Epilepsy in the Chinese Community
Compiled by: Puja Sahni
Introduction:
Currently, in Canada, there are almost one million (1 000 000) Chinese residents and this number grows each year. In addition, approximately 700 000 citizens speak a Chinese language and roughly 300 000 of these residents live in Ontario. People in this community tend to settle in the provinces of Ontario and British Columbia because there is already a large existing community present. Being accustomed to Chinese medicine, many people from this community may not feel comfortable with Western medicine. As a response to any doubts they may have, sensitivity should be developed by Canadian neurologists and counsellors so that cultural barriers do not prevent adequate care.
Epilepsy in the Chinese community is explored through the following:
- Socio-cultural Issues and Epilepsy
- History of Epilepsy and Chinese Medicine
- Epilepsy and Chinese Medicine Today
- Chinese Medicine and the Treatment of Epilepsy
- Chinese Herbal Medicines for Epilepsy
- Chinese Patent Medicines for Epilepsy
- Acupuncture and Moxibustion for Epilepsy Treatment
- Advantages of Chinese Medicine as a Treatment for Epilepsy
- Integration of Chinese Medicine and Western Medicine
- Other Chinese Customs, Beliefs, and Superstitions
Socio-cultural Issues & Epilepsy:
A study conducted in Henan, a province of China, examined the local population and its awareness, understanding, and acceptance of epilepsy. The study concluded that, in China, those suffering from seizure disorders face many negative attitudes. It was found that:
- 87% of people would not favour their child marrying someone with epilepsy
- 57% would not want their children playing with a child with epilepsy at school
- 53% of people share the idea that those diagnosed with epilepsy should not be entitled to the same jobs as the remainder of the population
The study also found an inverse correlation between the level of education and the degree of such prejudices, where a lower level of education corresponded to a higher degree of prejudice against people with epilepsy. Conversely, the misconception of a relationship between epilepsy and insanity was found to be greater among the more educated citizens of the province.
Social stigma plays a negative role in the lives of those living with epilepsy, whether part of the Chinese community or not. In China, however, the stigma, or burden, is not only placed upon the person with epilepsy, but upon his/her entire family.
The Henan population's choice of medical consultation was also shown in the study. It was found that 55% of people would choose to consult a medical doctor for treatment; whereas, 25% would rather resort to herbal medicine and 14% to Chinese folk medicine. It was also found that patients with epilepsy, who had already visited a physician, often combined Chinese traditional medicine with their biomedical drug therapy. Herbal medications, family remedies, and acupuncture are but a few measures taken by members of the Chinese community to cope with epilepsy.
History of Epilepsy and Chinese Medicine:
(A paper written by Chi-Wan Lai and Yen-Huei C. Lai in 1991 titled, History of Epilepsy in Chinese Traditional Medicine explored many different terms, classifications, etiologies, and treatments related to epilepsy and the history of Chinese medicine. The following information summarizes their research).
Chinese medical history has classified epilepsy in many different ways from as early as A.D. 610. The first classification included five types of epilepsy: Yang Dian, Yin Dian, Feng (Wind) Dian, Shih (Wet) Dian, and Lao (Labour) Dian. The word Dian denotes epilepsy in Chinese medicine. It translates to "the falling sickness". Other words for epilepsy are Xian ("convulsion") and Dian-Jian. One author of a historical medical textbook stated that "Jian is a seizure occurring before the age of 10, and Dian one after the age of 10." Epilepsy was first introduced in an early Chinese medicine book which discussed theory of humans in health and in disease. The book, titled
The Yellow Emperor's Classic of Internal Medicine, Huang Di Nei Jing describes epilepsy to be caused by an emotional shock, occurring in the pregnant mother, which goes on to give the child the disorder. In a comparably recent publication, five other causes were stated to be:
1) "hot phlegm"
2) "cold phlegm"
3) "stagnation of phlegm"
4) "insufficiency of blood"
5) "insufficiency of kidney"
The Yellow Emperor's Classic of Internal Medicine also stated that, "Initially the sickness occurs once a year. If not treated, then it will occur once a month. If not treated, then four or five times a month. This is called Dian." Along with this misconception were many others including the common confusion between epilepsy and psychosis or mania. At times, the word Dian was used to describe epilepsy and, at other times, insanity. However, clarifications between the two were made due to a noticeable difference in symptoms and actions of the patient with epilepsy and the patient with insanity. These clarifications were acknowledged in Chinese medicine texts written thereafter. Unfortunately, confusion between epilepsy and insanity still persists in many communities, as the two are thought to be related.
