The document discusses the Heidelberg Model of traditional Chinese medicine (TCM) and its use of functional diagnosis and a systems biology approach to understand biological systems. It proposes that TCM can be de-mystified and described mathematically using binary numbers. Double-blind studies show that acupuncture based on the Heidelberg Model's functional diagnosis is more effective than schematic acupuncture without diagnosis. The model provides a way to integrate TCM with modern biology and pharmacology.

1. Master Programme of TCM ICBAS – University of Oporto Heidelberg School of Chinese Medicine Henry Johannes Greten MD, PhD [email_address] TCM as a Model of System Biology New evidence by double blinding?

2. Functional diagnosis of Chin. Medicine describes biological systems by a mathematical language Heidelberg Model of TCM Double-blinded studies in acupuncture are now possible, augmenting the level of evidence Acupuncture is more efficient if based on such functional diagnosis Three points, one conclusion system biology of CM is relevant

3. Present „schematic“ acupuncture – No proof of efficacy Latest meta–analysis of 33 studies on acupuncture: „no specific effect“ (Linde 2009) No double blinding, no functional diagnosis No rational definition of diagnostic criteria

4. Mathematics in TCM (binary numbering of the I Ging: Leibniz 1643) structural deficiency vs. regulatory deficiency Defining the diagnosis: systemic approach constitution path. factor „ organ pattern“ orbs „ What is the patients „inner nature“ „ What affected the patient?“ „ Which signs and symptoms appear now ?“ 4x2guiding criteria „ snapshot of the actual functional state“ + + + repletio/depletio „ fullness“/„emptiness“ calor/ algor „ heat“/„cold“ extima/intima „ exterior“/„interior“ yin/ yang ? neurovegetative signs humoro-veget. signs neuro-immunolog. stages repletio depletio calor algor repletio depletio calor algor I II III IV V VI F W H M E F W H M E F W H M E F W H M E

7. Binary Numbers formed of Yin and Yang De-mystifying TCM - the Heidelberg model

8. De-mystifying TCM - the Heidelberg model Summer S Fire Water N Winter W Autumn Spring E Wood Metal

10. Summer S Heaven Earth N Winter W Autumn Spring E Hill Lake Thunder Wind Fire Water

11. Defining the Diagnosis: Periodicity of Regulation 37°C time 38°C 36°C thermostat electric heater water basin 35°C 39°C

12. yin (depletion) yang (repletion) time WATER METAL FIRE WOOD EARTH1 EARTH 3 EARTH 2

13. time yin (depletion) yang (repletion) WATER METAL FIRE WOOD EARTH1 EARTH 3 EARTH 2

14.  Hyper-dynamic sympathetic parasympathetic Cortisol Adrenaline Endorphines enteric NS active Hyper-tone T3, T4 Hypo- tone Hypo-dynamic enteric NS inactive enteric NS inactive 37°C time 38°C 36°C Wood Metal Water Fire

15. Clinical manifestations of wood high content of energy, upward movement postulated transmitters, hormones/ metabolism: Sympathetic N.S.  , adrenaline  , glycogenolysis  , glucose  , ACTH ira, power of descision, „ the general“ ; stress-, fight-, territorial-, hierarchy and conflict-programms (limbic system) sensory organ and body opening: eye ; sympathetic signs (tarsal- orbitalmuscles), tendency to high intra-occular pressure, mydriasis voice character: shouting ; tends to inspiratory posture, tongue and larynx go down and open with inspiration. „support“ „ ascendant yang“ sensation of extended liver splanchnic nerves (sympathetic n.s.) stimulate the liver, contracting livercapsule, rising pressure of the liver veins, leucozytosis, glycogenolysis „ hepatic orb rises upward and outward“; contraction of the physiological extensors, extension of the thorax with an inspiratory tendency fist-clenching ; flexor muscles of the arm are „physiological extensor muscles“ perfection: nervus increased neuromuscular excitability, hypertone patterns of movement „ flos“= blossom: nails ; impaired microcirculation (TCM: a „rough flow“ of qi and xue) leads to dystrophy rising (blood) pressure increasing heart rate swollen chest Copyright Greten 2003 chinese interpretation ; western equivalent

16. FIRE WOOD repletion YANG YIN   time depletion WATER METAL HEPATIC TENUINTESTINAL (“small intestine”) FELLEAL CARDIAL PERICARDIAL TRI-CALORIAL (triple ”burner”) PULMONARY CRASSINTESTINAL RENAL VESICAL PRINCIPAL PROBLEM OF REGULATION ORB distribution of fluids in back and lower burner re - generation breath, surface, rhythm surface of guts, conduction of nourishment control of “positive drive” shoulder-, ear-ache, “emotional abdomen” distribution of qi/fluids on sides and burners control of excitation and flow, “stress” suppressed impulse, ambivalence control of emotionality and associativity

17. Earth: the principle of regulation 1) downregulation 2) target value 3) upregulation © Greten 2003 De-mystifying TCM - the Heidelberg model time yin (depletion) yang (repletion) “ STOMACH” “ SPLEEN” 1 2 3

18. Clinical manifestations of Earth Yin, tends towards depletion intima horreal orb, transforms, brings the „clear“ upwards, disease like „postprandiale syndrome“ clears humor, pituita symbolizes metabolism „ rises“ „ holds“ the flesh De-mystifying TCM - the Heidelberg model time yin (depletion) yang (repletion) “ STOMACH” “ SPLEEN” 1 2 3 Yang, tends towards repletion extima aulic orb stores, transports brings the „turbid“ downwards needs to be moisturized ---- symbolizes digestion „ sedates“ --- © Greten 2003

