The development of rehabilitation medicine is a necessity of socio-economic development and a result of changes in disease spectrum and population structure. The concept of rehabilitation medicine in TCM was introduced after the 1980s. Although there is no name of rehabilitation medicine in ancient Chinese medical texts, the content about rehabilitation medicine is scattered in a large number of Chinese medical literature.
In ancient times, there was no strict boundary between rehabilitation medicine and health science, and many aspects of TCM clinical science were also related to rehabilitation. In a broad sense, TCM health science contains both preventive health and disease health, and the latter has the rehabilitation purpose of modern rehabilitation medicine, which is to make the disabled, elderly patients and chronic patients better return to society. It is just that this issue has not been systematized, standardized and independent during the long development of Chinese medicine.
With the development of society and the intercession of modern rehabilitation medicine, TCM rehabilitation as an independent discipline has become the need of the hour. As a branch of the world’s medicine, the emergence and development of modern rehabilitation medicine has provided experience from which to draw for the development of TCM rehabilitation. This development is not a negation or transformation of the theoretical system of TCM, but a supplement and improvement of the theory of TCM. This supplementation is done through the absorption of modern rehabilitation medicine ideas, and under the guidance of the theoretical principles of TCM, TCM rehabilitation science, especially the content related to disease rehabilitation, is organized and improved, which is a development in inheritance and marks the perfection and development of TCM in the field of rehabilitation medicine.
I. Rehabilitation and the concept of Chinese medicine rehabilitation science
Historically, the term “rehabilitation” was first used in Chinese medicine. According to “Erya? According to “Erya? The word “rehabilitate” means “to return to health”. In other words, to recover is to restore peace or health. The meaning of “recovery” in ancient medical texts is mainly as follows.
① refers to the cure and recovery of disease. For example, “The Case of the Continuing Famous Doctor? It is stated in the “Bandxia”: “Mao Dakke woman suffered from bandxia, but recovered as usual after taking care of it in accordance with the method”.
②Refers to the recovery of mental and emotional state.
③ refers to the recovery of the righteousness. In the 1980s, with the development of society and the intervention of modern rehabilitation science, the connotation of “rehabilitation” in Chinese medicine has also changed. The main point is that functional rehabilitation is the basis of rehabilitation medicine, and the target of rehabilitation is mainly people with disabilities, as well as people with various functional disorders such as chronic diseases and geriatric diseases. This is basically the same as the concept of “rehabilitation” in modern rehabilitation.
Rehabilitation in Chinese medicine refers to the use of various rehabilitation methods and other useful measures under the guidance of Chinese medicine theory for the disabled, the elderly, the chronically ill and those in the late stages of acute illnesses, in order to reduce the impact of functional impairment and reintegrate them into society. In the process of rehabilitation, the person himself/herself, his/her family and the community should be involved.
II. Obstacles and the relationship between obstacles and symptoms
The understanding of dysfunction in TCM rehabilitation has gone through a process of development, which has been gradually deepened with the development of TCM rehabilitation. There are three levels of impairment in modern rehabilitation, morphological dysfunction, i.e., biological level impairment, ability impairment, i.e., individual level impairment, and social disadvantage, i.e., social group level impairment. From the analysis of the literature, the understanding of the level of disorders in TCM is mainly reflected in the biological level. As for the latter two levels of disorders, no clear concept and systematic discussion have been seen in the ancient texts of TCM, and the contents with similar meanings are scattered in various medical texts. From the perspective of rehabilitation medicine, disorders at the biological level are expressed in TCM in the form of symptoms.
TCM considers symptoms as the basic factors and external manifestations that make up diseases and symptoms. The symptoms are a combination of various symptoms, causes, locations and pathological factors such as the contrast between evil and positive at a certain stage of the disease process, and are closely related to the disease, reflecting the pathological state of internal organs, meridians, qi and blood. Due to the action of certain causes, the body produces certain pathological changes, which are reflected internally as certain types of symptoms, and externally as certain symptoms from the perspective of rehabilitation, these symptoms are the factors leading to various dysfunctions. Therefore, the level and degree of disorders in TCM rehabilitation has the same significance as identifying the types of symptoms.
The modern view of impairment in rehabilitation is not the same level of problem as the concept of symptoms in TCM rehabilitation. Compared to the two, the symptoms reflect the internal physiological dysfunction of the body, while the disorders in rehabilitation reflect the external physical and behavioral dysfunction. The concept of both symptoms and disorders in TCM rehabilitation is a characteristic of TCM rehabilitation.
Evaluation and the relationship between evaluation and identification
Evaluation is one of the characteristics of modern rehabilitation science, and is a means to reflect the degree of dysfunction. Without evaluation rehabilitation medicine cannot be a complete system. The evidence of TCM is the core issue of TCM clinical practice, and is the main object of various TCM treatment methods. Therefore, the diagnosis of evidence is the necessary way to implement TCM treatment methods in the TCM clinical process: since the rehabilitation methods used in TCM rehabilitation are consistent with the methods of TCM clinical and TCM health care, the diagnosis of evidence is also a principle that must be followed in the TCM rehabilitation process. Therefore, TCM rehabilitation evaluation begins with the identification of evidence within the field of TCM diagnosis. This is mainly achieved through the four TCM diagnoses of looking, smelling, asking and cutting.
