ng. Hence Gua Shais relevant to almost an y p resenting disorder. Decongesting blood at th e surface moves blood internally, prom otes blood pr odu ction and im proves dissemination of fluids throu ghout the bod y. The following cases illustr ate that Gua Sha is able to counteract long stand ing problems deep to the sur face and hasten resolution.
Cases 1. Male, 55 Presenting Complaint This patient comp lained of a lifetime chronic infection in the right ear subsequent to a pu nctured ear dru m as a child. He has earaches and dr ainage, some head aches at the back of the head, sinu s drainage an d a p eculiar taste in the mouth. Tongue: red with thick white coating, dr y and sticky. Pulse: 64, clear*, even bu t for a m oving Lu ng p ulse. Other signs and symptoms His app etite and stools are norm al. Urination is normal with some n ight-time u rination. His sleep is good. He has a history of back pr oblems and occasional haemorr hoids. He has 2 martinis each evening. He wor ks outside most of the day. Treatment Back : Dazh ui DU-14, Tianyou SJ-16, Feng chi GB-20, Jianjing GB-21, Gua Sha right neck, shoulder and up per back. Front : Zho ng zh u SJ-3, Tian you SJ-16, Yifeng SJ-17, Erm en SJ-21, Tinghu i GB-2, Tingg ong SI-19 all right side . Ind irect moxa around ear, (at th e third session left Quchi L.I.-11 and Hegu L.I.-4 were add ed), Gua Shain front of ear, along right sternocleidom astoid and scalenes. Course of treatment : 9 sessions, 8 of them on e week ap art, with the n inth 5 weeks later. Recommendations: Avoid cold and sour foods and d rinks, keep the ear covered and warm, even to the point of wearing a light hat indoors. Results: The day after the first treatment he had a rush of brown an d red fluid from the right ear which abated. The ear was less sensitive and hearing imp roved. By the third session he had some pain in th e ear with clear fluid draining. By the fourth the fluid w as once again brow n, bad smelling and his ear really hurt. By the fifth treatment the ear stopped draining completely for the first time, but remained sensitive to cold an d n oise. By the sixth session he had n o pain or draining, and his hearing was m uch improved . His neck was now feeling warm . The last three sessions treated h is back, haemorrh oids and his ears secondarily. During this time he had one more ep isode of clear fluid from the ear. He pr esented five years later for a han d injury. H is ear remained completely h ealed. *This is a pu lse quality taugh t by Dr. James So mean ing a p ulse that has clear edges and is firm but not w iry. 9
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
2. Male, 36 Presenting Complaint:Patient complained of sharp epigastric pain, more p ronou nced after eating, with a d islike of touch or pressu re. He had been m edically diagnosed as suffering from a stomach ulcer, and h ad refused m edication. Tongue: red w ith a crack in the stomach region; yellow greasy coating thicker in the central stomach region. Pu lse: wiry an d fu ll, especially at both mid dle jiao positions. Other signs and symptoms The patient w orks as a contractor; his job involves ph ysical and mental stress. Treatment Back : Feishu BL-13, Ganshu BL-18, Weishu BL-21; Gua Sha midd le back. Front : Zu sanli ST-36, Neiguan P-6, Zhon gw an REN-12, Liangm en ST-21, ahshi on the left side, lateral to Jianli REN-11. Recommendations: Avoid overh eating foods: spicy, greasy and roasted. Avoid alcohol and coffee. Course of treatm ent : 6 session s. Results: This patient experienced steady imp rovement over the 6 sessions and his symptoms resolved completely. There has been no recurrence in the ten years since. 3. Female , 33 Presenting Complaint Patient feels very cold, has kn ee pain an d swelling, and mild low back pain. Tongue: flat, pale p ink, slightly p inker at the tip; coating at the rear of the ton gue is slightly yellow. Pulse: slow, overall weak with m idd le jiao showing m ore strength. Treatment Back : Ku nlu n BL-60, Weizhon g BL-40, Dacha ng shu BL-25, Shenshu BL-23, ahshi (lateral gluteu s med ius trigger p oint for knee). Gua Sha whole back and lateral gluteus medius. Front : Zusanli ST-36, Xuehai SP-10, ST-34, Xiyan (Extra), medial Wing of Knee (Extra)*. Course of treatm ent : 2 sessions 8 days ap art. Results: After the first session sh e felt warm all over. Her knees were no longer swollen or painful, but weak. 4 month s later she asked to be treated again for knee weakness. She reported th at the sensation of warm th had remained. It is satisfying for p ractitioners to b e able to d eepen th eir reach into the body and quicken the process of healing. The Hipp ocratic physician Boerhave h ad a vision, a sense of wh at petechial coun teraction could d o. The answ er to his prayer is Gua Shaand next to needles, it is the most valuable technique I know . Practitioners or p atients interested in learning exactly how and when to u se Gua Sha can refer to the book below.
