Tuesday, March 31, 2009

Evosia Blog

Take a look at our friend Jun Wah Lee's blog. It's fabulous, just like Jun Wah.

Monday, March 30, 2009

More Acupuncture vs. Chiropractic

I got a message the other day from Elie Goldschmidt, the administrator of the Medical Acupuncture Facts group on Facebook. Here it is:

I occasionally receive hate mail or email from MD's DC's who 'think' they are superior to us L.Ac.s in acupuncture and often try to spew out propaganda.

For example, here are a few things I just received from a chiropractor. If you could answer a few of his comments I will try to make a great blog post out of it. Just email it to me. Thanks!

What follows is attributed to an anonymous chiropractor:

In responce to your description of the difference between medical acupuncture and tcm style...obviously you are ill informed.

1. the training of a TCM style acupuncture actually includes roughly 300 hours of acupuncture (I did a nationwide survey of acupuncture school catalogues and phone survey).

2. the remaining hours is dealing with learning how to diagnose, qigong, tui na and of course herbal medicine which historically is thought to be superior to acupuncture.

3. I can only speak for chiropractors... I teach acupuncture at a texas chiropractic college... we have 4400 hours of medical training prior to taking the required 100 hours for the state of texas...and then an additional 300 hours that we offer. We offer acupuncture and nothing but acupuncture. we do not offer tui na, qigong or herbal medicine.

4. we study the broad spectrum of chinese acupuncture and japanese along with a 50 hour course on the ear alone. Roughly 1/2 the course is lab time practicing acupuncture techniques.

5. We do a typical medical examination with the use of labs and xray, blood tests etc and combine things like the 8 diagnostic criteria, 5 elements, etc.

6. We are in complaince with the World Health Organization regulations regarding physicians who are already trained in medicine.

7. If you are an acupuncturist..then you know as well as i do that 300 hours is more than what you would need to be competent in acupuncture.
Please stop attempting to fool the public. I have a full time acupuncunture practice in Houston and make many people well.
By the way there are 48,000 chiropractors trained in acupuncture in the U.S. practicing safe and effective acupuncture.

In the past I've said there's nothing to be gained from getting into some sort of tug-of-war with chiropractors over who can do acupuncture and who can't, and I still believe that's true.

Compared to Traditional Chinese Medicine, chiropractic is a piecemeal medical system, using the modern Western diagnostic system but treating in a different way. Modern TCM as practiced in China is much more advanced in integrating Western diagnostic tools such as blood tests, X-rays, ultrasound, MRIs, but retaining all the other traditional diagnostic tools - observation, palpation, listening/smelling, and inquiry. TCM diagnosis and Western diagnosis exist side by side, with both systems being used to deliver the best care.

The chiropractor who wrote the list above has some wrong ideas which I'll address in the coming days. But let's keep an eye on the bigger picture. Is it unsafe for chiropractors to do acupuncture? No. I'm sure they have adequate training to do it safely. As a profession, we can't credibly support the Pan-African Acupuncture Project, which gives short training courses so that local doctors can use acupuncture, and then pretend that there's something unsafe about chiropractors doing the same thing.

Is it better to visit an L.Ac (Licensed Acupuncturist) rather than a chiropractor for acupuncture? Certainly. L.Acs have much more training than chiropractors, or M.D.s, or PTs doing "dry needling" - Chinese medicine is what we're about. For us, acupuncture isn't just some side line we picked up to increase the revenue stream in the clinic.

Should you stop seeing your chiropractor, physical therapist, or M.D.? Of course not! Everyone has their place in this patchwork quilt of American health care, and there's no reason to try and put down others.

Friday, March 27, 2009

Dao of the Day

Dr. Alex Feng is my martial arts teacher since I was a child. He's also a Chinese medicine doctor, licensed acupuncturist, and Taoist leader. Once a month, in Oakland, California, he gives a talk about Taoism and leads a meditation. Now there are two videos of these talks online, and I'm pleased to be able to share them with you!