Historical Classifications of Different Epilepsies:
The earliest attempt at differentiating between epileptic seizures was made in A.D. 610. This classification was mentioned earlier and is listed below in greater detail:
- I) Yang Dian (Yang epilepsy) - the patient appears dead during the attack, becomes uncontrolled, and then recovers spontaneously shortly after.
- II) Yin Dian (Yin epilepsy) - thought to be caused by being given too many baths during the neonatal stage.
- III) Feng Dian (wind epilepsy) - description of attack similar to that of a tonic-clonic seizure. (i.e. goat-like crying, limbs sustained in tonic contraction, eyes fixed, etc.); thought to be caused by being sweaty and exposed to the wind or having taken part in excessive sexuality or alcohol.
- IV) Shi Dian (wet epilepsy) - frontal headache and heaviness of body, thought to be caused by not drying of the hair after shampooing (i.e. brain sweat cannot leave the head).
- V) Lao Dian (labour epilepsy) - attack in which eyes deviate upward, mouth shuts tightly, arms and legs in tonic contraction, and body feels hot.
Another system of classification, proposed in A.D. 682 was based on the noise/cry made by the person experiencing the seizure. The attacks were named after animals whose sounds were imitated by a person during their seizure. The classifications were:
- I) Yang Dian - goat epilepsy
- II) Ma Dian - horse epilepsy
- III) Zhu Dian - pig epilepsy
- IV) Niu Dian - cow epilepsy
- V) Qi Dian - chicken epilepsy
- VI) Gou Dian - dog epilepsy
The same book that organized epilepsy by animal sounds also classified the disorder by visceral organs that were thought to have been the point of origin for the seizures. These were organized into the following groups:
- I) Xin Xian - heart epilepsy
- II) Gan Xian - liver epilepsy
- III) Pi Xian - spleen epilepsy
- IV) Fei Xian - lung epilepsy
- V) Shen Xian - kidney epilepsy
- VI) Chang Xian - intestine epilepsy
It is interesting to note that the brain was not one of the organs thought to have been related to the cause of the patient's epilepsy, however, this is not the case today. Although Western medicine classifies seizures into being either partial (focal) or generalized in nature, Chinese traditional medicine does not seem to adapt to this concept. Medical textbooks from a few decades ago had not even included this system of classification in their work.
Epilepsy and Chinese Medicine Today:
Chinese medicine has described epilepsy for over two thousand years now. As time progressed, the etiology, clinical manifestation, diagnosis and characteristics developed and therapeutic methods were adjusted accordingly. Certain therapeutic methods are centred more on pathogenic factors while others pay more attention to enhancing defence abilities within the patient.
Chinese medicine uses a four-step process to diagnose epilepsy in an individual. These steps include:
1) Inspection
2) Auscultation (listening to the internal organs i.e. heart and lungs)
3) Inquiry
4) Palpation (examining by touching an organ or area of the body)
Together these four examinations strive to correctly diagnose the patient by carefully studying symptoms, dominant and recessive signs, history of the illness in the patient, etiology, etc.
