Thursday 5 August 2010

Reports from the Frontiers of Acupuncture: Dr U Win Ko talks traditional Myanmar medicine




Dr U Win Ko

In January 2010 I was privileged to be part of a small team of TCM practitioners who travelled to Sagiang in Myanmar (Burma). This was part of an ongoing project that has been teaching acupuncture to doctors of
traditional Myanmar medicine (TMM). One of the main driving forces behind the success of this project is Dr U Win Ko, a teacher and practitioner of traditional Myanmar medicine with some 30 years experience.

DK: Can you tell me about the history of traditional Myanmar medicine (TMM)?

Dr UWK: I should first explain what TMM is. As defined by the World Health Organisation (WHO), TMM includes a range of diverse health practices, knowledge and beliefs. It incorporates plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, which can be applied individually or in combination.

TMM has four basic principles:
• Desana Naya
• Beithizza Naya (ayurvedic method)
• Netkhatta Naya (medical astrology)
• Vizzadhara Naya (medical alchemy and spiritual powers)

We find written evidence of TMM in votive tablets from the Bagan era (10th century). It is generally believed that basic medical knowledge spread to Myanmar from India with the propagation of Buddhism. However, Desana Naya was invented by the physician U Hmont in the 17th century and has been in use ever since.

DK: What are the main diagnostic methods? What form of treatment do you most often use?

Dr UWK: Most TMM practitioners use a four-stage diagnostic method:
• analysis of urination based on Karma Smuthana (frequent, infrequent or painful urination related to sheeta (cold)         and ushna (hot)
• inspection of abdomen based on sheeta and ushna
• Utu Smuthana (seasonal causes): symptoms are aggravated or improve in cold or hot seasons, times or situations; patient has a feeling of aversion to cold or hot
• Ahara Smuthana (food-related causes): the symptoms are aggravated or improve when cold or hot foods are eaten.
Finally, the practitioner diagnoses and treats according to the following factors:
• the organ affected
• whether the cause of the disease corresponds to hot or cold
• whether the internal Prithvi (earth) element is excessive or deficient
• whether the Apo (water) element is excessively dispersed in the external part of the body.

The form of treatment I use most often is to harmonise the excessive or deficient element first, then regulate the affected organ, and finally reduce the symptoms.

DK: What is your history and connection to TMM?

Dr UWK: Actually, my initial ambition was to be a doctor of western medicine. But I was not eligible to attend the Institute of Medicine after matriculation on account of my score, so I went to the Arts and Science University in
Mandalay. Then I took an entrance examination for the Institute of Traditional Myanmar Medicine, which had been recently opened by the Ministry of Health. This was in 1977 and I was 19 years old. It satisfied my desire to work  in medicine, as although I was not a doctor it allowed me to become a practitioner and treat illness.

After a four-year course, I received my diploma in TMM. Following that, I worked for 16 years in the Ministry of Health. I was also in charge of a township’s traditional medicine centre and was an instructor, lecturer and physician. I retired in 1997 and continued to work full time in my own clinic. When I was in government service, I could work in my clinic only in the evening. My grandfather was also a practitioner of TMM, so I was able to inherit some of his knowledge.

DK: What do you think about the future of TMM in your country?

Dr UWK: Well, to answer that I have to briefly continue the history of TMM. Before 1976 knowledge of traditional
medicine was passed on from father to son. In 1976, the government opened the Institute of Traditional Medicine for a four-year diploma course, and in 2001 the University of Traditional Medicine started a five-year degree course.

Some study with experienced practitioners, by practising and observing over a number of years,
whereas others gain their knowledge through courses at the Institute or University, or the Ministry of Health’s Department of Traditional Medicine. These practitioners provide the entire nation with comprehensive traditional medical services through the existing healthcare system, either via Ministry of Health traditional medicine hospitals and township medical centres or via private clinics.

The important thing is people’s belief in TMM. In Myanmar, people respect TMM as our traditional heritage and believe it can treat the root of the disease causing chronic illness. Because local people accept and use traditional medicine, and because the government encourages it, TMM practitioners have a brilliant future.

Acupuncture outreach in Gadaw Village
DK: When did you start learning acupuncture? 

Dr UWK: When I was in my final year at the Institute, an acupuncturist who had just come back from China came to speak to us about his experiences and acupuncture’s efficacy. I was very interested to learn more. Fortunately,in 2000, I got the chance in Wachet Jivitadana Sangha Hospital, with the encouragement of Sayadaw U Lakkhana (the abbot of the monastery that supports our hospital). I was taught by Dr Michael Zucker from Hawaii and Dr Daniel Bruce from New Mexico. This teaching programme has continued every year since, with teaching from many foreign acupuncturists.

DK: How much similarity is there between Chinese and Myanmar medicine?

Dr UWK: TCM and TMM are both Oriental medicines and as such share certain understandings of causes of diseases, but they are quite different in their concepts of the five element theory and physiological aspects of the body. For instance, what in western medicine is called hypertension usually corresponds to one of five distinct patterns in TCM: liver fire uprising, deficient yin/excess yang, obstruction of phlegm and dampness, interior liver wind, or
deficient yin and yang. However, inTMM hypertension usually corresponds to functional disorder of one of the five elements, and the concept of these elements is quite different from TCM. In TMM, the human body is believed to be composed of earth (Prithavi), fire(Tezo), wind (Vayu), water (Apo) and space (Akasa). The earth element for instance corresponds to touchable, solid things in the body, such as the skin, the lungs, the heart, whereas in TCM it is believed to correspond to the spleenand stomach. So the two traditionsare quite different in certain aspects.


DK: What are your hopes for the future of acupuncture in Myanmar?

Dr UWK: I think it will depend on four main factors:

• efficacy
• public acceptance
• state encouragement
• integration with TMM.

All four aspects look promising at the moment. For example, the Ministry of Health established a department of acupuncture in the University of Traditional Myanmar Medicine in 2001 and since then every student has a chance to learn acupuncture in their third and fourth year. In terms of integration, at presentsome TMM practitioners have already studied a basic acupuncture course, so they have some experience integrating TMM and acupuncture in their treatments. Based on my experience, integration can reduce the duration of treatment for certain conditions, especially for strokes, post-traumatic injuries and gynaecological problems.

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