East Meets West: Synergy through Diversity

Transcription

1 Forschende Komplementärmedizin Wissenschft Prxis Perspektiven Review Article Übersichtsrbeit Forsch Komplementmed 2016;23(suppl 2):3 7 DOI: / Published online: My 30, 2016 Est Meets West: Synergy through Diversity Stefn Hger Jingzhng Di,b Volker Fischer Folkert Lüthke Anton Studinger TCM Hospitl Bd Kötzting, Bd Kötzting, Germny b Beijing University of Chinese Medicine, Beijing, Chin Keywords Trditionl Chinese Medicine TCM hospitl Bd Kötzting Psychosomtic medicine Lifestyle medicine Psychoeduction Summry The TCM hospitl Bd Kötzting is historiclly the first inptient fcility in Germny with n emphsis on Trditionl Chinese Medicine (TCM). The clinic s specilty is the multimodl tretment of somtic complints in conjunction with cute psychologicl or psychitric comorbidity. Most ptients present with clinicl problems of high degree of chronicity nd complexity. Over the pst 25 yers the tretment concept of the hospitl hs developed from strictly TCM pproch to multimodl combintion of TCM, psychosomtic medicine, nd lifestyle medicine. This rticle outlines the dmission nd intke procedures nd describes the process of determining the TCM dignoses nd tretment protocols. A typicl cse study illustrtes this process in more detils. Then, we present the vrious components of the psychotherpeutic nd psychoeductionl progrms, including innovtive pproches to lifestyle medicine. In conclusion, the tretment progrm t the TCM hospitl Bd Kötzting hs developed into multimodl pproch tht synergisticlly intertwines diverse therpies drwn from Estern nd Western trditions, effectively combining the best pproches of both contexts S. Krger GmbH, Freiburg Schlüsselwörter Trditionelle Chinesische Medizin TCM-Klinik Bd Kötzting Psychosomtik TCM Lebensstilmedizin Psychoeduktion Zusmmenfssung Die TCM-Klinik Bd Kötzting ist historisch ds erste deutsche Krnkenhus mit einem Schwerpunkt uf der Trditionellen Chinesischen Medizin (TCM). Die Klinik spezilisiert sich uf die multimodle Behndlung somtischer Beschwerden, die zusmmen mit kuten psychischen Erkrnkungen uftreten. Die meisten Ptienten leiden n komplexen Symptomen mit einer lngen Vorgeschichte konventioneller Behndlungen. In der 25-jährigen Geschichte der Klinik ht sich ds Behndlungskonzept von einer reinen TCM-Orientierung hin zu einem multimodlen Anstz entwickelt, der TCM, Psychosomtik und Lebensstilmedizin verbindet. Dieser Artikel beschreibt den Voruswhl- und Aufnhmeprozess n der Klinik. Außerdem wird der Prozess der TCM-Dignosefindung und der drus bgeleiteten Therpieindiktionen erklärt und nhnd einer Ksuistik illustriert. Es folgt eine Beschreibung der verschiedenen Komponenten des psychotherpeutischen und psychoeduktiven Progrmms, welches uch innovtive Ansätze der Lebensstilmedizin umfsst. Zusmmenfssend wird festgestellt, dss die TCM-Klinik Bd Kötzting ein multimodles Behndlungskonzept entwickelt ht, ds therpeutische Ansätze östlicher und westlicher Provenienz zusmmenführt. Die drus resultierende Synergie ht sich ls überus fruchtbr erwiesen. Bsic Informtion The TCM hospitl Bd Kötzting is historiclly the first inp - tient fcility in Germny with n emphsis on Trditionl Chinese Medicine (TCM) s the min tretment modlity. It is government-licensed 75-bed hospitl which provides cre for bout 1,000 inptients nd more thn 2,000 outptients yer. Over 90% of the inptients re fully covered by the sttutory helth insurnce; bout 10% re self-pying ptients. In most cses the hospitl sty is bout 4 weeks. Fx Informtion@Krger.com S. Krger GmbH, Freiburg /16/ $39.50/0 Accessible online t: Stefn Hger, MD TCM Hospitl Bd Kötzting Ludwigstrsse 2, Bd Kötzting, Germny tcm.info

