"Face
the simple fact before it becomes involved.
Solve
the small problem before it becomes big.
The
most involved fact in the world
Could
have been faced when it was simple.
The
biggest problem in the world
Could
have been solved when it was small."
C
Lao Tsu[1]
Chinese
medicine has treated many hundreds of millions of people over the last
three thousand years. It entered the U.S. in the 1700's with physicians
who were trained in France, and in the 1800's
with practitioners from the Orient. It was embraced to some degree by American
mainstream medicine early in this century, as evidenced by references to
the successful treatment of sciatica and lumbago by acupuncture in H. Gray's
Anatomy, Descriptive and Surgical (1901 edition) and W. Osler's
The Principles and Practice of Medicine (1892-1947 editions).
An
estimated 9 to 12 million patient visits per year are made to practitioners
of Chinese medicine in the U.S., most seeking acupuncture for treatment
of pain symptoms after unsatisfactory results with Western medicine.[2]
There are between 9 and 10,000 practitioners of acupuncture,[3]
including about 3,000 physicians who have varying amounts of training in
continuing education programs through American medical schools.[4]
Thirty-five
schools of Chinese medicine in the U.S. now train non-physician practitioners
in programs lasting three to four years. In 1973 Nevada became the first
state to license non-physician practitioners of acupuncture. Twenty-three
states restrict the practice of acupuncture to physicians only, while the remainder
have varying degrees of regulation for non-physicians.
To
the Westerner, perhaps its most striking quality is its differentness
from our conventional ways of thinking. This applies to its views of what
health is, what causes health and illness, how healing occurs, and the
language that is used to describe all this. In fact, it may seem that to
understand Chinese medicine one needs to learn a different language. And
indeed, as we shall see, even within Chinese medicine there are different
vocabularies.
"Chinese
medicine" is actually a blanket term for several different but related
traditions of healing. They trace their roots to the time of the Han Dynasty
about two thousand years ago and beyond. This was the golden age of philosophy,
culture and medicine in China. An important product of the era was an effort
by seven scholars of medicine to unify the society's medical practices.
They compiled The Nei Jing,
also known as The Yellow Emperor's Classic of Internal Medicine.
This book was an attempt to describe the many diverse and even contradictory
views of healing that had existed in China up to that time.
KEY
PRINCIPLES
Yin and
Yang
At
the foundation of Chinese medical theory is the concept of yin-yang. Just
as there are cycles of day and night, the ebb and flow of ocean tides,
and the changing of the seasons, human health is also a function of ever-changing
patterns of energy that are constantly seeking to be in harmony and balance.
The principle of yin-yang captures this dynamic interplay.
Yin
is sometimes described as the feminine principle and Yang the masculine.
All of life is somehow an expression of the interplay between yin and yang.
Every physiological process and symptom can be analyzed in the light of
yin-yang theory. Since the ultimate goal of Chinese medicine is to balance
and strengthen, every form of treatment has, in a broad sense, one of the
following aims:
To tonify
Yang
To tonify
Yin
To
eliminate excess Yang
To
eliminate excess Yin[5]
The Vivifying
Force: Chi (Qi)
Yin
and yang are complementary aspects of another concept at the heart of Chinese
medicine, which is chi, sometimes also spelled qi.
We have no equivalent word in English. Roughly translated as "life force
energy" or "life activity," chi is more than just energy as we think of
it in Western terms C
as, for example, horsepower or wattage. Rather, chi has the qualities of
life itself. As described by San Francisco practitioner Efrem Korngold,
chi is what makes life possible, suggesting a "biodynamic" quality of action
or movement. Chi is that intangible force that animates us and makes us
alive. All that is alive has chi, and what is not alive has no chi.[6]
The
diverse traditions or schools within Chinese medicine have different languages
for describing the action and qualities of chi, but the common principle
is that chi flows through the body and enlivens it. Health is a function
of a balanced, harmonious flow of chi and illness results when there is
a blockage or an imbalance in the flow of chi.
The
human being has pathways called "meridians" through which the chi flows.
The body has been mapped with these meridians which pass through all its
organs, and specific meridians correspond with specific organs or organ
systems ("organ networks"). Health is an ongoing process of maintaining
balance among all the organs and systems of the body.
The Meaning
of Symptoms
Symptoms
are seen as signals of trouble somewhere in the flow of chi. To
only remove a symptom would be like removing a flashing generator light
from your car's dashboard because you are annoyed by it, when what it is
doing is signalling to you the presence
of a deeper problem.
