Qi Spot

… but are a bit lacking in their conclusion.  Let me explain.

Their headline is “Acupuncture ‘lessens pain in brain not body’, scientists discover”.

Acupuncture works by making the brain, rather than the body, no longer experience pain, according to new research.

by Andrew Hough (http://www.telegraph.co.uk/health/healthnews/7167362/Acupuncture-lessens-pain-in-brain-not-body-scientists-discover.html)

Scientists who scanned the brains of volunteers as they were given the Chinese therapy found it deactivated pathways that govern pain.

Complementary medicine expert Dr Hugh MacPherson, of the University of York, said: “These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works.”

The findings, published in Brain Research, suggest acupuncture has a significant effect on specific nerve structures.

Dr MacPherson and colleagues explained when a patient receives acupuncture treatment a sensation called deqi can be obtained. Scientific analysis showed this switches off areas within the brain that are associated with the processing of pain.

After reading this, I came to the realization that one reason that people do not understand that it is quite difficult to conduct double blind studies with acupuncture is the fact that they fail to see that acupuncture is more than just sticking needles into points.  The manipulation of the aforementioned needles is important, as they lead to the deqi sensation.  The feeling of deqi (“acquiring qi”) or “needling sensation” can be present upon inserting the needles alone (if done right), or through a bit of manipulation.  These manipulations are very dependent on the manual skill of the practitioner.  Hence, acupuncture should be treated as a PROCEDURE and not a pill.

Electroacupuncture is a supplement to enhance the "de qi"

You can insert the needles on the same points and not have the same effect if one acupuncturist just pricks the skin and the other manipulates them properly according to the specific needs of the patient.  For example I know that some patients are sensitive at LI 4 and only insertion is needed.  At the same time others may need a bit of stroking at the handle of the needle to obtain the deqi.  This knowledge comes from experience both with the points themselves in general and from knowing patients personally.

It's not enough to stick it in. The needles may have to be manipulated to obtain the qi sensation or "de qi"

People sometimes ask me about my opinion regarding the use of cold lasers versus needles for acupuncture.  The first thing I say is that if it isn’t going to involve puncturing the skin, then it shouldn’t be called acu-PUNCTURE.  But we know what is meant by laser acupuncture.  It means using lasers to stimulate acupoints.

I’ve heard a lot of good things about it from my colleagues and patients who’ve tried it.  However, personally, I don’t think it works as well as the real thing.  Why is that?  Well just like in martial arts, you can have many different styles.  Some styles emphasize speed, some emphasize power.  In my acupuncture, my style is meridian style and it also relies a lot on the “needling sensation” or de qi.

This is something that’s hard to explain unless you’ve felt it.  Also, the sensation (if any) is not as pronounced in laser acupuncture.  I prefer the real thing.

This came to mind as I was reading this article:

Laser Acupuncture fails to Ease menopausal woes (http://www.reuters.com/article/idUSTRE61056H20100201)

NEW YORK (Reuters Health) – Women seeking relief of hot flashes and other bothersome symptoms of menopause might want to take a pass on laser acupuncture, based on a new study showing that it is largely ineffective in relieving menopausal symptoms.

Laser acupuncture uses a laser beam instead of the traditional acupuncture needles. The low-power laser beam is directed at the same points used in traditional acupuncture.

Here’s the first “red flag”.  The note that the points are the same as in traditional acupuncture.  Does this mean each patient is diagnosed individually and given a set of points that is tailored to their specific need at the time?  (That’s “traditional”) Or, do we mean a cookbook set of points to be used in any and all patients?

Studies on the ability of traditional acupuncture to cool hot flashes have been mixed and data regarding the effect of laser acupuncture on symptoms of menopause are lacking.

Given my first comment, I’m not surprised if the data is mixed.

To investigate, Dr. Paul A. Komesaroff, at Monash University Department of Medicine in Victoria, Australia and colleagues studied 40 otherwise healthy women 54 years old on average. The women were having about 40 to 50 daily and 20 or so nightly hot flashes a week and other symptoms of menopause, but were not using hormone replacement therapies.

Over 3 months, the women documented their menopause symptoms. During this time, 23 had laser-on and 17 had laser-off (sham) acupuncture to 10 specific body points every 14 days. Neither the women nor the laser operator knew the state of the laser during treatments.

Nice double blind, but I’m still not a fan of lasers except in Star Wars.

