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MESSAGES TO

Traditional Chinese Medicine (TCM)

A DxD Session with Lee Jin Shun


Ended on Thu Nov 15 2018
Ended

Top Answers


Thank you for giving me the opportunity to address this issue. Traditional Chinese Medicine is broadly classified into two types:

  • Medicinal materials (from plants, animals, or minerals in their natural states, or in processed forms that have undergone simple processing, such as trimming or desiccation.
  • Chinese proprietary medicine (CPM) (finished form such as capsule, tablets and granules).

Currently, only CPMs are subject to pre-market approval and licensing for their import and sale in Singapore. The next time you purchase a CPM product, you should look out for the following label:

TCM medication singapore

There are specific guidelines for traditional medicinal materials. According to the Health Science Authorities, (HSA) it is the responsibility of the dealer to ensure that:

(a)  The traditional medicinal materials do not contain any substances controlled under the Poisons Act and other prohibited substances such as Pangamic acid including its salts, Danthron, Suprofen including its salts and Rhodamine B.

(b)  The heavy metal contents of the traditional medicinal materials do not exceed the following limits: Arsenic (5 ppm), Copper (150 ppm), Lead (20 ppm) and Mercury (0.5 ppm).

(c)  The labels and packaging materials of the traditional medicinal materials (if any) do not stipulate any of the 19 diseases/conditions specified in the Schedule of the Medicines (Advertisement and Sale) Act, namely, blindness, cancer, cataract, drug addiction, deafness, diabetes, epilepsy or fits, hypertension, insanity, kidney diseases, leprosy, menstrual disorders, paralysis, tuberculosis, sexual function, infertility, impotency, frigidity, conception and pregnancy.

28 Aug 2018

This question brings me back to my undergraduate days. My journey with TCM started with a double degree in Biomedical Sciences and Traditional Chinese Medicine that is jointly conferred by the Nanyang Technological University and Beijing University of Chinese Medicine.

Just like any medical student, I had to go through 5 years of study and clinical rotation.

In addition, I also had to fulfill 400 hours of post-graduate clinical internship before I was allowed to sit for the Singapore TCM Physicians Registration Examination (STRE). This exam is organized annually by the Traditional Chinese Medicine Practitioners Board (TCMPB), a statutory board under the purview of Ministry of Health (MOH).

Candidates who passed the examination will be issued a registration certificate. Thereafter, a person is said to be registered and licensed by the TCMPB, and is allowed to practice.

tcm singapore

28 Aug 2018

Hi Siew Ping, 

When you're looking for a TCM physician in Singapore, there are a few things that you should take note of.

Firstly, you should find out if the physician is registered with the TCM Practitioners Board (TCMPB), a statutory board under the charge of Ministry of Health (MOH). If you are at his/her clinic, you should ask to see the physician’s registration certificate. Most of the times, the certificate will be hanging on the clinic's wall.

Here's a sample certificate: 

tcm singapore

Alternatively, you may visit the official website at www.tcmpb.gov.sg to verify his/her status.

Secondly, you may want to consider the physician’s academic qualifications, area of interest, years of experience and recommendations through online forums or by word of mouth. I believe that all TCM physicians are proficient and competent in their areas of specialty. The best physician should be one who is able to address your concerns. 

28 Aug 2018

'Qi' has a philosophical root from Taoism, and is believed to be the vital energy behind all occurrences in the universe and living entity.

As you can see from the table shown below,'Qi' and its movement plays a pivotal role for these processes to happen. In the absence of the energy source, there will be no structural or chemical changes and everything will be stagnant.

 

Rain formation (Universe)

Digestion (Human)

Material

Water

Food

Qi (energy source)

Sun

Intestinal contraction, enzymes

Building block

Water vapor

Nutrients

Movement

Evaporation - Upwards into sky

Absorption – inwards into blood

Condensation – forms cloud

Anabolism – promotes growth

Precipitation – falls as rain

Excretion – downwards as waste


'Qi' originates from two sources:

1. Innate or inherited from our parents before birth as Essence (精) 

2. Acquired after birth from our diet, air and water. We are given the innate ability to digest food through enzymatic breakdown and intestinal contraction, but we will need continuous (acquired) supplementation from our diet and oxygen to replenish this innate ability. The two sources are therefore, said to be interdependent.

