Systemic and Ocular Applications of Traditional Oriental Medicine (a)

Peter O. Im, OD, US Navy

Robert L. Yolton, PhD, OD, Pacific University College of Optometry

COPE Certification 13540-SD Expires 5-1-2008

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INTRODUCTION
In many areas of the world, including sections of the United States, patients receive part or all of their health care from physicians trained in the art of traditional Oriental medicine.(b,c,d) For example, in Japan it is not at all unusual for a person with an illness, perhaps an eye infection, to visit a "Western-oriented" physician, but then to also visit an Oriental physician and return home with a package of herbs as well as a prescription for antibiotics. Possibly the reason for this dual-physician regimen is that patients do not fully trust either the Oriental or the Western approaches to health care. Or perhaps it is because each type of physician provides something important to the sick patient. The Western physician provides scientifically validated diagnostic procedures and treatments, whereas the Oriental physician uses techniques that are psychologically and physiologically important in stimulating the body to heal itself. In this way the Oriental physician might be providing an important feature of care that is increasingly omitted from patient care delivered by Western physicians.

Oriental medicine is not entirely "foreign" to Western physicians. Most have heard of acupuncture and moxibustion, and some believe that these techniques have beneficial effects (although many write off any effects as being due to placebo), but few really understand the concepts upon which traditional Oriental medicine is founded.

Western medicine is largely based on the ability of certain chemicals or procedures to affect the body in ways that can be demonstrated with microscopes, x-rays, or other accepted technologies. Oriental medicine is based on art, philosophy, and beliefs that have been empirically validated over thousands of years.

In this paper, the concepts of health and disease upon which traditional Oriental medicine were founded thousands of years ago will be reviewed, examination techniques will be discussed, and several treatment methods will be presented.

Concepts of Traditional Oriental Medicine
To understand traditional Oriental medicine one must leave behind Western concepts of disease caused by organisms or manifestations of genetics, and of treatment efficacy being validated by clinical trials and scientific tools. Traditional Oriental medicine is based on a system of empirically derived conclusions, anecdotal proofs, and beliefs that date back to when records were kept by carving symbols into bones.(1) Many modern books describe these concepts;(1-4) some are quite scholarly whereas others are more approachable. The material presented below has been derived largely from "The Web That Has No Weaver," by Kaptchuk(2) and from "Traditional Medicine in Contemporary China," by Sevin.(3)

Disharmony
In Western medicine, physicians are most comfortable with the concept of a single disease process causing a patient's problem, but practitioners of Oriental medicine regard illness as a state of disharmony within the body's systems.(2,3) Thus, a problem that manifests in the eyes could be caused by disharmony involving a remote site, perhaps the liver. Treatments would then be directed toward restoring harmony in the liver and might not even involve the eyes at all.

The concept of harmony is difficult or impossible to define except by noting that it disappears when disharmony is present. Within the system of Oriental medicine, disharmony can be created by the environment, the patient's emotional outlook, and/or his or her lifestyle. In other words, a happy person who lives in a clean environment will most likely be in good health.

For Oriental physicians, sources of disharmony are the focus of primary health care, whereas for Western physicians they can be after thoughts. Many Western practitioners wait for the patient to actually show signs and symptoms of an illness before suggesting changes in lifestyle.

Closely related to the concept of disharmony is the concept of balance. An important part of Taoism from which some Oriental medicine concepts are derived, is the concept of Yin and Yang.(3) Together Yin and Yang form a cycle and are often represented as two fish chasing each other's tails. As they form a complementary pair, one can not be defined without referring to the other. Yin is the more latent component of the pair while Yang is more energetic. Balance is attained within a patient's body when there is a balance between the two extremes of Yin and Yang. A good analogy for the relationship between Yin and Yang involves the sun. When the sun is at its brightest it is also starting its decline.(3)

Medical disorders occur when balance is disrupted and there is a bias towards either Yin or Yang. To understand the importance of imbalance and disharmony, some additional knowledge of Oriental medicine concepts is required.

