The Importance of Sleep

The importance of a good night's sleep can't be overstated. We need sleep like we need air and water. Some of our modern American torture techniques include sleep deprivation, which when prolonged can lead to hallucinations and irritability. According to a recent study, night-shift workers have an increased incidence of cancer, possibly due to the disruption of the natural sleep cycle.

The pineal gland secretes melatonin, which is thought to play an important role in regulating sleep cycles. The Chinese medicine explanation for sleep involves blood circulation, the Heart and the Liver. During the day the 神 Shen, or spirit, resides in the Heart, giving us the spark of life that connects us to the outside world. At night the Liver is said to "store the blood", and the Shen goes with the blood to the Liver.

Insomnia can be due to a number of factors, including stress, constitutional deficiency, overeating or eating too close to bedtime. In TCM diagnosis this may correspond to Liver Qi Stagnation, Liver or Heart Fire, Liver Blood Deficiency, or Food Stagnation.

Another cause of poor sleep could be sleep apnea. If the soft tissue in the rear of the throat collapses and closes during sleep, your breathing will be obstructed, there could be very loud snoring, and you won't get adequate oxygen. In this case you may need a continuous positive airway pressure (CPAP) machine, which covers your mouth and nose at night and helps to keep your airways open. While not an ideal solution for the long-term, a CPAP machine can greatly improve the quality of your sleep. To determine if you need a CPAP machine, you may need to stay overnight at a sleep center, where they will observe you while you sleep.

Insomnia is one of the things that acupuncture and Chinese medicine are most effective at treating. If you have occasional or chronic insomnia, go see your local acupuncturist.

Also on the web:
Daytime Lullaby by Verlyn Klinkenborg in the New York Times
Sleep-deprivation.com
Effect of sleep deprivation on driving

People Are Talking About Chinese Herbs on Twitter

Take a look as someone tries to convince a friend to try Chinese medicine.

• technex: @Jools_jti Ouch dude, that sucks :( Hope you feel better soon.
  
  
• Jools_jti: @technex cheers, it's that or die trying :|
  
  
• technex: @Jools_jti If the NHS is gonna take forever try some alternatives like chinese herbal medicine, I've had really good results from that.
  
  
• Jools_jti: @technex Already taken 7weeks, if I cant see specialist this week, am walking into casualty. Its a strong antibiotic job, ginseng wont do :)
  
  
• technex: @Jools_jti I had a really bad skin infection and chinese herbs cleared it right up when conventional meds wouldn't, don't write it off.
  
  
• Jools_jti: @technex Was only joking, I have been using Manuka honey with better results than anything prescribed to date. However its now quite serious
  
  
• technex: @Jools_jti It's worth a visit to a good chinese herbal doctor, they have real diagnostic skill. But yeah, casualty might be a good backup.

This is so interesting to me because it follows the format of many conversations I have had and overheard about Chinese medicine. Someone complains of a health problem, you recommend Chinese medicine, there's a flip blow-off ("ginseng won't do") and an earnest rejoinder ("they have real diagnostic skill") and then...? It all depends. Keep having those conversations! And do good work - if you get results that's all anyone cares about.

You can follow us on Twitter too.

Swine Flu, Concerned Parents, Western Medicine and Chinese Medicine

Yesterday I got an email from my dad. I've been sick for the past few weeks, but what with finals and the end of school, I only got serious about treating it last Friday, when I went to see Dr. Yuhong Chen at the Yosan clinic (scroll down to read her bio). I had two acupuncture treatments and she wrote a kick-ass herbal formula, and five days later I'm back to 100%.

My main symptom was sore throat, persisting for three weeks, plus fatigue, and at various points during that four weeks I had body aches, slight fever, night sweats, thick sticky green phlegm streaked with blood, thin white phlegm, and probably something else too. It sounds bad when I write it all out, but it didn't bother me too much. All those symptoms didn't occur at the same time, and when they did occur they only lasted a day or so. The only thing that persisted was the sore throat.

In a phone conversation last weekend, my dad suggested that I go get a throat culture and, if it turned out to be strep throat, take antibiotics. I told him that I was fairly sure it wasn't strep, and even if it was, I'd rather take Chinese medicine. Like many Americans, I don't have health insurance, and my last trip to the ER cost me nearly $1000.