"When
people come to Chinese medicine they find one person who understands how
their back problem is connected to their abdominal distension, which is
connected to the dryness in their eyes, which is connected to their sometimes
aggressive and sometimes passive feelings. All the symptoms the person
may experience become integrated, which enables them to feel like one whole
person who is seeking guidance from another for help with all the parts
of themselves."[7]
Treatment
of Illness
When
illness arises, the practitioner thinks in terms of different qualities
of the person's chi and what the chi is doing as it moves through the person
-- for example, it may be stagnating or blocked in a certain place, or
it may deficient or excessive. To correct these dysfunctions, the main
treatments work directly with the flow of chi. The vocabulary of such work
often includes such verbs as tonify,
consolidate, replenish, comfort, disperse, purge, strengthen, and harmonize.
In Western terms, the goals of treatment are very much in alignment with
our concept of strengthening host resistance.
Perspective
on Modern Health Problems
Most
modern diseases are considered "chi deficiency" diseases, caused by our
not maintaining or supporting a harmonious internal ecology. Chronic stress
and tension deplete our inner resources and impair the flow of chi through
our organ networks. Our poor diet denies the nourishment needed to keep
the organ systems healthy so they can do their part in helping maintain
balance. Our sedentary lifestyle further promotes the stagnation of our
vital energy, with poor circulation and the accumulation of toxins in our
tissues.
When
our chi is depleted or blocked we become more vulnerable to infection by
viruses, bacteria, or other organisms. And, we are more vulnerable to the
degenerative processes that our society has come to associate with normal
aging.
Because
of our interconnectedness with the environment around us, the worldwide
ecological crises occurring at this time are especially problematic for
our health. As acupuncturist David Walker, O.M.D. of Santa Rosa, California
puts it, the erosion or mismanagement of the terrain around us makes it
more difficult for our inner terrain to maintain its vitality. "How can
you be well living in a sea of toxicity?"[8]
VARIETIES
OF CHINESE MEDICINE
Traditional
Chinese Medicine (TCM)
In
the 1940's and 50's the government of communist China undertook an effort
to coalesce the myriad forms of Chinese medicine into a unified system
called traditional Chinese medicine (TCM). Their intent was a practical
one: to integrate a large work force of traditional practitioners into
Western-style hospital medicine, as a way of providing care for a large
population with inexpensive and familiar methods. Contrary to what its
name implies, TCM is actually a modern system
and was not an idealistic effort to preserve one particular tradition.
Practitioners
of TCM outnumber those of other forms of Chinese medicine in the U.S. Most
American schools teach this approach. The majority of practitioners are caucasians
who studied here, though many have undergone short internships in China.
The
theoretical basis of TCM is the "eight principles." These are actually
four pairs of complementary opposites which describe the patterns
of disharmony within the person. Briefly the principles are interior/exterior,
referring to the location of the disharmony in the body (internal organs
versus skin or bones); hot/cold, referring to qualities of the disease
pattern, such as fever or thirst versus chilliness or desire to drink warm
liquids; full/empty, referring to whether the condition is acute
or chronic, and whether the body's responses are strong or weak; and the
balance of yin/yang, which adds further to the description of the
other six principles.
TCM
places a heavy emphasis on herbal medicine which is supplemented by acupuncture.
For many people this is practical in that they can treat themselves on
a daily basis with their herbal remedies and not have to rely on office
visits for acupuncture. However, using both methods together is considered
the ideal.
Traditional
Acupuncture
Also
known as "five element" or "classical acupuncture,"
traditional acupuncture is the longest-established in the U.S. Its philosophy
is that acupuncture (without herbs) is a complete medical system in itself.
As explained by David Walker, "Acupuncture itself is a complicated enough
art to master, and herbal medicine is another
whole study. To do justice to both in the same lifetime would be very difficult."
Practitioners
are trained according to the curriculum developed by J.R. Worsley
who founded the College of Traditional Acupuncture in Leamington
Spa, England. The theory of the five elements C
fire, earth, metal, water, and wood C
pervades the teaching, philosophy and methods of traditional acupuncture.
The five elements are conceived of not just as basic constituents of matter,
but as dynamic qualities of nature. They have been called "further
descriptions of the chi energy as it goes through cyclic transformations.