Five Elements
According to the tenets of traditional Oriental medicine, five fundamental elements exist within the human body: Jing, blood, Shen, fluids, and Qi. These are also sometimes known as the Fundamental Substances.(2)

Jing, translated as "essence," is the "substance that underlies all organic life." It is the basis for development and reproduction. Although it is not the same as blood (another element), it is considered to be fluid-like. Because Jing is manifested in activity and forward development, it is considered a Yang element. Blood, on the other hand, is "static over time" meaning that it is involved in processes that are repetitive and seldom change as the body develops. Therefore blood is a Yin element. Together Jing and blood form a complementary Yin-Yang pair.(2)

Shen or "spirit" is what differentiates humans from other species. It is what allows us to think, reason, and discriminate. When someone's Shen is bright they are very aware and thinking clearly, however when it is dim their thoughts are muddled and they can be forgetful. The state of a person's Shen can be determined by observing the eyes. When Shen is depleted or in disharmony, the eyes will be lusterless and dull. Shen is active and thus a Yang element.(2)

Fluids are considered to be any liquids within the body with the exception of blood. Blood is thought to be deeper and more potent than the other fluids. Fluids are liquid and thus a Yin element.(2)

Qi is the "life force" of the body and is thought to flow through the body protecting it from harm and illness. Qi is an active element and is therefore considered to be Yang.(2)

A healthy individual has a perfect balance between the five elements; the body is in harmony with itself and the universe. A practitioner of Oriental medicine diagnoses imbalances in the elements and attempts to restore balance using various treatment modalities. Many of these treatments involve influencing the patient's Qi.

Qi
Qi (sometimes written chi(3)) is a very significant factor in traditional Oriental medicine. It has been described in several different ways, but in general it is considered to be the body's "life force." In this context, Qi flows, exists, or can be influenced in the body along certain lines or meridians. Qi is entirely different from blood and does not flow through veins or vessels.

According to Kaptchuk,(2) Qi is the first part of the body encountered by an invading influence. When Qi is flowing through the body, "agents of disorder" (sometimes referred to as "pernicious influences") have nowhere to attack and thus cannot affect the body's health.(5) However, when an imbalance of Yin and Yang occurs, pernicious influences can overwhelm the body's Qi resulting in disease.

One of the most important aspects of Oriental medicine involves maintaining a strong protective Qi. This is not so different from the Western concept of keeping the body and mind healthy and in good condition.

Pernicious Influences
Six pernicious influences (also called the Six Excesses or the Six Evils(3)) are recognized in traditional Oriental medicine. Kaptchuk lists them as wind, cold, fire or heat, dampness, dryness, and summer heat.(2)

Pernicious influences are natural parts of the environment and only become harmful when the body has an inappropriate relationship to them. They can only invade the body if there is an imbalance of Yin and Yang, and then they must battle the Qi. If the Qi is strong enough, the pernicious influence is defeated and the patient recovers; if it is not, the patient succumbs to a deep and possibly fatal illness.

Pernicious influences can invade the body from the external realm or can arise internally. External pernicious influences tend to cause acute illnesses, whereas internal influences tend to cause chronic problems.

Each pernicious influence is correlated with certain types of illnesses. For example, the pernicious influence of wind, when invading from the external realm, could cause a sudden onset of fever (a sign of conflict between an external influence and Qi), fear of drafts, sweating, sudden headaches, stuffed nasal passages, and a sore itchy throat.(2)

As a second example, a diagnosis of internal wind influence might be made if a patient had chronic disharmony of the liver. Manifestations could include dizziness, tinnitus, numbness of the limbs, tremors, convulsions, and apoplexy.(2)

Organs
The concept of human organs used in Oriental medicine is not the same as the concept used by Western physicians. In Western medicine, organs are studied as anatomical entities with specific biochemical inputs and outputs that can be measured in the laboratory. In traditional Oriental medicine, organs have more philosophical definitions.(2,3)

According to Kaptchuk, there are five Yin organs, six Yang organs, and the miscellaneous or "Curious" organs.(2) Yin organs are the heart (pericardium), lung, liver, kidney, and spleen. These organs are responsible for producing, transforming, regulating, and storing the five elements.