19. Non-linear Aspects of Chinese Medicine Mathematics in TCM (binary numbering of the I Ging: Leibniz 1643) constitution path. factor „ organ pattern“ orbs „ What is the patients „inner nature“ „ What affected the patient?“ „ Which signs and symptoms appear now ?“ 4x2guiding criteria „ snapshot of the actual functional state“ + + + neurovegetative signs humoro-veget. signs neuro-immunolog. stages structural deficiency vs. regulatory deficiency repletio depletio calor algor repletio depletio calor algor I II III IV V VI repletio/depletio „ fullness“/„emptiness“ calor/ algor „ heat“/„cold“ extima/intima „ exterior“/„interior“ yin/ yang ? F W H M E F W H M E F W H M E F W H M E

20. Weak yin – the effect of a decrease of water in the basin Copyright Dr. Johannes Greten 2003 HSCM, *49-6221-374546, fax 302035 thermostat electric heater 37°C time 38°C 36°C water basin 35°C 39°C

21. Local : worse on pressure Pathophysiology of calor („heat“) Copyright Dr. Johannes Greten 2003 HSCM, *49-6221-374546, fax 302035 MICROCIRCULATION INCREASED Red tongue Warm sensation Pre-inflammatory state Relative lack of fluids in larger vessels Systemic : changing pain-location Heart rate increases Dry mouth, nose and lung Sparse, concentrated urine Water saving Dry, constipated stool

22. Mathematics in TCM (binary numbering of the I Ging: Leibniz 1643) structural deficiency vs. regulatory deficiency Defining the diagnosis: systemic approach constitution path. factor „ organ pattern“ orbs „ What is the patients „inner nature“ „ What affected the patient?“ „ Which signs and symptoms appear now ?“ 4x2guiding criteria „ snapshot of the actual functional state“ + + + repletio/depletio „ fullness“/„emptiness“ calor/ algor „ heat“/„cold“ extima/intima „ exterior“/„interior“ yin/ yang ? neurovegetative signs humoro-veget. signs neuro-immunolog. stages repletio depletio calor algor repletio depletio calor algor I II III IV V VI F W H M E F W H M E F W H M E F W H M E

23. Relevance of Classical Diagnosis Is acupuncture more effective using the classical diagnosis ? Can we perform double-blinding in acupuncture ?

24. Step 1 Diagnostic TCM Diagnosis Marking Points A, B, C Step 2 Therapist Usage of points Randomised order, ABC, BAC, CAB Double-Blinding Acupuncture Step 3 examiner blinding of patient blinding of therapist blinding of examiner

25. Objective Pain Evaluation (Flexion) 110 112 114 116 118 120 122 124 126 128 130 before treatment immediately after treatment 7 - days Classical Ac, HM Schematic Ac Control Ac - Knee flexion , degrees 0

26. Chin. Medicine-Based Acupuncture Superior to „Schematic“ Acupuncture Gonarthrosis pain + mobility: 2x better, n>100 Pain after tonsillectomy: HM beats standard by 3x Sertel et al., Archives of Otorhinolaryngology, in 2009 Congestion of the nose: classical points beat unsp. points Sertel et al. , American Journal of Rhinology, 2009 Gait improvement in the elderly : classical point significantly effective, sham acu no effect

27. Chin. Medicine-based Acupuncture superior to „schematic“ acupuncture Sternotomy induced pain: 78 % vs. 16,3% pain reduction (p< 0,001 lung function (IVC): + 360 ml vs. + 33ml (N=100, p <0,001 ) (Kick A et al. 2006) Walking distance in pAOD : 86,5 % vs. 40% (N= 34, p< 0,001) (Buhlmann E et al. AMSTCAR, Shanghai 2006) Capillary bloodflow (O2) in pAOD : 2-6 fold enhancement , Effects reversible by „counter acupuncture“ (Greten J, Krug A, Kick A, Remppis A, Diehm C, in preparation ) Polyneuropathy : 76% of the patients show enhanced nerve conductivity Schröder S et. al. European Journal of Neurology) Congestive Heart failure: HM better than standard points Journal of Acupunture and Tuina Sciences, 2008

28. Pharmacotherapy: Inhibition of macrophages by coptis through NFkB blockade comparable to Western pharmacology CaCo (Cancer-of-Colon) cells: inhibition of NFkB by coptis and scrophularia Curcumin: apoptotic effect in neuroblastoma cells Scrophularia: inhibition of proinflammatory NFkB C. elegans model: anti-oxidant effect of Chinese herbs Hesperitine („orange juice“): HERG blockade EGCG (green tee) electrophysiologically active Application in pharmacology

29. functional diagnosis of Chin. Medicine describes biological systems by a mathematical language Heidelberg Model of TCM Double-blinded studies in acupuncture are now possible, augmenting the level of evidence Acupuncture is more efficient if based on such functional diagnosis Three points, one conclusion system biology of CM is relevant

30. Subjective Pain Evaluation (WOMAC) treatment after treatment 0 8 9 10 11 12 13 14 15 16 17 18 19 before immediately 3 - days 7 - days Classical Ac (HM) Schematic Ac Control Ac - WOMAC pain score

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