Friday, February 26, 2010

9000 Needles

9000 Needles is the story of Devin Dearth, a champion bodybuilder and family man from Kentucky who suffers a devastating stroke. After a hospital stay and physical rehabilitation, he is sent home, still with limited mobility. Desperate for further treatment, Devin's family searches and somehow has the good fortune to find Dr. Shi Xuemin and the Tianjin acupuncture hospitals he is affiliated with. And then...? I don't know, all I've seen is the trailer above.

I admit that I am excited about the possibility that this film could bring greater awareness of how effective acupuncture is and can be. I'm also looking forward to watching interviews with the famous acupuncture doctor Shi Xuemin. However, the film also looks like an incredibly moving story about a family struggling through some tough times. The film was actually made by Devin's brother Doug Dearth.

It's coming to L.A. for two screenings in the next few weeks. One is a benefit screening in West Hollywood (tickets are $40), and the other is at Oasis Theater on Wilshire (tickets $10). I'll be going to one of them. If you're an acupuncturist, acupuncture student, acupuncture school administrator, or just enjoy a good movie, be sure to watch!

On the web:

Wednesday, February 24, 2010

Huang Qi

Huang Qi (黄芪 astragalus) and Mi Zhi Huang Qi (蜜炙黄芪 honey-fried astragalus)

At Fat Turtle Herb Company, Huang Qi is one the most popular herbs. Because it's generally safe in dosages up to 30 grams, practitioners freely prescribe Huang Qi in many different formulas. Yu Ping Feng San (玉屏风散 Jade Windscreen Powder) and Bu Zhong Yi Qi Tang (补中益气汤 Tonify the Middle and Benefit the Qi Decoction) are two of the most popular base formulas that use Huang Qi.

According to an article in Hei Long Jiang Zhong Yi Yao (黑龙江中医药 Heilongjiang Chinese Medicine & Pharmacology), translated and abstracted by Bob Flaws and available for free at Blue Poppy's TCM Infoline, regular Huang Qi is used in Yu Ping Feng San to help secure the exterior, disinhibit water and disperse swelling. Mi Zhi Huang Qi is used in Bu Zhong Yi Qi Tang to "upbear yang & lift the fallen, secure the qi & restrain desertion."

Benksy, Clavey and Stoger's 3rd Edition Materia Medica says that honey-fried Huang Qi
induces the astragalus to travel internally, and to specifically tonify and raise the clear qi of the middle burner. It is also somewhat moistening and is therefore more appropriate when the pattern involves blood deficiency, or dryness of the Spleen.

Chen and Chen's Chinese Medical Herbology and Pharmacology says
unprocessed Huang Qi (fresh or dried) has qualities better suited to treat exterior disorders, as it tonifies wei (defensive) qi, stops perspiration, regulates circulation of water, reduces edema, and promotes generation of flesh. The honey-processed herb has an enhanced ability to treat imbalances of the interior, such as Spleen and Lung qi deficiencies and yang deficiency. It is also commonly used to treat chronic cases of fatigue, diarrhea, organ prolapse, and all cases of deficiency.

When writing prescriptions, make sure you're using the right type of Huang Qi for the condition. Fat Turtle Herb Company carries regular Huang Qi and Mi Zhi Huang Qi in both raw and granule powder format.

Saturday, February 20, 2010

More Discussion of Herbal Dosing

Carl Stimson, an American acupuncturist living and working in Tokyo, has some interesting observations on medicinal dosing - you can read part one and part two here.

Running a Chinese pharmacy, I see all different levels of dosing. Some of our practitioners use 12-15 different herbs for each prescription, with 9-15 grams for each herb. Others use as little as 4 herbs and doses of 3-9 grams maximum. Some want their patients to take one bag of raw herbs per day, others one bag every other day. If you're not getting results, dosage might be one aspect of your treatment to consider (obviously a correct diagnosis is number one).