*An extra point used by Dr. James So.
10
References • The Apothecary in Eighteenth-Century Williamsburg, Williamsburg Craft Series, pub. Colonial Williamsburg MCMLXX. • 1987 Jinkui yaolue fanglun, Synop sis of the Golden Cham ber, New World Press, Beijing, first pu blished c.AD 220. • 1988Chinese-English Dictionary of T raditional Chinese Medicine, Ou Ming (ed), Guand ong Science and Technology Publishing Hou se, Hong Kong. • 1988Chinese-English Dictionary of T raditional Chinese Medicine, Joint Publishing, Hon g Kong. • Brockbank, W. 1954 A ncient Therapeutic A rts , In: Fitzpatrick Lectures, Royal College of Physicians, William Heineman Medical Books, London . • Castiglione, A. 1941 A History of Medicine, Krum bhaar E B (trans. and ed .) Knopf, New York. • Epler, D.C .1980 Bloodletting in Early Chinese Medicine and its Relation to the Origin of Acupuncture, Bulletin of the History of Medicine 54:337-367. • Epps, J.Counteraction, Viewed as a Means of Cure with Remarks of the Use of the Issue, Renshaw and Rush, London 1832. • Gilles, C .1895 The Theory and Practice of Counter Irritation , Macmillan and Com pany, London . • Jackson, H. 1806 On Efficacy of Certain External A pplications, Inaugu ral Dissertation pr inted in Med ical Theses, University of Pennsylvania, TW Brad ford, Philadelph ia. • Kaim, S. 1756 Dissertatio Inauguralis M edica de Frictionibus, Kaliwod ian Press, University of Vienna. tran slated for Arya Nielsen by Chipok R 1994. • Kluger, M. 1978 The Hist ory of Bloodlett ing , Natural H istory Vol 87 N o11 p78-83. • Mathew s, R.H. 1931 Mathews’ Chin ese-English Dictionary , A Chinese-English d ictionary comp iled for the China inlan d mission and Presbyterian Mission Press, Harvar d University Press, Cambridge MA. • McNeill, W. 1989 Plagues and Peoples, Anchor Press New York. • Nielsen, A. 1995 Gua Sha, A Traditional Technique for M odern Practice, Churchill Livingstone Edinburgh. • O’Conn or, J., Bensk y, D. 1981 A cupunctu re, a Comprehensive Text , Eastland Press Seattle. • Porket, M., Ullman , C. 1982 Chinese Medicine as a Scientific Syst em: its History, Philosophy, and Practice, and H ow it Fits wit h the Medicine of the West . Henry H olt, NY. • Stedman’s Medical Dictionary , 1987 Williams an d Wilkins, Baltimore MD. • Weiger, L. 1965 Chinese Characters: Their Origin , Et ym ology, History, Classification and Signification. A Thorough Study from Chinese Documents, Dover, New York first pu blished 1915.
Notes 1. Castiglione, 1941, "Hip po crates’ ...On Airs, Waters and Places ... constitutes the first examp le known to us of a ra tional attempt by a man of genius to put the phenomena of the macrocosm and the microcosm in direct causal relations ... The first part of the book is a true w ork on climatology. It considers the d iseases that occur in a given locality in relation to its climatic position and to the seasons. The second par t treats of the difference between Europe and Asia and without d oubt constitutes on e of the m ost interesting books that classical antiquity has transmitted to u s. It is the first attempt to p ut external causes in direct connection w ith the origin of diseases, but also with the constitution of man and with the ethnic characteristics of nations". Quoted in: 2. The Apothecary in Eighteenth-Century Williamsburg, Williamsburg Craft Series, publ: Colonial Williamsburg MCMLXX.