Everything in life is concordant with these elements..."[9]
As
chi circulates through us it is influenced by the elements as they build
upon each other, and support each other in a certain orderly sequence:
wood creates fire, fire creates earth, earth creates metal, metal creates
water, and water creates wood. Hence, according to Dianne Connelly, "Health
is the harmonious balanced cyclic interaction of these elements. Health
is maintained only when the energy flowing through each of the elements
is clear and lifegiving."[10]
Medical
Acupuncture
It
is somewhat awkward to include discussion of medical acupuncture in a chapter
on Chinese Medicine since it involves the importation of acupuncture techniques
into the practice of Western medicine, an altogether different tradition.
Because of its origins, however, we will discuss it here. Medical acupuncture
is the practice of acupuncture performed by a Western-trained allopathic
physician (M.D.) or osteopathic physician (D.O.). At this writing, twenty-three
states allow only this kind of acupuncture.
Medical
acupuncture developed in Europe as a result of the introduction of Chinese
medical texts and practices by traders and missionaries in the seventeenth
and eighteenth centuries. It has evolved alongside allopathic medicine
in Europe where it is taught in many medical schools and used in most fields
of medicine. In the U.S., training programs for physicians were first offered
in the late 1970's, and by the mid-1980's medical acupuncture emerged as
a medical discipline.
Most
practitioners are already established in a conventional medical specialty
and use acupuncture in that context. It serves as an adjunct technique
as opposed to being considered a complete medical system in itself.
According
to Joseph Helms, M.D., founding president of the American Academy of Medical
Acupuncture and coordinator of physician education in acupuncture, Office
of Continuing Education, UCLA School of Medicine, the practitioners tend
to use a "hybrid" approach to acupuncture, taking the diagnostic value
of as many approaches to acupuncture as possible and integrating them into
the context of Western medicine. Hence, they may draw upon the eight principles
used in TCM, the five elements approach of traditional acupuncture, and
other systems.
Medical
acupuncture conceives of the therapeutic mechanisms of acupuncture in the neurophysiologic
and bioelectric terms familiar to Western science, as well as the energetic
models derived from the classical texts.
The
American Medical Association does not yet recognize acupuncture as a specialty
of medicine or as a special technique of medicine.
Ethnic
Chinese Traditional Medicine
This
is a more loosely defined, generic form of Chinese medicine and is usually
practiced by the "Chinatown" Chinese in large urban centers in the U.S.
There is no organized body of theory. Both acupuncture and herbs may be
used, and some practitioners use electrical stimulation of the needles.
Japanese
Acupuncture
While
practitioners of this variety are definitely a minority, Japanese acupuncture
is growing in popularity among American acupuncturists. Japanese needles
are considerably thinner than others, and as a result are now used by many
practitioners of other forms of Chinese medicine because they are thought
to be less traumatic for the patient.
Japanese
acupuncture theory is devoid of herbal influence. The needling techniques
are reputed to be more gentle and sensitive than other approaches. According
to Daniel Kenner, L.Ac. of
Santa Rosa, California and San Francisco's Meiji College of Oriental Medicine,
Japanese-style training places greater emphasis on the practitioner developing
"an advanced level of tactile sensitivity in locating points with the fingertips.
This allows them to actually feel the chi flow and feel blockages of energy
that are impalpable to the unpracticed hand." The ideal is to then use
the mildest intervention possible while achieving the desired effect.
Auricular
Acupuncture
Auricular
acupuncture is a technique of treating points exclusively on the ear. The
points are chosen by different means C
palpation for tenderness, electrode resistance, and using the patient's
pulse to locate significant points.
Many
of its practitioners consider this approach to be a complete medical system
for treating functional and allergic disorders, and often use it exclusive
of any other type of practice. It is also used for pain control and to
assist in withdrawal from drug and alcohol addiction.
Work
with drug withdrawal began in Hong Kong in the 1970's. In recent years
there has developed a movement in the West to expand this application because
of evidence of its effectiveness. Abbreviated training programs in auricular
acupuncture are growing for detox technicians,
nurses, and physical therapists. Some conventionally-trained practitioners
question the wisdom of allowing people to practice with this briefer training.
The
French neurophysiologist Paul Nogier,
M.D. developed a method called "auricular medicine" or "auriculotherapy,"
based on neuroendocrine theory rather than
Chinese medicine. Like medical acupuncture, it integrates a technique drawn
from Chinese medicine into a Western context.
