Difficulties with acupuncture research

As I read the increasing number of medical studies on the efficacy of acupuncture, I am learning to become more aware of the qualities which make a study valid or flawed.  There are the professional guidelines of controls, double blind participants and researchers, and methods of standardizing results for large groups in a study. Medical research has developed very clear methods to calibrate success in all these areas through statistical calculations which remove results from the subjective realm, of patient feelings or potential placebo effect, and quantify them in the field of mathematics. Understanding studies through these rigorous methods will be a continual effort on my part, until then, I am thankful that many researchers publish a synopsis or abstract for easier interpretation by non-statistics majors.

Beyond the scientific methods lies an aspect of these acupuncture studies that I do find a bit troubling.  For many, but not all, there is a lack of use of Traditional Chinese Medicine disease diagnosis, pattern discrimination, and a subsequent matching treatment plan. Rather, many of the studies, use empirical points for their treatment protocol. For example, a point on the arm or leg, that commonly aides in digestion, will be used in a study on Irritable Bowel Syndrome. This is done without making the pattern determination which would indicate that the point is correct for that patient, correct only if used in conjunction with other points, or completely inappropriate for the patient altogether. Empirical points are often used because they very often provide some level of benefit, however, in a study of 150 people, one would assume that there are a wide variety of causative factors for their developing this common digestive ailment.

Invariably, these studies will find that some people improved slightly, often enough to warrant continued treatment, some stayed the same, and some patients got worse with treatment over a defined period of time.  Within professional Chinese medicine one may find four, five, or six causative factors for the western disease diagnosis of Irritable Bowel Syndrome.  With this in mind, it would be logical that not all the participants in the study would improve, or, even stay the same in regards to their symptoms.

What can be done about this problem in methodology with acupuncture research?

Well, I am pleased to see a increasing trend in the research, coming out of Europe, which is aiming to more accurately represent the standards of practice of Traditional Chinese Medicine, TCM, in China. I was recently handed an article relating to a study from the American Headache Society titled: Traditional Acupuncture in Migraine: A Controlled, Randomized Study (http://www.ncbi.nlm.nih.gov/pubmed/17868354).

This study, conducted at the University of Padua – Department of Medico-Surgical Specialties, used TCM guidelines in conjunction with western disease definitions of migraine headache without aura.

“Migraine prevalence is high and affects a relevant rate of adults in the productive phase of their life. Acupuncture has been increasingly advocated and used in Western countries for migraine treatment, but the evidence of its effectiveness still remains weak. A large variability of treatments is present in published studies and no acupoint selection according to TCM has been investigated so far; therefore, the low level of evidence of acupuncture effectiveness might partially depend on inappropriate treatment.”  http://www.ncbi.nlm.nih.gov/pubmed/17868354

This study identified seven different possible patterns for the cause of migraine without aura and gave treatments defined by the methodology of TCM. A control group on medication was tested against both a mock acupuncture and a traditional acupuncture group with patients blinded as to which group they were participating in.  While both the medication and mock acupuncture group showed initial improvement, possibly as a result of the placebo effect, the traditional approach to acupuncture yielded greater results and with improvement continuing beyond the initial treatments and with results lasting beyond the completion of the study.  Patients were treated with different points, based on their defined pattern, and yet the results were even more promising than either mock acupuncture or the use of standard empirical points for head pain.

These studies are encouraging to find in the western research literature.  Ironically, there are literally hundreds of these being done in China each year, but they are often disavowed by western researchers for being poorly constructed, too underfunded, or not well defined in outcome. Even more frustrating is the comment that there is no evidence for efficacy of acupuncture in the literature, simply because it is only written in Chinese. I am excited to know that there will be so much more to come in the future years of my profession to shed light to the thousands of years of our past.

Chinese Medicine and GERD

Gastro-Esophageal Reflux Disease, or GERD, can be a very difficult symptom to deal with on a daily basis.  It burns, it aches, it keeps us up at night, and it causes us to want to snack so that the discomfort may momentarily pass.  It is one of the conditions that most of us will experience in our lives, and which most of us will attempt to treat on our own with the wide variety of over the counter ant-acids that are now available at grocery stores.  Most of the drugs which once required a Medical Doctor’s prescription can now be bought by the case and gallon at Costco.  On any given trip to the store, I will see people analyzing and comparing ingredients, trying to discern their many differences.  Which pill is right for me? Which type of heart burn do I have? Is there an alternative to taking these pills everyday and if I keep taking them will something bad happen to my stomach?

