20171022 aging tsunami the important role of the integrative east-west health model by prof. ka-kit hui

1. Aging Tsunami
The Important Role of the
Integrative East - West Health Model
Ka-Kit Hui(許家傑 )M.D., F.A.C.P.
Wallis Annenberg Chair in Integrative East-West Medicine
Professor, Founder & Director
Center For East-West Medicine
Department of Medicine
Chair, Collaborative Centers for Integrative Medicine
UCLA
www.cewm.med.ucla.edu

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PwC HealthCast 2020:
Creating a Sustainable Future
• The current health systems of
nations around the world will be
unsustainable if unchanged over
the next 15 years.
• Increasing demand, rising costs, and
uneven quality, misaligned incentives
overwhelm health systems,
creating massive financial burdens
for individual countries and
devastating health problems for the
individuals who live in them.
Published 2005

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Actual Projections
Percentageofthepopulationaged65and
over(%)
Taiwan
Singapore
UK
USA
China
Italy
Japan
France
Year
Source： CEPD， A. Population Projections for Taiwan:2006-2051 ( June 2006 reported)
Aging speed of Taiwan compared to other countries is fast.
Trend of Population Aging

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UN estimates that China will go from 100 million
retirees in 2005 to 330 million in 2050
Dependency ratio (age 65 and above divided by
total working population) - 14% in 2015, will rise
to 44% by 2050
4:2:1

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Differences between older
and younger people…
• Increased allostatic load, ‘homeostenosis’
• Increased disease burden – degenerative,
malignant, infectious
• Increased medication use and risk for
adverse response to their use
• Heterogeneity
• Adverse social, economic and cultural
changes more common

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Inadequacy of disease model; think
more about presenting problems!
Immobility
Instability
Incontinence
Impairment of
vision and hearing
Immobility
Irritable colon
Isolation
(depression)
Inanition
(malnutrition)
Impecunity (having
no money)
Iatrogenesis
Insomnia
Immune
deficiency
Impotence

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… make for problematic issues in the
care of older people
• While chronic diseases account for most
deaths in modern society, the health
care system remains based on an acute
care model
• Fragmentation and discontinuity of care
are pervasive
• What ‘can be done’ may not necessarily
be what ‘should be done’

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Tinetti ME et al. NEJM 2004.

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At UCLA, 1972
UCLA CEWM 2016
My Student Years, 1971

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UCLA Center for East-West Medicine
Mission:
Lead in improving health & quality
of life by bringing together the
best of Western and Chinese
healing traditions to provide
healthcare that is safe, effective,
affordable, and accessible for
people, families, and
communities.
http://www.cewm.med.ucla.edu

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Internationa
l
Programs
Regional Networks
The Center
UCLA Center for
East-West
Medicine
Clinical
Program
s
Educatio
n
Researc
h
Project
s
Informatio
n Center,
Publicatio
n
Web Portal.
Visual Project,
Communicatio
n

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CCIM Members
Research Education
Clinical
Practice Policy
Center for East-West Medicine
Center for Excellence in Pancreatic
Diseases
Center for Human Nutrition
Center for Neurobiology of Stress
Cousins Center for
Psychoneuroimmunology
ECAM Journal
Mindful Awareness Research Center
Pediatric Pain Program
RAND
School of Medicine/Doctoring Program
School of Public Health
Simms/Mann – UCLA Center for
Integrative Oncology
UCLArts and Healing

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Integrative East-West Medicine Model
Chinese Medicine Western medicine
Combining components of Western Medicine and Traditional Chinese Medicine
together to benefit patients.
“Flip” shades provide a complementary view of medicine. Neither lens by itself is
sufficient to see all aspects of the spectrum of health.