Chinese medicine is highly respected around the world because of its long, successful history. For hundreds of years, certain herbs have been used, and have proven to be safe. Chinese medicine concentrates on balancing the entire body, even if the disorder is one of the brain, such as epilepsy. Western medicine is seen by some Chinese medical professionals to concentrate too heavily on the one part of the body that is believed to be causing the problem. For example, anti-seizure medications that are used to control seizures work to make neurons in the brain either more or less excitable, depending on the patient. They have an effect on the entire nervous system; however, the rest of the body is not treated to balance out this change. In addition, many medications result in unwanted side effects that need to be attended to. Epilepsy Toronto interviewed Dr. Fred Hui regarding Chinese medicine in the summer of 2000. Dr. Fred Hui, a graduate of the University of Toronto, integrates both Chinese and Western medicine together. In addition to Western medications he believes in three principles for improved control. These include:
1. Decreasing Irritability in the area of the brain from which the problem is originating - this includes becoming aware of the different stimulants around us that excite our brain. There are certain substances that can affect our seizure threshold such as excessive amounts of caffeine and sugar. We should be aware of the negative substances that prevent our bodies from reaching a healthy balance, such as smoking. Other considerations should also be taken into account such as sounds and sights that could disturb the internal balance and trigger a seizure. Dr. Hui recommends meditation as a form of relaxation or as a way to "reset" the body.
2. Nourishing the Brain
- nourishing the brain includes supplying the brain with materials that will maintain its healthy state or improve it. Dr. Hui mentions certain oils such as Fish Oil and Flax seed Oil that are found in health food stores. He says that since the brain is 99% an oil, it needs certain oils such as Vitamin E to improve its healthy state. He also advises to cut down on starches and to eat plenty of green vegetables. Some studies have also shown that a lack of certain vitamins and minerals may contribute to seizures as they affect the rates at which the body's fuels are burned. These fuels, in turn, excite the brain in different ways. Dr. Hui recommends mega-vitamins that have high levels of vitamins C and E, Calcium, Magnesium and all of the B vitamins.
3. Balancing the Rest of the Body
- balance is important to your body's internal system or "internal clock". Cutting down on things that make you excitable is recommended, as are appropriate sleep patterns (i.e., sleeping at night when it is dark, rather than in the day). During the daytime, getting as much light as possible is important because it helps to reset the internal clock, and to recharge your body's energy systems. Dr. Hui also recommends that fibre and fluids be a part of the daily diet so that you keep the "traffic going and flowing." Some Chinese traditional medicine states that seizures are caused by an excess of congested energy in the top of the head. Blockages in the bowels also block the circular flow of energy through the body. Therefore, fibres and fluids help to clean the intestines, unblock the energy flow and to keep the brain calm. Another important factor in balancing the body includes hormone balances. For example, it is believed that estrogen can kindle a seizure, whereas progesterone tends to decrease seizures. Lastly, stress can increase the likelihood of having a seizure. Therefore, methods of relaxation such as meditation and yoga are also recommended.
Chinese Medicine and the Treatment of Epilepsy :
(The information below is also based on the paper written by Chi-Wan Lai and Yen-Huei C. Lai).
Some Chinese medical professionals traditionally believe that one's health is disturbed by diseases and disorders when the balance between Yin and Yang is disturbed. (Yin is thought to be the energy received from the earth and Yang the energy from the sun). Another belief is that the human body is made up of a mixture of five natural elements: metal, wood, water, fire, and earth. Related to these five elements are the five organs: spleen, liver, heart, lungs, and kidneys, which interact with the elements in a complex manner to result in a particular balance in the body. Once again, if this balance is disturbed, one's health is expected to be affected. In the paper written by Lai and Lai on the history of Chinese medicine, eight rules in treating epilepsy according to a recent text of Chinese medicine are:
"[E]xpel the wind...expel the phlegms...calm the patient...bring down the fever...relieve the stagnation of food...activate the blood circulation (for cases of posttraumatic epilepsy or epilepsy secondary to birth trauma), energize the spleen (when epileptic attack becomes less frequent), energize the kidney (when it is a congenital epilepsy)."