These are all the questions I see mixed into the facial expressions of shoppers as they navigate the aisles at the drug department.  I wanted to write this blog entry about the different types of ant-acids out on the market and what options there might be to come off of them.  I will also address the potential side effects of long term use of over the counter medications.

Some people feel heartburn, a burning sensation beneath the sternum, immediately after eating a meal.  Our stomachs have a small opening at the top which is kept shut by something called our pyloric sphincter.  This structure helps keeps stomach hydrochloric acid, HCL, from regurgitating back up into our esophagus.  While our stomach has intricate systems in place to protect itself from the powerful effects of HCL, our esophagus has no such protection, and thus become corroded and burned by the high acidity. If the pyloric sphincter becomes relaxed and allows acid to leak out to the esophagus we feel pain. This problem could be due to over eating, lying down to rest after a meal, or consuming certain foods like coffee, chocolate, or wine.  These foods, along with certain others, should be avoided by those who suffer from chronic heart burn. They can aggravate the problem through both their acidity and their effect on our stomach’s containment of HCL.

Ginger Root

For those people who suffer discomfort immediately after eating a meal, Pepcid AC might be the preferred antacid as it quickly neutralizes the PH of our stomach. Old favorites like Tums and Rolaids, are made up of Sodium Bicarbonate (Baking Soda) and also work by neutralizing acidity in the stomach, providing a rapid change in the PH levels. When the acid levels are reduced than the burning should decrease, although, some damage may already have been done and it may take some time for the inflamed tissues to recover. This gnawing pain causes some people to want to snack to reduce it, which only increases acid production in the stomach, starting the chemical cycle over.

If you suffer from constant over production of stomach acid, even at times when your stomach is empty, you may end up developing more serious problems such as gastric ulcers.  If your problem has advanced to this stage you may be recommended to take Prevacid 24hr. Prevacid is an over the counter drug which is in the class called Proton Pump Inhibitors or PPIs.  This type of drug works by completely stopping the production of acid in your stomach. Good news for stopping the pain but one might wonder how a person is supposed to digest food, especially protein, if this production is limited or shut down completely. Prilosec, containing Esomeprazol, the active ingredient in Nexium’s “little purple pill”, is another over the counter PPI drug which can be used to treat chronic over production of HCL in the stomach.  It is important to note that this class of medication, PPI’s, is not the type which provides immediate relief.  These drugs take time to build up in the system and must be taken regularly if one wishes to see healing of the damaged tissues of the stomach and esophagus. Simply using these PPI medications on an as needed basis, as one would use Tums or Prevacid, will not give you results.

The long term effects of taking antacids or proton pump inhibitors are generally the same as any medication. The body become accustomed to their presence and may actually increase the amount of acid the stomach produces to reach the desired PH for digestion of proteins.  You may have to take more of the medication to get the same results and if you miss a dose the pain could now be significantly worse than it was at the start of the problem.  Additionally, there is the problem of tampering with the stomach’s natural self-protective measures.  It is the natural rise in acidity that triggers the stomach to release chemicals which protect its lining from the acids, stimulate the mechanical digestion of food, and signal the lower digestive tract, gallbladder and pancreas, that food is coming.  Every time our bodies release a chemical messenger there is another part of the body waiting for the message to signal the next process to begin. Using medications to stop or reverse these natural chemical processes can cause problems further down the digestive line.  Lastly, it is the stomach acid which represents our best line of defense against foreign bacteria which enter our bodies with food.  Without adequate acidity these bacteria will survive and pass to the intestines where some believe they cause chronic bacterial infections such as Candida Albicans which can cause another cascade of negative effects on our health.

Turmeric powder and root

Chinese medicine has a long lineage of treating high acidity with herbal medicine to reduce the production of acid and increase the tone of the stomach’s sphincters. It does this without shutting down acid production so that digestion may still occur. Essentially strengthening the digestion to get an improvement rather than down regulating the stomach’s function to reduce pain.  In Japan, some of the population has historically relied on tea made from turmeric, to calm the over production of stomach acid. In China, one can find tablets made from orange peel and ginger for aiding in the gastric reflux after a night of over-eating. Acupuncture works best when treating patients who suffer these digestive problems only when experiencing high periods of stress or anxiety.  Acupuncture works extremely well at reducing all the effects of stress on the body and studies of acupuncture for digestive disorders are becoming more and more common in the medical research literature.