By the end of treatment, the women reported no adverse events and very similar symptom improvements, regardless of treatment group, the researchers report in the journal Menopause.

On average, the laser-on and laser-off groups, respectively, reported about 37 and 33 percent fewer daytime and about 30 and 39 percent fewer nighttime hot flashes.

Other menopause symptoms also declined, but detailed analyses of the women’s diaries showed no significant between-group differences in specific symptoms such as mood, energy level, bloating, or sex drive.

The investigators surmise that touching the laser probe to the skin, as occurred in both treatment arms, may explain the similar between-group responses.

Touching the probe to the skin… wouldn’t tui na or acupressure be better?

Based on the current study, Komesaroff and colleagues do not recommend laser acupuncture for relief of menopause symptoms. In this direct comparison of laser-on versus laser-off acupuncture, laser-on treatments were “ineffective in altering menopausal symptoms,” Komesaroff noted in an email to Reuters Health.

Neither would I.  Menopausal symptoms for me are a sign of yin deficiencies, and deficiencies are better treated with herbal formulas.  The logic is thus: if something is deficient, then something has to be added to make up for it.  Acupuncture can work, but not as efficiently as herbs for this.

The researchers suggest further studies of laser acupuncture in menopausal women focus on alternative acupuncture points.

SOURCE: Menopause, published online January 8, 2010

Goji berries ‘help fight skin cancer’ (http://timesofindia.indiatimes.com/life/health-fitness/health/Goji-berries-help-fight-skin-cancer/articleshow/5524176.cms)

Nice to read, right?

At first glance, maybe, but a thorough examination of the article shows why it is such careless headlines such as these that fool the public into buying herbs and using them “off-label”.  Thus, the skeptics and naysayers are justified (apparently).

Let’s look at the article and see just how the wolfberry (aka Goji) does this.  Does it actually help contain the spread of melanoma?  Does it help kill squamous cell carcinoma cells?

In traditional Chinese medicine, the superfruit berry lycium barbarum, also known as wolfberry, has long been recognized for various therapeutic properties based on its antioxidant and immune-boosting effects, reports  The Daily Express  .

Okay, good start.  We’ll expound on wolfberry later.

And now, scientists at University of Sydney have found that liquid containing just five per cent goji berry juice can reduce the inflammatory oedema (fluid retention) of the sunburn reaction in hairless mice.

I can see how this will be useful in burns, scalds or any acute tissue repair.  Let’s get on to cancer!

Where’s the REST of the article?  If you’re going to make claims and headlines like that, better have more data!

The article ends with

But Dr Alison Ross, of Cancer Research UK, said, “This study in mice does not provide evidence that drinking goji berry juice can offer any protection against the skin-damaging effects of excessive sun exposure in people.”

Darned right it doesn’t!  And I’m not being sarcastic!  Where’s the evidence in this study that drinking goji berry juice prevents cancer?!?!?  At least, where’s the LINK to the research in the article?  What’s the study name so I can research it myself?  ARGH!

And what is so special about wolfberry anyway? From tcm.health-info.org: (http://tcm.health-info.org/Herbology.Materia.Medica/gouqizi-properties.htm)

Properties: Sweet, neutral

Enters Liver, Lung and Kidney Meridians

Nourishes Liver and Kidney, Benefits Essence, enriches Yin

Also Used For:

Orally, Gou Qi Zi / lycium is used for diabetes, hypertension, fever, malaria, and cancer. It’s also used for improving circulation, erectile dysfunction, dizziness, and tinnitus. It is used as an eye tonic for blurred vision, macular degeneration, and other ophthalmic disorders. Lycium is also used orally to strengthen muscles and bone, and as a blood, liver, and kidney tonic. It is used orally to reduce fever, sweating, irritability, thirst, nosebleeds, hemoptysis, cough, and wheezing.
In foods, the berries are eaten raw and used in cooking.

Okay I can see how it works but does it justify calling it king of herbs or whatnot?  That’s what most of them herb pusher quacks say.  Oh, and I’m sure you’ve heard about people talking about how goji berry was found in the himalayas and all that.  I couldn’t help but snicker at that.  You see, the truth is that wolfberry isn’t that exotic.  From acupuncture today (http://www.acupuncturetoday.com/herbcentral/lycium_fruit.php) :

Also known as the Chinese wolfberry, lycium comes from a medium-sized bush that is native to east Asia and Europe. In China, the best lycium grows and is cultivated in the Ningzia (sic), Gansu and Qinghai provinces.