Yang organs are the gall bladder, bladder, stomach, small intestine, large intestine, and the triple burner. The triple burner is an organ with a name but no shape. It is a relationship between the lungs, spleen, kidneys, small intestine, and the bladder. The triple burner is not an entity apart from these organs, but rather it is the pathway that unites them into a complete system. The Yang organs receive, break down, and absorb food that will be transformed into the five elements.

Finally, there are six miscellaneous organs, also called the "curious organs" including the brain, marrow (spinal cord and blood marrow), bone, blood vessels, uterus, and the gall bladder (both a Yang organ and a curious organ). These organs are termed "curious" because they resemble Yang organs in form but Yin organs in function.(2)

Any disharmony in one or a combination of these organs causes an imbalance within the body.

The Organs and the Eyes
Of special interest is the way in which the liver organ and the eyes are related. The liver is said to "open into the eyes," thus liver disharmonies can manifest as ocular problems such as dry eyes, "muddled vision," conjunctivitis, and glaucoma.(2)

Disharmonies in other organs can also cause ocular problems:
"Although it is the Liver that opens into the eyes, the state of all the Organs is reflected in them because the pure Jing Qi of all the Organs 'pours through the eyes.'The general appearance of the eyes is especially important for perceiving the Shen. Lively eyes indicate that the Jing is uninjured. Stiff, 'wooden,' inflexible eyes show either a Wind or a Deficient condition. If the whites of the eyes are red, it is a sign of a Heat condition caused by either External Pernicious Influences or Excessive Heat of an Organ. When the whites appear unclear or turbid, it is a sign of Dampness; a purple coloration indicates Liver Wind. Inordinate tears are usually a sign of Liver Fire. 'Sand in the eyes,' without redness, usually indicates Dampness or a weak Spleen. If the pupils are scattered and wide, it is a sign of Deficient Kidney Yin, or of poisoning, and is often a serious condition. Fear of bright light is usually a sign of Excess. When the eye sockets are gray and baggy, it often means Deficient Kidney Qi. Protruding eyes most often indicate Heat combined with mucus." (2) (pp. 339-40)

Although Western-oriented physicians will recognize the relationship between yellowing of the sclera and jaundice caused by liver dysfunction, and possibly the dilated pupils associated with certain poisons, most of the other relationships observed by Oriental physicians during their examinations of the eyes are harder to understand.

Examination of the Patient
Traditional Oriental medicine physicians use four major techniques to examine a patient. These include looking; listening and smelling; asking; and touching.(2,3)

In the looking phase, the physician pays special attention to facial color, body secretions and excretions, and the overall appearance of the patient. Physical appearance of the tongue is also a matter of concern during this phase; size, shape, color, and coating can indicate certain imbalances.

The doctor questions the patient during the asking phase of the examination. To a Western physician, the questions might seem unrelated to the patient's problem, but in Oriental medicine the body is viewed as an integrated system. Thus, questions could touch on sleep patterns, digestion, emotions, menstrual cycles, and energy level - even if none of these were specifically part of the patient's chief complaint.(6)

During the touching phase, analysis of the patient's pulse is of profound importance. Taking the pulse is such an important part of Oriental medicine that Chinese people often speak of going to the physician as "going to have my pulse felt." Pulse taking requires thorough training, great experience, and the gift of sensitivity. Although a pulse can be felt at various points on the body, Oriental medicine emphasizes taking it at the radial artery near the wrist. The pulse is felt at separate adjacent locations with three fingers and at different depths by exerting varying pressures with the finger tips.(e) Disharmonies in the body leave a clear imprint on pulse strength and/or rhythm.(2,6)

Pulse being felt by Dr. Hong Jin. Note that three fingers are used to feel various components of the pulse. (Photo taken at the Oregon College of Oriental Medicine.)