Then the swine flu media panic got out of control over the weekend, and I had the email exchange reproduced below with my dad. I guess I was a little defensive about Chinese medicine - after all, I just spent four years studying this completely different, completely effective system of medicine, and now my dad wants me to take antibiotics and Tamiflu? Sheesh.

But I think it's instructive about the way a lot of people feel about Chinese medicine - that's it's good for mild symptoms, but if it's "something serious," then you absolutely have to "go see a doctor," which means an M.D. The fact is, Chinese medicine can treat everything. Let me say that again: Chinese medicine can treat everything.

And now, without further ado...

>>>>>>>>>>>>>>>>>>>>>>>>>>>
11:54 AM (22 hours ago)
(My Dad)
to me

Hey Jonah,

Not sure if your symptoms fit this profile, but if they’re in the ballpark I would urge you to go to a clinic or even a hospital ER somewhere to get a test. This has public health implications – the only way the CDC can track what’s happening is by monitoring test results – but more important the health networks are well stocked with anti-virals (tamiflu and another one whose name I forget) that so far have been effective if the result turns out positive. So no need to panic, but also no reason not to be proactive. From the news reports it looks as if this could get serious down the line. As you have probably been reading, the group most at risk from this outbreak are healthy young adults in the 20-40 age range.

Love,

Dad



From: Lisa
Sent: Sunday, April 26, 2009 7:29 PM
Subject: IMPORTANT UPDATE! Swine Influenza Outbreak.
Importance: High

Fellow Employees:

The World Health Organization (WHO) and Center for Disease Control (CDC) have confirmed an outbreak of the Swine Influenza A/H1N1 (swine flu) in Mexico with now twenty (20) confirmed cases in the United States. Swine Influenza is a respiratory disease found in pigs caused by type A influenza that regularly causes outbreaks of influenza among pigs. CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Your health and the health of your family is greatly important. Please take some general precautions during this time.

Since influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people, there are many things you can to do preventing getting and spreading influenza:

Everyday actions:

· Cover coughs and sneezes with tissues or by coughing into the inside of the elbow. Throw the tissue in the trash after you use it.

· Wash your hands often with soap and water for 20 seconds, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

· Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

· Limit close contact (within 6 feet) with others when possible.

· Stay away from places where there are large groups of people.

· If you get sick, CDC recommends that you stay home from work and limit contact with others to keep from infecting them.

All offices remain open at this time. However, we would like to recommend that business travel to/from Mexico be delayed/re-scheduled. In lieu of travel, please consider conducting conference calls and/or video conferences.

The following link is the CDC’s Q&A which provides the detail regarding when to contact your health care provider, especially for children or someone with pre-existing health issues. http://www.cdc.gov/swineflu/swineflu_you.htm

We will continue to send you updates on any important information as it becomes available. Please contact your HRBP or the Benefits Team if you have any other questions or concerns.

Regards,

Lisa
Vice President, Human Resources

--------------------------------------------------
1:23 PM (21 hours ago)
Jonah Ewell
to (My Dad)

Hey Dad,

I appreciate your concern! But I'm getting much better. Chinese medicine is much much more effective for any kind of influenza than drugs. When SARS broke out in China, they used herbal medicine. If Chinese medicine were in wider use in the Americas, swine flu would be much easier to contain. Obviously, to treat the root of the problem you need to stop having factory farming and crowding huge amounts of pigs together, which concentrates effluvia (aka pigshit!) and breeds disease. Until that happens, Chinese medicine, handwashing, and rest are the best way to recover from a flu.

I'm currently taking a Chinese herbal prescription which consists of 15 herbs. Some of the key herbs, such as 茵陳蒿 Yin Chen Hao (a type of artemisiae) and 山豆根 Shan Dou Gen (a type of sophora root) have been proven in laboratory testing to have broad-spectrum antiviral and antibacterial actions. No need to worry, Chinese medicine is on the case!

love,
Jonah
------------------------------------------------

1:53 PM (20 hours ago)
(My Dad)
to me

OK, sounds good. But do you know whether you have the particular virus that’s in the news?