2 Fig. 1. Conceptul frmework. Over the pst 25 yers the tretment concept hs developed from strictly TCM pproch to multimodl combintion of TCM, psychosomtic medicine, nd lifestyle medicine (fig. 1). The mjority of our ptients present with clinicl problems of high degree of chronicity nd complexity. They frequently re referred to us with dignoses from the neurologicl, orthopedic, or internl medicine domins. Most come to us fter yers of conventionl tretment hve proven unstisfctory. Essentilly, our specilty is the multimodl tretment of somtic complints in conjunction with cute psychologicl or psychitric comorbidity. Thus, the vst mjority of our ptients crry both, somtic s well s psychitric dignoses. Predmission Procedures As prt of our predmission procedures prospective ptients fill out 4-pge questionnire detiling their physicl nd psychologicl complints, medicl history, desired tretment outcome, previous nd current dignoses, findings, etc. On the bsis of these dt the ptient receives one of three responses: () the request for tretment is pproved nd the ptient receives informtion bout further proceedings; (b) the request for tretment is denied nd the ptient receives informtion bout the resons; (c) recommendtion for outptient tretment prior to potentil inptient tretment is mde. If tretment request is ccepted, the ptient hs to procure the ssurnce of coverge from his or her helth insurnce crrier. Therefter, the ptient is dvised bout the prospective dte of dmission. In ddition, ptients receive instructions on filling out severl internet-bsed questionnires prior to dmission. These questionnires re designed to ssess vrious res of helth, stress, coping, resources, nd stisfction with multiple domins of life. The dt will be considered s source of informtion in the course of the initil medicl nd psychologicl ssessments. Ptient Admission On the dy of dmission the ptient undergoes first comprehensive interview nd exmintion by physicin trined in Western medicine. In the presence of the ptient, the findings from this interview will be jointly presented to TCM doctor (medited by trnsltor) s well s the ssigned psychotherpist. The TCM doctor will dd the TCM dignoses bsed on n evlution of the history, symptoms, clrifying questions, s well s tongue nd pulse dignosis. Drwing on this informtion, TCM dignosis nd n initil prescription of TCM tretments re being determined. The psychotherpist, in turn, tkes the opportunity to gther informtion bout the medicl bckground of the ptient nd to estblish first rpport. The TCM Process: Dignosis nd Tretment The TCM dignoses nd tretments re performed by doctors nd professors of the Bejing University of Chinese Medicine nd its ssocited university hospitls. The TCM doctor tkes detiled history of physicl nd vegettive symptoms, ugmented by informtion gined through tongue nd pulse dignosis (signs). Bsed on this comprehensive picture the TCM doctor rrives t n energetic dignosis on the bsis of the conceptul frmework of TCM (tking into considertion concepts like Qi, blood, yin/yng, 6-lyer model, etc.). Signs nd symptoms will be clustered round uniquely Chinese nosologicl ctegories nd dignostic terms, such s stgntion of meridins, liver-qi stgntion, blood stsis, dmpness, etc. We shll illustrte the TCM dignostic process for hypotheticl femle ptient with symptoms of chronic pin nd current dignosis of moderte depression. This ptient hs longstnding history of bck-pin; chronic personl nd professionl stress nd 4 Forsch Komplementmed 2016;23:3 7 Hger/Di/Fischer/Lüthke/Studinger

3 overwhelm; loss of energy; chordl pulse, nd bluish tongue with bluish stins. For dignostic workup, the TCM-doctor sorts the observed symptoms nd signs into clusters: Symptom cluster I (musculr tension, chordl pulse) gives rise to the dignosis of liver-qi stgntion. According to TCM techings, the liver network is of primry importnce for coping with stress nd stimuli. Blockges in the flow of liver-qi result in blockges in the circultion of bodily fluids, which ccounts for the observtion of the bluish tongue with bluish stins. Consequently, stsis of the blood gets coded into the dignostic frmework. Symptom cluster II is comprised of the following signs nd symptoms: loss of ppetite; ftigue with only 20% residul energy; dry mouth; night swets; incresed rumintions; difficulty concentrting; burning pin in the thighs; pulse qulity slippery. This symptom cluster suggests to the TCM doctor some digestive problems (coded s spleen-qi blockge) nd the resulting deficit in energy nd the vilbility of bodily fluids, coded s spleen-qi deficiency. Symptom cluster III includes: loss of interest; nhedoni; insomni; restlessness nd difficulty concentrting. According to TCM concepts, disturbnce in the hert network cn led to impired consciousness, insomni, difficulty