There are at least 28 different pulse qualities defined in traditional Oriental medicine.(3) They are specified on the basis of depth (the level at which the pulse is perceptible), speed, width, strength, overall shape and quality, rhythm, and length. As an example, the "floating pulse" is associated with an external pernicious influence and an excess of Yang. Another example is the "knotted pulse" which is thought to indicate cold obstructing Qi and blood, though it can also indicate deficient Qi, blood, or Jing. The presence of a knotted pulse shows that the heart is not ruling the blood, which is a condition of excessive Yin.(2) Other pulse terms include "large," "smooth," and "accelerated" that indicate excessive Yang, and "sunken," "subtle," "small," and "rough" that indicate excessive Yin.(2,3,6)

Information from all phases of the examination contributes to an evaluation of Yin and Yang balance and to a diagnosis by the Oriental medicine physician. Simplified examples illustrating effects of Yin and Yang imbalances revealed by the four examinations are provided in Table 1.

Table 1. Indications of Excessive Yin or Yang Influences Detected Using the Four Examinations (Modified from The Web That Has No Weaver(2))

LOOKING
EXCESSIVE YIN:
quiet behavior; withdrawn; slow, frail manner;
patient is tired and weak, likes to lie down curled up;
no spirit; excretions and secretions are watery and thin; tongue material is pale, puffy, and moist;
tongue moss is thin and white

EXCESSIVE YANG:
agitated behavior, restless, active manner;
rapid, forceful movement; red face;
patient likes to stretch when lying down;
tongue material is red or scarlet, and dry;
tongue moss is yellow and thick

LISTENING, SMELLING
EXCESSIVE YIN:
voice is low and without strength;
few words;
respiration is shallow and weak;
shortness of breath;
acrid odor

EXCESSIVE YANG:
voice is coarse, rough, and strong;
patient is talkative;
respiration is full and deep;
putrid odor

ASKING
EXCESSIVE YIN:
reduced appetite;
no taste in mouth;
desires warmth and touch;
copious and clear urine;
pressure relieves discomfort;
scanty, pale menses

EXCESSIVE YANG;
dislikes heat or touch;
constipation;
scanty, dark urine;
dry mouth, thirst

TOUCHING
EXCESSIVE YIN:
frail, minute, thin, empty, or otherwise weak pulse

EXCESSIVE YANG:
full, rapid, slippery, wiry, floating, or otherwise strong pulse

Making the Diagnosis: Patterns of Disharmony
The Oriental medicine physician weaves signs and symptoms (usually grouped together and called "complaints" in Chinese medicine) from the four examinations into a complex interacting pattern that helps to determine what treatments will be provided for the patient. In creating this pattern, it is important to understand that the meanings of individual signs and symptoms can change depending on what other signs and symptoms are present. No single sign or symptom has a universal meaning in Oriental medicine.(2)

For example, thirst or a dry tongue typically points to heat or deficient Yin. These signs have meaning because they usually appear in a configuration with other heat signs. However, if the person with a dry mouth feels cold and is pale, tired, weak, emotionally flat, and low-keyed, the meaning of the dry-mouth changes. It becomes a sign of extreme Yang deficiency with an inability to "raise water." The context defines the interpretation of individual signs and symptoms. The necessity of seeing the part simultaneously with the whole illustrates the artistry woven into Oriental medicine.(2)

Oriental medicine physicians recognize many patterns of disharmony that might loosely be called diagnoses in Western medicine. For simplicity, these patterns can be grouped into the Eight Principal Patterns. They are comprised of four pairs of polar opposites: Yin versus Yang, interior versus exterior, deficient versus excess, and heat versus cold. For the traditional Oriental physician, assessment of these patterns is important in determining the patient's diagnosis and treatment.(2)

Simplified examples of several diagnoses/patterns are shown in Table 2. It provides just a few of the thousands of possible patterns and sub-patterns that the Oriental medicine physician must consider when making a diagnosis.

Table 2. Examples of Oriental Medicine Disharmony Patterns
(From The Web That Has No Weaver(2))

YIN VERSUS YANG DISHARMONY
A Yin pattern occurs when a combination of an interior condition, a deficient condition, and cold influences the body. This is usually a chronic condition.

