What is health- East and West

Can these measure health?

In 1946, the WHO adopted a new definition of health: “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Before this, health was defined as a mere “absence of disease”, a concept that did not take into account mental, emotional or other than physical aspects of a person. Having experienced personally, and through dozens of people who have sought my help over the years, that many Western medics do not concern themselves much with our mental or social well-being, it was a huge surprise to find out that this definition has been in use for over 60 years!

The medical profession feels somewhat challenged by a definition that links “complete well-being” with the concept of health. In an article published last year in the British Medical Journal (1), a group of medical scientists discuss the limitations of this definition in the context of chronic illness, and the need to replace it for a more “attainable” one. One fair point made in this article is that “complete well-being” is a difficult to measure concept which in a culture of evidence-based medicine is not a useful aim for many medical interventions. On the other hand, the evidence-based medical practice is to blame for the growing lack of understanding of chronic disease and its treatment as, increasingly, individuals with their very unique symptoms are forced into a pre-determined symptom pattern that does not reflect their condition fully. As a result, treatments backed by “evidence” are foolishly wasted on the wrong patients.

The article concludes that “just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range, we propose the formulation of health as the ability to adapt and to self-manage.” Whether the authors consider that the earth is managing just fine despite everything we humans have been doing to it is not clear, nor is it clear how they propose to encourage this ability to adapt and self-manage in patients. What seems clear in my opinion is that Western medicine as it is currently practiced is mostly inadequate for the treatment of chronic illness and the discomfort provoked by the idea of complete well-being is actually rooted in this inadequacy. Rather than changing the definition of health as a whole, it may be worth exploring the possible role of Western doctors in maintaining health and preventing disease through educating patients rather than solely providing treatments that, in the case of many chronic illnesses, may fail to solve the problem.

Yin Yang symbol

Health according to TCM

In Traditional Chinese Medicine (TCM), the concept of health is very closely linked to the idea of balance which develops around the concepts of Yin and Yang. Yin and Yang are the two opposing qualities that lie at the root of everything that exists. Generally speaking, Yin has more to do with structure and Yang with function, but as they not only “control” but “contain” each other, there is nothing that is purely Yin or Yang. This is very well illustrated in the Yin Yang symbol in which Yin contains a little bit of Yang and vice-versa.  

Yin and Yang in action

Yin tends to be moist, cool, dark, heavy, and to contract and be still; while Yang tends to be dry, warm, light, airy, and to expand and move. A good allegory of how Yin and Yang work together is that of a hot air balloon where the top part of the balloon – the hot, “active” part- is Yang, and the basket – the heavier, more “structural” part - is Yin. Without the basket, the balloon will just fly off and disappear, while the basket by itself cannot fly. When both parts of the balloon are in perfect balance and there is harmony around it, the balloon is stable and its movement smooth. If there is too much Yang – more gas and expansion- movement may get out of control, but if there is too much Yin – too much weight- then the balloon may drop off the air. An expert pilot will know how to balance the weight and the amount of gas so that despite changes such as altitude and blowing winds, a smooth ride can be enjoyed. In Chinese medicine it is said that Yin and Yang are not only opposites, but they are interdependent (the basket needs the balloon and vice-versa), mutually consuming (the more weight on the basket, the more gas you will need to fly the balloon), and inter-transforming (the basket contains the possibility of being too light and fly off with the balloon, while the balloon contains the possibility of collapsing and becoming heavy, more Yin). Everything in and around us contains aspects of both Yin and Yang, where there is Yin there must be Yang or there will be no life. Thus, the two opposites are always at play balancing each other out so that life and harmony can exist.

In terms of our body, the balloon-like balance is attained through a mechanism - called homoeostasis - that allows it to maintain its functions despite constantly changing conditions. However, just like with flying the hot air balloon, balance does not occur by itself. Its maintenance requires from us a basic understanding of the needs of the body and of its relationship with the environment and how it gets affected by what we do. For example, when we eat a sugary food, this results in a rise in blood glucose levels which in turn triggers the production of insulin by the pancreas. This results from the homeostatic process in which the body uses feedback about an increase in blood glucose levels to perform the necessary actions to restore balance, i.e. produce insulin to lower glucose levels. However, if we expose ourselves to constantly high blood glucose levels over a long period of time by being under severe stress or constantly eating an excess amount of sugar, the body’s feedback mechanism will eventually become overloaded which will not allow the homeostatic process to respond efficiently. As a result, the lack of balance will become pathological and we may develop diabetes.