Eclectic
Chinese Medicine
Probably
the greatest number of Western practitioners of Chinese medicine would
describe themselves as eclectic, at least to some degree, though their
original training was in one of the above varieties. Given the richness
and unique perspectives of the different models, many borrow from several
sources to create their own synthesis that works best for them in their
own style of practice. The rationale are expressed well by Helms, who thinks
of the various models as being layered on top of one another: "Each case
makes sense is a slightly different way C
each case makes best sense in one model or another."[11]
PROCEDURES
AND TECHNIQUES
Diagnosis
is based upon identifying patterns of signs and symptoms. These
patterns reflect the condition of the internal organ networks as well as
the chi. The practitioner will examine skin,
complexion, bones, channels, smells, sounds, mental state, preferences,
emotions, tongue, pulse, demeanor, and body build. Each of these has its
own variety of qualities and nuances that help the practitioner discern
patterns that underlie the person's complaints. This approach is summed
up in the expression: "Inspect the exterior to examine the interior."[12]
Some
practitioners arrive at a diagnosis with very little verbal exchange with
the person. In situations where the practitioner does not speak English,
a rapid assessment may be made and work begun without such communication.
Other practitioners may conduct an exhaustive interview, while still others
will use written questionnaires to get a thorough picture of the patient's
pattern of complaints.
Pulse
Diagnosis. One of
the more mysterious aspects of Chinese medicine to Westerners is pulse
diagnosis. In Western medicine the pulse is a very simple thing and is
used only to measure heart rate C
the number of beats per minute.
In
Chinese medicine the pulse provides a whole world of information. The primary
use is as an indication of various conditions of chi moving through
the person's meridians. The condition of all the organ networks is assessed
via the pulse.
For
example, in TCM the flow of chi through each of twelve major meridians
can be assessed by the practitioner feeling the pulse at various positions
on the wrist (the leg or neck can also be used). There are six basic locations
and three depths on each wrist.
Each
of these positions can be assessed according to many different qualities
that the pulse can have C
twenty-eight in TCM, other numbers in other variations of Chinese medicine.
While
these qualities have esoteric sounding names such as "floating," "thick,"
"thin," etc., they are actually features of each pulse that we could see
if we were looking at a sine wave of the pulse on an oscilloscope. The
qualities may be such things as how strong each pulsation is,
its length, how it trails off, and what kind of activity may be present
between pulsations. Just as the Eskimo have a very rich vocabulary for
describing many varieties and features of snow, in Chinese medicine there
is a rich vocabulary for describing the nature of a person's pulse.
The
practitioner can feel the balance and flow of chi through the person's
meridians and corresponding organs. This is not only of value in diagnosis,
but also in measuring progress from one treatment to the next. In addition
the practitioner can discover weaknesses that would warn of future problems
with certain organ systems.
Treatment
Herbs.
Herbal medicine probably predates acupuncture and in some settings it is
the primary form of treatment. In the context of Chinese medicine, the
term "herb" is actually used to describe any natural material of plant,
animal, or mineral origin, or any traditional or modern preparation of
the natural materials short of preparing an isolated chemical.[13]
Chinese
herbs are available in three forms. The most traditional are the raw materials
themselves, which are given to the patient who takes them home and boils
them up into a beverage. This may take the form of a tea which is consumed
on a daily basis, one or more times, much the way a Westerner would take
allopathic medicines according to a certain schedule.
The
second form, a modern development, is where the herbal substances are compressed
into tablet form and taken as pills. Obviously much more convenient, this
eliminates the time involved in boiling the raw herbs. It also eliminates
the smell which can permeate the house as a result of boiling herbs and
can be strong and objectionable to some. The tablets can be difficult to
swallow, especially if there is a large number
of them, and some people question how well the body breaks down and absorbs
substances presented in this form. Practitioners generally reply that the
tablets are designed for quick breakdown in the stomach.
Finally
there are herbal extracts, also convenient. These are provided in an eye
dropper bottle in a concentrated form which is added to hot water and consumed
as a tea. The extracts have the advantages of being easier to consume and
perhaps easier for the body to assimilate than tablets. Being in a liquid
form, the extracts also allow greater combinations of herbal substances
to be easily mixed, and a unique "cocktail" can be easily designed for
the individual patient's needs.
Acupuncture.
This involves the insertion of thin, sterile, stainless steel needles into
points on the surface of the body to a depth just below the surface of
the skin in the epidural layer. Most acupuncturists use disposable needles,
while a few use reusable needles that are sterilized.