In previous posts, I've recommended using one bag of raw herbs per day, or its equivalent in granule form. While I still feel this is the best option, I have seen many practitioners get results with varied dosage forms, and results are what matter most. Heiner Fruehauf, a member of the Fire Spirit school of Chinese medicine, uses Fu Zi in almost every formula, and in this article cites his teachers in the Fire Spirit school as saying that if a patient feels palpitations and dizziness after taking Fu Zi it's most likely because the dose was too small rather than too high (he's also very specific on the type of Fu Zi used - it must be from Jiangyou County in Sichuan province).

Here's Carl:

When I was a student I remember reading a debate on dosages between several practitioners on a TCM internet discussion group. The argument that American patients did not need as much herbs as Chinese patients because they had not developed any tolerance to herbs was being discussed. One practitioner countered that if a doctor traveled to an isolated island where the inhabitants had never been treated with aspirin or antibiotics, the doctor wouldn't reduce his dosage because of this, he would continue to dose based on weight and severity of the illness. At the time I thought this was a wonderful argument. It illustrated the fact that we are all humans with the same biology and chemistry. I still think the point is an important one, but now I wonder about a related question. I think there is no doubt that a foreign doctor arriving in a new country / culture would continue to dose using the standards he was trained in. However, if the local doctors were given this new medicine, would they continue to follow the same dosage standards after many years of practical experience? It seems, based on what we have seen with acupuncture and pain medication, that there is no guarantee the local doctors would not develop different dosage standards.

So why does this happen? After all, the human body is the human body, no matter if it is American, Chinese, or any culture. It is subject to the laws of science no matter what national borders the body is living in. I believe that differences in dosage standards across cultural lines has very little to do with science, and mostly involves differences in each culture's relationship to health and medicine. In China, many patients will not be satisfied with an acupuncture treatment that is not painful, while in the US and Japan, a practitioner is unlikely to be in practice very long if his/her treatments cause much pain. Perhaps the Chinese have more faith in the "No pain, no gain" principle. The difference in pain medication dosages between the US and Japan probably reveals the fact that being able to withstand suffering without complaint is highly valued (and expected) in Japanese society. I have also heard that US doctors start to give medication for blood pressure and cholesterol at lower levels than Japan. This could reflect a tendency of Americans to be more proactive in using outside means to control nature. It could also reflect the pervasive paranoia about liability in America.

While it is true that we are all human beings and subject to the laws of science, let's remember that the laws of science are essentially a crude way of describing the laws of nature. The Daoist tradition has a much more elegant, somewhat less exact but much more complete way of describing nature, based on the the concepts of Wu Ji, Tai Ji (yin and yang), the five phases, ba gua and so on. When you look at humans from this perspective, it helps you remember that people get sick in different ways all over the world. So when the hypothetical doctors arrive on the island, why are they giving out aspirin and antibiotics in the first place? What criteria are they using to evaluate local people and their illnesses, and are those criteria valid?

There is a trope in Chinese medicine that Northerners (northern Chinese) come from a cold climate and therefore need higher doses, take to warming tonics better, and when they catch wind (cold) need stronger exterior-releasing herbs. Southerners (southern Chinese) come from a warmer climate and therefore usually need lower doses, and when they catch wind need a different treatment strategy. So of course people in places as different as China, Japan and the U.S. need different dosages.

In a heterogeneous society like the U.S., you'll treat all different body types and all different ethnicities. Some of your patients were born in faraway places, some were born around the corner from your office. Don't get caught up in dogma, whether it relates to dosing, diagnosing, or anything else. Evaluate each patient individually and decide what's appropriate for their situation.

See also: How much is in a qian? by Eric Brand

Tuesday, February 16, 2010

Roasted Vegetable Stew

Over the past few months, I've been prescribing slow-cooked root vegetables as an addition to many of my patients' diets. Root vegetables, particularly yams and sweet potatoes, are very nourishing and tonifying of Spleen energy. The Spleen in Chinese medicine falls under the domain of the Earth element, creating the foundation for the production of new, utilizable energy and all of the physiological processes in the body.