The type of therapy associated with these rules are herbs, acupuncture, Mai Yai (injection of herbs into the acupuncture points), Mai Xien (burying a piece of goat intestine into the acupuncture points), or massage. Some of these methods are further described below. Lastly, some guidelines in dealing with epilepsy were found by Lai and Lai to be as follows:
1) Physicians should see patients as frequently as possible.
2) A description of the epileptic attack should be given by an observer.
3) Physicians may change the treatment if epileptic attacks continue to recur.
4) Physicians should ask for any precipitating factors and circumstances under which epileptic attacks occurred.
Chinese Herbal Medicines for Epilepsy:
(Note: There was not a general consistency between the different sources from which the following information was obtained. The information below is an accumulation of all the different herbal therapies that were encountered throughout the research of this booklet. Spelling may differ, as may names, depending on the language in which it was written, or the country from which the information came from. In addition, current information on the availability and effectiveness of these medications in Canada or the United States was NOT determined for this information booklet).
| Name of Medicines (for epilepsy treatment) | What does it do? | Contents | Effectiveness |
| DianKeXing (capsule) | Removes phlegm and clear channels and collaterals; protects against electrical stimulation and pentretrazol convulsions. | calculus bovis, cornu saiga tatrica, pearl, amber, concretio silicea bambuseae, arisaeme bil, radix Salviae Mitiorrhizae | Found to be ~89.4% "markedly effective" and 98.76% effective in achieving any positive effect whatso- ever. |
| Dian Jien Ning | (not mentioned) | (not mentioned) | Found to be equally effective as phenobarbital against generalized tonic-clonic seizures; found to be more effective against other seizure types and less toxic. |
| Yi Nao Pian | Eliminate dampness so as to clear phlegm from the channels. In Western terms, it increases the oxygen supply to the brain, regulates excitation and inhibition and reduces abnormal discharges in the brain. | Rhizoma Pinelliae (mainly) | Study found that 41% of children became seizure-free and 44% improved significantly; total effective rate found to be 93.6%. |
| Piper nigrum | Found to have a protective effect against experimental convulsions, to extend the half-life of phenytoin and to simulate serotonin production | Piper nigrum | (not mentioned - only found effective against experimental convulsions) |
Other herbal medicines used in Chinese medicine:
Gastrodia tuber, Chinese medicine Tiannanxing, antelope horn, deadlocked silkworm, intact scorpion, centipede, white alum, stiff calamus, Chinese medicine Mengshi, vermilion, lobed leaf pharbitis, bezoar, borax, rhubarb, safflower, red-rooted saliva, Chinese medicine Wulingzhi, trillium, ruddle, amber, Chinese medicine Chaihu, banxia, Tuckahoe, Chinese medicine Chenxiang, ginseng, pearl, acorus gramineus, carthamus tinctorius, crocus sativus, curcuma, gastrodia elata, morus alba, uncaria rhynchophylla, paeonia, etc.
Chinese Patent Medicines for Epilepsy:
(Note: the patent medicines listed below are those according to the Beijing Epilepsy Therapy Center of China. The availability and effectiveness of the following medicines was not determined for the purposes of this information booklet).
- deadlocked pupa tablet
- gastrodia tuber capsule
- antelope horn capsule
- naoshenbao
- pearl pill with twenty-five ingredients
- zhixianling
- kangnaoling
- dianxianling
- shenkangning, etc.
Acupuncture and Moxibustion for Epilepsy Treatment:
Acupuncture: A form of non-invasive surgery, where needles are penetrated into specific points in the body; used to cure chronic aches and pain; to be practised by trained professionals only.
Acupuncture is an ancient Chinese healing practice that penetrates needles into a patient's body to relieve imbalances in the yin and yang of the body. Traditionally, there were 365 acupoints in the body; however, modern acupuncture reveals more than 2000 points of penetration. The Western explanation for this therapeutic method states that when a point in the body is penetrated, certain chemical substances are released by the body which go on to stimulate the neurotransmitters in the brain. A message is sent to brain via nerve impulses, allowing the desired effects to be obtained.