Love,

Dad

---------------------------------------------------------

2:35 PM (19 hours ago)
Jonah Ewell
to (My Dad)

In the framework of Chinese medicine, it's unimportant what exact microbe or virus is causing you problems. Western science and medicine is reductionist, always looking for that ONE THING that they can point to and say is the cause of illness. When you find the exact bacteria or virus, all you have to do is kill it, or remove it, or block it, or any of the other things Western medicine does. This is a relatively recent development, hinging on the invention of advanced microscopes. Thanks to these instruments, we have made incredible advances in being able to look at and detect these small microbes and viruses, which has helped the world deal with serious health problems. However, as we are seeing, looking for the one microbe and trying to eliminate it is a textbook case of missing the forest for the trees.

What causes disease? Why do some people get sick and others don't? If the swine flu was really so contagious, why haven't more people become sick and died? According to what I've heard on the radio and read in the newspapers, less than 10% of people with swine flu have died. Over 90% recover. Think of fruit in a basket. If you leave it for awhile, you might find that one piece of fruit has mold on it. Another piece of fruit, sitting right next to it and even touching it, cheek-by-jowl, is unaffected. Why is that?

Louis Pasteur, the father of modern bacteria studies (the process of pasteurization was named for him) was said to have renounced bacteria-based medicine on his deathbed, saying "Terrain is everything." Terrain means our bodies, our immune system, our environment. If you have a strong immune system (what the Chinese call 卫气 wei qi, or defensive qi) without underlying deficiencies, and live in harmony with your environment, you will not become sick.

Chinese medicine has, over the course of 2000-3000 years of recorded history, developed a number of powerful diagnostic systems that, properly applied, can cure nearly everything. Modern medicine has a place, and it adds to the world's knowledge. But it doesn't replace Chinese medicine.

Chinese medicine looks at the totality of a person and treats the person, not the disease. The herbal formula I'm taking was written exactly for me, taking into account all my body systems, my constitution and my presenting symptoms. This is what good medicine is. Simply telling millions of people, young, old, tall, short, skinny, fat, to go dose themselves with Tamiflu is ridiculous.

If you have an epidemic situation, in Chinese medicine it falls under the general classification of 温病 wen bing, or warm disease. There are many subcategories within it, but one of note is called 杂气 za qi, or miscellaneous qi. This is a type of qi that arises under special circumstances and is outside the realm of the ordinary system of Chinese medicine, which holds that there are six types of exogenous pathogens. This seventh type of qi was discussed by 吴有性 Dr. Wu Youxing in his work the 温疫论 Wen Yi Lun in 1642 A.D., many centuries after the main classics of Chinese medicine were written but two centuries before Dr. Pasteur made his discoveries in the area of germ theory.

In other words... don't worry!

love,
Jonah

--------------------------------------------------

6:05 PM (16 hours ago)
(My Dad)
to me

In principle I can see your point, but the 1918 flu pandemic killed millions of people in a single year before it ran its course, and the treatments that have been developed since then to combat viruses of this type are pretty specific and pretty effective once the agent has been identified. Not sure of the details, but I think that anti-virals are different from antibiotics, which are less specific and also ineffective against viruses. Also, according to the NYT article on it yesterday, what makes this particular virus so deadly is not so much what it does directly as the immune reaction that it triggers, literally drowning the patient as the body tries to activate its natural defenses to meet a perceived but not well understood threat. Viruses (which are basically small free-floating pieces of genetic code) are tricky, and developing an effective anti-viral agent on the molecular level seems mostly to be a matter of strategy. So maybe the most appropriate medical text for this kind of threat would be the Sunzi…

Anyway, my 2 cents for what it’s worth.

Love,

Dad

-------------------------------------------------------

10:03 PM (12 hours ago)
Jonah Ewell
to (My Dad)

Sunzi is used as a medical text, but antiviral medications are a far cry from the wisdom of Sunzi. One of Sunzi's basic tenets is to follow the laws of Heaven and Earth. In medical terms, that means the exterior and the interior, the environment and the body. Viruses are highly adaptable, which is why getting a flu shot is such a crap shoot. They have to guess which flu strain is going to go around, and a lot of times they get it wrong, so all these old folks are immunized against something which poses no threat, and they have no defense against the flu strain that actually does come around.

They would be far, far better off to do the basics: light exercise daily, eat foods in accordance with the seasons, and have a stable emotional life. Add handwashing, proper clothing for the weather, and there's your natural flu vaccine. It's easy to tune out because it's so basic. The basics are hard! Huaching Ni says that having a normal life is actually quite difficult, and that few people ever achieve it. Instead of focusing on the basics, everyone's looking for the magic pill or injection which is going to allow them to continue with their bad habits.