You have many options in dealing with chronic stomach pain including medication when necessary to control pain. Sometimes over the counter medicines are needed to bring the problem under control or to deal with an acute discomfort, as many of us will be experiencing at the family feasts of Thanksgiving and Christmas in the coming months.  Chinese Medicine will be there to shift the patterns in your life and personality that cause this problem to re-occur and you should ask us how we can help you make these changes now, before the turkey and stuffing, the sweet potatoes and pecan pie, and do not forget, all that family.

China Blog: Tibet

 

Top of the Johkram Temple

When I arrived in Tibet this summer, I had whittled down my ideas of what I might see as much as possible to the one source I found to be credible; though definitely written by a Tibetan Buddhist and so biased in that way, The Tibetan Book of Living and Dying by Sogyal Rinpoche gave me what I felt was an accurate depiction of the religion and belief system of the people before the Communist Revolution.  Since my one source was from a Tibetan–and I knew that the film Seven Years in Tibet did not count as a source–I felt compelled to seek the viewpoint of the Han Chinese people as I traveled through mainland China.

 

 

Some of my fellow Americans on the trip, seemingly getting most of their notions of Tibet and the Dalai Lama from Hollywood, were demanding explanations for the reasons for abusing the poor last Emperor of China (reference the movie The Last Emperor), or seeking clarification about why Chinese people hate the lovely Dalai Lama because Brad Pitt helped him in the Hollywood film.  I wanted to simply ask the young Chinese my age what they thought about the situation in Tibet.

 

What they told me was generally consistent from person to person: regardless of what Americans believe, Tibet is in fact part of China and has been for hundreds of years.  There has always been a special relationship of mutual support between the two countries; China has graciously granted Tibet the status of Semi-Autonomous Region, as it has with the Islamic region of the Uyghurs in the far West of China, or the Special Economic Zone status of Hong Kong.  Chinese who are struggling to get by in Beijing are quick to point out that not only are Tibetans allowed to live in newly constructed housing, built by the central government, but get to do so for extraordinarily small amounts of money.  Tibetans, as well as other minority groups, are allowed to have two children while the one-child policy binds the lives of the Han Chinese people.  New bridges, rail lines, airports, hospitals and schools have also been built by the Chinese government–for their own purposes of course–but the Tibetans benefit from them.

 

The subject of the Dalai Lama and the fact that Americans perceive Chinese as atheists because of the Communist system was surprising to most Chinese I spoke to.  One Chinese person pointed out that it is believed that there had been a type of monarchy in Tibet before Communism that supported a caste system in which average people were desperately poor and relegated to near-slavery by the religious leadership. In China it is believed that the Chinese form of Buddhism is more egalitarian though I could not tell in what way the role of the monks was different in either society. Both Tibetans and Chinese said that the monk’s role was simply to pray for the people and not necessarily conduct charity work.  Either way, Buddhist temples are very commonly visited for many reasons throughout the year and Tibet is looked to as a one of the centers of the religion.  People practice ideals of Confucian and Taoist beliefs in their daily activities, and there are growing communities of Christians and Muslims throughout the country which the government allows with some restrictions (for instance, Catholic churches are unaffiliated with the Holy Roman See at the Vatican).

 

When the chance to visit Tibet came up and permission was granted by the Chinese government, I jumped at the opportunity and the chance to see blue skies and breathe clear mountain air. In Tibet, one of the first things the guide–a local Tibetan–told us was that he could not answer any questions at all about the exiled Tibetan government, the Chinese government, the politics of the regions and specifically the status of the Dalai Lama.  We were not allowed to leave the hotel on our own other than to buy water next door which was disappointing (but frankly, the pounding headache and shortness of breath from the altitude made us pretty happy to lie down when we got there).  Security was heavy on the drive from the airport to Lhasa, and while visiting the temples and palaces we were under surveillance by men on the rooftops and by cameras inside the buildings– a very similar situation to that of the Old City in Jerusalem, where armed police and soldiers stand on many of the corners and cameras watch everything. Our guide was anxious about having to keep an eye on the Americans, as we were one of only two non-Chinese groups in the whole region who were allowed in…and I–this blonde boy–definitely did not blend in with the locals.