A little far from Tibet, eh?  Well okay, Qinghai is beside tibet…

Last time, I talked about how western “herb experts” took Ma Huang (ephedra) and turned it from a sweat inducer and body warming herb into the ultimate weight loss stimulant.  What happened as a consequence of this off-label use?  We all know.  And we ended up with Ma Huang taking a bad rap.  Now “they” are doing it with other herbs.  At least they chose a relatively safer herb like wolfberry (which is, by the way, used everywhere in China for cooking also).  But there is no justice in overhyping it.  It just makes real chinese medicine look bad.

I’m not doubting that these herbs can help cancer patients, but let’s keep the information down to earth and useful, not giving them false hope.  Wolfberry nourishes yin – I can see how it can help mediate chemotherapy side effects, but to come out with headlines like this is just irresponsible, in my not-so-humble opinion.

Much has been made about the non-effect of Ginkgo Biloba on alzheimer’s disease.  Surprisingly for the critics I ‘d have to agree with them.  Gingko Biloba works in Chinese medical theory by increasing blood flow.

In the classical text of “Ben Cao Pin Hui Jing Yao” it states that the characteristics of the leaves of yin xing are bitter sweet, astringent, neutral. and belong to the lung meridian and can control the lungs and calm asthma, calm the mind and arrest pain, rid of water retention and stop diarrhea…

…The main usage of the ginkgo leave extract is in cardiovascular therapy (including dementia caused by circulation dysfunction.)

(http://alternativehealing.org/ginkgo.htm)

So in theory, it should work only in a limited subset of patients with dementia.  It won’t work for most dementia patients, actually.  Personally I find that memory in general is better improved by tonifying Blood through the Kidney or Spleen.

But how did this come to my attention?  This work of art:

Gingko (sic) Biloba and other ‘Natural’ Remedies May Be Dangerous

by Benjamin Radford

http://news.discovery.com/human/gingko-biloba-and-other-natural-remedies-may-be-dangerous.html

I can’t help but smirk at this one.  At the risk of some commenters saying that it’s obvious when something gets under my skin, I have to say that these headline crafters are geniuses.  Radford takes the studies that show Ginkgo biloba isn’t as effective as it is thought to be (which I myself believe, never having prescribed it for dementia and memory problems and instead focusing on diet) and uses it as a springboard.  He mentioned ephedra, which I will comment on later.

In the meantime, what’s my irk?  Firstly, I have to honestly say the headline is true.  Well, I’ll have to be more specific.  Ginkgo Biloba and other natural medicines not only MAY be dangerous, they are DEFINITELY dangerous if not used properly!  I mean, come on, if one believes that a substance is powerful enough to effect changes in physiology so as to create a tangible medical effect, surely it is pure idiocy to believe that it can be taken at uncontrolled doses by just anyone without any adverse reactions!  We do not expect such sheepishness when we take western medicines, why shouldn’t we take the same attitude towards natural herbs?

This is also the fault of unscrupulous marketers who only care about selling their product.  To my commentors, I have to say that yes, news bias irritates me, but one thing that irritates me more is hearing “alternative” healers go about with such bullcrap as “oh it’s natural, there’s no such thing as an overdose, it’s safe.”  Oh please, I’ve seen people get admitted to ICUs for renal failure due to herb overdose.  The worst thing about such real quackery is that it gets real practitioners who only want the best for their patients lumped into the same duck fraternity as the herb pushers.

So why is this headline ticking me off? It’s the intention.  It’s obviously designed to plant suspicion in the minds of readers: God/Mother Nature is a quack.  Natural products “may be” dangerous.  Weasel wording.  You could say the same thing in a different way: “Natural Medicines Must Be Used with Caution” would say the same thing but with obviously different intent.

But on to the article:

According to new study in the Journal of Natural Products “restrictions should be placed on the use of Ginkgo biloba because of growing scientific evidence that Ginkgo may increase the risk of seizures in people with epilepsy and could reduce the effectiveness of anti-seizure drugs.”

Agreed.

Herbal supplements and remedies are not marketed as drugs (note the paragraph of legal fine print on bottles starting with, “This product is not intended to diagnose, treat, cure, or prevent any disease.”) That’s because in many cases the drugs have not been scientifically tested for safety or efficacy. They have not been proven to work in carefully-controlled clinical trials.