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The Best of Both Worlds:
Key Components of the East-West Framework
• A harnessing of biomedicine’s strengths in
disease detection, acute condition management
and vital system stabilization
• Reliance on the concept of balance, flow, and
spirit
• Trust in the body’s innate ability to heal
• A flexible and comprehensive approach
for personalized care
• Commitment to finding the root causes behind
the manifestation of symptoms and diseases
• Commitment to treating the whole patient by
addressing both the local and the global
• Active engagement in prevention and the
cultivation of health
• Safe, effective and affordable care

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UCLA CEWM Clinic
An example of an Integrative Medicine
Clinical Model
Clinic Staff
– Eleven board-certified physicians trained in E-W medicine
– Eleven licensed acupuncturists & massage therapist who were also trained
in E-W medicine
Patient referral
– About 21,000 patient visits a year
– Primarily referred from >500 specialists in the UCLA system
Patient population
– Most patients exhaust conventional treatments
– Patients who fail or are intolerant of medications/surgery
– Patients seek individualized care for wellness & prevention and
treatment of chronic conditions

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An approach to clinical problem solving comprising
judicious incorporation of principles and
therapeutic modalities of traditional Chinese
medicine (TCM), a biopsychosocial perspective,
enhanced appreciation of the role of the soft
tissues in health and disease and a sharp focus on
disease prevention and health promotion.
What is integrative East-West medicine?

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VS
An International Buffet Gourmet Dish
VS
Clinical models in Integrative
Medicine

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Traditional Chinese Medicine (TCM) View
Constitution
Increasing Age
Unhealthy Lifestyle
Overwork
Environmental
Social
Trauma
Infection
Emotional Strains
Irritable
Bowel
Syndrome
Chronic
Fatigue
Syndrome
Rhinosinusi
tis Asthma
Depletion Imbalance
Zheng (Pattern)
Flow Disturbance

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Therapeutic Goals of TCM
• Restore normal balance and flow
• Individualization
• Focus on enhancing the body’s
endogenous resistance (homeostatic
reserve) to disease
• Less emphasis on specific causal factors

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CEWM Clinical Model
Pre-Visit In Clinic ( Visit) Post-Visit
Whole Person
Assessment
(Both Eastern Dx &
Western Dx)
Education
(i.e. nutrition,
acupressure, stress
mgmt)
Treatment
(i.e. acupuncture, TPI,
drug reduction)
Prognosis
Self-careReferrals

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McEwen refers to the physiologic response to stress as
allostatic load and states:
Allostasis – the ability to achieve stability through change – is
critical to survival. Through allostasis, the autonomic nervous
system, the hypothalamic-pituitary-adrenal axis, and the
cardiovascular, metabolic, and immune systems protect the body
by responding to internal and external stress. Over time,
allostatic load can accumulate, and the overexposure to
mediators of neural, endocrine, and immune stress can
have adverse effects on various organ systems, leading to
disease.”
Neuroscience and Biobehavioral Reviews 35 (2010) 2–16

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Stress Management
Hobbies
Listen to music
Strong Support System
Eat regularly with
proper nutrition
Meditation/Relaxation
techniques
Cry
Exercise/Stretching
Self-massage
Sense of humor Positive thinking
Adequate sleep
Pets

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“Acupuncture restores the homeostatic balance by a differential effect of
suppressing hyperfunction, stimulating hypofunction, and regulating
disturbed function.”
Li, Y. et.al. The effect of acupuncture on gastrointestinal function and disorders. Am J
Gastroenterol. 87(10): 1372-1381, 1992.
What is Acupuncture?
In other words: A method of
sending a signal to the body (by
needle or other means of
stimulation) to “turn on” its
own self healing capacity

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What do we use Acupuncture for?
27
HEAD Lungs Neurologic Muskuloskeletal Gastrointestinal
Sinusitis COPD Headache/
Migraines
Neck pain Esophageal spasm
Allergies Asthma Trigeminal
neuralgia
Back pain/
Sciatica
Gastritis
Common
Cold
Heart Facial palsy/
Bells palsy
Tennis elbow IBD: Crohns/ UC
Central
retinitis
Hypertension Peripheral
Neuropathy
Osteoarthritis Constipation
Dry Mouth Chest pain Paralysis after
stroke
Frozen Shoulder Diarrhea
Cataract Arrhythmias Parkinson's Nausea/Vomiting
Tooth aches Autoimmune Abdominal Pain
Dizziness Lupus Thyroid disease
Tinnitus Rheumatoid
Arthritis
Fibromyalgia STRESS!!