This is a long video, but at about the 31-minute mark he talks about centenarians, those who live to be 100 years old.

There are a couple common denominators. It's not about do you smoke; it's not about do you eat fish, or vegetable or zucchini or ling zhi or ginseng, or chicken or tofu, it's not about that. Do you drink alcohol, whiskey, wine, lime juice... it's not about that. It's about number one: can you still walk? Motility, mobility. That's why tai ji says, first things first: train your legs, train your foundation.

Two, interestingly enough, all the centenarians were still working. Working. Busy. They got things to do, places to go, hands to shake, babies to kiss... people to make contact with. There's service, they're still servicing. Selflessly. Wu wei.


Thursday, March 26, 2009

RealAge Sells Your Information To Drug Companies

The popular website RealAge sells your information to drug companies so they can market to you better. That long "questionnaire" you take is not private - if you become a RealAge member, as many people do, drug cartels such as Pfizer, Novartis and GlaxoSmithKline will have highly detailed information on which drugs to market to you. As the New York Times article says:

While few people would fill out a detailed questionnaire about their health and hand it over to a drug company looking for suggestions for new medications, that is essentially what RealAge is doing.

Oprah's TV doctor is a spokesman. There's a RealAge Facebook app. You'll see their ads all over the internet.

If you get emails from RealAge, understand that they may actually be coming from a drug company.

RealAge acts as the middleman between the drug companies and its members: it sends the e-mail messages from its own address and does not release members’ names or e-mail addresses to drug companies. That is because pharmaceutical advertisers are among “the most heavily regulated industries in the world, and they don’t necessarily want those e-mail addresses — they like that we’re a proxy for their messages,” Mr. Mikulak said.

Don't put your health in someone else's hands! Taking the test is fine, but don't take health advice from those who have a vested interest in making you a permanent patient.

Wednesday, March 25, 2009

TCM Treatment of Prostate Disease

This CEU course will cover prostatitis, benign prostatic hyperplaysia and prostatic cancer. You'll learn effective herbal formulas and acupuncture techniques which not available in your text books.

Joseph Yang, BMed, MS, Ph.D.

Santa Monica, California
May 31, 2009
9:00 AM ~ 5:00 PM
CEU: 8
For CEU: Early bird $95 by April 15, 2009, $120 thereafter, 2009
Non-CEU: Early bird: $65 by April 15, 2009, $90 thereafter, 2009

To register, please call Dr. Todd at 310-713-4325 or Dr. Yang at 310-699-1028

See the website here. Dr. Yang earned his bachelors and masters degrees at Heilongjiang Medical University in China, and a PhD in neuroscience and psychiatry at Kobe University in Japan. He currently teaches and is a clinical supervisor at Yosan University of Traditional Chinese Medicine and Emperor's College of TCM.

Tuesday, March 24, 2009

Chinese Herbal Therapy for Childhood Eczema is Safe and Effective

Dr. Ming Jin of Ming Qi Natural Healthcare Center

Julia Wisniewski, MD, of Mount Sinai Hospital in New York studied 14 children who were treated for eczema at the Ming Qi Natural Healthcare Center in New York City between 2006 and 2008.

All of them drank Erka Shizheng Herbal Tea twice a day and soaked in an herbal bath for 20 minutes daily. They also applied an herbal cream to their skin two or three times a day and had acupuncture treatment.

At the start of the study, more than half of the participants had severe symptoms on a standard scale that doctors use to gauge eczema severity. After eight months of treatment, most had mild symptoms.

“Improvement in symptoms and quality of life was seen as early as three months,” Wisniewski says. She showed before-and-after photos of several children to document their progress: Red, scaly feet and hands appeared normal six months into therapy.

Participants also reported a reduction in the use of steroids, antibiotics, and antihistamines within three months of being treated with traditional Chinese medicine.

The herbal treatments proved safe, with no abnormalities in liver and kidney function observed, Wisniewski adds.