The CDC is doing their job by telling people to wash their hands (http://www.cdc.gov/swineflu/), but that doesn't get picked up by the media. Everyone's looking for a vaccine or treatment. As the Neijing says, treating an illness after it has started is like digging a well when you get thirsty, or forging weapons after the battle has begun.

There is an "attacking school" or "detoxification school" of Chinese medicine that concentrates on using harsh, bitter, cold herbs to drive pathogens from the body (攻邪学派 Gong Xie Xue Pai). It's one of the four famous schools of medical thought from the Jin-Yuan period. Most modern western medicine can be thought of as an extreme example of the attacking school. Antibiotics, antivirals, chemotherapy, radiation, are all very effective if used correctly (big if) but they absolutely destroy your body and leave it open to further attack. This mode of thought is just one of many overlapping theories that are used concurrently in Chinese medicine, and certainly not a dominant one.

love,
Jonah

-----------------------------------------------------
10:34 PM (11 hours ago)
Jonah Ewell
to (My Dad)

You're correct in that strategy is important, but if the only time you apply strategy is in a quest to find the best anti-viral medication, that's a misapplication of strategy. Everyone is looking through the microscope, which is fine, but if the virus is underneath a microscope that means it's not in a human body. At the same time as you bend over the microscope, you also have to step back and look at what's going on in a real live sick person, and then step back again to look at where that person lives, the state of the environment in which he or she lives, and all the people around them, sick or not. The strength of Chinese medicine is that we deal with living systems in their natural environments.

Modern machinery is great - who wouldn't want an MRI machine to peer inside the body? - but it doesn't replace the basics of the four examinations - palpation, listening/smelling, observation, and questioning. When you add blood tests, X-rays and scopes to that, you have a some very powerful diagnostic tools. If you rely too much on the machines and lab reports, as many modern doctors tend to do, you can very easily be misled. Western medicine, until very recently, made good use of palpation, physical exam, and the verbal investigation to form a complete diagnosis. Nowadays, it's just testing. Some of my patients in the clinic get sent for test after test after test. Some of these tests are very invasive, and at the end of it the doctors say, "we can't find anything wrong. It must be psychological." Well, they're looking in the wrong place, with the wrong tools, and the wrong mindset.

Balance Point Healing Center Blog: Herbs and Herbs

Take a look at this blog by Susan Hammett, Licensed Acupuncturist in Dallas, Texas. Her most recent post covers the important topic of self-medication with herbs and why it often doesn't work, or works less well than it should.

My patients are always explaining to me that they are already taking herbs for their health conditions. I, like Dr. Phil have to ask them; and so how's that working for ya? Usually the response is well, not so good. The problem I explain to them is not with the herb itself the problem lies in matching the herb to the correct diagnosis, therein lies the rub. Many people read about how one particular herb is good for their condition or they find a pre-made formula good for a particular condition. This is indeed a noble quest by the patient but one fraught with many an unforeseen obstacle.

Read the whole entry here...

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.

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.

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.

Community Style Acupuncture

Community acupuncture is springing up all over the place. This practice model uses a sliding scale, usually $15-$45 a treatment, which allows patients to come more often. Acupuncture works best when more treatments are done in less time - 12 treatments over two weeks are usually much more effective than 12 treatments over 12 weeks.

Here's a link to a story from upstate New York.

There is no standard practice model for acupuncture and Chinese medicine. It's a young field and prices are all over the map. Some insurance covers acupuncture, some doesn't. Some acupuncturists accept insurance, some don't. Chinese medicine is not fully integrated into the mainstream health care system, and might never be. But as someone about to graduate from a 4-year TCM school, I've noticed that most acupuncturists in private practice charge between $65 and $150 per treatment.

Community style acupuncture uses a group treatment room and mostly chair acupuncture to reduce overhead. With a group treatment room, more people can be treated at one time. Having to maintain a private room for each patient reduces the number of patients one can see in any given time period.

The people who popularized community-style acupuncture, Working Class Acupuncture in Portland, bring a very stridently socialist outlook to their practice. For more, take a look at this blog entry by Lisa Rohleder, entitled "A Guide to Understanding CAN's Anger, for Any Member of the Acu-Establishment."