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•Improperly designed tools or
machinery
•Non-ergonomic work
environment
•Excessive weightlifting and
other activities that result in
overload
•Motor vehicle
accidents
•Athletic injuries
•Falls
•Occupational
•Relationships
•Family and friends
Macro-trauma
Chronic
microtrauma
Psychosocial stress
TRIGGER/TENDER POINTS
Sleep disturbance
Systemic/metabolic influences
•Obesity
•Inflammatory disease

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Healthy Eating:
Integrative East-West Way
• West
• General (average healthy recommendation)
• TCM
• Fine tuning to the individual
(environment and constitution)
Optimized well-balanced Diet using an
integrative East-West approach

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Tai Chi: Research
highlights
VZV specific immunity and health functioning in older
adults Irwin M et al. Psychosom Med 2003. Irwin M et al.
JAGS 2007.
Symptom control and quality of life in patients with
fibromyalgia Wang C et al. N Engl J Med 2010.
Functional status and exercise capacity in patients with
chronic heart failure Yeh GY et al. Am J Med 2004.
Cardiopulmonary function and quality of life in patients
with chronic obstructive pulmonary disease Guo JB et al.
Clin Rehabil 2015.
Augmentation of pharmacotherapy for geriatric
depression Lavretsky H et al. Am J Geriatr Psychiatry
2011.
Falls in older adults, both robust and transitionally frail
Wolf SL et al. JAGS 1996; Sattin RW et al. JAGS 2005.
Hwang HF et al. JAGS 2016.
Osteoarthritic knee pain (Tai chi as effective as physical
therapy) Wang C et al. Ann Intern Med 2016.

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养生
Cultivating spirit
Adjusting diet
Exercising body
Regulating mood
Moderating sexual life
Adapting to the climate
Heaven (climate)
Earth (food)
Humanity (negative
emotions)
Nutrition
Circulating Qi
Within bedroom (sex)

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Focus on health
preservation as
opposed to
disease treatment

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Interventions to reduce allostatic load
and achieve balance
PERSON-CENTERED INTERVENTIONS
(INDIVIDUAL AND SOCIAL)
• Eat healthy
• Stop smoking
• Exercise
• Learn coping skills
• Recognize limitations
• Relax/meditate
• Avoid isolation
• Ensure adequate/restorative sleep

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Prevention
“To administer medicine to diseases which have
already developed and thereby suppress bodily
chaos which has already occurred is comparable
to the behavior of those who would begin to
dig a well after they have grown thirsty or
those who would begin to cast weapons after
they have engaged in battle. Would these actions
not be too late?”
–Huang Di Nei Jing, 475-211 B.C.

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Continuum of Prevention
Healthy
“Normal”
High Risk,
“Pre-disease”
Uncomplicated
Disease
Complicated
Disease
Onset Onset Progression
ImprovementRecovery Improvement
Primary Prevention Secondary Prevention Tertiary Prevention Disease management
CAM
Western medicine

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臨床： 全面的中西醫結合醫療服務
全科
醫學
Santa Monica
醫院
醫學
罗纳德里根医疗中心
專科
治療
全部三个诊所

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Primary Care at the Center for East-West Medicine

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ResearchClinical
Effective Affordable Safe Accessible
Health
Professionals/
Providers
Clinicians
Health educators
Information
Others
Business
Health Care Orgs
Herbs
Drug
Equipment
Information
Others
Public
Patients
Family
Work environment
Community
Others
Government/
Non-Profit
Policy Makers
Health Regulators

