Problems with Chinese medicine scientific studies

We've all seen the contradicting studies: acupuncture does work for this condition. Acupuncture doesn't work for the same condition. What's going on?

The problem with these scientific studies is that many of them are not being designed properly to match how the medicine works. Science is FABULOUS for pulling things apart to understand how every little cog works. However, Chinese medicine is about the whole machine. You can't remove one piece and study it alone.

In many studies I see have a conclusion that sounds something like this: "Acupuncture shown to be ineffective for treating X, Y or Z." Then, when I read farther into the study, it's because they used a single acupuncture point in all of their study participants. I always have to giggle at this. Acupuncture is not a system where all people with X biomedical disease end up having the same Chinese medical diagnosis. For example, knee pain isn't just knee pain. It could be due to Kidney Qi Deficiency, Kidney Yang Deficiency, Kidney Yin Deficiency, Cold Bi Syndrome, Hot Bi Syndrome, Qi and Blood Stagnation among the basic few. What one needle may work great for Kidney Qi Deficiency knee pain may actually exacerbate knee pain due to Qi and Blood Stagnation! So of course, when all of these patients with knee pain are grouped together and treated like they have the same disease, the researchers get poor/mixed results! Not to mention that most styles of acupuncture do not use a single-needle approach (there is a Japanese style in which a single needle is used - the PERFECT needle for that patient on that day at that moment).

I'm not saying get rid of the science. We need the science in order to validate our medicine in this society. We need the science to validate our medicine so that insurance companies will be willing to cover services that could greatly benefit a huge number of Americans suffering from debilitating disease processes. But what we need most of all is studies that are designed with the idea of how Chinese medicine works in mind, otherwise we're just wasting time and money on studies that aren't actually testing the medicine as it is used.

Researchers out there who may stumble upon this blog (okay, so I may be dreaming big here ;) ), please make sure you have an acupuncturist help you design your study. And I'm not talking about a biomedical doctor who has gone through "medical acupuncture" training, because that's not the same thing as an acupuncturist. An acupuncturist will be able to help point out when you're missing an aspect of how Chinese medicine works so that you can get the most true-to-life results possible!

Lastly, I want to point out that if/when a drug is shown to be ineffective, it isn't concluded that pharmacology, as a whole, doesn't work. Why, then, do we say that acupuncture, as a whole, doesn't work, when one point is found to be ineffective for a single diagnosis?

Preventive Medicine

I was reading an article today about biomedical health care and its outrageous costs. This isn't what I'm going to talk about today, however. In this article it mentioned that if people would use preventive medicine, it could greatly decrease the cost of health care overall by preventing the BIG health care costs such as bypass surgery, diabetes, etc. I agreed with this statement UNTIL it qualified what it meant by "preventive medicine."

Preventive medicine, according to this author, was the use of medications to prevent further disease. The example that was given was this: If a patient with high cholesterol would simply take statin-drugs to lower their cholesterol, they could likely prevent heart disease which can lead to further complications and further costs.

I sighed when I read this. While the above statement is true, it's missing the point. We, as a society, still haven't seemed to have figured out what preventive medicine is. It doesn't mean taking a pill for the rest of our lives to cover up a symptom. While this can be a valid step in making sure irreparable damage isn't done, it isn't preventive medicine.

Now, don't get me wrong. It is often necessary for someone to take a pill while their body learns to take over the function that the pill is meant to mimic. In the above case, it is extremely important to get high cholesterol under control, and a drug may be necessary to achieve this quickly to avoid damage to the vascular system. However, there are further steps that are required! Diet and exercise changes among the basic of these.

The end goal of ANY branch of medicine should not be to merely get bloodwork numbers within an acceptable range, but for the patient to be able to sustain those numbers on their own at some point.

(Disclaimer: I'm not saying that all people should live medication-free. Some health concerns are uncontrollable without chemical intervention. However, in an ideal world, these patients are still keeping their medication doses as low as possible by using preventive medicine.)

Preventive medicine should be seen as medicine that teaches and allows the body to function properly without chemical intervention on a permanent basis.

What is Qi?

Ooooh, this is a fun question! Biomedicine has been wondering this FOREVER! (Or, at least since they learned of Chinese Medicine and Qi.)

I like to tell my patients when they ask, that Qi is what makes the difference between being alive and being dead.

Biomedicine doesn't know what makes us alive vs. dead, and they don't know what Qi is. Coincidence? I think not!

One textbook definition of Qi is "The fundamental substance of which all matter in the natural world are composed. All matters in the natural world are formed by the change and movement of Qi." (Advanced Textbook on Traditional Chinese Medicine and Pharmacology, Vol. 1. New World Press, Beijing, China, 2002.)

Another textbook similarly describes it as "The fundamental substance constituting the universe, and all phenomena are produced by the changes and movement of Qi. Qi is both the essential substances of the human body which maintain its vital activities, and the functional activities of the organs and tissues." (Chinese Acupuncture and Moxibustion. Foreign Languages Press, Beijing, China, 2003.)