 

Prayer Wheels

What I was able to speak at length about was religion and its role in Tibetan life.  Monks and the Dalai Lama are extremely revered to the point of being infallible in the same way of that of the Pope in the Catholic faith.  They are on a level above the average Tibetan, and to visit the Jokhram Palace and the Potola Palace in Lhasa is considered one’s obligation in the same way Muslims are supposed to make the Haj pilgrimage to Mecca in their lifetimes. Within the temples and palaces in Lhasa I saw nearly everyone throwing money over the railings to the Buddhas–of which there are dozens–as offerings towards them in return for protection.  If true Buddhism is about self-sacrifice for others this act of offering money for one’s own protection seemed to me to be contradictory.  As I watched a Chinese couple negotiate the purchase from a monk of yards of gold cloth to be wrapped around a statue of the Buddha for protection, I had the strong feeling that I was watching them buy forgiveness for a sin that was weighing on their conscience.

 

The Chinese-Tibetan dynamic is full of contradictions; every story, of course, has two sides. I was told by our guide that Tibetans are provided with housing, but it is worth noting that the original town center was demolished by the Chinese government when it built the People’s Liberation Plaza and the giant monument to the military victory over Tibetan rebels.  I was told that education is free for Tibetans but that they are required to speak Chinese in school and not Tibetan…and that religion is legal, but pictures of the Dalai Lama are forbidden in public or private.  Many jobs have been created by mining activity in the mountains, but perhaps this is to enrich the Central government’s supplies of copper, uranium and plutonium so essential for the growth and development of China.

The Potola Palace from Jokhram Temple

I learned a great deal about Tibet while I was there, but the inability to talk openly with Tibetans left me feeling that I know little to nothing about what they really think or feel about the situation they live in. I would love to have the opportunity to return, wander the streets, read more books about the Chinese version of the story, and talk openly with both sides to see what the future holds for this beautiful country at the top of the world.

 

 

 

The importance of buying local honey

The global honey industry currently exceeds 1.2 billion metric tons of production per year with the vast majority of honey produced in mainland China. America, as one of the leading buyers of global honey at 400 million pounds annually, has an important stake in this massive international market. More of us are choosing honey as our go to sweetener because it is portrayed as being the healthy alternative to corn syrup and cane sugar. While the science behind wild honey’s benefits is sound, the reality is that nearly all of the globally produced honey is completely empty of any nutritional value. How did such a healthy product of nature become just another addictive and unhealthy sweet treat?

China is able to produce such massive amounts of honey through the use of highly effective antibiotics in their bee colonies. These same antibiotics have been banned in the U.S. because research has found that they leach into the end product from the bees and additionally spoil the naturally sweet flavors. To overcome this unfortunate side effect, Chinese honey producers mix in enough corn syrup to recreate the sweet taste but stay just under the international limits of honey purity. Just because the product says it is honey, it does not mean that it is entirely made of honey, more likely it is a blend of sweeteners that the consumer did not intend to ingest. Chinese companies send the product in barrels to Indonesia or Taiwan where its country of origin is relabeled as these more trustworthy neighbors. Then it is on to the American market where it goes into snacks, cereals, and of course, those delightful little honey bears.

Buying local honey from your farmers market is the perfect solution on every level of this problem. You support a local grower who in turn supports local farmers by maintaining a healthy bee colony near their farms. The honey you buy at the farmers market is rich in pollens from your environment which help with allergies and high in minerals and amino acids from the bees which are key to our health. Finally the money stays here in our market, our neighbors benefit, and Americans help each other grow in their health and in their business. So please, buy local honey, it sweetens life for all of us in Marin.

Should I be getting Acupuncture or taking Chinese herbal medicine for my condition?

In China, Acupuncture is used for a great variety of conditions that focus on reducing both the pain and stress responses in our bodies. Acupuncture excels at resetting the chemical and hormone mechanisms which cause our bodies to feel tight, painful, anxious and sluggish in their functional abilities. It can help us sleep more deeply, increase circulation in injured areas, and increase the efficiency and movement of our digestive systems. Acupuncture produces immediate feelings of calm and well-being. Patients leave relaxed, with reduced pain, and sleep deeply the night after treatment. Acupuncture is a convenient and effective way to deal with tension and pain in the body and the many myriad of disorders that can arise from chronic stress and anxiety.