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Education in Integrative Medicine
University
School of
Medicine
Mentorship
Residency Fellowship Practice
1st Year Medical
Student selective
Undergraduate
Summer Course
Public Health,
Anthropology
Medical Students
from China
Interns from
UCLA & Olive
View
Residents from
UCLA & Outside
Hospital
Primary Care
East –West Medicine
Nurse Practitioner
East-West
Consultative
Specialty
Limited
Fellowship
Hospitalist/Inpatient
Community
Public
lectures/Confe
rences
4th Year Elective,
Clerkship, Rotations
ExploreIM
web portal
3rd Year Core
Lecture series,
Preceptorship
International
Program

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Grooming Integrative East-West Change
Agents in various disciplines
Teaching Integrative East-West
Health Paradigm
(Theories and Ideas)
Change Agents, Future Leaders
Anthropology
and Sociology
Communication
and Media
Computer Science, Engineers
Business and
Law
Health
Professionals
(Nursing,
Medicine, Public
Health, CAM,
Researchers)
New Institution

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1992, San Francisco: Before launching CEWM, presented at a meeting
the need for an integrative East-West clinical model
1997, Beijing: 1st World Congress, warned about the looming healthcare
crisis and alluded to IM’s potential
1999, Macao, 1999 Beijing. 2000, Japan: WHO meetings, discussed the
potential impact of integrative East-West medicine on the current global
healthcare crisis
2002, Beijing: 2nd World Congress, emphasized the importance of
collaboration among the IM workforce
2007, Guangzhou: 3rd World Congress, delineated the need and plan for
improving global collaboration in IM thru better communication
2008, Sydney, 2011, Shanghai; 2012, Beijing, Tianjin: International
conferences, launching and disseminating an integrative East-West patient-
and society-centered model of healthcare that is safe and cost-effective
2013, Shanghai, 2014, Taiwan; 2015, Korea: WHO meeting, discussing
innovative approaches in TCM and IM evidence-based research and the
role of IM in global health systems, respectively.
My Journey in Improving Global Healthcare
through Integrative Medicine
2014

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WHO 2000

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April 22-24, 2011
Theme: New Life, New
Medicine Presented the
following talk:
The Important Role of Integrative Medicine in Health
Care Reform
Emphasizing the importance of the integrative health paradigm
in revitalizing primary care through health system redesign and
training of a new group of clinicians with enhanced ability to
solve most problems encountered in the out-patient and
community settings by utilizing the best of different healing
traditions.
Shanghai International Integrative Medicine Congress
2013- NOW
Teaching IM to 12,000 community-based clinicians/public health workers in Shanghai

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上海社區中西醫結合培訓項目
巡視考場
座談會

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“The two systems of traditional and Western medicine need not clash. Within
the context of primary health care, they can blend together in beneficial
harmony, taking advantage of the best features of each system and
compensating for certain weaknesses in each as well.”
1999 at UCLA
Visiting CEWM
Margaret Chan
Director General of WHO

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吴咸中 陈可冀 韩济生
王宝恩
李 恩 屠呦呦 俞 静
沈自尹 李连达
陈凯先
赵伟康
张代钊
谢竹藩
于尔辛 秦万章
UCLA Visual History Project
Preserving the intellectual heritage of Traditional
Chinese Medicine and Integrative Medicine
through the video documentation of the life-
changing experiences and wisdom shared by the
pioneers of integrative medicine and leading figures
in China.