There are some valid points in the article, for instance:

• No one is going to hire you to be an acupuncturist. There are very few salaried jobs available to people fresh out of acupuncture school. It's an entrepreneurial profession, and will likely remain so for quite a while. (President Obama might bring substantial change to American health care - if so, I hope Chinese medicine is integrated on a wide scale so that more people can benefit.) But I knew that when I started school, as did nearly all of my classmates. I can't imagine that anyone was seduced into Chinese medicine school and then was shocked (shocked!) to discover upon graduation that they had to start their own practice.
  
  
• Chinese medicine school is expensive. Typical costs are about $65,000 over four years, not including living expenses.
  
  
• Acupuncture works best when people get more frequent treatments. True! Bob Flaws wrote a great article on this called Acupuncture and the 50-Minute Hour.
  
  
• Acupuncture should be available to people of all income levels. This is, obviously, impossible to disagree with without looking like some sort of monster. No one will say that only rich people deserve acupuncture.

I dislike the whiny tone of this article and the setting up of acupuncture schools, the NCCAOM, ACAOM and others as "the acu-establishment" that needs to be struggled against (e.g. "The heads of the larger schools and of the NCCAOM make six-figure salaries." Horrors! No one should make that much!). I grew up in Berkeley and have seen these tactics used by people with left-leaning political views nearly all of my life. Perhaps they don't realize that by indulging in this kind of "otherization," they are fostering further division and creating more problems than they solve.

I give the Community Acupuncture Network kudos for all the work they have done. Most people just whine and let it be. The people of Working Class Acupuncture have done a wonderful job of setting up a practice model that new acupuncturists can use to make a reliable income and at the same time, help so many people with their health problems. A friend graduated from acupuncture school last year and started out with the standard model, renting a room once a week from another acupuncturist, seeing three or four patients a week, trying hard to get the word out. Our online chats filled me with dread: "I'm so bored," she would say. "I'm so lonely." Is this what would happen to me when I graduated?

Then she joined a community-style acupuncture group. All of a sudden she was seeing twenty patients a day and making almost enough money to quit her "day job" that she'd had all throughout school. In addition to financial benefits, seeing so many patients gives you an incredible amount of experience. In the clinical portion of our school education, we see one patient an hour (the exception being externships, where students often work at low-cost or free clinics and see many more patients). Seeing four patients an hour forces you to make good, fast diagnoses, and the low cost means you get to see the patient the next day and the next day and adjust their treatment as the condition progresses. This is priceless.

I do take issue with one particular point: Acupuncture is easy and we should have less training. Wha-a-a?? In Lisa Rohleder's own words:

the disconnection between how simple acupuncture actually is, and how much we paid to learn it. Acupuncture and herbs are not the same thing. You can get excellent clinical results with acupuncture with a minimum of training in Chinese medical theory. After a little time working with real patients in the real world, most of us come to the conclusion that we could have learned what we needed to know about acupuncture, in order to help most people, in eighteen months of schooling, tops. Most of what we spent armloads of money to learn has no direct (or even indirect) usefulness to our patients. That curricula are designed and accredited in this way suggest to us that what patients need does not interest you.

Now, I haven't treated any "real patients in the real world" yet so maybe I'll be changing my tune after the licensing exam later this year, but really... eighteen months? Yes, sticking a needle in someone and getting the qi is a skill that can be learnt relatively quickly. But that's not all there is to acupuncture. Like tai ji, acupuncture is easy to learn but difficult to master. Any argument for less training seem counter-intuitive.

Acupuncture is also not all there is to Chinese medicine. The process of Chinese medicine starts with diagnosis. If you get the diagnosis wrong, your treatment will be wrong. I don't think you can make the case that TCM diagnosis can be learned in eighteen months with a straight face.

Rohleder does bring up an important point: the disconnect between acupuncture and herbal education. In China, acupuncture and moxibustion are a separate department of medicine. Many TCM doctors who were trained in China, including many of our professors and clinic supervisors, think that acupuncture is inferior to herbal therapy. Our education in TCM school reflects these ideas. I don't necessarily think one type of therapy is better than the other (in fact, I think exercise and a healthy emotional life is the best medicine of all), but this is how it is. Your effectiveness as an acupuncturist certainly isn't stunted by learning about herbal medicine.

There is already a short training course available which certifies one to do acupuncture after only 300 hours of training. You just have to be an M.D. first.