Chinese herbal medicine uses formulas of medicinals that are combined in groups of four to twelve in an attempt to tailor the medicine to the particular needs of the individual. This concept in completely separate from western herbalism which uses single plant products to affect a single symptom. Examples: Valerian root sedates a restless person or Chamomile makes one drowsy. The Chinese medical approach is rather different and attempts to address the problem from its root cause not its manifestation on the surface. A second key difference is the the quality of production, craftsmanship, and care which go into cultivating Chinese medicinal plants. One can easily buy a “natural” product at Whole Foods but they have no idea where/how it was grown. Who tested it for pesticides, heavy metals, and who ensured plant authenticity.

It is important for all of us to question the products we buy and the purity of their ingredients. Would you want to know you are taking a safe product that actually contained the ingredients it claimed? Especially when said products often are imported from other countries? One should always buy these products from a professional in the field, not just a person with an Acupuncturist license, but someone who has actually committed themselves to the life of study in the field of Chinese herbal medicine. Remember, plants are medicine and all medicinal products contain the risk of side effects. You would not go and buy pharmaceuticals without being told so by a qualified practitioner of medicine and so I encourage patients to approach plant medicinals in the same way, with a prescription.

It must be noted that ALL internal medicine disorders are treated in China with herbal medicine and not necessarily acupuncture. Internal medicine is a broad category of diseases that includes some of the main medical fields that we know of in the west. Think Endocrine, Respiratory, Gynecological, Immunological, Urinary, Cardiology, Pediatric and the field Fertility medicine when you think of Chinese Medicinals. Often our conditions require daily administration of medicine and that is most effectively accomplished with internally administered medicinals. These formulas offer the benefit of daily care without the need for semi-weekly visits to the clinic and thought often not ideal in taste, they are the preferred means of treating chronic internal diseases of the body in China.

Visiting China Part 2

Visiting China again after a decade was a wonderful experience where I was able to revisit a number of cities to see how much things had changed over twelve years. Starting the trip in Beijing, where so much grew with the Summer Olympics in 2008, was a glimpse into the two time lines of China. Ancient temples and pagodas intermingled with high rises and modern government buildings. This was the perfect first stop experience, taking in the Forbidden City in the morning and the Summer Palace in the afternoon. Our first nights feast was fresh noodles and eggplant and with the first taste of chili sauce our trip took off.

The western ancient capital of Xi’an gave a glimpse of the Terracotta Warriors and the original city walls that once protected the end of the famed Silk Road to Europe. It is a city with a large Muslim quarter and vast number of college student give the city a nightlight with thousands strolling around the city’s central drum tower. Xi’an also happens to be the dumpling capital of China so be prepared to eat them in mass once you get there. From Xi’an the road headed south to Chengdu in the hot and humid Schezwan province. A nice small Chinese city (2 million!) with bamboo tea gardens, flowing rivers, and spicy spicy spicy food. It also provided us with the opportunity to spend a day with the Pandas in the famous Chengdu Panda Preserve where they have over thirty Pandas to see. Chengdu is the gateway to Tibet and from here the flight was several hours over the most amazing span of mountains I had seen before. Lhasa is at 13,000 feet and a world apart in climate from the humid air in Chengdu, it goes from feeling really thick to all of the sudden really thin. After the first day dealing with headaches we were able to climb the steps to the Potola Palace and visit the Jokhram Temple where there was a unending stream of ornately sculpted and decorated Buddhas of different origins. I was very grateful to have the chance to visit Tibet and was sorry to leave but braced for the change flying back into Shanghai. We lucked out and got blue skies there too, thanks to a rough typhoon season, and enjoyed the magnificent skyline. Shanghai was a great way to end a trip, a nice hotel and a rooftop bar, where you can finally enjoy the unbelievably hot weather.

It was a perfect trip and I am happy to be back in the foggy city with lots of new stories and pictures to remember it.