 

Lack of balance can lead to lack of health

In Chinese Medicine, all symptoms of disease are thought to result from lack of balance within the body. Observation of the relationships between our symptoms, our constitution, the functioning of our organs, our emotions, our environment and life-style, allows a TCM practitioner to identify the mechanisms that caused an imbalance in the first place. The treatment will then aim not just to restore balance to relieve the symptoms, but also to address all the factors that caused the imbalance in the first place. Balance - and as a result health - is not regarded as a fixed entity but a process by which every organism attempts to maintain continuity in its functions. Just like when walking on a narrow wood plank we may momentarily lose balance before quickly re-arranging our position not to fall off; our inner body is constantly rearranging itself to stay balanced. This does not mean that a momentary loss of balance equates to illness, but rather that our ability to adapt to constant changes in order to maintain balance equates to our ability to stay healthy.

Chinese medicine teaches us that balance is only achieved if we observe and respect the needs of our individual constitution by adapting our life-style to our changing circumstances. Unfortunately, in a culture where we are used to the one-size-fits-all model, and where we are not encouraged to take responsibility for our own health; we often fail to observe even the most basic needs of our bodies. The main areas in which we fail to achieve balance in the West are the following - think of the pairs as Yang/Yin and note how we have a societal tendency excessive Yang- :

Movement/Rest: Some of us work too hard, exercise constantly, and also play hard but fail to get enough sleep or take enough breaks, as a result we feel stressed, anxious and become exhausted or ill when we try to stop. Some others, have sedentary jobs, never exercise, and get home to sit on the sofa. As a result they feel constantly exhausted, demotivated, low, and lethargic.

Our individual constitution and strength dictates how much energy we can afford to use and how much rest we need. Trying to keep up with others against ourselves is not conducive to good health. Neither is to deny the body of its basic need to move.

 Heat/Cold: We are oblivious of the seasons and heat ourselves up in the summer eating barbecues and drinking too much alcohol, and do not wrap up properly in winter, while we carry on eating salads and ice cream. In addition, we favour a lot of things that create heat and toxicity in the body, both of which contribute to chronic illness: We are constantly stressed, hooked on stimulants, over-consume sugar, alcohol and processed foods, and fail to nourish ourselves properly.

Too much/ Too little: We tend to do too much of what we like or what we consider “healthy”, and too little of everything else. We binge on alcohol, greasy food, chocolate, coffee, sugar, drugs, etc. with the excuse that these are things we enjoy or even “need”, but consume too little in terms of healthy, de-toxifying foods. A smaller percentage of us do “healthy” things in excess. It is important to understand that even some things that are considered "healthy" such as exercise, drinking water, taking supplements, or eating specific foods can, when done to excess, turn into toxic or unhealthy. 

Balance means avoiding excess and favouring variety and moderation. When moderation cannot be exercised all the time, then giving the body a rest after a period of excess may help restore balance.

Activity/Stillness: Even when we’re a bit of a couch potato, we are always active in some way or another, constantly stimulating our senses with machines, computers, TV’s, iPhones, you name it.

Lack or real stillness like the one we can achieve during meditation, or quiet walks in nature, is a very common cause of imbalance and disease in our Western societies.

According to TCM, health is not a “state” but a “process” in which our body, mind, and spirit are constantly adapting to our changing circumstances in order to stay in balance, thus allowing us to enjoy well-being at all levels. The efficacy of this process depends on each of us, and on how attuned we are with our bodies and our needs. TCM therapeutic techniques such as Acupuncture and Chinese herbs can certainly promote balance when we experience physical, mental or emotional symptoms, but our ability to maintain this balance depends on how willing we are to promote it in our every-day life. Here, we may say that we get to a similar conclusion as the medical scientists in the BMJ article in that health relates to our ability to adapt and to self-manage, with the difference that the possibility of complete well-being is still there, and it is in our hands to achieve it.

 

REFERENCES

(1)This article by Huber et al., a group including some prominent medical scientists, was published in the BMJ last year and discusses how the concept of health should be more "realistic". Accessed online 1/9/2012. Found here: http://www.emgo.nl/news-and-events/news/141/article-how-should-we-define-health-published-in-bmj/