I realized today that all this time I have failed to provide any good recipes to go with my advice!

Here's a delicious and simple recipe for a Roasted Vegetable Stew that I've adapted from a recipe I found in a book on soups:

4 Parsnips, cut lengthwise into 4 pieces and then quartered
2 Red Onions, cut into thin wedges
3 Garnet Yams, cut into chunks
1 Large Leek, cut thickly
1 Fennel Bulb, cut into chunks
3 Celery Stalks, cut into diagonal slices
1 Butternut Squash, skinned, seeds removed, and cubed
2 Whole Heads of Garlic
4 Tablespoons Olive Oil
Herbs du Provence (or just Thyme), Salt, and Pepper for seasoning
4 Cups Vegetable Broth
Handful of Cherry Tomatoes

Pre-heat oven to 400 F. Put all of the cut veggies into a large roasting pan (I need to use two separate 9" x 13" pans for this recipe, but that's only because I don't have a bigger pan!). Drizzle 3 tablespoons of the Olive Oil over the veggies and toss to cover evenly. Put the last tablespoon of olive oil in a little bowl or mug and dip each whole head of garlic into it, being sure to entirely coat it. Place the two oiled heads of garlic on top of the pan of veggies, and moderately sprinkle Herbs du Provence over everything. Place the pan in the oven for at least 45 mins, or until the veggies are roasty browned and tender.

While you're waiting for the veggies to cook, you can make some delicious bread to go with your stew!

1 Loaf crusty bread, I would recommend Ciabatta or Thick Baguette
3 Tablespoons butter or butter substitute (I use Earth Balance)
2 Cloves Raw Garlic, chopped
4 Pieces Sun-dried Tomato
Paprika, Parsley, or in my case Mexican Spiced Chili Seasoning for taste and color

Take your loaf of crusty bread and cut diagonal slits into the bread without cutting all the way through. Mix 3 Tablespoons of butter stuff with the chopped garlic and sun-dried tomatoes. Use a butter knife to stuff and spread the mixture into the slices of the bread. When you're done, sprinkle some seasoning across the top of the loaf and put the bread back together, wrapping the whole thing in foil. When you're ready to bake, put the foiled loaf in the oven at 400F for 10 mins covered so that it can get flavorfully buttery infused, and then uncovered for 5 minutes so that it can get golden brown. I would recommend waiting until the stew is done to toast the bread so that you can serve it up immediately all warm and delicious and whatnot.

Once the veggies are done and you've removed them from the oven, take one head of garlic and squeeze the roasted cloves out. Save the other head for serving with your meal. Take half of the roasted veggies with the squeezed garlic and mash it all up with the 4 cups of vegetable broth with either a food processor or blender until it is almost smooth. Mix the rest of the roasted veggies into this stew and heat on the stove until boiling. Add salt and pepper to taste. When ready to serve, place a few cherry tomatoes on top and garnish with some herby green things (like thyme or rosemary sprigs) for looks and aroma.

It's plenty meal for 4-6 people when served with toasty bread and roasted garlic. What's more, when made with Earth Balance this recipe is vegan!

Tonight we complemented our meal with peach champagne avec fresh strawberries for a fun and tasty beverage. Bon apetit!

Monday, February 8, 2010

Dr. Chao's Herbal Drink

Just got a sample of this from a neighbor. No sugar, no calories, made with Chinese herbs, and no, it's not disgusting. It's actually quite sweet. I'm guessing that's because of the Luo Han Guo (罗汉果 Fructus Momordicae). From Chen's Materia Medica entry on Luo Han Guo, page 722:
Because mogroside VI is approximately 256 to 344 times sweeter than cane sugar, it is commonly used as a sweetening agent in drinks. It is also used as a sugar substitute by obese individuals or those with diabetes mellitus.