For
some people the insertion is barely noticeable, and for others there is
a small pinch, sometimes followed by a sensation of numbness, tingling,
ache, warmth, or heaviness. The point locations are determined by the geography
of the meridians and acupuncture points on the body as described by Chinese
medical theory. In some cases the needles are manually twirled to give
more stimulation. A few practitioners use electrical stimulation of the
needles to add even more effect (electroacupuncture).
The
practitioner selects points based on the diagnosis and goals of treatment.
Usually several different points are needled at the same time while the
patient is in a reclining position on a table. The insertions may be for
just a few seconds, or they last from twenty to forty minutes while the
patient lies still and rests. Most people find the sessions very relaxing,
and it is not uncommon to feel immediate effects and changes in symptoms.
In
some variations of Chinese medicine the practitioner remains present with
the patient throughout the treatment, continuously checking the pulse and
perhaps changing needle positions in response to the ongoing feedback from
it. This approach is most common among practitioners of traditional acupuncture.
In
China, acupuncture is routinely used for anesthesia. In the famous Bill Moyers
television series called Healing and the Mind shown nationally in
1993, millions of Americans witnessed a person having brain surgery while
conscious and carrying on a conversation C
all with the help of acupuncture anaesthesia.
Moxibustion. Moxibustion
treatment is the burning of the herb moxa
(mugwort) on an acupuncture point. Moxa
is applied in the form of a fluffy, wooly-like material that is rolled
up by the fingers into roughly the size of a small pea, placed in position,
and then lit, usually with an incense stick. It burns slowly, introducing
heat into the acupuncture point, and then is removed by the practitioner
when the patient is able to feel it become hot, usually after a few seconds.
The
use of moxibustion is older than that of
needles, and there was a time when moxa
was considered superior to all other treatments. There are different kinds
of moxa and its effects are determined by
such factors as its age, how tightly it is packed, how many applications
are used on a given point, and its juxtaposition with needles. Also, it
can be placed on a bed of salt, ginger, or a slice of garlic on the skin
to introduce additional properties or influences into the point.
Moxibustion
brings influences into the point that the needle cannot, especially heat.
It may also be placed on the exposed tip of the needle and burned in order
to change the temperature gradient of the needle.
Massage
(Acupressure, Shiatsu).
Acupressure and Shiatsu are sometimes called "acupuncture without needles."
They are variations of massage technique in which a similar geography of
points and meridians is used to guide the application of finger pressure
rather than the insertion of needles. The aims are similar in terms of
stimulating points and influencing the flow of chi through the meridians.
Some practitioners use these methods during the course of an acupuncture
session. These are discussed more thoroughly in Chapter 9.
Chi
Kung. Chi kung
(also spelled "qi gong") is the mother of all
the martial arts. It is estimated that 1.3 million residents of
Beijing use the practices of this five thousand year old tradition, with
tens of millions more nationwide. In Shanghai there is even a hospital
devoted to treating cancer with these methods.[14]
Chi kung
is the oriental counterpart to Western behavioral medicine and contains
elements of meditation, relaxation training, visualization, movement, postures
and breathing exercises. In the orient it serves both as a form of exercise
for physical fitness and a self-healing tool.
The
aim is to strengthen and direct the flow of chi through the body to promote
health and well-being. The benefits require daily practice to accrue. This
may mean a routine that takes from twenty to forty minutes per day. Some
practitioners of Chinese medicine teach these techniques to their patients,
while others will refer to classes taught by specialists.
SCIENTIFIC
SUPPORT
In
other words, two people with the same symptoms may be treated entirely
differently based on their own unique inner ecology. The idea of a "standardized
treatment," as is used in Western-style research, contradicts this principle.
What could help re-establish balance and harmony within one person may
have the opposite effect in the next.
The
attitude among many practitioners has been that Chinese medicine stands
on its own merit and has no need for the stamp of approval of Western science.
The implicit assumption has been that over the thousands of years in which
the methods have evolved, practitioners have refined their understanding
based on case-by-case observation, and have communicated this collective
wisdom effectively to their students or successors.
With
the rise of the information age, however, a surprising amount of research
has taken place both in the West and in the Orient. Many studies, particularly
with herbs, have managed to side-step the issue of individualization. This
is more difficult with acupuncture but there are some interesting findings
with this method as well.
Chinese
Herbs
While
the use of Chinese herbs clearly is based on a theory of energy medicine,
they do lend themselves to Western-style research since they can be studied
much like pharmacological substances. Their potential is very well-illustrated
by the clinical research that has been conducted with cancer and heart
disease.