A Yang pattern occurs when a combination of an exterior condition, an excess, and heat is influencing the body. This is usually an acute condition.

HEART DISHARMONY
Examples include patterns of cold mucus confusing the heart openings and mucus fire agitating the heart. The cold mucus condition is characterized by thick tongue moss, a slippery pulse, and abnormal behavior. It is sometimes accompanied by drooling since cold mucus is yin. Behavior is likely to be restrained and inwardly directed.

For the mucus fire condition, because hot mucus is relatively yang, hyperactivity, agitation, aggressive behavior, incessant talking, and perhaps violent lashing out might be seen. Other heat signs, such as rapid pulse and yellow tongue moss could accompany this condition.

SPLEEN DISHARMONY
The central tasks of the spleen are ruling the transformation of food into Qi and blood, and governing the blood. Internal disharmonies are usually linked to an insufficiency of spleen Qi required to perform these activities. Because the spleen is especially sensitive to dampness, its patterns of excess tend to involve dampness. Spleen disharmonies are usually internally generated.

LIVER DISHARMONY
An important function of the liver is to rule flowing and spreading of interdependent bodily processes. The liver is closely associated with headaches because its Qi often rises when the liver is in disharmony.

Liver stagnation characteristics develop excess and heat. The liver is the Yin organ more involved with excess heat disharmonies and internal heat (fire). Internal wind pernicious influences are also after generated in the liver.

Liver fire easily ascends and can affect the head and eyes.

Treatment Modalities
The Oriental medicine treatment modality most familiar to Westerners is acupuncture, however Oriental medicine physicians also use moxibustion, herbs, lifestyle modifications, and other procedures to aid in restoring the patient's balance and harmony.

Acupuncture
When Qi is blocked in conjunction with a disease, tiny needles can be inserted into the skin at specific points along the Qi meridians to remove the blockage. Because there are several hundred or more acupuncture points, each having specific therapeutic actions on the body, selection of the points into which needles will be inserted is part of the Oriental medicine art.(2)

Recently, Western physicians have begun to use acupuncture, most commonly as a form of anesthetic. The mechanism by which the insertion of needles reduces pain is not yet fully understood, but current theories suggest that the needles release endorphins that block pain, alter blood pressure, and cause other physiological changes.(2,5)

Insertion of acupuncture needles. (Photo taken at the Oregon College of Oriental Medicine.)

Moxibustion
Related to acupuncture, moxibustion is a treatment that involves burning substances along Qi meridians to help restore the flow of Qi and facilitate a return to harmony. Although there are a variety of moxibustion techniques, one form begins with an acupuncture needle being inserted into an appropriate location. A heating material called moxa (typically mugwort possibly mixed with other incense-like substances) is attached to the needle and ignited. The needle with the burning moxa can then be covered with a glass cup that holds the smoke over the acupuncture point.(2) Other forms of moxibustion involve burning small cones or sticks of moxa over acupuncture points on the skin.

The goal of treatment is to focus energy using heat and smoke at specific sites that depend on the patient's diagnosis. Moxibustion results in a slight warming and reddening of the skin at the site of application, but the skin is not actually burned in the process.(e)

An incense stick is used to ignite a commercially made moxibustion cone placed on the patient's abdomen at acupuncture point CV-4. Moxibustion at this location would be used as part of the treatment regimen for chronic retinal problems such as age-related retinal degeneration.(e) (Photo taken at the Oregon College of Oriental Medicine.)

Applying moxibustion by holding a burning moxa stick over the patient's abdomen at point CV-4. (Photo taken at the Oregon College of Oriental Medicine.)

As with acupuncture, the reason why moxibustion restores harmony and treats disease is not well understood by Western researchers.

Herbal Medicines
Herbal remedies have been a part of Oriental medicine for thousands of years.(2,6) They can be prescribed in the form of infusions, decoctions, compresses, tinctures, ointments, and/or capsules.(7) Infusions are prepared by steeping dried plant stems, leaves and/or flowers in boiling water for 10 to 20 minutes. Honey or lemon might then be added to mask strong flavors. Decoctions are prepared in a similar manner but use plant roots and bark. Tinctures can be prepared from dried and crushed plant products by steeping them in alcohol or vinegar for several weeks. This process yields a highly potent substance.