concentrting, nd diminished memory, thus resulting in mentl nd emotionl impirments. Hence, the TCM doctor would dignose blockges in the flow of hert-qi. Symptom cluster IV encompsses the following symptoms nd signs: loss of interest; bck pin; ftigue; feeling exhusted nd beten up t night; difficulty concentrting; loss of libido; wek kidney pulse. According to the techings of TCM, low vitlity, diminished sex drive, nd lower bck pin together suggest n impirment of the kidney network, leding to dignosis of kidney-qi deficiency. In summry, the complete list of TCM dignoses for this smple ptient would red s follows: liver-qi stgntion with stsis of the blood; spleen-qi blockge with spleen-qi deficiency; hert-qi disturbnce, nd kidney-qi deficiency. Generl TCM Tretments t the TCM Hospitl Bd Kötzting The primry TCM tretment modlities include highly concentrted Chinese medicinl remedies, cupuncture, Tuin (mssge) nd Qigong. Bsed on the TCM dignosis, the TCM doctor prescribes tretment designed to ddress the observed ptterns of symptoms. First, there will be prescription for Chinese medicinl remedies, often mixture of herbs mounting to totl of g, which will be boiled nd turned into pproximtely 200 ml of decoction to be tken twice dily. Second, prescription for individulized cupuncture tretments will be formulted. Most ptients receive three cupuncture tretments per week. Since vst mjority of ptients lso suffer from pin in their muscles, joints or bck, two mnul tretments either Tuin mssge or individul Qigong tretment will be dded to the prescribed regimen in most cses. Furthermore, ll ptients prticipte in series of 18 exercises derived from time-tested Ti Chi-Qigong trditions. The exercises incorporte slow movements, deep brething techniques, nd imgery components. These medittive movements re being modelled nd prcticed in group setting for 30 min in the morning nd in the fternoon. Video instructions re lso ccessible on demnd for ll ptients. In ddition, ll ptients re introduced to the trditionl chnting of heling sounds s well s self-cre progrm clled Those numbers stnd for three cupressure points, deep diphrgmtic brething, nd two squts. Heling sounds nd re tught s self-cre interventions. Lst but not lest, ll ptients receive nutritionl counseling which provides generl recommendtions in ccordnce with TCM dietry principles s well s specific guidnce tilored to the individul s TCM dignoses. While our hospitl strives to offer nutritious nd wholesome mels, nd while we mke numerous llownces for specil dietry needs or preferences, it would be overly complicted to offer ech ptient diet tilored specificlly to their dignoses, tstes, nd idiosyncrsies (e.g. llergies, intolernces, low crbohydrtes, vegetrin, or vegn preferences, etc.). Thus, we cnnot fully prctice wht we prech; ptients re encourged to pply our dietry recommendtions fter returning home. Individulised Tretment According to the conceptul frmework of TCM, the choice of tretments is guided by the generl objectives of improving the flow of Qi nd of the bodily fluids (micro-circultion) nd of regulting the orgn networks to improve the vegettive, musculr, nd mentl functions [1]. Bsed on the TCM dignoses the following tretment objectives would be identified for the hypotheticl ptient with chronic pin nd depression: The finding of liver-qi stgntion nd stsis of the blood clls for tretment tht moves the liver-qi. The dignosis of spleen-qi blockge with spleen-qi deficiency requires therpy tht moves nd strengthens the spleen-qi. The hert-qi disturbnce, in turn, should be ddressed with interventions tht move the hert-qi. Finlly, the kidney-qi deficiency needs to be countered by strengthening of the kidney-qi. To these ends, the following Chinese medicinl nd herbl remedies nd cupuncture points would be prescribed: In order to move the liver-qi, the ptient would tke Chinese herbs tht hve been identified to regulte liver-qi (e.g., Rdix Bupleuri-chihu/Rdix Scutellrie-hungqin/Rdix Angelice sinensis-dnggui). The cupoints Liver 3 nd Lrge Intestine 4 would get needled. To move nd strengthen the spleen-qi, herbs such s Fructus Aurntii-zhishi/Rdix Pseudostellrie-tizhishen/Pori-fuling would be prescribed. The cupuncturist would needle the points Spleen 6 nd Stomch 36 bilterlly, s well s Conception Vessel 12. Est Meets West: Synergy through Diversity Forsch Komplementmed 2016;23:3 7 5