However, the object of rehabilitation medicine is different from the object of clinical medicine. The object of rehabilitation medicine is functional disorders, and it is difficult to reflect the nature and degree of functional disorders and the resulting social disadvantages through the general diagnosis of the four diagnoses. Therefore, identification is the process of materializing the internal physiological dysfunction, and the symptoms are materialized objects; the process of evaluation in rehabilitation is the process of quantifying the external physical and behavioral dysfunction, and there is no substitutability between the two. For example, for two patients with stroke and hemiplegia who have the same Chinese medical diagnosis of qi deficiency and blood stasis, it is difficult to reflect the degree of hemiplegic dysfunction by the symptom of qi deficiency and blood stasis, and to assess (measure) the improvement of dysfunction by the change of qi deficiency and blood stasis only. Therefore, other methods of evaluation are needed for hemiplegic dysfunction.
In ancient Chinese medical texts, the evaluation methods of the degree of the disease have been recorded for a long time, for example, in the Jin Kui essay: “If the evil lies in the luo, the skin is not benevolent; if the evil lies in the meridian, that is, heavy and unsatisfactory; if the evil enters the internal organs, that is, not knowing the person; if the evil is in the hide, the tongue is difficult to speak and the mouth spits saliva.” However, the evaluation of functional disorders has not yet been clearly documented, so the establishment of the TCM rehabilitation view of disorder assessment is an important step towards the maturity of TCM rehabilitation. In recent years, when studying the efficacy of TCM rehabilitation therapies, most of the methods of functional assessment and analysis of modern rehabilitation medicine are used to evaluate the nature and degree of dysfunction and observe the efficacy of rehabilitation based on the identification of evidence in TCM. This is a development trend of TCM rehabilitation.
IV. Principles of TCM rehabilitation treatment
Through the above-mentioned research and analysis, the principles of TCM rehabilitation are different from both modern rehabilitation and TCM clinical science in terms of treatment.
1. Holistic rehabilitation
According to TCM, the human body is composed of organs, meridians, limbs and other tissues and organs, none of which exists in isolation. There are various physiological functions or structural links between organs, meridians, and between organs, meridians and limbs, which enable all parts of the human body to form a complete and unified organism to maintain normal and coordinated physiological activities. It is characterized by the five viscera as the center, together with the six internal organs, linking the five bodies, five organs and nine orifices and other tissues and organs. The local dysfunction of limbs and organs is often related to the functional state of other parts of the human body and even the whole body’s internal organs.
2.Recognition rehabilitation
The selection and application of TCM treatment methods for diseases cannot be separated from evidence-based treatment. In TCM rehabilitation, most of these methods are also applicable to the improvement of functional disorders, so identification is the premise and basis of rehabilitation. In the clinical process of TCM rehabilitation, the identification of evidence includes the identification of internal physiological dysfunction, and the improvement of physiological dysfunction is causally related to the improvement of external physical and behavioral dysfunction. Therefore, to improve the internal causes of various dysfunctions through evidence-based treatment reflects the principle of “treating the disease at its root” and holistic rehabilitation in Chinese medicine. This is another characteristic of TCM rehabilitation.
3.Functional Rehabilitation
Rehabilitation takes functional disorders as the object of action, therefore, functional rehabilitation is its main treatment purpose. In TCM rehabilitation, the basic principle of functional rehabilitation is “unity of form and spirit”. Chinese medicine believes that God is the master of life activities, and the unity of form and spirit constitutes human life. Huainanzi? The Original Tao Training says: “The form is the shed of life, the qi is the fullness of life, and the god is the system of life.” Functional rehabilitation is the training of the dominant role of “God” over “form”. Methods such as channeling, exercise training, and qigong are methods of rehabilitation in which both form and spirit are present. The loss of motor function in hemiplegia, for example, is the loss of the dominant role of God over the limbs, emphasizing the importance of active motor training, which is exactly the same as the guiding idea of motor relearning in modern rehabilitation. Unfortunately, these rehabilitation methods of Chinese medicine have failed to form a system and further apply to clinical treatment.
4. Comprehensive Rehabilitation
During the long development of Chinese medicine, through the development and perfection of successive generations of medical practitioners, from simple to complex, a variety of treatment and health rehabilitation methods have been created. Each method has different therapeutic scope and advantages. It is one of the characteristics of Chinese medicine to integrate these approaches and to make use of their respective advantages in order to achieve good therapeutic effects. The targets of TCM rehabilitation are the disabled, the elderly, the chronically ill, etc. Therefore, it is difficult to achieve good results with a single treatment method. Therefore, in the process of rehabilitation, it is advocated to adopt the “Treatments of different methods and prescriptions”, which is advocated in the “Treatments of different methods and prescriptions”, “The sages combine different methods and treatments, so that each one is suitable for the other.
V. Rehabilitation Treatment Methods
In ancient times, rehabilitation medical activities and rehabilitation medical treatment emerged in China, and developed with the development of Chinese medicine: with the efforts of successive generations of doctors, the content of Chinese medicine rehabilitation science has been constantly improved, and rehabilitation methods have been supplemented, including a large number of drug therapy and non-drug therapy. Such as Chinese medicine, acupuncture and moxibustion, massage, fumigation, qigong, exercise therapy, etc.: these methods are under the guidance of Chinese medicine theory, compared with modern rehabilitation methods, unique and tested in practice, effective treatment methods.