“Chinese medicine is a very good alternative to conventional therapy for children with eczema,” she says.

More good news about Chinese medicine! Take note that the TCM therapy was multi-pronged - the patients drank herbs, applied an herbal cream externally, soaked in herbal baths, and had acupuncture.

I met Dr. Ming Jin about five years ago when I went for acupuncture at her clinic. At that time she was on 6th Avenue just on the edge of Herald Square in a mostly residential building. Later on she moved to much fancier renovated digs in a medical building on 5th Avenue and 30th or 29th St. She's a very nice lady! If you explore her website you'll find that she treated Bill Cosby, among others.

Thursday, March 19, 2009

Five Branches Doctorate Graduation Ceremony

Congratulations to Five Branches for awarding the DAOM (Doctor of Acupuncture and Oriental Medicine) degree to 36 people! Wow! Our Yosan Master's-level graduating class was only 20 people!

That number sounds a little too big to me. I wonder if the Santa Cruz Sentinel got it wrong and there were 36 people total in the graduation ceremony, and some of them were at the doctorate level. Well either way it's a great thing.

Wednesday, March 18, 2009

Yosan Graduation!

Hey everybody, your blog authors just graduated!!! (Sort of - we have a few more weeks of classes and clinic before it becomes official.)

It's been a long journey - when I started four years ago at the Pacific College of Oriental Medicine in New York, I was married and living in suburban Queens. Now I'm no longer married (whew) and live on the west side of L.A. with a dog and cat and a lovely lady named Nini.

I want to send out a few thank you's to the universe... Dr. Alex Feng, 师夫, mentor, inspiration. Dr. John Pai Wen-Chiang of PCOM NY, for your passion and the lovely way you sing the name 血府逐瘀汤 Xue Fu Zhu Yu Tang, I still remember it. Dr. Roger Tsao, pulse master and karaoke legend. Dr. Steve Jackowicz, for lighting the fire and expanding the way I thought about TCM. Tom Leung, for giving me a chance. The whole Kamwo crew - Jenny, Judy, J2, Rocky, Mandy, Ming Jie, Yangguang, Ray, Jacky, Stacy, Matthew "celebrate good times" Weitzmann, Jonti, Will, Hongwei and Helen holding it down at Grand Meridian, all the guys behind the herb counter including my drinking buddy Mr. Chen... 凉瓜牛肉饭,夏枯草饮,咖啡没糖阿... all my supervisors at the Yosan clinic including Dr. Naiqiang Gu, Dr. Joseph Chang-Qing Yang, Dr. Yuhong Chen, Dr. Zhang, Dr. Jin... and to all my lovely classmates at both schools, some of whom have taught me far more than I could learn in a classroom. To all of you, thank you for making me who and what I am today. I love you.

And to Nini, for healing me, for letting your light shine, for your beauty both inside and out, thank you. I love you.

To my parents and my family, for giving me life, for shaping my life, for being you, you're all wonderful. I love you.

To everyone at Wu Tao Kuan, Zhi Dao Guan, Oishi Judo, Sawtelle Judo, Bryan Hawkins Kenpo Karate, Park's Tae Kwon Do Long Beach, Wu Jian Pai New York, 上海体育大学,Benzene Dojo in Asakusa, thank you thank you thank you. Martial arts and Chinese medicine are inextricably intertwined, all training in one leads to the other, like two sides of the same coin, as a wise man once said...

To the Great Spirit, God Almighty, The Universal Mother, Guanyin, Jesus Christ, the Jade Emperor, all the various spirits and demons that helped me or hindered me and gave me a lesson, thank you. George Clinton said everything is on the one. Everything is on the one. Everything is on the one.

Tuesday, March 17, 2009

Acupuncture: More and More Popular!

Mounting evidence that acupuncture is slowly but surely becoming part of the medical mainstream can be found in this article from the Washington Post.

