Investigate the emergence of epidemics in the late 20th and 21st century, based on reported published well written literature. What function does Chinese Medicine offer?
Author: Mark Mayes. This article is from my undergraduate days studying at Victoria University Bachelor of Chinese Medicine (Acupuncture and Herbs) double degree course. This is a third year assignment for the subject: MAJOR CLASSICS. Its been slightly updated to allow smoother transitions between ideas with relevant links included.
The definition of epidemic is a disease that rapidly affects a significantly large number of people with the same demographic segment of the population or geographical area (Harris, Nagy & Vardaxis, 2006). Throughout human history emerging infectious disease is not a new concept, in many instances there have been constant swellings of epidemics throughout the world. As recent as the twentieth-century, British physician Thomas McKeown debated with colleagues how a potential symbiotic relationship can exist between humanity at the local community level, together with their environment (Drexler, 2002). In other words, its not solely medical treatments or products that reduce the mortality rates of infection but rather its an overlapping set of circumstances. Microorganisms thrive and cause disease, in conditions that are squalid with people living in close quarters, eventually pathogens will contaminate food and/or water with the potential for epidemic outbreaks. This potential can be prevented if people together with public health procedures are implemented. The aim of this paper is to examine the published literature on the emergence of epidemics during recent times and to recommend where Chinese Medicine can be integrated into the global health paradigm.
Conditions which contribute to recent epidemics
Upon examination of the literature concerned with epidemics, today the global population is confronted with increasing levels of pathogenic microorganisms. The natural characteristics of these organisms is ‘survival,’ distinguished by their perpetual evolution and adaptability to new environments. Likewise, human beings have similar mechanisms, the difference is, that new generations of pathogens are conceived every thirty minutes, adding ever increasing pressure on medical science to adapt to them (Drexler, 2002; Mandell, Douglas & Bennett, 2005; Newman, Kelly, Harper, File & Carmago, 2007).
During the twentieth century science evolved rapidly with the development of penicillin (Penicillium notatum), thanks to the Scottish bacteriologist Alexander Fleming who made the initial discovery in 1928. This advancement had accomplished exceptional results in therapeutic efficacy by reducing deaths caused by for example staphylococcus infections (Staphylococcus aureus), today these strains are considered a multi-drug resistant bacteria, increasingly becoming resistant to penicillin treatments.
As the decades past complacency developed amongst the medical profession due to over prescribing and under their noses microorganisms became evermore resistant to their interventions. By the 1970’s and 1980’s new pathogenic microorganisms emerged, for example, acquired immune deficiency syndrome (AIDS), Lassa fever and severe acute respiratory syndrome (SARS) turning the established attitudes upside-down (Drexler, 2002; Huber, 2004).
Since the 1980’s globalization has been a major contributor to microbial spread, resistance and escalation of potential epidemics for example, Mandell et al. (2005) states that ‘today’s highly globalized and interconnected world enhances the rapid spread of infectious pathogens.’
The following points contribute to and enhance the emergence of epidemics;
1. Changes in human demographics and behavior
2. The impact of new technologies
3. Economic development and changes to land use
4. Increased international travel
5. Microbial adaption and change
6. The breakdown of public health measures
7. Global trade increasing carbon emissions
8. Increased movement in goods, services and people
9. Climate change
Moreover, a further negative effect of globalization deprives low income countries from self development, adding further to the proliferation of pathogenic microorganisms. In these countries their financial services funnel resources into long standing debts, creating slow economic growth leading to inadequate investment in education, health services, wellbeing and quality of life (Peoples health movement, 2005).
In the last ten years (2007) we have witnessed nine of the warmest years on record and it’s anticipated to increase (Peoples health movement, 2005). Consequently, expert predictions of what will manifest is uncertain, but the effects of rapid climate change could invoke increased outbreaks in vector-borne epidemics. Such as, malaria and dengue fever emerging in periods of drought and sudden spring rains (Drexler, 2002 p.64).
Firstly, it has to be said infection control and treating febrile disease is a complicated issue, especially when fighting pathogens that have evolved over millions of years. Having said that, it does not excuse poor application or lack of discipline in prescribing antibiotics which has also lead to the proliferation of resistant pathogens and their extension into the community, hospitals and general medical practice. This has not occurred without warning, Alexander Fleming also discovered antibiotic resistance and in 1945 he coined the term ‘evolutionary selection,’ where some bacteria prospered and took over in penicillin. Within four years staph infections in hospitals increased from 14 to 59 percent and today almost 100 percent are penicillin resistant (Drexler, 2002), although this last fact could be argued.