JOURNAL OF CHINESE MEDICINE NUMBER 50 JANUARY 1996
3. Sted ma n’s 1987 Discutient: Scattering or Dispersing a Pathologic Accumulation , refers to early med icine's hum our al view. 4. Epp s 1832. 5. Ibid . 6. Stedmans 1987. 7. This app roach has surv ived its hum oural context. For example, until the m id 1970’s malaria w as used to treat syp hilis, and is curren tly being researched as a tr eatmen t for AIDS. The bod y can also create its own a ntagonistic cond ition to a d isease as seen in sickle cell trait as defense again st malaria. 8. Kluger 1978. 9. Epler 1980. 10. Cautery is like direct moxibustion. Setons and Issues introdu ce a thread or piece of metal posterior to an infection. The thread or m etal is left in place, causing a sma ll surface infection wh ich counters th e deep er one. See Nielsen 1995, Brockban k 1954, an d O’Conno r & Bensk y 1981 (threa din g). 11. Kaim 1756. 12. Gilles 1985. 13. Jackson 1806. 14. Math ew s 1931, The cha racter for sha has several translations: ‘red dish elevated millet-like skin rash’, (Ou Ming 1988); Dr.So tr anslated sha as sand or shark skin. (So, lecture notes 1976). 15. Weiger 1965. 16. McNeil 1989. 17. Kluger, 1978. Bloodlettin g ma y be the rap eut ic in cases of infection from bacteria. Bacteria are dep enden t u pon trace amou nts of iron for grow th. "At elevated temp eratures, bacteria app ear to be even m ore sensitive to redu ced levels of iron". 18. Porkert 1982 quoting Dr . Arthu r Jores. 19. Ou Ming 1988. 20. Epler 1980. 21. Kaim 1756. 22. Jinkue yaolue fanglun, 220 Clause 1-15. All illustrations an d cases are taken from Gua Sha, A Traditional Technique for Modern Practice. The book gives details on how to u se Gua Shain clinical pr actice, includ es over 40 cases and gives classical point p rescriptions used with Gua Shafor treatment of common d isorders. The book can be p urchased from Customer Services, Churchill Livingston e, Robert Stevenson H ouse, 1-3 Baxter Place, Leith Walk, Edinb urg h EH1 3AF, United King do m. Tel: with in U K toll free: 0500 556 242, outsid e UK: 0131535-1022, Fax: 031-535-1022. The bo ok can be or de red in th e US throu gh: Redwin g Book Comp any, 44 Linden Street, Brookline MA 02146, Tel: 1-800-873-3946; or Chu rchill Livin gston e, 650 Aven u e of the Am erica’s, New York, NY 10114, Tel: 1-800-5535426.
Biography Arya N ielsen is National Board Certified in Acupu ncture and Chinese Herba l Medicine, a Fellow of the N ational Academ y of Acupun cture and Oriental Medicine, and Chair of the New York State Board for Acupu ncture. She has been in p rivate practice for nearly 20 years and is a Senior Faculty memb er at the Tri-State Institut e of Traditiona l Chinese Acupu nctu re in New York City. 1 irs, W aters and Places. ..constitutes the first examp le know n
to us of a rational attempt by a m an of genius to put the phenom ena of the marcrocosm and the microcosm in direct
causal relations...The first p art of the book is a tr ue w ork on climatology. It considers the d iseases that occur in a given locality in relation to its climatic position an d t o the
seasons. The second par t treats of the difference between Europe and Asia and without d oubt constitutes one of the most interesting books that classical antiquity has transmitted to u s. It is the first attempt to pu t external causes in direct connection with th e origin of diseases, but also with the constitution of man an d w ith the ethnic characteristics of nations. quot ed in 2 The Apothecary in Eighteenth-Cent ury W illiamsburg,
Williamsbu rg Craft Series, pu bl: Colonial Williamsbu rg MCMLXX 3 Stedman ’s 1987 ‘Discutient : Scattering o r d ispersing a path ologic accumu lation.’ refers to early med icines humoural view. 4 Epps 1832 5 Ibid 6 Stedman s 1987 7 This approach has su rvived its hu moural context. For examp le, un til the mid 1970’s malaria wa s used to treat syphilis, and is currently being researched as a treatment for Aids. The body can also create its own an tagon istic condition to a d isease as seen in sickle cell trait as defense again st malaria. 8 Kluger 1978 9 Epler 1980 10 Cauter y is like direct moxibustion. Setons and Issu es
introduce a thread or piece of metal posterior to an infection. The thread or m etal is left in place, causing a small surface infection which counters the deeper one. See Nielsen 1995, Brockba nk 1954, an d O’Conno r & Bensky 1981 (threadin g) 11 Kaim 1756 12 Gilles 1985 13 Jackson 1806 14 Mathew s 1931, The character for sha has several tran slations. ‘red dish elevated millet-like skin rash’, (Ou Ming 1988). Dr.So translated sha as sand or sharkskin. (So, lecture notes 1976) 15 Weiger 1965 16 McNeil 1989 17 Klug er 1978 Bloodletting m ay be th erap eutic in cases of infection from ba cteria. Bacteria are dep end ent u pon trace amounts of iron for grow th. ‘At elevated temperatures, bacteria app ear to be even more sensitive to red uced levels of iron.’ 18 Porket 1982 quoting Dr. Arthu r Jores 19 Ou Ming 1988 20 Epler 1980 21 Kaim 1756 22 Jinku e yaolu e fanglun . 220 Clause 1-15
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