The overwhelming majority of people are not dogmatic when it comes to medicine. They want something that works, and they don't care how it works. Most people aren't interested in yin and yang, the five phases, the Zang Fu, the history of Chinese medicine. All the things that fascinate and intrigue TCM students mean very little to the general public, except one thing: getting better.

Of course, as medical professionals, it's our job to educate patients so that they can take better care of themselves. If we don't try to educate people on preventive care and health maintenance, our patients will never really be cured.

Imagine you're a mechanic. People bring their cars in all the time with worn out brakes. When you tell them "You know, the correct way to drive is by pressing the gas pedal to go, and the brake pedal when you want to stop" - people scoff at you. "But I usually just hit the gas and brake at the same time!" they tell you. That's (sometimes) what it's like being an acupuncturist.

When people get better, that's our opportunity. When people get miraculous results, it makes them stop for a second and ask "Why did that work?" That's our chance to turn it around and say "Let's look at why you got sick in the first place." Because that's the real cure - understanding how you got sick, and how to avoid it in the future.

Monday, March 16, 2009

Big Pharma Chases Skirts

Today I'd like to point you towards an excellent column in the Huffington Post on how pharmaceutical companies pay close attention to women when marketing a new prescription drug.

Women need to know that they are being studied, targeted, and manipulated by very effective advertising that has little to do with good science. The ads and the target markets are heavily researched by internal marketing departments, branding experts and advertising companies.

In order to effectively drive sales with the important female demographic, companies first identify which issues in life women are most concerned and/or insecure about. They then develop their entire marketing campaign around those issues rather than the specific science of the drug. Big bucks go into finding the emotional hot button for any given pill or medical problem. The majority of ads feature sexy, smiling, happy people -- walking by the lake, rolling around with their children, or on a fun/hot date. We all want a little piece of that, don't we? Pharma knows how to play off of women's deepest insecurities and our biggest dreams...and it works.

The author worked in the pharmaceutical industry for 10 years, so she knows what she's talking about. It's an excellent wake-up call for anyone, female or male, who has been brainwashed into thinking that health comes from a pill.

Friday, March 13, 2009

Bump: Peter Panken L.Ac

Peter Panken's mustache is better than this one.

I started my TCM education in New York City. I met some wonderful people there, including Peter Panken L.Ac, sweat-lodge enthusiast and all around nice guy. He was my supervisor at the Fortune Society externship, doing free NADA ear acupuncture and full-body acupuncture for recently paroled people.

Every Wednesday we would take over the community room and set up four tables and a circle of chairs. The chairs were for people getting ear acupuncture only. One day it was slow and I got the NADA protocol in my ear. About a minute after the needles were inserted, I was so relaxed felt like I was going to slide off my chair.

Thursday, March 12, 2009

Trees Make Electricity!

According to Sandra Tsing Loh, "Scientists have long known trees generate trace amounts of electricity".

If they've known for a long time, why is this news? You guessed it - a man named Love has figured out how to harvest electricity from trees! Go ahead and let your hamster get off that treadmill you have hooked up to your generator... and plant a tree.

Wednesday, March 11, 2009

Yellow is the New Green

I had the opportunity to use a composting toilet last week. Apparently, when urine and solid waste are separated, bacteria can break them down much faster than when they are mixed, and the results can be used safely as excellent compost for your gardening and farming needs.

This NY Times piece discusses one of the main problems with the toilet:

Then there’s the sitting problem: in most urine-diversion toilets, a man must empty his bladder sitting down. This wouldn’t be a problem in some countries — Germany recently introduced a toilet-seat alarm that admonishes standers to sit — but it has been in others. Professor Jenssen was flummoxed by one participant at a training workshop in Cuba who said firmly, “If a man sits, he is homosexual.”

I wasn't crazy about sitting down to pee, either. I turned to sit down, but just couldn't make myself do it. Something about it seems... not right. So I compromised by turning as if I was going to sit down, but without actually letting my thighs touch the seat.