Qi

Function

Overview

Physiological (Normal)

Pathological (Abnormal)

Promoting

Growth & development, organ functions

Normal growth rate in newborn; regular heart rate etc.

Delayed growth and development in newborn; irregular heart rate

Warming

Warming the body and maintain functional activities

Body temperature is normal; respiratory and digestive functions are normal

Body feels cold; excessive phlegm production and diarrhea

Defending

Ward off pathogens

Fight diseases

Does not fall sick easily

Able to recover within expected timeframe

Falls sick frequently

Takes a longer time to recover or tendency to relapse

Consolidating and governing

Holds organ in place

Fluids flow within stipulated location

Anus and uterus are held in place; Blood flows within vessels

Anal, uterine prolapse

Abnormal bleeding

Transformation

Metabolism, conversion of material from one form to another

Food is broken down into nutrients, absorbed into the bloodstream and promote growth

Indigestion –flatulence, pain, constipation; poor absorption – nutritional deficiency; delayed growth

30 Aug 2018

Body type is a mode of classification founded on TCM principles and observations which categorizes an individual’s constitution based on his/her predominant physical and psychological characteristics.

Hence, this explains someone's temperament and susceptibility to certain medical conditions. An individual often exhibits a principal body type with a combination of the others.

You were told that you have a yin and cold body type, in other words – Yang deficient (low in Yang energy). This means that you often experience cold extremities and are sensitive to cold weather and environments. You prefer warm places, hot food, and tend to be introverted. Typically, a Yang deficient person, is susceptible to water retention and excessive weight gain.

The nine (9) major body types are:

  1. Neutral (well-balanced type)
  2. Yang deficient (cold type)
  3. Yin deficient (hot type)
  4. Qi deficient (fatigue type)
  5. Qi stagnation (sentimental type)
  6. Phlegm and Dampness (water retention type)
  7. Damp-heat (inflammatory type)
  8. Blood-stasis (poor circulation type)
  9. Hypersensitivity (allergies type)

Hope this helps!

30 Aug 2018

Acute Coronary Syndrome is a medical emergency and should be attended promptly by a hospital medical team. However, you may consider TCM treatment once the condition stabilizes, and we can explore the possibility of preventing the deterioration or slowing the progression of ACS.

ACS may be managed under ‘chest pain’ (胸痹) in TCM and a consultation is necessary to assess your body constitution and the primary cause to it.

TCM is also effective in disease prevention especially when one starts to show early signs of certain diseases.

30 Aug 2018

This is a question I get very often. Pulse taking is crucial, but does not necessary provide adequate information to make a diagnosis.

A physician collects medical history, signs, and symptoms through the four diagnostic methods. He/she then analyzes the information, and derives a syndrome. This analysis lays down the foundation for a treatment methodology and plan.

The four diagnostic methods are:

  1. Inspection (望): tongue color, coating, gait, facial expression, wound assessment etc.
  2. Olfactory and Auscultation (闻): cough and lung sounds, abnormal odors, vocals etc.
  3. Inquiry (问): inquire further with specific questions to confirm physician’s diagnosis.
  4. Palpation (切): pulse taking, physical examination such as abdomen, joints etc.

Here's an example of the diagnosis process:

Four diagnostics (Inspection, Olfactory & Auscultation, Inquiry, Palpation

Collect medical history, signs and symptoms (Sore throat, yellowish phlegm, fever

Syndrome (Upper respiratory infection of the Wind-heat type 风热型

Methodology (e.g. to expel Wind-heat 疏风散热)

Treatment plan (e.g. herbal prescription such as Mulberry and Chrysanthemum Decoction 桑菊饮)

30 Aug 2018

Hi Wei Jie,

We were taught the various organ systems and their functions during our TCM Diagnostics module. Some examples are the spleen governs the digestive system, the lung oversees immunity, and the heart is in charge of the mind.

The basis of TCM diagnosis is what we called syndromes classification (辨证型), which are sets of signs and symptoms grouped together.