Read this Face

Anyone care to analyze Alex Rodriguez's face from the perspective of Chinese medicine?

This story in the NY Times asks some body-language experts their opinions on Alex Rodriguez in his 2007 interview with Katie Couric, where he denies ever using steroids. Now that we know that was a lie, it's easy to try and analyze his body language.

This type of body language reading is a bit different than the face-reading Nini posted about earlier. It seems to be a more scientific version of "Look at the way Brad is leaning away from Angie in this photo. They are clearly headed for a breakup."

Book Review: The Face Reader

I highly recommend Patrician McCarthy's The Face Reader for anyone interested in what our faces say about our innate gifts and misgivings. It is a very quick read, especially if you already have an understanding of Chinese medical theory, but is also easy enough to follow if you don't. The book includes a summary of personalities based on the five elements, with a full-color insert of each of the types of faces and combinations of those types. It has pictures and descriptions throughout, highlighting the major differences between facial features. My only criticism of the book would be that it is too short!

A really fun thing about the book is that a handful of the models are former Yo San students. Patrician McCarthy used to teach a course on Mien Shiang here at Yo San, but now does lectures and seminars all over. It's too bad I missed it; the class had been described to me as "life-changing."

Here are excerpts from the book that describe some of my features:

The little wispy hairs that some people have along their hairline are what I call the Veil of Tears. Those delicate hairs act as a veil, hiding the true shape of the hairline, just as these people hide their true feelings when they are hurt.

A rounded nose belongs to the material girls or boys. They are not greedy, but they appreciate things of quality. They would rather go without than put up with an inferior substitute.

If you love good-quality food and drink, you most likely have a gourmand's nose, one with a fleshy tip. If you don't have one yourself, these are the people to dine with.

Chinese Herbal Medicine for the Common Cold

This article was written by Eric Martin, a licensed acupuncturist at Bastyr University. It's a concise introduction to the idea of the common cold from the point of view of Chinese medicine.

Traditional Chinese medicine has been refining its treatment of the common cold for more than 2,000 years. In Chinese medicine, symptoms of a cold -- headache, chills, fever, cough, runny nose -- are said to be caused by wind and cold, or wind and heat, that "invade" from the exterior and cause illness.

Read the whole article here.

Acupuncture vs. Chiropractic - WHO WILL WIN THE BLOODY BATTLE???

Yes, that's a rather dramatic title. I hope you'll take it for what it is - a light-hearted poke at the way some people view the medical profession in the United States.

With a few notable exceptions, almost every chiropractor I have ever met has a huge chip on his shoulder. He feels disrespected by M.D.s. He feels put-upon. He feels like the AMA is trying to put him out of business. Not without reason: just take a look at these articles on the epic battles waged over chiropractic scope of practice in California. Doctors don't want them to be able to give a diagnosis. Physical therapists don't want them to be able to do physical therapy. Acupuncturists don't want them to be able to do acupuncture.

Part of the problem is that chiropractors don't have a separate system of diagnosis in the way that Traditional Chinese Medicine (TCM) does. Doctors have no reason to feel threatened by someone who says their patient has Liver Qi Stagnation or Kidney Yin Deficiency - they have no idea what that is, so they can shrug it off.

But chiropractors, for whatever reason, seem to be squarely in the targets of the medical profession. Maybe it's because they are much more likely to act like what most people think of as "doctors" - they wear white coats, order X-rays and lab reports, bill insurance at a higher rate and much more frequently than acupuncturists. Also, they get to use the title of "doctor".

So, with all that in mind, I wasn't really surprised to see an article like this one surface on the internet. The author, John Amaro, wants chiropractors to be able to use acupuncture in their practice. The article is more than 10 years old now, but take the measure of the language used:

A Warning to All States That Do Not Currently Include Acupuncture into Your Practice Act. Do it now. Time is of the essence. The acupuncture profession is dedicated and is quickly becoming a major thorn in the side of chiropractic nationally. As acupuncture becomes more and more a generally accepted therapy, it is of the utmost importance we incorporate it into our practice rights. Currently, more than 60% of the chiropractic state boards in the United States regulate the practice of acupuncture.