Free, smooth movement of sufficient amounts of Qi is essential to health and vitality. When this is not the case, we begin to experience unhealth. Acupuncture is certainly not the only way to achieve free and plentiful Qi. Health CAN be retained and regained through healthful living, but Chinese medicine can speed the process back to health. In addition, Chinese medicine can PREVENT disease by ensuring that the amount of Qi that one has is always in adequate supply and moving properly throughout the body.

So what does Qi feel like? To me, as a practitioner, when I needle a patient and I'm aiming for the Qi, it often will feel like the tip of my needle is bouncing on the surface of a balloon. When I "get the Qi" it feels as though this balloon has let the needle in. I've heard other practitioners describe it as a gentle tugging sensation on the tip of the needle.

My patients often say that Qi feels like someone pressing on their skin at the site of the needle. Some patients will feel this same sensation of pressure run along the channel after the needle has been inserted. Some people will feel the Qi as a mild warm or cool sensation at the needle.

Perhaps it's this inability to even describe the sensation of Qi that has led so many to be skeptical of its existence? Okay, maybe it's due to the fact that there are no biomedical tests that can prove that it exists.

Regardless, Chinese medical practitioners can feel the Qi in your pulse, can see it reflected on your tongue and in your face, and can feel it through the needles. Thousands of years of patients and practitioners and positive results can't ALL be wrong.

One of my biggest pet peeves

We hear it all the time. "It couldn't hurt." It sounds innocent enough, and REALLY it is a sign that things are changing in the biomedical field. Doctors are starting to accept the fact that even though acupuncture and Chinese herbal medicine don't test well under "standard double-blind, placebo-controlled studies" (watch for a future post on the problems with this style of testing of Chinese medicine), they are seeing that their patients often get relief from non-biomedical medicine.

Here is my problem with hearing the words, "It couldn't hurt:" It COULD hurt if done improperly, and may not do any good. A licensed acupuncturist and Chinese herbalist goes through a 4-year program of learning in GREAT depth all of the intricacies of this style of medicine. In many states, doctors are allowed to practice acupuncture without ANY training because it is considered a "medical procedure" and thus falls under their scope of practice. Luckily, the doctors who practice acupuncture without ANY knowledge of the system are few in numbers. However, the "training" that many doctors receive should not be considered training, but a brief introduction. 100-300 hours of instruction just isn't enough to learn the ins and the outs of such an intricate system of medicine. Kudos to those doctors who have the conscience to get at least SOME knowledge, but this doesn't make you an acupuncturist.

Unfortunately, through programs to teach "medical acupuncture" there isn't enough hands-on training, and this is where the problems lie, in my opinion. There are proper angles and depths at which needles are inserted at each of the acupuncture points (of which there are over 500 commonly-used points). If needles are inserted improperly, such injuries can occur as tendonitis, neuritis, pneumothorax, peritonitis and more. An acupuncturist spends an entire YEAR learning just proper needle insertion, let alone the other aspects of the medicine.

"Medical acupucnturists" aren't given enough training in the art of Chinese medical diagnosis. For example, back pain, in Chinese medicine can have one of several different diagnoses that is leading to the patient experiencing pain in their back. Many medical acupucnturists use a standard set of acupuncture points (kind of like following a recipe to bake a cake) to treat back pain, regardless of the Chinese medical diagnosis. Doing so may lead them to use a point that, at best will have no effect, or at worst, exacerbate the complaint.

Another downfall to a lack of hands-on training is a lack of the concept and perception of Qi. Now, I know this may sound like a silly thing to be concerned with, but I assure you, it's not. (I will note here, that not believing in, or being able to feel Qi, at least isn't DIRECTLY harmful, just a waste of a patient's time, money and trust in the medicine). Medical practitioners who learn "medical acupuncture" are not taught to feel Qi. To me this is missing the entire point of the medicine! If you can't feel the Qi, or don't believe that it exists, how can you manipulate it in order to get the healing response that is desired?

Again, I applaud doctors for opening their minds to the possibilities that other styles of medicine can work. However, unless you're willing to dedicate your time to getting full training, please refer your patients to a specialist. Let's all stick to what we're good at, and refer our patients to each other. They will be the major benefactors, which is what should have gotten us into medicine in the first place.

Helping Benny

Benny is a LOVELY guy. A giant, big-hearted teddy bear of a pup. Benny came to see me after rupturing his cruxiate ligament. Poor guy hurt his knee and was hobbling around like an old man! (Benny's only 7 years-old, by the way, he's got a LONG time left of playing with his pet and human family!) You see, Benny had done what MANY other dogs do during this time of year. It's FINALLY nice outside and when you get the chance to run after a long, shut-in winter, you RUN. Benny was going to have to wait with hurting knee for a month for his surgery because of all the other dogs ahead of him in line!