Cancer.
In modern China, cancer is the leading cause of death. Practitioners there
advocate a combination of Chinese and Western medicine as the optimal cancer
treatment, accompanied of course by diet, exercise and lifestyle change.
The rationale for use of Chinese herbs is twofold: to attack the tumor
and to support and strengthen the patient's immune responses.
Chinese
medicine uses over 120 different herbs with cancer, depending on the type
of cancer and its cause according to Chinese medical theory. One class
of herbs used for centuries is called fu-zhen
herbs. Recent studies have shown why they have proven successful.
One
controlled study examined survival time of patients with stage II primary
liver cancer undergoing chemotherapy or radiation. Twenty-nine of the forty-six
patients receiving fu-zhen herbs along
with radiation or chemotherapy survived at least one year, and ten survived
for three years. Of the thirty patients who received only radiation
or chemotherapy, six survived one year, and none survived three years.[15]
Other
varieties of herbs have been used as well, with the following findings:
Improved
survival rates for patients with nasopharyngeal,
lung, throat, and breast cancers who used herbs in combination with radiation
or chemotherapy, as opposed to conventional treatment alone.[16],[17]
No
significant drop in white blood counts and platelet counts after three
cycles of chemotherapy in a group of 11 breast cancer patients using an
herbal treatment.[18]
In
181 patients with pre-cancerous throat lesions, only 9% of those treated
with herbs developed cancer within five years, as opposed to 26% in the
untreated group.[19]
A
study of 40 patients with various cancers found an herbal treatment to
significantly increase lymphocyte transformation.[21]
In
272 patients with nasopharyngeal cancer,
those treated with Chinese herbs and radiation had a significantly lower
five-year relapse rate than those with radiation alone (12% vs. 38%). Five-year
survival rates were also higher (67% vs. 48%).[22]
In
326 patients with postoperative stomach cancer, a significantly higher
percentage of those receiving herbal treatment were able to tolerate chemotherapy
than those not receiving it (95% vs 79%).
Other outcomes included improved weight gain, fewer complaints of low energy,
and improved natural killer cell activity.[23]
In
158 patients with late-stage stomach cancer, treatment with herbs was associated
with significantly higher 3-, 5-, and 10-year survival rates than normal.
Survivors also showed enhanced immune functioning.[24]
Heart
Disease.
The findings with heart disease include lower oxygen consumption by the
heart muscle, dilating the coronary arteries (which increases the blood
supply to the heart), reducing angina, lowering blood cholesterol levels,
reducing platelet aggregation and adhesion to arteries, increasing contractile
force of the heart, increasing cardiac output, and reducing high blood
pressure.[25]
A few examples of clinical studies include:
A
study of 37 patients with coronary heart disease and 14 with acute myocardial
infarction found an herbal combination to strengthen the left ventricular
performance, increase oxygen supply to the myocardium, and inhibit platelet
aggregation.[26]
A
placebo-controlled study of 46 angina pectoris patients found an anti-anginal
rate of 85% for the herbs (versus 37% for those not receiving the herbs),
and an ECG improvement rate of 45% (versus 3%).[27]
In
110 coronary heart disease patients, herbal treatment showed an 81% effective
rate for angina pectoris, improved ECG in 65%, and improved cardiac function
in 57%, all significant differences to the control group.[28]
A
double blind study of the effect of another herb on 65 coronary heart disease
patients found symptomatic improvement in 73% of cases (42% improvement
with placebo), and ECG improvement in 60% (25% with placebo).[29]
The benefits were attributed to increased volume of coronary blood flow,
bringing an increased oxygen supply to the myocardium.
A
study of 136 patients with abnormal blood lipid levels found the herb rosa multiflora
to be as effective as two common antihyperlipidemic
drugs in reducing blood lipids.[30]
A
controlled study with 75 coronary heart disease patients compared an herbal
formula to dextrose and cedilandid-D. The
effects of the two treatments were similar in increasing the muscular contractile
force and reduced oxygen consumption in the myocardium.[31]
In
60 coronary heart disease patients an herbal formula was found to have
positive effects on angina pectoris, blood lipids, and left cardiac function
tests.[32]
In
308 patients an herbal oil was tested for
its ability to reduce blood lipids. There was a significant decrease, along
with reduction in platelet aggregation rates and blood pressure.[33]
Finally,
a study of 120 cases of coronary heart disease found an herbal treatment
to reduce the occurrence of angina pain in 85% of patients and improve
ECG indices in 77% of patients.[35]
It
is worth noting that no adverse reactions or side effects were observed
in the above studies, many of which used blood, urine, liver, and kidney
tests to look for such effects.