4 To counter the stsis of the blood, herbs such s Rhizom Curcume longe-jinghung/rdix Achyrnthis bidentte-niuxi/rdix Peonie rubr-chisho would be dded to the mixture, nd points long the bck of the ptient would get stimulted by cupuncture. Finlly, in order to sedte the mind nd llevite the hert-qi disturbnce, the medicinl remedy Culis Polygoni multiflorishouwuteng would be dministered nd the cupoints Pericrdium 6 (bilterlly) nd Hert 7 would get needled. In ddition, the ptient would prctice twice dily series of 18 exercises derived from the Ti Chi-Qigong trditions (see bove). Furthermore, the ptient is counseled how to optimize her diet ccording to Chinese dietry principles in order to support her tretment gols. Following dischrge, the TCM medicinl remedies should be continued t lower dosge for severl months. The ptient would be dvised to incorporte the Ti Chi-Qigong exercises s well s numerous other dietry nd lifestyle recommendtions into her dily routine. The exmple bove serves to illustrte the systemtic process tht guides the TCM dignoses nd tretments: It is process of pttern recognition tht moves from the dignostic nlysis to the therpeutic ppliction in n orgnized fshion. In most cses, the primry tretment modlities re the ppliction of medicinl remedies nd the stimultion of the meridin system. Psychotherpeutic nd Psychoeductionl Progrms The conceptul frmework of the psychologicl tretment components is behviorl in orienttion with n emphsis on () improving the regultion of ffects, (b) reducing dysfunctionl cognitions, nd (c) teching ptients to tke chrge of their heling process through lifestyle djustments, self-cre pplictions, nd preventive mesures. A unique feture of our tretment pproch is the utiliztion of comprehensive, web-bsed helth-mintennce progrm [2]. Even prior to dmission, ptients receive ccess to this progrm nd re encourged to tke dvntge of its mny fetures nd components. The dt entered by ptients provide informtion for our therpists; simultneously, they serve s progress ssessment tool for the ptients themselves. The dt entered by the hospitl include dignostic informtion (including lb dt) nd record of ll therpeutic interventions. Thus, the ptient hs ccess to self-generted s well s hospitl-generted informtion. In ddition, the helth mintennce progrm links to welth of in-depth informtion, offering ech ptient the opportunity to further explore mny helth nd lifestyle topics tht get introduced, nd preferbly prcticed, in our multi-disciplinry presenttions nd lectures (see below). The helth mintennce progrm serves s yet nother venue to encourge ptients to get informed nd ctively engged in their heling process, both during nd fter the inptient sty. This computer ppliction is designed to fcilitte n interctive lerning process which is founded on the didctic concept of blended lerning. Above ll, we try to convey psychosomtic understnding of the mind-body connection. This often necessittes chnging the ptient s implicit disese model from lrgely externl to more internl locus of control. To such end, we drw on Western psychologicl insights, imprt helth nd lifestyle informtion, nd explin Estern mind-body concepts. For instnce, we my educte our ptients bout the bsic TCM premise tht disturbnces in the flow of Qi due to internl fctors, such s excessive or imblnced emotions, cn led to the mnifesttion of functionl (Qi-flow disturbnces) or somtic symptoms (Qi- nd blood-flow disturbnces). Individul Psychotherpy Following first encounter between ptient nd psychotherpist during the joint intke conference (see bove), n in-depth intke interview is conducted on the second dy of the inptient sty. Topics usully ddressed re: pst nd current physicl nd emotionl symptoms; mentl sttus nd level of functioning; nmnestic dt regrding the fmily of origin, eductionl nd voctionl history, nd significnt reltionships; stressors, resources, nd stisfction in vrious res of life. The purpose of the intke interview is, () to estblish tretment llince between ptient nd therpist; (b) to rrive t psychopthologicl ICD dignosis; nd (c) to determine tretment gols