This seems like an almost laughably easy problem to fix. What is a urinal? Just a funnel with a tube on the end. I could make one out of half an old milk bottle and some rubber hosing. Just point the hosing where you need the urine to end up, and now you've got both a urinal for the men and a toilet for both sexes. This wonder-toilet will never be hugely popular - there's no need to make things harder by trying to break deeply seated psychological conditioning.

The standing urination position may be about more than just psychology. The Kidney channel (foot shaoyin) runs from the bottom of the foot to the inner ankle and up the inside of the calf, to the crotch and the genitals, where it dives into the body and runs its internal course, linking with the urinary bladder and the kidney, before emerging near the pubic bone and rising up the front of the body to just under the clavicle.

In TCM, the Kidneys are the root of life. In addition to filtering toxins and purifying urine, the Kidneys store sexual energy and 精 Jing. Consequently, preserving Jing can improve your sexual health and lengthen your life.

A friend of mine from Taiwan says that if you gently rise up on the ball of your foot while urinating and lift your 会阴 Huiyin point, you can preserve some Kidney energy that would be otherwise lost. Thus it can be important for a man to stand up while urinating.

There are many theories on how to preserve Kidney energy. I don't think lifting your heels is a widely accepted part of TCM therapy, but it's food for thought.

Tuesday, March 10, 2009


夏枯草 Xia Ku Cao, I have discovered, is an excellent remedy for dry eyes, dry mouth, headache and fuzzy-head sensation brought on by alcohol consumption. The variety I tried was a commercial preparation made with sugar and water, similar to the picture above. I tried making Xia Ku Cao drink at home, but it wasn't the same - probably because I was leery of putting too much sugar in.

Xia Ku Cao is known in English as prunella or self-heal spike. I bought a plant once at a farmer's market, planted it in my then-backyard and watched it grow and grow all summer long, fighting with the mint for dominance of the herb patch (the mint won).

In TCM it is categorized with the Clear Heat, Drain Fire herbs and is especially good for heat in the upper part of the body manifesting as dizziness, red eyes, irritability, etc.

Monday, March 9, 2009

Dissociative Fugue: Is Your Hun Out Partying?

Jason Bourne, Matt Damon's fictional character from the movie series Bourne Identity, is the most famous 'person' who suffers from this rare amnesia. The name Bourne was taken from Ansel Bourne, the first recorded case of the dissociative fugue in 1887.

Dissociative fugue is a very rare form of amnesia, whereby the person loses complete memory of their identity and personality, but have full mental functioning for all other purposes. It's so fascinating, especially since the fugue state is associated with travel, and people sometimes end up across continents, not knowing how they got there. Psychiatrists attribute the onset of a fugue state with extreme stress, resulting in the person 'running away' or 'hiding' from their problems. In a recent story, a woman in a fugue state was able to go into an Apple store and check her email, but not remember who she was or what she was doing. She was eventually found three weeks after she went missing, floating in the water miles from where she lived.

In modern TCM theory, there is not one soul or consciousness, but five separate and distinct ones, each housed in the five major organs of the body. The 神 Shen, 意 Yi, 魄 Po, 志 Zhi, and 魂 Hun have their independent characteristics, but work together to form the mental-spiritual aspect of an individual.

From The Foundations of Chinese Medicine, by Giovanni Macciocia:

The Mind (Shen) is the consciousness that is responsible for thought, feeling, emotions, perceptions, and cognition. The Mind resides in the Heart and it is primarily for this reason that the Heart is called the 'Emperor' in relation to all the other Internal Organs. As the Mind is the consciousness that defines us as individual human beings and that is responsible for thinking, willing and feeling, the Heart plays a leading role among the Internal Organs.

The Intellect (Yi) is responsible for memory, concentration, thinking, logical thinking, capacity for studying, and application. In pathology, the capacity for thinking may become pensiveness, overthinking, obsessive thining, fantasizing or brooding. The intellect resides in the Spleen.