Moxibustion: The burning of dried fragments of vegetable matter on the body surface; moxa cauterization methods (cauterization: the act of coagulating blood and destroying tissue with a hot iron or caustic agent or by freezing).
These are two of the most important methods used for epilepsy therapy and they hold a high status in Chinese medicine therapy. Electroacupuncture instruments have been successfully developed using modern scientific technology. An electric needle with a weak current is used to stimulate the acupoints in the scalp to eliminate the pathologic abnormal waves in the cerebral nervous cells. The Beijing Epilepsy Therapy Center of China calls this treatment "Novel Electroacu-puncture Therapy"and uses qualitative techniques, such as electroencephalogram (EEG) and encephalic (relating to the brain) relief maps along with acupuncture to treat epilepsy. So far, they report to have been successful in their therapy methods and are integrating their therapeutic methods with those of the Western world.
Along with the therapies of acupuncture and moxibustion, massage is also an important mode of treatment.
Advantages of Chinese Medicine as a Treatment for Epilepsy:
The Beijing Epilepsy Therapy Center of China feels that there are several advantages in using Chinese medicine as a therapeutic tool for epilepsy. They feel that the therapy efficiently focuses on both the symptoms and the etiology of the disorder. They are satisfied with the long-term effect of Chinese medicine and the fact that it has been successful for so many generations. In addition, there are few side effects associated with their medicines which they find to be of a great advantage when compared to chemical drugs. It is also believed that Chinese medicine restores and regenerates the cerebral cells, allowing for the improvement of intelligence, thinking, activity, and memory.
Integration of Chinese Medicine and Western Medicine:
Currently, the Beijing Center is organically integrating the theories of Chinese medicine with modern medicine by using the two methods together. For example, if a certain Western drug has a risk of causing liver dysfunction, then a Chinese liver-protecting herbal medicine will be administered to the patient alongside that drug. It is important to note that one type of therapy is not thought to be better than the other by the Chinese community. Doctors stress that certain herbal remedies are safe to take as long as one does not stop taking his/her prescribed medication. The Beijing Center finds that the integration of the two types of therapies has a positive long-term effect and that it significantly decreases the rate of recurrence. The adverse effects of Western medicine are significantly reduced, which allows the long-term usage of the medications to be less of a struggle for the patient.
Other Chinese Customs, Beliefs, and Superstitions:
(A special recognition is given to Chinatown Online, from where the following information was obtained).
The Chinese culture believes strongly in fate and predestination and works to avoid bad luck and obtain good fortune and prosperity at all times. Fortune-tellers, and the like, are commonly used as consultants in regards to one's fate. A person's date and time of birth play a large role in determining their fortune, as do their palms, their facial features and "facial type" of which there are ten, each describing its own characteristics. The use of fortune sticks is the oldest method used to tell one's fortune. These sticks consist of 78 numbered sticks in a bamboo case, which is shaken until one of the sticks falls out. The number on the stick is then used to determine the person's fortune based on ancient writings.
Numbers | - the number eight is the luckiest number because the Chinese word for eight sounds like the word for "lucky"
- the number four is an unlucky number as the word for the number four sounds like the Chinese word for "death".
- the number seven can also signify death
- the number one can signify loneliness
|
Brooms | - thought to be inhabited by a spirit
- should only be used for cleaning purposes except when cleaning figures of household gods
- during the Spring Festival, the use of brooms is prohibited for three days from New Year's Day
- beating someone with a broom brings them bad luck for many years
- it is bad luck for the broom to touch the head
- sometimes used in temple rituals to remove bad luck
|
Facial Hair | - to wear a moustache is considered bad luck and unfortunate for the entire family
- not shaving is considered to be something of the lower class society, as they are thought to not have the time to remain clean-shaven
|
Nails | - it is considered bad luck to clip your toe nails and finger nails at night
- clippings are to be collected and disposed of in a place unknown to others, as it is thought that these clippings can place a spell or curse on to the person from whom they came
|
Dog's eyes | - dogs are thought to see supernatural beings and howl when they see one
- fluid from a dog's eye allows humans to see the spirit world
|
Colours | - three central colours are red, black, and white
- red symbolizes positives, such as happiness, wealth, fame, good luck, etc.