tht reflect psychosomtic understnding of the presenting problems. In more or less formlized process, ptient nd therpist jointly develop individulised tretment gols, such s: Incresed wreness of emotions, cognitions, nd inner sttes; Improved self-regultory competencies, especilly the incresed bility to relx nd reduce stress; Improved sense of self; reduced self-criticl cognitions; greter kindness towrd self; Heightened sense of responsibility, gency nd control, prticulrly regrding helth, self-cre, diet, nd prevention; Reduced nxiety nd voidnce behviors; Improved reltionship ptterns (e.g., setting limits; being more uthentic or ssertive); Processing of stressful or trumtic life experiences; Counseling regrding specific deficits or symptoms (e.g., sleep, pin, exercise, brething, diet, nxiety, depression); Development of life gols, ction plns, nd/or fter-cre recommendtions; Motivting the ptient to pursue outptient (psycho)therpies. In the course of the inptient sty, the ptient tkes prt in t lest one individul psychotherpy session (50 60 min) per week. During the lst session, progress review tkes plce, often tking into ccount the dt from before/fter self-reports (ISR). Most ptients receive fter-cre recommendtions nd, when pproprite, suggestions regrding further outptient tretments. Psychoeductionl Progrmming nd Lifestyle Medicine Over the spn of the inptient sty, ll ptients prticipte in nine-prt, multi-disciplinry group progrm, conducted in equl prts by Western physicins, psychologists, nd helth coches. 6 Forsch Komplementmed 2016;23:3 7 Hger/Di/Fischer/Lüthke/Studinger

5 Fig. 2. Comprehensive tretment process t the TCM hospitl Bd Kötzting. Prt 1 (physicin) gives n overview of the tretment progrm nd explins the underlying principles. Prt 2 (physicin) introduces ncient Chinese ides bout Yngsheng (self-cre nd prevention) nd builds bridge to Western concepts with specil reference to dt collected through our web-bsed helth mintennce progrm. The topics discussed pertin to generl helth fctors; stisfction with vrious res of life; ffect mngement; diet; exercise, nd relxtion. Prt 3 (helth coch) covers bsic concepts of stress nd coping in reltion to helth or lck thereof. Prt 4 (psychologist) introduces the concept of emotionl intelligence with n emphsis on self-wreness, mindfulness, nd the ttitude of grtitude s n ntidote to bitterness. Prt 5 (helth coch) discusses the significnce of emotions for person s helth nd strtegies for improving ffect mngement. Prt 6 (psychologist) ddresses the effects of chronic nd trumtic stress nd elbortes on stress-inducing cognitive ptterns (be liked, be perfect, be on gurd, etc.). Prt 7 (helth coch) discusses resiliency, resources, gency nd control, nd self-motivtion. Prt 8 (psychologist) reviews cognitive-behviorl strtegies for reducing stress-inducing cognitive ptterns. In ddition, the process of self-governed chnge is discussed, emphsising responsibility, gency, nd resources. Prt 9 (physicin) reviews the tretment progrm, the tkehome messges, nd the significnce of implementing helthpromoting lifestyle djustments fter the return home. This mndtory nine-prt progrm outlined bove is ugmented by severl presenttions bout diet nd nutrition, sleep hygiene, nd dditionl lifestyle topics. The Inptient Process: Pulling It All Together The course of tretment over time is summrized in figure 2. In summry, over the pst 25 yers the tretment progrm t our hospitl hs developed into multimodl pproch tht synergisticlly intertwines diverse therpies drwn from Estern nd Western trditions. Combining the best of both pproches, we hve found tht the totl mounts to more thn the sum of its prts. Disclosure Sttement All the uthors re employed t the hospitl; A.S. is the owner of the institution. References 1 So RWL, Wong HS, Ko KM: A trditionl Chinese medicine pproch in treting depression by promoting liver qi circultion: western medicine perspective. Chinese Medicine 2015; 6: Melchrt D, Eustchi A, Wellenhofer-Li Y, Bohnes E, Doerfler W: Individul helth mngement comprehensive lifestyle counselling progrm for helth promotion, disese prevention nd ptient eduction. Forsch Komplementmed 2016; 23: Est Meets West: Synergy through Diversity Forsch Komplementmed 2016;23:3 7 7