Acupuncture
In
contrast to herbal medicine, studies of acupuncture are more difficult
because the individual artistry of the practitioner is such an important
part of the technique, and treatment is normally individualized for each
patient. Hence there are very few studies that adhere to Western standards.
Proponents
of acupuncture argue that to insist on imposing such standards to justify
this form of medicine would be to our detriment. According to Joseph Helms,
M.D., "Using scientifically proven mechanisms as the exclusive foundation
to define acupuncture applications overlooks the heritage of empirical
observations by traditional practitioners. To ignore this heritage is to
deprive a contemporary physician of models of health, disorder, and treatment
that are presented in classical texts, models that have been vitally useful
to practitioners in many cultures during the long history of acupuncture."[36]
Research
in the West has dealt mostly with documenting its mechanisms in pain control.[37],[38]
As Helms states, "The basic neurophysiologic
and neurochemical science of the analgesic
and blood chemistry dimensions of acupuncture stimulation have been very
well defined. They are in fact defined more clearly than most drugs, and
certainly most analgesic drugs that are commercially in use today."[39]
Physiology
of Acupuncture Effects. There
is evidence that acupuncture activates the electric system, the nervous
system, the blood system, and the lymph system. In terms of pain control,
what Western science understands most clearly is that there is a cascade
of neurotransmitters that are released as a result of acupuncture stimulation.
These are the endorphins, enkaphalins,
monoamines, and neurotransmitters that help inhibit pain transmission and
reception through the central nervous system. Other mechanisms by which
acupuncture can benefit medical conditions remain less clearly understood.
Helms
is careful to
point out that while the basic science is strong in describing what acupuncture
does, this does not tell us how acupuncture works. From the
more traditional view of Chinese medical theory, of course, this is because
what really matters is how the technique influences chi, something which
Western science does not yet have the tools
to study.
Treating
Specific Diseases.
The world literature on acupuncture contains thousands of clinical studies
of virtually all kinds of illness. Most are published in hundreds of medical
journals in the Orient. Again, however, few apply strict Western principles
of research design. On this basis, some reviewers of the research state
that claims of effectiveness in treating specific ailments are not based
on well-performed clinical trials.[40],[41]
One
study of 50 patients with chronic low-back pain (which the American Medical
Association considered well-designed[56])
found acupuncture to be an effective treatment on a short-term basis.[57]
A review of several studies led two researchers to conclude, "Taken together,
the results from controlled studies with back pain suggest that a majority
(of patients) will derive clinically significant short-term benefits from
acupuncture."[58]
Substance
Abuse. Another
apparently fruitful application is in alcoholism. A controlled study with
54 hardcore alcoholic recidivists found acupuncture treatment to bring
significant reductions in expressed need for alcohol, drinking episodes,
and detox admissions.[59],[60]
The
U.S. Department of Justice is now exploring the use of acupuncture in treatment
of prisoners who are addicted to alcohol or other drugs. Dr. Michael Smith
of the Department of Psychiatry, Lincoln Hospital, New York City, is using
acupuncture in a probation program for drug abusers. The program is designed
to control withdrawal symptoms and craving and to reduce the fears and
hostilities that usually accompany drug abuse treatment settings. The program
has been so successful it is being replicated in 300 other locations in
the U.S. and around the world.[61]
Cost
Effectiveness. There
is some interesting evidence of the cost effectiveness in conventional
medical practice. Insurance statistics in France show that physicians who
practice acupuncture at least half-time use considerably less laboratory
examination, hospitalization, and prescriptions for medication.[62]
Also, a study in a managed care setting in the U.S. found patients receiving
acupuncture had a reduction in total clinic visits and telephone consultations,
and reduced laboratory, hospitalization, and prescription costs.[63]
Chi Kung
In
China, over eight hundred studies of varying levels of scientific sophistication
have been conducted on the medical effects of chi kung.
This research is virtually unknown in the West. Beneficial findings have
been reported for virtually all major and chronic illnesses. A computer
data base of English translation summaries of these studies is being developed.[64]
STRENGTHS
AND LIMITATIONS
As
a form of primary care Chinese medicine does well in certain acute conditions
such as colds, flu, allergy and headache. It also has success in treatment
of many chronic illnesses with which modern medicine often does not deal
successfully. Conditions whose disease process is not clearly understood
in allopathic terms may be readily addressed by this tradition.