The Corporeal Soul (Po) is responsible for physical sensations, feelings, and generally somatic expressions. It resides in the Lungs and it plays a role in all physiological processes of the body. It is formed at conception, it is Yin in nature, and, at death, it dies with the body returning to the Earth. The Corporeal Soul is described as the 'entering and exiting of the Essence (Jing)'.

The Will-power (Zhi) resides in the Kidneys and it is responsible for will-power, drive, determination and constancy.

The Ethereal Soul (Hun) is a soul that is Yang in nature and that, according to Chinese culture, enters the body three days after birth and is imparted to the baby by the father. After death, the Ethereal Soul survives the body and returns to a world of spirit. The Chinese character for Hun confirms the spiritual, non-material nature as it is made up by the radical gui, which means 'spirit' or 'ghost', and the radical yun, which means 'clouds'. The Ethereal Soul resides in the Liver and particularly in the Blood and Yin of the Liver where it should be 'anchored'; if Liver-Blood is deficient and the Ethereal Soul is not anchored in the Liver, it 'wanders' at night and causes the person to dream a lot. The Ethereal Soul is described as 'the coming and going of the Mind (Shen)'.

So if a person were to lose complete memory of their identity, which soul would be the one affected, and how would Chinese medicine proceed in the treatment of an individual who has had a fugue state experience?

My guess would be the Hun. If the Shen were to go on vacation, all mental faculties would cease. If the Po were to leave the body, the person would die, since it is in charge of all things physical and only returns to Earth upon death. The Hun is the only one known for 'wandering', and is the one most immediately affected by stress and deficiency. A person in a dissociative fugue state could be said then to be suffering from a case of their Hun going out to party during the day when it should be at home in the Liver. It's like being in an extended dream that ultimately can't be remembered.

To treat this individual, one would have to Nourish Liver Blood and Yin, and Soothe the Liver. Without a look at the tongue and pulse, I would guess that the base formula for such a condition would be 酸枣仁汤 Suan Zao Ren Tang, with the addition of herbs like 熟地黄 Shu Di Huang, 夜交藤 Ye Jiao Teng, 白芍 Bai Shao and 当归 Dang Gui to more strongly tonify Blood. 柴胡 Chai Hu could be added and 赤芍 Chi Shao could substitute for Bai Shao if there is more Qi stagnation, and 茯神 Fu Shen for 茯苓 Fu Ling to more strongly calm the shen. 远志 Yuan Zhi and 石菖蒲 Shi Chang Pu can be added to calm the spirit and clear the head, in the same way they're used in 定志丸 Ding Zhi Wan.

Acupuncture could include points like 曲泉 LV-8, 太冲 LV-3, 三阴交 SP-6, 足三里 ST-36, 手三里 LI-10, 四化 Four Flowers, 神堂 UB-44, 魂门 UB-47, and 四神聪 Si Shen Cong. Other points would be added or subtracted according to tongue and pulse and symptom pattern.

Friday, March 6, 2009

Book Review: Pulse Diagnosis

Here's another tribute to the Lakeside Master, Li Shi Zhen.

I've been on a book kick recently, and revisiting the Bin Hu Ma Xue, or Pulse Diagnosis book has been the best pick so far. It's so detailed! Reading this book makes me feel like I don't know anything, which is great. Makes me want to learn more.

For those who love charts, the appendix has charts of 32 different pulses (the 27 classic pulses developed by Li Shi Zhen, plus some variations) that describe the depth, strength, width, meaning behind the pulse, and explanation of the disease process for each of them. It also includes the English, Pin Yin, and Chinese characters for the pulses as well as a list of complicated diseases.

I've been using the book as a reference in clinic for the last month, and it's enriched my practice greatly. Did you know that there are seven different types of floating pulses, and five different types of sinking pulses? Based on that information alone, I've been much more observant of the pulse qualities when determining a diagnosis.