Dr. Jin in the Pharmacy of the Oregon College of Oriental Medicine. A typical Oriental medicine pharmacy would stock botanicals, patent medicines, and other substances that would be prepared on the basis of prescriptions written by Oriental medicine physicians. (Photo taken at the Oregon College of Oriental Medicine.)

Many of the herbs used in Oriental medicine are known by Western researchers to be biologically active. For example, Coptis herb and Scutellena herb have antibacterial properties and can inhibit the growth of streptococcus.(2) Other herbs have been used to treat certain conditions including those involving the eyes.

Treatment of Ocular Problems Using Oriental Medicine
Two brief and simplified examples illustrate how a traditional Oriental medicine physician might manage acute epidemic conjunctivitis and open angle glaucoma (which some Oriental physicians consider to be a manifestation of liver disharmony).(8) It is important to understand that there are many variations of these treatments and that entire books have been written describing Oriental medicine treatments for various ocular conditions.

Acute Epidemic Conjunctivitis
Acute epidemic conjunctivitis is characterized by rapid onset of complaints with edema and congestion of the bulbar conjunctiva. In traditional Oriental medicine, the disease is thought to be caused by factors that travel upward along the lung channel and attack the eyes. It can be associated with excessive heat of the lung and stomach.

Complaints include aversion to wind, lassitude, floating pulse, and reddened tongue with a thin, whitish coating. Treatment is directed at expelling wind and epidemic pathogenic factors, and at clearing away heat and toxic material. In part, this is accomplished by using a herbal prescription called Modified Puji Xiaodu.(8)

Treatment of Open Angle Glaucoma
In traditional Oriental medicine, open angle glaucoma is believed to be caused by emotional depression. This results in stagnation of the liver Qi, which will then turn into fire. When the fire goes upward to attack the eyes, glaucoma results. It can also be caused by retention of dampness due to hyperfunction of the spleen. Phlegm will stagnate and convert into fire. When the fire moves upward to attack the eye, glaucoma can occur. Another etiology involving a deficiency of liver and kidney (a condition called consumption of primordial Yin) can result in fire that attacks the eyes.(8)

Patient complaints include a feeling of slight ocular distention, headache, dizziness, fullness in the chest, reddened tongue with yellow fur, and a wiry, small pulse.

Therapy is directed at clearing away heat and relieving the liver. This is accomplished by acupuncture treatment once or twice a week at points known as BL-1 (eye), SI-6 (hand), GB-37 (leg), and Liver-3 (foot).(e) The liver site is important because the relationship between the liver and the eyes is believed to be of great significance.

Acupuncture needles being placed by Dr. Jin at location BL-1 to illustrate how they would be used as part of the treatment of glaucoma. The needles are inserted with tips approximate 2.0 cm deep beneath the skin surface. (Photo taken at the Oregon College of Oriental Medicine.)

Herbal therapy can also be used by combining the herbs specified in Table 3 and making a tea called Modified Danzhi Xiaoyao San to be drunk once per day.(8)

Table 3. Example of an Oriental Medicine Prescription for Herbs to Treat Glaucoma(8)

Radix Bupleuri 9 g
Cortex Moutan Radicis 9 g
Fructus Gardeniae 9 g
Poria 9 g
Rhizoma Atractylodis Macrocephalae 9 g
Radix Angeicae Dahuricae 9 g
Flos Chrysanthemi 9 g
Spica Drunellae 9 g
Radix Paeoniae Alba 12 g
Radix Angelicae sinensis 12 g
Ramulus Uncariae cum Uncis 12 g
Pulvis Cornu Saigae Tataricae 3 g

In considering the example of glaucoma, a Western physician might feel that patients were not being properly treated because there was no obvious attempt to reduce intraocular pressure (IOP). In fairness, it should be remembered that studies demonstrating that IOP reduction actually saves vision are hard to find in the Western literature, and that treatments used by Oriental physicians might work in ways not well understood by Westerners.

