Qi Spot

I don’t normally just cut and paste blog entries here in my own blog, but this article is too good for me not to quote and is so self-explanatory that I can’t really comment on it further except to say, “yeah, that’s right.”  I’ll just highlight some goodies.

The Science of Traditional Chinese Medicine: How Does it Really Work? <http://www.cityweekend.com.cn/shanghai/articles/blogs-shanghai/cw-radar/the-science-of-traditional-chinese-medicine-how-does-it-all-really-work>  by Trista Baldwin, posted by Andrea Wong (yeah I’m a bit confused…) posted and accessed 11/19/2009

Relegated to the realm of alternative medicine in the West, TCM is often viewed as a system based more on ancient superstition than science. Trying to understand TCM from the viewpoint of 20th century science is akin to trying to decipher Old English without a modern translation. There is a methodical approach at work; it’s just difficult to understand.

Couched in the ancient language and philosophy of the time, with references to qi, the five elements and yin and yang, that approach is often misinterpreted as being overly philosophical. However, the applications are actually quite practical. Qi refers to a physiological process; yin and yang to balance. The five elements (wu xing) are in fact a system used to describe the interactions and relationships that connect the various systems in the body to each other and to the environment–the flow of energy or fluids, for example. These systems are further confused by the Western understanding of anatomy.

When a TCM doctor refers to the Lung, this is not the same as its anatomical counterpart. The Chinese organs are interrelated systems. “An organ has its own qi , and delivers that to another organic system which gets its energy from another system and so forth,” explains Doris Rathgeber, general manager of Body & Soul Medical Clinics. As such, “A cough might actually be related to a problem with the Kidney,” explains Dr. Shao Lei, head of the acupuncture department of Huashan Hospital Fudan University. “This is often hard for patients to understand.”

Western studies on TCM have focused particularly on the workings of acupuncture and herbology, although explanations are not easily forthcoming. Many of the world’s pharmaceuticals come from herbs, but “it’s still hard to measure why the combination of one herb with another herb works,” Rathgeber says. Herbal prescriptions alter according to changes in the patient’s constitution and environment, making herbal remedies harder to test in isolation.

The healing effects of acupuncture, though not fully explained, are strongly linked to the nervous system. Piercing the skin with a needle triggers the sensation of injury. The brain generates an immune response, stimulating the area and strengthening the immune system in one fell prick. “The nervous system is interconnected,” adds Shao. “One point affects another.”

Despite its strengths in preventative and palliative medicine, neither Shao nor Rathgeber believes TCM needs to be practiced in isolation. Acute conditions requiring antibiotics or other Western treatments should not be avoided if necessary. Neither doctor shies from using Western diagnostic tools such as X-rays, MRIs or lab tests to more clearly pin-point the exact cause of a perceived deficiency. “Western medicine is more concerned with exact measurements, whereas TCM focuses on the overall result,” says Shao.

“For me, it’s not important if TCM is proven scientifically,” states Rathgeber, “more that it’s proven to work for the patient.”

Okay, room for ONE comment.  For me, whether it works for my patients or not is most important, but it is also important to prove TCM scientifically.  By not doing so, we are discouraging more MDs from integrating TCM into conventional medicine and thus giving more benefit to patients.

Greg Livingston is a doctor.  He goes to work in a hospital.  He wears a white coat while there.  The difference is, he will feel your pulse and look at your tongue before prescribing herbal medicine.

Greg Livingston is from San Francisco.  He studied Chinese Medicine in the US and in China, before landing a job as a tcm physician in Shanghai.

This story is too heartwarming not to mention: “Expat TCM docs take your pulse” (I think I have a better title anyway) <http://www.shanghaidaily.com/article/?id=419674&type=Feature>

Some significant tidbits with emphasis mine:

…But TCM today has adherents all over the world, and many come to China to study and practice the ancient healing arts.

Some are beginners, with no TCM background, while others have studied TCM in their own countries and seek further training in TCM academies. Some attach themselves as apprentices to TCM masters.

In Shanghai there are around 1,000 overseas students in short-term study and 700 others in long-term study in Shanghai University of TCM. About 100 expats enroll each year.

The city’s three major TCM hospitals – Shuguang, Yueyang and Longhua – each accepts 100-200 oversea interns each year…

I was one! But it was in Nanjing.

One of the successful graduates is Livingston, who has 15 years’ experience in TCM. He earned a master’s degree and then a PhD in TCM from Zhejiang Chinese Medicine University this year. He works as a TCM physician in the internal medicine department of Shanghai East International Medical Center.

Livingston was attracted by TCM’s understanding of human beings and their relationship to the universe.

