Back Pain: Clinical Updates in Women's Health Care Primary and Preventive Care Review.

Every age group experiences back pain, a common reason for activity limitation. Management of back pain in a woman is challenging because of physiologic and hormonal changes through the woman's life cycle. The treatment is dictated by etiology and a woman's stage of life or reproductive events, such as pregnancy, breastfeeding, and menopause. Most episodes of low back pain are temporary with minimal long-term sequelae, but recurrent and long-lasting episodes require more thorough clinical evaluation. This monograph describes the anatomy of the spine; illustrates a focused, thorough evaluation, including obtaining a medical history and performing a physical examination; discusses warning signs and symptoms of more serious etiologies; provides recommendations for further testing or referral; and offers case vignettes of common causes of low back pain as a woman progresses from young adulthood to advanced age.

"Feeling lighter": Why the patient's treatment evaluation matters to the health scientist.

"Feeling lighter" is a cross-culturally found subjective patient experience, but it may well contain a comment on intersubjectively recognisable physical, neuro-chemical and bio-electro-magnetic processes that natural scientific research can identify. The health scientist is advised to take the patient's experiences seriuosly, and regard them as a possible source of for future research topics.

Ancient Chinese methods are remarkably effective for the preparation of artemisinin-rich extracts of Qing Hao with potent antimalarial activity.

Ancient Chinese herbal texts as far back as the 4th Century Zhou hou bei ji fang describe methods for the use of Qing Hao (Artemisia annua) for the treatment of intermittent fevers. Today, the A. annua constituent artemisinin is an important antimalarial drug and the herb itself is being grown and used locally for malaria treatment although this practice is controversial. Here we show that the ancient Chinese methods that involved either soaking, (followed by wringing) or pounding, (followed by squeezing) the fresh herb are more effective in producing artemisinin-rich extracts than the usual current method of preparing herbal teas from the dried herb. The concentrations of artemisinin in the extracts was up to 20-fold higher than that in a herbal tea prepared from the dried herb, but the amount of total artemisinin extracted by the Chinese methods was much less than that removed in the herbal tea. While both extracts exhibited potent in vitro activities against Plasmodium falciparum, only the pounded juice contained sufficient artemisinin to suppress parasitaemia in P. berghei infected mice. The implications of these results are discussed in the context of malaria treatment using A. annua infusions.

Diverse biologies and experiential continuities: did the ancient Chinese know that qinghao had anti-malarial properties?

This article treats Chinese medical theories and concepts as cultural constructs that arose as much from practice-oriented concerns as from socio-political negotiations within the medical field. It further explores the interface of the biological and cultural. It is often futile to investigate how Chinese medical descriptions relate to biological processes, because the local biologies that the Chinese physicians recognized in the past and continue to describe in the present, are contested by mainstream medicine, but recent bioscientific research on the anti-malarial properties of the Chinese medical drug qinghao opens up new avenues for the historian. To be sure, no attempt is made to equate ancient nosologies to modern ones, nor to justify the cultural through the biological. In order to avoid pitfalls of simple equations, this article takes the experiential not merely as a subjective but as an inter-subjective reality that mediates the biological and cultural. The findings are striking: once one reads the Chinese medical texts as reporting on the experiential, one of their many possible readings is that they provide concrete descriptions of morbid conditions that also the contemporary mainstream physician recognizes.

Chinese propriety medicines: an "alternative modernity?" The case of the anti-malarial substance artemisinin in East Africa.

This article discusses various modes of "modernizing" traditional Chinese medical drugs (zhongyao [image: see text]) and transforming them into so-called Chinese propriety medicines (zhongchengyao [image: see text]) that are flooding the current neoliberal wellness markets. This article argues that the chemical procedures used in the manufacture of Chinese propriety medicines are highly culture-specific and deserve being considered as instantiations of an "alternative modernity" (e.g., Knauft 2002), rather than of "Westernization." These Western-Chinese combinations, produced in strife toward fulfilling Mao Zedong's Communist-revolutionary vision, have a potential to represent a critical alterity to Western health policies, challenging rhetoric against such combinations. However, as is also noted in this article based on ethnographic fieldwork in East Africa, their potential alterity has been corroded for at least two reasons. First, the medical rationale for dispensing these medications has been shaped by commercial demands in ways that have worked toward transforming the formerly scholarly Chinese medical tradition (as outlined by Bates 1995) into a consumer-near and popular "folk medicine" (as defined by Farquhar 1994:212). Second, the repertoire of Chinese propriety medicines is impoverished as its efficacious "alternatively modern" drugs are being redefined as "modern" biomedical drugs. The article concludes that the potentially critical alterity of any formerly scholarly traditional medicine is more likely to be lost in those fields of health care that are both highly commercialized and polarized by the biomedical imperative to distinguish between "traditional" and "modern" medicines. As example for demonstrating how contentious the issue is, qinghaosu [image: see text] (artemisinin) is put center stage. It is an anti-malarial substance which in the 1970s Chinese scientists extracted from the Chinese medical drug qinghao [image: see text] (Herba Artemisiae annuae). Some Chinese practitioners in East Africa argued that artemisinin belonged among the Chinese propriety medicines they sold. Although according to Western biomedical criteria and the Chinese scientists who were involved in its chemical identification, artemisinin is a "modern" Western drug, their polemics deserve to be more closely analyzed as what social scientists have recognized as an "alternative modernity."

A hybrid body technique: does the pulse diagnostic cun guan chi method have Chinese-Tibetan origins?