Here in the Philippines, they are marketed as “food supplements.”  This is bad, not because the herbs haven’t been tested (some have been, some haven’t, with varying degrees of success/failure), but because such dichotomy will lead the public into polarization.  Either they will join the “all natural, all safe” bandwagon or the “all unscientific” bandwagon.  Neither wagons are worth getting hitched to.

But here comes the kicker:

The herbal supplement industry is a multi-billion dollar business, and has lobbied hard to keep their products from being regulated by the FDA. As a result, the FDA can only step in when something goes wrong, after people have been injured or killed by natural herbs.

That’s just what happened in 2004, when the FDA banned ephedra, an herbal remedy used in traditional Chinese medicine for thousands of years. Millions of consumers took the herb, on the belief that it was natural, safe, and effective. The herb was widely used for treating everything from the common cold to asthma to weight loss. Then the herb was linked to over 100 deaths; healthy people who took ephedra had a wide range of symptoms ranging from insomnia to heart attacks.

Now it seems another natural herbal remedy may pose a hidden danger. All drugs, whether pharmaceutical or “natural,” can have dangerous and unintended side effects. But when people are harmed or killed by an herbal supplement that has never been shown to work in the first place, the situation is all the more tragic.

While it is true that herbal supplements are a big cash cow, I’m not a big fan of the FDA, seeing as they’ve had a tendency to rush approval of drugs (remember bextra?) and are seemingly dominated by Big Pharma.   The story of Ephedra is appropriate for this.

I refer you to this article for more clarity: Safety Issues Affecting Chinese Herbs: The Case of Ma Huang <http://www.itmonline.org/arts/mahuang.htm>

Herba Ephedrae or Ma Huang is usually the first herb one would see in a typical textbook of Chinese herbal medicine.  It is usually used to clear early symptoms of flu, and not ALL kinds of flu.  ANY look at the texts will give SPECIFIC indications for it’s use.  However, western herb enthusiasts had, according to the article, “converted from an herbal treatment for diseases to an energy stimulant and a weight-loss product.”

What are it’s classic textbook uses?

Actions: induces diaphoresis, resolves surface, ventilates the lungs to relieve asthma, regulates water metabolism.

Applications: febrile diseases due to exterior-excess, fever, chillphobia [aversion to cold], anhidrosis [lack of perspiration], ostealgia [bone pain], arthralgia, cough with dyspnea, edema, edema due to wind.

From this, it becomes obvious that Herba ephedrae is meant to be used in actual illness, not in a healthy person just trying to get a kick or lose weight.  The weight loss aspect is gleaned from it’s strong diaphoretic effect.  However, a basic look at any  Chinese herbal textbook will show that administration of ma huang should stop WHEN PERSPIRATION BEGINS, whether or not the flu has dispersed.

Again, if the patient has external symptoms (chills, slight fever, arthralgia, muscle pain) with no sweating, ma huang may be given AS PART OF A FORMULA to mediate effects (see ma huang tang, among others) and should be STOPPED when sweating begins.

Also, it should not be used as a tonic.  Many of the early ma huang/ephedra “supplements” were mixtures of ephedra and other tonics (including caffeine!)  Disaster waiting to happen.

How does that compare with western enthusiasts taking the herb individually for what we MDs would term as “off label use” contrary to all warnings?

OF COURSE they’ll get sick.  A professor of mine in China warned against yin collapse (shock due to blood or fluid loss) after using too much sweat-inducing herbs.

So what’s the take home message?

1) ANY herbal medicine should be prescribed by a trained and qualified health professional.  That may depend on your country or state.  In the United States, there are licensed acupuncturists.  In Japan, only MDs can prescribed Chinese formulas.

2) Always research any herbs you may want to take.  Find out all about them.  If it’s a chinese formula, learn about why the herbs are combined together, at least in theory.

3) NEVER EVER believe the “all natural so all safe” argument.

4) We should regulate Chinese herbs to ensure quality (prevent fakes, etc) but at the same time, have them regulated by Chinese herbalists, not MDs or quack herbal “experts” like the ones who gave Ma Huang and Ginkgo a bad name.  Real Chinese herbalists would never mix Ma Huang with caffeine, knowing exactly how it works.