The outcome of overuse from broad-spectrum antibiotics and prolonged exposure has resulted in wide spread infections, increased severity, mortality and costs due to protracted illness worldwide. For instance, a conservative statistic from Weber (2006) points out that hospital acquired infections increased over a twenty year period (1975 to 1995) from 7.2 per 1000 hospital days to 9.8 per 1000 hospital days an increase of 2.6 days. Not only can the medical profession be held accountable for lack of initial knowledge or over prescribing, but, also farming practices as well. Yes, I said it - farming practices. A downstream effect occurs in food supplies due to the over administration of antibiotics to live stock also exposing the public to resistant strains (Chiang et al, 2002; Drexler, 2002; Johnson, Stilwell, Fritsche & Jones, 2005; Weber, 2006).
So why integrate Chinese Medicine with current practices of western medicine? There are several reasons for this recommendation; firstly from a public health perspective physicians have a responsibility to provide ‘optimal’ care of those who are sick (Huber & Wynia, 2004). Secondly, the Chinese have a long history of clinical experience dealing with emerging epidemics and thirdly the fundamental role of Chinese Medicine is to ‘do no harm’ when dislodging pathogenic invasion which has favorable clinically road tested outcomes for more than one thousand years. This last point is a clear weakness in biomedical medicine when treating of multi-drug resistant microorganisms.
For instance, when providing safe and optimal health care for hospitalized infections the initial treatment is flawed because biomedicine is based on laboratory blood culture results. Until such time the results are determined together with focused treatment, inappropriate broad-spectrum empirical therapies are utilized which may substantially increase the mortality risk, antibiotic resistance or be the incorrect medicine. In such situations, Weber (2006) suggests that an infectious disease specialist could have a profound impact in the management of severe bacterial infections. The amalgamation of both medical paradigms can have an even more profound effect whereby the Traditional Chinese Medical specialist administers a herbal formula according to diagnosis before exact pathogen is known, during and after blood culture results are determined. This integration I would suggest shortens the patient recovery time and reduce the number of days in hospital (Esposito & Leone, 2006 p.497; Huber & Wynia, 2004; Weber 2006).
The value of Chinese Medicine has accrued over many years, for example, during the Song dynasty (960-1127) there was a rise in the number and frequency of epidemics due to social changes similar to globalization today. For the first time in Chinese history the majority of the population resided in the south a much warmer climate, the volume in trade increased and a spread in urbanization occurred. As a result, a rearguard action from the imperial government focused attention on merging the then present day approaches to medicine and revised ancient texts such as;
Shang Han Lun (200 AD) - (Focusing On Cold Damage, The Effects Of Cold Weather) and
The fledgling stages of Wen Bing (1100 AD) - (Warm Climate Infectious Disease).
The three books published with this article where the only three of four (the fourth Nan Jing: Difficult Issues) medical references for contagious disease existing during that time. With Song dynasty contemporary thought now taking into account the patients constitution, different geological areas together with changing climate conditions (seasons) of the year and that changed the treatment strategies to adapt to and counteract evolving pathogens.
Think about that for a minute... Herbal medicine strategies have been adapting to changing conditions since the Song dynasty for over 1,000 years. Whereas, contemporary medicine today cannot evolve quick enough due to multi-drug resistant gram-negative bacteria or severe acute respiratory syndrome SARS 1 or currently Long Covid.
In addition, herbal formula’s originating from this period such as Yu Ping Feng San where created to improve immune system and protect individuals from contracting infections. This product is available to order at our website National Herb Doctor.
(Bensky & Barolet, 1990; Goldschmit, 1999; Liu, 2005; Poon et al; 2006).
In some instances of treating multi-drug resistant microorganisms western medical treatment is aggressive using more potent medicine that can be toxic and increase the side effects by altering administration techniques of dose and duration, which in turn reduces its efficacy. This strategy might further debilitate the patient’s resistance and damage functions vital for life. The hallmark of herbal medicine is to prevent undesirable side effects, its individualized approach is to provide diagnostic and treatment strategies based on overall analysis of sign and symptoms that may vary over the course of the infection.
From recent knowledge gained during the emergence of SARS 1, an integration of both paradigms can be used to augment the other. In addition, to inhibiting the ability for pathogens to flourish, herbal medicine has unique ability to at certain stages of infection can improve the patient’s immune function by supplementing Qi (Ren Shen, Zhi Gan Cao, Da Zao) and nourish Yin (Sheng Di Huang, Mai Men Dong and Xuan Shen) this can be crucial in reducing mortality by stopping the pathogen diving deeper into an already weakened immune system. Accordingly, the resultant effect of its application has a reduction in lymphocyte activity and T-lymphocyte numbers increasing, accelerating recovery from pathogenic invasion. Meaning the immune function has been strengthened, vital substances protected and pathogens expelled (Esposito & Leone, 2006; Jun et al 2004; Ryan, 1994; Teeguarden, 1984; Zaiyang et al, 2004).