The Bin Hu Mai Xue was originally written in verse and is meant to be succinct. It does not describe in great detail what each of the pulses should feel like. For that, I would suggest referencing Bob Flaws' book, The Secret of Chinese Pulse Diagnosis for the standard TCM definitions, or for an extremely comprehensive exploration of the pulse, read Leon Hammer's Chinese Pulse Diagnosis: A Contemporary Approach.

Thursday, March 5, 2009

Ice Cream, Don't Do It

Here's a fun factoid: ice cream makes you sick. It's true.

Well, I should say that it made me more sick than I was before.

I had started to come down with something on Monday evening, starting with a sore throat and heaviness in the head. I blasted myself with herbs, and upon waking I was feeling better. By the end of my shift at noon, however, my sinuses were completely congested, and it felt as though it was clogged through to my ears.

I went home and nursed myself, taking a different set of herbs for my congestion. I even stayed home and canceled my shift, not wanting to infect anyone else with my evil qi. By the afternoon, I was feeling so much better that, despite better judgment, I decided to celebrate with some ice cream. Two spoonfuls, to be exact.

Before the ice cream, I had no sore throat, no headache, no congestion, and no runny nose. After the ice cream, within minutes, my nose clogged up and I was back to wiping snot off my face and I had to drink hot tea to combat the coldness I started to feel. It's as if the ice cream canceled out all of the herbs I've taken and the sleep I've gotten in the last two days.

So next time you think of having ice cream, just don't do it... Unless it's Ben & Jerry's New York Super Fudge Chunk, in which case it might be worth it.

Wednesday, March 4, 2009

Medicine In The News

While reading the New York Times yesterday, I couldn't help but notice the increasing number of articles about health care. Could it be that all this talk of health care reform is forcing people to look at what needs to be reformed? The ideas of conflict-of-interest and professional integrity have always come up in regards to medical care versus the medical industry. I feel that the growing discontent with the current mainstream medical system has finally reached a point of some kind of public vigilante justice, bent on shaming the perpetrators into following the rules of medical ethics and propriety.

Two articles in particular had stood out: Prosecutors Plan Crackdown on Doctors Who Accept Kickbacks, and Harvard Medical School in Ethics Quandary. Interestingly enough, both of these articles did not make their appearance in the Health section of the Times, but rather in the Money & Policy section and Business section respectively.

The first article describes how federal prosecutors are going to start enforcing laws that make it illegal for medical doctors to accept gifts from industry. They have already been going after the pharmaceutical companies that engage in such practices, but have found that even increasing fines is not enough of a deterrent, as some of them already set aside money for fines that they know they'll need to pay for breaking these laws. Now, they're going after the medical doctors.

[...] federal health officials are forcing a growing number of drug and device makers to post publicly all payments made to doctors who serve as consultants or speakers.

That means that information about the companies that illegally market their goods as well as the doctors who they bribe will be made completely public and searchable.

The second article discusses industry influence on education. The problem that a lot of medical schools face is that a good proportion of their funding comes from private companies, and a lot of star faculty act as consultants for companies to increase the marketability of their products. But what kind of education would future doctors be getting if their instructors were all on the payroll of big pharmaceutical companies? Some would argue that it wouldn't affect their jobs as teachers, but I suspect there must be a huge bias with the dissemination of information.

Harvard medical students, as part of the American Medical Student Association, have worked to make it a requirement that all professors and lecturers disclose their industry ties in class. They are the first and only medical school to do that, which is appropriate in this age of reform because they are ranked one of the lowest in terms of transparency and control of industry money.

Here is where I would normally tie this blog post to Chinese medicine somehow... for today, I think it would be sufficient to simply say that I hope all this reform of the health care system in its final incarnation will include low-cost, low-risk, highly effective therapies - such as Chinese medicine - into the grand plan of taking care of each other.