The vet gave him pain meds to help get him through the pain until surgery day, but his treat-hander-outer was hoping to keep him on lower doses of the medications. So we started doing acupuncture twice a week to keep his pain under control and to prepare him for his upcoming surgery. Benny also went home with an herbal formula that would do the same.

During the time prior to surgery, Benny's treat-hander-outer noticed that he was in good spirits! He was also in very little pain, which required lower doses of pain meds, just like they were hoping.

Benny's surgery day finally came and went and when I saw him for the first time after (a week after his surgery) I couldn't believe my eyes! Not only was he walking on his knee, he wasn't limping very much, either. On his second visit post-surgery, Benny waltzed right in with barely a hitch in his giddyup! The surgery that Benny had is pretty extensive, including reshaping of the bone in his knee. I've seen many pets who've had this surgery (while working at a vet clinic that performed such surgeries), and I've NEVER seen a dog with such a speedy recovery before!

I think this is a great case where biomedicine and natural medicine have worked together. While there was nothing that acupuncture could do to repair the torn ligament, acupuncture and Chinese herbs significantly reduced the amount of pain that was experienced, as well as prepared Benny's body for the surgery. His energy was already flowing smoothly pre-surgery, so it took very little to get back to that point.

Now, if only acupuncture could help keep this rearing-to-go pup calmer while his knee completely heals!

How to get your pet to take his or her herbs

Yesterday, I offered some ways to make it easier to take herbs yourself. Today I'm going to talk about the tricks I have up my sleeve for getting herbs into your pet.

Some pets are pickier than others. We all know the cat who will give you scars you'll remember for the rest of your life, or the dog who will very carefully extract even the smallest pill from a big glob of peanut butter. Here are a few tricks for making sure they get the herbs that will keep them happier and healthier for longer:

• If your pet is taking teapills and your pet isn't too picky, hide the teapills in something delectable. Typically, peanut butter or a slice of hot dog will do the trick. There is also a product called Pill Pockets that are special treats for hiding pills in. They come in several different flavors and sizes, and work for both cats and dogs. Many pets LOVE the taste of these!
• If your pet still won't take their teapills, you can crush them and sprinkle them on canned food. This works for many pets who then can't "pick out" a pill.
• If you pet STILL won't take their teapills, they can be dissolved in warm water (no more than a tablespoon) and fed to your pet using a syringe. Most vet clinics can give you a special syringe for doing just this.
• If your pet is taking a granule formula, try sprinkling, or mixing it in with some tasty (read: stinky) canned food. For many pets, this will suffice.
  
• If your pet isn't a fan of the granules contaminating their food, you can encapsulate the granule formula and give the herbs as you would any other pill. (see the first 2 bullets for tips)
• If your pet still won't take their granule formula, dissolve it in just enough water to be able to suck it up with a syringe, and feed it to your pet via the syringe, just like you would with the dissolved teapill.

Pets can be a little tricky to get herbs into, but what I have often found is that once a pet learns that the herbs make them feel better and don't have any side effects, they are MUCH more cooperative about taking them. I've had several pet patients who would come running to their owners when they said, "Okay, it's time for Becca's pills!" and then gobble them right down!

Hopefully one or more of these tricks will help you get herbs down your pet in a more relaxed, less-stressful way!

Tricks for getting those herbs down

If you're getting acupuncture done, chances are you're taking some form of herbs. They're not always pleasant tasting. They've been described as tasting, depending on the particular formula:

• earthy/dirty/muddy
• bitter/bile-like
• sweet
• sour
• blech/yucky/gross/&$#@!/etc.

Today I'm going to give you a few tricks that I've learned over the years from teachers, patients and through my own trial and error.

If you're taking a bulk formula (one where you're given the raw herbs and you make your own "witch's brew"), try making it a little more concentrated so that you don't have as much liquid to drink in the end. Once you have this smaller amount of liquid, try mixing it with your favorite juice. Many of my patients have found cranberry juice to be the must disguising of them all. Experiment and see what works for you and with your particular formula.

If you're taking a granule formula, you have several more options:

• Put the granules into capsules. Make sure to have your acupuncturist translate the dose of your herbs into number of capsules. There are encapsulating machines that you can find at your local health-food store for relatively cheap. This is a little time-consuming, but you'll be more likely to take your herbs, so you'll be feeling your best in no time flat!
• Put the granules directly onto your tongue and use your favorite juice to get them down. Some people really like this method, they find it's best to just get it done and over with.
• Mix the granules in your favorite juice, much like the bulk formula idea described above. Make sure to not use much juice, or else you'll just be drinking a TON of "off-tasting" juice. "Chase" your herbs with more juice.

If you're taking teapills, just take them ;)

Remember, you've paid for these herbs, you've invested not only your money, but time and your future into becoming healthier. Make sure to take your herbs as prescribed, and you're on your way to THRIVING!

Do you have any other tricks for taking herbs? I'm always looking for more ways to help my patients take their herbs!