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| | History of Chinese Psychiatry | | 2005-2-20 14:09:27 Chinese Society of Psychiatry Zou Yizhuang M.D, Ph.D |  A. Traditional Chinese Medicine (TCM)
Before 20th century, mental disorders were treated mainly by the TCM in China. Mental disorders were classified as "DIAN"(close to psychosis), "KUANG"(close to mania) and "JIAN"(close to epilepsy) in the TCM, and treated by herbs, acupuncture or "emotional therapy". The Bible of TCM: “Yellow Emperor’ Classic of Medicine” systematically described symptom, mechanism and therapy
of mental illness, 475BC-24AD. Emphasized relation between physical organ and emotion: “Extra angry is harmful on liver, extra-happy on heart, fear on kidney, sad on lung, … ” and the way to treat. The TCM also emphasizes the balance of the "Yin" and "yang", "inside" and "outside" World. People are considered as part of universe, related to food, weather and social environment.
The theory of "seven-emotion", "five-element", "three-classification" are most important for understanding mental illness in TCM; Main therapy for mental illness include driven “tan”, clean fire, protect heart, calm mental, and five-element psychotherapy. TCM Psychotherapy (based on five-element theory) is probably earliest documented psychotherapy in the World; Today, TCM is still widely used in many countries to treat physical and mental illness.
In the TCM, element "TAN" is also important to psychotic illness. "TAN" closes to phlegm or sputum, but more than that, "TAN" could "come and rise into heart and brain", cause mental or conscious problems. In pathology, "TAN" could blocks "JIN QI" (important element for mental activity) and causes confusion and mad. Some of the Chinese medication have the function of "driven TAN" out of body or reduce it. The method of "driven TAN" has been widely used in the TCM for treating psychotic illness.
The TCM is a psychosomatic medicine and emphasize the relationship between organs and emotions, for example, "heart" responds for mania and "liver" for angry. Therefore, mania would be treated through "heart" and angry through "liver".
The TCM has been widely practiced in China. Many patients seek help from TCM before Western medicine, especially in rural area. Most of medical students had basic TCM training in medical school. Many psychiatry hospitals have TCM doctors and it is common for the mixed therapy of the neurolaptic and Chinese medication. The neurolaptic like Heloperidol is for acute psychotic state and Chinese medicines are used to treat the symptoms, improve sleep and reduce side effect of neuroleptic, such as tardive dyskinesia, dry mouth and constipation.
The TCM is an integrated and comprehensive medical system. It emphasizes the overall analysis and understands illness and comprehensive solution, emphasizes the modification of the balance between environment and patient, and the balance inside patient.
B. The Development of Modern Chinese Psychiatry
At the end of 19 century, western neuropsychiatry was introduced into China, and psychiatric hospitals were founded in large cities like Guangzhou, Shanghai and Beijing. The 1st psychiatric hospital in China was founded in Guangzhou in 1898.
During the first 50 years of 20th century, Chinese psychiatry developed slowly because of the Chinese civil War and the World War II. Some Western psychiatrists and Chinese psychiatrists trained in Western countries came to China and started neurology-psychiatry division in universities and psychiatry hospitals. For example, the Beijing Union Medical School sponsored by the United States. There were less than 60 psychiatrists and 1000 psychiatry beds in China by the end of 1940s.
The 1st Chinese National Conference of Mental Health was held in 1958, which promote the three level prevention and treatment network for mental health, which had been set up gradually through out the country since 1958. Psychiatry hospitals were increased quickly, most cities established their public psychiatry hospitals. Some medical graduates were trained as psychiatrists and national psychiatry workshops were hold in Nanjing to improve the clinical and academic level of psychiatry.
The 2nd Chinese National Conference of Mental Health was held in Oct. 1968, emphasized the development of community psychiatry, psychiatry in general hospital and increase the education of mental health.
Since 1980s, the change of Chinese society and economy raises the requirement of mental health. The 3rd Chinese National Conference of Mental Health was held in Oct. 2001, which organized by Ministry of Health, Ministry of Civil affaire and Ministry of Public Security and the Chinese Federation of Handicapped. Three hundreds representatives from relative government agencies or large psychiatric institutes took part the conference. The purpose of the conference is to set up the priority, develop strategy and objective of the mental health in the new century, promote public awareness of mental health, and to raise the mental health level of Chinese people.
Since 1978, China has been opened to the World and started the economic reform. The psychiatry service, education, and research have been increased dramatically.
According to the WHO health report, mental disorders take the highest health burden of 20% in China and will increase to 25% in the next 20 years, which is much higher than the
World average level of 10% and Western Pacific Countries of 15%, mainly because of the relative higher stigma, lower education and awareness, less health insurance, lower income and lower service level of mental health in China.
To fighting stigma: "stop exclusion, dare to care". Low awareness of mental health and traditional stigma to mental illness are major obstacles for patients and their family from seeking professional help that could largely reduce the burden of patients and their family. Less than 10% of depression and 50% of schizophrenia patients have seek professional help, mainly because of the social stigma and under education of mental health, which caused under use of psychiatry, which blocked patients to get early intervention and treatment.
China is in the rapid changing of her society, economy, health insurance, service model and people s opinion about mental health. It might not be difficult for Chinese psychiatrists to learn the formulation like music therapy, day hospitals and to use new medication, but it might be more difficult to educate publics to change attitude to mental illness, work with government to integrate different resources and to be motivated to develop community psychiatry. Because the differences existed between West and East in history, culture, politics, religion, legal system, society and economy, Chinese psychiatry has to make its own choice to fit the special culture and social environment, but the exprience from developed Countries will be very important for China.
Any way, short of budget, short of professionals and low recognition from society are the three main obstacles for Chinese mental health. The family resource and the traditional Chinese medicine may play valuable role in mental health. It is important to use the rich World heritage and experience of psychiatry to make the right choice for Chinese psychiatry and to provide reasonable and efficient mental health service for the largest population in the World.
(Edited by Shuping,Tan) | | [CLOSE] |
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Ministry of Health, (2003) No.013
ICP:No.040657