He graduated from university with a bachelor’s degree in biology in his early 20s. Then he decided to pursue TCM and studied in the United States before coming to China.

Both Western and Chinese medicine are exploring the mysteries of the human body but in completely different ways, says Livingston.

“I like to use the analogy of the body as a forest. Western medicine is down in the forest examining each tree, each leaf and each cell, while Chinese medicine stands up on a mountain nearby, overlooking the whole forest,” he says.

TCM is more interested in the relationship between each part and how they cooperate while Western medicine is more engaged in exploring the micro world and seeing how each cell comprises the world, he says.

Beautiful analogy.

Some people consider TCM unscientific because much of it is impossible to explain through “science,” but Livingston says these skeptics are incorrectly trying to explain TCM through Western medicine rather than broader science.

The fact that qi (life force) and jing luo (qi channel) – the major TCM principles – are invisible leads many people to question or deny the validity of TCM.

Livingston acknowledges that nobody can actually find qi, but he maintains that it does exist – but not in the way most people would think.

“Of course you cannot find it, because qi is not a thing,” says Livingston. “It is just a word to explain certain phenomena, both in the general natural world and in medicine.”

The fact that there is no single word in English to describe these phenomena does not mean that using qi to identify the phenomena is unscientific.

Again, excellent points.  I have often told students that the secret to understanding a complex phenomenon is to clarify definitions.  If we do not define Qi properly (as very few popular science lecturers do) or correct misconceptions (such as “energy” flowing through channels -  it’s Qi and Blood – and we have to define what Blood is in TCM anyway!) then we should not blame people for misunderstanding it and maybe growing to detest not what it is, but what they think it is.

There’s no definite path for qi flow, either, in Livingston’s opinion. Jing luo is just a word to explain very complicated physiological phenomena when stimulation is applied to a certain point on the skin. It may involve the reactions of blood vessels, nerves, immune system and other systems. Though nobody so far can explain how it exactly works, the phenomena exist and do help to treat ailments.

“TCM is a science based on thousands of years of observation of the world and human beings themselves,” says Livingston. And TCM achievements by far predate Western medicine though its practitioners knew nothing about the microscopic and cellular world inside the human body.

Livingston observes: “‘Huangdi Neijing’ (‘Medical Classic of the Yellow Emperor’) says that the food we eat travels through the stomach and reaches the intestines, the ying qi (nutrient qi) is absorbed in the intestines and enters blood vessels to travel together with blood; the blood then travels through the heart and enters the lungs; qing qi (clear qi) is absorbed in the lungs and completes the blood; the blood then enters the heart again and then travels to all the other organs.

“Sound familiar? It is the blood circulation including systemic circulation and pulmonary circulation that everybody knows today, except for the different wording,” says Livingston. Ying qi is actually nutrition while qing qi refers to oxygen.

This description was completed in Chinese around 2,000 years ago, he says, while it was not until 1616 that William Harvey discovered and scientifically proved blood circulation.

Like I said.  Definitions.  And yes, Chinese culture beats western culture to a scientific discovery yet again.  I cringe when I hear that Guttenberg invented printing.

The same article shows the points of view of a south Korean student seeking to integrate east and west:

“Both traditional Korean medicine rooted in TCM and modern Western medicine are widely accepted in my country, yet they are completely separated from each other,” according to Hong.

“A traditional Korean medicine doctor never uses Western methods to diagnose or treat patients, while a Western medicine doctor never applies traditional Korean medicine in any cases, either,” she says.

Witnessing her father’s suffering from chemotherapy for his stomach cancer, Hong decided to search for another way to help people. Without any medical background, she began her TCM study in Shanghai in 1993 as the second group of foreign TCM students in the Shanghai University of TCM.

Here, she found extensive combination of Western and TCM diagnosis and treatments used in modern Chinese medicine.

Both a Western diagnosis and a TCM diagnosis are written on medical cards in TCM hospitals. TCM treatments are widely used to assist in recovering from serious diseases, together with Western medicine.

Hong earned her PhD in 2007 and became a TCM physician of Shanghai Shuguang Hospital affiliated to Shanghai University of TCM after graduation.

Both Western medicine and traditional Chinese medicine have their strengths and shortcomings, according to Hong.

Modern lab tests and X-rays in Western medicine can effectively discover conditions and diseases like inflammation or tumors, but they are less helpful in what TCM calls “sub-healthy” cases.

The traditional diagnostic methods – wang, wen, wen, qie (observation, auscultation (listening)/olfaction, questioning and pulse taking) – are good at identifying chronic ailments and conditions, and even wei bing (likely future diseases/conditions). But they cannot make a definitive diagnose of an organic problem, such as a tumor and organ/blood vessel hardening.