The article begins by throwing out a bunch of statistics about how miserable acupuncturists are at running their practices, how they're all a bunch of part-timers who don't bill insurance and make less than $30k a year. Amaro doesn't make any citations, just says it's from a study that "came across my desk." Then he amps it up even more with this:

As acupuncturists aggressively seek licensure in all states, we are now seeing the brick throwing, mud-slinging tactics of this new profession to discredit those DCs who have added acupuncture to their practice through state board regulated graduate school. Please remember, acupuncturists: DCs who have added acupuncture to their armamentarium do not have to retake anatomy, physiology and the multitude of basic science courses required in the acupuncture college. They have already done that! It is not necessary for us to sit in a college for 2,400 hours for the express purpose of retaking classes we have already been examined in by the national and state boards. Also understand that all acupuncture is not traditional Chinese medicine (TCM); there are numerous styles of acupuncture, just as there are different martial arts forms and chiropractic techniques.

The practice statistics for doctors of chiropractic are much more impressive than the ones we have just examined. I can only sense a severe case of sour grapes emanating from the acupuncturists who currently are doing everything they can politically and legislatively from allowing DCs to include acupuncture into their practice act.

John Amaro is an interesting cat. If you take a look at his biography, he's been studying acupuncture since before it was legal in the U.S. He writes a column for Acupuncture Today. So why would he throw bombs like this? I imagine it's just reflex, the habitual defensiveness that so many chiropractors fall into.

The reality is, there are plenty of patients for everyone. Let's not waste time by scrabbling over who gets to do what. I haven't yet made up my mind about who should be able to practice acupuncture. Is it wrong for chiropractors to be able to do acupuncture after 100 or 300 hours of training? To be honest, I'd love to be able to take a 300-hour course on chiropractic adjustments and then be certified to carry them out. I feel confident that after 300 hours I could perform an adjustment safely. Would I be a master? No. Would I understand chiropractic in the same way that a chiropractor does? No. But I would be able to help patients in a way that I can't do now.

Let's not even mention that ANYONE can prescribe Chinese herbs with absolutely no training whatsoever. That's a topic for another day.

Also:

Medical Acupuncture Facts
Medical Acupuncture Facts group on Facebook

Xiao Ke - Lower

Lower Xiao Ke falls under the pattern Kidney Yin Depletion. Typical symptoms include frequent urination, copious turbid milky urine, dry mouth and lips, thirst, high fluid intake, weak aching lower back and knees, dizziness and vertigo, blurred vision and red cheeks. The tongue is small and red with little coating, the pulse is deep, rapid and thready. The treatment method is to nourish kidney yin.

The prescription for this pattern is the famous Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill).
Shu Di Huang 24g (prepared rehmannia)
Shan Zhu Yu 12g (cornus fruit)
Shan Yao 12g (dioscorea root)
Ze Xie 9g (alisma)
Mu Dan Pi 9g (moutan)
Fu Ling 9g (poria)

This prescription is easily modified for many different presentations. For deficiency heat, Huang Bai (phellodendron) and Zhi Mu (anemarrhenae) are added. For eye irritation, add Gou Qi Zi (goji) and Ju Hua (chrysanthemum).

Xiao Ke - Middle

The second basic pattern for Xiao Ke is Stomach Fire. People with this pattern diagnosis often have ravenous hunger with high food intake, dry stools or constipation and thirst. You might often get the feeling "if I don't eat soon I'll die!" The tongue has a yellow coating and the pulse is slippery and forceful. The treatment method is to clear the stomach, drain fire, nourish yin and generate liquid.

Prescription: Yu Nu Jian (Jade Lady Brew)
Shi Gao 30g (gypsum)
Shu Di Huang 15g (prepared rehmannia)
Mai Men Dong 12g (ophiopogon)
Zhi Mu 9g (anemarrhena)
Niu Xi 9g (achyranthis)
Huang Lian 6g (coptis)
Zhi Zi 9g (gardenia)

As we noted last week, this is only a basic pattern. Often patterns are combined and there are many different ways of treating Xiao Ke. Only a qualified TCM practitioner is eligible to diagnose and treat with Chinese herbs.

Xiao Ke Continued

Xiao Ke is divided into three basic patterns: upper, middle and lower. Upper Xiao Ke has excessive thirst as the most prominent symptom, while middle Xiao Ke has excessive hunger, and lower Xiao Ke has excessive urination. In clinical practice these patterns are often mixed together. Today we'll cover upper Xiao Ke.