A physician collects medical history, signs and symptoms through the four diagnostic methods, analyzes the information, and derives a syndrome. It then lays down the foundation for a treatment methodology and plan.

Four diagnostics (Inspection, Olfactory & Auscultation, Inquiry, Palpation) → Collect medical history, signs and symptoms (Sore throat, yellowish phlegm, fever) → Syndrome (Upper respiratory infection of the Wind-heat type 风热型) → Methodology (e.g. to expel Wind-heat 疏风散热)→ Treatment plan (e.g. herbal prescription such as Mulberry and Chrysanthemum Decoction 桑菊饮)

30 Aug 2018

Hi Ming Lie,

Toxicity refers to undesirable and harmful effects produced by an herb that is unintended for its therapeutic effect. Toxicity may occur from overdose or when a drug has a narrow therapeutic index; the difference in its effective dose and toxic dose is very narrow.

Apricot seeds contain a compound which is converted to cyanide in the body, which inhibits the brain’s respiratory centre, explaining its ability to relieve cough and asthma.

It is also used to relieve constipation because of its oily content. However, overdosing or consuming it over a long period of time may potentiate cyanide poisoning.

Currently, all the herbal medicine physicians prescribe to their patients herbal have to be in accordance with the principles and requirements recommended by the TCM Pharmacopoeia (中药药典).

 

Herbal prescription consists of several herbs that are combined together with the purpose of enhancing the herb’s properties /action (improve performance) and to decrease its toxicity (minimize any possible side effects).

Therefore, it is important to consult a trained and licensed TCM practitioner to take charge of your health issues, where herbs can be used under supervision.

30 Aug 2018

Hi Kheng Siong,

There are numerous reasons that can cause insomnia. For example, a blocked airway due to allergies, heartburn from indigestion, painful medical conditions such as arthritis, premenopausal symptoms, or psychological disorders such as depression and anxiety.

So we come back to the concept of syndromes classification (辨证型), in which insomnia is divided into five syndromes. The physician you consulted most probably diagnosed each of you under a different syndrome, hence, two completely different prescriptions.

30 Aug 2018

It depends on what medical condition you are seeking treatment for.

tcm singapore tcm acupuncture

Acupuncture, which is recognized by the World Health Organization (WHO) is advantageous towards painful conditions such as sprain, muscle strain, arthritic disorders.

Some patients experience immediate relief after a single treatment. Herbal prescription, however, requires more time to take effect as the dose builds up in the bloodstream.

In general, acute conditions such as common cold, back sprain see faster and better results, while chronic conditions such as osteoarthritis, diabetes and high blood pressure etc require a longer course of treatment.

30 Aug 2018

Hi Jing Ni,

Natural does not always equate to safety. We have heard of poisonous plants and fruits in the nature which can have detrimental effects when consumed.

However, the herbs that a physician prescribes has been used over thousand of years and proven to be safe.

In addition, Chinese proprietary medicines (CPMs) are regulated by the Health Sciences Authority of Singapore (HSA) and manufacturers of medicinal herbs are obliged to ensure they comply with local regulations, free of heavy metals and adulteration with substances under the Poisons Act and/or active synthetic substances.

Dealers are also required by the law to report any adverse drug reaction within 7 days arising from the product which they are dealing. Herbs and/or products that are found to be unsafe will be isolated and barred.

It is therefore, I'd advise you to seek treatment from a professional and licensed TCM practitioner. The next time you purchase a CPM product, look out for the following label, this shows that the product has passed surveillance checks by HSA.

tcm singapore

30 Aug 2018

Patients are advised to take them separately to prevent potential drug-drug interactions.  It occurs when a compound affects the activity of a drug when both are taken together.

tcm singapore tcm singapore

If one increases the effect of another, an overdose may occur or the side effects profile may be intensified. Similarly, if the efficacy of a drug is reduced, it will not elicit a therapeutic response and can be dangerous in some instances (e.g. diabetes).

However, there remains a possibility that they may generate enhanced results when taken together, than when taken alone, but more extensive research is warranted for it to be conclusive. Therefore, there is no harm heeding your physician’s advice and remember to take them two hours apart.  

30 Aug 2018

Truth to be told, diabetes cannot be found in ancient TCM literatures.