It is also the case with treatments. Western treatments take effects fast but with great side-effects while TCM treatments protects the healthy qi but takes long to expel the pathogenic qi completely.

“You cannot expect to eliminate a tumor by drinking herbal soup,” says Hong, “but surgically removing a tumor from part of an organ and chemotherapy will inevitably damage the immune system and health.”

In such cases, the most widely used method in modern Chinese medicine is to surgically remove a tumor and help patients recover through acupuncture and drinking herbal soup.

“If we can help patients recover sooner while suffering less, I see no reason to oppose the complementary use of Western medicine and TCM,” says Hong.

My take is that Western medicine is like a rapid firing soldier, and Chinese Medicine the guys who maintain order and infrastructure.  I like the “sub-healthy” term though.  A person may not be sick but may not be functioning properly either.

An article in People’s Daily Online claims that the death rate in China from Swine Flu is 1/20th the world rate.  One of the reasons it lists for this is that Traditional Chinese Medicine is very effective for H1N1, among others.

The fatality rate of A/H1N1 carriers is 0.065 percent in China, accounting 1/20 of world’s 1.24 percent average, said Li Lianda, a member of the Chinese Academy of Engineering said on the Cross-Strait Chinese Medicine Development Conference, held in Beijing on Nov. 14-15.

According to the latest data released by the National Health Administration by Nov. 13, 2009, there were 65,927 confirmed A/H1N1 cases in 31 provinces, with 43 deaths. World Health Organization (WHO) said on Nov. 13 that by Nov. 8, 2009, there were over 500,000 A/H1N1 cases worldwide and at least 6,200 people have died.

Everyone already knows my opinions about H1N1 misdiagnoses – anyone found to have H1N1 and dies of whatever reason will be classified as an H1N1 death – but this is still worth examining because it means one of two things: less people who die have H1N1 antibodies and/or less people with H1N1 antibodies die.

Li claimed there are three main reasons contributing to the low fatality rate. First, efficient prevention and control methods help maintain low infection rate in the Chinese mainland. Second, key areas and focused groups were given priority to use the flu vaccine at an early stage, which slowed down its spread. Third, Chinese traditional medicine was very effective in flu control.

Traditional Chinese Medicine: Effective in Flu Control?

Li added that tamilflu was not the best choice for A/H1N1 carriers considering its limitations, including drug resistance, side effects and its high price. On the contrary, Chinese traditional medicine has a noticeable effect; no matter whether patients have light or severe conditions. Chinese traditional therapy has greater effect such as antibacterial, antiviral, pain-relieving, fever-easing and immune system adjusting.

However, Li suggested that China should do more research to bring effective traditional therapy.

I will be very very pleasantly surprised if this article reaches the western press.  But I’m not holding my breath.

Note that the article does not mention any specific formula.  This fits in with the idea that the herbal formula is to be customized for each patient.  Warm Disease Theory (under which H1N1 would fall) classifies disease into four stages.  From early to late, mild to worst, the stages are wei (defensive), qi, ying (nutritive) and blood.  As one can surmise, these stages may be compared to development from acute infection until sepsis.

Each stage even has subcategories, and each has their own recommended formulas.

The great part is that instead of having to go for ludicrously expensive pharmaceuticals, most warm disease theory formulas are made from common ingredients.  These include honeysuckle flower and chrysanthemum.

This is what I love about Chinese herbal medicine, the utter simplicity and beauty of it!

Once again, another study showing that “real” acupuncture is significantly better than “sham” acupuncture.  A single blind, randomized, sham-controlled trial was compared to use of standardized neck exercises aimed at chronic neck pain relief.  Shame on the Associated Press, really.

Certain Media Outlets' Ignorance of the Evidence is a Pain in the Neck

It seems that the Associated Press has gotten down to publishing, not one, but a series of articles proudly proclaiming that “experts” say that the benefits of alternative medicine are due to placebo.  A previous blog entry, “Associated Press Needs New Glasses” 11, Nov 2009, notes that these Associated Press-Big Pharma press releases proclaim that experts say that any beneficial effects of alternative medicine are due to placebo and that most studies that “prove” acupuncture effectivity aren’t worth reading because of lack of comparison of “real” acupuncture to “sham” acupuncture.

Before we cite another article that demolishes the “sham” sham, let’s examine some points (no pun intended) yet again.