Visiting China Part 1

Returning to China after a decade was an amazing experience of rediscovery. In a country whose growth rate requires a new city map to be printed every three months, the landscape is constantly evolving for both the casual tourist and the native resident. That speed of development manifested in ways that were both incredibly inspiring and at other times deeply troubling. It seems that China has the ability to get whatever it wants done when it comes to taking on new challenges but it also has the reckless sense of individual capitalism that makes that growth fraught with potential problems as the divide between the upper and lower classes inevitably grows.

When an American visits China I think it is valuable to take the time to reflect on our own history in this relatively young nation and consider those lessons learned and the time and work that went into the achievements and rights that we have today. America progressed through its own growing pains over a course of two hundred years and we experienced some very dark periods of worker rights, voters rights, and great failures in environmental foresight and protections. Despite the bold and universal claims that our Bill of Rights made so many years ago many of those rights failed to be realized for several generations and required the near destruction of the nation through civil war to impress their importance upon the citizenry. The industrial revolution saw brutal abuses in our steel, meat/agriculture, and coal industries with at times violent suppression of workers rights and organizations. It would take a hundred years for all the citizens of our country to achieve the right to vote, over a hundred years to establish security for our senior citizens, and nearly two hundred years for the protection of the National Parks and the development of the Environmental Protection Agency to mature.

China is going through this whole two hundred and fifty year process in just sixty years since the Cultural Revolution ended and reform began. At this moment in their growth it seems that they are right in the midst of our industrial revolution, with a nation many times larger than ours, populated by vast numbers of business tycoons like our Rockefellers, Carnegies, and JP Morgans of the last century. China is building and growing on a scale that is unprecedented in the world’s history. 3,000 new drivers licenses per day in Beijing, 39 National Universities in the single city of Xi’an which requires a entirely new subway line built every 2-3 years. A new Three Gorges Dam which created a reservoir 400 miles long and generated the electrical capacity of over a dozen nuclear reactors. 33 Million people moving to a rural agricultural city named Chongqing because the government declared it a new center of growth for the country. Of course, along with all the growth comes vast and horrible levels of air and water pollution, the relocation of over a million people, and the increased potential for environmental disaster and disease epidemics. The clear blue sky of Tibet was so beautify because of its contrast to the dense and foul air of Beijing. The renewable beauty of the vast solar fields of the north is tempered by the bitter sight of the country’s rivers and streams. The Yangtze’s level of pollution was staggering, in both sight and smell, and the sound of dredging and mining at the factories ran through the night as the river’s valuable silt was removed to feed the ever hungry cement industry.

There are constant reminders that the government is aware of the problems it faces and the individual people in China are aware that their growth is perhaps moving faster than they or the leaders of the country can sustain. Costs are constantly rising and a downtown apartment in Beijing or Shanghai has become just as out of reach as owning a home anywhere here in San Francisco. Despite the view we are given of China as a Communist country it has enormous and visible signs of problems it shares with it’s neighbor across the Pacific. Chinese people my age worry about rising health costs, rising day care cost for their children, having to work two jobs to feel stable, the burden of paying for education after 9th grade and the necessary after school tutors to prepare for college entrance exams. Like here, there is increasing difficulty of getting into a good college and the stark difference in opportunities for those who have a university degree and those who do not is constantly apparent.

I hope that as the country moves forward that education will begin to show people the risks of pollution and waste before there is nothing left to save. It is easy to take so much for granted living here in the Bay Area of California. Clean air and organic food did not come without many years of work and strict legislation that seems to many to limit the business growth and attractable locations of our area to big companies. How much longer, I wonder, can the people of Beijing walk down streets where visibility fades away after four blocks and you cannot ware anything white in the winter because of the coal dust in the air. We may not envision China as the land of free speech but they have a powerful and effective online community of bloggers who feed real news and opinion to the youth that is often in discord with the official government run news agencies. What gives me the most confidence about China is that point I made at the start, that when China makes a five year plan, you can bet that they are going to get it done. Let’s hope that the next five year plan will provide goals that will slow and reverse the level of damage being done by the amazing rate of growth they have been enjoying. Incidentally, the current plan is for 15% of ALL energy output in China to come from renewable energy by 2020. That is the same percentage as the United States, except they are producing 15% of all power for 1.5 Billion people instead of 300 Million. America could learn a great deal about priorities when we face a goal like that from our primary competitors.

Next month will be part two of my China blog about my experiences this last month in China. I will talk about the cities I visited and their unique characteristics within a country with thousands of years of tumultuous history.