- black symbolizes negatives such as dirt, sin, evil, disasters, sadness, cruelty, suffering, and bad fortune in general; it is (traditionally) not worn at festivals and other special occasions and is associated with low status or a lack of civilization.
- white symbolizes a mother's milk and signifies moderation, purity, honesty and life; it
- is believed to harmonize all imbalanced elements and is used in rituals and ceremonies.
- other colours are classified based on their relativity in lightness/darkness to these three colours.
|
Clothing | - traditional Chinese dress is not often worn and there are no specific rules or guidelines one must follow to obtain good fortune, etc.
- bright colours are generally preferred but, usually, one's clothes will be suited to his/her environment and age (i.e. elderly not encouraged to dress "young" by wearing jeans, etc.).
|
Greetings and Etiquette | - greetings are a very important aspect of Chinese culture
- proper Chinese etiquette encourages soft spoken words with the head slightly bowed down; loud spoken men are considered bad mannered and loud spoken women are ridiculed
- elders are to be respected and their advice is to be accepted; children who do not respect their elders are thought to be bad mannered and responsibility for their behaviour is placed on their parents
- business cards are to be offered using both hands, as using one hand is against traditional etiquette
- it is also considered ill-mannered to refrain from asking someone if they'd like something to eat or drink
|
Other customs and superstitions: | - dreaming about snow or teeth is believed to foreshadow the death of a parent
- if one hears a crow between the hours of 3 and 7 a.m., it is thought that the person will be the receiver of gifts; however, if the caw of the crow is heard between 7 and 11 a.m., rain and wind will follow and, if heard between 11 a.m. and 1 p.m., there will be some quarrelling.
- yarrow and tortoiseshell are thought to be lucky
|
Resources:
1. Alternate Systems of Healing, allAyurveda Page, 6 Aug. 2002 <http://www.allayurveda.com/alter_acupuncture.htm>.
2. Andermann, LF. Epilepsy in Different Cultures: Epilepsy in developing countries, Epilepsy Awareness 1999;10(1). (Courtesy of Epilepsy Toronto: <http://www.epilepsytoronto.org/people/eaupdate/vl10-1.html>).
3. Canadian Statistics - Immigrant population by place of birth and period of immigration, 1996 Census, Canada, Statistics Canada Page, 9 July 2002 <http://www.statcan.ca/english/Pgdb/People/Population/demo25a.htm>.
4. Canadian Statistics - Population by mother tongue, 1996 Census, Statistics Canada Page, 9 July 2002 <http://www.statcan.ca/english/Pgdb/People/Population/demo18b>.
5. Chinese Medicine Therapy, Beijing Epilepsy Therapy Center of China Page, 24 May 2002 <http://ep-hospital.com/13s.htm>.
6. Culture, Chinatown Online Page, 12 July 2002 <http://www.chinatown-online.co.uk/pages/culture/customs/miscellaneous.html>.
7. East Meets West: An Integrated Approach to Seizure Control, Epilepsy Awareness 2000; 1(2). (Courtesy of Epilepsy Toronto: <http://www.epilepsytoronto.org/people/epilepsymatters/vol1-2.html>).
8. Lai C, Lai YC. History of Epilepsy in Chinese Traditional Medicine. Epilepsia 1991; 32(3):299-302.
9. Sonnen, AEH. Alternative and Folk Remedies. Epilepsy: A Comprehensive Textbook 1997; 2:1370-1371.
(Author's note: selected sources listed above, particularly certain Internet websites, may not be valid or accurate in their information. However, information was used for the purpose of this information booklet in order to include any and all possible misconceptions existing in the Chinese community with respect to epilepsy.)