Hmm, I guess it's only a matter of time before someone patents a chemical copy of mogroside and markets it as a sugar substitute, eh? Anyway, back to the drink.

Ingredients: Water, Cordyceps, Saffron, Fructus Momordicae, Herba Hyperici Japonici, Herba Houttuyniae, Rubus Suavissmus, Lavender, Citric Acid.

Cordyceps (冬虫夏草 Dong Chong Xia Cao) is a parasitic fungus that grows out of the body of an insect which it infects and eventually kills. Bad for the insect, good for us! The wild product is unimaginably expensive, but cultivated cordyceps is available. Cordyceps is used as a general tonic herb that is good for the lungs and the immune system and has very few side effects.

Saffron is the common name of 红花 Hong Hua, which in Chinese medicine is considered a blood-mover. I've never heard of it being used for stress, but blood stasis could certainly contribute to stress, so... Fructus Momordicae, besides having that magical sweetening effect, is good for coughs. Hypericum (贯叶连翘 Guan Ye Lian Qiao) is the Chinese name for St. Johns Wort. Chen puts it in the category of Clear Heat Eliminate Toxin and notes:
Historically in China, this herb was used as a heat-clearing agent, to treat various types of infectious and inflammatory conditions. In Europe, it was used more as a nerve tonic, to address anxiety, depression, and restlessness.

Now we get to an odd one: Herba Houttuynia, or 鱼腥草 Yu Xing Cao. I have no idea what this herb is doing in a stress formula. It's also a Clear Heat Eliminate Toxin herb, generally used for infections. It also promotes urination and drains pus.

Rubus Suavissmus is a new one on me. It's not in my herbal medicine books, but googling it turns up a variety of research studies. Apparently its common name is Chinese sweet tea.

Lavender is a western herb used for relaxation. Citric acid is a preservative.

Well, I drank it, and I'm not dead. I don't know how much it retails for, but I probably wouldn't pay for it. I'm not much into exotic drinks. I stick with the basics: Chinese tea, Vietnamese coffee, water, beer, wine.

Dr. Chao also has some other drinks: Adult Drink, an aphrodisiac type of drink; Lady Drink, for the ladies; and 21, for the drinkers.

Thursday, February 4, 2010

Ling Zhi

My former roommate with some Ling Zhi

Eric Brand has a good blog post about about Ling Zhi (灵芝 ganoderma, aka reishi mushroom). Some key points are that although Ling Zhi is mentioned from way back as a very important herb, it does not appear in a single classical formula. Does that mean it was meant to be taken only by itself? Only on special occasions? Who knows?

The modern TCM functions, covered in Eric's blog post, suggest that it could be a useful addition to Tian Wang Bu Xin Dan or Yu Ping Feng San. Many people swear by it to prevent and/or as an adjunct therapy for cancer (see what Wikipedia has to say about it), but beware of the internet - it's full of shady sites that will claim to cure your cancer/AIDS/etc. with their special blend of super-extracted reishi mushroom (this blog post may automatically generate Google ads for some of these same sites). As always, the best way to determine how to use Chinese herbs is by visiting a trusted herbal doctor, or at the very least very careful and thorough self-directed research from authoritative sources.

A few years ago I took a trip to Chinatown and bought one of the large whole mushrooms, about a foot in diameter (that's it in the picture above). I took it home and looked at it for awhile, took pictures of it. Then I tried slicing it - very difficult. It turned out that the easiest way for me to decoct it was to break off pieces in chunks. I didn't bother weighing it since it was for personal use. I cooked it as do most tonics - low and slow with plenty of water, about 2 hours in all. It was late afternoon when it was done. I drank a mug. It was certainly bitter, but something about the taste appealed to me, like clean spicy dirt. About twenty minutes later I fell into a deep, dreamless sleep right there on the couch and woke up feeling slightly drugged but also very very refreshed.