As we noted yesterday, a TCM disease diagnosis is accompanied by a TCM pattern diagnosis. For the disease Xiao Ke, the pattern diagnosis of Lung Heat with Injury to Fluids is given when excessive thirst predominates.

The clinical signs are excess thirst, high fluid intake and dry mouth, along with frequent urination and excess hunger. The pulse is rapid, the tongue has a dry red tip with a thin yellow coating. The treatment method is to clear heat, moisten the lung, generate fluid and relive thirst.

Prescription: Xiao Ke Fang (Wasting Thirst Formula)
Tian Hua Fen 15g (trichosanthes)
Huang Lian 6g (coptis)
Sheng Di Huang 15g (rehmannia)
Sheng Jiang 3g (fresh ginger)
Xian Ou Zhi 50cc (fresh lotus root juice, stirred in)
Feng Mi 20g (honey)
Ren Ru Zhi 50cc (human or cow's milk, stirred in)
Ge Gen 15g (pueraria)
Mai Men Dong 12g (ophiopogon)

These ingredients are cooked together (except the lotus root juice and the milk) in water for about 30 minutes. After they are done, the other ingredients are added and stirred in.

This prescription was taken from Practical Therapeutics of Traditional Chinese Medicine, by Yan Wu and Warren Fischer.

Xiao Ke: Wasting and Thirsting

Modern TCM (Traditional Chinese Medicine) has a useful system of integrating with Western germ-based biomedicine. In our textbooks, diseases are categorized in two ways: by Chinese disease name and Western disease name. Under the Western disease name, it breaks down all the different Chinese diseases it could be, and then further divides it into Chinese medicine pattern, which we'll come back to.

This is most revealing when looking at something like hypertension. "Hypertension" is a Western disease term defined by a relatively arbitrary number system. Systolic pressure under 140 used to be considered normal, but now the definition is under 125, meaning anyone with systolic pressure between 126 and 139 is all of a sudden considered to have high blood pressure.

Classical Chinese medicine (and most other systems of medicine up to a few hundred years ago, from Roman and Greek to Ayurveda and Umami) uses the doctor's powers of observation as the tools of diagnosis. Modern TCM takes full advantage of advances in equipment, while still taking as primary the doctor's observation, including subjective pulse-quality readings and observations of the patient's tongue color, shape and coating.

This means that "hypertension" can fall under a few different TCM disease names, including such terms translated from the Chinese as "dizziness" "headaches" and so on.

In the case of diabetes, there is a fairly direct correlation between the Chinese term xiao ke, which translates as "wasting and thirsting" and the modern disease name "diabetes." However, the test for diabetes is based on two fasting blood sugars of 126 or more on consecutive days. This means that people who do not test with those numbers aren't considered to have diabetes, even if they have all the other clinical signs of diabetes (although there is a newer category called "pre-diabetic" which may be useful, if not a little depressing). This addiction to numbers-based medicine ties the hands of many good Western doctors, or at the very least may make them hesitant to prescribe treatment for someone who doesn't actually "have diabetes."

TCM diagnosis has a big advantage in this area, because the blood sugar level becomes just another useful tool with which to assess a patient's condition, rather than the be-all end-all of treatment.

To summarize: most diabetics have some sort of xiao ke, but not everyone diagnosed with xiao ke has diabetes as defined by the blood sugar level test. Tomorrow we'll go over the different kinds of xiao ke.

Chinese Face Reading

As we mentioned the other day, Chinese medicine uses external signs to get a picture of what's going on inside the body. Without MRIs or X-rays, a skilled Chinese medicine practitioner can tell you accurately the general condition of your internal organs and the specific pathological mechanisms taking place that need fixing.

Of course, now that magnetic resonance imaging and radiology have developed, we don't ignore them. They are very useful tools, but the drawback is the time and expense involved in obtaining results. X-rays are harmful to your cellular structure and therefore should be avoided unless necessary (why do you think you wear a lead gown when you get one?). MRI machines fill entire rooms!

One fast and inexpensive way to diagnose a person is to look at their face. In general, we look at three things: color, overall shape, and finally individual facial structures such as the nose or the forehead.

For more about Chinese reading, take a look at Patrician McCarthy's website. For a TCM-style analysis of Barack Obama, Sarah Palin, Joe Biden and yes, John McCain, take a look at this piece from the Huffington Post.