Summary
In many parts of Asia and in ethnic enclaves of Western countries, a significant number of patients receive health care from physicians trained to provide traditional Oriental medicine. Many of the underpinnings of Oriental medicine and the treatments prescribed by these physicians seem strange, backward, and mystical to Westerners, but it is well to remember that Oriental medicine has evolved over many centuries and predates Western medicine by thousands of years. The process by which Oriental medical techniques have been empirically validated has been a long one and this suggests that they have value even though this might not be readily apparent to Western-oriented physicians.

References
1. Ho PY, Lisowski FP. Concepts of Chinese science and traditional healing arts: a historical review. Singapore: World Scientific, 1993.
2. Kaptchuk TJ. The web that has no weaver: understanding Chinese medicine. Chicago: Congdon and Weed, 1983.
3. Sivin N. Traditional medicine in contemporary China. Ann Arbor: University of Michigan Press, 1987.
4. Leslie C, Young A. Paths to Asian medical knowledge. Berkeley: University of California Press, 1992.
5. Acupuncture: NIH consensus development panel on acupuncture. J Amer Med Assoc 1998;280(17):1518-41.
6. Schultz E. Acupuncture: where East meets West. RN 1996;59(10):55-60.
7. Castleman M. The healing herbs. Emmaus PA: Rodale Press, 1991.
8. Xiangiai X. The English-Chinese encyclopedia of practical traditional Chinese medicine; vol 17 ophthalmology. Higher Education Press: Beijing China, 1991.

Acknowledgements
We thank Beta Sigma Kappa for a grant that supported this project, and the faculty and administrators of the Oregon College of Oriental Medicine, Portland Oregon (especially Hong Jin, MD (PRC), LAc, Dean of Faculty and Clinical Supervisor, and Elizabeth Goldblatt, PhD, MPA/HA, President), who provided valuable information and references. We also thank Faith Gabelnick, PhD, President of Pacific University, for encouraging our study of Oriental Medicine. The material presented in this paper represents the views of the authors and does not necessarily represent the views of Pacific University College of Optometry or any of the individuals or organizations acknowledged.

Footnotes
a. An earlier version of this article was published as Im PO, Yolton RL. Concepts of traditional Oriental medicine. 2000 Optometry 71(10):621-9 and copyrighted by the American Optometric Association. This reprint and modification is with the permission of the American Optometric Association.

b.Although the term "Oriental" rather than "Asian," "Chinese," or "Eastern" is regarded as politically incorrect in some circumstances, the discipline described in this paper is referred to by its practitioners and by the schools that teach it as "Oriental Medicine." Hence that term is used in this paper. "Western" will be used to refer to the type of medicine typically practiced in the United States and comparable countries.

c. This paper is intended to be a brief overview of traditional Oriental medicine concepts rather than a complete review of Oriental medicine literature. As such, an exhaustive bibliographic list was not developed. Rather, concepts were derived from a few well-regarded texts. Readers who wish an extensive bibliography should access the National Institutes of Health National Center for Complementary and Alternative Medicine Web site at http://nccam.nih.gov. From this site, search requests can be made to the MEDLINEplus database.

d. Modern concepts of Oriental medicine are taught at over 40 institutions in the United Sates including the Oregon College of Oriental Medicine (OCOM) in Portland OR. OCOM grants the degree of Master of Acupuncture and Oriental Medicine in a four academic year program that includes health sciences, pathology, pharmacology, herbals, nutrition, acupuncture, Oriental medicine concepts, a clinical internship, and other components. Prerequisites include three years of college credit (four years recommended) with courses in biology, chemistry, and psychology.

e. Personal communication. Hong Jin, MD (PRC), LAc, Dean of Faculty and Clinical Supervisor, Oregon College of Oriental Medicine, Portland OR. August 18, 2000.

Or to the Continuing Education Department at the College of Optometry at kundart@pacificu.edu.

© Copyright 2006, Pacific University College of Optometry