Many
people have experienced the frustration of being told, "Your lab tests
are all normal, so there must not be anything wrong with you." Or worse
yet, "The feeling you have that something is wrong must be psychosomatic.
Go home and rest, or get some therapy."
It
can also be used to supplement allopathic care, for instance in speeding
recovery from surgery or, as we saw earlier, as an adjunct to chemotherapy
or radiation in cancer treatment.
In
1979 the World Health Organization assembled a list of illnesses that lend
themselves to acupuncture treatment.
The list is based both on research and clinical experience world-wide.
The major illnesses in each of the following categories are included: upper
respiratory tract, respiratory system, disorders of the eye, disorders
of the mouth, throat and teeth; gastrointestinal disorders, neurological
and musculoskeletal disorders.
More
recently, the American Foundation of Medical Acupuncture conducted a review
of world clinical literature. Their list of the most frequent successful
applications of acupuncture includes the following:
Pain
(chronic, perioperative, arthritic, malignant,
headache, backache, extremity, dental)
Organic
lesions (cardiovascular,
respiratory, gastrointestinal, skin, urological)
Neurological
(peripheral and central)
Substance
abuse (drugs, nicotine,
food, alcohol)
Gynecological
Psychiatric
(depression, anxiety)
This
tradition's diagnostic procedures are a unique strength because they allow
detection of much more subtle dimensions of health and illness than allopathy
is able to address. The practitioner can recognize and intervene in disorders
or dysfunction, according to Helms, "prior to the manifestation of that
disorder in a dense histological form."
It is in this sense that David Walker states, "Chinese medicine is at its
best as preventive medicine."
A
standard part of every training program is recognition of the limitations
of the tradition and when to refer. Demonstration of this knowledge is
also an important part of legal certification and licensing requirements.
The most obvious limitations are surgery, emergency medicine (e.g. bone
setting), and trauma care C
which are the strengths of allopathy.
THE
PRACTITIONER-PATIENT RELATIONSHIP
Practitioners
cover a wide spectrum in how they view their relationship with the patient.
Some of these differences represent the influence of their training, and
some are a matter of individual personalities.
In
classical or traditional acupuncture, the practitioner spends the entire
treatment session at the patient's side, continuously monitoring the effects
of the needling with pulse diagnosis, changing needle positions, perhaps
adding moxibustion, and asking the patient
for feedback. Essentially, this means almost continuous touch contact in
one form or another. This can be felt as a very intimate, interactive process.
At
the other extreme are practitioners who work in a more mechanical way C
a quick insertion of needles followed by leaving the patient alone in the
treatment room, perhaps for a half hour or more. This is a very different
experience in terms of the relationship and sense of interpersonal involvement
with the practitioner.
Some
patients desire a sense of therapeutic relationship more than others. Indeed,
some training programs stress that the practitioner is like an energy field
which the patient enters and which provides an energetic context that potentiates
the treatment; that the emotional and spiritual state of the practitioner
has a direct impact on the patient, and that this will significantly influence
how the patient responds. Some practitioners even meditate or pray before
a session, or may view the treatment process itself as a form of meditation.
Nevertheless,
there are practitioners who are convinced that the needles and herbal treatments
are so powerful that a personal, caring relationship is not a major part
of the healing equation.
EVALUATING
PERSONAL RESULTS
There
are three ways in which progress is monitored. First is the patient's subjective
appraisal of his or her symptoms from treatment to treatment. Second is
the practitioner's ongoing diagnostic process, mainly with pulse diagnosis
and other forms of observation, at each session, and, in some cases, during
the progress of the session. Third are objective tests such as laboratory
reports which may be made available from a regular medical lab. The latter
can be a welcome contribution, but are not a mainstay of Chinese medicine.
Practitioners'
observations are considered relatively objective, but clearly there is
a subjective component. Two practitioners may read a person's pulse slightly
differently. What is more important is the relativeness
from session to session, the changes or patterns observed over time. Hence,
even though two practitioners may perceive a different baseline for a certain
quality of the pulse, they should observe the same pattern of change
with time. According to Joseph Helms, M.D., the reading of the pulse is
subjective, but it is "objectified" by having the same practitioner be
the transmitter of the information.
Most
practitioners record notes on the qualities of the pulse from session to
session and in this way are able to monitor change.