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Patient SP sought help at the Center for East-West Medicine clinic
after having suffered for ninth months from her gastroesophageal
reflux symptoms. Upon review of her history, the physician
discovered a tangled network of problems far beyond
gastroesophageal reflux.
She is an 65 year old elderly, divorced, appeared overweight, and
was pre-hypertensive. A registered nurse, she has worked night
shifts in various high-stress Intensive Care Units for ten years.
Heartburn and bloating sensations often disrupt her sleep. Over-
the counter anti-acid drugs, have only provided temporary relief.
She also takes non-steroidal anti-inflammatory drugs (NSAIDs) to
help deal with tension headaches, migraines, and environmental
allergies.
Background

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Intake Interview
At the initial history intake, the clinician made note of the following on the patient’s
background:
Medications currently taken: NSAIDs, Triptan, nasal steroid sprays, anti-acid drugs,
and antihistamine agents
Supplements currently taken: vitamin D, calcium, multivitamins, gingko, and green tea
extract
Current diet:
• meals – mainly cold salads and Asian-dishes, such as fried rice and stirred fried
noodles with chicken and vegetables
• snacks – power bars, chips, string cheese, yogurt, and baked-goods
• high dependence on coffee and other caffeinated beverages
Exercise: cardio and weight lifting for half-an-hour once or twice a week
Medical history: chronic low back pain, allergic rhinosinusitis, osteoarthritis of the
knee, degenerative disc disease of the cervical spine, migraine headaches, dysthymia,
Hashimoto’s thyroditis, and frequent urination and constipation
Surgical history: tonsillectomy, septoplasty, and ACL reconstruction of the left knee

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Enumeration of Stressors
The provider identified the following stressors:
Pharmacological stressors: non-steroidal anti-inflammatory drugs have placed a major burden on
the gastrointestinal tract; nasal steroid sprays and antihistamine agents may increase drowsiness,
rebounding congestion, and dry mucosal layers
Psychosocial stressors: divorced, work-related stress incurred by dealing with patients, patients’
families, and doctors
Emotional stressors: loneliness, anxiety, and dysthymia
Environmental stressors: cold hospital environment results in contracted and tense muscles;
hypersensitivity to environmental allergens and patient germs, discharges, and drainages
Mechanical stressors: strain on the body from lifting and transferring patients and excessive hours
working on the computer
Hormonal stressors: menopausal symptoms, including hot flashes and night sweats, which disturb
her sleep at night
Dietary stressors: excessive intake of coffee/caffeinated beverage, cold foods (salad), spicy foods
Pain stressors: migraines, lower back problems, heartburns
Metabolic stressors: overweight and pre-hypertension; risk factors for cardiac and endocrine diseases

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Treatment Approach
In this initial visit, the provider began to develop a partnership with the patient
by identifying the underlying stressors that trigger her symptoms, and initiated a
jointly developed comprehensive treatment regimen that includes
acupuncture, acupressure, Chinese nutrition advice, and a stress
management strategy beginning with lifestyle modifications.
In addition, the clinician analyzed the long list of medications and made plans
to gradually reduce her dependence upon them. The patient returned for
weekly visits. She was further instructed to perform self-massage on the
essential acupressure points and how to use a tennis ball to massage her back.
She reviewed the recommended dietary modifications with the clinician, and
was taught the techniques to enhance her quality and quantity of sleep.
During each return visit the provider reviewed the skills, checked the patient’s
progress, and verified the outcomes with the patient.

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Outcome
After five weekly treatments, she reported that the heartburns, allergic
rhinitis, and tension headache have significantly decreased, and no
episode of migraines have presented treatment began. She also recognized
that to prevent the reoccurrence of her symptoms, she needed to maintain
the dietary modifications and continue to practice self-acupressure.
After ten weekly treatments, she reported that she rarely takes anti-acid
drugs and pain medicine for her headaches and back pain any more. Other
chronic conditions that she had for many years, including constipation,
nasal congestion, and insomnia, had improved considerably. No longer
suffering from sleep deprivation from heartburns and night sweats, she could
enjoy improved mood. Overall, she felt more relaxed and energized.

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Phone: +1 310-794-0712
Email: cewm@mednet.ucla.edu
Website: www.cewm.med.ucla.edu
http://exploreim.ucla.edu
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Thank you!