However, a condition called “Xiao Ke” (Wasting-Thirst) was mentioned in the Yellow Emperor’s Classic of Internal Medicine written in Han Dynasty (黄帝内经), which has records of the following symptoms: frequent thirst, excessive hunger, sweet-tasting urine, and weight loss. Doesn’t it sound exactly like the diabetes that we know?

Therefore, diabetes may be treated under “Xiao Ke” which arises due to a deficiency in body fluids with production of dry heat.

A person may inherit this body constitution from his/her parents (congenital or Type 1 diabetes) or acquire it through improper diet such as high in sugar, greasy, fried food, lack of physical exercises and excessive emotional activities such as stress (type 2 diabetes).

In TCM, the lungs, spleen and kidney are responsible for water regulation, overseeing metabolism, distribution and excretion of fluids throughout the body, while the dry heat often exhibits in the stomach system as excessive hunger.

Thus, TCM manages diabetes through the replenishment of body fluids (Yin) to subdue the excessive production of dry heat. This is usually achieved through herbal prescription and/or acupuncture. Some commonly used herbs are kudzu root (葛根), Chinese yam (山药), or a formula called Jade Woman Decoction (玉女煎).

Acupoints include SP6 San Yin Jiao (三阴交) to replenish Yin and ST44 Nei Ting (内庭) to expel stomach fire. Patients are advised to adopt a healthy lifestyle - engage in physical exercise, refrain from cigarette smoking and alcohol, watch their dietary habits and regulate their emotional status.

30 Aug 2018

Thank you for your interest in seeking TCM to manage your insomnia. 

tcm singapore insomnia

I always tell my insomniac patient that everyone is born with the innate ability to fall asleep, so sleep should happen naturally, just like breathing! Sometimes, what we need is just a little helping hand to tune us back. 

In fact, there are many possible reasons such as allergies, indigestion, pain, stress and anxiety which can lead to poor quality of sleep. Mental stress and fatigue makes up majority of the cases I see in practice. 

According to TCM, insomnia arises due to imbalances in yin and yang, which is analogous to the circadian rhythm. The sympathetic nervous system a.ka excitatory component (Yang) prepares us for fight and flight in the day, while the parasympathetic nervous system a.k.a relaxing portion helps us to unwind at night.

Due to availability of modern technology, we are now able to work 24/7 and are constantly exposed to large amount of information, which can lead to over-stimulation of the excitatory system and insomnia. 

We can only tackle the problem once its underlying cause is found. Hence, a physical consultation is necessary for a diagnosis to be made. Common methods we use include herbal prescription and acupuncture, examples are Rambling powder (逍遥散) and the Bai Hui (百会) acupoint respectively. 

In addition, patients are advised to abstain from mental work  or using of smartphones at least 1-2 hours before bedtime, have a small and light dinner and to regulate self emotional status. 

I hope you find this information useful! Do let me know if you have further question. 

Wishing you best of health!

Cheers!

3 Sep 2018

Gastrointestinal disorders are common among the population. Possible reasons include food allergies, gastro-esophageal reflux (GERD), gastric ulcers, gastroparesis (food moving slower) irritable bowel, constipation etc. 

In TCM, we seek to investigate and resolve the underlying factor resulting in your bloat so that you can feel well again. Contributing factors can be diet, stress, smoking, drinking, allergies etc. 

A physical consultation is often necessary as a TCM physician will need to assess your signs & symptoms, tongue and pulse in order to make a diagnosis. Some commonly asked questions are:

"Can you point out the exact spot?"
"Is there excessive belching, heartburn, bitter taste in the mouth?"
"Does the bloat occur when hungry or after meal?"
"Is there a specific period of the day you feel more bloated?"
"Is it related to your menstrual period?"
When this portion is done, the physician will take your pulse and look at the tongue. 

These information will be analysed for a syndrome diagnosis to be made. 

Following which, a treatment plan can be formulated specifically for you. Treatment includes dietary and lifestyle modifications, herbal prescription and/or acupuncture.

In addition, relatively new cases usually respond better and faster to treatment. 

I hope it helps you and may you feel better soon. 

Warmest regards, 
Phy Lee

27 Oct 2018