This article investigates the medieval origins of the main pulse diagnostic method in contemporary Chinese medicine, sometimes known as san bu (three sectors) method, which requires physicians to examine the mai (vessels, vessel movements or pulse) on the wrist at the three locations cun guan chi (inch, gate, foot). The article provides evidence to suggest that this body technique grew out of an earlier Chinese one, the cun chi (inch-foot) method, which appears to have aimed at investigating the qualities of yin and yang in order to determine the condition of a patient by means of exploring fairly large areas of the patient's body surface with the palms. The article furthermore posits that the cun chi method was decisively transformed in medieval times, presumably due to the impact of early Tibetan pulse diagnostic practices: it became framed in a numerology of three and started advocating the use of the fingertips for sensing the pulse beats. The article, which draws on detailed textual analyses of medieval manuscripts, on visual evidence and also on psychophysical research, furthermore highlights how misunderstandings can constructively contribute to cultural communication.

Reflections on the 'discovery' of the antimalarial qinghao.

Artemisinin, qinghaosu, was extracted from the traditional Chinese medical drug qinghao (the blue-green herb) in the early 1970s. Its 'discovery' can thus be hailed as an achievement of research groups who were paradoxically successful, working as they were at the height of a political mass movement in communist China, known in the West as the Cultural Revolution (1966-1976), a period that was marked by chaos, cruelty and enormous suffering, particularly, but by no means only, among the intelligentsia. On the one hand, China's cultural heritage was seen as a hindrance to progress and Mao set out to destroy it, but on the other hand he praised it as a 'treasure house', full of gems that, if adjusted to the demands of contemporary society, could be used 'for serving the people' (wei renmin fuwu). The success of the 'task of combating malaria' (kang nüe ren wu), sometimes known as 'task number five hundred and twenty-three', depended crucially on modern scientists who took seriously knowledge that was recorded in a traditional Chinese medical text, Emergency Prescriptions Kept up one's Sleeve by the famous physician Ge Hong (284-363).

The history of qing hao in the Chinese materia medica.

Artemisinin is currently used for treating drug-resistant malaria. It is found in Artemisia annua and also in A. apiacea and A. lancea. Artemisia annua and A. apiacea were known to the Chinese in antiquity and, since they were easily confused with each other, both provided plant material for the herbal drug qing hao (blue-green hao). This article shows, however, that since at least the eleventh century Chinese scholars recognized the difference between the two species, and advocated the use of A. apiacea, rather than A. annua for 'treating lingering heat in joints and bones' and 'exhaustion due to heat/fevers'. The article furthermore provides a literal translation of the method of preparing qing hao for treating intermittent fever episodes, as advocated by the eminent physician Ge Hong in the fourth century CE. His recommendation was to soak the fresh plant in cold water, wring it out and ingest the expressed juice in its raw state. Both findings may have important practical implications for current traditional usage of the plant as an antimalarial: rather than using the dried leaves of A. annua in warm infusions, it suggests that fresh juice extraction from A. apiacea may improve efficacy.

Tactility and the body in early Chinese medicine.

If visual inspection of corpses was central to the development of anatomy in modern Europe, one may ask which of the senses was important for the emergence of the predominant currents of scholarly medical knowledge and practice in third- and second-century B.C.E. China? This article argues that it was tactile perception prompted by a tactile exploration of living bodies. The evidence, derived from a close reading of the Mawangdui medical manuscripts, the 105th chapter of the Records of the Historian, and selected passages from the Huang Di's Inner Canon, points to three important trends: first, the tactile exploration of the extremities led to a rich vocabulary of compound words for pain as localized in specific body parts; second, the tactile exploration of the mai gave rise to an even richer vocabulary on qualities of touch in pulse diagnostics; and third, the tactile exploration of the abdomen led to the assessment of the quality of the internal viscera with words that generally were used for describing the tactile quality of skin and flesh. This finding may appear surprising in the light of later developments during the dynastic history of Chinese medicine where tactile exploration of abdomen and extremities would appear unseemly. The author suggests that extensive tactile explorations of the body were possible before Confucius' teachings became a predominant aspect of state ideology.

"The medicine from China has rapid effects": Chinese medicine patients in Tanzania.

Traditional Chinese Medicine (TCM) involves both biomedical and traditional medical training, which makes well-trained TCM doctors inexpensive health care providers for primary health care. The Tanzanian Ministry of Health and Ministry of Commerce recognised this potential, and in the mid-1990s issued short-term licences for private TCM enterprises. In Dar es Salaam, some of these practices experienced a period of considerable growth, but by the year 2000 a degree of ambivalence if not resentment existed against Chinese medical doctors who were accused of unlawfully using biomedical medication, and the government refused to issue further licences. In addition, some 'doctors' had insufficient training or minimal clinical experience (though I also met some notable exceptions). This article asks why Tanzanian patients turn to the Chinese for medical treatment, and what patients know about Chinese medicine and medication. One of the chief findings is that the Swahili term dawa ya Kichina is vague, which allows patients to transfer their positive experiences with Chinese biomedical doctors during the period of socialist orientation onto the current, entrepreneurial TCM doctors. Dawa ya Kichina is often considered a rapidly effective 'advanced' 'traditional' medicine; its ready-made patent formulas, which make it look 'scientific' and 'modern', are easy to consume; and its entrepreneurial set-up has several advantages over the bureaucratic structures of 'hospital medicine'. Chinese anti-malarials, artesiminin derivatives, reduce malarial fevers within hours, and though, strictly speaking, they are biomedical drugs, they are indeed dawa ya Kichina . Moreover, patients of TCM doctors sometimes experience rapid recovery, mostly due to skilled integration of biomedical and Chinese medical treatment. Further research is recommended to investigate the primary health care potential of such integrated Chinese and biomedical treatment.