Firstly, since it is obvious that alternative treatments do provide relief to patients, the powers-that-be can no longer use the “they don’t work” card.  They grudgingly acknowledge that they do make patients feel better but attribute it to being no better than placebo – or that the patient feels better because they THINK they’ll feel better.  The sheer irony here is that by that logic, we can also claim that western medicine works through placebo also.  Yet, for some reason, people are turning to alternative medicine precisely because western medicine doesn’t seem to work for them and their particular condition.  As my friend Noah Mckenna once told me, “just tell the naysayers that (our) placebo works better than (their) placebo”.

Secondly, since studies are indeed popping up proving that Chinese medicine (my thing) does have biomedical reasons for working, and has been shown to work, the next argument that “they” bring up is to critique the studies.  Among the most common whines are “the studies aren’t blinded”, or my favorite “acupuncture wasn’t compared to sham”.  My replies can be summarized in various previous blog entries.  (This Time, Chinese Herbal Medicine May Have Cure for Diabetes, October 15, 2009).  Sure, everyone has seen that back pain study that said sham acupuncture is the same as real acupuncture, but they have forgotten to note that sticking needles anywhere hypothetically can work because according to meridian theory, every square inch of the body is traversed by meridians and collaterals.  The point of using acupoints is that they are more specific in effect than common locus dolendi points.

But the point of this particular blog article was my finding of yet another article comparing acupuncture treatment (albeit with electrostimulation) vs sham.  Here’s the abstract:

Source: Chan, et al.  “Electrical Stimulation of the Wrist for Chronic Neck Pain: A Randomized, Sham-controlled Trial Using a Wrist-Ankle Acustimulation Device” The Clinical Journal of Pain: May 2009 – Volume 25 – Issue 4 – pp 320-326.  Accessed 15 Nov 2009 <http://journals.lww.com/clinicalpain/Abstract/2009/05000/Electrical_Acustimulation_of_the_Wrist_for_Chronic.10.aspx>

Discussion: Electrical acustimulation of the wrist administered as two, 30 minutes sessions /wk added value to standardized neck exercise for chronic neck pain. A 4-week course of treatment produced effects lasting 1-month posttreatment.

I set up a google alert to inform me of news regarding the topics I’m interested in, which obviously includes material I can use for this blog.  Look at the picture above.  Then hear my roar.

The very first line is from an article by the associated press in their newest obviously-big-pharma-sponsored war against natural medicine.  I’ve already blogged about how Big Pharma can present evidence anyway it wants to (http://qi-spot.com/2009/10/19/evidence-based-medicine/), how it may be rampant with (hopefully) isolated fraud (http://qi-spot.com/2009/10/24/vioxx-and-bextra-studies-allegedly-fabricated/) and others.

Now the Associated Press is starting a “series” or articles critiquing natural medicine.  So… imagine my laughter when I saw my google alert.

First line:

Acupuncture is especially hard to research. Positive studies tend to lack comparison groups that have been given a sham treatment. …

Then the very next line cites a study from Yale.  YALE.  This we’ve covered in the entry ( http://qi-spot.com/2009/10/17/lend-me-your-ears-ear-acupuncture-for-back-pain-in-pregnant-women/)

We quote again:

Ear acupuncture might offer a drug-free way to help ease pain in these women, Wang and colleagues say. They randomly assigned 159 women in the 25th to 38th week of pregnancy to receive real acupuncture, acupuncture delivered to points that would theoretically not affect pain in the pelvic or lower back area, and a control group. Every woman was also instructed to use self-care as needed, including resting, taking acetaminophen, and applying warm and cold compresses. (emphasis mine)

“…would theoretically not affect pain…” sounds like a SHAM to me.

Need I remind you of the result:

All of the 152 women who completed the two-week study reported some degree of pain reduction and improvement in their ability to function. A 30% or greater reduction in pain was reported by 81% of women in the acupuncture group, 59% of women in the sham acupuncture group and 47% of women in the control group. The difference between the sham and control groups wasn’t statistically significant.

In laymen’s terms: fake acupuncture was similar in effect to nothing.  Real acupuncture was better.  I can cite SO MANY MORE STUDIES. Just click on other researches I’ve commented on.  Check out the evidence in other cites such as those in my links.

Didn’t the AP just say “Positive studies tend to lack comparison groups that have been given a sham treatment”?  GET YOUR GLASSES FIXED ASSOCIATED PRESS!!!

Oh wait, they’re weasel wording.  “tend to”… Which means if people like me point out they’re misleading people with their statements they can always weasel their way out by saying “ah but we said ‘tend to’”.

Who’s not being scientific now?

God, there are times where I REALLY love being a western doctor.

And that explosion you heard is my sarcasm meter overloading.