When exposed to the light, facts stated above have shown a considerable decline in the efficacy of western medicine due to, in many instances incorrect treatment and to the resilience of microorganisms. It has been revealed that current medical procedures are not solely to blame for the emergence of epidemics, but also the dynamics of globalization and its interaction with the environment at all levels allows these conditions to prosper. During the recent SARS 1 epidemic Chinese medicine has proven its self a reliable colleague to Western medicine and now more than ever we need to consider these separate entities as one before emerging epidemics transform into pandemics.
Bensky, D., & Barolet, R. (1990). Chinese herbal medicine formulas & strategies. Seattle: Eastland Press.
Drexler, M. (2002). Secret agents: the menace of emerging infections. New York: Penguin Books.
Esposito, S., & Leone, S., (2006). Antimicrobial treatment for Intensive Care Unit (ICU) infections including the role of the infection disease specialist. International Journal of Antimicrobial Agents 29 (2007) 494-500
Garret, L. (1994). The coming plague: newly emerging disease in a world out of balance. New York: Farrar, Straus and Giroux.
Goldschmidt, A (1999). The transformations of Chinese medicine during the northern song dynasty (A.D. 960-1127): The intergration of three past medical approaches into a co. Michigan. Pro Quest.
Harris, P., Nagy, S., & Vardaxis, N. (2006). Mosbys dictionary of medicine, nursing & health professions. Sydney: Mosby Elsevier.
Huber, S., & Wynia, M. (2004). When Pestilence Prevails…Physician Responsibilities in Epidemics. The American Journal of Bioethics 4 (1): W5-W11.
Johnson, D., Stilwell, M., Fritsche, T., & Jones, R., (2006). Emergence of multidrug-resistant Streptococcus pneumonia: report from the SENTRY Antimicrobial Surveillance Program (1999-2003). Diagnostic Microbiology and Infectious Disease 56 (2006) 69-74.
Jun, L., Shaodan, L., Jinchao, L., Fusheng, W., Ning, D., Yi, D., Yongping, Y., & Xiaohe, X. (2004). Influence of integrated therapy with Traditional Chinese medicine and Western medicine on lymphocytes and T-lyphocyte subpopulations of patients with SARS. Retrieved September 7, 2007 from http://whqlibdoc.who.int/publications/20049241546433_report8.pdf
Liu, G. (2005). Warm pathogen disease: a clinical guide (Revised ed.). Seattle: Eastland Press.
Mandell, G. L., Bennet, J. E., & Dolin, R. (2005). Mandell, Douglas, and Bennett’s principles and practice of infections (Sixth ed., Vol. One). Philadelphia: Elsevier Churchill Livingstone.
Neuman, M., Kelley, M., Harper, M., File, T., & Carmargo, C. (2007). Factors associated with antimicrobial resistance and mortality in pneumococcal bacteria. The Journal of Emergency Medicine 32 (4) 349-357.
Peoples health movement. (2005). Global health watch 2005-2006: an alternative world health report. London: Zed Books
Poon, P., Wong, C., Fung., Fong., Wong., Lau., Leung., Tsui., Wan., Waye., Au., Lau., & Lam. (2006). Immunomodulatory Effects of a Traditional Chinese Medicine with Potential Antiviral Activity: A self-control study. The American Journal of Chinese Medicine, 34 (1) 13-21.
Ryan, M., & Shattuck, A. (1994). Treating aids with Chinese medicine. Berkeley: Pacific View Press.
Teeguarden, R (1984). Chinese tonic herbs. New York: Japan Publications, Inc.
Weber, D. (2006). Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. International Journal of Infectious Disease 10 (S2) S17-S24.
Wen, J. M., & Seifert, G. (2000). Warm disease theory: Wen bing xue. Brookline: Paradigm Publications.
Zaiyang, J., Xudong, T., Wensheng, Q., Yongjun, B., Qinqiao, S., Gongsu, L., Zhongzhong, Z., Yalong, F., Yinghui, W., Xiaopei, X., Rongbing, W., Yifan, C., Baoyan, L., & Yanming, X. (2004). Evaluation of clinical curative effects of Traditional Chinese medicine in treatment of patients convalescing from SARS. Retrieved September 7, 2007 from http://whqlibdoc.who.int/publications/20049241546433_report10.pdf