Tuesday, March 3, 2009

Give Your Patients More Herbs at a Higher Dose and See Better Results

Here's a quote from one of my favorite bloggers, Eric Brand, on one of my favorite subjects, the chronic underdosage of herbs here in the U.S. All emphasis is mine and does not appear in the original.

It could be said that the greatest overall differences in Chinese herbal medicine between the US and Asia relate to dosage. In Asia, raw herbs are generally taken by decoction at a dose of one pack per day, whereas in the Americas, one pack of raw herbs is often taken for two days. Despite the fact that North American patients tend to have a higher body weight than their Asian counterparts, they often consume Chinese herbs at a dosage that is essentially half of the traditional dose.

In a similar paradox, Taiwanese granules are often prescribed at doses that are a fraction of the doses used in Taiwan. Part of the confusion seems to lie with the labeling information, which is required by US law to state a specific dose. Given the litigious nature of American society, most companies are understandably cautious in their dosage recommendation, so the dosage listed on the label is often well-below the dosage that is regularly used by a trained practitioner. Furthermore, most loose granules have the Asian labeling on concentration ratios removed for the US market, so practitioners are often at a loss to know how the powder corresponds to the raw herbal weight.

Taiwanese granules are generally used at a dose of around 18g/day in Taiwan, but many practitioners in the US use doses as low as 4—6 g/day. Perhaps the majority of Western practitioners prescribe granules in a dose range of around 6—12g/day, but many practitioners remain uncertain about how proper granule dosing is determined. Additionally, many instructors in American schools come from China but teach in schools that stock Taiwanese granules, which are more prominent on the American market. The granule product is different than what they used in their training in China, and teachers cannot effectively educate students on granule dosage because the standard raw dose equivalent is absent from the label. Consequently, practitioners often rely on the label information, which is essentially just an overly cautious (read: “please don’t sue me”) guideline that is required by FDA laws.

As I work in the Yosan clinic, this continues to amaze me. Most of us are giving our patients less than a half dose of herbs. I have to admit I don't always insist that my patients take one bag per day of raw herbs. Whenever you see a patient there is a calculation that takes place - how committed to getting better is this person? How much are they buying what I'm saying? If they really want to get better and have trust in me as a practitioner, I'll generally prescribe five bags of herbs, one for each day, with one day off before the next weekly check-up. If they're one of these people that don't really believe Chinese medicine can help them, or they were cajoled into getting an appointment by a relative or a friend, I might give three bags of raw herbs, with the idea that some herbs is better than none.

The best patients are the ones that are ready to change their lives and just need some help doing it. I saw some amazing results with heavy smokers with life-long asthma using acupuncture and variations on 白果定喘汤 Bai Guo Ding Chuan Tang, but these people were also doing yoga every morning, going running, changing their diets, and had the support of partners and friends. Without Chinese medicine, these people might be the ones who said "I tried everything but I still need my inhaler" - their kidneys too weak, their lungs too encumbered with phlegm. For one of my patients, we got him from using his inhaler up to ten times a day down to once or twice a day within a week, and shortly after that he didn't need the inhaler at all. This patient of course took one bag of raw herbs per day. With a half dose, who knows how effective it would have been?

This is something I feel strongly about, and hopefully I've convinced a few TCM students it's an important subject that needs attention. Supervisors are another matter. Some clinical supervisors that were educated in California are so used to using one bag of raw herbs for two days that suggesting otherwise gives them a shock. "Why you brat," they seem to be thinking, "I've been doing this since 1987! I think I know what I'm doing!" Supervisors who were educated in China might be gung-ho about herbs, or they might just want to fit in and not rock the boat too much.

In either case, most supervisors I've encountered give wide latitude in dosing herb granule extracts. Using the method detailed here, you can figure the dose yourself and tell your patient just how to take it. You'll quickly find that most patients need 100 grams to last at least a week.

p.s. It almost goes without saying that a higher dose of herbs means absolutely nothing if your diagnosis is incorrect... it's just important to understand all the weapons at your disposal.